RED 3 LONDON BOROUGH OF REDBRIDGE ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for 1967 by I. GORDON, M.D., CH.B., M.R.C.P. (Lond.), D.P.H. (Edln.) table of contents Page HEALTH COMMITTEE 1 WELFARE COMMITTEE 1 EDUCATION COMMITTEE 2 STAKE 3-5 PREFACE 7-9 VITAL STATISTICS AND SOCIAL CONDITIONS 10 EPIDEMIOLOGY 11-20 NATIONAL HEALTH SERVICE ACT, 1946 21-48 HEALTH EDUCATION 49-59 EDUCATION ACT, 1944 61-92 MENTAL HEALTH 93-97 ENVIRONMENTAL HEALTH 99-135 WELF ARE 137-149 INDEX 150-154 1 health committee Municipal Year 1967-1968 Co-opted Member Dr. T. C. Mayer, B.Sc., M.B., Ch.B., M.R.C.S. welfare committee Councillor Mrs. M. H. Paige, Chairman Councillor Mrs. V. L. Wilson, Vice-Chairman Alderman L. A. S. Gooch, Mayor Alderman Miss A. S. Terry, J.P. Councillor Mrs. Q. M. Chamberlln, J.P., Chairman Councillor J. H. Norwood, Vice-Chairman Alderman L. A. S. Gooch, Mayor Alderman R. A. Dalton, J.P. Alderman Miss A. S. Terry, J.P. Alderman Mrs. L. Fallaize, O.B.E., J.P. Councillor A. C. Berry Councillor Mrs. M. H. Paige Councillor E. A. Earey, J.P., F.V.I. Councillor A. Reynolds Councillor V. W. Ferrier Councillor Mrs. W.J. Roberts Councillor Mrs. V. M. Grose Councillor J. A. Vane Councillor Mrs. K. E. M. Kelly Councillor D. E. Wightman, R.M.N. Councillor R. H. Ayres Councillor A. Reynolds Councillor T. F. Cobb, A.I.A.C. Councillor Mrs. A. Toms Councillor D. S. Davies, J.P., B.Sc. Councillor J. A. Vane Councillor E. F. Harris Councillor G.H. Watson Councillor F. H. James CouncUlor K. W. Webb Councillor F. C. Mountier CouncUlor D.E. Wightman, R.M.N. 2 EDUCATION COMMITTEE Councillor D. K. L'Estrange, B.A., LL.B., F.C.I.S., Chairman Councillor O. F. Waters, J.P., Vice-Chairman Alderman L. A. 3. Gooch, Mayor Alderman Mrs. L. Fallaize, O.B.E., J.P. Alderman Mrs. E.F.M. Hollis, M.B.E. Alderman C.I. Gibson Alderman Miss A.S. Terry,J.P. Councillor H. R. B. Aly, (Dep. Mayor) Councillor Mrs. M.J. Harvey, J.P., B.A Councillor R. H. Ayres - ... . _ „ Councillor L. M. Hipkins, B.A., Councilor A. C. Berry F.R.S.A.. F.R.G.S., F.R.Econ.S., Councillor L. G. Bridgeman A.C.C.S. Councillor D. A. Carradice Councillor N.C.N. Hurst Councillor T. F. Cobb, A.I.A.C. Councillor S. F. Loveless Councillor G. E. Davies, J.P., B.Sc. Councillor A.J. Shaw, B.A., M.P. Councillor Mrs. L. A. Emons Councillor H.J. Witts Councillor Mrs. V. M. Grose Councillor W. J. Westerbury Councillor Mrs. O. Hall Councillor A. P. White Councillor B. E. R. Hamilton Councillor Mrs. V. L. Wilson Co-opted Members Rev. A. J. Adams Mrs. D. E. Carter Dr. H. B. Chirgwin, M.A., B.Sc. Miss R. M. Fordham Mr. H. Goldner Mr. E. R. Lower, B.A. Rev. W. H. Robinson, M.A. Very Rev. Canon J. Walsh, D.D. 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.) Principal 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.) Chief Welfare Officer: R. W. HALL, A.M.I.S.W. CMej pubUc Health [nspeetor: S. R. DALY, LL.M., B.Sc., D.P.A. (Lond.), B.rrister-at-L.w C. R. COLE, D.S.S., A.M.I.S.W. Senior Assistant Medical Officer: Deputy Chief Public Health Inspectors: JOAN M. POOLEY, M.B., R E. SMALLEY, A.R.S.H. B.S., D.C.H. J.T.S. TEMPLEMAN, M.A.P.H.I. Departmental Medical Officers: G.B. TAYLOR, M.B., B.S., (Lond.), D.C.H., D.Obstr., R.C.O.G. (Resigned 6.2.67) M. B. GEE, M.B., Ch.B. (Bristol), D.C.H.+ ELIZABETH A. LITTLE, M.B., Ch.B., (Aber.) A.J. CROMPTON, M.B., B.S. (London), M.R.C.S., L.R.C.P. (Resigned 6.8.67) J. A. HOWELL, M.B., Ch.B. J. K. ANAND, M.B., B.S., B.Sc., L.S.M.F. M. R. DAS GUPTA, M.B., B.S. 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) A.M. GARMAN, L.D.S., R.C.S. (Eng.) 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, MISS L. E. A. PARISH, S.R.N., S.C.M., Q.I.D.N., H.V. S.R.N., S.C.M., Q.I.D.N., H.V. Superintendent Health Visitor: MISS J. M. OLIVER, S.R.N., S.C.M., H.V. Deputy Superintendent Health Villtor: Miss E.M.P. COLLINS, Principal Cental Health Social Worker! S R N SCM HV T. A. HAWLEY, S.R.N., A.A.P.S.W. (resigned 29.9.67) Senior Mental Welfare Officers: Senior Social Worker: t p, NORRIS MISS G. M. VENNING S.H.MAURICE 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 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.l.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. (resigned May 67) P. LANCER, M.B., B.S., M.R.C.S., L.R.C.P., D.O., D.C.H. N.M. 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. P. DHIR, M.B., B.S., D.O. (from 26.6.67) Surgeons in charge of Ear, Nose and Throat Clinics: MARGARET MASON, M.A., F.R.C.S. 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. Orthoptis ts: MRS. M. E. CLARKE (resigned July 67) MISS M. LEWIS MRS. J. ASHENDEN 7 preface HEALTH & WELFARE DEPARTMENT, Telephone: 17/23, Clements Road, 01-478 3020 ILFORD. August, 1968. Mr. Mayor, Ladles and Gentlemen, I hereby submit the third Annual Report of the Health and Welfare Services of the London Borough of Redbrldge. Once again, I must thank Dr. Shaw for his able editorship, and wish him well in his new appointment as Medical Officer of Health of Watford. His successor, Dr. Fernandes, will assume his duties here in the middle of September. This preface will, I hope, be reasonably brief, due to my involvement, with many others, in studying a number of reports that have appeared recently or will shortly appear, and all of which are of fundamental importance to the future of local government services. In chronological order, they are: — (a) Management of Local Government (Maud) (b) The Re-organisation of a London Borough (London Boroughs' Management Service Unit) (L.B.M.S.U.) (c) National Health Service. The Administrative Structure of the Medical and Related Services in England and Wales (Government Green Paper); beating by one hour in publication., the (d) Report of the Committee on Local Authority and Allied Personal Social Services (Seebohm) (e) Report of the Royal Commission on Local Government in England and Wales (not yet published). The great difficulty facing us all is that the first four and certainly the fifth, when it appears, cover much ground in common, but make conflicting recommendations. For example, Seebohm differs from the L.B.M.S.U. report and the spirit of the Maud report by completely separating the community health and social services. The Green Paper will transfer the community health services, "the organisation and management of the long-term sick, including disabled persons elderly mentally disordered- at present the responsibility of general practitioners, hospital authorities and local health authorities* to a new area authority for the National Health Services, and perhaps even the public health inspectors will go with them (page 17. para. 45). Seebohm, on the contrary, states (page 208. para. 676) "a family service 8 cannot be fully effective until the social service department and the housing, education and health departments are the undivided responsibility of the same local authority". In addition they will remove most of the mental health activities from the health to the social services department. When the Royal Commission reports it may well make recommendations on the health and social services that will differ from both the Green Paper and Seebohm. Much of the Maud Report can be Implemented Immediately and the L.B.M.S.U. report is so designed as not to await further legislation. Seebohm will require some legislation, and the report suggests an appointed day about a year later. Changes required by the Green Paper and the Royal Commission may be of such a fundamental nature that It can hardly be expected that the necessary blll» cm be promoted in the life of the present parliament. Seebohm is basically concerned with the activities of one profession, social workers; the Green Paper with the activities of the medical profession and its many associated professions; Maud, the L.B.M.S.U., and the Royal Commission are fundamental exercises in the well-being of local government is t whole. Twenty Years On In 1946, there appeared the "Report of the Care of Children Committee" (Curtis). The nation was disturbed at tragic stories of deprived and neglected children. The answer was of course an "ad hoc" solution, the Children's Committee, Department and Officer, separated from the rest of the Council's activities, a solution much criticized by the then chief officers (who were siid to be "protecting their empires"). Twenty years later we are still disturbed with tragic stories of deprived and neglected children, with the modern addition of the "battered baby syndrome". Seebohm would now reverse all this structure. Also, twenty years ago the National Health Service Act came into operation. Against the wishes of many doctors and authorities (who were, of course, "pro* tecting their empires") public health doctors and general practitioners were separated from the hospital service in an "ad hoc" solution. Now the Green Paper suggests a reversal of this structure. In twenty years' time, will the Seebohm solution, which is as divisive as It is integrative, if it is fully Implemented, be subject to a similar reversal? Seebohm hints that this may be so — "We must not be understood as wishing to dismiss for all time the idea of some possible future union of all the social services at local level. However, such a union must, in our view, also include some of those medical services which are at present outside local authority health services; education services and perhaps housing as well. We realise that such major reorganisation could only be a long-term Ideal" (Page 42, para 136). (Critics of Seebohm, once again, will be said to be "protecting their empires"). 9 Conclusion Surely all this suggests the need for great caution, for the study of the whole complicated problem with due regard to the relationship of one function with another, without undue preponderance of the views of any one profession. No single professional interest should be allowed to "jump the gun". Once again, may I thank the members of the Council, especially the Chairmen of the committees with which I am associated, for their help and encouragement. Alto, I would likewise thank my fellow chief officers and their staffs for a year of first-class co-operation. Any success that the health and welfare department has had during the past year is almost entirely due to the unstinting effort of the staff for which I am responsible, and for whose loyalty, skill and hard work the Council, public of Redbridge and I, are most grateful. Finally, I would once more draw attention to the large and enthusiastic body of voluntary workers in the town, without whose help our task would be so much more onerous, and, of course, expensive. I have the honour to be Your obedient servant, I. GORDON, Medical Officer of Health. 10 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, 1967 245,300 Number of inhabited houses( April 1 st, 1967)according toRate Books 77,326 Rateable Value — April 1st, 1967 £12,458,897 Sum represented by a penny rate, April 1st, 1967 £52,505 General Rate in the £ — 1967-68 Domestic Properties 11s. 71 Mainly Domestic Properties lls.l0d. Non-Domestic Properties 12s. Od. The following figures as to unemployment were supplied by the Ministry of Labour (Ilford area only): Males Females As at December, 1967 1,070 132 1967 Live Births 3,627 Live Birth rate per 1,000 population - Crude rate 14.79 Adjusted rate 15.23 Illegitimate Live Births per cent of total live births 6.41 Stillbirths 40 Stillbirth rate per 1,000 total live and stillbirths 10.91 Total Live and Stillbirths 3,667 Infant deaths (under 1 year) 66 Total Infant deaths per 1,000 total live births 18.20 Legitimate Infant deaths per 1,000 legitimate births 18.27 Illegitimate Infant deaths per 1,000 illegitimate births 17.09 Neo-natal mortality rate per 1,000 live births (first four weeks) 13.51 Early Neo-natal mortality rate per 1,000 total live births (under one week) 12.41 Perinatal mortality rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) 23.10 Maternal deaths (including abortion) Nil Maternal mortality rate per 1,000 live and stillbirths 0.00 Deaths (all causes) 2,741 Death rate per 1,000 population — Crude Rate 11.17 Adjusted rate 10.61 Comparability Factors — Birth rate 1.03 Death rate 0.93 Total rainfall 1967 24.43 inches Greatest rainfall in any 24 hours (on 25.6.67) 1.02 EPIDEMIOLOGY 12 Measles Whooping Cough Respiratory symptoms predominated, that Is to say sore throat, cough and running rose but some patients had abdominal pain, vomiting and diarrhoea. The period of acute illness lasted 3 or 4 days but it took anything up to 3 weeks for patients to recover completely. Absence from work due to illness was widespread and the returns of new claims to sickness benefit received by the Ministry of Social Security for Ilford alone rose to 1,152 compared with a previous weekly average of about 350. A similar dramatic rise in sickness absence had not been seen since February 1959 and October 1957, the latter being due to influenza A (Asian) virus. Measles showed the expected rise in incidence in 1967, 2,695 cases being notified compared with 827 in 1966. There were indications near the end of the year that the Ministry of Health would bestow its approval on measles vaccine.. When measles vaccination becomes freely acceptable it is expected that the disease will fall to very low levels. It has been the experience in the United States of America that the expected biennial epidemic of measles has been wiped out as a result of widespread measles vaccination. This is an unmixed blessing because in a 'measles year' In Redbridge some 3000 cases are notified and taking Into account the considerable undernotlfl* cation of this disease the true figure is probably In the region of 5,000 cases, at a conservative estimate. Measles is an unpleasant disease, children suffering from It being miserable for several days. Complications such as pneumonia and middle ear infection are common and the rarer complication of encephalitis is very serious. Anything which can be done to lighten the load of childhood sickness is therefore to be welcomed, as is the lightening of the work load of the family doctor and the other drain on the country's resources in the form of drug bills. Notified cases of whooping cough showed an unwelcome rise to 202 from 63 in 1967 and 80 in 1966. The age at which the disease was contracted showed a change in that nearly half of the cases were over the age of 5 years, the proportion In the preceding two years having been between one-third and one-quarter of the total. Not all of the notified cases were typical whooping cough with red eyes, machine-gun cough and prolonged inspiratory whoop. Many of them had only mild but persistent coughs and diagnosis was based on known contact with a case and the family doctor's experience of similar cases modified by previous whooping-cough immunisation. 13 Investigation at a national level is directed towards the Increase in whooping cough incidence and the department has been co-operating with the Public Health Laboratory Service in the collection of specimens. Tuberculosis 55 cases of pulmonary tuberculosis and 6 of non-pulmonary tuberculosis were notified during the year. In 1966 figures were 68 and 6 respectively. Appendix 2 gives the statistics relating to tuberculosis. Asian Immigrants In August a special effort was made to persuade Asian immigrants to attend for mass radiography. A mobile radiography unit visited three sites in the borough on three different dates. Of the 537 adults invited 259 attended, 55 of these after a second invitation. 7 persons were referred for further treatment and of these 2 were found to have pulmonary tuberculosis needing treatment and 2 needed occasional supervision. ThoBe who did not attend for X-ray are buing followed up. In addition to the mass X-ray campaign 361 Asian children up to school leaving age were visited and Heaf tested. 256 of this number were given B.C.G. vaccination and 75 were referred for further investigation. B.C.G. vaccination is alao given before discharge from hospital to Asian babies born in Ilford Maternity Hospital and Barking Hospital. Close contact is maintained with the Education Department on recent arrivals in the borough of Asian children and the children and the families are offered the opportunity of chest X-ray or Heaf testing. Notification of some adult Immigrants is made also by port and airport authorities. Venereal Disease Hypothermia in the Elderly Nine treatment centres in London sent returns of Redbridge residents treated compared with five last year. Accordingly the number of cases known rose to 11 of syphilis and 83 of gonorrhoea. The figures are incomplete and no firm conclusions can be drawn from them. However, It appears that there is a rise in the incidence of gonorrhoea and non-specific venereal conditions. This is particularly evident in the figures from the London Hospital which deals with most Redbridge patients (1966 figures shown in brackets):— syphilis 9 (8), gonorrhoea 67 (39), other conditions 447 (313). Non-Infectious Disease In the first 3 months of 1967, a pilot survey on hypothermia in the elderly was carried out in the Ilford part of the borough. 14 Hypothermia in Hospital Admissions The survey stemmed from work in 1965 by the Royal College of Physicians which investigated the incidence of hypothermia in hospital admissions. It was found, among other things, that 0.68% of all patients admitted to hospital during the winter months had temperatures below 95°F and that 47 out of their 126 hypothermic patients died. Persons over the age of 75 were a particularly vulnerable group. Hypothermia In the Community Design of Survey Results It appeared obvious that if 0.68% of the patients admitted to hospital suffered from hypothermia then there must be a considerable number of undetected cases in the community and that an attempt should be made to define their characteristic!. 20 Redbridge residents aged 75 and over were selected at random during the end of the months January, February and March making a total of 60 (later reduced to 59) each of whom took part in the survey for one calendar month. A questionnaire was completed In respect of each participant and district nurses recorded body temperature's and maximum and minimum bedroom and living room tempera cures every day for a month. 31 (52.5%) of the participants had a body temperature of 95 °F or below on one or more occasions. 11 out of the 31 were hypothermic on 10 or more occasions. The minimum bedroom and living room temperatures were significantly lower in hypothermic Individuals compared with normals. Because of the small number of participants no firm conclusions could be reached on the significance of various factors such as diet, type of heating and medical condition but interesting pointers towards the type of questions which should be asked in future surveys were evident. The main discovery made was that old people's body temperatures are extremely variable. It had been advised previously that an old person with a temperature below 95° F was probably in danger and should be warmed slowly. However, all of the hypothermic old people visited were in apparently good health and complaining cheerfully of being a little cold but nothing else. Appetite, mobility and mental alertness seemed unimpaired and in all cases it was decided that no treatment was necessary. Obviously a great deal more work must be done on this subject and this should be directed towards the rate of rewarming, the type of heating, diet, medical conditions and life expectation of hypothermics compared with normal individuals. I am grateful to the elderly people who took part in the survey and to the district nurses who willingly accepted the 15 Survey of the Elderly additional work that was necessary to conduct the survey. It Is hoped that a full report will appear In the medical press during 1968. The Chief Welfare Officer will deal in detail in another part of this report with the survey of the elderly which 1b taking place in the borough. The survey is the result of discussions at the Geriatric Liaison Committee which has members representing the hospital, general practitioners and health and welfare services. The aim of the survey, which will be confined to a sample of 2,000 of the 7,000 persons aged 75 and over in the Ilford part of the borough is, briefly, to define the extent of needs of this sector of the population. Social welfare officers, health visitors and district nurses are conducting the interviews; help has been given by the Greater London Research and Intelli* gence Unit on the design of the survey and the borough's computer will be used in analysing the data. Coronary Disease Lung Cancer Bronchitis One in four of all deaths between the ages of 35 and 55 years was caused by coronary artery disease. In males death would occur when they were at the peak of their earning power, probably supporting young families. Most of the deaths were preventable as it has been shown again and again that obesity, smoking and lack of exercise predispose to coronary artery disease. There were a further 166 deaths from lung cancer in 1968, mostly over the age of 66, but 6 of the deaths were In persons under 45 and 26 under the age of 55. A further 128 deaths were due to bronchitis. Both lung cancer and bronchitis are to a large extent due to the smoking habit. Female Cancers Accidents Suicide There were 92 deaths from female cancers, 68 of the breast and 24 of the uterus. The cervical cytology clinic by detecting early cancers of the cervix and by teaching the technique of self examination of the breast, is aimed towards reducing the number of deaths due to these causes. 77 people died as a result of accidents, 37 of these being road accidents. 6 accidental deaths were in children under the age of 15. Deaths from suicide remained fairly constant at 30. 6 suicides occurred in persons under the age of 25. 16 APPENDIX 1 CORRECTED NOTIFICATIONS OF INFECTIOUS DISEASES FOR THE YEAR 1967 NOTIFIABLE DISEASE Number of Cases Notified At ages — Years At all ages 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 137 1 36 81 15 2 - 2 Diphtheria, including Membranous Croup - - - - - - - - Enteric Fever (Typhoid and ParaTyphoid) 3 - 1 - - 2 - - Pneumonia 32 - 1 6 5 1 11 8 Puerperal Pyrexia 17 - - - 8 9 - - Acute Poliomyelitis - - - - - - - - Acute Encephalitis 1 - 1 - — - - - Meningococcal Infection - - - - - - - - Dysentery 543 19 111 109 76 176 37 15 Ophthalmia Neonatorum 2 2 — - - - - - Erysipelas 7 - - - - 4 2 1 Tuberculosis Pulmonary 55 — 4 3 3 14 23 8 Other Forms 6 — — — 1 3 2 - Anthrax — — — — — - - - Malaria — Believed contracted in this country - - - - - - - - Believed contracted abroad 3 - - 1 1 1 - - Measles 2695 111 1556 1006 13 8 1 - Whooping Cough 202 13 94 84 1 10 - - Food Poisoning 24 2 6 3 7 3 3 - Typhus Fever - - - - - - - - Totals 3727 148 1810 1293 130 233 79 34 •Excludes 205 cases notified by G.P.'s as "Suspected" — but which were not confirmed on subsequent investigation; and 18 proved cases which came to the knowledge of the department from other sources. 17 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 3 — — — — — — 5-14 — 3 — — — — — — 15 - 24 1 2 1 — — — — — 25 - 44 10 4 2 1 — — — - 45 - 64 18 5 2 — 2 1 — — 65 - 74 7 — — — 3 1 — — Over 75 1 - - - 1 1 - - Totals 38 17 5 1 6 3 - - The foregoing new cases were notified from the following sources:— Respiratory Tuberculosis NonRespiratory Tuberculosis Ilford Chest Clinic 32 1 Wanstead and Woodford Cheat Clinic 8 — Dagenham Chest Clinic 2 1 Local General Practitioners 2 — Wanstead Hospital 1 - Harts Hospital — 1 Hospitals outside Borough 10 3 55 6 In addition 49pulmonary and 5 non-pulmonary cases were transferred to Redbrldge. Pulmonary NonPulmonary Total Number of cases on register, 1st January, 1967 889 118 1,007 Number of cases entered on the register during the year 104 11 115 Number of cases removed from the register during the year Pul. NonPul. Recovered 48 1 Deceased 16 Left District 39 2 Lost sight of - Diagnosis not established 4 Number of cases remaining on register on 31st December, 1967 107 3 110 886 126 1,012 The Treatment of Tuberculosis Is under the control of the Regional Hospital Board. On the 31st December, 1967, there were 946 Redbrldge patients on the registers of the Ilford, Wanstead and Woodford and Dagenham Chest Clinics. Deaths of persons on T.B. Register but the cause of death not necessarily being Tuberculosis. 18 APPENDIX 3 MASS RADIOGRAPHY The mass radiography unit stationed at the Thompson Rooms continued to operate on Mondays from 2nd January to 10th July, 1967 and again from 4th 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 1,733 1,577 3,310 General Public 3,010 3,386 6,396 Organised Groups 393 1,925 2,318 Contact Groups 39 23 62 Total No. X-Rayed 5,175 6,911 12,086 In addition — Males Females Total 1,063 1,272 2,335 were x-rayed by the mobile unit operating at five different sites during 1967 in the Wanstead and Woodford area. APPENDIX 4 VENEREAL DISEASES Treatment received by new cases from Redbridge during 1967, as notified by the undernoted Treatment Centres Name of Centre Syphilis Gonorrhoea Other Conditions Total The Whitechapel Clinic, London Hospital, E.l 9 67 447 523 Homerton Grove Clinic, Eastern Hospital, E.9. - 2 17 19 Special Clinic, Queen Mary's Hospital, E.15 1 3 40 44 St. Bartholomew's Hospital, London, E.C.I. - 3 23 26 Albert Dock Hospital, London, E.16 - 2 28 30 Dreadnought Seamen's Hospital, Greenwich. - 1 2 3 Lydia Dept., St. Thomas Hospital, S.E.I. - - 4 4 Oldchurch Hospital, Romford. 1 5 66 72 Totals 11 83 627 721 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 2 5 Home Nursing section 26 Vaccination and Immunisation section 28 Prevention, Care and After Care section 29 Home Help Service 19 APPENDIX 9 Registrar-General's Short List of Deaths and Causes Causes of and Ages at Death during the year 1967. Met 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 65 and under 75 years 75 yeaars and over ALL CAUSES 2,741 49 17 10 10 26 20 55 195 415 700 1,244 1. Tuberculosis, reapiratory 9 – – – – – – – 2 1 4 2 Tuberculosis. Other – – – – – – – – — – — — 3 Syphilitic disease 5 – – – – – – 1 — 1 1 2 4 Diphtheria – – – – – – – – – – – – 5.Whooping Cough – – – – – – – – – 6.Meningococcal Infection 1 – – – 1 – – – – – – – 7 Acute poliomyelitis – – – — — — — — — — — — 8 Measles 1 – 1 – – – – – – – – — 9 Other infective and parasitic diseases 4 – – – – 1 – – – – 1 2 10 Malignant neoplasm stomach 61 – – – – – – 2 7 11 19 22 11 Malignant neoplasm, lung, bronchus 166 – – – – – – 6 20 47 65 28 12 Malignant neoplasm, breast 68 – – – – – 1 3 12 19 20 13 13 Malignant neoplasm,uterus ... 24 – – – – – – 3 4 8 7 2 14 Other malignant and lymphatic neoplaams 275 – 1 1 1 5 4 7 26 53 74 108 15. Leukaemia, aleukaemia 19 – – – – – 1 – 2 1 4 8 16 Diabetes 28 – – – – – – – – 2 8 18 17 Vascular lesions of nervous system 305 – – – – – – 1 14 29 88 173 18 Coronary disease, angina 537 – – – – – – 10 49 109 168 201 19 Hypertension with heart disease 41 – – – – – – – 4 4 18 20 20 Other heart disease 261 – – – – – 1 8 9 19 48 181 21. Other Circulatory Diseases 128 – – – – 1 – – 8 12 80 77 22 Influenza 2 – – – – – – – – – 1 1 23 Pneumonia 209 1 10 1 1 –– – – 4 7 34 131 24 Bronchitis 128 – – – – – – – 4 20 36 68 25 Other diseases of respiratory system 26 – – – – – – – 8 1 6 16 26 Ulcer of stomach and duodenum 29 – – – – – 1 1 1 6 5 15 27 Gastritis entertils and diarrhoea 12 – – – – – – 1 – – 3 8 28 Nephritis and nephrosis 21 – – – – – 1 2 – 8 6 4 29 Hyperplasia of prostate 7 – – – – – – – 1 – 2 4 30 Pregnancy, Childbirth,Abortion – – – – – – – – – – – – 31 Congenital malformations 21 7 2 4 – 2 2 – – 2 1 1 32 Other defaed and ill-defined diseases 246 41 2 2 1 5 3 6 14 36 45 91 33 All other Accidents 37 – 1 – 1 6 3 1 4 6 8 7 34 All Other Accidents 40 – – 2 2 – 2 – 1 6 6 21 35 Saicide 30 – – – – 6 1 3 6 7 2 5 36 Homicide and operations of war – – – – – – – – – – – – 20 APPENDIX 6 DEATH RATES EROM CANCER AND HEART DISEASE, 1067 The following Table shows the death-rates for 1967 for Redbridge, compared with those for 1966. 1967 1966 Cancer of lung and bronchus .677 .633 Cancer, other forms 1.745 1.820 Coronary and arteriosclerotic heart disease 2.189 2.109 APPENDIX 1 Table showing comparison between the Birth-rate, Death-rate, etc., of Redbridge, Greater London and of England and Wales for the Year 1967. 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 17.2 14.8 11.2 18.3 Greater London 15.81 13.3 10.91 18.40 REDBRIDGE (Estimated Population mid-1067 — 245,300) 15.23 10.01 10.61 18.20 21 SECTION 21 HEALTH CENTRES (by A. Shaw, M.B., B.S., D.P.H. Deputy Medical Officer of Health) Progress In 1967 Since the last Annual Report little progress has been made in the Health Centres programme if this is considered from the viewpoint of architects' plans and bricks and mortar. However, a great deal of advance has been made in the field of exploring general practitioners' attitudes, outline design of buildings, attachment of local authority staff and moving towards an overall plan for the Borough. In this sense the picture is clearer. High Road, Woodford, Health Centre An outline brief for the High Road, Woodford, Health Centre has been discussed with Ministry of Health officers and agreement reached on the necessity for a 3-Surgery Centre. Two single-handed doctors wish to use the centre full-time and a practice of three doctors wish to close down their present branch surgery and use the Health Centre for part of their work. The centre will have the usual local authority services, including maternal and child welfare, school health, ante-natal, chiropody, cervical cytology and dentistry. There will also be specialist clinics for orthopaedics and ophthalmology. The centre is included in the Council's capital programme for 1969/70. King George Hospital Health Centre Undoubtedly the most exciting project of the year is the Health Centre planned in the grounds of King George Hospital. A group of three doctors in Newbury Park have for a long time been expressing a strong wish for a Health Centre in the area. The present Council clinic in that area is in a hired hall and the need for local authority premises is equally pressing. It was thought at first that the Regional Hospital Board might permit building on the site of the War Memorial Grounds, which land the Council is in the prolonged process of exchanging for hospital land in Barley Lane. This was not to be, as the Regional Hospital Board intends to build a new out-patients' department on the site and this project is so far in the future that it is not feasible to wait to Incorporate a Health Centre in the building, which would be a good position for it. After consultation the Regional Board agreed to allocate a plot of land in the North East corner of the hospital grounds for the Health Centre, which is included in the capital programme for 1969/70. 22 Six general practitioners wish to practise full-time from the Centre and one part-time. The full range of local authority services is envisaged and in addition consideration is being given to basing social workers at the centre so that full integration with local authority staff i.e., health visitors, midwives, district nurses and social workers, will be possible. Vista Drive Health Centre The site for the Vista Drive Health Centre has been reserved for some twenty years although the land is not in the Council's possession and is not likely to be until the route of the new M. 11 is decided. Three general practitioners practise in the area and all have expressed a wish to enter a Health Centre full-time. It may take some time to bring this project to the planning stage. Goodmayes Lane Health Centre Doctors practising in the neighbourhood of the proposed Goodmayes Lane Health Centre were unable, because of the distribution of their patients, to give undertakings that the; would close down their other surgeries and practise full-time from the Health Centre. The Ministry of Health is not in favour of propagating the branch surgery system in urban areas and discouraged the idea of a Health Centre on this site. The project has therefore been abandoned but the situation for doctors in the area is not so poor as it seemed at one stage, the Council being in the process of negotiating the purchase of land near Goodmayes Railway Goods Yards. Part of the land In question will be available for a Health Centre and even at this early stage 7 general practitioners have expressed a strong interest in practising from such a Health Centre. Health Centre on Goodmayes Railway land Barley Lane Health Centre The site in Barley Lane is one which had been reserved for Health Centre development for many years but exploration of the attitudes of doctors in the area has been discouraging. The site is such that it is not suitable for exclusive surgery premises for doctors with practices in the district. It seems likely that the project will have to be abandoned. Future Developments The Council having expressed itself in favour of the principle of health centres, future development depends on three factors, namely money, the attitude of general practitioners and the availability of land. Financing Finance will continue to remain uncertain for many years although new procedures for processing schemes at the Ministry of Health will enable planning to progress in a more certain way. The scheme submissions for other health projects are required to be at the Ministry in the November preceding the year in which loan sanction is expected to be sought, but in the case of health centres schemes may be submitted at any 23 time and an indication of the date of likely loan sanction may be available relatively early. A certain amount of inspired guesswork will still be required to place any project in the correct year of the Council's capital programme. Attitudes of General Practitioners The attitude of general practitioners in Redbridge to health centres practice was explored during the year. All doctors practising in the borough were sent a questionnaire and over half of those replying were In favour of health centres and would be willing to practise from one. It is likely that as the health centre programme gets under way that the proportion of those in favour will rise. In any event it appears to be an impossibility for very many years to provide premises for all who are in favour of health centres, although thia undoubtedly would have an effect on contributing to effective medical care of the community. Sites Land for health centres in these early stages is a problem which will continue to grow. The price of urban land riaea annually and it ia eaay to aee that in not very many yeara to put a health centre only on a plot of land will be uneconomic. Thia might lead to auch buildings being incorporated in blocka of flata and office buildings and the chances are that they will work very well once it la accepted that conaulting rooms need not be on the ground floor and may equally effectively be on the tenth or even the twentieth floor provided an efficient lift service la provided. It in possible that such a health centre may be neceaaary in the central re-development area. It will be the scarcity of geographically sultable siteas ore than any other factor which will prevent the reallaatlon of full health centre practice. SECTION 22 CARE OF MOTHERS AND YOUNG CHILDREN (by Dr. W. H. Toma, B.M., Ch.B.(Edin), Principal Medical Officer) November 1967 aaw the publication of the Sheldon Committee Report on the medical functiona and atafflng of child welfare centrea, where infant welfare clinica, toddlera clinica and child health clinica would be carried on. The Sheldon Committee enviaaged a child health aervlce as part of an integrated family health aervlce, provided by general practitionera working from purpoae-bullt health centrea. Aa, of 24 course, the function of child health clinics is preventive rather than curative, laying strong emphasis on early detection and assessment of handicaps, the general practitioner of the future would be responsible for the complete care of the child. This step forward assumes, of course, the establishment of health centres run by groups of doctors whose members would include those with a specitil Interest and skill in development paediatrics. Health visitors and other local authority staff would work closely with doctors practising from these centres, with the eventual aim of team work covering both preventive and curativc aspects of medical practice. The Report goes on to say that this is a picture of the future, but for many years to come a great deal of this type of workwith children will be carried out by local authority medical officers, who have more time to spend with the children and their parents than general practitioners, whose attitudes are at present largely conditioned by demands made upon them In the therapeutic field. In Redbridge we have, as well as our own full time staff, four family doctors running infant welfare and toddler clinics on our premises. These doctors do not deal exclusively with their own patients, though some are working from centres in their own practice areas, so at least we have made a start along the lines advocated by Sheldon. It is always administratively tidier, and therefore a temptation to employ full time staff for clinic work of this type, as one has more knowledge of their interests, capabilities and training than that of part time staff working on a sessional basis. If, however, our policy in the future is to pass most of this work across to our general practitioner colleagues, it will be most necessary to provide in-service training for all doctors working from child health centres, whether they be general practitioners or local authority staff. At present very limited facilities exist for the free training of general practitioners undertaking work in development paediatrics, and this must be remedied if this is to be their future responsibility. Particular emphasis' is laid in the Report on "screening" tests. These tests are designed to pick out a child with defect as early as possible, and thus ensure effective treatment. For example, all children in Redbridge have their urine tested in very early Infancy to see whether they are suffering from phenylketonuria, as prompt recognition of this condition prevents the onset of permanent mental defect. It may well be that in the next year or two this procedure will be replaced with a 25 more accurate blood test which detects a wider range of biochemical abnormalities All babies also have their hearing screened in the first year of life and up to quite recently this has been carried out around the age of one. We now feel this is best performed when the baby is six months old, and we are planning to bring this test forward to that age in the future. If hearing is impaired, language and speech are both affected and the child often suffers permanent handicap. It is most important to make sure that hearing defects are treated early. As four out of five babies are brought to our centres during the first year of life, it is relatively easy to see that screening tests such as these are carried out, but as children get older, attendances fall off, so that at two years of age when we hope to test for visual defects, only two out of five children are still visiting the centres. This is one of the reasons why so many school children, when they are first seen at infants' school, are found to be suffering from squint, the treatment of which at this stage is often only partly successful. I should very much like to see many more children between two and five attending our centres. The sacred cow of regular routine weighing of babies comes in for some criticism, the Committee feeling that unless medically indicated a child should only be weighed at its first attendance, and thereafter at yearly intervals. They also concluded that height increase was of more significance than weight gain, and this should be recorded annually. I hope here in Redbridge we can persuade mothers to accept less frequent weighing when their babies are obviously healthy. Also, whenever possible, I should like to see appointments offered to mothers of young children who wish to see the doctor. This would save much waiting and overcrowding of premises, and during the coming year I hope to see more of our centres adopting this practice. One of the most important and valuable functions of health service centres is the help given by medical staff to families with emotional problems, presenting usually as a problem involving the child and mother. It is of the utmost Importance that doctors, and indeed all our staff, can see parents and children in a relaxed atmosphere. Many problems of this nature can be handled by the staff attached to the centre — others may need to be referred to specialist services. In many cases, simply listening and discussion can lead to lessening of tensions in the family. Much good work of this type is at present being carried out, but with better premises and increased privacy, more can still be done. Here again, an appointments 26 system will ensure that a mother has a reasonable period with the doctor in which to discuss her problems. The Sheldon Report is of great value as it has brought sharply into focus the true aims of the child health service, many of which have already been achieved here in Redbridge. Full implementation of the Report may take 10-20 years and n fresh generation of doctors, whose appreciation of the value of this work would result from a new kind of undergraduate education. Births In 1967 there were 3627 live births in the Borough and the illegitimacy rate was 15-23 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 Generator in the case of residents outside the Borough to the responsible Health Authority. 83 such cases were reported in 1967, details of which are given in Appendix 9. The Observation Register Dr. Joan M. Pooley, M.B., B.S., D.C.H., Senior Departmental Officer reports as follows:— The Observation Register in Redbridge has now been in existence for two complete years. The same five groups of factors are still in use namely:- 1. Genetic 2. Pre-natal 3. Peri-natal 4. Post-natal 5. Symptomatic Routine medical examinations are carried out by Local Authority Departmental Medical Officers, or In some instances by the patient's General Practitioner in each case with the help of a Health Visitor. The comparative figures given below show:— 1. A slight decrease in the number of infants admitted to the register during 1967. 2. A decrease in the number of factors involved (indieating a slightly greater degree of selectivity In their application). 27 The following figures illustrate the comparative size of the Register for the years 1966 and 1967: — at 31.12.66 at 31.12.67 (i) Number on Register 1,192 2,060 (ii) Number admitted to Register 1,255 1,056 (iii) Corrected number of births 3,873 3,557 (iv) % Live births considered at risk 32.3% 29.7% (v) Number removed from Register 28 122 (vi) Cases transferred to other Authorities (but still reremaining "at risk") 67 97 (vii) Number of factors involved 1,681 1,406 An extensive re-valuation and review of the criteria of factors which determine the inclusion of an infant on the Observation Register in Redbridge has now been completed, and new record cards are being printed. The list of factors, though still comprehensive, is more specific and definitive, and should, therefore, result in a more selective, and less inflated Register. It has also been decided that Midwives as well as Health Visitors should complete the "Factor Forms", as obviously the Midwives are in a better position to give accurate details for Domiciliary Cases. One use of:— 1. Labstix instead of Uristix for Urinalysis and 2. The Apgar Scoring System for assessment of the condition of the newborn infant has now been instigated as far as possible throughout the Borough, thus ensuring greater accuracy in, and compatable methods of, recording clinical details. It is worthy of note that much discussion and research, concerning the usefulness of any "At Risk" Register, has been conducted and published throughout the country in recent months — with varying conclusions. 28 Walker (Scottish Home and Health Department, 1967) concludes in his excellent assessment, that critical administrative appraisal end evaluation, combined with regular and thorough clinical Investigation results in a worthwhile contribution to the early detection and treatment of handicap in infancy". He agrees, however, with the observations of Hamilton and Richards (Glasgow, 1968), that a proportion of handicaps would be missed if the search be confined only to the infants who are registered as "At Risk". Also of considerable import, are the recently published observations of a Working Group (appointed by the W.H.O. and who met in Copenhagen in November/December, 1966, under the Chairmanship of Dr. J. D. Kershaw) for the early detection and treatment of handicapping defects in young children. This Group considers that "Screening Schemes and Risk Registers should not be alternatives but complementary to each other", and later add that "Screening by observation will continue to be the most rewarding procedure in general". The term "Special Care Register" is suggested by the Group, as opposed to the term "At Risk Register" — in order to obtain the understanding of the parents. In the London Borough of Redbridge the term "Observation Register" is used. This is proving to be acceptable to parents, who might otherwise be unduly concerned by the registration of their child as being "At Risk". In each case, the mother is first visited by the Health Visitor and the position is simply explained in the home. Screening tests for hearing are also carried out routinely, and cases with doubtful results are referred for Audlometric Testing and investigation as soon as possible. The Register, as It is being conducted at present, Is surely bringing forward a new alertness and interest in all the branches of the medical and nursing professions. 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:— Dental treatment was available at all the Dental Clinics in the Borough to expectant, nursing mothers and children under five years old. However, most of these patients were treated at Kenwood and Mayesbrook Clinics. At Kenwood Clinic Mr. Willson, the senior Dental Officer and Miss Burns, Dental 29 Auxiliary, coped with the majority of the patients living in the Northern side of the Borough, and at Mayesbrook Clinic for the South Redbridge area. Dental Auxiliaries have proved very useful for very young children because often these patients need great patience for a small amount of work. It has been the aim of the dental service for several years to increase the number of young children inspected and treated. It is important that children should commence attending a Dental Surgeon at a very early Age, usually not later than two and a half years old. At this age very little treatment is required and the child is not frightened by more drastic treatment which would occur if it was left until school age. Also at this age dental health education with the parent can have more lasting benefit. More mothers are having their children seen at an earlier age than a few years hijo. This is occurring in the general dental service but we tend to receive more difficult children for treatment. Often they are referred by private practitioners who are unwilling to spend the excessive time of treating these patients. As already stated, more expectant and nursing mothers attend a general dental practitioner and following this the number of these patients treated in the Borough continued to drop. This is a good sign in that at least these patients are receiving treatment and so becoming more conscious of dental disease. The statistics for 1967 show that in the Borough the total visits made by children under five to clinics increased by 12% with a corresponding increase of 12% in the number of fillings. It is also worth noting that the number of extractions for these children dropped by 28%. This fact shows that if only more parents would take their children for conservative treatment the extraction of deciduous teeth would decrease considerably. We can only increase the number of small children attending dental clinics by co-opting the help of medical and nursing staff and all persons that are in contact with parents. Dental health education continued on similar lines to the previous years. Towards the end of 1967 the Dental Auxiliary commenced dental health in Day Nurseries. This seems to be very popular and could do a great deal of good. I hope to see this expand to all Nurseries in the Borough during 1968. Dental health education also continued in Clinics at Infant Welfare Centres, Ante-Natal, Post-Natal and Relaxation Clinics. One 30 evening session a week continued at Mayesbrook Clinic to assist mothers who are working or have very young children and find it difficult to attend during the day. It is noticeable that mothers attending in the evening are more relaxed and easier to treat. Dentures were supplied to mothers whenever it was considered necessary; these were made at a local dental laboratory. Specialist Clinics Specialists clinics for orthopaedic, ophthalmic, ear, nose and throat and speech defects were held and details of attendances of all children are shown on pages 63—65 and 86. Our two 50-place Day Nurseries, one in Ley Street and the other in Goodmayes Lane, have functioned smoothly all the year, making life more tolerable for parents with diverse problems, and offering their children care and affection. Young children are frequently the victims of illness, usually infectious, and as a result the nurseries are in quarantine from time to time. This accounts for the average daily take-up of places being only 31 where 50 could be accommodated. Five free places are available in each nursery for children whose attendance is indicated on medical grounds, otherwise parents are assessed to pay a charge based on their income. Some children, whose presence at a nursery is part of their general medical treatment, will benefit most from full-time attendance, but others may receive enough help from morning or afternoon attendance only. This appears to be a realistic way of using five places, and we are now starting to admit children in the medical category for parts of the day only. 7 or 8 children can thus occupy five "places" and spread the benefit further. Many experts in the field of day nursery management would like to see more "family grouping" introduced. The traditional day nursery is divided "horizontally" into different age groups, often occupying separate rooms and sharing nurses among the groups. Many excellent nurseries are run on these lines even though they in no way create an ordinary family situation. In "family grouping" at a nursery, children from two or five are placed in groups of mixed ages in the care of a nursery nurse. This nurse is permanently attached to the same group, who eat together and play together, forming far more warm and significant relationships than those possible in a room of children of the same age under the more impersonal care of two or three nurses. It is really a case of "my family", rather than "the nursery". Inevitably this substitute mother relationship 31 throws more demands on staff, but gives them more identity with the children and a greater understanding of them. Details of attendances at the nurseries are shown in Appendix 8. Private Day Nurseries and Child Minders During the year courses were run, designed to help proprietors and assistants in Day Nurseries to understand and satisfy the needs of the children for whom they assume responsibility. These courses, after rather an unenthusiastlc response, became increasingly popular. A double result was achieved through our contacts at every meeting. Firstly, we attempted to put across the true needs of young children — the needs for affection, space, good food and stimulating play. Experts in child care led the discussions and gave most interesting and useful demonstrations of different types of play materials. Behaviour problems, physical and mental development, food and nutrition, were all topics of discussion and time often ran out before talk dried up. This, I feel, usually indicates a useful meeting. The second result achieved, was a better relationship with people working in the "private sector* of nursery work. We started to see their problems and try and solve them together. It would be quire unrealistic to regard many workers in this 'human industry' as being vocationally inspired. They are in it for what they consider to be a reasonable profit though of course natural affection for young children is a basic personality requirement for the job. Any advice we can give on true economy in the nurseries, and by that I mean a transfer of expenditure from, say, expensive commercially produced toys to equally valuable and far cheaper alternatives is well worth passing on. The improved relationship reveals Itself too in the warmer welcome one receives when visiting the nurseries. This, I feel sure, stems from the relaxed social atmosphere of these evening meetings, when people are learning together about their job; and our legal responsibility is replaced for a time by an exchange of experience between people working in the fascinating field of child development. It is tempting to connect these new and closer ties with a remarkably uneventful year in the exercise of our legal prerogatives under the appropriate Act!! At the end of the year 49 day nurseries and 29 childminders were registered under the Act for the care of 2,229 children. 32 SECTION 23 MIDWIFERY Domiciliary Confinement Rate There were 3,598 births (3,557 live and 41 stillbirths) to Redbrldge mothers in 1967 and of these 797 were born at home, making a hospital confinement rate of 77.85% and a domiciliary confinement rate of 22.15%. There were 5 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:— At the end of the year the staff consisted of one nonmedical supervisor (with dual responsibilities) and fifteen midwives, two of whom were employed part-time. Baby Sparklet Oxygen apparatus can be used by midwives, if necessary, to enable the baby born at home to have oxygen in the first 10 minutes of life. The Entonox apparatus for the administration of the premixed nitrous oxide and oxygen have replaced the gas and air machines. There are thirteen Entonex for home confinements. Psychopi-ophylaxis in Childbirth One midwife, with one health visitor, attended a three day course (week-end) sponsored by the National Childbirth Trust. Sterile Maternity Equipment The pupil midwives from Barking Hospital are using prepacked sterilised maternity equipment for home delivery. This equipment is made up into packs and sterilised by the Central Sterilizing Department at Barking Hospital. Training of Pupil Midwives During the year 42 completed their training on the district and 41 passed the Central Midwives Board Part II examination. Obstetric Nurses Seventeen were given an insight into the domiciliary maternity services. Inspection of Midwives This was carried out by the non-medical Supervisor of Midwives. All the midwives maternity equipment was in good 33 order, and all regulations under the Dangerous Drug Act, 1953, were observed. SECTION 24 HEALTH VISITING st>rr At the end of the year there were 37 Health Visitors (including 6 Part-time) and 10 (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 11 shows the number and type of visits made. Miss J. Oliver, Superintendent Health Visitor, reports:— Private Day Nurseries and Childminders In order to raise the standard of care in these establishments throughout the Borough, discussions were held on how to give practical help to those running them and working in them, and it was decided to run short courses for groups of interested persons. Though the first course was poorly attended, subsequent courses held at Kenwood Gardens and Manford Way Clinics proved most popular. Speakers included a Day Nursery Matron and Warden, Health Visitors, a member from the Pre-school Play Groups Association and one of our Principal Medical Officers. Following visits to premises and discussion with the owners and helpers, we have identified many of the needs and problems arising in caring for children and in turn those working in the nurseries have realised that we are not purely a supervisory body but are interested in the welfare of the children. Consequently, even where staff have already had some training in child care, there is a growing Interest in any courses which the Borough may organise in the future. It is hoped to run a short course In Wanstead early In 1968. As a result of visits made it is encouraging to know that several nurseries and child-minders are willing to accept a handicapped child (whether the handicap is mental or physical) and it would seem that several of these children have benefited by mixing with 'normal' children. 34 Hearing Tests In May 1967, a pilot scheme was started at the Health and Welfare Department offering hearing tests to all babies over 6 months whose names were on the Observation Register. Attendances have been good and the service has extended to other clinics where suitable rooms are available. Toddler Clinics These have now become much more popular and the demand sometimes exceeds the number of medical officers available to run these sessions. Health Visitors use suitable, colourful toy material to assess the child and his capabilities before going in to Doctor. Mothers discuss all types of problems with the Doctors. Liaison with Consultant Paediatrician, King George Hospital Our liaison with the above has been slightly altered and the Health Visitor now does a round with the Ward Sister of all children who are in-patients. We are most grateful for the experience and exchange of information which we have had previously In the Out Patient Department. Further Training and Refresher Course Despite the increasing demand on the health visitors it has still been made possible for staff to further their education by attending various courses and Day Conferences. Management courses are much in the news today and Miss P. Collins was fortunate enough to be invited to attend a course run by the Essex County Council for ten weeks, on one day a week. We have now trained three Field Work Instructors. The remaining staff had many opportunities to go to Day Conferences on varying subjects. The work of the Health Visitor changes so quickly that it is most important to keep up to date. We have also met our colleagues the midwives, district nurses, both on study days and in small groups to discuss topics of mutual interest. Students from all disciplines continue to spend time in clinics and visiting with health visitors to observe their work. 35 Home Accidents 468 home visits have been made to homes following accidents to the under 5 years and to the over 60 years of age. This total is slightly less than previous years due to a shortage of staff towards the end of 1967. These visits are well worth while as unfortunately the number of accidents do not decrease. Mental Health The Redbridge Association of Professional Social Workers as a group have people from different departments and agencies concerned with social work in the Borough. The members at the Child Guidance Clinic kindly held a discussion group once a month for interested persons. The health visitors have joined in these to discuss cases in greater depth and learn from the members of the group. We have also assisted the Child Guidance Clinic in their Research Project on Children's Thinking*. We are involved in finding for the survey the correct children in age, sex and parents background. The final results will, without doubt, assist all Child Guidance staff and others in their work. A number of the Health Visitors staff also join in group discussion once weekly at Claybury Hospital. Two Health Visitors join in the group run by Dr. Wedeles at Kenwood Gardens Clinic. Student Health Visitors In accordance with the new Syllabus for the Training of Health Visitors, the students trained and seconded to the Borough having successfully passed their written exams then came to us for their practical three months training. Their practical work had to be the responsibility of the Superintendent Health Visitor or her deputy. This placed a particularly heavy burden on all staff because it was a holiday period. We had to make them feel part of the Local Authority Service, show enthusiasm and interest in their work as it was a trial period for them before being allowed full professional status. Each student worked with a reduced case load on the area they were later to take over. The Future of Health Visiting Generally, the dedicated spinster is now reaching the period of retirement; this particularly applies to the profession and and her loss will be very much felt in the community. The future depends on the service being covered by young married women who once having completed their contract, will leave to have their families. Once the family are grown up they will, we hope, come back into the Service. The turn over of staff 36 will therefore be rapid and with the general shortage of Health Visitors the future i uncertain. Despite the employment of ancillary staff, there are many duties which only the health visitor can carry out successfully. SECTION 25 HOME NURSING Home Nursing Details of the work undertaken during 1967 by the Home Nurses are as follows: — Total patients nursed — 2,900 Aged under 5 years — 46 Aged over 65 years — 1,848 Others 1,006 Miss M. A. Potter, Superintendent of Midwives and District Nurses reports as follows on the Home Nursing Service:- Hypothermia Survey The year commenced with a pilot survey into the incidence of hypothermia in the elderly. Visiting took place in January, February and March- Twenty people were selected at random each month and visited daily for one calendar month. Body temperatures, using a low reading thermometer and the current and minimum temperatures of the living room and bedroom, were recorded. A questionnaire was completed for each person. Dr. Shaw, Deputy Medical Officer of Health, who conducted the survey, submitted an Interesting written report on the findings of the survey. Group Practice Attachment Two district nurses are attached to "Group Practice Doctors". The larger group in Woodford consists of five doctors and the second group inIlford of three doctors. After the nurses became attached meetings took place between the doctors in the group practices, the Principal Medical Officer for Maternity and Child Health Service and the Superintendent of District Nurses. Both nurses have reported that their work has become more interesting and are enjoying the liaison with the doctors In their groups. 37 In October the district nurses commenced working In groups of six, according to their geographical visiting areas. A total of six groups exist, Including Woodford and Wanstead. This pattern of work structure benefits not only the patients who receive a continuity of nursing care but the nurses who become more familiar with the patient's social environment. Each group meets one afternoon during the week, when patient care and the following weeks programme of work are discussed. The staff, at the end of the year, consisted of 37 nurses, including three male nurses. The male nurses have patients from all groups and relieve each other. Student District Nurses 1 nurse undertook the Queen's Institute of District Nursing Course and passed the examination. State Enrolled Nurses Two full-time and one part-time State Enrolled Nurses have been appointed and are part of the total establishment, working under the guidance of experienced district nurses. One fulltime S.E.N, attended a *day release course" and passed the examination for S.E.N.'s held by the Queen's Institute of District Nursing. The second full-time S.E.N, is at present attending a similar course. Research Appreciation Course Miss Fredman and Mrs. Miles attended a three day course at Leicester University. This course had been arranged by the University and the Queen's Institute of District Nursing. Members attending the course came from Hospital, Industry, Catering and Local Authority staffs. Cervical Cytology One district nurse was given instruction in taking cervical smears, with a view to undertaking this type of work in the patient's own home. This nurse decided to become a Student Health Visitor and as a result, and until suitable staff are trained, we are unable to offer this service to the community. The Changing Face of Domiciliary Nursing Two nurses attended a one-day Conference on this theme, arranged by the Hritish Commonwealth Society. The Use and Abuse of Dangerous Drugs A one and a half day Study Conference was arranged by the Royal College of Nursing and two of our nurses attended. 38 SECTION 26 VACCINATION AND IMMUNISATION Vaccination and Immunisation Protection against diphtheria, whooping cough, tetanus and poliomyelitis is given at most of our infant welfare centres in the Borough, and by general practitioners, who in fact carry out about two-thirds of these immunisation procedures. The schedule of immunisation adopted in Redbridge aims at achieving primary protection against these four diseases by the age of six months, with appropriate boosters at 18 months and just before school entry. Protection rates, in so far as the primary course is concerned, are satisfactorily high, but the same cannot be said of the booster Injections, which maintain and stimulate the level of immunity in the child. A special effort should be made by mothers to bring their children to their doctor or clinic at 18 months, and again at 4½, so that immunity is kept at a high level. Vaccination against smallpox is carried out in the second year of life, and even though the percentage of children receiving vaccination at that time has risen from 29% in 1966 to 40% this year, the rate is still too low. Contracting distances, and immigration from countries where smallpox is endemic make it most desirable for vaccination against smallpox to be accepted as a routine in childhood. The tables in Appendices 12 and 13 show the number ol completed courses of immunisation by year of birth and the number of boosters given against these diseases. Note: Protection rates follow last year's format. SECTION 28 PREVENTION, CARE AND AFTER CARE including Renal Dialysis Convalescent Treatment Provision of Sickroom Equipment Chiropody Tuberculosis Cervical Cytology and Cancer Education Geriatric Clinic Renal Dialysis On two occasions in 1967, London hospitals have asked for our help in modification of homes for Renal Dialysis:- Until quite recently patients suffering from kidney failure 39 were obliged to spend two or three twelve-hour sessions each week in a special hospital unit where they could have the inpurities removed from their blood with a 'kidney machine. Essentially a kidney machine consists of a large area of permeable membrane through which toxic substances can be filtered. Within the last two years more machines suitable for installation In ordinary homes have become available and are supplied by the Regional Hospital Board to patients on a highly selective basis. The advantages of home dialysis are obvious. Wearisome journeys are cut out, domestic life continues in a normal way and patients are often able to continue at work. Under the National Health Service Act, Section 28, Care and After-care, an obligation rests upon the local authority to see homes are suitably converted. The coat of this conversion to the patient depends on his or her resources, but charges and spread of payment are arrived at using liberal criteria. I should like to express the appreciation of this Department to the Borough Engineer for the interest taken in this specialised work and for the speed and imagination used by their Department in their first venture into this field. I am quite sure we will do more and more work for the Hospital Renal Units as they receive increased numbers of Dialyslng Units from the manufacturers and patients themselves demand the independence that home dialysis gives them. Convalescent Treatment This service was continued on similar lines as in previous years. The total number of cases being sent away for a recuperative holiday during 1967 was 129 an increase of 14% over 1966. The majority of the cases are referred by hospitals and general practitioners for two weeks convalescent but some conditions are considered to need three weeks. There was no change in the contribution towards the cost of the convalescent holiday. Provision of Sick Room Equipment The Department continued to issue items of sickroom equipment to necessitous cases being nursed at home. Apart from the items available (see Appendix 14) disposable paper pads for incontinent patients are issued and when requested the soiled sheets can be collected and disposed of in a Local furnace. Protective clothing for certain types of incontinent people continues to be available on medical recommendation. 40 Chiropody Mr. Gibson reports as follows: — Elderly people often have many handicaps to cope with. Stiffness of the joints, the liability to diseases associated with ageing, perhaps obesity, all contribute to diminished mobility. Painful feet, added to a time like this, can well be the cause of a final retreat to the house or the bedroom, and this situation is one which our Chiropody Service seeks to postpone. What do Elderly people want? As reported in the Sunday Times (10.12.67) a recent survey was conducted in Birmingham when 26,383 people aged over 75 replied to the survey. They were given an opportunity to request help from the 17 Welfare Services, but only one in four requested any help at all and only one in ten from more than one of the services. The total requests were: — Chiropody 3,350 Rent Rebates 1,343 General Advice 1,104 Home Helps 1,017 Free Buses 879 Visiting 703 Meals on Wheels 535 Extra Pensions 534 Health Visitors 523 Day Centres 338 The Service we are providing is an excellent one much appreciated by our patients. It helps to keep the elderly mobile and enables them to take an active part in life, social contacts, shopping etc. It further delays the bed-ridden state in the semimobile and the delay or avoidance of hospitalisation in the domiciliary invalid. But there is room for considerable expansion if we are to satisfy the increasing demand for this service. During this year we had a total staff of 5 full-time and 6 part-time Chiropodists. We were able to provide a complete service at Clinics, Welfare Homes and where necessary at the patient's home. The Hospital Car Service enables many handicapped patients to attend the Clinics who would otherwise have to receive treatment at home, thus allowing the house-bound to take full advantage of the domiciliary service. The number of school children referred to the Clinics increased — indeed we had to resort to waiting lists. Most children referred had Plantar Warts but many had conditions 41 due to ill fitting shoes. Parents were advised regarding foot hygiene and shoes. Details of the patients seen are shown in Appendix 15. Tuberculosis After-Care Health Visitors 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. Facilities Other facilities which exist for the after-care of tuberculosis patients include assistance in the maintenance charges at rehabilitation settlements, provision of free milk, boarding out of child contacts. During 1967 one patient continued to reside in a rehabilitation settlement and financial assistance was provided towards his maintenance. One patient was provided with the British Red Cross domiciliary library service for which the Borough was financially responsible. A total of 205 patients were provided with free milk during the year, an Increase of 31, and the one open air shelter In the Borough continues to be occupied. Voluntary Bodies Mr. H. R. Stanbridge, Senior Administrative Officer in the Department's Maternity and Child Health Services Section, continues to undertake the secretarial work of the Ilford Tuberculosis and Chest Care Association and reports as follows: — The Ilford Tuberculosis and Chest Care Association continued to provide assistance to those necessitous cases where such help is not obtainable from statutory sources, such as fares enabling re latives to visit patients in hospital, assistance with fuel and light bills, payment of radio and television licences, television rental, clothing and extra nourishment. As in previous years the Committee of the Association are indebted to the Redbridge Borough Council for the financial help afforded to them and also for allowing their administration to be undertaken from the Health and Welfare Department. 42 Details of assistance given during 1967 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) 51 414 I including I renewals Other grants 63 69 Cervical Cytology and Cancer Education This service continued to operate smoothly throughout 1967. Demand for appointments was well maintained until the latter end of the year, when a decrease in applicants for appointments made us reduce the clinics held at the Public Health Offices from two to one every thing Thursday. A letter from your Chairman to the Press, pointing out the necessity for, and the value of this service, resulted in a gratifying response and we were able, before the year was out, to resume our two sessions every week. Plans were made to extend the service to Wanstead and Hainault in 1968 when it is proposed to hold a session twice a month at Wanstead Place Clinic, and sessions on "demand' basis at Manford Way Clinic. At the Public Health Offices teaching is given on selfexamination of the breasts when women attend for smear tests, and this offers an excellent opportunity to discuss the signs of breast cancer. Self-examination is the most practical method at present of achieving early diagnosis, but most probably in the future women in the "at risk" age group will have periodic special X-ray examinations designed to detect malignant growths at a far earlier stage than any form of external physical examination. I think it is of some interest here to note that while our doctors and nurses were instructing women In this technique, three breast tumours were discovered and referred for treatment. This surely supports the case for periodic medical checks for women in certain age groups. 2,190 smears were taken in 1967 at our clinics, and 6 positive findings were recorded. This of course is ample justification for the service. Geriatric Clinic At the suggestion of a General Practitioner enquiries were made into the possibility of holding special sessions at a local clinic for the purpose of screening elderly patients. 43 The proposal was to examine people immediately on retirement or approaching retirement age so that a moving picture of the patient could be built up over the years in an attempt to watch health trends and avoid illness. With the approval of the Council and the Local Medical Committee those doctors practising in the Clayhall area of the Borough were approached with the suggestion that they should staff the clinic on a rota basis and that patients born in 1901 who were on their medical lists should be invited for examination. The first session was held at the Heathcote Clinic on 10th January, 1967 and has been held fortnightly since, two doctors being in attendance at each session. The total number of patients examined in the year were 129 out of 180 appointments made and of those examined 19 were referred to their own medical practitioner for further advice or treatment. So successful has the Clinic become that it is proposed to extend the service to another section of the Borough early in 1968. SECTION 29 HOME HELP SERVICE Home Helps The Department continued to provide a valuable service to the acute and chronic sick or infirm in the Borough. Despite the demand for help exceeding the staff available every effort was made to supply some help to all eligible applicants: — Mrs. Lawrence, Senior Home Help Organiser, reports:— 234 Home Helps were employed in the London Borough of Redbridge, as at the year ending 1967. These numbers vary from month to month. 2,033 applications for service were received during the year 1967. 3,081 cases Including those from the previous year were served during 1967, including aged-over 65 years of age, chronic sick — over and under 65 years of age, domiciliary confinements and problem family cases. 23 applications were received for Night Attendance, 18 of of whom were served, the remaining 5 were admitted to hospital 44 or deceased. Applications to provide service to motherless children are increasing, this often entails early morning and late evening duties. All applications are visited by the Organiser before help is given, this is essential to enable her to assess the needs of the household and to ensure that the right type of Home Help is allocated. The demand being greater than the supply priority is given to those in most need but every effort is made to supply some help to all eligible applicants. In conjunction with the Health Education Service two In Service Training courses for the Home Helps employed in the Wanstead and Woodford area of the Borough were held during the year. At these courses, the Helps received talks from quailfied members of the staff and included the Children's Officer, s Chiropodist, a District Nurse and Domiciliary Midwife and a Health Visitor. Advice was given on such subjects as cooking, diet, care of the feet and any other aspects they would meet during the course of their duties. General discussion followed each talk which greatly helped to impress upon those present the value of the service being given to the acute and chronic sick or infirm in the Borough. The structure of the Health and Welfare services became more apparent and emphasised the close liaison which should and does exist between them and all other members of the Department. 45 APPENDIX 8 CLINIC PREMISES CHADWELL CHRISTIAN MISSION HALL, Essex Road, Chadwell Heath. ALL SAINTS CHURCH HALL, Woodford Wells. BAPTIST CHURCH HALL, Dover Road, E.I2. 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), Chlgwell. ASHTON PLAYING FIELDS PAVILION, Chlgwell Road, Woodford Green. ST. LUKES CHURCH HALL, Baxter Road, Ilford. 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, Perry mans 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. (Closed w.e.f. 29.12.67). MEMORIAL HALL, Parish Church, E.18. FULLWELL CROSS LIBRARY, High Street, Barkingside. 46 APPENDIX 9 Details of the cases of Congenital Abnormality as reported to the Registrar General during 1967 Abnormality of Uro Genital Tract 2 Spina Bifida 5 Meningomyelocele Hypospadias 2 Anencephaly Hare Lip, Cleft Palate 5 Deformity of Wrist Feet or Hands etc. Down's Syndrome 3 Multiple Congenital Defects 1 Accessory Auricle 3 Congenital Heart Disease 1 Talipes 17 Hydrocele 3 Hydrocephalus 4 Atelectasis 1 Exomphalus Congenital Heart 1 Pilonidal Sinus Defects of Kidney and Ureter 1 Defects of Bladder and Urethra 1 Renal Agenesis 1 Hydronephrosis 1 Vascular Defects of Skin 1 Defects of Endocrine Glands 1 Defects of Face and Neck 1 Ventricular Septal Defect Diaphragmatic Hernia 1 Defects Alimentary System 1 APPENDIX 10 DAY NURSERIES Details of attendances during 1967 Name of Day Number of Total Average Daily Nursery Approved Places Attendances Attendance Ley Street 50 9,898 31.5 Goodmayes Lane 50 9,761 30.8 47 APPENDIX 11 Cases Visited by Health Visitor Number of Cases 1 Children born in 1967 3,382 2 Children born in 1966 3,377 3 Children born in 1962-65 9,765 4 Total number of children in lines 1 — 3 16,524 5 Persons aged 65 or over 1,618 6 Number included in line 5 who were visited at the special request of a G.P. or hospital 171 7 Mentally disordered persons 54 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) 31 10 Number included in line 9 who were visited at the special request of a G.P. or hospital 24 11 Number of tuberculous households visited 32 12 Number of households visited on account of other infectious diseases 31 13 Number of tuberculous households visited by tuberculosis visitors 805 APPENDIX 12 Completed Primary Courses — Number of persons under age 16 Type of vaccine Year of Birth Others under age 16 Total 1967 1966 1965 1964 1960-63 Diphtheria 1,089 1,988 273 74 170 94 3,688 Whooping Cough 1,081 1,974 265 66 96 24 3,506 Tetanus 1,086 1,993 277 79 268 738 4,441 Poliomyelitis 1,025 1,988 266 71 171 114 3,635 48 APPENDIX 13 Reinforcing Doses — Number of persons under age 16 Type of vaccine Year of birth Others under age 16 Total 1967 1966 1965 1964 1960-63 Diphtheria 2 572 1,084 186 2,233 234 4,311 Whooping Cough 2 545 1,024 138 517 52 2,278 Tetanus 2 572 1,085 189 2,195 338 4,381 Poliomyelitis - 659 982 198 2,285 160 4,284 APPEM)IX 14 The following articles of sickroom equipment are available on loan from the Health and Welfare Department Mattresses (Dunlopillo and hair) Linen Draw Sheets Invalid Chairs Bed-pans Rings (air and Dunlopillo) Feeding-cups Back-rests Urinals Beds (air, water and ripple) Sputum-Mugs Hospital Beds Bed Blocks Commodes Lifting Pole and Chain Fracture Boards Rubber Toilet Seats Plastic Sheets Crutches and Walking Aids Bed-cradles Hydraulic Hoists APPENDIX 15 CHIROPODY SERVICE Details of new cases and treatment given in 1967 New Cases Treatments Children under school leaving age 223 1,271 Expectant mothers 25 60 Physically handicapped 143 483 Persons aged 65 years or over 946 21.964, TOTALS 1,337 23,778 HEALTH EDUCATION 49 H E A LT H EDUCATION Kathleen Griffiths Health Education Officer "Remember" they used to say "remember the five 'Ps' of Health Education "Pushing Posters and Pamphlets to Passive People". And then the "quote" from an annual report "this year great progress has been made — 12,000 pamphlets have been distributed — an increase of 2,000 on the previous year These older concepts of massive distribution of posters and leaflets as being health education tre being replaced by new techniques using general teaching principles and methods. Many more senior school children and students carry out their own project work, and the role of the health education section is to guide interests along specific lines and act as a reference point. Looking back on an eventful year, it will only be possible to pick out some facets of the educational work carried out by many members of staff who collec: no publicity, and therefore, any picture that we attempt to pa.rit will be deficient. 1967 has been a year of challenge — a year which has seen work expansion and in the introduction of new ideas and programmes. The appointment of Miss V. Blanchard as Assistant Health Education Officer in January resulted in a considerable amount of health teaching carried out both in schools and at the clinics, and whose work earned the respect of Head Teachers and Stafl's in a number of schools in the Borough. It resulted, too, in establishing a place for health education within the school syllabus. Although Miss Blanchard has since resigned her appointment, her work will be remembered and continued. Health Visitors and public health inspectors have continued to contribute to health programmes in schools — their subjects ranging from general principles of hygiene and health to accident prevention and personal relationships and education for family life. Mothercraft courses are a valuable part of programmes for senior secondary girls — as one girl put It — "We think these, courses are very useful — its a pity that boys don't have something like it". Health education is an established part of the clinics held by the Health Visitors. Relaxation classes, toddlers clinics and mother's clubs have been organised to include short teaching programmes and the small numbers attending allow for useful, free and open discussion:— 50 To recall past events and to analyse them In retrospect can do little Justice to those who participate In particular programmes. Examples of some specific projects was the Introduction of: — Cancer Education during the weekly cervical cytology clinics held at the Health and Welfare Offices, a tape-recording was produced within the department, explaining the need for women to carry out self-examination of the breast, and together with the use of film to demonstrate this technique. Many people have real fear and anxieties which are allayed during the •questions and answers" sessions. Leaflets were handed out to reinforce the teaching. Attention of the public has been drawn to the Smear Test Clinics by distribution of posters and leaflets throughout the Thorough. It is hoped to extend this service to I wo new clinics which are to be set up early In 1968. Smoking and Health Education has continued with a view to discouraging young people taking up the cigarette smoking habit. Publicity material, part of the Ministry of Health campaign, has been distributed throughout the Borough. Mental Health Week In conjunction with the Youth Employment Officer, a School Leaver'3 Conference was held on the theme "Careers and Voluntary Service in Mental Health". Many boys and girls attended, and It proved to be a useful starting point for those who wished to make some sort of contribution to services for the mentally handicapped, and for which visits to Claybury and Goodmayes Hospitals were arranged. Dental Health Expansion of programmes In schools and at clinics has been possible with the contribution made by Miss Evelyn E. Burns, Dental Auxiliary. As well as class teaching, she has established small informal group discussions at Infant welfare clinics, and Is planning to start teaching sessions for staff, parents and children at day nurseries. This emphasis on establishing healthy routine with pre-school age children Is particularly Important. Toothbrushes have been distributed at several Infants and junior schools; with the consent and co-operation of teaching staffs toothbrushlng is carried out after school lunches. Toothbrushes are also on sale at the dental clinics at a cost of 3d. each. This Is an example of health education. Imparting 51 knowledge and giving the means whereby that knowledge can be put into practice. Staff — In-Service Training It was quickly realised that in order to keep up to date with current information, new methods and techniques, meetings should be held to exchange ideas, to comment and question, to evaluate. Although there are difficulties concerned with the attendance of staff at meetings, we are glad that occasionally courses can be held which have been well attended. Ono example was the course for Home Helps held once a week over a period of six weeks and the ahort courses for child minders and day nursery superintendents. Their effectiveness was shown by the questions that were asked and the exchange of information from each other. Mass Media Display boards have been constructed and set up at. clinics where this was necessary, and supplies of posters and publicity material sent out on a regular monthly basis. The display of posters has continued at local underground stations and on public notice boards snd in all the Borough Libraries. The local press has also assisted in publicising particular health problems and drawing attention of the importance of preventive medicine as a public health measure. Summary At least twenty-three junior schools and twelve secondary schools in the Borough have received a course of health talks and discussions and in many cases these courses are an integral part of the school syllabus. There has been a continuing increase in requests from teachers for information — for speakers on specific health topics and for visits to the various departmental establishments such as day nurseries and old people's homes and clinics. Although the Interest in health education has continued to increase in girls' schools, we hope that these courses will soon become an integral part of the syllabus in boys' schools. Whilst talks and group discussions dealing with personal relationships are of value, there is no doubt that they raise questions and possibly anxieties within the minds of those young people who perhaps are more reticent and more sensitive than their classmates. They may be in a dilemma, bewildered at Society's rather rigid attitude on the one hand, and permis- 52 siveness on the other. "How should I behave with my boyfriend?" — "Why is Venereal Disease a problem if it can be treated in hospital?", are not surprising questions. On the other hand, many groups of senior school children to whom we talk have sound value judgements which they have thought out for themselves. They are mature judgements and perhaps they have more clear-cut and soundly based principles than some of us, their elders. Nevertheless teenagers' questions that are not raised during group discussions do need to be answered in privacy and in confidence by a sympathetic and experienced "listener". There is a place for a schools counsellor where a boy or girl can "talk out" their problems. Health talks and discussions have also been carried out with a number of adult organisations In the Borough. Specific action campaigns have been conducted according to need and resources available. There is a limited value in talking to adults and one cannot be too optimistic about changing attitudes and habits. The moss media, especiallj television, may be a moire useful tool for adult education. However, it is felt that health courses for groups of parents would be a useful reinforcement of the teaching carried out in the schools for their children. HEALTH EDUCATION - GROUP TEACHING 1967 TABLE 1 TABI.K 2 53 Acknowledgements A number of staff In the Health and Welfare Department have contributed to teaching projects throughout the year, notably health visitors and sometimes doctors. The social workers, dental staff and public health inspectors have also been part of the team. Help in other ways, for example, the co-operation of Mr. Thompson and transport staff has enabled us to provide the health visitors with prepared teaching chart* and teaching aids whenever they have been required. Not least is the valuable contribution made by the health education technician in the preparation and construction of many audio/visual aids — ranging from tape recordings to teaching charts. Our thanks are extended to Mr. G. J. Bohannon for his help, as well as to the Departmental secretaries, especially to Mrs. Valerie Aiken for her valuable assistance and co-operation throughout the year. Sometimes there does not appear to be any appreciable change in our knowledge and beliefs so that it may be timely to remind the health educator — "never make abrupt changes in peoples' attitudes and habits" — "revolution breeds counter-revolution — evolution is painless"! Home Safety Home Safety Mr. David Ennals (Secretary of State at the Home Office) at the National Home Safety Conference in 1967, said that 200,000 people were seriously injured and five million people attend hospital each year due to Home Accidents. What emerged, was the question of human factor as opposed to the environment in Home accidents. And it is, of course, our task as members of the Redbridge Home Safety Committee and as health educators to convey this information. How do we do it? In Schools the subject is dealt with in relation to Accident Prevention as part of Health Education programmes. Duke of Edinburgh Award Scheme programmes are carried out by senior school girls and at Youth Organisations. Many staff in the Department are asked to participate in these courses and to test candidates for Home Safety Examination. Talks and discussions to voluntary and professional organisations. Participation in RoSPA National Campaigns by distribution of publicity material depicting specific subjects at three-monthly Intervals. Several Building Societies in Ilford and Woodford have kindly offered us space for window displays and on one occasion the subject of Accidents to the Elderly was dealt with, and on the other Holiday Safety. We are grateful for the opportunity to publicise this important subject. 54 CONCLUSIONS OF AN ANTI-SMOKINO CAMl'AIf.N (by Or. G. B. Taylor) The previous surveys carried out among the population of Ilford suggested that smoking was a true addiction. In the report of lf'63 I felt that there was little purpose in spending any more lime on the smoking population because, although they accepted the medical facts that smoking was associated with bronchitis and lung cancer, they were unable to stop the habit. It followed from this, that smoking should be treated as a true addiction and the addicts treated at special Smoking Clinics supervised by Doctors trained in the treatment of drug addiction. The only other approach was to prevent the addiction by health education, and this seemed the more feasible project. Two Secondary Boys' Schools, Mayfield and Fairlop were chosen for the Survey. Approximately 100 boys at each of the two schools were divided into a Test Group and a Control Group. The Control Group were given no health education at all, whilst the Test Group were given health education lectures every term. It was felt that, by dividing the boys into two such Groups, a valid comparison could be drawn on the effects of health education. The lectures began when the boys were aged 11 and continued for four years. The plan of the campaign was not to concentrate on smoking directly, but to bring this in, merely as a subject of health. The initial health education lectures were on general topics such as clothing, good housing, exercise, etc. Then the necessity for clean food was discussed; children were told that, if they ate infected food, then they would suffer from gastroenteritis and, likewise, if they drank infected water, they were liable to suffer from certain serious illnesses. When they had realised the need for pure food and pure water, their attention was drawn to the fact that it was just as necessary, for the maintenance of health, that they should breath pure air. In order to demonstrate this, they were shown the actual X-Rays of different dust diseases; silicosis, a dust disease common among coal miners and stannosis, a disease common among tin miners, were shown. The boys were told that these dust diseases, although they incapacitate the patient by making breathing difficult, never turned to cancer and, therefore, not all dust diseases produce cancer. They were then shown X-Rays which were known to be pre-cancerous, although not 55 always progressing to cancer itself. One of these, abestosis, is caused by breathing in the dust from asbestos and occurs in asbestos workers. Needless to say, asbestos workers are now subjected to rigorous routine medical inspections to exclude disease of the lung whilst they are engaged in this type of work. Finally, the boys were shown X-Rays of cancer of the lung occurring in cigarette smokers and they, therefore, accepted this as one of the many dust diseases. Having outlined the radiology of the dust diseases and discussed the environmental aspects, they were then shown slides of the different types of lung cancer. Not all types of lung cancer are due to cigaratte smoking and this explaing why some people, who are non-smokers, occasionally develop the disease. Graphs, demonstrating the increase in cancer of the lung, were discussed, and it is interesting to note that, during the study, deaths from lung cancer in cigarette smokers, continued to rise by 1,000 a year and this mortality has continued up to the present day. The boys were interested in treatment of cancer of the lung and the surgical, radiotherapeutic and hormonal aspects of treatment were discussed. The question naturally arose as to what the prognosis of this disease was and, generally speaking, the boys were told that there was an average expectation of life of only five years. Of course, this expectation of life depends upon the type of cancer and, also, the stage at which it is initially diagnosed but, rather than go deeply into the prognosis, they were given, what I consider to be, a very fair figure of five years expectation of life. The above is a summary of the general approach to the boys of this Survey, and it was only in the last two years that cigarette smoking and cancer were concentrated upon. Questionnaires, as printed on the following page, were given to both Groups before the Survey began. 56 COPY OF QUESTIONNAIRE USED IN THE SURVEY Q.l. DOES YOUR FATHER SMOKE? Ye. No Q.2. DOES YOUR MOTHER SMOKE? Ye. No Q.3. ARE YOU ALLOWED TO SMOKE AT HOME? Ye. No Don't knew Q.4. DO YOU SMOKE? Y No Q.S. HAVE YOU EVER SMOKED? Y No Q.6. HOW MANY CIGARETTES HAVE YOU None SMOKED DURING THE LAST 7 DAYS? Between 1 end 5 Between 6 .ml 10 more then 10 9 10 11 Q.7. DO YOU PERSONALLY THINK THAT Ye. SMOKING MAY CAUSE SERIOUS ILL- No NESS? Don't know A similar questionnaire was given at the end of the four-yeer Survey. These questionnaires were devised by Dr. Rose of the London School of Hygiene and Tropical Medicine, and he, kindly, carried out the Statistical Survey. His report is follows:— "Mayfield 1. The differences between the proportions of positive replies given by the treatment end control forms pre-surrey are not significant (P > 0.2 for each queatlon) I.e. It would seem that the 2 groups are Initially comparable with respect to these questions. 2. Post-survey the differences between treatment and control forms are all within chance limits except for Question 2 (where X2 6.355,1 degree of freedom, P.01 > P. > 0.01, i.e.; 57 differences of this size likely to occur by chance less often than 1 in 50 such tests). Thus the only 'significant' effect is an apparent reduction in the number of mothers reported as smoking. Although the other differences are within chance limits, this does not mean that they may not be real — only that one cannot be sure. They are in fact in the direction that would be expected from a beneficial effect of the programme. Falrlop 1. The differences between the treatment groups here and at Mayfield pre-survey are not significant. The difference!! post-survey between the treatment and control groups nre not significant, except for Question 1 (fathers smoking), where x2 (1 d.l.) - 4.321, 0.05 > P> 0.02. For Question 2 the difference is in the same direction as lit Mayfield, but is not 'significant'. General Conclusion There is a strong suggestion that the education reduced the number of parents reported as smoking. The difference in boyrf smoking habits between treatment and control groups are consistant with a modest benefit, but they are not statistically significant." I cannot add anything more to the succinct general conclusion which Dr. Rose drew. I would like to thank Mr. Hicks, Headmaster of Mayfield and Mr. C. Brantlngham (not present head) Headmaster of Fairlop for their co-operation. Also Miss Griffiths, Health Education Officer, for her help in the preparation of this report. 58 SCHOOL 1 - MAYFBELD 30YS 'Treated' Groups Positive Replies (excluding Q.6 - Nil) F orm No. of Boy# Q.l Q.2 Q.3 Q.4 Q.5 Q.6 Q.7 Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post XA1 30 33 25 24 17 13 2 2 2 4 19 24 30 29 24 26 1B2 25 17 18 12 13 9 1 1 5 •7 13 14 n3 .3 11 24 15 Total 55 50 43 36 30 22 3 3 7 11 32 38 53 40 48 41 Percentage 78.181 72 54.545 44 5.455 6 12.727 22 58.182 76 96.364 80 87.273 82 'Control' Groups Form No. of Boys Q.l Q.2 Q.3 Q.4 Q.5 Q.6 Q.7 Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post 1A2 31 26 23 23 19 19 3 3 3 11 15 22 27 15 23 20 1Bl 24 18 23 13 12 9 3 1 5 4 16 13 22 13 19 12 T otal 55 44 46 36 31 28 6 4 8 15 31 35 49 28 42 32 Percentage 83.636 81.818 56.364 63.636 10.909 9.091 14.545 34.091 56.363 79.545 89.091 63.636 76.364 72.727 59 SCHOOL 2 — FAIRLOP BOYS 'Treated' Groups Positive Replies (excluding Q.6 - Nil) Form No. of Boys Q.l Q.2 Q.3 Q.4 Q.5 Q.6 Q.7 Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post 1A2 28 30 22 20 15 17 0 4 0 18 16 22 27 14 27 18 1B 27 24 22 14 20 9 0 4 7 11 19 16 20 14 24 11 Total 55 54 44 34 35 26 0 8 7 29 35 38 47 28 51 29 Percentage 80 62.963 63.636 48.148 0 14.815 12.727 53.704 63.636 70.370 85.455 51.852 92.727 53.704 'Control' Groups F orm No. of Boys Q.l Q.2 Q.3 Q.4 Q.5 Q.6 Q.7 Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post Pre. Post 1A1 4XI 7 34 7 26 7 18 7 7 7 11 7 23 7 23 7 22 1C 4S 7 14 7 14 7 10 7 4 7 9 7 11 7 7 7 5 Total 7 48 7 40 7 28 7 11 7 20 7 34 7 30 7 27 Percentage 83.333 58.333 22.917 41.667 70.833 62.5 56.25 EDUCATION ACT 1944 61 SCHOOL HEALTH SERVICE (by w. H. Toms, M.D., Ch.B.(Edin.). Principal Medical Officer). Medical Officers, full and part-time, on the school health service staff, examined 9307 children in schools in 1967. This represents a 60% Increase over the number examined the previous year, and means that all children were seen after school entry, at twelve, and before leaving school. In addition, vision and hearing were screened at more frequent Intervals by our team of technicians. The school psychological service, through the educational psychologists contributed more and more In the identification and treatment of emotional problems occurring in school children — a role they now share with the school doctor — and which, until relatively recently has been an entirely medical responsibility. This all represents good clinical supervision of the child in school and it is tempting to accept the amount and quality of work done as in itself evidence of Its value without looking too deeply into its relationship with the alms of the service. Promotion of physical and mental health is the major Justification for the existence of a school health service. Without proper emphasis on this, its purpose can easily be frustrated. Involvement in health education, both in groups and in more formal courses, liaison with child guidance clinics, regular visits in the schools leading to discussion with the staff when they feel need for advice on either the child's physical or mental condition — these are some of the many ways in addition to medical examinations In which the school health service should contribute to the welfare of the child. This should all be part of a continuing process more important than the ritual of medical examinations at the age of twelve and before leaving school, except where handicap is known or suspected to exist. The great majority of defects should be discovered at the first examination in infant school and with this in mind much more time should be allowed for this examination than at present is the practice. We have left behind the days when children developed serious illnesses over the whole period of their school life leaving some with severe residual defects. Defects of vision and hearing do, of course, develop at any time in the school career, but with regular screening tests, independent of medical examination, these should be detected early and specialist advice obtained. 62 It would seem logical In what Is still an understaffed service to concentrate medical skill on those children known to suffer from handicap, reserving formal examinations for older children, only when indicated by contents of question* naires filled In by parents or after discussion with the school staff. School Roll & Premises The school roll on 31st December, 1967 was 31,364. These children attended 65 schools and the figure includes 96 at the Ethel Davis School for physically handicapped children. Medical Inspections 9,307 medical inspections were carried out in 1967 and of these only 37 were seen whose general physical condition was considered to be unsatisfactory (Appendix 16 Table A). In addition 1,511 special examinations were carried out (Appendix 16 Table 13). Screening Tests of Vision and Hearing This service which was commenced in April 1966 h«§ proved so beneficial that a second Keystone Teleblnocultr vision screener was obtained with a consequent Increase in the number of children visually screened at Bchool of 130%. Simplified Statlstlcs:- Number Tested Number Passed Total Number of Defects Number Referred for Advice Vision 15,529 11,083 4,446 1,929 Number Tested Number Passed Number Advised further Test Number Referred for Advice Hearing 10,915 9,469 1,231 215 Staffing There were some changes in the Medical Staff during 1967 and we were sorry to lose the services of: — Dr. F. E. O'Connor-Wilson who retired and Dr. M. Gee who died in October Dr. A. J. Crompton resigned to take up duties elsewhere. However, we welcomed Dr. A. J. Howell, Dr. J. K. Anand and Dr. M. DasGupta to the full time establishment during the ve ar. Special Schools and Specialist Clinic These are the subject of individual reports by Consultants and Medical Officers in charge. 63 Statistics The Department of Education and Science Returns are printed in the Appendix. Medical Treatment Minor Ailment Clinics: 327 children attended various clinics throughout the Borough in respect of minor aliments. Recuperative Holidays During 1967, 18 children were recommended for recuperative holidays und were placed by the Chief Education Officer. Ophthalmic Clinic Specialist Clinics Four clinics are evenly spread within various parts of the □orough. The Summary of Attendances of children is as follows: — No. of Session! New Cases Old Cases T otal Attendsnces New Spectacles Prescribed Spectacles Repaired or Replaced Kenwood Gdns. 98 358 706 1,350 453 100 Mayesbrook 88 312 469 1,487 359 75 Manford Way 31 51 158 378 90 21 Wanstead Place 33 121 276 512 155 38 Totals 250 842 1,609 3,727 1,057 234 Dr. P. Dhir, Ophthalmologist at Kenwood Gardens Clinic, rsports as follows:— The general atmosphere of the Ophthalmic Clinic remains pleasant. The nursing staff are very understanding and efficient. There Is a first rate optical service provided in the Clinic for the supply of glasses if required. The Clinic caters for a large area of Ilford and the neighbouring districts and cases are referred not only from the Schools and Infant Welfare Centres but also from the vision screening carried out in all schools. There are as well quite a number of children who after having squint operations at King George Hospital are referred to the School Eye Clinics for subsequent examinations and follow up treatment. With such a large number of squint cases which require special care,the attendance of an Orthoptist at the Clinic would be extremely beneficial for all concerned and would further Improve the services of this well organised Clinic. 64 Dr. G. F. Ensor, Consultant Ophthalmologist submits the following report on the work of the Wanstead Place Ophthalmic Clinic:— "We have had a full year without any difficulties, the Clinic remaining extremely busy and very harmonious. There seems to be variable results obtained from the screening at the School Medical Inspections, and I feel it would agree with the views recently expressed by the Faculty of Ophthalmologists If doubtful cases were re-tested by the longer established method. Nevertheless, it Is obviously a great help to the children when their myopia is spotted In the early stages as is possible In this day and age." Orthoptic Clinics Orthoptic Clinics, Indispensable to a satisfactory Ophthalmic Service, have been held at Mayesbrook and Wansteid Place Clinics staffed by one Orthoptlst in each case. In addition some patients living In the North Ilford area were seen by arrangements at King George Hospital. Summary of Attendances No. of Sessions New Cases Investigated Total Attendances Cases Discharged Cases in Attendance at 31.12.67. Mayesbrook 166 108 563 54 195 Wanstead Place 44 39 178 10 191 Totals 210 147 741 64 386 Orthopaedic Clinics Clinics were held In four areas of the Borough, the Con* sultants being Mr. H. G. Korvln, F.R.C.S., st Kenwood Gardens and Mayesbrook, and Mr. Mark L. Mason, F.R.C.S., at Manford Way and Woodford. A summary of the attendances of school children these clinics is as follows:— 65  No. of Sessions New Cases Old Cases Total Attendances Kenwood Gdns. 44 137 308 626 Mayesbrook 22 98 116 314 Manford Way 7 16 23 46 Wansteod Place 9 26 37 86 Totals 82 277 484 1,072 Mr. H. G. Korvln, F.R.C.S., Consultant Orthopaedic Surgeon, submits the following report of the work undertaken in the clinics under his control:— "The Clinics at Kenwood Gardens and Mayesbrook were conducted during 19(57 In the usual way. Attendance was satisfactory. Close co-operation between the Infant Welfare Clinics, School Clinics, and consultative Clinics promoted efficiency, especially In the field of early detection of abnormalities, with the occasional reward of a prompt and perfect cure. The co-operation of the midwifery service should also be mentioned in this connection as being of paramount Importance. There was a change in the provision of orthopaedic appliances which is now being carried out by a local firm Orthoplastics Ltd. As I have now retired from East Ham Memorial Hospital, operative cases requiring admission are no longer referred there but to King George Hospital, where Mr. Bryson has kindly agreed to carry out any necessary operations. I would like to take the opportunity to thank the Principal School Medical Officer and the Hospital Management Committee for allowing me to continue my work at the orthopaedic School Clinics. I find it very satisfying and appreciate the ideal conditions under which it is carried out." During the year 48 pairs of valgus insoles, 1 pair of surgical boots, 12 pairs night splints, 2 pairs calipers, 316 pairs of wedges to shoes, 1 urinal, 1 abdominal plate and 1 protective skull cap were supplied to children. 226 cases were discharged from the Orthopaedic Clinics 24 as cured, 53 due to failure to attend for further treatment, 66 43 left school or left the district and 106 as showing Improvement and were kept under observation by the departmental medical officers. Remedial Exercises and Physiotherapy The Ilford and District Hospital Management Committee were still unable to supply the services of a physiotheraplat for our Kenwood Gardens and Mayesbrook Clinics and we have appreciated the help of Mr. Brand, Superintendent Phyalotherapist at the Ethel Davies School, who has again held one session per week at each clinic to treat cases of some urgency Mrs. Rowe, Physiotherapist at Wanstead Placa Clinic resigned in August, and no replacement has yet been found. At Manford Way Clinic, also, two sessions per week were held regularly under the supervision of Mra. Pilbeam. Summary of Attendance of all Children New Cases Total Attendance Kenwood Gardens 114 31S Mayesbrook 70 221 Manford Way 24 532 Wanstead Place 22 116 Totals 230 1,187 Ear, Nose and Throat Clinic Miss M. M. Mason, F.R.C.S., Ear Nose and Throat Consultant, continued to attend at Kenwood Gardens Clinic during 1067. The following is a summary of attendances at this Clinic:— No. oi Sessions New Cases Old Cases Total Attendsnces Audiograms Advised Operation 47 83 84 502 120 101 In addition 27 children were referred to the Ear, Nose and Throat Clinic at Wan9tead Hospital and seen by Mr. R. T. S. Goodchild, F.R.C.8. Of these 10 were found to require operative treatment. Speech Clinics The following report of the work undertaken by the Speech Therapists has been submitted by Mrs. Pretious:— 67 Miss Barrett Full-time. School Clinics. Junior Training Centre and Special Education Units. Miss Osborne Full-time. School Clinics. Ethel Davis P.H. School and Special Education Units. Mrs. Pearce 3 sessions. Mayesbrook Clinic and Becontree School. Mrs. Pretious Full-time. School Clinics. Ethel Davis P.H. School. Mrs. Tingey 6 sessions. Mayesbrook Clinic and St.Vincent's School. In January 1967 we welcomed Miss Barrett to fill a fulltime post vacant for 8 months. This enabled us to re-open Manford Way Speech Clinic and resume the session at Osborne Mall, the Junior Training Centre. Later in the year, a former Redbridge speech therapist, Mrs. Pearce, returned for 3 sessions, working at Mayesbrook Clinic and Becontree School. This increase in the establishment allowed us to give 3 sessions to the Observation Unit and 2 to the Junior Training Centre. However, we feel that the Training Centre is still inadequately covered by these 2 sessions on one day. There is a need for more intensive treatment of all severely speech handicapped children whether they are receiving normal or special education. At the present time this is possible only for those who suffer a speech defect associated with a physical handicap and attend the Ethel Davis P.H. School. School Denial Service Mr. E. V. Haigh, Principal School Dental Officer reports as follows:— The School Dental Service continued on similar lines to the previous year. Our aim to inspect and treat as many children as possible and promote dental health whenever possible, owing to the resignation of a full-time dental officer and only able to replace by a part-time officer, the total sessions worked in the Borough dropped by 249, giving a percentage drop of 10% over the year. This difficulty of obtaining suitable dental officers is a nationwide problem, this is especially so for the north and east of London. Since February 1967 a Dental Auxiliary has been employed to work under supervision by the Senior Dental Officer at Kenwood Clinic. I am pleased to say that the Dental Auxiliary, Miss Burns, has been a great help to the dental service. Her clinical work has been very satisfactory and she has 68 taken valuable dental health instruction in the clinic and schools. This is a very difficult part of the service because nearly all children know what they should do concerning dental care due to the mass advertising, but our difficulty la to persuade them to carry it out. Miss Burns has worked in conjunction with Miss Griffiths, Health Education Officer. She has concentrated on Infant and Junior Schools whilst Miss Griffiths has brought Dental Health as part of general Health Education Programme in senior schools. It is generally thought that dental health must start at a very early age and, therefore, the infant school age group is important. We were fortunate to obtain the services of a full-time Dental Officer, Mr. Garman, who commenced duties in December. I am sure he will be a great asset to the service. Mr. Garman is working 6 sessions at Manford Way Clinic and 4 sessions at Mayesbrook. I am pleased that at last It it possible to dentally cover the Manford Way area and to offer a more efficient service there. Premises Eight dental surgeries remained open for dental treatment although some had to be staffed part-time due to the shortage of staff. Due to losing two part-time Dental Officers and rearrangement at Valentines Dental Clinic, the previous difficulty of having two double surgeries near to each other has partly been overcome. There now is the equivalent of one full-time Officer at Valentines and one full-time Officer, plus the auxiliary at Kenwood. This is adequate for this area. Owing to the closing of 93 High Road, Woodford, alternative accommodation had to be found until the new clinic is built. The surgery was moved to 118 Hermon Hill at the end of 1966 and sessions recommenced in 1967. Adapted premises are not ideal and I hope it will not be too long before the new clinic is built. Improvements to the other surgeries and waiting rooms continued on a progressive plan. This must be a yearly aim if the standard of buildings and equipment which is required is to be maintained. Conservative treatment to save teeth continued to be the main aim of the service. More children are receiving treatment at a much earlier age than years ago. General anaesthetics were administered by Medical Officers and later in the year also by a Consultant Anaesthetist. The same Anaesthetist attends and works with the same dental 69 staff as far as possible. This is important because extractions under general anaesthetics in a dental chair calls for team work which greatly adds to the safety of the patient. In addition to dental health in schools more dental instruction was given to individual patients at the surgeries. This takes time but the results are usually more rewarding. The total number of pupils inspected at schools or clinics amounted to 17,163 or 54% of the school population. This figure, although far from the ideal of 100% compares favourably with previous years with more staff. I continued with two evening sessions at Mayenbrook Clinic. These are still very popular for older children not wishing to lose school time and for mothers who are working or have difficulty to leave young children. Fluoridation of water supplies is still in the future. I hope this important step in the field of preventive dentistry will not be delayed too long. The sale of toothbrushes continued during 1967 In dental clinics. There are now five infant and junior schools running toothbrushing after school meals. This is a very Important dental health step. If children are taught to clean their teeth after meals and then not given the facilities to do so at school, then I feel we are failing between teaching and practice. The experiment has proved that given the will, It is possible to run such a service in the schools. I am hoping to extend this to more schools. The Ethel Davis School Dr. A. J. Howell, Medical Officer in Charge reports:— The appointment of Mrs. Craig as physiotherapist in April has done much to ease the workload Mr. Brand, our superintendent physiotherapist had been carrying on his own. In June our complement was completed by Miss Anderson, Occupational Therapist, joining the staff as a replacement for Miss Moorcroft. Our Speech therapists, Mrs. Pretlous and Miss Osborne, school nurse Mrs. Llewellyn and nursing auxiliary Mrs. Hallows continued ably as before. In July Miss Butler took over the school health clerical work at the office from Miss Burgess. Too little credit is often given to the work of a good clerk who can relieve all concerned of considerable administrative detail. The work of the school doctor continued as before with periodic medical Inspections on Mondays and attendance on Fridays when Mr- Lee, our visiting consultant orthopaedic 70 surgeon supervised the therapies and gave general advice. Mr. Lee's work has been greatly increased by doubling the number of children he superintends. Case conferences on children as they reach important stages in their development continue. Monthly staff meetings of therapists and doctor have been introduced and a medical dossier on each pupil has been compiled so that all concerned can readily ascertain the problems and the therapies being given. Teaching and health stiffs work together more closely than in an ordinary school. For much of each day the teachers themselves are necessarily Involved in helping with therapies and Mr. Causton, the Headmaster, has been most co-operative in an endeavour to put his teachers more into the picture as regards their pupils' disabilities and the objects of therapies. A "Music and Movement* session each week has been started for the younger more disabled children, and Mr. Brand, in spite of the resultant extra work, has this running smoothly. A new feature which has received considerable publicity in the press, culminating in a visit to the school by BBC television, has been the help given by Dr. Gardiner's senior pupils at Wanstead Grammar School in making puppets, special gadgets and in adapting existing equipment at Ethel Davis to any special needs. In October we were fortunate enough to receive a visit from Dr. Ursula Shelley, the consultant paediatrician at Queen Elizabeth Hospital, which many of our handicapped children attend. Mr. Farrell, Youth Employment Officer for handicapped children, has continued to be of great assistance in the placement of school leavers, sometimes a most difficult task. During 1967 there were 21 admissions and 15 discharges; recommendations for admission were received from the following sources:— Other Authorities 7 Hospitals 5 School Medical Officers 2 Principal Medical Officer 1 Transferred from another area 5 Parent 1 Total 21 71 The diagnoses were as follows:— Asthma and Eczema 2 Bronchial Asthma 1 Cerebral Palsy and Allied Conditions 10 Congenital Heart Disease 1 Congenital Absence of both Radii 1 Epileptic and Diabetic 1 Lumbo Dorsal Myelomeningocele and Hydrocephalus 1 Neurofibromatosis 1 Rt. Hemiplegia and Mild Plagiocephaly 1 Spina Bifida 2 21 Cerebral Palsy Unit Mr. H. B. Lee, Consultant Orthopaedic Surgeon submits the following report of the work undertaken at the Cerebral Palsy Unit:— "The Unit has been fully staffed with the necessary therapists again, though there is, of course, no guarantee that this state of affairs will continue. People with the high degree of skill required are not easy to come by. The children, many of them very severely physically handicapped have reaped the benefit of having more treatment, and some have shown unexpectedly rapid improvement. Co-operation between the treatment teaching and other members of the staff has continued at a high level with the common aim of doing the best for the children." Child Guidance Clinic Dr. L. P. Gurassa, Consultant Psychiatrist of the Redbridge Child Guidance Clinic submits the following report of the work undertaken during the year:— "This year we have been fortunate to acquire some additional premises as a result of daily cleaners taking over from a resident caretaker. This is most timely since the pressure of work continues unabated and we have been able to appoint additional staff. Mr. Bushong has joined us recently as a child therapist coming from the U.S.A. and specially trained in group methodB. At present he sees two groups of children each numbering about six and is hoping to be able to spend more time with us in the near future. In addition arrangements have been made for another child therapist to spend about half a week here for Intensive individual psychotherapy which is very much needed and for which there is a considerable waiting list. 72 An additional Educational Psychologist, Mr. Azam, has also Joined the staff and Mr. Fletcher, P.S.W. has replaced Mrs. McCowen who left last November to have a baby. We very much welcome all the new members of staff. Our responsibility to the maladjusted day classes continues and it is hoped to give more regular consultative time to the problems of the children in this group. At present these classes cater for a number of severely disturbed children who might otherwise require to be in a residential setting e.g. hospital or boarding school, where places are in any case very difficult to find for such children. There is also the advantage that while children continue to live at home, their families are aware of their children's growing adjustment and are able to participate in it. Nevertheless a small number of children are still placed in boarding school and residential psychiatric units each year and we make a point of remaining in close contact with the families after the children have gone away and with those responsible for them in residence, including visits to such institutions by staff members periodically. Conferences continue to be an essential feature of Clinic activity. As well as promoting team work it enables outside social workers etc., who are concerned with the families to come and share in discussion and they are also of value to students working in the Clinic. Provision for students has been a regular feature of the Clinic work and requests for this seem to be now increasing. Whilst these place some demand on the extended staff It is of value to the Clinic as well as to the social services of the country, to provide such a service. Outside visitors from other social services e.g. probation officers and school medical officers also child care officers are welcome to come and see something of the work that is going on. As always we are very much indebted to the continued support received from the Health and Education Departments. School Psychological Service For the year's work during 1967 Miss S. V. Gascoyne, Miss C. H. Watt and Mr. R. Azam, Educational Psychologists, report as follows:— In July Mr. Azam joined the psychological team so that it is now up to full strength. This was a very welcome addition both for the Child Guidance Clinic and the School Psychological Service as it brings the establishment very close to the recommended ratio of one psychologist to 10,000 school-age children recommended by the Underwood report. 73 The scope of the work has widened. Regular meetings are held at the Health and Welfare Department concerning the future of handicapped children who are about to leave school. Many of these children are well known to the psychologists who therefore can be of help in the discussions. During the year a number of residential schools for maladjusted and E.S.N, children were visited. It is necessary for contacts to be maintained in the schools where Redbridge children are placed so that by working in co-operation with the school and the family the maximum possible benefit can be derived for the child. The Woodford Bridge Unit established for E.S.N. children in September has filled a gap in the special educational provision in the area. All those children awaiting placement have been accommodated most successfully and although two children were expected to be extremely difficult the calm and happy atmosphere has enabled them to settle down for the first time in their school careers. The Observation Unit is now able to show an Increased turnover as those children who need E.S.N. schooling can now be transferred without much delay.. This is particularly fortunate as a number of infant age children have been in urgent need of placement in the Unit. During the year the Remedial Centre has increased In size with the addition of an extra class.. Care has been taken to avoid placing children there who are known to have serious emotional problems because this has been found in the past to cause difficulties in the very valuable remedial work that is being carried on there. There is a temptation to place such children In the protective, sympathetic environment that the Centre provides and undoubtedly some of these children have been very much helped but the disruptive element they present has slowed down other children and the essential need to provide a sound, stable learning situation for those who have fallen behind in school work is the primary purpose for which the classes were originally formed. The Treeside Unit for malajusted children was set up to help the emotionally disturbed children and has done excellent work over the year, this at present can only cater for the primary school age but It is hoped to provide for the senior school children when a building becomes available. In this connection the possibility was considered during the year of having a hostel for children of all ages for long or short-term placement. The value of such an establishment was seen in terms of the possibility of immediate placement at a moment of crisis in a family. At present this has been catered 74 for to some extent by Beech House Psychiatric Unit for adolescent boys at Canterbury, but this could only be used for boys from 12 to 16 and there was no equivalent accommodation for girls. Colchester Children's Psychiatric Unit has been very helpful for younger children and we have been able to maintain an excellent contact with both these units, but a local hostel where children could go to their own school or attend the Maladjusted Unit would facilitate continuity of treatment. Unfortunately the building which was under consideration as a hostel proved unsuitable, but the file containing the papers and plans remains, so we hope we shall be able to take It out again and consider some different site in the not too distant future. New school report forms have been drawn up which are more comprehensive than any we have previously used. The schools have been encouraged to keep a copy for their own use so that direct comparison can be made over a period as regards social adjustment and school progress for each child under consideration. The completion of the form requires care, thought and time but we hope that the information collected will prove to be of value not only to the psychologists but to the teachers themselves. These forms are now being used when children are formally referred to the clinic, on entry to any of the special units and in some cases where the head teachers have requested a psychologist to see a child at school. We are very grateful for all the help we have received from the Education and Health departments during the year and are really appreciative of such close co-operation." New cases 225 Follow-up for schools 129 Follow-up for clinic 121 Remedial Education 66 Children referred to Child Guidance Clinic 37 Enuresis Clinic Dr. Joan M. Pooley, Senior Departmental Medical Offlcer, reports as follows:— During the 12 months ended December 31st, 1967, the Enuresis Clinic has been held weekly at the Kenwood Gardens Centre and fortnightly at the Mayesbrook Centre. Sessions and New Cases (Comparative figures for the years 1963-1967 Inclusive) 75  Kenwood Centre Mayesbrook Centre Year Sessions held:— 57 24 1967 49 24 1966 No. of New Cases seen:— Total:- 161 129 32 1967 119 90 29 1966 110 110 — 1965 107 107 — 1964 99 99 — 1963 It is interesting and encouraging to note the increase in the number of new cases seen and treated through the clinic, the 1967 figures being practically double those for 1963. Appointment Analysis (Both Clinics) Under 5 years Over 5 years Boys Girls Boys Girls Recommended by:— 1. Infant Welfare Officers 3 6 — — 2. School Medical Officers — — 63 33 3. General Practitioners 6 - 12 6 4. Parents 1 — 6 2 5. Health Visitors 2 2 6 8 6. Head Teachers — — 1 2 7. Removal into Redbridge - - 2 - Total of 161 12 8 90 51 Total Attendances during 1967:— Kenwood Center Mayesbrook Center (Both clinics, old and new cases) 796 cases 650 146 Procedure The procedure adhered to throughout the preliminary and subsequent interviews and treatment, continuous as adopted and described in previous yearly reports. Analysis of Treatment The treatment and approach in each case naturally varies with the etiological factors and temperament of the child. Experience with cases seen at the Kenwood Centre has proved that the considerable time spent in talking to the child at the first interview (rather than specifically to the parent) is invaluable. Considerably more Impact is made with the child, 76 who becomes interested and keen. The mother is naturally listening and can then remind the child of what has been said. Medicinal Treatments 1. Syrup (or Tablets) of Tryptizol (5, 10 or 15 mgma as directed). The combined relaxant and antidepressive properties of this drug, plus the less understood but claimed specific action on bladder control, has justified the use of this drug in a fairly wide range of cases. The child who is nervous or worried benefits greatly and a change of temperament for the better has often been commented upon by the mother, apart from a fairly rapid lessening and cure of the enureric condition. * Discrimination of case etiology and disposition is of prime importance in cases treated with Tryptizol. There should be no doubt that the dose given in the first instance is adequate and a gradual reduction of dosage should be advised as the child's condition improves. This is of equal importance in the use of:— 2. Tofranil (10 mgm tablets). This has been used in a smaller number of cases, as can be seen from the chart below, but one has no doubt that, with careful selection of case, this drug has an established place in enuretic therapy. N.B. These two drugs are given by the kind cooperation of the child's General Practitioner. 3. Dexten. Dexten is used for its long-acting property of lightening the sleep plane and whilst the usual procedure is to give 5 mgms (half of the 10 mgm tablet) at bedtime, certain cases, particularly those in the* "Pre-waking Group", have responded more quickly if the dose is given at 10.30-11.30 p.m., coinciding with the evening "lifting". 4. The "Bed Buzzer". 31 of these are now in use in this Borough and a changeover to the transitorized type of buzzer is gradually being effected. 5. Routine and Charting. In all cases a special routine and charting system is instigated and * particular note is made as to whether the child would appear to belong to the now established * "Pre-waking Group" Ref. 1. In these cases an early waking routine proves rapidly effective and a normal "habit-wake reflex" appears to become established. 77 Results In 1967, 71 cases were discharged "dry":— (1) From Kenwood Gardens Centre- 58 ) (2) From Mayesbrook Centre- 13 ) as compared with:— 67 discharges in 1966 65 discharges in 1965 57 discharges in 1964 In addition, during 1967 (l)33 Cases were considered "selfdischarged". (2) 11 cases were discharged because of removal from area, or referral to hospital or childguidance clinic. Total Discharged Cases - 122 (From Kenwood Gardens Centre — 86) (From Mayesbrook Centre — 36) Further Analysis of Treatment and Effect This short analysis is extracted from those children treated at the Kenwood Centre during 1967 and who were receiving either:- (1) Dexten (2) Tryptizol or (3) Tofranil No. of children Treated Dexten Syrup (or tabs) Tryptizol Tofranil No. of children treated 86 119 32 Marked improvement in 4/52 (i.e. less than 5 nights wet in 4/52) 26 54 13 (approx.33%) (approx.50%) Completely dry in 3/12 9 11 - Completely dry in 6/12 9 12 4 Completely dry in 1 year 6 10 1 Little or no effect (and therefore change of treatment) 23 26 12 Once again, one would mention, with appreciation, the complete liaison and co-operation which exists between the General Practitioner and the Clinic Staff). (Ref. 1. Practitioner, April 1963, Vol.190. p.p.494-8 (Pooley and Shersby)) 78 Dr. J. Anand reports as follows on the Enuresis Clinic at Mayesbrook:— "The Investigation and treatment of enuretics Is being carried out on traditional lines. Dexten has been used less and less frequently. Syrup Tryptizol has given good results in selected cases. The bed buzzer has been invariably successful In certain cases referral to King George Hospital was necessary. These are being investigated for conditions like urinary calculi and small bladder. One case required admission for a few days." Peripatetic Teachers for the Partially Hearing The Peripatetic Teacher for the Partially Hearing Miss H. C. Hodges, submits the following report in conjunction with Mrs. J. Carney:— "There are now 38 partiallyhearing children on the register, 6 In the pre-school age group, and 16 in each of the primary and secondary groups. During the year 1,114 visits have been made to these children. 3 pre-school age severely deaf children have entered schools for the deaf and there have been 8 school leavers. 1 senior boy was admitted to the Partially Hearing Unit for Seniors in Tottenham. Among the pre-school children at present 3 attend day nursery, 2 severely-deaf children are awaiting admission to schools for the deaf, and 2 children will enter the new unit for the partially-hearing which is to be opened at Eastbury Infants' School, Barking, in 1968. 1 Infant will be transferred from his hearing school to the same unit. During the year 1 child in a special school was provided with an Amplivox Speech Training Unit for his personal use In the class room and a loop system Installed. As he has now been admitted to a residential centre for spastics this equipment has been transferred to the Ley Street Day Nursery, and is being used for the benefit of the 3 children who have a hearing Impairment attending this nursery. Several members of the staff have been trained to use this equipment, and thus this nursery is very well able to help children with a hearing defect who need the companionship of children of their own age. Numerous children were tested by us and referred for further investigation and treatment of their hearing problems. We are pleased to report that 19 children are deriving great benefit from the commercial hearing-aids purchased for them by the Authority during the year." 79 Handicapped Children The number of children coming within the various categories and their disposition as on 31st December, 1967 is shown in the table at the end (Appendix 20). B.C.G. Vaccination of School Children This scheme is offered to all pupils of 13 years attending. maintained and independent schools. In addition, those previously invited who did not accept are given a further opportunity to participate. 3,040 pupils were offered B.C.G. vaccination and of this number 1,854 or 61% consented. 1,443 or 77.8% received vaccination. As the result of the notification of five cases of tuberculosis in schools in the Borough during 1967, it was considered necessary to visit these schools for the purpose of tuberculin testing the contacts. The total number of tests undertaken was 554 but no further cases were discovered following those investigations. The Health Visitor and the School Nurse Miss J. Oliver, Superintendent Health Visitor, submits the following report of the work undertaken by the Health Visitors and School Nurses:— "Our work in the Schools continues on much the same lines as previous years. The staff who Joined us in September 1967 were quickly encouraged to take an active part in Health Education programmes in School. Aided by the Health Education Officer they have had further help on planning programmes, teaching and projection techniques. Some evening work examining girls on Home Safety subjects for a part of the Duke of Edinburgh awards has been continued. Case Conferences have been held when necessary, the Health Visitors' knowledge of families, their social and economic backgrounds have been helpful to other colleagues owing to a small concentration of housing larger families with continual problems in one part of the Borough, the Health Visitor, School Nurse and Teacher have had to maintain a much closer liaison—A Family Service Unit would be of considerable help to these families, they need daily visiting to encourage parents to send the older children to school, clean and suitably dressed and on time. If the children are excluded from school it often takes weeks to get them back, causing great unhappiness to them. Efforts from Welfare Officers in the Education Department combining with Health Visitors and other Social Workers appear to have little affect on some parents." 80 General Welfare and Research The National Society for the Prevention of Cruelty to Children (West Ham Branch) submits the following particulars of the work undertaken in Redbridge:— Total number of cases investigated 37 Neglect 17 Ill-treatment 11 Other causes 9 including Reported by Public Officials 9 97 children (boys 54 and girls 43) were involved, 56 being of school age. In addition to this work, 227 supervision visits were paid to different cases under supervision from this Branch. The Invalid Children's Aid Association The work of the Invalid Children's Aid Association (Essex Branch) for the year in question is set out below: — Casework 4 Casework with parents of children in I.C.A.A. Schools 3 Chiropody During the year 210 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 inspections of a particular age-group by a Chiropodist either at the Schools or Clinics. Surveys and Research During 1967 we continued to obtain information for a National Survey on Childhood Malignancies which is 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 1967 were:— 81 Accidental Death 3 Pneumonia 1 Leukaemia 2 Heart 2 Meningitis 1 Tumour 1 10 82 APPENDIX 16 DEPARTMENT OF EDUCATION AND SCIENCE MEDICAL INSPECTION AND TREATMENT RETURN FOR THE YEAR ENDED 31st DECEMBER, 1967. Part I — Medical Inspection of pupils attending maintained Primary and Secondary Schools (including Nursery and Special Schools) TABLE A. - PERIODIC MEDICAL INSPECTIONS Age groups Inspected (By year of Birth) No. of pupils who have received a fall medical examination Physical Condition of Pupils Inspected No. of pupils found not to warrant a medical examination Pupils found to require treatment (excluding dental diseases and infestation with vermin) Satisfactory Unsatisfactory for defective vision (excluding squint) for any other condition recorded at Part II Total individual pupils No No. (1) (2) (3) (4) (5) (6) (7) (8) 1963 and later - - - - - - - 1962 1,280 1,266 14 - 29 136 161 1961 2,182 2,168 14 - 51 264 307 1960 1,214 1,212 2 - 37 113 147 1959 201 201 - - 6 20 24 1958 131 130 1 - 5 21 26 1957 96 96 - - 4 17 19 1956 99 99 - - 7 17 22 1955 1,098 1,098 - - 69 130 190 1954 630 628 2 - 47 65 110 1953 121 120 1 - 11 14 24 1952 and earlier 2.255 2,252 3 - 152 76 209 TOTAL 9,307 9,270 37 - 418 873 1,239 Col. (3) total as a percentage of Col (2) 99.60% total Col (4) total an a percentage of Col (2) .40% total 83 APPENDIX 16 (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 100 2 213 2 5 Eyes — a. Vision 418 4 228 - b. Squint 37 — 71 - c. Other 14 1 30 6 6 Ears — a. Hearing 42 52 101 36 b. Otitis Media 6 2 25 1 c. Other 7 - 39 4 7 Nose or Throat 158 15 248 3 8 Speech 62 3 65 1 9 Lymphatic Glands 3 - 66 - 10 Heart and Circulation 21 - 156 2 11 Lungs 34 1 229 7 12 Development— a. Hernia 13 — 32 1 b. Other 73 13 178 26 13 Orthopaedic— a. Posture 22 — 42 — b. Feet 90 5 172 3 c. Other 72 4 159 5 14 Nervous system— a. Epilepsy 8 2 46 5 b. Other 12 1 44 3 15 Psychological— a. Development 12 36 41 11 b. Stability 52 120 137 18 16 Abdomen 7 — 29 - 17 Other 98 9 259 44 84 APPENDIX 16 (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. 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 649 Number of He-inspections 862 Total 1,511 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 14,408 (ii) Total number of individual pupils found to be infested 95 (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 28 By parents 67 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. 85 APPENDIX 17 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 7 Errors of refraction (including squint) 2,193 Total 2,200 Number of pupils for whom spectacles were prescribed 966 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 12 b. for adenoids and chronic tonsilitis 43 c. for other nose and throat conditions 9 Received other forms of treatment 205 Total 269 Total number of pupils in schools who are known to have been provided with hearing aids— a. In 1967 17 b. In previous years 59 TABLE C. - ORTHOPAEDIC AND POSTURAL DEFECTS Number known to have been treated a. Pupils treated at clinics or out-patients departments 666 b. Pupils treated at school for postural defects 22 Total 688 86 APPENDIX 17 (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 1 b. Body 2 Scabies - Impetigo 1 Other skin diseases 137 Total 141 TABLE E. - CHILD GUIDANCE TREATMENT Number known to have been treated Pupils treated at Child Guidance Clinics 179 TABLE F. - SPEECH THERAPY Number known to have been treated Pupils treated by Speech Therapists 372 TABLE G. - OTHER TREATMENT GIVEN Number known to have been dealt with a. Pupils with minor ailments 327 b. Pupils who received convalescent treatment under School Health Service arrangements 16 c. Pupils who received B.C.G. vaccination 1,443 d. Pupils who attended the Enuresis Clinic 241 Total 2,027 87 APPENDIX 18 DENTAL INSPECTION AND TREATMENT Attendances and Treatment (a) Number of first visits 3,648 (b) Number of subsequent visits 6,212 (c) Number of total visits 9,860 (d) Number of additional courses of treatment commenced 745 (e) Number of fillings in permanent teeth 6,641 (f) Number of fillings in deciduous teeth 3,248 (g) Number of permanent teeth filled 5,696 (h) Number of deciduous teeth filled 2,597 (i) Number of permanent teeth extracted 365 (j) Number of deciduous teeth extracted 1,845 (k) Number of extractions under general anaesthetics 646 (l) Number of emergencies treated 167 (m) Number of pupils x-rayed 245 (n) Number of pupils who received prophylaxis 1,014 (o) Number of teeth otherwise conserved 191 (p) Number of teeth root filled 14 (q) Number of inlays 2 (r) Number of crowns 19 (s) Number of courses of treatment completed 3,434 Orthodontics (a) Number of cases remaining from previous year 239 (b) Number of new cases commenced during year 103 (c) Number of cases completed during the year 113 (d) Number of cases discontinued during the year 17 (e) Number of removable appliances fitted 119 (f) Number of fixed appliances fitted 1 (g) Number of pupils referred to Hospital Consultants 1 Dentures (a) Pupils supplied with Full upper or Full lower (first time) - (b) Pupils supplied with other dentures (first time) 7 (c) Number of dentures supplied 7 Anaesthetics Number of General Anaesthetics administered by Dental Officers - 88 APPENDIX 18 (continued) Inspections (a) First inspection at school — Number of pupils 14,091 (b) First inspection at clinic — Number of pupils 3,072 Number of (a) and (b) found to require treatment 7,943 Number of (a) and (b) offered treatment 7,943 (c) Pupils re-inspected at school clinic 1.534 Number of (c) found to require treatment 948 Sessions (a) Number of sessions devoted to treatment 2,086 (b) Number of sessions devoted to inspection 115 (c) Number of sessions devoted to Dental Health Education 43 89 APPENDIX 19 SCHOOL HEALTH SERVICE: STAFF AND SCHOOL CLINICS (As at 31st December, 1967) 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 Offices Number in terms of full-time Officers employed (a) Medical Officers (including the Principal School Medical Officer) (1) Whole-time School Health Service - - (ii) Whole-time School Health Service and Local Health Service 7 2.25 (iii) General Practitioners working part-time in the School Health Service 9 0.58 (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) 4 3.7 (iii) Part-time School Health Service(including Orthodontists) 3 .75 (iv) Dental surgery assistants 7 6.47 (v) Dental Auxiliary 1 .925 (c) (i) Senior Speech Therapists - - (ii) Speech Therapists 5 3.81 (iii) Assistant Speech Therapists — — (d) (i) Audiometricians — — (5 Full-time plus 7 Contractual) 12 .40 (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 45 10.84 (ii) No. included at (i) who hold Health Visitors Certificates 33 (iii) Nursing Assistants and Trainee Nurses 1 1 90 APPENDIX 19 (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 10 III.- TYPE OF EXAMINATION AND/OR TREATMENT provided at the School Clinics returned in Section II. either directly by the Authority or under arrangements made with the Regional Hospital Board for examination and/or treatment to be carried out at the Clinic. Examination and/or Treatment Number of School Clinics (i.e. premises) as at 31st December, 1967where 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 7 - B. Asthma - - C. Audiology - - D. Chiropody 5 - 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 6 — T. Cerebral Palsy Unit - 1 91 APPENDIX 19 (continued) IV. - CHILD GUIDANCE CLINICS (1) Number of Child Guidance Centres provided by the Authority — 1. Staff Number employed Aggregate in terms of the equivalent number of whole-time officers by L.E.A. Under arrangements with Hospital Authorities (i) Psychiatrists — 2 .82 (ii) Educational Psychologists 3 — 1.5 (iii) Psychiatric Social Workers 4 — 4.0 (iv) Child Psycho- Therapists ( Contractual) 3 — .91 92 APPENDIX 20 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 4 Partially Sighted 9 3 4 — — — 2 — — — — — — 18 Deaf 9 3 — — — — 6 — — — — — — 18 Partially Deaf 12 2 1 1 - - 6 — — — — — — 22 Delicate 2 — 1 1 — — 5 — — — — — — 10 Physically Handicapped 59 — 1 1 — — 12 — — — — — — 73 E.S.N 99 7 12 2 — — 12 — — — — — — 132 Maladjusted 2 — 15 11 2 — 19 — — — — — — 50 Epileptic — — — — — — — — — — — — — — Speech Defect — — — — — — — — — — — — — — Total 192 15 35 17 3 — 64 — — — 1 — —- 327 MENTAL HEALTH 93 MENTAL HEALTH SERVICE (by C. H. A. Wedeles, L.R.C.P., M.R.C.S., D.P.M.(Lond.) Principal Medical Officer) Progress in the development of the Mental Health Service has remained a rather lop-sided affair this year. Whilst modernising sub-normality provision goes ahead at a steady pace, on the psychiatric side little more could be done than maintain essential services and plan for the future. Betterments and inovations all hang on having sufficient numbers of trained and experienced social work staff, especially in senior posts. To attract this still rather rare commodity, appropriate gradings and work-structure ere a prerequisite. The ground plans for these were laid in 1967; much patience and a little luck are all that is wanted now. General There is no need to re-Iterate the dire facts of unmet problems, since the size of the shortfall in provision has been well and often publicised. Just one "peak-of-the-iceberg" piece of local statistic shall suffice as an index of what remains to be done — in this Borough, one Psychiatrist alone sees 100 cases a year of attempted suicide at a General hospital. With luck he will be able to see each patient for a few minutes once; there Is as yet no social worker to whom he can designate at least some follow up. The implications of this state of affairs in terms of social costs and anguish speak for themselves. In the absence of a service that takes systematic notice of such problems, they tend to remain "silent". We hope to make a small beginning In filling some gaps in 1968 by providing for parents with emotionally disturbed pre school children a rapid consultation and diagnostic service coupled with a special Day Nursery ran by staff qualified to help such children with their problems. Often fairly serious disturbances in development are not recognised until the child goes to school; it is hoped that the very existence of such a service may bring them to the fore at an earlier and often more recoverable age. Projects In Hand We are continuing to investigate the need for additional rehabilitation facilities for mentally ill and physically handicapped people, and have come to the conclusion that we shall probably meet present need by building a centre for 40 patients. Plans for this centre, to be built at Fullwell Cross, are being modified in the light of new knowledge and information. We are actively searching for property suitable to be adapted to serve 94 as a hostel for psychiatric patients who are sufficiently well to leave hospital but require a period during which they can regain their social confidence. Many people either cannot leave the shelter of a hospital or have to return to it for want of such rehabilitation facilies. Many others, though they may never become totally independent, could live outside the hospital If various types of sheltered accommodation could be put at their disposal at no or little cost to the Authority. Burnslde Adult Training Centre Burnside Adult Training Centre was completed and occupied In March 1967 and has proved Itself a very pleasant and well planned building In use. An official opening ceremony to which parents were invited was held on 9th June, 1967 and was presided over by Mrs. G. M. Chamberlain, Chairman of the Mental Health Service Sub-Committee. Our endeavour now is to achieve a good balance of work, training and recreational activities and tailor these to the capacities and needs of individual trainees. Like many others in this field, we are convinced that the capacities and potentialities of at least a large number of the mentally handicapped are greater than has been realised and require an Imaginative and flexible approach for their development. Hyleford The newly christened Hyleford Junior Training School in hoped to be in service next summer and should be a very worthy addition to the best existing provision for mentally handicapped children, and an exciting stimulus to Its staff. Council has adopted new designations and pay scales In keeping with developments In this field. Goodmayes A beginning has been made in strengthening the social work organisation at Goodmayes Hospital which has had to endure a grave deficiency in this branch of its staff. Mrs. E. Thompson, the only P.S.W. so far In an establishment for 6 has valiantly undertaken this task. As mentioned above, virtually nothing can yet be done to assist the psychiatrists in their out-patient work. Mental Health Week The main event was a conference for School leavers on "Careers in Social and Mental Health Work", held at Fairlop School and organised In conjunction with the Youth Employment Service. This was very well attended by an interested audience, many of whom, we hope, will become recruits to social work. Staff Mr. T. A. Hawley left in the Autumn to take up a poet in the Borough of Latribeth. Mr. S. H. Maurice, Senior Mental 95 Welfare Officer on reaching his retiring age promptly decided that he was far too young to end his career and is continuing to work for us in a part time capacity. Mr. J. F. Norris, Senior Mental Welfare Officer went to Cardiff on the one year C.S.W. course. Miss J. E. Scrlven and Mrs. L. Brookes were seconded to the Diploma Course for teacher of mentally handicapped children. goodwlll Club This has continued its useful work at Scrafton Road Day Centre. Attendances have been approximately the same as in the past year. An annual outing was arranged attended by 24 patients and a Christmas social was held. Madeira Grove Clinic This has continued its Tuesday morning play group for mentally handicapped children under the auspices of its Health Visitors, and remains a boon to mothers. Other Items Junior Training Centre Physical education began in September for approximately 20 trainees at the Centre Youth Club Gymnasium. Adult Training Centre Football sessions for trainees began in October for approximately 1 session in three weeks; matches are being played with the neighbouring boroughs' training centres. Swimming sessions began in September for approximately 10 trainees, at the Seven Kings Bath. Regular medical examinations have been carried out on one session each week. Holidays St. Mary's Bay Holiday Camp 59 trainees from both Junior and Adult Training Centres attended this for a period of one week — lst-8th September. Outings Trainees attending both Junior and Adult Training Centres were taken on two outings during the year. Christmas parties were also held for both centres. Statistical Items Hospital Admissions (Mentally Handicapped) During the year 5 males and 4 females were admitted and and 6 children are on the waiting list. Hostel Admissions (Mentally Handicapped) Nil Hospital Admissions (Mentally III) The number of hospital admissions during the year was 222; 136 under order, 86 informally and 110 on extended admission orders. 96 Hostel Admissions (Mentally Ill) 8 patients from both hospitals have been admitted to private hostels and 2 to L.A. hostels. Temporary Care 25 children have been sent for temporary care to enable parents to have holidays or to assist families at times of difficulty. Transfer of Trainees 16 trainees over the age of 16 were transferred from Junior to Adult Training Centre 7 trainees resident in the L.B. of Barking attending the Redbridge J.T.C. were transferred to the Barking J.T.C. in December. School Leavers One maladjusted and 8 E.S.N, school leavers have been referred for admission and supervision to the Adult Training Centre. 97 APPENDIX 21 CASE LOADS OF MENTAL HEALTH SOCIAL WORKERS Mentally Sub-Normal (a) No. of cases on register... 472 (65 in residential care) (b) No. of visits 1,192 (c) Average No. of cases per officer 68 (d) Average No. of visits per case 3.5 Mentally 111 (a) No. of new cases referred 247 (b) No. of 2nd or subsequent referrals 60 (c) Total No. of visits/per officer 620 (d) Average No. of visits patients referred 10 (e) Total No. of visits 2,750 TRAINING CENTRES - AS AT 31.12.67. Junior Training Centre (a) Total No. of register 61 (b) Average dally attendance 44 (c) Discharges (including transfers) 31 Adult Training Centre (a) Total No. on register 95 (b) Average daily attendance 69 (c) Discharges (including transfers) 6 ENVIRONMENTAL HEALTH 99 ENVIRONMENTAL HEALTH by S. R. Daly, Ll.M., B.Sc., D.P.A.(Lond.), Barrister-at-Law Chief Public Health Inspector In presenting my third report on Environmental Health for the London Borough of Redbridge, I have endeavoured to alter the layout from previous years with slightly less emphasis on the various Acts and Regulations which it is the duty of my department to administer. In this age of amalgamation and larger units the passage of time is so fast that the preparation of one report seems to Immediately follow its predecessor, and I put forward the suggestion that local authorities should send their "annual report writing officers" to a remote spot for a period of meditation! However, during 1967 your Public Health Inspectors have continued to keep a vigilant eye on the environmental health of the residents in the borough by means of routine inspections and investigations of complaints. A balance sheet shows that we have had a successful year. On the credit side three more smoke control areas came into operation; the slum clearance programme has been amended; 4 Clearance Areas have been represented and 5 Individual unfit houses dealt with. Constant Inspection of food supplies and premises, and Increased sampling of food stuffs for adulteration, mis-description and for bacteriological purity took place. On the debit side, gypsies and fellow travellers are still entrenched and continued to foul the Woodford Avenue verge and presented a constant health hazard. One noise nuisance has caused considerable trouble during the year, but is likely to be finally abated in the near future. These are a few of the many branches of our work which come to mind but as you fight your way through the details which follow, it will be clear that despite a shortage of two or three Inspectors for most of the year, a reasonable standard of routine inspection has been maintained. Although at most Committee meetings I present a formidable list of properties for statutory notices, I would stress that these are a very small percentage of the total informal notices and letters sent to owners and traders which are complied with without resort to statutory action. This has been particularly noticeable in the case of houses In multi-occupation where on receipt of an informal letter the owners concerned have indicated their willingness to comply with our requirements. 100 I consider that the success of informal action is a good measure of the standing of the department with owners, estate agents, traders and others. For the early part of the report on water supply, I am indebted to the Metropolitan Water Board and South Essex Waterworks Company, and the Borough Engineer for the reports on Main Drainage and Sewerage, Refuse Collection and Disposal end Street Cleansing. Water Supply The water supply of the Borough of Redbridge is provided by two statutory undertakers, namely the Metropolitan Water Board and the South Essex Waterworks Company and has been of satisfactory quality and sufficient quantity during the period under review. The principal source of supply of the former is from Lee and Thames - derived water from lee Bridge Works, repumped at Woodford where it was supplemented between May and September by the interim output fro n the new Coppermills Works. In addition, parts of the borough receive well water from Wanstead Pumping Station. 1,125' samples were submitted to chemical and/or bacteriological examination. No fluoride was added, although there was a natural fluoride content of 0.35 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 1967. 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 1967 over 10,000 chemical and bacteriological examinations of raw water, water during treatment and water going into supply were, made at the Company s Langham Laboratory and all water going Into supply was reported as wholesome. 101 The fluoride content of the river derived supplies was 0.25 p.p.m. Whilst the three local wells had the following fluoride content:— Hford 1.1 p.p.m.; Roding 1.0 p.p.m.; Seven Kings 1.2 p.p.m. The following mains were laid in Redbridge during 1967: — 4 ins. 6 ins. 18 ins. Yards 29 223 98 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 7 samples of water during the year, 3 being from the South Essex Waterworks Company supply area and 4 from that of the Metropolitan Water Board district and both the chemical and bacteriological examinations gave satisfactory results. Main Drainage and Sewerage Work continues on the relief of flooding and it is anticipated that schemes at the following estimated cost will be commenced during the coming year and schemes 1, 2 and 5 are with the Ministry for approval at the present time: — 1. Tomswood Hill/Forest Road Soil Surface Water Scheme £348,400 2. Hainault Surface Water Sewer to Tudor Crescent £63,000 3. Eastern Avenue — Aldborough Road to Seven Kings Water Surface Water Sewer £55,100 4. Cranbrook Stage III to Dunspring Lane Surface Water Sewer £33,500 (Provisional) 5. Wynn Valley Surface Water Sewer, Pumping Station and new Storm Tanks at Eastern Sewage Works £900,000 6. Barley Lane Surface Water Sewer £45,000 In addition to the above and in conjunction with the GLC it is hoped to commence work on a new trunk sewer from Eastern Sewerage Works to a Newham pumping station, a distance of some 6 miles after the construction of which only 102 surface water will be treated at these Works, the domestic sewage (up to 3 times Dry Weather Flow) then being treated at the GLC Beckton Works. Spasmodic oil pollution of streams and lakes still occur* but some sources have been discovered and rectified. Total rainfall for the year 1967 as recorded by the Snowden Gauge In Valentines Park was 24.43 Inches with the greatest fall in any 24 hours of 1.02 on the 25th June. Cleansing of Public Sewers and Drains The cleansing and unblocking of choked sewers and drains has continued to be carried out by three manual staff of the Health and Welfare department. Whilst most of this work is done during normal working hours, I feel that praise is due to the men involved for their willingness to turn out during ever???ings and week-ends to deal with emergencies. The abatement of nuisances such as over flowing drains is always considered an urgent matter, and as stated in my last report, residents have expressed their appreciation of the promptness and efficient manner in which this work Is carried out. Altogether 1,514 blockages were dealt with during the year. Another service operated by the department is the testing of drains on request and payment of a fee based on a percentage of the gross rateable value of the property. This is very useful for a resident with doubts on the drainage systems of his house, and for prospective purchasers. It is limited by the availability of means for testing, i.e. inspection chambers, and no excavations are carried out. Refuse Collection and Disposal During the year 5 requests for drain tests were received and reports submitted. Tons Cwts. Qrs. Salvage Value *Refuse Collection 82,855 17 1 Wastepaper Salvage 2,148 13 0 £17,180. 3s. 2d. Mixed Rags 32 17 3 £633.12s.l0d. Woollens 2 1 7 £281.19s. 4d. Carpet 10 18 0 £71. 4s. 0d. Scrap Metal 53 2 2 £308. 7». 4d. Copper 3 0 £43. 8s. 0d. Lead 2 3 £10. 7s. 6d. Brass 1 2 £16.19s. 5d. * An Increase by weight of 3.4% over that collected last year. 103 Disposal (by GLC) to Fairlop Pit and Ockendon Pit (precise figures unobtainable from returns — about 80% to Fairlop — 20% Ockendon). GLC have provided (in advance of Civic Amenities Act, 1967) places where householders and business people may take refuse for disposal. Redbridge Council's services providing collection and disposal of bulky refuse at reasonable charges continue to grow In popularity. These facilities will be given wide publicity In the coming year. In the last few days of the year, a special vehicle was Introduced — the "Kuka Shark*. This vehicle crushes all refuse In the course of loading, including such Items as chairs, tables, cabinets, sideboards etc. It is hoped that these measures will reduce the volume of dumping In the Council's rural lanes but to date there are few indications of success. Transport and labour are employed every week-end collecting rubbish dumped illicitly on roadside verges. Street Cleansing This section, which is among the best equipped of its kind in the country, has (in the period under review) been studied by the London Boroughs Management Services Work Study Group. The Group's report is not yet to hand. The section employs giant Suction Cleaners and all-electric vehicles in the task of providing weekly cleansing of residential streets and cleansing of busier streets from twice weekly up to several times daily. All the busier centres have litter bins in ample numbers manufactured in modern materials in prizewinning designs. The footpaths In the borough are kept free from grass and weeds by regular spray treatment with suitable chemicals. During the year 51,034 gullies were cleansed. Public Conveniences There are 21 Public Conveniences (excluding Parks Conveniences) on highways in the borough. Six of these, sited in the busier centres, have an Attendant on duty at all times; the others are staffed every day during the times when they are most used. Very high standards of cleanliness are maintained. Free toilet facilities, free towels, soap and hot water are provided. Sanitary towels are available on sale In the Women's sections. A further Public Convenience will be built —on Chrlstchurch Green at Wanstead High Street — during the coming year. 104 Public Raths There are four Public Swimming Baths in the borough:High Road, Seven Kings (2) 1 — 120,000 gallons 1 — 68,000 gallons Fullwell Cross, Barkingside (1) 1 - 190,000 gallons Valentines Park Open Air Pool (1) 1 — 250,000 gallons The larger indoor Bath at Seven Kings and the Open Air Pool are closed in Winter. These are filled with mains water at the commencement of each season. The smaller Bath at Seven Kings and the Fullwell Cross Bath are open throughout the year. During the time the Baths are open the water is maintained at a high standard of purity by continuous filtration and chlorination. Footbaths for use prior to entering the Swimming Pools are Installed. In the case of Fullwell Cross Baths the public are not allowed on the Pool side. Periodic water tests are carried out by staff at each of the establishments and details of sampling by Public Health Inspectors are given later in the report. Fullwell Cross provides a Cafeteria seating approximately 48 persons. Laundry for all four Swimming Baths is handled at the High Road Baths. Sanitary Inspection of the Area I give below summary tables of Inspections carried out, samples obtained and complaints received. Further information and items of Interest are given later In the report, under the various headings. 105 INSPECTIONS DWELLINGS Initial Inspection Reinspections Notices Issued Notices Complied Informal Formal Informal Formal Housing Act (including Slum Clearance and Multi-occupation) 1515 5091 42 11 24 1 Rent Acts (Certificates of Disrepair) 32 24 - - - - Public Health Acts (Nuisances) 5583 5324 467 317 436 283 Clean Air Act (Smoke Control Areas) 7920 5273 7 170 4 82 Infectious Disease 1167 1444 - - — — OTHER PREMISES Food Premises 1804 1658 73 — 34 — Offices, Shops Act 685 720 148 — 121 — Factories & Workshops 275 165 14 1 9 — Dairies 37 16 1 — — — Schools 900 253 — — — — Swimming Baths 12 29 — — — — Clean Air Act (Industrial Premises) 259 278 14 5 6 3 Rag Flock Premises 9 2 — — — — Massage and Special Treatment Establishments 21 14 — — — — Hairdressers 22 16 — — — — Fertilisers and Feeding Stuffs 1 15 — — — — Pharmacy and Poisons 184 59 — — — — Animal Boarding Establishments 2 2 — — — — Riding Establishments. 30 20 — — — — Pet Animals Act 42 18 — — — — Diseases of Animals Act 69 234 — — — — Pests (Rats, mice, wasps, pigeons) 113 133 1 1 1 1 Atmospheric Pollution Measuring Instruments 600 — — — — 106  Initial Inspections Re-Inspections Public Conveniences 32 44 Parks and Open Spaces 5 11 Litter Act 63 22 Tents, Vans and Sheds 73 141 Places of Entertainment 8 16 Child Minders 19 - Day Nurseries 13 3 Massage and Special Treatment Establishmens 21 14 Miscellaneous 2298 295 Other Duties Food and Drugs Samplings 378 254 Bacteriological Sampling 58 11 Lectures to organisations, schools, etc 28 - SAMPLES - Formal Informal Unsatisfactory Food and Drugs for Adulteratiorn or Misdescription 245 51 49 Rag Flock 5 - Nil Fertilisers and Feeding Stuffs.. - 6 Nil Bacteriological: — Ice Cream 71 - Nil Dairy Cream 1 - Nil Milk 25 - Nil Liquid Eggs 4 - 2 Water 7 - Nil Swimming Baths 36 - Nil 107 COMPLAINTS The Public Health Inspectors dealt with 3235 complaints received on the following matters: — Accumulation of manure and refuse 61 Animals improperly kept 2 Bad Smells 44 Dampness of Premises 55 Defective drains, W.C.'s and fittings 855 Defective roofs, gutters, downpipes, etc 105 Defective water fittings 23 Dirty and verminous houses 20 Dirty condition of rearway 23 Flooding of premises 10 Overcrowding 22 Smoke Nuisances 51 Noise Nuisances 41 Defective or no provision of dustbin 176 Rats arid mice 817 Wasps Nests 537 Unsound Food 34 Miscellaneous 359 3,235 In addition 305 visits were made to newly arrived Long Stay Immigrants to give advice on the Health Services available. Disinfection and Dliilitfestation During 1967, eighteen premises and eighteen articles were disinfected, and twenty-nine premises were disinfested for verminous conditions. Litter Act 1958 The objects of this Act to prevent the disfiguation of town and countryside by unsightly dumping of rubbish and Indiscriminate distribution of litter undoubtedly meet with the approval of the vast majority of people. Unfortunately the practical enforcement of the Act is fraught with difficulties, and unless regular patrols are maintained there is little chance of catching the offenders. It is quite Impossible for the present staff of Public Health Inspectors to carry out more than token action under the Act. In any event the litter is rarely of an offensive character consisting mainly of paper, wrappers etc. and is not really a matter of public health. In my opinion the police and traffic wardens are in a more favourable position to ensure compliance with this Act. 108 Infectious Diseases During the year 543 cases of Dysentery and 229 cases of Food Poisoning were notified by Medical Practitioners in the Borough, plus a large number, coming to knowledge from other sources. All were investigated, 24 of the notified cases of food poisoning were confirmed bacteriologically. The following figures show the number of specimens submitted for examination:— No. of faecal specimens taken 792 No. of faecal specimens positive 149 Home Laundry Service Section 84 of the Public Health Act, 1936, enables the Local Authority to provide a free service for the cleansing of articles so soiled as to be insanitary and a danger to health, such as bedding and personal clothing of aged and Incontinent persons. By arrangement with the Regional Hospital Board, these articles are cleansed weekly at the Chadwell Heath Hospital laundry. During 1967, 98 persons were assisted and 10,566 articles laundered. Long Stay Immigrants All addresses notified by Port Health Authorities of the Long Stay Immigrants were visited, and when the person could be contacted they were urged to register with a general medical practitioner, and an appointment was arranged for them to have a chest X-ray where necessary. 180 successful visits were made during 1967. 25 visits were also made under The Public Health,(Alrcraft Amendment) Regulations 1963, and The Public Health (Ships Amendment) Regulations 1963 because of persons who were not in possession of a valid international certificate of vaccination. Noise With the very considerable increase in air and motor traffic, the general public are undoubtedly becoming more conscious of noise nuisances. The extent of the battering which our hearing system receives in built up areas particularly near main roads is not realised until one goes into the country. As it now seems possible that we will be spared the added crescendo from planes arriving and departing from Stansted, one looks forward to the time when town centres and civic centres will be free from all motor vehicles with their noise and fumes. In my last report I mentioned a timber yard which caused nuisance to surrounding residents with circular saws and a 109 diesel operated crane. During the year the firm removed its main activities to another site outside the borough and the nuisance has thus been abated. The most troublesome complaint during the year was noise from a furniture manufacturing factory situate within a Smoke Control Area in South Woodford. The firm installed a special furnace for burning wood waste, and the furnace included a fan which produced a penetrating whine when in operation. The furnace was installed without notice to the local authority and a conviction was secured in subsequent proceedings. The noise from the fan coupled with emissions of dark smoke caused a flood of complaints, and people living in the neighbourhood formed a residents committee. Public Health Inspectors carried out observations from 7.30 a.m. until 5 p.m. for a fortnight from a number of points around the factory, and the G.L.C. Scientific Branch assisted by taking and recording measurements. In proceedings which followed an abatement order was made against the firm and convictions secured for a number of smoke emissions. The co-operation of the G.L.C. Scientific Branch and evidence given by a member of its staff undoubtedly played a vital part in the proceedings. It now appears likely that the firm will move from its present premises to an industrial estate outside the borough. Launderettes have sprung up like mushrooms in recent years, and provide an extremely useful service for husband and wife working full or part-time, and for elderly people. Unfortunately they are sometimes sited in shop premises with living accommodation over. In one particular case this situation gave rise to a large number of complaints from the first floor tenant, but although observations were made the noise from the spin driers was not considered to be a nuisance. There appears to be a gap in the legislation which will allow a launderette to be established In such a position, without adequate sound insulation of the celling of the launderette being carried out. A number of Technical Colleges have run courses on "Noise" during the year, and several Public Health Inspectors have attended those held at Tottenham and St. Albans. 41 complaints were received in 1967 of which 11 related to 110 the furniture manufacturing factory. Apart from this factory, In 12 instances an informal representation to the person responsible secured abatement of the nuisance. In the remaining 18 cases, no nuisance was found on which statutory action could be taken. Pests The two rodent operatives have continued to carry out excellent work not only in the destruction of rats and mice but also in dealing with wasp nests and feral pigeon infestations. The main control work is against rats and mice. This is spread over the year with wasp and pigeon treatments concentrated during the summer months. Whether the proximity of Epping and Halnault Forests is the reason for the large number of wasps nests is not known, but during certain weeks of the summer life becomes quite hectic for the operatives. A rodent survey of both banks of the river Roding was made by Student Inspectors, and as a result treatments were carried out against a number of colonies which had become established. The principal poison used against both rats and mice is Warfarin, with zinc phosphide as first reserve. Although there is no evidence so far of the presence of any Warfarin resistsnt colonies, this is something which will have to be watched closely. A complaint of rat infestation in a basement flat in Wanstead revealed a defective drain and heavy rat infestation of the drains and public sewers in the neighbourhood. It is proposed to carry out test baiting of all sewers within the borough so that the extent of rat infestation can be seen. There is little doubt in a number of instances that the sewers act as a reservoir of rats which appear as surface infestations from s defective or broken drain or sewer. A summary of properties visited and infestations found is contained in Appendix 22. During the year eleven treatments using stupifying bait have been carried out against feral pigeons, and 327 pigeons have been destroyed. Pigeons can cause considerable damage to crops particularly to brassicas in allotments and private gardens, they disfigure buildings and cause nuisance from droppings on and in buildings and are a constant hazard to pedestrians. The use of stupifying bait allows the bird to recover if it is not collected within a reasonable time, but this method of treatment has limitations and difficulties can be encountered in collecting birds in densely built up areas. Successful treatment were carried out at Wanstead Hospital Odeon Cinema, Gants Hill and Christchurch Green, Wanstead. 1ll Efforts are being made to find a suitable person willing to shoot pigeons so that in places where stupifying bait is unusable this method can be used. Housing I mentioned in my last report that some difficulties had been experienced in obtaining re-housing of occupants of houses within Clearance Areas and in fact a number of Clearance Areas were deferred for 18 months at the request of the Housing Committee. This action has tended to place a blight upon the activities of my department in putting forward Clearance Areas, and individual unfit houses. The Borough is fortunate in not having large areas of sub-standard houses which are ripe for clearance, and the pause has been fully occupied by going through in some detail the existing Slum Clearance Programme. It became clear that in a Borough such as this where bad arrangement is not a major factor in determining unfitness that "slum clearance programmes" are not a feasible proposition. They do, in fact, cause considerable harm when quoted by persons without knowledge of the properties concerned and, of course, tend to render a house sterile. The advent of the Rent Acts together with the better standard of wages has meant that many people have bought their own houses — usually as sitting tenants. Such owners are young and enthusiastic "Do-it-yourselfers* and terraces of houses which had been earmarked for future slum clearance have been found, on inspection, to contain many houses which have been transformed by knocking down walls to enlarge rooms, curing dampness, remedying defects, painting and re-decorating, and even in several cases by fitting central heating. Such houses, which were deemed incapable of repair at reasonable cost, have been made fit for the price of the materials only. This poses a serious problem for the Local Authority when deciding slum clearance areas — if every house has been made fit the problem is resolved, but if a minority of the houses have been so repaired, the declaration of a Clearance Area is bound to cause large scale objections. As a result of inspections carried out during the year, 64 properties have been removed from the Slum Clearance Programme and the investigation is continuing. Two Closing Orders on basement flats were determined as s result of works being carried out to render the flats fit for habitation. 112 Despite the number of new houses which have been built in recent years, the continuous rise in the population, abetted by the influx of immigrants, means that the housing problem is ever with us. In my opinion, the prolongation of the life of the existing houses is a reasonable policy, and in fact the work carried out by the Public Health Inspectors in serving Housing Act and Public Health Act Notices for essential repairs in neglected properties is an Important part of this policy. A summary of houses inspected, the conditions found and the results of action taken is contained in Appendix 23. Improvement grants operated by the Borough Engineer's Department enabled owners to obtain, under the House Purchase and Housing Acts 1959 and 1964, a Standard Grant for providing- (a) A fixed bath or shower (b) A wash-hand basin (e) A W.C. (d) A food store, and (e) A hot and cold water supply to the bath or shower, wash-hand basin and to a sink. or where such level is not practicable a "Reduced Standard Grant" for providing - (a) A sink with hot and cold water supply (b) A W.C. (c) A food store. During the year the Health Committee agreed to Public Health Inspectors carrying out inspections in proposed improvement areas, but this enterprise has yet to come to fruition end further information has not yet become available. Another result of the Housing shortage is reflected in the increase in the number of houses in multiple occupation i.e. occupied by more than one family. Where only two families occupy a house the existing facilities are either sufficient or can easily be provided, but in cases where houses are let off in rooms, each room being occupied by a family, serious problems arise, e.g. shortage of toilets and bathrooms, overcrowding, lack of hot and cold water supplies and cooking facilities etc. and lack of adequate means of escape in case of fire, which is an ever present hazard where families are living in close confinement and using oil heaters. Such properties are found usually following complaint made by one of the tenants or as a result of a house-to-house inspection of all houses in the area, an undertaking requiring the 113 employment of a large number of Public Health Inspectors. Conditions such as recently found within this district where a five roomed house occupied by five families (13 people with two babies expected) shared 1 toilet, 1 bathroom, 2 gas cookers in a common kitchen (which also contained the only water suppl), lack of hot water supplies, ventilated food cupboards and dustbins and a complete absence of essential fire precautions at an average rental of £4.4s.0d. per week are then dealt with under the appropriate sections of the Housing Acta. Means of Escape in Case of Fire for houses in multiple occupation is required by Section 16 of the Housing Act 1961. Originally the Local Authority were required to consult the local Fire Authority for their recommendations which were then incorporated into any Notice under Section 16 served by the Local Authority. As a result of the meeting of the London Borough's Association it was decided that any Local Authority who adopted the "Code of Practice" used by the Fire Brigade would be deemed to have consulted the Fire Brigade, therefore inspections under Section 16 of the Housing Act are now carried out by Public Health Inspectors. The Code is complicated and the work Involved extensive, and much time and thought has to be applied to attain the required standard of safety without unnecessary expense to the owner. In the smaller houses in multiple occupation an escape route via the internal staircase is acceptable providing the staircase is brought to Vi-hour standard of fire resistance. In the larger multiples an external fire escape may have to be provided if alternative escape routes cannot be obtained. External fire escapes have to be purpose made and are consequently expensive to provide. In the latter part of the year a Charitable Organisation interested in the re-housing of problem families for short periods pending rehabilitation, took possession of a number of small houses for this purpose on short term leases. Unfortunately, this organisation acted without any prior consultation with the Local Authority, as a result of which serious overcrowding occurred aggravated by the lack of essential facilities, and in addition to which serious health hazards and fire risks were created. Consultations eventually took place between members of the organisation and the Local Authority, as a result of which alterations were made in the tenancies to obviate the risks created, and an undertaking was also given that the Local Authority would be consulted as to the future user of any premises acquired by them. 114 During the year the following action was taken in respect of houses in multiple occupation: Number of houses in which additional services or facilities were provided 16 Number of houses provided with means of escape in case of fire 20 Number of houses where directions were made to prevent or reduce overcrowding 2 Number of houses where overcrowding was abated 7 Applications for re-housing baled on medical priorities amounted to 222 during 1967, of which 197 were supported. A further 11 cases were reviewed and awarded increased priority. The administration of the Rent Acts, Insofar as the issue of certificates of disrepair was concerned continued much as in 1966, there being only five epplications received, all of which were granted. Three undertakings were received from landlords to carry out specific repairs. Two certificates of disrepair were issued. No certificates of disrepair were cancelled during the year. Gypsies and Other "Travellers" During the year a vast amount of time and paper has been wasted in endeavouring either to move on the itinerants who have occupied the verge on Woodford Avenue and to a lesser degree, on vacant land in Chigwell Road, and North View, Hainault, or to improve sanitary conditions. In the two latter cases as the land was owned by the Council the Town Clerk took action to remove the trespassers. As far as Woodford Avenue has been concerned, petitions from local residents and meetings with officers of the Ministries of Transport and Housing and Local Government have achieved nothing. In addition to the most unsatisfactory conditions existing which I enumerated in some detail in my last report, the verge has become heavily infested with rats, attracted by the amount of refuse and food littering the site. Efforts by the rodent operative have had little effect. Consideration is now being given to the provision of s temporary site, and from the Public Health point of view the sooner this is in operation and some control exercised over these people the better. There is no doubt in my opinion that a serious health hazard exists on this roadside verge, created of course, by the itinerants, but which could quite easily effect householders within the neighbourhood. 115 Innumerable notices were served on the Itinerants to abate nuisances with little effect, and I presume the Town Cleric had difficulty in serving summonses when these were passed to him for legal action as no cases reached Court. From the Public Health Inspector's view point this has all been a very frustrating and time wasting exercise, and it is to be hoped that I will be able to report some improvement in my next annual report. Clean Air Act This borough is making good progress in Clean Air. During the year three Smoke Control Areas came into operation, No. 11 (Woodford Wells), No. 12 (Seven Kings) and No. 13 (Fairlop), and the overall picture is as follows:— Total number of premises within borough 87,000 (estimated) Total number of premises with S.C.A. in operation 49,001 Total area of borough 13,983 acres Total area of borough covered by S.C.A.'s 9,721 acres As will be seen from the map in appendix 24 with the areas in operation the programmes of the former Ilford and Wanstead and Woodford Councils have now been joined together. From now on it is proposed to deal with one large area per year. This will save consideiable administration expenses. The dark cloud in the horizon is the economic position of the country which may cause some delay. It is hoped that this will be only of a temporary nature and that the Council will decide to complete its programme by either 1971 or 1972. There is little doubt of the benefits obtained in smoke control areas resulting in a much cleaner atmosphere, and as remaining areas cover the most densely populated part of the borough, It is most important that the momentum achieved since 1961 should be maintained until the job is completed. The tarry dark grey smoke which Issues from the domestic chimney discharged at low level is a far greater menace than most Industrial smoke and fumes which are emitted at a considerable height and are carried away by natural turbulence in the atmosphere. Very few complaints have been received regarding shortage of solid fuel, and it would seem that the manufacturers and distributors, given reasonable weather conditions, are able to cope with all demands. The swing towards gas from solid fuel 116 has continued, and this has helped in maintaining adequate supplies of the latter. One change which has become more noticeable during the year in the general move towards central heating, either complete or partial. The manufacture of solid fuel room heaters with high output boilers capable of heating a number of radiators, and a type of gas central heating using a master radiator, has lowered the total cost and provided impetus to central heating generally. There is no doubt that central heating ensures that a house or flat Is more comfortable and is therefore more fully used. One of the favourable bye products of the clean air programme is the stimulation of Interest in home heating with the scrapping of old inefficient and wasteful appliances, and the Installation of modern heaters of much higher efficiencies. The general routine of dealing with smoke control areas adopted in Redbridge following the pattern used in Wanstead and Woodford continued to work very satisfactorily. Every effort is made to keep the affected householders fully Informed. The Public Health Inspectors assist householders with general advice and completion of the various forms, and ensure that the works are carried out satisfactorily. Complaints of industrial smoke nuisance have been few in number. In two cases, however, legal proceedings were taken, one of which resulted in fines totalling £9, plus costs £5.5s.0d. for three offences, and the other a fine of £2 for one offence. I have divided the main detailed information into three main groups: a. Measurement of pollution. b. Control of pollution — Smoke Control Areas. c. Other activities such as conferences, exhibitions. a. Measurement of Pollution The department has five daily volumetric instruments for recording smoke and sulphur dioxide concentrations. They are sited in the following positions:— No. 1 Gantshill Library No. 2 John Bramston School No. 3 17/23, Clements Road No. 4 Croft Lodge Close No. 5 Oakhall Court. 117 These two latter stations are fitted with eight port valves which automatically change every twenty-four hours, thus ensuring complete records over weekends and holiday periods. The two stations are also part of the National Survey being conducted by the Department of Scientific and Industrial Research. I give below the average figures in micrograms per cubic metre for the various sites for the year ending March 1967, as supplied by the Warren Spring Laboratory. Smoke S.O.2 Summer Winter Year Summer Winter Year *Croft Lodge Close, Woodford 22 58 40 54 78 66 *Oak Hall Court, Wansteud 26 60 43 68 96 82 *John Btamston School, Hainault 18 41 30 Insufficient readings. Apparatus out of order. Gants Hill Library 36 128 83 63 115 89 Clements Road, Ilford 29 J4 64 96 189 146 *Instruments within or very close to existing Smoke Control Areas In the Wan-en Spring Laboratory Report for 1966 one of the most illuminating sections is on trends in pollution by smoke and sulphur dioxide. The important reduction in smoke emission that has taken place in recent years both in and outside London are cited. In London a decrease in both emissions and ground level concentration to about one third of that ten years ago has taken place. Emission of sulphur dioxide in London has increased by 30% since 1952, due mainly to conversion to oil firing, but ground level concentrations have not increased, and in some cases have reduced by 20% as a result of smoke control work. There can be no doubt that this considerable improvement in the London Area and confirmed by the absence of "Smog" in recent years, is due to the introduction of Smoke Control Areas. It is therefore most important that this work affecting the health of the community at large should proceed apace and not be delayed by financial considerations. 118 b. Smoke Control Areas The Order for No. 14 Smoke Control Area was made in July 1967 and confirmed by the Minister on the 13th December, 1967. The date of operation is the 1st October, 1968. Details of the area are as follows: Dwellings (erected before 1964) (a) Privately owned 9,240 (b) Local Authority owned 538 Industrial Premises 19 Commercial Premises 413 Other premises 24 It was estimated that the cost of replacing and adapting existing fireplaces would be £160,000 and £3,650 for privttely and Local Authority owned dwellings respectively, of which the Exchequer contribution would be £65,802, and the cost to the local authority would be £50,447. I give below a complete picture of the number of claims dealt with in the areas in operation, (the figures for Areas No. 11, 12 and 13 are not complete and a few claims are (till received for earlier areas). CLEAN AIR ACT, 1956 SMOKE CONTROL AREAS - EXPENDITURE TO 31.12.67. Ares Date of Operation No. of properties eligible No. of properties in respect of which Grants made (excluding Redbridge owned properties) Payments msde (7/10) with Discretiosary Qranta(exclades Redbridge L.A. Pro- perties) Ilford No. 1 1.11.80 487 32 £293. 9s. 2d. W. & W. No. 1 1.10.61 1548 399 £2,739. 11s. 84 W. & W. No. 2 1.10.61 2104 744 £6.837. 1s. 11d. W. & W. No. 3 1.10.62 2086 902 £7,895. 18s.. 64 Word No. 2 1. 7.63 784 144 £948. 7s. 5d Word No. 3 1. 7.63 886 249 £1,410. 3s. 5d. Word No. 4 1.10.63 383 172 £1,503.12s. 7d. W. & W. No. 4 1.10.63 2142 677 £5.842. 3s. 6d. Word No. 5 1. 6.64 1607 405 £2,802 . 8s. 11d. W. & W. No. 5 1.10.64 4052 1412 £31,880.13s. 6d. Word No. 6 1. 8.65 4260 1921 £25,543. 0s. 8d. W. & W. No. 6 1.10.65 2630 997 £17,890.18s. 8d. Word No. 7 1. 7.66 2296 567 £10.015. 3s. 11d. Redbridge No. 8 1. 7.66 4592 710 £7,571. 8s. 11d. Redbridge No. 9 1.10.66 2738 732 £12,188. 8s. 4d. Redbridge No. 10 1.10.66 2686 798 £15,738. 15s.l0d. Redbridge No. 11 1.10.67 2674 363 £7,577.19s. 3d. Redbridge No. 12 1.10.67 5412 1651 £39,568.15s. 5d. Redbridge No.13 1.10.67 3603 615 £12.510.10s. 9d. 119 During the year in 49 cases 100% grant was paid to persons in receipt of supplementary pensions and whose applications were supported by the Ministry of Social Security. The figures given above indicate the amount of effort which is put into this section of the work by both Public Health Inspectors and clerical staff. It is normal to expect some contraventions of a Smoke Control Order immediately after the Order comes into operation, but they are soon eliminated by prompt informal action. c. Other Activities 28 notifications of Intention to instal new furnaces have been received during the year. Our liaison has been maintained with the Borough Engineer's department regarding the height of new chimneys for industrial boilers. Recommendations are based on the memorandum on Chimney Heights issued by the Ministry of Housing and Local Government when appropriate. This authority continued to be represented in the following bodies:— National Society for Clean Air Standing Conference of Co-operating Bodies in the Investigation of Atmospheric Pollution The mobile exhibitions of the Solid Smokeless Fuel Federation, National Coal Board, and of the North Thames Gas Board have been sited within the new smoke control areas and created considerable interest. Offices, Shops and railway Premises Act, 1963 This Act has now been in force for three years, and steady progress has been made to ensure that employees in offices and shops enjoy the better working conditions envisaged by the varied provisions in the Act. The amount of work involved can be judged by the fact that in addition to two Senior Inspectors engaged part of their time on inspection of offices, each district Inspector is responsible for the shop premises within his area. During the year 1405 inspections were made and recorded, and although there remains a large number of premises to receive initial inspections, it is anticipated that the majority of these will be completed within the coming year. Generally speaking it is the older premises which are deficient in amenities, the newer premises either being 120 factory or failing to comply in some small detail. Close liaison is maintained with the Borough Engineer's Department, and all plans of new offices and shops are scrutinised to ensure compliance with the Act. Air space and means of heating and lighting are normally satisfactory, but as far as offices are concerned absence of running hot water is quite common, as is the absence of handrails to staircases. The manufacturers of thermometers and first aid kits together with the abstract printing department of H.M.S.O., must have experienced a boom following the activities of the Inspectoral The Inspectors are constantly checking that the necessary forms of registration have been submitted, and in 'Conformity with Government policy proceedings have not yet been Institutes for non-registration. 100 accidents were reported during the year and all were investigated by one of the Senior inspectors. The large majority were found to be due to the persons own carelessness. Seven accidents were due to riachinery, bacon slicers etc. and two to vehicles (fork lift and patent trucks). Although contravention of the Act is an offence it is normal practice to draw the attention of the responsible person to the matter by informal notice or letter. 148 such notices were served during the year, and 76 were complied with together with 45 from the previous year. The apparently large number outstanding from the present year is due to the fact that a considerable number of the notices served in the latter part of the year. One company was prosecuted for non compliance and on conviction was fined £16 with £3.3s.0d. costs. Factories and Workshops Most of the provisions of the Factory Act are administered by the Factory Inspector, but the P.H.I.s have three duties in respect of these premises which receive constant attention. They are: (a) the inspection of canteens and food preparing factories under the Food Hygiene Regulation*. (b) the approval of new furnace installations and chimney lengths under the Clean Air Act, and observations and enforcement of contraventions from existing chimneys; and 121 (c) the provision and maintenance of suitable sanitary conveniences within factories and workshops. Regular inspections are also paid to outworkers within the borough which number 157. Details of the administration of the Act are contained in Appendix 25. Inspection and I have divided details of this important branch of the work Supervision of under the following headings:— (a) Registration (b) Sampling (i) Food and Drugs (ii) Bacteriological (c) Inspection of food (d) Inspection of premises, hawkers etc. (a) Registration: Milk and Dairies Premises registered as dairies 24 Persons registered as distributors of milk 211 Licences, for five year period ending 31.12.70 in operation at end of year:— Pasteurisers 1 Sterilisers 1 Pasteurised (Dealers) 145 Sterilised (Dealers) 128 Untreated (Dealers) 33 Ultra Heat Treated (Dealers) 34 Ice Cream Premises on register for manufacture and/or storage and sale of Ice cream 631 Food Preparation Premises Premises on register for the preparation or manufacture of sausages or potted, pressed, pickled or preserved meat, fish or other food intended for sale 323 Hawkers Hawkers of food, and premises used for the storage of such food, on register 121 122 (b) Sampling (i) Food and Drugs A simple statement "Food and Drugs Sampling", but behind this, a very detailed and comprehensive web of legislation, trade practices and scientific investigation. As the years roll by, new foods, new techniques and processes, new hazards and problems, changing habits plus the influx of immigrants from many lands bringing their own exotic food stuffs to these shores, as well as the importation of food and drugs demanded by a public who are widening their horizons by the ease of present travel and communication, spell out a fascinating story. Modern methods of food processing mean that we can have a vast array of food and drugs ell the year round. "Fresh* strawberries on Christmas Day, fish tasty and in first class condition months after the caten; food refrigerated, freeze dried, quick frozen, dried, cured, irradiated, bottled, canned and treated in many different ways. Vitamins added, sweetened artiflcally, coloured, emulsified, stabilised, preserved, concentrated, diluted, packaged and labelled in an infinite variety of ways. The story seems endless and ever changing. Our food, our 'daily bread' can give us health and vitality; it can also kill and maimll By steady and regular sampling by the Council's officers, a check is kept on this very important aspect of our dally life. This year, more samples have been taken than in previous years. The number of non-genuine reports received from the Public Analyst may appear small in relation to the number of samples taken, but this only serves to demonstrate that manufacturers are aware of the constant check upon their products and thereby constitutes a vital safeguard to the public. During the actual taking of formal samples by the Council's sampling officers a very great interest is shown by public and traders alike. It fascinates and stimulates them. Without doubt they are emphatically in favour of these checks upon the food they sell or consume. Any observer would be impressed by the public interest shown when samples are taken in any public house — or supermarket. During the year, samples have been very varied, including such items as haggis, ready cooked Chinese food to take away, rum, gin, beer, milk, children's sweets, drugs, slimming aids, water purifiers for Continental travel as well as the more day to day food and drugs and nationally known products. 123 Milk is checked for any contamination by atomic fall-out or the carry over of antibiotics. Labels are checked for any misleading claims. The story goes on "Foods and Drugs Sampling" — it must be continuous — it must keep pace with our everchanging civilization and culture. Statistics as indicated in the appendix can only give a glimmer of the full story. (ii) Bacteriological Water Supply: Seven samples of water supplied to the Borough by The Metropolitan Water Board and the South Essex Waterworks Company were taken and found satisfactory. Swimming Baths: Monthly samples from The Public Swimming Baths and those in our schools were taken in order to ensure that they were suitable for the purpose of swimming. A total of 36 samples were taken during 1967 and all were found satisfactory. Ice Cream: Samples of ice cream were taken. These were largely from itinerant traders, for very obvious reasons. During 1967, 21 samples were submitted for examination, all of which proved satisfactory. Results were as follows:— No. of Samples Ministry of Health Provisional Grade % of Total 15 I 71 3 n 14 2 III 9 1 IV 6 21 100 Milk: 25 samples of milk were taken from schools, milkroundsmen and vending machines. All were found satisfactory. Liquid Egg: Samples were taken but difficulty was experienced in interpreting the results of some of these. The presence of other substances found in a bakehouse causes a sample to fail the presribed test, but this failure doesn't mean that proper pasteurisation has not been carried out. The question of routine bacteriological sampling of foodstuffs has been considered but very little has been done because the existing public health laboratories are already overworked. The laboratory which serves this area is at Chelmsford, and the time-distance factor also raises further difficulties. 124 Of four samples taken during 1967, two failed the Alpha Analyse test. (c) Inspection of Food: A constant surveillance of food premises whether retail, wholesale, manufacturing or hawkers has been maintained during the year to ensure that food for sale or manufacture or preparation for sale is fit for human consumption. There are no slaughter-houses or knackers yards within the borough, but there are several large wholesale food depots, and a meat depot and cold store. Very frequent inspections are made of these premises. As mentioned in my last report the normal procedure when a retailer or wholesaler finds he has some unsound food is for him to notify my department, surrender the food for destruction and receive a condemnation certificate. In cases of doubt the Inspector is frequently called in to decide whether food is fit for human consumption or not. The large quantities of food surrendered are enumerated in appendix 26 but this, in fact, represents a Very small proportion of the total food inspected either during routine or special inspections. In one case food was found to be exposed for sale in a retail shop in an unfit condition. The food was seized by the Inspector, taken before a Magistrate for condemnation, and In subsequent proceedings fines and costs totalling £25 were imposed. During the year 47 complaints concerning food were received, mainly relating to the presence of a foreign body. In 15 of these cases the food which had been surrendered by the complainants was submitted to the Public Analyst for examination and following the receipt of his reports in 9 cases further action was considered necessary. In 24 cases details were submitted to the Health Committee by the Town Clerk. In 4 Instances warnings were given, in 18 cases proceedings were instituted and fines and costs totalling £173.5s.0d. were Imposed by the Magistrates, and the remaining two cases were referred to the Borough's concerned. Inspection of Premises, hawkers, etc. The enforcement of the Food Hygiene Regulations has received regular attention during the year and 3,515 inspections were made for this purpose. Informal action was taken in 74 instances to secure compliance with the Regulations, and in two contraventions, 125 ceedings were instituted. Convictions were obtained with total fines and costs of £27.7s.0d. A further statutory instrument viz. The Food Hygiene (Markets Stalls and Delivery Vehicles) Regulations 1966 came into operation during the year. Whilst this borough has no public market, there are a number of hawkers scattered around the area. During the year some effort was made to enforce these Regulations but due mainly to staff shortage it was not possible to devote much time to this task. It is hoped to improve the situation in the coming year. Inspection of canteens at factories and schools has been carried out regularly and advice given to supervisors and food handlers where appropriate. 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 212 211 212 212 Factory Canteens 47 47 47 46 Butchers' Shops 140 140 140 140 Grocers' Shops 294 293 294 292 Fruiterers' and Greengrocers' Shops 156 - - - Fishmongers' and Fishfryers' Shops 59 58 59 58 Bakehouses 19 19 19 19 Bakers' Shops 48 46 48 48 Confectioners' Shops 273 - - - 1248 814 819 815 The Merchandise marks Act 1887-1953 These Statutes afford protection to the public by prescribing trade descriptions regarding the stipulated standards of quality, quantity, materials, strength, performance etc, of goods and foods, the latter forming an important subject of environmental health administration, in that, the inspectors are required to visit premises wherein imported specified foods are offered or exposed for sale to ensure that such commodities are marked or labelled or so notified as to indicate the country of origin and that they are fit for the description so denoted. 126 Diseases of Animals During the latter part of the year one of the worst outbreaks of foot and mouth disease within living memory occurred in numerous counties in the Midlands and Wales. It started in Cheshire in September and until the end of the year an avalanche of Foot and Mouth Disease (Infected Areas) Special Orders were made, 73 in all, which culminated in the whole of England and Wales being made a Controlled Area in November. Fortunately the disease did not reach Essex, and as this Borough has no slaughterhouse or market the action taken was limited to the issue of 4 movement licences. This outbreak, which was continuing at the end of the year undoubtedly placed a heavy strain upor. those local authority staffs directly concerned. Generally the movement of swine has progressed without the issue of any licences throughout the year, though in two instances the movement of pigs into the borough by licence have been made. 5 licences were granted by the Council under the Diseases of Animals (Waste Foods) Order 1957 which requires the effective sterilisation of all 'pig-swill' in properly constructed appliances to prevent the spread of animal diseases. 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. 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 ties as required by this Act. Five samples of filling materials were obtained and submitted to the analyst during 1967. All proved to be satisfactory Fertilizers and Feeding Stuffs Under the Act of 1926 retailers are required to give a statutory declaration of the composition of fertilizers and animal feeding stuffs. Most of these products sold in the Borough are pre-packed by the manufacturers and the required information is printed on the packet. Surveys are made at intervals to ensure that the Act is being complied with. Six samples (four of fertilizers and two of feeding stuffs) were taken during the year, and the Public Analyst reported all as satisfactory. 127 Pharmacy and Poisons The Pharmacy and Poisons Act, 1933 requires registration with the Local Authority of premises used for the sale of those poisons prescribed in Part II of the Poisons List issued under the Pharmacy and Poisons Act, 1933. Inspections were carried out in respect of 165 applications for renewal of entry on the Statutory register, whilst 14 new applications for registration were investigated and found satisfactory. A total of 243 visits were made during the year. 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. These premises are visited annually and 3 new applications to a licence were approved by the Council, and 35 licences were renewed during 1967. Hairdressers and barbers Establishments 38 inspections were made of these premises during the year, and no action was found necessary. The Pet Animals Act 1951 Local Authorities ore required to licence premises wherein designated animals are kept, stored or sold aa peta 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 21 such establishments licensed in the Borough and all have been found to be well administered. Animal Boarding Establishments Act 1963 During the year, periodic inspections were carried out of the three licensed premises and no contraventions were found. Riding Establishments Act 1964 There are 4 licensed establishments in the Borough and in addition to visits made to them by Inspectors, the premises were visited once during the year by a Veterinary Surgeon whose report was considered at the time of licence renewal. National Assistance Act 1948 Section 50 During 1967, the burial and cremation of six persons, without known relatives or in respect of whom no other suitable disposal arrangements were being made, were effected and attended by a representative of this section of the department. An interesting problem arose in respect of a person who died whilst attending a hospital as an outpatient and in respect of whom the hospital Committee requested this Authority to make the necessary burial arrangements. 128 Circular 13/49 issued by the Ministry of Health removed such responsibilities from the jurisdiction of the Local Authority in cases where the deceased was a patient in a hospital at the time of death. No definition is contained in the Circular as to the word "patient" and consequently the matter was raised informally with the legal consultants at the Ministry, who were unable to adjudicate as to whether an out-patient constituted a "patient" within the meaning of the Circular. As such a case had not been previously raised, a formal submission of the details of the circumstances was requested. However, as obviously prompt action was necessary to effect the burial, and as it then became evident that the effects of the deceased were sufficient to fully reimburse this Authority for the funeral arrangements eventually made, the matter was not pursued. 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. 6,486 enquiries were so dealt with during 1967. 129 APPENDIX 22 Prevention of Damage by Pests Act 1949 Type of Property NonAgricultural Agricultural 1. Number of Properties in district 90,242 29 2. (a) Total number of properties (including nearby premises) inspected following notification 1,493 2 (b) Number infested by (i) Rats 1,047 2 (ii) Mice 211 - 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 — — 130 APPENDIX 23 HOUSING STATISTICS 1. Inspection of dwelling-houses during 1967 (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 4,151 (b) Number of inspections made for the purpose 12,341 (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 ... 43 (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 382 2. Remedy of defects during the year without service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 351* 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 138 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 85* (b) By local authority in default of owners - 131 APPENDIX 23 (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 3 (2) Number of dwelling-houses closed in pursuance of am undertaking given-by the owners and still in force - D. Proceedings under Section 18 of the Housing Act, 1957. Number of separate tenements in respect of which Closing Orders were made 1 4. Housing Act, 1957, Part IV Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 3 (ii) Number of families dwelling therein 3 (Hi) Number of persons (units) dwelling therein 16 (b) Number of new cased of overcrowding reported during theyear 2 (c) (1) Number of cases of overcrowding relieved during the year 7 (ii) Number of units concerned in such cases 27 (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 1967 of Notices served prior to 1st January, 1967. 132 133 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 160 36 - - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authorities 703 467 13 (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 59 88 1 - Total 921 591 14 - 2. Cases in which DEFECTS were found. (If defects are discovered at the premises on two, three or more separate occasions they should be reckoned as two, three or more "cases"). Psrticulars (1) Number of esses in which defects were found Number of - ssei 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 Conveniences (S.7) - - - - - (a) Insufficient 1 1 - - - (b) Unsuitable or defective 12 8 - 3 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Out-work) - - - - - Total 13 11 - 3 - 134 APPFINDIX 25 (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 Hat required by Section 133(l)(c) (2) No. of casea of default in sending lists to the Council (3) No. of prosecutions for failure to supply lists (4) No. of inatances of work in unwhole- aome premises (5) Notices served (6) Prosscutions (7) Wearing apparel — Making etc 90 - - - - - Cosaques, Christmas stockings, etc. 60 - - - - - Making of cardboard boxes 9 - - - - - Total 159 - - - - - 135 APPENDIX 26 ARTICLES OF FOOD SURRENDERED AND CONDEMNED AS BEING UNFIT FOR THE FOOD OF MAN DURING 1967 Description Quantity Bacon 814 1bs. Beverages 80 tins Biscuits 297 1bs. Butter 91 1bs. Cereals 210 1bs. Cream 316 1bs. Eggs (shell) 22 gross Fish (wet and dry) 316 stone Fish (tinned) 840 tins Fish (paste) 19 jars Flour 414 1bs. Fruit (tinned) 13,517 tins Game 99 1bs. Ice Cream 22 bricks Jam (preserves) 516 1bs. Jellies 41 Lard 76 1bs. Meat (fresh) 16 tons 12 cwts. Meat (tinned) 13 cwts. Meat (pies) 19 pies Margarine 98 1bs. Milk (tinned) 1027 tins Pickles 226 Jars Poultry 314 1bs. Salt 8 1bs. Sausages 88 1bs. Sugar 215 1bs. Soups (tinned) 3714 tins Tea 219 1bs. Tomatoes 57 1bs. Vegetables (tinned) 1919 tins Vinegar 17 bottles WELFARE 137 WELFARE SERVICES (by R. W. Hall, Chief Welfare Officer) This changing service constantly having to review its attitudes and policies seems during the past year to have consolidated its position in the borough and to have improved contacts with those in need in Redbridge. All year we waited for the publication of the Seebohm Report with its forecasted proposals for radical changes in the structure of the local authority social services but unfortunately the report is not yet available. We were however able to welcome a team from the London Boroughs Management Services Unit which probed our organisation and methods for a number of weeks, showing great interest in the service and making many useful suggestions. Their report is looked forward to with interest and a keen desire to make our service even more effective. The two reports mentioned above will doubtless call for a closer integration of the social services with loss of Identity for the existing separate departments. The Welfare Service is willing end anxious to take up triis challenging new situation believlnf; that with hard work and goodwill it can only produce a better service for the less fortunate in our community. Homes for the Elderly What a pleasure it is to report that the Ministry of Health has give n the go ahead for the new home to be erected on a site in Hermon Hill, Wanstead and by the time this report is printed, work will have commenced with a completion scheduled for the end of 1969. The home will accommodate 50 elderly persons requiring care and attention and will have within it a special unit for the elderly mentally infirm. After 20 years of feverishly seeking for more and more places in homes for the elderly during which time the need for experimentation and development for new ideas has almost been crushed by the pressing demand for new places of almost any sort, we are slowly turning to a closer examination of what has been provided and what is needed in order to ensure that those in our care can use their talents, exploit their abilities and give rein to their interests to the limit. No longer can we think in terms of providing insulated communities shielding them from all risks and dangers within and outside the homes, wrapped in a cocoon of loving care which risks the stifling of all individuality. The elderly in our homes have the right to participate in all the activities within them and to influence these activities. 138 It was interesting to take a look during the year at the people in our homes and the parts of the Borough from which they originated. 70% came from Ilford and 21% from Wanstead and Woodford, the remaining 9% came from outside the Borough area but the majority of these have been resident since before 1965. We also examined the ages of our residents and noted that most of them came within the age range of 75-95 years (the average being 82 years) with the ladles outnumbering the men by over 3 to 1 and falling into age groups some 10 years higher than the men. In the year under review the policy of short stay admission was continued and developed due to the Committee's decision to make some staff accommodation at Hyleford available for short stay residents. We were able to admit over 50 persons for 2 or 3 weeks thereby relieving relatives to enable them to take holidays or hospital treatment ard providing care for some elderly persons in emergency situations. There is no doubt that this service is most valuable, not only giving a welcome break to those relatives who accept responsibility for caring for the elderly members of their families but also in some cases saving the Council's Exchequer by deferring the need for permanent care. I hope that this service will continue to expand and possibly become a very significant part of our residential service. At some future date when the financial situation is easier, perhaps the Committee will review the idea of providing a special short stay home possibly outside the borough boundaries. The waiting list for admission to homes shows no sign of decreasing, remaining at well over 200 the whole of the year. We have started a full review of this waiting list and have made comparisons with the list of elderly persons awaiting rehousing with a view to identifying more clearly residential needs of the persons concerned. There is no doubt that elderly persons are sometimes admitted to homes for the elderly because of inadequate housing and we are endeavouring to improve the existing good liaison with the Housing Dept. in such cases although it will doubtless be some time before the housing for- the elderly can be met. Similarly, we are continuing to effect exchanges between sheltered housing and homes for the elderly. During the year there were 256 persons admitted to the Borough homes and The Willows (Including short stay and readmission from hospital etc.). 139 Survey of the Elderly One of the most interesting and we hope some productive projects which the Social Welfare Officers and their colleagues in health visiting and district nursing will be working on during next year, will be a survey of the living circumstances, problems and needs of some 2,000 persons aged 75 and over residing in the Ilford part of the Borough. Whilst there is much statistical information available concerning the elderly and certainly many services exist for them, which will improve as the years pass, it was felt both in the department and by members of the Ilford and District Geriatric Liaison Committee, (with representatives from the General Practitioners Hospital Medical Staff and Local Authority Medical and Social Work Staff serving on it) that we needed to know much more about the local situation in regard to the elderly. Originally the thought was to carry out a survey of everyone over 75 years of age with a view to ascertaining such individuals problems but it was shown that this would necessitate the interviewing of some 10,000 people by already hard pressed social work and nursing staff and it was decided to embark upon a less ambitious programme in terms of numbers interviewed but to make the study in much greater depth. Results will be invaluable as pointers to the development of the services for the elderly and will have put us in touch directly with 2,000 of them. Discussions on the project started at the beginning of the year and were led by Dr. Shaw, Deputy Medical Officer of Health and giving invaluable support and guidance of Mrs. M. Myers and Mrs. E. Fernando of the Greater London Council Intelligence Unit and the Borough Treasurer's Computer staff. Added urgency was given to the proposed survey by reports late in the year of elderly persons being found in very distressing conditions. It should be emphasised at this point that whilst a survey will put us in touch with many people and produce useful planning information, it will not avoid situations where elderly persons are found in a collapsed condition in which they have been for hours or in some cases days and short of having a daily visiting service to all elderly persons in the Borough, it is difficult to envisage how this situation can be avoided. In a limited survey of this sort, lines have to be drawn somewhere and the line was drawn at the age of 75 because the planning group considered that people of this age and over were more frail and more vulnerable, more in need and assistance and more 'at risk' than those elderly In the lower age group. 140 Many discussions have taken place on the information to be sought, the purpose of obtaining such information, manner in which it should be obtained, the number and phrasing and sequence and coding of the questions to be put and at the end of the year the briefing of interviewers was being planned. The success of the survey will depend largely on the skill and patience of the interviewers and the goodwill of those interviewed. Day Centres for the Elderly The three Day Centres continue to be well supported and planning is well ahead for the opening of the new small day centre in Aldborough Road. If the Borough's preventive setvices are to develop in effectiveness, that is to say to aid old people to lead a normal life and to delay their admission to a home or to hospital, there will be an increasing need for day centres sited in every parish of the Borough providing not only companionship but a meal at a reasonable price. The steady demand for meals at Fullwell Cross Day Centre convinced the Welfare Committee of a need to provide a similar service at the centres in Scrafton Road and Goodmayes and a meals service is proposed in these centres next year. Whilst the able bodied elderly are at all times welcome to use the centres, there is a feeling that the handicapped elderly should be aided to take advantage of them and to this end some transport has been provided to take handicapped elderly to Fullwell Cross Day Centre and this service will be extended as the economic situation permits. As time goes by, it is hoped that an increasing number of both mentally and physically handicapped elderly persons will be using the day centres so stimulating their interests and relieving relatives of the continuous burden of caring for them. Welfare Services for the Blind The services for the blind in the Borough continued with little change except in two respects. The Borough took over responsibility for the rental of talking book machines and 70 of such machines are at present in use by the blind in Redbridge. The handicraft classes were transferred from 249 Aldborough Road and All Saints Church Hall to the newly acquired premises at 363 High Road, Ilford. This latter situation is considered much more accessible than the others. More and more during the last few years the blind and partially sighted have been more closely integrated in society and they have established themselves to be quite capable of undertaking work far beyond the simple craft work which not so long ago was considered to be the limit of their capabilities. 141 In the employment field the blind have shown themselves to be as up-to-date as their sighted colleagues by showing themselves capable of employment in computer programming and it is hoped that the pattern of services for other classes of handicapped will follow along those for the blind and result in a far greater integration of the handicapped in the community than exists at present. Deaf Welfare Two of the Social Welfare Officers trained in communication with the deaf have been carrying the heavy burden of looking after this group of the community and have been tremendously successful with the club for the deaf which they initiated at Fullwell Cross Day Centre. In view of the limited understanding of the problems of the deaf possessed by these officers when they first commenced this work it says much for their devotion and hard work that we now have within the Borough a service which is in frequent contact with most if not all deaf persons in Redbrldge and which provides effective assistance for them, not only by visual aids such as the light flashing doorbells, but by steady social work support and the companionship of people with similar problems. Services for the Physically Handicapped The number of physically handicapped on the registers increased by over 100 during the year and this increase was reflected by the number of aids and gadgets issued (313), which was half as much again as the figure for the preceding year. Similarly the number of adaptations to property increased, 34 of such jobs have been undertaken ranging from the installation of a downstairs toilet and shower unit in a house to the provision of a simple handrail by the bath. For the first time the Borough took part in the National Help the Disabled Week and arranged open days at Fellowship House Occupational Centre, the High Road centre for the blind and also arranged an exhibition of aids for the disabled at the Scrafton Road Day Centre for the Elderly. For the latter co-operation was received from a number of outside organisations including the Red Cross Society and the G.P.O. Telephone Service but unfortunately very few people attended. During this week the inaugral meeting of the Redbrldge Association for the Handicapped was held and this Association was formed with the object of promoting the welfare of handicapped persons resident in the Borough by co-ordinating the activities of interested organisations. An average of 25 people attended daily at the Fellowship 142 House Occupational Centre, there being 74 people on the register of attendance and 32 on the waiting list. These figures demonstrate the inadequacy of the occupational centre and this is emphasised when it is known that the social workers have been instructed to avoid placing people on the waiting list unless it is absolutely necessary because of the long delay before they are able to attend. Sales from the occupational centre of articles made there remained at high level and for the week ending 22nd December, 1967 sales exceeded £105. Those persons registered as physically handicapped, I.e. permanently and substantially handicapped, the greatest number come within the two groups arthritis and rheumatism (325) and organic nervous diseases including epilepsy, disseminated sclerosis, poliomyelitis (295). Many of those persons registered are elderly and there is a constant demand for assistance for them both by way of aids and gadgets and social case work. The Borough continued to provide holidays for the physlcally handicapped at a wide variety of places, and a number joined with the elderly for the May/September holiday camps at Corton Beach. Others went to the camps arranged by the Essex Physically Handicapped Association and quite a large number were accommodated at Redhill and Grange Farm, Chlgwell by the W.R.V.S. Holidays for the Elderly The holidays for the elderly again proved to be very popular with a total of 750 persons visiting Corton Beach Holiday Camp near Lowestoft, during May and September. We know that the holidays were appreciated because of 300 letters received from participants and all of them indicated that the writers had enjoyed themselves. This year we included with the parties of elderly some physically, blind and deaf persons and with an increased number of helpers these handicapped persons did not present any great problem, and certainly seemed to find the holiday beneficial. We also sent a number of residents from the old peoples homes in the Borough and this gave them not only a change of environment but a general tone up both physically and mentally. At the risk of repetition, may I say again that this service is one of the most valuable preventive services introduced by the Borough Council and is well worth the £10,000 which is costs annually. Meals on Wheels Service This service which is operated in the Ilford part of the Borough by the Welfare Department staff assisted to a small 143 extent by the W.R.V.S. and in the Wanstead and Woodford part of the Borough wholly by the W.R.V.S. continues to expand and there are now 196 persons receiving meals. In Ilford alone during the year we introduced the delivery of meals in disposable tinfoil containers and these have proved to be most popular since the meal is received in a more palatable condition and can be eaten straight from the container if the recipient so wishes apart from the fact that the additional cost was absolved by reductions in staff. Meals are supplied in the Ilford area from the Town Hall kitchen and co-operation with the Borough Treasurer and his staff is much appreciated. As in previous years the Christmas meal was prepared in the Town Hall kitchen and the Good Companions of North Ilford paid for the cost of the meal provided to recipients in the Ilford area. At Christmas a survey was carried out to ensure that all the meals recipients would be having a meal over the holiday and it was found that with only a few exceptions the necessary arrangements had been made by relatives, neighbours and friends. I am grateful to the office staff who turned out during the holiday to deliver meals to those persons who could otherwise not have had them. In the Borough an average of over 800 meals are delivered each week and to the year end 31st December, 1967 almost 37,000 meals were delivered. Voluntary Organisations We have continued our close working relationship with the many voluntary organisations in the Borough concerned with the welfare of the community and the Welfare Committee has made grants to a large number of them. The Council is also affiliated to a number of regional and national associations and contact has been maintained with these associations to ensure that the best service is provided locally. It is worth a mention that membership of the Ilford and District Geriatric Liaison Committee has developed a closer understanding and co-operation between General Practitioner and hospital medical staff and I look forward to a continued development of this association which can only benefit the Borough. In common with all local authority departments, there was a steady demand during the year for officers to talk to various organisations concerning the work of the departments and some 63 talks were In fact given. In addition we had a number of students visiting departments, some just briefly for an hour or two and some being with us for almost 6 months. The presence of students in the department creates a good deal of additional work but they are very welcome since it not only enables us to give an accurate picture of the welfare service but also helps us In recruitment and the students themselves are often 144 lating young people who help us to remove some of the cobwebs which occasionally gather round our work. The staffing of the department is slowly becoming better balanced and the staff who have always been enthusiastic are developing in skill and raising the quality of the service given. I am grateful to the support of staff whether they are social workers, office staff or working in the homes or centres and I am grateful for their sustained Interest and enthusiasm, understanding and co-operation with the health service part of the department as developed during the year and I will express my appreciation of the co-operation of Dr. Gordon and Dr. Shaw and of the health service staff. 145 APPENDIX 27 LIST OF PREMISES (Local Authority) Old Peoples Homes Name Address No. of Places Superintendent/Matron Heath Gate Chadwell Heath Lane, Chadwell Heath, Romford. 60 Mr. ft Mrs. J. Luckett Hyleford Loxford Lane, Seven Kings. 64 Mr. & Mrs. J.P.W.Jordan Pegram House Longhayes Avenue, Marks Gate, Romford. 50 Mr. & Mrs. H. E. Hockley Rose Park Heathccte Avenue, Clayhall. Ilford. 60 Mr. & Mrs. D. Church Wood side 162 High Road, Woodford Wells 15 Mrs. A. Hopkins Occupational Centre No. on Register as at 31.12.67 Supervisor Fellowship House, Green Lane, Ilford. 74 Mrs. R. Low Day Centres (Local Authority) Name Address Scrafton Road Day Centre Scrafton Road, Ilford. Goodnayes Day Centre Broomhill Road, Goodmayea. Fullwell Cross Day Centre Fullwell Cross, Fairlop, Day Centre (Voluntary) Grove Park 2 Grove Park, Wanstead. (Managed by Wanstead and Woodford Old Peoples Welfare Association List of Homes (Private) Name Address No. of Places (Male and Female) Telephone No. Arden House 40 Emerson Road, Ilford. 20 male and female VAL 6198 Arlington 12 Snakes Lane, Woodford Green. 18 females BUC 1970 Belmont 66 Derby Road, South Woodford, E.18. 15 females BUC 5712 146 APPENDIX 27 (continued) List of Homes (Private) (continued) Name Address No. of Places (Male and Female) Telephone No. Greenholme 29 The Avenue, Wanstead, E.11. 22 male and female Chelmsford 52560 Homesdale 7 New Wanstead, Wanstead, E.11. 16 females WAN 0847 Osmont 8 Grove Park, Wanstead. 28 females WAN 4955 106 Aldborough Road, Seven Kings. 14 male and female SEV 3164 24 Glengall Road, Woodford Green 8 handicapped males and females 505 0408 6 Snakes Lane, Woodford Green. 10 handicapped males and females BUC 0445 29&31 Valentines Road, Ilford. 24 male and female VAL 2287 Persons In Care (as at 31.12.1967) Borough Homes 231 Out-Borough Homes 156 Voluntary Homes 109 Total 496 Voluntary Organisations to which grants are paid Redbridge Council of Social Service Redbridge Old Peoples Welfare Association Wanstead and Woodford Old Peoples Welfare Association Toc H (Warning Lamp Scheme) Essex County Association for the Blind Southern Regional Association for the Blind Essex Physically Handicapped Association Ilford Physically Handicapped Committee Wanstead and Woodford Association for Physically Handicapped Hainault Association for Physically Handicapped British Epilepsy Association Spastics Society Redbrldge Association for the Handicapped Essex League of Hard of Hearing Essex League of Hard of Hearing (Redbridge group) Royal Association in aid of Deaf and Dumb Miscellaneous Disbursements to Clubs Redbrldge Deaf Club Redbrldge Association of Professional Social Workers 147 APPENDIX 28 Voluntary Organisations to which the Council is affiliated South East Regional Association for the Deaf Central Council for the Disabled Handicrafts Advising Association for the Disabled Essex Physically Handicapped Association APPENDIX 29 PHYSICALLY HANDICAPPED STATISTICS MINISTRY CATEGORIES No. as at 31.12.67 Amputation 39 Arthritis and Rheumatism 325 Congenital Malformations and Deformities 32 Diseases of the digestive and genito-urinary systems; of the heart of circulatory system; of the respiratory system (other than tuberculosis) and of the skin 82 Injuries of the face, head, neck, thorax, abdomen, pelvis or trunk. Injuries or diseases (other than tuberculosis) of the upper and and lower limbs and of the spine 113 Organic nervous diseases — epilepsy, disseminated sclerosis, poliomyelitis, hemiplegia, sciatica etc. 295 Neuroses, psychoses and other nervous and mental disorders 4 Tuberculosis (respiratory) 2 Tuberculosis (non-respiratory) 7 Diseases not listed above — Total 899 APPENDIX 30 Description of Aid Number issued (including reissued) Bath Aids 112 Toilet Aids 43 Walking Aids 47 Chairs 4 Tables 6 Hoists 7 Small Miscellaneous Aids 94 Total 313 148 PHYSICALLY HANDICAPPED HOLIDAYS APPENDIX 31 No. of Person Hotel or Holiday Camp 1.1.67 - 31.12.67 British Rheumatism and Arthritis Association (Margaret Pinder House) 2 British Epilepsy Association (Colwyn Bay) 1 Cheshire Homes (Seven Rivers Colchester) 1 Corton Beach Holiday Camp — May 21 September 29 Essex Physically Handicapped Association 29 Grants 6 Jewish Association for the Physically Handicapped (Bournemouth) 7 Private Arrangements 2 Oueen Elizabeth Foundation for the Disabled (Lulworth Court) 3 Shaftesbury Society 2 Westbourne Lodge Guest House 12 WRVS Crabhill House, Redhill 24 WRVS Grange Farm, Chigwell 9 Transport only 4 Total 152 Blind and Partially Sighted Holidays No. of Person 1.1.67-31.12.67 Hotel or Holiday Camp Corton Beach Holiday Camp 7 Essex County Association for the Blind (Frinton) 5 Grants 1 Ilford Blind Welfare Association (Cliftonville) 16 Westbourne Lodge Guest House 2 Total 32 APPENDIX 32 HOLIDAYS FOR THE ELDERLY Corton Beach Holiday Camp, Nr. Lowestoft, Suffolk. No. of Persons Elderly Escorts May 1967 356 24 September 1967 *54 6 September 1967 333 25 Totals 743 55 *This figure includes 37 residents of the Boroughs' Homes for the Elderly. 149 APPENDIX 33 MEALS ON WHEELS As at 31.12.67 Ilford area (administered by Dept.) Wanstead & Woodford area (W.R.V.S.) Average No. of meals delivered per week 610/630 180/200 Average No. of recipients 200 50/60 Total No. of meals delivered during year ending 31.12.67. 25,978 10,954 150 INDEX Page No. Accidents 15 Adult Training Centre 94 Dr. Anand — Enuresis Clinic 78 Animal Boarding Establishments Act, 1963 127 Anti-Smoking Campaign 54 Asian Immigrants 13 Atmospheric Pollution — Clean Air Act 115 At Risk Register 26*28 Mr. Azam — Educational Psychologist 72 B.C.G. Vaccinations 79 Births 26 Blindness 140 Bowel Infections 11 Bronchitis 15 Care of Mothers and Young Children 23 Causes of Deaths 19 Cerebral Palsy Unit 71 Cervical Cytology 37,42 Child Guidance 71 Child Minders 31,33 Children at Risk 27 Chiropody Service (including School Health) 40, 80 Clean Air Act — Smoke Control Orders 115 Clearance Areas 111 Clinics and Treatment Centres — Child Guidance Dental 28,67 — E.N.T. 66 — Enuresis 74,78 — Minor Ailments 63 — Ophthalmic 63 Orthopaedic 64 — Orthoptic 64 — Premises 45 — Speech 66 — Vaccination and Immunisation 38 Congenital Abnormalities 46 Convalescent Treatment 39 Coronary Disease 15 Mr. Daly — Chief Public Health Inspector 99 Day Centres 140 Day Nurseries 46 Deaf Welfare 141 Deaths and Causes 19 Deaths Rates 10,20 151 Dental Health Education 50 Dental Treatment (including Schools) 28-30,67-69 Department of Education and Science — Statistical Tables 82-92 Development of L.A. Health Services 23 Diseases of Animals (Waste Food) Order, 1957 126 Diseases of Animals (Movement Orders, etc.) 126 Diseases (notifiable) 16 Disinfection and Disinfestatlon 107 Domiciliary Nursing 36 Drainage and Sewerage 101 Dysentery 11 Ear, Nose and Throat Clinic 66 Education Committee 2 Mr. Ensor — Consultant Ophthalmologist M Enuresis 74-78 Environmental Health 99 Epidemiology 11-15 Ethel Davis School (Physically Handicapped) 69 Factories and Workshops 120 Female Cancers 15, 42 Fertilisers and Feeding Stuffs Act, 1926 126 Food and Drugs Sampling Food Hawkers 124 Food Hygiene 124 Foods, Fitness and Consumer Protection 121 Food Poisoning 11 Food Preparation — Premises 125 Food Surrendered 133 Miss Gascoyne — Educational Psychologist 72 General Welfare and Research (School Health) 80 Geriatric Clinic 42 Goodmayes Hospital 94 Group Practice Attachment 36 Dr. Gurassa — Psychiatrist 71 Gypsies and Other Travellers 114 Mr. Haigh — Chief Dental Officer 28, 67 Hairdressers and Barbers Establishments 127 Mr. Hall Chief Welfare Offiser 137 Handicapped Children 79 Health Committee 1 Health Centres 21-23 Health Centres — Sites 23 Health Education (including Schools) 49-59 Health Services Clinics 45 Health Visitors and School Nurses 33-36, 79 Hearing Tests 34 152 Holidays for the Elderly 142 Home Helps 43 Home Laundry Service 108 Home Nursing 36 Home Safety 35, 53 Homes for the Elderly 137 Hospital Admissions — Mentally 111 and Mentally Handicapped 95 Housing 111-114 Dr. Howell — Deputy Medical Officer — Ethel Davis School 69 Hypothermia in the Elderly 13, 36 Hypothermia in Hospital Admissions 14 Hypothermia in the Community 14 Ice Cream 121 Illegitimate Births and Deaths 10 Immigrants — Long Stay 108 Immunisation 38 Infant Mortality 10 Infant Welfare Centres 45 Infectious Diseases 11,108 Influenza 11 Inspections and Supervision of Food 121, 124 Junior Training Centre 94 Mr. Korvin — Orthopaedic Surgeon 64 Land Charges Act 128 Laundry Service for the Aged Incontinent 108 Mr. Lee — Orthopaedic Surgeon 71 Litter Act, 1958 107 Liquid Egg (Pasteurisation) Regulations, 1963 123 Live Births 10 Loan of Sick Room Equipment 39 Lung Cancer 15 Miss M. M. Mason — E.N.T. Consultant 66 Massage and Special Treatment Establishments 127 Mass Radiography 18 Maternal Mortality 10 Meals on Wheels 142 Measles 12 Meat and Other Foods — Inspection and Supervision 124 Medical Inspection at Schools Mental Health Service 93 Mental Welfare Officers 94 Merchandise Marks Act 125 Midwifery 32 Milk 123 Minor Ailments 63 153 National Assistance Act, 1948 137 National Assistance Act, 1948 — Section 50 127 National Health Service Act, 1946 21 Neonatal Mortality 10 Noise Abatement Act, 1960 108 Notifiable Diseases 16 Nurseries and Child Minders Regulation Act 31, 33 N.S.P.C.C. 80 Observation Register 26-28 Occupational Centre (Fellowship House) 142 Officers of the Public Health Services 3-5 Officers, Shops and Railway Premises Act, 1963 119 Miss Oliver — Superintendent Health Visitor 33, 79 Ophthalmic Clinic 63 Orthopaedic Clinic 64 Orthoptic Clinic 64 Overcrowding 112 Paratyphoid Fever 11 Partially Sighted 140 Peripatetic Teachers of the Deaf 78 Pests 110 Pet Animals Act, 1951 127 Pharmacy and Poisons 127 Physically Handicapped 141 Physiotherapy 66 Dr. Pooley — Departmental Medical Officer — Enuresis Clinic 74-78 Population 10 Miss Potter — Superintendent of Midwives and District Nurses 32, 36 Preface 7-9 Mrs. Pretious — Speech Therapist 66 Private Day Nurseries and Child Minders 31 Public Baths 104 Public Conveniences 103 Rag, Flock and Other Filling Materials, etc. 126 Rainfall 10 Rats and Mice 110 Recuperative Holidays 63 Refuse Collection and Disposal 102 Remedial Exercises 66 Renal Dialysis 38 Research 80 Residential Accommodation for the Elderly 137 Riding Establishments Act, 1964 127 Rivers and Streams 100 Sanitary Inspection of the Area 104 School Dental Service 67 School Health Service 61 School Nurses 79 154 School Psychological Service 72 School Roll and Premises 62 Screening Tests of Vision and Hearing 62 Services for the Elderly 137, 140 Services for the Handicapped 141 Sickroom Equipment 39 Slaughter of Animals Act 126 Social Clubs for the Mentally 95 Speech 66 Specialist Services 30 Staff 3, 62 Statistics — Environmental Health 129-135 — Epidemiology 16-20 —- Mental Health 97 — Personal Health 45-48 — School Health 82-92 — Vital and Social10 — Welfare 145-149 Street Cleansing103 Suicide 15 Survey of the Elderly 15, 139 Swimming Baths 123 Dr. Taylor — Anti-Smoking Campaign 54 Toddlers Clinic 34 Dr. Toms — Principal Mcdical Officer, N.H.S. Act, 1946 & School Health Service 21,61 T.B. Care and After Care 41 T.B. — Notifications, deaths etc.13 Typhoid 11 Vaccination and Immunisation 38 Venereal Diseas 13, 18 Voluntary Bodies 41, 80, 143 Water Supply 100 Miss Watt — Educational Psychologist 72 Dr. Wedeles — Principal Medical Officer — Mental Health Service 93 Welfare Service 137 Welfare Committee 1 Whooping Cough 12 Printed by: The London Borough of Redbrldge, Town Hall, Ilford, Essex.