AC 43393 ach'd TOWER HAMLETS LONDON BOROUGH 1971 ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH & PRINCIPAL SCHOOL MEDICAL OFFICER LONDON BOROUGH OF TOWER HAMLETS ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH & PRINCIPAL SCHOOL MEDICAL OFFICER 1971 R. W. WATTON M.B., B.S.. D.P.H., D.C.H.. D.I.H. CONTENTS PAGE Health Committee 1 Introductory 2 Staff 4 Summary of Statistics 5 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 23 IV Environmental Health Services 37 V Miscellaneous Services 57 VI School Health Services 65 VII Appendix of Statistical Tables 71 INDEX 117 TOWER HAMLETS HEALTH AND HOUSING MANAGEMENT COMMITTEE (as at 31st December, 1971) Ex-Officio: The Worshipful the Mayor, Councillor V. Harris Alderman J. Orwell (Stepney) CHAIRMAN Councillor E.W. Hill VICE-CHAIRMAN Councillor G.T. Desmond ALDERMEN G.W. Negus COUNCILLORS J.D. Allen I.P. Mc Dougall R.W. Ashkettle J. Milrood H. Conway D. Thyeson A.W. Downes Mrs. P M. Thompson A.P. Hegarty E.G. Walker J. Kennedy R.J. Warner -1- HEALTH DEPARTMENT; 227/233 Commercial Road, London E1 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 1971 • It has been a year of rumour and counter rumour as plans are formulated for the unification of the National Health Service by April 1974. For some time in this borough increasing liaison between the three areas of the health service has been fostered. Joint liaison committees exist with members from the London Hospital group, other hospital groups, and with general practitioner and local health authority representatives. In addition a special committee has been set up to discuss the future planning of health services by St. Bartholomews, and the London Hospital:, and the London Boroughs of Hackney and Tower Hamlets and the City of London No doubt when the constituent elements of the Area and District boards in the locality have been finally agreed executive powers will enable tentative plans to be incorporated in future policy decisions. Future impetus to joint training schemes in nursing as between hospitals and the community nursing services has been encouraged in 1971. Effective links with hospital nursing staff and our district services ensure adequate information being available to maintain continuity of care when patients pass backwards and forwards across the interface of hospital and community. Schemes of attachment of district nurses to general practices have multiplied. By early 1972. more than a third of the nursing staff will work in this way. Less advance has been made in the case of health visitors as their work at child health clinics remains of paramount importance until such time that more local general practitioners take a greater interest in the provision of well baby clinics at their surgeries undertaking all the fundamental work now carried out at our infant welfare clinics An indicat ionofthe load borne by this authority is given by the data on vaccination and immunisation which shows that year after year more than 90% of these procedures are undertaken at local health authority clinics Family planning services have continued to expand. The pilot domiciliary scheme has extended since its provision on an agency basis by the Family Planning Association assisted by grant under the Urban Aid Scheme -2- Discussions have been held on maternity liaison and from 1972 there should be a unified maternity liaison committee meeting regularly to ensure an effective comprehensive service. No doubt, with the continued diminution of domiciliary cases, the role of the hospital side will tend to greater dominance. However, there are still some patients who much prefer, where possible, to have a home delivery. But, in the near future there might well be a combined midwifery service in this borough. Provision of health centres continues to be very slow due. for the most part, to the reluctance of general practitioners seeking to work in the same In addition to the plans for a health centre in the Watney Street development, firm proposals are now in hand to build a further centre in Gill Street. This will be combined with the provision of a child guidance clinic to cater for the south east part of the borough, including the Isle of Dogs The health education section was brought up to establishment again in the year. Emphasis was placed on anti-smoking, venereal diseases and cervical cytology, as can be seen from the report on page 28- Venereal disease contact tracing by the social workers seconded to the Whitechapel Clinic continued to be highly effective as summarised in the account on page 19, Good relationships were forged with the new directorate of social services Medical and nursing advice made available has been readily accepted. There have been no demarcation disputes as between the roles of the health department staff and the social workers Case conferences at field level are proving effective incombining the expertise from both departments in catering for clients' needs. The borough council has engaged the services of the London Boroughs Management Services Unit to advise on a general reorganisation of the Council's services, One of the four directorates set up, the Directorate of Community Services, includes overall administration of the departments of Health Housing Management Libraries, Baths, Public Control and the Recreat ion and Entertainments sec tion The Medical 0 f f icer of Health/Principal School Medical Off ice r was appoint ed the f i r st Director of Community Services With the advent of the unification of the National Health Service, it is planned by 1972/73 to form the transferring personal health services into a viable administrative unit which can be 'hived' off to function in the future operations of the district health services management team Slum clearance continued during the year. After completion of the agreed quinquennial programme up to 1976-7, clearance of the greater part of the borough's unfit housing will have been concluded. The continued hold up of plans for the redevelopment of the local docks area, pending an overall review, leaves large riverside areas b1ighted Once again, as we all face reorganisation with its attendant uncertainties and anxieties for staff, I can report that the department has maintained its high standards for the betterment of the public health in the borough, For this my thanks primarily go to all the staff of the department as also to the Chief Executive and my senior colleagues in other departments who have assisted in the integrated running of all the borough services From the respective Chairmen and members of committees I acknowledge continued encouragement and help in the implementation of our work during the year, I am, Yours faithful1y, R. W. WATTON Medical Officer of Health and MAY, 1972 Principal School Medical Officer. -3- STAFF OF HEALTH DEPARTMENT (as at 31st December 1971) MEDICAL OFFICER OF HEALTH Dr. R.W. Watton ASSOCIATE MEDICAL OFFICER OF HEALTH Medical Officers 38 (6.2) PRINCIPAL MEDICAL OFFICER Dr. W.C. Turner Dr. K. Winship CHIEF ADMINISTRATIVE OFFICER SENIOR MEDICAL OFFICER E P. Webber Dr. J. Richards DEPUTY CHIEF ADMINISTRATIVE OFFICER M. Pliskin SENIOR ADMINISTRATIVE OFFICERS C.H. Drake J E. Pestell G.R. Williamson Administrative and Clerical Staff 55 (52.1) CHIEF PUBLIC DEPUTY CHIEF PUBLIC HEALTH INSPECTOR Public Health Inspectors 22 HEALTH INSPECTOR H S Davies J J fceniry Technical Assistants 7. CHIEF DENTAL OFFICER Pupil Public Health Inspectors 6. D F Waller Dental Officers 6 (5). Dental Auxiliaries 3. Dental Surgery Assistants 12 PRINCIPAL NURSING OFFICER DEPUTY PRINCIPAL NURSING OFFICER ASSISTANT NURSING OFFICER Mrs. D.E. Marrin Miss AM Thomson Mrs. I.E. Nicholls Health and Tuberculosis Visitors Student Health Clinic and School Nurses 33 Visitors 9. 23 (17.2) PRINCIPAL SOCIAL WORKER (Acting) Social Workers 3 SUPERVISOR CLEANSING SERVICES (HEALTH SERVICES) Miss E. New Miss M,Y. Lindsey CHIEF CHIROPODIST Chiropodists (Sessional 9 (2.6) P. Twort NON MEDICAL SUPERVISOR OF MIDWIVES SUPERINTENDENT OF HOME NURSING Miss I „M. Clarke Miss N.O. Humphris NURSING SUPERINTENDENT (Agency) 1. DEPUTY SUPERINTENDENT OF HOME NURSING Midwives (Agency) 7. Miss P.J. Ribbans District Nurses (inc,Agency) 31 (30.5) HEALTH EDUCATION OFFICER ASSISTANT HEALTH EDUCATION OFFICER Mrs. M.A. Twiston-Davies (Vacant) OTHER STAFF 23 (18.0) OTHER MANUAL STAFF 86(69.7) Total staff of Department 396 Note - Numbers in brackets relate to equivalent whole-time -4- SUMMARY OF STATISTICS, 1971 Area of Borough (Acres) 4,876 Rateable Value (1st April 1971) £14, 970, 633 Population: Mid-year estimate ... 164, 650 Sum represented by a penny rate (1971-2) £ 133,800 Census, 1971 164, 948 General Rate (1971-2) Census, 1961 205,682 Dwelling houses 90.5p. in £ Density of population (persons per acre) 33. 77 Mixed hereditaments 95.5p. in £ Number of inhabited dwellings according to Rate Books at 1st April 1971 61,193 „ „ structurally separate dwellings - Census 1961 59,885 „ „ private households - Census 1961 67,858 Births Total Male Female All Births 2,265 1,179 1,086 Live Births Legitimate 1, 928 997 931 Illegitimate 306 166 140 Total: 2,234 1,163 1,071 Still Births Legitimate 29 15 14 Illegitimate 2 11 Total; 31 16 15 Deaths All Causes 2,147 1,195 952 Maternal - - - Infants under 1 year Legitimate 44 30 14 Illegitimate 10 8 2 Total: 54 38 16 Rates Live birth-rate per 1,000 population 13.57 Death rate per 1,000 population 13.04 Still-birth rate per 1,000 total births 13.69 Maternal death rate per 1,000 total births 00.00 Infant death rate (under 1 year) per 1, 000 live births 24.17 Legitimate infant death rate per 1, 000 legitimate live births 22.82 Illegitimate infant death rate per 1, 000 illegitimate live births 32. 68 Neo-natal death rate (under 4 weeks) per 1, 000 live births 18.35 Early neo-natal death rate (under 1 week) per 1, 000 live births 15.22 Perinatal death rate (still births plus deaths under 1 week) per 1, 000 total births 28.70 Illegitimate live births per cent of total live births 13.69 Area Comparability Factors Births 0.92 Deaths 1.19 -5- -6- PART I STATISTICS AND SOCIAL CONDITIONS OF THE AREA ' ■ - 1. STATISTICS AND SOCIAL CONDITIONS OF THE AREA The borough of Tower Hamlets is bounded on the west side by the City of London, on the east by the Borough of Newham on the north by the Borough of Hackney and on the south by the River Thames. The river boundary is some seven miles in length along which exist numerous wharves engaged in trans-shipping activities. The area of the borough is 4,876 acres, being approximately four miles long and four miles wide at the most distant points. Mileage of roads covered is 178.5. Some 266 acres cover canals and 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 premisesbeing 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 who1esa1e fruitand vegetable market and the London Fruit Exchange a re situated in the borough, and there are many wholesal e food depots from which goods are distributed throughout the count ry. 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 164,650, a decrease of 17,610 from last year's figure. The decennial census of the population was takenon25th April 1971. The census revealed the borough populat ion to be 164,948. a reduction of 40,734 or 19.8% from the 1961 census. It is apparent that the estimated population of the borough during the intercensal years is too great, with the result that birth rates given in Annual Reports for those years were too low and the death rates too high. Live births exceeded deaths by 87 so that as the estimated population decrease was 17,610 the net estimated movement of residents out of the borough would normally amount to 17,697 persons. The density of population is 33.77 persons per acre, a reduction of over 8 persons per acre (19.5%) since 1965 In 1961 the density was 52.06 and 169.0 persons per acre in 1901. -7- 50 YEARS AGO In 1921 the census revealed the population of the boroughs of Bethnal Green, Poplar and Stepney, which now form the borough of Tower Hamlets, tobe 530,656. There were 13,650 births (rate 25.7) and 6,863 deaths. Cases of infectious disease notified in Stepney included 1,996 scarlet fever, 956 diphtheria and 573 pulmonary tuberculosis, There were 41 deaths from measles , 24 from whooping cough, 180 deaths of children from "summer diarrhœa," 42 deaths from influenza and 299 from tuberculosis. In Poplar 1,423 cases of scarlet fever were notified, 648 diphtheria and 392 of pulmonary tuberculosis. Deaths included 182 from pulmonary tuberculosis, 64 diphtheria, 39 measles, 29 whooping cough and 5 from typhoid fever. The Medical Officer of Health, Stepney,reported that the decline in popu1ation was due to the erection of business premises, the conversion of living rooms in upper parts of dwellings into workshops, conversion of ground floor rooms in houses into food shops and the demolition of slum properties. Free milk supplied during the year cost the Council £12,000. He reported that unemployment was very prevalent during the year,the health visitors stating that the only food in the house, on some occasions,was the municipal milk, and that if it had not been for this provision many babies would have had a poor chance of surviving. Typhoid fever used to be prevalent but has now nearly disappeared; in 1901 there were 245 cases notified, with 47 deaths, compared with this year's 20 cases and 2 deaths. He stated that in spite of the Tuberculosis Regulations 1912 which required notification of tuberculosis, half of the deaths registered had never been notified. The Chief Health Visitor of Poplar reported that no less than 19 of the notified cases of zymotic enteritis were dead when notifications were received. Registered workshops in Poplar included those of two Glassblowers and two Clay Pipe Makers. In the three boroughs there were 1,219 deaths ofchi1dren under one year of age, giving an infant mortality rate of 91.8 per 1,000 live births. The Mayor and Members of the Council of the Metropolitan Borough of Poplar were imprisoned by order of the High Court for disobeying an Order of the Court and refusing to levy certain rates for precepting Authorities, and Minutes of the Council contain reco.rds of meetings of the Council held in Cell No. 5 (Councillor G. Lansbury's cell) of Brixton Prison. The male Members of the Council were joined by women Members, transported from Hoi 1oway Prison. This dramatic event led to a change in the rating system - an ;Act was passed equalising the rate burden over the whole of London. Poplar Council resolved that the Ministry of Education and the London County Council be urged to raise the school leaving age to 15 years, with full maintenance grants for children attending elementary and day continuation schools between the ages of 14 and 16 years. -8- The Stepney Council agreed to borrow P.11,400 for acquisition of the Arbour Square site for the proposed Municipal Offices. Arrangements were entered into by the Stepney Council with the London Hospital for the dental treatment of necessitous nursing and expectant mothers attending voluntary and municipal child welfare centres. Decisions taken by the Council included replacing the horse-drawn disinfecting van by a motor van, and the take-over of the three dispensaries administered by the joint Committee of the Stepney Dispensaries for the Prevention of Consumption. At a Conference convened by the London County Council it was stated that the notification of measles by the medical profession was necessary, and that registration should be introduced to strengthen the powers of Local Authorities to deal with verminous bedding and clothing. The Conference also wished to make widely known the composition of the preparation recently introduced for shampooing the hair of children, namely - 1 lb. of soft soap, 10 ozs. paraffin and 6 drams of turpentine. A conference of Local Authorities in Greater London resolved that in the interest of public health and cleanliness/Local Authorities should be empowered to carry out the washing and drying of clothes and other articles, and to collect and deliver such articles at reasonable charges for their services. LIVE BIRTHS There were 3,225 live births registered in the borough during the year. After correction for place of residence (inward transfers 168 outward transfers 1,159), the number allocated to the borough was 2,234 comprising 1,163 boys and 1,071 girls, a decrease of 237 from 1970, giving a crude birth rate of 13.57 per 1,000 population compared with 13.55 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 12.48 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 306 equivalent to 13.69% of the total live births, compared with 13.47% last year. The comparablefigure for England and Wales was 8%. STILLBIRTHS This year stillbirths numbered 31 equivalent to a rate of 13.68 per 1,000 total births compared with 12 78 in 1970. The rate for England and Wales was 12.0. -9- DEATHS The number of deaths registered - 2,147, shows a decrease of 23 from the figure of last year. The death rate was 13.04 and when adjusted by the comparability factor becomes 15.51 as compared with 11.8 for the country as a whole. The largest single cause of death was heart disease, 29% of total deaths, followed by cancer 26% and respiratory conditions 16%, The various causes of death and distribution by age groups are set out in Table 1. INFANT MORTALITY Deaths during the first year of life numbered 54 equivalent to a rate of 24.17 per 1,000 live births. The rate for the previous year was 20.23 and 17.61 for 1969. Fluctuations occur in years in the same decade but generally the downward trend continues in 1931 the comparable rate for the area was 77 per 1.000 live births and in 1921 almost 1 in 10 babies died before their first birthday. The rate for England and Wales was 18.0 for 1971. Details of causes of death at various ages under 1 year will be found in the Appendix on page 72. MATERNAL MORTALITY There were no maternal deaths this year. NEO-NATAL MORTALITY During the year there were 41 deaths of infants under 4 weeks representing a neo-natal mortality rate of 18.35 the rate for England and Vales being 12.0.Last year there were 33 deaths giving a rate of 13.35 per 1,000 live births. PERI-NATAL MORTAU TY This term is used to describe the combination of still births 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 28.70 the rate for England and Wales being 22.0. ACCIDENTAL DEATHS Deaths due to acc'idehts numbered 58 (compared with 66 last year) motor vehicles being the cause of 19 deaths. Statistics supplied by the Road Safety Officer will be found on page 72. EXPECTATION OF LIFE The expectation of life at birth, based on the estimated home population and -10- mortality experience over the three years 1968 to 1970, is 68-6 years fox a boy and 74.9 for agirl. This is an increase of 0.6 years for males and 1.2 years for females over the figures based on mortality during the years 1957 to 1959 The figures also show that at age 65 a man has a life expectancy of 11.9 years and a woman 15.8 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 genera] 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 El., E.2, E.3 and E.14 postal districts,(Monthly figures are to be found on page 76.) MARRIAGES The number of marriages solemnised in the borough during the year was 1,322 or 193 less than last year made up as follows Register Office 663 Church of England 442 Authorised persons and other denominations 217 The marriage rate per 1,000 population was 16.0 compared with 16 6 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 Council Meeting Topics to which attention was drawn during the year related to the work of the Public Health Inspector, Home Nursing. Domiciliary Midwifery and Cervical Cytology Services, Registration of Houses in Multiple Occupation, Home Safety (electrical wiring), details of changes in Services provided at Clinic Centres and publicity for the Mass Radiography Unit's weekly Service in the Borough. In addition the practice of circulating a weekly bulletin to general practitioners and hospitals in the borough giving information on infectious disease, morbidity and relevant topical matters was continued. PUBLIC TRANSPORT Public transport facilities in the borough include eleven District Metropolitan and Tube Railway Stations- and 4 Suburban Railway Stations. -11- UNEMPLOYMENT The number of wholly unemployed adult persons registered at the Poplar, Shoreditch and Stepney Employment Exchanges at 7th December totalled 3,977 men and 238 women, or 1,406 more than last year. It must be borne in mind that the above figures do not apply solely to Tower Hamlets residents as one does not need to be a resident to register with an employment exchange of a particular area. Furthermore, the Shoreditch Exchange figures include the Shoreditch area of the London Borough of Hackney. Information supplied by the Youth Employment Service shows that unemployed young persons (under 18), numbered 96 boys and 24 girls, compared with 1970 figures of 76 and 17 respectively. OPEN SPACES Following the transfer of responsibility to the Council from the Greater London Council of certain parks and open spaces in the borough, the Council's share increased from approximately 11% to 48% of the total, which is now 346.29 acres and equivalent to 2.10 acres per 1,000 population. A list of the sites is given on pages 87 and 88. COMPARATIVE STATISTICS A table showing vital statistics for the area covered by the borough at various years from 1901 is on page 73. HEALTH DEPARTMENT ESTABLISHMENTS A list of all Health Department Establishments showing clinic sessions held and services provided is given in the Appendix on pages 113 to 115. -12- PART II PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES II PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES WEATHER CONDITIONS The year began cold and foggy, January then becoming mild and wet with whirlwinds reported in East London on one day, February was mainly dry and mild, snowfalls occurring in March and April It was the sunniest May in London for 28 years,whilst June saw record high rainfalls, July was unusually dry. August being dull and unsettled„ It was a mainly dry September with sunshine records being broken in October and November, The year ended with an unusually warm December, INFECTIOUS DISEASES - NOTIFICATIONS The number of notified cases of infectious disease, corrected for revised diagnoses and duplicate notifications was 619 compared with 1,619 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 76 and a list of diseases notifiable in the borough on page 75- ANTHRAX No case of anthrax was reported during the year. CANCER Of a total of 567 deaths from cancer occurring this year 178 were due to cancer of the lung The death rate of lung cancer was 1.08 per 1,000 population, an increase of 50% since 1965- CHOLERA Owing to outbreaks of cholera in areas of Southern Europe during the year, information was received from Port Health Authorities of 90 persons, mainly holidaymakers, who had entered the country without International Vaccination Certificates. These persons were kept under surveillance for the incubation period and in some instances faecal specimens were taken when there had been a history of agastrioi d i sorde r„ DIPHTHERIA No cases of diphtheria were notified during the year, DYSENTERY Notified cases of dysentery total led 39, compared with 36 during the previous year. -13- FOOD POISONING Sixty-eight cases of food poisoning were notified during the year compared with 82 in 1970. Salmonella typhi-murium was isolated in 18 instances. Other Salmonella organismsisolated included 9 enteritidis, 2newport and2indiana. Clostridium welchii was discovered in 2 cases. Five family outbreaks were reported to the Department of Health and Social Security as required by Memorandum 188/Med. INFECTIVE JAUNDICE Notifications of infective jaundice numbered 66 during the year, compared with 127 during 1970. MALARIA No cases of malaria were notified during the year. MEASLES Notified cases of measles totalled 238 during 1971. In the previous year 1,063 notifications were received. Children vaccinated against the disease during the year numbered 1996. ACUTE MENINGITIS Eight notifications were received during the year, compared with two in 1970. OPHTHALMIA NEONATORUM No cases were notified during the year. POLIOMYELITIS Once again no cases of poliomyelitis occurred in the borough during the year. Details of vaccination against poliomyelitis will be found on page 77. PSITTACOSIS One case of Psittacosis was reported in a man of 44 years. No apparent cause for his illness was found. SCABIES Cases of scabies which came to notice during the year totalled 317, compared -14- with 493 in 1970. Patients and contacts were given medicinal baths and their clothing disinfected at the Council's cleansing station. The number of baths given was 581. 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 follow-up by home visits to ensure that the patients and their contacts receive treatment at the Council's cleansing stations. SCARLET FEVER There were 50 confirmed cases notified, compared with 48 dur ing 1970. 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 bo rough who may have been in contact withsmal1 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 1266. In July the Chief Medical Officer of the Department of Health and Social Security issued a Circular in which was stated that the following advice of the Joint Committee on Vaccination and Immunisation had been accepted. (1) Vaccination against smallpox need not now be recommended as a routine procedure in early childhood; (2) all travellers to and from areas of the world where smallpox is endemic or countries where eradication programmes are in progress should be protected by recent vaccination; (3) heal th se rv ice staf f who come into cont act w it h pat ien ts should be offered vaccination and regular re-vaccination. TYPHOID There were two typhoid cases notified during 1971. One was in the case of a man of 40 years, who had spent two years hitch-rhiking in Asia, Africa and Europe. He became ill while in prance and was diagnosed as a case of typhoid fever on his return to this country a few days later. He made a satisfactory recovery aftertreatment in hospital . -15- The second case was in a man of 34 years, who had recently returned from a holiday in India. After diagnosis in a local hospital, ward contacts were traced and c1 eared. WHOOPING COUGH There were 54 notifications compared with 138 during 1970. Statistics relating to immunisation are on page 77. TUBERCULOSIS The number of primary notifications of pulmonary tuberculosis received during the year was 76, giving a notification rate of 0.46 per 1,000 population compared with 0.55 last year. Non-pulmonary cases notified numbered 18. The mortality rate for pulmonary tuberculosis was 4.2 per 100,000 population compared with 6.5 in 1970. This is the first year that notifications have totalled less than 100. Statistical data relating to new cases, deaths and variations in the register will be found on page 78. 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. Mass Radiography One of the two mobile units operatnng in this borough (Unit 6B) was closed down by the North-East Metropolitan Regional Hospital Board on 30th June 1971. Unit 6A's weekly session at Toynbee Hall continues to operate. As partial compensation for reduction in the service the Regional Hospital Board is arranging for a limited service to operate next year at certain selected hospitals in the area. I am indebted to the Medical Directors and Organising Secretaries for the information given on the work of the Units in the borough during the year which will be found on page 79. B.C.G. Vaccination The number 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 estab1ishments and mental1y subnormal persons at training -16- centres, are shown in Table 15 on page 79. The figures for this year are low because of inability to obtain Mantoux test material occasioned by the postal strike early in the year. Other Preventive Measures In addition to the B.C.G. vaccination scheme, other preventive measures include the chest X-ray of all newly appointed staff and a triennial X-ray of those who are likely to work in close and frequent contact with children, staff at the Council's training centres for mentally subnormal persons and tuberculin reactors discovered among thirteen-year old schoolchildren, students and others tested with a view to B.C.G. vaccination. Epidemiological investigations are made among the contacts of cases of tuberculosis notified in children, staff or residents in the Council's establishments. Similar investigations are carried out at secondary schools where the reactor rates disclosed by tuberculin surveys are significantly higher than the average for secondary schools in the area. CHEST CLINICS In conjunction with the North East Metropolitan Regional Hospital Board and the Brompton Hospital, and in accordance with proposals under Section 28 of the National Health Service Act 1946, tuberculosis prevention, care and after-care services for patients living at home are provided at three chest clinics in the borough staffed by chest physicians, tuberculosis visitors, welfare officers and clerks. Services 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; these services became the responsibi 1 ity of the Social Services Department of the Council on 1st April. The Poplar Chest Clinic at Wellington Way closed on 31st December 1971, its activities transferring to the London Chest Hospital, Victoria Park. The Stepney Chest Clinic is likewise to close on 31st March 1972 which will complete the centralisation by the North-East Metropolitan Regional Hospital Board of the Chest Clinic services of the Borough at the London Chest Hospital. After Care Other services provided by the department for the care and after care of patients and contacts include - boarding-out of child contacts, home nursing, loan of bedding and nursing equipment rehousing of selected tuberculous families, Chest Diseases Care Committees Three Chest diseases care committees continued to operate in the borough in 1971 and I append the reports of the consultant chest physicians on the work of two of the committees and clinics during the year, -17- Dr. B.C. Hanson, Acting Consultant Chest Physician at the Stepney Chest Clinic repor ts: "December 1971 was marked by the retirement of Dr. Orpwood, Consultant Chest Phys ician for many years.. At a farewell gathering, staff and colleagues past and present expressed their appreciation of the achievements of his service to the East End, and extended personally their best wishes to Dr. and Mrs. Orpwood for a happy retirement. During 1971 the clinic continued to provide a readily available service for the assessment and treatment of respiratory disease. There was some decline in the notification of tuberculosis and hence innew contact examinations and B.C.G. vaccinations. This followed the national trend in relation to age, sex, ethnic and social categories. Due to a preponderance in certain areas of Stepney ofsusceptible groups, the incidence of tuberculosis remained higher thail the national average. The problems presented by other chest conditions prevailed as in previous years. The Care Committee continued to help patients in need who attended the Chest Clinic. Assistance was given in helping to solve the many problems arising from a long illness, and in some cases grants were made from the voluntary fund. The value of this fund, which is readily available in an emergency, cannot be over-estimated and the assistance of the Care Committee over many years in providing both financial and supportive help has been a most valuable contribution to the work of the Chest Clinic. The prevalence of chest illness in Tower Hamlets has had much bearing on the work of the clinic. Within the shifting lodging house populace existis a reservoir of tuberculosis amongst undiagnosed and lapsed cases. In pockets of the Borough poverty and poor environmental conditions predispose to chest affections in general. The acceleration of the acquisition of smoking habits during adolescence intensifies the challenge already posed by lung cancer. Psychiatric illness, maladjustment and alcoholism militate against those in whomi the need is greatest seeking aid, and credit is due to the vigilance of the general practitioners who initiate referral to the clinics. Throughout the years all sorts and conditions of men have passed through Stepney Chest Clinic. The concerted efforts of a closely knit anci11ary staff who have adopted af 1 exib1e approach to their several needs, have both encouraged and enabled the acceptance of medical advice proffered. Since 1936 this clinic has worked as a self contained unit. It is soon to be embraced by the London Chest Hospital. The divers facets of respiratory medicine will now be unified under the auspices of a teaching hospital. This should augur well. The expertise now gained will yet be deployed in accordance with the established principles of traditional chest clinic practice". -18- Dr. M. Cap]in, Consultant Chest Physician to the Chest Clinic of the London Chest Hospital reports:- "The work of the Chest Clinic in 1971 showed little change over recent previous years. Lung cancer, asthma and chronic bronchitis have largely replaced pulmonary tuberculosis as the major disease dealt with at the clinic. Tuberculosis, however, still remains an important problem, particularly amongst the elderly and amongst immigrants in whom the disease sometimes assumes atypical features. Modern treatment is fortunately very effective and complete cure can be expected in nearly all cases if drugs are taken regularly for a specified period. Difficulties arise occasionally amongst patients who have no fixed address and wander from one common lodging house to another and fail to take their drugs regularly. These patients may remain infectious and may become resistant to the standard drugs. Such patients often present a considerable problem in management to the doctor, social worker and health visitor. The Care Committee has adjusted to the changed chest clinic function and the great majority of the patients who were helped were not tuberculous, but suffering from lung cancer or bronchitis. These conditions are often associated with serious social problems, and there is frequently a great need for advice and financial help beyond that which canbe obtained from statutory sources. I want to thank the Care Committee for giving this advice and help so freely. The past year saw the building of the new outpatient department at the London Chest Hospital. This purpose built department will house the Poplar, Stepney, Metropolitan and Shoreditch Chest Clinics which are due to be absorbed II into the London Chest Hospital in 1972. Health Control of I mm i g r a n t s During the year 390 advice notes of immigrant arrivals were received in the department from various ports of entry, and successful contact was made in 212 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 to be as follows:- -19- Area of Residence Syphilis Gonorrhoea Other Conditions Total (1970) Tower Hamlets 69 476 1,952 2,497 (2,524) Other London Borough 116 1,276 5,464 6,856 (6,496) Other Areas 12 139 993 1, 144 ( 1, 186) Total 197 1,891 8,409 10,497 ( 10 , 206 ) Returns received from 9 other hospitals in London of new patients attending their clinics during the year showed that 303 were residents of Tower Hamlets, comprising 5 syphilis, 34 gonorrhoea and 264 other venereal conditions. Two welfare officers appointed by the Council work from the Whitechapel Clinic under the direction of Dr. E.M.C. Dunlop, M. D. , F. R. C. P. , Senior Physician to the Department, for tracing contacts and following up defaulters. Dr. Dunlop reports as follows:- "We dealt with 197 new cases of syphilis (1970 215 new cases); with 1,891 cases of gonorrhoea (1970 - 1,882) and with 8,409 Other Genital Infections and Other Conditions (1970 --8,109). In all the clinic dealt with a total of 10,497 new cases compared with 10,206 in 1970. However, the total for Tower Hamlets was slightly decreased at 2,497 compared with 2,524 in 1970. There were 69 cases of syphilis compared with 52 in 1970 and 476 cases of gonorrhoea compared with 541 in the previous year. Although the decrease in the number of cases of gonorrhoea in this area is slight, it is particularly gratifying because it has occurred at a time that the national figures are increasing. The activities of the contact tracers in this department have kept the infectious reservoir of gonorrhoea in this area as small as possible by bringing infected women to treatment. In 1971, 1,258 male patients suffering from gonorrhoea were seen; 455 women who were alleged sources of infection were examined and, of this number, 430 (94.5%) were found to be infected. One hundred and eighty-five other contacts were also examined and 131 (70.8%) were found to be infected with gonorrhoea, in 1971 twenty two male patients were seen suffering from syphilis who had darkfie1d-positive infectious genital lesions. This compares with 17 such patients in the previous year. In 1971 six contacts who were said to be the source of the syphilitic infection in the cases of patients attending this department were examined and all were found to be infected. This compares with 5 in the previous year of which number 3 were found to be infected. Another 5 persons who were said to be contacts of patients suffering from syphilis attended and in fact none of these contacts was found to be infected. -20- It is clear that the contact tracers are most valuable members of our 1 * team and contribute materially to the work of this department. 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. No notices under this section were served during the year. -21- * * * * * * * * * * * * -22- PART III PERSONAL HEALTH SERVICES III PERSONAL HEALTH SERVICES The Principal Nursing Officer, Mrs. D.E. Marrin, reports as follows:- "Staff changes during the year included one Assistant Nursing Officer who left to take up the position of Chief Nursing Officer of aneighbouring borough, the vacancy being filled by the promotion of one of our Centre Superintendents. A second Assistant Nursing Officer left to take a tutoring post. This vacancy was not filled as, apart from health aspects, the responsibi1ity for supervision of child minders and pre-school playgroups passed to the Social Services Department. One Health Visitor took up duties with the Save the Children Fund in Bangladesh and another was appointed a Justice of the Peace. Staffing stability was poor during 1971. 19 Health Visitors (including students who completed their training) were appointed, 17 resigned. Training Nine Health Visitor students were sponsored for training commencing in September, 1971, one of whom was a District Nurse. The six Health Visitor students sponsored in 1970 were successful in their examination. Three Health Visitors attended courses to obtain the Field-Work Instructors certificate , thus assisting in the continuity of the increasingly heavy training programme for nurses from surroundin-g hospitals andforHealth Vis i tors and al 1 ied workers, which each year is undertaken by the nursing section. Plans were laid for providing the community experience for student nurses based in hospitals in preparation for their State Registration. The community experience required is now considerably increased in accordance with the requirements of the new syllabus of nurse training as laid down by the General Nursing Council, Special arrangements have also been made for the London Hospital based students taking the SRN/RMN course of training, to receive sixteen weeks community experience in co-operation with the Social Services Department. A total of 96 medical students and 261 student nurses were assisted in gaining community experience throughout the year First Line Management courses were attended by four Health Visitors, to ensure their understanding of the proposed new "Mayston" structure. Study days and conferences attended by various grades of nursing staff covered a wide range of topics including the following - audiometric training, home safety, family planning, colostomy and ileostomy care, multiple sclerosis and family psychiatry. Clinic Centre Activities Placed strategically throughout the borough as they are and easily -23- accessible to the public, the thirteen centres continue to give a wide range of services affecting the health and stability of the family and school children. Increasing 1iaison between al1 grades of staff and with hospitals, general practitioners andother Allied services, and voluntary organisations has been maintained and brings the staff into contact with all age groups of the public. In addition to the home visiting and routine sessions such as child welfare, ante natal (and prophylaxic), some centres have such facilities as mothers'clubs (sometimes fathers included), famfly planning, creche and health education sess ions. The range of observers attending one CIinic Centre during the year was as follows and is not untypical of the pattern at other centres. 8 London Hospital medical students. 2 pupil midwives weekly for 5 sessions 12 student nurses from St. Andrew's and the London Hospital 1 health visitor student in training 2 doctors from World Health Organisation 6 groups of dental students (approximately 10 in each). Lunch-time meetings between health visitors and allied voluntary and statutory workers have helped to improve co-operation at field level. Surveys: (a) Lead FalI Out At the Island Clinic which is a busy all-purpose centre, one health visitor was engaged-al most full-time in assistingiwith the Purvey inte "le&d fall-out', her colleagues at the centre relieving her as far as possible of day to day duties. (b) Foundation for the Study of Infant Deaths The health visitors are now involved, together with a doctor, in early follow-up visits to homes where an infant has died suddenly and inexplicably. It is hoped, that when more detailed information is collated on the causes of these deaths, such tragedies may be considerably lessened. School Nursing Service The school/clinic nurses have continued their busy role of assisting in maintaining and improving the health and hygiene of the school children in the borough. Their work has a high social content as they are frequently in touch with parents, either at school medicals or through home visits, when persuasion maybeneeded for particular action to be taken on the part of the parents in the child's interest. In add i t i on to the i r routine work and relief duties undertaken for their colleagues, these nurses have ass i s ted at exam inat ions of approximately 200 children to determine them 'free from infection' or take necessary action prior to recuperative holidays or reception into care. Altogether abusy though rewarding year for the personnel of the nursing sect ion. " -24- ANTE - AND POST-NATAL 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 80 ) ANTENATAL 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 80). ADOPTION AND BOARDING OUT OF CHILDREN Adoption Persons proposing to adopt children are required to submit medical certificates as to their health before achild 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 Director of Social Services 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. Boarding -Out The medical examination is given in accordance with the Boarding Out of Children Regulations, 1955. and includes the Wasserman and/or Kahntests 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 results of these medical examinations are scrutinised in the Health Department and the Director of Social Services informed as to their suitability. The following is a summary of the cases dealt with from 1968 - 1971:- 1971 1970 1969 1968 Adoption Cases Children suitable for adoption 20 25 33 37 Children suitable for adoption subject to certain conditions - - - - Children unsuitable for adoption - - - 1 Couples suitable to adopt children 48 23 39 36 Couples unsuitable to adopt children Boarding Out Cases 1 - - 1 Children suitable for boarding out 34 44 44 33 -25- 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 agenera] 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 inCouncil ilinics. Examinations were also carried out at two Centres of employment in the borough. From these 2,336 examinations were carried out. In addition hospitals in the area read 10,687 slides and although all the latter did not Jefer to borough residents it can be assumed that the majority did. Details will be found on page 80 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 stillborn and liveborn chi1dren 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 congenital defects 31 Number of stillbirths and livebirths notified over the same period 2,265 The rate of notifications per 1,000 total births was 13.7 compared with 14.3 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. CLINIC CENTRES There are 6 clinic centres in the borough, 4 school treatment centres and 7 combined clinic and school treatment centres. Clinic auxiliaries continued 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. The Wapping Clinic Centre transferred from premises at Pier Head to Riverside Mansions. Services provided at each of the Centres are given on pages 113 and 114 of the Appendix -26- CRECHES Children can be piaced increches 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 berelieved 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 9p per session is made if the mother wishes to leave her child there whilst she attends to shopping or other domestic duties. ASSESSMENT CLINIC Almost four years ago a combined local authority and hospital assessment clinic was set up for the detection of all defects which might be present, i.e. defects of function, delay in 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 aclinic 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 children 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 both physically and mentally handicapped children. 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, aMedical Social Worker, Health Visitor and a Nursing Sister. Apart from diagnostic assessments, follow-up assessments are made to ensure comprehensive continuing care which includes parent guidance, counselling and integration of care and supervision of all concerned. A child wi..th a phys i cal handicap e.g. cerebral palsy, andhis/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 -27- nursery, creche orplaygroup. Special educational help is required for many children. FAMILY PLANNING Family Planning sessions conducted on behalf of the Council by the Fami1y Planning Association are held at three of the Council's Clinic Centres, 313 sessions being held during the year. In addition, Council sessions staffed by Medical Officers and Health Visitors are operated at a further four clinic centres. In November the Family Planning Association commenced to provide a Domiciliary Service following the partial service provided for some time by the Council whereby preliminary visiting was carried out by the Non-medical Supervisor of Midwives the patients subsequently being transported to a clinic to see the Doctor. This year new patients numbered 1 371, an increase of 121 ovfer last year. Statistics on page 83. FEEDING DIFFICULTIES Facilities are provided at a centre outside the Borough for in-patient treatment of mothers and babies when breast feeding difffCulties are experienced or of babies with dietary problems. It was not found necessary to utilise these facilities during the year. HEALTH EDUCATION The resources of the health education section have been more widely used by the clinic centres for their mothers' clubs, one notable result of this being an evening meeting for parents when a series of films on sex education was shown, with marked success and requests from the parents for further meetings of this nature. This link with parents isparticular1y valuable on account of the interest it stimulates in health education in schools. Requests from schools have fallen into two distinct categories; firstly, those requiring active participation by heal th educators, andsecondly, those seekingadvice, liaison with other agencies and/or assistance with audio-visual aids. Owing to shortage of staff it has not been possible to maintain the former intensive involvement in schools and short courses on various health topics have been arranged. Health visitors have continued to take part in these courses as well as in several cases meeting the demands of their own local schools. In all, nine secondary and six primary schools (including two schools for the educationally subnormal) have taken part in health education programmes during the year. In addition, several secondary schools requested assistance with Newsom-type science courses and/or audio-visual aids. Subjects covered by schools programmes ranged from hygiene to smoking, which have been discussed both specifically and in relation to other subjects, e.g. pregnancy. Films and slides have been used in discussions of -28- both smoking and venereal disease, which have been included in programmes onpersonal relationships and infectious diseases. A total of 73 sessions was spent on sex education and venereal disease, during which 1,029 secondary school pupils took part. At present the pattern of health education in schools is that the demand is increasing for a broader spectrum of health education activities inside individual schools. This means that health education staff and health visitors may be simultaneously involved with several different groups within any one school. Activities with several voluntary organisations varied from talks on nutrition to the,elderly to a pilot course on personal hygiene with psychiatric patients undergoing rehabilitation. The section has also continued to arrange visits for and hold discussions with degree course students and overseas nurses from the London Hospita1, The poster and 1eaf1et campaigns onvarious health education topics havecontinued, with posters and leaflets being distributed on a monthly basis for external display, and to clinic centres, social services departments, libraries, baths, surgeries, factories, youth clubs and voluntary organisations- One such campaign was on the subject of smoking and this was followed up in schools. In addition, leaflets have been distributed on the subjects of venerea] disease and cervical cytology at the request of clinics and other agencies. Metal posters giving detai1sof cl inicsheld for the treatment of venereal disease have been displayed in public conveniences and have been made available to such factories as were willing to display them. Health Education Activities - 1971 Subject No. of Occasions Persons Participating Mothercraft 236 2,065 General Health Subject; Schools 186 3,691 Other 94 918 Cancer Prevention 26 285 Psychoprophy1 axis 57 279 Total: 599 7,238 Films and filmstrips 157 2,608 No., of posters displayed ... 3,981 (excluding 132 metal posters on V.D.) No. of leaflets displayed ... 9,984 HEALTH VISITING Health visitors maintain close liaison with the staff of statutory and voluntary bodies, general practitioners and hospitals in the borough. Their visits to expectant mothers and to children under five years of age are shown with other statistics on page 83 - Health education work is carried out by means of personal contact as well -29- as in group sessions held at the clinics. At the request of the paediatricians concerned health visitors attend out-patients djpartments 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 35 and 31 respectively, there being 12 resignations and 8 appointments during the year. Command Paper 1973 recommended an estab 1ishment 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 30 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 suture removing. Thishas resulted in the proportion of patients over 65 years of age reducing from 57% last year to 48% this year. Two senior staff completed the advanced course of Practical Work Instruction during the year. Two State Registered Nurses completed the District Nursing Training course one obtaining the National Certificate. One state Enrolled Nurse had a course of District Nurse instruction. The following number of pupils from the London Hospital undertook the State Enrolled Nurses' Integrated course of training, 23 pupils for 2 days District Nurse training. 25 pupils for 2 weeks District Nurse training and 9 pupils for 8 weeks District Nurse training, all 9 being successful intheir examination for the National Ce rt i f icate. Two pilot liaison schemes with general practitioners commenced during the year. In 1970 two pilot schemes for Group Practice attachment commenced. Nursing Auxiliaries assist District Nurses by undertaking the bathing of patients in their own homes, thus allowing them more time for nursing duties. Statistics relating to the Home Nursing Service are on page 84. 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, The number of collections made showed an increase of 12% over those made in 1970. Additional equipment was purchased for the laundry at a cost of £1,625. Statistics on page 84. -30- 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 41,000 pads plus 40,000 linings were purchased during the year and issued to 246 persons, 32-% 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 or hospital medico-social worker etc., free of charge for an indefinite period to persons being nursed in their own homes. The Council purchased many items of additional equipment required to meet requests for loans. In addition equipment is loaned by the British Red Cross Society and by the Council's Welfare Department to handicapped persons. Statistics on page 85. 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. Three patients received a total of 215V4 hours under the Day and Night Nursing Service while a further 35 patients were provided with special equipment. A grant is made by the Council to the Foundation DOMICILIARY MIDWIFERY SERVICE The Council operates a domiciliary midwifery service under Section 23 of the National Health Service Act 1946,by an arrangement for utilising the services of midwives employed by tjie London Hospital and by the Nursing Sisters of St. John the Divine, In addition the Council directly employs the non-medical supervisorof m i dw i ve s. 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 142 home confinements at tended by the Midwives,Four general practitioners from practices in the borough. -31- provided ante-natal care with midwives, at four of the Council's clinics. Statistics on page 86. 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 98, the number practising at the end of the year being 74. MATERNITY LIAISON COMMITTEES The department is represented on local maternity liaison committees by the 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 al 1 children up to the age of 15 years continued; 1996 chi1dren be ing vaccinated during the year , including 217bygeneral practitioners. VACCINATION AGAINST RUBELLA Vaccination against rubella continued to be offered to all girls between their 11th and 14th birthdays. The purpose is to ensure that as many girls as possible are offered protection against rubella by vaccination before reaching child-bearing age because of the known association of certain foetal abnormalities with rubella infection in pregnancy. During the year 1 027 girls were vaccinated. OBSERVATION REGISTER At the end of the year, the Observation Register totalled 5,740 persons, comprising:- Children under 5 "at risk" 2,514 -do- handicapped 275 Young persons aged 5-21 years handicapped 2,744 Children non-resident but attending schools in the borough 207 The Principal Medical Officer keeps the register under constant review. Further details relating to the register will be found on page 74, -32- A booklet produced by the department setsout detai]s of the servicesavai 1 ab]e 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 readily given by the hospitals in the borough having maternity wards, both in regard to taking the specimens and the pathological examinations. Arrangements are made with regard to domiciliary births by attending midwives and for health visitors to deal with other babies found not to have been tested. PREMATURE BABIES Any child weighing 5$lbs. (2,500 grammes) or less when born is regarded as premature, and necessary advice and assistance is afforded to mothers with premature bab ies. Statistics relating to premature births occurring during the year will be found on page 83. RECUPERATIVE HOLIDAYS FOR SCHOOLCHILDREN Unaccompanied school children placed by the Inner London Education Authority on recuperative holidays numbered 317, and 16 schood children accompanied by their parents were placed during the year. RESIDENTIAL ESTABLISHMENTS FOR CHILDREN IN CARE The Health Department's visiting medical officers regularly attend at the soc ia1 Services Department's residential establishments to examine the children, treat any cases ofi11ness 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 anumber of surveys during the year in associat ion with various research studies being carried out by the fol1 owing bodies/authorities:- Department of Health and Social Security National Surveillance of Congenital Rubella Defects Department of Social Medicine, Oxford University: Survey of Childhood Cancers Greater London Council Research and Intelligence Unit Spina Bifida. Medical Research Council Tower Hamlets Coronary Project Medical Research Council Measles. Medical Research Council National Survey of Health and Development British Births Survey Child Study St. Pancras Coroner Foundation Study of Infant Deaths -33- I am indebted to Dr. H. D. Tunstall Pedoe, Project Senior Registrar, for the following report on the Tower Hamlets Coronary Project: "From an office in Stepney, information on residents of Tower Hamlets who have heart attacks is being collected for analysis by the World Health Organisation. The results are to be compared with those from 15 other European cities. Tower Hamlets Coronary Project is run jointly by the Medical Research Council Social Medicine Unit and the London Hospital Cardiac Department, and it is funded by the Department of Health. The office is situated in Walden street, close to the Tower Hamlets Health Department offices. The staff of the Health Department have given invaluable help at all stages of the Survey. The object of the study is to register all residents of the borough below the age of 65, who have coronary heart attacks, and to find out what happens to them. Unlike infectious diseases, coronary thrombosis isnot a notifiab1e disease and a system has been developed for searching for cases in hospital and at home, that keeps the number lost to a minimum. The information is collected in confidence and virtually everyone approached has agreed to help, including many of the relatives of those who have died suddenly, who canoften give personal information that is otherwise unobtainable. In the first year of the study (to March 1971) 393 cases were registered including 132 deaths. Results of the analysis showed that the majority of deaths, two-thirds of them, occurred outside hospital and that about half occurred within an hour of the start of the attack- Half of all the victims died without seeing a doctor in the previous 14 days and half of the deaths outside hospital were not witnessed. However, most of the victims were known to have some heart trouble before they died and many of them had had previous heart attacks. 2 out of 3 of al 1 patients who had heart attacks survived and of the ones who were treated in hospital, the vast majority survived and returned to their previous work. The above results reinforce similar information that has been or is being obtained from other areas. One of the interests of The Tower Hamlets study is the use that is made by the population of the hospitals and General Practitioners. During 1971, preliminary results show that approximately a third of patients with heart attacks went to the nearest hospital without seeing a doctor first, another third were seen at home, either by their own doctor or by "the emergency doctor" and that many of the remainder we refirst seen in a General Practitioner's surgery. These findings are being analysed in greater detail and in addition a special study is underway on the effects of the heart attack on the family life and work of the sufferer." -34- 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 of their work in the same c]inics 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 is available at every dental surgery.Dental Auxiliaries trained to treat very young children as a speciality attend to the majority of pre-school children. The number of courses of completed treatment showed an increase of 89% over last year. Statistics are on page 81. 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'6 Clinic Centres, Issues during the year (Value £2,359) included:- National Dried Milk tins 3,787 Cod Liver Oil bottles 1,529 Orange Juice bottles 27,293 Vitamin Tablets packets 1,279 Vitamn Drops bottles 1,461 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 £5,208. -35- * * * * * * * * * * * * -36- PART IV ENVIRONMENTAL HEALTH SERVICES IV. ENVIRONMENTAL HEALTH SERVICES The Chief Public Health Inspector Mr. H.S. Davies reports as follows:- CLEAN FOOD Since the advent of the General & Markets Regulations set standards for food premises and market food stalls, a concentrated effort has been made to ensure that these are maintained. Some reward for these efforts is to-day quite noticeable, particularly in market food stalls. Members of the Council have also shown their awareness for the necessity to improve standards for' the sale of food in the open air and some of the success attained is directly attributable to the policy which has been adopted. The Council, for example, have decided not to issue street trading licenses for the sale of ice-cream which is not prepacked. They have also resolved that casual licenses shall not be issued to food traders, and that the sale of the following foods be excluded from future licences in respect of the streets in the Borough designated for street trading: (a) Meat, Poultry, Fish, Bread, Confectionery and Sweets (unless prepacked) (b) Cooked and prepared food, except such as are cooked or prepared and are prepacked prior to the time of trading as prescribed by the Council. The implication of the latter resolution is that vendors of meat, poultry and fish will presumably disappear from the street markets when the present 1icencees, for one reason or another, surrender their licences, as new applicants appear unwilling to prepack these foods for sale from stalls. Likewise hot dog trolleys, none of which is licensed at the moment, are not permitted to trade in the borough, which is a very desirable feature by any standards. But despite this, we have persons trading illegally in hot dogs and loose ice-cream. The Metropolitan Police have been most helpful in arresting these illegal traders. They and their trolleys are held in custody at the Police Station until a public health inspector has visited, and made his inspection under the Food and Drugs Act 1955, and most important they are held until their identity has been proved. The heavy fines imposed in these cases do not, unfortunately, deter these individuals who charge tourists and others excessive prices for their foods and have a lucrative business. CLEAN AIR Notices were given to the Council of proposals toinstal furnaces in three -37- premises. Six applications for prior approval of furnace installations were received and approved. Seven 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 11 heating appliances, the total estimated grants amounting to £256. In addition a discretionary grant of £9 in respect of the 30 per cent balance of cost of works of adaptation to heating appliances in the dwelling was approved by the Council on grounds of hardship. FOOD AND DRUGS Food Hygiene (General) Regulations 1970 Food Hygiene (Markets. Stalls and Delivery Vehicles) Regulations 1966 Food premises in the borough are subject to frequent inspection by the public health inspectors to ensure that the provisions of the Food Hygiene Regulations are being observed, and a public health inspector visits the borough's Sunday markets each week There are 3,411 food premises including stalls,.in the area, Notices of requirements served numbered 360 and 102 summonses involving 19 premises/stal1s were heard during the year Imported Food Routine examination and sampling of all imported foodstuffs was maintained during the year. Unsatisfactory samples remained fairly constant at about one tenth of the total taken. Early in the year following a ship-board fire in the Port of London some 36 tons of salvaged tea were brought into the area for examination as to soundness. Following sampling and examination 9 tons were found to be water and chemical foam damaged, subsequently being released for chemical processing on the continent. There were two contraventions of the Colouring Matter in Food Regulations, Marzipan Easter eggs were found to contain brilliant blue F.C.F. a prohibited colour in the applied fancy icing decoration. This consignment was destroyed at the importer's premises in another Local Authority's area under their supervision. Chewing gum was found to contain Patent Blue V, a prohibited colour, and was subsequently returned to the producer in Italy. Attention was given to the examination and samp]ingof"pre-import samples" of foodstuffs entering the area. One such consignment, for a northern hospital group, of diabetic jams was found to contain Sorbic Acid a non-p«rmi11ed preservative. Immediate action was taken on our advice of the contravention and importation stopped. -38- There were a number of labelling offences taken up with importers and producers. Two consignments of frozen cooked prawns were detained and returned to the Malaysian producers due to excessive bacterial plate counts. Much of the imported foodstuffs is by direct or indirect importation in containers. The associated problems are now gradually being ironed out, but there will always be a weakness in the examination system at point of entry as an incident in the area shows A consignment of prepared meat in gravy from an approved source was brought in a "cleared" container to a distrubution warehouse and on "unstuffing" many cartons were found to contain blown cans. The Food Inspector investigated this and samples showed the causative organism to be Clostridium Perfringens (Welchii) a serious food poisoner Had the journey from source not been five weeks, time enough for all cans with this organism present to incubate and cause blowing this would have been disastrous as the cans were of catering size for use on re-heating as pie filling, The Port of Entry and the Veterinary Office of the country's representatives in London were immediately informed and all consignments carefully examined with an investigation into slaughtering and processing method at the canning factory. Analysis of Food and Drugs Samples During the year 945 samples of food and drugs were submitted for analysis by the Public Analyst, 17 being purchased formally, 908 informally, and 20 were private samples. Irregular samples ascertained numbered 134. Legal proceedings were instituted in respect of the following;- Pork chipolatas which were in a stale condition; fried chicken and chips which had been wrapped in printed matter; sliced bread which contained ferrous metal and rust; Cornish pasties which showed evidence of bacteria] growths, unfit for consumption- lemonade which contained budding yeast cells. Matters taken up with manufacturers or importers included macaroons having a soapy taste; rust particles in a loaf of bread; fruit yoghourt containing high levels of benzoic acid; food colour containing Ponceau MX which has recently been removed from the permitted 1 ist; flour containing incorrect proportions of Creta Preparata; margarine having a moisture content in excess of that permitted by the Margarine Regulations buttered rolls spread witha mixture of butter and margarine a piece of leather in a bottle of milk; pickled herring found to be decomposing (the complainant had purchased this in Amsterdam); table salt containing the contents of a cold cure capsule, which appeared to be due to accidental contamination in the home; chewing gum containing Ponceau SX, a non-permitted food colour (this was found to have been manufactured in Mexico at least six years previously, the importers having long since gone out of business); strawberries containing Ponceau MX - these had -39- been canned during the previous season when this food colour was still on the permitted list; soft drink containing excessive amounts of permitted preservatives -the soft drink had been made by diluting a concentrate and this concentrate had not been sufficiently diluted; fish and chips wrapped directly in newsprint contrary to the Food Hygiene Regulations; wine which had been subject to a spillage of phenolic disinfectant; ice-cream deficient.in non-fatty milk solids; fruit juices claiming vitamins and minerals but amounts not stated; pork chipolatas found stale; salmon found to be decomposing; a cheese roll containing a rodent dropping; ghee with an uncharacteristic odour probably due to storage near a strong smelling food; a chocolate jelly confection alleged to have an unusual taste (this could not be confirmed); sardines and porage oats suggested to have caused sickness, both found to be satisfactory.; orange drink containing cyclamate (stocks surrendered); soft drink powder contained in a toy having a non-permitted food colour (Brilliant Blue FCF); processed cheese containing an insect larva, (the entire stocks withdrawn from sale and subsequently sent back to the producing country); dried fruit with live mites, a common pest of dried fruit; grapefruit juice containing tin slightly in excess of the recognised limits; milk contaminated with 62% of added water, (the cause of the contamination could not be established); a sour Cornish Pasty; lemonade containing actively growing yeasts, improperly processed} coffee concentrate containing lead in excess of the legal limit, (stocks withdrawn and manufacture discontinued as it had not proved possible to overcome the technical problems involved); nutmeg deficient in volatile oils. The absence, inadequacy or improper declaration of ingredients on labels ascertained in 50 samples were also the subjects of correspondence with manufacturers or importers. A summary of the samples analysed and included in quarterly reports submiitted by the Pub:l i£ Analyst in compliance with Section 99 of the Food and Drugs Act, 1955, will be found on page90. Bacteriological Examination of Foodstuffs Samples submitted for bacteriological examination numbered 209 comprising;- 4 Canned Fish and Shellfish 32 Frozen Ready Meals 2 Canned Meat 5 Gelatine 1 Cooked Rice 52 Ice Cream 2 Cream 52 Meats - Prepared and Cooked 1 Cream Buns 1 Meat Pie 1 Custard Tarts 1 Milk 3 Curry 4 Shellfish - Cooked 12 Boneless Beef 27 Shrimps and Prawns (Raw and 2 Egg Noodles Cooked) 1 Fish Cakes 4 Smoked Salmon 2 Tea -40- Of these the following 41 samples were unsatisfactory:- 1 Canned Meat 4 Gelatine 5 Cooked Meat 20 Ice Cream 6 Frozen Ready Meals 5 Shrimps and Prawns Investigations were carried out and recommendations made, all subsequent samples being satisfactory. Pie and Mash Shops The improvement effected in the meat content of pies produced in these establishments has been maintained and the average meat pie now meets the minimum required (i.e. 25%) by the Meat Pie and Sausage Roll Regulations. Liquid Egg Pasteurisation There are two plants in the borough where liquid egg is pasteurised.The supply of eggs again was spasmodic, both plants operating intermittently during the year. The satisfactory standard of hygiene of former years was maintained. Nine samples of egg taken proved satisfactory when subjected to the alpha amylase test. Milk Supply Samples Twenty-nine samples were submitted for chemical analysis, of these 12 were slightly deficient in so 1 ids-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 so 1ids-not-fat content of the ordinary milk samples analysed was 3.78% and 8.49% respectively, and of the superfatted variety 4.65% and 8.85% No samples were taken for the purpose of examination for the presence of bruce11 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 76 tons London Fruit Exchange and Spitalfields Market 135 tons Other Premises 149 tons TOTAL 360 tons -41- 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 690 were issued in respect of unsound food in 1971. 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 24. The complaints referred to - Alleged unsound condition: Apple turnover 1, bread 6, cake 1, chicken and chips 1, cream 1, ham 1, jelly 1, meat pie 1, sardines 2. Alleged dirty condition and/or foreign body or deposit: Bread 1, corned beef 1, cornflakes 1, mango chutney 1, milk 3, mincemeat 1, sausage roll 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 Treabnent etc.) Regulations 1959 and no contraventions were found. 53 samples of ice cream manufactured in the borough and submitted to the methylene blue reduction test gave the following results:- Grade No. I 18 II 6 III 8 IV 21 Of the unsatisfactory samples (grades III and IV), 18 were manufactured in the borough. In all cases investigations were carried out and recommendations made. It was found that the unsatisfactory gradings were, in the main, due to incorrect handling at the point of sale and appropriate action was taken. -42- Food Export Certificates Certificates numbering 70 were issued in respect of avariety of foodstuffs exported to Belgium, Canada, Canary Islands, Ceylon, Cyprus, France, Greece, Italy, Madeira, South Africa, Spain and Sweden. 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. DISEASES OF ANIMALS The Corporation of London, through its veterinary officers and inspectors, carried out on an agency basis duties imposed on the Council under the Diseases of Animals Act 1951 and Performing Animals Act 1925. 226 visits were paid during the year to the 17 poultry slaughterhouses and 11 live poultry dealers in the borough. Each of 20 pet shops received quarterly visits. Close attention has been paid to the animal market heldon 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 slaughtered, concerning the disposal of waste materials and cleaning and disinfecting of crates and vehicles used for the conveyance of poultry. A child, bitten by a dog which died later the same day, was detained in hospital for a few days. The carcass of the dog, which had been disposed of in a canal, was recovered and taken away for examination. A restriction notice under the Rabies Order 1938 was served on another dog which had been in contact with the dead animal. Following negative results of tests for rabies,the restrictions were withdrawn. Following confirmation of psittacosis in two persons, residents of other areas, one of whom died, enquiries were carried out at a petsshop in the borough from which both persons had purchased birds. A full history of shipments of birds was obtained and all the birds in the shop were examined. All stocks appeared healthy, and there were no cases of illness among the staff. The public health aspect of psittacosis was fully explained to the owner and he agreed to notify any suspicious cases. 11 was considered that, in view of the large throughput at this shop (5,000 to 10,000 per month) psittacosis carriers might well pass through the hands of this company on any number of occasions without the knowledge of any one connected with the firm. The shop is subject to regular inspection. -43- OFFICES AND SHOPS Reg i st rat ion and inspection Premises registered during the year under the Offices, Shops and Railway Premises Act 1963 numbered 268, the total registrations at the end of the year being 2,785 in which 27,317 persons are employed. There has been a steady decline in the number of premises registered and persons employed since registration began in 1966 when the figures were 3,197 and 33,144 respectively. Office employees have increased by 19%, whilst employees at other premises have reduced by 20%. Surveillance of these premises is executed by apublic health inspector who made general inspections of 1,535 premises, and carried out 2,006 other visits. Statistics will be found on page 97. Offices, Shops and Railway Premises (Hoists and Lifts) Regulations, 1968 Mechanical Handling - Belt Conveyors More dangerous conditions have been observed on belt conveyors than any other type ofmechanical handling equipment, the hazard most frequently met with being the trapping point between the moving belt, the head pulley and the first roller of the roller conveyor. Four accidents were investigated during the year where belt conveyors were involved. In two cases serious injuries were sustained by persons working at the transfer point, and a successful prosecution was taken on one of these. The others were of injuries caused by articles falling from conveyors. Fork Lift Trucks The standard of care exercised by the drivers of fork lift trucks in the exercise of their duties is deplorably low. Among the matters notio-ad by Inspectors have been insufficient care taken to ensure stability of loads, loads carried with the forks elevated, lifts given to workmates on forks and forks used to assist personnel to reach goods stacked at high levels. Sufficient consideration for the safety of others is seldom shown when trucks are manoeuvred in confined areas, and thoughtless and careless acts are commonplace. The possible consequences of these practices were pointed out to drivers and management, and although employers have been made aware that courses of instruction are held for drivers at the Industrial Training Centre at Acocks Green, Birmingham, there is no evidence that any advantage has been taken of them. -44- In Tower Hamlets alone, there have been two fatal accidents arising from driver error since the commencement of the Act, andnodoubt, the figure for the country as a whole is proportionate. Whilst a situation exists where fork lift trucks can be driven by untrained personnel serious accidents will continue to occur. There seems to be a need for legislation to ensure that trucks can only be operated by licensed or registered drivers who have attained a satisfactory standard of competency at courses organised by manufacturers of the Department of Employment at regional schools situated within easy reach of each of the country's larger industrial areas. Openings in walls and Floors used for Loading and Unloading Materials In relatively few instances has it been found necessary to require additional safeguards in the case of wall openings, but the absence of adequate fencing of floor openings has required a great deal of attention in all types of registered premises. Public houses, however, present particular difficulties in this respect. Many beer crate hoists rise from cellars to hinged flaps in the floor of serveries above.The most convenient method of fencing the opening that is created when flaps are raised is by the flaps themselves on two sides, and by stay bars which keep the flaps in a vertical and rigid position on the other two. Alternatively, "flap raisers" fixed to hoist platforms are sometimes used instead. These considerably reduce the hazard, but do not protect the opening at all times when the hoist is in use. Floor space in serveries is often very limited, and an opening fenced in the manner described, can partially or completely restrict the free passage of bar staff from one end of the servery to another. A practical solution to the problem is not always easy to achieve, and in these circumstances, licensees are advised to bring up to ground floor level all the bottled beers they require before the public house opens for business. The change that has taken place in recent years in the retai1ing ofdraught beers has helped in this respect, Beer in "keg" containers does not require the special storage conditions as that contained in the traditional casks, and a growing tendency has been observed for ground floor rooms and outbuildings to replace cellars for the storage of both draught and bottled beers. Every opportunity is taken to encourage brewers- architects to alter the servery layout or re-site hoists in a more suitable position when bar improvements are under consideration; it is hoped that these efforts will be reinforced when the outcome of the discussions held by the Engineering Department of the Factory Inspectorate with the Brewers' Society on the subject of lifts and hoists in public houses, to which I referred in my Report for 1970, is known. -45- 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 4 Clearance areas were represented, involving 168 houses. Three Public Inquiries were held and 4 Orders confirmed. The whole of the borough was surveyed to check the condition of the properties and the 1971-75 programme compiled. Towards the end of the year the Greater London Council agreed the programme and the allocation between the Councils was finalised. When this survey was being carried out it was necessary to bear in mind the wishes of the Government fol1qwing the Housing Act, 1969, regarding "improvement conversions". Councils are urged to save as many houses as possible by inf1uencing owners arid agents to take advantage of the various types of grants. This means that each house must be considered in the light of the Government's wishes and causes more work at the time of representation of areas. Underground Rooms The closure of basement rooms continued throughout the year, 49 such rooms in 21 premises being closed. Closing and Demolition Orders During the year Closing Orders were made in respect of 8 houses which were unfit for human habitation, and 3 premises were the subjects of Closing Orders on parts of the premises, amounting to 8 rooms. Undertakings not to relet were accepted in respect of two houses and six other rooms. A Demolition Order was made on one house. Houses in Multiple Occupation The Tower Hamlets (Registration of Houses in Multiple Occupation) Informatory and Regulatory Scheme 1971 The above-mentioned scheme came into force on the 1st January, 1971. Its purpose is to provide a register of certain houses in multiple occupation, to control overcrowding and to encourage landlords to instal essential facilities. Many landlords fai1edtoregister on the appointed date, and failure to register new houses in multiple occupation is still occurring. It is regretted that the Scheme has its failings, one of which is that occupants who are al1 owed to take up residence without registration cannot be forced to move out and thus, the landlord profits by his offence. This practice is on the increase. -46- Under the Scheme landlords who wish to increase the number of occupants must obtain permission from the Council who can ask for facilities to be provided. Where it is not possible to provide facilities, a Direction under Section 19, Housing Act 1961, is served on the landlord, but again many landlords are deliberately ignoring the Direction and are overcrowding their properties Although they are prosecuted the excess number of occupants cannot be ejected. At the end of the year 1,151 houses were under surveillance. During the year 48 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 deficiences. Management Orders were made in respect of 31 premises and informal notices to remedy conditions caused by neglect of management were served with regard to 101 houses In 53 cases the conditions were rectified. Summonses served forcontraventions of the Management Regulations numbered 108, fines amounting to £646 beingimposed- Overcrowding Overcrowding by immigrant landlords appears to be on the increase. Immigrant males arrive in this country without their families, and having found accommodation which in most cases consists of one or two rooms- arrange for their families to join them and thus overcrowding occurs. Notices in respect of overcrowding under the provisions of Section 90 of the Housing Act 1957. were served in 38 instances Visits in the late evening continue to be made to check that the notices are being complied with, 18 summonses were issued in respect of contraventions, resulting in fines amounting to £410 Directions to prevent or reduce overcrowding were served in 42 instances under Section 19 of the Housing Act 1961 Summonses numbering 24 were issued forcontravention of the Directions, resulting in fines amounting to £775 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. Lorry Drivers' Establishments A number of lorry drivers' establishments have opened during the past year, but there were no applications for registration. In one establishment which is a public house. 28 drivers were being accommodated without any faci1ities being provided. Notices have been served on the owners of all premises to provide the necessary facilities. General Contraventions under the Housing Acts are rising steeply and more prosecutions -47- are being taken. The housing laws are being completely ignored by numerous immigrant 1 and]ords. Standard and Improvement Grants Twelve 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 curent officer for a fair rent to be registered. During the year 132 such applications were received, and 16 approved. It appears that some owners are making applications for certificates for the sole purpose of obtaining a report on the condition of the premises, and thus saving themselves the expense of employing a private, surveyor. Applications for Rehousing At the end of the year, there were 5,830 applications for rehousing on the Council waiting list, 439 less than last year. Tenants of Council dwellings who have applied for transfer to larger or smaller accommodation number 1,319. Preferential Housing on Health Grounds Application for preferential housing on health grounds investigated during the year numbered 488, An 'urgent' assessment was granted in 64 cases and balancing points were awarded in afurther 134. Tenant transfer was supported in the case of 142 tenants of Council dwellings. New Housing During the year 1,202 new permanent dwellings were completed in the borough;361 by the Borough Council 703 by the Greater London Council and 138 by other persons. Details are given on page 92. At the end of the year units of accommodation owned by the Borough Council numbered 15,129 comprising 13,615 erected by the Council, 37 prefabricated bungalows and 1,477 properties acquired. Dwellings in the borough owned by the Greater London Council totalled 26,204 at the end of the year. Local Authority owned dwellings now comprise 68% of the total dwellings in the Borough, -48- FACTORIES Provision is made in Section 153 of the Factories Act 1961 for the Medical Officer ofHea]th to include in his annua] report prescribed particuiars withrespect to matters under the ^ct administered by the Council. These details are given on pages 93 and 94. Certificates of suitability under Section 70 of the fret continue in force in respect of 2 basement bakehouses in the borough. LEAD POLLUTION In July 1968 complaint was made of the scorching of foliage in the Isle of Dogs. This was found not to be due to pollution but to idiosyncrasies of the weather. However, during the investigation lead was found on the surface of the leaves, and a survey was mounted to ascertain the levels of lead inthe air and deposited atcertfiin fixed points. The preliminary findings of the amount of lead in the air did not indicate dangerous levels of pollution. The survey showed a pattern of raised lead deposits along the main road which suggested that 1 ead-coiitaining dust was ibeing deposited on the roadway by vehic1es bringing waste material into a large Lead Works, plus the transport of lead-containing dust on the workers' feet. Subsequently, an epidemiological study was commenced on children and their mothers. All the children under 5, of whom there are 157, within a 500 metre radius of the Lead Works had their blood leads compared with their mothers. Several children were found to have higher than normal blood leads, occurring inchildren whose parents actually worked inthe Lead Works, or who lived adjacent to a battery dump. Monitoring of these children continues. The management of the Lead Woriks took immediate steps to deal with problems shown to exist. The battery breaking machinery has been dismantled and the dump cleared. A concrete perimeter fencehasalso been erected to prevent access ofchi1dren and animals, and to minimise wind blown dust from the site. The Secretary of gtate for the Environment subsequently commissioned a survey designed to show the extent of lead pollution around all lead works which use particularly dusty processes and therefore most likely to cause pollution problems. HAIRDRESSERS AND BARBERS Premises registered with the Council in accordance with Section 21 of theGreater London (General Powers) Act, 1967 numbered 167 at the end of the year. LEGAL PROCEEDINGS A summary of 1egal proceedings instituted during the year under various Acts and Regulations following ascertainment of contraventions by the public health inspectors -49- and technical assistants will be found on page 95. 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 acontinuous flow of men to the Station for delousing. Statistics on page 96. DISINFECTION AND DISINFESTATION These services are provided on site at Branch Road Disinfecting Station where teams of operators are also based todeal with infection and infestat ions atpremises. Premises and fomites are disinfected after the occurrence of certain infectious diseases, generally by means of steam under pressure or by formaldehyde. Articles of clothing etc. for export are also dealt with where the country to which the goods are being exported requires an official certificate. A service is provided for the disinfestit ion of premises infested by insects, etc. including ants, bed bugs,cockroaches, fleas,carpet beetles, woodlice,clovermites firebrats, spider beetles, silverfish and dermestidae. (Statistics on page 96). LICENSING ACT, 1961 Applications for registration of clubs under the Licensing Act 1961 are dealt with by a mag istrates court, copies of the applanations being seiit to the Council for any observations it 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 during the year numbered 18. LODGING HOUSES - COMMON There are three licensed common lodging houses in the borough, providing accommodation for 769 persons as foil cws:- Salvation Army Hostel, Garford Street 218 Men Salvation Army Women's Hostel, Hopetown Street 228 loomed Salvation Army Hostel, 177 Whitechapel Road 323 Men The premises are inspected regularly including visits made at night to ensure compliance with the byelaws relating thereto. -50- LODGING HOUSES SEAMEN There are 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 atnight, MORTUARY SERVICE The Council's mortuary is situated in Cottage Street, Poplar High Street, and adjoins the coroner's court. The mortuary has accommodation for 15 bodies and serves the Poplar and Stepney areas. Prior to the formation of the borough, Bethnal Green Council had an arrangement with Hackney Council for the use of the latter's mortuary, which arrangement continues in respect of mortuary accommodation for that part of the borough the cost being shared on a population basis A total of 515 bodies was received during the year (396 in the Council's mortuary and 119 in Hackney mortuary) including the bodies of 139 persons who were resident in other areas. Other statistics will be found on page 95, OFFENSIVE BUSINESSES There are 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 *7 Leyden Street *19 Bell Lane *10b Leyden Street 107 Bethnal Green Road 13 Leyden Street 28 Burslem Street 15 Leyden Street 161 Cannon Street Road *7 Lower Hessel Street *163 Cannon Street Road *21/22 Lower Hessel Street 16/18 Cobb Street *4 Monthope Street *14 Hessel Street *6 Monthope Street 36 Hesse] Street 10a Monthope Street 75 Hesse] Street (*Establishment orders on these premises are subject to renewal from time to time). The Council adopted a recommendation to make a declaratory order under Section -51- 107 of the Public Health Act 1936 declaring the business of dressers of poultry, slaughterers of rabbits and dressers of rabbits to be offensive trades. MISCELLANEOUS REPORTS BY DISTRICT AND SPECIALIST PUBLIC HEALTH INSPECTORS Some 678 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. 69 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 1,106, compared with 629 in the corresponding list last year. PET ANIMALS ACT, 1951 There are 67 licensed pet shops in the borough including stalls in markets. See also page 43 (Diseases of Animals) PHARMACY AND POISONS ACT, 1933 The sale of certain poisons (chiefly those used for sanitary, domestic and horticultural purposes) by persons other than pharmacists is subject to provisionsofthis 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 67 names on the list, 10 being removed from and 8 added to the list during the year. POULTRY PROCESSING AND PACKING There are 19 Poultry Slaughterhouses, 16 having been in regular use. About 2½ million birds are slaughtered annually (1,800,000 by Jewish ritual slaughter and 700,000 for the Muslim trade). All these premises are unsatisfactorily sited in -52- built up areas, but at long last there are signs that most will be relocated to an area zoned for the purpose. The Board of Shechita who give ritual slaughtering facilities at 13 premises commenced work building anew poultry abattoir which when completed, about June next year, will mean that 5 existing premises will close forthwith and after the expiration of 6 months, slaughtering facilities for Kosher purposes will be withdrawn from the other 8 premises. Four of these eight businesses have already acquired sites near the Board of Shechita's new premises, to buildnew abattoirs for their own use, Ultimately this will leave only slaughterhouses for the Muslim trade in built up areas. Control over the Muslim trade business is rendered more difficult by the Slaughter of Poultry Act; whereas Kosher slaughter is required tobecarried out by a Jew licenced by the Rabbinical Commission. Muslim slaughter can be carried out by any Muslim without need for licence or control. The method of trading also makes inspection almost impossible, as the birds are brought alive, killed and dressed to the requirements of the customer, usually skinned and chopped all within amatter of a few minutes. As a poorer quality hen is usually used for this trade, the necessity for the provision of adequate control is overdue. 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 1 ined, requires the 1icensingor registrat ion. as the case may be of premises where rag f1ock i s manufactured or stored or filling materials used. Regulations made under the Act prescribe standards of cleanliness for filling materials. 16 samples of filling materials were obtained from registered premises during the year and submitted to the prescribed Analyst for examination. One sample of wool felt did not comply with the Regulat ions as it exceeded the limit for chloride content and was referred to the local authority concerned for investigation at the place of manufacture. 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, 11 notices were served during the year requiring the provisionof sanitary accommodation to comply with the Council's standards REFUSE DISPOSAL The Cleansing Officer of the Council has kindly supplied some statistics relating to refuse disposal for the year, given on page 101 -53- 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 3,969 dwellings and other premises requiring inspection 3,668 were found to be infested with mice or rats compared with 2,964 last year. The number of complaints received' was the highest since 1966. Treatments we r.e car r i ed ou t by the department' s rodent control staff in 5,761 properties the charges for servicing business premises amounting to £1,495. Statistics are given on page 98. SEWERAGE The arrangement in the area for sewerage and sewage disposal are satisfactory. The planned programme of reconstruction of defective sewers is proceeding. SWIMMING BATHS The water in the seven public swimming baths in the borough and in the bath at the Council'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 121 samples taken during the year proved satisfactory. Eight were unsatisfactory and appropriate action taken. In addition 75 samples were taken fromnine school swimming.baths in the borough, 2 samples being unsatisfactory. VACANT SITES If the situation can be assessed by the number of sites that have been fenced throughout the Borough during the year, then it can be said that the improvement of last year has been maintained. The development of some sites for open space and car parking has prevented recurring misuse of c1eared and fenced sites and isapolicy which should be encouraged on a temporary basis. Of the 65 sites which came to notice during the year 42 were cleared of rubbish and fenced by the end of the year. A further 24 from the previous year were also dealt with. -54- Ownership of the sites dealtwith was as follows:- Sites requiring action Sites dealt with Greater London Council 31 24 Borough Council 16 6 Private Ownership 18 12 In 13 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 pi umbo-so 1 vent. 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 1971. No artificial f1uoride 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 13 occasions where wastage of water was taking place. Notifications were received from the Board on 13 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 pipes etc. The Medical Officer of Health is authorised by the Council to exercise its powers under this enactment in appropriate cases. -55- WORKS IN DEFAULT Works were carried out by the Council on 53 occasions during the year indefault of persons on whom notices were served requiring the execution ofworks. They comprised 35 instances offai]ure to comply with notices served under Section 17, Public Health Act, 1961 regarding cliok'ed drains, 4 for failure to comply with notices served under Section 75 of the Public Health Act, 1936 with respect to the provision of dustbins, 13 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, and one for the repair or renewal of water service pipe to water closet cistern after failure tocomply with notice under Greater London Council (General Powers) Act 1967, Section 23. STATISTICS Tables 31 to 51 of the Appendix give additional statistical information of the environmental health services. -56- PART V MISCELLANEOUS SERVICES ETC V. MISCELLANEOUS SERVICES SERVICES TRANSFERRED TO SOCIAL SERVICES DEPARTMENT With the formation of the Social Services Department, services hitherto operated by the Health Department were transferred to that department on the 1st April 1971 Transferred services comprised the following - Mental Health Day Nursery and Child Minding Home Help Family Casework Invalid Meals Recuperative Holidays Tuberculosis Welfare Services Staff transferred numbered 127 officers and 300 employees andpremses included 4 day nurseries, 2 mental health training centres and 1 day centre New premises under construction included a day nursery an adult training centre for the mentally handicapped and a hostel for mentally subnormal adults Another transfer which took place on 1st April 1971 was that of the Junior Training School for severely subnormal children from the responsibi1ity of the Council to The Inner London Education Authority The school. now known as the Beatrice Tate School was completed by the Council in December 1969, and provides places for 115 children Staff transferred with the school numbered 17 teaching and other staff and 7 employees, ACCIDENTS IN THE HOME The powers and duties of the Council under the Home Safety \ct 1961, relating to the dissemination of information and advice for promoting safety in the home and encouraging proper precautions against accidents, are exercisable by the Health Committee, Health education for the prevention of home accidents has continued throughout the year, with particular reference both to those groups at greatest risk and to the most prevalent causes , Inquests were held during the year on 7 fatalities in the borough arising from accidents which occurred in the home, including 1 fromafall.l from poisoning 2 from asphyxia and 3 following outbreaks of fire. Many children were admitted to hospital or treated as out patients after swallowing medicines in tablet or capsule form, Special publicity is arranged each year regarding home accident prevention including the necessity for preventing medicines and other dangerous materials from being accessible to children and for precautions to be taken during the "firework" season The number of people treated in hospital in England and Wales in 1971 for -57- injuries received from fireworks during the period 17th October to 13th November was the lowest since records began in 1962 - 1,059 compared with 1,164 in 1970 and less than half that of 1962. AMBULANCE FACILITIES The. Greater London Council isresponsible under Section 27 of the National Health Service Act 1946 for the provision of ambulance transport in the area. ARTIFICIAL KIDNEY MACHINES During the year the Council undertook the work, and bore the cost, of carrying out necessary adaptations including plumbing, electricity and water supplies to two more dwellings in the borough where renal dialysis machines were being installed by the London Hospital The cost of adaptation was £1,112, 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 4 185 signatures on certificates were verified as those of medical practitioners practising in the borough and thecertificates endorsed accordingly 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 76 examinations by a consultant ophthalmologist during the year, and certificates accepted from other local authorities, hospitals and private ophthalmologists numbered 64 Transport to the clinic for examination is arranged for these persons where necessary. BURIALS Section 50 of the National Assistance Act 1948 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 57. (Statistics on page 88.) CHIROPODY Treatment is provided free to old persons in receipt of retirement pensions, expectant mothers, school children and the physically handicapped. -58- Foot clinics are held at 9 of the Health Department's establishments, and at 3 other establishments, provid ing a total of 36 sessions, each weekbyone full-time Chief Chiropodist, and nine part-time chiropodists. For those unable to attend clinics, 7 of the chiropodists visit their homes to give treatment. The number of treatments carried out in Council clinics and in Social Services Homes for the Elderly are set out in Table 19. The new purpose designed clinic for "transport" cases, i.e. those with limited physical capabilities, was completed inDecember atCheviot House, and will be staffed by a full-time Senior Chiropodist at the beginning of 1972. A lecture was given to the Bathing Attendants on general foot care and two lecture demonstrations given for the District Nurses. Four talks on foot health were given to mothers and Old People's Clubs. 29 orthopaedic appliances were supplied to patients, consisting of 5 pairs of corrective arch supports to school children, 7 pairs of rest supports to elderly patients and 17 other appliances, i.e. toe guards and bunion shields, etc. CONFERENCES Conferences at tended by members of the Council and/or officers of the department are summarised on pages 102 and 103. DECEASED PERSONS Inquests Inquests were held on 91 residents of the borough during the year, the verdicts being 17 deaths due to road accidents, 29 other accidents, 15 suicide, 14 misadventure, 8 open verdicts, 5 natural causes, 1 drug addiction, 1 murder and 1 self neglect. 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. Thirteen such certificates were issued this year, relating to 11 bodies flown to Israel, 1 to Cyprus and 1 to Italy. HOME BATHING Aged persons who are bedfast or homehound 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 84). -59- 60- HOSPITAL FACILITIES The undermentioned hospitals are situated within the borough: No. of Beds. Bethnal Green Hospital, Cambridge Heath Road, E.2. 308 London Hospital, Whitechapel Road, E.l. 719 London Chest Hospital, Victoria Park, E,2. 142 London Jewish Hospital, Stepney Green, E.1. 128 Mildmay Mission Hospital, Austin Street, E.2. 70 London Hospital (Mile End) Bancroft Road, E.l. 410 Poplar Hospital, East India pock Road, E.14 107 Queen Elizabeth Hospital for Children, Hackney Road, E.2. 146 St. Andrew's Hospital, Devons Road, E.3. 365 London Hospital (St. Clement's) Bow Road, E.3. 128 The Mile End Hospital was renamed during the year to The London Hospital (Mile End) and St. Clement's Hospital to The London Hospital (St. Clement's). LABORATORY FACILITIES Bacteriological investigations for infectious diseases are carried out on behalf of the health department 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.I. Investigations carried out by the Laboratory on specimens submitted by the department totalled 286, comprising 284 faeces, 1 throat swab and 1 vomit. Bacteriological investigations on 208 food samples were 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 Animals Act 1971 12. 5.71 1.10.71 Dangerous Litter Act 1971 27. 5.71 27. 6.71 Education (Milk) Act 1971 5 8 71 1 8.71 Orders and Regulations Alkali Works Order 1971 9. 6.7 1. 7.7 Central Council for Education and Training in Social Work Order 1971 28. 7.71 1.10.71 Clean Air (Measuring of Grit and Dust from Furnaces) Regulations 1971 1. 2.71 1. 3.71 Clean Air (Emission of Dust and Grit from Furnaces) Regulations 1971) 1. 2.71 1. 3.71 61 Orders and Regulations Date made Date Operative Diseases of Animals (Extension of Definition) Order 1971 26. 3.71 26, 3.71 Education of Handicapped Children (Transfer of Staff and Property) Order 1971 3. 3.71 12. 3,71 Fees of Appointed Factory Doctors Order 1971 28. 6.71 8. 7,71 Health Services and Public Health Act 1968 (Commencement No, 5) Order 1971 1. 3.71 1. 4,71 Meat Inspection (Amendment) Regulations 1971 20, 7.71 16. 8.71 Poisons List Order 1971 28. 4,71 21 6,71 Poisons (Amendment) Rules 1971 9.11.71 1. 1.72 Preservatives in Food (Amendment) Regulations 1971 25. 5,71 1. 9,71 Provision of Milk and Meals (Amendment No, 2,) Regulations 1971 26. 8 71 1. 9.71 Rag Flock and Other Filling Materials Regulations 1971 8,10.71 2,11,71 Slaughter of Poultry (Humane Conditions) Regulations 1971 20. 4,71 1. 8.71 Smoke Control Areas (Authorised Fuels) Regulations 1971 17. 6.71 28, 6.71 Smoke Control Areas (Authorised Fueis) No 2 Regulations 1971 22, 7.71 4, 8.71 Smoke Control Areas (Authorised Fuels) No, 3 Regulations 1971 17.11.71 15.12,71 Smoke Control Areas (Authorised Fuels) No, 4 Regulations 1971 21,12.71 28, 1,72 Smoke Control Areas (Exempted Fireplaces) Order 1971 30. 7,71 24, 8.71 Weifare Foods Order 1971 18. 3.71 4, 4.71 Welfare Foods (Amendment) Order 1971 19, 1.71 15. 2.71 do- 25,11.71 2. 1.72 Welfare Foods (Extension of Definition) Order 1971 15. 3.71 16, 3.71 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:- Availability of solid smokeless fuels; Family Planning: Health centres Financial Arrangements: Help in the Home: Hospital services for the mentally ill; Health and Personal Social Services Capital Programme (other than child health), House and Area improvement development and improvement areas; Local Authority Health and Social Services programme for capital projects: Local Government Reorganisationin England - functions, areas and names: Reorganisation of water and sewage services; Safety in the home; Smoking andHealth: The handicapped and impaired in Great Britain; Vaccination against Rabies Vaccination against smallpox: Youth treatment centres. 62 MEDICAL EXAMINATION OF STAFF The department's medical officers undertake for the Council the medical examination of new entrants to the Council's service, of staff and employees absent due to sickness exceeding one month, of employees considered for participation in the Sick Pay Scheme and for extension of service beyond the age of 65 years, as well as assessments for gratuities and other reasons as required Examinations or assessments carried out during the year numbered 1,600 (details on page 89.) 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 14 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 104 to 108 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 Justice of the Peace 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 3 persons, who were removed to hospital. STAFF CHANGES Appointments and resignations of members of the staff numbered 69 and 78 respectively, and 99 staff were transferred to the Social Services Department and 17 to the Inner London Education Authority on the 1st April 1971. Appointments Resignations Administrative and Clerical 10 9 Dental Staff 14 18 Medical Officers 1 0 Nursing staff: Health Visiting 19 17 Clinic and School 8 13 District Nurse 7 7 Public Health Inspectors and Pupils 5 6 Social Workers 1 5 Miscellaneous 4 3 TOTAL 69 78 63 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 numbered 154 comprising:- 97 Pupil Nurses London Hospital, Integrated S.E.N. Course 11 Student Nurses London,St. Andrew's, London Jewish Hospitals 20 Medical Students National, St Andrew's, St. Bartholomews and Middlesex Hospitals. 1 Hospital Sister London Hospital 2 Doctors World Health organisation 2 Degree and integrated Nurse-Health Visitor Nursing Degree Course, Course Students 10 Student Health Visitors Polytechnic of North London, North East London Polytechnic, Polytechnic of South Bank Reading College of Technology 2 Nurses (U.S.A.) Society of Medical Officers of Health, 1 Post Graduate Student Goldsmiths College, 1 Student Overseas Development Administration, 6 Pupil Public Health Hertfordshire College of Building and Inspectors Corporation of London 1 Trainee Hospital London Hospital Administrator -64- ************ PART VI REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER ON THE SCHOOL HEALTH SERVICE 65 VI REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER ON THE SCHOOL HEALTH SERVICE The Inner London Education Authority is respons ible for the School Heal th 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 in previous years, close liaison with the Medical Adviser and his central staff has maintained an effective service. At local divisional level, Mr. Peirce and his staff have been ever willing to continue good working relationships. SCHOOLS AND SCHOOL ROLLS Pupils on school rolls numbered 31,112 at the end of the year, attending 102 maintained schools in the borough which include four 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. The registers were as follows:- Type of School No. of Schools Pupils Primary 67 18,268 Secondary 21 11,163 Nursery 6 730 Special 8 951 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 clinics 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 and at the request of the head teacher, school nurse, parent or medical officer. Clinical trials were carried out in the area last year by the Department of Entomology, London School of Hygiene and Tropical Medicine, in conjunction with the staff of this department, in which the insecticide Malathion was used on the heads of infested children. The results of the trials were decisive in that no live lice remained on the head after 24 hours. Subsequently the Medical Adviser of the Inner -66- London Education Authority agreed with the Principal School Medical Officers that a commercial product containing Malathion be used throughout the School Health Service in the Inner London Area. This year the number of treatments for'vermin and nits' increased to 1,529 . The schools principally affected are those with high ratios of immigrant children on their rolls, some of whom move on before adequate treatment can be completed. Attendances for treatment of scabies at the bathing centres decreased from 398 last year to 205 in 1971, A combined approach with the co-operat ion of local schools, general practitioners and the borough cleansing station staff continued during the year to ensure where possible that al 1 known cases, and their fami 1y and other contacts are given a complete course of treatment. HANDICAPPED PUPILS Every possible care is given to ensure that any child with a handicap which might affect his or her educational attainment iskept under careful review and consideration, whether he or she is in an ordinary school or special school, and a register of all handicapped children is maintained to ensure no child is lost sight of when he/she moves from school to school or borough to borough. Tower Hamlets children placed in special schools are as follows:- Handicap No. at Day Schools No. at Boarding Schools Blind - 6 Partially sighted 20 1 Deaf 1 3 Partially hearing 48 5 Educationally subnormal 521 123 Ep i1ep t i c - 2 Maiadjusted 82 86 Physically Handicapped 94 12 Delicate 128 32 Multiple Handicaps - 3 TOTALS 894 273 INFECTIOUS DISEASE IN SCHOOLS Of the 619 cases of infectious disease notified 218 or 35% related to schoolchildren. In addition 618 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 specimen s for bacteriological examination, to ascertain the sources of, and contain, the outbreak. -67- 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 19,819 compared with 17,379 last year. VACCINATION AND IMMUNISATION RECORDS OF SCHOOLCHILDREN The percentage of school-children on school rolls immunised and vaccinated is as fol1ows:- Diphtheria Tetanus Poliomyelitis Smallpox 86.1 79.3 86.3 46.4 B.C.G. VACCINATION The arrangements continued during the year for vaccinating 13 year old schoolchildren against tuberculosis using B.C.G., 1,027 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 emp1oyment such as de1ivering newspapers, etc., that they be medically examined to ensure they are fitfor the proposed employment. All 86 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 af heal th 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 audio1ogy 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 partial1 y-hearing, or the child remains under observation 68 where the loss is sl ight. There are no special schools for this defect in the borough, children having to go to school either in Hackney, Islington, Camden or Wandsworth. EDUCATIONALLY SUBNORMAL CHILDREN From the 1st April 1971, under the Education (Handicapped Children) Act 1970, the provision for notifying a child as unsuitable for education at school ceased, and theprovis ions of Section 34 of the Education Act 1944 regarding special educational treatment apply to such children. The Education Act 1944 makes provision for the statutory examination of chi1dren who may require special educational treatment and for review examinations of such children. Children examined for these purposes during the year by specially qualified medical officers numbered 163. There are four 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 Health education sessions held at schools numbered 293 during the year, attended by 5,422. EDUCATION (MILK) ACT 1971 This Act of Parliament restricted, from the commencement of the autumn term, Education Authorities from providing school milk other than to children under 7 years of age, children attending special schools and children in primary schools for whom the school medical officer certified that such provision was necessary on medical grounds. Following the adoption of a resolution by this Council that expenditure be incurred under the provisions of section 6 of the Local Government (Financial Provision) Act 1963 for the provision of free milk to schoolchildren resident in the borough in the age group 7 to 11 years, these children continue to receive school milk hitherto provided by the Inner London Education Authority. SCHOOL DENTAL SERVICE There are 8 dental clinics in the borough providing dental suites with a total of 13 surgeries, one surgery being used exclusively for orthodontics. All premises are provided with up-to-date equipment. 69 Pupi1s examined for the first time during the year at schools and clinics numbered 24,216 compared with 25,525 in 1970. Of those inspected 62.7% were found to require treatment (62.3% last year). Pupils attending for treatment for the firsttime numbered 7,110 compared with 6,757 last year. STATISTICS Statistics relating to the School Health Service will be found on pages 109 to 112. 70 ★ ★★★★★★★★★★★ PART VII APPENDIX OF STATISTICAL TABLES 71 TABLE 1 TOTAL DEATHS BY CAUSE AND AGE OF TOWER HAMLETS RESIDENTS - 1971 (Registrar-General s Return) CAUSE OF DEATH ALL AGES AGE GROUP TOTAL. M F - 1 1- 5- 15- 25- 35- 45- 55- 65- 75- Enteritis and other diarrhoeal diseases 3 3 - 1 _ _ _ - - - 1 - 1 Tuberculosis of respiratory system 6 6 - - - - - - - 2 3 - 1 Late effects of respiratory tuberculosis 1 1 - - - - - - - - - 1 - Other tuberculosis 4 2 2 - 1 - - - - - 2 1 - Meningococcal infection 1 - 1 - 1 - - - - - - - - Other infective and parasitic diseases 2 1 1 - - - - - - - - 1 1 Malignant neoplasm - buccal cavity etc. 3 2 1 - - - - - - 1 1 1 - Malignant neoplasm - oesophagus 18 11 7 - - - - - 1 1 7 2 7 Malignant neoplasm - stomach 59 28 31 - - - - - 1 2 11 14 31 Malignant neoplasm - intestine 70 33 37 - - - - - 2 6 15 28 19 Malignant neoplasm - larynx 6 5 1 - - - - - 2 - 2 1 1 Malignant neoplasm - lung, bronchus 178 151 27 - - - - 1 4 26 65 55 27 Malignant neoplasm - breast 41 - 41 - - - - - 2 8 11 6 14 Malignant neoplasm - uterus 11 - 11 - - - - - - 5 5 1 - Malignant neoplasm - prostate 18 18 - - - - - - - - 2 6 10 Leukaemia 8 2 6 - - - - - - 2 - 2 4 Other malignant neoplasms 155 78 77 - - 1 - - 4 9 46 49 46 Benign and unspecified neoplasms 4 - 4 - - - - - - - - 1 3 Diabetes mellitus 23 7 16 - - - - - - - 1 12 10 Avitaminoses, etc. 1 - 1 - - - - - - - - - 1 Other endocrine etc. diseases 5 - 5 - - 2 - - - 1 - 1 1 Anaemias 4 1 3 - - - 1 - - - 1 1 1 Other diseases of blood etc. 1 1 - - - - - - 1 - - - - Mental disorders 6 3 3 - - - - - - 3 - - 3 Meningitis 1 1 - - - - - - - 1 - - - Multiple Sclerosis 1 - 1 - - - - - 1 - - - - Other diseases of nervous system 18 11 7 - 3 - - - - 4 1 4 6 Chronic rheumatic heart disease 46 16 30 - - - - 2 5 6 13 13 7 Hypertensive disease 31 9 22 - - - - - 1 1 5 8 16 Ischaemic heart disease 466 263 203 - - - - 2 12 32 89 153 178 Other forms of heart disease 75 34 41 - 1 - - - - 3 11 20 40 Cerebrovascular disease 197 99 108 - - - - 1 4 11 17 65 99 Other diseases of circulatory system 78 42 36 1 - - - - - 2 18 26 31 Influenza 2 1 1 - - - - - - - - - 2 Pneumonia 170 78 92 4 1 - 1 - 3 8 16 44 93 Bronchitis and emphysema 164 126 38 - - - - - 2 7 34 58 63 Asthma 3 1 2 - - - - - - 1 1 - 1 Other diseases of respiratory system 33 21 12 6 - - - - 2 1 5 7 12 Peptic ulcer 16 11 5 - - - - - - 1 4 4 7 Appendicitis 4 2 2 - - - 1 - - - 1 - 2 Intestinal obstruction and hernia 10 4 6 - - - - - - - 1 1 8 Cirrhosis of liver 5 3 2 - - 1 - - - 2 1 - 1 Other diseases of digestive system 19 12 7 - - - - - - 1 2 9 7 Nephritis and Nephrosis 11 5 6 - _ _ - -- - 3 3 2 3 Hyperplasia of prostate 7 7 - - - - - - - - 1 3 3 Other diseases, genito-urinary system 19 10 9 - - - - 2 - - 4 3 10 Diseases of skin, subcutaneous tissue 3 2 1 - - - - - 1 - - 1 1 Diseases of musculo-skeletal system 10 1 9 - - - - 1 - - 1 1 7 Congenital anomalies 12 9 3 10 1 1 - - - - - - - Birth injury, difficult labour, etc. 16 13 3 16 - - - - - - - - - Other causes of perinatal mortality 15 10 5 15 - - - - - - - - - Symptoms and ill-defined conditions 6 3 3 - - - - - 1 - - 1 4 Motor vehicle accidents 19 12 7 - 1 2 2 - 2 - 4 4 4 All other accidents 39 29 10 1 - - 5 6 4 11 4 3 5 Suicide and self-inflicted injuries 16 11 5 - - - 2 1 1 5 3 3 1 All other external causes 7 6 1 - 1 - 1 3 1 1 - - - Males 1,195 38 7 4 10 14 38 117 288 366 313 Females 952 16 3 3 3 5 19 50 124 250 479 GRAND TOTAL 2, 147 54 10 7 13 19 57 167 112 616 792 72 TABLE 2 SUMMARY OF ROAD ACCIDENTS OCCURRING IN THE BOROUGH Pedestrians Motor Cyclists Pedal Cyclists Other Road Users Total 1971 killed 13 1 3 5 22 injured 587 178 75 857 1,697 1970 killed 13 - - 5 18 injured 655 120 100 973 1,848 TABLE 3 INFANT MORTALITY Deaths from stated causes at various ages under i 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- Respiratory Distress Syndrome 4 3 - - - - - (-) 7 12.7 Bronchitis -- -- -- - - - 3 1 -- (3) 4 7.3 Pneumoni a - - 1 1 1 -- 2 -- - (3) 5 9.1 Congenital Malformations 4 1 - 1 1 - - - - (6) 7 12.7 Premature Birth 13 2 - - - - - - - (21) 15 27.3 Asphyxia, Atelectasis 1 1 - - - - - 1 - (-) 3 5.5 Birth injuries - 1 - - - - - - - (2) 1 1.8 Other causes 3 2 - 1 - - 3 3 1 (14)13 23.6 TOTALS 25 10 1 3 2 - 8 5 1 (49)55 100.0 (*Figures in parenthesis denote corresponding deaths in 1970) TABLE 4 INFANT MORTALITY Comparative table showing deaths of infants at various ages under i year Year under 24 hours 1-6 days 14 weeks Total under 4 weeks 1-12 months Total under 1 year Percentage deaths under 4 weeks of total Infant deaths 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 1971 25 10 6 41 14 55 74 -73- TABLE 5 COMPARATIVE VITAL STATISTICS Year Population Live Births Deaths Deaths under 1 year Maternal Deaths Cancer Deaths (all forms) Tuberculosis Deaths (all forms) No. Rate* No. Rate* No. Rate** No. Rate** No. Rate* No. Rate* 1901 597,106 21,515 36.0 12,143 20.3 N.A. N.A. 420 0.7 1,670 2.8 1911 570,429 17,461 30.6 10,272 18.0 2,664 152.5 51 2.9 506 0.8 1,223 2.1 1921 530,656 13,283 25.0 6,863 12.9 1,219 91.8 29 2.1 571 1.1 751 1.4 1931 491,300 8,585 17.5 6,286 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 1971 164,650 2,234 13.6 2,147 13.0 54 24.2 0 0 567 3.4 9 0.05 * * Per 1, 000 population * Per 1,000 total births N. A. - Not available NOTE: Figures prior to 1965 relate to those of the former Metropolitan Boroughs of Bethnal Green, Poplar and Stepney. 74 TABLE 6 OBSERVATION REGISTER (i) Observation Register (Children under 5 years) No. on Register on 1st January No. added during year 3,206 970 4,176 No. removed during year - died 32 - moved away 459 - no longer at risk 830 - transferred to ages 5-21 Register 66 1,387 Total on Register at 31st December 2,789 No. of above total suffering from handicaps 275 Year of birth of those on Register at 31st December 1971 810 1970 686 1969 534 1968 383 1967 376 Total: 2,789 (ii) Observation Register (5-21 years) Total on Register at 31st December 2,744 (iii) Handicaps of children and young persons on Observation Register 0-4 years 5-21 years Educationally subnormal - 871 Severely subnormal - 137 Physically handicapped 183 581 Mentally retarded 27 - Maladjusted - 328 Blind (Registered) - 5 Visual defects 6 72 Speech defects (requiring special or other school) 15 27 Epileptic 10 101 Deaf and partially hearing 11 201 Delicate (including diabetic) - 155 Multiple handicaps 23 266 Total: 275 2, 744 In addition there are 207 children suffering from handicaps attending schools in the Borough, but living outside the Borough. 75- 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- rdo- 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 76 TABLE 8 INFECTIOUS DISEASE NOTIFICATIONS Corrected Notifications Removed to Hospital Notified in 1970 Notified in 1969 Acute Encephalitis Infective - - - - Post - infectious - - - - Acute Meningitis 8 8 2 17 Acute Poliomyelitis Paralytic - - - - Non-paralytic - - - - Anthrax - - - - Cholera - - - - Diphtheria - - 6* Dysentery 39 9 36 78 Food Poisoning 68 25 82 71 Infective Jaundice 66 10 127 124 Leptospirosis - - - - Malaria - - - - Measles 238 11 1,063 1,201 Ophthalmia Neonatorum - - 2 - Plague - - - - Relapsing Fever - - - - Scarlet Fever 50 1 48 79 Smallpox - - - - Tetanus - - - - Tuberculosis Pulmonary 76 101 99 Non-pulmonary 18 17 14 Typhoid Fever 2 2 3 - Whooping Cough 54 3 138 20 Yellow Fever - - - - TOTALS 619 69 1,619 1,709 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 E1., E. 2., E. 3., and E. 14. were as follows;- 1971 1970 1969 1971 1970 1969 January 5,074 6, 432 5,254 July 2,371 2,557 3,436 February 2,603 3,670 5,053 August 2,698 2,607 2,791 March 3,892 4,074 4,696 September 2,383 3,410 2,649 April 2,350 3,447 3,802 October 2,704 3,265 4,171 May 3,050 2,710 2,919 November 3,457 3,145 3,286 June 2,387 2,934 2,826 December 2,718 3,406 6,643 TOTALS 35,687 41,657 47,526 77 VACCINATION AND IMMUNISATION Children vaccinated/immunised Others aged T O T A L Year of birth 1971 1970 1969 1968 196467 Under 16 Over 16 Diphtheria 727 1,196 119 107 122 112 - 2,383 Re-inforcing Dose - 414 974 377 1,431 818 - 4,014 Tetanus 727 1,196 119 106 132 151 10 2,441 Re-inforcing Dose - 414 976 378 1,482 1,034 66 4,350 Whooping Cough 721 1,182 74 44 20 2 - 2,043 Re-inforcing Dose - 395 817 247 81 5 - 1,545 Poliomyelitis 723 1,197 125 102 133 136 9 2,425 Re-inforcing Dose - 426 970 386 l,32i 948 - 4,055 Measles 1 1,222 298 268 122 85 - 1,996 Rubella - - - - - 1, 916 - 1,916 Under 1 1 year 2-4 5-15 16 and over Total Smallpox vaccination Primary 19 814 177 55 2 1, 067 Re- vaccination - - 6 140 53 199 Diphtheria immunisation of children under 5 Children under 5 immunised during 1967/71 9,873 Estimated population under 5 as at 30th June, 1971 11,500 Percentage protected 85.9 Vaccinations/immunisations (all ages) carried out at clinics/general practitioners' surgeries At Council Clinics By General Practitioners % Primary by General Practitioners. Primary Reinforcing Primary Reinforcing Diphtheria 2,083 3,525 300 489 12.6 Tetanus 2,092 3,628 349 722 14.3 Whooping Cough 1,778 1,345 265 200 12. 9 Poliomyelitis 2,121 3, 566 304 489 12.5 Smallpox 835 36 232 163 21.7 Measles 1,779 - 217 - 10. 9 Rubella 1,822 - 94 - 4.9 78 TABLE 11 TUBERCULOSIS - NEW CASES AND DEATHS 1971 New Cases and Deaths: Primary notifications of 76 pulmonary and 18 nonpulmonary cases were received; 7 other cases came to light via death returns from Registrars. Pulmonary tuberculosis (including late effects) accounted for 7 deaths, there being 4 deaths from non-pulmonary tuberculosis. Age distribution of new cases and deaths is as follows;- -1 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total (all ages) (a) New Cases Pulmonary M _ _ _ - 1 6 5 6 19 15 6 5 1 64 F - - - 1 - - 1 3 6 - 1 - - 12 Non- Pulmonary M - - 1 - - 2 2 2 1 - 3 - - 11 F - - - - - 1 2 1 - 1 1 1 - 7 (b) Deaths Pulmonary M - - - - - - - - -- 2 3 1 1 7 F - - - - - - - - - - - - - - Non-Pulmonary M - - - - - - - - - - 2 - - 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, 402 692 116 117 2,327 No. cases notified during 1971 64 12 11 7 94 Other cases added to register 48 9 2 3 62 No. cases removed from register 130 58 5 11 204 Remaining on register at 31st December 1,384 655 124 116 2,279 79 TABLE 13 TUBERCULOSIS - CARE AND AFTER CARE Home Care and Treatment Patients receiving attention by home nurses 8 Work of Tuberculosis Visitors No. of tuberculous households visited 785 No. of visits to above and tocontacts 7,709 No. of unsuccessful visits ... ... ... 645 Children No. child contacts boarded out during year Nil No. child contacts boarded out for segregation during B. C. G. vaccination Nil TABLE 14 MASS RADIOGRAPHY Unit 6A Unit 6B * Total No. of factories, sites, etc. visited 8 10 18 persons x-rayed - Males 731 2,263 2,994 - Females 351 2,015 2,366 - Total 1,082 4,278 5,360 No. referred for further investigation 45 22 67 Toynbee Hall - persons x-rayed 5,102 - 5,102 - referred for further investigatio n 154 -- 154 Abnorma lities Total persons x-rayed 6,184 4,278 10,462 Tuberculosis requiring immediate treatment 11 - 11 Tuberculosis requiring clinic supervision 1 2 3 Cancer of lung 5 2 7 Other 83 7 90 Active tuberculosis cases discovered - - - Per 1, 000 examined * Tanuarv to June only 1.94 0 1.94 TABLE 15 TUBERCULIN TEST AND B.C,G. VACCINATION Contacts Schoolchildren and Students Total No. of skin tests 141 1,264 1,405 No. found positive 50 94 144 No. found negative 91 1,027 1,118 No. vaccinated 105 1,027 1,132 8 0 TABLE 16 ANTE AND POST NATAL SERVICES No. Ante and Post Natal Sessions held by: Medical Officers 1 Midwives 49 No. women attending for ante natal examination 69 No. women attending for post natal examination 36 Total attendances 431 No. General Practitioners holding sessions in Council clinics 4 Mothercraft and Relaxation Classes: No. women attending (a) Institutionally booked 45 (b) Domiciliary booked - No. attendances 259 No. sessions held by Health Visitors 55 TABLE 17 CHILD WELFARE CENTRES No. premises at end of year 14 No. sessions during year held by: Medical Officers 230 Health Visitors 122 Sessional General Practitioners 1,639 Hospital medical staff 53 Total sessions: 2,044 No. children attending - born this year 2,006 - born last year 1,974 - born 1966-69 2,712 No. attendances of children of all ages 37,150 Average attendance per session 18.1 No. children referred elsewhere 415 TARIF 18 CERVICAL CYTOLOGY Premises Number Sessions Examinations Council Clinics 3 186 1,284 General Practitioners Surgeries 1 36 166 Family Planning Clinics 3 313 886 Other Slides read in Submitted by G. P's Hospital Other Hospital Laboratories Hospitals St. Andrew's Hospital 172 915 78 Mile End Hospital 428 1,951 43 London Hospital - 7,100 - (Residents of all areas) + 81 TABLE 19 CHIROPODY Treated at Clinics Domiciliary Treatment New patients during year 641 161 Total patients at end of year 3,162 659 Treatments - children 240 - - expectant mothers - - - physically and mentally handicapped 53 - - aged persons 11,654 3,391 No. of chiropodists employed 10 No. of clinic sessions held 1,674 No. of patients treated per clinic session 7.0 Percentage of total patients receiving domiciliary treatment 17.2 No. of sessions held in Old Peoples' Homes 95 Total No. of treatments; 15, 338 TABLE 20 DENTAL TREATMENT FOR EXPECTANT AND NURSING MOTHERS Expectant Mothers Children Persons examined 63 499 No. requiring and offered treatment 63 456 Visits during the year 229 1,291 Courses of completed treatment 63 417 Teeth extracted 13 13 Teeth filled 146 927 Emergencies treated 3 44 General anaesthetics given - - No. patients x-rayed 27 1 No. patients treated by scaling etc. 63 426 Dentures - full 3 - - partial 19 3 No. of sessions for treatment 190 -do- for health education 27 Np. of treatrrent Centres at end of year 8 - 82- TABLE 21 HEALTH EDUCATION ACTIVITIES Discussion groups or talks on the following subjects were arranged during the year; Subject No. Occasions Persons participating Mothercraft 236 2,065 Cancer prevention 26 285 General Health Subjects - Schools 186 3,691 - Other 94 918 Psychoprophylaxis 57 279 599 7,238 Films or filmstrips were shown on 157 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, 981 posters were exhibited and 9, 984 leaflets distributed. 83 TABLE 22 FAMILY PLANNING SERVICE Attendances at sessions held at clinics in the borough during the year. Premises New Cases Old Patierts Total Patients Total Visits No. of Sessions. Council Clinics St. Georges 119 - 119 377 92 Wigram House 10 - 10 10 1 Domiciliary Service 21 21 42 198 - Greenwood 234 - 234 716 97 Leopold Street 232 - 232 830 69 Family Planning Association Clinics Underwood Road 451 842 1,293 3,072 190 Wapping 30 54 84 269 26 Wellington Way 274 374 648 1,631 97 Totals: 1970 Statistics 1.371 1.291 2,662 7,103 572 1,250 987 2,405 * 5, 927 517 TABLE * including 168 transfers. HEALTH VISITING No. Visited No. of Visits Children born this year 2,103 ) „ „ last year 1,653 ) 33,738 „ „ 1966-69 4,594 ) Aged persons 141 466 Mentally disordered persons 39 199 Tuberculous households 6 13 Households on account of other infectious diseases 16 62 Persons, excluding maternity cases, discharged from hospital (other than Mental Hospitals) 14 59 Other Cases 876 2,135 Visits to expectant and nursing mothers - 1,605 Visits to problem families - 2, 177 Total effective visits 40,454 Unsuccessful visits 8,449 TABLE 24 PREMATURE BIRTHS Born in Hospital Born at Home or in Nursing Home 1971 1970 1969 1968 1971 1970 1969 1968 No. of Births 166 211 211 177 10 9 5 23 Died within 24 hours 18 11 8 12 1 - - 2 Died within 1/28 days 7 8 11 13 - - 1 - Premature still births 20 23 17 26 2 - - 2 84 TABLE 25 HOME BATHING Persons serviced during the year; Male 366 Female 1,107 Total 1,473 Persons receiving service at end of year; Male 94 Female 290 Total 384 Total baths given during year 9, 662 TABLE 26 HOME NURSING Number of patients nursed during year ... 3,296 Number aged under 5 ... 100 " " over 65 ... 1, 607 " of visits during year ... 93,119 TABLE 27 LAUNDERING FOR AGED AND INCONTINENT No. of articles cleansed and laundered during year ... 50, 976 No. of collections made during year ... 5,024 No. of persons who received service during year ... 249 No. of persons receiving service at end of year ... 55 TABLE 28 RECUPERATIVE HOLIDAYS Category No. for whom holiday arranged Accompanied children: At School 16 Pre-school - Unaccompanied children: Placed by Inner London Education Authority: At school 317 Pre-school Total 333 85 TABLE 29 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 were as follows:- Article No. on loan at 1/1/71 No. loaned during year No. returned during year No. on loan at 31/12/71 Air rings 7 25 6 26 Back rests 19 21 19 21 Beds - Air - - - - Bed cradles 16 23 20 19 *Beds - Egerton - - - - Beds - Hospital 13 7 11 9 *Beds - cot and mattress 4 1 1 4 Bed pans 26 31 26 31 Bottles 26 40 28 38 *Chairs - wheel 51 29 27 53 *Chairs - Ambulance type, carrying 1 1 1 1 Commodes - Chair 180 137 134 183 Commodes - Stool 9 16 15 10 Crutches, Elbow 1 5 2 4 Cushions - Sani - - - - Cushions - Sponge 3 1 4 - Fracture boards 17 7 4 20 *Hoists 1 - - 1 Hoists - Penrhyn 4 3 5 2 Mattresses - ordinary 4 - 3 1 Mattresses - Dunlopillo 8 7 5 10 Sheets. - rubber 27 16 10 33 Walking frames 14 19 6 27 Walking frames - wheeled 1 - - 1 Walking frames - Zimmer adjustable 1 - - 1 Walking sticks - Tripod 19 10 10 19 Walking sticks - Quadruped 4 4 5 3 Water Closet Seats inflatable 5 - - 5 TOTALS 461 403 342 522 *Stocks of these were transferred to the Social Services Department in August 1971. OTHER EQUIPMENT LOANED Fireguards 523 59 9 573 86 TABLE 30 DOMICILIARY MIDWIFERY Category Midwives of the Nursing Sisters of St. John the Divine District Nurses Midwives of the London Hospital Total Home Confinements 1971 85 - 57 142 1970 118 - 76 194 1969 112 - 121 233 1968 119 - 151 270 1967 146 - 202 348 Planned Early Discharges 1971 64 - 74 138 1970 73 2 61 136 1969 44 - 44 88 1968 45 - 30 75 1967 55 - 42 97 Unplanned Early Discharges 1971 13 148 58 219 1970 2 196 7 205 1969 4 117 16 137 1968 8 93 13 114 1967 4 ~ 10 14 -87- TABLE 31 PARKS AND OPEN SPACES IN THE BOROUGH Administered by Borough Council Location Area in Acres Albert Square Gardens .66 Alfred Street Playground . 16 Allen Gardens 1.69 All Saints Churchyard 1.55 Alton Street Open Space 2. 29 Arbour Square Gardens .66 Arnold Circus Bandstand .33 Bartlett Park 13.32 Bazely Street Playground .30 Beaumont Square Gardens 1.00 Bethnal Green Gardens 11.97 Blackwall Commemoration Park 1. 83 Blair Street Playground .68 Bromley Recreation Ground 1.65 Carlton Square 1.95 Christchurch Gardens Spitalfields . 15 Claredale Playground .57 Club Row Gardens .07 Columbia Road Triangle .07 Dee Street Playground .45 Ford Square Gardens • 40 Ford Street Playground .09 Furze Green 1.93 Gale Street Playground .24 Glaucus Street Playground .70 Globe Road. Memorial Garden .08 Gosling Gardens 2.50 Grove Hall Park 4. 50 Ion Square, 2. 50 Island Gardens 3.00 Jodrell Road Gardens . 10 King Edward Memorial Park 8. 50 Kirkwall Place Playground . 12 Langdon Park 2.61 Mallon Gardens . 19 Meath Gardens 10.54 Mile End Gardens .50 Millwall Park 13.50 Peel Grove Gardens 1.19 Pelter Street Playground .12 Poplar Recreation Ground 4.41 Prescot Street Playground .23 Rochelle Street Gardens .07 Ropewalk Gardens 1.51 St. Bartholomew Churchyard .45 St. George in the East Churchyard 2.25 St. James Churchyard 2.00 St. James, Ratcliffe Garden 2.50 St. Johns Parish Garden 2.50 St. Mary'.s Whitechapel 1.26 St. Matthews Churchyard 2.07/cont'd 88 TABLE 31 PARKS AND OPEN SPACES IN THE BOROUGH (Continued) (a) Administered by Borough Council (continued) Location Area in Acres Schoolhouse Lane. Playground .08 Shandy Park 3,18 Sidney Square Gardens ,33 Sir John McDougall Garden 6.32 Stepney Churchyard 6.96 Stepney Green Gardens 5.86 Swanfield Street Playground . 23 Swedenborg Square Playground .67 Trafalgar Square Gardens .60 Tredegar Road Garden .08 Tredegar Square Playground 1.24 Trinity and Wakefield Gardens 1.29 Trinity Churchyard 1.03 Tunnel Gardens .96 Va] lance Road Gardens 1.69 Wapping Gardens 5.48 Weavers Fields 15.12 Wyvis Street Playground .26 York Square Gardens .20 165.49 (b) Administered by Greater London Council Location Brickfield Gardens 5,73 Burdett Gardens 4,14 King George s Field East London Stadium 15,93 Limehouse Churchyard 2,00 Victoria Park 148,50 Tower Hamlets Cemetery Gardens 4,50 180 80 346. 29 TABLE 32 BURIALS UNDERTAKEN Under Section 50. National Assistance Act, 1948 Number of Adults 49 Number of Children 7 Number of Stillborn 1 Total Cost £1,271 Burials requested by - Coroner 35 - Relatives 19 - Others 3 -89- TABLE 33 MEDICAL EXAMINATIONS OF COUNCIL STAFF (a) Medical Examinations Number New appointees 429 Transfers to permanent staff 76 Entry to Council's Sick Pay Scheme 30 Sickness absence exceeding one month 265 Extension of service beyond 65 years of age 43 Reviews, heavy goods vehicle drivers, etc. 67 Student Teachers 100 Examinations arranged with other Authorities 24 Total; 1,034 Abortive appointments (b) Medical Assessments 227 For entry to Sick Pay Scheme 477 New appointees (from November) 70 Transfers to permanent staff (from November) 19 TABLE 34 DISEASES OF ANIMALS ACTS Kosher Poulterers and Poultry Slaughterhouses Inspections for cleanliness and fowl pest control 226 Street Markets Inspection re sale of animals and observations on movemehts of live poultry 28 Pet Shops Visits 80 TABLE 35 VISITS BY PUBLIC HEALTH INSPECTOR (CLEAN AIR) AND TECHNICAL ASSISTANT To premises regarding complaints 409 „ „ „ Smoke Control Orders 2,664 „ „ for smoke observations 773 „ „ regarding installation of boilers and chimneys 300 " " " routine boiler inspections 154 No. of notices served under Sec. 12(2) Clean Air Act 15 „ „ „ Sec. 16 -do- - 90 TABLE 36 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 945 samples were submitted for analysis, as follows;- 1 Baby Food 10 Margarine 4 Biscuits 48 Meat and meat preparations 5 Bread 24 Meat pies and sausage rolls 5 Bread and Butter 44 Meat products - canned 14 Butter 31 Milk 20 Cereals and starch products 31 Milk preparations 23 Cheese and cheese preparations 7 Milk - dried and condensed 16 Cocoa and chocolate preparations 16 Nuts and nut preparations 6 Coffee and coffee preparations 1 Nutritional Liquid Meal 2 Colourings 23 Oils fats and fatty foods 3 Cream 29 Pickles and sauces 51 Drugs 2 Rum 10 Eggs and egg products 1 Salad Cream 60 Fish and fish preparations 68 Sausages and other meat products 3 Flavourings 1 Sherry 20 Flour and flour products 37 Soft drinks 15 Flour confectionery 9 Soup and soup mixes 7 Food additives 19 Spices and condiments 95 Fruit and fruit preparations 38 Sugar confectionery 1 "Fruit Juice" (Display sachet) 11 Sugars, syrups, etc. 4 Gin 9 Table jelly preparations 4 Gravy preparations 41 Tea 9 Herbs and herb preparations 32 Vegetables and vegetable preparations 10 Ice cream 6 Vinegar and acetic acid 1 Ice lolly 5 Whisky 8 Jam and preserves 5 Wine 91 TABLE 37 HOUSING INSPECTORS AND TECHNICAL ASSISTANTS VISITS AND NOTICES VISITS Housing Act, 1957 (Sections 16, 17 and 18) 305 Slum Clearance 1,414 Overcrowding 67 Town Planning applications 67 Houses in Multiple Occupation 7,156 Preferential re-housing 398 Sites 3,918 Qualification Certificates 132 Miscellaneous 453 Total; 13, 910 NOTICES, ORDERS, ETC. HOUSING ACTS 1957-64 Informal notices 129 Requiring Additional Services (Section 15) 1 Management Orders made 24 Intention to make Directions 86 Directions made (Section 19) 61 Overcrowding (Section 90 Housing Act, 1957) 25 Means of Escape in Case of Fire (Section 16) 57 No. Registered Part I Registration Scheme 241 No. Registered Parf II Registration Scheme 1 No. Registered : Registration Scheme, Subject to condition 8 92 TABLE 38 DWELLINGS ERECTED DURING 1971 (a) By Borough Council Jeremy Bentham House 1-30 Pollard Street 30 Lefevre Walk 183-270 88 Portia Way 2-20, 1-31,33-63, 65-87,89-107,109-139 80 SJege House 1-70 Sidney Street 70 Southwood Smith House 1-21 Florida Street 21 Tyrone House 351-373 Old Ford Road 12 Wager Street 2-16, 18-36,17-31, 33-67, 40-70 60 361 (b) By Greater London Council Bradbury House Holland Estate 6 Cable Street Barnardo Gardens 26 Carradale House Brownfield Estate 88 Denning Point Holland Estate 82 Devonport Street Barnardo Gardens 22 Farrell House Barnardo Gardens 52 Gales Gardens Horwood Estate 43 Harkness House Berner Estate 28 Holyhead Close Crossways Estate 22 Hatton House St. Georges Estate 85 Ladbroke House Holland Estate 6 Muskey Street Ex mouth 66 Noble Court St. Georges 43 Ronald Street Barnardo Gardens 30 Robin Hood Gardens Robin Hood Gardens 104 703 (c) By Others Cyprus Street 1-21 21 Dawson House Walden Street 14 Garthwaite House Bell Lane 1 Horace Evans House Ashfield Street 34 Kent House Walden Street 32 Regent Square 1-36 36 138 TOTAL 1, 202 93 TABLE 39 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 105 151 - Factories with mechanical power 1, 740 2, 949 124 Other premises under the Act (Electrical stations, institutions, and sites of building operations and works of engineering and construction) 73 12 - Total: 1,918 3,112 124 2. Cases in which defects were found Particulars Found Remedied Referred ToH.M. Inspector By H.M. Inspector Want of cleanliness 1 - 1 - Overcrowding - - - - Unreasonable temperature - - - - Inadequate ventilation - - - - Ineffective drainage of floors - - - - Sanitary conveniences: (a) Insufficient 7 6 - 3 (b) unsuitable or defective 168 118 - 7 (c) not separate for sexes 8 6 - - Other offences against the Act (not including those relating to outwork) 108 62 4 - Total; 292 192 5 10 94 TABLE 40 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. 979 - - Cleaning and washing - - - Household linen - - - Lace, lace curtains and nets - - - Curtains and furniture hangings - - - Furniture and upholstery 7 - - Electro- plate 24 - - File making - - - Brass and brass articles 2 - - Fur pulling - - - Iron and steel cables and chains - - - Iron and steel anchors and grapnels - - - Cart gear - - - Locks, latches and keys - - - Umbrellas, etc. 4 - - Artificial flowers 7 - - 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 81 - - Brush making - - - Pea Picking - - - Feather sorting - - - Carding, etc. of buttons, etc. - - - Stuffed toys - - - Basket making - - - Chocolates and sweetmeats - - - Cosaques, Christmas stockings - - - Textile weaving - - - Lampshades 2 - - Total; 1,106 - - Section 134. There were no instances of work found in unwholesome premises. 95 TABLE 41 LEGAL PROCEEDINGS INSTITUTED DURING THE YEAR No. of Summonses Fines £ Costs £ Housing Act, 1961: Houses in Multiple Occupation; Contravention of Direction 24 775 91 Contravention of Regulations 108 646 71 Means of escape from fire not provided 17 445 56 Housing Acts, 1961/69; Contravention of Tower Hamlets (Registration of Houses in Multiple Occupation) Informatory and Regulatory Scheme, 1971 9 96 27 Housing Act, 1957: Overcrowding in Houses in Multiple Occupation 18 410 74 Public Health Act, 1936: Nuisance Orders 39 _ 152 Non- compliance with Nuisance Orders 6 60 30 Public Health (Recurring Nuisances) Act, 1969 1* - - Food and Drugs Act, 1955 9 215 72 Food Hygiene (General) Regulations 1960 37 225 50 Food Hygiene (General) Regulations 1970 56 327 37 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966 43 222 23 Offices Shops and Railway Premises Act, 1963 2 50 10 Byelaws as to Artificial Lighting of Common Staircases in Tenement Houses and Flats 2 13 6 Total: 371 3,484 699 * Prohibition Order for 28 days obtained. TABLE 42 MORTUARY SERVICE Tower Hamlets Mortuary Hackney Mortuary Total Bodies received 396 119 515 Post-mortems 347 106 453 Inquests 41 13 54 Deposit only 8 - 8 96 TABLE 43 CLEANSING STATION Persons treated for scabies: Men 80 Women 74 School children 109 Children under 5 54 Total; 317 No. treatments given 581 Persons treated for verminous conditions Men 522 Women 104 School children 840 Children under 5 68 Total; 1,534 TABLE 44 DISINFECTING STATION Disinfection: No. of dwellings disinfected for infectious diseases 45 No. of dwellings disinfected for other reasons 265 No. of rooms involved 328 No. of articles disinfected by steam 2,098 No. of articles disinfected by formaldehyde 1,596 No. of premises other than dwellings disinfected 76 Disinfestation; No. of dwellings disinfested for bed bugs 527 - for other vermin 151 No. of rooms involved 3,088 No. of other premises and sites disinfested 569 No. of articles disinfested by steam 11,650 No. of articles disinfested by formaldehyde 1,931 Drainage: No. of premises where drains tested 61 No. found defective 26 97 TABLE 45 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 137 975 604 17,398 Retail Shops 56 1,012 459 3, 533 Wholesale Shops 51 538 297 4, 835 Catering establishments/ Staff Canteens 24 259 175 1,536 Fuel Storage Depots - 1 - 15 Total: 268 2,785 1,535 27,317 (Males: (Females: 18, 032) 9,285) Other visits to registered premises 1,184 Visits to non-registered premises 822 Informal Notices served Offices, Shops and Railway Premises Act, 1963 Notification of Employment of Persons Order, 1964 Lifts and Hoists Regulations 1968 589 153 130 Accidents notified - Causes Machinery Non-power driven machinery or relevant part in motion 2 Power driven machinery or relevant part in motion 2 - Machinery or relevant part at rest (power or non-power driven 1 Transport; Vehicle in motion not moved by power 2 Vehicle in motion moved by power 5 Vehicle stationary 1 Falls of persons; On or from fixed stairs 5 On or from ladders or step ladders 1 Other falls from one level to another 4 Falls on the same level 8 Stepping on or striking against object or person 6 Handling Goods (not otherwise classifiable) 17 Struck by falling object 6 Not otherwise specified 8 Total: 68 98 TABLE 46 RODENT CONTROL Properties inspected Number inspected Number found to be infested by Rats Mice Oil complaint 3,313 970 2,182 Otherwise 656 198 318 Total: 3, 969 1,168 2,500 Properties treated by Council (including 1, 034 business premises) 3,701 Visits by Rodent Operatives 14,310 Notices served under Section 4 of the Act (a) treatment - (b) structural work (proofing) 25 Cases where default action taken following service of notice 12 Number of "Block Control" schemes carried out 23 Sewer Treatments No. of Manholes No. Treated. 5504 4496 99 TABLE 47 VISITS BY PUBLIC HEALTH INSPECTORS Type of Premises No. Visitsor Inspections Registered and Licensed Premises Common Lodging Houses 3 13 Pur Skin Dressers 3 3 Hai rdr essers 167 143 Ice-Cream 456 250 Massage Establishments 4 7 Milk Distributors 244 221 Pet Shops and Stalls 67 141 Pharmacy and Poisons 67 98 Poultry slaughterhouses 19 20 6 Prepared Food Meat 97 87 - Fi sh 67 101 Rag Flock 33 26 Seamen's Lodging Houses 2 16 Dwellings No. of visits on complaint ) 4,821 No. of visits for drainage ) 61,193 2,237 No. of revisits ) 6,258 No. of other visits 998 Other Premises Bakehouses 40 83 Baker Shops and Stalls 90 139 Butcher Shops and Stalls 163 303 Canteens and Clubs 604 159 Chemists 52 15 Confectionery Shops and Stalls 350 237 Fish Shops and Stalls 123 102 Greengrocers and Fruiterers Shops and Stalls 502 442 Grocers Shops and Stalls 358 571 Hospitals, Institutions and Day Nurseries 37 11 Public Houses 450 612 Poultry Shops and Stalls 107 116 Restaurants, Cafes and Stalls 548 683 School Meal Centres 135 71 Wholesale Food Depots, Markets and Wharves 142 1,915 Other Food Premises 148 197 Food Delivery Vehicles - 18 Factories (Mechanical) 1,845 2,949 Factories (Non Mechanical) 105 151 Factories (other) 78 12 Outworkers 1,106 462 Schools 102 115 Drainage Work - 2628 27.617 There are 3 411 food premises including stalls in the Borough, Some of the premises listed above are included under more than one trade category. -100- TABLE 48 MISCELLANEOUS WORK OF PUBLIC HEALTH INSPECTORS Rent Act 1957 - Certificates of Disrepair Applications for disrepair certificates - Applications for cancellation of disrepair certificates - Complaints Number received at Office 3, 599 Dangerous Structures Number of premises notified to District Surveyor 72 Drainage Plans Number of plans on which observations submitted to Director of Technical Services 205 Land Charges Number of premises reported upon to Chief Executive 1,378 Town Planning Applications No. of premises reported upon to Borough Architect and Planning Officer 678 Public Houses Number of premises reported upon to Licensing Justices 69 Licensed Clubs No. of premises reported upon to the Chief Officer of Public Control 18 101 TABLE 49 NOTICES SERVED BY DISTRICT PUBLIC HEALTH INSPECTORS Factories Acts 1961 124 Food Hygiene (General) Regulations 1970 325 Food Hygiene (Markets, Stalls, and Delivery Vehicles) Regulations, 1966 35 Hairdressers and Barbers Byelaws 7 Informal Notices to Local Authority Housing Departments 1,798 Prevention of Damage by Pests Act 1949 25 Public Health Act, 1936, Section 39 11 -do- 44 1 - do- 45 4 -do- 48 2 -do- 75 10 -do- 89 11 -do- 93 956 Public Health Act, 1961, Section 17 104 Staircase Lighting Byelaws 11 Total: 3,424 TABLE 50 OUTWORKERS Firms in the b orough employing outworkers 450 Outworkers residing in and employed by firms in the borough 891 Outworkers residing outside the borough employed by firms in the borough 1,932 Outworkers residing in the borough employed by firms outside the borough 215 Total outworkers in the borough 1,106 TABLE 51 REFUSE DISPOSAL Home and trade refuse 73,356 tons Street and market collections 14,912 tons No. of bulk containers in use 3,340 No. of bulk trailers in use 40 N o. of street gulleys cleansed 7,060 102 TABLE 52 CONFERENCES The Council was represented at the following conferences during the year; Conference Venue Dates Representatives Association of Public Health Inspectors Annual Conference Eastbourne 4th - 8th October Chief Public Health Inspector (Cllr. (Mrs.) L. E. Brazier Association of Sea and Air Port Health Authorities Annual Conference London 30th June - 2nd July Cllr. (Mrs.) L. D. Crook Councillor J. O'Connor Associate Medical Officer of Health British Dental Association Annual Conference Eastbourne 6th - 9th June Chief Dental Officer Senior Dental Officer Chest and Heart Association "Chest and Heart Diseases in the Modern Community" London 19th November Councillor G. T. Desmond Tuberculosis Visitor Department of Health and Social Security "Continuation of Local Chairman, Finance Committee Chairman, Health Health Services" London 28th June. Committee Medical Officer of Health Assistant Nursing Officer. Friendship Week for Sick and Handicapped Children "Long Stay Residential Care - Help or Handicap?" London 26th May. Assistant Health Education Officer Health Visitors Association Annual Conference Bournemouth 28th-30th October Councillor C. H. Main Health Visitor London Boroughs Training Committee "The Work of the Health Visitor" London 26th May Principal Nursing Officer Marie Curie Fund "Rehabilitation of the Cancer Disabled" London 18th May District Nurse National Association for Maternal and Child Welfare 58th Annual Conference London 30th June 2nd July Principal Medical Officer Councillor (Mrs.) D. M. Couling 103 TABLE 52 (cont'd) CONFERENCES (contd) Conference Venue Dates sentatives National Association for Mental Health Annual Conference London 25th - 26th February Social Worker (Mental Health) Councillor J. O'Connor National Association for Welfare of Children in Hospital London 24th November Councillor W. T. Tuson Councillor Mrs. L. E. Brazier National Women's Citizen Association "Pollution and Environmental Cleanliness ' London 15 th October Councillor Mrs. L. E. Brazier Supervisor of Cleansing Services. National Association of Nursery Matrons Annual Conference Eastbourne 20th - 21st March Day Nursery Matron Royal College of Nursing (a) Nurses at Law London 13 th May Deputy Superintendent (b) Community Coronary Care London 4th June (District Nursing,) District Nurse Health Visitor District Nurse Royal Society for the Prevention of Accidents National Home Safety Conference Scarborough 3rd - 4th November Health Education Officer Royal Society of Health (a) Sex Education of School Children London 11th February Assistant Health Education Officer (b) Congress Eastbourne 19th - 23 rd April Councillor Miss H. Morsman Medical Officer of Health (c) Lecture on Air Pollution London p. m. 26th November Councillor Mrs. D. M. Couling Public Health Inspector Standing Conference of Co-operating Bodies on Air Pollution London 25 th October Councillor J. O'Connor Chief Public Health Inspector World Federation for Mental Health International Conference Dublin 27th March 1st April Chairman, Health Committee Councillor J. O'Connor Principal Social Worker (Mental Health) 104 TABLE 53 REFRESHER AND TRAINING COURSES Courses attended by staff during the year were as follows;- Course Venue Dates Attended by Association of Health Administrative Officers' Summer School Canterbury 15th - 18th September Chief Administrative Officer Association of Public Health Inspectors, Week-end Seminar Canterbury 26th - 28th March 2 Public Health Inspectors Chiswick Polytechnic First Line Management Courses London 7th - 18th June 4th - 15th October 18 th - 29 th October ) Centre Superintendent ) ) ) Centre Superintendent College of Special Education "Relevance of transfer to different disciplines" London 20th March Sessional Medical Officer Family Planning Association (a) One day courses in training London 8th January 19th February 26th March Centre Superintendent Centre Superintendent Centre Superintendent (b) Theoretical training Course London 12th - 13th July Health Visitor Inner London Education A uthority (a) Orthodontics London 17th - 19th March Sessional Dental Officer (b) Follow-up course on Mentally Subnormal Children London 7th - 11th June Sessional Medical Officer (c) Health Visitor Association Refresher Course Cambridge 19th - 31st July School Nurse (d) Paedodontics London Mondays 6th - 27th September Dental Officer 105 TABLE 53 (Cont'd) REFRESHER AND TRAINING COURSES (contd.) Course Venue Dates Attended by (e) Course for Medical Officers on Mentally Subnormal Children London 6th September 1st October Principal Medical Officer (f) In-service training for Dental Officers London 4 afternoons during October Dental Officer (g) Course for School Nurses engaged in Audiometric testing London 10th - 11th November School Nurse Institute of Family Psychiatry Nursing Refresher Course Ipswich 1st - 5th November Centre Superintendent Institute of Health Education Course on Statistics and Epidemiology Bristol 27th September - 1st October Assistant Health Education Officer King Edwards Hospital Fund; Meeting on the Integrated Care of the Psychiatric Patient London 27th September Health Visitor Lansbury Institute Pre-School Playgroup Leaders' Course London Day release Wednesdays, Commencing January 1971 for 1 year 2 Clinic Auxiliaries LAMSAC, Computer Appreciation Course London 3rd - 4th June Deputy Chief Administrative Officer London Boroughs Training Committee (a) Management Principles and Practice for Supervisors of Day Centres London Wednesdays. 6th - 27th January 3 Supervisors of Training Centres (b) Course for Supervisory Staff Clacton 8th - 12th February Assistant Principal Social Worker(Health Services) (c) Recall day - change and the Home Help Service London a. 10th February b. 17th February Home Help Organiser and Asst. Home Help Organiser 2 Assistant Home Help Organisers (d) Course for Area Team Leaders London 10th - 12th & 18th - 19th March Principal Social Worker (Health Services) 106 TABLE 53 (Cont'd) REFRESHER AND TRAINING COURSES (contd.) Course Venue Dates Attended by (e) Study Days and Seminars on Mental Illness London 30th March & 15th-16th April 2 Health Visitors (f) Introductory Course for Clinic Nurses London a. 22/23/29/ 30 April 6/7 th May 2 Clinic Nurses b. 21/22/28/29 October, 4/5th November 2 Clinic Nurses (g) Workshop on In-service training of staff London 10th- 11th June Deputy Principal Nuising Officer (h) Study day "Needs of the Pre-School Child " London 16th June Principal Nursing Officer Assistant Nursing Officer (i) Study Day "Developmen in the treatment of Gynaecological Disorde rs" London 27th July Supervisor of Midwives Senior District Nurse Health Visitor (j) Course of Supervision and Consultation London Fridays 12th November10th December Deputy Principal Nursing Officer (k) Study Day for Home Nurses on care of feet London 10th November District Nurse London Diocesan Committee for Personal Relationships Course London 17th - 19th May Assistant Health Education Officer Ministry of Agriculture, Fisheries and Food Rodent Control Courses London London London 26th - 28th January 19/2 0/2 6/2 7th Ma . 5th - 7th October Rodent Operative ' 4 Rodent Operatives Technical Assistant 2 Rodent Operatives London Borough of Newham School of Community Nursing District Nurse training Course London London 3 Months from February 4 Months from October 2 District Nurses District Nurse On role in dealing with problems of bereavement and separation London 2nd November Senior District Nurse 2 District Nurses 107 TABLE 53 (Cont'd) REFRESHER AND TRAINING COURSES(contd , Course Venue Dates Attended by North East London Polytechni Field Work Instructors Course London Commencing September 1971 Health Visitor Polytechnic of North London (a) Advanced Practical WorK Instructors Course London 15th - 27th June Senior District Nurse District Nurse (b) Field Work Instructors' Course London Commencing September 1971 2 Health Visitors Queens Institute of District Nursing (a) Study Day on Multiple Sclerosis London 14th January District Nurse (b) Study Day on Colostomy and Ileostomy Care London 15th June Senior District Nurse District Nurse Royal College of Midwives Midwives refresher courses Hastings 31st January to 6th February Senior District Nurse Oxford 19th - 25 th September Senior District Nurse R. O.S. P. A. Home Safety In-service Course London 18th November Health Visitor Royal Society of Health Diploma in Atmospheric Pollution London Commencing September 1971 Public Health Inspector Society of Medical Officers of Health Week-end Study Group in Developmental Paediatric London 29th - 30th January Principal Medical Officer University of London Extra Mural Studies Seminar in Social Work London 12 evenings from September Social Worker (Health Services) -108- TABLE 53 (Cont'd) REFRESHER AND TRAINING COURSES(contd.) Course Venue Dates Attended by University of London, Department of Developmenta Paediatrics. Course on Raynell Scales 1 London 2nd - 3rd December Senior Medical Officer Course on Griffiths Scales London Wednesdays 15th November - 15th December Senior Medical Officer Internal Training Courses (a) Middle Management 6 Thursdays from 27th May Senior Administrative Assistant (b) - 6 Thursdays from 16 th September Deputy Chief Public Health Inspector Senior Administrative Officer Administrative Assistant (c) Basic Supervision 8th - 10th December Deputy Superintendent, Disinfecting Station. Leading Rodent Operative (d) Written CommunicationS 15th - 16th December 2 Clerical Assistants 109 TABLE 54 SCHOOL HEALTH STATISTICS Pupils on School Rolls 1,168 part-time 1,407 Infants 6, 902 Juniors 10,275 Seniors 11, 327 Special 979 Total; 32,058 Recuperative Holiday Homes Number of schoolchildren (including Nursery schoolchildren) admitted during the year 333 Health Surveys No. examined Occasions vermin found Percentage (a) Comprehensive 22,781 786 3.45 (b) Selective 15, 603 1,455 9.38 No. of individual pupils found verminous 1, 181 Percentage of school roll 3.68 Vermin - occasions advice and/or shampoo given 1, 951 - occasions attendance at bathing centre 290 (c) Communicable disease - No. examined for 1,420 Routine Audiometer Testing No. of children given screening test 3, 567 No. failing screening test and given pure tone test 270 No. failing pure tone test and referred to Otologist ... 157 School Medical Treatment Clinic No. of premises Sessions in year New Cases Attendances Audiology 1 80 165 453 Bathing 2 576* 1, 092 1,736 Minor ailments - Medical Officer 4 68 532) - Nurse 8 771 898) Ophthalmic 4 254 1,564 2, 955 Orthoptic 1 76 49 139 Special investigation 3 192 148 1,401 *includes also adult sessions 110 TABLE 54 (Cont'd) Defects treated at School Treatment Centres and Hospital Clinics Errors of refraction and squint 892 Other eye defects 90 Spectacles ordered 853 Athlete's foot 26 Verrucae 408 Ringworm - body 28 Impetigo 49 Other skin diseases 267 Eye diseases 76 Ear diseases 55 Miscellaneous lacerations etc. 537 Orthopaedic and postural defects (treated at schools) - B. C. G. Vaccination - Schoolchildren Number of schools visited 24 Number of 13 - year old children offered test. 1,540 Number of consents received 1,560 Number of children tested 1,264 Number of positive reactors 94 Number of children vaccinated 1, 027 Infectious and Other Diseases notified by Schools Disease No. of Notifications Chickenpox 195 Dysentery, Diarrhoea 16 German Measles 71 Glandular Fever 9 Impetigo 39 Influenza ' 8 Jaundice 8 Measles 85 Meningitis 1 Mumps 38 Ophthalmic conjunctivitis 8 Pyrexia 1 Ringworm 37 Scabies 17 Scarlet Fever 31 Tonsillitis 41 Whooping Cough 13 618 (Number notified last year 1,235) 111 TABLE 54 (Cont'd) SCHOOL HEALTH STATISTICS School Dental Service Number of half day sessions devoted to Treatment 3,662. 9 -do- Inspections in Schools 300. 7 -do- Dental Health Education 713. 9 Total; 4, 677.5 Inspections Pupils first inspected at school 18, 012 Pupils first inspected at clinic 6,204 Percentage requiring treatment 62.7 Pupils reinspected 6, 977 Percentage requiring treatment 56. 5 Treatment Sessions (average per session in brackets) New cases attended 7,110 (1.8) On-treatment cases attended 14, 372 (3. 6) Emergencies 794 (0.2) Total attendances: 22,276 Treatment given (average per session in brackets) Fillings in permanent teeth 8,766 (2.2) Fillings in temporary teeth 8,779 (2.2) Extraction of permanent teeth 181 (0.1) Extraction of temporary teeth 1,038 (0.3) Other operations 11,047 (3.0) Orthodontic treatment New cases commenced in year 46 Number of removable appliances fitted 22 Number of fixed appliances fitted 32 112 TABLE 54 (Cont'd) SCHOOL HEALTH STATISTICS Routine Medical Inspections Number of children inspected 12,283 Percentage of total inspected 38.3 Percentage referred for treatment of defects 20.7 Percentage referred for treatment of defects other than vision 11.9 Percentage whose physical condition not satisfactory 0.2 Non-routine Medical Inspections Re-inspections 3, 830 Employment certificates 121 School journeys 1,860 Recuperative holidays - before holiday 180 Boarding Schools for the Delicate before departure 4 Handicapped pupils - statutory examinations 227 - periodic special defect examination 314 Research investigation and enquiries 2 2,708 Specials: at request of Head Teacher - special book 106 - others 477 School Nurse - after health survey 93 - others 136 Divisional Officer (Education) 48 (Welfare) 29 Parent 124 School Medical Officer 78 1,091 All other non-routine inspections (including inspections specifically for provision of free milk) 1,093 8,722 Routine Tests Number of boys tested 5,425 Number of girls tested 4, 825 113 TABLE 55 HEALTH DEPARTMENT ESTABLISHMENTS Particulars of Clinics held and Services provided as at 31st December, 1971 (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, Keep Fit Class, Vaccination and Immunisation. Clinic Centre, 673, Commercial Road, E. 14. Infant Welfare, Occasional Creches, Toddlers, Mothers' Club, Keep Fit Class, Vaccination and Immunisation. Clinic Centre, 1-2 Newmill House, Empson Street, E. 3. Infant Welfare, Toddlers, Dressmaking Class, Mothers' Club and Creche, Vaccination and Immunisation. 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, Vaccination and Immunisation. 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, 32 Riverside Mansions, E. 1. Infant Welfare, Minor Ailments, Family Planning, Vaccination and Immunisation. Clinic Centre, 35, Stepney Green, E. 1. Chiropody, Infant Welfare, Toddlers , Vaccination and Immunisation , Mothers' Club. 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, Family Planning, Vaccination and Immunisation. 114 TABLE 55 (Cont'd) (a) CLINICS AND SCHOOL TREATMENT CENTRES (cont'd) Address Clinics and other activities held Clinic Centre, Tiller Road Baths, E. 14. Infant Welfare, Toddlers, Vaccination and Immunisation. Clinic and School Treatment Centre, Ruston Street, E. 3. Chiropody, Dental, Infant Welfare, Occasional Creches, Toddlers, Vision. Dressmaking, Special Advisory, English Language Class, Speech Therapy, Vaccination and Immunisation. Clinic Centre, 1-2 Wigram House, Wades Place, E. 14. Infant Welfare, Toddlers, Speech Therapy, Chiropody, Vaccination and Immunisation. Clinic and School Treatment Centre, Wellington Way, E. 3. Dental, Infant Welfare, Occasional Creches, Toddlers, Vaccination and Immunisation, G. P. Obstetriciaii, Cervical Cytology, Dressmaking, Family Planning, Cookery Class. Chiropody. Clinic and School Treatment Centre, Underwood Road, E. 1. Audiology, Chiropody, Dental, Infant Welfare, Minor Ailments, Special Investigation, Toddlers, Vaccination and Immunisation, Family Planning, Occasional Creches, School Treatment Centre, 3-4 Phillips House. Coventry Cross, E. 3. Dental, Minor Ailments, Special Investigations, Vision. School Treatment Centre, Bernhard Baron Settlement, Henriques Street, E. 1. Dental, Minor Ailments, Vaccination and Immunisation. 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. 115 TABLE 55 (Cont'd) (b) CHEST CLINICS Days and Times London Chest Hospital, Weekdays (except Tuesdays) 10. 00 a. m. Victoria Park, E. 2. Wednesday 5. 00 p. m. Thursday 2. 30 p. m. Wellington Way, Tuesday and Thursday (Adults) 2. 00 p. m. Bow Road, E. 3. Friday (Adults) 10. 00 a . m. Tuesdays (Working Adults) 5. 30 p. m. Thursdays (Children) 10. 00 a. m. Steels Lane, E. 1. Monday, Tuesday, Wednesday, 10. 00 a. m. Friday (Adults - New Patients) Monday (Adults - Other) 2. 00 p. m. Tuesday, Friday (Adults - Other) 10. 00 a. m. Tuesday (Children) 2. 00 p. m. Thursday (Children) 10. 00 a. m. Tuesday (Working Adults) 5. 00 p. m. (c) MORTUARY Poplar High Street, E. 14. ★ ★★★★★★★★★★★ 116 117 INDEX A Page Nos, Accidental Deaths 10 Accidents in the Home 57 Adoption and Boarding Oirt 25 Analysis of Food and Drug Samples 39,90 Ante—Natal Clinics 25, 80 Anthrax 13 Area of Borough 5 Artificial Kidney Machines 58 B Bacteriological Examination — Food 40 B.C.G. Vaccination 16,67,79 Births 5,9 Blind, Partially Sighted 58 Burials 58,88 c Cancer 13 Cervical Cytology 26, 80 Chest Clinics 17, 115 Chief Public Health Inspector's Report 37 Child Welfare Clinics 80 Chiropody 58,81 Cholera 13 Circulars — Ministry 61 Clean Air 37, 89 Cleansing Station 50,96 Clinic Centres 26 Common Lodging Houses 50 Comparative Statistics 12,73 Conferences and Courses 59, 102^ 108 Congenital Defects 26 118 C (continued) Page Nos. Creches 27 D Deaf Children 67 Deaths 10,71 Dental Services 35,81 Developmental Assessment Clinic 27 Diphtheria 13 Diseases of Animals 43, 89 Diseases — Notifiable 75 Disinfection/Disinfestation 50,96 Dysentery 13 E Educationally Sub—Normal Children 68 Employment of Schoolchildren 67 Environmental Health Services 37 Establishments 113-115 F Factories 49,93 Family Planning 28,83 Fifty Years Ago . 8 Food and Drugs 38 Food Hygiene 38 Food — Imported 38 Food — Unsound 41 Food Poisoning 14 H 5 1 Hairdressers 49 Handicapped Pupils 66 Health Committee 1 Health Education 28,68,82 119 H & 1 (continued) Page Nos. Health Visiting 29,83 Home Bathing 59,84 Home Nursing 30, 84 Hospital Facilities 60 Houses in Multiple Occupation 46 Housing 46,91 Hygiene in Schools 67 Ice—Cream 42 Immunisation 67, 77 Incontinence Pads 31 Infant Mortality 10,72 Infectious Diseases 13, 66, 75, 76 Infective Jaundice 14 Inquests 59 L Laboratory Facilities 60 Laundry Service 30, 84 Lead Pollution 49 Legal Proceedings 49,95 Legislation 60 Licensing Act 1961 . 50 Loan of Nursing Equipment 31, 85 Lodging Houses 50 M Malaria 14 Marie Curie Memorial Foundation 31 Marriages 11 Mass Radiography 16, 79 Maternal Mortality 10 Measles 14, 32 M (continued.) Page Nos. Medical Inspection of Schoolchildren 65 Midwifery 31,86 Milk Supply 41 Minor Ailments Clinics 67, 113, 114 Miscellaneous Services 57 Morbidity 11,76 Mortuary 51,95 N Neo-Natal Mortality 10 New Houses 48,92 Notices serve|i by Public Health Inspectors 101 Nursing Equipment —Loan of 31,85 0 Observation Register 32, 74 Offensive Businesses 51 Office?,Shops and Railway Premises 44, 97 Open Spaces 12,87 Ophthalmia Neonatorum 14 Outwork and Outworkers 52,94, 101 P & Q Partially Hearing Children 67 Partially Sighted Persons 58 Peri—Natal Mortality 10 Personal Health Services 23 Pet Animals Act 52 Pharmacy and Poisons Act 52 Phenylketonuria 33 Poliomyelitis 14,77 Population 7 Post Natal Clinics 80 120 P & Q (continued.) Page Nos. Poultry Processing and Packing 52 Premature Babies 33,83 Principal Nursing Officer's Report 23 Principal School Medical Officer's Report 65 Psittacosis 14 Public Analyst's Quarterly Reports 90 Public Health Inspectors — Visits 89,91, 99, 100 Public Relations 11 Public Transport 11 n Radioactive Substances 62 Rag Flock etc. Act 53 Recuperative Holidays 33 Refreshment Houses 53 Refuse Disposal 53, 101 Removal of Persons in Need of Care 62 Renal Dialysis 58 Rent Act 54 Residential Establishments for Children in Care 33 Road Accidents 72 Rodent Control 54,98 Rub ell a 32 s Scabies 14 Scarlet Fever 15 School Dental Service 68 School Health Service 65, 109-112 Seamen's Lodging Houses 51 Sewerage 54 Slum Clearance 46 121 122 S (continued) Page Nos. Smallpox 15 Social Conditions of the Area 7 Staff 4,62,89 Statistics and Social Conditions 7 Statistics — Summary 5 Students — Training of 63 Swimming Bath 54 T Tuberculosis 16, 78 Typhoid 15 u Underground Rooms 46 Unemployment 12 V Vacant Sites 54 Vaccination 32,67, 77 Venereal Diseases 3, 19 W Water Supply 55 Weather Conditions 13 Welfare Foods 35 Whooping Cough . 16,77 Works in Default 56