A C .43395 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 1969 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 London Borough of Tower Hamlets with the Eompliments of the Medical Officer of Health HEALTH DEPARTMENT, 227/233 COMMERCIAL ROAD, STEPNEY, E.l Tel.: 01-790-1818 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 23 IV Community Care Services 37 V Environmental Health Services 45 VI Miscellaneous Services, etc. 63 VII School Health Serice 69 VIII Appendix of Statistical Tables 81 INDEX 133 - 1 - TOWER HAMLETS HEALTH COMMITTEE (as at 31st December, 1969) Ex-Officio: The Worshipful the Mayor, Councillor E.G. Walker J.P. CHAIRMAN Councillor J. O'Connor M.B.E., J.P. VICE-CHAIRMAN Councillor A.W. Downes ALDERMEN C. Blaber J.P. J. Orwell (Stepney) (Ex-Of f ici.o) COUNCILLORS. Mrs. D.M. Couling J. Olley M.J. Durell M. Pollins Mrs. A. Elboz W.C. SimsQn E.W. Hill W.T. Tuson M.S. Levitas Mrs. I.B. Vines J. Milrood G.H. Wall Miss H. Morsman - 2 - HEALTH DEPARTMENT, 227/233 Commercial Road, London, El 2BU 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 1969. COMMUNICABLE DISEASES In July, continued swabbingof two children during investigations after admission to hospital proved the existence of C. Diphtheria (Mitis) The children had arrived some days previously from Malta to join their parents living in the borough. None had attended school here. There were no positive findings found when close contacts were treated. As is discussed elsewhere in this report by the Chest Physicians, tuberculosis notifications, though continuing to decline, still remain at a level higher than the national average, MENTAL HEALTH Proposals to link the department's services for the mentally ill with those of the London Hospital and St, Clement's Hospital were agreed during the year. The establishment is to be increased and further conjoint appointments made between hospital and local health authority staffs. Shared responsibility for community work by the hospital social workers, with increasing participation by our workers in the care of hospital in-patients, will go far to create a comprehensive care service in this field. The new purpose-built junior training school was ready for occupation in December, and arrangements were made for an official opening by the Deputy Mayor in the new year. Good liaison has continued with the Tower Hamlets branch of the Society for Mentally Handicapped Children. This organisation has a strong parents' association which complements the work done in our cent res by the i r taking a great interest in the children's progress, and in the running of many extra-mural activities, Some of these latter are now held in the new premises, at night as required, with the consent of the Health Committee A truly professional variety performance was put on by this local branch in the presence of the Secretary of State for Education and Science, the Rt. Hon Edward Short, M P Early legislation is promised for the transfer to Education Departments of the responsibility for education and training of mentally subnormal children. At least the Health Committee hets the consolation that it will hand over better premises, than it acquired in 1965, to its successors the Inner London Education Authority. Plans for a new adult training centre to serve both sexes, and integrate our existing Industrial Training Centre for males with the Centre for females are being made with a view to the commencement of building in 1970. - 3 - Attention was drawn during the year, at national level, to the overcrowded conditions prevai 1 ing in hospi tal s for the subnormal s , Local author i t ies are being urged to make more provi sions for the care of suitable patients in the community. Solution of the problem is not so easy as first appears, for many of the persons at present in hospital, capable of living in the community, one is told, are the backbone of the domestic staff in institutions which already have serious staff shortages, Further, many adults in this category have lived happily in hospitals with extensive grounds and facilities for care and recreation, and, in the case of many, links with their original home communi ty by now are nonexistent or very tenuous. To bring them back into an area such as Tower Hamlets, if family ties are not viable, would border on administrative cruelty. However, it is proposed to explore the need for a hostel for subnormals in the borough. Particularly in respect of borderline E,S.N./sub-normal young adults some difficulty in piacement and care has arisen when a family breaks up. Hostel care would obviate the present necessity to send these persons outside the borough for care and for guardianship. Further, it would be possible to continue to build on existing community roots. Unless there is a concern by the community for its own. e.g. a local league of friends, it is difficult to envisage success from the provision only of staff and premises, however first class, by the local authority. Under the Urban Aid programme, consent for loan sanction enabled plans to be made to replace one Day Nursery, at present in a prefabricated building, by a permanent building on a new site. Limited finances were also avail able to assist pre-school play groups which have been started, by a variety of organisations, in different parts of the borough. Experience has shown that these groups, suitably led by trained persons, can make a worthwhile contribution to services for the under 5-year olds supplementing the services of our own day nurseries and creche sessions at Infant Welfare Clinics* HOUSING As stated in last year's annual report, there will remain some 4,000 or so unfit dwellings for consideration in the next quinquennial up to 1975. The impetus of public inquiries, clearance and redevelopment, on the borough council side, has been maintained throughout the year.A boost to morale came at the very end of the year with news that the Council's Spitalfields compulsory purchase order areas had been confirmed. As outlined elsewhere in the report, these cover the largest single area, in terms of density of population and acreage, to be represented in the London area. Taking some years to complete rehousing and demolition, it will remove acres of slum tenement blocks in that ward of the borough having some of the worst environmental and social conditions to be found in the metropolis. It is hoped this will be an augury for further successful orders in respect of other slum and sub-standard tenements still remaining. With the beginning of the end in sight of slum clearance, it is opportune to consider future development removed from an overwhelming urgent necessity to demolish and rapidly rebuild residential areas; this has been the right priority over the last decade or so. The questions can be posed, what type of community is being created, and what ideal should now be pursued? The expression 'balanced community' has been coined to denote a design in which development is planned to form separate areas of residential, commercial and industrial use (as is now being done in the borough) and also to achieve a balance of social groups. For too long, the borough has been a place of work for professional and executive persons who commute home to other areas at the end of the working day. Thus, there has resulted an absence of the social and cultural - 4 - mix, in the local community, arising from the differing attitudes and traditions of all levels of the social strata. Limited provision of housing to cater for other than municipal tenants has been made by the Greater London Council and the Inner London Education Authority, and by certain Housing Associations. With the release of large areas such as St. Katharine and London Docks, an opportunity exists for more 'mixed development' without depriving the borough of vital land for slum clearance purposes. The advantages of long river frontages, and proximity to Central London, offer chances of providing 'amenity areas' including pleasure gardens, hotels,conference centres and restaurants, which will not only attract the affluent outsider but can also serve the indigent citizen of the borough with much needed faci1ities-and increase rateable values! The resultant creation of a 'new image' for Tower Hamlets would also have bene f i c i al repercussions in that it would further the holding of and perhaps immigration of vital people, including the young, within the resident community. For some time there has been a steady drain away, particularly of young married persons unable to find suitable living conditions in their home borough; despite a willingness to buy their own homes and not add to the inflated waiting list for municipal accommodation. Unless some sharing out of the multifarious and multitudinous social problems bedevilling Tower Hamlets is soon achieved, the outward flow of talent, by a process of dysgenic selection, will lead to further intensification of local problems. Some way out of this impasse has to be found lest there is to be merely a new physical environment (which is fast being achieved as is plain to all) without a concomitant effect in the social sphere. The restructuring of the social milieu is less easy, but probably more important for the public heal th in the long term, than good physical amenities, necessary and essential though thoy must be. The work of the department has been maintained at a consistently high level, and provided a service worthy of praise. My own debt to all the staff is gratefully acknowledged, as is that to the Chairmem and Members of Committees who have always given ready encouragement to our proposals. I am, Yours faithfully, R. W, WATTON Medical Officer of Health and Principal School Medical Officer, May, 1970. - 5 - STAFF OF HEALTH DEPARTMENT (as at 31st December, 1969) HEDICAL OFFICER OF HEALTH Dr. R.W. Watton DEPUTY MEDICAL OFFICER ASSOCIATE MEDICAL OFFICER SENIOR MEDICAL OFFICER OF HEALTH OF HEALTH Dr. C.M. Gourlay Dr. W.C. Turner Dr. K. Winship Medical Officers 51 (10.1) CHIEF ADMINISTRATIVE OFFICER E. P. Webber DEPUTY CHIEF ADMINISTRATIVE OFFICER M. Pliskin SENIOR ADMINISTRATIVE OFFICERS C.H. Drake J. E. Pestell G. R. Williamson Administrative and Clerical Staff 76 (72.47) CHIEF PUBLIC HEALTH INSPECTOR DEPUTY CHIEF PUBLIC HEALTH INSPECTOR H.S. Davies J. J. Keniry Public Health Inspectors 24. Technical Assistants 7. Pupil Public Health Inspectors 5. CHIEF DENTAL OFFICER D. F. Waller Dental Officers 13 (8.7.) Dental Auxiliaries 3. Dental Surgery Assistant^ 12 (11.9) PRINCIPAL NURSING DEPUTY PRINCIPAL NURSING ASSISTANT NURSING OFFICER OFFICER OFFICERS Mrs. D.E. Marrin Miss A. M. Thomson Miss E. Brosnan Miss P. Rolph Health and Tuberculosis Visitors Student Health Visitors Clinic and School Nurses 39 (37.37) 6 22 (18.8) PRINCIPAL SOCIAL WORKER ASSISTANT PRINCIPAL SOCIAL WORKER (MENTAL HEALTH) (MENTAL HEALTH) F. Sullivan Vacant Social Workers (Mental Health) 11 (10.5) Supervisory Staff at Mental Health Training and Day Centres 19 PRINCIPAL SOCIAL WORKER ASSISTANT PRINCIPAL SOCIAL WORKER (HEALTH SERVICES) (HEALTH SERVICES) Miss E. Brett vacant Social Workers and Family Caseworkers 7 (6.8) CHIEF CHIROPODIST - P. Twort Chiropodists (Sessional) 9 (2.4) NON-MEDICAL SUPERVISOR OF MIDWIVES SUPERINTENDENT OF HOME NURSING Miss I.M. Clarke Miss N.O. Humphris NURSING SUPERINTENDENT (Agency)l DEPUTY SUPERINTENDENT OF HOME NURSING Midwives (Agency) 6 Miss P.J. Ribbans District Nurses (inc. Agency) 31 (29.38). HEALTH EDUCATION OFFICER ASSISTANT HEALTH EDUCATION OFFICER Miss P.G. Hodges Mrs E.E. Rogers HOME HELP ORGANISERS 3 HOME HELPS 279 (182.7.) ASSISTANT HOME HELP ORGANISERS 6. DAY NURSERY STAFF 44 (43..05) OTHER STAFF 16 (15.17) OTHER MANUAL STAFF 115 (88.61) Total Staff of Department 849 (653.75) Note - Numbers in brackets relate to equivalent whole-time. -6- - 7 - SUMMARY OF STAT 1 ST 1 CS, 1969 Area of Borough (Acres) Population: 4, 876 Rateable Value (1st April) £15,120,322 Mid-year estimate 188, 080 Sum represented by a penny rate (1969-1970) £56,750 Census, 1966 196, 830 (Revised 1970 201,280) General Rate (1969-1970) Dwelling houses 12s. lid. in £ Census, 1961 205, 682 Density of population (persons per acre) 38.57 Mixed hereditaments 13s. 7d. in £ Number of inhabited dwellings according to Rate Books at 1st April, 1969 62, 843 " " structurally separate dwellings - Census 1961 59, 885 " " private households - Census 1961 67, 858 B i r t h s Total Male Fema1e All Births 2,646 1,332 1,314 Live Births Legitimate 2,308 1,163 1, 145 Illegitimate 304 156 148 Total: 2,612 1,319 1,293 Still Births Legitimate 31 12 19 Illegitimate 3 1 2 Total: 34 13 21 Deaths All Causes 2,315 1,260 1,055 Maternal 2 - 2 Infants under 1 year Legitimate 34 19 15 Illegitimate 12 7 5 Total: 46 26 20 Rates Live birth-rate per 1, 000 population 13.88 Death rate per 1,000 population 12.31 Still-birth rate per 1,000 total births 12. 85 Maternal death rate per 1, 000 total births 0.76 Infant death rate (under 1 year) per 1, 000 live births. 17.61 Legitimate infant death rate per 1, 000 legitimate live births 14.73 Illegitimate infant death rate per 1, 000 illegitimate live births 39.47 Neo-natal death rate (under 4 weeks) per 1, 000 live births 11. 86 Early neo-natal death rate (under 1 week) per 1, 000 live births 9. 95 Perinatal death rate (still births plus deaths under 1 week) per 1, 000 total births 22.67 Illegitimate live births per cent of total live births 11.63 Area Comparability Factors Births 0.92 Deaths 1.19 *★★★★★★★★★★★★★★ - 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- Mileage of roads covered is 178.5. Some 266 acres cover canals and enclos ed docks including St„ Katharine's and London Docks5 East and West India Docks, and the Millwall Docks The St Katharine's Dock covering 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 in conjunction with this Council. The Ste Katharine Docks scheme has been hailed as London's most ambitious redevelopment since the Great Fire, Work is scheduled to begin in 1971 on a 614 year target programme, as follows:- Left in the photograph opposite is the Tower of London and Tower Bridge. Beyond the Bridge rises London's largest convention hotel with 776 rooms and convention hall for over 2,000 delegates. To the left, along the approach road to London Bridge is the Hardwick Warehouse built in 1829 which is to be incorporated in the scheme0I t wi 11 be refurnished and become the Br i tish Export Centre, offering economic London representation to provincial companies, and be let with the International World Trade Centre communications networks Facing it across the inner basin is another warehouse built in I860, This will be converted into housing and a yacht club* War-damaged buildings beyond repair have been demolished by,the Greater London Council. The other darker buildings to the left are outside the scheme. The redevelopment area covers 24.4 acres of which 10.4 are water. Development will give London its first yacht marina, and the Chapel of St. Katharine to be built on the jetty behind the hotel, will link the site with the original hospice of St. Katharine, established by Queen Matilda in 1148c The Queen Mother is the Patron of the Royal Foundation of St; Katharinec Down river beyond the hotel wi11 be Theatrevision, avast entertainment complex with theatres, sound and television studios, linked to a floating bar and restaurant in the river Further to the right are new facilities for both private and local authority housing, complete with schools and playgrounds, adjoining asports centre with squash courts, swimming pool and gymnasium,. The housing continues around the farthest basin and at top left is a shopping centre. To-day the population is nil. When the St. Katharine Docks Scheme(£22 million) is completed, there will be 700 houses and three school s with a resident population of over 2,000. When al 1 the other facilities are in use the population will be as much as 10,000. The predominant geological stratum of the Borough 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, - 9 - This 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 Spitfclfields 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 m:d-year population of the borough was 188,080 a decrease of 4,170 from last year's figure, This is a continuation of the downward trend which has occurred since 1947 While the population of the Greater London area continued to decline, the South East of England outside the London area increased by 148,000 (1.6%) the population has increased in this area by over a third in 17 years. Live births exceeded deaths by 297 so that as the estimated population decrease was 4,170 the net estimated movement of residents out of the borough amounted to 4,467 persons: The density of population is 38-57 persons per acre FIFTY YEARS AGO In 1919 the estimated population of the Boroughs o f Bethnal Green, Poplar and Stepney, which now form the Borough of Tower Hamlets, was 502,642- The Medical Officer of Health of Stepney, in referring to the estimate for his Borough, namely 242,202, stated that, in his opinion, the figure was nearer 280,000 which he based on the number of ration books issued at the local food office of which he was the Executive Officer In Poplar the live birth rate was 24.68, death rate 14.4 and the infant mortality rate 83.05 Of the 7,022 cases of infectious disease notified in Poplar and Stepney, 1,358 were cases of Scarlet Fever, 1,030 Diphtheria, 53 Enteric Fever, 1,293 Measles and two were of Smallpox. Among the causes of death in these two Boroughs were 562 from Pulmonary Tuberculosis, 207 from Summer Diarrhoea (in children under 1 year of age), 12 from Enteric Fever, 39 from Whooping Cough, 81 from Diphtheria, 21 from Measles» 13 from Scarlet Fever, In Poplar there were 139 deaths from Influenza It was reported to the Bethnal Green Council that a milk vendor,, charged with selling milk containing 1616% added water, was sentenced to three months51 imprisonment after having had eight previous convictions. There were 40 prosecutions for adulterated milk in Poplar and Stepney, - 10 - The Poplar Council recommended that representations to the proper authorities be made that all motor cars should have elastic and resilient tyres and that the speed limit of heavy motor cars (exceeding 6 tons) in the metropolis be reduced from 8 to 5 miles an hour. The Bethnal Green Health Committee authorised the engagement of the services of District Nurses in cases of Pneumonia, Influenza and Measles at a charge of 10do per visitcThe Public Analyst reported that 16%of all articles analysed were adulterated, stating that evident scarcity of supply and the high cost of food had„ after four years„ increased the proportion of adulteration It was also reported to the Bethnal Green Council on the 3rd April that by Command of H.M., Queen Mary, the Mayor waited upon Her Majesty at Buckingham Palace on the 14th March and discussed with her the housing and social conditions affect ing the inhabi tants of the Borough.The Queen subsequently expressed a wish to view some of the houses and this took place on the 17th March when Her Majesty visited premises in the Brady Street area and Digby Walk Dr, Go Po Bate resigned after 44 years service as part- time Medical Officer of Health for the Borough On the 18th September arrangements for the local celebration of the signing of the Treaty of« .Peace were brought to a successful conclusion by the entertainment of 27,000 school children of the Borough at Victori a Park, each child receiving a bun, a piece of fruit cake, an apple or banana* a stick of sweetmeat and a drink of lemonade, the catering cost being £600« In a prosecution in Stepney a carman was seen by a Police Inspector to take water from a horse trough in Mile End Road and put it into milk churns in a van, Charged with maliciously damaging milk and with adding water to milk entrusted to him for sale;, he was sentenced to three months5 imprisonment, Prosecutions taken by the Food Control Committee included many against licensees for refusing to serve whisky in the public bar although it was sold in the saloon bar. Following adoption of the provisions of the Maternity and Child Welfare Act 1918 the Stepney Council advertised for a Lady Assistant Medical Officer of Health at a salary of £400 per annumand for four Health Visitors at £100 per annum plus War bonus The estimated net expenditure for the year 1919 - 1920 for the Public Health Committee was £17,670, The Council recommended to the Local Government Board that power be given to local authorities to ensure that no new premises should be al lowed to be opened for the preparation and sale of human food until the Medical Officer of Health certified that such premises were in a fit condition for the purpose for which it was proposed to use them0 This Council also supported a proposal by the London County Council for the making of an Order declaring the business of a SIaughterer o f Fowls to be an 6'offensive business'' LIVE BIRTHS There were 3,760 live births registered in the borough during the year After correction for place of. residence (inward transfers 121, outward transfers 1,269), the number allocated to the borcugh was 2,612 comprising 1,319 boys and 1,293 girls* a decrease of 263 from 1968, giving a crude birth rate of 13.88 per 1,000 population compared with 14.95 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 12.77 compared with 16.3 (estimated) for England and Wales, a ratio of 0„78 to the national rate- - 11 - I LLEGiTIMATE LIVE BIRTHS The number of illegitimate live births during the year was 304 equivalent to 11,63% of the total live births, compared with 12.48% last year The comparable figure for England and Wales was 8%. STILLBIRTHS This year stillbirths numbered 34 equivalent to a rate of 12.85 per 1,000 total births compared with 18 08 in 1968 The rate for England and Wales was 13.0 DEATHS The number of deaths registered - 2,315, shows a decrease of 67 from the figureof last year. The death rate was 12.31 and when adjusted by the comparability factor becomes 14.64 as compared with 11,9 for the country as a whole The largest single cause of death was heart disease, 28% of total deaths, followed by cancer 21% and respiratory conditions 18%. The various causes of death and distribution by age groups are set out in Table 1, on page 81 INFANT MORTALITY Deaths during the first year of life numbered 46 equivalent to a rate of 17.61 per 1,000 live births The rate for the previous year was 24.00 and 17.16 for 1967. 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 1969, Details of causes of death at various ages under 1 year will be found in the Appendix on page 82 . MATERNAL MORTALITY There were two maternal deaths this year NEO-NATAL MORTALITY During the year there were 31 deaths of infants under 4 weeks representing a neo-natal mortality rate of 11.86, the rate for England and Wales being 12.0, Last year there were 51 deaths giving a rate of 17.74 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 22c67 the rate for England and Wales being 23.05 - 12 - ACCIDENTAL DEATHS Deaths due to accidents numbered 79, (compared with 50 last year) motor vehicles being the cause of 31 deaths- Statistics supplied by the Road Safety Officer will be found on page 82 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. 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 postal districts (Monthly figures are to be found on page 86. MARRIAGES The number of marriages solemnised in the borough during the year was 1,357, or 200 less than the average for the last 3 years made up as foil ovs:- Register Office 588 Church of Engl and 513 Authorised persons and other denominations 256 The marriage rate per 1,000 population was 14.4 compared with 16.2 last year. PUBLIC RELATIONS Activities of the Health Department are publicised in "Tower Hamlets News" which is issued to the public after each Council Meeting. Topics to which attention was drawn during the year related to Child Minders, Clean Air, Chiropody, Safeguarding of Medicines and Drugs, Vaccination and Immunisation, details of changes in Services provided at Clinic Centres, How to obtain a Doctor in an Emergency and publicity for the Mass Radiography Unit's weekly Service in the Borough, In addition the practice of circulating a weekly bulletin to general practitioners and hospitals in the borough giving information on infectious disease, morbidity and relevant topical matters was continued, UNEMPLOYMENT The number of wholly unemployed adult persons registered at the Poplar, Shoreditch and - 13 - Stepney Employment Exchanges at 8th December, totalled 2,993 men and 153 women, or 65 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. Furthermore, 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 60 boys and 9 girls, compared with 1968 figures of 77 and 22 respectively. OPEN SPACES There are 334 acres of parks and open spaces within the borough, representing 1.77 acres for every 1,000 population, some 7 acres being added this year. Since 1965 open spaces in the Borough have increased by 20 acres or from 1.5 to 1.77 acres per 1,000 population. The County of Lcndon plan provides for 4 acres within the county per 1,000 population with an interim standard of 2Vi acres. A list of the sites is given on pages 103 and 104. COMPARATIVE STATISTICS A table showing vital statistics for the area covered by the borough at various years from 1901 is on page 83. HEALTH DEPARTMENT ESTABLISHMENTS A list of all Health Department Establishments showing clinic sessions held and services provided is given in the Appendix on pages 129 to 131. - 14 - PART II PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES II PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES WEATHER CONDITIONS The year began with very mild weather, in fact it was the mildest January for 48 years, but February was very cold with several snowfalls. The dullest March since 1916 was followed by a cool dry April and thundery May. June and July were the sunniest for some years, whilst August although f ine and. warm in the early part was the wettest-Ai gust for 12 years. Warm and very dry weather was experienced in September and October. Some snow fell in late November and December was cold and dull. Throughout the year sunshine was average, with rainfall 80% of average. INFECTIOUS DISEASES - NOTIFICATIONS The number of notified cases of infectious disease, corrected for revised diagnoses and duplicate notifications, was 1,709, compared with 1,197 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 in'th^ borough 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 86 and a list of diseases notifiable in the borough on page 85. ANTHRAX No case of anthrax was reported during the year. CANCER Of a total of 493 deaths from cancer occurring this year 142 were due to cancer of the lung. The death rate of lung cancer was 0.75 per 1,000 population. DIPHTHERIA Six cases of diphtheria were notified during the year, the first for 4 years. All cases occurred in a family recently entering this country from Malta. The mother had requested the Council to take the children into care, and, since they were suffering from impetigo and head infestation, tfrey were admitted to hospital for treatment. Routine swabs were taken in hospital and the diphtheria organism was isolated. It wonld appear that at least one of the children was a ''carrier''. Following a period of hospital treatment, the children were discharged and arrangements were made for booster immunisations to be carried out. DYSENTERY Notified cases of dysentery totalled 78, compared with 40 during the previous year. - 15 - FOOD POISONING Seventy-one cases of food poisoning were notified during the year, compared with 53 in 1968. Organisms of Salmonella typhi- murium were isolated in 20 cases. Five of these occutred in a hospital outbreak. Other Salmonella organisms isolated during the year included 1 livingstone, 6 enteritides.2 thompson, 1 infantes, 3 St. Paul and 7 virchow. The Salmonel1 a virchow was isolated in an outbreak inalocal hospital and three members of the staff and four patients were affected. A severe outbreak of food poisoning occurred at a school in Lewisham during September. Six pupils residing in this borough were taken ill, faecal specimens being examined with negative results. Two general outbreaks and eight family outbreaks were reported to the Ministry of Health as required by Memorandum 188/Med. INFECTIVE JAUNDICE Notifications of infective jaundice numbered 124 during the year, compared wi th 61 dur ing the 7 months of 1968 when the condition was notifiable. LEPROSY A notification of leprosy was received during the year in a child who had recently arrived in the country from Uganda. MALARIA No cases of malaria were notified during the year. MEASLES Notified cases of measles totalled 1,201 during 1969. In the previous year 616 notifications were received. Children vaccinated against the disease during the year numbered 1,482. ACUTE MENINGITIS Seventeen notifications were received during the year. OPHTHALMIA NEONATORUM No cases were notified this year. POLIOMYELITIS It is gratifying once again to report that no cases of poliomyelitis oocurred in the borough during the year. Details of vaccination against poliomyelitis will be found on page 87. PSITTACOSIS A case of psittacosis was diagnosed in a man who had purchased parrots in the Club Row Sunday Market some weeks earlier. The Veterinary Officer of the City of London, investigated conditions in the premises of the importers. Both parrots had died and been disposed of so examination of the carcases was therefore not possible! 16 SCABIES Cases of scabies which came to notice during the year totalled 288, compared with 374 in 1968. Patients and contacts were given medicinal baths and their clothing disinfected at the Council's cleansing station. The number of baths given was 508. 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' scleansing stations. SCARLET FEVER There were79 confirmed cases notified, 4 less than in 1968 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 smallpox. Observation is kept on such persons by officers of the Health Department for the necessary peribd. The number of persons successfully vaccinated or revaccinated against smallpox at the Council's clinics and by general practitioners during the year was 2,169. TYPHOID No case of typhoid fever was reported during the year. WHOOPING COUGH There was a marked reduction in the number of cases notified during the year. There were 20 notifications cpmpared with 66 during 1968 and 89 in 1967. Statistics relating to immunisation are on page 87. TUBERCULOSIS The number of primary notifications of pulmonary tuberculosis received during the year was 99, giving a notification rate of 0.52 per 1,000 population compared with 0.53 last year. Nonpulmonary eases notified numbered 14i The mortality rate for pulmonary tuberculosis was 4.2 per 100,000 population compared with 6.2 last year. Statistical data relating to new cases, deaths and variations in the register will be found on page 88. 17 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 1969 which will be found on page 90 (Details of abnormalities ascertained are not yet available in respect of this year's survey and those figures given relate to 1968). Public Health (Prevention of Tuberculosis) Regulations, 1925 These Regulations provide that persons suffering from tuberculosis of the respiratory tract shall not be employed in the handling of milk or milk receptacles. Power is given to the Council to cause such persons to discontinue their employment. It was not found necessary to take action under the Regulations during the year. B.C.G. Vaccination The numbers of children vaccinated during the year, under the Council's scheme for the B.C.G. vaccination of susceptible (tuberculin negative) child contacts of known tuberculous patients, diabetic children, thirteen-year old schoolchildren, students at further education establishments and mentally subnormal persons at training centres, are shown in Table 15on P age 90 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 otherp 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 CI inics 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 off icers and clerks Services providedfrom the Chest Clinics include, social work by wel fare officers and assistance in cash or kind not available from official sources by chest clinic commi ttees from their voluntary funds. 18 After Care Other services provided for the care and after care of patients and contacts include boarding-out of child contacts; home nursing including the loan of bedding and nursing equipment, home helps, extra nourishment, rehousing of selected tuberculous families; recuperative hoi idays, maintenance during industrial rehabilitation at voluntary village settlements and admission to hostels for homeless tuberculous men. Statistics relating to these services are on page 89.- Chest Diseases Care Committees Three such committees operate in the borough and I append the reports of the consultant chest physicians on the work of the committees and clinics during the year. Dr. M. Caplin, Consultant Chest Physician to the Chest Clinic at the London Chest Hospital reports: ''Since the end of the war there have been notable advances in medicine, but none has been more dramatic, than the change inithe morbidity'and mortality of tuberculosis. General improvement in the standard of living has contributed considerably to the reduction in the incidence of this disease, but the major factor has been'the introduction from 1950 onwards of anti-tuberculous drugs and preventive vaccination with B.C.G. Tuberculosis is no longer the scourge it used to be. The disease, however, has not yet been conquered. The rapid fall witnessed in the fifties has now begun to level out, and the total eradication of the.disease will still require considerable effort. This effort must stem from the chest clinic, and in 1969 the diagnosis, treatment; prevention and aftercare of tuberculosis still formed a primary function of the Chest Clinic at the London Chest Hospital. During 1969 the major portion of the work at the clinic was concerned with other chest conditions which to-day are equally and indeed more severely disabling than pulmonary tuberculosis. Such conditions are lung cancer, chronic bronchitis and asthma. This area has had for many years a high incidence of both lung cancer and chronic bronchitis. Recently in Tower Hamlets about one in four of all deaths in males results either from lung cancer-or from chronic bronchitis and emphysema. Both these conditions often pose serious social problems, and the close c.o-opera.tion of the medical and welfare parts of the chest clinic, developed initially to deal with the social problems produced by tuberculosis is well suited to deal with the problems of lung cancer and chronic bronchitis. We are greatly helped in this work by our Chest Diseases Care Committee whose members are drawn from local statutory and voluntary bodies. However, the financial situation of the Committee is now causing some concern. The auditor in 1969 commented as follows: ''If the past.year's level (of expendi ture) H 8 maintained and income isnot increased the funds of the Committee will soon become exhausted. 19 Frequently statutory and voluntary sources are unable to supply all the help required in a particular case, and the limited funds of the Committee have then to be drawn on. It will be a sad day for many of our patients if this fund ceases to exist''. Dr. R. M. Orpwood, Chest Physician at the Poplar and Stepney Chest Clinics reports: '"There has been no major change in the pattern of work at the Poplar and Stepney Chest Clinics during 1969. As far as this section of the Tower Hamlets area is concerned, tuberculosis still remains an important problem both clinically and epidemiologically. Statistically we seem to have reached ''rock bottom" regarding the number of deaths and new notifications of this disease. There has been no significant drop in either of these numbers during the past few years. With the relatively high incidence amongst Lodging House residents and people of no fixed abode, it. seems likely that these numbers will remain constant for some years yet. Immigrants still produce a higher proportion of new cases compared with native-born U. K. citizens, but there is a definite reduction.of cases amongst those of West Indian origin. The increase in lung cancer continues to be a matter of major concern, and with the heavy smoking habits in the population particularly during the past 25-30 years, we must expect the position to worsen further during the next decade. The oniy positive action likely to produce favourable results will be with the young, and one is, so far, disheartened with the lack of effect all efforts so far have had in this age group. An even more positive approach through the schools and youth organisations is clearly indicated. All who have influence with' the young must bear a heavy responsibility in this problem, both by precept and example. The welfare of all patients attending the Chest Clinics remained the chief concern of the Care Committees during t;he year. Patients were assisted in claiming the statutory allowances to which they were entitled and, in cases of emergency, grants were made from the Care Committee's voluntary fund. Local firms again contributed to the fund and this enabled the Stepney Committee to arrange a day's outing in the summer for the chronic sick, and at Christmas time gifts were made to those at home in need of extra comforts. Several elderly home-bound patients were also given help with extra fuel during the winter months. The social problems of immigrant patients were more difficult to resolve owing to the language difficulty and their confusion oyer the complex welfare state regulations, but on the whole, patient's problems have decreased asaresultof increased allowances and improved standards of living. Pensioners, and those who have had a very long period of illness,continue to need the additional voluntary help given by the Care Committees''. Health Control of Immigrants r During the year, 549 advice notes of immigrant arrivals, were received in the department from various ports of entry and successful contact was made in 330 instances. Of the remaining 219 some had moved to addresses outside the borough and details were forwarded to the authority 20 concerned but the majority were either not known or had never arrived at the address given. One immigrant suffering from tuberculosis was admitted on condition that she reported to the Medical Officer of Health for examination She was not found at the address given and no contact was made. VENEREAL DISEASE The annual return received from the Venereal Disease Clinic at the London Hospital shows the new cases attending the clinic during the year were as follows:- Area of Syphilis Gonorrhoea Other Total (1968) Residence Conditions Tower Hamlets 72 466 1,931 2,469 (2,768) Other London Boroughs 129 1,065 4,870 6,064 ( 5,208) Other Areas 28 162 1,202 1,392 (1,138) 229 1,693 8,003 9,925 (9,114) Returns received from 8 other hospitals in London of new patients attending their clinics during the year showed that 206 were residents of Tower Hamlets, comprising 1 syphilis. 36 gonorrhoea and 169 other venereal conditions. . Two welfare officers appointed by.the Council work from the Whitechapel Clinic under the direction of Dr. E.M.C. Dunlop, M,D.,F.R.C.P. , Medical Director of the Clinic, for tracing contacts and following up defaulters. Dr Dunlop reports as follows:'- ''We dealt with 229 new cases of syphilis in 1969 compared with 228 in 1968,with 1,693 new cases of gonorrhoea compared with 1,600 andwith8,003 cases of other conditions compared with 7,286 last year. The highest total for new cases (2,469) was for Tower Hamlets representinga considerable decrease on the figure for 1968 which was 2,768 The figures for Tower Hamlets included 72 cases of syphilis, compared with 95 for 1968, and 466 cases of gonorrhoea compared with 548. The continued decline in the number of cases of gonorrhoea in this area is gratifying when compared with the general national increase. The activities of our Contact Tracers have resulted in more women with gonorrhoea attending the clinic. It seems inescapable that this has led to the decline in the numbers of infected men. A study here has shown that in 1960, prior to intensive contact tracing for gonorrhoea, we saw only 11 women as a result of 100 cases of gonorrhoea in men. In 1969,, wi th our present system of contact tracing, We saw ho less than 54 women as a result of contact tracing in 100 cases of gonorrhoea in men In 1960 only 6 of the 11 women who attended were the sources of infection. In 1969, 36 of the 54 women attending were the sources of infection. 21 In the period January to December, 1969, 6 of 25 sources of early syphilis in men were brought for examination and all were found tobe infected. Ten other contacts attended and 4 were found to be infected. In the same period 1,171 male patients suffering from gonorrhoea were seen; 399 women who were alleged sources of infection were examined (34%) . Of this number 373 (93.5%)were infected. 179 other contacts were also examined and 133 (74.3%) were found to be infected''. 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 di scon t inue work with aview to preventing the spread of infectious disease, such person to be compensated for any loss suffered as a consequence, Notices under this section were served on three occasions during the year, concerning a diphtheria contact working in a restaurant, a dysentery contact employed in a food factory and a butcher from whom dysentery organisms were isolated. Food handlers excluded from work on account of suffering from infectious disease and for whom certificates were issued for the purpose of claiming National Insurance benefit numbered 15 during the year, 22 PART III PERSONAL HEALTH SERVICES 111 PERSONAL HEALTH SERVICES The Principal Nursing Officer, Mrs. D. E. Marrin, reports as follows:- Main changes in the nursing services ''One Assistant Nursing Officer resigned for domestic reasons and a former Centre Superintendent on the Borough staff was appointed to replace her.An additional Assistant Nursing Officer was appointed to meet the requirements of the new nursery and child minders legislation. The Home Nursing service transferred in April from its voluntary grant aided setting: to the direct service of the Council, all the home nurses now being based at Cheviot House, It has so far proved difficult to achieve the full establishment of home nurses, a small number still being recruited from private agencies. During the year 84,927 home nursing visits were paid in addition to those undertaken by Bathing Attendants Over 50% of these visits were to citizens over 65 and the social content of the home nurses' visiting increased accordingly, Heaith Visiting The health visiting service is provided by the Council under Section 24 of the National Health Service Act 1946 The many faceted work of the health visitor has direct and indirect links with all the social services provided for every member of the family. She maintains close liaison with general practit bners, social workers and hospitals. Her important function of health education is continued by parentcraft classes and films in the clinics, by mothers' clubs, home visits and talks in schools. Nine health visitors were appointed during 1969 and there were nine resignations, but as 1969 was the best year ever for recruitment to training nationally (the Council for the Training of Health Visitors reports 1,000 candidates) it is hoped recruitment and retention of those trained will improve. Mental Heaith Emergency Rota Health Visitors continue to assist on the mental health emergency rota at night, week-ends and Bank Holidays School Health Service The outbreak of influenza among the staff in December and January, brought additional pressure on all nursing staff left on duty. The clinic and school nurses were markedly willing to leave their own work in hand and relieve, repeatedly at short notice, over wide areas of the Borough to ensure the maintenance of the school nursing service. 23 Day Nurseries Recruitment of trained nursery nurses remained difficult, but it was possible to secure places for two senior members of nursery staff on a course for mature students leading to the certificate of the Nursery Nurses Examination Board. Training Liaison between the local hospitals, the local authority nursing and health visiting services and the nurse training school in the Borough of Newham, has continued throughout the year for the training of district nurses. District training was given to twenty London Hospital pupil nurses in preparation for thi integrated district nursing state, enrolled nurse certificate. Six Borough sponsored health visitor students successfully completed their training and practical experience was provided for six additional pupils in liaison with various training colleges. Six members of the health visiting staff have taken additional training and are designated as 'Field Work' instructors to undertake responsibility under the guidance of an assistant nursing officer, for the day to day practical training of these students. In-service training by means of the once fortnightly discussion groups conducted by a psycho-therapist at the London Hospital has continued to give support and guidance to health visiting staff, who attend, commitments permitting on a rota basis. Staff have been encouraged whenever possible, to attend all available courses and conferences, to help give them stimulus and insight and to enhance the quality of the the service given to the public. Speakers on various topics, incl uding computeri sation and Police work with juveniles have been introduced at staff meetings. Fami ly Planni ng The health visiting staff who commenced their Family Planning training in 1968. completed the course and received the relevant certificate. Liaison with AlIied Services Orientation of hospital personnel into the Public Health services has continued by the arrangement of approximately six hundred observation visits for medical, nursing and social work students. Senior nursing officers and health visitors have continued to lecture and conduct seminars in the majority of the local hospitals. The Principal Nursing Officer took part in a one day conference arranged by the London Boroughs Training Committee to explore further ways of increasing the general practitioner local authority liaison. In this borough, general practitioners are increasingly assisting in the clinic centres and schools, thus providing a link between the community preventive and curative services. 24 Pre-SchooI Play Groups and Child Hinders By December 1969 there were approximately fifty registered Child Minders and twenty registered Pre-School Play Groups. The Principal Nursing Officer, together with the Principal of the Lansbury Adult Education Institute, initiated the first course to be held in the Borough, which it was hoped would help those mothers who wished to start play groups or who needed help in running them. The newly appointed Assistant Nursing Officer has successfully continued the demanding task of instigating these courses in various of the Borough's clinic centres and in available halls in conjunction with the Adult Education Institutes and officers of the Inner London Education Authority. The staff at the clinic centres appreciate any support they receive in the important task of helping to inculcate desirable standards in the early formative years of the lives of children.'' ANTE- AND POST-NATAL C-LINiCS Sessions are conducted in Counci1 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 91) ANTE-NATAL MOTHERCRAFT AND RELAXATION CLASSES These classes are held by domiciliary midwives and health visitors in Council clinics for both institutional and domiciliary booked cases. (Statistics on page 91) ADOPTION AND BOARDiNG-OUT Children are medically examined by Heal th Department Medical Of ficers prior to admission to children's homes orprivate foster homes on request f rom 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 76 children were examined and reports were made on 39 prospective adopters. CERVICAL CYTOLOGY The service for the col 1ection of cervical smears for cytology investigation by hospital authorities continued during the year with sessions in the Council's clinics. In addition a general practitioner continued holding regul ar sessions in his surgery, assisted byamember of the staff of the Health Department, and the Family Planning Association continued taking smears at sessions held in Council clinics.. From these 1,519 examinations were carried out.In addition, hospi tal s in the area read 11,482 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 92 of the Appendix. 25 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 34 Number of stillbirths and livebirths notified over the same period 2,646 The rate of notifications per 1,000 total births was 12,8 compared with 14.7 last year. There are obvious difficulties in assessing the real incidence of congenital defects under such a voluntary scheme, but some help does flow in maintaining observation registers and in follow-up to assess any handicap. CHILD MINDERS The amendments to the Nurseries and Child Minders Regulation Act 1948 by Section 60 of the Health Services and Public Health Act 1968 did not come fully into force until February this year. Wide publicity was given in the Borough to the new requirements which occasioned a considerable volume of work in the department An Assistant Nursing Officer, appointed for the purpose, visits all applicants and reports on their suitability, on the conditions existing in the premises and on the measures necessary to comply with the Act. By the end of the year women who applied for registration or who otherwise came to the notice of the department numbered 264 Registrations effected numbered 46 and 7 were refused registration. Applications cancelled or withdrawn for various reasons totalled 175. Consequent upon a notice having been seen in a local Post Office advertising a local child minding service and a report being made by a Health Visitor that she had seen several children being taken to a house early morningSj attempts were made to interview the occupier of the premises, but no access could be obtained Letters addressed to the occupier, who was not registered for child minding, also remained unanswered. A warrant for entry was then obtained from the Petty Sessional Court, under Section7of the Nurseries and Child Minders Act, which was executed by the Senior Medical Officer accompanied by two pol ice constables. Two children were found being minded in unsatisfactory conditions. The circumstances were reported to the Health Committee, who instructed that the person be cautioned that if she continued minding children in contravention of the provisions of the Act legal proceedings would be instituted. Child minding at the premises was subsequently found to have ceased. Details will be found on page 92 of the Appendix, 26 CLINIC CENTRES There are 6 clinic centres in the borough, 3 school treatment centres and 7 combined clinic and school treatment centres. Additional clinic auxiliaries were engaged during the year to carry out various tasks in the clinic centres, thereby affording more time to the health visiting and nursing staffs to cope with their professional duties. Further housing development on the western side of the Isle of Dogs necessitated additional clinic sessions at the Island Baths sub-clinic. Services provided at each of the Centres are given on pages 129 to 131of the Appendix. 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, and 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 9 clinic centres, 5 additional sessions per week being provided at the Isle of Dogs centre. The number of creche sessions have been trebled since 1965. Attendances numbered 6,803 during the year. DAY NURSERIES AND PLAYGROUPS 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. A day nursery was approved as aTraining Nursery from 1st April this year, so that three of the nurseries are now 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 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 1 iving 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 total ly disabled or inprison, provided the mother works at least 35 hours a week. 27 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 66 the turnover of staff for the year was considerable. Under the Urban Aid Programme the Home Office agreed to makeagrant towards the construction of a purpose-bui1t Day Nursery in 1970/1971, at an estimated cost of £48,290, to replace a pre-fabricated nursery-The existing nursery premises besides being unsuitable are in an unsatisfactory area, and furthermore recently lost the use of outdoor play space taken over for housing development- Private day nurseries and pre-school playgroups also became subject to the provisions of the Health Services and Public Health Act 1968 amending the Nurseries and Child Minders Regulation Act 1948 A nursery in an industrial premises was registered this year for children of mothers working on the premises, as also were 12 additional playgroups which provide accommodation for 225 children, At the end of the year two private day nurseries and 24 playgroups registered provided facilities for 464 children. Under the Urban Programme (2nd phase), the Home Office approved revenue expendi ture of £1,000 for grants to voluntary playgroups and arrangements were made for deficiency payments to playgroups on the basis of 6d, per child/attendance. The Secretary of State for Social Services approved the modification to the Council's approved proposals under Section 22of the National Health Service Act 1946 to enable the Council to provide a day nursery and child minder service for children under 5 who have a special need for care on health and welfare grounds, and to pay reasonable charges where appropri ate, and to recover them from parents according to their ability to pay. Statistics will be found on page 92, FAMILY PLANNING Family planning sessions conducted on behalf of the Council by the Family PIaiming Association are held at three of the Council's Clinic Centres, 337 sessions being held during the year In addition, Council sessions staffed by a Sessional and an Assistant Medical Officer and Health Visitors are operated at a further three clinic centres. The Council provides a domiciliary service particularly for families with multiple, social, or other handicaps. The Council co-operated with the Family Planning Association in ''Family Planning Week'' by making available the Council's premises, staff and equipment on Open Days in the Clinics and providing publicity for the week His Worship the Mayor attended one of the Open Days, This year new patients numbered 1,080, an increase of 14% over last year or 138% over 1966, (Statistics on page 95.) 28 FEEDING DIFFICULTIES Facilities are provided at a centre outside the borough for in-patient treatment of mothers and babies when breast feeding difficulties are experienced or of babies with dietary problems. No children were accommodated at the centre during the year, HEALTH EDUCATION Involvement by the health education staff with professional colleagues in health education techniques is proving of enormous value in further spreading the ethos of health education. Whereas development of the service in schools depends to a certain extent on adequate staff and the department's flexibility in filling the gap, the trend now seems to be for health education to be accepted as a subject in its own right. Improved relationships with schools have further led to the use of the section workers as counsellors, group workers, liaison workers for sccial studies and Newsom courses and advisers for visual aids. The health visiting service in increasing its use of the heal th educat ion staf f has greatly improved health education display material in clinics. Help has also been offered by the nursing officers with health education lectures other than the regular sessions in schools. How the future of health education develops in youth clubs and other services depends. 1argely on the conservation and distribution of time and energy the staff have available. A handbook on home safety entitled ''Tower Hamlets Guide to Safer Living'' was produced and made available to the public during the year. The annual firework safety campaign was continued and it is pleasing to note that official figures for the country show that this year 1,636 people received hospital treatment for firework injuries compared with 2,537 in 1968. Increasing use of visual aids necessitated the purchase of another film projector largely for use in schools. Other health education activities during the year took the form of entries by the staff of the department in the Borough Carnival. The public health inspectors and pupils adopted the theme of ''Kill that Fly'', incidentally gaining 2nd prize. The dental section portrayed their ''Dental Health Stamps Campaign'* (3rd prize), and the Home Help service's float endeavoured to aid recruitment. Statistics on the work of the section are given on page 94. HEALTH VISITING Health visitors maintain close liaison with the staff of statutory and voluntary bodies , general practitioners and hospitals in the borough. Their visits to expectant mothers andto children under five years of age are shown with other statistics on page 95 . Heal th education work is carried out by means of personal contact as well as in group sessions held at the 29 clinics. At the request of the paediatricians concerned health visitors attended the out-pat ients departments at hospitals to provide a link between hospital and home. The numbers of health visitors including centre superintendents and tuberculosis visitors employed at the beginning and end of the year were 39, there being 11 resignations and 11 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, which ratio would equate to 34 staff for the current year. HOME NURSING Until the 31st March this year the home nursing service for the borough was carried out on an agency basis by the East London Nursing Society for the major part of the borough, and by the Nursing Sisters of St. John the Divine for the remainder of the area. Following adoption by the Council of a recommendation that, having regard to the wide range of health services provided directly by the Council in pursuance of its statutory powers, it was in the best Interests of the borough and its inhabitants to bfciing the home nursing service under the Council's direct control, and consequent upon approval being received from the Department of Health and Social Security to amending proposals under Section 25 of the National Health Service Act, 1946, the district nurses attached to the East London Nursing Society transferred their services to the Council on the 1st April, from which date they operated from the Health Department offices; The Society's premises, comprising headquarters and residential nurses' home, were not transferred and housing accomirodation was made available by the Council to the nurses. Additional auxiliary staff were appointed during the year for domici1iary bathing duties and the like, in order to make more effective time available to nurses for nursing duties. Statistics relating to the home nursing service are on page 97. LAUNDRY SERVICE Soiled personal clothing, bed linen, etc., iscollected at least twice weekly from the homes of persons who are incontinent, and cleansed and laundered in the 1 aundry at Branch Head Cleansing station. Increased demands led to a further expansion of the service necessitatingthe purchase of additional equipment and the appointment of an additional 1 aundrywoman. (Statistics on page 97). INCONTINENCE PADS Special commercially prepared disposable pads and/or knickers are supplied free in suitable cases for use by incontinent and chronical ly il1 aged pesons. Over 27,000 pads plus knickers and 1 inings were purchased during the year and issued to 165 persons, 29% more persons than 1 ast year receiving this service. LOAN OF NURSING EQUIPMENT Articles of nursing and sick room equipment are loaned at the request of the general 30 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 98. MARIE CURIE MEMORIAL FOUNDATION The Council participates in both schemes operated by the Marie Curie Memorial Foundation for the welfare of persons suffering from cancer who are being nursed in their own homes, namely the Day and Night Nursing Service and the Area Grant Welfare Scheme. Nurses and/or ''sitters-in'' are provided for short periods to patients who live alone and to others to enable relatives to obtain adequate rest periods from the responsibi1ity of nursing. Under the Wei fare Scheme grants are made on behalf of the Foundation towards the cost of hire or supply of special equipment, 1inen, bedding etc. A grant is made by the Council to the Foundation. DOMICILIARY MIDWIFERY SERVICE The Council operates adomiciliary midwifery service under Section 23 of the National Health Service Act 1946, by an arrangement for utilising the services of midwives employed by the London Hospital and the Nursing Sisters of St. John the Divine. In addition the Council directly emp toys the non-medical supervisor of midwives. 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 16 with4pupils 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 233 home confinements attended by the Midwives. • Four general practitioners from practices in the borough provided ante-natal care, wi th midwives, at fourof the Council's clinics. (Statistics on page 99), 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 111. 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. As the borough is served by two hospital management committees, there are separate maternity liaison committees for each group catchment area. 31 VACCINATION AGAINST MEASLES Vaccination against measles for all children up to the age of 15 years continued; 1,482 children being vaccinated during the year, including 229 by general practitioners. OBSERVATION REGISTER At the end of the year, the Observation Register totalled 6,070 persons, comprising:- Children under 5 ''at risk'' 2,994 -do- handicapped 298 Young persons aged 5-21 years handicapped 2,457 Children non-resident but attending schools in the borough 321 The senior medical officer keeps the register under constant review. Further details relating to the register will be found on page 84. A booklet produced by the department sets out details of the services avai 1 ablefor 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 Tests for phenylketonuria are carried out by means of the Guthrie method on all babies. Co-operation is readily given by the hospitals in the borough having maternity wards, both in regard to taking the specimens and the pathological examinations. Arrangements are made with regard to domiciliary births by attending midwives and for health visitors to deal with other babies found not to have been tested. PREMATURE BABIES Any child weighing 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 95. RECUPERATIVE HOLIDAYS Recuperative holidays for mothers and young children are provided under Section 22 of the National Health Service Act 1946 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. 32 A total of 343 adults and children were placed in recuperative holiday homes during the year, including 196 schoolchi ldren for whom the Inner London Education Authori ty 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 38 homes inspected 31 of which were recommended for continued use. (Statistics on page 97). CARE OF THE UNMARRIED MOTHER AND HER CHILD 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 Wei fare Committees. Expectant and nursing mothers admitted to such homes during the year numbered 9. 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 casesofi11ness 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 required at these establ ishments. 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 Department of Education and Science Survey of Physically Handicapped children in ordinary schools. Greater London Council, Research and Intelligence Unit Spina Bifida National Child Development Study Childhood development Medical Research Council: Measles DENTAL CARE FOR THE PRIORITY CLASSES Section 22 of the National Health Service Act 1946 puts local authorities under anobl igation to provide dental care for children not yet at school and for nursing and expectant mothers.The same dental officers and dental auxiliaries who treat school children in the school health 33 service carry cut this part of their work in the same clinics and at the same time as they treat the school children under the school dental service. This arrangement for mixing sessions to enable the family to attend together has proved popular and this service is available atevery dental surgery. Dental Auxiliaries are trained to treat very young children as a speciality and it is to the three dental auxiliaries on our staff that the majority of pre-school children go. The amount of time devoted to this work has been increased by 48.5% during the year. The personal dental health of expectant and nursing mothers is of paramount importance and the assistance of all the health personnel in the borough is invoked to achieve this end. At this time mothers (and even fathers) are particularly receptive towards dental heal th instruction and this can be of supreme benefit to them and their children. Likewise the establishment of a normal routine visit to the dentist long before dental disease is rampant can condition the toddler to the dental environment and make further treatment much more readily acceptable when the necessity arises. In clinics where the dental surgery is situated in the same building as a welfare clinic, mothers and toddlers are encouraged to visit the dentist as soon as possible after two years of age and once seen the children are 1isted for routine recal1. The routine examination of toddlers at toddlers clinics is highly desirable but for the time being this essential service cannot be provided at every toddlers clinic due to shortage of staff. Until it is the following simple rules can be followed by clinic staff and parents to reduce the potential of dental disease: 1. NEVER give children undiluted blackcurrant, orange or similar vitamin syrups. These are exceedingly harmful to teeth if taken from a spoon, bottle or dinky feeder; 2. Clean teeth immediately after breakfast and last thing at night,if possible with fluoride toothpaste. Never rely on young children cleaning their own teeth,' even so they should always be allowed'to have a go'as well as mother. 3. Finish meals withafibrous food such as apples, carrots and nuts and then rinse mouth with water; 4. Eat full meals at regular intervals throughout the day, but avoid between meal snacks and sweets whenever possible; 5. Eliminate sticky toffees and long-lasting sweets from the diet. It is not unreasonable to allow children the occasional sweet but reasonable restrictr ions can make a big difference; 6. The ear ly introduction of excessive sugar and sweets to the diet only encourages a sweet tooth for the restof life. Far better to encourage a taste for savoury food and fruit to avoid obesity problems as well as achieving better teeth; 7. Above all else the regular attender at the dentist from two yearson will establisha pattern, achieve minimal treatment as soon as it is necessary and give the dentist the opportunity to apply topical solutions to the teeth which will strengthen them against potential future decay. 34 The service meets all the demands made upon it. During 1969 811 pre-school children were examined and treated and 48 nursing and expectant mothers, a total of 751 fillings being provided and 25 teeth extracted. During the year talks were given to mothers clubs and 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 93. 35 *************** 36 PART IV COMMUNITY CARE SERVICES IV COMMUNITY CARE SERVICES MENTAL HEALTH SERVICE Referrals Persons referred to the department showed a decrease of 12 per cent from last year, and the number under community care decreased by 5 per cent,, Admissions to Hospital In addition to community care for patients and their families the mental heal th social workers are responsible for the statutory admission where necessary of patients to hospital. Informal and compulsory admissions for the year numbered 169 a decrease of 17 per cent from last year. Emergency Night and Weekend Service A designated mental health officer must, statutorily, be available at all times to deal with emergency calls for the mental health service. This means providing a 24-hour service, seven days a week, including bank holidays. The mental health social workers augmented by some nursing staff provide a night and weekend duty service on a rota basis. This emergency service operates from 5 p.m. each evening to 8.45 a.m. the following morning and at weekends from 5 p.m. on Fridays to 8.45 am. 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. Four 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 Arrangements were made for 20 patients this year. 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 1ocal 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, 39 other persons were in hostels at the end of the year and were being financially supported by the Council - 37 - During the year the Council agreed to make available to the Psychiatric Rehabilitation Association premises for use as a Group Home for former psychiatric patients who have undergone a period of rehabilitation is Nicholas House, the Association's short stay hostel, but who are unable to find housing accommodation which they can afford due to their low earning capacity. A grant towards the necessary adaptations was also made Junior Training School Construction of a purpose built junior training school to replace the existing premises commenced in 1968 and was completed at the end of 1969 at a cost of £90,000. The School provides training places for 95 mentally severely sub-normal children, plus a special unit for 20 children suffering from physical as well as mental handicap. The accommodation includes assembly hall, 7 class rooms, 3 rooms for the special care unit, a nursery, handicraft room and domestic science room. There are also recreational facilities including large hall, playground, grassed area and children's flower garden. Photographs of the new school face this page- Last year the Government made known its intention 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. Special Care Units A special care unit for juniors, catering for those trainees who are too severely handicapped to be able to be taught and trained with other juniors, was accommodated until the end of the year in part of the University House Day Nursery, The special unit for severely handicapped children under 5 years of age was housed in part of the Council's Queen Mary Day Nursery until the end of the year. Transport Transport is provided by coaches and minibus to take trainees from their homes and training centres each day. Transport covers trainees attending the junior training school, adult female centres, the special care unit, the day nursery special unit, psycho-geriatric patients attending the Day Centre and some of those attending the men's industrial training centre. Holidays Many trainees from the training centres take part in a holiday at a holiday camp at Dymchurch, Kent, joining groups of trainees from other London Boroughs, Recuperative holidays are arranged for mentally ill persons under community care. - 38 - Tower Hamlets Junior Training School Junior Training School for Mentally Handicapped 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 makes available the use of its junior training school premises to the Society on three evenings a week for youth club purposes and dancing class, and on a Saturday evening each month for social and sports activities. The 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 school gives her services. Day Centres There is a Council day centre for the mentally ill and two others admihistered by a voluntary organisation in the borough, which is financially supported by the Council. 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. From September the supplyof midday meals to the day and training centres was undertaken by the Council's Welfare Department, replacing the service continued since 1965 provided by the Inner London Education Authority School Meals Service. The Council's day centre for psycho-geriatrics is open on three days a week. 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 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. A social club for the trainees commenced at the Industrial Training Centre this year on Wednesday evenings at which the Supervisor and his assistants give their services. Parents are able to see the types of work carried out by their sons. - 39 - Industrial Work at Training and Day Centres Industrial work undertaken during the year, included such tasks as assembling cardboard boxes, packing curtain rings, toys, pencil cases, geometry sets, pocket games, plastic toys,making playing bricks, toy irons and ironing boards, tidy boxes, sorting trays, blackboards and easles, test-tube racks, Wendy houses, dolls cots, needlework boxes, trays and childrens chairs,trimming and bundling plastic mouldings, thumb-holing medical boxes, and repairs to furniture. Amounts received for work executed by the trainees amounted to £3,178 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. £2,202 was paid out as incentive pocket-money during the year. Guardianship One severely sub-normal patient remained under guardianship of the Council at the end of the year. This patient for whom the Council is financially responsible is placed with the Guardianship Society and cared for by being boarded-out with a specially chosen family 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. The London Hospital It was announced during the year that plans were being made for the London Hospital's Annexe at Brentwood, Essex, to be adapted to accommodate sub-normal patients requiring hospital care. The Psychiatric Department of the London Hospital, has kindly supplied the following report:- ''During the past year, a Day Unit for pre-school disturbed children and their parents has been started at Oxford House. This is a joint venture supported by the London Hospital Medical College, the Health Department of the Borough of Tower Hamlets and the Inner London Education Authority. It is designed to give intensive care to a small number of severely disturbed young children and their families. Dr. Kenneth Martin has been appointed a Part-time Consultant at the London Jewish Child Guidance Clinic, and Senior Lecturer in Child Psychiatry at The London Hospital Medical College. He also does sessions in the Borough of Tower Hamlets, co-ordinating all aspects of the mental health of children in the Borough. Further links are being forged between the Social Work Department of The London Hospital and the Mental Welfare Officers of the Borough of Tower Hamlets, so that as far as possible a single Department of Social Work caters for both the Borough and the Hospital". - 40 - Statistics relating to the Mental Health Services appear on pages 100 to 10? REHABILITATION AND AFTER CARE OF ALCOHOLICS (including Crude Spirit Drinkers) In an attempt to rehabilitate crude spirit drinkers and other alcoholics a pilot scheme was planned last year with the Salvation Army, to come into operation in April of this year. An assessment unit forms part of the Salvation Army's new premises, Booth House, Whitechapel whence suitable cases are sent for rehabilitation to the Salvation Army's country premises near Swindon, Wilts. Financial support is given by the Council towards the expenses of the Medical Unit at Booth House, and the costs of patients'sojourn at the Wiltshire home are reimbursed to the Salvation Army. The Home Office agreed to make agrant towards this expenditure in the Urban Aid programme. The Secretary of State for Social Services approved the modification of the Council's proposals under Section 12 of the Health Service, and Public Health Act 1968 by the inclusion of the following:- ''In order to secure rehabil itation of individual patients there shall be close collaboration from the earliest possible stage between the Council and hospital authorities, general practitioners and voluntary bodies. In particular the Council may provide assistance in the following ways, namely- (a) Social Support: The Council to provide, subject to patients' agreement, anynecessary social support by its own social workers and/or voluntary bodies. (b) Provision of Hostels: The Council to provide itself, or in conjunction with other local authorities, or by the use partly or wholly of voluntary organisations, hostel accommodation for the after care of alcoholics (including crude spirit drinkers) and, (c) Generally: To assist generally in the after care of alcoholics (including crude spirit dr inkers).' ' REHABILITATION OF HEROIN ADDICTS - HOSTEL ACCOMMODATION The Council expressed agreement with a proposal that four 12-bed hostels for ex-heroin addicts be established in the Metropolitan area, including the financing of the expenditure by rateable contributions from all the London Boroughs. By the end of the year two voluntary associations were well advanced with pilot schemes and were given grants by the Greater London Council in accordance with the financial arrangements referred to above. 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 109 examinations by a consultant ophthalmologist during the year and certificates accepted from other local authorities, hospitals and private ophthalmologists numbered 69. Transport to the clinic for examination is arranged for these persons where necessary. - 41 - CHIROPODY This service has doubled since 1965. Foot clinics are held at 8 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 36 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. When such patients can be taken to clinics transport is provided, a total of 369 patients being conveyed during the year. Treatment is free to old persons, to those on retirement pensions, expectant mothers, schoolchildren and the physically handicapped. The appointments system was reviewed during the year, resulting in the average number of patients treated per session being increased from 6.0 to 6.7.The average time between clinic appointments is 9 weeks and 10-11 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 93. HOME HELP SERVICE Home helps are provided under Section 13 of the Health Services and Public Health Act 1968 , 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, understandably because of the growing number of aged persons in the community, earlier discharge from hospital as the community care service expands, and the policy of keeping the aged in their own homes as long as possible rather than admitting them to a hospital or welfare home. At the end of the year 279 home helps were employed by the Council. The present standard charge for home help service is 6/10d an hour which iis reduced according to the financial circumstances of the person assisted. 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 medical certificates. An in-service course of 7 lectures designed to assist helps in their work was attended by 30 home helps. Households numbering 3,724 were provided with the service during the year compared with 3,643 last year. Section 13 of the Health Services and Public Health Act 1968 also confers on local health authorities power to provide laundry facilities for households where home help is being provided , but the Minister has deferred bringing this section into operation in the light of the present economic situation. (Statistics on page 96 ) - 42 - 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 neighbours willing to undertake this paid work. ARTIFICIAL KIDNEY MACHINE During the year the Council undertook the work,and bore the cost,of carrying out the necessary adaptations including plumbing, electricity and water supplies to a dwelling in the Borough where a renal dialysis machine was being installed for a 22 year old patient by the London Hospital. The cost of adaptation was £618. 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. This service was again expanded during the year by the engagement of 4 additional bathing attendants to relieve the district nurses of as much non-nursing duty as possible. (Statistics on page 96 ) BURIALS Section 50 of the National Assistance Act 1947 places a duty on the Council to arrange for the burial of any person found dead within the borough where no private arrangements have been made. Burials undertaken during the year numbered 39. (Statistics on page 104) 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 12 persons, who were removed to hospital. - 43 - *************** - 44 - PART V ENVIRONMENTAL HEALTH SERVICES V ENVIRONMENTAL HEALTH SERVICES The Chief Public Health Inspector reports as follows:- Slum Clearance "Apart from a few houses, the Borough's 1966/1970 slum clearance programme has been completed. A final survey of the Borough was made when it was found that there are 1,612 houses and 889 flats which are considered unfit. The speed wi th which these can be represented largely depends on factors outside the control of the Health Department. There is an acute shortage of building land in Tower Hamlets, and it is essential for one area to be completely redeveloped for housing purposes so that it is available for rehousing families from the next area to be represented. Closely associated with the shortage of land is the necessity often for each Pt. III area to be considered in conjunction with a larger area for redevelopment, under Pt. V,which necessitates programming and the representation in conjunction with the Borough Architect and Town Planning Officer. Common to other Boroughs, Tower Hamlets has its decanting probl ems which tend to increase rather than decrease, but the effect here maybe greater than in some places. It is a problem that even the computer cannot solve. Despite these difficulties, if it i8 possible to maintain the progress of the last five years, hopes are high to see the last of the slum areas represented before 1975. Just on the turn of the year news of the confirmation of the Spitalfields area was received from the Ministry. This is the largest clearance area to be represented and confirmed in Inner London. It comprised 589 flats in 11 blocks and 2 houses which are occupied by 1,413 persons in 549 families. The Clearance Area is approximately 2H acres. ( It is estimated that decanting wi 11 take about 5 years). Improvement Areas It is not easy to envisage improvement of dwellings on the scale indicated in the Housing Act 1969 and in the guidance given by the Ministry in circulars. Trial areas, as defined, just do not exist, and it may well be that the implementation of small improvement areas would prejudice the slum clearance and housing programme due to the work involved and the resultant little effect on the eradication of slum and substandard property. Secondary to this is the assumption that there will be only a few applications for qualification certificates. Only one has been received in respect of a house, but 62 have been dealt with for privately owned blocks of flats. In the latter the potential number is very limited as the majority of privately owned blocks of flats do not lend themselves to improvement either economically or from a practical view point. Overcrowding The statutory standard has been in force since the Housing Act 1935 became - 45 - operative. It is a very low standard and condones living conditions bordering upon intolerable. It is appreciated that whilst so many cases exist in occupied houses there is no point in raising the standard but there is certainly no reason why it shouldbe perpetuated in new and converted dwellings. A revised standard, based on where persons have to sleep would be more in keeping with the present trend pf improving living conditions. Pet Foods The sale of meat for pet food has for many years const i tuted a very pos it ive heal th hazard. To effect control The Meat (Staining and Sterilising) Regulations 1960, were introduced, whereby unfit meat from slaughterhouses was required to be sterilised.whilst meat from knackers' yards required staining only. The difficulty of staining meat effectively for retail sale and the ease presented in removing it, are well known. The gate was still wide open. Knacker meat was surely as great a hazard, if not greater, than unfit meat.from slaughterhouses, from a food poisoning view point. It is significant that during a dock strike when the meat ration was reduced to 6d. all pet shops and stalls in a certain area, were sold out within an hour of opening. It may be wondered if this was due to genuine pet food buyers being joined by unscrupulous landladies and cafe proprietors, buying meat for their "POTS". The 1960 Regulations were replaced this year but although an improvement, a loophple still exists. A pet meat factory receiving unfit meat for sterilisation may also purchase meat which is fit for, but not intended to be used for human consumption, and send this out as raw meat for pet food to retail sales points. If the trader is genuine there is a positive risk of cross infection of this meat before it leaves the distribution depot, and if he is not genuine, who is able to identify meat which should have been sterilised, when it is exposed for retail sale? We may hopefully wait for legislation to require that al1 meat intended for pet food shall be sterilised before release for sale and that no pet food shall be sold from food premises unless it is delivered in impervious containers and sold by retail only in those containers. To-day this is big business and unfortunately the bigger this type of business, the greater the risk to health. Whilst it is still possible for a person to trade in fit and unfit me at and to wholesale the former as carcase meat or offal for pets, the problem of control borders on the impossible!' CLEAN AIR The Clean Air Act, 1968, (Commencement No. 1 Order) appointed the 1st April 1969 as the date on which provisions of the Act came into force relating to the emission of grit and dust from furnaces, approval as to the height of chimneys and the acquisition and sale of unauthorised fuel in a smoke control area. These requirements together with that contained in Section 3 of the Clean Air Act, 1956, relating to the notification of new boiler installations is leading to abetter control of industrial smoke emission. - 46 - Notices were given to the Council of proposals to install furnaces in four premises and fifteen applications for prior approval of furnace installations were received and approved. Nine applications for chimney height approval were received and approved, subject in some instances to the chimney heights being amended. The whole of the Borough is covered by smoke control orders. Approval, for grant purposes, was given to the installation of 107 heating appliances, the total estimated grants amounting to £1,840. In addition 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. The most important effects of smoke control operations by London Boroughs, as stated by the Greater London Council Research and Intelligence Unit, are - Smoke concentrations in central London have decreased by 80% since 1958 and sulphur dioxide concentrations by 40%; sunshine in central London in December has increased by 70% since 1958 and winter visibility has increased threefold since the Act came into force. In early July, 1968, complaint was received concerning the "browning" of foliage. Observation and enquiry suggested that the condition was widespread and not confined to this locality, it being due to hot, drying winds during a period of relative drought and unusually high temperatures so early in the year. It had, however, been considered that the effluent gases from a major generating station on the south bank of the River opposite, might have been a contributing cause under appropriate conditions because of toxic gases such as sulphur dioxide and possibly sulphur tri-oxide being brought to the ground in the vicinity. Samples of leaves taken from trees in the street were submitted for chemical analysis. Quite unexpectedly the results indicated that there was a deposit of lead on the leaves which, being of an inert nature, could have had no bearing on the actual browning of the leaves but which was a little disconcerting because of the proximity of a large lead works. These premises operate a registered process under the Alkali, etc., Works Act, and are under the regular supervision of the Alkali Inspectorate, in whose opinion the plant is considered to be a model of its kind with no evidence of excessive exposure to lead among the workers, and from which checks on the effluent had consistently been below acceptable limits. Experiments which have repeated the findings have continued throughout the year with no clear indication of the origin of the deposits. DISEASES OF ANIMALS The Corporation of Lqndon, 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 19 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. .01 use at tent ion has been paid to the animal market held on Sunday mornings in Club Row, and visits of inspection made regularly. - 47 - FOOD AND DRUGS Analysis of Food and Drugs Samples During the year 981 samples of food and drugs were submitted for analysis by the Public Analyst, 10 being purchased formally, 940 informally, and 31 were private samples. Irregular samples ascertained numbered 131. Action taken with respect to the irregular samples was as follows:- Legal proceedings were instituted in respect of seven samples, namely, a bread roll which contained a lead-free paint film, together with discoloured dough which had been baked in the bread; a bread roll which contained 6 pellets of rodent excreta which were embedded in the dough prior to baking; a white loaf which contained rodent excreta which was present in the breadprior to baking; a loaf which contained a cockroach leg which was not baked in the bread; a bottle of pasteurised milk which contained a plastic potato crisp bag, the milk being contaminated with alkali; a bottle of pasteurised milk stained on the inner surface with a carbonaceous residue, and minced meat which contained sulphur dioxide (4,500 p.p.m.) the addition of which is not permitted. The total fines and costs awarded amounted to £135 and £37.lis. respectively. Matters taken up with manufacturers or importers included garnishing paste which contained benzoic acid, contrary to the Preservatives in Food Regulations; dairy cream, deficient in milk fat; thyme containing excess sand and siliceous matter; creamed coconut which contained sulphur dioxide; pork sausages deficient in meat content and pork sausages which contained the remains of a merchant grain beetle; condensed full cream milk contaminated with iron, and which contained an open can, comminuted orange containing benzoic acid; a meat pie deficient in meat content; lemon ice deficient in fat and milk solids; somilan which contained brilliant blue FCF a non-permitted colouring matter; a sausage roll containing heavy mould growth; diabetic raspberry jam which contained a smal1 aluminium turning; fruit salad which contained a non-permitted orange colouring matter; blackcurrant drink containing a non-permitted colouring matter formed by decomposition of red 6B; bubble gum which contained brilliant blue FCF; full cream milk food tainted with trace of aromatic suostance; abread roll containing burnt particl es of bread; milk powder which contained excessive moisture; messu and pera containing blue VRS a non-permitted colouring matter, and golden halva which contained excessive lead. The absence, inadequacy or improper declaration of ingredients on labels were ascertained in 47 samples and were also the subject of correspondence with manufacturers or importers. A summary of the samples analysed and included in quarterly reports submitted by the Public Analyst in compliance with Section 99 of the Food and Drugs Act, 1955, will be found on page 106. Dacterio,logical Examination of Foodstuffs Samples submitted for bacteriological examination numbered 219 comprising:- 9 Canned fish 5 Egg pasta and noodles 4 Canned meats 81 Egg Powder, liquid and albumen 2 Canned sausages 23 Ice cream 4 Chicken 14 Meat pies and sausage rolls 5 Desiccated coconut 8 Milk 6 Eels (jellied and cooked) 19 Miscellaneous foods 12 Egg noodles 24 Prawns and shrimps (frozen and cooked) 3 Rissoles All the samples submitted were found to be satisfactory. - 48 - Ice Cream There are 18 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. 25 samples of ice cream submitted to the methylene blue reduction test gave the following results:- Grade Manufactured Total In Borough Outside Borough I 3 1 4 II 12 2 14 III 6 - 6 IV - - - "Parev" Ice Cream: Satisfactory 1 - 1 25 Consequent upon taking the unsatisfactory samples (grade 3), careful investigations were carried out and recommendations made. The 5 samples taken since have all been satisfactory. 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 3,760 food premises, including stalls, in the area. Notices of requirements served numbered 622 and 114 summonses involving 26 premises/stalls were heard during the year. Food Export Certificates Certificates numbering 123 were issued in respect of a variety of foodstuffs exported to Belgium, Canada, Canary Islands, Israel, Greece, Italy, Kuwait, Libya, Madeira, Malta, Muscat, New Zealand, South Africa, Spain, Sweden, Tanzania and United States of America. Before certificates are issued the foodstuffs destined for export are examined and where necessary samples taken for analysis. Relevant investigation is also made into the methods of production. Imported Food There were breaches of the Labelling of Food Regulations 1967 in respect of 16 samples which were the subject of correspondence between the manufacturers and importers. - 49 - A consignment of Turkish dried apricots found to contain an excess of sulphur dioxide preservative was re-exported. In the case of a consignment of Iranian dried apricots, whilst this complied in respect of preservative cpntent, the apricots were found to be generally dirty and the consignment was re-exported. A similar consignment, samples of which were found to contain marginally excess amounts of sulphur dioxide preservative, was released with the proviso that the apricots be used for catering or manufacturing purposes and not sold for direct consumption by retail . Two consignments of groundnuts in shell were rejected because of excess aflatoxin and both were re-exported. When consignments which fail to comply with United Kingdom standards are re-exported, the appropriate authorities of the countries to which they are sent are informed. Mention has been made in previous Annual Reports of the risk of contamination of foodstuffs in transit by chemicals stowed in the same ship. A consignment of 5,200 cartons of sultanas was contaminated by powdered sodium sil ico fluoride, a toxic substance, contained in bagswhichhad split whilst being landed, the powder falling on the carton of sultanas stowed immediately below. The cartons of sultanas were vacuum cleaned and the dock workers were advised to wear protective masks and gloves whilst discharging them. The consignment was examined and samples taken, which were found to be free from excess fluoride contamination and the consignment was released, except for a small number of cartons which had been holed or had open flaps, which were destroyed. It has been suggested that, in a forthcoming review of the Public Health Ships' Regulations, the question of proper separation of food-stuffs from potentially contaminating consignments should be considered. Samples of Italian canned sliced beef in jellified Consomme were found to have total meat contents of 72% and 73% instead of the 80% required by the Canned Meat Product Regulations, 1967. The manufacturers stated that because of the process of slicing the space available in the can is less than with a minced or solid pack, and, after cooking most of the fat is skimmed off. For these reasons it was difficult, if not impossible, to achieve an 80% meat content. The matter was brought to the attention of the Food Standards Division of the Ministry of Agriculture, Fisheries and Food as it appeared to disclose a discrepancy in the Regulations when compared with meat in gravy with a required meat content of 75%, or sliced meat in gravy, with a required content of 60% meat. The Ministry replied that the difficulty experienced by the manufacturer of this particular product was recognised by the Food Standards Committee with regard to canned meat products in general. "Any standard must be arbitrary in the sense that there will be little difference between a product just above the standard and one just below it, but, provided that the standards are fixed reasonably, the adjustments the trade will have to make need not be onerous". Subsequently it was learned that the manufacturers are now conforming to the requirements of the Regulations. A sample of blackcurrant flakes was found to contain 4.5 parts per million of lead. The Lead in Food Regulations require foods other than those specified in the Regulations to contain not more than 2 parts per million of lead. The importer stated that the flakes were to be reconstituted with water and used in a blackcurrant and apple filling for blackcurrant and apple -50- pies, so that the lead content of the finished product would be less than the required minimum. The consignment was, therefore, released for this purpose. The Lead in Food Regulations allow dried vegetables to have a maximum of 5 parts per million of lead, and the attention of the Ministry of Agriculture was drawn to the inconsistency in respect of the lower permitted standard for dried fruit. The Ministry stated that the matter would be borne in mind for the next review of the Regulations. Meat and meat products have generally been found to comply with the requirements of the Imported Food Regulations as regards the attachment of official Certificates to the packages, but where there has been failure in this respect appropriate action has been taken. Samples of imported dried and liquid egg, and frozen prawns and shrimps, periodically submitted for bacteriological examination during the year, were all found to be satisfactory. Liquid Egg Pasteurisation There are two plants in the borough where liquid egg is pasteurised. Neither worked to capacity during the year, owing to a shortage of eggs, and the smaller firm was compelled to cease pasteurising, sometimes for a week at a time.' The satisfactory standard of hygiene of former years was maintained. 17 samples of egg taken proved satisfactory when subjected to the alpha-amylase test. Milk Supply-Samples 8 samples submitted to bacteriological examination were satisfactory. 16 samples submitted tochemical analysis (including 7 samples taken from hospitals, schools and day nurseries in the borough) were satisfactory. The average fat and sol ids-not-fat content of the ordinary milk samples analysed was 3.9% and 8.6% respectively, and of the superfatted variety 4.7% and 8.8%. No samples were taken for the purpose of examination for the presence of brucella abortus. Unsound Food The following quantities of unsound foodstuffs were disposed of under the Public Health (Imported Food) Regulations and the Public Health Acts: Wharves 67 tons London Fruit Exchange and Spitalfields Market 106 tons Other Premises 167 tons TOTAL 340 tons - 51 - About 11 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 was mixed with household refuse, under supervision, and removed by barge to a controlled tipping site in Essex. Condemnation certificates numbering 979 were issued in respect of unsound food in 1969. 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 39. The complaints referred to All leged unsound condition Apple pie 1, cheese 1, custard tart 3, cornish pastie 1, bread 2, pickles 1, ice cream 1, milk 1, pork 1, pork luncheon meat 1, sausages 1. sausage rolls 14, steak 1, sardines 1. Alleged dirty condition and, or foreign body or deposit Chocolate cream 1, bacon 1, milk 1, milk loaf 1, rolls 3, liver sausage 1, spaghetti 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 multiple occupation of dwellings. Slum Clearance During the year 6 Clearance Areas were represented involving 268 houses. There were 11 Public Inquiries and 8 Orders were confirmed. Underground rooms The policy of closing basement rooms after rehousing of tenants continued throughout the year nineteen such rooms being closed. A number of applications to use basements for storage were approved during the year. Applications for Rehousing At the end of the year, there were 6,945 applications for rehousing on the Council's waiting list, 671 less than last year. Tenants of Council dwellings who have applied for transfer to larger or smaller accommodation number 830, a decrease of 392 from last year. - 52 - Coniston House Preferential Housing on Health Grounds Applications for preferential housing on health grounds investigated during the year numbered 496. An 'urgent' assessment was granted in 79 cases and balancing points were awarded in a further 109. Tenant transfer was supported in the case of 116 tenants of Council dwellings. Houses in Multiple Occupation At the end of the year some 1,100 houses were under surveillance, 253 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 142 premises were found to be deficient in the means of escape in the case of fire and it was necessary to serve 134 notices to remedy the deficiencies. Management Orders were made in respect of 35 premises. Of representations received from owners of three premises, for the revocation of Management Orders one was not accepted as it was considered that the house was likely to fall into disrepair, the remaining two orders were revoked. Necessary works to remedy conditions caused by neglect of management were completed in 63 houses, 68 summonses were served for contraventions of the Management Regulations, fines amounting to £330 being imposed. Notices, in respect of overcrowding, under the provisions of Section 90 of the Housing Act, 1957, were served in 30 instances. Visits in the late evening and early morning are necessaryto check that the notices are being complied with. Seven summonses were issued in respect of contraventions, resulting in fines amounting to £62. 28 directions to prevent or reduce overcrowding were served under Section 19 of the Housing Act, 1961. Summonses were issued in 5 instances for contravention of the directions, resulting in fines amounting to £60. Standard Grants and Improvements In conjunction with officers of the Borough Engineer and Surveyor's Department, the Housing Inspector inspected 16 premises regarding which applications had been made to the Council for standard or improvement grants. New Housing During the year 1,978 new permanent dwellings were completed in the borough: 906 by the Borough Council, 1,024 by the Greater London Council and 48 by other persons. Details are given on page 108 , some new dwellings completed this year being illustrated opposite this page. At the end of the year units of accommodation owned by the Borough Council numbered 14,839 comprising 12,631 erected by the Council, 122 prefabricated bungalows and 2,086 properties acquired. Dwellings in the. borough owned by the Greater London Council totalled 24,926,at the end of the year. Local Authority owned dwellings now comprise 63% of the total dwellings in the Borough. - 53 - FACTORIES Provision is made in Section 153 of the Factories Act 1961 for the Medical Of f icer of Heal th to include in his annual report prescribed particulars with respect to matters under the Act administered by the Council. These details are given on pages 109 and 110. Certificates of suitability under Section 70 of the Act continue in force in respect of 3 basement bakehouses in the Borough. HAIRDRESSERS AND BARBERS Premises registered with the Council in accordance with Section 21 of the Greater London Council (General Powers) Act, 1967 numbered 193 at the end of the year. LEGAL PROCEEDINGS A summary of legal proceedings instituted during the year under various Acts and regulations following ascertainment of contraventions by the public health inspectors and technical assistants will be found on page 111. 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 112. DISINFECTION AND DISIHFESTATION 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 prem ises infestedby insects, etc. including ants, bed bugs, 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 and the Mile End Hospital (London Hospital Group) any necessary work of disinfestation at hospitals and other premises in the borough coming under their direction. (Statistics on pagelis) - 54 - 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 7. LODGING HOUSES - COMMON The common lodging house operated by the Church Army at 10/22 Johnson Street, E.l. closed on 20th October 1969. The premises known as the "Wilson Carlisle Hostel for Homeless Men" was opened by the Earl of Athlone on 21st November 1935. There are now three licensed common lodging houses in the borough, providing accommodation for 769 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 The premises are inspected regularly including visits made at night (8 this year) to ensure compliance with the byelaws relating thereto. 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. Prior to the formation of the borough, Bethnal Green Council had an arrangement with Hackney Council for the use of the latter's mortuary, which arrangement continues in respect of mortuary accommodation for that part of the borough, the cost being shared on a population basis. A total of 616 bodies was received during the year (501 in the Council's mortuary and 115 in Hackney mortuary) including the bodies of 143 persons who were resident in other areas. Other statistics will be found on page 104. - 55 - OFFENSIVE BUSINESSES Two additional offensive businesses were established during the year, namely a fur skin dresser at 419 Old Ford Road and a slaughterer of poultry at 17 Bell Lane. There are 2? offensive businesses in the borough. The register comprises the following premises:- Dresser of Furskins (3 ) 34/38 Brodlove Lane 74 Florida Street *419 Old Ford Road Poultry Slaughterhouses (19) *17 Bell Lane *7 Leyden Street *19 Bell Lane *10b Leyden Street 107 Bethnal Green Road 13 Leyden Street 28 Burslem Street 15 Leyden Street 161 Cannon Street Road *7 Lower Hessel Street *163 Cannon Street Road *21/22 Lower Hessel Street 16/18 Cobb Street *4 Monthope Street * 14 Hessel Street *6 Monthope Street 36 Hessel Street 10a Monthope Street 75 Hessel Street (*Establishment orders on these premises are subject to renewal from time to time). OFFICES AND SHOPS Registration and inspection Premises registered during the year under the Offices, Shops and Railway Premises Act 1963 numbered 263, the total registrations effected to date being 3,133 in which over 27,000 persons are employed. An extension was granted during the year of exemption of apremises from the requirements of Section 9 relating to sanitary conveniences, the premises having an expected life of one year. Surveillance of these premises is executed by a public health inspector and a technical assistant, who made general inspections of 1,231 premises, and carried out over 2,300 other visits; Statistics on page 113. MISCELLANEOUS REPORTS BY DISTRICT AND SPECIALIST PUBLIC HEALTH INSPECTORS Some 594 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, 8 reports in respect of betting offices were submitted to the Chief Officer, Public Control. - 56 - 114 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 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 597, compared with 659 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. Contraventions of Section 2 were discovered in two cases, which resulted in legal proceedings being instituted and fines of £12 being imposed (See also page 47 Diseases of Animals). The Council adopted a recommendation of the Public Control Committee not to prescribe in any new street trading licence the sale of cats or dogs under the age of 6 months. The Council also supported a Bill before Parliament to amend the Act so as to make it an offence to sell animals at a stall or barrow in a market. 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 alist kept by the Council, and must make application annually for re-entry and pay aprescribed fee. Compliance must be made with the requirements relating to storage, transport, 1abel1ing and containers. There are 68 names on the list, 21 being removed from and 3 added to the list during the year. POULTRY PROCESSING AND PACKING There are 19 poultry processing premises in the Borough at which approximately 2½ million chickens (1,800,000 by Jewish ritual and 700,000 Muslim) and a small seasonal number of turkeys, geese and ducks, were slaughtered during the year. 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. - 57 - In December a complaint was received that ''Teddy bears'' purchased from a market stall emitted a strong unpleasant odour which might be harmful to children. Three ''Teddy bears'' were purchased and sent to the Public Analyst, the distributor was traced and agreed not to continue trading until a report from the Public Analyst was available. The ''Teddy bears'' were filled with polyurethane foam which smelled strongly of an amine type odour. This eventual ly disappeared on exposure to warm air and was not considered to beahealth hazard, although the Public Analyst was of the opinion that the ''Teddy bears" were unsuitable for immediate use as toys. One sample of feathers failed the requirements of the Rag Flock and Other Filling Materials Regulations 1961, in that the extracted matter exceeded 2 per cent. The Prescribed Analyst observed that this may have been due to the presence of wet plucked broiler feathers from young birds, which owing to their immaturity tend to partially dissolve in the test solution and give an artificially high result. These circumstances appear to warrant an investigation. Premises registered for the use of filling materials number 31, there being no licensed premises. Seventeen samples of filling materials were obtained from registered premises during the year and all were reported as satisfactory. REFRESHMENT HOUSES In connection with the provisions of Section 89 of the Public Health Act, 1936 and Section 80 of the Public Health Act, 1961 relating to sanitary conveniences in refreshment houses, 23 notices were served during the year requiring the provision of sanitary accommodation to comply with the Council's standards. REFUSE DISPOSAL A stoppage of work occurred in the Autumn involving initially refuse collectors, but which subsequently spread to other departments. No personnel of the Health Department stopped work, but due to inability to obtain vehicles certain services were affected. During the stoppage the Department's disinfecting staff were engaged on spraying with insecticide/disinfectant rubbish dumps in street markets, on housing estates and refuse chutes. The Cleansing Officer of the Council has kindly supplied some statistics relating to refuse disposal for the year, given on page 117. RENT ACT, 1968 One application under the Rent Act 1968 was received from a tenant for a certificate of disrepair, which was 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 5,164 dwellings and other premises requiring inspection 4,515 were found to be infested with mice or rats. Treatments were carried out by the department's rodent control staff in 4,712 properties the charges for servicing - 58 - business premises amounting to £4,267. Business premises under regular servicing contract with the Council numbered 247 at the end of the year. Statistics are given on page 114. SEWERAGE The arrangement in the area for sewerage and sewage disposal are satisfactory. The planned programme of reconstruction of defective sewers is proceeding. ARTIFICIAL LIGHTING OF COMMON STAIRCASES - BYELAWS Bye laws made under the London County Council (General Powers) Act 1956 by the former Boroughs of Bethnal Green, Poplar and Stepney for adequate artificial lighting of common staircases in tenement houses and flats differed from each other in some minor respects, but the major difference related to the hours during which the staircases should be artificially lit. The Bethnal Green and Poplar Bye laws required staircase lighting from half an hour before sunset until midnight and for one hour before sunrise during months October to March inclusive, whereas the Stepney Council bye laws required staircases in its area to be lit from half an hour before sunset until sunrise throughout the year. New bye laws drafted for the borough as a whole on the lines of the Stepney bye laws were submitted to the Ministry of Housing and Local Government which gave preliminary approval at the end of the year SWIMMING BATHS The water in the seven public swimming baths in the borough and in the bath at the Council's Horn church 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 107 samples were taken during the year. Two samples were found to be in an unsatisfactory condition, due to too high free chlorine content. In addition 51 samples were taken from nine school swimming baths in the borough, 6 samples being unsatisfactory. VACANT SITES Efforts to get sites cleared of rubbish and fenced continue to show good results. Of the 279 sites which came to notice during the year 211 were cleared of rubbish and fenced. - 59 - Ownership of the sites dealt with was as follows:- Sites requiring Sites dealt action with Greater London Council 200 156 Borough Council 31 20 Private Ownership 48 35 In 8 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 supplied by the Metropolitan Water Board. The supply to the area is derived from the Rivers Thames and Lea, and is not plumbo-solvent. Daily 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 1969. No artificial fluoride was added and where fluoride is indicated in the analyses it represents the naturally occurring fluoride in the water. 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 stand pipe. There are 18 deep wells in the borough in use. The Metropolitan Water Board was notified on 29 occasions where wastage of water was taking place. Notifications were received from the Board on 24 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 Counci1 (General Powers) 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 authorised by the Council to exercise its powers under this enactment in appropriate cases. - 60 - WORKS IN DEFAULT Works were carried out by the Council on 73 occasions during the year in default of persons on whom notices were served requiring the execution of works. They comprised 61 instances of failure to comply with notices served under Section 17, Public Health Act, 1961 regarding choked drains, 3 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 9 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 51 to 53 of the Appendix give additional statistical information of the environmental health services. - 61 - - 62 - PART VI MISCELLANEOUS SERVICES, ETC. VI MISCELLANEOUS SERVICES, ETC. ACCIDENTS 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 prevent ion of home accidents has continued throughout the year, with particular reference both to those groups at greatest risk and to the most prevalent causes Inquests were held during the year on 21 fatalities in the borough arising from accidents which occurred in the home. Five adults died from accidental poisoning and many children were admitted to hospital or treated as out patients after swallowing medicines in tablet or capsule form. Special publicity was arranged during the year on the necessity for preventing medicines and other dangerous materials from being accessible to children and for unwanted medicines to be disposed of. 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 4,681 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 118-126. DECEASED PERSONS Inquests Inquests were held on 134 residents of the borough during the year, the verdicts being 28 deaths due to road accidents, 41 other accidents, 30 suicide, 6 misadventure, 7 manslaughter, 2 alcoholism. 13 open verdicts, 1 unascertain able and 2 natural causes. There were three verdicts of murder and a decision in one case was adjourned. - 63 - Transport of bodies abroad From time to time certificates are issued regarding bodies being transported abroad to the effect that the deceased had not died from an infectious disease and that the coffin was hermetically sealed. Three such certificates were issued this year, relating to bodies flown to Israel and to South Africa. HOSPITAL FACILITIES The undermentioned hospitals are situated within the borough: No. of Beds. Bethnal Green Hospital, Cambridge Heath Road .E-2. 308 The London Hospital, White chapel Road, E.l. 719 London Chest Hospital, Victoria Park, E.2. 142 London Jewish Hospital, Stepney Green, E.l. 128 Mild may Mission Hospital, Austin Street, E.2. 70 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 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 Society Security) at County Hall, S.E.I. Investigations carried out by the Group Laboratory on specimens submitted by the health department totalled 521, comprising 516 faeces, 2 throat swabs, 2 nasal swabs, 1 urine . Bacteriological investigation on 219 food samples was carried out during the year. LEGISLATION The following acts, orders, and regulations affecting the department were made during the year Acts of Parliament Date made Date Operative Greater London Council (General Powers) Act 1969 25.7.69 Various Housing Act 1969 25.7.69 25.8.69 Local Government (Social Needs) Act 1969 30.1.69 30.1.69 Nurses Act 1969 25.7.69 25.8.69 Public Health (Recurring Nuisances) Act 1969 25.6.69 25.7.69 Rent (Control of Increases) Act 1969 11.12.69 1.1.70 Slaughter of Poultry Act 1969 29.7.69 1.1.70 - 64 - Date Orders and Regulations Date made Operative Artificial Sweeteners in Food Regulations 1969 17.12.69 1.1.70 Asbestos Regulations 1969 13.5.69 14.5.70 Clean Air (Arrestment Plant) (Exemption) Regulations 1969 4.9.69 1.10.69 Clean Air (Emission of Dark Smoke) (Exemption) Regulations 1969 4.9.69 1.10.69 Clean Air Act 1968 (Commencement No, 2) Order 1969 22.7.69 1.10.69 Clean Air (Height of Chimneys) (Exemption) Regulations 1969 20.3.69 1.4.69 Clean Air (Height of Chimneys) (Prescribed Form) Regulations 1969 20.3.69 1.4.69 Health Services and Public Health Act 1968 (Commencement No- 3) Order 1969 11.2.69 1.4.69 Health Services and Public Health Act 1968 (Commencement No 4.) Order 1969 5.3.69 31.3.69 Housing (Qualification Certificates and Rights of Entry Proceedings) Rules 1969 4.12.69 22.12.69 Humane Slaughter, Slaughter of Poultry Act (Commencement) Order 1969 29.7.69 1.1.70 Meat (Sterilization) Regulations 1969 24.6.69 1.11.69 National Assistance (Charges for Accommodation) Regulations 1969 5.9.69 3.11.69 National Health Service (East End Maternity Hospital) Order 1969 28.1.69 5.2.69 Offices, Shops and Railway Premises Act 1963 (Exemption No.8) Order 1969 17.9.69 1.10.69 Provision of Milk and Meals (Amendment) Regulations 1969 31.7.69 3.11.69 Public Health (Infectious Diseases) (Amendment) Regulations 1969 23.6.69 7.7.69 Soft Drinks (Amendment) Regulations 1969 17.12.69 1.1.70 Smoke Control Areas (Authorised Fuels) Regulations 1969 16.12.69 31.12.69 Standards of School Premises (Middle Schools and Minor Amendments) 21.3.69 1.4.69 REGULATIONS 1969 CIRCULARS Circulars on other matters relevant to the functions of the department and issued by the various Ministries during the year included those relating to the following subjects:- Attachment of Local Authority Nursing Staff to General Practice; Canned Meat Products (Amendment) Regulations 1968 and The Sausage and Other Meat Product (Amendment)Regulations 1968; Census of Residential Accommodation; Fluoridation of Water Supplies; Food Hygiene, Codes of Practice - Hygiene in the Meat Trade; Industrial Noise; Milk and Dairies (General)Regulations 1959 (Approved Chemical Agents); National Emergencies; Rehabilitation of Drug Addicts; Safety of Medicines in Homes for the Elderly; Screening for Phenylketonuria by the Guthrie Test;The Building Regulations 1965; Urban Programme - Second Phase. - 65 - 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 1,296( details on page 105) 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 11 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 121 to 126. STAFF CHANGES - 66 - Appointments and resignations of members of the staff numbered 163 and 139 respectively, as follows:- Appointments Resignations Administrative and Clerical 17 20 Dental Staff 26 19 Home Help Organisers 2 3 Medical Officers 1 3 Mental Health Staff 10 11 Nursing Staff: Health Visiting 20 18 Clinic and School 15 17 Day Nursery 19 21 District Nurses 41 13 Public Health Inspectors 7 8 Miscellaneous 5 6 Total: 163 139 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. Students accepted during the year numbered 358 , comprising:- 27 Medical Students London and Middlesex Hospitals. 279 Student Nurses London, Queen Elizabeth, Bethnal Green, Mile End, St.Andrew's and London Jewish Hospitals. 1 Child Care Officer Student North West Polytechnic. 3 Social Worker Students Barking College of Technology. 8 Degree Course Students London Hospital. 3 Diploma Course Students Chiswick Polytechnic. 4 Student Health Visitors Royal College of Nursing. 8 Medical Officers National Association for Mental Health, Ministry of Overseas Development and School of Medicine, Universidea de los Andes, Venezue1a. 2 Public Health Inspectors Ministry of Overseas Development, W.H.O. Fellowship. 18 Pupil Public Health Inspectors Boroughs of Lewisham and Eastbourne, Dartford Rural District Council and Hertfordshire College of Building. 5 Nursery Students I.L.E.A., Rachel Keeling Nursery School and Volunteers. - 67 - - 68 - 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 The Inner London Education Authority is responsible for the School Health Service, but by virtue of an agreement required by Section 32 of the London Government Act 1963, there is joint use by the Authority and the Council of professional staff, premises and equipment. The Medical Officer of Health is the Principal School Medical Officer of the Inner London Education Authority for the area of the borough and is responsible to that Authority for the day to day running of the Service. The work of the school health service during the year proceeded uneventfully. The Bethnal Green Audiology Centre re-opened after extensive alterations and repairs to produce adequate sound proofing. With a decline, over a period of years, in the recruitment of full-time medical officers opportunity has been taken to enlist the help of more local practitioners who, after a short period of inservice training, have proved adequate replacements. As always, ready support has been given by the Medical Adviser and his central staff. Similarly, our Local Divisional Education Officer and his staff continued their close liaison enabling us all to maintain an effective service. My personal thanks are given to my Deputy, Dr. C. Gourlay, who has been responsible for the day to day running of the school health section. SCHOOLS AND SCHOOL ROLLS Pupils on school rolls numbered 32,337 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 Pupi1s Primary 68 18,858 Secondary 21 12,095 Nursery 5 532 Special 7 852 MEDICAL INSPECTION OF SCHOOLCHILDREN Routine medical examinations These are carried out by medical officers of the department assisted by school nurses. Where further examinations are found to be required children are referred to special clinics e.g., vision, hearing, dental, ear nose and throat, special investigation clinic etc. - 69 - 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. CLEANSING OF VERMINOUS SCHOOLCHILDREN This year the number of treatments for 'vermin and nits' decreased from 844 to 707. 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 increased from 175 last year to 201 in 1969. A combined 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 Every possible care is given to ensure that any child with a handicap which might affect his or her educational attainment is kept under careful review and consideration,whether he or she is in an ordinary school or special school, and a register of all handicapped children is maintained to ensure no child is lost sight of when he/she moves from school to school or borough to borough. Tower Hamlets children placed in special schools are as follows:- Handicap No.at Day Schools No. at Boarding Schools Blind - 6 Partially sighted 24 2 Deaf 7 7 Partially hearing 50 1 Educationally subnormal 454 133 Epileptic - 2 Maladjusted 78 113 Physically Handicapped 99 16 Delicate 121 39 Multiple Handicaps - 3 TOTALS 833 322 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 investigation special visits are made and any necessary investigations carried out, including the taking of speciments for bacteriological examination, to ascertain the sources of, and contain, the outbreak - 70 - Notifications were received of 943 children so absent, measles being the reason for the largest number viz. 245. 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 are 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, attendances this year totalled 16,872 compared with 20, 967 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 82.2 *64.6 80.9 47.8 *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. 1,581 children being vaccinated. PART TIME EMPLOYMENT OF SCHOOLCHILDREN It is a requirement of the Children and Young Persons Act 1933/Education Aot 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. All children examined for this purpose during the year were found fit for the employment proposed. DEAF AND PARTIALLY-HEARING CHILDREN Children under 5 suspected of hearing loss are tested by health visitors at health centres. School children are normally tested during their first year at school. 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 schools for the deaf or partially-hearing, or remain under observation where the loss is slight, There are no special schools for this defect in the borough, children having to go to school either in Hackney, Islington Camden or Wandsworth - 71 - Eleven new cases were added to the deaf register during the year, the register now totalling 170. 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 132. There are three schools in the borough for the educationof these children who are medically examined each year, HEALTH EDUCATION IN SCHOOLS At the beginning of the year the syllabus was such that school activities by the health education staff were largely concentrated on one school A rearrangement at the start of the new school year resulted in health education being more evenly spread throughout the schools. In these schools health education has shown a leaning towards the use of informal mixed discussion groups rather than lectures to segregated classes and has been accepted to such an extent that many schools have included it as part of a complete social education programme, The employment of Visual Aids' Officers in some of the schools has proved of great help Greater liaison with schools has led to the health education staff working more and more with the teachers as colleagues and advisers rather than simply filling a gap in the school curriculum. Subjects dealt with during the year included: Mother craft, Sex Education and Venereal Disease at 1,171 sessions and attended by 21,573 pupils. SCHOOL DENTAL SERVICE The Principal School Dental Officer, Mr-D.F. Waller reports as follows:- "1969 has been a year of consolidation of the dental services for the 33,000 school children in the Borough. The benefits that have accrued from the developments of the previous three years during which re-staffing, re-building re-equipping and re-decoration had taken place, have been appreciated more and more during the year by the children, their parents and teachers. The demand for treatment at all our clinics has increased considerably and one of the main problems which the staff have had to face this year has been the control of lengthy waiting lists for treatment. The effect of the new image which we have achieved has created a problem which can only be met by a considerable expansion of staff and surgeries within the service or a closer liaison with local general dental practitioners working within the National Health Service who would be willing to see greater numbers of school children for treatment. - 72 - The annual reports for the past three years have reviewed many aspects of the dental service which will not be repeated here. The main features of the service described therein still apply and it is again hoped that the following remarks under similar headings will be read in conjunction with those reports. Prevention The prevention of dental disease is a feasible possibility where time, knowledge and enthusiasm exist together in individual cases but it still remains a rather insuperable problem when considered on a community basis. The only really safe and effective measure for controlling dental caries is fluoridation of our water supplies, but this has still not been made available to the Borough's children in spite of the Council's recorded support. The overwhelming majority of local authorities within the Metropolitan Water Board area favour fluoridation and the following paragraph appeared in the 1966 report ''In view of the Council's wish to improve the dental health of our children by the fluoridation of water, it is hoped that strong pressure will be applied in the near future in concert with other London Boroughs to reduce the present position of stalemate and achieve the introduction of this simple, safe and effective public health measure.'' This still applies. Whilst complete agreement may never be reached between the thirty five Local Authorities supplied by the Board, it is hoped that the will of the majority will be met and that every Authority that favours fluoridation will press for early legislation which would make fluoridation mandatory. In schools and in our surgeries children are taught the following four rules for dental health and this oft repeated message makes the problem of dental disease apparent and better understood: 1. Sugar rots your teeth so cut down on sweets and lollies and all sugary things. 2. Brush your teeth after breakfast and last thing at night with fluoride toothpaste and no more eating after the bedtime clean-up. 3. Swish and swallow or eat an apple after each meal if you cannot clean your teeth. 4. Check up with your dentist at least twice a year and he will give you your Dental Heal th Stamps. It must be acknowledged that it is still the fourth rule involving regular attendance at the dentist which is the most effective preventive measure of all. The benefit of individual personal instruction, the early detection and elimination of dental disease and the application of measures to strengthen the teeth and to reduce the danger can only be achieved by those children who go to the dentist. It is the main aim of our service to get all our children to their own dentists regularly and to develop the understanding that this is a normal routine requirement demanded by our 20th century dietary habits. The co-operation of parents and teachers has increased enormously and the element of fear is overcome more and more by the Children's fuller understanding of all that is involved and the mechanics of treatment. -73- Inspection It is the aim of the dental service to examine all primary school children every other term and to examine all secondary school children once a year. In 1969 we have come closer to achieving our target. The method of examination is such that we are able, in spite of the vast numbers of children involved, to record an accurate assessment of the dental caries state of each child at each inspection,, As children are seen at each succeeding inspection the record develops and it is possible to follow, and where necessary to influence, the changing disease pattern, Because of this system we can show the children, their parents and teachers the need for treatment in some detail and we are now much more effective in our stimulation of them to take action where it is indicated Further development of this system is continuing and it is hoped eventually to be able to follow the evolving patterns of gum disease and malocclusion in a similar way. The,need for passing the results of these inspections not only to our own staff but also to the many local general dental practitioners who treat the majority of the children is self apparent. We know in most cases the name of the dentist which each dentally conscious child attends Where the dentist is a member of our own staff it automatically follows that appointments are sent where the need for treatment has been found. In similar circumstances when a child regularly attends a local general dental practitioner or the London Hospital it is logical that the practitioner involved should be informed about his patient's dental needs and given the opportunity of offering an appointment should the situation demand it. The tripartite nature of the health service, professional independence and the size of the administrative task have precluded full development of this concept but some progress has been made in individual cases. The recently published Green Paper on the Future Structure of the National Health Service gives hope of unification of the dental services within the Health Service. It is hoped that much greater co-operation can be achieved locally during the next few years before the principle of unification is implemented by legislation. The dental health of the children has improved considerably during the past four years but there is as yet no cause for complacency. The percentage of children found to require treatment at school dental inspections during the year was 62.2%The figures for previous years were: 1966-81.7%, 1967-70.6% and 1968-68%. Treatment The treatment provided in our surgeries is still of an overwhelmingly conservative nature. The quantity of restorations inserted has increased by 35% since 1968. The number of fillings completed totalled 20,408 (10,995 in permanent and 9,413 in deciduous teeth) whilst extractions were only 341 permanent and 984 deciduous teeth The ratios of permanent teeth fi1led to extracted being27.2: 1 and deciduous teeth filled to deciduous teeth extracted 8.5: 1. - 74 - The number of broken appointments at our clinics has again been reduced this year to 32.5% (1968-39.6%) but this figure is still of grave concern to all the staff During the year a system of informing schools of the appointments of children booked to attend the following week at each clinic was tried in some are as The response achieved justifies the expansion of the scheme but a further burden of paperwork on our already overworked dental surgery assistants is the inevitable concomitant The volume of demand for treatment is such that parents have to be advised to obtain treatment from local general dental practitioners when waiting lists reach irrational proportions The problem is particularly great in the Stepney and Wapping are as served by the single surgery clinic at Prunel1a Treatment Centre and in the Bow and Bromley areas served by single surgery clinics at Wellington Way and Bromley Treatment Cnetres. The demand at Wapping and Stepney will be met when new premises already planned become factual entities but problems at the other clinics can only be met by converting existing rooms into extra surgeries. As discussed in previous reports the alternative of mobile equipment or mobile surgeries in caravans taken to schools during term time would be even more acceptable as they would enable dentistry to be taken to the patient thereby reaching those dentally deprived children who will never be taken to any dentist by their parents for routine treatment Dental Health Education and Dental Health Stamps The routine dental health activities have continued with increased impetus during the year and follow the guide lines described in the 1968 report. In September Dental Health Stamps returned in a revised form to all our primary schools. They were originally introduced in May, 1966 to the 86 primary schools in the borough The stamps are given to the children by their own dentist when they attend for examination and treatment- They are intended to add interest and incentive to the children's dental activities whilst at the same time helping to co-ordinate the efforts of all the dental personnel in the area whose mutual co-operation is enhanced by a unifying enterprise. The modern idiom of consumer stimulation through consumer stamp collecting and potential of personal reward has been used and the children have been spurred to greater efforts by inter-class and inter-school competition. In the age groups served by these schools it is apparent that for children to be able to display tangible evidence of dental treatment and dental fitness is often more important to them than the largely unseen and unappreciated improvements in the state of their teeth. The objectives of the scheme are: 1. Motivation of children to attend their own dental practitioners for regular examination and treatment - this to be integrated with routine dental health education and the normal school dental inspection procedure. - 75 - 2. Provision of an exercise in which all the dental profession in the area would be involved; i.e the general dental practitioner, the school dental officer and the hospital dental surgeon together with those dental students who provide clinical treatment for children. 3. Provision of a method whereby a simple statistical analysis of treatment received and the category of dentists from which it was received can beobtained. The method is: 1. Stamp collection - two systems of stamp collection have been tried: a) Old system- the children are issued with individual collecting cards which they kept themselves and took to their dentist and upon which the stamps were fixed, b) New system- every class in the primary schools has a wall collecting chart upon which there are lines for each child to stick the stamps which are collected from the dentist and brought to the school. 2. Stamp distribution- all local general dental practitioners, at their practices, school dental officers at local clinics and the staff and students at the local London Hospital Medical College Dental School, are issued with books of each of the four coloured stamps for distribution to Tower Hamlets children, but to be issued only in relation to the treatment received. 3. Stamps- are issued in four colours: a RED Stamp for an examination a SILVER stamp for a filling a BLACK stamp for an extraction and a GOLD stamp as a bonus when all treatment is completed and the child is dentally fit; i.e. to stay the course means an extra stamp. ONE RED AND THREE GOLD STAMPS are given to children when they are found to be dentally fit and not requiring any treatment at their routine check up. 4. Badges - are given as a 'dental health award' a) Old system - when twelve stamps have been achieved. b) New system - when ten stamps have been achieved. 5. Class awards and the Golden Toothbrush Trophy - during 1970 the best dental stamp class in each school will be given an award at the end of the school year and the best dental health stamp school will achieve the Golden Toothbrush Trophy, - 76 - 6. Stamps are identifiable to the extent that they distinguish between the general dental practitioner, the school dental service and the London Hospital by individual markings on the stamps but specific practitioners, clinics, etc. cannot be traced. 7. At the commencement of the scheme a handout describing the system and its objectives in simple terms was issued to the children, parents and teachers, so that everyone would know what was involved and thus potential help and co-operation was initiated. Routine: After the initial circulation of stamp books and rules to those providing dental treatment, charts to schools and handouts to parents and children, it is essential that the scheme be kept well publicized and 'on the boil'. Teachers, dentists, parents etc. - let alone children - all lose enthusiasm after a while and need reminding at regular intervals. The dental health stamp scheme is apart only of the picture of dental health education and routine dental inspections in the schools. Integrated with a full programme of dental stimulation and treatment it can provide the in format ion and motivation which is necessary to obtain positive results - 'dental health in action'. The wall charts have to be opened daily by class teachers to receive stamps .Each individual class is visited regularly by a dental auxiliary who issues badges to * ten stampers' and uses the closed wall chart as a basis for general teaching. When opened out with stamps showing it is used to check the dental progressof individual children. The dental auxilnary also uses the chart after the routine school dental inspection to relate treatment needs as shown at examination to the known treatment pattern as shown by each child's stamp collection. The spirit of inter-class competition can be stimulated by the headteacher at school assembly and 'stamp ladders' etc, can be devised to show the related progress of each class. Routine servicing of local practitioners etc. with new stamp books when necessary, is reasonably simple, whilst dental health education material is offered for their individual use. Results Being part only of an integrated system of dental health stimulation in the area it is impossible to assess the effect of the dental health stamps on their own. Suffice to say that those involved with the scheme are satisfied that it has already had a considerable' effect on the children involved in getting increasing numbers of them regularly to seek inspection and treatment. The original individual collecting cards were withdrawn because so may of them got lost, stolen or strayed, but the new wall charts will, it is hoped, be equally if not more effective. - 77 - During the summer a carnival float was entered in the Borough Carnival depicting the return of dental health stamps, (see photograph) In November Pierre the Clown came back to Tower Hamlets for two weeks and provided excellent support for the stamps by emphasising them during his entertaining dental health talks. Staff At December 31, 1969, the professional full time dental staff consisted of one Principal School Dental Officer, one Senior Dental Officer, two full timedenta) officers, a part time orthodontist and fourteen part time dental officers together providing a whole time equivalent of 9.5 (compared with 8.9 in December 1968). These dental officers were assisted by three full time dental auxiliaries who devote half their time to clinical dentistry and half to dental health education. The Principal School Dental Officers joint appointment with the London Hospital Medical College Dental School involves him as part of his academic duties in teaching community dentistry to clinical dental students. These students visit the borough on several occasions during their training and one of the results of this liaison has been a greatly increased demand from new graduates for positions on the dental staff. Consequently the average age and the enthusiasm of the dental staff has improved greatly during the year. The professional staff are ably assisted by thirteen full time dental surgery assistants without whom the volume of clerical as well as clinical work would never be achieved. The one whole time clerk who carries the burden of the routine every day administration with great efficiency will it is hoped receive some extra clerical assistance during the coming year. Itisnot possible to administer the dental inspection programme and its analysis and efficient follow up together with the administration of the dental health stamps and all the other normal routine work without further assistance. The problemof recruiting young dental surgery assistance because of the unreal istic scale of pay in the younger age bracket was discussed last year. Unfortunately no advance has been achieved with this problem in 1969. Premises and Equipment Further improvement in the equipment and decoration at our fclinics was carried out during the year. The impetus reported in previous years has now diminished with the accomplishment of so much of our programme. The future must be served by the acquisition of new or converted premises for additional surgeries where the need is greatest. Special Services The programme of routine dental treatment for the mental ly and physical ly handicapped children in our special schools was continued by taking the mobile dental caravan on its routine circuit. The one large special school which had never been visited was - 78 - Dental Health Educational Exhibit in Borough Carnival visited this year after gates into the school playground had been adjusted to allow the caravan entry. The effect of these routine visits is such that our stay at each school is now much shorter as the effect of near total cfental health is achieved with over 90%of the children seen and treated at each visit. It is gratifying to note that the children in these circumstances are encouraged to have treatment in the caravan by school staff and parents alike. The orthodontic service was improved at the end of the year by the appointment of a part time orthodontist who will it is hoped become full time early in 1970, The Principal School Dental Officer and the orthodontist plan to carry out a very detailed survey of occlusion of all the children in secondary schools in the Borough, By so doing it is anticipated that the need and demand for orthodontic treatment can be accurately assessed and tte < degree of malocclusion analysed. Academic Activities During the year the Principal School Dental Officer completed the full year's academic course leading to the newly instituted Diploma in Dental Public Health of the Royal College of Surgeons of England and was successful in passing the final examination Several of the dental officers attended refresher courses during the ye sr and a number of the staff attended the British Dental Association's Annual Conference where the dental health activities of the Borough were demonstrated. Over half our dental surgery assistants attended evening classes in dental assisting during the year. The Principal School Dental Officer and staff involved in these post-graduate activities benefited greatly from the opportunity afforded them by the Borough Council and the Inner London Education Authority" STATISTICS Statistics related to the School Health Service will be found on pages 127-128 (Those supplied by the Inner London Education Authority are not yet available ) - 79 - ******************* - 80 - PART VIII APPENDIX OF STATISTICAL TABLES TABLE 1 TOTAL DEATHS BY CAUSE AND AGE OF TOWER HAMLETS RESIDENTS - 1969 (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 3 3 _ 1 1 - - - - 1 - - Tuberculosis of respiratory system 8 7 1 - - - - - - 3 2 3 - Other tuberculosis, including late effects 7 5 2 - - - - 1 1 - 1 2 2 Meningococcal infection 2 2 - - 1 1 - - - - - - - Siyphilis 3 2 1 - - - - - - - 1 - 2 Other infective and parasitic diseases 6 2 4 - 1 - 1 - - 1 3 - - Malignant neoplasm - buccal cavity etc. 10 7 3 - - - - - - 1 1 5 3 Malignant neoplasm - oesophagus 11 8 3 - - - - - - 2 4 4 1 Malignant neopl asm - stomach 5 1 32 19 - - - - - - 1 11 18 21 Malignant neopl asm - intestine 56 23 33 - - - - - 3 3 7 16 27 Malignant neopl asrn - larynx 3 3 - - - - - - 1 - 1 - 1 Malignsnt neoplasm - lung, bronchus 142 122 20 - - - - 2 4 11 50 48 27 Malignait neoplasm - breast 49 1 48 - - - - - 5 10 11 10 13 Malignait neoplasm - uterus 5 - 5 - - - - - - 1 - 3 1 Malignsnt neopl asm - prostate 13 13 - - - - - - - - 1 3 9 Leukaemia 8 4 4 - - 1 - 2 - 2 1 2 - Other malignant neoplasms, etc. 145 78 67 - 1 - 1 - 12 13 36 48 34 Benign and unspecified neoplasms 5 1 4 - - - - - 1 3 1 - - Diabetes mlitus 31 8 23 - - - - - - - 9 11 11 Avitaninoses, etc. 1 1 - 1 - - - - - - - - - Other endocrine etc., diseases 11 3 8 - - 1 - - - 2 2 2 4 Anaeias 8 2 6 - - - - - - 1 1 1 5 Other diseases of blood, etc. 1 1 - - - - - - - - - - 1 Mental disorders 8 5 3 - - - - 1 - - 2 - 5 Meningitis 2 1 1 - - 1 - - - - - - 1 Other diseases of nervous system 30 15 15 1 - - 1 1 1 4 2 4 16 Chronic rheumatic heart disease 53 25 28 - - - 1 - 2 7 15 20 8 Hypertensive disease 37 24 13 - - - - - 3 1 9 11 13 Ischaenic heart disease 474 295 179 - - - - - 8 50 83 152 181 Other forms of heart disease 95 33 62 - 1 - 1 1 - 1 5 26 60 Cerebrovascular disease 242 85 157 - - - 2 - 3 12 31 67 127 Other diseases of circulatory system 80 34 46 - - - - - 1 1 7 24 47 Influenza 9 3 6 - - - - - - - 1 4 4 Pneumoni a 157 76 81 2 - - - 2 4 7 14 35 93 Bronchitis and emphysema 214 154 60 - - - - - 2 7 44 69 92 Asthma 5 3 2 - - - - 1 1 - 2 1 - Other diseases of respiratory system 40 22 18 9 2 - - - 1 4 9 9 6 Pqptic ulcer 28 15 13 - - - - - - 3 7 11 7 Apppendicitis 3 1 2 - - - - - - 2 - 1 Intestinal obstruction and hernia 16 5 11 - - - - - - - 1 7 8 Cirrhosis of liver 9 9 - - - - - - - 3 4 2 - Other diseases of digestive system 18 8 10 - - - - 1 - 2 1 7 7 Nephritis and Nephrosis 11 5 6 - - - - 1 2 3 3 - 2 Hyp erpl asi a o f p ro st at e 6 6 - - - - - - - - - 1 5 Other diseases, genito-urinary system 14 4 10 - - - - - 1 1 1 5 6 Abortion 2 - 2 - - - 1 - 1 - - - - Diseases of skin, subcutaneous tissue 2 1 1 - - - - - 1 - - 1 - Diseases of musculo-skel etal system 11 1 10 - - - - - 1 - - 2 8 Congenital anomalies 8 2 6 3 - 1 - 1 2 1 - - - Birth injury, difficult labour etc. 16 12 4 16 - - - - - - - - - Other causes of perinatal mortality 9 3 6 9 - - - - - - - - - Symptoms and ill-defined conditions 7 3 4 - - - - - - - - 2 5 Motor vehicle accidents 31 20 11 - 1 3 5 - 3 3 2 10 4 All other accidents 48 3 2 16 2 1 - 5 7 5 6 8 2 12 Suicide and self-inflicted injuries 30 17 13 - - - 4 5 3 7 6 4 1 All other external causes 21 13 8 2 - - 5 2 3 4 - 5 - Males 1260 26 8 6 15 17 46 135 284 378 3 45 Femal es 105 5 20 1 2 12 11 29 46 119 279 536 GRAND TOTAL 2315 46 9 8 27 28 75 181 403 657 881 - 81 - TABLE 2 SUMMARY OF ROAD ACCIDENTS OCCURRING IN THE BOROUGH Pedestrians Motor Cyclists Pedal Cyclists Other Road Users Total 1969 Killed 15 1 1 2 19 Injured 635 111 93 979 1,818 1968 Killed 22 2 - 4 28 Injured 650 229 96 777 1, 752 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 - 1 - - 1 5 3 - - (6) 10 23. 3 Pneumonia - - - 1 - 1 1 - - ( 9) 3 7.0 Congenital malformations - 3 1 - - 1 1 - - (13) 6 14.0 Premature birth 5 6 - - - - - - - (16) 11 25.6 Asphyxia, Atelectasis 4 1 - - - - - - - (11) 5 11. 6 Birth injuries 1 - - - - - - - - ( 3) 1 2. 3 Other causes 1 2 1 - - 2 - 1 - (10) 7 16. 2 TOTALS: 11 13 2 1 1 9 5 1 - (68) 43 100.0 (*) Figures in parenthesis denote corresponding deaths in 1968 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 19 68 20 18 11 49 19 68 72 1969 11 13 4 28 15 43 65 - 82 - - 83 - COMPARATIVE VITAL STATISTICS Year Population Live Births Deaths Deaths under 1 year Maternal Deaths Cancer Deaths (all forms) Tuberculosis Deaths (all froms) 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 1969 188,080 2, 612 13.9 2,315 12.3 46 17.6 2 0.8 493 2.6 15 0.1 * Per 1,000 population ** Per 1,000 total births N.A. - Not available NOTE: Figures prior to 1965 relate to those of the former Metropolitan Boroughs of Bethnal Green, Poplar and Stepney TABLE 5 TABLE 6 OBSERVATION REGISTER (i) Observation Register (Children under 5 years) No. on Register on 1st January 3,207 No. added during year 1,086 4,293 No. removed during year - died 13 - moved away 410 - no longer at risk 532 - transferred to ages 5-21 Register 46 1, 001 Total on Register at 31st December 3,292 No. of above total suffering from handicaps 298 Year of birth of those on Register at 31st December 1969 857 1968 985 1967 871 1966 415 1965 164 Total: 3,292 (ii) Observation Register (5-21 years) Total on Register at 31st December 2,457 (iii) Handicaps of children and young persons on Observation Register 0-4 years 5-21 years Educationally subnormal - 841 Severely subnormal - 138 Physically handicapped 196 509 Mentally retarded 34 - Maladjusted - 263 Blind (Registered) ) - 5 Visual defects ) 6 80 Speech defects (requiring special or other school) 15 21 Epileptic 21 69 Deaf and partially hearing 9 162 Delicate (including diabetic) - 140 Multiple handicaps 17 229 Total: 298 2,457 In addition there are 321 children suffering from handicaps attending schools in the Borough, but living outside the Borough. - 84 - TABLE 7 DISEASES NOTIFIABLE IN THE BOROUGH Disease Authority for Notification Statutory Instrument No. Acute Encephalitis Health Services and Public Health Act 1968 1968/1366 (Section 56) 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 - 85 - TABLE 8 INFECTIOUS DISEASE NOTIFICATIONS Corrected Notifications Removed to Hospital Notified in 1968 Notified in 1967 Acute Encephalitis Infective - - 1 - Post - infectious - - 2 - Acute Meningitis (from 1.10.68) 17 9 2 NN Acute Poliomyelitis Paralytic - - - - Non-paralytic - - - - Anthrax - - - - Cholera - - - - Diphtheria 6 6 - - Dysentery 78 17 40 49 Food Poisoning 71 30 53 80 Infective Jaundice (from 15.6.68) 124 30 68 NN Leprosy - - - - Leptospirosis (from 1.10.68) - - - NN Mai aria - ' - 1 1 Measles 1, 201 30 616 1,690 Ophthalmia Neonatorum - - - 1 Paratyphoid Fever - - - - PI ague - - - - Relapsing Fever - - - - Scarlet Fever 79 3 83 91 Smal lpox - - Tetanus (from 1.10.68) " - - NN Tuberculosis Pulmonary 99 - 102 10 2 Non-pulmonary 14 - 19 13 Typhoid Fever - 2 - Whooping Cough 20 1 66 89 Yellow Fever (from 1.10.68) - - - NN TOTALS: 1, 709 126 1,055 2, 116 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:- 1969 1968 1967 1969 1968 1967 January 5, 254 7,401 4, 411 July 3, 436 3, 311 2,625 February 5,053 3,279 3, 797 August 2, 79 1 2, 977 2, 506 March 4, 696 4,079 2,989 Sept ember 2, 649 3.037 4, 10 5 April 3, 802 3,832 3,951 October 4, 171 4, 456 3, 584 May 2,919 3,193 2, 844 November 3, 286 3, 781 3, 550 June 2,826 2,796 3, 572 December 6, 643 4,041 5,191 TOTALS 47, & 26 46, 183 43, 125 - 86 - TABLE 10 VACCINATION AND IMMUNISATION Children vaccinated/immunised Others aged Total Year of birth 1969 1968 1967 1966 196265 Under 16 Over 16 Diphtheria 896 1,078 128 47 157 124 - 2,430 Re-inforcing Dose - 698 825 153 1,440 486 1 3,603 Tetanus 896 1,078 128 47 168 160 75 2,552 Re-inforcing Dose - 698 825 153 1,451 542 56 3, 722 Whooping Cough 892 1,064 119 40 50 4 - 2,169 Re-inforcing Dose - 686 800 121 134 25 - 1, 766 Poliomyelitis 883 1, 102 126 55 242 296 98 2,802 Re-inforcing Dose - 668 793 164 1,356 664 68 3, 713 Measles - 467 447 240 237 91 - 1,482 Under 1 1 year 2-4 5-15 16 and over Total Smallpox vaccination: Primary 18 803 319 60 62 1,262 Re- vaccination - - 15 185 607 807 Diphtheria immunisation of children under 5 Children under 5 immunised during 1965/69 11, 578 Estimated population under 5 as at 30th June, 1969 14,700 Percentage protected 78.7 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 2,174 3,219 256 384 10.5 Tetanus 2,216 3,256 336 466 13.2 Whooping Cough 1, 922 1, 531 247 219 11.4 Poliomyelitis 2,455 3, 239 347 474 12.4 Smallpox 1, 009 290 253 617 21.0 Measles 1,253 - 229 16. 9 - 87 - TABLE 11 TUBERCULOSIS - NEW CASES AND DEATHS - 1969 New Cases and Deaths: Primary notifications of 99 pulmonary and 14 non-pulmonary cases were received. 2 other cases came to light via death returns from Registrars. Pulmonary tuberculosis accounted for 8 deaths, there being 7 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 - - 1 - - 2 6 11 21 15 14 4 2 76 F - - - 1 - 2 4 5 4 1 2 1 3 23 Non-pulmonary M - - - 1 - 1 2 • 3 1 . 1 1 10 F - - - - - 2 1 - - - - - - 4 (b) Deaths Pulmonary M - - - - - - - - - 3 1 3 - 7 F - - - - - - - - - - 1 - - 1 Non-pulmonary M - - - - - - - 1 - - 1 2 1 5 F - - - - - - - - 1 - - - 1 2 TABLE 12 TUBERCULOSIS - VARIATIONS IN REGISTER Pulmonary Non-pulmonary Total Cases Males Females Males Females No. cases on register at 1st January 1,372 711 115 114 2,312 No. cases notified during 1969 76 23 10 4 113 Other cases added to register 34 13 6 3 56 No. cases removed from register 96 45 18 4 163 Remaining on register at 31st December 1,386 702 113 117 2,318 - 88 - TABLE 13 TUBERCULOSIS - CARE AND AFTER CARE Home Care and Treatment Patients awaiting admission to hospital Nil Patients under treatment in their own homes 6 Patients receiving attention by home nurses 7 Work of Tuberculosis Visitors No. of Tuberculous households visited 1,029 No. of visits to above and to contacts 8, 340 No. of unsuccessful visits 561 Work of Chest Clinic Welfare Officers Patients assisted for the first time with Beds, bedding 2 Clothing, footwear 20 Patients at end of year receiving Extra nourishment 86 Home help 41 Diversional Therapy Patients receiving instruction in their own homes Nil Rehabilitation Hostels Patients in residence at end of year 1 Hostels for homeless infective tuberculous men Patients in residence at end of year 2 Child contacts boarded out during year 4 Child contacts boarded out for segregation during B.C.G. vaccination - - 89 - TABLE 14 MASS RADIOGRAPHY Unit 6A Unit 6B Total No. of factories, sites, etc. visited 4 17 21 Persons X-rayed - Males 649 4, 503 5,152 - Females 89 1, 884 1, 973 - Total 738 6,387 7,125 No. referred for further investigation 21 57 78 Toynbee Hall - persons x-rayed 3,433 - 3,433 - referred for further investigation 119 - 119 Abnormalities discovered in 1968 Surveys; Total persons x-rayed 7,137 Not available Tuberculosis requiring immediate treatment 13 " " clinic supervision 29 Cancer of lung 13 Other 111 Active tuberculosis cases discovered per 1,000 examined 1.8 TABLE 15 TUBERCULIN TEST AND B.C.G. VACCINATION Contacts Schoolchildren and Students Total No. of skin tests 239 1, 911 2,150 No. found positive 72 61 133 No. found negative 167 1, 581 1, 748 No. vaccinated 175 1, 581 1, 756 - 90 - TABLE 16 ANTE AND POST NATAL SERVICES No. Ante and Post Natal Sessions held by: Medical Officers 27 Midwives 49 Sessional General Practitioners 61 No. women attending for ante natal examination 236 No. women attending for post natal examination 115 Total attendances 824 No. General Practitioners holding sessions in Council clinics 4 Mothercraft and Relaxation Classes: No. women attending (a) Institutionally booked 76 (b) Domiciliary booked ~ No. attendances 331 No. sessions held by Health Visitors 59 TABLE 17 CHILD WELFARE CENTRES No. premises at end of year 14 No. sessions during year held by: Medical Officers 112 Health Visitors 164 Sessional General Practitioners 1,691 Hospital medical staff 51 Total sessions: 2, 018 No. children attending - born this year 2,178 - born last year 2,451 - born 1966-7 3,124 No. attendances of children of all ages 41,387 Average attendance per session 20.5 No. children referred elsewhere 452 - 91 - 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 25 136 Child/day attendances - Under 2 years - 8,190 - Over 2 years 4,270 25,138 No. of days open 237 254 Average daily attendance 18.0 131.2 OTHER PREMISES REGISTERED UNDER NURSERIES AND CHILD MINDERS REGULATION ACT, 1948 No. of premises registered at end of year 24 Capacity 464 CHILD MINDERS Statutorily Registered No. at 1st January 6 Additions during the year 46 Deletions during the year 9 No. at end of year 43 No. of children authorised to be minded at end of year 79 TABLE 19 CERVICAL CYTOLOGY Premises Number Sessions Examinations Council Clinics 3 165 1,065 General Practitioners Surgeries 1 37 148 Family Planning Clinics 4 202 306 Other Slides read in Hospital Laboratories Thames Group Submitted by G. P's. Hospital St. Andrew's Hospital 235 913 East London Group Mile End Hospital 615 1, 835 Other Hospitals in Group - 1,123 London Hospital - 6, 761 (Residents of all areas) - 92 - TABLE 20 CHIROPODY Treated at Clinics Domiciliary Treatment New patients during year 592 110 Total patients at end of year 2,612 798 Treatments - children 153 - - expectant mothers - - - physically and mentally handicapped 58 2 - aged persons 11,721 4, 043 No. of chiropodists employed 10 No. of clinic sessions held 1,695 1,695 No. of patients treated per clinic session 7.1 7.1 Percentage of total patients receiving domiciliary treatment 23.4 23.4 Total no. of treatments 15. 977 (plus 1.147 by Welfare Department in Old People's Homes) TABLE 21 DENTAL TREATMENT FOR EXPECTANT AND NURSING MOTHERS Expectant Mothers Children Persons examined 27 442 No. requiring and offered treatment 25 374 Visits during the year 56 829 Courses of completed treatment 15 252 Teeth extracted 13 12 Teeth filled 46 667 Emergencies treated - 5 General anaesthetics given - - No. patients x-rayed 4 3 No. patients treated by scaling etc. 17 259 Dentures - full - partial 3 3 " No. of sessions for treatment 104 -do- for health education 14 No. of Treatment Centres at end of year 8 - 93 - TABLE 22 HEALTH EDUCATION ACTIVITIES Discussion groups or talks on the following subjects were arranged during the year; Subject No. Occasions Persons participating Mother craft 65 632 Cervical Cytology 15 131 Family Planning 4 83 General Health Subjects - Schools 1,171 21, 573 - Other 186 2,760 Psychoprophylaxis 86 537 Health Education Techniques 34 125 Total: 1,561 25, 841 Films or filmstrips were shown on 436 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, 2,257 posters were exhibited and 5,000 leaflets distributed. - 94 - 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 St. Georges 116 - - 116 231 46 Wigram House 172 - - 172 416 41 Domiciliary Service 18 1 21 40 168 - Family Planning Association Clinics Underwood Road 512 89 • 551 1,152 2,643 191 Wapping 40 8 63 111 354 48 Wellington Way 222 69 312 603 1,474 98 Totals; 1,080 167 947 2,194 5,286 424 1968 Statistics 982 67 756 1, 805 3,732 306 TABLE 24 HEALTH VISITING No. Visited No. of Visits Children born this year 2, 724 39,668 " " last year 2,148 " 1964-1967 5,139 Aged persons 149 302 Mentally disordered persons 56 309 Tuberculous households 13 45 Households on account of other infectious diseases 58 99 Persons, excluding maternity cases, discharged from hospital (other than Mental Hospitals) 37 64 Other cases 1,026 1, 792 Visits to expectant and nursing mothers - 2,161 Visits to problem families - 2,230 Total effective visits - 46,670 Unsuccessful visits - 8, 553 TABLE 25 PREMATURE BIRTHS 1969 Born in Hospital 1969 Born at Home or in Nursing Home 1968 1967 1968 1967 No. of Births 211 177 213 5 23 11 Died within 24 hours 8 12 16 - 2 - Died within 1/28 days 11 13 8 1 - - Premature still births 17 26 28 - 2 1 - 95 - TABLE 26 HOME BATHING Persons serviced during the year: Male 340 Female 881 Total 1,221 Persons receiving service at end of year: Male 91 Female 260 Total 351 Total baths given during year 12, 083 TABLE 27 HOME HELP SERVICE Persons for whom service provided during year: No. of persons Aged persons 3,049 Chronic sick and tuberculous persons 463 Mentally disordered 40 Maternity cases 29 Others 143 Total: 3,724 No. of persons receiving service at end of year: 2, 541 Staff Number Whole-time equivalent Organisers 3 3 Assistant Organisers 6 6 Home Helps 279 182. 7 - 96 - TABLE 28 HOME NURSING Number patients nursed during year 2,230 Number aged under 5 45 " over 65 1,417 " of visits during year 84,927 TABLE 29 LAUNDERING FOR AGED AND INCONTINENT No. of articles cleansed and laundered during year 43,018 No. of collections made during year 3, 552 No. of persons who received service during year 291 No. of persons receiving service at end of year 77 TABLE 30 RECUPERATIVE HOLIDAYS Category No. for whom holiday arranged Expectant and nursing mothers 2 Adults - Psychiatric 17 - Tuberculous 1 - Other 117 Accompanied children: 1. At school 1 2. Pre-school 9 Unaccompanied children; 1. Placed by I. L. E. A. at school 196 pre-school - 2. Placed by Tower Hamlets Council at school - pre-school - Total: 343 - 97 - 98 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 No. loaned No. returned No. on loan at 1/1/69 during year during year at 31/12/69 Air rings 5 11 6 10 Back rests 12 16 12 16 Beds - Air - - - - Bed cradles 7 15 10 12 Beds - Egerton - - - - Beds - Hospital 11 5 5 11 Beds - Cot and mattress 1 3 1 3 Bed pans 21 23 20 24 Bottles 18 21 16 23 Chairs - wheel 45 55 53 47 Chairs - Ambulance type, carrying 1 - - 1 Commodes - Chair 188 132 135 185 Commodes - Stool 12 13 13 12 Cushions - Air - - - - Cushions - Sani 1 - - 1 Cushions - Sponge 2 4 3 3 Fracture boards 14 8 8 14 Hoists 2 2 2 2 Hoists - Penrhyn 6 4 5 5 Mattresses - ordinary 2 4 2 4 Mattresses - Dunlopillo 12 3 5 10 Sheets - rubber 27 12 11 28 Walking frames 10 10 9 11 Walking frames - wheeled 1 - - 1 Walking frames - Zimmer adjustable 1 - - 1 Walking sticks - Tripod 21 23 24 20 Walking sticks - Quadruped 1 6 4 3 Water Closet Seats - inflatable 4 1 1 4 OTHER EQUIPMENT LOANED Fireguards 447 43 490 - 99 - TABLE 32 DOMICILIARY MIDWIFERY Attendances by Midwives Doctor Doctor not present present Doctor not booked Midwives of Nursing Sisters of St. John the Divine - 4 " the London Hospital - 1 Total - 5 Doctor booked Midwives of Nursing Sisters of St. John the Divine 8 100 " " the London Hospital 11 109 Total 19 209 No. of planned early discharges 67 Institutional deliveries attended by midwives on discharge before tenth day 225 Patients receiving - Gas and air 27 - Gas and oxygen 83 - Trilene 5 - Pethidine alone 5 - Pethidine with gas/air 2 - Pethidine with gas/oxygen 35 - Pethidine with trilene 1 - No analgesia 75 Total 233 - 100 - 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 - 25 - - - 1 26 Hospitals, on discharge from in-patient treatment _ 132 _ _ _ 6 138 Hospitals, after or during out-patient or day treatment _ 43 _ _ _ 4 47 Education authorities 5 6 _ _ 24 32 67 Police and courts _ 3 _ _ _ _ 3 Other sources _ 35 _ _ 6 11 52 Totals 5 244 _ _ 30 54 333 (ii) Psychogeriatric Unit, St. Clement's Hospital In-patient Unit - Dundee Ward 1969 1968 1967 Admissions 157 128 114 Discharges - Home 64 71 65 - Long Grove Hospital 16 19 23 - Other 77 37 28 Total 157 127 116 Day Hospital Admissions 87 48 58 Patient/day attendances 5,617 5,601 5,699 Discharges - Home 16 10 5 - Long Grove Hospital - - 3 -St. Clement's in-patient 29 17 26 -General hospitals 5 15 25 - Other 6 5 3 T otal 56 47 62 Out-patient Attendances New referrals 44 43 36 Other A ttendances 247 230 184 (iii) Admissions to Hospital under Mental Health Act, 1959 Male Female Total Admitted under Section 25 17 28 45 Section 26 1 4 5 Section 29 8 13 21 Section 60 4 1 5 Section 135 1 - 1 Section 136 5 1 6 Admitted informally 39 47 86 Total 75 94 169 - 101 - MENTAL HEALTH (iv) Patients under Care at 31st December. TABLE 34 Mentally 111 Elderly M ent ally In f1rm Psychop at hi c Subr normal and Severely Sub-normal Total Under 16 Over 16 Under 16 Over 16 Under 16 Over 16 1. Total number _ 375 134 _ 1 115 343 968 2. Attending training/day centre - 29 13 - - 97 69 208 3. Awaiting entry - 1 - - - 4 1 6 4. Receiving home training - 1 - - - - 1 2 5. Awaiting home training - - - - - • • - 6. Resident in L.A. hostel - - - - - 2 _ 2 7. Awaiting residence in L.A. hostel - - - - - - - . 8. Resident at L.A. expense in other hostels - 21 7 - - 1 10 39 9. Boarded out at L.A. expense - - - - - - • - 10. Attending day hospital - 8 10 - - - - 18 11. Receiving home visits and not included in 2-10 above - 315 104 _ 1 11 262 693 12. Admissions to guardianship during year _ _ _ _ _ _ _ 13. Under guardianship at end of year - - - - - - 1 1 14. On waiting list for admission to hospital: (a) in urgent need _ _ _ _ _ _ _ _ (b) not in urgent need - - - - - - - - 15. Admission for temporary residential care: (a) to N. H. S. hospitals _ 1 _ _ _ 8 3 12 (b) to L.A. residential accommodation - - - - - - - - (c) elsewhere _ _ _ _ _ 7 1 8 - 102 - MENTAL HEALTH (v) Day.and Training Centres TABLE 35 Trainees Adult Training Centre Underwood Road Industrial Training Centre White Horse Road Junior Training Centre Cornwall Ave. Special Care Units 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 12 33(1) 42 34 28 14 8 18(2) 11(1) 1. 15 216(4] New entrants - 1 3 1 2 3 4 32 7(1) 3 7 63(1 Transferred from other centres - - 3 1 . • _ _ _ _ _ 4 Removals Moved out of borough • 1 2 3 1 . 2(1) 3 12(1) Excluded - - - - 1 - - - - - - 1 Self-discharged - 1 - - - 1 - 14 1 - - 17 Failed to attend - - - 2 - - - 7 - 2 4 15 Admitted to hospital 3 - - 2 1 1 2 1 - 1 4 15 Transferred to other centres 2 . . 1 _ 1 _ 1 _ _ _ 5 Transferred to E. S. N. school - . _ . _ _ _ _ _ _ _ _ Died - - - - - - - - - - 2 2 Left to take up employ ment 1 1 1 - - - - 9 - 1 - 13 Residential placing - - - _ - - - - - - - - No. oa roll at 31st December 6 32(1) 46 29 25 13 10 16(1) 14(2) 12 203(4) Figures in parenthesis denote City of London TABLE 36 PARKS AND OPEN SPACES IN THE BOROUGH (a) Administered by Borough Council Loc at ion 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 Bazely 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 36.30 103 - 104 - TABLE 37 BURIALS UNDERTAKEN Under Section 50, National Assistance Act, 1948. Number of Adults 32 Number of Children 7 Number of Stillborn Nil Total Cost £717 Burials requested by - Coroner 23 - Relatives 14 - Others 2 TABLE 36 (cont inued) 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 1.93 Gosling Gardens 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 6.96 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 15.12 297.27 TOTAL 333.57 TABLE 38 MEDICAL EXAMINATIONS OF COUNCIL STAFF (a) Reason for Examination Number examined New appointees 303 Transfers to permanent staff 75 Entry to Council's Sick Pay Scheme 45 Sickness absence exceeding one month 377 Extension of service beyond 65 years of age 33 Reviews, etc. 56 Total: 889 (b) Medical assessments for entry to Sick Pay Scheme 385 Examinations arranged with other authorities 22 Abortive appointments 268 - 105 - TABLE 39 DISEASES OF ANIMALS ACTS Kosher Poulterers and Poultry Slaughterhouses Inspections for cleanliness and fowl pest control 281 Street Markets Inspection re sale of animals and observations on movements of live poultry 114 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 263 " Smoke Control Orders 5,279 " for smoke observations 357 " " applications under Sec. 3(2) 33 " " routine boiler inspections 67 No. of notices served under Sec. 12(2) 57 " Sec. 16 3 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 Food and Drugs Act, 1955. A copy of each quarterly report is submitted to the Minister of Agriculture, Fisheries and Food in accordance with the Act. During the year 981 samples were submitted for analysis, as follows;- 3 Baby Foods 15 Jam and preserves 2 Biscuits 22 Meat pies and sausage rolls 2 Brandy 28 Meat and meat preparations 9 Bread 38 Meat products (canned) 3 Bread and butter 19 Milk 21 Butter 4 Milk (dried and condensed) 14 Cereal and starch products 57 Miscellaneous samples 15 Cheese and cheese preparations 24 Nuts and nut preparations 8 Cocoa and chocolate preparations 17 Oils fats and fatty foods 4 Coffee and coffee preparations 21 Pickles and Sauces 6 Colourings 1 Rum 3 Cream 2 Salad cream 83 Drugs 68 Sausages and other meat products 18 Eggs and egg products 20 Soft drinks 24 Fish and fish preparations 12 Soup and soup mixes 1 Flavourings 22 Spices and condiments 5 Flour confectionery 10 Sugars, syrups, etc. 3 Flour and flour products 36 Sugar confectionery 5 Food additives 6 Table jelly preparations 200 Fruit and fruit preparations 23 Tea 3 Gin 40 Vegetables and vegetable 4 Gravy preparations preparations 21 Herbs and herb preparations 8 Vinegar and acetic acid 20 Ice cream 1 Waxsol 8 Ice lollies, sorbets, etc. 2 Whisky 106 - 107 - TABLE 42 HOUSING INSPECTORS AND TECHNICAL ASSISTANTS VISITS AND NOTICES VISITS Housing Act, 1957 (Sections 16, 17 and 18) 579 Slum Clearance 5,252 Overcrowding 241 Standard and Improvement grants 10 Betting offices (Betting and Gaming Act, 1960) 9 Town Planning applications 112 Houses in Multiple Occupation 5,404 Preferential re-housing 765 Sites 1, 982 Qualification Certificates 62 Miscellaneous 485 Total 14, 901 NOTICES, ORDERS ETC. HOUSING ACTS 1957-64 1 Informal notices 61 Intention to make Management Orders 46 Management Orders made 35 Intention to make Directions 21 Directions made (Section 19) 28 Overcrowding (Section 90 Housing Act, 1957) 30 Means of Escape in Case of Fire (Section 16) 142 TABLE 43 DWELLINGS ERECTED DURING 1969 (a) By Borough Council No. of Dwellings Anglia House, Salmon Lane 66 Athenia House, Blair Street 23 Berkeley House, Wellington Way 130 Buttermere House, Mile End Road 22 Caledonia House, Salmon Lane 8 Cambria House, Salmon Lane 8 Charles Dickens House, Mansford Street 130 Darnley House, Camdenhurst Street 66 Eric Street, 95- 103 and 109-117 10 Glengarnock Avenue, 2-84 42 Lefevre Walk, 322-393 and 445-516 144 Manchester Road, 179-225, 227-297 and 390 132 Maroon Street, 41-53 7 Seyssel Street, 21-103 42 Stebondale Street, 52-74 and 76-98 24 Trident House, Blair Street 15 Windermere House, Eric Street, 1-6, 15-20 , 29-34, 35-40, 49-54, 63-68, 36 '"Mount Everest'' (Old Peoples' Home) 1 906 (b)By Greater London Council Ackroyd Drive, Leopold Estate 18 Ballinger Point, Bow Bridge Estate 41 Barnardo Gardens, Barnardo Gardens Estate 36 Brewster House, Barley Mow Estate 56 Dorrington Point, Bow Bridge Estate 41 Havannah Street, Barkantine Estate 10 Henshall Point, Bow Bridge Estate 41 Ingrain House, Ranwell Estate 82 Jamaica Street, Exmouth Street 65 Kingward House, Chicksand Estate 91 Lantern House, Barkantine Estate 40 Malting House, Barley Mow Estate 56 Risby House, -do- 56 Sandal House, Ranwell Estate 82 Shelmerdine Close, Leopold Estate 88 Solander Gardens, Sol ander Gardens Estate 23 Starboard Way, Barkantine Estate 20 Strafford Street -do- 14 Topmast Point -do- 82 Wilmer House, Ranwell Estate 82 1,024 (o) By Others 1, Gernon Road 1 'Kingwood'' Globe Road 10 Pemberton Court, Portelet Road 21 ''Tytherton'' , Old Ford Road 16 48 TOTAL 1,978 108 - 109- TABLE 44 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 433 265 7 Factories with mechanical power 3,564 1,405 142 Other premises under the Act (Electrical stations, institutions, and sites of building operations and works of engineering and construction) 110 48 - Total 4,107 1,718 149 2. Cases in which defects were found Particulars Found Remedied Ref erred To H. M. Inspector By H. M. Inspector Want of cleanliness 9 8 6 - Overcrowding 3 - 3 - Unreasonable temperature 1 - 1 - Inadequate ventilation 3 1 2 - Ineffective drainage of floors - - - - Sanitary conveniences: (a) insufficient 2 5 - 1 (b) unsuitable or defective 162 201 1 8 (c) not separate for sexes 2 1 - 2 Other offences against the Act (not including those relating to outwork) 12 19 3 2 Total; 194 235 16 13 TABLE 44 (continued) 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. 470 - - cleaning and washing - - - Household linen 2 - - Lace, lace curtains and nets - - - Curtains and furniture hangings 10 - - Furniture and upholstery - - - Electro-plate - - - File making - - - Brass and brass articles - - - Fur pulling - - - Iron and steel cables and chains - - - Iron and steel anchors and grapnels - - - Cart gear - - - Locks, latches and keys - - - Umbrellas, etc. 1 - - Artificial flowers 1 - - 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 107 - - Brush making 1 - - Pea picking - - - Feather sorting - - - Carding, etc. of buttons, etc. - - - Stuffed toys - - - Basket making - - - Chocolates and sweetmeats - - - Cosaques, Christmas stockings - - - Textile weaving - - - Lampshades 5 - - Total: 597 - - Section 134. There were no instances of work found in unwholesome premises. 110 TABLE 46 MORTUARY SERVICE Tower Hamlets Mortuary Hackney Mortuary Total Bodies received 501 115 616 Post-mortems 400 99 499 Inquests 97 16 113 - Ill - TABLE 45 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 5 60. 0. 0. 21. 17. 0. Contravention of Regulations 68 330. 0. 0. 33. 12. 0. Housing Act, 1957: Overcrowding in Houses in Multiple Occupation 7 62. 0. 0. 15. 5. 0. Public Health Act, 1936: Nuisance Orders 65 _ 243. 8. 0. Non-compliance with Nuisance Orders 8 108. 0. 0. 29. 8. 0. Failing to provide a suitable dustbin 1 1. 0. 0. - Food and Drugs Act, 1955 17 340. 0. 0. 86. 11. 0. Food Hygiene (General) Regulations, 1960 88 244. 0. 0. 41. 13. 0. Food Hygiene (Market Stalls and Delivery Vehicles) Regulations, 1966 26 160. 0. 0. 25. 0. 0. Preservatives in Food Regulations 1962 2 24. 0. 0. 10. 10. 0. Milk and Dairies (General) Regulations 1959 1 10. 0. 0. 5. 5. 0. Offices Shops and Railway Premises Act, 1963 1 10. 0. 0. 5. 5. 0. Pet Animals Act, 1951 2 12. 0. 0. 4. 0. 0. Clean Air Acts 1956/1968 2 20. 0. 0. 9. 5. 0. Offences against the Person Act 1861 1 15. 0. 0. - Total: 294 1,396. 0. 0. 530. 19. 0. TABLE 47 CLEANSING STATION Persons treated for scabies: Men 78 Women 58 School children 94 Children under 5 58 Total: 288 No. treatmehts given 508 Persons treated for verminous conditions: Men 695 Women 90 School 'children 424 Children under 5 75 Total: 1, 284 TABLE 48 DISINFECTING STATION Disinfection: No. of dwellings disinfected for tuberculosis 4 No. of dwellings disinfected for other infectious diseases 5 No. of dwellings disinfected for other reasons 32 No. of rooms involved 80 No. of articles disinfected by steam 5, 184 No. of articles disinfected by formaldehyde 823 No. of premises other than dwellings, disinfected 12 Dislnfest at ion: No. of dwellings disinfested for bed bugs - 492 - for other vermin 580 No. of rooms involved 2. 478 No. of other premises and sites disinfested 1, 110 No. of articles disinfested by steam 13, 922 No. of articles disinfested by formaldehyde 804 Dr ainage: No. of premises where drains tested 59 No. found defective 18 112 TABLE 49 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 Type of Premises Registered during year Regi st rat ions Registered premises receiving general inspections during ye ar P ersons employed Offices 121 1,028 429 16,227 Retail Shops 68 1,168 463 3,951 Wholesale Shops 34 632 193 5,531 Catering establishments/ Staff Canteen 40 30 3 146 1.746 Fuel Storage Dfnots - 5 _ 99 Tot al: 263 3,133 1,231 27,477 (Males: 18,262 (Females: 9,215 Other visits to registered premises 1,299 Visits to non-registered premises 1,038 Informal Notices served Offices, Shops and Railway Premises Act,1963 603 Notification of Employment of Persons Order, 1964 135 Accidents notified- Causes Machinery: Machinery or relevant part at rest (power and non-power driven) 2 Transport: Vehicle in motion not moved by power 1 Vehicle in motion moved by power 1 Vehicle stationary 3 Hand tools 1 Falls of persons: On or from fixed stairs 9 On or from ladders or step ladders 5 Other falls from one level to another 4 Falls on the same level 10 Stepping on or striking against object or person 5 Handling Goods (not otherwise classifiable) 18 Struck by falling object 9 Not otherwise specified 2 Tot al 70 113 TABLE 50 RODENT CONTROL Properties inspected Number inspected Number found to be infested by Rats Mice On complaint 2, 942 1,093 1, 620 Otherwise 1, 994 411 990 Total; 4, 936 1,504 2,610 Properties treated by Council 4, 772 Visits by Rodent Operatives 17,139 Notices served under Section 4 of the Act (a)treatment Nil (b) structural work (proofing) 27 Cases where default action taken following service of notice 9 Number of "Block Control" schemes carried out 7 No! of Business premises under servicing contract at 1st January 203 No. of new contracts during the year - No. of contracts terminated during the year 14 No. remaining under contract at 31st December 189 114 TABLE 51 VISITS BV PUBLIC HEALTH INSPECTORS Type of Premises No. Visits or Inspect ions Registered and Licensed Premises Animal Boarding Establishments 1 1 Common Lodging Houses 3 27 Pur Skin Dressers 3 3 Hairdressers 188 169 Ice-Cream 495 327 Massage Establishments 5 5 Milk Distributors 313 231 Pet Shops and Stalls 70 199 Pharmacy and Poisons 77 149 Poultry Slaughterhouses 19 198 Prepared Food - Meat 108 76 - Fish 64 63 Rag Flock 31 35 Seamen* s Lodging Houses 3 11 Dwellings No. of visits on complaint 5.996 No. of visits for drainage 3,323 No. of revisits 62.843 9,607 No. of other visits ) 2,637 Other Premises Bakehouses 52 124 Baker Shops and Stalls 95 203 Butcher Shops and Stalls 191 447 Canteens and Clubs 601 277 Chemists 61 24 Confectionery Shops and Stalls 384 319 Fish Shops and Stalls 142 318 Greengrocers and Fruiterers Shops and Stalls 694 728 Grocers Shops and Stalls 49 4 612 Hospitals, Institutions and Day Nurseries 30 14 Public Houses 411 819 Poultry Shops and Stalls 108 130 Restaurants, Cafes and Stalls 347 1,137 School Meal Centres 131 65 Wholesale Food Depots, Markets and WharVes 131 1,102 Other Food Premises 170 318 Food Delivery Vehicles 1 8 Factories (Mechanical) 3,564 1,405 Factories (Non-Mechanical) 433 265 Factories (Other) 110 48 Outworkers 597 641 Schools 101 54 Drainage Work - 2.216 Tot al: 34,330 There are 3,760 food premises including stalls in the Borough. Some of the premises listed above are included under more than one trade category. 115 TABLE 52 MISCELLANEOUS WORK OF PUBLIC HEALTH INSPECTORS Rent Act 1957 - Certificates of Disrepair 1. Applications for disrepair certificates 1 Notice of proposal to issue certificates 1 Undertaking accepted - Undertaking refused - Certificates issued 1 2. Applications for cancellation of disrepair certificates - Complaints Number received at Office 5,246 Dangerous Structures Number of premises notified to District Surveyor 160 Drainage Plans Number of plans on which observations submitted to Borough Engineer and Surveyor 251 Land Charges Number of premises reported upon to Tovsn Clerk 1,218 Town Planning Applications No. of premises reported upon to Borough Architect and Planning Officer 594 Public Houses Number of premises reported upon to Licensing Justices 114 116 TABLE 53 NOTICES SERVED BY DISTRICT PUBLIC HEALTH INSPECTORS Food Hygiene (General) Regulations 1960 481 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 141 Public Health Act, 1936, Section 39 43 -do- 44 2 -do- 45 13 -do- 75 51 -do- 89 23 -do- 93 1,671 Public Health Act, 1961, Section 17 187 Informal Notices to Local Authority Housing Departments 1, 977 Factories Act 1961 149 Prevention of Damage by Pests Act 1949 27 Stepney Council Common Staircase Lighting Byelaws 24 Poultry Slaughterhouse Byelaws 2 Total 4, 791 TABLE 54 OUTWORKERS Firms in the borough employing outworkers 117 Outworkers residing in, and employed by firms in the borough 480 Outworkers residing outside the borough employed by firms in the borough 984 Outworkers residing in the borough employed by firms outside the borough 117 Total outworkers in the borough 597 TABLE 55 REFUSE DISPOSAL Home and trade refuse 74,173 tons Street and market collections 16,327 tons No. of bulk containers in use 2, 924 No. of street gulleys cleansed 15,542 117 r 118 - TABLE 56 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 22nd January Chairman, Health Committee. Public Health Inspector (b) Annual Conference Eastbourne 6th - 10th October Councillor Mrs. L. D. Crook. Chief Public Health Inspector. King Edwards Hospital Fund for London (a) One Day Conference London 22nd January Chief Administrative Officer. (b) One Day Conference London 8th December Principal Nursing Officer. National Association of Mental Health (a) Annual Conference London 20th-21st February Chairman, Health Committee Principal Social Worker, (Mental Health) (b) Stress and Work London 9th- 10th October Senior Social Worker, (Mental Health) (c) Annual General Meeting London 12th November Chairman, Health Committee. Assistant Principal Social Worker. (Mental Health) Federation of Associations of Mental Health Workers Scarborough 11th-14th April Teacher, Training School. Royal Society of Health (a) Health Congress Eastbourne 28th April 2nd May Medical Officer of Health (b) Loneliness London 2nd October Chairman, Health Committee. Senior Social Worker (Mental Health) (c) Layman's Guide to Food Regulations London 19th November Vice-chairman, Health Committee. Councillor Miss H. Morsman, Public Health Inspectors. - 119 - TABLE 56 (Continued) CONFERENCES (Continued) Conference Venue Dates Representatives Ministry of Technology (a) The Investigation of Air Pollution Manchester 2nd June Chairman, Health Committee. Deputy Chief Public Health Inspector (b) Air Pollution London 10th November Chairman, Health Committee. Associate Medical Officer of Health British Dental Association Annual Conference Bournemouth 2nd - 6th June 3rd - 6th June Chief Dental Officer Dental Officer Chest and Heart Association New Ideas in Asthma and its Management London 24th June Associate Medical Officer of Health Family Planning Association Birth Control London 25th - 26th June Medical Officer The Institute of Water Pollution Control Annual Conference Isle of Man 15th - 19th September Chairman, Health Committee. Councillor W. Harris Chief Administrative Officer. Royal Institute of Public Health and Hygiene Annual Conference York 24th - 26th September Councillor Mrs. E. Armsby. Deputy Medical Officer of Health. Association of Chief Chiropody Officers The Changing Pattern of Chiropody Service Exeter 9th - 10th October Chief Chiropodist TABLE 56 (Continued) CONFERENCES (Continued) Conference Venue Dates Representatives National Society for Clean Air (a) Annual Conference Eastbourne 21st - 24th October Councillor G.W. Negus. Public Health Inspector (b) One Day Conference London 11th November Chairman, Health Committee. Associate Medical Officer of Health. Joint Conference of Local Authorities on Clean Air Chigwell 30th October Chairman, Health Committee. Chief Public Health Inspector. National Home Safety Conference Folkestone 5th - 6th November Chairman, Health Committee. Assistant Nursing Officer. Council for the Training of Health Visitors Cheltenham 5th - 7th November Principal Nursing Officer National Elfrida Rathbone Society Annual Conference London 15th November Social Worker (Mental Health) Teacher, Training School Phillips Electrical Communications 70's Style London 26th November Senior Administrative Officer. Inner London Education A uthority Dental Health Conference London 24th - 25th November Chief Dental Officer World Health Organisation Environmental Health London 2nd December Chief Public Health Inspector Queens Institute of District Nursing London 4th December Principal Nursing Officer London Boroughs Training Committee and London Boroughs Association For Practitioners with Services for Disturbed A dolescents London 25th February Social Worker (Mental Health) Social Worker (Health Services) School Nurses 120 - 121 - TABLE 57 REFRESHER AND TRAINING COURSES Courses attended by staff during the year were as follows;- Course Venue Dates Attended by Guy's Hospital Medical School For Dental Officers London From 10th January 8 half days Dental Officer Goldsmiths College Film Projector London From 14th January 12 evenings Centre Superintendent North Western Polytechnic. Immigrant children and their families London 13th - 17th January 2 Day Nursery Matrons For Staff holding qualifications other than N. N. E. B. or C. C. R. Certificates London 16th June 4th July School Nurse Family Planning Association Lectures followed by Practical Sessions London 20th/21st January llth/12th February lOth/llth March 12th/13th May lOth/llth June 9th/10th Sept. 8th/9th December Health Visitor Health Visitor Health Visitor Health Visitor Health Visitor 2 Health Visitors Health Visitor Lectures only London 15th/16th April lOth/llth June 14th/15th July School Nurse School Nurse School Nurse Association of London Borough Medical Officers Nutrition in the Health Services London 30th January Assistant Health Education Officer North London College Nursery Education London 2nd - 20th March 9th - 27th June 17th Nov/ 5th Dec. Nursery Assistant Nursery Assistant Nursery Assistant For Mature Students London From 14th April. 2 days per week for 36 weeks Nursery Assistant Day Nursery Warden Greater London Home Safety Council London 8th March Health Education Officer TABLE 57 (Continued) REFRESHER AND TRAINING COURSES (Continued) Course Venue Dates Attended by British Association of Dental Auxiliaries Symposium London 13th - 14th June 2 Dental Auxiliaries Tavistock Institute of Human Relations, School of Family Psychiatry Seminar for Public Health Workers London 30th June - 4th July Health Visitor Queens Institute of District Nursing Study Day London 9th July 2 District Nurses City College for Further Education Surgery Assistants London Year commencing September. 1 evening per week 7 Dental Surgery Assistants South East London College Diploma in Air Pollution London September 1969 to June 1970 Public Health Inspector Inner London Education Authority Dental Officers - Child Dental Health London 6th - 8th January Dental Officer Sessional Dental Officer College of Physical Education Foor remedial exercises London 10th - 12th June Sessional Medical Officer Association of Health Administrative Officers Staff Relations Worthing 21st - 23rd November (week-end) Chief Administrative Officer 122 TABLE 57 (Continued) REFRESHER AND TRAINING COURSES (Continued) Course Venue Dates Attended by Tottenham Technical College Diploma in Municipal Administration (Inter. Part II) London Commenced September Administrative Assistant Diploma in Air Pollution London From September 1 year day release course Public Health Inspector Chiswick Polytechnic. Fieldwork Instructors' Course London 8th - 19th September 2 Centre Superintendents Clerical Work Supervision London From 30th Sept. 2nd December 1 day per week Administrative Assistant For Supervisors of Child Minders and Pre-School Play Groups London 24th - 28th November Assistant Nursing Officer The Association of Health Administrative Officers' Annual Summer School York 17 th - 20 th September Senior Administrative Officer Institute of Home Help Organisers Week- End School Swansea 18th - 20th September Home Help Organiser University of Leeds Certificate in Psychiatric Social Work Leeds Commenced 1st October. 1 year full time course Mental Health Social Worker National Society of Children's Nurseries Experienced Nursery Nurses London 15th October and 12th November 2 Nursery Nurses London Borough of Haringey Detection of Hearing Defects, etc. London 16th- 17th October 2 Health Visitors -123- TABLE 57 (Continued) REFRESHER AND TRAINING COURSES (Continued) Course Venue Dates Attended by London Boroughs Training Committee (continued) For Mental Health Social Workers London 3rd October 9th January 1970 Day release Social Worker (Mental Health) Seminar for Home Help Organisers and Assistants London From 8th October 8 days Assistant Home Help Organiser Report of the Seebohm Committee - Future Re-organisation - Existing Responsibilities London 9th October Principal Social Worker (Health Services) Adolescence London From 17th October 20 Lunch time Seminars Family Caseworker Social Work with Children and their Families London From 21st October 8 weekly sessions Social Worker (Health Services) Community Health Option London 27th October Principal Nursing Officer Study Day for Health Visitors London 29th October 3 Health Visitors University of London Outlook for Local Government London From 29th August 8 evenings Chief Administrative Officer University of London, Institute of Laryngology and Otology Diagnosis and Treatment of the Deaf Child London 21st - 23rd October Senior Medical Officer Course for Health Visitors London 25th - 27th November Health Visitor Hearing Testing Techniques London 25th - 27th November Health Visitor London Borough of Hounslow Refresher Course at Heston Hearing clinic Heston 9th - 11th June Medical Officer - 124 - TABLE 57 (Continued) REFRESHER AND TRAINING COURSES (Continued) Course Venue Dates Attended by Eye Care Information Bureau Eye Care for Children London 12th December Clinic Nurse London Boroughs Management Services Unit Chief Administrative Officer 4 Senior Administrative Officers Demonstrations of Terminal Equipment London June to December 4 Senior Administrative Assistants 2 Administrative Assistants Filing and Records System London 12th - 13th June 2 Administrative Assistants Project and Network London 7th July Administrative Assistant Analysis for Professional and Administrative Staff Management Appreciation for Professional and Administrative Staff London 9th July Administrative Assistant London Boroughs Training Committee Field work Instructors' Supplementary Course London 7th January to 11th March One day per week Health Visitor Study Days for Child Minder Course Organisers London 6th - 7th March Principal Nursing Officer Introductory Course for School Nurses London 8th - 9th & 15th 16th May 2 School Nurses 13th- 14th & 20th - 21st Nov. 2 School Nurses Qualified Staff in Junior Training Centres London 8th May - 9th July 11 Attendances Training Centre Teacher Matrons and Deputy Matrons of Day and Residential Nurseries (Residential) Sunningdale 2nd - 6th June Matron Day Nursery Study Days for Head Teachers of Junior Training Schools London 4th June 13th November Headteacher, Training Centre. Headteacher, Training Centre. Health Education in Schools London 23rd - 24th June Health Visitor Half Day Study for Nursing Officers London 2nd July Principal Nursing Officer Study Day for Health Education Officers London 18th September Health Visitor - 125 - TABLE 57 (Continued) REFRESHER AND TRAINING COURSES (Continued) Course Venue Dates Attended by University of Warwick Fieldwork Instructors' Follow- up Course (Residential) Coventry 21st March - 2nd April Health Visitor Association of Public Health Inspectors Week End Seminar Folkestone 21st - 23rd March 3 Public Health Inspectors National Society for Mentally Handicapped Children Study Week End (Residential) Cambridge 21st - 23rd March Social Worker (Mental Health) Royal College of Nursing Refresher Course Oxford 14th- 18th April Centre Superintendent Newham School of Community Nursing District Nurse Refresher Course London 21st - 25th April 2 District Nurses District Nurse Training London From 22nd September (4 months) District Nurse British Post Medical Federation Infections of the Teeth Supporting Structures London From 6th May 5 half days Dental Officer Marie Curie Memorial Foundation Domiciliary Care of the Patient with Cancer London 28th May Superintendent, District Nursing District Nurse University of London, Department of Extra Mural Studies. Supportive Counselling London 30th May - 1st June Health Education Officer - 126 - TABLE 58 SCHOOL HEALTH STATISTICS Pupils on School Rolls at December, 1969 Under 5 years - full-time 1,486 - part-time 1,516 Infants 5, 917 Juniors 10,471 Seniors 12, 095 Special 852 Total: 32,337 Recuperative Holiday Homes Number of schoolchildren (including Nursery schoolchildren) admitted during the year 196 Health Surveys No. examined Occasions vermin found Percentage (a) Comprehensive 12,460 301 2.41 (b) Selective 8,605 565 6.56 No. of individual pupils found verminous 511 Percentage of school roll 1.58 Vermin - occasions advice and/or shampoo given 760 - occasions attendance at bathing centre 106 (c) Communicable disease - No. examined for 369 Routine Audiometer Testing No. of children given screening test 4, 520 No. failing screening test and given pure tone test 259 No. failing pure tone test and referred to Otologist 141 School Medical Treatment Clinic No. of premises Sessions in year New Cases Attendances Audiology 1 87 234 645 Bathing 2 578* 671 1,032 Ear, Nose and Throat - 52 113 277 Minor ailments - Medical Officer 6 130 767 16,872 - Nurse 8 782 898 Ophthalmic 4 316 1,345 2,799 Orthoptic 1 88 84 205 Special Investigation 3 185 222 1,489 * includes also adult sessions - 127 - TABLE 58 (Continued) SCHOOL HEALTH STATISTICS Defects treated at School Treatment Centres and Hospital Clinics Errors of refraction and squint 710 Other eye defects 9 Spectacles ordered 719 Athlete's foot 40 Verrucae 401 Ringworm - body 5 Impetigo 61 Other skin diseases 191 Eye diseases 116 Ear diseases 58 Miscellaneous lacerations, etc 692 Orthopaedic and postural defects (treated at schools) 124 B.C.G. Vaccination - Schoolchildren Number of schools visited 30 Number of 13-year old children offered test 2,839 Number of consents received 2,356 Number of children tested 1,881 Number of positive reactors 61 Number of children vaccinated 1,581 Infectious and Other Diseases notified by Schools Disease No. of Notifications Chickenpox 173 Dysentery, Diarrhœa 86 Food poisoning 2 German Measles 66 Glandular Fever 1 Impetigo 19 Influenza 28 Jaundice 29 Measles 245 Mumps 160 Ophthalmic conjunctivitis 36 Pneumonia 2 Ringworm 1 Scabies 19 Scarlet Fever 43 Tonsillitis 26 Whooping Cough 7 Total: 943 (Number notified last year - 1,051) - 128 - TABLE 59 HEALTH DEPARTMENT ESTABLISHMENTS Particulars of Clinics held and Services provided as at 31st December, 1969. (a)CLINICS AND SCHOOL TREATMENT CENTRES Address Clinics and other activities held Clinic and School Treatment 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 Newmill House, Empson Street, E. 3. Infant Welfare, Toddlers, Vaccination and Immunisation, Mothers' Club and Creche. Clinic and School Treatment 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 and School Treatment 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. Clinic and School Treatment Centre, Roserton Street, E. 14. Ante-Natal, Chiropody, Dental, Infant Welfare, Minor Ailments, Occasional Creches, Toddlers, Vaccination and Immunisation, Mothers' Club, Cervical Cytology. - 129 - TABLE 59 (Continued) (a) CLINICS AND SCHOOL TREATMENT CENTRES (Contd.) Address Clinics and other activities held Clinic and School Treatment 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 and School Treatment Centre, Wellington Way, E. 3. Dental, Infant Welfare, Occasional Creches, Toddlers, Vaccination and Immunisation, G. P. Obstetrician, Mothers' 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. - 130 - TABLE 59 (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, Tues. 2. 0 - 4. 0 p. m. (adults) 5.30 - 7. 0 p. m. (adults) Bow Road, E. 3. 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 School, St. Judes Road, 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. (g) MORTUARY Poplar High Street, E. 14. - 131 - - 132 - INDEX A Page Nos. Accidental Deaths 13, Accidents in the Home 63 Adoption and Boarding Out 25 Adult Training Centres 39,131 Aged Persons 43 Alcoholics 41 Ambulance Facilities 63 Ante—Natal Clinics 25,91 Anthrax 15 Area of Borough 7 B Bacteriological Examination - Food 48 B.C.G. Vaccination 18,71,90 Births 7,11,95 Blind, Partially Sighted 41 Burials 43,104 Byelaws 59 c Cancer 15 Cervical Cytology 25,92 Chest Clinics 18,131 Chief Public Health Inspector's Report 45 Child Minders 26,92 Children in Care 33 Child Welfare Clinics 91 Chiropody 42,93 Circulars — Ministry 65 City of London - Mental Health Service 40 - 133 - C (continued) Page Nos. Clean Air 46,105 Cleansing Station 54,112 Clinic Centres 27,129 Common Lodging Houses 55 Community Care Services 37 Comparative Statistics 14,83 Conferences and Courses 118—126 Congenital Defects 26 Creches 27 Crude Spirit Drinking 41 D Day Care Service 43 Day Centres (Mental Health) 39,131 Day Nurseries 23,27,92,131 Deaf Children 71 Deaths 7,81 Dental Health Education 75 Dental Services 37,93 15 Diphtheria Diseases of Animals 47,105 Diseases — Notifiable 85 Disinfection / Disinfestation 54,112,131 Dysentery 15 E Educationally Sub—Normal Children 72 Employment of Schoolchildren 71 Environmental Health Services 45 Establishments 14,129 F Factories 54,109 - 134 - F (continued) Page Nos. Family Planning . 28,95 Fifty Years ago 10 Food and Drugs 48 Food Hygiene 49 Food — Imported 49 Food — Unsound 51,52 Food Poisoning 16 G Guardianship 40 H & I Hairdressers 54 Handicapped Pupils 70 Handicap Register 84 Health Committee 2 Health Education 29,72,94 Health Visiting 23,29,95 Heroin Addicts Home Bathing 43,96 Home Help Service 42,96 Home Nursing 30,97 Hospital Facilities . 64 Houses in Multiple Occupation 53 Housing 4,52, 107 Hygiene in' Schools 71 Ice—Cream 49 Immigrants 20 Immunisation 71,87 Incontinence Pads 30 Industrial Training Centre 40,131 135 - H & I (continued) Page Nos. Infant Mortality 7,12,82 Infectious Diseases 3,15,70,86 Infective Jaundice 16 Inquests 63 J & K Junior Training School 38 L Laboratory Facilities 64 Laundry Service 30,97 Legal Proceedings 54,111 Legislation 64 Leprosy 16 Licensing Act, 1961 55 Loan of Nursing Equipment 30,98 Lodging Houses 55 London Hospital 40 M Malaria 16 Marie Curie Memorial Foundation 31 Marriages 13 Mass Radiography 18,90 Maternal Mortality 7,12 Measles 16,32 Medical Inspection of Schoolchildren 69 Mental Health 3,37,100-102 Midwifery 31,99 Milk Supply 51 Minor Ailments Clinics 71 Miscellaneous Services 63 - 136 - M (continued) Page Nos. Morbidity 13,86 Mortuary 55,111,131 N Neo—Natal Mortality 7,12 New Houses 53, 108 Notices Served by Public Health Inspectors 117 Nursing Equipment — Loan of 30,98 R Observation Register 32,84 Offensive Businesses 56 Offices, Shops and Railway Premises 56,113 Open Spaces 14,103 Ophthalmia Neonatorum 16 Outwork and Outworkers 57,110,117 Overcrowding 45 P & Q Partially Hearing Children 71 Partially Sighted Persons 41 Peri—natal Mortality 7,12 Personal Health Services 23 Pet Animals Act 57 Pet Foods 46 Pharmacy and Poisons Act 57 Phenylketonuria 32 Playgroups 25,27 Poliomyelitis 16 Population 7,10 Post Natal Clinics 25 - 137 - P & Q (continued) Page Nos. Poultry Processing and. Packing 57 Premature Babies 32,95 Pre-School Playgroups 27 Principal Nursing Officer's Report 23 Principal School Dental Officer's Report 72 Principal School Medical Officer's Report 69 Psittacosis 16 Public Analyst's Quarterly Reports 106 Public Health Inspectors - Visits 105,107,115 Public Relations 13 Pupils on School Rolls 69 R Radioactive Substances 66 Rag Flock, etc. Act 57 Recuperative Holidays 32,97 Refreshment Houses 58 Refuse Disposal 58,117 Relaxation Classes 91 Removal of Persons in Need of Care 43 Renal Dialysis 43 Rent Act 58 Road Accidents 82 Rodent Control 58,114 St. Katharine's Dock Scheme 9 Scabies 17 Scarlet Fever 17 School Dental Service 72 School Health Service 23,127 - 138 S (continued) Page Nos. Seamen's Lodging Houses 55 Sewerage 59 Slum Clearance 45,52 Smallpox 17 Social Conditions 9 Special Care Units — Mental Health 38 Staff 6,66,105 Statistics and Social Conditions 9 Statistics — Summary 7 Street Trading in Food 49 Students - Training of 67 Surveys 33 Swimming Baths 59 T Training Centres (Mental Health) 39,131 Tuberculosis 17,88,89 Typhoid 17 U Underground Rooms 52 Unemployment 13 Unmarried Mothers 33 V Vacant Sites 59 Vaccination 32,63,71,87,90 Venereal Diseases 21 Verminous Schoolchildren 70 Visits by Public Health Inspectors and Technical Assistants 105 w Water Supply 60 Weather Conditions 15 Whooping Cough 17 Works in Default 61 - 139- '