AC-43384 Acled.24.11.19 RED 4 annual report of the Medical Officer of Health ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for 1968 I. GORDON, London Borough of Redbridge, WD., Ch.B., M.R.C.P. (Lond.), D.P.H. (Edin.) Health & Welfare Department, 17-23, Clements Road, llford, Essex. TABLE OF CONTENTS Page No. HEALTH COMMITTEE 1 WELFARE COMMITTEE 1 EDUCATION COMMITTEE 2 STAFF 3-4 PREFACE 5-8 VITAL STATISTICS AND SOCIAL CONDITIONS 10 EPIDEMIOLOGY 11-18 GENERAL SERVICES 19-24 NATIONAL HEALTH SERVICE ACT, 1946 25-51 HEALTH EDUCATION 53-60 EDUCATION ACT, 1944 61-92 MENTAL HEALTH 93-97 ENVIRONMENTAL HEALTH 99-134 WELFARE 135-151 INDEX 152-156 1 HEALTH COMMITTEE Municipal Year 1968-1969 Councillor Mrs. G.M. CHAMBERLIN, J.P., chairman Councillor J. H. Norwood, vice-chairman Aldermen S. G. GLEED, mayor Alderman R. A. DALTON, J.P. Alderman Miss A. S. TERRY, J.P. Alderman Mrs. L. FALLAIZE, O.B.E., J.P. (deputy mayor) Councillor Miss CLARK Councillor J.J. SMITH Councillor FOLLOWS Councillor Miss THURGOOD Councillor Mrs. V.M. GROSE Councillor J.A. VANE Councillor Mrs. HARVEY Councillor YATES Councillor LEGGATT Councillor YOUNG Councillor Mrs. M. H. PAIGE 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 S. G. GLEED, mayor Alderman Mrs. L. FALLAIZE, O.B.E., J.P. (deputy mayor) Councillor BILLINGHAM Councillor LEGGATT Councillor Miss CLARK Councillor F.C. MOUNTIER Councillor T. F. COBB, A.I.A.C. Councillor OPEN Councillor FOLLOWS Councillor Mrs. ROBERTS Councillor GLOVER Councillor J.A. VANE Councillor E. F. HARRIS Councillor K.W. WEBB Councillor Mrs. KELLY 2 EDUCATION COMMITTEE Councillor D. K. L'ESTRANGE, B.A., LL.B., F.C.I.S., chairman Councillor 0. F. WATERS, J.P., vice-chairman Alderman S. G. GLEED, mayor Alderman Mrs. L. FALLAIZE, O.B.E., J.P. Alderman Mrs. E.F.M. HOLLIS, M.B.E, (deputy mayor) Alderman C.I. GIBSON Alderman Miss A.S. TERRY, J.P. Councillor H. R. B. ALY Councillor N.C.N. HURST Councillor L. G. BRIDGEMAN Councillor JACKSON Councillor D.A. CARRADICE Councillor Mrs. ODHAM Councillor T. F. COBB, A.I.A.C. Councillor OWEN Councillor G. E. DAVIES, J.P., B.Sc. Councillor SAVAGE Councillor DEDMAN Councillor J.J. SMITH Councillor DIXON Councillor R.E. SMITH Councillor GLOVER Councillor TOVEY Councillor Mrs. V.M. GROSE Councillor H.J. WATTS Councillor B.E.R. HAMILTON Councillor Mrs. V.L. WILSON Councillor L.M. HIPKINS, B.A., F.R.S.A., F.R.G.S., F.R.Econ.S., A.C.C.S. Co-opted Members: Rev. A.J. ADAMS Mr. J. ANDREWS Mrs. D.E. CARTER DR. B.H. CHIRGWIN, M.A., Ph.D. Miss R.M. FORDHAM Mr. H. GOLDNER 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 and principal school medical officer: I. GORDON, M.D., Ch.B., M.R.C.P. (Lond.), D.P.H. (Edin.) deputy medical officer of health and deputy principal school medical officer; A. SHAW, M.B., B.S. (Durham), D.P.H. (Leeds) (to 31.7.68) M.T. FERNANDES, M.B., B.S., D.P.H., D.I.H., D.C.H., L.M. (from 16.9.68) principal dental officer: E.V. HAIGH, L.D.S., R.C.S. (Eng.) principal medical officers: deputy chief public health inspector: W.H. TOMS, M.B., Ch.B. (Edin.) R. E. SMALLEY, A.R.S.H. (to 2.2.68) CLAUDE H.A. WEDELES, L.R.C.P., J.T.S. TEMPLEMAN, M.A.P.H.I. M.R.C.S., D.P.M. (Lond.) health education officer: SENIOR ASSISTANT medical officer: Miss K.M. E. GRIFFITHS, D.M.E. JOAN M. POOLEY, M.B., B.S., D.C.H. home help organisers: departmental medical officers: Miss J. M. PEMBERTON (Senior) ELIZABETH A. LITTLE, M.B., Ch.B.,(Aber.) Mrs. K. BEDWELL J.A. HOWELL, M.B., Ch.B. Mrs. E. MARTIN J.K. ANAND, M.B., B.S., B.Sc., L.S.M.F. M.R. DAS GUPTA, M.B., B.S. chief welfare officer: R.W. HALL, A.M.I.S.W. DENTAL officers: G.H. WILLSON, L.D.S., R.C.S.(Eng.) deputy chief welfare officer: J.J. BOWE, L.D.S. (Belfast) C. R. COLE, D.S.S., A.M.I.S.W. A.M. GARMAN, L.D.S., R.C.S: (Eng.) SESSIONAL DENTAL OFFICES: superintendent health visitor: R.A. SOAR B DS Miss J,M. 0LIVER, SRN., S.C.M., H.V. Mrs. E. KIMELMAN, M.D. (Vienna) Y.G. TOOLSY, B.D.S. (Durham) deputy superintendent health visitor: D. O'CONNELL, B.D.S. (Dublin) Miss E. M. P. COLLINS, S.R.N., S .C.M., H.V. (from 15.10.68) non-medical supervisor of midwives/ CHIEF PUBLIC health inspector: superintendent of district nurses: S R. DALY, LL.M., B.Sc., D.P.A. (Lond.), Miss M. A. POTTER, S.R.N., S.C.M., Barrister-at-Law Q.I.D.N., H.V. 4 Officers of the Health and Welfare Department - continued PRINCIPAL MENTAL HEALTH SOCIAL WORKER: ASSISTANT PRINCIPAL SOCIAL WORKERS: J. HORAK, R.M.N., A.A.P.S.W. (from 1.7.68) W. RUMSBY, C.S.W. (from 1.6.68) Miss J. HILL, A.J.M.S.W. (from 3.9.68) M. PERRY, C.S.W. (from 12.8.68) ASSISTANT PRINCIPAL MENTAL HEALTH SOCIAL WORKERS: CHIEF ADMINISTRATIVE ASSISTANT: Mrs. E.J. THOMPSON, A.A.P.S.W. D.H. GODWIN, A.R.S.H. (from 17.7.68) Miss M.D. BOYD, M.A.(Edin.), A.A.P.S.W. senior administrative assistants: (from 1.9.68) Miss H.M. NUNN H.R. STANBRIDGE F. W STRFFT PRINCIPAL SOCIAL WORKER AND CASE WORK CONSULTANT: A.J. HOWLETT F.R. DICKINSON, C.S.W. I.J.C. USHER, D.M.A. PUBLIC ANALYSTS: J. HUBERT HAMMENCE, M.Sc., Ph.D. (Part-time) P.S. HALL, F.R.I.C. (Part-time) REGIONAL HOSPITAL BOARD: Surgeons in charge of Orthopaedic Clinic H.G. KORVIN, D.M., F.R.C.S. M. MASON, F.R.C.S. Opthalmologists 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. R. PESWANI, M.B., B.S., D.O. (London) Surgeons in Charge of Ear, Nose and Throat Clinics — MARGARET MASON, M.A., F.R.C.S. Child Guidance Clinic — Consultant to the Cerebral Palsy Unit - Medical Director - H.B. LEE, F.R.C.S. W. P. GURASSA, M.D., M.R.C.P. Orthoptics - Miss M. LEWIS Pyschiatrist — Mrs. J. ASHENDEN H.J. ALTSCHULOVA, M.D. Miss L. McCONNELL 5 PREFACE Health and Welfare Department, 17/23, Clements Road, TELEPHONE: 01-478 3 020 ILFORD. August, 1969. Mr. Mayor, Ladies and Gentlemen, I hereby submit the fourth Annual Report of the Health and Welfare Services of the London Borough of Redbridge. The fresh format is largely due to Dr. Fernandes, our new deputy, who has taken over the editorship, and I must thank him for his efforts. Last year I mentioned our difficulties in "waiting for Seebohm", this year we are still waiting, now for Mr. Richard Crossman to pronounce on Seebohm. The statistics of the borough for 1968 present a number of very interesting features. The population has risen by 790, in itself not very remarkable, but viewed in the light of a steady decline over the last few years, and the general consensus of opinion among statisticians that the population of most of the London boroughs, including Redbridge, will decline still further in the next few years, it seems that the statisticians should have a second think. It should be noted in this regard that the number of inhabited houses has risen by 99. The most remarkable statistic of all is the infant mortality rate, which has fallen from 18.20 deaths per 1,000 live births to 12.74 (Greater London 18.6). As the number of such deaths was however only 45 (in 1967 there were 66), statistics become less valid as numbers diminish, but nevertheless it is a remarkable achievement, in view of the total number of live births, 3,582, only 85 less than the previous year. The mortality fates in the first four weeks of life, and in the first week of life have also fallen dramatically, but as there were 9 more stillbirths (49) the so-called perinatal mortality rate has only fallen from 23.10 to 20.38. The percentage of live births that were illegitimate has risen from 6.41 to 7.50, a minor reflection of what obtains throughout London (11.5). A strange feature of this is that bed-occupancy in mother and baby homes (for unmarried mothers) is steadily diminishing, and fears are expressed that some of these homes may have to be closed. An explanation of this paradox may be that society is becoming more permissive, unmarried mothers can remain with their parents. The rise in illegitimacy is also mirrored by the rise in venereal diseases. These are not notifiable but the London Clinics give us the numbers of those resident in Redbridge, which have risen from 721 to 855. 6 The adjusted death rate has risen from 10.61 per 1,000 population to 11.08 (Greater London 11.71). One reason for this rise is the susceptibility of the middle-aged male to coronary heart disease (good living, little exercise) and cancer of the lung (cigarette smoking). Infectious diseases dropped dramatically, scarlet fever 137 to 94, dysentery (a minor type) from 543 to 345, pulmonary tuberculosis from 55 to 42, whooping cough from 202 to 60, and measles from 2,695 to 432. With respect to the latter, epidemics occur every alternate year, so to evaluate the effectiveness of measles vaccination we must await the 1969 figures. We were all expecting an outbreak of influenza in Britain from the new Hong Kong virus, but as is well known, this did not happen. Precautions, at some expense, were taken in Redbridge to immunise essential council staff, but it must not be assumed that the money was wasted, the new virus is undoubtedly still with us, and may bethe immunity we promoted will stand us in good stead in the winter of 1969/70. FLUORIDATION It is impossible in this preface to do more than briefly comment on a very few selected items of interest, much more detail will be found in the main body of my report, written by the principal officers concerned. However I would like to refer to the new circular and campaign by the Department of Health and Social Security on fluoridation of water supplies. Also the World Health Assembly of WHO in July of this year, passed without dissent a resolution recommending the procedure as effective in reducing dental caries and completely harmless. There are of course no waters completely devoid of fluoride, but many are deficient, including water supplied in Redbridge, where the content is between one quarter and one third of the recommended one part per million. Unfortunately, our water suppliers will not proceed until there is unanimity among the local authorities they supply and the handful of backward boroughs (not, of course, Redbridge) are preventing the application of this useful procedure in Greater London. IMPROVING OUR ENVIRONMENT So much is said and written about pollution of the environment, with the suggestion that within the near future we will all be poisoned, that a few points to the contrary should be made. It will be noted in the report of the Chief Public Health Inspector that the Clean Air Campaign is nearing its end and in a very few years the wholeof Redbridge will be a smoke control zone. The atmosphere in London has improved recently out of oil recognition, with great benefit to the health of its inhabitants. Our rivers are less polluted, especially the Thames, where fish have been found lower down its reaches than for many decades. In publicising the dangers from insecticides, artificial fertilisers 7 and weed killers a lot has been said of their threats to human and animal life, so far minimal, and in many cases, such as DDT, apparently non-existent. Strangely little is said of the millions of lives they have saved from starvation and disease, such as malaria. HOSTELS FOR MENTALLY HANDICAPPED Recent public anxiety as to conditions in hospitals for the mentally subnormal have made these hospitals excessively cautious about conditions in their wards, especially with respect to overcrowding. So cautious in fact that a halt has been called (temporary, one hopes) to all admissions to the two main such hospitals in the North East Metropolitan Board area. This makes it even more urgent that hostel accommodation be provided by the local authority for those who cannot be reasonably accommodated at home, or have no home, and do not require medical and nursing attention. These severely mentally subnormal people are on the average quieter and more law-abiding than the overage citizen and some, such as those with Down's Syndrome (formerly called Mongols) often attract more affection than their brothers and sisters. It is to be hoped that our modest efforts to house a few will meet with success. Parents who wonder what will happen to their handicapped children when they are no longer alive to care for them will be eternally grateful. PERSONAL HEALTH SERVICES Just two points. After years of discussion and planning with respect of health centres, although none have yet been built, a number are under discussion, and one, in the grounds of King George Hospital, is well forward in planning. This would be a unique and prestige project, for not only is it adjacent to a general hospital, with all the general practitioners in its neighbourhood working therein, but it would cater for training medical students and possibly post-graduate doctors receiving vocational training to become G.P's., and be adjacent to a post-graduate medical centre for all doctors in the area. The latter projects would not of course be financed by the local authority. All our home nurses are now attached to G.P. practices with which, in the past, they have always had a close association. We are limited in our establishment, and one large practice partnership wanted two nurses attached; we could only let them have one. An anicable and unusual solution was evolved. The practice appointed their own nurse, helped in their selection by our superintendent of home nurses from a short list we provided, at an equivalent salary, and professionally integrated with our home nursing service. A case of a practice attaching a nurse to the local authority! 8 That 1968 passed with services well maintained, even improved, in spite of severe restrictions in spending could only have been achieved by the loyal and conscientious efforts of a staff that was often overworked. My colleagues in other departments have, as ever, been co-operative and helpful. My thanks must also go to the Councillors and Chairmen with whom I am associated who, whilst laying down our policies, have borne with our difficulties and understood our problems. Finally, as usual, many thanks to the great army of volunteers who have helped us in our efforts, often blazed a new trail, provided a link with the community, and saved the ratepayers some money. 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 (in Acres) (Tidal Water ) 13,983 Registrar-General's Estimate of resident Population:— June, 30th, 1968 246,090 Number of inhabited houses (April 1st, 1968) according to Rate Books 78,025 Rateable Value - April 1st, 1968 £13,114,140 Sum represented by a penny rate, April 1st, 1968 £52,412 General Rate jn the £ - 1968-69 — Domestic Properties 12s.2d. Mainly Domestic Properties 12s.7d. Non-Domestic Properties 13s.0d. The following figures as to unemployment were supplied by the Ministry of Labour (Ilford area only): Males Females As at 6th January, 1969 1,028 116 1968 Live Births 3,533 Live Birth rate per 1,000 population — Crude rate 14.36 Adjusted rate 14.79 Illegitimate Live Births per cent of total live births 7.50 Stillbirths 49 Stillbirth rate per 1,000 total live and stillbirths 13.68 Total Live and Stillbirths 3,582 Infant deaths (under 1 year) 45 Total Infant deaths per 1,000 total live births 12.74 Legitimate Infant deaths per 1,000 legitimate live births 12.55 Illegitimate Infant deaths per 1,000 illegitimate live births 15.09 Neo-natal mortality rate per 1,000 live births (first four weeks) 8.49 Early Neo-natal mortality rate per 1,000 total live births (under one week) 6.79 Perinatal mortality rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) 20.38 Maternal deaths (including abortion) Nil Maternal mortality rate per 1,000 live and stillbirths 0.00 Deaths (all causes) 2,869 Death rate per 1,000 population — Crude Rate 11.66 Adjusted rate 11.08 Comparability Factors - Birth rate 1.03 Death rate 0.95 Total rainfall 1968 29.40 inches Greatest rainfall in any 24 hours (on 31.7.68) 3.00 EPIDEMIOLOGY 11 EPIDEMIOLOGY (Dr. M.T. Fernandes, M.B., B.S., D.P.H., D.I.H., D.C.H., L.M., Deputy Medical Officer of Health) Dysentery and Food Poisoning Although compared with last year, the notified cases of d/sentery dropped from 543 to 345, notified cases of food poisoning increased from 24 to 78. To this latter figure, however, must be added 53 cases which were notified by general practitioners as suspected food poisoning and a further 77 cases which came to the knowledge of the Department other than by notification. All of the cases were investigated and amongst the 99 proven cases 10 salmonella infections were found, but these were isolated cases. The 77 cases referred to above were discovered due to the initiative of an Ambulance Officer advising the Medical Officer of Health of persons attending a wedding reception who were being removed to five local hospitals with food poisoning symptoms. This timely information enabled us to make complete and full investigations, including the taking of samples of food on the spot, and with the co-operation of the staffs of local bacteriological laboratories the cause of this staphylococcal food poisoning was traced. The complete investigation elicited that the chicken, cooked, and carved the evening prior to this wedding, and the jelly and cream served at the reception, were contaminated by staphylococcal pyogenes. The caterer who carried out the preparation of the food had an eczematous condition with secondary infection of all his fingers. Swabs taken of his fingers revealed a profuse growth of staphylococcus pyogenes. Paratyphoid 4. cases of paratyphoid were notified but were not confirmed bacteriologocally. Influenza In an endeavour to mitigate the effect of the much publicised "Hong Kong" A2 strain of influenza which in alarmist propaganda was scheduled to reach this country in late 1968 or early 1969 with consequential havoc, the Council agreed to immunise certain key personnel to enable vital services to continue. Fortunately the predictions were wrong and apart from small outbreaks in parts of the country and local incidents the effect was minimal. 12 However, some of the resulting immunity from these injections may persist for the forthcoming winter. Number of persons given the Reaction reported influenza vaccine (if any) 3,320 1 (mild giddiness) Measles 1968 was a non-measles year but the 432 cases notified, although expected to be a considerable reduction on the 2,695 cases for 1967, fell well below the 827 in 1966. Measles immunisation commenced in June 1968 and although it is too early to draw conclusions, it would seem that it is indeed having some effect. Whooping Cough Notified cases of whooping cough fell from 202 in 1967 to 60 in 1968, a figure which compared more with the pattern of 1966 and 1965, 63 and 80 respectively. Tuberculosis 42 cases of pulmonary tuberculosis and 9 of non-pulmonary tuberculosis were notified during the year. Statistics relating to tuberculosis are given in Appendix 2. Venereal Disease Irrespective of the fact that returns of Redbridge residents treated for Venereal Disease were only received from 8 treatment centres in 1968 compared with 9 in 1967, the numbers of cases known rose to 16of syphil is and 95 of gonorrhoea. Particulars of the returns are contained in Appendix 4. Coronary Disease Owing to a reclassification of the causes of death by the Registrar General there is some difficulty in relating the deaths from coronary disease in 1967 and 1968 as contained in the table in Appendix 5. Over one in four of all deaths between the ages of 35 and 55 years was caused by ischaemic heart disease. Cancer Lung and Bronchus 173 persons died from this form of cancer in 1968, an increase of seven over 1967. Most of these occurred in persons over the age of 55. 13 Bronchitis Emphysema Deaths due to bronchitis and emphysema increased by 14 above the 1967 figure to 142. Female Cancers There were 76 deaths from female cancers, 59 of the breast and 17 of the uterus, which showed a decline from similar deaths in 1967. Accidents 81 people died as a result of accident, 35 of these being road accidents. There were 8 accidental deaths in children under the age of 15. Suicide Suicides remained at the same fairly constant figure of 30; 3 of these occurred in persons under the age of 25. Lead Poisoning There was an unusual occurrence when, following notification of the admission of an Asian child aged 3½ years to hospital with a diagnosis of gastro-enteritis, treatment and investigation proved it to be a case of severe lead poisoning and lead encephalopathy. The child was seriously ill and comatose although eventually recovered. Constant liaison was established with the hospital and the family; father, mother and two of the children were investigated, the latter showed a raised blood lead level but after two days treatment in hospital were discharged. The parents showed no abnormality. Samples of potential lead bearing elements in the home were sent for analysis but were not considered causal. However, the mother, in common with certain asiatics, used an imported eye cosmetic which proved to contain 88% lead sulphide. This substance had been stated as the cause of a similar case of poisoning in another hospital. In addition, an analysis was done of antimony in hair and nails of the children "at risks" by the neutron activation technique of Smales and Pate, Anlayst, 1952, 77, 196. For this sophisticated technique we are grateful to the Laboratory of the Government Chemist. However, antimony and arsenic estimations were within normal limits. Considerable publicity was given to the potential dangers of using such cosmetics. 14 APPENDIX 1 NOTIFICATIONS OF INFECTIOUS DISEASES FOR THE YEAR 1968 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 94 - 27 63 3 - 1 - Diphtheria, including Membranous Croup - - - - - - - - Enteric Fever (Para-Typhoid) 4 - - - 1 2 1 - Pneumonia (Up to 31.9.68) 37 - - 3 1 2 13 18 Puerperal Pyrexia 13 - - - 5 8 - - Acute Poliomyelitis - - - - - - - - Acute Encephalitis 1 - - - - 1 - - Meningococcal Infection - - - - - - - - Dysentery 345 17 77 78 36 89 48 - Ophthalmia Neonatorum 3 3 - - - - - - Erysipelas 4 - - - 1 2 1 - Tuberculosis - Pulmonary 42 1 1 4 4 13 13 6 Other Forms 9 - - 2 - 5 2 - Anthrax - - - - - - - - Malaria — Believed contracted in this country - - - - - - - - Believed contracted abroad - - - - - - - - Measles 432 20 231 171 4 5 1 - Whooping Cough 60 2 27 27 1 3 - - *Food Poisoning 78 5 15 16 28 12 2 - Typhus Fever - - - - - - - - Infective Jaundice (From 15.6.68) 10 - 1 2 3 3 - 1 Totals 1,132 48 379 366 87 145 82 25 *Excludes 53 cases notified as "Suspected". Of the total (131) notified, 20 cases were confirmed, plus 2 notified as Dysentery. A further 77 cases, which came to the knowledge of the department, other than by Doctor's notification, were confirmed as food poisoning. 15 APPENDIX 2 TUBERCULOSIS Age Periods New Cases Deaths Respiratory Non-Respiratory Respiratory Non-Respiratory M F M F M F M F Under 1 year - 1 - - - - - - 1- 4 years - 1 - - - - - - 5-14 „ 1 3 2 - - - 1 - 15-24 „ 2 2 - - - - - - 25 - 44 „ 7 6 2 3 3 1 - 1 45-64 „ 11 2 - 2 6 - - - 65 - 74 „ 2 1 - - 5 - - - Over 75 „ 2 1 - - 2 - - - Totals 25 17 4 5 16 1 1 1 The foregoing new cases were notified from the following sources:— Respiratory Tuberculosis Non-Respiratory Tuberculosis Ilford Chest Clinic 19 3 Wanstead and Woodford Chest Clinic 11 - Epping Chest Clinic 1 - Local General Practitioner - 1 Wanstead Hospital - - Harts Hospital 2 - King George Hospital 1 1 Dagenham Hospital 2 - Hospitals outside Borough 6 4 Totals 42 9 In addition 32 pulmonary and 6 non-pulmonary cases were transferred to Redbridge. Pulmonary NonPulmonary Total Number of cases on register, 1st January, 1968 886 126 1,012 Number of new cases entered on register during the year 42 9 51 Number of other cases during the year 32 6 38 Totals 960 141 1,101 Number of cases removed from register during the year — Recovered 94 4 98 *Deceased 17 2 19 Left District 28 2 30 Lost sight of - - - Diagnosis not established 1 - 1 Totals 140 8 148 Number of cases remaining on register on 31st December, 1968 Total 820 133 953 Treatment of Tuberculosis is under the Control of the Regional Hospital Board. On the 31st December, 1968, there were 953 Redbridge patients on the registers of the llfora, Wanstead and Woodford and Dagenham Chest Clinics. Deaths of persons on T.B. Register but the cause of death not necessarily being Tuberculosis. 16 MASS RADIOGRAPHY APPENDIX 3 The mass radiography unit stationed at Vine Church Hall operated on Mondays from 1st January to 1st July, 1968 and again from 12th August, 1968 to the end of the year. The service is still in operation and Dr. R.S. Francis, 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 1,861 1,527 3,388 General Public 3,233 3,341 6,574 Organised Groups 361 2,165 2,526 Contact Groups 37 6 43 Total Number X-rayed 5,492 7,039 12,531 APPENDIX 4 VENEREAL DISEASES Treatment received by new cases from Redbridge during 1968, as notified by the undernoted Treatment Centres Name of Centre Syphilis Gonorrhoea Other Conditions Total The Whitechapel Clinic, London Hospital, E.1. 12 67 545 624 Homerton Grove Clinic, Eastern Hospital, E.9 - 2 7 9 Special Clinic, Queen Mary's Hospital, E.15 2 4 59 65 St. Bartholomew's Hospital, London, E.C.1. 1 1 25 27 Albert Dock Hospital, London, E.16 - 1 20 21 Dreadnought Seamen's Hospital, Greenwich - - 3 3 Lydia Dept., St. Thomas Hospital, London, S.E.1. - 1 3 4 Oldchurch Hospital, Romford, Essex 1 19 82 102 Totals 16 95 744 855 17 APPENDIX 5 DEATH RATES FROM CANCER AND ISCHAEMIC HEART DISEASE, 1968 The following Table shows the death-rates for 1968 for Redbridge, compared with those for 1967. 1968 1967 Cancer of lung and bronchus .703 .677 Cancer, other forms 1.800 1.745 *lschaemic heart disease 2.475 2.189 *The heading relative to this figure was previously "Coronary and Arteriosclerotic Heart Disease". APPENDIX 6 Table showing comparison between the Birth-rate, Death-rate, etc., of Redbridge,. Greater London and of England and Wales for the Year 1968. 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 16.9 14 11.9 18 Greater London 15.25 13.5 11.71 18.6 REDBRIDGE (Estimated Population — mid-1968 - 246,090 14.79 13.68 11.08 12.74 18 APPENDIX 7 Registrar-General s Short List of Deaths and Causes Causes of and Ages at Death during the year 1968 Net Deaths at the subjoined apes of "Residents" whether occurring witnin or without the district Total-All ages Under 4 weeks 4 weeks & under 1 years 1 & under 5 years 5 & under 15 years 15 & under 25 years 25 & under 35 years 35 & under 45 years 45 & under 55 years 55 & under 65 years 65 & under 75 years ears & over/ Enteritis and other Diarrhoeal Diseases 1 - 1 - - - - - - - - _ Tuberculosis of Respiratory System 8 - - 1 - - 2 - 1 - 1 3 Other Tuberculosis, incl. Late Effects 4 - - - - - 1 - 1 1 1 - Meningococcal Infection 1 - 1 - - - - - - - - - Other Infective and Parasitic Diseases 2 - - - - - - - - 1 - 1 Malignant Neoplasm - Stomach 69 - - - - - - - 4 15 19 31 Malignant Neoplasm - Lung, Bronchus 173 - - - - - 2 4 22 49 62 34 Malignant Neoplasm - Breast 60 - - - - - - 2 17 19 13 9 Malignant Neoplasm - Uterus 17 - - - - - - - 4 6 5 2 Leukaemia 23 - - - 2 - - - 7 3 3 8 Other Malignant Neoplasms, etc 276 - - 2 4 2 4 10 30 59 82 83 Benign and Unspecified Neoplasms 9 - - - 1 - - - 2 4 - 2 Diabetes Mellitus 30 - - - - - - 1 - 1 11 17 Avitaminoses, etc 1 - - - - - - - - - - 1 Other Endocrine etc. Diseases 6 - - - - - - - - 2 1 3 Anaemias 9 - - - - - - - - - 2 7 Other Diseases of Blood, etc. 2 - - - - - - - -- 1 - 1 Mental Disorders 27 - - - - - - - 2 1 6 18 Meningitis 4 - - 2 - - - - - 1 1 - Other Diseases of Nervous System, etc. 19 - - - - 1 1 - 4 3 6 1 Chronic Rheumatic Heart Disease 41 - - - - - - 2 3 16 7 13 Hypertensive Disease 78 - - - - 1 - 1 2 12 23 39 Ischaemic Heart Disease 609 - - - - - 2 7 42 118 178 262 Other Forms of Heart Disease 156 - - - - 1 - - 2 9 28 116 Cerebrovascular Disease 344 - - - - - 1 8 13 38 80 204 Other Diseases of Circulatory System 102 - - - - - 2 2 4 6 25 63 Influenza 36 - - - - - - - 1 4 6 25 Pneumonia 278 1 8 3 - - - 3 3 20 51 189 Bronchitis and Emphysema 142 - - - 1 - - - 4 20 40 77 Asthma 12 - - - - - - 1 1 5 2 3 Other Diseases of Respiratory System 20 - 2 1 - - - - - 1 4 12 Peptic Ulcer 19 - - - - - - - 1 4 6 8 Appendicitis 2 - - - - 1 - - - - _ 1 Intestinal Obstruction and Hernia 16 1 - - - 2 - 1 1 2 1 8 Cirrhosis of Liver 8 - - - - - - - 1 2 2 3 Other Diseases of Digestive System 24 - - - - - - 1 1 5 5 12 Nephritis and Mephrosis 16 - - - - - 1 1 2 6 - 6 Hyperplasia of Prostate 9 - - - - - - - 1 - 4 4 Other Diseases, Genito-Urinary System 23 - 1 - - - - 1 2 2 4 13 Diseases of Skin, Subcutaneous Tissue 1 - - - - - - - - - 1 - Diseases of Musculo-Skeletal System 15 - - - - - - - 4 3 8 Congenital Anomalies 17 9 2 - - 1 - - 1 2 2 - Birth Injury, Difficult Labour, etc. 8 8 - - - - - - - - - - Other Causes of Perinatal Mortality 11 11 - - - - - - - - - - Symptoms and Ill-defined Conditions 19 - - - - - - - - 1 1 17 Motor Vehicle Accidents 35 - - - 4 8 1 3 4 5 3 7 All other Accidents 46 - - 1 3 4 1 2 1 3 9 22 Suicide and Self-inflicted Injuries 30 - - - - 1 2 5 8 8 4 2 All Other External Causes 11 - - - - 2 - 1 2 2 1 3 TOTALS - All Causes 2,869 30 15 10 15 24 20 56 194 461 703 1,341 GENERAL SERVICES 19 Housing Allocation Medical Grounds GENERAL SERVICES M.T. FERNANDES, M.B., B.S., D.P.H., D.I.H., D.C.H., L.M., Deputy Medical Officer of Health The Housing Points Scheme remains operational in the Department and applications for rehousing continue to be referred to the Medical Officer of Health when medical facts, supported by general practitioner's certificate or hospital letter are put forward for consideration. Applications from Council tenants who wish to transfer to other accommodation for medical reasons are also referred to the Medical Officer of Health. Although the Medical Officer of Health may recommend "points" (5, 10 or 15) or outright rehousing on medical grounds, in many cases in which the medical condition is considered not to be aggravated by existing living conditions, no recommendation is made. During 1968, 287 cases were referred and recommendations were made in only 251 of such cases, the remaining ones being considered not to warrant medical support for rehousing. In a small number of cases the applicant may not satisfy the residential qualifications or it may be considered that he is already adequately housed. If, however, the medical conditions is being seriously aggravated by the existing living conditions, the Medical Officer of Health may recommend that such a case be given special consideration. This represents a very small percentage of the total number of applications and shows that such a recommendation is made only in cases of exceptional hardship. The following table summarises the cases dealt with during the year 1968, and compared with 1967. Number of cases Referred or Reviewed Recommendations made for "medical points" 1968 1967 1968 1967 287 233 251 208 It will be seen from the statistics that the recommendations made for "Medical Points" during 1968 continue to rise over the 1967 figures. Obviously if all applications with medical support were allowed to qualify for extra "points" or other preferential treatment, many applicants could put forward some conditions, physical or psychological, which 20 they could claim as worthy of support and then the whole purpose of the scheme which allows consideration of health factors would be defeated, It is only in cases in which a medical condition affecting the applicant or a member of his family or occupant of the dwelling in which he resides is being aggravated by the existing circumstances do I feel that support should be recommended. Mass Radiography The following figures show the attendances and results during the 45 days of operations of the unit at Vine Church Hall during 1968:— General Practitioners General Public etc. Male Female Total Male Female Total Referrals X-rayed 1,861 1,527 3,388 3,631 5,512 9,143 Found torequire further investigation 115 64 179 51 65 116 Certain Conditions Found — Pulmonary Tuberculosis Requiring immediate treatment 2 - 2 1 3 4 Requiring close supervision - - - - 1 1 Malignant Neoplasms in the Thorax 29 4 33 9 4 13 (Comprising 42 Lung (Primary and 4 Lung (Secondary)) Massage and Special Treatment Amongst other abnormalities discovered were:- Male Female Acquired abnormalities of the heart and vascular system 4 8 Pneumonoconiosis 6 1 Bacterial and virus infection of lung 15 7 Pulmonary Fibrosis (Not T.B. or Industrial) 11 9 Abnormalities of the Diaphragm and Oesophagus 4 10 Pleural Effusion (Non-Tuberculous) 5 7 Premises used for the reception or treatment of persons requiring massage or special treatment must be registered and are subject to inspection by a senior medical officer of this authority. 39 such establishments in the borough, offering therapeutic services of various kinds, are shown in the Appendix. These are all periodically visited an generally the standard maintained has not produced any significant criticism throughout the year. 21 All staff are required to complete a medical history form before appointment. From the information given it may be decided that a candidate is fit to carry out the duties of the appointment, or it may be considered necessary for a medical examination to be carried out, to determine his or her fitness. Approximately 25% were so examined during the year. The following cases were considered during the year:- 1. Medical assessments 973 2. Medical examinations — Staff (from No. 1 above) 96 Teachers 57 Students 258 Authorities 6 Total number of medical examinations 417 There were four private nursing homes in the Borough at the commencement of 1968, one of which was closed during the year. Periodic inspections were carried out at these establishments, which on the whole maintained an acceptable standard. The three nursing homes remaining licensed at the end of 1968 were as follows:- Name of Nursing Home Address Marie Celeste 15/17 Sunset Avenue, Woodford Green. Lady Jane 69 Woodford Avenue, E.18. St. Anne's 14 Cambridge Park, E.11. Nursing Homes Medical Examination of Staff 22 Venereal Diseases Information relating to the incidence of venereal disease which has come to the notice of this Department, as provided by the various hospitals, is given below:- Syphilis Gonorrhoea Other Conditions Total The Whitechapel Clinic, London Hospital, E.I. 12 67 545 624 Homerton Grove Clinic, Eastern Hospital, E.9 — 2 7 9 Special Clinic, Queen Mary's Hospital, E.15 2 4 59 65 St. Bartholomew's Hospital London, E.C.I 1 1 25 27 Albert Dock Hospital, London, E.16 - 1 20 21 Dreadnought Seamen's Hospital, Greenwich - - 3 3 Lydia Dept., St. Thomas Hospital, London, S.E.I - 1 3 4 Oldchurch Hospital, Romford, Essex 1 19 82 102 Totals 16 95 744 855 23 APPENDIX 8 MASSAGE AND SPECIAL TREATMENT ESTABLISHMENTS Treatment Carried Out Number of Premises Licensed A. Massage and other treatment 9 B. Chiropody 17 C. Chiropody and Massage 8 D. PhysIotherapy 4 E. Hair and Scalp Clinic 1 List of Establishments for Massage and Special Treatment Licensed in 1968:— Name Premises Licensed Treatment Carried Out (See Table above) 1. Baruch, L. 6A, Goodmayes Road, Ilford. B 2. Baxter, R.N. 85, Berkeley Avenue, llford. D 3. Beckett, Miss E.M. 27, Madeira Grove, Woodford Green. A 4. British Bata Shoe Co. Ltd. 102, High Road, llford. C 5. Budd, M. 27, York Road, llford. A 6. Camp T/A Seabrooks Clements Road, llford. A 1. Coplen, V. F. 32, Denham Drive, llford. B 8. Drake, F. 318, Eastern Avenue, llford. B 9. Farrell, T. E. 12, Forest Approach, Woodford Green. B '0. Gibson, Mrs. M. 50, Kings Avenue, Woodford Green. B 11. Greshaqm, Mrs. F. E. 116, Beattyville Gardens, llford. A 12. Hagan, V. 7, Cambridge Park, Wanstead, E.ll. B 13. Hawkins Clinic 43A, Cranbrook House, llford. A 14. Hyam, G. D. 21/23, York Road, llford. B 15. Jardine, K. L. 67, Clayhall Avenue, llford. C 16. Jardine, K. L. 119, Eastern Avenue, llford. B 17. Johnson, A. E. 85, Berkeley Avenue, llford. D 18. Jones, E. & Shorer, Mrs. A. 9, Brook Road, llford. B 19. Longley, J.W. 6, Shawville Gardens,Cranbrook Road, llford. c 20. Langley, Mrs. J. 121, Belgrave Road, llford. C 21. Leary, E. 30, Broomhill Road, Woodford Green. A 22. Leavesley, Mrs. J. 19, Grays Corner, Eastern Avenue, llford. C 23. Morris, W. P. 46, Ranelagh Gardens, llford. A 24. Murdoch, C. W. 8, The Drive, llford. B 25.Oxenham, P. R.H. 75, The Drive, llford. D 26. Pearce, G. S. 07 n i 238, Balfour Road, llford. B 27. Roberts, R. N. 80, Snakes Lane, Woodford Green. B 24 APPENDIX 8(continued) Nome Premises Licensed Treatment Carried Out (See Table above) 28. Roberts, R.H. 318, Cranbrook Road, llford. B 29. Sadowski, R. 22, Alloa Road, llford. B 30. Scholl Manufacturing Co. Ltd. 81A, Cranbrook Road, llford. B 31. Skipper, Mrs. A. M. 20, Seagry Road, Wanstead, E.11. D 32. Souster Bros. Ltd. 8, Clements Road, llford. C 33. Stevens, B. 4, Cameron Road, llford. E 34. Stonnill, Mrs. T. E. 10, The Shrubberies, E.18. C 35. Struminger, o. 171, llford Lane, llford. B 36. Teager, D. P. G. 85, Sunnymede Drive, llford. A 37. Turner, R.T. 60, Fairfield Road, llford. C 38. Warren & Crinsted Ltd. 53/57, Eastern Avenue, llford. A 39. Weinberg, J. 11, Queenborough Gardens, llford. B NATIONAL HEALTH SERVICE ACT 1946 SECTION 21 Health Centres SECTION 22 Care of Mothers and Young Children SECTION 23 Midwifery SECTION 24 Health Visiting SECTION 25 Home Nursing SECTION 26 Vaccination and Immunisation SECTION 28 Prevention, Care and After Care SECTION 29 Home Help Service 25 Progress in 1968 SECTION 21 - HEALTH CENTRES M.T. FERNANDES, M.B., B.S., D.P.H., D.I.H., D.C.H., L.M., Deputy Medical Officer of Health Since the last Annual Report a great deal of advance has been made in the field of exploring general practitioners' attitudes to architects' plans of buildings, attachment of local authority Staff, and acceptance in principle by the Department of Health and Social Security of our plans. Of course, in terms of bricks and mortar, fulfilment of these plans is envisaged in the near future. There were many meetings and discussions during the course of the year with general practitioners, members of the Executive Council, Department of Health and Social Security, and our own staff in various departments concerned with the projects. As outlined in the various plans for the future, health centres are going to occupy an important place in the tripartite system of medical practice at the moment. For this reason, space has been taken in one of the plans for site allotment for post-graduates, as the general practice of the future is aoina to be a SDecialist branch of medical practice. King George Hospital Health Centre This has been our most exciting project of the year. The site would be within the grounds of King George Hospital between Perrymans Farm Road and Buntingbridge Road, near to the present nurses' home. A postgraduate medical centre is also envisaged to be built close by. This site will be leased by the Council from the Regional Hospital Board. 7 general practitioners have expressed a wish to practise from the Centre. The Centre will serve a population in excess of 20,000. The Local Executive Council and the Local Health Authority have agreed that it is a viable proposition. At a meeting on 17th December 1968 with the Department of Health and Social Security the scheme was agreed in principle and, subject to economic pressure, they will no doubt be prepared to recommend loan sanction. This Health Centre has been included in our three-year capital programme for building to commence in 1969 and to be completed in 1971. Preliminary plans have been prepared. At a later stage, consideration is to be given to the provision of consulting accommodation for use by post-graduate doctors training to be general practitioners of the future, and space has been allocated on the site for this possible extension to the building. 26 High Road, Woodford, Health Centre This Health Centre will provide consulting suites for 6 general practitioners in the area. A Local Authority child health session at present held in a church hall will be transferred to the new building and also certain sessions from the Wanstead Place Clinic. The Department of Health and Social Security have agreed to the scheme in principle and subject to a few minor amendments in the plans loan sanction should be forthcoming to enable the work to commence on site in 1970 for completion in 1972. Full we 11 Cross (Alcoe's Timber Yard) This site is ideally suitable as it is on a main road junction with public transport facilities. Loan sanction has been obtained (24.12.68) for the purchase of the site for Health Centre purposes. 3 general practitioners have expressed their willingness to enter, whilst two others are interested. Local Health Authority and Local Executive Council consider this project a viable proposition. It has been included in our 3-year capital programme for building to commence in 1970 and for completion in 1972. A brief will be prepared early in 1969 following which a scheme submission will be forwarded to the Department of Health and Social Security, who have already agreed to the purchase of the site. This Centre will serve a population in excess of 20,000 and will replace Local Health Authority sessions at present held in Fullwell Cross Library. Seven Kings Health Centre The site of this Health centre is on the railway land opposite Seven Kings Station in Salisbury Road. This is an alternative site chosen when land suitable for a Health Centre was not available at Goodmayes (railway goods yard). 4 doctors have expressed a desire to practise from a Centre in this area, but in the case of this particular site (the only one available) they have made their entry into the scheme conditional upon the provision o suitable access from the north of the Seven Kings High Road by means of an underpass or bridge, which matter now has been referred to the Borough Engineer. This project is also included in the capital programme for 1970/71. if the building proceeds it will replace the Local Healt Authority Child Health session at present held at the Seven Kings Methodist Church Hall. 27 Vista Drive Health Centre The site for the Vista Drive Health Centre has been reserved for some 20 years, although the land is not yet in the possession of the Council and is not likely to be until the route of the new M. 11 is decided. It had been intended to include this project in the next 3-year programme for the construction to commence in 1972/3, but at the present time this preliminary work is being postponed. The 3 general practitioners who had previously expressed their wish to participate have now withdrawn, and in any case the site is now unlikely to be acquired. There is a possibility that this item will be deleted from the programme altogether. Ilford Central Redevelopment Area It is intended to provide a Health Centre within the redevelopment area and a site has been provisionally allocated south of the High Road in the present Oakfield Road area. Meetings have been held with the Local Executive Council and there has been sufficient response from the general practitioners whose present premises will be affected by the redevelopment to make this a viable proposition. Certain dental practitioners likewise affected have also expressed an interest. Although it will be at least five years before the building is required, or the site available, close contact will be maintained with all concerned. Should the project be completed, the Local Authority Child Health sessions will be transferred from a church hall in this area, and other Local Authority services would be provided. Financing finance will continue to remain uncertain tor many years because of the economy "freeze and squeeze". New procedures for presenting schemes to the Department of Health and Social Security will enable planning to progress in a more certain way. A certain amount of inspired guesswork will still be required to place any project in the correct year of the Council's capital programme. Financial stringency might delay the project envisaged. The construction of Health Centres in the future depends on the attitude of general practitioners wanting to practise from such premises. It is likely that as the Health Centres programme gets under way, more and more general practitioners would like to practise from Health Centres. 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 28 Sites this undoubtedly would have an effect on contributing to the effective medical care of the community. Land for Health Centres is a problem which will continue to grow, The price of established land rises annually and it is easy to see that in not very many years, to put a Health Centre only on a plot of land will be uneconomic. This may lead to such buildings being incorporated in blocks of flats and office buildings and the chances are that they will work very well once it is accepted that consulting rooms need not be on the ground floor and may equally effectively come to be on the 10th or 20th floor, provided there is an efficient lift service. It is quite possible that such a Health Centre may be necessary in the Central Redevelopment Area. It would be the scarcity of geographically suitable sites more than any other factor which will prevent the realisation of full Health Centre practice for the future. With medical education undergoing changes, as laid down in the Todd report, this puts a large part of the responsibility for the future in the hands of the Local Health Authorities, which we will have to be prepared to share and enjoy. SECTION 22 - CARE OF MOTHERS AND YOUNG CHILDREN (Dr. W.H. TOMS, B.M., Ch.B.(Edin), Principal Medical Officer) South Park Health Services Clinic, opened in November 1968, will be the last of the clinics constructed to provide Local Health Authority Services only. It is now certain that Health Centres staffed largely by general practitioners, will be the only building activity of this type encouraged by the Government. Be that as it may, South Park Health Services Clinic is a handsome building, both elegant and functional. In addition to all the usual services, directed at the promotion of health among young children, there is accommodation for a dental surgeon and chiropodist, a sound-proof room for hearing testing, and counselling rooms for social workers. It is anticipated that as more homes are built in the area, this clinic, will be a centre of positive health activity in the community. Dr. Joan Pooley reports later and at some length on the functioning of the Observation Register for which she is responsible. The purpose of such a register is to identify those children most likely to suffer from handicapping conditions. This of course is done by reference to the 29 health of the mother in pregnancy and the normality or otherwise of her labour. Genetic factors may also be involved. The problem with observation registers at present is that 40% of children born with handicap, or subsequently developing handicap, do not fall into the group deserving special surveillance because of these factors. Observation registers require much skilled professional time in determining "at risk" factors and administering the register, and it may well be argued that with this high percentage of children falling outside the register, careful thorough examination of all children would be more satisfactory both clinically and administratively. This is not intended to be a condemnation of all observation registers as it is quite apparent that for research purposes alone the idea of the observation register should be continued in certain areas, though not universally applied. Whatever the fate of these registers, I am convinced they are responsible for an enormous generation of interest in the early diagnosis of handicap, and a radical change in the function of infant welfare centres. All children aged approximately seven months can now have their hearing tested by Health Visitors trained for this purpose. To avoid lengthy travelling by the parent this service is now provided at 7 centres throughout the Borough and it is hoped that early in 1969 4 more premises will be available for these appointments. Births In 1968 there were 3,533 live births in the Borough and the illegitimacy rate was 7.5%. Close liaison exists with all midwives and maternity units in the area for the immediate notification of all births where some form of congenital abnormality is present or is suspected. Arrangements are made for the follow up of these cases by Health Visitors, or by direct approach to the Paediatrician in charge of the case so that full details can be forwarded to the Registrar General or in the case of residents outside the Borough to the responsible Health Authority. 73 such cases were reported in 1968, details of which are given in Appendix 10. The Observation Register Dr. Joan M. Pooley, M.B., B.S., D.C.H., Senior Assistant Medical Officer reports as follows:- 30 On 31.12.68 the Observation Register in Redbridge had been in existence for three complete years. In February 1968, the revised Factor Form and the correspondingly revised Record Card were introduced and are now gradually replacing those previously used. The original grouping of Factors, or Criteriq, has been retained on the current forms and record cards, namely:— I. GENETIC II. PRE-NATAL III. PERI-NATAL IV. POST-NATAL V. SYMPTOMATIC The figures shown below, however, illustrate that the new list of factors included under these headings, though still comprehensive, is more specific and has made possible a more selective and less inflated register. I. SELECTION OF CASES FOR THE REGISTER- This effected by:- (1) Examination of Hospital Discharge Summaries. (2) Completion of Factor Forms by Health Visitors and Midwives (details being obtained from the Mother, Hospital, Charts or Domiciliary Midwifery Cards). These two sources of information are then correlated by the Medical Officer in Charge of the Register and the infants name entered on the Register when indicated. II. CASE EXAMINATION AND FOLLOW-UP - The purpose of the Register is fully explained to the parents of the infants concerned, by a personal visit of the Health Visitor to the home and the infant under observation is then examined — (1) as soon after birth as possible (2) at 6/12 of age (3) at 12/12 of age (4) at 18/12 of age (5) at 2 years 31 The infant is then either discharged from the Register or kept under observation at the examining Medical Officer's discretion. Auditory Screening is routinely carried out on all infants before discharge. The use of the Labstix for Urinalysis is shortly to be combined with, or replaced by the Guthrie Test and the use of the Apgar Scoring System is proving most effective in ensuring greater accuracy in, and compatible methods of, recording clinical details. III. ANALYSIS OF FIGURES - During 1968 1967 1966 (1) (i) Number admitted to Register 1011 1056 1255 (ii) Total number of children on Register at end of year 2525 2060 1192 (iii) Number of children removed from Register during 12/12 ended 31st December, 1968 389 122 28 At 31.12.68 At 31.12.67 At 31.12.66 (2) (iv) Corrected number of births 3557 3873 (v) % Live Births considered to be "At Risk" 29.7% 32.3% (vi) Total number of children registered as handicapped during the period 1.1.66 — 31.12.68 (whether "on" or "off" the Observation Register) 182 (vii) Total on Register from 1.1.66 — 31.12.68 found to have handicaps 60 (viii) Total on Register from 1.1.68 - 31.12.68 found to have handicaps. 9 It is interesting to note, therefore, that the number of children outside The Register found to have handicaps during the period 1.1.66 — 31.12.68 = 162, i.e. only 33% of children registered as handicapped in the past three years had been included on the Observation Register. IV. SOURCES OF NOTIFICATION OF HANDICAPPED INFANTS- 1. Birth Registration 107 2. General Practitioners — 3. Hospitals 37 4. Health Visitors 22 5. Infant Welfare Clinics 4 6. Transfers in 7 177 7. Other sources 5 182 cases 32 V. TYPES OF HANDICAPS- (on and off Register during 1.1.66 — 31.12.68) 1. Talipes 29 2. Cardiac Defect 22 (or Murmur under observation) 3. Down's Syndrome 12 4. Extra Digit 11 5. Hydrocephalus 8 6. Hare Lip 8 7. Slow Developer 8 8. EpiIepsy 5 9. Deafness 5 10. Dislocation of Hip 5 11. Pilonidal Sinus 4 12. Sicklecelled Anaemia 3 13. Spina Bifida 3 14. Meningocoele 3 15. Webbed fingers or toes 3 16. "E.S.N." 1 17. Abnormal Genitalia 1 18. Lump on neck 1 19. Kidney Defect 1 20. Autistic 2 21. Spastic(mild) 2 22. Cretin 1 23. Malignant Tumour 1 24. Lung defect 2 25. Ptosis 1 26. Hirschsprungs Disease 1 27. Asthma 2 28. Osteomyelitis 1 29. Hammer Toe 2 30. Coeliac Disease 2 31. Cerebral Palsy 2 Other defects included Cystic Fibrosis (3) Hiatus Hernia (2) Misplaced Bladder (2) Cleft Palate (2) Cataract (1). The Observation Register must certainly be regarded as one, but only one, of the reliable means whereby early defects are noted. It must surely encourage a full and alert examination by the Medical Officer concerned and through its routine screening techniques serves to exclude as well as to detect certain abnormalities. However, agreement is being reached that it is not the whole answer to early diagnosis. Other methods of detection and prevention must ultimately be examined and compared. The Swedish National Register of Congenital Malformations (ref.1) for instance, is designed to give early warning of teratogen widespread in the environment. "Malformations in the new born are reported verbally to the register each month and any increase of a specific type of malformation is investigated." Is it possible that a "Two-way Investigation Register" might be of more significance? On the one hand investigation would be directed onto the comparison of Etiology of registered congenital malformations and on the other, special observation would be arranged of those infants where abnormal or unusual factors have presented before, during or after 33 Dental Treatment birth, or in the family history, such as the present "Observation Register" sets out to cover. It is suggested that the potential opportunities which would be afforded by such a Dual Register be seriously considered. (Ref: Kallen & Winberg, Sweden Paediatrics 41 : 765-776, 1968) 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- The treatment of expectant, nursing Mothers and children under 5 years of age continued to be available from any of the nine surgeries in the Borough. However, most patients attended either Kenwood Dental or Mayesbrook Dental Clinic. The treatment of very small children can demand rather specialized ability of Dental Officers and staff. These children need more patience and can be very time consuming. However, by careful handling these children can be most rewarding and we hope they will become regular patients and lose the old fears of visiting the dentist. It is certain that one of the main ways to combat dental disease in the future is to start now with the young children. By showing their parents the importance of good dental habits and regular dental treatment, these children will be conscious of the fact that they are important to their health when they are older. Many of these young children are dentally neglected and many parents still tend to think that deciduous teeth are not important. To further dental health education the dental auxiliary commenced visiting Council Day Nurseries and Private Day Nurseries and Child Minders. She also spent several sessions talking to mothers with young children at Infant Centres. Tooth brushes continued to be sold in Dental Clinics to assist in furthering dental health. The demand for treatment by expectant and nursing mothers continued to decrease. This is due to the fact that most mothers use the general dental service. Most expectant and nursing mothers are more dentally health conscious and as such are under private practitioners supervision prior to the Ante-natal or Post-natal care and as such prefer to continue with the dental surgeon of their choice. Another factor is that a mother may only attend for twelve months after the confinement. Continuity of treatment is, I am certain, very important and the fact that they may only attend for a limited period stops many mothers attending at all. Dentures were supplied to patients whenever it was considered necessary. These were made at a local dental laboratory. 1,092 visits to dental clinics were made by mothers and young children during 1968 an increase of 25% and 261 sessions were held for this purpose, 43 more than during 1967. Fluoridation of water supplies should be the next major step to be taken in the field of preventive dentistry. However, it appears it will be many years before this is possible. The addition of one part of fluoride per million of water would reduce the number of caries teeth in children by 50-60%. I would to thank all Medical Officers, Health Visitors, Clinic Nurses, Health Education Officer and staff for their assistance in trying to encourage more of these under 5 year old children to be under regular dental care. 34 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 paqes 63-67. Day Nurseries The two Council day nurseries, one in Ley Street and one in Goodmayes Lane, continued to function without difficulty during 1968. It was necessary, however, to close the Ley Street premises for two weeks from 23rd November to allow certain interior alterations to be undertaken, but thanks to the co-operation of the church authorities the children were satisfactorily accommodated at the IIford High Road Baptist Church Hall for this period. The free places available in each nursery for children on medical grounds were always fully occupied, and the details of all attendances are shown in appendix 11. Private Day Nurseries and Child Minders The Health Services and Public Health Act 1968, Section 60, which amends the Nurseries and Child Minders Regulation Act 1948 came into force in November 1968 with a three months period of grace for Child 35 Domiciliary Confinement Rate Minders (and day nursery proprietors) to adjust their activities to this new legislation. The essence of the Act is that every person looking after a child, to whom she is not related, for gain, must register with the Local Authority. In the past a woman was permitted to care for up to two children without registration or supervision. This change of legislation has involved this Department in a great deal of extra work. Every applicant is visited at home by a Senior Medical Officer and an effort is made to create a sympathetic relationship with the childminder. In cases where there appears to be a limited understanding of the needs of young children these needs are discussed as fully as possible and an invitation extended to attend a course on this subject due to be held later this year. I am convinced that our involvement in this field of child care encourages high standards. Certain other recommendations of the Ministry of Health as it was then known, on the Day Care facilities for children under five have also been implemented and altogether it can be said that the children who are cared for by residents of the Borough, other than relatives, or attend registered premises in the Borough receive the best supervision possible as far as health standards are concerned. At the end of the year 56 day nurseries and 29 childminders were registered under the Act for the care of 2,572 children. SECTION 23 - MIDWIFERY There were 3,582 births (3,533 live and 49 stillbirths) to Redbridge mothers in 1968 and of these 681 were born at home, making a hospital confinement rate of 81% and a domiciliary confinement rate of 19%.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 — Training of Pupil Midwives: During the year 38 completed their training on the district and all passed the Central Midwives Board Part II Examination. 36 Staff Obstetric Nurses: There were 25 nurses from 11 ford Maternity Hospital who were given an insight into the domiciliary maternity service. Psychoprophylaxis for Childbirth: A two day conference was held in Wanstead Place Clinic. Instruction was given by Mrs. Montgomery (chartered physiotherapist). All the midwives were able to attend; the total number 20, including Health Visitors and one midwife from 11 ford Maternity Hospital. At the end of the year the staff consisted of sixteen midwives; two of whom were employed part-time. SECTION 24 - HEALTH VISITING At the end of the year there were 47 Health Visitors (including 7 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 12 shows the number and type of visits made. Miss J. Oliver, Superintendent Health Visitor, reports:Health Visiting: Seebohm and "The Green Paper" have naturally caused Health Visitors much to think about this year. Undoubtedly these papers cause some unhappiness to staff which is not conducive to good work. We are most fortunate to have worthwhile jobs and can readily forget our own difficulties once immersed in the daily problems of those we are paid to serve. Hearing Tests: The facilities for the mothers and children are improved this year, we have included all children reaching the age of seven months and have by January 1968 we hope nearly covered the whole area. Some church halls are being used for this and we are at present negotiating for one more hall. We find mothers are not prepared to travel too far for this service. Some testing in the homes is done, especially if a mother is finding difficulty in bringing twins out etc. This added but essential service has without doubt cut down the Health Visitors visiting time, plus the fact that in outlying clinics she 37 is also responsible for sending appointments out to mothers. Staff continue to be trained for this testing and go either to the R.N.T. Ear Hospital or Newham Audiology unit. Toddlers Clinics: These clinics have also become well known and are now part of the Child Health Service; they are run on the appointment system. Liaison with Hospitals: Our liaison with King George Hospital, Children's Ward, continues. Also one health visitor continues at Claybury Mental Hospital attending once weekly joining in with the group discussion. Our joint study days continue at the llford Maternity Hospital and this year a visit was made to King George Hospital physiotherapy department where we heard about the problem of Spina Bifida after care from a physiotherapist who had spent some time in America. Liaison with General Practitioners: Some discussions have taken place this year when decisions of policy were being changed in the G.P. set-up. One in the practice where a Health Visitor was already attending and the other where the Health Visitor was to start assisting the G.P. I myself worked for three months in one group practice of three doctors. At this period we were rather short of Health Visitors to take over owing to retirements and this maintained the link for the next Health Visitor. The extra Health Visitor and G.P. liaison made this year brings the total of 5 Health Visitors liaising in group practices. Home Accidents: 591 Home visits were made to homes following accidents to the under 5 years and over 60 years of age. The number of visits are much improved this year as our staff situation improved when our five student health visitors came to us in July. The deputy superintendent health visitor is on the local Home Safety Committee taking matters of interest and not infrequently making points for further action and consideration in safety. Child Health Centres: Following the Sheldon report some thought was given to changing our ways in these clinics, to put away the scales and start appointment systems was amongst some of the ideas. One clinic in a large church hall started this system in April 1968 and the mothers certainly appear to 38 appreciate this. The standard of child care in the area was high, no doubt the centre was a contact for the mothers. The Health Visitors decided on the clinic day once a month, they would start a mother's club with a speaker, this is running smoothly. Because of the large hall, children have ample scope for play. The appointment system is also running smoothly in one block built clinic. In some other clinics weighing charts are not produced when mothers wish to weigh their babies and in this way it is hoped the frequent weighing will not be thought such a necessity. As the services revolve round the block built centre, the centre Superintendent's have kindly contributed a short report on their centres. Manford Way Health Centre: A new health visitors office has been added at this centre, our previous office was small and cramped. The health visitors in this area find great changes over the past year. One of the five pre-fab sites have been completely demolished and others are to follow. This has resulted in a decreased number of families served, for the present. A large wooden area is being developed by the G.L.C. who are building a huge block of flats completely altering the skyline. A gypsy site has become established with 16 caravans. AnteNatal Clinics and Cytology monthly, still continue to cover the demand in this area. One evening clinic for family planning is run by the Family Planning Association and this body of voluntary people continues to run at our other clinics numbering 5 in all, covering all corners of the Borough. Medical and Social cases being helped when necessary. Fullwell Cross Library: Following the opening of the above, a child health clinic wasopened here in 3 rooms on the 5th January 1968. The church hall clinic at Mossford Green was closed and the services taken to the new premises. Modern techniques of examination are always difficult in church halls, especially during the winter months. It was with mixed feelings the change was made from a roomy hall to smaller rooms. The clinic however finally settled down and hearing testing commenced in February 1969. Madeira Grove Centre: The area extending around this centre now includes a large housing estate, adding to the work of the Ashton Playing Fields centre which is nearby. Fortunately the midwives ante-natal clinic had begun at the Grove and this had proved helpful to the newcomers. The Tuesday morning 39 club for a group of mentally handicapped children still continues, many of their activities are financed by voluntary help plus the annual Jumble sale. Many of these children transferred to Hyleford Junior Training School depleting the group but since September it is back to strength. Two Mother's clubs in the evenings now function and remain popular because of the effort of the committee in arranging successful projects. The Summer Fair in the grounds outshining all activities. All Saints Clinic, Woodford Wells, formed a play Group on the afternoon of the child health centre. The children play with numerous toys and are cared for by mothers. Mayesbrook Child Health Centre: This area is not now so busy, due possibly to the falling birth rate, and the confidence of the younger mothers. Many of the G.P's. have their own infant clinics. The Greater London Council Estate tenants change frequently, the larger families moving in. The original families whose own children have grown up and married are moving out into smaller homes or pensioners flats. The numbers attending now have reduced the centre to one child health clinic per week plus toddlers clinics, numbers improving in the latter now that interest has been aroused. 35 Wanstead Place: The upstairs rooms have finally been decorated giving more space to carry out mothercraft and relaxation classes. Modern decorations and light paint make this old house set near the church an attractive place to which to invite mothers for many different purposes. The mothers are forming a mother's club here in February. Kenwood Gardens Clinic: This is a very busy clinic and is used to its full capacity being used four nights per week by the F.P.A. and Marriage Guidance Councils of both denominations. The number of births in this area are down from previous years. Voluntary Organisations: We continue to work with and assist where possible. One small but helpful plan was carried out in co-operation with the two voluntary bodies concerned with mentally handicapped children. The organiser of the Catholic Group and the Health Visitor of the group held in the clinic 40 both wrote articles on their groups activities. This was then combined into a small booklet of four pages and sent to churches, Doctors, libraries etc. It is also useful as a hand out to mothers with mentally handicapped children, giving them ideas of the nursery facilities available, The one or two mornings a week give the mothers the opportunity to leave their children and they can then make appointments for dentists etc. South Park Clinic: The opening of the above clinic in September 1968 gives the service opportunity to cover an area which is being developed in Loxford Lane, This is the first Clinic to have a sound-proof room enabling staff to carry out testing in ideal conditions. To enable the district nurses and midwives to get to know the clinic a tour of the building was arranged followed by educational films. SECTION 25 - HOME NURSING Home Nursing: Details of the work undertaken during 1968 by the Home Nurses ore as follows:- Total patients nursed-3,709 Aged under 5 years-47 Aged over 65 years-1,207 Others - 2,455 Miss M.A. Potter, Superintendent of Midwives and District Nurses reports as follows on the Home Nursing Service:— Needs of the Elderly Survey: During the first three months twenty-three district nurses, with other members of the Health and Welfare Department, participated in this survey. A wide selection of people over retirement age were visited. The interviewees completed a two-fold questionnaire involving:- (a) The Respondent (b) The Housewife or Housekeeper District Nurses Residence: The closing of Abury House caused concern amongst the District Nurses as they felt apprehensive in that a meeting point was no longer available. 41 Arrangements were made at the Health Clinics for the nurses to meet as groups, at weekly intervals. A Robophone was installed at Hyleford Home for the Elderly and this enabled General Practitioners and Hospital staff to leave messages after office hours and during holidays. Refresher Courses: Three district nurses attended a course held at the Borough of Newham's School of Community Nursing. District Nursing Training: Six newly appointed nurses attended a four months' course, arranged by the London Borough of Waltham Forest. The practical instruction and experience was gained within the Borough of Redbridge. The staff at the end of the year consisted of 35 S.R.N's. and 3 S.E.N's. There are now four male nurses who are responsible for visiting the majority of male patients. The year closed with discussions on future arrangements for all District Nurses to be attached to General Practitioners. SECTION 26 - VACCINATION AND IMMUNISATION Vaccination and Immunisation In August 1968 all Local Authorities were advised that a new schedule of vaccination and immunisation procedures in childhood had been issued, based on the recommendations of the Joint Committee on Vaccination and Immunisation. Following meetings of the Immunological Committee of five adjacent London Boroughs a new schedule, based on these recommendations was introduced in Redbridge on 1st November 1968. The new schedule consists of fewer injections, starting earlier and more widely spaced. This altered timing is expected to result in a higher level of immunity in the child population. Earlier in the year the Department of Health and Social Security, then known as the Ministry of Health recommended that all children up to age of 15 years should be given the opportunity of receiving vaccination against measles unless they had already acquired a natural immunity. The acceptance rate was not so high as had been anticipated because of acquired immunity but by holding special sessions for these 42 vaccinations and by undertaking others within the normal Child Health Centre programme together with those undertaken by private doctors, a total of 3,726 children received protection against this disease before the onset of the anticipated outbreak. The tables in Appendices 13 and 14 show the number of 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 By the end of 1968 three patients had been established on Home Renal Dialysis. Two of these patients were able to fit the apparatus into rooms in their present homes - in the third case the house occupied by the patient was quite unsuitable so the Local Authority provided a larger and more modern house to rent. Enquiries from hospitals lead us to believe that during 1969 the total number of cases in Redbridge may be doubled. 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 1968 was 112, several less than in 1967. The standard contribution towards the cost of the convalescent holiday was increased during 1968 to £7. Chiropody Mr. Gibson, the Chief Chiropodist, reports as follows:- "Feet give a lot of trouble from time to time but hardly amounting to a bill between £100 and £150. Still it is excusable in one case- the feet have not been attended to for several centuries. They are those of the 43 sole remaining mediaeval eagle-shaped brass lectern in St. Margaret's Church, Lynn, and it has just been discovered that the feet of it are badly cracked and need specialist attention. (Extract from Lynn News and Advertiser — 27.11.1968.) I trust that the feet of persons living in Redbridge are not in such bad shape, however many people have had to be content with a reduced number of treatments during the year. Shortage of staff and numerous new referrals resulting from the Survey of the Elderly were the two main factors causing prolonged periods between treatments. During the middle of the year we were unfortunate in losing one of our full-time chiropodists and we have been unable to appoint a replacement. There have been various changes amongst our sessional chiropodists and we now have 6 chiropodists undertaking sessions for us and 4 chiropodists working full-time. Although the staffing situation improved slightly towards the end of the year, we are still not at full strength. The survey of the Elderly seems to have proved what had long been suspected, that there were many old people with sadly neglected feet who did not realise the availability of a Chiropody Service. Consequently it became extremely difficult to meet the demand especially for domiciliary visits and treatments where the patient had to be transported to the Clinic. 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 aftercare 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 1968 the one patient continuing to reside in a rehabilitation settlement was provided with financial assistance towards his maintenance. 44 One patient was provided with the British Red Cross domiciliary library service for which the Borough was financially responsible. A total of 157 patients were provided with free milk during the year, a net decrease of 48, and the one open air shelter in the Borough continues to be occupied. Voluntary Bodies: During the year the Wanstead and Woodford Tuberculosis Care Association assisted 26 patients with grants of extra nourishment and Christmas gifts were sent to 65 patients, 32 of whom were in hospital at the time. 1 family received financial assistance towards the cost of fares to visit a relative in hospital. The voluntary work of the Committee of the Ilford Tuberculosis and Chest Care Association continued successfully throughout the year, thanks mainly to the financial support received from the Local Authority, to whom the members are sincerely grateful. The increasing difficulty in raising funds for charity together with the rise in the cost of living have had their effect on the finances of the Association but during the year the number of cases assisted and the number of grants made have both increased over those for 1967. Details of assistance given during 1968 are:— 53 applications for extra nourishment were approved and a total of 450 grants made. 4 cases received assistance towards the cost of fares to visit relatives in hospital. 4 patients were given financial assistance towards fuel bills. 1 rental television set and licence was provided. 63 patients either in hospital or at home received gifts of cash at Christmas time. The Committee continued to meet at King George Hospital, due to the generosity of the Hospital Management Committee. Cervical Cytology and Cancer Education This service continued to operate smoothly throughout 1968. Two Local Health Authority Clinics per week on Thursdays were held at 17/23 Clements Road, Ilford, during 1968 and as reported last 45 year additional sessions were commenced at the Manford Way and Wanstead Place Health Service Clinics. The demand for a fortnightly clinic at Wanstead Place has not materialised but there have been sufficient requests for appointments to hold monthly clinics both there and at Manford Way Clinic. During the year the number of Local Health Authority sessions held and smears taken were as follows:- Sessions held - 108. Smears taken — 1,933. Six positive smears were reported by the consultant pathologists. This represents a "pick-up" rate of 3 per 1,000 and corresponds closely with the national figure. Geriatric Clinics These clinics, now held in two different areas of the Borough, originated two years ago with sessions at one of our purpose-built clinics, the intention being to offer a full medical examination to both men and women, as they attain the age of 65. The examinations are carried out by general practitioners whose practices are involved in the programme, though in many instances doctors who are willing for their patients to participate are unable, through pressure of work, to undertake the examinations. The names of persons, as they become 65, are supplied by the Local Executive Council, and the invitation letter to the patient is signed by the patient's own doctor. It was felt that this personal touch would make the examination more acceptable - also that the patient would know that his own doctor supported the proposal. It is a matter of policy that doctors do not examine their own patients, as it was felt familiarity might sometimes condition diagnosis and objectivity be diminished. The patient completes a 57-point questionnaire which is sent to him at home, and brings it with him to the clinic so the examining doctor may read it at the commencement of the interview. Four appointments are made in every two-hour session. The form of medical report is comprehensive and angled towards identification of degenerative conditions. At the beginning of this programme no haematology was undertaken, but a year ago, when these facilities became available, clinics were started in a second area and a small battery of blood tests are now run. These tests include haemoglobin estimation, white cell count, and film, sugar, urea and serum acid phosphatase, when appropriate. Labstix paper reagent 46 is used for urinary pH, Protein, glucose, keytones and blood. Patients, on leaving the clinic, are advised to have a chest x-ray at the local mass radiography unit. When the haematology reports are available, the completed examination form, which may include recommendations, is forwarded to the patient's own general practitioner. Not only is thorough medical assessment of particular value to any person reaching a critical social milestone, but it is anticipated that analysis of the information obtained from the results of such examinations could be of value in planning for the medical and general care ofan ageing population. From the inception of the service in January 1967 until December 1968, 330 patients have been examined. The Chief Education Officer has organised pre-retirement courses in the Borough in which Senior Medical Officers have participated. Several course members have expressed interest in these examinations and with their general practitioner's consent have been included in the sessions. SECTION 29 - HOME HELP SERVICE Home Helps Miss Pemberton, Senior Home Help Organiser, reports:- The Home Help Service continued to provide assistance to elderly and sick people in the Borough during 1968. 1,941 applications for service were received and a total of 3,022 cases were served during the year, 2,273 of these being chronic sick patients over 65 years of age. At the end of the year 194 Home Helps were working in this Borough, 40 less than at the end of 1967. Considerable difficulty is being experienced in obtaining a sufficient number of suitable women for employment as Home Helps and it is therefore frequently impossible to give as much service to patients as would be desirable. In addition, by reducing the hours allocated to patients to a less than adequate number, a greater strain is put on the Home Helps who are employed, thus making the jo more exhausting for them. 47 This shortage of staff also means that when a Home Help has to be sent to a priority case, such as a home confinement, or when she is ill or on holiday, many of her cases can only be covered by reducing the help given to other patients, and some may be left without any assistance for a time. Continuing efforts are being made to recruit suitable Home Helps and the matter is being kept under review. 18 applications were received for Night Attendance, 14 of which were served, the remaining 4 having been admitted to hospital or deceased. 48 APPENDIX 9 CLINIC PREMISES CHADWELL CHRISTIAN MISSION HALL, Essex Road, Chadwell Heath. ALL SAINTS CHURCH HALL, Woodford Wells. BAPTIST CHURCH HALL, Dover Road, E.12. MAYESBROOK CLINIC, Goodmayes Lane, Goodmayes (adjoining Mayfield School). ST. JOHN'S CHURCH HALL (entrance in Devonshire Road), Newbury Park. MANFORD WAY CLINIC, Manford Way (corner of Tufter Road), Chigwell. ASHTON PLAYING FIELDS PAVILION, Chigwell Road, Woodford Green. 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, Perrymans Farm Road, Barkingside. CECIL HALL, Granville Road, Ilford. 35, WANSTEAD PLACE, E.11. METHODIST CHURCH HALL, The Drive (at junction with Eastern Avenue), Cranbrook. MEMORIAL HALL, Parish Church, E.18. FULLWELL CROSS LIBRARY, High Street, Barkingside. SOUTH PARK CLINIC, 100, South Park Drive, (corner of Loxford Lane) Seven Kings, Ilford. 49 APPENDIX 10 Details of the cases of Congenital Abnormality as reported to the Registrar General during 1968 Spina Bifida 7 Meningomyelocele 3 Hypospadias 4 Anencephaly 4 Hore Lip, Cleft Palate 4 Deformity of Wrist, Feet or Hands etc. 7 Down's Syndrome 7 Multiple Congenital Defects 1 Accessory Auricle 1 Congenital Heart Disease 2 Talipes 14 Hydrocele 2 Hydrocephalus 3 Congenital Heart 4 Pilonidal Sinus 2 Vascular Defects of Skin 1 Defects of Face and Neck 1 Ventricular Septal Defect 2 Diaphragmatic Hernia 1 Defects Alimentary System 1 Congenital Dislocation of Hip 1 Anthrogyposis of Lower Limb 1 APPENDIX 11 DAY NURSERIES Details of attendances during 1968 Name of Day Nursery Number of Approved Places Total Attendances Average Daily Attendance Ley Street 50 10,089 39.6 Goodmayes Lane 50 11,245 44.9 50 APPENDIX 12 Cases Visited by Health Visitor Number of Cases 1 Children born in 1968 3,802 2 Children born in 1967 3,122 3 Children born in 1963-66 9,358 4 Total number of children in lines 1-3 16,282 5 Persons aged 65 or over 2,662 6 Number included in line 5 who were visited at the special request of a G.P. or hospital 255 7 Mentally disordered persons 32 8 Number included in line 7 who were visited at the special request of a G.P. or hospital 9 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 21 11 Number of tuberculous households visited 2 12 Number of households visited on account of other infectious diseases 53 13 Number of tuberculous households visited by tuberculosis visitors 897 APPENDIX 13 Completed Primary Courses - Number of persons under age 16 Protection against Year of Birth Others under age 16 Total 1968 1967 1966 1965 1961-64 Diphtheria 1,081 1,732 228 57 83 61 3,242 Whooping Cough 1,081 1,724 228 49 47 12 3,141 Tetanus 1,083 1,743 235 60 121 338 3,580 Poliomyelitis 612 1,982 173 82 113 67 3,029 Measles 21 405 653 573 1,852 222 3,726 51 APPENDIX 14 Reinforcing Doses - Number of persons under age 16 Protection against Year of Birth Others under age 16 Total 1968 1967 1966 1965 1961-64 Diphtheria 1 558 1,341 210 2,463 363 4,936 Whooping Cough - 537 1,259 157 639 68 2,660 Tetanus 2 560 1,347 218 2,494 497 5,118 Poliomyelitis 2 247 1,145 150 2,043 162 3,749 APPENDIX 15 CHIROPODY SERVICE Details of new cases and treatment given in 1968 New Cases Treatments Children under school leaving age 253 2,008 Expectant mothers 26 88 Physically handicapped 101 582 Persons aged 65 years or over 1,006 21,056 1,386 23,734 HEALTH EDUCATION 53 HEALTH EDUCATION Kathleen M. E. Griffiths - Health Education Officer "The Definition of Life", said one National newspaper "is a permament state of emergency". This statement with its implications could set for us a whole range of health education activities — priorities — to combat the vast amount of ill health that exists in advanced societies — very often the result a life of "keeping up", "dashing around", the competition that is all too prevalent in day-to-day working life. Coronary and Vascular disease, stomach ulcers, depression and neuroses — all on the increase, are aptly named "diseases of civilisation*. Recently, the National Press and learned medical journals have devoted space to inform us of the need for prevention of ill health, and indeed of the duty of those engaged in the health and social services to pay more attention to the education of the public in ways in which they may achieve more positive health. To this end, the Government has now set up the Health Education Council, some of whose aims are to coordinate, diversify the activities previously carried out by the Ministry of Health and Central Council for Health Education. In addition, its role will be to advise and assist Local Authority Health and Welfare Departments in their health education projects. It is somewhat of an anomoly that although local authorities are encouraged and pressed to carry out health education to all groups of the population, nevertheless there is no statutory duty to do so. On the other hand, to be effective, the process of education should be a permissive one — there is no success in permanent persuasion. Human motives, attitudes and changes of behaviour are too elaborate, too concealed for us to effect a speedy solution. Progressive local health authorities such as Redbridge have seen the urgent need for action and have set up a health education service. The importance of communication with colleagues to exchange information, to crystallise ideas, needs to be developed. No doubt "teething troubles" will be solved as the service progresses and administrative difficulties will be resolved in the not too distant future. In Redbridge, during 1968, Health Education has continued along the lines set out in last year's report — it has been a year of consolidation. The Health and Welfare Department with the Education Department 54 have achieved a most useful working partnership, collaborating in the preparation and execution of programmes of teaching in order to make health education a more attractive presentation to young people. There are difficulties; no one would pretend that it is an easy task, but perhaps we are beginning to set the foundations for future development. Staffing: At the beginning of the year we were pleased to welcome to the Health Education Section, Mrs. Jean Bailey who took up her appointment as Technician/Projectionist and whose expert knowledge of Art has been of immense value not only in the setting up of numerous health displays but also in the production of teaching charts which have been used extensively by staff engaged in teaching. At the end of the summer, Mrs. C. M. Cannon took up her appointment as Assistant Health Education Officer and her wide nursing, health visiting and teaching background will be a most valuable asset in advice and carrying out the many lecturing duties which will be required. A brief resume of some of the projects undertaken during 1968 is outlined below. Mass Media: A useful liaison with the local press was established to give prominence to subjects of topical interest - e.g. Home Safety, Cancer Education and campaigns such as Influenza and Measles Vaccination. Journalism, in the form of monthly contributions to the magazine "Better Health" has continued. Poster Publicity on all topics was a regular service provided by the Health Education Section. Printed material has been supplied routinely and on demand for the Clinics and establishments throughout the Borough. At the Annual Borough Citizenship Meeting held in June, the work of the Health and Welfare Department was portrayed at the Exhibition which aroused a considerable amount of interest amongst young people. Details of teaching duties undertaken by professional staff is shown in Tables I — IV at the end of this report. 55 OTHER PROJECTS INCLUDE: Research —Correlation of smoking and health survey undertaken by Dr. Taylor as described in Annual Report of Medical Officer of Health 1967. Schools - Discussions with teachers and planning of programmes for Senior Secondary School Children and School Leavers. Talks to staff on drug taking amongst young people and drug recognition. Requests from the Schools for talks or for information have increased during the year. Further information is given in Tables I, II and III. Local Adult and Voluntary Organisations Speakers are requested to talk on the aspects of the work of the Health and Welfare Department. Other topics most often requested — Home Safety, Cancer Education, Drug Dependence, Smoking and Health. Ilford Maternity Hospital — At three-weekly intervals throughout the year talks and films have been shown as part of the Parentcraft Course. These evening meetings have been very well attended by prospective mothers and fathers. Staff Meetings — film appraisal sessions have been arranged to include Drug Dependence, and Cancer Prevention. Talks and Discussions — have been given on subjects of relevance to future developments — e.g. Child Minding and Pre-School Playgroups. Dental Health Education - the need for talks to mothers of preschool age children was realised and these were arranged in co-operation with the Health Visitors at the Infant Welfare Clinics. Miss Burns and Mrs. Lewis have organised useful teaching sessions with demonstrations of dental care to try to cut down early dental caries amongst very young children and to encourage mothers to see the dentist with the child, in order to set up a happy relationship at an early age. Valuable work is continued in the schools when requested by the Head Teachers. Details are shown in Table I. Home Safety — Talks, demonstrations, displays and staff exhibitions have been carried out on all aspects of this important subject at appropriate times of the year when particular hazards are most prevalent. Since the greatest number of accidents occur in the very young and the elderly, advice and information has been geared to these groups. A 56 prehensive account of Home Safety activities is given in the Report of the Home Safety Committee. Doctors, Health Visitors, Chiropodists, Public Health Inspectors and the Dental Auxiliaries have all participated in health teaching in many spheres of activity. Their valuable work has been commented on and appreciated by Schools and many outside organisations. Programmes carried out by the Health Visitors have become an integral part of many schools time tables, and as such they are valued members of the visiting teaching staffs. Dr. Toms has been consulted a number of times on medical matters, and has organised seminars for staff, dealing with specific problems. Conclusion - The Health Education Officers have dealt with many enquiries during the year - advice on the content of courses and demonstrations of techniques of presentation. An increasing number of students of all disciplines have asked for information and ideas for their projects and dissertations. The recent National Publicity given to the need for 'in service' staff training and education of the public has led to an increase in staff interest, and requests for assistance. The Health Education Officer's role as a "catalyst" and as a "buffer" absorbing and containing problems is an important one especially in the present difficult time of change. And The Future .... ? No report would be complete without mention of future plans - what lies ahead is all important. The increase in illegitimacy - (amongst teenagers of 11-19 years in 1966 the number was over 20,000 in England and Wales), means that this will be one priority for action. Similarly, the increase in Venereal Disease is a problem which will need to be given attention. Ways of attracting sections of the public to avail themselves of Health Services — for instance to encourage young women to attend our cervical cytology clinics, need to be expanded. Parents today have a difficult task in bringing up their children and will look to us for support in helping to solve some of their problems Information on the recognition of drug taking amongst young people is on example of help of very real value. 57 "In Service" training for staff - to educate the educators both in methods of teaching and of latest developments in subject content is being developed. We hope to report on this and other issues in future reports. 58 TABLE I HEALTH EDUCATION CARRIED OUT BY DOCTORS, PUBLIC HEALTH INSPECTORS No. of Sessions No. in Group Schools 21 257 Old People's Homes 3 168 Youth Groups 2 80 Courses 4 24 Women's Organisations 5 152 TOTALS 35 681 TABLE II HEALTH EDUCATION OFFICERS HEALTH TEACHING CARRIED OUT No. of Sessions No. in Group Schools 30 1,620 Clinics 4 24 Others 8 240 Staff Training 29 229 Centres for Elderly 5 209 Mothers' Clubs 1 40 Parents' Meetings 1 40 TOTALS 78 2,402 59 TABLE III GROUP HEALTH EDUCATION CARRIED OUT BY HEALTH VISITORS "BREAKDOWN" FOR THE YEAR 1968 Jan. Feb. March April May June July August Sept. Oct. Nov. Dec. No. of Sessions No. attending No. of Sessions No. attending No. of Sessions No. attending No. of Sessions No. attending No. of Sessions No. attending No. of Sessions No. attending No. of Sessions No. attending No. of Sessions No. attending No. of Sessions No. attending No. of Sessions No. attending No. of Sessions No. attending No. of Sessions No. attending Duty Hours: Schools 15 275 17 557 6 79 3 50 10 222 1 20 2 58 - 58 4 108 9 145 15 246 1 15 Ante-natal Clinic Relaxation Class 23 185 14 151 15 127 10 106 17 167 10 133 27 246 12 73 11 87 26 181 15 127 10 44 Post Natal Clinic Infant Welfare Clinic Toddler's Clinic Others 1 40 3 64 1 15 1 14 3 23 4 21 1 20 Out of Duty: Youth Groups 3 30 1 36 Classes for Elderly Prof. Orgs. Others 5 184 2 80 1 20 3 24 1 10 3 135 3 203 2 125 TOTALS 44 684 39 882 23 257 13 156 28 403 15 196 36 349 13 83 18 330 38 529 33 518 11 59 60 TABLE IV MISS BURNS/MRS. LEWIS DENTAL HEALTH EDUCATION, 1968 DENTAL AUXILIARIES Schools No. of Sessions No. in Group 2 400 2 300 2 500 2 360 2 360 2 340 2 250 2 250 2 350 (Mrs. Lewis) 2 100 2 60 2 90 24 3,360 EDUCATION ACT. 1944 62 Medical Inspections 7,741 medical inspections were carried out in 1968 and of these only 30 were seen whose general physical condition was considered to be unsatisfactory (Appendix 16 Table A). In addition 946 special examinations were carried out (Appendix 16 Table B). With the co-operation of Head Teachers of schools in the borough, all immigrant children are medically examined as soon as possible after admission to school. Included in this examination is a skin test to detect tubercular infection and those children who show by this test that they are susceptible to tuberculosis, are offered B.C.G. vaccination. Dr. J. K. Anand, one of our Departmental Medical Officers, has been of great help in advising our staff on problems arising from our lack of knowledge of Asian surnames and prenames. Screening Tests of Vision and Hearing This service has continued satisfactorily during 1968, but due to the change in staff and the subsequent loss of their services for a temporary period whilst training is undertaken the total number of pupils tested has decreased slightly. Simplified Statistics Number Tested Number Passed Total Number of Defects Number Referred for Advice Vision 14,482 9,674 4,808 1,508 Number Tested Number Passed Number Advised further Test Number Referred for Advice Hearing 9,024 7,401 1,396 227 A breakdown of the figures for children of 15 at selective and nonselective secondary schools shows that one third more children at selective schools show visual defects than do pupils at non-selective schools. The old theory that myopia or short sight — which is the cause of the vast majority of these defects — is due to failure of the lens of the eye to adapt to the strains of the academic life has been discredited on current thinking suggests that while there is little difference between the non-verbal intelligence of children with myopia and those with 63 perfect eyesight, reading skills and attainment are considerably higher in short sighted children. As short sight is genetically determined and the defect often excludes the sufferer from occupations and recreations requiring normal vision, a tradition of high parental ambition in the intellectual field has been established in myopic families and this quite naturally puts the children in a position of advantage. As myope is attracted to myope by common interests an elite tends to be formed and the handicap more than adequately compensated by success in school, university and life. There have been recent allegations that the intelligence of some of our immigrants is lower than that of the indigenous population. A look at the success of the myopes reveals some fallacies inherent in this proposition. Special Schools and Specialist Clinic These are the subject of individual reports by Consultants and Medical Officers in charge. Statistics The Department of Education and Science Returns are printed in the Appendix. Medical Treatment Minor Ailment Clinics: 499 children attended various clinics throughout the Borough in respect of minor ailments. Recuperative Holidays During 1968, 17 children were recommended for recuperative holidays and were placed by the Chief Education Officer. Ophthalmic Clinic Specialist Clinics: Due to the re-arrangement of the appointment system, made at the request of the Ophthalmologist at Kenwood Gardens Clinic, the number of sessions held there has increased although the attendances of new cases has fallen. A summary of the attendances at the four clinics serving the Borough is as follows:— 64  Number of Sessions New Cases Old Cases Total Attendances New Spectacles Prescribed Kenwood Gardens 105 264 785 1,443 462 Mayesbrook 88 269 550 1,476 321 Manford 30 46 237 323 72 Wanstead Place 28 95 249 488 190 Totals 251 674 1,821 3,730 1,045 Dr. R. Peswani, Ophthalmologist at Kenwood Gardens Clinic, reports as follows:- The work in the clinic is concerned mainly with the investigation and correction of refractive errors, muscle inbalances and squints. Alll cases referred are first refracted, the majority under cycloplegia and glasses prescribed as required. Cases of muscle inbalance and squint are then referred to the orthoptist for investigation and any required treatment. Any cases needing surgery are referred to King George Hospital and it is nice to see close co-operation of consulting staff there. Dr. G. F. Ensor, Consultant Ophthalmologist submits the following report on the work of the Wanstead Place Ophthalmic Clinic:- "I am very pleased to be able to state that work at this Clinic has progressed very favourably during the past year, due I feel to the staff involved working hard and in complete harmony. The fact that the Orthoptist is present on the same day the Ophthalmic Sessions are held has proved a great help in the smooth running of the Clinics. The attendances are good and the register in consequence is up to date." Dr. P. Lancer, Ophthalmologist at Mayesbrook Clinic comments on his clinic as follows:— The work of the school clinic is essentially that of refraction work associated with investigation and treatment of squints. There is a good liaison between hospital and clinic and the advantage of combined appointment helps continuity of treatment. I would ask for early referral of children regarding defective vision since the incidence of amblyopia is still high. 65 In conclusion I would thank the nursing staff for their co-operation in the smooth running of the clinics. Orthoptic Clinics Orthoptic Clinics, indispensable to a satisfactory Ophthalmic Service, have been held at Mayesbrook and Wanstead Place Clinics staffed by one Orthoptist in each case. In addition some patients living in the North Ilford area were seen by arrangements at King George Hospital; but it is hoped that an additional clinic will commence at Kenwood Gardens early in 1969. Summary of Attendances No. of Sessions New Cases Investigated Total Attendances Cases Discharged Cases in Attendance at 31.12.68 Mayesbrook 209 294 604 120 90 Wanstead Place 48 45 275 31 63 Totals 257 339 879 151 153 Orthopaedic Clinics Clinics were held in four areas of the Borough, the Consultants being Mr. H. G. Korvin, F.R.C.S., at Kenwood Gardens and Mayesbrook, and Mr. Mark L. Mason, F.R.C.S., at Manford Way and Woodford. A summary of the attendances of school children at these clinics is as follows:— No. of Sessions New Cases Old Cases Total Attendances Kenwood Gardens 44 141 323 619 Mayesbrook 22 139 129 355 Manford Way 7 15 30 58 Wanstead Place 10 44 39 101 Totals 83 339 521 1,133 Mr. H.G. Korvin, F.R.C.S., Consultant Orthopaedic Surgeon at Kenwood Gardens and Mayesbrook Clinics reports as follows:— 66 "The activities during 1968 at the Kenwood Gardens and Mayesbrook Clinics took their normal course. Attendances were at a reasonable level. As in the second half of 1967 children requiring operative treatment were referred to King George Hospital where Mr. Bryson, F.R.C.S., obligingly accepted them under his care. In fact, their numbers were small compared with those 10 or 15 years ago. One likes to think this to be due to more successful treatment at the clinics and to early referring by the Infant Welfare and School Clinics and general practitioners, and to increased watchfulness of parents. This is certainly true for knock-knee deformities for which operative intervention, at one time quite common, has become a rarity. The main factor in this struggle has been the fight against over-eating, one of the less attractive features of the affluent society. In other conditions it is the referral on mere suspicion of serious trouble that makes successful conservative treatment possible." During the year 61 pairs of valgus insoles, 3 pairs of surgical boots, 16 pairs night splints, 5 pairs calipers, 305 adaptations to shoes, 1 urinal were supplied to children. Remedial Exercises and Physiotherapy We had been without the services of a Physiotherapist at Wanstead Place Clinic since August 1967 but on 18th June, 1968 Mrs. Bretland commenced two sessions per week there. She also took over the two sessions per week being held at the Manford Way Clinic. Summary of Attendance of all Children New Cases Total Attendances Kenwood Gardens 102 272 Mayesbrook 71 312 Manford Way 4 334 Wanstead Place 1 91 Totals 178 1,009 Ear, Nose and Throat Clinic The Ear, Nose and Throat Clinic held at Kenwood Gardens Clinic continued as in previous years under the Consultant, Miss M.M. Mason, F.R.C.S., who reports no change in the running of the clinic:— Details of the sessions held and cases seen are as follows:- 67 No. of Sessions New Cases Old Cases Total Attendances Audiograms Advised Operation 40 163 95 469 75 88 In addition 51 children were referred to the Ear, Nose and Throat Clinic at Wanstead Hospital and seen by Mr. R.T.S. Goodchild, F.R.C.S. Of these 15 were found to require operative treatment. Speech Clinics The following Speech Therapists were employed at the end of 1968:- Miss Cox Full-time. School Clinics and Woodford Bridge E.S.N. Unit. Miss Littlewood Full-time. School Clinics. Becontree Schools and Junior Training School. Miss Osborne Full-time. School Clinics and Observation Unit. Mrs. Pretious Full-time. Valentines Clinic and Ethel Davis Physically Handicapped School. Mrs. Tingey 6 sessions. Mayesbrook Clinic and St. Vincent's School. Mrs. Pretious reports on their work as follows:- "In September 1968 we welcomed Miss Cox and Miss Littlewood to full-time posts to replace Miss Barrett and Mrs. Pearce, who had resigned earlier in the year. As Mrs. Pearce had been employed for three sessions only, this increased the establishment by seven sessions, which was most helpful. It was possible to increase to four sessions the Junior Training School and to five sessions the Observation Unit. We are pleased to receive so many referrals of pre-school children. From the age of 2½ years onward, parental guidance as to the best ways to stimulate the child's speech development is given by the therapist, and opportunity provided for the mother to observe her working with the child. It is widely said that conversation is a dying art and we find that some young children lack opportunities to converse with adults who know how to speak in a simple interesting manner. This type of "nursery conversation" is the basis of future linguistic abilities. We take this opportunity of thanking everybody for their helpful co-operation in the past year." 68 School Dental Service Mr. E.V. Haigh, Principal School Dental Officer reports as follows:- The Policy of the school dental service during 1968 was to increase the number of school dental inspections and to treat all patients willing to accept treatment from the Authority. The staffing remained almost identical to last year with the full time equivalent of 5.17 dental surgeons employed on the school dental service. Dental inspections are very important, it is often only by these inspections that parents can be informed that their children require dental treatment. It is then the responsibility of the parent whether treatment should be carried out by the general dental service or by the school dental service. However many parents do not accept treatment from either and it is only when the child complains of pain that treatment is sought. During 1968 the dental surgeons inspected 67% of the school population, this being 12% more than in 1967. Obviously our aim is 100% each year but with staff shortage this is difficult. The amount of treatment carried out in the clinics also increased, 8.5% more fillings. The following table shows the clinics, number of surgeries, attendances, sessions worked and the number of fillings. No. of Surgeries Attendances Treatment sessions No. of fillings Mayesbrook 2 3,340 601 2,952 Kenwood 2 3,199 646 3,157 Manford Way 1 1,310 248½ 1,451 Valentine 2 2,268 396 1,964 118 Hermon Hill 1 1,295 233 1,092 South Park 1 196 57 174 Totals 9 11,608 2,181½ 10,790 The South Park clinic was opened in 1968 and the dental suite is well equipped. In October Mr. O'Connell commenced working 6 sessions per week at this clinic. The number of patients attending is increasing. It will be noted that with a staff of 5.17 full time equivalents it was impossible to fully staff each clinic. in some areas such as Manford Way and South Park the amount of sessions worked has proved to be sufficient. A dental auxiliary has continued to be employed at Kenwood Clinic under the supervision of Mr. Willson, senior dental officer. Her work has been of a good standard and her pleasant manner helps to cope with the 69 more difficult small children. The dental auxiliary has also undertaken dental Health Education in infant and junior schools creating dental posters to help in this work. 53 sessions were spent on this during 1968. Dental Health Education continued to be given by the Health Education Officer and staff as part of general Health Education in all schools that they visit. All dental officers give dental health instruction to patients when they attend for treatment. The yearly progressive programme for the replacement of old or obsolete equipment continued. A new dental unit was installed at Manford Way and a new dental chair at Valentines dental clinic. Waiting rooms have been improved to make them more pleasant for the patients. This is important because the more relaxed the patient is the easier to treat. A high standard of decoration in surgeries and waiting rooms must be maintained both from the point of hygiene and also the acceptability of the service to the patients. Toothbrushes continued to be sold at 3d. each in the surgeries to children. The small pilot scheme in one of the Junior schools of having toothbrushes for all the children staying to school dinners has continued to work very well. It is now working in four infant schools and one junior school. Due to the fact that many head teachers have staffing problems it has not been possible to expand this scheme to as many schools as I would have wished. I am convinced that this habit forming routine of cleaning teeth after a meal could do considerable good in reducing dental caries. This is shown by the number of small children who insist on taking a toothbrush to school when they leave an infant school with this facility and go to the junior department. Fluoridation of the water supply in the London Area appears to be unlikely for many years. This major step forward in preventive dentistry would save thousands of fillings and extracted teeth. The Ethel Davis School Dr. A.J. Howell, Medical Officer in Charge reports:— This year saw a further reduction in the number of pupils attending with conditions due to infections. Improvements in preventive medicine including environmental measures, early diagnosis, better medical care and modern antibiotics are largely responsible for this decrease. On the other hand improved obstetrics and surgical paediatrics are preserving the lives of many infants born with congenital defects resulting in an 70 increase in handicapped pupils of this nature, often unfortunately with multiple defects. In particular this year saw a rise in the admissions of children suffering from Spina Bifida. Modern surgery has been saving over a thousand such children yearly for the past five or six years and these are now reaching school age. Many, though in the hands of neurologist, urologist and orthopaedic surgeons, have unlike the cerebral palsy child quite normal patterns of intelligence. As they will have to rely entirely on their intellectual abilities in adult life, education is even more important to them than to the ordinary child and much thought should be given to their best placement. As a result of the above factors there are now vacancies in the larger P.H. classes while there is a growing waiting list for admission to the smaller classes of the Nursery and Cerebral Palsy Units. The overall 10% reduction in the scholars attending is due to this pattern of ever increasing preponderance of congenital defects, a pattern likely to continue and give increasing need for small classes. Staff We regret the resignations of Mrs. Craig, physiotherapist and Mrs. Hallows, nursing auxiliary but welcome Miss Barton, physiotherapist, who is already proving a valuable member of the staff. Mr. Lee our visiting orthopaedic consultant continued to supervise the pupils' therapies and advise in many other ways. School medical examinations followed previous lines, case conferences were held where necessary and there were useful meetings with Mr. Causton the Headmaster and Mr. Farrell the Youth Employment Officer who has again been of great help in the difficult problem of placing school leavers in suitable work. During holidays therapy for Redbridge pupils continued at the school as before, coupled with any essential visits by therapists to advise parents on problems in the home. One spastic pupil benefitted from an enjoyable 2 weeks I.C.A.A. holiday at Cambridge. In June the medical and therapist staff visited for the day the Lady Zia Wehner Centre at Luton where Mrs. Esther Cotton's athetoid unit use the approach advocated by Dr. Peto of Budapest, intensive therapy combined with education being given by the same person. The visit both stimulated and gave fresh ideas for adaptation. In September we wel- 71 comed a visit from Dr. Udall of St. Bartholomew's Hospital, who brought with him a few medical students as part of their undergraduate training. Excellent co-operation has continued between therapists, nursing and teaching staff, while the Headmaster, Mr. Causton showed great forbearance in fitting in with temporary alterations to the schedule of school medical examinations. During 1968 there were 12 admissions and 21 discharges, recommendations for admissions being received from the following sources:— Other Authorities 6 School Medical Officer 5 Hospital 1 Total 12 The diagnoses of admissions were as follows:— Cerebral Palsy 3 Hydrocephalus 1 Malnutrition 1 Muscular Dystrophy 1 Neurofibromatosis 1 Perthe's Disease 1 Spina Bifida 3 Still's Disease 1 Total 12 Cerebral Palsy Unit Mr. H.B. Lee, Consultant Orthopaedic Surgeon submits the following report of the work undertaken at the Cerebral Palsy Unit: — The work of the Cerebral Palsy Unit has gone on satisfactorily, and the arrival of a second physiotherapist, Miss Barton, who has great experience in this kind of work, has made it possible for more adequate treatment to be given to the seriously handicapped cases, who have made progress accordingly. Appreciation is again due to all the members of the staff, who work together efficiently and harmoniously for the benefit of 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 72 during the year:- Mrs. Handja, Child Psychotherapist left us after a number of years and we were sorry to lose her services, especially with the more severely disturbed children. Dr. Doron, Child Psychotherapist fortunately arrived to take her place soon after and we were fortunate too in being able to appoint an additional P.S.W. Miss Ogden to start work with us on the 1st January, 1969. The Clinic was one of the first to be established in the London area after the war. Now in its twenty-first year, it is probably the largest and busiest Clinic in Greater London. We have a total staff of nineteen full time or part time. Increased size has meant taking a new look at our organisation and structure so as to use our resources to the full and provide an optimum service to the children of Redbridge. We have been rethinking our role within the community as well as our professional roles within the Clinic. Our links with the Mental Health Services in the borough have been strengthened by Miss Boyd's new appointment in which she combines her work within the Clinic with responsibilities for the mental health social work service for children in the community. Miss Ogden, a P.S.W. who joined us on 1st January, 1969 will have a similar combined role, Dr. Doron, one of our psychotherapists, is working for one session a week in the classes for maladjusted children where he sees children singly or in small groups. Mr. Bushong's therapeutic groups, now four in number, are held in the Clinic and continue to flourish. Our emphasis this year has therefore been on developing group work and on extending our services into the community. Adapting to new ideas and meeting new needs is often strenuous but always immensely worth while. School Psychological Service For the year's work during 1968, Miss S.V. Gascoyne, Miss C.H. Watt and Mr. R. Azam, Educational Psychologists, report as follows:— Redbridge children are fortunate that there are so many specialized teaching units within the borough. In theory and to a large extent in practice, children who are failing at any given time to profit fully from education in normal school surroundings can be given extra very specialized help on a permanent or temporary basis according to their needs. Each unit has expanded from the single class, often started on an experimental basis, to a group of classes as the need for each category has become more apparent. It is almost an axiom that to start a 73 teaching unit for some specific category is to create a waiting list within two years irrespective of how enlarged the unit has become. This has certainly been the case in the Redbridge area, as the purpose and value of the unit has become more apparent the more candidates are put forward for consideration by Head teachers and school medical officers. The exception to this pressure is the Treeside Unit for maladjusted children where a waiting list cannot be built up as help must be offered in some other form if no early vacancy is available. This problem of the waiting lists has been particularly pressing over the last year, partly on a cumulative basis and partly because three psychologists see more children in a year than two. All this has meant that a re-assessment of the handling of waiting lists and the possibility of more part time attendance for children is under consideration. This is a trend that is evident wherever specialized units have been set up and it has not been detrimental to them or the children that they are being considered more astringently and less as an umbrella system to give the less educationally robust child a sanctuary. We are very fortunate in being able to have a full time remedial teacher at the Clinic who sees between 35-40 children for hourly sessions each week for remedial work in reading and mathematics. Approximately two-thirds of these children come from the school psychological service and the teacher also visits a local school for one morning a week to help groups of children with their reading. The average length of attendance is from 2-3 terms. The psychologists have also seen 21 children for remedial work during the year, so a great deal of extra help is available but even so the waiting list grows. During the last 2½ years the psychologists have given some assistance in a research project being undertaken at Manchester University to devise a new individual intelligence test for children intended for psychologists use. The research project is financed by the Department of Education and Science. Initially with the agreement of the Redbridge Education Committee, Miss Watt went on a short course at Manchester University in order to learn about the new test and to be briefed about the work to be done locally — Miss Gascoyne and Mr. Azam helped in the try out testing stage. Local Authorities selected for this purpose were chosen to provide a representative cross-section of the whole of Britain. There were a vast number of items to each test as only onethird of the number will ultimately be included in the final result which will take one to one and a half hours to administer. The lengthy try outs 74 were very time consuming. Thirty-two children in Redbridge took part, several hours of work being necessary for each child as the whole range within the appropriate age group had to be presented. Normal children were needed for this survey with equal numbers of boys and girls representing different social economic backgrounds in specified numbers, The schools very kindly provided the majority of cases and Health Visitors found the pre-school children. The parents concerned were extremely helpful and went out of their way to provide information and facilitate the project. The children themselves were willing and in some cases enthusiastic participants being extraordinarily patient about the marathon series of tests that were imposed on them. For the psychologists the task was interesting though arduous and it is hoped that the test which is to be the end product of this work will provide a valuable additional tool in the work of assessing children's abilities to difficulties in learning. The test will be the first one of its kind to be produced in Britain as the comparable individual tests available for our present use are American and the scoring standards based on the performance of American children although British standardisation have been carried out. Besides the interest of taking a minor part in creating something new of its kind certain unexpected by-products of value were gained during the work. Children from the age of 2 years onwards were tested which for the first time gave an opportunity of seeing normal 2-3 year old reactions to a test situation. Some of the responses of these very young children gave further insight into the reactions sometimes found in older, backward children in test situations showing that such responses are normal at a certain stage of development. Picture materials were of no interest at all to most 2 year olds but they were to 3 year olds; 2 year olds showed a lot of frustration and even stamped their feet in minor tantrums if pressed to continue with uncongenial tasks that were unsuitable for their level of development. In the normal course of events no one would make such sustained demands on the concentration and directed efforts of very young children so there was a unique opportunity of seeing their reactions which were recognized as something seen in normal children who were immature in development. 75 New Cases 337 Follow-up for schools 170 Follow-up for clinic 134 Remedial Education Cases 57 Children referred to Child Guidance Clinic 50 Enuresis Clinic Dr. Joan M. Pooley, Senior Departmental Medical Officer, reports as follows:- During the 12 months ended 31st December 1968, the Enuresis Clinic has been held weekly at the Kenwood Gardens Centre and fortnightly or monthly as cases demanded, at the Mayesbrook Centre. 1 SESSIONS AND NEW CASES:- Kenwood Gardens Mayesbrook TOTAL Sessions held 52 16 68 New cases seen 111 36 147 Total attendances new and old cases 661 126 787 Sessions held: Kenwood Centre Mayesbrook Centre Year Number:- 52 16 1968 (57 24 1967) (49 24 1966) Total 1968 New cases seen:— 147 111 36 1968 Total attendances:— 787 (Old and new cases) 661 126 1968 Throughout the year the attendance of patients has been good, though a certain number of cases have failed to reattend after 3 or 4 interviews and have subsequently been found to be "dry". 76 II APPOINTMENT ANALYSIS (Both Clinics) Under 5 years Over 5 years Boys Girls Boys Girls Recommended by:— 1. Infant Welfare M.O's 11 8 _ _ 2. School Medical Officers _ _ 48 25 3. General Practitioner 2 2 12 7 4. Parents 1 1 6 3 5. Health Visitors 2 2 9 3 6. Moved into Area _ _ _ 2 7. Welfare Officers _ _ 1 _ 8. Hospitals _ _ 1 _ 9. E.N.T. Consultant _ _ 1 _ Total = 147 16 13 78 40 III ANALYSIS OF TREATMENT The treatment and approach in each case naturally varies with the etiological factors and temperament of the child. On the whole, Dexten is being used much less frequently - although it has a definite use in certain selected cases, and has also been used with success as an adjunct to the Bed Buzzer for children who are very deep sleepers. In each case, prior to any consideration of medicinal therapy, or use of the buzzer, a considerable time is spent in talking to the child and then to the mother. The child's attention and confidence is thus more easily gained and the mother is asked to talk over the salient points with the child at home. This method of approach has proved very effective and the child's increasing interest during the interview has been obvious. Specific Treatments:- (1) Routine and Charting: This has been instigated in all cases, and the charting of dry nights only by marking a "small home made diary" with coloured stars obviously encourages the child. Children who are definitely of the enuretic "prewaking group" are routinely woken for voiding at 5 a.m. for a period of six weeks, which is usually long enough to establish a normal "habit wake reflex". 77 (2) Cases treated with:- "Dexten" Amitriptylene Imipromine Bed Buzzer Bonded — Amphetamine (tabs. or syrup in 10 or 25 mgm. doses) (10 or 20 mgm. in tab. form) Number of children 73 85 14 59 (There are now 33 bed-buzzers available through the Clinic) IV RESULTS:- During 1968, 77 cases were discharged "dry" = 57 (Kenwood) and 20 (Mayesbrook) + 48 cases who were considered "self-discharged" Total discharges (old and new cases) - = 236 (including removals and defaulters). V COMMENT AND CONCLUSIONS: The Etiology of Enuresis has been ascribed to so many factors, and it's treatment varied accordingly — with equally varying successes and failures, that one is now faced with a vast series of "series of cases" to study and compare. In drawing conclusions from so wide a field, whether the cases be grouped (1) Etiologically:- according to age, sex, disposition, emotional instability, depth of sleep, family background etc., etc., or (2) Therapeutically:- following the use of placebos, "buzzers", charts, or the variety of drugs proven to be of some value in this symptom-complex - it becomes increasingly obvious that rarely, if at all, is there only one predisposing factor. Similarly, in the majority of cases, results show that the most effective therapeutic attack is a combined one. A sympathetic persuasive approach, with the establishment of a regular routine and charting system, supported by the use of bed-buzzer (and or-concurrent administration of a bonded amphetamine) or of Amitriptylene, or of Imipramine, or even of a placebo, has given a higher success rate than the mere handing out of pills and prescriptions. 78 During the past ten years, between 500 and 800 cases each year have been interviewed, treated and followed up in llford and later in Redbridge. Experience has shown without any doubt, that self-confidence gained through rapid and encouraging results is the biggest insurance against relapse. This early improvement, however, can only be achieved and maintained if there is complete understanding by both parent and child of what is being attempted - namely the breaking of a bad habit, however long established it may have been. Bed-wetting cannot be regarded as a single entity - it is a symptom of the "Enuretic Syndrome". Effective treatment must be directed primarily at the cause supportive therapy will then more rapidly eliminate this distressing and frustrating symptom. 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:- As usual the work of the peripatetic teachers has concerned partially hearing pre-school children and those of school age who do not require special educational treatment in schools for the deaf. We have undertaken the supervision of the use of hearing aids, auditory training, the teaching of speech, language and general subjects, parent guidance, and thetesting of hearing. At present there are 37 children on our register. Of these 4 are of pre-school age. 12 are in primary schools, 18 in secondary schools and 3 in special schools. During the year I have made 621 visits to these children, their parents and teachers, in homes, day nurseries and schools. Since September, when Miss Hodges was seconded to attend a one year University Course, I have been working unaided in two boroughs, and I have had to reduce auditory training for each pre-school age child to one session a week. In the past year 9 children from our register have been recommended for special educational treatment, 3 children were admitted to the Unit for Partially Hearing Infants in Barking last April and have made good 79 progress so far. One 4 year old girl was admitted to the Woodford School for the Deaf, 2 severely deaf children age 4 and 5 entered the William Morris School for the Deaf, one 3 year old girl and a 15 year old immigrant boy were accepted by the Newham School for the Deaf, and a profoundly deaf 5 year old was transferred to the Margate School from a hearing infants school where he spent a short period while placement was being found for him. A 6 year old boy, previously placed in the Junior Training Centre, has been admitted to the Royal Eastern Counties Hospital as a long term patient. A junior and 2 senior pupils who have removed from the borough have been referred for help to the peripatetic teachers in the areas where they are now living. A 13 year old boy has been admitted to our Remedial Centre from the William Morris School for the Deaf. During the year deafness has been diagnosed in 4 junior and 5 senior children in attendance at ordinary schools, and hearing aids have been issued. Many children on our visiting list are deriving benefit from commercial hearing aids purchased for them by the Education Authority, and two speech training units are on loan to parents of pre-school children. A loop induction system has been installed at the Ley Street Day Nursery for the benefit of the partially hearing pre-school children who are admitted there for their social needs. I would like to express my gratitude to the matron and staff at this nursery for the help and support which they have continued to give us in our work with young deaf children and their parents. May I also thank the Health Department for their continued cooperation and important contribution to the development of the peripatetic services. Handicapped Children The number of children coming within the various categories and their disposition as on 31st December, 1968 is shown in the table at the end (Appendix 19). 80 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. 2,987 pupils were offered B.C.G. vaccination and of this number 1,823 or 61% consented. 1,564 or 85.7% received vaccination. As the result of the notification of 2 cases of tuberculosis in schools in the Borough during 1968, it was considered necessary to visit these schools for the purpose of tuberculin testing the contacts. Thetotal number of tests undertaken was 404 but no further cases were discovered following these 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:- Little change has taken place in our work in the Schools. It is possible that we have had a few more scattered instances of scabies and the usual emergency calls after routine hygiene inspections to come back again as odd cases of head infestation have occurred. Health Visitors and State Registered Nurses continue to visit difficult cases at home, persuasion and tact with positive help still have good effect. Much to our surprise one lady this year did not realise she could not keep her child away from school when she liked. Population round some schools vary, especially as young parents prefer to move further out if possible. Health Visitors find some areas are constantly changing, strangers coming in, living in rooms and demanding re-housing immediately. One new school has been added to the area at Woodford Green. 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 33 Neglect 17 IIl-treatment 2 Other causes including 14 Reported by Public Officials 3 81 117 children (boys 63 and girls 54) were involved, 62 being of school age. In addition to this work, 407 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) in this borough, consists only of visiting those families where there is a child attending one of their schools. During 1968 there was one such child and the family was visited by the Association's representative. Chiropody; During the year 375 school children were referred to the Clinics for treatment (mostly for Verrucae) and many parents were advised regarding suitable shoes for their children. Surveys and Research: During 1968 we continued to participate in the National Survey on Childhood Malignancies. This involved the interviewing, by a Medical Officer, of the parents of a child who had died in 1967, from malignant disease and also the parent of a healthy child of the same age as a control case. Six such cases and six controls were interviewed and a lengthy questionnaire completed on each occasion. The causes of death among children of school age resident in Redbridge during 1968 were:— Asphyxia 1 Ewings Tumour 1 Leukaemia 3 Acute Pulmonary Oedema 1 Mediastivitis, due to swallowing foreign body 1 Road accident 5 Encephalitis 1 Post operative Cerebral Necrosis 1 Total 14 82 APPENDIX 16 DEPARTMENT OF EDUCATION AND SCIENCE MEDICAL INSPECTION AND TREATMENT RETURN FOR THE YEAR ENDED 31st DECEMBER, 1968 Part I — Medical Inspection of pupils attending maintained Primary and Secondary Schools (including Nursery and Special Schools) TABLE A. - PERIODIC MEDICAL INSPECTIONS Age groups Inspected (By year of birth) No. of pupils who have received a full medical examination Physical Condition of Pupils Inspected Pupils found to require treatment (excluding dental diseases and infestation with vermin) Satisfactory No. Unsatisfactory No. For defective vision (excluding squint) For any other condition recorded at Part II Total individual pupils (1) (2) (3) (4) (5) (6) (7) 1963 746 732 14 17 85 101 1962 1,010 1,003 7 25 97 116 1961 382 381 1 15 31 42 1960 122 121 1 6 20 25 1959 92 92 - 3 18 19 1958 74 74 - 4 13 17 1957 135 135 - 8 21 28 1956 1,421 1,419 2 80 121 193 1955 1,071 1,068 3 49 84 132 1954 296 296 - 15 26 39 1953 and earlier 2,392 2,390 2 175 117 280 TOTALS 7,741 7,711 30 397 633 992 Col. (3) total as a percentage of Col. (2) 99.61% total Col. (4) total as a percentage of Col. (2). 39% total 83 APPENDIX 16 (continued) • Part II - Defects Found by Period 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 160 - 133 - 5 Eyes - a. Vision 397 10 204 4 b. Squint 17 - 26 - c. Other 18 - 19 - 6 Ears - a. Hearing 17 81 73 19 b. Otitis Media 4 1 17 - c. Other 5 2 9 1 7 Nose or Throat 64 2 167 1 8 Speech 43 11 48 4 9 Lymphatic Glands 1 - 27 - 10 Heart and Circulation 8 - 94 - 11 Lungs 24 1 171 7 12 Development — a. Hernia 13 - 18 - b. Other 34 5 146 18 13 Orthopaedic — a. Posture 12 1 40 3 b. Feet 57 - 151 - c. Other 84 - 209 - 14 Nervous System — a. Epilepsy 6 - 32 1 b. Other 8 1 32 3 15 Psychological — a. Development 5 46 55 19 b. Stability 12 105 138 6 16 Abdomen 3 - 27 - 17 Other 66 - 258 29 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 607 Number of Re-inspections 339 Total 946 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 19,548 (ii) Total number of individual pupils found to be infested 113 (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 17 By parents 96 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 16 (continued) TABLE A. - EYE DISEASES, DEFECTIVE VISION AND SQUINT Number of cases known to have been dealt with External and other, excluding errors of refraction and squint 2 Errors of refraction (including squint) 2,211 Total 2,213 Number of pupils for whom spectacles were prescribed 992 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 6 b. for adenoids and chronic tonsilitis 65 c. for other nose and throat conditions 3 Received other forms of treatment 206 Total 280 Total number of pupils in schools who are known to have been provided with hearing aids — a. In 1967 21 b. In previous years 65 TABLE C. - ORTHOPAEDIC AND POSTURAL DEFECTS Number of cases known to have been treated a. Pupils treated at clinics or out-patients departments 650 b. Pupils treated at school for postural defects 19 Total 669 86 APPENDIX 16 (continued) TABLE D. - DISEASES OF THE SKIN (excluding uncleanliness, for which see Table C of Part 1) Number of pupils known to have been treated Ringworm — a. Scalp - — b. Body 2 Scabies 10 Impetigo 3 Other skin diseases 156 Total 171 TABLE E. - CHILD GUIDANCE TREATMENT Number known to have been treated Pupils treated at Child Guidance Clinics 183 TABLE F.- SPEECH THERAPY Number known to have been treated Pupils treated by Speech Therapists 352 TABLE G. - OTHER TREATMENT GIVEN Number known to hove been dealt with a. Pupils with minor ailments 335 b. Pupils who received convalescent treatment under School Health Service arrangements 17 c. Pupils who received B.C.G. vaccination 1,616 d. Pupils who attended the Enuresis Clinic 234 Total 2,202 87 APPENDIX 17 DENTAL INSPECTION AND TREATMENT Attendances and Treatment (a) Number of first visits 4,034 (b) Number of subsequent visits 7,574 (c) Number of total visits 11,608 (d) Number of additional courses of treatment commenced 960 (e) Number of fillings in permanent teeth 6,612 (f) Number of fillings in deciduous teeth 4,178 (g) Number of permanent teeth filled 5,756 (h) Number of deciduous teeth filled 3,836 (i) Number of permanent teeth extracted 509 (j) Number of deciduous teeth extracted 2,107 (k) Number of extractions under general anaesthetics 556 (l) Number of emergencies treated 195 (m) Number of pupils x-rayed 260 (n) Number of pupils who received prophylaxis 1,229 (o) Number of teeth otherwise conserved 248 (p) Number of teeth root filled 14 (q) Number of inlays — (r) Number of crowns 7 (s) Number of courses of treatment completed 4,194 Orthodontics (a) Number of cases remaining from previous year 212 (b) Number of new cases commenced during year 93 (c) Number of cases completed during the year 71 (d) Number of cases discontinued during the year 20 (e) Number of removable appliances fitted 102 (f) Number of fixed appliances fitted 6 (g) Number of pupils referred to Hospital Consultants — Dentures (a) pupils supplied with Full upper or Full lower (first time) 1 (b) Pupils supplied with other dentures (first time) 4 (c) Number of dentures supplied 5 88 APPENDIX 17 (continued) Anaesthetics Number of General Anaesthetics administered by Dental Officers - Inspections (a) First inspection at school — Number of pupils 18,379 (b) First inspection at clinic — Number of pupils 3,354 Number of (a) and (b) found to require treatment 9,328 (c) Pupils re-inspected at school clinic 1,711 Number of (c) found to require treatment 1,112 Sessions (a) Number of sessions devoted to treatment 2,181 (b) Number of sessions devoted to inspection 137 (c) Number of sessions devoted to Dental Health Education 53 89 APPENDIX 18 SCHOOL HEALTH SERVICE: STAFF AND SCHOOL CLINICS (As at 31st December, 1968) 1. STAFF OF THE SCHOOL HEALTH SERVICE Principal School Medical Officer — 1. Gordon, M.D., Ch.B., M.R.C.P.(Lond.), D.P.H. Deputy Principal School Medical Officer — M.T. Fernandes, M.B., D.P.H., D.I.H., D.C.H. Principal School Dental Officer — E.V. Haigh, L.D.S., R.C.S. Principal Medical Officer — W.H. Toms, M.B., Ch.B.(Edin.) Number of Officers Number in terms of full-time Officers employed (a) Medical Officers (including the Principal School Medical Officer) - (i) Whole-time School Health Service — — (ii) Whole—time School Health Service and Local Health Service 8 3.0 (iii) General Practitioners working part-time in the School Health Service 10 0.4 (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 3.93 (iii) Part—time School Health Service (including Orthodontists) 4 1.56 (iv) Dental surgery assistants 7 6.23 (v) Dental Auxiliary 1 0.93 (c) (i) Senior Speech Therapists — — (ii) Speech Therapists — 4.6 (iii) Assistant Speech Therapists — — (d) (i) Audiometricians — — (ii) Chiropodists (4 Full—time plus 6 Contractual) 10 .40 (iii) Orthopaedic Nurses — — (iv) Orthoptists — — (v) Physiotherapists 2 2 (vi) Remedial Gymnasts — — (vii) Occupational Therapists 1 1 (viii) Clinical Technicians employed on Audiometry and vision screening 3 2 (e) (i) Nurses 47 13.8 (ii) Number included at (i) who hold Health Visitors Certificates 37 — (iii) Nursing Assistants and Trainee Nurses 1 1 90 APPENDIX 18 (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 dentil examination and treatment of pupils attending maintained primary and secondary schools. Number of School Clinics 13 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, 1968 where such treatment is provided Directly by the Authority Under arrangements made with Hospital Authorities (1) (2) (3) A. Minor ailment and other non-specialist examination or treatment 7 – B. Asthma – – C. Audiology – – D. Chiropody 7 – E. Dental 6 – 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 10 – R. Sunray – – S. Vaccination and Immunisation 7 – T. Cerebral Palsy Unit – 1 91 APPENDIX 18 (continued) IV. - CHILD GUIDANCE CLINICS (i) Number of Child Guidance Centres provided by the Authority - 1, Staff Number employed Aggregate in terms of the equivalent number of whole-time officers by L.E.A. Under arrangements with Hospital Authorities (i) Psychiatrists — 2 .80 (ii) Educational Psychologists 3 1.5 1.5 (iii) Psychiatric Social Workers 4 — 4.0 (iv) Child Psycho-Therapists (Contractual) 3 — 1.0 92 APPENDIX 19 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 Number of chi Idren of school age requiring S.E.T. Blind – – 1 1 – – 2 – – – – – – 4 Partially Sighted 11 3 4 – – – 1 – – – – – – 19 Deaf 7 – 2 – – – 5 – – – – – – 14 Partially Deaf 16 – 1 – – – 7 – – – – – – 24 Delicate 2 – 1 – 1 – 6 – – – – – – 10 Physically Handicapped 54 4 1 2 – – 16 – – – – – – 77 E.S.N 111 11 14 3 – – 13 – – – – 1 – 153 Maladjusted 18 – 11 12 1 – 27 – – – – – – 69 Epileptic – – – – – – 1 – – – – – – 1 Speech Defect – – – 1 – – 3 – – – – – – 4 TOTALS 219 18 35 19 2 – 81 – – – – 1 – 375 Wanstead Place, Health Services Clinic PLATE 1 South Park Health Services Clinic Music Making, Hyleford Junior Training School PLATE 2 Hyleford Junior Training School Work in progress at the Burnside Adult Training Centre PLATE 3 Burnside Adult Training Centre PLATE 4 Dental Treatment in Progress PLATE 5 Blind Club, High Road, llford PLATE 6 Residents Lounge, Pegram House Rose Park Home for the Elderly plate 7 PLATE 8 Preparing Meals on Wheels MENTAL HEALTH 93 MENTAL HEALTH SERVICE (C.H.A. Wedeles, L.R.C.P., M.R.C.S., D.P.M.(Lond.) (Principal Medical Officer) General By the end of the year, there has been some encouraging progress progress in the development of this Service. The four new posts of 1 Principal and 3 Assistant Principal Mental Health Social Workers, created in the previous year, were filled or about to be so. The 3-team structure — hospital, community and children — has proved attractive to staff, as it permits the pursuit of specialised interests, makes possible a clear definition of responsibilities, and the working of a system of referrals, allocation and supervision of cases. We have begun the major task of reviewing the work that is being done by the Service with the intention, where possible, to bring about more effective use of our resources: e.g. the Assistant in charge of the hospital team now receives all referrals for social work, sifts and allocates them and keeps track of their progress. Thus she is able to provide training and assistance to members of her team, be aware of the changing Social Work needs of the hospital, and help define the scope of her department to the medical staff. Though this necessitates a reduction of her case load, this should be more than balanced' by the greater efficiency of the team as a whole. A similar scheme operates for the community team. We have ceased routine visiting of families of subnormals, temporarily closed cases that appear dormant, and concentrate on families obviously in need of short or long-term help. It is hoped that the pruning in low priority areas will make more time available for work with psychiatric problems at present poorly covered. For instance, one hopes, at some time in the future, to be in a position to offer psychiatric social work help to those G.P's. interested in some form of part-time liaison arrangement. The parents of all children with diagnosed mental handicaps or disorders are seen as soon after birth as the condition is known. The problems of child and family are assessed, suitable psychiatric or social work help is offered, and a foundation laid for future planning. A Psychiatric Social Worker trained in child guidance work acts in a consulting capacity to the staff of the Junior Training School and advises on any relevant problems arising from its work. The Head Teacher of the Junior Training School is freely accessible to parents, and herself 94 deals with most day to day problems arising, so that the P.S.W. is only brought in when social work skills are clearly required. Establishment The prospects of filling our present establishment of 12 Mental Health Social Workers appear not unpromising at the present moment. When the remaining vacancy is filled, we shall have the minimum staff recommended by Younghusband at al. for our population. A Trainee Mental Health Social Worker post has been in the deep freeze since devaluation and appointments to 2 additional posts for qualified personnel, agreed by Council for 69/70 will have to be deferred. The main areas which will suffer from these delays will be the psychiatric hospital, especially in it's out-patient work, and the G.P. who has large numbers of patients suffering from conditions amenable to help and alleviation by trained social workers. Two further posts, now in abeyance, are of a trainee each for Junior and Adult Training Centres. It was intended to use these for people eligible for Local Education Authority grants after completing one or two years as trainees, enabling these posts to be permanently filled to the advantage of the Centres and Trainees. A Nursery Nurse has been employed to take charge of a special play group meant for children with moderate emotional disturbances. Lack of suitable accommodation, and the need to care for a severely psychotic little boy have so far foiled the true purpose of this provision. Staff We were pleased to appoint the following in the course of the year- Mr. J. Horak, A.P.S.W., as Principal Mental Health Social Worker. Mrs. E.J. Thompson, A.P.S.W., as Assistant Principal Mental Health Social Worker in charge of the Goodmayes team. Miss M. D. Boyd, A.P.S.W., as Assistant Principal Mental Health Social Worker in charge of Children and Adolescents team. Miss Boyd is combining this appointment with that of Senior Psychiatric Social Worker at the 11 ford Child Guidance Clinic. Mr. S. T. Mi Id inh all, C.S.W., as Mental Health Social Worker to the team based on Goodmayes Hospital. Mrs. R. Jarvis, Head Teacher of the new Hyleford Junior Training School. Mr. J.F. Norris, M.W.O. successfully completed the one-year C.S.W. course at Cardiff. Mr. A. E. Kent, M.W.O. was seconded to the same course in the autumn. 95 Miss Johnson, Supervisor of the Redbridge Junior Training Centre retired at the end of the summer after 36 years of dovoted service to the mentally handicapped children and we wish her a very active and happy retirement. Hyleford Junior Training School This exciting new building opened its doors in September for the new term. Staff and children were delighted with it and everybody feels very much at home. Lady Grenfell formally declared the school opened on 28th September, a ceremony which was attended by many guests and followed by a conducted tour arousing a great deal of interest. Both the Special Care Unit and the Nursery Class are in heavy demand. We admit children at the age of 3, or younger in cases of special need. A programme of activities and training in keeping with the advanced design of the building is already well under way. Burnside Adult Training Centre This Centre, now in its second year, has proved itself to be extremely well adapted for its purpose. A new programme of social training was begun in the autumn; its aim is to make sure that all trainees receive all the training they are capable of using, and that this is well grounded in basic "know how". Side by side with this go efforts to make the work programme more diversified, productive and realistic. An improved Incentive Payment Scheme is being worked out. The Centre is very active in participating in sports and games organised in the region. Staff join members of the Redbridge Society for Mentally Handicapped Children in running a Social Club which holds regular meetings at the Centre. Mental Health Hostel Abury House, until recently the headquarters of District Nurses, is being adapted as a 12-bedded hostel for the rehabilitation of patients suffering from psychiatric illness. Referrals will be taken from any sources within the Borough; though most patients will initially come from within psychiatric hospitals, it is hoped that later suitable cases will also be referred from psychiatric out-patients and G.P's, circumventing in some cases the need for hospital admission. The hostel is to be mixed, and will be very flexible as far as diagnostic categories and length of stay are concerned. 96 Rehabilitation Plans for a 40-place centre at Fullwell Cross were given provisional Centre approval by the Department of Health and Social Security. We hove ceived advice on the design of the workshop from the Department of Employment and Productivity, and have found their interest most helpful and encouraging. It is intended to provide a standard of rehabilitation procedures not unlike those offered at I.R.U's. though for a longer period of time, for 30 patients with psychiatric and 10.with physical disabilities. The Centre should also be of assistance in preparing for work school leavers not yet ready for employment. Other A promising development is an offer by the Authority to consider Projects the possibility of finding accommodation for suitable long-stay patients from local psychiatric hospitals, in either warden-supervised flatlets or in houses for Group Homes. The initiative for this scheme came from Claybury Hospital, which is preparing a list of suitable patients in collaboration with the Mental Health Service. This plan holds out hope of a fuller and more dignified life for many people now only in hospital for want of somewhat to go and someone to give them a little supervision in the open community. A hostel for adult mentally handicapped persons is planned for 1970/71. A suitable house (Woodside), to be adapted, is earmarked for this purpose. We should like to have a hostel for the Temporary Care of Mentally Handicapped Children. If such a place existed in the locality, it would open up new possibilities for giving planned relief to the families of these children all the year round. Being a fairly costly scheme (though probably extremely good value in alleviating stresses and strains), this will no doubt have to await easier days. It should be possible to organise such a venture on an inter-Borough basis. Goodwill Club This continues to provide light social diversions. As soon as time allows we should like to increase its scope and widen its function. Madeira The weekly play group for mentally handicapped children under the Grove aegis of Health Visitors, provides relief and very useful introductory Clinic and advisory services to their mothers. This clinic also serves as a regular meeting place for discussion groups for patients discharged from Claybury Hospital and their relatives, with hospital and Iocal authority staff; this is felt to be an economic way of offering after-care. 97 ANNUAL REPORT - FIGURES Informal Order Extended Order TOTAL Hospital Admissions - Mentally ill 77 144 101 322 Hostel Admissions - Mentally ill 15 Hospital Admissions - Mentally subnormal 5 Temporary care admission — Mentally subnormal 25 Hostel Admissions - Mentally subnormal Nil 6 permanent care STATISTICS-31.12.68 Mentally Subnormal Number of cases on Register 406 (67 in residential care) Number of visits 987 Average Number of cases per officer 65 Average Number of visits per case 2.9 Mentally ill Number of new cases referred for Social Work 155 Number of second o r subsequent referrals 55 Total Number of visits per officer 475 Average Number of visits patients referred 13.7 Total Number of vis its 2,852 TRAINING CENTRES - AS AT 31st DECEMBER 1968 Junior Training Centre A. Total Number on Register 77 B. Average Daily Attendance during year 52 C. Discharges (including transfers) 8 Adult Training Centre A TotaI Number on Register 98 B. Average Daily Attendance during year 75 C. Discharges (including transfers) 18 ENVIRONMENTAL HEALTH 99 ENVIRONMENTAL HEALTH (S.R. Daly, LI.M., B.Sc., D.P.A.(Lond.), Barrister-at-Law Chief Public Health Inspector) This is my fourth Annual Report on Environmental Health for the London Borough of Redbridge, making a total of 24 with previous ones as Chief Public Health Inspector to the Borough of llford. 1968 has been a rather unsettling year and I find it difficult to stand away and look back over a period during which Public Health Inspectors have been, at loca[ level, investigated and reported upon by a 0. & M. unit, and at national level mentioned in Government Committee Report and Green Paper (neither really concerned with P.H.I's work!) for dismemberment, disintegration and one can only presume for possibly final extermination. Whilst the latter tragedy may bring joy to some, I hasten to assure members that morale within the Inspectorate is reasonably high despite the aforementioned distractions, and the work has proceeded satisfactorily. In fact, for the first time for a number of years, I am happy to report that the establishment has been full throughout most of the year. It has been possible, therefore, to maintain routine inspections to a normal level. The establishment consists of 5 Senior Inspectors and 14 District Inspectors. The Senior Inspectors duties are allocated as follows:- (a) Housing and food complaints. (b) Food and Drug sampling and Student training. (c) Infectious Disease and Food Poisoning. (d) Offices and shops and noise. (e) Clean Air - Smoke Control Areas and industrial installations. Six student P.H.I's receive practical training in the borough and theoretical training at Tottenham Technical Institute. The two matters which caused trouble during 1967, i.e. gypsies and noise nuisance from a furniture factory have been resolved. A site for 16 itinerant caravans has been provided by the Council at Hainault, and 100 no further trouble has been experienced from gypsy caravans on the road verges. The furniture factory has moved out of the borough and taken its noise with it. Accordingly we hoped that with the elimination of these problems, peace and tranquility would descend upon the borough, but from long experience of environmental health I felt that this would be too much to expect. Alas, my forebodings proved correct for during 1968 the gypsies were replaced by squatters who took over a number of unoccupied premises within the Town Centre Redevelopment Area, and the furniture factory by a garage which on change of ownership increased in size and activities to the irritation of the surrounding residents. Town Planning which separates industrial and residential properties has no greater supporter than the P.H.I, who finds himself sandwiched between the two warring factions in a case such as this. It was some relief to find that we were not involved to any large extent with the squatters. Clean Air activity has continued to progress with Smoke Control Area No. 14, the largest so far declared in this authority, coming smoothly into operation on October 1st. Smoke Control Order No. 15 (Cranbrook and Park) was delayed for some months for financial reasons, but was subsequently made and confirmed with date of operation 1st July 1970. The end of the smoke control programme is, therefore, well within sight, one area, 11 ford, Clementswood and Mayfield remaining. The value of this work is clearly obvious to anyone, and it is gratifying to know that this authority is well to the fore emongst London Boroughs, who in turn are well ahead of the rest of the country. The Clean Air Act 1968, which amends the original Act to a certain extent, did not come into operation during the year, but it is anticipated that there will be an increase in duties under this Act in respect of grit and dust emission and chimney heights. The changed control of the latter from planning to public health is welcome. This borough has no large slum clearance problem and as you will read later in this report, the programme has been overhauled and the number of properties involved reduced considerably. Undoubtedly, there is a vast volume of work outstanding in the improvement of existing 101 houses, and it is on this aspect that our efforts should now be concentrated. The division of housing work relating to existing properties amongst different departments does not lend itself to effective progress in this field. 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 and 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 from the new Coppermills Works. In addition, parts of the borough receive well water from Wanstead Pumping Station. 1,012 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. Special tests for lead have been carried out during 1968 on 100 premises where a lead supply pipe is installed. The premises were chosen to give an even distribution of samples throughout the whole of the Board's area. Two samples were collected from each premises; one was the first running of water standing in the lead pipe overnight and the other was a sample of water after running the tap for a few minutes. The results were very satisfactory and the figures within the limits of the World Health Organisation European Standards for Drinking Water Quality. 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 102 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 1968, 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 1968 over 10,000 chemical and bacteriological examination 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. The fluoride content of the river derived supplies was assessed at 0.25 p.p.m. The following mains were laid in Redbridge during 1968 by the South Essex Waterworks Company:- 4 ins. Yards 358 No supplementary supplies of water were obtained by the Company from the Metropolitan Water Board. The Council has approved in principle the addition of fluoride to public water supplies. The Borough is not supplied with water from any public wells nor are there any private supplies providing domestic water to the general public. The Public Health Inspectors took 4 samples of water during the year, 2 being from the South Essex Waterworks Company supply area and 2 from that of the Metropolitan Water Board district and both the chemical and bacteriological examinations gave satisfactory results. Main Drainage and Sewerage Schemes: Progress continues on the relief of flooding in the Borough and the following scheme was commenced during the year:— Hainault Surface Water Sewer to Tudor Crescent (Limes Farm) £69,830 Works scheduled to commence in 1969 are as follows at an estimated cost as shown:— 103 (a) Seven Kings Water — Stage II £390,150 (b) Eastern Avenue / Aldborough Road to Seven Kings - Water — Surface Water Sewer £56,750 (c) Cranbrook Stage III to Clayhall Avenue - Surface Water Sewer — Completion £56,500 (d) Barley Lane/Langham Drive — Surface Water Sewer £46,100 (e) Barley Lane to New Schools — Surface Water Sewer — Extension to Primrose Avenue £45,900 (f) Green Lane/Goodmayes Lare/Trenance Gardens — Surface Water S ewer £58,400 (g) Green Lane/Hazeldene Road- Surface Water Sewer £45,150 (h) Wynn Valley Storm Relief Sewer £927,000 Schemes (c) and (h) are with the Ministry of Housing and Local Government awaiting approval. In addition to the above schemes work commenced, during February 1969, on the Tomswood Hill/Forest Road - Soil and Surface Water Sewers Scheme - £297,550. On the 1st April 1969 the Greater London Council took over the Eastern and Southern Sewage Works, the result being that the new trunk sewer project from the Eastern Sewage Works to a London Borough of Newham Pumping Station will be carried out by the Greater London Council. The London Boroughs of Redbridge and Barking jointly vested main sewers were taken over by the Greater London Council on the 1st April 1969. Rivers and Streams: No floodings have occurred,but spasmodic oil pollutions have; some of the sources have been discovered and remedied. Rainfall: Total rainfall for the year 1968 as recorded by the Snowden Gauge in Valentines Park was 29.40 inches with the greatest fall in any 24 hours of 3.00 on the 31st July. Cleansing of Public Sewers Drains The year showed a considerable increase in the number of requests for the cleansing and unblocking of choked sewers and drains which were dealt with by the three manual staff of the Department appointed for this purpose. 104 Once again the prompt action necessary could only be achieved in many cases by the willingness of these men to carry out overtime and be called out during the evenings and week-ends. Of the 1911 blockages cleared, the Borough Engineer's staff with their specialised equipment assisted in 66 cases and additionally private contractors were called in to deal with 51 cases where in the main the blockages were associated with structural defects of the sewers or drains concerned. Refuse Collection and Disposal The service offered to householders for the testing and reporting on drains at the appropriate fee was used twice during the year. Tons Cwts. Qrs. Lbs. Salvage Value *Refuse Collection 84,095 — _ _ Wastepaper Salvage 1,951 — — — £16,360. Brass 1 2 £3.12.6. Copper 3 2 21 £78.17.11. Copper Cable 3 2 7 £17.16.3. Lead 3 6 £3. 4.5. Light Scrap 38 12 — - £86.17.0. Iron 56 2 1 — £465. 1.3. Miscellaneous Scrap One Load £25.10.0. 16 2 1 — £48.6.9, Woollens 11 2 2 £319. 8.1. Rags 25 4 — - £529. 1.11. Carpet 7 1 2 21 £48.13.9. *An increase by weight of 1.44% over the corresponding period of last year. The final arrangements have been completed for the early introduction of an experimental scheme, embracing 3,400 premises in the north-east of the borough, in which paper and plastic expendable sacks will be used instead of dustbins for the storage of house refuse between collections. The Council's Health Committee plans to test in use various types of sack and sack holders. There are obvious advantages to the householder who will be supplied with fresh sacks each week and the dustmen's work will be easier. There are additional costs involved, however, and it may not be possible to extend the method to other districts quickly. Another decision of the Health Committee during 1968 concerned the scouring of large refuse containers used at high-rise housing blocks, 105 schools, hospitals and large trade premises. It is proposed in 1969 to acquire steam washing plant and to have the containers cleaned thoroughly at frequent intervals. There was a small advance in September in the prices received for all grades ofwastepaper and the Board Mills have been pleased to accept unrestricted deliveries; but there are no worthwhile financial gains for local authorities in this business and as the plant at 11 ford is very old and the depot at Woodford is affected by plans for new major highways, in 1969 the Health Committee must consider whether the reasons for continuing to separate wastepaper from other refuse are sound. The routine services of the Refuse Collection Section have continued without major interruption. There is a steady growth in the demand for collection of old furniture and other bulky rubbish, and a second "Kuka Shark" (now made in Britain) which permits the acceptance of such items at the time of the dustmen's normal weekly call has been acquired. Redbridge Council has gone to some lengths to publicise the G.L.C's. service for accepting bulky rubbish at selected depots and, although the illicit dumping of this kind of rubbish on the Council's rural lanes is still a serious and expensive problem, there has been some improvement. Street Cleansing During the year the London Boroughs Management Services Work Study Group have worked closely with the officers of the Borough Engineer's Public Cleansing Section anda detailed scheme for reorganisation should be ready in 1969. This very well equipped Section maintained scheduled frequencies for street cleaning throughout the year: residential streets were cleaned weekly and busier thoroughfares from twice weekly up to several times daily in the central area. Gullies cleansed 56,249 Public Conveniences A new public convenience was opened at Christchurch Green, Wanstead, in August. The building is well appointed and will provide the same facilities now available in the Council's other 21 public conveniences which include free paper towels, soap and hot water in addition to free toilet facilities. Plans for a further convenience at Broadmead Road, Woodford are being considered. 106 Public Baths 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 Pool at Seven Kings and the Open Air Pool are closed during the winter months. Both are filled with mains water at the commencement of each season. The smaller Pool at Seven Kings and the Pool at Fullwell Cross are open throughout the year. As an experiment the Indoor Pools were opened on Bank Holidays (Christmas excepted), and this arrangement proved to be successful. The Fullwell Cross Pool was officially opened on 20th March 1968, although the public had been admitted from the end of February. There is provision for seating 401 spectators, and a cafeteria serving light refreshments is operated under the supervision of the Chief Baths Superintendent. During the time that the Pools are open the water is maintained at a high standard of purity by continuous filtration and chlorination. In each case footpaths are provided for u.se prior to entering the Pools, and in the case of Fullwell Cross the public are not allowed on the Pool side and any person using the Pool surrounds must wear plimsolls or similar footwear. Periodically samples of water are analysed in respect of each establishment. The Laundry in operation at the High Road Baths handles all the necessary work for all the other establishments. 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. 107 SECTIONS Initial Re- Notices Issued Notices Complied Inspection inspections Informal Formal Informal Formal DWELLINGS: HousingAct(including Slum Clearance and Multi-occupation) 2,882 2,438 16 8 18 4 Rent Acts (Certificates of Disrepair) 32 43 - - - - Public Health Acts (Nuisances) 7,301 5,440 456 129 385 97 Clean Air Act (Smoke Control Areas) 4,595 3,823 5 120 7 158 Infectious Disease (including visits to odvise long stay immigrants) 1,023 991 - - - - OTHER PREMISES: Food Premises 1,908 995 119 — 59 — Offices, Shops Act 1,953 990 414 — 276 — Factories and Workshops 504 122 32 — 23 — Dairies 37 15 6 — 5 — Clean Air Act (Industrial ses) 319 223 7 1 8 1 Pests (Rats, mice, wasps, pigeons) 334 192 14 1 6 — Rag Flock Premises 21 52 — — — — Schools 877 167 — — — _ Swimming Baths 29 42 _ — — — Hairdressers 56 17 _ — _ _ Fertilisers and Feeding Stuffs 11 — — — — — Pharmacy and Poisons 78 312 — — — — Animal Boarding Establishments 3 — — — — — Riding Establishments 15 46 — _ — _ Pet Animals Act 52 10 — _ — _ Diseases of Animals Act 42 83 — _ Atmospheric Pollution Measuring Instilments — 750 — — — — 108 Initial Inspections Re-Inspections Public Conveniences 39 18 Parks and Open Spaces 12 - Litter Act 53 93 Tents, Vans and Sheds 37 41 Places of Entertainment 34 19 Day Nurseries and Child Minders 162 21 Massage and Special Treatment Establishments 30 4 Miscellaneous 1,844 534 Visits Re-Visits Other Duties Food and Drugs Sampling 278 48 Bacteriological Sampling 82 43 Lectures to organisations, schools, etc 27 1 SAMPLES Formal Informal Unsatisfactory Food and Drugs for Adulteration or Misdescription 327 11 14 Rag Flock — 3 — Fertilisers and Feeding Stuffs — 11 3 Bacteriological:- Ice Cream 24 — — Milk 36 — — Water 4 — — Swimming Baths 48 — — 109 COMPLAINTS The Public Health Inspectors dealt with 3,337 complaints received on the following matters:— Accumulation of manure and refuse 40 Animals improperly kept 3 Bad Smells 38 Dampness of Premises 57 Defective drains, W.C.'s and fittings 1,140 Defective roofs, gutters, downpipes, etc 59 Defective water fittings 12 Dirty and verminous houses 16 Dirty condition of rearway 18 Flooding of premises 14 Overcrowding. 27 Smoke Nuisances 38 Noise Nuisances 35 Defective or no provision of dustbin 143 Rats and mice 864 Wasps Nests 417 Unsound Food 60 Miscellaneous 356 3,337 Disinfection and Disinfestation During 1968, 35 premises and 71 articles were disinfected, and 61 premises were disinfested for verminous conditions. Litter Act 1958 As a consequence of notifications from various sources, five cases of potential infringements of the Act were considered during the year. Two cases were not proceeded with, and the other three cases, together with an outstanding case from 1967, were taken to court. Fines imposed totalled £22, with £10 costs. Infectious Diseases During the course of the year 131 notifications for food poisoning and 345 for dysentery were received from Medical Practitioners. These were all investigated together with cases which came to the knowledge of the Department from other sources. 110 Several minor outbreaks of Shig-sonnei were also experienced during the year — generally affecting children at junior schools. Considerable assistance was given by the Public Health Inspectors to general practitioners by collecting specimens and linking with the pathological laboratories for both the notified and non-notified cases. Further demands were made on the time of the Public Health Inspectors by the follow-up visits necessitated by. the introduction of the Public Health (Infective Jaundice) Regulations 1968 operative from 15th June 1968. These regulations were revoked on 1st October 1968 when the requirements under them were incorporated in the Public Health (Infectious Diseases) Regulations 1968. The latter Regulations consolidated all previous Regulations relating to notification and prevention of infectious disease (excluding tuberculosis) and arising from them medical practitioners who notified such diseases were paid 5/-d. per certificate instead of 2/6d. as previously. 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 1968, 73 persons were assisted and 7,036 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. 441 Immigrants were visited during 1968. 28 visits were also made under The Public Health (Aircraft 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 Last year mention was made of a furniture factory at South Woodford which caused considerable nuisance to the surrounding residents. The 111 firm moved to an industrial estate outside the borough early in the year, and so this chapter was closed. I also mentioned launderettes in my last report and here there has also been some improvement as few complaints have been received. Business premises in South Woodford were taken over by a firm of car body repairers and as a result of numerous complaints, continuous observations were carried out by Inspectors during working hours for a week. Obstruction of the highway and constant movement of cars and lorries appeared to be the principal sources of annoyance, but a noise nuisance was not established. Informal approaches to the firm concerned has practically eliminated the complaints. Towards the end of the year a garage in the Seven Kings area became the focal point of innumerable complaints of great variety. Amongst these were noise and fumes from car and lorry washing and it is clear that detailed observations will have to be carried out to establish whether the complaints are justified. Once again business premises, surrounded by houses in a residential area, which had for a number of years operated on a small scale without objection from the residents, has been taken over, enlarged and the throughput of work increased thus arousing the anger of the residents. Th is is basically a Town Planning problem, but although it is difficult to deal with when once established, one is reluctant to advocate an increase in controls. Pests The two rodent operative have continued to carry out excellent work in the destruction of rats and mice, and also with wasps nests and feral pigeon infestations. Evidence has been accumulating that mice are becoming "Warfarin Resistant", and where found to be so an alternative poison has been used. During the year a percentage survey of all the soil sewers was undertaken. Reference to this survey has enabled a programme of treatment to be commenced. This systematic treatment will be continued, dealing with the more heavily infested areas first and moving to less densely infested areas progressively. Records are being kept for subsequent treatments and assessment. The work is being carried out by our own staff. 112 The survey does not show excessively high rodent infestations,but their activities are fairly widespread. The following table summarises the results of treatments carried out during the year. Initial Survey: Manholes treated 1,012 No takes 833 Partial takes 4 Complete takes 175 1,012 First treatment area: Manholes treated 538 No takes 465 Partial takes 20 Complete takes 53 538 A summary of properties visited and infestations found is contained in Appendix 20. Our rodent operatives have carried out five treatments using stupifying bait against feral pigeons, and 147 were destroyed. A contractor has been used in two instances where it was impossible to use baity and by netting and shooting 400 pigeons were dealt within one case and 100 in the other. Housing In my last report I stated that the Borough was fortunate in not having large areas of sub-standard houses which were ripe for clearance and also that due to the Rent Act, better standard of wages, and enthusiastic "Do-it-yourselfers" many houses had been made fit for roughly the price of materials only. This in combination with the Governments new policy of saying old houses and improving them where possible to the 5-Point Standard with the aid of Standard/Discretionary grants led to a complete survey of the existing 5-year slum clearance programme, as a result of which many areas were removed from the programme and a new five year scheme was submitted to and approved by the Council The new programme consists of 131 houses plus a possible 15 individual unfit houses compared with the original list of 287 properties. These figures indicate the smallness of the unfit housing problem within the Borough, but nevertheless it is anticipated that whatever area is submitted as a Clearance Area, objections will be received from owners, 113 leading to the inevitable Housing Inquiry, causing lengthy delays before action can be taken to rehouse the tenants and demolish the houses. The following Clearance Areas were declared by the Council during 1968 with the results shown. (1) 3-31. Tomswood Hill: Objections received by Minister. Public Enquiry held 3.12.68. Confirmed with modifications by Minister 15.4.69. (2) 1 & 3. 11-15(odds). 21 & 23. 8-30(evens), Wilton Road: Objection received by Minister. Public Inquiry held, March 1969. Decision awaited. (3) 31 & 36-38(evens). Wilton Road: Objection received by Minister. Public Inquiry held, March 1969. Decision awaited. (4) 35-40(odds). 44-48(evens) and 60. Wilton Rood: Objection received by Minister. Public Inquiry held, March 1969. Decision awaited. (5) 11-23(odds). Essex Road and 1 & 2, Cross Road: Awaiting submission to Minister. (6) 27-33(odds). 37. 39, 47. 51. Essex Rood and 1-4. Railway Street: Awaiting submission to Minister. (7) 73-87(odds). Horns Road: Discussions in progress between owners and Council regarding future development. A Demolition Order was made in respect of 1 house. The tenant has now been rehoused and demolition is awaited. Four Closing Orders were made and the premises concerned are now unoccupied. During the year applications were received to terminate Closing Orders made regarding two basement flats and 1 house. In each case the applications were granted. The house, in particular, having been gutted, the flank wall rebuilt and the modern amenities of bathroom, wash basin and internal W.C. provided in line with the present policy of new homes from old houses. Another house, the subject of a Demolition Order was made fit, at considerable expense, by the Owner and the Order lifted. In three cases where Demolition Orders had been made requiring the demo- 114 three cases where Demolition Orders had been made requiring the demolition of premises within 6 weeks of vacation by the tenants, it was found that the houses had not been so demolished, resulting in further correspondence with the Owners concerned. The inspection of houses in multiple occupation continues and whilst most owners do not prove too difficult over the provision of facilities, the means of escape in case of fire required by Section 16 of the Housing Act 1961, often leads to strong objections on the grounds that such provisions are unnecessary as the house has stood for many years, and that fire has not occurred. This part of the Act, however, is of utmost importance and cannot be neglected by the L.A. for, in the words of the Fire Brigade, "according to the law of averages a house which has not had to make use of their services for many years is just about due for a fire". Fire is an ever present hazard in houses of multiple occupation due to the presence of more families and occupants than the premises were originally designed for, and if such families comprise of many children and use oil stoves — still the cheapest means of heating - the risk is high, more so if, as often happens, the families are immigrants whose native lands enjoy warmer weather than is experienced in this country, and therefore have little knowledge of *the dangers of paraffin. Should a fire occur in a house in multiple occupation, resulting in the loss of life, the Public Health Inspector could well be called upon to explain at a Coroner's inquest, why the house was not provided with means of escape and if provided why they failed in their intended purpose. The administration of the Rent Acts, insofar as the issue of certificates of disrepair was concerned continued much as in 1967, there being only five applications received, all of which were granted. Two undertakings were received from landlords to carry out specific repairs. Two certificates of disrepair were cancelled during the year. Gypsies and Other 'T ravellers' Last year I reported on the most unsatisfactory conditions then existing on the verge of Woodford Avenue as a result of occupation by a number of gypsies and other travellers with families. I am pleased to report that the provision of a temporary site at Hainault for 16 gypsy caravans has completely abated the nuisance which has troubled this authority for a number of years. The site which has W.C's., wash basins, showers and laundry facilities with hot water was provided at a total cost of £11,000, The 115 site is under the control of the Housing Manager and one of the gypsies has been appointed Warden. The weekly rent charged is an economic one and is approximately £2.10s.0d. for each pitch. Since the opening of the site most of the pitches have been occupied. The Council has agreed to spend a further £1,000 on increasing the number of W.C's. and the provision of wash boilers to supplement the existing immersion heater hot water system. Clean Air Act The promotion and maintenance of Clean Air in the Borough is still making good progress. During the year Smoke Control Area No. 14 (Clayhall and Barkingside) came into operation and the position to date is as follows:- Total number of premises within the Borough 90,963 Total number of premises with Smoke Control areas in operation 59,255 T ota I area of Borough 13,983 acres Total area of Borough covered by Smoke Control areas 11,029 acres Reference to the map in appendix 00 shows the two remaining areas not yet under Smoke Control. The Council made an order in September for one of these areas, No. 15 (Cranbrook and Park) and this has been submitted to the Minister of Housing and Local Government for confirmation. Due to the economic position some slight delay in completing the programme may be expected, but it is still hoped that this will not be later than 1971. There is little doubt that the promotion of Smoke Control areas receives a great deal of local support. An article published in a local newspaper in December 1968 on this subject was based on information from this Department. The degree of co-operation, especially by residents, has been one of the most encouraging features of the whole programme. With regard to fuels, there is still a tendency to prefer gas to solid fuel. Due to the lifting of the restrictions, by the Minister in August, on fixed electric space heaters, grants can now be made towards the cost of these appliances. Shortage of some named smokeless solid fuels occurs from time to time, and in order to overcome this trouble the public are advised to cultivate the use of an alternative fuel. In addition to the abolition of smoke the programme is helping to provide a more efficient heating system in peoples' homes. The more modern appliances are not as wasteful as the old and thus extra heat for warming rooms etc. is provided. The number of applications for grants on 116 central heating continues to grow. Many elderly people, although, loathe to give up their coal fires, admit that the switch-on appliances save work and the trouble of carrying in coal and removing ashes. In fact, the great majority of applicants state that the newer appliances are far preferable to the old, inefficient coal fires. As in previous years there have been few nuisances reported from industrial smoke. In two cases, however, legal proceedings were taken which resulted in fines totalling £10 and costs £2. Information on smoke control can be divided into four main groups- fa) Measurement of pollution. (b) Control of pollution — Smoke Control Areas. (c) Other activities such as Conferences and Exhibitions. (d) New Legislation. (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 Oak Hall Court. These two latter stations are fitted with eight port valves which automatically change every twenty-four hours, thus ensuring complete records over weekends and holidays. These two stations are also part of the National Survey being conducted by the Ministry of Technology. Owing to mechanical breakdowns, complete records of smoke and dioxide concentrations cannot be given for all of the stations, but average figures in micrograms per cgbic metre for the year ending March 1968, as supplied by the Warren Spring Laboratory, for two sites, Nos. 3 and 5, are shown below. are shown below. Site No. 5 is within and Site No. 3 outside existing smoke control areas. Smoke S.0.2 Summer Winter Year Summer Winter Year No. 5 Oak Hall Court, Wanstead 24 62 42 64 127 95 No. 3 17/23 Clements Road, llford 31 90 61 88 207 147 117 A report from the Warren Springs Laboratory dated 1968 investigates smoke measurements for London during the period 1966-67. Regarding Inner London the report states "the position with regard to smoke in this area is better now than the most sanguine could have hoped for ten years ago". With regard to S.0.2 emissions, the use of non-sulphur fuels such as electricity and gas, at the point of use, and light fuel oils is tending to reduce the amount of this pollutant at ground level, especially in residential and commercial areas coming under smoke control. Such reports as mentioned above confirm the testimony of many local residents that the benefits of smoke control are more apparent as each year passes. (b) Smoke Control Areas The No. 14 (Clayhall and Barkingside) Smoke Control Order became operative on the 1st October 1968. No. 15 (Cranbrook and Park) Smoke Control Order was made by the Council on the 8th October 1968. It is now awaiting confirmation by the Minister of Housing and Local Government. Details of the area No. 15 are as follows:— Dwellings (erected before 1964) (a) Privately owned 8,185 (b) Local Authority owned 198 Industrial Premises 98 Commercial Premises 645 Other Premises 45 It was estimated that the cost of replacing and adapting existing fireplaces would be £140,600 and £2,000 for privately and Local Authority owned dwellings respectively, of which the Exchequer contribution would be £57,143, and the cost to the Local Authority would be £43,800. I give below a complete picture of the number of claims dealt with in the areas in operation. The figures for areas Nos. 11, 12, 13 and 14 are not complete and a few claims are still being received for earlier areas. 118 CLEAN AIR ACT, 1956 SMOKE CONTROL AREAS - EXPENDITURE TO 31.12.68 Area Date of Operation No. of properties eligible No. of properties In respect of which Grants made (excluding Redbridge owned properties) Payments mode (7/10) with Discretionary Grants (excludes Redbridge L.A. Properties) llford No. 1 1.11.60 487 32 £293. 9s. 2d. W. & W. No. 1 1.10.61 1,548 399 £2,739.11s. Id. W. & W. No. 2 1.10.61 .2,104 744 £6,837. 1s.11d. W. & W. No. 3 1.10.62 2,086 902 £7,895.18s. 1d. llford No. 2 1. 7.63 784 144 £948. 7s. 5d. llford No. 3 1. 7.63 886 249 £1,410.3s. 5d. llford No. 4 1.10.63 383 172 £1,503.12s. 7d. W. & W. No. 4 1.10.63 2,142 677 £5,842. 5s 6d, 11 ford No. 5 1. 6.64 1,607 405 £2,802.6s.11d. W. & W. No. 5 1.10.64 4,052 1,417 £21,687. 6s.10d. llford No. 6 1. 8.65 4,260 1,921 £25,543. 0$. 8d. W. & W. No. 6 1.10.65 2,630 1,007 £18,086.17s. 8d. llford No. 7 1. 7.66 2,296 570 £10,078.19s. 7d. Redbridge No. 8 1. 7.66 4,592 732 £8,116. 3s. 1d. Redbridge No. 9 1.10.66 2,738 761 £12,675.17s. 7d. Redbridge No. 10 1.10.66 2,685 820 £16,124. 9s. 4d. Redbridge No. 11 1.10.67 2,674 630 £12,507. 1s.10d. Redbridge No. 12 1.10.67 5,412 2,152 £51,821. 2s. 3d. Redbridge No. 13 1.10.67 3,603 794 £16,706. 0s. 7d. Redbridge No. 14 1.10.68 9,798 1,561 £38,099. 9s. 8d. During the year in 45 cases 100% was paid tb persons in receipt of supplementary pensions and whose applications were supported by the Ministry of Social Security. Contraventions of Smoke Control Orders occur from time to time and these are dealt with mainly by informal action. The new Clean Air Act 1968 will make it an offence to deliver raw coal to houses in Smoke Control areas, and this measure, it is hoped, will go a long way in reducing contraventions. (c) Other activities Ten notifications of intention to instal new furnaces have been received during the year. 119 Liaison with the Boroug0h Engineer's Department in connection with the height of new industrial chimneys, continued during the year. The Department makes recommendations based on the Memoranda on Chimney Heights issued by the Ministry of Housing and Local Government when appropriate. The 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 on display within the new smoke control area and again created considerable interest. (d) New Legislation The following enactments came into force during the year. 1. The Clean Air Act (Measurement of Grit and Dust) Regulations 1968 operative as from 1 st May, 1968. 2. Circular 46/68, Ministry of Housing and Local Government (The Clean Air Act 1956; Housing Act 1964) Designation of Direct Acting Electric Space Heaters, operative as from 29th August 1968. 3. The Clean Air Act 1968 (main provisions not operative until April 1969). Offices, Shops and Railway Premises Act, 1963 This is the fourth full year of the operation of this Act and a considerable improvement in amenities enjoyed by office and shops workers is apparent. Inspection of premises under this Act continues to occupy a considerable part of the Inspector's time, and during the last quarter of the year alL visits were made by the District Public Health Inspectors under the supervision of one of the Senior Public Health Inspectors, who is also responsible for all enquiries in connection with reported accidents and applications for exemptions. 2,943 inspections were made during the year and 414 informal notices were served for contravention, as well as very many verbal notices for minor infringements. Proceedings were taken against three firms and fines of £10, £15 and £25 were imposed and costs given to the Council. 120 Many new occupiers of premises which are subject to the Act are still unaware of its provisions, especially in regard to notification of employment of persons and a firmer line may have to be taken in future. The penalty for neglect of this duty is "a fine not exceeding £20". At present the offenders are supplied with the necessary form (OSR.l) and these are usually completed and returned. 91 accidents were notified during the year and all were investigated by the Senior Public Health Inspector. Many were found to be due to the injured person's own carelessness, but two were due to contraventions of the Act and resulted in prosecutions. Five were due to machinery (bacon slicers etc.) and two to vehicles (fork lift, trucks etc.). By far the greatest number (34) were due to falls, 19 to handling goods, 16 to hand tools (butchers' knives etc.) and 12 by striking against or falling objects. One involved burns caused by an explosion. It would appear from the notifications received that accidents only happen to employees of large or multiple firms as the majority of notifications are received from these firms. This, of course, is not so and an effort is being mode to have the requirements of Section 48 brought to the notice of all employers. So that the reader can judge the wide range of problems involved under this Act, I append a list of the Circulars issued during the past year, with brief notes on each. L.A. Circular 7 — Supplement 14 "Guarding of Belt Conveyors". This explains the need for guards on the rollers and belts of conveyors such as are used in warehouses. L.A. Circular 7 — Supplement 15 "Guarding of Food Slicing Machines". This explains the problems being met in fitting guards to some of the existing slicing machines such as are used in grocers shops, etc. L.A. Circular 9 — Supplement 5 "Lighting*. This circular gives guidance to Local Authorities on the amount ol light which will be accepted as complying with the requirements of Section 8 for differing conditions of work or situations. A Booklet entitled "Lighting in O.S. & R. Premises' has since been issued giving more details of acceptable levels of lighting. L.A. Circular 9 — Supplement 6 "Noise*. It was envisaged when the Act was made that experience may 121 L.A. Circular 9 (Contd.) prove that the problem of noise could adversely effect the health of office workers. Section 21 gave the Minister power to make regulations for controlling noise and vibration. A Booklet entitled 'Noise and the Worker' has also been issued giving advice on reduction of noise and insulation problems. L.A. Circular 10 - Supplement 1 "Washing Facilities": "Accommodation for Clothing*. This circular and a Booklet entitled "Cloakroom Accommodation and Washing Facilities" gives further advice regarding the provision of adequate facilities on these subjects as there is some concern that the requirements of these sections of the Act are not receiving sufficiently serious consideration. L.A. Circular 17 Supplement 3 and Supplement 4. These circulars give reports of prosecutions. Taken by Local Authorities throughout the country and the findings of the Courts. L.A. Circular 18) — "Hoists and Lifts" Regulations 1968. L.A. Circular 18) - Supplement 1. These circulars introduce new requirements concerned with the safety and testing of hoists and lifts as used in office and shop premises. These regulations came into force in 1969 and require that all apparatus of this type be examined regularly by a competent person who shall issue a certificate reporting his findings. This certificate to be available for inspection by the Local Authority and in cases where serious defects are found a copy must be sent to the Local Authority. In this connection it is noted that certain firms who carry out inspection and maintenance of lifts are requiring a considerable fee for the issue of this necessary certificate. 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 which receive constant attention. They are: (a) The inspection of canteens and food preparing factories under the Food Hygiene Regulations. (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 (c) the provision and maintenance of suitable sanitary conveniences within factories and workshops. 122 Regular inspections are also paid to outworkers within the borough which number 251. Details of the administration of the Act are contained in Appendix 23. Inspection and Supervision of Food I have divided details of this important branch of the work 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 10 Persons registered as distributors of milk 203 Licences, for five year period ending 31.12.70 in operation at end of year- Pasteurisers 1 Sterilisers 1 Pasteurised (Dealers) 149 Sterilised (Dealers) 131 Untreated (Dealers) 31 Ultra Heat Treated (Dealers) 42 Ice Cream - Premises on register for manufacture and/or storage and sale of ice cream 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 336 Hawkers - Hawkers of food, and premises used for the storage of such food, on register (b) Sampling: (i) Food and Drugs - A total of 328 Food and Drugs samples were purchased during the year, and i only four of these were found to be unsatisfactory. 123 Routine sampling is regularly carried out to check upon the great variety of Food and Drugs on the market today. (ii) Bacteriological - Water Supply: Four 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 ant those in our schools were taken in order to ensure that they were suitable for the purpose of swimming. A total of 48 samples were taken during 1968 and all were found satisfactory. The purchase of the Lovibond comparator water test kit in 1968, which has enabled the Public Health Inspectors to carry out immediate bath-side checks, has already proved of considerable value with a worthwhile financial saving in respect of the preliminary investigations made. Ice Cream: Samples of ice cream were taken. These were largely from itinerant traders, for very obvious reasons. During 1968, 24 samples were submitted for examination, all of which proved satisfactory. Results were as follows:— No. of Samples Ministry of Health Provisional Grade % of Total 19 I 78 2 II 9 3 III 13 24 100 Milk: 36 samples of milk were talen from schools, milk-roundsmen and vending machines. All were found satisfactory. (c) Inspection of Food: The constant inspection 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. With the growth of "container* food traffic from the continent, the duties of the Public Health Inspectors under the Imported Food Regulations is likely to increase. Inspections previously carried out by Port Health Inspectors are now being carried out at the destination of the "container", usually a wholesale food depot. The large quantities and varieties of food dealt with as unfit for human consumption are enumerated in Appendix 24. 124 In one case a quantity of meat and chickens were found stored for sale in o retail shop in an unfit condition. The food was seized by the Inspector and condemned by a Justice of the Peace. Insubsequent proceedings fines totalling £92.0s.0d. and £10.10s.Od. costs were imposed at Barking Magistrates Court. During the year 60 complaints concerning food were received, mainly relating to the presence of a foreign body. Of these 10 cases were submitted to the Public Analyst for report. In 37 cases details were submitted to the Health Committee by the Town Clerk. Letters of warning were sent in 9 of these cases, and legal proceedings taken in 13 cases, which resulted in lines totalling £113.0s.0d. and costs £44.13s.0d. being imposed by the Magistrates. (d) Inspection of Premises, Hawkers, etc. The enforcement of the Food Hygiene Regulations has received regular attention during the year and 2,955 inspections were made for this purpose. Informal action was taken in 125 instances to secure compliance with the Regulations. In 8 contraventions, proceedings were instituted and convictions were obtained. 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 Number of premises fitted to comply with Regulation 16 Number of premises to which Regulation 19 applies Number ol premises titled to comply with Regulation 19 Cafes and Restaurants 263 261 263 263 Factory Canteens 67 66 67 66 Butchers' Shops 148 144 148 147 Grocers' Shops 304 303 304 304 Fruiterers' and Greengrocers' Shops 156 - _ _ Fishmongers' and Fishfryers' Shops 72 72 72 72 Bakehouses 18 17 18 18 Bakers' Shops 62 61 62 62 Confectioners' Shops 271 _ _ _ 1,361 924 934 932 The Merchandise Marks Acts 1887-1953 These Statutes afford protection to the public by prescribing trade descriptions regarding the stipulated standards of quality, quantity, materials, strength, performance etc., of goods and foods, the latter. 125 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. Diseases of Animals The disastrous Foot and Mouth epidemic of 1967 which affected 2,364 farms and caused the destruction of 430,000 cloven-hoofed animals (a greater total than the combined totals of the 5 worst Foot and Mouth epidemics previously experienced in Britain), and which cost the Government more than £30 million to fight and in compensation and which together with uncompensated losses suffered by farmers and those who serve them is estimated by some to have brought the total cost to at least £150 million, fortunately petered out early in the year and only three Movement Licences were issued before all restrictions imposed by the Control Order were lifted on the 14th February 1968. The movement of swine progressed without the necessity of issuing any licences during the year. To prevent the spread of Animal Diseases all pig swill and similar waste must be effectively sterilised under the Diseases of Animals (Waste Food) Order 1957. Four premises having the necessary properly constructed equipment were licensed for this purpose. Slaughterhouses Slaughter of Animals Acts 1933-195 4 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 10 premises at present on the register and one establishment has been licensed for the manufacture of those commodities as required by this Act. Three samples of filling materials were obtained and submitted to the analyst during 1968. All proved to be satisfactory. Fertilizers and Feeding Stuffs A Statutory Declaration showing the exact composition of Fertilisers and Animal Feeding Stuffs is required by the 1926 Act. iPrepacked articles supplied by manufacturers have the necessary information 126 printed on or enclosed in the packet, in other cases the declaration is given by the retailer from information supplied by the maker. During the year 9 samples of Fertiliser and 2 of Feeding Stuffs were purchased, of which 2 samples of Fertiliser (prepacked) and 1 of Feeding Stuffs (bulk) were found unsatisfactory. Inquiries made of the Manufacturers showed the fertilisers to be old stock, whilst inquiries made regarding the bulk feeding stuff showed it to be stock acquired 18 months beforehand by the new owner of a retail shop from the original owner, no details as to the manufacturer were available. The remaining stock (20 lbs.) were destroyed at the owners request. 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 178 applications for renewal of entry on the Statutory register, whilst 5 new applications for registration were investigated and found satisfactory. A total of 390 visits were made during the year. Establishments for Massage and Special Treatment Another duty discharged by the Public Health Inspectors relates to the examination of Establishments set up for massage and special treatment under Part IV, Essex County Council Act, 1933. These premises are visited annually and 5 new applications for a licence were approved by the Council, and 41 licences were renewed during 1968. Hairdressers and Barbers Establishments 73 inspections were made of these premises during the year, and no action was found necessary. The Pet Animals Act 1951 20 establishments were licensed during the year under the provisions of the above Act, which ensures that Animals kept, stored or sold as pets by way of business are cared for in a humane and healthy manner. All the establishments were well administered and random visits found no contraventions to the Act. Animal Boarding Establishments Act 1963 Three premises were licensed during the year and periodic inspections found them well maintained. 127 Riding Establishments Act 1964 All premises requiring licences under the above Act are inspected by a Veterinary Surgeon prior to consideration of the application. Subsequent inspections are made by Inspectors. Three licences were granted during the year. National Assistance Act 1948 Section 50 During 1968, the burial and cremation of five 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. Land Charges Act 1925 Regular enquiries are received and searches carried out to ascertain any outstanding notices or charges on properties arising from the operation of the various Acts and Regulations with which the Department is concerned. 5,935 enquiries were so dealt with during 1968. Training of Went Public Health Inspectors As the need for Public Health Inspectors increases so must more Pupil Public Health Inspectors be educated to discharge the onerous duties imposed on these officers by various statutes. The Redbridge Borough Council is playing its part in fulfilling the request of the working party and the training qualifications and duties of Public Health Inspectors and the Ministry of Housing and Local Government by appointing four Trainee Public Health Inspectors and accepting two other students from the London Borough of Hackney at that Authority's expense, for training within the Environmental Department of Redbridge. This work entails a four year course and the passing of a Part I and Final Examination. Trainjng is of a twofold nature, partly theoretical, at a recognised Training College and the practical aspects undertaken within the Environmental section of the Redbridge Borough Council. Their work is strictly supervised and both the aspects of the work are inculcated in the students by practical visits accompanied by qualified inspectors with sessional talks and discussions by the Senior Public Health I nspectors. The standard of Pupil Public Health Inspector now presenting himself for training is improving yearly, some of them possessing 7 or 8 "0" level certificates, some even having "A" levels. Once such students are accepted in Redbridge, this type of pupil furthers his laudable 128 object of improving the general standard of Public Health Inspectors of the future. Three of the four students employed by Redbridge Council are on 4-year courses. Two of these students have successfully passed their intermediate examinations at the first attempt, the third student is completing his first year training and sits a terminal examination in June, 1969. 129 APPENDIX 20 PREVENTION OF DAMAGE BY PESTS ACT 1949 Type of Property NonAgricultural Agricultural 1. Number of Properties in district 91,273 30 2, (a) Total number of properties (including nearby premises) inspected following notification 1,295 - (b) Number infested by (i) Rats 798 - (ii) Mice 189 - 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 21 HOUSING STATISTICS 1. Inspection of dwelling-houses during 1968: (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 5,966 (b) Number of inspections made for the purpose 11,436 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were ted 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 62 (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 418 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 339* 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 1 (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 101 (2) Number of dwelling-houses in which defects were remedied after service of formal notices — 73* (a) By owners (b) By local authority in default of owners - 131 APPENDIX 21 (continued) C. Proceedings under Section 17(1) of the Housing Act, 1957- (1) Number of dwelling-houses demolished as a result of formal or informal procedure - (2) Number of dwelling-houses closed in pursuance of an undertaking given by the owners and still in force — D. Proceedings under Section 18 of the Housing Act, 1957 — Number of separate tenements in respect of which Closing Orders were made 5 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 (iii) Number of persons (units) dwelling therein 19 (b) Number of new cases of overcrowding reported during the year 3 (c) (i) Number of cases of overcrowding relieved during the year 3 (ii) Number of units concerned in such cases 15 (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 condition s upon which the Medical Officer of Health may consider it desirable to report - *Includes compliances during 1968 of Notices served prior to 1st January, 1968. 132 APPENDIX 22 133 APPENDIX 23 FACTORIES ACT 1961 PART 1 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 134 106 1 - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authorities 697 583 31 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises 51 79 1 - T otal 882 768 33 - 1 Cases in which DEFECTS were found. (If defects are discovered at the premises on two, three or more separate occasions they should be reckoned as two, three or more "cases"). Particulars (1) Number o( cases in which delects were found Number of cases in which prosecutions were instituted (6) Found (2) Remedied (3) Referred To H.M. Inspector (4) By H.M. Inspector (5) Want of cleanliness (S.l) Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — _ — _ Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) — (a) Insufficient 2 2 — 1 — (b) Unsuitable or defective 32 22 — 6 — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Out-work) - - - - - Total 34 24 - 7 - 134 APPENDIX 23 (continued) PART VIII OF THE ACT OUTWORK (Sections 133 and 134) Nature of Work (1) Section 133 Section 134 Number of out-workers in August list required by Section 133(1 )(c) (2) Number of cases of default in sending lists to the Council (3) Number of prosecutions for failure to supply lists (4) Number of instances of work in unwholesome premises (5) Notices served (6) Prosecutions (7) Wearing apparel — Making etc 128 - - - - - Cosaques, Christmas stockings, etc 43 - - - - - Making of cardboard boxes 11 - - - - - Total 182 - - - - - APPENDIX 24 ARTICLES OF FOOD SURRENDERED AND CONDEMNED AS BEING UNFIT FOR THE FOOD OF MAN DURING 1968 DESCRIPTION QUANTITY DESCRIPTION QUANTITY Bacon 391 lbs. Meat (fresh) 4 tons 4 cwts. Beverages 69 tins Meat (tinned) 1 cwt. 3 qrs. Biscuits 178 lbs. Meat (pies) 48 pies Butter 148 lbs. Margarine 247 lbs. Cereals 214 lbs. Milk (tinned) 209 tins Cream 92 tins Pickles 81 jars Eggs (shell) 4 gross Poultry 130 lbs. Fish (wet and dry) 202 stone Salt 14 lbs. Fish (tinned) 623 tins Sausages 74 lbs. Fish (paste) 20 jars Sugar 166 lbs. Fruit (tinned) 3,990 tins Soups (tinned) 1,264 tins Game 70 lbs. T ea 97 lbs. Jam (preserves) 315 lbs. Tomatoes 45 lbs. Jellies 17 Vegetables (tinned) 722 tins Lard 98 lbs. Vinegar 12 bottles WELFARE 135 WELFARE SERVICES (R.W. Hall, Chief Welfare Officer) The long awaited Seebohm report with its implications of radical change in our social service has been published but has been received with caution in view of the multiplicity of other associated papers and reports in connection with health, welfare, hospital services and committee structures. The report from the London Boroughs Management Services Unit which probed our organisation and methods has also been received, some useful suggestions having already been implemented to provide a more effective service within the Health and Welfare Department. In this time of radical change, one wonders if too much emphasis is being placed on reports, green papers and reorganisation, but the welfare staff has always in mind its prime responsibility; and responsibility to the client in the community. With the limited resources available in our present times of financial stringency however, any genuine endeavour to streamline and co-ordinate effective action within the Social Services is as welcome to the Welfare Services as it is to those who ultimately depend on the services, the less fortunate members of our community. Social Work Staffing The year in review has been a period of intensive reorganisation for the social casework services of the Welfare Department. For some time it had been apparent that the developing service with its personal approach was being subjected to intense pressures. It is a fact of social work that as soon as a beginning is made in seeing the needs of individuals in the context of their personal situation, the complexity of the problems revealed creates a need for more workers with more skill and lower case-loads. This has certainly been the experience of the Department's social workers for as the quality of service improved it was seen to be cumulative in effect and loading to an increased demand on their services. To meet these demands without a lowering of hard-won standards was clearly impossible unless additional professional support could be provided. Early in the year a Principal Social Worker was appointed to be responsible for the organisation and direction of the social work section and to give professional guidance to the field workers. To support him in this task, three Assistant Principal Social Workers were appointed to act as Team Leaders and assume responsibility for social welfare services in geographical areas of the Borough. The filling of these senior 136 posts by professionally qualified staff with wide experience of social services has made a significant contribution to the functioning of the Department and enabled the social workers to offer a more comprehensive service to the community. Staff in Post on 31 st December 1968 Senior Social Workers Social Workers Trainee Sociol Workers Whole Time Part Time (a) Professionally Qualified 4 2 — _ (b) Declaration of Recognition of Experience of the Council for Training in Social Work 1 1 - - (c) Basic qualification only, viz: university degree, diploma or certificate in social science - 1 1 - (d) Home Teachers Certificate of the College of Teachers of the Blind - 5 - - (e) Seconded for professional training to two-year Certificate in Social Work Course - 1 - 1 (f) Other officers - 5 - 1 Total 5 15 1 2 Organisation To facilitate better local contact and further closer irelationships with other community workers, the social work section has been divided into three teams serving geographical areas of the Borough. These area teams are each led by an Assistant Principal Social Worker with the Principal Social Worker, who has overall responsibility, co-ordinating their efforts. In addition to the Team Leader, each team has been allocated five social workers with the appropriate knowledge and skill to undertake any necessary casework and so far as is possible provide on effective family orientated social work service. In addition to domiciliary work the teams liaise closely with the hospitals, old people's homes and other establishments in their area. Plans are well advanced to integrate the existing social work departments of King George Hospital and Chadwell Heath Hospital into the community based services. Subject to financial agreement between the Hospital Management Committee and the Council it is hoped to operate this scheme as from the 1st April 1969. 137 In the light of the subsequent recommendations of the Seebohm Committee, it would appear that the decision to reorganise the social work section on an area team basis was a correct one. Seebhom's proposals relating to the organisational structure of a social service department, envisage the setting up of area teams serving populations of about 50,000— 100,000. They recommend at least 10 — 12 social workers per team but this would of course include child care and mental health workers. Population was not the only considerating in determining the team areas, account had also to be taken of the differing patterns of need arising from variations in age distribution, social composition and other factors. Additional to the team structure, it has been possible to deploy a senior social worker to the vital task of liaising with the local voluntary organisations and the various charities. This particular social worker, who has worked in the Redbridge area for many years and brings a wealth of local knowledge and experience to the post, is also concerned with the visiting and registration of private homes for the elderly. AREA TEAMS - Population (1966 Census) (1) NORTH-EAST TEAM: Aldborough 14,940 Barkingside 14,270 Fairlop 17,400 Hainault 15,860 Park 11,720 74,190 (30%) (2) SOUTH TEAM: Chadwell 17,690 Clementswood 11,620 Goodmayes 12,810 llford 11,430 Mayfield 13,460 Seven Kings 14,150 81,160 (33%) 138 (3) WEST TEAM: Bridge 16,370 Clayhall 13,540 Cranbrook 15,690 Snaresbrook 13,770 Wanstead 14,960 Woodford 16,130 90.460 (37%) 245,810 (100%) T raining In September 1968, one of the unqualified social workers and one of the two trainee social workers were seconded to the two year full time certificate for social work course at Barking College of Technology. The secondment of staff for full time training depletes the effective strength of the social work section but is essential if the department is to achieve a qualified service. Ideally, locum appointments should be made to fill the gaps but in the prevailing economic climate, this does not seem possible. In reality it has meant higher case loads for already overburdened staff with consequent dilution of available resources. The importance of learning to apply knowledge and to develop skill in practice is an integral part of social work education. To achieve this universities and colleges concerned with the professional training of social workers place their students in selected social agencies where professionally qualified social workers are available to undertake practical casework teaching. Since the inception of the Borough in 1965, the Welfare Department has been host to many students of social work and other disciplines who wished to observe the working of the various services provided by the department. Until recent times though, because of the shortage of trained social workers, it was not possible to offer professional casework placements. However, as the department has now recruited several professionally qualified social workers with experience of field work teaching, it is now feasible to accept social work students from local colleges for extended professional placements. Participation in student training can make a significant contribution to the department's development. Apart from contributing to the pool of qualified social workers, the department could benefit in many ways from providing student placements. The knowledge and skill of the student supervisor is usually increased through teaching and contact with others concerned with student teaching. The presence of students is often a most useful stimulus to the work of the department. The 139 freshness of their viewpoint often results in questions being asked that have not been asked before, while the attempt to explain what is being done results in new formulations of problems and their possible solutions. Possibly the most important gain is in future staffing as some students are unsponsored by Local Authorities and consequently free to accept offers of employment on completing training. A department that takes students and provides them with a professionally stimulating experience rarely has difficulty in finding new staff of high quality or retaining those who come to them. Experience has shown that close involvement with student training is good for staff morale and considerably improves a department's standards. Services for the Handicapped From the statistics it can be seen that the number of physically handicapped on the register has again increased this year by 14% to 1,030. This is reflected by an increase in the number of aids and gadgets issued and whilst the number of adaptations to premises remains numerically the same there has been a greater proportion of major adaptations such as construction of ground floor toilets and shower units. In our endeavours to publicize the needs of the handicapped the Borough again took part in the National Help the Disabled week in conjunction with the Redbridge Association for the Handicapped arranging among other events a local church service at St. Laurence's, Donnington Road, and an exhibition of Aids for the Disabled at Congregational Church Hall, Woodford Avenue, Gants Hill. Our need for local expansion of Occupational Centre activity is again emphasised by an increase in the numbers on the waiting list and the fact that many handicapped who would benefit by daily attendance are restricted to two days per week only at Fellowship House. The high quality of goods produced is however reflected by the fact that Christmas sales produced over £100. The number of deaf and blind on our registers remains fairly constant as does the weekly attendance at the Deaf Club held at Fullwell Cross Day Centre. 1968 was the centenary year for the R.N.I.B. the occasion being marked by the issue of £1 gift vouchers to all registered blind persons. This Authority avails itself of many R.N.I.B. services including re-habilitative workshop and holiday facilities for the blind. For severely disabled drivers in the Borough eighty car badges were issued and our scheme extended to allow the drivers to park free of charge at parking meters in addition to the specified off-street parking areas. 140 In our endeavours to assist voluntary organisations the Authority agreed that its specially adapted vehicles be made available to them whenever possible. One vehicle is now regularly used by a club for the physically handicapped and vehicles are frequently borrowed for outings and shopping expeditions. Financial conditions have somewhat curtailed expansion of activities for the handicapped but it is hoped that deferred projects will be resumed when the national economic situation improves. Homes for the Elderly Ideally one would wish to see our senior citizens living in their own homes within the community supported by adequate domiciliary services. Even if domiciliary services were expanded to an optimum level however .it is apparent that the need for Council Homes for the elderly would still exist. At present the elderly who cannot cope alone are catered for to a limited extent in the Housing Department's supervised flatlets. The Geriatrician with a limited number of hospital beds endeavours to cater for those elderly who are in need of hospital care. Between these two categories the welfare services provides for those who are "in need of care and attention" but not in need of hospital care. We are indebted to the Housing Manager and the Hospital Geriatrician for their invaluable co-operation and exchanges are effected between the three categories of accommodation but the interpretation of "in need of care and attention" has considerably widened since 1948. An increasing proportion of residents in Council Homes are becoming confused in mind presenting a fourth category - the Elderly Mentally Infirm who cause some distress and concern to both residents and staff. To meet this problem new EMI units are being developed within our existing homes and a new EMI home is planned at Mossford Green. At the same time we are planning self involvement of the more active residents in our homes. The circle has been completed from old harsh poor law institutions to our present sheltered hotel type homes for the elderly but one would not wish to see this sheltered existence developed to such an extent that the resident loses his sense of individuality and purposeful life. Our residential homes staff are co-operating in both these growing fields of activity and far from being subjected to "sans everything" type of publicity, it is felt that they should be congratulated for their willingness and devotion in care for the efderly often under adverse conditions. Day Centres for the Elderly An additional Day Centre opened during the year at Aldborough Road which although small, soon developed an extremely good atmosphere and is well attended. Meals are now provided at all 4 Day 141 Centres and it is hoped to increase to a five day meals service at all Centres during 1969. Although no structural organisation of activities has been introduced, inter-centre competitions have developed, theatre outings, socials and dances have been arranged and old time dancing classes at two of the centres have proved to be extremely successful. The increasing popularity of such day centres confirms the importance of their role in services for the elderly within the community. Transport is still provided for the handicapped elderly who benefit from day centre attendance and it is hoped that this aspect of day care can be developed during the coming year. Holidays for the Elderly This Service still continues in popularity despite the fact that for the first time this year it was deemed financially necessary to request contributions at the rate of £2.8s.0d. per single person and £3.8s.0d. for for a married couple. A choice of camps was offered between St. Margaret's Bay, Dover (in May) and Corton Beach, near Lowestoft (in September). Despite the cold spell at the beginning of the May holiday, and the torrential rain during the first weekend at Corton Beach, it was apparent from the volume of letters of appreciation received that the holidays were greatly enjoyed. Following last year's success, it was decided to include some seventy physically handicapped people with the elderly this year which entailed an increase in the number of escorts to cover the additional care involved. The fact that many of the escorts have had experience on previous holidays arranged by the Authority ensured success in our endeavours to cater for those elderly and handicapped in the community who otherwise would not have been able to enjoy a holiday. It is significant of the need that exists that applicants have to be restricted to one holiday every other year. Meals on Wheels The service has again expanded and there are now approximately 240 people receiving meals up to 4 days a week in the llford part of the Borough which is operated by paid staff assisted on 3 days per week by the W.R.V.S. manning one vehicle. In the Wanstead and Woodford part of borough the service is operated wholly by the W.R.V.S. where approximately 40 persons receive meals. Owing to the financial climate it was not possible to provide a full five day service as originally intended, however this is planned to commence during the next financial year. The Good Companions again paid for the Christmas meal in the llford part of the borough and members of the office staff delivered 142 meals from one of our Old People's Homes on the three days over Christmas when the Town Hall kitchen was closed. Temporary Accommodation Under Section 21 of the National Assistance Act, it is the duty of the Local Authority to provide temporary accommodation for families who are rendered homeless through "circumstances which cculd not reasonably have been foreseen". Until recently the provision of temporary accommodation by Redbridge was a fairly self-contained problem in comparison with the large numbers involved in the majority of inner London Boroughs. In conjunction with the Redbridge Housing Deportment, plans were evolved to meet the needs of the less fortunate Redbridge families in a humanitarian fashion and to cater for the replacement of units no longer available at Suttons Hostel, Hornchurch. It is to be regretted that the London Squatters Association and the intricacies of the law of trespass should bring even more problems to those families who were unfortunate enough to be brought into the Borough by the Squatters Association. Whilst giving due credit to the Squatters Association for their apparent concern for homeless families in general, it is cause for concern that homeless families in particular in Redbridge are victims of further anxiety occasioned by squatting activities. Health Services & Public Health Act, 1968 This Act which received the Royal Assent on the 26th July, 1968, makes amendments connected with the Local Authorities Services under the National Assistance Act 1948 enabling Local Authorities to extend their services for the Elderly in a number of directions, including the use of Private Homes for the accommodation of Elderly Persons in need of care and attention. Before the Government authorises the introduction of some of the new services provided for under the Act, Local Authorities have been requested to investigate the needs of the Elderly and in this connection the survey of people over 75 years of age residing in the 11 ford part of the Borough will be invaluable. With regard to the use of Private Homes, the Council agreed to seek an amendment to their Scheme under the National Assistance Act, 1948 and it is unfortunate that at the time of going to press authority has not yet been received from the Secretary of State to this amendment, therefore, arrangements can not yet be made for the care of old people in Private Homes, which would relieve the pressure to some extent on the Council's Residential Homes for the Elderly. Voluntary Organisations The year has been marked by developing good relations with Voluntary Organisations and in this connection mention should be made of 143 Miss G. Venning, Senior Social Welfare Officer, who has been given specific responsibility for liaison with such Organisations. It is of great value to the Borough that the Redbridge Council of Social Service seems to have been revitalised with the appointment of Mr. George Osborne as Organizing Secretary and much useful work is done between us. Redbridge Association for the Handicapped is growing in strength and developing a close link with every handicapped person in the Borough, particularly those who are isolated because they do not belong to a specialist Association and this Association receives much support from members of the Welfare Service staff. In a Borough such as ours, with a small purse, it is essential that the Service be administered as economically as possible and comparative figures from other Authorities show that this is indeed the position. Whilst there will be a continuing need to develop services and spend money on Capital Projects, it is very important that we should keep in mind the need to involve all members of the community in the Welfare Services a/id so provide a better service at a reasonable cost. 144 APPENDIX 25 LIST OF PREMISES (Local Authority) Old People's Homes Name Address No. of Places Superintendent/Mtron Heath Gate Chadwell Heath Lane, Chadwell Heath, Romford. 60 Mr. & Mrs. J. Luckett Hyleford 1 Boundary Close, Loxford Lane, llford. 64 Mr. & Mrs. J.P.W. Jordan Pegram House Longhayes Avenue, Marks Gate, Romford. 50 Mrs. J. E. Fisher Rose Park Heathcote Avenue, Clay hall, llford. 60 Mr. & Mrs. D. Church Woodside 597 High Road, Woodford Green. 15 Mrs. A. Hopkins Temporory Accommodation 34/36 Grosvenor Rood, 11 ford. No. of Places Approx. 5/6 families Supervisor Mrs. M. Digby Persons Resident as at 31.12.1968 Family Units Men Women Children 1 Nil 1 2 1 1 1 3 1 1 1 2 Totals: 3 2 3 7 Occupational Centre Fellowship House, Green Lane, 11 ford. Day Centres (Local Authority) No. on Register as at 31.12.1968 80 Supervisor Mrs. R. Low Name Aldborough Road Day Centre Fullwell Cross Day Centre Goodmayes Day Centre Scrafton Road Dav Centre Address Aldborcugh Road, Seven Kings. Fullwell Cross, Fairlop. Broomhill Road, Goodmayes. Scrafton Road, llford. Organiser of L.A. Day Centres Mrs. G. Wilson 145 APPENDIX 25 (continued) Day Centre (Voluntary) Name Grove Pork Address 2 Grove Park, Wanstead. (Managed by Wanstead and Woodford Old People's Welfare Association) List of Homes (Private) Nome Address No. of Places (Male & Female) Telephone No. ArdenHouse 40 Emerson Road, llford. 20 male & female 554-6198 Arlington Residence 12 Snakes Lane, Woodford Green. 18 females 504-1970 lor Elderly Ladies Belmont 66 Derby Road, South Woodford, E.18. 13 females 504-5712 Greenholme 29 The Avenue, Wanstead, E.11. 22 blind male & female Chelmsford 52560 Homesdale 7 New Wanstead, Wanstead, E.ll. 16 females 989—0847 Osmont 8 Grove Park, Wanstead. 28 females 989—4955 106 Aldborough Road, Seven Kings. 7 females 590-3164 24 Glengall Road, Woodford Green. 8 handicapped males & 505—0408 females 6 Snakes Lane, Woodford Green. 10 handicapped males & 504-0448 females 29 & 31 Valentines Road, llford. 24 males and females 554—2287 Glengall Eventide 5 Glengall Road, Woodford Green. 12 females 505-0121 Home the Chestnuts 63 Cambridge Park, Wanstead, E.ll. 35 males and females 989—0250 Cavalier Ltd. 36 Redcliffe Gardens, llford. 12 females 554-2771 Persons in Care (as at 31.12.1968) Borough Homes 240 Out-Borough Homes 132 Voluntary Homes 105 477 (The Willows-26) 146 APPENDIX 25 (continued) Age Structure of Residents in Part III Accommodation: Establishment Under 65 65 to 74 75 to 89 90 years & over Totals Average Ages Hyleford 1 4 10 nil 15 60 Average age male 77 Male Female 3 3 29 10 45 " female 82 Woodside Female nil 4 10 1 15 Average age female 79 Pegram House 2 3 11 nil 16 50 Average age male 78 Male Female 1 4 23 6 34 " " female 82 Heath Gate 3 nil 14 4 21 58 Average age male 81 Male Female nil 3 26 8 37 " " female 82 Rose Park nil 3 8 3 14] 57 Average age male 81 Male Female nil 4 27 12 43 " " female 84 Average of all males:— 79 Average age of all females:- 81 Average age of all residents, male and female:— 80 Origin of Residents in Part III Accommodation: District Number Percentage IIford Area 171 71% Wanstead and Woodford 43 18% Out-Borough 26 11% Origin of all New Admissions (Permanent and Short-Stay) to Part III Accommodation during the Year (1.1.1968 to 31.12.1968: District Number Percentage llford Area 145 77% Wanstead and Woodford 34 18% Out-Borough 9 5% 147 APPENDIX 25 (continued) Admissions to Part III Accommodation durinq the Year (1.1.68 to 31.12.68): Male Female Total Permanent Admissions 27 53 80 Short-stay Admissions 31 77 108 Permanent Admissions (The Willows) 6 19 25 Short-stay Admissions (The Willows) 2 2 4 66 151 217 Voluntary Organisations to which Grants are paid: Redbridge Council of Social Service Redbridge Old People's Welfare Association Wanstead and Woodford Old People's Welfare Committee Toc H (Warning Lamp Scheme) Essex County Association for the Blind Southern Regional Association for the Blind Essex Physically Handicapped Association llford Physically Handicapped Committee Wanstead and Woodford Association for Physically Handicapped Hainault Association for Physically Handicapped British Epilepsy Association Spastics Society Redbridge 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 Redbridge Deaf Club Redbridge Association of Professional Social Workers Voluntary Organisations to which the Council is affiliated: South East Regional Association for the Deaf Central Council for the Disabled Handicrafts Advisory Association for the Disabled Essex Physically Handicapped Association 148 APPENDIX 26 STATISTICS OF THE PHYSICALLY HANDICAPPED MINISTRY CATEGORIES No. as at 31.12.68 Amputation 45 Arthritis and Rheumatism 381 Congenital Malformations and Deformities 33 Diseases of the digestive and genito-urinary systems; of the heart or circulatory system; of the respiratory system (other than tuberculosis) and of the skin 99 Injuries of the face, head, neck, thorax, abdomen, pelvis or trunk. Injuries or diseases (other than tuberculosis) of the upper and lower limbs and of the spine 125 Organic nervous diseases — epilepsy, disseminated sclerosis, poliomyelitis, hemiplegia, sciatica etc. 331 Neuroses, psychoses and other nervous and mental disorders 5 Tuberculosis (respiratory) 2 Tuberculosis (non-respiratory) 9 Diseases not listed above - Total 1,030 Deaf and Hard of Hearing: Deaf with speech 76 Deaf without speech 41 Hard of hearing Total 174 Blind and Partially Sighted: Blind 384 Partially sighted 161 Total 545 149 APPENDIX 27 AIDS ISSUED TO PHYSICALLY HANDICAPPED PERSONS Description of Aid: No. issued (including reissued) Bath aids 156 Toilet aids 53 Walking aids 69 Chairs 5 Tables 8 Hoists 7 Small miscellaneous aids 77 Total 375 APPENDIX 28 HOLIDAYS FOR THE PHYSICALLY HANDICAPPED Hotel or Holiday Camp: No. of Persons 1.1.68-31.12.68 British Rheumatism and Arthritis Association (Margaret Pinder House) 2 Cheshire Homes (Seven Rivers, Colchester) 2 Corton Beach Holiday Camp (Council organised) 41 St. Margarets Bay Holiday Camp (Council organised) 26 Essex Physically Handicapped Association 33 Grants 6 Jewish Association for the Physically Handicapped (Bournemouth) 7 Private arrangements 6 Queen Elizabeth Foundation for the Disabled (Lulworth Court) 6 Shaftesbury Society 2 Westbourne Lodge Guest House (Clacton) 19 Southdene Guest House (Ramsgate) 20 WRVS Crabhill House, Redhill 8 WRVS Grange Farm, Chigwell 15 Transport only 4 Total 197 150 APPENDIX 29 HOLIDAYS FOR THE BLIND AND PARTIALLY SIGHTED Hotel or Holiday Camp: No. of Persons 1.1.68 -31.12.68 Corton Beach Holiday Camp (Council organised) 6 Essex County Association for the Blind (Frinton) 3 Ilford Blind Welfare Association (Cliftonville) 11 Westbourne Lodge Guest House 5 Southdene Guest House 1 Total 26 APPENDIX 30 HOLIDAYS FOR THE ELDERLY Council Organised: No. of Persons Elderly Escorts May, 1968— St. Margarets Bay Holiday Camp 364 92 September, 1968— Corton Beach Holiday Camp 321 29 685 44 APPENDIX 31 MEALS ON WHEELS As at 31.12.68: ilford area (administered by Dept.) Wanstead & Woodford area (W.R.V.S.) Average number of meals delivered per week 925 140/160 Average number of recipients 240 35/40 Total number of meals delivered during year ending 31.12.68 37,018 8,055 151 APPENDIX 32 MEALS AT DAY CENTRES Days provided per week Commenced Total No. Aldborough Road 4 10. 9.68 816 Fullwell Cross 5 All year 11,841 Goodmayes 3 18. 6.68 2,313 Scrafton Road 2 4.12.68 111 15,081 Grove Park (Voluntary) — 19,305 152 INDEX Page No. Accidents 13 Adult Training Centre 95 Animal Boarding Establishments Act, 1963 126 Anti-Smoking Campaign 55 Atmospheric Pollution— Clean Air Act 115-119, 132 At Risk Register 29-33 B.C.G. Vaccinations 80 Births 29 Blindness 139 Bronchitis 13 Cancer, Lung and Bronchus 12 Care of Mothers and Young Children 28 Causes of Deaths 18 Cerebral Palsy Unit 71 Cervical Cytology 44, 45 Child Guidance 71, 72, 91 Child Minders 34 Children at Risk 29-33 Chiropody Service (including School Health) 42, 43, 51, 81 Clean Air Act— Smoke Control Orders 115-119, 132 Clearance Areas112-114 Clinics and Treatment Centres 48 — Child Guidance 71, 91 — Dental 33, 34 – E.N.T 67 – Enuresis 75-78 — Minor Ailments 63 – Ophthalmic 63-65 – Orthopaedic 65-66 — Orthoptic 65 – Premises 48 — Speech 67 Congenital Abnormalities 49 Convalescent Treatment 42 Coronary Disease 12 Day Centres 140, 141, 144, 145, 151 Day Nurseries 34, 49 Deaf Welfare 139 Deaths and Causes 18 Deaths Rates 17 Dental Health Education 55, 60 153 Page No. Dental Treatment (including Schools) 33, 34 Department of Education and Science- Statistical Tables 82-92 Diseases of Animals (Waste Food) Order, 1957 125 Diseases of Animals (Movement Orders, etc.) 125 Diseases (notifiable) 14 Disinfection and Disinfestation 109 Drainage and Sewerage 102-104 Dysentery 11 Ear, Nose and Throat Clinic 66, 67 Education Committee 2 Enuresis 75—78 Environmental Health 99—134 Epidemiology 11—18 Ethel Davis School (Physically Handicapped) 69—71 Factories and Workshops 121-124, 133, 134 Female Cancers 13, 44, 45 Fertilisers and Feeding Stuffs Act, 1926 125, 126 Fluoridation 6 Food and Drugs Sampling 108,122 Food Hawkers 122, 124 Food Hygiene 124 Foods, Fitness and Consumer Protection 122—124 Food Poisoning 11 Food Preparation-Premises 122-124 Food Surrendered 134 General Services 19—24 General Welfare and Research (School Health) 80, 81 Geriatric Clinic 45, 46 Group Practice Attachment 7, 37, 41 Gypsies and Other Travellers 114,115 Hairdressers and Barbers Establishments 126 Handicapped Children 79, 92 Health Committee 1 Health Centres 7, 25 Health Education (including Schools) 53—60 Health Services Clinics 48 Health Services and Public Health Act 1968 142 Health Visitors and School Nurses 36—40, 50, 80 Hearing Tests 36 Holidays for the Blind and partially sighted 150 Holidays for the Elderly 141,150 Holidays for the Physically Handicapped 149 154 Page No, Home Help Service 46,47 Home Laundry Service 110 Home Nursing 40, 41 Home Safety 37, 55 Homes for the Elderly 140, 144, 145, 146, 147 Hospital Admissions - Mentally III and Mentally Handicapped 97 Hostels for Mentally Handicapped 7 Housing 112-114, 130, 131 Housing Allocation—Medical Grounds 19-20 Ice Cream 122, 123 Illegitimate Births and Deaths 10 Immigrants-Long Stay 110 Immunisation and Vaccination 41, 42, 50, 51 Infant Mortality 10 Infant Welfare Centres 48 Infectious Diseases 14, 109, 110 Influenza 11 Inspections and Supervision of Food 122-124 Junior Training School 93-95 Land Charges Act 127 Laundry Service for the Aged Incontinent 110 Litter Act, 1958 109 Live Births 10 Loan of Sick Room Equipment 42 Lung Cancer 12 Massage and Special Treatment Establishments 20, 23, 126 Mass Radiography 16, 20 Maternal Mortality 10 Meals on Wheels 141-142, 150 Measles 12 Meat and Other Foods - Inspection and Supervision 122-124 Medical Examination of Staff 21 Medical Inspection at Schools 62 Mental Health Hostel 95 Mental Health Service 93-97 Merchandise Marks Act 124, 125 Midwifery 35, 36 Milk 122-123 Minor Ailments 63 Multiple Occupation 114 155 Page No. National Assistance Act, 1948 135 Notional Assistance Act, 1948-Section 50 127 Notional Health Service Act, 1946 25-51 Neonatal Mortality 10 Noise Abatement Act, 1960 110, 111 Notifiable Diseases 14 Nurseries and Child Minders Regulation Act 34 Nursing Homes 21 N.S.P.C.C 80 Observation Register 29—33 Occupational Centre 139 Officers of the Health and Welfare Department 3-4, 89 Offices, Shops and Railway Premises Act, 1963 119—121 Ophthalmic Clinics 63-65 Orthopaedic Clinics 65, 66 Orthoptic Clinics 65 Overcrowding 114 Paratyphoid Fever 11 Partially Sighted 139 Peripatetic Teachers of the Deaf 78, 79 Personal Health Services 7 Pests 111, 112, 129 Pet Animals Act, 1951 126 Pharmacy and Poisons 126 Physically Handicapped 148—150 Physiotherapy 66 Play Group for Mentally Handicapped Children 96 Poisoning—Lead 13 Population 10 Preface 5-8 Prevention, Care and After Care 42 Private Day Nurseries and Child Minders 34 Public Baths 106 Public Conveniences 105 Rog, Flock and Other Filling Materials, etc. 125 Rainfall 10 Rots and Mice 111, 112, 129 Recuperative Holidays 63 Refuse Collection and Disposal 104, 105 Rehabilitation Centre 96 Remedial Exercises 66 Renal Dialysis 42 Research 80 156 Page No. Residential Accommodation for the Elderly 140, 145-147 Riding Establishments Act, 1964 127 Rivers and Streams 101-102 Sanitary Inspection of the Area106-109 School Dental Service 68, 69 School Health Service 61-92 School Nurses 80 School Psychological Service 72-75 School Roll and Premises 61 Screening Tests of Vision and Hearing 62 Services for the Elderly137, 140 Services for the Handicapped 139-140 Sickroom Equipment 42 Slaughter of Animals Act 125 Social Clubs for the Mentally III 95 Social Work 135-139 Speech Clinics 67 Specialist Services 34 Staff 3, 4, 89, 135 Statistics— — Environmental Health 107-109, 129-134 — Epidemiology 14-18 — Mental Health 97 — Personal Health 48-51 — School Health 82-92 — Vital and Social 10 — Welfare 144-151 Street Cleansing 105 Student Public Health Inspectors—Training of 127-128 Suicide 13 Swimming Baths 106 Temporary Accommodation 142, 144 Toddlers Clinic 37 Tuberculosis 12 T.B. Care and After Care 43 T.B. — Notifications, deaths etc 12, 15 Vaccination and Immunisation 41, 42, 50, 51 Venereal Disease 12, 16, 22 Voluntary Bodies 41, 80, 142, 143, 147 Water Supply 101, 102 Welfare Committee 1 Welfare Service 135-151 Whooping Cough 12 Printed by The London Borough of Redbridge, Town Hall, Ilford.