I WAL 66 London Borough of Waltham Forest REPORT OF THE MEDICAL OFFICER OF HEALTH E.W. WRIGHT, MB., Ch.B., D.P.H 1970 WALL 66 CONTENTS MEMBERS OF THE HEALTH AND WELFARE COMMITTEE DEPARTMENTAL STAFF INTRODUCTION BY MEDICAL OFFICER OF HEALTH THE WORK OF THE DEPARTMENT DURING 1970:- Control of Communicable Disease Residential Accommodation Day Centres School Health Service Field Work Services SPECIAL ARTICLES:- St. James' Health Centre Food for Human Consumption CONTRIBUTIONS FROM COLLEAGUES:The Social Responsibility Centre Family Survey - M.R.C. Child Development and Behaviour Unit Rainfall and Sewerage Water Supplies STATISTICAL SECTION PRINTED BY THE LONDON BOROUGH OF WALTHAM FOREST LONDON BOROUGH OF WALTHAM FOREST HEALTH AND WELFARE COMMITTEE 1970 - 1971 Chairman: Councillor Mrs.P.K.Williams Vice- Chairman: Councillor L.Braham Members: Alderman G.S.Mace Mrs.E.V.Pearson Councillor 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 L.E.F.Watling Mrs.E.J.White F.W.Wigg Ex-officio: Alderman S.G.Shepherd, J.P. - I - STAFF OF THE HEALTH AND WELFARE DEPARTMENT (at 31.12.1970) 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. Carmel P.Dooley, L.R.C.P. & S.I. . Vacant post 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. *Margaret Edwards, B.Sc., M.B., B.Ch., C.P.H. *Jocelyn N.Newman, M.B., Ch.B., D.C.H., D.(Obst.) R.C.O.G. Joan Whitaker, L.R.C.P., L.R.C.S., L.R.F.P.S., D.(Obst.) R.C.O.G. 2 vacant posts *(Part-time) Plus sessional Medical Practitioners Psychiatric Adviser - *W.R.Little, M.R.C.P., M.B., B.S., D.P.M. 3 Sessional Psychiatrists; 2 Educational Psychologists; 5 Social Workers + 3 vacant posts. Principal Dental Officer - G.P.L.Taylor, L.D.S., R.C.S. Senior Dental Officer - Vacant post 13 Dental Officers (Whole-time equivalent in post = 5.1); 3 Dental Auxiliaries; I Dental Technician + 3 vacant posts. Principal Social Worker - Sybil A.Abley, A.A.P.S.W. Social Work Adviser - J.Cotton, M.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 Leaders - Lucy Baxter, S.R.N., C.S.W. J.Golden, C.S.W. 13 Social Welfare Officers 7 Mental Health Social Workers 14 Social Work Trainees I Mental Health P.S.W. Trainee (vacant) - 2 - Chief Public Health Inspector - W.Richards, D.P.A., M.A.P.H.I. Deputy Chief Public Health Inspector - J.H.Butler, F.R.S.H., M.A.P.H.I. Senior Public Health Inspectors - D.R.King, M.R.S.H., M.A.P.H.I. N.Smith, M.A.P.H.I. 13 Public Health Inspectors (5 posts vacant); 3 Technical Assistants; 5 Pest Control Assistants; 2 Pupil Public Health Inspectors (3 posts vacant). Chief Nursing Officer - Post vacant Superintendent Nursing Officer - Elizabeth O'Connor, S.R.N., S.C.M., H.V.Cert., 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. 52 District Nurses 21 Midwives I District Nurse/Midwife 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. 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. Joy Green, S.R.N., H.V.Cert. Mary Young, S.R.N., S.C.M., H.V.Cert. 2 Field Work Instructors (I vacant post) 31 Health Visitors 4 Tuberculosis Visitors 16 Clinic Nurses (4 vacant posts) 6 Student Health Visitors I Infectious Diseases Nurse Health Education Officer - H.Bradley, M.I.H.E. Chief Chiropodist - R.J .King, M.Ch.S. 15 Chiropodists (5 vacant posts) Other Staff - 5 Day Nursery Matrons 4 Home Help Organisers 2 Training Centre Managers I Head Teacher I Work Centre Manager 3 Speech Therapists (I vacant post) I Occupational Therapist 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 18 Administrative Assistants; 78 Clerical Assistants; 14 Clinic Clerks, I M.O.H.Secretary; I Typing Supervisor; 6 Supernumeraries; I Storenran; I Administrative Trainee. - 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 1970, the sixth year since the creation of the new London Borough. As one looks forward to the great tasks still ahead for the development of the Health Services and for the building of the Social Services in their new structure headed by the Director, one may perhaps take some pleasure in reviewing the achievements of the Waltham Forest Council in this field since 1965. Up and down the Borough there are new buildings - health centres, homes, hostels, day centres for all types of need — the numbers of field workers in the Social Services have increased to four times the 1965 figure. In every field of Health and of Welfare progress has been made, in many cases great progress; in others patient groundwork has been laid. The year began with a pause in progress and some regression, but then came the opening of the Essex Hall Old People's Home, Grosvenor House School for the Severely Subnormal and the St. James Health Centre - all three advances not only in the quantity of the Borough's contribution but significant landmarks in new thinking as to the very nature of the services which a local authority should provide. In the estimates prepared at the end of the year came the foreshadowing of the largest increase in social workers we have ever had in one year,together with other advances From the administrative point of view, the department was in great difficulty because of the illness and then retirement of the Chief Welfare Officer, coupled with the prolonged illness of the Senior Medical Officer for Child Health, all this at a time when re-organisation was in the air but impossible to implement due to difficulties in appointing the Director of Social Services. So for a year, direction, supervision, and staff support almost disappeared at the most senior levels, all effort going to keeping the services running at all. A single phrase in an annual report may hit the headlines, sometimes embarrassingly so, and in a number of fields desirable objectives appear which flicker into popularity and become unexpected priorities only to be overtaken later by others. It is particularly in such areas that triennial changes of party control leave officers a little breathless. But the broad road of progress is not so fickle and the needs for which the Social Services exist are accepted by all, if ill-defined at the edges; nor are they one iota different for changes in the department to whom field workers owe their loyalties, or the route by which the public purse finances these departments. It is therefore familiar matters which it is my duty to keep before the Council, all the more important because they are always with us. The field of Health in which the Local Authority has the most to offer — the environment — has traditionally been, and is now of key importance. Local Authorities have done more to prevent illness and promote health by building and engineering works than the so-called health services (almost entirely illness services in fact) have ever done. The link between the new Health Services and the Local Authorities, not yet clear at the time of writing, must be an organic functioning one, clear for all to see, or the process of setting up the expected new pattern of Health Services will indeed be mutilating. So much lies in the Local Authority's hands to do. - 4 - The constant monitoring of air, water and food are vital for the exclusion of pollutants and for ensuring that those substances are present which in minute quantities build the foundations of health — vitamins, minerals (flouride in water which a vociferous minority deny to all) and others. Not only is it the duty and responsibility of the Council to provide a healthy external environment, but an internal one also, and this means persuasion of people not to smoke, persuasion of people to handle food in ways which do not give rise to all sorts of disease, and many other things. Waltham Forest, which has done so much for buildings, engineering works with health implications and clean air to name but three, must now bring much greater weight to bear in all that is implied in Health Education. Persuasion of men, women, boys and girls in all that leads to their health is hard work, needs proper resources, and offers great rewards. This report, addressed as it is to members of the Council, has nevertheless a wider readership and to each reader may I say sincerely and personally as I say on posters in a number of buildings "In the interests of your own health and for the benefit of others please refrain from smoking". The cigarette is a killer. The cigarette leaves families fatherless. The cigarette makes chronic invalids. The cigarette is socially offensive to some people. If you smoke cigarettes please, oh please, listen to what is being said. Listen again — and give it up. The concept of health as an absolute — as total physical, mental and social wellbeing — is now becoming old hat, for common observation indicates that it is an ideal concept very rarely found in real life. But the more modest objective of health as the ability to live a full life in which one's little infirmities are tolerated within a general resilience has very real administrative implications. Sheltered housing with warden service is a theme which must continue to be hammered home. So often the entire rationale of using this form of housing is misunderstood. If only, someone says, this or that old lady who is borderline for an old persons' home could be in a "warden flat". But what would be the result? If a block of warden flats was filled with such people, before long many would cross the borderline at an age when they could not adapt and would really need the facilities of an old persons' home. The state of affairs would then be an inappropriately and extravagantly designed old persons' home, hampered by unsuitable staffing arrangements. Housing of this kind is not only for old people, but in their case admission must occur at an age when they are still able-bodied, having years ahead of them in which to form links with the social matrix of the area, and indeed with others in the same block, so that as infirmity increases they have built up a resilience to cope with it. This is why small numbers of such flats make so little impact on the problem. The need is for a large pool of this type of housing lightly staffed, not for a small pool heavily staffed. The minute of the Health and Welfare Committee, approved by the Council on the 24th February, 1967 that "a target be approved for the provision of 300 dwellings a year for elderly people with some form of warden service" was nothing less than realistic, if daunting in terms of resources. The Severely Subnormal need local residential provision. This is part of a national strategy of rescuing them from a situation built up when mass production methods of care were felt necessary for smaller numbers than now exist. A situation has now been reached where a basic under-provision and historic lack of imagination in large hospitals up and down the country is causing occasional scandals to burst through the fog of public apathy. The public now at last demands that something should be done. The difficulties of the Royal Eastern Counties Hospital which cares for our subnormal patients from its large blocks of buildings 50 miles away are matched by the greater and much appreciated efforts of the staff to overcome them, but such a state of affairs must be improved and - 5 - quickly. As the recent White Paper on Services for the Mentally Handicapped says "The Government will play its part but the main responsibility lies with the local authorities themselves. Faster development of their services is crucial". The opening of the St.James Health Centre marks further a big step forward in constructing the modern Health Service which the country as a whole so badly needs. The archaic system of family doctors, health visitors, district nurses and similar staff all struggling with different facets of the same problem in isolation desperately needs the forceful boost of such buildings to integrate these staff into a pattern which not only makes sense to patients, families and the staff who man them, but also results in a very substantial increase in output of the skills available, to the benefit of all. Good communications save time, and time is money. Important as these centres are to the country as a whole, they are vital to areas such as the southern end of the Borough. In a national situation of a shortage of doctors, what doctor entering practice is likely to choose to work in an old-fashioned surgery in an area of depressed housing? There are plenty of other opportunities open to him. Parts of the Borough have little else to offer and the doctors there are in many cases approaching retirement. No report of this kind would be complete without expressing an appreciation of the work of those who make a voluntary contribution. Just as the individual needs resilience and material aids may help him to achieve it, so does a community. The local authority by appropriate material aid can produce an output of voluntary effort out of all proportion to the funds which have primed it. Moreover, a richness of life can be added to society by the interchange of giving and receiving help, as in the mushroom development of social service projects by school children which the Voluntary Work Centre has done so much to bring about in the last year. In conclusion may I thank my staff and those of other departments who have given such great help during the year. I am sure those staff would join me in my thanks to the Council committees for their interest and support and particularly to the Health and Welfare Committee whose chairman, Councillor Mrs.P.K.Williams, showed an enthusiasm and support for our work which was greatly appreciated. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant Medical Officer of Health - 6 - THE WORK OF THE DEPARTMENT CONTROL OF COMMUNICABLE DISEASE Dr. Geoffrey Poole, Deputy Medical Officer of Health, writes:- The incidence of common infectious diseases showed little significant change from last year. There was a welcome reduction in the number of cases of Measles to 800 (1,558), due in part to the natural bi-ennial epidemic rhythm of the disease but also, we hope, to increased efforts to secure vaccination of all susceptible children. Waltham Forest compares well with the National average rate for all standard immunisations with the exception of vaccination against Smallpox. One cannot stress too much the importance of prophylactic immunisation. Walthamstow and Leyton shared 622 cases of diphtheria and 327 cases of smallpox during 1930; because of effective immunisation these diseases have virtually disappeared as has poliomyelitis with its ghastly sequel of paralysis. B.C.G. vaccine is playing a prominent part in eradicating tuberculosis throughout the world and effective vaccines are now available for both measles and rubella. But, when the incidence of an infectious disease is reduced, it is even more important to keep up the proportion of the population immunised. Populations in which a disease has been present for many generations gradually develop a racial or "herd" immunity to it, as we have to the common fevers. Without immunisation we should all catch measles in childhood but few would die from it whereas in isolated communities which have never been exposed to that virus, such as Eskimo villages, the whole population dies; lacking a pattern of inherited immunity on which to build, they are overwhelmed by the infection before their bodies can create sufficient immunity. Recent research into the rejection of transplanted organs has greatly increased our knowledge of how immunity works in the body and is clearly pointing the way towards immunisation against that most dreaded disease - Cancer. There was an insignificant increase in the number of cases of infectious jaundice notified at 54 (3I). All were investigated and the possibility of (drug) syringe-transmitted jaundice excluded. Perhaps the most remarkable feature of 1970 in this context was the extraordinarily low figure for dysentery, only 12 cases being notified against (240) last year. No effective drug treatment has yet been discovered which will clear patients or carriers with this disease but much work has been done over the past few years to improve standards of hygiene, especially in school lavatories, and by health education directed towards parents and teachers. Perhaps these efforts are beginning to show results but if we have three, or better, five years without an outbreak I should feel more confident that we are winning. Our two typhoid cases were both imported; quickly diagnosed and isolated and no secondary spread occurred. Food Poisoning continued to plague the inhabitants of Waltham Forest - the numbers notified mean nothing since the usual form of gastro-enteritis though violent is of such short duration that most sufferers do not even consult their doctor. Though there were only three deaths from gastro-enteritis this year there can be few of us who entirely escaped a "tummy upset" due to food poisoning germs. The widespread prevalence of this infection in an urban community with an unimpeachable water (and milk) supply must give us cause for concern. Through increased efforts in Health Education and strict enforcement of the Food Hygiene Regulations we shall make every endeavour to prevent contamination or faulty storage and handling of food by those employed in food commerce. The increasing use of "convenience" pre-packed prepared foods greatly increases the risk. Though prevented from "going bad" by refrigerated storage such foods are often contaminated and once out of the freezer they rapidly "go off". Infection among the animals, poultry or staff at a modern high output factory-farm sending frozen carcasses all over the country could produce widespread outbreaks unless great care is taken to defrost thoroughly and then cook slowly so that enough heat penetrates right through the meat to ensure that germs deep in the tissues are also cooked-dead! _ 7 _ Tuberculosis shows a small reduction with 79 notifications (84) but this is mainly due to the fall in immigrant cases - from (44) to 38. One hopes that this may indicate a change in the rising trend of recent years which, hitherto, has shown a progressive increase in the proportion of cases occurring in the relatively small (about 9%) immigrant fraction of the community. Percentages of immigrants to total notifications annually 1965/70 were; 27.7%, 34%, 33%, 50% and now 48.1%. Lack of inherited racial resistance, proneness to overcrowding and, perhaps, to sub-optimal nutrition may combine to render immigrants so liable to develop tuberculosis and to have it in such an acute and progressive form as they often do. Unfortunately these factors apply equally to the children, even those born here and it may take several generations before they can become acclimatised to the infinitely variable English weather. No wonder it is a standard opening gambit for conservation. It is, however, reassuring to find a rising awareness of the need for B.C.G. vaccination of all schoolchildren against T.B. Our target is 100% acceptance. Last year I drew attention to the almost total eclipse of T.B. and other infectious diseases as important causes of death by the rapidly increasing death rate from Lung Cancer, Ischaemic Heart Disease and Bronchitis with Emphysema. In the space of only one year deaths from smoker's cancer have risen by over 121/2% for men 169 (150) and by over 16% for women 36 (3I). Approximately half the deaths occurred in the age group 35 to 64 years. What a price to pay for cigarettes! This is no chance variation in the figures but a steadily progressive increase affecting all countries of the world where cigarettes are smoked. Taking a longer view of local epidemiology (the populations of the old boroughs of Leyton and Walthamstow together approximate to that of Waltham Forest) the following tables show how, within the lifetime of most of us, infectious diseases have been brought firmly under control but that deaths from diseases associated with smoking and with mental and emotional stress are increasing with great rapidity in our Borough. TYPICAL INFECTIOUS DISEASES Year Population Smal Ipox Scarlet Fever Diphtheria Tuberculosi s 1930 253,100 327 1,068 622 316 Leyton 128,300 138 461 313 157 Walthamstow 124,800 189 607 309 159 1950 229,300 0 400 1 270 Leyton 106,600 219 165 Walthamstow 122,700 181 1 105 1970 235,040 0 85 0 79 SELECTED CAUSES OF DEATH Y ear Population Heart Disease Bronchitis Lung Cancer Tuberculosis 1930 253,100 480 100 16 189 L. 256 58 5M + 5F 100 W. 224 42 5M + IF 89 1950 229,300 698 160 85 68 L. 421 L. 80 L. 25M + I0F 35 W. 277 W. 80 W. 4IM + 9F 33 1970 235,040 819 189 183 1 - 8 - Quarantine, isolation, vaccination and therapeutic advances have enabled us to exclude many of the agents of infection from the environment and to render many others impotent. Environmental hygiene has virtually eliminated enteric fevers from these islands. The sewage effluent discharged into the rivers from which our water supply is derived is highly purified but constant vigilance is still needed especially when, as happened during the municipal workers strike crude sewage was discharged untreated into the river Lea. During the year 1,699 notices were issued for contraventions, in food premises, of requirements under the various Clean Food Regulations and 57 individuals or firms had to be referred to the Legal Department in respect of 94 offences. The Council are winning the battle against the need for Waltham Forest residents to live in unfit or sub-standard dwellings; purity of the water supply and clean air are taken for granted, as well as protection from exposure to infectious disease. But the figures I have quoted make it plain that those concerned with the health of Waltham Forest cannot afford the time to reflect on past achievements when we are faced with an epidemic increase in smokers' cancer and of ischaemic heart disease (coronary and angina) where nicotine addiction and the current stress of the working environment combine to cause almost one third of all the deaths occurring in the Borough. So often these deaths occur in comparatively young men and women at a time when they have great family responsibilities and often, in their work, are making their greatest contribution to the community. No girl should marry a man who smokes unless he agrees to pay a weekly life assurance premium equal to the amount he is spending on cigarettes. Already powerful support is coming in to help our campaign against the tobacco habit, especially in schoolchildren but there is little a Medical Officer of Health can do about the almost equally dangerous environmental stress except to point to the figures and ask employers to consider whether, in the long run, stress inducing high-pressure productivity schemes are really worth while. The human animal lives a pretty unnatural life as it is and if driven beyond his capacity inevitably breaks down. Higher productivity may mean more pay for shorter hours but it may be for a shorter life as well. Executive stress in the "rat race" is becoming very common these days, about as common as death from coronary thrombosis. Over 2,000 visits were made by the Deputy Medical Officer of Health and/or the Infectious Diseases Nurse for Infectious Disease control during the year and 800 specimens taken for laboratory examination. Our thanks are due to our colleagues in general medical practice and in the hospital service for their ready co-operation and prompt notification of all cases where a public health risk is present; also to Dr.B.T.Thorn and his colleagues at the Whipps Cross Public Health Laboratory for much help and valued advice. With regard to venereal disease, the following table shows the numbers of new cases notified to hospitals in the London area from this borough during 1970:- - 9 - HOSPITAL SYPHILIS GONORRHOEA OTHER VENEREAL CONDITIONS TOTAL PRIMARY a SECONDARY OTHER Seamen's Hospital, Greenwich - - - 4 4 St. Thomas' Hospital, S.E. 1 - 1 3 25 29 The Prince of Wales Hospital, N. 15 - 2 19 162 183 The London Hospital, E. 1 1 7 90 524 622 Queen Mary's Hospital, E. 15 - - 31 182 213 St. Bartholomew's Hospital - - 4 33 37 Eastern Hospital, E.9 - - 5 25 30 The Middlesex Hospital, W.I - - 4 34 38 Westminster Hospital, S.W.I - - - 6 6 1 10 156 995 1,162 Local health educational efforts against venereal disease are by means of posters, leaflets, lectures by doctors, nurses, health visitors and teachers to schools and youth groups in the educational system and to outside organisations. Special posters are used in all the conveniences under the control of the borough, giving the necessary warning and showing details of all the hospitals in the area where treatment can be obtained. RESIDENTIAL ACCOMMODATION Old People's Homes Although, over all, staffing was not the problem it had been in previous years, nevertheless at some times of the year in certain homes we ran into acute problems and in fact Heathcote at Christmas faced total breakdown, something only once before experienced in the life of Waltham Forest. The Social Responsibility Centre found volunteers to come to our rescue and in a few days the crisis was overcome but the prospect of sixty elderly, confused, many incontinent, people with no one to care for them was for a time a real possibility staring us in the face. The high spot of the year was the opening of Essex Hall. This Home, the first to be built in the Borough by the Council for Waltham Forest (the other six having been built by the Essex (County Council) was opened in 1970. - 10- It was erected on a site of local historical interest on which for many years stood the Manor House of Higham Benstead, which ceased to function as a manorial centre in about 1768, but continued to be occupied. In the 19th Century it became the residence of a very distinguished local figure - the Rev.Eliezer Cogan, who conducted his well known Academy there. Perhaps the most famous of the many notable persons who attended the Academy was Benjamin D'lsraeli. The old house was eventually demolished in 1934 and its name was given to the Old Persons' Home to perpetuate the title. The Home provides residential accommodation for 52 elderly persons of either sex comprising 36 single and 8 double bedded rooms, a ground, first and second floors. A special workroom is included to provide occupation for about 24 persons of whom half will be non-resident. The dining room of the Home is large enough to permit these nonresident persons and several others attending at the Home for "day-care" to be fed. Use is also made of this room by a number of blind persons who attend for handicraft instruction from Social Workers. Several interesting features, some of which were suggested by the former Chief Welfare Officer for the Borough, Miss B.Warshaw, are incorporated in the design of the building and its fittings. These include an electronic system of personal intercommunication for staff patrolling at night, a "Medic-bath" which enables the user to step into it through a removable front panel which, when replaced, is sealed by air pressure to prevent water escaping and a specially constructed "shop" in the foyer for the sale of stationery, toilet sundries, sweets and other small commodities to the residents. Specially designed fitments and surrounds to the washbasins are installed to enable the residents who have difficulty in washing themselves to overcome this by resting their arms at the sides of the basins. There are small areas at the ends of the corridors on each floor where residents can sit if they do not wish to use the lounges and on each floor is a room with the necessary facilities for tea making, which is available to residents or their friends and relatives who would like to share a cup of tea with them when visiting. Self contained flats for the Matron and Deputy Matron are available together with three bedsitting rooms for other residential staff. The cost of the building, including professional fees, was £125,500 and almost £15,000 was spent on furniture and equipment. Hostel for the Subnormal Sylvan Lodge settled down for a year of normal working during 1970, the Matron, Mrs.Bridgland, giving sterling service under recurrent difficulties with regard to supporting staff. As reported last year a small hostel of this kind, the only one run by the authority, lives on a knife edge with regard to staffing as it has no resilience to deal with staff shortage, sickness or leave. More hostels of this kind remain the greatest single need for capital development in the borough's welfare services. - 11 - Temporary Accommodation Cecil House settled down during the year, to provide with Woodlands for Homeless Families, at times being overfull to a degree causing great concern. Comments made in previous years about the problems of homeless families still apply, there being nothing new to report. DAY CENTRES Grosvenor House School The major event in the year was the opening of Grosvenor House School for Mentally Subnormal Children in Hoe Street. In October, 1947 Mrs.Knight, the present head teacher opened in the main hall of the Friends' Settlement, Greenleaf Road, Walthamstow, an "Occupation Centre for 46 people ("ineducable", "imbecile", "feebleminded", "moron") aged 6 to 30. A year later it moved to All Saints Church Hall, Shortlands Road, Leyton, where there were 125 on the register for Mrs.Knight and her four helpers to cope with. In 1951 they moved again to Woodbine Place in Wanstead where, as the Junior Training Centre they remained until 1970, losing in due course all the adults to the new Adult Training Centre. Now in April 1971 in a brand new purpose built building they go forward as part of the general educational system, accepted, as fully as the law of the land can make it so, as equal citizens with the rest of us. There can be few examples of social progress as striking as this. As Medical Officers of Health now hand on the baton to Education Officers they can sincerely wish them well for the battle is only half won and there is a long way to go. The great advance made so far is only an indication of how far behind the rest of the field this section of the population were twenty years ago, Mrs.Knight writes:- "That part of the population described as mentally subnormal contains a range of ability as wide as it is among the intellectually normal and superior; the range includes children whose profound constitutional impairment renders them devoid of the capacity to acquire anything much in the way of language or conceptual ability and involving an intensive degree of nursing care; and children who are malformed, mal co-ordinated with limited conceptual abilities and severe speech defects to those children with milder degrees of subnormality who at the upper levels merge into the "slow learners" section of the community. It was with this wide ability range in mind that Grosvenor House School was discussed and planned. Before the actual building commenced the following points had to be considered and worked out in detail. Anticipating the differing (and often identical though in degree only) needs of the children with regard to their education, training and nursing requirements. Deciding on the type of building bearing in mind the need for possible future extension and limitations of the site. Design and overall aesthetic appearance. Drawing up lists of equipment and furniture for every room as the foundations were being laid. Defining the roles and designation of the staff to be recruited. Cost and amount of money available. Visiting the homes of the child on the waiting lists; and - 12 - Arranging for transport for the children. As building progressed, time tables, rotas and educational programmes were drawn up and staff briefed. The school was completed and ready for occupation in June 1970. It is run as two departments with a certain amount of co-mingling. Department I. Day hospital and special care units 35 places Department II. School department 70 places The children attend daily during the usual school terms and are transported to and from the school. Meals are brought in from a central kitchen. Everything functioned smoothly from the start. The more sophisticated a society becomes the higher its standard of education, the more complicated and technical it is, the more obvious is the deviation from the norm of those who cannot keep up with their fellows and as the principle must be accepted that all children whatever the extent or nature of their handicap have a right to some place in the education system, it is the purpose and function of this school to provide facilities so that the approach to the education of mentally handicapped children may be a real and positive one reflecting increasing knowledge about human learning and teaching techniques. Day Nurseries Dr.G.Richards, Senior Medical Officer for Child Care, writes:- Despite the higher fees in Day Nurseries, requests for admission continue to be high. The waiting lists of priority cases could have filled another three or four nurseries. It is evident that despite the increase in Play Groups and Nursery Schools, Nursery places are still in great demand. Parents and those they turn to for help see just the individual child and try to exert pressure for the admission of the one they consider the only pressing case. This adds to the work of the Nursery staff and to the difficulty of keeping an overall general picture of all the individual needs. The number of students in training has been lowered in the interests of economy. This has unfortunately come at a time when the value of the N.N.E.B. Diploma has become widely known and respected as a qualification for children's work. Three years ago many of the students were anxious to continue work in our own Nurseries as there were few openings for them elsewhere unless they wished to go for further training as nurses or teachers. Vacancies were kept open for them to qualify as we were then able to choose the best of that year's students for our own Nurseries. This year only one student decided to continue in a Day Nursery after obtaining her N.N.E.B. qualification. The posts the others applied for and easily obtained were varied; some went into libraries and offices, where although untrained, salaries were higher; some went for teaching or nursing training; others were swallowed up to work as private nannies, with babies in hospitals, in nursery, special or infant schools or play groups. It is perhaps not surprising that these young people opted for the easier work, shorter hours and longer holidays. The work in nurseries has long hours and, as many difficult children who cannot be managed at home or in a play group require admission to a Day Nursery, the work is very heavy and exacting - but also very rewarding. - 13 - I do not think enough praise is given to the staff in the Nursery who quietly continue to do their duty even if this involves coming in early on frosty mornings to see that the Nursery is as warm as possible by the time the children arrive, or staying late in the evening (sometimes taking a child home) because a parent "has forgotten" to collect the child at the end of the day. From the decorations and the festivities at Christmas at all five Nurseries it was obvious that the children who were fortunate enough to have attended had been given every opportunity to express themselves in various ways as well as enjoying their time with other children. Work Centre for the Physically Handicapped Mr.Butler, Manager of the Centre, writes:- I should like to start my report concerning the centre, by saying that the past year has been a very happy one at Roberts Hall. The Centre has expanded all round since our last report, and over the year 30 or 40 more people have been able to take advantage of the Centre. Unfortunately some have left us, but for some this has been for personal advantage. They have been placed in open industry. The woodwork section has been kept busy, in fact a hive of industry, with orders for the Borough, i.e. seat benches, show cases and shop for Essex Hall. Many orders were the direct result of the 'Sales' at the Town Hall etc. These are very successful. The handcraft section is also trying to keep pace with the numerous orders placed at the 'Sales' and the 'open week' held at the Centre. Work has been moving very well in the Industrial Section, the Plessey contract has been bringing in a lot of work, and has kept all machines working flat out. Unfortunately this contract was almost lost during the Industrial dispute. A wider variety of work has been received from the other factories. One of the newer jobs we have obtained is packing Air Line cutlery kits. Our outing this year went with a swing. This year we took two parties of 70 people on consecutive days to Folkestone, and luckily the weather held for us. Everybody seemed to enjoy the trip, which made all the effort that went into it worthwhile. Just before Christmas, we had our Christmas Party which went down very well. It was another two day effort. To finish the year we all joined one of the girls in celebrating her 21st Birthday. The expenses all being paid for by her parents. The League of Friends have progressed well over the last year, and have held several fund raising functions. They were presented last month with a van by the Walthamstow Round Table, for the use of Roberts Hall, for the collecting of work etc. A very nice gesture. In closing we should like to thank Dr.Wright for coming to our Christmas lunch, and also for the help and understanding from the department as a whole. May this continue throughout the coming year. Birkbeck Adult Training Centre Mr.W.P.Everard, Manager of the Centre, writes:- The current number of trainees is 101. During the year one girl was placed in open employment. - 14 - In our industrial workshop we have successfully increased our output for the three local firms with whom we have dealt with for some years. In the handwork workshops we have again been busy, keeping pace with the large volume of orders received during the year. The continued support speaks well for the high standard of work produced in this department. With our two trainee instructors returning from their year's course as qualified staff we have been able to widen the scope of our educational classes and the special care unit to the benefit of the trainees. In September, 44 trainees and 7 staff from Birkbeck and Queens Road Centres went to St.Marys Bay Holiday Camp for a week, in many cases this is the only holiday trainees get and it is found to be very beneficial in the respect of mixing with other people and managing without parental backing. During this week the remainder of the trainees and staff of Birkbeck Road Centre spent a pleasant day at Colchester Zoo. In January the entire Centre went to the Wembly Ice Show, and all trainees were del ighted. The Essex Training Centres Sports competitions have now developed into a 2 division football league and netball league. In the latter the Birkbeck girls were runners up. In the Essex Centres Annual Sports at Basildon the combined team from Birkbeck and Queens Road won the trophy scoring most points, for Waltham Forest. Thus repeating their success of 1969. Yet again considerable progress has been made during the year and it is confidentially expected this will continue in 1971/72. Queen's Road Adult Training Centre Mr.L.W.Hammond, Manager of the Centre, writes:- The number of trainees attending the Centre on January 1st, 1970 was 60. On 31st December, 1970 this number remained stable at the same figure. Our annual increase has in past years remained at 8 per cent, and I have to report a loss of four trainees from this Centre during 1970. One has moved from the district, another has been transferred to another Centre within the authority, and unfortunately two have died. I understand from Mrs.Knight that two or three trainees will be coming to us from her Centre during 197 I. Staffing Staffing problems have made the year a difficult one, sickness being the main cause. One member was absent for three months, and another for a total of 23 weeks which included three periods in hospital. Another member of staff resigned during the year due to pregnancy. Two other members of staff began a one year course at Chiswick College. - 15 - It is most unfortunate that these circumstances have made it necessary to suspend our pottery classes for the time being. This activity will be started at the earliest possible moment. Swimming I am pleased to report that our weekly sessions at Leyton baths continues to be extremely popular with our trainees. We have arranged for six trainees to enter for Diploma Awards early in 197I. Dymchurch Twelve trainees from our Centre took part in this most popular holiday in 1970. I am able to report that although a charge of three pounds, twelve shillings was made for the first time, there appeared to be no resentment about this. You will remember that Parents were given the opportunity to pay this sum with weekly payments, and only two elected to pay by this method. Shoeburyness A new venture was tried during 1970, with caravan holidays for a number of our trainees This was organised by the staff, and a charge of seven pounds for one week was made. I am pleased to report that this was a most successful holiday. A number of parents visited the camp and expressed sincere appreciation concerning our efforts. We hope to make this an annual event. I must mention in closing this summary of report, that co-operation from the Health and Welfare Department during 1970 has been most helpful. With the excellent relationship which exists, one feels that the coming year will be a successful one for Queens Road Adult Training Centre. Psychiatric Rehabilitation Centre Dr.John Wilder, Director of the Psychiatric Rehabilitation Association, has sent us this report:- Psychiatric Rehabilitation Association's contribution to the mental health programme of the London Borough of Waltham Forest gained momentum in 1970. The groupwork approach at the Day Centre continued the success of previous years. By stimulating initiative and fostering self-respect, this approach enables members to take interest in, and more responsibility for their own lives. In consequence the intense stress that families face when caring for a sick relative is considerably reduced. During the year, the Centre moved to new premises provided by the Borough at the Low Hall Lane Health Services Clinic. Inspite of the disruption caused by this second move in two years, there was a record number of attendances in 1970. This new accommodation is smaller than the Civil Defence Centre in Apsley Lane which housed the Day Centre during the first half of the year, but there are considerable advantages in the exclusive use which is now provided. It has been evident for some time that the Day Centre is only one stage of a comprehensive rehabilitation service. Some members of the Centre had improved considerably but were unable to return to work immediately because of a lack of basic education and because of the chronicity of the illness. They were transferred to the Industrial Education Unit run by - 16 - Psychiatric Rehabilitation Association in Bethnal Green, a unit which has rehabilitated many patients thought unsuitable for training schemes provided by the Government. The need for such a Unit in Waltham Forest was quickly recognised. The Borough Social Services Committee has now approved in principle plans for an Industrial Unit in Waltham Forest. Much of the initial cost of this project will be met from charitable sources. Under the Urban Aid Programme, the Home Office has guaranteed 75% of £1,000 per annum for a period of five years towards the running costs. This new Unit, which will be situated next to the Day Centre would enable more patients to prepare for a return to employment and a useful role in the community. We look forward to reporting next year a success similar to that achieved by the Day Centre. Number of People attending Day Centre in the 12 months ending December 1970:- Home address: EI7 - 34 EI0 - 13 Ell - 6 E4 - 8 Other - 15 76 = 6,377 attendances. Average daily attendance. Movement of Members:- 10 returned to work 9 able to manage at home 4 transferred to P.R.A. Industrial Unit 3 moved away 2 died I returned to hospital 47 on register at 31st December, 1970 76 SCHOOL HEALTH SERVICE Although 1970 can be remembered as a time of improving Child Health it will also be remembered as a time of long periods of ill health involving one quarter of the entire Waltham Forest medical staff and resulting in extra work for some of the healthy ones. The return of one member half-way through the year to part-time work was followed by Dr.Eirwen Harrison experiencing increasing difficulty in carrying on working, followed by her much regretted death and temporary closure of the Audiology Unit. Shortly before Christmas another Medical Officer became acutely and extremely ill and at the time of writing is still very ill. It has been said that doctors and nurses meet so many germs in their work they do not get the usual minor illnesses. We appear to have proved this point. Every effort was made to ensure that the work suffered as little as possible from the shortage of staff and the lack of the usual continuity. The Health Department is fortunate in having staff in the Child Health Section (administrative and professional) who worked in the previous departments for many years and have continued with newer staff to give a comprehensive service. Some members of staff - 17 - have been working in the same area for 10-15 years getting to know the families and their problems well. As each clinic is comparatively self contained, each is responsible for the supervision of the welfare of the children in that area from birth until school leaving age unless a child attends a school in a different area. Both these factors provide valuable continuity in the School Health Service where schools and clinics tend to regard the other as "our clinic" or "our school" with a happy relationship existing between the two. Staff who have been working for many years in the borough are able to look back over the past decade and see that during that time there has been a gradual change in emphasis in the work with children. There has been a gradual change from seeing that the child is healthy, through the stage of finding defects as young as possible, to seeing that the child is developing normally and, if not, finding the cause and if possible the treatment. This is Developmental Paediatrics and true preventive medicine. We would still be concerned if wee Jamie was losing weight and had a sore throat, but far more attention is now given to whether he is able to lift his head or use his fingers correctly at the normal age. This has meant special training for the staff and has added, not only to the interest of the work, but has made it more exacting and heavy. At birth some babies are found to have congenital abnormalities. In 1970,73 were found to have defects apparent at birth. 3 I of these are minor defects such as birth marks which cause no handicap and disappear without treatment. About 25 will respond to treatment leaving no handicap. About 11 would be expected to cause no serious defect, but 6 would be expected to require special help all their life. Not all congenital abnormalities are apparent at birth and appear later. These also are noted in the At Risk and Pre-School Handicap registers and receive the necessary supervision and help. Those apparent at birth are notified to the Department of Health providing not only statistical information but would serve as an early warning system if there was an increase in the total number of one defect. Investigation could then provide information regarding a possible causative agent. The handicapped and potentially handicapped children are specially watched during the pre-school period so enabling a fuller picture of the child to be available at school. Many by school age already having experience of attending a Day Nursery or Play Group. The parents are also able to know what facilities are available well before school age. Infants and toddlers continued to attend the appropriate clinics in large numbers so the Medical Officer already knows many children and families well on their admission to school and the time for their child's first statutory school medical examination. All children are seen during their first year at school and many are found to be perfectly healthy. Others with defects are referred for treatment and observation. With the improved standard of health it was found that the majority of children at the 9-10 year old medical inspection were healthy so when Waltham Forest first came into existence it was decided to continue the Leyton method of selective medicals for a trial period. After scrutiny of a comprehensive questionnaire completed by the parent, the results of hearing and vision tests carried out by the school nurse, perusal of medical records and discussion with the Head Teacher and Class Teacher, varied time was allocated to children selected on a basis of being in most need of the attention of the Medical Officer. Attendance of parents at the medical examination has been very good. This has not reduced the total time spent in a school but after four years we are satisfied that this is a more advantageous way of using the available personnel at this age group. All children are seen before they leave school and at this time future plans are considered in the light of any physical defect. - 18 - Children with handicaps are seen more frequently by medical officers, and as the visits to the Special Schools are nearly every week each child becomes well known. Unfortunately, as a result of sick leave, only two of the special schools received regular visits in 1970. The opening of the Grosvenor House School has filled a very great gap in the provision for handicapped children in the Borough. Not only has it provided better premises and facilities for the children who were previously in the Junior Training Centre, but also Special Care Units for the even more handicapped children. Some of these will always lie in bed with full care carried out by others. Others will make slow progress and perhaps learn to walk and feed themselves; some might attain more, but none can gain higher skills than they are capable of attaining, and no-one can attain more than their highest in every group. Our aim is to give what skill we have to help them to attain it. Dr.G.Richards, Senior Medical Officer for Child Care Audiology Clinic The illness during the year and finally the death of Dr.Harrison, apart from the sense of personal loss to all of us, was a severe blow to the Audiology Service which she had pioneered and developed. It has now ceased altogether until her successor is able to start it again. School Dental Service Mr.G.P.L.Taylor, the Principal Dental Officer, writes:- There is little significant change in the general pattern of dental treatment carried out by the department, to that of 1969. However, again, I am glad to report that there was an increase in the number of fillings in permanent teeth and a fall in the number of permanent teeth extracted. In this connection it may be remembered that a fair proportion of permanent teeth are extracted for orthodontic reasons and not because they are decayed beyond repair. There is one figure that does show a marked increase, and that is in the number of courses of treatment completed. This is a step in the right direction. I regret to say that less dental inspections at school were carried out in 1970. This is due to the constantly changing staff position. While we recruited one full time officer in August, we shall lose another early in the new year. So, we shall still only have one full time dental officer in addition to myself. An endeavour will be made to increase inspections in 1971. There was little change in the number of children under school age treated, but a slight increase in treatments of expectant and nursing mothers. The dental laboratory has been fully occupied, with a slight increase in dentures for the general dental service, and a substantial increase in the ear moulds for the deaf children at Hawkswood School. I understand that this system by our technician provides a quicker and much less expensive service than the former method of waiting for treatment at and travelling to the Nuffield Centre at the National Ear, Nose and Throat Hospital in Grays Inn Road. FIELD WORK SERVICES Environmental Services Delegated Powers. In 1969 the Council decided to delegate certain of their powers to the Chief Public Health Inspector. This delegation came into full operation during 1970 and included such items as the service of statutory notices under the provisions of the Public Health Acts in respect of the abatement of nuisances, the remedy of defective drainage and defective sanitary appliances, and for information as to the ownership and occupation of premises. - 19 - Powers were also delegated under the provisions of the Food and Drugs Act, the Food Hygiene Regulations and the Food Hygiene (Markets Stalls and Delivery Vehicles) Regulations. These delegated powers were in respect of legal proceedings for sale of unsound food and for non-compliance with the above Regulations. Delegation was also given in respect of the issue of licences or registration for premises used for the sale of ice cream, milk, pet animals. Also delegated was the power to issue licences or registration for premises used as animal boarding establishments, hairdressers and in respect of food hawkers. Full use has been made of these delegated powers, and this has resulted in a speeding up of the work as it is no longer necessary to wait for a meeting of a Committee before the appropriate action can be taken. Statutory notices can be served at any time and the various licences can be issued at very short notice. Under the provisions of the Clean Air Act power has also been delegated in respect of approval of proposed fireplace conversions and the payment of grant on completion of the conversion, in smoke control areas. Clean Air Act, 1956. The department continues to co-operate with the Ministry of Technology in a national survey of atmospheric pollution. There are three sites where measurements are taken in the Borough. Action in respect of smoke control was partly reduced during the year due to economics in cost and to a shortage of solid smokeless fuel. The Ministry of Housing and Local Government confirmed the Councils No. 16 Smoke Control Order but the Council decided to alter the date of operation from 1st November, 1970 to 1st November, 1971. There are at present 23 smoke control areas in full operation in the Borough. Due to the shortage of solid smokeless fuel the Ministry of Housing and Local Government suggested to local authorities that they may consider the suspension of 40% of their smoke control areas. The Council considered this matter and decided not to suspend any smoke control areas at present, but to delegate powers to the Chairman of the Health and Welfare Committee to suspend any areas as considered necessary. By the end of the year it had not been found necessary to suspend any of these areas, sufficient supplies of solid smokeless fuels being available. A small number of smoke nuisances have arisen in respect of discharge from factory chimneys, these have been investigated and appropriate action taken. Noise Abatement Act, I960. Several complaints of noise nuisances have been received, these vary from barking dogs to noise from factories and from amplifiers. Various methods of noise abatement have been carried out and these include, the removal of the noise source, the reduction of the noise level, screening the noise source, absorbing or modifying the noise. Every noise problem has its own peculiarities, and each one must be dealt with under its own special circumstances. Offices, Shops and Railway Premises Act, 1963. There were a small number of new premises registered during the year. Inspection of a large number of premises were carried out, a number of defects were found and these were remedied by either formal or informal action. - 20 - Accidents continue to occur in registered premises, these fortunately are minor in character, but each accident is investigated and action taken to prevent a recurrence. In the field of housing. The year was notable in that for the first time the principle of improvement and repair of houses was made sufficiently attractive to house owners to encourage serious attempts at modernisation of their properties. The legislation was, of course, the procedure prescribed in the Housing Act, 1969 which enabled the substitution of Regulated Tenancies for Controlled Tenancies in certain defined circumstances, thereby giving landlords the incentive of higher rents for improved dwellings. Thus there is now a two pronged attack on the housing problem; firstly the demolition of unfit houses which have reached the end of their useful life, and secondly the new policy of encouragement to improve and repair dwellings to a reasonable state of maintenance where they have a suitable life expectation. The programme for the replacement of unfit dwellings proceeded according to plan during the year when Stage III of the Cathall Road Slum Clearance/Redevelopment Scheme covering an area of some 8 acres was confirmed by the Ministry of Housing and Local Government (now renamed the Department of Environment). Local Public Inquiries in respect of Sidmouth Road, E. 10 and Markhouse Road, E. 17. areas were conducted during the year; the former received Ministry confirmation by the end of the year. The Sidmouth Road area adjoins a General Improvement Area and the sites of most of the unfit houses are scheduled to become a recreation space which will provide a much needed environmental improvement to the area as a whole. It is pleasant to record that the Council opened two show-houses within this General Improvement Area, thus demonstrating to the public the practical benefits of the modernisation of properties. The number of visitors to these dwellings well justified the efforts of the Borough Architect's Department. It should also be recorded that the Markhouse Road, E.I7. area is the first scheme to be adopted which deals both with clearance areas and also with an adjoining area of houses which, in the opinion of the Council although not unfit for habitation, have passed their useful life. This combination of powers under Parts III and V of the 1957 Housing Act may be the forerunner of similar proposals to bring obsolescent areas up to standard by way of urban renewal. So far as improvement of properties by way of repairs and provision of amenities is concerned, sound, indeed hectic, progress has been made during the year. In spite of a slow start during the early months a total of 1,294 applications were received for Qualification Certificates or Certificates of Provisional Approval. As the majority of applications have necessitated at least 2 visits to each property, this has involved the Public Health Inspectorate in considerable work which has had to be carried out in addition to existing duties and without additional staff. To qualify for regulated rent, houses must possess all 5 standard amenities of sink, bath, wash-hand basin, hot water supplies, and internal W.C.; they must be in good repair having regard to age, character and locality, and must be in all other respects fit for habitation. Good repair is a variable state, and standards adopted in one locality may not be reasonable in another area of different character. This work therefore calls for judgement based on experience as well as sound technical knowledge. The new financial inducements contained in the 1969 Housing Act present owners and Local Authorities alike with an opportunity to rehabilitate those dwellings which have been let at rentals insufficient to secure proper maintenance and which in the past have been doomed to creep into obsolescence. - 21 - It may be apposite to consider how far improvements carried out now will reduce the need for clearance in the future. It is to be expected that the steady rise over the years in the standard of living enjoyed by the general public will continue through the years to come. Indeed, I am tempted to say "the inevitable rise", so accustomed have we become to our bigger and better cars, electrical gadgets and foreign holidays etc. In only one major sphere of their lives can many of our fellow citizens look about them and see virtually no improvement in their standard of life; that of housing. But this situation is no immutable law of nature. The younger and more affluent sector of our citizens will tend to drift away in their search for houses to satisfy their rising social standards. This is the true urgency of the Boroughs housing problem. The solution lies in the implementation of a policy at national level to give even greater impetus to the improvement of existing houses and urban renewal. Health Visiting The case for unification of the National Health Service is now widely accepted. We realise that sick and disabled persons should be cared for in the community unless it is essential for them to receive the type of treatment and care which can only be provided in hospital. It follows that the community services cannot be considered in isolation as they are interlocked with the general practitioner services, providing a new dimension of community practice in all branches of nursing and medicine. Neither hospital nor community practice in either discipline can meet the requirements of today if they are divided, and it is towards the realisation of this philosophy of an integrated service that we have turned our attention during the last year. Change should not be rapid but built up on solid foundations. We have taken the following steps towards achieving this aim:- Working in Close Co-operation with General Practitioners Health Visitors working closely with general practitioners are involved, to a greater degree, with the whole family as a unit so mental, physical and social breakdown can be detected and treated in the early stages. A good deal of work is being done in the sphere of screening and immunisation, not only against diphtheria, whooping cough, tetanus, vaccination against smallpox, but also thirteen year old girls are being immunised against rubella. Some general practitioners and health visitors have special interests, e.g. Obesity Clinic where most patients are referred for medical reasons, including all age groups and now also school chiIdren. Hospital Liaison This work continues to expand and the gap between home and hospital is narrowing. Langthorne Hospital A health visitor visits regularly one morning a week to discuss cases with the medical and social work team. In a considerable number of cases a hospital discharge notification to the health visitor is sometimes the first introduction to a family or elderly person in need of services. When an elderly person has been admitted for rehabilitation to the hospital it would be a waste of effort on the part of the hospital staff if therapy was discontinued after discharge home and the health visitor is in the ideal position to see that the patient receives the necessary services. In this way deterioration and re-admissions are avoided with the support of the community services. Often a health visitor works with the relatives and supports them in coping with their elderly relatives. - 22 - When an elderly couple have been separated by illness and admission to hospital the spouse left at home can be re-assured and supported, especially where age and disability make frequent visits to the hospital more and more difficult and help may also be given through statutory and voluntary agencies. Claybury Hospital In the present time when there is so much public concern over mental health, the liaison between the health visiting staff and Claybury Hospital is of great benefit to all concerned. The essence of this liaison is the participation of the health visitor in the group therapy meeting and her presence at the following staff meeting. These meetings take place on Tuesday mornings at Claybury. The health visitor attends the group therapy on N.I ward where the patients are encouraged to talk about their problems and difficulties. Those who, because they are introverted or because of their illness or for other reasons, find communication difficult just listen, and benefit from hearing others discuss their problems and are reassured that there are others experiencing the same or similar difficulties. Following the ward meeting there is a staff meeting, this consists of the professional staff attending the ward meeting. Treatment, progress and aims are discussed and comments are invited from all present. Information is exchanged between the hospital staff and those workers from the community. The health visitor participates fully in all aspects and is made very aware of the latest mental health problems and treatments, and passes on information to other health visitors which will be of assistance in dealing with their families with mental health problems. Whipps Cross Hospital An interesting and rewarding aspect of the Health Visitor's work is the continuation of liaison that has been established between the health visiting staff and several of the local hospitals. This is extremely useful for the passing on of information received from the hospital about a family to the appropriate health visitor and the feed back of information from the health visitor to the hospital. This liaison is well established at Whipps Cross Hospital, where twice a week a health visitor participates in the consultant paediatrician's round on Margaret and Edward Ward. The health visitor plays an active part in these rounds, as Dr.Hinden (the consultant) will often ask for social and domestic information on a child being treated, and the health visitor will then contact the colleague concerned and the information requested will be passed, within a few days, back to the hospital, resulting in a better understanding of the family and often bringing to light some difficulty of which the hospital was not aware. This is extremely helpful especially in cases of battered babies where Dr.Hinden will often call for a conference between the medical staff, the health visitor, Children's Department and N.S.P.C.C. to establish facts and work out a course of action for when the child concerned is fit for discharge. At the same time the passing on of the information of a child's stay in hospital to the health visitor will help to a greater awareness of those children 'at risk', such as the baby with a feeding problem, or the immigrant child with a deficient diet, or the family with a mentally or physically handicapped child that will need extra support, in fact everyone concerned benefits from this liaison scheme. - 23 - Thorpe Coombe Maternity Hospital The health visitors continue to attend the admission clinic regularly. The advantages to the mother and hospital are great. The mother is less apprehensive, she has a chance to discuss some of her problems in private with the health visitor and the medical and nursing staff may be saved time if the health visitor can sort out a problem before the actual examination or admission. The mother who is worried about the care of her other children whilst she is being delivered in hospital may often refuse admission because of this worry and the health visitor will be able to help her so that she may be able to cope with the many problems of family life. It was felt that many young mothers were discharged from hospital and as their own mothers or relatives were not living nearby they found it extremely difficult to cope. It was therefore decided to hold group discussions in the hospital with the mothers a day before discharge from hospital. This group is attended by the sister from the hospital and a health visitor. The mothers have an opportunity-to discuss their individual problems and advice can be given on how to handle the baby and infant feeding. It is in this informal atmosphere that the health visitor can help the mother overcome many anxieties that she may have about her inability to cope with a young baby on her return home. We continue to hold three monthly meetings between hospital, midwifery and health visiting staff, which are very successful in discussing mutual problems, to undertake in service training and thus to bridge the gap between hospital and community services. Child Development Sessions Eleven sessions are being run weekly in Health Centres and Maternity and Child Welfare Clinics, for children who are referred by doctors, psychiatrists or health visitors. The majority of the children admitted are in the age group between three and five years and suffer from the following defects:- 1. Speech difficulties 2. Hearing defects 3. Asthma and bronchitis 4. Vision defect - Glaucoma 5. Mentally retarded - some are admitted before attending Grosvenor House School 6. Mongols 7. Clumsy child syndrome - poor muscular co-ordination and speech difficulties -? brain injury 8. Hare lip - cleft palate 9. Autistics 10. Hemiplegia I i. Diabetes 12. Mother had rubella during pregnancy. Child has congenital heart defect, cataract, delayed speech and needs hearing aid 13. Spina Bifida We would like to expand the sessions in the following year. The clinic doctor, health visitors and nursery nurses caring for the children meet regularly with the psychiatrist to discuss the children's progress and problems. - 24 - The two Play Groups for the mentally handicapped children continue to meet weekly and these children are being cared for by voluntary workers. However, the health visitor may be able to help these mothers by giving them an opportunity to discuss their money problems and being readily available for advice. Mothers' Clubs These continue to meet monthly, one in the afternoon, where two school girls regularly assist with the care of the children, and one in the evening. The programmes for both these clubs are varied and cover a wide range of interests, such as cookery, flower arranging, discussions on current problems including social problems, a talk and questions being answered by a member of the Parks Department on problems in the garden, and several very successful social events, including a cheese and wine party to which husbands were invited. Outings are also arranged where groups of mothers and children went to the London Palladium and thoroughly enjoyed the pantomime. Rent Arrears The health visitors have continued during the year, working in close liaison with the Housing Department and the Social Work agencies to prevent the breakup of families within the borough. Perhaps one of the most significant points arising from this year's figures, is the number of one parent families (in these cases the one parent being the mother) who are finding it very difficult to cope with their financial problems. Year Notifications to H.Vs for investigation Discussed at Co-Ord. Committee No. of one parent families 1970 753 237 81 This figure shows that slightly more than I in 10 is a one parent family. Home Nursing and Midwifery The district nurses paid more visits than ever before and there was an increase in requests for care for the over sixties. The attachment schemes &ith General Medical Practitioners and General Practitioner Obstetricians continued to develop and show beneficial results in better standards of patient care. The nurses, midwives and doctors work well together; there is more enthusiasm and a greater sense of achievement for all workers. Good co-operation exists between the Hospital services and the Local Health Authority services and the work of the liaison officer is of great benefit. In the domiciliary midwifery service the number of home confinements decreased slightly in 1970, and this was counterbalanced by an increase in the number of patients discharged early from hospital and cared for in their own homes by the district midwives. The relationship with Thorpe Coombe Maternity Hospital is very good and the midwive are anticipating an even closer relationship when they will be permitted to take their patients into the hospital for delivery under the care of the domiciliary team. The provision of sterile supply by Whipps Cross Hospital for the maternity requirements of district patients is most useful. - 25 - Good progress was made in training for the National Certificate in District Nursing and all candidates were successful in the examination. Recruitment for the Part II Midwifery Training School was good and some eighty pupil midwives passed through the School. Social Workers Progress was made during the year, in spite of one frustration after another in the social work field. During the year the second Area Team was set up in St.James Health Centre and a system of out of hours duty Welfare Officers introduced - a system whose only merit was that it was better than the previous system. While on the Mental Health side there is a well recognised system of statutory officers under the Mental Health Act, on the Welfare side, where the problems are diverse but homelessness predominates, the system is not so welI recognised. In the situation which existed in Waltham Forest in 1970 where social workers were relatively few (and a number of those had a restricted area of experience) the difficulties of finding an off duty system acceptable and workable with the right people to serve on it proved almost insuperable and took up a disproportionate amount of senior staff time. The Second Area Team was a signal step forward simultaneously relieving pressure on the facilities available at the Leyton offices. There is no doubt that the Area Team concept, further strengthened in due course by Child Care Officers, has a great deal to offer in making a worthwhile impact on the needs of the community in which it is centred. Welfare Catering Food Preparation The Alice Burrell Kitchen produces between 650 and 700 meals daily. A number of these are supplied to Grosvenor House School, Training and Work Centres, but the kitchen primarily exists to help the aged and most of the meals cooked are delivered by the Mealson-Wheels Service or consumed at Luncheon Clubs. Until the end of 1967 the Alice Burrell Kitchen was unable to supply more than half our requirements and the remaining meals were supplied by the School Meals Service. Following the closure of the School Kitchens during school holidays other arrangements became necessary to deal with the needs of the department. Deep frozen cooked,or partly cooked, products offered by a number of commercial firms were tried for an experimental period and the important fact was brought to light that by using this method of catering all the existing un-met needs of the department could be provided for from the one kitchen. From the point of view of improvement in production capacity, the introduction of frozen and convenience foods has been an unqualified success and the potential output has increased from approximately 400 to 800 meals per day. There have been other advantages. Good cooks are hard to come by. The techniques of handling frozen foods in the kitchen are straight forward, requiring staff to follow relatively simple cooking instructions regarding oven temperatures and time. As a result a good quality product can be achieved by staff who do not possess the highest degree of cooking skill. However, the Cook-Supervisor does need to have catering knowledge and organising ability. It is not a simple matter to plate and pack so many meals in so small a kitchen by 11 o'clock in the morning when delivery commences. Another advantage concerns costs. Detailed reports have been submitted on several occasions to the Health and Welfare Committee on this aspect and the one point to be made now is that because every ounce of food purchased can be served on the plate, i.e. no preparation wastage, costs can be controlled fairly precisely. In this regard the application of normal management skills is more important than the possession of specialised catering knowledge. That is to say that cost control is exercised from the office rather than the kitchen. - 26 - Meals-on-Wheels The very first meals-on-wheels were produced by an inspired member of the Women's Voluntary Service in the Second World War, and taken down the road on a pram, and one imagines without the slightest knowledge that a nation-wide service would grow from these small beginnings. The W.R.V.S. are still very active in this field wherever the membership and organisation is strong enough to support a voluntary service. We count ourselves fortunate that in the northern part of the borough the W.R.V.S. staff a small kitchen and completely run a meals-on-wheels round on our behalf. In many ways this is the ideal arrangement. Individually prepared meals can of course be made to look more attractive and because the kitchen is placed in the centre of the area it serves delivery times can be kept shorter. Local authorities who can depend on the W.R.V.S. to man a series of such kitchens throughout the area of their responsibility are indeed fortunate, but in a situation where staff need to be employed and paid,the cost of the enterprise must be taken into account. It is more economic to produce the maximum number of meals from as few kitchens as possible. Although by far the greater part of the meals-on-wheels service is organised and the work undertaken by members of the staff, invaluable help is given by a member of volunteers who are not affiliated to any particular organisation. At the time of writing this report there are 50 volunteers who accompany the drivers and deliver the meals to recipients. Many of these devoted people have been doing the work for a long time, one for 28 years, and as they grow older and decide to "retire" it is quite a problem to recruit replacements. Time after time in the last year or two the service appeared to be on the point of collapse owing to lack of volunteers, but usually the vacant spaces on the rota have been filled at the eleventh hour and sometimes members of the staff have been detached from their ordinary work to fill the gaps. On occasions the Social Responsibility Centre has been able to supply volunteers in an emergency. This organisation provided a succession of volunteers with private cars during the strike in the Autumn when local authority transport was not available and thanks to this magnificent effort not a single old person failed to get their mid-day meal during the six weeks of the dispute. Luncheon Clubs Volunteers also assist at some of the Luncheon Clubs, of which there are six in various parts of the town. The Meals-on-Wheels Service provides for the housebound, but the Luncheon Clubs are intended to serve the senior citizen who is lonely and socially isolated. For many such people the visit to the Luncheon Club is often the focal point of the day. The membership of one of the Clubs was analysed recently, and the results are interesting:- Total Membership 67 (men 31) (women 36) Of this total: 49 are widows or widowers 16 are single members I married couple Age range of members 70-92 years (3 special exceptions who are younger) - 27 - Known disabilities:- Mental Illness 8 Physically Handicapped 3 Epileptic 2 Registered Blind 2 Thirty five members have a dinner each day. The attendance of the remainder varies from once to four times each week. Objectives The aim of the Welfare Catering Service is to supplement the diet of the elderly and handicapped to enable them to live independent lives in their own homes, but much remains to be done if the objective is to be reached. The number of retired men and women continues to grow but there has been no development in the size of the service for a long time. When the financial resources are available to permit expansion these services should receive high priority. Research carried out in 1965 into the dietary of elderly women living alone, concluded that domiciliary and club meals are of great potential value but should be provided four or more times a week in order to have an effective influence on the total dietary standard. These findings were echoed during 1970 by a circular issued by the Department of Health and Social Security, which drew attention to the fact that Meals Services make a significant contribution to nutrition only if they ensure to the consumer at least five hot main meals a week. Many of our elderly people are receiving meals only twice and three times a week and some not at all. Additional rounds will be necessary if we are to achieve the desired standard. No meals at all are provided at weekends and a better standard of service would be given if we could reduce our existing rounds from 50 to 40 recipients. Luncheon Clubs are provided in premises which, although adequate, can be somewhat cheerless in the depths of winter and in any case would be much better associated with Social Clubs such as the Alice Burrell Centre, where comfortable facilities exist for relaxation T.V., Cards and Billiards. However, much has already been done and it is interesting to recall that a substantial part of the service described has been developed in the five short years since London Government was re-organised in 1965. Health Education Health Education is one of the primary methods of preventive medicine, but much research is needed to devise the most effective techniques. One of the main problems today is to discover why people of all ages, knowing the danger of smoking and drugs, still persist in dabbling, often to their decease? Considerable quantities of leaflets are handed out, posters displayed and lectures given, but are we getting any nearer solving the problems? Cases come to light of persons who, realising the dangers, have turned the corner to a better and healthier life, but this is just skimming the surface, what about the hard core? Do people care?, are we becoming fatalists, "what has to be will be"? Nevertheless we must press on and upward on the hard path of reality, the older to take more interest in the young, teaching not only by word of mouth but by example. - 28 - Take smoking for example, how many times do we hear of parents offering cigarettes to their children, saying "well of course he will come to it one day", and the little shops near to a school selling single cigarettes to the school children, thinking more of the monetary gain than health values, what chance has an anti-smoking project at the school? There are also too many tablets available for all types, and the parents who, in front of the children, refer to them as sweets? Here again the child is brought up in an atmosphere of tablets, and again the people who must lean on something, turn to tablets instead of facing up to life, tackle the problem in the right way and make themselves stronger for the next one. Here health education can assist in numerous ways. A great deal of health education work is carried out by our own staff, especially Doctors and Health Visitors by means of talks and lectures at clinics, schools and other organisations using films, filmstrips and slides together with leaflets and poster displays, using some of our own material and some hired from specialist firms. A fair amount of health education work is carried out at a number of schools, using their own staffs, but one would like to see all schools doing this work, in fact the time has come when it should be included in the curriculum. Some schools are very keen and have Health Weeks and Projects on a specific subject, the Health Education Officer is often approached for information and advice on planning and assistance. There is a dearth of good material of all types, (films, filmstrips, slides, tapes, leaflets, posters etc.) which quite often means that our own staff have to produce material. Sometimes this is to our own advantage as it fits our specialised requirements. We cannot, of course, carry a large stock because of storage problems and this necessitates hiring from specialist firms which can be quite expensive. Health Education has so many deeply entrenched evi Is and dangers to overcome that progress is necessarily slow: but leaders of public opinion are increasingly becoming aware of its value, and of the need ultimately to save money by making more manpower and equipment available now to obviate expensive treatment of addictions and preventable diseases later. SPECIAL ARTICLES ST.JAMES' HEALTH CENTRE Continuing the Council's long-term policy of Health Centre Development in the Borough, the third such building to be erected since 1965 was opened in September, 1970. The site is at the junction of Markhouse Road and St.James' Street, Walthamstow. This is a main bus route and the Health Centre is in close proximity to the local railway station. It was with the knowledge of proposed redevelopment and the effect it could have upon the practices and surgery accommodation of a number of general medical practitioners working in the area, together with the need to replace an existing but old and inadequate Health Services Clinic in Markhouse Road, that led to the decision to erect a Health Centre in the locality. - 29 - The building has two floors providing consulting room accommodation for seven medical practitioners and one Departmental medical officer on the ground floor. A departure has been made from the usual practise of providing examination rooms adjoining the consulting rooms. Instead a total of twelve rooms, all of which are similarly equipped, is available and these can therefore be used alternatively for consultations or examinations or by various other personnel at the Health Centre who have need of a room at times for consultative purposes. Incorporated in the consulting room area is a treatment room for dealing with patients referred by the medical staff for dressings, injections, minor injuries, blood tests, etc.and also a room equipped with an operating table and light and anaesthetic apparatus in which minor surgical treatment can be carried out. There are two rooms for chiropody treatment and the Council also provides facilities for Infant Welfare Sessions, Toddlers Clinics, Ante-natal Relaxation Classes and Immunological Sessions. Office accommodation for groups of Social Workers, Health Visitors, Home Nurses and Midwives is provided on the first floor and there is also a flat for the resident caretaker. The staff of clerks, receptionists and telephone operators attached to the Health Centre who serve the needs of the general practitioner service, and the local authority services are controlled by an Administrative Assistant in Charge. All these persons are employees of the Council and a proportionate charge for the work they perform for the general practitioners is reclaimed from the North East London Executive Council, together with appropriate amounts for caretaking, cleaning, lighting and heating. After 41 very full and active years the services and staff of Low Hall Lane Health Services Clinic moved in September to a brighter future more in keeping with the 70's in this new centre. Most of the modern services were tried out in the old surroundings but were hampered by poor facilities. The move came at a good time to develop to the full all the advantages which could accrue from the 'Seebohm era*. Liaison with General Practitioners started in the mid 50's in this area with one Health Visitor and one group practice once a week - this was extended to three practices over the years but distance and the difficulties of telephone contact limited its usefulness. A modified GP/HV attachment scheme started in April, 1970 in anticipation of the move to the Health Centre, this paved the way for the development of the complete attachment of 2 Health Visitors from September. The situation where clients can see Doctor - Nurse Health Visitor and Social Worker within one building and without lengthy delays in contacting or travelling to them, improves the service so much for all concerned in it. We look forward to the time when all practitioners using the centre can have this attachment. Half the areas families are registered with general practitioners not in the centre. These families use the accessory facilities fully and 2 Health Visitors serve them. It is probable that their numbers will fall somewhat in the future when those families moving into new housing projects find travelling long distances back to their previous doctors impractical. The increased telephone provision means not onlythat Health Visitors are more easily contacted by colleagues; Social Workers from many London Hospitals as well as local ones, Voluntary Societies etc., but the families are often saved time, worry and a journey by more immediate contact themselves. - 30- The availability of dual purpose rooms for Infant Welfare Sessions affords the opportunity for private consultation, so lacking in the old premises. This allows more freedom for mothers to discuss personal and family difficulties, and advice given, away from the clamour of a busy clinic, is more readily understood. The provision of a beautiful self-contained children's unit with full toilet facilities and safe outdoor play area, has enabled the Development Sessions to continue. Future plans for extra sessions in addition to the hoped for expansion of facilities for under 5's in Play Groups and Nursery Classes, should go a long way to overcome the natural deprivation of young children in our community. The new building being flexible in design lends itself to subdivision for small groups for film shows and discussion. These will be much enhanced by having varied members of the team to take part in them. Already planned, and in operation:- Ante Natal and Mothercraft Classes Short courses for mothers of first babies Mothers with toddlers The staff co-operating with the Medical Research Councils Units into such subjects as Sleep difficulties in toddlers, and carrying on the usual varied clinic and visiting service to the community. The social work team, comprising a team leader, three full-time social workers, a welfare assistant, a trainee and a full-time support clerk, moved out from Leyton Town Hall to the newly-built St.James' Health Centre in September, 1970. This was the first group of social workers in the borough to work in such close proximity with a Group of General Practitioners. The advantages of accessibility for all concerned has become apparent. Close contact with G.P.'s., health visitors, district nurses, chiropodist and administrative staff was established very early on and is maintained by frequent meetings in the Centre, which include case discussions. Information about people making use of the Centre is easily collated by the staff involved, thus effecting the maximum use of knowledge and skills for the benefit of the patient or client. When the team is completed as the Seebohm Report envisages, it will be responsible for all the social work needs of the area. From a social work point of view the ability to discuss common problems informally with professional staff from other disciplines within the Centre has enabled a sense of common purpose to emerge, and it is hoped that the Health Centre will become a real focal point for the exploration and development of community needs. FOOD FOR HUMAN CONSUMPTION The purchaser of any food has a right to expect that the food shall be safe for consumption by him. All types of processed food should have been prepared from uncontaminated food and under proper hygiene conditions. Prosecutions taken in very bad cases of food contamination such as bandages in food, beetles in bread, dirty milk bottles etc., should be given sufficient publicity to impress the public that the necessary steps are being taken by the authority to safeguard their food. - 31 - Should a serious outbreak of food poisoning occur the publicity given is out of all proportion to the public health significance, in actual fact this is a good thing. In recent outbreaks of typhoid fever this has been traced to bad processing of the product overseas and the bad handling in the shops in this country. The consumer believes that the fitness of food is related to the age of that food, this does apply in certain types of perishable foods, but again this depends on the storage and to certain extent the method of production. The purchaser of food often agitates for the date of production to be stamped on the food package. If this was done the purchaser would always take the food with the most recent date. This difficulty may be overcome by stamping on the food container "this food must be consumed by a certain date", instead of the actual date of production. Another suggestion is that the food should be date stamped in a code that is understood by the retailer and by the local authority. With respect to the factory production of food there is little comment by the consumer, he reserves his expressions "dirty" and "filthy" to the actual conditions he can see in the shop. A number of surveys have been made in respect of the conditions of food handling in shops and these have shown that these are very low. There have been improvements since the coming into operation of Food Hygiene Regulations in the provisions of equipment for the storing and preparation of food and for the personal cleanliness of the person serving the food. There still remains the human element, this might include such things as sneezing over food, licking of fingers, before picking up wrapping paper, handling of dogs and cats and scratching hair. This may all be visible to the consumer. This may or may not apply where food is prepacked in preparation rooms out of sight of the consumer, as better supervision may be possible. It all depends on the personal standard of hygiene of the food handlers. The raising of the standard of hygiene will take time. The public may be more ready to complain when they see bad handling of food, but there is still a great need for more frequent inspection of premises and advice from public health inspectors. Cleanliness of shops is always considered important by the consumer, there are very few consumers who will purchase food from dirty shops. It is only education in food hygiene given to todays young people which will improve the peoples standards of cleanliness. Courses of lectures in food hygiene were set up by one of the public health associations, these were for food handlers, but they had to be discontinued through lack of attendance. The consumer has a right to be informed about the food he purchases, he may require to know the source or origin of the food. Much of the present day food is prepacked and the consumer has no way of examining the food before purchase. There are few guides to assist the purchaser to judge the article of food, there may be no informed assistants available to answer questions and if the product is new to the purchaser the only guide may be the label. For a consumer a label has to give information about the product and its use, for the manufacturer it has to sell the product. The demands made by either side can become excessive and then conflict arises. The manufacturer would want to include on the label a picture which would show the product to the best advantage, and by law the label may have to show a list of the chemical names of all the ingredients. These two items may cover the whole of the surface of the wrapper and give practically no information of value to the purchaser. The consumer is often prepared to accept the terms "pure" and "fresh", these are very vague and cannot be considered as satisfactory. With reference to tins of meat one housewife said "this must be the best as the label states it has been passed by the Ministry of Agriculture", - 32 - another stated, "this is the best, the picture of the meat is much better". One housewife stated with reference to pork luncheon meat and chopped ham and pork, "I do not see why they should have different names if they all taste near enough the same". Information on labels is not much use unless consumers can put it to work and before they can do this they must be told what it is all about. Most consumers rather like their food packages to have glamorous labels, they do not object to these being exaggerated and they are also in favour of having glamorous words on the packs. In the midst of these conflicting desires protective legislation has to be considered, this may be dealt with under the headings of quantity and quality. Under the provisions of the Weights and Measures Act certain household products have to be sold in specified weights. This list should be increased, in particular to include biscuits and similar foods. The purchasers think they are getting ½lb packs when in fact these may range from 5oz. to ½lb. It is almost impossible for the purchasers to work out unit prices unless he is a genius at mental arithmetic. A suggestion has been made that this could be overcome by stamping on each package a unit price. This would involve considerable difficulty as prices are normally marked by the retailer. The check on quality is the list of ingredients shown on the label these are listed in the order of quantity and this should be stated on the label. As an example a tin labelled meat and gravy should show first the amount of meat, second the amount of gravy and thirdly the amount, if any other additions. If these items were divided into three groups it would indicate more clearly and simply to the consumer the exact contents of the tin. Where additives are present the best solution for labelling appears to be to use terms like, "with permitted preservatives", "with permitted colouring" etc. The use of the word permitted appears to act as a considerable reassurance to the consumer. Turning more to the manufacturers contribution to the production of good and clean food. The British public today spend some £6,000 million on food and more than half of this is provided by the food processing industry, an industry that has contributed significantly towards making Britain one of the best fed countries in the world. The manufacturer has been able to provide at reasonable prices, good food which will give a well balanced diet. Part of this has been done by developing technological methods of preservation that are second to none in the world. The quality of these products can be best assessed by the fact that over £130 million of them are exported each year. An industry of this size feeding so many millions of people must ensure that its products are as safe as it is possible to make them. There are few firms employed in food production on any large scale that do not employ technical advisers including chemists and bacteriologists. Many firms have their own hygiene booklets and notices for their employees independent of Ministry publications. Research within the food industry is continuous, it may be concerned with improving the same product or developing new or improved products or devising safe methods of packaging. In addition to research within individual companies the food processing industry is served by at least five research associations. All these make their own individual contribution to the food processing industry. - 33 - Additives to food are used by manufacturers where these are essential to that particular food. Food additives cost money and are normally only used to improve the quality of the food, to act as a preservative or to improve the appearance of the food, they are not used without discrimination or to disguise inferior quality. Those who criticise food additives usually do so from a basis of emotion rather than reason, they invariably refer to them as "chemicals" which of course they are. But in the same context meat, fish, potatoes, cereals etc. are also chemicals. They also claim that there are poisonous chemicals, but again many foods are poisonous but very large amounts must be consumed to cause any ill effects. Even salt will kill if enough is consumed, the same applies to food additives. The use of food additives is constantly under review and if there is the slightest suspicion of danger to health that additive is withdrawn from use. Legislation strictly controls the use of additives such as preservatives, colouring matters, anti-oxidants, emulsifiers and stabilising agents. Only permitted substances may be used, and then only in specified food and for specified purposes such as enhancing flavour, nutritive values and keeping properties. The future of food legislation. Our existing Food Hygiene Regulations will eventually require drastic improvement if better standards of food hygiene are to be enforced by law. A permit and grading system may have to be introduced, it being necessary to obtain a permit before a food shop is opened and then the premises may be graded "A", "B" or "C" after further inspection, the grading depending on the standard of food hygiene maintained in the premises. If it is considered too severe a step at present to introduce a permit and grading system, a system of registration should be introduced with power for a local authority to revoke registration. This system would allow much better control of premises and would ensure better structural conditions and better standards of equipment. W.Richards, D.P.A., M.A.P.H.I., Chief Public Health Inspector. CONTRIBUTIONS FROM COLLEAGUES THE SOCIAL RESPONSIBILITY CENTRE Contributed by Joan Payne, Voluntary Work Organiser 1970 proved to be another eventful year for us. We saw a tremendous growth in the volume of welfare work and by the end of the year we were receiving an average of 17 new cases a day. Referrals from all agencies show a big increase over the previous years figures. Calls from the Social Welfare Officers doubled. Almost 100% up on last year were calls from Health Visitors, Medical Social Workers at local and London hospitals, Mental Health Officers, Children's Department and others. Fortunately the volunteer force also continues to grow steadily. The work continues to be very varied. The emergency work which needs immediate attention can mean anything from taking care of children because mother is ill; providing transport to take a person to hospital to have a wound dressed; providing a volunteer, perhaps at two hours notice, to help at a luncheon club. - 34 - Many volunteers are involved in regular long-term work such as driving handicapped people to Roberts Hall, helping with the classes for the blind, at Essex Hall and weighing babies at the clinics. Others are needed for supportive work, - sitting regularly with a sick or handicapped person to allow a relative a few hours break. Children of unsupported mothers are collected from school, given tea, and looked after until Mother arrives home from work. There is a very great need for transport:- To take the elderly, handicapped lady to view possible new council accommodation. To take the father, with three children under three to St.Anne's Hospital, Tottenham, for outpatient treatment. To collect a small boy three times a week from Finchley and take him back to school at Loughton. To take the elderly man to a Home in Kent. To take the young man suffering from multiple sclerosis to his office until his Invacar is ready. and many others. Most journeys are local, some involve travelling to London hospitals, others involve drivers travelling as far as Clacton, Westgate and Southend. Several holidays were arranged for needy families and elderly people. Some were paid for by local Rotary Clubs and others by a Trust which allows us a certain amount of money for this purpose each year. It is encouraging to see so many young people in our schools interested in voluntary work. Last year 28 homes were decorated and the figure should be much higher this year. In most cases the Department of Health and Social Security will pay for the cost of the materials if we can find the voluntary labour. The transport strike in October presented quite a challenge to our resources. For six weeks volunteer drivers using their own cars, delivered over 700 meals a day to help keep the Meals-on-Wheels service in operation. Drivers also delivered some of the emergency sick-room equipment. Five volunteers helped at Heathcote Lodge during the Christmas holiday when the Home was faced with an acute staff shortage. This increase in our work resulted, of course, in heavily increased expenses and a large deficit in our budget. By August we had reached crisis point. To cope with the work we were faced with the urgent need to provide another telephone and to extend our office hours. An emergency meeting with the Medical Officer of Health resulted in a recommendation to the Council,who responded by making an immediate grant to balance our accounts until the end of the year and by promising substantial grant-aid for the coming year. - 35 - The need to distinguish the voluntary work more clearly from the rest of the activities of the Social Responsibility Centre and to have a separate bank account has resulted in a change of name and we are now to be known as the Voluntary Work Centre. I cannot speak too highly of the help and co-operation we receive from the Health Visitors, Social Workers and Office staff with whom we are in contact, and I feel sure that this teamwork will bring about even greater things in the coming year. MEDICAL RESEARCH COUNCIL - FAMILY SURVEY UNIT Contributed by Elizabeth Cooper, B.A. The Unit has concentrated in the last year on two main aspects of research in the Borough; the development of a family register and the study of children in the first year of school. The register continues to maintain records of families with children under five resident in the borough, and a number of families were visited during 1970. This showed the importance of the register in enabling us to contact children of this age and several studies are now being planned or carried out which make use of the register in this way. One such study is an investigation of the effect of housing and other environmental factors on the health and behaviour of young children; another study using the register is comparing the family patterns, social networks and child rearing practices of a sample of English and West Indian mothers living in the borough; in further studies the health, behaviour and development of children selected from the register is being compared with the behaviour of groups of special children, such as twins and the handicapped. The assistance of the Department of Health and Welfare and of the Health Visitors in particular is essential to the maintenance of the register and we are most grateful for the very considerable co-operation and help we have received. In the schools project the first stage has been completed and preliminary reports have been sent to the head teachers of the schools concerned. Two schools were used, an ordinary infant school and a school for educationally subnormal children. The data were collected from four sources: from the teacher's assessment of the child; from a filmed record of the child in the classroom; from the child's behaviour and performance on a vocabulary test and from interviews with the mothers at home. The data are in the process of being analysed. Preliminary results showing differences between the two schools in teachers assessments and classroom behaviour have led us to concentrate more work in schools for 'special' children and since September, 1970 we have also been examining the classroom situation within a school for maladjusted children and a unit for severely disturbed non-communicating children. We are also looking more closely at the interaction between teacher and child in the classroom than we did in the first stage. We are experimenting with the use of video tape in showing teachers themselves in action as well as giving them an opportunity to observe their children's behaviour from a distance. We are very grateful indeed to the Education Department, the head teachers concerned and to the class teachers in particular who have given us such free access to their classrooms and staff meetings. - 36 - RAINFALL AND SEWERAGE Contributed by D.M.P.Sullivan, C.Eng., M.I.C.E., F.I.Mun.E., Borough Engineer and Surveyor Rainfal I The rainfall recorded at Auckland Road Depot was 23.2 inches, excluding the period from the 5th October to 11th November when the operators were on strike. This is about average rainfall for this area. One heavy rainstorm occurred on the 6th August and caused some flooding. Sewerage Work continued on the Walthamstow Southern Area (Southern Branch) Relief Surface Water Sewer, and will be completed this spring. Work also continued on the Leytonstone Area Relief Surface Water Sewer (Stage I) and completion is programmed for the end of this year. A tender was accepted and work has now started on the Hale End South Relief Surface Water Sewer (Stage II) and this is also programmed for completion towards the end of this year. The Council approved the reconstruction of the Low Hall Depot pumping station, a tender for the pumps has been accepted and tender documents for the civil engineering and building work are being prepared. The Council also approved the Highams Sewer Area (Southern Branch) and the Leytonstone Area (Stage IIA) Surface Water Relief Sewers, the design has been completed and subject to receipt of the approval of the Department of the Environment, these will be started this year. Minor relief schemes at Old Church Road/Mansfield Hill and Valleyside were completed. The vesting of main foul sewers in the Greater London Council was finalised and the following are now so vested:- the main Walthamstow Outfall Sewer and storm tanks the main Leyton Outfall Sewer and storm tanks the Walthamstow Northern Relief Sewer the Chingford Western Interceptor Sewer the Chingford Eastern Interceptor Sewer Sewage Disposal All sewage is passed on to the Greater London Council for treatment and this Council has now no sewage disposal responsibilities. 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. I. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1970. - 37 - (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 the analytical 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, 1970, was 235,040. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride is being 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 Lea-derived via Lea Bridge Works, and well water from Chingford Mill pumping stations. A small area of Lower Chingford adjoining Sewardstone Road north of Kings Head Hill is supplied with River Thames-derived water. Between May and September much of Walthamstow and parts of Chingford receive River Lea-derived water from Coppermills 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 the attached sheets. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not 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. - 38 - VOLUNTARY ORGANISATIONS The following received grants from the Council during 1970:- 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 Sports and Social Committee for Adult Training Centres 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. - 39 - STATISTICAL INFORMATION VITAL STATISTICS Area of Borough (in acres) 9,805 Population (Registrar General's Estimate, midyear 1970) 235,040 Number of Rate Assessments at 31st December 1970 95,587 Total Assessable Value £12,430,934 Product of a penny rate £49,700 Live Births: M AL ES FEMAL ES WALTHAM FOREST EN GLAND & WAL ES Legitimate 1870 1805 3675 Illegitimate 181 177 358 4033 Live Birth Rate per 1,000 population 17.2 16.0 " " " as adjusted by comparability factor (1.06) 18.2 Illegitimate live births per cent of total live births 9.0 Stillbirths: Number (31 males : 32 females) 63 Rate per 1,000 total live and stillbirths 15 13 Total live and stillbirths 40% Infant deaths (deaths under one year) 63 Infant Mortality Rates: Total infant deaths per 1,000 total live births 16 18 Legitimate infant deaths per 1,000 legitimate live births 16 Illegitimate infant deaths per 1,000 illegitimate live births 17 Neo-Natal Mortality Rate (deaths under four weeks per 1,000 total live births) 11 12 Early Neo-Natal Mortality Rate (deaths under one week per 1,000 total live births) 9 11 Perinatal Mortality Rate (stillbirths and deaths under one week combined per 1,000 total live and stiIIbirths) 24 23 Maternal Mortality: Number of deaths 1 Rate per 1,000 total live and stillbirths 0.26 Deaths: Total number 3017 Death rate per 1,000 population 12.8 11.7 " " as adjusted by comparability factor (0.89) 11.4 - 41 - CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE - 1970 I.C.D. CAUSE HEADING CAUSE OF DEATH TOTAL (ALL AGES) AGE GROUPS - MALES AGE GROUPS - FEMALES UNDER 1 1-4 514 1524 2534 3544 4554 5564 6574 75 + TOTAL MALES UNDER 1 1-4 514 1524 2534 3544 4554 5564 6574 75 + TOTAL FEMALES B4 Enteritis and other diarrhoeal diseases 3 1 - - - - - - - - - 1 2 - - - - - - - - - 2 B5 Tuberculosis of respiratory system 3 - - - - - - - - 1 1 2 - - - - - - - - - 1 1 B6(1) Late effects of respiratory tuberculosis 1 - - - - - - - - - - - - - - - 1 - - - - 1 B6(2) Other tuberculosis 2 - - - - - - - - - - - - - - - - - - - 1 1 2 B11 Meningococcal infection 3 - - - - - - - - - - - - 2 - - - - 1 - - - 3 B17 Syphilis and its sequelae 9 - - - - - - - 3 1 - 4 - - - - - - 1 - - 4 5 B18 Other infective and parasitic diseases 4 - - - - 1 - - - - 1 - - - - - - 1 2 - - 3 B19(1) Malignant neoplasm, buccal cavity etc. 7 - - - - - - - 2 2 4 - - - - - - - 1 2 - 3 B19(2) Malignant neoplasm, oesophagus 12 - - - - - - 1 2 5 2 10 - - - - - - - - - 2 2 B19(3) Malignant neoplasm, stomach 89 - - - - - 1 2 14 26 6 49 - - - - - - 4 5 11 20 40 B19(4) Malignant neoplasm, intestine 73 - - - - - - 3 4 6 15 28 - - - - 1 - 2 10 9 23 45 B19(5) Malignant neoplasm, larynx 4 - - - - 1 - - 1 1 - 3 - - - - - - - - 1 - 1 B19(6) Malignant neoplasm, lung bronchus 205 - - - - - 2 14 59 63 31 169 - - - - - - 6 11 11 8 36 B19(7) Malignant neoplasm, breast 61 - - - - - - - 1 - - 1 - - - - 1 4 6 19 16 14 60 B19(8) Malignant neoplasm, uterus 13 - - - - - - - - - - - - - - - - - 2 4 4 3 13 B19(9) Malignant neoplasm, prostate 26 - - - - - - - 4 5 17 26 - - - - - - - - - - - B19(10) Leukaemia 17 - - - 1 - - - 4 1 - 6 - 1 - 1 - 3 2 2 - 2 11 B19(11) Other malignant neoplasms 149 - 1 1 - 1 1 5 22 20 20 71 1 - - - 2 10 22 20 23 78 B20 Benign and unspecified neoplasms 5 - - - - - 1 1 1 - 1 5 - - - - - - - - - - - B21 Diabetes mellitus 32 - - - - - 1 - - 1 3 5 - - - - - 1 - 1 9 16 27 B22 Avitaminoses, etc. 2 - - - - - - - - - - - - - - - - - - - 1 1 2 B46( 1) Other endocrine etc. diseases 7 - 1 - 1 - - - - - - 2 - - - - - - - 1 - 4 5 B23 Anaemias 12 - - - - - - - - 1 - 1 - - - - - - - 1 3 7 11 B46(3) Mental disorders 2 - - - - - - - - - - - - - - - - - - - - 2 2 B24 Meningitis 1 - - - - - - - - - - - 1 - - - - - - - - - 1 B46(4) Multiple sclerosis 6 - - - - - - - 1 - - 1 - - - - - 1 2 1 1 - 5 B46(5) Other diseases of nervous system 26 - 2 - 1 1 1 1 - 5 - 11 - 1 1 - 1 - - 2 4 6 15 B26 Chronic rheumatic heart disease 32 - - - I - - 5 1 1 2 10 - - - - - - 3 6 5 8 22 B27 Hypertensive disease 66 - - - - - 1 2 6 6 10 25 - - - - - - 1 2 8 30 41 B28 Ischaemic heart disease 646 - - - - - 8 34 112 116 97 367 - - - - - - 3 22 96 158 279 B29 Other forms of heart disease 173 1 - - - - 1 1 10 16 35 64 - - - - - - 2 2 20 85 109 B30 Cerebrovascular disease 358 - - - - - 3 4 20 42 65 134 - - - - - 2 5 18 34 165 224 B46(6) Other diseases of circulatory system 116 - - - - - - 1 3 21 19 44 - - - - - 1 2 5 13 51 72 B31 Influenza 27 - - - - - - - 3 6 4 13 - - - - - 1 - 1 5 7 14 B32 Pneumonia 351 6 - 1 - 1 - 3 13 26 86 136 1 - - 1 1 - 1 11 25 175 215 B33( 1) Bronchitis and emphysema 165 - - - - - - 4 21 52 49 126 - - - 1 - - 3 4 10 21 39 B33(2) Asthma 5 - - - - - 1 - 1 1 1 4 - - - - - - - - - 1 1 B46(7) Other diseases of respiratory system 30 3 1 - - - - 1 2 4 8 19 - - - - - - 1 - 2 8 11 B34 Peptic ulcer 21 - - - - - 1 - 2 6 4 13 - - - 1 - - - 1 1 5 8 B35 Appendicitis 2 - - - - - - - - 1 - 1 - - - - 1 - - - - - 1 B36 Intestinal obstruction and hernia 11 2 - - - - - - 1 1 2 6 - - - - 1 - - - - 4 5 B37 Cirrhosis of liver 2 - - - - - - 1 - - - 1 - - - - - - - - 1 - 1 B46(8) Other diseases of digestive system 30 - 1 - 1 - - 2 1 1 7 13 - - - - - - 2 3 4 8 17 B38 Nephritis and nephrosis 11 - - - - - 1 - 3 - 5 9 - - - - - - - - 1 1 2 B39 Hyperplasia of prostate 5 - - - - - - - 1 1 3 5 - - - - - - - - - - - B46(9) Other diseases, genito-urinary system 23 - - - - - - 2 - 2 5 9 - - - - 1 - 1 1 1 10 14 B40 Abortion 1 - - - - - - - - - - - - - - - - - - - - - 1 B46( 10) Diseases of skin, subcutaneous tissue 2 - - - - - - - - 1 - 1 - - - - - - - - - 1 1 B46( 11) Diseases of musculoskeletal system 21 - - - - - - 1 1 - 3 5 - - - - - 2 - 2 4 8 16 B42 Congenital anomalies 22 4 2 - - - - - 3 - - 9 7 1 - 1 - - - - 2 2 13 B43 Birth injury, difficult labour, etc. 13 6 - - - - - - - - - 6 7 - - - - - - - - - 7 B44 Other causes of perinatal mortality 20 11 - - - - - - - - - 11 9 - - - - - - - - - 9 B45 Symptoms and ill defined conditions 11 - - - - - - - - - 2 2 - - - - - - - - 1 8 9 B47 Motor vehicle accidents 18 - 1 - 2 2 1 2 1 - 3 12 - - - - - - 2 1 2 1 6 B48 All other accidents 41 - 3 - 2 4 2 1 - 3 3 18 1 1 - 1 1 2 1 - 6 10 23 B49 Suicide and self-inflicted injuries 18 - - - 1 1 1 - 4 2 1 10 - - - 1 - 2 2 - 1 2 8 B50 All other external causes 2 - - " - - - - - " - - - 1 - - - - - - 1 - 2 TOTALS 3017 34 12 2 10 11 28 92 325 447 512 1473 29 7 1 7 9 22 66 161 336 906 1544 DEATHS FROM CANCER AGE AT DEATH MALES FEMAL ES TOTAL Under 5 years 1 2 3 5 and under 15 years 1 - 1 15 and under 25 years 1 1 2 25 and under 45 years 6 1 1 17 45 and under 65 years 136 106 242 65 years and over 222 169 391 Total 367 289 656 Previous Years - 1969 351 274 625 1968 379 287 666 BIRTHS During the year a total of 4,096 births were registered. In the same period 4, 095 births were notified in accordance with Section 203 of the Public Health Act which were distributed as follows:- DOMl CI LI AR Y INSTITUTIONAL LIVE STILL LIVE STILL Notified births which occurred in the Borough 694 4 2008 28 Birth notifications transferred outwards 2 - 233 2 Birth notifications transferred inwards . 1 - 1557 40 Adjusted Total 693 4 3332 66 Previous Years - 1969 778 8 3231 57 1968 359 4 3221 53 CARE OF PREMATURE INFANTS (weighing 5½lbs or less) LIVE STILL BORN Number born at home 33 - Number born in Hospital or Nursing Home 230 39 -43 - MIDWIFERY The work of the Council's Midwives was as follows:- 1970 1969 1968 Domiciliary confinements attended under N.H.S. arrangements where: 5 14 8 743 785 838 Cases delivered in hospital and other institutions but discharged and attended before tenth day 637 679 712 3 3 5 1,065 958 1,108 Cases on the books at the end of the year 505 366 560 Medical aid notices issued 12 20 Visits paid (as midwife): (a) Ante-natal 4,842 5,876 5,875 (b) Nursing 15,741 14,791 15,229 (c) Other post-natal 769 676 385 Total Visits 21,352 21,343 21,489 Administration of Analgesics Cases in which Gas and Air was administered - 3 96 Cases in which Trilene was administered 22 24 34 Cases in which Entonox was administered 436 487 414 Cases in which Pethidine or a related compound was administered 261 287 321 Clinic Sessions Number of sessions attended: (a) General practitioner's clinics 1,290 1,441 I.I 17 (b) Midwife's clinics 412 444 568 Number of ante-natal examinations by the midwife: (a) General practitioner's clinics 10,542 10,587 10,337 (b) Midwife's clinics 2,273 2,601 3,664 Number of women attending midwife's clinics who had not previously attended any ante-natal clinic in the current year 423 474 675 - 44 - -45 - Child Welfare Clinic Attendances ASSEMBLY HALL DAWLISH ROAD EMM ANU EL HALL G R AN L El GH RO AD HATCH L AN E HANDSWORTH AVE HURST ROAD LEY TON GREEN LOW HALL LANE/ ST. J AM ES* S MARMION AVENUE PRIORY COURT ST. FR AN CI S H ALL WEST AVENUE TOTAL FOR THE YEAR- ALL CLINICS 1 970 1969 1 968 Children attending for the first time in 1970 who were born in 1965 21 72 2 19 8 12 - 34 39 33 5 1 19 265 290 270 1966 19 155 8 54 24 20 1 1 14 98 51 20 7 48 619 571 613 1967 35 171 20 106 43 42 5 185 164 81 43 14 54 963 941 835 1968 47 352 43 154 93 124 6 191 199 1 12 89 22 1 10 1.542 1,526 1 .621 1969 79 324 80 309 90 366 45 175 361 225 253 68 241 2,616 3,321 2,813 1970 1 12 461 88 370 75 260 256 487 341 268 238 S21 301 3,309 3,506 3,405 Total attendances 2.781 6,763 1,819 5,308 1,689 5.012 3,689 4,370 5,253 7,634 3,468 1,335 4,525 53,646 55.328 58,825 Attendance of children seen by Medical Officer 557 2,354 353 1,390 439 1,401 1,145 1,432 1,743 767 1,620 96 1,725 15.022 15.410 17,632 No. of children referred elsewhere 29 188 30 198 22 9 14 101 66 48 129 4 20 858 707 569 No. of sessions (a) Medical Officers 55 >88 15 160 64 149 68 166 146 88 153 13 144 1.409 1,327 1,315 (b) Sessional G.P's - 3 - 10 13 7 23 - 2 7 - - - 65 134 134 (c) Health Visitors 46 S 37 10 - 2 8 20 - 98 2 40 3 271 220 186 - 46 - NUTRIENTS WELFARE FOODS Distribution of Welfare Foods and Nutrients A D E XO LINE OPTROSE M ARMI T E COW & GATE OSTERMILK NO. 2 S.M. A. HUMSD. TRU FOOD F AREX GRO ATS T WIN-P ACK N AT-DRI ED MILK COD LI VER OIL A. & D. T A BL ETS OR AN G E JUICE Assembly Hall 1.132 5,794 1,734 596 370 156 - 106 48 52 260 208 212 6,002 Hurst Road 1,048 2,772 764 1,242 1.132 252 24 96 78 94 244 218 212 3,978 Dawlish Road 566 2,538 991 1,285 2,150 136 - 217 1 12 - 1,320 591 304 5,622 Emmanuel Hall 194 991 276 475 468 130 - 44 19 9 50 165 66 1.312 Granleigh Road 735 3,737 1,215 2,318 1,156 761 - 182 106 5 1,168 374 339 6,232 Handsworth Avenue 1.334 8,242 1,902 1,378 1,326 358 40 174 164 60 420 192 204 8.592 Hatch Lane 252 1,302 630 1,230 300 92 60 48 20 28 186 66 90 2.042 Leyton Green 1,852 3,260 1,057 2,059 1,282 I.I 16 - 155 47 32 784 322 282 6.397 Old Monoux School 636 2,964 720 764 324 192 24 64 - - 772 276 270 5,464 Priory Court 1,470 4,300 1,510 2,098 1,564 708 34 127 162 46 504 230 298 4,708 Low Hall Lane 1,184 2,622 488 1,752 1,382 478 12 98 40 32 892 212 210 3,864 Marmion Avenue 2,256 8,932 2,524 1,158 1,514 900 152 300 174 36 346 272 288 10,060 St.Francis Hall 190 1,154 274 226 364 92 - 28 26 10 100 82 50 1.3 12 West Avenue 784 2,520 382 1,920 794 470 - 178 60 24 47 1 334 128 2,766 W.V.S. Chingford - - - - - - - - - - 6 - 16 380 Hospitals and Nurseries - - - - - - - - - - 21 126 - 856 13,633 51,128 14,467 18,501 14,126 5,841 346 1,817 1,056 428 7.523 3,542 2,969 68,725 Previous Years - 1969 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 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 14.1 10 52,935 11,147 13,684 10,831 5,013 303 1,672 856 1,128 24,394 5,185 3,415 70,377 Mothercraft and Relaxation Classes New cases 252 Attendances 974 No. of classes held 177 Day Nurseries Attendances: NAME OF NURSERY ELLINGHAM ROAD EPSOM ROAD HIGH AM HILL HANDSWORTH AVENU E CHINGFORD MOUNT TOTALS 1970 1969 1968 Number of approved places 50 50 60 60 52 272 272 272 Number of children on register at end of year 49 53 60 65 46 273 292 301 Total attendance during 10,187 11.140 11,836 14,249 10,495 57,907 58,615 60.251 Number of days open 255 255 255 255 255 - - - Nurseries and Child Minders Regulations, 1948 1970 1969 1968 Premises registered at end of year: Number of premises 41 36 36 Number of places provided 1,317 1,138 1,120 Persons registered at end of year: Number of persons 231 181 19 Number of places provided 443 362 1 14 Child Development Sessions DAWLISH ROAD CLINIC GRANLElGH ROAD CLINIC LEY TON GREEN CLINIC LOW HALL. CLINIC PRIORY COURT CLINIC WEST AVENUE CLINIC HANDSWORTH AVENUE CLINIC No. of attendances 1,372 1,262 1,446 1,236 422 846 370 No. of sessions 147 144 143 98 50 103 44 New cases attending for first time in year 45 89 78 36 27 27 20 - 47 - Congenital Malformation Eighty-four cases of congenital malformation were notified to the Department of Health and Social Services during the year. Children "At Risk" 1970 1969 1968 Children on Register at 1st January 2,600 3.070 2,156 Children added during year 1,412 1,276 1,560 Children removed during year 1,387 1,746 646 Children on Register at 31st December 2,625 2,600 3*070 Cervical Cytology Clinics [ HATCH LANE GRANLEIGH ROAD No.of smears taken 873 394 No.of sessions 42 22 Dental Treatment of Expectant and Nursing Mothers and Children under five years [ CHILDREN UNDER 5 YRS. EXPECTANT & NURSING MOTHERS 1970 1969 1968 1970 1969 1968 Number of patients given first inspections during year 272 312 182 26 19 15 Number of patients who required treatment 171 194 1 11 22 18 14 Number of patients who were offered treatment 164 194 103 22 18 14 Attendances for treatment: First visit 569 513 475 33 30 21 Subsequent visits 560 644 587 38 52 86 Total visits 1,129 1,157 1,062 71 82 107 Treatment provided: Number of fillings 720 766 775 29 54 63 Teeth filled 666 682 708 23 48 50 Teeth extracted 213 192 323 1 1 29 34 General anaesthetics given 81 79 140 5 7 6 Emergency visits by patients 37 33 45 4 5 - Patients X-rayed 2 2 5 5 6 7 Patients treated by scaling and/or removal of stains from the teeth (Prophylaxis) 327 221 141 7 23 11 Teeth otherwise conserved 147 163 70 - Teeth root filled - _ _ - • _ - - - - - - • - - - 1 1 Number of courses of treatment completed during year 374 259 212 16 17 12 Patients supplied with full upper or full lower dentures 3 Patients supplied with other dentures _ - - 2 1 • Number of dentures supplied - - 2 1 7 -48 - Family Planning GR ANLElGH ROAD HATCH U AN E HURST ROAD LEVTON GREEN Number of new patients 241 361 502 267 Number of persons treated 692 1,404 1,412 558 Number of attendances 1 ,882 3,616 3,617 1,585 Number of sessions 50 99 86 52 HEALTH VISITING (a) Sessions Worked Number of sessions (half days) devoted to: 1970 1969 1968 (i) Health visiting 7,892 7,529 7,915 (ii) Child welfare centres 3,674 3,578 3,476 (iii) Ante-natal, post-natal, relaxation etc. clinics 313 409 361 (iv) School clinics 979 897 1,057 (v) Other school nursing 1,887 1,890 2,062 (vi) Health education (including mothercraft) 351 551 481 (vii) Other work (including clerical) 5,078 5,193 5,634 Total sessions 20,174 20,047 20,986 (b) Cases visited for the first time in the year (i) children born in 1965 1,217 1,090 1,075 ,, ,, ,, 1966 1,621 1,409 1,488 ,, ,, ,, 1967 1,828 1,857 1,775 ,, ,, ,, 1968 2,263 2,149 2,132 ,, ,, ,, 1969 2,464 2,401 2,420 ,, ,, ,, 1970 3,778 3,861 3,786 (ii) persons aged 65 or over 2,327 2,443 2,41 1 (iii) others (excluding school nursing cases) 1,409 1,707 2,250 Total 16,907 16,917 17,337 (c) Number included in item (b) (i) mentally disordered persons 136 157 220 (ii) persons discharged from hospital (other than mental hospitals) 397 406 521 (iii) tuberculosis households 12 5 15 (iv) households visited on account of other infectious diseases 17 20 1 (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 567 548 653 (ii) mentally disordered persons 52 64 60 (iii) persons discharged from hospital (other than mental hospitals) 107 222 261 - 49 -  EFFECTIVE INEFFECTIVE (e) Total number of visits to: (i) children under 5 years of age 24,593 5,867 (ii) persons aged 65 or over 6,098 1,461 (iii) other (excluding school nursing cases) 4,757 589 Total visits 1970 35,448 7,917 Total visits 1969 36,288 7,864 Total visits 1968 39,683 7,594 1970 1969 1968 (f) Sessions attended at G.P's surgeries (included above) 388 270 326 (g) Phenylketonuria (i) children tested at home or clinic 394 2,856 3,264 (ii) special visits to homes to collect specimens 222 856 1,177 HOME NURSING (a) Cases visited for the first time in the year: CASES TOTAL VISITS 1970 1969 1968 1970 1969 1968 (i) aged under 5 917 745 405 3,114 2,291 1 ,478 (ii) aged 5 and under 65 2,632 2,109 1 ,798 32,596 34,691 29,815 (iii) aged 65 or over 2,431 3,084 2,363 105,870 98,443 95,1 54 Total cases 5,980 5,938 4,566 141 ,580 135,425 126,447 (b) Cases on the books at the end of the year 1970 1,512 1969 1,405 1968 1,188 LOAN OF SICKROOM EQUIPMENT New Issues in 1970 EQUIPMENT HEALTH 8, WELFARE DEPT. CHINQFORO RED CROSS EQUIPMENT HEALTH 8, WELFARE DEPT. CHINSPORD RED CROSS Commodes 279 184 Urine Bottles 57 49 Wheelchairs 164 170 Bed Boards (sets) - - Bed Cradles 89 56 Feeding Cups 8 16 Air Rings 79 40 Crutches (pairs) 15 34 Bed Pans 117 58 Air Beds - - Back Rests 136 56 Bed Tables 10 16 Rubber Sheets - 37 Walking Sticks 25 21 Plastic Sheets 230 - Others - 32 -50 - CHIROPODY TREATMENT N EW C ASES CLINIC ATTENDANC ES DOM I C 1 LI A R Y TREATMENTS TREATMENTS AT OLD PEOPLES' RESIDENTIAL HOMES CASES TREATED DU RIN G TH E YEAR Children 832 4,573 - - 1,126 Expectant mothers 2 3 - - 3 Physically Handicapped 2 138 25 - 39 Aged (over 65 years of age) 467 21,647 4, 150 1,829 5,049 427 7,997 39 - 1,762 Total for 1970 1,730 34,358 4,214 1.829 7,979 Previous Years - 1969 2,177 37,750 6,000 1,617 1966 2,287 42,519 4,1 18 1.791 CONVALESCENCE The number of recuperative holidays provided for adult persons in accordance with Section 28 of the National Health Service Act, 1946 was 39. Recuperative holidays were also provided under Section 22 of the Act for I 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. VISI TS FIRST VISI TS TO HOMES RE-VISITS TO HOMES Ml SC. VISITS HELP PR ESEN T OTHERS HELP SEEN OTHERS ATTENDANT PRESENT OTH ERS 1,076 658 5,569 347 372 2 - - - -51 - Help provided AGED 65 OR OVER MATERNI TY CHRONIC SI CK (UNDER 65 YRS.) OTHERS (UNDER 65 YRS.) TOTALS 1970 1969 1968 Requests for help from new cases during year 888 81 114 101 1,184 1,370 1,433 Cases not eligible for assistance or not requiring service 242 40 46 28 356 347 278 New cases helped during year 613 26 70 70 779 1,025 1.157 Cases helped earlier in present year and re-opened. 241 1 35 3 280 232 257 Total cases completed during year 965 30 142 76 1,213 1,465 1,241 Cases being helped at end of year 2,309 1 143 33 2,486 2,641 2,849 Total cases helped during year . 3,274 31 285 109 3,699 4,106 4,090 Hours of help provided during year 283,843½ 635½ 24,573½ 4,553½ 3 13,606 362,570 380,133 Analysis of "Others" REASON FOR PROVISION OF HELP NEW CASES HELPED CASES COMPLETED CASES BEING HELPED AT ENDOF YEAR Mental disorder under 65 years 4 5 9 Help for harassed mothers 9 5 7 Problem family - - - Absence of mother 3 3 3 Acute Illness 49 58 14 Toxaemia 5 5 - Others - - - Night Attendance Service (Attendance provided) PATIENTS RESIDING ALON E INABILITY OF AGED HUSBAND OR Wl FE RELIEF OF RELATIVES Requests for help from new cases during year - 1 1 New cases helped - - - Total cases completed - - - Cases being helped at end of year - - - Total cases helped during year - - • Hours of attendance provided - - 411 -52 - Neighbourly Help Scheme aged OTHERS TOTAL Cases being helped at beginning of the year 1 1 - 1 1 New cases commenced 10 1 1 1 Cases completed or ceased 2 1 3 Cases continuing at end of the year 19 - 19 SERVICES FOR BLIND, PHYSICALLY HANDICAPPED. DEAF AND OLD PEOPLE 1 (a) Blind persons registered at 31st December, 1970 AGE 04 510 1 11 5 1620 2 129 3039 4049 5059 6064 6 569 7079 80" 84 6 589 90 & OVER TOTAL M 1 - - 1 3 6 16 26 15 19 23 20 23 8 187 F 3 4 - 2 3 8 9 18 17 23 52 58 51 37 345 Total 4 4 - 3 6 14 25 24 32 42 75 78 74 45 532 Persons registered at 31st December, 1969 541 ,, ,, ,, ,, ,, 1968 519 (b) Blind persons on register with other handicaps at 31st December, 1970 MENTALLYILL MENTALLY H ANDIC APPED DEFECTIVE DEAF WlTHOUT SPEECH DEAF Wl TH SP EECH HARD OF HEARING M EN TALL Y H AN Dl CAPPED & DEAF WITH SPEECH M EN TALLY H AN Dl C APPED & H ARD OF HEARING PHYSICALLY DEFECTI V E & DEAF WITH SPEECH TOTAL M l 2 15 3 9 7 2 - l 40 F 4 6 33 3 13 23 • 1 4 87 Total 5 8 48 6 22 30 2 1 5 127 2 Partially sighted persons registered at 31st December, 1970 AGE 510 11* 15 16- 20 2 129 3 flag 40- 49 5059 6064 65- 69 7079 eo- 84 8 589 90 & OVER TOTAL M 4 2 3 5 5 3 7 7 5 12 7 3 4 67 F 1 1 1 1 4 3 4 5 10 36 15 17 9 107 Total 5 3 4 6 9 6 11 12 15 48 22 20 13 174 Persons registered at 31st December, 1969 161 ,, ,, ,, ,, ,, 1968 165 -53 - 3 Deaf persons registered at 31st December 1970 1970 1969 1968 Hard of hearing 101 138 147 Deaf with speech 27 128 1 15 Deaf without speech 35 42 16 Total registrations 163 308 278 N.B. This includes those on the blind register. 4 Physically handicapped persons registered at 31 st December, 1970 CATEGORY UNDER 16 Y EARS 18-29 30-49 50-64 65& OVER TOTAL Amputation 1 3 2 16 42 64 Arthritis and rheumatism - 7 18 83 629 737 Congenital malformations and 6 8 3 2 5 24 Diseases of the genito-urinary and digestive systems, of the heart or circulatory system, of the respiratory system (other than tuberculosis) or of the skin 1 5 9 46 1 10 171 Injuries of the head, face, neck, thorax, abdomen, pelvis or trunk. Injuries or diseases (other than tuberculosis) of the upper and lower limbs and of the spine 1 8 13 28 97 147 Organic nervous diseases - epilepsy, disseminated sclerosis, poliomyelitis, hemiplegia, sciatica, etc 4 40 80 152 182 458 Neurosis, psychosis, and other nervous diseases not included 1 4 5 6 9 25 Tuberculosis (respiratory) - 1 - 5 1 7 - - 1 1 4 6 Diseases and injuries not specified 1 4 - 1 1 31 47 Total 15 80 131 350 1,1 10 1,686 Persons registered at 31st December, 1969 1,591 1968 1,507 - 54 - 5 Other services for the handicapped (a) (i) Roberts Hall Work Centre Attendance during the year were 14,182 out of a possible 21,884 Number on roll at 31st December, 1970 - 154 (a) (ii) Spastic Society Workshop 6 people made 915 attendances (b) Rehabi litation Blind persons sent on course - Nil Other handicapped persons sent - Nil (c) Sheltered Workshops Blind persons in sheltered workshops 4 Other handicapped persons in sheltered workshops 2 (d) Homeworkers Number of blind workers supplemented by the authority 4 Number of blind persons sent on training Nil (e) Adaptations of Premises Adaptations carried out in 1970: Lowering of meters I Installation of bathroom heaters 2 Drawing of parking space for invalid car I Raising of floors I Provision of taps I Fixing of handrails 63 Provision of downstairs toilets 2 Provision of showers I Alterations to bathrooms - new baths for the disabled I Provision of closed way to toilet 2 Provision of access to garden I Provision of ramps - fixed 2 Provision of ramps - portable 3 Alterations to front elevation of house 2 Carriage crossings I Raising of electric points I Provision of electric point I Provision of visual doorbell 6 Removal of doors I Building of new bathrooms I 94 - 55 - (f) Aids for Handicapped Persons Aids issued in 1970 — 1,062 (see table below) (g) Holidays for Handicapped Persons 1970 1969 1968 For the blind 32 31 29 For others 141 181 246 Personal helpers (both categories) 46 58 50 (h) Disabled Drivers Car badges issued - 48 AIDS FOR PHYSICALLY HANDICAPPED EQUIPMENT PROVIDED ISSUED DURING 1970 ON LOAN AT 3 1.12. 1970 Bathing Aids:- Bath rails 87 173 ,, mats 123 * ,, seats 1 17 141 ,, boards 1 10 130 Domestic Aids:- Egg cup holders - 6 Helping hands and pick up sticks 136 267 Large handled knives 5 17 ,, ,,forks 1 5 ,, ,, spoons 1 3 Kitchen stools 1 1 Potato peeler 2 3 Tap turners 4 16 Tin openers 5 15 Bread boards 1 3 Toilet Aids:- Stocking pulls 29 70 Long handled sponges 6 7 ,, ,, shoe lift 8 21 Toilet frames 33 38 ,, seats 52 75 Bed Tables 10 13 Hoists 15 15 Lifting poles 7 1 1 Special chairs 32 46 Walking aids 190 318 Miscellaneous 87 1 16 1,062 1,510 Previous Years - 1969 550 1,126 1968 459 982 *Records are no longer being kept of the number of baths mats on loan as they are no longer being returned to stock. - 56 - 6 People in Care - 57 - Persons provided with accommodation at 31st December, 1970 Analysis according to age:- UNDER 30 30 - 49 so 64 TOT AL 65 - 74 75 - 84 85 & OVER TO T AL TOTAL ALL AGES M F M F M F UNDER 65 M F M F M F OVER 65 1970 1969 1968 Persons accommodated in Waltham Forest Old People's Homes:- (a) Waltham Forest Residents - - - 1 1 8 19 17 21 44 113 31 118 344 363 303 300 (b) From other Local Authority areas - - - - - 1 1 1 1 2 3 1 10 18 19 27 33 Persons from Waltham Forest accommodated in Homes outside the Borough:- (a) In Voluntary Organisations' Homes 3 1 5 4 6 6 25 6 7 5 28 1 27 74 99 101 104 (b) In other Local Authorities' Homes. - - - - 2 2 4 3 2 5 8 4 16 38 42 55 64 Total number of persons from Waltham Forest in Residential Homes 3 1 5 4 19 17 49 27 31 56 152 37 171 474 523 459 468 Number of new permanent admissions during 1970 181 Number of temporary admissions during 1970 72 Waiting list for accommodation in homes for the elderly at 31st December, 1970 MALE FEMALE List "A" - Priority grading. Visited by Social Welfare Officer 31 76 List "B" - Elderly persons supported by Social Welfare Officers 32 141 Community Care List 2 - Persons in hospital and private homes wishing to be transferred - visited by Social Welfare Officers 6 16 List 3 - Persons residing in Waltham Forest waiting to be accommodated by another authority - visited by Social Welfare officers 1 12 List 4 - Persons in outside areas wishing to be accommodated 2 1 1 Totals 72 256 Totals in 1969 100 285 Totals in 1968 65 233 HOMELESS FAMILIES ACCOMMODATION Persons accommodated:- NO.OF FAM 1 LI ES NO.OF PERSONS Resident on 1.1.1970 23 101 New admissions during year 57 232 Discharges during year 55 233 Resident on 3 1. 12.1970 25 100 Of the 55 families discharged during the year 27 were rehoused by the Council, 8 left for unknown destinations, 3 found accommodation privately, 9 were rehoused by other Councils and 8 left for other known destinations Length of stay:- UNDER I MON TH 1 MON TH AN D UNDER 6 MON TH S 6 MON TH S AN D UNDER 18 MONTHS 18 MONTHS Families discharged 1 1 23 19 2 Families still in residence 4 16 4 1 MEALS-ON-WHEELS AND LUNCHEON CLUBS MEALS-ON-WHEELS LUNCHEON CLUBS Meals provided for:- Walthamstow residents 35,322 15,795 Leyton residents 33,505 18,204 Chingford residents 9,415 3,078 Totals 78,242 37,077 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 C ASES RESIDENTAL HOM ES 27,708 26,849 Owing to the manual workers' strike, the laundry service was suspended during October and part of November. - 58 - - 59 - (a) Distribution of cases under care MEN TALLY ILL ELDERLY MENTALLY INFIRM PSYCHOPATHIC MENTALLY HANDICAPPED SEVERELY MENTALLY H ANDIC APPED TOTAL UNDER 16 16 & OVER UNDER 16 16 & OVER UNDER 16 16 e, OVER UNDER 16 16 & OVER M F M F M F M F M F M F M F M F M F 1970 1969 1968 1. Total number 3 5 1,133 1.446 * - - - 10 8 6 9 225 164 61 50 65 51 3.236 2,657 2,342 2. Attending workshops/occupation training centres - - 32 16 " - - - - - 6 9 38 26 36 23 49 40 275 255 250 3. Awaiting entry to workshops/ occupation training centres - - - - - - - - - - - 1 1 3 2 - - 7 22 7 4. Receiving home training - - - - - - - - - - - - - - - - - - - - 5. Awaiting home training - - - - - - - - - - - - - - - - - - - - - 6. Resident in L.A. home/hostel - - - - - - - - - - - - 2 3 - - 3 4 12 1 1 - 7. Awaiting residence in L.A. home/ hostel - - - - - - - * - - - - - - - - - - - 10 8. Resident at L.A. expense in other homes/hostels - - 7 6 - - - - - - - 5 3 - 2 - - 23 28 23 9. Resident at L.A. expense by boarding out in private household . - - - - - - - - - - - - 1 1 " - 2 2 2 10. Attending day hospitals - - - - * - - • - - - - - - - - " - - 3 2 1 1. Receiving home visits and not included in lines 2-10 (a) suitable to attend a training centre - - - - - - - - - - - - - - - - - - - - - (b) others 3 5 1.094 1,424 " - - - 10 8 - - 179 I3| 21 22 13 7 2,917 2,336 2,048 MENTAL HEALTH SERVICE .60 . (b) Number of patients awaiting entry to hospital, or admitted for temporary residential care during 1970 MENTALLY ILL ELDERLY MEN TALLY INFI RM PSYCHOPATHIC MENTALLY HANDIC APPED SEVERELY MENTALLY H AN DIC APPED TO T AL UNDER 16 16 & OVER UNDER 16 16 & 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 1970 1969 1968 A. Number of patients in L.H.A. area on waiting list for admission to hospital at 31.12.70 (i) in urgent need of hospital care - - - - - - - - - - 1 - " - 3 - - - 4 8 2 (ii) not in urgent need of hospital care - - - - - - - - - - - - 4 * 2 6 1 - 13 16 18 (iii) Total - - - - - - - - - - 1 - 4 - 5 6 1 - 17 24 20 B. Number of admissions for temporary residential care (e.g. to relieve the fami ly) (i) to N.H.S. hospitals - - 1 - - - - - - - 5 3 7 - 15 2 1 1 10 54 21 30 (ii) to L.A. residential accommodation - - - - - - - - - - - - 2 2 - - 3 1 8 - - (iii) elsewhere - - - - - - - - - - 1 - 2 - 3 4 1 2 13 39 72 (iv) Total - - 1 - - - - - - - 6 3 11 2 18 6 15 13 75 60 102 . 61 . (c) Number of patients referred to Local Health Authority during year ended 31st December, 1970 REFERRED BY MENTALLY ILL PSYCHOP ATHI C MENTALLY H AN DIC APPED SEVERELY MENTALLY HANDICAPPED TOTAL MENTALLY HANDICAPPED AND SEVERELY MENTALLY H AN Dl C APPED GRAND TOTAL O F COLS. 1 - 16 UNDER 16 16 & OVER UNDER 16 16 & 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 UNDER 16 16 & OVER 1970 1969 1968 (i) General practitioners - 1 1 16 226 - - 2 3 - - - - 1 " - 1 349 347 359 (ii) Hospitals, on discharge from inpatient treatment - - 48 57 - - 1 1 - ' 1 " - 1 - - 3 1 10 88 189 (iii) Hospitals, after or during outpatient or day treatment - - 22 27 - - - - 1 - - 1 1 - 2 1 52 76 96 (iv) Local education authorities - " - - - - - - 7 5 ' - 3 2 - - 17 1 18 15 23 (v) Police and courts - - 17 27 - - 2 1 - - - - - - - - - - 47 27 33 (vi) Other sources 2 2 64 85 - - 5 3 1 - 2 4 2 - 1 - 3 7 171 139 135 2 3 267 422 - - 10 8 8 6 4 5 5 3 4 - 22 13 747 692 835 (d) Training Centres BIRKBECK ADULT CENTRE QUEENS A DULf CENTRE GROSVENOR HOUSE JUNIOR CENTRE Places provided 100 60 100 Trainees on register at end of year 101 59 83 Average daily attfendance 76.9 40.9 48.3 INFECTIOUS DISEASES - NOTIFICATIONS DISEASE 1ST QU AR TER 2N D QU ARTER 3RD QU A R T E R 4 TH QUARTER TOTAL Scarlet Fever 23 23 9 30 85 Whooping Cough - 14 40 78 132 Measles 22 1 17 322 339 800 Tuberculosis 15 20 41 13 89 Typhoid - - 2 - 2 Paratyphoid - - • - - Meningococcal Infection 1 - 1 3 5 Acute Meningitis 4 3 4 - II Dysentery 4 4 1 3 12 Ophthalmia Neonatorum - 2 4 - 6 Food Poisoning 2 5 15 3 25 Infective Jaundice 12 17 18 7 54 Malaria - - - - - Totals 83 205 457 476 1,221 TUBERCULOSIS New Notifications and Deaths during 1970 AGE PERIODS NEW CASES DEATHS PULMONARY NONPULMON ARY PULMON ARY NONPULMONARY Under 1 year M F M F M F M F - - 1 - - - _ 1-4 years - 1 1 1 - - - - 5-9 years - 2 - - - - - . 10 - 14 years - 2 1 - . . _ _ 15-19 years 3 - 4 2 _ . . . 20 - 24 years 1 1 1 2 - _ _ _ 25 - 34 years 5 4 3 4 - - - . 35 - 44 years - 5 1 1 - - • - 45 - 54 years 4 3 1 - - - . - • 55 - 64 years 6 3 - 3 - _ _ 65 and pver 8 2 - 3 - - - - Totals 27 23 12 17 - - - - 50 29 - - 79 - - 62 - Tuberculosis among Immigrants Cases of tuberculosis among immigrants seen at the local Chest Clinic numbered 38. These occurred in the following groups:- RESPIRATORY NO N-RESPIRATORY Pakistani 14 9 Indian 5 3 Chinese 1 - Kenyan - 1 Spanish 1 - French - 1 American - 1 Mauritian 1 - Irish 1 - Tuberculosis - Care and Aftercare (a) Extra Nourishment (all Chest Cases) (i) Number of new cases supplied with free milk during the year - (ii) Persons receiving free milk at end of March, 1970 24 N,B. The service was discontinued at end of March (b) Work of Tuberculosis Visitors (i) Visits to new cases 149 (ii) Total visits to households 1,328 (iii) Sessions attended at Chest Clinic 798 (c) Contacts Examination of contacts during the year (i) first examinations 344 (ii) subsequent examinations 353 - 63 - VACCINATION AND IMMUNISATION TYPE OF COURSE OR DOSE Y E AR OF BIRTH OTH ERS UNDER 16 Y EARS TOTAL 1970 1969 1968 1967 1963-66 Diphtheria-Primary 65 1,990 595 41 61 14 2,766 Booster - 56 611 114 2,41 1 68 3,260 Whooping Cough - Primary 65 1,967 579 39 42 6 2,698 Booster • 48 566 94 375 19 1.102 Tetanus - Primary 65 1,993 596 44 74 1 15 2,887 Booster - 56 612 121 2,515 179 3,483 Poliomyelitis - Primary 65 2, 184 636 47 90 27 3,049 Booster. - 44 588 122 2,414 78 3,246 Measles - 582 71 1 330 443 90 2,166 Rubella - - - - - 243 243 TYPE OF VACCINE USED IMMUNISATIONS OR VACCINATIONS COMPLETED BY GENERAL PRACTITIONERS IMMUNISATIONS OR VACCINATIONS COMPLETED BY BOROUGH STAFF PRIMARY COU RS ES REINFORCING DOSES PRIMARY COURSES REINFORCING DOSES Diphtheria, Whooping Cough, Tetanus and - . - - Diphtheria, Whooping Cough and Tetanus 1,228 787 1,470 315 Diphtheria and Whooping Cough combined - - - - Diphtheria and Tetanus combined 9 6$0 57 1,478 Diphtheria only 2 4 - 6 Whooping Cough only - - - - Tetanus only 120 143 3 100 Poliomyelitis:- (a) Salk - - - - (b) Sabin 1,467 1,399 1,582 1,847 Small pox 1,119 254 479 27 Measles 1,452 - 704 - Rubella - - 243 - - 64 - B.C.G. Vaccination of Children Results of Heaf Test:- (a) Tuberculin Positive 60 (b) Tuberculin Negative 1 ,195 Number vaccinated with B.C.G 1,195 REGISTRATION OF PREMISES Public Health Act, 1936 - Nursing Homes BEDS P RO VI DED NO.OF HOMES MAT E RN1 TY O TH ERS Homes registered at 31st December, 1970 1 - 71 National Assistance Act, 1948 - Disabled Persons and Old Persons Homes NO.OF HOMES BEDS PRO VIDED Homes registered at 31st December, 1970 8 81 Mental Health Act, 1959 - Nursing and Residential Homes NO.OF HOMES B EDS P RO VI DED Nursing Homes registered at 3 1 st Dec. 1970 1 127 Residential Homes registered at 31st Dec. 1970 2 36 Essex County Council Act, 1933 - Establishments for Massage and Special Treatment CHIROPODY MASSAGE ETC. Establishments registered at 31st Dec. 1970 8 8 MEDICAL EXAMINATIONS OF STAFF Completed during period 1st January to 31st December, 1970:- Medical Examinations 248 Medical Assessments 1,087 . 65 . GENERAL DENTAL SERVICE Number of Sessions 200 Number of appointments made 1,374 Number of new patients seen 227 Analysis of Treatments Provided Fillings - Plastic 136 Amalgam 287 Inlays 2 Crowns 4 Scaling and gum treatment 189 Dressings 129 Extractions 18 General Anaesthetic given Local Anaesthetic given 104 X-rays 210 Dentures supplied 82 Dentures repaired 66 Impressions 204 Bites 50 Try-in 100 Minor Oral surgery 4 Other treatment 304 DENTAL LABORATORY DENTURES REPAIRS REMAKES OR RELINE APPLIANCES C ROWNS INLAYS STUDY MODEL TRAYS EAR INSERTS General Dental Service 82 66 8 - 4 2 1 91 - School Dental Service 18 19 1 88 21 1 227 1 1 307 Maternity and Chi Id Welfare 1 1 • . - - - - - - -66 - PUBLIC HEALTH INSPECTION 1. Inspections, Re-inspections, Action (a) GENERAL STATUTORY PROVISIONS COMPLAINTS RECEIVED INSPECTIONS AND RE-INSPECTIONS INFORMAL NOTICES SERV ED FO RM AL NO Tl C ES SERV ED HOUSES CLASSIFIED Clean Air Act, 1956 106 2,294 - 279 - Housing Acts, 1936/69 and Regulations - 5,430 - - - Public Health Acts, 1936/64, and Noise Abatement Act, I960 1,864 17,123 741 325 - Prevention of Damage by Pests Act, 1949 2,899 13,608 26 9 - Food and Drugs Act, 1955 and Food Hygiene Regulations, 1960/66 187 3,694 133 - - Factories Act, 1961 41 296 36 - - Pet Animals Act, 1951 , Riding Establishments Act, and Animal Boarding Establ ishments Act, 1963 - 47 - - - Offices, Shops and Railway Premises Act, 1963 - 3,045 177 - - -67 - (b) DETAILED (i) Rent Act, 1957 - Para. 4, First Schedule Applications for certificates received 5 Decisions not to issue certificates Nil Decisions to issue certificates 5 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 4 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, 1957/69 (a) Individual Houses - Demolition/Closing Orders Undertakings accepted (Section 16) 4 Closing Orders made 23 Demolition Orders made (Section 17) 1 Closing Orders revoked and Demolition Orders substituted (Section 28) 1 Orders/Undertakings determined 1 (b) Slum Clearance Areas Number of areas represented (Sections 42 & 157 (1)) 5 Houses unfit for human habitation 37 Houses included by reason of bad arrangement Nil Houses on land acquired under 43 (2) 22 Numbers of people to be displaced (a) individuals 151 (b) Families 56 (c) Compulsory Purchase Orders confirmed The Waltham Forest Housing Part 111 (Cathall Road Area) Compulsory Purchase Order, 1969, comprising 5 clearance areas was confirmed by the Ministry of Housing and Local Government during the year. Local Public Inquiries were held in September in respect of the Waltham Forest Part III (Sidmouth Road Area) Compulsory Purchase Order, 1969, and in December in respect of the Waltham Forest Part III (Markhouse Road Area) Compulsory Purchase Order, 1970. The Minister has confirmed the Sidmouth Road Area and his decision is awaited with regard to Markhouse Road Area. (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 Council Act, 1952, and relevant legislation. TYPE OF PREMISES NUMBER OF INSP ECTIONS Retails Food Shops 2,228 Catering establishments (including factory canteens, hospitals, nursing homes, school meals kitchens) 754 Food Hawkers/Street Traders/Fairgrounds 201 Food Manufacturers/Depots, Dairies, Bakehouses 285 Off-Licences 97 Public Houses 129 3,694 68 (iv) The Offices, Shops and Railway Premises Act, 1963 (a) Registrations and General Inspections CLASS OF PREMISES NO. OF PREMISES REGISTERED DURING THE YEAR TOTAL NO. OF REGISTERED PREMISES AT END OF YEAR NO. OF REGISTERED PREMISES RECEIVING A GENERAL INSPECTION DURING THE YEAR Offices 39 533 162 Retail shops 38 1.613 602 Wholesale shops, warehouses 1 94 18 Catering establishments open to the public, canteens 6 186 93 Fuel storage depots - 6 • Totals 84 2,432 875 Number of visits of all kinds by Inspectors to registered premises 3,045 (b) Analysis of Contraventions Found SECTION NO. OF CONTRAVENTIONS FOUND SECTION NO. OF CONTRAVENTIONS FOUND 4 Cleanliness 89 12 Clothing Accommodation 2 5 Overcrowding Nil 13/14 Seating Facilities 3 6 Temperature 40 15 Eating Facilities 2 7 Ventilation 4 16 Floors, passages and stairs 40 8 Lighting 16 17/18/19 Machinery 7 9 Sanitary Conveniences 142 21 Noise and Vibration Nil 10 Washing Facilities 53 24 First Aid General Provisions 34 11 Drinking Water 5 50 Exhibition of Forms 56 493 69 (c) Analysis of Persons Employed in Registered Premises by Workplace CLASS OF WORKPLACE NUMBER OF PERSONS EMPLOYED Offices 5,287 Retail shops 7,494 Wholesale departments, warehouses 1,087 Catering establishments open to the public 1, 197 Canteens 80 Fuel storage depots 58 Total 15,203 Total Males 7,137 Total Females 8,066 (d) Reported Accidents WORK PLACE NUMBER REPORTED ACTION RECOMMENDED NO ACTION PROSECUTlON FORMAL WARNING INFORMAL ADVICE Offices 1 — — 1 — Retail shops 29 — — 29 — Wholesale shops, warehouses 7 — — 7 — Catering establishments open to public, canteens — — — — — Fuel storage depots — — — — — Totals 37 — — 37 — 70 (v) Prevention of Damage by Pests Act, 1949 - Rodent and Pest Control/Disinfestation/ Disinfection Complaints received 2,899 Inspections and Re-inspections 13,608 Premises treated 2,112 2. Nuisances Abated, Defects Remedied, Improvements Effected (i) PUBLIC HEALTH ACTS The total number of repairs and improvements carried out to dwellings and other premises is as follows, compared with the past two years:- 1968 1969 1970 2,931 2,796 2,750 (ii) FOOD AND DRUGS ACTS/FOOD HYGIENE REGULATIONS The total number of repairs and improvements carried out to food establishments and industrial premises is as follows, compared with the past two years:- 1968 1969 1970 1,360 1,657 1,704 3. Registration and/or Licensing of Business Premises (i) Approximate number of business premises in the Borough and functions involved. OFFICES, SHOPS AND RAILWAY PREMISES ACT. 1963 NO. FOOD PREMISES BUSINESS DESIGNATION SUBSIDIARY FUNCTIONS NO. Registration 94 Local Authority 2,430 Butcher 136 H.M.F. Inspector 859 Canteen/Staff* 51 Exempt 2,063 Canteen/School* 72 Total 5,354 Catering/Public 186 Catering/Misc.* 3 Class of Premises Registered by Local Authority Chemist 86 Office 533 Confectionery 280 Retail Shop 1,613 Fishmonger 51 Wholesale 94 Fish Frier 45 Catering/Public 186 Greengrocer 160 Fuel Store 6 Grocer/General 327 Factories Act, 1961 Off-Licence 97 Power 800 Public House 87 Non-power 59 18 Trade Store/Multiple 14 Depots/Food Storage 63 Non-food 3,710 Stall/Vehicle 308 Food 1,644 71 (ii) Details of Registrations/Licences ACT OR REGULATION ON REGISTER 31.12.1970 Food and Drugs Act, 1955 Ice-cream Premises 878 Food Preparation, etc. Premises 97 Milk and Dairies (General) Regulations, 1959 Distributors 264 Dairies 8 Milk (Special Designation) Regulations, I960 Pasteurised 197 Sterilised 226 Untreated 27 Ultra Heat Treated 57 Essex County Council Act, 1952 Hawkers of Food 201 Hawkers' Storage Premises 37 Leyton Corporation Act, 1950 Section 63 - Vendors of Shellfish 16 Section 48 - Hairdressers' Premises 244 Pet Animals Act, 1951 Annual Licences 24 Animal Boarding Establishments Act, 1963 3 Rag Flock and Other Filling Materials Act, 1951 11 Riding Establishments Act, 1964 1 Total 2,291 72 4. Legal Proceedings (i) Public Health Acts, 1936/61; Clean Air Act, 1956 83 applications were made for legal proceedings to enforce the requirements of notices served. 22 cases were subsequently heard by the court and abatement orders made. The remaining 61 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 110 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 Legal proceedings were authorised in respect of 10 contraventions under Food Hygiene (General) Regulations, I960. Analysis of Legal Proceedings SEC. ACT/ REG. NATURE OF OFFENCE NUMB ER OF OF FEN C ES FINES IMPOSED £ 6 Articles of equipment not kept clean and in good order and condition 3 30 8 Food so placed as to involve risk of contamination 1 15 9 Smoking in a room in which there was open food 1 3 14 Failure to maintain sanitary convenience in a clean and/or efficient condition 1 5 16 Failure to provide a wash basin and/or hot and cold water supply and/or hand washing requisites 2 15 23 Walls/floors/ceilings and/or woodwork not maintained in clean condition 2 30 Total 10 98 Total Costs awarded to the Council 27 73 (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.10., 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 19 contraventions under Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966. Analysis of Legal Proceedings SEC. ACT/REG. NATURE OF OFFENCE NUMBER OF OFFENCES FINES IMPOSED £ s. d. 4 Food stall insanitary and food exposed to risk of contanimation 2 10. 0. 0. 5 Failure to maintain delivery vehicle in clean condition 1 25. 0. 0. 6 Cleanliness of equipment 1 30. 0. 0. 7 Food not protected from risk of contanimation 2 35. 0. 0. 8 Personal cleanliness 2 20. 0. 0. 9 Persons handling open food not wearing washable overclothing 3 12. 0. 0. 13 The name and address of the person carrying on the food business was not legibly and conspicuously displayed 1 2. 0. 0. 15 Failure to supply clean wholesome water 1 2. 0. 0. 16 Failure to provide suitable wash hand basins and failure to supply hot water 2 7. 0. 0. 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 A 20. 0. 0. Total 19 163. 0. 0. Total Costs awarded to the Council 19. 10. 0. 74 5. Sampling - Food and Drugs Act, 1955 Samples Submitted for Chemical and Bacteriological Examination TYPE OF EXAMINATION AND ANALYSIS OF RESULTS MISC. FOODS MILK ICE CREAM ICE LOLLIES COOKED MEATS WATER DRINKING SWIMMING POOLS No. Chemical 88 — — — — 1 5 No. Bacteriological 17 48 18 — 65 — 14 No. Satisfactory 88(C) 17(B) 46 12 — 54 1 5(C) 13(B) No. Fairly Satisfactory — — 6 — 8 — 1(B) No. Unsatisfactory — 2 — — 3 — — 6. Meat and Food Condemned Condemnation certificates were issued in respect of the under-mentioned unsound foodstuffs surrendered by various traders in the Borough as a result of routine inspection of food premises. COMMODITY TINS PACKETS/ BOXES/ BOTTLES QUANTITY TONS CWT. ST. LBS. Tinned Goods 717 — — — — — Tinned Meats 82 -— — 5 — — Tinned Fruit 24 — — 1 3 3 Frozen Foods — 10,351 — — — — Fish — — — 6 1 4 Meat — — — 14 1 5 Vegetables — — — — 7 4 Fruit — — 7 1 6 75 7. Factories Act, 1961 The following are the prescribed particulars required by Section 153 (1) of the Factories Act, 1961, to be included in annual reports. 1. Inspections PREMISES (1) NUMBER ON REGISTER (2) NUMBER OF INSPECTIONS (3) WRITTEN NOTICES (4) OCCUPIERS PROSECUTED (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 18 12 8 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 860 241 28 — (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 41 43 — — Total 859 296 36 — 2. Cases in which defects were found PARTICULARS (1) NUMBER OF CASES IN WHICH DEFECTS WERE FOUND NUMBER OF CASES IN WHICH PROSECUTIONS WERE INSTITUTED (6) FOUND (2) REMEDIED (3) REFERRED TO H.M. INSPECTOR (4) BY H.M. INSPECTOR (5) Want of cleanliness — — — — — Overcrowding (S.2) — -— — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) 2 2 — 2 — Sanitary Conveniences (S.7) (a) Insufficient 4 1 — 3 — (b) Unsuitable or defective 28 22 — 26 — (c) Not separate for sexes 7 3 — 7 — Other offences against the Act (not including offences relating to out-work) — — — — — Total* 41 28 — 38 — * See also Contraventions under the Offices, Shops and Railway Premises Act, 1963. 76 3. Outwork NATURE OF WORK SECTION 133 SECTION 134 NO. OF OUTWORKERS IN AUGUST LIST REQUIRED BY SECTION 133 (1) (C) NO. OF CASES OF DEFAULT IN SENDING LISTS TO THE COUNCIL NO. OF PROSECUTIONS FOR FAILURE TO SUPPLY LISTS NO. OF INSTANCES OF WORK 1N UN WHOLESOME PREMISES NOTICES SERVED PROSECUTION S Wearing apparelMaking 1 19 — — — — — Footwear 1 — — — — — Umbrellas, etc. — — — — — — Handbags 4 — — — — — Artificial flowers 4 — — — — — Garment hangers 18 — — — — — Boxes, etc. wholly or partly of paperMaking 23 — — — — — Gents Neckwear 24 — — — — — Upholstery trimmings 2 — — — — — Brushes 3 — — — — — Loose cover specialist — — — — — — Toys 6 — — — — — Watch strap — — — — — — Buttons, carding — — — — — — Christmas crackers, etc. 8 — — — — — Belts for power transmissions 2 — — — — — Lampshades 8 — — — — — Household Linen — — — — — — Curtain and furniture hangings — — — — — — File making 2 — — — — — Furniture and upholstery — — — — — — Caning — — — — — — Hampers and Baskets 9 — — — — — Paint Boxes 6 — — — — — Total 239 — — — — — - 77 - SCHOOL HEALTH SERVICE SCHOOL POPULATION NUMBER OF SCHOOLS NUMBER OF PUPILS ON SCHOOL REGISTERS AT END OF YEAR Nursery 2 167 Primary 74 20,341 Secondary 27 13,153 Special 6 535 Totals 1970 109 34,196 1969 108 32,799 1968 107 31.221 SCHOOL MEDICAL INSPECTION (a) Periodic Medical Inspections 1970 1969 1968 5 year age group 2,766 3,172 2,719 10-11 year age group 1,212 1,214 1,480 14 years age group 1,169 1,725 2,018 Others 704 751 1,315 Total 5,851 6,862 7,532 No. of special inspections 1,409 1,351 1,618 No. of re-inspections 5,019 4,721 4,701 6,428 6,072 6,319 (b) Physical Condition of Children Inspected AGE GROUP INSPECTED (BY YEAR OF BIRTH) NO. OF PUPILS INSPECTED PUPILS WHOSE CONDITION WAS CLASSIFIED UNSATISFACTORY 1966 and later 87 — 1965 1,030 — 1964 1,647 2 1963 217 — 1962 86 — 1961 129 — * I960 879 — * 1959 333 — 1958 135 — 1957 29 — 1956 108 — 1955 and earlier 1,169 — Total 5,849 2 * Selective Medicals - A total of 703 children were found not to warrant a medical examination. 79 (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 TOTAL INDIVIDUAL PUP1LS 1966 and later 8 17 21 1965 75 147 204 1964 120 157 273 1963 22 19 35 1962 14 14 26 1961 12 23 34 I960 96 128 209 1959 36 38 67 1958 4 4 8 1957 2 4 5 1956 20 18 33 1955 and earlier 178 116 279 Total 587 685 1,194 80 (d) Pupils found to have undergone tonsillectomy AGE GROUP NO. INSPECTED NO. FOUND TO HAVE UNDERGONE TONSILLECTOMY BOYS GIRLS BOYS GIRLS Infant 1,421 1,345 55 38 Junior 650 562 57 56 Leaver 475 964 59 133 Other 373 331 25 22 Totals 2,919 2,932 196 249 (e) Pupils found to have defects of colour vision INTERMEDIATE INSPECTIONS LEAVER INSPECTIONS OTHERS Tested for Colour Vision 1,212 1,169 704 Found to have defects of colour vision — 20 - (f) Parents present at Medical Inspection NO. INSPECTED PARENT PRESENT PER CENT. Infant Boys 1,421 1,288 90.6 Girls 1,345 1,188 88.3 Junior Boys 650 473 72.8 Girls 562 413 73.5 Leaver Boys 475 40 8.4 Girls 694 151 21.8 Other Boys 373 196 52.5 Girls 331 175 52.9 81 82 (g) Defects found by Periodic and Special Inspections during the year DEFECT CODE NO. DEFECT OR DISEASE PERIODIC INSPECTIONS SPEClAL INSPECTIONS ENTRANTS LEAVERS OTHERS TOTAL (ALL GROUPS) TREATMENT OBSERVAT1ON TREATMENT OBSERVATION TREATMENT OBSERVATION TREATMENT OBSERVATION TREATMENT OBSERVAT1ON 4 Skin 45 86 35 19 51 37 131 142 109 50 5 Eyes (a) Vision 203 163 178 27 206 82 587 272 84 54 (b) Squint 41 45 5 2 19 22 65 69 — 1 (c) Other 6 19 8 3 25 22 39 44 7 8 6 Ears (a) Hearing 28 80 3 17 19 61 50 158 34 23 (b) Otitis Media 8 71 1 20 11 40 20 131 3 1 (c) Other 6 21 4 1 8 18 18 40 4 1 1 7 Nose and Throat 67 226 9 26 28 133 104 385 32 22 8 Speech 25 152 1 3 8 47 34 202 31 10 9 Lymphatic Glands 1 1 60 3 4 2 31 16 95 — 1 10 Heart 9 45 — 9 1 37 10 91 1 5 11 Lungs 18 84 3 22 17 47 38 153 — 11 12 Developmental (a) Hernia 2 23 1 — 3 10 6 33 1 (b) Other 12 213 7 28 15 151 34 392 21 41 13 Orthopaedic (a) Posture 5 22 5 44 7 55 17 121 4 4 (b) Feet 62 135 12 17 30 72 104 224 12 4 (c) Other 14 57 9 14 15 82 38 153 46 16 14 Nervous System (a) Epilepsy 3 11 5 — 4 9 12 20 1 2 (b) Other — 21 3 5 7 26 10 52 6 12 15 Psychological (a) Development 8 98 1 8 4 98 13 204 9 13 (b) Stability 19 228 3 10 10 158 32 396 32 80 16 Abdomen 4 16 — 11 3 25 7 52 5 9 17 Other 7 34 1 19 11 36 19 89 119 35 OTHER MEDICAL INSPECTIONS (a) Employment of children (other than in entertainment) (i) initial examinations 120 (ii) re-examinations — (b) Employment of children in entertainment (i) initial examinations 1 (ii) re-examinations — EXAMINATIONS BY SCHOOL NURSES Head Inspections Number of examinations 13,503 Number of children found to be unclean 164 Vision Testing at School Number of children tested 18,947 Number referred to Eye Clinic 627 Foot Inspections at School Number of children inspected 4,494 Number referred for treatment 112 MINOR AILMENT CLINICS New Cases Boys Girls Ringworm - Head 2 — Body 1 — Scabies 2 — Impetigo 3 3 Other Skin Diseases 89 100 Defective Vision and Squint 221 188 Other Eye Defects 26 23 Defective Hearing 146 1 19 Other Ear Diseases 29 31 Nose and Throat Defects 81 91 Speech Defects 69 30 Lymphatic Glands 31 12 Heart and Circulation 17 22 Respiratory Diseases 29 13 Developmental Defects 151 101 Orthopaedic Defects 140 155 Nervous Disorders 35 33 Psychological Disorders 261 155 Other Defects and Diseases 212 209 1,555 1,285 Total attendances 4,453 83 SPECIALIST CLINICS 1970 1969 1968 (a) Aural Sessions 66 60 61 New cases 240 286 271 Total attendances 791 818 794 Referred to hospital for operative treatment 202 222 192 (b) Ophthalmic Sessions 377 365 373 New cases 974 889 877 Attendances 6,472 5,965 5,342 Glasses prescribed 1,366 1,292 1,215 Glasses obtained (i) through H.M.C. optician 1,079 1,011 919 (ii) privately 287 281 270 (c) Orthoptic Sessions 381 261 340 New cases 216 158 253 Attendances 1,576 982 2,011 (d) Orthopaedic Sessions 61 61 59 New cases 430 41 1 331 Attendances 1,607 1,558 1,418 Appliances provided 514 348 215 (e) Physiotherapy Sessions 560 527 644 New cases 190 189 146 Attendances 2,425 2,679 2,760 (f) Paediatric Sessions 20 22 22 New cases 53 62 85 Attendances 141 100 180 (g) Child Guidance Cases referred or re-opened for treatment during year:- (i) Under 5 years-Boys 40 43 43 Girls 34 24 21 (ii) Over 5 years-Boys 234 222 230 Girls 170 133 139 478 422 433 Cases closed during year 315 657 170 84 DENTAL INSPECTION AND TREATMENT (a) Attendances and Treatment AGES 5 TO 9 AGES 10 TO 14 AGES 15 AN D OVER TOTALS 1970 1969 1968 First visit 4,616 2,876 271 7,763 6,991 5,916 Subsequent visits 5,910 4,237 557 10,704 11,133 10,272 Total visits 10,526 7,113 828 18,467 18,124 16,188 Additional courses of treatment commenced 288 126 13 427 1,081 851 Fillings in permanent teeth 3,074 5,211 774 9,059 8,189 9,048 Fillings in deciduous teeth 6,933 817 — 7,750 7,838 6,532 Permanent teeth filled 2,762 4,926 729 8,417 7,606 7,541 Deciduous teeth filled 6,569 786 — 7,355 7,253 5,728 Permanent teeth extracted 153 612 64 829 1,308 747 Deciduous teeth extracted 2,395 847 — 3,242 3,661 3,319 General anaesthetics 822 436 29 1,287 1,394 1,452 Emergencies 275 127 16 418 253 260 1970 1969 1966 Pupils X-rayed 368 375 332 Prophylaxis 3,147 2,033 1,714 Teeth otherwise conserved 1,209 1,305 782 Teeth root filled 37 12 27 Inlays 4 4 1 Crowns 27 32 39 Courses of treatment completed 6,137 5,266 4,893 85 (b) Orthodontics 1970 1869 1968 New cases commenced during year 75 76 70 Cases Completed during year 60 81 92 Cases discontinued during year 4 8 13 Removable appliances fitted 76 100 97 Fixed appliances fitted 5 3 — Pupils referred to Hospital Consultant 9 3 2 (c) Prosthetics 5 TO 9 10 TO 14 15 & OVER TOTAL Pupils supplied with F.U. or F.L..(first time) — — — — Pupils supplied with other dentures (first time) — 8 5 13 Numbers of dentures supplied 2 10 6 18 1970 1969 I968 (d) Anaesthetics General Anaesthetics administered by:- Dental Officers — — — Medical Officers 1,052 1,358 846 (e) Inspections (i) First inspection at school:- Number of Pupils 13,836 14,045 13,513 (ii) First inspection at clinic:- Number of Pupils 3,118 2,835 3,405 Number found to require treatment 10,116 9,459 9,637 Number offered treatment 9,267 8,971 7,808 (iii) Pupils re-inspected at school clinic 1,290 516 999 Number found to require treatment 664 329 252 (f) Sessions Sessions devoted to treatment 3,266 3,175 3,278 Sessions devoted to inspection 116 111 122 Sessions devoted to Dental Health Education 23 78 25 86 SPEECH THERAPY (a) Attendances DAWLISH ROAD HATCH LANE HURST ROAD TOTAL Number in attendance at beginning of year 99 71 69 239 Number under observation at beginning of year 122 3 22 147 New cases 81 69 54 204 Re-admitted — 1 — 1 Transfer from other clinics 1 2 1 4 Discharges-cured 34 56 25 115 improved 2 3 7 12 defaulted — 13 4 17 transferred to other clinics 3 3 3 9 left district 14 2 2 18 no progress — — 2 2 Number in attendance at end of year 98 69 84 251 Number under observation at end of year 152 — 19 171 87 (b) Analysis of defects treated DAWLISH ROAD HATCH LANE HURST ROAD TOTAL Stammer 11 15 7 33 Dyslalia 117 94 56 267 Stammering and dyslalia 3 1 8 12 Delayed language development 24 32 33 89 Cleft palate speech 2 1 1 4 Voice defects 2 1 2 5 Speech defect due to deafness 4 — 16 20 Defects of neurological origin — 2 19 21 Unclassified — — 4 4 New cases referred 202 Attendances during year 6,291 HANDICAPPED PUPILS BLIND PARTIALLY SIGHTED DEAF PARTIAL HEARING PHYSICALLY HANDICAPPED DELICATE MALADJUSTED E.S.N. EPILEPTIC SPEECH DEFECT TOTAL Children newly assessed as handicapped during year ended 31.12.1970:- Boys — 1 — 1 8 3 11 29 — — 53 Girls — — — 5 12 — 7 10 — — 34 Children who on 21.1.1971 were receiving special educational treatment:- (i) at maintained special schools:- (a) Day — 9 8 12 65 3 48 232 4 6 387 (b) Boarding — 3 — 1 1 1 8 4 — — 18 (ii) at non-maintained special schools:- (a) Day — — — — — — — — — — — (b) Boarding — — 1 — 1 2 6 — 1 — 1 1 (iii) at independent schools — — — — — — 11 1 — — 12 (iv) at boarding homes — — 1 — — 1 — — — — 2 (v) special classes or units — — — 7 — — — — — — 7 Children awaiting placement in special schools at 21.1.1971. — — — 2 2 — 1 1 — — 6 Children who, at 21.1.1 971 were being educated:- (i) at hospital — — — — 3 — 13 — — — 16 (ii) at home — — — — — — 1 — — — 1 88 SPECIAL SCHOOLS Brookfield House School for Physically Handicapped Children At the end of 1970 the medical classification of the 86 children on the roll was as follows:- Congenital Deformities 6 Cerebral Palsy 28 Cardiac Disabilities 4 Muscular Dystrophy 3 Haemophilia 5 Perthes Disease 2 Spina Bifida 3 Asthma 13 Other Physical Handicaps 22 Joseph Clarke School for Partially Sighted Children The ophthalmic conditions on admission of the 68 children who attended the school during 1970 were as follows:- Albinism 5 Aniridia 7 Cataracts 26 1 Congenital Day Blindness Detached Retina 1 Dislocation of the Lenses 3 High Myopia 7 Iridocyclitis 3 Microphthalmos 1 Nystagmus 6 Optic Atrophy 7 Retinal Degeneration 1 Retinoblastoma 1 Retrolental Fibroplasia 1 Coloboma 1 Macular degeneration 1 Retinitis pigmentosa 2 Their visual acuities (Snellen), after correction, were as follows:- Visual acuity of less than 6/60 22 Visual acuity of 6/60 21 Visual acuity of 6/36 14 Visual acuity of 6/24 11 Visual acuity of 6/18 4 Not yet assessed because of age 2 William Morris School for the Deaf Of the 92 children on the roll at the end of the year 70 were classified as deaf and 22 as having partial hearing. 89 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 1970 WARDS FLATS HOUSES Chingford South 210 — Leyton Central 47 — Cann Hall 289 — Walthamstow East 206 — West 235 4 987 4 Dwellings completed by private enterprise during 1970 WARDS FLATS HOUSES Chingford Central 30 — North-West 9 5 South 5 — Hale End 13 20 1 Leyton Forest — Leyton 4 — Walthamstow East 1 — West 2 22 64 48 Dwellings completed by Housing Associations during 1970 WARDS FLATS Chingford Central 34 Leyton Forest 6 Walthamstow East 18 58 NOTE: All were permanent houses and flats. 91 In addition to the main building programme, improvements and conversions were carried out at a number of Council owned properties. Improvement Grants Applications received 1,275 DISCRETIONARY STANDARD Total number of grants approved 257 551 Total amount of grants approved £136,658 £109,457 (b) Contributed by H.Thorne, Esq., A.I.H.M., Borough Housing Manager. Properties in Management at December 1970 Pre-War houses 1,973 Pre-War flats 130 Post-War houses 1,860 Post-War flats 9,177 Out Borough houses 840 Out Borough flats 59 Prefabricated bungalows 24 Acquired properties 3,084 17,147 Garages 4,072 21,219 Number of properties made available for letting Number of properties 1,422 Families rehoused Number rehoused 1,450 92 - 93 - METROPOLITAN WATER BOARD - WATER EXAMINATION DEPARTMENT AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE LONDON BOROUGH OF WALTHAM FOREST DURING 1970 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 CL 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) (i) (2) (3) (4) (5) (6) (7) (8) (9) (10) do (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) Thames-derived 363 0.026 0.083 4.8 1.02 274 79 5 27.7 5.6 40 2.7 9 70 0.20 0.03 0.1 1 1 7.9 570 Lea Bridge 52 0.022 0.096 5.3 I.I 1 304 98 7 35.4 6.6 48 3.5 10 92 0.25 0.03 0.2 13 7.9 640 Chingford Mill 4 0.190 0.019 0.9 0.30 285 71 27 0.50 0.1 6 7.4 530 Coppermills 52 0.012 0.105 5.6 1.14 306 109 7 35.4 6.6 50 3.5 9 92 0.25 0.03 0.1 10 7.9 640 - 94 - BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1970 OF WATER SUPPLIED TO THE LONDON BOROUGH OF WALTHAM FOREST Source of supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Collform count Escherichia coll count Number of samples Agar plate count count Collform count E. coll count 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. 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. Lea Bridge 2,709 76.7 - 32.85 1 1.8 54.60 2.9 429 28.9 - 99.53 99.77 Chingford Mill 247 0.1 9 99.60 - 99.60 - 251 0.1 4 100.0 100.0 Th ames-derived 8,259 31.9 • 37.91 17.3 53.58 4.7 3,710 8.0 - 99.92 99.97 Coppermills 723 50.0 - 23.52 12.5 40.94 5.2 257 12.5 - 98.44 100.0 INDEX A Pages Adaptation of premises 55 Aids for handicapped persons 56 Alice Burrell Centre 26,28 Analgesics 44 Animal Boarding Establishments Act 1963 67 Audiology Clinic 17,19 Aural Clinics B Birkbeck Adult Training Centre 14 Births 41,43 Births - Congenital abnormalities 18 Blind 55 Blind Homeworkers 55 Blind, registration of 53 Bronchitis 8 Brookfield House School for Physically Handicapped children 89 Burial of the Dead 58 Business premises, registration and licensing of 71 C Cancer 7,8,9,43 Car badges for disabled drivers 56 Catering, Welfare 26 Causes of Death 9,42 Cecil House 12 Cervical Cytology Clinics 48 Child Care Officers 26 Child Development Sessions 24,47 Child Guidance Clinics 84 Child Health 17 Child Welfare Clinic Attendances 45 Children "At Risk" 48 Children, dental treatment of 48 Children, handicapped 18,19 Chingford Red Cross 50 Chiropody Treatment 51 Cigarette Smoking 5,8,9,29 Claybury Hospital 23 Clean Air Act 1956 20,67.73 Clean Food Regulations 9 C (cont.) Pages Committee 1 Communicable Disease 7 Compulsory Purchase Orders 68 Condemned meat and food 75 Congenital Malformation 18,48 Convalescence 51 D Day Centres 12 Day Nurseries 13,18,47 Deaf, registration of 54 Deaths 41 Deaths - Causes of 9,42 Deaths - from Cancer 43 Dental Laboratory 66 Dental Service 19,48,66,85,86 Diphtheria 8 Disabled drivers car badges 56 Disabled persons homes, registration of 65 District Nurses 25,50 Dysentery7 E Elderly, warden supervised housing for 5 Emphysema 8 Environmental hygiene 9 Environmental Services 19,67 Essex County Council Act 1933 - Establishments for Massage and Special Treatment 65 Essex Hall 10,14,35 Examinations by School Nurses 83 Expectant and Nursing mothers, dental treatment 48 F Factories Act 1961 67,76 Families Rehoused 92 Family Planning 49 Fieldwork Services 19 Food additives 34 Food and Drugs Act 1955 20,67,68,71,72, 73,74 Food and meat condemned 75 F (cont.) Pages Food for Human Consumption 31 Food Hygiene Regulations 7,20,32,34,67, 68,71,73,74 Food Legislation 34 Food Poisoning 7,32 G Gastro-enteritis 7 Grosvenor House School 12,19 H Handicapped, aids for 56 Handicapped Children 18,19 Handicapped, holidays for 56 Handicapped school pupils 88 Health and Welfare Committee I Health Education 10,28 Health Visiting 22,49 Health Visiting - attachment to G.Ps 22,30 Health Visiting - liaison with hospitals 22 Heart Disease 8,9 Heathcote Lodge 10,35 Holidays for handicapped persons 56 Home Help Service 51 Homeless Families Accommodation 12,58 Home Nursing 25,50 Hostel for the Subnormal Housing 21,91 Housing Act 1957 21 Housing Act 1969 21,67 Housing Acts Regulations 67,68 Housing Associations 91 I Immigrants, tuberculosis among 63 Immunisation and vaccination 7,8,64,65 Improvement Grants 92 Incontinent Laundry Service 58 Industrial Unit '7 Infectious Diseases 7,8,9,62 Infant Mortality 41 Infants and Toddlers Clinics 18,31 Infants, premature 43 Ischaemic Heart Disease 8,9 J Pages Jaundice7 Joseph Clarke School for Partially Sighted Children 89 L Langthorne Hospital 22 Laundry for the Incontinent 58 Luncheon Clubs 26,27,28,58 M Massage and Special Treatment, establishments for 65 Maternal Mortality, 41 Meals-on-Wheels 26,27,58 Meals Service, School 26 Medical examinations of staff 65 Medical inspections, school 79,80,81 Medical inspections, other 83 Medical Research Council 36 Mental Health Act 1959 - Registration of Nursing and Residential Homes 65 Mental Health Service. 26,59 Mental Subnormai ity 12 Midwifery 25,44 Midwifery - Clinic Sessions 44 Minor Ailments Clinics .. . 83 Mortality Rates 41 Mothercraft and Relaxation Classes 47 Mothers' Clubs 25 N National Assistance Act 1948 - Registration of Disabled Persons and Old People's Homes 65 Neighbourly Help Service 53 Noise Abatement Act I960 20,67 Nurseries and Child Minders Regulations, 1948 47 Nursery Schools 13 Nursing Homes, registration of 65 0 Offices, Shops and Railway Premises Act 1963 20,67,69 Old People's Homes 10,57,58 Old People's Homes - registration of 65 Ophthalmic Clinics 84 Orthopaedic Clinics 84 Orthoptic Clinics 84 P Pages Paediatric Clinics 84 Partially-sighted, registration of 53 Pet Animals Act 1951 67,72 Physically Handicapped, registration of 54 Physiotherapy Clinics 84 Play Groups 13,18,25,31 Population 41 Population - School 79 Premature Infants, care of 43 Premises, registration of 65 Premises, registration of - issue of licences 20 Prevention of Damage by Pests Act 1949 67,71 Psychiatric Rehabilitation Association 16 Public Health Acts 67,68,71,73 Public Health Acts - Statutory Notices 19,20 Public Health Act 1936 - registration of Nursing Homes 65 Public Health Inspection 19,67 Q Queens Road Adult Training Centre 15 R Rainfall • 37 Red Cross, Chingford 50 Redevelopment and Slum Clearance 21,68 Registration of Premises ; 65,71 Registration of Premises - issue of licences 20 Rehabilitation 55 Rent Act 1957 68 Rent Arrears 25 Residential Accommodation '0 Residential Accommodation for the Subnormal Riding Establishments Act 1963 67 Roberts Hall Work Centre ; 14,35,55 S St.James' Health Centre 6,26,29 Scarlet Fever 8 School Dental Service 19,66 School Health Service 17,79 School Meals Service 26 School Medical Inspections 18,79,80 School Population S (cont.) Pages Sewerage 9,37 Sheltered Warden Supervised Housing for Elderly 5 Sheltered Workshops 55 Sickroom Equipment 50 Slum Clearance and Redevelopment Schemes 21,68 Smallpox 8 Smoke Controlm 20 Smoking, cigarette 5,8,9,29 Social Responsibility Centre 10,27,34 Social Workers 26 Spastics Society Workshop 55 Specialist Clinics 84 Special Schools 89 Speech Therapy 87 Staff 2,3 Staff - Medical Examinations 65 Statistics 41 Subnormal ity 2 Subnormal, Hostel for 11 Subnormal, residential accommodation for 5 Sylvan Lodge 11 T Temporary Accommodation 12,58 Thorpe Coombe Maternity Hospital 24,25 Training Centres, Mental Health 62 Tuberculosis 8,62,63 Typhoid 1 U Unfit Dwellings 21 V Vaccination and Immunisation 7,8,64,65 Venereal Disease Vital Statistics 41 Voluntary Organisations 6,39 W Walthamstow Round Table '4 Warden - supervised housing for the elderly 5 Water Examination 93,94 W (cont.) Pages Water Supplies 37 Weights and Measures Act 33 Welfare Catering 26 Welfare Foods and Nutrients 46 Whipps Cross Hospital 9,23,25 William Morris School for Deaf 89 Women's Royal Voluntary Service 27 Woodlands '2 Work Centre for the Physically Handicapped - Roberts Hall 14,35,55 Workshop, Spastic Society 55 Workshops, Sheltered 55 .