C43393 TOW 002 TOWER HAMLETS LONDON BOROUGH ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH LONDON BOROUGH OF TOWER HAMLETS ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1966 R. W. WATTON M.B., B.S., D.P.H., D.C.H., D.I.H., Medical Officer of Health TOWER HAMLETS HEALTH COMMITTEE (as at 31st December, 1966) Ex-Officio: The Worshipful the Mayor, Alderman J. Orwell, J.P. CHAIRMAN: Councillor (Miss) H. Morsman VICE-CHAIRMAN: Councillor C. Dimes ALDERMAN J. Orwell P. Connolly. Mrs. D.M. Couling. A.W. Downes. M.J. Durell. Mrs. A. Elboz. E.W. Hill. E.J. Johns. S. Kaufman. R.A. McCarthy. COUNCILLORS: C.W. Negus J. Milrood. Mrs. K. O'Connor. T.E. Phillips. A.M. Praag. P. Roche. W.T. Tuson. E.G. Walker. G.H. Wall. 1. Health Department, 227/233, Commercial Road, Stepney, E.l. TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE LONDON BOROUGH OF TOWER HAMLETS Mr. Mayor, Ladies and Gentlemen, This year has been one of consolidation following the convulsions of the first fully operational year of the new borough, It is a pleasure to report that the department settled down to work as a more integrated team after the upheavals associated with the forced union of public health sections from four different authorities. COMMUNICABLE DISEASES Full details are given in the main body of the report on page 15 . As has been observed elsewhere, the incidence of scabies shows an increase over the last few years. Whilst this is no longer notifiable since the repeal of the County of London Scabies Order 1943 in April 1965, control was simplified by the close liaison of the Council's cleansing station staff with general practitioners and hospital staff reporting cases. Similar intensive work with schoolchildren and young persons has contained the rising rate of infestation with head lice - a sore reflection of poor personal hygiene s tandards. A minor outbreak of Sonne dysentery occurred in a day nursery, and there were sporadic cases in some nursery and infant schools. Tuberculosis notifications show an encouraging decline over the year. A high incidence continues to be found in the immigrant population of the borough, and also associated with persons in the lodging houses which abound in the area. Hopes for the future of further drastic reductions in morbidity and mortality are high if the proven methods of full investigation of each case, and the contacts, are scrupulously carried out. STAFF Whilst staffing difficulties, both qualitatively and quantitatively, in certain categories have not been overcome entirely no critical insurmountable problems were encountered. The Council has been generous in its support of training facilities, and in the case of the chronically scarce grades of health visitors and public health inspectors, the department is sponsoring for training each year more students per capita than the average London borough. However, the trend continues for newly trained staff to be enticed away to other areas within a short time of obtaining their qualifications, 2. and sometimes before expiry of the agreed two year stay after successful training. Unless and until each local authority is required to maintain an agreed quota of students in training, the overall scarcity and the local deficiency on establishment of, for example, public health inspectors will continue. It seems inequitable that areas such asTower Hamlets whose priority needs ought to receive preferential treatment should continually export its own expensively trained staff to authorities with fewer problems yet who, by inadequate provision of training schemes,refrain from contributing to the common pool of trained staff. Continual upgradings and new salary scales can do little in the long run to remedy a chronic scarcity of available staff. HOUSING The agreed slum clearance programme has continued with reasonable speed over the year. A further review of houses, including particularly the many sub-standard tenement blocks, was made to differentiate those ripe for immediate consideration for clearance from those where 'as and when' conversions are feasible, or those considered reasonable for full conversion. Approximately 13,000 dwellings are tentatively defined as unfit throughout the borough and these should be dealt with by the end of the quinquennium 1970-75, if not before. The publication of the Denington Report "Our Older Homes - A Call for Action" of the Ministry of Housing and Local Government, in particular that part dealing with the renewal of twilight areas' does not appear relevant to the situation existing here. In my view, our only answer is full scale clearance and redevelopment of the blighted areas according to a programme which will ensure new housing set in planned residential areas, insulated particularly from industry. This alone will remove the adverse environmental conditions that have plagued the area since its 'laissez-faire' growth in the 19th century and earlier. An illustrative example is the long overdue project to remove all the poultry slaughter houses (now fouling residential areas) to an industrial zone in the north eastern part of the borough. Using every power available, including those in the Poplar/Stepney Comprehensive Development Area, the combined efforts of the Greater London Council and the London Borough of Tower Hamlets are transforming the borough, albeit too slowly for some, such that its residents will be enabled for the first time in recent history in this part of the East End to live in good housing set in reasonable surroundings provided with adequate open space nearby. LIAISON - NATIONAL HEALTH SERVICE On page 27 , changes and developments during the year in respect of Sections 21 - 29 of the National Health Service Act, 1946 are enumerated at the request of the Ministry of Health. In the borough a special problem regarding the hospital services arose with proposals made by the London Hospital in response to the need to provide additional facilities for the clinical teaching of an expanding medical student pupulation. The teaching hospital recommends 'designation' to it of certain regional hospital board hospitals for this purpose. In this scheme the 'designated' hospital passes to the overall control of the teaching hospital. 3. The regional hospital board favours 'association' of their hospitals where required for the teaching of undergraduate students, without loss of administrative control. The local general practitioners are anxious not to lose the existing facilities allowing easy access of patients to the local non-teaching hospitals which have operated successfully as district hospitals for many years. The Borough Council is on record in favour of closer integration of the area health services by the encouragement of health centre types of practice; linking its own services with the general practitioners working in groups. The future may ultimately bring a combined approach of the hospital, executive council, and local health authority services perhaps in the manner foreshadowed in the Area Health Board concept of the 'Porritt Report' 1962, - replacing the numerous liaison committees and meetings now attempting to facilitate harmonious working of a tripartite national health service. DERELICT SITES This topic is of perennial concern but one which fortunately does decrease proportionately with the years. Despite the efforts of departments of the Council, unsightly and unhygienic conditions continue to exist in parts of the borough often accentuated by inadequate fencing failing to prevent fly-tipping and trespassing. 'Meth drinkers' have become associated with these sites particularly on the western side of the borough. Reports on their activities are exaggerated but there is a great social nuisance' occasioned from these small schools of vagrants. This has led to a reaction by local residents in the formation of a 'Tower Hamlets Clean Up' campaign. The Spitalfields area is one focus of concentration of these undesirable elements. Whilst Cable Street is now being developed its former unsalubrious aspects are being transferred to the environs of Brick Lane. The process is the repetition of a familiar pattern that socially depressed areas in which slum property is intermixed with industrial, commercial activities together with a few lodging houses existing therein, will always proceed in a vicious spiral downward. If this extreme western section could be cleared and redeveloped without dispersing the problems to adjacent parts the major black spot of the borough would be eradicated. Vagrant elements, a floating population originating from outside the borough, cease to congregate in newly developed areas, and new arrivals of the same type would no longer be encouraged following the removal of the adverse environment in which they can at present find a precarious existence. There is a school of thought which argues that the social deviant should be rehabilitated at a place where he comes to rest. The Council has been unable fully to support this view, and would favour rehabilitation facilities outside the borough rather than that to its other manifold problems there should be added care and rehabilitation of the social flotsam and jetsam from many parts of the country. Various bodies, church and voluntary agencies, continue with specific projects to assist this small group of misfits. The reception centre section of the Ministry of Social Security, whose nearest hostel is in South London, has begun sending transport nightly into inner London areas known to have vagrants congregating on sites. Any such in need is offered free transport and a night's lodging at the centre, with provision of the Ministry's rehabilitation services to those wishing to avail themselves of the same. 4. CO-ORDINATION OF SOCIAL SERVICES The co-ordinating procedure as between the Children's, Health, Housing and Welfare Departments continued successfully throughout the year. The Members' Co-ordinating Committee has proved an effective machine for ensuring the allocation of responsibility between departments of the Council for its general policy on matters appertaining to the various social services. At field worker level good relationships exist with the numerous statutory and voluntary bodies working in the borough. A visit by members of the 'Seebohm Committee' was made recently to study the working of the borough's social services. The findings and any recommendations of that Committee are awaited with interest by all concerned departments. SOCIAL CONDITIONS Although many problems still exist, the image so often presented of the East End by the mass media is really more reminiscent of conditions in the late 19th century with undertones of Jack the Ripper. The area is continually chosen to personify a romanticised picture of the human jungle, red in tooth and claw yet tempered by a spirit of good neighbourliness. It is time to demonstrate the falsity of this image by citing the recent vast improvements made, not least in housing, schools and the general environment, so counteracting the distorted false view which pictures a meths drinker on every derelict site, a psychotic on every street corner, and an overt juvenile deliquent in every schoolboy. Failure to do so may nullify the good effects of the changes for the better by a resultant inability to attract and hold stable communities in new estates. The transfer of problem families from other areas of London to large lettings in the pre-war blocks within the borough has not helped in this respect. Gresham's law can be applied to human society, 'the bad will drive out the good'. Other results also flow; for instance teachers, health and social workers may become difficult to recruit to the borough which, whilst it will not be a garden city for a long time, if ever, deserves a long overdue approach to proclaim it's virtues. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, R.W. WATTON. Medical officer of Health May, 1967. 5. STAFF OF HEALTH DEPARTMENT (as at 31st December, 1966) MEDICAL OFFICER OF HEALTH Dr. R.W. Watton. DEPUTY MEDICAL OFFICER ASSOCIATE MEDICAL OFFICER SENIOR MEDICAL OFFICER OF HEALTH OF HEALTH Dr. C.M. Gourlay Dr. W.C. Turner (Vacant) Assistant Medical Officers Full-Time: 1 Part-time: 21 CHIEF ADMINISTRATIVE OFFICER E.P. Webber SENIOR ADMINISTRATIVE OFFICERS C.H. Drake J.E. Pestell M. Pliskin G.R. Williamson Administrative and Clerical Staff: Full-time70 Part-time: 8 CHIEF PUBLIC HEALTH INSPECTOR DEPUTY CHIEF PUBLIC HEALTH INSPECTOR H.W. Luke H.S. Davies Public Health Inspectors: 24 Pupil Public Health Inspectors: 10 CHIEF DENTAL OFFICER D. Waller Dental Officers: Full-time: 3 Part-time: 7 PRINCIPAL NURSING DEPUTY PRINCIPAL NURSING ASSISTANT NURSING OFFICER OFFICER OFFICER Miss E.J. Early Miss A.M. Thomson (Vacant ) Health and Tuberculosis Visitors: Clinic and School Nurses: Full-time: 28 Part-time: 3 Full-time: 21 Part-time: 7 PRINCIPAL SOCIAL WORKER ASSISTANT PRINCIPAL SOCIAL WORKER (MENTAL HEALTH) (MENTAL HEALTH) Miss A.M. Joseph F. Sullivan Social Workers (Mental Health): 9 Supervisory Staff at Mental Health Training and Day Centres: 18 PRINCIPAL SOCIAL WORKER ASSISTANT PRINCIPAL SOCIAL WORKER (HEALTH SERVICES) (HEALTH SERVICES) Miss E. Brett Miss C.M. Chase Social Workers and Family Caseworkers: 4 OLD PEOPLE'S VISITORS: 5 NON-MEDICAL SUPERVISOR .OF MIDWIVES NURSING SUPERINTENDENTS (Agency): 3 Miss I.M. Clarke Midwives (Agency): 7 District Nurses (Agency): Full-time: 28 Part-time: 8 HEALTH EDUCATION OFFICER Miss P.G. Hodges HOME HELP ORGANISERS: 3 ASSISTANT HOME HELP ORGANISERS: 6 Total Staff of Department 836 (equivalent full-time 652) 6. SUMMARY OF STATISTICS. 1966 Area of Borough (Acres) 4,994 Rateable Value (1st April) £14,759,006 Population: Mid-year estimate 202,560 Census, 1961 (former Sum represented by a penny Boroughs) 205.682 rate (1966-67) £61,496 Density of population (persons per acre) 41.54 General Rate (1966-67) lis. 4d. in £ Number of inhabited dwellings according to Rate Books 61,991 " structurally separate dwellings - Census 1961 59,885 " " private households - Census 1961 67,858 Births Total Male Female All Births 3,766 1,929 1,837 Live Births Legitimate 3,272 1,680 1,592 Illegitimate 431 219 212 Total: 3,703 1,899 1,804 Still-Births Legitimate 54 26 28 Illegitimate 9 4 5 Total: 63 30 33 Deaths All Causes 2,245 1,228 1,017 Maternal Nil - Nil Infants under 1 year Legitimate 56 35 21 Illegitimate 6 5 1 Total: 62 40 22 Rates Live birth-rate per 1,000 population 18.28 Death rate per 1,000 population 11.08 Still-birth rate per 1,000 total births 16.73 Maternal death rate per 1,000 total births Infant death rate (under l year) per 1,000 live births 16.74 Legitimate infant death rate per 1,000 legitimate live births 17.11 Illegitimate infant death rate per 1,000 illegitimate live births 13.92 Neo-natal death rate (under 4 weeks) per 1,000 live births 12.15 Early neo-natal death rate (under l week) per 1,000 live births 10.53 Perinatal death rate (stillbirths plus deaths under l week) per 1,000 total births 27.08 Illegitimate live births per cent of total live births 11.64 Area Comparability Factors Births 0.93 Deaths 1.14 ********* - 8 - PART I STATISTICS AND SOCIAL CONDITIONS OF THE AREA I. STATISTICS AND SOCIAL CONDITIONS OF THE AREA The Borough of Tower Hamlets is bounded on the west side by the City of London, on the east by the Borough of Newham, on the north by the Borough of Hackney and on the south by the River Thames. The river boundary ,is some seven miles in length along which exist numerous wharves engaged in trans-shipping activities. The area of the borough is 4,994 acres, being approximately four miles long, and four miles wide at the most distant points. Some 266 acres cover canals and enclosed docks including St. Katharine and London Docks, East and West India Docks, and the Millwall Docks. The predominant geological stratum is dark blue London clay found at a depth of between 20-30 feet from the surface; above this level are layers and patches of gravel and sand, with brown and yellow clays found nearer the surface. In some parts of the borough there are layers of "made" ground, the result of earlier habitation, and as is to be expected the flow of subsoil water is towards the river. The area is to a large extent industrial in character, factory premises being spread throughout the borough with light industry tending to concentrate in the western end, and heavy industry in the east. One of the chief industries of the borough is the manufacture of clothing of all kinds and it is estimated that one-third of the tailoring industry of London is carried on in this area. Other major industries include brewing, engineering, the manufacture of furniture and ship repairing. Tower Hamlets is also one of the most important wholesaling districts in London. Spitalfields wholesale fruit and vegetable market and the London Fruit Exchange are situated in the borough, and there are many wholesale food depots from which goods are distributed through the country. Notable landmarks in the borough include the Tower of London and the Royal Mint. THE BOROUGH'S COAT OF ARMS The official "Blazon" or description of the Council's Armorial Bearings (reproduced on the cover of this Report) as given in the Letters Patent is as follows: The Arms "Argent out of a Base wavy Azure thereon two Bars wavy Argent a Lymphad sail furled Sable pennon and flags flying Gules on a Chief Azure between a pair of Fire Tongs and a Weaver's Shuttle a Pale Argent charged with a sprig of Mulberry fructed proper." Crest on a Wreath of the Colours "In front of a representation of the White Tower of the Tower of London proper two Anchors in saltire Or." 9. Supporters "On the dexter side a Seahorse (Hippocampus) and on the sinister side a Talbot proper." POPULATION The Registrar-General's estimated mid-year population of the borough was 202,560, a decrease of 2,000 from last year's figures. This is a continuation of the downward trend which has occurred since 1947. Births exceeded deaths by 1,458, so that as the estimated population decrease was 2,000, the net estimated movement of residents out of the borough amounted to 3,458 persons. The density of population is 41.54 persons per acre. The estimated child population is as follows:- Under 1 year 1-4 years 5-14 years 15 years 3690 13610 28800 46100 The Registrar-General has published results of an attempt to subdivide the estimates of net civilian migration into movements wholly within England and Wales and movements involving other countries. It is reported that perhaps the most significant feature of the estimates of net migration is the balanced position for the South East Standard Region. It is clear from these figures that there is not, and has not been for the last five years, any drift of population from the remainder of England and Wales to the South East Standard Region. Estimates for a region as a whole necessarily conceal differences within that region, and this is particularly significant in the South East. The balanced position for the region as a whole conceals an overall net outflow of some eighty seven thousand persons from Greater London. Furthermore, as Greater London is estimated to have gained thirty thousand persons from outside England and Wales, a net movement from Greater London to the rest of the country (including other parts of the South East) of some one hundred and seventeen thousand persons is estimated. The South East has an average birth rate (a low rate in London off-setting high rates elsewhere in the region) and a low death rate. The crude death rate in the remainder of the region outside the Metropolitan Area is high, though not so high as the high proportion of older persons (especially in the coastal towns) might suggest; but it is offset by the low rate in London and - particularly - the Outer Metropolitan Area. 10. The regions with balanced migration are affected in opposite directions by natural increase. Wales, with a very low natural increase, has a low share of the overall increase. The South East, on the other hand, has a slightly higher than average overall population increase because of the high rate of natural increase reflecting the low death rates in the Metropolitan Area. LIVE BIRTHS There were 5,457 live births registered in the borough during the year. After correction for place of residence (inward transfer 187, outward transfer 1,941), the number allocated to the borough was 3,703, comprising 1,899 boys and l,804 girls, a decrease of 164 from 1965, giving a crude birth rate of 18.20 per 1,000 population compared with 18.90 last year. When adjusted by the Registrar-General's area comparability factor for the borough, which makes allowances for differences in the age and sex distribution of the population throughout the country, the rate is 17.00, compared with 17.7 for England and Wales. ILLEGITIMATE LIVE BIRTHS The number of illegitimate live births during the year was 431, equivalent to 11.64% of the total live births, compared with 12.33% last year. STILLBIRTHS This year stillbirths numbered 63, equivalent to a rate of 16.73 per 1,000 total births compared with 14.77 in 1965. The rate for England and Wales was 15.3. DEATHS The number of deaths registered - 2,245, shows a decrease of 35 from the figure of last year. The death rate was 11.08, and when adjusted by the comparability factor becomes 12.63 as compared with 11.7 for the country as a whole. The largest single cause of death was heart disease - 28% of total deaths, followed by cancer 21% and respiratory conditions 18%. The various causes of death and distribution by age groups are set out in Table I, on page 95 . INFANT MORTALITY Deaths during the first year of life numbered 62 equivalent to a rate of 16.74 per 1,000 live births. The rate for the previous year was 19.65 and 22.4 for 1964. Minor fluctuations occur in years in the same decade but generally the downward trend continues: in 1931 the comparable rate for the area was 77 per 1,000 live births and in 1921 almost 11. 1 in 10 babies died before their first birthday. The rate (provisional) for England and Wales was 18.9 for 1966. Details of causes of death at various ages under 1 year will be found in the Appendix on page 96. MATERNAL MORTALITY No maternal deaths occurred in the borough during the year. NEO-NATAL MORTALITY During the year there were 45 deaths of infants under 4 weeks representing a neonatal mortality rate of 12.15: the rate for England and Wales was 12.9. Last year there were 52 deaths giving a rate of 13 .44 per 1,000 live births. PERI-NATAL MORTALITY This term is used to describe the combination of stillbirths and deaths in the first week of life expressed as a rate per 1,000 total live and still births. The rate for this year was 27.08, the rate for England and Wales being 26.3. ACCIDENTAL DEATHS Deaths due to accidents numbered 71, motor vehicles being the cause of 24 deaths. Statistics supplied by the Road Safety Officer will be found on page 95 . MORBIDITY The number of first claims for sickness benefit are obtained from local offices of the Ministry of Social Security and are included for information in a monthly bulletin circulated by the department to all hospitals and general practitioners in the area. The Ministry's offices are not coterminous with the borough boundaries but rather with postal districts, so that these claims do not relate entirely to borough residents; they cover the E.l, E.2, E.3 and E.14 postal districts. (Monthly figures are to be found on page 99 ). MARRIAGES The number of marriages solemnised in the borough during the year was 1,560, made up as follows:- Register Office 701 Church of England 563 Roman Catholic, Methodist and other non-conforming churches 257 Synagogues 39 12. The marriage rate per 1,000 population was 15.4 compared with 16.0 last year. UNEMPLOYMENT The number of unemployed persons registered at the Poplar, Shoreditch and Stepney Employment Exchanges at 12th December, 1966 totalled 3,330 men and 369 women, an increase of 2,103 over last year. It must be borne in mind that the above figures do not apply solely to Tower Hamlets residents as one does not need to be a resident to register with an employment exchange of a particular area. Furthermore the Shoreditch Exchange figures include the Bethnal Green and Shoreditch areas. Unemployed young persons (under 18), as supplied by the Youth Employment Officers, numbered 115 boys and 40 girls, compared with 1965 figures of 44 and 15 respectively. OPEN SPACES There are 312 acres of parks and open spaces within the borough, representing 1.54 acres for every 1,000 population, some 6 acres being added this year. The County of London plan provides for 4 acres within the county per 1,000 population, with an interim standard of 2½ acres. A list of the sites is given on page 116. COMPARATIVE STATISTICS A table showing vital statistics for the area covered by the borough at various years from 1901 is on page 97 . HEALTH DEPARTMENT ESTABLISHMENTS A list of all Health Department Establishments showing clinic sessions held and other services provided is given in the Appendix on pages 142 - 150. 13. ********** - 14 - PART II INFECTIOUS AND OTHER DISEASES II. PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES WEATHER CONDITIONS January was a dry and very cold month, whilst February was wet but milder than usual. March also was rather mild, April being the dullest for 46 years with snow in London in the middle of the month. May saw the sunniest Whitsuntide for eighteen years, but overall the month was changeable with thunderstorms and ground frost. Sunshine in June was less than average, and rainfall was 50 per cent higher. July was dull and cool. It was the coldest 1st August at Kew since 1917, the month generally being cool with heavy rain at times. September was dry with average sunshine, followed by a dull and wet October. A dry, cold November was fog free, the year terminating with a mild December and the sunniest Christmas Day this century. INFECTIOUS DISEASES - NOTIFICATIONS The number of notified cases of infectious disease, corrected for revised diagnosis and duplicate notifications, was 2,267, compared with 2,981 during the previous year. Liaison is maintained with general practitioners and hospitals in the area by a monthly bulletin which is circulated giving them information on the number of infectious diseases occurring in the borough during the month, the number of new claims for sickness benefit received at local offices of the Ministry of Social Security in the area, and other relevant information from time to time. A summary of notifications of infectious diseases received during the year will be found on page 99 and a list of diseases notifiable in the borough on page 98. ANTHRAX No case of anthrax was reported during the year. CANCER Deaths from cancer this year numbered 481 of which 157 were due to cancer of the lung. The death rate of lung cancer was 0.77 per 1,000 population,an increase of 7% over last year. In a circular issued during the year the Minister of Health pointed out that in the country generally deaths from lung cancer continue to rise, increasing since 1961 by an average of 1,000 per annum. Deaths in Great Britain in 1963 were over 29,000 i.e. about 80 a day. Research studies provide ever increasing evidence of the connection between 15. cigarette smoking and lung cancer and other serious diseases. DIPHTHERIA No cases of diphtheria came to the notice of the department during 1966. Particulars relating to children immunised against diphtheria will be found on page 100. DYSENTERY Notified cases of dysentery totalled 181, compared with 61 during the previous year. There were two incidents of dysentery in day nurseries and one in a nursery school. Faecal specimens from 23 persons were examined in one of the nursery outbreaks and six children were found to be positive. In the other nursery incident, six suspects were tested and Sonné dysentery organisms isolated in four cases. In the incident at the nursery school, 55 children and adults were tested and Sonné dysentery was isolated in 12 children, 3 members of the staff (including a kitchen employee) and 5 other family contacts. Particular attention is paid to personal hygiene during an outbreak, paper handtowels and hand-dipping solution are issued and surfaces which are touched by children when using the water-closet are frequently cleansed with disinfectant. The staffs of schools and nurseries keep constant vigilance for incidents of diarrhoea and vomiting and advise the Health Department of suspected cases among absentees so that they may be followed up by the public health inspectors. ENTERIC FEVER One case of paratyphoid fever was notified by a hospital within the borough. The patient was not a resident of Tower Hamlets. FOOD POISONING There were 48 notifications of food poisoning during the year and a further 11 cases came to the notice of the department. Organisms of Salmonella typhi-murium were isolated in 22 cases, of which 10 were in one family and two in another. The remaining 10 were found in sporadic instances. In one case, salmonella Brandenberg was isolated. In 1965, 42 notifications were received. One outbreak was reported to the Ministry of Health as required by Memorandum 188 Med. issued by the Ministry. 16. LEPROSY The Public Health Leprosy Regulations 1951 were replaced by regulations made this year, which came into operation on 1st March. Under the new regulations the disease is notifiable to the Medical Officer of Health, instead of to the Chief Medical Officer of the Ministry of Health as formerly. MALARIA A case of malaria, contracted abroad, was notified by a hospital in the borough. MEASLES Notified cases of measles totalled 1,469 during 1966. In the previous year, 2,236 notifications were received. MENINGOCOCCAL INFECTION Eight cases were notified, compared with five during 1965. OPHTHALMIA NEONATORUM Two cases were notified, compared with four last year. POLIOMYELITIS It is gratifying once again to report that no cases of poliomyelitis occurred in the borough during the year. Details of vaccination against poliomyelitis will be found on page 100. PSITTACOSIS A diagnosis of psittacosis was confirmed in a couple, who had purchased a parrot in a local street market. The parrot was destroyed and its carcase sent to the Public Health Laboratory Service for examination. PUERPERAL PYREXIA Notifications of puerperal pyrexia numbered 26 (13 in 1965). Of these, 16 related to residents of Tower Hamlets. SCABIES Cases of scabies which came to notice during the year totalled 104, compared with 17. 86 in 1965. Patients and contacts numbering 303 were given medicinal baths and their clothing disinfected at the Council's cleansing station. The number of baths given was 448. Instances of scabies appear to be on the increase, and although it ceased to be a notifiable disease on 1st April, 1965, by the co-operation of the general practitioners information is forwarded to the Health Department of persons suffering from the condition, and arrangements made for follow-up by home visits to ensure that the patients and their contacts receive treatment at the Council's cleansing stations. SCARLET FEVER There were 95 confirmed cases notified, 76 less than in 1965. SMALLPOX No cases of smallpox were notified during the year although the advice of the Medical Officer of Health was sought by general practitioners in some instances where the disease was suspected. Notifications are frequently received from port and airport authorities of persons coming into the borough who may have been in contact with smallpox. Observation is kept on such persons by officers of the Health Department for the necessary period. The number of children under 15 years successfully vaccinated or revaccinated against smallpox at the Council's clinics, during the year, was 1,752 WHOOPING COUGH Cases notified during the year numbered 127, compared with 101 during 1965. Statistics relating to immunisation are on page 100. TURERCULOSIS The number of primary notifications of pulmonary tuberculosis received during the year was 109, giving a notification rate of 0.53 per 1,000 population compared with 0.71 last year. Non-pulmonary cases notified numbered 24. The mortality rate for pulmonary tuberculosis was 10.8 per 100,000 population compared with 9.7 last year. The number of cases on the register fell during the year by 87, all pulmonary cases. Statistical data relating to new cases, deaths and variations in the register will be found on page 101 18. Persons X-rayed by the two Mobile Mass Radiography Units of the Regional Hospital Board which pay periodic visits to the borough, are referred to on page 103. MEDICAL ARRANGEMENTS FOR LONG-STAY IMMIGRANTS With the growing numbers of long-stay immigrants who have come to this country during recent years, special problems have arisen in connection with their health and treatment. Many of them are unfamiliar with our customs and are, in particular, ignorant of the scope and arrangements of the National Health Service. They may, at first, live under very difficult conditions and some of them are from countries where tuberculosis is a serious hazard. The problem has been to ensure that, at an early date, these immigrants learn to use the Health Service. They are encouraged to have a chest X-ray as soon as possible after arrival, if they come from a country with a high incidence of tuberculosis. Arrangements were, therefore, made by the Ministry of Health for long-stay immigrants to be given a leaflet at the port of entry, printed in several languages, encouraging them to register with a medical practitioner so that, if necessary, a chest X-ray can be arranged. In addition, these immigrants are asked to provide their destination addresses, which are forwarded to the Medical Officer of Health of the area concerned. In this borough, the public health inspector visits each address of which the department is informed and newly-arrived immigrants are again urged to register with a doctor and further copies of the leaflet are supplied, in cases where the original has been mislaid. During the year, 278 advice notes, of immigrant arrivals, were received in the department from various ports of entry and successful contact was made in 130 instances. Of the remaining 148, some had moved to addresses outside the borough and details were forwarded to the authority concerned but the majority were either not known or had never arrived at the address given. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. These regulations provide that persons suffering from tuberculosis of the respiratory tract shall not be employed in the handling of milk or milk receptacles. Power is given to the Council to cause such persons to discontinue their employment. It was not found necessary to take action under the Regulations during the year. B.C.G. VACCINATION The numbers of children vaccinated during the year, under the Council's scheme for the B.C.G. vaccination of susceptible (tuberculin negative) child contacts of known 19. tuberculous patients, diabetic children, thirteen-year old schoolchildren, students at further education establishments and mentally subnormal persons at training centres, are shown in Table 14 on page 103. OTHER PREVENTIVE MEASURES In addition to the B.C.G. vaccination scheme, other preventive measures include the chest X-ray of all newly appointed staff and an annual X-ray of those who are likely to work in close and frequent contact with children, staff at the Council's training centres for mentally subnormal persons and tuberculin reactors discovered among thirteen-year old schoolchildren, students and others tested with a view to B.C.G. vaccination. Epidemiological investigations are made among the contacts of cases of tuberculosis notified in children, staff or residents in the Council's establishments. Similar investigations are carried out at secondary schools where the reactor rates disclosed by tuberculin surveys are significantly higher than the average for secondary schools in the area. CHEST CLINICS In conjunction with the North-east Metropolitan Regional Hospital Board and the Brompton Hospital, and in accordance with proposals under Section 28 of the National Health Service Act 1946, tuberculosis prevention, care and after-care services for patients living at home are provided at three chest clinics in the borough staffed by chest physicians, tuberculosis visitors, welfare officers and clerks. Services include:- (i) B.C.G. vaccination of persons who have been in contact with tuberculous patients; (ii) Home visiting by health visitors; (iii) Social Work by welfare officers; (iv) Assistance in cash or kind not available from official sources by chest clinic voluntary committees from their voluntary funds. The welfare officers act as secretaries to these voluntary committees; (v) Boarding-out of child tuberculous contacts; (vi) Home nursing including the loan of bedding and nursing equipment; (vii) Home helps; (viii) Extra nourishment; (ix) Rehousing of selected tuberculous families; (x) Recuperative holidays; (xi) Maintenance during industrial rehabilitation at voluntary village settlements; (xii) Admission to hostels for homeless tuberculous men. Statistics relating to these services are on page 102. 20. CHEST DISEASES CARE COMMITTEES Three such committees operate in the borough and I append the reports of the consultant chest physicians on the work of the committees and clinics during the year. Dr. M. Caplin, Consultant Chest Physician to the Chest Clinic at The London Chest Hospital reports: "The work of the Hackney and Bethnal Green Chest Diseases Care Committee has continued throughout the year. In addition to the usual activities of the Committee in providing fares for relatives to visit patients in hospital, holidays for wives and families of patients, clothing, television licences, fuel allowances, the Committee provided parcels at Christmas for the lonely and needy, and Christmas presents to the tuberculosis ward in Bethnal Green Hospital, and the wards of the London Chest Hospital. Wherever possible the Committee first enlists the help of statutory sources in attempting to solve the patient's problems, and we have been pleased to refer many of our patients to the National Assistance Board (now the Ministry of Social Security) for maintenance grants, for additional needs grants such as clothing, etc., and extra nourishment and fuel allowances. Our close liaison with the Ministry of Labour, in particular the disablement sections, has ensured that patients whose work is considered unsuitable have been given sympathetic help and consideration. The pattern of life is changing rapidly in the field in which the Committee operates and the ageing population is leading to greater problems of care and attention at home. We have found considerable help with this problem by being able to send a large number of our chronic sick housebound patients to Darvell Hall, Robertsbridge, and Eversfield Chest Hospital, St. Leonard's-on-Sea,for holidays. In this way not only has the patient benefitted but also the strained relatives. The ability to obtain hospital beds has helped solve the problems of acute illness, but chronic illness brings with it a great need for increased financial help and domestic help, diversional therapy and a voluntary body interested in 'their' type of illness, all of which services we have been able to call upon to help our patients. Our principle problems in the clinic lie within the categories of housing and employment. Included in the category of housing difficulties are those living in poor conditions, those who are overhoused, and those imprisoned by their inability to cope with the stairs to their flat. The employment problem can be divided into two categories, first the acute shortage of light work for the unskilled worker probably aged 50 or more, and secondly when such work is available the grossly inadequate pay which is offered for the post makes it difficult for him to accept it. 21. The work of the Bronchitis Register has continued in Bethnal Green, and we are very grateful to the local general practitioners for the co-operation they have shown in participating in this scheme. Much interesting social knowledge is being obtained and we hope our social report on the first 200 bronchitic patients we have seen, to be published later in 1967, will prove most useful." Dr. R.M. Orpwood, Chest Physician at the Poplar and Stepney Chest Clinics, reports: "The work of the Poplar and Stepney Chest Clinics has continued during 1966 along the well proved lines that have been followed in the past. The function of the clinics remains unaltered and, although there is a continuing and significant reduction in the number of newly notified cases of tuberculosis, this disease remains the primary concern. The follow-up of cases for many years after treatment is an important aspect of the work. Reactivation of the disease has been found in patients who have been considered inactive for a period in excess of 5 years. This underlines the importance of continuing follow-up of treated cases and the need for adequate staff to see that such patients do not default on their routine attendances for check-up. It has been noted for some years that tuberculosis-formerly a disease most common in girls and young women of 15-30 age group - is now predominantly a disease of middle aged and older men. The "problem" cases arise mainly amongst those who live in lodging houses, or who have no proper home or relatives to care for them, and also amongst immigrants, particularly those from Asiatic countries. The numbers of the latter group are, however, beginning to decrease (20% of all new notifications at the Stepney Clinic in 1966, compared with 37% in 1965). This is due, no doubt, to the new regulations for health checks now applying to all new immigrants. This group remains a problem and will need to be kept under constant review. New cases come to the clinics either via a reference for investigation by the family doctor, or from one of the hospitals. X-ray facilities are also available for the general practitioners' patients at Mile End Hospital X-ray Department, the films being reported by the Chest physician, and abnormalities reported are subsequently investigated at the chest clinics. This has proved a valuable and increasingly popular form of investigation during the past four years: —2,282 patients were examined in this way during 1966; 11 cases of tuberculosis and 9 cases of carcinoma of the lung were discovered (a rate of 4.6 per 1,000 and 2.6 per 1,000 respectively.) The elimination of tuberculosis may become a possibility during the next decade. It should then be possible for the chest clinics to direct all their energies to the alleviation of other chest conditions, many of which are as disabling to the patient as tuberculous disease has been in the past." 22. VENEREAL DISEASE Annual returns received from venereal disease clinics at the London Hospital; Dreadnought Seamen's Hospital, Greenwich; Albert Dock Hospital, Woolwich,and the Middlesex Hospital, show that new cases attending these hospitals during the year were as follows:- AREAS OF RESIDENCE OF NEW PATIENTS TREATED:- AT THE WHITECHAPEL CLINIC DURING THE PERIOD APRIL - DECEMBER:- Area Syphilis Gonorrhoea Other Conditions Total Tower Hamlets 66 546 1580 2192 Other London Boroughs 74 629 2599 3302 Other Areas 15 105 691 811 155 1280 4870 6305 AT DREADNOUGHT SEAMEN'S HOSPITAL DURING THE YEAR: Tower Hamlets 0 5 17 22 Other London Boroughs 4 77 397 478 Other Areas 33 84 484 601 37 166 898 1101 AT ALBERT DOCK HOSPITAL DURING THE YEAR Tower Hamlets 0 2 13 15 Other London Boroughs 3 22 115 140 Other Areas - U.K. & Eire. 9 49 411 469 Elsewhere 4 23 100 127 16 96 639 751 AT MIDDLESEX HOSPITAL DURING THE YEAR: Tower Hamlets 2 4 30 36 Other London Boroughs 172 1044 4326 5542 Other Areas 20 236 1135 1391 194 1284 5491 6969 Two welfare officers appointed by the Council work from the Whitechapel Clinic under 23. the direction of Mr. Ambrose King, F.R.C.S., Medical Director of the Clinic, for tracing contacts and following up defaulters. Mr. King reports as follows:- "As in other years the largest number of patients comes from Tower Hamlets although there are considerable contributions from Hackney, Newham and elsewhere. The 66 new cases of syphilis included 33 early or infectious cases. The following table refers to the search for infecting contacts of infectious cases of syphilis and of gonorrhoea: Early Syphilis Year 1966 January - October 1966 1965 1964 No. of sources of infection 55 51 107 59 No. attending 10 10 13 1 Percentage attending 18 20 12 2 No. infected 9 9 10 0 Percentage infected of those attending 90 90 77 0 Gonorrhoea No. of sources of infection 1162 975 1021 1355 No. attending 321 260 201 148 Percentage attending 28 27 20 11 No. infected 295 238 166 121 Percentage infected of those attending 92 91 83 85 It will be noted that persons alleged to be primary sources of infection in 20 per cent of cases of infectious syphilis in the period January to October were presented for examination and of the 10 patients concerned 9 were found to be infected. This compares with 12 per cent of the total for a similar period in 1965. The number of cases of infectious syphilis was considerably less in 1966 than in 1965 and I have no doubt that diligent contact tracing has been responsible for this. As regards gonorrhoea, sources of infection traced and brought for investigation in January to October amounted to 27% and for the full year 28%; this compares with 20% for January to October 1965. This represents a great deal of devoted and diligent work. Considering the difficulties I think these efforts must be regarded as most successful. The outcome 24. has been a coasiderable reduction in infectious syphilis and also a reduction in cases of gonorrhoea. I suspect the latter will be against the national trend.. In assessing these results we must bear in mind that many of the patients whom we see are seamen and others who have been infected abroad. There are of course some who have been infected in other parts of the country or of London. In all these cases attempts are made to bring the sources of infection and contacts under treatment by liaison with other clinics and with other authorities." COMPENSATION FOR STOPPING EMPLOYMENT Section 41 of the Public Health Act 1961 makes provision for a medical officer of health to request any person to discontinue work with a view to preventing the spread of infectious disease,such person to be compensated for any loss suffered as a consequence. It was not found necessary to take any such action this year. Food handlers excluded from work on account of suffering from infectious disease and for which certificates were issued for the purpose of claiming National Insurance benefit numbered 3 during the year. 25. ********** - 26 - PART III PERSONAL HEALTH SERVICES III. PERSONAL HEALTH SERVICES Personal Health Services comprise services provided by the Council, in its capacity as a local health authority, under the provisions included in Part III of the National Health Service Act 1946. Included in this section of the report also are services provided under the Mental Health Act 1959. CHANGES AND DEVELOPMENTS DURING THE YEAR- SECTIONS 21-29 OF THE NATIONAL HEALTH SERVICE ACT 1946- Section 21 - Provision of Health Centres A great deal of discussion is taking place on the integration of the services available under the National Health Service Act 1946, particularly those provided by general practitioners and local health authorities. Whilst most would agree that monolithic 'health centres' are not the answer, provision of centres under Section 21 is not acceptable to all. In this area, five years ago, the response from general practitioners to discuss possible schemes for joint working from combined centres was very poor. However, in the last year or two, in different areas of the borough interest has been forthcoming from many groups of doctors. Discussions initiated by this authority have taken place which were attended by representatives of the Inner London Executive Council, Inner London Local Medical Committee, the Ministry of Health and general practitioners. Throughout the borough there are now tentative plans for group practice liaison with the local health authority in at least four areas- i) Roman Road area, E.2. In a large-scale borough housing development over the next few years it is hoped to build a medical group practice centre planned integrally with the community housing scheme; ii) Spitalfields area, E.1. A group of doctors has shown interest in practising from a centre planned in the new Toynbee Hall redevelopment; iii) Bethnal Green area, E.2. In the redevelopment of University House Settlement plans include group practice premises for local doctors; iv) The Watney Street development area, south of Commercial Road, E.1. includes seven general practitioners who are, or will be, displaced by current developments and who have met to explore methods of working from a group practice combined with premises for the provision of local health authority services preferably within the same building. In the Ten-Year Development Programme, the replacement of St. George's Infant Welfare Centre, Cable Street, by a purpose-built clinic is planned. It is hoped that this can be incorporated with a group practice to serve the seven doctors either as a Section 21 or Section 22 centre, or a group medical practice centre with local health authority services provided in close proximity thereto. A site has been earmarked and, subject to financial provision 27. and agreement on the type of centre, it is hoped to complete this within the next three years. The Health Committee, and Council, having considered the principle of integrating group practice premises with their own services, agreed to support the implementation of such schemes in this area. Section 22 - Care of Mothers and Young Children (a) To date, recruitment of part-time medical officers to work at infant welfare clinics has not been difficult. There is a cadre of experienced (many married) women doctors able to provide for this service. In line with proposals under consideration for integration of general practitioner and local authority services, the question of provision of 'infant and baby' clinics by general practitioners has been considered. During the year, a woman doctor, one of the seven general practitioners who are likely to form a group practice in the Watney Street development scheme, has undertaken regular weekly sessions at the Council's St. George's Centre. Faced with a shortage of medical manpower, and the need to integrate, more use of local general practitioners in the authority's service appears to be the way of the future. Whilst the latent hostility that has been known in the past between some general practitioners and local health authority clinic staff has not entirely disappeared, such linked use of staff should decrease risks of disagreement. There are inherent difficulties which prevent a widespread immediate implementation of this policy but, as and when opportunity occurs by mutual consent of the local practitioners in an area, change is possible. (b) The concept of preventative mental health has received much attention in recent years, and by a joint seminar approach of medical officers in infant welfare clinics and psychiatrists some authorities have sought to give greater insight to staff dealing with problems presented by mothers and young children. At the latter part of the year, a child psychiatrist holding an appointment in a local school for maladjusted pupils, and in a local hospital, took over a weekly 'toddlers' session in one of the borough clinics. His role is that of an ordinary sessional medical officer. It is hoped that the different orientation expected from a trained child psychiatrist may enhance the value of a routine toddlers' session which so often can take the form of a check on immunisation state, general progress, and the assessment of non-existent flat feet on which mothers tend to fix their anxieties. The multi-disciplinary approach from such a doctor working in the local hospital service, the school health service and a local authority clinic must surely prove integrative. Subject to assessment of the value of this scheme, it is hoped to extend it by making similar appointments in other clinics throughout the borough. In a rational plan for the local child guidance services, the value of these appointments would be enhanced. (c) The joint appointment of the Chief Dental Officer/Principal School Dental Officer with the London Hospital Dental College is expected to lead, by closer relationship 28.. with a teaching centre, to the maintenance of higher standards in the borough's dental services. This is discussed more fully in the report of the Principal School Dental Officer. (d) The liaison of health visitors and social workers in the Health Department with hospital clinics continued to develop. The following hospital attendances are now made in respect of 'care of mothers and young children, and schoolchildren'- i) London Hospital - Spastics out-patients. Attendance for discussion on children in wards. Vision clinics. ii) Mile End Hospital - Vision and ear, nose and throat clinics. iii) St. Andrew's Hospital - Paediatric out-patients. iv) London Jewish Hospital - Paediatric out-patients. v) Poplar Hospital - Paediatric out-patients. Section 23 The domiciliary midwifery service is run on an agency basis with approximately half the borough allocated to the London Hospital domiciliary midwives, and half to the Nursing Sisters of St. John the Divine. The former group have a direct link with their own teaching hospital; the latter have for some years with their Part II school been indirectly associated with the obstetric department of the Mile End Hospital and its Part I school. This relationship was strengthened during the year, by agreement with the Central Midwives Board, with the formation of a combined midwifery training school based at Mile End Hospital with its district coterminous with that of the Nursing Sisters of St. John the Divine. Lectures and discussions on public health are given to student midwives at the Health Department during their course of training. Section 24 Health visiting attachment schemes have not been feasible in this borough where many general practitioners cover wide areas. Doctors are kept informed on details of local authority staff and the facilities available in nearby clinics. In most districts there is increasingly better co-operation between the field worker and the local medical practitioner. If and when it is possible to accelerate provision of combined group practice centres and clinics, a true domiciliary team headed by the family doctor will be possible. Section 25 Home nursing continued on an agency basis with the East London Nursing Association, 29. and the Nursing Sisters of St. John the Divine. Section 26 Approval was being sought at the end of the year to proposals for the implementation of a scheme for measles vaccination restricted to children between the ages of 10 months and 2 years. Payment will be made to general practitioners who supply completed records of children vaccinated. Section 28 - Prevention, Care and After-care (i) Mental Health Expansion of the service included extended use of Pritchard's Road Adult Day Centre for the mentally ill to include psycho-geriatric patients on two days a week; the domiciliary occupational therapist continues with supervision of their home activities. The local 'Peter Pan' branch of the National Society for Mentally Handicapped Children now holds its evening club once weekly on these premises. Working drawings have been prepared for early submission to the Ministry of Health in support of loan sanction for the provision of a 115-place junior training centre to include a special unit for twenty severely subnormal youngsters. The established close working with St. Clement's Hospital has continued. With the formation of an academic psychiatric unit at the London Hospital, schemes to co-ordinate all psychiatric services in the borough are under discussion. Catchment areas are being reviewed to arrange if possible that, in addition to the E.3 and E.14 postal districts at present allocated to St. Clement's, the remaining districts of the borough, E.1. and E.2, will be provided for by hospital beds in the area. This will obviate, except for a few psycho-geriatric and long-term cases, the necessity for patients to be transferred to Long Grove, Epsom. Any further proposals must include more provision of psychogeriatric beds in the borough either in hospital and/or local authority Part III accommodation. It will be noted that the borough's Ten-year Health and Welfare Programme does include provision of a 40-bed home for mentally disturbed old people. (ii) Tuberculosis The well-documented higher incidence of tuberculosis in Asiatic immigrants receiyed consideration when, prior to and during visits of the Mass Radiography Unit to certain wards of the borough, an intensive campaign of persuasion to co-operate was carried out by the Health Education Officer working with field workers from both voluntary and statutory organisations. This is to be continued in association with other activities of the East London Council for Citizens, affiliated to the National Committee for Commonwealth Immigrants. 30. (iii) Prevention of break-up of families In association with the Children's, Housing, and Welfare Departments and voluntary workers, work in this field was strengthened under a revised co-ordinating committee procedure, including a members' co-ordinating committee for social services, composed of the Chairmen of the appropriate Standing Committees of the Council. (iv) Venereal Diseases Contact tracing was developed further over the year in conjunction with the Whitechapel Clinic, as described by Mr. Ambrose King, F.R.C.S., elsewhere. (v) Cervical Cytology Service Expansion of this service included provision of kits for general practitioners, extension of local authority clinic sessions and provision of smear-taking in local Family Planning Association clinics as part of the family planning service. Section 29 - Home Help Service As an aid to home help recruitment, introductory courses were organised for new and potential recruits to the service. These take the form of seminars, discussion groups and practical visits and demonstrations to make the new staff more familiar with the associated domiciliary services. To investigate the problem of the 'old, social isolate' a meeting arranged by the Health Department was attended by representatives of general practitioners, local hospitals, and social workers from many organisations in the borough. From this came a proposal for a case conference approach, to be arranged by the home help organisers at the request of any of the interested agencies, in which full investigations and special help for intractable cases could be planned. This is now in operation. ANTE- AND POST NATAL CLINICS Sessions are conducted in Council clinics by midwives and medical officers for anteana post-natal examinations. In addition seven general practitioners have undertaken ante-natal work for their own patients in the Council's clinics which are made available to them free of charge, and with a domiciliary midwife in attendance. (Statistics on page 104). ANTE - NATAL MOTHERCRAFT AND RELAXATION CLASSES These classes are held by domiciliary midwives and health visitors in Council clinics for both institutional and domiciliary booked cases. (Statistics on page 104). 31. ADOPTION AND BOARDING-OUT Children are medically examined by Health Department medical officers prior to admission to children's homes or private foster homes on request from the Children's Department. Reports are also made to the Children's Officer as to the suitability of persons wishing to adopt or foster children, and advice provided on children being considered for adoption or boarding-out. During the year 51 children were examined and reports were made on 24 prospective adopters. CERVICAL CYTOLOGY The Minister of Health approved the Council's proposals to extend the services provided under Section 28 of the National Health Service Act by the provision of a service for the collection of cervical smears for cytological investigation by hospital authorities. Following an increase in facilities for reading slides in the pathological laboratory of one of the local hospitals, this service was expanded during the year by increased sessions in the Council's clinics. In addition a general practitioner commenced holding regular sessions in her surgery, assisted by a member of the staff of the Health Department, and the Family Planning Association continued taking smears at sessions held in Council clinics. From these 879 examinations were carried out. In addition, hospitals in the area read 3801 slides and although all the latter did not refer to borough residents it can be assumed that the majority did. Furthermore equipment was supplied to eight other general practitioners in the borough but no records are available of the numbers examined by them. Details will be found on page 106 of the Appendix. CHIROPODY Foot clinics are held at seven of the Health Department's establishments and at two other premises. Treatment is provided for corns, callosities and malformed nails; advice is given on shoe fitting, foot hygiene and exercises. A total of 32 sessions are held each week by one full-time and eight part-time chiropodists. For those unable to attend clinics, five of the chiropodists visit their homes to give treatment. Treatment is free to old persons, to those on retirement pensions, expectant mothers and to schoolchildren. Statistics on page 106 . CONGENITAL DEFECTS Notifications of congenital abnormalities under the national scheme recommended by the Ministry of Health in 1963 continued throughout the year. Defects found in stillborn and liveborn children within 36 hours of birth were made on birth notification forms by hospital or domiciliary staff, details of which are as follows:- 32. CONGENITAL DEFECTS - Continued 1966 1965 Number of babies notified as having one or more congenital defects 51 63 Number of stillbirths and livebirths notified over the same period 3766 3747 The rate of notifications per 1,000 total births was 1.3, compared with 1.6 last year. There are obvious difficulties in assessing the real incidence of congenital defects under such a voluntary scheme but some help does flow in maintaining observation registers, and in follow-up to assess any handicap. 'OBSERVATION' AND 'HANDICAP' REGISTERS At the end of the year the number in the 'Observation' register was 1,930. This register contains the names of children under 5 years who are considered to be 'at risk' of developing some handicap and requiring special observation. The register is based on information supplied on birth notifications or on hospital discharge reports. The 'Handicap' register comprised 304 cases made up as follows:- Physically handicapped 161 Mentally retarded 41 Blind (registered) 3 Visual defects 7 Speech defects 24 Fits 12 Diabetic 4 Deaf 9 Autistic and maladjusted 1 Physical plus other defects 26 Mental plus other defects 13 Deaf plus other defects 3 A joint circular was issued during the year by the Minister of Health and the Secretary of State for Education and Science, inviting education, health and welfare authorities to review their arrangements for the care of physically and mentally handicapped children and young persons, and to join with other authorities and voluntary associations in this review to ensure a co-ordinated approach to the services provided. The circular suggested that the review should be directed to the following matters: 33. (i) The earliest detection and complete diagnosis of handicap, whether physical or mental, taking account of all evident or suspected disabilities of the child's general health and assessment of practicable measures to deal with the handicap; (ii) Regular review of medical, educational and social factors to enable an optimum service to be given in the interest both of the child and of the family; and in due course, consideration of employment prospects and the need for welfare services in adult life. (iii) Consistent advice and continuing support to the family and, as appropriate, to the child or young person. A working party was set up comprising medical officers of health of inner London boroughs, chief welfare officers, children's officers, Inner London Education Authority, metropolitan regional hospital boards, and the London Medical Committee to consider modifications desirable to ensure that the best services are provided for handicapped children and their families. The working party made a number of recommendations, summarised below, which were adopted by the Council. Register of handicapped children and young persons: A comprehensive register under the control of the medical officer of health should be maintained in each borough containing the names of every handicapped child living in the borough. This would, in effect, be an extension of the existing 'at risk' and deaf children's registers. A child's name should be placed on the register as soon as he is known to be 'at risk' and should remain on it at least until he is 21 years old. It should be the duty of all those who work with handicapped children to ensure that relevant information is passed to the medical officer of health, who, in turn, should ensure that the information is not merely entered on the register but passed to all those known to be interested in the child. When a child moves to another area, all relevant information in the register should be passed to the medical officer of health of the new area. To enable children moving from borough to borough to be easily assimilated and statistical information readily made available a standard form of register is desirable. Nominated officer: As soon as a child's name is placed on the register the medical officer of health should appoint a 'nominated officer' (preferably the head of a department) to co-ordinate all field-level services that the child might need,arrange case conferences, keep other workers concerned fully briefed and feed the register with necessary information. Case conferences: Case conferences should be held frequently so that all concerned with a handicapped child may have opportunities to exchange information and discuss the most appropriate ways of helping it. 34. Co-ordination at special schools: In view of the problems of co-ordination at special schools where there may be children from many different boroughs, information on the progress of the children should be passed to the medical officers of the home boroughs. It would also be an advantage to attach a social worker (health services) to each school. Early consultation about a handicapped child's future: The welfare officer and the mental welfare officer should be consulted about a handicapped child's future much earlier than at present and should be kept informed right through the Child's school life about how he is progressing in case they can do something for him in his own home and to put them in a better position to care for him when he leaves school. Immigrants and new entrants to an area: All parties concerned will look out for new entrants into the borough with handicaps and refer them to the medical officer of health for inclusion in the register, and subsequent action. This will apply particularly to immigrants. Special education: The existing procedure with regard to recommendations for the provision of special education should be kept under constant review. Publicity: Each borough should prepare a simple pamphlet setting out all the services available for handicapped children and there should also be a clearly defined and well-publicized centre in each borough to which parents can go for information about all the services available for their handicapped child. Attachment of local authority social workers to hospitals: The medical officer of health and the chief welfare officer will consult the hospitals in the borough and the Inner London Medical Committee and local general practitioners on the means of extending co-operation, including participation in the compilation of the handicapped register. The medical officer of health furnishes the education officer annually with an estimate of future demands for special education for certain categories of handicap: The statistical use of the register will include the possibility of forecasting trends of need, e.g. to the education officer for special education places and to the chief welfare officer for services for handicapped adults. Ultimate use of the computer will be considered. By the end of the year, arrangements were well under way for a complete review of the existing observation and handicapped registers, for consultation with all other agencies concerned, both statutory and voluntary, and for putting into effect the accepted recommendations of the working party as referred to above. 35. DAY NURSERIES There are four non-residential day nurseries in the borough operated by the Council, providing places for a maximum of 210 children under 5 years of age. In one of the nurseries there is a special unit for the care of mentally handicapped infants for whom transport is provided. The aim of this service is to provide relief for the parents, particularly the mother rather than to afford her the opportunity of going out to work. Two of the day nurseries are classified as training nurseries and provide practical training facilities for student nursery nurses undertaking courses for the examination of the Nursery Nurses' Examination Board. In addition the Council has a claim on 25 places at a voluntary day nursery in respect of which an annual grant is made to the voluntary body concerned. The Council's nurseries are staffed by 74 persons, which include matrons and nursing and domestic staff. Children are admitted to the nurseries in the following circumstances: First priority is given to cases where the mother is in ill-health and cannot adequately care for the children, or during a mother's confinement; where living conditions are detrimental to health or where it is considered desirable for the health of the child that it should be admitted to a nursery; where mothers are required to work because they are widows, unmarried, separated or divorced, or whose husbands are totally disabled or in prison, provided the mother works at least 35 hours a week. In addition there are the second and third priority categories, for children whose mothers are compelled to go to work as an economic necessity, and where vacancies are not required in the other priority classes, for children whose parents are both working, provided that the mother is employed 35 hours a week. Private day nurseries, of which there are six in the borough (maximum capacity 135 children), are subject to registration and inspection by the Council under the provisions of the Nurseries and Child Minders Regulation Act 1948. Two additional nurseries were registered during the year providing accommodation for 45 children. (Statistics on page 105 ). CHILD MINDERS Anyone looking after more than two children for payment for a fair part of the day must register with the Council under the provisions of the Nurseries and Child Minders Regulation Act 1948. There is also a system of voluntary registration of persons caring for less than three children. Lists of child-minders and day nurseries are available on application to the Health Department. At the end of the year there were six statutory and 52 voluntary child-minders. 36. CLINIC CENTRES The Clinic Centre at Rhondda Grove closed in March, and was transferred to Wellington Way Centre. This centre occupied rooms in a convent, in which an infant welfare clinic session was held twice-weekly, and the closure was necessitated by the transfer of the convent to new premises in another part of the borough. CRECHES Children can be placed in creches for an afternoon at many of the infant welfare centres by mothers who wish to attend the mothers' club or sewing class at the centre or who have hospital appointments. Creches provide facilities for mothers to be relieved of their children for 2 or 3 hours during the day; they also provide an opportunity for an only child to associate with other children of the same age. No charge is made where the mother is attending a centre activity but a charge of l/9d per session is made if the mother wishes to leave her child there whilst she attends to shopping or other domestic duties. PLAYGROUPS There are four playgroups in the borough, organised by a voluntary association, which cater for approximately 118 children daily. DENTAL CARE FOR THE PRIORITY CLASSES It is the responsibility of the Local Health Authority, under Part III of the National Health Service Act, 194 6, to make special provision for the dental care of expectant and nursing mothers and for those children under school age. There were 3,765 babies born in the borough during the period July, 1965 to June 1966 and of those mothers seeking dental treatment during pregnancy the great majority attended their local general dental practitioner. Approximately 6% of expectant mothers attend the borough's ante-natal clinics while the majority attend a local hospital or general medical practitiorter. The need for personal dental health during and after pregnancy and the need to consider the developing dentition of the unborn child must be understood by all expectant mothers, who should be advised to seek a dental consultation as soon as possible by their ante-natal medical advisers. The borough's dental service is available to all expectant mothers on request. 37. There were 3,690 babies under one year old and 13,610 children aged between 1 and 4 years resident in the borough during the period July 1965 to June 1966. Of these only 129 attended the borough's dental clinics. It is to the needs of these very young preschool children that the attention of this branch of the borough's dental services must increasingly be drawn. It is highly desirable that parents' attention is drawn to the means whereby they may safeguard the developing dentition of their children. It is equally important for them to understand the need to take their children to the dentist regularly from the earliest possible age, thereby establishing a pattern wherein the young child will accept the dentist and the dental surgery as a routine event before the need for treatment ever arises. It is to this fundamental feature of the dental service that the attention of dental, medical and nursing staff must primarily be directed. At present the service meets the small demand made upon it and during 1966 maternity and child welfare dental sessions were held at Ida Samual, Old Ford and Prunella Dental Clinics, the number of sessions during the year being 70. It is hoped that when the overwhelming demands of the school dental service have been met by increased staff and facilities, that a great expansion will take place in the borough's dental services for the priority classes. Dental health education will, in future, be featured at all postnatal clinics, thereby stimulating mothers to take their children for regular dental examinations from a very early age. Examination of childrens' teeth in nursery schools and at toddlers' clinics will be commenced as soon as possible. Details of dental treatment provided for expectant and nursing mothers and preschool children will be found on page 106. FAMILY PLANNING In a circular issued early in the year the Minister of Health urged local authorities to review their existing arrangements for family planning, with particular reference to education and publicity, and requested that advice and treatment (including supplies) be given without charge to those women to whom pregnancy would be detrimental to health. Accordingly, and following representations by the Family Planning Association, the Council agreed to the following revised payments to be made to the Association for examinations and medical supplies provided for women in the borough referred by the department:- Oral contraception £2. 2s. 0d. plus cost of a year's supply of medicaments (averages £5. 3s. 0d.) 38. FAMILY PLANNING (Continued) Intra-uterine coil device £5. 5s. Od. Other methods £5. 5s. Od. The Council did not agree to make payment to the Association in respect of women not referred via the Health Department. The association is given free use of accommodation in three of the Council's clinics for holding weekly family planning sessions. Additional clinic premises were made available for their use this year, and new patients increased by 40 per cent over 1965. FEEDING DIFFICULTIES Facilities are provided at a centre outside the borough for in-patient treatment of mothers and babies when breast feeding difficulties are experienced or of babies with dietary problems. No children were accommodated at the centre during the year. HEALTH EDUCATION The appointment of a health education officer in January of this year resulted in greatly increased numbers of topics on health education being dealt with and to more varied classes of audience. Better co-ordination with the various sections of the department has led to a more efficient and streamlined machine. By changes in teaching techniques, lectures have given way to discussion groups, stocks of visual aids have been augmented and made more freely available, courses of health education in schools have increased and more staff have attended part-time murses in teaching as well as psycho-prophylactic and projectionist courses. Considerable attention has been given to immigrant groups, smoking and lung cancer, sex education and venereal disease, prevention of accidents in the home, mass radiography, and cervical cytology. (Statistics on page 107). HEALTH VISITING AND CLINIC CENTRE ACTIVITIES Health visitors maintain close liaison with the staffs of statutory and voluntary bodies, general practitioners and hospitals in the borough. Their visits to expectant mothers and to children under five years of age are shown with other statistics on page 108 . Health education work is carried out by means of personal contact as well as in group sessions held at the clinics. At the request of the paediatricians concerned health visitors attended the out-patients departments at hospitals to provide a link between hospital and home. 39. The numbers of health visitors and tuberculosis visitors employed at the beginning and end of the year were 35 and 33 respectively, there being 8 resignations and 6 new appointments during the year. Command Paper 1973 recommended an establishment for the year 1967 of 36 health and tuberculosis visitors, based on a proportion of 0.18 visitors per 1,000 population. The shortage of health visitors was offset by a re-appraisal of their duties and the subsequent appointment of clinic and school nurses whose training and qualifications enable them to carry out certain of the duties which are not necessarily required to be performed by health visitors. HOME BATHING Aged persons who are bedfast or homebound are given bed baths and, where the person is sufficiently agile, complete baths in their own homes by the Council's cleansing attendants. If the dwelling is without a bath, a 'bungalow' bath is taken to the premises, together with hot water in insulated containers. More than 4,000 baths were given during the year. HOME HELP SERVICE Home helps are provided under Section 29, National Health Service Act 1946 to undertake domestic work in homes during emergencies, such as illness or confinements, and tp assist aged persons who are unable to fend unaided for themselves. Increasingly the service is attending to the demands of the latter category, understandably because of the growing number of aged persons in the community, earlier discharge from hospital as the community care service expands, and the policy of keeping the aged in their own homes as long as possible rather than admitting them to a hospital or welfare home. At the end of the year 300 home helps were employed by the Council, the majority on a part-time basis, the equivalent full-time number being 199. The present standard charge for home help service is 5/8d. an hour which is reduced according to the financial circumstances. The service is free to certain classes e.g. persons in receipt of old age or retirement pensions or on national assistance, or suffering from toxaemia of pregnancy where a medical certificate is submitted. Specially trained helps are utilised to provide assistance to problem families. An in- service training course of 13 lectures designed to assist them in servicing difficult families was attended by 24 home helps. The Council approved the issue of raincoats and shoes to home helps in addition to overalls which were already supplied. Households numbering 3700 were provided with the service during the year compared with 3553 last year. (Statistics on page 109). 40. DAY CARE SERVICE The experimental day care service, commenced last year as an adjunct to the home help service, continued during the year. By this service, help is given to aged persons in selected cases by neighbours or persons living in the immediate vicinity, and is intended to cater for those persons who are chronically ill, or bedridden and living alone and who require visiting and attention several times a day. HOME NURSING The home nursing service for the borough is carried out on an agency basis by the East London Nursing Association and the Nursing Sisters of St. John the Divine. Patients given service during the year numbered 2,405 involving 90,730 visits. Approximately 56 per cent of the patients were aged persons. The increase in baths given to homebound persons this year, plus the stepped-up issue of disposable pads for the incontinent, has relieved the district nurses of some time-consuming work thus enabling their services to be put to more advantageous use commensurate with their training and qualifications. LAUNDRY SERVICE Soiled personal clothing, bed linen, etc. is collected at least twice weekly from the homes of persons who are incontinent, and cleansed and laundered in the laundry at Branch Road cleansing station. (Statistics on page 110). INCONTINENCE PADS Special commercially prepared disposable pads and/or knickers are supplied free in suitable cases for use by incontinent and chronically ill aged persons. LOAN OF NURSING EQUIPMENT Articles of nursing and sick room equipment are loaned free of charge for an indefinite period to persons being nursed in their own homes at the request of the general practitioner, district nurse or hospital medico-social worker, etc. The Council purchased many items of additional equipment required to meet requests for loans. In addition equipment is loaned by the British Red Cross Society and by the Council's Welfare Department to handicapped persons. (Statistics on page 111). DOMICILIARY MIDWIVES The Council operates a domiciliary midwifery service under Section 23 of the National Health Service Act 1946, by an arrangement for utilising the services of midwives employed 41. by the Nursing Sisters of St. John the Divine and the London Hospital. In addition the Council directly employs a midwife who is also the non-medical supervisor of midwives,. It is generally accepted that domiciliary midwives should have the same opportunities for training and the use of similar equipment as hospital midwives. In accordance with this principle, the midwives in the borough have been given facilities for statutory refresher courses, and attendance at study days. The newest resuscitation and analgesia apparatus has also been made available to the Nursing Sisters of St. John the Divine, and the London Hospital authorities have similarly equipped their midwives.In conjunction with wise selection of patients for home delivery, the service can offer facilities comparable to those at a hospital unit. A scheme for training midwives commenced this year jointly by the Nursing Sisters of St. John the Divine and the Mile End Hospital, each pupil spending three months on the district. Pupils who completed the course during the year numbered 8 with 4 pupils under training at the end of the year. The Council pays to the hospital 40 per cent of the expenditure involved under the provisions of the Ministry of Health Circular 8/56. MIDWIVES ACT, 1951 The Council is a local supervising authority under the Midwives Act 1951, supervising functions being carried out by the Council's non-medical supervisor of midwives. The number of midwives who notified their intention to practice as midwives within the borough, including those in hospitals, and who were practising at the end of the year, was 97. The Council is also responsible under the Act for payment of fees to medical practitioners summoned for medical aid to 'unbooked' patients. These occasions may arise as a result of a doctor not being booked in advance by the mother or urgent requests for immediate help by a midwife from a local practitioner. MATERNITY LIAISON COMMITTEES The department is represented on local maternity liaison committees by the medical officer of health or deputy medical officer of health and the non-medical supervisor of midwives or the principal nursing officer. Meetings were attended during the year when common problems were discussed. As the borough is served by two hospital management committees, there are separate maternity liaison committees for each group catchment area. PHENYLKETONURIA During 1966 babies numbering 3,162 were tested either in clinics or in their homes at about the fourth week of life. No cases of phenylketonuria were detected. 42. PREMATURE RABIES Any child weighing 5'A lbs. or less when born is regarded as premature, and necessary advice and assistance is afforded to mothers with premature babies. Statistics relating to premature births occurring during the year will be found on page 108 . RECUPERATIVE HOLIDAYS Recuperative holidays for mothers and young children are provided under Section 22 of the National Health Service Act, and for the prevention of illness, care and aftercare under Section 28 of the Act. Medical recommendations for recuperative holidays are submitted by general practitioners, hospitals, health visitors and social workers. A total of 482 adults and children were placed in recuperative holiday homes during the year, including 236 schoolchildren for whom the Inner London Education Authority made arrangements. CARE OF THE UNMARRIED MOTHER AND HER CHILD (a) Mother and Raby Homes: Voluntary organisations provide accommodation in mother and baby homes for those in need. Such organisations are supported by grants from the Council via the Health and Welfare Committees. Expectant and nursing mothers admitted to such homes during the year numbered 30 (b) Moral Welfare Associations: Financial assistance is also given to Moral Welfare Associations providing service for residents of the borough. RESIDENTIAL ESTABLISHMENTS FOR CHILDREN IN CARE The Health Department's visiting medical officers regularly attend at the Children's Department's residential establishments to examine the children, treat any cases of illness occurring and advise on medical aspects of child welfare, hygiene and the prevention of infection. The department is also responsible for the provisions of relief nursing staff as required at these establishments. 43. THE PRINCIPAL NURSING OFFICER REPORTS: The borough has been fortunate throughout the year in maintaining a reasonable staffing position, although recruitment of all grades of nursing staff has not reached the level hoped for. Four health visitor students sponsored by the borough successfully completed their training and joined the staff. In September six sponsored students commenced health visitor training. Despite some staffing shortages clinic activities have not only been maintained, but it has been found possible due to the extra efforts of members of staff, to expand in some fields. Two training colleges send health visitor students to the borough for practical experience. Facilities have been provided for post-graduate medical students from countries throughout the world. Visits of social studies students to centres and day nurseries have continued. The department provides services which play an important part in enabling families to be kept together during periods of stress. Day nursery places are arranged during times when mothers are in hospital or ill at home, and home helps can be provided for social reasons. The creche service, in addition to providing play opportunities for children under 5 years, also relieves the mother who is feeling some stress, particularly where there are no relatives or neighbours to act as sitters-in for an afternoon. No major changes have taken place in the day nursery service during the year. Facilities for deaf children and other handicapped children are provided in either special groups or as part of the routine service. MENTAL HEALTH SERVICES A film entitled "Stranger in his own Country" was shown to members of the Health Committee. The film deals with the patient processes of accustoming the mentally afflicted to self reliant life in the community. Day Centres: There is a Council day centre for the mentally ill and two others administered by a voluntary organisation in the borough. Their aim and purpose is to provide a meeting place where patients who live at home can obtain occupational and educational therapy. Patients are able to discuss with mental health social workers their personal problems and difficulties. An incidental object of the day centres is to provide some relief to relatives from the care of mentally ill persons. The patients attend for the whole day on five days a week and are provided with a midday meal and light refreshments. 44. Junior Training Centres: At the formation of the borough on 1st April 1965 there were no facilities in the borough for training mentally subnormal children, the nearest centre being at Hackney at which most of the children residing in the borough attended. In September this year, following the carrying out of adaptations in a centre formerly used for adult girls, all the borough's mentally subnormal juniors were accommodated in a centre within the borough. This is a temporary expedient, pending the construction of a 115-place purpose built centre, included by the Council in its 10-Year Health and Welfare Development Plan, loan sanction for which was approved by the Ministry of Health by the end of the year. Adult Training Centres: Adults resident in other boroughs and attending training centres in this borough were transferred to centres in their own boroughs during the year which facilitated the change of user of the centre referred to in the previous paragraph. There are now two centres in the borough for training subnormal adults, one being an industrial centre for males and the other comprising a senior group for females aged 16 and over with an adolescent group of both sexes aged. 13 plus. At these centres social and work training are given. The majority are so handicapped as not to be able to take up outside employment, but the introduction to working conditions and routine gives sufficient support and self-confidence to enable some of the less severely handicapped to take up open employment. Referrals: Persons referred to the department showed an increase of 24 per cent over the last year. The number under community care however decreased by 10 per cent. The increase in referrals reflects the increasing awareness that illness and other conditions may be due to mental dysfunction, although it is gratifying to note that only a small proportion of those referred required hospital treatment or community care. Admissions to Hospital: In addition to community care for patients and their families the mental health social workers are responsible for the statutory admission where necessary of patients to hospital. Informal and compulsory admissions for the year numbered 286, an increase of 14 per cent over the last year. Industrial Work at Training and Day Centres: Industrial work undertaken during the year included such tasks as assembling cardboard boxes, sets of darts, skipping ropes, paint boxes; packing curtain rails, toys, pencil cases, cardboard boxes; sorting chess-sets, pocket games, plastic egg-cups, whips and tops; making playing bricks, toy ironing boards, tidy boxes, sorting trays, easels, test-tube racks, basketry bases, cots; trimming and bundling plastic mouldings, thumb-holing medical boxes, and repairs to furniture. Money earned by the trainees amounted to £2,370, against which has to be offset the cost of materials. Payment is made to trainees, based on attendance, and is regarded 45. as incentive pocket-money to supplement state benefits which they receive. £1,620 was paid out as incentive pocket-money during the year. The illustration shows work being carried out in part of the industrial training centre. Guardianship: Four severely subnormal patients remained under guardianship of the Council at the end of the year. One person was discharged from guardianship. These patients for whom the Council is financially responsible are placed with the Guardianship Society and are cared for by being boarded-out with specially chosen families in the Sussex area. Emergency Night and Weekend Service: A designated mental health officer must, statutorily, be available at all times to deal with emergency calls for the mental health service. This means providing a 24-hour service, seven days a week, including bank holidays. The mental health social workers augmented by some nursing staff provide a night and weekend duty service on a rota basis. This emergency service operates from 5p.m. each evening to 8.45a.m. the following morning and at weekends from 5p.m. on Fridays to 8.45a.m. on Mondays,during which period all requests are directed to the duty doctor at St. Clement's Hospital, Bow Road, E.3. who contacts the mental health officer on duty as required. Approval of Doctors under Mental Health Act 1959: The Mental Health Act 1959 provides that one of the two medical recommendations required for the compulsory removal of mentally disordered persons to hospital shall be made by a doctor approved for this purpose by the local health authority as having special experience in the diagnosis or treatment of mental disorders. One application was received during the year for approval and following the appropriate consultation with members of the advisory panel the applicant was approved for a period of five years. Short-Term Care: Temporary care is arranged in homes and hospitals for mentally subnormal patients to give relatives a welcome relief and to allow them to take a holiday. Residential Hostel Accommodation: The Council accepts financial responsibility for the care of mentally disordered persons in residential hostel accommodation provided in the borough by a voluntary organisation, and in hostels provided by other local authorities and voluntary associations. Where patients are in employment or have other incomes, an assessment is made to determine their contribution towards their maintenance. Apart from those under guardianship, 33 other persons were in hostels at the end of the year. Special Care Units: A special care unit for juniors operates at the Cornwall Avenue Training Centre, which caters for those trainees who are too severely handicapped 46. to be able to be taught and trained with other juniors. In addition there is a special unit in one of the Council's day nurseries for severely handicapped children under 5 years of age. Transport: Transport is provided by coach and minibus to take trainees to and from their homes and the training centres each day. Transport covers trainees attending the junior centres, adult female centres, the special care units and the day nursery special unit, whilst those attending the men's industrial training centre make their own way. Holidays: Many trainees from the training centres take part in a holiday at the holiday camp at Dymchurch, Kent, joining groups of trainees from other London boroughs. Recuperative holidays are arranged for mentally ill persons under community care. PROVISION OF SERVICES FOR CITY OF LONDON This Council undertakes all mental health functions for the City of London on an agency basis as provided for in Section 5(2) of the London Government Act 1963. THE PRINCIPAL SOCIAL WORKER (MENTAL HEALTH) REPORTS: This year the Council saw the realisation of its hope that all the mental health service facilities would be contained within the borough. The children are established at Cornwall House Training Centre; a junior mixed group has been started within the senior girls' centre at Whitechapel and its success has given us confidence to make the senior centres mixed in the future; the industrial centre has absorbed all the senior lads and is a hive of activity. The day centre at Pritchard's Road has made steady progress. Two clubs are held weekly and a monthly bulletin is now issued from the clubs. Twice-weekly geriatric groups are held. The Tower Hamlets Society for the Mentally Handicapped has been allowed to use these premises for their weekly club and social. A site has been procured for the new junior centre and the architect's plans are ready so that building will be started as soon as loan sanction is obtained. The Ruston Street diagnostic clinic has had more children referred and additional sessions have been arranged. Although it is still, of course, essential to run an emergency service for the mentally ill, the actual emergency admissions have dropped considerably and for this our appreciation goes to the active work of the medical director at St. Clement's Hospital and the consultants at Long Grove Hospital. 47. As in the past, voluntary and statutory bodies have been very co-operative, showing real understanding of the problems of our patients. Gratitude must also be expressed to the staff of the hostels in this area. Temporary care for the mentally handicapped was arranged as each emergency arose; recuperative holidays were granted for all urgent patients, and the Dymchurch holiday was again subsidised by the borough. All centres were open to the public during Mental Health Week and there was quite an amount of interest shown by the general public. Students have been received and the medical students from St. Bartholomew's Hospital continued to visit in groups throughout the year. At the request of the Matron of St. Clement's Hospital the Council agreed to an experiment with the General Nursing Council. A student nurse has spent three months in his last year of training doing community work with the mental health section instead of further training in a psychiatric hospital. This seems to have been successful and a second nurse will be following the same course in April 1967. ST. CLEMENT'S PSYCHOGERIATRIC IN-PATIENT UNIT AND DAY HOSPITAL The Consultant Psychiatrist to St. Clement's Hospital, J.J. Cockburn.M.B.,M.R.C.P.I., D.P.M., has kindly supplied the following report on the year's work of the hospital's psychogeriatric in-patient unit and day hospital. Satisfactory progress has been maintained in all departments during the year. The In-patient Assessment Unit (Dundee Ward) had an increased turnover; admissions (131 patients) show an increase of 22% over 1965 (see graph). The same overall policy outlined in my previous report has been pursued, and we have tried to make the best use of the existing facilities, including the long stay beds at Long Grove Hospital. Patients are not admitted to Dundee Ward unless out-patient or day-patient treatment or assessments are impossible. Most depressive patients can be treated on an out-patient basis, but of course, psychotic patients in whom the suicidal risk is high, must be admitted. Another group where out-patient or day hospital treatment is often unsuccessful, is the persistent paranoid illnesses in the elderly, where adequate drug therapy is essential. These patients are often suspicious and unreliable in taking their drugs at home, and hospitalisation for a time may be unavoidable. Finally, it is only possible in hospital to investigate fully younger organic dementias. Some older dementing patients, particularly where there has been a recent rapid deterioration in their mental state, also require in-patient investigation. The importance of physical illness such as bronchopneumonia in this latter group can hardly be over-emphasized, and it is often difficult definitely to exclude pneumonia on an out-patient basis. It often produces no pyrexia in the elderly, and it may be difficult to examine the patient adequately owing to his mental state. Many patients, with serious physical illness symptoms, have been treated in the in-patient unit during this year, and have been able to return home or go to a welfare home. 48. PSYCHOGERIATRIC UNIT. ST. CLEMENT'S HOSPITAL ADMISSIONS 49. A successful conclusion does not occur in all cases, and sometimes delays in discharge occur owing to the waiting list for admission to a long stay bed at Long Grove Hospital, or to a welfare home. The in-patient unit has just passed through a most difficult few months because of short term difficulties on the male side at Long Grove Hospital, outside the control of my colleagues there. This resulted in considerable delays in obtaining transfers from Dundee Ward, of male patients who required a long stay psychogeriatric bed, and a consequent difficulty in admitting male patients to Dundee. This situation has now been resolved, and I am glad to say that the situation is back to normal. It meant a considerable increase in nursing of sick chronic patients in Dundee, and the nursing staff and junior medical staff must be congratulated on the skill and devotion shown. We are grateful for the generous support of the general physicians at St. Andrew's Hospital, and of the local geriatricians, with whom our relations have been excellent. Short term admissions, to allow relatives to go on holidays, have been arranged throughout the year, and we are convinced of the value of this policy. Social relief to relatives is often a decisive factor in enabling a patient to remain at home. During 1966 we have established closer links with the Borough of Tower Hamlets, and two of the old people's visitors attended on alternate weeks the weekly case conference on Dundee Ward. This link has been most valuable to us in the hospital, and has, I consider, increased the effectiveness of the service. Recently, co-ordination has suffered because of re-organisation within the borough's social services, but things have now improved with the proposed alterations made, and the new arrangements should be an improvement. We were sorry that the Stepney Old People's Welfare Organisation came to an end in June 1966, but our links with voluntary organisations have been maintained at the quarterly meetings of the unit. These meetings have proved a most valuable opportunity for the exchange of views of people from different organisations and backgrounds. The Day Hospital has had another successful year. The number of admissions has increased to 61, a rise of 9% over 1965. Again our policy has been one of supporting incapacitated patients to enable them to remain longer at home. This has had the effect of reducing demand on the long stay beds at Long Grove, where the length of the waiting list has been reduced. It is thus possible to arrange urgent admissions more quickly than previously. We have become increasingly convinced of the value of the Day Hospital. Its supportive role for relatives is considerable, and it takes a central place in the local arrangements for support of chronic psychogeriatric patients. Trinity Church, Poplar, has a day centre for this type of patient, and in March 1966 Tower Hamlets extended the day centre in Pritchard's Road, E.2, to take 12 psychogeriatric patients per week. Good liaison exists between the Day Hospital at St. Clement's and these centres, and patients can be referred back quickly to the Day Hospital for medical assessment when necessary. It is often possible to share the support of a partially recovered patient between the Day Hospital and a day centre, and a patient may come to St. Clement's one day a week and go to a day centre for a further one or two days. This seems an economic 50. use of skilled medical and nursing care, but without links with the Day Hospital, the types of patient who could be supported by non-medical workers in day centres would be more limited. The work of these two day centres has been a major contribution to the care of the elderly in the community. The Day Hospital plays a valuable role in the assessment of patients. Townsend and Wedderburn have drawn attention to the importance of social factors in precipitating admissions to hospital, and also to the large numbers of severely incapacitated old persons .being cared for by their relatives at home. Often, requests for admission are associated with developments of tension within the family, who do not want to "put Mum away" but can see no alternative. The Day Hospital is often a satisfactory solution, for some time at least. Occasionally it is difficult to know whether relatives are exaggerating the behavioural difficulties of a patient, when they demand admission to hospital. Often, it is difficult to discharge patients so admitted. It may be impossible to evaluate the situation adequately in an out-patient clinic. Admission to a day hospital allows assessment in a cooler atmosphere, and enables the doctor to offer something concrete to relatives, short of in-patient admission. Further information about home conditions and family relationships is often obtained by the nurse who regularly travels in the ambulance on its daily round to collect patients. We have been very fortunate in our ambulance service. Transport is one of the essential factors necessary for success of any day hospital for old people, and we greatly value the hard work of our ambulance driver. Another key figure is the senior nurse on duty. We lost an excellent sister during the year but she has been replaced by an equally excellent charge nurse. Much responsibility for the smooth running of the Day Hospital rests with the nurse in charge. He has to organise lists of names and addresses of the patients for the ambulance on the appropriate days and co-ordinate medical treatment, physiotherapy, occupational therapy and social events. He is often the first person contacted by relatives in distress, or by the day centre staffs in the area. He is daily in touch with the patients and therefore likely to be one of the first to observe that a patient is not well and needs medical attention. It is our policy to limit the attendance at the Day Hospital to the over 65 age group, though on occasions exceptions are made. It seems reasonable to admit patients who would obviously benefit from day hospital attendance, when they live very near to St. Clement's and particularly if they do not require an ambulance to bring them. I have tried to limit day hospital attendance to patients who could not adequately be treated in the out-patient clinic with additional attendance at an old persons' club. Patients are assessed for suitability before admission to the day hospital, usually in the out-patient clinic. Many of the patients are severely incapacitated and would 51. wise require admission to a long stay bed. The atmosphere is friendly and optimistic, and we are fortunate in having voluntary workers who entertain the patients regularly at two social afternoons per week. The incidence of physical diseases is high, and again we get much assistance from our general medical and geriatric colleagues at St. Andrew's Hospital. The Outpatient Clinic for Psychogeriatric Patients has increased its activity during the year. Both new referrals and follow-up appointments have been more than in 1965. In addition, the amount of domiciliary work, has increased steadily. Both aspects of outpatient work present problems of organisation. The most obvious feature of psychogeriatric referrals is the urgency with which an opinion is requested, and this often places great demands on the service. In the out-patient clinic the demand for appointments often fluctuates markedly, and the clinic is difficult to organise as patients arriving by ambulance are often latei. The time required for the assessment of a new patient varies more than that required for younger patients. Domiciliary consultations are rightly regarded as a very valuable part of the service, but they are time consuming, and often have to be done late at night. It may be difficult to find time for an urgent domiciliary visit as I am only available in East London three days a week. This only emphasizes the geographical difficulties of psychogeriatric care at St. Clement's. Relatives have to travel 20 miles to visit long stay patients at Long Grove Hospital, Epsom. It is difficult to run an efficient community service 20 miles across London, and I would like to reiterate the need for more local long stay beds for old people as a matter of priority. I would like to thank all those who have been involved in this work, for their contribution to the welfare of the elderly of the East End. STATISTICS Statistics relating to the Mental Health Services appear on pages 113 - 115. 52. PART IV ENVIRONMENTAL HEALTH SERVICES IV. ENVIRONMENTAL HEALTH SERVICES AGED PERSONS Following a suggestion contained in a Memorandum issued with Ministry of Health Circular No. 18/1965, area geriatric liaison committees were set up by the North-East Metropolitan Regional Hospital Board for the East London, Forest and Thames Groups of hospitals, on which committees the medical officer of health represents the Council's Health services. Two of the departments six old people's visitors resigned during the year to take up other appointments. It was decided not to fill the vacancies pending consideration of the future of this service with that provided by the Welfare Department. Home visiting forms the major part of the work of the old people's visitors leading to arrangements for the provision of services needed, .but mention is made elsewhere of departmental services also supervised by them, viz. incontinent laundry service, home bathing service, compulsory removal to hospital, treatment of scabies and cleansing of verminous persons. The Council is empowered by Section 47 of the National Assistance Act 1948, as amended by the National Assistance (Amendment) Act 1951, to make application to a court of summary jurisdiction for an Order for the removal to a hospital or institution of any aged, infirm or physically incapacitated person living in insanitary conditions and who is in heed of care and attention. This year it was found necessary to apply for 18 such Orders under this enactment, in respect of 13 old persons who were removed to hospital and 5 to a welfare home. Statistics will be found on page 118. CLEAN AIR Three smoke control orders covering 933 acres became operative during the year, namely the Poplar No. 16 Order made by that Council on 5th October, 1964, theStepney No. 5 Order made on 13th December, 1963 and the Stepney No.6 Order made on 19th November, 1964. Tower Hamlets No.2 Order was made by the Council this year and was awaiting the Minister's confirmation at the end of the year. Early next year the final Order will be made, when the whole borough will be covered by smoke control orders. 53. The proposed installation of 2,157 heating appliances was approved for the purpose of grant, during the year, the estimated grants totalling £131,998. Applications for the supply and installation of gas fires account for 90% of the total applications. During the year the Council accepted a recommendation that gas fires should be regarded as "fixtures"rather than "fixed but readily removable" appliances, so that the grant of seven-tenths of the approved cost would be payable on completion of the work instead of as formerly in two instalments, the second at the end of 2 years. Discretionary grants in respect of the 30 per cent balance of cost of works of adaptation to heating appliances were approved by the Committee in 16 cases, during the year, on grounds of hardship. During the year a number of complaints were received and investigated and an increasing number of these related to the burning of rubbish on sites being cleared by demolition contractors. In most cases, however, an approach to the management of the companies concerned secured good co-operation. Complaints were still received from time to time regarding smoke emission from the three electricity generating stations within the borough. In most cases this was due to unsuitable fuel, but some improvement in their performance has been secured during the year. Under the provisions of section 3(3) of the Clean Air Act 1956 furnaces may not be installed in a building unless notice of proposal to install has been given to the Council. Notices were given to the Council of proposals to install furnaces in three premises, applications for prior approval under Section 3(2) being submitted and approved in 16 instances. DISEASES OF ANIMALS The Corporation of London, through its veterinary officers and inspectors, carried out on an agency basis duties imposed on the Council under the Diseases of Animals Act 1959 and associated acts, Pet Animals Act 1951, Performing Animals Act 1925 and the Animals Boarding Establishments Act 1965. A summary of this work appears on page 118. FOOD AND DRUGS Analysis of Food and Drugs Samples During the year 1018 samples of food and drugs were submitted for analysis by the Public Analyst, 18 being purchased formally, 986 informally, and 14 were private samples. Irregular samples ascertained numbered 115. 54. Action taken with respect to the irregular samples was as follows. Legal proceedings were instituted with regard to 4 samples; namely, the sale of bread and margarine as bread and butter and the sale of Polish bacon as Danish bacon. Fines imposed and cost awarded amounted to £75 and £19.4.0d. respectively. Matters taken up with manufacturers or importers included ground ginger contaminated by metallic compound, pickles containing benzoic acid, Brazilian coffee and tea contaminated with mould growth, brown rice infested with dead merchant grain beetles, dried fruit infested with mites, sugar contaminated with sodium antimonate and coffee contaminated with tung oil. The absence, inadequacy or improper declaration of ingredients on labels were ascertained in 56 samples and were the subject of correspondence with manufacturers or importers. A summary of the samples analysed and included in quarterly reports submitted by the Public Analyst in compliance with Section 99 of the Food and Drugs Act 1955 will be found on page 119. Bacteriological Examination of Foodstuffs Samples submitted for bacteriological examination numbered 250, comprising: 2 Pasteurised milk 3 Tea 11 Tuberculin tested (pasteurised) milk 23 Desiccated coconut 12 Ice cream 2 Canned soups 1 Ice lolly 1 Canned banana dessert 1 Parev (Kosher) ice cream 3 Canned crab 1 Artificial cream 116 Imported dried egg 1 Sausage roll 23 Imported frozen or cooked prawns 1 Pork sausage 38 Canned meats 11 Water Unsatisfactory results from 35 of the samples included: 1 Pakistani uncooked frozen prawns and High plate count - released on condition 5 Chinese frozen peeled prawns they were kept refrigerated and cooked before use. 1 Chinese cooked peeled prawns Heavy plate count and coli resembling faecal coli. Consignment rejected. 3 Chinese frozen prawns Excessively high plate count. ment re-exported. 55. Unsatisfactory results (Continued) 1 Norwegian frozen cooked peeled prawns High plate count - released on condition they were used immediately after thawing. 24 Australian canned minced be ef loaf Included 12 blown tins - consignment exported. Cautionary Letters On the instructions of the Health Committee, a cautionary letter was sent in respect of the sale of a pie containing green mould. Ice Cream There are 35 premises in the borough registered for the manufacture of ice cream. Inspections were made from time to time under the Ice Cream (Heat Treatment etc.) Regulations 1959 and no contraventions were found. Fourteen samples of ice cream submitted to the me-thylene blue reduction test gave the following results: Manufactured Ice Cream: In Borough Outside Borough Total Grade I 2 6 8 II 1 3 4 III 1 0 1 IV 0 0 0 "Parev" Ice Cream: Satisfactory 1 0 1 In the case of the unsatisfactory sample (Grade III), an investigation was carried out and advice given on improving methods of production. Food Hygiene (General) Regulations 1960 Food premises in the borough are subject to freguent inspection by the public health inspectors to ensure that the provisions of the Food Hygiene Regulations are being observed, and a public health inspector visits the borough's Sunday markets each week. There are over 4,000 food premises, including stalls, in the area. Notices of requirements served numbered 399 and legal proceedings were instituted in 61 cases. Details of action taken under Regulations 16 and 19 are contained in the Appendix, page 120. Food Export Certificates Certificates numbering 99 were issued in respect of a variety of foodstuffs exported 56. to Belgium, Canada, Finland, France, Greece, Israel, Italy, Jordan, Lebanon, Libya, Majorca, Portugal, Switzerland, Tanzania and West Germany. Before certificates are issued the foodstuffs destined for export are examined and where necessary samples taken for analysis. Relevant investigation is also made into the methods of production. Imported Food The public health inspector dealing with inspection of imported foodstuffs at wharves in the borough reports that a sample of unfermented non-alcoholic grape juice taken from a consignment at a wharf was found to contravene the Labelling of Food Order, the name and address of the packer or labeller not being stated. A letter was sent to the producers, who agreed to remedy the matter. Contraventions of this Order in respect of the requirement to list the ingredients in decreasing proportion by weight and, in one case, of including an ingredient found to be absent, were similarly brought to the attention of the manufacturers. From time to time, samples taken on import are found not to comply with the Order, which adds emphasis to the suggestion that the new Labelling of Food Order should contain a provision requiring pre-packed foods to be correctly labelled before importation. The proposed Order, however, only requires wholesalers to comply before distribution to retailers. Samples of frozen cooked and uncooked peeled prawns from Pakistan, China and Norway were submitted for bacteriological examination. Counts varying from 50,000 organisms per gram to more than a million colonies per gram were found, but none showed the presence of pathogenic organisms of food poisoning strains. All the consignments were released subject to being refrigerated and cooked before use, or used immediately after thawing in the case of cooked prawns. A sample of Chinese frozen cooked peeled prawns was submitted for examination before the consignment was to be imported. The viable count was found to be more than 2 million per gram plus the presence of coli indistinguishable from faecal coli in 0.001 gram. As a result the import was refused. In May, 2,546 bags of Czechoslavakian sugar were detained at a wharf because some of the bags had been contaminated with sodium antimonate, a highly toxic chemical which had fallen from kegs on to the sugar on board ship. Sodium antimonate is a white powder resembling granulated sugar, and it was impossible to distinguish between the contaminated bags and the rest, as most had external white powdery patches after unloading. Samples were taken from a number of bags thought to be contaminated, and also of the gunny (bag material) and all were reported to contain sodium antimonate. In view of the high toxicity of this chemical, the consignment was rejected for human consumption and was eventually disposed of for industrial use under supervision. The weight of the sugar was approximately 250 tons. In October, examination of a consignment of Australian canned minced beef loaf 57. comprising more than 70,000 12-oz. tins showed an unusual percentage of blown tins. Samples of the blown and sound tins were submitted for bacteriological examination, and all the blown tins gave a heavy growth of spore-bearing organisms of bacillus and Clostridium groups. In view of the presence of spore bearing Clostridium, there was a risk of Clostridium botulinum being present, a spore bearer which can give rise to a serious paralytic, possibly fatal, type of food poisoning. There had been a change of pack from a round to a square tin and it was considered that these bacteriological results arose as a result of under-treatment in autoclaving, probably due to a change in the geometry of the cans. The consignment, which is detained at the wharf is to be destroyed or re-exported to Australia, the country of origin. Mention should be made of the disposal of damaged tea and tea sweepings which accumulate in fairly large amounts on wharves. Details of weights and number of bags are checked and the unfit tea is periodically disposed of for industrial or fertiliser use, the medical officer of health of the area to which it is sent being notified. In this connection, it was discovered in April that quantities of damaged tea and sweepings were being disposed of to a small firm outside the borough, for industrial purposes. Investigation revealed that this tea was being sieved and sold cheaply for human consumption. As a result of representations made to the firm originally disposing of the unfit tea, supplies to the small firm were stopped. Samples of dried egg and desiccated coconut submitted for bacteriological examination during the year have all proved satisfactory. 301 detention notices and 272 release notices were served under the Public Health (Imported Food) Regulations 1937-48. These notices affected a variety of foodstuffs including: animal casings, almonds, bacon, bay leaves, dried apricots, capsicums, chillies, cocoa, cocoa-butter, coffee, curry powder, desiccated coconut, dates, dried egg, gum arabic, groundnuts, gum tragacanth, ginger, tinned ham, hazel nuts, hops, lard, milk powder, muscatels, olives, frozen prawns, canned pork, prunes, rosemary leaves, liver sausage, salami, sugar, sultanas, tea, thyme, canned tomatoes, tomato paste, tartaric acid, wheat gluten and wine. Liquid Egg Pasteurisation There are two plants in the borough where liquid egg is pasteurised. Hygiene at the larger establishment was maintained at a high level during the year, and many representatives of foreign governments and trade organisations continue to visit these premises. The smaller of the plants is due for demolition in the near future which prohibits the undertaking of any major improvements. 10 samples taken proved satisfactory when submitted to the alpha-amhlase test. 58. Milk Supply - Samples Milk samples submitted for chemical analysis, numbered 35 including 11 taken at hospitals, schools and day nurseries in the borough. The average fat and solids-not-fat content of ordinary milk samples analysed was 3.68 and 8.58 per cent, respectively, and of the superfatted variety 4.10 and 8.80 per cent. No raw milk is processed nor indeed sold in the borough. Consequently, no samples were taken for the purpose of examination for the presence of brucella abortus. Unsound Food The following quantities of unsound foodstuffs were disposed of under the Public Health (Imported Food) Regulations 1937-48 and the Public Health Acts: Wharves 147 Tons London Fruit Exchange and Spitalfields Market 180 Tons Other Premises 83 Tons 410 Tons About 30 tons of unsound food was allowed to be used for chemical or animal feeding purposes or for manufacturing purposes other than for human consumption, the remainder being delivered to, or collected by, the Public Cleansing Department at whose riverside depot it was mixed with household refuse, under supervision, and removed by barge to a controlled tipping site in Essex. Approximately 1,600 condemnation certificates in respect of unsound food were issued in 1966. Unsound Food etc. - Complaints Complaints made by members of the public as to the alleged unsound condition, etc. of foods, and which were investigated during the year, numbered 45. The complaints referred to - Alleged unsound condition: bacon 1, bread 5, cake 1, cheese 1, chicken 1, corned beef 1, fish 1, meat 3, meat pie 2, potatoes 1, potato crisps 1, rice 1, sausages 2, sausage sandwich 1, sausage rolls 2, tea 1, tomatoes 1. 59. Alleged dirty condition and/or foreign body or deposit: bread 7, cake 1, chocolate 1, coconut 1, corned beef sandwich 1, dates 2, fruit pie 1, meat 1, mince tart 1, popcorn,1, sausage roll 1, steak pie 1. HOUSING The number of commonwealth immigrants coming into the borough continues to increase with the consequent additional work required to be carried out by all sections of the department not least the environmental health section, particularly in respect of overcrowding and the increasing attention needing to be paid to houses in multiple occupation. Slum Clearance During the year, 13 clearance areas involving 272 dwellings were declared by the Borough Council. One compulsory purchase order and two clearance orders were confirmed involving 177 units of accommodation. All sub-standard tenement blocks have been surveyed. Some are considered capable of improvement but many fall in a category where improvement is either not economically sound or is undesirable, and yet they are not so far defective within the meaning of Section 4, Housing Act, 1957, to be representable. It would help considerably in this respect if a satisfactory means of refuse storage and means of escape from fire were conditions of fitness. In many cases a storage chamber is provided often at basement level, and entails the refuse being carried from the chamber by baskets to the refuse lorry. This is undesirable from every aspect. Overcrowding Alleged overcrowding was investigated in 97 instances, 86 being confirmed and added to the register. Seventeen overcrowded families were rehoused by the Greater London Council and 11 by this Council, the register of overcrowded premises being increased, during the year, from 259 to 317 families. Underground Rooms There are approximately 2,000 underground rooms in the borough used for living or sleeping purposes, of which 1,500 are unfit. During the year, five such rooms were closed. Town and Country Planning (Housing Accommodation) Direction, 1952 Under this order the department is consulted by the Borough Architect and Planning Officer before applications are determined for planning permission for development 60. volving change of user of premises from use as a dwelling. Investigation of one such application was carried out during the year. Applications for Rehousing At the end of the year, there were 8,015 applications for rehousing on the Council's waiting list, an increase of 315 on last year. These included tenants of 1,668 Council dwellings who desired transfer to larger or smaller accommodation. Preferential Housing on Health Grounds Applications for preferential housing on health grounds, investigated during 1966, numbered 420. An 'urgent' assessment was granted in 52 cases and balancing points were awarded in a further 115. Tenant transfer was supported in the case of 83 tenants of Council dwellings. Houses in Multiple Occupation In November 1964 the former Stepney Metropolitan Borough Council made a scheme, under Section 22 of the Housing Act 1961 as amended by Section 70 of the Housing Act 1964, for the registration of houses in multiple-occupation in certain wards of the borough. The scheme was submitted for confirmation to the Minister of Housing and Local Government in January, 1965 but by 1st April when the new London boroughs were formed the scheme had not been approved, the Minister stating that this was the first scheme presented for confirmation and a special study was taking place in connection with which visits were being made to local authorities all over the country. Several discussions took place with the Ministry's officers and changes in the scheme were agreed. In consequence of these changes and of alterations to the wards following the formation of the new borough of Tower Hamlets, an amended scheme was approved by the Council in September 1966. At the end of the year the Minister's confirmation was awaited. Continued progress was made during the year by the technical assistants in dealing with houses in multiple-occupation and in the use of the Council's powers under the provisions of Part II of the Housing Act 1961 and regulations made thereunder. Management orders were made in respect of 45 premises following upon the service of 57 notices of intention to make such orders. One management order was revoked after representation was received from the owner of the premises concerned. Necessary works to remedy conditions caused by neglect of management were completed in 82 houses, 62 summonses being granted for contraventions of the regulations, fines amounting to £405 being imposed. Eleven notices were served under the provisions of Section 90 of the Housing Act, 1957, for permitting overcrowding in houses in multiple occupation. Many visits by the 61. technical assistants in the late evening and early hours of the morning are necessary to check that these notices are being complied with. 17 summonses were issued for contravention of notices, resulting in fines amounting to £222 being imposed, with costs of £42. Nineteen directions to prevent or reduce overcrowding were served under Section 19 of the Housing Act 1961. Summonses were issued in three instances for contravention of the directions. Two notices under Section 16 of the Housing Act, 1961, were served to secure the provision of means of escape in case of fire. Standard Grants and Improvements In conjunction with officers of the Borough Engineer and Surveyor's Department, the housing inspector inspected 36 premises regarding which applications had been made to the Council for standard or improvement grants. New Housing During the year 951 new permanent dwellings were completed in the borough: 466 by the Borough Council and 485 by the Greater London Council. (See Appendix on page 12 1 ). Illustrated are examples of new dwellings completed by the Council this year. At the end of the year units of accommodation owned by the Borough Council numbered 12,899 comprising 10,383 erected by the Council, and 249 prefabricated bungalows and 2,267 formerly requisitioned and other premises were purchased. Dwellings in the borough owned by the Greater London Council totalled 22,026 at the end of the year. FACTORIES Provision is made in Section 153 of the Factories Act 1961 for the medical officer of health to include in his annual report prescribed particulars with respect to matters under the Act administered by the Council. These details are given on page 122. There is only one basement bakehouse in the borough in respect of which a certificate of suitability under Section 70 of the Act continues in force. HAIRDRESSERS AND BARBERS Prior to 1st April, 1965, barbers and hairdressers in the area could not conduct such businesses unless they and their premises were registered with the Borough Council, which also had powers to make byelaws for the conduct of the business. Byelaw powers 62. Council dwellings completed 1966 - Sabella Court, Tredegar Road. Council dwellings completed 1966 - Lewey House and Broadhurst House, Bede Road. are contained in the Public Health Act,1961, and byelaws made by the Council were confirmed by the Minister on 31st May, 1966, and came into operation on 1st July, 1966. There are still no powers enabling councils to require compulsory registration. LEGAL PROCEEDINGS A summary of legal proceedings instituted during the year under various acts and regulations following ascertainment by the public health inspectors and technical assistants of contraventions will be found on page 124. LEGISLATION The Local Government Act 1966 repealed the provisions of the Public Health Act 1936 relating to the registration of canal boats and also made provision for the making of Regulations varying the licence and/or registration fees at present payable under various enactments, including the Animal Boarding Establishments Act 1963, Riding Establishments Act 1964, Pet Animals Act 1951, Rag Flock and Other Filling Materials Act 1951, and the Public Health Act 1936 relating to the registration of nursing homes. The Colouring Matter in Food Regulations 1966, which become operative on 26th June, 1967, re-enact with amendments the Regulations of 1957 which are revoked. The principal amendments delete six coal tar colourings from the permitted list of food colourings and one is to be added. The Cheese (Amendment) Regulations 1966, operative on 1st February, 1967, postpone until 1970 some of the labelling requirements of the Regulations made in 1965 and prescribe fat and moisture standards for certain foreign processed cheeses. The Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966, which came into operation on 1st January, 1967 set standards of hygiene for market stalls and delivery vehicles, including requirements for provision of water supply and washing facilities. PERSONAL CLEANSING STATION A cleansing service for verminous persons and persons suffering from scabies operates at Branch Road and Digby Street Cleansing Stations, in addition to the service provided for schoolchildren at the school treatment centres. The several large common lodging houses in the area provide a continuous flow of men to the Branch Road Station for delousing. Statistics on page 125. DISINFECTION AND DISINFESTATION These services are provided on site at Branch Road and Digby Street Disinfecting 63. Stations where teams of operators are also based to deal with infection and infestation at premises. Premises and fomites are disinfected after the occurrence of certain infectious diseases, generally by means of steam under pressure or formaldehyde. Articles of clothing etc. for export are also dealt with where the country to which the goods are being exported requires an official certificate. A service is provided for the disinfestation of premises infested by insects, etc. including ants, bed bugs, cockroaches, fleas, carpet beetles, woodlice, clovermites, firebrats, larder beetles and silverfish. The Council carries out on behalf of the East London and Thames Group Hospital Management Committees any necessary work of disinfestation at hospitals and other premises in the borough coming under their direction. (Statistics on page 125). LICENSING ACT, 1961 Applications for registration of clubs under the Licensing Act 1961 are dealt with by a magistrates' court, copies of the applications being sent to the Council for any observations they may wish to make. Public health inspectors visit the premises to report on their suitability as regards the requirements of public health and food and drugs legislation. Premises inspected and reported on during the year numbered 11. LODGING HOUSES - COMMON There are four licensed common lodging houses in the borough, providing accommodation for 949 persons as follows:- Salvation Army Hostel, Garford Street 223 Men Salvation Army Women's Hostel, Hopetown Street 228 Women Salvation Army Hostel, 177, Whitechapel Hoad 323 Men Church Army Hostel, 10/22, Johnson Street 175 Men As a result of bringing a staff lounge into use the accommodation at the Salvation Army Hostel, Garford Street was reduced from 244 beds to 223. The premises are inspected regularly including visits made at night to ensure tha the byelaws relating thereto are complied with. LODGING HOUSES - SEAMEN Three such premises in the borough provide accommodation for 575 seamen as follows:- 64. LODGING HOUSES - SEAMEN Continued Empire Memorial Hostel, 747, Commercial Road 145 Seamen Queen Victoria Seamen's Home, 121/123, East India Dock Road 187 Seamen Sailors' Home, Dock Street 243 Seamen The premises at 137, Leman Street ceased to be a seamen's lodging house during the year. Regular inspections are carried out at these premises. MORTUARY SERVICE The Council's mortuary is situated in Cottage Street, Poplar High Street,and adjoins the coroner's court. The mortuary has accommodation for 15 bodies and serves the Poplar and Stepney areas. Prior to the formation of the borough, Bethnal Green Council had an arrangement with Hackney Council for the use of the latter's mortuary, which arrangement continues in respect of mortuary accommodation for that part of the borough. (Statistics on page 124). A total of 689 bodies were received during the year (600 in the Council's mortuary and 89 in Hackney mortuary) including the bodies of 182 persons who were resident in other areas. OFFENSIVE BUSINESSES There are 20 offensive businesses in the borough. The register comprises the following premises:- Dresser of Furskin (2) 34/38, Brodlove Lane Poultry Slaughterhouses (18) *19, Bell Lane *7, Leyden Street 105, Bethnal Green Road 10b, Leyden Street 28, Burslem Street 13, Leyden Street 161, Cannon Street Road 15, Leyden Street *163, Cannon Street Road *7, Lower Hessel Street 16/18, Cobb Street *21/22, Lower Hessel Street *14, Hessel Street *4, Monthope Street 36, Hessel Street *6, Monthope Street 75, Hessel Street 10a, Monthope Street (*Establishment orders on these premises are subject to renewal from time to time.) 65. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 Registration The survey commenced in 1965 to determine those premises requiring registration under Section 49 of the Act was completed during the year. This, with other measures, resulted in a further 306 registrations, the total registrations at the end of the year being 3,197. Many employers and employees are still unaware of the existence of the Act. The number of 'voluntary' registrations received is very small, and as the occupation of premises constantly changes, there is undoubtedly a number of businesses which are not registered. These will be dealt with during the course of routine inspections(Statistics on page 126). Exemptions No exemptions from the provisions of Sections 5,6,9 and 10 of the Act were granted during the year. One application for exemption from Section 9, which relates to sanitary conveniences, was received. It was possible to arrange for the sharing of conveniences with a neighbouring organisation, and this was considered a suitable alternative. Accidents During the year 35 accidents were reported. None was fatal. A summary of the causes of the accidents is given in Table 48 on page 126. In spite of efforts made during the course of inspections to make employers fully aware of their responsibilities under Section 48 of the Act, it is believed that many accidents occur without the requisite notification being made. MISCELLANEOUS REPORTS Following a request by the Housing Committee a survey of the 1,071 railway arches in the borough was made to ascertain the present occupiers and use of each arch. Reports were submitted to the Borough Architect and Planning Officer on 396 inspections of offices and shops made in connection with applications for permission to develop premises under the Town and Country Planning Act, 1962. In connection with applications under the Betting, Gaming and Lotteries Act, 1963, 14 inspections of betting offices were carried out and reports submitted to the Chief Officer, Public Control. OUTWORKERS Employers of outworkers in the borough in certain specified occupations are required 66. by the provisions of Section 133 of the Factories Act 1961 to supply the Council, in February and August each year, with a list of the names and addresses of all persons employed by them as outworkers during the preceding six months. Where the outworker resides in another area, the Council is required to forward details to the local authority for that area. It is an offence to fail to submit lists of outworkers or to give outwork to be done in a place which is considered to be injurious to the health of the persons employed therein. Statistics will be found on page 127. PET ANIMALS ACT, 1951 There are 78 licensed pet shops in the borough including stalls in markets. No contraventions were discovered of the conditions subject to which annual licences are granted by the Council. PHARMACY AND POISONS ACT, 1933 The sale of certain poisons (chiefly those used for sanitary, domestic and horticultural purposes) by persons other than pharmacists is subject to the provisions of this Act and the rules made thereunder. A person selling such poisons must have his name entered on a list kept by the Council, and must make application annually for reentry and pay a prescribed fee. Compliance must be made with the requirements relating to storage, transport, labelling and containers. There are 129 names on the list. POULTRY PROCESSING AND PACKING Approximately two million hens and chickens are slaughtered annually at slaughterhouses in the borough. There are 18 slaughterhouses where birds are killed by ritual slaughter either for the Kosher trade or for consumption by Muslims. Eleven of the slaughterhouses are situated in confirmed compulsory purchase order areas, or in areas where such action is imminent, and a site in the borough has been allocated for centralising the industry. Only top quality birds are brought from farms for Kosher slaughter; the majority are plucked before removal from the slaughterhouse but only a few are eviscerated. Most of the carcases are sent to dealers or retailers, and some for processing and packing. Few, if any, are sent to wholesale markets. Frequent visits are made to these establishments to ensure that the requirements of the Food Hygiene (General) Regulations, 1960, and the recommendations of the Code of Practice on Poultry Dressing and Packing, are being observed. 67. The conduct of the business of poultry slaughtering is governed by byelaws made by the former London County Council, the premises being subject to the provisions of Section 107 of the Public Health Act, 1936 dealing with restrictions on establishment of offensive trades. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 This Act, designed to secure the use of clean filling materials in articles which are upholstered, stuffed or lined, requires the licensing or registration, as the case may be, of premises where rag flock is manufactured or stored or filling materials used. Regulations made under the act prescribe standards of cleanliness for filling materials. Premises registered for the use of filling materials number 49, there being no licensed premises. Fourteen samples of filling materials were obtained from registered premises during the year and all were reported as satisfactory. REFRESHMENT HOUSES In connection with the provisions of Section 89 of the Public Health Act, 1936 and Section 80 of the Public Health Act, 1961 relating to the provisions of sanitary conveniences in refreshment houses, the Council in May this year adopted a set of standards for sanitary accommodation, as recommended by the Medical Officer of Health, to be required in such premises. There are 1,477 refreshment houses in the borough, 515 of which comply with the Council's standards. Notices were served requiring additional accommodation in 18 premises, three being complied with at the end of the year. REFUSE DISPOSAL The Cleansing Officer of the Council has kindly supplied some statistics relating to refuse disposal for the year, given on page 127. RENT ACT, 1957 Six applications under the Rent Act 1957 were received from tenants for certificates of disrepair, 4 certificates being issued. RODENT CONTROL In accordance with the requirements of the Ministry of Agriculture, Fisheries and Food, statistics on rodent control work for surface infestations carried out by the department during the year were submitted to the Ministry. In this period, out of 3,777dwellings and other premises requiring inspection 2,964 were found to be infested with mice or rats. 68. Treatments were carried out by the department's rodent control staff in 2,875 properties, the charges for servicing business premises amounting to £6,110. Business premises under regular servicing contract with the Council numbered 246 at the end of the year. Continuous baiting of the sewers, using fluoracetamide, is carried out throughout the year by gangs of men consisting of one rodent operative and two sewermen from the Borough Engineer's Department acting under the supervision of the Health Department's officers. Statistics are given on page 128. SWIMMING BATHS The water in the seven public swimming baths in the borough and in the bath at the Council's Hornchurch children's home is sampled at monthly intervals by the Scientific Department of the Greater London Council on this Council's behalf. A total of 90 samples were taken during the year. Four samples were found to be in an unsatisfactory bacteriological condition, due to breakdown in the chlorination plants. In addition 30 samples were taken from seven school swimming baths in the borough, 5 samples being unsatisfactory. VACANT SITES Derelict buildings and vacant sites continued to be a problem this year as in previous years. The depositing of refuse and the misuse by vagrants and children will still continue until the sites are either adequately fenced or redeveloped. At the end of the year, following a report considered by various committees of the Council concerned, it was decided that in view of the provisions existing in various acts of Parliament enabling the Council t.o take action regarding derelict sites the problem could best be dealt with by one committee and one chief officer. The Health Committee and Medical Officer of Health were designated for the purpose. It is hoped to commence concerted action to deal with nuisances and other unsatisfactory conditions on derelict sites in the borough early next year. WATER SUPPLY The domestic water supply in the borough is taken from the Metropolitan Water Board. The supply to the area is a mixture of filtered water derived from the River Thames and River Lee in varying proportions and is not plumbo-solvent. Samples of the water are subjected for quality control to regular routine chemical and bacteriological examination 69. at the Board's laboratories. The water supply to the borough has been satisfactory both in quality and quantity during 1966. No fluoride was added, there being a small amount of fluoride naturally present in the supply. Immediate action is taken in respect of any form of contamination revealed by inspection or analysis. All new and repaired mains are disinfected with chlorine and the water subsequently checked as to quality, before the structures are restored to service, No houses are permanently supplied by standpipe. There are 19 deep wells in the borough used for industrial purposes. Bacteriological and chemical analyses of water from these wells are made periodically and the results reported to this department. The number of instances where the water supply to premises was reinstated or repaired following action taken by the department was 128 and the Board was notified on 28 occasions where wastage of water was taking place. Notifications were received from the Board on 27 occasions of intention to withdraw the supply from premises because of non-payment of rates. The Council resolved in favour of fluoridation of the water supply. However, in this respect councils in the Greater London area do not have overall control of the water supplies to their boroughs which are provided by the metropolitan and other water boards. THE CHIEF PUBLIC HEALTH INSPECTOR, REPORTS: This year has not been notable for new legislative measures. Those introduced relate mostly to food and, in addition to a spate of official certificates concerning imported meat and meat products, include revised standards for butter, salad cream and colouring matter in food and, finally, a measure calculated to improve conditions where food is sold from stalls, viz. the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966. It has long been felt that standards of food hygiene for stalls in street markets should not be set lower than those for food premises. When unwrapped food is sold from stalls in crowded, muddy or dusty streets the risk of contamination is obviously greater and it cannot be said that the hygienic practice of stall holders is higher than that of shop-keepers; indeed, a general impression is that they are much lower. One effect of the new regulations is to extend to all businesses selling open food the requirements to screen stalls, provide water supply and washing facilities. Food traders have been advised by circular of the requirements of the regulations and the subject has been discussed with representatives of traders' associations. So far reactions are somewhat mixed and although the need for general improvement is 70. not denied it seems that some resistance may be expected, principally from greengrocers selling fruit, who are inclined to dispute the necessity to screen stalls and provide hand washing facilities. The Council had already taken the initiative by imposing a condition on new street trading licences that only prepacked food will be sold but there are over four hundred stalls in thirty three designated market streets with existing licences, not including private markets outside the scope of this condition, to which the regulations will have to be fully applied. There are still far too many food premises in the borough where standards of food hygiene are by no means satisfactory and despite the efforts of public health inspectors to achieve improvements by persuasion, it has been found necessary to prosecute no fewer than forty three food traders on this account. It seems extraordinary in this day and age, when advice is available and a guide to simple hygienic practite is set out in regulations, that it should be necessary to invoke the time consuming process of the law so frequently. The habit of smoking in food premises is also too prevalent and, in addition to numerous warnings, thirteen persons were prosecuted for this offence. Concern has been expressed regarding horseflesh and kangaroo meat imported into this country for use by the animal food trade. The provisions of the Public Health (Imported Food) Regulations requiring official veterinary certificates do hot apply to meat from the horse or kangaroo. Port health authorities are required by the terms of the Meat (Staining and Sterilising) Regulations to release meat when they are satisfied that it will be sterilised by the recipient. Care is taken in checking the destination of this meat but there is a fear that some of it, if in the hands of an unscrupulous trader, may find its way into products used for human food. Both the Meat (Staining and Sterilising) Regulations and the Public Health (Imported Food) Regulations are under review and port health authorities have made recommendations with a view to closing any loopholes that now exist. For the first time in many years the district has been almost free from invasions by trespassing caravans. Quite clearly the reduction of available land by adequate fencing of cleared sites is the reason. Both the Council and the Greater London Council have now adopted the practice of protecting land with corrugated iron sheeting or other close fencing as soon as possible after buildings have been demolished. The same freedom has not been experienced with another intruder - the chronic alcoholic - who by his degraded manner of living excites the most conflicting passions in the minds of all who have an interest in the social welfare of their fellow men whatever the field of activity, be it voluntary or official. For the purpose of this report the problem created by methylated spirit drinkers haunting a particular locality has been expounded upon by the Medical Officer of Health since it has its medical, psychological and spiritual facets but it seems 71. reasonable to comment that the sanitary aspect of the problem is a very real one and appears to be the basis of the greatest resentment by the public in general. Methylated spirit drinkers commonly adopt, in numbers, any vacant or derelict property to which access may be gained, creating filth and squalor to such a degree that no self respecting community, however sympathetic, can be expected to tolerate such invasion of its environs without protest. On one occasion a recreation ground was visited following the receipt of a complaint. There were a number of methylated spirit drinkers on the benches and a litter bin was found smothered with body lice. The lice were crawling on the exterior of the bin, on the pedestal and even on the grass below. Under the litter at the bottom of the bin a pair of trousers was found smothered with lice fully gorged. Rodent Control With assistance from the Borough Engineer sewer disinfestation is carried out regularly and methodically over the whole borough with the use of fluoracetamide. The number of complaints received regarding rodent infestations is still fairly high and efforts have been concentrated on establishing the source of infestation. A considerable amount of work has been done in connection with repair and sealing of drains which have become a source of rat infestation from the sewer. Water Supply From time to time the internal water systems of tall blocks of flats which include such fittings as booster pumps, valves, control switches and water tanks are in need of repair and maintenance. As a precaution against risk of contamination through the somewhat extensive handling of the various parts by maintenance and workshop staff, arrangements have been made with the Scientific Branch of the Greater London Council for sterilisation of the water systems in the Council's housing estates to be carried out immediately following works of maintenance. Sterilisation is carried out by members of the Scientific Adviser's staff. The relevant position of the water system requiring attention is isolated from the rest of the system by closing appropriate valves. Parts of the system removed such as flanges and washers are sterilised by soaking in a solution of sodium hypochlorite. The system is then chlorinated and water samples taken the next day are followed by a report on the purity of the supply. This service is an extension to that provided by the Scientific Branch in connection with housing estates in the ownership of the Greater London Council. Health Education and Public Relations Public health inspectors have taken a reasonably active part in health education, particularly having regard to their general commitments. Parties of post-graduate and other students have been entertained from the London School of hygiene and 72. Tropical Medicine and the Ministry of Overseas Development. Working in co-operation with the Health Education Officer, talks have been given in hospitals, secondary schools and to members of the home help service. Staff The staffing position in relation to public health inspectors shows no improvement; five were lost to the department during the year. Three of these officers retired and two resigned to take appointments with other authorities. Again no applications have been received in response to advertised vacancies. It is fortunate that the Council was able to secure the temporary services of an inspector retiring from another authority and that two pupil public health inspectors who qualified to receive their diploma were appointed. To maintain the establishment of ten pupils attached to the department and provide a continuity of training, two students were appointed to replace those qualifying. Response to advertisement for pupil public health inspectors showed a marked improvement on pr evious years both in relation to the number and qualifications of applicants. Three pupils are due to take their final examination next year and it is to be hoped that they will be successful and. emulate their preceding colleagues by remaining in the service of the Council. STATISTICS Tables 35 to 55 of the Appendix give additional statistical information on the environmental health services. 73. 74 PART V MISCELLANEOUS SERVICES V. MISCELLANEOUS SERVICES, ETC. ACCIDENTS IN THE HOME Inquests were held on 17 fatalities in the borough arising from accidents which occurred in the home. Information is received monthly from the Medical Adviser to the Greater London Council of the number of borough residents removed to hospital by the London Ambulance Service following the occurrence of home accidents. The total for the year was 564. An analysis of the figures shows that a large proportion (39%) of accidents are, as may be expected, sustained by old people. The powers and duties of the Council under the Home Safety Act 1961, relating to the dissemination of information and advice for promoting safety in the home and encouraging proper precautions against accidents, are exerqisable by the Health Committee. The prevention of home accidents was included in the syllabus of health education for all groups, with emphasis on the dangers from oil heaters. Particular attention on this topic was paid to persons in the older age groups. Arrangements were made with the Housing Departments of the Council and the Greater London Council to include educational leaflets on home safety when they sent out notifications to tenants of rent/rate increases. Leaflets thus distributed numbered 34,000. AMBULANCE FACILITIES The Greater London Council is responsible under Section 27 of the National Health Service Act 1946 for the provision of ambulance transport in the area. AUTHENTICATION OF INTERNATIONAL CERTIFICATES OF VACCINATION AND INOCULATION Persons proceeding abroad are required in certain countries to produce a certificate of recent successful vaccination and/or inoculation, and in addition the signature of the vaccinating doctor must be verified by the medical officer of health of the district . During the year, 10,049 signatures on certificates were verified as those of medical practitioners practising in the borough and the certificates accordingly endorsed. The number authenticated last year was almost quadrupled due to continental countries requiring travellers from this country to show evidence of recent vaccination against smallpox following an outbreak in the Midlands. BLIND AND PARTIALLY SIGHTED PERSONS It is necessary,for the purpose of the Council's scheme to provide welfare services under the National Assistance Act 1948 for the blind and partially sighted,to arrange medical examinations in connection with the certification of such persons. The department 75. arranged 165 examinations by a consultant ophthalmologist, during the year, at a cost-of £476. Transport to the clinic for examination is arranged for these persons where necessary. In addition, certificates accepted from other local authorities, hospitals and private ophthalmologists numbered 41. CONFERENCES Conferences and courses attended by members of the Council and/or officers of the department are summarised on pages 133-136. DECEASED PERSONS Inquests: Inquests were held on 88 residents of the borough during the year, the verdicts being: 15 deaths due to road accidents, 17 home accidents, 19 other accidents, 15 suicides, 5 misadventure, 1 murder, 1 natural causes, 9 open verdicts, 2 manslaughter, 2 asbestosis and 2 other causes. Burials: Section 50 of the National Assistance Act 1947 places a duty on the Council to arrange for the burial of any person found dead within the borough where no private arrangements have been made. Burials undertaken during the year numbered 38. (Statistics in Appendix, page 117 ). Transport of bodies abroad: From time to time certificates are issued regarding bodies being transported abroad to the effect that the deceased had not died from an infectious disease and that the coffin was hermetically sealed. Three such certificates were issued this year, relating to bodies flown to Israel and Malta. HOSPITAL FACILITIES The undermentioned hospitals are situated within the borough: No. of Beds Bethnal Green Hospital, Bethnal Green Road, E.2. 302 East End Maternity Hospital, 384, Commercial Road, E.l. 54 The London Hospital, Whitechapel Road, E.l. 707 London Chest Hospital, Victoria Park, E.2. 143 London Jewish Hospital, Stepney Green, E.l. 128 Mildmay Mission Hospital, Austen Street, E.2. 72 Mile End Hospital, 275, Bancroft Road, E.l. 410 Poplar Hospital, East India Dock Road, E.14. 121 Queen Elizabeth Hospital for Children, Hackney Road, E.2. 146 St. Andrew's Hospital, Devons Road, E.3. 433 St. Clement's Hospital, 2a, Bow Road, E.3. 128 76. LABORATORY FACILITIES Bacteriological investigations for infectious diseases are carried out on behalf of the health department by the Regional Hospital Board's Group Laboratory at Mile End Hospital and for food samples by the Public Health Laboratory Service (directed by the Medical Research Council for the Ministry of Health) at County Hall, S.E.I. Investigations carried out by the Group Laboratory on specimens submitted by the Medical Officer of Health and by general practitioners in the borough totalled 527, comprising 488 faeces, 32 throat swabs, 4 urine, 1 blood, 1 nasal swab and 1 skin scraping. LEGISLATION The following acts, byelaws, orders and Pegulations affecting the department were made during the year; Date Date Made Operative Acts The Alkali Works Regulations Act 1966 12.9.66 1.12.66 Greater London Council (General Powers) Act 1966 9.8.66 Various Local Government Act 1966 13.12.66 Various Ministry of Social Security Act 1966 3.8.66 6.8.66 Orders and Regulations Alkali Etc. Works Order 1966 12.9.66 1.12.66 Antioxidant in Food Regulations 1966 30.11.66 9.12.66 Butter Regulations 1966 12.8.66 1.9.66 Cheese (Amendment) Regulations 1966 28.12.66 1.2.67 Colouring Matter in Food Regulations 1966 19.9.66 26.6.67 Food Hygiene (Market Stalls & Delivery Vehicles) Regulations 1966 29.6.66 1.1.67 Food Hygiene (Market Stalls & Delivery Vehicles) Amendment Regulations 1966 28.11.66 1.1.67 Handicapped Pupils and Special Schools Amending Regulations 1966 15.12.66 1.1.67 Housing (Prescribed Forms) Regulations 1966 18.3.66 23.6.66 London Government Order 1966 14.10.66 22.10.66 Local Government (Records) Order 1966 14.2.66 22.2.66 Meat Inspection (Amendment) Regulations 1966 22.7.66. 30.9.66 Mineral Hydrocarbons in Food Regulations 1966 12.8.66 27.8.66 Nurses (Area Nurse Training Committee) Order 1966 22.7.66 1.8.66 77. LEGISLATION Orders (Continued) Date Made Date Operative Poisons List Order 1966 11.6.66 6.7.66 Poisons Rules 1966 11.6.66 6.7.66 Public Health (Aircraft) Regulations 1966 8.3.66 1.4.66 Public Health (Leprosy) Regulations 1966 10.1.66 1.3.66 Salad Cream Regulations 1966 10.8.66 19.9.66 Schools Amending Regulations 1966 15.12.66 1.1.67 Skimmed Milk with Non-Fat (Amendment) Regulations 1966 12.7.66 22.7.66 Slaughterhouse (Hygiene) (Amendment) Regulations 1966 19.10.66 1.2.67 Stands for Carry-Cots (Safety) Regulations 1966 19.12.66 1.2.67 Smoke Control Areas (Exempted Fireplaces) Order 1966 2.3.66 10.3.66 Offices,Shops & Railway Premises Act,1963(Exemption No.4) 3. 8.66 3.8.66 Ordar 1966 Byelaws made by the London Borough of Tower Hamlets Hairdressers and Barbers Byelaws 24.11.65 1.6.66 Mortuary Byelaws 17.11.66 1.3.67 A summary of relevant Circulars issued by Ministries during the year is as follows:Ministry of Agriculture, Fisheries and Food Relating to official certificates accompanying foodstuffs imported from other countries and to approved chemical agents. Ministry of Health Relating to: Annual Reports of Medical Officers of Health; Dental Aftcillaries; Deferment of Expenditure on Capital Projects on Health and Welfare Services; Family Planning; Vaccination against Measles; Co-ordination of Education, Health and Welfare Services for Handicapped Children and Young People; Local Government Bill-Rate Support Grant Expenditure on Local Health and Welfare Services; Code of Practices for the Protection of Persons against Ionising Radiation arising from Medical and Dental Use; Facilities for Incontinent Pads; Food Hygiene Codes of Practice-Hygiene in the Bakery Trade and Industry; Population Screening of Cancer of the Cervix; Radiological Hazards to Patients; Local Authority Dental Service. Ministry of Housing and Local Government Review of South-East Study-County Population Forecasts 1964-1981; Our Older Homes and Call for Action; Gypsies; Smoke Control Areas (Authorised Fuels) Regulations; Clean Air Act-Grant Arrangements. 78. Ministry of Labour Offices, Shops and Railway Premises Act 1963 - Various Circulars. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT The Council is the licensing authority for establishments for massage and special treatment, under Part IV of the London County Council (General Powers) Act 1920. Byelaws made by the London County Council in 1921 with respect to these establishments continue in force. Establishments licensed during the year numbered 6. MEDICAL EXAMINATION OF STAFF The department's medical officers undertake for the Council the medical examination of new entrants to the Council's service, of staff and employees absent due to sickness exceeding one month, of employees considered for participation in the Sick Pay Scheme and for extension of service beyond the age of 65 years, as well as assessments for gratuities and other reasons as required. Examinations carried out during the year numbered 1,073, compared with 670 last year. RADIOACTIVE SUBSTANCES Persons who keep or use radioactive materials, unless exempted, are required, under the provisions of the Radioactive Substances Act 1960, to register with the Ministry of Housing and Local Government and to obtain authority for the accumulation or disposal of radioactive waste. The Ministry has issued 8 registration certificates under Section 1 of the Act with respect to premises in the borough. In addition two hospitals for which registration certificates are not required use radioactive materials. STAFF CHANGES Staff changes which took place during the year are summarised as follows:- 79. STAFF CHANGES (Continued) Resignations Appointments Administrative Staff - 6 Assistant Home Help Organiser 1 1 Assistant Nursing Officer 1 - Assistant Supervisors, Training Centres 2 6 Chief Dental Officer - 1 Chiropodists (Sessional) 2 2 Clerical Staff 14 11 Clinic Auxiliaries 2 1 Clinic Nurses 9 11 Clinic Centre Superintendent 1 - Creche Assistant - 1 Day Nursery Assistants 11 12 Day Nursery Deputy Matron 1 1 Day Nursery Matron 1 1 Day Nursery Staff Nurses 5 5 Day Nursery Students 8 8 Day Nursery Wardens 1 2 Dental Auxiliary - 1 Dental Officer 1 - Dental Officers (Sessional) 3 5 Deputy Medical Officer of Health 1 1 Health Education Officer - 1 Health Visitors 7 5 Health Visitor Students 5 6 Medical Officers 2 1 Medical Officers (Sessional) 6 5 Old People's Visitors 2 - Ophthalmologists (Sessional) 1 1 Public Health Inspectors 5 3 Pupil Public Health Inspectors 2 2 Rodent Investigator - 1 Senior Medical Officer 1 - School Nurses 4 3 School Nursing Sisters 3 - Social Workers (Health Services) 2 2 Social Worker (Mental Health) 1 Storekeeper - 1 Supervisor, Training Centre - 1 Technical Assistants 1 2 Tuberculosis Visitors 1 1 107 111 80. PART VI SCHOOL HEALTH SERVICE VI. REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER ON THE SCHOOL HEALTH SERVICE The routine work of the School Health Service continued over the year in the regular examinations of children at prescribed age groups, and with special examinations for those referred by the Divisional(Education)Officer, Head Teachers, School Care Committee, or at the request of the parents. Out of a school roll of 33,778, 13,501 pupils received routine inspections; 4,178 special inspections and 5,676 reinspections were carried out. It has not been found practicable in this borough to apply the selective system of examinations to the 7-year age groups. The large number of immigrants into the area from other countries and other parts of Britain, in conjunction with general movements of population in and out of the borough, results in children having frequent changes of schools and entering different schools at all ages. To ensure that such children are examined, it has been found advisable in many cases to examine each new entrant to a school, whatever his age. In September 1966, another large secondary school opened when Sir John Cass School moved from its old building in the City of London to join with Redcoat School, Stepney in a new building near to St. Dunstan's Church. These large secondary schools produce their own problems for the School Health Service. The children require a period of adjustment to the large buildings and to the greater numbers of fellow pupils following their previous experience of small primary schools. To provide the complete advisory medical service in both physical and emotional aspects, which is the aim of the service, the school doctor needs to be known by the teaching staff. This mutual "getting to know each other" is a slowly maturing process so easily broken by staff changes on either side. The shortage of full-time recruits to the medical branches of the public health services, particularly males, may lead to difficulties in continuity of service for the future. We are fortunate in having a number of experienced part-time medical officers, including general practitioners, accustomed to the required work which has enabled us to meet all demands to date. A second day school for maladjusted pupils opened also in September, taking children from Hackney and Tower Hamlets. This has helped considerably to reduce the local waiting list of disturbed children requiring special educational treatment. Admissions are necessarily slow to allow individual children time to accustom themselves to their new environment. As stated in the Report for 1965 the high rate of verminous children was to be met by additional measures, if necessary invoking legal sanction for cleansing at the borough cleansing stations. As a result for the year 1966, the number of treatments for 'vermin and nits' increased from 265 to 528. The schools principally affected are those with high ratios of immigrant children on their roll some of whom move on before adequate treatment can be completed. Attendances for treatment of scabies at the bathing centres increased from 50 last year to 172 in 1966. There has undoubtedly been an increased 81. incidence over the last few years of scabies which is confirmed by reports from other parts of the country. A combined approach with the co-operation of local schools, genera} practitioners and the borough cleansing station staff was initiated during the year to ensure where possible that all known cases, and their family and other contacts, are given a complete course of treatment. A limited trial of 'Tetmosol' prepatations was made in intractable cases after treatment with benzyl benzoate had proved adequate. Thanks must be expressed to the Medical Adviser and his central staff, as well as to the local Divisional Officer of the Inner London Education Authority for their cboperation throughout the year. Joint Scheme: During the year a scheme for the administration of the School Health Service jointly by the Inner London Education Authority and the Council, including the joint use of professional staff, equipment and premises, was submitted to and approved by the Minister of Education and Science and the Minister of Health in accordance with Section 32 of the London Government Act 1963. PUPILS ON SCHOOL ROLLS Pupils on school rolls numbered 33,778 at the end of the year, attending 104 schools in the borough which include three schools for the educationally subnormal, two for the maladjusted, one for delicate children, one for the physically handicapped and one for the partially-sighted. SCHOOL NURSING SERVICE Increasing use is made of health visitors on school health work. All the Council's health visitors participate in this work in addition to the school nurses employed for for the purpose. MEDICAL INSPECTION OF SCHOOLCHILDREN Routine medical examinations These are carried out by medical officers of the department assisted by school nurses. Where further examinations are found to be required children are referred to special clinics e.g., vision, hearing, dental, ear nose and throat, special investigation clinics, etc. This year 13,501 examinations were carried out. Non-routine medical examinations These examinations are carried out for various reasons e.g. prior to departure on school journeys; for ascertainment of suitability for ordinary school; at the request of the head-teacher, school nurse, parent, medical officer, etc. Non-routine examinations carried out this year totalled 9,854. 82. MINOR AILMENTS CLINIC Children suffering from minor ailments may be referred to minor ailment clinics where they are seen by a nurse and/or doctor and the appropriate treatment given. There are 8 such clinics situated in school treatment centres in the borough. Use of these clinics is gradually declining. HEALTH EDUCATION IN SCHOOLS During the year a system has been followed in which flexibility of syllabus and adaptation to the needs of each individual school has been the theme. Thus, although in the main the health education officer and the health visitors involved have preferred to work with small groups presenting applied biology by discussion group methods, in actual fact the general picture has been that they have "fitted in" with what was felt to be the need of each individual hegdteacher. In spite of other agencies also working in some schools, invitations to the Health Department to teach have continued to be in excess of the available staff. Assistance was given on request to one school with regard to the preparation of C.S.E. examination syllabuses, to another with a Newsom course and at a third school a course for a Certificate in Maternity and Child Welfare was inaugurated. The following subjects were dealt with at schools during the year:- Subject Occasions No. participating General Health Topics 220 2,802 Mothercraft 22 407 Sex Education and Venereal Disease 40 429 Smoking and Lung Cancer 12 132 INFECTIOUS DISEASE IN SCHOOL Notification is made by head teachers of pupils absent from school on account of infectious and other illnesses. Where the notifications from any particular school warrant further investigation special visits are made and any necessary investigations carried out, including the taking of specimens for bacteriological examination, to ascertain the sources of, and contain, the outbreak. Notifications were received of 2,173 children so absent, mumps being the reason for the largest number viz. 704. 83. DEAF AND PARTIALLY-HEARING CHILDREN Children suspected of hearing loss are tested by health visitors at health centres. Where such loss is confirmed or there is any doubt, the child is referred to an audiology clinic and seen by a specialist and a teacher of the deaf. Action taken includes referral to hospital for treatment or for the issue of a hearing-aid, to school for the deaf and partially-hearing, or to a health centre for further observation where loss is slight. There are no special schools for this defect in the borough, children having to go to school either in Hackney or Islington. 25 new cases were added to the deaf register during the year, the register now totalling 259. EDUCATIONALLY SUBNORMAL CHILDREN The Education Act 1944 makes provision (a) for the statutory examination of children who may require special educational treatment and (b) as amended by the Mental Health Act 1959 for the examination of children who are deemed to be unsuitable for education at school, and for review examinations of such children. Children examined for these purposes during the year by specially qualified medical officers numbered 292. There are three schools in the borough for the education of these children who are medically examined each year. VISION During the year test were carried out on 10,907 schoolchildren. B.C.G. VACCINATION The arrangements continued during the year for vaccinating 13-year old schoolchildren against tuberculosis using B.C.G. This year 38 schools were visited compared with 29 last year, 44 per cent more children being tested than in 1965. PHYSIOTHERAPY A physiotherapy clinic service providing ultra-violet light, remedial exercises, massage and infra-red treatment operates for children who have posture and breathing defects, flat feet, knock-knees, bow legs and valgus ankles, etc. JUVENILE EMPLOYMENT It is a requirement of the Children and Young Persons Act 1933/Education Act 1944 84. where children wish to take up part-time employment such as delivering newspapers, etc. that they be medically examined to ensure they are fit for the proposed employment Children numbering 324 were examined for this purpose during the year. ENVIRONMENTAL HYGIENE IN SCHOOLS Visits were made to schools by public health inspectors in 28 instances in connection with enquiries and investigations concerning infectious diseases, sanitary conveniences,etc. THE SCHOOL DENTAL SERVICE The Principal School Dental Officer, Mr. D.F. Waller, took up his appointment on 1st January, 1966, and his first report is as follows:- The year's work shows the beginning of the controlled evolution of a new high standard of dental service being made available.to all the thirty four thousand school children in the borough. The service stems from the priority services provided by the London County Council prior to 1965. The planning and development of those aspects of the Service which have to be agreed collectively with the Inner London Education Authority and with the other Inner London Boroughs, takes time and it was therefore only towards the end of the year that tangible fruits of the planning could be seen. Following the Inner London Education Authority's review of the School Dental Service dated 29th June, 1966 it is hoped that a much greater improvement will be seen in the Service during 1967, reflecting the planning and financial provisions made during 1966. It is the duty of the borough's School Dental Service to make dental treatment available to all children for whom the Inner London Education Authority is responsible in this borough. It is also obligatory that at least an annual dental inspection shall be provided so that parents and guardians can be made aware of the dental needs of their children. In addition to this, it is the duty of the Principal School Dental Officer and his staff to provide adequate education in dental health so that the children, together with their parents and teachers, may understand the problems involved and may be shown the way to the prevention and control of dental disease. When it is realised that an average of 81.7% of children of all age groups examined in school in 1966 required dental treatment, the magnitude of the problem of dental disease will be understood. Fortunately, the borough has within its boundaries the dental treatment resources provided by the Dental Institute of The London Hospital andalso 51 general dental practitioners working within the National Health Service. Many of our children go to the Hospital for emergency, routine and specialist dental treatment and many more attend their family dentist regularly. All developments within the borough for improving the dental health of its children 85. must be made with the mutual understanding and co-operation of all the dental and medical services in the area. It may well be that the school examinations carried out next year will create a demand for treatment that will outstrip the treatment facilities at our clinics and it is then that even greater demands for treatment may fall on the general dental practitioner. The local development of the School Dental Service must be swift, sure and imaginative but immediate expansion has been restricted by the physical availability of new clinic accommodation. A great improvement in the image of the School Dental Service is required and, when this is achieved, will result in an ever increasing demand for treatment. Staff At December 31st, 1966, the professional staff consisted of the Principal School Dental Officer, two full-time dental officers and 7 part-time dental officers, together providing a whole time equivalent of 6.5, (compared with 4.8 at December, 1965). These dental officers were joined during the latter part of the year by a dental auxiliary. The professional staff were ably assisted by 7 full-time surgery assistants and one full-time clerk. The number of professional officers is inadequate to meet the examination and treatment needs of the Service and recommendation has been made for an initial increase in the establishment as follows: (Figures in brackets denote existing establishment). Chief Dental Officer 1 (1) Dental Officers 9 (6) Orthodontist 1 (0) Dental Auxiliaries 3 (1) Dental Surgery Assistants 13 (8) This revised establishment is related to the anticipated availability of new premises during 1967 and will be further expanded when more premises can be made available. The recruitment of suitable full time paedodontists to the Service is directly related to the image the Service maintains, both locally and nationally. The often unsatisfactory image of the school dental officer and the service within the profession stems from unsatisfactory premises and equipment, unacceptable conditions of service and inadequate remuneration, combined with limited incentives and career structure. There is also a tendency for patients, parents and teachers to look down upon the School Dental Service. The result has been a serious shortage of recruits of the requisite calibre for full-time service and whilst every effort is being made in this borough to improve premises, equipment and local conditions of service, no 86. complete answer can be found until national scales of pay for dental officers compare more favourably with other branches of the dental profession. In a similar way the national scales of pay for dental surgery assistants makes their recruitment by the service very difficult. Inspection The only school dental inspections carried out in the borough prior to the last quarter of 1966 were for children on their initial entry into school. The annual inspection of the rest of the school children was discontinued in 1965 under the London County Council scheme whereby parents were sent a form giving them the opportunity of taking their children to a clinic for regular examination and treatment, if they so desired. Following the Inner London Education Authority's review of the School Dental Service, and after consultation with the Principal School Dental Officers of the other inner London Boroughs, a revised scheme to meet the practical and statutory demands of the service for the reintroduction of full school dental inspections was drawn up and school dental inspections recommenced in October. A substantial number of pupils should receive routine inspections in 1967 with the target of at least an annual inspection for all children be reached eventually. Local modifications to the basic procedure common to all the Inner London Boroughs has allowed for a method of recording to be instituted which gives an assessment of the oral health of each child and brief details of treatment required. This assessment will make it possible when checking the child's dental health at subsequent yearly intervals to determine whether treatment has been sought and whether oral health has improved or deteriorated and appropriate action being taken. In addition to this, the "score" for each child is recorded with his age group in each school, thus making it possible to compare the average state of oral health of one school with another in all age groups. An analysis of the results of this system will be published next year. The treatment provided in the clinics is of an overwhelmingly conservative nature. During 1966, 10,406 fillings were completed, 6,295 in permanent teeth and 4,113 in temporary teeth, whilst extractions were 236 permanent teeth and 922 temporary teeth. The overall ratio of permanent teeth filled to permanent teeth extracted was 26.6: 1 and temporary teeth filled to temporary teeth extracted was 4.4: 1. As figures are not available showing extractions carried out during orthodontic treatment and many of these will have been included in the totals, the ratios may, in fact, be more satisfactory. However, extractions under general anaesthesia referred to The London Hospital Dental Institute are also not recorded and consequently accurate conclusions cannot be made. Compared with the national average for fillings to extractions ratios of 5.3: 1 (permanent) and 0.6: 1 (temporary) the borough's figures prove that the pattern of conservative dentistry for children is firmly established. 87. Concern must be expressed for the frequency of broken appointments atour clinics. Parents and older pupils, who may not realise the frustrating waste of valuable professional time that they cause, will have their attention drawn to the large number of children on our treatment waiting list during 1967. Greater cooperation between our staff and parents and head teachers could do much to meet this problem in the future. For the time being patients requiring extractions under general anaesthesia are referred to The London Hospital Dental Institute. The help and co-operation of the staff of the Dental Institute has been much appreciated. The intended full-time opening of the dental clinic at the Island Treatment Centre on the Isle of Dogs makes it probable that extractions under general anaesthesia will be provided at this Centre. The further development of general anasthetic facilities within the borough will be made where necessary. Special Services At present only two half day sessions per week are devoted to orthodontic treatment. In spite of this restriction, a satisfactory number of treated cases has been completed this year and has been augmented by cases treated by dental officers at their own clinics. School dental inspections show that many children who require orthodontic treatment are not achieving it and it is estimated that as many as 25% of the children require orthodontic treatment of some sort during school life. The orthodontic needs of the borough can only be met by the eventual appointment of an orthodontist who would take patients referred through the School Dental Service and could also take patients referred by local general dental practitioners. Such an appointment might be combined with a post-graduate training appointment. Whilst this is not possible at present, owing to lack of accommodation, provision has been made for an orthodontic clinic at the Ida Samual Clinic, Underwood Road, which it is hoped will be available during 1967. Dental care for that important section of the priority classes which includes pre-school children aged 0-5 years, should be considered the province of the specialist paedodontist and dental auxiliary, and is dealt with elsewhere in this report. 88. Dental treatment of mentally and physically handicapped children who are in special schools and training centres presents a particular challenge to the Dental Service and these children frequently require the services of a skilled paedodontist. Whilst it is hoped that the new two-surgery clinic at Leopold Street will meet the needs of many of these children who can be transported to a clinic, the concept of taking dentistry to these children in school must be considered. A mobile dental caravan, two of which are about to be made available by the Inner London Education Authority to the Inner London Boroughs, will be taken to special schools experimentally during 1967. This borough's children are particularly fortunate in having the orthodontic department and all other specialist dental departments readily available to them at The London Hospital Dental Institute when the need arises. Premises and Equipment It is important that the dental clinics should avoid being institutional in appearance. They require a high standard of equipment and decoration in order that the image of the service may be improved. Of the nine dental surgeries in use at the beginning of the year, all but one needed major re-equipping and redecoration to meet modern requirements. Three of these surgeries cannot be made acceptable without complete rebuilding. During 1966 re-equipment was commenced and some progress achieved with the provision of operating lights in all the surgeries and some high speed drills. It is hoped that 1967 will see the complete modernisation of all our clinics. Provision has been made and detailed planning has taken place for five additional new dental surgeries to be provided during 1967. A two-surgery dental suite is at present under construction at the new school treatment and clinic centre being built at Leopold Street. With the co-operation of the architects, modifications to the original plans for a single surgery clinic were made and this has allowed a special dental clinic for handicapped and "difficult" children to be devised. Three new surgeries have been planned in existing premises which allow for two-surgery clinics at Old Ford Clinic, Ruston Street, and Bethnal Green Clinic, Lyte Street, and the third surgery for orthodontics at Ida Samuel Clinic, Underwood Road. All these surgeries should be functioning by the end of 1967. 89. Dental Health Education and Dental Health Campaign The principle that parents and children can help themselves to control and often eliminate dental disease is well established. They must, however, be constantly taught how this can be achieved. Instruction in the cause and prevention of dental disease should feature in every health education programme and be adapted to the needs and age of the recipient. Such a programme must include mention of dietary control, oral hygiene, the importance of early diagnosis and regular dental examinations, and the measures that the dentist can take to prevent dental caries. Simple but interesting explanation of the methods used by the dentist during treatment may often remove the 'fear of the unknown' and produce a willing and co-operative patient from the fearful dental rebel. At the end of May a Dental Health Campaign was inaugurated among the primary school children in the borough with the slogan - "We give Dental Health Stamps". The objects of the Campaign were: 1. the improvement of the dental health of the children by instruction and propaganda on established lines, combined with the incentive to attend for treatment provided by the reward of dental health stamps for specific items of dental treatment; 2. to provide an exercise in dental health education in which all the dental profession in the area would be involved; i.e. the general dental practitioner, the hospital dental surgeon and the school dental officer; 3. to provide means whereby a simple statistical analysis of where children in the borough go for dental treatment might be obtained. The form of the campaign was as follows:- (a) The campaign commenced during the week May 23 - 27 when every child in each school was given a dental health lecture in which the principles of dental hygiene were outlined and the idea of dental health stamps explained. (b) After these lectures had taken place in each school, teachers were asked to distribute to each child (i) a dental health stamp collecting card (ii) an open letter to the child's parents explaining the scheme and (iii) a copy of the Oral Hygiene Service's small bathroom poster - "4 Rules for Good Teeth". (c) At the same time, there were distributed to schools adequate quantities of dental health education posters, pamphlets and teachers' handbooks on teaching dental health. 90. Dental Health Education Campaign Dental Health Education Campaign - At a school. (d) Dentists in and around Tower Hamlets, where children might be expected to go for treatment, were issued with dental health stamps to give to the children, stamps for the general dental practitioner, the hospital dentist and the school dental officer all being overprinted in such a way as to allow for differentiation. (e) A follow-up campaign was organised to keep the idea of stamp collecting before the children and to maintain enthusiasm. (f) To encourage children to collect stamps, they were offered a "dental health award" badge, to be issued after twelve stamps had been collected. (g) To encourage schools, a prize of a golden toothbrush was promised to the school returning the greatest number of stamps in relation to the number of children involved. (h) The stamps - 250,000 of which were printed - are in four colours, red for an examination, silver for a filling, black for an extraction and a gold stamp, to be given as a bonus to the children who "stay the course" and become dentally fit. (j) Towards the end of the year, after the appointment of our first dental auxiliary, a programme was initiated whereby she will visit every class in each primary school in the borough, giving further instruction and encouragement. Approximately 19,500 children in 86 schools are involved and stamp collecting is very popular. A feature of the campaign has been the enthusiasm with which local dental practitioners have accepted the scheme, not one refusing to take or issue the stamps. It must be emphasised that this has been an experiment; a statistical analysis of the results will be made and may result in modifications in the future. Tribute must be paid to the hundreds of people who have contributed to the success of the campaign. During the opening week, thanks to the Director and staff of the School for Dental Auxiliaries at New Cross, 66 student Dental Auxiliaries gave lectures at 50 schools supported by Miss Doreen Land from the Oral Hygiene Service (six schools) and Mr. P. Picton 'Pierre the Clown', sponsored by the Apple and Pear Publicity Council (30 schools). The Director and staff of the Oral Hygiene Service donated very practical and generous financial help with the provision of publicity material and the printing of cards and stamps. Further dental health education material was given by the General Dental Council and the Ministry of Health. Above all,without the enthusiastic co-operation of headteachers, class teachers, 91. dentists, and their staffs, the whole project would not have been possible. Fluoridation of Water Supplies The Council, on the recommendati6n of the Health Committee, agreed on October 13, 1965,to inform the Metropolitan Water Board that they supported the fluoridation of water supplies in this area. The present position regarding fluoridation in all the London Boroughs and those Home Counties whose water supply comes wholly or in part from the Metropolitan Water Board, is as follows: of twenty-nine boroughs within the area, twenty-two are in favour and seven against; of the four Home Counties within the area, three are in favour and one against. These figures show a three quarters majority in favour of fluoridation. A deputation from the London Boroughs' Association attended on the Minister of Health on August 3, 1966. The Association felt that "The delay in introducing this important preventive health measure was frustrating and pressed for introduction of legislation to enable the fluoridation of water supplies to be directed nationally". The Minister indicated that whilst he recognised the case for legislation, its difficulty should not be underestimated. He felt that further public education in the advantages of fluoridation would be essential to counter the existing opposition to it. In the meantime, the Ministry of Health and the Ministry of Housing and Local Government were working closely with water authorities and legislation was "under consideration". In view of the Council's wish to improve the dental health of our children by the fluoridation of water, it is hoped that strong pressure will be applied in the near future in concert with other London boroughs to reduce the present position of stalemate and achieve the introduction of this simple,safe and effective public health measure. Dental Care in Children's Residential Schools and Houses Dental services are provided for children at the following residential homes within and outside the borough; Langley House, E.14. - regular dental inspections at the Home and treatment at Bethnal Green Clinic. St. Leonards, Hornchurch, Essex. - the 260 children in this Home receive regular inspection and treatment at our own dental surgery in the sick bay. A dental officer attends for one day each week. 92. At all other residential homes outside the borough, arrangements have been made with local general dental practitioners for examination and treatment, as required. Liaison with The London Hospital and local General Dental Practitioners The Chief Dental Officer's appointment as part-time lecturer in the Department of Child Dental Health at The London Hospital Dental Institute and to the Dental Health Study Unit of the Hospital, has facilitated the liaison established between the Health Department and the Dental Institute. The treatment facilities available to children in this borough are provided by dental officers, general dental practitioners and the Dental Institute of The London Hospital. If the profession is to meet its obligations and to function happily and efficiently, some liaison must be maintained by the Chief Dental Officer/Principal School Dental Officer with all concerned. Further developments to strengthen the ties between the borough's dental officers and the local practitioners, which started with the Dental Health Campaign, will, it is hoped, evolve during the coming year. Statistics Statistics relating to the School Health Service will be found on pages 137-141. 93. ********** -94- PART VII APPENDICES OF STATISTICAL TABLES TABLE 1 TOTAL DEATHS BY CAUSE AND AGE OF TOWER HAMLETS RESIDENTS - 1966 (Registrar-General's Return) CAUSE OF DEATH ALL AGES -1 1- 5- AGE GROUP 55- 65- 75- Total M F 15- 25- 35- 45- 1. Tuberculosis - Respiratory 22 21 1 - - - - - 1 2 9 7 3 2. " - Other - - - - - - - - - - - - - 3. Syphilitic Disease 6 5 1 - - - - - - - 3 1 2 4. Dlphtherla - - - - - - - - - - - - - 5. Whooping Cough - - - - - - - - - - - - - 6. Meningococcal Infection - - - - - - - - - - - - - 7. Acute Poliomyelitis - - - - - - - - - - - - - 8. Measles - - - - - - - - - - - - - 9. Other Infective and Parasitic Diseases 6 3 3 1 1 1 - - 1 - - 1 1 10. Malignant Neoplasm - Stomach 63 36 27 - - - - 1 - 1 6 18 20 17 11. " " - Lung, Bronchus 157 132 25 - - - - - 7 20 47 53 30 12. " " - Breast 33 1 32 - - - - - 2 9 5 10 7 13. " " - Uterus 18 - 18 - - - - - 1 7 3 4 3 14. " " - Other 204 105 99 1 1 - 1 1 8 12 37 78 65 15. Leukaemia, Aleukaemla 6 4 2 - - - - - 1 - 2 1 2 16. Diabetes 33 10 23 - - - - - - - 5 13 14 17. Vascular Lesions of Nervous System 207 82 125 - - 1 - - 1 8 25 61 111 18. Coronary Disease, Angina 420 250 170 - - - - 1 11 36 79 144 149 19. Hypertension with Heart Disease 25 13 12 - - - - - 1 - 5 10 9 20. Other Heart Disease 199 82 117 - - - - 2 6 13 16 48 114 21. Other Circulatory Disease 75 36 39 - - - 1 - - 5 11 20 38 22. Influenza 6 4 2 - - - - - - - - 2 4 23. Pneumonia 164 81 83 6 2 - 1 1 - 5 11 31 107 24. Bronchltjs 217 153 64 3 1 - - - 1 11 37 51 113 25. Other Diseases of Respiratory System 10 6 4 - - - - - 1 2 2 3 2 26. Ulcer of Stomach and Duodenum 35 21 14 - - - - - 1 1 8 6 19 27. Gastritis, Enteritis and Diarrhoea 13 2 11 - 3 - - - 2 1 - 4 3 28. Nephritis and Nephrosis 14 8 6 - - - 1 - 2 2 4 1 4 29. Hyperplasia of Prostate 12 12 - - - - - - - - 1 3 8 30. Pregnancy, Childbirth, Abortion - - - - - - - - - - - - - 31. Congenital Malformations 18 12 6 13 1 1 - - 2 1 - - - 32. Other Defined and Ill-defined Diseases 194 91 103 37 3 1 5 6 6 17 31 39 49 33. Motor Vehicle Accidents 24 15 9 - - 3 2 1 2 4 2 7 3 34. All Other Accidents 47 30 17 1 3 3 3 2 6 8 4 4 13 35. Suicide 14 11 3 - - 1 3 - 2 3 3 2 - 36. Homicide and Operations of War 3 2 1 - - - - - 1 2 - - - Males: 1228 40 6 10 12 7 47 112 256 361 377 Females: 1017 22 9 1 5 9 20 63 112 263 513 GRAND TOTAL: 2245 62 15 11 17 16 67 175 368 624 890 TABLE 2 SUMMARY OF ROAD ACCIDENTS OCCURRING IN THE BOROUGH Pedestrians Motor Cyclists Pedal Cyclists Other Road Users TOTAL 1966 Killed 18 2 2 3 25 Injured 738 225 121 939 2,051 1965 Killed 10 3 1 4 18 Injured 560 336 109 710 1,715 TABLE 3 INFANT MORTALITY, 1966 Deaths from stated causes at various ages under 1 year (compiled from local death returns) Under 24 Hours 1-6 Days AGE PERIODS Total* Deaths under 1 Year Per cent of Total Weeks Months 1- 2- 3- 1- 4- 7- 10- Bronchitis - - - - - - 1 2 1 4 (3) 6.8 Pneumonia - - - - - 1 2 - 1 4 (3) 6.8 Salmonella Typhitiurium - - - - - - 1 - - 1 (-) 1.7 Congenital Malformations - 4 2 1 1 - - 1 - 9 (6) 15.2 Premature Birth 13 4 - 1 - - - - - 18 (23) 30.5 Asphyxia, Atelectasis 3 2 - - - 1 - - - 6 (5) 10.2 Meningococcal Infection - - - - - - - - - - (1) - Meningitis - - - - - - - 2 - 2 (4) 3.4 Birth Injuries - - - - - - - - - - (2) - Other Causes - 10 - - 1 1 3 - - 15 (29) 25.4 TOTALS: 16 20 2 2 2 3 7 5 2 59 (76) 100.0 (*) Figures in parenthesis denote corresponding deaths in 1965. TABLE 4 INFANT MORTALITY, 1966 Comparative table showing deaths of infants at various ages under 1 year Year Under 24 Hours 1-6 Days 1-4 weeks Total under 4 Weeks 1-12 Months Total under 1 Year Percentage Deaths under 4 weeks of Total Infant Deaths 1965 20 27 10 57 19 76 75 1966 16 20 6 42 17 59 71 -96- - 97 - COMPARATIVE VITAL STATISTICS Year Population Live Births Deaths Deaths under 1 year Maternal Deaths Cancer Deaths (all forms) Tuberculosis Deaths (all forms) No. Rate* No. Rate* No. Rate** No. Rate** No. Rate* No. Rate* 1901 597,106 21,515 36.0 12,143 20.3 N A. N.A. 420 0.7 1,670 2.8 1911 570,429 17,461 30.6 10.272 18.0 2,664 152.5 51 2.9 506 0.8 1,223 2.1 1921 530,656 13,283 25.0 6,863 12.9 1.219 91.8 29 2.1 571 1.1 751 1.4 1931 491,300 8,585 17.5 6,268 12.7 685 79.8 26 2.9 692 1.4 565 1.1 1941 174,520 2,607 14.9 3,733 21.4 117 44.8 5 1.8 399 2.2 272 1.5 1951 229,118 4,092 17.8 3,083 13.4 101 24.7 5 1.2 531 2.3 90 0.4 1961 204,340 4,037 19.7 2,484 12.1 95 23.5 5 1.2 480 2.3 25 0.1 1962 204,050 4,086 20.0 2,474 12.1 79 19.3 0 0 503 2.5 24 0.1 1963 203,850 3,988 19.6 2,531 12.4 96 24.1 2 0.5 510 2.5 24 0.1 1964 206,080 4,026 19.5 2, 256 10.9 92 22.8 1 0.2 523 2.5 12 0.05 1965 204,560 3,867 18.9 2,280 11.1 76 19.6 0 0 529 2.6 21 0.1 1966 202,560 3,703 18.3 2,245 11.1 62 16.7 0 0 481 2.4 22 0.1 * Per 1,000 population. * Per 1,000 total births. N.A. - Not available. NOTE:- Figures prior to 1965 relate to those of the former metropolitan boroughs of Bethnal Green, Poplar and Stepney. TABLE 5 TABLE 6 DISEASES NOTIFIABLE IN THE BOROUGH Disease Authority for Notification and Regulations. Acute Encephalitis Public Health Act, 1936 (Section 143); S.I. 1949/2259 Acute Poliomyelitis - do - Acute Influenzal Pneumonia Public Health Act, 1936 (Section 143): S.I. 1953/299 Acute Primary Pneumonia - do - Anthrax Public Health Act, 1936 (Section 143); S.I. 1960/1989 Cholera Public Health Act, 1936 (Section 144); Diphtheria - do - Dysentery Riblic Health Act, 1936 (Section 143); S.I. 1953/299 Enteric Fever (including Typhoid and Paratyphoid) Public Health Act, 1936 (Section 144); S.I. 1953/299 Erysi pelas Public Health Act, 1936 (Section 144); Food Poisoning Food and Drugs Act, 1955 (Section 26); Leprosy Public Health Act, 1936 (Section 143); S.I. 1966/12 Malaria Public Health Act, 1936 (Section 143); S.I. 1953/299 Measles Public Health Act, 1936 (Section 143)1 S.R.O. 1940/204 Membranous Croup Public Health Act, 1936 (Section 144); Meningococcal Infection Public Health Act, 1936 (Section 143); S.I. 1949/2259 Ophthalmia Neonatorum Hiblic Health Act, 1936 (Section 143); S.R.O. 1926/971, 1937/35 Plague Public Health Act, 1936 (Section 143); Regulations of Local Government Board, 1900. Puerperal Pyrexia Public Health Act, 1936 (Section 143); S.I. 1951/1081, 1954/1691 Relapsing Fever Public Health Act, 1936 (Section 144); Scarlet Fever - do - Smallpox - do - Tuberculosis Public Health Act, 1936 (Section 143); S.I. 1952/704 Typhus Fever Public Health Act, 1936 (Section 144); Whooping Cough Public Health Act, 1936 (Section 143); S.R.O. 1940/204 - 98 - TABLE 7 INFECTIOUS DISEASE NOTIFICATIONS Total Notifications Corrected Notifications Removed to Hospital Notified in 1965 Acute Encephalitis - Infective - - - 4 Post-infectious 1 1 1 2 Acute Poliomyelitis - Paralytic - - - - Non-paralytic - - - - Diphtheria - - - 8 Dysentery 181 181 13 61 Enteric Fever 1 1 1 3 Erysipelas 15 15 1 10 Food Poisoning 49 48 6 42 Malaria 1 1 1 - Measles 1,469 1,469 32 2,236 Meningococcal Infection 8 8 8 5 Ophthalmia Neonatorum 2 2 - 4 Pneumonia 160 160 6 158 Puerperal Pyrexia 26 26 26 13 Scarlet Fever 95 95 5 171 Tuberculosis- Pulmonary 115 109 146 Non-pulmonary 25 24 17 Whooping Cough 128 127 8 101 TOTALS: 2,276 2,267 108 2,981 TABLE 8 MORBIDITY - First Claims for Sickness Benefit Claims made to local offices of the Ministry of Social Security covering postal districts E.l, E.2, E.3, E.14 during 1966 were as follows:- January 4970 July 2909 February 5648 August 3188 March 4621 September 2908 April 3311 October 4642 May 3618 November 4185 June 2916 December 3712 TOTAL 46,528 Figures available for 1965 covered only the second half of the year for which period the total was 20,993, compared with 21,544 for the same period this year. - 99- TABLE 9 VACCINATION AND IMMUNISATION Others Aged Total Children Vaccinated/Immunised Year of Birth 1966 1965 1964 1963 1959 62 Under 16 Over 16 Diphtheria 1,534 1,278 152 94 431 120 - 3,609 Reinforcing Dose - 1,080 865 213 2, 599 1,266 - 6,023 Tetanus 1,534 1,278 153 94 447 185 195 3,886 Reinforcing Dose - 1,081 865 213 2.537 1,269 - 5,965 Whooping Cough 1,506 1,258 141 73 82 3 - 3,063 Reinforcing Dose - 1,047 785 159 220 22 - 2,233 Poliomyelitis 1,480 1,789 313 172 806 703 145 5,408 Reinforcing Dose 312 182 65 2,320 1,716 - 4, 595 Under 1 1 year 2-4 5-15 16 and over Total Smallpox Vaccination: Primary 37 1,095 600 144 208 2,084 Revaccination - - 23 225 447 695 Diphtheria Immunisation of children under 5 Children under 5 immunised during 1962-66 13,502 Estimated population under 5 as at 30th June, 1966 17,300 Percentage protected 78% Vaccinations / Immunisations carried out at Clinics / General Practitioners' Surgeries At Council Clinics By General Practitioners %Primary by General Primary Reinforcing Primary Reinforcing ioners Diphtheria 3,405 5,702 204 321 5.6 Tetanus 3,565 5,641 321 324 8.2 Whooping Cough 2,869 2,053 194 180 6.3 Poliomyelitis 5,142 4,285 266 310 5.0 Smallpox 1,863 624 221 71 10.6 - 100 - TABLE 10 TUBERCULOSIS NEW CASES AND DEATHS New Cases and Deaths: Primary notifications of 109 Pulmonary and 24 nonpulmonary cases were received. 7 other cases came to light via death returns from Registrars. Pulmonary tuberculosis accounted for 22 deaths, there being no deaths from non-pulmonary tuberculosis. Age distribution of new cases and deaths is as follows:- -1 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total (all ages) (a) New Cases Pulmonary M - - 2 3 4 1 - 11 5 29 10 8 6 79 F - 2 1 3 2 1 5 5 3 4 2 - 2 30 Non-pulmonary M 1 - - - 1 1 4 3 3 - - 2 - 15 F - 1 - - - 1 1 2 3 - 1 - - 9 (b) Deaths Pulmonary M - - - - - - - - 1 2 8 7 3 21 F - - - - - - - - - - 1 - - 1 Non-pulmonary M - - - - - - - - - - - - - - F - - - - - - - - - - - - - - TABLE 11 TUBERCULOSIS - VARIATIONS IN REGISTER Pulmonary Non-pulmonary Total Cases Males Females Males Females No. cases on register at 1/1/66 1,478 803 120 109 2,510 No. cases notified during 1966 79 30 15 9 133 Other cases added to register 75 15 3 - 93 No. cases removed from register 212 74 16 11 313 Remaining on register at 31/12/66 1,420 774 122 107 2,423 - 101 - TABLE 12 TUBERCULOSIS - CARE AND AFTER CARE Home Care and Treatment: Patients awaiting admission to hospital Nil Patients under treatment in their own homes 2 Patients receiving attention by home nurses 6 Total home visits (including contacts) by T.B. Health Visitors 6,221 Work of Chest Clinic Welfare Officers: Patients assisted for the first time with Beds, bedding 4 Clothing, footwear 31 Patients at end of year receiving Extra nourishment 93 Home help 41 Diversional Therapy: Patients receiving instruction in their own homes 9 Rehabilitation Hostels: Patients in residence at end of year 2 Hostels for homeless infective tuberculous men: Patients in residence at end of year 2 Child contacts boarded out during year 4 Child contacts boarded out for segregation during B.C.G. vaccination Nil TUBERCULOSIS VISITORS First visits to tuberculous households 2,151 Total visits - effective 5,462 - unsuccessful 759 - 102 - TABLE 13 MASS RADIOGRAPHY Chest X-ray by mass miniature radiography is carried out in the borough by two mobile units of the North-East Metropolitan Regional Hospital Board. Unit PA, whose headquarters are at the Connaught Hospital, Walthamstow, covers mainly the Stepney area of the borough whilst Unit PB, sited at First Avenue, Plaistow, is responsible for the Bethnal Green and Poplar areas. I am indebted to the medical directors and organising secretaries for the following information on visits to the borough by the units during 1966. (Details of abnormalities ascertained are not yet available in respect of this year's survey and those figures given relate to 1965):- Unit 6A Unit 6B No. of factories, sites, etc. visited 17 21 Persons X-rayed - Males 4,231 6,825 Females 1,617 3,857 Total: 5,848 10,682 Abnormalities discovered in 1965 Survey: Total persons X-rayed 14,691 Tuberculosis requiring immediate treatment 11 " " Clinic supervision 30 Cancer of lung 5 Other 84+ (Unit 6B figure not available) Active tuberculosis cases discovered per 1,000 examined 2.79 TABLE 14 TUBERCULIN TEST AND BC.G. VACCINATION Contacts Schoolchildren and Students Total No. of skin tests 250 2, 060 2,310 No. found positive 81 141 222 No. found negative 169 1,919 2,088 No. vaccinated 186 1,919 2,105 - 103 - TABLE 15 ANTE AND POST NATAL SERVICES No. Ante and Post Natal Sessions held by: Medical officers - Midwives 49 Sessional general practitioners 152 No. women attending for ante natal examination 219 No. women attending for post natal examination 169 Total attendances 1,693 No. general practitioners holding sessions in Council clinics 7 Mothercraft and Relaxation Classes: No. women attending (a) institutionally booked 251 (b) Domiciliary booked - No. attendances 1,656 No. sessions held by health visitors 198 CHILD WELFARE CLINICS No. clinic premises at end of year 14 No. sessions during year held by: Medical officers 216 Health visitors 213 Sessional general practitioners 1,531 Hospital medical staff 52 Total sessions: 2,012 No. children attending - born this year 2,949 - born last year 3,024 - born 1961-4 3,770 No. attendances of children of all ages 56,789 Average attendance per session 28.2 No. children referred elsewhere 668 No. children on observation register at end of year 1,930 - 104 - TABLE 16 DAY NURSERIES AND CHILD-MINDERS DAY NURSERIES Voluntary Nurseries Council Nurseries Capacity 25 210 No. attending at end of year 21 172 Child/day attendances - Under 2 - 9,682 - Over 2 4,514 27,014 TOTAL 4,514 36,696 No. of days open 237 254 Average daily attendance 19.0 144,4 CHILD MINDERS Statutorily Registered No. at 1st January, 1966 7 Additions during the year - Deletions during the year 1 No. at end of year 6 No. children authorised to be minded at end of year 25 No. being minded 22 Under Voluntary scheme No. at 1st January, 1966 63 Additions during the year 37 Deletions during the year 48 No. at end of year 52 No. children authorised to be minded at end of year 88 No. being minded 37 No. Child-minders receiving fees at 31st December, 1966 29 TABLE 17 CERVICAL CYTOLOGY Premises Number Sessions Examinations Council Clinics 2 54 647 General Practitioners Surgeries 1 22 84 Family Planning Clinics 2 - 148 Other Slides read in Hospital Laboratories Thames Group Hospitals Submitted by G.P.s. Hospital St. Andrew's Hospital 159 609 Other Hospitals in Group - 224 East London Group Hospitals Mile End Hospital 356 685 Other Hospitals in Group - 1246 London Hospital - 1037 (Tower Hamlets Residents) TABLE 18 CHIROPODY Treated at Clinics Domiciliary Treatments M F M F New patients during year 30 308 47 252 Total patients at end of year 370 954 177 479 Treatments - children 6 30 - — - aged persons 4015 8022 1823 3646 No. of chiropodists employed ... 10 No. of sessions held ... 1829 No. of patients treated persession ... 6 Percentage of total patients receiving domiciliary treatment 33.1 TABLE 19 DENTAL TREATMENT FOR EXPECTANT AND NURSING MOTHERS Expectant Mothers Children Persons examined 5 129 Visits during the year 16 391 Completed treatment 3 100 No. extractions 4 3 No. fillings 14 204 Emergencies treated - 2 General anaesthetics given - - No. patients X-rayed - - Prophylaxis 4 2 Dentures - full 2 - - partial 1 - No. of sessions 70 No. of treatment centres 4 - 106 - TABLE 20 HEALTH EDUCATION ACTIVITIES Discussion groups or talks on the following subjects were arranged during the year: Subject No. Occasions No. Participating Smoking and Lung Cancer 14 156 Sex Education and Venereal Disease 51 636 Mothercraft 300 3,410 Cervical Cytology 4 51 Needs of the Elderly 5 90 Home Accidents 7 162 General Health Subjects 347 4,380 Psychoprophylaxis 72 394 Health Education Techniques 19 116 Total: 819 9,395 Films or filmstrips were shown on 90 of the above occasions. Posters on health subjects are displayed on poster sites and in clinics and public buildings throughout the borough, the topic being changed in accordance with a monthly programme. The distribution of leaflets is planned to coincide with the poster displays and topical health education activities. During the year 4,100 posters were exhibited and 15,140 leaflets distributed. - 107 - TABLE 21 FAMILY PLANNING CLINICS Patients and attendances at the once-weekly sessions held at clinics in the borough were as follows:- Wapping Underwood Road Wellington Way TOTAL 1966 1966 1965 1966 1965 1966 1965 New cases 25 221 189 208 135 454 324 Transfers 12 5 44 9 27 26 71 Old patients - 261 353 283 313 544 666 Total patients 37 487 586 500 475 1,024 1,061 Total visits - 1,118 1,099 933 705 2,117 1,804 TABLE 22 HEALTH VISITING First visits to children born 1966 3,527 " " " " " 1965 2,555 " " " " " 1961-4 6,720 Persons over 65 85 Mentally disordered persons 20 Persons excluding maternity cases discharged from hospital (other than mental hospitals) 50 Tuberculous households 18 Total unsuccessful visits 9,970 Total effective 43,970 TABLE 23 PREMATURE BIRTHS Born in Hospital Born at Home or in Nursing Home 1966 1965 1966 1965 No. of births 238 253 21 11 Died within 24 hours 11 9 4 - Died within 28 days 18 32 4 - Premature stillbirths 32 34 - 1 - 108 - TABLE 24 HOME BATHING Persons serviced during the year: Male 108 Female 268 Total 376 Persons receiving service at end of year: Male 48 Female 154 Total 202 Total baths given during year: 4,245 TABLE 25 HOME HELP SERVICE Persons for whom service provided during year: No. of Persons Hours of Service as % of total Aged persons 2,974 86.6 Chronic sick and tuberculous persons 482 9.8 Mentally disordered 41 0.7 Maternity cases 44 0.5 Others 159 2.4 Total: 3,700 100.0 No, of persons receiving service at end of year: 2,424 Staff Number Whole-time equivalent Organisers 3 3 Assistant Organisers 6 5.6 Home Helps 302 194.2 - 109- TABLE 26 HOME NURSING Total number nursed during year 2,405 Number aged under 5 at first visit in 1966 105 " " over 65 " " " " " 1,352 Total number of visits during year 90,730 TABLE 27 LAUNDERING FOR AGED AND INCONTINENT No. articles cleansed and laundered during year 32,689 Total collections made during year 2,277 No. of persons who received service during year 101 No. of persons receiving service at end of year 54 TABLE 28 RECUPERATIVE HOLIDAYS Category No. for whom holiday arranged Expectant and nursing mothers 1 Adults - Psychiatric 18 Tuberculous 1 - Other 195 Accompanied children: 1. At school 6 2. Pre-school 10 Unaccompanied children: 1. Placed by I.L.E.A. at school 236 pre-school 6 2. Placed by Tower Hamlets Council at school 9 pre-school — Total: 482 - 110 - TABLE 29 LOAN OF NURSING EQUIPMENT AND FIREGUARDS Nursing equipment loaned, free of charge, by the Council to residents of the borough during the year was as follows:- No. on loan at 1/1/66 No.loaned during 1966 No.returned during 1966 No. on loan at 31/12/66 Chair commodes 151 105 79 177 Stool commodes 7 9 6 10 Wheelchairs 36 47 45 38 Wheelchair headrests - 1 1 - Fracture boards 13 2 3 12 Bed pans 5 2 3 4 Bottles 10 - 5 5 Bed - hospital 9 2 4 7 Dunlopillo mattress 13 5 6 12 Ordinary mattress 2 - - - Penrhyn hoist 5 4 4 5 Levitt bath lift 1 - - 1 Rubber sheet 5 6 1 10 Cot bed and mattress 1 - 1 - Bed cradle 3 5 1 7 Back-rest 2 6 2 6 Air cushion 3 - - 1 Air ring - 2 2 3 Sani-cushion 4 - 3 1 Inflatable toilet seat 1 2 1 2 Quadruped stick 7 2 3 6 Tripod stick 22 8 10 20 Walking frame 4 3 1 7 Zimmer adjustable walking-aid 1 - - 1 Hoist - 2 1 1 OTHER EQUIPMENT LOANED Fireguard 274 88 16 346 - 1ll- TABLE 30 DOMICILIARY MIDWIFERY Attendances by Midwives Doctor present Doctor not present Doctor not booked Midwife - Council - - - Nursing Sisters of St. John the Divine - 4 - The London Hospital - 3 Total - 7 Doctor booked Council 1 13 Nursing Sisters of St. John the Divine 4 149 The London Hospital 12 227 Totals: 17 396 No. of planned early discharges 106 Institutional deliveries attended by midwife on discharge before tenth day 166 Patients receiving - Gas and air 125 - Gas and oxygen 26 - Trilene 81 - Pethidine alone 8 - Pethidine with gas/air 3 - Pethidine with gas/oxygen 1 - Pethidine with trilene 16 - No analgesia 153 Total: 413 - 112 - TABLE 31 MENTAL HEALTH (1) Patients referred to Council during the year Referred by Mentally 111 Psychopathic Subnormal Total Under Over Under Over. Under Over 16 16 16 16 16 16 General practitioners 1 98 - 1 1 1 102 Hospitals, on discharge from in-patient treatment 1 284 - 1 4 5 295 Hospitals, after or during out-patient or day treatment - 47 - _ 5 3 55 Education authorities 4 18 - - 52 37 111 Police and courts - 27 - - - 1 28 Other sources - 80 - - 9 12 101 Totals 6 554 - 2 71 59 692 (ii) Psychogeriatric Unit, St. Clement's Hospital In-Patient Unit - Dundee Ward 1966 1965 Admissions 131 107 Discharges - Home 70 63 - Long Grove Hospital 23 21 - Other 29 31 Total: 122 115 Day Hospital Admissions 61 56 Patient/day attendances 5,382 5,567 Discharges - Home 9 17 - Long Grove Hospital 3 3 - St. Clement's - in-patient 25 8 - General hospitals 22 1 - Other 6 3 Total: 65 32 Out-Patient Attendances New Referrals 48 36 Follow-up patients 195 103 (iii) Admissions to Hospital under Mental Health Act, 1959 Male Female Total Admitted under:Section 25 25 30 55 Section 26 2 2 4 Section 29 16 28 44 Section 60 9 3 12 Section 136 6 6 12 Admitted informally 60 99 159 Total: 118 168 286 - 113 - - 114 - MENTAL HEALTH Patients under Care at 31st December, 1966 Mentally 111 Elderly Psychopathic Subnormal and Severely Sub-normal Total Under 16 Over 16 Mentally Infirm Under 16 Over 16 Under 16 Over 16 1. Total number 1 439 45 - 8 114 395 1.002 2. Attending training centre - 39 9 - - 73 86 207 3. Awaiting entry - - - - - 2 1 3 4. Receiving home training - 11 - - - 1 7 19 5. Awaiting home training - - - - - - - - 6. Resident in L.A. hostel - - - - - - - - 7. Awaiting residence in LA. hostel - - - - - - - - 8. Resident at L.A. expense in other hostels - 26 - - - 2 9 37 9. Boarded out at L-A expense - - - - - - - - 10. Attending day hospital - - 9 - 2 - - 11 11. Receiving home visits and not included in 2-10 above 1 363 27 - 6 36 292 725 12. Admissions to guardianship during year - - - - - - - - 13. Under guardianship at end of year - - - - - - 4 4 14. On waiting list for admission to hospital: (a) in urgent need - - - - - 1 1 2 (b) not in urgent need - - - - - 1 1 2 15. Admission for temporary residential care: (a) To N.H S hospitals 2 - - - - 6 7 15 (b) to L.A. residential accommodation - - - - - - - - (c) elsewhere - - - - - 9 6 15 TABLE 32 - 115 - MENTAL HEALTH Day and Training Centres, 1966 Trainees Adult Girls Underwood Rd. Men's Industrial Junior Cornwall Ave. Special Care Unit Cornwall Ave. Pritchard's Road Day Centre Pritchard's Road Geriatric Unit M F M F M F M F M F M F No. on roll at 1/1/66 - 40 27 - - 39* 6 6 17 13 - - New entrants 1 11 11 - 6 12 3 2 55 31 4 13 Transferred from other centres 14 19 11 - 24 20 - - - - - - Removals Moved out of borough - - 3 - - 3 - - 1 3 - - Excluded 1 - 1 - - - - - 8 - - - Self-discharged - 2 2 - - - - - 22 17 - - Failed to attend - 1 2 - - - - - - 1 1 2 Admitted to hospital - - 1 - 4 2 - - - 1 - 1 Transferred to other centres 1 27 - - - 41 2 4 1 - - 2 Residential placing - - - - - - - - - - 1 - Died - - - - - - - - - - 1 - Left to take up employment - 1 4 - - - - - 12 9 - - No. on roll at 31/12/66 13 39 36 - 26 25 7 4 28 14 1 8 * Elder girls transferred to Underwood Rd. on 5/9/66 TABLE 33 TABLE 34 PARKS AND OPEN SPACES IN THE BOROUGH (a) Administered by Borough Council Location Area in Acres Albert Square Gardens .66 Alfred Street Playground .42 All Saints Gardens (Poplar) 1.06 Arbour Square Gardens .66 Arnold Circus Bandstand .07 Bazeley Street Playground .30 Blair Street Nursery School Site .68 Beaumont Square Gardens 1.00 Bromley Recreation Ground 1.52 Brunswick Road Gardens .45 Cable Street Schoolhouse Lane Playground .18 Christchurch Gardens (Spitalfields) 1.25 Claredale Estate Playground .07 Club Row Gardens .07 Dee Street Playground .45 Ford Square Gardens .40 Ford Street Playground .09 Gale Street Playground .24 Glaucus Street playground .70 Globe Road Memorial Gardens .08 Jodrell Road Gardens .10 Kingward Street Playground .13 Kirkwall Place Playground .12 Kingsley Hall Gardens .13 Mallon Gardens (Commercial Street) .19 Peel Grove Gardens 1.12 Pelter Street Playground .12 Poplar Recreation Ground 4.41 Mile End Gardens .50 Newby Place Playground .49 Rochel1e Street Gardens .07 St. Bartholomew's Gardens (Bethnal Green) .45 St. George's-in-the-East Gardens 2.25 St. James's Gardens, Ratcliffe 2.00 St. John's Parish 2.50 St. Matthew's Gardens (Bethnal Green) 2.06 Sidney Square Gardens .33 Stepney Green Gardens 1.50 Swanfield Street Playground .23 Swedenborg Square Playground .67 Trafalgar Square Gardens .60 Tredegar Square Playground 1.24 The Triangle Gardens .07 Trinity Square Gardens 1.23 Tunnel Gardens, Blackwall .86 Vallance Road Recreation Ground 1.69 Wakefield Gardens, Tower Hill .06 Wyvis Street Playground .26 .20 york Square Gardens 36.43 - 116 - TABLE 34 (continued) PARKS AND OPEN SPACES IN THE BOROUGH (continued) (b) Administered by Greater London Council Location Area in Acres Allen Gardens 1.69 Bartlett Park 7.79 Bethnal Green Gardens 11.97 Brickfield Gardens 5.73 Burdett Gardens 1.49 Carlton Square Gardens 1.95 Diggon Street Playground .13 Gosling Gardens 1.66 Grove Hall Park 4.5 Ion Square 1.75 Island Gardens 3.0 King Edward VII Memorial Park, Shadwell 8.5 King George's Field, Stepney 16.37 Langdon Park 1.15 Limehouse Churchyard 2.0 Meath Gardens 10.54 Millwall Park 13.5 Ropewalk Gardens 1.51 St. George's, Cable Street, Gardens 0.75 St. Mary's Churchyard 1.26 Shandy Park 3.18 Stepney Churchyard 9.75 Stepney Green Open Space 5.29 Trinity Garden 1.03 Vallance Road Open Space .07 Victoria Park (part) 148.5 Wapping Gardens 3.56 Waterside Gardens 1.92 Weavers' Fields 5.18 275.72 Total Acreage 312.15 TABLE 35 BURIALS UNDERTAKEN Under Section 50, National Assistance Act, 1948 Number of Adults ... 30 " " Children ... 6 " " Stillborn ... 2 Total cost ... £555* Burials requested by - Coroner ... 22 - Relatives ... 11 - Others ... 5 *Irrecoverable expenditure ... £170 117 TABLE 36 AGED PERSONS No. of aged persons on register at 1st January 8,368 No. of new cases added during year 1,042 No. of cases removed from register during year 1,022 No. on register at 31st December 8,388 No. of effective visits to aged persons during year by visitors 12,312 No. of persons removed to hospital compulsorily 18 TABLE 37 DISEASES OF ANIMALS ACTS Kosher poulterers and Poultry Slaughterhouses Inspections for cleanliness and fowl pest control 238 Street Markets Inspection re-sale of animals and observations on movements of live poultry 105 Pet Shops Visits 95 Animal Boarding Establishments Visits 1 TABLE 38 VISITS BY PUBLIC HEALTH INSPECTORS (CLEAN AIR) AND TECHNICAL ASSISTANT To premises regarding complaints ... 101 " " " smoke control orders ... 8,974 " " " miscellaneous visits ... 293 " " " for smoke observations ... ... 233 " " " applications under Sec. 3(2) ... 15 " " " routine boiler inspections ... 178 No. of notices served under Sec. 12(2) ... 913 " " " " " Sec. 16 ... 3 118 TABLE 39 SUMMARY OF PUBLIC ANALYST'S QUARTERLY REPORTS The following is a summary of the samples analysed and included in reports submitted each quarter of the year by the Council's Public Analyst in compliance with Section 99 of the Food and Drugs Act, 1955. A copy of each quarterly report is submitted to the Minister of Agriculture, Fisheries and Food in accordance with the Act. During the year, 1,018 samples were submitted for analysis, as follows:- 1 Acetic Acid 10 Dried Vegetables 5 Oils 2 Anadin Tablets 12 Eggs 2 Orange Juice 1 Apricot Brandy 69 Fats 1 Pastry 3 Aspirin 2 Fish 3 Phensic Tablets 2 Aspro (new) 21 Fish, Canned 1 Pholcodeine Tablets 1 Back and Kidney Pills 11 Fish Paste 48 Pickles 3 Balsam 8 Fish Preparations 7 Potatoes 1 Beecham's Pills 5 Flavourings 5 Poultry, Canned 1 Beecham's Powder 1 Formula 21' 11 Preserves 1 Benzol Tablets 41 Fruit, Canned 1 Pro-plus Tablets 6 Biscuits 18 Fruit preparations 5 Puddings 1 Bread 1 Fynnons Salt 1 Pudding, Canned 11 Bread and butter 3 Gelatine 2 Rennies Tablets 1 Bronchial Balsam Tablets 1 Germoloid Suppository 2 Rum 1 Cachous 1 Glycerine and Lemon 2 Saccharin 3 Cake 3 Gin 2 Salad Cream 7 Cake Decorations 8 Gravy 2 Salt 6 Cake Mixes 1 Haliborange Tablets 17 Sauces 25 Cereal 1 Halibut Oil Capsules 18 Sausages 7 Cheese 7 Honey 1 Senna 9 Chocolate preparations 12 Ice Cream 2 Settlers Tablets 1 Cochineal 1 Iron Tonic Tablets 7 Soft Drinks 1 Cochineal Essence 1 Italian Seasoning 17 Soups 1 Cocoa 2 Jelly 24 Soups, Canned 2 Codeine Tablets 1 Lime Cordial and Lager 41 Spices 1 Codeine Phosphate Pastilles 1 Linctus 1 Stomach Powder 14 Coffee and Chicory 2 Liqueur Chocolates 1 Suet 1 Coldrex 27 Meals 11 Sugar 1 Cola and Rum 52 Meat, Canned 19 Sugar Confectionery 3 Colourings 8 Meat Paste 8 Syrups (B.P.) 1 Concentrated Almond 7 Meat Pies 65 Tea Flavouring Essence 21 Meat Preparations 8 Throat Pstilles 8 Condensed Milk 6 Medicated Shampoos 1 Tonic 1 Cornflour 35 Milk 7 Vegetables 1 Cough Mixture 11 Milk Powder 18 Vegetables 4 Cream 1 Moorlands Tablets 1 Vingegar 5 Custard Powder 1 Nasal Spray 7 Whisky 1 Disprin 1 Nipits 1 Yeast 54 Dried Fruit 3 Non-brewed Condiment 1 Yeastvite Tablets 11 Dried Herbs 17 Nuts 4 Yoghourt 119 TABLE 40 FOOD HYGIENE (GENERAL) REGULATIONS. 1960 Type of Premises (excluding stalls) Regulation 16 Regulation 19 Total No. of premises No. of Premises fitted to comply with Regulatlon Notices served 1966 Notices complied with No. of Premises to which Regulations applies No.of Premises fitted to comply with Regulation Notices served 1966 Notices complied with Bakehouses 56 51 3 2 56 54 1 - Baker Shops 77 68 1 1 77 70 - - Butchers 187 168 4 3 187 169 - - Catering 1,457 1,391 21 11 1,457 1,457 3 3 Fish 48 46 2 1 48 48 - - Greengrocers/ Fruiterers 416 372 3 2 416 416 - - Grocers 860 696 11 5 860 704 2 1 Public Houses 499 497 5 4 499 499 1 1 Poultry Dealers 39 37 4 1 39 36 - - Confectioners 85 72 5 4 62 59 2 1 Totals: 3,724 3,398 59 34 3,701 3,512 9 6 120 TABLE 41 VISITS MADE BY HOUSING INSPECTORS AND TECHNICAL ASSISTANTS Underground rooms ... 308 Section 16. Housing Act, 1957) " 17. do ) ... 56 Slum clearance ... 2,797 Overcrowding ... 85 Standard and improvement grants ... 36 Betting offices (Betting and Gaming Act, 1960) ... 8 Town planning applications ... 31 Houses in multiple occupation ... 340 Preferential re-housing ... 420 Miscellaneous ... 517 Re-inspections ... 2, 253 Notices served ... 153 TABLE 42 DWELLINGS ERECTED DURING 1966 (a) By Borough Council No. of Dwellings Argyle House, Manchester Road. 20 Bacton Tower, Roman Road. 52 Broadhurst House, Bede Road. 30 Cadell House, Shipton Street. 18 Cephas House extension, Cephas Street. 6 Clayhall Court, St. Stephen's Road. 1 Keats House, Sceptre Road. 12 Lewey House, Bede Road. 92 Lingard House, Manchester Road. 36 Mary James House, St. Peter's Avenue. 16 McEwen House, Roman Road. 4 Montfort House, St, Johns Parish Estate. 18 Sabella Court, Tredegar Road. 39 Sheppard House, St. Peters Avenue. 46 Sivill House, Columbia Square. 76 466 (b) By Greater London Council Allenby House, Ocean Estate. 40 Channel House, Ocean Estate. 40 Corringham House, Pltsea Estate. 28 Doughty Court, Wapping Estate. 34 Dunmore Point, Virginia Estate. 51 Hobson's Place, Chicksand Estate. 66 Inglefi eld Square, Wapping Estate. 24 Linton House, Burdett Estate. 24 Oswell House, Wapping Estate. 58 Pennyfields, Birchfield Estate. 14 St. Leonard's Road, Brownfield Estate. 12 St. Paul's Way, Burdett Estate. 14 Sovereign House, Collingwood Estate. 12 Studland House, Ocean Estate. 40 Swedenborg Gardens, St. George's Estate. 8 Wingfield House, Virginia Estate. Total: 20 485 951 121 TABLE 43 PRESCRIBED PARTICULARS ON THE ADMINISTRATION OF THE FACTORIES ACT, 1961 1. Inspections fbr purposes of provisions as to health Type of Factory No. on Register Inspections Written Notices Factories without mechanical power 605 109 9 Factories with mechanical power 3,593 732 83 Other premises under the Act (Electrical stations, institutions, and sites of building operations and works of engineering and construction) 112 28 1 Total : 4,310 869 93 2. Cases in which defects were found Particulars Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 10 6 4 - Overcrowding - - - - Unreasonable temperature - - - - Inadequate ventilation 2 1 1 - Ineffective drainage of floors 1 1 - m Sanitary conveniences: (a) insufficient 4 4 - 2 (b) unsuitable or defective 91 91 - 18 (c) not separate for sexes 2 2 "" 2 Other offences against the Act (not including those relating to outwork) 10 - 10 - Total : 120 105 15 22 122 TABLE 43 (continued) PART VIII OF THE ACT - OUTWORK Section 133 Nature of Work No. of outwo rkers in August list No. Cases of default in sending lists to the Council No. of prosecutions for failure to supply lists to the Council Wearing apparel: Making, etc. 1, 463 - - cleaning and washing - - - Household linen - - - Lace, lace curtains and nets - - - Curtains and furniture hangings - - - Furniture and upholstery - - - Electro-plate - - - File making - - - Brass and brass articles - - - Fur pulling - - - Iron and steel cables and chains - - - Iron and steel anchors and grapnels - - - Cart gear - - - Locks, latches and keys - - - Umbrellas, etc. 3 - - Artificial flowers 3 - - Nets (other than wire nets) - - - Tents - - - Sacks - - - Racquet and tennis balls - - - Paper bags - - - Making of boxes and other receptacles or parts thereof made wholly or partially of paper 98 Brush making 5 - - Pea picking - - - Feather sorting - - - Carding, etc. of buttons, etc. - - - Stuffed toys 3 - - Basket making - - - Chocolates and sweetmeats 5 - - Cosaques, Christmas stockings 6 - - Textile weaving - - - Lampshades Total : 1, 586 - - Section 13"1. There were no instances of work found in unwholesome premises. 123 TABLE 44 LEGAL PROCEEDINGS INSTITUTED DURING THE YEAR No.of Summonses Pines Costs £. s. d. £ s. d. Housing Act, 1961: Houses in Multiple Occupation Contravention of Directions 3 32. 0. 0. 12. 12. 0. Contravention of Regulations 62 405. 0. 0. 64. 1. 0. Housing Act, 1957: Overcrowding in Houses in Multiple Occupation 17 252. 0. 0. 42. 0. 0. Public Health Act, 1936: Nuisance Orders 116 8. 0. 0. 463. 10. 0. Non-compliance with Nuisance Orders 14 121. 0. 0. 42. 0. 0. Prevention of Damage by Pests Act, 1949: 1 10. 0. 0. 4. 4. 0. Pood and Drugs Act, 1955: 12 235. 0. 0. 50. 8. 0. Pood Hygiene (General) Regulations, 1960: 216 2056. 15. 0. 249. 13. 0. Merchandise Marks Act, 1887: 2 50. 0. 0. 15. 0. 0. Total : 443 3169. 15. 0. 943. 8. 0. TABLE 45 MORTUARY SERVICE Tower Hamlets Mortuary Hackney Mortuary Total Bodies received 600 89 689 Post-mortems 533 73 606 Inquests 66 16 82 124 TABLE 46 CLEANSING STATIONS Persons treated for scabies: Men 98 Women 79 School children 103 Children under 5 23 Total: 303 No. treatments given 448 Persons treated for verminous conditions: Men 547 Women 76 School children 352 Total: 975 TABLE 47 DISINFECTING STATION Disinfection: No. of rooms disinfected after infectious disease 20 No. of articles disinfected by steam 21, 068 " " " " " " for export 96 " " " " by formaldehyde 2, 648 " " " " " " for export 2,140 Disinfestation: No. of rooms disinfested for bed bugs 1,888 No. of rooms disinfested for other infestations 1,398 Other sites, premises disinfested 1,645 Drains: No. of premises tested 237 No. found defective 52 125 TABLE 48 OFFICES. SHOPS AND RAILWAY PREMISES ACT, 1963 Type of Premises Registered during year Total Registrations Registered premises inspected during year Persons Employed Offices 86 1,018 107 14,683 Retail Shops 118 1,253 217 4,543 Wholesale Shops 61 616 52 5,994 Catering Establishments 41 305 34 1,878 Fuel Storage Depots - 5 - 46 Total : 306 3,197 410* 27,144 (Males: 17,148 (Females: 9,996 (*) Other visits to registered premises 1,367 Visits to non-registered premises 1,762 Informal Notices served under: Offices, Shops and Railway Premises Act, 1963 268 Notification of Employment of Persons Order, 1964 272 Accidents Notified - Causes Falls of persons - on or from fixed stairs 5 Transport - stationary vehicle 2 Struck by falling object 3 Other falls from one level to another 2 Stepping on or striking against object or person 5 Handling goods 5 Falls on the same level 7 Hand tools 1 Fall on person - on or from ladder 2 Fire or explosion 1 Machinery - Power driven or part in motion 1 " - Non-power driven or part in motion 1 Total: 35 126 TABLE 49 OUTWORKERS Firms in the borough employing outworkers 126 Outworkers residing in, and employed by firms in the borough 523 Outworkers residing outside the borough employed by firms in the borough 908 Outworkers residing in the borough employed by firms outside the borough 155 Total outworkers in borough: 678 TABLE 50 REFUSE DISPOSAL Home and trade refuse ... • • • 75,812 Tons Street and market collections ... • • • 15,978 Tons Waste paper salvage • • • • • • 514 Tons No. of bulk containers in use ... ... 2,527 Tons No. of street gulleys cleansed ... ... 26,905 Tons 127 TABLE 51 RODENT CONTROL Type of property Total Local Authority Dwelling Houses (including Council Houses) All Other (including Business Premises) No. of properties in area 146 61,496 15,302 76,944 No. of properties inspected as result of notification 26 1,524 1,937 3,487 No. of such popoerties found to be infested by: Common rat Major - 1 10 11 Minor 18 812 523 1,353 Ship rat Major - - - - Minor - - - - House mouse Major 3 120 242 365 Minor 1 548 496 1,045 No. of properties inspected in course of survey under the Act 1 124 98 223 No. of such properties found to be infested by: Common rat Major - - - - Minor - 38 22 60 Ship rat Major - - - - Minor - - - - House mouse Major - - 10 10 Minor - 46 19 65 No. of properties otherwise inspected - 47 20 67 No. of such properties found to be infested by: Common rat Major - - - - Minor - 14 7 21 Ship rat Major - - - - Minor - - - - House mouse Major - 3 1 4 Minor - 25 5 30 128 TABLE 51 (continued) RODENT CONTROL (continued) Type of Property Total Local Authority Dwelling Houses (including Council Houses) All Other (including Business Premises) Total Inspections carried out including re-inspections 67 2, 988 7.091 10,956 No. of infested properties treated by Council 22 1, 601 1,225 2,848 Total treatments carried out including re-treatments 24 1,614 1, 237 2,875 No. of notices served under Section 4 of the Act: (a) Treatment (b) Structural work (i.e. proofing) - 30 26 56 No. of cases in which default action taken following Section 4 notice Legal proceedings - - 1 1 No. of 'Block' control schemes carried out 10 Sewer Treatments Manholes Complete Takes Partial Takes Pre-baited 7,386 735 754 Poison Baited 3,830 122 2,424 Business Premises' Servicing Contracts No. under contract at 1st January, 1966 242 No. of new contracts during year 25 No. contracts terminated during year 21 No. remaining under contract at 31st December, 1966 246 129 TABLE 52 VISITS BY DISTRICT PUBLIC HEALTH INSPECTORS Type of Premises Number Visits or Inspections Notices Legal Proceedings Registered and Licensed Premises Milk Distributors 345 - - - Licensed premises under the Milk (Special Designation) Regulations 1963 315 170 _ _ Ice Cream Premises - Sale 371 201 10 _ - Manufacture 35 - Storage only 4 Prepared Food Premises - Meat 107 61 2 - - Fish 58 40 5 - Rag Flock Premises 49 62 - - Pet Shops 78 81 - - Offensive Businesses 20 44 3 - Pharmacy and Poisons Premises 126 102 - - Common Lodging Houses 4 21 - - Seamen's Lodging Houses 3 15 1 - Massage Premises 6 6 - - Dwellings No. first visited during year (3,558) 2,817 157 No. Visits 28,856 No. revisits 14,677 Other premises Mechanical Factories 3,593 732 83 - Non-Mechanical Factories 605 109 9 - Other Factories 112 28 1 — Outworkers 678 - - - Bakehouses 56 22 12 Baker Shops 77 162 8 10 Butcher Shops and Stalls 194 124 27 27 Catering Establishments 1,477 530 179 8 Fish Shops 110 63 12 1 Greengrocers and Fruiterers 416 101 46 2 Grocers (Wholesale and Retail) 860 377 60 10 Public Houses and Off-Licences 499 256 91 1 Poultry Dealers (excluding butchers) 50 46 14 2 Wharves 70 1,271 - " Miscellaneous Food Premises 634 586 41 1 Meat Vehicles - 38 1 " Revisits - 673 - " Totals: 49,454 3,422 219 There are 4,024 food premises including stalls in the borough. Some of the premises listed above are included under more than one trade category. 130 TABLE 53 NOTICES SERVED BY DISTRICT PUBLIC HEALTH INSPECTORS Pood Hygiene (General) Regulations 1960 ... 399 Public Health Act, 1936, Section 39 ... 36 " " 44 ... 4 " " 45 ... 34 " " 75 ... 126 " " 89 ... 18 " " 93 ... 2,432 Public Health Act 1961, Section 17 ... 140 Factories Act 1961 ... 88 Prevention of Damage by Pests Act, 1949 ... 56 Stepney Borough Council (Staircase Lighting) Byelaws ... 15 Tower Hamlets Council (Hairdressers) Byelaws ... 6 Total: 3,354 TABLE 54 DEFECTS IN DWELLINGS REMEDIED FOLLOWING SERVICE OF NOTICES Dirty and dilapidated rooms ... 450 Defective and/or choked drains and water-closets ... 606 Defective and/or dirty water-closets ... 1,051 Defective water supply ... 129 Defective paving ... 88 Defective gutters and rainwater pipes ... 401 Defective roofs ... 878 Dampness ... 2,210 Dustbins supplied ... 126 Accumulations of refuse removed ... 427 Smoke nuisances abated ... 21 Miscellaneous defects remedied ... 2,661 131 TABLE 55 MISCELLANEOUS WORK OF PUBLIC HEALTH INSPECTORS Rent Act 1957 - Certificates of Disrepair 1. Applications for disrepair certificates • • • 6 Notice of proposal to issue certificates • • • 5 Undertaking accepted • • • 1 Undertaking refused • • • - Certificates issued • • • 4 2. Applications for cancellation of disrepair certificates • • • 1 Cancellations issued • • • - Cancellations refused • • • 1 Tenant Landlord 3. Applications for certificates as to remedying of defects - 4 Certificates issued - All defects remedied - 2 - Some defects remedied - 2 Complaints Number received at Office • • • 6,155 Dangerous Structures Number of premises notified to District Surveyor • • • 94 Drainage Plans Number of plans on which observations submitted to Borough Engineer and Surveyor • • • 243 Land Charges Number of premises reported upon to Town Clerk • • • 1,680 Public Houses Number of premises reported upon to Licensing justices 109 132 TABLE 56 CONFERENCES The Council was represented at the following Conferences during the year: Conference Venue Dates Representatives Royal Society of Health Annual Congress Blackpool 25th-29th April Cr. B. A. McCarthy Dr. S. Boyd (Deputy Medical Officer of Health) Royal Society of Health International Conference The Hague 5th-9th September A1 d. J.J. Long Mr. E.P. Webber (Chief Admininstrative Officer) National Association for Maternity and Child Welfare London 29th June 1st July Cr. G. E. Walker Miss P.G. Hodges (Health Education Officer ) Association of Mental Health Workers Scarborough 15th - 18th April Mr. P. Sullivan (Deputy Principal Social Worker Mental Health) Association of Public Health Inspectors Scarborough 19th - 23rd September Cr. (Mrs.) K. O'Connor Mr. H. W. Luke, (Chief Public Health Inspector) Mr. S. F. Everitt (Public Health Inspector) Institute of Shops Act Administration Llandudno 4th - 6th October Cr. (Miss) H. Mo rsman (Chairman) Mr. W. Hart (Public Health Inspector) Royal Institute of Public Health and Hygiene Scarborough 28th - 30th September Cr. G. M. Browne Dr. R. W. Watton (Medical Officer of Health) National Society for Mentally Handicapped Children Paris 21st - 26th March Cr. (Mrs.) D.M. Couling Miss A.M. Joseph (principal Social Worker, Mental Health) Mr. J. Strain (Social Worker, Mental Health) Association of Sea and Airport Health Authorities Newport (Mon) 24th June 1st July Cr. (Mrs.) L.D. Crook Dr. W. Turner (Associate Medical Officer of Health) British Dental Association Scarborough 13th - 17th June Mr. D. Waller (Chief Dental Officer) National Society for Clean Air London 3rd - 7th October Cr. E.W. Hill Cr. C. Dimes (Vice Chairman) Mr. L. Windsor (Public Health Inspector) (continued over) 133 TABLE 56 (continued) CONFERENCES (continued) Conference Venue Dates Representatives Health Visitors Association Folkestone 13th - 15th October Cr. A.C. Jacob Mrs. E. Evans (Centre Superintendent) National Council for Home Help Services London 11th November Cr. (Miss) H. Morsman (Chairman) Mrs. B. Kenworthy (Home Help Organiser) National Association for Mental Health London 5th November Aid. C. Blaber Miss A.M. Joseph (Principal Social Worker, Mental Health) Queen's Institute of District Nursing London 20th October Cr. (Miss) H. Morsman (Chairman) Miss I.M. Clarke, (Non-Medical Supervisor of Midwives) Royal Society for the Prevention of Accidents London 19th - 20th October Cr. C. Dimes Miss 0. R. Parsons (Old People's Visitor) Area Home Safety Council Conference London 26th November Cr. C. Dimes Miss P. G. Hodges (Health Education Officer) Chartered Society of Physiotherapy. Annual Congress London 6th - 8th October Miss J. Conroy (physiotherapist) London Boroughs Training Committee London 11th - 12th February Cr. A. W. Downes (Vice Chairman) Dr. R. W. Watton (Medical Officer of Health) - do - London 10th October Mr. J. E. Steeden (Public Health Inspector) British Association for Social Psychiatry London 1st - 2nd April Mr. H. Mayer (Social Worker, Mental Health) Mrs. R.M. Geoghegan (Social Worker, Mental Health) Standing Conference of Co-operating Bodies Investigation of Atmospheric Pollution London 7th November Cr. (Miss) H. Morsman (Chairman) Mr. L. Windsor (Public Health Inspector) Association of Public Health Inspectors - Pood Hygiene London 23rd November Cr. (Miss) H. Morsman (Chairman) Mr. H. W. Luke (Chief Public Health Inspector) 134 TABLE 57 REFRESHER COURSES. ETC. Courses attended by staff during the year were as follows:- Course Venue Dates Attended by London Boroughs Training Committee: Seminars: "Principal and Practice in Social Work" London 12 weekly sessions commencing 6th Jan. Mrs. G. Karton (Family Case Worker) Seminars: "principals and Practice in Social Work" London 17 sessions from 25th Oct.-7th Mar. Mr. J. A. McCrory (Social Worker - Mental Health) Introductory Course for School Nurses London 17th, 18th, 24th and 25th May. Miss C. A. McKenna Mrs. R. E. Dunn (Clinic Nurses) Refresher Course for Matrons and Deputy Matrons Day Nurseries Sunningdale 5th-9th September Miss L. Hayes Miss M. olive (Nursery Matrons) Study Days for Nursing Staff London 3rd. and 15th November Miss I.M. Clarke (Supervisor of Midwives) Fieldwork Instructors Course London Wednesdays (10) commencing 12th October. Miss B. McGarry (Health Visitor) National Childbirth Trust: Seminar: "Preparation for Childbirth" London 21st-23rd January 11th- 13th February Miss P. A. Langston Miss C. Taylor (Health Visitors) "The Relief of Menstrual Pain" London 19th November Miss B.M. Cryer Miss B. McGarry (Health Visitors) North-Western Polytechnic: "Retarded Child in the Nursery" London 14th- 18th February Miss G. Leach (Nursery Assistant) Nursery Staff concerned with 3-5 years age group London 6th-l0th June Miss P. M. 0' Hara (Nursery Assistant) Supplementary Child Care Reserve Course London 26th September 21st October Miss C. Emmerson (Nursery Staff Nurse) Course on the Retarded Child in the Nursery London 31st October 4th November Mrs. M. McNerney (Nursery Assistant) Supplementary Child Care London 25th April - Mrs. I. Manwaring Reserve Course 20th May (Day Nursery Warden) (continued over) 135 TABLE 57 (continued) REFRESHER COURSES, ETC. (continued) Course Venue Dates Attended by Inner London Education Authority Remedial Foot Classes for Teachers and Others London 14th, 16th and 18th November Dr. J. Wilson (Medical Officer) Training in Teaching Techniques London December Miss S.M. Mowat Miss J. E. Dennett (Health Visitors) Association of Public Health Inspectors: Week-end School Clacton 18th-20th March Mr. G. Wimborne (Public Health Inspector) Society of Medical Officers of Health: Refresher Course for Medical Officers "Development of Children etc" London 28th March 1st April Dr. J. Freeman (Medical Officer) Association of Public Health Lay Administrators week-end School Oxford 14th - 17th September Mr. G.R. Williamson (Senior Administrative Officer) British Dental Association "Dental Treatment for the Handicapped Child" Bristol 28th - 30th September Mr. D. Waller (Chief Dental Officer) Institute of Home Help Organisers Week-end School Brighton 29th and 30th September and 1st October. Mrs. D. Ward (Home Help Organiser) College for the Distributive Trades Advanced Supplementary Course for Inspectors of Meat and other Foods London 7th November Mr. S. Vogler (Public Health Inspector) Central Council for Health Education Health Education Officers Study Course London 25th November Miss P. G. Hodges (Centre Superintendent) Royal College of Nursing Fieldwork Instructors Course London 28th November 9th December Mrs. E. Evans (Centre Superintendent) 136 TABLE 98 SCHOOL HEALTH STATISTICS Pupils on School Rolls at December, 1966 Under 5 years - full-time 1,832 — part — time 1,142 Infants 6, 341 Juniors 10,995 Seniors 12,576 Special 89 2 Total: 33,778 Routine Medical Inspections Number of children inspected 13,501 Percentage of total inspected 39.9 Percentage referred for treatment of defects 16.0 Percentage referred for treatment of defects other than vision 9.0 Percentage whose physical condition not satisfactory 0.4 Non-routine Medical Inspections Re-inspections 5,67 6 5, 676 Secondary School reviews 104 Theatrical children 23 Employment Certificates 324 School journeys 1,031 Recuperative holidays - before holiday 308 Outward Bound courses 9 Infectious disease investigations 2 Tuberculosis contacts 1 Boarding Schools for the Delicate - before departure 27 - on return 2 Handicapped pupils - statutory examinations 29 2 - periodic special defect examinations 493 Research investigations and enquiries 36 2, 652 Specials: at request of - Head Teacher - special book 17 1 others 518 - School Nurse - after health survey 76 - others 227 Divisional Officer (Education) 92 District Care Organiser/Care Committee 99 - Parent 141 School Medical Officer 175 1, 499 All other non-routine inspections 27 27 Total non-routine medical inspections 9,854 (continued over) - 137 - TABLE 58 (continued) Defects ascertained at Routine Medical Inspections Number of children noted for treatment or observation expressed as a rate per 1,000 inspected: Defects Treatment Observation Skin 11 .55 10.74 Eyes - Vision 79. 25 85.85 - Squint 12.74 5.63 - Other 2. 89 2.67 Ears - Hearing 5. 41 5.63 - Otitis Media 2.30 3.18 - Other 3. 33 1.70 Nose and Throat 11.70 34.37 Speech 3. 33 6. 89 Lymphatic Glands 0.81 5.33 Heart 2.15 7.70 Lungs 4. 44 9.48 Development - Hernia 0. 59 1.93 - Other 0.96 9.33 Orthopaedic - Posture 1. 04 2. 22 - Peet 7.33 14.15 - Other 3.70 6.74 Nervous System - Epilepsy 0. 59 0.89 - Other 1.19 2.34 Psychological - Development 1.41 4.52 - Stability 1. 26 4.89 Abdomen 0.07 0.52 Other 18.15 30.22 - 138 - TABLE 58 (continued) Recuperative Holiday Homes Number of Schoolchildren (including Nursery schoolchildren) admitted during the year 240 School Dental Service Number of half day sessions devoted to: Treatment 2, 081.5 Inspections in schools 32.0 Dental Health Education 39.0 Total sessions 2,152. 5 Inspections Pupils first inspected at school 1,466 Pupils first inspected at clinic . . 3,29 2 Percentage requiring treatment 81.7% Pupils reinspected 1,912 Percentage requiring treatment 62. 2% Treatment sessions (average per session in brackets) New cases appointed 12,476 (6.0) New cases attended 5,282 (2 .5) On-treatment cases appointed 14,553 (7.0) On- treatment cases attended . . 10,660 (5.1) Emergencies 255 (0. 1) Total attendances 16,197 Treatment given (average per session in brackets) Fillings in permanent teeth 6 29 3 (3.0) Fillings in temporary teeth 4,113 (2.0) Extraction of permanent teeth 236 (0.1) Extraction of temporary teeth 922 (0.4) Other operations 3,1ll (1.5) Number of dentures supplied • * • Orthodontic treatment Cases remaining from 1965 142 New cases commenced in year 168 Cases completed in year 50 Number of removeable appliances fitted 173 Number of fixed appliances fitted 6 Staff (full time equivalent) Medical 5.35 Nursing ••• 19.00 Social Workers ••• 3.00 Physiotherapists 1. 40 Dental Officers 6.18 Dental Auxiliaries 1.00 Dental Surgery Assistants 6.68 (continued over) - 139- TABLE 98 (continued) Routine Vision Tests - Visual acuity standards expressed as percentage of children tested Not wearing spectacles Wearing spectacles 6/6 6/9 6/12 or worse Referred for treatment 6/6 6/9 6/ 12 or worse Referred for treatment Boys 77.9 8. 6 6. 5 6. 2 3.0 1.9 2. 1 4. 5 Girls 77. 1 8.4 6. 0 5. 7 4. 3 2. 3 1.8 3. 2 No. of boys tested - 5,583; No. of girls tested - 5,324. Health Surveys No. examined Occasions vermin found Percentage (a) Comprehensive 20,400 554 2.72 (b) Selective 6,99 3 479 6.85 No. of individual pupils found verminous 822 Percentage of school roll 2.43 Vermin - occasions advice and/or Lorexane given 872 occasions attendance at bathing centre 161 (c) Communicable disease - No. examined for: Athlete's foot 1,464 Plantar warts 2,244 Other communicable diseases 36 Routine Audiometer Testing No. of children given screening test 4,472 No. failing screening test and given pure tone test 545 No. falling pure tone test and referred to Otologist 222 School Medical Treatment Sessions Clinic No. of premises Sessions in year New cases Attendances. Audiology 1 84 180 608 Bathing 3 262 438 705 Ear, Nose and Throat 9 9 27 8 619 Minor ailments - Medical Officer 109 989 25,227 - Nurse 8 882 1.710 Ophthalmic 4 38 2 1,495 3,811 Orthoptic 1 89 92 364 physiotherapy 2 454 65 3,188 Special Investigation 3 168 186 1,304 Physiotherapy No. of sessions 454 No. of new cases 65 Total attendances 3,188 Treatments - Remedial exercises 2,882 - Massage 2,761 - Ultra-violet light 424 - Infra-red 118 - Other 18 - 140 - - 141- TABLE 58 (continued) DEFECTS TREATED AT SCHOOL TREATMENT CENTRES AND HOSPITAL CLINICS Errors of refraction and squint 2, 059 Other eye defects 51 Spectacles ordered 1,005 Athlete's foot 32 Verruca 435 Ringworm - body 3 Impetigo 25 Other skin diseases 340 Eye diseases 244 Ear diseases 100 Miscellaneous lacerations, etc. 1,429 Orthopaedic and postural defects 59 Orthopaedic and postural defects (treated at schools) 136 Pupils provided with hearing-aids 21 B.C.6. Vaccination - Schoolchildren Number of Schools visited 38 Number of 13-year old children offered test 3, 251 Number of consents received 2, 266 Number of children tested 2, 060 Number of positive reactors 141 Number of children vaccinated 1, 919 Other Treatment Number of children - Ear, nose and throat 158 treated - Audiology 29 4 Special Investigation 190 Infectious and other Diseases notified by Schools Disease No. of Notifications Chickenpox 477 Dysentery, Diarrhoea 53 Pood Poisoning 1 Gastric Flu 3 German Measles 142 Glandular Fever 3 Impetigo 12 Infective hepatitis 1 Influenza 69 Jaundice 42 Measles 467 Meningitis 1 Mumps 704 Ophthalmic conjunctivitis 11 Pulmonary Tuberculosis 1 Ringworm (scalp) 6 (body) 1 Scabies 1 Scarlet Fever 44 Sore Throat 16 Tonsilitis 81 Whooping Cough 47 Total: 2,17 3 HEALTH DEPARTMENT PARTICULARS OF CLINICS HELD AND ABBREVIATIONS M.O. = MEDICAL OFFICER H.V. = HEALTH VISITOR. SCHOOL OR CLINIC NURSE MID. = MIDWIFE S.W. = SOCIAL WORKER PREMISES (a) CLINICS AND SCHOOL TREATMENT CENTRES ANTE-NATAL AUDIOLOGY CHIROPODY DENTAL INFANT WELFARE MINOR AILMENTS Bethnal Green Centre, Lyte Street, E. 2. Mon. P.M. Tues. A. M. (M.O. &H. V.) Mon. P.M. and evening Tues. and Weds. A.M. and P.M. Thurs. P.M. Pri. A.M. Mon., Tues., Weds, and Fri. A. M. and P.H. Thurs. A. H. Mon., Weds., Thurs. and Fri. A.M. (H.V.) Tues. A.M. (M.O. & H.V.) Bromley Clinic Centre, 1-2, Newmlll House, Empson Street, E. 3. Mon. and Tues. P.M. Pri. A.M. (M.O. &H.V. Bromley Centre, 3-4, Phillips House, Coventry Cross, E. 3. • Hon. A. H. P.H. and evening Tues., Wed., and Pri. A.M. & P.M. Mon. - Fri. A. H. (H. V.) Greenwood Centre, Peel Grove. E. 2. Hon. P.M. Thurs. A.M. (M.O. &H. V.) Tues. P.M. (H.V.) Weds, and Pri. P.M. (M.O.& H.V.) ________ - 142 - ESTABLISHMENTS SERVICES PROVIDED AS AT 31.12.66. OCCASIONAL CRECHES PHYSIOTHERAPY SPECIAL INVESTIGATIONS TODDLERS VACCINATION AND IMMUNISATION VISION OTHER Thurs. P.M. (M.O.& H.V.) Pri. A.M. 2nd and 4th in month (M.O.& H.V.) Thurs. A.M. 4th in month (M.O.& H.V.) Pri. P.M. (M.o.&H. V.) Tues. and Thurs. P. M. Mon. P. M. Pri. P.M. Pri. P.M. 2nd and 4th in month (M.O.& H.V. Weds. P.M. (M.O.& H.V.) ) Cervical Cytology Mon A.M. (M.O.& H.V.) Therapeutic Mon. P.M. 1st and 2nd & 3rd Thurs. P.M. Mothercraft Mon. P.M. Thurs. A.M. (H.V.) Relaxation Tues A.M. (H.V.) - 143 - PREMISES CLINICS AND SCHOOL TREATMENT CENTRES ANTE-NATAL AUDIOLOGY CHIROPODY DENTAL INFANT WELFARE MINOR AILMENTS Greenwood Centre, (Continued) Island Centre, Roserton Street, E. 14. Pri. P.M. (Mid-weekly M.O. alt. weeks). Thurs. A. M Thurs. A.M. Mon. P.M. (H. V.) Wed. P.M. (M.O. &H. V.) Tues. and Thurs. A.M. (H.V.) Mon., Wed, and Fri. A. M. (H.V.) (•Held at Harbinger School) Limehouse Centre, 673, Commercial Road, E. 14. Tues. and Thurs. P.M. Fri. A.M. (M.O.&H. V. ) Mary Hughes Centre, and Ida Samuel Centre, Underwood Road, E. 1. Mon. and Thurs. P.M. Tues. P.Mand evening Wed. A.M. Mon. -Fri. A.M. & P.M. Mon. and Thurs. P.M. Mon. -Fri. A.M. (H.V.) Mon. P.M. (M.O.&H. V.) Nursing Sisters of St.John the Divine. Lodore Street, E. 14. Thurs. A. M. and P.M. (M. O.&Mid. ) Poplar Centre, 69, East India Dock Road, E. 14. Mon. and Fri. A.M. and P. M. Tues, A.M. Weds, and Thurs. P.M. Tues. A. M. Thurs. A.M. and P.M. (M.O.&H. V.) Mon., Wed. and Thurs. A.M. (H.V.) - 144 - OCCASIONAL CRECHES PHYSIOTHERAPY SPECIAL INVESTIGATION TODDLERS VACCINATION AND IMMUNISATION VISION OTHER Dressmaking Tues. and Thurs. P.M. Health Education Tues. P.M. 2nd. and 4th. in month (H. V.) G.P. Obstetrician Mon. P.M. Mothers' Club Thurs. P.M. last in month (H.V.) Mon. A.M. and P.M. Fri. P.M. Weds. A. M. 1st and 3rd. in month (M.O. &H.V. Thurs. P.M. (M.O. &H. V. ) ) Mothers' Club Thurs. P.M. 1st in month (H.V.) Mon. P.M. (M.O.&H. V.) Relaxation Weds. A.M. Tues. P.M. al ternate weeks. Mon. A.M. al ternate weeks Tues. P.M. Thurs. A. M. (M.O. &H. V. ) (S. W.) Tues. P.M. 1st and 3rd in month Weds. P.M. (M..O.&H. V. ) Mothers' Club Alternate Tues. P.M. Family Planning Friday evening Tues. P.M. Tues. P.M. (M.O. & H.V.) (S. W.) Weds. A.M. 1st & 3rd in month (M.:0.&H.V.) Weds. P.M. 1st in month (M.O. &H.V.) Mon. A.M. Fri. A.M. and P.M. (M.O.&H. V.) Mothers' Club Mon. P.M. (H.V.) Dressmaking Tues. P.M. - 145 - - PREMISES CLINICS AND) SCHOOL TREATMENT CENTRES ANTE-NATAL ALP 1OLOGY CHIROPODY DENTAL INFANT WELFARE MINOR AILMENTS Poplar Centre (continued) Prunella Centre, Bernhard Baron Settlement, Henriques Street. E. l. Mon. A. M. P.M. & eve Tues fri. A.M.& P.M. Mon. -Thurs. A.M. (H.V.) Fri. A.M. (M.O.&H.V.) Rochelle Centre, Club Row, E. 2. Mon. P.M. Weds. A. M. (M.O.&H. V.) Mon. A.M. (M.O.&H.V.) Tues.-Fri. A.M. (H.V.) Ruston Street Centre, Ruston Street, E. 3. Tues. A.M. and P.M. Pri. A.M. Mon. A.M. and P.M. Wed.-Fri. A.M. Thurs. A. M. and P.M. (M.O.&H. V.) St. George's Centre. Library Place, Cable Street, E. 1. Thurs. A.M. and P.M. Alternate Fri. A.M. Tues., Wed. and Fri. P.M. (M.O.&H. V.) Stepney Green Centre, 35, Stepney Green, E.l. Mon. A.M. P.M. & eve. Tues., Thurs. and Fri. A.M. Tues. A. M. Weds. P.M. (M.O.&H.V.) Thurs. P.M. (H. V.) - 146 - OCCASIONAL CRECHES PHYSIOTHERAPY SPECIAL INVESTIGATION TODDLERS VACCINATION AND IMMUNISATION VISION OTHER G.P. Obstetrician Weds. P.M. Auditory Training Fri. A.M. and P.M. Orthoptist Mon A.M. and P.M. Thurs. P.M. (M.O.&H.V. ) Weds. P.M. 4th in month (M.O.&H. V.) Bathing Tues. A.M. Thurs. P.M. Fri. A.M. 2nd and 4th in month (M.O.&H.V.) Weds. P.M. Fri. A.M. (M.O.&H.V. ) Dressmaking Mon. P.M. G.P. Obstetrician Weds. P.M. Special Advisory Friday A.M., 3rd in month (M.O. & H.V.) Speech Therapy Tues. A.M. Tues. A. M. 1st in month (M.O.&H.V.) Tues. P.M. (M.O.&H. V.) - 147 - PREMISES CLINICS AND SCHOOL TREATMENT CENTRES ANTE-NATAL AUDIOLOGY CHIROPODY DENTAL INFANT WELFARE MINOR AILMENTS Wapping Centre, 5, Pier Head, E. 1. Wed. P.M. (M.O.&H.V,) Mon. - Fri. A.M. (H.V.) Wellington Way Centre, Bow Road, E. 3. Mon. and Wed. A.M. Tues. and Thurs. A.M. &P.M. Tues. A.M. Wed. and Thurs. P. M. (M.O.&H. V.) Will Crooks Centre, 1-2. Wigram House, Wades Place, E. 14. Mon. P.M. (H. V. ) Tues. A.M. 1st, 3rd and 5th in month Tues. P.M. (M.O./H.V. ) - 148 - OCCASIONAL CRECHES PHYSIOTHERAPY SPECIAL INVESTIGATION TODDLERS VACCINATION and IMMUNISATION VISION OTHER Wed. A. M. Thurs. P.M. Family planning Mon. P.M. Dressmaking Thurs. P.M. Mothers' Club Alternate Thurs. evening Girls' Club Alternate Thurs. evening Mon. -Fri. P.M. Thurs. A.M. (M.O.&H.V.) Weds. P.M. (M.O.&H.V.) G.P. Obstetrician Mon. P.M. Mothers' Club Tues. P.M., 2nd and 4th in month (H. V.) Cervical Cytology Wed. A.M. (M.O. & H.V.) Marriage Guidance Council Wed. A.M. Dressmaking Wed. and Fri. P.M. Family Planning Fri. A.M. Blind Certificate Examination Fri. A.M. (M.O.) Thurs. P.M. 2nd and 4th in month Mon. A. M. Wed. A.M. and P.M. Fri. P.M. Tues. A.M. 2nd and 4th in month (M.O.&H.V.) Speech Therapy Mon., Wed. and Fri. P.M. Mothers' Club Thurs. P.M., 2nd and 4th in month - 149 - (b) CHEST CLINICS London Chest Hospital, Mon. Wed. Thurs. Fri. 9.15-11.30 am. Victoria Park, E.2. Sat. 9.15-11.0 am. Wed. 5.0-6.30 pm. Thurs. B. C. G, Clinic 2.30 pm. Wellington Way Clinic, Tues. 2.0-4.0 pm. (adults), 5. 30-7.0 pm (adults) Bow Road, E. 3. Thurs. 10.0-12 noon (children), 2.0-4.0pm(adults) Pri. 10.0-12 noon (adults). Stepney Chest Clinic, Mon. 10.0-12 noon and 2.0-4.0 pm. Steels Lane, E. 1. Tues. 10.0-12 noon and 2.0-4.0 pm. ,5.0-7 pm. Wed. 10.0-12 noon. Fri. 10.0- 12 noon. Sat. 10.0-12 noon. (c) DAY NURSERIES Mary Hughes, 22, Underwood Road, 3.1. Monday to Friday 8.0 am - 6.0 pm. Christian Street, E. 1. " " " 7.30 am - 5.30 pm. University House, Sugar Loaf Walk, E. 2. " " " 7.30 am.- 5.30 pm. Queen Mary, Tidey Street, E. 3. " " " 7. 30 am - 5.30 pm. Alice Model, 14/24, Beaumont Grove, E. l. " " 11 8.0 am - 6.0 pm. (Voluntary) (d) MENTAL HEALTH TRAINING CENTRES Whitechapel Centre, 28, Underwood Road, E. l. " " " 9.30 am - 4.0 pm. Bethnal Green Centre, Cornwall Avenue,E. 2. " " " 9.30 am - 4.0 pm. Industrial Centre, Harry Gosling School, Henriques Street, E. 1. " " " 9.30 am - 4.30 pm. (8) MENTAL HEALTH DAY CENTRE Pritchards Road, E. 2. " " " 9.30 am - 4.0 pm. (f) DISINFECTING AND CLEANSING STATIONS Digby Street. E. 2. " " " 8.0 am - 5.0 pm. Branch Road, Commercial Road, E. 14. " " " 8.0 am - 5.0 pm. - 150 INDEX A Page Nos. Accidental Deaths 12, 95 Accidents in the Home 75 Accidents at Work 66, 126 Adoption and Boarding Out 32 Adult Training Centres 45, 115 Aged Persons 53, 118 Ambulance Facilities 75 Ante-Natal Clinics 31, 104 Anthrax 15 Area of Borough 7 B Bacteriological Examination — Food. 55 Barbers 62 B.C.G. Vaccination 19, 84, 103 Births 11, 97, 108 Blind, Partially Sighted 75 Burials 76, 117 C Cancer 15 Care of Mothers and Young Children 28, 106 Cervical Cytology 31, 32, 106 Chest Clinics 20, 21, 102 Chief Public Health Inspector's Report 70 Child Minders 36, 105 Children in Care 43 Child Welfare Clinics 28, 104 Chiropody 32, 106 City of London — Mental Health Service 47 Clean Air 53, 118 Cleansing Stations 63, 125 Clinic Centres 37, 39, 108, 142-149 Clinics Held 142-150 Coat of Arms, The Borough's 9 Common Lodging Houses 64 Communicable Diseases 2, 15, 83, 98, 99 Comparative Statistics 13, 97 Compensation for Stopping Employment 25 Conferences and Courses 76, 133, 134, 135, 136 Congenital Defects 32 Co—ordination of Social Services 5 Creches 37 - 151 - D Page Nos. Day Care Service 41 Day Centre (Mental Health) 44, 45, 115 Day Hospital 48, 113 Day Nurseries 36, 105 Deaf Children 84 Deaths 11, 95, 97 Deceased Persons 76, 117 Dental Care for the Priority Classes 37 Dental Health Education 90 Dental Services 37, 85, 106, 139 Derelict Sites 4, 69 Diphtheria 16, 100 Diseases of Animals 54, 118 Disinfection / Disinfestation 63, 125 Dysentery 16 E Educationally Sub—Normal Children 84 Emergency Night and Weekend Service — Mental Health 46 Enteric Fever 16 Environmental Health Services 53, 117—132 Establishments 13, 14-150 F Factories 62, 122, 123, 127 Family Planning 38, 108 Families — Prevention of Break—Up 31 Feeding Difficulties 39 Fluoridation of Water Supplies 92 Food and Drugs 54, 119 Food Hygiene (General) Regulations 56, 120 Food — Imported 57 Food — Unsound 59 Food Poisoning 16 G Guardianship 46 H& I Hairdressers 62 Handicap Register 33 Health Centres, Provision of 27 Health Committee 1 Health Education 39, 72, 83, 107 Health Visiting 39, 108 Home Accidents 75 Home Bathing 40, 109 - 152 - H & I (continued.) Page Nos. Home Help Service 31, 40, 109 Home Nursing 41, 110 Hospital Facilities 76 Housing 3, 60, 121, 131 Hygiene in Schools 85 Immigrants 19 Immunisation 100 Incontinence Pads 41 Industrial Training Centre 45, 115 Infant Mortality 11, 96 Infant Welfare Clinics 28, 104 Infectious Diseases 2, 15, 83, 98, 99 Inquests 76, 124 J & K Junior Training Centres 45, 115 Juvenile Employment 84 L Laboratory Facilities 77 Laundry Service 41, 110 Legal Proceedings 63, 124 Legislation 63, 77 Leprosy 17 Liaison — National Health Service 3 Licensing Act, 1961 64 Loan of Nursing Equipment 41, 111 Lodging Houses 64 M Malaria 17 Marriages 12 Massage and Special Treatment Establishments 79 Mass Radiography 103 Maternal Mortality 12 Maternity Liaison Committees 42 Measles 17 Medical Inspection of Schoolchildren 82 Meningoccocal Infection 17 Mental Health 30, 44, 113, 114, 115 Midwifery 41, 42, 112 Milk Supply 59 Minor Ailments Clinic 83 Morbidity 12, 99 Mortuary 65, 124 - 153 - M (continued) Page Nos. Mothercraft Classes 31, 104 N Neo—Natal Mortality 12, 96 Notices Served by Public Health Inspectors 131 Nursing Equipment — Loan of 41, 111 0 Observation Register 33 Offensive Businesses 65 Offices, Shops and Railway Premises 66, 126 Open Spaces 13, 116 Ophthalmic Neonatorum 17 Outwork and Outworkers 66, 123, 127 P&Q Perinatal Mortality 12, 96 Personal Health Services 27 Pet Animals Act 67 Pharmacy and Poisons Act 67 Phenylketonuria 42 Physiotherapy 84 Playgroups 37 Poliomyelitis 17, 100 Population 10 Post Natal Clinics 31, 104 Poultry Processing and Packing 67 Premature Babies . 43, 108 Prevention, Care and After Care 30 Principal Nursing Officer's Report 44 Principal School Dental Officer's Report 85 Principal School Medical Officer's Report 81 Principal Social Worker's (Mental Health) Report 47 Priority Classes — Dental Care 37 Psittacosis 17 Psychogeriatric Unit 48, 113 Public Analyst's Quarterly Reports 54, 119 Public Health Inspectors — Visits 118, 130 — Miscellaneous Work 132 Puerperal Pyrexia 17 Pupils on School Rolls 82 R Radioactive Substances 79 Rag Flock, etc. Act 68 Railway Arches 66 - 154 - R (continued.) Page Nos. Recuperative Holidays 43, 110 Refreshment Houses 68 Refuse Disposal 68, 127 Relaxation Classes 31, 104 Rent Act 68 Residential Establishments — Children In Care 43 Road Accidents 95 Rodent Control 68, 72, 128, 129 S Scabies 17 Scarlet Fever 18 School Dental Service 85, 139 School Health Service 81, 137-141 Seamen's Lodging Houses 64 Smallpox 18, 100 Social Conditions 5 Special Care Units — Mental Health 46, 115 Staff 2, 6, 79 Statistics and Social Conditions 9 Statistics — Summary 7 St. Clement's Hospital 48, 113 Swimming Baths 69 T Training Centres (Mental Health) 45, 115 Tuberculosis 18, 19. 30, 101, 102 U Unemployment 13 Unmarried Mothers 43 V Vacant Sites 4, 69 Vaccination 100 Vaccination Certificates 75 Venereal Diseases 23, 31 Vision — Schoolchildren 84 Visits by Public Health Inspectors and Technical Assistants 118, 130 W Water Supply 69, 72 Weather Conditions 15 Whooping Cough 17, 100 - 155