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29ac057d-2e42-429a-9885-e968c8df52e6 | They are keen to have the whooping cough injections, however, and we thus feel that our results using the combined" method are of practical importance. Infective Hepatitis Towards the end of March one or two general practitioners informed me that they were meeting cases of infective hepatitis epidemic jaundice) in the Ripple Road area. Infective hepatitis is not, unfortunately, a notifiable disease in Barking, but I immediately asked all doctors in the Borough to let me have an unofficial notification of such cases. Enquiries revealed that there had been four cases in the Becontree area during the matter months of 1953, but no connection could be Page 21 traced with the outbreak which followed at the other end of the Borough during 1954. The first case in "Old" Barking occurred in January, 1954, in a girl attending the Westbury Infants' School. In February there were 4 further cases 2 of these being in the same class as the first case. |
732862e7-1655-4902-b8a1-f59b8ad26a0b | The elder sister of the first case also developed the disease in February, and spread infection to the Junior School. From there on the disease spread throughout the two departments, there being a total of 37 cases in the Infants' Department and 46 in the Junior School during the year. There was a short outbreak at the Church of England School from February to June involving 13 children. In April the first of 28 cases developed in the Gascoigne Infants' School, and the following month saw the spread of infection to the Junior Department in which 36 cases had been reported by the end of the year. Ripple Infants' School first became involved in August and the Junior School in October, 5 infants and 13 juniors developing jaundice before the end of the year. There were also 58 cases amongst children attending various other schools. It had been hoped that the infection would die out during the long summer school holidays, but early in the September Term it was apparent that this had not happened. |
c2397959-9d75-483b-aac7-3aca2e4efc10 | I personally v sited each of the schools primarily affected together with the appropriate Health Visitor, and we took the opportunity of explaining to the members of the teaching staff the methods by which the spread of infection was believed to take place and the hygienic measures necessary to control it. I also suggested to the Barking Committee for Education that we should try the effect of excluding known contacts from school during the two-week period when it was most likely that the contacts would be in an infectious stage. Analysis of the results of this policy was not encouraging: 51 children were excluded from school and of these only 7 subsequently developed attacks of hepatitis; 2 of these 7 children became ill before the beginning of the exclusion period and 4 developed the disease following exclusion at intervals varying from 1—11 days after return to school. Only 1 case developed the disease during the exclusion period. Exclusion was, therefore, discontinued after the Christmas holidays. |
03ae9999-babd-42fa-9bb8-9b4040f64f9f | By November figures suggested that whilst the outbreak was drying out or was stationary in other schools, infection at the Gascoigne Page 22 Junior School was spreading and other measures of combating the disease had to be considered. It was known that a substance called gamma-globulin, prepared from human blood, had been used successfully in America for the prevention of infectious hepatitis, although it was not certain whether the gamma globulin prepared from British blood donors had a similar protective effect. We did know it was harmless however, and it was worthwhile trying it out. An approach was, therefore, made to the Central Public Health Laboratories at Colindale and Dr. McDonald kindly promised us a supply. This was offered to all children attending the Gascoigne Junior School, and 83% of the parents gave their consent for the injections which were carried out on 29th November; 278 children were injected and of these only one subsequently developed jaundice. |
053256e2-f3bd-4d00-9f8c-5079f64e8c02 | This child became ill only 48 hours later and was thus obviously about to develop the disease when the injection was given. Of the 98 children who did not receive gamma globulin (either because consent had not been given or because they were believed to have had the disease already) 3 subsequently developed jaundice. These figures suggest that gamma globulin was of value, but must be interpreted with caution since the two groups of children may not have been exactly alike. Those whose parents gave consent might possibly have come from homes where the standards of hygiene and care were above average, and wer cases might have occurred in this group even had they not been injected. Opportur, y for a reliable assessment of the value of gamma globulin was provided in early 1955 and a short note on the results might not be cut of place in this year's report. |
6dad71e3-3ab6-49a3-9ce6-26d75d3c35e0 | On the first day of the Spring Term the Headmaster of Ripple Junior School telephoned roe to say tha 0 or more of his pupils were away believed to be ill with jaundice. Dr. McDonald was again approached with a request for gamma globulin but unfortunately only about 200 doses were available. Sir judging by the demand at Gascoigne, we were expecting some 00 parents to ask for gamma globulin, an immediate decision had to be made whether to inject all the children in certain selected classes whether to give equal opportunities to all children in the school. he latter alternative was chosen and parents were asked whether they would like their children to have the chance of having an injection; 432 parents gave their consent and alternate names on class rolls were picked to receive the injections; 207 children received injections of gamma globulin on the 19th January (7 others chosen being absent), whilst 218 children were observed as "controls". |
96cd0f16-e892-4565-a4cf-cdeebd326c0e | Page 23 There were two cases of jaundice amongst the children who received gamma globulin. As before, however, both children must have been on the point of developing the disease since they fell ill within 48 hours, and the gamma globulin could not have been expected to stop the attack. Of the children who did not receive an injection, 5 subsequently developed jaundice at intervals varying from 3 to 9 weeks, thus providing valuable and fairly substantial evidence that the gamma globulin prepared in this country is of value in preventing jaundice. I must record my very sincere thanks to Dr. McDonald for his expert advice and for coming to Barking personally to help Dr. Adamson and myself give the injections both at Gascoigne and at Ripple Schools. We all owe much to Mr. Wood and Mr. Aston, headmasters of the two schools, for the excellent arrangements and for their help subsequently in following up all children with suspicious symptoms. |
56af0545-ceef-4805-acc5-311f75c5fc4d | Since we believe that this is one of the first "controlled' trials of gamma globulin carried out in this country, Dr. McDonald and 1 hope to publish these results in one of the medical journals. Unfortunately the shortage of gamma globulin will prevent its use on any wide scale as a method of controlling the spread of this infection. TUBERCULOSIS During the year, the Ministry of Health published a memorandum on the prevention of tuberculosis. I took the opportunity of submitting to you a fairly detailed summary and certain comments thereon, and I think that many of the points bear repetition here. The memorandum pointed out that whilst deaths from tuberculosis have been falling rapidly during the past five years, there has been a very much smaller decline in the number of notifications. This, it was suggested, called for intensified efforts to bring the disease finally under control. METHODS OF CONTROL It cannot be emphasized too often that tuberculosis is an infectious disease and that the same principles of control apply. |
1afe06c5-3286-4896-8077-e945faa196a0 | as with other, but more dramatic, infectious diseases. Can we not deal with tuberculosis with the sense of urgency that we should devote to say a smallpox outbreak? Tuberculosis has a longer incubation period and the epidemics therefore occur in “slow Page 24 motion", with one peak of infection superimposed upon another, but otherwise there is no fundamental difference. Let us consider the measures needed to control an outbreak of smallpox. These are:— (1) The doctor making the diagnosis must immediately inform the local Medical Officer of Health (notification). (2) The patient must be removed to hospital (isolation). (3) The immediate contacts must be protected by vaccination and then carefully watched for early symptoms of the disease (surveillance). (4) A careful search must be made for unsuspected but nevertheless highly infectious cases which may give rise to further spread of infection (tracing possible sources of infection). |
63503d05-aab5-4e22-9ccd-8de95557e5dd | (5) One measure should have been taken before the outbreak commenced—the routine vaccination of a large proportion of the population in early life, thus making a large epidemic unlikely (prior vaccination). Now can we apply these five principles to tuberculosis? NOTIFICATION The Ministry memorandum stated "completeness of notification of all detected cases is, of course, one essential contribution clinicians in or out of hospital should make". I could not agree more wholeheartedly. I did mention last year that I felt certain that by no means all rases of tuberculosis infection were being notified. A particularly good (or bad) example of this can be quoted this year in that a member of the Health Area staff, picked up as a case by mass X-ray examination, has been off duty for many months but has never been notified to me. On taking up this point with the Chest Physician he pointed out,quite correctly, that the regulations only require notification where a person is suffering from tuberculosis. |
cc1e6cc2-7db2-4d74-a16f-39b6f87a88ed | In this particular case the disease was not active and therefore she was not, in his opinion, suffering from the disease. This is solely a matter of opinion, although personally feel that where a patient has to stay away from work for such a prolonged period that person is indeed suffering from tuberculosis. There is urgent need for a revision of the tuberculosis regulations so that all cases of tuberculous infection are notifiable. Page 25 2. ISOLATION During the year waiting lists for admission to local sanatoria vanished for the first time, and we are now in the fortunate position of being able to secure the admission of any patient to hospital within a few days when this is necessary. There will now presumably be little demand for the loan of garden shelters for home isolation, since when the patient's condition demands it and where a separate bedroom is not available at home an immediate transfer to hospital will be made. |
30b55720-b8be-4378-a868-b8173406d683 | Where patients are, for one reason or another, being nursed at home the hygienic disposal of sputum is of great importance in the prevention of spread of infection. After discussion with Dr. Paterson I did make arrangements so that, on his recommendation, patients could obtain plastic sputum containers and supplies of a special disinfectant for use with these flasks. Later in the year the County Council's arrangements for the care and after-care of the tuberculous were modified so as to permit of these being provided routinely through Health Area sources. 3. SURVEILLANCE The tracing and regular examination of family cor acts is one of the main jobs of the chest clinic. It is a task which is carried out extremely well in Barking, although of course from time to time we fail to persuade relatives (particularly Granny or Grandad) to attend. B.C.G. vaccination is offered to all contacts where necessary. 4. |
39836b6f-fd17-4ba4-adf4-1387bdf804f6 | TRACING SOURCES OF INFECTION (a) Skin Tests The memorandum drew attention to the value of these skin test particularly amongst the school population—both to detect childhood infection and, indirectly through them, previously unsuspected adult cases of tuberculosis. I believe that a T.B. skin test should form anintegral part of every routine school medical examination and 1 had hoped to arrange this long ago. In view of the apparent unreliability of the jell) test in older children, referred to in my last year's r port, I thought it wise to await our experience with the "Heaf" test however. reported later will now enable me to submit suggestions for the incorporation of these tests with periodic medical examinations. Page 26 (b) Staff Examinations The memorandum also made reference to a circular issued in 1950 advising local authorities to arrange routine chest X-rays for all members of their staffs coming into contact with children, both prior to appointment and annually thereafter. |
ee119256-fbac-4b1a-9151-d283e3ef8c1a | The County Council has implemented this circular so far as staff of day nurseries is concerned, but not as yet in respect of Health Visitors, Medical Officers and other members of the Health Area staff. The reason for this is (so I believe) once again bound up with the unfortunate division of administrative responsibility. Routine X-rays carried out by mass X-ray units are free of charge to the local authority, but where such examinations are carried out at a chest clinic the Regional Hospital Board expects the local authority to pay a fee of £2 2s. per X-ray. The Regional Hospital Board adamantly refuse to waive this ridiculous distinction, whilst the County Council are unwilling to undertake the additional expense involved for the two years out of every three that we shall be without a visit from the mass X-ray unit. |
bc8890a6-0636-4213-9761-0c1d21438387 | Fortunately most of the members of the Health Area staff voluntarily submit themselves for X-ray examinations at intervals if and when a mass X-ray unit is working in the vicinity, although this sometimes involve what should be an unnecessary journey and an irritating waste of valuable time. Ministry of Education regulations already provide for the routine chest X-ray of new entrants to the teaching profession, but at present annual re-examinations remain a matter at the discretion of each local education authority. Arising out of a report to the Barking Committee lor Education you decided to refer to the Staff Consultative Committee a suggestion that all teachers should submit themselves to annual chest X-ray examination, and the staff side has agreed to take this matter to their members. I confidently expect that the teachers will respond favourably to the suggestion. |
8f8fef24-c3c9-403f-90ed-582d491df08d | I also earnestly hope that the administrative tangle will be sorted out before the since either teachers will have to travel to mass X-ray units in distance parts of London or the County Council will have to foot the bill for X-rays taken on the miniature camera installed in the Chest Clinic. (c) Mass Radiography The memorandum naively suggested that the strategic use of mass radiography units should be "a matter for consultation between the 'director of the -fit and the Medical Officer of Health". In practise Page 21 Page 28 this is difficult to achieve owing to the fact that several units may serve the area of one local health authority, whilst one unit may well cover an area including parts of several local health authorities. The memorandum continued: "There is much to be gained by selective use of radiography for groups which show some evidence of special risk, rather than for the re-examination of large groups of employed persons in conditions that facilitate the recording of exceptionally large totals of persons radiographed". |
114e72d0-0e41-44a4-90e3-90ea5ec71e69 | It seems to me unfortunate that this particular memorandum was stated to be for the information of Medical Officers of Health and Chest Physicians only. Here is a point which should be driven home with the directors of the X-ray units, for it is my impression that only too often their main concern is to achieve and maintain impressive statistics of examinations carried out. Early in the year we received a visit from the mass X-ray unit— our first since 1951. This unit worked mainly from the Baths Hall although we did manage to arrange sessions for school children and teachers at several other centres in order to reduce unnecessary travelling. The results of this survey, kindly supplied by the Director of No. |
8b004ceb-e0e0-4052-9ae1-113d7ff2bab5 | 6a Mass X-ray Unit, can be summarized as follows:— Total Number X-rayed Male Female Total Miniature films 4,084 4,014 8,098 Recall for large film 178 164 342 Did not attend for large film 5 7 12 Did not attend for investigation 1 - 1 Findings Total number of active pulmonary tuberculosis cases 4 2 6 Total number of inactive pulmonary tuberculosis cases 34 28 62 Other abnormalities-heart 10 24 34 -lungs 10 9 19 From this you will see that only 6 cases of active tuberculosis were discovered, a rate of 0.74 cases per 1,000, which is well below the national figure of 3.37. I felt that it was my duty to make certain that these 6 cases picked up had been notified to me, that they were receiving necessary treatment, that contacts had been examined and that attempts were being made to trace the source of infection. |
76dd3f46-1a67-4236-8fea-04420afc7e2c | Despite a voluminous corres pondence with the Director of the Unit he felt unable to give me the information requested regarding these patients, owing to strict instructions from the Ministry of Health regarding secrecy. Page 29 The Public Health (Tuberculosis) Regulations, 1952, clearly state that "every medical practitioner who forms the opinion that a person is suffering from tuberculosis shall, as soon as he forms that opinion, send to the Medical Officer of Health a certificate (of notification)", and since the directors are medical practitioners they cannot claim exemption from this obligation. I know that many directors of mass X-ray units will immediately say "we do not diagnose, we merely send patients with abnormal X-rays to the chest clinics for investigation and the chest physicians make the actual diagnosis". If this is so then I regard the practice of bringing the patient back to the unit for clinical examination to be a waste of time both for the patient and the director. |
8244187a-fc0b-43c1-a2b4-158e0f2d693a | Where, under the present system, the director sees both the patient and his X-ray he must on occasion "form the opinion that a person is suffering from tuberculosis", and I have the gravest doubts as to whether any administrative instruction from any Ministry can excuse anyone from obeying the law of the land. What really concerns me is that the existing ruling means that the Medical Officer of Health is deprived of information vital to him in the control of this disease. You yourselves have been most unhappy about the present position from other aspects. In particular you have been told that you cannot expect visits from the unit more often than once in every three years, and in consequence you have pressed the Regional Hospital Board to increase facilities so as to enable the unit to visit Barking annually. You also suggested that the County Council should themselves purchase an X-ray unit for use with staff and older schoolchildren in Barking and adjacent metropolitan Essex Boroughs, a suggestion which was unfortunately turned down. 5 B.C.G. VACCINATION The scheme for B.C.G. |
511037f8-0fa5-46e6-82f7-234c8ef39cea | vaccination of school leavers (to which brief reference was made in last year's report) was approved by the County Council during the year and vaccinations were started in dirking schools in the September Term. The work has been carried out by Drs. Martin and Seligmann, who attended special courses at the Hospital for Sick Children to gain experience in the technique. The response of parents was encouraging, over three-quarters agreeing to allow their children to have this protection. These children firs received a special skin test, and those showing a positive reaction (i.e. were already thought to be resistant to tuberculosis) were excluded from the scheme, although arrangements were made for them to have an X-ray examination at the Chest Clinic. During the first term's work only 14.6 per cent were found to be positive, a finding which has so far been confirmed by further experience. During the trials of B.C.G. |
baa0e564-51d9-484c-ae1e-d5e761b52e41 | in 1951-52 (which took place with somewhat older children and using a slightly different test) the Medical Research Council's team found that on the average from 20 to 30 per cent of children showed evidence of earlier infection. This is encouraging since it seems to me good evidence that in Barking the incidence of tuberculous infection is below average, and must reflect on the excellent preventive and curative services which were developed in the past. We have taken the opportunity of comparing the older skin test (which involves a small injection) with a newer and simpler technique (the Heaf test). Although it is yet too early to be certain, our initial results suggest that this newer test gives equally reliable results as the older and more complicated one. Of the first 214 children tested, 208 results were the same by both methods (19 positive, 189 negative). |
6f20a018-75b5-4ccf-a8bb-44b4fc4b8a3e | Of the remaining 6, 3 were positive according to the old method (Mantoux test) but negative to the new (Heaf) test, whilst 3 were negative to the Mantoux test but positive to the Heaf test. These 6 children were all classified as "positive" and were thus not given B.C.G. EMPLOYMENT OF THE TUBERCULOUS The memorandum stressed that employment for the tuberculous should be chosen both to avoid risk to others and sc that no harm can come to the patient from unsuitable placement Patients are usually non-infectious by the time they are fit to retur to work, and those cases who are still infectious are usually willing to accept advice concerning employment. Nevertheless, we have no powers to prevent such an individual from returning to work and exposing others to infection if he declines our advice. |
011ccf2a-3a72-47ee-9dae-213bcc75ba1d | Problems involving the individuals' own interest cc concern two mam categories of patient—those who will eventually be be able to resume their former employment and those who for their own welfare need to be retrained for and re-employed in lighter work. The Occupational Therapist already provides domiciliary therapy for bedridden patients in the very early stages of their recovery. During the year the Health Area Sub-Committee conferred with the Dagenham Health Area Sub-Committee (who share Miss Mercer’s service) iti a view to a possible extension of the scheme to provide an occupationl Page 30 Page 31 centre. Such a centre would be of value both physically and psychologically to those patients who were convalescent but not yet fit to go back to work. In most cases there is next a phase when the patient is fit to resume part-time work for a few hours per day. |
3439b0f4-1974-4d47-b983-18f5e0350836 | In practice it is exceptionally difficult to arrange this, since firms (and, I am sorry to say, even some public bodies) are often unwilling to allow employees to resume part-time work. There are also difficulties from the point of view of the National Insurance Regulations, which only recognize an individual as being 100% ill or 100% fit. The permanent employment of those who are unlikely to be able to go back to their former jobs, and those who are likely to remain infectious, urgently calls for solution. During the year a series of meetings was held on the initiative of our neighbours in East Ham. These were ended by the Chest Physicians and Medical Officers of Health from East and West Ham, Ilford, Barking and Dagenham and by a representative from the Ministry of Labour. As a result of our discussions was decided to ask the Ministry to consider setting up a special workshop for the tuberculous to cover this part of Greater London. |
e3d179f7-2ada-4c66-8824-9a589ce2b747 | Although this particular suggestion has not been adopted it is possible that an alternative scheme, using the care and after care provisions of the National Health Service Act, may yet emerge as a result of our liberations and certain other parallel suggestions put forward by the Barking Association for the Welfare of the Physically Handicapped home conditions The Ministry memorandum stated: "It is essential that the Medical Officer of Health and his staff shall have detailed knowledge of the home condition of all persons suffering from tuberculosis in his area. Without such information he cannot properly advise his Council on housing requirements." It so happened that I was making such a survey when the memorandum was received, concentrating first on those families where, in the opinion of the Tuberculosis Health Visitors, conditions were worst. This initial survey covered 44 households and an attempt was made to assess in each case the risk of further spread of infection under existing conditions. Various factors obviously had to be taken into account. |
f581358b-4d10-48bd-a341-0b2eda9ea310 | After a personal visit to each of these households, examination of records at the Chest Clinic and, where necessary, consultation with the Chest Physician, I endeavoured to classify these families into three main groups as follows:— Group A. Urgent need for rehousing at earliest possible date This group included families where there was a highly infectious case of tuberculosis, or a case likely to be infectious from time to time and where the family contained children or adolescents living in extremely overcrowded conditions. In these families there was an ever-present danger of spread of infection, which was increasing every day they remained in their existing accommodation. Group B. Require considerable priority in rehousing I placed in this category those patients who, although not infectious at the time, might have deteriorated and become infectious if they had to live indefinitely in existing accommodation. I also included those patients who, although potentially infectious, were living in households where overcrowding was not so severe or where there were no children or adolescents. |
54c85077-2c4b-4520-ac5f-754ec3e7ea26 | Group C. Only low priority needed Whilst all the families included in this category would have benefited from rehousing, I placed them in this group if I felt that the benefit would be no more than that which would accrue to other families containing patients suffering from non-tuberculous disabilities. The following table shows the number of families falling into these categories at the time of my visit, excluding four families who were rehoused prior to my report to the Housing Committee. On Council's Housing List On Exchange List Not on Housing List OnL.C.C. List Total Group A EXTREMELY URGENT 5 - 2 - 7 Group B HIGH PRIORITY 11 - - 1 12 Group C LOW PRIORITY 13 4 3 1 21 TOTAL 29 4 5 2 40 Page 32 Group C Families I suggested that the families on your housing list and in my Group C had been generously treated since most had been granted ten extra priority points. |
93fe7728-e4b1-4d41-8ee6-24e6aade1a5a | Group B Families The eleven families on your housing list and in Group B had points totals averaging 68. In all except two instances these totals included 15 priority points. Whilst these families were all in desperate need of rehousing, I suggested that in all the circumstances these applicants were being given reasonable priority, and I could not ask you to do more. 1 also drew your attention to the fact that 3 of the 11 applicants were grown up children of now elderly L.C.C. tenants. The most logical action would have been to rehouse the old couple in one bedroom accommodation, leaving their children and grandchildren in full occupation of the house. Unfortunately the parents were L.C.C. tenants whilst their children were on your housing list, so that administrative difficulties prevented this practical solution. Group A Families Since I h, d chosen to visit the families regarded by the Tuberculosis Health Visitors as most in need of rehousing, the fact that only 7 were plaed in Group A is to some extent reassuring. |
641d0ee1-d1df-4bac-a6fe-0136b1597324 | Condition in these 7 households were bad however. For example, in one three-bedroomed L.C.C. house were living 4 adults (including the T.B. case) and no less than 9 children. Another family consisting of the applicant, his wife (T.B. case) and child ate, lived and slept in one small room of a relative's house: there were 4 other young children and their parents in this two-bedroomed Council house. I am pleased to say that the Housing Committee authorized the Chousing Offer to offer all these families better accommodation. NEED FOR COLLABORATION The memorandum concluded by emphasizing the need for close collaboration between all concerned. Others mentioned besides the Medical Officer of Health and Chest Physician include (with the responsible administering authority for Barking in parenthesis):— Page 33 Family Doctors (Local Executive Council) Factory Doctors (Ministry of Labour) T.B. |
bf88b4f7-4308-45bd-81a9-3bbdbac48307 | Health Visitor (Health Area Sub-Committee of County Health Committee) District Nurse (Training Homes Sub-Committee of County Health Committee) Sanitary Inspector (Borough Council) Housing Officer (Borough Council for "Old" Barking. L.C.C. for Becontree Estate) Important individuals not included in the list include he Director of the Mass X-ray Unit (Regional Hospital Board) and the Disablement Resettlement Officer (local office of Ministry of Labour). I should like to stress the very good co-operation which exists between the Chest Physician and myself, and once again to thank Dr. Paterson for his ever ready and willing help throughout he year. Difficulties with others, when they arise, spring from division in administrative responsibility rather than from any lack of a spirit of co-operation, and with housing problems the fault probably lies more in general shortage of accommodation than in divided responsibilities at the Becontree end of the Borough. |
ab21744b-2b2a-413e-be57-2c7b57e4b47d | ESTABLISHMENTS FOR MASSAGE AMD SPECIAL TREATMENT Licences were renewed during the year in respect of the four establishments which are governed by the Borough's bye laws. PROBLEM FAMILIES Last year I reported the setting up of a co-ordinating committee in connection with problem families and children neglected in their own homes. This Committee has now been functioning for eighteen months and all are agreed that though it is not th whole answer, much useful work has been done. It has proved most helpful to meet together, to pool our ideas and co-ordinate our activities, but we had already reached the conclusion that something more was needed when in November the Ministry of Health issued Circular 27/54. In this the Minister suggested that authorities should consider whether their Health Visiting Service could be re-deployed, so that more time was devoted to those families where problems are likely to arise or were known to exist. |
9c42c5f6-59fb-4947-bd24-5d95e7b9953f | It also recommended that local authorities should use any existing voluntary services to assist in this work and, where necessary, appoint a specially qualified worker. Page 34 One of our main objects is to co-ordinate the activities of the various social workers and thus to reduce the number of visitors to the home, so that any suggestion of creating yet another type of worker must be examined critically. Surely the Health Visitor, whom I have elsewhere described as the "general practitioner of the medico-social services", is the logical person to deal with these families ? Remember though that her job is primarily to prevent, and she leaves treatment to other colleagues. If, for example, she fails to persuade parents to have a child immunized and the child catches diphtheria then the care is passed over to medical and nursing colleagues working in a hospital. Similarly if she fails to educate parents in the correct handling of early behaviour difficulties the child may become seriously maladjusted and may have to receive help from the Child Guidance Team. |
31fdc0d5-048d-4526-ae36-6b68217439bd | Why then should she not turn over a whole family to a special case worker when, despite her efforts, it is in danger of breaking up? Our experience has been that the families most in need of help require much more intensive efforts than can be devoted to them by any of us individually, and in one case much valuable assistance has been given by a specially trained woman worker loaned by the N.S.P.C.C. whether such workers should be attached to a voluntary body rather an to the "Town Hall" is a matter for debate. I should like to be able to give you full details of one particular family since it happens to be the first we dealt with when we started work last year and since we believe the break up of this family has been prevented by our concerted and co-ordinated efforts, and that this case alone justifies our first year's work. Unfortunately to do so might make possible for others to identify the family. |
b2145241-fcfc-4c4f-a8da-a7b8c62bdd3b | RE OF THE AGED AND INFIRM There is a continued shortage of hospital beds for aged and chronic sick which is particularly acute in Barking as there is no hospital in th Borough catering specifically for such patients. Even When acute illness develops in an elderly patient it is often virtually impossible to obtain a hospital bed until circumstances become really desperate. There is also a great demand for accommodation in County Council homes and hostels where old people who still retain a measure of independence and who are physically able to care for themselves are able enjoy the company of people of contemporary age. There is still almost complete absence of accommodation of an intermediate Page 35 type for old people who are too frail to look after themselves (and who are excluded from the County's Old Peoples' Homes) yet who do not require medical or skilled nursing attention (and who are thus not really "hospital" cases). Laundry Service for the Incontient Once again the Borough Council's laundry service proved an invaluable adjunct to the services provided in the home to care for the chronic sick. |
834d0749-e09c-4b46-ac35-65486a7940e3 | During the year 20 cases were assisted. Night Attendant Service Another important service developed during the year by the Health Area Sub-Committee was one of "night attendants" to sit in with those elderly patients who are restless or inclined to wander at night. The attendants are not qualified or expected to give any nursing care, but simply to make the patient comfortable in the way a relative would by adjusting pillows making hot drinks, etc., and calling in help if needed. This assistance is of inestimable value to those relatives who might otherwise have to sit up for nights on end with little or no sleep and still carry out a full day's work. Although provided through the Health Department, the attendants are not directly employed by the County Council. They are paid by the patient (or relatives) who are re-imbursed up to 15 -d. per night at the end of the week. This system has proved somewhat clumsy in operation and has on occasion prevented the relatives accepting the service. |
85ea8778-57a0-4fd6-ae9f-eb993ef18f18 | I feel it would be preferable if we could employ the attendants directly as we do Home Helps. Employment of the Elderly It is now being realized that two of the most important things in the care of the elderly are preserving their sense of independence and making them feel they still have a useful function in the life the community, thereby helping to postpone the ageing process Nowadays old people besides living somewhat longer are much healthier, and an increasing proportion of those above present retiring ages are both able and willing to continue at work. here is much evidence to show they are also happier and healthier if allowed to do so. Page 36 One of the objections raised to the employment of people beyond the present retiring ages is the alleged increased incidence of sickness amongst older members of the staff. In this connection a recent report on sickness in a health department of a local authority (published in the "Monthly Bulletin of the Ministry of Health and the Public Health Laboratory Service" for October, 1954), is of the greatest interest. |
188ec7f0-1408-4b5a-96a9-c3f62608e659 | It was found that in general women lost more time through illness than men and married women lost more time than a single woman. For each category, however, the sickness rates rose to a maximum for staff between the ages of 50 and 55, and decreased markedly thereafter. Both single and married women over 60 lost less working days per year than those in any other age group and men over 60 lost almost as little time as the youngest. Specimen figures are given in the following table:— WORKING DAYS LOST PER YEAR Ages Men Single women Married women 30 years+ 4 8 28 40 years+ 7 15 21 50 years+ 13 21 29 60 years+ 5 3 3 From the medical point of view, therefore, there is much to be said for the continued employment of men and women beyond the present retiring ages, where it would be to the common benefit of employer, em ployee and community. |
3663cb68-2c57-4fa4-acc2-59a703f1d6bb | Compulsory Removal In spite of the difficulties outlined above, it was not necessary to invoke powers under Section 47 of the National Assistance Act, 1948, to remove compulsorily any person not able to look after themselves and not receiving proper care and attention. One old man living by himself in a Council house was found to be living in grossly insanitary conditions, but we were able to persuade him to leave home temporarily whilst the premises were cleansed and redecorated. The Area Welfare Officer very kindly arranged to take him into St. George's, Hornchurch, whilst this was carried out, and on his return domestic help was put in to help him keep the home clean. Page 37 Our satisfaction at having "prevented" a permanent placement in St. George's was a little premature, for even with the domestic help conditions deteriorated and before long the old man developed an illness from which he died shortly after admission to hospital. |
fe1d3c18-cdb9-4697-9691-0e8351b6e907 | Efforts to keep old people in their own homes (and this must be our objective) must obviously start much earlier if they are to be successful. Page 38 PERSONAL HEALTH SERVICES This section deals with those services which come under the control of the Barking Health Area Sub-Committee of the Essex County Council. I am grateful to Dr. G. C. Stewart, County Medical Officer, for permission to comment on matters which I have dealt with in my capacity of Area Medical Officer. CLINICS AND HEALTH CENTRES This year our efforts have been concentrated on the provision of a new clinic for the rapidly growing Thames View Estate, and these have been dealt with earlier in this report. The premises of the Greatfields Clinic have been purchased by the County Council, and the Borough Council agreed to rehouse the present tenants; of the living accommodation on condition that the first floor accommodation was made self-contained and the tenancy made over the Borough Council for a family on their housing list. |
577f17db-ce4b-4926-a770-babd11df5db7 | This has left us with the whole of the ground floor accommodation for clinic purposes—a much more satisfactory arrangement. We are also taking the opportunity of providing some much needed improvements to the fncilities—particularly necessary with the heavier use the premises will have, at any rate until the Thames View Clinic is built. Progress on the projected new Upney Clinic has been purposely deferred to allow all possible priority for the Thames View Clinic, but we have countinued negotiations and reached tentative agreement with the Regional Hospital Board on the purchase of a site within the grounds the Barking Hospital adjacent to Upney Lane. The Health Area Sub-Committee and the Hospital Management Committee agree to the transfer of the Orthoptic Clinic to the Paget Ward Clinic durin£ the year. To improve the accommodation at the Central Clinic would have involved unreasonable expenditure, and the suggestion of moving the clinic to a vacant room in the East Street premises could not be implemented after a further dental officer had been appointed. |
cc81e020-21eb-4bac-b6b7-1f35b8e9f4fb | We hope that this clinic, together with others temporarily housed in the Paget Ward, will move to the new Upney Clinic when this is erected. Members have for some long time been anxious to see the Physiotherapy and Orthopaedic Clinics moved from Manor School, partly because the acceommodation had become quite inadequate for the demands of the service and partly because the classrooms were so badly needed for educational purposes. The Hospital Management Page 39 Committee converted part of the Ross Ward, Barking Hospital for this purpose and the clinic moved there in August. The new accommodation is more pleasant and more adequate, and has undoubtedly further enhanced the value of the clinic. CARE OF MOTHERS AND YOUNG CHILDREN MATERNITY SERVICE Ante-Natal Care. |
3db07b2d-5523-44e5-bbc9-af76bf42c06c | This was received by all but 5 of the 1,012 Barking mothers confined during 1954 and was given as follows:Clinics 865 Hospitals (excluding Barking Hospital) 92 General Practitioners 50 No ante-natal care 1,012 From these figures you will see that a very considerable proportion of mothers receive their ante-natal care in our clinics—whether they are being confined in the Barking Hospital or in their own home. By the end of the year some modifications of the present system had been arranged which, it is hoped, will further increase the value of the care given during 1955—and with more convenience to the mothers. It is hoped that, as a first step, each mother will be interviewed by a health visitor before coming to a doctor's clinic. |
46e9c193-407f-4ff9-a79c-234ea0af5f0b | This interview can be conducted without any atmosphere of haste—difficult to eradicate when a medical officer is waiting to be "fed" with patients— and will give the mother a chance to discuss any problems fully with her "own" health visitor. An appointment will then be made for a visit to a special "booking" session at the Upney Clinic, attended by the resident medical officers of the Upney Maternity Hospital. This will give the mother-to-be an early opportunity of meeting the doctors who will look after her if she is admitted to hospital for confinement, and will allow the medical officers to "vet" the cases they are being asked to book. At the same visit the mother will be able to have her chest X-rayed—a service which I have been anxious to arrange lor some time. This is of importance since pulmonary tuberculosis is perhaps more common in women of childbearing age than those younger or older, and since those with the disease tend to relapse following a confinement. |
d3496925-ee4e-4332-89a0-50e65eb86235 | To save the mother unnecessary travelling, the remaining visits will be paid to the clinic nearest to her home This will also maintain close contact with the health visitors who provide the most important part of ante-natal care—the instruction Page 40 of the mother in such matters as health during pregnancy, relaxation during the confinement, and the care of the baby. The medical examinations will be carried out by our own medical officers in the case of patients booked for Upney, and one of the hospital medical officers will visit each of the clinics at fortnightly intervals to see each mother towards the end of pregnancy or at any other time requested by our own Medical Officer. Where the patient is booked for home confinement intermediate examinations will be carried out in the clinic by the midwife booked to attend her; the family doctor (who is called in during labour if the midwives ask for medical assistance) will be given the option of undertaking the necessary medical examinations, but if preferred these can be carried out in the clinic as with those mothers booked for hospital confinement. Confinements. |
7f14d81b-beec-41d3-a127-642f69ea736c | During the year 1,012 mothers were confined, giving birth to 1,027 infants (including 15 pairs of twins). These were born as follows:— Barking Hospital 707 Other hospitals 100 At home 220 1,027 From this it will be seen that the majority of Barking babies continue to be born in hospital. I regret to have to report a maternal death during 1954, in a patient who steadfastly refused to enter hospital despite the earnest advice of the Midwife, General Practitioner and Clinic Medical Officer. She finally consented to enter hospital but it proved too late and she died six days after admission. The maternal mortality rate is thus 0.97 per thousand live and still-births. Post-Naial Care. 941 women attended the Post-Natal Clinic making a total of 1,211 attendances; 288 women had conditions requiring a further attendance. |
57580339-ffe6-4f3d-b5f8-660af9d35cb4 | Of the 941 women who attended 284 were resident outside the area but had their babies in Barking Hospital. Out of a total of 1012 confinements of Barking mothers during the year 657 attended the Post-Natal Clinic; 67 were under the care of their General Practitioner and 96 were under the care of a hospital outside the district. This gives us a figure of 77% attendance at the Post-Natal Clinic—a further imprpvement on last year's figures, but still short of our aim of 100%. Page 41 Gynaecological Clinic GYNÆCOLOGICAL CLINIC Number attending for first time 211 Total number of attendances 1,156 INFANT WELFARE ATTENDANCES AT INFANT WELFARE CLINICS—1954 Number of children born in 1954 who attended 866 Total number of children who attended 2,824 Total attendances 29,340 Live births in 1954 numbered 998. |
003b8cd4-a355-4e8f-a51f-65bb6d9f8230 | Taking into account the fact that 46 babies were born in the last two weeks of 1954, and their mothers could scarcely have had the opportunity of bringing them along to a clinic in that year, approximately 91% of all children born to Barking mothers were seen at our infant Welfare Clinics. Distribution of Welfare Foods In June, 1954, local health authorities took over the distribution of codliver oil, orange juice, national dried milk and vita: in A and D tablets from local food offices. In Barking the distribution of these foods has been grafted on to the existing scheme for the distribution of milk foods and other nutrients from infant welfare clinics. The change over was effected very smoothly, and thanks are due to the Municipal Restaurant staff and to the Borough Treasurer for the efficient way in which the extra work was taken over at very short notice. Central Clinic was made the main distribution centre and is open each afternoon of the week and Saturday morning for the distribution of these foods. |
9bfbc446-3f60-48bb-930f-06f3ad592fd6 | At each of the other clinics the appropriate foods are available at every ante-natal and infant welfare session. Mental Health. Last year I said: "I am sure that a very important part of the work of the infant welfare service of the future will be the promotion of sound emotional development by means of the instruction of parents and parents-to-be in the art of handling their children. One cannot instruct without knowledge and understanding. Only the more recently qualified health visitors have received specific training in this aspect of their work, whilst few have families of their own. Even today the medical student's training includes little child psy chology, although later many doctors have the opportunity of learning through their own children. The first step—the provision of “in Page 42 service" training for our staff—was taken last year when the interested medical officers and health visitors began to participate in case conferences at the Ilford Child Guidance Clinic. Two main developments have taken place this year. |
47d314fd-7daf-4af1-a3c4-76cf30bfa07a | Hitherto the Child Guidance team has dealt with cases of established behaviour disorders in children of school age. In our case conferences we have been struck how, time and time again, the story has emerged of mishandling by parents since the child's babyhood and the presence of symptoms from those earliest days. It seems so much more logical to treat such disorders when they first arise, than to stand by and await the development of serious trouble in later years. Dr. Davidson, Consultant Psychiatrist at the Ilford Child Guidance Clinic, has very kindly devoted some of her own time to the experiment of herself attending infant welfare clinics to advise mothers of babies showing symptoms of early behaviour disorder. This help has been much appreciated by our own staff, and by the mothers who do not have to make special visits to a Child Guidance Cilnic outside their district. We soon realized, however, that this method could only scratch the surface of the problem. Dr. |
e31018a8-f6cc-4899-928e-68d5f44ac77f | Davidsocould not possibly devote enough time to see all such mothers at each clinic. Even more important was the fact that we were not satisfied with early treatment—we wanted to prevent troubles arising. Clearly this could only be achieved by the health visitors and medical officers who, with adequate knowledge and experience, could education mothers-to-be before their babies were even born. Dr. Davidson ther fore agreed to come along to our Welfare Clinics, not to see mothrs herself, but to discuss problems with the appropriate health visitor and medical officer and advise them how to deal with the more difficults cases. This indirect method will enable more early behaviour problems to be treated, and will give our own staff the insight and knowledge for their real work—that of prevention. Infant Death. Twenty infants under 1 year of age died during the year, and of these 16 babies died within the first month of life. |
9e8a559c-0c75-464e-acda-b81d68893a22 | These figures compare well with 1953 when 29 infants died in their first year of life, 22 of them the first month. It will be seen from these figures that the main problems still lie in conditions arising during the neo-natal period. These problems are closely related to those of still-births, of which 29 occurred during the year as compared with 33 in 1953. This loss of infant life has already been fully discussed. Page 43 DAY NURSERIES The closure of Lodge Farm Day Nursery at the end of 1953 meant that at the beginning of the year there were 196 nursery places available. As I pointed out in my report last year you were not unaware that it might be necessary to close a further day nursery, and the Health Area Sub-Committee was in fact reluctantly forced to make such a recommendation during 1954. It was not easy to decide which nursery to close. |
792f6fbb-7604-466e-a25e-339a242c3d44 | At first sight Eastbury appeared the obvious choice since the lease was due to expire and the premises were the most unsuitable. Against this were the facts that Eastbury catered for a greater number of children than the other two, and that it was the only nursery sited in the western end of the town. You were also very much aware of the need for better accommodation for the mentally handicapped children attending the Grieg Hall Centre, so that it was eventually decided to close the Rippleside Nursery and to offer the buildings to the Mental Health Sub-Committee of the County Health Committee for use as an Occupation Centre. The nursery closed in September, but although it had been agreed in principle to re-open the premises as an Occupation Centre the necessary adaptions had not been completed by the end of the year. Attendances During 1954 Total of of places No. |
2acab311-eb94-4e5b-9ea1-93ae664fb8f3 | on Register Average daily attendances January 196 78 56.4 February 196 76 58.2 March 196 81 62.9 April 196 76 65.7 May 196 78 67.0 June 196 81 70.0 July 196 86 65.0 August 196 82 57.1 September 130 86 65.5 October 130 92 72.9 November 130 89 76.2 December 130 77 63.7 Page 44 New Day Nurseries. At the "appointed day" the programme for the expansion of the day nursery service provided that in addition to the existing nurseries (Gale Street, Eastbury and Lodge Farm) a further nursery should be opened in the former Castle School, i.e. Rippleside Day Nursery. |
54861d00-e092-4794-a086-750bd97c3ada | It was further envisaged that an additional day nursery (making 5 in all) should be erected in the western part of the town and that eventually a new day nursery should be erected to replace Eastbury House. Since 2 nurseries had been closed within a year it was obvious that the additional (fifth) nursery would not be required in the forseeable future, and it was agreed that the St. Ann's Road site should be relinquished to the Housing Committee rather than leave the site vacant and derelict indefinitely. There was, however, an understanding that eventually, should there be the need, a site would be made available in the Gascoigne re-development area. The position regarding the Mayesbrook Meadow Nursery was somewhat different. The closure of two nurseries had left us with only Eastbury and Gale Street. The National Trust were pressing for the return of Eastbury House since the lease was already up, and the life of the Gale Street premises was limited to just over ten years by planning restrictions. |
d101c1cc-04d6-4690-aa93-deeb11c65caa | Plans are, therefore, being prepared for a new building on the Mayesbrook Meadow at the junction of Upney Lane and Ripple Road, which will be near to the existing Eastbury Nursery yet more convenient for transport to most parts of the Borough—an important consideration if this becomes your only nursery when Gale Street eventually closes. Nursery and Child Minders' Regulation Act. During the year the remaining two registrations of Child Minders were cancelled. dental services Mr. A. r. Levy, Dental Officer, reports:— Maternity and Child Welfare Service. The number of pre-school children who were brought for treatment showed an increase over the previous year. But far too many of these cases are brought in only after severe pain, when extraction is usually then the sole remedy. Dental decay at this age is frequently extremely rapid; but it is also not generally realized how excellently the average toddler will tolerate filling procedures, or even enjoy them, if he can be treated before the caries have progressed too far. |
88da449f-f073-4827-a307-910cbba8bb5b | Page 45 Of ante-natal cases referred by the Medical Officers for examination, it is gratifying to note that many had been receiving regular attention by their private dentists. But the melancholy fact remains that in the period under review the number of extractions closely approached the number of fillings for ante-natal cases, and for postnatal mothers it actually exceeded them. These figures tell their own story of "neglect until it is too late". Public Dental Service. A successful effort was made during the year to continue to provide treatment for the general public in Barking dental clinics. A part-time officer was employed for two evening sessions a week for this purpose, and one of the full-time officers worked additional sessions in the Public Service for the greater part of the year. Though the cost to the patient is exactly the same as that of any patient of a private dentist under the Health Service, there remained a continued and heavy demand for treatment in the Clinics, a demand that could only partially be met by the man-power available. |
a69efca3-9c78-4844-9a45-28fbd14b8d88 | Many mothers who have received ante-nata' and postnatal dental care as a Priority Class, desire to carry on treatment in the clinics; and it is to be regretted that since the introduction of the National Health Service treatment as a Priority ceases one year after the birth of their child instead of five years as was the case in Barking before 1948. The Public Service also provides continuity of treatment for adolescents who have left school, filling what might otherwise be a gap in their dental care at a most important age. MIDWIFERY During 1954 we had five midwives practising in the district, including two under the auspices of the Queen's Nurses 220 patients were delivered in their own homes, only some 21% of all patients confined. This small percentage continues to cause anxiety for the future of the domiciliary midwifery service. Towards the end of the year the report of the Medical Research Council on the use of "Trilene" analgesia by domiciliary midwives was published. |
f11f24f2-205b-4ab7-b95d-684cd752e9a6 | Whilst the results suggest that "Trilene" is only slightly more effective than the "gas and air" we have used hitherto, the machines are very much more compact and lighter for the mid- wives to carry, and you are most anxious that they shall be supply to all our midwives next year. In the meantime arrangements have been made for the transport of the heavy gas and air machines by a private car hire firm, rather than using the Ambulance Service as before. Page 46 Supervision of Midwives. Miss D. Riseley, Matron of the Barking Hospital, has continued to act as non-medical supervisor of midwives, although the nature of her hospital duties makes it difficult for her to visit midwives on the district as often as she considers desirable. It is anticipated that we shall have approval to the appointment of Dr. Adamson as Medical Supervisor of Midwives early next year. |
8b1d50b9-57c3-4c68-a83f-674893462350 | HEALTH VISITING The implementation of the National Health Service Act has put a steadily increasing load of work on to the Health Visitors. More and more old people, chronic sick and physically handicapped are being added to their case load. The shortage of Health Visitors continues, which means that the increasing weight of work is being borne by already overburdened staff. No longer can a Health Visitor pay regular "routine" visits to all the mothers in her area but she has to "select" for visits those homes where she knows there is a real need It is with pleasure I am able to report that there is developing a very much closer liaison between the Health Visitors and the General Practitioners. During the year a series of little "tea-parties" was held at the clinic to which all the General Practitioners in the area were invited—and in fact about half attended. This gave the General Practitioners an opportunity of meeting the Public Health team, and the staff an opportunity to meet some of the doctors for the first time. |
e18f5e6f-4d8d-4f3e-982b-371585f43937 | There is also a closer liaison with hospital almoners who are constantly seeking our help in dealing with their patients' problems or requesting reports on the home background of the patients, to help the physician Dr surgeon who is treating the case. The new syllabus laid down by the General Nursing Council for the training of nurses includes lectures in public health to be given by Public Health staff, and the Rush Green Hospital has been allocated to Barking for this purpose. The first series of five lectures was given by Miss MoGilrray in April and May and two groups of student nurses came to Barking in June and September to see the various branches of the work of the Public Health Department. HEALTH VISITING, 1954 No. of visits to Expectant Mothers 1,405 No. of visits to Children under five 13,451 No. of other visits 4,008 No. |
84095af7-dbd7-4d16-a3e0-8f8dbb33eaea | of Non-Access visits 2,560 Page 47 HOME NURSING This service is still administered from the County Training Home at Leytonstone, although a strong case can be made for the transfer to the Health Area Sub-Committee—as indeed envisaged in the County Council's scheme for decentralization. VACCINATION AND IMMUNISATION Smallpox Vaccination. The number of primary vaccinations carried out in 1954 was 209 in infants under one year, 89 in those over one year. This means that only about 20% of infants are being vaccinated during the first year of life. Diphtheria and Whooping Cough Immunization. Last year I reported that the scheme for "combined" diphtheria and whooping cough immunization, introduced by the Borough Council in 1946, had been discontinued by decision of the County Council. 1 added that we had been given dispensation to continue the use of combined immunization for the purpose of continuing certain investigations started by Dr. |
79257720-d4b5-4181-9769-f873c6be5537 | Spiller, with the proviso that the prophylactic was not to be purchased through County funds. It was explained to mothers that the only chance of having their babies protected against both diseases by the "combined" method was to enter them in the research scheme. Babies over six months of age, and those whose parents did not wish to enter the scheme, were immunized strictly to County Council policy by the "separate" method involving five injections (three for whooping cough followed by two for diphtheria). Babies entered in the scheme were divided into two groups quite at random by drawing slips "out of the hat". Half received the three "combined" injections whilst the other half had the five "separate injections. When each baby was about fifteen months old a small quantity of blood was taken from the heel, and this was analysed for us at the Wright Fleming Institute, St. Mary's Hospital. |
fbdbfbef-122c-45a0-b20f-a3e2f76c56d2 | Results showed that there was no real difference between the amounts of protective "antibodies" against whooping cough both methods appeared equally good so far as laboratory tests could show the children will be followed up to find out whether there is equal protection over a period of years. Page 48 So far as protection from diphtheria was concerned, the "combined" method gave better results than other workers had reported with the A.P.T. issued by the Ministry of Health. The separate method, using a prophylactic called P.T.A.P. (which had been used in Barking for many years instead of the Ministry A.P.T.) gave even better results. These are summarized in the table below which show the failures with each method. Prophylactic Failures per 10,000 injections . A.P.T. (Ministry of Health) 30 Combined Diphtheria/ Whooping Cough 6 P.T.A.P. Barking 3 Since the results with A.P.T. |
d1e11804-ac3c-447c-8b4b-7af788457724 | have always been accepted as satisfactory surely those using the combined prophylactic are more so? Against whooping cough there is little to chose between the two methods, so it would seem that your 1946 policy of adopting the "combined” immunization has been fully vindicated. We naturally hope the County policy will be changed since parents not unnaturally prefer their babies only to have the three injections instead of five. Our thanks are due to Dr. Holt of the Wright Fleming Institute for the free supply of combined prophylactic (W.D.P.(Red)) used in this work. |
37e137aa-2328-4412-ae07-572f3ef0c22b | The number of children receiving primary courses of immunization during the year was as follows:— DIPHTHERIA Family doctors Clinics Total Separate 158 566 724 Combined with whooping cough 123 147 270 Total Diphtheria 281 713 994 Page 49 WHOOPING COUGH Family doctors Clinics Total Separate 43 436 479 Combined with diphtheria 123 147 270 Total whooping cough 166 583 749 The relatively small number of children immunized by the "combined" method at the clinics is, of course, explained by the fact that this method could no longer be used except for those babies in the investigation. It is particularly satisfying to be able to report that the whooping cough immunizations are being carried out much earlier now—for it is in the early months of life that protection is most needed. Last year only 56% of the courses were completed before the first birthday, and a bare 6% before six months of age. |
465c814c-1d81-493f-b8fb-1f3d3d0067b2 | For 1954 these figures are 73% (before 1st birthday) and 31% (before six months). AMBULANCE SERVICE This service is administered "centrally" from Chelmford, and I am indeed happy that this should be so. The provision of transport to and fro hospital is no proper function of a Health Department which should have all eyes focused on prevention. PREVENTION OF ILLNESS, CARE AND AFTER-CARE I have rather laboured the word "prevention" and you may be surprised to see such a short paragraph regarding it Prevention, however, is not one facet of our services which can be reported separately, it is a philosophy which permeates all our work. The aim of our ante-natal work is to prevent complications and enable our mothers to have natural and easy labours, by immunizing children we aim to prevent diphtheria and so on. |
bd49ea49-9d4e-412a-8f8d-5b75d8c39e00 | I would single out for special mention this year the courses in Health Education, and developments in the field of Mental Health, referred to earlier in this report. During the year the Health Area Sub-Committee agreed to the purchase of a filmstrip projector with sound equipment, which has Page 50 enabled us to employ the sound filmstrips prepared by the Central Council for Health Education—a new technique which has been taken up enthusiastically by the Health Visitors. Those services dealing with the tuberculous have been dealt with at some length in an earlier part of this report. Foot Health. During the year Dr. Adamson and Dr. Martin attended a foot health course organized by the Central Council for Health Education, and following this they presented to their colleagues and to the Health Visitors a most entertaining and instructive synopsis of the course. |
3c0a4322-11e8-447e-9cf1-75748e0684cb | This was followed by a stimulating discussion, from which it was apparent that we should all henceforth take a much doser interest in the question of proper shoe fitting—one of the most important aspects in the prevention of foot defects. Mr. Lvesley, Chief Chiropodist, reports:— "There is a marked increase of interest by parents, and shoe retailers in shoe fitting. Greater work can be done by further stimulating the interest of parents, teachers, health visitors, shoe retailers. doctors, and chiropodists, along these lines. Shoe retailers should be aware that we are keenly watching their activities. There is a marked evidence of closer co-operation between the town's General Practitioners and the Foot Clinics since the "get together” meetings in 1954. Contacts are made by letter and telephone Generally speaking the severity of foot troubles in the over 40's is less than some 5 or 6 years ago. |
b6174497-00d7-44c9-a6b9-85980f81094f | I think this may be due to regularity of treatments, and increase of foot consciousness in the town. There are not now so many really chronic conditions in evidence among our very old people." CHIROPODY SERVICE At tendances: School Children 925 Adults 19,632 The number of patients being brought to the foot clinics by ambulance has slowly but steadily risen to 30. The Minister of Health still adamantly refuses to sanction expansion of the County Council's service so as to allow treatment to be provided in the patient's home— despite the fact that this would be far easier for both patient and chiropodist, and much cheaper. Page 51 This difficulty has been overcome by the Barking Old People's Welfare Committee, which has arranged to pay chiropodists to attend old people in their own homes where I certify them as being unable to attend the clinic. All credit is due to them for their initiative in this matter. |
62d02a87-5301-4928-8939-b114b45cd413 | "Meals on Wheels.” This is another invaluable service provided by the Old People's Welfare Committee. There does, however, appear to be a need to extend this service for chronic sick persons requiring "invalid" meals, for example, where a woman who, due to economic necessity goes out to work leaving her invalid husband in the home, would be greatly relieved of her anxieties if she could be assured that a suitable meal was being served to her husband. Even with the aged chronic sick, a lighter meal than is at present served would sometimes be desirable. In certain cases the provision of such a service could result in a saving of Domestic Help "man" hours. Sitters-ln. There is a very great need to establish a "sitters-in" service for chronic sick, particularly aged persons, so many of whom are living alone and whose needs are not fully covered by provision of all other available services, i.e. Domestic Help, Night Attendant. |
65dc0bb8-a9a5-4602-87c7-dee741d72a61 | District Nurse, Laundry Service, and who, due to the shortage of hospital accommodation, must of necessity remain in their own homes. Night Attendant Service. The inauguration of this new service has already been mentioned earlier in this report. DOMESTIC HELP SERVICE There was a slight decrease in the number of hours of domestic help given this year, the total being 101,960. Year Number of Helps Employed Number of Cases Helped Total Hours Worked 1950 55 387 80,699 1951 49 327 70,611 1952 84 318 85,743 1953 89 384 105,121 1954 89 503 101,960 Page 52 There was considerable pressure from the County Health Committee for a limitation of the hours devoted to certain cases, which were said to be of higher average than for some other areas of the county. You strongly opposed any reduction in standards however. |
81e6a499-1d6a-467b-8c4a-a76ce74743a9 | Whilst the rising cost of this service cannot be viewed complacently, it must be remembered that it provides for the care of many who should really be in hospital or hostels. More important is the fact that in some cases an adequate service can prevent the need for admission to accommodation which costs far more to provide than supportive services in the home. page 53 SCHOOL HEALTH SERVICE MEDICAL INSPECTION AND TREATMENT In last year's report I mentioned that I felt some adjustments were needed in the programme of school medical inspections, and these were made during 1954. Instead of going into each school once in approximately eighteen months to two years and examining every child in that school, each Medical Officer now visits his schools at least once a year and twice if possible. During his annual visit he does a complete examination of every child in certain age groups only, i.e. |
6a4cfc41-1cc1-40c7-8f3b-6eccb39277f4 | the first year group in Infant Schools (5 years +), the first and third year groups of Junior Schools (7 years + and 9 years +), and the first and last years in Secondary Schools (11 years + and 14 years +). In Grammar Schools an additional examination is carried out before leaving at 17 +. In addition to these "periodic" examinations the Medical Officer also sees children of other age groups brought forward at the request of parent or teacher ("specials"), and checks on defects found at previous examinations ("re-inspections"). This system is more selective since the healthy children are seen less frequently whilst those with defects are examined more often than before. In addition the more regular, though somewhat briefer, visits to each school are welcomed by the head-teachers. The reorganization timed to begin with the school year is, I think, the main reason for the fact that during 1954 there were over twice as many "entrants" examined as "leavers". |
72d9f5af-f7af-429b-bc87-20ef0663c95f | PERIODIC MEDICAL INSPECTIONS Nun. r of Inspections in the prescribed Groups:— Entrants 2,189 Second Age Group 1,561 Third Age Group 1,019 Total 4,769 Number of other Periodic Inspections.. 3,788 Total 8,557 Page 55 The last examination prior to school leaving is an important one, and this year we have tried to increase its value in two main ways. Firstly, the Youth Employment Officer talked to the Medical Officers and answered questions put by them. We hope that as a result the confidential school leaving medical reports will be enhanced in value and minimize the risk of a child entering employment unsuited to his health. |
311b8ae9-5ef2-4504-901c-57e278cb5b8c | Secondly, I arranged to send to the family doctor of each school leaver a note drawing his attention to the fact that the child would no longer receive regular medical supervision under the school system, mentioning any serious illnesses or handicaps from which he had suffered, and offering to send to the doctor all our medical records if he wished for them. General Condition A member of the Committee for Education drew attention to an apparent discrepancy in the proportions of school entrants placed in nutritional (or more accurately "general condition") categories in two successive quarterly statistical reports. The figures to which he referred were as follows:— 2nd quarter 3rd quarter A 526 97 General condition B 133 239 C 12 He very rightly asked whether this indicated a sudden and alarming drop in the health of children entering school. I felt quite certain that this was not the explanation, and ventured the opinion that the difference might be due largely to the fact that different doctors had carried out examinations in this particular age group in the two quarters. |
55d553b8-816e-4e4e-9cb5-207e4e60b9b7 | I am afraid I failed to convince many members of the difficulties in accurately classifying children into such vague groups. and that it should not surprise them if two or more perfectly competent doctors were to place the same child in different "nutritional" groups. Following this we worked out the averages for the six medical officers over a period of approximately eighteen months. The figures art revealing:— Page 56 Nutritional Classification Total No. examined ABC % % % Doctor 1 450 25. 69. 6. Doctor 2 1,087 38. 62. Doctor 3 2,568 47. 53. Doctor 4 203 47.29 52.22 .49 Doctor 5 4,628 70.9 29. |
ec6c894c-5cc3-47cc-aee0-c6d878b75056 | .1 Doctor 6 2,433 77.8 22.1 .1 It shows that Doctors 1, 2, 3 and 4 (especially 1 and 2) placed most children in Group B. They obviously took "B" as average, "A" as particularly good and "C" as bad. On the other hand Doctors 5 and 6 regarded "A" as satisfactory, "B" as "not so good" and "C" as very poor. I have carefully examined the figures for each school and am convinced that at these differences cannot be explained by the fact that each doctor broadly speaking covers one area of the Borough. To take one example the doctor placing the second lowest number of children into category "A" has schools where one might expect the children's health to be highest. There is no doubt that differences of similar magnitude occur in the statistics of other authorities and to me it provides further evidence, if such were needed, of the futility of collecting such statistics. |
41e6705a-b422-4f80-b1f0-e376294e4abe | The Ministry should seriously consider dropping this classification. Cleanliness Inspections The number of these fell somewhat during 1954, but the proportion of children found infested remained at about 0.7%. Total number of examinations in the schools 16,572 Number of pupils found to be infested 118 Page 57 Minor Ailment Clinics Attendances at these clinics has been well maintained this year, showing their popularity and usefulness. CASES TREATED AT MINOR AILMENT CENTRES Eyes: (External and other—excluding errors of refraction and squint) 410 Ears, Nose and Throat Defects (other than operative) 729 Skin: Ringworm (body) 3 Scabies 6 Impetigo 75 Other 1,100 Other minor ailments (e.g. minor injuries, bruises, sores, chilblains, etc.) |
2ded8709-5755-40af-a302-5fcf5bdc0292 | 3,778 Total attendances 25,097 Speech Therapy This year we have felt the full benefit of the extra help from the part-time therapist appointed towards the end of 1953. we have been enabled to give the more intensive therapy required by some of the children at Faircross School, and also to reduce the waiting list to reasonable proportions. No. of cases treated 124 Total attendances 2,305 The use of a recording machine would be an asset to he therapists and I think consideration should be given to this nee next year. DENTAL SERVICES Mr. Levy reports as follows:— "The Dental Services of the Borough have been maintained at a comparatively high level during the year under review. Page 58 Staffing Mr. Robinson left us in January 1954, but we were fortunate in securing Mr. Pitts to replace him, together with the services of a further full-time dental officer—Mr. J. Buntin. |
73e784ba-41fe-449c-a395-dff442f20b35 | A new clinic had already been equipped for his use in the hutted buildings behind the Town Hall. (This, incidentally, was the site of the original Barking Dental Clinic before the erection of Central Clinic nearby.) The functioning of an additional clinic in this area had long been felt to be necessary in order to relieve the pressure on Central Clinic's Dental Officer. The dental staff now numbers five full-time officers as well as their attendants; an oral hygienist, and a laboratory staff of six (which includes two apprentices). The County authorities, however, have not; yet seen fit to sanction the appointment of a Senior Dental Officer to fill the gap caused by the transfer of Mr. Tran at the end of 1952. Such an appointment, it is felt, could do much to increase the admin trative efficiency on the dental side, as well as to relieve the Divisional School Medical Officer of a certain degree of responsibility for purely dental matters. |
706df54c-7510-44a5-b7bc-6b63ddd5590a | During the period under review the long negotiations of a dental Whitley Council resulted in an increased national salary scale for dental officers, bringing their remuneration to a figure somewhat less remotely related than hitherto to that normally earned by their colleagues in private practice. Recruiting to the ranks of public dentistry is still lamentably slow, however, and Barking must be considered extremely fortunate, in comparison with some of her neighbouring boroughs, in the number of full-time officers employed. School Service One or two interesting points emerge from the figures of work carried out in 1954. The percentage of children who were found to require treatment on routine examinations at school was 60, as against 63% in 1953. Thus it can be said that a slight but definite improvement in the dental health of Barking school children has taken place This is more likely to be the result of previous treat- went than due to an actual improved resistance to dental disease. |
e23cf163-ad97-45d2-9da2-d823a645c118 | The actual number of children so examined shows an increase on the previous year, but the figure is still only a little over half of the total school population. This is the cause of the comparatively large number of school children who present themselves for Page 59 tion at the clinics, nearly all of whom are found to require treatment, It is also one of the main reasons for the loss of the 1,000 permanent teeth that had to be extracted during the year because they had decayed beyond repair. Oral Hygienist The Oral Hygienist continued to function for the benefit of the Priority classes. She carried out a large number of scalings and prophylactic treatments but perhaps the more important side of her work was in the sphere of Dental Education. Apart from chairside instruction to her patients, she has given talks on dental hygiene in schools and at ante-natal clinics. It is felt that there is scope in the future for even greater activity in this field. |
f8bcfee6-9395-49ae-bfcf-f08199c29339 | Education of mothers and children in the fundamentals of dental hygiene is the one sure way of producing a dentally conscious, and hence a more dentally healthy nation." DENTAL INSPECTION AND TREATMENT (1) Number of pupils inspected:— (a) In school 7,639 (b) In clinics 2,177 Total 9,816 (2) Number found to require treatment 6,576 (3) Attendances for treatment 19,597 (4) Fillings: Permanent Teeth 6,786 Temporary Teeth 2,616 Total 9,402 (5) Extractions: Permanent Teeth 1,078 Temporary Teeth 6,115 Total 7,193 (6) Treatments undertaken by Oral Hygienist. 2,178 Page 60 The continued usefulness of the Dental Workshop is evidenced by the following figures:— No. of Dentures 511 Repairs to Dentures 173 No. of Orthodontic Appliances 606 No. of Inlays, etc. |
3bfe20c5-15ca-466b-99df-175f12b3a74b | 125 SPECIALIST SERVICES Eye Clinics Dr. R. F. Jamison, M.B. Ch.B., D.O.M.S., continues to attend Central, Porters Avenue and Woodward Clinics. Cases dealt with were as follows:— External and other diseases excluding errors of refraction and squint 34 Errors of refraction (including squint) 1,351 Total 1,385 Number of pupils for whom spectacles were prescribed 918 It was mentioned last year that the Orthoptic Clinic was being held in somewhat unsatisfactory accommodation, and I am pleased to report that —with the concurrence of the Hospital Management Committee— arrangements were made for its transfer to rooms alongside the Speech Therapy Clinic in the Paget Ward of Barking Hospital. Miss Lewis, Orthoptist, treated 232 school children during 1954. Nose and Throat Clinics Following the death of Mr. F. Courtenay-Mason, F.R.C.S., in 1953, Mr. |
cc28e9c9-e430-4009-ab0f-df2e2bf776d2 | G. Grunberger acted as locum Consultant Ear, Nose and Throat Specialist, until the appointment (by the Regional Hospital Board) of Miss M. Mason, F.R.C.S., in May 1954. Page 61 Figures for treatment are:— Operative treatment (cases):— (a) For diseases of the ear 2 (b) For adenoids and chronic tonsillitis 308 (c) For other nose and throat conditions 16 Other forms of treatment (cases) 429 Orthopaedic Clinic In August this clinic was transferred from Manor school to Ross Ward at Barking Hospital, thus releasing classrooms badly need for educational purposes and also providing far more adequate accommodation for this expanding service. Mr. L. Gillis, M.B.E., F.R.C.S., continues as the Consultant Orthopaedic Surgeon and attends fortnightly. Cases treated were:— In hospital 6 In clinics or out-patient departments As a result of arrangements made directly between the County Council and the Regional Hospital Board, Mr. |
9ea4d18e-8f5c-4fe7-858e-c88e26463d04 | ogle, Remedial Gymnast, was transferred to the Hospital Management Committee's employ as from the beginning of the year. We have been fortunate in securing an assurance that his assistance will be available as before, and he has continued to give the necessary extra attention to the children at Faircross School. Unfortunately, however, this move has made it virtually impossible to extend his duties into the school in association with the Advisors on Physical Education as envisaged in my last report. Skin Clinic Dr. P. M. Deville, M.R.C.P., M.R.C.S., Consultant Dermatologist now attends the Skin Clinic, Paget Ward, Barking Hospital, twice a month. |
d38867ff-abca-48ef-9b1c-d998436d7abd | Page 62 Number of cases treated or under treatment during the year were:— Ringworm:— (i) Scalp 2 (ii) Body 6 Scabies 4 Impetigo 13 Other skin diseases 517 During the year the County Council decided that cases of plantar warts should not be treated at any of their clinics under general anaesthesia Such children are now referred to Dr. Deville's Clinic, but Dr. Adamson continues to hold her own clinic for subsequent follow up id for treatments not requiring anaesthesia. Child Guidance This year emphasis has been placed on prevention of emotional difficulties. This involves starting with children of pre-school age and their mothers and these developments have been described earlier in this report. Figure for school children treated are as follows:— No. of cases. referred 40 No. who received treatment 18 (Of this number, 6 were subsequently recommended for residential placement as Maladjusted Children.) No. |
50500323-195f-4343-b678-13ad800bc071 | of case closed—left district or appointments not kept 7 No. of case referred but still awaiting investigation at end of year 15 Participation on in case conferences has continued to be of invaluable help and in st, and we are grateful to Dr. Davidson and her team for their enthusiastic support. HYGIENE AND INFECTION Washing Facilities I am particularly pleased to be able to report a very material improvement in hand-washing facilities during the year. Many schools Page 63 have installed hot water supplies and various methods of supplying soap and towels have been tried. It will be of the greatest interest to compare costs and headteachers evaluations of the different methods in due course. Toilets It is perhaps unreasonable to expect such rapid improvements in toilet facilities, since these often involve considerable expense which Governors and Managers may be unwilling to incur in old property which they hope to replace. It is unfortunately in these oldest schools where conditions are worst. You have very high standards where your public conveniences are concerned—rightly so. |
5d12faa0-c3fa-4c1f-82ab-5bef04735eaa | In almost everything else your motto is "only the best for Barking—and extra best for the children" which encourages me to feel that you will insist on improvements before long. Plimsolls and Athletes Foot The investigation of the problems of sterilizing plimsolls made rather slow headway during the year, owing to the necessity of fitting this in with other routine work. As part of the first stage of the investigation, figures for the routine foot inspections carried out by Dr. Adamson have been kept separately for each age group of children. These have confirmed our impression that athletes foot is virtually non-existent in infant schools, that the incidence (even including very mild cases) is as low as 1% in the younger children in junior schools, but that it rises steadily in older age groups to reach a figure approaching 9% in the senior secondary school children. |
458ecb54-0186-4eec-ba65-a2728837152f | The main difficulties occasioned by your decision to prohibit the transfer of plimsolls from child to child have arisen in the infant schools—for here rate of growth is the most rapid. There would appear to be little chance of obtaining an increased capitation allowance to permit heads to purchase adequate numbers of plimsolls, and I believe you consider it undesirable to ask parents to provide them It would be tragedy if physical education were to be restricted on account of a decision taken by you with the best of motives. I hesitate to advise you to allow plimsolls to be passed from child to child wit out having completed our projected investigations, but the position in infant schools particularly may force you to this decision before long. Page 64 Of her foot inspections Dr. |
c3bf2b16-9612-49ab-808c-70f3516bcc59 | Adamson writes:— "During 1954 our practise of routine foot inspections at schools was continued as in previous years and it is gratifying to report that by this periodic check the incidence of Verrucae or Warts has been considerably lessened, and in the cases found at these inspections the lesions are discovered at a much earlier stage thus improving the chances of a more rapid cure. May I add that the staff of the schools and even the children are becoming 'foot conscious' and their co-operation has lightened our task to a great extent. At these foot inspections a watchful eye is kept for cases of Athlete's Foot, the incidence of which rises rapidly during the summer months when the ideal conditions for the growth of the fungus, namely heat and moisture, are present. |
42d31c1f-f8c2-475c-892b-4ab1742f24c1 | This condition which commences as peeling of the skin between the toes, causing irritation to the affected individual, followed by possible spread to other parts of the foot, is aggravated by the constant wearing of rubbersoled shoes such as plimsolls—their use should be restricted to the hours devoted to games and physical training. Cases of Athlete's Foot are referred to their appropriate Minor Ailment Clinic for treatment, while cases of Warts are referred to the Skin Clinic at Upney Hospital." Tuberculosis As reported earlier the mass X-ray unit visited Barking in the new year and (including some examinations carried out at the end of 1953) 1,569 school children aged 14 years or over were X-rayed; 28 of these were recalled for large films; 4 cases of tuberculosis were discovered- 1 boy with active disease and 1 with an inactive lesion, together with two girls referred to in last year's report. As anticipated, the scheme for B.C.G. |
6ed1f6b9-d4d6-442e-9b6e-2b760e4950fa | vaccination of school children in the 13-year age group was started this year. Parents of the eligible children were sent letters describing the scheme and there was a remarkable acceptance rate of 73%. The children were first tested to find out whether they already had some resistance as a result some pre\ious unknown and slight infection, and only 11.7% of those tested showed such evidence (i.e. were "tuberculin positive"). These children were all invited to the Chest Clinic for X-ray. The training 88.3% were "tuberculin negative" and all received B.C.G. "Vitiation by either Dr. Martin or Dr. Seligmann who had received special training in the technique. Page 65 The opportunity was also taken of comparing the older "Mantoux" test, involving an injection just under the skin, with a newer and simpler test known as the "Heaf" test. |
413ba393-9dad-45db-a6fe-97189e3d43b0 | Out of the 214 children thus tested the results were the same by both tests in 207; of the remaining 7, 3 were positive by the Mantoux yet negative according to the Heaf test, whilst 4 were positive to the Heaf test and negative by Mantoux. These results, if maintained when larger numbers have been tested, indicate a very reasonable agreement (over 97%), and would appear to justify the routine adoption of the Heaf test if the other advantages claimed for it are confirmed in our experience. Infective Hepatitis The outbreak of infective hepatitis which took place largely amongst infant and junior school children in the Gascoigne-Westbury area, has already been fully described. HANDICAPPED PUPILS At the end of the year there were 173 pupils at Faircross Special School distributed as follows:— Barking Other Districts E.S.N. Section 35 Open Air Section 35 40 E.S.N. Section The new East Ham E.S.N. |
fb11e678-f6e1-4c2e-9a05-d46c726f8c98 | School was opened d during the year and 14 East Ham children were transferred there at the commencement of the summer term. This has enabled us to admit it all E.S.N children from the waiting list. During the year 16 children left the E.S.N. Section ceasing to be of compulsory school age (9 Barking and 7 out of-district children)—all were recommended for supervision by the Local Health Authority under Section 57(5) of the Education Act, 944. One Barking child reached compulsory school leaving age and was also recommended for supervision by the Local Health Authority but arrangements have been made for him to receive further year’s education at Faircross School. One child (llford) was found to be ineducable and recommended for action under Section 57(3) of the Education Act,; 944. Two children (1 Barking and 1 llford) were transferred to Residential School. |
7c46c229-9764-42e3-99ce-7ef46e812f14 | Page 66 One child, aged 15 (Barking), was no longer considered to require special educational treatment and allowed to leave school. |
f14b7344-c7fc-48be-b4ab-1f81201e6675 | Open Air Section The children in this section at the end of the year were suffering from the following conditions:— Barking Other districts Cerebral Palsy (Spastics) 8 1 Other diseases of nervous system 6 3 Diseases of Bones and Joints 4 1 Heart disease 3 5 Asthma 5 10 Bronchiectasis and other lung conditions 5 13 Debility 3 5 Others 1 2 35 40 Thirty- four Barking children were placed in other special schools as follows:— Category Day Residential Blind 2 Partially Sighteds 2 2 Deaf 3 1 Partially Deaf 6 2 Physically Handicapped 2 Delicate 4 Diabetic 1 Epileptic 2 Educational; Sub-Normal 3 Maladjusted 4 In addition there was one deaf child not placed at the end of the year. |
2e77d0bf-a92b-402d-8e27-c841253b45d9 | During; year 11 children (4 Barking and 7 out-of-district children) returned to ordinary schools; 4 children were transferred to residential schools and 2 left on reaching school-leaving age. Convalescence One hundred and thirty-three children were sent away for periods of convalescence of up to 8 weeks. Page 67 REPORT OF THE CHIEF SANITARY INSPECTOR FOR THE YEAR 1954 STAFF In common with the rest of the country the department has continued to be short of establishment. With the increasing demand on the services made by changes in legislation and the growing interest shown in slum clearance and food hygiene, it is unfortunate that officers available for such duties continue to be in short supply. The Council is, therefore, to be congratulated upon the appointment of two Student Sanitary Inspectors who are to be trained in the department and have undertaken to stay with the Corporation for at least two years after qualification. |
c4faad94-3fcf-48ba-9614-037f7896f0d5 | SANITARY CIRCUMSTANCES OF THE AREA During the year there were 1,075 complaints received compared with 1,474 in the previous year. The tables included on page 93a show the type of inspections made, notices served and the work carried out. DEFAULT ACTION Not with standing many complaints by owners that the rent income is insufficient to provide for proper care and maintenance, local circumstances have been such that only 26 premises were referred for default, of these 22 were repaired by the owners before the Corporation intervened. RAINFALL During the year rain fell on 278 days, with a rainfall for the year of 23.81 inches compared with 96.8 inches in the previous year. WATER SUPPLY The whole of the water supply for domestic purposes is drawn from the main water supply of the South Essex Waterworks Company. Samples were submitted monthly for bacteriological examination and twice during the year for chemical examination. The whole of the samples were reported to be pure and wholesome. |
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