TOWER HAMLETS LONDON BOROUGH annual report of the medical officer of health & principal school medical officer LONDON BOROUGH OF TOWER HAMLETS ANNUAL REPORT of the medical officer of health & principal school medical officer 1968 R. W. WATTON M.B., B.S., D.P.H.. D.C.H., D.I.H. Medical Officer of Health and Principal School Medical Officer CONTENTS Page Health Committee 2 Introductory 3 Staff 6 Summary of Statistics 7 Part I Statistics and Social Conditions of the Area 9 II Prevalence of and Control over Infectious and Other Diseases 15 III Personal Health Services 25 IV Community Care Services 39 V Environmental Health Services 49 VI Miscellaneous Services, etc. 69 VII School Health Service 75 VIII Appendix of Statistical Tables 85 INDEX 141 TOWER HAMLETS HEALTH COMMITTEE (as at 31st December, 1968) Ex-OffiCio: The Worshipful the Mayor, Councillor F W. Briden J.P CHAIRMAN: Councillor J. O'Connor M.B.E., J.P. VICE-CHAIRMAN: Councillor A.W Downes ALDERMAN J. Orwell (Stepney) (Ex-Officio) COUNCILLORS T.J. Beningfield J.P. J. Milrood Mrs. D.M. Couling Miss H. Morsman G. Desmond M. Pollins Mrs. A. Elboz W.T. Tuson A. Friedlander Mrs.I.B Vines E.W. Hill G.H. Wall M.S. Levitas Miss J.E. Wiggins -2- HEALTH DEPARTMENT, 227/233 Commercial Road, E.l. TO: The Mayor. Aldermen and Councillors of The London Borough of Tower Hamlets Mr. Mayor, Ladies and Gentlemen, I present the Annual Report on the health of the Borough for 1968 COMMUNICABLE DISEASES A campaign for vaccination against measles was initiated on a national scale in the mid-year. A reasonable response from the recommended age group of 1 year ensued in the area By the end of the year there was some evidence of a reduction over the expected notification rate for a "measles' year. With the threatened extension of Asiatic influenza to this country at the latter part of the year, key personnel in the Council's employ in touch with the public, and the staff of residential homes, were offered and largely accepted vaccination against the new mutant strain. Fortunately, the forecast of a large outbreak did not materialise Tuberculosis notifications showed little change over the year at rates of 0.53 per 1,000 for pulmonary, and 0,098 per 1000 for non-pulmonary cases However, the death rate for cancer of the lung in the borough is now about one per thousand of the population A total of 190, comprising 160 males and 30 females died from this disease in 1968. an increase again on last year's total HOUSING In 1964-65 it was estimated that there were approximately 13,800 properties, in the constituent boroughs, to be dealt with as 'Unfit' Considerable progress has been made in the intervening five years, including almost four years as the new borough of Tower Hamlets The backlog of 3 500 of the 1960-65 quinquennium has been dealt with, and another 6,300 are being dealt with in the 1965-70 programme Additional tenement blocks have been included too It is estimated that about a further 4,000 unfit properties can be incorporated in the 1970-75 programme After this the bulk of slum property will have been covered for representation Thus a total of 9,000 properties, up to and inclusive of the current quinquennial programme, will have been declared/represented within a six year period in the combined Greater London Council and Tower Hamlets housing programmes If confirmation, clearance, and redevelopment proceed apace the demise of all large areas of unfit properties within the borough is in sight in the very near future. -3- FAMILY PLANNING Population control is one of the most important problems of public health today. It has been calculated that for the United Kingdom the annual increase of population is, on average over recent years, more than a quarter of a million persons. Within this borough live births exceeded deaths by an average of 1,167 in each of the last 4 years. Fortunately, the local increase in past years has been cushioned by an annual outward migration of population, consequent on redevelopment and rehousing. Nevertheless, as charity begins at home so does the responsibility of all of us for endeavouring to equate, as far as humanly possible, birth rate with death rate if life is to be lived with dignity and grace in the world of the future. Consent for the implementation, in full, of the provisions of the National Health Service (Family Planning) Act 1967, by the Council, has enabled an expansion in the local Family Planning Association clinics now run on an agency basis for the borough council. Family planning advice and help by local health authority staff, in the setting of routine welfare clinics, is also in operation. In addition our domiciliary family planning service continued over the last year under the guidance of amedical officer and health visitor. The aim must be, in conjunction with the hospital and general practitioner services, to provide ultimately a comprehensive service to all seeking assistance. CRUDE SPIRIT DRINKING The report of the Working Party on Habitual Drunken Offenders, for which the Council gave evidence, was still awaited at the end of the year. As an earnest of the good intentions of the local authority, further means are being sought to alleviate the problem of crude spirit drinking within its area. Towards the latter part of the year discussions were held with the Salvation Army - an organisation founded in the borough 100 years ago, and still represented with 3 hostels including the new centenary building extension, Booth House, opened by H.M. the Queen in March 1968. A special medical unit forms part of the new building. In conjunction with the Medical Adviser, Salvation Army, a pilot scheme seeking to rehabilitate selected persons in the category of crude spirit drinkers was planned by the Council to come into operation as from April 1969. Financial support is to be given to the unit at Booth House where assessment of cases will be made. Suitable cases will be sent for rehabilitation to a Salvation Army home in the country, with financial support by the Council under its 'prevention, care and after-care' powers. The co-operation of all agencies within the borough working with this needy group is to be sought in the venture. It is difficult to please everybody all the time, particularly perhaps in local government, so it was not surprising to read in the correspondence column of a local paper, on this proposal, an indignant letter demanding why the body of ratepayers should have to pay for such 'do gooding'? Not with standing, for some years a larger and more vociferous group has been demanding why the Council did not do something in this field! MENTAL HEALTH SERVICES Links between the department's mental health section and the local hospital psychiatric services continued to be strengthened. In-service seminars at both the London and St.Clement's Hospitals, are attended by our field staff. Towards the end of the year, it was agreed to employ the Head Social Worker of the London Hospital, also responsible for psychiatric social work, half-time in the Health Department. It is hoped this will facilitate further integration of -4- social work at all levels, whether that of the health department's community work or the hospitals' in-patient service. For the mentally ill, a really comprehensive community care service is the first priority to establish The work of the Psychiatric Rehabilitation Association, supported finaneially by the Council, increased during the year when it was possible for them to take over larger premises, vacated by the Council, for use as an additional occupation centre for the mentally ill. Some expansion in the provision of psycho-geriatric care was possible such that our Pritchard's Road Centre, operated in conjunction with the day hospital at St, Clement's, was increasingly utilised Work with the mental ly sub—normal has not been forgotten Construction of the purpose built junior training centre for 115 persons, with special care unit places, is up to schedule and should be open in November, 1969 Meanwhile, activities at our three existing centres have progressed Opportunity has been taken under the secondment for training courses to increase the number of centre staff holding a recognised qualification, usually the Diploma for Teachers of the Mentally Handicapped Acceptance of the local proposals for the upgrading of salary scales of teachers and workers in the centres will enhance the service given by the section, albeit some of this work may soon be taken over by the Education Authority In the face of, or despite continuing theoretical deliberations on the future of the personal health and social services in local government. I am pleased to report that good liaison and working relationships with all the other likely to be affected departments were enjoyed throughout the year On behalf of the department, I express my gratitude to the Chairmen and Members of Committees for support and encouragement, and to the Town Clerk and other Chief Officer colleagues for the same To the staff of the department I give my thanks for another good year of service. I am, Yours faithfully, R.I. WATTON- Medical Officer of Health and Principal School Medical Officer May. 1969 -5- STAFF OF HEALTH DEPARTMENT (as at 31st December, 1968) MEDICAL OFFICER OF HEALTH Dr. R. W. Watton DEPUTY MEDICAL OFFICER OF HEALTH Dr. C. M. Gourlay ASSOCIATE MEDICAL OFFICER OF HEALTH Dr. W. C. Turner Medical Officers 41(10.1) CHIEF ADMINISTRATIVE OFFICER E.P. Webber SENIOR MEDICAL OFFICER Dr. K. Winship SENIOR ADMINISTRATIVE OFFICERS C.H. Drake J.E. Pestell M.Pliskin G.R. Williamson Administrative and Clerical Staff 81(77.25) CHIEF PUBLIC HEALTH INSPECTOR H.W. Luke DEPUTY CHIEF PUBLIC HEALTH INSPECTOR H.S. Davies Public Health Inspectors 24.Technical Assistants 9(8.6) CHIEF DENTAL OFFICER D.F. Waller Pupil Public Health Inspectors 6 Dental Officers 11(7.3) PRINCIPAL NURSING OFFICER Mrs. D.E. Marrin Health and Tuberculosis Visitors Dental Auxiliaries 3 DEPUTY PRINCIPAL NURSING OFFICER Miss A.M. Thomson Student Health Visitors 6 Dental Surgery Assistants 9 ASSISTANT NURSING OFFICER Mrs. A. Cowell Clinic and School Nurses 27(23.33) PRINCIPAL SOCIAL WORKER (MENTAL HEALTH) Miss A.M. Joseph ASSISTANT PRINCIPAL SOCIAL WORKER (MENTAL HEALTH) F. Sullivan Social Workers (Mental Health) 10 Supervisory Staff at Mental Health Training and Day Centres 19 PRINCIPAL SOCIAL WORKER (HEALTH SERVICES) Miss E. Brett ASSISTANT PRINCIPAL SOCIAL WORKER (HEALTH SERVICES) (vacant) Social Workers and Family Caseworkers 8 CHIEF CHIROPODIST - P. Twort NON-MEDICAL SUPERVISOR OF MIDWIVES Miss I.M. Clarke Midwives (Agency) 7 HEALTH EDUCATION OFFICER Chiropodists(Sessional)8(2.4) NURSING SUPERINTENDENTS (Agency) 3 District Nurses (Agency) 33(30.75) ASSISTANT HEALTH EDUCATION OFFICER Miss P.G. Hodges HOME HELP ORGANISERS 3 DAY NURSERY STAFF 49(48) HOME HELPS 280(185.2) OTHER STAFF 24(22) Mrs. E.E. Rogers ASSISTANT HOME HELP ORGANISERS 6 OTHER MANUAL STAFF 111(86.4) Total Staff of Department 839 (equivalent whole-time 664) Note - Numbers in brackets relate to equivalent whole-time. -6- SUMMARY OF STATISTICS, 1968 Area of Borough (Acres) 4,876 Rateable Value (1st April) £15, 015, 140 Population: Mid-year estimate 192, 250 Sum represented by a penny rate (1968-69) £57, 800 Census, 1966 196, 830 Census, 1961 205, 682 General Rate (1968-69) Dwelling houses 11s. 11d. in £ Density of population (persons per acre) 39.43 Other hereditaments 12s. 9d. in £ Number of inhabited dwellings according to Rate Books at 1st April, 1968 62, 662 " structurally separate dwellings - Census 1961 59, 885 " " private households - Census 1961 67, 858 Births Total Male Fema1e All Births 2, 927 1, 514 1, 413 Live Births Legitimate 2, 516 1,304 1,212 Illegitimate 359 182 177 Total: 2,875 1, 486 1,389 Still-Births Legitimate 42 23 19 Illegitimate 10 5 5 Total: 52 28 24 Deaths All Causes 2,382 1, 346 1,036 Maternal – - - Infants under 1 year Legitimate 61 46 15 Illegitimate 8 5 3 Total; 69 51 18 Rates Live birth-rate per 1, 000 population 14, 95 Death rate per 1, 000 population 12.39 Still-birth rate per 1, 000 total births 18. 08 Maternal death rate per 1,000 total births 0. 00 Infant death rate (under 1 year) per 1, 000 live births 24. 00 Legitimate infant death rate per 1, 000 legitimate live births 24.24 Illegitimate infant death rate per 1, 000 illegitimate live births 22.28 Neo-natal death rate (under 4 weeks) per 1, 000 live births 17. 74 Early neo-natal death rate (under 1 week) per 1, 000 live births 13.56 Perinatal death rate (stillbirths plus deaths under 1 week) per 1, 000 total births 31. 09 Illegitimate live births per cent of total live births 12.48 Area Comparability Factors Births 0.92 Deaths 1.18 -7- ************ - 8 - PART 1 STATISTICS AND SOCIAL CONDITIONS OF THE AREA 1. 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 4,876 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's and London Docks, East and West India Docks, and the Millwall Docks. The St. Katharine's Dock comprising 10 acres of water, has ceased being used as for dock purposes and has been purchased by the Greater London Council, together with adjacent land, for redevelopment inconjunction with this Council. Mileage of roads covered is 178.5. 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 throughout the country. Notable landmarks in the borough include the Tower of London and the Royal Mint. POPULATION The Registrar-General's estimated mid-year populatidnof the borough was 192,250, adecrease of 5,980 from last year's figure. This is a continuation of the downward trend which has occurred since 1947. The 1966 1055 sample census showed the population to be 196,830, although the Registrar-General commented that in Greater London the population was understated by from 2½ to 3 per cent. Live births exceeded deaths by 493 so that as the estimated population decrease was 5,980, the net estimated movement of residents out of the borough amounted to 6,473 persons. The density of population is 39.43 persons per acre. The estimated child population is as follows:- Under 5 years 5-14 years Total under 15 years 15,800 27,400 43,200 -9- FIFTY YEARS AGO In 1918 the population of the Boroughs of Bethnal Green, Poplar and Stepney, which now form the Borough of Tower Hamlets, was 510,640. Referring to the number of births during the year(4,622) the Medical Officer of Health of Stepney stated that they had been declining for years and were only a little over half the number in 1910 and 1912. Deaths of children under 1 in Stepney numbered 536, and in reporting the advent of the Maternity and Child Welfare Act, 1918, the Medical Officer of Health said there was still an enormous wastage of child life which proper measures might abolish. Deaths from measles in Poplar and Stepney totalled 296, and 880 children died under the age of one, 101 being due to diarrhoea. In the Stepney area smallpox accounted for 23 deaths. In his Annual Report for 1918 the Medical Officer of Health for Stepney reported:- "The Public Health Committee have on many occasions called the attention of the Borough Council and of the Local Government Board to the fraud perpetrated with impunity by dishonest tradesmen under the cloak of the Warranty Clause. One glaring instance of the abuse of the Warranty Clause is worth repeating. It is that of a milkman residing in our district who was convicted 17 times- 11 summonses were for adulteration,5 for refusing to serve the Inspector with milk, and 1 summons was for obstructing the Inspector, On the latter occasion, the Inspector actually saw him adding water to the milk, and when the Inspector demanded a sample from the mixture, the milkman tried to upset the can. A struggle ensued and most of the milk was spilt, but sufficient remained in the can to be analysed. This was divided into three parts in the ordinary way, and it showed 22 per cent of added water. He was prosecuted on several occasions after' this occurrence, and, although convicted several times, the summonses were dismissed on a Warranty on 6 occasions, once when the milk showed 21 per cent of added water. I am glad to state that this milkman will not defraud the public in our district in a similar way again. He was caught red-handed on 28th and 30th January, 1918, deliberately adding water to Milk. I reported the matter to the Local Food Committee and was instructed to prosecute him under the Milk (Amendment) Order, 1917, No. 1317. He was sentenced to four months' imprisonment, and his brother, who was assisting him in the transaction to three months, and his name was removed from the Register of milk sellers.'* The Minutes of the Stepney Council's Meeting of 8th October 1918 record the following:- ''We have had this question (as to whether any steps have been taken to impress upon H.M. Government the need for a Ministry of Health without delay) under consideration, and would direct the Council's attention to the fact that under present circumstances there are in addition to the Council's Health Visitors, Inspectors appointed by various bodies and institutions in the Borough, all working more or less with differing standards and all associated with the administration of the public health, resulting in a great deal of over-lapping, and we are, therefore, strongly of opinion that it would be in the interests of the public if a Ministry of Health were created to co-ordinate the administration of these and similar agencies and to bring them under one control." -10- The report of the Public Health Committee dated 27th November 1918 to Bethnal Green Borough Council relating to a 'flu epidemic and the difficulty experienced by local undertakers in respect of removal and burial of fatal cases, stated that the Sanitary Inspectors had visited all the undertakers on 4th November and ascertained there were 14 bodies in their premises, that they had 174 funerals in hand and had refused some hundreds of orders during the past weeks and that they could do with 17 additional coffin makers, and were in need of upwards of 6,000 ft. of timber. The Medical Officers of Health reported 713 deaths from influenza in Stepney and 524 in Poplar during the 6 weeks of the epidemic. Another report of the Bethnal Green Health Committee stated that during the 5 weeks ending the 2nd February, 1918, five persons were fined under Food Control Orders for sel1ing bread less than 12 hours old. The Minutes of the Poplar Council stated that the net estimate of expenditure of the Health Committee for the year 1917/1918 was £9,331. It is also recorded that in 1918 four prosecutions were taken against publicans for selling Spanish brandy as Scotch whisky. LIVE BIRTHS There were 4,445 live births registered in the borough during the year. After correction for place of residence (inward transfers 144, outward transfers 1,693), the number allocated to the borough was 2,875 comprising 1,486 boys and 1,389 girls, a decrease of 387 from 1967, giving a crude birth rate of 14.95 per 1,000 population compared with 16.45 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 13.75 compared with 16.9 (estimated) for England and Wales, a ratio of 0.82 to the national rate. The crude rate for Inner London is 16.9. ILLEGITIMATE LIVE BIRTHS The number of illegitimate live births during the year was 359 equivalent to 12.48% of the total live births, compared with 13.52% last year. The comparable figure for Inner London was 15.5%. STILLBIRTHS This year stillbirths numbered 52 equivalent to a rate of 18.08 per 1,000 total births compared with 16.58 in 1967. The rate for England and Wales was 14.3 (estimated) and for Inner London 13.1. DEATHS The number of deaths registered - 2,382, shows an increase of 252 over the figure of last year. The death rate was 12.39 and when adjusted by the comparability factor becomes 14.62 as compared with 11.9 for the country as a whole. The crude death rate for Inner London is 11.9. The largest single cause of death was heart disease, 28% of total deaths, followed by cancer 23% and respiratory conditions 21%. Last year cancer accounted for 25% of deaths. -11- The various causes of death and distribution by age groups are set out in Table l,on page 85 INFANT MORTALITY Deaths during the first year of life numbered 69 equivalent to a rate of 24.00 per 1,000 live births. The rate for the previous year was 17.16 and 16.74 for 1966. 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 1 in 10 babies died before their first birthday. The rate for England and Wales was 18.0 for 1968 and for Inner London 19.8. . Details of causes of death at various ages under 1 year will be found in the Appendix on page 86 MATERNAL MORTALITY There were no maternal deaths this year. NEO-NATAL MORTALITY During the year there were 51 deaths of infants under 4 weeks representing a neo-natal mortality rate of 17.74, the rate for England and Wales being 12.3 and for Inner London 14.0. Last year there were 37 deaths giving a rate of 11.34 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 31.09 the rate for England and Wales being 25.0, and for Inner London 25.3. ACCIDENTAL DEATHS Deaths due to accidents numbered 50, motor vehicles being the cause of 18 deaths. Statistics supplied by the Road Safety Officer will be found on page 85 EXPECTATION OF LIFE On the basis of the mortality experience for the years 1965-7, the expectation of life of a boy at birth is 68.7, and of a girl 74.9 years, stated the Registrar-General. Ten years ago life expectations were 67.6 and 73.1 years respectively. Sixty years ago the expectation of life of a boy at birth was 48.5 years and of a girl 52.4 years. 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 weekly 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 -12- postal districts. (Monthly figures are to be found on page 90 MARRIAGES The number of marriages solemnised in the borough during the year was 1,557, made up as follows:- Register Office 715 Church of England 552 Authorised persons and other denominations 290 The marriage rate per 1,000 population was 16.2 compared with 15.4 last year. PUBLIC RELATIONS Health Department activities are publicised in ''Tower Hamlets News'' a publication issued by the Council to the public after each Council Meeting. Topics included in the publication during the year related to Measles Vaccination, Child Minders, Dental Health Campaign, Mental Health Week and Exhibition, Loan of Nursing Equipment, Services available for the care of handicapped children and young persons, the Domiciliary Midwifery Service, Laundry Service for incontinent patients, Vaccination and Immunisation, and publicity for the Mass Radiography Unit's weekly service in the Borough. In addition, a bulletin is circulated to general practitioners and hospitals in the borough giving information on infectious disease, morbidity, and relevant topical matters. This bulletin, formerly issued monthly, is now circul ated each week. UNEMPLOYMENT The number of wholly unemployed adult persons registered at the Poplar, Shoreditch and Stepney Employment Exchanges at 9th December, totalled 2,964 men and 247 women, or 956 less than 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. Further more, the Shoreditch Exchange figures include the Shoreditch area of the London Borough of Hackney. Information supplied by the Youth Employment Officers shows that unemployed young persons (under 18), numbered 77 boys and 22 girls, compared with 1967 figures of 81 and 16 respectively;. OPEN SPACES There are 326 acres of parks and open spaces within the borough, representing 1.7 acres for every 1,000 population, some 10 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 2!4 acres. A list of the sites is given on pages 107 and 108 -13- COMPARATIVE STATISTICS A table showing vital statistics for the area covered by the borough at various years from 1901 is on page 87 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 138 to 140 -14- PART II PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES 1 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES WEATHER CONDITIONS In the month of January very variable temperatures were experienced, snow falling on 11 days, with heavy falls on the 9th. February was the coldest for 5 years, March being dry windy and unsettled. There were snowfalls in early April, Kew having its coldest April night on the 8th for 30 years, whilst the 21st was the warmest April day since 1952, May was dull and cool, and June mostly dry, with normal mean temperature. July was mainly dry and warm, apart from scattered thunderstorms, Kew having its dullest August since 1912 and its dullest summer for 80 years. Unsettled and thundery with heavy rain and floods mid-month was recorded for September, whilst it was the mildest October since records began in 1871. November was dull and very cold during the first half, but had little fog. It was the coldest December recorded at the London Weather Centre since 1963. LEGISLATION The Public Health (Infective Jaundice) Regulations 1968 made this disease notifiable from 15th June. On the 1st October, the Public Health (Infectious Diseases) Regulations 1968, made under Section 56 of the Health Services and Public Health Act 1968, came into operation, consolidating with amendments all previous Regulations relating to the notification and prevention of infectious disease except the Tuberculosis Regulations of 1925. The principal changes were to make acute primary pneumonia, acute influenzal pneumonia, acute rheumatism and puerperal pyrexia no longer notifiable, whilst tetanus, yellow fever and 1eptospirosis became notifiable for the first time. Additionally the powers of a Medical Officer of Health to vaccinate contacts of persons suffering from smallpox have been extended to other diseases, and the power of a local authority to require a person to stop work in order to prevent spread of infection are extended to permit action in cases of food poisoning. The Medical Officer of Health has been authorised to serve notices required under the Regulations with regard to measures to be taken by a local authority if and when cases occur of typhus, relapsing fever, food poisoning, typhoid and paratyphoid fevers. INFECTIOUS DISEASES - NOTIFICATIONS The number of notified cases of infectious disease, corrected for revised diagnoses and duplicate notifications, was 1,197, compared with 2,265 during the previous year. Liaison is maintained with general practitioners and hospitals in the area by a weekly bulletin which is circulated giving them information on the number of infectious diseases occurring intheborough during the week, 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 90 and a list of diseases notifiable in the borough on page 89 -15- ANTHRAX No case of anthrax was reported during the year. CANCER Of a total of 539 deaths from cancer occurring this year 190 were due to cancer of the lung. The death rate of lung cancer was 0.98 per 1,000 population, an increase of more than 7% over last year. DIPHTHERIA No cases of diphtheria came to the notice of the department during the year. Particulars relating to children immunised against diphtheria will be found on page 91. DYSENTERY Notified cases of dysentery totalled 40, compared with 50 during the previous year. FOOD POISONING Fifty-three cases of food poisoning were notified during the year, compared with 78 in 1967. Organisms of Salmonella typhi-murium were isolated in 17 cases. Ten of these were connected with an outbreak at a local hospital, four being patients and six home contacts. Organisms of Salmonella panama were discovered in two instances as was Salmonella oranienberg. Salmonella Stanley was found in one case and Salmonella enteritides in another. Clostridium welchii was found in one case during investigation of contacts of an incidence of dysentery. Twenty-four cases of suspected food poisoning were reported in an outbreak at an office canteen in the borough. The investigations led to the conclusion that this outbreak was attributable to twice cooking meat into which an organism had been introduced during the chain of distribution. From the material available it was not possible to prove the presence of the organism, and all faecal samples were negative. Two general outbreaks and one family outbreak were reported to the Ministry of Health as required by Memorandum 188/Med. INFECTIVE JAUNDICE During investigation of the 61 notifications received from 15th June, it became apparent that some of these cases were drug addicts. The cases between the ages of 15 and 30 years numbered 20, and of these, six were known addicts, attending a local clinic. LEPROSY One notification of leprosy was received during the year in a person who had lived many -16- years in the Far East. MALARIA A case of malaria, contracted abroad, was notified by a hospital in the borough. MEASLES Notified cases of measles totalled 616 during 1968, and there was one death from the disease. In the previous year 1,690 notifications were received. Children vaccinated against the disease during the year numbered 2 ,82.7. ACUTE MENINGITIS This disease became notifiable on 1st October, two notifications being received during the last quarter of the year. OPHTHALMIA NEONATORUM No cases were notified this 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 91. PUERPERAL PYREXIA Notifications of puerperal pyrexia numbered 25 of which 9 related to residents of the Borough. The condition ceased to be notifiable after the 30th September. SCABIES Cases of scabies which came to notice during the year totalled 374, compared wi th 450 in 1967. Patients and contacts were given medicinal baths and their clothing disinfected at the Council's cleansing station. The number of baths given was 632. Although scabies ceased to be a notifiable disease on 1st April, 1965, by the co-operation of the general practitioners and hospitals 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 83 confirmed cases notified, 8 less than in 1967. -17- 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 occasionally received from port and airport authorities of persons coming into the borough who may have been in contact with smal lpox. Observation is kept on such persons by officers of the Health Department for the necessary period. The number of persons successfully vaccinated or revaccinated against smallpox at the Council's clinics and by general practitioners during the year was 2,679. TYPHOID During the year three incidents involving typhoid occurred. One, a native of Pakistan recently returned from that country, developed symptoms 10 days after arrival here, and was found to be suffering from typhoid fever which, unfortunately, appears not to have been typed. This case was regarded as having been contracted abroad. Another, an old lady with a history of bowel symptoms, living alone, developed typhoid fever, indentified as phage type D.l (of Mediterranean origin). She had not been out of the country and, in spite of exhaustive investigations, no source could be found, neither were there any other cases of this type reported in the country at the time. The third incident, involving two fatal cases, which were not notified, is a matter of some concern. Mr. R.B. (65 years) was admitted to a general hospital as an emergency, deeply unconscious from coal gas poisoning (blood level 76% saturated with carbon monoxide). He was resuscitated and because of his mental attitude, was removed after some 18 days to a psychiatric hospital for assessment. He developed pyrexia and was incontinent, and was returned to the original hospital after 11 days with a fluctuating temperature. The P.U.O. continued and some 12 days later a Widal test was positive but no action was taken. The man continued to be nursed in an open ward in the general hospital. Five days later the Widal test repeated, was also positive; one day later he died unexpectedly, 50 days after his initial admission. All signs pointed to his having died of typhoid which had been contracted in the hospital. The man was under a variety of antibiotics so that the typhoid organism was not, in fact, grown. Two wards of the hospital were immediately closed, all contacts screened, and case papers of patients who had been in the ward for three weeks before his admission were scrutinized. On investigation of suspicious deaths in this period it was disclosed that another man, 78 years old, had had an illness involving abdominal pain and diarrhoea for one week, and who had collapsed and was brought in from the street. He died 10 days later, two days before the admission of R.B. A Widal which had been taken was interpreted as positive but no action had been taken. As the result of screening patients and staff still in the ward one other case was -18- isolated with a positive Widal but at no time was the diagnosis confirmed by growth of the S. typhi organism. He was transferred to a fever hospital but as he developed no symptoms he was discharged. The general hospital and the psychiatric hospital both use a contract laundry service operating from an adjoining borough and the incidents called for very extensive examination of contacts, which involved active seamen engaged on short trips between this country and the Mediterranean, but nothing further was found. WHOOPING COUGH Cases notified during the year numbered 66, compared with 89 during 1967. Statistics relating to immunisation are on page 91 TUBERCULOSIS The number of primary notifications of pulmonary tuberculosis received during the year was 102, giving a notification rate of 0.53 per 1,000 population compared with 0.51 last year. Non-pulmonary cases notified numberedl9. The mortality rate for pulmonary tuberculosis was 6.2 per 100,000 population compared with 8.1 last year. The number of cases on the register fell during the year by 62. Statistical data relating to new cases, deaths and variations in the register will be found on page 92 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 6A, whose headquarters are at the Connaught Hospital, Walthamstow, covers mainly the Stepney area of the borough whilst Unit 6B, 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 information on visits to the borough by the mobile units and on the work of the static unit during 1968 which will be found on page 94.(Details of abnormalities ascertained are not yet available in respect of this year's survey and those figures given relate to 1967). 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 -19- B.C.G. vaccination of susceptible (tuberculin negative) child contacts of known tuberculous patients, diabetic children, thirteen-year old school children, students at further educationestablishments and mentally subnormal persons at training centres, are shown in Table 15 on page 94 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 a triennial 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 CIinics 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 93 Chest Diseases Care Committees Three such committees operate in the borough and I append the reports of the consultant -20- 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 Chest Clinic at the London Chest Hospital showed little change in 1968. The shift in emphasis in the type of new case from tuberculosis to other respiratory disease such as chronic bronchitis and lung cancer has continued. Tuberculosis is now largely a disease of the elderly indigenous male inhabitants of the United Kingdom, a proportion of whom are homeless and alcoholic, and of the younger male immigrants. Cases occur, however, in all sections of the community. Chronic bronchitis and lung cancer are seen to occur predominantly in the indigenous population, and the incidence for both conditions is high. A survey of chronic bronchitis involving the close co-operation of many of the local general practitioners in Bethnal Green has been under way at this clinic since January 1963. Useful information on the medical and social aspects of this disease has resulted. Lung cancer is rapidly taking the place of tuberculosis as an important cause of death. Its causal relationship to cigarette smoking is now generally accepted. Bronchitis and lung cancer are not commonly met with in the immigrant population at present. It is interesting to speculate on the future incidence of these conditions in immigrants as they adopt the local smoking and working habits and live longer in the climate which has been accused of playing a part in the aetiology of bronchit is. No Doubt, however, improved working conditions and cleaner air will reduce the risk of bronchitis in all local inhabitants. Extension of the facilities originally created for the care of tuberculous patients to those suffering from other chest diseases continues through the function of the Care Committee. Unfortunately the income of the Care Committee from whose funds extra help is distributed to patients in need is now falling. The main source of income in the past has always been the sale of Christmas Seals from the Chest and Heart Association. With the decline of tuberculosis, and the resulting fall in its interest to the pub1ic,,coup1ed with the large number of rival groups appealing at Christmas in the same way, sales of the Association seals have fallen. However, the need remains, not only for tuberculous patients but for those suffering from other forms of chest disease.'' Dr. R.M. Orpwood, Chest Physician at the Poplar and Stepney Chest Clinics, reports: ''The work of the Chest Clinics at Stepney and Poplar has followed similar lines to 1967 and there have been no major developments to report. Applications for help from the Care Committee funds were fewer than in previous years, probably as a result of a higher standard of living and increased statutory allowances. Patients with a short-term illness were able to manage on their allowances, but grants were made from the voluntary fund to meet the specific needs of patients who -121- had been ill a considerable time. Elderly housebound patients were also assisted with extra fuel in the winter. The Stepney Care Committee again provided a coach outing to Brighton during the summer, and at Christmas time gifts to provide extra comforts were taken to the more needy patients at home. The Future of the Chest Services In July, the Ministry of Health issued a report on the future of the chest services by a sub-committee of the Standing Medical Advisory Committee. The terms of reference of the subcommittee were to consider the general organisation of chest clinics in relation to the rest of the hospital services and to make recommendations. Generally the recommendations were still being discussed at the end of the year with the Regional Hospital Board. A financial recommendation is being put into operation as from 1st April next year, namely, that relating to the cessation of payment by the Council of part of the salaries of the Chest Physicians. Removal to Hospital of Infectious Person Section 69 of the Health Services and Public Health Act 1968 repealed Section 172 of the Public Health Act 1936 regarding removal to hospital ofaperson suffering from tuberculosis of the respiratory tract. By regulation the provisions of Sect ions 169 and 170 of the 1936 Act now apply in such circumstances. Health Control of Immigrants In March the Minister of Health issued a circular which referred to new powers to control immigration from the Commonwealth provided in the Commonwealth Immigration Act 1968. Under these new powers any immigrant may be medically examined at the port of entry and may be required as a condition of entry to report to a Medical Officer of Health with a view to further examination and any necessary treatment. However, there is no power to apply measures of compulsion to immigrants who refuse to accept treatment any more than exists to apply such measures to the indigenous population. During the year, 544 advice notes, of immigrant arrivals, were received in the department from various ports of entry and successful contact was made in 366 instances. Of the remaining 178 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. Two immigrants were admitted on condition that they reported to the Medical Officer of Health for examination. One was suffering from a minor skin complaint, the other person having had trachoma. Swabs were taken in the latter case with negative results. VENEREAL DISEASE The annual return received from the Venereal Disease CIinic at the London Hospital shows that new cases attending the clinic during the year were as follows:- -22- Area of Residence Syphi1 is Gonorrhoea Other Conditions Total (1967) Tower Hamlets 95 548 2,125 2,768 (2,951) Other London Boroughs 114 917 4,177 5,208 (4,502) Other Areas 19 135 984 1,138 (924) 228 1,600 7,286 9,114 (8,377) Two welfare officers appointed by the Council work from the Whitechapel Clinic under the direction of Dr. E.M.C. Dunlop, M.D..M.R.C.P., Medical Director of the Clinic, for tracing contacts and following up defaulters. Dr. Dunlop reports as follows:- ''We dealt with 228 new cases of syphilis in 1968 compared with 172 in 1967, with 1,600 new cases of gonorrhoea compared with 1,671 and with 7,286 cases of other conditions compared with 6,486. The highest total for new cases (2,768) was for Tower Hamlets but this total has decreased from that for 1967 which was 2,951. The figures for Tower Hamlets included 95 cases of syphilis, compared with 86 for 1967. There were 548 cases of gonorrhoea compared with 722. It is gratifying that the number of cases of gonorrhoea has declined in this year. An important factor in this decline must be the activity of our Welfare Officers in tracing contacts of infectious disease. A summary of the results of contact tracing in early syphilis is given in Table A. TABLE A Alleged Sources of Infection - EARLY SYPHILIS Year Total A11ended Infected 1966 55 10 (18.2%) 9 (90.0%) 1967 27 4 (14.8%) 4 (100% ) 1968 27 8 (29.6%) 8 (100% ) Other contacts: 1966 - 2. 1967 - 3. 1968 - 20. Of 27 alleged sources of infection with early syphilis eight (29.6%) attended and all were found to be infected. Of 20 other contacts of early syphilis who attended six (30%) were found to be infected A summary of the results of contact tracing in gonorrhoea is given in Table B. -23- TABLE B Alleged Sources of Infection - GONORRHOEA Year Total At tended Infected 1966 1,162 321 (27.6%) 295 (91.9%) 1967 1,160 344 (29.7%) 304 (88.4%) 1968 1,064 375 (35.2%) 350 (93.3%) Other contacts: 1966-124. 1967-135. 1968-147. Thus of 1,064 alleged sources of infection 375 (35.2%) were persuaded to attend compared with 29.7% in the previous year. Of the number attending 350 (93.3%) were found to be infected. 147 other contacts of gonorrhoea attended and 99 (67.3%) were found to be infected This increase in the effectivity of contact tracing in gonorrhoea results from a continued co-operative endeavour by the staff of the department and in particular from the valuable contribution made by the Social Workers." 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 action this year in this respect. 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 11 during the year -24- PART III PERSONAL HEALTH SERVICES III. PERSONAL HEALTH SERVICES The Principal Nursing Officer, Mrs. D.E. Marrin, reports as follows:- ''Staff recruitment in the Health Visiting and School/Clinic Nurse services remained steady, although turnover was rapid Six Student Health Visitors were sponsored during the year and training places were provided for six additional Health Visitors by arrangements with the various Colleges. One Health Visitor who left the service has joined Voluntary Services Overseas and has been appointed to a post in Kenya; it is hoped to publish a short article on her experiences there in due course. Day Nurseries It has been difficult to recruit staff of a suitable calibre for the Day Nurseries, especially the trained Nursery Nurse grade, of which there is a continuing shortage. As a result of a routine inspection at two of the Council's Day Nurseries by Inspectors from the Ministry of Health and Ministry of Education, the Christian Street Day Nursery has been upgraded as a Training Nursery, This should result in a better ratio of trained Nursery Nurses in our Borough. The places in the Special Unit for handicapped children, which is attached to Queen Mary Day Nursery, have been increased to ten to meet the increased demand, CIinic Centre Activities Health Visitors continue to carry out combined school nursing/health visiting duties and all School/Clinic Nurses continue to take part in the Maternity and Child Welfare Services, Cytology The Supervisor of Midwives assisted in a project aimed at taking the cytology test to women working in factories in the Borough, but response to this facility was rather disappointing The cytology sessions in the two Borough Clinics continue to thrive. Family Planning One Health Visitor assisted a doctor in starting a project to provide family planning facilities for mothers in their own home, who were unable, for various reasons, to avail themselves of the clinic facilities Some degree of success has been reported The Health Visitor withdrew after initiating this project and the Supervisor of Midwives is continuing supervision of mothers in the group, A number of nursing staff have attended the Family Planning Association's Two-Day Lecture Course and it is to be hoped that arrangements will be made for them to attend the eight practical sessions necessary to complete the training and obtain the recognised Cert if icate. -25- Prophylaxis During a period of shortage of doctors in the Clinics, some Health Visitors have carried out immunisations, under medical coverage, in order to keep the children adequately protected. It is hoped to extend the use of health visiting staff in this sphere of work. Creche Sessions These have been increased in number to accommodate young children of mothers attending the educational activities in the Clinics, e.g. sewing classes. Mothers' Clubs have continued in the Clinics and Psychoprophylactic (preparation for childbirth) sessions have been given by Health Visitors to mothers in clinics and in Bethnal Green Hospital. Pre SchooI Play Groups The number of these groups in the Borough is increasing steadily and all of them require regular supervision and advice from the Health Visitors and occasional visits by a Nursing Officer. ChiId Mi nders At the end of October, 1968 there were 6 statutory minders in addition to 42 minders voluntarily registered with the Council and who received a fee from the Council. On 1st November, the amendments to the Nurseries and Child Minders Regulation Act, 1948, came into force with a period of 3 months ''grace'' to make the necessary arrangements to comply with the very stringent new regulations. This involves detailed inspection of the premises, together with full enquiries into the health of the entire household and obtaining personal references with the result that many reliable minders refused to apply for registration. It will be appreciated that this has placed an unprecedented extra burden on Nursing Officers and Health Visitors alike, due to the short time available in which to inaugurate the scheme. Liaison with General Practitioners and Hospitals A good liaison between al1 the nursing and health visiting staff has been maintained with the local hospitals Liaison with general practitioners in their surgeries has made a promising start. Four general practitioners in the Borough now receive weekly visits from their local Health Visitor to facilitate constructive action and follow up of cases where necessary. Health Education Health Visitors continue to take part in health education programmes carried on in the schools. -26- Occasional evening meetings are arranged to which fathers are also invited to participate Training Certain Health Visitors acted as Field work Instructors to student Health Visitors Facilities were made available during the year for practical work and for experience in the public health field to Health Visitor students from the Royal College of Nursing. North Western Polytechnic and Barking and Chiswick Colleges Observation visits were also arranged for medical students and nurses from local hospitals and for post graduate social studies students and others-some from overseas Observation visits totalled 329 Management Course One Centre Superintendent attended a First-Line Management Course Teaching The Senior Nursing Officers have lectured on the Public Health services to Home Helps, Student Nurses in hospital and at Cheviot House The Principal Nursing Officer has assisted with lectures in hospital to obstetric nurse students and in the hospital examination of pupil midwives preparing for their Part 1 Examination of the Central Midwives Board. In addition, small groups of pupil midwives undertaking training for the qualification of State Certified Midwife attended the Health Department for discussion The Principal Nursing Officer attended various committees in hospitals and organisations in the Borough regularly and family case conferences at intervals These conferences and committees afford an opportunity to strengthen the liaison between the Local Authority and allied services A steady and profitable liaison was maintained between the Senior Nursing Officers at Cheviot House and the staff of the District Nurses' Home at Stainsby Road, all the more important in view of the pending integration of the District Nurse services in the Health Department in April, 1969. School Health Service The normal sessions have been held in the various Treatment Centres, but in view of the incidence of verminous conditions due to the type of families being re-housed in the Wapping area, the Health Visitor and School Nurse have been actively engaged in head cleansing for a considerable period. Due to constant observation and selective hygiene inspect ions at frequent intervals, infestation generally is being kept under control in all the schools in the Borough -27- In the autumn of 1967 there was a serious outbreak of ringworm in one of the schools, which was eliminated, due to the vigilance and work of the school nurses concerned,early in 1968, Research and Surveys Health Visitors and School Nursing Sisters assisted in the following studies at the request of hospitals and research organisations:- a) National Survey of Health and Development. b) Survey of Childhood Cancers c) Measles vaccination follow-up. d) Spina Bifida surveys (2). Supervisor of Midwives Miss Clarke states that the Domici 1 iary Midwifery service has continued its work as usual during the past year. An innovation, which involves the hospital and domiciliary idwives, together with the Health Visitors, has been the introduction of the Guthrie Test for the early detection of Phenylketonuria in babies, which replaces the Phenistix or ''napkin'' test. This has the advantage that it can be done at an earlier age, is more accurate and enables the appropriate treatment to be started promptly. Mental Health, Emergency Night Rota Health Visitors have continued to assist with the duties in respect of the mental health emergency service for covering nights, weekends and public holidays." ANTE - AND POST-NATAL CLINICS Passions are conducted in Council clinics by midwives and medical officers for ante- and post-natal examinations. In addition four general practitioners undertake ante-natal work for their own patients in Council clinics which are made available to them free of charge, and with a domiciliary midwife in attendance (Statistics on page 95 ) ANTE-NATAL MOTHER CRAFT 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 95) 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 71 children were examined and reports were made on 37 prospective adopters. -28- CERVICAL CYTOLOGY In 1966 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 cytology investigation by hospital authorities. This service continued during the year with sessions in the Council's clinics. In addition a general practitioner continued holding regular sessions in his 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 1,347 examinations were carried out In addition, hospitals in the area read 11,084 slides and although all the latter did not refer to borough residents it can be assumed that the majority did. Details will be found on page 97 of the Appendix. 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:- Number of babies notified as having one or more congenital defects 43 Number of stillbirths and livebirths notified over the same period 2,927 The rate of notifications per 1,000 total births was 14.7 compared with 15.6 last year There are obvious difficul ties 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 CHILD MINDERS Section 60 of the Health Services and Public Health Act 1968 which came into operation on 1st November amended the Nurseries and Child-Minders Regulation Act 1948 in order to remove various deficiencies which have become evident in its operation regarding the registration and supervision of child-minders and premises used for the purpose. Registration is now required of persons who look after one or more children under age of five for reward (not less than 3 children as previously) for two or more hours in the day. Formerly a ''substantial part of the day'' was the requirement for registration. Other provisions extended the existing powers enabling local authorities to refuse to register a person or premises and gave power to make various requirements in registering a person. Because the scope of the 1948 Act was so extended and the maximum penalties for failure to register were substantially increased, wide publicity to the new provisions was given by press, poster and leaflet campaigns. -29- A period of grace was allowed of three months from the date on which Section 60 came into operation before an offence against the amended provision was committed, consequently few persons now brought within its scope were registered this year. Details of registrations are given on page 96. CLINIC CENTRES There are 6 clinic centres in the borough, 3 school treatment centres and 7 combined clinic and school treatment centres. In connection with this year's programme of improvements to premises, solid fuel boilers for space and domestic heating were converted to or replaced by gas fired boilers in four clinic centres, and in the four day nurseries. To facilitate mothers living on the Isle of Dogs inattending child welfare sessions, with the co-operation of the Baths Committee and with the assistance of the Baths Manager, a branch of the Island Clinic Centre was opened at the Tiller Road Baths where child welfare clinic sessions are held now on alternate weeks. Additional toddlers sessions arranged this year numbered four per month. Following an offer made by the Education Officer of the Inner London Education Authority an English language class for immigrant mothers was inaugurated in June at one of the Clinic Centres, acreche session being held simultaneously to care for the children whilst the mothers received instruction. An average attendance of four mothers at each session can hardly be rated as very successful, although it is considered somewhat of an achievement to persuade Indian and Pakistani women to attend at all, since the majority seldom venture out of their homes other than to purchase food. Section 6 of the Health Services and Public Health Act 1968 enables Boards of Governors of Teaching Hospitals, subject to the Minister's approval, to make arrangements with a local health authority to provide specialist services at clinic centres. Regional Hospital Boards have had this power since 1948. CRECHES Children can be placed in creches for an afternoon at many of the clinic centres by mothers who wish to attend the mothers' club or sewing class at the centre or who have hospital appointments Creches also 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. Creches are provided at nine clinic centres, six additional sessions per month being provided at two centres. Attendances numbered 6,788 compared with 5,860 last year. -30- A recommendation was made under the Urban Expenditure Programme for additional creche sessions to be held at the Island Clinic Centre, which is situate in an area lacking in such facilities, so that sessions would be available morning and afternoon, each weekday. CHARGES AND ASSESSMENT SCALES FOR THE SOCIAL SERVICES In 1967 the London Boroughs Association considered the report of a Working Party set up to consider the calculation of charges levied for certain Health, Children's and Welfare Services and the abatement of these charges where appropriate by means of assessment scales. The Association after making certain amendments commended the report to the London Boroughs as a memorandum of advice and guidance. Following consideration of the matter by the Council's Co-ordinating Committee for Social Services and the other relevant Committees, certain amendments were made to the proposals and the amended scheme was adopted by the Council, the consequent revised charges and assessment scales coming into operation on 1st Apri1 1968. The general principle of the revised scheme is that the standard charge for any particular service for which a charge is required to be made should be the full unsubsidised cost, and if the applicant cannot afford to pay the standard charge the contribution made by him should be computed on his means. 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 unit is to provide relief for the parents, particularly the mother rather than to afford her the opportunity of going out to work. Three 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 69 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 disabledorin 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 at least 35 hours a week. Staffing problems of day nurseries still remain acute, particularly with regard to the categories of nursery assistants and students. As will be seen on page 137 the turnover of staff for the year was 29. In connection with the Government's Urban programme of expenditure in areas of special social need, mentioned elsewhere in this Report, one of the recommendations made by the Council was that higher salaries than those prescribed by the Nurses and Midwives Council be paid to day nursery staff in special areas. The Nurses and Midwives Council stated that they could not agree to this course of action. The Council's Heal th and Welfare Service Development Programme provides for the construction of a purpose-built Day Nursery in 1970/1971, at an estimated cost of £93,660, to replace a pre-fabricated nursery the lease of which expires in 1971. Private day nurseries and pre-school playgroups of which there are 12 in the borough (maximum capacity 235 children), are subject to registration and inspection by the Council under the provisions of the Nurseries and Child Minders Regulation Act 1948. Four additional playgroups were registered during the year providing accommodation for 67 children, (Statistics on page 96). FAMILY PLANNING Family planning sessions are conducted on behalf of the Council by the Family Planning Association at three of the Council's Clinic Centres, 460 sessions being held during the year. In addition, commencing this year, a weekly session staffed by one of the Council's Sessional Assistant Medical Officers and a Health Visitor is operated at another clinic centre. Also commencing this year, the Council now provides a domiciliary service particularly for families with multiple, social, or other handicaps. This year new patients numbered 950, an increase of 52% over 1966 and nearly 200% over 1965. (Statistics on page 99). FEEDING DIFFICULTIES Facilities are provided at acentre 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 Two interesting factors emerged last year while following the pattern of health education originally laid down. Firstly, the long-term contact and good personal relationships established through school discussion groups have added a new facet of prevention which can be fulfilled by the work of the section, i.e. that young persons who have left school have come back to health education assistants for social work referral when in need. Secondly, the many invitations to speak on the uses of health education work rather than how to do it, to teachers, social workers and others, have shown that the image of health education as a systematic technique of communication has finally been accepted, and that it -32- has become recognised in the form in which it is practised in this Borough has been shown by the number of students from other areas and disciplines who have visited the Health Education Officer during the year. The Mental Health Section having been the first to recognise the potential has increased its use of the health education services,including requests for a highly successful and well attended exhibition and regular attendances at training centres and clubs. The new Degree Course students from the London Hospital have visited the department for district ''orientation'' and discussion. The Health Education Council, which was set up by the Government to plan and promote national programmes of health education and to assist in the development of local programmes in co-operation with local authorities, professional organisations, voluntary bodies, industry and commerce, took over on lst April the health education promotional activities of the previous Ministry of Health and the work of the Central Council for Health Education. The Council's Welfare Committee expressed concern at the increasing number of applications received for admittance to part III accommodation for the homeless as a result of fires arising from use of oil heaters, and following a recommendation to the Health Committee appropriate action was taken to ensure the widest publicity being given to the matter, including house to house visits to immigrants to instruct them on the dangers of misuse of these appliances. Statistics on the work of the section are given on page 98. HEALTH VISITING 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 99 . 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 outpatients departments at hospitals to provide a link between hospital and home. The numbers of health visitors and tuberculosis visitors employed at the beginning and end of the year were 37 and 39 respectively, there being 9 resignations and 11 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. HOME NURSING The home nursing service for the borough is carried out on an agency basis by the East London District Nursing Society and the Nursing Sisters of St. John the Divine. The Council adopted a recommendation that having regard to the wide range of health services now provided directly by the Council in pursuance of its statutory powers, it would be in the interest of the borough and its inhabitants for the home nursing service to be brought under the Council's direct control and directed that discussions be commenced with the East London District Nursing Society and the Nursing Sisters of St. John the Divine with a -33- view to formulation of proposals which would enable such arrangement to be brought into operation on 1st April, 1969, In the event, arrangements were made for the Nursing Staff of the East London Nursing Society to come under the direct control of the Council in 1969, following amending proposals made to the Department of Health and Social Security under Section 25 of the National Health Service Act 1946 f Statistics relating to the home nursing service are on page 101. 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. Increased demands led to an expansion of the service necessitating the purchase of an additional hydro-extractor (Statistics on page 101> 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 Over 25,000 pads plus knickers and linings were purchased during the year and issued to 128 persons, almost doubling the service given last year LOAN OF NURSING EQUIPMENT Articles of nursing and sick room equipment are loaned at the request of the general practitioner, district nurse or hospital medico-social worker, etc free of charge for an indefinite period to persons being nursed in their own homes 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 102) DOMICILIARY MIDWIFERY SERVICE 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 by the Nursing Sisters of St John the Divine and the London Hospital In addition the Council directly employs a non-medical supervisor of midwives. Section 10 of the Health Services and Public Health Act 1968 consolidated earlier provisions relating to midwifery services and extends the scope of these services in a number of ways. No reference is made to the ''lying in period'' which removes any doubts as to the ability of a local health authority sending inahealth visitor or home nurse rather than a midwife if the latter is not required The joint scheme for training midwives by the Nursing Sisters of St. John the Divine and the Mile End Hospital, continued during the year Pupils who completed the course numbered 12 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, There were 270 home confinements attended by the Midwives Four general practitioners from -34- practices in the borough provided ante-natal care, with midwives, at four of the Council's clinics.( Statistics on page 103) 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 139. 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. VACCINATION AGAINST MEASLES Following approval given by the Minister of Health in 1967 for the Council to include vaccination against measles in its arrangements under Section 26 of the National Health Service Act 1946, general practitioners were invited to participate invaccinating children between the ages of 10 months and 2 years. By the end of the year notifications were received from general practitioners that they had vaccinated 664 children, the Council's staff vaccinating 2,163 children at Cl inic Centres. OBSERVATION REGISTER At the end of the year, the Observation Register totalled 5,800 persons, comprising:- Children under 5 ''at risk'' 2,912 -do- handicapped 295 Young persons aged 5-21 years handicapped 2,276 Children non-resident but attending schools in the borough 317 The senior medical officer keeps the register under constant review. Further details relating to the register will be found on page 88. A booklet is produced by the department setting out details of the services available for the care of handicapped children and young persons provided by the Council, the Inner London Education Authority and by other statutory and voluntary bodies. PHENYLKETONURIA Following the recommendations of the Department of Health and Social Security arrangements were made for the testing of infants for phenylketonuria to be carried out by the Guthrie -35- method to replace the Phenistix test. Co-operation was readily given by the hospitals in the borough having maternity wards, both in regard to taking the specimens and the pathological examination. The necessary arrangements were made with regard to domiciliary births by attending midwives and for health visitors to deal with other babies found not to have been tested. During 1968 babies numbering 1,688 were tested either in clinics or in their homes at about the fourth week of life. No cases of phenylketonuria were detected. PREMATURE BABIES Any child weighing 5½ lbs. (2,500 grammes) 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 99. 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 after-care of other persons under section 28 of the Act. Medical recommendations for holidays are submitted by general practitioners, hospitals, health visitors and social workers in respect of persons who are recovering from a recent acute physical or mental illness and who do not need nursing care. A total of 355 adults and children were placed in recuperative holiday homes during the year, including 181 school children for whom the Inner London Education Authority made arrangements. One Inner London Borough is responsible for the inspection of holiday homes on behalf of other boroughs included in the scheme which share the costs involved. During the year reports were received of 37 homes inspected 31 of which were recommended for continued use. (Statistics on page 101). CARE OF THE UNMARRIED MOTHER AND HER CHILD Mother and Baby 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 21. 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 provision of relief nursing staff as -36- required at these establishments. SERIOUSLY DISTURBED ADOLESCENTS In 1966 the London Boroughs Association set up a Working Party to study the problem of provision for seriously disturbed adolescents with a view to ascertaining what could be done to alleviate the difficulties existing in placing these young people in accordance with their needs. This Council approved of the Working Party's proposal to establish a pilot project, aimed at the statistical assessment of the needs of disturbed adolescents and the provision of co-ordinating services for them, in an area comprising the London Boroughs of Newham and Tower Hamlets. An East London Pilot Project Committee was formed, the Committee meeting several times during the year, and a conference sponsored by the London Boroughs Association was held at County Hall on 3rd July SURVEYS The Department has taken part in a number of surveys during the year in association with various research studies being carried out by the following bodies/authorities:- Department of Social Medicine, Oxford University: Survey of childhood cancers Greater London Council: Research and Intelligence Unit Physical handicaps in young people Medical Research Council: Measles. DENTAL CARE FOR THE PRIORITY CLASSES Section 22 of the National Health Service Act 1946 puts Local Authorities under an obligation to provide dental care for expectant and nursing mothers and children not yet at school This service is provided for in the same clinics and by the same dental officers who treat school children in the school health service. Previously separate sessions were devoted to the priority classes but mothers and their young children are now seen at any of the sessions in the clinics. It has been found that this arrangement makes it very much easier for mothers and young children to attend clinics and to receive dental inspections and treatment on the same day. The personal dental health of mothers during and after pregnancy and the protection and proper care of their children's developing and erupting teeth is of paramount importance; it is equally important for all concerned to understand the need for the toddler to be taken to the dentist regularly from before their second birthday. In establishing a pattern at this early age, the young child can easily accept the dentist and his environment, and fear never need develop. Far better that the child's first visit should merely include simple rides in a dental chair and the polishing of teeth, than wait until dental decay has brought pain and discomfort which will always be associated with the dentist. Advice on measures which can be used to prevent dental disease and applications which can be made to the teeth to strengthen them against decay will be made available at the same time. -37- The simple rules which clinic staff and parents can follow to help reduce dental disease are as follows: (i) Avoid eating sweet and sticky drinks and foods, especially between meals. (ii) Never give children undiluted black currant, orange or similar vitamin syrups. These are exceedingly harmful to teeth if taken from a spoon or miniature feeder. (iii) Clean teeth immediately after breakfast and supper. (iv) Finish meals with a fibrous food such as apples, carrots and nuts, and then rinse mouth with water. (v) Eat full meals at regular intervals throughout the day, but avoid between-meal snacks and sweets whenever possible. (vi) Eliminate sticky toffees and long lasting sweets from the diet. It is not unreasonable to allow children the occasional sweet but reasonable restrictions can make a big difference. (vii) Above all regular attendance at the dentist from two years on to obtain advice, establish a pattern, achieve minimal treatment as soon as it is necessary and to obtain topical application of solutions which will strengthen the teeth against potential future decay. The service meets the small demands made upon it. This year 361 children and 13 mothers were treated, a total of 598 fillings being provided and 5 teeth extracted. It is obvious that greater stimulation of demand for treatment from the pre-school child must be established. Now that we have a staff of three dental auxiliaries who are particularly trained to treat children in this age bracket, it is hoped that a considerable improvement will be seen in next year's report. During the year talks were given to mothers'clubs and to clinic personnel by all three dental auxiliaries. Details of dental treatment provided for expectant and nursing mothers and pre-school children will be found on page 97. -38- PART IV COMMUNITY CARE SERVICES IV COMMUNITY CARE SERVICES GREEN PAPER, MAUD AND SEEBOHM REPORTS Following the issue of the Report of the Committee on the Management of Local Government (Maud Report) in 1967 and in this year those of the Committee on Local Authority and Allied Personal Social Services (Seebohm Report) and of the Minister of Health on the Administrative Structure of Medical and Related Services (Green Paper) a Special (ad hoc) Committee of the Council was appointed in the latter part of the year to consider these reports together with that of the London Boroughs' Management Service Unit on the Reorganisation of aLondon Borough. MENTAL HEALTH The Principal Social Worker (Mental Health) Miss A.M. Joseph reports as follows: ''Ten years ago social workers were aware that in a few months the 1959 Mental Health Act would be in operation; an Act which would give a new look at Mental illness in particular. Until April 1965, Inner London was dealt with as a whole, but then came the transfer of the responsibility to the Boroughs. The emphasis on Community Care in the Act was probably the most difficult for people, whether relatives, neighbours or indeed other social workers to understand and accept. The patients must be willing to accept visiting, they may not be compelled to attend Day Centres or Clubs. It is still surprising to find how frequently mental health social workers are expected to be able to exercise power and remove people to hospital or indeed to enter their homes and to ignore the fact that the General Practitioner is the pivot. It is also strange how many still think that there must be a psychiatric problem when someone does not conform. It is not appreciated how different is working in and with the community, from treating people in hospitals whether general or psychiatric. Tower Hamlets is fortunate in having St. Clement's Hospital in its boundaries and now that the London Hospital has absorbed St. Clement's and Mile End Hospitals it is expected that the services for the patient will expand further. Much is talked of joint appointments but I think it is appropriate to point out that Tower Hamlets has provided 5 social workers for St. Clement's referrals and the number dealth with was over 756 in addition to other work done by these officers; the great difference is that the Borough pays all the salaries and expenses involved. It is also seemingly often forgotten that it is the Borough Mental Health Section that takes referrals from ''anywhere'' when the patient comes to live in it's area. In the future it is hoped that there will be joint appointments with hospital staff coming out into the community and that salaries and other expenses will be shared. This has been expected for a long time. It would mean staff would be doubled, visiting lists lessened for al1 and the emergency duties would come round less frequently. The department works well with the Psychiatric Rehabilitation Association but I think few realise that the Council gives an annual grant to the Association and recently has provided much improved premises for a Day Centre, making no charge for rent. Working with the Day Hospital for the Elderly, Pritchards Road Day Centre now opens (for Psychiatric -39- patients) on 3 days weekly. An Occupational Therapist continues to pay domiciliary visits to some who are unable to attend a Day Centre. The Borough continues to support the Day Centre at Trinity Congregational Church At Pritchards Road, the Disablement Resettlement Officer has continued to be helpful in finding work for those ready to resume work. It is also worth noting that 2 boys left a Training Centre at 16 years and went to work. They had been excluded from school at about 8 years of age The Special Care Units, Training Centres and Diagnostic Clinic have continued to do good work and the Borough is fortunate in having such enthusiastic staff to run them The new premises at Whitehorse Road for the Industrial Centre have made possible expansion in work and insocial activities Recently a Club has been opened at the Centre which welcomes both sexes and it is gratifying to note how many fathers come along as well as the ever supporting mothers Everyone is looking forward to the opening of the new Junior Training School and naturally hope that a new adult Centre will be provided for both sexes in the near future The Borough adopted the modern methods in their Centres as soon as all came under their wing, and there is no doubt that those attending have benefitted All Centres had happy parties, open days and outings during the year- Temporary care and recuperative holidays have been provided whenever necessary, the Centres sharing in the Dymchurch holiday with other London Boroughs I would like to pay tribute to Dr Jessie Edwards who opened the first Diagnostic clinic for subnormal children in East London as an experiment. She retired at Christmas this year. Hundreds of children have come to the Clinic in the past 11 years and many parents have been helped by her. I think the Clinic was able to help so many because Dr. Edwards and Miss E James, the Health Visitor were with me from the beginning. Although continuity is now not thought to be necessary, I think it will be a sad day when it goes as people with such stress in their families need continuity This does not mean emotional involvement. Changes are upon us once again and it must be hoped that in whatever way social workers are affected, the people, children and adults, mentally ill, maladjusted and mentally handicapped will in no way suffer. I also wish to thank the Parents Association for their help and finally my staff who work so hard to provide a service.'' Referrals Persons referred to the department showed a decrease of 50 per cent from last year, and the number under community care decreased by 14 per cent. 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 197 a decrease of 20 per cent from last year. Emergency Night and Weekend Service A designated mental health officer must, statutorily, be available at all times to deal -40- 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 5 p.m, each evening to 8.45 am the following morning and at weekends from 5 p,m. on Fridays to 8.45 a.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. No applications were received this year for approval, 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. 35 other persons were in hostels at the end of the year. By reason of the large amount of accommodation existing in the Borough for transients e.g common lodging houses, seamen's lodging houses and other lodging houses and houses in multiple occupation, an inordinate burden is thrown upon the Council by requests from hospital and other authorities for it to accept full responsibility for the care of mentally disordered persons in residential homes, on the grounds that the person had a Tower Hamlets residence prior to admission to hospital. The Ministry of Health Circular which governs the responsibility of local health authorities for providing such accommodation, is capable of varying interpretations, Accordingly, steps were taken in 1967 to have this matter brought before the London Boroughs Association with a view to obtaining agreement as to which authority should accept responsibility in the various categories of circumstances likely to arise The Council adopted the recommendations of the London Boroughs Association in the matter which were made known at the end of the year, namely, where the need for residential accommodation arises immediately upon discharge from a National Health Service hospital the test shall be ordinary residence prior to the date of admission; where the need arises immediately on a child ceasing to be in the care of a local authority the financial responsibility shall attach to the local authority which was responsible for the person whilst in care; where it cannot be established that the person had any settled residence within a reasonable time prior to the need arising, he shal1 be deemed to have been ordinarily resident in the place where he slept on the night before - 41 the day upon which the need arose. Special Care Units The special care unit for juniors which caters for those trainees who are too severely handicapped to be able to be taught and trained with other juniors, was transferred in June from the Junior Training Centre at Cornwall Avenue to more capacious accommodation at University House Day Nursery. In addition the special unit in the Council's Day Nursery for severely handicapped chi ldren under 5 years of age increased its intake from 6 to 10 children. Transport Transport is provided by coach and minibus to take trainees from their homes and training centres each day. Transport covers trainees attending the junior centres, adult female centres, the special care unit, the day nursery special unit and psycho-geriatric patients attending the Day Centre, whilst those attending the men's industrial training centre hitherto make their own way. Some trainees attending the industrial training centre who are unable to travel on public transport unaccompanied were escorted by guides employed for the purpose. At the request of the Parents' Association the Council agreed as an alternative to provide coach transport. A purpose built coach provided with a lift at the rear for handling persons in wheelchairs is used for transporting children to and from the special care unit (Photograph facing this page) 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. Parents Association Effective liaison with the Tower Hamlets Society continued throughout the year. This Society comprising mentally handicapped children and young persons receiving community care and their parents, relatives and friends is a very active organisation in the Borough and arranges many activities, social and cultural, for its charges Quarterly meetings of the Society are attended by an officer of the department to further the liaison between the Society and the Council, and to discuss common problems The Chairman of the Health Committee attended a quarterly meeting to discuss suggestions to improve the services and facilities provided by the Council, The Council make available the use of its day centre premises to the Society one evening a week, and on a Saturday evening each month for social and sports activities The junior training centre premises are also made available one evening each week for experimental reading and writing classes for mentally sub-normal children, at which the supervisor of the training - 42 - A purpose built coach with lift at rear for transporting mentally and physically handicapped children to and from the Special Care Unit of the Junior Training School. MENTAL HEALTH Junior Training School Activities centre gives her services. 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. The day centre for psycho-geriatrics is now open on three days a week, an extra day being arranged this year. The Psychiatric Rehabilitation Association operate two day centres for the mentally ill. During this year, one of their centres transferred to premises leased by the Council and which became vacant following curtailment of Civil Defence activities. In addition to the grant made by the Council these premises have been made available free of rent and maintenance costs to the Association. Junior Training School Construction of the new junior training school began mid-year and completion is expected by the end of 1969. The centre will provide training places for 95 mentally severely sub-normal children of school age, plus a special unit for 20 children suffering from physical as well as mental handicap. The accommodation to be provided will include assembly hall, 7 class rooms, 3 rooms for the special care unit, a nursery, handicraft room and domestic science room. There will also be recreational facilities including playground, grassed area and children's flower garden. During the year the Government made known i ts intent ion to transfer the responsibility for the education and training of mentally sub-normal children from the Department of Health and Social Security to the Department of Education and Science. Photographs of junior trainees activities are facing this page. Adult Training Centres There are two centres in the borough for training sub-normal adults, one being an industrial centre for males and the other comprising a senior group for females aged 16 and 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. - 43 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. Amounts received for work executed by the trainees amounted to £3,440, against which has to be offset the cost of materials. Payment is made to trainees, based on attendance, and is regarded as incentive pocket-money to supplement state benefits which they receive. £1,995 was paid out as incentive pocket-money during the year. Guardianship Three severely sub-normal patients remained under guardianship of the Council at the end of the year. 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. 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. St. Clement's Hospital The Medical Director of St. Clement's Hospital, Dr. John Denham M.D.,D.P.M., has kindly supplied the following report on the year's work of the hospital:- "In 1968 St. Clement's Hospital finally took on the responsibility for the psychiatric treatment and care of the residentsof the London Borough of Tower Hamlets, Four years ago the Regional Hospital Board accepted a plan for the provision of a comprehensive psychiatric service in East London based on St. Clement's Hospital. This could only be achieved by close co-operation with the Mental Welfare Department and the assistance of the Psychiatric Rehabilitation Association. The essential steps towards a comprehensive service were provision of:- 1. Emergency service 2. Early treatment 3. Community care 1. The Emergency Services for the newly created London Borough of Tower Hamlets were based on St. Clement's Hospital since 1st April 1965. During the day the duty doctor has examined, treated and accepted patients at their own request or from general practitioners or other social agencies. At night and during week-ends the duty doctor deals with all requests from the community in the hospital or in appropriate cases at home. - 44 - Within three months the provision of this Emergency Service during dayandnight had reduced the emergency admissionsduring the night and weekends from fourteen to four per month. The majority of urgent cases were treated and followed up in the Emergency Unit - Coborn Ward- The effect of this service can be illustrated in the reduction of compulsory admissions under Section 29 of the Mental Health Act 1959. ORDER 1965 1966 1967 1968 Section 29 (3 days) 106 63 53 52 Section 25 (28 days) 48 52 42 43 2. Early diagnosis and treatment was provided through rationalisation and centralisation of out-patient clinics, and expansion of out-patient and day patient facilities. OUT-PATIENTS 1963 1964 1965 1966 1967 1968 New 278 283 581 6 7 7 8 7 2 921 Total 1,704 2,169 7327 9,122 11,060 12006 Emergency Unit - - 2941 3812 6,144 6821 DAY-PATIENTS Psychiatric 75 829 1,762 290 1 3,873 7,147 Geriatric 5,254 5,191 5,567 5,382 5,699 5,607 This was backed up by short-term treatment and increased bed-occupancy. It was greatly assisted by the absence of a waiting-list and the opportunity of daily visits for the patients in hospital. ADMISSIONS 1963 1964 1965 1966 1967 1968 From Tower Hamlets 287 296 502 611 622 726 Total 475 570 1,174 1,200 1,146 1,143 Emergency Unit 110 132 260 337 335 332 3. Community care has been provided by the Mental Welfare Department and the Psychiatric Rehabilitation Association. Mental Welfare Officers attend the hospital to receive referrals of cases for after-care and visit their patients during their treatment and after their return home. Each one covers one of the four postal districts in Tower Hamlets with an annual referral rate of between 40 to 65 per social worker. One Day-Centre at Pritchards Road has been provided by the Local Authority and twoothersin Shandy Stree t and Kiteat Terrace by the Psychiatric Rehabil i tat ion Association. They provide occupation for the patients who require further treatment at home or who need a period of training before returning to full employment, or who live alone or under stress, and finally those handicapped who are unable to work but able to live at home. Five evening centres provide for the social rehabilitation of the patients.A hostel for 23 psychiatric patients recently discharged from hospital has been provided by the Cheshire Foundation and the Psychiatric Rehabilitation Association at Nicholas House, Old Nichol Street. On the same premises an Industrial Education Unit was opened in 1967 by the Psychiatric Rehabilitation Association assisted by the Inner London Education - 45 - Authority, to provide training and education for patients in new and old skills before their return to work. With the assistance of these community services it was possible to avoid the need of long-term hospitalisation at Long Grove Hospital and to reduce the rate of relapse in an area of above average prevalence of psychiatric disorder. On 1st April 1965 St. Clement's Hospital accepted the statutory responsibility for the eastern half of Tower Hamlets, i.e. the postal districts E.3, and E.14; and on 1st November 1967 for the remainder For the first time a small psychiatric hospital or unit has been given full statutory obligation and provided a comprehensive psychiatric service. Further developments include the designation as a teaching hospital in April 1968 and the administrative transfer to the London Hospital, and the opening of a drug addiction centre in February 1968. A new unit was built which currently houses a Day Hospital and Treatment Centre for 100 heroin addicts ' St, Clement's Psychogeriatric In-Patient Unit and Day Hospital I am indebted to Dr. K. Hemsi, M.R.C.P D.P.M., the Consultant Psychiatrist to St, Clement's Hospital for the statistics given on page 104 relating to the work during 1968 of the In-Patient Unit and Day Hospital and for the following - The Unit is staffed on the medical side by one Consultant for three sessions a week and one full time P.egistrar There are twenty-eight beds in the In-patient Unit, eighteen female and ten male, while the Day Unit is able to accommodate about 25 patients per day and has about fifty-five patients on the books.'' Mental Health Week An exhibition in one of the Council's Libraries to show the very considerable work done by the mental health section towards the training and rehabilitation of the mentally ill and sub-normal in this area, was held in connection with Mental Health Week from 9th-15th June. The exhibition was staged by the health education and mental health sections of the department, and during the week over 600 members of the genera] public were interested visitors. It is felt that the personal attention they were given both at the exhibition and in the subsequent visits to training centres and the open days, will have made a lasting impression of the efficiency and adequacy of the service provided which, because of the method by which it was done, they will pass on to an ever widening circle of the public. A photograph showing part of the exhibition faces this page. Stat ist ics Statistics relating to the Mental Health Services appear on pages 104 to 106. - 46 - MENTAL HEALTH WEEK EXHIBITION HEROIN ADDICTS The Council approved in principle the recommendation of the London Boroughs Association that a Joint Board be set up for the purpose of providing and maintaining hostels for the rehabilitation and after-care of heroin addicts. Each borough would be represented on the Board and all London Boroughs would contribute to the costs. BLIND AND PARTIALLY SIGHTED PERSONS For the purpose of the Council's scheme for providing welfare services under the National Assistance Act 1948 for the blind and partially sighted, it is necessary to arrange medical examinations in connection with the certification of such persons. The department arranged 158 examinations by a consultant ophthalmologist during the year and certificates accepted from other local authorities, hospitals and private ophthalmologists numbered 75. Transport to the clinic for examination is arranged for these persons where necessary. CHIROPODY Foot clinics are held at 7 of the Health Department's establishments and at 3 other premises. Treatment is provided for corns, callosities and malformed nails; advice is given on shoe fitting, foot hygiene and exercises. A total of 38 sessions are held each week by one full-time and nine part-time chiropodists. For those unable to attend clinics, six of the chiropodists visit their homes to give treatment: Treatment is free to old persons, to those on retirement pensions, expectant mothers, schoolchildren and the physically handicapped. When such patients can be taken to clinics arrangements were begun this year to provide transport for them, a total of 81 patients being transported during the year. The average time between clinic appointments is 8 weeks and 9 weeks between domiciliary treatments. In addition a chiropody service is provided by the Welfare Department of the Council for residents of old people's homes, and I am indebted to the Chief Welfare Officer for the information on this service provided by him and included in the statistics on page 97. 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 bathing attendants. If the dwelling is without a bath, a 'bungalow' bath is taken to the premises, together with hot water in insulated containers. This expanding service necessitated the engagement of additional bathing attendants this year. (Statistics on page 100). 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 to assist aged persons who are unable to fend unaided for themselves. Increasingly the service is attending to the demands of the latter category (87%) understandably because of the growing number of 47 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 280 home helps were employed by the Council. 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. those persons in receipt of supplementary benefit or families where the mothers, suffering from toxaemia of pregnancy, have submitted a medical certificate. Specially trained helps are utilised to provide assistance to problem families. An in-service course of 8 lectures designed to assist helps in their work was attended by 30 home helps. Households numbering 3,643 were provided with the service during the year compared with 3,585 last year. Section 13 of the Health Service and Public Health Act 1968 confers on local health author ities power to provide laundry facilities for households where home help is being provided,but the Minister deferred bringing this section into operation for the present in the light of the present economic situation. (Statistics on page 100). DAY CARE SERVICE The day care service continued to function satisfactorily. This service which is additional to the normal home help service, is given to selected aged persons by neighbours or persons living in the immediate vicinity, and is intended to cater for those persons chronically ill or bedridden and living alone who require visiting or attention several times a day. The service is however, limited to the availability of the neighbours willing to undertake this paid work. REMOVAL OF PERSONS IN NEED OF CARE AND ATTENTION 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 hospital or institution of any aged, infirm or physically incapacitated person living in insanitary conditions, and who is in need of care and attention. It was found necessary this year to apply for Removal Orders under this enactment in respect of 14 persons, 13 of whom were removed to hospital and one to a Welfare Home. BURIALS Section 50 of the National Assistance Act 1947 places a duty on the Council to arrange for the burial ofanyperson found dead within the borough where no private arrangements have been made. Burials undertaken during the year numbered 52. (Statistics on page 108). - 48 - PART V ENVIRONMENTAL HEALTH SERVICES V ENVIRONMENTAL HEALTH SERVICES The Chief Public Health Inspector reports as follows:- Street Trading in Food "The Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 have been in operation for two years and it would have been reasonable to assume that after this time a satisfactory overall improvement would have been achieved. This is not the case, for only certain stalls here and there are seen to be fully complying with the Regulations. A half-hearted effort has been made by others. To say the least, this is certainly not a reflection on the time and trouble which Public Health Inspectors have spent explaining the requirements verbally, and in writing to traders, and after these painstaking efforts have failed, taking numerous prosecutions to the Magistrates' Court where heavy penalties have been imposed, With most sections of the community the law is respected and co-operation in implementing it is forthcoming, but street traders are, in some cases, stubborn and unco-operative. This could be attributed to their inability to appreciate that cleanliness is of paramount importance where the handling of food is concerned, and their reluctance to change habits which have been practised for years. However, when a trader states that "You can't have fish without flies", then Food Hygiene Regulations are obviously not the complete answer neither is "Petticoat Lane" on a Sunday morning the place to try to preach Health Education. These are just some of the many difficulties encountered in trying to improve street trading conditions With the licensed trader, hope is held high that common sense and persuasion will prevail eventually, but with the unlicensed trader we are fighting a losing battle for the moment. These "pirates" appear in this and other areas knowing that, even if they are prosecuted for illegal trading, the fine will probably be less than a genuine trader would pay for a licence over a period. Invariably they are abusive and belligerent when approached and in cases where a name and address is given it is often false so that summonses cannot be served. Hot dog and ice cream trollies are the chief offenders in the streets, and fruit and vegetable vendors on vacant land. Much heavier penalties for illegal trading would certainly help in this direction. Street trading is not likely to disappear, so what for the future? Two street markets are about to be absorbed in redevelopment schemes and alternative facilities to be provided in the new development. Here are chances which must not be missed. Consideration should be given to Council owned stalls and awnings being hired out to traders in the new market and to storage facilities, refuse disposal and hot water points being provided in the development. This will not only give the Public Health Inspectors a sound basis to work from but will prevent worn out stalls with bedraggled awnings being incorporated in a new development. It is foreseeable that most street markets could eventually be transformed in this way. - 49 - In 1965, this Council, in its wisdom, resolved that new licences would not be granted for the sale in the open air of Meat, Poultry, Fish, Bread, Confectionery and Sweets i.e. as open food. Ultimately, this will result in all these commodities being sold only if pre-packed, albeit progress will be slow, A joint consultative committee comprising Street Traders' representatives and members of the Health Committee has been formed and meetings are held from time to time, when traders discuss their problems. Imported Food Inspection On the 1st August, 1968, the Imported Food Regulations, 1968 came into operation; the first complete change in the laws concerned with the supervision of imported food for 20 years. The new Regulations have taken into account the remarkable change that has recently occurred in the transport of imported food by means of containers, which has revolutionised the whole system of food imports and exports, also resulting in inland authorities having a responsibility for the inspection and supervision of imported food, The number of forms and letters required under the 1968 Regulations has increased considerably, but it is generally agreed that, whilst not perfect, the Regulations are a great improvement on the 1937 - 1948 Regulations which they have superseded. In preparation for the operation of the new Regulations, new forms were devised and a review of the Regulations in comparison with the old Regulations was undertaken after considerable discussion and consideration by officers of the Port of London Health Authority and the London Riparian Authorities Offices, Shops and Railway Premises Act, 1963 Although few complaints have been made by employees, numbers of anonymous queries are received from staff reluctant to disciose their identities or the addresses of their places of work. Evidently many employees in offices and shops are now aware of the protection afforded them by the Act, but, unfortunately, they hesitate to report bad conditions, because, being members of small staffs, they fear incurring their employers' displeasure. An interesting difficulty frequently occurs in enforcing Section 16 of the Act. It was found that numbers of premises situated on, or entered from, roads designated "Clearways" had their internal passageways obstructed by cartons, cases, packages, etc. stacked ready for dispatch. When occupiers of such premises were informed of the contravention of the Act, they pointed out that they had no alternative but to stack goods in the vicinity of the door, because it was essential for goods to be transferred to and from vehicles as speedily as possible. Vehicles on "Clearways" are legally permitted a period of only 20 minutes a day to load or unload, so that occupiers of premises adjoining a "Clearway" experience great difficulty in not contravening one or other of the laws If they stack goods as described, the Offices, Shops and Railway Premises Act 1963 is contravened; if they stack elsewhere on the premises, loading or - 50 unloading may exceed 20 minutes and the Road Traffic Act is contravened; and the stacking of goods on the footway is forbidden by the Highways Acts 1959 and 1965 which is enforced by the Borough Engineer and Surveyor. Altogether, it is difficult for occupiers to comply with Section 16 in some parts of the Borough, though much improvement is achieved by advice on replanning the storing and loading of goods A list of premises in the Borough subject to the Hoists and Lifts Regulations 1968 is being compiled. When premises are added to the list, occupiers are sent a letter outlining the purpose of the Regulations, and requesting them to make suitable arrangements for regular inspection after the commencement date. During August and September letters were sent to all occupiers of registered premises pointing out their responsibilities under Section 48 of the Act relating to accidents. As a result of this letter, many telephone enquiries were received which clearly indicated that many employers were ignorant of these provisions, and consequently the number of accidents reported during the second half of the year rose by nearly 100% over those reported during the first six months, so that by the end of the year 63 accidents were reported, as against 45 in 1967. The response to the letter was therefore encouraging, and, in future, a copy will be sent to each new occupier as his registration is received. There was one fatal accident reported during the year. Poultry Inspection The majority of birds slaughtered are for the Jewish trade and all birds are inspected by the officers of the Beth Din at the time of slaughter. Prior to this they are culled out at the farms and a further live inspection takes place before slaughter birds which are not considered top quality being returned or sold elsewhere alive. This is done to ensure that the number of birds rejected ritually is kept to an absolute minimum. Of the birds that are rejected a very small percentage are unfit, the main reason for rejection being bruising, damaged legs, wings and breasts. It is estimated that 1,838,500 birds are slaughtered for the Kosher trade in borough poultry slaughterhouses. About 170,000 birds are slaughtered annually for the Muslim trade. The pattern of business is unique inasmuch as the customer picks and buys a live bird, it is slaughtered for him, and if he so desires it is plucked, eviscerated and chopped. This method of trading makes inspection a practical impossibility. The slaughter-houses are visited regularly to see that proper standards of hygiene are maintained. Health Education Requests for assistance in this field remain popular. Senior Girls' Schools, a Mothers' Club and many overseas students were given instruction which included practical - 51 visits and the use of film strips. The work is undertaken by the Public Health Inspectors in conjunction with the Health Education Officer, The Health Department entered a decorated float in the Tower Hamlets Carnival based on the theme "Wash Your Hands" and were awarded second prize in the Civic Publicity Section, with a cash award of six guineas, which was donated to the Tower Hamlets Health Amenities Fund Slum Clearance In addition to the present quinquennial programme which is nearing completion, other additional areas have been represented which formed part of the Council's 10 year housing programme These properties would have been included in the next slum clearance programme at present under preparation. Lorry Drivers If necessity is the mother of invention then it is high time that proper provision, checked by statutory controls, was made to accommodate long distance transport drivers and their vehicles. It is important that all such premises should be required to be registered with the Local Authority and that standards to control overcrowding and the provision of amenities be legally enforceable. The Council has adopted a standard for overcrowding and amenities, but although it is being enforced where applicable it still has yet to withstand the test of the Courts. Drainage and Water Closet dyelaws New drainage work and alteration to existing drainage is supervised by the Public Health Inspectors, who also observe on all plans submitted to the Council. During the year 238 plans were examined and 5,539 visits made to work in progress. With the trend to use new materials for drainage work, both above and below ground, supervision of the work on site is of paramount importance to ensure that only approved materials are used. There is a tendency to drift from the provisions of the bye-laws, particularly where enclosed water closets are installed, It is difficult to appreciate what is to be gained by not siting a water closet and bathroom on an externa] wall when the inconvenience of absence of natural lighting and ventilation also necessitates the expense of installing and maintaining a system of mechanical ventilation. Where mechanical ventilation is installed, on this account, the balance of the system is checked by the Public Health Inspector using an anemometer. Staff The position regarding technical staff has remained numerically static. The Department has at present six Student Public Health Inspectors including three students in their fourth and final year. During the year two students who sat the final examination succeeded in passing and were appointed to the Inspectorial staff. 52 - Apart from visits arranged by the Technical Colleges, further visits of interest were arranged by the Inspectorial Staff in the Department, These included visits to new building projects, licensed and unlicensed caravan sites in Kent, prefabricated building factories, salmon curing plant, an egg processing plant, common and seamen's lodging houses (day and night visits), practical meat inspection and handling, inspection of fish at Billingsgate Market (early morning). Many more visits were made in the company of Public Health Inspectors during the normal course of their work," CLEAN AIR Two smoke control orders became operative during the year, namely the Tower Hamlets No. 3 Order made on 11th May 1967, and Tower Hamlets No, 4 Order made on 28th September 1967. The orders came into operation on the 1st July 1968 and the whole of the Borough is now covered by Smoke Control Orders; As the result of schemes of modernisation, amendment of development programmes and or additions to the slum clearance programme, six variation orders to exempt premises not previously exempted from smoke control orders became operative during the year. The proposed installation of 1,004 heating appliances was approved for the purpose of grant during the year, the estimated grants totalling £9,100 Discretionary grants in respect of the 30 per cent balance of cost of works of adaptation to heating appliances in dwellings were approved by the Committee in two cases, on grounds of hardship Under the provisions of Sect ion 3(3) of the Clean Air Act 1956 furnaces may not be installed in buildings unless notice of proposal to install has been given to the Council, Notices were given to the Council of proposals to install furnaces in two premises, applications for prior approval under Section 3(2) being submitted and approved in two 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 Animal Boarding Establishments Act 1965. . Visits were paid during the year to the 18 poultry slaughterhouses and 12 live poultry dealers in the borough. Each of 14 pet shops received quarterly visits and a routine inspection regarding renewal of licence was made of an animal boarding establishment. Close attention has been paid to the animal market held on Sunday mornings in Club Row, and visits of inspection made at frequent intervals On several occasions investigations were carried out following complaints by individual members of the public and on one occasion by the Royal Society for Prevention of Cruelty to Animals. Following a suspected case of psittacosis in a man who had previously purchased four budgerigars from pet shops in the area, all such shops were visited and information obtained as to the numbers of imported birds on their premises. - 53 - Statistics will be found on page 109). FOOD AND DRUGS Analysis of Food and Drugs Samples During the year 961 samples of food and drugs were submitted for analysis by the Public Analyst, 2 being purchased formally, 939 informally, and 20 were private samples. Irregular samples ascertained numbered 82, Action taken with respect to the irregular samples was as follows:- Legal proceedings were instituted in respect of five samples, namely an almond cake which contained a piece of jute string, grapenuts which were infested with biscuit beetle, a meat pie embedded in which was a bacon beetle, a wrapped sliced white loaf containing a cigarette end, and minced meat which contained added sulphur dioxide preservative. The total fines and costs awarded amounted to £74 and £29.8. respectively.' Matters taken up with manufacturers or importers included an almond cake which contained jute string, bread containing a baked-in end of filter tipped cigarette, butter and raisin bran contaminated with mould growth, canned braised kidneys containing sodium nitrite, canned aubergines containing excess tinwith considerable discolouration, canned blackberries containing dogwood berry, canned red plums containing added colouring matter, soft drink which contained 56 per cent rum, currants containing excess mineral hydrocarbons, kippers containing nitrite and nitrate, lemon juice and minced meat containing added sulphur dioxide preservative, pasteurised milk containing fragments of potato, sterilised milk containing two per cent added water, amilk bottle which contained red coloured plaster of paris, apple turnover, dried fish, bubble gum, coloured sweets, confectionery eggs and smokers' cough pastilles containing prohibited colouring matter, pork sausage deficient in total meat content, soft drink containing mould growth and a splinter of wood, and white bread containing wholemeal dough, grape-nuts, meat pie and whole nutmeg infested with insects. The absence, inadequacy or improper declaration of ingredients on labels were ascertained in 44 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 andDrugs Act, 1955. will be found on page 110. Bacteriological Examination of Foodstuffs Samples submitted for bacteriological examination numbered 146 comprising: 19 Spray dried hen egg albumen. pasteurised (American) 1 Canned pork luncheon meat (Dutch) 4 Dried hen egg albumen crystals (Chinese) 1 Canned mussels (Dutch) 23 Egg noodles, pasta, macaroni (Italian) 1 Canned stringless green beans (Chinese) 1 Canned tomato Paste (Portuguese) 1 Corned beef 2 Canned corned beef (Argentine) 1 Canned pork 1 Canned corned beef (Paraguayan) 1 Prawns - 54 - 1 Cooking butter 6 Frozen Prawns 1 Canned cooked chicken skins (Dutch) 1 Canned cleaned prawns (American) 1 Canned whole chicken without giblets 6 Frozen cooked peeled prawns (Japanese) 1 Cooked chicken 2 Fresh egg Rusks (Dutch) 3 King crab meat 1 Sardines 1 Artificial cream 3 Sauces, ketchup 1 Canned Jersey cream 6 Canned shrimps (Pakistan) 3 Jellied eels 1 Shrimp spawn noodles 1 Salted duck eggs (Chinese) 2 Canned Kangaroo tail soup 2 Sweetwater assorted dried fish (Pakistan) 1 Real turtle soup 2 Canned turtle meat 3 Ham 1 Turtle meat in wine 24 Ice cream 1 Canned ox tongue (Brazilian) 4 Ice lollies 1 Bulk lard (Dutch) 1 Canned poultry liver 1 Canned lychees in syrup 8 Meat pies Unsatisfactory results were obtained from 2 of the samples, of egg noodles , Salmonella montevideo and Salmonella braenderup being isolated. The consignments were destroyed under supervision. Ice Cream There are 22 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. 24 samples of ice cream submitted to the methylene blue reduction test gave the following results: Manufactured Grade In Borough Outside Borough Total I 5 7 12 II 5 3 8 III 1 1 2 IV - - - "Parev" Ice Cream: Satisfactory 2 - 2 In the case of the unsatisfactory sample (Grade III) manufactured in the Borough, an investigation was carried out and recommendations made. Details of the sample manufactured in another area were referred for action to the Borough concerned. - 55 - Catering Premises Catering premises in the borough numbered 1,322 at the end of the year. Consideration was given last year to the suggestion for the introduction of legislation requiring that catering establishments register with local authorities. The Council agreed that there was a need for registration and supported the proposal of the London Boroughs Association to seek inclusion of suitable provisions in a Greater London Council (General Powers) Bill. Food Hygiene (General) Regulations 1960 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966 Food premises in the borough are subject to frequent 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 628 and 280 summonses involving 58 premises/stalls were heard during the year. Details of action taken under Regulations 16 and 19 of the Food Hygiene (General) Regulations 1960, are contained in the Appendix, page 111, Food Export Certificates Certificates numbering 89 were issued in respect of a variety of foodstuffs exported to Belgium, Brazil, Canada, Canary Islands, Finland, France, Greece, Italy, Jordan, Kuwait, Lebanon, Libya, South Africa, Portugal, Spain, Sweden and Zambia. 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 product ion. Imported Food During the year 17 samples of imported food were found not to comply with the Labelling of Food Order and importers and manufacturers were notified so that labels could be amended. Non-permitted colours were found in samples from two consignments of imported confectionery. One of the consignments was dealt with by the Local Authority to which it had been sent; the other is still detained at the wharf. At the request of the Customs, a sample of Absinthe was submitted for analysis. One of the constituents, thujone or absinol, is of such potency that it is important that it should be controlled. In the U.S.A. the recommended limit is 10 p.p.m. in alcoholic drinks flavoured with wormwood oil. Thujone in the sample submitted was approximately 3 p.p.m. Samples of Pakistani sweetwater dried fish were found to be affected by insect contamination and were released for sorting before distribution. Insect attack was also responsible for the condemnation of a consignment of Sudanese groundnuts in shell which were subsequently released for use as bird food. A number of consignments of groundnuts in shell were sampled for the presence of aflatoxin, but were - 56 - found to be negative. Indonesian nutmegs, heavily affected by insect contamination were released for essential oil extraction, and, in a lesser attack, for screening and cleaning before use for human consumption. Turkish dried apricots containing Sulphur dioxide preservative, marginally in excess of the permitted limit, were released only for catering purposes where cooking was required before use. Another consignment, packed for retail sale, where the amount of Sulphur dioxide was much in excess of the permitted limit, was detained and is being exported. There are regular arrivals of bulk lard in tanker ships, and in each case, the requisite official certificates are scrutinised for compliance with the Regulations. Such Certificates are now required to indicate the position in the ship of the tanks, to state the quantity of lard in the tanks, and to state that the tanks were inspected and found to be clean before the lard was loaded: Samples of the lard are periodically taken for analysis. Samples of imported dried egg and frozen prawns and shrimps, periodically submitted for bacteriological examination during the year, were all found to be satisfactory. Detention notices numbering 143 and 114 release notices were served under the Public Health (Imported Food) Regulations 1937-48 and the Imported Food Regulations 1968. These notices affected a variety of foodstuffs including; animal casings, cocoa, coffee, confectionery cocoa butter, dried apricots, dried egg and dried fish, fruit juice, groundnut kernels, groundnuts in shell, meats, nutmegs, salami, sausages, shrimps, spaghetti, sugar, tea, tomato paste and walnut kernels. Section 62 of the Health Services and Public Health Act 1968 brought hovercraft within the scope of the Food and Drugs Act 1950 and the Public Health Act 1936 by construing the words "Vessel" and ''Ship" as including hover vehicles. Liquid Egg Pasteurisation There are two plants in the borough where liquid egg is pasteurised. The high level of hygiene at the larger of the two establishments was well maintained during the year. At the smaller premises difficulties are still experienced because of cramped conditions in an old building due for demolition in the future. Pasteurising occurs there intermittently and all 15 samples taken proved satisfactory when submitted to the alpha amylase test. Milk Supply-Samples Milk samples submitted for chemical analysis numbered 30, including 8 taken at hospitals, schools and day nurseries. The average fat and solids-not-fat content of ordinary milk samples analysed was 3.88 and 8.54 per cent respectively, and of the superfatted variety 4.55 and 8.85 per cent. No raw milk is sold or processed in the Borough. Consequently no samples were taken for examination for the presence of brucella abortus, One sample of milk, purchased at a retail shop, was found to contain, surprisingly, at least 2 per cent of extraneous water, Additional samples obtained from the same source of production were satisfactory, and investigation at the dairy failed to reveal the reason for the discrepancy. - 57 Unsound Food The following quantities of unsound foodstuffs were disposed of under the Public Health (Imported Food) Regulations and the Public Health Acts: Wharves 77 tons London Fruit Exchange and Spitalfields Market 89 tons Other Premises 126 tons TOTAL 292 tons About 12 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 Cleansing Department at whose riverside depot it wa6 mixed with household refuse, under supervision, and removed by barge to a controlled tipping site in Essex. Condemnation certificates numbering 1,053 were issued in respect of unsound food in 1968. 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 31. The complaints referred to - A11eged unsound condition: Apple pies 2, corned beef 1, butter 1, cheese 1, chicken 2, jam 1, lemons 1, minced meat 1, mushrooms 1, pancake roll 1, pies 2, raisin bran 1, sausages 1, canned tomatoes 1, canned mixed vegetables 1, yoghourt 1. Alleged dirty condition and/or foreign body or deposit: Baby Food 1, corned beef 1, bread rolls 1, bread 2, cake 1, cheese 1, chicken 1, chocolate eclair 1, grapenuts 1, peanuts 1, sausage 1. HOUSING The number of commonwealth immigrants coming into the borough continues to demand vigilance to be exercised by all sections of the department not least the environmental health section, particularly in respect of overcrowding and houses in multiple occupation. - 58 - Slum Clearance During the year 10 Clearance Areas were represented involving 339 houses. There were 13 Public Inquiries and 9 Orders have been confirmed to date. Overcrowding Principally, this arises from two main causes; natural increases in families and deliberate over-occupation. The latter occurs in many cases of immigrants who are ignorant of the existence of standards. This is difficult to condone, however, when a person applies to his Government for an assisted passage which is refused on the grounds that the accommodation he has provided for his family is not adequate and promptly proceeds to arrange for his wife and eight children to come here on full fare and occupy ONE ROOM. The problems caused thereby for various Council Departments need no mention here. To control this type of overcrowding is difficult. A general requirement that adequate accommodation was available for immigrants would only lead to the establishment of ''Clearing Houses'* without there being control also over further movement from the original approved address. The standard for overcrowding has remained the same for the past 34 years and whilst it is a very poor standard there is no point in raising it whilst there are far too many overcrowded conditions by definition of the existing standard. Underground Rooms There is a considerable number of underground rooms in the Borough used for living and sleeping purposes. When it is known that an occupier of an underground room is likely to be rehoused closing order prpcedure under the Housing Act, 1957, is implemented. During the year Closing Orders were made in respect of eight such rooms. Applicat ions for Rehousing At the end of the year, there were 7,616 applications for rehousing on the Council's waiting list, 410 less than last year. Tenants of Council dwellings who have applied for transfer to larger or smaller accommodation number 1,122, an increase of 82 on 1967. Preferential Housing on Health Grounds Applications for preferential housing on heal thgrounds investigated during the year numbered 558. An 'urgent' assessment was granted in 39 cases and balancing points were awarded in a further 168. Tenant transfer was supported in the case of 112 tenants of Council dwellings. Houses in Multiple Occupation The multiple-occupation of houses is increasing and spreading to two storey houses, where it is not unusual to find three or four families in occupation. Houses occupied in this way become known to the Department by routine inspection, complaints and newsagents advertisements. - 59 - At the end of the year some 920 houses were under surveillance, 231 being registered in accordance with the registration scheme affecting four wards of the Borough. Due to the mode of occupation and the use of paraffin heaters the fire risk in these dwellings is high. During the year 170 premises were found to be deficient in the means of escape in the case of fire and it was necessary to serve 101 notices to remedy the deficiency. One person was fined £25 and two persons £10 each for failing to comply with notices. Management Orders were made in respect of 27 premises following the service of 70 notices of intention to make such orders. Representations, received from owners of three premises, for the revocation of Management Orders were not accepted as it was considered that the houses were likely to fall into disrepair. Necessary works to remedy conditions caused by neglect of management were completed in 47 houses, 119 summonses were served for contraventions of the Management Regulations, fines amounting to £464 being imposed." Notices, in respect of overcrowding, under the provisions of Section 90 of the Housing Act, 1957, were served in 58 instances. Visits in the late evening and early morning are necessary to check that the notices are being complied with. Thirty five summonses were issued in respect of contraventions, resulting in fines amounting to £248, Twenty directions to prevent or reduce overcrowding were served under Section 19 of the Housing Act, 1961. Summonses were issued in twelve instances for contravention of the directions, resulting in fines amounting to £210. Standard Grants and Improvements In conjunction with officers of the Borough Engineer and Surveyor's Department, the Housing Inspector inspected four premises regarding which applications had been made to the Council for standard or improvement grants. New Housing During the year 2,123 new permanent dwellings were completed in the borough: 943 by the Borough Council, 1,178 by the Greater London Council and 2 by other persons. Details are given on page 112 , some new dwellings completed this year being illustrated opposite this page. Although the Borough offers many at tract ions for tourists, they will not find for their cameras' shutters conditions as depicted in the photograph facing page 61. At the end of the year units of accommodation owned by the Borough Council numbered 14,018 comprising 11,851 erected by the Council, 164 prefabricated bungalows and 2,003 properties acquired. Dwellings in the borough owned by the Greater Lpndon Council totalled 23,902 at the endof the year. Local Authority owned dwellings now comprise 61% of the total dwellings in the Borough. FACTORIES Provision is made in Section 153 of the Factories Act 1961 for the Medical Officer of Health to include inhis annual report prescribed particulars with respect to matters under the Act administered by the Council. These details are given on pages 114 and 115. - 60 - MONTEITH ROAD AREA HOUSING DEVELOPMENT SCHEME-STAGE I The Boroughs first Multi-Storey Dwellings. PROVIDENCE PLACE, STEPNEY-1908. The four basement bakehouses in the borough, in respect of which certificates of suitability under Section 70 of the Act continued in force, became due for quinquennial examination. The certificates were renewed for three of the bakehouses, the other premises being closed. HAIRDRESSERS AND BARBERS Section 18 of the London County Council (General Powers) Act, 1954, requiring the registration of the hairdressers or barbers premises, was repealed by the London Government Act, 1963. These powers were re-enacted by Section 21 of the Greater London Council (General Powers) Act, 1967, the "appointed day" approved by the Council being the 1st January, 1968. Premises registered with the Council numbered 190 at the end of the year. LEGAL PROCEEDINGS Under the provisions of Section 92 of the Criminal Justice Act 1967, increases in maximum fines for certain offences under the Public Health Act 1936 took effect from the 1st January 1968. In the case of failure to abate a nuisance the maximum fine was increased from £5 to £20, and for offences in connection with common lodging houses from £5 to £10. In addition the maximum fine in respect of breaches of byelaws made under the Local Government Act 1933 was increased from £5 to £20. Newspaper publicity drawing attention to these matters was arranged by the Town Clerk. A summary of legal proceedings instituted during the year is on page 116. PERSONAL CLEANSING STATION A cleansing service for verminous persons and persons suffering from scabies operates at Branch Road Cleansing Station, in addition to the service provided for school children at school treatment centres. The several large common lodging houses in the area provide a continuous flow of men to the Station for delousing. Statistics on page 117. DISINFECTION AND DISINFESTATION These services are provided on site at Branch Road Disinfecting Station where teams of operators are also based to deal with infection and infestations at premises. Premises and fomites are disinfected after the occurrence of certain infectious diseases, generally by means of steam under pressure or by 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, bedbugs, cockroaches, fleas, carpet beetles, woodlice .clovermites, firebrats, spider beetles, silverfish and dermestidae. The Council carries out on behalf of the East London Group Hospital Management Committee any necessary work of disinfestation at hospitals and other premises in the borough coming under its direction. (Statistics on page 117). -61- 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 8. LODGING HOUSES-COMMON There are four licensed common lodging houses in the borough, providing accommodation for 944 persons as follows:- Salvation Army Hostel, Garford Street 218 Men Salvation Army Women's Hostel, Hopetown Street 228 Women Salvation Army Hostel, 177 Whitechapel Road 323 Men Church Army Hostel, 10/22 Johnson Street 175 Men The premises are inspected regularly including visits made at night (7 this year) to ensure compliance with the byelaws relating thereto. The licensed number in respect of the Garford Street Hostel was reduced during the year from 223 to 218. The Salvation Army completed the construction of a new hostel in Whitechapel Road adjoining their common lodging house.' Known as "Booth House" the hostel, which cost £300,000 was opened by H. M. the Queen on 27th March, and provides accommodation for 200 men and permanent residential accommodation for 60 elderly men. LODGING HOUSES-SEAMEN Three such premises in the borough provide accommodation for 545 seamen as follows:- Empire Memorial Hostel, 747 Commercial Road 115 Seamen Queen Victoria Seamen's Home, 121/123 East India Dock Road 187 Seamen Sailors' Home, Dock Street 243 Seamen Regular inspections are carried out at these premises, including visits at night. 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. Improvements were carried out to the premises this year including the provision of new refrigerating plant and cabinets and laying of terrazzo floor. Prior to the formation of the borough, Bethnal Green Council had an arrangement with Hackney Council for the use of the letter's mortuary, which arrangement continues in respect of mortuary accommodation for that part of the borough, the cost being shared on a population basis. -62- A total of 564 bodies was received during the year (456 in the Council's mortuary and 108 in Hackney mortuary) including the bodies of 116 persons who were resident in other areas Other statistics will be found on page 108. OFFENSIVE BUSINESSES There are 20 offensive businesses in the borough. The register comprises the following premises:- Dresser of Furskins (2) 34/38 Brodlove Lane 74 Florida Street Poultry Slaughterhouses (18) *19 Bell Lane *7 Leyden Street 107 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) OFFICES AND SHOPS Registration and Inspect ion Premises registered during the year under the Offices, Shops and Railway Premises Act 1963 numbered 222, the total registrations effected to date being 3,238 in which over 27,000 persons are employed. Surveillance of these premises is executed by a public health inspector and a technical assistant, who made general inspections of 1,082 premises, and carried out over 2,800 other visits: Statistics on page 118. MISCELLANEOUS REPORTS BY DISTRICT AND SPECIALIST PUBLIC HEALTH INSPECTORS Some 585 reports were submitted to the Borough Architect and Planning Officer in respect of applications for planning permission under the Town and Country Planning Act, 1962,for redevelopment or change of use. In connection with applications under the Betting, Gaming and Lotteries Act, 1963, 15 reports in respect of betting offices were submitted to the Chief Officer, Public Control. 142 reports in respect of the transfer of publicans' licences under the Licensing Act, 1964, were submitted to the Licensing Justices. OUTWORKERS Employers of outworkers in the borough in certain specified occupations are required by -63- 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. The number of outworkers included in the August list was 659, compared with 872 in the corresponding list last year. It is significant to note that there were 1,586 outworkers included in the August lists for 1966. PET ANIMALS ACT, 1951 There are 72 licensed pet shops in the borough including stalls in markets. A contravention was discovered in one case of a condition(absence of adequate heating for animals exposed for sale)subject to which an annual licence is granted by the Council, which resulted in legal proceedings being instituted and a fine of £15, with costs of £44,being imposed. (See also page 53 Diseases of Animals). 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 of 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 re-entry and pay a prescribed fee. Compliance must be made with the requirements relating to storage, transport, labelling and containers. There are 86 names on the list, 23 being removed from and 3 added to the list during the year. POULTRY PROCESSING AND PACKING There are 18 poultry processing premises in the Borough at which 2,008,500 chickens and a small seasonal number of turkeys, geese and ducks, were slaughtered during the year. The weight of poultry condemned as unfit for human consumption totalled approximately 13 tons, birds rejected amounting to 0.3%. 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 38, there being no licensed premises. Eight samples of filling materials were obtained from registered premises during the year and all were reported as satisfactory, -64- 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 sanitary conveniences in refreshment houses. 34 notices were served during the year requiring the provision of sanitary accommodation to comply with the Council's standards REFUSE DISPOSAL The Cleansing Officer of the Council has kindly supplied some statistics relating to refuse disposal for the year, given on page 122. RENT ACT, 1957 Two applications under the Rent Act 1957 were received from tenants for certificates of disrepair, one certificate 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 3,829 dwellings and other premises requiring inspection 3,275 were found to be infested with mice or rats. Treatments were carried out by the department's rodent control staff, in 3,760 properties the charges for servicing business premises amounting to £4,250 Business premises under regular servicing contract with the Council numbered 244 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 119. SANITARY CONVENIENCES IN LONDON TRANSPORT RAILWAY STATIONS Coincidental with the receipt of a notification from the London Transport Executive that the lavatories at Stepney Green Underground Station would close on 1st September, a complaint was received concerning the condition of the Mile End Station, allegedly due to there being no lavatory available on the station. The Health Committee of the Council after consideration of the matter instructed that a request be made to the London Transport Executive for the construction of sanitary conveniences at railway and omnibus stations where such facilities do not exist, and for those which have been closed to be reopened The London Transport Executive's reply indicated that they were unable to accede to the request. SEWERAGE The arrangement in the area for sewerage and sewage disposal are satisfactory The planned -65- programme of reconstruction of defective sewers is proceeding. SWIMMING BATHS The water in the seven public swimming baths in the borough and in the bath at the Council'£ 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 110 samples were taken during the year. One sample was found to be in an unsatisfactory condition, due to low free chlorine content and high bacteriological count. In addition 49 samples were taken from nine school swimming baths in the borough, 8 samples being unsatisfactory, TRADE DESCRIPTIONS ACT 1968 The above Act came into force on 30th November and repealed the Merchandise Marks Acts 1887-1953, Since the Act places a duty on Weights and Measures authorities to enforce the Act the Council delegated its powers and duties under the Act to the Public Control Committee. Enforcement of the Merchandise Marks Acts as they related to foodstuffs was formerly del egated to the Health Committee and measures were taken to achieve close liaison between public health and weights and measures inspectors to avoid overlapping of functions anent action with regard to misdescription of foods and drugs. VACANT SITES Two years ago vacant sites in the Borough presented not only an amenity problem but were, in many cases, a serious public health nuisance providing harbourage for rats, due to the dumping of rubbish This rubbish emanates principally from three sources, discarded household chattels, trade refuse and fly tipping. In an effort to discourage the dumping of household discards the Cleansing Department have a free, well advertised service whereby rubbish of this nature is removed on notification, Despite this, the obsession to dump on vacant sites continues, and the determination to do so requires some understanding when the corrugated iron sheeting round a cleared site is either bent or removed in order to dump a bedstead or mattress and other unwanted articles. Fly tipping, which was a very live problem twelve months ago is apparently decreasing. A concentrated effort to get sites cleared of rubbish and fenced has shown a marked improvement. There are 292 known vacant sites, 223 of which have been cleared of rubbish and fenced This year in 26 cases where the owners were not traced or who defaulted the work was carried out by the Council's contractor and the cost made a charge on the land. 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 Lea in varying -66- proportions and is not plumbo-solvent. Samples of the water are subjected for quality control to regular routine chemical and bacteriological examination at the Board's laboratories. The water supply to the borough has been satisfactory both in quality and quantity during 1968 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 16 deep wells in the borough. Bacteriological and chemical analyses of water from these wells are made periodically and the results reported to this department. The Metropolitan Water Board was notified on 49 occasions where wastage of water was taking place. Notifications were received from the Board on 17 occasions of intention to withdraw the supply from premises because of non-payment of rates. In October 1965 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. Section 23 of the Greater London Council (General Purposes) Act 1967 empowers the Council to carry out work and recover the reasonable expenses incurred thereby to secure that the supply of water to a building is restored by the statutory water undertakers where such supply has been disconnected by reason of the defective state of the supply pipe etc. The Medical Officer of Health is authprised by the Council to exercise its powers under this enactment in appropriate cases. WORKS IN DEFAULT Works were carried out by the Council on 79 occasions duringthe year in default of persons on whom notices were served requiring the execution of works. They comprised one instance of failure to abate nuisances under Section 93 of the Public Health Act, 55 instances of failure to comply with notices served under Section 17, Public Health Act, 1961 regarding choked drains, 11 instances of failure to comply with notices served under Section 75 of the Public Health Act, 1936 with respect to the provision of dustbins, and 12 instances of failure to comply with notices served under Section 4 of the Prevention of Damage by Pests Act, 1949 for clearance of refuse from sites and erection of corrugated steel fencing. STATISTICS Tables 52 to 54 of the Appendix give additional statistical information of the environ* mental health services. -67- -68- PART VI MISCELLANEOUS SERVICES ETC. VI MISCELLANEOUS SERVICES, ETC. ACCIDENTS IN THE HOME Inquests were held during the year on 7 fatalities in the borough arising from accidents which occurred in the home. 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 exercisable by the Health Committee. Health Education for the prevention of home accidents has continued throughout the year, with particular reference both to those groups at greatest risk and to the most prevalent causes. Re-emphasis of the campaign to show the dangers of oil heaters which commenced last year has been continued this year with the inclusion of the filmstrip in school programmes, the loan of the filmstrip to Mothers' Groups and by means of house to house visiting in the mainly immigrant areas during the Christmas holidays. It is felt that points missed for one reason or another during home visits will have been finally assimilated by families by the issue of leaflets in the vernacular or by talks in schools. Talks to groups of senior citizens accompanied by a small film have also been given during the year and particularly during the winter months. Advantage was taken of the greater impact of personal contact in prevention of accidents through more group discussions and films on the subject, with a consequent saving on posters and leaflets, the value of which in the field of preventive work is still regarded by some as doubtful in relation to the cost involved. 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 4,170 signatures on certificates were verified as those of medical practitioners practising in the borough and the certificates endorsed accordingly. CONFERENCES Conferences and courses attended by members of the Council and/or officers of the department are summarised on pages 123 to 131. DECEASED PERSONS Inquests Inquests were held on 80 residents of the borough during the year, the verdicts being 14 -69- deaths due to road accidents, 28 other accidents, 26 suicide, 1 misadventure, 2 manslaughter, 1 acute alcoholism, 5 open verdicts, 1 asbestosis, 1 unascertainable and 1 natural causes. 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 Iraq. Italy and Pakistan. HOSPITAL FACILITIES The undermentioned hospitals are situated within the borough: No. of Beds. Bethnal Green Hospital, Bethnal Green Road, E.2. 308 The London Hospital, Whitechapel Road, E.l. 719 London Chest Hospital, Victoria Park, E.2. 143 London Jewish Hospital, Stepney Green, E.l. 128 Mildmay Mission Hospital, Austin Street, E.2. 72 Mile End Hospital, 275 Bancroft Road, E.l. 410 Poplar Hospital, East India Dock Road, E.14. 107 Queen Elizabeth Hospital for Children, Hackney Road, E.2. 146 St. Andrew's Hospital, Devons Road, E.3. 365 St. Clement's Hospital, 2a Bow Road, E.3. 128 On the 1st April the Queen Elizabeth Hospital for Children transferred from the North East Metropolitan Regional Hospital Board to the administration of the Board of Governors of the Hospital for Sick Children, Great Ormond Street, and the Mile End and St. Clement's Hospitals to the administration of the Board of Governors of the London Hospital. The East End Maternity Hospital, Commercial Road was closed, on 30th September-the first patient was admitted on 22nd December 1884 to the "Mothers Lying in Hospital" then in Glamis Road, which transferred to premises in Commercial Road in 1889, extended in 1896 and again in 1926. Factors which influenced the closure were that the maternity departments of five hospitals within the area hadasurplus capacity in 1967 for 1,510 patients, and in recent years in Tower Hamlets 87% of confinements took place in hospital as against 72% for the country as a whole; the excess of beds in the area was in spite of the high proportion of mothers in the locality having their babies delivered in hospital. 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 infection of food samples are carried out by the Public Health Laboratory Service (directed by the Medical Research Council for the Department of Health and Social Security)at County Hall, S.E.1. Investigations carried out by the Group Laboratory on specimens submitted by the health department totalled 356, comprising 336 faeces, 4 throat swabs, 10 urine, 4 blood, 1 eye swab and 1 vomit. Bacteriological investigation on 146 food samples was carried out during the year. -70- LEGISLATION The Government decided to merge in one comprehensive department the former functions of the Ministries of Health and Social Security which, from the 1st November, were transferred to the newly created Department of Health and Social Security. The following acts, orders and regulations affecting the department were made during the year: Acts of Parliament Date made Date Operative Clean Air Act 1968 25.10.68. Various Commonwealth Immigrants Act 1968 1.3.68. 2.3.68. Greater London Council (General Powers) Act 1968 26.7.68. 1.4.69. Health Services and Public Health Act 1968 26.7.68. Various Race Relations Act 1968 25.10.68. 26.11.68. Trade Descriptions Act 1968 30.5.68. 30.11.68. Orders and Regulations Abortion Regulations 1968 15.3.68. 22.4.68. Ancillary Dental Workers Regulations, 1968 8.3.68. 1.9.69. Canned Meat Product (Amendment) Regulations 1968 19.12.68. 4.1.69. Clean Air (Measurement of Grit and Dust) Regulations 1968 20.3.68. 1.5.68. Clean Air Act 1968 (Commencement No. 1) Order 1968 2.12.68 1.4.69. Dangerous Drugs (Supply to Addicts) Regulations 1968 18.3.68. 16.4.68. Fish and Meat Spreadable Products Regulations 1968 15.3.68. 15.3.71. Health Services and Public Health Act 1968 (Commencement No. 1) Order 1968 23.8.68. 1.10.68. Health Services and Public Health Act 1968 (Commencement No. 2) Order 1968 18.10.68. 1.11.68. Imported Food Regulations 1968 24.1.68. 1.8.68. London Authorities (Staff) Order 1968 26.3.68. 8.4.68. Miscellaneous Fees (Variation) Order 1968 9.2.68. 1.4.68. National Health Service (Charges for Drugs and Appliances) (Amendment) Regulations 1968 3.10.68. 17.10.68. National Health Service (V.D.) Regulations 1968 14.10.68 2.12.68. Nursing Agencies (Increase of Licence Fees) Regulations 1968 24.1.68. 1.4.68. Nursing and Residential Homes (Variation) Order 1968 24.1.68. 1.4.68. Offices, Shops and Railway Premises Act 1963 (Exemption No. 7) Order 1968 6.12.68. 1.1.69. Offices, Shops and Railway Premises (Hoists and Lifts) Report Order 1968 30.5.68. 28.5.69. Offices, Shops and Railway Premises (Hoists and Lifts) Regulations 1968 27.5.68. 28.5.69. Poisons Increases (Approved Scheme) (Local Government) Regulations 1968 7.8.68. 21.8.68. Poisons List Order 1968 17.1.68. 8.2.68. Poisons Rules 1968 17.1.68. 8.2.68. -71- Orders and Regulations (Continued) Date made Date Operative Poisons(No. 2) Rules 1968 23.10.68. 6.12.68. Public Health (Fees for Notification of Infectious Diseases) Order 1968 23.8.68 1.10.68. Public Health (Fees for Notification of Infectious Diseases) Regulations 1968 23.8.68. 1.10.68. Public Health (Infective Jaundice) Regulations 1968 29.5.68. 15.6.68. Public Health (Ships) (Amendment) Regulations 1968 2.10.68. 10.10.68. Rag Flock and Other Filling Materials (Variations) Order 1968 24.1.68. 1.4.68. Rate Support Grants (Health Authorities) (Pooling Arrangements) Regulations 1968 20.3.68. 29.3.68. Sausage and Other Meat Products (Amendment) Regulations 1968 19.12.68. 4.1.69. School Health Service (Amendment) Regulations 1968 2.8.68. 19.8.68. Secretary of State for Social Services Order 1968 25.10.68. 1.11.68. Skimmed Milk with Non-Milk Fat (Amendment) Regulations 1968 16.9.68. 26.9.68. Slaughterhouse (Hygiene) Regulations (Appointed Day No. 1) Order 1968 2.2.68. 1.3.68. Slaughterhouse (Hygiene) Regulations (Appointed Day No. 2) Order 1968 30.9.68. 1.11.68. Slaughter of Animals (Prevention of Cruelty) Regulations (Appointed Day No. 1) Order 1968 2.2.68. 1.3.68. Slaughter of Animals (Prevention of Cruelty) Regulations (Appointed Day No. 2) Order 1968 30.9.68. 1.11.68. Welfare Foods Order 1968 15.3.68. 31.3.68. Welfare Foods (Amendment) Order 1968 8.10.68. 17.10.68. 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 5. CIRCULARS Circulars on matters relevant to the functions of the department and issued by the various Ministries during the year included those relating to the following, apart from circulars dealing with the above-mentioned Statutory Instruments:- Adaptations of Homes to install Artificial Kidney Machines Ambulance and First Aid Services in War - Training in Nursing Amendment to the Nurseries and Child-Minders Regulation Act 1948 Brucellosis (Accredited Herds) Scheme Control of Venereal Disease Day Care Facilities for Children Under five Designation of Direct Acting Electric Space Heaters Dogs in Food Shops. Restaurants and other Food Premises -72- CIRCULARS (Continued) Family Planning Fluoridation of Water Supplies Functions of the Ministry of Health Future of the Chest Service Head-Worn Hearing Aids for Children Health Control of Immigrants Health Education Council Industrial Effluents Local Authority Health and Welfare Services Development Plans and Programme of Capital Projects Manual of the International Classification of Diseases, Injuries and Causes of Death Milk and Dairies (General) Regulations 1959 - Approved Chemical Agents Model Byelaws for Preventing the Keeping of Animals so as to be Prejudicial to Health Noise Old Houses into New Homes The Solvents in Food (Amendments) Regulations 1967 Treatment of Alcoholism Urban Programme of Expenditure Use of Ancillary help in the Local Authority Nursing Services Vaccination and Immunisation (several) Voluntary Community Service by Young People. 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 or assessments carried out during the year numbered 982, details on page 109. 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 9 registration certificates under Section 1 of the Act with respect to premises in the borough. REFRESHER COURSES Refresher and training courses attended by staff during the year are listed on pages 126 to 131. STAFF CHANGES Appointments and resignations of members of the staff numbered 120 and 114 respectively. Details on page 137. -73- TRAINING, etc. FOR STUDENTS As part of their training and studies, students such as student nurses, medical students and others need to make visits of observation to local health authority establishments and to spend time with certain field staff. Such students accepted during the year numbered 478, comprising:- 13 Students Central School of Speech and Drama 15 Student Midwives Nursing Sisters of St. John the Divine 103 Medical Students London and St. Bartholomew's Hospitals 242 Student nurses London, Queen Elizabeth, Bethnnl Green, Mile End, St. Andrews and London Jewish Hospitals. 1 Child care officer student, North West Polytechnic. 11 Social studies students, Bedford College, etc. 5 Social worker students, Barking Regional College of Technology etc 5 Diploma course students, National Association for Mental Health 6 Student health visitors, North West Polytechnic. 9 Post graduate students, London School of Hygiene and Tropical Medicine. 8 Pupil Public Health Inspectors, Hertfordshire County Council 14 Medical Officers, Society of Medical Officers of Health and National Association for Mental Heal th 23 Welfare Students, General Post Office and Salvation Army 23 Other students, Various organisations -74- PART VII REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER ON THE SCHOOL HEALTH SERVICE VII. REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER ON THE SCHOOL HEALTH SERVICE As is shown in the statistics for the year, routine work of the school health service continued on an even course. In previous years attention has been drawn to the incidence of scabies - this showed a decrease for 1968 compared with 1967. Vigilance on the part of staff at school inspections, treatment centres and the bathing centre has doubtless been a factor in this reduction. However, as the results of both routine and special inspections show, the division has a high incidence of head infestations. The top of the league is not an enviable position in this respect. Whether the higher yield compared with other divisions is a result of better diagnostic acumen by our school nursing staff as a result of hard won experience, or more detailed reporting, nevertheless there is no room for complacency. Slum clearance and redevelopment will provide a better environment but unless the children and parents are motivated towards hygiene standards in a personal acceptance of responsibility what is gained on the one side may be lost on the other. Here lies an opportunity for health education in its widest sense for this and other similar problems affecting the public and private health. Programmes of health education in schools have expanded during the year. In addition to the Authority's workers, the borough's health education team now numbering three officers has undertaken a major part of the work in the schools. The school dental service has also increased its work in dental health education. It is a pleasure to thank the Medical Adviser, and his central staff for ready help throughout the year- Our links with Mr. Peirce, Divisional EducationOfficer and his staff locally remain strong and cordial I would also thank my deputy Dr. C. Gourlay particularly for her endeavours in the school health section which is largely run under her day to day direction. SCHOOLS AND SCHOOL ROLLS Pupils on school rolls numbered 33,020 at the end of the year, attending 101 maintained schools in the borough which include three schools for the educationally subnormal, two for the maladjusted, one for delicate children, and one for the physically handicapped. There are no direct grant or independent schools included in the School Health Service. At the end of the year the school registers were as follows:- Type of School No. of Schools Pupils Primary 68 19,291 Secondary 21 12,331 Nursery 5 509 Special 7 889 MEDICAL INSPECTION OF SCHOOLCHILDREN Routine medical examinations These are carried out by medical officers of the department assisted by school nurses. -75- 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 12,663 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 during the year totalled 8,163. CLEANSING OF VERMINOUS SCHOOLCHILDREN This year the number of treatments for 'vermin and nits' increased from 817 to 844. The schools principally affected are those with high ratios of immigrant children on their rolls, some of whom move on before adequate treatment can be completed.' Attendances for treatment of scabies at the bathing centres decreased from 308 last year to 175 in 1968. Acombined approach with the co-operation of local schools, general practitioners and the borough cleansing station staff continued during the year to ensure where possible that all known cases, and their family and other contacts, are given a complete course of treatment. HANDICAPPED PUPILS Tower Hamlets children placed in special schools are as follows:- Handicap No. at Day Schools No. at Boarding Schools Blind - 4 Partially sighted 22 2 Deaf 24 4 Partially hearing 29 3 Educationally subnormal 385 134 Epileptic - 1 Maladjusted 62 94 Physically Handicapped 85 19 Delicate 135 39 Multiple Handicaps - 1 TOTALS 742 301 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. -76- Sixteen new cases were added to the deaf register during the year, the register now totalling 192. 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 150. There are three schools in the borough for the education of these children who are medically examined each year. VISION During the year vision tests were carried out on 10,350 schoolchildren. HEALTH EDUCATION IN SCHOOLS At the beginning of this year an overall health education syllabus was drawn up and later offered firstly to schools in which invitations to work had been accepted, and then to all others who made enquiries for information, visual aids, etc. In these schools also, health education has been included as a subject in its own right on the timetables during the year, and the health education team can now work to achieve the wider and more even spread of information on health education topics which would appear to be socially necessary and justifiable from the point of view of prevention of disease in this area. It is felt that a greater interest in health education in schools which draw from catchment are as already visited by individual staff members would pay dividends towards the success of their future preventive work and it is hoped that this may yet receive consideration as a valuable aspect. The following subjects were dealt with at schools during the year:- Subject Occasions No. Participating General Health Topics 1,410 22,676 Mothercraft and Mental Health Sex Education and Veneral Disease 46 993 INFECTIOUS DISEASE IN SCHOOLS 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 -77- 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 1,051 children so absent, german measles being the reason for the largest number viz. 275. ENVIRONMENTAL HYGIENE IN SCHOOLS Each school in the Borough is visited annually by public health inspectors for environmental hygiene inspection and results of their findings are reported to the Medical Adviser of the Inner London Education Authority. Visits were also made to schools by public health inspectors in connection with enquiries and investigations concerning infectious diseases. MINOR AILMENTS CLINICS Children suffering from minor ailments may be referred to minor ailments 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, although attendances this year totalled 20,967 compared with 19,246 last year. VACCINATION AND IMMUNISATION RECORDS OF SCHOOLCHILDREN, The percentage of school-children on school rolls immunised and vaccinated is as follows:Diphtheria Tetanus Poliomyelitis Smallpox 82.8 *58.4 82.2 54.1 *Children generally speaking only given opportunity during late 1950's. B.C.G. VACCINATION The arrangements continued during the year for vaccinating 13-year old schoolchildren against tuberculosis using B.C.G. 1,681 children being vaccinated. PART TIME EMPLOYMENT OF SCHOOLCHILDREN It is a requirement of the Children and Young Persons Act 1933/Education Act 1944, 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 220 were examined for this purpose during the year, all being found fit for the employment proposed. SCHOOL DENTAL SERVICE The Principal School Dental Officer, Mr. D.F. Waller reports as follows:"The expansion and rational development of the dental services provided for the -78- Area's 34,000 school children have continued during 1968. The greatly improved image which was achieved during 1967 has been maintained and the confidence shown by the children, parents, teachers, administrators and professional colleagues working within and without the Borough's Health Services augurs well for the future. The progress which has been made towards achieving an efficient and comprehensive dental service stems from the combination of a young, happy and enthusiastic professional staff with the atmosphere which the modernization of clinics and their equipment produces. A review of most aspects of the dental service was contained in the 1967 report and this will not be repeated here. The principles and methods described therein continue to apply and it is hoped that the following remarks under similar headings will be read in conjunction with that report. Prevention The complete prevention of dental disease whilst a very practical possibi1ity in individual and enthusiastic cases where dental personnel, parents and children are willing to co-operate and to devote time and money on the procedures involved is still a rather remote objective when considered on a community basis. The chairside time involved counselling each child and their parents in the preventive oral hygiene procedures (including the use of a fluoride containing toothpaste) which can be carried out at home the analysis and control of the cariogenic features of our modern diet, and the strengthening of erupted teeth by the topical application of solutions which will reduce the amount of dental decay, is considerable and cannot be given to more than a small proportion of our potential patients. This essential part of our dental service is therefore only available to those parents and children who really care and come regularly to our clinics for treatment and advice. Prevention on a mass community can only be achieved by community measures and the most effective measure-the fluoridation of our water supplies is still not available to the Borough's children. The Council has been on record since 1965 as being in favour of fluoridation wi th the overwhelming majority of all the Local Authorities in the Metropolitan Water Board's area also being in favour. Perhaps 1969 may see an increase in the vociferous demand which will influence the Board to accede to the will of the majority of parents and the dental needs of all the children in the Board's area. During the year, in conjunction with the London Hospital Medical Col lege Dental School, a clinical trial of a fluoride containing mouthwash was commenced in two of the Area's secondary schools. Whilst the anticipated reduction in dental disease may not be as high as that which would be obtained from the fluoridation of water it may be found that this administratively difficult but attractive method of getting fluoride to children's teeth is a second best measure which could be used in other schools in the Borough. The effect of dental health education procedures and school dental inspections, particularly where they are combined with the use of dental health stamps and school dental counselling several times a term by dental auxiliaries in each class in all our primary schools, results in a vastly increased demand for treatment and attendance "at the dentist'. It is reasonable to assume that the most effective preventive measure available -79- to us at the moment is this type of stimulation of children to attend their own dentist i.e. general dental practitioner, school dental officer or the staff at the London Hospital Dental Department and thus achieving early treatment of small dental lesions and preventive therapy and advice. Inspection Regular school dental inspections continue and the object of inspecting primary schools every other term and secondary schools once each year has been achieved in almost every case. The percentage of children found to require treatment in all age groups examined has remained fairly constant at approximately 68%. The system of examination described in last year's report has been continued and the details of each child's dental treatment needs are sufficient to show each individual child's progress of disease and treatment pattern. It is therefore possible to inform parents, teachers and the dental personnel involved of the dental neglect or achievement of each child and thus stimulate the attention which each case deserves. Treatment The treatment provided in our clinics continues to be of a gratifyingly conservative nature. The number of fillings completed totalled 15,807 (9,119 in permanent and 6,688 in temporary teeth) whilst extractions were only 263 permanent and 799 temporary teeth. The ratios of permanent teeth filled to extracted being 38.5:1 (national average 5.3:1) and temporary teeth filled to temporary teeth extracted 8.3:1 (national average 0.6:1) which must be considered very satisfactory. The number of broken appointments at our clinics has been reduced to 39.6% which is a reasonable improvement during one year. The figure is still far too high and a system of informing both school and parent of each child's dental appointment will it is hoped reduce the broken appointment rate still further. As has been mentioned in previous reports the solution to the problem of broken appointments and of the dentally deprived child whose parents will never co-operate and take him/her to adental surgery for treatment can only be met in the long term by taking -80- TOWER HAMLETS CARNIVAL 1968 Dental Health Education dentistry to the child in school. Mobile dental caravans, very large schools equipped with dental surgeries or the provision of mobile dental equipment which can be taken into a school and set up on a temporary basis are the means by which such a policy can be implemented. Dentistry which is available in or alongside schools has been available in rural areas for many years. In urban areas this principle is only now being investigated. In Tower Hamlets we have been taking dentistry to our special schools in one of the ILEA mobile dental caravans during 1968 and this has proved very successful. There are no broken appointments, dentistry and dental equipment and dental personnel become part of everyday school life and apprehension is almost completely eliminated. The parents responsibility is perhaps regrettably somewhat reduced but equated against this disadvantage must be the fact that these schools are now on average more dentally fit than any other of the schools in the area. Dental Health Education Dental Health Educat ion activities have expanded considerably with the increase in the establishment of dental auxiliaries from one to three Each auxiliary spends one half of her total working time on dental health education activities. The primary schools in the area are divided into three sectors, each dental auxiliary being responsible for her own schools. The basic primary school programme includes a remit to visit each class in each school at least once each term, to follow up each school dental inspection with an individual approach to each child related to the result of their own dental inspection and to act in all ways as the school's link with dentistry. A theme is determined each term so that a similar programme may be followed throughout the Borough in each school. With the return of our dental health stamps in 1969 the administration of this scheme will also be carried out by the dental auxiliaries and the results of the use of dental health stamps will be integrated so that they form part of our programme of 'dental health in action'. Dental health education activities at the chairside are of course a routine part of normal dental treatment and the opportunity is taken to indoctrinate mothers in the need for and the ways of dental preventive procedures. During 1969 routine dental health education activities will become the responsibility of the dental officer to whom each of the secondary schools is attached. The demands on the time of all the professional dental staff has been such that this section of dental health education has had to be postponed to allow the more urgent needs of the younger children to be met. Teaching material is still supplied to science departments of local secondary schools and a project of 'Careers in Dentistry' is being evolved. A carnival float was again entered in the Borough Carnival this year by the dental staff (see photograph facing page 80). - 81 - Staff At December 31, 1968 the professional full time dental staff consisted of one Principal School Dental Officer, four full time and ten part time dental officers together providing a whole time equivalent of 8.9 (compared with 8.6 at December 1967). These Dental Officers are assisted by three full time dental auxiliaries who devote half their time to clinical dentistry and half to dental health education. The professional staff were assisted by ten full time dental surgery assistants and one full time clerk. It must be realized that the number of professional officers cannot possibly meet in full the examination and treatment needs of the children in the Borough particularly owing to the stimulation of the dental health education. Again attention must be drawn to a difficulty in recruiting dental surgery assistants because here again their unrealistic scale of pay particularly in the younger age groups can only attract those school leavers who wish to take up dental nursing to work in a general dental practice rather than the local authority service, Dealing as our service does almost exclusively with young children we need a particularly high calibre of dental surgery assistant and this person can only be attracted if we see fit to offer a salary at least comparable with that which can be obtained elsewhere in dentistry. Premises and Equipment The final stages of the modernization and redecoration programme which achieved so much in 1967 were reached this year with the provision of new dental units in both surgeries at Ida Samuel Dental Clinic at Underwood Road, X-ray developing machines and other items of minor dental equipment were provided where necessary together with new waiting room furniture. (See photographs facing this page). There remain only two surgeries in the Borough which require new modern dental units and it is hoped that these will be achieved next year. In the summer the new double surgery clinic at Leopold Street was opened. The dental suite comprises two dental surgeries, waiting room and office, the recovery room at present being used as temporary accommodation for the chiropody service. When the recovery room becomes available it is hoped that a day stay service will be developed for those children who cannot accept dental treatment any other way to achieve dental fitness by conservation under general anaesthesia. This service together with projects for handicapped and 'difficult' children will be commenced as soon as possible during 1969. Future plans include provision of a third (orthodontic) dental surgery at Ida Samuel - 82 - Re-equipped dental surgery at Wellington Way Centre Re-equipped dental surgery at Ruston Street Centre Clinic and the building of a three surgery preventive dental clinic at Watney Street (to replace Prunella Clinic), as mentioned last year but still awaiting achievement. The long waiting lists for treatment at Bromley and Wellington Way make the provision of a second surgery at each of these clinics highly desirable and the particular needs of patients in the Wapping area must be met. The new building which is being carried out in the Wapping area makes this a potentially more urgent problem as time passes. Special Services All the remarks and observations related to treatment of mentally and physically handicapped children, orthodontic treatment and treatment for children in residential homes made in the 1967 report still apply. It is hoped that a full orthodontic service will materialize in the new surgery at Ida Samuel Clinic during 1969, whilst the dental surgery at St. Leonards, Hornchurch is scheduled for re-equipment. Liaison with the London Hospital The unique relationship between the School Dental Department and the London Hospital Dental Institute andDental School and Dental Health Study Unit continued during the year. Groups of fifth year students have again been taken into the borough and have experienced at first hand the needs and demands of the school population for dentistry and how the school dental service fits into the community dental pattern of this area of London. An unexpected but gratifying result of this liaison with the clinical students has been the large increase in applications from newly qualified graduates for posts in this Borough and in the Inner London Education Authority's area.'' STATISTICS Statistics relating to the School Health Service will be found on pages 132 to 136. - 83 - -84- PART VIII APPENDIX OF STATISTICAL TABLES TABLE 1 TOTAL DEATHS BY CAUSE AND AGE OF TOWER HAMLETS RESIDENTS-1968 (Registrar-General's Return) CAUSE OF DEATH ALL AGES AGE GROUP TOTAL M F -1 1- 5- 15- 25- 35- 45- 55- 65- 75- Enteritis and other diarrhoeal diseases 2 2 _ 1 - - - - - - . 1 - Tuberculosis of respiratory system 12 10 2 - - - - - 2 1 1 5 3 Other tuberculosis, including late effects 6 1 5 - - - - - 1 - 2 1 2 Meningococcal infection 1 1 - - 1 - - - - - - - - Measles 1 1 - 1 - - - - - - - - - Other infective and parasitic diseases 3 2 1 - - 1 - - - - 1 - 1 Malignant neoplasm-stomach 60 30 30 - - - - - - 4 16 25 15 Malignant neoplasm-lung, bronchus 190 160 30 - - - - - 6 10 74 70 30 Malignant neoplasm-breast 32 1 31 - - - - 1 3 7 4 9 8 Malignant neoplasm-uterus 13 - 13 - - - - - - 3 4 2 4 Leukaemia 8 4 4 - - 1 - 1 2 - 1 1 2 Other malignant neoplasms, etc, 236 136 100 1 1 - 3 1 4 21 57 81 67 Benign and unspecified neoplasms 10 7 3 - - - - - - 1 7 1 1 Diabetes mellitus 25 7 18 - - 1 - - - - 7 12 5 Other endocrine etc., diseases 9 4 5 - 1 1 1 1 1 - 1 2 1 Anaemias 16 6 10 - - - - - 1 - 2 3 10 Other diseases of blood, etc. 1 1 - 1 - - - - - - - - - Mental disorders 5 3 2 - - - 1 - - 1 - - 3 Meningitis 2 1 1 - - - 1 - - - - 1 - Other diseases of nervous system 14 5 9 - - - 1 - 2 3 3 2 3 Chronic rheumatic heart disease 49 15 34 - - - - - - 5 11 11 22 Hypertensive disease 32 15 17 - - - - - - 1 8 11 12 Ischaemic heart disease 499 287 212 - - - - - 15 51 94 145 194 Other forms of heart disease 91 39 52 - - - - 4 - 4 10 17 56 Cerebrovascular disease 217 94 123 - - - - 4 3 14 35 54 107 Other diseases of circulatory system 89 49 40 - - - - - 4 6 17 17 45 Influenza 7 4 3 - - - - - - - - 2 5 Pneumonia 233 120 113 13 - 1 - 1 4 2 16 46 150 Bronchitis and emphysema 231 163 68 1 - - - - 1 9 34 77 109 Asthma 7 4 3 - - - - - 2 - 4 1 - Other diseases of respiratory system 26 16 10 3 - - - 1 - 2 3 8 9 Peptic ulcer 23 14 9 - - - - - - 1 3 8 11 Appendicitis 1 1 - - - - - - - - 1 - - Intestinal obstruction and hernia 15 9 6 1 1 - - - - 2 1 3 7 Cirrhosis of liver 6 4 2 - - - - - - 1 2 2 1 Other diseases of digestive system 22 10 12 1 - - - 1 - - 4 8 8 Nephritis and nephrosis 11 6 5 - - - - - 2 - 3 1 5 Hyperplasia of prostate 5 5 - - - - - - - - - 1 4 Other diseases, genito-urinary system 15 7 8 - - - - - - 2 1 4 8 Diseases of skin, subcutaneous tissue 1 - 1 - - - - - - - - 1 - Diseases of musculo-skeletal system 9 5 4 - - - - - - - 1 1 7 Congenital anomalies 20 14 6 13 3 1 - 1 - 1 - 1 - Birth injury, difficult labour, etc. 15 7 8 15 - - - - - - - - - Other causes of perinatal mortality 17 15 2 17 - - - - - - - - - Symptoms and ill-defined conditions 9 3 6 1 - - - - - - - - 8 Motor vehicle accidents 18 11 7 - - 1 3 2 1 1 4 3 3 All other accidents 32 23 9 - 3 1 1 3 4 7 3 5 5 Suicide and self-inflicted injuries 26 18 8 - - - 1 4 3 4 9 4 1 All other external causes 10 6 4 - - - 2 1 1 3 2 1 - Males 1346 1036 51 7 4 12 17 37 101 309 404 404 Females 18 3 4 2 9 25 66 137 244 528 GRAND TOTAL 2382 69 10 8 14 26 62 167 446 648 932 TABLE 2 SUMMARY OF ROAD ACCIDENTS OCCURRING IN THE BOROUGH Pedestrians Motor Cyclists Pedal Cyclists Other Road Users Total 1968 Killed 22 2 4 28 Injured 650 229 96 777 1,752 1967 Killed 11 2 1 2 16 Injured 683 248 110 772 1,813 -85- TABLE 3 INFANT MORTALITY Deaths from stated causes at various ages under 1 year (compiled from local death returns) AGE PERIODS Total* Deaths under 1 year Per cent of Total Under 24 hours 1-6 days Weeks Months 1- 2- 3- 1- 4- 7- 10- Bronchitis - - - - - - 5 1 - 6(8) 8.8 Pneumonia - - - - - 1 4 4 - 9(4) 13.2 Congenital malformations 2 4 1 3 1 1 1 - - 13(2) 19.1 Premature birth 11 5 - - - - - - - 16(14) 23.6 Asphyxia, Atelectasis 3 4 2 2 - - - - - 11(6) 16.2 Meningitis - - - - - - - - - (3) - Birth injuries 2 1 - - - - - - - 3(1) 4.4 Other causes 2 4 1 1 - - 1 1 - 10(15) 14.7 TOTALS 20 18 4 6 1 2 11 6 - 68(53) 100.0 (*) Figures in parenthesis denote corresponding deaths in 1967 TABLE 4 INFANT MORTALITY 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 1967 13 12 10 35 18 53 66 1968 20 18 11 49 19 68 72 -86- -87- TABLE 5 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 1967 198,230 3,262 16.4 2,130 10.7 56 17.2 1 0.3 539 2.7 18 0.1 1968 192,250 2,875 15.0 2,382 12.4 69 24.0 0 0 539 2.8 18 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 6 OBSERVATION REGISTER (i) Observation Register (Children under 5 years) No. on Register on 1st January 2,713 No. added during year 1,301 4,014 No. removed during year-died 6 - moved away 375 - no longer at risk 393 - transferred to ages 5-21 Register 33 807 Total on Register at 31st December 3,207 No. of above total suffering from handicaps 295 Year of birth of those on Register at 31st December 1968 1,040 1967 1,040 1966 741 1965 245 1964 141 Total: 3,207 (ii) Observation Register (5-21 years) Total on Register at 31st December 2,276 (iii) Handicaps of children and young persons on Observation Register 0-4 years 5-21 years Educationally subnormal - 808 Severely subnormal - 141 Physically handicapped 189 465 Mentally retarded 34 - Maladjusted - 225 Blind (Registered) 1 5 Visual defects 8 70 Speech defects (requiring special or other school) 15 22 Epileptic 17 52 Deaf and partially hearing 7 154 Delicate (including diabetic) - 129 Multiple handicaps 24 205 Total: 295 2,276 In addition there are 317 children suffering from handicaps attending schools in the Borough, but living outside the Borough. TABLE 7 DISEASES NOTIFIABLE IN THE BOROUGH Disease Authority for Notification Statutory Instrument No. Acute Encephalitis Health Services and Public Health Act 1968 (Section 56) 1968/1366 Acute Meningitis -do- -do- 1968/1366 Acute Poliomyelitis -do- -do- 1968/1366 Anthrax -do- -do- 1968/1366 Cholera -do- (Section 48) - Diphtheria -do- (Section 56) 1968/1366 Dysentery (Amoebic) -do- -do- 1968/1366 Dysentery (Bacillary) -do- -do- 1968/1366 Food Poisoning -do- (Section 48) - Infective Jaundice -do- (Section 56) 1968/1366 Leprosy -do- -do- 1968/1366 Leptospirosis -do- -do- 1968/1366 Malaria -do- -do- 1968/1366 Measles -do- -do- 1968/1366 Ophthalmia Neonatorum -do- -do- 1968/1366 Paratyphoid fever -do- -do- 1968/1366 Plague -do- (Section 48) - Relapsing fever -do- -do- - Scarlet fever -do- (Section 56) 1968/1366 Smallpox -do- (Section 48) - Tetanus -do- (Section 56) 1968/1366 Tuberculosis -do- -do- 1968/1366 Typhoid fever -do- -do- 1968/1366 Typhus -do- (Section 48) - Whooping Cough -do- (Section 56) 1968/1366 Yellow fever -do- -do- 1968/1366 -89- TABLE 8 INFECTIOUS DISEASE NOTIFICATIONS Corrected Notifications Removed to Hospital Notified in 1967 Notified in 1966 Acute Encephalitis Infective 1 1 - - Post-infectious 2 2 - 1 Acute Meningitis (from 1.10.68) 2 2 NN NN Acute Poliomyelitis Paralytic - - - - Non-paralytic - - - - Anthrax - - - - Cholera - - - - Diphtheria - - - - Dysentery 40 17 49 181 Erysipelas (to 30.9.68) 7 - 11 15 Food Poisoning 53 3 80 48 Infective Jaundice (from 15.6.68) 68 10 NN NN Leprosy - - - - Leptospirosis (from 1.10.68) - - NN NN Malaria 1 1 1 1 Measles 616 38 1,690 1,469 Meningococcal Infection (to 30.9.68) - - - 8 Ophthalmia Neonatorum - - 1 2 Paratyphoid Fever - - - - Plague - - - - Pneumonia (to 30.9.68) 110 10 124 160 Puerperal Pyrexia (to 30.9.68) 25 25 15 26 Relapsing Fever - • - - Scarlet Fever 83 1 91 95 Smallpox - - - - Tetanus (from 1.10.68) - - NN NN Tuberculosis Pulmonary 102 _ 102 109 Non-pulmonary 19 - 13 24 Typhoid fever 2 2 - 1 Whooping Cough 66 10 89 127 Yellow Fever (from 1.10.68) - - NN NN TOTALS: 1,197 122 2,266 2,267 NN=Not notifiable TABLE 9 MORBIDITY-First Claims for Sickness Benefit The number of Claims made to local offices of the Ministry of Social Security covering postal districts E.1, E.2, E.3, and E.14, were as follows:- 1968 1967 1966 1968 1967 1966 January 7,401 4,411 4,970 July 3,311 2,625 2,909 February 3,279 3,797 5,648 August 2,977 2,506 3,188 March 4,079 2,989 4,621 September 3,037 4,105 2,908 April 3,832 3,951 3,311 October 4,456 3,584 4,642 May 3,193 2,844 3,618 November 3,781 3,550 4,185 June 2,796 3,572 2,916 December 4,041 5,191 3,712 TOTALS 46,183 43,125 46,628 -90- TABLE 10 VACCINATION AND IMMUNISATION Children vaccinated/immunised Others aged Total Year of birth 1968 1967 1966 1965 196164 Under 16 Over 16 Diphtheria 1,105 1,092 138 75 257 123 3 2,793 Reinforcing dose - 921 921 116 1,674 805 13 4,450 Tetanus 1,105 1,093 139 77 264 153 113 2,944 Reinforcing dose - 921 921 118 1,670 842 81 4,553 Whooping Cough 1,096 1,085 128 63 66 5 - 2,443 Reinforcing dose - 893 888 99 196 20 - 2,096 Poliomyelitis 1,061 1,125 137 91 379 349 155 3,297 Reinforcing dose - 856 899 141 1,677 1,374 61 5,008 Measles 2 508 486 418 1,358 55 - 2,827 Under 1 1 year 2-4 5-15 16 and over Total Smallpox vaccination: Primary 17 955 365 83 110 1,530 Revaccination - - 10 187 952 1,149 Diphtheria immunisation of children under 5 Children under 5 immunised during 1964/68 12,513 Estimated population under 5 as at 30th June, 1968 15,800 Percentage protected 79.2 Vaccinations/immunisations(all-ages) carried out at clinics/general practitioners' surgeries At Council Clinics By General Practitioners % Primary by General Practitioners Primary Reinforcing Primary Reinforcing Diphtheria 2,513 4,021 280 429 9.8 Tetanus 2,544 4,075 400 478 11.7 Whooping cough 2,188 1,846 255 250 11.1 Poliomyelitis 2,903 4,603 394 405 9.6 Smallpox 1,238 301 292 848 42.5 Measles 2,163 - 664 - 23.4 -91- TABLE 11 TUBERCULOSIS-NEW CASES AND DEATHS New Cases and Deaths: Primary notifications of 102 pulmonary and 19 non-pulmonary cases were received. 11 other cases came to light via death returns from Registrars. Pulmonary tuberculosis accounted for 12 deaths, there being 5 deaths from nonpulmonary tuberculosis, including late effects. 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 - - 3 2 3 2 6 5 16 12 12 12 2 75 F - - 1 3 - 2 - 5 10 2 3 1 - 27 Non-pulmonary M - - - 1 1 1 - 2 2 1 - - - 8 F - 1 - 1 - 2 2 1 2 1 - - 1 11 (b) Deaths Pulmonary M - - - - - - - - 2 - - 5 3 10 F - - - - - - - - - 1 1 - - 2 Non-pulmonary M - - - - - - - - - - 1 - - 1 F - - - - - - - - 1 - 1 1 2 5 TABLE 12 TUBERCULOSIS-VARIATIONS IN REGISTER Pulmonary Non-pulmonary Total Cases Males Females Males Females No. cases on register at 1.1.68 1,405 747 14 108 2,274 No. cases notified during 1968 75 27 8 11 121 Other cases added to register 28 2 2 1 33 No. cases removed from register 136 65 9 6 216 Remaining on register at 31.12.68 1,372 711 15 114 2,212 - 92- TABLE 13 TUBERCULOSIS-CARE AND AFTER CARE Home Care and Treatment Patients awaiting admission to hospital Nil Patients under treatment in their own homes Nil Patients receiving attention by home nurses 7 Work of Tuberculosis Visitors No. of Tuberculous households visited 1,581 No. of visits to above and to contacts 7,679 No. of unsuccessful visits 863 Work of Chest Clinic Welfare Officers Patients assisted for the first time with Beds, bedding 3 Clothing, footwear 25 Patients at end of year receiving Extra nourishment 76 Home help 36 Diversional Therapy Patients receiving instruction in their own homes Nil 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 Nil Child contacts boarded out for segregation during B.C.G. vaccination 1 -93- TABLE 14 MASS RADIOGRAPHY Unit 6A Unit 6B Total No. of factories, sites, etc. visited 7 19 26 Persons X-rayed-Males 2,308 5,184 7,492 - Females 461 2,995 3,456 Total 2,769 8,179 10,948 No. referred for further investigation 34 99 133 Toynbee Hall - persons x-rayed 4,368 - 4,368 - referred for further investigation 180 - 180 Abnormalities discovered in 1967 Surveys: Total persons x-rayed 2,946 Not available Tuberculosis requiring immediate treatment 9 „ „ clinic supervision 2 Cancer of lung 2 Other 30 Active tuberculosis cases discovered per 1,000 examined 3.0 TABLE 15 TUBERCULIN TEST AND B.C.G. VACCINATION Contacts Schoolchildren and Students Total No. of skin tests 276 1,862 2,138 No. found positive 75 186 261 No. found negative 201 1,681 1,882 No. vaccinated 197 1,681 1,878 -94- TABLE 16 ANTE AND POST NATAL SERVICES No. Ante and Post Natal Sessions held by: Medical Officers - Midwives 49 Sessional General Practitioners 93 No. women attending for ante natal examination 167 No. women attending for post natal examination 108 Total attendances 1,041 No. General Practitioners holding sessions in Council clinics 4 Mothercraft and Relaxation Classes: No. women attending (a) Institutionally booked 131 (b) Domiciliary booked 2 No. attendances 881 No. sessions held by Health Visitors 122 TABLE 17 CHILD WELFARE CENTRES No. premises at end of year 14 No. sessions during year held by: Medical Officers 86 Health Visitors 181 Sessional General Practitioners 1,687 Hospital medical staff 51 Total sessions: 2,005 No. children attending - born this year 2,379 - born last year 2,695 - born 1963-6 3,418 No. attendances of children of all ages 44,966 Average attendance per session 22.4 No. children referred elsewhere 599 -95- TABLE 18 DAY NURSERIES AND CHILD-MINDERS DAY NURSERIES Voluntary Nurseries Council Nurseries No. of Nurseries 1 4 Capacity 25 210 No. attending at end of year 19 167 Child/day attendances-Under 2 years - 9,367 -Over 2 years 4,237 25,840 No. of days open 233 253 Average daily attendance 18.2 139.1 OTHER PREMISES REGISTERED UNDER NURSERIES AND CHILD MINDERS REGULATION ACT, 1948 No. of premises registered at end of year 12 Capacity 239 CHILD MINDERS Statutorily Registered No. at 1st January 6 Additions during the year - Deletions during the year - No. at end of year 6 No. of children authorised to be minded at end of year 24 No. being minded at end of year 19 Under Voluntary Scheme No. at 1st January 52 Additions during the year 23 Deletions during the year 37 No. at end of year 38 No. children authorised to be minded at end of year 68 No. being minded at end of year 36 No. Child-minders receiving fees at end of year 26 -96- TABLE 19 CERVICAL CYTOLOGY Premises Number Sessions Examinations Council Clinics 3 147 937 General Practitioners Surgeries 1 41 162 Family Planning Clinics 2 105 248 Other Slides read in Hospital Laboratories Thames Group Submitted by G.P.s Hospital St. Andrew's Hospital 185 671 East London Group Mile End Hospital 586 1,552 Other Hospitals in Group - 1,403 London Hospital - 6,687 (Residents of all areas) TABLE 20 CHIROPODY Treated at Clinics Domiciliary Treatment New patients during year 618 229 Total patients at end of year 2,135 806 Treatments-children 241 - -expectant mothers - - -physically and mentally handicapped 105 2 -aged persons 11,355 4,771 No. of chiropodists employed 10 No. of clinic sessions held 1,735 No. of patients treated per clinic session 6.7 Percentage of total patients receiving domiciliary treatment 27.4 Total No, of treatments 16, 474(plus 911 by Welfare Department in Old People's Homes) TABLE 21 DENTAL TREATMENT FOR EXPECTANT AND NURSING MOTHERS Expectant Mothers Children Persons examined 15 410 No. requiring and offered treatment 15 310 Visits during the year 16 589 Courses of completed treatment 6 153 Teeth extracted 7 5 Teeth filled 10 556 Emergencies treated - - General anaesthetics given - - No. patients x-rayed 2 4 No. patients treated by scaling etc. 5 223 Dentures-full 1 - -partial 3 - No. of sessions for treatment 69.3 -do- for health education 16 No. of Treatment Centres at end of year 8 -97- TABLE 22 HEALTH EDUCATION ACTIVITIES Discussion groups or talks on the following subjects were arranged during the year: Subject No. Occasions Persons participating Smoking and Lung Cancer 4 85 Sex Education and Venereal Disease 46 993 Mothercraft 75 663 Cervical Cytology 22 163 Needs of the Elderly 23 542 General Health Subjects -Schools 1,410 22,676 -Other 173 2,468 Psychoprophylaxis 96 657 Health Education Techniques 67 691 Total: 1,916 28,938 Films or filmstrips were shown on 486 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 2, 580 posters were exhibited and 12, 650 leaflets distributed. -98- TABLE 23 FAMILY PLANNING SERVICE Patients and attendances at the once-weekly sessions held at clinics in the borough were as follows:- Premises New Cases Transfers Old Patients Total Patients Total Visits No. of Sessions Council Clinics Wigram House 25 - - 25 32 8 Domiciliary Service 32 4 - 36 100 - Family Planning Association Clinics Underwood Road 562 41 362 965 1,747 155 Wapping 67 7 58 132 337 49 Wellington Way 296 15 336 647 1,516 94 Totals: 982 67 756 1,805 3,732 306 1967 Statistics 624 78 549 1,251 2,892 211 TABLE 24 HEALTH VISITING No. Visited No. of Visits Children born this year 2,858 „ „ last year 2,715 „ „ 1963-1966 6,202 45,381 Aged persons 99 284 Mentally disordered persons 69 280 Tuberculous households 10 38 Households on account of other infectious diseases 56 111 Persons, and maternity cases, discharged from hospital (other than Mental hospitals) 37 110 Other cases 1,023 1,636 Visits to Expectant and Nursing mothers - 1,927 Visits to problem families - 2,419 Total effective visits - 52,186 Unsuccessful visits . 9,324 TABLE 25 PREMATURE BIRTHS Born in Hospital Born at Home or in Nursing Home 1968 1967 1966 1968 1967 1966 No. of Births 177 213 238 23 11 21 Died within 24 hours 12 16 11 2 - 4 Died within 1/28 days 13 8 18 - - 4 Premature still births 26 28 32 2 1 - -99- TABLE 26 HOME BATHING Persons serviced during the year: Male 108 Female 255 Total 363 Persons receiving service at end of year: Male 81 Female 185 Total 266 Total baths given during year: 5,468 TABLE 27 HOME HELP SERVICE Persons for whom service provided during year: No. of persons Hours of Service as % of total Aged persons 2,986 87.3 Chronic sick and tuberculous persons 466 11.0 Mentally disordered 35 0.6 Maternity cases 31 0.2 Others 125 0.9 Total 3,643 100.0 No. of persons receiving service at end of year: 2,504 Staff Number Whole-time equivalent Organisers 3 3 Assistant Organisers 6 5.6 Home Helps i 280 185.2 -100- - 101 - TABLE 28 HOME NURSING Number patients nursed during year 2,354 Number aged under 5 75 " over 65 1,356 " of visits during year 89, 861 TABLE 29 LAUNDERING FOR AGED AND INCONTINENT No. of articles cleansed and laundered during year 49,175 No. of collections made during year 3, 650 No. of persons who received service during year 129 No. of persons receiving service at end of year 79 TABLE 30 RECUPERATIVE HOLIDAYS Category No. for whom holiday arranged Expectant and nursing mothers 1 Adults - Psychiatric 24 - Tuberculous 1 - Other 142 Accompanied children: 1. At school - 2. Pre-school 5 Unaccompanied children; 1. Placed by I. L. E. A. at school 181 pre-school - 2. Placed by Tower Hamlets Council at school 1 pre-school - Total: 355 - 102 TABLE 31 LOAN OF NURSING EQUIPMENT AND FIREGUARDS Nursing equipment and fireguards loaned, by the Council, free of charge to residents of the borough during the year was as follows:- No. on loan at 1/1/68 No. loaned during year No. returned during year No. on loan at 31/12/68 Air rings 5 7 7 5 Back rests 11 9 8 12 Beds - Air - 1 1 - Bed cradles 7 5 5 7 Beds - Egerton - 1 1 - Beds - Hospital 10 5 4 11 Beds - Cot and mattress 2 2 3 1 Bed pans 12 34 25 21 Bottles 11 19 12 18 Chairs - wheel 42 49 46 45 Chairs - Ambulance type, carrying - 2 1 1 Commodes - Chair 185 150 147 188 Commodes - Stool 11 7 6 12 Cushions - Air 1 - 1 - Cushions - Sani 1 1 1 1 Cushions - Sponge - 4 2 2 Fracture boards 14 10 10 14 Hoists 2 3 3 2 Hoists - Penrhyn 6 5 5 6 Mattresses - ordinary - 5 3 2 Mattresses - Dunlopillo 14 6 8 12 Sheets - rubber 20 27 20 27 Walking frames 10 10 10 10 Walking frames - wheeled 1 - - 1 Walking frames - Zimmer adjustable 1 - - 1 Walking sticks - Tripod 19 13 11 21 Walking sticks - Quadruped 3 - 2 1 Water Closet Seats - inflatable 3 1 - 4 OTHER EQUIPMENT LOANED Fireguards 392 66 11 447 - 103 - TABLE 32 DOMICILIARY MIDWIFERY Attendances by Midwives Doctor present Doctor not present Doctor not booked Midwives of Nursing Sisters of St. John the Divine - 3 " the London Hospital - 1 Total - 4 Doctor booked Midwives of Nursing Sisters of St. John the Divine 14 102 " the London Hospital 14 136 Total 28 238 No. of planned early discharges 58 Institutional deliveries attended by midwives on discharge before tenth day 189 Patients receiving - Gas and air ... ... 40 - Gas and oxygen ... ... 64 - Trilene ... ... 22 - Pethidine alone ... ... 7 - Pethidine with gas/air ... ... 4 - Pethidine with gas/oxygen ... ... 30 - Pethidine with trilene ... ... 7 - No analgesia 96 Total: 270 - 104 - TABLE 33 MENTAL HEALTH (i) 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 - 33 - - 1 - 34 Hospitals, on discharge from in-patient treatment _ 153 _ 1 _ 3 157 Hospitals, after or during out-patient or day treatment _ 51 _ _ _ _ 51 Education authorities 12 - - - 25 41 78 Police and courts - 3 - - - - 3 Other sources 1 45 - - 1 7 54 Totals 13 285 - 1 27 51 377 (ii) Psychogeriatric Unit, St. Clement' s Hospital In-patient Unit - Dundee Ward 1968 1967 1966 Admissions 128 114 131 Discharges - Home 71 65 70 - Long Grove Hospital 19 23 23 - Other 37 28 29 Total 127 116 122 Day Hospital Admissions ... ... 48 58 61 Patient/day attendances 5, 601 5,699 5,382 Discharges - Home 10 5 9 - Long Grove Hospital - 3 3 - St. Clement's -in-patient 17 26 25 - General hospitals 15 25 22 - Other 5 3 6 Total 47 62 65 Out-Patient Attendances New Referrals .. 43 36 48 Other Attendances .. 230 184 195 (iii) Admissions to Hospital under Mental Health Act, 1959 Male Female Total Admitted under; Section 25 18 28 46 Section 26 3 2 5 Section 29 14 17 31 Section 60 6 - 6 Section 136 2 1 3 Admitted informally 42 64 106 Total: 85 112 197 - 105 - MENTAL HEALTH (iv) Patients under Care at 31st December. Mentally 111 Elderly Mentally Infirm Psychop athic Sub-normal and Severely Sub-normal Total Under 16 Over 16 Under 16 Over 16 Under 16 Over 16 1. Total number 1 553 45 - 2 96 328 1025 2. Attending training/day centre - 29 16 - - 78 84 207 3. Awaiting entry - - - - - 1 - 1 4. Receiving home training - 4 1 - - - 1 6 5. Awaiting home training - - o - - - - - 6. Resident in L. A. hostel - - • - - 2 - 2 7. Awaiting residence in L. A. hostel - - - - - - - 8. Resident at L. A. expense in other hostels - 27 - - - 1 8 36 9. Boarded out at L. A. expense - - - - - - - - 10. Attending day hospital - 8 4 - - - - 12 11. Receiving home visits and not included in 2- 10 above 1 485 24 _ 2 14 235 761 12. Admissions to guardianship during year - - - - - ■ - - 13. Under guardianship at end of year - - - - - - 3 3 14. On waiting list for admission to hospital: (a) in urgent need - - - - - 1 2 3 (b) not in urgent need - - - - - 1 3 4 15. Admission for temporary' residential care: (a) to N. H. S. hospitals . _ 1 _ _ 4 2 7 (b) to L. A. residential accommodation _ - - _ - - - - (c) elsewhere 6 3 9 TABLE 34 - 106 - MENTAL HEALTH (v) Day and Training Centres Trainees Adult Training Centre Underwood Road Industrial T raining Centre White Horse Road Junior Training Centre Cornwall Ave. Special Care Unit University House Day Centre Pritchard's Road Geriatric Unit Pritchard's Road T 0 T A L M F M F M F M F M F No. on roll at 1st January 15 37(1) 37 31 27 8 4 22(2) 14 1(1) 11 207(4) New entrants 1 4 7 7 4 2 1 42 19(1) 2 7 96(1) Transferred from other centres - - 1 1 - - - - - - - 2 Removals Moved out of borough 1 1 - 3 1 1 - - - - - 7 Excluded - - - - - - - 2 - - 2 Self-discharged - 1 - - - - - 22 9 1 1 34 Failed to attend - 1 2 - - - - 9 5 - - 17 Admitted to hospital 1 2 - - - - ; - 7 - - - 10 T ransferred to other centres 1 2 1 _ - 1 - - - - - 5 " E. S. N. school - - - - 1 - - - - - - 1 Residential placing - - - - - - - - - - - - Died - - - 2 1 - - 1 2 1 2 9 Left to take up employment 1 1 - - - - - 5 6 -(1) - 13(1) No. on roll at 31st December 12 33(1) 42 34 28 8 5 18(2) 11(1) 1 15 207(4) Figures in parenthesis denote City of London patients in addition - 107 - TABLE 36 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 57 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 Kingsley Hall Gardens 13 Kirkwall Place Playground 12 Mallon Gardens (Commercial Street) 19 Mile End Gardens 50 Newby Place Playground 49 Peel Grove Gardens 1.12 Pelter Street Playground 12 Poplar Recreation Ground 4.41 Rochelle 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 York Square Gardens 20 36.30 - 108 - TABLE 36 (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 11. 57 Bethnal Green Gardens 11..97 Blackwall Tunnel (Commemoration Park) 1.33 Brickfield Gardens 5.73 Burdett Gardens 1. 49 Carlton Square Gardens 1.95 Diggon Street Playground . 13 Furze Green 1.9 3 Gosling Garders 2. 5 Grove Hall Park 4.5 Ion Square 1.75 Island Gardens 3.0 King Edward VII Memorial Park 8. 5 King George" s Fields 15.93 Langdon Park 2. 61 Limehouse Churchyard 2.0 Meath Gardens 10.54 Millwall Park 13. 5 Ropewalk Gardens 1.51 St. Mary's Churchyard 1. 26 Shandy Park 3. 18 Sir John McDougall Gardens 6. 32 Stepney Churchyard 9.75 Stepney Green Open Space 5. 29 Trinity Garden 1.03 Victoria Park (part) 148.5 Wapping Gardens 3.56 Waterside Gardens 1.92 Weavers' Fields 5. 25 Total Acreage 326.49 290.19 TABLE 37 BURIALS UNDERTAKEN Under Section 50, National Assistance Act, 1948. Number of Adults 38 " " Children 13 " Stillborn 1 Total cost £914* Burials requested by - Coroner 30 - Relatives 20 - Others 2 * Part irrecoverable - 109 - TABLE 38 MEDICAL EXAMINATIONS OF COUNCIL STAFF (a) Reason for Examination Number examined New appointees 340 Transfers to permanent staff 193 Entry to Council's Sick Pay Scheme 56 Sickness absence exceeding one month 312 Extension of service beyond 65 years of age 32 Reviews, etc. 49 Total: 982 (b) Medical assessments for entry to Sick Pay Scheme 379 Examinations arranged with other authorities 19 Abortive appointments 248 TABLE 39 DISEASES OF ANIMALS ACTS Kosher Poulterers and Poultry Slaughterhouses Inspections for cleanliness and fowl pest control 298 Street Markets Inspection re sale of animals and observations on movements of live poultry 122 Pet Shops Visits 56 Animal Boarding Establishments Visits 1 TABLE 40 VISITS BY PUBLIC HEALTH INSPECTOR (CLEAN AIR) AND TECHNICAL ASSISTANT To premises regarding complaints 9 Smoke Control Orders 2, 358 " for smoke observations 8 " " " applications under Sec. 3(2) 2 " " routine boiler inspections 3 No. of notices served under Sec. 12(2) 338 " " Sec. 16 3 - 110 - TABLE 41 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 Pood 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 961 samples were submitted for analysis, as follows:- 11 Beer 91 Meat and meat preparations 4 Biscuits 32 Milk 4 Brandy 1 Milk (condensed) 5 Bread 7 Milk preparations 4 Bread and butter 7 Miscellaneous samples 20 Butter 2 Non-brewed condiment 11 Cake and flour confectionery 23 Nuts and nut preparations 19 Cereal s 25 Oils and fats 7 Cheese and cheese preparations 24 Pickl es 4 Chocolate liqueurs 2 Puddings 18 Chocolate preparations 1 Pulses 7 Coffee and coffee preparations 1 Rum 3 Colourings 2 Salad Cream 5 Cream 14 Sauces 105 Drugs 26 Sausages 15 Eggs 21 Soft drinks 59 Fish and fish preparations 12 Soups 5 F1avourings 24 Slices 2 Flour 3 Sugar 6 Food additives 48 Sugar confectionery 145 Fruit and fruit preparations 2 Suet 1 Gin 1 Sweeteners 5 Herbs 1 Syrup 10 Ice cream 35 Tea 11 Jam and preserves 42 Vegetables and vegetable 17 Macaroni products preparations 1 Margarine 5 Vinegar 1 Meal 4 Whisky -1ll - TABLE 42 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 Regulation Total No. of Premises No. of premises fitted to comply with Regulation Bakehouses 54 54 54 54 Baker Shops 98 98 98 98 Butchers 172 172 172 172 Catering 1,322 1,322 1,322 1, 322 Fish 119 119 119 119 Greengrocers/ Fruiterers 381 267 381 381 Grocers 447 435 447 396 Public Houses 481 481 481 481 Poultry Dealers 46 46 46 46 Confectioners 352 352 310 309 Totals: 3,472 3, 346 3,430 3,378 - 112 - TABLE 43 HOUSING INSPECTORS AND TECHNICAL ASSISTANTS VISITS AND NOTICES VISITS Housing Act, 1957 (Sections 16, 17 & 18) 123 Slum Clearance 6, 380 Overcrowding 141 Standard and Improvement grants 4 Betting offices (Betting and Gaming Act, 1960) 15 Town Planning applications 236 Houses in Multiple Occupation 4, 580 Preferential re-housing 747 Sites 1,615 Miscellaneous 287 Total 14, 128 NOTICES, ORDERS ETC. HOUSING ACTS 1957-64 Informal notices 149 Intention to make Management Orders 70 Management Orders made 27 Intention to make Directions 23 Directions made (Section 19) 20 Overcrowding (Section 90 Housing Act, 1957) 58 Means of Escape in Case of Fire (Section 16) 101 - 113 - TABLE 44 DWELLINGS ERECTED DURING 1968 (a) By Borough Council No. of Dwellings Antrim House, Old Ford Road 130 Arapiles House, Blair Street 15 Brodick House, Sutherland Road 130 Cavan House, Old Ford Road 130 Clare House, Old Ford Road 130 Coniston House, Southern Grove 66 Eric Street 45-93 25 Jura House, Aberfeldy Street 57-79 12 Kilbrennan House, Findhorn Street 32 Mull House, Stafford Road 27 Robinson Road, 26-49 (cons.) 24 Roman Road 27 3-28 5 7 Russi a L ane 2-80 40 Sinclair House, St. Stephens Road 24 Sleat House, Saxon Road 18 Solebay Street 97A-109B 14 Tay House, St. Stephen's Road 26 Tuscan House, Knottisford Street 48 John Bond House.(Old Peoples' Dwellings) 13 Fitzgerald Lodge (Old Peoples' Dwellings) 32 943 (b) By Greater London Council Alderney Road, Osier Estate 12 Alpha Grove 85-137 (odd) 132-142 (even) 35 Argos House, Minerva Estate 18 Barents House, Ocean Estate 4 Barley Corn Way, Barley Mow Estate 72 Ben Jonson Road, Ocean Estate 9 Bowsprit Point, Barkantine Estate 82 Cheval Street, -do- 18 Donegal House, Collingwood Estate 63 Globe Road, Osier Estate 4 Heathpool Court, Collingwood Estate 45 Hedley House, Samuda Estate 54 Janet Street, Barkantine Estate 26 Kelson House, Samuda Estate 145 Knighthead Point, Barkantine Estate 82 Lantern House, -do- 40 Midship Point, -do- 82 Oswel1 House, Wapping Estate 2 Pinnace House, Samuda Estate 36 Priory Street, Bow Bridge Estate 10 Reef House, Samuda Estate 27 Shandy Street, Ocean Estate 2 Spring Walk, Chicksand Estate 9 Stockholm House, St. George's Estate 65 Swedenborg Gardens, St. George's Estate 43 The Quarterdeck, Barkantine Estate 46 Tideway House, -do- 28 Winch House, -do- 12 Winterton House, Watney Market Estate 95 Yarrow House, Samuda Estate 12 1, 178 (c) By Others "Lovat Arms" Public House, Burdett Road 1 Stepney Meeting Hall, Stepney Way 1 2 Total 2, 123 - 114 - TABLE 45 PRESCRIBED PARTICULARS ON THE ADMINISTRATION OF THE FACTORIES ACT, 1961 1. Inspections for purposes of provisions as to health Type of Factory No. on Register Inspections Written Notices Factories without mechanical power 441 169 1 Factories with mechanical power 3,577 1,122 134 Other premises under the Act (Electrical stations, institutions, and sites of building operations and works of engineering and construction) 75 67 Total: 4, 093 1,358 135 2. Cases in which defects were found Referred Particulars Found Remedied To H. M. Inspector By H. M. Inspector Want of cleanliness 19 13 2 - Overcrowding - - - - Unreasonable temperature - - - - Inadequate ventilation 5 1 1 - Ineffective drainage of floors - - - - Sanitary conveniences: (a) insufficient 7 4 1 - (b) unsuitable or defective 109 74 1 24 (c) not separate for sexes 19 8 - 2 Other offences against the Act (not including those relating to outwork) 28 8 6 - Total: 187 108 11 26 - 115 - TABLE 45 (continued) i PART VIII OF THE ACT - OUTWORK Section 133 Nature of Work No. of outworkers 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. 564 - - cleaning and washing - - - Household linen 1 - - Lace, lace curtains and nets - - - Curtains and furniture hangings - - - Furniture and upholstery - - - Electro-plate - - - File making - - - Brass and brass articles 4 - - Fur pulling - - - Iron and steel cables and chains - - - Iron and steel anchors and grapnels - - - Cart gear - - - Locks, latches and keys - - - Umbrellas, etc. - - - Artificial flowers - - - 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 84 - - Brush making 3 - - Pea picking - - - Feather sorting - - - Carding, etc. of buttons, etc. 3 - - Stuffed toys - - - Basket making - - - Chocolates and sweetmeats - - - Cosaques, Christmas stockings - - - Textile weaving - - Lampshades - - - Total: 659 - - Section 134. There were no instances of work found in unwholesome premises. -lift- TABLE 46 LEGAL PROCEEDINGS INSTITUTED DURING THE YEAR No. of Summonses Fines Costs £. s. d. £. s. d. Housing Act, 1961 Houses in Multiple Occupation Contravention of Directions 12 210. 0. 0. 56. 14. 0. Contravention of Regulations 119 464. 0. 0. 35. 14. 0. Means of escape in case of fire 3 45. 0. 0. 10. 8. 0. Housing Act, 1957: Overcrowding in Houses in Multiple Occupation 35 248. 0. 0. 48. 6. 0. Contravention of Closing Orders (Basements) 1 5. 0. 0. 5. 5. 0. Public Health Act, 1936: Nuisance Orders 66 - 214. 2. 0. Non-compliance with Nuisance Orders 12 280. 0. 0. 40. 17. 0. Setting up offensive trade without consent (S. 107) 2 15. 0. 0. 5. 5. 0. Food and Drugs Act, 1955 10 252. 0. 0. 77. 14. 0. Food Hygiene (General) Regulations, 1960 69 595. 0. 0. 70. 7. 0. Food Hygiene (Market Stalls and Delivery Vehicles )Regulations, 1966 211 1,303. 0. 0. 217. 9. 0. Merchandise Marks Act 1926 2 20. 0. 0. 6. 6. 0. Factories Act, 1961 2 10. 0. 0. 14. 14. 0. Offices Shops and Railway Premises Act, 1963 2 30. 0. 0. 6. 6. 0. Pet Animals Act, 1951 1 15. 0. 0. 4. 4. 0. L. C. C. (General Powers) Act 1956 1 5. 0. 0. 4. 4. 0. L. C. C. Drainage Byelaws 1962 21 44. 0. 0. 19. 19. 0. L. C. C. Water Closet Byelaws, 1930 4 9. 0. 0. 10. 10. 0. Total: 573 3, 550. 0. 0. 848. 4. 0. TABLE 47 MORTUARY SERVICE Tower Hamlets Mortuary Hackney Mortuary Total Bodies received 456 108 564 Post- mortems 393 99 492 Inquests 60 19 79 - 117 - TABLE 48 CLEANSING STATION | Persons treated for scabies: Men 107 Women 86 School children 101 Children under 5 80 Total 374 No. treatments given 632 Persons treated for verminous conditions: Men 906 Women 76 School children 401 Children under 5 73 Total 1,456 TABLE 49 DISINFECTING STATION Disinfection: No. of dwellings disinfected for tuberculosis 7 No. of dwellings disinfected for other infectious diseases 19 No. of dwellings disinfected for other reasons 14 No. of rooms involved 71 No. of articles disinfected by steam - Export 552 Other reasons 6,108 No. of articles disinfected by formaldehyde - Export 18 tons rags. Other reasons 465 plus 12 tons rags. No. of premises other than dwellings, disinfected 11 Disinfeftation: No. of dwellings disinfested for bed bugs - 471 - for other vermin 421 No. of rooms involved 2,415 No. of other premises and sites disinfested 273 No. of articles disinfested by steam 17,156 No. of articles disinfested by formaldehyde 457 Drainage: No. of premises where drains tested 81 No. found defective 14 - 118 - TABLE 50 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 Type of premises Registered during year Registrations Registered premises receiving general inspections during year Persons employed Offices 75 1,036 281 15,103 Retail shops 63 1,227 485 4,223 Wholesale Shops 57 651 187 6,189 Catering establishments 27 320 128 1,801 Fuel storage depots - 4 1 26 Total: 222 3,238 1,082. 27,342 (Males: 17,565 (Females: 9,777 (*) Other visits to registered premises 2,078 Visits to non-registered premises 771 Informal Notices served Offices, Shops and Railway Premises Act, 1963 485 Notification of Employment of Persons Order,1964 139 Accidents notified - Causes Machinery: Power-driven machinery or relevant part in motion 2 Machinery or relevant part at rest (power and non-power driven) 4 Transport: Vehicle in motion not moved by power 2 Vehicle in motion moved by power 4* Vehicle stationary 2 Fire and Explosion 1 Electrical 1 Falls of persons: On or from fixed stairs 4 Other falls from one level to another 4 Falls on the same level 9 Stepping on or striking against object or person 3 Handling Goods (not otherwise classifiable) 12 Struck by falling object 9 Not otherwise specified 6 Total 63 * Includes one fatal accident. - 119 - TABLE 51 RODENT CONTROL Properties inspected Number Inspected Number found to be infested by Rats Mice - on complaint 2,268 773 1,387 - otherwise 1, 561 368 747 Total 3, 829 1,141 2, 134 Properties treated by Council 3, 760 Visits by Rodent Operatives 16, 659 Notices served under Section 4 of the Act (a) treatment Nil (b) structural work (proofing) 35 Cases where default action taken following service of notice 12 Number of "Block Control" schemes carried out 3 No. of Business premises under servicing contract at 1st January 231 No. of new contracts during the year 189 No. of contracts terminated during the year 176 No. remaining under contract at 31st December 244 Sewer Treatments Number of manholes in system 3, 589 First treatment(February/April) Test bait followed by poison 2,879 manholes treated 69 complete takes 368 partial takes Second treatment (June/July) Direct poison 3, 024 manholes Third treatment (September/October) Direct poison 3,130 manholes -120 - TABLE 52 VISITS BY PUBLIC HEALTH INSPECTORS Type of Premises No. Visits or Inspections Registered and Licensed Premises Animal Boarding Establishments 1 2 Common Lodging Houses 4 18 Fur Skin Dressers 2 3 Hairdressers 190 275 Ice Cream 507 355 Massage Establishments 5 18 Milk Distributors 317 255 Pet Shops and Stalls 72 130 Pharmacy and Poisons 96 64 Poultry Slaughterhouses 18 193 Prepared Food - Meat 98 78 - Fish 58 60 Rag Flock 38 26 Seamen's Lodging Houses 3 20 Dwellings No. of visits on complaint - 5,788 No. of visits for drainage - 3,582 No. of revisits - 9,416 No. of other visits - 2,400 Other Premises Bakehouses 54 127 Baker Shops and Stalls 105 218 Butcher Shops and Stalls 198 344 Canteens and Clubs 609 363 Chemists 66 27 Confectionery Shops and Stalls 411 332 Fish Shops and Stalls 144 317 Greengrocers and Fruiterers Shops and Stalls 7 26 945 Grocers Shops and Stalls 505 649 Hospitals, Institutions and Day Nurseries 29 12 Public Houses and Off Licences 481 685 Poultry Shops and Stalls 113 178 Restaurants, Cafes and Stalls 626 857 School Meal Centres 130 90 Wholesale Food Depots, Markets and Wharves 89 1,251 Other Food Premises 178 319 Food Delivery Vehicles - 25 Factories (Mechanical) 3,577 1,122 Factories (Non Mechanical) 441 169 Factories (Other) 75 67 Outworkers 659 258 Schools 99 150 Drainage Work - 1,957 Total 33,145 There are 4,088 food premises including stalls in the Borough. Some of the premises listed above are included under more than one trade category. TABLE 53 MISCELLANEOUS WORK OF PUBLIC HEALTH INSPECTORS Rent Act 1957 - Certificates of Disrepair 1. Applications for disrepair certificates 2 Notice of proposal to issue certificates 1 Undertaking accepted 1 Undertaking refused - Certificates issued 1 2. Applications for cancellation of disrepair certificates - Tenant Landlord 3. Applications for certificates as to remedying of defects 1 - Certificates issued - all defects remedied 1 - Complaints Number received at Office 6,091 Dangerous Structures Number of premises notified to District Surveyor 144 Drainage Plans Number of plans on which observations submitted to Borough Engineer and Surveyor 238 Land Charges Number of premises reported upon to Town Clerk 1,369 Town Planning Applications No. of premises reported upon to Borough Architect and Planning Officer 585 Public Houses Number of premises reported upon to Licensing Justices 142 - 121 - - 122 - TABLE 54 NOTICES SERVED BY DISTRICT PUBLIC HEALTH INSPECTORS Food Hygiene (General) Regulations 1960 441 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 187 Public Health Act, 1936, Section 39 44 -do- 45 8 -do- 56 1 -do- 75 53 -do- 89 34 -do- 93 2,035 Public Health Act, 1961, Section 17 198 Informal Notices to Local Authority Housing Departments 1,757 Factories Act 1961 135 Prevention of Damage by Pests Act 1949 35 Stepney Council Common Staircase Lighting Byelaws 22 London County Council Drainage Byelaws, 1962 3 Tower Hamlets Council Hairdressers Byelaws 19 Total: 4,972 TABLE 55 OUTWORKERS Firms in the borough employing outworkers 92 Outworkers residing in, and employed by firms in the borough 386 Outworkers residing outside the borough employed by firms in the borough 808 Outworkers residing in the borough employed by firms outside the borough 273 Total outworkers in the borough 659 TABLE 56 REFUSE DISPOSAL Home and trade refuse 71,393 tons Street and market collections 17,108 tons No. of bulk containers in use 2,836 No. of street gulleys cleansed 15,542 - 123 - TABLE 57 CONFERENCES The Council was represented at the following Conferences during the year: Conference Venue Dates Representatives Association of Public Health Inspectors. (a) One Day Conference London 24th January Vice-Chairman, Health Committee. Public Health Inspector (b) Annual Conference Blackpool 16th - 20th September Councillor Miss H. Morsman Public Health Inspector. The Central Council for Health Education. Annual Conference London 25th January Vice-Chairman, Health Committee. Health Education Officer National Committee for Commonwealth Immigrants. The Care of Pre-School Coloured Children London 14th February Centre Superintendent Health Visitor National Association of Mental Health. (a) Annual Conference London 22nd - 23rd February Councillor Miss H. Morsman. Principal Social Worker (Mental Health) (b) Hostels for Mentally Disordered London 30th April Medical Officer of Health. (c) The Camphill Village Trust London 13th March Principal Social Worker (Mental Health) Greater London Council. Old People's Welfare London 14th March Principal Social Worker (Mental Health) Institute of Water Pollution Control. Effluent Treatment for the Food Industries Bath 20th March Public Health Inspector Royal Society of Health. (a) Family Planning for Britain London 5th April Vice-Chairman, Health Committee. (b) Health Congress Eastbourne 29th April 3rd May Chairman, Health Committee. Medical Officer of Health (c) Psychiatric Care in the Community London 4th December Chairman, Health Committee. Principal Social Worker (Mental Health) - 124 - TABLE 57 (continued) CONFERENCES (continued) Conference Venue Dates Representatives  National Council for Home Help. Coventry 26th April Home Help Organiser Queen's Institute of District Nursing. London 4th May Principal Nursing Officer Queen's Institute of District Nursing. London 12th October Principal Nursing Officer Nursery School Association. London 10th May Deputy Medical Officer of Health Noise Abatement Society. London 13th/18th Chairman, Health Committee. International Congress May Public Health Inspector Camberwell Council on Alcoholism and The London 15 th - 17 th Principal Social Worker International Council on May (Mental Health) Alcohol and Alcoholism. National Council for the Single Woman and Her London 30th May Deputy Principal Nursing Officer. Dependents Limited. British Association of Dental Auxiliaries . London 7th June Dental Auxiliary. Sea and Airport Health Liverpool 12th - 14th Councillor W. T. Tuson. Authorities. June Associate Medical Officer of Annual Conference Health. National Association for Maternal and Child Welfare. London 12th - 14th Alderman J. Orwell(Bethnal Green) Councillor Mrs. D. M. Couling Annual Conference June Senior Medical Officer British Dental Association. 17th-21st June Chief Dental Officer Annual Conference Brighton 17th & 20th June Dental Officer Family Planning Association. Annual Conference Leicester 26th - 27th June Health Visitor St. Lawrence's Hospital. Surrey 3rd - 5th July Social Workers, (Mental Health) London Boroughs Association. Vice- Chairman,Health Committee. Services for Disturbed London 3rd July Councillor Mrs. D. M. Couling. Adolescents Deputy Medical Officer of Health. Scottish Health Visitors' Association and English Health Visitors' Association. Joint Conference Edinburgh 12th - 16th August Principal Nursing Officer - 125 - TABLE 57 (continued) CONFERENCES (continued) Conference Venue Dates Representatives  World Federation for Mental Health. International Congress London 12th - 17th August Councillor Mrs. D. M. Couling Principal Social Worker (Mental Health) Institute of Shops Acts Administration. Annual Conference Scarborough 10th - 12th September Chairman, Health Committee. Public Health Inspector. Royal Institute of Public Health and Hygiene. Bristol 25th - 27th September Councillor J. Milrood. Deputy Medical Officer of Health. Annual Conference Royal College of Nurses. London 19th October Principal Nursing Officer Institute of Water Pollution Control. Annual Conference Scarborough 21st - 25th October Alderman J. Orwell(BethnalGreen) Public Health Inspector National Society for Clean Air. Annual Conference Harrogate 22nd - 25th October Councillor Miss H. Morsman. Public Health Inspector National Home Safety. Conference Southport 30 th - 31st October Councillor M. Pollins Health Education Officer North East Metropolitan Regional Hospital Board. Psycho-geriatric Conference Buckhurst Hill 31st October Senior Medical Officer London Guild of Health London 18th November Assistant Health Education Officer Education Officers. Inner London Education Authority. London 20th February (Assistant Nursing Officer. Health Education Officer. (a) Health Education 21st February (Principal Nursing Officer. (Health Visitor. (b) Drug Taking in School Children London 11th March (Deputy Medical Officer of Health. Assistant Medical Officer. (c) Education and Training of Nursery Nurses London 29th June Matron, Day Nursery (d) The West Indian London 16th October Social Worker (Mental Health). Background 30th October (School Nurse. (Social Worker (Health Services) London Boroughs Training Committee. Principal Nursing Officer. (a) Nursing Officers London 31st January Deputy Principal Nursing Officer. (b) Head Teachers - Junior Training Schools London 14th February Supervisor, Training Centre (c) -do- London 3rd July Supervisor, Training Centre - do- London 14th November Supervisor, Training Centre - 126 - TABLE 58 REFRESHER AND TRAINING COURSES Courses attended by staff during the year were as follows: Course Venue Dates Attended by  The Guild of Teachers of Backward Children. Research on Education of Children with Learning Handicap London 2nd January Senior Medical Officer Royal Institute of Public Health and Hygiene. Development Paediatrics London 22nd January 24th February Senior Medical Officer Central Council for Health Education, Seminar for Medical Officers of Health London 26th - 28th February Deputy Medical Officer of Health The Society of Medical Officers of Health. Refresher Course on Epilepsy Totnes 25 th - 28th March Deputy Medical Officer of Health Coal Utilisation Council. London 26 th - 28th March Public Health Inspector Association of Public Health Inspectors. Week-end School Hastings 29th - 31st March Public Health Inspectors Staffordshire County Council. Refresher Course for Teachers of Mentally Handicapped Stafford 8 th - 11th April Supervisor, Training Centre University of London. Supportive Counselling for Adolescents London 26th - 28th April Followed by six weekly seminars commenced 28th May Social Worker, Mental Health Institute of Municipal Safety Officers. London 18th June Senior Administrative Officer Greater London Whitley Council. Residential Course in Office Management Sussex 15 th - 19th July Senior Administrative Assistant TABLE 58 (continued) REFRESHER AND TRAINING COURSES (continued) Course Venue Dates Attended by Royal College of Nursing. Residential Refresher Course Liverpool 9th - 13th September Supervisor of Cleansing Services The Association of Health Administrative Officers. Summer School (Residential) Oxford 11th - 14th September Chief Administrative Officer Institute of Home Help Organisers. Week-end School London 12th - 14th September Home Help Organiser. Councillor Miss J. E. Wiggins Tottenham Technical College. Day Release Course Diploma in Municipal Administration (Part I) London Commenced 18th September Clerical Assistant Waltham Forest Technical College and School of Art. 2-year Day Release Course for O. N. C. in Public Administration London Commenced 19th September Clerical Assistant Local and Public Authorities Computer Panel. Croydon 24th September Medical Officer of Health London Borough of Hounslow. Hearing Loss in Children Heston 21st - 22nd October Health Visitor South East London Technical College. Fire Prevention in Buildings London 21st October to 2nd December One day per week for 7 weeks Technical Assistants The Institute of Family Psychiatry, Refresher Course (Residential) Ipswich 28th October 1st November Health Visitor - 127 - TABLE 58 (continued) REFRESHER AND TRAINING COURSES (continued) Course Venue Date Attended by Royal College of Surgeons. Diploma in Dental Public Health Course London Commenced October 2½ days per week for 30 weeks Chief Dental Officer and Principal School Dental Officer Family Planning Association. London 11th - 12th November Non-Medical Supervisor of Midwives National Society for Mentally Handicapped Children. Movement Training for the Mentally Handicapped London 13th November 18th December (six evenings) Assistant Supervisor, Training Centre. Trainee Teacher North London College for Further Education. Nursery Education London 23rd September 1st November Nursery Nurse -do- London 11th - 29th November Nursery Assistant National Childbirth Trust, Psychoprophylactic Method London 19th - 21st January Health Visitor -do- London 27th - 29th September Health Visitor National Childbirth Trust. Study Course London 18th July School Nurse Management Services Unit Training Courses. Techniques - Job Analysis London 29th February to 1st March Senior Administrative Officer Filing Records London 18th - 19th April Administrative Assistant London Borough of Newham. Seminar London 19th - 20th August Health Visitor Senior Social Worker (Mental Health) London Borough of Newham. Preparation for G. P. Attachment London 23rd - 25th September Principal Nursing Officer - 128 - TABLE 58 (continued) REFRESHER AND TRAINING COURSES (continued) Course Venue Dates Attended by Health Visitors' Association. Residential Refresher Course Canterbury 7th - 21st September Centre Superintendent -do- London 31st December, 1968 10th January, 1969. School Nurse Chiswick Polytechnic. Administrative Assistants in Local Government London 23rd April 25th June One day per week (10 weeks) 2 Administrative Assistants Chiswick Polytechnic. Field work Instructors Follow-up Course London 13th - 24th May Health Visitor Chiswick Polytechnic. Diploma for Teachers of Mentally Handicapped London Commenced 24th September 2 Year Trainee Teacher of the Mentally Handicapped. Children -do- London Secondment 1 Year Secondment Assistant Supervisor, Training Centre. North Western Polytechnic. Nursery Staff London 4th - 22 nd March 22nd April 31st May 1st - 5th July Nursery Assistant Nursery Nurse Nursery Warden British Post-Graduate Medical Federation. Child Dental Health Orthodontics Course London 3rd - 5th January 15th October 19th November (6 afternoons) Dental Officer British Dental Association. Resident Post-Graduate Study Course Staffordshire 4th - 6th April Dental Officer - 129 - TABLE 58 (continued) REFRESHER AND TRAINING COURSES (continued) Course Venue Dates Attended by College for the Distributive Trades Modern Techniques and Food Processing and Analysis. Bacteriology of Food London 23rd April ½ day weekly (10 weeks) 12th January ½ day weekly (10 weeks) Public Health Inspector College for the Distributive Trades Refresher Course in Meat and Food Inspection London 5th November Tuesday evenings for 12 weeks Pupil Public Health Inspector I. L. E. A. Aural and Visual Aids Course London 12th - 15th March Health Visitor London Boroughs Training Committee (1) The Role of Senior Professional Staff (Residential) Sunningdale 8th - 12th January Assistant Nursing Officer (2) The Sub-normal Child and the Family London 12th January to July (Alternate Friday afternoons) 9th October 1968 to July 1969 (Alternate Wednesday afternoons) Social Worker (Mental Health) (3) Day Release Course for Teaching Staff in Junior Training Centres London 16th January to 27th March Attendance on 12 days Assistant Supervisor, Training Centre. (4) Nursing Staff and Social Workers London 19th January 26th January Health Visitor Senior Social Worker (Mental Health) (5) Management Appreciation for Health Visitors/ Centre Superintendents London 10th - 14th June Centre Superintendent - 130 - TABLE 58 (continued) REFRESHER AND TRAINING COURSES (continued) Course Venue Dates Attended by London Boroughs Training Committee (continued) (6) Supervisory District Nursing Staff London 25th June Principal Nursing Officer (7) Domiciliary Midwives London 1st July Non-Medical Supervisor of Midwives (8) Residential Course for Matrons of Day Nurseries Sunningdale 16th-20th September Deputy Matron, Day Nursery (9) Seminars for Home Help Organisers and Assistant Organisers London 23rd, 30th October, 6th, 13th 20th November, and 4th December Assistant Home Help Organiser (10) Introductory Course for School Nurses London 21st, 22nd, 28th, 29th November Clinic Nurse School Nurse - 131 - TABLE 59 SCHOOL HEALTH STATISTICS Pupils on School Rolls at December, 1968 Under 5 years - full-time 1,576 - part-time 1,426 Infants 6,013 Juniors 10,785 Seniors 12,331 Special 889 Total: 33,020 Routine Medical Inspections Number of children inspected 12,663 Percentage of total inspected 37.5 Percentage referred for treatment of defects 16.0 Percentage referred for treatment of defects other than vision 8.0 Percentage whose physical condition not satisfactory 0.1 Non-routine Medical Inspections Re-inspections 3,999 Employment Certificates 220 School journeys 1,656 Recuperative holidays - before holiday 66 Boarding Schools for the Delicate - before departure 14 - on return - Handicapped pupils - statutory examinations 224 - periodic special defect examinations 472 Research investigations and enquiries 26 2,678 Specials: at request of - Head Teacher - special book 136 - others 560 - School Nurse - after health survey 79 - others 249 - Divisional Officer (Education) 65 - District Care Organiser/Care Committee 37 - Parent 125 - School Medical Officer 140 1,391 All other non-routine inspections 95 Total non-routine medical inspections 8,163 (continued over) - 132 - TABLE 59 (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 1968 1967 1968 1967 Skin 7.34 9.50 8.61 12.22 Eyes - Vision 85.60 79.40 49.75 69.82 - Squint 10.90 10.93 5.21 9.95 - Other 2.29 2.04 1.58 3.32 Ears - Hearing 6.24 6.56 3.71 5.35 - Otitis Media 1.58 1.81 2.37 2.71 - Other 1.26 1.81 1.74 1.43 Nose and Throat 6.63 11.84 25.19 32.12 Speech 5.29 4.60 6.24 6.41 Lymphatic Glands 0.47 0.23 1.90 3.47 Heart 2.29 2.34 3.79 7.46 Lungs 5.21 6.33 6.45 9.80 Development - Hernia 0.87 1.13 1.66 2.49 - Other 1.11 2.04 7.74 10.71 Orthopaedic - Posture 0.87 0.45 3.08 3.32 - Feet 3.32 8.29 10.27 16.51 - Other 2.61 3.85 4.50 5.81 Nervous System - Epilepsy 0.95 1.06 0.55 1.06 - Other 0.71 0.90 1.34 1.28 Psychological - Development 2.37 1.58 4.58 3.77 - Stability 3.00 1.51 6.20 5.81 Abdomen 0.55 0.30 0.79 0.75 Other 20.77 18.40 26. 45 34.38 - 133 - TABLE 59 (continued) Recuperative Holiday Homes 1968 1967 Number of schoolchildren (including Nursery schoolchildren) admitted during the year 179 184 School Dental Service Number of half day sessions devoted to; Treatment 2,649.0 3,028.5 Inspections in schools 205.1 198. Dental Health Education 793.8 459. Total sessions 3,737.9 3,685.5 Inspections Pupils first inspected at school 16,684 18,279 Pupils first inspected at clinic 5,010 3,934 Percentage requiring treatment 67.8 70.6 Pupils reinspected 3,395 1,008 Percentage requiring treatment 63.9 53.5 Treatment sessions (average per session in brackets) New cases attended 4,773 (1.8) 6,076 (2.0) On-treatment cases attended 12,148 (4.6) 13,796 (4.6) Emergencies 478 (0.2) 294 (0.1) Total attendances 17,399 20,166 Treatment given (average per session in brackets) Fillings in permanent teeth 9,119(3.4) 8,889 (2.9) Fillings in temporary teeth 6,688 (2.5) 7,435 (2.5) Extraction of permanent teeth 263 (0.1) 195 (0.1) Extraction of temporary teeth 799 (0.3) 1,018 (0.3) Other operations 6,872 (2.6) 4,738 (1.6) Number of dentures supplied 9 (0.003) 5 (0.001) Orthodontic treatment Cases remaining from last year 179 118 New cases commenced in year 66 163 Cases completed in year 53 51 Number of removable appliances fitted 99 148 Number of fixed appliances fitted 1 5 Staff (full-time equivalent) Medical 6.35 5.75 Nursing 18.61 18.00 Social Workers 3.30 5.00 Physiotherapists 2.00 1.40 Dental Officers 7.75 8.01 Dental Auxiliaries 2.25 1.00 Dental Surgery Assistants 8.65 8.32 (continued over) - 134 - TABLE 59 (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 6/12 or worse Referred for treatment Boys 82.1 6.3 5.5 5.7 3.0 1.4 1.7 3.8 Girls 79.2 7.7 6.0 7.0 3.5 1.8 1.8 4.6 No. of boys tested - 5,492 No. of girls tested - 4,858 Health Surveys No. examined Occasions vermin found Percentage (a) Comprehensive 18,291 444 2.43 (b) Selective 7,699 494 6.42 No. of individual pupils found verminous 672 Percentage of school roll 1.99 Vermin - occasions advice and/or Lorexane given 834 - occasions attendance at bathing centre 104 (c) Communicable disease - No. examined for; Athlete's foot 65 Plantar warts 164 Other communicable diseases 72 Routine Audiometer Testing No. of children given screening test 4,293 No. failing screening test and given pure tone test 307 No. failing pure tone test and referred to Otologist 198 School Medical Treatment Clinic No. of premises Sessions in year New cases Attendances Audiology 1 96 215 659 Bathing 2 590* 681 1,065 Ear, Nose and Throat 101 250 594 Minor ailments - Medical Officer 6 106 634 20,967 - Nurse 8 871 1,366 Ophthalmic 4 316 1,102 3,022 Orthoptic 1 94 77 256 Physiotherapy (to 7 September 1968) 3 251 12 2,082 Special Investigation 3 168 189 1,350 Physiotherapy treatments - Remedial exercises 1,909 - Massage 1,861 - Ultra-violet light 156 - Infra-red 20 * includes also adult sessions - 135 - TABLE 59 (continued) Defects treated at School Treatment Centres and Hospital Clinics Errors of refraction and squint 1,002 Other eye defects 33 Spectacles ordered 776 Athlete's foot 59 Verrucae 452 Ringworm - body 1 Impetigo 28 Other skin diseases 294 Eye diseases 129 Ear diseases 79 Miscellaneous lacerations, etc. 960 Orthopaedic and postural defects 12 Orthopaedic and postural defects (treated at schools) 94 Pupils provided with hearing-aids 15 B. C. G, Vaccination - Schoolchildren Number of schools visited 26 Number of 13-year old children offered test 2,969 Number of consents received 2,498 Number of children tested 1,862 Number of positive reactors 186 Number of children vaccinated 1,676 Other Treatment Number of children - Ear, nose and throat 62 treated - Audiology 207 - Special investigation 132 Infectious and Other Diseases notified by Schools Disease No. of Notifications Chickenpox 203 Dysentery, Diarrhoea 58 Erysipelas 1 German Measles 275 Glandular Fever 1 Impetigo 13 Influenza 4 Jaundice 24 Measles 143 Meningitis 2 Mumps 148 Ophthalmic conjunctivitis 16 Pneumonia 1 Ringworm 16 Scabies 13 Scarlet Fever 28 Shingles 1 Tonsillitis 58 Whooping Cough 46 Total: (Number notified last year - 1,527) 1,051 - 136 - TABLE 60 STAFF CHANGES Staff changes which took place during the year are summarised as follows:- Appointments Resignations Administrative Assistants 1 1 Assistant Home Help Organisers 1 1 Assistant Supervisors (Training Centre) 1 1 Assistant Health Education Officers 1 1 Assistant Principal Social Workers (Health Services) . 1 Clerical Assistants 1 2 Clinic Auxiliaries 1 1 Clinic Centre Superintendents 1 2 Clinic Nurses 12 14 Creche Assistants 3 4 Chiropodists (Sessional) 2 1 Day Nursery Matrons 1 1 Day Nursery Deputy Matrons 1 1 Day Nursery Staff Nurses 7 7 Day Nursery Assistants 16 14 Day Nursery Students 6 7 Day Nursery (Enrolled Nurses) 2 1 Dental Officers 3 2 Dental Officers (Sessional) 3 4 Dental Surgery Assistants 4 4 Dental Auxiliaries 3 1 General Clerks 6 4 Health Visitors 8 8 Health Visitor Students 6 8 Home Help Organisers 1 1 Medical Officers 2 - Medical Officers (Visiting) 2 - Public Health Inspectors 3 - Pupil Public Health Inspectors 1 3 Psychiatric Social Workers 1 - Rodent Investigators 1 - Senior Physiotherapists - 1 School Nurses 8 5 School Nurses (Residential) - 2 Secretary/Shorthand Typists 1 - Social Workers (Health Services) 1 3 Social Workers (Mental Health) 1 1 Senior Social Workers(Mental Health) - 1 Telephonists 2 2 Technical Assistants 3 3 T. B. Visitors 2 1 Training Centre Supervisors 1 - Total: 120 114 - 137 - TABLE 61 HEALTH DEPARTMENT ESTABLISHMENTS Particulars of Clinics held and Services provided as at 31st December, 1968. (a) CLINICS AND SCHOOL TREATMENT CENTRES Address Clinics and other activities held Clinic Centre, Club Row, E.2. Infant Welfare, Minor Ailments, Toddlers, Vaccination and Immunisation. Clinic Centre, 673, Commercial Road, E. 14. Infant Welfare, Occasional Creches, Toddlers, Psychoprophylaxis. Clinic Centre, 1-2 New mill House, Empson Street, E. 3. Infant Welfare, Toddlers, Vaccination and Immunisation, Mothers Club and Creche Clinic Centre, Leopold Street, E. 3. Chiropody, Infant Welfare, Minor Ailments, Occasional Creches, Special Investigation, Toddlers, Vaccination and Immunisation, Vision, Mothers' Club, Dressmaking, G. P. Obstetrician, Auditory Training, Orthoptic. Clinic Centre, Library Place, Cable Street, E. 1. Chiropody, Infant Welfare, Toddlers. Clinic Centre, Peel Grove, E.2. Ante-Natal, Infant Welfare, Occasional Creches, Physiotherapy, Toddlers, Vaccination and Immunisation, Cervical Cytology, Psychoprophylaxis, Dressmaking, Keep Fit Class, G. P. Obstetrician, Mothers' Club. Clinic Centre, 5, Pier Head, E. 1. Infant Welfare, Minor Ailments, Occasional Creches, Family Planning, Dressmaking. Clinic Centre, 35, Stepney Green, E. 1. Chiropody, Infant Welfare, Toddlers, Vaccination and Immunisation. - 138 - TABLE 61 (continued) Address Clinics and other activities held Clinic Centre, Roserton Street, E. 14. Ante-Natal, Chiropody, Dental, Infant Welfare, Minor Ailments, Occasional Creches, Toddlers, Vaccination and Immunisation, Mother's Club, Cervical Cytology. Clinic Centre, Ruston Street, E. 3. Chiropody, Dental, Infant Welfare, Occasional Creches, Toddlers, Vision, Dressmaking, G. P. Obstetrician, Special Advisory, Speech Therapy. Clinic Centre, 1-2 Wigram House, Wades Place, E. 14. Infant Welfare, Toddlers, Speech Therapy. Clinic Centre, Wellington Way, E.3. Dental, Infant Welfare, Occasional Creches, Toddlers, Vaccination and Immunisation, G. P. Obstetrician, Mother's Club, Cervical Cytology, Dressmaking, Family Planning. Clinic Centre and School Treatment Centre, Underwood Road, E. 1. Audiology, Chiropody, Dental, Infant Welfare, Minor Ailments, Special Investigation, Toddlers, Vaccination and Immunisation, Family Planning. School Treatment Centre, 3-4 Phillips House, Coventry Cross, E.3. Dental, Minor Ailments, Special Investigations. School Treatment Centre, Bernhard Baron Settlement, Henriques Street, E. 1. Dental, Minor Ailments, Vaccination and Immunisation, Vision. School Treatment Centre, Lyte Street, E. 2. Audiology, Chiropody, Dental, Minor Ailments, Vision. Mission House (Nursing Sisters of St. John the Divine) Lodore Street, E. 14. Ante-Natal, Post-Natal. - 139 - TABLE 61 (continued) (b) CHEST CLINICS Days and Times London Chest Hospital, Mon. Wed. Thurs. Fri. 9.15-11.30 a.m. Victoria Park, E. 2. Sat, 9.15 - 11.0 a.m. Wed. 5.0 - 6.15 p.m. Thurs. B. C. G. Clinic 2.30 p.m. Wellington Way, Bow Road, E. 3. Tues. 2.0 - 4.0 p.m. (adults) 5.30-7.0 p.m. (adults) Thurs. 10.0 - 12 noon (children) 2.0-4.0 p.m. (adults) Fri. 10.0 - 12 noon (adults) Steels Lane, E. 1. Mon. 10.0-12 noon and 2.0-4.0 p.m. Tues. 10.0-12 noon and 2.0-4.0 p.m. 5.0-7.0 p.m. Wed. 10.0-12 noon Fri. 10.0-12 noon Sat. 10.0-12 noon (c) DAY NURSERIES 22, Underwood Road, E. 1. " " " Monday to Friday 8.0 a.m. - 5.30 p.m. Christian Street, E. 1. " " " 8.0 a.m. - 5.30 p.m. Sugar Loaf Walk, E. 2. " " " 8.0 a.m. - 5.30 p.m. Tidey Street, E.3. " " " 7.30 a.m. - 5.30 p.m. Alice Model, 14/24, Beaumont Grove, E.1. (Voluntary) " " " 8.0 a.m. - 5.30 p.m. (d) MENTAL HEALTH TRAINING CENTRES Adult Centre, 28, Underwood Road, E. 1. " " " 9.30 a.m. - 4.0 p.m. Junior Centre, Cornwall Avenue, E. 2. " " " 9.30 a.m. - 4.0 p.m. Industrial Centre, 43, Whitehorse Road, E. 1. " " "9.15 a.m. - 4.30 p.m. (e) MENTAL HEALTH DAY CENTRE Marian Place, Pritchards Road, E. 2. " " " 9.30 a.m. - 4.30 p.m. (f) DISINFECTING AND CLEANSING STATION Branch Road, Commercial Road, E. 14. 8.0 a.m. - 5.0 p.m. - 140 - INDEX A Page Nos. Accidental Deaths 12,85 Accidents in the Home 60 Adolescents, seriously disturbed 37 Adoption and Boarding Out 28 Adult Training Centres 43,106,140 Aged Persons 48 Ambulance Facilities 69 Ante-Natal Clinics 28,95 Anthrax 16 Area of Borough 7 B Bacteriological Examination — Food 54 B.C.G. Vaccination 19,78,94 Births 7,11 Blind, Partially Sighted 47 B urials 48,108 c Cancer 16 Catering Premises 56 Cervical Cytology 25,29,97 Charges and Assessment Scales for the Social Services 31 Chest Clinics 20,93 Chief Public Health Inspector's Report 49 Child Minders 26,29,96 Children in Care 36 Child Welfare Clinics 95 Chiropody 47,97 Circulars — Ministry 72 City of London — Mental Health Service 44 - 141 - C (continued) Page Nos. Clean Air 53,109 Cleansing Station 61,117 Clinic Centres 25,30,138 Common Lodging Houses 62 Community Care Services 39 Comparative Statistics 14,87 Compensation for Stopping Employment 24 Conferences and Courses 69,73,123"131 Congenital Defects 29 Creches 26,30 Crude Spirit Drinking 4 0 Day Care Service 48 Day Centres (Mental Health) 43,106,140 Day Hospit al 46 Day Nurseries 25,31,96 Deaf Children 76 Deaths 7,11,85 Dental Care for the Priority Classes 37,97 Dental Health Education 81 Dental Services 37,78,134 Diphtheria 16,91 Diseases of Animals 53,109 Disinfection / Disinfestation 61,117 Dysentery 16 E Educationally Sub—Normal Children 77 Employment of Schoolchildren 78 Environmental Health Services 49 Establishments 14,138—140 - 142 - F Page Nos. Factories 60,114 Family Planning 4,25,32,99 Feeding Difficulties 32 Fifty Years ago 10 Food and Drugs 49,54 Food Hygiene 56,111 Food — Imported 50,56 Food — Unsound 58 Food Poisoning 16 G Guardianship 44 H & I Hairdressers 61 Handicapped Pupils 76 Handicap Register 88 Health Committee 2 Health Education 26,32,51,77-81,98 Health Visiting 33,99 Heroin Addicts 47 Home B athing 47,100 Home Help Service 47,100 Home Nursing 33,101 Hospital Facilities 70 Houses in Multiple Occupation 59 Housing 3,59,112 Hygiene in Schools 78 Ice-Cream 55 Immigrants 22 Immunisation 78,91 Incontinence Pads 34 Industrial Training Centre 44 Infant Mortality 7,12,86 - 143 - H & I (continued.) Page Nos. Infectious Diseases 15,77,89,90 Infective Jaundice 16 Inquest s 69 J & K Junior Training School 43 L Laboratory Facilities 70 Laundry Service 34,101 Legal Proceedings 61,116 Legislation 15,71 Leprosy 16 Licensing Act, 1961 62 Loan of Nursing Equipment 34,102 Lodging Houses 62 H Malaria 17 Marriages 13 Massage and Special Treatment Establishments 72 Mass Radiography 19,94 Maternal Mortality 7,12 Maternity Liaison Committees 35 Measles 17,35 Medical Inspection of Schoolchildren 75 Mental Health 5,39,104-106 Midwifery 28, 34, 35, 103 Milk Supply 57 Minor Ailments Clinics 78 - 144 - M (continued) Page Nos. Miscellaneous Services 69 Morbidity 12,90 Mortuary 62,116 Mothercraft Classes 28,95 N Neo—Natal Mortality 7,12 New Houses 60,113 Notices Served by Public Health Inspectors 122 Nursing Equipment — Loan of 34,102 0 Observation Register 35,88 Offensive Businesses 63 Offices, Shops and Railway Premises 50,63,118 Open Spaces 13,107 Ophthalmia Neonatorum 17 Outwork and Outworkers 63,115,122 Overcrowding 59 P & Q Partially Hearing Children 76 Partially Sighted Persons 47 Peri—natal Mortality 7,12 Personal Health Services 25 Pet Animals Act 64 Pharmacy and Poisons Act 64 Phenylketonuria 35 Playgroups 26 Poliomyelitis 17 - 145 - P & Q (continued) Page Nos. Population 7,9 Post Natal Clinics 28,95 Poultry Processing and Packing 51,64 Premature Babies 36,99 Pre-School Playgroups 26 Principal Nursing Officer's Report 25 Principal School Dental Officer's Report 78 Principal School Medical Officer's Report 75 Principal Social Worker's (Mental Health) Report 39 Public Analyst's Quarterly Reports 110 Public Health Inspectors — Visits 109,112,120,121 Public Relations 13 Puerperal Pyrexia 17 Pupils on School Rolls 75 R Radioactive Substances 73 Rag Flock, etc. Act 64 Recuperative Holidays 36,101,134 Refreshment Houses 65 Refuse Disposal 65,122 Relaxation Classes 28,95 Removal of Persons in Need of Care 48 Rent Act 65 Road Accidents 85 Rodent Control 65,119 s Scab ies 17 Scarlet Fever 17 School Dental Service 78,134 School Health Service 27,75,132-136 - 146 - S (continued) Page Nos. Seamen's Lodging Houses 62 Seriously Disturbed Adolescents 37 Sewerage 65 Slum Clearance 59 Smallp ox 18 Social Conditions 9 Special Care Units - Mental Health 42 Staff 6,52,73,82,109,137 Statistics and Social Conditions 9 Statistics — Summary 7 St. Clement1s Hospital 44 Street Trading in Food 49 Students — Training of 74 Surveys 37 Swimming Baths 66 T Trade Descriptions Act 1968 66 Training Centres (Mental Health) 43 Tuberculosis 19,92,93,94 Typhoid 18 u Underground Rooms 59 Unemployment 13 Unmarried Mothers 36 V Vacant Sites 66 Vaccination 35,69,78,91 Venereal Diseases 22 Verminous Schoolchildren 76 Vision — Schoolchildren 77 Visits by Public Health Inspectors and Technical Assistants 109,112,120,121 w Water Supply 66 Weather Conditions 15 Whooping Cough 19 Works in Default 67 - 147 -