AC 43387 RED 5 LONDON BOROUGH OF REDBRIDGE annual report Medical Officer of Health and Principal School Medical Officer for the Year 1969 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for 1969 I. GORDON, M.D., Ch.B., M.R.C.P. (Lond.), D.P.H. (Edin.) London Borough of Redbridge, Health & Welfare Department, 17-23, Clements Road, llford, Essex. TABLE OF CONTENTS Page No. HEALTH COMMITTEE 1 To November, 1969 WELFARE COMMITTEE 1 SOCIAL SERVICES/CHILDRENS COMMITTEE - From December, 1969 2 EDUCATION COMMITTEE 2 STAFF 3-4 PREFACE 5-7 VITAL STATISTICS AND SOCIAL CONDITIONS 8 EPIDEMIOLOGY 9-17 GENERAL SERVICES 19-25 NATIONAL HEALTH SERVICE ACT, 1946 27-57 HEALTH EDUCATION 59-63 EDUCATION ACT, 1944 65-97 MENTAL HEALTH 99-103 ENVIRONMENTAL HEALTH 105-138 WELFARE 139-161 INDEX 162-166 1 Municipal Year 1969-1970 (to November) HEALTH COMMITTEE Councillor Mrs. G.M. CHAMBERLIN, J.P., CHAIRMAN Councillor J.H. NORWOOD, vice-chairman Councillor I.B. NATZLER, mayor Alderman R.A. DALTON, J.P. Alderman Mrs. L. FALLAIZE, O.B.E., J.P. Councillor Miss M. CLARK Councillor A.J. FOLLOWS Councillor Mrs. V.M. GROSE Councillor Mrs. K.M. HARVEY Councillor A.L.G. LEGGATT Councillor Mrs. M.H. PAIGE Alderman Miss A.S. TERRY, J.P. Councillor J.J.M. SMITH, A.R.I.B.A., M.lnst.R.A.,F.R.S.H. Councillor Miss N.H. THURGOOD Councillor J.A. VANE Councillor A.W. YATES Councillor A. YOUNG, M.A. Co-opted Memten Dr. T.C. MAYER, B,Sc., M.B., Ch.B., M.R.C.S., L.R.C.P., D.Obst., R.C.O.G., M.R.C.G.P. WELFARE COMMITTEE Councillor Mrs. M.H. PAIGE, chairman Councillor Mrs. V.L. WILSON, vice-chairman Councillor I.B. NATZLER, mayor ALderman Mrs. L. FALLAIZE, O.B.E., J.P. Councillor J.D. BILLINGHAM, Dip.Arch., Dip.T.P.,A.R.I.B.A. Councillor Miss M. CLARK Councillor T.F. COBB, A.I.A.C. Councillor A.J. FOLLOWS Councillor W.S. GLOVER Councillor E.F. HARRIS Councillor Mrs. K.E.M. KELLY Councillor A.L.G. LEGGATT Councillor F.C. MOUNTIER Councillor R.W.J. OPEN Councillor Mrs. W.J. ROBERTS Councillor J.A. VANE Councillor K.W. WEBB 2 Municipal Year 1969-1970 (from December) SOCIAL SERVICES/CHILDREN COMMITTEE Councillor Mrs. V.L.WILSON, ch airman Councillor Mrs. G.M. CHAMBERLIN, J.P., vice-chairman Councillor I.B. NATZLER, mayor Alderman Mrs. L. FALLAIZE, O.B.E., J.P. Councillor H.R.B. ALY Councillor J.D. BILLINGHAM Councillor Miss M. CLARK Councillor E.F. HARRIS Councillor Mrs. K.E.M. KELLY Councillor F.C. MOUNTIER Councillor J.H. NORWOOD Councillor Mrs. M.H. PAIGE Councillor A. REYNOLDS Councillor Mrs. W.J. ROBERTS Councillor J.J.M. SMITH, A.R.I.B.A., M.lnst.R.A.,F.R.S.H. Councillor Mrs. A. TOMS Councillor K.W. WEBB Municipal Year 1969-1970 EDUCATION COMMITTEE Alderman D.K. L'ESTRANGE, J.P., B.A., LL.B., F.C.I.S., chairman Councillor O.F. WATERS, J.P., (deputy mayor) vice-chairman Councillor I.B. NATZLER, mayor Alderman Mrs. L. FALLAIZE, O.B.E., J.P. Alderman S.F. LOVELESS Councillor H.R.B. ALY Councillor L.G. BRIDGEMAN Councillor D.A. CARRADICE Councillor T.F. COBB, A.I.A.C. Councillor G.E. DAVIES, J.P., B.Sc. Councillor H.W.G. DEDMAN, B.Comm(Lond.), M.lnst.T., M.B.I.M. Councillor A.G. DIXON Councillor W.5. GLOVER Councillor L.M. bOLDING Councillor Mrs. V.M. GROSE Councillor B.E.R. HAMILTON Alderman Miss A.S. TERRY, J.P. Councillor L.M. HIPKINS, B.A., A.C.C.S., A.M.B.I.M. Councillor N.C.N. HURST Councillor H.J. JACKSON Councillor A.L.G. LEGGATT Councillor Mrs. D.W. ODAM Councillor J. OWEN, B.A. Councillor J.V. SAVAGE, M.A. (CantabJ Councillor J.J.M. SMITH, A.R.I.B.A., M.lns».R.A.,F.R.S.H. Councillor H.J. WATTS Councillor Mrs. V.L. WILSON Rev. A J. ADAMS Mr. J. ANDREWS Mrs. D.E. CARTER Dr. B.H. CHIRGWIN, M.A., Ph.D. Miss R.M. FORDHAM, L.R.A.M. Co-opted Members: Mr. H. GOLDNER, C.Eng., M.I.E.E. 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! M.T. FERNANDES, M.B., B.S., D.P.H., D.I.H., D.C.H., L.M. principal medical officers: W.H. TOMS, M.B., Ch.B. (Edin.) CLAUDE H.A. WEDELES, L.R.C.P. M.R.C.S., D.P.M. (Lond.) SENIOR departmental medical officers: JOANM. POOLEY, M.B., B.S., D.C.H. J.A. HOWELL, M.B., Ch.B., D.P.H. J.K. ANAND, M.B., B.S., B.Sc., L.S.M.F., D.P.H. (from 1.1.1970). departmental medical officers: ELIZABETH A. LITTLE, M.B., Ch.B., (Aber.) M.R. DAS GUPTA, M.B., B.S. principal dental officer: E.V. HAIGH, L.D.S., R.C.S. (Eng.) DENTAL officers: G.H. WILLSON, L.D.S., R.C.S. (Eng.) J.J. BOWE, L.D.S. (Belfast) A.M. GARMAN, L.D.S., R.C.S. (Eng.) SESSIONAL dental officers: R.A. SOAR, B.D.S. Mrs. E. KIMELMAN, M.D. (Vienna^ Y.G. TOOLSY, B.D.S. (Durham) D.O'CONNELL, B.D.S. (Dublin) G. GLOVER-CLARKE B.D.S. (Lond.) (from 1.7.1969). chief public health inspector: S.R. DALY, LL.M., B.Sc., D.P.A. (Lond.), Barrister-at-Law deputy chief public health inspector: J.T.S. TEMPLEMAN, M.A.P.H.I. chief welfare officer: R.W. HALL, A.M.I.S.W. deputy chief welfare officer: C.R. COLE, D.S.S., A.M.I.S.W. health education officer: Miss K.M.E. GRIFFITHS, D.M.E. home help organisers: Miss J.M. PEMBERTON (Senior) Mrs. K. BEDWELL Mrs. E. MARTIN superintendent health visitor: Miss J.M. OLIVER, S.R.N., S.C.M., H.V. deputy superintendent health visitor: Miss E.M.P. COLLINS, S.R.N., S.C.M., H.V. non-medical supervisor of midwives/ superintendent of district nurses: Miss M.A. POTTER, S.R.N., S.C.M. O.I.D.N., H.V. deputy non medical supervisor of midwives and district nurses Mrs. S.M. CHARLTON, S.R.N., S.C.M., O.N. (from 15.10.1969). 4 Officers of the Health and Welfare Department - continued principal mental health social worker: J. HORAK, R.M.N., A.A.P.S.W. (from 1.7.68) assistant principal mental health social workers: Mrs. E.J. THOMPSON, A.A.P.S.W. Miss M.D. BOYD, M.A. (Edin.), A.A.P.S.W. K.W.R. CRANE, D.M.H. (from 3.3.69) principal social worker and case work consultant: F.R. DICKINSON, C.S.W. (to 30.6.69) M. PERRY, C.S.W. (from 11.8.69) assistant principal social workers: W. RUMSBY, C.S.W. Miss J. HILL, A.I.M.S.W. M. PERRY, C.S.W. (to 10.8.69) J.F. NORRIS, C.S.W. (from 27.10.69) chief administrative assistant: D.H. GODWIN, A.R.S.H. principal administrative assistant Miss H.M. NUNN (from 1.4.69) senior administrative assistants: H.R. STANBRIDGE F.W. STREET A.J. HOWLETT 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. Ophthalmologists 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 — Medical Director - W.P. GURASSA, M.D., M.R.C.P. Psychiatrist - H.J. ALTSCHULOVA, M.D. Consultant to the Cerebral Palsy Unit H.B. LEE, F.R.C.S. Orthoptists — Miss M.LEWIS Mrs. J. ASHENDEN Miss L. McCONNELL Mrs. J. GIBB (to 30.4.1969) (from 21.7.1969) 5 PREFACE TELEPHONE: 01-478 3020 Health and Welfare Department, 17/23, Clements Road, ILFORD. September, 1970. Mr,Mayor, Ladies and Gentlemen, I hereby submit the fifth Annual Report of the Health and Welfare Services of the London Borough of Redbridge. A few points on the statistics of the borough are presented. Last year, I mentioned that there had been a steady decline over the years in the population, but contrary to the opinion of statisticians that this would continue, there was a slight rise in 1968. The statisticians now seem to have been correct in their prophecy, for in 1969, the population dropped from 246,090 to 244,800, although the number of inhabited houses increased by 1,041 to 79,066. The adjusted live birth rate has fallen slightly from 14.79 to 14.36. The infant mortality remains low, but not so remarkably low as in 1968, when the rate of 12.74 per 1,000 live births (Greater London 18.6) will probably stand as a record for many years. In 1969, the rate was 15 (Greater London 17.9) and there were 51 deaths, six more than in the previous year. In spite of the rise, this is still an exceptionally low figure. Stillbirths fell from a rate of 13.68 to 13, with fi ve fewer. The percentage of live births that are illegitimate dropped from 7.50 to 6.09. A temporary drop; a change in morals; the Abortion Act; or the Pill? There was a drop in the adjusted general death rate from 11.08 to 10.66 (93 fewer deaths) but this statistic can be so influenced by variable factors such as weather, influenza, etc., that there is no occasion yet to cheer. We have become accustomed to the statement that "there were no maternal deaths"; 1969 was no exception. As far as infectious disease is concerned the year was uneventful. This maybe is the reason why so much fuss is made of the occasional unusual case that does occur, such as the case of anthrax, or recently, when a healthy typhoid carrier, who had not been abroad for a number of years, came to the attention of the national press. The reporter rang me up and said that their informant (naturally anonymous) had told them it was a case of cholera and we were concealing the information! 6 In Redbridge, I hope 1969 and 1970 will be remembered in future years from a medical aspect as the years when our first Health Centre and District General Hospital were started (the centre) and inspired (the district general hospital) at King George Hospital site. There can seldom have been such appreciative unanimity in the borough as was disclosed when the Borough Council offered to consider exchanging land at Newbury Park for the building of a district general hospital. The local authority would be delighted to have a hospital to serve the borough itself, rather than that the citizens would have to travel to one of three hospitals outside the borough and one on its western edge. The general practitioners would be glad that a local hospital would serve their own and their patients' interests; the hospital staff at King George Hospital would be happy and relieved that the future of the hospital and its staff was assured and the Regional Hospital Board pleased to be taken off the hook should they impose a site elsewhere, unwelcome to so many local interests. The location on one site of a district general hospital, a health centre, training facilities for medical students in general practice and maybe later a post-graduate medical centre and vocational training facilities for graduates would enhance the medical reputation of the borough and make a national planning impact. Incidentally, it is generally known that the medical profession are adamant that they do not want "town hall interference" in running the health services. Here is a significant example of how wrong they can be, if they are rescued by the "town hall" from outside planners. Inevitably, mention must be made of the Local Authority Social Services Act that will produce a Social Services Committee and Director of Social Services. It confers a boon, in that most (not all)social services are to be brought under one umbrella by dissolving the Children's Department, and in unprogressive boroughs, where Health and Welfare are separated (unlike Redbridge) bringing certain of their functions together. The advantages to combined Health and Welfare Departments are, however, much more slender, and in many cases retrogressive. No amount of semantic somersaults, for instance, can conceal the fact that in Redbridge now the handicapped child is cared for by two departments, Education and combined Health and Welfare, and in the future will be cared for by three departments, Education, Health and Social Services. This is, in certain circles, called progress and unification. Again, I must thank my staff, often overworked, for their loyal support and continued efforts in spite of the threats and uncertainties that the future holds. Co-operation and help from colleagues in other departments has been outstanding. I trust the Chairmen and Councillors involved with our work have appreciated our efforts. We, on our side, have been grateful for their support and understanding, a situation which does not always hold, so hearsay tells, in many other authorities, as it does in Redbridge. 7 As always, I wish to record my appreciation of the numerous voluntary workers and associations in the town, who provide the equivalent of many man-hours (women-hours!) of unobtainable staff and save the rate-payers money, besides bringing enthusiasm and initiative. Finally, I must thank my secretary, Miss Cudby, for the thankless task of gathering, ordering, persuading and editing involved in producing this annual report. I have the honour to be, Your obedient Servant, I. GORDON, Medical Officer of Health and Administrator of Social Services. 8 STATISTICS AND SOCIAL CONDITIONS OF THE AREA (Land and Inland Water) Area (in Acres) (Tidal Water ) 13,983 Registrar-General's Estimate of resident Population:- June, 30th, 1969 244,800 Number of inhabited houses (April 1st, 1969) according to Rate Books 79,066 Rateable Value - April 1st, 1969 £12,996,517 Sum represented by a penny rate, April 1st, 1969 £52,900 General Rate in the £ — 1969-1970 — Domestic Properties 14s.1d. Mainly Domestic Properties 14s.9d. Non-Domestic Properties 15s.4d. The following figures as to unemployment were supplied by the Ministry of Labour (llford area only): Males Females As at 12th January, 1970 1,043 103 1969 Live Births 3,414 Live Birth rate per 1,000 population - Crude rate 13.94 Adjusted rate 14.36 Illegitimate Live Births per cent of total live births 6.09 Stillbirths 44 Stillbirth rate per 1,000 total live and stillbirths 13 Total Live and Stillbirths 3,458 Infant deaths (under 1 year) 51 Total Infant deaths per 1,000 total live births 15 Legitimate Infant deaths per 1,000 legitimate live births 14 Illegitimate Infant deaths per 1 000 illegitimate live births 34 Neo-natal mortality rate per 1,000 live births (first four weeks) 10 Early Neo-natal mortality rate per 1,000 total live births (under one week) Perinatal mortality rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) 22 Maternal deaths (including abortion) Nil Maternal mortality rate per 1,000 live and stillbirths Nil Deaths (all causes) 2,776 Death rate per 1,000 population — Crude Rate 11,34 Adjusted rate 10.66 Comparability Factors — Birth rate 1.03 Death rate 0.94 Total rainfall 1969 21.81 inches Greatest rainfall in any 24 hours (on 29.7.69) 1.70 inches EPIDEMIOLOGY 9 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 During the year we were fortunate in that only two small incidences of Shigella sonnei were confirmed; at a junior school and at a day nursery. 419 cases of dysentery were notified but only 43 were confirmed bacteriologically. These were all isolated cases with very little, if any, connection with other known cases. 97 cases of Food Poisoning were notified and 31 were also investigated which were brought to our notice from other sources. No outbreaks, to our knowledge, originated in the Borough. A number of cases were from guests who attended four different weddings. Although our evidence is small it is obvious that not too much care can ever be given when food, in quantity, is being prepared, particularly if frozen poultry is used. Typhoid and Paratyphoid Because of the number of cases of typhoid which originated in Mediterranean countries last summer we were involved in checking many contacts. No cases of typhoid were discovered but oneyoung man was removed to hospital where he was clinically confirmed as a Paratyphoid. It was interesting to know that another member of the same party, living in a different part of England, was also a confirmed Paratyphoid. Four other cases of Salmonella were also found from returning tourists who had visited this area. Leptospirosis One case of leptospirosis was notified and although bacteriological examination of blood did not confirm the diagnosis, it was discovered that the child had spent much time caring for, and playing with, gerbils, a small desert rat. With increased travel and interest in a wider variety of animals as pets, monkeys, terrapins etc., I feel it is reasonable to believe that the lesser known infectious diseases may be encountered from time to time. 10 Measles 1969 was a "measles" year. The 639 cases notified, although in excess of the 432 cases notified in 1968, show a considerable decrease on the 2,695 cases notified in 1967, the previous "measles" year. Measles immunisation commenced in June 1968 and it would appear to have had some effect. Whooping Cough Only 12 cases of whooping cough were notified during the year,compared with 60 in 1968. Infective Jaundice 45 cases of Infective Jaundice were notified in 1969 compared with 10 cases in the last six months of 1968, following its classification as a Notifiable Infectious Disease in June of that year. Tuberculosis 43 cases of pulmonary tuberculosis and 7 cases of non-pulmonary tuberculosis were notified during the year. Statistics relating to tuberculosis are given in Appendix 2. Venereal Disease Returns of Redbridge residents treated for Venereal Disease were received from 10 centres. These showed that 9 cases of Syphilis and 115 cases of Gonorrhoea attended these Centres. Full particulars of the returns are contained in Appendix 4. Ischaemic Heart Disease 343 males and 199 females died within this category during 1969, compared with a total of 609 in the previous year when this reclassification was introduced by the Register General. Bronchitis Emphysema Deaths due to bronchitis and emphysema continued to increase, 148 persons dying from these conditions during 1969, compared with 142 in 1968, and 128 in 1967. Cancer Lung and Bronchus 186 persons died from this form of cancer in 1969. 147 were males and 39 females, an increase of 13 over 1968. Most of these.occurred in persons over the age of 55. Female Cancers There were 89 deaths from female cancers, 70 of the breast and 19 of the uterus, wnich showed an increase from similar deaths in 1968. 11 Accidents 57 people died as a result af accident, 30 of these being road accidents. There were 3 accidental deaths in children under the age of 15. All figures show a reduction on those for 1968. Suicide Suicides remained at the same fairly constant figure of 28; 3 of these occurred in persons under the age of 25. 12 APPENDIX 1 NOTIFICATIONS OF INFECTIOUS DISEASES FOR THE YEAR 1969 NOTIFIABLE DISEASES 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 Measles 639 27 382 210 13 7 - - Dysentery 419 21 86 88 62 95 67 - Scarlet Fever 83 - 30 45 5 2 1 - Whooping Cough 12 - 6 4 2 - - - Infective Jaundice 45 - 2 11 8 20 3 1 Tuberculosis - Respiratory 43 - 1 2 5 14 14 7 Other Forms 7 - 1 - 1 4 - 1 Diphtheria - - - - - - - - Tetanus - - - - - - - - Acute Meningitis 5 2 1 - 1 1 - - Acute Encephalitis - - - - - - - - Ophthalmia Neonatorum 3 3 - - - - - - Acute Poliomyelitis - - - - - - - - Leptospirosis 1 - - 1 - - - - Paratyphoid Fever 1 - - - 1 - - - Typhoid Fever - - - - - - - - *Food Poisoning 97 2 21 13 25 13 19 4 Malaria - Believed contracted in this country - - - - - - - - Believed contracted abroad - - - - - - - - Anthrax - - - - - - - - Smallpox - - - - - - - - Totals 1,355 55 530 374 123 156 104 13 *0f the total (97) notified, 18 cases were confirmed, plus 2 notified as Dysentery. A further 22 cases, which came to the knowledge of the department, other than by Doctor's notification, were confirmed as food poisoning. 13 TUBERCULOSIS APPENDIX 2 Age Periods New Cases Deaths Respiratory Non-Respiratory Respiratory Non-Respiratory M F M F M F M F Under 1 year - - - - - - - - 1 - 4 years 1 - - 1 - - - - 5-14" 1 1 - - - - - - 15-24 " 4 1 - - - - - - 25 - 44 " 10 4 1 4 1 - - - 45-64 " 12 2 - - 2 - 3 1 65 - 74 " 5 - - - 3 1 - - Over 75 " 2 - - 1 2 - - 1 Totals 35 8 1 6 8 1 3 2 The foregoing new cases were notified from the following sources:- Respiratory Tuberculosis Non-Respiratory Tuberculosis llford Chest Clinic 19 3 instead and Woodford Chest Clinic 8 - Dagenham Hospital 4 - ihipps Cross Hospital 2 1 lonstead Hospital 1 - Chadwell Heath Hospital 6 - London Hospital 1 1 St. Bartholomew1 s Hospital - 1 Eor, Nose and Throat Hospital - 1 Rush Green Hospital 1 - University College Hospital 1 - Totals 43 7 In addition 13 pulmonary and 1 non-pulmonary coses were transferred to Redbridge. Pulmonary NonPulmonary Total Number of cases on register, 1st January, 1969 820 133 953 Number of new cases entered on register during the year 43 7 50 Number of other cases during the year 13 1 14 Totals 876 141 1,017 Number of cases removed from register during the year — "covered 45 — 45 deceased 17 — 17 Left District 21 4 25 Lost sight of (Returned to Country of Origin) 5 — 5 Diagnosis not established 4 — 4 Totals _92 4 96 Number of cases remaining on register on 31st December, 1969 784 137 921 14 MASS RADIOGRAPHY APPENDIX 3 The mass radiography Unit stationed at Vine Church Hall operated on Mondays from 6th January - 23rd June, 1969 and again from 4th August - 29th December, 1969, 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 1,632 1,315 2,947 General Public 2,339 2,774 5,113 Organised Groups 399 1,830 2,229 Contoct Groups 34- 7 41 Total Number x-rayed 4,404 5,926 10,330 The unit also visited and x-rayed personnel of various companies and establishments within the Redbridge area. The numbers x-rayed were 2,202 1,366 3,568 VENEREAL DISEASES APPENDIX 4 Treatment received by new cases from Redbridge during 1969, as notified by the undernoted Treatment Centres Name of Centre Syphilis Gonorrhoea Other Conditions Total The Whitechapel Clinic, London Hospital, E.1 6 83 703 792 Homerton Grove Clinic, Eastern Hospital, E.9 - 4 18 22 Special Clinic, Queen Mary's Hospital, E.15 2 12 76 90 Albert Dock Hospital, Alnwick Road, E.16 - 1 14 15 Lydia Dept., St. Thomas Hospital London, S.E.1 - - 4 4 Oldchurch Hospital, Romford, Essex - 13 149 162 Mothers' Hospital (Salvation Army) Lower Clapton, E.5 - 1 43 44 St. Bartholomew's Hospital, E.C.1 - 1 28 29 Special Treatment Clinic, Moorfields Eye Hospital 1 - 7 8 Dreadnought Seamen's Hospital, Greenwich - - - Totals 9 115 1,042 1,166 15 APPENDIX 5 DEATH RATES FROM CANCER AND ISCHAEMIC HEART DISEASE, 1969 APPENDIX 6 Table showing comparison between the Birth-rate, Death-rate, etc., of Redbridge, Greater London and of England and Wales for the Year 1969. 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 16.3 13 11.9 18 Greater London 14.6 12.7 11.61 17.9 REDBRIDGE (Estimated Population — mid-1969 - 244,800) 14.36 13 10.66 15 The following Table shows the death-rates for 1969 for Redbridge, compared with those for 1968. 1969 1968 Cancer of lung and bronchus .760 .703 Cancer, other forms 1.871 1.800 Ischaemic heart disease 2.214 2.475 16 APPENDIX 7 Registrar-General's Short List of Deaths and Causes Causes of and Ages at Death during the year 1969 Net Deaths at the subjoined ages of "Residents" whether occurring within or without the district Total — All ages Under 4 weeks 4 weeks & under 1 year 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 75 years & over Enteritis and other Diarrhoeal Diseases 1 - - - - - - - - - - 1 Tuberculosis of Respiratory System 9 - - - - - 1 - - 2 4 2 Other Tuberculosis, incl. Late Effects 5 - - - - - - - - 4 - 1 Meningococcal Infection 2 - 1 - - 1 - - - - - - Other Infective and Parasitic Diseases 2 - - - - 1 - - 1 - - Malignant Neoplasm, Buccal Cavity etc. 6 - - - - - - 1 1 2 2 Malignant Neoplasm, Oesophagus 13 - - - - - - 1 1 6 3 2 Malignant Neoplasm, Stomach 65 - - - - - - 1 3 20 17 24 Malignant Neoplasm, Intestine 01 - - - - - - 2 4 14 32 29 Malignant Neoplasm, Larynx 2 - - - - - - - - - - 2 Malignant Neoplasm, Lung, Bronchus 186 - - - - - - 7 11 56 65 47 Malignant Neoplasm, Breast 73 - - - - - 1 4 12 18 22 16 Malignant Neoplasm, Uterus 19 - - - - - - - 2 3 7 7 Malignant Neoplasm, Prostate 13 - - - - -- - - 1 3 9 Leukaemia 19 - - - 1 1 - 1 2 3 9 2 Other Malignant Neoplasms 167 - - - 1 1 6 6 21 41 52 39 Benign and Unspecified Neoplasms 7 1 - - 1 - - - 1 1 1 2 Diabetes Mellitus 20 - - - - - 1 1 - 5 5 8 Avitaminoses, etc. 4 - - - - - - - 1 - - 3 Other Endocrine etc. Diseases 6 - - 1 - - - - - - 4 1 Anaemias 8 - - - 1 - - - 2 - - 5 Mental Disorders 19 - - - - - - 1 1 - 1 16 Meningitis 1 - - - - - - - - - 1 - Other Diseases of Nervous System 40 - - - - - 2 1 1 13 13 10 Chronic Rheumatic Heart Disease 46 - - - - - - - 3 16 11 16 Hypertensive Disease 75 - - - - - - 1 5 9 20 40 Ischaemic Heart Disease 542 - - - - - - 9 39 101 180 213 Other Forms of Heart Disease 150 - - - - 1 - - 3 7 34 105 Cerebrovascular Disease 352 - - - - 1 - 2 8 35 94 212 Other Diseases of Circulatory System 118 - - - - 1 - - 4 9 28 76 Carried Forward 2,051 1 1 1 4 6 12 36 125 366 608 890 17 APPENDIX 7 (continued) Causes of and Ages at Death during the year 1969 Net Deaths at the subjoined ages of "Residents* whether occurring within or without the district Total — All ages Under 4 weeks 4 weeks & under 1 year 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 75 years & over Brought Forward 2,051 1 1 1 4 6 12 36 125 366 608 890 Influenza 21 - - - - - 1 - 4 6 8 2 Pneumonia 250 4 7 - - - - 7 4 21 46 161 Bronchitis and Emphysema 148 5 23 60 60 Asthma 8 - - - 1 - 2 1 1 1 1 1 Other Diseases of Respiratory System 27 - 1 - - - - 2 1 3 5 15 Peptic Ulcer 21 - - - - - - - - 2 8 11 Appendicitis 1 - - - - - - - - - - 11 Intestinal Obstruction and Hernia 13 1 - 1 11 Cirrhosis of Liver 9 - - - - - 1 - - 2 2 4 Other Diseases of Digestive System 16 - - - - 1 - - 1 4 4 6 Nephritis and Nephrosis 12 - - - - - - - 5 2 4 1 Hyperplasia of Prostate 6 - - - - - - - - - 1 5 Other Diseases, Genito-Urinary System 27 - - 1 - - - 1 - 3 7 15 Diseases of Skin, Subcutaneous Tissue 2 - - - - - - - - 1 1 - Diseases of Musculo-skeletal System 14 - - 1 - - - - - 1 4 8 Congenital Anomalies 22 7 . 6 1 - - 1 1 1 - 2 3 Birth Injury, Difficult Labour, etc 15 14 1 - - - - - - - - - Other Causes of Perinatal Mortality 9 8 1 - - - - - - - - - Symptoms and III Defined Conditions 13 - - - - 1 - - - - 1 11 Motor Vehicle Accidents 30 - - - 2 8 8 - 2 1 3 6 All Other Accidents 27 - - 1 - 1 3 1 2 5 4 10 Suicide and Self-Inflicted Injuries 28 - - - - 3 3 1 4 6 9 2 All Other External Causes 6 - - - - - - - 5 - 1 - TOTALS - All Causes 2,776 34 17 5 7 20 31 51 161 447 780 1,223 GENERAL SERVICES 19 GENERAL SERVICES M. T. FERNANDES, M.B., 3.S., D.P.H., D.I.H., D.C.H., L.M., Deputy Medical Officer of Health Housing Allocation Medical Grounds The Housing Medical 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 1969, 269 cases were referred and recommendations were made in only 234 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 are 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 df 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 1969, and compared with 1967 and 1968. Number of cases Referred or Reviewed Recommendations made for "medical points" 1969 1968 1967 1969 1968 1967 269 287 233 234 251 208 20 It will be seen from the statistics that the recommendations made for "Medical Points" during 1969 are steady compared with 1968, but higher than those for 1967. 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 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 During the 47 days of operation of the mass Radiography Unit at Vine Church Hall during the year, the following attendances and results were obtained:- General Practitioners General Public etc. Male Female Total Male Female Total Referrals X-rayed 1,632 1,315 2,947 2,772 4,611 7,383 Found to require further investigation 112 45 157 38 51 89 Certain Conditions Found - Pulmonary Tuberculosis Requiring immediate treatment 4 - 4 1 - 1 Requiring close supervision - - - - - - Malignant Neoplasms in the Thorax (Comprising 23 Lung (Pr 18 mary) c 5 nd 3 Lun 23 g (Seco 1 ndary)) 2 3 Amongst other abnormalities discovered were:- Male Female Acquired abnormalities of the heart and vascular system 5 7 Pneumonoconiosis (of which 2 were asbestosis) 4 - Bacterial and virus infection of lung 19 15 Pulmonary Fibrosis (Not T.B. or Industrial) 12 2 Abnormalities of the Diaphragm and Oesophagus 4 - Pleural Effusion (Non-Tuberculous) 5 3 21 Massage and Special Treatment Registration and supervision of premises used for the treatment of persons where massage or similar therapeutic activities were carried out, continued during 1969. The premises listed in Appendix 8 were all periodically visited by either a senior departmental medical officer or senior public health inspector and the standard generally remained satisfactory. During the year two premises ceased operation and one new was licensed. 1969 added the registration of a new nursing home: to the three already operating. This home was for surgical cases and was the first in this category to be opened in this area since before the last war. Cooperation between the applicant and the Health and Welfare Department involving a considerable amount of time and research resulted in an up-to-date establishment with a modern operating theatre accommodating twelve patients. The Nursing homes now licensed are 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, E11 The Park Clinic 14 Seagry Road, E.11 Nursing Homes lurses Agency The application and registration of the Nurses Agency (East London)) at 3A Station Bridge, Seven Kings, established the first such Agency since 1951. Mortuary The mortuary situated in St. Mary's Churchyard, 11 ford, previously under the control of the Borough Engineer was transferred to the Health and Welfare Department on 1st December, 1969. This establishment with a nominal capacity for nine bodies, serves Redbridge and the London Borough of Barking (formerly, the Boroughs of Barking and Dagenham) the latter on an agency basis. In addition, bodies are from time to time directed to this mortuary by the Coroner or by local arrangement from the Boroughs of Newham, Waltham Forest and Havering. The'Borough Engineer had been concerned with the rising occupancy of the mortuary since the London Government Act increased its catchment area. 22 This concern is shared and in the absence of agreement between adjoining Authorities for the construction of a joint mortuary a new one is now proposed for Redbridge. The mortuary accommodated 708 bodies in 1969, an increase of 114 over the previous year and 223 above the figure for 1967. Medical Examination of Staff The arrangements for medical examination of new staff where required and other staff where a determination of fitness or otherwise for continuance of their duties was necessary were continued during 1969 and the following table summarises the numbers and categories so examined:- 1. Medical assessments 977 2. Medical examinations:— Staff (from No. 1 above) 201 Teachers 18 Students 222 Authorities 2 Total number of medical examinations 443 Roding Valley Pumping Station Following an application from a local firm to discharge certain chemicals through this pumping station which in turn would have alleviated some of the pollution problems of the River Roding, and in an endeavour to ascertain there would be no resultant adverse effects on the staff employed there, a very intensive study of the possible hazards was made. With the co-operation of the Borough Engineer, the Greater London Council (Scientific Branch and the Department of Public Health Engineering), H.M. Medical Inspector of Factories and the firm concerned, Health and Welfare Department representatives under the Deputy Medical Officer of Health and the Chief Public Health Inspector co-ordinated the results of the research which included test sampling of the effluent passing through the pumping station over a considerable period and in the light of this were unable to elicit any health hazard. 23 National Assistance Act, 1948 (Section 47) 8 cases were referred during the year from varying sources of persons ostensibly being aged, infirm or incapacitated by handicap or disease, living in insanitary conditions and not able to receive proper care and attention. The necessary removals to appropriate accommodation were effected in two cases supported by the certificate required of the Medical Officer of Health. All cases were visited and assessments were supported by the Chief Public Health Inspector and in certain cases the Social Worker concerned. 24 APPENDIX 8 MASSAGE AND SPECIAL TREATMENT ESTABLISHMENTS Treatment Carried Out Number of Premises Licensed A. Massage and other treatment 9 B. Chiropody 16 C. Chiropody and Massage 8 D. Physiotherapy 4 E. Hair and Scalp Clinic 1 List of Establishments for Massage and Special Treatment Licensed as at 31.12.69:- Name Premises Licensed Treatment Carried Out (See Table above) 1. Baruch, L. 6A, Goodmayes Road, llford. 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 7. 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 10. Gibson, Mrs. M. 50, Kings Avenue, Woodford Green. B 11. Gresham, Mrs. F. E. 116, Beattyville Gardens, llford. A 12. Hagan, V. 7, Cambridge Park, Wanstead, E.ll. B 13. Hyam, G. D. 21/23, York Road, llford. B 14. Jardine, K. L. 67, Clayhall Avenue, llford. C 15. Jardine, K. L. 119, Eastern Avenue, llford. B 16. Johnson, A. E. 85, Berkeley Avenue, llford. D 17. Jones, E. & Shorer, Mrs. A. 9, Brook Road, llford. B 18. Langley, J.W. 6, Shawville Gardens, Cranbrook Road, llford. C 19. Langley, Mrs. J. 121, Belgrave Road, llford. C 20. Leary, E. 30, Broomhill Road, Woodford Green. A 21. Leavesley, Mrs. J. 19, Grays Corner, Eastern Avenue, llford. C 22. Morris, W. P. 46, Ranelagh Gardens, llford. A 23. Murdoch, C. W. 8, The Drive, llford. B 24. Oxenham, P. R. H. 75, The Drive, llford. D 25. Pearce, G. S. 238, Balfour Road, llford. B 26. Roberts, R.N. 80, Snakes Lane, Woodford Green. B 25 APPENDIX'8 (continued) Name Premises Licensed Treatment Carried Out (See Table above) 27. Roberts, R. H. 318, Cranbrook Road, llford. B 28. Sadowski, R. 22, Alloa Road, llford. B 29. Scholl Manufacturing Co. Ltd. 81 A, Cranbrook Road, llford. B 30. Skipper, Mrs. A. M. 20, Seagry Road, Wanstead, E.11. D 31. Souster Bros. Ltd. 8, Clements Road, llford. C 32. Stevens, B. 4, Cameron Road, llford. E 33. Stonnill, Mrs. T.E. 10, The Shrubberies, E.18. C 34. Teager, D. P. G. 85, Sunnymede Drive, llford. A 35. Travers, 1 J. 11, Grove Crescent, E.18. A 36. Turner, R.T. 60, Fairfield Road, llford. C 37. Warren & Crinsted Ltd. 53/57, Eastern Avenue, llford. A 38. 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 27 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 progress has been made in finalising plans for some of our Health Centres, including the inviting of tenders by the Borough Architect for the building of King George Hospital Health Centre. 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. There are four Health Centres included within our revised 3-year programme for the years 1970-1973. These are in addition to the Centre destined to be built near King George Hospital. It is our hope that Health Centres will occupy a predominant place in the National Health Service, whereby general practitioners and local authority health services would be brought together. This was the most important project of the year. I mentioned in my report for 1963 that it is proposed to build this Centre on a leased site within the grounds of King George Hospital between Perrymans Farm Road and Buntingbridge Road, near the present Nurses' Home. A postgraduate medical centre may be built nearby. Seven general practitioners will practise from the Centre, which will serve a population of 20,000. Negotiations for the leasing of the site have continued satisfactorily during the year, and a cost limit for the building has been received from the Department of Health and Social Security. Work on the site will commence early in 1970 and the Centre should be open in the latter half of 1971. At a later stage consideration is to be given for the provision of consulting room 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. 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. As previously Progress in in 1969 King George Hospital Health Centre High Road, Woodford, Health Centre 28 mentioned in my report for 1968, the Department of Health and Social Security have agreed in principle to the scheme for this project, and last year I stated that work would commence in 1970. However, due to the comprehensive redevelopment of the site (114-126 High Road, Woodford), the commencement of the building of the Health Centre must await the commencement of the building of the other municipal projects, i.e. library, youth employment office, registrar's office, certain types of housing, etc., as it is intended to have only one building contract for the whole complex. As schemes for some of the other buildings have yet to be finalised, it is anticipated that work on the Health Centre will not commence before March, 1971. Full we 11 Cross Health Centre (Alcoe's Timber Yard) This site is ideally suitable as it is on a main road junction with public transport facilities. The site for this Centre has now been purchased and 4 general practitioners are at present discussing participation. Preliminary sketch plans have been prepared and it is anticipated that buiIding work will commence on this project in March, 1971. The site for this Health Centre is on railway land opposite Seven Kings Station in Salisbury, Road. Four doctors have expressed a desire to practise from a Centre in this Area, but with the proviso that they make their entry conditional upon the provision of a suitable access from the north of Seven Kings High Road by means of an underpass or bridge. A survey by the Greater London Council was carried out to explore such a possibility, but the resultant information culiminated in a refusal, at this time, to provide a bridge or underpass. However, doctors south of the High Road are still interested and the Executive Council therefore consider that this Health Centre still remains a viable proposition. Numerous meetings were held during the course of the year and sketch plans were drawn. The project is included in the year 1972/3 for opening in October 1974. Seven Kings Health Centre Manford Way Health Centre The Executive Council indicated during the year an interest by several general practitioners for having a Health Centre in the vicinity of Manford V/ay, Hainault. Should this prove a viable proposition, the 29 Borough Architect has confirmed that a suitable and adequate extension could be made to the present Manford V/ay Clinic. It is intended to provide a Health Centre within the redevelopment area and a site had been provisionally allocated south of the High Road in the present High Road area. Meetings held during the year with general practitioners and the Local Executive Council showed that this was a viable proposition, except that the Executive Council would now prefer to see the project commenced within the next five years and not, as previously stated, that "it will be at least five years before the building is required, or the site available". Every endeavour is being made to obtain a site within the redevelopment area or just beyond (to the south), which may be used for building a Health Centre within this five-year period. It is also proposed that all local authority health services will operate from the Health Centre. Finance for these various projects will continue to remain uncertain for many years because of the country's present economic troubles. Every effort is being made to expedite the various schemes and stick to schedules, but 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. It is likely that as such Health Centre programme gets underway, more and more practitioners will like to practise from Health Centres. It might not be possible for many years to provide premises for all who are in favour of Health Centres, although this undoubtedly could have an effect on contributing to the effective medical care of the community. Land for Health Centres is a problem which still persists. The price of established land rises annually. It will 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 the likely implementation of the Todd Report, the Seebohm and other allied Reports in respect of the health services, greater responsibility will be put in the hands of the local authorities, which we will have to be prepared to share and enjoy in conjunction with the community, general practitioners, and local authority staff. Ilford Town Redevelopment Area Financing Sites 30 SECTION 22 - CARE OF MOTHERS AND YOUNG CHILDREN (W.H. TOMS, B.M., Ch.B.(Edin.), Principal Medical Officer) It is a matter of some interest to all members of the community to note that the number of unmarried mothers, for whom we have been asked to accept financial responsibility, is decreasing. In certain areas mother and baby homes are finding it difficult to fill their vacancies. There is no doubt that this decrease in the number of undesired pregnancies is due to the wider knowledge of contraceptives and safer, more acceptable techniques. Women are now able to take precautions for themselves and have been liberated to the sexual freedom long enjoyed by men. Despite apparently numerous examples, mainly from the world of "pop", cinema and stage, the vast majority of women wisely prefer to have their children inside marriage and certain liberal attitudes apparent in contemporary society in no way affect this choice. In 1969 there were 3,414 live births in the Borough and the illegitimacy rate was 6%. 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. 64 such cases were reported in 1969, details of which are given in Appendix 10. Dr. Joan M. Pooley, M.B., B.S., D.C.H., Senior Assistant Medical Officer reports as follows:- The Observation (At Risk) Register was first introduced in Redbridge on 1st January, 1966. Analysis of the figures during its first two years of existence showed that too many infants were being included on the register. This resulted in an inflated number, rather than a realistic proportion of births as "At Risk" being observed. This preliminary artifical outcome was being noted concurrently in many Boroughs and County Boroughs throughout the British Isles. Care of the Unmarried Mother The Observation Register 31 Revision of the factors determining whether an infant be "At Risk" or not (February 1968) has made possible a register more concise and accurate in the representation of those cases found either to have definite handicaps, or who need to be followed up closely in order to detect, or exclude early,the presence or development of any abnormality. The original grouping of factors has been retained on the current forms and record cards, nomely:- I. GENETIC II. PRE-NATAL III. PERI-NATAL IV. POST-NATAL V. SYMPTOMATIC and within each group the relative factors have been made more specific. The brief analysis and figures below now show the "At Risk" (Observation) Register to be a more selective, accurate and valuable means of follow up, assessment and care of the infant, particularly during the first 24 months of life. ANALYSIS OF FIGURES: 1969 1968 1967 1966 1. NUMBER ADMITTED TO REGISTER during:- 934 1,011 1,056 1,255 TOTAL NUMBER OF CHILDREN ON REGISTER at end of year:- 3,069 2,525 2,060 1,192 (including other years) NUMBER OF CHILDREN REMOVED FROM REGISTER during 12/12 ended 31st December 1969:- 342 389 122 28 (including 48 removals from area) At At At At 31.12.69 31.12.68 31.12.67 31.12.66 2. (i) CORRECTED NUMBER OF BIRTHS:- 3,414 3,533 3,557 3,873 (ii) % LIVE BIRTHS CONSIDERED TO BE "AT RISK" 27% 28.6% 29.7% 32.3% 32  At 31.12.69 At 31.12.68 At 31.12.67 At 31.12.66 3. (i) Total number of children born 1.1.66 — 31.12.69 — notified as handicapped (whether 'on or off' Observation Register — all under 5 years):— 265 182 - - (li) Total on Observation Register only from 1.1.66 - 31.12.69 registered as handicapped:- 101 60 - - (iii) Total on or off Observation Register 1.1.69 31.12.69 found to have handicaps:- 67 - - _ (See 4). (iv) Total on Observation Register as handicapped 1.1.69 _ 3t. 12.69:- 32 - - - 4. Types of handicaps on Observation Register 1.1.69 — 31.12.69:- No. of Cases No. of Coses Pierre Robin Syndrome 1 Brought Forward 24 Heart murmur 3 Hernia 1 Talipes 9 Retarded/Spastic 1 Spina Bifida 1 Extra digits 1 Spina Bifida/Hydrocephalus 2 Deformed hands 1 Spina Bifida/Hydrocephalus/Talipes 1 Cleft palate/Hare lip 1 Mongol 3 Mental retardation 1 No testes left side 1 Huge Meningocele on head/vision 1 Hypospadias 2 Deep Sacral cleft Hare lip 1 Carried Forward ~24 TOTALS 32 5. Types of Hondicops now removed from Register 1.1.69 - 31.12.69:- Meningocele 1 Talipes 6 Right Lobectomy 1 TOTAL 8 6. Total notified as deaf born 1969 whether on or off register:— 7. Total under 2 years notified as deaf from 1.1.69 — 31.12.69 who were on register:- 33 8. Sources of Notification of Handicapped Infants 1969:— Birth Registration 55 General Practitioners - Hospitals 7 Health Visitors 3 Child Health Centres 1 Transfers In 1 TOTALS 67 9. IT IS INTERESTING TO NOTE THAT:- Born between 1.1.66 - 31.12.69 Born between 1.1.69 - 31.12.69 (1) The number o( children tound to have handicaps both on and off the Register:— 265 67 (2) 01 these children those on the Observation Register numbered:— 101 32 - 38% - 48% This surely indicates that the potential field covered by an Observation Register will expand with experience and that its value is enhanced by increased selectivity of cases It is suggested that the advantages of setting up a "Dual Investigation Register" be considered. This would involve: — (1) Investigation and comparison of any relative etiological factors in known registered cases of congenital defects. (2) The continued special and routine observation of those infants already covered by the present Observation (At Risk) Register — i.e. those where abnormal or unusual factors have presented before, during or after birth. Subsequent comparison of the two groups would enable the significance of common etiological factors to be more scientifically surveyed. The provision of dental services to expectant and nursing mothers and to children under the age of 5 is reported on by Mr. E,. V. Haigh, Principal Dental Officer - Dental Treatment 34 Mothers The demand for treatment by expectant and nursing mothers continued to decrease slightly. This is due to the fact that most mothers are being treated by the general dental service. Most are young adults and more dentally health conscious than ever before and as such these expectant and nursing mothers are usually under private practitioners' supervision prior to the Ante-Natal orPost-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. Many of the mothers that do attend, however, are the ones that do not attend a dentist regularly and as such they often need a considerable amount of treatment to make them dentally sound. They also tend to be more nervous than patients that attend for regular inspections and treatment. Children The treatment of small children under the age of five can demand rather specialised ability of Dental Officers and staff. These children need mora patience and can be very time consuming. However, by careful management these children can be most rewarding and I hope that they will become regular patients and lose the old fears of visiting the dentist that so often have been given to them by their parents. By showing their parents the importance of good dental habits and regular dental treatment, these children will be conscious of the fact that good teeth are an important part of good health when they are older. Many of these under five children are dentally neglected and many parents still think that deciduous teeth are not important. It has been my aim for several years to try and reach more of these children and the number examined and treated have steadily increased. In 1963 only 348 children were examined but in 1969, 1,225 children were examined (Appendix 12). To further dental health education, the dental auxiliary continued visiting nurseries and talking to mothers with young children at Infant Centres. 35 An important step forward in trying to see more of these young children occurred in 1969. In January a colourful three year old birthday card was sent to all known children of this age in the Borough on their third birthday, over 7,000 cards being sent out. These cards have a small amount of dental health information and urges the parent to commence dental inspection and treatment as soon as possible. If inspection and treatment is required through the local authority a pre-paid reply cord is attached. On receiving these cards an appointment is sent to the parent. The percentage accepting treatment was 8%. This may not seem a very good response but it must be realised that a higher percentage may have gone to their general practitioner as a result of this card. Many parents have been very pleased to be reminded in a pleasant way and are nbw regular patients. It has also helped to bring younger or older children in the family under dental care so the percentage is really much higher. I would like 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. Specialist Clinics Specialists clinics for orthopqedic, ophthalmic, ear nose and throat and speech defects were held and details of attendances of all children are shown on pages 66-71. The two Council day nurseries, one in Ley Street and one in Goodmayes Lane, continued to function with.little difficulty during 1969. The heating at Ley Street Day Nursery which had, through modifications, supplements and repairs, been nursed through the last few years as tenderly as the children, finally succumbed at the end of 1969, and will have to be renlaced in 1970 with a gas convector system, which can be salvaged and re-used when the nursery is replaced in the 10-year plan. It became evident during the year that the waiting lists for priority places at the two nurseries showed no signs of decreasing and that children at risk might have to wait for up to sixmonths before admission. It was felt by the Council that the most satisfactory way of resolving this problem and putting some 'give' into the system, would be to use selected private nurseries and childminders in different parts of the Borough, the parent to be assessed for responsibility to contribute to Day Nurseries 36 the cost of a place in the same way as with the Local Authority Nurseries. This policy has now been implemented and next year I hope to report on how effective the innovation has been. 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 The implementation of that part of the Health Services, and Public Health Act 1963, amending the Nurseries and Child Minders Regulation Act 1948, has demanded much of our professional and administrative workers this year. At the beginning of the year all new applicants for registration were interviewed by a senior medical officer and a health visitor, but under pressure of numbers this policy was changed so that health visitors interviewed all prospective childminders and referred any difficult cases to a doctor in the Department for decision. Where registration is for more than 7 children, the applicant is seen as a matter of course by a medical officer, along with a health visitor. At the beginning of 1969, there were 29 childminders and 56 day nurseries registered in Redbridge; on December 31st 1969, there were 110 childminders and 79 day nurseries for the care of 3,218 children. During the year, two mothers with one child each were sent away for a total of 4 weeks convalescence. Private Day Nurseries and Child Minders Convalescence SECTION 23 - MIDWIFERY There were 3,458 births (3,414 live and 44 stillbirths) to Redbridge mothers in 1969 and of these 599 were born at home, making a hospital confinement rate of 83*^and a.domiciliary confinement rate of 17^. There was 1 domiciliary stillbirth, and no maternal deaths were recorded among either hospital or domiciliary confinements. Domiciliary Confinement Rate Miss M. A. Potter, Superintendent of Midwives and District Nurses, reports as follows on the Domiciliary Midwifery Service — 37 Place of Birth Quarter Ending 31.12.69 30.9.69 30.6.69 31.2 .69 Live Still Live Still Live Still Live Still Hospital 588 15 607 5 654 10 642 7 Nursing Homes 1 - 1 - 1 - 6 — At Home 118 - 129 - 177 1 174 - 707 15 737 5 832 11 822 7 Hospital discharges before the 10th day 909 Hospital discharges before the 3rd day 335 Of the cases discharged before the 3rd day, 101 were booked for home confinement but confined in hospital for various medical reasons. Emergency Obstetric Ambulance Barking Maternity Unit instead of Rush Green Hospital, have an obstetridal resuscitation team on call for domiciliary midwifery cases. Thorpe Coombe continues to provide the service for Wanstead, Woodford and Hainault. Guthrie Test for Phenylketonuria The Hospital for Sick Children, Great Ormond Street, gave advice and arrangements were made with the hospital before commencing the tests. A number of problems have arisen especially with the number of unsatisfactory specimens. It is hoped that after experience is gained, this problem will resolve itself. Midwives Attachments to General Practitioners Three group practices of Family Doctors have a midwife attached and one group has a liaison scheme. Further liaison schemes will be arranged to cover more Family Doctors. Training of Pupil Midwives Thirty-eight pupils were accepted from Barking Maternity Unit, Thorpe Coiombe and 11 ford Maternity Hospitals. All pupils passed the second part Central Midwives Board Examination. 38 The Education Officer from the Central Midwives Board visited the patients' homes with the pupil midwives and afterwards met the training midwives. A satisfactory report was submitted. The establishment consists of sixteen midwives (including two parttime) and excludes a Salvation Army Midwife who continues to practice within the Borough. A Deputy Non-Medical Supervisor of Midwives was appointed in October, with dual responsibilities with the District Nurses Service. The following summarises work undertaken for the yeor:- ANTE NATAL CLINIC HOSPITAL BOOKING Quarter Ending DOMICILIARY BOOKING Quarter Ending 31.12.69 30.9.69 30.6.69 31.3.69 30.12.69 30.9.69 30.6.69 31.3.69 No. of sessions Held during the quarter 153 144 149 156 116 117 140 140 Total number of attendances 3,218 3,479 3,474 3,539 1,195 1,211 1,357 1,487 SECTION 24 - HEALTH VISITING Staff At the end of the year there were 33 Health Visitors (including 6 Part-time) and 9 (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 13 shows the number and type of visits made. MissJ. Oliver, Superintendent Health Visitor, reports:- Once again Health Visitor colleagues have submitted such pleasing reports on their activities that it leaves me little to say. The introduction of the Guthrie Test this year for the detection of phenylketonuria has made us busier, especially as our two local hospitals started to participate and then stopped covering "this service on their premises. V/e have, therefore, needed to fill a gap and have been helped by our colleagues, the Midwives. 39 The problem of communication with other workers in the department is still with us and it was with this in mind that the Principal Officers from other services, with myself included, started to meet. The meetings at this level have, I feel, benefited us all and in turn the staff who are working in the field. Already two area team meetings have taken place so that people working in given areas can get together, talk over problems and so avoid duplication. Much time and effort has also gone into training programmes and informal groups for talks and discussions. We hope that trainees coming into the service, such as Child Care Officers, Social Workers and Welfare Assistants, have benefited from visits and discussions. Our load of all types of people for training has increased this year and range from D.P.H. and S.R.N, students to students in technical college and ordinary school. I should like to thank not only our own staff for all the work they do but also the large band of voluntary workers who assist at Chilcf Health Centres. Programmes of Training Staff continued to be trained when spaces were available, for hearing testing-this essential service is a very important part of the Health Visitor's work. V/e have also taken full advantage of the London Boroughs' Training Schemes which range from Management Courses for Senior Health Visitors to courses for State Registered Nurses. Our liaison with our local hospitals continues and this year we have extended our services to trainee nurses at The London Hospital. One Health Visitor completed her training as a Field Work Instructor this year, and is now participatina in student health visitor's training. "Welcome to Citizenship" Exhibition Once again the section participated in the above and the simple stand with a new health centre as its focal point, surrounded by local authority nursing staff, proved popular. Nurseries and ChiId Minders Regulation Act, 1948, as amended by Health Services and Public Health Act 1968. Section 60. Miss Collins, Deputy Superintendent Health Visitor has kindly contributed the attached report. The added responsibilities of covering the 40 service of Child Minders has grown since the new Act. The need for Minders in the area is tremendous; many young mothers work to help save for a mortgage. The Council decided in March, 1969 to enforce the recommendations made by the Department of Health and Social Security contained in Circulars 36/68 and 37/68, within the next 12 months in respect of all existing registrations, having already decided to enforce them in respect of all Nurseries and Child Minders registered since the introduction of the amending Act. Circular 37/68 states "that as a general rule, the risks of cross infection make it unwise for the maximum number of children in (nursery) premises to exceed 50". All persons providing day care facilities for more than 50 children in registered premises were requested to reduce the number to 50 within the next 12 months and to notify the Medical Officer of Health as soon as the number had been reduced. Circular 37/68 also states that "single-handed" child minder should care for 13 chiIdren only under five years of age (including any of her own within that age group), but in the event of an assistant being employed she may care for up to seven children under five, subject to compliance with the Medical Officer of Health's requirements concerning the accommodation to be used. All registered child minders having more than 3 children in their care were requested within the next 12 months either (i) to reduce the number of children to three, or (ii) to employ an assistant; the Medical Officer of Health to be notified about a decision as soon as possible. Early in 1970 the Committee would consider what action should be taken to make these recommendations compulsory in respect of existing registration. At the present time there are:- 71 Playgroups providing sessional care and 8 Playgroups providing all day care 4 persons providing sessional care 106 persons providing all day care 41 In addition, numerous applicants withdrew their applications, possibly at the time of interview and quite a number were considered unsuitable for registration. Since visits to prospective minders were in most cases unplanned and, therefore sometimes ineffective, the actual number of calls made was in excess of the number of applicants that were finally registered. Reports from Centre Superintendents Centre Superintendents have each contributed something from their purpose-built centres; we only wish we had more of these centres as the public like them and the activities that are available for them there. It also makes the work of the staffs much easier as they can cover their full range of duties, i.e. Mothercraft and Relaxation, Child Health Session, Toddlers Examination and Hearing Testing. Kenwood Gardens Clinic This is a busy clinic, at times every room is in use and we have difficulty in finding waiting room space. One Health Visitor Field Work Instructor works from this centre so that two student Health Visitors are trained for Barking Technical College each year. Madeira Grove Clinic This centre is now opened in the evenings for the Probation Officers Sessions. The Claybury Hospital "After Care Club" is also running here in the evenings. The Madeira Grove Mothers' Club continues to be most ambitious in their programme. One Speaker, Professor Camps, on "Battered Babies" was particularly welcomed and this surely is one of the ways to educate the public. One member of the club trained as a "Keep Fit" expert and started a class for the mothers. Two church halls included in this area continue to flourish. All Saints Child Health Centre has a Mother and Children Club which runs at the same time as the Child Health Clinic and a mutual help service has been inaugurated by the mothers. 42 Ashton Playing Fields Child Health Centre The activities at this Centre have been extended to a Hearing Session and Toddlers' Session, the New Broadmead Estate making if busier. Heathcote Clinic This Centre continues on busy lines; Mothercraft and Relaxation classes are not always so well attended as one would wish. Many mothers work up to the 6th and 7th month of pregnancy so are not always able to make full use of the classes. Others book for their confinements outside the area and are often not known until the birth of the baby. The Geriatric Clinic continues to be a useful link with our senior citizens as they know where to make contact should they need help at any time. Manford Way Clinic Services. - During the past year the services at the clinic have functioned although the staff have changed rather frequently. This has shown itself in fluctuating numbers at Relaxation classes and Child Health Sessions. The introduction of hearing tests for infants and the pre-school medical clinics have been accepted very well by the mothers who have shown great interest especially in the latter. Therehas been increased demand for speech therapy within thearea. The mothers have experienced difficulty in travelling to Beehive Lane to obtain this service since the Speech Therapist left this clinic. Guthrie tests for phenylketonuria have gradually increased. At present these are performed before the Child Health Session, but as the numbers increase, a special session may have to be used for this. The ante-natal clinics are now staffed by the District Midwives with the assistance of the Clinic Nurses and are running well. Housing. - The new housing estate being built within the area includes several blocks of flats. This is gradually being completed, and some families have already moved in. It is too soon to pinpoint any 43 definite problems although there have been comments about the lack of suitable playing area and lack of facilities for hanging washing. The gipsy site has had a few difficulties, e.g. rats and flooding of the washroom, but these were solved by the Health Department. A day nursery for the children has been built but as yet has not opened. The families are quite receptive to visiting but give poor response to immunisation although they have used the facilities of the clinic for a Child Health Centre and cervical cytology. Problems have arisen in the area where private and Council house tenants occupy the same road. This has caused disharmony due to two different standards of living within close proximity to one another. Numerous exchanges between residents have occurred due to nervous tension. The chief problems are caused by the occupants of the upper maisonettes disposing refuse out of their windows into the doorways of those living on the ground floor, and children playing out late at night disturbing those in bed. A tarmac playing area would help alleviate some of this "wrangling". A grass play area adjacent to the buildings was promised but as there are several dogs within the vicinity it would be more hygienic to have a tarmac base. Wanstead Place Clinic This clinic covers Wanstead and South Woodford and some changes have taken place here this year as staff retirements brought in replacements With fresh ideas. This clinic has become very busy and Health Visitors receive many telephone enquiries. The toddlers and the pre-school medicals are valuable; more time to assess the child's development is allowed and the mothers appreciate this service. Some hearing testing is done at the clinic, and some in the homes. Mothercraft and Relaxation Classes are also held regularly. Health Visiting staff go out from this centre to three church hall clinics which are used to the full and are very homely places. Mention should be made of the Memorial Hall Clinic, which is a hive of activity, being a part of a very large church hall. The Health Visitors have built up an extensive toy col lection, which has been purchased by the efforts of 44 the mothers in money making schemes. Now whilst the mothers chat over a cup of tea, the toddlers play happily. The mothers, have in fact, formed themselves into a mother's club at the Centre, in order to meet and chat. This is a useful meeting place for lonely mothers and many friendships develop; even the occasional father at times calls in for a cup of tea. The Health Visitor, too, is at liberty to introduce mothers she feels Would benefit, such as people who are mentally ill. The idea gradually extended to a second afternoon, owing to increased numbers. The mothers do form themselves into rotas for minding so that if a mother wanted to have a "hair do" or shop in peace, she could go off feeling happy about the care of her children. The group have now joined the National group of the "Working Association of Mothers"; they have many ideals which, alas, are too many to list. From our point of view the idea of one mother helping another in an emergency or illness, is highly commendable. Mayesbrook Clinic This clinic shows signs of change. On the nearby estate we find the children have grown up and are working. The numbers at the Child Health Centre and School Clinic tend to drop and so changes in sessions are needed. Some larger families have been re-housed but this has created certain problems, plus the fact that this has; involved the severing of family ties (not forgetting statutory supporting services). The clinic is well used and mothers gradually get used to new ideas like the toddlers Clinic. South Park Clinic The clinic has settled down well, and is very busy. We have been unable to expand outside our Child Health Toddler and Hearing Sessions. The nearby estate still has to be finished and we find removals make a lot of work, people tending to move in and out quickly at first. We also have had a shortage of Health Visitors and supporting Clinic Nurses at this clinic. 45 SECTION 25 - HOME NURSING Miss M. A. Potter, Superintendent of Midwives and District Nurses reports as follows on the Home Nursing Service:- There is an establishment of forty district nurses, including four male nurses. Details of the work undertaken during the year are as follows:- Quarter ending 31.12.69 30.9.69 30.6.69 31.3.69 Number of cases visited for the first time this year 917 723 1,046 1,646 Total visits made to all coses at home 23,564 19,271 20,139 16,987 Cases seen in General Practitioners surgeries 1,230 1,317 1,888 - Cases on the books at the end of the quarter 840 949 860 935 First visits to patients aged under 5 years = 144 First visits' to patients aged 5 years and under 65 years = 1,555 First visits to patients aged 65 years and over = 2,633 Geriatric Nursing These figures give some indication of the proportion of geriatric nursing Undertaken at home. It is rewarding work in that elderly people are able to remain in familiar surroundings so long as possible. Tribute must be paid to the Home Nurses for the care and understanding given to the long term and terminal patients, and their relatives. Marie Curie Foundation Fund This year five patients suffering from cancer were able to have a night nurse. The nurses expenses were paid by the above fund. Nursing Auxiliaries Four nursing auxiliaries were appointed for the first time. Their duties are arranged and supervised by the trained staff. The patients whom they visit are mainly the elderly who need help with bathing and dressing. 46 Home Nurses, Attachment to General Practitioners The home nurses working in groups of five or six have been attached to the Family Doctors. Most nurses visit the Doctors on a daily basis, others visit at regular times during the week. Some nurses undertake treatment and attend clinics at the doctors' surgery. Each group of nurses meet weekly to plan their visiting and arrange relief work. The nurses after a settling down period are enjoying the attachments. There is a two way exchange about the patients' treatment and progress and ultimately the patients benefit. Refresher Courses Three nurses attegded the London Borough of Newham School of Community Nursing and two nurses the Queen's Institute of District Nurses' Course at Birmingham University. District Nurse Training Two newly appointed nurses attended a course of training arranged by the London Borough of Waltham Forest. Both successfully passed the National Examination for District Nursing. Vaccination and Immunisation SECTION 26 - VACCINATION AND IMMUNISATION At first sight the immunisation and vaccination figures for the year show a considerable drop from 1968. This in fact is apparent rather than actual, and is due to the introduction of new schedules for immunisation — the primary course is now recommended to be started at 4 months, and to finish at 12 months, rather than the previous course, starting at 4 and finishing at 6 months. Next year it should be possible to compare the primary courses completed in 1970 with the last complete year when the previous schedules were in use. The tables in Appendices 14 and 15 show the number of completed courses of immunisation by year of birth and the number of boosters given against these diseases. 47 SECTION 28 - PREVENTION, CARE AND AFTER CARE including Renal Dialysis Convalescent Treatment Provision of Sickroom Equipment Chiropody Tuberculosis Extra Nourishment Cervical Cytology and Cancer Education Geriatric Clinic Marie Curie Memorial Foundation Fund Renal Dialysis At 31st December 1969, six patients were receiving home dialysis. As the limited number of beds in hospital dialysis units are always under pressure it seems the Local Authorities will be called upon more to supply facilities for this treatment at home once the patients are fully trained in the use of the equipment in hospital. Patients will also be dialysed at home while they are awaiting kidney transplant. Recently a great deal of interest has been shown in portable dialysis units, fully fitted, which can be lowered on to a site adjacent to the home. For the short term selected case, this could offer many advantages, the greatest of which is that the specially constructed unit can be removed after a successful transplant and used for another patient. Recuperative Holidays This service was continued on similar lines as previous years. The total number of cases sent away for a recuperative holiday during 1969 was 102, ten less than in 1968. The standard contribution towards the cost of the holiday remained the same as last year, viz. £7. Section 28 91 persons for 2 weeks 182 weeks 4 persons for 3 weeks 12 weeks 3 persons for 1 week 3 weeks Total 197 weeks 48 Chiropody Mr. Gibson, the Chief Chiropodist, reports as follows:- How many people hobble along in misery, when a visit to the Chiropodist would put them right' There must be many among the elderly in Redbridge! Whilst the demand for treatment increased during the year, the number of sessions available did not. We have had to resort to waiting lists. This is due to the present financial restrictions. The service continues to cater for all persons of pensionable age, the physically handicapped, expectant mothers and some children. Housebound patients receive treatment in their own homes, and residents in all the Council's homes for the elderly are treated regularly. The fee is 4s.0d. but for persons receiving Supplementary Pension there is no charge; many patients' incomes are assessed and they may qualify for a reduced fee or free treatment. A car service is provided to transport patients unable to use public transport to and from the Chiropody Clinics. The majority of patients attend the most convenient clinic in their neighbourhood. Treatment is mainly conservative and palliative, but prevention is far better than cure and quite often, even among the elderly, valuable advice con be given regarding shoes, hygiene, etc. Faulty shoes are the biggest single cause of foot problems. The best advice, whether medical or parental, is likely to be rejected in favour of fashion. Children. - Verrucae (foot warts) have been very widespread indeed for the first time we were unable to meet the demand because of lack of staff. There must consequently have been many irate parents. Childrens' feet are being damaged by ill-fitting shoes and socks, stretch socks causing quite a lot of trouble. V/e advise parents regarding these, but it is felt the shoe and hosiery manufacturers need to be educated first. Details of the patients seen are shown in Appendix 16. 49 Tuberculosis After-Care Health Visitors Three full-time Tuberculosis Visitors are attached to the 11 ford Chest Clinic and one full-time and one part-time visitor to Harts Hospital. A very close liaison is maintained with the Chest Clinics and the after-care services are closely integrated. Facilities Other facilities which exist for the after-care of tuberculosis patients include assistance in the maintenance charges at rehabilitation settlements, provision of free milk, boarding out of child contacts. During 1969 the one patient continuing to reside in a rehabilitation settlement was provided with financial assistance towards his maintenance. One patient was provided with the British Red Cross domiciliary library service for which the Borough was financially responsible. Extra Nourishment The following received extra nourishment (milk) during 1969:— Number of New T.B. Patients during year 23 Number of existing T.B. Patients 91 Number at 31.12.69 114 Number of New Cases (other than T.B.) 17 Number of Existing Cases (other than T.B.) 18 Number at 31.12.69 35 Voluntary Bodies The Wanstead and Woodford Chest Care Association continued their good work during the year. Included in the assistance given were 10 patients who received weekly extra nourishment grants and 51 Christmas gifts (27 to inpatients at Harts Hospital and 24 outpatients). The 11 ford Tuberculosis and Chest Care Association maintained their active help to necessitous patients during 1969 due to funds raised 50 by their own efforts and from financial assistance from the Redbridge Council for which the members express their grateful thanks. Details of assistance given during the year:— 53 patients given a total of 451 grants for extra nourishment 5 grants were made for relatives to visits patients in hospital 1 Television rental and licence paid 54 Patients received cash gifts at Christmas time 1 Child patient and her mother were sent on o convalescent holiday The excellent accommodation provided at King George Hospital for the monthly meetings is again much appreciated. Cervical Cytology and Cancer Education This service continued to operate smoothly throughout 1969. Clinics are held weekly at the Health and Welfare Department in Clements Road, and on a 'demand' basis at Manford Way Health Services Clinic and V/anstead Place Clinic. Smears are examined at either King George Hospital for 11 ford cases, or Wanstead Hospital for those from V/anstead Place Clinic. Demand for appointments at the Local Health Authority Clinics in 11 ford has dropped from 1,706 in 1968 to 926 in 1969, though there has been, to offset this, a dramatic increase in the work done by hospitals and Family Planning Association Clinics in this field. It would be a great pity if the cause of cervical cytology was to be lost through apathy either on the part of the consumers or promoters of the service. It is also unfortunate that women using these clinics are those who are least 'at risk'. The women who are most liable to develop carcinoma of the neck of the womb are those married early and with a large family. It will be our responsibility in the future to take the service to them. Geriatric Clinics With the valuable co-operation of the few general practitioners willing to attend these two clinics, this service has continued during 1969. It became evident, however, following a survey of a cross section of the examinations undertaken, that the vast majority of those patients attending were remarkably fit and that those with a condition were attending their own doctor. 51 Following a meeting between interested parties to discuss the progress and evaluate the results, it has been decided to continue to invite and examine at one clinic those patients aged 65 years, but at the other clinic the age for examination will be raised to 72 years. In this way a comparison of the findings from two age groups can be made and so help plan future policy. In addition the 57 point questionnaire previously completed by the patient is being reduced in complexity for the benefit of the patient. During 1969 the following sessions and attendances were recorded:- Sessions held 45 Patients examined 238 Marie Curie Memorial Foundation This fund which exists to provide various forms of help for cancer patients, where this help is not obtainable through statutory sources, has, during 1969 assisted the following cases:- Provision of extra nourishment (milk, eggs etc.) 2 patients Prevision of toilet requisites 1 patient Provision of night attire 1 patient Payment for services of night nurses 5 patients Ourthanks are extended to the Foundation for this valuable service. Home Helps SECTION 29 - HOME HELP SERVICE Miss Pemberton, Senior Home Help Organiser, reports:- The Home Help Service in 1969 continued to provide assistance, as in previous years, to sick, elderly and needy people in the Borough. 1,812 applications for service were received and a total of 2,810 cases were served during the year, 2,210 of these being chronic sick patients over the age of 65 years. During the year, 142 new Home Helps were appointed to the staff, but, due to the number of resignations and retirements during this period, the total of 224 Home Helps employed at the end of 1969 showed a final increase of only 30 Helps on the register over the previous year. 52 tinuing efforts are being'made to recruit more staff and I am hopeful that the situation during 1970 will improve further. 7 new applications for the service of a Night Attendant were received and a total of 983 hours'service were provided during 1969. Other Activities In addition to the running of the Maternity and Child Health Services of the Borough the medical, nursing and administrative staff have continued throughout the year to co-operate with official and voluntary organisations, clubs, scout troops, womens guilds etc., in giving talks and lectures on a wide variety of health subjects. Other forms of help given include interviews with trainee teachers, social workers, medical secretaries etc., requiring detailed information and statistics on certain :specialised health subjects, the organising of visits to child health centres, specialists clinics, day nurseries, special schools, for parties of D.P.H. students, pupils from secondary schools, and locum general practitioners. Another "Welcome to Citizenship" exhibition involved the preparation, assembly and-manning of the department's display. 53 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. WANFORD WAY CLINIC, Manford Way (corner of Tufter Rood), Chigwell. ASHTON PLAYING FIELDS PAVILION, Chigwell Road, Woodford Green. ST. LUKES CHURCH HALL, Baxter Road, llford. 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, llford. MOOD 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, llford. 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, 1OO, South Park Drive, (corner of Loxford Lane) Seven Kings, llford. 54 appendix 10 Details of the cases of Congenital Abnormality as reported to the Registrar General during 1969 Spina Bifida 4 Meningomyelocele 4 Hypospadias 2 Anencephaly 7 Hare Lip, Cleft Palate 6 Deformity of Wrist, Feet or Hands etc. 2 Down's Syndrome 2 Multiple Congenital Defects 1 Talipes 17 Extra Digits 4 Hydrocele 3 Hydrocephalus 3 Congenital Heart Defects 1 Pilonidal Sinus 3 Chondrodystrophy 1 Undescended Testicle 1 Sacral Cleft 1 Deformity of External Genitalia 2 appendix 11 DAY NURSERIES Details of attendances etc. during 1969 Name of Day Nursery Number of Approved Places Total Attendances Average Daily Attendance Days in Quarantine Ley Street 50 10,628 41.6 97 Goodmayes Lane 30 10,178 40 92 55 APPENDIX 12 Details of Dental Treatment for Expectant and Nursing Mothers and Children under 5 years of age given during 1969 Number of Visits for Treatment during Year Children 0-4 (inc.) Expectant & Nursing Mothers First Visit 534 72 Subsequent Visits 602 106 Total Visits 1,136 178 Number of Additional Courses o( Treatment other than the First Course commenced during year 105 14 Treatment provided during the yeor — Number of Fillings 1,256 99 Teeth Filled 1,169 97 Teeth Extracted 130 33 General Anaesthetics given 52 - Emergency Visits by Patients 24 7 Patients X-Rayed 2 12 Patients Treated by Scaling and/or Removal of Stains from the teeth (Prophylaxis) 119 61 Teeth Otherwise Conserved 183 - Teeth Root Filled - 2 Inlays - - Crowns - 3 Number of Courses of Treatment Completed during the year 519 76 Number of Patients given First Inspections during year 1,225 107 56 APPENDIX 13 VISITS BY HEALTH VISITING STAFF Cases Visited by Health Visitor Number of Coses 1 Children born in 1969 3,461 2 Children born in 1968 2,828 3 Children born in 1964-67 9,031 4 Total number of children in lines 1-3 15,320 5 Persons aged 65 or over 1,643 6 Number included in line 5 who were visited at the special request of a G.P. or hospital 238 7 Mentally disordered persons 23 8 Number included in line 7 who were visited at the special request of a G.P. or hospital 12 9 Persons, excluding Maternity cases, discharged from hospital (other than mental hospitals) 38 10 Number included in line 9 who were visited at the special request of a G.P. or hospital 27 11 Number of tuberculous households visited 3 12 Number of households visited on account of other infectious diseases 9 13 Number of tuberculous households visited by tuberculosis visitors 744 appendix 14 VACCINATION AND IMMUNISATION Completed Primary Courses - Number of persons under age 16 Protection against Year of Birth Others under age 16 Total 1969 1968 1967 1966 1962-65 Diphtheria 307 1,472 221 43 114 34 2,191 Whooping Cough 306 1,459 215 43 71 10 2,104 Tetanus 307 1,478 221 48 126 333 2,513 Poliomyelitis 284 1,793 113 37 55 99 2,381 Measles 2 290 673 510 815 790 3,080 57 APPENDIX 15 VACCINATION AND IMMUNISATION (continued) Reinforcing Doses - Number of persons under age 16 Protection against Yeor of Birlh Others under age 16 Total 1969 1968 1967 1966 1962-65 Diphtheria - 463 1,119 119 2,414 192 4,307 Whooping Cough - 446 1,053 93 483 25 2,100 Tetanus — 464 1,121 124 2,419 597 4,725 Poliomyelitis - 301 1,189 219 2,665 701 5,075 APPENDIX 16 CHIROPODY SERVICE Details of new cases and treatment given in 1969 New Cases Treatments Children under school leaving age 340 2,768 Expectant mothers 27 85 Physically handicapped 130 667 Persons aged 65 years or over 882 19,968 1,379 23,488 HEALTH EDUCATION 59 HEALTH EDUCATION Kathleen M. E. Griffiths - Health Education Officer More and more questions are being asked regarding Health Education and the part it should play in a modern Social Services department. Certainly, these questions are difficult to answer and it is probable that they will be closely examined and some positive action taken in the not too distant future. We are in the midst of change, especially so in the re-organisation of health and social services and the preventive and educational services will, no doubt, receive a large "share of the cake"; Certainly this has been a challenging year for the health education staff. The problems of the working environment have occupied a great deal of our time!! However these and other problems have been overcome and a large amount of sterling work has been carried out by the departmental staff, most notably the health visitors', who have spent time both during and out of working hours in health teaching to young children, mothers and adult groups. To them, and to other professional staff, the health education service owes a great deal. Health Education in Schools The controversy continues as to who should be responsible for carrying out health teaching and whether it should be a "set" subject in the school curriculum. We most fortunate in being able to establish a useful working partnership with a growing number of schools, whereby many members of health and welfare staff contribute to health programmes. During the year we have increased the number of schools visited by our staff to thirteen secondary, and six junior schools plus one special school for the educationally sub-normal. This is an indication of the growing awareness in schools of this subject for their pupils. Indeed it is often the pupils themselves who request and instigate the visits. The fact that help is sought from the department shows an understanding of the specialised nature of the many facets of health education and the great value of outside help from specialists given within the framework of the school syllabus and curriculum. The topics range from talks on human development, safety qnd sex education to health problems of today's society. 60 Doctors have talked to senior secondary and grammar school children (usually school leavers) on some of today's medical problems which are preventable, and most valuable discussions have arisen from these talks not only on purely medical facts but the social implications. The young are really misunderstood if it is thought that they pay no due regard to their own behaviour, their own contribution to Society and to the solution to some of today's problems; but the fact is that they are on the whole most concerned with the misfortunes of others and are keen to try and "put things right". The part played by a health visitor is a large one - after the initial planning has been completed she carries out a series of talks and discussion groups as and when required by a school. The health education section gets asked quite frequently to give individual talks on sex education, venereal disease, problems of unmarried mothers, drug addiction, all of which have been given so much publicity through the mass media especially television. An example of this was the recent BBC programme for teachers and parents which dealt with sex education for junior schools. Both the health education officers have talked in the schools and to parents which has been a valuable opportunity. Mrs. Cannon's experience as a health visitor and as a qualified teacher enabled her as a Health Education Officer to give advice, guidance and suggestions both to staff and to lay audiences and she also carried out valuable work in the schools. Dental Health Education Redbridge, in common with other progressive Local Authorities has, the advantage of the services of our dental auxiliary who, as part of her duties, carries out dental health education to all sections of the community. Of her work in schools Mrs. Lewis writes " 1969 was yet another year in the fight against dental decay in children. In schools my Welsh accent was a particular source of amusement, when one small lad thought I had said to get "gnats" instead of nuts. It takes some explaining too, that eating apples and coconuts does not include toffee apples and chocolate coconut bars! 61 Unfortunately, there are still some children who do not possess their own toothbrush. One little girl explained that her toothbrush had lots of bristles because Grandma also used it - for her dentures! It would be a good idea if some way could be found to supply children with toothbrushes, probably on entry to school. As regards pre-school children, 1969 was a more promising year, with more dental health materials being produced for this age group; and also leaflets for parents on the importance of deciduous teeth. However, as we enter 1970 we must still try to improve the children's knowledge of dental health — particularly the boy who was most emphatic about wanting dentures, so that he could do a ventriloquist - type act with them between his fingers - like his grandfather did!!! Local Organisations in Redbridge A glowth in the number of requests for talks to voluntary and professional organisations show the trend towards "prevention" which the public are now beginning to demand. Talks and discussions have dealt with druig addiction, smoking and health, home safety and health problems of today's Society, as well as factual talks on the health service. It is remarkable that still too many people do not realise that they can help or where they can get it. There is a fluctuation in the demand for these talks and most have been carried out by health education officers. Hospitals A usfeful pilot scheme has been carried out by the health visitors in conjunction with a local hospital. Mrs. Wolffe writes "We were pleased to be able to help with mothercraft and relaxation for a short time at llford Maternity Hospital. This gave us the opportunity to train mothers inside a hospital and hear of the results from the midwives and the mothers themselves. 62 We were also able to adapt the "psychoprophylactic" method to the "Helen Herdman" method that is practised in this Hospital. In fact the type of method taught did not seem to matter. What helped the mothers most was being able to do something towards the birth of their baby, learning how to help themselves when the time comes. We were able to answer the many questions which worried them, in the short time for discussion after each relaxation session. We found that mothers really did enjoy this and we were able to reassure them allay their fears by answering their queries not only on pregnancy and labour but on baby care and feeding, and on the services provided by our Child Health Centres. We found that most of the mothers attended fairly regularly and a few practised at home and were quite confident by the end of their 6th lesson. We were very grateful for the co-operation and encouragement given to us by Matron and the Ante-Natal Clinic Staff. The evening parentcraft courses at 11 ford Maternity Hospital have continued, and have proved to be very popular as shown by the continued large attendances, especially on the evenings when the film "To Janet a Son"? has been shown, when fathers also attended in good numbers and they were very much welcomed. Cervical Cytology The education service set up some three years ago in the Clinic at this office has continued. Breast self examination techniques are demonstrated by the nursing staff to the ladies who attend, and the teaching aids provided are considered to be very helpful. Publicity and Mass Media After a re-appraisal of the situation and by general demand, poster distribution throughout the Borough continued at monthly intervals dealing with subjects of topical importance. Special campaigns have been mounted to cover the new colour coding for electrical wiring, immunisation, influenza, food hygiene, smoking and health. An example of a health project tied to action was the Dispose of Your Drugs Safely" Campaign - the idea of clearing out medicine cabinets and returning unwanted drugs to the chemists was something that appeals to most of us when positive action can be taken and results achieved. 63 Even so, the response was disappointing but at least the publicity reached a great number of Redbridge residents. Three new booklets have been produced dealing with two specific services, and also the first publication of its kind in the country dealing with the Guthrie Test for babies. The local press have continued to co-operate by giving publicity and support to these projects - we are most grateful for their help. It becomes even more urgent that we, as health educators, should be aware of the important developments that are taking place in terms of medical science - the "biocrats" are with us! Maybe we shall have to accept genetic counselling, genetic "engineering" which will allow the scientists to produce a human race free of some of the defects at present known to man. In this event, it would be even more important that we, as individuals, should be aware of the make up of our bodies and how they work in order to make thoughtful and valid decisions when the time arises. This is a somewhat "fragmented" resume of aspects of health education - it must of necessity be so - time to consider each subject in depth is not available. More time needs to be spent on research for health priorities, and for evaluation. V/e hope that in future reports we may be able to fulfill these aims. EDUCATION ACT, 1944 65 SCHOOL HEALTH SERVICE (W.H. Toms, M.B., Ch.B.(Edin.), Principal Medical Officer) The Plowden report recommended that children should be examined before school entry so the treatment of any handicapping condition could be commenced as early as possible, and any special educational needs considered by doctors and educationists working together. This type of examination developmentally angled is more time consuming than the usual examination after school entry so it was decided in implementing this proposal to limit the number of children seen to eight in a session, each session to be held at a Child Health Centre. The candidates for this earlier and extended examination are taken from those children attending Toddler Clinics - about 20% of the four year olds in the Borough. In practice a large pilot scheme is being operated and the great majority of young children are.still seen for the first time after their admission to primary school. Special attention is being paid to communication with the schools when children are examined before entry. When handicap is present or risk of handicap exists the school nurse or health visitor is responsible for putting the headteacher fully in the picture. Entrqnts to a large mixed secondary school are now being examined on a selective basis using a questionnaire to the parents devised by Dr. J. A. Howell, one of our Senior Departmental Medical Officers. The completed questionnaires are considered along with reports from the school teaching staff and the school nurse and a list of children for examination compiled, From this very small sample it would appear that about 30% of pupils should have a medical examination. As this group is one of high risk more time is given to each child than would be the case if all children in that age group (12 years) were to be examined. I should like to thank the teaching staff of Caterham School for their co-operation in this project. School Roll & Premises The school roll on 31st December, 1969 was 32,702. These children attended 95 schools and the figure includes 77 at the Ethel Davis School for physically handicapped children. 66 Medical Inspections 10,164 medical inspections were carried out in 1969 and of these only 23 were seen whose general physical condition was considered to be unsatisfactory (Appendix 17 Table A). In addition 1,003 special examinations were carried out (Appendix 17 Table B). With the co-operation of Head Teachers of schools in the borough, all immigrant children are medically examinated as so6n 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. Streening Tests of Vision and Hearing This service has continued satisfactorily during 1969, and the following is a summary of the examinations undertaken. Number Tested Number Passed Total Number of Defects Number Referred for Advice Vision 15,320 10,521 4,799 1,502 Number Tested Number Passed Number Advised. further Test Number Referred for Advice Hearing 12,532 9,731 2,416 385 Special Schools and Specialist Clinics 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 j the Appendiceis. Medical Treatment Minor Ailment Clinics: 511 children attended various clinics throughout the Borough in respect of minor ailments. Recuperative Holidays During 1969, 19 children were recommended for recuperative holidays and were placed by the Chief Education Officer. 67 Ophthalmic Clinics A summary of the attendances at the four clinics serving the Borough is as follows:- Number of Sessions New Cases Old Cases Total Attendances New Spectacles Prescribed Kenwood Gardens 94 239 741 1,372 404 Mayesbrook 92 229 504 1,442 267 Manford Way 31 56 131 296 63 Wanstead Place 23 101 221 400 149 Totals 240 625 1,597 3,510 883 Dr. R. Peswani, Ophthalmologist at Kenwood Gardens Clinic, reports as follows:— The work in this Clinic progressed smoothly during the past year. There are two sessions weekly and attendances have been fairly good. The work continues to be predominantly the investigation and treatment of refractive errors and squints in school children. Cases requiring orthoptic investigation and treatment are referred to the orthoptist after refraction. During the year orthoptic sessions were started at this clinic and this was welcomed by many parents as it meant a shorter journey for them. Dr. G. F. Ensor, Consultant Ophthalmologist submits the following report on the work of the Wanstead Place Ophthalmic Clinic:— The Ophthalmic clinic held on Wednesday morning at 35 V/anstead Place, E.11, has been very well attended this year. The staff includes a consultant ophthalmologist, orthoptist, dispensing optician,and ophthalmic secretary. This ensures that all patients have full and comprehensive treatment, with the minimum of visits. This is particularly important in the case of schoolchildren. The age of children attending the clinic for the first time appears to be getting younger. This is very satisfactory. In cases of strabismus in particular, the earlier treatment is commenced, the more beneficial it is likely to be. Amblyopia is less inclined to develop, and if present, is more easily eradicated. This is also the case with anisometropes, who are likely to develop amblyopia, if glasses are not prescribed and worn at an early age. 68 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. In conclusion I would thank the nursing staff for their co-operation in the smooth running of the clinics. Orthoptic Clinics During 1969 an additional Orthoptic Clinic, indispensable to a satisfactory ophthalmic service, was commenced at Kenwood Gardens Health Services Clinic, making three now operative in the Borough. The following is a summary of the attendances etc. at each clinic. No. of Sessions New Coses Investigated Total Attendances Cases Discharged Cases in Attendance at 31..12..69 Mayesbrook 149 182 394 45 93 Wan stead Place 47 41 324 12 30 Kenwood Gardens 30 29 83 11 78 Totals 226 252 801 68 201 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 Wanstead Place, A summary of the attendances of school children at these clinics is as follows:- 69  No. of Sessions New Cases Old Cases Total Attendances Kenwood Gardens 45 128 276 537 Mayesbrook 23 89 142 313 Manford Way 7 18 25 55 Wanstead Place 9 34 37 87 Totals 84 269 480 992 Mr. H.G. Korvin, F.R.C.S., Consultant Orthopaedic Surgeon at Kenwood Gardens and Mayesbrook Clinics reports as follows:— Mo new developments can be reported for the year 1969 from the orthopaedic clinics. It is my impression that, over the last few years, the proportion of "trifling" or indeed "normal" cases amongst those referred to the clinics has increased, while the total number has remained much the same. At first sight this would suggest a wasteful use of staff and installations, but this is not so. If in only a small fraction of these cases a minor defect can be detected and prevented from developing into a serious one, the effort is worth-while. The same applies to the considerable number of X-ray examinations carried out merely to confirm normal findings on clinical examination. One would like to think that the almost complete disappearance of "missed" congenital abnormalities from the clinics is due to an obsessional search for them at an early stage. Remedial Exercises and Physiotherapy Due to the decline in the number of cases requiring remedial exercises and physiotherapy in the Manford Way area, the number of sessions held at this clinic were reduced during 1969 to one per week. The following is a summary of attendances at all the four clinics held in the Borough. 70 Summary of Attendance of all Children New Cases Total Attendances Kenwood Gardens 78 214 Mayes brook 93 215 Manford Way 4 134 Wanstead Place 16 234 Totals 191 797 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:- No. of Sessions New Cases Old Cases Total Attendances Audiograms Advised Operation 48 206 84 513 195 107 In addition 42 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 18 were found to require operative treatment. Speech Clinics The following Speech Therapists were employed at the end of 1969:- 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. Mayesb'rook Clinic and St. Vincent's School. Mrs. Pretigus reports on their work as follows:- For the greater part of the year we were in the happy position of being fully staffed, but in September we lost both Miss Cox and Miss Littlewood by marriage and removal from the district. We wish them both every happiness, but it has not yet been possible to replace them, and the speech therapy service has had to be severely pruned. 71 We have withdrawn from the Remedial Education Classes, the Becontree Infant and Junior Schools, the Hyleford Junior Training School and the E.S.N. Unit at Woodford Bridge. Work at the Woodman Path Observation Unit has had to be reduced from 5 to 2 sessions, where the number of special defective children there is increasing. The school speech clinics at Manford Way, South Park and Wanstead Place have been closed, bringing extra pressure on the clinics that remain open, as the therapists there are attempting to give some treatment or advice to all urgent cases. This does, however, mean that they are under a strain with increased case loads and waiting lists. This year we were pleased to publish a pamphlet describing the special defects commonly found in school children, and circulate it to schools and other interested parties. The idea came from two Infant School teachers after a series of meetings to promote liaison between the schools and the school health services. School Dental Service Mr. E.V. Haigh, Principal School Dental Officer reports as follows:— The school dental service continued to give treatment to school children at the following Clinics. The number of surgeries at each Clinic and attendances made for treatment is shown:- Clinic No. of Surgeries Attendances for Treatment Mayes brook 2 3,474 Kenwood 2 3,277 Manford Way 1 1,662 Valentines 2 2,235 118 Hermon Hill 1 1,756 South Park 1 929 Total 9 13,333 Staffing During 1969 the staffing position slightly improved and by the end of the year the full-time equivalent of 5.4 dental officers were employed on the school dental service. It is worth noting that the full-timeequivalent dental officers employed has not changed considerably over the past seven years, and it is now exactly the same as in 1962. 72 However, in 1962 the school population of the 11 ford area was 22,500 whereas now the Redbridge school population is over 32,000. In 1960 it was only possible to inspect 6,5% of the children; this figure has slowly increased over the ten years to 1969 when 95% were inspected. This has been possible for two reasons. Firstly, less demand for treatment on the school dental service, as more conservative treatment is now being carried out under the general dental service and, secondly, the higher standard of dental health in school children which, I am sure, is due to the increase in dental health education which has gone on over the past years. The aims of the service are in the following order:— 1. Inspection of as many children as possible each year. 2. Treatment of all who wish to receive it through the school dental service. 3. Dental health education. Inspections It is very important that as many children as possible are dentally examined each year. It is often only by these inspections that parents can be informed that their children require dental treatment. During 1969 30,359 children were dentally examined and this represents 95% of the school population. It has taken a considerable effort to achieve this but looking to the future I think that one inspection per year is not sufficient. Teeth in children can decay very rapidly and, therefore, an inspection every 4-6 months would be the ideal. There are many difficulties to overcome before this will be possible. The number of children referred for treatment was 12,970. I think this figure shows the value of school dental inspections. Treatment Treatment was carried out on all patients accepting it from the Authority. The South Park Dental Clinic, which commenced to treat patients in October 1968, continued during 1969 with six sessions per week. The number of patients attending has slowly increased. The six sessions per week appear to be adequate for the school population in the Clinic area. The number of crowns supplied mainly to children having broken one or more front teeth, increased considerably. This shows a higher 73 standard of dentistry is being carried out in the Clinics and the output of work also increased. Dental Health A dental auxiliary has continued to be employed at Kenwood Clinic under the supervision of a senior dental officer. Besides the dental auxiliary's clinical duties, she has undertaken more dental health education in infant, junior and senior schools, creating dental posters to help in this work. 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. Equipment The yearly progressive programme for the replacement of older obsolete equipment continued as far as the financial squeeze permitted. A new dental chair was provided at Manford Way but unfortunately a replacement unit for Mayesbrook had to be postponed due to the sudden increase in cost of the unit. Obviously the longer the delay in ordering, the higher the cost, and should the old unit become completely unserviceable, the surgery would have to be closed. The standard of decoration in surgery and waiting rooms was maintained. This is most important from the point of view of hygiene. The general high standard of decoration was praised by the Chief Dental Officer from the Department of Education and Science during a recent visit. Fluoridation The benefits of increasing the amount of fluoride in the water supply to the recommended level of one part per million are still being denied to the population of Redbridge. Although the Department of Health and Social Security has campaigned for this very strongly, it seems that it may take years before this great step forward in preventive dentistry will occur. This is due to a few misguided Local Authorities who refuse to have fluoride added to the water. 74 The Ethel Davis School Dr. A.J. Howell, Medical Officer in Charge reports:- 1969 has been a particularly busy year at The Ethel Davis School as regards new pupils, there having been no fewer than 32 discharges and 24 admissions. V/hile there has been no great change in purely medical work, more attention is being paid in the latter part of pupils' time at school to potentialities for work and optimum placements. In this connection Miss Hill, Assistant Principal Social Worker, regularly attends meetings with Mr. Farrell, Mr. Causton, parents and myself to discuss school leavers. We have also established a much closer link with the Queen Elizabeth Training College at Leatherhead. At present we have under consideration the possibility of riding instruction for some pupils where it might improve their balance. More important perhaps an extension of swimming activities is being investigated. At present some pupils have hydrotherapy in our own pool and the older ones who are fit enough are taken to the ordinary baths at Ilford. However, there are a large number of either young or more severely handicapped pupils who would benefit either emotionally or physically from swimming but require a more heated pool and more individual attention. At present the only facility of this kind is at the pool at Dr. Barnardo's, V/oodford, on Saturday afternoons during the summer months under the care of The Dolphin Club. I would hope that in the future some similar facility might be available for pupils on a weekday afternoon. Staff We very much regret that Mr. Lee, our Orthopaedic Consultant, officially retired on 17th December 1969 after nine years supervision of pupils at The Ethel Davis School. His expert advice has been much appreciated and he will be greatly missed. We extend our best wishes to him in his retirement. During the past year Mrs. Hearne, Physiotherapist, was attached to the school part-time and Mrs. Percival replaced Mrs. Hollows as nurse assisting Mr. Brand. Already both have given excellent service. During 1969 there were 24 admissions and 32 discharges, recommendations for admissions being received from the following sources:- 75 Other Authorities 6 School Medical Officer 12 Hospital 5 Temporary Care whilst in this area 1 Total 24 The diagnoses of admissions were as follows:- Arthrogryposis Multiplexa 1 Asthma 2 Bronchitis 2 Cerebral Palsy 10 Compound fracture of skull 1 Kidney disease 1 Muscular Dystrophy 2 Spina Bifida 1 Spina Bifida/Congenital Dislocation of the Hip 1 Spinal Tumour 1 Spinal Tumour/Epilepsy 1 Talipes 1 fhilld Guidance Clinic Dr. W.P. Gurassa, Consultant Psychiatrist of the Redbridge Child Guidance Clinic submits the following report of the work undertaken during the year:- Dr. Doron left and also Mrs. Freud. Psychotherapists are in short supply and usually live in central London so that we have to devise ways of tempting them to make the journey out to Redbridge. We can offer a fully staffed team in a large and lively Clinic, but unfortunately we cannot offer the same rates of pay as elsewhere in central London, so that we are often short staffed" and as a consequence are limited in the treatment we can offer the children, especially individually. We continue to develop our work with groups. We have play groups where younger children can express their feelings in play with materials such as sand, paints, dolls house, tin soldiers, etc., and so come to terms with themselves and their families. There are also groups for older children in which the children can discuss their problems with the therapist and with each other and so gain insight which enables them to modify their behaviour. We would like to extend this way of working yet further, and are at present planning groups for parents. 76 Weappreciate the support given by our colleagues in Clements Road. Lines of communication now seem shorter, as we get to know our colleagues better. V/e are particularly grateful for the effort which has gone into redecorating and refurnishing the Clinic; our patients have commented with delight on the brightness and gay colours which have, we feel sure, a therapeutic effect. School Psychological Service For the year's work during 1969, Miss S. V. Gascoyne, Miss C.H. Watt and Mr. R. Azam, Educational Psychologists, report as follows:- There have been various changes in the special educational units over the past year. In July we were sorry to lose Mrs. Bowman the teacher in charge of the Treeside Unit after four invaluable years' work, V/e wish her well in her new post as a lecturer at Avery Hill. We are fortunate in having Mr. Brown, an experienced teacher in the field of maladjusted children to carry on in her place so the work of the unit has been continued without any major disruption. During last year several children left Treeside to return to normal schools. This was accomplished successfully in all cases. Dr. Doron the psychotherapist who carried on weekly treatment at the Unit was a considerable help to all the children and we very much regret that he left in July. As yet no replacement has been found to carry on his work. Mrs. Shipp, in charge of the Observation Unit left the area after her marriage in July, we were grateful to her for all the hard work and help she had brought to the children over the last three years. During the year there were a number of successful transfers to the Woodford Bridge Unit. Miss Chase, in charge of the Autistic Unit is now in overall charge of a larger and more comprehensive Observation Centre which incorporates the autistic group of children. This has led to the interesting inclusion of two autistic children in separate observation groups with six children in each and definite progress has been made so that it was not felt necessary to transfer them back with other autistic children when a teacher was available to take them. This is very encouraging as the original reason for having both units under the same roof was to provide more normal companionship for autistic children when they could begin to work and play in a larger group. 77 The Remedial Centre has expanded very profitably to help more children in part-time tutorials. Mrs. Humphreys went to St. Barnabas Boys' School for three days a week for a year. During this time she did remedial work with more than 20 children with reading ages from six to eight years. There was an average gain of three years reading ability over this time which meant the children could do their full range of normal school work at the end of the year. Three children who had made little progress were then placed for intensive work full time at the Remedial Centre. A similar tutorial system was set up at St. Vincent's School to make a concentrated effort to give remedial help'to the chiIdren there. This should prove a more economical way of helping in schools where there have been concentrations of children with low ability and should cut down the waiting list for children who need to come to the Remedial Centre. The increased number of tutorials as against full-time attendance at the Centre has also been beneficial to many children so that more overall help can be given to greater numbers. We very much welcome these developments which should in time cut out much of the frustration of long waiting lists. The psychologists have been involved in the mounting local interest in nursery groups. A series of talks were given on child development in the pre-school years. Miss Watt has started a teacher's group for regular weekly discussion on the psychological aspects in treatment of severe reading disability. During the year a very successful meeting was held at the Child Guidance Clinic with Head Teachers from three schools to discuss adolescents. The original purpose was to discuss normal adolescent behaviour with members of the Clinic teams. This was felt to be so worthwhile that further meetings with more teachers are planned. Over the year three mature students have been supervised by the psychologists. Two are in training as educational psychologists, one from the Tavistock Clinic and one from University College. There has also been a student on the course for teachers of maladjusted children. New Cases 213 Follow up (or schools 215 Remedial Education 58 Children referred 43 78 Enuresis Clinic Dr. Joan M. Pooley, Senior Departmental Medical Officer, reports as follows:- During the 12 months ended 31st December 1969, the Enuresis Clinic has been held weekly at the Kenwood Gardens Clinic, and fortnightly or monthly at the Mayesbrook Clinic, according to the number of cases to be seen. 1. SESSIONS AND NEW CASES:- Kenwood Gardens Mayesbrook Total Sessions held 43 11 54 New Cases seen 111 36 147 (of which 23 were under 5 yrs. of age) (3 under 5 years) Total attendances (Old and new cases) 581 129 710 Total seen under 5 years of age 71 6 77 Throughout the year the attendances have been good, although a certain number have failed to re-attend after 3 or d interviews and have subsequently been found to be "dry". II. ARPOINTMENT ANALYSIS (both clinics):- Under 5 years Over 5 years Recommended by — Boys Girls Boys Girls 1. Infant Welfare Medical Officers 13 8 - - 2. School Medical Officers - - 50 38 5 3. General Practitioners 2 2 6 4. Parents - 1 4 3 5. Health Visitors 1 - 4 4 6. Transfers into area - - 2 - 7. Hospitals - - 2 - 8. E.N.T. Consultant 1 - - - 9. Child Care Officer - - 1 - Total = 147 17 11 69 50 79 These figures are strikingly similar to those seen and reported on each year, over the past 6 years. Once again, one wogld mention with appreciation, the complete liaison and co-operation shown by the general practitioners over many years. III. ANALYSIS OF TREATMENT 1. GENERAL With each child a considerable amount of time is devoted to a thorough history taking, during which a number of constructive suggestions are made. The approach is mode almost entirely through the child, with the Mother (or Father) at hand to help in eliciting an accurate history. It is encouraging to note the increasing interest and co-operation of the Mother as the child's confidence and enthusiasm is gained. This approach, with the added explanation of a strict routine, "lifting system", etc. etc., coupled with instruction to the child about the charting of all dry nights, has proved over the years, to be all important in speeding on a "cure". The existence of the "Pre-waking Enuretic" is now well recognised and a period of 6 or 8 weeks of consecutive early (5 a.m.) waking by parents or an alarm, often proves sufficient to establish a reflex waking habit. 2. SPECIFIC (i) Of behaviour, anxiety or home problems This aspect of the etiology of enuresis is extremely varied and of great significance and naturally needs to be discussed and treated with diplomacy and care - often taking up a considerable amount of "therapeutic time". (ii) Drug Therapy This is issued by liaison with the patient's general practitioner. The drugs most commonly used have been:- 1. Amitriptyline 2. Imipramine 3. Dexten 4. Limbitrol - 5 (more recently) 80 Limbitrol - 5 (Roche), is a combination of chlordiaze-poxide (librium) 5 mgms.and amitriptyline (tryptizol) 12.5 mgms. and has been used more (requently in recent months. The' preparation was first used on a trial basis with the co-operation of Roche Ltd., and more frequently since it has been established on the market, as it has proved a very useful therapeutic agent. ANALYSIS OF CASES RECEIVING TREATMENT TYPE OF TREATMENT Bed Buzzer Amitriptyline Imipramine Dexten Limbitrol-51 Dosage Dosage Dosage Dosage Plus or minus dexten 5 mgms. (Tablets or syrup in 10 or 25 mgm. doses) at bedtime or tea and bedtime. (Tablets or syrup in 10 or 25 mgm. doses) at bedtime (Bonded amphetamine 5 mgms.) at bedtime or 11 p.m. (1 capsule) ½ hour before bedtime. Number of children treated:- 50 82 62 34 65 | There are 33 bed buzzers available for use through the clinics. IV. RESULTS During 1969:- 59 cases were discharged "dry" - 50 Kenwood and 9 Mayesbrook, plus 15 cases who were considered 'self-discharged'. Total coses discharged during the year (old and new cases, including removals and defaulters) 105 (= 87 Kenwood and 18 Mayesbrook) Conclusiqn So many are the theses, surveys, reviews and case analyses that have been written up or presented on the problem of Enuresis, that itl must now be recognised and accepted that any sort of attempt at generalisation or classification is going to lead either nowhere, or to a state of complete confusion and erroneous conclusion. The "Enuretic Child" (or Adult) can only be regarded as a Low unto Itself''. 81 "A COMMON FACTOR" Out of the many thousands of children treated, however, and from the midst of the weight of printed material now available, one "common factor'' is quite definitely emerging:- ANXIETY. Whether the Anxiety be an Etiological Factor of, or a Resultant Symptom from, the Enuretic Condition - if the child is "one who cares" and wants to be cured - he is an "Anxious Child" to a greater or lesser extent. The Existence of Anxiety as a common factor in both Primary and Secondary Enuresis and the important role which it plays, has probably not been fully recognised, yet it surely indicates the most logical line of therapeutic approach. Peripatetic Teachers for the Partially Hearing The Peripatetic Teacher for the Partially Hearing, Miss H.C. Hodges, submi ts the following report in conjunction with Mrs. J. Carney:— As usual the work of the peripatetic teachers has concerned partially hearing pre-school age 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 some testing hearing. Miss Hodges completed her University Course in July and returned to peripatetic work in September, when a third member was appointed to our team - Mrs. B. Savage, another qualified teacher of the deaf. With a team of three it is possible to give very adequate supervision to the children on our register and we can now offer two sessions of auditory training a week, where necessary, to pre-school age children, which helps their progress considerably. At present there are 42 children on the register. Of these 9 of preschool age, 11 are in primary schools, 19 in secondary schools and 3 in special schools. During the year we have made 511 visits to these chiIdren, their parents and teachers, in homes, day nurseries and schools. In the past year three chiIdren have been recommended for special educational treatment. Of these, one A year old girl was admitted to the 82 Partially Hearing Unit in Barking in September, and a severely deaf 3 year old boy is waiting for admission to Hawkswood School. One 8 year old boy is waiting for admission to a Steiner School. One junior pupil removed to Kent and has been referred to the senior teacher for deaf children in that area. One boy with a severe high frequency hearing loss was successful in the 11+ examination and has entered West Hatch Technical High School, and a senior boy has obtained a pass in eight subjects in the Ordinary Level General Certificate of Education. During the year deafness has been diagnosed in 4 pre-school children, and 4 children in attendance at junior schools, and hearing aids have been issued. Several children have now been issued with the new Medresco postaural hearing aid to replace their body-worn Medresco aids. Once again I would like to thank the Matrons and staff of the two Day Nurseries in the Borough for their continued help and support in our work with our youngest DUDils. Handicapped ChiIdren The number of children coming within the various categories and their disposition as at 31st December, 1969 is shown in the table at the end (Appehdix 20). B.C.G. Vaccinatior of School Chi Idren 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. 2,735 pupils were offered B.C.G. vaccination and of this number 1,777 or 65% consented. 1,406 or 78% received vaccination. 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:- I find that like surrounding boroughs we have had quite a lot of head infestation in schools this year. Certainly, too, we have had many more cases of scabies. Many parents are naturally shocked at such "happenings" and tend to unload their wrath on the school nurse. We 83 have tried to improve our communications with Head Teachers and with this in view the Health Visitor does try to discuss children she knows entering school who may give cause for concern. A good deal of valuable work has been done amongst the Asian community by a State Registered Nurse speaking the language of the mothers (Appendix 17, Table C). Health Visitors and School Nurses, have met teachers at symposia at the Teachers Training Centre; these often lead to valuable discussions. Later programmes of health education or single talks have been asked for at schools. This year we started to examine some 4'/2 year old children before their entry to school. V/e could not hope to cover the whole of the population but these sessions are held in purpose built clinics where both the doctor and health visitor can spend-so much more time discussing the child's health both mentally and physically. Space for periodic medicals in schoofs has always been difficult and it was felt if such examinations could be done in clinics, this would help. We have also been pleased to participate in panel type talks and discussions in two girls' grammar schools this year. Their questions have been enlightening and knowledgeable and certainly they are well equipped to enter the world of work without the fears which beset many youngsters in the past. The giving of knowledge is a tremendous responsibility and it is reassuring to know that the majority of parents support their child's teachers, in arranging such meetings. One health visitor has been pleased to participate in a "ParentTeachers Association Meeting". This was a lively affair which has since proved valuable as the parents now come to the health visitor for advice. General Welfare and Research Welfare The National Society for the Prevention of Cruelty to Children (West Ham Branch) submits the following particulars of the work undertaken in Redbridge:- Cases 41 New cases opened 109 Children involved in new cases 84 Referred by 14 Parent 3 Other relative 17 General public 7 Official Ages of the chiIdren 19 Under two years 28 2 and under 5 years 32 5 and under 11 years 23 11 and under 15 years 7 15 and under 18 years Chi Idren found to be 3 Lacking physical care 1 Physically injured 3 Emotionally disturbed 100 At risk but without symptom at present 2 Not living at home The fomily 13 Serious disharmony between parents 7 Disturbed parent/child relationship 10 Only one parent 2 Physical disability in family 9 Mental or emotional disability in family 8 Parent(s) from outside U.K. 5 Serious financial problem 4 Unsatisfactory housing Court action 1 Juvenile Court case Visits and interviews 557 Home visits Chiropody During the year 606 school children were referred to the Clinics for treatment (mostly for Verrucae) and many parents were advised regarding suitable shoes for their children. 85 Surveys and Research In 1958, all children in England, Scotland and Wales, born in the week 3rd to 9th March, were the subject of a questionnaire devised by the National Birthday Trust. In 1964 the opportunity arose to study the same children again and the National Child Development Study, supported by Government Funds, was set up for this purpose. 90% of the original group were traced and information obtained on their progress and present condition from schools, parents, and medical officers who carried out a full medical examination. Much important information flowed out of this assessment. For example, it was discovered that three children in every thousand had a degree of hearing loss sufficient to warrant some form of special educational treatment, and that squinting children, as a group, had a lower educational performance, poorer social adjustment, and poorer physical co-ordination than the rest of the sample. Descriptive findings by no means exhaust the possibilities of this study and as an example, it was found that children who were premature either by gestational age or low birthweight are not only more likely to have a handicap than full term infants, but are likely to fare less well at school with learning and behaviour problems. In March 1969, these children were eleven, and again all authorities co-operated to assess their history and present social, educational, and physical condition. Sixty children in the Redbridge area were examined by local authority doctors, who received valuable help from speech therapists and health visitors, and the conclusions reached by the National Child Development Council on this group throughout the country is awaited with great interest. The causes of death among children of school age resident in Redbridge during 1969 were:- Accident 3 Asthma 1 Cerebral Haemorrhage 1 Leukaemia 1 Lymphosarcoma 1 Tumour 2 9 86 appendix 17 DEPARTMENT OF EDUCATION AND SCIENCE MEDICAL INSPECTION AND TREATMENT RETURN FOR THE YEAR ENDED 31st DECEMBER, 1969 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) 1965 and later 169 169 - 2 5 7 1964 1,360 1,360 - 23 123 145 1963 2,190 2,134 6 36 184 217 1962 829 827 2 13 76 88 1961 139 139 - 5 11 16 1960 128 127 1 6 19 24 1959 108 106 2 8 8 16 1958 224 223 1 10 19 28 1957 1,414 1,413 1 42 121 156 1956 770 766 4 30 52 82 1955 143 141 2 6 11 16 1954 and earlier 2,690 2,686 4 138 163 294 TOTALS 10,164 10,141 23 319 792 1,089 Col. (3) total as a percentage of Col. (2) total - 99.77% Col. (4) total as a percentage of Col. (2) total - .23% 87 APPENDIX 17 (continued) TABLE B. - OTHER INSPECTIONS NOTES: A special inspection is one that is carried out at the special request of a parent, doctor, nurse, teacher or other person. 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 424 Number of Re-inspections 579 Total 1,003 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 26,083 (ii) Total number of individual pupils found to be infested 143 (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:- 3y Local Authority 10 By parents 133 88 APPENDIX 17 (continued) Part II — Defects Found by Periodic and Special Medical Inspections during the Year Defect or Disease Number of Defects Requiring Treatment Number of Defects Requiring Observation but not Treatment Periodic Inspection Special Inspection Periodic Inspection Special Inspection Skin 109 - 246 - Eyes - a. Vision 319 3 264 2 b. Squint 23 - 44 - c. Other 17 - 40 - Ears — a. Hearing 18 80 108 24 b. Otitis Media 4 - 43 - c. Other 5 2 41 1 Nose or Throat 96 2 413 4 Speech 57 2 84 1 Lymphatic Glands 1 - 138 - Heart and Circulation 18 1 131 - Lungs 21 2 186 2 Development — a. Hernia 24 1 29 - b. Other 47 5 217 10 Orthopaedic — a. Posture 17 1 57 1 b. Feet 87 1 235 - c. Other 79 - 238 - Nervous System — a. Epilepsy 5 - 31 - b. Other 2 - 57 - Psychological - a. Development 1 18 97 - b. Stability 24 32 225 - Abdomen 3 - 22 1 Other 165 6 350 10 89 APPENDIX 17 (continued) Port 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. TABLE A. - EYE DISEASES, DEFECTIVE VISION AND SQUINT Number of cases known to have been dealt with External and other, excluding errors of refraction and squint 4 Errors of refraction (including squint) 1,958 Total 1,962 Number of pupils for whom spectacles were prescribed 842 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 13 b. for adenoids and chronic tonsillitis 160 c. for other nose and throat conditions 13 Received other forms of treatment 237 Total 423 Total number of pupils in schools who ore known to have been provided with hearing aids - a. In 1969 20 b. In previous years 73 90 APPENDIX 17 (continued) TABLE C. - ORTHOPAEDIC AND POSTURAL DEFECTS Number of cases known to have been treated a. Pupils treated at clinics or out-patient departments 601 b. Pupils treated at school for postural defects 18 Total 619 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 2 — b. Body - Scabies 13 Impetigo 1 Other skin diseases 182 Total 198 TABLE E. - CHILD GUIDANCE TREATMENT Number known to have been treated Pupils treated at Child Guidance Clinics 175 91 APPENDIX 17 (continued) TABLE F. - SPEECH THERAPY Number known to have been treated Pupils treated by Speech Therapists 437 TABLE G. - OTHER TREATMENT GIVEN ] Number known to have been dealt with a. Pupils with minor ailments 280 b. Pupils who received convalescent treatment under School Health Service arrangements 19 c. Pupils who received B.C.G. vaccination 1,406 d. Pupils who attended the Enuresis Clinic 235 Total 1,940 92 APPENDIX 18 DENTAL INSPECTION AND TREATMENT Attendances and Treatment Number of first visits 4,608 Number of subsequent visits 8,725 Number of total visits 13,333 Number of additional courses of treatment commenced 1,033 Number of fillings in permanent teeth 7,769 Number of fillings in deciduous teeth 4,498 Number of permanent teeth filled 6,791 Number of deciduous teeth filled 4,256 Number of permanent teeth extracted 435 Number of deciduous teeth extracted 2,168 Number of extractions under general anaesthetics 552 Number of emergencies treated 167 Number of pupils x-rayed 335 Number of pupils who received prophylaxis 1,430 Number of teeth otherwise conserved 302, Number of teeth root filled 33 Number of inlays - Number of crowns 24 Number of courses of treatment completed 4,423 Orthodontics Number of cases remaining from previous year 214 Number of new cases commenced during year 106 Number of cases completed during the year 66 Number of cases discontinued during the year 4 Number of removable appliances fitted 132 Number of fixed appliances fitted 1 Number of pupils referred to Hospital Consultants 3 Dentures Pupils supplied with Full upper or Full lower (first time) - Pupils supplied with other dentures (first time) 11 Number of dentures supplied 13 93 APPENDIX 18 (continued) Anaesthetics Number of General Anaesthetics administered by Dental Officers - Inspections (a) First inspection at school - Number of pupils 26,482 (b) First inspection at clinic — Number of pupils 3,877 Number of (a) and (b) found to require treatment 12,970 (c) Pupils re-inspected at school clinic 1,658 Number of (c) found to require treatment 1,119 Sessions Number of sessions devoted to treatment 2,260 Number of sessions devoted to inspection 203 Number of sessions devoted to Dental Health Education 134 94 APPENDIX 19 SCHOOL HEALTH SERVICE: STAFF AND SCHOOL CLINICS (As at 31st December, 1969) 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. Femandes, M.B., D.P.H., D.I.H., D.C.H. Principal Medical Officer - W. H. Toms, M.B., Ch.B. (Edin.) Principal School Dental Officer - E. V. Haigh, L.D.S., R.C.S. Number of Officers Number in terms of full-time Officers employed (a) Medical Officers (including the Principal School Medical Officer) — (i) Whole-time School Health Service - - (ii) Whole-time School Health Service and Local Health Service 8 2.8 (iii) General Practitioners working part-time in the School Health Service 11 .7 (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 3.5 (iii) Part-time School Health Service (including Orthodontists) ... 5 1.9 (iv) Dental surgery assistants 7 7.0 (v) Dental Auxiliary 1 6 (c) (i) Senior Speech Therapists _ - (ii) Speech Therapists 3 2.6 (iii) Assistant Speech Therapists - — (d) (i) Audiometricians — - (ii) Chiropodists (4 Full-time plus 9 Contractual) 13 .4 (iii) Orthopaedic Nurses - — (iv) Orthoptists - — (v) Physiotherapists 3 2.4 (vi) Remedial Gymnasts - — (vii) Occupational Therapists 1 1.0 (viii) Clinical Technicians employed on Audiometry and vision screening 3 2.0 (e) (i) Nurses 48 13.4 (ii) Number included at (i) Who hold Health Visitors Certificates 35 7.0 (iii) Nursing Assistants and Trainee Nurses — - 95 APPENDIX 19 (continued) II. - NUMBER OF SCHOOL CLINICS (i.e. premises at which Clinics are held for school-children) provided for the medical and/or dental examination and treatment of pupils attending maintained primary and secondary schools. Number of School Clinics 18 III. - TYPE OF EXAMINATION AND/OR TREATMENT provided at the School Clinics returned in Section II. Examination and/or Treatment Number of Clinics Minor ailment and other non-specialist examination or treatment 7 Audiometry 1 Chiropody 9 Dental 6 Ear, Nose and Throat 1 Enuretic 2 Ophthalmic 4 Orthoptic 3 Orthopaedic 4 Physiotherapy and remedial exercises 5 Speech Therapy 12 School Medical Officers special examination 16 Vaccination and Immunisation 9 Cerebral Palsy Unit 1 96 APPENDIX 19 (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 .8 (ii) Educational Psychologists 3 1.5 1.5 (iii) Psychiatric Social Workers 5 - 5.0 (iv) Child Psychotherapists (Contractual) 1 - .7 (v) Remedial Teacher 1 - 1.0 97 APPENDIX 20 handicapped children category Number of children of school age formally ascertained as handicapped pupils and requiring special educational treatment (S.E.T.) Attending day special school Awaiting placement in day special school Attending residential special school Awaiting placement in residential special school Attending boarding homes Awaiting placement in boarding homes Attending independent schools Awaiting placement in independent schools Attending hospital schools Awaiting placement in hospital schools Receiving Education in hospital under Section 56 Receiving home tuition under Section 56 Awaiting home tuition under Section 56 Total number of children of school age requiring S.E.T. Blind - - 2 1 - - - - - - - - - 3 Partially Sighted 15 1 3 - - - - - - - - - - 19 Deaf 6 - 2 1 - - 8 - - - - - - 17 Partially Deaf 9 2 5 - - - 7 - - - - - - 23 Delicate 1 - 4 - - - 1 - - - - - - 6 Physically Handicapped 54 2 12 1 - - 5 - 3 - - - 1 78 E.S.N. 120 9 15 2 - - 3 - - - - - - 149 Maladjusted 1 - 18 9 - - 16 - - - - - - 44 Epileptic - - 1 - - - - - - - - - - 1 Speech Defect 1 - 3 - - - - - - - - - - 4 TOTALS 207 14 65 14 - - 40 - 3 - - - - 344 PLATE 1 Home Help Service PLATE 2 Residents' Coach Outing — "Forest Dene Home for the Elderly PLATE 3 School Medical Examination - Newbury Hall PLATE 4 Old Time Dancing - Fullwell Cross Day Centre PLATE 5 Goodmayes Lane Day Nursery PLATE 6 Occupational Centre for the Physically Handicapped, Fellowship House, Green Lane PLATE 7 Special Care Unit - Hyleford Junior Training School MENTAL HEALTH 99 MENTAL HEALTH SERVICE (C.H.A. Wedeles, L.R.C.P., M.R.C.S., D.P.M.(Lond.) (Medical Officer for Mental Health) General The Mental Health of the Service has emerged reasonably intact from the year of coloured papers with their glossy prospects, in such contrast to the embattled reality. We have chipped away at our programme of doing a little better and a little more, and of seizing opportunities to knit in with the work of other psychiatric agencies, Hospital, Child Guidance Clinic, etc. Seasoned personnel for social work posts has been hard to come by; people seem to be staying put awaiting re-organisation. Our vacancies have thus been mainly filled with graduate recruits, whose training absorbs a great deal of the time of senior staff. We estimate that given twenty-five Mental Health Social Workers, we could do justice to the work generated in the Borough — a target not within the realm of present possibilities. A good deal of informal discussion and some research have taken place about operating Area Teams from Area Offices. We have a fair idea of the best locations for these from maps we have plotted showing the incidence and distribution of cases. No decisions have, as yet, crystallised. Such deployment would have clear value in reducing travelling times, lead to improved contacts with clients and referring agencies, especially general practitioners, and relieve our increasingly very cramped working conditions. We intend to appoint, in 1970, a Training Officer for the Social Services; he is to undertake the work of all staff development and recruitment. Such a post should, in time, relieve fieldworkers of a heavy burden of responsibility and help to ensure the continuous raising of standards of work. Abury House Hostel for the Mentally III In May, we opened Abury House as a twelve-bedded Mental Health Hostel. We use it as a staging post for patients on their return from hospital to ordinary life, and for others who, whilst not needing full hospital services, require residential care for a period of time. All referrals are seen by the Principal Medical Officer, the Principal Mental 100 Heolth Social Worker and the Warden; admissions and discharge decisions are made jointly. We find the usual difficulty in getting referrals of suitable patients in adequate numbers, but think that they are to be found in acute admission wards, psychiatric out-patients and general practice, where we are building up contacts. The "ethos" of the Hostel is one of reasonable tolerance and understanding by staff of residents' problems, coupled with maximum encouragement of their adult capabilities and responsibilities. Sheltered Accommodation The project for re-settling long-standing psychiatric patients from local hospitals into Local Authority Sheltered Accommodation is well under way. Several are now living in warden-supervised flatlets, run by our Housing Department; a council house, being adapted as a group-home for four patients will be ready shortly. These schemes are self-supporting, since patients pay rent either out of earnings or from M.S.S. allowances. It appears that there is a fair supply of patients with personalities able to sustain a reasonably independent life in such sheltered conditions, with minimum supervision. Such provision would thus appear to be an economic and humane way of dealing with quite a proportion of our future chronic psychotic population. A plentiful supply of varied housing, and flexible housing policies, must have very high priority in helping to solve our social and medical welfare problems. Care of Sub-Normals The same would apply, of course, to the future care of subnormalsj of all categories. The distance, let along the overcrowding, of our catchment area Subnormality Hospital at Colchester remains a distressing fact of life. The hospital is being most helpful in difficult circumstances, and plans to offer us local out-patient facilities next year: a very desirable service. We are moving as fast as we can, taking into account the shortage of all resources, to get our hostel programme off the ground. We hope to have the first one open in 1970/71 and another one possibly soon after. We would greatly welcome a small Day-Hqspital of say 30-40 beds, possibly to be shared with a neighbouring Borough, in our vicinity. This should offer day-care on week-days, as well as longer periods of temporary care, to the whole range of subnormality problems of all ages. We wonder if a unit, suitable for adaptation, may not exist in one of the local hospitals, or could not be added to it. 101 Meanwhile, we have set aside money to carry out a survey into the needs of our subnormal population. In this, we hope to have the assistance of the G.L.C. Intelligence Unit, and to emerQe with clearer ideas of how best to plan future services. Adult Iraining Centre Our search for a suitable site for a second Adult Training Centre has, so far, been fruitless. A second Centre is becoming a matter of urgency, since our waiting list for Burnside is steadily growing. We try to alleviate distress arising from this by rationing attendance, and where possible, by 'boxing and coxing' some of the trainees. A suitable venue for a temporary 'overflow' unit has similarly not been found. Waltham Forest have kindly offered us some of their present spare capacity at one of their centres; the transport problem, except in the odd case, is however formidable. Good progress has been made in refining the social training programme for adult subnormals, and linking this with a meaningful production process. A Point Scheme of incentive payments has been instituted, and all earnings are now distributed to trainees according to points earned. The staff are improving contacts with parents, in order to further the trainees' welfare and training. Much thought is also being given to improving liaison with the Junior Training School and to devising good transitional procedures. Hyleford Junior Training School The Hyleford Junior Training School continues to receive a large number of visitors, who are attracted by the novelty of the building and the reputation of its staff. We receive a steady stream of applications from young women who wish to work there in order to learn about looking after mentally handicapped children, prior to formal training. Here again, we have a small waiting list for Special-Care children, and try to help as many as possible by rationing attendance. A meeting with the Education Authority to lay plans for future provision is due to take place quite soon. The local Parents' Societies have raised a considerable sum of money and commissioned an architect to design an Adventure Playground adjacent to the school on land made available by the Education Committee. This should be a very exciting addition to the school's ability to train for independence and self-confidence. 102 It is likely that we shall drop, next year, the annual week's Camp for the mentally handicapped. It throws an excessive burden on already hardworking staff, who provide a very full programme in term time, including outings and special treats. Temporary care will, of course, continue to be offered where needed. We are considering the possibility of taking small groups of adult trainees on more educational holidays, on something like 'Boy Scout' lines. Fullwell Cross Rehabilitation Centre Work on our Fullwell Cross Rehabilitation Centre, which is to serve as an Advanced Training Unit for physically handicapped and mentally ill patients with suitable potentialities, is due to start next Spring. We should like to have, at an early date, a Unit serving as o Sheltered Workshop for mixed categories, since there is room for something between 'occupation' and intensive training for open employment for quite an appreciable number of people who would otherwise deteriorate through loss of self-respect and boredom. Staff The following staff joined the Mental Health Service in the course of the year:- Mr. K.Y(.R. Crane, D.M.H. as Assistant Principal Mental Health Social Worker. Miss J.^. Bray, B.AJLond.) as Mental Health Social Worker. Miss A.J. Boughton, B.Sc., as Mental Health Social Worker. Mr. W.M. Leslie as Warden of Abury House Hostel for the Mentally III. fMr. A. E. Kent, Mental Welfare Officer, successfully completed the one year certificate in Social Work at Cardiff College of Commerced. 103 APPENDIX 21 MENTAL HEALTH STATISTICS - YEAR ENDED 31.12.69 Informal Order Extended Order TOTAL Hospital Admissions - Mentally ill 53 219 133 405 Hostel Admissions - Mentally ill 17 Hospital Admissions — Mentally subnormal 12 Temporary care admission — Mentally subnormal 33 Hostel Admissions - Mentally subnormal 3 4 permanent care totally Subnormal timber of cases on Register 510 (88 in residential care) Number of visits Average Number of cases per officer 64 Average Number of visits per case 2.2 Mentally Number of new cases referred for Social Work 233 M number of visits per officer 57 Avrage Number of visits to patients referred 5.9 Total Number of visits 933 Junior Training School A. Total Number on Register 103 B. Average Daily Attendance during year 73 C. Discharges (including transfers) 10 Adult Training Centre A Total Number on Register 93 Average Daily Attendance during year 73 C. Discharges (including transfers) 9 ENVIRONMENTAL HEALTH 105 ENVIRONMENTAL HEALTH (S.R. Daly, LI.M., B.Sc., D.P.A.(Lond.)., Barrister-at-Law Chief Public Health Inspector) In my last report I mentioned that 1968 had been an unsettled year. I made no forecast for 1969, but in fact the 'unsettled' has become more pronounced. Local Government generally is being bombarded by Reports, Green and White Papers, and under constant threat of amalgamation, loss of responsibilities and demotion to Parish Council level. For officers in long established departments, already only just recovering from the London re-organisation this is like being in an endless storm at sea, and one only hopes the squalls will die down soon, and a spell of calmness ensue, when ones thoughts can be concentrated on the tasks in hand. However, I am happy to report that the full complement of Public Health Inspectors continued during the year, and routine work has been maintained at a satisfactory level. Progress has been made with the slum clearance programme and this will probably speed up in the years to come as various redevelopment areas and road plans come to fruition. I made mention last year of the vast amount of improvement work required in the large number of quite sound but older houses, lacking amenities within the borough. Action in areas on similar lines to Smoke Control procedure is needed to ensure that all houses are brought up to the necessary standard. Clean Ait has continued to make steady progress, the only black cloud in the sky at present is a statement by the Chairman of the National Coal Board that there is likely to be a shortage of solid smokeless fuel. At local level it is most difficult to understand this, as the vast majority of conversions in Smoke Control areas are to fuels other than solid fuel. The N.C.B. has had at least 14 years to put its house in order since the passing of the 1956 Clean Air Act. With only one Smoke Control area to be confirmed, this borough is well in the top half of the "Greater London Clean Air League". 106 The coming year 1970 has been named European Conservation Yeor and protection of the environment has and will receive considerable publicity. From the local authority viewpoint this is very welcome, as in the past this battle in which the Public Health Inspector is in the forefront, has tended to play second fiddle to more grandiose schemes. Pollution of streams and water courses is common, and with the tremendous increase in motor vehicles, the disposal of old sump oil creates many problems. Unfortunately in a number of instances this is poured into a rainwater or surface water gully which discharges into a ditch or river, thereby causing gross pollution. Hedges, streams and rivers are favourite dumping grounds for all types of refuse, putrescible and otherwise which, in addition to contaminating the water supply and disfiguring the landscape, provide breeding grounds for rats and flies. 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 Metropolitan Water Board for the western half of the Borough was from River Lee — derived water from Lee Bridge Works and well water from Ferry Lane pumping station, supplemented between May and September by River Lee — derived water from the new Coppermills Works. Parts of 11 ford receive well water from Wanstead pumping station. 1,036 samples were submitted to chemical and/or bacteriological examination. No artificial fluoride was added, although there was a natural fluoride content of 0.30 milligrammes per litre in the River Lee derived water. The supply, being hard in character, is not liable to be plumbosolvent. All new and repaired mains are disinfected with chlorine and after a predeterminea period of contact the pipes are flushed out and refilledSamples of water are then collected from these treated mains and the mains are returned to service only after results are found to be satisfactory. 107 The quality control from the laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system and through to the consumer. Any sign of contamination or other abnormality is immediately investigated. No houses were permanently supplied by standpipe, during 1969. 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 1969 over 10,000 chemical and bacteriological examinations of raw water, water during treatment and water going into supply were made at the Company's Laboratory and all water going into supply was reportea 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 1969 by the South Essex Waterworks Company:- 3 ins. 4 ins. 6 ins. 9 ins. 18 ins. Yards 91 286 264 6 156 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 5 samples of water during the year, 3 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 Coinage and Sewerage Schemes: Progress continues on the relief of flooding in the borough and the following schemes are envisaged to commence during 1970 at an estimated cost as shown:- 108 (a) Cranbrook Stage III - Surface Water Sewer - extension to Clayhall Avenue £74,661 (b) Goodmayes Lane - Trenance Gardens - Hazeldene Road area - Surface Water Sewer £113,300 (C) Barley Lane - Langham Drive - Grove Road Surface Water Sewer £100,300 (d) Cranbrook Road to Dr. 3arnardo's - Surface Water Sewer £24,750 (e) Wynn Valley - Soil and Surface Water Sewers £600,000 (f) Old River Bed - Nutter Lane to River Roding £45,200 (g) Eastern Avenue - Aldborough Road to Seven Kings Water - Surface Water Sewer £80,000 (h) Seven Kings Water — Stage II £429,300 (i) Cranbrook to The Rise - Surface Water Sewer £22,000 (j) Mighell Avenue - Surface Water Sewer £15,000 Schemes (a) and (b) have been approved by the Ministry of Housing and Local Government. The Hainault Surface Water Sewer to Tudor Crescent (Limes Farm) scheme was completed in February 1969. Rivers and Streams Flooding has occurred and spasmodic oil pollutions; some of these sources have been discovered and remedied. Rainfall Recordings were as follows:- January 2.06 ins. July 3.49 ins Febru ary 1.84 „ August 3.22 „ March 2.24 „ September .31 „ April .56 „ October .13 „ May 1.92 „ November 2.93 „ June .98 „ December 2.03 „ Annual - 21.81 ins The greatest fall in 24 hours was recorded on 29th July, the amount being 1.70 inches. 109 Cleansing of Public Sewers and Drains The service of cleansing and unblocking choked sewers and drains continued. 2,020 blockages were cleared by the three manual staff of the Department, 45 were cleared by the Borough Engineer with specialised equipment and 52 were dealt with by private contractors. Refuse Collection and Disposal The service offered to householders for the testing and reporting on drains at the appropriate fee was used four times during the year. T. Cwt. Otrs. Lbs. £ s. d. Refuse Collection 76,046 _ _ _ Y/astepaper Salvage 1,521 — — _ 13,386. 0. 0. Mixed Rags 14 4 2 — 285. 1. 6. Carpet 1 10 — — 6. 0. 0. Woollens 1 14 2 — 153. 15. 0. Iron 11 14 — _ 81. 18. 0. Iron and Steel One Load 150. 0. 0. Lead — 2 _ 2. 3. 9. Copper — 1 — - 17. 10. 0. Misc. Scrap 31 3 — — 124. 13. 0. Copper Wire One Load 55. 0. 0. Old Venicles 5. 0. 0. Over the past 25 years there have been significant developments in vehicle design and the modern refuse vehicle is a very sophisticated machine. Loading takes place at the rear; only the reception hopper is exposed and refuse is crushed and fed to the front of the body in a continuous mechahical operation. Refuse storage receptacles are better too; the long-serving heavy galvanised iron dustbin is slowly giving way to plastic bins (not all of them of practical design) and expendable paper or plastic sacks are becoming increasingly popular. Slowly then, the dustmen's lot is improving, but much of the unpleasantness remains and in many parts of the country it is difficult to recruit men to do the job. Few among those responsible for the management of refuse collections can remember a year with more labour problems than 1969. Many authorities in London and elsewhere had minor disturbances early in the year, but the climax was reached at the end of September when strikes 110 which began in the London Borough of Hackney spread rapidly to other London Boroughs and places outside the capital. In Redbridge, routine services stopped on October 1st and a settlement with the men was not concluded until the 17th. Emergency arrangements made to reduce the inconvenience to householders worked remarkably well - paper sacks were issued, official dumps were opened, containers were sited in the streets - but we were all pleased when the dustmen returned to work on the 20th October. Redbridge suffered less from unauthorised dumping than most other London boroughs but, regrettably, the sites in Loxford Lane and Painters Road, which are used by the unscrupulous at all times, were stacked high with sacked refuse. Work at the new G.L.C. refuse disposal plant at Edmonton has been delayed and aeliveries from Redbridge will not now start until January 1971. Street Cleansing Disturbances among the street cleansing staff are few indeed, and if the routine is interrupted, it is usually because of the failure of a machine or shortage of numbers. But sweepers in Redbridge and other London boroughs were induced to support the dustmen's strike in October and our streets vent unswept from the 3rd to the 18th. The consequences in London generally were horrifying to the eye and several eminent experts were persuaded by T.V. and newspaper reporters to give their opinions about the health hazara involved. Wholly conflicting views from authoritative sources served only to confuse and if the rate at which litter was dropped in the streets is any criterion the public were not impressed. It is indeed very difficult to enlist the assistance of the British public in this matter of keeping the streets clean, and no one faction or age group is primari-ly to blame. In 1969 dogs were allowed to foul footpaths; commercial vehicle drivers spilled debris from their loads; and John Citizen dropped empty cigarette packets - just as always. Mattresses, discarded items of furniture and the residues of do-it-your- self activity were dumped unceremoniously in the ditches and verges of our prettiest country lanes, and when, in one place, a fence was erected 111 to deter the offenders, huge gaps appeared in it within a few days. There are, of course, ordinances on the subject: Byelaws were superceded by the Litter Act and the Civic Amenities Act increased the penalties still further; but enforcement, without special staff, is not easy. The solution must lie in a complete change of public attitude; but the question of how this can be brought about remains unanswered. Public Conveniences The public continue to make good use of the 22 public conveniences in the borough and there were the usual, very welcome, compliments about the high standards of cleanliness maintained. An increase in the consumption of soap and paper towels indicates that more people than ever are taking advantage of the free facilities; and it is pleasing to report that in this sector at least vandalism has not been a serious problem in 1969. Public Baths During the 1969 summer season attendances at all establishments were very good. The Vapour section is still popular and the high attendances in the swimming pools can be attributed to the excellent summer, the peak months in the indoor pools being as follows:— June Fullwell Cross High Road (1st & 2nd Class) 27,641 38,735 July 35,757 30,555 Due to the inadequate depth of water, the 3-metre diving boards were removed from both pools at the High Road in the interests of safety. A similor board will be removed from the Open Air Pool in 1970, for the same reason. The arrangement whereby the swimming pools were open in the mornings on Bank Holidays (Christmas excepted) continued and is now permanent. It was necessary to carry out minor remedial works which involvea draining the pool at Fullwell Cross in January and the swimming pool was closed from the 6th January and reopened on the 3rd February. The public were notified by an announcement in the local press. A further closure was necessary at Fullwell Cross in order to carry out repairs to the chlorination equipment in August 1969. On each occasion the private baths and vapour section were not affected and were open as usual to the public. 112 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. INSPECTIONS Initial Re- Notices Issued Notices Complied Inspection inspections Informal Formal Informal Formal DWELLINGS: Housing Act(including Slum Clearance and Multi-occupation) 2,021 2,188 15 4 9 Rent Acts (Certificates of Disrepair) 9 11 - - - - Public Health Acts (Nuisances) 9,808 5,399 399 144 318 130 Clean Air Act (Smoke Control Areas) 2,052 2,438 — 129 — 104 Infectious Disease (including visits to advise long stay immigrants) 1,040 1,010 — — — — OTHER PREMISES: Food Premises 2,357 1,430 92 - 79 - Offices, Shops Act 1,737 911 243 - 227 - Factories and Workshops Dairies 223 41 177 27 24 _ 22 - Clean Air Act (Industrial Premises) 603 302 2 _ 2 - Pests (Rats, mice, wasps, pigeons) 1,149 632 6 2 7 2 Rag Flock Premises 12 - - - - - Schools 353 50 - - - - Swimming Baths 71 17 - - - - Hairdressers 19 19 - - - - Fertilisers and Feeding Stuffs 14 - - - - - Pharmacy and Poisons 17 1 - - - - Animal Boarding Establishments 7 2 - - - - Riding Establishments 17 5 - - - - Pet Animals Act 77 20 - - - - Diseases of Animals Act 122 5 _ - - - Atmospheric Pollution Measuring In- stuments — 762 - - — 113 INSPECTIONS (continued) Initial Inspections Re-Inspections Forms 6 Litter Act 20 14 Tents, Vans and Sheds 22 13 Nursing Homes 39 8 Day Nurseries and Child Minders 138 46 Massage ond Special Treatment Establishments 14 - Miscellaneous 1,965 942 Visits Re-Visits Other Duties Food and Drugs Sampling 225 153 Bacteriological Sampling 83 17 Lectures tf organisations, schools, etc 61 5 SAMPLES F ormal Informal Unsatisfactory Food and Drugs for Adulteration or Misdescription 312 117 21 Rog Flock - 11 - Fertilisers and Feeding Stuffs - 16 2 Bacteriological: — Ice Cream 12 - - Milk 33 - 2 Water..j 5 - - Swimming Baths 63 - - 114 COMPLAINTS The Public Health Inspectors dealt with 3,310 complaints received on the following matters:- Accumulation of manure and refuse 37 Animals improperly kept 4 Bad Smells 29 Dampness of Premises 51 Defective drains, W.C.'s and fittings 976 Defective roofs, gutters, downpipes, etc 78 Defective water fittings 15 Dirty and verminous houses 20 Dirty condition of rearway 20 Flooding of premises 18 Overcrowding 19 Smoke Nuisances 28 Noise Nuisances 64 Defective or no provision of dustbin 140 Rats and mice 917 Wasps Nests 344 Unsound Food 50 Miscellaneous 500 3,310 Disinfection and Disinfestation During 1969, 59 premises and 17 articles were disinfected, and 77 premises were disinfested for verminous conditions. Litter Act 1958 As a consequcnce of notifications from various sources, five cases of potential infringements of the Act were considered during the year. One cast was not proceeded with, and the other four cases were taken to court. Fines imposed totalled £27, with £19 costs. Infectious Diseases During the course of the year 97 notifications for food poisoning and 419 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. 115 Only two small outbreaks of Shigella sonnei occurred, which were fortunately contained in local areas. The extension of jet travel, allowing many people to venture further afield for annual holidays, increased the notification and consequent investigation of contacts of typhoid and salmonella infections. Exotic type animals being imported as pets for children are another potential hazard to health with which the department was confronted. Terrapins are from time to time known to excrete paratyphoid, and recently Gerbils (desert rats) were thought to have been responsible for a case of jaundice. Cold roost chicken eaten at wedding receptions proved to cause several different outbreaks of food poisoning. This shows what great care should be taken when preparing foodstuffs, and how frozen poultry must be thoroughly "thawed out" to allow sufficient heat penetration to take place when being cooked. 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 1969, 72 persons were assisted and 7,042 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. 333 Immigrants were visited during 1969. 57 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. 116 Noise Numerous complaints of nuisance from noise were received during the year varying from that caused by large scale building operations and road works, to neighbours' sewing machines. Some complaints were found to be well founded whilst others had no substance. All complaints were investigatea and steps taken to have the nuisances abated where a nuisance was proved to exist. A very thorough investigation regarding an alleged noise from a garage and workshop in Seven Kings (reported last year) was made. This included a complete week of observation by the Public Health Inspectors with noise level recordings made every minute. No statutory nuisance was established, although complaints are still being received from the same two or three residents in the immediate vicinity. This matter is also being dealt with under Town Planning. Other complaints referred to alleged noise from two factories in Chadwell Heath. The companies concerned were notified and have carried out works to abate these nuisances. The effectiveness of these measures are being further investigated. Pests The two rodent operatives have continued to carry out excellent work in the destruction of rats and mice, and also with wasps nests and feral pigeon infestations (Appendix 22). The systematic treatment of the sewers commenced last year is proceeding steadily with existing staff and equipment, and records are kept. No major problems or excessively high rodent infestations have been encountered. The procedure and technique is flexible and continuous, economic and efficient in comparison with other methods. Further sewer treatment can be assessed and programmed in the light of the systematic treatment areas at present in progress. Partial takes 33 Complete takes 120 No takes 308 Total number of Manholes treated 466 117 Housing Last year, in the housing section of my report, I stated "but nevertheless it is anticipated that whatever area is submitted as a Clearance Area, objections will be received from the owners leading to the ineviable Housing Inquiry, causing lengthy delays before action can be taken to rehouse the tenants and"demolish the houses". The correctness of this statement can be judged from the fact that during 1969, five Public Inquiries were held, three regarding Compulsory Purchase Orders made in 1968 all of which were subsequently confirmed with minor variations and two regarding Compulsory Purchase Orders made by the Council in the early part of 1969 for which the Minister's decision is still awaited. Confirmation with slight variations was also received in 1969 regarding a Compulsory Purchase Order made in 1968 and a further Compulsory Purchase Order made in 1968 is still awaiting a Public Inquiry. Fortunately a Clearance Order dealing with only four houses invoked no objections and rehousing is now in progress prior to rapid demolition of the premises. Closing Orders were made with regard to seven houses found to be incapable of repair at reasonable cost whilst one Closing Order made by the former Borough of Wansteaa and Woodford was rescinded following extensive works; of repair under the supervision of the public health inspector. During the year, 117 houses were informally surveyed to assist the Borough Engineer's Planning Department who were conducting a Redevelopment Study Survey in two of the older and more congested areas of the Borough. An increasing number of properties, namely 160, subject of applications for grants were surveyed for fitness. The Housing Act 1969 produced 149 applications from owners, agents, etc. for Qualification Certificates under S.44 of the Act. This Certificate, which enables the owner to apply to the Rent Officer for a regulated rent to be fixed can only be issued if the Council are satisfied in respect of the controlled dwelling:- 118 (a) that all the standard amenities are provided for the exclusive use of its occupants. (b) that it is in good repair having regard to its age, character and locality and disregarding internal decorative repair and (c) that it is in all other respects fit for human habitation. It is to be hoped that having brought the property up to the desired standard of fitness, a certain portion of the higher rental obtained thereby will be used to maintain that standard. The administration of the Rent Acts, insofar as the issue of certificates of disrepair was concerned, continued. Three applications were received, which were granted, and in each case an undertaking was received from the landlord to carry out specific repairs. Two certificates of disrepair were cancelled during the year. Clean Air Act The abatement of domestic smoke is still the most important task of the Council's clean air policy. There are, at present, fourteen Smoke Control Orders in operation, one Order (No.15) to become operative in July, 1970, and a final Order yet to be made. The number of premises involved is shown in the following table: Total number of premises within the Borough 80,931 Total number of premises with Smoke Control areas in operation 59,255 Total area of the Borough 13,983 acres Total area of the Borough covered by S.C.A.'s 11,029 acres Reference to the map in appendix 24 shows the two remaining areas not yet under Smoke Control. The No.15 (Cranbrook and Park) Order was confirmed by the Minister and is due to come into operation in July 1970. The completion of the programme is still expected to be not later than 1971. The subject of Clean Air is of widespread interest today, and this is shown by the number of articles that appear in the press and discussions on T.V. programmes. "The Times" published a two-page Clean Air special report on 23rd September 1969, and the Reader's Digest includea a similar article in their November 1969 edition. In addition, the increase in enquiries we receive from Redbridge newspapers and 119 residents exhibits a keen local interest on the subject. One hears of shortages of certain solid smokeless fuels during the winter months, but local residents appear to overcome this trouble by using alternative solid smokeless fuels or other appliances such as gas, electricity or oil. Certainly we find very few contraventions of our Smoke Control Orders even at such times. It may be that our local residents are keen to preserve the benefits that they can now see derive from clean air. 1 he trend still continues towards the use of gas and electricity when replacing coal-fired grates, but with regard to central heating, many applicants instal solid fuel systems as these are very efficient and cheaper to instal and run. The majority of industrial installations in the Borough are oil-fired and as a result of automatic control their stacks rarely emit smoke. Generally, contraventions from these sources are few in number. The work of the department on air pollution abatement can be divided into four main groups. ^a) Measurement of pollution (b) Control of pollution — (mainly 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 ahd sulphur dioxide concentrations. They are sited in the following positions. No. 1 Gants Hill Library No. 2 John Bramston School No. 3 17/23, Clements Rood No. 4 Croft Lodge Clo se No. 5 Oak Hall Court These two latter stations are fitted with eight port valves which automatically change every twenty-four hours. These instruments are designed to ensure complete records over week-ends and holidays. 1 hese two stations are also part of the National Survey being conaucted by the Ministry of Technology. 120 Below are shown average figures in micrograms per cubic metre for the year ending March 1969, as supplied by the Warren Springs Laboratory. These are for two sites within the Borough. Site No.2 is within and Site No.3 outside existing Smoke Control Areas. Smoke S.0.2 Summer Winter Year Summer Winter Year No. 2 John Bramston School, Hainault 11 33 22 51 109 81 No. 3 17/23, Clements Road, llford. 25 1 04 6 4 1 03 2 08 155 At a meeting of the Standing Conference of Co-operating Bodies on 2nd June 1969, a paper read at the meeting concluded that the reduction in smoke appears to be continuing smoke concentrations in London are now on an average not much higher than the urban areas in the rest of the southern part of the country. Also London had by 1967-8 a concentration of smoke which was only 23-30% of the 1956 level. With regard to sulphur dioxide, concentrations were, on the average, about two thirds of their value ten years previously. Decreases are expected to continue as natural gas and nuclear energy take over from the more traditional fuels. Mo less an authority than the London Weather Centre have praised the efforts of the London Clean Air Campaigns. In an article in the Daily Express on Saturday, September 27th, 1969 headed "The Cleaned-up Smoke gets a Place in the Sun", it was stated that London today is seeing half as much winter sunshine again. This referred to the months of November to January, and the comparison was made against the long term average (1931-1960). The article went on to say that this improvement was probably associated with the decrease of smoke since the Clean Air Act came into force. The traditional London "pea-souper" appears to have vanished and the last bad fog in London was in December 1962. (b) Smoke Control Areas: Applications for conversions and adaptations on No. 15 (Cranbrook and Park) Smoke Control Area are now being accepted and the Order for this area will come into operation on the 1st July 1970. 121 No. 16 (11 ford, Clementswood and Moyfield) Smoke control Order was made by the Council on 2nd December 1969. It is now awaiting confirmation by the Minister of Housing and Local Government. Details of the area No.16 are as follows. Dwellings (erected before 1964) Privately owned 11,210 (b) Local Authority owned 394 Industrial premises 71 Commercial premises 594 Other premises 75 This area, when operative, will complete the Council's domestic smoke-control programme for the whole Borough. It was estimated that the cost of replacing and adapting existing fireplaces would be £256,000 and £2,500 for privately and Local Authority owned dwellings respectively, of which the Exchequer contribution would be £103,785 and the cost to the Local Authority would be £78,975. The following is 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. 122 CLEAN AIR ACT, 1956 SMOKE CONTROL AREAS - EXPENDITURE TO 31.12.69 Area Date of Operation No. of properties eligible No. of properties in respect of which Grants made (excluding Redbridge owned properties) Payments made (7/10) with Discretionary Grants (excludes Redbridge L.A. Properties) llford No. 1 1.11.60 487 32 £293. 9s. 2d. W. 8. W. No. 1 1.10.61 1,548 399 £2,739.11s. 8d. W. & W. No. 2 1.10.61 •2,104 744 £6,837. ls.lld. W. & W. No. 3 1.10.62 2,086 902 £7,895.18s. 6d. 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. llford No. 5 1. 6.64 1,607 405 £2,802. 6s.lid. 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. 0s. 8d. W. 8. W. No. 6 1.10.65 2,630 1,007 £18,086.17s. 8d. llford No. 7 1. 7.66 2,296 570 £12,390. 0s. Od. Redbridge No. 8 1. 7.66 4,592 736 £8,194.14s. 7d. Redbridge No. 9 1.10.66 2,738 766 £14,957.19s. 9d. Redbridge No. 10 1.10.66 2,685 828 £16,226.16s. Id. Redbridge No. 11 1.10.67 2,674 700 £13,985. 4s. 10d. Redbridge No.12 1.10.67 5,412 2,267 £54,798.15s. 7d. Redbridge No. 13 1.10.67 3,603 823 £17,346. 4s. 9d. Redbridge No. 14 1.10.68 9,798 2,292 £55,639. 0s. Od. During the year 35 grants of 100% were paid to persons in receipt of supplementary pensions and whose applications were supported by the Ministry of Social Security. The number of contraventions of Smoke Control Orders is very small and informal action in dealing with these is all that is necessary. Constant checks are made to ensure that no one is flagrantly disregarding the law. In the same way, strict supervision is kept on the delivery of coal to Smoke Control Areas which is now an offence under the Clean Air Act, 1968. Warning letters have been sent to two coal merchants on this matter in the past year. 123 (c) Other Activities Eight notifications of intention to instal new furnaces have been received during the year. The department is now solely responsible for making recommendations in connection with the height of new industrial chimneys which serve furnaces. Recommendations are based on the Memoranda of Chimney Heights issued by the Ministry of Housing and Local Government. In the same way the Department deals with the provision of grit and dust arrestment plant in certain new industrial installations. The Authority continued to be represented in the following bodies: Motional Society for Clean Air. Standing Conference of Co-operating Bodies in the Investigation of Atmospheric Pollution. (d) Hew Legislation: The following enactments came into force during the year. 1. Clean Air Act, 1963 — main provisions 2. The Clean Air (Height of Chimneys)(Prescribed Form) Regulations, 1969. 3. The Clean Air (Height of Chimneys) (Exemption) Regulations, 1969. 4. The Smoke Control Areas (Authorised Fuels) Regulations, 1969. 5. Clean Air Act, 1956, Order re-Exempted Fireplaces. 6. The Clean Air (Emission of Dark Smoke) (Exemption) Regulations, 1969. 7. The Clean Air (Arrestment Plant) Exemption Regulations, 1969. Offices, Shops and Railway Premises Act, 1963. The inspection of office and shop premises is carried out by the District Public Health Inspectors under the supervision of a Senior Public Health Inspector who also investigates all notified accidents and applications for exemption. 2,648 inspections were made during the year and 243 informal notices were served for contraventions of the Act. Many verbal notices were given at the time of inspection for minor infringements. Six cases of non-compliance were reported to the Committee and six prosecutions were initiated. Two firms were also reported for contraventions which came to light as the result of accidents to employees. Eighty-five accident reports were received and investigated, but it is still felt that many more accidents occur in small establishments 124 which are not notified. The three main causes of accidents are falls (25), handling goods (21) and hand tools (Butchers knives etc.)(l6). Power machines (bacon slicers, fork lift trucks, etc.) (8) being fourth, Un-registered premises are still found, new occupiers especially professing ignorance of this requirement. The following circulars were issued by the Ministry during the year giving further advice on the interpretation of various sections. L.A. Circular 4 Exemption No. 7 Order. Supplement 2 This extends the provisions of Exemption No. 3 Order indefinitely. L.A. Circular 4 Exemption No. 8 Order. Supplement 3 L.A. Circular 7 Refers to small air circulating fans Supplement 16 L.A. Circular 8 (Rev) Gives advice on classification of accidents. Supplement 3 L.A. Circular 9 Lighting. Supplement 7 Gives advice on standards. L.A. Circular 9 Noise Supplement 8 L.A. Circular 17 Further reports of prosecutions under the Act. Supplement 5 L .A. Circular 20 Refers to use of Radioactive Luminous Components. L.A. Circular 21 Post Office Act,1969. The provisions of this Circular are interesting as they transfer the responsibility for inspection of premises occupied by the new Post Office Authority, generally speaking, from H.M. Factory Inspectorate to the Local Authority. Several reports have been received, of the inspection of lifts, os required by the regulations which came into force on 28th May, 1969 and all are investigated. Factories and Workshops Most of the provisions of the Factory Act are administered by the Factory Inspector, but the Public Health Inspectors have three duties in respect of these which receive constant attention. 125 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. Regular inspections are also paid to outworkers within the borough which number 215. Details of the administration of the Act are contained in Appendix 25 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 209 Licences, for five year period ending 31.12.70 in operation at end of year- Pasteurisers 1 Sterilisers 1 Pasteurised (Dealers) 147 Sterilised (Dealers) 130 Untreated (Dealers) 33 Ultra Heat Treated (Dealers) 41 Ice Cream - Premises on register for manufacture and/or storage and sale of ice cream 658 126 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 343 Hawkers — Hawkers of food, and premises used for the storage of such food, on register 137 (b) Sampling: (i) Food and Drugs - In a world of rising population and the growth of urban and industrial life, the multitudes to be fed have created ever increasing pressures upon the available food sources. Scientific and technical knowledge have enabled greater yields to be harvested and marketed. Faster transportation allied to modern preservation and packaging have developed wider markets to satisfy and stimulate changing food habits. In solving some problems, others are thereby created. Fertilisers and pesticides are used in vast quantities for crops. Hormones and antibiotics are used for livestock. Mew strains are evolved. Food is then prepared for the market using modern factory techniques. Emulsifiers, preservatives, stabilisers, colouring additives, fungicides etc. are used. Standards are laid down and reviewedresearch is world wide and continuous. Hence the necessity for food and drugs sampling to ensure that standards are maintained. A comprehensive sampling programme has been carried out and is continuing over the full range of food products. New and traditional products are sampled regularly; complaints are investigated and samples submitted for analysis. Manufacturers, suppliers and traders are informed to keep them aware that sampling and checking is continuously being carried out. In this technological age sampling of the nation's food supplies becomes more vital each succeeding year. During the year, 429 samples were submitted to the Public Analyst. 21 were found to be unsatisfactory and appropriate action taken in each case. Included in these, were 16 samples submitted as a result of complaints received, of which 8 were found unsatisfactory. Appendix 27 gives the list of foods sampled, and it will be seen that the range is very comprehensive. Only 13 of the samples obtained by routine sampling procedures were unsatisfactory (mainly labelling infringements). 127 It would seem that the low incidence of unsatisfactory samples is indicative that manufacturers, importers and traders of food and drugs in this country are kept aware of their responsibilities by the surveillance of the sampling legislation and procedures. (ii) Bacteriological Water Supply: Five samples of water supplied to the Borough by the Metropolitan Water Board and the South Essex Waterworks Company were taken and found satisfactory. Swimming Baths: Monthly samples from the Public Swimming Baths and those in our schools were taken in order to ensure that they were suitable for the purpose of swimming. A total of 63 samples were taken during 1969 and all were found satisfactory. In addition, numerous bath-side tests for PH and chlorine content were made with the Lovibond comparator. Ice Cream: During 1969, 12 samples were submitted for examination, all of which proved satisfactory. Results were as follows:— No. of Samples Dept. of Health & Social Security Provisional Grade % of Total 10 1 83 — II — 2 III 17 12 100 Milk: 33 samples of milk were taken from school*, milk-roundsmen and vending machines. Two samples of pasteurised milk failed the Methylene Blue Reduction test. (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 ate 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. 128 The large quantities and varieties of food dealt with as unfit for human consumption are enumerated in Appendix 26. Fifty complaints regarding unsound food and foreign bodies in food were received during the year. Complaints included dirty milk bottles and objects in milk bottles, foreign bodies or mould in bread, unsound tinned and fresh meat and rodent excretia in pre-packed tapioca. All complaints were investigated and 16 were submitted to the Public Analyst for his examination and report. The remainder were dealt with by the inspector with his detailed knowledge of the subject. 33 were reported to the Committee and 30 were referred to the Town Clerk for legal action. Of those already dealt with, fines totalling £107 and £66 costs were imposed and 1 3 are still pending. (d) Inspection of Premises, Hawkers, etc. The enforcement of the Food Hygiene Regulations has received regular attention during the year and 3,855 inspections were made for this purpose. Informal action was taken in 92 instances to secure compliance with the regulations. In two contraventions, proceedings were instituted and convictions were obtained. Inspection of canteens of 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 fitted to comply with Regulation 19 Cafes and Restaurants 298 298 298 297 Factory Canteens 71 71 71 70 Butchers' Shops Grocers' Shops 148 300 148 299 148 300 147 296 Fruiterers' and Greengrocers' Shops 161 — - — Fishmongers' and Fishfryers' Shops 75 74 75 75 Bakehouses 17 17 17 17 Bakers' Shops 60 60 60 60 Confectioners' Shops 294 — — — 1,424 967 969 962 129 Hawkers of food and their premises are registered under the Essex County Council Act, 1952. There are 137 registered hawkers and food storage premises associated with them. During the year 478 visits were made by public health inspectors in connection with these. Ten new registrations were approved for traders and three for storage premises. More exacting testing of commercial vehicles has resulted in a higher maintenance interest by the hawkers in their vehicles, and the disuse of unsatisfactory vehicles. The traders are generally hard working and perform a useful service by supplying outlying areas and enable elderly people and mothers of children to obtain food supplies without the necessity of travelling to shopping areas. As the smaller shops disappear due to supermarket competition, the hawker may become even more useful by bringing the food to the homes of the people, but increasing road taxes and running costs have resulted in a number of hawkers ceasing to trade. Their future is problematical. Diseases of Animals 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. Three premises having the necessary properly constructed equipment were licensed for this purpose. Generally the movement of swine throughout the year has progressed without the issue of any licences, though in two instances pigs were moved into the borough by licences under the Regulation of Movement of Swine Order 1959. Maughternouses daughter of Animals Acts 1933-1954 There are no registered slaughterhouses within the Borough of Redbridge and no licences were issued to slaughtermen during the year, no applications having been received therefor. Flock and Other Filling Meterials Acts, 1951 This Act requires the Local Authority to register premises wherein rag flock and other filling materials are used. There are 12 premises at present on the register and one establishment has been licensed for the manufacture of those commodities as required by this Act. Eleven samples of filling materials were obtained and submitted to the analyst during 1969. All proved to be satisfactory. 130 Fertilizers and Feeding Stuffs A statutory declaration showing the exact composition of fertilizers and feeding stuffs is required by the Act of 1926. Prepacked articles supplied by the Manufacturers have the necessary information printed on or enclosed in the packet. In other cases the declaration is given by the retailer from informatibn supplied by the Manufacturer. During 1969 15 informal samples of fertilizer (pre-packed) and 1 informal sample of feeding stuffs were purchased. Of these, 2 samples of fertilizer were found to be unsatisfactory, the contents being slightly deficient in potash beyond the prescribed limit of variation. In each case corresponddence with the Manufacturer proved the fertilizers to be old stock and no further action was taken. 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 142 applications for renewal of entry on the statutory register, whilst 5 new applications for registration were investigated and found satisfactory, Establishments for Massage and Special Treatment The public health inspectors continued their work of the examination of establishments set up for massage and special treatment under Part IV, Essex County Council Act, 1933. These premises are visited at least once annually. One new application for a licence was approved, two premises closed down and 39 licences were renewed during 1969. Hairdressers and Barbers Establishments 38 inspections were made of these premises during the year, and generally conditions were found to be satisfactory. The Pet Animals Act 1951 22 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. The establishments generally were well administered. An intimation notice was served in respect of conditions at one establishment and this was complied with. Animal Boarding EstabIishments Act 1963 Three premises were licensed during the year and periodic inspections found them well maintained. 131 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 1969, the burial and cremation of four 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. 5,988 enquiries were so dealt with during 1969. Training of Student Public Health Inspectors The five student public health inspectors continue to make steady progress, passing their terminal examinations successfully. Four students are preparing to sit their Final examinations during 1970 and a fifth student will si t for his Intermediate in 1970. Theoretical instruction is carried out at Tottenham Technical College, but practical training is obtained in this department with the Public Health Inspectorate. The students are under the supervision of a senior public health inspector,' and visits to neighbouring abbatoirs, fish markets, London Docks and similar places necessary as part of their training have been arranged and are continuing, to enable them to obtain maximum experience. 132 APPENDIX 22 PREVENTION OF DAMAGE BY PESTS ACT 1949 Type of Property NonAgricultural Agricultural 1. Number of Properties in district 92,786 30 2. (a) Total number of properties {including nearby premises) inspected following notification 1,170 _ (b) Number infested by (i) Rats 802 - (ii) Mice 305 - 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 - - 133 APPENDIX 23 HOUSING STATISTICS Inspection of dwelling-houses during 1969: (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6,145 (b) Number of inspections made for the purpose 9,285 (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 11 (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 325 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 265* I. Action under Statutory Powers during the year: A. Proceedings under Sections 9, 10 and 16 of the Housing Act 1957 — (1) Number of dwelling-houses in respect of which notices were served requiring repairs- (2) Number of dwelling-houses which were rendered fit after service of formal notices- (a) By owners — (b) By local authority in default of owners — B. Proceedings under Public Health Acts — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 109 (2) Number of dwelling-houses in which defects were remedied after service of formal notices — (a) By owners 99* (b) By local authority in default of owners — 134 APPENDIX 23 (continued) C. Proceedings under Section 17(1) of the Housing Act, 1957 — (1) Number of dwelling-houses demolished as a result of formal or informal procedure 4 (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 7 4. Housing Act, 1957, Part IV Overcrowding: (a) (i) Number of dwellings overcrowded at the end of the year3 (ii) Number of families dwelling therein 5 (iii) Number of persons (units) dwelling therein 23 (b) Number of new cases of overcrowding reported during the year 2 (c) (i) Number of cases of overcrowding relieved during the year 2 (ii) Number of units concerned in such cases 6??? (d) Particulars of arty cases in which dwelling-houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding - (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report - *includes compliances during 1969 of Notices served prior to 1st January, 1969. 135 APPENDIX 24 136 APPENDIX 25 FACTORIES ACT 1961 PART I OF THE ACT 1. INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors). Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 133 77 - - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authorities 707 294 23 - iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 42 47 1 - Total 882 418 24 - 2. Cases in which DEFECTS were found. (If defects are discovered at the premises on two, three or more separate occasions they should be reckoned as two, three or more "cases"). Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.l) - - - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) — (a) Insufficient 3 2 - - - (b) Unsuitable or defective 20 12 - 1 - (c) Not separate for sexes 1 1 - - - Other offences against the Act (not including offences relating to Out-work) - - - - - Total 24 15 - 1 - 137 APPENDIX 25 (continued) PART VIII OF THE ACT OUTWORK (Sections 133 and 134) Section 133 Section 134 Nature of Work Number of out-workers in August list required by Section 133(l)(c) Number of cases of default In sending lists to the Council Number of prosecutions for failure to supply lists Number of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing apparel — Making etc. 129 - - - - - Cosaques, Christmas stockings, etc. 41 - - - - Making of cardboard boxes 10 - - - - - Total 179 - - - - - APPENDIX 26 ARTICLES OF FOOD SURRENDERED AND CONDEMNED AS BEING UNFIT FOR THE FOOD OF MAN DURING 1969 DESCRIPTION QUANTITY DESCRIPTION QUANTITY Bacon 603 lbs. Jellies 50 Beverages 46 tins Lard 37 lbs. Biscuits 236 lbs. Meat (fresh) 11 tons 1 cwt. Butter 111 lbs. Meat (tinned) 10 cwts. Cereals 104 lbs. Meat (pies) 31 pies Cream 115 tins Milk (tins) 805 tins Eggs (shell) 13 gross Pickles 90 jars fish (wet and dry) 250 stone Poultry 210 lbs. fish (tinned) 518 tins Sausages 97 lbs. fish (paste) 25 jars Sugar 376 lbs. fnit (tinned) 10,507 tins Soups (tins) 2,995 tins Gome 41 lbs. Tea 105 lbs. Ice Cream 14 bricks Tomatoes 14 lbs. Jams (preserves) 494 lbs. Vegetables (tins) 870 tins Vinegar 5 bottles 138 APPENDIX 27 SHORT SUMMARY OF FOOD AND DRUGS SAMPLES DEaLT WITH BROADLY LISTED UNDER TRADITIONAL TRADES GROCERS GREENGROCERS CONFECTIONERS Leek Soup Chicken Spread Maple and Walnut flavour jelly Onion Chutney Cooking Oil Tea Margirine Custard Powder Salmon Spread Prawn Curry and Rice Strawberry Yoghurt Bananas Dates Filbert Nuts Figs Potatoes Swedes Cooked beetroots Parsnips Melon Apple Squash (low calorie) Dew drops Vanilla fudge Mints Chocolate Assortment Turkish Delight Treacle Toffee BUTCHERS LICENSED TRADE CHEMISTS Sage and Onion Stuffing Shredded Beef Suet Corned Beef Brawn Minced Meat Bacardi Rum Websters Whisky White Horse Whisky Cossack Vodka Spanish Sherry Martell Cognac Gordon's Gin Cascara Sagrada B.P. Panadeine . Boracic Acid Powder E T.C.P. Blackcurrant Throat Pastilles Phyllosan Tablets Sero Calcium Droxatin Sister Laura's Food Breakfast Vitamins FOODS OF FOREIGN ORIGIN Smoked Norwegian Brisling in Olive Oil French Capers in Malt Vinegar Californian Prunes Tinned Tuna Dried Fish Ikan Bilis Pure Glee Meat Masala Salt Fish Cutlets Ranga Pickle WELFARE 139 WELFARE SERVICES (R. W. Hall, Chief Welfare Officer) Social Work Staffing During 1969 there have been a number of changes in the Social Work staff. In July 1969 our Principal Social Worker took up one of the appointments of Director of Social Services in Scotland and was replaced by one of the three Assistant Principal Social Workers in mid-August. However, the vacancy thus created and was not filled until November. Two of our social workers also left us in the summer and unavoidable delays in replacing them by other officers of sufficient calibre, coupled with similar delays in replacing the Assistant Principal, inevitably resulted in a period when existing staff were working under even greater pressures than usual. Towards the end of the year, plans to increase the staffing establishment of the Welfare Services by the introduction of three Welfare Assistant posts - one for each of the three geographical teams — became possible and it was anticipated that the vacancies would be filied early in 1970. It is significant that whilst there was only a limited response to our advertisements for an Assistant Principal Social Worker and the Social Welfare Officer vacancies, particularly from professionally qualified ancj/ or experienced people, our advertisement of the Welfare Assistant posts produced almost a hundred enquiries and over thirty applications. It has become apparent that among mature married women there are many who, though they may lack high academic or professional qualifications, nevertheless have the necessary qualities of personality and a desire to give service to the community which renders them a rich potential source of recruitment to the staff of Welfare Services at a Welfare Assistant level. Unfortunately, whilst plans to integrate the existing social work departments of King George Hospital and Chadwell Heath Hospital into the community based services were completea, it was not possible to advertise a joint appointment until the end of 1969 and the response was so limited that the post will be readvertised in the New Year. This setback, which resulted from economic pressures both for the Hospital Management Committee and the Local Authority, has been a disappointment to us all. 140 Training Following our policy of encouragement to the various training colleges etc. with whom we now have close links to place their students, because of the increased number of professionally qualified social workers now employed by Welfare Services, it was possible for us to participate in the exciting new Married Women's Social Work Assistants Course run by the Havering Technical College by accepting three of their students for a ten week observation placement of one day a week, in the early part of 1969. In addition, arrangements were also finalised during the latter part of the year for three students from the Enfield College of Technology One Year Certificate in Social Work Course to come to us for their seven month fieldwork placement from 31st December, 1969. We shall also be welcoming one of the Enfield Child Care Course students for her fieldwork placement. As was expected, the response of our existing staff to the arrival of these students has been welcoming, despite the demands of time and energy which are required to ensure the students are provided with a worthwhile learning experience. Our remaining trainee Social Worker was successful in gaining a place on the two year Certificate in Social Work Course at Sheffield and left in September, 1969 to commence his studies. Staff Development With the appointment of a new Principal Social Worker, and two additional social welfare officers and the advent of increasing numbers of students on placement, considerable thought has been given in 1969 to the needs of new and existing staff for in-service training. An in-service Induction Course for new staff was introduced towards the end of the year and met with immediate and wide enthusiasm. Also, casework discussion groups were introduced in connection with our responsibilities to provide preventive casework services to those threatened by eviction. These have been attended by those social workers involved in family casework and have been of great value to them in providing opportunities to increase their knowledge and skills in the application of casework. It is planned to extena these groups to embrace the spheres of casework with the visually and physically handicapped and with the elderly, in order to meet the needs of our social 141 workers to stimulate their thinking about how they can most appropriately and effectively meet the needs of the clients whom they serve. Organisational Developments to meet the growing needs of Clients During the summer of 1969 an attempt was made to examine individual social worker's caseloads both in terms of size and the varying degrees to which clients need social casework support. Whilst the purpose of this examination was primarily to provide information which would be helpful to us in considering the possibilities of setting up area offices, the information also indicated that the existing social work establishment was deficient by seven social workers if the high standard of service to our clients which they need is to become a reality. However, because of the continuing demands for national economies, it seems unlikely that any further increase in establishment will be possible before 1970/71 and that even then only a proportion of the required additional staff will be possible. An analysis of new referrals investigated by the social workers during 1969 reveals a number of significant factors. 142 REFERRALS DURING YEAR ENDED 31st DECEMBER, 1969 TABLE 1 Referred by Elderly Persons Families Handicapped Persons Blind Persons Deaf Person s Grand Total - 75 75 + Na of Children - 18 18 + - 18 18 + - 18 18 + M F M % 0 1 2 3/4 M F M F M F M F M F M F (1) (2) (3) (4) (5) '6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (a) General Practitioners 8 11 14 42 4 1 1 6 8 1 3 7 106 (b) Hospitals, on discharge from in-patient treatment 10 13 26 45 3 10 19 1 4 131 (c) Hospitals, after or during out-patient or day treatment 7 9 12 26 1 8 12 1 16 1 93 (d) Local Authority Depts. 9 22 21 70 2 9 23 11 4 3 18 50 1 7 12 2 2 266 (e) Government Depts. 6 11 5 12 ■\ 1 1 1 3 1 2 11 55 (f) Voluntary, Charitable or Private Organisations 5 7 10 18 2 1 1 2 '3 6 3 8 1 67 (g) Relatives or friends 13 28 28 141 3 2 1 18 44 4 12 3 297 (h) Self 8 22 14 30 3 9 11 5 12 22 1 3 140 (i) Other sources 3 4 4 6 1 3 5 1 4 31 (i) TOTAL 69 127 134 390 12 24 36 18 7 9 79 169 2 1 23 77 1 2 6 1,186 NOTES: Only one referral should be recorded for each client or family unless the local authority ceased to provide services after one referral and before the next. The five classifications are not mutually exclusive, and clients with a dual classification should be recorded in the most appropriate category depending on the circumstances of the referral. Date: 26.2.70. Signed M. PERRY, Principal Social Worker. 143 TABLE 2 Referrals Elderly Persons 720 ( male 203) (Under 75- 196) 60% (female 517) (Over 75- 524) Fami lies 90 7% Physically Handicapped 264 23% Blind 103 9% Deaf 9 \% Totals 1,186 TABLE 3 Total Referrals by Month January 71 February 114 March 153 April 104 May 105 June 105 July 118 August 96 September 81 October 86 November 79 December 72 144 Organisotional Developments to meet the growing needs of Clients(Continued) The investigation of new referrals, particularly those involving elderly people, is demanding of time (because clients do not find it easy to express the extent of their problems and needs) and casework skill (in order to gain the client's confidence in the ability of our caseworkers to understand the client's problems and to suggest a wide range of services which can most appropriately enable the clients to function independently to the full extent of their capabilities). Each new referral involving at least one domiciliary visit, will take, on average, an hour to complete initial assessment. The total of 1,186 new referrals during 1969 represents therefore, the equivalent of one social worker's time for the full year, and this takes no account of any follow-up or on-going casework, which will be necessary in at least hall of the number of new referrals. Because of the low rate of case closure, this examination of the implications of the high number of new referrals will give some indication of the growing demands by clients, in number and complexity, upon Welfare Services and will to some extent explain why the Welfare Services express the need for increased staff establishment so regularly. One other significant factor in the analysis table is that of the very high percentage of referrals relating to the elderly. This is symptomatic of the increasing proportion of numbers of elderly people within the community and is indicative of a growing need for resourcefulness in conceiving a multiplicity of variety of new supportive services which will be needed if we are to realise our aims to enable elderly people to continue to live happily within the community, which most people desire, for as long as is possible. There is no doubt that with the thoughtful co-ordination of information supplied by the social workers concerning clients' needs, and an analysis of the implications in terms of determining how the needs are to be met, Welfare Services will continue to develop rapidly, and in particular the vital casework service which we aim to provide. 145 Services for the Handicapped The number of physically handicapped people on the Register continues to increase, underlining the wisdom of appointing a part-time occupational therapist during the year, and the addition of a further 80 persons on the register is also reflected in the increase in the number of aids and adaptations. Structural alterations have also increased in number and include the installation of two electric stair lifts for the first time, which enable the handicapped persons involved to have complete use of their houses. Publicity was again afforded both by the Borough and by the Redbridge Association for the Handicapped to highlight the needs of the handicapped - the "Welcome to Citizenship" Exhibition in October being thrown open to the public, of whom some 1,500 persons attended, and the quarterly news letter "Wheels Away" from the Redbridge Association for the Handicapped being distributed to over 1,000 handicapped persons in the borough. The use of our transport outside office hours by voluntary organisations has increased and a notable success was achieved in conjunction with the Rotary Club and Marks and Spencers in a joint experiment in Christmas shopping for the handicapped. Unfbrtunately the number of physically handicapped on our waiting list for Fellowship House Occupational Centre continues to increase, but the quality of goods produced was reflected again in Christmas sales which rose to a new highest ever figure of £600. It is hoped that we will soon be in a position to expand occupational centre facilities in order, not only to absorb the waiting list, but also to extend the number of daily attendances possible for the handicapped. In our services for the blind and deaf, there has been a small increase on both registers, but blind class activities were curtailed for a few months due to ibuiIding defects, and shortage of staff compelled some curtailment of visiting the partially sighted on our register. This position we hope to rectify in the near future. A number of blind and handicapped joined the old people's holiday week at Corton Camp and others were accommodated via voluntary organisations who cater for specific types or degrees of handicap. For the handicapped, the Council also hired a hotel at Ramsgate, providing an 146 enjoyable holiday at which the Department's specially adapted coach was made available to the hotel to take the holidaymakers out and about. Homes for the Elderly Professor Townsend used the phrase "at home or in a home" when discussing residential accommodation for the elderly. Implicit in this phrase is the suggestion of attitudes held at the beginning of the century - of attitudes that Part III Welfare Homes gave residential institutional care, oblivious of affection and individual consideration. Redbridge Welfare Homes are considered not as residual care establishments but as homes catering for individual needs as opposed to institutional care. They are indeed only one facet of the wider range of overall services provided for the elderly - overall services which include Housing Department flatlets, Voluntary Organisation homes, Private homes, the Day Centres, home helps, district nurses, "meals-on-wheels", the visiting G.P., social worker or voluntary worker, not forgetting the family who, at times, undergoes considerable stress and strain in devoting care and attention to the aged relative. Even within that facet of "a Council Part III Home" however, we are endeavouring to cater for varying degrees of care. Mention has been made of the family under considerable strain with an elderly relative. Increasingly short-stay beds are being used to relieve that strain enabling both the family and the elderly relative to enjoy a short change of environment and, in fact, proving that "at home" or "in a home" can be complementary and not opposite concepts. Again, an experimental venture with "Day Care Residents" at Peggram House is proving successful; the elderly people being transported morning and evening from and to their own homes, thus avoiding the depressive effects of long, lonely daylight hours. There has been a total of 269 Day Care attendances at Pegram House from the period June to December, these attendances not only being of benefit to the elderly people concerned, but also serving to relieve the pressure arising from a waiting list for permanent admission which is still in excess of 250. Increasing thought is also being given to rehabilitative work. The appointment of an Occupational Therapist has led to an increase of occupational handicrafts within the homes and in addition practical encouragement far self involvement by the residents in the day-to-day life and running of the home is being given. In fact, with those numbers of elderly who substantially improve after admission to one of our homes 147 it is not such a far cry to envisage a "rehabilitation flat" within the home where those who would benefit could be re-taught the arts of cooking, housekeeping, etc., and become acclimatised again to living "at home". In this connection possibly more exchanges could be effected between sheltered housing and Part III homes, although one must always balance what the people want against statutory limitations. Some overlap is unavoidable when comparing Part III homes and sheltered housing with Warden service, which can range from mere caretaker to the sensitive caseworker. The standards and age of admission to sheltered housing, however, can soon blur or even conflict with Part III "care and attention" assessment. Similarly some overlap will occur at the other end of the scale with those residents in our Part III homes who have deteriorated to such an extent as to warrant admission to hospital. Self contained special care units for the elderly mentally infirm have now been established within our homes, but there is still a strain which is fortunately eased in Redbridge by the co-operation of the local Geriatricians. From this short exposition it can be seen that residential homes staff arelcontending with a far wider range of duties than mere "residual care". It is indicative of their devotion to the elderly and their willingness to co-operate that we are achieving varying degrees of care and attention instead of mere hotel-type service. Concepts such as day care, short-stay rehabilitation, special care units and resident participation inevitably bring extra pressures to bear upon the home staff and they are to be congratulated in "caring for people" in the homely yet forward looking manner outlined in the Williams Report. Mention should also be made of the part-time attachment of a Senior Departmental Medical Officer to our services. Correct use of medical advice is of real value to the social worker and to the homes staff. Liaison work with G.P's and hospitals and general advice within the homes on medical matters, diets, etc., has proved the value of this appointment. The attachment of a medical advisor linked with the appointment of a Homes Officer covering the fabric and day-to-day running of the homes, together with social work support from our specialist teams, has now formed a firm basis for progressive thinking and action within the homes. 148 Private Homes In common with other Local Authorities, Redbridge has a duty to register and maintain contact with Private Homes for the Elderly situated within the Borough boundaries. There are nine such homes registered at present and a further ten in process of registration. These private homes render an important contribution towards the total provision of accommodation for the elderly and it was hoped that they could be used to reduce the lengthy waiting list of elderly people wishing to enter a Council home. Recent legislation has made it possible for the Borough to place applicants in privately run homes in addition to Council homes. Before financial arrangements can be made, however, it has been agreed that the private homes should conform to the latest Ministry requirements and the response has, unfortunately, not been as great as was originally envisaged. V/e hope, however, to see a greater response next year in this new provision for accommodation of the elderly. Day Centres for the Elderly The Day Centres are considered to be one of the main agencies by means of which our senior citizens can combat loneliness and share common interests. The range of activities within the Centres is not very extensive but of more importance to the elderly seems to be the relaxed informal atmosphere with an absence of regimentation where individuality can be preserved. Among the activities, old time dancing still seems to be a firm favourite with the more active elderly; Medau classes are equally as popular with those who are more restricted in movement and the coach trips to shows are always well attended. Our thanks must be extended to those volunteer workers who assist on a rota basis at the Centres and to those voluntary organisations and individuals who help provide entertainment for the elderly. It is indicative of demand that the mid-day meals service has now been increased to five days per week at all Centres. Two more Day Centres are planned and part-time Day Centre assistants have been appointed to release the Day Centre Organiser for the more important role of co-ordinating existing activities and initiating and planning future activities now that the concept of a network of Day Centres throughout the Borough is becoming a reality. Our scheme for transporting the less active "homebound" to the Centres still continues on a one day per week basis but more and more the question of transport gives cause for concern. It is apparent that not 149 only the "homebound" but also the active elderly are. experiencing difficulty with transport. As fares increase the pensioner has to consider whether he or she can afford to attend quite so frequently and this is a problem which is demanding more and more attention. Holidays for the Elderly This service continues to be held in high regard, as indicated by the numerous letters of appreciation received. Warner's Holiday Camp was taken over completely and the excellent co-operation between helpers and camp staff ensures that the elderly thoroughly enjoy a carefree holiday. This year a charge of £2.10s.0d. for a single person and £3.10s.0d. for a married couple was made(against a cost of approximately £10 per person) but no reduction in demand was observed and many old people seemed to welcome the opportunity to pay for their holiday. Active consideration is being given to the provision of holidays for higher income groups. "Meals on Wheels" The service has again expanded and there are now 270/275 persons receiving meals up to 5 days per week in the llford part of the Borough. There are now 5 rounds delivering up to 60 meals and plans are in hand to cope with the increasing demand and to reduce the existing rounds to a more manageable size. The price of the meal was increased from l/-d. to 1/6d.on 1st April. This is one of the most important of the domiciliary services, where not only is nourishment provided but friendly and safeguarding contacts are made. In the Wanstead and Woodford part of the Borough the service is still operated entirely by the W.R.V.S. where approximately 40/45 meals are delivered 4 days per week using two Council vehicles. The "Good Companions" paid a substantial part for the Christmas meal in the 11 ford part of the Borough. Members of the office staff delivered meals from one of our Old People's Homes on the three days over Christmas, when the Town Hall kitchen was closed. The cost of these meals and use of a Council vehicle was paid for from money bequeathed to the "Meals-on-Wheels" service. Temporary Accommodation Of all categories covered by the Welfare Services, the problem of homelessness seems to be the most insoluble. Basically a problem of general housing shortages, the situation is aggravated by some landlords and by some families who on low income levels find their economic ability inadequate and descend, through debt, to final eviction. The 150 general plight of the homeless was highlighted in Redbridge by the activity of squatters in the early part of the year when the Council were compelled to take legal action and eventually returned the squatter families to their Boroughs of origin. Fortunately, Redbridge has only a small proportion of families to contend with in comparison with most inner London Boroughs, but the mere fact that temporary accommodation still has to be provided to such an extent is a warning against complacency. Contemporary thought on the matter (as reflected in the Seebohm Report) has been implemented in Redbridge, the Housing Department providing the fabric of temporary accommodation, leaving Welfare Services to provide the skilled services of the family caseworkers and the provision of overnight reception and rehabilitation units. In fact, a policy of rehabilitation is pursued in Redbridge rather than the old authoritarian approach. The policy is implemented in three stages: (1) preventive stage when the family caseworker assists the family in their own borne to avoid eviction; (2) rehabilitative stage in local accommodation for those families who are literally homeless. In this rehabilitation unit we have a Supervisor who, in conjunction with the social worker, advises and guides the eight families in the accommodation which is nearer to normal housing conditions, the families having their own rooms although sharing the kitchen facilities; (3) supportive stage - a follow-up period after families are rehoused to give gradually declining support and prevent recurrence of trouble. This aspect of social work calls for exteme patience and perse verence on the part of the trained family caseworkers. Some success is achieved and although a few families will need support for most of their lives, others who have passed through rehabilitation units and temporary accommodation undoubtedly benefit from the casework support given. We have, in fact, partially succeeded in our aim to help them to help themselves. Society to-day is changing in its attitude but it would appear that some time will have to elapse before Welfare Service Officers can think of temporary accommodation in terms of "duty cases" only, namely those rendered homeless by fire or flood or urgent cases arising from "circumstances which could not reasonably have been foreseen". Voluntary Organisations There are many Voluntary Organisations in the Borough doing splendid work amongst the elderly, the blind, deaf, physically handicapped and the children of less fortunate families. 151 Their activities range from visiting, delivering some of the "Mealson-Wheels", running a Day Centre for the elderly, a handicraft class for the physically handicapped, a creche for mongol children, trolley service in the old people's homes, etc., to running Clubs with all their associated organisation of entertainments, outings, holidays, etc. Some provide clothing and some a little financial help. We are in close touch with many of them and hope to get to know the remainder and, in fact, would be pleased if they would like to contact the Department when we could arrange to meet and talk over our work and let each other know what service we are able to offer. | During this year there have been many groups, individual persons (many of whom have been young people) and schools, coming forward and offering their services; some asking in which way they can help, others with a project already planned. They are carrying out visiting, decorations, gardening odd jobs, shopping, letter writing, running play groups and teaching English to immigrants, etc. There are also the 'special' events — parcels, parties and children's pantomime trips at Christmas, also the day's hospitality to lonely old folk on Christmas Day; the gifts of produce at Harvest Festival time. Volunteers (including school girls) visit and help at Day Centres and Old People's Homes. Religious bodies in the Borough are becoming more alive to the need and are extending a helping hand wherever they can and some have formed community care ("Good Neighbours" or "Fish") services. I look forward to the day when every parish in the Borough is covered by such a scheme. Voluntary bodies are also assisting by providing housing schemes for the elderly as well as old persons' homes in the area. Some kind hearted persons in the Wanstead area have been escorting blind folk in their cars to and from the handicraft class week after week for many years and there have been many other instances where volunteers have provided transport. The Council is grateful for the help given direct by volunteers who have acted as escorts and helpers at the Camps and Hotels on the holidays arranged annually for the elderly, blind and physically handicapped. The Council is generous in its grants to voluntary organisation, some receive quite large sums of money to maintain services; others, 152 such as old people's clubs, are helped by the provision of games or other small items, or by lending one of the Department's specially adapted vehicles (when available) to convey the physically handicapped to clubs, etc. People are becoming more and more conscious of the hardships, deprivations and loneliness which exist even in this Welfare State and since 1965 the Council's policy has been to encourage and assist the many organisations in the Borough, which exist to alleviate distress. Charities A central register of charities is maintained jointly by the Charity Commissioners and the Secretary of State for Education and Science, the latter registers educational charities and those for other purposes which concern him and the Commissioners register all other charities. There are certain classes of charities which are excepted from the requirement to register. The register is open to public inspection at all reasonable times. This Council has exercised its power under the Charities Act and maintains an index of local charities, the information therein having been supplied by the Commissioners and the Minister of Education from the central register and they keep the Council informed of any changes, (The local index is maintained by the Town Clerk and is available for inspection). The Charities Act 1960 opens up, the way for a closer liaison between charities and local authorities if the trustees of charities so desire, and in the mutual exchange of information in the interests of beneficiories and the co-ordination of their activities in the common field of welfare, it may be found that the statutory authorities will often have knowledge of local needs which are not being met and this may be useful to the trustees looking for outlets in which to use their money; and would ensure that each, other's work complemented and not duplicated the other. Some trustees are finding that they are so tied by the terms of their trust deed which, may be narrow and obscure that they are unable to make an effective contribution towards relieving distress in the changed and ever-changing conditions of today; this is another field in which liaison could help — the local authority, after consultation with the trustees, may make recommendations to the Commissioners who have wide powers in this respect, but without whose consent no change can be made. 153 At the request of the Charity Commissioners, it is proposed to contact Charities shortly — in the first instance those for the poor and sick poor — and if they are willing to co-operate this may be beneficial to everyone - trustees, beneficiaries and local authorities alike. If any trustees feel the need to contact the Authority before this - they are most welcome to do so. One has done so already. Charities lor the Disabled The National Assistance Act 1948 (Section 41) extended the provisions of the V/ar Charities Act 1940 to include charities for disabled persons. Charities for the disabled whose principal object is for the promotion of the welfare of persons to whom Section 29 of the National Assistance Act 1948 applies, are registered locally - without such registration or exemption from registration, appeals to the public for funds or gifts are not lawful. Certain charities which had been registered by the County Council of Essex and whose administrative centres were within this area, were transferred to the London Borough of Redbridge in 1965, this Borough having become a registration authority in this respect by virtue of the London Government Act 1963. One further charity for disabled persons was registered by this Authority this year and there are now seven such charities in the Register. They are all active bodies - helping with the needs of the physically handicapped, blind, deaf, deaf-blind and spastics. 154 APPENDIX 28 LIST OF PREMISES (Local Authority) Old Peoples Homes Address No. of Places Superintendent/Matron Heath Gate Chadwell Heath Lane, Chadwell Heath, Romford. 60 Mr. & Mrs. R. Wardle. Hyleford 1 Boundary Close, Seven Kings, llford. 64 Mr. & Mrs. J.P.W. Jordan. Pegram House Longhayes Avenue, Marks Gate, Romford. 50 Mrs. J.E, Fisher. Rose Park Heathcote Avenue, Clayhall', llford. 60 Mrs. D. Church. Woodside 597 High Road, Woodford Wells. 15 Mrs. R. Chambers. Temporary Accommodation No. of Places Supervisor 28 Grosvenor Road, llford Approx. 2/3 places Mrs. M. Digby 34/36 Grosvenor Road, llford Approx. 6/7 families — do — Persons Resident as at 31.12.69 Family Units Men Women Children Total 12 7 13 24 44 Occupational Centre No. on Register as at 31.12.69 Supervisor Fellowship House, Green Lane, llford 71 Mrs. R. Low Day Centres (Local Authority) Name Address Organiser of L.A. Day Centres Aldborough Road Day Centre Aldborough Road, Seven Kings. Mrs. G. Wilson Fullwell Cross Doy Centre Fullwell Cross, Fairlop. Goodmayes Day Centre Broomhill Road, Goodmayes. Scrafton Road Day Centre Scrafton Road, llford. Broadmead Day Centre Broadmead Road,-Woodford. (For residents of estate only.) Day Centre (Voluntary) Grove Park 2 Grove Park, Wanstead. (Managed by Wanstead and Woodford Old Peoples Welfare Association.) 155 APPENDIX 28 (continued) List of Homes (private and voluntary) Name Address No. of Places (male & female) Telephone No. Arden House 40 Emerson Road, llford. 20 male & female 554-6198 Arlington Residence lor Elderly Ladies 12 Snakes Lane, Woodford Green. 18 females 504-1970 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 5 & 7 New Wanstead, Wanstead, E.ll. 36 females 989-0847 Osmont 8 Grove Park, 28 females 989-4955 106 Aldborough Road. Seven Kings. 7 females 590-3164 24 Glengall Road, Woodford Green. 8 handicapped males & females 505-0408 6 Snakes Lane, Woodford Green. 10 handicapped male & female 504-0448 29 & 31 Valentines Road, llford. 24 male & female 554-2287 Glengall Eventide 5 Glengall Road, Woodford Green. 12 females 505-0121 The Chestnuts 63 Cambridge Park, Wanstead, E.ll. 35 male & female 989-0250 Cavalier Ltd. 36 Redcliffe Gardens, llford. 12 female 554-2771 Persons in Care (as at 31.12.69) Borough Homes 249 Out-Borough Homes 123 (includes The Willows - 37) Voluntary Homes 118 490 156 APPENDIX 28 (continued Age Structure of Residents in Part III Accommodation: Establishment Under 65 65 to 74 75 to 84 85 & over Totals Average Ages Hyleford Male - 6 5 5 16 | 64 Average age Male 76 Female 1 4 24 19 48 1 " " Female 82 Woodside Female - 3 7 5 15 Average age Female 80 Pegram House Male 1 3 9 2 15 50 Average age Male 77 Female - 5 15 15 35 " " Female 82 Heath Gate Male 3 2 4 14 23 60 Average age Male 81 Female - 2 16 19 37 " " Female 84 Rose Parle Male 1 2 6 6 15 60 Average age Male 80 Female - 2 15 28 45 " " Female 85 Average age of all males 78 Average age of all females 82 Average age of all residents, male and female 80 Origin of Residents in Part III Accommodation: District Number Percentage llford Area 188 75% Wanstead and Woodford 51 21% Out-Borough 10 4% Origin of all New Admissions (permanent and short-stay) to Part III Accommodation during the year 1.1.1969 to 31.12.1969. District Number Percentage llford Area 178 73% Wanstead and Woodford 60 25% Out- Borough 4 2% 157 APPENDIX 28 (continued) Admissions to Part III Accommodation during the Year (1.1.69 to 31.12.69) Male Female Total Permanent Admissions 16 48 64 Short-stay Admissions 16 122 138 Permanent Admissions (The Willows) 7 17 24 Short-stay Admissions (The Willows) - 16 16 TOTALS: 39 203 242 Voluntary Organisations to which Grants ore paid: Redbridge Council of Social Service Redbridge Old Peoples Welfare Association Wanstead and Woodford Old Peoples Welfare Committee Toe H (Warning Lamp Scheme) Essex County Association for the Blind Southern Regional Association for the Blind llford Physically Handicapped Committee Wanstead and Woodford Association for Physically Handicapped Hainault Association for Physically Handicapped British Epilepsy Association Spa sties 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 Redbridge Deaf Club Redbridge Association of Professional Social Workers Wingfield Music Club 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 158 APPENDIX 29 STATISTICS OF THE PHYSICALLY HANDICAPPED MINISTRY CATEGORIES No. as at 31.12.69 Amputation 44 Arthritis and Rheumatism 432 Congenital Malformations and Deformities 39 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 89 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 122 Organic nervous diseases - epilepsy, disseminated sclerosis, poliomyelitis, hemiplegia, sciatica etc 370 Neuroses, psychoses and other nervous and mental disorders 5 Tuberculosis (respiratory) 2 Tuberculosis (non-respiratory) 7 Diseases not listed above 1 Total 1,111 Deaf and Hard of Hearing: Deaf with speech 77 Deaf without speech 48 Hard of hearing 56 Total 182 Blind and Partially Sighted: Blind 395 Partially sighted 168 Total 563 159 APPENDIX 30 AIDS ISSUED TO PHYSICALLY HANDICAPPED PERSONS Description of Aid: No. issued (including reissued) Bath aids 175 Toilet aids 59 Walking aids 75 Chairs 3 Tables 9 Hoists 5 Small miscellaneous aids 83 Total 409 APPENDIX 31 HOLIDAYS FOR THE PHYSICALLY HANDICAPPED Hotel or Holiday Camp: No. of Persons 1.1.69 - 31.12.69 Warners Holiday Camp, Corton 58 Essex Physically Handicapped Association 29 Grants 2 Jewish Association for the Physically Handicapped (Bournemouth) 6 Private Arrangements 6 Queen Elizabeth Foundation for the Disabled (Lulworth Court) 8 Shaftesbury Society 3 Four Winds Hotel (Ramsgate) 24 W.R.V.S. Crabhill House, Redhill 5 W.R.V.S. Grange Farm, Chigwell 13 Transport only 1 Others 2 Total 157 160 APPENDIX 32 HOLIDAYS FOR THE BLIND AND PARTIALLY SIGHTED No. of Persons 1.1.69 - 31.12.69 Hotel or Holiday Camp: Warners Holiday Camp Lowestoft (Council organised) 4 London Association for the Blind 4 llford Blind Welfare Association (Cliftonville) 13 Four Winds Hotel (Ramsgate) 7 Royal National Institute for the Blind 4 Others 7 Crants to Cuides 6 Total 45 APPENDIX 33 HOLIDAYS FOR THE ELDERLY (Council organised) No. of Persons Elderly Escorts May, 1969 - Warners Holiday Camp (Corton) 340 26 September, 1969 - Warners Holiday Camp (Corton) 320 23 Total 660 49 APPENDIX 34 MEALS ON WHEELS As at 31.12.69 llford area (administered by Dept.) Wanstead & Woodford area (W.R.V.S.) Average number of meals delivered per week 1,200 160 Average number of recipients 270/275 40/45 Total number of meals delivered during year ending 31.12.69 54.922 8,344 161 APPENDIX 35 MEALS AT DAY CENTRES Days provided per week Total No. Aldborough Road 4 2,573 Fullwell Cross 5 11,658 Goodmayes 3 (5days w.e.f. 17.11.69) 4,933 Scrafton Road 2 2,510 21,674 Grove Park (Voluntary) 16,144 162 INDEX Page No. Accidents 11 Abury House Hostel for the Mentally III 99 Animal Boarding Establishments Act, 1963 130 Atmospheric Pollution — Clean Air Act 118-121,135 At Risk Register 30-33 Attachment to General Practitioners 37,46 B.C.G. Vaccinations 82 Births 30 Blind and Partially Sighted 160 Bronchitis and Emphysema 10 Burnside Adult Training Centre 101 Cancer Education 50 Cancer, Lung and Bronchus 10 Care of Mothers and Young Children 30-36 Care of Subnormals 100 Care of the Unmarried Mother 31 Cervical Cytology 50, 62 Charities 152-15 Child Guidance Clinic 75, 90,96 Child Health Centres and Clinics 41-44, 53 Child Minders 36 Children at Risk 30-33 Chiropody Service (including School Health) 48,57 Clean Air Act - Smoke Control Orders 118-123,135 Clearance Areas 117-118 Clinics and Treatment Centres 53 - Child Guidance 75, 90,96 -Dental 33-35, 55, 92-93 - E.N.T 70, 89 - Enuresis 78-81 - Minor Ailments 66 - Ophthalmic 67-68, 89 - Orthopaedic 68-69, 90 - Orthoptic 68 - Premises 53 - Speech 71, 91 Congenital Abnormalities 54 Convalescence 36 Day Centres 148-149, 154, 161 Day Nurseries 35 Deaf and Partially Hearing 81-82, 145 163 Page No- Deaths and Causes of Deaths 16-17 Death Rates 15 Dental Health Education 60 Dental Treatment (including Schools) 33-35, 55, 92-93 Department of Education and Science - Statistical Tables 86-97 Diseases of Animals (Waste Food) Order, 1957 129 Diseases of Animals (Movement Orders, etc.) 129 Diseases (notifiable) 12 Diseases of the Skin 90 Disinfection and Disinfestation 114 Domiciliary Confinement Rate 36 Drainage and Sewerage 107-109 Dysentery 9 Ear, Nose and Throat Clinic 70, 89 Education Committee 2 Enuresis Clinic 78-81 Environmental Health 105—138 Epidemiology 9-17 Ethel Davis School (Physically Handicapped) 74-75 Extra Nourishment 49-50 Factories and Workshops 124—125; 136-137 Female Cancers 10 Fertilisers and Feeding Stuffs Act, 1926 130 Food and Drugs Sampling 113, 125 Food Hawkers 125, 128 Food Hygiene 128 Foods, Fitness and Consumer Protection 125—129 Food Poisoning 9 Food Preparation — Premises 125-129 Food Surrendered and Condemned 137 General Services 19-25 General Welfare and Research (School Health) 83-85 Geriatric Clinics 50 Guthrie Tests for Phenylketonuria 37, 38 Hairdressers and Barbers Establishments 130 Handicapped Children 82, 97 Health Committee 1 Health Centres 27—29 Health Education (including Schools) 59—63 Health Visitors and School Nurses 38—44, 56, 82 Holidays for the Blind and partially sighted 160 Holidays for the Elderly 149, 160 Holidays for the Physically Handicapped 159 164 Page No. Home Help Service 51, 52 Home Laundry Service 115 Home Nursing 45-46 Homes for the Elderly 146-147, 154, 156 Hospital Admissions - Mentally III and Mentally Handicapped 103 Housing 117-118, 133-134 Housing Allocation - Medical Grounds 19-20 Hyleford Junior Training School 101 Illegitimate Births and Deaths 8 Immigrants — Long Stay 115 Immunisation and Vaccination 46, 56-57 Infant Mortality 8 Infectious Diseases 114-115 Infective Jaundice 10 Inspection and Supervision of Food 125-129, 137-138 Ischaemic Heart Disease 10 Land Charges Act 131 Leptospirosis 9 Litter Act, 1958 114 Live Births 8 Marie Curie Memorial Foundation 51 Massage and Special Treatment Establishments 21, 24-25, 130 Mass Radiography 14, 20 Maternal Mortality 8 Meals on Wheels 149, 160 Measles 10 Medical Examination of Staff 22 Medical Inspection at Schools 66, 86-88 Mental Health Service 99-103 Midwifery 36-38 Minor Ailments 66 Mortuary 21 National Assistance Act, 1948 — Section 47 23 National Assistance Act, 1948 — Section 50 131 National Health Service Act, 1946 27-57 Neonatal Mortality 8 Noise Abatement Act, 1960 116 Notifiable Diseases 12 Nurseries and Child Minders Regulation Act, 1948 36 Nurses Agency 21 Nursing Homes 21 165 Page No. Observation Register 30—33 Occupational Centre 154 Officers of the Health and Welfare Department 3-4, 94 Offices, Shops and Railway Premises Act, 1963 123—124 Ophthalmic Clinics 67—68,89 Orthopaedic Clinics 68-69 Orthoptic Clinics 68 Pests 116, 132 Pet Animals Act, 1951 130 Pharmacy and Poisons 130 Physically Handicapped 145-146, 158-159 Physiotherapy 69 Population 8 Preface 5—7 Prevention, Care and After Care 47-51 Private Day Nurseries and Child Minders 36 Private Homes 148, 155 Public Baths 111 Public Conveniences 111 Rag, Flock and Other Filling Materials Acts, 1951 129 Rainfall 8 Recuperative Holidays 47, 66 Refuse Collection and Disposal 109-110 Rehabilitation Centre (Fullwell Cross) 102 Remedial Exercises 69 Renal Dialysis 47 Riding Establishments Act, 1964 131 Roding Valley Pumping Station 22 Sanitary Inspection of the Area 112—114 School Dental Service 71—73 School Health Service 65—97 School Psychological Service 76—77 School Roll and Premises 65 Screening Tests of Vision and Hearing 66 Services for the Elderly 146-151, 160-161 Services for the Handicapped 145—146, 150—152, 153-159 Sheltered Accommodation 109 Sickroom Equipment and Aids for the Physically Handicapped 47, 159 Slaughter of Animals Act, 1933—1954 129 Social Services/Children Committee 2 Social Work 139-144 Speech Clinics 70, 91 Specialist Clinics and Special Schools 35, 67-71, 74 166 Page No. Statistics — — Environmental Health 112—114, 132-137 — Epidemiology 12-17 — Mental Health 103 — Personal Health 53-56 — School Health 86-97 — Vital and Social 8 — Welfare 154-161 Street Cleansing 110-111 Student Public Health Inspectors - Training of 131 Suicide 11 Temporary Accommodation 149-150, 154 Tuberculosis 10, 13 T.B. Care and After Care 49 T.B. — Notifications, deaths etc 13 Typhoid and Paratyphoid Fever 9 Vaccination and Immunisation 46, 56-57 Venereal Disease 10, 14 Voluntary Organisations 150-152, 157 Water Supply 106-107 Welfare Committee 1 Welfare Services 139-161 Whooping Cough 10 Printed by The London Borough of Redbridge, Town Hall, llford.