TOWER HAMLETS LONDON BOROUGH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH & PRINCIPAL SCHOOL MEDICAL OFFICER L O W 006 LONDON BOROUGH OF TOWER HAMLETS ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH & PRINCIPAL SCHOOL MEDICAL OFFICER 1970 R. W. WATTON M.B., B.S., D.P.H.. D.C.H.. D.I.H. Medical Officer of Health and Principal School Medical Officer CONTENTS Page Health Committee 1 Introductory 2 Staff 5 Summary of Statistics 6 Part I Statistics and Social Conditions of the Area 7 II Prevalence of and Control over Infectious and Other Diseases 13 III Personal Health Services 25 IV Community Care Services 41 V Environmental Health Services 49 VI Miscellaneous Services etc. 69 VII School Health Service 75 VIII Appendix of Statistical Tables 81 INDEX 133 TOWER HAMLETS HEALTH COMMITTEE (as at 31st December, 1970) Ex-Officio: The Worshipful the Mayor, Alderman J. Orwell (Stepney) Councillor W.T.G. Guy CHAIRMAN Councillor W. T. Tuson VICE-CHAIRMAN Councillor A. W. Downes ALDERMEN C. Blaber J. P. COUNCILLORS Mrs. D.M. Couling E.W. Hill M.S. Levitas Miss H. Morsman J. O'Connor M.B.E., J.P. Mrs. R.E. Perkins M. Poll ins Mrs. I.B. Vines E.G. Walker G.H. Wall -1- 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 1970. COMMUNICABLE DISEASES Vaccination against Rubella was offered to girls in their fourteenth year - to be extended later to lower age groups. A reasonable acceptance rate was forthcoming. As discussed by the Chest Physicians in the main report, tuberculosis notifications remain at 0.6 per 1,000 population: higher than the national average. It is hoped that the weekly open session provided by one Miniature Mass Radiography Unit will be allowed to continue in the area of Spital fields. HOUSING Progress was maintained in this important field. The next quinquennial programme of clearance of unfit properties should complete the representation of the major areas of slums. Proposals to plan the comprehensive development of the London Docks would have provided much needed land within the borough but these are now to form part of a larger investigation of dockland development on both sides of the river. This should not be-allowed to reduce the impetus of our own borough housing schemes. VENEREAL DISEASE An account of "contact tracing' methods undertaken by the social workers of the department based at the Whitechapel clinic, London Hospital, is given on page 20.It should be noted that in past years, despite anational trend upwards these workers have been able to reduce the local incidence of gonorrhoea - and in the year 1970 almost to contain the level. Concentrated and diligent attention to duty has been required to ensure this success. Health education in such acomplex field has continued by both the Health Education officer and her staff, and health visitors in the department, with specific attention to the venereal diseases and also as part of the wider aspects of education for healthy living. -2- HANDICAPPED AND OBSERVATION REGISTER Ascertainment of congenita] defects and the keeping of handicapped and observation registers have been sustained. The success of the Development Assessment Centre, based at the London Hospital, has helped appreciably in the diagnosis and management of children in these categories. The dual approach, from paediatricians cljtiically orientated and our own staff seconded to the clinic,. ensures a balance of complimentary skil1s. LIAISON WITH HOSPITALS AND GENERAL PRACTITIONERS It is appropriate, at a time when the consultative paper on the unification of the health services is awaited, to consider the degree of liaison already achieved in the borough. Closer links have been made with general practitioners over recent years so that more now take an active part in the maternity and child welfare clinics and the school health service. Tentative planning for health centres in four areas has required mutual consultation on purpose-bui1t premises to provide for local authority and general practitioner services. The new syllabus for nurse training giving greater scope for community nurse training options, is bringing about linked schemes for the training of hospital and community nurses One of the district nursing staff was seconded on a tutor's course during the year to further the development of these programmes. As it is, most of the local hospital nurse training schools send their students out to the department for theoretical and practical experience in the community. The mental health services continued to develop as a unified service with the London and St. Clement's hospitals. The passing of responsibility in 1971 to the Directorate of Social Services, should bring further close liaison. Plans have been discussed with the Department of Psychiatry, London Hospital, to provide increased child psychiatric facilities. Particularly, this is required for the Children's department's residential homes, within and outside the borough. Also in conjunction with the Inner London Education Authority, the Oxford House project of the London Hospital Medical College's Academic Psychiatric Unit continued with its investigations of pre-school children having a deprived home background. Emphasis is placed on the formulation of preventive guide-lines. With the extensionof family planning services at some local hospitals, patients resident in the borough have been taken into the borough's schemes on discharge from hospital. Family Planning continues to be provided partly by the Family Planning Associat ion on an agency basis, and also as part of our own direct services at health clinics. Application was made under the Urban Aid programme for a grant to extend the pilot domiciliary family planning service. The existing three chest clinics, serving the previous Metropolitan Borough -3- areas, will, from 1971 be amalgamated and based at the London Chest Hospital. There, with the construction of new premises and the avai1abi1ity of al1 requisite investigatory and treatment facilities it will be possible for patients to receive full care. At present, the physical divorce of chest clinic premises from hospitals often requires repeated visits between the clinics an d hospitals. The tuberculosis visitors will remain based on their districts, but the Chest Clinic social workers (transferring to the Department of Social Services) will be based at the hospital. Redeployment of hospital geriatric catchment areas has given consultant cover and allocation of beds by borough areas, so facilitating integrated action with the local authority health and social services. To date, it has not been possible to arrange a conjoint appointment for a consultant geriatrician to further the care of the aged, particularly as between placement in hospital or Part III accommodation. For the future, it would appear that the borough will have one district genera] hospital and probably satellite community hospitals, under a single health authority. Suffice it to say. that the good measure of close liaison now existing locally between different arms of the National Health Service has laid the foundation for a future effective unified service. ENVIRONMENTAL HEALTH It has been increasingly apparent from the rising incidence of 1 ice infestationsparticularly noted in special surveys of schoolchildren - that existing measures were not effective. Local studies made in conjunction with research workers from the Department of Entomology, London School of Hygiene and Tropical Medicine, have proved the exi st ence of resist ance, in head lice, to Gammexane and D.D.T. A preparation using Malathion. with nil resistance to date, is now available for use following extensive field trials undertaken at some of our clinics and the cleansing station. Once again I express my thanks to the Chairmen and members of appropriate Committees, and to the Town Clerk and colleague chief officers for their support. As always, the staff of the department have given loyal and efficient service in yet another year. I am, Yours faithfully, R.W. WATTON Medical Officer of Health and Principal School Medical Officer. May 1971 -4- STAFF OF HEALTH DEPARTMENT (as at 31st December 1970) ASSOCIATE MEDICAL OFFICER OF HEALTH Dr. W.C. Turner MEDICAL OFFICER OF HEALTH Dr. R.W. Watton Medical Officers 35 (9.70) CHIEF ADMINISTRATIVE OFFICER E.P. Webber PRINCIPAL MEDICAL OFFICER Dr. K. Winship SENIOR MEDICAL OFFICER Vacant C.H. Drake CHIEF PUBLIC HEALTH INSPECTOR H. S. Davies Technical Assistants 8. Dental Officers 16 (10.4) PRINCIPAL NURSING OFFICER Mrs. D.E. Marrin Health and Tuberculosis Visitors 34 (32.59) PRINCIPAL SOCIAL WORKER (MENTAL HEALTH) F. Sullivan DEPUTY CHIEF ADMINISTRATIVE OFFICER M. Pliskin SENIOR ADMINISTRATIVE OFFICERS J. E. Pestel1 Administrative and Clerical Staff 76 (72.41) Public Health Inspectors 22. G.R. Williamson DEPUTY CHIEF PUBLIC HEALTH INSPECTOR .J. J. Keniry CHIEF DENTAL OFFICER D. F. Waller Dental Auxiliaries 3. DEPUTY PRINCIPAL NURSING OFFICER Miss A. M. Thomson Student Health Visitors 7. Pupil Public Health Inspectors 6. Dental Surgery Assistants 12 (11.82) ASSISTANT NURSING OFFICERS Miss E. Brosnan Miss P. Rolph Clinic and School Nurses 27 (24.49) ASSISTANT PRINCIPAL SOCIAL WORKER (MENTAL HEALTH) J. M. Ashton Social Workers (Mental Health) 14 (13.33) Supervisory Staff at Mental Health Training and Day Centres 23. PRINCIPAL SOCIAL WORKER (HEALTH SERVICES) Miss E. Brett Social Workers and Family Caseworkers 8. ASSISTANT PRINCIPAL SOCIAL WORKER (HEALTH SERVICES) B. Grist SUPERVISOR CLEANSING SERVICES Miss E. New CHIEF CHIROPODIST P. Twort NON-MEDICAL SUPERVISOR OF MIDWIVES Miss I. M. Clarke NURSING SUPERINTENDENT (Agency) I Midwives (Agency) 5 HEALTH EDUCATION OFFICER Miss P. G. Hodges Chiropodists (Sessional) 9 (2.4) SUPERINTENDENT OF HOME NURSING Mi ss N. 0. Humphris DEPUTY SUPERINTENDENT OF HOME NURSING Miss P. J. Ribbans District Nurses (inc. Agency) 28 (27) (SS I STUNT HEALTH EDUCATION OFFICER Mrs. M. A. Twiston-Davies HONE HELP ORGANISERS 3. DAT NURSERY STAFF 43. HOME HELPS 264 (175.1) OTHER STAFF 34 (26.51) Total Staff of Department 806 (636.45) Note - Numbers in brackets relate to equivalent whole-time. ASSISTANT HOME HELP ORGANISERS 6. OTHER MANUAL STAFF 123 (95.8) -5- SUMMARY OF STATISTICS, 1970 Area of Borough (Acres) 4,876 Rateable Value (1st April) 1970 £15, 009,795 Population: Mid-year estimate 182,260 Sum represented by a penny rate (1970-1971) £56,850 Census, 1966 196,830 (Revised 1970) 201,280 General Rate (1970-1971) Dwelling houses 14s. 5d. in £ Census, 1961 205,682 Density of population (persons per acre) 37.38 Mixed hereditaments 15s. 3d. in £ Number of inhabited dwellings according to Rate Books at 1st April 1970 62,18S " " structurally separate dwellings - Census 1961 59,88S " " private households - Census 1961 67,858 Births Total Male Female A11 Births 2,503 1,299 1,204 Live Births Legitimate 2,138 1,112 1,026 Illegitimate 333 173 160 Total: 2,471 1,285 1,186 Still Births Legitimate 26 11 15 Illegitimate 6 3 3 Total: 32 14 18 Deaths All Causes 2,170 1,150 1, 020 Maternal 1 - 1 Infants under 1 year Legitimate 43 30 13 Illegitimate 7 5 2 Total: 50 35 15 Rates Live birth-rate per 1, 000 population 13.55 Death rate per 1,000 population 11.91 Still- birth rate per 1, 000 total births 12.78 Maternal death rate per 1, 000 total births 0.40 Infant death rate (under 1 year) per 1, 000 live births 20.23 Legitimate infant death rate per 1, 000 legitimate live births 20.11 Illegitimate infant death rate per 1, 000 illegitimate live births 21.02 Neo-natal death rate (under 4 weeks) per 1, 000 live births 13.35 Early neo-natal death rate (under 1 week) per 1, 000 live births 12.14 Perinatal death rate (still births plus deaths under 1 week) per 1, 000 total births 24.77 Illegitimate live births per cent of total live births 13.47 Area Comparability Factors Births 0.92 Deaths 1.19 -6- PART I STATISTICS AND SOCIAL CONDITIONS OF THE AREA 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 enclosed docks including the East and West India Docks and the Millwall Docks 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 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 Spitalfields wholesale fruit and vegetable market and the London Fruit Exchange are situated in the borough and there are many wholesale food depots from which goods are distributed throughout the country Notable landmarks in the borough include the Tower of London and the Royal Mint POPULATION The Registrar General's estimated mid-year populationof the borough was 182.260. a decrease of 5-820 from last year s figure This is a continuation of the downward trend which has occurred since 1947 The population of the Greater London area also continues to decline, the decrease (91 000; being much sharper this year than last year (56 000) The estimated child populat ion i s 39 600 being 1.900 less than last year and made up as fol1ows - Live births exceeded deaths by 301 so that as the estimated population decrease was 5,820 the net estimated movement of residents out of the borough amounted to 6, 121 pe rsons Under 1 year 2.500 1-4 years 10.900 5-14 years 26.200 -7- The density of population is 37.38 persons per acre, a reduction of 4½ persons per acre (11%) since 1965. FIFTY YEARS AGO In 1920 the estimated population of the Boroughs of Bethnal Green, Poplar and Stepney, which now form the Borough of Tower Hamlets, was 548,300. There were 7,347 Stepney births or 1,884 more than in 1919. The marriage rate was 20.5 per 1,000 population. Of the 4,014 cases of infectious disease notified in Stepney, 2,411 were cases of Scarlet Fever. 651 of Diphtheria, and two were of Smallpox. Malaria notifications numbered 17 with one of Trench Fever and one of Dysentery - all in ex-soldiers who had served overseas. Among the causes of death in this Borough were 283 from Pulmonary Tuberculosis, 89 from Summer Diarrhoea (in children under 1 year of age), 74 from Whooping Cough, 38 from Diphtheria, 48 from Measles, 15 from Scarlet Fever, 12 from Encephalitis Lethargica and 7 from Cerebro Spinal ("Spotted") Fever. Of the deaths from Phthisis 40% were not notified during lifetime. Deaths of children under one year numbered 663, the infant mortality rate being 90 per 1,000 births. Deaths from old age numbered 136, whilst violence and suicides accounted for 164 deaths. Consideration was given by the Stepney Council during the year to the employment of home helps to assist in management of homes in cases of confinement. Free milk was distributed to 6,500 families for nursing and expectant mothers and chi 1 dren under 5 years, at a cost of £20,000. The addition of water tomilk by retailers was not uncommon, the War ran ty offence being pleaded successfully on 100 occasions during past 7 years. The Public Analyst estimated that about 18,000 gal 1ons of either water or separated mi 1 kwere sold annua] ]y as new milk. The Medical Officer of Health asked the Ministry of Health "to make such orders as it may think advisable to put an end to the scandal that exists". The result of bacteriological examination carried out of milk samples led the Medical Officer of Health to state that "the bacteria content of some of the milk samples can be quite justly compared with the bacteria content of the Thames sewage". Summonses heard under the Public Health (London) Act numbered 177, 40,000 notices being served. Houses let in lodgings numbered ?,512 and there were 27 cowsheds with 600 cows. Due to dilapidations in dwellings following inattention or neglect during the war years, the Council decided to take advantage of the powers contained in the Housing of the Working Classes Act, 1919 and to undertake themselves the repair of houses which were not reasonably fit for human habitation, where owners didnot comply with notices served upon them. Five temporary Sanitary Inspectors were engaged for this work which included a rapid house to house survey of the Borough. The Council adopted an estimate of £16,700 for the erection of a block of 15 4 roomed flats, including the cost of the land. It also approved the expenditure of £10 for the purchase of a col lection of stuffed and mounted trout caught in the River -8- Lea. A bye]aw made by the London County Council came into force prohibiting the use of whistles for the purpose of hailing cabs. The Mayor of the Borough was Major Clement R. Attlee, M.A.,J.P. LIVE BIRTHS There were 3,495 live births registered in the borough during the year. After correction for place of residence (inward transfers 168 outward transfers 1,192), the number allocated to the borough was 2,471 comprising 1,285 boys and 1,186 girls, a decrease of 141 from 1969, giving a crude birth rate of 13.55 per 1,000 population compared with 13.88 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 12.46 compared with 16.0 (estimated) for England and Wales, a ratio of 0.78 to the national rate. ILLEGITIMATE LIVE BIRTHS The number of illegitimate live births during the year was 333 equivalent to 13.47% of the total live births, compared with 11,63% last year. The comparable figure for England and Wales was 8%. STILLBIRTHS This year stillbirths numbered 32 equivalent to a rate of 12.78 per 1,000 total births compared with 12.85 in 1969. The rate for England and Wales was 13. BEATHS The number of deaths registered - 2,170, shows a dec rease of 145 from the figure of last year. The death rate was 11.91 and when adjusted by the comparability factor becomes 14.17 as compared with 11.7 for the country as a whole. The largest single cause of death was heart disease, 29% of total deaths, followed by cancer 25% and respiratory conditions 17%. 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 50 equivalent to a rate of 20.23 per 1,000 live births. The rate for the previous year was 17.61 and 24.00 for 1968. 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 -9- in 1921 almost 1 in 10 babies died before their first birthday. The rate for England and Wales was 18 for 1970. Details of causes of death at various ages under 1 year will be found in the Appendix on page 82. MATERNAL MORTALITY There was one maternal death this year. MEO-NATAL MORTALITY During the year there were 33 deaths of infants under 4 weeks representing a neo-natal mortality rate of 13.35,the rate for England and Wales being 12. Last year there were 31 deaths giving a rate of 11.86 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 24.77 the rate for England and Wales being 23. ACCIDENTAL DEATHS Deaths due to accidents numbered 66 (compared with 79 last year) motor vehicles being the cause of 24 deaths. Statistics supplied by the Road Safety Officer will be found on page 89. EXPECTATION OF LIFE The expectation of life at birth based on the estimated home population and mortality experience over the three years 1967 to 1969. is 68.7 years for a boy and 74.9 for a girl. This is an increase of 0.7 years formal es and 1.2 years for females over the figures based on mortality during the years 1957 to 1959. The figures also show that 70%of males and 82% of females can be expected to live to age 65, and that at age 65 a man has a life expectancy of 12.0 years and a woman 15.9 years. 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 .) -10- MARRIAGES The number of marriages solemnised in the borough during the year was 1.515, or 158 more than last year, made up as follows- Register Office 755 Church of England 509 Authorised persons and other denominat ions 251 The marriage rate per 1.000 population was 16.6 compared with 14.4 last year, PUBLIC RELATIONS Activities of the Health Department are publicised in "Tower Hamlets News" which is published by the Council and issued to the public after each CoUnci1 Meeting Topics to which attention was drawn during the year related to Child Minders, Vaccination and Immunisation, details of changes in Services provided at Clinic Centres- Care of Oil Heaters Cancer of the Womb- English Language Classes for Immigrant Mothers Laundry Service for Incontinent Persons, Home Help Service- Loan of Nursing Equipment Internationa] Certificates of Vaccination and Publicity for the Mass Radiography Units 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 One of the department s entries in the Borough Carnival this year was submitted by the Public Health Inspectors and Pupi1s (see photograph) This float was successful in gaining first prize in the Civic Publicity Section. PUBLIC TRANSPORT Public transport facilities in the borough include eleven District Metropolitan and Tube Railway Stations and 4 Suburban Railway Stations UNEMPLOYMENT The number of wholly unemployed adult persons registered at the Poplar, Shoreditch and Stepney Employment Exchanges at 7th December totalled 2,653 men and 156 women, or 337 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. -11- Information supplied by the Youth Employment Service shows that unempl oyed young persons (under 18), numbered 76 boys and 17 girls, compared with 1969 figures of 60 and 9 respectively. OPEN SPACES There are 338 acres of parks and open spaces within the Borough, representing 1.85 acres for every 1,000 population, some 4 acres being added this year, Since 1965 open spaces in the Borough have increased by 32 acres or from 1.49 to 1.85 acres per 1,000 population. The County of London plan provides for 4 acres withip the county per 1,000 population with an interim standard of 2y, acres. A list of the sites is given on pages 103 and 104 . COMPARATIVE STATISTICS A table showing vita] 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 c]inic sessions held and servipes provided is given in the Appendix on pages 129 to 131. -12- PART II PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES II PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES WEATHER CONDITIONS January began very cold to become mild and wet. February saw some snow, but also record sunshine. There was snow at times during March and April. The month of May was dry and generally fine, June being the sunniest since records began in 1929. July and August had alternate fine and unsettled spells. Above average temperatures with little rain was experienced in the latter half of September and in October, whilst November showed record rainfall. With December came fog and a white Christmas INFECTIOUS DISEASES - NOTIFICATIONS The number o f noti fied cases of infectious disease, corrected for rev i sed di agnoses and duplicate notifications, was 1.619 compared with 1,709 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 numbers of infectious diseases occurring in the 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 537 deaths from cancer occurring this year 160 were due to cancer of the lung. The death rate of lung cancer was 0.87 per 1,000 population. DIPHTHERIA No cases of diphtheria were notified during the year. DYSENTERY Notified cases of dysentery totalled 36, compared with 78 during the previous year. FOOD POISONING Eighty-two cases of food poisoning were notified during the year compared with -13- 71 in 1969. Salmonella typhi-muriura was isolated in 24 instances. Other Salmonella organisms isolated during the year included 3 enteritidis, 1 enteriticus, 1 saint paul, 1 panama, 1 thompson and 1 banana, Clostridium welchii was discovered in 21 cases. Two family outbreaks we re reported to the Department of Health and Social Security as required by Memorandum 188/Med. INFECTIVE JAUNDICE Notifications of infective jaundice numbered 127 during the year, compared with 124 during 1969. MALARIA No cases of malaria were notified during the year. MEASLES Notified casesofmeasles totalled 1,063 during 1970. In the previous year 1,201 notifications were received. Children vaccinated against the disease during the year numbered 2,201. ACUTE MENINGITIS Two notifications were received during the year, compared with 17 in 1969. OPHTHALMIA NEONATORUM Two cases were notified during the year, POLIOMYELITIS It is gratifying once again to report that no cases of poliomyelitis occurred in the borough during the year. Details of vaccination against poliomyelitis will be found on page 8 7. SCABIES Cases of scabies which came to notice during the year totalled 493, compared with 288 in 1969 . Patients and contacts were given medicinal baths and their clothing disinfected at the Council's cleansing station. The number of baths given was 832. Although scabies ceased to be a notifiable disease on 1st April, 1965, by the co-operation of the genera] practitioners and hospitals information is forwarded to the Health Department of persons suffering from the condition, and arrangements made for follaw-up by home visits to ensure that the patients and their contacts receive treatment at the Council's cleansing stations. -14- SCARLET FEVER There were 48 confirmed cases notified, compared with 79 during 1969. 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 smal1 pox. Observation is kept on such persons by officers of the Health Department for the necessary period. The number of persons successfully vaccinated or revaccinated against smallpox at the Council's clinics and by general practitioners during the year was 1.867. TYPHOID Three cases of typhoid fever were notified during the year. One case occurred in a merchant seaman, who became ill in December, 1969, on board the m.s. "Oronsay" and who was admitted to hospital in Florida, U.S.A. After treatment he was flown home in January to an address in this borough. Shortly afterwards because of a recurrence of symptoms, the seaman was admitted to hospital. Subsequently, information was received from America that Salmonella typhi had been grown from the man's blood and stools. All contacts were kept under surveillance, and all general practitioners involved were advised. The second case was notified in a lady who had been on holiday at Benidorm in Spain. Some 70 local authorities were advised of contacts who were resident at the sane hotel over the relevant period. Local contacts were interviewed and bacteriological specimens were taken in 9 cases with negative results. The third case occurred in a lady who had recently returned from a holiday village in Majorca. Family contacts were investigated as also were twelve former hospital patients who were in the same ward when the disease was confirmed. WHOOPING COUGH There were 138 notifications compared with 20 during 1969. Statistics relating to immunisation are on page 87. TUBERCULOSIS The number of primary notifications of pulmonary tuberculosis received during the year was 101, giving a notification rate of 0.55 per 1,000 population compared -15- with 0.52 last year. Non-pulmonary cases notified numbered 7. The mortality rate for pulmonary tuberculosis was 6.5 per 100,000 population compared with 4.2 in 1969. Statistical data relating to new cases, deaths and variations in the register will be found on page 88. 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 1970 which will be found on page 90. The Secretary of State has approved the proposals of the North-East Metropolitan Regional Hospital Board to reduce mass miniature radiography units operating in the region from four to two by the end of 1971. This will result in the demise of Unit 6B and will restrict, if not curtail, the mobility of Unit 6A. However, the regular Tuesday afternoon sessions carried out by Unit 6A in the borough at Toynbee Hall are to continue. 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 15 on page 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 -16- training centres for mentally subnormal persons and tuberculin reactors discovered among thirteen-year old schoolchildren, students and others tested with a view to B.C.G. vaccination. Epidemiological investigations are made among the contacts of cases of tuberculosis notified in children, staff or residents in the Council's establishments. Similar investigations are carried out at secondary schools where the reactor rates disclosed by tuberculin surveys are significantly higher than the average for secondary schools in the area. Chest clinics In conjunction with the North-East Metropolitan Regional Hospital Board and the Brompton Hospital, and in accordance with proposals under Section 28 of the National Health Service Act 1946, tuberculosis prevention, care and after-care services for patients 1iving at home are provided at three chest clinics in the borough staffed by chest physicians, tuberculosis visitors, welfare officers and clerks. Services provided from the Chest Clinics include social work by welfare officers and assistance in cash or kind not available from official sources by chest clinic committees from their voluntary funds. The North-East Metropolitan Regional Hospital Board announced during the year that the chest clinic services for Tower Hamlets and Hackney would be centralised at the London Chest and Bethnal Green Hospitals, and that the Poplar and Stepney Chest Clinics would transfer to the London Chest Hospital in July 1971 and January 1972 respectively. 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; extranourishment; rehousing of selected tuberculous families; recuperative holidays; 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 chest diseases care 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. Cap]in, Consultant Chest Physician to the Chest Clinic at the London Chest Hospital reports: "As far as the Chest Clinic at the London Chest Hospital is concerned, 1970 was the end of an era. The Chest Clinic was founded in 1915 as the Tuberculosis -17- Dispensary for the southern part of Hackney. Later, in 1917, its area was enlarged to include the whole of the Borough of Bethnal Green. Since then the Tuberculosis Dispensary - or the Chest Clinic as it is now called - has witnessed many important changes. The more important of these were a dramatic fall in the incidence, prevalence and mortality relating to tuberculosis, an equally dramatic rise in the incidence of lung cancer, and, finally, recognition of the medical and social problems resulting from chronic bronchitis. These changes have been seen against a background of considerable improvement in living conditions in this area. There are four other chest clinics within a two-mile radius of the London Chest Hospital, and al1 are within the adjoining Boroughs of Tower Hamlets and Hackney. It has now been agreed that from the latter part of 1971 these should be gradually absorbed by the London Chest Hospital to form one large chest clinic serving both boroughs. Such centralisation should provide increased faci1ities for investigation and treatment. During 1970 agreat deal of planning, preparation and building has taken place to ensure a smooth changeover as the other clinics are absorbed over a period of a year or so. In addition all the ordinary work of the Chest Clinic has been maintained, and this has changed little compared with the last three or four years. Our Care Committee has again provided us with invaluable support and help for those of our patients in need. In spite of the Welfare State there are still those patients who can onlybe helped from voluntary services, and I am grateful to the work of our Care Committee whose responsibility will be enlarged with the absorption of the other chest clinics in Tower Hamlets and Hackney." Dr. R.M. Orpwood, Chest Physician at the Poplar and Stepney Chest Clinics, reports: "The pattern of slow change in Respiratory Medicine has continued during the year 1970. While the numbers of fresh cases of Pulmonary T.B. showed no marked drop, the increase in other respiratory conditions has become more obvious. There must still be some passage of time, at present difficult to determine, before we see the disappearance of T.B. from this area. Unfortunately, other respiratory diseases, e.g. cancer of the lung, chronic bronchitis, etc., show every evidence of becoming an increasing problem. A two-pronged attack on both fronts must, therefore, be continued, with no scaling down of effort. Non-tuberculous chest disease frequently demands the use of methods of approach for diagnosis and treatment not easily available except to specialised centres. Some of this work is not always possible with the limited facilities of the older type of Chest Clinic set-up. I welcome, therefore, the plan that the functions of the Chest Clinics at Poplar and Stepney should be, in the near future, transferred to the London Chest Hospital, where such facilities are readily available. This will make a considerable contribution to dealing with the medical and other problems of the patients. -18- The existing Stepney Chest Clinic has been functioning continuously at Steels Lane since it was opened by the Stepney Borough Council in 1936. The value of the work there is vindicated in the way, during the succeeding years that tuberculosis has almost, although not entirely, disappeared from our midst, The more concentrated approach at a larger, hospital-based Chest Clinic, cannot fail to continue this trend. The activities of the two Care Committees have continued as in previous years Grants were made from the Voluntary Funds to patients in need, particularly pensioners and those in financial difficulties following a long periodof i11ness. Gifts were made at Christmas-time to patients ill at home, to enable them to have extra comforts. Donations to the Funds were received from local firms in response to the annua] appeal, but the income is falling every year. The Committees hope, however to be able to continue this voluntary effort as long as the need exists." Health Control of Immigrants During the year, 529 advice notes of immigrant arrivals, were received in the department from various ports of entry and successful contact was made in 351 instances Of the remaining 178 some had moved to addresses outside the borough, and details were forwarded to the authority concerned, but the majority were either not known or had never arrived at the address given. One immigrant suffering from tuberculosis was admitted on condition that she reported to the Medical Officer of Health for examination. Arrangements were made for her to attend a Chest Clinic. VENEREAL DISEASE The annual return received from the Venerea] Disease Clinic at the London Hospital shows the new cases attending the clinic during the year were as follows:- Area of Residence Syphilis' Gonorrhoea Other Conditions Total (1969) Tower Hamlets 52 541 1,931 2,524 (2,469) Other London Boroughs 139 1,193 5,164 6,496 (6,064) Other Areas 24 148 1,014 1,186 (1,392) To tal 215 1,882 8.109 10,206 (9,925) Returns received from 8 other hospitals in London of new patients attending their clinics during the year showed that 231 were residents of Tower Hamlets, comprising 6 syphilis. 35 gonorrhoea and 190 other venereal conditions. -19- Two welfare officers appointed by the Council work from the ^hitechapel 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 215 new cases of syphilis in 1970 compared with 229 in 1969, with 1 882 new oases of gonorThoparcompat-ed with l,693iand with 8,109 cases of other conditions compared with 8,003 last year. The highest total for new cases (2,524) was for Tower Hamlets representing an increase on the figure for 1969 which was 2,469. The figures for Tower Hamlets included 52 cases of syphilis, compared with 72 for 1969, and 541 cases of gonorrhoea compared with 466. There has been an increase of 75 in the number of cases of gonorrhoea for Tower Hamlets. This increase would undoubtedly have been greater if it had not been for the activities of the Contact Tracers. By bringing infected women to treatment they have kept the infectious "reservoir" of gonorrhoea as small as possible. In the period January to December 1970, 5 of 17 alleged sources of early syphilis in men were brought for examination and 3 were found to be infected. Five other contacts attended and 3 were found to be infected. In the same period 1,270 male patients suffering from gonorrhoea were seen; 434 women who were alleged sources of infection were examined. Of this number 409 (92%) were infected. 181 other contacts were also examined and 127 (70%) were found to be infected." Mrs. Lamb, one of our Contact Tracers at the Whitechapel Clinic reports as fol1ows:- "in December 1964 more active contact tracing was commenced at the Clinic. The intention was to try to gain enough information from the male patients who were suffering from syphilis or gonorrhoea to ensure the attendance of their contacts and thereby reduce the spread of venereal infection. In the clinic I interviewed any man who was found to be infected. I found the majority of patients were co-operative and tried to be helpful. When possible I completed a form giving details of the contact, including name and address, , full description and any other relevant information. I tried to build up a composite picture of the woman; of her habits such as smoking, drinking and drug taking and of the cafes and public houses she might frequent. This interview couldbelong and although it demanded patience and perseverance it was sometimes most rewarding and I rarely met with rudeness or antagonism. -20- I have a private office with a telephone line which does not pass through the main hospital switchboard. This I find invaluable. Many patients ask their contacts to telephone me to discuss the problem, thus providing them with a persona] link and smoothing the way to the first visit. I am able to mitigate unnecessary fears and to coax frightened girls to meet me outside the hospital or at the nearest tube station. I have brought young girls who have been literally terrified of being examined The doctors and nurses have patiently and skilfully allayed their fears I particularly remember asixteen year old girl who was acontact of early syphilis and gonorrhoea. It took a very long time to persuade her to submit to examination She eventually did and was found to have secondary syphilis and gonorrhoea Moreover, she was a very promiscuous girl. When adequate descriptions were obtained of contacts in other parts of the country, I sent them either to the Medical Officers of Health concerned or direct to the clinics in the area When contacts were abroad, to the Ministry of Health in London. The tracing of contacts presented many difficulties. In some cases I was given a false address, or contacts had just moved or been turned out by irate landladies. Many times the women concerned had been admitted to hospital with severe pains in the abdomen, presumably due to salpingitis. I often had to make several visits before finding the contact at home and even when she was finally traced, the inte rvi ew was not easy as it was essential to speak to the worn an alone. Naturally enough many contacts asked the inevitable quest ion of "who gave my name?" Some said they were clean one even showing me a gleaming electric kettle and oven to prove it. Some disliked hospitals, doctors and particularly "needles". There were those who resented, not unnaturally, the suggestion from a complete stranger that they should attend a clinic for tests There were those who threatened to sue me and those who asserted that they were virgins. One elderly woman assured me I had obviously been given the wrong information because she was a Christian. Prostitutes were difficult to trace because they used so many different names and could change their appearances quickly and easily. Their addresses changed as quickly as their names and coiffures. They would also change their professional areas for a few weeks and then return again. The situation was not conducive to detection, Many girls, not al1 of whom were prostitutes, drift from large town to town by being pickedupby lorry drivers. These easy pick up girls stay with one man for a few days and then drift off with someone else. Such ephemeral relationships make the work very much more difficult. A girl may be named as a contact by several men after she has already moved elsewhere. During my first year there was a large number of male Pakistani patients with early infectious syphilis. These immigrants are notparticularly promiscuous -21- but neither are they easily assimilated into the ordinary local society, partly because they speak very little English and par11y because of their very different customs. Thus they do not easily find girl friends, their wives are invariably back home in Pakistan and they resort to local prostitutes. To get descriptions from such patients was well nigh impossible. Apart from the language difficulty they were extremely reticent and loath to discuss their personal affairs. However a pattern of what was taking place soon became apparent. A girl would go into one room of a man who would not have to pay and then the other men of the house would come to her. leave money and depart. The room was probably dark and the men would hardly see her. The prostitutes found this very easy and lucrative. Soliciting as such was unnecessary and should anyone recognise the girl, his limited command of English would debar him from describing her, even if he wished to do so. Because it seemed impossible to get descriptions of contacts from this group of immigrants I decided to bring to the clinic the prostitutes who could be seen around the area in the cafes and clubs mostly patronised by Pakistanis. I felt that if I could gain the confidence of these girls I might be able to persuade them to attend the clinic regularly for tests. I explained to them the dangers of the infection to which they might be exposed and its damaging results if left untreated. Eight prostitutes from the area concerned were treated at the clinic for infectious syphilis. These girls must have been the cause oof much of the epidemic and seven of the eight had been approached by me. They may well, if not treated, have infected hundreds of men. About this time I received a notification from Copenhagen of aprostitute said to have infected a Dane with primary syphilis. I called on this woman and brought her to the clinic and she was treated for infectious syphilis. The major aim of my work was to bring to treatment the sources of gonococcal infection and thereby reduce the number of men attending the clinic with gonorrhoea. 1963 was the last full year before active contact tracing was carried out in the Whitechapel Clinic. In that year 1741 cases of men attending with gonorrhoea were treated. In 1965, the first full year of active contact tracing the number of male cases of gonorrhoea dropped ky 475 to 1266. This was a a fal1 of 27.3%. For the first year I shared the work with a part time colleague, Miss B. Muspratt; but since 1966 have had a full time colleague, Mrs. D.M King. We cover all clinics from 10 a.m. to 7 p.m. from Monday to Friday, only missing the Saturday morning session. During these years of contact tracing the cases of new men treated for gonorrhoea have dec]ined by 30%. In 1960 there were 1677 and in 1969, 1171. The ratio of men patients to women has changed from 3.9 to 1 to 2.2 to 1. The decline in the total male and female cases of 20% is to be compared with the national increase of 33%. -22- I am convinced that tracing of contacts of patients who suffer from venereal disease provides the greatest hope of reducing the incidence of syphilis and gonorrhoea.". COMPENSATION FOR STOPPING EMPLOYMENT Section 41 of the Public Health Act 1961 makes provision for a Medical Officer of Health to request any person to discontinue work with a view to preventing the spread of infectious disease, such person to be compensated for any loss suffered as a consequence. Notices under this section were served on six occasions during the year. 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 4 during the year. -23- -24- PART III PERSONAL HEALTH SERVICES I I I PERSONAL HEALTH SERVICES The Principal Nursing Officer, Mrs, D.E Marrin. reports as follows:- Main changes in the nursing services "The home nursing and the p reventive nursing services ( he alth vi s i to rs . school nurses and clinic nurses) have moved slowly towards integration during the year. In preparation for an integrated health service, liaison between the local authority nursing services, the general practitioners and the local hospitals has steadily increased. In November a Liaison Nursing Officer was appointed by the London Hospital for the purpose of assisting in estimating the future nursing needs of the Borough community. To facilitate co-operation with the local authority services generally and to exchange ideas in the interest of the community, aNursing Liaison Committee has been established. Meetings are held at the London Hospital and are at tended by the Borough's Principal Nurs ing Of f i cer . Sickness The senior nursing officers experienced an aggregate of nine months sickness during the year. This 1 ed inevitably to some 1imiting of continuity in supervisory and o ther dut ies and 1 imited to some extent the ful1 support which i s des i rabl e for newly trained and newly recruited staff. Senior Nursing Structure - Mayston Report The Department of Health& Social Security requested by December 1970 a plan for a senior nursing structure to include first, middle and top 1ine management as described in the Department's Mayston' Report. Early implementation of such a structure would relate the Local Authority nursing services with those of the hospitals, which are rapidly re-structuring on similar lines as recommended in the Salmon' report. In addition to this correlation with the hospital services it is hoped that the introduction of suchaplan will lead to a career structure, with clearly defined roles for the management grades, and will attract and retain younger members of staff for the future development of the services. Home Nursing Service A total of 85,129 visits were paid by the home nurses during the year, an increase of 200 on the previous year. Approximately 60% of these visits were paid to the elderly, and close liaison was maintained between the home nursing and the home bathing service. Three home nurses paid visits of observation to cyto!ogy sessions held in the clinics. In order to give a more efficient service to the patient and to improve the -25- liaison between general practitioners and the local authority services , home nurses were attached to three genera] practitioner group practices. Conferences and study sessions of varying lengths were attended and appreciated by 19 home nurses throughout the year. Day Nurseriies Throughout the year, an average of 107 children (and their families) were helped by the provision of nursery vacancies. Many of these children were from home back-grounds having multiple difficulties and in consequence made considerably demands on the skills of the nursery staff. Despite frequent staff shortages and lack of fully trained personnel, the staff continued to give of their best to provide a happy environment for the children. Child Minders and Pre -School Playgroups In December, there was a total of 37 registered Child Minders and 24 Pre-school Playgroups. The work of inspection, registration and supervision of all groups was continued. Health visitors visited and advised all established child-minders and groups but follow up visits by the Assistant Nursing Officer were also necessary to maintain satisfactory standards and to check on health aspects, changes in staffing and attendances. The Assistant Nursing Officer responsible continued to assist with courses for mothers attending clinics, for playgroup leaders, child-minders and creche attendants. Several of these courses were organised in conjunction with adult education colleges in the Borough. In addition to advising on a wide range of enquiries from the public, the Assistant Nurs ing Of f ice r superv i s ing , formedthe link between the Council and voluntary organisations. School Health The Health Visitors and Clinic/School Nurses are responsible for the surveillance of the genera] health and care of children in nursery, primary and secondary schools. The health visitors' contact with the fami ly environment can be useful to the school staff in understanding the behaviour of children. Three School Treatment Centres are available in the Borough to deal with minor ailments, verrucae etc. Vision and Special Investigation sessions are also held at these centres. All types of sessions held at these centres frequently highlight problems of deeper significance in the children attending. School nurses and health visitors continue to play their part in the prophylaxis programme and no opportunity is missed by the staff for 'one-to-one' health education in whichever sphere of service they happen to be engaged. -26- Hair infestation in school children did not decline during the year commensurately with the efforts of the staff spent in trying to eradicate it. Observations made by a health visitor on the diminishing effectiveness of preparations being used for head cleansing led to a small survey being conducted in one area of the Borough and the trial of a new preparation which it is hoped may reduce the incidence in the future. Maternity and Child Health Centres The Health Visitor as a 'non-crisis visitor' is in a unique position within the health and allied services Her work is mainly preventive with the objective of assisting inpromoting and maintaining the total physical and mental health of the family. The majority of health visitors have good contact with the Genera] Practitioners on their areas, often calling at their surgeries for liaison purposes and have maintained and increased their links with local hospitals. They attend paediatric, developmental and psychoprophylactic sessions in hospitals, thus providing a link between hospital and home. This increasing liaison with allied services will inevitably lead to a lessening of home visits being made by the Health Visitor, with the diminishing time available to her for this purpose. Health visitors are frequently invited to case conferences in hospitals and with other borough and allied services in an attempt to provide the most comprehensive care and assistance for the pat ient and family. Their taskofhealth education and social advice continues undramatica]1y but none the less effectively in the homes, schools, clinics and various groups in the fiorough - the child in the family and school setting being the focal point of their work. The results of their work will be long-term rather than immediate. Twenty-eight Health Visitors and Clinic/School Nurses have attended and appreciated conferences and courses of varying lengths and on various topics throughout the year. These courses are important if the staff are to be kept up-to-date in their knowledge. They are also helpful if the staff in the preventive health field are to maintain their morale and not feel themselves considered as just a residua] service in the coming changes in the Local Authority services. A total of 504 observation visits were arranged by the Maternity and Child Wei fare and Schools sections for students from allied professions, for the purpose of orientation in the Local Authority health services. The total of 50* visitors was made up as follows:- 30 Pupil Midwives 97 Medical Students 18 Post Graduate Students 14 District Nurses 344 Student Nurses 1 World Health Organisation Nurse Planner -27- The staff were unstinting in their efforts to make these observation visits pleasant informative and useful for the students Midwifery In addition to her statutory functions the Supervisor of Midwives has continued to co-ordinate and to liaise with the hospitals general practitioners and clinic staff on cytology fami1y planning (inc1uding domiciliary) and Guthrie tests" ante - and post hiatal clinics Sessions are conducted in Council clinics by midwives and medical officers for ante and post-natal examinations In addition four general practitioners undertake ante natal work for their own patients in Council clinics which are made available to them free of charge and with a domiciliary midwife in attendance (Statistics on page 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 of children Adopt ion Persons proposing to adopt children are required to submit medical certificates as to their health before a child is placed with them These certificates are verified by the Medical Officer of Health before consent is given Similarly the medical records of the children to be adopted are scrutinised and the Children's Officer advised on the child's suitability for adoption Should the reports reveal any medical defects inheritable disease or handicap in the child further enquiries are made and, in the case of inheritable disease in the natural parents the prospective parents are interviewed by their own practitioner Boa'dsng Out The medical examination is given in accordance with the Boarding Out of Children Regulations 1955- and includes the Wasserman and/or Kahn tests except where the child is over school leaving age or is boarded out in an emergency or in accordance with Part III of the Regulations Again the resultsof these medical examinations are scrutinised in the Health Department and the Children's Officer informed as to their suitability. -28- The following is a summary of the cases dealt with from 1967 - 1970:- 1970 1969 1968 1967 Adopt ion Cases Children suitable for adoption 25 33 37 37 Children suitable for adoption subject to certain conditions - - - - Children unsuitable for adoption - - 1 1 Couples suitable to adopt children 23 39 36 54 Couples unsuitable to adopt children - - 1 2 Boarding Out Cases Children suitable for boarding out 44 43 33 57 CERVICAL CYTOLOGY The service for the collection 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 regular sessions in his surgery, assisted by a member of the staff of the Health Department, and the Family Planning Association continued taking smears at sessions held in Council clinics. From these 2,055 examinations were carried out. In addition, hospitals in the area read 11,783 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. CONGENITAL DEFECTS Notification of congenital abnormalities under the national scheme recommended by the Ministry of Health in 1963 continued throughout the year. Defects found in stil lborn and 1iveborn children within 36 hours of birth were noted on birth notification forms by hospital or domiciliary staff, details of which are as follows:- Number of babies notified as having one or more congenita] defects 36 Number of stillbirths and 1ivebirths notified over the same period 2,503 The rate of notifications per 1,000 total births was 14.3 compared with 12.8 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. -29- CHILD MINDERS An Assistant Nursing Officer, appointed for the purpose, visits all applicants for registrat ion as child minders and reports on their suitability, on the conditions existing in the premises and on the measures necessary to comply with the Nurseries and Child-Minders Regulation Act, as amended. Since February 1969 women who applied for registration or who otherwise came to the notice of the department numbered 358; of these 261 had cancelled or withdrawn their applications for various reasons. Registrations effected numbered 11 and 10 were refused registration. Further details will be found on page 92 of the Appendix. 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 131 of the Appendix. CRECHES Children can be placed in creches for an afternoon at eight 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. Attendances numbered 7,362 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 -30- age. Three of the nurseries are classified as training nurseries and provide practical training facilities for student nursery nurses undertaking courses for the examinati'oni 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. Notification was received from this voluntary association, the Council of the Stepney Jewish C)ubs and Sett 1ement. that through financial difficulties inmaintaining the high standards of the nursery under present rising costs they intend to open negotiations with the Inner London Educat ion Author i ty wi th the obj ec t of that Authority taking over this day nursery as a maintained nursery school. Children are admitted to the nurseries in the following circumstances: First priority is given to cases where the mother is in ill-health and cannot adequately care for the children, or during a mother's confinement; where living conditions are detrimental to health or where it is considered desirable for the health of the child that it should be admitted to a nursery; where mothers are required to work because they are widows, unmarried, separated or divorced or whose husbands are totally disabled or in prison, provided the mother works at least 35 hours a week. In addition there are the second and third priority categories, for children whose mothers are compelled to go to work as an economic necessity, and where vacancies are not required in the other priority classes, for children whose parents are both working, provided that the mother is employed 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 73 the turnover of staff for the year was considerable. Under the Urban Aid Programme the Home Office agreed to make a grant towards the construction of a purpose-built Day Nursery in 1970/71, at an estimated cost of £48,290, to replace existing unsatisfactory premises. The premises were under construction at the end of the year. Private day nurseries and pre-school playgroups are also subject to the provisions of the Nurseries and Chi 1d-Minders Regulation Act 1948, as amended. At the end of the year two private day nurseries and 22 playgroups were registered which provided facilities for 485 children. Under the Urban Programme (3rd phase) the Home Office approved revenue expenditure of £7,000 for grants to voluntary playgroups. Statistics will be found on page 92. -31- DEVELOPMENTAL ASSESSMENT CLINIC Almost three years ago a combined local authority and hospital assessment clinic was set up for the detection of al1 defects which might be present, i.e. defects of function, development and behaviour and the social limitations interfering with or preventing normal development of children. The Assessment Clinic is based at the London Hospital Children's Outpatients Department, where a clinic for children with cerebral palsy was already in existence. The clinic functions on one day a week, and although it serves mainly Tower Hamlets, children from neighbouring boroughs are also seen. Increasing numbers of chi1dren are being referred by the local authority medical officers, following consent having been obtained from the family doctor,and by consultant paediatricians from other hospitals in the borough, as more doctors, health visitors and social workers concerned in the care of these children realise the value of early assessment, treatment and training of bo th physical1y and mental 1 yhand i capped children. Assessments prior to adoption have been undertaken for the Children's Department of the local authority. The staff of the Assessment Clinic consists of a Consultant Paediatrician, a Principal Medical Officer of the Health Department, a Psychologist, two Physiotherapists, an Occupational Therapist, a Speech Therapist, a Medical Social Worker, Health Visitor and a Nursing Sister (see photographs) Apart from diagnostic assessments, follow-up assessments are made to ensure comprehensive continuing c are which includes parent guidance,pounsel1ijig and integration of efforts of all concerned. A child with a physical handicap e.g. cerebral palsy, and his/her parents, receive any necessary help and supervision by the physiotherapists and occupational therapist, who also obtain any special equipment or appliance considered necessary for the child. The Principal Medical Officer and the Health Visitor co-ordinate the work of the clinic and health department, ensuring that these children, who are placed on the Observation Register, receive continuing support from the community. Any help that can be given by local authority facilities is recommended e.g. attendance at a day nursery, creche, play group, nursery school or special care unit of the junior ing school. Special educational help is required for some children. FAMILY PLANING Family planning sessions conducted on behalf of the Counci1 by the Fami1y PIanning Association are held at three of the Council's Clinic Centres, 340 sessions being held during the year. In addition. Council sessions staffed by Medical Officers and Health Visitors are operated at a further three clinic centres The Council providesa domiciliary service particularly for families with multiple, social, or other hand icaps. -32- Assessment Clinic - hearing test in progress Assessment Clinic - vision test in progress This year new patients numbered 1,250 an increase of 170 over last year. Statistics on page 95. 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. It was not found necessary to utilise these facilities during the year. HEALTH EDUCATION Health education continued to take its part in the department's activities during the year, albeit at a reduced pace as the Health Education Officer was on leave of absence attending a teacher training course, and other staff changes took place in the section. Liaison with schools continued, the teaching staff now showing more interest in the work of the department and appreciating the need for health education.Ass istance was given to the London Hospital with community training of Degree Nursing Students and to the Superintendent of Home Nursing with in-service training of nursing auxi1iaries. 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, genera] practitioners and hospitals in the Borough. Their visits to expectant mothers and to children under five years of age are shown with other statistics on page 95. Health education work is carried out by means of personal contact as well as in group sessions held at the clinics. At the request of the paediatricians concerned health visitors attended the out-patients departments at hospitals to provide a link between hospital and home. The numbers of health visitors including centre superintendents and tuberculosis visitors employed at the beginning and end of the year were 39 and35 respective!y, these being 24 resignations and 20 appointments during the year. Command Paper '1973 recommended an establishment for the year 1967 of 36 health and tuberculosis visitors, based on aproportion of 0.18 visitors per 1,000 population, which ratio would equate to 33 staff for the current year. HOME NURSING An increasing number of patients are being nursed at home by the District Nurses, partly because of earlier discharge from hospital e.g. , for sutur'e removing. . 57% of patients are over 65 years of age. -33- Three senior staff completed the first course of Practical Work Instruction during the year, two of whom will be doing the advanced course in 1971. This complete course (1 month) is equivalent to afirst-1ine management course. Three staff completed a District Nurse Refresher Course. These courses are taken every five years,depending on the needs of the service.As refresher courses become due it is shoped to send'all seinior staff to Practical Work Instruction Courses. Three State' Registered Nurses completed the District Nurse Training course and obtained the National Certificate. One State Enrolled Nurse had a course of District Nurse instruction. The following number of pupi1s from the London Hospital undertook the Integrated course of training. 16 pupils for 2 days District Nurse training, 14 pupils for 2 weeks District Nurse training and 5 pupils for final 6 weeks District Nurse training, all being successful in their examination. Nursing Auxiliaries assist District Nurses by undertaking the bathing of patients in their own homes, thus allowing them more time for nursing duties.Twopi1ot schemes for Group Practice attachment were commenced in 1970. In each case a nursing auxiliary was attached with a trained nursing sister, each practice having its own relief nurse for off-duty days, holidays, sickness etc. Statistics relating to the Home Nursing Service are on page 97. LAUNDRY SERVICE Soiled personal clothing, bed linen, etc., is collected at least twice weekly from the homes of persons who are incontinent, and cleansed and laundered in the department's laundry at Branch Road Cleansing Station. 42 more persons received the service than last year, despite a withdrawal of 1abour by the Council's vehicle drivers which affected the collection and delivery service. A photograph of the laundry at work faces this page. 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 chronically ill aged persons. Over 36,000 pads plus knickers and linings were purchased during the year and issued to 185 persons, 12% more persons than last year receiving this service. LOAN OF NURSING EQUIPMENT Articles of nursing and sick room equipment are loaned at the request of the general practitioner, district nurse of hospital medico-social worker, etc., free of charge for an indefinite period to persons being nursed in their own homes. The -34- Laundry for the Incontinent 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 responsibility of nursing. Under the Welfare Scheme grants are made on behalf of the Foundation towards the cost of hire or supply of special equipment, linen, bedding etc. A grant is made by the Council to the Foundation. DOMICI LIARY MIDWIFERY SERVICE The Council operates a domiciliary midwifery service under Section 23 of the National Health Service Act 1946, by an arrangement: for utilising the services of midwives employed by the London Hospital and the Nursing Sisters of St. John the Divine. In addition the Council directly employs 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 with 4 pupils under training at the end of the year. The Council pays to the hospital 40 per cent of the expenditure involved under the provisions of the Ministry of Health Circular 8/56. There were 194 home confinements attended by the Midwives. Four general practitioners from practices in the Borough provided ante-natal care, with midwives, at four of 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 during the year their intention to practice as midwives within the Borough, including those in hospitals was 127, the number practising at the end of the year being 80. MATERNITY LIAISON COMMITTEES The department is represented on local maternity liaison committees by the -35- Medical Officer of Health or Principal Medical Officer 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. VACCINATION AGAINST MEASLES Vaccination against measles for al1 chi1dren up to the age of 15 years continued' 2,201 children being vaccinated dur ing the year , including 255 by general practitioners. VACCINATION AGAINST RUBELLA Notification was received from the Department of Health and Social Security that vaccination against rubella could be offered to all girls between their 11th and 14th birthdays, but that initially priority should be given to older girls, i.e. those in their 14th year (13 years old). The purpose is to ensure that as many girls as possible are offered protection against rubella by vaccination before reaching childbearing age because of the known association of certain foetal abnormalities with rubella infection in pregnancy. By the end of the year 515 girls aged 13 years had been vaccinated - 50 by general practitioners and 465 at Council Clinic Centres. OBSERVATION REGISTER At the end of the year, the Observation Register totalled 6,010 persons, comprising:- Children under 5 "at risk" 2,902 -do- handicapped 304 Young persons aged 5-21 years handicapped 2,594 Children non-resident but attending schools in the Borough 210 The Principal Medical Officer keeps the register under constant review. Further details relating to the regist;err will be found on page 84. A booklet produced by the department sets out details of the services available for the care of handicapped children and young persons provided by the Council, the Inner London Education Authority and by other statutory and voluntary bodies. PHENYLKETONURIA Tests for phenylketonuria are carried out by means of the Guthrie method on all babies. Co-operation is redily 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 domici1iary births by attending midwives and for health visitors to deal with other babies found not to have been tested. -36- PREMATURE BABIES Any child weighing 5½ lbs. (2.500 grammes) or less when born is regarded as premature, and necessary advice and assistance is afforded to mothers with premature babies. Statistics relating to premature births occurring during the year will be found on page 95. PREVENTION OF BREAK-UP OF FAMILIES A Co-Ordinating Committee comprising officers of the Children's Health and Welfare Departments of the Council, of the Education Welfare Service of the Inner London Education Authority, and of the Greater London Council Housing Welfare Section, together with fieldworkers from various agencies both statutory and voluntary, meets frequently, with the object of ensuring that the most effective use is made of existing resources provided by statutory and voluntary services and available for the welfare of children in their own homes. The Health Department is represented on this Committee by the Principal Social Worker (Health Services) who also acts as Convenor to the Committee. A high proportion of the Committee's time is taken up wi th the problem of preventing homelessness caused by, rent arrears. A total of 46 cases was considered during the year with 17 individual case conferences being held. Of these conferences nine concerned families at risk through rent arrears. Sixteen specially difficult families were dealt with during the year by a family case worker who was employed in the department until July. 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. A total of 404 adults and children were placed in recuperative holiday homes during the year, including 205 school children for whom the Inner London Education Authority made arrangements. One Inner London Borough is responsible for the inspection of holiday homes on behalf of other boroughs included in the scheme which share the costs involved. During the year reports were received of 50 homes inspected 44 of which were recommended for continued use. (Statistics on page 97). -37- 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 Welfare 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 cases of illness occurring and advise on medical aspects of child welfare, hygiene and the prevention of infection. The department is also responsible for the provision of relief nursing staff as required at these establishments. 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 an obligation 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 service carry out this part to 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 at every dental surgery. Dental Auxiliaries are trained to treat very young children as a speciality and it is to the dental auxiliaries on the staff that the majority of pre-school children go. -38- WELFARE FOODS AND VITAMIN SUPPLEMENTS The distribution of dried milk, cod liver oil, orange juice and vitamin tablets on behalf of the Department of Health and Social Security continued at the Council's Clinic Centres Issues during the year (Value £3,506) included:- National Dried Milk - tins 5,601 Cod Liver Oil - bottles 2,157 Orange Juice - bottles 29,839 Vitamin Tablets - packe is 1,621 Additionally, various brands of proprietary cereals, dried milk and vitamin preparations recommended by Health Visitors or Medical Officers were available at Clinic Centres, sales of these amounting to £4,140. -39- ********* -40- PART IV COMMUNITY CARE SERVICES IV COMMUNITY CARE SERVICES MENTAL HEALTH SERVICE Referrals Persons referred to the department showed a decrease of 28 per cent from last year and the number under community care decreased by 19 per cent. Admissions to Hospital In addition to community care for patients and their fami1ies the mental health social workers are responsible for the statutory admission where necessary of patients to hospital. Informal and compulsory admissions for the year numbered 149, adecrease of 12 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. onFridays to 8.45 a.m. on Mondays, during which period all requests are directed to the duty doctor at St. Clement's Hospital, Bow Road, E.3. who contacts the mental health officer on duty as required. Approval of Doctors under Mental Health Act 1959 The Mental Health Act 1959 provides that one of the two medical recommendations required for the compulsory removal of mentally disordered persons to hospital shall be made by a doctor approved for this purpose by the local health authority as having special experience in the diagnosis or treatment of mental disorders. Two 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 15 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 -41- organisation, and in hostels provided by other local authorities and voluntary associations Where patients are in employment or have other incomes, an assessment is made to determine their contribution towards their maintenance, Apart from one under guardianship, 42 other persons were in hostels at the end of the year and were being financially supported by the Council. In addition there are 12 subnormal and severely subnormal children in care of the Children's Department in residential homes The Council has inc1uded in its Capital Programme the construction of a hostel in the borough to provide residential accommodation for mentally subnormal males- Junior Training School The purpose built Junior Training School opened its doors at the beginning of the January term The School provides training places for 95 mentally severely subnormal 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. The Education (Handicapped Children) Act 1970, which received Royal assent in July, made provision as from a day to be appointed, for removing the powers for classifying children suffering from a disability of mind as unsuitable for education at school and for removing the power and duty of a local health authority to make arrangements for the training of children of school age who suffer from such a disability. The ‘appointed day’ was subsequently fixed as the 1st April 1971. so that the new school referred to above, of which the Council is justly proud, is to be in the possession of the Council but 15 months before transfer to the Inner London Education Author i ty Special Care Unit Provision is made for a Special Care Unit (see photograph) in the new school for those trainees who are too severely handicapped to be taught and trained with the other juniors 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 cent re, the special care unit, psycho-geriatric pat ien t s attending the Day Centre and some of those attending the men's industrial centre., Hot idays Many trainees from the training centres take part in a holiday at a holiday -42- The Special Care Unit of the Junior Training School camp at Dymchurch, Kent, joining groups of trainees from other London Boroughs. Recuperative holidays are arranged for mentally ill persons under community care. Parents Association Effective liaison with the Tower Hamlets Society continued throughout the year. This society comprising mentally handicapped children and young persons receiving community care and their parents, relatives and friends is a very active organisation in the borough and arranges many activities, social and cultural, for its charges. Quarterly meetings of the Society are attended by an officer of the department to further the liaison between the Society and the Council, and to discuss common problems. The 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 avai1able one evening each week for experimental reading and writing classes for mentally sub-normal chi1dren at which the head teacher of the training school gives her services. Day Centres There is a Council day centre for the mentally ill and two others administered by a voluntary organisation in the borough, 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 dayon five days a week and are provided with a midday meal and light refreshments. An increased service for psychogeriatric patients was commenced during the year, by the opening of the Council's day centre for these persons on five days a week, instead of three days per week. A social club for day centre patients is held on two evenings per week at which staff of the Centre voluntarily give their time. One of the Supervisors commenced an Art and Educational class this year. 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. -43- A social club for the trainees is held at the Industrial Training Centre 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. Included in the Council's Capital Programme is the construction of an Adult Training Centre to replace the two centres mentioned, at an estimated cost of £180,000 It is hoped that construction will commence next year. Industrial Work at Training and Day Centres Industrial work undertaken during the year, included such tasks as assembling egg cups, egg slicers, making bed blocks, playing bricks, toy irons and ironing boards, tidy boxes, sorting trays, blackboards and easels, test-tube racks, Wendy dressers, dolls cots, needlework boxes, trays and childrens chairs, thumb-holing medical boxes, rivetting handles to travel bags and repairs to furniture. Amounts received for work executed by the trainees amounted to £3,735 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, 215 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 A statistical report received from the London Hospital shows that in-patients suffering from mental illness and discharged from four hospitals in the borough (London, St. Clement's, Mildmay ssion and Queen Elizabeth Hospitals) numbered 1,192 during the year from 148 available beds. New out-patients seen totalled 1,858their attendances amounting to 16,501. The Drug Addiction Unit at St. Clement's Hospital saw 88 new patients attending on 7,832 occasions. -44- New out-patients seen at the Child Psychiatry Clinics at the London, London Jewish and Queen Elizabeth Hospitals numbered 524 during the year with 2,708 at tendance s It is estimated that two thirds of the patients referred to in the above paragraphs are residents of the borough. Statistics relating to the Mental Health Services appear on pages 100 to 102. REHABILITATION AND AFTER CARE OF ALCOHOLICS (including Crude Spirit Drinkers). In an attempt to rehabilitate crude spirit drinkers and other alcoholics a joint scheme between the Council and the Salvation Army came into operation last year. An assessment unit forms part of the Salvation Army's new premises, Booth House, Whitechapel whence suitable cases are sent for rehabi1itat ion 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 makes agrant towards this expenditure under the Urban Aid programme. 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 116 examinations by a consultant ophthalmologist during the year and certificates accepted from other local authorities, hospitals and private ophthalmologists numbered 76 Transport to the clinic for examination is arranged for these persons where necessary. CHIROPODY Treatment is provided free to old persons in receipt of retirement pensions, expectant mothers, school children and the physically handicapped. Foot clinics are held at 8 of the Health Department's establishments and at 3 other establishments providing a total of 36 sessions by one full-time Chief Chiropodist and eight part-time chiropodists. For those unable to attend clinics, six of the chiropodists visit their homes to give treatment. The average number of patients treated per clinic session was 7 and the average time between clinic appointments was 10 weeks. Transport sessions whereby selected patients are taken to a clinic, have proved successful, not only for reducing the cost on the domiciliary service, but as a means -45- of enabling some of the aged and physically handicapped persons to get out of their homes if only for an hour or two. This has brought about a waiting list for this service and plans are in hand to extend the number of such sessions in a clinic designed for the treatment of those with limited physical abilities. With the increasing awareness of foot health, talks on this subject were started for mothers' clubs at clinic centres to assist young mothers to understand the foot problems of their children in addition to their own, especially during and after pregnancy when so many foot problems may develop. 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 ahospital or welfare home. At the end of the year 264 home helps were employed by the Counci1. The present standard charge for home help service is 10/- an hour which is 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 certificattes. An in-service course of 7 lectures designed to assist home helps in their work was attended by 29 home helps. Households numbering 3,765 were provided with the service during the year compared with 3,724 last year. (Statistics on page 96). DAY CARE SERVICE The day care service continues 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 necessary adaptations including plumbing, electricity and water supplies to another dwelling in the borough where a renal dialysis machine was being installed -46- by the London Hospital. The cost of adaptation was £671. 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 is of increasing assistance in relieving 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 45. (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 8 persons, 7 of whom were removed to hospital and one to a Welfare home. -47- ********* -48- PART V ENVIRONMENTAL HEALTH SERVICES V. ENVIRONMENTAL HEALTH SERVICES The Chief Public Health Inspector reports as follows HEALTH EDUCATION “For many years health officers have been battling to impress upon the community the importance to health of observing basic standards of hygiene where food is concerned and more generally of conforming to basic principles in everyday hygienic conduct in their homes businesses and public places. There has been improvement but it is limited and does not appear to have registered with average John Citizen despite the aids such as radio television and the press used by the health officer Dirty and verminous houses and persons were commonplace, in certain areas, pre-1939 but to-day there is a marked improvement. To a large degree this can be attributed to service in the armed forces where persons, male and female. who had lived in dirty homes experienced for the first time in their lives the comfort of living under clean conditions and of personal cleanliness Unfortunately it is a far more difficult task to bring home the importance of hygienic practices in handling food despite the fact that a not unusual observation from a food poisoning victim is that "I' ve eaten something"! Health education in certain respects seems to be something which is not absorbed by the community generally. Smoking tobacco, and taking drugs have been established as very serious health hazards at the highest medical level and abundant publicity has been given but to what effect? There has been little, if any reduction in smoking tobacco and in some quarters it is thought that drug taking in a mild form should not be illegal. The attitude of the public to Health Education is difficult to understand, all the efforts that have been made appear to have registered with some of the people yet during the dustmen's strike self appointed experts on public health arose from all sections of the community overnight which did illustrate the great importance they attached to public health but revealed that their primary concern was not public health but an inconvenience to carrying on their livelihood, which they themselves had prejudiced due to not availing themselves of the emergency provisions made to dispose of their trade refuse THE EXHUMATION OF HUMAN REMAINS In recent years redevelopment has necessitated the disturbance of old burial grounds and, in accordance with ecclesiastical and statutory law, reinterment must ensue at an approved place It is a duty of the Public Health Inspector, under the direction of the Medical Officer of Health to enforce the Regulations by supervising works and ensuring that excavation and the storage of remains prior to reinterment, are conducted in the proper manner with due reverence and above all effectively screened from public view. -49- Plague pits, mass graves for the victims of epidemics rife in the past, have been discovered in this Borough, probably due to its proximity to the City. Consequently much time has been spent by the inspectors at St. Mary's at Bow churchyard. Tower Hamlets Cemetery, and at the site of the former Brunswick Methodist Chapel in Limehouse. Evidence in the vaults at St Mary's indicated that these premises had been not only popular with eighteenth century body snatchers. but that it had been frequent practice in those days to inter sawdust filled coffins without bodies. It is also believed that some of the vaults were disturbed by potential thieves, encouraged by rumours that jewellery and valuables had been buried with local dignitaries. The work of supervising such exhumations may seem to be uncongenial, but in fact it stimulates the imagination and enables one to speculate what life was like so many years ago. The human remains found were in fact in varying stages of decomposition according to ground conditions and whether or not the bodies had been buried in coffins and if so whether of lead or timber Some bodies were found wrapped in lead and other had been wholly or partially embalmed before interment The embalmed bodies were found to be in good condition. The vaults in the Brunswick Chapel contained many well preserved babies and infants, and one coffin contained a mother who had died while giving birth to triplets She was buried holding a child in her arms and still retaining the others in her womb The graveyard at this site was found to contain about 1,200 bodies in a small area but to a depth of over 10 ft., this meant that as with the other sites, the exhumation required many months of arduous work Many bodies unearthed were without coffins and had been literally heaped into the pit. This was probably a communal "plague pit" which provided a rapid means of removing the victims of an early nineteenth century epidemic On this evidence it can readily be said that the exhumations are carried out in a more reverent manner than the original burials. As the remains in the pit were unearthed the bodies were easily fragmented and the only reliable means of ascertaining the number of dead removed, was to count the lower jaw bones collected. During the excavations on the various sites many clay pipes were discovered presumably used by the gravediggers while about their work One was of particul ar interest as the base of the pipe bowl featured a football, of a design associated with the era around the turn of the 18th century (see photographs) In addition to exhumations bodies are regularly transported to other countries for burial for reasons of religious beliefs; an inspector must ensure that the body is hermetically sealed in a zinc lined coffin It must also be certified that the deceased was not suffering from an infectious disease. -50- Clay pipes discovered when exhuming human remains CLEAN AIR Notices were given to the Council of proposals to instal furnaces in eight premises. Seventeen applications for prior approval of furnace installations were received and approved. Nineteen 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 1,494 heating appliances, the total estimated grants amount ing to £28, 468. 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 8 cases on grounds of hardship. A report published by the Research & Intelligence Unit of the Greater London Council on the progress and effect of smoke control in London states that since the introduction of the Clean Air Act the amount of coal consumed in London for domestic use has fallen by 80% and that between 1962 and 1968 the emission of smoke declined by 60%. Concentrations of sulphur dioxide have not fallen so much as smoke, but despite the fact that this pollutant is not controlled by the Clean Air Act there has been a significant decrease. There is evidence to show that the symptoms of respiratory disease are less evident now that air pollution has been reduced. There has been a substantia] increase in hours of sunshine in central London during the winter months, e.g. an increase of 73% in December, and there has been no major fog for seven years. Due to the shortage of solid smokeless fuel nationally and the closure of five gas works in and adjoining Tower Hamlets which supplied the local merchants with coke, it was estimated that the shortage in this area would be in the region of 100,000 tons. It became patent that it would be necessary to supplement solid smokeless fuel with bituminous coal. As early as July application was made to the Minister of Housing and Local Government for the suspension of all Smoke Control Orders in the Borough from 1st November, 1970 to 31st March. 1971. This matter was, however, not resolved until November when the Minister finally agreed to a suspension of 40% of the Smoke Control Orders. At the time this was considered inadequate due to the fact that the whole Borough was subject to confirmed Smoke Control Orders but, probably due to avery mild winter, no cases of hardship either from consumers or merchants came to the notice of the Department. -51- FOOD AND DRUGS Food Hygiene (General) Regulations 1960 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 3,614 food premises including stalls in the area. Notices of requirements served numbered 366 and 134 summonses involving 22 premises/stal1s were heard during the year. The Food Hygiene (General) Regulations 1970 made on 3rd August 1970, consolidate and amend the Regulations of 1960 and 1962. The principal changes which come into operation on 1st March 1971, are - (1) raw food which has to be milled or refined to make it fit for human consumption is no longer outside the scope of the Regulations. (2) before food is offered for sale it must be separated from any food which is unfit for human consumption. (3) animal food must not be kept in a food room unless it is in a closed container that eliminates the risk of contamination. (4) any person handling open food must wear clean and washable overclothing, subject to certain exceptions. Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966 Stalls were regularly inspected during the week and at week ends. The issue of casual street trading licences to food traders did not take into consideration these Regulations. In some cases traders did not even have a stall and if they did, were not in a position to provide the facilities required by the Regulations To resolve this unsatisfactory state of affairs the Council decided that no casual licences would be issued to food traders selling open food. This not only solved the problem of the casual trader but al so seemed to give encouragement to the permanent traders, "Pirate" ice cream and hot dog vendors in the Tower Hill area continued to trade illegally. With the assistance of the Metropolitan Police and the Officers of the Public Control Department, some convictions for breaches of the regulations and illegal trading were obtained and fairly heavy penalties imposed by the Magistrates One trader was fined £90 with £10.10s costs under the Regulations, fined £30 for illegal trading in respect of his ice cream van and, in addition, fined £10 for failing to give information. -52- Imported Food This year has seen the closure of two up river wharves on the Wapping and Shadwell foreshores which had operated vessels for 100 years from the Continent and Mediterranean Ports. The loss of imports through wharves has been more than compensated by the increase in "containerised" goods entering this area for customs and health clearance at two large depots and for health clearance at some 25 other premises known to the food inspector, Containerisation has created a number of problems in regard to inspection and examination which are gradually being resolved by food inspectors working nationally through various committees. Of samples taken for chemical analysis, objection was taken to the 1abe11ing of 28 samples resulting in correspondence with the producers and importers. Severe insect infestations were found in dried apricots prunes and egg noodles which had been in storage on the Continent during the summer dock strike, under conditions existing suitable for the completion of their 1ife cyc1e. before arrival and distribution here these consignments were destroyed A prohibited preservative was found to be present in a consignment of tartare sauce from the United States of America and which was subsequent1y destroyed Prohibited colouring matter in sweets attached to plastic toys from Hong Kong was found and the goods were immediately returned to the manufacturers at their request in order that the toys could be saved. There has been a considerable increase in the importation of Chinese canned and bottled products which has given rise to many of the labelling offences previously mentioned. A consignment of pickled leeks was fermenting on entry and was destroyed. Rigid sampling and inspection control is still maintained on groundnuts and frozen cooked prawns Early in the year af1atoxin was found in a consignment of groundnuts from Eritrea which was detained and re-exported. Aflatoxin is a toxic product of the mould Aspergillus Flavus. which grows readi1y in groundnuts in storage and is known to cause carcinoma in turkeys and mammals. Two samples of frozen cooked and peeled prawns were found to be below the expected bacteriological standard although no pathogenic organisms were found. A strong line was taken with the producers and importers to maintain standards. One overseas producer was advertising approval by the Health Department of his country and the Trade Attache at its London Consulate was informed. 53 Food standards and the provisions and requirements of food legislation are generally being maintained by food producers, although their own countries' legislation may differ considerably. Analysis of Food and Drugs samples During the year 1,055 samples of food and drugs were submitted for analysis by the Public Analyst 19 being purchased formally, 1,013 informally, and 23 were private samples Irregular samples ascertained numbered 151. Legal proceedings were instituted in respect of one sample, namely, minced meat, which contained sulphur dioxide (390 parts per million) the addition of which is not permitted Matters taken up with manufacturers or importers included flour deficient in Creta Preparata (a form of chalk) food colour containing metanil yellow a non permitted colouring matter orange juice sweetened with cyclamates a nonpermitted artificial sweetener a jam doughnut containing a filter tip from a cigarette (the purchaser was not prepared to give evidence) dried milk powder having a moisture content in excess of that permitted by the Dried Milk Regulations cooking oil sold loose in a dirty bottle shandy having insufficient alcohol content, unsalted butter containing salt, ginger beer containing cyclamic acid vinegar containing fragments of glass parmesan cheese deficient in milk fat non brewed condiment sol d as vinegar sausages containing preservative which was not declared imported sweets containing Brilliant Blue F.C.F and Blue V R S non-permitted colouring matters, lemon cheese having alcoholic fermentation canned meat having insufficient meat lemonade deficient in sugar content non brewed condiment made from technical acetic acid beefburgers deficient in meat content sultanas and dried fruit mixture having a mineral oil content in excess of that permitted yoghourt with benzoic acid fruit salad deficient in peach content margarine with excess water cream cheese deficient in milk fat meat pies deficient in meat content. The absence inadequacy or improper declaration of ingredients on labels ascertained in 53 samples 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- Bacteriological Examination of Foodstuffs Samples submitted for bacteriological examination numbered 192 comprising:- 6 Canned Meats 29 Canned Shrimps and Crabmeat 1 Caviare 3 Meat Pies 39 Prepared and Cooked Meats 1 Salad 54 12 Cooked chicken and Chicken dishes 2 Cream Doughnuts 1 Eels (jellied and cooked) 1 Frogs legs 10 Hen eggs and Albumen 6 Horsemeat 35 Ice Cream 2 Liquid egg 5 Shellfish (cooked) 30 Shrimps and Prawns (Raw and cooked) 1 Skim Milk Powder 1 Synthetic Cream 2 Trifles 1 Uncooked chicken 1 Vermicel1i 3 Water Of these the following 35 samples were unsatisfactory:- 5 Cooked chicken and chicken dishes 14 Cooked meat 16 Ice Cream Investigations were carried out and recommendations made, all samples taken since being satisfactory. A check has been made on the many small manufacturers producing meat pies since these are a regular item in the mid-day meal of many people in this area. Generally the meat content of these products is below the minimum required by the Meat Pie and Sausage Roll Regulations (i.e. 25%). The producers have been cautioned and informed of the requirements and. in all cases, some improvement has been effected. Liquid Egg Pasteurisation There are two plants in the borough where liquid egg is pasteurised. The shortage of eggs being even more acute than last year both plants ceased pasteurising for lengthy periods during the year. The satisfactory standard of hygiene of former years was maintained. Seven samples of egg taken proved satisfactory when subjected to the alphaamylas e test. Mi Ik Supply-Samples Twelve samples were submitted for chemical analysis, of these two were slightly deficient in solids-not-fat content. Investigation showed that this was due to the seasonal variation occurring when cows are put out to grass in the spring. The average fat and solids-not-fat content of the ordinary milk samples analysed was 3.6% and 8.5% respectively, and of the superfatted variety 4.6% and 8.7%. Ple and Mash Shops 55 No samples were taken for the purpose of examination for the presence of brucel1 a 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 38 tons London Fruit Exchange and Spitalfields Market 182 tons Other Premises 139 tons TOTAL 359 tons These foodstuffs were delivered to, or collected by, the Council's 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 1,064 were issued in respect of unsound food in 1970. 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 36 . The complaints referred to Alleged unsound condition: Bread 5, cream 4, cream dessert 1, fruit pie 1, liver 1, mushrooms 1, pork chop 1, sausage rolls 4, soup 1 and steak pie 2. Alleged dirty condition and/or foreign body or deposit: Bread 3, bread rolls3, bun 1, doughnut 1, orange squash 1, pears 1, prawns 1, sausage 1, soup 2 and suet 1. Ice Cream There are 4 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. 56 42 samples of ice cream manufactured in the borough and submitted to the methylene blue reduction test gave the following results:- Grade I 14 II 14 III 4 IV 10 Consequent upon taking the unsatisfactory samples (grades III and IV) careful investigations were carried out and recommendations made. (9 samples taken later have all been satisfactory.) The manufacturer from whom the grade IV samples were taken has since ceased production. Food Export Certificates Certificates numbering 95 were issued in respect of avariety of foodstuffs exported to Barbados, Belgium, Canada, Canary Islands, France, Israel, Greece, Italy, Japan, Kuwait, Lebanon, Libya, New Zealand, Poland, South Africa, Spain, Sweden and Trinidad. 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. The Corporation of London, through its veterinary officers and inspectors, carried out on an agency basis duties imposed on the Council under the Diseases of Animals Act 1951 and Performing Animals Act 1925. Visits were paid during the year to the 17 poultry slaughterhouses and 11 live poultry dealers in the borough. Each of 14 pet shops received quarterly visits. The only animal boarding establishment in the bo rough has now closed Close attention has been paid to the animal market held on Sunday mornings in Club Row, and visits of inspection made regularly. In accordance with the Fowl Pest Order 1938, many visits were also made to premises where poultry are s1aughtered, concerning the disposal of waste materials and cleaning and disinfecting of crates and vehicles used for the conveyance of poultry. The correct disposal of viscera etc. is necessary in preventing the spread of disease and this problem was heightened by the strike of dustmen which occurred during the Autumn. At the request of the Ministry of Agriculture, Fisheries and Food, a complete list of these premises was sent giving details of methods of disposal of viscera etc. DISEASES OF ANIMALS 57 OFFICES AND SHOPS Registration and Inspection Premises registered during the year under the Offices, Shops and Railway Premises Act 1963 numbered 172, the total registrations at the end of the year being 2,938 in which 26,867 persons are employed. Surveil1ance of these premises is executed by a public health inspector and a technical assistant, who made general inspections of 1,295 premises, and carried out over 2,400 other visits; Statistics on page 113. Offices Shops and Railway Premises (Hoists and Lifts) Regulations, 1968 It was evident for some time after the commencement date of the Regulations that many of the "competent persons" carrying out lift inspections were unaware that requirements for construction and maintenance of lifts, which have been in force for factories for some years, had been extended to offices and shops. In some cases, reports examined at premises during the course of inspections revealed that although lifts could not continue to be used with safety, no notification had been made to this Department. On each occasion the attention of the Company concerned was drawn to Regulation 6(3), and an explanation sought. However, now that the Regulations have been in operation for a year and a half, reports are received regularly, and no great difficulty is experienced in enforcement. Some difficulty, however, is being met with regard to the alteration of hand powered service lifts and platform beer crate hoists to meet the requirements of the Regulations in public houses. Existing lifts fall short of the required standard in almost every public house visited, and defects are referred to the Brewers concerned. Brewers' architects have replied claiming an almost accident free record over a period of 50 years, and have pointed out their difficulties in making these alterations. They state that the disturbance to the kitchens brought about by alteration of liftways will often involve a complete revision of lay-out and, in the case of smaller kitchens be completely impracticable. They say that where hand powered service 1ifts are situated immediately adjacent to a bar, ropes outside liftways would be subject to interference by customers standing close by, with the possible chance of an accident to an employee with his or her head within the liftway at another level. They also say that the layout of many cellars is such as to make the enclosure of the liftway and the provision of a door impracticab1e. These and other objections, it is understood, are being discussed by the London Brewers' Council with the Engineering Division of H. M . Factory Inspectorate The Department of Employment have been asked that, if it should be established as a result of these discussions that difficulties involved in the alteration of lifts in public houses will be such that a standard short of that 58 required by the Regulations can be accepted, suitable guidance should be given as a Supplement to Local Authority Circular No. 18, as this problem is being experienced by Inspectors throughout the London area. Food Si icing Machines A number of imported food slicing machines which are being offered for sal e for domestic purposes have been found in use in retail shops and staff canteens. These machines are now widely used by housewives, but do not meet the provisions of Section 17 of the Act which requires that all machines must be " securely fenced" so that no worker can come into contact with any dangerous part while the machine is in motion. It has been found necessary to prohibit the use of these machines in premises subject to the requirement of the act. HOUSING The constant influx of commonwealth immigrants into the borough still demands vigilance in respect of overcrowding and multiple occupation of dwellings. Slum Clearance During the year 5 Clearance Areas were represented, involving 232 houses. Three public inquiries were held and 8 Orders confirmed. Underground Rooms The closure of basement rooms continued throughout the year, 13 such rooms being closed. Closing and Demolition Orders During the year closing orders were made in respect of 13 houses which were unfit for human habitation, and 8 premises were the subject of closing orders on parts of the premises. A demolition order was made on one house. Houses in Multiple Occupation At the end of the year 1,138 houses were under surveillance. During the year 104 premises were found to be deficient in means of escape in the case of fire and it was necessary to serve notices to remedy the deficiencies. Management Orders were made in respect of 13 premises and informal notices to remedy conditions caused by neglect of management were served with regard to 74 houses. In 23 cases the conditions were rectified. Summonses heard served for contraventions of the Management Regulations numbered 46, fines amounting to £238 being imposed. 59 Notices in respect of overcrowding under the provisions of Section 90 of the Housing Act 1957, were served in 40 instances. Visits in the late evening continue to be made to check that the notices are being complied with. 25 summonses were issued in respect of contraventions, resulting in fines amounting to £185. During the year, managers of two houses appealed to the County Court in respect of the requirements of the notices, one appeal being upheld and the other dismissed. Directions to prevent or reduce overcrowding were served in 12 instances under Section 19 of the Housing Act 1961. Summonses numbering 8 were issued for contravention of the Direction, resulting in fines amounting to £155 being imposed. Owing to the constant change of management of houses in multiple occupation, notices frequently have to be re-served thus causing a prolonged delay in getting repairs and fire precautions work carried out and overcrowding abated. Standard and Improvement Grants Nine premises were inspected regarding applications made to the Council for standard or improvement grants. Qualification Certificates The Housing Act 1969, provides for the conversion from rent control to rent regulation of dwellings which satisfy qualifying conditions. Where a house which is subject to a controlled tenancy is in good repair and is provided with the standard amenities, a qualification certificate is issued to the owner which enables him to apply to the rent officer for a fair rent to be registered. During the year 74 such applications were received, and 10 approved. Applications for Rehousing At the end of the year, there were 6,269 applications for rehousing on the Council's waiting list, 676 less than last year. Tenants of Counci1 dwellings who have applied for transfer to larger or smaller accommodation number 1,372 an increase of 542 since last year. Preferential Housing on Health Grounds Applications for preferential housing on health grounds investigated during the year numbered 522. An 'urgent' assessment was granted in 53 cases and balancing points were awarded in a further 158. Tenant transfer was supported in the case of 165 tenants of Council dwellings. New Housing During the year 1,670 new permanent dwellings were completed in the borough; 60 873 by the Borough Council, 795 by the Greater London Council and 2 by other persons. Details are given on page 108. At the end of the year units of accommodation owned by the Borough Ccuncil numbered 14,681 comprising 13,011 erected by the Council, 68 prefabricated bungalows and 1,602 properties acquired. Dwellings in the borough owned by the Greater London Council totalled 25.486 at the end of the year. Local Authority owned dwellings now comprise 65% of the total dwellings in the Borough. FACTORIES Provision is made in Section 153 of the Factories Act 1961 for the Medical Officer of Health to include 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 (General Powers) Act, 1967 numbered 194 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 schoolchildren 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 DIS INFESTATION 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. 61 A service is provided for the disinfestation of premises infested by insects, etc. including ants, bedbugs, cockroaches, fleas, carpet beetles, woodlice, clovermites, firebrats, spider beetles silverfish and dermestidae. The Council carries out on behalf of the East London Group Hospital Management Committee any necessary work of disinfestation at hospitals and other premises in the borough coming under their direction. (Statistics on page 112). 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 There are three licensed common lodging houses in the borough, providing accommodation for 769 persons as follows:- Salvation Army Hostel, Garford Street 218 Men Salvati on 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 The Empire Memorial Hostel, 747 Commercial Road, ceased use as a Seamen's Lodging house. There are now two premises in the borough which provide accommodation for 430 seamen as follows:- 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. 62 Prior to the formation of the borough. Bethnal Green Council had an arrangement with Hackney Council for the use of the letter's mortuary, which arrangement continues in respect of mortuary accommodation for that part of the borough, the cost being shared on a population basis. A total of 593 bodies was received during the year (458 in the Council's mortuary and 135 in Hackney mortuary) including the bodies of 120 persons who were esident in other areas. Other statistics will be found on page 111. OFFENSIVE BUSINESSES Towards the end of the year the Secretary of State for the Environment was asked to confirm an Order made by the Council under Section 107 of the Public Health Act declaring the business of a Slaughterer or Dresser of Poultry an offensive trade. Draft byelaws were also submitted for approval to the Secretary of State to cover such businesses on the lines of the existing byelaws relating to a slaughterer of poultry, but also to cover the Muslim trade and further to provide that the whole of the business be Confined within the curtilage of the premises and that no poultry cretes, receptacles etc. be permitted to remein outside the premises. There ere 22 offensive businesses in the borough,as follows:- DRESSER OF FURSKINS (3) 34/38 Brodlove Lane 74 Florida Street *419 Old Ford Road POULTRY SLAUGHTERHOUSES (19) *17 Bell Lane *19 Bell Lane 107 Bethnal Green Road 28 Burslem Street 161 Cannon Street Road *163 Cannon Street Road 16/18 Cobb Street * 14 Hesse] Street 36 Hessel Street 75 Hessel Street *7 Leyden Street *10b Leyden Street 13 Leyden Street 15 Leyden Street *7 Lower Hessel Street *21/22 Lower Hessel Street *4 Monthope Street *6 Monthope Street 10a Monthope Street (*Establishment orders on these premises are subject to renewal from time to time) . MISCELLANEOUS REPORTS BY DISTRICT AND SPECIALIST PUBLIC HEALTH INSPECTORS Some 684 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. 63 98 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 629, compared with 597 in the corresponding list last year. It is significant to note that there were 1,586 outworkers included in the August list for 1966. PET ANIMALS ACT, 1951 There are 69 licensed pet shops in the borough including stalls in markets. Contraventions of Section 2 were discovered in 8 cases, which resulted in legal proceedings being instituted and fines of £16 being imposed (See also page 57 Diseases of Animals). PHARMACY AND POISONS ACT, 1933 The sale of certain poisons (chiefly those used for sanitary, domestic and horticultural purposes) bypersons other than pharmacists is subject to the provisions of this Act and of the Rules made thereunder. A person selling such poisons must have his name entered on a list kept by the Council, and must make application annually for re-entry and pay a prescribed fee. Compliance must be made with the requirements relating to storage, transport, labelling and containers. There are 69 names on the list, 9 being removed from and 10 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 were slaughtered during the year, (1,800,000 by Jewish ritual and 700,000 Muslim) together with a small seasonal number of turkeys, geese and duck s . 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 64 materials used. Regulations made under the Act prescribe standards of cleanliness for filling materials. No samples of filling materials were obtained from registered premises this year. The prescribed Analyst who has tested our samples in the past was unable to continue owing to a dispute with the Ministry of Housing and Local Government as to the amount of fees payable for testing. Premises registered for the use of filling materials number 31, there being no licensed premises. 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. 12 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 by Council employees again occurred in the autumn resulting in a disruption of the refuse collection services. As a consequence the Health Department received numerous complaints of nuisance from refuse accumulations in blocks of flats, on pavements and on highways and of the presence of insects and rats. Accumulations of offensive refuse in certain street markets of the borough were declared hazards to heal th by the Medical Officer of Health, and the Council thereupon took steps to have the refuse removed. Later, when further accumulations of refuse could not be removed by approved contractors, the guidance of central government had to be sought. Assistance from troops on one occasion enabled certain health hazards to be disposed of overnight. The Cleansing Officer of the Council has kindly supplied some statistics re1ating to refuse disposal for the year, given on page 117. RENT ACT, 1968 No applications under the Rent Act 1968 were received for certificates of disrepair during this year. One application for cancellation of certificate was refused. 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 4,533 dwellings and other premises requiring inspection 3,950 were found to be infested wi th mi ce or rats. Treatments were carried out by the department's rodent control 65 staff in 4,673 properties the charges for servicing business premises amounting to £3,860, Business premises under regular servicing contract with the Council numbered 177 at the end of the year. Statistics are given on page 114 The arrangement in the area for sewerage and sewage disposal are satisfactory. The planned programme of reconstruction of defective sewers is proceeding. Byelaws 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 Byelaws required stair case 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 byelaws required staircases in its area to be lit from half an hour before sunset until sunrise throughout the year. New byelaws drafted for the borough as a whole on the lines of the Stepney byelaws were submitted to and confirmed by the Ministry of Housing and Local Government, and came into operation on 1st May 1970. The water in the seven public swimming baths in the borough and in the bath at the Council's Hornchurch Children's Home is sampled at monthly intervals by the Scientific Department of the Greater London Council on this Council's behalf. A total of 130 samples taken during the year proved satisfactory. In addition 59 samples were taken from nine school swimming baths in the borough, one sample being unsatisfactory. Efforts to get sites cleared of rubbish and fenced continue to show good results Of the 239 sites which came to notice during the year 148 were cleared of rubbish and fenced by the end of the year, SEWERAGE ARTIFICIAL LIGHTING OF COMMON STAIRCASES - BYELAWS SWIMMING BATHS VACANT SITES Ownership of the sites dealt with was as follows:- Sites requiring action Sites dealt with Greater London Council 190 118 Borough Council 28 10 Private Ownership 21 20 66 In 7 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 1970. 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 standpipe. There are 18 deep wells in the borough in use. The Metropolitan Water Board was notified on 15 occasions where wastage of water was taking place, Notifications were received from the Board on 28 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 supplied to their boroughs which is provided by the Metropolitan and other Water Boards. Section 23 of the Greater London Council (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. WORKS IN DEFAULT Works were carried out by the Council on 53 occasions during the year in default of persons on whom notices were served requiring the execution of works. They comprised 45 instances of failure to comply with notices served under Section 17, Public Health Act, 1961 regarding choked drains, one for failure to comply with a notice served under Section 75 of the Public Health Act, 1936 with respect to the provision of dustbins, and 7 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. 67 STATISTICS Tables 39 to 54 of the Appendix give additional statistical information of the environmental health services. 68 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 prevention of home accidents has continued throughout the year, with particular reference both to those groups atgreatest risk and to the most prevalent causes. Inquests were held during the year on 9 fatalities in the borough arising from accidents which occurred in the home, including 3 from falls and 4 following outbreaks of fire. Many children were admitted to hospital or treated as out patients after swallpwing medicines in tablet or capsule form. Special publicity is arranged each year regarding home accident prevention and 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 irresponsible under Section27of 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 4,584 signatures on certificate swere verified as those of medical practitioners practising in the borough and the certi ficates endorsed accordingly. Following a resolution passed by the World Health Assembly in 1969, all Internationa] Certificates of Vaccination against smallpox, cholera and yellow fever must be issued in the form laid down in the new International Health Regulations as from 1st January 1971. The main difference between the old and the new certificates is that from January 1971 doctors will need to record the name of the manufacturer of the vaccine and to sign the certificate by hand. A stamped facsimile signature will not be sufficient. The majority of these certificates are authenticated for the purpose of persons travelling abroad on holiday, and include a large number relating to immigrants journeying to and from India and Pakistan. 69 CONFERENCES Conferences and courses attended by members of the Council and/or officers of the department are summarised on pages 118 to 121. DECEASED PERSONS Inquests Inquests were held on 100 residents of the borough during the year, the verdicts being 29 deaths due to road accidents, 20 other accidents, 10 suicide, 16 misadventure, 5 manslaughter. 14 open verdicts, 1 asbestosis and 5 natural causes. Transport of bodies abroad From time to time certificates are issued regarding bodies being transported abroad to the effect that the deceased had not died from an infectious disease and that the coffins were hermetically sealed. Eight such certificates were issued this year, relating to bodies flown to Israel. The North East Metropolitan Regional Hospital Board's proposals for the future hospital service in the Greater London area, announced in March, provide for the development of the London Hospital as a District hospital for Tower Hamlets. It was thought that St. Andrew's Hospital might ultimately become a Community hospitaland the future use of the sectarian hospital s as the London Jewish and Mi1dmay Mission, it was stated, must await guidance from the Secretary of State. Notification was also received during the year from the North East Metropolitan Regional Hospital Board that it proposed to review the groupings of hospitals under Hospital Management Committees, so that as from 1st April 1972, the three hospitals in the Borough controlled by the East London Hospital Management Committee (Bethnal Green, London Jewish and Mildmay Mission hospitals) will be transferred to the Board of Governors of the London Hospital and the East London Hospital Management Committee terminated. Action on these proposals is at present, deferred. The London Hospital closed its Brentwood Annexe; the North East Metropolitan Regional Hospital Board having proposals to take over the premises for mentally sub-normal patients. HOSPITAL FACILITIES The undermentioned hospitals are situated within the borough; No. of Beds. Bethnal Green Hospital, Cambridge Heath Road, F.,2. 308 The London Hospital, Whitechapel Road, E.l. 719 London Chest Hospital, Victoria Park, E.2. 142 London Jewish Hospital, Stepney Green, E.l. 128 Mildmay Mission Hospital, Austin Street, E.2. 70 Mile End Hospital, 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, Bow Road, E.3. 128 70 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 by the Public Health Laboratory Service (directed by the Medical Research Council for the Department of Health and Social Security) at County Hall, S.E.1. Investigations carried out by the Group Laboratory on specimens submitted by the heal th department totalled. 521, comprising 520 faeces and l blood. Bacteriological investigation on 192 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 Chronically Sick and Disabled Persons Act 1970 29. 5.70 Various Education (Handicapped Children) Act 1970 23. 7.70 1. 4.71 Food and Drugs (Milk) Act 1970 29. 1.70 29. 1.70 Local Authority Social Services Act 1970 29. 5.70 Various Orders and Regulations Cheese Regulations 1970 23. 1.70 31. 1.70 Colouring Matters in Food (Amendment) Regulations 1970 24. 7.70 1. 9.70 Cream Regulations 1970 13. 5.70 1. 6.70 Diseases of Animals (Approved Disinfectants)0rder 1970 15. 9.70 17. 9.70 Emulsifiers and Stabilisers in Food (Amendment) Regulations 1970 24. 7.70 1. 9.70 Food Hygiene (General) Regulations 1970 3. 8.70 1. 3.71 Labelling of Food Regulations 1970 12. 3.70 31. 3.70 Local Authority Social Services Act 1970 (Commencement No.l) 12. 2.70 1. 3.70 London Government Order 1970 30. 6.70 Various Poisons Order 1970 21. 5.70 8. 7.70 Poisons Rules 1970 21. 5.70 8. 7.70 Public Health (Aircraft) Regulations 1970 4.12.70 1. 1.71 Public Health (Ships) Regulations 1970 4.12.70 1. 1.71 Smoke Control Areas (Exempted Fireplaces) Order 1970 21. 4.70 1. 5.70 Smoke Control Areas (Exempted Fireplaces) (No. 2.) Order 1970 9.11.70 19.11.70 Smoke Control Areas (Authorised Fuels) (No. 2.) Regulations 1970 19.10.70 28.10.70 Soft Drinks(Amendment) Regulations 1970 26.10.70 3.11.70 71 Circulars Circulars on other matters relevant to the functions of the department and issued by the various Government Departments during the year included those relating to the following subjects:- Accidental hypothermia: Active immunisation against tetanus; Avoidance of carcinogenic aromatic amines in schools and other educational establishments; Condensation in dwellings; Disposal of solid toxic wastes: Domestic smoke controlAvailability of solid smokeless fuel; Housing Act 1969 - House improvements and repair; International certificates of vaccination against smallpox and cholera; Local Authority purchasing; Local authority health and welfare services programme of capital projects; Management structure of the local authority nursing service; Ministerial responsibility for the persona] social services; Psycho-geriatric assessment units; Teachers of deaf and partially hearing pupils; Training of state enrolled nurses in district nursing: Vaccination against anthrax; Vaccination against rubel1a. MEDICAL EXAMINATION OF STAFF The department's medical officers under take 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 1,478 (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 13 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 122 to 126. 72 STAFF CHANGES Appointments and resignations of members of the staff numbered 180 and 155 respectively as follows:- Appointment s Resignations Administrative and Clerical Staff 23 19 Dental Staff 31 27 Home Help Organisers 2 1 Medical Officers., 2 3 Mental Health Staff 25 11 Nursing Staff Health Visiting 20 24 Clinic and School 24 16 Day Nursery 30 30 District Nurses 10 11 Public Health Inspectors and Pupils 3 4 Social Workers 3 3 Miscellaneous 7 6 Total 180 155 TRAINING, etc FOR STUDENTS As part of their training and studies 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 were as fol1ows Post graduate Medical and Medical Students London School of Hygiene and Tropical Medicine London and St. Bartholomew s Hospitals. Student Nurses London Bethnal Green St. Clement's. Mile End St. Andrew's. London Jewish Hospitals and Hospital for Sick Children Child Care Officer Students Social Worker Students North West Polytechnic and N.S PC C. London University and North Eastern Polytechnic. Diploma Course Students Medical Officers Chiswick Polytechnic. National Association for Mental Health, Society of Medical Officers of Health Pupil Public Health Inspectors County Borough of Hastings British Council. Hertfordshire College of Building Trainee Welfare Officers Post Office, Town Clerks (Israeli) British Council Trainee Medical Secretary Rush Green Technical College Pupil Midwives Mile End Hospital. Ward Sister Queen Elizabeth Hospital. School Pupils Cardinal Griffin School 73 ★ ★★★★★★★★ -74- PART VII REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER ON THE SCHOOL HEALTH SERVICE VII REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER ON THE SCHOOL HEALTH SERVICE 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, As always, ready support has been given by the Medical Adviser and his central staff. Similarly, the Education Officer of Division 5 and his staff continued their close liaison enabling us all to maintain an effective service. Dr. Gourlay, Deputy Principal School Medical Officer, resigned in May to take a similar post with the Cambridge City Council. Her work since 1965, particularly with the School Health Section helped greatly to continue an effective joint service, previously the responsibility of the London County Council. SCHOOLS AND SCHOOL ROLLS Pupils on school rolls numbered 32,617 at the end of the year, attending 99 maintained schools in the borough which include three schools for the educationally subnormal, two for the maladjusted, one for delicate children, and one for the physically handicapped. There are no direct grant or independent schools included in the School Health Service. At the end of the year the school registers were as follows:- Type of School No. of Schools Pupils Primary 66 19,748 Secondary 21 11,518 Nursery 5 515 Special 7 836 -75- 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, special investigation clinic etc. 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' increased from 707 to 717, 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 201 last year to 398 in 1970 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 Tests carried out in the Department of Entomology. London School of Hygiene and Tropical Medicine, showed that head lice (taken from local children) bred in the laboratory were resistant to D.D.T., Gamma B.H.C and Dieldrin. but ful1y susceptible to Propoxur. Malathion and Carbaryl. In other laboratory tests colonies of lice were selected for resistance over 44 generations with Malathion and no sign of resistance developed Clinical trials with Malathion on infested children which took place in this borough showed that no live lice remained on the head after 24 hours and the children remained free of head lice for at least 3 months in an area where rapid reinfestation would have been considered almost inevitable. An additional advantage is that unlike the organochlorines which exhibit a limited ovicidal effect, Malathion is very toxic to the eggs of lice. A commercial product using Malathion was awaited at the end of the year 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 No. at Day Schools Boarding Schools B1ind - 6 Partially sighted 17 2 Deaf 3 4 Partially hearing 42 2 -76- Handicap No. at Day Schoo1s No. at Boarding Schools Educationally subnormal 367 140 Epi1eptic - 2 Maladjusted 97 133 Physically Handicapped 105 17 Delicate 137 43 Multiple Handicaps - 3 TOTALS 768 352 INFECTIOUS DISEASE IN SCHOOLS Of the 1,619 cases of infectious disease notified 567 or 35% related to school children. In addition 1,235 notifications were made by head teachers of pupils absent from school on account of infectious and other illnesses. Where the notifications from any particular school warrant further investigation special visits are made and any necessary investigations carried out, including the taking of specimens for bacteriological examination to ascertain the sources of, and contain, the outbreak. 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. Attendances this year totalled 17,379 compared with 16,872 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 87.9 75.2 86.6 47.3 77 B.C.G, VACCINATION The arrangements continued during the year for vaccinating 13 year old schoolchildren against tuberculosis using B.C.G., 1,382 children being vaccinated. PART TIME EMPLOYMENT OF SCHOOLCHILDREN It is a requirement of the Children and Young Persons Act 1933/Education Act 1944, where children wish to take up part-time employment such as delivering newspapers etc., that they be medically examined to ensure they are fit for the proposed employment. 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 the child remains 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. Eleven new cases were added to the deaf register during the year, the regi ster now totalling 144. 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 204. There are three schools in the borough for the education of these children who are medically examined each year. HEALTH EDUCATION IN SCHOOLS Continued liaison with schools is giving good results. Teaching staff show more interest in the work of the Health Department and appreciate the need for health education. 78 Health education sessions held at schools numbered 628 during the year, attended by 12,000 pupi1s. SCHOOL DENTAL SERVICE The report of The Principal School Dental Officer, will be circulated separately. STATISTICS Statistics relating to the School Health Service will be found on pages 127 and 128. (Those supplied by the Inner London Education Authority are not yet available). 80 PART VIII APPENDIX OF STATISTICAL TABLES TOTAL DEATHS BY CAUSE AND AGE OF TOWER HAMLETS RESIDENTS - 1970 (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 diarrhoea diseases 1 1 _ 1 _ _ _ _ _ _ , _ _ Tuberculosis of respiratory system 12 11 1 _ _ _ _ _ 1 1 3 5 2 Other tuberculosis, including late effect 3 5 3 2 _ _ _ _ 1 1 1 _ 1 1 Meningococcal infection 2 1 1 1 _ 1 _ _ _ _ _ _ _ Syphili s 1 1 _ _ _ _ _ _ _ _ _ 1 _ Other infective and parasitic diseases 1 _ 1 _ _ _ _ _ _ _ _ 1 _ Malignant neoplasm _ buccal cavity etc. 1 _ 1 _ _ _ _ _ _ _ _ _ 1 Malignant neoplasm _ oesophagus 11 7 4 _ _ _ _ _ _ 2 2 2 5 Malignant neoplasm _ stomach 62 29 33 _ _ _ _ _ 1 5 15 18 23 Malignant neoplasm _ intestine 72 29 43 _ _ _ _ 1 3 1 12 26 29 Malignant neoplasm _ larynx 5 3 2 _ _ _ _ _ _ _ 1 3 1 Malignant neoplasm _ lung, bronchus 160 139 21 _ _ _ _ _ 2 17 46 69 26 Malignant neoplasm _ breast 42 _ 42 _ _ _ •• _ 2 10 12 9 9 Malignant neoplasm _ uterus 17 _ 17 _ _ _ _ _ _ 3 2 3 9 Malignant neoplasm _ prostate 6 6 _ _ _ _ _ _ _ _ 1 _ 5 Leukaemia 11 5 6 _ _ 3 _ 1 1 _ 2 3 1 Other malignant neoplasms, etc. 149 76 73 _ _ _ 2 2 3 13 34 45 50 Benign and unspecified neoplasms 9 3 6 _ _ _ _ _ _ _ 3 3 3 Diabetes mellitus 25 8 17 _ _ _ _ _ 1 2 5 8 9 Other endocrine etc., diseases 7 1 6 _ _ _ _ _ _ _ 1 2 4 Anadmi as 5 _ 5 _ _ _ _ _ _ _ _ _ 5 Other diseases of blood etc. 1 _ 1 _ 1 _ _ _ _ _ _ _ _ Mental disorders 5 2 3 _ _ _ _ _ _ 1 _ _ 4 Meningitis 1 _ 1 _ _ _ _ _ 1 _ _ _ _ Other diseases of nervous system 21 5 16 1 _ _ 1 1 _ 2 1 5 10 Chronic rheumatic heart disease 48 15 33 _ _ _ _ _ 1 5 11 13 18 Hypertensive disease 29 17 12 _ _ _ _ _ _ 1 5 12 11 Ischaemic heart disease 463 275 188 _ _ _ : _ 2 15 35 98 150 163 Other forms of heart disease 95 39 56 2 1 _ 2 _ _ 1 10 21 58 Cerebrovascular disease 190 68 122 _ _ _ _ 2 2 10 24 58 94 Other diseases of circulatory system 72 24 48 _ _ _ _ _ 1 1 10 20 40 Influenza 10 6 4 _ _ _ _ _ _ 1 _ 4 5 Pneumonia 163 88 75 3 _ 1 1 _ 2 8 14 29 10 5 Bronchitis and emphysema 164 116 48 _ _ _ _ _ 1 10 22 63 68 Asthma 3 1 2 _ _ _ _ 1 1 _ _ _ 1 Other diseases of respiratory system 33 19 14 4 _ _ _ _ 1 1 4 9 14 Peptic ulcer 20 13 7 _ _ _ _ _ 2 2 7 9 Intestinal obstruction and hernia 10 5 5 _ _ _ _ _ _ _ 3 1 6 Cirrhosis of liver 8 6 2 _ _ _ _ _ _ 2 2 3 1 Other diseases of digestive system 36 9 27 _ _ _ _ _ 2 4 4 12 14 Nephritis and Nephrosis 20 10 10 _ _ _ 1 1 1 2 4 4 7 Hyperplasia of prostate 3 3 _ _ _ _ _ _ _ _ 1 1 1 Other diseases, genito_urinary system 21 7 14 _ _ _ _ _ 2 _ 6 _ 13 Other complications of pregnancy 1 _ 1 _ _ 1 _ _ _ _ _ _ Diseases of musculo-skeletal system 9 1 8 _ _ _ _ _ _ 1 1 7 Congenital anomalies 16 13 3 10 3 1 1 _ _ _ 1 _ _ Birth injury, difficult labour, etc. 13 8 5 13 _ _ _ _ _ _ _ _ _ Other causes of perinatal mortality 14 10 4 14 _ _ _ _ _ _ _ _ _ Symptoms and ill_defined conditions 4 _ 4 _ » _ _ _ _ _ _ _ 4 Motor vehicle accidents 24 15 9 _ 3 3 _ 1 5 4 6 2 All other accidents 42 30 12 1 5 1 3 3 6 3 4 4 12 Suicide and self_inflicted injuries 10 6 4 . _ _ 1 1 _ 4 4 _ All other external causes 17 16 1 _ _ 3 _ 3 3 3 2 1 2 Males 1, 150 35 6 10 9 11 34 10 2 258 350 335 Females 1,020 15 4 3 6 8 22 50 118 277 517 GRAND TOTAL 2,170 50 10 13 15 19 56 152 376 6 27 852 81 TABLE 2 SUMMARY OF ROAD ACCIDENTS OCCURRING IN THE BOROUGH Pedestrians Motor Cyclists Pedal Cyclists Other Road Users Total 1970 killed 13 - - 5 18 injured 655 120 100 973 1,848 1969 killed 15 1 1 2 19 injured 635 111 93 979 1,818 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 - - - - - 2 1 • - (10) 3 6.1 Pneumonia - - - - 1 1 1 - - ( 3) 3 6.1 Congenital Malformations - 2 - - 1 2 - 1 - ( 6) 6 12.2 Premature Birth 11 8 2 - - - - - - (11) 21 42.9 Asphyxia, Atelectasis - - - - - - - - - ( 5) - Birth injuries 1 1 - - - - - - ( 1) 2 4.1 Other causes 4 2 - - - 5 1 2 - ( 7) 14 28.6 TOTALS 16 13 2 - 2 10 3 3 - (43) 49 100.0 (*) Figures in parenthesis denote corresponding deaths in 1969 TABLE 4 , INFANT MORTALITY Comparative table showing deaths of infants at various ages under 1 year Year Under 24 hours lr 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 1966 16 20 6 42 17 59 71 1967 13 12 10 35 18 53 66 1968 20 18 11 49 19 68 72 1969 11 13 4 28 15 43 65 1970 16 13 4 33 16 49 67 82 83 COMPARATIVE VITAL STATISTICS TABLE 5 Year Population Live Births Deaths Deaths under 1 year Maternal Deaths Cancer Deaths (all forms) Tuberculosis Deaths (a11 forms') No. Rate* No. Rate* No. Rate* No. Rate* No. Rate* No. Rate* 1901 597,106 21,515 36.0 12,143 2.0.3 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 6,286 12.7 685 79.8 26 2.9 692 1.4 565 1.1 1941 174,520 2,607 14.9 6, 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 1970 182,260 2,471 13.6 2,170 11.9 50 20.2 1 0.4 537 2. 9 17 0.1 *Per 1, 000 population N.A. - Not available *Per 1, 000 total births NOTE: Figures prior to 1965 relate to those of the former Metropolitan Boroughs of Bethnal Green, Poplar and Stepney TABLE 6 OBSERVATION REGISTER (i) Observation Register (Children under 5 years) No, on Register on 1st January 3,292 No. added during year 1,089 4,381 No. removed during year - died 24 moved away 499 no longer at risk 602 transferred to ages 5-21 Register 50 1,175 Total on Register at 31st December 3,206 No. of above total suffering from handicaps 304 Year of birth of those on Register at 31st December 1970 872 1969 787 1968 702 1967 538 1966 307 Total: 3,206 (ii) Observation Register (5-21 years) Total on Register at 31st December 2,594 (iii) Handicaps of children and young persons on Observation Register 0-4 years 5-21 years Educationally subnormal - 857 Severely subnormal - 141 Physically handicapped 184 546 Mentally retarded 36 - Maladjusted - 298 Blind (Registered) ) 1 7 Visual defects ) 5 65 Speech defects(requiring special or other school) 19 22 Epileptic 14 88 Deaf and partially hearing 12 170 Delicate (including diabetic) - 155 Multiple handicaps 33 245 Total: 304 2,594 In addition there are 210 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 (Section 56) 1968/1366 Acute Meningitis -do- -do- 1968/1366 Acute Poliomyelitis -do- -do- 1968/1366 Anthrax -do- -do- 1968/1366 Cholera -do- (Section 48) - Diphtheria -do- (Section 56) 1968/1366 Dysentery (Amoebic) -do- -do- 1968/1366 Dysentery (Bacillary) -do- -do- 1968/1366 Food Poisoning -do- (Section 48) - Infective Jaundice -do- (Section 56) 1968/1366 Leprosy -do- -do- 1968/1366 Leptospirosis -do- -do- 1968/1366 Malaria -do- -do- 1968/1366 Measles -do- -do- 1968/1366 Ophthalmia Neonatorum -do- -do- 1968/1366 Paratyphoid fever -do- -do- 1968/1366 Plague -do- (Section 48) - Relapsing fever -do- -do- - Scarlet fever -do- (Section 56) 1968/1366 Smallpox -do- (Section 48) - Tetanus -do- (Section 56) 1968/1366 Tuberculosis -do- -do- 1968/1366 Typhoid fever -do- -do- 1968/1366 Typhus -do- (Section 48) - Whooping Cough -do- (Section 56) 1968/1366 Yellow fever -do- -do- 1968/1366 85 TABLE 8 INFECTIOUS DISEASE NOTIFICATIONS Corrected Notifications Removed to Hospital Notified in 1969 Notified in 1968 Acute Encephalitis Infective - - - 1 Post - infectious - - - 2 Acute Meningitis (from 1.10.68) 2 2 17 2 Acute Poliomyelitis Paralytic - - - - Non-paralytic - - - - Anthrax - - - - Cholera - - - - Diphtheria - - 6 - Dysentery 36 16 78 40 Food Poisoning 82 12 71 53 Infective Jaundice (from 15. 6. 68) 127 11 124 68 Leptospirosis (from 1.10.68) - - - Malaria - - - 1 Measles 1, 063 38 1,201 616 Ophthalmia Neonatorum 2 2 - - Plague - - - - Relapsing Fever - - - - Scarlet Fever 48 2 79 83 Smallpox - - - - Tetanus (from 1.10.68) - - - - Tuberculosis Pulmonary 101 99 102 Non-pulmonary 17 14 19 Typhoid Fever 3 3 - 2 Whooping Cough 138 7 20 66 Yellow Fever (from 1. 10. 68) _ _ _ _ TOTALS: 1, 619 93 1, 709 1,055 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:- 1970 1969 1968 1970 1969 1968 January 6,432 5,254 7,401 July 2,557 3,436 3,311 February 3,670 5,053 3,279 August 2,607 2,791 2,977 March 4,074 4,696 4,079 September 3,410 2,649 3,037 April 3,447 3,802 3, 832 October 3,265 4,171 4,456 May 2,710 2,919 3,193 November 3,145 3,286 3,781 June 2,934 2,826 2,796 December 3,406 6,643 4,041 TOTALS 41,657 47,526 46,183 86 TABLE 10 VACCINATION AND IMMUNISATION Children vaccinated/immunised Others aged Total Year of birth 1970 1969 1968 1967 1963 -66 Under 16 Over 16 Diphtheria 792 1,173 99 36 95 72 - 2,267 Re-inforcing Dose - 410 675 126 1,276 597 47 3, 131 Tetanus 792 1, 173 97 38 100 118 24 2, 342 Re-inforcing Dose - 409 674 128 1,273 717 72 3,273 Whooping Cough 785 1, 161 93 26 14 2 - 2, 081 Re-inforcing Dose - 405 646 103 138 10 - 1, 302 Poliomyelitis 806 1,183 105 37 132 132 15 2, 410 Re-inforcing Dose - 398 661 123 1,176 893 126 3,377 Measles 1 1,307 447 154 244 48 - 2,201 Rubella - - - - - 516 - 516 Under 1 1 year 2-4 5-15 16 and over Total Smallpox vaccination Primary 11 1,013 398 82 14 1, 518 Re-vaccination - - 17 223 109 349 Diphtheria immunisation of children under 5 Children under 5 immunised during 1966/70 10,663 Estimated population under 5 as at 30th June, 1970 13, 400 Percentage protected 79.6 Vaccinations/immunisations (all ages) carried out at clinics/general practitioners' surgeries At Council Clinics By General Practitioners 7o Primary by General Practitioners. Primary Reinforcing Primary Reinforcing Diphtheria 2, 080 2, 700 187 431 8.3 Tetanus 2, 099 2, 762 243 511 10.3 Whooping Cough 1, 901 1,135 180 180 8. 6 Poliomyelitis 2,204 2, 958 206 519 8.1 Smallpox 1,314 173 204 176 13.4 Measles 1, 946 - 255 - 11. 5 Rubella 465 - 51 - 9. 9 87 TABLE 11 TUBERCULOSIS - NEW CASES AND DEATHS - 1970 New Cases and Deaths: Primary notifications of 101 pulmonary and 17 non-pulmonary cases were received . 7 other cases came to light via death returns from Registrars. Pulmonary tuberculosis accounted for 12 deaths, there being 5 deaths from non-pulmonary 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 1 4 3 9 19 14 17 13 1 84 F - - 4 1 1 3 1 2 2 - 2 - 1 17 Non-Pulmonary M - - - - 1 1 2 4 2 1 - 1 - 12 F - - - - - - 1 1 1 - 1 - 1 5 (b) Deaths Pulmonary M - - - - - - - - 1 1 3 5 1 11 F - - - - - - - - - - - - 1 1 Non-Pulmonary M - - - - - - - - 1 1 - 1 - 3 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 1,386 722 113 117 2,318 No. cases notified during 1970 84 17 12 5 118 Other cases added to register 40 7 3 2 52 No. cases removed from register 108 34 12 7 161 Remaining on register at 31st December 1,402 692 116 117 2,327 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 Nil Patients receiving attention by home nurses 4 Work of Tuberculosis Visitors No. of Tuberculous households visited 764 No. of visits to above and to contacts 7,744 No. of unsuccessful visits 584 Work of Chest Clinic Welfare Officers Patients assisted for the first time with Beds, bedding 6 Clothing, footwear 27 Patients at end of year receiving Extra nourishment 88 Home help 32 Diversional Therapy Patients receiving instruction in their own homes Nil Rehabilitation Hostels Patients in residence at end of year Nil Hostels for homeless infective tuberculous men Patients in residence at end of year 4 Child contacts boarded out during year 8 Child contacts boarded out for segregation during B. C. G. vaccination Nil 89 TABLE 14 MASS RADIOGRAPHY Unit 6A Unit 6B Total No. of factories, sites, etc. visited 7 8 15 Persons X-rayed - Males 971 2,702 3,673 - Females 399 789 1,188 - Total 1,370 3,491 4,861 No. referred for further investigation 43 10 53 Toynbee Hall - persons x-rayed 4,306 - 4,306 - referred for further investigation 145 - 145 Abnormalities discovered in 1970 Surveys: Total persons x-rayed 5,676 Tuberculosis requiring immediate treatment 8 Not available clinic supervision 33 Cancer of lung 13 Other 74 Active tuberculosis cases discovered per 1,000 examined 1.4 TABLE 15 TUBERCULIN TEST AND R. C. G. VACCINATION Contacts Schoolchildren and Students Total No. of skin tests 221 1,989 2,210 No. found positive 89 146 235 No. found negative 132 1,697 1,829 No. vaccinated 129 1,697 1,826 90 TABLE 16 ANTE AND POST NATAL SERVICES No. Ante and Post Natal Sessions held by: Medical Officers 16 Midwives 49 No. women attending for ante natal examination 124 No. women attending for post natal examination 52 Total attendances 589 No. General Practitioners holding sessions in Council clinics 4 Mothercraft and Relaxation Classes: No. women attending (a) Institutionally booked 41 (b) Domiciliary booked - No. attendances 287 No. sessions held by Health Visitors 52 TABLE 17 CHILD WELFARE CENTRES No. premises at end of year 14 No. sessions during year held by: Medical Officers 160 Health Visitors 125 Sessional General Practitioners 1,661 Hospital medical staff 51 Total sessions: 1,997 No. children attending - born this year 2,063 - born last year 2,346 - born 1966-7 2,488 No. attendances of children of all ages 39,531 Average attendance per session 19.8 No. children referred elsewhere 389 -91- Table 18 DAY NURSERIES AND CHILD MINDERS DAY NURSERIES Voluntary Council Nurseries Nurseries No. of Nurseries 1 4 Capacity 25 210 No. attending at end of year 12 137 Child/day attendances - Under 2 years - 7,395 - Over 2 years 2,955 19,992 No. of days open 234 255 Average daily attendance 12.6 107.4 OTHER PREMISES REGISTERED UNDER NURSERIES AND CHILD MINDERS REGULATION ACT, 1948 No. of premises registered at end of year 24 Capacity 472 CHILD MINDERS Statutorily Registered No. at 1st January 43 Additions during the year 11 Deletions during the year 17 No. at end of year 37 No. of children authorised to be minded at end of year 61 table 19 CERVICAL CYTOLOGY Premises Number Sessions Examinations Council Clinics 3 173 1,345 General Practitioners Surgeries 1 39 140 Family Planning Clinics 5 274 570 Other Slides read in Hospital Laboratories Thames Group Submitted by G. P's. Hospital St. Andrew's Hospital 176 1,131 East London Group Mile End Hospital 340 1,950 Other Hospitals in Group - 1,216 London Hospital ' 6,970 (Residents of all areas) 92 TABLE 20 CHIROPODY Treated at Clinics Domiciliary Treatment New patients during year 630 117 Total patients at end of year 3, 077 777 Treatments - children 159 - - expectant mothers - - - physically and mentally handicapped 41 - - aged persons 11, 624 3,706 No. of chiropodists employed 10 No. of clinic sessions held 1,695 No. of patients treated per clinic session 7. 0 Percentage of total patients receiving domiciliary treatment 20.1 Total no. of treatments 15.530 TABLE 21 DENTAL TREATMENT FOR EXPECTANT AND NURSING MOTHERS Expectant Mothers Children Persons examined 30 524 No. requiring and offered treatment 27 420 Visits during the year 100 911 Courses of completed treatment 20 234 Teeth extracted 40 7 Teeth filled 79 706 Emergencies treated 2 9 General anaesthetics given - - No. patients x-rayed 16 6 No. patients treated by scaling etc. 20 303 Dentures - full 2 - partial 17 No. of sessions for treatment 142 -do- for health education 19 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 Mothercraft 201 1,650 Cervical Cytology 95 756 General Health Subjects - Schools 628 11,869 - Other 154 1,488 Psychoprophylaxis 33 211 1, 111 15,974 Films or filmstrips were shown on 274 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, 3, 847 posters were exhibited and 17, 910 leaflets distributed. 94 TABLE 23 FAMILY PLANNING SERVICE Attendances at sessions held at clinics in the borough during the year. Premises New Cases Transfers Old Patients Total Patients Total Visits No. of Sessions Council Clinics St. Georges 144 - - 144 384 79 Wigram House 147 - - 147 332 32 Domiciliary Service 12 - 26 38 189 - Greenwood 146 - - 146 421 49 Leopold Street 60 - - 60 215 17 Family Planning Association Clinics Underwood Road 476 146 594 1,216 2,765 194 Wapping 32 5 44 81 264 48 Wellington Way 233 17 323 573 1,357 98 Totals: 1,250 168 987 2,405 5,927 517 1969 Statistics 1. 080 167 947 2.194 5.286 424 TABLE 24 HEALTH VISITING No. Visited No. of Visits Children born this year 2,430 " " last year 1,803 36,229 " " 1965-1968 4,294 Aged persons 109 321 Mentally disordered persons 40 234 Tuberculous households 9 33 Households on account of other infectious diseases 32 88 Persons, excluding maternity cases, discharged from hospital (other than Mental Hospitals) 20 61 Other cases 924 2,034 Visits to expectant and nursing mothers - 1,723 Visits to problem families - 2,235 Total effective visits 42,958 Unsuccessful visits - 8,098 TABLE 25 PREMATURE BIRTHS Born in Hospital Born at Home or . in Nursing Home 1970 1969 1968 1967 1970 1969 1968 1967 No. of Births 211 211 177 213 9 5 23 11 Died within 24 hours 11 8 12 16 - - 2 - Died within 1/28 days 8 11 13 8 - 1 - - Premature still births 23 17 26 28 - - 2 1 95 TABLE 26 HOME BATHING Persons serviced during the year: Male 326 Female 1,123 Total 1,449 Persons receiving service at end of year: Male 109 Female 251 Total 360 Total baths given during year ... 9, 171 TABLE 27 HOME HELP SERVICE Persons for whom service provided during year; No. of persons Aged persons 3, 145 Chronic sick and tuberculous persons 438 Mentally disordered 47 Maternity cases 21 Others 114 Total: 3,765 No. of persons receiving service at end of year; 2,582 Staff Number Whole-time eauivalent Organisers 3 3 Assistant Organisers 6 6 Home Helps 264 175.1 TABLE 28 HOME NURSING Number of patients nursed during year 2,464 Number aged under 5 73 " " over 65 1,407 " " of visits during year 85,129 TABLE 29 LAUNDERING FOR AGED AND INCONTINENT No. of articles cleansed and laundered during year 46,379 No. of collections made during year 4, 470 No. of persons who received service during year 333 No. of persons receiving service at end of year 88 TABLE 30 RECUPERATIVE HOLIDAYS Category No. for whom holiday arranged Expectant and nursing mothers 1 Adults - Psychiatric 23 - Tuberculous 1 - Other 165 Accompanied children; 1. At school 4 2. Pre-school 4 Unaccompanied children: 1. Placed by I. L. E. A. at school 205 pre-school 1 2. Placed by Tower Hamlets Council at school - pre-school - Total: 404 97 TABLE 31 LOAN OF NURSING EQUIPMENT AND FIREGUARDS Nursing equipment and fireguards loaned, by the Council, free of charge to residents of the borough during the year was as follows:- No. on loan at 1/1/70 No. loaned during year No. returned during year No. on loan at 31/12/70 Air rings 10 9 12 7 Back rests 16 22 19 19 Beds - Air - 2 2 - Bed cradles 12 15 11 16 Beds - Egerton - 1 1 - Beds - Hospital 11 4 2 13 Beds - cot and mattress 3 3 2 4 Bed pans 24 31 29 26 Bottles 23 19 16 26 Chairs - wheel 47 59 55 51 Chairs - Ambulance type, carrying 1 2 2 1 Commodes - Chair 185 129 134 180 Commodes - Stool 12 11 14 9 Crutches, Elbow - 3 2 1 Cushions - Sani 1 - 1 - Cushions - Sponge 3 - - 3 Fracture boards 14 8 5 17 Hoists 2 - 1 1 Hoists - Penrhyn 5 3 4 4 Mattresses - ordinary 4 - - 4 Mattresses - Dunlopillo 10 6 8 8 Sheets - rubber 28 10 11 27 Walking frames 11 13 10 14 Walking frames - wheeled 1 - - 1 Walking frames - Zimmer adjustable 1 - - 1 Walking sticks - Tripod 20 25 26 19 Walking sticks - Quadruped 3 3 2 4 Water Closet Seats - inflatable 4 1 - 5 OTHER EQUIPMENT LOANED Fireguards 490 41 8 523 98 TABLE 32 DOMICILIARY MIDWIFERY Category Midwives of the Nursing Sisters of St. John the Divine District Nurses Midwives of the London Hospital Total Home Confinements 1970 118 - 76 194 1969 112 - 121 233 1968 119 - 151 270 1967 146 - 202 348 Planned Early Discharges 1970 73 2 61 136 1969 44 - 44 88 1968 45 - 30 75 1967 55 - 42 97 Unplanned Early Discharges 1970 2 196 7 205 1969 4 117 16 137 1968 8 93 13 114 1967 4 - 10 14 -99- TABLE 33 MENTAL HEALTH (i) Patients referred to Council during the year Mentally Ill Psychopathic Subnormal Total Under 16 Over 16 Under 16 Over 16 Under 16 Over 16 General Practitioners - 23 - - - 2 25 Hospitals, On discharge from in patient treatment - 33 - - - - 33 Hospitals, after or during out-patient or day treatment - 43 - - - 3 46 Education authorities - 7 - - 16 45 68 Police and courts - 1 - - - - 1 Other sources - 38 - - 13 15 66 Totals - 145 - - 29 65 239 (ii) Psychogeriatric Unit St. Clement's Hospital In-patient Unit - Dundee Ward 1970 1969 1968 Admissions 131 157 128 Discharges - Home 27 64 71 - Long Grove Hospital 18 16 19 - Other 84 77 37 Total 129 157 127 Day Hospital Admissions 90 87 48 Patient/day attendance 6,478 5,617 5,601 Discharges - Home 29 16 10 - St. Clement's in-patient 21 29 17 - General hospitals 2 5 15 - Other 8 6 5 Total 60 56 47 Out-patient Attendances New referrals 36 44 43 Other Attendances 167 247 230 (iii) Admissions to Hospital under Mental Health Act, 1959 Admitted under Male Female Total Section 25 24 25 49 Section 26 - 3 3 Section 29 17 22 39 Section 60 4 2 6 Section 135 - - - Section 136 - 1 1 Admitted informally 19 32 51 Total 64 85 149 -100- MENTAL HEALTH (iv) Patients under Care at 31st December. Mentally Ill Elderly Mentally Infirm Psychopathic Sub-normal and Severely Sub-normal Total Under 16 Over 16 Under 16 Over 16 Under 16 Over 16 1. Total number - 301 96 - - 105 280 782 2. Attending training/day centre - 28 39 - - 91 82 240 3. Awaiting entry - 2 1 - - 2 - 5 4. Receiving home training - 1 - - - - 1 2 5. Awaiting home training - - - - - - - - 6. Resident in L.A. Hostel - - - - - 1 - 1 7. Awaiting residence in L.A. hostel - - - - - - - - 8. Resident at L.A. expense in other hostels - 21 5 - - 1 14 41 9. Boarded out at L.A. expense - - - - - - - - 10. Attending day hospital - - 9 - - - - 9 11. Receiving home visits and not included in 2-10 above - 249 42 - - 10 183 484 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 - - - - - 3 3 6 (b) not in urgent need - - - - - 2 1 3 15. Admission for temporary residential care: (a) to N.H.S. hospitals - - - - - 3 3 6 (b) to L.A. residential accommodation - - - - - - - - (c) elsewhere - - - - - 4 5 9 TABLE 34 -101- MENTAL HEALTH (v) Day and Training Centres Trainees Adult Training Centre Underwood Road Industrial Training Centre White Horse Road Junior Training School St..Judes Road Special Care Units Day Centre Pritchard' s Road Geriatric Unit' Pritchard's Road T O T A L M F M F M F M F M F No. on roll at 1st January 6 32(1) 46 29 25 13 10 16(1) 14(2) - 12 203(4) New entrants - 5 5 3 6 6 8 18(1) 10 1 12 74(1) Transferred from other centres - 1 1 1 1 - - - - 1 5 10 Removals Moved out of borough - 2(1) 4 3 - 1 - 2 1 - - 13(1) Excluded - 1 - - - - - - - - - 1 Self-discharged - 1 - - - - 1 9 4 - 3 18 Failed to attend - - 1 - - - - 3 3 - 1 8 Admitted to hospital - - - - - - 1 3 1(1) - 3 8(1) Transferred to other centres 1 - - 1 - 1 2 2 - - - 7 Transferred to E.S.N. School - - - - - - - - - - - - Died - - - - - - - - 1 - 1 2 Left to take up employment - 1 2 - 1 - - - 1 - - 5 Residential placing - - 1 - - - - (1) - 1 2(1) No. on roll at 31st December 5 33 44 29 31 17 14 15 (2) 13 2 20 223(2) Figures in parenthesis denote City of London patients in addition. Also, not included above, five patients are attending Centres in other boroughs. TABLE 35 -102- TABLE 36 PARKS AND OPEN SPACES IN THE BOROUGH (a) Administered by Borough Council Location Area in Acres Albert Square Gardens .66 Alfred Street Playground .42 All Saints Gardens (Poplar) 1.06 Arbour Square Gardens .66 Arnold Circus Bandstand .07 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 School house Lane Playground .18 Christ church Gardens (Spital fields) 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 feel 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- TABLE 36 (cont'd) 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 Mill wall Park 13.5 Rope walk Gardens 1.51 St. Mary's Churchyard 1.26 Shandy Park 3.18 Sir John Mc Dougall Gardens 6.32 Stepney Churchyard 6.96 Stepney Green Open Space 5.42 Tower Hamlets Cemetery 4.50 Trinity Garden 1.03 Victoria Park (part) 148.5 Wapping Gardens 3.56 Water side Gardens 1.92 Weavers' Fields 15.12 301.90 TOTAL 338.20 TABLE 37 BURIALS UNDERTAKEN Under Section 50, National Assistance Act, 1948 Number of Adults 34 Number of Children 11 Number of Stillborn Nil Total Cost £876 Burials requested by - Coroner 33 - Relatives 11 - Others 1 -104- TABLE 38 MEDICAL EXAMINATIONS OF COUNCIL STAFF (a) Reason for Examination Number examined New appointees 406 Transfers to permanent staff 96 Entry to Council's Sick Pay Scheme 31 Sickness absence exceeding one month 277 Extension of service beyond 65 years of age 30 Reviews, heavy goods vehicle drivers, etc. 72 Total: 912 (b) Medical assessments for entry to Sick Pay Scheme 528 Examinations arranged with other authorities 26 Student Teachers 12 Abortive appointments 205 TABLE 39 DISEASES OF ANIMALS ACTS Kosher Poulterers and Poultry Slaughterhouses Inspections for cleanliness and fowl pest control 296 Street Markets Inspection re sale of animals and observations on movements of live poultry 64 Pet Shops Visits 56 TABLE 40 VISITS BY PUBLIC HEALTH INSPECTOR (CLEAN AIR) AND TECHNICAL ASSISTANT To premises regarding complaints 440 „ „ „ Smoke Control Orders 5,065 „ „ for smoke observations 805 „ „ regarding Installation of boilers and chimneys 121 „ „ „ routine boiler inspections 85 No. of notices served under Sec. 12(2) Clean Air Act 35 „ „ „ „ Sec. 16 -do- 1 -105- 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 1,055 samples were submitted for analysis, as follows:- 4 Ale 5 J am and preserves 7 Baby Foods 1 Lager 6 Biscuits 10 Margarine 1 Brandy 66 Meat pies and sausage rolls 4 Bread 44 Meat and meat preparations 15 Bread and Butter 44 Meat products (canned) 24 Butter 14 Milk 23 Cereal and starch products 9 Milk (dried and condensed) 18 Cheese and cheese preparations 6 Milk preparations 25 Cocoa and chocolate preparations 20 Miscellaneous samples 6 Coffee and coffee preparations 35 Nuts and nut preparations 7 Colourings 18 Oils fats and fatty foods 8 Cream 41 Pickles and Sauces 77 Drugs 2 Rum 5 Eggs and egg products 4 Salad Cream 26 Fish and fish preparations 46 Sausages and other meat products 9 F1avourings 2 Shandy 30 Flour confectionery 35 Soft drinks 18 Flour and flour products 28 Soup and soup mixes 7 Food additives 42 Spices and condiments 122 Fruit and fruit preparations 4 Sugars, syrups, etc. 3 Gin 34 Sugar confectionery 7 Gravy preparations 14 Table jelly preparations 1 Stout 22 Tea 2 Herbs and herb preparations 27 Vegetables and vegetable preparations 3 Ice Cream 19 Vinegar and acetic acid 1 Ice lollies, sorbets, etc. 4 Whisky -106- TABLE 42 HOUSING INSPECTORS AND TECHNICAL ASSISTANTS VISITS AND NOTICES VISITS Housing Act, 1957 (Sections 16, 17 and 18) 455 Slum Clearance 2, 183 Overcrowding 72 Standard and Improvement grants 9 Town Planning applications 75 Houses in Multiple Occupation 8,353 Preferential re-housing 560 Sites 2,796 Qualification Certificates 66 Miscellaneous 435 Total: 15,004 NOTICES, ORDERS,ETC. HOUSING ACTS 1957-64 Informal notices 74 Management Orders made 13 Intention to make Directions 19 Directions made (Section 19) 12 Overcrowding (Section 90 Housing Act, 1957) 40 Means of Escape in Case of Fire (Section 16) 104 -107- TABLE 43 DWELLINGS ERECTED DURING 1970 (a) By Borough Council Adams House, Blair Street, 8, 10, 12-18 (consec.) 9 Burdett Road, 1-7 (odd) 4 Chipka Street, 6-37 32 Cork House, Monteith Road, 16-26 (even) 6 Cruden House, Vernon Road, 1-32 32 Donegal House, O'Shea Grove, 121-147 (odd) 14 Dornoch House, Angle Road, 1-20 20 Down House, O'Shea Grove, 61-119 (odd) 30 Dunnet House, Vernon Road, 1-16 16 East Ferry Road, 26-44 (even) 10 Enard House, Cardigan Road, 1-24 24 Eric Street, 105, 107, 119 and 121 4 Forth House, Tredegar Road, 1-18 18 Frazerburgh House, Vernon Road, 1-20 20 Glengall Grove, 5-35, 5A-35A, 47-65, 47A-65A 52 Glengarnock Avenue, 86-108 (even) 12 Gosford House, Tredegar Road, 1-16 16 Grafton House, Wellington Way, 1-130 130 Gullane House, Shetland Road, 1-24 24 Jones House, Blair Street, 8, 10, 12-18 (consec.) 9 Keats House, Roman Road, 13-22 10 Kildare House, O'Shea Grove, 1-23 (odd) 12 Langley House, East India Dock Road 4 Lefevre Walk, 271-321, 394-444, 517-567 153 Lunan House, Shetland Road, 1-30 30 Manchester Road, 165-177 (odd) 7 Munster House, O'Shea Grove, 25-59 (odd) 18 Theseus House, Abbott Road Estate, 1-23 23 Water view House, Carr Street, 1-66 66 Went worth Mews, 1-36 36 Windermere House, Eric Street, 7-14, 21-28, 41-48, 55-62 32 873 (b) By Greater London Council Sovereign House, Collingwood Estate 56 Priestman Point, Crossways Estate 92 Hackworth Point, Crossways Estate 92 Mallard Point, Crossways Estate 92 Clark Street, Exmouth Estate 81 Jamaica Street 56 Fitzgerald House, Lansbury Estate 73 Kerbey Street 15 Market Square 15 Ackroyd Drive, Leopold Estate 60 Shearsmith House, St. George's Estate 107 Solander Gardens. Solander Gardens Estate 56 795 (c) By Others 11 Deal Street 1 75 Wapping High Street 1 2 TOTAL 1,670 -108- 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 386 112 4 Factories with mechanical power 3,488 1,900 76 Other premises under the Act (Electrical stations. institutions, and sites of building operations and works of engineering and construction) 99 32 - Total: 3,973 2,044 80 2. Cases in which defects were found Particulars Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 5 4 3 - Overcrowding - - - - Unreasonable temperature - - - - Inadequate ventilation - - - - Ineffective drainage of floors - - - - Sanitary conveniences: (a) Insufficient 5 4 - 1 (b) unsuitable or defective 84 84 - 8 (c) not separate for sexes 5 2 - 2 Other offences against the Act (not including those relating to outwork) 38 36 3 1 Total: 137 130 6 12 -109- TABLE 44 (cont'd) 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. 536 - - Cleaning and washing - - - Household linen 1 - - Lace, lace curtains and nets - - - Curtains and furniture hangings 9 - - 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. - - - Artificial flowers - - - Nets (other than wire nets) - - - Tents - - - Sacks - - - Racquet and tennis balls - - - Paper bags - - - Making of boxes and other receptacles or parts thereof made wholly or partially of paper 73 - - Brush making 2 - - Pea Picking - - - Feather sorting - - - Carding, etc. of buttons, etc. 5 - - Stuffed toys - - - Basket making - - - Chocolates and sweetmeats - - - Cosaques, Christmas stockings - - - Textile weaving - - - Lampshades 3 - - Total: 629 - - Section 134. There were no instances of work found in unwholesome premises. -110- 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 8 155 - - 35 9 - Contravention of Regulations 46 238 - - 40 - - Means of escape from fire not provided 5 105 - - 18 6 - Housing Act, 1957: Overcrowding in Houses in Multiple Occupation 25 185 - - 45 5 - Public Health Act, 1936: Nuisance Orders 59 - 208 2 - Non-compliance with Nuisance Orders 11 120 - - 32 12 - Failing to repair W.C. drain 2 7 - - 6 - - Food and Drugs Act, 1955 19 265 - - 100 12 - Food Hygiene (General) Regulations 1970 57 250 - - 23 8 - Food Hygiene (Market stalls and Delivery Vehicles) Regulations, 1966 77 481 - - 71 18 - Offices Shops and Railway Premises Act, 1963 7 23 - - 7 7 - Pet Animals Act, 1951 8 16 - - 10 - - Clean Air Acts 1956/1968 1 25 - - 5 - - Factories Act 1961 1 - 4 4 - Total: 326 1,870 - - 608 3 - TABLE 46 MORTUARY SERVICE Tower Hamlets Mortuary Hackney Mortuary Total Bodies received 458 135 593 Post-mortems 401 118 519 Inquests 56 17 73 Deposit only 1 - 1 -1ll- TABLE 47 CLEANSING STATION Persons treated for scabies: M en 83 Women 94 School children 236 Children under 5 80 Total: 493 No. treatments given 832 Persons treated: for verminous conditions Men 617 Women 63 School children 426 Children under 5 79 Total: 1,185 TABLE 48 DISINFECTING STATION Disinfection: No. of dwellings disinfected for tuberculosis 10 No. of dwellings disinfected for other infectious diseases 8 No. of dwellings disinfected for other reasons 138 No. of rooms involved 175 No. of articles disinfected by steam 3,399 No. of articles disinfected by formaldehyde 98 an d 12 tons rags. No. of premises other than dwellings, disinfected 18 Disinfestation: No. of dwellings disinfested for bed bugs 526 - for other vermin 645 No. of rooms involved 2,576 No. of other premises and sites disinfested 580 No. of articles disinfested by steam 8,48 4 No. of articles disinfested by formaldehyde 2,726 Drainage: No. of premises where drains tested 59 No. found defective 28 -112- TABLE 49 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 Type of Premises Registered during year Total No. of Registered Premises at end of year Registered Premises receiving general inspections during year Persons employed Offices 65 991 372 16,343 Retail Shops 52 1,081 472 3,792 Wholesale Shops 36 577 289 5,078 Catering establishments/ Staff Canteens 19 287 162 1,632 Fuel Storage Depots - 2 - 22 Total: 172 2,938 1,295 26,867 Males: 17,7 59 Females: 9,108 Other visits to registered premises 1,140 Visits to non-registered premises 1,295 Informal Notices served Offices, Shops and Railway Premises Act, 1963 407 Notification of Employment of Persons Order, 1964 150 Accidents notified - Causes Machinery: Power driven machinery or relevant part in motion 5 Transport: Vehicle in motion not moved by power 2 Vehicle stationary 2 Hand tools 4 Fall soof persons: On or from fixed stairs 7 On or from ladders or step: 1 adders 1 Other falls from one level to another 4 (1 fatal) Falls on the same level 10 Stepping on or striking against object or person 8 (1 fatal) Handling Goods (not otherwise classifiable) 21 Struck by falling object 5 Not otherwise specified 1 Total: 70 -113- TABLE 50 RODENT CONTROL Properties inspected Number inspected Number found to be infested by Rats Mice On complaint 2,740 1,017 1,593 Otherwise 1,793 446 894 Total: 4,533 1,463 2,487 Properties treated by Council 4,673 Visits by Rodent Operatives 15,551 Notices served under Section 4 of the Act (a) treatment Nil (b) structural work (proofing) 54 Cases where default action taken following service of notice 7 Number of "Block Control" schemes carried out 15 No. of business premises under servicing contract at 1st January 189 No. of new contracts during the year Nil No. of contracts terminated during the year 12 No. remaining under contract at 31st December 177 -114- TABLE 51 VISITS BY PUBLIC HEALTH INSPECTORS Type of Premises No. Visits or Inspections Registered and Licensed Premises Common Lodging Houses 3 14 Pur Skin Dressers 3 3 Hairdressers 194 94 Ice-Cream 456 263 Massage Establishments 5 11 Milk Distributors 246 406 Pet Shops and Stalls 69 136 Pharmacy and Poisons 70 116 Poultry Slaughterhouses 19 201 Prepared Food - Meat 94 52 - Fish 56 46 Rag Flock 31 7 Seamen's Lodging Houses 2 19 Dwellings No. of visits on complaint 62,189 5,589 No. of visits for drainage 2,582 No. of revisits 7,197 No. of other visits 1,917 Other Premises Bakehouses 45 92 Baker Shops and Stalls 95 163 Butcher Shops and Stalls 174 311 Canteens and Clubs 610 195 Chemists 55 12 Confectionery Shops and Stalls 368 213 Fish Shops and Stalls 129 239 Greengrocers and Fruiterers Shops and Stalls 577 425 Grocers Shops and Stalls 374 657 Hospitals, Institutions and Day Nurseries 31 12 Public Houses 396 591 Poultry Shops and Stalls 109 121 Restaurants, Cafes and Stalls 565 610 School Meal Centres 134 46 Wholesale Food Depots, Markets and Wharves 151 2,010 Other Food Premises 192 109 Food Delivery Vehicles - 13 Factories (Mechanical) 3,488 1,900 Factories (Non- Mechanical) 386 112 Factories (other) 99 32 Outworkers 629 357 Schools 101 91 Drainage Work - 2,929 Total: 29,890 There are 3,614 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 - Notice of proposal to issue certificates - Undertaking accepted - Undertaking refused - Certificates issued - 2. Applications for cancellation of disrepair certificates 1 Cancellations issued - Cancellations refused 1 Complaints Number received at Office 4,148 Dangerous Structures Number of premises notified to District Surveyor 53 Drainage Plans Number of plans on which observations submitted to Borough Engineer and Surveyor 281 Land Charges Number of premises reported upon to Town Clerk 1,063 Town Planning Applications No. of premises reported upon to Borough Architect and Planning Officer 684 Public Houses Number of premises reported upon to Licensing Justices 98 -116- TABLE 53 NOTICES SERVED BY DISTRICT PUBLIC HEALTH INSPECTORS Factories Act 1961 80 Food Hygiene (General) Regulations 1970 292 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 74 Hairdressers and Barbers Byelaws 6 Informal Notices to Local Authority Housing Departments 1,669 Prevention of Damage by Pests Act 1949 51 Public Health Act, 1936, Section 39 19 -do- 75 17 -do- 89 12 -do- 93 1,139 Public Health Act, 1961, Section 17 128 Staircase Lighting Byelaws 3 Total: 3,490 TABLE 54 OUTWORKERS Firms in the borough employing outworkers 174 Outworkers residing in, and employed by firms in the borough 496 Outworkers residing outside the borough employed by firms in the borough 1,120 Outworkers residing in the borough employed by firms outside the borough 133 Total outworkers in the borough 629 TABLE 55 REFUSE DISPOSAL Home and trade refuse 72,500 tons Street and market collections 15,500 tons No. of bulk containers in use 3,200 No. of street gulleys cleansed 9,500 -117- 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 on Environment London 21st January Councillor J. O'Connor. Public Health Inspector. (b) Two Day Symposium on Housing London 18th - 19th June Deputy Chief Public Health Inspector Public Health Inspector. (c) Annual Conference Blackpool 14th - 18th September Councillor Mrs. Brazier. Councillor Mrs. Crook. Public Health Inspector. (d) Evening Conference London 10th December Public Health Inspector. Association of Sea and Air Port Health Authorities Conference Hull 1st - 3rd April Chairman, Health Committee Associate Medical Officer of Health. British Dental Association Annual Conference Manchester 13th -17th July Chief Dental Officer. Sessional Dental Officer. Federation of Association of Mental Health Workers Annual Conference Torquay 3rd - 6th April Principal Social Worker (Mental Health). Royal Society of Health; (a) Health Congress Eastbourne 27th April 1st May Councillor Moore. Medical Officer of Health. (b) Thamesmead Project London 2nd July Vice-Chairman, Health Committee Medical Officer of Health. (c) International Conference Edinburgh 21st - 25th September Councillor Mrs. O'Connor. Principal Nursing Officer. (d) Meat Preservation London 29th October Councillor J. O'Connor. Chief Public Health Inspector (e) Condensation Problems in Modern Housing London 19th November Councillor Miss Morsman. Public Health Inspector. (f) Reconstruction of Local Government. The National Health Services and the Social Services. London 26th November Councillor J. O'Connor. Principal Nursing Officer. -118- TABLE 56 (cont'd) CONFERENCES (cont'd) Conference Venue Dates Representatives Royal Society of Health: (g) Radiation Levels Air, Water and Food London 10th December Councillor Miss Morsman. Public Health Inspector. Institute of Water Pollution Control: (a) Water pollution Bournemouth 19th - 21st May Chief Administrative Officer (b) Annual Conference Blackpool 7th- 11th September Councillor J. O'Connor. Councillor Harris. Chief Public Health Inspector. Institute of Shops Acts Annual Conference Morecombe 29th September - 1st October Councillor Negus. Councillor Wall. Public Health Inspector. National Association for Maternal and Child Welfare: Annual Conference London 24th - 26th June Principal Medical Officer National Association for Mental Health: (a) Protecting the Mental Health of the Elderly London 2nd June Councillor J. O'Connor. Alderman Mitchell. Principal Social Worker (Mental Health) (b) Out of Hospital "Who Cares" London 22nd September Senior Social Worker (Mental Health) (c) Annual General Meeting London 11th November Senior Social Worker (Mental Health) National Association of Nursery Matrons: Conference Llandudno 14th - 15th March Day Nursery Matron National Council for Home Help Services International Conference of Home Helps London 7th - 11th April Three Home Helps. -119- TABLE 56 (cont'd) CONFERENCES (Cont'd) Conference Venue Dates Representatives National Council for the Unmarried Mother and her Child London 19th November Two Health Visitors National Society for Clean Air Southport 20th - 23rd October Councillor Negus. Public Health Inspector. National Union of Teachers Health Education from Special Agencies and Groups London 6th March Assistant Health Education Officer Council for the Training of Health Visitors Conference Harrogate 22nd - 24th April Principal Nursing Officer Friendship Week for Sick and Mentally Handicapped Children, Conference London 19th May School Nurse. Health Visitors Association Study Conference Buxton Spa 24th - 26th September Deputy Principal Nursing Officer Inner London Education Authority Care is Invisible London 19th May Principal Medical Officer King Edward Hospital Fund (a) Voluntary Help in the field of Subnormality London 13th March Supervisor, Training Centre. (b) Mental Health in the Community London 4th May Principal Social Worker (Mental Health). Senior Social Worker (Mental Health). District Nurse. (c) The Incontinent Adult in the Community London 18th June District Nurse. (d) Geriatric Services Incontinence in the Elderly London 12th November Senior Social Worker (Mental Health) -120- TABLE 56 (cont'd) CONFERENCES (Cont'd) Conference Venue Dates Representatives London Boroughs Training Committee (a) Treatment and Care of Spina Bifida Children London 23rd October Superintendent of Midwives. Health Visitor. School Nurse. (b) Survey of the work of the Health Visitor London 27th October Principal Nursing Officer. Assistant Nursing Officer. Health Visitor. Noise Abatement Society International Congress Holland 11th - 14th May Councillor J. O'Connor Deputy Chief Public Health Inspector Queens Institute of District Nursing. Relationship between the Hospital and Local Authority Services. London 4th December Principal Nursing Officer. Race Relations Committee of the Religious Society of Friends Playgroups and the Needs of Under 5's in Urban Areas. London 20th February Vice-Chairman, Health Committee. Assistant Nursing Officer. Royal Institute of Public Health and Hygiene Annual Conference Cheltenham 1st - 4th September Councillor Mrs. Couling. Councillor Pollins. Sessional Medical Officer. St. Lawrences Hospital Centenary Conference Caterham 24th - 26th June Senior Social Worker (Mental Health). Social Worker (Mental Health). Teacher, Junior Training School. Society of Medical Officers of Health "The Diabetic Child" London 12th March Principal Medical Officer. Social Worker (Health Services). 2 School Nurses. -121- TABLE 57 REFRESHER AND TRAINING COURSES Courses attended by staff during the year were as follows:- Course Venue Dates Attended by London Boroughs Training Committee Principal Nursing Officer. Superintendent District Nursing. Superintendent of Cleansing Services. a)Study Day for Chief and Senior Nursing Officers. London 8th January (b) Management Appreciation Course for Centre Superintendents London 12th - 16th January 2 Health Visitors. (c) Re-entry Course for Health Visitors. London 19th January 11th March. Health Visitor. (d) Study Day for Health Education Officers. Bristol 12th February Health Visitor. (e) Health Surveillance for Older Age Group London 19th - 20th February Centre Superintendent. Health Visitor. (f) Series of Seminars for Social Workers with Special Responsibilities with Day Centres London 20th - 27th February 6th, 13th, 20th, March 10th, 17th, 24th April Senior Social Worker (Mental Health) (g) Middle Management Course. London 23rd February 20th March. Assistant Nursing Officer (h) Study Day London 24th March Head Teacher, Junior Training School ,, ,, ,, 9th July ,, ,, ,, 27th November (i) 6 Seminars for Home Help Organisers London 7th April 12th May 2 Assistant Home Help Organisers. (j) Residential Course for Matrons Clacton 4th - 8th May Matron, Day Nursery. (k) Newham Course for Practical Work Instructors London 1st 13th June District Nurse. (1) Refresher Course for Health Visitors York 1st - 11th September Health Visitor. -122- TABLE 57 (cont'd) REFRESHER AND TRAINING COURSES (Cont'd) Course Venue Dates Attended by (m) Health Education in Schools London 23rd - 24th September Health Visitor (n) Management Appreciation London 28th September 2nd October 2 Centre Superintendents (o) 18 Seminars on Marital Casework London 2nd October May 1971 Assistant Principal Social Worker (Health Services). (p) Seminars in Group Work London 6th October July 1971 Senior Social Worker (Mental Health) (q) Residential Course Clacton 12th - 16th October Matron. Day Nursery. Deputy Matron, Day Nursery (r) Introductory Course for School Nurses. London 5th, 6th, 12th, 13th November 2 Clinic Nurses. London Borough of Newham School of Community Nursing (a) District Nurses' Training Course London 4 Months commencing 19th January 3 District Nurses. (b) District Nurses' Training Course London 10 Weeks, 16th February District Nurse. (c) Refresher Course London 27th April 1st May 3 District Nurses. North East London Polytechnic FieldWork Instructors' Course London 30 Days from 23rd November 28th May 1971 2 Health Visitors. North West London Polytechnic (a) Field Work Instructors' Course London 30 Days from 23rd November - Centre Superintendent 2 Health Visitors. (b) Practical Work Instructors' Course London 21st September3rd October 2 District Nurses. Central Training Council for Teachers of Mentally Handicapped Children 2 - yrs. secondment London Commencing September 1970 2 Trainee Teachers. -123- TABLE 57 (cont'd) REFRESHER AND TRAINING COURSES (Cont'd) Course Venue Dates Attended by Licentiate Institute of Building Construction Technicians Course 1 Day per week for 1 year London Commencing September 1970 Technical Assistant Thirteenth Annual Refresher Course for Nursing Profession Ipswich 2nd-6th November Health Visitor Margaret Pyke Centre Family Planning Courses London 9th October , 20th November Centre Superintendent Institute of Home Help Organisers' Weekend School Malvern. Worcs. 24th-26th September Home Help Organiser Greater London Whitley Council Office Management London 6th-10th July Administrative Assistant The Spastics Society Course Wallingford lst-4th December Teacher, Junior Training School National Childbirth Trust Course in Psychoprophylaxis London 29th-31st May Health Visitor National Association for Mental Health 1. Course for Medical Officers on Mentally Subnormal Children London 13th April 8th May Sessional Medical Officer 2. Development of Communication Skills in the Mentally Handicapped London 1st May Assistant Supervisor 3. Making Music with Mentally Handicapped Children Bristol 14th-16th April Teacher, Junior Training School Royal College of Nursing Follow-up Course for Fieldwork Instructors London 7th-18th December Health Visitor Association of Health Administrative Officers Summer School Public Health Administration Warwick University 9th-12 th December Administrative Assistant Chiswick Polytechnic Courses for Local Government Officers in Health Departments London 1st-12 th June 7th- 18th September Health Visitor -do- London 2nd- 13th November Centre Superintendent -124- TABLE 57 (cont'd) REFRESHER AND TRAINING COURSES (Cont'd) Course Venue Dates Attended by Royal College of NursingCommunity Health Nurse Teacher CertificateOne year secondment London Commencing September 1970 Senior District Nurse. Society of Medical Officers of Health Refresher Course for Local Authority Dental Officers Oxford 22nd - 24th September Senior Dental Officer British Postgraduate Medical Federation 2 Day Course London 20th - 21st March Chief Dental Officer. Dental Officer Course on Paedodontics London 7th, 14th, 21st and 28th September Sessional Dental Officer. Course on Crowns London 29th September 1st October Sessional Dental Officer Health Visitors' Association Residential Course for Nursing Staff Swansea 31st March 10th April School Nurse. Inner London Education Authority (a) Course on Drug taking among School children London 5th - 6th January Deputy Medical Officer of Health (b) Course for Public Health Dental Officers. London 1st - 3rd July Dental Officer. (c) Production and Presentation Techniques in Education London 7th - 11th December Dental Auxiliary. North London College for Further Education 1. Course for qualified Staff London 19th January 2nd February Nursery Warden 2. Course for unqualified Nursery Assistants London 2nd - 20th March Nursery Assistant 3. Further Course in Nursery Education London 5th October 13th November Deputy Matron -125- TABLE 57 (cont'd) REFRESHER AND TRAINING COURSES(Cont'd) Course Venue Dates Attended by 4. One year course for Mature Students, 2 days per week, leading to N.N.E. B. certificate London Commencing September 1970 Nursery Warden Nursery Assistant Association of Public Health Inspectors Annual week-end Seminar Canterbury 3rd - 5th April 3 Public Health Inspectors Greater London Council Department of Transport and Planning The Problem of Noise London 17th - 18th September Deputy Chief Public Health Inspector Ministry of Agriculture, Fisheries and Food Rodent Control Course London 9th - 11th June Rodent Operative -do- London 22 nd - 24th September 2 Rodent Operatives Royal Society of Health Smoke Inspectors' Certificate 1 Day per week for 1 year London Commencing September 1970 2 Public Health Inspectors. Queens Institute of District Nursing 1. Study Day - Student Assessment London 13th May Supt. District Nurses. District Nurse. 2. Follow up Study Day London 2nd December District Nurse. 3. The diabetic within the Community London 14th July District Nurse. -126- TABLE 58 SCHOOL HEALTH STATISTICS Pupils on School Rolls at December, 1970 Under 5 years - full-time 1,306 - part-time 1,392 Infants 7,181 Juniors 10,384 Seniors 11,518 Special 836 Total: 32,617 Recuperative Holiday Homes Number of schoolchildren (including Nursery schoolchildren) admitted during the year 206 Health Surveys No. examined Occasions vermin found Percentage (a) Comprehensive 22,639 759 3.35 (b) Selective 13,726 743 5.41 No. of individual pupils found verminous ... 356 Percentage of school roll ... 1.09 Vermin - occasions advice and/or shampoo given ... 1,326 - occasions attendance at bathing centre ... 176 (c) Communicable disease - No. examined for ... 1,462 Routine Audiometer Testing No. of children given screening test 3, 852 No. failing screening test and given pure tone test ... 205 No. failing pure tone test and referred to Otologist ... 114 School Medical Treatment Clinic No. of premises Sessions in year New Cases Attendances Audiology 1 93 224 650 Bathing 2 578* 801 1, 176 Minor ailments - Medical Officer 6 134 661 17,379 - Nurse 8 753 994 Ophthalmic 4 293 1,230 3,011 Orthoptic 1 80 101 172 Special investigation 3 141 121 1,126 *includes also adult sessions -127- TABLE 58 (cont'd) Defects treated at School Treatment Centres and Hospital Clinics Errors of refraction and squint 799 Other eye defects 21 Spectacles ordered 833 Athlete's foot 55 Verrucae 445 Ringworm - body 2 Impetigo 57 Other skin diseases 277 Eye diseases 134 Ear diseases 62 Miscellaneous lacerations, etc. 623 Orthopaedic and postural defects (treated at schools) 84 B.C.G. Vaccination - Schoolchildren Number of schools visited 30 Number of 13- year old children offered test 2,425 Number of consents received 1,881 Number of children tested 1,638 Number of positive reactors 110 Number of children vaccinated 1,382 Infectious and Other Diseases notified by Schools Disease No. of Notifications Chickenpox 258 Dysentery, Diarrhoea 25 German Measles 48 Glandular Fever 4 Impetigo 43 Influenza 24 Jaundice 38 Measles 267 Mumps 354 Ophthalmic conjunctivitis 8 Ringworm 9 Scabies 19 Scarlet Fever 20 Tonsillitis 63 Whooping Cough 55 Total: 1,235 (Number notified last year 943) -128- TABLE 59 HEALTH DEPARTMENT ESTABLISHMENTS Particulars of Clinics held and Services provided as at 31st December, 1970. (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, Clinic Centre, 1-2 Newmill House, Empson Street, E.3. Infant Welfare, Toddlers, Mothers' Club and Creche. Clinic and School Treatment Centre, Leopold Street, E.3. Dental, Infant Welfare, Minor Ailments, Occasional Creches, Special Investigation, Toddlers, Vaccination and Immunisation, Vision, Dressmaking, G.P. Obstetrician, Auditory Training, Orthoptic. Family Planning. Clinic Centre, Library Place, Cable Street, E.1. Chiropody, Infant Welfare, Toddlers, Family Planning. Clinic Centre, Peel Grove, E.2. Ante-Natal, Infant Welfare, Occasional Creches, Toddlers, Vaccination and Immunisation. Cervical Cytology, Psychoprophylaxis, Dressmaking, Keep Fit Class, G.P. Obstetrician, Mothers' Club. Post-Natal. 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, Mothers' Club, Cervical Cytology, Dressmaking. Clinic Centre, Tiller Road Baths E.14. Infant Welfare, Toddlers, Vaccination and Immunisation. -129- TABLE 59 (cont'd) (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, English Language Class. Clinic Centre, 1-2 Wigram House Wades Place, E.14. Infant Welfare, Toddlers, Speech Therapy, Chiropody 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, Cookery Class, Chiropody. 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, Sewing Class. 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, Wadeson 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 (cont'd) (b) CHEST CLINICS Days and Times London Chest Hospital, Victoria Park, E.2. Mon. Wed. Thurs. Fri. 9.15-11.30 a.m. Sat. 9.15-11.0 a.m. Wed. 5.0 -6.15 p.m. Thurs. B.C.G. Clinic 2.30 p.m. Wellington Way, Bow Road, E.3. Tues. 2.0 - 4.0 p.m. (adults) 5.30 - 7.0 p.m. (adults) Thurs. 10.0 -12 noon (children) 2.0 - 4.0 p.m. (adults) Fri. 10.0 -12 noon (adults) Steels Lane, E.1. Mon. 10.0 -12 noon and 2.0 -4.0 p.m. Tues. 10.0-12 noon and 2.0 -4.0 p.m. 5.0 -7.0 p.m. Wed. 10.0 -12 noon Fri. 10.0 -12 noon Sat. 10.0-12 noon (c) DAY NURSERIES 22,Underwood Road, E.1. Monday to Friday 8.0 a.m. - 5.30 p.m. Christian Street, E.1. „ „ „ 8.0 a.m. - 5.30 p.m. Sugar Loaf Walk, E.2. „ „ „ 8.0 a.m. - 5.30 p.m. Tidey Street, E.3. „ „ „ 7.30 a.m. -5.30 p.m. Alice Model, 14/24, Beaumont Grove, E.1. (Voluntary) „ „ „ 8.0 a.m. - 5.30 p.m. (d) MENTAL HEALTH TRAINING CENTRES Adult Centre, 28 Underwood Road, E.1. „ „ „ 9.30 a.m. - 4.0 p.m. Junior 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 10 Accidents in the Home 69 Adoption and Boarding Out 28 Adult Training Centres 44, 131 Alcoholics 45 Analysis of Food and Drugs Samples 54, 106 Ante—Natal Clinics 28, 91 Anthrax 13, Area of Borough 6. Artificial Kidney Machines 46 B Bacteriological Examination — Food 54 B.C.G. Vaccination 16,77,90 Births 6,9 Blind, Partially Sighted 45. Burials 47, 104 C Cancer 13 Cervical Cytology 29, 92 Chest Clinics 17 Chief Public Health inspector's Report 49 Child Minders 26, 30, 92 Child Welfare Clinics 91 Chiropody 45, 93 Circulars - Ministry 72 Clean Air 51, 105 Cleansing Station 61,112 Clinic Centres 30 Common Lodging Houses 62 Community Care Services 41 -133- C (continued) Page Nos. Comparative Statistics 12, 83 Conferences and Courses 70, 118-126 Congenital Defects 29 Creches 30 D Day Care Service 46 Day Centres (Mental Health) 43 Day Nurseries 26, 30, 92 Deaf Children 77 Deaths 9, 81 Dental Services 38, 93 Developmental Assessment Clinic 32 Diphtheria 13 Diseases of Animals 57, 105 Diseases — Notifiable 85 Disinfection/Disinfestation 61, 112 Dysentery 13 E Educationally Sub-Normal Children 77 Employment of Schoolchildren 78 Environmental Health Services 49 Establishments 129-131 F Factories 61, 109 Family Planning 32, 95 Fifty Years ago 8 Food and Drugs 52 Food Hygiene 52 Food - Imported 53 Food — Unsound 56 Food Poisoning 13 Guardianship 44 -134- H & I Page Nos. Hairdressers 61 Handicapped Pupils 76 Handicap Register 3 Health Committee 1 Health Education 33, 49, 77, 94 Health Visiting 33, 95 Home Bathing 47, 96 Home Help Service 46, 96 Home Nursing 25, 33, 97 Hospital Facilities 70 Houses in Multiple Occupation 59 Housing 2, 59, 107 Hygiene in Schools 77 Ice—Cream 56 Immunisation 77, 87 Incontinence Pads 34 Industrial Training Centre 44 Infant Mortality 9, 82 Infectious Diseases 2, 13, 77, 85, 86 Infective Jaundice 14 Inquests 70 J & K Junior Training School 42 L Laboratory Facilities 71 Laundry Service 34, 97 Legal Proceedings 61, 111 Legislation 71 Licensing Act, 1961 62 Loan of Nursing Equipment 34, 98 -135- L (continued) Page Nos. Lodging Houses 62 London Hospital 44 M Malaria 14 Marie Curie Memorial Foundation 35 Marriages 11 Mass Radiography 16, 90 Maternal Mortality 10 Measles 14, 36 Medical Inspection of Schoolchildren 75 Mental Health 41,100-102 Midwifery 35, 99 Milk Supply 55 Minor Ailments Clinics 77 Miscellaneous services 69 Morbidity 10,86 Mortuary 62,111 N Neo—Natal Mortality 10 New Houses 60, 108 Notices Served by Public Health Inspectors 117 Nursing Equipment — Loan of 34, 98 O Observation Register 36, 84 Offensive Businesses 63 Offices, Shops and Railway Premises 58, 113 Open Spaces 12, 103 Ophthalmia Neonatorum 14 Outwork and Outworkers 64, 110, 117 P & Q Partially Hearing Children 78 Partially Sighted Persons 45 -136- P & Q (continued.) Page Nos. Peri—natal Mortality 10 Personal Health Services 25 Pet Animals Act 64 Pharmacy and Poisons Act 64 Phenylketonuria 36 Playgroups 30 Poliomyelitis 14 Population 7 Post Natal Clinics 91 Poultry Processing and Packing 64 Premature Babies 37, 95 Pre-School Playgroups 26, 30, 92 Principal Nursing Officer's Report 25 Principal School Medical Officer's Report 75 Public Analyst's Quarterly Reports 106 Public Health Inspectors — Visits 105, 107, 115, 116 Public Relations 11 Pupils on School Rolls 75 R Radioactive Substances 72 Rag Flock, etc. Act 64 Recuperative Holidays 37, 97 Refreshment Houses 65 Refuse Disposal 65, 117 Removal of Persons in Need of Care 47 Renal Dialysis 46 Rent Act 65 Road Accidents 82 Rodent Control 65, 114 Rubella 36 -137- s Page Nos. Scabies 14 Scarlet Fever 15 School Dental Service 79 School Health Service 75, 127—128 Seamen's Lodging Houses 62 Sewerage 66 Slum Clearance 59 Smallpox 15 Social Conditions of the Area 7 Special Care Units — Mental Health 42 Staff 5, 72, 73, 105 Statistics and Social Conditions 7 Statistics- Summary 6 Students - Training of 73 Swimming Baths 66 T Tuberculosis 15, 88, 89 Typhoid 15 Underground Rooms 59 Unemployment 11 Unmarried Mothers 38 Vacant Sites 66 Vaccination 36, 77, 87 Veneral Diseases 2, 19 Verminous Schoolchildren 76 w Water Supply 67 Weather Conditions 13 Welfare Foods 39 Whooping Cough 15 Works in Default 67 -138- V •*) % '•? £ 1 :t 11 1:: i :! :: n t U y;:::: i