Mc patoson Ac 43389 RED 2 LONDON BOROUGH OF REDBRIDGE ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for 1966 by I. GORDON, M.D., Ch.B., M.R.C.P. (Lond.), D.P.H. (Edin.) TABLE OF CONTENTS Page HEALTH COMMITTEE 1 WELFARE COMMITTEE 1 EDUCATION COMMITTEE 2 STAFF 3-5 PREFACE 7-10 VITAL STATISTICS AND SOCIAL CONDITIONS 11 EPIDEMIOLOGY 13-23 NATIONAL HEALTH SERVICE ACT, 1946 25-59 EDUCATION ACT, 1944 61-98 MENTAL HEALTH 99-103 ENVIRONMENTAL HEALTH 105-134 WELFARE 135-145 INDEX 146-150 1 HEALTH COMMITTEE Municipal Year 1966-1967 Alderman Miss A. S. Terry, J.P., Chairman Councillor Mrs. G. M. Chamberlin, Vice-Chairman Councillor H. R. B. Aly, Mayor Alderman R. A. Dalton, J.P. Alderman Mrs. L. Fallaize, J.P. Councillor A. C. Berry Councillor A. Reynolds Councillor D. A. Carradice Councillor Mrs. W. J. Roberts Councillor E. R. Earey, J.P., F.V.I. Councillor Mrs. D. E. Smith Councillor Mrs. V. M. Grose Councillor J. A. Vane Councillor J. H. Norwood Councillor D. E. Wightmanf R.M.N. Councillor Mrs. M. H. Paige Councillor Mrs. V. L. Wilson Co-opted Member: Dr. T. C. Mayer WELFARE COMMITTEE Councillor H. F. Harris, Chairman Councillor Mrs. M. H. Paige, Vice-Chairman Councillor H. R. B. Aly, Mayor Councillor R. H. Ayres Councillor Mrs. A. Toms Councillor T. F. Cobb, A.I.A.C. Councillor J. A. Vane Councillor D. S. Davies Councillor C. J. A. Watson Councillor F. C. Mountier Councillor G. H. Watson Councillor Miss M. N. Powers Councillor K. W. Webb Councillor A. Reynolds Councillor D. E. Wightman, R.M.N. Councillor Mrs. W. J. Roberts Councillor Mrs. V. L. Wilson 2 EDUCATION COMMITTEE Alderman Mrs. E. F. M. Hollis, M.B.E., Chairman Alderman C. I. Gibson, Vice-Chairman Councillor H. H. B. Aly, Mayor Alderman Mrs. L. Fallaize, J.P. Alderman Miss A. S. Terry, J.P. Councillor R. H. Ayres Councillor N. C. N. Hurst Councillor A. C. Berry Councillor D. K. L'Estrange, B.A., LL.B., F.C.I.S. Councillor L. G. Hridgeman Councillor S. F. Loveless, Councillor D. A. Carradice (Deputy Mayor) Councillor T. F. Cobb Councillor A. J. Shaw, M.P., B.A. Councillor G. E. Davies, J.P., B.Sc. Councillor J. ff. S. Telford, D.F.H., Councillor Mrs. V. M. Grose A.M.l.E.E. Councillor Mrs. O. Hall Councillor G. E.Tovey, J.P., F.I.A.C. Councillor B. E. R. Hamilton Councillor O. F. Waters, J.P. Councillor Mrs. M. J. Harvey, J.P., B.A. Councillor C. J. A. Watson Councillor L. M. Hipkins, B.A., Councillor W. J. Westerbury F.R.S.A., F.R.G.S., F.R.Econ.S., Councillor A. P. White A.C.C.S. Councillor Mrs. V. L. Wilson Co-opted Members: Rev. A. H. Adams Mrs. D. E. Carter Dr. B. H. Chirgwin, M.A., B.Sc. Rev. C. Creede Miss R. M. Fordham Mr. H. Goldner Mr. E. R. Lower, B.A. Mr. W. H. Robinson, M.A. 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.R.C.P. (Lond.)., D.P.H. (Edin.). Deputy Medical Officer of Health, Deputy Principal School Medical Officer! A. SHAW, M.B., B.S. (Durham), D.P.H. (Leeds). Principal Dental Officer: E. V. HAIGH, L.D.S., R.C.S. (Eng.). Printipal Medical Officer: Principal Medical Officer: W. H. TOMS, M.B., Ch.B. (Edin.). CLAUDE H. A. WEDELES, L.R.C.P., M.R.C.S., D.P.M. (Lond.) (Appt.24.10.66). Chief Welfare Officer: Chief Public Health Inspector: R. W. HALL, A.M.I.S.W. S.R. DALY, LL.M., B.Sc., D.P.A. (Lond)., B arrister- at-L aw. Deputy Chief Welfare Officer: Deputy Chief Public Health Inspectors: C.R. COLE, D.S.S., A.M.I.S.W. R. E. SMALLEY, A.R.S.H. J. T. S. TEMPLEMAN, M.A.P.H.I. 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.). (Retired 23.1.66.). 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. EVELYN B. KILSBY, M.R.C.S., L.R.C.P., B.Sc. (Lond.)., B.A. (Cantab.). (Resigned 11.9.6J5.) ELIZABETH A. LITTLE, M.B., Ch.B., (Aber.). A. J. CROMPTON, M.B., B.S. (London), M.R.C.S., L.R.C.P. 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 Dental Officers: R. A. SOAR, B.D.S. W. V. VICTORS, L.D.S., B.D.S. R. C. BIGMORE Non-Medical Supervisor of Midwives/ Asst. Superintendent of District Nurses: Superintendent of District Nurses: MISS M. A. POTTER, S.R.N., S.C.M., MISS L. E. A. PARISH, S.R.N., S.C.M., Q.I.D.N., H.V. Q.I.D.N., H.V. Superintendent Health Visitor: Deputy Superintendent Health Visitor: MISS J. M. OLIVER, S.R.N., S.C.M., MISS E.M.P. COLLINS, S.R.N., S.C.M., H.V. H.V. Principal Mental Health Social Worker: Senior Mental Welfare Officers: T. A. HAWLEY, S.R.N., A.A.P.S.W. J. F. NORRIS S. H. MAURICE Senior Social Worker: MISS G. M. VENNING Health Education Officer: MISS K. M. E. GRIFFITHS, D.M.E. Chief Administrative Officer: D. H. GODWIN, A.R.S.H. 5 Officers of the Public Health Services — continued. Senior Administrative Assistants: MISS H. M. NUNN E. S. JENKINS, (Retired7.12.66.) H. R. STANBRIDGE F. W. STREET A. E. TOURLE A. J. HOWLETT Public Analysts: J. HUBERT HAMENCE, M.Sc., Ph.D. (Part-time). P. S. HALL, F.R.I.C. (Part-time). Regional Hospital Board Surgeons in charge of Orthopaedic Clinics: H. G. KORVIN, D.M., F.R.C.S. M. MASON, F.R.C.S. Ophthalmologists: 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. Child Guidance Clinic: Medical Director: W. P. GURASSA, M.D., M.'R.C.P. Pyschiatrist: 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. M. E. CLARKE. 7 Preface HEALTH & WELFARE DEPARTMENT, Telephone: 17/23 Clements Road, 01-478 3020 ILFORD. May, 1967. Mr. Mayor, Ladies and Gentlemen, 1 submit herewith the second Annual Report of the Health and Welfare Services of the London Borough of Redbridge. Under the able editorship of Dr. Shaw, my deputy, there has been some pruning of the previous content to avoid unnecessary repetition, but I believe all essential matter is still included. The past year has been one of consolidation and progress. Staffing deficiencies have been much alleviated, particularly on the administrative side. Establishment difficulties still exist however with departmental medical officers, mental health social workers and some medical auxiliaries. Home helps of suitable calibre are, in this area, in short supply, and until adequate numbers are available we cannot wholly fulfil our responsibilities in that section. In Welfare, we have almost a complete establishment, but are finding that we set our sights too low; very adequate by former Essex standards, but not comparable with much of London, and more importantly, insufficient to deal with recently disclosed needs. I would like to enter a caveat here however, in that in Welfare, as in Health, it will probably never be possible to provide all the staff and services that some would wish. Co-ordination of the Social Services It is possible that when the Seebohm Committee reports, and Government acts upon their recommendations, that thefe may be many structural changes in the shape of these local government services. Without entering the present fray I feel it is necessary, even if only for eventual historical reasons, to record the progress made to date and envisaged for the near future, in the co-ordination of the social services in Redbridge. Health and welfare Firstly within any combined Health and Welfare Department far too much emphasis is made of the Welfare Services being under the Medical Officer of Health, rather than with the Medical Officer of Health. In Redbridge the Chief Welfare Officer (as for the Chief Public Health Inspector) has almost complete professional freedom; the Medical Officer of Health should be consulted on broad aspects of planning and must insist on adequate liaison between the different sections; which he has the power to do. There are regular weekly meetings with the five heads of sections to facilitate this, and to discuss matters 8 of topical interest. However, a most important link in the combined department is not the Medical Officer of Health at all, but a single general administrative section (that deals with establishment matters, finance and supplies, maintenance of buildings, development projects and publications and acts as a co-ordinating section in these matters) for the separate divisions of Welfare, Personal Health (including Mental Health), School Health and Environmental Health. This scheme allows for the development of management expertise. Without doubt it has had a somewhat stormy youth as in the past Welfare, School, Personal and Environmental Health dealt with their administrative problems separately and many folk would have liked that to continue. No one would disagree however that it is more economical in money and space. A further integration is that the administration of Welfare and Mental Health, the two sections most involved with social work, is combined, (at the moment only in the sectional head, his staff are still attached to the one or the other). I think there can be little doubt that some such arrangements will be involved in the Seebohm recommendations. Another important link is that the Principal Medical Officer in Charge of the Mental Health Section is also adviser on the medical aspects of Welfare. It is not in my view at the moment a perfect set-up, and some changes are envisaged. For instance the Home Help Service, Chiropody, Recuperative Holidays and Provision of Sick Room equipment are in the Personal Health Services section by virtue of their authorisation by the National Health Service Act, whereas functionally they are more closely allied to the Welfare Services, although the latter functions under the National Assistance Act. In a combined department such a "swop" can be done with little trouble, committee consent being only required for any revised gradings of staff concerned. Other Departments Much of the social work of the local authority is, of course, within the province of other departments, mainly Childrens, but also Education and Housing. In Redbridge the Chief Welfare Officer, Childrens Officer, Chief Education Officer, Housing Manager and Medical Officer of Health meet regularly with the first deputy Town Clerk in the Chair to discuss matters of mutual concern to the Social Services. Two or more of these officers, according to the problems involved, meet separately to discuss topics requiring any such specialised treatment. Case conferences, at the request of a social worker, can be organised by the Health and Welfare Department, in its Conference room. Membership of such case conferences varies of course according to the problem of the client. Case Work Register For too many years to enumerate I recollect complaints from newcomers to medico-social activities, of the many visitors involved with each client. The modern social worker is apt to sympathise with the "confused" client, and press for the "single door" entry to those wishing receipt of social services. Here the 9 medical profession, having matured over some thousands of years, could give helpful advice. Even in Britain, where everyone can have their "single door", i.e. the National Health Service general practitioner, the average patient, from any rank of wit or wealth, tends to seek advice from as many sources as possible, a private doctor, a medical friend, a straight-forward quack, the chemist shop, a neighbour or granny and continues until he (or she) gets the advice he wants, (remember that in Britain anyone can practice medicine, provided they do not pretend they are qualified, do not treat certain diseases or sign certain certificates). If the medical profession, with its authoritarian attitude, cannot ensure a "single door", what hope have the social workers, with a far more permissive approach? Anyway, the problem exists, and to minimise its repercussions, we have instituted in the Health and Welfare Department a Social Work Case Register, after discussion with the main social work agencies in the borough. It is really an index, with only name and address of the client and the agency, or agencies involved. Social workers are asked to help compile by sending details as they arise, and social workers are aware that by writing or phoning, they can be informed who else is dealing or has dealt with the case, and nothing more. The register now contains over 5000 names, of these 279 are served by more than one agency within the Health and Welfare Department, in 139 cases are involved agencies other than in our own department. In 11 cases five or more agencies are implicated. Of the social workers in the town the psychiatric social workers and probation officers have refused to co-operate on the grounds of confidentiality (thereby enjoying the luxury of complaining that too many agencies are concerned and failing to do anything about it!). Confidentiality carried to extremes, where it is neither in the interest of the client or community,, is a religion which some social workers share in common with many of the medical profession. So far, enquiries, a few dozen in about six months, have been disappointing. Strangely enough, some of them have come from hospital P.S.Ws who refuse to add the names of their own clients. Training A term bandied about in Social Workers training is "generic", indicating that there is a common basis before specialisation. In professions this is nothing new, as of course all medical men be they surgeons, psychiatrists or regional hospital board administrators, have a "generic" training before qualification. (We share much with the social workers, including a mistaken idea that professional identity is paramount above functional dispersal; in our case, the demand that the three National Health Service sections of the medical profession should be joined in an area health board!). To enable this type of training to be locally effective, the Health, Welfare and Childrens Department are probing the possibility of a joint training officer and to this end we have already had discussions with the Home Office and London Boroughs Training 10 Committee. The gains in expertise, efficiency and economy are obvious, the difficulties also apparent, for even now the Health Department has a joint social work department with the local psychiatric hospital, and we are engaged in discussions for a similar arrangement with the general hospitals and their medical social workers, although this would additionally involve another borough. Other Activities In Redbridge social workers, in a wide sense, to include Health Visitors and others, are joined in the Redbridge Association of Professional Social Workers, which is active and meets regularly. It is pleasing to note, in view of the atti-. tude of their national association, that the local probation officers are prominent members. This association has taken under its wing the Social Workers Luncheon, where voluntary workers, others with a marginal interest in social work, such as family doctors, clergymen and teachers, meet the professionals over sandwiches in a clinic to hear lectures and discnss. This luncheon club, begun by a Vicar, nourished by the Council of Social Service and the Health Department, has I hope come to rest in its proper sphere. This therefore, is a summary, brief and somewhat incomplete, of the efforts at co-ordination of the Social Services in the London Borough of Redbridge. Should another arrangement be imposed upon us, it is to be hoped it will be as effective. Once again I would like to thank all those who have made my task a pleasure and so much easier over the last year. The large band of Voluntary Workers in the borough, the members of the Council, my fellow Chief Officers and Colleagues in the Health and Welfare Department. 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 Registrar-General's Estimate of resident Population:— June 30th 1966 246,600 Number of inhabited houses (April 1st, 1966) according to Rate Books 76,953 Rateable Value — April 1st, 1966 £12,561,417 Sum represented by a penny rate, April 1st, 1966 £52,000 1966-67 General Rate 11s,3d. in the £ The following figures as to unemployment were supplied by the Ministry of Labour:— Males Females As at December, 1966 1,013 101 1966 Live Births 3,891 Live Birth rate per 1,000 population — Crude rate 15.78 Adjusted rate 16.25 Illegitimate Live Births per cent of total live births 6.43 Stillbirths 52 Stillbirth rate per 1,000 total live and stillbirths 13.19 Total Live and Stillbirths 3,943 Infant deaths (under 1 year) 56 Total Infant deaths per 1,000 total live births 11.57 Legitimate Infant deaths per 1,000 legitimate births 13.18 Illegitimate Infant deaths per 1,000 illegitimate births 32.00 Neo-natal mortality rate per 1,000 live births (first four weeks) 10.28 Early Neo-natal mortality rate per 1,000 total live births (under one week) 9.00 Perinatal mortality rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) 22.06 Maternal deaths (including abortion) Nil Maternal mortality rate per 1,000 live and stillbirths 0.00 Deaths (all causes) 2,811 Death rate per l,000 population — Crude Rate 11.40 Adjusted rate 10.60 Comparability Factors - Birth rate 1.03 Death rate 0.93 Total rainfall 1966 26.36 inches Greatest rainfaull in any 24 hours (on22.6.66) 1.38 inches EPIDEMIOLOGY 13 EPIDEMIOLOGY (by A. Shaw, M.B.. B.S., D.P.H., Deputy Medical Officer of Health) Infectious Disease Since last year's report was prepared leprosy has been made notifiable to the Medical Officer of Health. This brings the number of notifiable infectious diseases up to 24.(Appendix 1). Notification of Leprosy This department has always known the extent of leprosy in the borough and the new regulations merely transfer the direction of notification to the Medical Officer of Health instead of directly to the Ministry of Health. The very closest contact is maintained with the Ministry of Health, which maintains a central register and a panel of leprosy experts. Leprosy has a particularly sinister connotation to the lay mind. This reputation is totally undeserved as the disease seen today has a low infectivity and should not engender the superstitious horror that it did in biblical and mediaeval times. Even in African hospitals devoted to the treatment of leprosy, when the disease is in an infectious and active stage, transmission to the children of patients is rare. There are no infectious cases of leprosy in Redbridge. Poliomyelitis One case of paralytic poliomyelitis, in a man of 21,occurred during the year. The patient had not been vaccinated against the disease. Our last information was that he was suffering from a residual paralysis of the left leg. One death from the late results of poliomyelitis was notified. This was in a female medical missionary aged 41, who contracted the disease in Nigeria and was flown for treatment at Oxford. She died nine months later. Intestinal Infections 294 cases of dysentery, 12 cases of food poisoning and 1 case of enteric fever (paratyphoid B) were reported during the year. These numbers represent the tip of an iceberg. It is known that dysentery is considerably undernotified. Food poisoning and the enteric fever caused by the paratyphoid organisms often have dysenteric symptoms and may be diagnosed as dysentery, and may fail to be notified. In this way the causal organism is missed and links in the chain of infection are lost. Person-to-person infection is the most important factor in 14 Sonne Dysentery dysentery, particularly that type of dysentery caused by the Shigella sonnei (Sonne dysentery). This accounts for the frequency of its occurrence in children of infant school age. There is little doubt that a high proportion of Sonne dysentery in this age group is due to those children who came to school with diarrhoea. The explosive stool spreads widely over the W.C. bowl and a fine film of bacteria — containing water droplets is deposited on the undersurface of the lavatory seat. Mothers (and fathers) of young children will know that their children often sit gripping the edge of the lavatory seat. An investigation into further activities, confirmed by cinematography some years ago, shows that a high proportion of such children managed to put their fingers in or near their mouths at some stage of the procedure. Additionally, hands infected by the organism touch the toilet roll, sometimes the toilet roll holder, the handle of the lavatory chain and the door handle, all potential hazards for the next user. From there on, it is a clear case of person-to-person transmission to brothers and sisters and parents. Preventive Measures Preventive measures are imperfect in the absence of an antibiotic which will kill the organism. Many antibiotics have been tried and all have had only partial success. An epidemic of Sonne dysentery will have a natural end, but it is possible to hasten this by certain measures, as exemplified by the outbreak at Chadwell Infants and Junior Mixed Schools during the year. It became apparent during May that a large number of children were absent on account of diarrhoea. A number were attending school suffering from this condition. Immediately those in the acute phase of the disease were suspended and measures were taken to improve the hygiene of the children. Frequent swabbings with disinfectant of the W.C. bowls, seats and handles were instituted and most important, the opportunity was taken to push home health education on the importance of hand washing and general hygiene by the Health Education Officer and a Senior Public Health Inspector. Children at this age are very impressionable and often act as proselytes in their home environment. In cases like this the school lavatories often came in lor a lot of uninformed criticism, especially if the school is an old one. While it is true that lavatories often act as vehicles of infection in Sonne dysentery, the main vehicle is the age group of the children involved, and in the absence of suitable instrnction the disease will spread regardless of the condition 15 of the lavatories. It is important, however, to have adequate handwashing facilities easily available. Food Poisoning In the 12 cases of food poisoning notified, salmonella was notified in only 7 cases (5 Salm. typhimurium, 1 Salm. brandenburg, 1 Salm. panama). Not su prisingly, no vector of infection was discovered. In isolated cases such as these it is likely, when the organism is the same, that the single case represents the outward manifestation of very many more, some of them without symptoms. The other cases, overt and concealed, may be spread over a whole region. In many cases, central authorities arc able to uncover infected sources of food, often imported animal food which contaminates carcases. Paratyphoid The single case of paratyphoid B was in a young girl and was probably contracted in Rimini. A number of cases of diarrhoea developed in the same hotel and it was necessary to obtain the names of other members of the tour from the tonr organiser and inform the Medical Officers of Health of the areas in which they lived. Tuberculosis 68 cases of pulmonary tuberculosis and 6 of non-pulmonary tuberculosis were notified during the year. Last year's figures were 69 and 13 respectively. Appendix 2 shows the age distribution, sources of notification and composition of the tuberculosis register. I am grateful to Dr. D. Adler, Consultant Chest Physician at the Ilford Chest Clinic, for the following contribution:— "The situation as regards tuberculosis remains static, and although over the years there has been a reduction in new notifications there is still no cause for complacency. Approxi28% of the new notifications are immigrants. Thanks to the introduction of chemotherapy over the past 15 years or so the prognosis is almost invariably excellent, and practically every patient with tuberculosis now fully recovers and is able to return to work within a few months. Relapses are now very infrequent. With modern treatment certain types of the disease can be treated at home, whilst others have to be admitted to hospital. As far as this clinic is concerned, beds are available at Dagenham Hospital for male tuberculosis patients, and at Chadwell Heath Hospital for female tuberculosis patients. Tuberculosis among children remains very low and this is due largely to the effective treatment of adults, thus removing 16 the source of infection. The immediate families and other close contacts of tuberculous patients are investigated and when indicated B.C.G. immunisation is offered. Whilst the situation as regards tuberculosis remains static the same cannot be said of bronchial carcinoma which is undoubtedly on the increase. This is a preventable disease, and whilst it is difficult to persuade adults to give up smoking, an anti-smoking campaign in schools might prove effective, and is certainly worth trying." Asian Immigrants As was mentioned last year the problem of tuberculosis in immigrants is a very real one. Measures were taken during the year to ascertain the size of the immigrant population and it was discovered that there are approximately 580 Asian families living in the borough, representing a population of about 2,500, or 1% of the total population. lt is hoped that it will be possible to skin-test, X-ray and if necessary give B.C.G. to all of this number. This is not the answer to the problem. The remedy lies in examining potential immigrants in their country of origin. Mass Radiography Appendix 3 shows the details of work carried out at the Static Mass Radiography Unit at the Thompson Rooms, Ilford. Venereal Disease The figures for 1966 are incomplete. Returns of numbers of cases were received from four treatment centres in London and are shown in Appendix 4. The only conclusion which can be drawn from the figures is that at least 9 cases of syphilis, 55 of gonorrhoea, and 422 of other conditions occurred in persons giving a home address in Redbridge. The true figures will be higher. Measles Only 827 cases of measles were notified as against 3,393 in 1965 which was a 'measles year'. Whooping Cough 63 cases of whooping cough were notified, most of them under the age of 5 years. 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 Labatory at Oldchurch Hospital provided courteous and helpful service and advice throughout the year and to them also I am most grateful. 17 Non-Infectious Disease Appendix 5 (Registrar General's Short List of Deaths and Causes) shows that of the 2,811 deaths of Redbridge residents 1,282 were due to diseases of the heart and circulation and 624 to cancer. Coronary Disease and Cancer 520 persons died from coronary disease and angina, a fall compared to last year but still a substantial cause of death in the middle age group. Cancer was responsible for 624 deaths, 156 of them cancer of the lung. There were 94 deaths from female cancers, 71 of the breast and 23 of the uterus. Coronary disease is probably preventable to a large extent by suitable food habits, exercise, and moderation in cigarette smoking. Lung cancer incidence bears a direct relationship to the number of cigarettes smoked and both breast and uterine cancers give premonitory symptoms in the early treatable stages. It is to this group of diseases that our health education campaign is being directed. Lung cancer particularly is a good example of self-inflicted disease. The relative risks of a man dying from lung cancer between the ages of 35 and 74 are 1 in 300 if he is a nonsmoker but 1 in 14 if he smokes 25 or more cigarettes a day. Such a smoker has a 1 in 9 chance of dying from lung cancer between the ages of 35 and 84. (Appendix 6). The majority of people who develop lung cancer smoke for 20 — 40 years before the disease becomes apparent, but there is no evidence of a safe smoking limit below which there is no risk. There is, however, evidence of a progressive and significant fall in the death rate of ex-smokers. Our main efforts in Health Education on cigarette smoking are directed towards school children. This is the most promising line of attack, although the result of such strenuous efforts may not be seen for another 30 years. It seems apparent that efforts directed towards adult smokers have little chance of success and all that we can do is to place the facts before them. It must be admitted that many adults wishing to give up smoking are strengthened in their resolve by the attitude of those of their children who have absorbed the health education in school. This is a welcome fringe benefit but not the main object of the exercise, which is to get children to regard themselves as unwelcomely different if they smoke. Accidents 66 people died in accidents, 22 of these on the road. Only 2 children under the age of 15 died accidentally. 18 Suicides There were 27 suicides and 3 deaths attributable to 'Homicide and operations of war'. Other Aspects It should not be thought that epidemiology is confined to the notifiable infections diseases or to deaths classified by the Registrar General. Any disorder which affects the wellbeing of the individual may be subject to study and elncidation. During the year the Department has been involved in a study of the protective value of gamma globulin in infectious hepatitis, preparations were laid for a study of hypothermia in the elderly in the first quarter of 1967, and much information of value was gathered about canine jaundice which is transmissible to humans. These represent only three aspects of the work of the epidemiological section of a Health Department. As close co-operation comes about with colleagues in general practice it is likely that epidemiological work will become more fruitful. (Appendix 7). 19 APPENDIX 1 CORRECTED NOTIFICATIONS OF INFECTIOUS DISEASES FOR THE YEAR 1966 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 145 3 37 94 11 — — — — Diphtheria, including Membranous Croup — — — — — — — — — Enteric Fever (Typhoid and ParaTyphoid) 1 — — 1 — — — — — Pneumonia 20 — — 1 — 1 12 6 — Puerperal Pyrexia 4 — — — 2 2 — — — Acute Poliomyelitis 1 — — — 1 — — — — Acute Encephalitis 1 — — 1 — — — — — Meningococcal Infection — — — — — — — — — Dysentery 294 9 56 40 35 81 51 22 — Ophthalmia Neonatorum 2 2 — — — — — — — Erysipelas 6 — — 1 — — 3 2 — Tuberculosis Pulmonary 68 — 1 2 13 22 28 2 — Other Forms 6 — 1 1 1 2 1 — — Anthrax — — — — — — — — — Malaria — Believed contracted in this country — — — — — — — — — Believed contracted abroad — — — — — — — — — Measles 827 21 447 350 9 — — — — Whooping Cough 63 1 39 20 3 — — — — Food Poisoning 12 — 3 4 1 3 — 1 — Typhus Fever — — — — — — — — — Totals 1,450 36 584 515 76 111 95 33 — 20 APPENDIX 2 TUBERCULOSIS Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under 1 year — — — — — — — — 1 - 4 years 1 — — 1 — — — 1 5-14 1 1 1 — — — — — 15 - 24 2 11 1 — — — — — 25 - 44 11 11 — 2 — — — — 45 - 64 23 5 — 1 3 2 — — 65 - 74 — 1 — — 3 — — — Over 75 1 — — — — — — — Totals 39 29 2 4 6 2 — 1 The foregoing new cases were notified from the following sources:— Respiratory Tuberculosis NonRespiratory Tuberculosis Ilford Chest Clinic 36 — Wanstead and Woodford Chest Clinic 9 — Dagenham Chest Clinic 6 — Local General Practitioners 1 — King George Hospital, Ilford — 1 Chadwell Heath Hospital 5 1 Hospitals outside the Borough 11 4 68 6 In addition 67 pulmonary and 3 non-pulmonary cases were transferred to Redbridge. Pulmonary NonPulmonary Total Number of cases on register, 1st January, 1966 933 127 1,060 Number of cases entered on the register during the year 135 9 144 Number of cases removed from the register during the year Pul. NonPul. Recovered 69 4 Deceased 22 1 Left District 84 13 Lost sight of — — Diagnosis not established 4 — 179 18 197 Number of cases remaining on register on 31st December, 1966 889 118 1,007 The Treatment of Tuberculosis is under the control of the Regional Hospital Board. On the 31st December, 1966, there were 955 Redbridge patients on the registers of the Ilford, Wanstead and Woodford and Dagenham Chest Clinics. 21 APPENDIX 2 (continued). The number of patients from Redbridge sent to Institutions under the Regional Hospital Hoard Tuberculosis Scheme during 1966 was as follows:— Pulmonary Non-Pulmonary Total Males Females Males Females Adults 38 25 — 1 64 Children 2 1 — — 3 APPENDIX 3 MASS RADIOGRAPHY The mass radiography unit stationed at the Thompson Rooms continued to operate on Mondays from 4th January to 11th July, 1966 and again from 5th 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 preliminary figures relating to the period under review. Male Female Total Referred by General Practitioners 1,850 1,594 3,444 General Public 2,465 2,850 5,315 Organised Groups 519 2,005 2,524 Total numbers X-rayed 4,834 6,449 11,283 APPENDIX 4 VENEREAL DISEASES Number of New Cases from Redbridge treated at various Treatment Centres during 1966 Name of Centre Syphilis Gonorrhoea Other Conditions Total *The Whitechapel Clinic London Hospital, E.l. 8 39 313 360 Homerton Grove Clinic, Eastern Hospital, E.9. - 5 18 23 Special Clinic, Queen Mary's Hospital E.15. 1 7 49 57 The Middlesex Hospital, W.l. - - 21 21 Albert Dock Seamen's Hospital, E.16. — 4 21 25 Totals 9 55 422 486 *Details for April to December 1966 only. 22 APPENDIX 5 Registrar-General's Short List of Deaths and Causes Causes of, and Ages at, Death during the year 1966. Net Deaths at the subjoined ages of "Residents" whether occurring within or without the district All Ages Under 4 weeks 4 weeks and under 1 year 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 35 years 35 and under 45 years 45 and under 55 years 55 and under 65 years 55 and under 75 years 75 years and over ALL CAUSES 2,811 40 16 3 9 22 18 62 182 474 679 1,306 1 Tuberculosis, respiratory 8 - - - - - - - 2 3 3 - 2 Tuberculosis, other 1 - - 1 - - — — — - — — 3 Syphilitic disease 5 - - - - - - - - - 1 4 4 Diphtheria - — — — — — — — — — - — 5 Whooping Cough — — — — — — — — - — — — 6 Meningococcal Infection — — - — — - — — — — — — 7 Acute poliomyelitis 1 — — — — — — 1 — — — — 8 Measles — — — — — — — — — — — — 9 Other infective and parasitic diseases 9 — 2 — — — — — — 3 2 2 10 Malignant neoplasm,stomach 70 — — — — — — — 7 13 27 23 11 Malignant neoplasm, lung, bronchus 156 — — — — — — 2 16 56 47 35 12 Malignant neoplasm, breast 71 — — — — — — 8 15 15 15 18 13 Malignant neoplasm,uterus 23 — — — — — — 1 6 1 6 9 14 Other malignant and lymphatic neoplasms 285 — — 1 — 2 4 7 24 72 78 97 15 Leukaemia, aleukaemia 19 — — — — 1 — 3 — 4 7 4 16 Diabetes 29 — — — — — — 2 1 9 9 8 17 Vascular lesions of nervous system 361 — — — — 1 — 6 7 35 85 227 18 Coronary disease, angina 520 — — — — — — 8 37 115 162 198 19 Hypertension with heart disease 38 — — — — — — — 1 2 10 25 20 Other heart disease 224 — — — — — 2 3 10 18 37 154 21 Other circulatory disease 139 — — — — — 1 3 7 17 28 83 22 Influenza 13 — — — — — 1 — 2 2 1 7 23 Pneumonia 269 1 8 — 3 1 1 1 3 25 45 181 24 Bronchitis 146 — — — — — — 1 7 20 45 73 25 Other diseases of respiratory system 26 — — — 1 — 1 — 1 3 11 9 26 Ulcer of stomach and duodenum 21 — — — — — — — 1 2 4 14 27 Gastritis,enteritis and diarrhoea 17 — 1 — — 1 — — 1 4 4 6 28 Nephritis and nephrosis 14 — — — — 1 — — 4 1 3 5 29 Hyperplasia of prostate 8 — — — — — — — — — 1 7 30 Pregnancy, childbirth, abortion — — — — — — — — — — — — 31 Congenital malformations 19 7 3 1 2 1 — — 1 2 1 1 32 Other defined and ill-defined diseases 225 31 2 — 1 3 3 7 17 34 38 89 33 Motor vehicle accidents 22 — — — 1 6 1 1 — 4 4 5 34 All other accidents 42 — — — 1 1 1 4 6 7 3 19 35 Suicide 27 — — — — 4 3 3 5 7 2 3 36 Homicide and operations of war 3 1 — — — — — 1 1 — — — 23 APPENDIX 6 DEATH RATES FROM CANCER AND HEART DISEASE, 1966 The following Table shows the death-rates for 1966 for Redbridge, compared with those for 1965. 1966 1965 Cancer of lung and bronchus .633 .593 Cancer, other forms 1.820 1.403 Coronary and arteriosclerotic heart disease 2.109 2.254 APPENDIX 7 Table showing comparison between the Birth-rate, Death-rate, etc., of Redbridge, Greater. London and of England and Wales for the Year 1966. Rate per 1,000 Population Rate per 1,000 Total (Live and Still) Births Rate per 1,000 Population Rate per 1,000 Live Births Live Births Stillbirths Deaths (all ages) Deaths under 1 year England and Wales 17.7 15.4 11.7 19.0 Greater London 16.5 14.2 11.2 17.8 REDBRIDGE (Estimated Population mid-1966 - 246,000) 16.25 13.19 10.60 11.57 NATIONAL HEALTH SERVICE ACT 1946 SECTION 21 Health Centres SECTION 22 Care of Mothers and Young Children SECTION 23 Midwifery SECTION 24 Health Visiting SECTION 25 Home Nursing SECTION 26 Vaccination and Immunisation SECTION 28 Prevention, Care and After Care SECTION 29 Home Help Service 25 SECTION 21 HEALTH CENTRES (by A. Shaw, M.B., B.S., D.P.H., Deputy Medical Officer of Health) Development of the Health Centre Concept The Act lays upon local health authorities the duty to provide, equip and maintain health centres for all or any of the following services: general medical services, general dental services, pharmaceutical services, any of the services which the local health authority is required or empowered to provide, and specialist services. The idea of Health Centres was hinted at by Beatrice Webb in 1918, but it was not until 1920 that definite proposals were put forward by a British Medical Association Committee headed by Lord Dawson of Penn. Lord Dawson's Committee, which reported on the future provision of medical and allied services, recommended that personal health services should be provided by primary and secondary health centres. The primary health centres were to be staffed by general practitioners and were to offer preventive and curative services; the secondary health centres were to be hospitals with consultant staff. These proposals were shelved for 22 years and then revived in a modified form by the Medical Planning Commission of the British Medical Association in 1942. The changes proposed involved grouping of doctors in practice, a strong link with a local hospital, facilities for X-rays and pathological examinations in the Centres and apparently a take over of the local authority medical services. The Government White Paper in 1944 which followed the Beveridge Report accepted the health centre as necessary and the concept was included in the 1946 National Health Service Act. Enthusiasm ran high for a time and then died altogether. The reasons for this are easy to see. Woodberry Down Health Centre One of the first health centres to be built was by the L.C.C. at Woodberry Down. Many reasons were put forward for its apparent lack of success including fears for the doctor-patient relationship, lack of security of tenure, progression to an aventual salaried service, but it is generally agreed now that the basic reason was that it was too expensive. In the early 1950's rent for an individual doctor's suite was £450 and by 1959 this had risen to £550. This was more than most general practitioners could afford or were willing to pay. A few other authorities tried brave experiments without conspicuous suc- 26 cess, and many more held back in the face of general practitioner opposition. The situation changed dramatically in 1966 and again the reasons are easy to see. Charter for General Practice For many years general practitioners had been dissatisfied with their pay and conditions of service. Working as they do on a contractual basis they considered they were overworked and underpaid. Repeated batterings on the gate of Government obduracy finally produced a Royal Commission which gave for a time a measure of industrial peace but the discontent with conditions of service continued unabated. Very large numbers of doctors emigrated to end their clinical isolation and to practise the sort of medicine they had been taught and it was this, rather than any other single factor, which made the Government realise that if it was not very careful there would be a National Health Service with no doctors to run it. Accordingly, 1966 produced the Charter for General Practice which, among many other things, made provision for partial reimbursement of practice premise expenses and the expense of ancillary help. Group Practice Most doctors now realise that the days of single-handed practice are drawing to a close and recognise that the future of family medicine lies in group practice in which several practitioners work together in close association, consulting each other about their patients and often developing a special interest such as paediatrics, obstetrics or dermatology. Such groups often employ ancillary help and draw heavily on local authority services. It is a natural step from such a group practice to a health centre practice with a full range of local health authority services attached. This realisation, allied with the recent Charter, has again aroused interest in Health Centres. On this occasion the Ministry of Health recognises and encourages the interest to the extent of setting aside £2m for health centres in 1967-68. Early Development in Redbridge Goodmayes Lane Health Centre In Redbridge the new wave of enthusiasm for Health Centres made itself felt early in 1966, when an approach was received from the North East London Local Medical Committee. It was possible to say that if sufficient family doctors were interested then all future clinic building projects could be designated as Health Centres. Plans for the clinic in Goodmayes Lane, which had reached an advanced stage, were scrapped and a fresh start was made to provide accommodation for family doctors. Preliminary consultations with the Ministry were very favourable and it appeared that loan sanction would be readily forthcoming for a scheme acceptable to the Ministry. 27 Five doctors have agreed to take part in the Health Centre and they will be actively consulted, together with the Executive Council, at all stages of planning. High Road Woodford, Health Centre The Council has long planned a clinic at High Road, Woodford, and only the acquisition of more land adjacent to the site, making a comprehensive redevelopment possible, had delayed the start of the scheme. In retrospect, this delay was fortunate because it enabled consultations to take place with local doctors, several of whom have agreed to enter a Health Centre on that site. It is hoped that both the Woodford High Road Health Centre and the Goodmayes Lane Health Centre will be started in 1968/69. Future Developments In 1948, sites were set aside in the Development Plan for Health Centres but only three of these remain. These are at Vista Drive, Redbridge, Barley Lane, Chadwell Heath and at Goodmayes Lane, However, other sites in mind are on railway land near Goodmayes Station and at Wanstead Place. There is a need for a Health Centre in the Newbury Park area but building land is at present unobtainable. Other sites, including part of the Central Redevelopment Area, will no doubt become available as time goes on and each one will be carefully evaluated. Design of Health Centres The design of Health Centres must incorporate the needs of the Local Health Authority, general practice, and to a certain extent specialist clinics. Local Health Authority use includes the traditional functions of public health, that is to say antenatal, maternal and child welfare, school health, health education, dentistry and chiropody, together with district offices for health visitors and office accommodation for a district nurse. General practitioners require consulting rooms, examination cubicles, waiting room space and space for minor pathological procedures and minor operations. There must also be a focal point where all staff using the centre can meet and exchange information and experiences. It is possible also that some Health Centres will provide general dental and pharmaceutical services. Integration Although the Local Health Authority has power to build Health Centres for general practitioners alone, this course of action should be followed only in the most unusual circumstances. Instead, the over-riding consideration should be as complete an integration as possible between public health and general practice. This will be largely accomplished by an increased use by general practitioners of health visitors and 28 other local authority staff working from premises where integration is possible. Benefits of Health Centres The benefits to public health of a closer co-operation are a clearer understanding by general practitioners of the benefits of preventive medicine and the fact that a large segment of the popnlation not previously easily accessible to public health will now become accessible. This will extend the range of public health outside the mother and young child, the school child and the elderly, who have hitherto been our main preoccupation. The general practitioner will of course benefit in a number of cases from better premises and more help, both para-medical and clerical. In any case the patient, to whom all this change is directed, will benefit from a better service. It may be that if Health Centres come to be the main form of practice premises that the patient will have to travel further to consult his doctor, but with the increasing use of appointment systems, the increased distance travelled will be counterbalanced by a shorter wait to see his family doctor. Specialist Services Unity of Health Service Specialist services have always been provided in some Redbridge clinics but these have been largely ophthalmic and orthopaedic for the use of infants and schoolchildren. A possible extension to adult patients would be a mixed blessing because many specialist services rely on sophisticated and complicated apparatus which can only logically be situated in a hospital. The aim, therefore, must be to forge an even closer link with the hospital service so that for the first time in the history of the National Health Service the three parts, hospital and specialist, general practice and public health, can function as one and not as isolated fragments. SECTION 22 CARE OF MOTHERS AND YOUNG CHILDREN (by Dr. W. H. Toms, B.M., Ch.B.(Edin), Principal Medical Officer) Clinics In Redbridge we have a nucleus of four purpose built Clinics where infant welfare centres are held. In addition infant welfare clinics take place in many hired and adapted buildings. These vary greatly in the amenities they offer — some of these are of high standard while at the other end of the spectrum some of our Staff work in halls which 29 combine Victorian grimness with olive green dados. We anticipate that some of these buildings will be made superfluous when new clinics are built but it appears that for some considerable time work will have to be done with young children in substandard premises in which lighting and heating are of a 'background' variety. (Appendix 8) Toddlers' Clinics are already held at the more modern centres but as mentioned later in this report, they should really be held in connection with all the infant welfare centres. Over 9,000 infants and children from birth till pre-school age were examined last year and an indication of the popularity of the clinics is shown by the fact that four babies out of five born in 1966 in Redbridge attended them. Other activities at the Clinics include Health Education carried out both personally and in groups, ante- and post-natal sessions, and relaxation classes for women run in conjunction with the maternity clinics. These relaxation classes are supervised by our Health Visitors and it is hoped that next year will see their techniques in this branch of ante-natal care made more effective by attendance at courses run by Miss Erna Wright. Births In 1966 there were 3891 live births in the Borough and the illegitimacy rate was 6.5%. Close liaison exists with all midwives and maternity units in the area for the immediate notification of all births where some form of congenital abnormality is present or is suspected. Arrangements are made for the follow up of these cases by Health Visitors, or by direct approach to the Paediatrician in charge of the case so that full details can be forwarded to the Registrar General or in the case of residents outside the Borough to the responsible Health Authority. 67 such cases were reported in 1966, details of which are given in Appendix 9. Children at Risk 1966 was the first full year of the operation of the Observation Register. There have been inevitable teething troubles in such a project and we are concerned at present with the evaluation of criteria which puts a child "At Risk". The number of children on this register exceed 30% of the births and if this proportion continues it may well make the register unwieldy and difficult to operate. Dr. Joan M. Pooley, who has given a great deal of time to this scheme, reports. 30 The Observation Register was first launched in Redbridge on 1st December, 1965, its object being the earlier diagnosis of Disease or Abnormality in the Infant. During the first few months, certain minor problems were encountered. These have now been overcome to a large extent, the solutions being facilitated very greatly by the ready cooperation and liaison between medical officers, general practitioners, health visitors, midwives and the administrative staff. Observation Register Certain general practitioners have expressed a wish or willingness to see their own patients and in this way have naturally added greatly to the smooth running of what is proving to be a large and worthwhile project. The original form of "Notification Factors" is still in use with minor modifications. These forms and hospital discharge summaries (often with the hospital obstetric charts of the mother and infant in addition) are carefully examined by the Medical Officer in charge, before an infant is eventually placed on the Observation Register. Examination of infants is then carried out routinely at the following times:— (1) As soon after birth as is practicable (at about 6/52 age)* (2) At 6/12 age (3) At 10/12 age (4) At 18/12 age and (5) At 2 years age. If at any stage it is considered that the infant may be taken off the Register, the examining medical officer will indicate this, and the reasons therefor are duly considered. Factors influencing inclusion on the Register These factors (26 in all) are divided into the following 5 categories:— 31 1. GENETIC 2. PRENATAL 3. PERINATAL 4. POST-NATAL 5. SYMPTOMATIC (After birth and daring follow-up). The following figures indicate the size of the Register and their relative importance:— Number on Register as at 31.12.66 1,192 (b) Number admitted to Register during 1966 1,255 (c) Corrected number of births for 1966 3,873 (d) % of births admitted to the Register during the 12 months ended 31.12.66 32.3% (This is higher than was estimated from the figures extracted during the first 3 months of the Register's establishment, when approx. 25% of births had been admitted to the Register between 1.12.65 and 28.2.66) (see Summary — Note (2)). (e) Number removed from Register in 1966 28 (f) Cases transferred to other Authorities (but still remaining "At Risk") 67 (g) Number of factors involved with the 1966 admissions to the Register 1,681 This would indicate approximately 4 factors per 3 cases being observed. Further analysis of Case Figures (1) % of Live Births considered At Risk 32.3% (= 1,255 cases) (2) % of Live Births considered At Risk and subsequently found to have abnormalities (of varying types and degree of severity) 3.5% (= 46 cases) (3) Number of cases discovered to have a congenital abnormality without any apparent predisposing cause (and counted in the Post-Natal group) 19 32 Examples of Relative Etiological Factors (in the 46 abnormal infants) Number of Abnormal Cases GENETIC (1) Family History of congenital abnormality 1 (+ other factors) PRE-NATAL (2) Illnesses necessitating the use of certain drugs during pregnancy 6 (+ other factors) (3) Abdominal or pelvic X-ray in pregnancy 1 (+ other factors) (4) Uterine bleeding during pregnancy 4 (+ other factors) (5) Toxaemia 4 (+ other factors) (6) Mother over 40 years of age 1 (+ other factors) (7) Anaesthesia in pregnancy 2 (+ other factors) PERINATAL (8) Abnormal, prolonged or assisted delivery 11 (+ other factors) (9) Birth weight under 4 lbs. (no other abnormality) 1 (+ other factors) (10) Birth anoxia (blue or white colour) 5 (+ other factors) POST-NATAL (ll) Jaundice 1 (+ other factors) (12) Convulsions 4 (-) (13) Prolonged poor sucking 1 (-) No abnormalities have been found so far in cases of:— (i) Rhesus Sensitivity (ii) Virus infection in pregnancy (iii) Maternal Diabetes (iv) Severe Hydramnios (v) Multiple pregnancy and also, of 57 mothers over the age of 40 years, only 1 case showed abnormality and that was a Mongol child. Examples of Numbers of Certain Abnormalities Type of abnormality No. of cases 1. Talipes or abnormality of digits 17 2. Hare lip + or - cleft palate 3. Congenital heart 3 4. Mongol infant 8 33 Summary 1. It was noted that the following 4 factors occurred with by far the highest incidence:— No. of cases (a) Abnormal, prolonged or assisted delivery 477 (b) Toxaemia 256 (c) Birth anoxia 182 (d) Abdominal or pelvic X-ray 102 2. The higher percentage of children considered to be at risk this year is attributed mainly to 3 possible reasons:— (i) "Toxaemia" — The possible inclusion of too many cases, due to insufficient detail. (ii) "Jaundice" — Insufficient detail available as to its nature and severity. (iii) "Drugs in Pregnancy"—Lack of detail, specific enough to warrant exclusion from Register. It is considered that the possibility of a Nation-wide Standardised Obstetric Hospital Discharge Sheet would eliminate many doubtful cases. After considerable research into the comparison of types of these particular Discharge Sheets in detail (as used in 46 hospitals known to admit Redbridge Obstetric Cases), several suggested specimen Discharge Summaries were drawn up, aiming to be as comprehensive, yet concise, and as clear and as legible as possible. These have been submitted to the Advisory Committee on Standardisation of Hospital Records (chaired by Dr. Avery Jones) and are now under consideration. The demonstration that such handicaps as deafness, phenylketonuria and congenital dislocation of the hip can be detected in the presymptomatic stage, must be followed up by more and more attention to a true Observation Register. It is felt now that there are possibly too many criteria influencing the admission of an infant to the Register, and so insufficient discrimination results. As a result, the "At Risk" group is showing signs of inflation, with too many normal children (viz. only 46 of the 1,255 children on the Register were found to be abnormal). These criteria, or factors, are shortly to be reviewed in order to bring into effect a more selective Register in this area. 34 Toddlers Clinics Toddlers Clinics continue to prove popular with the mothers of young children who find the advice and service they offer both helpful and stimulating. These clinics follow on from the Infant Welfare Centres and their aim is to observe the development of the pre-school child and diagnose defects at an early stage so treatment can be fully effective. Examinations are at regular intervals and are spaced in accordance with the need of the child (or parent). A doctor performs the examination and he works in close collaboration with Health Visitors who weigh and measure the children, test eyesight and urine and supply invaluable 'background' information about the family to the examining doctor. Behaviour difficulties in these children are among the commonest complaints made by parents and here the Clinic Staff reassure, explain and support the family. Small changes in personal attitudes can decrease stress in a young child and at times dramatically improve a difficult parent-child relationship. Advice on matters like this is never didactic and results are achieved by suggestion in most cases. Physical defects, which are usually orthopaedic or opthalmic are detected at these clinics and as we, along with the Regional Hospital Board, run consultant clinics in these specialities, cases can-be referred to them without delay often encountered at hospital. I should like to see these clinics increase in number so that wherever an Infant Welfare Centre is functioning there also is an active Toddlers Clinic. In this way the pattern of development can be followed from birth through infancy, early childhood, through school years and beyond into the early years of employment. Significant deviation from physical or mental normality can be detected early and the child passed on for treatment to his own doctor or hospital consultant. The community physician of tomorrow will be largely concerned however with showing the healthy man how to stay healthy and enjoy his health. Dental Treatment 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:— Expectant and nursing mothers and children under five were able to receive full dental treatment at the Redbridge Dental Clinics. The demand for treatment by expectant and nursing mothers continued to decrease. This has been so in 35 the Borough over the past ten years. 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 and as such are under private practitioners supervision prior to the ante-natal or post-natal care. Another factor is that a mother may only attend for twelve months after the confinement. Continuity of treatment is I am certain very important and the fact that they may only attend for a limited period stops many mothers attending at all. Pre-School Children The number of children under five years old inspected during 1966 increased by 13% and also the amount of treatment Increased. This increase has continued over the past few years and has been made possible by the co-operation of Medical Officers, Health Visitors and Health Education, making parents realise the importance of commencing dental supervision and treatment at an early age. The need for many more of the preschool children to receive regular dental care is important. I am certain that one of the main ways to combat dental disease is te start now with the very young children. By showing their parents the importance of good dental habits and regular dental treatment, these children will be conscious of the fact that their teeth are important to their health when they are older. Many of these young children are dentally neglected, some private practitioners are not anxious to treat them and parents still tend to think that deciduous teeth are not important. It is gratifying to note that 21% more fillings were done for these patients during 1966, but at the same time the number of extractions also increased by the same percentage which I think shows that these children are not being seen at a sufficiently early age. The use of high speed airotors for cavity preparation continued to be of great value. There is less fear by mothers of fillings now than there used to be and small children accept this method of cavity preparation surprisingly well, partly because it is less painful and so much quicker. Dentures Dentures were supplied to patients whenever it was considered necessary. These were made by a local dental laboratory, the same as for many years in the past and has continued most satisfactorily. 36 Toothbrushes 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 session. Specialist Clinics 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 is responsible for two Day Nurseries, one in Ley Street and one in Goodmayes Lane. These are both prefabricated buildings and have neither elegance nor architectural merit when viewed externally. Inside, however, they are light and airy. Each will accommodate 50 children and the average daily attendance rate is 30. The discrepancy between the average daily number and the possible capacity results from periods of quarantine and infectious illness and the relatively high (general sickness) rate in young children. The great majority of these children are in the nurseries because of the inability of the parents to provide a full home life, either due to family troubles, illness, or the economics of a single mother attempting to support a child. These nurseries also offer emergency care for children when stress appears to be precipitating mental illness in the family, or if it is felt that the absence of a child from home for a short period may prevent a family break-up. As such, they are a very important part of our preventive services in the community. Normally parents are assessed to pay a daily charge related to their income, but each nursery has five places reserved for children who are admitted on medical grounds. No charge is made for these places, as they are regarded as part of the child's general treatment. We find in this category children with hearing and speech defects, and the peripatetic teacher of the partially hearing visits the nurseries to give auditory training. Also included in this class are children whose general condition suggests the necessity for a full medical assessment before determining the correct type of education for them at the age of 5 years. The nurseries are training schools for the National Nursery Examination Board's examinations and this is an incentive to a high standard of work by the staff. Several of our private child minders and nursery proprietors have visited 37 the nurseries (or new ideas and advice and I (eel this is a valuable contribution to child care in the area. It is a disquietening (act that more mothers are going out to work and leaving their children. in the hands of people with whom they have no ties of blood or a((ection. For many, the "affluent" society does not really exist at all unless the mother goes out. to work and if she does the increase of income is often accompanied by an impoverishment of family life. It surely must be the aim of all those who are concerned with the true well being of the community to work for economic conditions where one wage will keep one family in comfort. Details of attendances at the nurseries are shown in Appendix 11. Private Day Nurseries and Child - Minders In last year's report mention was made of the Local Health Authority's powers in their supervision of those persons running Day Nurseries or acting as Childminders. This relationship is one of ambivalence as far as the nursery proprietresses, childminders and ourselves are concerned. On the one hand we support them by advising on the physical and emotional needs of the children and on the other we act in an almost judicial capacity when we are obliged to reprove (either mildly) or in cases of persistent disregard of regulations, bring the offenders before a Committee. We can, and do lay down minimum standards for the material environment in which the young child may live for up to ten hours a day. What we cannot do is to ensure that all applicants have a genuine affection for children which will provide a warm secure atmosphere in the Nursery. It is inevitable, however carefully the interviewing of applicants is carried out, that a minority of unsuitable people motivated mainly by financial gain will be allowed to open nurseries. Where profit is the over riding concern we usually find dull diets, deficient in protein, and more important, dull lives for the children. In such establishments there is no encouragement for the child to adventure in his environment — the environment is physically restricted and its contents colourless and unstimulating. To the mother or father contemplating putting a child in the care of strangers for profit I would say this:— However good a nursery, it will be a poor substitute for an affectionate home but if you are obliged to make use of this "service industry" be certain that the home in which you place your child is 38 liberal in space, kindness and diet. Avoid the nursery where yon are kept on the doorstep while yon enquire, where there is little play material, and children sit round apathetically arranged on chairs. You will find such nurseries to be in a minority, but they do exist. At the end of the year 39 day nurseries and 19 childminders were registered under the Act for the care of 1,646 children. Domiciliary Nursing Attachments General medical practice and the domiciliary nursing services both seek to treat the sick person in a domestic background. 'Attachment' schemes aim at promoting a more rewarding and productive relationship between the two professions. In these schemes the nurse works with her own doctors, and visits their patients wherever they may be within the area. The boundaries of her work are the boundaries of the practice and she may travel widely. She is only responsible clinically to the doctor, and reports back to him regularly so the patients may be fully discussed. In some attachments the nurse may help the doctor at his surgery providing this work requires her professional skills. She is not a substitute for a receptionist nor is it her job 'to pop round the corner as the doctor hasn't time and make sure Willy Smith hasn't broken his leg' Meeting doctors regularly, talking over cases, being told the reason for treatment, side-effects to watch for, response expected, should enrich her intellectual life, and give her profession more meaning. The doctor should gain much from the observations she passes on to him about his patient, as good nurses have an amazing faculty for assessing home situations and the total effect of illness on a family. The same case can be made for attaching midwives to general practitioners and in Redbridge we are always pleased to hear from doctors who would like to discuss an attachment scheme in their practice, either of a midwife or a domiciliary nurse. I have reservations about full attachment of Health Visitors. Apart from their domiciliary work with young children and the aged they run child health clinics, supervise ante and post natal clinics, run relaxation classes and are deeply involved in systematic health education in the schools. They have the arduous and increasing burden of visiting Day Nurseries and 39 Child Minders and often evening committments in the field of Health Education. It is important for them to have an intimate knowledge of an area and all the services available in it so advice they give on these matters is responsible. It is of course important for the Health Visitors to discuss their cases and problems with the family doctor and to give him help in his work. This probably is best achieved through a liaison rather than a full attachment. The Health Visitor attends at the doctors surgery to assist with Health Education, advises at his well baby clinic and reports back to him on her case load in his practice area. Not only from Redbridge but from throughout the country and in places where attachments and liaison schemes have been established for long enough to evaluate them, good reports are coming in from doctors and nurses alike. At the end of the year 5 Health Visitors and 4 Domiciliary Midwives were so "attached" to or liaising with general practitioners and it is hoped that 2 District Nurses would commence early in 1967 in a scheme of full attachment. SECTION 23 MIDWIFERY Domiciliary Confinement Rate There were 3,928 live and stillbirths to Redbridge mothers in 1966 and of these 868 were born at home, making a hospital confinement rate of 77.9% and a domiciliary confinement rate of 22.1%. There were 4 domiciliary stillbirths, and no maternal deaths were recorded among either hospital or domiciliary confinements. Miss M.A. Potter, Superintendent of Midwives and District Nurses reports as follows on the Domiciliary Midwifery Service: — With efficient ante-natal care by the general practitioners and domiciliary midwives, the selection of the at risk mother and baby for hospital confinement contributes toward the increase in the hospital rate. At the same time the 48 hour discharges of maternity patient to the domiciliary midwife, although increasing in numbers still remain in the minority. Included in the 48 hour discharges, are those patients who would have wished a home confinement but were delivered in 40 hospital for medical reasons. Goodwill on both sides helps this scheme to work well and relieves the pressure on the hospital beds. The shortage of hospital beds necessitates the "home investigation report", this is time consuming bat in many circumstances it is the first introduction of the mother to the domiciliary midwife. Two Entonox machines have been in use on the district and it is hoped by the end of 1967 to have replaced all existing gas and air machines. When in October the British Oxygen Company (due to tragic results after contamination of a few cylinders) recalled all the nitrous oxide, the domiciliary midwives relied on the three Trilene Inhalation apparatus. Obstetrical Emergency Medical Assistance The old privately run office was closed down and the arrangements for the midwife to call the nearest Duty Doctor with obstetrical experience is made through ANSACALL (Tel: Latimer 1718) and in all but a few cases this has worked very well. Pupil Midwives During the year fifty one completed 3 months training on the district and all successfully passed the Central Midwives Board Part II examination. Ilford Maternity Hospital commenced a Part II training school and three pupil midwives completed their training and three with in training at the end of the year. Obstetric Nurses Fourteen were given an insight into the domiciliary maternity services, all were in training at Ilford Maternity Hospital. Domiciliary Midwives Fourteen full time and two part time midwives were employed of whom nine were approved by the Central Midwives Board, for the responsibility of training the pupil midwives on the district. Inspection of Midwives In January, the Deputy Medical Officer of Health inspected the midwives equipment and homes and found all to be to his satisfaction. 41 The Home Help Service — constantly back up the family after a home confinement and add their contribution toward providing an efficient domiciliary maternity service. SECTION 24 HEALTH VISITING Staff At the end of the year there were 35 Health Visitors (including 9 Part-time) and 11 (including 2 Part-time) State Registered Nurses employed in the Borough, in addition to the Superintendent and Deputy Superintendent Health Visitors. The table in Appendix 12 shows the number and type of visits made. Central Registry of Casework The Central Registry of Casework now contains about 5,000 names and is growing weekly. Most of the names are contributed by the Health and Welfare Department, as would be expected from the largest provider of casework advice. Enquiries are not as frequent as had been expected but this is a growing service which will take some time to prove its worth. Miss J. Oliver, Superintendent Health Visitor, reports:— Liaison with Chadwell Heath Hospital Geriatric Unit Discussion took place in March between Dr. Dunn, Consultant Physician; Dr. Cordon, Medical Officer of Health; Mr. Hall, Chief Welfare Officer and Miss Oliver, Superintendent Health Visitor about the renewal of a weekly visit to the hospital and subsequent follow-up of discharged patients, a practice discontinued since Miss Copping's retirement. As the Welfare Service were short of staff it was agreed that Miss Collins should undertake this liaison for a period of three months. It was continued for seven months, until it was decided that a joint hospital and Local Authority appointment (part-time) would be made, possibly early in 1967, to cover this service. It was felt that the period spent doing this work, although time-consuming, was both interesting and a valuable experience. Meeting patients with Dr. Dunn prior to discharge and being given information both about their physical disabilities and home conditions was helpful when later visiting them at home. 42 Although not always possible, an attempt was made to ensure that Local Authority services such as domestic help, meals-on-wheels, special laundry service and sick room equipment were available as soon as practicable after the patients return home. All discharges were checked with the Welfare Department to see if they were known to a Social Welfare Officer and if this was so, the case would be discussed and a copy of the report following Miss Collins' visit sent to the appropriate Officer. Otherwise, following a visit, the report would be sent to a Health Visitor with a request for routine visits should this be thought desirable. Madeira Grove Clinic Health Visitor, Miss Roe, felt that there was a need in this area to start a creche for mentally and physically handicapped children, similar to the one at Fellowship House, Ilford. This was opened on 19th April, 1966 with the willing co-operation of mothers and others sufficiently interested to offer their help. The creche is open every Tuesday morning and has been found to benefit both the mothers, who can discuss their mutual problems and the children, who often show progress through mixing with others. The tendency to over-protect the child is diminished and the mother begins to realise that she is not alone in facing what to her may seem an insurmountable problem. A Jumble Sale was held in the grounds of the clinic during the Summer, the proceeds being used to buy suitable equipment for the creche. A group visit was arranged by Health Visitor, Miss Roe, so that mothers could see the facilities provided for children at the John Kennedy Unit, Newham. This again perhaps allayed some fears that although a child might not be eligible for ordinary education, that he was not forgotten and that thought was given to make the best use of the abilities which he had and the use which can be made of them. Wanstead Place Clinic Following completion of alterations, the Infant Welfare Centre previously held at Cromwell Hall was transferred to Wanstead Place in April 1966. 43 Ante-Natal Clinics As Ilford Maternity Hospital now have their own clinic for mothers attending for their first examination we have been able to discontinue the session which was held for this purpose at Mayesbrook on a Saturday morning. Health Education Relaxation and Mothercraft Classes continue to be held at Madeira Grove, Wanstead Place, Manford Way, Kenwood Gardens, Mayesbrook and Heathcote Clinics. In addition, Health Visitors have given talks on health education subjects at various group meetings in the Borough. Health Visitor Students Four Student Health Visitors are doing their practical training in the Borough between 1966/67 under the supervision of Health Visitor Field Work Instructor, Miss Arnold. Altogether Redbridge have five students in training who will return to work in the area in September 1967. Unfortunately, one Field Work Instructor left to take up duties as a Health Visitor Tutor and we were extremely sorry to lose her services, but hope to replace her with a second Field Work Instructor in 1967. Other Students Observation visits have been arranged during the year for student nurses from King George Hospital and Oldchurch Hospital and also for trainee Social Welfare Officers to provide them with an insight into Local Authority preventive services. Meetings with other Colleagues Ample opportunities have been available to meet others engaged in Social Work, whether statutory or voluntary. Many employees in the Health and Welfare Department and Children's Department have joined the Redbridge Association of Professional Social Workers, one of the aims of which is to promote fellowship and co-operation among Social Workers. The activities of the Association are intended to include a monthly Luncheon Club where members may meet and get to know each other. In October a full day's Conference was organised by the National Association of Probation Officers at Fairlop School, which was attended by many Health Visitors. The theme was 44 'Families in Stress' and the focus on 'Gambling, Alcoholism, Drug Addiction and Crime'. In October 1966, Health Visitor Miss Cooke was invited to spend a half-day at the Nursing Exhibition on the stand "Recruitment of Student Health Visitors" for the Council for the Training of Health Visitors. Home Accidents Accident prevention continues to be one of our special priorities for health education in the home. At the time of writing the report 694 children under 5 and elderly people over the age of 60 years of age have been visited following the usual note from King George Hospital. The note advises us that the patient has been treated in casualty and the Health Visitors follow-up the cases at home. We often do not know immediately that the elderly have been admitted to the wards. If the child has been admitted the Health Visitor visiting the children's ward weekly, lets the Health Visitor know. SECTION 25 HOME NURSING Home Nursing 1966 was the first full year of the Home Nursing Service under the administration of the London Borough of Redbridge. Details of the work undertaken by the Home Nurses are as follows:— Total patients nursed — 3,054 Aged under 5 years — 70 Aged over 65 years — 1,891 Others — 1,093 Miss M.A. Potter, Superintendent of Midwives and District Nurses reports as follows on the Home Nursing Service:- Since the merging of the two Boroughs of Wanstead and Woodford and Ilford into the present Borough of Redbridge and having celebrated our first anniversary we feel that some of the "teething* problems have been resolved. Although the changes have been only minor in detail they have presented themselves as problems to the individuals concerned. 45 We look forward (to the future) with optimism knowing that whatever changes may take place the District Nurses, with humour and understanding can solve them. The majority of our patients are over 65 years and this is in keeping with the national trend. With co-operation with the Mental Health and Welfare Officers the elderly patients social difficulties are reduced. Mental illness in the community is increasing and as District Nurses we have to be aware of the recent developments in Psychiatry. Four district nurses attended a one-day course on mental illness in the elderly and it is hoped that more nurses will attend similar courses in 1967. One district nurse, together with three other members of the Health and Welfare Department attended a one-day a week course, for 8 weeks, in Psychiatry and Mental Health in the community. Chadwell Heath hospital continues to admit elderly persons for 6 weeks stay in and out basis, thereby relieving the relative for a short period. SECTION 26 VACCINATION AND IMMUNISATION Vaccination and Immunisation Protection against diphtheria, whooping cough, tetanus and poliomyelitis is given at most Infant Welfare Centres in the Borough and by general practitioners. Our schedule of immunisation in Redbridge is aimed at giving primary protection against diphtheria, whooping cough, tetanus and poliomyelitis by the age of 6 months. Booster doses against all four diseases are given at 18 months, and a further booster against diphtheria, tetanus and poliomyelitis only is given before admission to school. It is pleasing to report that last year the total number of completed courses of immunisation against all four diseases increased by over 50% on last year's total. This would appear to be a direct result of the Department's new immunisation programme. Vaccination against smallpox is carried out in the second year of life. Whilst protection rates against diphtheria, whooping cough, tetanus and poliomyelitis remain commendably high in 46 the borough; the same cannot be said of smallpox, which remains at 29%. The wisdom of vaccination against smallpox in infancy cannot be too strongly emphasised. It avoids the situation in later life when primary vaccination, carrying a much higher incidence of complications, may be necessary because of contact, travel or Service life. Most important of all, it helps to raise the level of vaccination in the community to a point where epidemics are unlikely. This level is not high enough for safety and parents are urged to see their children are vaccinated at the recommended age. Protection Rates The table in Appendix 13 shows the number of com- pleted courses of immunisation by year of birth. It is estimated that 80% of those children born in 1966 who were eligible to receive protection by reason of age were in fact protected against diphtheria, whooping cough, tetanus and polio. The number of boosters given against these diseases is shown also in Appendix 14. Computers During the year the use of computers in the vaccination and immunisation programme was studied. It was felt that the time was not yet opportune for this procedure to be introduced, though it was recognised that computers will eventually replace ordinary office records. Agreement would have to be reached on programming and availability of computers among the London Boroughs. 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 Cervical Cytology Health Education The newly created Health Education Section has amply fulfilled its early promise. Accurate information on all aspects 47 of this subject, so central to the working of any Local Health Authority, has been readily available. Equipment has been carefully but imaginatively chosen and is well used. Miss K.M.E. Griffiths, Health Education Officer, reports as follows: — How can Health Education be reported to give the reader a true picture of the efforts of all the staff who were involved in this work? Would statistical evidence be sufficient comment on their efforts? No reporting system has yet been devised which could adequately record examples of this type of education. Health Education is not a new subject, what is new is the setting up of a co-ordinating service, which attempts to provide help and good shape to all the teaching aspects of the Health and Welfare Department. 1966 has been a year of activity in building and expanding the Health Education Section; there have been teething troubles and problems but out of this ideas have been formed, policies formulated which will give shape to the future service. This year has seen an increase in equipment and of expansion of stocks of teaching aids. Staffing In August, 1966 we welcomed Mr. G.J. Bohannon on his appointment as technician/projectionist and look forward to the Assistant Health Education Officer, Miss V. Blanchard, taking up her appointment in January 1967. Individual Health Education Counselling, advice and help are given by so many members of staff in their day-to-day work that it would be presumptuous to record it. Professional staff employed in the health services today are trained towards this end, and all use their experience to promote health and well-being amongst people in our care. Group Education Health Visitors, at their relaxation classes, ante-natal clinics, infant welfare centres, mothers clubs, have carried out health education programmes in which departmental staff and other speakers have participated. Examples of parentcraft courses, which might comprise a series of six talks, discussion and films to expectant mothers and fathers, are given at Ilford Maternity Hospital and Mayesbrook Clinic. At all these 48 classes topics range from personal health and child development to environmental and community health. There has been an increasing number of requests by professional and voluntary organisations for advice, for speakers for syllabus planning or for short health education courses and also for the supplies of educational material. The following table shows some of the work carried out by the Health Visitors and the Health Education Section. It will be seen that work at the relaxation classes has been constant throughout the year, and that education in schools and also to other adult groups has increased. 49 Visiting Students and Staff Health education and health visitor students have visited the section during the year as part of their field training. Student teachers undertaking projects come in for advice and assistance. Medical practioners and professional staff from other Authorities also visit this Department. The Mass Media The practice of distributing material to clinics, libraries and Borough establishments and also to London Transport underground stations and to general medical practioners, has continued. Literature is requested from voluntary and youth organisations. Topics of importance are dealt with by local press coverage, which is one of the most valuable outlets in communication. Projects From time to time, there are health topics which need to receive special coverage. An example of this was the "teachin" arranged as part of Mental Health Week which was a series of talks by eminent speakers, discussion groups and films, together with an exhibition. Arrangements are in hand for the inclusion of health education topics and programmes of the future, such as cancer education, health of immigrants, and at the Health Advisory Clinic at Heathcote Avenue. Another opportunity for health education will be the creche for handicapped children at Madeira Grove Clinic. The notion of health education being a series of prohibitions still prevails in some quarters, and it is our task to give a lead in creative thinking. Not so much in imparting information but more to teach the techniques and methods of knowing where to look for it, and to help people solve their own problems through discussions on the general principles of healthy living and behaviour which are acceptable to society. I should like to acknowledge the work of all staff who carry out health education, particularly to the health visitors who have always made a large contribution and also to the technical assistant, without whom much of the art and display work would not have been possible. Home Safety The Health Education Section in co-operation with the Redbridge Home Safety Committee has been active during the 50 year by participating in RoSPA national campaigns and by carrying out local projects when the opportunity arises. Examples were an exhibition at the Ilford Horticultural Society's Annual Flower Show and window displays made possible by the kind offer of the manager of a local Building Society. Talks and films have been given to local organisations and youth clubs and literature has been distributed on a wide scale. Comment Talks at ante-natal relaxation classes have remained constant throughout the year. Work in the schools has steadily increased except for the seasonal "drop" due to summer holidays. Talks and courses to adult and other voluntary organisations have been established, though there is a great deal of scope for health education courses at youth clubs. 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. A contribution towards the cost of the convalescent holiday is made by the patient after assessment. During the year 113 cases received this service. Provision of Sickroom Equipment The Department holds a very large stock of sickroom equipment, which is issued on loan to persons requiring it 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. 51 Daring the year a service was introduced to provide, under this Section of the National Health Service Act, 1946, protective clothing (or certain types of incontinent people, including elderly people, and where the provision of such protective clothing would enable the patients to lead a relatively normal life either ambulant or in a wheelchair. The Department also runs a laundry service for the bed linen of incontinent patients. Chiropody Mr. F.E. Gibson was appointed as Chief Chiropodist in 1966 and it is worthy of note that in 1966 the Chiropody Service gave 23,000 treatments compared with 18,000 in 1965— an increase of 28%. This service is deservedly popular with elder citizens as their mobility is increased by foot comfort. Mr. Gibson reports as follows:— "There were 5 full time and 6 part-time Chiropodists employed at the end of the year, the Service continuing to expand. The demand is ever increasing and we have been able to provide a complete service to the elderly in Clinics based at convenient sites throughout the Borough. Transport is provided by the Hospital Car Service when necessary, to convey handicapped patients to and from the Clinics. All the Welfare Homes in the Borough are visited regularly, also domicilary treatments are given to house-bound patients. The service is also available to expectant mothers and the physically handicapped. Details of the patients seen are shown in Appendix 16." Tuberculosis Health Visitors 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. Occupational Therapy A domiciliary occupational therapist has not yet been appointed but 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 52 rehabilitation settlements, provision of free milk, boarding out of child contacts and assistance towards the travelling expenses of relatives visiting hospital patients. During 1966 one patient was admitted to a rehabilitation settlement and financial assistance was provided towards his maintenance there. In addition a total of 174 patients were provided with free milk and the one open air shelter provided by the Borough continues to be occupied. Voluntary Bodies Statutory services work very closely with voluntary services 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 work of the Ilford Tuberculosis and Chest Care Association continued in 1966 on similar lines as in previous years. There are more non-tuberculous patients in receipt of help from the Association now than at any other time, some 40% coming into this category. Various forms of help were given, mainly extra nourishment for the patient, but other assistance in the form of payment of fares for relatives to visit patients, assistance with fuel and light bills, and a television licence was also provided. The Committee are always mindful of the financial assistance given by the Redbridge Borough Council and also the valuable help in allowing the Association's affairs to be administered from the Health and Welfare Department. Details of assistance given during 1966 are:— No. of persons assisted Total No. of grants made Extra nourishment grants (usually made for a period of one month and renewed as required) 50 ( 334 (including (renewals Other grants 57 61 Cervical Cytology With the help and advice of Dr. McGee, Consultant Pathologist to the Ilford and Barking Hospital Management Committee a cervical cytology clinic was started for one 53 session a week at the Public Health Offices in June 1966. In October 1966 we were allowed to increase the number of smears to 60 a week so a second session was commenced. Our waiting list at the end of 1966 was 350 and waiting time for an appointment was six weeks. Women over the age of 30 are seen. The Clinic is run by two State Registered Nurses who have been trained in the technique by one of our Medical Officers with special experience in this work. A medical officer is also always on call. It should be emphasised that this Clinic is solely for the detection of cancer of the cervix before symptoms arise and any woman who has symptoms which worry her should attend her own doctor. It is hoped to show a film accompanied by a tape recording on early detection of breast cancer in 1967 as it is felt this is a good opportunity for Health Education. SECTION 29 HOME HELP SERVICE Home Helps The woman who works as a Home Help has not only a job. One might say she has a vocation. For an hourly wage less than she could earn in industry or private domestic employment she may be asked to run a home, look after a bedfast old person, co-operate with one of our domiciliary nurses in a case of acute illness, or do the housework and give support to a patient discharged from hospital. In-service training should be included in our plans for a proportion of the staff each year. Talks and demonstrations on balanced diet, invalid cooking, the special needs of the aged, the handling of sick and disturbed people and other related topics would not only instruct our workers but should make them conscious of their part in the Health Services we administer. This policy could well be an aid to recruitment. Mrs. Lawrence, Senior Home Help Organiser, reports:— "There are 230 Home Helps employed in the London Borough of Redbridge. This is 16 fewer than last year and I would appeal to any woman who feels capable of carrying out this interesting and demanding work to get in touch with me. 54 As a great deal of the duties of this department lie with old and sick people it is essential that a person taking up this employment should be cheerful and able to adapt herself to different households. The work is never lacking in variety and often involves co-operation with nurses and midwives. In the allocation of domestic help, priority is given to lying-in mothers, families with young children when the mother is in hospital, the acutely ill, and bedfast and chairbound patients. On receipt of an application for home help an Organiser visits the home and finds out whether the case falls into one of the categories for which this service is considered necessary. If approved, a financial assessment is made and the applicant pays on a scale related to his income. Low income cases receive the service free of charge." 55 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. SEVEN 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. (closed w.e.f. 12th January, 1967). 56 APPENDIX 9 Details of the cases of Congenital Abnormality as reported to the Registrar General during 1966 Abnormality of the Genitalia 1 Imperforate Anus 1 Spina Bifida 1 Meningomyelocele 4 Hypospadias 3 Anencephaly 4 Hare Lip or Cleft palate 8 Deformity of wrist, hands, feet etc. 6 Downs Syndrome 7 Multiple Congenital defects 2 Accessory auricle 2 Congenital Heart Disease 1 Talipes 7 Hydrocele 2 Hydrocephalus 3 Reduction Deformities 1 Atelectasis 5 Exomphalus 1 Congenital heart 3 Pilonidal Sinus 2 Oesophageal Atresia 1 Other Malformations 2 APPENDIX 10 Details of attendances of children under 5 years of age at specialists clinic during 1966 Orthopaedic Clinics 129 new cases attended the clinics during the year, and with 156 old cases, made a total of 419 attendances. There were 79 sessions held during 1966. Ophthalmic Clinics A total of 237 children attended these clinics during the year making 449 attendances. 61 pairs of spectacles were prescribed. Ear, Nose and Throat Clinics 27 new cases made 39 attendances at 34 sessions of these clinics and eleven operations for Tonsils and Adenoids were performed at local hospitals. Speech Clinics 330 children attended these clinics making 781 attendances for various speech defects. Enuresis Clinic 19 new cases attended these clinics during 1966 and the total attendances by all cases was 73. 57 APPENDIX 11 DAY NURSERIES Details of attendances during 1966 Name of Day Nursery Number of Approved Places Total Attendances Average Daily Attendance Ley Street 50 9,659 30.8 Goodmayes Lane 50 9,635 30.7 APPENDIX 12 Cases Visited by Health Visitor Number of Cases 1 Children born in 1966 3,780 2 Children born in 1965 3,483 3 Children born in 1961-64 9,706 4 Total number of children in lines 1 — 3 16,969 5 Persons aged 65 or over 2,723 6 Number included in line 5 who were visited at the special request of a G.P. or hospital 180 7 Mentally disordered persons 39 8 Number included in line 7 who were visited at the special request of a G.P. or hospital 13 9 Persons, excluding Maternity cases, discharged from hospital (other than mental hospitals) 133 10 Number included in line 9 who were visited at the special request of a G.P. or hospital 45 11 Number of tuberculous households visited 11 12 Number of households visited on account of other infectious diseases 14 13 Number of tuberculous households visited by tuberculosis visitors 1,154 58 APPENDIX 13 Completed Primary CoursesNumber of persons under age 16 Type of vaccine Year of birth Others under age 16 Total 1966 1965 1964 1963 1959-62 Diphtheria 1,181 2,157 274 82 157 43 3,894 Whooping Cough 1,175 2,140 262 69 83 20 3,749 Tetanus 1,180 2,157 278 87 419 346 4,467 Poliomyelitis 1,100 2,306 314 77 201 87 4,085 APPENDIX 14 Reinforcing Doses— Number of persons under age 16 Type of vaccine Year of birth Others under age 16 Total 1966 1965 1964 1963 1959-62 Diphtheria 4 274 714 141 2,077 159 3,369 Whooping Cough 3 250 642 106 496 33 1,530 Tetanus 4 276 712 143 2,045 216 3,396 Poliomyelitis 1 213 398 126 1,932 125 2,795 59 APPENDIX 15 The followlhg articles of sickroom equipment are available on loan from the Health and Welfare Department Mattresses (Dunlopillo and hair) Bed-pans Invalid Chairs Feeding-cups Rings (air and Dunlopillo) Urinals Back-rests Sputum-Mugs Beds (air, water and ripple) Bed Blocks Hospital Beds Lifting Pole and Chain Commodes Commode Sorbo Cushions Fracture Boards Plastic Sheets Rubber Toilet Seats Medical Sandbags Crutches and Walking Aids Bed-cradles Hydraulic Hoists APPENDIX 16 CHIROPODY SERVICE Details of new cases and treatment given in 1966 New Cases Treatments Children under school leaving age 159 946 Expectant mothers 20 35 Physically handicapped 141 657 Persons aged 65 years or over 781 22,127 TOTALS 1,101 23,765 EDUCATION ACT 1944 61 SCHOOL HEALTH SERVICE (by W. H. Toms, M.B., Ch.B. (Edin.). Principal Medical Officer). 1966 saw the second year of the School Health Service in the London Borough of Redbridge. There have been inevitable changes in the service which may have suggested to some schools that they were in danger of losing the close contact they had previously enjoyed with the School Health Service. These changes have largely been the result of the more centralised administration which a school population of 31,000 requires. Medical records are now kept at the Public Health Offices and appointments are made from there. I should like to thank the teaching staff of those schools affected by this change for the flexibility and goodwill they have shown and assure them that while the control of some administrative functions may have passed from their hands our aim is to co-operate as fully as we can in the care of the whole child. It is our endeavour to offer as full a preventive medical service as possible to the child in school, and I have been very pleased that in the last year teachers have called upon us for advice upon many occasions and on cases as diverse as the disturbed five year old who could not settle in a large class and the grammar school pupil whose vision was so impaired he required not only special seating arrangements but a special syllabus. I am convinced that there are school children whose problems require the teacher and doctor to meet personally and evolve a plan for the child in school. All periodic medical inspections should present an opportunity for this relationship and I deplore those which take place away from the school background and in professional isolation. At present, with only a few exceptions, school medical officers are not attached to their own schools. This is a bad thing. With a greater number of full time departmental medical officers on our staff it would be possible to devise a scheme in which one doctor would look after Infant Welfare Centres, Toddlers Clinics and the school population in a definite area. He would be able to establish a sound relationship with all workers in the field of Community Care, including the general practitioners. He would have identity and his work should have cohesion. He might even become known by name and not as the "Clinic Doctor*. 62 The stumbling block here is the difficulty in recruitment of suitable doctors for this kind of work. The salary range is not only unrealistic but borders on the farcical as a newly qualified assistant in general practice can command a salary almost £1,000 a year higher than the Local Authority will pay him. Unless an appreciable increase in salary is agreed for this career grade we may be obliged to go on with depleted staff relying on casual work done for us by general practitioners. School Roll & Premises The school roll on 31st December, 1966 was 31,495. These children attended 65 schools and the figure includes 90 at the Ethel Davis School for physically handicapped children. Medical Inspections 5,768 medical inspections were carried out in 1966 and of these only 34 were seen whose general physical condition was considered to be unsatisfactory (Appendix 17 Table A). In addition 1,337 special examinations were carried out (Appendix 17 Table B). Screening Tests of Vision and Hearing This service commenced in April 1966 and has justified our early enthusiasm. Three technicians whom we have trained are on the establishment and work exclusively screening vision and hearing in the schools. We now possess two transistorised audiometers and a Keystone Telebinocular vision screener with a second on order. The Keystone vision screener with which it was started, in the hands of trained technicians, gives an accurate assessment of a child's vision — both near and distant and shows if muscle inbalance causing squint is present. It can be used to test the vision of schoolchildren including those too young to read. In cases where vision is shown to be defective or where any doubt exists the parent is informed and can choose either to take the child to our ophthalmic clinic or the family doctor. At present children are 'screened' at 5, 8 and 11 years of age and we are in the process of extending the service to children of 13 and 15 in Secondary Schools. Auditory screening, also carried out by trained technicians, takes place at the same ages but as yet we have not tested hearing in the Secondary Schools. It should be possible to achieve the aim set out in last year's report of testing vision annually and hearing four times during school life. It is realised that vision screening in Secondary Schools 63 may interfere slightly with the class routine but in view of the fact that myopia can develop quite quickly in that age group I feel this part of the programme should be persevered in. Simplified Statistics:— Number Tested Number Paesed Total Number of Defects Number Referred for Advice Vision 6,722 5,263 1,459 783 Number Tested Number Passed Number Advised further Test Number Referred for Advice Hearing 11,888 10,621 1,087 180 Staffing The Medical Staff was depleted by illness and resignation in 1966. Dr. G. B. Taylor was ill for the whole of the year and has been obliged to resign. Dr. E. Kilsby obtained a post nearer her home in Havering. Dr. Y. H. Toms transferred from the post of Departmental Medical Officer. Dr. H.B. Grange retired.. We were on aggregate 3 doctors short for most of the year and though we attempted to cover the work with the sessional employment of general practitioners over 1,000 less periodic medical examinations were done than in the previous year. General practitioners because of their other obligations only do sessional work in the afternoons, and there are not enough afternoons in the school terms to get through the work required. The help of general practitioners is invaluable to us but the proportion of part to full time medical officers is far too high- Special Schools and Specialist Clinic 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 Treatment Minor Ailment Clinics: 308 children attended various clinics throughout the Borough in respect of minor ailments. 64 Recuperative Holidays Daring 1966, 23 children were recommended for recuperative holidays and were placed by the Chief Education Officer. Specialist Clinics Ophthalmic Clinic Four clinics are evenly spread within various parts of Borough. The Summary of Attendances of school children is as follows:- No. of Sessions New Cases Old Cases Total Attendances New Spectacles Prescribed Spectacles Repaired or Replaced Kenwood Gdns. 104 229 642 1,258 449 137 Mayesbrook 96 165 512 1,175 326 78 Manford Way 29 40 153 336 104 12 Woodford 28 120 173 405 172 27 Totals 257 554 1,480 3,174 1,051 254 Dr. J.A. Fairhurst, Ophthalmologist at Kenwood Gardens Clinic, reports as follows:— The general atmosphere of the Kenwood Gardens ophthalmic clinic remains pleasant. The attendance for routine visits is still high and there is an increasing number of new patients. This latter fact is due to:- 1. The child health services are referring children much earlier. This is very satisfactory. 2. Vision screening in schools is picking up very small errors and in many cases causing referral of patients who eventually prove to be normal. I must stress once again how big a proportion of the clinic consists of squints — not only pre-operative but post-operative cases referred back from the hospital. The clinic's bookings are very much behind for ordinary cases and I feel that a lot of this is due to the high number of squints. These nave to be seen frequently in order to avoid the risk of amblyopia developing and remaining undetected. 65 If the clinic remains overloaded I would suggest once again that the attendance of an orthoptist would help tremendously. If this is not possible then it may be necessary either to have an additional clinic or to restrict the return of the children from hospital clinics. Orthoptic Clinics Orthoptic Clinics, indispensable to a satisfactory Ophthalmic Service, have been held at Mayesbrook and Woodford Clinics staffed by one Orthoptist in each case. In addition some patients living in the North IIford area were seen by arrangement at King George Hospital. Summary of Attendances No. of Sessions NewCases Investigated Total Attendances Cases Di sch arg ed Cases in attendance at 31.12.66. Mayesbrook 171 109 515 67 188 Woodford 47 70 183 12 186 Totals 218 179 698 79 374 Orthopaedic Clinics Clinics were held in four areas of the Borough, the Consultants being Mr. H. G. Korvin, F.R.C.S., at Kenwood Gardens and Mayesbrook, and Mr. Mark L. Mason, F.R.C.S., at Mapford Way and Woodford. A summary of the attendances of school children at these clinics is as follows:— No. of Sessions New Cases Old Cases Total Attendances Kenwood Gdns. 43 45 218 331 Mayesbrook 19 15 63 103 Manford Way 7 7 18 34 Woodford 10 17 42 78 Totals 79 84 341 546 Five children of school age were found to require surgical treatment. 66 Mr. H. G. Korvin, F.R.C.S. Consultant Orthopaedic Surgeon reports as follows:— There is little to report on the work in the orthopaedic clinics during 1966. It is worth mentioning, however, that the publicity given during the last few years to the earliest diagnosis of congenital dislocation of the hips is beginning to bear fruit. Among the suspects referred for investigation there has been one or the other in whom full development of the condition could be prevented by timely treatment. One major change has taken place at Kenwood Gardens, Nurse McDermott, who had been in charge of the clinic ever since it was built (and before in Perryman's Farm Road) has been promoted to a different post. I would like to take this opportunity to thank her sincerely for the devoted, quiet and efficient way she has been running the clinic all these years. 5 children of school age were found to require surgical treatment. During the year 30 pairs of valgus insoles, 2 pairs of surgical boots, 1 pair Genu Valgum splints, 7 pairs calipers and inverting irons, 153 pairs of wedges to shoes, and 2 urinals were supplied to school children. 143 cases were discharged from the Orthopaedic Clinics 36 as cured, 16 due to failure to attend for further treatment, 10 left school or left the district and 83 as showing improvement and were kept under observation by the school medical officers. Remedial Exercises and Physiotherapy The Ilford and District Hospital Management Committee were still unable to supply the services of a physiotherapist for our Kenwood Gardens and Mayesbrook Clinics and we have appreciated the help of Mr. Brand, Superintendent Physiotherapist at the Ethel Davis School, who has again held one session per week at each clinic to treat cases of some urgency. Mrs. Haseldine, Physiotherapist at Woodford Clinic for a considerable time, resigned in June and we are now fortunate to have the services of Mrs. Rowe who commenced two sessions per week in December. At Manford Bay Clinic, also, two sessions per week were held regularly under the supervision of Mrs. Pilbeam. 67 Summary of Attendance of School Children New Cases Total Attendances Kenwood Gardens 36 186 Mayesbrook 22 145 Manford Way 10 311 Woodford 14 51 Totals 82 693 Ear, Nose and Throat Clinic Miss M. M. Mason, F.R.C.S., Ear, Nose and Throat Consultant at Kenwood Gardens Clinic, was unfortunately obliged to take sick leave for almost six months of 1966. During this time Dr. B.I. Copeland or Mr. T.R. Bull, F.R.C.S., held the Clinics in a locum capacity whenever possible. Summary of Attendances No. of New Old Total Advised Audiograms Sessions Cases Cases Attendances Operation 34 140 79 368 107 47 In addition 35 children were referred to the Ear, Nose and Throat Clinic at Wanstead Hospital and seen by Mr. R.T.S. Goodchild, F.R.C.S. Of these 9 were found to require operative treatment. Speech Clinics Mrs. P. A. Pretious, Senior Speech Therapist, submits the following report:— Miss Osborne, Full time, School Clinics, Ethel Davis Physically Handicapped School, Special Education Units. Appointed in March 1966. Mrs. Pretious, Full time. School Clinics, Ethel Davis Physically Handicapped School. Miss Sacks, Full time, School Clinics, School, Junior Training Centre. Resigned May, 1966. Mrs. Tingey, 6 sessions per week. Mayesbrook Clinic and Schools. Miss Marquand, Temporary Therapist, 4 sessions per week 22nd June — 29th September. In March 1966 we welcomed Miss Valerie Osborne to the Redbridge Staff and for a short while we enjoyed the services of three full time and one part time therapist but soon the work 68 was curtailed. In May, Miss Sacks resigned her post to be married and although a temporary therapist worked (our sessions per week from June till October, children referred to Valentines Clinic were being placed on a Waiting List; Manford Way Clinic was unavoidably closed for three months of the year; and the session at the Junior Training Centre was discontinued. The vacancy for a full-time therapist, although advertised, was not filled until January 1967. However, this staff shortage did not prevent the establishment of a speech clinic in an area where one has been sorely needed. In April, the smaller medical room at the Public Health Offices in Clements Road, was made available to us for one session per week. The session was quickly filled with children who had previously had to make awkward and lengthy journeys either to Valentines or Mayesbrook Clinic. In addition, when the Observation Unit was expanded and rehoused in Chigwell and an Autistic Unit established, we were able to provide a therapist to visit the Unit one session per week. We feel that children placed in special education units should receive speech therapy on the premises wherever there is a sufficient number of children to justify it, and the necessary staff available. It was lack of this staff that caused the part session at the Becontree Remedial Education Unit to be withdrawn in the Autumn, though fortunately it was restored within the terra. We are grateful for the very good co-operation we continue to receive from head teachers and from all other clinic staff. The number of children of pre-school age referred to the speech clinics is increasing; something welcomed by all the Redbridge Speech Therapists. In fact the Waiting List at Mayesbrook Clinic is composed mostly of pre-school referrals. The appeals made consistently in previous reports are now bearing fruit. School Dental Service Mr. E. V. Haigh, Principal School Dental Officer reports as follows:— The school dental services in the Redbridge area continued on similar lines to last year. The policy of the service was to inspect as many school children as staffing permitted during the year either at schools or in the clinics and to treat all that wished treatment to be carried out. During 1966 the Dental staff position remained almost the same as during 1965 and also the amount of work carried out on patients was almost identical. 69 Starffing With eight surgeries and a total staff employed on the school dental service equivalent to 5.45 full time officers, it has been necessary for one dental officer to cover two clinics. By doing this it has been possible to offer a service at all the clinics in the area. The recruitment position concerning dental officers has become worse in this area during the past two years. From 1960-1964 the staffing position improved considerably but now it is much more difficult to get suitable applicants. This is a national problem which finance plays a large part but also it seems to be geographical as well with certain outer London Boroughs. Dental officers who wish to work in London find the journey too tiresome, also it is not far enough out of London to attract people who wish to work in a more rural area. Mr. Willson working at Kenwood Dental Clinic was appointed Senior Dental Officer for the additional duties of supervising a dental auxiliary. Mrs. L. French commenced duties as a dental auxiliary on 1st March 1966. The quality of her work was of a high standard and she was liked by the children. I am sure there is a place for auxiliaries in the school dental service, especially when it comes to treating very young children who need careful handling and patience. However, the auxiliary only stayed six months because she wished to move to the south coast. I am hoping to shortly replace her at the beginning of 1967. Premises The dental clinic at 93 High Road, Woodford, was moved to 118 Hermon Hill in November because it was planned to rebuild on the site at 93 High Road, Woodford. Adapting old premises for surgery use is never very satisfactory but at least we are continuing a dental service in the Wanstead", and Woodford area until new premises are built. All the other dental surgeries continued as last year to be in use. The new clinic being built at Loxford Lane in the southern part of the borough will have one dental surgery. This should help to dentally cover a large number of children living in this area. Equipment Some of the surgeries have equipment which is becoming old and inefficient such as dental units. These will be replaced on a yearly progressive programme and so spread the cost over several years. 70 Inspections and treatments Dental inspections are a very important duty of the school dental service. Often it is only by these inspections that parents can be informed that their children require treatment. It is then the responsibility of the parent whether treatment should be carried out by the school dental service or under the general dental service. During 1966 18,044 dental inspections were made. This represents 59% of the school population. It is interesting to note that the number of fillings increased by 10% over last year to a total of 11,095 and the number of teeth that had to be extracted decreased by 12%. This now gives a permanent teeth filled to permanent extraction ratio of 19 to 1. This high ratio gives some idea of the good dental care of the children. General anaesthetic sessions continued as in previous years. Medical Officers giving most of the anaesthetics. When a Medical Officer was not available the services of a Dental Anaesthetist was used. Orthodontic cases have been treated by dental officers interested and capable of dealing with this specialised subject. The number of orthodontic patients attending the school dental service, appears to be decreasing slightly. I think this is due to the fact that more private practitioners are now undertaking this work than in the past. Dental Health Education which is an increasing important duty of the service continued to expand mainly through the work carried out by the Health Education Officer. With the shortage of dental staff it is inadvisable to use Dental Officers' time on this work when actual treatment is required by patients. All Dental Officers give dental health instruction to patients when they attend for treatment. Miss Griffiths, Health Education Officer, has been undertaking a systematic dental health education programme in infant and junior schools. The response for this by the Head Teachers. was surprising and I am sure considerable good has been achieved. Dental health propaganda has continued with posters and leaflets. Toothbrushes continued to be sold for 3d. each to children. The small pilot scheme which was introduced in one of the Junior Schools in the Borough of having toothbrushes for all the children staying to school dinners has continued to work very well. It has been possible with the co-operation of three Head Teachers to extend this scheme to three other schools during 1966. It has needed considerable help from the teachers 71 and staff because the children have to be under supervision when they clean their teeth after the meal. However, I am convinced this is a worthwhile task because it seems wrong to tell children to clean their teeth after meals and then deny them the facility at school. Fluoridation of water supplies should be the next major step to be taken in the field of preventive dentistry. However, it appears it will be many years before this is possible. The Ethel Davis School Staffing Changes Miss Moorhouse, Occupational Therapist, left in April to work with another Authority and was replaced in July by Miss Moorcroft who came to us from a course in cerebral palsy at the Cheyne Walk Centre. Miss Dotzler, physiotherapist, left us in June and unfortunately her place has not yet been filled. With only one physiotherapist it is impossible to give the children all the treatment they require, though Mr. Brand, our Superintendent Physiotherapist, has worked hard to bridge the gap- New Equipment New equipment includes an extra hoist, an oxygen resuscitator and an Amplivox speech training aid for use with an induction loop system. This last piece of equipment is for the use of a partially hearing spastic boy whose speech development has been retarded because of his hearing defect. It should enable him to hear well anywhere in the classroom. Therapy As reported above 1966 was a disappointing year for physiotherapy. Occupational therapy was carried out by our full time therapist and 1 consider this to be one of the most valuable treatments we give, particularly where hand control and use are involved. Two Speech Therapists visit the school for a total of nine sessions a week. Most of their time is occupied with the cerebral palsied children, many of whom have speech defects, though their skills extend to advising on techniques of feeding children who have difficulty in swallowing. The children are under continuous medical supervision and Mr. Lee, our Consultant Orthopaedic Surgeon, reports elsewhere on his weekly visits. Our ophthalmic and dental services are used by many of the children and the school nurse accompanies them to these clinics. 72 In May Dr. Dormandy, Senior Lecturer in Haematology at the Royal Free Hospital asked us to co-operate in her study on the problems of haemophilic children and as a result, and after consultation with their general practitioners, all our three haemophiliacs were registered at the Royal Free Hospital for immediate plasma treatment for "bleeds". This treatment is said to greatly rednce the danger of deformities due to haemorrhage into joints. Good relationships between teaching and medical staff have been maintained and case conferences are a feature of the school life. Wherever possible all people involved with the child attend and are encouraged to pnt their point of view. Particularly valuable are the conferences which take place in the two years before a child leaves where in addition to medical and teaching staff we welcome Mr. Farrell, the Youth Employment Officer for handicapped children, and all efforts are made to plan a useful future for the leavers. During 1966 there were 32 admissions and 39 discharges; recommendations for admission were received fron> the following sources:— Other Authorities 9 Hospitals 5 School Medical Officers 5 Headteachers 3 Principal Medical Officer 2 Dr. Barnardo's 2 General Practitioners 2 Transfer from another area 1 Health Visitor 1 Education Welfare Officer 1 Parent 1 32 73 The diagnoses were as follows:— Cerebral Palsy 4 Left Haemiparesis 2 Brain Damage 1 Spastic Quaduplegia 1 Left Hemiplegia 1 Asthma 4 Asthma and bronchitis 2 Asthma, bronchitis and eczema 1 Recurrent bronchitis 1 Muscular dystrophy 2 Peroneal muscular atrophy 1 Congenital heart disease 2 Myocarditis 1 Epilepsy 1 Epilepsy and right hemiplegia 1 Paraplegia due to fracture of T.3. vertebrae 1 Hypoglycemia 1 Fibrocystic disease of the pancreas 1 Congenital deformities of pelvis and lower limbs 1 Recurrent hepatitis 1 Arthrogryphosis multiplexa 1 Myotonia congenita 1 32 Cerebral Palsy Unit Mr. H. B. Lee, F.R.C.S, Orthopaedic Surgeon, reports as follows:— The unit has again done excellent work for the children, many of whom are severely handicapped, and the treatment and welfare staffs have as always pulled well together to see that the best is done for them. Treatment has been difficult at times because of the shortage of staff in the physiotherapy department. Similar shortages are felt throughout the Health Service, but this work requires special training and dedication beyond that usually needed for other types of patient. The Superintending Physiotherapist has worked heroically to see that the children did not suffer from lack of treatment. Child Guidance Clinic Dr. W. P. Curassa, Medical Director of the Child Guidance Clinic, reports as follows:— We are fortunate to have had few changes of staff this year; 74 all our former staff are still with us, and we have in addition gained the services of Mrs. Freud as a part-time psychotherapist. She has both trained and worked at Anna Freud's Hampstead Clinic and brings skill and experience into her work, so that although she can only spare two days a week to work in Redbridge, her contribution to both the children and colleagues is much valued. Our resident caretaker and his wife, Mr. and Mrs. Sutton retired at Christmas after giving devoted service to the Clinic, and have moved to a new home. We shall miss their services, particularly when there are minor but urgent crises such as a blown electric fuse or a Christmas tree to plant. Although few actual changes have taken place within the Clinic, there has been a feeling of movement in the Clinic as new pressures have been experienced and new ideas developed. We welcome the expanding service of community mental health within the Health Department and have established close liaison. This has enabled us to transfer to community care a few very disturbed young people who although they have left school are unlikely to obtain or to settle into jobs readily and and who will therefore need continuing help if they are to live in the community. These young people have continued to be severely handicapped, despite all the measures that have been taken to help them in childhood. Fortunately they are very few in number, but work with them is time consuming. The new educational unit for autistic children will enable some children to have specialised help at an early stage, and here too we have been fortunate in establishing close collaboration. Each child in the unit is under the psychiatric supervision of this Clinic, while the parents are receiving casework support from the psychiatric social workers. An increase in numbers of children in the observation classes has also been linked with increased supportive work in the Clinic with their parents. We have also had an increase in referrals of children who are in the care of the Childrens Department, or under the supervision of child care officers. We would like to be able to give more time with less delay to these consultations which are often needed most at times of crisis, but we have to be fair to those children already on our waiting list, whose needs may also be urgent. We have for instance a number of children who are unable to attend school because of fears within themselves,and these children are given priority, and because of the severity of their disturbance they are also likely to need treatment over a considerable length of time. We have been glad of discussions with the School Enquiry Officers about these children, 75 close co-operation here can be of great assistance in the childrens' treatment. Mention should also be made of the children who are admitted to special boarding schools on psychiatric recommendation; these children continue to attend the Clinic at intervals in their holidays and our psychiatric social workers maintain contact with the parents. Often it is necessary to work intensively for a time with these children and their families so that they may get the full benefit of the therapeutic environment of their boarding school. We work closely with the staff of these boarding schools and this year we have been able to make rather more visits to the children and their schools, and so have discussed the children more fully with the schools' staff. Unfortunately there is a shortage of such schools, particularly for older girls and for E.S.N, boys, and at times distance has prevented the close co-operation between school, family and Clinic which we would like to maintain. We continue to take our part in the practical work training of students, and this year have had students from the Certificate of Social Work course at Barking College and from the Social Science Department at London School of Economics. Although student training takes up staff time, we welcome this contact with students and college tutors and find our students can bring us ideas which are both stimulating and challenging. Only a few of our students intend to work in Child Guidance Clinics, but during their stay with us, they have an opportunity to study in depth the dynamics of the family and the use of a casework relationship. We have been glad to give hospitality this winter to a social workers discussion group which was initiated by the Redbridge Association of Professional Social Workers. This has proved to be a valuable forum for social workers to air their views and to learn about each other's sphere of work, and we welcome these visitors to the Clinic. School Psychological Service This year has seen the start of a small specialised unit for Autistic children and the expansion of other units for disturbed children. There is still no provision for E.S.N, day pupils within the Borough and at the beginning of 1967 there were 36 children on the list for this type of education. We have some hope that two classes may be opened in 1967. Miss S. V. Gascoyne and Miss C. H. Watt, Educational Psychologists, report as follows:— 76 *There has been further development and expansion in the special educational units within the Borough during the year and we have been closely concerned in these projects The plans outlined in last year's report for the expansion of the Observation Croup into two classes and the opening of a new unit for autistic children have come into effect. These now comprise the Woodman Path Unit with Mrs. Shipp in charge of the Observation Unit and Miss Chase in charge of the Unit for Autistic Children. There are one or two children at present in the Observation Unit whose educational problems have been assessed suffi* ciently to make it clear that they need placement in a school for Educationally Sub-Normal children and their social adjustment suggests that they would soon be ready for a move to a larger group. At the moment it is not possible to work out a move for them in advance but as there are plans in hand for day E.S.N, provision to be made within the Borough as soon as premises are available and suitably adapted for the purpose the placement of these children should, we hope, be possible within the next year. The other aspect of the work at the Woodman Path Unit is an entirely new venture; three children have been admitted to the Autistic Unit during this term. The previous experience which Miss Chase had as a teacher of non-communicating children in a hospital setting is very relevant to the work with children in our Autistic Unit. The problems of these children are extremely severe so their behaviour is often unpredictable. They are also difficult to manage as it is not easy and sometimes impossible to gel through to them, they are so unresponsive to people. This demands great persistence and endless patience before any results can be seen but the two children who have been in the Unit throughout the term have shown a definite improvement. The day class for Maladjusted Children is now known as the Treeside Unit to distinguish it from the other special classes in the Borough as there has been some confusion in the past. At present there is one class at Treeside Unit which has built up in numbers over the year. All the children admitted are within the normal range of intelligence but have emotional problems of various kinds. In this Unit the aim is to help the children to function as a group. The selection has to be made carefully to enable the teacher to use the group interaction to help children work out their problems in relation to the group, the adults and the teaching situation. A most valuable year's 77 work has been done and the very close contact between the Child Guidance Clinic and Mrs. Bowman has been maintained. A second teacher has been appointed to assist Mrs. Bowman so that more children will be admitted during the year. The Remedial Classes also now have a definite name, being known as the Becontree Remedial Centre. A small group was formed there during the year to provide the maximum opportunity for six very withdrawn children to work with a specially appointed teacher in a more protected setting. This has been very helpful to them and for the first time five of the children were able to form a corporate group. All these special units require a very considerable amount of liaison in their organisation and in catering for their special requirements. We are very grateful for all the help that has been so generously offered by the Education Officers and the cooperation of the School Medical Service which has been so valuable. Our work of testing the children in the normal schools has continued as usual and we very much appreciate the extra provisions that are made so that we can cater for those children who need extra help at some time during their school careers." New Cases 243 Follow-up for Schools 82 Follow-up for Clinic 97 Remedial Education 60 Children referred to Child Guidance Clinic 10 Enuresis Clinic Dr. Joan M. Pooley reports as follows:- "During the 12 months ended December 1966, the clinic has been held weekly at the Kenwood Gardens Centre, and fortnightly at the Mayesbrook Centre. Sessions and New Cases 49 sessions were held this year at the Kenwood Gardens Centre, and 24 at the Mayesbrook Centre. 78 In all, 119 new cases were seen during the year 1966, comparing favourably with numbers seen in previous years, as can be seen from the following table:— Year No. of New Cases Seen 1963 99 1964 107 1965 110 1966 119 I. Appointment List (Both Clinics) Under 5 years Over 5 years Boys Girls Boys Girls Recommended by:— 1. Infant Welfare Officers 6 4 — - 2. School Medical Officers — — 35 22 3. General Practitioners 2 2 14 7 4.. Parents — 1 6 3 5. Health Visitors 4 — 9 3 6. Educational Psycho logist — — 1 - 119 New Cases = 12 7 65 35 (It has been noted that 10 fewer cases were referred by General Practitioners this year — often treatment has been carried out in the first instance by the General Practitioner himself, and later certain of these cases have been referred to the Clinic (or further treatment. Co-operation between the General Practitioner and the Clinic Medical Officer has been ideal and welcome, althongh if referral seems likely, it is sometimes easier to deal with the case from the beginning.) Total Attendances Both Clinics (old and new cases) 1966 — 773 1965 - 509 1964 - 523 1963 - 463 II. Procedure As in previous years, the procedure adopted with each new case is as follows:— 1. Urinalysis 2. History of enuresis, temperament, home environment, and previous illnesses 3. Physical examination 4. Treatment 79 III. Treatment This naturally depends on the type of enuresis in each patient and on the etiological factors and temperament of the child. Invariably the time spent in talking to the child in explaining the cause and the routine which will be adopted has proved invaluable, particularly where the mother is conscientious and interested, as it then rests with her to remind the child of what has been said. Medicinal Treatments 1. Syrup (or tablets) of Tryptizol is proving to be more and more effective in certain cases. This is prescribed through contact with the patient's general practitioner. The dosage can easily be adjusted according to age and type of enuresis and the results therefrom have been extremely interesting and successful. 2. Dexten. The bonded (long acting) dexamphetamine 5 mgm. usually at bedtime. 3. The Bedbuzzer. 26 of these are now in use through the Clinic and recently a vibratory type has been used for a deaf child. The Buzzers in use will now gradually be replaced by the transistorised type of alarm. 4. Tofranil. 16 children were treated with Tofranil during 1966 with quite striking results after careful selection of the case. 5. Routine and Charting. This is used in conjunction with one of the above treatments in all cases, and in some cases may be the only approach used. IV. Results In 1966, 67 cases were discharged dry, as compared with 65 in 1965, and with 57 in 1964. Children discharged during 1966:— Over 5 years Under 5 years Boys Girls Boys Girls 44 18 2 3 In addition, 27 cases were considered "self-discharged", 80 and of these some parents have written to state that their child was then "dry". Once again, one must mention how worthwhile the Clinics are proving, and co-operation, liaison and interest between general practitioner, Departmental Officer, and patient, is well to the fore. Peripatetic Teachers for the Partially Hearing Because of better staffing this service has expanded in the last year and much good work has been done, especially among the very young children. Miss Hodges and Mrs. Carney report:— "At present there are 42 children on our joint visiting-list. 5 pre-school children, 15 in primary schools, 20 in secondary schools and 2 in a special school. During the year we have made 469 + 256 - 725 visits to homes and schools for the purposes of auditory training, supervision of the use of hearing aids, and parent guidance, as well as teaching. As far as possible we have given two periods a week auditory training to pre-school children. School-age children have been given help according to their individual needs. One severely-deaf four year old boy was admitted to the Newham School for the Deaf. A three year old boy, at present attending a Day Nursery, will probably need special educational treatment within the next few months. A partially-hearing three year old girl awaits admission to a Day Nursery, and placement in a Unit for Partially-Hearing Infants is being sought for a five-year old child (at present in a Day Nursery). It is likely that he will have to travel a considerable distance from his home for this educational treatment, owing to lack of provision within the Borough. Four children in primary schools have been issued with hearing-aids during the year. At least six Commercial Hearing aids have been purchased by the Local Education Authority" One Special (C.P.) School has been equipped with a loop system in one of the class rooms and its own Speech Training Unit. One day nursery also has a speech training unit on permanent loan for the partially-hearing children it admits. A partially-hearing five year old, who had been in attendance at a Day Nursery, was admitted to an ordinary Infants School. One child was attending a fee-paying primary school which has now closed down. She has been placed at another independent school, but the Local Education Authority are no longer helping the parents with the fees. 81 Two senior pupils have come to us from the Markfield Unit for Partially-Hearing Children in Tottenham. One is now taking a Commercial Course and one is attending a County Secondary School. Yet another senior girl came to us from a school for the deaf in Leicester, and has also entered a normal school. One boy from a Secondary School has been transferred to Markfield Partially-Hearing Unit at Tottenham. One little girl aged 3½ years is still awaiting admission to a school for the deaf since last September 1966. A place was obtained for her at this school from the commencement of the summer term, but owing to the consultant's delay in granting permission for special education this vacancy was filled and no further children have been admitted to this school. Two junior pupils and one senior pupil have left the Borough. Heads of schools have asked us to test the hearing of various children, and where necessary we have referred these cases to the Principal School Medical Officer for further investigation and treatment. Now there are two peripatetic teachers for the partiallyhearing we have been able to greatly increase our number of visits and service to the partially-hearing children in the borough, and there is a very good liaison with both the medical and education departments." Handicapped Children Each year when I look at the tables of handicapped children at the end of this report and the schools which they attend, I feel a tribute is due to those Headteachers and their staffs who accept and keep in their ordinary schools children whose disabilities would easily qualify them for special educational treatment. I am not talking here of children with deficiencies of sight, speech and hearing which require specialised techniques in education. Unfortunately they must go to Special Schools so they can benefit from small groups, specialist teachers and sophisticated medical apparatus. I am referring to the asthmatic children, children with eczema, dwarfs, children with other orthopaedic deformities, one child who for a time required treatment on a kidney machine, a girl with a permanent colostomy, children with epileptic fits not always perfectly controlled and many others who live a normal school life because of the interest and compassion of those who teach them. 82 I would like to be able to visualise a future in which the School Cor physically handicapped will cater for children with severe or moderate degrees of cerebral damage causing dysfunction, and those children so disabled that their lives would be endangered at an ordinary school. Even this special unit wpuld be from choice attached to an ordinary school. The number of children coming within the various categories and their disposition as on 31st December, 1966 is shown in the table at the end (Appendix 21). B.C.G. Vaccination of School Children This scheme is offered to all pupils of 13 years attending maintained and in dependent schools. In addition, those previously invited who did not accept are given a further opportunity to participate. 3,090 pupils were offered B.C.G. vaccination and of this number 1,757 or 56.8% consented. 1,510 or 85.9% received vaccination. As the result of the notification of two cases of tuberculosis in schools in the Borough during 1966, it was considered necessary to visit these schools for the purpose of tuberculin testing the contacts. The total number of tests undertaken was 101 but no further cases were discovered following these investigations. The Health Visitor and the School Nurse Miss J. M. Oliver, Superintendent Health Visitor, reports as follows:— "Many girls in the 14/15 year age group are studying for various badges with the Girls' Life Brigade, Church Rangers etc. Included in the curriculum are visits to Infant Welfare Centres, the girls have attended in small groups usually in their school holidays. These visits help the girls to understand the various facilities provided by the Local Authority. The Health Visitor/School Nurse is available to answer questions at the visit. Immigrants We have spent a considerable amount of time this year on improving our communications with the Indian population in the Borough. Birmingham Public Health Department also asked our assistance with a long questionnaire on immigrants. One clinic nurse speaking Hindi and Urduh has given great assistance to teachers and medical officers. Teachers often wish to assist children in making parents understand mattets 83 on hygiene, clothes and school meals. Medical Officers wish to know aboat children's immunisations and a visit to explain to parents about referrals to special clinics by this special nurse has made things much easier. The families usually attend the chest clinic with at least one English speaking member of the family (sometimes a school child) so that our difficulties here are not so great. The Health Visitors and School Nurses have also taken part in obtaining information on the number of immigrants and children of school age resident in the Borough. This was a much bigger job than at first thought. Surnames have a most disconcerting way of changing to plain English ones in a few months. Our present day school work contains a fair amount of visiting families to persuade them to accept the facilities provided. Poor clothing and foot wear are noticed by school teachers or the Health Visitor/School Nurse. The W.R.V.S. and the Education Authority are approached if the parents agree. No child needs to stay away from school to care for a sick parent at home. Home Help Services and District Nurses are all available to assist. So often the child is away from school that persuasion from the Health Visitor and School Nurse with supportive services, quickly gets the child back to the classroom. Case conferences continue to be held on families with problems. Fortunately these are few, but they are usually known to many other officers both statutory and voluntary. Planned educational programmes by the Health Visitoi/ School Nurse and the Health Education Officer are held in school. Family life, human relationships at home, at school and in the community are all helpful to children." Co-ordination of Education, Health and Welfare Services for Handicapped Children and Young People Last year, as a result of a request from two ministries, local authorities were asked to review the co-ordination of these services in their areas. In our reply the following were among points made. Redbridge operates an Observation Register so that children whose history indicates an increased risk because of adverse pre, peri or post natal factors are specially observed so handicaps, if they arise are detected and diagnosed early. At the Local Authority's own school for Physically Handicapped Children the closest co-operation, exists between the responsible medical officer and the educational staff. (The headmaster and the school doctor meet at least twice a week to plan for the children). 84 Full reports are received from boarding schools and day special schools outside the Borough where Redbridge children occupy places. In the case of children attending boarding schools a school nurse makes an annual visit when the child is home on holiday. Social welfare workers also visit some of these children. Case conferences about the future of handicapped schoolleavers are held regularly and are attended by all professional workers, including the Youth Employment Officer, concerned with the placement of handicapped school leavers. Support for the handicapped young person is continued after leaving school and is then the responsibility of medical and social workers. The Central Register of all casework which has been set up in the Health Department ensures the maximum co-ordination between all case workers. It was felt that while generally the three services worked satisfactorily and were well co-ordinated some improvement was desirable in the part played by the Hospital Authorities in providing full information to this Authority. Health Education in Schools Miss K. M. E. Griffiths, Health Education Officer, reports as follows:— "Work in the Schools has increased during 1966 and the demand for speakers and teaching aids is growing. In Secondary Schools programmes of Health Education are arranged and carried out by the Health Visitors and Departmental Staff, and increasingly these programmes are becoming part of the school syllabus. One example of Health Education programme for Senior Secondary School Children would include the following topics:- Personal Responsibilities Good Grooming Skin, hair, foot health, Dental Health Food Hygiene Human Relationships Growing Up Boy — girl friendships Courtship and Marriage How Life Begins Child Development Use of Leisure 85 Some Health Problems of Today Malnutrition — dangers of overweight The Common Cold — Bronchitis Smoking — Drags of addiction What is cancer? Accidents in the Home Community Health Environmental Sanitation Prevention of Spread of infection — including Venereal Disease Health Services This syllabus is an outline of talks, films and discussions which can be the starting point for study and project work by the pupils. In some cases Health Education is dealt with by the teaching staff as and when opportunities arise in the curriculum of studies. Here the health education section can help by providing speakers in specialist fields and by being a reference part for general information. Education in personal relationships has always been a feature of these programmes and its purpose is to attempt to deal with any problems, to let young people make their own decisions and choice of behaviour. So often this choice is one of responsibility and social awareness. The national problem of drug taking is one which we need to tackle in order to protect our young people from this very real danger. As a result of press and radio and television publicity, we have received requests for advice and talks on the hazards of drug taking. Many health topics can be dealt with at a younger age and after discussions with the Chief Education Officer and with the Head Teachers of Junior Schools, it was decided that basic facts of how the body works and healthy living could be introduced in the school syllabus. We hope to implement these ideas further in 1967. Talks on dental health have continued in consultation with the Chief Dental Officer and the co-operation of dental staff. Several schools have instituted regular toothbrushing after school meals and many schools have reduced the sale of sweet foods and instead, provide non-cariogenic foods. Smoking and Health — talks and films have been shown in the Schools together with working models and sections to show the effect of smoking on general health. Posters and leaflets 86 are distributed regularly in support of the Ministry of Health national campaign. To sum up — the aims of the Health Education Service are threefold:— To assist in planning syllabuses which are meaningful to school children at various stages of development To teach, by involving the group in projects, through discussion groups and by providing the stimulus to seek further information To provide information on teaching aids and other educational methods There has been a close and happy liaison with Head Teachers and Staff of all the Schools, with the medical staff and health visitors who have played a large part in these educational programmes. General Welfare and Research Work done by the N.S.P.C.C. The following 38 cases were investigated by the Society:- (1) Neglect 27 (2) Ill-treatment cases 6 (3) Other causes 5 97 children (43 boys and 54 girls) were involved, 36 being of school age. In addition to this work 201 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 1966. Casework 12 Casework with Parents 3 Grant towards television licence 1 Loan of Invalid Chair 1 Chiropody During the year 119 school children were referred to the Clinics for treatment (mostly for Verrucae) but many parents were advised regarding suitable shoes for their children. Perhaps when Staffing permits this service could be extended to include regular foot inspection's of a particular age-group by a Chiropodist either at the Schools or Clinics. 87 Surveys and Research During 1966 we took part in a research project initiated by the Public Health Laboratory at Colindale. This involved giving Gamma Globulin to contacts of Infective Hepatitis and observing the spread of an epidemic in a school both in the children who had received this injection, and those who had acted as controls. This, of course was done with the cooperation of the parents and the school authorities. We also continued to obtain information for a National Survey on Childhood Malignancies which in still proceeding. This involves interviewing the parents of a child who has died from malignant disease and filling in a lengthy questionnaire on the case. The parent of a healthy child of the same age and sex is interviewed and the same questionnaire filled in. Done on a National scale over several years and covering as many cases and controls as possible. It may be that pattern will emerge which could help in our understanding some of the altrological factors in childhood malignancies. The causes of death among children of school age in Redbridge during 1966 were:— Accidental Death 4 Bronchopneumonia 2 Gas poisoning 1 Heart 2 Meningitis 1 Nephritis 1 Tracheitis 1 12 88 APPENDIX 11 DEPARTMENT OF EDUCATION AND SCIENCE MEDICAL INSPECTION AND TREATMENT RETURN FOR THE YEAR ENDED 31st DECEMBER, 1966. Part I — Medical Inspection of pupils attending maintained Primary and Secondary Schools (including Nursery and Special Schools) TABLE A. - PERIODIC MEDICAL INSPECTIONS Age groops Inspected (By year of Birth) No. of pupils who have received a full medical examination Physical Condition of Papils 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 (exclud ing squint) for any other condition reco rded at Part II Total individual papils No No. (1) (2) (3) (4) (5) (6) (7) (8) 1962 and later - - - - - - - 1961 512 509 3 - 7 54 60 1960 1,260 1,251 9 - 25 144 166 1959 246 245 1 - 11 26 35 1958 79 78 1 - 6 12 16 1957 75 74 1 - 4 17 20 1956 67 67 - - 6 3 9 1955 178 178 - - 11 13 23 1954 1,494 1,485 9 - 153 104 243 1953 731 722 9 - 75 65 129 1952 93 93 - - 10 15 22 1951 and earlier 1,033 1,032 1 - 100 62 157 TOTAL 5,768 5,734 34 - 408 515 880 Col. (3) total as a Col (4) total as a percentage of Col (2) 99.41% percentage of Col (2) .59% total total 89 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 90 - 103 - 5 Eyes — a. Vision 408 6 176 1 b. Squint 12 1 16 - c. Other 7 - 17 - 6 Ears — a. Hearing 25 66 78 33 b. Otitis Media 3 2 9 2 c. Other 1 2 4 - 7 Nose or Throat 81 10 118 1 8 Speech 35 8 25 2 9 Lymphatic Glands 2 - 21 - 10 Heart and Circulation 10 3 76 3 11 Lungs 12 12 121 10 12 Development — a. Hernia 12 - 17 - b. Other 11 3 68 13 13 Orthopaedic— a. Posture 32 - 41 - b. Feet 70 3 84 - c. Other 40 13 158 6 14 Nervous system- a. Epliepsy 12 4 16 1 b. Other 7 14 26 - 15 Psychological — a. Development 7 23 72 13 b. Stability 20 101 68 5 16 Abdomen 3 - 11 - 17 Other 51 3 238 17 90 APPENDIX 17 (continued) 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. 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 14,241 (ii) Total number of individual pupils found to be infested 79 (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 32 By parents 47 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. 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 560 Number of Re-inspections 777 Total 1,337 91 APPENDIX 18 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 8 Errors of refraction (including squint) 2,153 Total 2,161 Number of pupils for whom spectacles were prescribed 998 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 1 b. for adenoids and chronic tonsilitis 88 c. for other nose and throat conditions 6 Received other forms of treatment 167 Total 262 1 otal number of pupils in schools who are known to have been provided with hearing aids — a. In 1966 7 b. In previous years 65 TABLE C. - ORTHOPAEDIC AND POSTURAL DEFECTS Number known to have been treated a Pupils treated at clinics or out-patients departments 573 b. Pupils treated at school for postural defects 42 Total 615 92 APPENDIX 18 (continued) 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 — Scabies 1 Impetigo - Other skin diseases 170 Total 171 TABLE E. - CHILD GUIDANCE TREATMENT Number known to have been treated Pupils treated at Child Guidance Clinics 163 TABLE F. - SPEECH THERAPY Number known to have been treated Pupils treated by Speech Therapists 351 TABLE G. - OTHER TREATMENT GIVEN Number known to have been dealt with a. Pupils with minor ailments 308 b. Pupils who received convalescent treatment under School Health Service arrangements 23 c. Pupils who received B.C.G. vaccination 1,510 d. -Fuplis who attended the Enuresis Clinic 194 Total 2,035 93 APPENDIX 19 DENTAL INSPECTION AND TREATMENT Attendances and Treatment (a) Number of first visits 3,447 (b) Number of subsequent visits 8,837 (c) Number of total visits 12,284 (d) Number of additional courses of treatment commenced 999 (e) Number of fillings in permanent teeth 7,967 (f) Number of fillings in deciduous teeth 3,128 (g) Number of permanent teeth filled 6,908 (h) Number of deciduous teeth filled 2,673 (i) Number of permanent teeth extracted 365 (j) Number of deciduous teeth extracted 1,558 (k) Number of extractions under general anaesthetics 616 (i) Number of emergencies treated (m) Number of pupils x-rayed 306 (n) Number of pupils who received prophylaxis 1,176 (o) Number of teeth otherwise conserved 404 (p) Number of teeth root filled 26 (q) Number of inlays (') Number of crowns 29 (s) Number of courses of treatment completed 3,374 Orthodontics (a) Number of cases remaining from previous year 209 (b) Number of new cases commenced during year 132 (c) Number of cases completed during the year 84 (d) Number of cases discontinued during the year 18 (e) Number of removable appliances fitted 159 (f) Number of fixed appliances fitted 1 (g) Number of pupils referred to Hospital Consultants 6 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 12 Anaesthetics Number of General Anaesthetics administered by Dental Officers — 94 APPENDIX 19 (continued) Inspections (a) First inspection at school — Number of puplis 14,980 (b) First inspection at clinic — Number of pupils 3,064 Number of (a) and (b) found to require treatment 7,496 Number of (a) and (b) offered treatment 7,496 (c) Pupils re-inspected at school clinic 1,902 Number of (c) found to require treatment 1,247 Sessions (a) Number of sessions devoted to treatment 2,339 (b) Number of sessions devoted to inspection 114 (c) Number of sessions devoted to Dental Health Education 40 95 APPENDIX 20 SCHOOL HEALTH SERVICE: STAFF AND SCHOOL CLINICS (As at 31st December, 1966) 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 School Medical Officer A. Shaw, M.B., B.S., D.P.H. Principal School Dental Officer E. V. Haigh, L.D.S., R.C.S. Principal Medical Officer W. H. Toms, M.B., Ch.B.(Edin). 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 6 1.90 (iii) General Practitioners working parttime in the School Health Service 4 0.70 (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 4.63 (iii) Part-time School Health Service (including Orthodontists) 4 .82 (iv) Dental surgery assistants 8 7.44 (c) (i) Senior Speech Therapists - - (ii) Speech Therapists 4 3.55 (iii) Assistant Speech Therapists - - (d) (i) Audiometricians - - (ii) Chiropodists (5 Full time plus 7 Contractual) 12 .35 (iii) Orthopaedic Nurses - - (iv) Orthoptists - - (v) Physiotherapists 1 1 (vi) Remedial Gymnasts - - (vii) Occupational therapists 1 1 (viii) Clinical Technicians employed on Audiometry and vision screening 3 2 (e) (i) Nurses 48 9.19 (ii) No. included at (i) who hold Health Visitors' Certificates 37 - (iii) Nursing Assistants and 'Trainee 1 1 96 APPENDIX 20 (continued) 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 Boaro 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, 1966 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 5 - B. Asthma - — C. Audiology 1 1 D. Chiropody 4 - E. Dental 5 - F. Ear, Nose and Throat — 1 G. 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 8 - R. Sunray — - S. Vaccination and Immunisation 5 - T. Cerebral Palsy Unit - 1 MENTAL HEALTH 97 APPENDIX 20 (continued) IV. - CHILD GUIDANCE CLINICS (i) Number of Child Guidance Centres provided by the Authority — I. Staff Number employed Aggregate in terms by L.E.A. Under arrangements with Hospital Authorities of the equivalent number of whole-time officers (i) Psychiatrists — 2 .82 (ii) Educational Psychologists 2 2 (iii) Psychiatric Social Workers 4 4 (iv) Child Psycho- Therapists (Contractual) 2 - .41 98 APPENDIX 21 HANDICAPPED CHILDREN CATEGORY Number of children of school age 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 - - 1 1 - - - - - - - - - 2 Partially Sighted 11 - 2 - - - 1 - - - - - - 14 Deaf 8 2 — — — — 4 - — — - - - 14 Partially Deaf 14 1 1 - - - 4 - - - - - - 20 Delicate 4 - 1 1 - - 1 - - - - - - 7 Physically Handicapped 74 1 1 1 1 - 4 - - - - 1 - 83 E.S.N. 64 31 14 1 - - 5 - — — — - - 115 Maladjusted 3 — 19 16 2 - 12 — - - - - - 52 Epileptic - - — - — — - — - - - - - - Speech Defect - - - - - - - - - - - - - - Total 178 35 39 20 3 - 31 - - - - 1 - 307 99 MENTAL HEALTH SERVICE (by C.H.A. Wedeles, L.R.C.P., M.R.C.S., D.P.M.(Lond.) Principal Medical Officer). The growth of this Section during the year has been hampered by a variety of factors. Apart from the freeze and its inevitable consequences for expansion of staff and building, we lost the services of Dr. S.F. Meyer, our P.M.O., due to her departure to the U.S.A., regretted by all. We wish her well. I took over the post in October and hope that my psychoanalytic training and interest in the meeting-points of Social Work, Medicine and Education will enable me to make a useful contribution to the department. Recruitment of Staff Next, it has proved difficult to recruit suitably trained and experienced social workers, no doubt mainly due to the national shortage and the intense competition between Local Authorities. Integration of Mental Health Social Work Department with Hospitals However, the structure we have of a Combined Department serving both the Borough and the Psychiatric and General Hospitals should help, by and by, to attract people predominantly interested in Community services and schemes. All posts are to be re-designated as 'Mental Health Social Worker'not a particularly elegant appellation, but intended to indicate our intention to do away with unhelpful barriers of either status or function. We consider that all members of staff should have the widest possible experience of all tasks coming within the scope of the service, though specialisation according to talent and inclination will be desirable and fostered. Staff Mr. T. A. Hawley, A.A.P.S.W., was appointed in August to post of Chief Mental Health Social Worker, to be in charge of the Combined Social Work Department. Mrs. E. J. Thompson, who as 'Trainee P.S.W' had been seconded to the Mental Health Course at the L.S.E., rejoined us in September on the successful completion of her studies. Mr. H. G.Bartlett, M.W.O. attended the 5-month' course in Social Studies at the L.S.E. and obtained his diploma. In July, Mr. A. E. Kent joined our staff as an additional Mental Welfare Officer. Staff Training Policy Our policy will be to recruit trained, partly trained and untrained staff of suitable personality, and to second at all levels of training, in so far as this is compatible with maintaining reasonable services. For this purpose trainee posts should ideally be supernumerary to existing posts; this should, of course, include Training Centre Staff. 100 In 1967 we have planned to second to one- or two-year courses of up to two Mental Welfare Officers, two trainees at the Junior Training Centre and one at the Adult Training Centre. At present one trainee on our Junior Training Centre Staff is away on the full-time course at the Chiswlck Polytechnic. Vulnerable Sectors of the Population Every encouragement is given to our Staff to further their skills and experience by attending short courses, conferences, lectures, seminars and by visits to centres of enterprise and originality. We increasingly aim to improve the economy, efficiency and impact of the service by close co-operation in work and study, with doctors, Health Visitors, Welfare social workers, Child Care Officers and other statutory and voluntary workers, and intend to pay special attention to vulnerable sectors of the population e.g. young children, adolescence, the middle-aged and elderly etc. For this reason much thought is also given to the smooth functioning and adaption of the administrative side of the Mental Health and Welfare Services, in order to free fieldworkers as far as possible from office duties. We are in the process of re-organising our record-keeping and statistical systems; this is going hand-in-hand with the institution of a Central Register of cases for all Social Work Departments in order to improve co-ordination and help to eliminate wasteful overlap. Burnside Adult Training Centre We are looking forward to the opening, next Spring, of our first purpose built Training Centre, the Adult Training Centre in Burnside Road. Thought is now being given to its furnishing, staffing and to the improvement and expansion of the curriculum. The try-out at the previously exclusively male Adult Centre of six female trainees, under a female supervisor has been a great success and this will, no doubt, mean that the new Centre will be a fully co-education venture. Junior Training Centre The staff of our Junior Training Centre will, we hope, be encouraged by the start of building activities on their new Centre in Loxford Lane early in the New Year. Meanwhile, we do our best to assist them in their still very restricted circumstances and we are grateful for their patience and hard work. 101 Combined Day Centre for Mentally-Ill and Physically Handicapped Towards the end of the year, we obtained provisional agreement from the Ministry for planning a Combined Day-Centre for the rehabilitation of the physically-handicapped and the mentally ill and are engaged in the detailed working out of its design, staffing and programming. We are also studying, in conjunction with our local hospitals, the feasibility ot a hostel for psychiatric patients, and think that this is likely to become a definite plan in 1967. Social Clubs for Mentally 111 Thought is being given to ways of improving and expanding the functions of the two Social Clubs for mentally ill patients which have been run on a regular basis for some time; we hope to interest voluntary workers in giving us a hand with these. We are also endeavouring to find people with the interest and time to take part in founding and running a local branch of the National Association for Mental Health in Redbridge; such a body should be able to do much to improve the scope, pace and effectiveness of a variety of community-care projects. The existence and achievements of the Redbridge Society for Mentally handicapped Children should provide a most helpful stimulus in furthering such an undertaking. Case Conferences on Special School Leavers We have, this year, taken steps to improve the provision of support and advice to educationally subnormal and other special school-leavers by increasing the frequency of conferences and instituting a follow-up procedure; this task should become easier and also more productive when Redbridge children can attend local E.S.N. Classes in September, 1967. We have come to the conclusion that a substantial number of these schoolleavers will require further support for between five and ten years- this will make heavy but worthwhile demands on the Youth Employment and other social services. Creches for Mentally Handicapped Children Support and advice is also being given to mothers of mentally handicapped children attending two special creches in the Borough. This, like other provision for the pre-school child, and his mother, is likely to be increasing in demand, and of great preventive value. Long Term Planning As far as more long-range projects are concerned, the residential needs of the mentally handicapped, both short and long-stay, will soon have to be thought about, as well as provision of sheltered workshop facilities both for sub-normal and psychiatric patients; these two types of provision will probably have to be coupled in planning and construction. 102 Last but not least, we wish to record the steady interest and encouragement we have received from the Chairman and members of the Mental Health Sub-Committee and would like ta take this opportunity of expressing our gratitude to them. ENVIRONMENTAL HEALTH 103 APPENDIX 22 MENTAL HEALTH SERVICE STATISTICS ESTABLISHMENT (Officers) - as at 31.12.66. Mental Health Social Workers Junior Training Centre Adult Training Centre In post Vacant In post Vacant In post Vacant 8 3 10 - 10 - CASE LOADS OF MENTAL HEALTH SOCIAL WORKERS Ment. y 111 (a) New referrals 393 (b) Re-referrals 64 (c) Total number of visits made 1,657 (d) Average number of visits per Officer 276 (e) Average number of visits per case 3.6 (f) Number of cases on Register receiving Community Care 129 Mentally Sub-normal (a) Number on Register 344 (b) Total number of visits made 1,046 (c) Average number of visits per Officer 208 (d) Average number of visits per case 3 TRAINING CENTRES - AS AT 31.12.66. Junior Training Centre — (a) Total number on Register 69 (b) Average daily attendance 50.3 (c) Discharges and transfers out during year 12 (d) Number of out-Borough Trainees 11 Number of Redbridge Trainees in other Boroughs 33 Adult Training Centre — (a) Total number on Register 70 (b) Average daily attendance 57 (c) Discharges and transfers out during year 8 (d) Number of out-Borough Trainees 24 Number of Redbridge Trainees in other Boroughs 12 Number of cases afforded temporary care 31 Number of permanent hospital admissions of subnormals 14 Number of hospital admissions of mentally ill:— (a) Informal 108 (b) Compulsory 243 A party of 53 trainees from both Centres attended a holiday camp for one week. Each Centre arranged a coach outing during the year. 105 Water Supply ENVIRONMENTAL HEALTH by S. R. Daly, LL.M., B.Sc., D.P.A. (Lond.), Barrister-at-Law Chief Public Health Inspector. The water supply of the Borough of Redbridge is provided by two statutory undertakers, namely the Metropolitan Water Board and the South Esse* 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 Lee Bridge Works repumped at Woodford where some well water is also received from time to time from Ferry Lane Pumping Station. In addition, parts of the borough receive well water from Wanstead Pumping Station. During the year no new sources of supply were instituted. 1,191 samples were submitted to chemical and/or bacteriological examination. No fluoride was added, although there was a natural fluoride content of 0.20 milligrammes per litre in the River Lee derived water. The supply being hard in character is not liable to be plumbo-solvent. All new and repaired mains are disinfected with chlorine, after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control from the laboratories is carried out by means of daily sampling from sources of supply, through the treatment works or well stations, from the distribution system and through to the consumer. Any sign of contamination or other abnormality is immediately investigated. No houses were permanently supplied by standpipe, during 1966 and the total distance of supply mains laid in the Borough by the Board was 199 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 1966 over 8,152 chemical, bacteriological and biological examinations were made at the Company's Langham Laboratory and all water going into supply was reported as wholesome. In addition samples were examined for radioactivity. Samples from the wells situated in the Company's supply area were taken and analysed weekly and 106 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 1966:- 3 ins. 4 ins. 6 ins. Yards 263 191 125 No supplementary supplies of water were 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 4 samples of water during the year, 3 being from ihe South Essex Waterworks Company supply area and 1 from that of the Metropolitan Water Board district and both the chemical and bacteriological examinations gave satisfactory results. School Swimming Baths There are seven swimming baths in *maintained* schools in the Borough. Regular sampling of the water was carried out and a total of 24 samples, all of which were satisfactory, were obtained during 1966. 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 (13 from the indoor baths and 5 from the Open Air Pool) proved to be satisfactory. Mains water is used in all baths. Drainage and Sewerage As for last year the flooding of certain areas of the district was non-existent, because of the furtherance of the Council's main drainage scheme. The South Woodford Scheme (£457,000),the Monkhams Valley Scheme (£180,000) and that in Sunset Avenue (£26,000) have now been completed. There is no doubt that flooding will be further alleviated by the 107 carrying out of works in a further 11 areas, information regarding which can be found in the following table, particulars of which have been kindly supplied by the Borough Surveyor:— 1. Extension of Eastern Sewage Works Stage III £350,000 2. Toms wood Hill, Forest Road soil and surface water scheme £285,000 3. Green Lane, Goodmayes Lane, Trenance dens surface water scheme £55,000 4. Green Lane, Hazeldene Road surface water scheme £42,500 5. Seven Kings Water Stage II £368,000 6. Hainault surface water scheme to Tudor Crescent £58,000 7. Eastern Avenue, Aldborough Road to Seven Kings Water £53,500 8. Wynn Valley surface water scheme £295,000 9. St. Barnabas Road screening chamber and syphon to Eastern Sewage Works £61,000 10. Culvert — Eagle Pond £6,200 11. Chig well Road — re-laying sewer £89,000 Insofar as complaints of choked drains are concerned, the two drainage officers operating in the Wanstead and Woodford and Ilford areas 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. Further complaints have been received regarding pollution of streams and lakes within the Borough generally the pollution being by oil, due mainly to the parking, not only of private motor cars but also of commercial vehicles, in the roadways together with the carrying out of repairs thereto on the highways, resulting in a great deal of oil gaining access to surface water sewers thereby causing pollution of the lakes within the district particularly at Goodmayes, Cranbrook and South Park. Special efforts have been made to trace the more serious contaminations. 108 Refuse Disposal The collection and disposal of refuse which is under the control of the Borough Surveyor, has increased, the 1965 figure being 77,972 tons; that for 1966 amounted to 80,087 tons. Waste paper salvaged amounted to 2,340 tons having a value of £19,173. Rags, woollens, carpets, scrap metal and tyres contributed to the income of the Borough in that 128 tons of these commodities were collected and disposed of affording an income of £2.038. Sanitary Inspection of the Area Work in this field was of a high standard, despite understaffing of the inspectorate. Visits were more frequent and resulted in many improvements in general housing conditions. 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 23,343 Houses and premises reinspected (work in progress) 24,878 Houses in which nuisances were detected 2,815 Houses in which nuisances were abated *2,674 Premises disinfected Articles disinfected 344 Premises disinfested for verminous conditions 35 *Includes 131 nuisances detected before 1st January, 1966. Notices served:— Served Complied with Statutory:— Public Health Act, 1936 163 88 Clean Air Act, 1956 — - Housing Acts, 1957 and 1961 4 - Factories Act, 1961 1 - Food and Drugs Act, 1955 2 - Prevention of Damage by Pests Act, 1949 2 1 Informal 883 485 1,055 574 109 In addition to the above, 169 notices (12 statutory and 157 informal) served previous to 1st January, 1966 were also complied with. 3,152 complaints of nuisances were received and investigated by the Inspectors, as follows:— Accumulation of manure and refuse 50 Animals improperly kept 4 Bad Smells 38 Dampness of premises 62 Defective drains, W.C.'s and fittings 901 Defective roofs, gutters, downpipes, etc 91 Defective water fittings 19 Dirty and verminous houses 19 Dirty condition of rearway 15 Flooding of premises 23 Overcrowding 27 Smoke Nuisances 73 Noise Nuisances 32 Defective or no provision of dustbin 101 Rats and mice 850 Miscellaneous 847 3,152 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. There are 13 premises at present on the register and one establishment has been licensed for the manufacture of those commodities as required by this Act. 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. Eight samples of filling materials were obtained and submitted to the analyst during 1966. All proved to be satisfactory. 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. Utter Act 1958 5,826 enquiries were so dealt with during 1966. This Act is in part administered by the Public Health 110 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 make reference to the authority as do the Inspectors, and the Town Clerk on the instructions of the council institutes proceedings. Some 127 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. Noise Abatement Act, 1960 32 complaints regarding noise nuisances were received in 1966. In 17 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 8 instances an informal representation to the person having control of the causative agent secured amelioration of the complaint. Six informal notices and one statutory notice were served. A series of complaints which persisted regarding a timber yard 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 which are being seriously considered. Establishments for Massage & 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 annually and 1 new application for a licence was approved by the Council, and 34 licences were renewed during 1966. 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 of the Public Health Act, 1961 which were approved by the Central Department in November 1965 and became operative on 1st March, 1966. 58 inspections were made during the year 1966. 111 Home Laundry Service Another important and valuable service provided by 'he Borough is the service provided under Section 84 of the Public Health Act, 1936, which enables the local authority to cleanse, at their own 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 regarding its filthy condition. During 1966, 98 persons were assisted and 10,566 articles were laundered. Fertilizers and Feeding Stuffs Act, 1926 The Fertilizers and Feeding Stuffs Act, 1926 requires the satisfactory labelling or notification of the chemical constituents of 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 eight samples (6 of fertilizers and 2 of feeding stuffs) during the review year. In the case of one sample of fertilizer the nitrogen content was 0.10 per cent in excess of the prescribed limit of variation and the vendors attention was drawn to this. Factories and Workshops The local authority is clothed with powers to supervise the sanitary circumstances obtaining in factories and workshops but only in relation to the provision of suitable, sufficient and satisfactory sanitary conveniences; separate for the use of, 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 circumstances under which outwork is performed in domestic dwellings, particularly with a view of preventing the spread of infectious diseases. Various commodities are issued to women generally for adapting which work would be uneconomical to carry out in factories, especially appendages to clothing such as belts, fasteners, buckles etc. which afford an opportunity to augment the family income where the housewife is prevented from working in, or unable to attend at the factory. Twice yearly inspections are made and in general the conditions were found to be very good in the 162 premises under supervision. Details of the administration of the Act are contained in Appendix 23. 112 Offices, Shops and Railway Premises Act, 1983 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 the district Inspectors in general. There were 25 additional premises registered during the year making the total 2,487. They comprised 569 offices, 1,696 retail shops, 55 wholesale shops and warehouses, 167 premises ill which food is supplied to the public and 10 fuel storage depots. The figure of persons employed in registered premises was 19,561 comprising 8,736 males and 10,825 females. The Inspectors paid 1,591 visits to registered premises. One application which was granted was received for exemption from the provisions of Section 9 (sanitary conveniences) and two for exemption from the provision of washing facilities under Section 10 which were refused. In addition, three applications were received for extentions of exemptions already granted from the provisions of Sections 9 and 10. In one case an extension of exemption from the provisions of Section 9 was granted but the other applications were refused. Housing The administration of the provisions of the various Housing Acts was continued. Insofar as overcrowding is concerned, two statutory notices and two informal notices were served requiring abatement in 1966 and one area was declared by the Council to be a clearance area 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 sum clearance programmes but also those who are in urgent need of housing accommodation. Various figures in relation to 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 24. 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 113 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 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 157 in 1966 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. The continued use of land within the Borough by itinerants occupying an assortment of caravans both mechanically and horse propelled, principally the former provided a recurring problem. These so called "gypsies" occupied various sites within the Borough and still do, necessitating many visits by the Public Health Inspectors to ensure that the sanitary circumstances arising from the occupation of these sites are 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 themselves to other sites and in many cases lodge 114 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, bat where the land is in public ownership, controlled by a Central Government Department which is unwilling to take any steps whatsoever to prevent nuisances being created on land under their jurisdiction, 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, immediately 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. 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 which must be in accordance with their own particular standards of living. It is freely acknowledged that these people have a right to live a reasonable life but the obligations to provide them with the right to live freely as they wish should not fall upon any particular local authority to which they make no rate contribution but rather on the central government which should provide national sites at suitable points and subject to strict control by both Police and Public Health Officers. A reasonable charge should also be made on those persons using the accommodation. I he prevention of serious nuisances would be ensured by careful supervision and the provision of suitable sanitary amenities regulated by the local authorities. Housing Repairs and Rents Acts, 1954 and 1957. Rent and 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 1965, there being only six applications received all o( which were granted. Four undertakings were received from landlords to carry out specific repairs. No Certificates of Disrepair were issued and two Certificates of Disrepair were cancelled during the year. 115 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. 202 persons are 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 is actually produced which are subject to control by the Ministry of Agriculture, Fisheries and Food, are also registered. The number of inspections of dairy premises made during the year amounted to 47. Furthermore, under the Milk (Special Designation) Regulations, 1963 and the Milk (Special Designation) (Amendment) Regulations, 1965, dealers licences (which currently operate for the five-year period ending 31.12.70) were issued in relation to pre-packed milk as follows:— Pasteurised 14 Sterilised 11 Ultra Heat Treated 23 At the end of the year the following licences were in operation:— Pasteuriser's 1 Steriliser's 1 Pasteurised (dealers) 134 Sterilised (dealers) 123 Untreated (dealers) 33 Ultra Heat Treated (dealers) 27 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. Milk supplies, including supplies to maintained schools were regularly sampled during the year. A total of 43 Pasteurised and 3 Sterilised milk samples were taken. All proved to be satisfactory apart from 2 Pasteurised samples which failed the Methylene Blue Reduction Test. In those instances the retailers were communicated with. 116 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 eleven 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 eleven retailers complained of when fines totalling £28 with the addition of £15.8s.0d. costs were imposed by the Court on the proven offenders. Ice Cream Duties relating to the registration of premises used for the manufacture, storage and sale of ice cream were carried out under Section 16 of the Food and Drugs Act, 1955. During the year five new applications for registration were considered and all were granted. At the end of the year there were 619 premises on the register. 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 1966 6 samples were submitted for examination with the following results:— No. of Samples Ministry of Health Provisional Grade % of Total Unsatifactory Samples 4 I 66 - - II — - 1 III 17 1 1 IV 17 1 6 100 2 The two unsatisfactory samples failed the Methylene Blue Reduction test. 117 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 staff, barrow, vehicle, etc. Meat and Other Foods Continuous supervision and inspection of the food supply of the district was carried out by the Inspectors during the year. 3,314 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 Hygiene (General) Regulations, 1960, were discovered. In two instances the necessary works to remedy the unsatisfactory conditions were carried out, in two instances the businesses closed down, and in the other instance which related to exposing food to contamination legal proceedings were taken and the offender was fined £5 on each of two summonses, plus £5.5s.0d. costs. In addition, 64 informal notices and 2 statutory notices were served under the Food and Drugs Act, 1955; 36 informal notices were complied with including informal notices served prior to 1966. The following information gives the numbers of food premises in the area with details of compliance with the Food Hygiene (General) Regulations, 1960:— Type of Business Total number of premises No. of premises fitted to comply with Regulation 16 No. of premises to which Regulation 19 applies No. of premises fitted to comply with Regulation 19 Cafes and Restaurants 212 209 212 211 Factory Canteens 47 47 47 47 Butchers' Shops 146 132 146 142 Grocers' Shops 306 293 306 299 Fruiterers' and Greengrocers' Shops 144 - - - Fishmongers' and Fishfryers' Shops 61 61 61 60 Bakehouses 20 19 20 19 Bakers' Shops 50 50 50 50 Confectioners' Shops 255 - - - 1,241 811 842 828 118 Foods, Fitness and Consumer Protection Further protection is afforded 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. 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 25. 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. 61 such complaints were received in 1966. Letters of warning were sent in 9 cases and legal proceedings taken in 22 cases and fines totalling £118.0s.Od. plus £89.8s.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 119 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 26 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 test to be satisfied (the alpha-amylase test) are prescribed in the Regulations. There are no egg pasteurisation plants in the Borough but during 1966, seven samples of liquid egg were obtained and submitted to the alpha-amylase test. Two samples failed the test, but subsequent re-sampling gave satisfactory results. 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 114 persons are at present on the register and their premises are regularly supervised. Two new registrations were granted during 1966. 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 1966, one new registration was granted making a total of 317 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 snch commodities 120 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 179 applications for renewal of entry on the Statutory register, whilst annlications for registration of 27 new names were investigated. Not one of these was refused. A total of 328 visits elicited the fact that all premises were satisfactory and the Act and Rules conformed to. 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 one instance the movement of pigs into the borough by licence has been made. Diseases of Animals (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 19 such establishments licensed in the Borough and all have been found to be well administered. Animal Guarding 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 121 dance and the keeping of records of animal movements. Daring the year, periodic inspections were carried out to prove that the Act was well observed by occupiers of the three licensed premises. 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 licensing authorities to control stables where horses etc. are let or hired for riding. The licensing provisions are imilar 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. There are 3 licensed establishments in the Borough. Rats 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 27. 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. 122 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 a dapted 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 Dorough 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 Uainault) 1.7.1963. No. 3 (South Uainault) 1.7.1963. No. 4 (South Uainault) 1.10.1963. No. 5 (South Hainault) 1.6.1964. No. 6 (South Uainault and Good- mayes) 1.8.1965. No. 7 (North Uainault) 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 Hedbridge No. 8 (Uainault) 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 28. Complaints were received during 1966 of alleged smoke nuisance in 22 instances from factories and other premises in various parts of the Borough. In 5 instances no emission was noted which would have enabled action to be taken under the Public Health Act, 1936, or Clean Air Act, 1956. Three letters of warning were sent and in all other cases verbal intimations and advice were given. Five stations for measurement of atmospheric pollutionhave been installed in the Borough as follows:— 123 No. 1 — Gantahill Library, Cranbrook Road, Ilford. No, 2 — John Bramaton School, Newcastle Avenue,Hainault, No. 3 — 17/23, Cleraenta Road, Ilford, No. 4 — Croft Lodge Cloae, Snakes Lane, Woodford. No. 5 — Oak Hall Court, Wanstead. Each atation has a volumetric apparatua and the two latter stations are selected sites in connection with a National Survey of Air Pollution being conduoted by the Department of Scientific and Industrial Research. 124 APPENDIX 23 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 (1) Number on Register (2) Number of Inspections (3) Written notices (4) Occupiers prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 151 33 1 - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authorities 659 302 8 - (iii) Other premises in which Section 7 is en forced by the Local Authority (excluding out-workers' premises) 30 45 - - Total 840 380 9 - 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 (1) Number of cases in which defects were found Number of cases in which prosecutions were instituted (6) Found (2) Remedied (3) Referred To H.M. Inspector (4) By H.M. Inspector (5) Want of cleanliness (S.l) - - - - - Overcrowding (S.2) - - - - - Unreasonable temperature(S.3) 1 — — — — Inadequate ventilation (S.4) 1 - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniehces (S.7) (a) Insufficient - 1 - - - (b) Unsuitable or defective 9 9 - 6 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Out-work) - - - - - Total 11 10 - 6 - 125 APPENDIX 23 (continued) PART VIII OF THE ACT OUTWORK (Sections 133 and 134) Nature of Work (1) Section 133 Section 134 No. of out-workers in August list required by Section 133(1) (c) (2) No. of cases of default in sending lists to the Council (3) No. of prosecutions for failure to supply lists (4) No. of instances of work in unwholesome premises (5) Notices served (6) Prosecutions (7) Wearing apparel— Making etc. 115 - - - - - Cosaques, Christmas stockings, etc. 60 - - - - - Making of cardboard boxes 18 - - - - - Total 193 - - - - - 126 APPENDIX 24 HOUSING STATISTICS 1. Inspection of dwelling-houses during 1966. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,944 (b) Number of inspections made for the purpose 10,736 (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 - (b) Number of inspections made for the purpose - (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 40 (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 439 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 Audiority or their officers 333* 3. Action under Statutory Powers during the year:— A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1957. (1) Number of dwelling-houses in respect of which notices were served requiring repairs - (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners (b) By local authority in default of owners - B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 141 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 65* (b) By local authority in default of owners - 127 APPENDIX 24 (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 12 (2) Number of dwelling-houses closed in pursuance of an undertaking given by the owners and still in force 1 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 35½ (b) Number of new cases of overcrowding reported during the year 2 (c) (i) Number of cases of overcrowding relieved during the year 2 (ii) Number of units concerned in such cases 6 (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 1966 of Notices served prior to 1st January, 1966. 128 APPENDIX 25 Items of Food surrendered and condemned as being unfit for the food of man, during 1966 Description Quantity Bacon 501 lbs. Beverages 119 tins Biscuits 205 lbs. Butter 70 lbs. Cereals 491 lbs. Cheese 200 lbs. Cream 104 tins Eggs (Shell) 7 gross Fish (Wet & Dry) 520 stones " (Tinned) 600 tins " (Cakes) 14 cakes " (Paste) 7 jars Flour 203 lbs. Fruit (Tinned) 10,420 tins " (Juices) 79 tins Game 115 lbs. Ice Cream 4 bricks. Jam (Preserves) l97 lbs. Jellies 35 Lard 57 lbs. Meat (Fresh) 7 tons, 8 cwts. 1 stone " (Tinned) 1 ton. 4 cwts. " (Pies) 35 pies Margarine 71 lbs. Milk (Tinned) 900 tins Pastry (Mix) 7 packets Pickles 127 jars Poultry 414 lbs. Salt 20 lbs. Sausages 114 lbs. Sausage Rolls 75 rolls Sugar 318 lbs. Soups (Tinned) 2,120 tins Tea 190 lbs. Tomatoes 14 lbs. Vegetables (Dried) 113 lbs. " (Tinned) 2,010 tins Vinegar 2 bottles 129 APPENDIX 28 FOOD AND DRUGS ACT 1955 List of samples obtained and action taken regarding unsatisfactory samples in 1966 Description Formal Informal Description Formal Informal Brought forward 27 37 Aspic Jelly - 1 Corned Beef - 5 Ackees 1 - Dressed Crab — 1 Aqualclene - 1 Dairy Topping - 1 Almond Marzipan 1 — Denebrook block 1 — Ale, mild 1 — Demi Sel — 1 Blackcurrant Health Drink — 1 Desiccated Coconut 1 — Bread - 8 Dream Topping 1 — Biscuits - 3 Dried flaked onions 1 - Baking powder - 1 Drinking Chocolate 1 — Beef suet - 1 Dripping — 1 Bitter Lemon drink 2 - Elderflowers & Peppermint 1 — Butter 1 1 Entero Vioform — 1 Bitter Beer 1 — Farlene — 1 Baby Cham 1 — Fruit Cocktail - 1 Beef & 4 vegetables 1 — Flour, Self-raising — 1 Beef Chop Suey — 1 Froment 1 — Butter Puff 1 - French dressing — 1 Beer, mild 1 - French Mustard 1 — Brandy 3 — Fynnon Salts - 1 Cake - 2 Fruit Salad 1 1 Cheese Sauce - 1 Grape Preserve - 1 Crescent Roll - 1 Grape Fruit Juice 1 - Crisp Bread - 2 Ground Almonds - 1 Cheese Spread - 1 Ground White Pepper - 1 Chi can 1 - Ground Cloves - 1 Chicken Curry - 1 Gin 6 - Chicken Supreme 1 — Ginger Wine 1 — Chocolate Poudre - 1 Ginger Beer - 1 Chow Mein 1 - Gravy colouring - 1 Cooking Oil 1 1 Ground Beans 1 - Cornflour - 1 Glycerine of Thymol 1 - Creamed Rice 1 1 Glucose 1 - Custard Powder 1 1 Ham Roll - 1 Champignons 1 _ Hamburgers 1 - Chestnut spread 2 - Haggis 1 — Chocolate Liqueurs - 4 Honey — 1 Com Oil 1 - Hot Dog Sausages 1 - Coffee & Chicory essence - 1 Ice Cream - 5 Cola & Rum 1 - Ice Lolly — 2 Cream Slices 1 - Irish Stew 1 — Cream Meringues 1 - Jam 1 2 Cream of Magnesia - 1 Jelly 1 1 Carried forward 27 37 Carried forward 53 71 130 APPENDIX 25 (continued) Description Formal Informal Description Formal Informal Brought forward 53 71 Brought forward 85 103 Junior Beef Dinner 1 — Sauerkraut — 1 Jaffa Juice 1 — Sweets 4 6 Jam doughnut - 1 Sage & Onion Stuffing 1 - Juniper Pills 1 - Salad Cream - 1 Kipper fillets 1 2 Sausages, Beef 4 - Kobli Charna 1 — Sausages, Pork 2 - J.emonade Shandy - 1 Sea food dressing - 1 Lime Cordial & Lager — 1 Slim Disks - 1 Liver Sausages - 1 Slimbix - 1 Limmits Milk Chocolate - 1 Slym bread — 1 Margarine 1 1 Spam spread — 1 Meringue - 1 Special K. - 1 Minced Beef - 1 Sponge drops - 1 Mashed Potato Instant 1 1 Starch reduced Slices - 1 Melbroton 1 - Syrup of Figs 1 - Mayonnaise 1 - Smoked Cheese & Ham 1 - Mushroom Ketchup 1 - Smoked Cods Roe - 1 Mustard Pickle - 1 Soup - 1 Menthol B.P.C. 1 — Sparkling Spring 1 - Mini Sax. 1 - Sweet Soupari 1 - Meat Pie - 1 Screen Travel Sickness Tablets - 1 Milk 6 3 New Potatoes (Tinned) 1 - Setlers — 1 Orange Juice - 1 Solzets — 1 Orange Drink 1 2 Stero Tablets — 1 Ostermilk Two - 1 Salad Cream 1 1 Paste - 1 Sultanas 1 - Potted Beef with Butter - 1 Tea - 3 Paprika - 1 Tomato Juice 1 - Pie filling - 2 Tomato Puree - 1 Pear drax - 1 Tonic Water 1 - Paella - 1 Top of Milk 1 - Prawn Ballichong 1 - Travellettes - 6 Quick Jel - 1 Vinegar 2 — Ratafia - 1 Vodka 4 - Russian dressing - 1 Vegetable Oil 1 - Rum 10 - Vit O. Pep 1 - Red Wine Vinegar 1 1 Wheat Flakes - 1 Rye King - 1 Whisky 10 - Carried forward 85 103 Total 123 137 131 APPENDIX 26 (continued) UNSATISFACTORY SAMPLES Large wholemeal loaf (informal). - Contained mass of woven fabric. Legal proceedings were taken and the bakers were fined £3, plus £5.5s.Od. costs. Crescent roll (informal). - Contained one arm of large hairpin. Legal proceedings were taken and the bakers were fined £5, plus £5.0s.0d. costs. Slimcea bread (informal). — Contained part of winged insect of nature of house fly. Legal proceedings were taken and the bakers were fined £5, plus £5.5s.Od. costs. Starch reduced crispbread (informal). — Claimed to aid slimming but no statement to comply with Bread and Flour Regulations, 1063, that to do so must form part of controlled diet. Letter sent to manufacturers. Sliced bread (informal). — Contained 4" long nail file sandwiched between two slices. A letter of warning was sent to the bakers concerned. Slices of bread (informal). — Contained large steel nut. Legal proceedings were taken and the bakers were fined £5, plus £3 costs. Milk bottle (informal). — Contained mass of leaf tissue and mould growth. A letter of w&rning was sent to the dairy firm. Ham roll (informal). — Contained rodent excreta. Legal proceedings were taken and the baker was fined £5, plus £3 costs. Sausages, beef (formal). — Contained preservative, but no declaration made to this effect. A letter of warning was sent to the retailer. Sausages, pork (formal). — Contained preservative but no declaration made to this effect. A letter of warning was sent to the retailer. Blackcurrent Eclairs (informal). — Contained Vitamin C, as claimed, but amount per ounce not stated as required by Labelling of Food Order. Manufacturers subsequently modified label. Gin (formal). — Contained only 67.9 per cent proof spirit instead of 70 per cent stated on lebel. A letter of warning was sent. Slymbread (informal). — Claimed to aid slimming but no statement to comply with Bread and Flour Regulations 1963, that to do so must form part of a controlled diet. Letter sent to manufacturers. Starch Reduced Wheat Flakes (informal). — Claimed to aid slimming but no statement to comply with Bread and Flour Regulations 1963, that to do so must form part of a controlled diet. Letter sent to manufacturers. Milk (informal). — Contained mould growth. Legal proceedings were taken and the Dairy firm was fined £5, plus £3.3s,0d. costs. 132 APPENDIX 26 (continued) Uncut loaf (informal). — Contained insect. Legal proceedings were taken and the bakers were fined £5, plus £3.3s.0d. costs. Loaf of bread (informal). — Contained piece of metal. Legal proceedings were taken and the bakers were fined £5 pins £3.3s.0d. costs. Hamburgers (formal). — Contained only 59 per cent meat. A letter of warning was sent to the butcher concerned. Cola and Rum (formal). — Proportion of rum low (Alcohol (proof spirit) 1.5 per cent) Representations to manufacturers as a result of which more appropriate labels are to be used in future. Ostermilk Two (informal). — Had poor solubility which resulted in considerable separation in the reconstituted milk. A letter was sent to the manufacturers. Bread (informal). — Contained blackish foreign matter found to be piece of dried fruit. No action taken. Biscuit (informal). — Contained rubber composition. Legal proceedings against manufacturers pending. Meat pie (informal). — Contained tuft of black hair of bovine origin. Legal proceedings were taken against the manufacturers who were fined £5 plus 12 costs. Jam Doughnut (informal). — Contained stub of small cigar and miscellaneous vegetable fibre and silicious matter or sand. Legal proceedings were taken and the retailer was fined £6 plus £5.5s.0d. costs. Dripping (informal). — Contained fragments of fly. Legal proceedings were taken and the manufacturers were fined £2, plus £2 costs. Corned beef (informal). — Some slight black staining with some evidence of rusting in opened can, but meat satisfactorily free from metallic contamination. No action. 133 APPENDIX 27 Prevention of Damage by Pests Act 1949 Type of Property NonAgricultural Agricultural 1. Number of Properties in district 89,588 29 2. (a) Total number of properties (including nearby premises) inspected following notification 1,598 2 (b) Number infested by (i) Rats 928 1 (ii) Mice 294 - 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification - - (b) Number infested by (i) Rats — - (ii) Mice — — 134 WELFARE 135 THE WELFARE SERVICES (by R. W. Hall, A.I.S.W., Chief Welfare Officer) Following upon last year's report which served as something of an introduction to the new Borough Welfare Service and a description of the services available, this Report for the year ending 31st December, 1966 will be an attempt to describe the developments during the year together with a look at the main problems encountered and possibly to look at future activities. The year under review was one in which the economic situation of the country was headlined almost every day and the National economic difficulties were reflected in the need to restrain local expenditure. At the same time the welfare service became better known locally and the demands upon the service were accordingly heavier. This is evident by the increase in the number of registered physically handicapped persons, the increase in the number of elderly persons on the waiting list for accommodation in the homes and the number of enquiries received daily. To meet this demand with very limited increases in Staff meant there must be improvement in the productivity of each member of staff and this was achieved due to considerable effort by the Staff concerned. Very little improvement in this direction can be anticipated in the future and further increases in productivity will mainly have to come from increased staff. Social Case Work The social case work team comprises, one senior social welfare officer, twelve social welfare officers and one trainee social worker. These staff operate in districts and have mixed case loads with each case load biased in content to allow for the individual social welfare officers special skill, experience and preference. On this basis, there are two Officers mainly engaged on work with the elderly, two involved in family case work, four social welfare officers for the blind, and four officers working with the physically handicapped. Two officers are involved in the welfare of deaf persons in addition to their other work. During the year we reviewed the areas worked by the social welfare officers in order to introduce mixed case loads and to adjust case loads to achieve so 'ar as possible, a reasonable balance of work between officers. A further review of districts and case loads will have to be undertaken but this will not obviate the present situation in which social welfare officers' case loads are much too high for them to carry out their work effectively. Services for the Elderly A number of schemes came to fruition during 1966 providing additional facilities for l.he elderly. The major additions are those set out below:— 136 Fullwell Cross Day Centre for the Elderly This Centre was opened on the 10th January, 1967 for the use of those elderly living in the district and was an immediate success. At the Centre, not only can elderly citizens enjoy a chat with their friends in warm and comfortable surroundings or play darts, cards, shove ha'penny etc. hut a cup of tea, and biscuits can be obtained and for those desiring a mid-day meal, this is available at a cost of 2/-d. Approximately 40 mid-day meals are served daily Monday to Friday and some expansion of the number of meals served is anticipated. It is also planned to use the kitchen of the Centre for the expansion of the Meals on Wheels Service to the Ilainault area and at the end of the year consideration was being given to the need to provide transport for the conveyance of the more infirm elderly to the Day Centre. Hyleford Home for the Elderly This new home built to accommodate 60 elderly persons was handed over by the builders on the 5th December, 1966. Following this date when Mr. and Mrs. Trigg took up their appointment as Superintendent and Matron, the building had to be thoroughly cleaned, furniture delivered and placed in the various rooms and Staff introduced to their new duties. Owing to this work, the need for some minor building work and other problems which arose, it was the 25th January 1967 before the first resident could be admitted. Holidays for the'Elderly The planned holiday for the elderly arranged for May and September proved to be a great success and literally hundreds of letters of appreciation were received from those people who had participated. The holiday held at Corton Beach Holiday Camp, Near Lowestoft, was blessed with reasonably good weather and many new friendships were formed, old acquaintances renewed and many old people who had been leading rather isolated lives, were able to find their way back into the community. There were lots of old people who said that they felt much better in health after the week at the seaside and certainly staff who made these arrangements, many of them giving up their private time on the Saturdays before and at the end of the holidays, were well rewarded for their efforts. Homes for the Elderly — During this period, the Welfare Committee have felt increasingly concerned at the number of elderly mentally infirm old people accommodated in our homes for the elderly and the strain that their care placed upon the staff, and consideration is being given to the ways in which this increasing problem with all its difficulties, can be met. Some staff difficulties have continued to be met at the homes, particularly the shortage of experienced cooks but there was some easing of the situation and a greater availability of labour, possibly due to the impact of the Selective Employment Tax. In spite of the increased accommodation available, the number of old people on the waiting 137 list (or admission to homes increased (rom 213 to 229, and the need (or additional accommodation is becoming increasingly urgent. Day Centres (or the Elderly — The Day Centre at Scra(ton Road continued to be well patronised and the new Centre which we opened in January 1966 the Congregational Church in Broomhill Road, has slowly increased in popularity and is much appreciated by the old people who use it. Services (or the Physically Handicapped — There has been a considerable increase in the number o( physically handicapped persons registered by the Council. At the beginning of the year 679 were registered and at the end the number was 793. Persons are registered as physically handicapped when they are considered by the Authority to be substantially and permanently handicapped by illness, injury or congenital de(ormity. The increase in the number of persons registered, demonstrates the advantage of having a local weHare service known and used by the community. It is hoped that all handicapped persons will eventually become known to the Department to enable us to assist them to lead as normal a life as their handicap will permit. With all the physically handicapped persons now known to us as being resident in the Borough, the need for a new Occupational Centre is becoming more and more urgent and towards the end of the year, work was commenced on the planning of a combined Centre for the physically handicapped and the mentally ill at Fullwell Cross. The Occupational Centre at Fellowship House continued to take approximately 30 handicapped people daily and whilst the facilities there are limited, people who do attend seem to benefit (rom the social contacts they make together with the handicra(t work which is undertaken. Welfare Services for the Blind — These long established services have continued to function with very little change in the pattern of service or in the numbers of registered blind persons. Nevertheless consistent work is undertaken by Social Welfare Officers for the blind with regular visits and the teaching of Braille, Moon and handicrafts and whilst there is no room for complacency in any of the services, it is felt that this section of the handicapped persons in the community are receiving adquate services. The Welfare Committee decided during the year that they would meet the rental of talking book machines (or blind persons in the area (rom the 1st April, 1967 instead of meeting only part of the cost through the Essex County Association for the Blind. Services for the Homeless — In June 1966 the first family was admitted to 'he Council's new Temporary Accommodation Unit in Grosvenor Road, Ilford. This accommodation which comprises ten main living rooms plus communal 138 kitchens, food preparation rooms, laundry etc., provides accommodation for five/six families and is much superior to the Temporary Accommodation at Suttons Hostel, Hornchurch which was the only accommodation available to the Council previously. In these new surroundings, families can be given a sense of dignity and of belonging to the community and when necessary social workers spend much time with them, helping them to learn to manage their own affairs. Relationships with Voluntary Organisations — There has been a steady build up in good relationships between the statutory welfare service and the voluntary services and perhaps this is one of the most pleasing sides of the Department's work during the year. We believe that only by a true and full partnership with the voluntary organisations can we establish a truly comprehensive welfare service in Redbridge and slowly during the year the two sides have drawn closer together, There has also been signs of closer co-operation between the different organisations and between different parts of the Dorough and the Council is helping where possible to improve this co-operation and co-ordination. As stated at the beginning, work could not have been carried out without the extra effort of all the members of staff including social workers, administrators, clerks, Superintendents and Matrons, cleaners and other members of the staff of the homes or Centres and I am grateful to them for their sustained effort. Good working relationships have been established with colleagues in other Departments and their assistance has always been forthcoming in good measure. My thanks are also due to Dr. Gordon, Medical Officer of Health and his Deputy, Dr. Shaw for their invaluable assistance and support during the year. Finally I would wish to thank the Chairman and members of the Welfare Committee for their continued courtesy and kindness shown to me and their active interest and support for the work of the service. 139 APPENDIX 29 LIST OF PREMISES (Local Authority) Homes for the Elderly Address No. of Occupants Superintendent/Matron Heath Gate Chadwell Heath Lane, Chadwell Heath, Romford. 60 Mr. and Mrs. Luckett Hyleford South Park Drive, Entrance from Loxford Lane, Seven Kings, Ilford. 60 Mr. and Mrs. Trigg Pegram House Longhayes Avenue, Marks Gate, Romford. 50 Mr. and Mrs. Hockley Rose Park Heathcote Avenue, Clayhall, Ilford. 60 Mr. and Mrs. Church Woodside 162 High Road, Woodford Wells. 15 Mrs. Bond Admissions to Homes (including "The Willows", joint-user establishment within the London Borough of Havering): For the Period 1.1.66 to 31.12.66 Permanent Admissions 117 Short stay Admissions 64 Permanent Admissions (The Willows) 17 Short stay Admissions (The Willows) 3 Total 201 No. on Register Occupational Centre as at 31.12.66 Supervisor fellowship House, Green Lane, 67 Mrs. Low Ilford. Day Centres (Local Authority) Name Address Scrafton Road Day Centre Scrafton Road, Ilford. Goodmayes Day Centre Broomhill Avenue, Goodmayes. Fullwell Cross Day Centre Fullwell Cross, Fairlop. 140 APPENDIX 29 (continued) Day Centre (Voluntary) Grove Park 2 Grove Park, Wanstead. (Managed by Wanstead and Woodford Old People's Welfare Association) List of Homes (Private) Name Address No. of Occupants (Male & Female) Telephone No. Homesdale 7 New Wanstead, E.U. 16 females WAN 0847 29 The Avenue, Wanstead, E.l 1. 22 males and females (blind) WAN 6349 24 Glengall Road, Woodford Green. 8 males and females (handicapped persons) IVA 0408 6 Snakes Lane, Woodford Green. 10 males and females (handicapped persons) BUC 0448 Osmont 8 Grove Park Wanstead, E.ll. 28 females WAN 4955 Arden House 40 Emerson Road, Ilford, 20 males and females VAL 6198 Belmont 66 Derby Road, south Woodford, E.18, 15 females BUC 5712 106 Aldborough Road, Seven Kings. 7 females SEV 3164 29/31 Valentines Road, Ilford. 24 males and females VAL 2287 Arlington 12 Snakes Lane, Woodford Green. 18 females BUC 1970 141 APPENDIX 30 Persons in Care As at 31.12.66 Borough Homes 179 Ont-Borough Homes 176 Voluntary Homes 100 Total 455 APPENDIX 31 1. Voluntary Organisations to which grants are paid. Redbridge Council of Social Service. Redbridge Old People's Welfare Committee. Wanstead and Woodford Old People's Welfare Association. TOC H (Emergency Call lamps). Essex County Association for the Blind. Southern Regional Association for the Blind. Ilford Physically Handicapped Committee. Wanstead and Woodford Association for Physically Handicapped. Hainault Association for Physically Handicapped. British Epilepsy Association. Spastics Association. Redbridge Council for the Disabled. Essex League of Hard of Hearing. Essex League of Hard of Hearing (Redbridge Group). Royal Association in aid of Deaf and Dumb. South Eastern Regional Association for the Deaf. Miscellaneous disbursements to Clubs. 2. Voluntary Organisations to which the Council is affiliated; South Eastern Regional Association for the Deaf. Central Council for the Disabled. Handcrafts Advising Association for the Disabled. Essex Physically Handicapped Association. 142 APPENDIX 32 PHYSICALLY HANDICAPPED STATISTICS MINISTRY CATEGORIES No. as at 31.12.66 Amputation 34 Arthritis and Rheumatism 276 Congenital Malformations and Deformities 26 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 67 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 100 Organic nervous diseases — epilepsy, disseminated sclerosis, poliomyelitis, hemiplegia, sciatica, etc. 278 Neuroses, psychoses and other nervous and mental disorders 5 Tuberculosis (respiratory) 1 Tuberculosis (non-respiratory) 6 Diseases not listed above - Total 793 APPENDIX 33 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 201 143 APPENDIX 34 PHYSICALLY HANDICAPPED HOLIDAYS No. of Persons Hotel or Holiday Camp 1.1.66 — 31.12.66 British Epileptic Association (Shanklin) 1 Cheshire Homes (Seven Rivers, Colchester) 1 Disabled Drivers Association ... 1 Donkey Club, St. Peters, Lancing ... ... ... ... 1 Essex Connty Council — Chelsea House, Clacton 1 Essex Physically Handicapped Association 27 Grants ... ... ... ... ... ... ... ... ... ... 10 Jewish Association for the Physically Handicapped (Bournemouth) ... ... ... ... ... ... ... ... 6 Longleat Guest House, Clacton — May 24 Longleat Guest House, Clacton — September ... 12 Lulworth Court, Westcliff 1 Shaftesbury Society ... ... ... ... ... ... ... 4 Westboume Lodge Guest House, Clacton 16 W.R.V.S. Grange Farm, Chigwell 11 W.R.V.S. Crabhill House, Redhill ... _18 Total 134 APPENDIX 35 BLIND AND PARTIALLY SIGHTED HOLIDAYS No. of Persons Hotel or Holiday Camp 1.1.66 — 31.12.66 Essex County Association for the Blind, Frinton 3 Essex County Council — Carlton Guest House, Clacton 3 Ilford Blind Welfare Association, Cliftonville 17 Royal National Institute fpr the Blind, St. Leonards 1 Total 24 144 APPENDIX 36 HOLIDAYS FOR THE ELDERLY No. of Persons Elderly Escorts Corton Beach Holiday Camp, Near Lowestoft, Suffolk: May 1966 ••• ••• ••• 398 14 June 1966 ••• ••• ••• ••• 51 6 September 1966 400 17 849 37 APPENDIX 37 MEALS SUPPLIED BY TOE W.R.V.S. IN BOTH ILFORD AND WANSTEAD AND WOODFORD AREAS Days per Week on which meal received Number of Persons as at 31.12.1966 1 5 2 78 3 60 4 68 In addition, 16 people receive 2 meals on 1 day. Total average per week — 629 meals. 145 APPENDIX 38 REGISTERED BLIND AND PARTIALLY SIGHTED PERSONS As at 31.12.1966 Male Female Blind 145 254 Partially Sighted 59 91 Defective Sighted 5 14 Total 209 359 APPENDIX 39 REGISTERED DEAF AND HARD OF HEARING (Ascertained to Date) As at 31.12.1966 Male Female Deaf 29 31 Hard of Hearing 16 28 Total 45 59 146 INDEX Page No. Accidents 17 Dr. Adler — Consultant Chest Physician 15 Adult Training Centre 100 Animal Boarding Establishments Act, 1963 120 Asian Immigrants 16 Atmospheric Pollution — Clean Air Act 121 At Risk Register 30-33 B.C.G. Vaccinations 82 Births 29 Blindness 137,143 Cancer 17 Care of Mothers and their Young 28 Causes of Deaths 22,87 Central Registry of Case Work 41 Cerebral Palsy Unit 73 Cervical Cytolcgy 52 Charter for General Practice 26 Child Guidance 73 Children at Risk Chiropody Service (including School Health) 51,86 Clean Air Act — Smoke Control Orders 122 Clearance Areas 112 Clinics and Treatment Centres 56 — Child Guidance 73 — Dental 34,68 — E.N.T 56,67 — Enuresis 56,77 — Minor Ailments 63 — Ophthalmic 56,64 — Orthopaedic 56,65 — Orthoptic — Premises 28,55 — Speech 56 — Vaccination and Immunisation Congenital Abnormalities 30,56 Co-ordination of Education, Health and Welfare Services for Handicapped Children and Young People Convalescent Treatment Coronary Disease Mr. Daly — Chief Public Health Inspector Day Centres 136,137 Day Nurseries 36,37 70 Dental Health Education Dental Treatment (including Schools) 34-36,68-70 Department of Education and Science — Statistical Tables 88-98 Development of L.A. Health Services 147 Diseases of Animals (Waste Food) Order, 1957 120 Diseases of Animals (Movement Orders, etc.) 120 Diseases (notifiable) 19 Domiciliary Nursing 38 Drainage and Sewerage 106 Dysentery 14 Ear, Nose and Throat Clinic 56,67 Education Committee Enuresis 56,77-79 Environmental Health Epidemiology 13-18 Ethel Davis School (Physically Handicapped) 71 Dr. Fairhurst — Ophthalmologist 64 Factories and Workshops 111 Fertilisers and Feeding Staffs Act, 1926 111 Fieldwork Instructors 43 Food and Drugs Sampling 118 Food Hawkers 119 Food Hygiene 117 Foods, Fitness and Consumer Protection 118 Food Poisoning 15 Food Preparation — Premises 119 Food Surrendered 118 Foreign Bodies in Food 116 Miss Gascoyne — Educational Psychologist 75 General Welfare and Research (School Health) 86 Group Practice 26 Dr. Gurassa — Psychiatrist 73 Mr. Haigh — Chief Dental Officer 34,68 Hairdressers and Barbers Establishments 110 Mr. Hall — Chief Welfare Officer 135 Handicapped Children 81 Health Committee 1 Health Centres 25~28 Health Education (including Schools) 46,84-86 Health Services Clinics 55 Health Visitors and School Nurses 41,57,82 Home Helps 53 Home Laundry Service 1ll Home Nursing 44 Home Safety 50 Homes for the Elderly 136 Housing 112 Housing Repairs and Rents Acts 114 Cream 116 Illegitimate Births and Deaths 11 Immunisation 45 148 Infant Mortality 11 Infant Welfare Centres 55 Infectious Diseases 13 Inspections and Supervision of Food 115 Intestinal Infections 13 Junior Training Centre 100 Mr. Korvin — Orthopaedic Surgeon 66 Land Charges Act 109 Laundry Service for the Aged Incontinent 111 Mr. Lee — Orthopaedic Surgeon 73 Leprosy 13 Litter Act. 1958 109 Liquid Egg (Pasteurisation) Regulations, 1963 119 Loan of Sick Room Equipment 50 Massage and Special Treatment Establishments 110 Mass Radiography 16 Maternal Mortality 11 Measles 16 Meals on Wheels 144 Meat and Other Foods — Inspection and Supervision 117 Medical Inspection at Schools 62 Mental Health Service Mental Welfare Officers Merchandise Marks Act 119 Midwifery Milk 115 Minor Aliments 63 National Assistance Act, 1948 135 National Health Service Act, 1946 Neonatal Mortality Noise Abatement Act, 1960 110 Notifiable Diseases Nurseries and Child Minders Regulation Act 37,38 N.S.P .C.C. 86 Observation Register 30 33 Occupational Centre (Fellowship House) 137 Occupational Therapy Officers of the Public Health Services Offices, Shops and Railway Premises Act, 1963 112 Miss Oliver — Superintendent Health Visitor 41,82 Ophthalmic Clinic 56,64 Orthodontics 70 Orthopaedic Clinics 56,65 Orthoptic Clinic Overcrowding 149 Paratyphoid Fever • •• ••• Mt ••• ••• ••• ••• ••• ••• ••• ••• Partially Sighted ••• ••• ••• ••• ••• ••• • •• ••• 135,143 Peripatetic Teachers of the Deaf ••• ••• ••• ••• ••• ••• 80 Pet Animals Act, 1951 ••• ••• ••• ••• ••• ••• ••• ••• ••• 120 Pharmacy and Poisons ... ... ••• ••• •••. ••• ••• ••• ••• 119 Physically Handicapped ... •tt ••• ••• ••• ••• ••• • •• »»• 137 Physiotherapy • • ••• ••• ••• ••• ••• ••• ••• 66 Dr. Pooley — Departmental Medical Officer — Enuresis Clinic ••• • •• 77-79 Poliomyelitis • ••• ••• ••• ••• ••• ••• ••• ••• ••• ••• ••• 1^ Population ... ... ... *•» ■*« ... ... ••• ••• ••• ••• ••• 11 Miss Potter — Superintendent of Midwives and District Nurses ... 44 Preface • •• ••• ••• ••• ••• ••• ••• ••• • •• •• • ••• •• • 7-10 Mrs. Pretious — Speech Therapist 67 Psychiatric Social Workers 99 Preventive Measures — Infectious Diseases 14 Rag, Flock and Other Filling Materials, etc 109 Rainfall 11 Rats and Mice 121 Recuperative Holidays 64 Refuse Collection and Disposal 108 Remedial Exercises 66 Research 86 Residential Accommodation for the Elderly 136 Riding Establishments Act, 1964 121 Rivers and Streams 107 Sanitary Inspection of the Area 108 School Health Service 61 School Nurses 82 School Psychological Service.. 75 School Roll and Premises 62 Screening Tests of Vision and Hearing 62 Services for the Elderly 135 Services for the Handicapped 137 Services for the Homeless 13 < Sickroom Equipment 50 Slaughter of Animals Act 119 Social Case Work 135 Social Clubs for the Mentally 111 101 Speech 56,67 Specialist Services 28 Staff 3,63 Statistics ... Environmental Health 124-133 Epidemiology 19-23 Mental Health 103 —— Personal Health 56—59 — School Health 88-98 Vital and Social 11,23 — Welfare 139—145 150 Suicide 18 Swimming Baths 106 Temporary Accommodation 137 Toddlers Clinic 34 Dr. Toms — Principal Medical Officer — School Health Service 61 T.B. Care and After Care 51 T.B. — Notifications, deaths etc* 15,20 Vaccination and Immunisation 45 Venereal Disease 16 Voluntary Bodies 52,86,138,141 Water Supply 105 Miss Watt — Educational Psychologist 75 Dr. Wedeles — Principal Medical Officer — Mental Health Service 99 Welfare Service 135 Welfare Committee 1 Whooping Cough 16