I LrOfrL. £ ^ E.W. WRIGHT, M.B., Ch.B., D.P.H. London Borough of Waltham Forest REPORT OF THE MEDICAL OFFICER OF HEALTH 1969 CONTENTS MEMBERS OF THE HEALTH AND WELFARE COMMITTEE DEPARTMENTAL STAFF INTRODUCTION BY MEDICAL OFFICER OF HEALTH THE WORK OF THE DEPARTMENT DURING 1969:- Control of Communicable Disease Residential Accommodation Day Centres School Health Service Field Work Services Environmental Health Services SPECIAL ARTICLES:O & M The Environment, Past, Present, Future Housing Survey - Cann Hall Road Area A Medical Officer's View of Rehousing Requests The Handicapped - Clothing and Housekeeping CONTRIBUTIONS FROM COLLEAGUES:- Family Survey - M.R.C. Child Development and Behaviour Unit The Social Responsibility Centre Water Supplies Rainfall and Sewerage STATISTICAL SECTION PRINTED BY THE LONDON BOROUGH OF WALTHAM FOREST LONDON BOROUGH OF WALTHAM FOREST HEALTH AND WELFARE COMMITTEE 1969 - 1970 Chairman: Councillor Mrs.K.B.Latreille V ice-Chairman: Alderman G.S.Mace Members: Alderman H.F.Fulton „ Mrs.E.V.Pearson Councillor L. Braham „ Miss H.E. Digby „ W.J.C. Dooley „ G.A.King, A.M.B.I.M. „ N.A.Lyons „ Mrs.V.L. Maguire „ F.W.Marshall, J.P. „ Mrs. A. Mynott „ Mrs. H.N. Potter, J.P. „ W.C. Warren „ Mrs. E.J .White „ F.W. Wigg Ex-officio: Her Worship the Mayor - Councillor Mrs. P.K. Williams - 1 - STAFF OF THE HEALTH AND WELFARE DEPARTMENT (at 31.12.1969) Medical Officer of Health and Principal School Medical Officer - E.Walter Wright, M.B., Ch.B., D.P.H. Deputy Medical Officer of Health - Geoffrey H.G. Poole, M.B., B.S., D.P.H., D.(Obst.) R.C.O.G. Senior Medical Officers - Gwyneth 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 Medical Officers in Department - 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.l. *Margaret Edwards, B.Sc., M.B., B.Ch., C.P.H. *Eirwen M.Harrison, M.B., Ch.B., D.P.H., Dip.Audiol. *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; 8 Social Workers Principal, Dental Officer - G.P.L. Taylor, L.D.S., R.C.S. 13 Dental Officers (Whole-time equivalent = 5.8); 3 Dental Auxiliaries; 2 Dental Technicians Chief Welfare Officer - Birdie A. Warshaw, A.H.A., A.I.S.W., F.W.I. Principal Social Worker - Sybil A. Abley, A.A., P.S.W. Senior Mental Welfare Officer - H. West, S.R.N., R.M.P.A., C.S.W., F.W.I. Senior Social Worker - R. Dillon, A.A., P.S.W. Homeless Families Officer - L.F. Pyne, Dip.Soc: A.I.S.W. Area Team Leader - L.Baxter 10 Social Welfare Officers 7 Mental Health Social Workers 12 Social Work Trainees 1 Mental Health P.S.W. Trainee 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. 15 Public Health Inspectors (3 posts vacant); 3 Technical Assistants; 3 Pupil Public Health Inspectors (2 posts vacant) - 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. 49 District Nurses 16 Midwives 4 District Nurse/Midwives 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.B.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 21 Clinic Nurses 5 Student Health Visitors 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 Home Help Organisers 3 Training Centre Supervisors 1 Work Centre Supervisor Chief Administrative Officer - B.F. Hampson, A.C.C.S. Premises and Development Officer - F.J. Aylward Special Duties Officer - R.L. Apperley, M.A.P.H.I. Senior Administrative Assistants - R.T. Prudden F.C. Ware 13 Administrative Assistants 1 M.O.H. Secretary 1 Typing Supervisor 18 Clinic Clerks 58 Clerical Assistants 1 Storeman 7 Supernumeraries - 3 - THE MAYOR, ALDERMEN AND COUNCILLORS OF THE LONDON BOROUGH OF WALTHAM FOREST Mr. Mayor, Ladies and Gentlemen, I have the honour to present my report for the year 1969. It was a year of such strain for Council and senior staff as I hope we shall not see again, due to the intensity with which shortage of resources, as seen by those concerned with finance, clashed with increase in demand, as seen by those in touch with public needs. Just fifty years before in 1919 the Medical Officer of Health of Walthamstow, Dr. J.J. Clarke, on the direction of the Council following the Maternity and Child Welfare Act of 1918, put up excellent recommendations as to what should be done locally. The Council minute reads that having regard to "the low rateable value of the District, the rates at present amounting to l2/6d in the £, the Council do not see their way to put the scheme into operation unless the Government make a contribution of at least 75 per cent of the cost". The Local Government Board then refused the request of the Council. Frustration is not new. What principles should guide decisions with regard to allocation of restricted funds in the Social Services? At times of shortage there is always a cry for priorities to be evaluated and put in order. In the most crude and obvious way it can be done but a good list of priorities is a will o' the wisp objective. The concept that needs can be given an ideal order of precedence which can be defined by objective scientific criteria is a view which can only be held by those who are not in the real world at all. The play of public opinion, the pull of the overt need as against the hidden need (which may be much greater), or of the needs of those whose image evokes sympathy as against those whose image evokes rejection (which may be quite unjustified in both cases), all these influence the shape of the services. It is useless to say one should not be guided by emotion for this is the motivation for the very existence of the social services. There are very few objective or economic criteria for doing anything at all about old people, the physically or mentally handicapped or the homeless. Yet we human beings are united in the determination that something should be done. Why? Human values are various, change constantly and display themselves quite differently if expressed in words or deeds. In recent years in this part of the country, as in others, it has been taken for granted that ever better medical and social services are expected. Let us talk less about priorities, press on with making existing services as productive of human good as can be, and expand as resources allow all those services which, in our personal opinions, are deserving. Cost benefit analysis is an attractive technique, but in complex social fields sophisticated techniques are only acceptable if they support conclusions already arrived at by the common sense. Dr. Goodey's views on page 38 i llustrate delightfully the value of common sense when we are becoming bemused by statistical abstractions. We may without discredit accept that others may well have different views, but let no-one interpret this to mean we might just as well do nothing. Quite the reverse. The needs and expectations are so great in so many directions that no expansion responsibly proposed would be unjustified or unappreciated. Many are very urgently needed. - 4 - The common sense or "public opinion" changes its conclusions as to what is important from time to time and should be led to do so by those far seeing people who are more conscious than the majority of a wider strategy of human living many years into the future. Once the environment was all important to local government, then came the swing to all the social needs which arouse sentiment. Now there is some evidence of a swing back. I must repeat my comments in my past report on the importance of the environment for if it is not attractive we open the door to the two biggest enemies of competent social work; a high migration rate of the population; a high emigration rate of the staff of the social services. With this in mind I asked Mr. Ashcroft, Chief Public Health Inspector, to write before he retires this year an article (page 26) on the environment, for hi s wisdom over the years has contributed much to Council policy and his thoughtful essays in my Annual Report have been much valued. Public opinion must be guided into new scales of values. Field staff of all kinds should be trained and provided in sufficient numbers to mobilise families to deal with their own problems rather than to carry out the patchwork action which only deals with the immediate need. The provision of a Home Help, for instance, sufficiently often to prevent a situation spiralling downwards is more important than using one to keep a higher standard of cleanliness than is essential for daily living. A scale of values which is new to some is needed in voluntary work. Voluntary work must be seen by professional staff in particular to stand comparison with professional work, in that it also is concerned with aspects of the real meat of problems and not just the frills - though different aspects, of course, from those which require specialist skills. The attitude that the really demanding and interesting work should all be done by paid staff while the volunteers do the easy and monotonous work can take much of the blame for a low level of enthusiasm to volunteer in any population, as can the view that professional staff may expect support from the senior staff of the organisation, while volunteers have only the support of their inner idealism. People need satisfying and appreciated occupations whether they are clients or volunteers. The fact that the Social Responsibility Centre, whose Welfare Organiser, Mrs. Payne, writes on page 43, has erupted with such vigour into the social scene of this Borough is because these two principles were firmly grasped and acted upon from the start. Public values may well be at variance with the opinion of a minority who are better informed than average. There were several examples of this during the year. The Council's decision not to re-open the fluoridation question was understandable in view of the glazed look of boredom which this subject now generates in public personalities, and to this extent the anti-fluoridationists have succeeded. Fluoridation, like all measures which are right in principle, will come one day. It must simply wait its opportune moment. Let us hope for the sake of complete generations of children that this comes soon. The smoking of cigarettes, to which Dr. Poole refers on page 8 is another subject where the informed can see so clearly what to them is frank stupidity in others, but which common sense is not yet ready to accept. Cigarette smokers would be wise to read carefully what he says, and ponder upon it. The drug problem in the Borough - yes, there is one - was caught up in such an emotive whirlwind that some felt that public opinion was wildly at variance with official opinion. In fact, I do not believe that public opinion as such ever reached the pitch that a vocal minority would have us believe, and the view of the best informed people - that there is a problem but that the existing machinery is still the best way of dealing with it - was not much at variance with common sense. - 5 - The staff of the department had a strenuous year and my thanks to them for their efforts in the face of all the difficulties are real and sincere. I can also express on their behalf and mine thanks to colleagues in other departments for all their co-operation during the year. We should like to thank members of Council Committees concerned with the work of the department, particularly the Health and Welfare Committee and Councillor Mrs. K.B. Latreille, Chairman at a time of considerable stress both in committee and with the general public, for all the help received, and also to Councillor Mrs. P.K. Williams, Chairman for the early part of the year. I have the honour to be, Mr.Mayor, Ladies and Gentlemen, Your obedient servant E.W. Wight Medical Officer of Health - 6 - THE WORK OF THE DEPARTMENT CONTROL OF COMMUNICABLE DISEASE Dr. Geoffrey Poole, Deputy Medical Officer of Health, writes:— That perennial pestilence, Sonne Dysentery struck early this year, the first case (an 18 month-old toddler attending a Day Nursery) being notified on January 4th. Immediate investigation revealed that other children in the nursery were carrying the germ and eventually 40 children and 4 nurses had to be excluded. Family contacts spread the disease in the northern part of the Borough and twelve schools (one private) and another nursery became involved with a total of 224 families affected necessitating over 1,000 home visits. Through the ready cooperation of parents, teachers and family doctors the outbreak was contained, no spread to the rest of the Borough occurred nor were there any other large-scale outbreaks. As forecast in last year's report it has now been generally recognised that antibiotics have little effect in this disease and are worse than useless in the convalescent or symptomless case where they tend to prolong the carrier state. Stringent hygienic precautions and the control of carriers offer the only means of preventing the spread of diseases of this type against which even the latest wonder drugs are impotent. Measles was again the commonest notifiable disease with 1,558 cases compared with (308) last year and this might suggest that vaccination against this disease had not proved effective. But this year's figures should really be compared with the 2,615 cases notified in 1967 since the biennial epidemic pattern, though modified by vaccination, persists to some extent. Futhermore this year's vaccination programme was seriously disrupted when the whole of one manufacturer's stock of vaccine was recalled following the occurrence of some adverse reactions. Measles is a miserable and dangerous disease which sometimes leaves permanent damage to the brain and special senses and, now that vaccine supplies are again adequate, should be prevented wherever possible. Whooping-cough with only 30 notifications (126) showed a welcome reduction due to the development of more effective vaccines following the recent Medical Research Council investigation into the currently prevalent strains of the causative organism. Scarlet Fever was up, but not significantly at 102 cases (79) but there was a marked increase in Food Poisoning with 33 notifications against only (4) last year. In this condition the notified cases are well known to be only the tip of the iceberg as the vast majority of people suffering mild transient attacks do not call their doctor. There is no reason to suppose, as these figures might suggest, that Food Poisoning has increased eightfold. But even a single caseof Food Poisoning is one too many and it is our constant endeavour by inspection, enforcement of Food Hygiene Regulations, and by Health Education to prevent this eminently preventable disease. Infective jaundice too, showed an increase to 31 cases (9) and all were investigated to exclude the possibility of syringe-transmitted jaundice from self-injection of drugs. A small outbreak of meningitis, fortunately of a mild type, occured but no common source could be found. Potentially the most dangerous epidemiological event was the occurrence in August of Typhoid Fever in a very severe form in a Walthamstow lady who had not been abroad and must have been infected locally. The source of her infection was never traced despite the most urgent and painstaking investigation in which great assistance was given by Dr. B.T. Thorn, the Director of the Public Health Laboratory at Whipps Cross. No secondary case occurred and the prompt and efficient action by all concerned prevented what might have become a serious epidemic. Another possible source of danger arose as a result of the strike by the refuse collectors involving almost the whole of Greater London. Rodent control in this Borough being excellent - 7 - the chief hazard was from flies which, due to the unusually warm Autumn, were more than usually numerous. However the foresight of the responsible officer in obtaining and distributing ample supplies of plastic sacks and the help of the local Press in publicising the need to use them for all discarded food scraps in which flies could breed, prevented much fly-borne infection and helped to reduce the stench of the rotting garbage. Tuberculosis notifications at 84 were marginally lower than last year (88) but no less than 42 of these, 50% of the total, occurred in immigrants which is the highest proportion experienced; percentages for years 1965/1968 being, in sequence, 18%, 27.7%, 34% and 33%. The ratio of immigrants to the home population is not precisely known but was estimated last year at 8/2%. During the year Port and Airport Health Officers notified us of a further 458 immigrants giving destination addresses in Waltham Forest but no estimate can be formed of the numbers in transit, transferring to or from other Local Authority areas. We do know, however, that Commonwealth Immigrant children make up 10.8% of children in our primary schools. While only some of them are highly susceptible to tuberculous infection, even an average shows the disease to be nine times as common among immigrants generally as among the local population. It is to be hoped that there will be no phasing out of the Mass Miniature Radiography Units while this situation continues. All new arrivals who can be traced are referred to the Chest Clinic at Whipps Cross Hospital and over 300 were sent for investigation in 1969. Contrary to our expectations of a few years ago T.B. cannot be written-off as conquered and with a persisting pool of infected persons in the community it is as important as ever that all schoolchildren receive B.C.G. vaccination which gives very substantial protection. The place of Tuberculosis as "The Captain of the Men of Death" has, however, been usurped - by Lung Cancer. In 1947 respiratory T.B. killed 20,156 people in England and Wales and lung cancer only 9,204. By 1965 the deaths from respiratory T.B. had been reduced to 2,008 but 26,398 people died that year from cancer of the lung. By 1968 this figure had risen to 28,836 nearly twenty times as many as died from respiratory tuberculosis, 1,456. It is plain that despite the import of a large number of very susceptible people we are slowly winning the battle against tuberculosis but over the past ten years deaths from lung cancer have shown an inexorable increase from a rate of 782 per million (men) in 1958 to 1,012 per million in 1968. For women the increase has been proportionately much greater from 118 per million to 198, a rise of nearly 68%. Only in doctors, 70% of whom (including the writer!) have given up smoking has a marked reduction in mortality from lung cancer occurred. Lung Cancer, especially in the younger age groups (my youngest patient was 27) is almost exclusively a disease of cigarette smokers who also provide most of the victims of coronary thrombosis and fatal chronic bronchitis and emphysema. Sir George Godber, in presenting his Report for 1968 to the Minister of Health, stresses the importance of cigarette smoking in the causation of these diseases and gives as a conservative estimate the attribution of practically all deaths from lung cancer and from coronary heart disease occurring below the age of 55 years to cigarettes as well as 85% of such deaths at later ages. For adult deaths from bronchitis two thirds are probably due to cigarettes. In the face of such clearly expressed opinion by the Government's own Chief Medical Officer it is surprising that the tobacco companies are still permitted to spend twelve million pounds a year advertising such a dangerously addictive drug. Dare one suggest to the Chancellor a pound for pound levy on such advertising, the resulting £12,000,000 revenue to be spent making roads safer? To the usual cigarette smoker's retort "One must die of something" I would reply that it is usually much less uncomfortable, and appears more sensible, to die from a stroke at 75 rather than at 45 from lung cancer or a coronary; smoke a pipe or cigar if you must but avoid cigarettes like poison. - 8 - During the year over 3,000 visits were made by the deputy Medical Officer of Health and/or Infectious Diseases Nurse in connection with infectious disease control and over one thousand specimens were examined by the laboratories to whose directors and staff our thanks are due for their willing help and advice; also to our colleagues in General Practice for their prompt notification of all cases where a Public Health risk is suspected. DEATHS OF WALTHAM FOREST RESIDENTS DURING 1969 FROM CERTAIN DISEASES ASSOCIATED WITH SMOKING DISEASE MEN WOMEN TOTAL 25-64 65+ 25-64 65+ Lung Cancer 55 95 13 20 183 Ischaemic Heart Disease 132 255 36 218 641 Bronchitis and Emphysema 29 103 9 48 189 Old People's Homes RESIDENTIAL ACCOMMODATION Although for reasons beyond our control, it was not possible to open Essex Hall, our seventh old people's home, there were three other important developments during 1969. Alliston became (like Heathcote Lodge) a "designated home" for those who, by reason of great infirmity, senility and/or incontinence require so much extra care that an increased staffing ratio must be provided. There has been much debate as to whether such cases should be evenly distributed round ordinary homes or concentrated in this way. Opinion remains divided but a majority view is that concentration in "designated" homes is the better answer, great though the difficulties are. The other system means that a few mentally infirm and socially unacceptable residents can seriously depress the quality of life for a large number of ordinary residents if left among them. If segregated in any way within the home, this segregation is made obvious to the residents with even more unfortunate attitudes developing than occur where they are segregated in a separate home. The other developments arose out of the increasing frailty of our residents due to higher ages of admission and the publication of the report of the Williams Committee on residential homes. Residential care of all kinds has been going through a crisis due to a number of factors not least of which are the long hours and heavy strains which staff are expected to bear, with a public attitude regarding residential care as a dumping ground for those cases with which the domiciliary services had failed to cope. The Williams Committee gave great thought to these problems and recommended, inter alia, better staffing ratios and raising the image and efficiency of the job by training courses leading to a Diploma. The Council embarked on a three year programme of increasing the staff in these homes; none too soon for crises were coming thick and fast at the time. Now things are easier after the implementation (at the time of writing) of the second phase. The need for the third phase is already apparent. - 9 - Our first trainee was seconded to Enfield College of Technology on the first course to be started in the Country, for training for the Diploma in Residential Social Work. Now the future staffing of homes no longer has the picture of desperation with which we started 1969 and future difficulties should be easier to overcome. Hostel for the Subnormal The new hostel, eventually named Sylvan Lodge after some discussion was brought gradually into action during the year. Mrs.Bridgeland, who started as Matron in the summer, has proved a most valuable person to launch this scheme which is a new field for the Council to enter, and one in which the officers had little experience. The support of the Waltham Forest Society for Mentally Handicapped Children has been invaluable and the ways in which they, and Mr. Bridgeland, have rallied round have seen us through a number of difficult times. We have learnt much, not least that staffing is our weakest point, for with one small hostel we have no reserve to cope with staff sickness or leave. The second hostel in our capital programme, badly needed for its own sake, should help our resilience here. Temporary Accommodation During the year Cecil House opened for homeless families and we were able gradually to withdraw from the other accommodation - 1031 Forest Road and Suttons Hostel - which had been in use temporarily. Woodlands and Cecil House are now the only buildings in use for this purpose. It is worth re-stating the obvious since the complicated stories of ineptitude and irresponsibility, appropriate to most of these families, distract attention from it, namely that what a homeless family needs is a home! The only complete alternative is to break up the family. Only very rarely is this the right course on either humane or economic grounds. Faced with these problems the officers of this department must express great appreciation of the help of the Housing Department in finding housing for those families for whom this could be recommended. The persistent pressure upon us is not going to get any less and our gratitude to the Housing Department does not imply that we shall pester them any less in future! Cecil House is a very great improvement on anything we have had so far, with a resident warden and with families having sufficient rooms to live with reasonable dignity and some degree of privacy. Nevertheless, the families there live for the day when they can get a home of the ir own. Intensive social work is the key to rehabilitation and one wishes resources allowed of more adequate provision. Frustrations and discouragements in social work with these families frequently lead one to wonder if we are making any headway, but standing back and reviewing what has happened over the last three or four years to each family that has been admitted brings to light a general picture of successof which our social workers can be very proud. Day Nurseries DAY CENTRES During the year new charges and assessment scales on a numberof services were applied but it was on day nurseries that a public furore arose led by a group of mothers who, if they had enquired, would have discovered that they gained rather than lost by application of the new scales. In fact, most mothers did benefit, but one or two hard cases did arise, and the Chairman's powers of discretion were needed on more than one occasion. The cuts in expenditure during the year brought such close scrutiny of the financing of the day nurseries, and the calculating of unit costs was in danger of becoming so academic an - 10 - exercise that the fact that young children, already in some degree deprived, need individual nurses with whom to form relationships was almost lost sight of. Human relationships of such great significance to the child's emotional development are vital but impossible to evaluate if one is expected to quantify everything in figures. The final outcome is that the nurseries are still taking nearly the same number of children but the children get a little bit less attention. Whether this is a reduction in the service has caused some debate. Junior Training Centre The number on the register remained fairly constant at 61. The number on the waiting list at the end of the year was 33. Number of possible attendances: 11,458; Number of actual attendances: 9,272. Approximately three-fifths of absenteeism was due to holidays and short term institutional placements occurring during term time. Of the other two-fifths, 70% was due to sickness and 30% to other causes - mainly transport difficulties. Illnesses were the usual childish ailments - chickenpox, rubella, measles and whooping cough. Diarrhoea was a particular nuisance, as also was a run of boils and whitlows during the autumn term. Catarrhal discharge was very much in evidence and difficult to deal with. Three children were transferred to the Adult Training Centres and five from E.S.N. Schools to the Junior Training Centre. These latter were children with behaviour and emotional problems who all settled down after varying periods. One typical case was a boy aged 12 who was constantly wet and consequently defiant, aggressive and cheeky. He became continent, confident, developed some personal pride and his manners have improved. We can now take him anywhere! Another was a girl of 12½ who stammered and was in a state of constant embarrassment and was bossy with younger children and unable to perform simple tasks without fuss and tears. She became stable and reliable and began to volunteer for work previously beyond her apparent abilities. 16 children accompanied by two staff and three helpers spent a happy week at Hales House Holiday School near to Yarmouth at the beginning of October. Other projects included a day's outing to Shoeburyness, visits to London Zoo, Bethnal Green Museum, the Science Museum, Christmas shopping in Oxford Street, tube, train and bus journeys, nature rambles and local shopping. The children put on one puppet play and, a mime for our own entertainment and the student teachers performed Snow White with a great deal of help from the children. Several film shows and three parties in addition to "The Christmas Party" completed a very full year's activity. During the year three students were away on teacher training courses. Due to sickness the Centre was not fully staffed in any one week out of the 42 weeks of term time. 162 people visited the Centre during the year; many of them were students from overseas - teachers, health visitors and medical staff, etc. Transport retained its position of No.1 Problem for parents, Centre staff and administration, all became involved in trying to sort out difficulties with the transport contractor and individual drivers. Much time and thought was given to the project of the new school in Hoe Street intended to rehouse the children and staff of this Centre in the New Year. - 11 - Adult Training Centres While the number of trainees at North Birkbeck only increased by one during the year, Queen's Road Centre, where there is still spare capacity, added six to its roll and a steady increase may be expected to go on for a number of years yet. There has been a very good flow of orders for the handicraft workshops which speaks well for the standard of work carried out. During the year Queen's Road was able to take advantage of the co-operation of the Education Department and start pottery classes in their premises which form part of the same group of buildings. Swimming classes were started for the Queen's Road trainees at Walthamstow and continued at Leyton High Road Baths which are within walking distance. The educational classes have been expanded to take many more trainees and this has been found beneficial, particularly for those with the higher grades of mental retardation. In September 30 trainees and 6 staff from both Centres went to Dymchurch Holiday Camp for a week. The trainees benefited greatly and gained much confidence while away from home, learning to do things for themselves, while the parents gained a welcome break and rest for the week. Also in September there was an outing to Maiden for a day which the trainees thoroughly enjoyed. January saw the Birkbeck Centre going to the Wembley Ice Show once again, to the delight of the trainees. We have now enlarged our Essex Training Centres Sports Competition to 6 teams and have organised weekly football, cricket and netball games throughout the year for the trainees. In the Essex Centres Annual Sports at Waltham Forest, the combined team from Queen's Road and Birkbeck Road Centres was successful in winning the trophy for scoring most points. In all of our activities we feel that we have ended the year on a higher level than we started and look forward confidently to making continued progress in the future. Work Centre for the Physically Handicapped This was a year of progress at Roberts Hall during which some have come to think of the Centre as a way of life, as well as a place where we can offer sheltered occupation. All sections of the Centre have been active; the woodwork shop has been working flat out to keep pace with the order book. A very gratifying side to this particular shop is that the more able bodied workers carry out alterations and adaptations for the needs of other handicapped persons found by our own social welfare staff, and also for other boroughs for use by disabled persons less fortunate than themselves. The Manager justifiably gained great satisfaction in convincing The Plessey Co. Ltd., after three months talking and organising during which time he took one of the young women in his car to the factory to be trained, that disabled people if given the chance could be usefully employed. They finally put equipment worth £400 in the Centre. To date the job has earned the Centre over £2,000. Another first for the year was the formation of the Roberts Hall League of Friends. Although it is early days for them yet they have bought three very useful items of equipment. This is something that is sure to benefit the Centre in the coming year. During the year three afternoon concerts were enjoyed. There was an evening at the Kingfisher Night Club, a good meal and cabaret; it was even possible to hold a dance and the final function of the year was the Christmas Party. - 12 - Psychiatric Rehabilitation Association Mr. John Wilder, Director of the Psychiatric Rehabilitation Association, writes:- The day centre, grant aid,ed by the Borough, is based on group work lines, thus involving and evolving patients' initiative and self-help. Whilst economy is not the prime motive for these methods, they have nevertheless enabled the centre to operate at a cost of 10/- per trainee day. More important, the centre has done much to prevent patients from relapsing, and gave most of them a lessening of ennui and an increased interest in life. The centre commenced its activities in a Leytonstone Church Hall, which premises were replaced during 1969 by the temporary use of the Civil Defence Centre in Apsley Road. The change to brighter premises brought with it, however, the disadvantage of having to share accommodation, thereby reducing work potential to simple tasks which could be packed away each day. The alternative premises now envisaged by the Council will solve this problem and enable P.R.A. to instal necessary equipment.. No. of patients referred 12 months ending December 1969 Home address: E.10 22 E.11 2 E.4 8 E.I7 19 Others 10 61 total = 5,620 attendances Average daily attendance 26 patients Movement of patients 1 moved away 3 transferred to P.R.A. Industrial Education Unit 8 returned to work 2 transferred to other P.R.A. Centres 2 returned to hospital 45 on register 31st December 1969 61 total We wish to thank the Council, Medical Officer of Health and his staff for their constant advice and help. SCHOOL HEALTH SERVICE This service has firm foundations and a well established machine, which is just as well for it has had insufficient direction from senior staff, last year Dr. Richards, our Senior Medical Officer for Child Health, having been off ill for most of the year and at the time of writing is still off. My deputy and I have had more than enough trouble coping with the reorganisation of the department and severe shortages on the social work side with the strains which these set up. On top of this came the reductions in the estimates after the financial year had begun. The fact that the Committee have had no occasion during the year to review any features of this service (except insofar as the Audiology Clinic relates to it) results from the above facts and not from any lack of work, a fact that statistics at the end of this book will support. Reports on the School Dental Service and Audiology Clinic are given below. - 13 - Audiology Clinic Dr. Harrison, the Senior Medical Officer who runs this clinic, writes:- For the first four months of the year the clinic was out of service due to staff illness, but it can be said that the clinic now provides a viable and established service though it cannot be said to be fully staffed by an audiological team. Referrals were made in the main by the Local Authority Medical Officers from Infant Welfare Centres and Schools but it was gratifying to find the clinic being used also by consultant otolaryngologists, consultant paediatricians and general practitioners. The number of referrals have steadily increased since the service commenced in November 1967 and in December 1969 there was a six week waiting list for an initial consultation after referral. It is considered that this is too long for a child with a suspected hearing loss to wait for investigation and in order to deal with the work it is necessary to allocate more time to the Medical Officer in Charge or to broaden the team by training or employing technical assistance. The children referred varied in age from infants of 4-5 months who were known to be especially "at risk" from causes either before or after birth; to children of school age varying from 5-16 years of age. Occasional requests for investigation of hearing in adults have also been received. A simple statistical analysis is shown at the end of this report indicating the outcome of the work during 1969. It is hoped that in future more detailed analyses will be possible. Young children at school with a loss of 20-30 decibels can be in difficulty educationally, and in infants a hearing loss of any degree can interfere considerably with the acquisition of speech and language. Early diagnosis of hearing loss is, therefore, vital and if the loss is of a sensori-neural nature early auditory training and parent-guidance by the Peripatetic Teacher of the Deaf is essential. The Peripatetic Teacher also visits children in ordinary schools with hearing losses as frequently as possible. When a diagnosis of defective hearing is made no effort is spared to explain to parents the degree and nature of their child's hearing loss and of the possible difficulties the child may encounter in his home, in the school and in the community, and to advise on how these difficulties can best be overcome or minimised. One highlight of the year was to be able to inform parents who had both suffered from a hearing loss from birth that they had been fortunate enough to have an infant daughter with entirely normal hearing. She was later admitted to a day nursery where she is sharing normal childhood experiences with hearing children. It is to be hoped that for the future a full screening programme of children attending school can be initiated. STATISTICAL ANALYSIS NEW CASES: Referred for speech defect 13 „ „ upper respiratory infections 18 „ „ delayed speech 19 „ „ hearing investigations 77 „ „ educationally retarded 3 „ „ general retardation 5 135 OLD CASES 54 189 Total consultations 282 Number normal 95 - 14 - NUMBER FOUND TO HAVE HEARING LOSS 74 Type Mixed Bilateral 4 Unilateral 1 Conductive Bilateral 28 Unilateral 16 Perceptive Bilateral 18 Unilateral 7 Not yet diagnosed 10 Failing follow up 10 *Referred for further treatment, etc. 57 Referred to Peripatetic Teacher 23 Newly placed in Deaf School 4 *These referrals were most frequently to an E.N.T. consultant but others were referred for Child Guidance, Educational, Paediatric investigations or speech therapy. School Dental Service Mr. G.P.L. Taylor, the Principal Dental Officer, writes:- As will be seen in the statistical table on page 97, 2,000 more visits to the dental clinics were made by children in 1969 than in 1968, and 1,000 more were inspected at school than in 1968. Even so, owing to lack of staff, we were not able to inspect quite half of the school population. I am glad to say that the proportion of both deciduous and permanent teeth filled to each one extracted is well above the national average. Also, the numbers of emergency visits and visits for extractions under general anaesthesia are below the national average. The employment of more full time dental officers who could carry out more inspections at school would prevent a great number of emergency treatments. At the present time, as in the past, recruitment of full time officers is extremely difficult. The help we receive from part time sessional officers is of great value. The work of the dental auxiliaries, too, has been excellent and of a high standard. The creation of a Senior Dental Officer post would, I am sure, help to recruit staff and lead to greater efficiency. Improvement in premises and equipment would also help in recruitment, I feel. I am glad to report that we have been able to provide some modern equipment at Hurst Road. It was a great disappointment not to have a dental suite at St. James Health Centre since patients in that area do experience some difficulty in coming to Hurst Road. Much dental decay could be prevented by a stricter control of children's intake of sugar. While many parents seem to recognise this, they do little to try any sort of control. At present a great deal of research is being done on the subject of the harmful effects of sugar and other sweeteners. As to the future of the dental health of the children of Waltham Forest, I feel the main hope of any great improvement can only come when fluoridation of the water supply is permitted. - 15 - Health Visiting FIELD WORK SERVICES The cuts in the departmental budget, made after the financial year had begun, had a most unfortunate effect on this service since the number of clinic/school nurses who assist the Health Visitors had to be held below establishment while the number of Health Visitors was also kept below the number required to provide an adequate service and the number of visits made by Health Visitors fell off sharply. Both Medical Officers and Health Visitors were involved in duties normally carried out by Clinic Nurses, such as preparation of clinics, hygiene inspections in schools, or weighing of babies in Infant Welfare Clinics; a most uneconomical use of the scarce and highly trained professional staff. The Health Visitors continued to work in close co-operation with the Housing Department and social agencies to prevent the break-up of families where rent arrears are very often the presenting symptom of more serious social problems. The statistics show that this part of the work is increasing. Notification of families in tower blocks again formed a substantial proportion of the total notifications of those liable to be evicted for rent arrears. But a new pattern is now emerging - it would appear that families living in any new development area, not necessarily in tower blocks, are being subjected to greater stress owing to the need to pay a much higher rent than that of their old accommodation. YEAR NOTIFICATION TO H.VS FOR INVESTIGATION DISCUSSED AT CO-ORDINATING COMMITTEE ADMITTED TO TEMPORARY ACCOMMODATION ADMITTED TO TEMPORARY ACCOMMODATION FROM NON-COUNCIL DWELLINGS 1967 468 180 0 24 1968 717(*176) 150(*33) 3 29 1969 915(*209) 196(*61) 10 36 *Tower Blocks At the Hurst Road Health Centre and Handsworth Avenue Health Centre Health Visitors are attached to the group of general practitioners. The medical and health visiting staff are most enthusiastic about these schemes and the patients are receiving a more comprehensive service. A weekly obesity clinic is held at Handsworth Avenue Health Centre. Patients with medical conditions which necessitate slimming, are referred by their general practitioner. Advice is given regarding diet; a low carbohydrate diet is used, height and weight charted at first visit and then the person is weighed weekly. The department was informed of the following accidents during 1969 and Health Visitors have visited these homes to give the parents all the necessary help and to try to prevent any future accidents occurring:- - 16- AGE BURNS SCALDS POISONING FALLS CUTS SUFFOCATION FOREIGN BODIES EYE INJURIES 0-5 57 (*1) 40 118 42 10 2 47 5 5-16 18 12 5 7 6 - 22 1 16-20 - 1 - - - - - - 60+ - - - 1 - - - - TOTAL 75 53 123 50 16 2 69 6 *Died GRAND TOTAL: 404 District Nursing During the year the major part of the necessary reorganisation was achieved in changing the system of working from districts outlined on a map, where any one nurse might have patients of 20 or 30 general practitioners, to attachment to specific practices for the patients on the lists of those doctors. The attachments are in groups - twelve groups in all of nurses who are related to groups of practices (there are over 100 G.Ps). Within each group the nurses stand in for each other for sickness, holidays, etc. The nurses are finding their work very much more interesting and stimulating as it relates to one or two doctors whom they get to know well personally rather than a very large number of doctors, some of whom are little more than a voice on a telephone. They are also enabled to give a better service because of the efficiency of the system and the fact that they can see some patients at the doctor's surgery and get immediate advice from him about them. Nevertheless the amount of work continues to increase, and supplementation of the nurses by S.E.Ns for the more routine duties is essential. District nurses are a very loyal breed and will shoulder great burdens and long hours without the complaints which other staff would have voiced under much lesser strain. Social Workers During the year slow progress was made towards the new structure of social work with the creation of the post of Principal Social Worker and the setting up at the end of the year of the first Area Team of Social Workers with its Team Leader and its own support clerk at Hatch Lane Clinic. In the months which have passed this new structure has proved itself and we wait now with impatience until we can set up the other three teams which will establish a framework within which the new Social Services Department can launch itself on modern lines. The team concept means a blurring of the old rigid lines of specialism in blindness, old age, mental illness, etc., which exist due to the historical development of the social services, though special skills are still required (e.g. teaching braille or understanding schizophrenia) and will always call for some specialist social workers. The greater flexibility means that staff can help each other and thus economise on their time and their resources of special skills while developing mutual trust. The greater professionalism, which is being fed in by the ever increasing proportion of staff who have been trained, also means that staff time is used to much greater advantage. It does not mean that the staff are any less full of human compassion as is sometimes feared, but that human compassion is steered productively by insight into the real causes and solutions of the problems presented. - 17 - The other advantage of the team system is that it is comprehensive. Individuals can always say that a particular case is outside their specialty but the team as a whole is charged with responsibility for all social case work in the area and there should be no gaps in the provision of its services. Gaps do arise but this is because of the quantity of work which is revealed and which results in the staff feeling unable to give proper attention to all the demands made upon them. We felt we were short of social workers before. Now we know it, and to some degree can quantify the extent to which we are short because of the way the integrated filing system demonstrates the total need of an area. There is no doubt that a substantial increase in social workers is going to be indicated as better assessment of the needs becomes available. Particular strains were put on the Mental Health social workers by the virtual cessation of admissions to Mental Subnormality hospitals arising out of public concern over the Ely hospital enquiry. We must however express great appreciation of the co-operative attitude of the psychiatrists concerned in helping with short term care for difficult cases. The links we have managed to build up with the Royal Eastern Counties Hospital in Colchester over the last two years have enormously improved the service given to our patients though the 50 mile gap is still a formidable barrier. It is exasperating indeed to have Leytonstone House Hospital actually within the Borough and yet not to be in its catchment area, but in that of a hospital 50 miles away. We were fortunate during the year to have our new Social Welfare Officer for the Deaf starting work, thus being one of the very few boroughs able to provide this very specialised skill of communication. Almost at once he found himself with a caseload at least twice that recommended for any social worker. An evening Advisory Service for the Deaf was set up in October with a view to extending the help available to the Deaf Community of Waltham Forest. It was found that a number of deaf people in employment who required advice on various matters, were forced to take time off work to visit the Welfare Department. The new once weekly evening service enabled them to visit the Department after working hours. An invitation was also extended to hearing relatives of deaf people who wi shed to discuss problems associated with this handicap. ENVIRONMENTAL HEALTH SERVICES Mr. Ashcroft, Chief Public Health Inspector, writes:- Offices, Shops & Railway Premises Act, 1963 - Coin Operated Launderettes As a result of a report on the operation and enforcement of the Offices, Shops and Railway Premises Act, 1963, for the year 1969, which the Council is required to submit to the Ministry of Employment and Productivity, the Health and Welfare Committee resolved to make representations to the Association of Municipal Corporations with respect to the highly unsatisfactory situation which had developed regarding self-service launderettes, and requested that consideration be given to amending legislation. There are 67 coin operated and self-service launderettes and cleaners in the Borough; broadly speaking the following general classes can be distinguished: (a) Coin operated self-service launderettes and cleaners where mechanics call occasionally to service the machines and other staff call periodically to collect the cash; - 18 - (b) self-service launderettes and cleaners with one or more staff at the cash desk to take money and hand out detergents, etc; (c) self-service launderettes and cleaners as in (b) but where the staff, probably with the employer's knowledge bur no formal obligation, will take a customer's washing or cleaning and deal with it for a tip while the customer goes shopping; (d) self-service launderettes and cleaners as in (b) but where service washing and cleaning is also done for an extra charge; and (e) laundries and cleaners which offer in the same premises facilities for selfservice and also a service of washing, cleaning and pressing by paid employees. Self-service launderettes and cleaners appear to be a business venture operated by people with little or no technical knowledge or sense of responsibility with respect to hygiene and danger, and who are rarely seen on the premises. Staff are employed only on a part time basis and at some establishments there is virtually no supervision. Unfortunately, the exemption provisions under the O.S.R.P. Act which excludes premises where the sum of hours worked by all employees is less than 21 hours per week, applies to most of the 67 such premises in the Borough with the result that the local authority has no control beyond a limited application of the nuisance provisions of the Public Health Acts. It was suggested to the Association of Municipal Corporations that self-service launderettes should be excluded from the exemption clauses altogether and that a full-time attendant should be obligatory. Supervision and control by both local authority and occupier are essential for the maintenance of adequate standards of hygiene and safety. Machinery and equipment damaged and rendered defective as a result of vandalism and misuse by irresponsible persons frequenting premises where there is little, if any, supervision could well constitute a serious danger to bona fide customers. The report submitted by the Council received considerable publicity in the local press and in a trade journal "Laundry and Cleaning". From these press reports I gathered that the well established business interests in the Borough were generally in favour of stricter legal controls for this type of establishment. Noise Abatement Act, I960 In this country, as in the majority of the advanced countries of the world, one of the biggest problems in the urban environment is that of noise. Noise may be regarded as a form of environmental pollution which, as with other forms of pollution, must be prevented or at least reduced to an acceptable level. Considerable efforts are being directed towards the control of this social nuisance in the Borough and the public health inspector is becoming increasingly concerned with the solution of the many problems involved. Close consultation is needed between industrialists, architects, planning officers and the health department before approval is given to new developments involving processes which are likely to cause noise and vibration. When urban renewal programmes and major redevelopment schemes are being prepared there must be the fullest possible co-operation between the various professional officers concerned with the environment so as to prevent the creation of noise nuisances. The Ministry of Housing and Local Government requested the Council to submit a report on the action taken to deal with industrial noise over the two year period 1967/68. - 19 - The following is an extract from the report submitted:- "Complaints Received During 1967/68, 251 complaints were received and investigated by the public health inspectorate about noise from a variety of sources including factories, launderettes, scrap metal yards, machinery in commercial premises, pneumatic road drills, car and motor cycle engines, slamming of car doors late at night and clubs and public houses where musical entertainment is provided. Assessment of Statutory Nuisance In dealing with complaints of industrial noise the recommendations of British Standard No. 4142; 1967 (method of rating industrial noise affecting mixed residential and industrial areas) have been used as a guide to the assessment of statutory nuisances. The criteria recommended in the Wilson Report (Cmnd.2056/63) for noise inside houses is also a very useful guide as to whether formal action is justified. The present recommendations, however, are not accepted as statutory standards and the position would be considerably improved if this omission was rectified. Complainants often continue to complain after a noise nuisance has been abated to the satisfaction of the local authority because the complainant feels that the noise complained of should be entirely eliminated even though it has been reduced and complies with B.S.4142. It is generally found that industrial managements are anxious to abate alleged noise nuisances in order to maintain good public relations, but financial considerations weigh heavily and owing to the absence of statutory standards they often feel that they are acting under duress. The "best practical means" defence in Section 1(3) of the Noise Abatement Act, I960 is often a deterrent to local authorities to take action even where noise complaints are justified. General Observations Many noise complaints originate from plant which requires no prior planning consent. Many cases are found to be caused by plant and machinery which has been installed in ignorance of its noise output and of the sound proofing measures needed to ensure that its operation will not be detrimental to the environment of a residential area. The Clean Air Acts, 1956/68 provide for prior approval and control of new furnaces and chimney heights. This type of control could well be applied to noise emission from new plant and machinery, manufacturers should be required to specify the noise rating of new machinery to enable adequate consideration to be given to the design of premises in which the plant is to be housed, prior to its installation, to ensure that the noise climate in the surrounding area is kept within acceptable limits. A specific case in this category dealt with by the Department concerned a serious noise nuisance from a breeze block making plant where obsolete machinery had been replaced by an automated production-line process. The installation of this machinery did not require planning consent and the first intimation that a serious nuisance existed was when complaints were received - 20 - from adjoining residents and from the staff of a neighbouring school. Investigations revealed a maximum noise level of 91 dBA. The management co-operated with the Department and carried out extensive sound insulation works which proved to be sufficient to bring the case within the "best practicable means" defence provided in the Noise Abatement Act, thus limiting further statutory action. The noise from this factory, although considerably reduced within the limits prescribed by B.S.4142, is still a source of annoyance in the neighbourhood and will continue to be so as a non-conforming industry situated in close proximity to a school and a large housing estate. This is a case in point where prior approval by the local authority, following notification by the management of its intention to install new plant and machinery, with an indication from the plant manufacturers of expected noise emission, would have prevented a serious nuisance occurring. Many of the complaints received were less than, or on the borderline of, the recommendations set out in B.S.4142 and were in the main dealt with informally by negotiation with the management of the factories concerned. In nearly every case the question was asked both by complainants and managements "what is the level of noise allowed by law". The local authority is building a large Council estate on land flanked by factories and already complaints have been received of noise nuisance at night. As the noise levels recorded comply with B.S.4142, no formal action is contemplated. An automatic car "wash and dry" installation caused serious nuisance at night time and was abated by the management agreeing to switch off the plant at 9.00 p.m. A similar situation concerning a water pump situated in a launderette below and adjacent to residential property was dealt with by persuading the management to insulate the premises and to protect water pipes from damage by frost, thus enabling the pump to be switched off between the hours of 9.00 p.m. and 7.00 a.m. A noise nuisance from a single fan was abated by altering the fan blades and reducing the speed of the motor with no loss of efficiency. Alleged noise nuisances at night from a bakery using a bread slicing machine and from a factory manufacturing paper are at present under review." Clean Air Act, 1956 Measurement of Air Pollution 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 sites situated in the north, centre and south of the Borough. During the year further measures were taken for the measurement of air pollution in order to monitor an area likely to be affected by grit and dust emission from the new Greater London Council refuse disposal plant, which is in the course of erection in the adjoining Borough of Enfield. A directional deposit gauge has been installed in a suitable position approximately three quarters of a mile from, and due west of, the BOO ft. high chimney of the proposed disposal plant. Monthly measurements are at present being taken to ascertain the present level of grit and dust pollution in the area. This will be used for comparison with the results obtained when the plant is in full operation, to determine whether there is any significant increase in airborne pollution. - 21 - Housing Acts A further milestone in housing legislation was reached during the year when the Housing Act 1969 received the Royal Assent. Its content was disappointing in some respects as the Dennington Report (Central Housing Advisory Sub-Committee 'Our Older Homes, a Call for Action') published earlier suggested that improvement of houses should become compulsory. To implement the improvement sections local authorities have now to gain the confidence of house owners by launching schemes based on voluntary co-operation with financial inducements. The task ahead is to save older houses from deteriorating into such a state that they have to be demolished and the need to provide families with an improved standard of living conditions by the provision of baths, hot water, wash hand basins and internal water closets. To nurture older housing stock is a national economic necessity whilst rising social standards demand facilities in dwellings denied to the masses of the former generation. The implementation of these two aims will be carried out by linking repairs with improvement grant work and the proposed review of the rent structure among the rent controlled tenancies is aimed to stimulate landlords to action. Information as to the repair, renovation and improvement necessary to the existing housing stock can clearly only be gained by accurate assessment of the properties, and so during the past three years three surveys have been carried out which should prove to be invaluable for future planning. The first survey was undertaken in 1967 which gave information based on a 4% sample consisting of 3,529 rateable units, and secondly in 1968 a broad assessment was attempted to ascertain the problem of multiple occupation of houses and the extent to which commonwealth immigrants were involved. During the present year a detailed house to house survey of some 1,500 dwelling units in the Cann Hall Road area was carried out. A comprehensive report on the findings of Cann Hall Road survey was considered by a Housing Working Party under the direction of the Town Clerk - a copy of the detailed report and the report and recommendations on the Working Party is on page 30. Meanwhile the slum clearance programme has continued. During the year the Minister of Housing and Local Government confirmed Stage II of the Acacia Road area consisting of 8 clearance areas and added lands sited on 2.95 acres. Stage III of the Cathall Road area consisting of 6 clearance areas and added lands on 8 acres was officially represented to the Council and the Public Inquiry was conducted by an Inspector appointed by the Minister of Housing and Local Government on the 11th November; the result is awaited. An Official Representation was submitted to the Housing Committee on the 16th September in respect of 6 clearance areas in Sidmouth and Dawlish Roads, E.10. A report was submitted to the Housing Committee at its meeting on 20th January, 1970 (Minute No.171), setting out a Slum Clearance Programme for 1970/73 as requested by Ministry of Housing and Local Government Circular No.92/69. A copy of the report on which the programme was based is attached. In addition to aggregations of unfit houses which will enable redevelopment to take place there are a number of unfit properties which remain to be dealt with during the next 5 years by way of small clearance areas under Part III, or by individual demolition closing order procedure under Part II of the Housing Act, 1957. As, however, the powers under Part II are essentially provisions for securing the repair/improvement of unfit housing, it is only when the house is considered not capable at reasonable expense of being rendered fit for habitation, that the question of demolition or closing order procedure is applicable. Reasonable expense is basically a question of economics influenced by income derived from the rent which varies according to the type of tenancy. A house may prove to be incapable at reasonable expense of being made fit only because it is let at a low rent on a controlled tenancy. In such cases conversion to decontrolled/regulated tenancies will automatically render its renovation a viable economic proposition. Experience shows that this sort of situation is often brought about when - 22 - Section 16/18 of the Housing Act, 1957 is initiated. As demolition of individual houses situated within a terrace is not always practicable owing to the need for lateral support to adjoining property and weatherproofing, closing orders which leave properties vacant and derelict present problems. In these circumstances it is preferable for a property to be repaired and brought back to use. During the year 18 dwelling houses were subject to closing order procedure and as a result of works being carried out by the owners to render the houses fit, 7 orders were determined. Three parts of houses were subjected to closing order procedure during the year and an example of the kind of transformation that can occur as a result of this action with a willingness on the part of the owner, can be seen by the photographs which are reproduced in this book. Health Education Most Inspectors accept the duties of health education in their day to day dealings with the public. It is generally agreed that the voluntary execution of public health requirements have far more permanent effects than those carried out as a result of prosecutions. As an extension of the role of the public health inspector in health education, lectures were given during the year to pupil midwives, nurses and housewives organisations. In conjunction with other officers of the Health and Welfare Department a series of lectures were arranged at one of the schools where students were preparing to sit for an 'O' level examination in Biology and Hygiene. The technical and administrative procedures in connection with the clearance and redevelopment of a residential area were selected as a project for discussion with a further group of students. Lectures were given by representatives of all the various departments of the Council involved in the exercise. It is of interest to note that the contribution by the public health inspectorate was recorded and screened in other classrooms by close circuit television. - 23 - O. & M. A review of the Health and Welfare Department was carried out by the London Boroughs Management Services Unit, in compliance with a quinquennial programme of study agreed with constituent London Boroughs, during the period 14th August to 14th October, 1967. The report which was divided into 3 volumes was received by the local authority during May 1968. Volumes 2 and 3 deal separately with the Children's and Health and Welfare Departments, whereas volume I recommends an integrated organisation for the Social Services. The reports which were accepted as working documents were subjected to detailed examination in the departments concerned and were discussed by the members and officers during the year. The Borough subsequently requested assistance in implementing the Organisation and Methods reports and an officer from the unit was assigned to this task during the period 30th January, 1969 until 12th September, 1969. His assignment was to discuss the faults, identify the problems and plan a programme of implementation. It is fair to say that the report generally was not accepted as a true picture of the department's work at the time of the review, and certainly by now it was considerably out of date. Following this a number of modifications have been made both to the original recommendations and to the top structure of the department. These are that the lines of responsibility to the Medical Officer of Health should be channelled through three heads who will have functional responsibilities covering the whole department. The Deputy Medical Officer of Health, the Chief Social Services Officer and the Chief Administrative Officer. The Chief Social Services Officer is not to be appointed at present so, in themeantime, the Principal Social Worker will carry out some of these responsibilities and the Chief Welfare Officer in her new advisory role will continue to perform others. It has been decided not to proceed with the appointment of a Principal Mental Health Social Worker or the Assistant Chief Welfare Officer (Administration). The aim has been to produce more expeditious decision making and executive action and formal procedures have been introduced in order that staff involvement at a proper level is maintained and professional advice between different sections flows properly. To improve the flow of information and communications within what is a large and scattered department, regular meetings are convened with all types of staff participating. In order to assist clarification of roles job descriptions have been issued covering the key posts in the department. However, such is the complexity and interrelatedness of different aspects of Health and Welfare that these cannot be exhaustive and there must always be mutual support and advice between different members of the team. So far as the administrative staff based in the central office are concerned, two administrative posts and four clerical posts have been dis-established. This small reduction in staff must be viewed against a backcloth of a constantly changing scene. I refer here to increasing demands for services and a plethora of reports and investigations, all suggesting change. The net result viewed at this distance looks small but this should not diguise the considerable upheaval and unrest and the effect upon morale of staff which is still apparent. The general theme of the report was decentralisation and the desirability of providing a central administration and support of both the personal health and combined social service to ensure that professional and technical staff can apply maximum effort to their various fields - 24 - of application. This will require that comprehensive information is provided as economically as possible together with adequate manpower and equipment. To this objective a number of senior officers were allocated different duties and responsibilities. This has had the effect of improving the Chief Administrative Officer's span of control by developing an integrated headquarter unit which will assist the establishment of area teams. Instead of working through a deputy 3 senior administrative officers are responsible on a functional basis to the Chief Administrative Officer. This has enabled a senior officer to devote more time to the managerial and maintenance problems associated with controlling a large number of premises catering for a variety of needs. His expertise is also available in connection with planning new capital projects. It was considered appropriate that normally the Special Duties Officer would be responsible also to this post. Hitherto the organisation of the department has been divided in two. The system has operated tolerably well though it is arguable that the structure has a divisive effect and coordination can be made more difficult when responsibility for operating services is considered separate from staffing and financial implications. However, in co-operation with the accountant in the Borough Treasurer's department who is concerned with Health and Welfare finance, a better system of budgetary control has been established with up-to-date information available to enable better decisions to be made thus enabling optimum use of scarce resources. It is intended to further underpin all aspects of the services with a thorough understanding of the finance and staffing implications involved but further organisation changes will be required before further implementation is possible. It is to be expected that ambitious professional staff would wish to influence policy and be responsible for allocation of resources. This tendency is likely to increase in line with the Fulton Committee recommendations on the Civil Service. It does throw into question the whole future for the generally trained administrative officer who emerges on his merits from the lower ranks. For the top managers of the future in Local Government are likely to be those who take management training after gaining a relevant professional qualification in a particular discipline either within or without Local Government. This can only mean that the calibre of future administrative staff will decline further. The administration of the Social Services is made more difficult, in common with other departments, with the wide scatter of central offices. I refer to the separate town halls and the difficulties of co-ordinating arrangements in what is essentially old-fashioned and out of date office accommodation. Further economies could be made and improvements shown if the Council decides to adopt a Maud type structure and combine many of the existing departments under Directorships with consequent fusion of the administrative and financial processes to serve these large groupings of services. This is a policy matter affecting as it does the Committee structure and and interests of Members. Apart from re-organisation of administrative staff a number of other suggestions were made relating to a number of services operating within the department. So far as the Home Help Service is concerned it was decided to change the organisation to a three-tiered system in four areas from a two-tiered system in five areas. This necessitated the appointment of Assistant Organisers with the intention of increasing the supervision on follow-up of individual cases. This is particularly important as the Home Help Service spend a high proportion of the total estimate. I referred earlier to the Chief Welfare Officer assuming an advisory role and together with this recommendation it was suggested that a Principal Social Worker should be appointed - 25 - to be responsible for the professional aspects and supervision of casework. Following from this and the establishment in principle of area social work teams it will be necessary for the establishment of four area team leaders of whom the first has already been appointed to coordinate and allocate social work in the areas concerned. To assist the work with problem families a senior social worker responsible to the Principal Social Worker has been designated Homeless Families Officer. The unsatisfactory organisation structure in the nursing services was also mentioned and it has been agreed in principle that a Principal Nursing Officer to co-ordinate the work of the Health Visitors, Midwives and Home Nurses should be established and the recent report of the working party set up by the Department of Health and Social Security further recommends this. Turning to the environmental services it is recommended that the Deputy Chief Public Health Inspector and Senior Public Health Inspector (Housing) posts should be amalgamated and the future organisation should be a Chief Public Health Inspector with 3 Senior Inspectors reporting directly to him. As in all things what is achieved falls short of the ideal but the aim of management should always be to provide the necessary services in the most efficient way. B.F.Hampson Chief Administrative Officer THE ENVIRONMENT PAST PRESENT FUTURE ''Suffering and evil are nature's admonitions; they cannot be got rid of; and the impatient attempts of benevolence to banish them from the world by legislation, before benevolence has learnt their object and their end, have always been more productive of evil than good." The above unctuous passage appeared in the "Economist" newspaper in May, 1848; it was written in opposition to the first Public Health Act (1848) which resulted from cholera and the efforts of Edwin Chadwick who had come to realise the facts about the revolting insanitary conditions which had arisen from the Industrial Revolution and urbanisation. Doctrine of one kind or another has been the cause of many of the woes of mankind, but fortunately the English of this period were not entirely doctrinaires, and passed the Public Health Act despite the prevalent laissez-faire theories and the dismal lopsided social economy of the age. But the provisions of the Act were permissive rather than compulsory, and it was some twenty years later before Local Government Boards were established to enforce the law of building and sanitary reform. Looking back over 38 years of service with six urban authorities in different parts of the country, considerable progress has undoubtedly been made in the various fields of environmental health, but there are no grounds for complacency concerning the need for further improvement of standards in housing, food, air pollution and noise. There has been a gradual movement away from the disease oriented concept of environmental sanitation. We now seek to achieve an environment not only free from disease but one in which people can live in a state of complete physical, mental and social wellbeing. The relationship between man and his - 26 - environment is undergoing profound changes in the wake of modern scientific and technological developments. There is clear evidence that advances in technology are themselves creating potential dangers and impairing the quality of the environment. Pressures for more effective action are growing. My first sight, at close quarters, of slum housing was in the year 1932 as a student in the City of Liverpool and later as a housing inspector with the same authority; it was a shocking experience - Blake's dark satanic mills took no greater toll in human misery and social degradation than did the slum courts and back to back houses of that time. In the intervening years there has been considerable change for the better in the social pattern and living standards; slums are no longer associated with poverty, hunger and squalor reminiscent of the thirties. But incredibly, the basic problem of unfit houses and that of providing satisfactory housing for all sections of the community remains. The growing discrepancy between twentieth-century standards and nineteenth-century planning has aggravated the housing situation and created new problems. Outside the areas schedule for slum clearance and redevelopment, there are many thousands of houses which are neither bad enough to condemn by statutory standards nor good enough for modern living. It is now accepted that suitability for habitation is as much conerned with the environment in which a house stands as with its physical condition and equipment. Living conditions in houses situated close to industrial premises, railway viaducts and heavy traffic may become intolerable as a result of noise and vibration. As these twilight areas represent the major part of the urban fabric, improvement of such houses and the neighbourhood environment present a colossal problem. The solution to the housing problem seems to have been lost in a tangled web of legislation, human needs, economics, selective subsidies and agencies. By whom should housing be provided — local authorities, housing associations, building societies or private enterprise? Ideally, to produce a balanced community, all agencies should be used. But unless there is a radical change in housing finance and government subsidies, this can never be a viable proposition. Meanwhile, with the decline of the private landlord and the inability of private enterprise owing to the high cost of land, to provide houses at a rent people can afford, it must be accepted that the hopes of the under-privileged in the housing field rests more than ever with the local authority. One of my earliest recollections of food and drugs administration was to sample raw milk for chemical and bacteriological examination from churns unloaded at a railway station in the County Borough of Wallasey at 5 a.m. Out of twelve samples, two were found to contain added water and three failed to pass the test for purity and harmful bacteria. In those days such a result was not uncommon; today compositional standards, bacteriological purity and hygienic practices have all come to be accepted, although their maintenance calls for unrelaxing vigilance. The pace of advance in food technology has created new production and distribution problems with respect to the ever increasing range of processed and pre-packed foods, which preclude pre-sale examination by retailer and customer. The principles and tenets of food reform are unchanged, but now the field has enlarged and some aspects of the work are only just beginning. The possible dangers arising from chemical additives in food, and hazards arising from the use of toxic insecticides and pest control agents in agriculture and food storage, and from the use of antibiotics and synthetic materials to regulate the metabolism of food animals in order to stimulate growth, have yet to be accurately assessed. These dangers are felt rather than seen, as unpredictable and portentous as vitamins must have been to the concepts of nutrition. - 27 - It is a far cry from the London 'pea-soup' smog of 1952 which was said to have been directly responsible for the deaths of 4,000 people, mostly elderly bronchitics. The national press contained a vivid account, with photographs, of farmers at the Smithfield Dairy Show, which coincided with the smog period, trying to save their prize cattle from suffocation by shrouding their snouts with towels soaked in brandy. A large number of animals were in fact asphyxiated as a result of the smoke - you might say it was more in the nature of a sacrifice at the shrine of Bacchus. Whatever the merits of this press article, it did demonstrate, in a very dramatic way, the "killer" effect of the smog. The adverse effects of air pollution on the environment of an urban community was recognised as long ago as the thirteenth century, when smoke abatement legislation was first introduced. It needed the tragic consequences of the 1952 smog to bring about the 1956 Clean Air Act which, inter alia, empowered local authorities to establish smoke control areas. As a direct result of this Act the amount of smoke in London's air has been reduced by at least three-quarters; its effectiveness has been proved by a considerable reduction in the density and frequency of fog and a 70% increase in winter sunshine. As pollution has diminished, there have been other less tangible but beneficial changes, not so well documented, such as the increase of plant life and bird species in London. Not all local authorities have been as energetic in declaring smoke control zones as London. Why should measures of proven effectiveness not be made compulsory? The year 1963 marked an important place in the history of environmental health legislation as being the year when the framework of welfare legislation, first introduced for factory workers in the year 1833, was extended into new fields of non-industrial employment by the Offices, Shops and Railway Premises Act. This Act proved to be a most impressive piece of legislation, and six years experience of administering its provisions has vindicated its declared objective of improving standards of welfare and safety of employees in office and shop premises. By 1969 the environment and its preservation became something of a cause celebre. Ecological science is being talked about in the right places, and by the right people. On an international scale European Conservation Year was launched and during 1970 the nations of Europe will try to thrash out a common policy on the improvement and conservation of the environment. The United Nations has also decided to convene a world-wide conference on this subject in 1972. In the United Kingdom the government has reacted by appointing a Minister of State with special responsibilities for the environment; it has also set up a Royal Commission on environmental pollution — the dangerof all this froth and activity is that conservation may be lost in the welter of conversation. It was the legislation of 1888 and 1894 which carved out of the chaos of nineteenthcentury ad hoc municipal administration, the system of autonomous county boroughs and administrative counties with their second tier of non-county boroughs, urban and rural districts. The first indication of any fundamental thought about the future pattern of local government came in 1945 with the setting up of the Local Government Boundary Commission. Though it had no brief to look at functions, its 1947 report, in fact, made quite far-reaching proposals for the status and functions of local authorities. The most significant change came in 1965 as aresultof the London Government Act of 1963 which put into effect the recommendations of the Royal Commission, which had been set up in 1957, to look at the structure in Greater London; 101 authorities were replaced by a Greater London Council covering the whole of the built-up area and a second tier of 32 London Boroughs, plus the City of London. Amalgamation is now past history, but subsequent events have proved that it was only the beginning of aprocess of upheaval which is still with us — it could, more aptly, be described as "the lesson of London". - 28 - Each of the 32 new boroughs started off with roughly the same population and were to be responsible for administration of similar services. But the opportunity to equate establishments, salary structures, administrative procedures and managerial services throughout London was not taken — this was left to the London Boroughs Management Services Unit which moved in a year or two later, just when the boroughs were beginning to settle down. Amalgamation also provided an opportunity for central government to examine local authority finance but, as far as I am able to ascertain, this was not seriously considered. It seemed that London was being thrown in at the deep end as an experiment to provide experience and evidence for the reports of the Committees, set up to advise on local government re-organisation, which were to follow — Maud (1967) on management; Mallaby (1967) on staffing; Seebohm (1968) on allied personal social services; the Royal Commission (1969); the Green Papers (1968 and 1970) on the future structure of the national health service, and the White Paper (1970) on local government reform - I can think of no other reason for putting the cart before the horse. However, amalgamation proved to be the first real step towards management, co-ordination and integration of the services provided by the local authority. In the past the emphasis had been on administration of an established system to run smoothly with the minimum of change. Officers of various departments were on a nodding acquaintance with each other and tended to work in isolation; overal I direction and co-ordination was lacking. The old system perpetuated the out dated concept of environmental sanitation and there was a general reluctance to accept that modern environmental health problems cannot adequately be dealt with by a departmental and fragmentary approach. The fact that the Health Department was receiving hundreds of complaints each year concerning defects and deficiencies in the quality of the environment seemed to be of little significance, and the public health inspectorate, in their customary anonymity, were left to try and pacify the complainants by operating the powers available to them. Amalgamation brought no real change or extension in the duties and responsibilities of the public health inspectorate, but the new organisation which emerged provided the means for the various professional and technical disciplines to be brought together to deal with facets of the same problem — that of preserving and improving the quality of the environment. The principle of placing under one "Director" a group of professional disciplines which can be said to have related functions was later recommended by both the Maud and Mallaby Committees. This type of set up would seem to be necessary to achieve maximum co-ordination and implementation of any necessary plan of action in relation to housing surveys, slum clearance, urban renewal, improvement areas, location of industry and noise prevention. But if it is to be really effective, the relationship between the role of management and the function of the professional officer must be clearly defined. The next logical step would be to reflect this new approach in the Committee organisation. The second Green Paper on the future structure of the national health service was published in February, 1970. This important document set the seal on the extent of participation by the local authority in the health service. The present tripartite organisation of the health service has been held by most people to be unsatisfactory for a long time. The Green Paper makes perfectly clear the government thinking in this respect. It proposes to set up area health authorities coterminous with new local government boundaries, which will administer the unified national health service. It recognises that social work cannot be divided by a hard line and that the services should be organised according to the main skills required to provide them, rather than be any categorisation of primary user. It is proposed that the health authority will be responsible for the services where the primary skill needed is that of the health professions and the local authority will be responsible for services where the primary skill is social care - 29 - or support; bridges will have to be built to ensure effective co-operation between both branches of the service. Local authority and other interested organisations are already expressing disagreement with this formula and there are likely to be many impassioned debates before legislation, to give effect to the governments proposals, is introduced. I am pleased to note that local authorities are to retain their full responsibilities for the environmental health services. This is a local service in that those officers performing the work must have an intimate knowledge of their district and be readily accessible to the local residents. When the final pattern emerges it is hoped that there will be strong and comprehensive machinery, at all levels, for the protection of the environment in its widest sense. It would be disastrous if environmental health work is fragmented and subordinated to other interests. One point of cardinal importance, which cannot be stressed too strongly, is the inter-relationship of the various facets of environmental health problems. However, the only thing that can be said with certainty at this moment is that within the next year or so vitally importantdecisionsare likely to be taken on the future structure of local government, on the administration of the national health service and on re-organisation of the personal social services. The plans for changing these public services are receiving, and will continue to receive, the most critical examination and will naturally reflect personal, professional and corporate interests, but when decisions are made it must be hoped that the public interest will be the paramount consideration. Whatever system is finally adopted, it must not be overlooked that the ultimate test of any service is the quality of the men and women who run it. In conclusion it is my privilege to acknowledge the support and encouragement accorded to me by the Medical Officer of Health and the Town Clerk, and the interest shown by past and present Chairmen and members of the Committees concerned with the work of the environmental health services. I would also like to express my thanks to all my colleagues in the health and welfare service and to officers of other departments for their help and co-operation over the years. And finally, I wish to acknowledge my indebtedness to the industry and loyalty of the members of the staff of the public health inspectorate and to tender to all of them my sincere thanks and appreciation. B.J.Ashcroft Chief Public Health Inspector HOUSING SURVEY - CANN HALL ROAD AREA I. INTRODUCTION Publication by the Ministry of Housing and Local Government of the White Paper 'Old Houses Into New Homes' (Cmnd 3602) in April 1968 foreshadowed the new and strengthened powers to be given to local authorities with respect to house improvement and repair, area environmental improvement, multiple occupation and rent reassessment, which were subsequently contained in the new Housing Act, introduced in August 1969. The White Paper also implied a widening of the scope of the duty imposed on local authorities under previous housing legislation to review housing conditions in their districts from time to time with a view to determining what action to take in performance of their statutory functions. - 30 - In anticipation of these new powers and duties an area situated in the extreme south of the Borough - Cann Hall Road - was defined for detailed examination. Selection of the area to be surveyed was influenced by the findings of the 4% sample house condition survey completed in 1967 which gave a broad indication of age and condition of property and deficiency of essential facilities and amenities. The survey was carried out during the period May to October, 1969. Detailed analysis of its findings are set out in a series of tables which appear in the form of appendices to the report which follows. 2. THE SURVEY AREA The area is bounded by the borough boundary to the south and east, by Cann Hall Road to the north and Leytonstone High Road to the west; the area is predominantly residential embracing 25 roads and covers 37 acres excluding cemeteries. The boundary with the London Borough of Newham dissects several roads situated in both boroughs and this may warrant some liaison with the council of the adjoining authority. The term 'dwelling unit' was used throughout the survey to enable an accurate assessment of occupation to be made. A dwelling unit in general terms can be interpreted as a unit of accommodation which is an entity either by reason of its self-containment or by its possessing the five standard amenities for the exclusive use of the occupants; a single building may therefore contain several dwelling units. The area contains 1,498 dwelling units and 54 business premises made up as follows business use only 24, part business and dwelling 27 and vacant 3. Generally speaking the business interests are small and consist mainly of retail shops, garages and light engineering etc; there are no large factories in the area. A detailed inspection of 1,367 dwelling units resulted from the survey and 3,322 visits were made. In the case of 87 houses access and information was either refused or repeated visits proved unsuccessful and 44 properties were vacant. There are 130 council dwellings within the area, 98 of these are post-war and have been excluded for the purpose of analysis since it was felt that their inclusion would distort the results obtained from the older property most prevalent in the area. 3. AGE OF DWELLINGS The properties fall within the following age groups. PRE/1880 1880/1890 1890/1899 1900/1919 1920/1930 AFTER 1940 % NO. % NO. % NO. % NO. % NO. % NO. 6.7 101 72.3 1083 6.3 94 7.0 105 0.4 6 7.3 109 Age Grouping Over 90 years 79/89 years 70/79 years 50/69 years 39/49 years Less than 29 years It will be noted that by far the greater proportion of the property (85.3%) was built before the turn of the century. - 31 - 4. OWNERSHIP OF DWELLINGS Ownership of dwelling units were owner/occupiers 44.5% (666), private 46.8% (702) and L.B.W.F. 8.7% (130). It is interesting to note that the number of owner/occupiers and private landlords are of the same order 44.5% and 46.8% respectively; the trend of increasing owner/occupation of this type of property continues. 5. OCCUPATION Assessment of multiple occupation was made in accordance with the new definition in Section 58 of the Housing Act, 1969. There are many kinds of situations to be covered and the new definition has been framed in general terms viz - "a house which is occupied by persons who do not form a single household", Circular 67/69 indicates that it would be resonable to regard the new definition as covering in particular: (i) a house occupied by two or more households; (ii) a house occupied by a number of persons where the relationships between the various individuals resident at any one time are so tenuous as to support the view that they can neither singly nor collectively be regarded as forming a single household; and (iii) a house which is occupied by one main household together with varying numbers of individuals who do not form part of that household. The principal example of this third situation is where a house is used for accommodating lodgers, although in certain circumstances an individual lodger might form part of a household. It was found that 144 dwelling units (I 1.3%) were in multiple occupation by reason of two household sharing one or more of the available facilities; in addition 5 dwellings were occupied by more than two households. 6. STRUCTURAL CONDITION - INTERNAL AND EXTERNAL The overall situation with respect to structural repair and maintenance may be summarised thus: Good Fair Poor Unfit Total External 689(49.2%) 612(43.7%) 92(6.6%) 7(0.5%) 1400 Internal 982(77.3%) 266(20.9%) 14(1.2%) 7(0.6%) 1269 Excludes 98 post-war L.B.W.F. properties. Most of the 666 owner/occupied dwelling units were conspicuous by their attractive external appearance which is also a reflection of their good condition and maintenance; 75% were classified to be in good structural condition and repair; 23.5% were fair and only 1.5% poor. The position is almost reversed in the private sector; only 24.7% of 702 dwelling units being in a good state of structural repair, 62.9% in fair condition, 11.4% poor and 1.0% (7) unfit. - 32 - The internal condition of owner/occupied dwellings inspected showed a similar pattern of maintenance; some 99% falling within the good and fair classification. Regarding the private sector, the terms of most tenancies are such that the tenant is responsible, or assumes responsibility, for the internal decorative state of the dwelling and this coupled with the natural desire to live in decent surroundings accounts for the relatively high percentage of dwelling units (97.3%) in the good and fair categories. A degree of reservation must be made in relation to the dwelling condition analysis because of the exceptionally dry weather before and during the survey period, this undoubtedly accounted for lack of tangible evidence of dampness in many instances. 178 premises were referred to the Borough Architect for consideration of means of escape from fire and fire-proofing in accordance with Section 60 of the Housing Act, 1969 and Section 16 of the 1961 Act. 7. AVAILABILITY OF STANDARD AMENITIES The survey sought to obtain information as to the extent to which the standard amenities are provided in the area. These amenities are facilities which are considered essential in a dwelling house in order to rank for improvement grant and/or for reassessment of rent in the case of controlled tenancies. Of the 1,269 dwelling units fully inspected 312 were found to possess the full standard amenities and to be in a reasonable standard of repair having regard to their age, character and locality. The extent and natureof the deficiencies occurring in the remaining 957 dwellings may be summarised thus; absence of - bath 633 (66.1%), wash hand basin 719 (75.1%), sink 2 (0.2%), internal W.C. 808 (84.4%), hot and cold water supplies 758 (79.2%). In many of these dwellings there is some provision for hot water supplies but not at the three points - fixed bath or shower, wash hand basin and sink as required under the Act. A further breakdown of these figures was made to ascertain the number of potential applications for 'Qualification Certificates' which could arise if, in fact, owners w;re to take advantage of the new rent provisions under Part III of the Act. In considering the extent of the work which may devolve on the local authority in this connection, it was found that of the 448 controlled tenancies within the survey area only 25 premises comply with the standard of amenities and repair. The remaining 423 are deficient in bath 383 (90.5%), wash hand basin 408 (96.4%), sink I (0.2%), internal W.C. 394 (93.1%) and hot and cold water supplies 413 (97.6%). 8. EXPECTED LIFE OF DWELLINGS In assessing the expected life of dwellings due regard was paid to the structural condition of the property assuming that the existing standard of maintenance would be continued and to the general condition of any buildings to which it is physically attached. - 33 - On this basis the position is as follows:- 5 YEARS OR LESS 6-14 YEARS 15 YEARS OR MORE TOTAL % NO. % NO. % NO. % NO. 0.5 7 5.6 79 93.9 1314 100.0 *1400 *Excludes 98 post-war L.B.W.F. properties. 9. CAR PARKING FACILITIES Car parking facilities are summarised as follows:- Vacant No Space Space within Curtilage Space Elsewhere No Access 83.8%(1173) 4.5% (63) 2.3%(33) 9.4%(131) Conclusions and General Observations 10. AREA IMPROVEMENT POTENTIAL The findings of the survey confirm this to be an area for improvement and repair rather than one for slum clearance and redevelopment. Both the environment and the dwellings ought to be improved; the action to be taken to achieve this under the new legislation will require consideration of a number of factors: (i) economic considerations; (ii) future development proposals within the context of the development plan system; (iii) the quality of the environment, roads and their traffic function, existing and future car parking provisions, spare land for amenity purposes; (iv) situation of residential property in relation to commercial and industrial premises, shops and schools; and (v) the physical potential of the area in relation to dwellings and other buildings. Regarding (v) above, the physical potential of 1,314 dwelling units (93.9%) in the terms of expected life, assessed on their structural condition, is estimated to be in the region of 15 years and upwards. Although 957 dwelling units (75.4%) in the area are deficient in one or more of the standard amenities, the buildings are essentially sound in fabric and worthy of some improvement. Thirty years has been specified by the Ministry of Housing and Local Government under Section 3 (2) of the Housing Act, 1969 as being the period during which a dwelling should provide satisfactory housing accommodation after completion of works of repair and improvemeni within the framework of the 12-point standard. A shorter period (not less than 10 years) may be accepted as reasonable in the circumstances of a particular case. As a general rule a 15 year life would be taken as a minimum requirement for approval of standard grants under Section 9 - 34 - or special grants under Sections 13/15, but these would have to be considered in relation to the needs of individual dwellings and not on an area basis. Having regard to this consideration alone, it would appear that the area under review is not one that can be dealt with in the long term as a 'General Improvement Area' within the terms of Section 28 of the Housing Act, 1969. II. SHORT TERM - ALTERNATIVE ACTION FOR REPAIR/IMPROVEMENT Ideally, repairs and improvement should be carried out at the same time, but since the standard grant provisions under Part I of the Act, and the rent provisions (conversion of controlled tenancies) under Part III are not compulsory, it is extremely doubtful whether this can be achieved. In any event progress on improvements is likely to be slow. On the other hand, the information produced from the survey is of sufficient detail to enable statutory enforcement procedure to be invoked forthwith with respect to the service of Notices to secure essential repairs and such improvements as can be obtained to houses in multiple occupation under the Housing Acts 1957/69. The question to be decided is whether to (a) initiate statutory procedure immediately to give the area a repair and maintenance face-lift in the hope that owners will be prompted to seek improvement grants and/or apply (where appropriate) for 'Qualification Certificates' under Part III of the Act or; (b) treat the area ostensibly as an area for improvement and endeavour to secure both repair and improvement by informal action. Regarding method (a) to blanket the area at this stage with statutory Notices carrying the implied threat of legal proceedings and/or work in default, without prior notice of the Council's proposals for the area, would not be conducive to good public relations; it might well create a hostile attitude and destroy any real chance of securing the co-operation of owners and residents. Since good public relations is one of the most important factors to be considered, the second method (b) would seem to be the one most likely to succeed. In this connection it is of interest to note that the introductory letter inviting the co-operation of residents in the area when the survey was in progress was well received and access was obtained at 85% of the properties. Also, the publicity created by house to house inspections in the area has already stimulated some owners into action in carrying out fairly extensive repairs to a number of houses. To test public reaction further, I suggest that an informal letter be sent to owners and occupiers drawing their attention to defects and deficiences where they exist, and inviting them to take full advantage of the grant scheme. Opportunity would also be taken in the letter to inform all interested persons of the Council's proposals for the area and at the same time to include explanatory publicity material about the working of the Act and the new grant and rent provisions. Mobile exhibition units and a demonstration house could perhaps be provided showing in practical terms a reasonable and economical improvement scheme, this latter point is important because I feel that quite often we destroy our own case by presenting a model conversion/improvement scheme which is unrealistic and out of keeping with the age, character and locality of the properties. - 35 - Meanwhile, matters requiring urgent attention will continue to be dealt with by routine procedure; this includes any action necessary with respect to unfit properties. 12. MULTIPLE OCCUPATION - NEW STATUTORY CONTROL PROVISIONS The powers available to the local authority to control and improve conditions in houses in multiple occupation have been considerably strengthened by the amendments to the Housing Acts of 1961/64 in Sections 59/63 of the new Act. Generally speaking, the powers in relation to repair, provision of facilities, improvement and permitted occupation of such houses should, if properly administered, prove to be adequate to deal with conditions in areas where the majority of multiple occupation is of the two household category. Where the problem of multiple occupation exists on an extensive scale and is associated with squalor and severe housing stress, additional control measures may be applied to the whole or part of a local authority's district by promoting a regulatory/informatory scheme under Section 22 of the Housing Act, 1961 as extended by Section 64 of the 1969 Act. The implications of applying a scheme of registration and control to a defined area within a local authority's district may not be readily appreciated. Multiple occupation has no boundaries; the effect of the stigma attached to an area, down-graded for special control, may tend to perpetuate the squalid conditions the scheme seeks to eradicate, and at the same time may impair public relations among the stable population of the area, particularly in the increasing owner occupied sector. I would prefer to see these powers applied to the whole of a local authority's district rather than to a part only, if in fact the general problem of multiple occupation justifies such a course. However, whatever type of scheme is adopted, the Minister requires to be fully informed about conditions in the area. This would seem to imply that a fairly comprehensive examination of the area under consideration will be necessary. To be really effective, such schemes will require fairly constant and specialised attention and will thus create heavy demands on limited staff. The pros and cons therefore, will require careful consideration before any scheme is submitted for confirmation. 13. MULTIPLE OCCUPATION - THE SITUATION IN THE SURVEY AREA The present survey shows that although 144 dwelling units (11.3%) are in multiple occupation by reason of two households sharing one or more of the available facilities, only five dwellings are occupied by more than two household. This can largely be attributed to the restricted accommodation in the houses under survey. The majority of which are small terraced five roomed two storied properties built originally for habitation by one family. It can be said that no serious housing stress or squalor exists within the survey area and it would seem that there is no justification for making a regulatory and/or informatory scheme under the new Act. 14. MULTIPLE OCCUPATION - THE GENERAL PROBLEM The object of a survey carried out during 1968 was to obtain a broad assessment of the general problem of multiple occupation of houses in the borough and the extent to which immigrants were involved. - 36 - In my report dated 15th October, 1968 on the findings of this survey, I stated that a conservative estimate of the number of houses in multiple occupation was in the region of 8,000 of which 2,000 were thought likely to be in the 3 or more household category envisaged by the new legislation. As this exercise covered the whole borough and was not so detailed as the survey under review, its findings cannot be related to a particular area or areas for the purpose of formulating a scheme of registration and control. Much more detailed information will be required, and it will be necessary to carry out further fact finding surveys in areas known to contain a concentration of multiple occupation. Their scope and practicability will be limited to the staff available. As stated in the above mentioned report, 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 vigorous follow-up procedure would, in my opinion, require the full time services, for an indefinite period, of at least 4 Inspectors. 15. OCCUPATION OF HOUSES BY IMMIGRANTS The number of dwelling units in the survey area occupied by immigrants was 81 (6.4%) comprising 88 families and 424 persons. By far the greater proportion of immigrants (76.5%) were found to own their own houses. This can perhaps be accounted for by the fact that immigrants experience difficulty in obtaining accommodation at a reasonable rental; the outgoings resulting from the purchase of sub-standard property are possibly not greatly in excess of exhorbitantrents they are obliged to pay for furnished accommodation which more often than not is the only type of letting available; immigrants often share the financial burden of house purchase by joint mortgage/ownership. The survey did not produce any substantial evidence of squalor or housing stress among the immigrant population in the area. Aggregations of property owned and/or occupied by immigrants is the natural outcome of people of similar backgrounds, customs and language being drawn together; the number of immigrant pupils in the schools is a reliable indicator of the districts where such areas of occupation are to be found. The estimated immigrant population in the borough is in the region of 20,000 situated mostly in the catchment area of schools in Walthamstow and Leyton. 16. WORK POTENTIAL - IMPROVEMENT GRANTS/QUALIFICATION CERTIFICATES The number of controlled tenancies with comparatively low rents is quite high, 448 dwelling units (63.8%). The low income derived from these properties is reflected in the poor standard of maintenance, repair and lack of basic facilities. Increasing owner occupation will undoubtedly result in a general improvement in maintenance of property in the area. It is hoped that the added financial inducements under the new Act will provide the necessary incentive to owners in the private sector to improve their property in order to qualify for higher rents resulting from conversion of controlled tenancies to regulated tenancies. Assuming that owners and occupiers in the survey area were to take advantage of the provisions contained in the new Act, the number of potential applications for standard grants under Section 9, or special grants under Section 13/15 is 957, and the number of potential applications for 'Qualification Certificates' under Part III is 448. It will be interesting to see how this works out in practice after a trial period. - 37 - B.J.Ashcroft Chief Public Health Inspector A MEDICAL OFFICER'S VIEW OF RE-HOUSING REQUESTS A survey has been made in the Borough of what people do in fact say that they want in the way of housing. These requirements are not exigent; perhaps not very imaginative; otherwise put; they don't want much but they know what they want. The necessity for shelter and living space is taken for granted, so under these heads the only comments are about what people object to. Shelter: Roofs which let the rain in are disliked, and recognised as a sign of general neglect of the property. Living Space: (i) Overcrowding is less easily endured when it follows from "not having a place of one's own with a front door": frequently (and especially disliked) with in-laws, or in a home of two or three rooms with shared facilities in half a house. (ii) When the family is grown up and dispersed one of the pleasures of older people lies in entertaining each other. For this a spare bedroom is required and lack of it is a true hardship. (iii) Mice and black beetles: sharing accommodation with these courageous commensals is much disgusted. This is a point in favour of concrete construction, which mice find difficult. It might be supposed from the existing housing stock in the Borough that style in domestic architecture has absolutely no effect on the inhabitants. This is not true. Up to a point, the customer will stand anything; but beyond that, general acceptance, it seems, would depend on market pressure. Formerly these limits were closely determined by the speculative builder and they have not greatly altered today. Thus many normal sensible women feel their situation repulsive when their homes are embedded in an extensive tract of concrete. In the circumstances there is nothing they can do about it. When they contemplate their surroundings they sit and cry and cry. There are some disadvantages in housing with which, from experience, the public is very familiar. These are mainly incidental to large scale constructions. There are notorious difficulties which arise when very many dwelling units, are concentrated into one monolithic block. Transport of sewage, and of personnel in and out of the building, is in fact not distributed evenly through the twenty four hours, and may over-tax the facilities provided. In the largest blocks the lifts are a matter of incessant complaint. During the busy hours, some are monopolised by tradesmen; when one lift out of several breaks down (which happens frequently) the extra loading increases the risk to all the others. A large block is apt to contain many children; prevented (when possible) from playing in the corridors(l), their main occupation becomes the disablement of the lifts. All this is contrasted with what is regarded as the natural method of getting in and out of one's house through the street door. An additional complaint against lifts is the common approach by ramp or steps. - 38 - Plate No. I - BASEMENT ACCOMMODATION - UNFIT FOR HABITATION. Showing condition of part of basement accommodation when Closing Order was made. Plate No.2 - BASEMENT ACCOMMODATION - UNFIT FOR HABITATION. Showing condition of same basement on completion of structural works and repairs. Note staircase (Plate No.1) has been removed and basement is now self-contained. Plates Nos.3 & 4 - BASEMENT ACCOMMODATION - UNFIT FOR HABITATION. Showing condition of basement accommodation when Closing Order was made. Note indirect natural light and ventilation which is borrowed from derelict back addition bathroom as shown in Plate No.4. Plate No.4 Plate No.5 - BASEMENT ACCOMMODATION - UNFIT FOR HABITATION. Showing condition of same basement on completion of structural works and repairs. Note removal of window and part of wall (Plate No.3) and kitchen area replacing back addition bathroom (Plate No.4). Plate No.6 — No service has ever been so appreciated The laundry for the incontinent provides a discreet service for those whose linen is unacceptable to the laundry or launderette. Plate No.7 — Special vehicles bring physically handicapped people from destructive isolation within four walls to a friendly community life at Roberts Hall Work Centre. In a large block there are likely to be some tenants who enjoy making loud unseasonable noise, and also some who dislike it. In a very large block this becomes a practical certainty. In a street, the nuisance affects only a few neighbours, but many more in a closely packed block; and some of these blocks are notorious for transmitting sound from one end to the other. Similarly the noise of cars which would be a minor nuisance spread over a street becomes a nightly pandemonium when concentrated beneath one building. This occasions very great resentment among tenants who do not have cars. These disadvantages of size are recognised as such by the general public; but the abstruse reasons are not appreciated, which lead to planting high blocks on particularly bleak and windy sites. It is merely felt that living is more snug in a street of houses. Because of the deficiency of housing stock people cannot look forward to changing their homes often. Therefore in specifying the accommodation one would like, it is prudent to think of the home one is prepared to stay in for most of a working life. A flat in a tower, perhaps quite satisfactory to a couple early in marriage, is not what will be required for a young growing family. People have constantly before them in the Borough examples of all that they desire in housing as well as all that they would wish to avoid; and there is in fact a concensus with regard to the reasonable housing requirements of a family. 1. A dwelling should be rain-proof and without visible evidence of rising damp or condensation water. This simple requirement, in past and present times, has often proved beyond the capacities of those concerned. Damp accommodation is detested; in fact it can make a mess of home and possessions and it is also regarded as a menace to health. 2. There is a strong preference for heating, by solid fuel with an open hearth in every room. The public is aware of the beneficial effects of a cheerful fire, and of adequate chimney ventilation; and they know the inadequacies and extra costs of the other methods. 3. Stairs to the extent of one flight are generally accepted as an accompaniment of family life. It is felt that children can be supervised from this distance. The disabilities of age might be thought an argument against any stairs at all, but in fact, though people expect to live a long time, they do not look forward to getting infirm. On the other hand the enormous difficulties that multiple flights of approach steps occasion with young children are appreciated everywhere. 4. An indoor water-closet, and a bathroom with hot water available, have high place among the domestic amenities; and lack of them is felt to be a mark of second-class accommodation. 5. The over-mastering requirement, with priority above all others, demanded universally, is that the home of a family where children are to be expected should have a back garden. For this necessity there is no substitute. The reasons, which affect mothers and children, are obvious to everybody. To sum up: for most people in the Borough, the ideal of a permanent home, is then> - 39 - A dry brick house, with a bathroom and indoor water-closet, and a fire place in every room, with a little back garden, in a street near a bus route. And most important of all a low rent. Dr. F.J.Goodey Senior Medical Officer for Community Care THE HANDICAPPED: CLOTHING AMD HOUSEKEEPING This is the third article on the needs of the handicapped, the previous two having been included in the Medical Officer of Health's reports for 1967 and 1968 and dealt with Mobility, Feeding, Toiletting and Washing. Handicaps range from complete crippling or total blindness to some slight disability or defect of sight. They may arise from some failure in pre-natal development, or disease later in life or from accident. The disabilities may be stable or progressive. The handicap matters on how severely it interferes with what one is desirous of doing. The loss of a finger is not a handicap to a professional footballer but is a major catastrophe to a professional pianist. Stable handicaps are easier to accept and to adjust to than are the fluctuations of progressive diseases, or the incidence of epileptic fits which may lead to losing a job for which during the major part of the time, one is fully competent. As with so many other things the question of clothes is much the same for the person with a disability as for the person without a disability. Looking well in clothes does something for the wearer and good clothes are an asset. They can help to minimize the appearance of disability. A person with a disability should be a little more disciplined in the choice of clothing. Available are wrinkleproof materials, fabrics which do not need ironing, and stuff which is warm without weight. A slippery lining to a coat helps in putting it on. For wheelchair users short or three-quarter length coats are easier to wear. Convenience in getting into and out of garments is important. Front openings are easier than back fasteners, and coat style is easier than over-the-head type. Two-piece garments are often easier than straightthrough dresses. Wide armholes are better than fitting ones. They give more freedom and wear better, but raglan styles are not suitable for crutch users. Pleated or full skirts are more comfortable for wheelchair users than tight fitting skirts. Zippers or Velcro are better fasteners than buttons, press-studs or hooks and eyes. If hips and knees will not allow bending, a 10" length of cord passed round the neck, fastened on to trouser buttons and the surplus tucked into trouser legs will allow the trousers to be dropped on to the floor and remain anchored round the neck when the toilet is used. The trousers can be raised by pulling them up with the cord. A maternity wrap-round skirt worn back to front helps a disabled women with her toilet problems. Putting on and doing up shoes is a problem for those unable to bend. Shoes which can be slipped on will be more comfortable for most people but some will need to wear the lace-up type of shoe. Elastic shoelaces already threaded, which open out when the foot is pushed in with the aid of a long-handled shoehorn, and close up when the foot is in place, solve the problem of doing up shoelaces when one is stiff. Seams in the uppers of shoes should be avoided as disabled feet are susceptible to pressure and seams can cause blisters and corns. - 40 - Special holders are available on which a tie can be knotted and held in place by a piece of elastic round the collar.. A glove for a one-handed person can be put on without help by sewing a loop of tape on to the back edge of the glove, hanging it by the loop on to a hook on the wall and pushing the hand into the glove. Resistance to the push is maintained by the loop over the hook. Loops on the edge of jacket or long arm dress sleeves, to go over the thumb and little finger, will prevent these sleeves riding up when the outer garments are pulled on. Aids for holding materials and for the threading of needles enable the one-handed to sew, and electric sewing machines can be operated by putting the foot-control on the table and operating it with the elbow if the user has last the use of her legs. Being independent of others' ministrations, however, is only the beginning of rehabilitation. The handicapped need guidance in performing duties which will enable them to become an asset in the households in which they live, or in the places of their employment, and eventually to become the helper instead of the helped. The more useful a handicapped person can become the more secure is his or her position whether it be in the home or in the factory. A woman's greatest desire is to be able to look after her family herself and as she spends most of her time in the kitchen this is as good a point as any from which to start off on the needs for suitable gadgets and adaptations. It is important that attention be paid to the position of doors which will include the back door, the inner door to the kitchen and larder and cupboard doors, and of the sink unit, cooking stove and work tops. The most practical layouts are in a U shape or L shape, at a height suitable for the individual according to whether she is seated in a wheelchair, on a swivel-seated chair, or standing. All tops of sink, cooker and work benches should be at the same height to allow saucepans and dishes to be slid instead of being lifted from one position to another. For most disabled and old people the split stove, oven next to boiling rings, is the safest type of cooker. It removes the necessity to stoop at the oven and allows all cooking to be seen and reached at between waist and chest level. Sinks should be of the shallow type, about 5" deep inside 6" outside and fixed at about 33" top edge above the floor. For those who stand the bottom of the sink is not too low and for those who sit the top is not too high and the bottom will not get in the way of the user's knees. Taps are best at one corner of the sink with a central swivel tap for both hot and cold water. The tap should send a jet out to the middle of the sink and not straight down to the back of the sink. By swivelling the tap over the draining board it is possible to fill a saucepan or kettle ready to slide on to the cooker and thus obviate the necessity of having to lift up a full utensil which is usually too heavy for a handicapped person to do. Shallow drawers under a worktop for cookery tools and shelves not too high above the worktop on which pots and jars may be placed, save considerable movement to and fro. A V-shaped bottle-top opener can be fixed below the bottom shelf to allow aone-handed person to perform an otherwise impossible operation. A sliding board under the worktop pierced with various sized holes in which mixing bowls and basins may be rested help the one-handed to mix pastry and beat cake mixture. A paint roller which has been adapted by fitting a wooden roller instead of the usual lambswool or rubber roller, will make an ideal one-handed rollingpin. A walking trolley with trough arm supports on top and cut-back lower shelf to allow movement of legs, and a top shelf level with work-top, provides a carrying and walking aid for someone who needs support in walking at the same time as needing help in carrying items from one part to another part of the kitchen or to another room. - 41 - The washing machine and the spin dryer have revolutionised the former heavy work of washing and the most suitable appliances for the particular handicapped person should be carefully chosen. The handicapped housewife also needs adjustment and help in performing household duties in parts of the house other than in the kitchen. Dustpans and brushes with long handles and very light carpet sweepers are available in large stores and are as useful to the ablebodied as to the disabled. A broom with a trough armpiece fixed along the end of the handle and a right-angled handgrip about 12" away overcomes the difficulties experienced by a onehanded person in sweeping. Specially adapted or designed gardening tools are available and for those unable to bend the raised garden provides great pleasure both for those who are stiff and those who are wheelchair users. A national campaign to make public buildings and facilities accessible to the disabled was sponsored originally by the Central Council for the Disabled, and is now continued by the Disabled Living Foundation, and Local Authorities have been asked to give consideration to the needs of the elderly and the handicapped when studying applications for the erection of public buildings. The British Standards Institution has published a Code of Practice on the subject. B.Warshaw Chief Welfare Officer MEDICAL RESEARCH COUNCIL Contributed by Elizabeth Cooper, B.A. FAMILY SURVEY - M.R.C. CHILD DEVELOPMENT AND BEHAVIOUR UNIT There have been two main developments in the Unit's work in the Borough since the last report was written. The earlier attempts to develop quantitative measures of the activities and interactions of small children have been extended using observational methods supplemented by video and sound recording. We have also been given access by the Education Department to a number of schools in the area and a study is under way which examines the child's behaviour in the classroom during his first year at school. This is being related to his teacher's attitudes towards him, his pre-school experiences, social class and ethnic origins. In 1969 a study was completed on a group of 4½ year old children from a wide variety of home and ethnic origins whose behaviour in problem solving situations was the focus of attention. Our interest was in behavioural differences in the way immigrant and English born children tackled test problems. An extension of this study is now being run with 5½ year old children using video equipment, a simple test of vocabulary and a more detailed analysis of behaviour. Also completed in 1969 were two studies of children whose mothers had unusual characteristics - in one the mothers were excessively houseproud and in the other they were either highly rigid or highly permissive in their attitudes. The main aim of these studies was - 42 - to see the ways in which attitudes were related to actual behaviour. In each study, groups of mothers were initially selected by Health Visitors in the Borough. In the study of houseproud mothers it was found that their children, compared with a control group, spent more time alone, more time physically restricted and had more intense interactions with adults. In the second study where observational studies of the mother's and children's behaviour were made, it was found that highly restrictive mothers exerted more verbal direction and control over their children's behaviour than the women in the control group. We are pleased to be able to report that some of the work we are currently engaged on is a direct result of ideas from our colleagues in the Borough. In one school we have been asked by the headmistress to make a special study of a particular group of children whose behaviour is felt by the teachers to reflect unusual environmental circumstances; this study is expected to be finished in 1970. In response to a request from Dr. Little we are using video equipment to provide a descriptive account of the behaviour of children attending a psychiatric unit of Whipps Cross Hospital. We hope in the future to provide a similar account of children's progress at the Remedial Centre as requested by Mr. Jeffrey. Progress has been made on the development of a register of children in the Borough, the basis of which is information given by Health Visitors about all the births to families resident in Waltham Forest. The Health Department also keep us informed of changes of address and movements out of the Borough. The register is now running smoothly and will shortly be available for use as a sampling frame for the Unit's studies in this area. A yearly analysis of the data collected has been asked for by Dr. Wright who hopes to use it to solve some outstanding administrative questions. Since our last report the name of our Unit has been altered in keeping with the changing nature of our interests and work, and we are now the M.R.C. Child Development and Behaviour Unit. We are very grateful to both the Department of Health and Welfare and the Education Department for the assistance and co-operation extended to us in the course of our work in the Borough without which the studies described here would not have been possible. THE SOCIAL RESPONSIBILITY CENTRE Contributed by Mrs. J. Payne, Welfare Organiser 1969 saw important developments in the work of this centre:- Staff By now, welfare had grown to be the largest single part of our work. In January Margaret Filer came to assist me. To leave us free to concentrate our full-time efforts on the welfare work, Miss Shilling joined us in August to take over the organising of the School Leaver Conferences, Housing Trust, and to develop the Centre's other activities. Telephone We obtained a new 'easy to remember' number — 520 2000. Case-work We began to receive requests for help with more complex and long-term cases as well as the increasing number of short-term emergencies. -43- Volunteers Our volunteer force underwent a change. Originally all calls received were channelled out through the churches. A map of the Borough, displayed in our office, pinpoints churches of all denominations. 1969 saw the steady growth of our list of individual volunteers— people not necessarily attached to a church, who had heard of our work, and other who had written to the Borough offering to do voluntary social work and had been referred to us. Some of the people who have received help have, in turn, offered their help. All volunteers are interviewed to find out what type of work they would like to do i.e. working with children or old people, or whether they would prefer to work independently or with a group. Our volunteers come from all walks of life — our youngest is a schoolboy of ten who shops for elderly people and helps with gardening — others include a recently retired bus driver, policemen and nurses willing to help in their limited off duty time, housewives, garage mechanics, clerical workers, an ex-child care officer, probation officer and health visitor. These are joined on the list by groups of young people from youth clubs. By the end of 1969 we had dealt with over 600 cases. The variety is wide. Sometimes the request is straightforward — can we find someone to transport a person to the psychiatric clinic? Others are more complex and need consultation with the social worker involved. Sometimes we are fortunate and find help at our first attempt. We have made 19 telephone calls during two hours of continuous telephoning, to find someone to sit with a dying man. It is very important in some cases to find the right volunteer. Here again we are helped and guided by the social worker' Please send someone who will be kindly but firm' This close relationship and consultation helps to ensure that volunteer effort is used most effectively and perhaps to avoid any disasters. What can volunteers do? Looking through our case histories it is exciting to see what can be done. Sometimes a volunteer has helped prevent a person having a nervous breakdown — in one case this meant giving relief on three days a week to a mother with a severely subnormal and spastic child. Sometimes volunteers have enabled a person to return home instead of remaining in hospital. During a strike in October, volunteer drivers, using their own cars, kept the Meals on Wheels service in operation by helping to deliver over 300 meals. At 48 hours notice two volunteers stepped in and acted as escorts for a party of 22 handicapped people due to go for two weeks holiday. Children have been cared for when mothers have been ill. Volunteers have supplemented the work of the home helps, especially during the winter months when elderly people are temporarily bedridden with colds and 'flu. Much of the work can be put into categories but in a large proportion of the cases there are many different needs to be met and any help given must be worked out with the social worker in an attempt to make this right and acceptable to the individual or family. We have managed to provide a 'round-the-clock' service for emergencies. In May the Walthamstow West Rotary Club held a ball at the Assembly Hall and raised over £1,000 to buy us a minibus. This is used extensively at the time of writing this report, plans are in hand to help transport people to Roberts Hall. -44- Increasing interest is shown by schools in the Borough. Some give one or more days a week to social work. The young people have undertaken some valuable work — decorating, gardening, shopping, changing library books. Girls have escorted children to clinics for regular appointments. Boys have repaired gates, put draught excluder round doors and many other odd jobs for elderly people. These are our future volunteers. Every encouragement should be given to them and much thought should go into selecting useful and interesting jobs for them to do. The Churches have risen to the challenge and with the help and encouragement of the Medical Officer of Health and the confidence his staff have shown in us, our volunteers have a unique opportunity for applying their talents in the service of the community. 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 1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1969. (b) 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. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1969, was 235,880. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride was added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations:- River Lee derived via Lee Bridge Works, and well water from Ferry Lane and Chingford Mill pumping stations. A small portion of Lower Chingford adjoining Sewardstone Road north of Kings Head Hill is supplied with River Thames derived (Northern) water. Between May and September much of Walthamstow and parts of Chingford receive River Lee derived water from the new Coppermill Works. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on page 105. -45- (b) 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. Surveys carried out between 1966 and 1968 on analyses of water from consumers' premises confirmed this statement. RAINFALL AND SEWERAGE Contributed by D.M.P.Sullivan, C.Eng., M.I.C.E., F.I.Mun.E., Borough Engineer and Surveyor Rainfall The average rainfall recorded at three stations in the Borough was 21.5 inches which is slightly below the average annual rainfall of 24 inches due mainly to the exceptionally dry months of September and October. One heavy rainstorm occurred on the 3rd August and caused considerable flooding. In the first three months of the year many areas of open land were waterlogged due to the exceptionally wet period during the latter half of 1968. Sewerage During the year work commenced on the Walthamstow Southern Area (Southern Branch) Relief Surface Water Sewer, and also on the Leytonstone Area Relief Surface Water Sewer (Stage I), both of which will be completed in 1971. Work also commenced on minor relief sewers at Old Church Road/Mansfield Hill and Valleyside. The Hale End South Relief Surface Water Scheme (Stage II) was submitted to the Ministry of Housing and Local Government but approval has not yet been received. The Greater London Council have vested in themselves the main Outfall foul sewers from Walthamstow and Leyton to Hackney, together with the storm water tanks at Low Hall and Auckland Road Depots and the ancillary works. They have also notified the Council that they propose to vest in themselves the Walthamstow Northern Relief Sewer, the Chingford Western Interceptor and the Chingford Eastern Interceptor. Sewage Disposal Sewage disposal is carried out by the Greater London Council and this Council has no responsibilities in this connection. -46- VOLUNTARY ORGANISATIONS The following received grants from the Council during 1969:- British Epilepsy Association Chest and Heart Association Chingford Committee for Welfare of the Physically Handicapped Chingford Old People's Welfare Committee Essex League of the Hard of Hearing Information Service for the Disabled International Voluntary Service Leyton Physically Handicapped Club Middlesex and Surrey League of the Hard of Hearing National Association for Mental Health Nursery School Association (Waltham Forest Branch) Royal Association in Aid of the Deaf and Dumb St.John Ambulance Brigade (Chingford Division) Waltham Forest Association for Mental Health Walthamstow and District Group of the Hard of Hearing Waltham Forest Chest Care Association Walthamstow Physically Handicapped Club Wingfield Music Club Social Responsibility Centre Richmond Fellowship Wingfield Fellowship Trust Chingford Workshop for the Elderly Invalid Children's Aid Association Waltham Forest Disabled Drivers Club Indirect assistance from the Council's resources was also given to a number of other voluntary organisations and financial help provided for some local clubs for old people. -47- STATISTICAL INFORMATION VITAL STATISTICS Area of Borough (in acres) 9,805 Population (Registrar General's Estimate, midyear 1969) 235,880 Number of Rate Assessments at 31st December 1969 94,391 Total Assessable Value £12,189,681 Product of a penny rate £48,900 Live Births: WALTHAM FOREST ENGLAND & WALES MALES FEMALES Legitimate 1855 1825 3680 Illegitimate 150 160 310 3990 Live Birth Rate per 1,000 population 16.9 16.3 " " " as adjusted by comparability factor (1.06) 17.9 Illegitimate live births per cent of total live births 8.0 Stillbirths: Number (34 males:25 females) 59 Rate per 1,000 total live and stillbirths 17 13 Total live and stillbirths 4059 Infant deaths (deaths under one year) 61 Infant Mortality Rates: Total infant deaths per 1,000 total live births 15 18 Legitimate infant deaths per 1,000 legitimate live births 15 Illegitimate infant deaths per 1,000 illegitimate live births 16 Neo-Natal Mortality Rate (deaths under four weeks per 1,000 total live births) 10 12 Early Neo-Natal Mortality Rate (deaths under one week per 1,000 total live births) 9 10 Perinatal Mortality Rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) 25 23 Maternal Mortality: Number of deaths 4 Rate per 1,000 total live and stillbirths 0.99 Deaths: Total number 3035 Death rate per 1,000 population 12.9 11.9 " " as adjusted by comparability factor (0.89) 11.5 -49- -50- CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE - 1969 I.C.D. CAUSE HEADING CAUSE OF DEATH TOTAL (ALL AGES) AGE GROUPS - MALES AGE GROUPS FEMALES UNDER 1-4 514 1524 2534 3544 4554 5564 6574 75 + TOTAL MALES UNDER 1-4 514 1524 2534 3544 4554 5564 6574 75 + TOTAL FEMALES B4 Enteritis and other diarrhoeal diseases 4 1 1 - - - - - - - - 3 1 - - - - - - - - - 1 B5 Tuberculosis of respiratory system 1 - - - - - - - - - - - - - - - - - - 1 - - 1 B17 Syphilis and its sequelae 5 - - - - - - - - - 1 1 - - - - - - - - - 4 4 BI8 Other infective and parasitic diseases 3 - - - - - - - - - 1 1 1 - - - - - - - 1 - 2 B19( 1) Malignant neoplasm, buccal cavity etc. 4 - - - 1 - - - - 1 1 3 - - - - - - - 1 - - 1 B1 9(2) Malignant neoplasm, oesophagus 13 - - - - - - - 2 1 4 7 - - - - - - 1 - ? 3 6 B19(3) Malignant neoplasm, stomach 58 - - - - - 1 1 8 19 10 39 - - - - - - 2 5 4 8 19 BI9(4) Malignant neoplasm, intestine 75 - - - - - 1 1 8 12 12 34 - - - - 1 3 6 16 15 41 B19(5) Malignant neoplasm, larynx 6 - - - - - - - 3 1 1 5 - - - - - - - - - 1 1 B19(6) Malignant neoplasm, lung, bronchus 183 - - - - - 4 11 40 76 19 150 - - - - - 1 2 10 6 1 4 33 B19(7) Malignant neoplasm, breast 62 - - - - - - - - - - - - - - - 1 4 5 17 17 18 62 B19(8) Malignant neoplasm, uterus 19 - - - - - - - - - - - - - - - - 7 3 3 4 7 19 B19(9) Malignant neoplasm, prostate 20 - - - - - - - 2 3 15 20 - - - - - - - - - - - B19( 10) Leukaemia 11 - - 1 - - - - 4 1 - 8 - - - - - - - - 2 1 3 B19(11) Other malignant neoplasms 174 - _ 1 - 1 4 9 24 79 17 85 - 1 - - 1 6 8 17 75 3 1 89 B20 Benign and unspecified neoplasms 9 - - - - - 1 - 1 2 1 5 - - - - - 1 - 3 - - 4 B21 Diabetes mellitus 29 - - - - - - - 1 6 5 12 - - - - - - - 3 6 8 17 B22 Avitaminoses, etc. 2 - . - - - - - - 1 - 1 - - - - - - - - - 1 I B46( 1) Other endocrine etc. diseases 9 - - - - - - 1 - - 1 2 - - - - - - - 1 1 5 7 B23 Anaemias 11 - - - - - - - - 1 3 5 - - - 1 - - - - - 5 6 B46(2) Other diseases of blood, etc. 3 - - 1 - - - - - - 1 1 - - - - - - - - - 2 2 B46( 3) Mental disorders 6 - - - 1 - - 1 - - 1 3 - - - - - - - 1 - 2 3 B24 Meningitis 3 - - - - - - - - - - - - - 1 - 1 - - - 1 - 3 B46(4) Other diseases of nervous system, etc. 39 - 1 - - 2 2 - 4 - 7 17 - - 1 1 1 - 3 7 6 8 22 B26 Chronic rheumatic heart disease 47 - - - - - - 1 7 5 3 17 - - - - - 1 5 3 7 1 4 30 B27 Hypertensive disease 68 - - - - - - 2 a 9 9 28 - - - - - - 1 5 17 17 40 B28 Ischaemic heart disease 641 - - - 2 7 33 90 139 16 387 - - - - - - - 79 57 161 254 B29 Other forms of heart disease 188 - - - - - - - 5 15 50 70 - - - - - - 1 1 15 101 118 B30 Cerebrovascular disease 341 - - - - 1 3 6 28 36 60 134 - - 1 - - - 13 14 41 138 207 B46(5) Other disease of circulatory system 108 - - - - - - 1 13 14 18 46 - - - - - - 1 6 10 45 62 B31 Influenza 31 - - - - - 1 3 1 9 1 15 - 1 - - 1 - - 4 5 5 16 B32 Pneumonia 322 4 - - 1 - - 3 13 73 68 112 6 1 - - 1 - - 17 28l 162 210 B33(1) Bronchitis and emphysema 189 - - - - - 1 3 25 44 59 132 - - - 1 1 1 6 10 38 57 B33(2) Asthma 9 - - - 1 1 1 3 - 1 1 7 - 1 . . - - 1 - - - 2 B46(6) Other diseases of respiratory system 28 5 - - - - - - 2 5 4 16 1 1 - - - - - - 4 6 12 B34 Peptic ulcer 21 - - - - 1 - 3 1 4 6 15 - - - - - - 1 - - 5 6 B35 Appendicitis 2 - - - - - - - - - 1 1 - - - - - - - - - 1 1 B36 Intestinal obstruction and hernia 15 - - - - - - 1 2 2 3 8 - - - - - - 1 1 3 2 7 B37 Cirrhosis of liver 6 - - - - 1 - - - 1 7 4 - - - - - - - - - 1 2 B46(7) Other diseases of digestive system 43 1 - - - 1 - 2 2 4 8 18 - - - - - - - 4 4 17 25 B38 Nephritis and nephrosis 17 - - - - - 1 1 2 2 2 8 - - - 1 - 1 2 2 1 2 9 B39 Hyperplasia of prostate 7 - - - - - - - 1 2 4 7 - - - - - - - - - - - B46(8) Other diseases, genito-urinary system. 29 - - - - - - 1 2 2 9 14 - - - - - - 1 2 3 9 15 B41 Other complications of pregnancy, etc. 2 - - - - - - - - - - - - - - - 1 1 - - - - 2 B46(9) Diseases of skin, subcutaneous tissue 5 - - - - - - - - 1 - 1 - - - - - - - 1 - 3 4 B46(I0) Diseases of musculo-skletal system 16 - - - - - - - 2 4 1 7 - - - - - - 1 2 - 6 9 B42 Congenital anomalies 19 3 - 2 - 1 - - 1 1 - 8 6 - - 1 1 - 1 1 - 1 11 B43 Birth injury, difficult labour, etc. 13 12 - - - - - - - - - 12 1 - - - - - - - - 1 B44 Other cause of perinatal mortality 17 8 - - - - - - - - - 8 9 - - - - - - - - - 9 B45 Symptoms and ill defined conditions 10 1 - - - - - - 1 - 1 3 - - - - - - 1 - - 6 7 BE47 Motor vehicle accidents 25 - - 2 1 1 2 - 2 3 1 12 - 2 - - 1 - 1 7 7 5 13 BE48 All other accidents 41 1 - 1 3 2 2 5 3 2 2 21 - - - - - 1 1 - 15 20 BE49 Suicide and self-inflicted injuries 20 - - - - - 1 2 3 3 3 12 - - - 2 - - - 3 - 3 8 BE50 All other external causes 6 - - - - 1 - - 1 - - 2 - - - 1 - 1 - 1 1 4 TOTALS 3035 36 2 9 8 15 32 94 312 484 535 1527 25 7 3 7 10 20 68 170 30 897 1508 DEATHS FROM CANCER AGE At DEATH MALES FEMALES TOTAL Under 5 years - 1 1 5 and under 15 years 2 - 2 15 and under 25 years 1 - 1 25 and under 45 years 1 1 16 27 45 and under 65 years 1 13 83 196 65 years and over 224 174 398 Total 351 274 625 Previous Years- 1968 379 287 666 1967 370 299 669 BIRTHS During the year a total of 4,049 births were registered. In the same period 4,074 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 779 8 1993 37 Birth notifications transferred outwards 1 - 259 4 Birth notifications transferred inwards - - 1497 24 Adjusted Total 778 8 323 1 57 Previous Years - 1968 859 4 3221 53 1967 914 8 3126 60 CARE OF PREMATURE INFANTS (weighing 5½lbs or less) LIVE STILLBORN Number born at home 28 5 Number born in Hospital or Nursing Home 246 46 -51- MIDWIFERY The work of the Council's Midwives was as follows:- 1969 1968 1967 Domiciliary confinements attended under N.H.S. arrangements where: (a) doctor was not booked 14 8 10 (b) a doctor was booked 785 838 900 Cases delivered in hospital and other institutions but discharged and attended before tenth day 679 712 668 Miscarriages attended 3 5 7 New cases booked 958 1,108 977 Cases on the books at the end of the year 366 560 494 Medical aid notices issued 12 20 20 Visits paid (as midwife): (a) Ante-natal 5,876 5,875 5,509 (b) Nursing 14,791 15,229 15,749 (c) Other post-natal 676 385 459 Total Visits 21,343 21,489 21,717 Administration of Analgesics Cases in which Gas and Air was administered 3 96 412 Cases in which Trilene was administered 24 34 111 Cases in which Entonox was administered 487 414 71 Cases in which Pethidine or a related compound was administered 287 321 373 Clinic Sessions Number of sessions attended: (a) General practitioner's clinics 1,441 1,117 1,029 (b) Midwife's clinics 444 568 503 Number of ante-natal examinations by the midwife: (a) General practitioner's clinics 10,587 10,337 6,626 (b) Midwife's clinics 2,601 3,664 3,300 Number of women attending midwife's clinics who had not previously attended any ante-natal clinic in the current year 474 675 916 -52- -53- Child Welfare Clinic Attendances assembly hall. dawlish road emmanuel hall granl eigh road hatch l an e handsworth ave hurst road ley ton green low hall lane marmion avenue priory court st.francis hall west avenue total for the year-all CLINICS 1969 1968 1967 Children attending for the first time in 1969 who were born in 1964 27 63 2 12 9 15 6 58 40 25 9 7 17 290 270 - 1965 38 113 3 49 12 15 9 134 69 42 22 7 58 57 1 613 - 1966 81 170 1 t 64 51 58 14 151 131 84 34 25 67 941 835 - 1967 131 232 30 50 64 142 46 257 167 137 93 60 117 1,526 1,621 - 1968 409 359 63 296 90 290 151 421 323 244 312 120 243 3,321 2,813 - 1969 159 485 81 588 85 243 226 363 349 305 272 64 286 3,506 3,405 - Total attendances 3,586 7.209 1,538 5.880 1,670 4,841 3,216 5.078 5.071 7.920 3.608 1,090 4,621 55.328 58.825 70.028 Attendance of children seen by Medical Officer 570 2.318 244 1,595 370 1.478 1,036 1,649 1.631 1.069 1,488 140 1,822 15.410 17.632 21,235 No. of children referred elsewhere - 207 19 180 - 10 29 89 54 42 53 3 21 707 569 608 No. of sessions (a) Medical Officers 65 193 11 133 23 136 79 169 134 83 134 29 138 1.327 1,315 1,194 (b) Sessional G.P.s 1 - - 32 52 - 9 - 2 38 - - - 134 134 229 (c) Health Visitors 34 4 36 3 - 9 13 12 2 75 9 20 3 220 186 218 -54- Distribution of Welfare Foods and Nutrients NUTRIENTS WELFARE FOODS ADEXOLINE OPTROSE MARMITE COW & GATE OSTER MILK NO. 2 S.M.A. HUMSD. TRUFOOD FAREX GROATS TWIN-PACK NAT- DRIED MILK COD LIVER OIL A. & D. TABLETS ORANGE JUICE Assembly Hall 1,299 4,941 1,334 680 427 314 - 129 55 96 236 232 288 6,210 Hurst Road 970 2,217 596 1,358 725 220 75 1 15 51 140 361 278 164 3,444 Dawlish Road 704 2,756 775 2,419 3,426 735 - 228 140 30 1,250 747 315 5,930 Emmanuel Hall 526 956 201 459 363 88 - 28 13 19 86 198 42 1,260 Granleigh Road 934 1,485 704 1,927 2,408 679 - 171 75 79 1,975 488 301 6,333 Handsworth Avenue 1,498 7,791 1,719 1,385 1,358 375 26 212 144 87 592 228 245 8,228 Hatch Lane 619 1,741 520 419 181 57 24 68 46 38 194 84 130 2,792 Leyton Green 1,741 1,326 1,020 1,955 2,176 629 - 125 55 65 1,435 514 266 6,121 Old Monoux School 709 3,781 615 1,165 491 217 20 101 - - 1,561 343 315 6,099 Priory Court 1 ,404 4,214 1,195 1,998 1,537 449 4 87 71 107 950 220 282 4,788 Low Hall Lane 1,298 2,588 384 1 ,816 1,174 477 8 73 29 61 777 252 128 3,207 Marmion Avenue 2,617 2,287 2,042 1,193 743 814 200 118 101 106 459 308 355 9,549 St.Francis Hall 235 1,103 293 11 4 171 78 1 35 30 30 70 49 38 1 ,241 West Avenue 756 2,769 412 2,400 864 415 37 151 59 65 604 326 151 2,891 W.V.S. Chingford - - - - - - - - - - - 2 5 706 Hospitals and Nurseries - - - - - - - - - - 23 294 - 1,700 15,310 39,955 11,810 19,288 16,044 5,547 395 1,641 869 923 10,573 4,563 3,025 70,499 Previous Years- 1968 14,126 44,567 11,582 15,938 12,656 5,557 472 1,509 762 1,125 15,238 4,753 3,057 68,142 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 316 Attendances 1,217 No. of classes held 239 Day Nurseries Attendances: NAME OF NURSERY ELLINGHAM ROAD EPSOM ROAD HIGHAM HILL HANDSWORTH AVENUE CHINGFORD MOUNT TOTALS 1969 1968 1967 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 61 57 68 52 292 301 308 Total attendance during the year 10.789 12,597 11,934 13,231 10,064 58,615 60,251 60,057 Number of days open 255 255 255 255 255 - - - Nurseries and Child Minders Regulations, 1948 1969 1968 1967 Premises registered at end of year: Number of premises 36 36 28 Number of places provided 1,138 1,120 848 Persons registered at end of year: Number of persons 181 19 21 Number of places provided 362 1 14 1 18 Child Development Sessions DAWLISH ROAD CLINIC GRANLElGH ROAD CLINIC LEYTON GREEN CLINIC LOW HALL CLINIC PRIORY COURT CLINIC WEST AVENUE CLINIC HANDSWORTH AVENUE CLINIC No. of attendances 1,581 1,479 1,706 1,146 347 965 269 No. of sessions 157 153 155 99 44 102 46 New cases attending for first time in year 132 84 94 28 19 15 18 -55- Congenital Malformation Eighty-one cases of congenital malformation were notified to the Department of Health and Social Services during the year. Children "At Risk" 1969 1968 1967 Children on Register at 1st January 3,070 2,156 1,731 Children added during year 1,276 1,560 1,368 Children removed during year 1,746 646 943 Children on Register at 31st December 2,600 3,070 2,156 Cervical Cytology Clinics HATCH LANE GRANLEIGH ROAD No. of smears taken 1,040 393 No. of sessions 55 28 No. waiting at 31.12.68 120 105 Dental Treatment of Expectant and Nursing Mothers and Children under five years CHILDREN UNDER 5 YRS. EXPECTANT & NURSING MOTHERS 1969 1968 1967 1969 1968 1967 Number of patients given first inspections during year 312 182 254 19 15 15 Number of patients who required treatment 194 111 150 18 14 15 Number of patients who were offered treatment 194 103 144 18 14 15 Attendances for treatment: First visit 513 475 517 30 21 47 Subsequent visits 644 587 726 52 86 102 Total visits 1,157 1,062 1,243 82 107 149 Treatment provided: Number of fillings 766 775 868 54 63 72 Teeth filled 682 708 719 48 50 68 Teeth extracted 192 323 492 29 34 50 General anaesthetics given 79 140 210 7 6 8 Emergency visits by patients 33 45 69 5 - 4 Patients X-rayed 2 5 5 6 7 12 Patients treated by scaling and/or removal of stains from the teeth (Prophylaxis) 221 141 155 23 1 1 24 Teeth otherwise conserved 163 70 187 - - - Teeth root filled - - - - - 6 Inlays - - - - - - Crowns - - - 1 1 - Number of courses of treatment completed during year 259 212 300 17 12 19 Patients supplied with full upper or full lower dentures - - - - 3 1 Patients supplied with other dentures - - - 1 - 3 Number of dentures supplied - - - 1 7 7 -56- Family Planning GRANLEIGH ROAD HATCH LANE HURST ROAD Number of new patients 332 401 487 Number of persons treated 709 1,440 1,314 Number of attendances 1,950 3,812 3,410 Number of sessions 51 101 81 HEALTH VISITING (a) Sessions Worked Number of sessions (half days) devoted to: 1969 1968 1967 (i) Health visiting 7,529 7,915 8,489 (ii) Child welfare centres 3,578 3,476 3,327 (iii) Ante-natal, post-natal, relaxation etc. clinics 409 361 486 (iv) School clinics 897 1,057 998 (v) Other school nursing 1,890 2,062 1,839 (vi) Health education (including mothercraft) 551 481 450 (vii) Other work (including clerical) 5,193 5,634 5,506 Total sessions 20,047 20,986 21,083 (b) Cases visited for the first time in the year (i) children born in 1964 1,090 1,075 „ „ „ 1965 1.409 1,488 „ „ „ 1966 1,857 1,775 „ „ „ 1967 2,149 2,132 „ „ „ 1968 2,401 2,420 „ „ „ 1969 3,861 3,786 (ii) persons aged 65 or over 2,443 2,41 1 (iii) others (excluding school nursing cases) 1,707 2,250 Total 16,917 17,337 18,290 (c) Number included in item (b) (i) mentally disordered persons 157 220 246 (ii) persons discharged from hospital (other than mental hospitals) 406 521 427 (iii) tuberculosis households 5 15 16 (iv) households visited on account of other infectious diseases 20 1 8 (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 548 653 547 (ii) mentally disordered persons 64 60 96 (iii) persons discharged from hospital (other than mental hospitals) 222 261 191 -57-  effective ineffective (e) Total number of visits to: (i) children under 5 years of age 24,576 5,973 (ii) persons aged 65 or over 6,263 1,292 (iii) other (excluding school nursing cases) 5,449 599 Total visits (1969) 36,288 7,864 Total visits 1968 39,683 7,594 Total visits 1967 44,737 7,972 1969 1968 1967 (f) Sessions attended at G.P's surgeries (included above) 270 326 258 (g) Phenylketonuria (i) children tested at home or clinic 2,856 3,264 3,657 (ii) special visits to homes to collect specimens 856 1,177 1,214 HOME NURSING (a) Cases visited for the first time in the year: cases total visits 1969 1968 1967 1969 1968 1967 (i) aged under 5 745 405 1 14 2,291 1,478 648 (ii) aged 5 and under 65 2,109 1,798 1,136 34,691 29,815 28,745 (iii) aged 65 or over 3,084 2,363 1,754 98,443 95, 154 90,574 Total cases 5,938 4,566 3,004 135,425 126,447 119,967 (b) Cases on the books at the end of the year 1969 1,405 1968 1,188 1967 1,208 LOAN OF SICKROOM EQUIPMENT New Issues in 1969 EQUIPMENT HEALTH & WELFARE DEPT. CHINGFORD RED CROSS EQUIPMENT HEALTH a WELFARE DEPT. CHING FORD RED CROSS Commodes 133 81 Urine Bottles 58 39 Wheelchairs 91 127 Bed Boards (sets) - - Bed Cradles 73 37 Feeding Cups 7 30 Air Rings 64 56 Crutches (pairs) 4 10 Bed Pans 150 70 Air Beds - - Back Rests 123 78 Bed Tables 5 25 Rubber Sheets _ 43 Walking Sticks 12 - Plastic Sheets 169 - Others - 21 -58- CHIROPODY TREATMENT NEW CASES CLINIC ATTENDANCES DOMICILIARY TREATMENTS TREATMENTS AT OLD PEOPLES' RESIDENTiAL HOMES CASES BEING TREATED AT END OF YEAR Children 947 4,970 * - 679 Expectant mothers 3 14 - - 2 Physically Handicapped 7 153 - - 47 Aged (over 65 years of age) 707 22,708 5,936 1,617 5,389 Others 513 9,905 14 - 3,634 Total for 1969 2,177 37,750 6.000 1,617 9,751 Previous Years- 1968 2,287 42,519 4,118 1,791 10,931 1967 2,955 49,497 4,031 1,690 12,006 CONVALESCENCE The number of recuperative holidays provided for adult persons in accordance with Section 28 of the National Health Service Act, 1946 was 66. Recuperative holidays were also provided under Section 22 of the Act for 1 mother and 2 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 MlSC. VISITS HELP PRESENT OTHERS HELP SEEN OTHERS ATTENDANT PRESENT OTHERS 1,266 755 4,731 447 445 2 1 - - -59- Help provided AGED 65 OR OVER MATERNITY CHRONIC SICK (UNDER 65 YRS. OTHERS (UNDER 65 YRS. TOTALS 1969 1968 1967 Requests for help from new cases during year 1,023 109 1 17 121 1,370 1,433 1,318 Cases not eligible for assistance or not requiring service 235 37 34 41 347 278 252 New cases helped during year 790 72 83 80 1,025 1,157 1,062 Cases helped earlier in present year and re-opened 198 1 26 7 232 257 306 Total cases completed during year 1,107 76 194 88 1,465 1,241 1,242 Cases being helped at end of year 2,420 3 183 35 2,641 2,849 2,397 Total cases helped during year 3,527 79 377 123 4,106 4,090 3,639 Hours of help provided during year 326,902 1,273 29,020 5,375 362,570 380,133 419,553 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 9 3 10 Help for harassed mothers 6 5 3 Problem family - 3 - Absence of mother 6 8 3 Acute Illness 59 59 19 Toxaemia 6 7 - Others 1 3 - Night Attendance Service (Attendance provided) PATIENTS RESIDING ALONE INABILITY OF AGED HUSBAND OR WlFE RELIEF OF RELATIVES Requests for help from new cases during year - - 1 New cases helped - - 1 Total cases completed - - 1 Cases being helped at end of year - - - Total cases helped during year - - 1 Hours of attendance provided - - 432 -60- Neighbourly Help Scheme AGED OTHERS TOTAL Cases being helped at beginning of the year 19 1 20 New cases commenced 10 - 10 Cases completed or ceased 18 1 19 Cases continuing at end of the year 11 - 11 SERVICES FOR BLIND, PHYSICALLY HANDICAPPED, DEAF AND OLD PEOPLE 1 (a) Blind persons registered at 31st December, 1969 AGE 04 5- 10 1115 16- 20 2129 3039 4049 5059 6064 6569 7079 80- 84 8589 90 & OVER TOTAL M - 2 - 1 3 5 16 24 14 18 46 22 20 8 179 F 3 4 - 3 5 6 12 15 20 29 103 60 68 34 362 Total 3 6 - 4 8 11 28 39 34 47 149 82 88 42 541 Persons registered at 31st December, 1968 519 " " 1967 550 (b) Blind persons on register with other handicaps at 31st December, 1969 MENTALLY ILL MENTALLY SUBNORMAL PHYSICALLY DEFECTIVE DEAF WITHOUT SPEECH DEAF WITH SPEECH HARD OF HEARING MENTALLY ILL & HARD OF HEARING MENTALLY SUBNORMAL at PHYSICALLY DEFECTIVE MENTALLY SUBNORMAL & DEAF WlTH SPEECH MENTALLY SUBNORMAL & HARD OF HEARING PHYSICALLY DEFECTIVE & HARD OF HEARING TOTAL M 1 2 14 1 3 7 - 1 2 - - 31 F 3 2 24 1 13 19 1 - - 1 3 67 Total 4 4 38 2 16 26 1 1 1 1 3 98 2 Partially sighted persons registered at 31st December, 1969 AGE 5- 10 11- 15 16- 20 21- 29 3039 4049 5059 6064 6569 7079 8084 8589 90 & OVER TOTAL M 3 2 3 6 1 5 6 7 3 13 4 3 2 64 F 2 1 - 2 5 2 4 6 7 29 18 12 9 97 Total 5 3 3 8 12 7 10 13 10 42 22 15 11 161 Persons registered at 31st December, 1968 165 " " " " " 1967 172 -61- 3 Deaf persons registered at 31st December 1969 1969 1968 1967 Hard of hearing 133 147 169 Deaf with speech 128 1 15 1 17 Deaf without speech 42 16 18 Total registrations 308 278 304 N.B. This includes those on the blind register. 4 Physically handicapped persons registered at 31st December, 1969 CATEGORY UNDER 16 YEARS 16-29 30-49 50-64 65 & OVER TOTAL Amputation M - 2 1 3 21 32 F - 1 - 7 18 26 Arthritis and rheumatism M - - 3 21 68 92 F - 2 17 75 490 584 Congenital malformations and deformities M 1 1 1 3 1 7 F 3 3 3 1 5 15 Disease of respiratory system (non-TB) M - 3 - 4 20 27 F - 1 - 7 12 20 Disease of digestive and genito urinary systems of heart or circulatory and of skin M - 1 4 14 40 59 F - 2 7 9 46 64 Injuries to head, trunk or limbs M - 2 4 4 4 14 F 1 1 4 3 45 54 Disease of spine and limbs M 1 2 6 11 11 31 F - - 3 10 31 44 Organic nervous disease; epilepsy; poliomyelitis; hemiplegia; sciatica; disseminated sclerosis M 1 26 35 63 70 195 F 3 17 42 92 99 253 Neurosis, psychosis and other nervous disorders M 1 3 1 - - 5 F - 3 2 2 5 12 Tuberculosis (resp.) M - - - 1 - 1 F - - 1 1 - 2 Tuberculosis (other) M - - 1 2 1 4 F - - - 1 4 5 Unspecified diseases and injuries M 1 5 - 3 9 18 F - 1 1 9 16 27 Total 12 76 136 351 1,016 1,591 Persons registered at 3 1st December, 1968 1,507 " " " " " 1967 1,302 -62- 5 Other services for the handicapped (a) (i) Roberts Hall Work Centre Attendance during the year were 13,086 out of a possible 19,306 Number on roll at 31st December, 1969- 134 (a) (ii) Spastic Society Workshop 5 people made 510 attendances (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 1969: Provision of toilet in existing bathroom 1 Provision of gate 2 Provision of fall bar 1 Fixing of handrails 27 Provision of downstairs toilets 1 Provision of showers 2 Alterations to bathrooms for equipment for the handicapped 1 Alterations to toilets 1 Provision of access to toilet 5 Provision of access to garden 2 Provision of window pull cords 2 Provision of false floors 1 Provision of ramps - fixed 1 Provision of ramps - portable 4 Alterations to front elevation of house 5 Provision of base for Invacar shed 2 Carriage crossings 1 Provision of new steps 4 Raising of electric points 2 Provision of electric point for Invacar battery charging 2 Removal of steps 1 Alterations to hallway 1 Provision of visual doorbell 4 Provision of electric push buttons to operate lifts 1 74 -63- (f) Aids for Handicapped Persons Aids issued in 1969 550 (see table below) (g) Holidays for Handicapped Persons 1969 1968 1967 For the blind 31 29 35 For others 181 246 197 Personal helpers (both categories) 58 50 27 (h) Disabled Drivers Car badges issued 48 AIDS FOR PHYSICALLY HANDICAPPED EQUIPMENT PROVIDED ISSUED DURING 1969 ON LOAN AT 31.12.1969 Bathing Aids:- Bath rails 70 90 " mats 94 225 " seats 29 56 " boards 3 6 Domestic Aids:- Egg cup holders 1 6 Helping hands and pick up sticks 62 169 Large handled knives 7 17 " " forks 0 6 " " spoons 1 3 Kitchen stools 0 0 Potato peeler 0 4 Tap turners 1 16 Tin openers 1 14 Bread boards 0 3 Toilet Aids:- Stocking pulls 17 57 Long handled sponges 1 3 " " shoe lift 9 21 Toilet frames 8 13 " seats 22 60 Bed Tables 5 8 Hoists 10 6 Lifting poles 3 8 Special chairs 15 33 Walking aids 143 220 Miscellaneous 48 82 550 1,126 Previous Years- 1968 459 982 1967 545 768 -64- -65- 6 People in Care Persons provided with accommodation at 31st December. 1969 (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 1969 1968 1967 Persons accommodated in Waltham Forest Old Peoples' Homes:- (a) Waltham Forest Residents - - - 1 8 8 17 1 1 14 38 106 25 92 286 303 300 303 (b) From other Local Authority areas - - - - - 2 2 1 1 4 7 2 10 25 27 33 36 Persons from Waltham Forest accommodated in Homes outside the Borough:- (a) In Voluntary Organisations' Homes 5 2 5 4 4 8 28 4 8 8 25 - 28 73 101 104 107 (b) In other Local Authorities' Homes - - - - 2 3 5 4 1 4 13 7 21 50 55 64 68 Total number of persons from Waltham Forest in Residential Homes 5 2 5 5 14 19 50 19 23 50 144 32 141 409 459 468 478 Number of new permanent admissions during 1969 82 Number of temporary admissions during 1969 23 (b) Analysis according to defect:- BLIND DEAF EPILEPTIc PHYSICALLY HANDICAPPED MENTALLY SUB-NORMAL MENTALLY ILL OTHERS TOTAL Persons accommodated in Waltham Forest Old Peoples' Homes (a) Waltham Forest Residents 2 11 3 115 23 93 56 303 (b) From other Local Authority areas - 1 - 5 - 1 20 27 Persons from Waltham Forest accommodated in Homes outside the Borough:— (a) In Voluntary Organisations' Homes 22 1 8 16 - - 54 101 (b) In other Local Authorities' Homes - 7 - 13 - 1 34 55 Total number of persons from Waltham Forest in Residential Homes 24 19 11 144 23 94 144 459 (c) Waiting list for accommodation in homes for the elderly at 31st December, 1969 MALE FEMALE List "A" Priority grading. Visited by Social Welfare Officer 37 93 List "A" 1- Persons visited 3 monthly by Social Welfare Officers 23 64 List "A" 2- Persons visited 6 monthly by Social Welfare Officers 22 65 Community Care List 2 -Persons in hospital and private homes wishing to be transferred - visited by Social Welfare Officers 13 34 List 3 -Persons residing in Waltham Forest waiting to be accommodated by another authority - visited by Social Welfare Officers 3 18 11 List 4 -Persons in outside areas wishing to be accommodated within this authority 22 Totals 100 285 Totals in 1968 65 233 Totals in 1967 87 260 HOMELESS FAMILIES ACCOMMODATION Persons accommodated:- NO. OF FAMILIES NO. OF PERSONS Resident on 1.1.1969 16 68 New admissions during year 47 185 Discharges during year 40 165 Resident on 31.12. 1969 23 101 Of the 40 families discharged during the year 25 were rehoused by the Council and 15 left for unknown destinations or found accommodation privately. Length of stay:- UNDER 1 MONTH 1 MONTH AND UNDER 6 MONTHS 6 MONTHS AND UNDER 18 MONTHS 18 MONTHS AND OVER Families discharged 10 13 16 1 Families still in residence 2 13 8 0 MEALS-ON-WHEELS AND LUNCHEON CLUBS MEALS-ON-WHEELS LUNCHEON CLUBS Meals provided for:- Walthamstow residents 35,229 16,324 Leyton residents 34,165 19,148 Chingford residents 10,031 3,782 Totals 79,425 39,254 BURIAL OF THE DEAD Burial arrangements were made for 8 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 35,507 23,670 -66- -67- (a) Distribution of cases under care mentally ill elderly mentally infirm psychopathic sub-normal severely sub-normal total under 16 16 & over under 16 16 & 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 m f 1969 1968 1967 1. Total number 1 - 913 1,092 - - - 1 - - 7 10 227 170 62 50 69 55 2,657 2,342 1,679 2. Attending workshops/occupation training centres - - 31 10 - - - - - - 4 7 39 25 29 22 49 39 255 250 205 3.: Awaiting entry to workshops/ occupation training centres - - - - - - - - - - - - - - 10 12 - - 22 7 3 4. Receiving home training - - - - - - - - - - - - - - - - - - - - - 5. Awaiting home training - - - - - - - - - - - - - - - - - - - - - 6. Resident in L.A. home/hostel - - - - - - - - - - - - 5 6 - - - - 11 - - 7. Awaiting residence in L.A. home/ hostel - - - - - - - - - - - - - - - - - - - 10 - 8. Resident at L.A. expense in other homes/hostels - - 11 - - - - - - - - 2 4 4 - - - - 28 23 26 9. Resident at L.A. expense by boarding out in private household - - - - - - - - - - - - - - 1 1 - - 2 2 2 10. Attending day hospitals - - 1 1 - - - - - - - - - - - - - - 3 2 - 1 I. Receiving home visits and not included in lines 2-10 (a) suitable to attend a training centre - - - - - - - - - - - - - - - - - - - - - (b) others 1 - 870 1,073 - - - 1 - - 3 1 179 135 22 15 20 16 2,336 2,048 1,443 MENTAL HEALTH SERVICE 68 (b) Number of patients awaiting entry to hospital, or admitted for temporary residential care during 1969 MENTALLY ILL ELDERLY MENTALLY INFIRM PSYCHOPATHIC SUB-NORMAL SEVERELY SU B-NORM A L TO T AL UNDER 16 16 1 OVER UNDER 16 !6 & OVER UNDER 16 16 & OVER UNDER 16 16 a OVER M F M F M F M F M F M F M F M F M F 1969 1968 1967 A. Number of patients in L.H.A. area on waiting list for admission to hospital at 3 1.12.69 (i) in urgent need of hospital care - - - - - - - - - - - - - - 3 5 - - 8 2 1 (ii) not in urgent need of hospital - - - - - - - - - - - - - - 1 5 7 3 16 18 4 (iii) Total - - - - - - - - - - - - - - 4 10 7 3 24 20 5 B. Number of admissions for temporary residential care (e.g. to relieve the family) (i) to N.H.S. hospitals - - - - - - - - L - 2 4 2 6 3 3 1 21 30 29 (ii) to L.A. residential accommodation - - - - - - - - - - - - - - - - - - - - - (iii) elsewhere - - - - - - - - - - 2 - 8 4 13 3 4 5 39 72 71 (iv) Total - - - - - - - - - - 2 2 12 6 19 6 7 6 60 102 100 ON vO (c) Number of patients referred to Local Health Authority during year ended 31st December, 1969 REFERRED BY MENTALLY ILL PSYCHOP ATHIC SU B-NORM AL SEVERELY S'U B-NORM AL TOTAL SUB-NORMAL AND SEV ERELY SU B-NORM A L GR AND TOTAL OF COLS. '1 - 16 TOTAL UNDER 16 16 a OVER UNDER 16 16 a OVER UNDER 16 16 a OVER UNDER 16 »6 a OVER M F M F M F M F M F M F M F M F UNDER 16 16 a OVER 1969 1968 1967 (i) General practitioners 3 - 126 216 - - - - - - - - - 2 - - 2 - 347 359 317 (ii) Hospitals, on discharge from inpatient treatment - - 40 48 - - - - - - - - - - - - - - 88 189 168 (iii) Hospitals, after or during outpatient or day treatment - 31 45 - - - - - - - - - - - 76 96 121 (iv) Local education authorities - - - - - • - - 1 1 4 - 7 2 - - 4 15 23 23 (v) Police and courts - - 14 13 - - - - - - -- - - - - - 27 33 39 (vi) Other sources I I 52 72 - - - - 3 7 1 - 1 I 1 12 139 135 148 (vii) Total 4 I 263 394 - - - - 1 1 7 7 8 4 1 i 14 16 692 835 816 (d) Mental Health Officers - Statutory and other work during the year VISITS IN CONNECTION WITH HOSPITAL ADMISSIONS OR PATIENTS ALREADY IN HOSPITAL PRELIMINARY VISITS FOL LOWING COMPLAINTS OR REQUEST FROM G.P. IN FORM AL ADMISSIONS ARRANGED MENTAL HEALTH ACT, 1959 VISI TS TO P ATI EN TS IN HOSPI TAL VISI TS REGARDING PRO TEC TING OF P ATIENT'S PROPERTY SEC TION 25 SECTION 26 SEC TION 29 598 180 I 7 7 49 631 32 COMMUNITY CARE INTERVIEWS WITH AGENCIES CONTACTED OTHER VI SI TS NEW PATIENTS OTHER PATIENTS 661 3,771 632 628 (e) Training Centres BIRKBECK ADULT CENTRE QUEENS ADULT CENTRE WANSTEAD JUNIOR CENTRE Places provided 100 60 60 Trainees on register at end of year 91 67 61 Average daily attendance 74.1 53. 1 48 70 INFECTIOUS DISEASES - NOTIFICATIONS DISEASE 1ST QUATER 2N D QUARTER 3RD QUARTER 4 TH QUARTER TOTAL Scarlet Fever 50 22 17 13 102 Whooping Cough 20 4. 2 4 30 Measles 589 717 191 61 1,558 Tuberculosis 29 18 21 16 84 Typhoid - - 1 " Paratyphoid - - 1 Meningococcal Infection - - - - - Acute Meningitis 2 1 1 5 9 Food Poisoning 177 44 15 4 240 Ophthalmia Neonatorum 1 - 1 " 2 Puerpal Pyrexia- 2 2 6 " 10 Acute Pneumonia 39 1 1 " 41 Food Poisoning 3 5 19 6 33 Erysipelas 5 5 3 - 13 Acute Encephalitis - - - " - Infective Jaundice 4 10 10 7 31 Malaria - - 1 1 2 Totals 875 821 280 1 17 2,093 TUBERCULOSIS New Notifications and Deaths during 1969 AGE PERIODS NEW C AS ES DEATHS PULMONARY NONPULMONARY PULMONARY NONPULMONARY M F M F M F M F Under 1 year - - - - - - - - - 1 - 4 years - - - - - - 5-9 years - 1 1 - - - - - 10 - 14 years 2 1 2 - - - - 15 - 19 years 4 2 1 1 - - - - 20 - 24 years 1 4 - 2 - - - - 25 - 34 years 9 6 4 5 - - - - 35 - 44 years 5 2 3 1 - - - - 45 - 54 years 4 2 - - - - " - 55 - 64 years 8 2 - 1 - 1 - - 65 and over 5 - 1 4 - - - - 38 20 10 16 1 - - Totals 58 26 1 - - 84 1 71 Tuberculosis among Immigrants Cases of tuberculosis among immigrants seen at the local Chest Clinic numbered 44. These occurred in the following groups:- RESPIRATORY NON - RESPIRATORY Pakistani 24 7 Indian 3 6 Jamaican - 1 Kenyan - 1 Persian 1 - Burmese - 1 Tuberculosis - Care and Aftercare (a) Extra Nourishment (all Chest Cases) (i) Number of new cases supplied with free milk during the year 2 (ii) Persons receiving free milk at end of year 24 (b) Work of Tuberculosis Visitors (i) Visits to new cases 199 (ii) Total visits to households 1,366 (iii) Sessions attended at Chest Clinic 942 (c) Contacts Examination of contacts during the year (i) first examinations 362 (ii) subsequent examinations 475 72 VACCINATION AND IMMUNISATION TYPE OF COURSE OR DOSE YEAR OF BIRTH OTHERS UNDER 16 YEARS TOTAL 1969 1968 1967 1966 1962-65 Diphtheria - Primary 72 1,230 109 5 I 84 12 1.558 Booster 8 519 1,408 133 2,232 100 4,400 Whooping Cough - Primary 72 1,220 108 47 49 9 1,505 Booster 8 490 1,363 123 453 25 2.462 Tetanus - Primary 72 1,230 1 10 49 95 66 1,622 Booster 8 522 1,408 139 2,296 198 4,57 1 Poliomyelitis-Primary 73 1,233 121 57 163 28 1,675 Booster 8 517 1,293 140 2,130 172 4,260 Measles 148 415 328 576 427 1,894 TYPE OF VACCINE USED IMMUNISATIONS OR VACCINATIONS COMPLETED BY GENERAL PRACTITIONERS IMMUNISATIONS OR VACCINATIONS COMPLETED BY BOROUGH STAFF PRIMARY COURSES REINFORCING DOSES PRIMARY COURSES REINFORCING DOSES Diphtheria, Whooping Cough, Tetanus and - - - - Diphtheria, Whooping Cough and Tetanus combined 91 1 1.106 .592 1,355 Diphtheria and Whooping Cough combined - - - - Diphtheria and Tetanus combined 12 439 40 1,486 Diphtheria only 4 3 - 10 Whooping Cough only - 2 - - Tetanus only 57 128 10 56 Poliomyelitis:- (a) Salk (b) Sabin 964 1,540 71 1 2,720 Smallpox 901 191 496 10 Measles 975 - 919 - 73 B.C.G. Vaccination of Children Results of Heaf Test:- (a) Tuberculin Positive 145 (b) Tuberculin Negative 1,596 Number vaccinated with B.C.G 1,596 REGISTRATION OF PREMISES Public Health Act, 1936 - Nursing Homes BEDS PROVIDED NO. OF HOMES MATERNITY OTHERS Homes registered at 31st December, 1969 1 - 71 National Assistance Act. 1948 - Disabled Persons and Old Persons Homes NO. OF HOMES BEDS PROVIDED Homes registered at 31 st December, 1969 10 112 Mental Health Act, 1959 - Nursing and Residential Homes NO.OF HOMES BEDS PROVIDED Nursing Homes registered at 31st Dec. 1969 I 120 Residential Homes registered at 31st Dec. 1969 2 36 Essex County Council Act, 1933 - Establishments for Massage and Special Treatment CHIROPODY MASSAGE ETC. Establishments registered at 31st Dec. 1969 10 8 MEDICAL EXAMINATIONS OF STAFF Completed during period 1st January to 31st December, 1969:- Medical Examinations 1,112 Medical Assessments 192 74 GENERAL DENTAL SERVICE Number of Sessions 178 Number of appointments made 1,113 Number of new patients seen 173 Analysis of Treatments Provided FiIIings - Plastic 122 Amalgam 247 Inlays Crowns 3 Scaling and gum treatment 164 Dressings 125 Extractions 58 General Anaesthetic given 8 Local Anaesthetic given 99 X-rays 233 Dentures supplied 91 Dentures repaired 88 Impressions 241 Bites 54 Try-in 140 Minor Oral surgery 6 Other treatment 266 DENTAL LABORATORY DEN TU RES REPAIRS REMAKES OR RELIN E APPLIANCES CROWNS INLAYS STUDY MODEL TRAYS EAR INSERTS General Dental Service 8 88 10 2 3 1 - 103 - School Dental Service 15 25 - 112 14 1 260 - 250 Maternity and Child Welfare 7 5 - - - - ' - 75 PUBLIC HEALTH INSPECTION 1. Inspections, Re-inspections, Action (a) GENERAL STATUTORY PROVISIONS COMPLAINTS RECEIVED INSPECTIONS AND RE-INSPECTIONS INFORMAL NOTICES SERVED FORMAL NOTICE SERVED HOUSES CLASSIFIED 130 4,366 - 4,459 - Housing Acts, 1936/61 and Regulations - 4,560 16 84 2,059 Public Health Acts, 1936/6 1, and Noise Abatement Act, I960 3,036 21 ,434 690 282 - Prevention of Damage by Pests Act, 1949 2,646 16,062 26 3 - Food and Drugs Act, 1955 and Food Hygiene Regulations, 1960/66 192 3,620 150 - - 31 406 36 - - Pet Animals Act, 1951, Riding Establishments Act, and Animal Boarding Establ ishments Act, 1963. - 59 - - - Offices, Shops and Railway Premises Act, 1963 - 4,138 212 - 77 (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 1 Undertakings refused by local authority under proviso to paragraph 5 of the First Schedule Nil Certificates issued 5 Applications by landlords for cancellation Nil Objection by tenants to cancellation Nil Certificates cancelled by local authority Nil Applications for certificates (Form P) Nil (ii) Housing Acts, 1957/64, Housing (Consolidated) Regulations, 1925/32. (a) Individual Houses - Demolition/Closing Orders Undertakings accepted (Section 16) 3 Closing Orders made 15 Demolition Orders made (Section 17) Nil Closing Orders revoked and Demolition Orders substituted (Section 28) Nil Orders/Undertakings determined 7 (b) Slum Clearance Areas Number of areas represented (Sections 42 & 157 (I) 13 Houses unfit for human habitation 217 Houses included by reason of bad arrangement Nil Houses on land acquired under 43 (2) 87 Numbers of people to be displaced (a) Individuals 769 (b) Families 305 (c) Compulsory Purchase Orders confirmed The Waltham Forest Housing Part III (Acacia Road Area) Compulsory Purchase Order, 1968 and the Waltham Forest Housing Part III (Sedgwick Road Area) Compulsory Purchase Order, 1968, comprising 9 clearance areas were confirmed by the Ministry of Housing and Local Government during the year. A Local Public Inquiry was held in November in respect of the Waltham Forest Part III (Cathall Road Area) Compulsory Purchase Order, 1969, and the result is awaited. (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 Counci I Act, 1952, and relevant legi si at ion. TYPE OF PYEMISES INSPECTIONS Retail Food Shops 2, 154 Catering establishments (including factory canteens, hospitals, nursing homes, school meals kitchens) 712 Food Hawkers/Street Traders/Fairgrounds 325 Food Manufacturers/Depots. Dairies, Bakehouses 209 Off-Licences 81 Public Houses 139 3,620 78 (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 P R EMI SES AT EN D O F Y E AR NO. OF REGISTERED PREMISES RECEIVING A GENERAL INSPECTION DURIN G TH E Y EAR Offices 23 495 91 Retail shops 3 1 1,583 563 Wholesale shops, warehouses 3 93 27 Catering establishments open to the public, canteens 2 180 63 Fuel storage depots - 6 1 Totals 59 2,357 745 Number of visits of all kinds by Inspectors to registered premises 4,138 (b) Analysis of Contraventions Found SECTION NO. OF CONTRAVENTIONS FOUND SEC TION NO. OF CONTRAVENTIONS FOUND 4 Clean 1 iness 85 12 Clothing Accommodation 1 5 Overcrowding 1 15 Eating Facil ities 1 6 Temperature 25 16 Floors, passages and stairs 29 7 Ventilation 9 17/18/19 7 8 Lighting 10 21 Noise and Vibration 1 9 Sanitary Conveniences 67 24 First Aid General Provisions 22 10 Washing Facilities 35 50 Exhibition of Forms 49 Total 342 79 (c) Analysis of Persons Employed in Registered Premises by Workplace CLASS OF WORKPLACE N UM B ER O F PERSONS EMPLOYED Offices 4,4 15 Retai 1 shops 7,406 Wholesale departments, warehouses 1,080 Catering establishments open to the public 1, 164 Canteens 78 Fuel storage depots 58 Total 14,201 Total Males 6,427 Total Females 7,774 (d) Reported Accidents WORKPLACE NUMBER REPORTED ACTION RECOMMENDED NO ACTION PROSECUTION FORMAL WARNING INFO RM AL ADVICE Offices 2 - - 2 - Retai 1 shops 25 - 25 - Wholesale shops, warehouses 3 1 - 3 Catering establishments open to publ ic, canteens 1 - - 1 - Fuel storage depots - - - Totals 31 - 31 - 80 (e) Legal Proceedings NO. PREMISES NO. CONTRAVENTIONS Legal Proceedings pending 1968 2 8 Legal Proceedings authorised by the Council 6 21 Legal Proceedings instituted 6 21 Analysis of Legal Proceedings (i) (2) (3) (4) SEC.ACT/REG. NATURE OF OFFENCE NUMBER OF OFFENCES FIN ES IMPOSED £ s. d. 6 (4) Failure to provide a thermometer 6 18 9 (2) & San.Con. Regs. Failure to maintain a sanitary convenience 6 27 10 (1) & The Wash.Fac. Regs. Failure to provide adequate washing facilities 2 10 10 (2) & The Wash.Fac. Regs. Failure to maintain washing facilities 1 5 16(1) Failure to maintain the floors of the premises 3 9 16 (2) Fai lure to provide a hand rail or handhold to a staircase 1 5 24(1) First Aid General Provisions A 14 50 & Inf. Emp. Regs. Failure to provide information for employees 6 19 Total 29 £107 0. 0. Total Costs awarded to the Council £35 17. 0. (v) Prevention of Damage by Pests Act, 1949 - Rodent and Pest Control/Disinfestation/ Disinfection Complaints received 2,646 Inspections and Re-inspections 16,062 Premises treated 1,544 81 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 38 Choked drains cleared 10 Dampness remedied 931 F loors repaired 17 | Guttering repaired or renewed 124 Miscel laneous defects remedied 219 New W.C. pans and traps provided 46 Plaster work repaired 370 Rainwater pipes repaired or renewed 54 Roofs repaired or renewed 287 Rooms redecorated 3 Sashcords renewed 149 Sinks provided 6 Sink waste pipes repaired or renewed 45 Stoves repaired or renewed 37 Vent pipes repaired or renewed 14 W.C. cisterns repaired or renewed 10 I Window-sills, etc., repaired 96 Yard provided 27 Drains relaid or partly relaid 14 Defective brickwork 42 Defective light fittings 12 (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 790 Ceilings not kept clean or repaired 144 Floors not kept clean 83 Inadequate ventilation 24 Inadequate receptacles for refuse 30 Accumulation of refuse in room 24 Cleanliness of apparatus and fittings 89 Facilities for personal cleansing and/or washing food and equipment inadequate, i,e.:- Wash basins 41 Hot water 56 Soap/Towel/Nail brushes 43 Sinks 23 Food not protected from contamination 66 First-aid equipment 40 Wash-hand notices 24 Inadequate locker (clothing) accommodation 7 Redecoration 106 Miscellaneous 43 Artificial light in W.C 6 W.C. pans renewed 3 Yard paving 5 Roofs repaired 4 Name and address not displayed 1 82 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. FOO D PREMISES BUSINESS DESIGNATION * SUBSIDIARY FUNCTIONS NO. Registration 94 Local Authority 2,357 Butcher 136 H.M.F. Inspector 921 Canteen/Staff* 51 Exempt 2,018 Canteen/School* 72 Total 5,296 Catering/Public 180 Catering/Misc.* 3 Class of Premises Registered by Local Authority Chemist 86 Office 495 Confectionery 280 Retail Shop 1,583 Fishmonger 51 Wholesale 93 Fish Frier 45 Catering/Public 180 Greengrocer 159 Fuel Store 6 Grocer/General 323 Factories Act, 1961 Off Licence 96 Power 921 Public House 88 Non-power 26 Clubs 18 T rade Store/Multiple 14 Non-food 3,671 Depots/Food Storage 63 Food 1.625 Stall/Vehicle 298 83 (ii) Details of Registrations/Licences ACT OR REGULATION ON REGISTER 31.1 2.1969 Food and Drugs Act, 1955 Ice-Cream Premises 860 Food Preparation, etc. Premises 95 Milk and Dairies (General) Regulations, 1959 250 Dairies 8 Milk (Special Designation) Regulations. I960 Pasteurised 187 2I8 27 Ultra Heat Treated 54 Essex County Council Act, 1952 196 Hawkers' Storage Premises 37 Leyton Corporation Act, 1950 15 Section 48 - Hairdressers' Premises 239 Pet Animals Act, 1951 26 Animal Boarding Establishments Act, 1963 3 Rag Flock and Other Filling Materials Act, 1951 9 Riding Establishments Act, 1964 3 Total 2,227 84 4. Legal Proceedings (i) Public Health Acts, 1936/61; Clean Air Act, 1956 86 applications were made for legal proceedings to enforce the requirements of notices served. 18 cases were subsequently heard by the court and abatement orders made. The remaining 68 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 98 complaints regarding foodstuffs were investigated and reported for consideration of legal proceedings. 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. (iii) Food Hygiene (General)Regulations, I960 and The Cheese Regulations, 1965 Legal proceedings were authorised in respect of 25 contraventions under Food Hygiene (General) Regulations, I960 and The Cheese Regulations, 1965. Analysis of Legal Proceedings SEC. ACT/ REG. NATURE OF OFFENCE NUMBER OF OFFENCES FINES IMPOSED £ 5 The Food business carried on in insanitary premises 3 55 6 Articles of equipment not kept clean and in good order and condition 3 35 8 Food so placed as to involve risk of contamination 3 15 9 Smoking in a room in which there was open food 1 5 14 Failure to maintain sanitary convenience in a clean and/or efficient condition 1 3 14 Failure to exhibit "wash hands" notice 1 3 16 Failure to provide a wash basin and/or hot and cold water supply and/or hand washing requisites 2 8 17 Failure to provide bandages, dressings and antiseptics for first aid treatment 2 8 18 Failure to provide accommodation for employee's clothing 1 5 23 Walls/floors/ceilings and/or woodwork not maintained in clean condition 4 53 24 Accumulation of refuse in a food room 1 10 CHEESE REGULATIONS, 1965 13 Label 1 ing Offences 3 15 Total 25 215 Total Costs awarded to the Council 46 85 (iv) Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 Hawking of Food and Pleasure Grounds Pleasure fairs operating at Chingford Plain, E.4. and Lea Bridge Road, E.IO., were visited by members of the Public Health Inspectorate during the Bank Holiday periods. Food hawkers'stalls, mobile canteens and ice cream vendors etc., were inspected and registrations checked. While the general standard of hygiene practiced by food vendors was reasonable for open air trading, it was necessary to issue a number of verbal warnings and written intimations regarding infringements of the Food Hygiene (General) Regulations, I960. Legal proceedings were authorised in respect of 18 contraventions under Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966. Analysis of Legal Proceedings SEC. AC T/REG. NATURE OF OFFENCE NUMBER OF OFFENCES FINES IMPOSED £ S. d. 4 Food stall insanitary and food exposed to risk of contanimation 1 30 5 Failure to maintain delivery vehicle in clean condition 1 20 8 Person engaged in the handling of food, did not refrain from the use of tobacco 1 5 9 Persons handling open food not wearing washable overcloth ing 3 5 13 The name and address of the person carrying on the food business was not legibly and conspicuously displayed 2 4 15 No supply of clean and wholesome water 1 3 16 Failure to provide suitable wash hand basins 1 3 17 Failure to provide bandages, dressings and antiseptics for first aid treatment 2 3 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 6 30 Total 18 103 Total Costs awarded to the Council 28. 7. 0. 86 5. Sampling • Food and Drugs Act, 1955 Samples Submitted for Chemical and Bacteriological Examination TYPE OF EXAMINATION AND AN AL Y SI S OF RESULTS Ml sc. FOO DS MILK 1 C E C RE AM 1 C E LOL LI ES COOKED MEATS WAT ER DRINKING SWIMMI N G POOLS No. Chemical 1 17 - - - - 3 3 No. Bacteriological 19 29 44 - 69 4 20 No. Satisfactory 1 14(C) 15(B) 29 37 - 45 3(C) 4(B) -(C) 16(B) No. Fairly Satisfactory 4(B) - 2 - 24 - - No. Unsatisfactory 3(C) - 5 - - - 4 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 premi ses. COMMODITY TINS PACKETS/ BOXES/ BOTTLES QUANTITY TONS CWT. ST. LBS. Tinned Goods 2,294 - - - - - Tinned Meats 97 - - 6 5 8 Tinned Fruit 52 - 2 2 8 Drinks - 432 - - - - Frozen Foods - 7,431 - - - - Cereals, Dried Goods, etc 427 - - - - Fish - - - 5 2 - Meat - - 1 13 2 1 Vegetables - - - 7 4 Fruit - - 19 4 3 87 7. Factories Act, 196 I The following are the prescribed particulars required by Section 153 (I) of the Factories Act, 1961, to be included in annual reports. 1. Inspections PREMISES NUMBER OF NUMBER ON REGISTER INSPECTIONS WRITTEN NOTICES OCCUPI ERS PROSECUTED ( 1) (2) (3) 14) (5) (i) Factories in which Sections 1 , 2, 3, 4 and 6 are to be enforced by Local Authorities 26 14 9 _ (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 921 313 27 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 52 79 - - Total 999 406 36 - 2. Cases in which defects were found PARTICULARS NUMBER OF CASES IN WHICH DEFECTS WERE FOUND NUMBER OF CASES IN WHICH PROSECUTI ON S WERE INSTITUT ED FOUND R EM EDI ED REFERRED TO H.M. BY H.M. INSPECTOR INSPECTOR (1) (2) (3) (4) (5) (6) Want of cleanliness 6 A - 2 - Overcrowding (S.2) - - " - ' - Unreasonable temperature (S.3). - - - r - Inadequate ventilation (S.4) 2 2 - - - Ineffective drainage of floor (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient - 1 - 2 - (b) Unsuitable or defective 27 24 - 21 - (c) Not separate for sexes - 1 - 1 - Other offences against the Act (not including offences relating to out-work) - - - - - Total* 35 32 - 26 - * See also Contraventions under the Offices, Shops and Railway Premises Act, 1963. 88 3. Outwork NATURE OF WORK SECTION 133 SECTION 134 NO. OF OUTWORKERS IN AUGUST LI ST R EQU1R ED BY SECTION 133(1) (CI NO. OF CASES OF DEFAULT IN SENDIN G LI STS TO THE COUNCIL N O. O F PROSECUTION S FOR FAILURE TO SUPPLY LI STS NO. O F 1NSTANCES O F WORK IN UN WHO L E- SOME P REMISES NOTlCES SERVED PROSECUTIONS Wearing apparel Making 134 - - - - - Footwear - - - - - - Umbrellas, etc. 8 - - - - - Handbags 8 - - - - - Artificial flowers 14 - - - - - Garment hangers 12 - - - - - Boxes, etc. wholly or partly of paper Making 19 - - - Gents Neckwear 1 1 - - - - - Upholstery trimmings - - - - - Brushes 8 - - - - - Loose cover specialist - - - - - - T ays - - - - - - Watch strap - - - - - - Buttons, carding - - - - - - Christmas crackers, etc. 12 - - - - - Belts for power transmissions - - - - - - Lampshades - - - - - - Household Linen 3 - - - - - Curtain and furniture hangings 2 - - - - - File making - - - - - - Furniture and upholstery - - - - - - Caning - - - - - - Hampers and Baskets 8 - - - - - Paint Boxes 6 - - - - - Total 245 - - - - - 89 SCHOOL HEALTH SERVICE SCHOOL POPULATION NUMBER OF SCHOOLS NUMBER OF PUPILS ON SCHOOL REGISTERS AT END OF YEAR Nursery 1 97 Primary 74 19,645 Secondary 27 12,544 Special 6 513 Totals - 1969 108 32,799 1968 107 31,221 1967 103 30,169 SCHOOL MEDICAL INSPECTION (a) Periodic Medical Inspections 1969 1968 1967 5 year age group 3,172 2,719 2,466 10-11 year age group 1,480 2,173 14 years age group 1,725 2,018 1,974 1 ,315 1,568 Total 6,862 7,532 8,181 No. of special inspections 1,351 1,618 1,598 No. of re-inspections 4,721 4,701 4,937 6,072 6.3 19 6,535 (b) Physical Condition of Children Inspected • AGE GROUP INSPECTED (BY YEAR OF BIRTH) NO. OF PUPI LS INSPECTED PUPILS WHOSE CONDITION WAS CL ASSIFl ED UNSATISFACTORY 1965 and later 101 _ 1964 1,423 8 1963 1,648 - 1962 333 - 1961 73 - * I960 108 - * 1959 699 1 * 1958 407 - 1957 41 - 1956 44 . 1955 255 - 1954 and earlier 1,725 - Total 6,862 9 * Selective Medicals - A total of 673 children were found not to warrant a medical examination. 91 (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 condition ITO T AL 1NDI VI DU AL PUPI LS 1965 and later 6 - 17 1964 61 173 227 1963 75 146 199 1962 1 1 26 37 1961 8 7 14 I960 7 " 18 1959 67 96 138 1958 47 52 91 1957 3 7 9 1956 5 6 " 1955 54 22 72 1954 and earlier 209 131 321 Total 553 688 1,154 92 (d) Pupils found to have undergone tonsillectomy AGE GROUP NO. INSPECTED NO. FOUND TO HAVE UNDERGONE TONSILLECTOMY BOYS GIRLS BOYS GIRLS Infant 1,623 1,549 77 62 Junior 680 534 80 72 Leaver 814 911 96 98 Other 454 297 49 25 Totals 3,571 3,291 302 257 (e) Pupils found to have defects of colour vision INTERMEDIATE INSPECTIONS LEAVER INSPECTIONS OTHERS Tested for Colour Vision 1,387 1,725 340 Found to have defects of colour vision 28 22 3 (f) Parents present at Medical Inspection NO. INSPECTED PARENT PRESENT PER CENT. Infant Boys 1,623 1,351 83.2 Girls 1,549 1,435 92.6 Junior Boys 680 495 72.8 Girls 534 442 82.8 Leaver Boys 814 94 11.5 Girls 911 101 11.1 Other Boys 454 203 44.7 Girls 297 193 64.9 - 93 - 94 (g) Defects found by Periodic and Special Inspections during the year DEFECT CODE NO. DEFECT OR DISEASE PERIODIC INSPECTIONS SPECIAL INSPECTIONS ENTRANTS LEAVERS O TH ERS TOTAL (ALL GROUPS) TREATMENT OBSERVAT1ON TREATMENT OBSERVATION TREATMENT OBSERVATION TREATMENT OBSERVATION TREATMENT OBSERVATION 4 Skin 47 86 33 24 42 52 122 162 108 80 5 Eyes (a) Vision 142 135 209 29 202 87 553 251 97 50 (b) Squint 41 40 7 4 12 14 60 58 3 1 (c) Other 12 24 6 7 7 19 25 50 19 13 6 Ears (a) Hearing 39 80 13 16 15 85 67 181 57 38 (b) Otitis Media 15 70 15 3 47 18 132 2 2 7 (c) Other 2 22 1 4 6 13 9 39 29 20 Nose and Throat 65 276 13 37 28 113 106 426 37 49 8 Speech 38 145 2 3 22 36 62 184 25 17 9 Lymphatic Glands 3 69 - 4 1 37 4 110 - 3 10 Heart 11 50 2 11 1 38 14 99 1 3 11 Lungs 27 100 12 8 12 60 51 168 12 11 12 Developmenal (a) Hernia 3 26 - - 2 10 5 36 2 7 (b) Other 11 193 7 31 20 101 38 325 26 46 13 Orthopaedic (a) Posture 2 21 8 25 8 51 18 97 3 5 (b) Feet 44 122 15 27 31 85 90 234 18 10 (c) Other 21 93 11 22 9 41 41 156 44 13 14 Nervous System (a) Epilepsy 6 13 7 1 1 6 14 20 5 5 (b) Other 2 29 2 8 3 22 7 59 29 7 15 Psychological (a) Development 7 80 - 10 7 57 14 147 20 23 (b) Stability 20 247 2 31 23 198 45 476 24 51 16 Abdomen 5 17 • 5 2 19 7 41 4 2 17 Other 7 14 7 14 7 24 21 52 91 51 OTHER MEDICAL INSPECTIONS (a) Employment of children (other than in entertainment) (i) initial examinations 187 (ii) re-examinations (b) Employment of children in entertainment (i) initial examinations 3 (ii) re-examinations EXAMINATIONS BY SCHOOL NURSES Head Inspections Number of examinations 20,338 Number of children found to be unclean 161 Vision Testing at School Number of children tested 20,951 Number referred to Eye Clinic 394 Foot Inspections at School Number of children inspected 5,328 Number referred for treatment 136 MINOR AILMENT CLINICS New Cases Boys Girls Ringworm - Head - - Body - - Scabies - - Impetigo 1 - Other Skin Diseases 90 121 Defective Vision and Squint 132 146 Other Eye Defects 17 26 Defective Hearing 143 110 Other Ear Diseases 54 40 Nose and Throat Defects 97 102 Speech Defects 62 27 Lymphatic Glands 34 10 Heart and Circulation 9 17 Respiratory Diseases 31 14 Developmental Defects 132 102 Orthopaedic Defects 87 129 Nervous Disorders 49 38 Psychological Disorders 147 125 Other Defects and Diseases 136 128 1,221 1,135 Total attendances 3,907 - 95 - Corriggenda Report of the Medical Officer of Health for 1969 p.95 Examinations by School Nurses Head Inspections Nunber of examinations 20,338 Nunber of children found to be unclean 161 Vision Testing at School Nunber of children tested 20,951 Nunber of children referred to Eye Clinic 394 Foot Inspections at School Nunber inspected 5,328 Nunber referred for treatnent 136 SPECIALIST CLINICS 1969 1968 1967 (a) Aural Sessions 60 61 58 New cases 286 271 274 Toral attendances 818 794 797 Referred to hospital for operative treatment 222 192 227 (b) Ophthalmic Sessions 365 373 343 New cases 889 877 931 Attendances 5,965 5,342 5,731 Glasses prescribed 1,292 1,215 1,246 Glasses obtained (i) through H.M.C. optician 1 ,011 919 971 (ii) privately 281 270 278 (c) Orthoptic Sessions 261 340 405 New cases 158 253 278 Attendances 982 2,011 2,297 (d) Orthopaedic Sessions 61 59 62 New cases 411 331 407 Attendances 1,558 1,418 1,455 Appliances provided 348 215 189 (e) Physiotherapy Sessions 527 644 634 New cases 189 146 167 Attendances 2,679 2,760 2,927 (f) Paediatric Sessions 22 22 24 New cases 62 85 109 Attendances 100 180 205 (g) Child Guidance Cases referred or re-opened for treatment during year:- (i) Under 5 years Boys 43 43 38 Girls 24 21 17 (ii) Over 5 years Boys 222 230 235 Girls 133 139 141 422 433 431 Cases closed during year 657 170 229 - 96 - (g) Child Guidance (contd.) 1969 1968 1967 Interviews conducted during the year:- Psychiatrists 3,568 2,655 1,963 Psychotherapists 977 541 316 Psychiatric Social Workers 4,887 3,595 2,848 Educational Psychologists 294 278 570 Remedial Teacher 368 320 343 DENTAL INSPECTION AND TREATMENT (a) Attendances and Treatment AGES 5 TO 9 AGES 1O TO 14 AGES 15 AND OVER TOTALS 1969 1968 1967 First visit 4,409 2,285 297 6,991 5,9 16 6,280 Subsequent visits 6.369 4,103 661 11,133 10,272 8,645 Total visits 10,778 6,388 958 18.124 16,188 14,925 Additional courses of treatment commenced 726 318 37 1.081 851 889 Fillings in permanent teeth 2,926 4,411 852 8,189 9,048 9,813 Fillings in deciduous teeth 7,061 777 - 7,838 6,532 6,222 Permanent teeth filled 2,595 4,237 774 7,606 7,541 7,154 Deciduous teeth filled 6,621 632 - 7,253 5,728 4,814 Permanent teeth extracted 108 1,140 60 1,308 747 835 Deciduous teeth extracted 2,854 807 - 3,661 3,319 3,670 General anaesthetics 912 458 24 1,394 1,452 1,724 Emergencies 208 25 20 253 260 351 1969 1968 1967 Pupils X-rayed 375 332 507 Prophylaxis 2,033 1,714 1,481 Teeth otherwise conserved 1,305 782 1,402 Teeth root filled 12 27 75 Inlays 4 1 8 Crowns 32 39 38 Courses of treatment completed 5,266 4,893 4,748 -97- (b) Orthodontics 1969 1966 1967 New cases commenced during year 76 70 134 Cases completed during year 81 92 77 Cases discontinued during 8 13 44 Removable appliances fitted 100 97 158 Fixed appliances fitted 3 - 5 Pupils referred to Hospital Consultant 3 2 13 (c) Prosthetics 5 TO 9 10 TO 14 15 & OVER TOTAL Pupils supplied with F.U. or F.L. (first time) 1 - - 1 Pupils supplied with other dentures (first time) - 1 7 8 Numbers of dentures supplied 2 1 11 14 1969 1968 1967 (d) Anaesthetics General Anaesthetics administered by:- Dental Officers - - - Medical Officers 1,358 846 1,749 (e) Inspections (i) First inspection at school:- Number of Pupils 14,045 13,513 12,772 (ii) First inspection at clinic:- Number of Pupils 2,835 3,405 2,673 Number found to require treatment 9,459 9,637 7,629 Number offered treatment 8,971 7,808 6,322 (iii) Pupils re-inspected at school clinic 516 999 494 Number found to require treatment 329 252 270 (f) Sessions Sessions devoted to treatment 3,175 3,278 3,481 Sessions devoted to inspection 111 122 134 Sessions devoted to Dental Health Education 78 25 54 -98 - SPEECH THERAPY (a) Attendances DAWL1SH ROAD HATCH LANE HURST ROAD TOTAL Number in attendance at beginning of year 101 64 73 238 Number under observation at beginning of year 121 5 22 148 New cases 83 66 37 186 Re-admitted 1 1 1 3 Transfer from other clinics - 5 5 10 Discharges cured 48 54 30 132 improved 2 2 5 9 defaulted 4 5 3 12 Transferred to other clinics 10 4 6 20 left district 21 2 2 25 no progress - - 1 1 Number in attendance at end of year 99 71 69 239 Number under observation at end of year 122 3 22 147 (b) Analysis of defects treated DAWLISH ROAD HATCH LANE HURST ROAD TOTAL Stammer 17 8 6 31 Dyslalia 130 94 59 283 Stammering and dyslalia 3 2 7 12 Delayed language development 32 20 26 78 Cleft palate speech 2 3 2 7 Voice defects 3 2 1 6 Speech defect due to deafness 2 - 20 22 Defects of neurological origin 1 1 15 17 Unclassified - - 2 2 New cases referred 206 Attendances during year 6,914 - 99 - HANDICAPPED PUPILS BLIND PARTIALLY SIGHTED DEAF P ARTI AL HEARING PHYSICALLY HANDICAPPED DELICATE MALADJUSTED E.S.N. EPILEPTIC SPEECH DEFECT TOTAL. Children newly assessed as handicapped during year ended 31.12.1969:- Boys - l 1 1 1 4 15 24 - l 48 Girls - l - 4 4 - 7 15 1 - 32 Children who on 22.1.1970 were receiving special educational treatment:- (i) at maintained special schools:- (a) Day - 11 12 20 61 3 51 203 4 7 372 (b) Boarding - 2 - 1 2 1 9 7 - - 22 (ii) at non-maintained special schools:- (a) Day - - - - - - - - - - - (b) Boarding - - 1 - 2 2 6 2 1 - 14 (iii) at independent schools - - - - - - 11 1 - - 12 (iv) at boarding homes - - - - - 1 - - - 1 (v) special classes or units - - - 3 5 - 13 - - - 21 Children awaiting placement in special schools at 22.1.1970. - - - 2 - - 4 2 - - 8 Children who, at 22.1.1 970 were being educated:- (i) at hospital - - - - - - - - - . (ii) at home - 100 - SPECIAL SCHOOLS Brookfield House School for Physically Handicapped Children At the end of 1969 the medical classification of the 72 children on the roll was as follows:- Congenital Deformities 6 Cerebral Palsy 22 Cardiac Disabilities 5 Muscular Dystrophy 2 Haemophilia 4 Post Poliomyelitis 1 Delicate 1 Spina Bifida 3 Asthma/Asthma Eczema 12 Other Physical Handicaps 16 Joseph Clarke School for Partially Sighted Children The ophthalmic conditions on admission of the 68 children who attended the school during 1969 were as follows:- Albinism 4 Aniridia 7 Cataracts 24 Congenital Day Blindness 1 Detached Retina 1 Dislocation of the Lenses 3 High Myopia 6 Iridocyclitis 2 Microphthalmos 1 Nystagmus 7 Optic Atrophy 9 Retinal Degeneration 1 Retinoblastoma 1 Retrolental Fibroplasia 1 Their visual acuities (Snellen), after correction, were as follows:- Visual acuity of less than 6/60 24 Visual acuity of 6/60 16 Visual acuity of 6/36 14 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 62 children on the roll at the end of the year 39 were classified as deaf and 23 as having partial hearing. - 101 - Dwellings completed by private enterprise during 1969 WARDS FL ATS HOUSES Chingford Central - - North-West - 4 South - - Leyton Forest - 2 Leyton 6 5 Leytonstone 6 - Walthamstow Chapel End - - Hale End 30 16 Hoe Street - 4 42 31 Dwellings completed by Housing Associations during 1969 WARDS FLATS Chingford North-West 10 Leyton Leytonstone 12 22 - 103 - 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 1969 WARDS FLATS HOUSES Chingford South 393 - Leyton Central - - Forest - - Lea Bridge - - Leyton - - Walthamstow Forest - - Hale End 13 - Wood Street 99 - 505 - In addition to the main building programme, improvements and conversions were carried out at a number of Council owned properties. DISCRETION ARY STANDARD Applications received 345 170 Total number of grants approved 102 178 Total amount of grants £42,185 £19,510 (b) Contributed by S.J.Horstead, Esq., A.I.H.M., Borough Housing Manager Properties in Management at December 1969 Pre 1939 houses and flats 2,104 New houses and flats 10,146 Properties at Billericay 446 Properties at Wickford 151 Properties at Epping 206 Properties at Hutton 96 Prefabricated bungalows 24 Properties acquired for housing purposes 2,321 Properties for Clearance and Demolition 745 16,239 Number of properties made available for letting New properties 545 Acquired properties 73 Normal vacancies 485 1,103 Families rehoused from the housing register Number rehoused 918 - 104 - 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 C1 Phosphate as P04 Silicate as Si02 Sulphate as S04 Natural Fluoride as F Surface-active material as Manoxol OT 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 371 0.024 0.083 4.4 1.05 282 79 5 24.0 5.4 32 2.1 9 58 0.25 0.02 0.1 11 7.9 550 Lee Bridge 53 0.021 0.095 4.5 1.10 322 98 6 35.0 7.1 45 3.2 9 88 0.30 0.03 0.1 12 8.1 660 Ferry Lane 1 0.052 0.042 1.0 0.28 436 201 41 0.80 0.1 2 7.7 850 Chingford Mill 4 0.180 0.043 0.5 0.40 285 73 24 0.60 0.1 6 7.5 530 Coppermill 30 0.019 0.1 10 4.4 1.09 324 103 6 35.0 7.1 45 3.1 6 88 0.30 0.03 0.1 10 8.2 650 - 105 - BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1969 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 22° C. Per cent. samples negative in 100 ml. Per cent. samples negative in 100 ml. Lee Bridge (Lee-derived) 2,675 203.5 - 40.67 9.3 60.34 2.3 495 52.0 - 99.60 99.80 Ferry Lane 77 0.3 - 98.70 - 100.0 - 79 7.1 - 100.0 100.0 Chingford Mill 250 0.4 8 100.0 - 100.0 - 250 0.3 4 100.0 100.0 Thames-derived, North of River 8. 196 66.5 - 39.79 19.0 53.97 7.0 3,698 12.9 - 99.89 100.0 Coppermill 308 130.8 - 45.13 14.7 68.51 1.6 127 43.5 - 100.0 100.0 *Mixed with filtered River Lee - derived water before chlorination - 106 - INDEX A Pages Accidents 16, 17 Accommodation for Aged or Handicapped Persons 9, 65, 66 Acreage 49 Adaptations to Premises 63 Administration 24-26 Aids for Handicapped Persons 64 Analgesia 52 Area Tearn 17, 25 Assessments 49 "At Risk" Register 56 Attachment Schemes 16, 17 Audiology 14 Aural Clinic 96 B B.C.G. Vaccination 8,74 Birth Control (Family Planning) 57 Births 49, 51 Blind Persons 61 Burials 66 C Cancer 51 Car Badges 64 Care of Mothers and Young Children 51-58 Cervical Cytology 56 Chest Clinic 72 Child Development Sessions 55 Child Guidance Service 96, 97 Child Minding 55 Child Welfare 53 Chiropody 59 Clean Air 21, 77, 85 Clearance Areas 78 Committee 1 Communicable Disease 7 Comparability Factor 49 Compassionate Laundry 66 Condemned Food 87 Confinements 52 Congenital Malformations 56 Convalescence 59 D Pages Day Centres 10 Day Nurseries 10, 55 Deaf 18, 62 Death Rate 49 Deaths, Causes of 41 Deaths, Infants 49 Dental Laboratory 75 Dental Services 15, 75, 97 Dental Treatment/Inspections 56, 97, 98 Dentures 56,75,98 Development Sessions 55 Diphtheria Immunisation 73 Disabled Drivers 64 Disabled Persons 40-42 District Nursing 17 Domiciliary Chiropody 59 Domiciliary Midwifery 52 Drugs 5, 7 Dysentery 7,71 E Ear, Nose and Throat Clinic 96 Educationally Subnormal Children 100 Employment of Children 95 Environmental Health 18, 26-30 Eye Clinics 96 F Factories Act 77, 88, 89 Family Survey 42,43 Family Planning 57 Field Work 16,17 Flooding 46 Food and Drugs Act 77,78,82,84, 85,87 Food Hygiene 7,82,85,86 Food Inspection 77 Food Poisoning 7, 71 Food, Welfare 54 Foot Inspections 95 Funerals 66 G Gas and Air Analgesia 52 General Dental Service 75 General Practitioners 16, 17,52,69 H Pages Handicapped Persons 40-42, 64 Handicapped Pupils 100, 101 Health Education 7, 23 Health Visiting 16,57 Health and Welfare Committee 1. 6 Holidays 59, 64 Home Help Service 25, 59, 60 Home Nursing 58 Homeless Persons 66 Homes 9, 55, 56 Homeworkers 63 Hostels 10, 66, 67 Housing Acts 22,30-37,38- 40,77,78 Housing, General 10,22,103, 104 Housing Survey 22, 30-37 I IceCream, Premises 84 Illegitimate Births 49 lmmigrants 8,72 Immunisation 73 Incontinence Services 66 Infant Mortality 49 Infant Welfare 51,53-58 Infectious Diseases 7-9, 71 Introduction 4-6 J Jaundice 71 Junior Training Centre 11 L Laundry Service, Incontinent 66 Local Authority Homes 65 Luncheon Clubs 66 Lung Cancer 8, 9 M Massage and Special Treatment 74 Maternal Mortality 49 M (cont.) Pages Maternity and Child Welfare 51-58 Meals on Wheels 66 Measles 7, 71 Measles Immunisation 73 Medical Examinations 74 Medical Inspections 91-95 Medical Research Council 42 Medical Treatment 92-96 Medical Officers 2 Mental Health 67-70 Meningitis 7,71 Midwifery 52 Minor Ailment Clinics 95 Milk, National Dried 54 Milk Suppliers 84 Mothercraft 55 Mothers and Children 51-58 N National Dried Milk 54 Neighbourly Help Scheme 61 Neo-Natal Mortality 49 Night Attendance Service 60 Noise Abatement 19,20,21 Notices, Sanitary 77 Notification of Births 51 Nurseries and Child Minders Regulation Act 55 Nurseries, Day 10, 55 Nursing Homes 74 Nutrients 54 0 Obesity 16 Offices, Shops and Railway Premises Act 18, 19,77,79, 80,81,83 Old People's Homes 9,65,66,74 Ophthalmic Clinics 96 Orange Juice 54 Organisation and Method 24 Orthodontic Treatment 98 Orthopaedic Clinics 96 Orthoptic Clinic 96 Outwork 89 P Pages Paediatric Clinic 96 Paratyphoid Fever 71 Partially-Sighted Persons 61 Pet Animals Act 77, 84 Phenylketonuria 58 Physiotherapy 96 Physically Handicapped Persons 62 Poliomyelitis Vaccination 73 Population 49 Premature Infants 51 Premises, Registration etc 83, 84 Prevention of Damage by Pests Act 77, 81 Public Health Inspection 77-89 Public Health Acts 77-89 Psychiatric Rehabilitation 13 R Rainfall 46 Rateable Value 49 Recuperative Holidays 59 Rehousing 104 Relaxation Exercises 55 Rent Act 78 Residential Accommodation 9, 65, 66 Rodent Control 81 S Sampling of Food 87 Scarlet Fever 7,71 School Health Service 13, 91 Sewerage 46 Sheltered Workshops 63 Sickroom Equipment 58 Slum Clearance 22 Smallpox Vaccination 73 Smoke Control 21 Smoking 5,8,9 Social Responsibility Centre 5, 43, 45 Social Workers 17 Social Work Teams 17, 18 Special Schools 101 Specialist Clinics 97 Speech Therapy 99 Staff 2,3,6,9,11, 24,25,74 S (cont.) Pages Statistics 49-106 Stillbirths 49, 51 Subnormals 10, 11 T Temporary Accommodation 10 Tetanus Immunisation 73 Training Centres 12,70 Training 10 Transport 11 Tuberculosis 8,71,72,74 Typhoid Fever 7, 71 V Vaccination and Immunisation 73 Verminous Premises 81 Vision 92, 93 Vital Statistics 49 Voluntary Organisations 47, 65 Volunteers 44 W Water Supplies 45,105,106 Welfare Centres 53 Welfare Foods 54 Welfare Services 61-66 Whooping Cough 7, 71 Whooping Cough Immunisation 73 Workshops, Sheltered 63 Work Centre 12, 63