WAL 64 London Borough of Waltham Forest REPORT OF THE MEDICAL OFFICER OF HEALTH 1968 Dr. E.W. WRIGHT, m.b., ch., d.p.h. WAL 64 CONTENTS MEMBERS OF THE HEALTH AND WELFARE COMMITTEE DEPARTMENTAL STAFF INTRODUCTION BY MEDICAL OFFICER OF HEALTH THE WORK OF THE DEPARTMENT DURING 1968:Residential Accommodation Day Centres, etc. Clinic Services Transport Field Work Control of Infectious Diseases SPECIAL ARTICLES:- The changing pattern of Childhood Handicaps The Handicapped: Feeding, Toiletting and Washing Offices, Shops and Railway Premises Act, 1963 Medical Research Council - Family Survey Twenty years in Day Nurseries Handsworth Avenue Health Centre CONTRIBUTIONS FROM COLLEAGUES:The Children's Department Water Supplies Rainfall and Sewerage STATISTICAL SECTION LONDON BOROUGH OF WALTHAM FOREST HEALTH AND WELFARE COMMITTEE 1968 - 1969 Chairman: Councillor Mrs. P.K. Williams Vice-Chairman: Councillor G.A.King Members: Alderman W.R. Bishop Mrs. E.V. Pearson Councillor L. Braham R.W. Burlton W.J.C.Dooley Mrs. K.B. Latreilie " N.A.Lyons Mrs. V.L. Maguire F.W.Marshall, J.P. D.T.S. Morris, B.A. Mrs. H.N. Potter W.C. Warren Mrs. E.J. White F.W. Wigg Ex-officio: His Worship the Mayor - Alderman G.S. Mace, J.P. - I - STAFF OF THE HEALTH AND WELFARE DEPARTMENT (at 31.12.1968) Medical Officer of Health and Principal School Medical Officer Deputy Medical Officer of Health Senior Medical Officers Assistant Medical Officers E.Walter Wright, M.B., Ch.B., D.P.H. Geoffrey H.G.Poole, M.B., B.S., D.P.H., D.(Obst.) R.C.O.G. Gwyrieth Richards, L.R.C.P., L.R.C.S., L.R.F.P.S., D.C.H., D.(Obst.) R.C.O.G. F.John Goodey, B.A.(Hons.), M.R.C.S., L.R.C.P. Margaret J.Caton, M.R.C.S., L.R.C.P. Eileen M.Cameron, M.B., Ch.B. Scott Cameron, M.B., Ch.B. Carmel P.Dooley, L.R.C.P. & S.I. *Margaret Edwards, M.B., Ch.B., D.C.H. *Eirwen M.Harrison, M.B., Ch.B-, D.C.H. *Mary D.Humphries, M.B., Ch.B., D.A. D.(Obst.) R.C.O.G. *Jocelyn N.Newman, M.B., Ch.B., D.C.H., D.(Obst.) R.C.O.G. Narishta M.C. Ratnanather, M.B., Ch.B. Joan Whitaker, L.R.C.P., L.R.C.S., L.R.F.P.S., D.(Obst.) R.C.O.G. *( Part-time) Plus sessional Medical Practitioners Psychiatric Adviser - *W.R. Little, M.R.C.P., M.B., B.S., D.P.M. 3 Sessional Psychiatrists; 2 Educational Psychologists; 5 Social Workers Principal Dental Officer - G.P.L.Taylor, L.D.S., R.C.S. 14 Dental Officers (Whple-time equivalent =6.6); 2 Dental Auxiliaries; I Dental Technician Chief Welfare Officer - Birdie A.Warshaw, A.H.A., A.I.S.W., F.W.I. Assistant Welfare Officer - R.Apperley, M.A.P.H.I, Social Work Adviser - Sybil A. Abley, A.A.P.S.W. Senior Social Welfare Officer - L.F. Pyne, Dip.Soc., A.I.S.W. 12 Social Welfare Officers; 7 Trainee Welfare Assistants Chief Public Health Inspector - B.J. Ashcroft, M.A.P.H.I., M.lnst.B.E. Deputy Chief Public Health Inspector - W.Richards, D.P.A., M.A.P.H.I. Senior Public Health Inspectors - J.H.Butler, F.R.S.H., M.A.P.H.I. D.R.King, M.R.S.H., M.A.P.H.I. N.Smith, M.A.P.H.I. 18 Public Health Inspectors (2 posts vacant); 3 Technical Assistants; 5 Pupil Public Health Inspectors. - 2 - Superintendent - Midwifery and District - Elizabeth O'Connor, S.R.N., S.C.M., H.V.Cert., Nursing M.T.D., Q.N. Assistant Superintendents - Winifred Clinton, S.R.N., S.C.M., Q.N. F.P.Griffiths, S.R.N., Q.N. Miriam Kewley, S.R.N., S.C.M., Q.N. Midwifery Tutor - Amy M.Delves, S.R.N., S.C.M., M.T.D., Q.N. Superintendent Health Visitor - E.M. (Anne) Lindsey, S.R.N., S.C.M., H.V.Tutor Cert., R.N.T., Q.N., Dip.Soc., M.A.S.W. Deputy Superintendent Health Visitor - Clare Oldham, S.R.N., S.C.M., H.V.Cert., F.R.S.H., Soc.Sc.Dip. Group Advisers - Annie Churton, S.R.N., S.C.M., H.V.Cert. Evelyn M.Geary, S.R.N., S.C.M., H.V.Cert. 3 Field Work Instructors; 33 Health Visitors; 4 Tuberculosis Visitors; 20 Clinic Nurses; 5 Student Health Visitors Senior Mental Welfare Officer - H.West, S.R.N., R.M.P.A., C.S.W., F.W.I. 5 Mental Welfare Officers Senior Social Worker - R.Dillon, A.A.P.S.W. 2 Social Workers; 2 Trainees Health Education Officer - H.Bradley, M.I.H.E. Chief Chiropodists - R.J.King, M.Ch.S. J.O'Brien, M.Ch.S. Other Staff - 5 Day Nursery Matrons 4 Domestic Help Organisers (plus I Acting) 3 Training Centre Supervisors I Occupation Centre Supervisor Chief Administrative Officer - B.F.Hampson, A.C.C.S. Deputy Chief Administrative Officer - F.J.Aylward Senior Administrative Assistants - R.T.Prudden F.C.Ware 5 Administrative Assistants; 12 Section Officers; I M.O.H's Secretary; I Typing Supervisor; I Liaison Officer; 53 Clerical Assistants; 16 Clinic Clerks; 4 Supernumeraries. - 3 - THE MAYOR, ALDERMEN AND COUNCILLORS OF THE LONDON BOROUGH OF WALTHAM FOREST Madam Mayor, ladies and gentlemen, I have the honour to present my report for the year 1968. The year was dominated for senior staff by two factors. One was the deluge of paper to do with re-organisation, of which the Seebohm Committee's Report, the Ministry of Health Green paper and the department's own Organisation and Methods survey were the most substantial. The hours of work needed to digest and assess these was only a foretaste of the amount of time and effort to be needed for discussing them and assimilating the reports about comments on the reports, reports on those etc. The other was the intensity with which attention focussed on an already present need for economy in the Council's services; this also caused a lot of work, The strains put on senior staff in all the Council's departments caused me some anxiety during the year, as the threat to their health was real, only to be surpassed this current year from a further intensification of the same problem. As regards re-organisation of the Social Services the Government's proposals are still awaited. The proposals with regard to our own department were given much thought and some committee consideration, but the major changes were not possible during 1968. Many minor improvements in procedure have of course been implemented over the last two years, and some of these, often suggested by our own staff, also appear in the M.S.U. proposals. Consideration of the shortage of money has been depressing, but as this report makes clear we have much of which we can be proud and even where, as often, the evident need or the public demand show the service to be inadequate by modern standards, there is no case to undervalue the enormous amount of good work done by the Council's staff. Our despondency should be realistic if real. But facts force an enquiry into priorities. What should the Council's strategy be to promote in Waltham Forest the maximum Health and Welfare of its people? It is at once clear that to thumb through the estimates of the Health and Welfare Committee is far too narrow an approach. There will always be inadequate material resources while attention is focussed on what public funds are not providing. Moreover statutory or organised voluntary services can only be a superstructure. The basic foundation is the extent to which a community cares for itself. First attention should go to the foundations. For the social services to flourish an attempt must be made to slow the enormous migration of borough residents and to stabilise the population. Communities cannot be created by planners, preachers or politicians but primarily by stopping the human stones rolling so that they can gather some moss. Until this happens people are vulnerable to the hazards of life — be they high rents, disablement or hardening of the arteries — and helplessly expect tailor-made solutions from the public purse. The most obvious of the ways of attacking this problem is to make the borough such a nice place that people wish to stay — all people, but with emphasis on the professional classes so important to medical and social work. With regard to the environment I must press for improvements of social convenience and aesthetic appeal with all the vigour that my predecessors pressed for its improvement hygienically, and this for solid reasons of Health and Social Welfare. - 4 - The next approach is to foster all those factors likely to encourage a sense of community responsibility. One of these is the presence of the Christian churches, whose members are motivated by a unique concept of community, and who spell out more clearly than others that they see their vocation as caring for people. In knowledge of this, attempts were made during the year to link the statutory services in a more organised way with the human resources on which the churches can call. The result was the phenomenal growth of the Social Responsibility Centre, set up by the Council of Churches and used as a contact point by the borough's social work staff. It was a most exciting feature of the year and promises great things. A third stabilising factor is the provision of accommodation flexible enough for people to feel no pressure to migrate as their circumstances change — accommodation where self help can flouri sh. One aspect, but only one, of this is the need for warden flatlets for old people. There has been progress with these recently in the Council's planning and practice, for which a handful of old people will have great cause to be grateful, but it remains and will remain for years a blemish on the borough that so many old people have to uproot themselves at a time of life when the ability to adapt is beyond them, to enter an expensive and unfamiliar institution, simply because they could not move earlier to a dwelling of this type. It is not that the Council's programme should be twice as much. It should be five times as much. A fourth factor is transport. It is mistaken nowadays to feel that a community can always be defined on a map. It is vital to improve the mobility of the population — particularly those most isolated by age or handicap — by all means, but particularly by money for transport of all kinds for all sorts of need. It is very expensive, but it is also one of the highest priorities of need. (One does, however, look a little sadly at some costly transport requested to bring special classes of people together from great distances. People of a specific disability for instance would rather have as friends people of the same age and interest, whether able bodied, convalescent from mental illness, or in social or medical need, than all the other people of the same specific disability in the surrounding ten square miles, brought together by an imperceptive community because they are considered to be in the same class. The 'ideal village' is perhaps no more real a concept than the 'noble savage' and all the organisations that do such wonderful work in bringing people together in this classified way are a veritable life line to them, but life lines ought so often to be reaching them from nearer at hand.) The fifth factor I would draw to the Council's attention in its review of priorities is the need for a sense of community amongst the givers of help. Money spent fostering this promotes great economies in the time and effort of the front line workers. Grouping social workers — as the Council is planning with area teams, or Health Visitors, or nurses or, for that matter, family doctors or Ministers of religion makes for economy and efficiency and it is welcome to see these trends in parts of Waltham Forest. How much better still when people of all the varied disciplines form a group identity in the service of an area. The council can do and has done much to foster this as Handsworth Avenue Health Centre, opened during the year, already does, and as St. James Street Health Centre, approved during the year, will do, perhaps even more. It will be seen that much which I have been discussing is in fields already entered by the Council, but it is not always appreciated that these are top priorities to be considered first and given due weight as investments for the future. Only then should one turn to the health and social services in their daily struggle to cope with the present. - 5 - With these the rest of this report is concerned and members will find much to encourage and interest them in the pages that follow, together with food for thought where the Council services are falling short. It remains for me to thank all the staff for this work through the year and particularly for the loyal work of some senior staff who had reason to feel personally anxious and threatened by changes which the Council were, or appeared to be, contemplating. I should also like to thank my colleagues and all the staff of other departments who have co-operated in so friendly a way during the year. Finally may I thank the members of the Counci I committees concerned with the work of the department but particularly the Health and Welfare Committee, with special thanks to the present Mayor, Council lor Mrs.P.K.WiIIiams, whose support, help, and enthusiasm as Chairman in a situation where much was new, was much appreciated, and also to Councillor F.W.Marshall, J.P., Chairman f or the early part of the year. I have the honour to be, Madam Mayor, ladies and gentlemen, Your obedient servant, Waltn Wright Medical Officer of Health - 6 - THE WORK OF THE DEPARTMENT RESIDENTIAL ACCOMMODATION Old People's Homes The pressure on our old people's homes continued to increase resulting in a steady increase in the average age (and consequently infirmity) of those admitted. In particular, Alliston became so loaded with cases of infirmity that designation of this home as one for the more infirm - with staffing to match - was becoming a pressing need by the end of the year. During the year a start was made on the new home (to be called Essex Hall) which will enable Waltham Forest residents at the Willows, a larger former Public Assistance Institution, to return to the borough when it closes in a few months time. This factor, and the increase in the aged in the borough since Essex Hall was planned, will mean that the number of places per thousand elderly population will be only fractionally higher when this new home opens than it was when planned. But it will at least mean that we shall regain the ground we have lost in the meanwhile. Though there are 344 places in our own homes and over a hundred former Waltham Forest residents for whom the borough pays in other homes, the waiting list at the end of the year was 280, of whom 143 women and 40 men were classed as priority. The nine voluntary and private homes in the borough continued to be supervised by our staff. Hostel for the Mentally Subnormal The new hostel for the mentally subnormal did not come into use during the year due to delays beyond our control. Temporary Accommodation Accommodation for homeless families presented a real problem during the year in spite of the two houses (for a total of twelve families) available to us and an enormous amount of help from the Housing Department, and we were never without a number of families at the unsatisfactory hostel at Suttons in Hornchurch. This rise in need for temporary accommodation is general throughout London and in fact we admitted less than the average number per 1,000 population admitted by the outer London Boroughs, this latter figure being one quarter of that for Inner London. Not admitting families is very hard work. We shall be glad when the opening of Cecil House allows us to get down to two premises only without the use of Suttons, but the increasing pressure on the staff dealing with this problem will need attention when opportunity allows. Highams House This house, run by the Richmond Fellowship for the rehabilitation of the mentally ill, works very closely indeed with this authority which did a great deal in the early days to get the scheme launched. It also works closely with Claybury Hospital, and Dr.Pippard, the Psychiatrist there who works most closely with Waltham Forest, is the Consultant Psychiatrist for the House. During the year the authority was responsible for the maintenance of a total of 19 patients. Our original grant of £100 per annum was reviewed in November and was raised to £200 per annum. The fees for maintenance also went up from 14 gns to 16 gns per week. A number of rooms, including bedrooms and the dining room, were completely redecorated and some new furniture was purchased by the community, which replaced some of the original furniture which had been given as gifts. - 7 - DAY CENTRES Day Nurseries The pressure on these continues to build up also, for whereas Chingford Day Nursery could take a few non-priority cases in the early days of the borough, it now has a waiting list and in the south of the borough the waiting list of priority cases would fill two complete day nurseries at once. A somersault in Government policy caught us badly here. We had a day nursery in our capital programme, for the need was evident, but it was also evident from discussions with the Ministry staff that loan sanction for a new day nursery was extremely unlikely. In these circumstances, in order to plan a capital programme realistically, the day nursery was omitted to make a place from the limited capital available for projects where loan sanction was likely. Then the Government announced the Urban Programme to encourage, inter alia, day nurseries in areas of housing stress. The south of the borough most certainly is one of these and it is to be hoped that this can be remedied in the future. Child Minding and Playgroups Nursery schools are also needed and will benefit children, but they are not a realistic answer where the main need is for child minding to allow the mother, from social need, to go to work or to be admitted to hospital. Of course there is much child minding in the private sector. Greater numerically are the children in playgroups - also supervised by our staff. There has been a great increase in this. The position at 31st December was as follows:- 1968 1964 Registered child minders 19 13 No. of children cared for 114 94 Registered Play Group Premises 36 6 No. of children permitted 1,120 182 As from 1st November, 1968 the Health Services and Public Health Act, 1968 extended the provision of the Nursery and Child Minders Regulation Act, 1948 to require any person (not being a relative) who minds a child for reward for two hours or more a day to be registered with the local authority. Under previous legislation registration was required only where three or more children were being minded. The Health Visiting staff had for the latter part of the year been compiling lists of persons known or suspected of looking after one or two children. Approximately 170 such persons were circulated, informing them of the new legislation and giving details of the required standard for child minding. The response was in fact quite poor, only 33 replies having been received by the end of the year. Those who did not reply will be re-circulated early in the New Year. Posters and leaflets (with translations in Hindu and Urdu) were printed and distributed in early January, 1969 in conjunction with notices in the local press, and a much greater response was achieved. By 25th January, 103 applications for registration were received and three or four requests are being received daily at the time of writing. Junior Training Centre During the year the Prime Minister announced that Junior Training Centres were to be transferred to Education Departments at an indefinite time in the future when the problems involved are solved. This is no less than social justice which Medical Officers of Health generally support. The problems are tricky ones involving, amongst other things, the future of the staff and the role of the Mental Welfare Officers. - 8 - During 1968 our Junior Training Centre had a varied programme in spite of the highest staff absence through sickness ever, the Centre only being fully staffed for three weeks out of 43. Four students came from the Training Council for six weeks practical training and all passed their assessment examinations on their work with us. Also 121 students visited in groups for half or one day observation periods. Outings - All the children and staff went to Shoeburyness for one day during July, the weather was fine and a good time was had by all. Three "mystery" afternoon coach tours were also enjoyed by a majority of the children and staff. Holiday excursions by bus and tube for the benefit of the experience were made and, except for the very young children, a lot of fine weather time was spent in the park and forest near to the Centre. Nineteen children, including several with multiple handicaps, and five escorts had a happy holiday of one week at Winterton-on-Sea, Norfolk, in September. Exhibitions - During what must have been the wettest June week ever recorded, there was an exhibition of the children's artwork and handwork at the public library in Church Lane, Leytonstone, which approximately 600 people visited. A successful climax to the week was the showing of the film of the Borough's Health and Welfare Service in action. Parents9 Afternoons - From the 14th March, 1968, a series of Parents' afternoons was arranged. Four or five parents, whose children attend the Centre, and two or three parents whose children for various reasons are not yet able to attend the Centre, received invitations to visit the Centre for a cup of tea and to talk over their ideas and problems. Dr.Richards advised upon medical and related matters. Mrs.Knight dealt with educational and training queries. These sessions proved valuable to all participants. Entertainments - Three parties were indulged in - one during the Spring term because everyone felt like it, one to end the summer term and the third at Christmas. Throughout the year five film shows were given. The films shown were those taken at the Centre and on outings. The four student teachers gave a puppet show for the children - twice - by popular demand and, although both occasions were hilarious and several children actually wet themselves through laughing, the effort everyone put into the venture was well worthwhile. Work on the new Junior Centre in Hoe Street started during the year. Adult Training Centres On April 1st, 1968, the Birkbeck Adult Training Centre had 102 trainees (64 boys and 38 girls) and Queens Road had 54. During the year one boy and one girl started work from Birkbeck and are still working. Three Essex trainees transferred to the Loughton Centre and five Redbridge trainees transferred to the Redbridge Centre. Two others left and also four left the Queens Road Centre which however took in eight more during the year, finishing the year with 36 boys and 22 girls. During the year they have carried on their high standard of work and have received many orders in their handicraft workrooms and carried out a steady flow of work for local factories. Queens Road report a marked increase in output. In September, 26 trainees and five staff from the two centres went to Dymchurch Holiday Camp for a week from which the trainees received great benefit and their parents a welcome break. An outing to Maiden from Birkbeck for the day and outings to Shoeburyness and High Beach from Queens Road were a great success. - 9 - Queens Road trainees have also been visiting local places of interest including Vestry House Museum and Queen Elizabeth Museum, Chingford. In September a variety of articles were entered in Waltham Forest Exhibition for Handicapped Persons and again won many 1st, 2nd and 3rd prizes. In February all Birkbeck trainees went to the Wembley Ice Show to their delight. During this year Birkbeck have been a party in starting a football league and cup competitions amongst Training Centres in Essex and also took part in an Athletics competition between Enfield, Haringey and Waltham Forest which they won. In the latter part of the year they have started an afternoon for games, hobbies and outings. This has greatly improved the social side of the Centre, helping the trainees to mix better and become more self-reliant. Perhaps the most significant event of the year was the return of Mr.R.Gum from his successful year on the Ministry of Health's Diploma Course and so becoming the first member of the staff to have this training. This has allowed him to start regular Education classes and also to give great help to our trainee instructors to learn more of this side of the work before they go on their Diploma Course next September. At Queens Road there was Mrs.Goodhand who is a Montessori trained teacher and was invaluable, and who has now gone for training for the Diploma. Work Centre for the Physically Handicapped For Roberts Hall it has been a year of change, starting the year as an Occupation Centre. Many handcrafts are taught and there is a great demand for coffee tables, draughts and chess inlaid tables, garden seats, bath mats, cosies, knitting, jewellery and other goods. But the old traditional crafts with which the market is flooded are being replaced by new skills to attract more purchasers. Many walking aids and carrying aids, bath seats and other appliances are produced at this Centre. The success of the new Workshop for Industrial Activities has been a joy to watch. The workers are grouped in teams, each one to perform that part of the assembly within his or her capabilities. The support of the local factories in supplying work is appreciated but we known the partnership between us would not be continued if they were not satisfied with the work turned out. There is also the social side with this year a visit to the Kingfisher Pool for dinner and cabaret and the Christmas festivities. And so into the new year with a new title - The Roberts Hall Work Centre. The Alice Burrell Centre This day centre for the elderly continues to flourish. The dining room is filled for lunch every day and is used by clubs every afternoon and most evenings. Darts, billiards and other pastime activities are run by the old people themselves. They have access to a small kitchen where they can make their own tea if they want it. The large comfortable lounge and T.V. room is always occupied. Luncheon Clubs and Meals-onWheels The six luncheon clubs, including the Alice Burrell Centre referred to above, continue to flourish and the meals-on-wheels kitchen is working over capacity. The W.R.V.S. continue valiantly, and with our appreciation, to supply the Chingford area with meals-on-wheels and the Borough's own kitchens supply Walthamstow and Leyton areas. In addition, these kitchens provide meals not only to the luncheon clubs, but also to the work centre for the physically handicapped and training centres for the mentally handicapped and mentally ill. - 10 - Psychiatric Rehabiitation Association During 1968, the second year of the P.R.A's existence in the Borough, the number of patients referred increased by 50%. The group also changed its premises and is now installed downstairs instead of upstairs at the Fillebrook Baptist Church Hall. A holiday was arranged by the Superintendent for members and five people went to St. Leonards, Sussex, for one week. This proved most successful and a similar venture is to be undertaken in 1969. The most significant change which took place during the year was the setting up of the sheltered employment scheme by which members still in receipt of supplementary benefit are gradually drawn into open industry. This scheme was started in November, originally with three members; one worked only one week, one for two weeks and one continued working, then becoming a full time employee of the local firm concerned. The scheme is still in the pilot stage and it is hoped to encourage other local firms to participate. "Play" Group for the severely subnormal There were relatively few changes during 1968 in the play groups which are run by the Waltham Forest & District Society for Mentally Handicapped Children. The groups are still held at Granleigh Road Clinic and Hurst Road Health Centre on two mornings each week. The transport costs increased slightly. During the year there were more children referred suffering from multiple handicaps. Frequent visits were made to the play groups by health visitors, student health visitors, trainees from our own training centres and day nurseries, together with staff from Claybury Hospital. They are staffed by volunteers and for one morning a week they look after severely subnormal children who cannot attend our own centre because they are too young, too incapable or in some other way more than our present facilities can cope with. It is a wonderful service to the parents. It is also a service the local authority should provide and illustrates one of the reasons why a new Junior Centre is being built to replace the existing one. Needless to say, children who are too difficult for our centres are a more than usually heavy burden on parents, and these are the very parents to whom the State refuses even the ordinary help that other parents get. CLINIC SERVICES Dental Services We began the year with a crisis in the School Dental Service due to a shortage of dentists, and were driven to abandon the dental service entirely in most secondary schools in order to concentrate on the more essential primary school children - leaving the others to go to the N.H.S. dentists. However, the position gradually improved during the year and by the end of the year we were gradually taking on the secondary schools again as circumstances permitted until virtually the full service had been re-established. Chiropody The Chiropodists kept up their valuable service (the motto of their Society ".Post Curam Otium" or roughly "Relief after treatment" means much more than that to many. It may well mean mobility, the loss of which is the first step to isolation with all its problems). Apart from work with the aged, where the chiropodists forms one of our team of staff, school children can also be referred via their own doctor or the school medical service or their parents, the appointments usually being made via the school secretary. The recent Schools Careers Exhibition held last December was manned by Council staff in conjunction with the - 11 - Society of Chiropodists, and some hundreds of children were talked to, and had their questions answered. This was not only an opportunity to recruit future chiropodists but also a useful educational exercise. Chiropody charges were revised by the Health and Welfare Committee as from 1st April, 1968. The charge was increased from 2/6d to 7/6d after approximately 20 years of increasing costs, without a related increase in the charges. The charge was subject to reduction, or free treatment could be given, in accordance with the Council scale of assessment, Scale A. At the Health and Welfare Committee of 4th December, 1968, the matter was reconsidered in the light of criticisms of the assessment scale for chiropody and further increases in costs. The Committee revised the charge to l2/6d per treatment, with a charge of 2/6d for pensioners and free treatment for those in receipt of supplementary benefit. Assessment scales will no longer be applied. The increased charges were greeted with widespread criticism even in the press, but it is now an equitable scheme and there is general acceptance. Audiology Clinic Our Audiology Clinic continued to struggle against formidable difficulties during the year with Dr.Harrison providing an excellent service insofar as delays and shortage in the provision of equipment allowed and, with a virtual impasse at the Regional Hospital Board preventing the appointment of the Consultant which the clinic requires --as everyone accepts. Some degree of expansion was achieved by Dr.Harrison before unfortunately she herself had to take sick leave. It is to be hoped that she will be able to return before long and we can renew our efforts to make this clinic the fine thing it was supposed to be, serving not only Waltham Forest but surrounding boroughs and parts of Essex. Family Planning Prior to the National Health Service (Family Planning) Act of 1967, this Authority already had an arrangement with the Family Planning Association whereby clinic premises were provided free for five evening sessions a week, financial responsibility was accepted for a proportion of the rent of the Association's local office and fees and supplies were paid for in respect of previously agreed domiciliary and medical or special grounds cases. The 1967 Act extended the powers of Local Authorities to enable them to provide advice on family planning to both the married and the unmarried on social grounds and not as previously only for medical cases. The Minister held the view that no charge whatsoever should be made for medical cases, but that a charge could properly be made for prescriptions and supply in non-medical cases, but not for advice and examination. Protracted discussions followed between representatives of the London Boroughs Association but wide divergences of opinion precluded any general agreement, and it was left to individual boroughs to make their own arrangements with the Family Planning Association. On the 4th September, 1968 the Committee agreed to accept financial responsibility for partial implementation of the Act. The previous arrangements with the Association were continued and, in addition, financial responsibility was accepted in respect of cases on medical grounds, and also increased fees in respect of previously agrred domiciliary cases which would be adequate fully to cover the Association's costs. - 12 - TRANSPORT Clubs Voluntary organisations run social clubs for the elderly, the blind, the deaf and the physically handicapped, and voluntary helpers who are responsible for them are dedicated people. Meetings are held at various times ranging from several times a week to once a fortnight. Transport, or lack of it, again rears its head. There is not sufficient to take all those requiring to attend these meetings. The club organisers arrange various activities including whist drives, bingo, concert parties and outings. They arrange to visit their members who are sick and keep in touch with those who cannot attend often. The cost of all this, for transport is a costly business, is beyond the means of most voluntary organisations and it is natural that the local authority should be approached expectantly for help. It is then seen that the local authority is having its own problems. It is desirable that more physically handicapped people should go to Roberts Hall, more meals-onwheels be delivered, old people brought to centres for food, fellowship and attention. Those that are least mobile are most deprived of the very things that a caring community would like to make available, by far the most important being human company. That Health and Welfare presents a sizeable bill for its mobility is undoubted. Nevertheless progress implies that this factor of all must grow if the service is to keep pace with public expectations. FIELD WORK Public Health Inspectorate Much of the work of the Public Health Inspectorate is accomplished by persuasive informal measures rather than by punitive powers. Broadly the function of a Public Health Inspector is to secure compliance on the part of the public with an ever increasing number of Acts, Orders and Regulations designed to protect the health, welfare and safety of the community. I say to "secure compliance" rather than to "enforce" because whilst enforcement by process of law is the ultimate remedy, compliance is in fact increasingly secured by advice, persuasion and education. The Inspector has also unrivalled opportunities for effective health education by demonstrating on the spot how the principles and practices of environmental hygiene should be observed and pointing out faulty habits and practices as they occur. Food and Drugs - In a highly organised industrial society the preparation, processing and distribution of food become increasingly complicated. The Public Health Inspectorate is concerned with the problems of the fitness of food for human consumption; chemical, bacteriological and organoleptic quality; production and processing methods, packaging and food storage techniques, construction and equipment of food premises and trading methods, including distribution, display and stock rotation problems. Housing: Multiple Occupation --The objects of a survey undertaken during the year was to obtain a broad assessment of the problems of multiple occupation of houses in the borough and the extent to which immigrants from the Commonwealth are involved. Separate records of the time spent by staff visiting immigrants were kept in order to assess the degree to which differences of language and customs in any particular situation affected the service and to enable the Council to give consideration to the question of claiming grant under Section II of the Local Government Act, 1966 in accordance with the provisions of Home Office Circular No. 15/1967. - 13 - The most serious and potentially dangerous conditions arising from multiple occupation are to be found in the larger three or more storied type of property and in houses occupied by immigrants. But this is a generalisation which must not be taken too literally. Fire hazard is particularly associated with immigrants irrespective of the size of the house in which they live and it is also known that there are many serious cases of multiple occupation in two storied property. It was decided to concentrate on these aspects of the problem and to initiate action on the important question of means of escape in case of fire and of fireproofing. The findings of the survey confirmed that multiple occupation and immigrants present the Department with a formidable problem which will obviously get progressively worse. A conservative estimate of the number of houses in multiple occupation in the borough would be in the region of 8,000, of which 2,000 are likely to be of the type of multiple occupation envisaged by the Ministry of Housing and Local Government in the proposals for legislation outlined in the White Paper "Old Houses into New Homes" (Cmnd.3602). The co-ordinated measures required to deal with this aspect of the housing situation is in accord with current housing problem which places emphasis on repair, renovation and improvement of the existing housing stock rather than on wholesale demolition and redevelopment. As such it demands equal priority of thought and action. To overtake arrears of cases of multiple occupation revealed by the survey and requiring detailed investigation, to keep abreast of new cases arising and to pursue a rigorous follow-up procedure would require the full time services, for an indefinite period, of at least four additional Inspectors. Slum Clearance Redevelopment - A Public Inquiry in respect of Stage I of the Acacia Road Area was held on the 3rd April, 1968, and confirmed with modifications by the Minister of Housing and Local Government on Nth October, 1968. This area consists of 11 clearance areas and added lands sited on 3.79 acres. Stage II of the Acacia Road Area was officially represented to the Council on the 6th February, 1968 and a Public Inquiry was conducted by the Ministry of Housing and Local Government on the 30th October, 1968. The result is awaited. This area consists of eight clearance areas and added lands sited on 2.95 acres. Individual Unfit Properties - Having regard to the extent of repairs necessary and anticipated life of the properties concerned, 47 council owned dwellings and 2 part dwellings were certified as being unfit and not repairable at reasonable expense. Four houses and ten parts of houses were reported to the Housing Committee as being unfit and not capable at a reasonable expense of being rendered fit and the Housing Committee authorised procedure under Section 16 of the Housing Act, 1957. Five Closing Orders were made during the year and ten Undertakings were accepted by the Council in lieu of Closing Orders. In two instances extensive works were undertaken by the owners and one Closing Order was cancelled and one Undertaking determined. Basement Accommodation - A register of basements/underground rooms within the borough was compiled during the year. 235 visits were made to 188 underground rooms and the conditions in nine instances were reported to the Housing Committee. Whilst a number of the remaining basements do not fully comply with the Underground Room Regulations the degree of deficiency does not warrant closure procedure and subsequent loss of housing accommodation. - 14 - The register of this class of property will facilitate re-inspections and enable any further deterioration in their standard to be noted. Clean Air - The phased programme of Smoke Control continues to make satisfactory progress with the making of two more Smoke Control Orders during the year. This brings the total number of Orders to 23 comprising 59,198 premises and covering 6,567 acres - about 65% of the borough. Other measures taken to mitigate air pollution included approval of new factory furnaces and chimney heights, inspection of existing boiler installations and discussions with engineering and managerial staff. The Department continues to co-operate with the Ministry of Technology in a national survey of air pollution; concentrations of smoke and sulphur dioxide are measured by apparatus installed at three selective sites. Clean Air legislation and more especially the powers enabling local authorities to establish smoke control areas is achieving spectacular results. Outside London smoke had decreased by 25% since 1958/59 and in London concentrations have been reduced by 66% since 1956. Mental Health Social Workers The Mental Health Service has developed considerably during the last year. Many more after care referrals have been received, social workers have been under additional stress, carrying out responsibilities for 15 to 30 families suffering from psychiatric illness, together with subnormal lists of 80 plus and there is always much informal interchange concerned with planning and evaluating the work with families. More formal assessment takes place in individual supervision sessions or in group casework discussions. The Psychiatric Rehabilitation Association has been a great help in the after care of patients discharged from hospitals. New premises have been opened and we are expecting to accommodate many more patients and rehabilitate them back to a normal way of life. This has been one of our greatest assets in 1968. Also in 1968, with the help of Drs. Lynch and McGibben, we have started a subnormal assessment clinic at the Mental Health Department. This has been a great success and many more admissions have been secured, resulting from this clinic. Also the parents now feel more supported and know they can see a Consultant and have their children diagnosed early. Two Psychiatric and one Subnormal Clinic are now held at the Mental Health Department. We are continually supported by the local Society for Mentally Handicapped Children, who run special care unit groups under the direction of Mrs.Sowerby. When asked this Association never fails to give assistance to enable this department to overcome its many problems. The Social Responsibility Centre is also foremost in their endeavours to assist us in our after care difficulties. Both of these agencies are first class. The staff continue to give excellent support to the Training Centres with whom we have excellent liaison. Dr.Denham of St.Clement's Hospital has given this department valuable assistance with the few, but rapidly increasing, drug cases. Social Welfare Officers Problem and Homeless Families - This subject is expanded below under Health Visiting as it is very much a team effort, but it should be noted here how very much work Social Welfare Officers are involved in in emergencies and in the rehabilitation of those who come into our Homeless Families Hostels. The hardest work of all is in the category whcih - 15 - is undemonstrable - finding other answers for those who present as homeless, but for whom the hostel is the wrong answer. These are the great majority. Handcraft Classes for the Blind - Classes are run by the social workers for the blind who teach various crafts by means of touch. The finished articles are of high standard and great credit is due to the teachers and to the blind workers for their patience and diligence. Craft Teaching at Home - Those who wish to do handcrafts but cannot attend classes or the Centre through lack of transport or physical disability, receive tuition at home from craft instructors. Several sighted handicapped have been taught dressmaking and they are actively engaged in making dresses for incontinent elderly ladies living in the Council's Homes and for those living at home. They receive payment for their labours. Everyone producing saleable craft work receives some remuneration. Aids and Adaptations - The provision of aids has covered very nearly the entire range, from walking aids to dressing, feeding and recreational aids. Lifting hoists issued aid the family in caring for their handicapped member and stair lifts installed allow the disabled person to take himself upstairs. Provision of downstairs toilets and bathrooms, ramps, rails on walls and wider doorways are some of the adaptations carried out. Holidays - Approximately 342 holiday places for the blind and physically handicapped and their helpers at holiday camps and guest houses were arranged during the year. Because of the demand upon this service holidays may be provided two years running but not the third year unless there are special circumstances necessitating its provision each year. Every case is considered on its merits. Health Visitors Health Visitors themselves base their involvement with any form of family service on the impossibility of divorcing personal health and personal welfare. Their conception of health as physical, mental and social well-being inevitably necessitates their constant involvement in and co-operation with all forms of social service to the family. During the year their wide involvement continued, though as always heavily weighted on the side of mothers and children. The demands that are made on them to deal with old people are great and they do their best particularly in crisis situations to be of service. The number of visits to old people achieved in these circumstances is much to their credit. There has been a large increase in the Health Visitors' work towards the prevention of a possible break-up of many families within the borough. Close liaison with the Housing Department by early notification of rent arrears of all families with children up to school leaving age, each year necessitates an increasing number of special follow-up visits. Frequent supervision and supportive action is essential, often necessitating much evening work to encompass the whole family. A large number of families respond to this extra surveillance. Where several social agencies are involved, cases are referred to the Co-ordinating Committee. Under the chairmanship of the Medical Officer of Health representatives of both statutory and voluntary departments meet monthly to decide (a) who is to be the keyworker, to avoid overlapping of duties, (b) the most efficacious approach - to benefit both client and Council. It is of interest to note that from hundreds of cases investigated only a few families had finally to be evicted. - 16 - COUNCIL PROPERTY Year Notifications to H.Vs for Investigation Discussed at Co-ordinating Committee Admitted to Temporary Accommodation Admitted to Temporary Accommodation from Non-Council Dwellings 1966 186 233 3 16 1967 468 180 0 24 1968 717 (*176) 150 (*33) 3 29 TOTAL 1,371 563 6 69 *Tower Blocks Thanks are due to the Housing Manager and his staff for the amount of co-operation received. Reference was made under child minding to the great increase in this field - a substantial burden to be added to the Health Visitor's already heavy load. District Nursing During the year the main event affecting the District Nursing Service was the transfer of the Training School from the former Lady Rayleigh Nurses Home to the Leyton Municipal Offices. At the same time, due to the contraction in the amount of district nurse training required because of other schools setting up elsewhere, the question arose as to whether the North East Region of London was over-provided with district nurse training schools, there being another relatively newly formed in Newham. Negotiations were opened with the Borough of Newham with a view to seeing how far we might make common use of our facilities. The policy of attaching district nurses in groups to general practitioners moved forward slowly and it is to be hoped that by the middle of 1969 all general practitioners in the borough will be served in this way. This is a method of working which is much more efficient as the district nurse gets to know the relatively small number of general practitioners with whom she is working and this saves an enormous amount of time in trying to contact the doctor when she wants further instructions with regard to any patient. The general practitioners also find it a much more satisfactory service for the same reason. To some it comes as a novel idea and for them a period of assessment must be expected, but for those who are settled in this way of working it is such a great improvement that a return to the old system of working districts, where each nurse might have 30 or more general practitioners, is not to be contemplated. CONTROL OF INFECTIOUS DISEASES The outstanding event of this aspect of the work of the department during 1968 was the introduction of measles vaccine in May; 2,056 children were given the protection during the remainder of the year, 1,041 by family doctors and 1,015 at our own clinics. Had the disease followed its established pattern of biennial epidemics we should have expected an average of about 200 notifications a week during December - in fact the average was nine and this can only have been due to the greater number of immune children in the susceptible age groups. Research is currently being undertaken to produce a similar vaccine against German Measles. - 17 - During the year 598 (2,615) cases of measles were notified, whooping cough cases fell from (276) to 126 and scarlet fever from (155) to 79. Other infectious diseases followed the trend of fluctuating decline; the only important exception being tuberculosis which increased to 88 (77). (Note: Figures for 1967 given in brackets.) Once again this figure was inflated by the exceptionally high incidence among immigrants, figures for recent years being as follows:- Country of Origin 1965 1966 1967 1968 R. N.R. R. N.R. R. N.R. R. N.R. Pakistan 12 3 10 4 14 6 18 7 West Indies 3 1 1 - 1 - - - Hungary 1 - - - - - - - China - - 2 2 4 - 1 India - - 1 - - - - - Cyprus - - 1 - - - - - Others - - 5 - 1 - - 1 RESPIRATORY NON-RESPIRATORY 17 4 19 6 20 6 19 10 TOTAL FOR BOROUGH 94 17 79 11 67 10 66 22 PERCENTAGE IMMIGRANT CASES R. AND N.R. 18% 27.7% 34% 33% Present estimate of immigrant population: 19,784 Approximately 8/2% of total. Tuberculosis is not only much more prevalent among immigrants but also much more difficult to control, throwing a disproportionate work load on the Chest Clinic at Whipps Cross as well as on our own staff. Tracing and control of contacts is made more difficult by the frequent migration of new arrivals and their failure to leave a forwarding address; lack of a common language adds a further complication. Three cases of typhoid fever were notified; one a Pakistani boy aged 9 in Whipps Cross Hospital, a West Indian lady aged 43 confined in Thorpe Coombe Hospital and another Pakistani boy of 8 diagnosed at home by the family doctor. All were transferred to St. Ann's Hospital and bacteriological confirmation of the first and third cases obtained. Immediate precautions, disinfection of premises and surveillance of contacts were instituted and once again we were able to avoid any spread of the disease. Besides these cases occurring within the borough a large number of contacts of cases notified elsewhere had to be traced and supervised. Unquestionably the disease with the greatest nuisance value encountered this year was again Sonne dysentery. As usual the disease first showed itself among small children, 28 cases occurring in connection with a private day nursery and a further 10 at the Epsom Road Day Nursery. Three primary schools (infant and junior departments) all had small outbreaks - Mayville, 9 cases, Downsell 10 and Davies Lane, 15 while a rather larger outbreak occurred at George Tomlinson School (Infants) where 14 children and 16 family contacts - 18 - developed the disease. Although rarely serious, this mild form of dysentery i s most difficult to control. Treatment with antibiotics has little effect except in the early acute phase and may even prolong the period during which the patient, though clinically recovered, continues to carry the germs. Often the patients, or their symptomless contacts, remain infectious for months and have to be excluded from work in some occupations, e.g. food handlers. The germs can survive for long periods outside the body, even in extremes of temperature. Young children are especially susceptible but all age groups are vulnerable and recovery does not appear to confer any immunity; reinfection within the school or family circle is common. Spread from the bowel, the best defence against dysentery is the maintenance of the highest standards of personal hygiene. Modern water closets with adequate and adjacent washing facilities (hot and cold water, soap and paper towels) should be provided in all school lavatories and, in infant schools, adult supervision to ensure that they are properly used. Lids should be fitted and lowered before flushing which otherwise fills the air of the lavatory with a spray of infected water droplets. Gradual renovation and improvement in toilet facilities and training should help to eliminate this troublesome infection which accounted for a large proportion of almost 3,000 visits made by the Deputy Medical Officer of Health and/or Infectious Diseases Nurse during the year and of the 1,502 specimens submitted to the laboratory. An event of great epidemiological interest was the world-wide spread of an influenza epidemic due to a variant of the Type A influenza virus christened "Hong Kong 68" after its source of identification. Alternatively known as "Mao flu" the epidemic, like the "Asian flu" of 1959, spread from China to all parts of the world. A vaccine was available giving a fair degree of protection for a limited time but it was decided to advise against general use in Waltham Forest and only a few doses were purchased (approximately 10/-per dose) for certain key personnel. A close watch was kept on the track of the epidemic and the local offices of the Ministry of Social Security co-operated in giving weekly returns of all new sickness claims. Events proved our estimation correct and no serious outbreak occurred in Waltham Forest. - 19 - THE CHANGING PATTERN OF CHILDHOOD HANDICAPS With increasing knowledge, facilities, discovery of new drugs and a higher standard of living, the types of handicapped children have become modified during the past 10 to 20 years. Surgery for hydrocephaly and spina bifida in early infancy has meant that the majority born alive live to adult life, many with no disabling handicap and fewer with severe physical and mental handicaps. Without surgery many used to die and many of the now more fortunate ones were left extremely handicapped. Early diagnosis of deafness has mea'nt provision of a hearing aid and the child being taught to use the hearing which is present and made useful by the aid and to speak well in early childhood. Instead then of attending "Schools for the Deaf", the majority are able to attend ordinary schools or units for the partially deaf in ordinary schools and (even fewer) the schools for the partially deaf. Mainly children with dual handicaps are now needing admission to the schools for the deaf. Prevention of eye infection and treatment of various eye conditions by medication and by surgery has resulted in fewer "blind" children and some, as a result of treatment, transfer to "partially sighted" schools from blind schools or to ordinary schools from schools for the partially sighted. At one time, children who had had rheumatic fever, tuberculosis or poliomyelitis or had asthma or epilepsy needed special help and special facilities. Now, with preventive care and suitable medication these children live normal active and healthy lives; these children now survive illnesses where previously death would have been immediate. Malignant tumours treated surgically and with radiotherapy, severe accidents on the road and in the home were previously fatal but now life is saved and, although some make complete recoveries, some are left severely handicapped for the rest of their life. Heart surgery has prolonged the life of many children and enabled some to live a normal life. Orthopaedic surgery, physiotherapy and abdominal surgery have enabled children to live normal lives and to be far less handicapped than previously. Some children require help from specialists in all spheres to enable them to attain as much normality as possible. Severely handicapped children are now of course less likely to die and children who are very severely retarded, and who would previously have died at a very early age, now live on to adult life, becoming larger and more difficult to lift until they finally require hospital care for the rest of their life. To balance that there is the progressive help given in Junior and Senior Training Centres to children who were at one time institutionalised or hidden away at home. Instead they develop into well socialised, happy and pleasant individuals, able to do easy and repetitive work in adult life and make most use of their limited abilities. They are less likely to cause embarassment when taken out than too many "normal" adolescents. Increased facilities now provided for the ante-natal and peri-natal period, the easily attainable expert advice on infant rearing, day nursery care for children in priority categories and closer supervision of people who daily mind the children of others provide, although unfortunately in only limited cases, the necessary company of other children and stable adults so necessary in the formative years. G.Richards Senior Medical Officer for Child Care - 20 - THE HANDICAPPED - FEEDING, TOILETTING AND WASHING Introduction Any disablement slows down activity, not the least of limitations being caused by the length of time it takes a handicapped person to perform the simplest tasks. The family will often step in and act for him in order to save their time thus denying him the satisfaction of personal accomplishment. The handicapped are often in rebellion against the fate which prevents them from doing everything for themselves and as they want it done, and the families often resent the tie they are upon their time and energies. Rebellion and resentment are not always on the surface but manifest themselves in overprotection or rejection, in dissatisfaction or acquiescence. Feeding It will be seen, therefore, that a disabled person in the house will slow the tempo of living for the family if they are to include him in their activities. At meal times, for example, a blind person has to be told where the various foods are - nine o'clock potatoes; six o'clock meat; three o'clock carrots; and if he has not learned to cut up his own food this has to be done for him. A one-handed person, perhaps having suffered a stroke, will take longer to get the food into his mouth because of the difficulties in getting it on to his fork. There are several causes for difficulty in feeding oneself normally, such as loss of control of steady hand movements, fingers which will not grip, loss of feeling (touch), loss of sensation of position, inability to bring the hand towards the mouth, inability to bend the elbow or move the shoulder joint, loss of mobility in thecervical spine. Feeding utensils can be of the "standing" type which do not have to be lifted, i.e. a polythene tube in a cup or beaker, or the raised tilting container held in a swivel bracket on side supports which tilts as the lips press on it and which regains its upright position when the lips no longer touch it. The feeding cup with its spout, the Doidy cup which is fashioned to slope towards the mouth, the perforated lid on a cup which prevents spilling and the two handed cup (soup bowl) are aids to drinking which have to be held and which help to overcome the difficulties which those with weak hands experience in using ordinary drinking receptacles. Where only one hand can be used, cutting the food on the plate presents the feeder with some embarrassment unless an aid can be obtained to meet the particular need. The curved pronged type of cheese knife known as the "Nelson" knife will break through the fibres with pressure on the curved part of the blade, and by turning the handle round in the hand the "prongs" spear the food which can then be carried to the mouth. As the prongs and the sharp curve are on opposite sides of the blade it is impossible for the feeder to cut himself. The scissor-knife has prongs at which would normally be the pointed ends of the scissors. Meat and other foods are cut with the scissors and then conveyed to the mouth on the prongs. Counter-balanced spoon-bowls and weights on handles at right angles to the bowl enable liquids to be lifted without spilling. Long handles, fat handles, bent handles, are some of the many modifications which have to be made to feeding utensils. Plate bunkers to clip on to the rim of a plate and stand up at right angles to the plate, are available in plastic or stainless steel and prevent food being pushed off the plate on to the table. Double suckers fixed under the bottom of the plate will prevent it sliding across the table as a one-handed attempt is made to grapple with recalcitrant food which will not go on to the fork or in to the spoon. There are many more aids available to help with feeding but the process is slower than if two able hands and arms were available. Eating is a personal activity and it is extremely frustrating to be forced to depend upon another's help. Toiletting About a thousand times a year one needs to use the toilet and a handicapped person who has not become independent needs to ask this number of times for help in lifting and lowering on to and off the chair and the toilet pan. How embarrassing and undignified for him. \ raised toilet seat attached to the pan and rails either side will give many handicapped persons the independence they require in this particular function. A fall-bar covered in foam rubber and fixed to the walls will give confidence and support to someone whose balance is - 21 - uncertain and who might otherwise fall forward off the toilet seat. It is important that the disabled person should not have to wait until someone is available to help him as this help might not be there at the time it is needed and thus result in other complications arising. The necessity of being independent in this particular is of utmost importance. Other toilet aids which may have to be provided are receptacles for use in bed, commodes, or an Elsan. Toilet tongs for holding toilet paper to aid in cleaning the perineum is one of the most useful and personal of aids. Washing The technique of washing, comprising soaping, rinsing and drying, applied to the head face, hands and arms, trunk legs and feet, has to be re-learnt according to the disability suffered. Special bath rails and various types of bathseats, help on getting into and out of a bath. A slatted seat with a shoulder-level shower spray may be the solution for the all-over wash for certain people. A bath into which one can walk, and sit and close the door after entering, is the greatest invention in this sphere of activity. Those with only one useable hand may dry their back with a roller towel, the roller being hung on a hook on the door by means of a strong elastic cord. The person stands or sits back to door and with the good hand pulls down the towel across his back, the elastic pulling it up again. Long handled tooth brushes, combs, razors, lipstick holders, etc., help those with limited arm movements to carry out their washing routine. Conclusion Disability is more a matter of degree than of type and the degree of disability is not only influenced by the physical limitations but also by the mental attitude towards it, the mental attitude of the community in which the handicapped person lives, as well as by his own attitude. Someone with a disability is a person just as someone without a disability is a person. The disability will naturally influence the personality of each member of the family just as education, age, nationality and environment influence it. B.Warshaw Chief Welfare Officer OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 A Charter for the Health, Welfare and Safety of Office Workers "Such vapid and flat daylight as filtered through the ground glass windows and skylights, leaving a black sediment upon the panes, showed the book and papers, and the figures bending over them, enveloped in a studious gloom, and as much abstracted in appearance from the world without as if they were assembled at the bottom of the sea, while a mouldy little strong room in the obscure perspective, where a shady lamp was always burning, might have represented the cavern of some ocean monster looking on with a red eye at those mysteries of the deep". — Charles Dickens, 1843 When Charles Dickens wrote that penetrating description of the cheerless atmosphere of a nineteenth-century business house one hundred and twenty five years ago, he was in fact drawing attention to the need for legislation to improve and control the working environment of those employed in offices and other non-manual employment. The extension of the framework of welfare legislation which had long been enjoyed by factory workers, to include hitherto unprotected office workers, and certain other classes of employment, was not achieved unti 1964 when the Offices, Shops and Railway Premises Act became operative. The Ministry of Employment and Productivity requires the Council to submit an annual report on the operation and enforcement of the Act. The report which follows was submitted for the period 1st January - 31st December, 1968. Four years experience of administering the Act has vindicated its declared objective which was "to improve standards of welfare and safety of employees in office, shop and raiIway premises". - 22 - 1. REGISTRATION AND INSPECTION (a) Details of Premises Registered and General Inspections Class of Premises No. of Premises Registered during the Year No. of Registered Premises at end of the Year No. of Registered Premises receiving a Detailed Inspection during the Year Offices 26 482 40 Retail Shops 28 1,584 132 Wholesale Shops, Warehouses 6 90 10 Catering Establishments open to the public, Canteen 4 179 8 Fuel storage depots - 6 - Totals 64 2,341 190 Total number of Inspections/Re-inspections 2,509 (b) General Observations The specialised attention given to registration and initial inspection during formative years of the new legislation accounted for practically 100% of the business premises in the Borough falling within the scope of the Act. A district survey carried out during 1968 to check the business premises register has shown that the pattern of business occupation is continually changing, due to slum clearance and redevelopment, the establishment of new businesses and others closing down or changing hands, or falling outside the scope of the Act by reason of a reduction in the number of hours worked. A practice has also come to light whereby subordinate employees such as salesman or representatives have been said to be "self employed". Recent legislation has been introduced to deal with this abuse. As compliance with the requirement to register premises is seldom effected on an occupiers own initiative but only after one or more written communications and a visit by an Inspector, follow up procedure will have to be a continuous process to keep abreast of the problem of non-registration and initial inspections. Other activity under the Act during the year has been devoted to enforcement of the requirements of notices previously served and a large number of re-inspections have been made. It is gratifying to report that owners and occupiers are becoming increasingly aware of their responsibilities under the Act and are showing willingness to co-operate with the local authority in remedying any instances of non compliance with recommendations made by inspectors. Many employers, have in fact, raised their standards above those required by statute and quite often advice is sought prior to the setting up of new businesses. The small minority who have shown reluctance to meet their obligations have either been prosecuted or warned accordingly, full details of which are given later in the report. - 23 - 2. OPERATION OF THE GENERAL PROVISIONS OF THE ACT (a) Analysis of Contraventions Found Section No. of Contraventions Found Section No. of Contraventions Found 4 Cleanliness 45 12 Clothing Accommodation 3 5 Overcrowding Nil 13/14 Seating Facilities 1 6 Temperature 39 15 Eating Facilities Nil 7 Ventilation 2 16 Floors, passages and stairs 36 8 Lighting 11 17/18/19 Machinery 3 9 Sanitary Conveniences 76 23 Prohibition of heavy work Nil 10 Washing Facilities 76 24 First Aid General Provisions 53 11 Supply of Drinking Water Nil 50 Exhibition of Forms 47 Total 392 (b) General Observations Reports of practical operations relating to inspections are shown below under the appropriate Section sub-heading. Section 4 - Cleanliness General standards continued to improve but stockrooms, passages, washrooms and toilets at the rear of premises were often found to be neglected. In the smaller businesses, allegedly due to lack of funds, office and shop staff have been made responsible for cleansing work generally with poor effect. Unsatisfactory conditions in larger premises were often attributed to difficulties in obtaining suitable cleaning staff. Overcrowding of rooms by stock piled on floors so as to provide a danger hazard has generally been remedied by verbal warning on the spot. Shortage of staff was the usual excuse. Sections 6 and 7 - Temperature and Ventilation The enforcement of these Sections requires a realistic interpretation particularly with regard to the possibility of deterioration of stock by the maintenance of the temperature standard set. Prosecutions against occupiers of food premises are liable to fail on these grounds. A successful case was taken for lack of ventilation in an office built inside a warehouse. On one occasion, during a hot spell, a temperature of 100° Fahrenheit was recorded inside a newly built supermarket, where the ventilating system had failed and was working in reverse. No provision is made in the Act regarding top level temperatures although if it were necessary to take proceedings in such a case no doubt the offence of lack of ventilation could be substantiated. - 24 - Section 8 - Lighting Since the detailed survey conducted by the Department in 1965/66 during which some 2,513 light meter readings were taken in shops and offices in the Borough and occupiers advised as to the suitability of their lighting arrangements, a general improvement has been achieved. Less satisfactory conditions often prevailed in rear rooms where the sales promotion factor of good lighting could be disregarded. The danger of accidents to employees as a result of poor lighting on staircases and in passages and stockrooms has been stressed to good effect. An inspection of the local office and warehouse of one of the largest chemical firms in the country disclosed a deplorable standard of lighting in almost every room. A demonstration to the management with a light meter and a general appraisal of the situation resulted in a complete re-arrangements of the lighting system and the installation of modern equipment. Successful prosecutions have been taken for lack of lighting in toilets and washrooms, evidence being given of readings from a light meter. Here lighting standards often relate directly to cleanliness and the issue cannot be too strongly emphasised, particularly in food premi ses. Section 9 - Sanitary Conveniences It has been found that repeated visits for enforcement by inspectors with verbal or written notices are necessary to maintain the improved standards achieved since the Act came into operation. Cases have arisen where the use of compartments as additional stockrooms have rendered the actual toilet facilities completely inaccessible and where, in consequence, the water seal in sanitary fittings evaporated through lack of usage resulting in offensive effluvia penetrating into the building. Prosecutions have been taken for unclean conditions, lack of maintenance, no lighting and failure to provide an enclosed and properly ventilated intervening space between toilet compartments and workrooms. Section 10 - Washing Facilities The requirements are similar to those of the previous Section, in fact regularly one compartment has been found to serve the dual purpose. This is quite acceptable unless the water supply above the wash hand basin is used for drinking purposes. Almost every business has provided running hot water facilities and prosecutions have been taken where previous warnings have been ignored. Tactful advice has been tendered, particularly to staff in food shops, on using the hot water, soap and clean towels provided. Section II - Drinking Water Few problems arose. Chemical and bacteriological tests have been made of drinking water from storage cisterns. While this practice is clearly undesirable, analysis generally has proved the water to be of excellent quality. The danger of contamination of drinking water from taps situated over wash hand basin in toilet compartments from aerosols (fine airborne droplets which result from the flushing of W.C's) has been discussed with occupiers and alternative sites have been provided for drinking water taps. Section 12- Accommodation for Clothing No standards are set by the Act and usually it has been found that employees satisfactorily make their own arrangements. - 25 - Sections 13 and 14 - Seating Arrangements Few difficulties arose. In shops where space precluded seating behind counters, facilities were generally found in rear stockrooms. Flimsy and crowded seating behind cash desks at exit points in self-service stores has been given careful consideration having regard to the accident potential. Section 15 - Eating Facilities Only few employees in shops were found to eat full meals on the premises, although as mentioned previously, without exception satisfactory arrangements were found to be provided for the preparation and consumption in privacy of hot drinks and snacks. Section 16 - Floors, Passages and Stairs Large numbers of offences were disclosed and where previous warnings had been given successful prosecutions have followed. Defects included torn and worn linoleum, dangerous floorboards, no hand rails to stairs, stocking of goods on staircases and many others. All these provide serious accident potentials, particularly to female staff wearing high heels or carrying goods. Explanations on these lines to magistrates have resulted in fairly severe penalties. In one case a woman fell from a shop floor into a cellar through an unguarded trap door but luckily escaped serious injury. Sections 17, 18 and 19 - Dangerous Machinery Close liaison with H.M.Factory Inspectorate is essential with regard to questions relating to potentially dangerous machinery installed in premises subject to control under various enactments by both local and central authorities. Bowl choppers and mechanical saws in manufacturing butchers premises, food mixing machines in bakehouses and catering establishments, hoists and lifts in restaurants are examples of the type of machinery which present a danger hazard. The fact that fifteen supplements have been added to the original Ministry circular on the guarding and use of dangerous machinery illustrates the complexity of the subject. However, the human element is still the most unpredictable factor in accident prevention, no matter how fool proof the machine. Guards are frequently removed from food cutting machines for cleansing purposes and not replaced. In a local bakery, in spite of a safety guard having been fitted which had the effect of reversing the movement of a roller in a dough machine when lifted, making it impossible for a person to trap his fingers, a youth for some reason and with obvious difficulty, inserted his hand under the safety guard injuring his fingers under the rol ler. Section 21 - Noise and Vibration The only complaints of noise from employees came from office workers regarding the density of road traffic noise. A large number of complaints have been received from residents regarding noise from industrial and other sources and these have been dealt with under the Noise Abatement Act and Public Health Acts. - 26 - Section 23 - Prohibition of Heavy Work Apart from the inability of shop assistants to load and off load directly outside their premises due to obstruction by other vehicles or parking restrictions, no complaints were made. In these cases advice as to the use of trolleys was tendered. In some multiple grocery shops it was found that the male manager with an entire staff of females, was solely responsible for carrying loading or off loading stock. Section 24 - First Aid Most premises were found to have a first aid box. One prosecution in a bakers shop showed the first aid box to consist of an oxo tin containing 2 plasters, 2 candles, I bottle of gum, one roll of sellotape, 2 ink markers and 3 biro pen refills. Sections 28 and 38 - Fire Precautions Again action under these sections has been confined to common sense advice on obstructions to exits and in relation to legal requirements as to the issue of fire certificates. Information has been passed to the enforcing authority where glaring anomolies were found to exist. Section 50 - Information to Employees Several prosecutions have been taken for failure to display an abstract of the Act on the premises. While this offence may appear to be trivial, its purpose in informing employees both of the requirements of the Act and their rights and responsibility under it, is most important. Section 48 - Accidents This section requires occupiers of premises which are subject to the Act to report any accident which causes the death of an employee or disabled any such person from doing his usual work for more than 3 days. (a) Number of Accidents Reported Causation Falls 18 Injuries whilst handling goods (strains etc.) 5 Hand Tools (cuts etc.) 8 Struck by falling objects Machinery 2 Miscellaneous 6 Total 39 (b) General Observations The number of accidents reported is roughly comparable with the 1967 figure and the conclusion reached after that period still remains, namely, that the requirement to report accidents is still not being complied with. No excuse can be made for these lapses as the requirement is clearly printed on Form OSR.9 which should be permanently posted in all business premises. In addition, printed advice as to employers responsibilities is provided on - 27 - intimation Notices issued by the Department. I feel that in the event of an unreported accident coming to light, consideration should be given to the institution of legal proceedings. 3. PROSECUTIONS Prosecutions have not been sought by the Inspectorate and only where informal action has been ignored have proceedings been recommended to the Council. Even then only offender were reported where at least one of the contraventions presented danger or serious discomfort to employees. Usually, however, the disclosure of one major offence has brought to light a complete disregard to all the requirements of the Act and proceedings have then been recommended for all such offences. Number of Number of Premises Contraventions Legal Proceedings instituted, (pending 1967) 7 20 Legal Proceedings authorised by the Council during 1968 18 67 Legal Proceedings instituted 16 56 Legal Proceedings pending 2 II 4. PERSONNEL (a) Analysis of Persons Employed in Registered Premises by Workplace Class of Workplace Number of Persons Employed Offices 4,281 Retail Shops 7,241 Wholesale departments, warehouses 1,046 Catering Establishments open to public 1,163 Canteens 72 Fuel storage depots 58 Total 13,861 Total Males 6,268 Total Females 7,593 Numbers of persons employed in the Borough in offices, shop and other commercial premises are slightly more than 1967. 5. CONCLUSION A limited amount of specialisation was necessary during the formative years of the Act to secure registration and survey of all commercial premises. This objective was sufficiently advanced towards the end of 1967 to enable the administration and enforcement of the Act to be absorbed by the District Public Health Inspectorate as part of their routine work. However, it may be necessary to introduce a further measure of specialisation to keep abreast of the changing pattern of business occupation in the Borough and the problem of non- - 28 - General Practitioner's Consulting Room Reception Area and Waiting Room for General Practitioner's patients Main Hall—Infant Weighing Session in progress registration. As indicated earlier compliance with Section 49, which requires occupiers to register their premises, is seldom effected on an occupiers own initiative but only after one or more written communications and a final visit by an Inspector. The provisions of the Act which automatically exempt, without written application, premises where only self-employed people work or where the only persons employed are close relatives of the employer, and businesses where the total hours worked by all employees do not exceed 21 hours per week, provide a loophole which is liable to exploitation and is being used as a delaying action to evade responsibility under the Act. Occupiers of such businesses are under no statutory obligation to make a signed declaration to the local authority and the true situation cannot be ascertained without prying into matters which, quite properly, may be considered the private concern of the individual who is under no compulsion to divulge to officers of a local authority intimate details of his business. In my opinion the registration requirements of the Act would be more effective and realistic if they were amended to make it compulsory for occupiers of all commercial premises to notify the local authority on Form OSR.I, and make a signed declaration (in a standard form) stating the reason or reasons why they consider their premises should be exempted from the provisions of the Act. This would enable enforcement action to be initiated without officers having to spend much needless time in carrying out detailed investigations to establish whether or not premises are subject to the Act. A recent Parliamentary announcement indicated that preparatory work had begun on a comprehensive revision of the safety, health and welfare legislation which might well lead to the amalgamation of the Factory Act and the Offices, Shops and Railway Premises Act into one enactment and possibly the setting up of a new Central Inspectorate. In this connection I wish to re-iterate the comment made in my 1967 report namely, that this is a field in which local responsibility is fundamental and there are strong grounds for opposing any suggestion of transferring responsibility for enforcement of the Act to central government. Inspection of business premises by officers, of a local authority covers a wide sphere of activity involving many separate, but inter-related, statutes, orders and regulations concerned with environmental health, welfare, hygiene and public protection. Such a transfer would bring about duplicity of inspections and responsibilities resulting in officers of both central and local government visiting the same premises for essentially the same purpose. It would also be bad for the promotion of good public relations. Finally, I consider that there is a need for amending legislation to strengthen the procedure for the notification of accidents under Section 48. All accidents reported to the Ministry of Social Security for monetary insurance benefits should be referred to the appropriate authority for verification and investigation under the Act. B.J .Ashcroft Chief Public Health Inspector - 29 - MEDICAL RESEARCH COUNCIL Contributed by Doctor A.J.Costello, M.A., M.B., B.Ch., D.P.M., D.Obst. R.C.O.G. FAMILY SURVEY - M.R.C. UNIT FOR THE STUDY OF ENVIRONMENTAL FACTORS IN MENTAL AND PHYSICAL ILLNESS The unit's work in the Borough during 1968 has been steadily expanding. Three projects which had been started earlier were completed. The first of these, the "The Toddlers Day" which began some time ago is still in the course of analysis, but some interesting findings have already emerged and some have been published.* The study consists of over fifty mothers with two children who were first seen when they were expecting the second child and they and their children were followed until the youngest child was fourteen months old. The mothers were interviewed to obtain a detailed account of what happened to the child throughout the preceding twenty-four hours on three occasions of six month intervals. Perhaps the most interesting finding is the predictability of the mother's behaviour from one child to the other, and the consistency from day to day, in spite of the fact that different mothers have very different patterns of child care, particularly in the attention they give to the child. In a co-operative study with the Health Department we undertook a controlled trial of the affect of attending a Play-Group. Unfortunately, the time period chosen for assessment has to be limited to only six weeks, and although the Play-Group children were rated by their mothers as, 'happier' after attendance, no more specific changes could be shown in so short a time, though direct observation confirmed that some individuals showed marked changes for the better. Another project involved Health Visitors in a search for families of two children under five born close together. Some of these families agreed to come to our observation room where the two children could be watched in play and later both children attended Play-Groups. The aim of this study was to investigate the effect of being first or second born on the relationship of the child with the mother. First born children are known to do better at school, other things being equal, but it is uncertain if this is due to the stimulus of the second child or the advantage of having the parents' undivided attention in the earlier years. We could find no evidence that the mothers showed more attention to first borns than second borns, but the first born children did attract more attention from the adult supervisor of the Play-Group. This suggests a quite different explanation; that the advantage of being first born lies in learning to develop a special relationship with adults. This explanation is consistent with other work on older children in schools. Of the new work which has been started in this year perhaps the project of most interest is an attempt to construct and up date a comprehensive register of the children in the Borough. The rate of migration of young families in and out of the Borough makes it difficult to keep track of individual children and to make soundly-based plans for the provision of services. This register is based on the notification of births and uses other information including direct enquiries to parents to update the file at regular intervals. The record is stored on a computer to provide speed of access and manipulation, and to ensure confidential ity. It is hoped that the use of the file wiII bring improvements to the infant vaccination and immunisation rate and to the running and evaluation of the 'At Risk' register. It is also planned to use it for several research studies in particular in the construction of a developmental scale to improve the diagnosis and detection of abnormal or delayed development in children. We are exceedingly grateful to all our colleagues in the Borough and particularly in the Department of Health and Welfare for the help they have given us in these studies and we hope that continued co-operation will prove as fruitful in the future as it has been already. * Proceed ings of the Royal Society of Medicine, December 1968, Vol.61, No. 12, Pages 1319-1322, (Section of Psychiatry, Pages 49-52). J.W.B.Douglas, J.E.Cooper et al. 20 YEARS IN DAY NURSERIES Contributed by Mrs.G.Moore, S.R.N., Matron, Higham Hill Day Nursery - 1948/68 On entering Day Nursery Service as a trained nurse, I soon realised that it was a completely new life; that although observing children was important, one should not lose sight of the fact that we were dealing with healthy children who were there to play and be happy, but through play to learn to live in a community. As the years went by, it became obvious that a trained nurse had a big role to play, to cope with emergencies, to maintain the balance between the young student and their older contemporaries. One was able to appreciate what the Nursery Nurses Certificate meant to the students at the end of their two years training, realising also that this period was valuable in bridging the gap between leaving school and entry into training as hospital nurses. In the early days a large proportion of the staff were Nursery Assistants, with valuable help from voluntary workers. Students were enrolled at 16 years of age, but not in sufficient numbers. When a good 15 year old was engaged, working 4 days at the Nursery, she spent one day per week at a local Secondary Modern School for further education. 16 year old students spent one day at the Technical College, and lectures were given by a Course Tutor and a Nursery Matron. The students were required to work at the Nursery before going to College in the morning and returning after the College day ended. However, as the Certificate obtained at the end of the 2 years training became fully recognised, and became known as the Diploma of Nursery Nursing, Day Nurseries were established as a worthwhile career. 16 year olds only were admitted to the Course, with two days being spent at College and the syllabus expanded to cover a wide range. Entry to College was at the beginning of the College year, and not each term, with consequent overlapping of training. Gradually sufficient students were enrolled and soon there was a waiting list for appointments as Staff Nursery Nurses. They gradually replaced the untrained helpers and assistant nurses, and other trained N.N.E.E.B. nurses went on to Teacher Training Colleges or into hospital for further training. In recent years, however, the trend has been at the end of training to try other jobs with more attractive hours of work - namely the Nursery Schools and Save the Children Fund. Nursery Nurses want more experience with older children and talk about employment in nurseries on board Ocean Liners, Air Hostess work and the Women's Police Force. It seems that recruitment to Day Nursery Service has reached a full cycle, losing the young nurse and being replaced by young married women with families. This maturity is valuable, and they are without doubt the nucleus of a good Nursery staff. The Nursery nurse marries at an earlier age and then uses her Certificate when her family has reached school age. - 31 - Many Play-Groups are now staffed with the young N.N.E.E.B. nurse who is keeping her contact with young children, and who one day will return to the Day Nursery. In the early days, the lists of children awaiting admission at all the Nurseries were long due to the lack of school places, but as more of these became available, children left the Nursery at 4½ years of age and gradually the waiting lists became shorter. Today the waiting lists is again heavy. In the early years, up to 1965, medical inspection of children was carried out twice weekly and monthly immunisation sessions for 20 children were held. Very few children are now immunised at Day Nurseries, as most are either receiving injections at the Infant Welfare Clinics or from their family doctor. The mother today is very keen on immunisation. At one time it was rare for a Nursery not to have three or four bottle fed babies, but today the baby is weaned and the mother prefers to stay at home until it is older. The unmarried mother no longer slips in and out of the Nursery, hoping not to be noticed, but takes a full part in all Nursery activities. Grandmothers are younger, with their own lives to lead, and young mothers prefer to deal with their own children. However, throughout the years the children have benefitted; particularly the children with speech and hearing defects, the children of deaf and dumb parents, the children who fail to thrive, the withdrawn and the inarticulate children. In the early days, the office work at a Day Nursery was simple but effective. All parents were charged the same fee, payable on a Monday. The cost was one shilling per day, for which a printed receipt in the form of a ticket was issued. Banking of cash was simple. Ordering of supplies and goods was by means of duplicate books and came direct from the Central Stores in the area. Check on expenditure was thorough. Communication and co-operation with Central Office staff was uncomplicated. Then, in 1948, came the introduction of the National Health Service Act which transferred responsibility for Day Nurseries (and other Health Services) from the local Borough Councils to the Essex County Council. At first, the effects were not noticeable but gradually more elaborate procedures were introduced. The Nursery fees substantially increased and a system of assessing each parent's financial situation came into being. Central Stores ceased to exist and orders for supplies went out to contractors, but gradually things settled down and ran smoothly, principally because all the Nurseries still maintained their own contacts with the officers at their own local Town Hall, and they remained the same with the exception of one or two new officers. They were still a closely knit community, and all staff were known by name. Expenditure had to be contained, which was no hardship as living within a budget had always been a "must", but now an explanation of over expenditure had to be given and sent to County. Years went by and through various ways the 'amalgamation' of London Boroughs became talked about. In 1965 this also became a reality. The change was immediately felt, as all the Day Nurseries lost their immediate contacts that through the years had been closely built up. New names were introduced, and from a small unit we became part of a vast organisation. This was not peculiar to us, but was experienced by Day Nurseries far and wide. Some unnecessary office work was abolished but some complicated book work was added. No longer were staff appointments made in the evenings, which had been social occasions for all Matrons concerned. - 32 - However, Day Nurseries benefitted by the change, as more information and more contact with people in all fields of the welfare of the child became available. The co-operation between staff of Infant Welfare Clinics and Day Nurseries was firmly strengthened and information was always readily given. As the welfare of the child is what Day Nurseries are all about, this change was the most valuable of all. It speaks highly for the staff of the Nurseries, that, to the parents and onlookers, Day Nurseries have altered little, showing the adaptability of the staff that notwithstanding all else the rhythm of the child's day remains untouched. HANDSWORTH AVENUE HEALTH CENTRE In my Annual Report for 1966 reference was made to the opening of the first Health Centre in the Borough at Hurst Road, Walthamstow. In June, 1968 the Council's second purpose-built Health Centre was completed and brought into use. This building is situated in Handsworth Avenue, Highams Park and is very near the boundaries of the former boroughs of Chingford and Walthamstow. It is adjacent to a shopping area, bus routes and the local railway station and is constructed as an integral part of a housing scheme. Accommodation is provided, in four consulting rooms (with adjoining examination rooms), for five medical practitioners of whom three are making full-time use of the Health Centre. A waiting room for the general practitioners' patients is provided separately from that used by the Local Health Authority Services but the reception and office area is shared by the clerical staff employed by the general practitioners and those employed by the Borough Council. The Council offers the usual range of Local Health Authority Services such as Infant Welfare Sessions, Toddlers' Clinics, Ante-Natal Relaxation Classes, Chiropody, Dental Treatment, Minor Ailment Treatments, Midwives Ante-Natal and Post-Natal Clinics etc. There is full attachment of Home Nursing and Midwifery staff to the group of medical practitioners and close liaison with the team of Health Visitors and School Nurses based at the Health Centre. Photographs of the building appear between pages 20 and 21 and on page 34 is a layout drawing of the Ground floor accommodation. On the first floor is the dental suite consisting of a surgery, recovery room, X-ray and dark room and a waiting room. The Staff Common Room is also on this floor. - 33 - - 34 - CHILDREN'S DEPARTMENT Contributed by Geo.H.Baker, Children's Officer The year 1st April, 1968 to the 31st March, 1969 has been one of accelerated and increasing demands on the Children's Department services which have strained our resources in every way to maintain the high standards we had reached in previous years. We are now much engaged in preventive work in helping families not to break up and lose their children to the care of the department or of approved schools. On the 3 Ist March, 1969, we were working with 150 families comprising 33 I children and during the whole of the year we had 558 families referred to us with a total of 1,145 children. This has meant more intensive and close casework on the part of our Child Care Officers increasing their caseloads and the amount of work they each have to do and the amount of strain they have to bear. However, the result has been that only those children whose needs cannot be dealt with in any other way have had to come into care, but their problems were such that still a large proportion of them needed residential care and consequently at times we have had great difficulty in placing these children in our own homes and nursery due to the shortage of vacancies. Our residential staff have risen to the occasion in a most praise-worthy effort and have taken children when they have already the maximum number in their care. This is a matter of expediency to meet a difficult situation, but is not in the children's interest or that of the staff to continue indefinitely. We have also placed children in children's homes, in hostels run by voluntary associations such as St. Mary's Convent in Walthamstow and Dr. Barnardo's Home because of our increasing need of residential vacancies at certain periods during the year. On the 31st March, 1969, we had 209 children in care, 42% of whom were boarded out with foster parents, 44% in residential establishments and 12% were children who had been committed to care and allowed home on trial (the odd 2% consisted of children who were temporarily in hospital). These figures show a slight decrease in the number of children in care since last year (215) and I feel that the fact that we have maintained the figure more or less as before is due to the preventive work carried out by the department. However, the number of children boarded out has decreased and this is not a very welcome fact. We are finding more and more difficulty in obtaining suitable foster homes in the area for the children received into care. Some of the children are the children of immigrant families. Unfortunately we have not found many immigrant families who will act as foster parents and this is disturbing as the children remain in residential care much longer than they should. We also experience difficulty in finding foster homes for brothers and sisters to be together or Roman Catholic children who should have Roman Catholic foster parents, and for those children who have special needs because of physical or mental handicaps. They has always been a consistent demand for placements for children usually of the younger age group to be received into care for only short periods, sometimes for only as little as ten days, but in other cases up to three months when the mother is seriously ill and in hospital. Though the demand has been as great as ever, we have decreased the number actually taken into care as such cases by working with the father of the children and involving the help of relatives or neighbours and using the special provisions of the authority, principally that of day nurseries and daily minders. Many of these children whenever possible have been boarded out with foster parents who are prepared to take children on a short term basis. However, quite a number of them have had to have residential placement especially in the nursery, therefore increasing the demand for residential vacancies. - 35 - Our Officers have also concentrated a great deal of their efforts on rehabilitating parents of the children in care so that the children can return to their families. This is done by supporting and often giving material help so that the home situation can be improved, as well as the relationship between the parents and children. Even the children who are committed to care under fit person orders are allowed to return home on trial as soon as we feel that this is a possibility, and if we are successful in getting the children to settle back with their family we encourage the parents to return to the Court for the revocation of the Order. The Juvenile Bureau of the Metropolitan Police was introduced into this area by Scotland Yard at the beginning of the year. The policy is to prevent children who have committed offences appearing before court where it is felt that it would not be in their interests to do so and where an official caution by a senior member of the Police Force would be sufficient. Gladly we have co-operated by giving our opinion whether a child should be prosecuted or not to the Bureau on each individual case and many children and young people have been saved from a court appearance for committing offences. However, there is an increasing number of children and young persons, especially teenagers, who have been brought before the Court in need of care, protection or control. This usually means in the case of older children, a vacancy in a remand home which has sometimes been difficult for us to find. As a consequence we have had to admit such youngsters in children's homes when in many cases this arrangement was certainly not in their interest or that of the other children in the home. The need for a reception home for this area is becoming more and more evident for such cases and for children who are either received or committed to care and can be placed for an assessment to be made as to their future. As before, during the last year we have carried out our duties under the Adoption Act, 1958, having supervised 72 cases and having been appointed Guardian ad litem in 77. On the 31st March, 1969, we were supervising 61 private foster homes. Most of these were satisfactory, but we have been anxious in a minority of cases where the standards were minimal. At present with the powers under the Children Act, 1958, we have not been able to change the circumstances very much and, therefore, we are looking forward to the changes that are envisaged in respect of this part of our work outlined in the new Children and Young Persons Bill which is at present before the House. Both the Matrimonial and Juvenile Courts have made supervision orders to my staff and on the 31st March, 1969 we were responsible for 29 children under these orders and close supervision has been carried out on all of them. Our Child Care Officers have also been appointed as after-care officers of children who have been committed to approved schools in 16 cases. This entails the Officer visiting both the parents at their home and the child in the school and may mean the Child Care Officer travelling some distances as the schools are situated all over the country. When the children are released from the school, the officers continue the after-care by visiting and advising the children for two years after their return home. As before, we have continued our policy of encouraging Child Care Officers and Residential Staff attending courses both full-time and part-time to undergo further training or to improve or to learn about new ideas and techniques. We have also helped universities and the colleges of further education with their students needing practical placements either with the Child Care Officers or with the Residential Staff in the children's homes. We realise that in the next two years our department will have to extend its services because of the provisions of the new Children and Young Persons Bill and that consequently increases in staff and number of residential placements available will be needed. It appears that our work in the Juvenile Court will be very much increased. Much of the work now done by the Probation Officer will have to be carried out by our staff. - 36 - WATER SUPPLIES Contributed by Dr.E.Windle Taylor, C.B.E., M.A., M.D., D.P.H., F.C.Path Director of Water Examination, Metropolitan Water Board The supply was satisfactory both as to quality and quantity throughout 1968. All new and repaired mains are disinfected with chlorine, after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains, and the mains are returned to service only after results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. The population supplied direct according to the Registrar General's estimates at 30th June, 1968, was 236,900. No houses were permanently supplied by standpipe. No fluoride was added, and where fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. The supply was derived from the following works and pumping stations:- River Thames (Northern Group - Ashford Common, Kempton Park, Hanworth Road and Barn Elms) Lea Bridge Works Ferry Lane Works Chingford MiII Coppermills Works (Summer only) No new sources of supply were instituted and there were no changes in the general scheme of supply. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on pages On account of their hardness content and alkaline reaction the Board's river and well water supplies are not considered to be plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. Special tests for lead have been carried out during 1968 on 100 premises where a lead supply pipe is installed. The premises were chosen to give an even distribution of samples throughout the whole of the Board's area. The results of the tests are shown in the following table:- - 37 - LEAD CONTENT OF WATER FROM MAIN TAPS IN CONSUMERS' PREMISES Lead Content (mg/ l Pb) Samples of water standing in lead pipe overnight Samples of water after running the tap Less than 0.0 1 10 37 0.01 31 57 0.02 21 4 0.03 8 1 0.04 9 0 0.05 5 0 0.06 5 0 0.07 4 1 0.08 1 0 0.09 3 0 0.10 1 0 0.12 1 0 0.16 1 0 100 premises 100 premises These results are very satisfactory and the figures are within the limits of the World Health Organisation European Standards for Drinking Water Quality. RAINFALL AND SEWERAGE Contributed by D.M.P.Sullivan, C.Eng., M.I.C.E., F.l.Mun.E., Borough Engineer and Surveyor Rainfall The rainfall recorded at Auckland Road Depot was 31.08 inches, which is the highes annual amount for 10 years with the unusually high monthly amount of 6 inches during September. Two heavy rainstorms on the 10th July and 14th July caused considerable flooding throughout the Borough and limited flooding also occurred on the 31st July, 23rd September and 17th December. The high annual rainfall in 1968 which has continued during the first three months of 1969 has resulted in an abnormally high sub-soil water level, with many areas of open land becoming waterlogged. Sewerage During 1968 work was commenced on the reconstruction of the Foul Sewer and the provision of a relief surface water sewer in Drysdale Avenue, E.4. also four small relief or reconstruction schemes were completed. Approval in principle was received from the Ministry of Housing and Local Government to proceed with the Walthamstow Southern Area Relief Surface Water Sewer (Southern Branch and the Forest View/Forest Side Relief Foul and Surface Water Sewers and work proceeded on preparation of the contract documents for these schemes. - 38 - The Ministry deferred approval to the Chingford Mount Area Relief Surface Water Sewers scheme in view of the restriction on Capital Expenditure. The Leytonstone Drainage Area Relief Surface Water scheme was submitted to the Ministry but approval has not yet been received. Design has continued on two other major relief schemes. The Greater London Council have agreed to vest in themselves, as main drainage authority under the London Government Act, 1963, several main foul sewers together with storm tanks and some pumping stations and are considering the vesting of further main foul sewers. Sewage Disposal The Council now has no functions with regard to sewage disposal, which is carried out by the Greater London Council. - 39 - STATISTICAL INFORMATION VITAL STATISTICS Area of Borough (in acres) 9,805 Population (Registrar General's Estimate, midyear 1968) 236,900 Number of Rate Assessments at 31st December 1968 93,747 Total Assessable Value £12,082,290 Product of a penny rate £48,350 Live Births: WALTHAM FOREST ENGLAND & WALES MALES FEMALES Legitimate 1935 1788 3723 Illegitimate 160 170 330 4053 Live Birth Rate per 1,000 population 17.1 16.9 " as adjusted by comparability factor (1.06) 18.1 Illegitimate live births per cent of total live births 8.1 Still births: Number (30 males : 24 females) 54 Rate per 1,000 total live and stillbirths 13.1 14 Total live and stillbirths 4107 Infant deaths (deaths under one year) 74 Infant Mortality Rates: Total infant deaths per 1,000 total live births 18.2 18 Legitimate infant deaths per 1,000 legitimate live births 7.4 Illegitimate infant deaths per 1,000 illegitimate live births 27.2 Neo-Natal Mortality Rate (deaths under four weeks per 1,000 total live births) 11.8 12.3 Early Neo-Natal Mortality Rate (deaths under one week per 1,000 total live births) 10.1 10.5 Perinatal Mortality Rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) 23.1 25 Maternal Mortality: Number of deaths I Rate per 1,000 total live and stillbirths 0.24 Deaths: Total number 3089 Death rate per 1,000 population 13.03 11.9 " as adjusted by comparability factor (0.88) I 1.46 - 40 - - 41 - CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE - 1968 I.C.D. CAUSE HEADING CAUSE OF DEATH TOTAL (ALL AGES) AGE GROUPS - MALES AGE GROUPS - FEMALES UNDER 1 1-4 5-14 1524 2534 3544 4554 5564 6574 75 + TOTAL. MALES UNDER 1 1-4 5-14 1524 2534 3544 4554 5564 6574 75 + TOTAL FEMALES B 5 Tuberculosis of respiratory system 9 - _ - - - - 1 1 4 1 7 - - - - - - 1 - 1 - 2 B 6 Other tuberculosis, incl. late effects 2 - - - - - - - - 1 1 2 - - - - - - - - - - - B 17 Syphilis and its sequelae 1 - - - - - - - - - - - - - - - - - - - - 1 1 B 18 Other infective and parasitic diseases 2 - - - - - - - 1 - - 1 - - - - - - - 1 - - 1 B I9(1) Malignant neoplasm - stomach 74 - - - - - 1 2 13 19 16 51 - - - - - 1 1 4 6 11 23 B 19(2) Malignant neoplasm - lung, bronchus 187 - - - - - 2 10 51 55 42 160 - - - - - 1 2 9 8 7 27 B 19(3) Malignant neoplasm - breast 80 - - - - - - - - - - - - - - - 1 - 16 24 21 18 80 B 19(4) Malignant neoplasm - uterus 15 - - - - - - - - - - - - - - - - - 2 4 4 5 15 B 19(5) Leukaemia 11 - - 1 1 - 1 - 1 1 - 5 - - - - - - 1 - 2 3 6 B 19(6) Other malignant neoplasms, etc. 299 - - - 2 2 3 11 37 52 56 163 - - - 1 1 1 14 33 35 51 136 B 20 Benign and unspecified neoplasms 5 - - - - - - 1 - 2 1 4 - - - - - - 1 - - - 1 B 21 Diabetes mellitus 27 - - - - - - 2 - 5 2 9 - - - - - 1 1 1 6 9 18 B 46( 1) Other endocrine etc. diseases 13 - - - - - - - - - - - - 1 - - - - 1 2 4 5 13 B 23 Anaemias 7 - - - - - - - - - - - - - - - - - - - - 7 7 B 46(2) Other diseases of blood, etc. 1 - - - - - - - - - - - - - - - - - - - - 1 1 B 46(3) Mental disorders 4 - - - - - - - - - - - - - - - - - - - - 4 4 B 24 Meningitis 1 - - - - 1 - - - - - 1 - - - - - - - - - - - B 46(4) Other diseases of nervous system, etc. 53 - 1 2 - 1 1 4 7 5 9 30 1 - - - 1 2 - 4 2 13 23 B 26 Chronic rheumatic heart disease 33 - - - - - - 1 3 2 3 9 - - - - - 1 3 5 8 7 24 B 27 Hypertensive disease 67 - - - - - 1 1 2 9 12 25 - - - - - 2 - 5 8 27 42 B 28 Ischaemic heart disease 657 - - - - - 9 43 91 115 121 379 - - - - - 1 3 33 69 172 278 B 29 Other forms of heart disease 195 2 - - - - - - 4 14 47 67 - - - - 2 2 1 5 22 96 128 B 30 Cerebrovascular disease 357 - - - - 1 3 1 16 32 72 125 - - - 1 - - 3 9 43 176 232 B 46(5) Other diseases of circulatory system 115 - - - - 2 - 2 5 12 21 42 - - - - - - 3 4 18 48 73 B 31 Influenza 34 1 - - - 1 - - 1 4 4 11 - - - - - - - 1 2 20 23 B 32 Pneumonia 324 6 1 2 - - - - 8 28 102 147 12 1 - - - - 4 15 20 125 177 B 33( 1) Bronchitis and emphysema 181 - - - - 1 1 3 26 43 54 128 - - - - - - - 2 14 37 53 B 33(2) Asthma 13 - 1 - - - 1 1 2 1 1 7 - - - - - - - 2 3 1 6 B 46(6) Other diseases of respiratory system 24 1 - - - - - 2 - 4 6 13 1 - - - - 1 2 1 1 5 11 B 34 Peptic Ulcer 21 - - - - - - 3 1 4 5 13 - - - - - - - - 2 6 8 B 35 Appendicitis 2 - - 1 - - - - - - - 1 - - - - - - - - - 1 1 B 36 Intestinal obstruction and hernia 10 1 - - - - - - - 1 2 4 2 - - - - - - - - 4 6 B 37 Cirrhosis of liver 4 - - - - - - - 1 1 - 2 - - - - - - - - - 2 2 B 46(7) Other diseases of digestive system 24 - - - - - - 1 1 3 6 11 - - - - - - - 2 3 8 13 B 38 Nephritis and nephrosis 10 - - - 1 - 3 - 1 - - 5 - - - - - - - 2 - 3 5 B 39 Hyperplasia of prostrate 14 - - - - - - - 2 3 9 14 - - - - - - - - - - - B 46(8) Other diseases of genito-urinary system 36 - - - - 1 - 1 3 6 4 15 - - - - - 1 - 3 6 11 21 B 41 Other complications of pregnancy 1 - - - - - - - - - - - - - - - 1 - - - - - 1 B 46( 10) Diseases of musculo-skeletal system 16 - - - - - - - - 2 1 3 - - - - - - - - 2 11 13 B 42 Congenital anomalies 21 9 - 1 1 - - 1 - - - 12 5 1 - 1 - 1 1 - - - 9 B 43 Birth injury, difficult labour etc. 11 4 - - - - - - - - - 4 7 - - - - - - - - - 7 B 44 Other causes of perinatal mortality 21 8 - - - - - - - - - 8 13 - - - - - - - - - 13 B 45 Symptoms and ill-defined conditions 20 - - - - - - - - 1 4 5 - - - - - - - - 1 14 15 BE 47 Motor vehicle accidents 26 - 1 - 6 3 - 4 - 1 4 19 - - 1 1 - - - 1 2 2 7 BE 48 All other accidents 31 1 - 2 1 2 2 - - 1 2 11 - - - 1 1 1 1 2 7 7 20 BE 49 Suicide and self-inflicted injuries 24 - - - - 3 2 4 3 3 - 15 - - - 1 - 1 2 3 1 1 9 BE 50 All other external causes 6 1 - - 1 - 1 - - 1 - 1 - 2 - 5 TOTALS 3089 33 4 9 12 18 30 99 282 434 608 1529 41 4 1 6 8 17 64 177 323 919 1560 DEATHS FROM CANCER AGE AT DEATH MALES FEMALES TOTAL Under 5 years - - - 5 and under 15 years 1 - 1 15 and under 25 years 3 1 4 25 and under 45 years 9 5 14 45 and under 65 years 125 110 235 65 years and over 241 171 410 Total 379 287 666 Previous Years - 1967 370 299 669 1966 334 284 618 BIRTHS During the year a total of 4,107 births were registered. In the same period 4,137 births were notified in accordance with Section 203 of the Public Health Act which were distributed as follows:- DOMICILIARY INSTITUTIONAL LIVE STILL LIVE STILL Notified births which occurred in the Borough 859 4 2022 31 Birth notifications transferred outwards 4 - 297 3 Birth notifications transferred inwards 4 - 1496 25 Adjusted Total 859 4 3221 53 Previous Years - 1967 914 8 3126 60 1966 1074 3 3029 64 CARE OF PREMATURE INFANTS (weighing 5½lbs or less) LIVE STILL BORN Number born at home 25 2 Number born in Hospital or Nursing Home 271 32 - 42 - MIDWIFERY The work of the Council's Midwives was as follows:- 1968 1967 1966 Domiciliary confinements attended under N.H.S. arrangements where: (a) doctor was not booked 8 10 10 (b) a doctor was booked 838 900 1,049 Cases delivered in hospital and other institutions but discharged and attended before tenth day 712 668 561 Miscarriages attended 5 7 10 New cases booked 1,108 977 1,248 Cases on the books at the end of the year 560 494 459 Medical aid notices issued 20 20 23 Visits paid (as midwife): (a) Ante-natal 5,875 5,509 6,799 (b) Nursing 15,229 15,749 17,062 (c) Other post-natal 385 459 360 Total Visits 21,489 21,717 24,221 Administration of Analgesics Cases in which Gas and Air was administered 96 412 519 Cases in which Trilene was administered 34 111 137 Cases in which Entonox was administered 414 71 - Cases in which Pethidine or a related compound was administered 321 373 372 Clinic Sessions Number of sessions attended: (a) General practitioner's clinics 1,117 1,029 868 (b) Midwife's clinics 568 503 496 Number of ante-natal examinations by the midwife: (a) General practitioner's clinics 10,337 6,626 5,859 (b) Midwife's clinics 3,664 3,300 4,687 Number of women attending midwife's clinics who had not previously attended any ante-natal clinic in the current year 675 916 1,567 - 43 - I -U I Child Welfare Clinic Attendances ASSEMBLY HALL DAWLISH ROAD EMMANUEL HALL GRANLEIGH ROAD HATCH LANE HURST RO AD LEYTON GREEN LOW HALL LANE MARMION AVENUE PRIORY COURT ST. FRANCIS HALL SILVERDALE ROAD (CLOSED JUNE, 1968) WEST AVENUE WINCHESTER ROAD HANDSWORTH AVE. (FROM JULY, 1968) TOTAL FOR THE YEAR - ALL CLINICS 1968 1967 1966 Children attending for the first time in 1968 who were born in 1963 - 90 3 24 4 7 39 38 25 11 - - 26 i 2 270 - - 1964 2 160 10 65 14 8 105 119 58 18 - . - 47 6 1 613 - - 1965 21 191 12 102 18 19 131 136 82 26 3 11 56 20 7 835 - - 1966 51 301 22 173 46 36 223 227 114 66 39 69 149 82 23 1,621 - - 1967 44 405 48 362 80 38 460 372 203 251 33 99 265 127 26 2,813 - - 1968 206 454 82 469 86 209 363 306 264 273 122 45 362 44 120 3,405 - - Total attendances 5,288 7,201 1,613 5,919 1,730 2,610 5,760 5,606 6,773 4,346 2,095 1,274 5,104 1,234 2,271 58,825 70,028 68,923 Attendance of children seen by Medical Officer 574 2.810 195 1,805 445 1,106 1,498 2.1 19 994 1,830 259 413 2,345 362 903 17,632 21,235 17,500 No.of children referred elsewhere 13 125 14 104 2 9 92 48 32 89 3 3 22 2 11 569 608 561 No.of sessions (a) Medical Officers 56 193 10 124 18 90 162 136 72 147 24 44 143 25 71 1,3 IS 1,194 996 (b) Sessional G.P's - 4 - 40 49 8 3 1 31 - - - - - 2 134 229 372 (c) Health Visitors 46 1 38 3 - - 19 - 51 2 26 - - - - 186 218 293 45 Distribution of Welfare Foods and Nutrients NUTRIENTS WELFARE FOODS ADEXOLINE OPTROSE MARMITE COW 8c GATE OSTERMILK NO.2 S.M. A. HUMSD. TRU FOOD FAREX GROATS TWIN-PACK NAT. DRIED MILK COD LIVER OIL A. & D. TABLETS ORANGE JUICE Assembly Hall 1,413 5,004 1,298 522 490 254 - 123 40 78 406 221 180 5,962 Hurst Road 499 1,591 521 1,000 672 321 - 121 55 130 556 334 187 2,961 Dawlish Road 681 2,604 864 1,950 1,716 884 - 143 140 120 2,230 817 302 6,293 Emmanuel Hall 425 1,371 216 489 200 96 - 38 28 14 147 104 54 1,201 Granleigh Road 1, 102 1,860 649 1,934 1,825 963 - 154 43 1 1 1 2, 183 566 305 6,769 Handsworth Avenue 812 3,524 780 635 532 74 41 83 52 71 175 122 125 4,028 Hatch Lane 519 2,451 597 92 192 216 12 29 18 40 47 1 76 1 1 1 2,616 Leyton Green 1,604 3,409 1,084 1,854 1,429 531 65 161 83 100 1,955 492 31 1 5,9 19 Old Monoux School 521 2,688 517 982 607 267 27 105 - - 2,309 276 275 5,647 Priory Court 1,390 4,262 1,195 1,493 1,329 394 13 78 79 103 1,389 250 307 4,238 Low Hall Lane 1,576 3,424 488 1,813 1,304 368 16 94 28 71 1,408 295 153 2,980 Marmion Avenue 1,889 4,846 1,685 663 690 326 189 86 69 104 727 329 458 8,611 St.Francis Hall 243 1, 191 368 452 205 136 79 49 40 36 6 52 34 1,293 Silverdale Road 472 1,961 407 248 276 30 6 63 31 52 160 85 79 2,233 West Avenue 543 2,612 377 1,538 994 677 24 137 30 41 834 300 122 2,613 Winchester Road 437 1,769 536 273 195 20 - 45 26 54 213 76 47 1,874 W.V.S. Chingford - - - - - - - - - - 20 3 7 756 Hospitals and Nurseries - - - - -: - - - - - 49 355 - 2,148 14,126 44,567 1 1,582 15,938 12,656 5,557 472 1,509 762 1,125 15,238 4,753 3,057 68,142 Previous Years- 1967 14,110 52,935 11,147 13,684 10,831 5,013 303 1,672 856 1,128 24,394 5,185 3,415 70,377 1966 12,203 56,546 8,632 14,419 12,468 3,263 884 2,107 1,502 1,480 33,289 5,315 3,702 70,746 Mothercraft and Relaxation Classes New cases 337 Attendances 1,481 No. of classes held 255 Day Nurseries Attendances: NAME OF NURSERY ELLINGMAM ROAD EPSOM ROAD HIGHAM HILL HANDSWORTH AVENUE CHINGFORD MOUNT TOTALS 1968 1967 1966 Number of approved places at end of year 50 50 60 60 52 272 272 272 Number of children on register at end of year 54 60 61 69 57 301 308 296 Total attendance during the year 10,396 11,993 12,229 14,750 10,883 60,251 60,057 60,114 Number of days open 245 245 245 245 245 - - - Nurseries and Child Minders Regulations, 1948 1968 1967 1966 Premises registered at end of year: Number of premises 36 28 18 Number of places provided 1,120 848 505 Persons registered at end of year: Number of persons 19 21 19 Number of places provided 114 118 92 Child Development Sessions DAWLISH ROAD CLINIC GRANLElGH ROAD CLINIC LEYTON GREEN CLINIC LOWHALL CLINIC WEST AVENUE CLINIC No. of attendances 1,325 1,485 1,327 1,110 843 No. of sessions 123 143 125 101 105 No. on roll at 3 1.12.68 45 46 35 12 6 - 46 - Ante-Natal and Post-Natal Clinic Attendances ANTE-NATAL POST-NATAL New Patients 13 1 Attendances 13 1 Congenital Malformation Eighty-six cases of congenital malformation were notified to the Department of Health and Social Services during the year. Children "At Risk" 1968 1967 1966 Children on Register at 1st January 2,156 1,731 1,696 ChiIdren added during year 1,560 1,368 1,175 Children removed during year 646 943 1,140 Children on Register at 31st December 3,070 2,156 1,731 Cervical Cytology Clinics HATCH LANE GRANLElGH ROAD No. of cases referred 1,024 274 No. of smears taken 1,028 391 No. of sessions 51 31 No. waiting at 31.12.68 208 324 Dental Treatment of Expectant and Nursing Mothers and Children under five years CHILDREN UNDER 5 YRS. EXPECTANT & NURSING MOTHERS 1968 1967 1966 1968 1967 1966 Number of patients given first inspections during year 182 254 430 15 15 Number of patients who required treatment 111 150 232 14 15 31 Number of patients who were offered treatment 103 144 227 14 15 30 Attendances for treatment: First visit 475 517 537 21 47 57 Subsequent visits 587 726 694 86 102 73 Total visits 1,062 1,243 1,23 1 107 149 130 Treatment provided: Number of fiIIings 775 868 941 63 72 63 Teeth filled 708 719 - 50 68 - Teeth extracted 323 492 703 34 50 56 General anaesthetics given 140 210 137 6 8 4 Emergency visits by patients 45 69 64 - 4 4 Patients X-rayed 5 5 7 7 12 10 Patients treated by scaling and/or removal of stains from the teeth (Prophylaxis) 141 155 156 1 1 24 38 Teeth otherwise conserved 70 187 176 - - - Teeth root filled - - - - 6 - 1nlays - - - - - - Crowns - - - 1 - - Number of courses of treatment completed during year 212 300 236 12 19 24 Patients supplied with full upper or full lower dentures - - - 3 2 2 Patients supplied with other dentures - - - - 3 4 Number of dentures supplied - - - 7 7 9 - 47 - Family Planning GRANLEIGH ROAD HATCH LANE HURST ROAD Number of new patients 449 499 527 Number of persons treated 630 1,483 1, 127 Number of attendances 1,076 3,155 2,536 Number of sessions 51 100 52 HEALTH VISITING (a) Sessions Worked Number of sessions (half days) devoted to: 1968 1967 1966 (i) Health visiting 7,915 8,489 7,274 (ii) Child welfare centres 3,476 3,327 3,156 (iii) Ante-natal, post-natal, relaxation etc. clinics 361 486 449 (iv) School clinics 1,057 998 933 (v) Other school nursing 2,062 1,839 1,907 (vi) Health education (including mothercraft) 481 450 568 (vii) Other work (including clerical) 5,634 5,506 4,700 Total sessions 20,986 21,083 18,987 (b) Cases visited for the first time in the year (i) children born in 1963 1,075 " " " " 1964 1,488 " " " " 1965 1,775 " " " " 1966 2,132 " " " " 1967 2,420 " " " " 1968 3,786 (ii) persons aged 65 or over 2,41 1 (iii) others (excluding school nursing cases) 2,250 Total 17,337 18,290 17,307 (c) Number included in item (b) (i) mentally disordered persons 220 246 203 (ii) persons discharged from hospital (other than mental hospitals) 521 427 375 (iii) tuberculosis households 15 16 1 1 (iv) households visited on account of other infectious diseases 1 8 5 (d) Number included in item (b) and where appropriate item (c) who were visited at the special request of a G.P. or hospital: (i) persons aged 65 or over 653 547 456 (ii) mentally disordered persons 60 96 49 (iii) persons discharged from hospital (other than mental hospitals) 261 191 158 - 48 -  EFFECTIVE INEFFECTIVE (e) Total number of visits to: (i) children under 5 years of age 26,382 5,488 (ii) persons aged 65 or over 7,624 1,422 (iii) other (excluding school nursing cases) 5,677 684 Total visits (1968) 39,683 7,594 Total visits 1967 44,737 7,972 Total visits 1966 39,725 6,924 1968 1967 1966 (f) Sessions attended at G.P's surgeries (included above) 326 258 275 (g) Phenylketonuria (i) children tested at home or clinic 3,264 3,657 3,881 (ii) special visits to homes to collect specimens 1,177 1,214 502 HOME NURSING (a) Cases visited for the first time in the year: CASES TOTAL VISITS 1968 1967 1966 1968 1967 1966 (i) aged under 5 405 114 97 1,478 648 556 (ii) aged 5 and under 65 1,798 1,136 665 29,815 28,745 26,812 (iii) aged 65 or over 2,363 1,754 1,127 95,154 90,574 91,708 Total cases 4,566 3,004 1,889 126,447 119,967 119,076 (b) Cases on the books at the end of the year 1968 1,188 1967 1,208 1966 1,198 LOAN OF SICKROOM EQUIPMENT New Issues in 1968 EQUIPMENT HEALTH & WELFARE DEPT. CHINGFORD RED CROSS EQUIPMENT HEALTH 8. WELFARE DEPT. CHINGFORD RED CROSS Commodes 139 71 Urine Bottles 46 47 Wheelchairs 90 69 Bed Boards (sets) 5 - Bed Cradles 56 47 Feeding Cups 12 27 Air Rings 66 51 Crutches (pairs) 3 10 Bed Pans 1 14 64 Air Beds 1 _ Back Rests 108 87 Bed Tables - 24 Rubber Sheets 1 65 Walking Sticks _ 2 Plastic Sheets 157 - - 49 - CHIROPODY TREATMENT NEW CASES CLINIC ATTENDANCES DOMIClLIARY TREATMENTS TREATMENTS AT OLD PEOPLES' RESIDENT! AL HOMES CASES BEING TREATED AT END OF YEAR Children 969 5,916 - - 609 Expectant mothers 4 14 - - - Physically Handicapped 4 186 2 - 75 Aged (over 65 years of age) 515 21,386 4,116 1,791 6,273 Others 795 15,017 - - 3,974 Total for 1968 2,287 42,519 4,118 1,791 10,931 Previous Years- 1967 2,955 49,497 4,031 1,690 12,006 1966 2,287 42,457 3,701 1,554 12,039 CONVALESCENCE The number of recuperative holidays provided for adult persons in accordance with Section 28 of the National Health Service Act, 1946 was 91. Recuperative holidays were also provided under Section 22 of the Act for I mother and 3 young children. HOME HELP SERVICE Visits by Home Help Organisers HOME HELP SERVICE NIGHT ATTENDANCE SERVICE FIRST VISITS TO HOMES RE-VISITS TO HOMES MISC. VISITS FIRST VISITS TO HOMES RE-VISITS TO HOMES MISC. VISITS HELP PRESENT OTH ERS HELP SEEN OTHERS ATTENDANT PRESENT OTHERS 1,428 803 5,500 529 399 1 - 4 - - 50 - Help provided AGED 65 OR OVER MATERNITY CHRONiC SICK (UNDER 65 YRS.) OTHERS (UNDER 65 YRS.) TOTALS 1968 1967 1966 Requests for help from new cases during year 1,065 129 147 92 1,433 1,318 1,521 Cases not eligible for assistance or not requiring service 186 36 29 27 278 252 266 New cases helped during year 880 88 121 68 1,157 1,062 1,175 Cases helped earlier in present year and re-opened 218 - 37 2 257 306 293 Total cases completed during year 917 88 164 72 1,241 1,242 1,375 Cases being helped at end of year 2,539 6 268 36 2,849 2,397 2,577 Total cases helped during year 3,456 94 432 108 4,090 3,639 3,952 Hours of help provided during year 338,979 1,884 34,314 4,956 380,133 419,553 422,919 Analysis of "Others" REASON FOR PROVISION OF HELP NEW CASES HELPED CASES COMPLETED CASES BEING HELPED AT END OF YEAR Mental disorder under 65 years 3 7 4 Help for harassed mothers 5 6 2 Problem family - - 1 Absence of mother 5 2 5 Acute Illness 52 55 21 Toxaemia 13 2 1 Others - - 2 Night Attendance Service (Attendance provided) PATIENTS RESIDING ALONE INABILITY OF AGED HUSBAND OR WIFE RELIEF OF RELATIVES Requests for help from new cases during year 1 1 1 New cases helped - - 1 Total cases completed - - 3 Cases being helped at end of year - - - Total cases helped during year - - 3 Hours of attendance provided - - 132 - 51 - Neighbourly Help Scheme AGED OTHERS TOTAL Cases being helped at beginning of the year 6 - 6 New cases commenced 21 1 22 Cases completed or ceased 8 - 8 Cases continuing at end of the year 19 1 20 SERVICES FOR BLIND, PHYSICALLY HANDICAPPED, DEAF AND OLD PEOPLE 1 (a) Blind persons registered at 31st December, 1968 AGE 04 5- 10 1115 16- 20 21 29 3039 4049 5059 6064 6569 7079 8084 8589 90 & OVER TOTAL M - 1 - 1 3 6 15 23 15 17 41 23 18 9 172 F 1 2 1 2 6 6 14 16 16 29 107 52 61 34 347 Total 1 3 1 3 9 12 29 39 31 46 148 75 79 43 519 Persons registered at 31st December, 1967 550 ,, ,, ,, ,, 1966 510 (b) Blind persons on register with other handicaps at 31st December, 1968 MENTALLY ILL MENTALLY SUBNORMAL PHYSICALLY DEFECTIVE DEAF WlTHOU T SP EECH DEAF WITH SPEECH HARD OF HEARING MENTALLY ILL & HARD OF HEARING MENTALLY SUBNORMAL 8c PH YSI C ALLY DEFECTIVE MENTALLY SUBNORMAL & HARD OF HEARING PHYSICALLY DEFECTIVE & DEAF WlTH SPEECH PHYSICALLY DEFEC T1 VE 8t HARD OF HEARING TOTAL M l 2 13 l 3 7 - - - 2 - 29 F A 2 22 1 12 21 I 1 1 - 3 68 Total 5 4 35 2 15 28 1 1 1 2 3 97 2. Partialy Sighted Persons at 31st December. 1968 AGE 5- 10 1115 16- 20 2129 3039 40- 49 5059 6064 65- 69 7079 8084 8589 90 & OVER TOTAL M 3 3 1 6 5 7 8 3 1 14 7 4 3 65 F 2 1 - 3 5 2 6 6 5 26 14 20 10 100 Total 5 4 1 9 10 9 14 9 6 40 21 24 13 165 Persons registered at 31st December, 1967 172 ,, ,, ,, ,, 1966 154 - 52 - 3 Deaf persons registered at 31st December 1968 1967 1966 Hard of hearing 147 169 186 Deaf with speech 115 117 204 Deaf without speech 16 18 9 Total registrations 278 304 399 N.B. This includes those on the blind register. 4 Physically handicapped persons registered at 31st December, 1968 CATEGORY UNDER 16 YEARS 16-29 30-49 50-64 65 & OVER TOTAL Amputation M - 2 1 6 19 28 F - - II 7 16 24 Arthritis and rheumatism M - - 1 20 61 82 F - 1 19 80 434 534 Congenital malformations and deformities M - 2 1 1 1 5 F 4 5 1 3 5 18 Disease of respiratory system (non-TB) M - 3 1 7 8 19 F - 3 1 2 3 9 Disease of digestive and genito urinary systems of heart or circulatory and of skin M . . . 11 33 44 F - - 3 14 48 65 Injuries to head, trunk or limbs M 1 4 5 12 20 42 F 1 2 3 19 64 89 Disease of spine and limbs M - - 2 2 3 7 F - - 6 1 3 10 Organic nervous disease; epilepsy; poliomyelitis; hemiplegia; sciatica; disseminated sclerosis M 1 22 33 80 78 214 F 1 22 43 91 85 242 Neurosis, psychosis and other nervous disorders M 1 3 2 2 - 8 F - 1 3 2 5 11 Tuberculosis (resp.) M - - - 3 - 3 F - - 2 - - 2 Tuberculosis (other) M - - 1 - 1 2 F - 1 - 1 4 6 Unspecified diseases and injuries M - 4 2 7 10 23 F - - 2 8 10 20 Total 9 75 133 379 901 1,507 Persons registered at 31st December, 1967 1,302 " " " 1966 1,033 - 53 - 5 Other services for the handicapped (a) Roberts Hall Occupation Centre Attendance during the year were 12,1 19 out of a possible 18,462 Number on rolI at 3I st December, 1968-129 (b) Rehabilitation Blind persons sent on course-Nil Other handicapped persons sent-Nil (c) Sheltered Workshops Blind persons in sheltered workshops - 5 Other handicapped persons in sheltered workshops - 4 (d) Homeworkers Number of blind workers supplemented by the authority - 6 Number of blind persons sent on training - Nil (e) Adaptations of Premises Adaptations carried out in 1968: Fixing of Shelves I Fixing of Handrai Is 69 Provision of downstairs toilets 6 Construction of bathroom I Provision of showers I Alterations to bathrooms 4 Provision of special baths for the handicapped 2 Alterations to bathrooms for equipment for the handicapped 2 Alterations to toilets 2 Provision of special wooden toilet seat with armrests I Provision and fixing of wooden bath seat I Provision of access to toilet 2 Provision of access to garde 3 Provision of window pull cords 2 Provision of hooks and pull chains 3 Provision of false floors I Provision of ramps - fixed 3 Provision of ramps - portable 4 Alterations to front elevation of house 2 Drive ways I Installation of stairlift I Provision of base for Invacar shed I Carriage crossings 3 Provision of new steps 4 Provision of electric pull cord I Raising of electric points 2 Provision of electric point for Invacar battery charging I Provision of electric heater/light I 125 Number of adaptations completed in 1967 71 " " " " " " 1966 34 - 54 - (f) Aids for Handicapped Persons Aids issued in 1968-459 (see table below) (g) Holidays for Handicapped Persons 1968 1967 1966 For the blind 29 35 40 For others 246 197 146 Personal helpers (both categories) 50 27 38 (h) Disabled Drivers Car badges issued-39 AIDS FOR PHYSICALLY HANDICAPPED EQUIPMENT PROVIDED ISSUED DURING 1968 ON LOAN AT 3.1.12. 1968 Bathing Aids:- Bath rails 46 73 " mats 57 156 " seats 27 121 " boards 3 4 Domestic Aids:- Egg cup holders 3 6 Helping hands and pick up sticks 55 129 Large handled knives 8 8 " " forks 2 7 " " spoons 0 3 Kitchen stools 1 1 Potato peeler 1 4 Tap turners 5 15 Tin openers 6 13 Bread boards 2 3 Toilet Aids:- Stocking pulls 24 53 Long handled sponges 1 2 " " shoe lift 5 13 Toilet frames 17 12 " seats 34 48 Bed Tables 5 7 Hoists 6 14 Lifting poles 1 6 Special chairs 30 58 Walking aids 102 184 Miscellaneous 18 42 459 982 Previous Years - 1967 545 768 1966 224 513 - 55 - -I - 56 - 6 People in Care Persons provided with accommodation at 31st December, 1968 (a) Analysis according to age:- UNDER 30 30-49 50-64 TOTAL 65-74 75-84 85 & OVER TOTAL TOTAL ALL AGES M F M F M F UNDER 65 M F M F M F OVER 65 1968 1967 1966 Persons accommodated in Waltham Forest Old Peoples' Homes:- (a) Waltham Forest Residents - - - - 8 6 14 16 17 40 104 20 89 286 300 303 282 (b) From other Local Authority areas - - - - 1 1 2 2 2 5 8 2 12 31 33 36 54 Persons from Waltham Forest accommodated in Homes outside the Borough:- (a) In Voluntary Organisations' Homes 2 2 7 6 2 1 20 3 10 2 13 11 45 84 104 107 107 (b) In other Local Authorities' Homes - - - - 2 3 5 2 2 8 15 9 23 59 64 68 92 Total number of persons from Waltham Forest in Residential Homes 2 2 7 6 12 10 39 21 29 50 132 40 157 429 468 478 481 Number of new permanent admissions during 1968 112 Number of temporary admissions during 1968 44 (b) Analysis according to defect:- BLIND DEAF EPILEPTlC PHYSICALLY HANDICAPPED MEN TALLY SUB-NORMAL MENTALLY ILL OTHERS TOTAL Persons accommodated in Waltham Forest Old Peoples* Homes (a) Waltham Forest Residents 3 19 3 108 13 80 74 300 (b) From other Local Authority areas - 3 - 8 2 - 20 33 Persons from Waltham Forest accommodated in Homes outside the Borough:— (a) In Voluntary Organisations' Homes 22 2 7 17 - - 56 104 (b) In other Local Authorities' Homes 1 6 - 16 - 1 40 64 Total number of persons from Waltham Forest in Residential Homes 26 27 10 141 13 81 170 468 (c) Waiting list for accommodation in homes for the elderly at 31st December, 1968 MALE FEMALE List "A" - priority grading 40 143 List 1 - persons residing at private addresses 13 43 List 2 - persons in hospitals and private homes wishing to be transferred 7 25 List 3 - persons in areas outside Waltham Forest wishing to be accommodated within this authority 2 16 List 4 - persons residing in Waltham Forest wishing to be accommodated by another authority 3 6 Totals 65 233 Total's in 1967 87 260 Total s in 1966 67 254 HOMELESS FAMILIES ACCOMMODATION Persons accommodated:- NO.OF FAMILIES NO.OF PERSONS Resident on I.I.1968 17 78 New admissions during year 32 131 Discharges during year 33 141 Resident on 31.12.1968 16 68 Of the 33 families discharged during the year 20 were rehoused by the Council and 13 left for unknown destinations or found accommodation privately. Length of stay:- UNDER 1 MONTH 1 MONTH AND UNDER 6 MONTHS 6 MON THIS AND UNDER 18 MONTHS 18 MONTHS AND OVER Families discharged 9 6 14 4 Families still in residence 2 9 5 0 MEALS-ON-WHEELS AND LUNCHEON CLUBS MEALS-ON-WHEELS LUNCHEON CLUBS Meals provided for:- Walthamstow residents 34,461 16,218 Leyton residents 33,593 20,284 Chingford residents 9,923 3,841 Totals 77,977 40,343 BURIAL OF THE DEAD Burial arrangements were made for 19 people who died within the Borough and for whom no private arrangements could be made. LAUNDRY FOR THE INCONTINENT ARTICLES LAUNDERED DOMICILIARY CASES RESIDENTIAL HOMES 30,707 20,282 - 57 - - 58 - MENTAL HEALTH SERVICE (a) Distribution of cases under care MENTALLY ILL ELDERLY MENTALLY IN FIRM PSYCHOPATHIC SUB-NORMAL SEVERELY SUB-NORMAL TOTAL UNDER 16 16 & OVER UNDER 16 16 & OVER UNDER 16 166. OVER UNDER 16 16 & OVER M F M F M F M F M F M F M F M F M F 1968 1967 1966 1. Total number - - 717 796 76 100 - 1 - - 8 7 221 173 59 48 76 59 2,342 1,679 1,062 2. Attending workshops/occupation training centres - - 32 6 - - - - - - 3 2 47 24 27 26 46 37 250 205 200 3. Awaiting entry to workshops/ occupation training centres - - - - - - - - - - 3 4 - - - - - - 7 3 1 4. Receiving home training - - - - - - - - - - - - - - - - - - - - 5. Awaiting home training - - - - - - - - - - - - - - - - - - - - - 6. Resident in L.A. home/hostel - - - - - - - - - - - - - - - - - - - - - 7. Awaiting residence in L.A. home/ hostel - - - - - - - - - - - - 7 3 - - - - 10 - - 8. Resident at L.A. expense in other homes/hostels - - 8 6 - - - - - - - - - - - 2 3 4 23 26 18 9. Resident at L.A. expense by boarding out in private household - - - - - - - - - - - - - - - - - - 2 2 1 10. Attending day hospitals - - - 2 - - - - - - - - - - - - - 2 - - 11. Receiving home visits and not included in lines 2-10 (a) suitable to attend a training centre - - - - - - - - - - - - - - - - - - - - - (b) others - 1 677 782 76 100 - 1 - - 2 1 167 146 31 19 27 18 2,048 1,443 842 - 59 - (b) Number of patients awaiting entry to hospital, or admitted for temporary residential care during 1968 MENTALLY ILL ELDERLY MEN TALLY IN FlRM PSYCHOPATHIC SUB-NORM AL SEVERELY SUB-NORMAL TOTAL UNDER 16 16 ft OVER UNDER 16 16 ft OVER UNDER 16 16 ft OVER UNDER 16 16 ft OVER M F M F M F M F M F M F M F M F M F 1968 1967 1966 A. Number of patients in L.H.A. area on waiting list for admission to hospital at 31.12.68 (i) in urgent need of hospital care - - - - - - - - - - - - - - - 2 - - 2 1 4 (ii) not in urgent need of hospital care - - I 2 - - - - - - - - - - 5 3 7 - 18 4 6 (iii) Total - - I 2 - - - - - - - - - - 5 5 7 - 20 5 10 B. Number of admissions for temporary residential care (e.g. to relieve the family) (i) to N.H.S. hospitals - - - - - - - - - - - - 11 2 8 3 5 1 30 29 27 (ii) to L.A. residential accommodation - - - - - - - - - - - - - - - - - - - - - (iii) elsewhere - - - - - - - - - - I - 9 4 10 16 20 12 72 71 15 (iv) Total - - - - - - - - - - 1 - 20 6 18 19 25 13 102 100 42 I 60 (c) Number of patients referred to Local Health Authority during year ended 31st December, 1968 REFERRED BY MENTALLY ILL PSYCHOP ATHIC SUB-NORMAL SEVERELY SUB-NORMAL TOTAL SUB-NORMAL AND SEVERELY SUB-NORMAL GRAND TOTAL OF COLS. 1 16 UNDER 16 16 & OVER UNDER 16 16 6c OVER UNDER 16 16 & OVER UNDER 16 16 & OVER M F M F M F M F M F M F M F M F UNDER 16 16 a OVER 1968 1967 1966 (i) General practitioners - - 153 204 - - - - - 1 - - - 1 - - 2 - 359 317 560 (ii) Hospitals, on discharge from inpatient treatment - 1 80 107 - - - 1 - - - - - - - - - - 189 168 196 (iii) Hospitals, after or during outpatient or day treatment - - 44 52 - - - - - - - - - - - - - - 96 121 148 (iv) Local education authorities - - - - - - - - 2 2 1 1 12 5 - - 21 2 23 23 19 (v) Police and courts - - 17 16 - - - - - - - - - - - - - - 33 39 42 (vi) Other sources - - 66 57 - - - - - - 4 4 - 2 1 1 2 10 135 148 334 (vii) Total - 1 360 436 - - - 1 2 3 5 5 12 8 1 1 25 12 835 816 1,299 (d) Mental Health Officers - Statutory and other work during the year VISITS IN CONNECTION WITH HOSPITAL ADMISSIONS OR PATIENTS ALREADY IN HOSPITAL PRELIMINARY VISITS FOLLOWING COMPLAINTS OR REQUEST FROM G.P. IN FORMAL ADMISSIONS ARRANGED MENTAL HEALTH ACT, 1959 VISITS TO PATIENTS IN HOSPITAL VISITS REGARDING PROTECTING OF PATIENT'S PROPERTY SECTION 25 SECTION 26 SECTION 29 512 150 33 4 54 484 25 COMMUNITY CARE INTERVIEWS WlTH AGENCIES CONTACTED OTHER VISITS NEW PATIENTS OTHER PATIENTS 390 3,075 584 804 (e) Training Centres BIRKBECK ADULT CENTRE QUEENS ADULT CENTRE WANSTEAD JUNIOR CENTRE Places provided 100 60 60 Trainees on register at end of year 90 57 59 Average daily attendance 82.1 52.1 47 - 61 - INFECTIOUS DISEASES - NOTIFICATIONS DISEASE 1ST OUARTEB 2ND QUARTER 3RD QUARTER 4 TH QUARTER TOTAL. Scarlet Fever 41 16 11 11 79 Whooping Cough 60 16 32 18 126 Measles 22 50 131 105 308 Tuberculosis 25 18 25 20 88 Typhoid - - - - - Paratyphoid - - - - - Meningococcal Infection - - 1 - 1 Acute Meningitis - - - 3 3 Dysentery 25 38 24 48 135 Ophthalmia Neonatorum - - 1 - 1 Puerperal Pyrexia 2 2 6 - 10 Acute Pneumonia 39 1 1 - 41 Food Poisoning - 1 1 2 4 Erysipelas 5 5 3 - 13 Acute Encephalitis - - - - - Infective Jaundice - - 6 3 9 Totals 219 147 242 210 818 Note: In accordance with Statutory Instrument 1366 a revision of the list of notifiable infectious diseases was introduced in October, 1968. TUBERCULOSIS New Notifications and Deaths during 1968 AGE PERIODS NEW CASES DEATHS PULMONARY NONPULMONARY PULMONARY NONPULMONARY M F M F M F M F Under I year - - - - - - - - 1-4 years - 1 - - - - - - 5-9 years - - 1 - - - - - 10 - 14 years - - 1 - - - - - 15 - 19 years 3 2 - 2 - - - - 20 - 24 years 2 3 1 2 - - - - 25 - 34 years 7 2 2 3 - - - - 35 - 44 years 10 3 1 - - - - - 45 - 54 years 6 1 - - 1 - - - 55 - 64 years 14 3 - 3 1 - - - 65 and over 7 3 2 3 5 1 2 - 49 18 8 13 7 2 2 - Totals 67 21 9 2 88 11 - 62 - Tuberculosis among Immigrants Cases of tuberculosis among immigrants seen at the local Chest Clinic numbered 27. These occurred in the following groups:- RESPIRATORY NON-RESPIRATORY Pakistani 13 7 Indian 3 2 Italian 1 1 Tuberculosis - Care and Aftercare (a) Extra Nourishments fall Chest Cases) (i) Number of new cases supplied with free milk during the year 7 (ii) Persons receiving free milk at end of year 68 (b) Work of Tuberculosis Visitors (i) Visits to new cases 141 (ii) Total visits to households 1,616 (iii) Sessions attended at Chest Clinic 786 (c) Contacts Examination of contacts during the year (i) first examinations 460 (ii) subsequent examinations 823 - 63 - VACCINATION AND IMMUNISATION TYPE OF COURSE OR DOSE YEAR OF BIRTH OTHERS UNDER 16 YEARS TOTAL 1 968 1 967 1 966 1 965 1961-64 Diphtheria - Primary 1.228 2,916 129 42 121 23 3,459 Booster 22 794 1.540 I74 2,056 115 4,701 Whooping Cough - Primary 1,223 1,901 122 39 71 8 3,364 Booster 4 754 1,480 146 545 39 2,968 Tetanus - Primary 1.230 2,919 128 43 178 129 3,627 Booster 22 794 1,542 178 2,103 214 4,853 Poliomyelitis - Primary 1,199 1,984 165 52 235 30 3,665 Booster 3 810 1,686 152 2,080 112 4,843 Measles 4 217 254 252 1,224 105 2,056 TYPE OF VACCINE USED IMMUNISATIONS OR VACCINATIONS COMPLETED BY GENERAL PRACTITIONERS IMMUNISATIONS OR VACCINATIONS COMPLETED BY BOROUGH STAFF PRIMARY COURSES REIN FORCING DOSES PRIMARY COURSES REINFORCING DOSES Diphtheria, Whooping Cough, Tetanus and Poliomyelitis combined - - - - Diphtheria, Whooping Cough and Tetanus combined 1,744 1,534 1,608 1,434 Diphtheria and Whooping Cough combined - - - - Diphtheria and Tetanus combined 32 480 65 1,217 Diphtheria only 9 6 1 20 Whooping Cough only 12 - - - Tetanus only 95 138 83 40 Poliomyelitis:- (a) Salk - - - - (b) Sabin 1,810 1,856 1,855 2,787 SmalIpox 1,199 120 921 1 Measles 1,041 - 1,015 - - 64 - B.C.G. Vaccination of Children Results of Heaf Test:- (a) Tuberculin Positive 118 (b) Tuberculin Negative 1,476 Number vaccinated with B.C.G 1,476 REGISTRATION OF PREMISES Public Health Act, 1936 - Nursing Homes BEDS PRO VIDEO NO.OF HOMES MATERNITY OTHERS Homes registered at 31st December, 1968 1 - 71 National Assistance Act, 1948 - Disabled Persons and Old Persons Homes NO.OF HOMES BEDS PROVIDED Homes registered at 31st December, 1968 9 103 Mental Health Act, 1959 - Nursing and Residential Homes NO.OF HOMES BEDS PROVIDED Nursing Homes registered at 31st Dec. 1968 1 120 Residential Homes registered at 31st Dec. 1968 2 36 Essex County Council Act, 1933 - Establishments for Massage and Special Treatment CHIROPODY MASSAGE ETC. Establishments registered at 31st Dec. 1968 11 7 MEDICAL EXAMINATIONS OF STAFF Completed during period 1st January to 31st December, 1968:- Medical Examinations 1,256 Medical Assessments 190 - 65 - GENERAL DENTAL SERVICE Number of Sessions 214 Number of appointments made 1,458 Number of new patients seen 240 Analysis of Treatments Provided Fillings - Plastic 159 Amalgam 443 Inlays 2 Crowns 6 Scaling and gum treatment 231 Dressings 126 Extractions 123 General Anaesthetic given 7 Local Anaesthetic given 151 X-rays 354 Dentures supplied 124 Dentures repaired 80 Impressions 303 Bites 69 Try-in 141 Orthodontic cases completed and discharged I Minor Oral surgery 2 Other treatment 258 DENTAL LABORATORY DENTURES REPAIRS REMAKES OR RELINE APPLIANCES CROWNS INLAYS STUDY MODEL TRAYS General Dental Service 10 80 11 2 5 1 - 107 School Dental Service 7 21 2 102 19 4 290 3 Maternity and Chi Id Welfare 13 3 - - 2 1 - 4 - 66 - PUBLIC HEALTH INSPECTION 1. Inspections, Re-inspections, Action (a) GENERAL STATUTORY PROVISIONS COMPLAINTS RECEIVED INSPECTIONS AND RE-INSPECTIONS INFORMAL NOTICES SERVED FORMAL NOTlCES SERVED HOUSES CLASSIFIED Clean Air Act, 1956 122 6,237 - 1,305 - Housing Acts, 1936/61 and Regulations - 3,809 41 76 408 Public Health Acts, 1936/6 1, and Noise Abatement Act, I960 4,007 23,090 883 376 - Prevention of Damage by Pests Act, 1949 1 ,998 10,991 24 11 - Food and Drugs Act, 1955 and Food Hygiene Regulations, 1960/66 178 3,377 114 - - Factories Act, 1961 46 386 41 - - Pet Animals Act, 1951, Riding Establishments Act, and Animal Boarding Establishments Act, 1963 - 59 - - - Offices, Shops and Railway Premises Act, 1963 - 2,509 269 - - - 67 - (b) DETAILED (i) Rent Act, 1957 - Para. 4. First Schedule Applications for certificates received 6 Decisions not to issue certificates Nil Decisions to issue certificates 6 Undertakings given by landlords under paragraph 5 of the First Schedule 2 Undertakings refused by local authority under proviso to paragraph 5 of the First Schedule Nil Certificates issued 4 Applications by landlords for cancellation Nil Objection by tenants to cancellation Nil Certificates cancelled by local authority Nil Applications for certificates (Form P) 1 Discrepancies in the above figures are caused by procedure in some cases extending over December - January. (ii) Housing Acts, 1957/64. Housing (Consolidated) Regulations, 1925/32. (a) Individual Houses - Demolition/Closing Orders Undertakings accepted (Section 16) 10 Closing Orders made 54 Demolition Orders made (Section 17) Nil Closing Orders revoked and Demolition Orders substituted (Section 28)Nil Orders/Undertakings determined 2 (b) Slum Clearance Areas Number of areas represented (Sections 42 & 157 (1)) 9 Houses unfit for human habitation 36 Houses included by reason of bad arrangement Nil Houses on land acquired under 43 (2) 29 Numbers of people to be displaced (a) Individuals 225 (b) FamiIies 81 (c) Compulsory Purchase Orders confirmed The Waltham Forest Housing Part III (Acacia Road Area) Order 1967 comprising 11 clearance areas was confirmed by the Ministry of Housing and Local Government during the year. (iii) Food and Drugs Act, 1955 (Inspection and Supervision of Food Premises) The following inspections were carried out at the under-mentioned food premises in accordance with the requirements of the Public Health Act, 1936, Food and Drugs Act, and Food Hygiene (General) Regulations, I960, Ice-cream (Heat Treatment) Regulations, 1947/52, Factories Act, 1961, Leyton Corporation Act, 1950, Essex County CounciI Act, 1952, and relevant legislation. TYPE OF PREMISES NUMBER OF INSPECTIONS Retail Food Shops 1,990 Catering establishments (including factory canteens, hospitals, nursing homes, school meals kitchens) 510 Food Hawkers/Street Traders/Fairgrounds 567 Food Manufacturers/Depots, Dairies, Bakehouses 138 Off-Licences 69 Public Houses 103 3,377 - 68 - (iv) The Offices, Shops and Railway Premises Act, 1963 (a) Registrations and General Inspections CLASS OF PREMISES NO. OF PREMISES REGISTERED DURING THE YEAR TOTAL NO. OF REGISTERED PREMISES AT END OF YEAR NO. OF REGISTERED PREMISES RECEIVING A GENERAL INSPECTION DURING THE YEAR Offices 26 482 40 Retail shops 28 1,584 132 Wholesale shops, warehouses 6 90 10 Catering establishments open to the public, canteens 4 179 8 Fuel storage depots - 6 - Totals 64 2,341 190 Number of visits of all kinds by Inspectors to registered premises 2,509 (b) Analysis of Contraventions Found SECTION NO. OF CONTRAVENTIONS FOUND SECTION NO. OF CONTRAVENTIONS FOUND 4 Cleanliness 45 12 Clothing Accommodation 3 5 Overcrowding Nil 13/14 Seating Facilities 1 6 Temperature 39 15 Eating Facilities Nil 7 Ventilation 2 16 Floors, passages and stairs 36 8 Lighting 11 17/18/19 Machinery 3 9 Sanitary Conveniences 76 23 Prohibition of heavy work Nil 10 Washing Facilities 76 24 First Aid General Provisions 53 11 Supply of Drinking Water Nil 50 Exhibition of Forms 47 Total 392 - 69 - (c) Analysis of Persons Employed in Registered Premises by Workplace CLASS OF WORKPLACE NUMBER OF PERSONS EMPLOYED Offices 4,281 Retail shops 7,241 Wholesale departments, warehouses 1,046 Catering establishments open to the public 1,163 Canteens 72 Fuel storage depots 58 Total 13,861 Total Males 6,268 Total Females 7,593 (d) Reported Accidents WORKPLACE NUMBER REPORTED ACTION RECOMMENDED NO ACTION PROSECUTION FORMAL WARNING INFORMAL ADVICE Offices 2 - - 2 - Retail shops 32 - - 32 - Wholesale shops, warehouses 2 - - 2 - Catering establishments open to public, canteens 3 - - 3 - Fuel storage depots - - - - - Totals 39 - - 39 - - 70 - (e) Legal Proceedings NO. PR\EMISES NO. CONTRAVENT1ONS Legal Proceedings pending 1967 7 20 Legal Proceedings authorised by the Council 18 67 Legal Proceedings instituted 16 56 Legal Proceedings pending 2 11 Analysis of Legal Proceedings (1) sec. act/reg. (2) nature of offence (3) number of offences (4) fines imposed £ 6 (4) Failure to provide a thermometer 5 14 7 (1) Failure to provide effective and suitable ventiIation 1 5 9 (I) Failure to provide suitable and sufficient sanitary convenience 3 I2 9 (2) & San.Con. Regs. Failure to maintain a sanitary convenience 18 90 10 (I) & The Wash.Fac. Regs. Failure to provide adequate washing facilities 8 48 10 (2) & The Wash.Fac. Regs. Failure to maintain washing facilities 8 33 13 (1) Failure to provide seating facilities 1 2 16 (1) Failure to maintain the floors of the premises 11 69 16 (2) Failure to provide a hand rail or handhold to a staircase 2 15 17 (1) Failure to fence exposed parts of machinery 1 2 24 (1) First Aid General Provisions 6 26 50 & Inf. Emp. Regs. Failure to provide information for employees 12 53. 2. 0. Total 76 £369. 2. 0. Total Costs awarded to the Council £142.1 3. 0. (v) Prevention of Damage by Pests Act, 1949 - Rodent and Pest Control/Disinfestation/ Disinfection Complaints received 1,998 Inspections and Re-inspections 10,991 Premises treated 1,095 - 71 - 2. Nuisances Abated, Defects Remedied, Improvements Effected (i) PUBLIC HEALTH ACTS Nature of work carried out to dwelling houses and other premises:- Cement work to sink waste gullies repaired 49 Choked drains cleared 3 Dampness remedied 824 Floors repaired 145 Guttering repaired or renewed 227 Miscellaneous defects remedied 326 New W.C. pans and traps provided 32 Plaster work repaired 335 Rainwater pipes repaired or renewed 82 Roofs repaired or renewed 409 Rooms redecorated 9 Sashcords renewed 166 Sinks provided 10 Sink waste pipes repaired or renewed 41 Stoves repaired or renewed 28 Vent pipes repaired or renewed 27 W.C. cisterns repaired or renewed 85 Window-sills, etc., repaired 109 Yard provided 24 (ii) FOOD AND DRUGS ACTS/FOOD HYGIENE REGULATIONS Nature of contraventions and improvements effected to food establishments and business/ industrial premises as a result of statutory and informal action:- Walls/Doors/Windows not kept clean or repaired 615 Ceilings not kept clean or repaired 140 Floors not kept clean 46 Inadequate ventilation 23 Inadequate receptacles for refuse 33 Accumulation of refuse in room 25 Cleanliness of apparatus and fittings 48 Facilities for personal cleansing and/or washing food and equipment inadequate, i.e.:- Wash basins 27 Hot water 56 Soap/Towel/Nail brushes 39 Sinks 11 Food not protected from contamination 73 First-aid equipment 27 Wash-hand notices 17 Inadequate locker (clothing) accommodation 19 Redecoration 53 Miscellaneous 76 Artificial light in W.C 12 W.C. pans renewed 3 Yard paving 9 Roofs repaired 3 Name and address not displayed 5 - 72 - 3. Registration and/or Licensing of Business Premises (i) Approximate number of business premises in the Borough and functions involved. offices, shops and railway premises act, 1963 no. food premises business designation *subsidiary functions no. Registration Baker 94 Local Authority 2,341 Butcher 131 H.M.F. Inspector 906 Canteen/Staff* 71 Exempt 1 ,942 Canteen/School* 68 Total 5,189 Catering/Public 179 Class of Premises Registered by Local Authority Catering/Misc.* 3 Chemist 84 Office 482 Confectionery 271 Retail Shop 1,584 Fish Monger 47 Wholesale 90 Catering/Public 179 Fish Frier 49 Fuel Store 6 Greengrocer 155 Factories Act, 1961 Grocer/General 318 Power 906 Off Licence 94 Non-power 24 Public House 68 Trade Store/Multiple 14 Depots/Food Storage 63 Non-food 3,622 Stall/Vehicle 294 Food 1 ,567 - 73 - (ii) Details of Registrations/Licences ACT OR REGULATION ON REGISTER 31.12. 1966 Food and Drugs Act, 1955 Ice-Cream Premises 840 Food Preparation, etc. Premises 91 Milk and Dairies (General) Regulations, 1959 Distributors 242 Dairies 7 Milk (Special Designation) Regulations, I960 Pasteurised 181 Sterilised 213 Untreated 27 Ultra Heat Treated 48 Essex County Council Act, 1952 Hawkers of Food 188 Hawkers' Storage Premises 36 Leyton Corporation Act, 1950 Section 63 - Vendors of Shellfish 14 Section 48 - Hairdressers' Premises 233 Pet Animals Act, 1951 Annual Licences 25 Animal Boarding Establishments Act, 1963 3 Rag Flock and Other Filling Materials Act, 1951 7 Riding Establishments Act, 1964 3 Total 2,158 4. Legal Proceedings (i) Public Health Acts. 1936/61; Clean Air Act, 1956 99 applications were made for legal proceedings to enforce the requirements of notices served. 15 cases were subsequently heard by the court and abatement orders made. The remaining 84 cases were withdrawn before the court hearing, or after adjournment, the work required by the notices having been completed. (ii) Food and Drugs Act, 1955 107 complaints regarding foodstuffs were investigated and 39 reported to the Health and Welfare Committee. A wide variety of food was implicated, i.e. milk, bread, cakes, sausages, tinned goods, bacon and confectionery. The reason for the complaint was either the presence of foreign matter or the appearance of mould growth on the food. The Committee authorised legal proceedings in respect of 19 cases and dealt with the remainder 20 by warning letters and/or representations to manufacturers. (iii) Food Hygiene (General)Regulations, I960 and Food and Drugs Act, 1955 Legal proceedings were authorised in respect of 29 contraventions under Food Hygiene (General) Regulations, I960 and Food and Drugs Act, 1955. Analysis of Legal Proceedings sec. act/reg. nature of offence numb er o f o f f en c es fin es imposed £ 5 The food business carried on in insanitary premises 2 35 6 Articles of equipment not kept clean and in good order and condition 6 35 8 Food so placed as to involve risk of contamination 3 20 14 Sanitary convenience ventilating directly into a food room 2 10 14 Failure to exhibit "wash hands" notice 3 6 16 Failure to provide a wash basin and/or hot and cold water supply and/or hand washing requisites 3 30 18 Failure to provide accommodation for employees' clothing 2 10 19 Suitable facilities for washing food and equipment not prov ided 2 15 23 WalIs/floors/ceilings and/or woodwork not maintained in clean condition 4 30 FOOD AND DRUGS ACT, 1955 Section 16 Failure to register premises for the preparation and cooking of food 2 4 Total 29 195 Total Costs awarded to the Council 81. 2. 0. - 75 - (iv) Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 Legal proceedings were authorised in respect of 30 contraventions under Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966. Analysis of Legal Proceedings sec. act/reg. nature of offence number of offences fines imposed £ s. d. 7 Food not protected from risk of contamination 5 6. 10. 0. 9 Persons handling open food not wearing washable overclothing 2 2 13 The name and address of the person carrying on the food business was not legibly and conspicuously displayed 8 14 16 Failure to provide suitable wash hand basin 1 5 17 Failure to provide bandages, dressings and antiseptics for first aid treatment 6 11 18 Failure to provide facilities for washing and sorting food and equipment 1 5 21 The stall was not suitably covered and screened at the sides and back thereof in such a manner as to prevent any mud, dust, dirt, filth or other contaminating substance from being deposited upon any open food thereon 5 11. 10. 0. 22 Failure to provide sufficient number of covered receptacles for waste trimmings and refuse 2 2. 10. 0. Total 30 57 10. 0. Total Cost awarded to the Council 22. 11. 0. - 76 - 5. Sampling • Food and Drugs Act, 1955 Samples Submitted for Chemical and Bacteriological Examination type of examination and analysis of results Mlsc. foods milk ice cream Ice lollies cooked meats water drinking swimming pools No. Chemical 178 - - - - 7 4 No. Bacteriological 19 54 64 - 92 3 23 No. Satisfactory 176(C) 14(B) 54 53 - 55 7(C) 3(B) 4(C) 23(B) No. Fairly Satisfactory 5(B) - 7 - 34 - - No. Unsatisfactory 2(C) - 4 - 3 - - 6. Meat and Food Condemned Condemnation certificates were issued in respect of the under-mentioned unsound foodstuffs surrendered by various traders in the Borough as a result of routine inspection of food premises. commodity tins packets/ boxes/ bottles quantity tons cwt. st. lbs. Tinned Goods 3,082 - - - - - Tinned Meats 131 - - 8 1 7 Tinned Fruit 102 - - 6 1 2 Drinks - 2,554 - - - - Frozen Foods - 8,538 - - - - Cereals, Dried Goods, etc - 1,489 - - - - Fish - - - 4 7 2 Meat - - 1 16 7 2 Vegetables - - - 1 4 - Fruit - - 2 16 5 2 Mango Pickle - - 4 15 - - *Condemned at the request of H.M. Customs and Excise. - 77 - 7. Factories Act, 1961 The following are the prescribed particulars required by Section 153 (1) of the Factories Act, 1961, to be included in annual reports. 1. Inspections premises ( 1) number on register ( 2) number of inspect ions (3) written notices (4) occupiers prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 24 23 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 906 332 41 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 45 31 - - Total 975 386 41 - 2. Cases in which defects, were found particulars number of cases in which defects were found number of cases in which prosecutions were instituted Found remedied referred to H.M. by H.M. inspector inspector (1) 92) (3) (4) (5) (6) Want of cleanliness 7 4 - 2 - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3). - - - - - Inadequate ventilation (S.4) 5 2 - 2 - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) - - - - - (a) Insufficient 11 6 - 7 - (b) Unsuitable or defective 37 32 - 32 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to out-work) - - - - - Total* 60 44 - 43 - *See also Contraventions-under the.Offices, Shops and Railway Premises Act, 1963. - 78 - 3. Outwork nature of work section 133 section 134 no. of outwork ers in august list required by section 133 (1) (c) no. of cases of default in sen ding lists to the council no. of prosecution sfor failure to supply lists no. of in st an ces of work in unwhole- som e premises notices served prosecutions Wearing apparel Making 128 - - - - - Footwear - - - - - - Umbrellas, etc. 8 - - - - - Handbags 6 - - - - - Artificial flowers 9 - - - - - Garment hangers 8 - - - - - Boxes, etc. wholly or partly of paper Making 11 - - - - - Gents Neckwear 8 - - - - - Upholstery trimmings - - - - - - Brushes 6 - - - - Loose cover specialist - - - - - - Toys - - - - - - Watch strap - • - - - - Buttons, carding - - - - - - Christmas crackers, etc. 9 - - - - - Belts for power transmissions - - - - - - Lampshades - - - - - - Household Linen 3 - - - - - Curtain and furniture hangings - - - - . - File making - - - - - - Furniture and upholstery - - - - - - Caning - - - - - - Hampers and Baskets 6 - - - - - Paint Boxes 2 - - - - - Total 204 - - - - - - 79 - SCHOOL HEALTH SERVICE SCHOOL POPULATION number of schools number of pupils on school registers at end of year Nursery 1 80 Primary 73 18,503 Secondary 27 12,142 Special 6 496 Totals -1968 107 31,221 1967 103 30,169 1966 106 29,427 SCHOOL MEDICAL INSPECTION (a) Periodic Medical Inspections 1968 1967 1966 5 year age group 2,719 2,466 2,081 10-11 year age group 1,480 2,173 2,685 14 years age group 2,018 1,974 2,343 Others 1,315 1,568 904 Total 7,532 8,181 8,013 No. of special inspections 1,618 1,598 1,639 No. of re-inspections 4,701 4.937 4,740 6,319 6,535 6,379 (b) Physical Condition of Children Inspected age group inspected (by year of birth) no. of pupils inspected pupils whose condition was classifled unsatisfactory 1964 and later 58 - 1963 1,249 5 1962 1,470 2 1961 293 2 I960 113 - 1959 181 1 1958 1,045 - 1957 435 2 1956 119 - 1955 173 - 1954 378 - 1953 and earlier 2,018 - Total 7,532 12 - 80 - (c) Individual Pupils found to require treatment and Periodic Medical Inspections during the year (excluding dental diseases and infestation with vermin) age group inspected (by year of birth) individual pupils found to require treatment for defective vision (excluding squint) for any other conditlon total Individual pupils 1964 and later - 13 13 1963 99 172 250 1962 108 266 338 1961 37 70 94 I960 17 11 24 1959 21 46 61 1958 130 199 294 1957 46 119 153 1956 10 17 26 1955 19 16 33 1954 66 30 88 1953 and earlier 293 227 475 Total 846 1,186 1,849 - 81 - (d) Pupils found to have undergone tonsillectomy age group no. inspected no. pound to have undergone tonsillectomy boys girls boys girls Infant 1,340 1,379 42 32 Junior 781 699 74 59 Leaver 933 1,085 84 94 Other 745 570 63 38 Totals 3,799 3,733 263 223 (e) Pupils found to have defects of colour vision intermediate inspections leaver inspections others Tested for Colour Vision 1,480 2,018 851 Found to have defects of colour vision 29 37 20 (f) Parents present at Medical Inspection no. inspected parent present percent. Infant Boys 1,340 1,209 90.0 Girls 1,379 1. 137 82.4 Junior Boys 781 604 77.3 Girls 699 535 76.4 Leaver Boys 933 99 10.6 Girls 1,085 248 23.7 Other Boys 745 386 51.8 Girls 570 380 66.6 - 82 - 00 0 (g) Defects found by Periodic and Special Inspections during the year DEFECT CODE NO. DEFECT OR DISEASE PERIODIC INSPECTIONS SPEClAL INSPECTIONS ENTRANTS LEAVERS OTHERS TOTAL (ALL GROUPS) TREATMENT OBSERVATION TREATMENT OBSERVATION TREATMENT OBSERVATION TREATMENT OBSERVATION TREATMENT OBSERVATION 4 Skin 19 22 87 38 114 88 220 148 139 35 5 Eyes (a) Vision 99 50 293 50 454 106 846 206 96 53 (b) Squint 22 21 9 8 46 26 77 55 6 3 (c) Other 20 7 4 7 14 29 38 43 20 6 6 Ears (a) Hearing 7 40 4 13 56 139 67 192 48 47 (b) Otitis Media 4 33 1 12 27 84 32 129 5 7 (c) Other 4 14 5 5 26 23 35 42 28 16 7 Nose and Throat 38 167 17 39 98 276 153 482 38 34 8 Speech 21 54 2 5 44 83 67 142 15 8 9 Lymphatic Glands 3 32 3 10 4 96 10 138 5 8 10 Heart 9 24 1 16 15 112 25 152 3 2 11 Lungs 16 34 7 21 51 100 74 155 11 12 12 Developmental (a) Hernia 3 9 5 4 2 28 10 41 2 1 (b) Other 13 73 13 40 35 246 61 359 7 32 13 Orthopaedic (a) Posture 3 18 6 41 16 59 25 118 5 2 (b) Feet 28 73 16 48 88 153 132 274 16 8 (c) Other 8 17 28 27 47 111 83 155 34 14 14 Nervous System (a) Epilepsy 1 4 2 3 6 5 9 12 2 3 (b) Other 1 14 5 10 8 41 14 65 4 5 15 Psychological (a) Development — 4 53 3 14 23 110 30 177 || 13 (b) Stability 3 118 5 24 57 432 65 574 35 49 16 Abdomen 2 6 5 10 7 31 14 47 3 2 17 Other 6 18 3 27 18 45 17 70 126 61 OTHER MEDICAL INSPECTIONS (a) Employment of children (other than in entertainment) (i) initial examinations 160 (ii) re-examinations - (b) Employment of children in entertainment (i) initial examinations 6 (ii) re-examinations - EXAMINATIONS BY SCHOOL NURSES Head Inspections Number of examinations 19,663 Number of children found to be unclean 220 Vision Testing at School Number of children tested 22,576 Number referred to Eye Clinic 596 Foot Inspections at School Number of children inspected 6,981 Number referred for treatment 202 MINOR AILMENT CLINICS New Cases Boys Girls Ringworm - Head 4 2 Body - - Scabies 1 - Impetigo - - Other Skin Diseases 98 95 Defective Vision and Squint 124 153 Other Eye Defects 11 16 Defective Hearing 157 103 Other Ear Diseases 39 42 Nose and Throat Defects 98 99 Speech Defects 37 18 Lymphatic Glands 21 26 Heart and Circulation 7 13 Respiratory Diseases 38 21 Developmental Defects 125 70 Orthopaedic Defects 88 85 Nervous Disorders 30 24 Psychological Disorders 157 123 Other Defects and Diseases 151 137 1,186 1,027 Total attendances 4,534 - 84 - SPECIALIST CLINICS 1968 1967 1966 (a) Aural Sessions 61 58 58 New cases 271 274 269 Total attendances 794 797 813 Referred to hospital for operative treatment 192 227 233 (b) Ophthalmic Sessions 373 343 365 New cases 877 931 849 Attendances 5,342 5,731 5,665 Glasses prescribed 1,215 1,246 1,198 Glasses obtained (i) through H.M.C. optician 919 971 973 (ii) privately 270 278 225 (c) Orthoptic Sessions 340 405 408 New cases 253 278 224 Attendances 2,011 2,297 2,052 (d) Orthopaedic Sessions 59 62 58 New cases 331 407 428 Attendances 1,418 1,455 1,377 Appliances provided 215 189 159 (e) Physiotherapy Sessions 644 634 646 New cases 146 167 273 Attendances 2,760 2,927 3,672 (f) Paediatric Sessions 22 24 23 New cases 85 109 90 Attendances 180 205 182 (g) Child Guidance Cases referred or re-opened for treatment during year:- (i) Under 5 years Boys 43 38 46 Girls 21 17 27 (ii) Over 5 years Boys 230 235 204 Girls 139 141 143 433 431 420 Cases closed during year 170 229 326 - 85 - (g) Child Guidance (contd.) 1968 1967 1966 Interviews conducted during the year:- Psychiatrists 2,655 1,963 2,085 Psychotherapists 541 316 - Psychiatric Social Workers 3,595 2,848 2,572 Educational Psychologists 278 570 730 Remedial Teacher 320 343 358 DENTAL INSPECTION AND TREATMENT (a) Attendances and Treatment ages 5 to 9 ages 10 to 14 ages 15 and over totals 1968 1967 1966 First visit 3,539 2,025 352 5,916 6,280 6,535 Subsequent visits 5,578 3,918 776 10,272 8,645 12,862 Total visits 9,617 5,943 1,128 16,188 14,925 19,397 Additional courses of treatment commenced 549 268 34 851 889 808 Fillings in permanent teeth 3,215 4,815 1,018 9,048 9,813 10,136 Fillings in deciduous teeth 5,946 586 - 6,532 6,222 7,570 Permanent teeth filled 2,625 4,076 840 7,541 7,154 7,758 Deciduous teeth filled 6,208 520 - 5.728 4,814 5,792 Permanent teeth extracted 137 502 108 747 835 941 Deciduous teeth extracted 2,577 742 - 3,319 3,670 4,000 General anaesthetics 1,005 402 45 1,452 1.724 1,664 Emergencies 176 77 7 260 351 601 1968 1967 1966 Pupils X-rayed 332 507 464 Prophylaxis 1,714 1,481 1.522 Teeth otherwise conserved 782 1,402 1,717 Teeth root filled 27 75 81 Inlays 1 8 3 Crowns 39 38 45 Courses of treatment completed 4,893 4,748 5,155 - 86 - (b) Orthodontics 1968 1967 1966 New cases commenced during year 70 134 139 Cases completed during year 92 77 82 Cases discontinued during year 13 44 35 Removable appliances fitted 97 158 158 Fixed appliances fitted - 5 5 Pupils referred to Hospital Consultant 2 13 13 (c) Prosthetics 5 TO 9 10 TO 14 15 a OVER TOTAL Pupils supplied with F.U. or F.L (first time) - - - - Pupils supplied with other dentures (first time) - 2 2 4 Numbers of dentures supplied - 2 2 4 1968 1967 1966 (d) Anaesthetics General Anaesthetics administered by:- Dental Officers - - - Medical Officers 846 1,749 1,640 (e) Inspections (i) First inspection at school:- Number of PupiIs 13,513 12,772 16,831 (ii) First inspection at clinic:- Number of PupiIs 3,405 2,673 3,486 Number found to require treatment 9,637 7,629 10,650 Number offered treatment 7,808 6,322 9,013 (iii) Pupils re-inspected at school clinic 999 494 1,048 Number found to require treatment 252 270 483 (f) Sessions Sessions devoted to treatment 3,278 3,481 4,069 Sessions devoted to inspection 122 134 207 Sessions devoted to Dental Health Education 25 54 39 - 87 - SPEECH THERAPY (a) Attendances davvlish road hatch lane hurst road total (1) (2) Number in attendance at beginning of year 96 77 8 80 261 Number under observation at beginning of year 117 5 106 31 259 New cases 82 45 29 27 183 Re-admitted 3 - 5 - 8 Transfer from other clinics - 3 1 5 9 Discharges - cured 39 52 38 25 154 improved 2 1 30 9 42 defaulted 2 6 6 3 17 Transferred to other clinics 1 5 4 6 16 - left district 25 2 5 5 37 - no progress - - 1 - 1 Number in attendance at end of year 99 64 33 73 269 Number under observation at end of year 130 - 22 77 184 (b) Analysis of defects treated DAWLiSH RO AD HATCH LANE HURST ROAD TOTAL. (1) (2) Stammer 12 1 1 28 11 62 Dyslalia 119 93 96 51 359 Stammering and dyslalia 3 4 4 9 20 Delayed language development 28 18 10 29 85 Cleft palate speech 1 2 2 5 10 Voice defects 2 1 2 2 7 Speech defect due to deafness 2 - 3 17 22 Defects of neurological origin 2 1 1 17 21 Unclassified 6 - 3 2 1 1 New cases referred 210 Attendances during year 6,003 - 88 - HANDICAPPED PUPILS BLIND PARTIALLY SIGHTED DEAF PARTIAL HEARING PHYSICALlY HANDICAPPED DELICATE MALADJUSTED E.S.N. EPILEPTIC SPEECH DEFECT TOTAL Children newly assessed as handicapped during year ended 31.12.1968:- Boys - - - 3 9 2 17 15 - - 46 Girls - 1 1 1 7 - 1 13 - - 24 ChiIdren who on 23.1.1969 were receiving special educational treatment:- (i) at maintained special schools:- (a) Day - 9 10 13 58 18 34 214 1 - 357 (b) Boarding - 2 - 1 2 - 8 11 - • 24 (ii) at non-maintained special schools:- (a) Day - - - - - - - - - - - (b) Boarding - - - - 1 2 1 3 1 - 8 (iii) at independent schools - - - 1 - - 16 1 - - 18 (iv) at boarding homes - - - - - 1 - - - - 1 (v) special classes or units - - - 3 - - - - - - 3 Children awaiting placement in special schools at 23.1.1969. - - - 1 4 - 3 10 - - 18 ChiIdren who, at 23.1.1 969 were being educated:- (i) at hospital - - - - 6 - 1 - - - 7 (ii) at home - - - - - - - - - - - - 89 - SPECIAL SCHOOLS Brookfield House School for Physically Handicapped Children At the end of 1968 the medical classification of the 85 children on the roll was as follows:- Congenital deformities 7 Cerebral palsy 19 Cardiac disabilities 8 Muscular dystrophy 1 Haemophiliacs 5 Post poliomyelitis 1 Delicate 7 Spina Bifida 4 Other physical handicaps 33 Joseph Clarke School for Partially Sighted Children The ophthalmic conditions on admission of the 68 children who attended the school during 1968 were as follows:- Albinism 4 Aniridia 3 Cataracts 25 Congenital Day Blindness 1 Detached Retina 1 Dislocation of the Lenses 4 High Myopia 4 Iridocyclitis 2 Macular Aphasia 1 Microphthalmos 1 Nystagmus 8 Optic Atrophy 10 Retinitis Pigmentosa 1 Retinal Degeneration 2 Retinoblastoma 1 Their visual acuities (Snellen), after correction, were as follows:- Visual acuity of less than 6/60 21 Visual acuity of 6/60 15 Visual acuity of 6/36 18 Visual acuity of 6/24 10 Visual acuity of 6/18 2 Not yet assessed because of age 2 William Morris School for the Deaf Of the 63 children on the roll at the end of the year 39 were classified as deaf and 24 as having partial hearing. - 90 - HOUSING (a) Contributed by A.S.Brickell, Esq., A.A.Dip., A.R.I.B.A., Borough Architect. Dwellings completed by the Local Authority during 1968 WARDS FL ATS HOUSES Chingford South 108 147 Leyton Central - 20 Forest 97 7 Lea Bridge 58 - Leyton 200 - Walthamstow Forest 32 - Hale End 62 - Wood Street 132 4 689 178 Dwellings completed by private enterprise during 1968 WARDS FLATS HOUSES Chingford Central 58 1 North-West 4 12 South 8 4 Leyton Forest - 2 Leyton 6 3 Leytonstone - 1 Walthamstow Chapel End 8 1 1 Hale End 21 5 Hoe Street 6 1 1 1 39 Dwellings completed by Housing Associations during 1968 WARDS FLATS HOUSES Chingford North-West 211 - Leyton Leytonstone 1 1 - 222 - Outbuilding scheme » dwellings completed during 1968 FL ATS HOUSES Barn Hall Estate, Wickford, Essex 54 42 NOTE: All were permanent houses and flats - 91 - In addition to the main building programme, improvements and conversions were carried out at a number of Council owned properties. DISC RETION ARY ST AN DARD Applications received 186 224 Total number of grants approved 131 156 Total amount of grants approved £53,030 £19,655 (b) Contributed by S.J.Horstead, Esq., A.I.H.M., Borough Housing Manager Properties in Management at December 1968 Pre 1939 houses and flats 2,105 New houses and flats 9,615 Properties at Billericay 446 Properties at Wickford 151 Properties at Epping 206 Properties at Hutton 96 Prefabricated bungalows 24 Properties acquired for housing purposes 2,339 Properties for Clearance and Demolition 703 15,685 Number of properties made available for letting New properties 1,035 Acquired properties 171 Normal vacancies 476 1,682 Families rehoused from the housing register Number rehoused 1,370 - 92 - - 93 - METROPOLITAN WATER BOARD - WATER EXAMINATION DEPARTMENT AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE LONDON BOROUGH OF WALTHAM FOREST Milligrammes per litre (unless otherwise stated) Description of the Sample Number of Samples Day of the month Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMn04 4 hrs. at 27°. C. B.O.D. 5 days at 20°. C. Hardness (total) CaC03 Hardness (non-carbonate) CaC03 Magnesium as Mg Sodium as Na Potassium as K Chloride as CI Phosphate as P04 Silicate as Si02 Sulphate as S04 Natural Fluoride as F Surface-active material as Manoxol OT C02 Turbidity units Colour (Burgess units) pH value Electrical Conductivity (micromhos) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) Thames derived North of River 207 0.019 0.085 3.8 1.19 287 78 5 23.4 5.2 32 1 .9 9 62 0.30 0.02 0.1 14 8.0 570 Lee Bridge 52 0.025 0.092 3.7 1.15 316 96 6 33.5 7.3 44 2.8 10 96 0.35 0.03 0.1 14 8.1 670 Ferry Lane 3 0.014 0.082 4.1 1.11 371 149 6 33.5 7.3 45 2.4 12 96 0.35 0.03 0.1 7 7.7 750 Chingford Mill 4 0.142 0.029 0.4 0.33 276 59 25 0.55 0.1 2 7.5 560 Coppermill 33 0.021 0.105 3.3 1.24 314 98 6 33.5 7.3 42 2.7 8 96 0.35 0.03 0.2 13 8.2 620 - 94 - BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1968 OF WATER SUPPLIED TO THE LONDON BOROUGH OF WALTHAM FOREST Source of supply BEFORE TREATMENT AFTER TREATMENT Agar plate count per ml. Coliform count Escherichia coli count Agar plate count per ml. Coliform count E. coli count Number of samples 20-24 hours at 37° C. 3 days at 22° C. Per cent. samples negative in 100 ml. Count per 100 ml. Per cent. samples negative in 100 ml. Count per 100 ml. Number of samples 20-24 hours at 37° C. 3 days at 22c C. Per cent. samples negative in 100 ml. Per cent. samples negative in 100 ml. Lee Bridge (Lee-derived) 507 21.2 99.41 99.80 Ferry Lane 15 5.9 100.0 100.0 Chingford Mill 241 0.1 7 99.59 - 99.59 - 246 0.1 8 100.0 100.0 Thames-derived, North of River 1,720 12.1 99.94 99.94 Coppermill 156 30.7 1 00.0 100.0 INDEX A Pages Accommodation for Aged or Handicapped Persons 5,7, 56-57 Acreage 40 Adaptations to Premises 16, 54 Administration 3 Aged Persons 5,7 Aids for Handicapped Persons 16, 21-22, 55 Ante-Natal Clinics 46 Analgesia 43 Assessments 40 "At Risk" Register 47 Attachment Schemes 17, 33 Audiology 12 Aural Clinic 85 B B.C.G. Vaccination 65 Birth Control 12, 48 Births 40, 42 Blind Persons 16, 52 Burials 57 C Cancer 42 Car Badges 55 Care of Mothers and Young Children 42-48 Cervical Cytology 47 Chest Clinic 63 Child Development Sessions 46 Chi Id Guidance Service 85-86 Child Minding 8 Child Welfare Sessions 44 Children's Department 35-36 Chiropody 11-50 Clean Air 15 Clearance Areas 14, 68 Clinic Services 11-12 Clubs 5, 13 Committee 1 Comparability Factor 40 Compassionate Laundry 57 Condemned Food 77 Confinements 43 Congenital Malformations 47 Convalescence 50 Co-operation 5,7-17 D Pages Day Centres 8, 10 Day Nurseries 8, 31-33, 46 Deaf Persons 53 Death Rate 40 Deaths, Causes of 41 Deaths, Infants 40 Dental Laboratory 66 Dental Services 11, 66 Dental Treatment/Inspections 47, 86-87 Dentures 47, 66, 87 Development Sessions 46 Diphtheria Immunisation 64 Disabled Drivers 55 Disabled Persons 2 1-22 District Nursing 17,49 Domiciliary Chiropody 50 Domiciliary Midwifery 43 Dysentery 18-19 E Ear, Nose and Throat Clinic 85 Educationally Subnormal Children 89 Employment of Children 84 Environmental. Health 13 Eye Clinics 85 F Family Survey 30 Family Service Unit 16 Factories Act 78-79 Family Planning 12, 48 Field Work 13-17 Flooding 38 Food and Drugs Act 13, 68, 72, 74 Food Hygiene 72, 75-77 Food Inspection 72-74 Food Poisoning 62 Foods, Welfare 45 Foot Clinics 11, 50 Foot Inspections 84 Funerals 57 G Gas and Air Analgesia 15, 52 General Dental Service 75 General Practitioners 9, 14-15, 32-33 H Pages Handicapped Persons 16, 20-22 Handicapped Pupils 89-90 Handicrafts 16 Hard of Hearing Persons 53 Health Centres 5, 33-34, 44 Health Education 19, 48, 87 Health Services Clinics 44 Health Visiting 16-17, 30, 48-49 Health and Welfare Committee 1 Holidays 16, 55 Home Help Service 50-51 Home Nursing 17, 49 Homeless Persons 7, 15, 57 Homes 56-57 Homeworkers 54 Hostels 7, 15, 57 Housing Acts 68 Housing, General 13, 91-92 Hygiene 19 I Ice Cream 74 Illegitimate Births 40 Immigrants 18, 63 Immunisation 17, 64 Incontinence Services 57 Infant Mortality 40 Infant Welfare 44 Infectious Diseases 17-19, 62 Influenza 19 Introduction 4-6 J Junior Training Centre 8-9 L Laundry Service, Incontinent 57 Local Authority Homes 56 Luncheon Clubs 6, 57 Liaison with Hospitals and General Practitioners 7, 15 M Massage and Special Treatment 65 Maternal Mortality 40 M (cont.) Pages Maternity and Child Welfare 42-48 Meals on Wheels 10, 57 Measles 17, 64 Medical Examinations 65 Medical Inspections 80-84 Medical Research Council 30 Medical Treatment 81-85 Medical Officers 2 Mental Health 7, 15, 30, 58-61 Midwifery 43 Minor Ailment Clinics 84 Milk, National Dried 45 Milk Supplies 74 Mothercraft 46 Mothers and Children 43-48 N National Dried Milk 45 Neighbourly Help Service 52 Neo-Natal Mortality 40 Night Attendance Service 51 Notices, Sanitary 67 Notification of Births 42 Nurseries and Child Minders Regulation Act 8, 46 Nurseries, Day 8, 31-33, 46 Nursing, Home 17, 49 Nursing Homes 65 Nutrients 45 O Occupation Centre 10, 54 Offices, Shops and Railway Premises Act 22-29, 69-71 Old People's Homes 5, 7, 56-57 Old People's Services 50, 51, 56 Ophthalmic Clinics 85 Orange Juice 45 Organisation and Method Report 4 Orthodontic Treatment 87 Orthopaedic Clinics 85 Orthoptic Clinic 85 Outwork 79 P Paediatric Clinic 85 Paratyphoid Fever 62 Partially-Sighted Persons 52 P (cont.) Pages Pet Animals Act 74 Physiotherapy 85 Physically Handicapped Persons 10, 53-55 Poliomyelitis Vaccination 64 Population 40 Play Groups 8, 11, 30 Post-Natal Clinics 46 Premature Infants 42 Premises, Registration etc 65 73-74 Prevention of Damage by Pests Act 71 Priority Dental Service 47 Public Health Inspection13,67-79 Public Health Acts 72 Psychiatric Services 7, II, 15 R Rainfall 38 Rateable Value 40 Recuperative Holidays 50 Rehabilitation 54 Rehousing 92 Re-inspections 80, 87 Relaxation Exercises 46 Rent Act 68 Residential Accommodation 5, 7, 56-57 Rodent Control 71 S Sampling of Food 77 Scarlet Fever 18 School Health Service 80-90 Schoolchildren 80-90 Sewerage 38-39 Sheltered Workshops 54 Sickroom Equipment 49 Slum Clearance 14 Smallpox Vaccination 64 Smoke Control 15 Social Responsibility Centre 5 Social Workers 15 Special Schools 20, 90 Speech Therapy 88 Staff 2-4,6 Statistics 40-94 Stillbirths 40 T Pages Temporary Accommodation 7, 57 Tetanus Immunisation 64 Training Centres 8-9, 61 Training 9 Transport 5, 13 Tuberculosis 18,62-63 Typhoid Fever 18 V Vaccination and Immunisation 17, 64-65 Verminous Premises 70 Vision 8 1-82 Vital Statistics 40 Voluntary Organisations 5, 13 W Walking Aids 16, 55 Water Supplies 37-38, 93-94 Warden Flatlets 5 Welfare Centres 44 Welfare Foods 45 Welfare Services 7, 10, 15,52-61 Whooping Cough 18 Whooping Cough Immunisation 64 Workshops, Sheltered 54 Work Centre 10, 54