County Borough of Croydon ANNUAL REPORT ON THE HEALTH AND SANITARY CIRCUMSTANCES OF CROYDON, TOGETHER WITH THE REPORTS OF THE BOROUGH HOSPITAL AND OF THE BOROUGH LABORATORY. AND THE REPORT TO THE EDUCATION COMMITTEE. FOR THE YEAR 1910. BY H. MEREDITH RICHARDS, M.D., B.S. (Lond.), Member of the Royal College of Surgeons, and Licentiate of the Royal College of Physicians; Fellow of University College, London, and of the Royal Sanitary Institute ; Medical Officer of Health ; Medical Superintendent of the Borough Hospital, and of the Croydon and Wimbledon Joint Smallpox Hospital; School Medical Officer. Cropdon : PRINTED BY S. 11. I'URNELL, ic8, HIGH STREET, 1911. 3 TABLE OF CONTENTS A —Vital Statistics— PAGE Population 6 Area 9 Births 10 Deaths 10 Ward Death Rates n Infantile Mortality 14 Diarrhoea and Epidemic En' erit s 14 Death Certification 16 Inquests 16 Smallpox 16 Crovdon and Wimbledon Joint Smallpox Hospital 17 Vaccination 19 Measles 19 Scarlet Fever 20 Return cases of Scarlet Fever 20 Epidemic Influenza 22 Whooping Cough 22 Diphtheria and Membranous Croup 22 Enteric Fever 26 Puerperal Fever 28 Erysipelas 28 Tuberculosis 28 Tuberculosis and Milk 29 Midwives' Act, 1902 29 Notification o! Births Art, 1907 30 Customs and Inland Revenue Acts 31 Disinfection 31 Local Government Board Returns : Table I Vital Statistics of whole district during 1910 and previous years 32 Table II Vital Statistics of separate localities in 1910 and previous years 33 Table III Cases of Infectious Disease notified during the year 1910 34 Table IV Causes of,and Ages at,Death during year 1910 35 Table V Infantile Mortality during ihe year 1910 Deaths from stated causes in weeks and months under one year of age 37 Table VI Cases notified and deaths from the principal zymotic diseases for the year 1910 and preceding years 46 4 Page B —Sanitary Work— Inspections 47 Notices Served 47 Paving of Back Yards 47 Municipal Common Lodging House 48 Other Common Lodging Houses 48 Houses Let in Lodgings 49 Housing of the Working Classes Act 49 Factory and Workshop Act, 1901 49 Smoke Nuisances 52 Slaughterhouses 52 Meat and Food 54 Dairies and Cowsheds 55 Ice Cream Vendors 55 Offensive Trades 55 Sale ol Food and Drugs Acts (Prosecutions) 56 '1 he work of the Health Visitors 58 Health Lectures 58 Table VIII Health Visitors Summary of work done during 1910 59 Table IX Work done by the Sanitary Inspectors during the year 1910 61 Table X Workshops on Register, number of Employees, and visits paid during the year 1910 62 Table XI Food and Drugs Acts Number of samples taken during the year 1910 63 Table XII Food and Drugs Acts Particulars of samples taken during 1910 and previous years 64 Table XIII Meteorological Record—Year 1910 65 C —Work of the Borough Hospital 66 D —Work of the Borough Laboratory 70 F —Public Elementary Schools 75 Appendix 103 5 Gentlemen, I beg leave to present my Eleventh Annual Report on the Fealth and Sanitary circumstances of the Borough, together u'ith reports of the Borough Hospital and Borough Laboratory. The Report has been delayed pending the publication of the preliminary census report. The report presented to the Education Committee is also presented herewith, so that the Council may have particulars of the whole of the ivork undertaken by the Public Health Department. I am, Gentlemen, Your obedient Servant, H. MEREDITH RICHARDS, M.D. June 15th, 1911. 7 COUNTY BOROUGH OF CROYDON. Sanitary Committee, igog-io. The Mayor—Alderman Major J. E. Fox, J.P. Mr. Alderman Allen, J.P. „ Sir F. T. Edridge, J.P. (Chairman). King, J.P. „ Lillico, J.P. Price Mr. Councillor Denning, .P. „ Holt. „ Hussey. „ Moss (Vice-Chairman). Mr. Councillor Mr. Councillor Page. „ Peck. „ Shirley. ,, Southwell. Umney. Staff of tbe public iKailb Department. Chief Sanitary Inspector and Inspector under Food Drugs Acts, P. Saunders (Cert. R. San. Institute). Thos. H. Cui.ver (Cert. R. San. Institute), Deputy Chief and District Inspector. J. C. Earwicker ,, ,, District Inspector. A. I). Peck F. Richardson „ „ „ „ Chas. J. Vincent „ „ „ „ S. T. Brown ,, „ ,, „ G. G. Flint Fredk. F. Fulker ,, ,, Inspector for Infectious Diseases A. Low, C.S.A., Inspector of Meat, Dairies, Cowsheds and Milkshops. Jos. H. Bull, C.R.S.I., Inspector under the Factory and Workshop Act and Shop Hours Act. W. Davis, Disinfector. A. VV. Fink F. H. Lennard A. C. Larcombe L. F. Selfe Miss Tawney Miss Chapman Miss Raw Miss Stevens Miss King Clerks. Health Visitors. Matron of Borough Isolation Hospital, Miss Bond. Senior Resident Medical Officer and Bacteriologist, A. G. Peter, M.R.C.S , D.P.H. (Camb.) Assis ant Aledical Office/-, Borough Hospital, A. T. Nankivell, M.D. (Lond.), D.P.H. Assistant to Medical Officer of Health, Sophie Jackson, M.D., D.P.H. Medical Officer of Health and School Medical Officer H. Meredith Richards, M.D. (Lond.) 8 SUMMARY OF ANNUAL HEALTH REPORT FOR 1910 COUNTY BOROUGH OF CROYDON. Area—9,012 acres. Soil and Situation—Croydon is situated in the county of Surrey, 10 miles south of London Bridge. The greater part of the Borough is in the watershed of the Wandle, the remainder draining towards the Effm and Ravensbourne. The subsoil in the. north of the Borough is London clay, while the upper chalk comes to the surface in the south, the clay and chalk being separated by a strip of lower London tertiaries composed of beds of clay, sand and pebbles. Both the London clay and chalk are in parts overlaid by irregularly disposed beds of gravel. Altitude—The height above ordnance datum varies from 375 feet at All Saints' Church, Upper Norwood, to 110 feet at Mitcham Road ; Average about 250 feet above ordnance datum. Fopulation—Census of 1901—133,895. Estimated Population, June, 1910 — 166,884. Estimated Inhabited Houses, June, 1910—33,276. Rateable Value, £1,135,573. General District Kate, 3s. 6d. in the £. Poor Rate, including Education Rate, 3s. 8d. in the £. VITAL STATISTICS, 1910. Birth Rate, per 1,000 living, 22'8. Death Rate, per 1,000 living, 10^7 Infantile Mortality, per 1,000 births, 87. Isolation Hospitals—For fever at Waddon Marsh Lane. For smallpox at North Cheam. Water Supply—From the Thames, and from deep wells in the chalk. 9 County Borough of Croydon. REPORT of the MEDICAL OFFICER OF HEALTH. For the Year 1910. A.—VITAL STATISTICS. THE POPULATION at the Census of 1891 was 102,625, and had ncreased at the Census of 1901 to 133,895. The population at the middle of 1910, according to the estimate of the Registrar-General, was 164,485. The number of inhabited houses cannot be ascertained with accuracy. At the last Census, in April, 1901, it was 25,726, while 1,354 houses were empty at that date. From this date until June 30th, 1910, 9893 houses have been passed by the Borough Engineer as fit for occupation. The total number of inhabitable houses has, therefore, been increased to that extent. It is, however, a matter of common knowledge that the number of vacant houses in Croydon was larger than at the time of the census, being about 10 per cent., as compared with about 5 per cent, in 1901,and 10 per cent, in 1909. Taking this into consideration it is probable that the number of inhabited houses in June. 1910, was about 33,276. If the population per house remained the same as in 1901, this would have given a total population of 173,035, but from the preliminary census figures (or 1911 it is clear that the actual population in June, 1910 was 166,884. This figure has been used for calculating the general death rates in this report. The true ward population cannot yet be ascertained, and the estimates are based on the census of 1901. THE AREA of the Borough is 9,012 acres, and the density of the population 18.8 per acre 10 The approximate acreage of the Wards is as follows Areas in Acres Wards 1660 Upper Norwood (sub-division) Thornton Heath do 980 South Norwood 998 West 1181 North 404 Central 2209 East 1580 South 9012 THE BIRTHS during the year numbered 3,810 Of those born 1,902 were boys and 1,908 were girls The birth rate equalled 22 8 per 1,000 as compared with 24 8 for England and Wales Of the total births, 180, or 47 per cent, were illegitimate The births were distributed as follows Total Birth rale per 1,00 estimated population Upper Norwood Sub-Division *139 166 Central Ward 298 17.1 South Ward 376 18.0 East 404 20.5 South Norwood Ward 548 22.2 BOROUGH 3810 23.2 Thornton Heath Sub-Division 474 25.3 West Ward 824 26.4 North ,, 665 28.7 The Workhouse 82 *Including 29 births at 89, Central Hill (Servants' Reformatory) DEATHS —During the year, 1,817 deaths were registered in the Borough, or 10.9 per 1000 One hundred and nine of the deaths registered in the Borough were those of strangers dying at the Workhouse or Infirmary, 21 of strangers dying at the Croydon General Hospital, 3 at the Cottage Hospital, Purley, 9 at the Cottage Hospital, Upper Norwood, 1 at "Victoria House," 89, Central Hill (Servants' Reformatory, while ; deaths at the Borough Hospital occurred among patients admitted from Penge, and Streatham If we deduct these 145 deaths and add 36 deaths at the Mental Hospital, Warlingham, and 75 deaths of Croydon residents known to have occurred outside the district during the same period, we get a nett total of 1783 deaths, which is equal to 107 per 1,000 as 11 compared with 13.4 for England and Wales, 14.3 for the 77 great owns, 12.9 for the 136 smaller towns, 12.8 for England and Wales less the 213 towns. Corrections for deaths of strangers occurring within the Borough and of deaths of Croydon people dying outside the Borough are more complete than was formerly possible. This is due to returns being now available for the deaths of Croydon lunatics occurring at the Mental Hospital, Warlingham, and of Croydon people dying in London institutions. The latter return has been furnished by the courtesy of the Superintendent of Statistics, Somerset House, and has been available since 1903. Since these deaths have been added to those registered in the Borough, all deaths of strangers occurring at the General Hospital, Cottage Hospital, Purley, and Cottage Hospital, Upper Norwood, have been deducted. Formerly, these were included in the total number of deaths on the supposition that they were balanced by Croydon deaths in London institutions. The nett death-rates for the four quarters of the year were :— 1910. Average for 1900-1909. 1st Quarter 12.3 15.9 2nd Quarter 10.4 11.9 3rd Quarter 9.4 11.0 4th Quarter 11.1 13.1 Year 10.7 13.0 WARD DEATH-RATES.—Table II. gives the number of deaths assignable to each district in the Borough. Institution deaths have been, as far as possible, debited to the Wards in which the deceased lived prior to admission to hospital. The Ward deaths for the year were as follows :— Deaths. Death-rate per 1000. South Ward 180 8.8 Thornton Heath Sub-Division 168 8.9 South Norwood Ward 239 9.7 East Ward 195 9.9 Central 179 10.2 BOROUGH 1783 10.7 NorthWard 256 11.0 Upper Norwood Sub-Division 102 12.2 West Ward 437 14.0 Note.—There is reason to believe that the estimated population of the wards is inaccurate until the Census office is able to supply special local figures. From the preliminary report it would seem that the combined population of the North and West Wards is larger than my estimate, and that in South Croydon, which includes the Central, East and South Wards, the growth of the population has not been quite as large as the previous decennium. 12 From the Registrar General's Annual Summary for 1910 it is seen that Croydon maintains its position at the head of what were the 33 great towns. But several of the other 76 towns present a considerably lower figuie than Croydon. Table A.—Crude and Corrected Death Rates per 1,000 Persons living in 77 Great Towns in 1905.9 and in 1910. Towns, in the order of their Corrected Death rates, 1910. Factor for Correction for Sex & Age Distribution* Crude Death rate. Corrected Death rate. Comparative Mortality Figure, 1910.† Average 1905.9. 1910. Average 1905.9. 1910. Cols. 1. 2. 3. 4. 5. 6. England and Wales 1.0000 14.96 13.36 14.96 13.36 1,000 England & Wales, less the 77 Great Towns. 9.9637 14.69} 13.31 14.18 12 83 960 77 Towns 1.0627 15.28 13.42 16.23 14 26 1,067 Kings Norton 1.0456 9.81 8 .01 10.26 8.38 627 Hornsey 1.1400 8.33 7.71 9.50 8.79 658 Handsworth (taffs.) 1.1007 10.40 8.41 11.45 9.26 693 East Ham 1.0671 10.93 8.92 11.66 9.52 713 Leyton 1 .0285 10.83 9.27 11.14 9.53 713 Walthamstow 1.0572 11.12 91.1 11.76 9 63 721 Willesden 1.0728 11.13 913 11.94 9.79 733 Reading 1.0343 12.36 9.91 12.78 10.25 767 Croydon 1.0250 12.55 11.00 12 86 11 .28 844 Southampton 0.9942 13.34 11 76 13.26 11.69 875 Northampton 1.0397 12.18 11.40 12 66 11.85 887 Bristol 1.0273 13.69 11.54 14 06 11.86 888 Norwich 0 9511 15.31 12.47 14 61 11 90 891 Smethwick 1.0940 13.29 10.88 14 54 11.90 891 Derby 1.0778 13.91 11.07 14.99 11.93 893 Aston Manor 1.1087 13 05 10.82 14.47 12 00 898 Leicester 1.0671 13.21 11.29 14 10 12 05 902 Hastings 0 9616 1.2.64 12.54 12 15 12 06 903 York 1 0297 13.40 11.77 13.80 12.12 907 Burton upon rent 1.0747 12.26 11.29 13 18 12.13 908 Devonport 1.0486 13 02 11.60 1365 12.16 910 Bournemouth 1 0566 12.74 11 69 13.46 12.35 9.24 Tottenham 1.0791 12.81 11.45 13.82 12 36 925 West Ham 1.0696 14.61 11.69 15.63 12.50 936 West Hartlepool 1.0980 13.43 11.51 14 75 12 64 946 Walsall 10590 14.75 12 01 15 62 12 72 952 West Uromwich 10085 16 07 12.70 16.21 12.81 959 Cardiff 1.0875 13.69 11.89 14.89 12.93 968 Wolverhampton 1 0343 15 04 12.55 15 56 12.98 972 Plymouth 0.9750 15.46 13.50 1507 1316 985 Great Yarmouth 0.9152 16.12 14.43 14.75 13.21 989 Ipswich 0.9766 14.40 13.57 14.06 13.25 992 * The factor for Correction is the figure by which the Crude Death.rate should be multiplied in order to correct for differences of age and sex constitution of population. † The Comparative Mortality Figure represents the corrected Death.rate in each town compared with the death.rate at all ages in England and Wales during 1910, the latter being taken as 1,000. †For the years 1905.9 the group of Great Towns consists of 76 towns, the Factor for Correction for England and Wales less the 76 Great Towns being 09652 and that for the 76 Great Towns 10621. 13 Table A continued.— Crude and Corrected Death.rates per 1,009 Persons living in 77 Great Towns in 1905.9 and in 1910 —continued. Towns in the order of their Corrected Death.rates, 1910. Factor for Correction for Sex & Age Distribution * Crude Death.rate. Corrected Death rate. Comparative Mortality Figure, 1910. Average 1905.9. 1910. Average 1905.9. 1910. Cols. 1. 2. 3. 4. 5. 6. London 1.0511 14.53 12.71 15.27 13 .36 1,000 Wallasey 1.0940 1315 12.50 14.39 13.68 1,024 Gateshead 1.0541 14.97 12.98 15.78 13.68 1,024 Halifax 1.0836 14.37 12.83 15.57 13.90 1,040 Rotherham ... 1.0343 15 12 13.56 15.64 14.03 1,050 Brighton 0.9856 14 58 14.25 14.37 14.04 1,051 Portsmouth ... 1.0267 15 11 13.78 15 51 14.15 1.059 Coventry 1.0024 15.37 14.23 15.41 14.26 1,067 South Shields 1.0584 16.19 13.59 1714 14.38 1,076 Sheffield 1.0778 16.28 13.41 17.55 14.45 1,082 Newport (Mon.) 1.0804 15.77 13.44 17 04 14.52 1.087 Birmingham... 1.0759 1609 13.67 17.31 14.71 1,101 Leeds 1.0908 15.10 13 67 16.47 14.91 1,116 Newcastle upon Tyne 1.077.2 1614 13 85 17 39 14.92 1,117 Nottingham ... 1.0535 16 32 1419 17.19 14.95 1,119 Grimsby 1.0709 14.70 14.01 15.74 15.00 1,123 Bolton 1.1308 15 52 13.41 17.55 15.16 1,135 Bradford 1.1053 15.23 14 02 16.83 15.50 1,160 Hull 1.0250 16 08 15.25 16.48 15.63 1,170 St. Helens ... 1.0836 17.41 14.48 18.87 15.69 1,174 Warrington ... 1.077.2 17.11 14.57 18.43 15.69 1,174 Stockton on Tees 1.0486 16.77 15.19 17.59 15.93 1,192 Blackburn 1.1308 16.23 14.16 18.35 16.01 1.198 Bootle 1.1013 17.68 14.68 19.47 16.17 1,210 Barrow in Furness 1.1364 13.50 14.28 15.34 16.23 1,215 Sunderland 1.0314 18.20 15.86 18.77 16.36 1,2.25 Bury 1.1196 16.19 14.67 18.13 16.42 1/229 Rochdale 1.1060 17.17 14.95 18.99 16.53 1,237 Wigan 1.0973 18.49 15.17 20.29 16.65 1,246 Salford 1.1047 17.74 15.15 19.60 16.74 1,253 Stockport 1.0804 17.62 15.70 19.04 16.96 1,269 Rhondda 1.1000 17.22 15.63 18.94 17.19 1,287 Stoke on Trent 1.0791 ? 15.97 ? 17.23 1,290 Birkenhead 1.0658 15.95 16.22 17.00 17.29 1,294 Merthyr Tydfil 1.0603 19.51 16.43 20.69 17.42 1,304 Tynemouth 1.0326 18.07 17.13 18.66 17.69 1,324 Dewsbury 1.0993 ? 16.15 ? 17.75 1,329 Preston 1.0940 17.99 16.29 19.68 17.8.2 1,334 Huddersfield 1.0728 16.9.2 16.64 1815 17.85 1,336 Manchester 1.1135 18.28 16.05 20.35 17.87 1,338 Middlesbrough 1.0888 20.09 16.87 21.87 18.37 1,375 Burnley 1.1273 17.53 16.31 19.76 18.39 1,376 Swansea 1.0728 18.16 17.64 19.48 18.92 1,416 Liverpool 1.0702 19.50 17.75 20.87 19.00 1,422 Oldham 1.1245 19.00 17.29 21.37 19.44 1,455 For notes * and † see page 12. 14 INFANTILE MORTALITY is measured by the proportion of deaths under one year to 1,000 births, and amounted to 87 as compared with 79 in 1909, 99 in 1908, 94 in 1907, 125 in 1906, and 96 in 1905. During the year 1910 the rate for England and Wales was 106, while in the 77 large towns it ranged from 66 in Leyton, 67 in King's Norton, 70 in Hornsey to 151 in Gateshead, 158 in Preston to 168 in Burnley. I'he figures for the various Wards were :— Births, Deaths under 1 year Death-rate per 1000 Births (all causes) Death-rate per 1000 births from " diarrhoea " diseases. †Upper Norwood Subdivision 139 6 43 7 North Ward 665 37 56 6 Central Ward 29S 21 71 13 South Ward 376 30 80 11 East Ward 404 33 82 5 South Norwood Ward 548 45 82 16 BOROUGH 3810 331 87 10 Thornton Heath Subdivision 474 47 99 17 West Ward 824 112 135 8 † Including 29 births at " 89, Central Hill " (Servants Reformatory). The following table shows the fluctuations since 1892 in the infantile mortality from " all causes," from "diarrheal diseases*," and from "causes other than diarrhœal." Years. Total Infantile Mortality from all causes. Infantile Mortality from " diarrhceal diseases. Infantile Mortality from other than 'diarrhœal" diseases. 1893—1897 142 25 117 1898—1902 143 38 IO5 1903 104 9 95 1904 128 29 99 1905 96 14 82 1906 125 42 83 1907 94 10 85 1908 99 12 87 1909 79 7 72 1910 87 10 77. DIARRHEA AND EPIDEMIC ENTERITIS. During 1910 diarrhoea and epidemic enteritis accounted for 27 deaths, of which 21 occurred in children under one year of age. There were also 24 deaths from other forms of enteritis, of which 18 *Under "diarrhœal" disease- are included death from "diarrhœa" from epidemic and zymotic enteritis, and from enteritis, that is from the causes classified in schedules 10, II, and 107 of Table IV. 15 were under one year of age. Thus 39 out of the 51 deaths from what are usually classified as " diarrhœal "deaths occurred in infants under one year of age.* The accompanying chart shews the seasonal distribution of the 39 diarrhoeal deaths under one year of age in 1910 and previous years The following are the particulars as to feeding of infants dying, during the first six months of life :— METHOD OF FEEDING. Method of Feeding during the first six months of life of children who survived, and of children who died between one week and six months old. Deaths of infants under one week have been excluded because it is unlikely that methods of feeding can have been responsible for a fatal issue in so short a time. TABLE A. Infants dying *rom Diarrhoeal Diseases. 0-6 months. Infants dying from other than Diarrhoeal Diseases. 0-6 months. Infants surviving 6 month Total investigated. Breast Fed only 7 81 1536 1624 Breast and subsequently Cow's milk 8 8 157 173 Ditto Condensed Milk — * 69 73 Ditto Other foods 3 5 80 88 Breast & simultaneously Cow's Milk 1 1 33 35 Ditto Conden:ed Milk — — 38 38 Ditto Other foods — — 57 57 Entirely Hand Fed— Cow s Milk 2 u 151 164 Ditto Condensed Milk 2 7 66 75 Ditto Other foods 3 2 47 52 Number investigated 26 119 2234 2379 * Deaths from Gastritis are sometimes classified as " diarrhoeal." If this were done, a further addition of 8 deaths under one year must be made to the total " diarrhoeal ' deaths. It has not, however, been the practice to include these in former years, and for the sake of comparison the figures have been prepared as in past years. 16 TABLE B gives the same information expressed in percentages. All infants investigated under 6 months. Infants dying from Diarrhoea Diseases. Infants dying from other than Diarrheal Diseases. Breast Fed only 68 27 68 Breast and subsequently Cow's Milk. 7 30 7 Ditto Condensed Milk 3 - 3 Ditto Other foods 4 11 4 Breast and simultaneously Cow's Milk 2 4 1 Ditto Condensed Milk 0 — — Ditto Other foods 2 — — Entirely Hand Fed—Cow's Milk 7 8 9 Ditto Condensed Milk 3 8 6 Ditto Other foods 2 12 2 100 100 100 There is a satisfactory increase in the percentage of purely breast fed infants (see Table B) and the mortality as before falls most likely on this group. Apart from diarrhoeal deaths the mortality is not disproportionately heavy in any one group of infants classified according to methods of feeding. DEATH CERTIFICATION All deaths in the Borough were certified by the Medical Attendant or by the Coroner. INQUESTS were held in 193 instances, or 10.6 per cent, of the total deaths. THE ASSIGNED CAUSES OF DEATH are fully set out in Tables IV., V. and VI., but certain of them require special comment. SMALLPOX Smallpox has been absent from the Borough since April, 1906. 17 CROYDON AND WIMBLEDON JOINT SMALLPOX HOSPITAL. The Smallpox Hospital District comprises the County Borough of Croydon, the Borough of Wimbledon, the Urban Districts of Penge and of Merton, and the Croydon Rural District. The Hospital has not been used for smallpox since August, 1906. During the course .of the year the Board considered the desirability of using the hospital for patients suffering from consumption and I accordingly prepared the following report :— Public Health Department, Town Hall, Croydon, July 18th, jgio To the Chairman and Members of the Croydon and Wimbledon Joint Smallpox Hospital Board. Gentlemen,— In accordance with your instructions, I beg to report on the question of utilising the Hospital for patients suffering from tuberculosis. As desired, I have also conferred with the Medical Officer of the Local Government Board, who is personally in sympathy with the suggested utilisation of the Hospital for other than smallpox patients. The first question that arises is the legality of utilising a Smallpox Hospital for patients suffering from other diseases. As the Croydon and Wimbledon Joint Board was constituted for the sole and specific purpose of isolating small pox, it would doubtless be necessaiy to apply for an amendment of the Pro visional Order under which the Board was constituted. It is possible that such an amending Order would be opposed by people living in the neighbourhood of the Hospital, and if it were we might have to face an expensive fight in the Houses of Parliament, and the risk of interference with the present use of the Hospital. Apart from this difficulty, I can see considerable advantage in utilising the Hospital for tuberculosis. The second point which deserves "consideration is the suitability of the Hospital for the purpose of treating phthisis patients. It should be said at once that neither the soil nor the general surroundings are such as one would select for an ideal sanatorium. On the othe other hand, the conditions are reasonably suitable for the treatment of the class of patients that would be likely to avail themselves of the institution, and I believe that valuable work might be done in a Hospital so situated. I do not think that the fact that the Hospital was built for small pox would eventually be a bar to patients seeking admission, though no doubt a certain amount of prejudice would have to be overcome in the first instance At any rate, other towns, such as Manchester, are using smallpox accommodation for phthisis patients, and the South Staffordshire Smallpox Hospital Board has recently adopted a recommendation of their Medical Officer to make similar use of their hospital. In order that the Board might carry out their primary duty of isolating smallpox, it would be necessary either to reserve the small four-bedded block for smallpox emergencies or to erect a small temporary ward ot a greater distance from the present buildings, and to reserve this for the first case or two of smallpox. Were this done I can see no difficulty in utilising the rest of the Hospital for phthisis patients provided they were admitted on the understanding that in the event of an epidemic they might have to be sent home at a few days notice. 18 Since the Hospital was opened in December, 1901, it has been used for smallpox at the following times (omittiing occasions on which patients were isolated owing to errors in diagnosis) : — From December 10th, 1901, to September 22nd, 1902 (Empty nearly five months). February 17, 1903, to December 24th, 1903 (Empty nearly three months). March 17th, 1904, to April 14th, 1904 Empty nearly four months). Juiy 31st, 1904, to September 28th, 1904 (Empty seven months). April 29th, 1905, to May 16th, 1905 (Empty nearly six months). November 10th, 1905, to December i6th, 1905 (Empty nearly three months). March 7th, 1906, to April 23rd, 1906 (Empty three months). July 28th, 1906, to August 9th, 1906 (Empty nearly four years to date). The Hospital has thus been free from smallpox for about 6 years out of the 8½ years that have elapsed since its erection. It is also important to have some idea of the probable number of patients in the constituent districts. I find from the death return that the total number of deaths from phthisis for the 10 years 1900-1909 was 2,435, or an average of 234 deaths per annum. Assuming that each fatal case has an average duration of three years from the first symptoms to fatality, there must be at least 732 patients suffering from phthisis within the area of the Joint Board. In all probability this is an understatement, as I am of opinion that three \ears is too short an estimate for the duration of the disease. As far as the constituent districts are concerned, the average annual number of deaths for the past ten years and the estimated number of sufferers were as follows :— Deaths. No. of Patients. Croydon Borough 146 438 Croydon Rural (including Merton) 37 111 Penge 27 81 Wimbledon 34 102 It will thus be seen that there is ample material from which to select patients for Hospital treatment. It would next be necessary to arrive at some approximate principle to guide the Board or the Constituent Authorities in selecting patients for treatment. Practically one can divide the sufferers from pulmonary phthisis into three great classes :— (1) Early Cases, in which there is considerable hope of permanently arresting the disease by open-air treatment, provided the patients can subsequently live under hygienic qonditions. Unfortunately, it is improbable that many early cases would seek admissi n. Among the class that the Hospital is likely to serve the early detection of incipient phthisis is at present impracticable. (2) More Advanced Cases, in which six weeks or two months in Hospital would be of great value, as it would afford an opportunity fi r instructing the sufferers how they can avoid infecting their relations and the publ c generally. Many of them, too, would be so improved by Hospital treatment that their working life would be materially prolonged. 19 (3) Hopeless Cases in the last stages. These patients are a great menace to their relatives, and there is reason 11 believe that much benefit would result from their isolation in Hospital. There would be little difficulty in filling the Hospital with patients from the second and third classes. Cost.—This has been carefully considered, and I will, if desired, prepare a detailed estimate. From a comparison of the cost of the Borough Hospital, and from figures supplied me by Dr. Reid (Staffordshire C.C.) I am of opinion that the extra cost (over and above present expenditure) of maintaining an average of 44 beds for phthisis patients would be about 30s. per bed 1 ccupied per week or in round figures about £3400 per annum. To this would have to be added some small expenditure on shelters and other small alterations which would oe required in order to adapt the Hospital for phthisis patients. Should the Committee consider the time opportune, I would suggest that the Constituent Authorities should be asked whether they approve of the lioard admitting cases of phthisis on this basis, and whether they would support the necessary application to the Local Government Board for an Amending Order. H. MEREDITH RICHARDS, Medical Superintendent. This report has been considered by the Joint Hospital Board and Constituent Authorities, but action thereon has for the moment been postponed. The whole question of municipal activity in relation to phthisis must remain in abeyance pending the passage of the National Insurance Bill. Very considerable provision both for capital and revenue expenditure in relation to consumption is made by this Bill, but the full effect thereof cannot be discussed until the Bill becomes law. VACCINATION During the year ending December 31st, 1910, the number of primary vaccinations in Croydon and Penge amounted to 2,436, as compared with 4,179 registered births. The number of infants vaccinated, therefore, amounted to 58 per . cent, of the registered births as compared with 62 per cent, in 1909, 62 per cent, in 1908, 90 per cent, in 1907, and 82 per cent, in 1906. The increase in the proportion of unvaccinated infants is doubtless due to the increased facilities offered to conscientious objectors by the last amendment of the Vaccination Acts. MEASLES. Measles accounted for 31 deaths, as compared with 21 in 1909. Though measles is not notifiable in the borough, the relative number of children attacked can be judged from the notifications received from the elementary schools. 20 The following are the figures for 1910 and the preceding six years :— Year Cases reported to Elementary Schools Deaths 1904 1335 62 1905 1267 24 1906 595 37 1907 363 8 1908 2335 92 1909 364 21 1910 857 3i I he prevalence of measles was mainly confined to the spring months (March—May) during which 27 of the 31 deaths occurred The number of deaths in proportion to the number of cases ranked about the average Twenty-nine out of the 31 deaths occurred in small houses This is approximately the same proportion as was rrecorded in 1909 SCARLET FEVER (See Tables III, IV and VI) Seven hundred and fifty-nine cases were notified, of which 7 ended fatally The number of cases slightly exceeded those of 1909, in which year the disease was more prevalent than in any of the preceding years The mortality was less than 1 per cent The numbers were high in all the wards, with the exception of Upper Norwood, but the chief sufferers were the West and North Wards, During 1910 South Norwood Ward was more fortunate than in the pre vious three years, the incidence of the disease being relatively light The case incidence was highest in the last week of September and the first week in October, This was due to an outbreak at one of the schools, ended by the closure of the school RETURN CASES OF SCARLET FEVER In 1910 the number of patients discharged from isolation who subsequently proved infectious was exceptionally large In no less than 52 instances secondary cases, to the number of 70 in all, arose in homes to which patients had been discharged from hospital This problem has been discussed in detail in several previous reports It must not be taken for granted that the discharged patients were in all cases the cause of renewed infection In many cases this was not so Special attention should also be drawn to the long interval that elapsed between the discharge of the patient and the occurrence of the subsequent case It is the chronicity of infection both in the actual patients and, in my opinion, in their relatives that makes the control of scarle fever so very difficult, 21 The particulars of each of the 52 suspected patients are given in the following table :— No of Register Discharged Patient. Days in Hospital. Length of illness. Nut s as to any abnormality on Discharge. Onset and number of return case. Interval between discharge of pati nt and onset of return case. Age. Sex. Date of Discharge. 814 5 M 6/1/10 46 50 Nil 21/1 10 (49) 15 ,, 851 5 F 10/2/10 66 70 Tonsils ++ adenoids. 13/2 10 (90) 3 ,, 13/2/10 (91) 3 ,, 16 2 10 (89) 6 ,, 798 5½ F 19/2/10 99 102 Otorrhoea and rhinorrhoea. 24/2/10 (103) 5 „ 24/2/10 (104) 5 ,, 1/3 10 (116) 10 „ 880 4½ M 5/2/10 52 55 Nil. 14/2/10 (88) 9 ,, 2/3/10 (121) 25 „ 10 919 40 4½ M F 115/2/10 42 48 44 50 Nil. 27/2/10 (114) 12 „ 860 10 4-12ths M 20/1/10 43 46 Nil. 9/3/10 (143) 48 „ 879 7 11-12ths M 17/2/10 64 67 Nil. 11/3/10 (149) 22 „ 15/3/10 (154) 26 „ 17/3/10 (159) 28 „ 6/4/10 188 48 ,, 12/4/10 (201) 54 ,, 911 6 M 24/2/10 61 64 Nil. 15 3/10 (158) 19 „ 848 8 10-12ths F 15/2/10 72 74 Nil. 17/3 10 (165) 30 „ 914 6 F 24/3/10 86 88 Rhinorrhoe.i present. 2 4/10 (186) 9 „ 882 5 F 5/2/10 52 70 Nil. 11/4/10 (199) 65 ,, 62 6 4-12ths F 5/4/10 67 71 Nil. 16/4/10 (210) 11 ,, 18 5 M 17/3/10 82 84 Glands palpable. 18 410 (214) 32 ,, 131 3 M 28/4/10 53 54 Glands palpable. 4/5 10 (2531 6 „ 92 6 10-12ths F 19/4/10 63 64 Glands palpable. 7/5/10 2551 18 ,, 39 7 M 19/4/10 93 93 Glands palpable. 7/5 10 (258) . 18 „ 157 12 M 28/4/10 43 44 Glands palpable. 20/5 10 (280 22 „ 33 8¾ F 7/4/10 83 84 Glands palpable. 24/5/10 (287) 47 „ 7/6/10 367) 61 „ 35 6 M 24/5/10 129 131 Glands +. 26/5/10 .290 2 ,, 15/6/10 (*—) 5/6/10 (3201 22 „ 12 „ 41 6 M 23/5/10 125 126 Nil. 31/5/10 (309) 8 „ 225 44 M 4/6/10 42 44 Glands palpable, fauces and soft 6/6/10 (328) 2 „ palate red. 173 6 F 7/6/10 77 80 Glands palpable. 11/6/10 (336) 4 ,, 13/6/10 (345 6 „ 296 5J M 14/7/10 46 50 Desquamation on feet. 26/7/10 (475) 12 ,, 276 11J F 30/6/10 45 46 Nil. 28/7/10 484) 28 ,, 314 5 F 21/7/10 48 49 Nil. 1/8/10 (502 11 ,, 287 61 F 19/7/10 55 56 Nil. 14/8/10 (534) 26 „ 362 9 M 23/8/10 63 64 Nil. 28/8/10 (557) 5 „ 10/9/10 (587) 18 „ 417 2 l-12th F 18/8/10 42 51 Glands palpable. 26/8/10 (5591 8 „ 386 6¾ M 16/8/10 50 54 Nil. 22/8/10 (560) 6 ,, 22/8 10 (551) 27/8/10 (561) 6,, 341 9 ll-12ths M 26/7/10 43 44 Nil. 27/8 10 564) 32 „ 130 6 M 6/8/10 153 160 Slight intermittent right ear discharge 13/9/10 (591) 38 ,, 476 5 4-12ths M 6/9/10 42 43 Glands palpable. l eft side nasal septum red. Nose dry. 21/9/10 (612 15 „ 22 Discharged Patient. Notes as to any ahnormality on Discharge. Onset and number of return case. Interval between discharge of patient and onset of return case. No. in Register. Age. Sex. Dale of Discharge. Days in Hospital Length of illness. 251 5 10-12ths F 21/6/10 52 55 Nil. 289/10 (637) 99 „ 574 5 M 15/10/10 46 47 Feet rough. 19/10/10 (7291 4 „ 576 8 F 181010 47 49 Nil. 4/11/10 (779) 17 „ 569 9 M 20/10/10 51 57 Nil. 4/11/10 (784) 15 „ 558 9 F 1/11/10 66 70 Nil. 5/11/10 (*—) 4 „ 584 2½ F 22/10/10 44 45 Glands palpable. 6/11/10 (790) 15 „ 610 5 M 29/10/10 37 39 Nil. 21/11/10 (830) 23 ,, 644 7 2-12ths M 10/11/10 42 44 Gland- papable, hands and feet rough 27/11/10 8481 17 „ 27/11 10 (8471 17 646 7½ M 8 11/10 41 42 I lands dry. 30/11 10 (855) 22 ,, 727 7 8 12ths M 1/12/10 43 44 Had septic finger healed on discharge 6/12/10 (869) 5 „ 713 3½ F 26/11/10 42 43 Face rough. 28/11/10 (886) 2 „ 717 10 4-12ths M 29/11/10 43 48 Glands palpable, ichthyotic skin. 15/12/10 (888) 16 „ 779 6 2-12ths M 17/12/10 42 43 Nil. 21/12/10 (898) 4 „ 4/1/11 (6) 18 ,, 661 7 5-12ths F 22/11/10 51 52 Glands palpable. 20/12/10 (897) 28 ,, 658 7 10 12ths M 10/12/10 69 70 Glinds palpable. 23/12/10 (*-) 13 ,, 543 4 F 8/11/10 82 83 Nil. 30 12/10 (912) 52 „ 30/12/10 (913) 52 ,, 662 8 9-12ths M 8/11/10 37 39 Nil. 14/1/11 (30) 67 ,, 737 24 F 20/12/10 59 61 Glands palpable, heels rough. 17/1/11 (33) 28 ,, 619 7 2-12ths F 15/12/10 73 76 Glands palpable. 29/1/11 (74) 45 „ *— Return case isolated at home. It will be observed that the interval between the discharge of the patient and the onset of the return case varied from two days to 99 days and in 40 instances was more than 14 days. EPIDEMIC INFLUENZA was the assigned cause of death in 25 instances, as compared with 59 in 1909. WHOOPING COUGH accounted for 20 deaths, 19 of which occurred in children under five years of age. The number of deaths is smaller than in 1909, when 30 were registered. The number of cases is unknown, but was in all probability smaller than in the previous year, as 474 school notices were issued in reference this disease as compared with 654 in 1909. DIPHTHERIA AND MEMBRANOUS CROUP. The number of cases notified amounted to 267 as compared with 356 in 1909, while 21 cases terminated fatally, as compared with 24 deaths in 1909. 23 The quarterly incidence of cases and deaths in 1910 and previous years is shown in the following table:— Diphtheria. Year. 1904. 1905. 1906. 1907. 1908. 1909. 1910. Notified Cases— 1 st quarter 50 100 60 93* 101 124 61 2nd „ 38 42 42 49 89 75 57 3rd „ 98 44 54 59 92 78 40 4th „ 126 80 148 84 123 79 109 Registered deaths- 1 st quarter 4 13 13 21* 11 13 1 2nd „ 4 2 5 3 7 4 6 3rd „ 6 2 9 5 7 4 6 4th „ 10 8 13 11 12 3 8 *Not including a fatal case admitted to General Hospital from Mitcham and thence transferred to the Borough Hospital. It will be seen that the number of cases is much smaller than in any of the preceding 6 years with the exception of 1905, when the number was also 267, but arising from a smaller population. Taking the previous 10 years into consideration the number of deaths is also less than in any year except 1903. RELATION OF DIPHTHERIA TO DRAINAGE DEFECTS. Two hundred and sixty-seven notified cases occurred in 227 houses. In 8 instances the drains were not examined. The following is the result of the examination of the drains of the remaining 219 houses:— Number of houses where no defects were found:—161, or 73.5 per cent. Number of houses where serious defects were found :—16, or 7.3 per cent. Number of houses where slight defects were found:—42, or 19.1 per cent. The proportion of houses infected with diphtheria that were found to have serious defects in their drains was 7.3, a figure which is rather less than those found in 1907 and 1908. This figure confirms the view previously expressed that drainage defects are not an important factor in the causation of diphtheria 24 NECESSITY FOR PROMPTNESS IN DEALING WITH DIPHTHERIA. In my last Annual Report I called attention to the fact that many patients die from diphtheria because they do not come under treatment sufficiently early in the course of the disease. The following are the approximate times at which patients came under treatment during 1910:— Day of Disease. Patients. Deaths Mortality, per cent. 1 18 — — 2 80 3 3.7 3 47 1 2.1 4 36 5 13.8 5 12 1 8.3 6 10 — —- 7 5 1 20.0 8 & upwards 14 2 14.2 It is noteworthy that none of the cases admitted on the first day died, and that the mortality of those admitted on the second and third days of this disease is small, while there is a considerable rise on the fourth and fifth days. Though the number of patients which come under treatment during the first two days of the disease is somewhat larger than in 1909, there is still room for improvement. Some of the delay is apparently due to hesitation in making a diagnosis, but I also find that in a large proportion of instances, the doctor is not summoned sufficiently early. In the case of young children there is also much doubt a< to whether the alleged date of onset of the disease is to be relied on. Diphtheria in small children is often painless and insidious in its preliminary stages and it is not until the child is poisoned by the disease that unobservant persons notice any departure from health. It cannot be too often repeated that every sore throat in a young child is a serious symptom.' "EARLY TREATMENT OF DIPHTHERIA" By an Order of the Local Government Board, known as "The Diphtheria Antitoxin (Outside London) Order, 1910," the Council was empowered to provide through the Medical Officer of Health a 25 porary supply of diphtheria antitoxin. In accordance with this, the following notice was issued to the medical men practising in the borough :— COUNTY BOROUGH OF CROYDON. Public Health Department, Town Hall, Croydon, October 10th 1910. Dear Sir, A recent Order of the Local Government Board has again drawn attention to the desirability of making arrangements for the prompt administration of antitoxin to patients suffering from diphtheria. Hospital experience conclusively shows that diphtheria patients treated on the first or second day of the disease can almost invariably be cured, and it is therefore of the highest importance that antitoxin should be administered as soon as diphtheria is suspected, and without waiting for bacteriological confirmation of the diagnosis. For the last three years the Corporation has offered a free supply of antitoxin to be used for preliminary doses for patients Who will be admitted to the hospital if the diagnosis is confirmed. I have now to advise you that, in order to facilitate the early use of antitoxin, a supply may be obtained at The Public Health Department, Town Hall (during office hours). The Chief Fire Station, Park Lane, Croydon (any hour). The South Norwood Fire Station, South Norwood Hill, South Norwood (any hour). The Thornton Heath Fire Station, Beulah Road, Thornton Heath (any hour). The Tramway Offices. Thornton Heath Pond (8.30 a.m. to midnight). The Borough Hospital, Waddon Marsh Lane, Croydon (any hour). Should you obtain a supply for any of your patients, I should be glad if you would be good enough to sign the form of receipt provided at the depot, and state the name of the patient for whom the antitoxin is required. The latter information is required in order that we may distinguish between private and hospital cases. Yours faithfully, H. MEREDITH RICHARDS. 26 This provision has been freely taken advantage of. As it came into force only in the latter part of the year, the benefits experienced from it will not show themselves appreciably until more time for its use has elapsed. ENTERIC FEVER. Twenty-six cases were notified, and no deaths from this disease were registered during the year. Seventeen cases were removed to hospital and one to the Croydon General Hospital, and of these seven were subsequently found to be suffering from some other complaint, viz.:—One from pelvic abscess, one from pyosalpynx, one from tubercular peritonitis, one from meningitis, one from influenza, one from lateral sinus and jugular thrombosis, and one from ulcerative colitis. There were thus 19 cases of supposed enteric fever which required investigation. Of these four were due to personal infection from a preceding case in the same house, and in six cases the disease appears to have been contracted outside the borough. In the remaining nine cases the origin of the disease was indefinite in no less than seven cases, while in one instance shell fish and in another instance watercress or shell fish was the suspected cause of the infection. As epidemics of enteric fever are commonly traceable to infected water, and as Croydon has two distinct sources of water supply, I have once more compared the incidences of the disease in the parts of the Borough supplied by Croydon and by Lambeth (Metropolitan Water Board) water. As the numbers for one year are small, the particulars have been taken out for the eleven years, 1900-1910 inclusive. PARTICULARS OF ENTERIC FEVER CASES 1900 TO 1910 INCLUSIVE. Cases Notified.—422 (including 14 cases of Continued Fever). Removed to Bovough Hospital.—247 cases (including four cases of Continued Fever). On removal to the Borough Hospital fifty-eight (58) and the Croydon General Hospital one (1) were found to be suffering from other diseases. Water Supply of the Cases Notified :— CROYDON 292 LAMBETH 123 Cases brought to Public Institutions in the Borough from outside Districts 7 Total 422 27 Concerning the Notified Cases the following facts were ascertained:— Suffering from other diseases, and not enteric fever 59 Doubtful diagnosis 1 Home case,diagnosis subsequently amended 2 Infected outside the Borough 56 Possibly infected by shellfish, watercress, &c. 47 Infected from other cases 58 ,, while unstopping of drains. 1 ,, by overflow of sewer 1 225 Source of illness not traced 197 Total 422 Of the 197 cases, the source of which was not traced, and which, therefore, might have been water-borne infection, 140 lived within the area of the "Croydon" supply, and 57 in the "Lam beth" area. The enteric fever incidence in the two areas was, therefore, 12 per 10,000 in the "Croydon" area, and 14 per 10,000 in the "Lambeth" area for the eleven years. The numbers for both water supplies are small, and conclusively disprove the suggestion that there has been any water-borne epidemic in Croydon during recent years. When the numbers of cases of enteric fever are so small as they were in Croydon in 1910, the question of a water epidemic does not arise, but knowing what we do of the potential dangeis of water infection, it is still essential that the efforts made by the Water Committee to further safeguard the public supplies should be in no way relaxed. Investigation was also made into the sanitary condition of all premises in which cases of enteric fever occurred, which could not be traced to infection outside the borough. As the numbers for 1910 are small, particulars have been extracted for the six years 1905—1910. 28 ENTERIC FEVER. (Deducting wrong diagnosis and definitely imported cases). Year. Houses Infected. Houses Tested. Serious defects, i.e. bad stoppages, and drains requiring to be re-laid. Slight defects, i.e. defective joints of ventilation pipes, &c. Remarks. 1905 16 16 2 4 1906 27 27 4 6 1907 12 12 — 2 1908 31 30 0 6 The Convent at Upper Norwood was not tested. Croydon Union Infirmary not tested 1909 18 17 2 5 1910 10 10 — 2 114 112 13 25 PUERPERAL FEVER was notified on 8 occasions, in 4 of which a doctor was present at the confinement. Puerperal fever occurred in one case attended by a midwife, who was suspended from practice for 14 days until her clothing and outfit were cleansed and disinfected. One case ended fatally. ERYSIPELAS was notified on 69 occasions, and one ended fatally. TUBERCULOSIS of all forms was the assigned cause of death in 186 instances, or 1.1 per 1,000 persons living, whilst phthisis alone was responsible for 135 deaths or .81 per 1,000. It will be seen from Table VI. that there is a slight decline in the mortality from phthisis. 29 Voluntary notification has been in force since the last quarter of 1903, and since January 1st, 1909, all cases treated by Poor Law Medical Officers have been compulsorily notifiable. The number of cases notified in each year was as follows:— Year. Cases Notified. 1903 (part of) 57 1904 129 1905 75 1906 96 1907 83 1908 106 1909 139 1910 130 Of the 130 cases notified in 1910, 58 were notified by the Medical Officers of the Croydon Union Infirmary, and 11 by the local district medical officers. The notifications received from the latter are incomplete. All the notified cases are visited by one of the health visitors who makes the necessary enquiries and give verbal instructions in accordance with the local handbill on the prevention of consumption. The premises are in addition inspected by the sanitary inspectors. As just pointed out the notifications are very incomplete, but 1 am not hopeful that very much success will attend our efforts until some further provision is made for phthisis either by means of a special clinic or in the shape of hospital accommodation. TUBERCULOSIS AND MILK. Pending fresh legislation, no samples were taken under the Model Milk Clauses during the year. MIDW1VES ACT, 1902. An inspection of the midwives was carried out by Dr. Jackson. The practice for gain by these unqualified women became illegal in April, 1910. During the year one registered midwife withdrew from practice, and six new names were added, leaving 35 on the register on December 31st, 1910. Three midwives were cautioned. 30 NOTIFICATION OF BIRTHS ACT, 1907 This Act was adopted by the Council on January 13th, and came into force on February 19th, 1908, after confirmation by the Local Government Board. During the year 3,502 notifications were received. These births were notified as follows:— Notified by medical men 1058 Notified by parents 1456 Notified by certified midwives 817 Notified by uncertificated midwifery nurses, before April, 1910 117 Ditto, after April 1st, 1910 54 171 3502 The number of births which actually occurred in the borough during the year was 3,810. The number of births notified by parents, medical men and midwives therefore amounted to 92 per cent. of the total. As instructed I have to report that the following measures are adopted with a view of diminishing the mortality among young nfants. All houses were births have taken place are visited by one of the health visitors, if the home circumstances are such as to make it probable that any advice given will be acceptable or necessary No hard and fast rule is drawn, but an endeavour is made to include all houses where a medical man is not likely to be in attendance for more than ten days after the confinement of the mother. The number of visits paid during 1910 amounted to 6,305. In most instances it is not possible to make more than two visits during the first six months of life. I am strongly of opinion that the visits made by the health visitors should be supplemented by medical advice at an Infants' Consultation. An attempt has at present been made to carry this into effect in two parts of the Borough, but it is too early to say whether mothers will avail themselves of the assistance placed at their disposal. Other means taken to check infantile mortality in Croydon include inquiries into deaths under one year of age, and the very general dissemination of leaflets. A special handbill has been prepared in connection with puerperal fever and other accidents of childbirth, clothing 31 of infants, the feeding and care of infants, and summer diarrhceaHealth lectures or talks to mothers have also been very generally given by members of the staff during the past nine years, and as many as 359 addresses have been given during that period. It will be seen from a previous table that there has been a steady and satisfactory decline in infantile mortality during the last ten years. CUSTOMS AND INLAND REVENUE ACTS. No application under Section 26, 53 and 54 Vict., c. 8, was received during the year. DISINFECTION. During the year 1,234 rooms and contents thereof and 12,213 articles were disinfected. The articles disinfected were as follows 872 Beds; 703 Mattresses; 2.158 Blankets: 534 Sheets; 2,044 Billows; 912 Bolsters; 178 Palliasses; 381 Cushirns: 108 Carpets: 407 Books; 3,916 Other Articles. Total, 12,213. 32 TABLE I. For whole District, (or Calendar Year 1910. Year. Population estimated to Middle of each Year. Births. Deaths under One Year of Age. Deaths at all Ages. Total. Deaths in Public Institutions. Deaths of Non-residents registered in District. Deaths of Resident registered beyond District. Deaths at all Ages Nett d. Number. Rate.* Number. Rate per 1,000 Births registered. Number. Rate.* Number. Rate* a b c d e X 2 3 4 5 6 7 8 9 10 11 12 13 1900. 131,186 3270 24 9 432 132 1977 15.1 419 63 6 1920 14.6 1901. 134,665 3578 26 6 501 140 1829 13.6 383 83 2 1748 12.9 1902. 137,917 3576 25 9 476 133 1965 14.3 429 74 13 1904 13.8 1903. 141,157 3726 26 4 386 104 1740 12.3 454 129 57 1670 11.8 1904. 144,419 3769 26 1 483 128 2071 14.3 598 148 75 1998 13.8 1905. 147,704 3894 26 4 372 96 1941 13.1 541 142 83 1S82 12.7 1906. 151,011 3886 25 7 485 125 2085 13.8 629 160 94 2019 13.4 1907 154,342 3967 25 7 371 94 1953 12.5 611 149 97 1901 12.3 1908. 157,698 4017 25 5 398 93 2C53 13.0 608 137 105 2021 l2.3 1909 161,078 3938 24 4 313 79 1974 12.3 572 16 3 70 1879 11.7 Averages for years 1900—1909 146,118 3762 25 8 422 113 1959 13.4 524 125 60 1894 13.0 1910. 166,884 3810 22 8 331 87 1817 10.9 562 145 111 1783 10.7 *Rates calculated per 1,000 of estimated population. a These are total births (uncorrected for Institutions). b These are corrected for Institutions. c Includes all deaths of residents and non-residents in Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Purley Cottage Hospital, 89, Central Hill (Servants Reformatory), and Norwood Cottage Hospital. d Deaths of non-residents have been excluded in the case of the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Purley Cottage Hospital, 89, Central Hill (Servants' Reformatory), and Norwood Cottage Hospital. Prior to 1903 correction was only made for the first three institutions. e In 1903 arrangements were made for the first time whereby deaths of Croydon persons in the London district were notified to the Medical Officer uf Health. Area of District in acres (exclusive of area covered by water), 9,012. At Census of 1901.—Total population at all ages, 133,895; number of inhabited houses, 25,726 ; average number of persons per house, 5'2. Ca» TABLE II. Vital Statistics of separate Wards in 1910 and previous years. Names of Localities. 1. West Ward 2. Central Ward. 3. East Ward. 4. South Ward. 5. South Norwood Ward. 6. Upper Norwood Sub-Division. 7. Thorntor Heath Sub-Division. 8. Undistributed Institution Births and Deaths. Year. Population estimate to middle of each year. Births Registered. Deaths at all ages. Deaths under 1 Year Population estimated to middle of each year. Births Registered. Deaths at all ages. Deaths under 1 Year Population estimated to middle of each year. Births Registered. Deaths at all ages. Deaths under 1 Year Population estimated to middle of each year. Births Registered. Deaths at all ages. Deaths under 1 Year Population estimated to middle of each year. Births Registered. Deaths at all ages. Deaths under 1 Year Population estimated at middle of each year. Births Registered. Deaths at all ages. Deaths tinder 1 Year Population estimated to middle of each year. Births Registered. Deaths at a 1 ages. Deaths under 1 Year Population estimated to middle of each year. Births Registered. Deaths at all ages. Deaths under 1 Year a b c d a b c d a b c d a b c d a b c d a b c d a b c d a b c d 1900 41,839 1142 662 175 16,694 355 264 46 14,241 327 177 33 17,624 394 246 52 19,852 501 234 62 8,241 129 96 11 12,685 353 ,57 43 *Prior to 1900, Institution Deaths could not he distributed as the Registrar did not supply the necessary information. 69 84 10 1901 43,136 1230 640 208 16,778 397 200 48 14,799 345 158 45 18,011 409 197 49 20,399 571 245 73 8,254 132 93 16 13,288 414 164 57 80 51 5 1902 44,361 1271 658 191 16,863 326 219 44 15,326 61 175 44 18,363 413 222 45 20,899 547 276 75 8,277 156 113 26 13,828 404 158 43 98 83 8 1903 45,540 1355 570 169 16,957 379 210 45 15,836 339 156 34 18,735 378 181 27 21,412 611 260 55 8,302 149 85 7 14,375 443 171 48 72 37 1 1904 46,741 1319 699 190 17,051 362 229 35 16,346 375 193 17 19,107 399 227 55 21,925 621 322 70 8,327 148 90 20 14,922 463 192 63 82 46 3 1905 47,944 1446 706 162 17,106 344 236 37 16,983 387 161 30 19,404 384 197 34 22,370 648 297 60 8,335 134 105 10 15,562 466 159 39 85 21 .. 1906* 49,219 1451 744 207 17,171 362 255 51 17,530 393 182 51 19,711 366 232 40 22,825 630 276 61 8,313 148 88 7 16,21 £ 447 227 65 89 15 3 1907* 50,500 1515 715 171 17,236 351 207 38 18,083 392 172 25 20,022 363 210 29 23,284 643 285 55 8,351 145 94 9 16,666 456 195 44 102 23 .. 1908* 51,801 1550 747 185 17,310 340 209 24 18,634 388 190 30 20,329 361 237 36 3,739 647 267 61 8, 64 15 119 6 17,521 492 231 53 83 21 .. 1909* 53,125 1560 721 142 17,391 266 211 24 19,185 396 189 33 20,636 371 198 27 24,195 634 267 39 8,377 151 87 8 18,176 455 184 40 85 23 .. Averages of Years 1900 to 1909. 47,420 1383 686 180 17,056 348 224 39 16,706 370 175 37 19,194 384 214 39 22,990 637 272 61 8,317 145 97 12 15,343 439 184 49 85 40 3 1910* 54,458 1489 693 149 17,478 298 170 21 19,736 404 105 33 20 943 376 180 30 24,651 548 239 45 8,388 139 102 6 18,831 474 168 47 82 27 Notes.—Deaths of residents occurring beyond the district are included in sub-columns c of this table, and those of non-residents occurring at the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Norwood Cottage Hospital, Purley Cottage Hospital, and 89, Central Hill (Servants' Reformatory) are excluded. Deaths of residents occurring in Public Institutions are allotted to the respective localities, according to the addresses of the deceased, and all deaths of Croydon residents whose exact home could not be ascertained, are included in Block 8. *Including North Ward. 34 TABLE III. Cases of Infectious Disease notified during the Year 1910. Notifiable Disease. Cases notified in whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 At all Ages. . At Ages—Years. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. Institution cases which could not he distributed. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. Institution Cases. Total. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 & upwd. Small pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 267 4 63 166 16 18 .. 66 46 25 23 35 31 6 34 1 55 34 18 21 28 21 4 26 1 208 Membranous Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 69 2 3 3 6 47 8 17 16 7 5 8 11 1 4 .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 759 6 171 489 46 46 1 301 131 61 73 47 68 17 61 .. 264 102 49 53 33 60 17 42 .. 620 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 26 .. 3 4 8 11 .. 4 1 1 2 5 8 .. 3 2 3 .. 1 2 1 8 .. 2 .. 17 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 8 .. .. .. 1 7 .. 2 1 .. 2 .. 1 .. .. 2 .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Phthisis 130 .. 1 12 22 86 9 41 21 16 4 3 16 4 12 13 .. .. .. .. .. .. .. .. .. .. Totals 1259 12 241 674 99 215 18 431 216 110 109 98 135 28 114 18 322 136 68 76 62 89 21 70 1 845 The Borough (Fever) Isolation Hospital is situated in the West Ward. The Croydon and Wimbledon (Smallpox) Isolation Hospital is at North Cheam. 35 TABLE IV. Causes of, and ages at, Death during Year ending December 31st, 1910. excluding Deaths of Stranger, at he Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Cottage Hospital Purley, Cottage Hospital Upper Norwood, 89, Central Hill (Servants' Reformatory), and adding Deaths of Croydon Residents known to have occurred outside the District. Schedule No. Causes of Death in Croydon during the Year ending December 31st, 1910. Deaths in whole District at Subjoined Ages. Deaths in Localities at All l Aces. Institution and Street Deaths which could not be distributed. Total Institution Deaths distributed and not distributed. Inquest Cases. all Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 2ft. 25 and under 65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. Total M. F. 2 Measles 31 20 11 4 27 .. .. .. .. 13 4 2 5 3 .. .. 4 .. .. .. 3 Scarlet Fever 7 4 3 .. 3 4 .. .. .. 3 2 1 .. .. .. .. 1 .. 7 .. 5 Epidemic Influenza 25 13 12 .. 1 .. 1 12 11 5 5 3 3 4 4 1 .. .. 7 .. 6 Whooping Cough 20 10 109 10 1 .. .. .. .. 5 3 1 4 5 1 1 .. .. 1 3 7 Diphtheria (mem. Croup) 21 19 9 .. 13 8 .. .. .. 8 3 3 .. 1 1 1 .. .. 17 (2) 1 8 Enteric Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (1) .. 10 Diarchœa, Dysentery 24 10 14 18 4 .. 1 1 .. .. 4 4 .. 4 5 .. 7 .. 4 .. 11 Epidemic Enteritis 3 3 .. 3 .. .. .. .. .. 1 .. .. .. .. 1 .. 1 .. 1 .. 12 Other Allied Diseases 1 1 .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 15 Tetanus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (2) 2 18 Syphilis 7 4 3 3 .. .. .. 3 1 1 1 .. .. 2 2 .. 1 .. 3 (1) .. 19 Gonorrhœa 1 1 .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. 1 .. 21 Erysipelas 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. 1 .. 22 Puerperal Fever 1 .. 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. (3) .. 23 Pyæmia (Septicaemia) 5 2 3 1 .. .. 1 2 1 3 .. .. .. 1 1 .. .. .. 3 24 Infective Endocarditis 1 1 .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. 25 Other Allied Diseases 6 3 3 2 .. .. .. 2 2 2 1 .. .. 1 1 .. 1 .. 3(1) .. 26 Malarial Fever 3 3 .. 1 .. .. 1 1 .. 1 .. .. .. 1 .. 1 .. .. 1 .. 27 Rheumatic Fever 4 2 2 .. .. 1 1 2 .. .. .. .. .1 1 .. 1 .. .. (1) 1 29 Tuberculosis of Brain 22 14 8 5 11 2 2 2 .. 7 3 3 3 2 1 .. 3 .. 7(2) .. 31 Phthisis 135 81 54 4 2 6 28 87 8 36 20 11 18 11 15 8 14 2 64(20) 2 32 Abdominal Tuberculosis 10 4 6 3 3 .. 2 2 .. 2 1 2 1 1 2 .. 1 .. 6(2) 1 33 General Tuberculosis 10 5 5 3 3 1 1 2 .. 4 1 .. .. 1 2 .. 2 .. 7 .. 34 Other forms Tuberculosis 9 4 5 .. 4 .. 2 2 1 3 2 .. 2 1 .. .. 1 .. 7 (2) 1 41 Acute Alcoholism 1 .. 1 .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. 42 Chronic Alcoholism 6 2 4 .. .. .. .. 5 1 2 .. 2 1 .. 1 .. .. .. 1 3 43 Chronic Industrial Poisonings 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. 45 Osteo-arthritis 13 9 4 .. .. .. 1 3 9 2 1 6 .. 1 1 2 .. .. 5 .. 46 Gout .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (1) .. 47 Cancer 164 61 103 .. .. 1 4 94 65 26 23 24 19 16 29 14 13 .. 51(12) 1 48 Diabetes Mellious 15 6 9 .. .. .. 3 6 6 1 3 1 2 4 3 .. 1 .. 5(1) .. 49 Purpura Hæmorrhagica 1 .. 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. 1 .. 51 Anæmia 15 10 5 .. 2 1 .. 8 4 .. 5 1 2 2 1 .. 4 .. 4 .. 52 Lymphadenoma 2 1 1 .. .. .. 1 1 .. 1 .. .. .. 1 .. .. .. .. .. .. 53 Premature Birth 91 49 42 91 .. .. .. .. .. 35 6 8 13 9 8 2 10 .. 5(1) 2 54 Injury at Birth 6 3 3 6 .. .. .. .. .. 1 2 .. 1 1 1 .. .. .. .. 2 55 Debility at Birth . 7 6 1 7 .. .. .. .. .. 3 1 1 1 .. 1 .. .. .. 1 .. 56 Atelectasis 11 7 4 11 .. .. .. .. .. 3 2 .. .. 1 4 .. 1 .. .. 1 57 Congenital Defects 12 6 6 12 .. .. .. .. .. 4 1 2 .. .. 2 1 2 .. 3 1 58 Want of Breast Milk 4 1 3 4 .. .. .. .. .. 1 1 .. .. .. .. 1 1 .. .. 2 59 Atrophy. Debility, Marasmus 38 24 14 35 3 .. .. .. .. 10 7 1 3 2 5 1 9 .. 12(4) 1 60 Dentition 1 1 .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 61 Rickets 1 1 .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 62 Old Age, Senile Decay 68 22 46 .. .. .. .. .. 68 13 8 8 7 4 11 9 8 .. 3 4 63 Convulsions 16 12 4 13 3 .. .. .. .. 6 3 3 1 .. 1 1 1 .. 1 11 64 Meningitis 11 4 7 1 3 3 .. 3 1 4 2 .. 1 .. .. .. 3 1 3 2 65 Encephalitis 3 1 2 .. .. .. 1 2 .. .. .. 2 1 .. .. .. .. .. 3(1) .. 66 Apoplexy 9 3 6 1 .. .. .. 3 5 2 3 1 .. .. .. 2 .. 1 .. .. 67 Softening of Brain 9 6 3 .. .. .. .. 2 7 2 2 .. 3 1 .. 1 .. .. 2 .. 68 Hemiplegia 8 5 3 .. .. .. .. 2 6 1 .. .. .. .. 5 2 .. .. .. .. 69 General Paralysis 14 12 2 .. .. .. .. 13 1 4 .. 2 .. .. 1 .. 3 4 13 .. 70 Other forms of Insanity 16 7 9 .. .. .. .. 11 5 2 .. 2 1 1 1 1 2 6 16 .. 72 Cerebral Tumour 3 1 2 .. .. .. .. 2 .. 1 .. 1 .. .. .. 1 .. .. .. .. 73 Epilepsy 2 2 .. .. .. .. .. .. 1 .. 1 1 .. .. .. ..l .. .. 2(1) 1 74 Laryngismus Stridulus 3 2 1 2 1 .. .. .. .. 1 .. .. 1 .. .. 1 .. .. (1) 3 76 Paraplegia 12 7 5 .. 1 1 1 6 3 4 2 1 1 1 2 .. 1 .. 1 1 77 Other forms, Brain Diseases 13 9 4 .. .. 2 1 8 2 3 2 1 2 2 3 .. .. .. 4 .. 78 Otitis 4 1 3 .. .. 2 .. 2 .. 2 1 .. 1 .. .. .. .. .. 3 1 81 Pericarditis 7 1 6 1 .. 1 1 3 1 2 1 .. 1 2 .. .. 1 .. 3(1) 1 82 Endocarditis 65 25 40 .. .. .. .. 28 35 19 11 4 8 5 10 1 5 2 26(8) 4 84 Angina Pectoris 7 6 1 .. 1 .. .. 3 4 2 3 .. 1 .. 1 .. .. .. .. 3 85 Aneurism 7 5 2 .. .. .. .. 4 3 2 1 1 2 .. 1 .. .. .. 2 2 86 Senile Gangrene 4 1 3 .. .. .. .. .. 4 2 .. 2 .. .. .. .. .. 3(1) .. 87 Embolism Thrombosis 7 4 3 .. .. .. .. .. 7 1 2 1 .. 2 .. 1 .. .. 4(3) .. 90 Other Diseases, Heart and Vessel 219 90 129 4 .. 3 3 65 144 50 20 24 23 22 33 20 19 8 95(30) 32 91 Laryngit's 3 2 1 .. 1 .. .. 1 1 .. 1 .. .. 1 .. .. 1 .. 1 .. 94 Acute Bronchitis 61 30 31 21 8 .. 1 10 21 16 14 6 8 5 5 1 6 .. 1 3 195 Chronic Bronchitis 78 39 39 .. .. .. .. 16 62 19 7 18 5 12 7 3 6 1 18(5) 2 96 Lobar Pneumonia 20 8 12 1 3 .. .. 9 7 1 9 1 3 2 1 2 1 5(2) 1 97 Lobular Pneumonia 41 23 18 14 12 1 .. 9 5 14 6 2 1 6 5 3 4 .. 21 (7) 4 36 TABLE IV—continued. Causes of, and ages at, Death during Year ending December 31st, 1910. Schedule No. Causes of Death in Croydor during the Year ending December 31st, 1909. Deaths in whole District at subjoined Ages. Deaths in Localities at all Ages. Institution and Street Deaths which could not be distributed. Total Institution Deaths distributed and not distributed. Inquest Cases all ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. Total. M. F. 98 Pneumponia 47 22 25 7 4 .. 1 21 14 9 6 4 5 8 9 3 3 .. 10(4) 10 99 Emphysema, Asthma 12 7 5 .. .. .. .. 6 6 5 .. .. 2 1 4 .. .. .. 3 .. 100 Pleurisy 4 2 2 .. .. .. 1 3 .. .. .. .. 1 1 .. 1 .. .. 1 1 101 Other Diseases Respiratory System 1 .. 1 .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 102 Diseases of Mouth and Annexa 2 1 1 .. .. 1 .. 1 .. .. 1 .. .. 1 .. .. .. .. .. .. 103 Diseases of Pharynx .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 105 Ulcer of Stomach and Duodenum 10 3 7 .. .. .. 1 6 3 .. .. 2 1 1 5 .. .. .. 5 (1) 1 106 Other Diseases of Stomach 14 5 9 8 1 .. .. 1 4 5 .. .. 2 2 1 2 2 .. 2 (1) .. 107 Enteritis 24 14 10 18 3 .. .. .. 3 9 2 2 2 .. 4 2 3 .. 2 (1) .. 108 Appendicitis 14 9 5 .. .. 6 9 6 .. 1 8 9 1 1 .. .. 1 .. 11(3) .. 109 Obstruction of Intestine 15 5 10 6 1 .. .. 5 3 4 3 3 2 2 .. .. 1 .. 10 (3) 1 110 Other Diseases of Intestine 2 1 1 2 .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. 111 Cirrhosis of Liver 11 7 4 .. .. .. .. 6 5 2 2 .. 2 .. 2 2 1 .. 5 (3) .. 112 Other Diseases of Liver 9 5 4 .. .. .. 1 5 3 3 1 1 .. 1 1 1 1 .. .. .. 113 Peritonitis 3 1 2 .. .. .. .. .. 3 .. .. .. 2 .. 1 .. .. .. 1 .. 114 Other Diseases, Digestive 3 2 1 1 .. .. .. 1 1 .. .. .. .. 1 1 .. 1 .. .. .. 115 Diseases, Lymphatic System and Glands 3 .. 3 .. .. .. 1 2 .. .. 1 .. .. 9 .. .. .. .. .. 1 116 Acute Nephritis 8 1 7 .. .. .. 2 6 1 2 .. 3 .. .. 1 1 .. (2) 1 117 Brignt's Disease 47 29 18 .. .. l .. 22 24 14 9 3 6 4 8 2 1 .. 8(3) 3 118 Calculus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 119 Diseases of Bladder and Prostate 15 13 2 .. .. .. .. 12 3 3 4 1 .. .. 1 2 4 .. 4 1 120 Other Diseases, Urinary .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 121 Diseases of Testis & Penis 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. 1 .. 122 Diseases of Ovaries 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. 1 .. 123 Diseases of Uterus and Appendages 4 .. 4 .. .. .. .. 4 .. .. .. 1 1 .. .. .. 1 .. 4 .. 125 Diseases of Breast .... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 126 Abortion, Miscarriage 1 .. 1 .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. 127 Puerperal Mania .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 128 Puerperal Convulsions 3 .. 3 .. .. .. 1 2 .. .. .. .. 1 .. 1 1 .. .. 1 .. 129 Placenta Prævia Flooding 5 .. .. .. .. 1 4 .. 3 .. .. 2 .. .. .. .. .. 1 1 130 Puerperal Thrombosis 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. 131 Other and ill-defined Accidents and Diseases of Pregnancy and Childbirth 1 .. 1 .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. 132 Arthriti, statis, Periostitis 2 1 1 .. .. 1 .. 1 .. .. .. .. 1 1 .. .. .. .. 1 .. 133 Other & ill-defined Diseases .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. (1) .. 134 Ulcer. Bedsore 2 1 1 .. .. .. .. 2 .. .. .. .. .. 2 .. .. .. .. 2(1) .. 136 Pemphigus 3 1 2 2 .. .. .. .. 1 2 .. .. .. .. 1 .. .. .. 1 .. Accidents. 139 In Vehicular Traffic 8 6 2 .. 1 1 3 3 .. 1 1 1 1 1 3 .. .. .. 10(4) 12 140 On Railways 4 4 .. .. .. .. 2 2 .. .. .. .. .. 1 .. .. .. .. 1 4 142 In Building Operation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 145 Burns and Scalds 9 4 5 .. 2 1 1 3 9 2 3 .. .. 2 1 .. 1 .. 4 9 147 Surgical Narcosis 2 2 .. .. 1 .. 1 .. .. .. .. .. .. 1 1 .. .. .. 1 2 150 Drowning 4 2 2 .. .. .. .. 4 .. 1 .. .. 2 .. 1 .. .. .. .. 4 151 Suffocation, Overlaid in Bed 4 2 2 4 .. .. .. .. .. 2 .. .. 1 .. .. .. 1 .. .. 4 151 ,, Otherwise 2 1 1 .. .. .. 1 1 .. 1 .. .. .. .. .. .. 1 .. .. 2 153 Falls not specified 10 1 3 .. 1 1 .. 5 3 1 1 .. 3 2 .. 1 1 1 8 (2) 12 155 Otherwise, not stated 5 6 2 2 .. .. .. 3 .. .. 1 .. .. 1 2 .. .. 1 2 5 156 Homicide 1 .. 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 Suicides. 157 By Poison 2 1 1 .. .. .. 1 .. 1 1 .. .. .. .. 1 .. .. .. 1 2 158 By Asphyxia 2 2 .. .. .. .. .. 2 .. 1 1 .. .. 1 .. .. .. .. 1 2 159 By Hanging & Strangulation 2 2 .. .. .. .. .. 2 .. .. .. .. 1 .. .. .. .. .. .. 2 160 By Drowning 2 1 1 .. .. .. .. 2 .. .. 1 .. .. .. 1 .. .. .. .. 2 161 By Shorting 1 1 .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. 1 1 162 By Cut or Stab 1 .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. 2(1) 1 164 By Crushing 2 2 .. .. .. .. .. 2 .. 1 .. .. .. .. 1 .. .. .. 1 3 165 By other and unspecified methods 3 3 .. .. .. .. .. 3 .. .. 1 .. .. 1 1 .. .. .. 1 3 168 Ill-defined and Unspecified Causes 5 4 1 .. 1 .. 2 1 1 1 2 .. .. .. 1 1 .. .. 1 5 Total 1783 394 389 331 136 55 78 594 589 437 256 179 195 180 239 102 168 27 562 (145) 193 The total Institution Deaths include those of strangers occurring within the Borough. Deaths of such strangers occurring at the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Cottage Hospital, Purley, Cottage Hospital, Upper Norwood, and 89, Central Hill (Servants' Reformatory), are excluded from all other columns of the Table. The numbers so excluded are in brackets. 37 TABLE V. County Borough of Croydon—Whole District. INFANTILE MORTALITY DURING THE YEAR 1910. Deaths from stated Causes in Weeks and Months under One Year of ]CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-20 Months. Total Deaths Under One Year. All Causes. Certified 87 28 30 10 155 40 21 25 23 10 10 8 11 8 10 10 331 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pos ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 ... 1 4 measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 1 3 ... 2 ... 1 1 ... ... 1 9 Darihœal Diseases. Diarrhœa, all forms ... ... ... ... ... 4 ... 5 5 ... 3 ... 1 ... 1 2 21 Enteritis (not Tuberculous) ... ... 1 l 2 5 2 ... 3 2 ... 1 2 1 ... ... 18 Gastritis 2 ... 2 ... 4 ... 1 ... 2 1 ... ... ... ... ... ... 8 Washing Diseases. Premature Birth 56 16 12 3 87 4 ... ... ... ... ... ... ... ... ... ... 91 Congenital Defects 14 3 2 2 21 4 1 1 ... ... ... ... 1 1 1 ... 30 Injury at Birth 6 ... ... ... 6 ... ... ... ... ... ... ... ... ... ... ... 6 Want of Breast milk 1 ... ... ... 1 1 1 ... 1 ... ... ... ... ... ... ... 4 Atrophy, Debility Marasmus 2 4 2 ... 8 12 3 4 2 1 ... ... ... ... 4 1 35 7 Tuberculous Diseases Tuberculous Meningitis ... ... ... ... ... ... ... 1 1 1 2 ... ... ... ... ... 5 Tuberculous Peritonitis: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tabes Mesenterica . ... ... ... ... ... ... ... 2 ... ... ... ... 1 ... ... ... 3 Other Tuberculous D ses ... ... ... ... ... 1 ... 1 ... ... ... ... 1 1 1 2 7 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... 2 1 3 ... ... ... ... ... ... ... ... ... ... ... 3 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions 1 1 1 1 4 3 2 ... 4 ... ... ... ... ... ... ... 13 Bronchitis ... ... 2 ... 2 2 5 9 1 ... 3 2 2 1 1 ... 21 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... 1 2 1 4 2 ... 4 1 1 1 2 1 3 2 1 22 Suffocation, overlying ... ... ... 1 1 ... 1 1 ... 1 ... ... ... ... ... ... 4 Other causes 5 3 4 ... 12 2 3 1 3 1 1 1 1 ... ... 2 27 87 28 30 10 155 40 21 25 23 10 10 8 11 8 10 10 331 38 TABLE V.—continued. County Borough of Croydon—West Ward District. INFANTILE MORTALITY DURING THE YEAR 1910. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths Under One Year. All Causes. Certified 26 9 14 2 51 14 8 7 5 5 ... 4 5 5 5 3 112 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... 3 Diarrhœl Diseases. Diarrhœa, all forms ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Enteritis (not Tuberculous) ... ... ... ... ... 2 2 ... ... ... ... 1 ... 1 ... ... 6 Gastritis 1 ... 1 ... 2 ... ... ... 1 1 ... ... ... ... ... ... 4 Wasting Diseases. Premature Birth 19 0 8 1 34 1 ... ... ... ... ... ... ... ... ... ... 35 Congenital Defects 4 ... ... 1 5 2 1 ... ... ... ... ... ... ... 1 ... 10 Injury at Birth 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Want of Breast-milk ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Atrophy, Debility, Marasmus ... 2 1 ... 3 3 ... ... ... ... ... ... ... ... 2 ... 9 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous D'ses ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... 2 6 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... 1 2 ... 2 ... ... ... ... ... ... ... 5 Bronchitis ... ... 1 ... 1 1 2 ... ... ... 2 1 ... 1 ... 9 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... 1 1 ... 1 ... 3 ... ... 9 Suffocation, overlying ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 2 Other Causes 1 1 1 ... 3 2 1 ... ... 1 ... ... 1 ... ... 1 9 26 9 14 2 51 14 8 7 5 5 ... 4 5 5 5 3 112 Population Estimated to middle of 1910 —31,259. legitimate, 790. legitimate infants,102. Births in the year Deaths in the year of illegitimate, 34 illegitimate infants, 10. Deaths from all Causes at all Ages 437. 39 TABLE V.—continued. County Borough of Croydon—North Ward District. INFANTILE MORTALITY DURING THE YEAR 1910. Deaths from stated Causes in Weeks and Months under 0ne Year of Age CAUSE OF DEATH. Under 1 Week 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Deaths Under One Year. All Causes. Certified 11 5 ... ... 16 3 3 2 3 2 2 1 2 ... ... 1 37 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Darrhœal Diseases, Diarrhœa, all forms ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... Enteritis (not Tuberculous) ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 2 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wasting Diseases. Premature Birth 4 2 ... ... 6 ... ... ... ... ... ... ... ... ... ... ... 6 Congenital Defects 3 ... ... ... 3 1 ... ... ... ... ... ... ... ... ... ... 4 Injury at Birth 2 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast milk ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Atrophy, Debility Marasmus ... 2 ... ... 2 2 ... 1 ... 1 ... ... ... ... 1 ... 7 Tuberculous Diseases Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 3 bronchitis ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 2 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other causes 1 ... ... ... 1 ... 1 ... 1 ... 1 ... ... ... ... ... 4 11 5 ... ... 16 3 3 2 3 2 2 1 2 ... 2 1 37 Population Estimated to middle of 1910—23,199. legitimate, 676. legitimate Infants, 32 Births in the year Deaths in the year of (illegitimate, 71.* illegitimate inlants 5 Deaths from all Causes at all Ages 256. †Including 31 at the Workhouse Infirmary. * Including 51 „ „ 40 TABLE V.—continued. County Borough of Croydon—Central Ward District. INFANTILE MORTALITY DURING THE YEAR 1910. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths Under One Year All Causes. Certified 5 2 1 2 10 3 ... 1 5 ... 1 ... ... 1 ... ... 21 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœal Diseases. Dianhœa, all forms ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 2 Enteritis (not Tuberculous) ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wasting Diseases. Premature Birth 4 1 1 1 7 1 ... ... ... ... ... ... ... ... ... ... 8 Congenital Defects ... 1 ... ... 1 1 ... ... ... ... ... ... ... 1 ... ... 3 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... ... ... 2 Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 5 2 1 2 10 3 ... 1 5 ... 1 ... ... 1 ... ... 21 Population Estimated to middle of 1910 — 17 478. legitimate, 290. legitima e in'ants, '20 Births n the year Deathsin the year illegitimate, 8 illegitimate infants, 1, Deaths from all Causes at all Ages 179. 41 TABLE V.—continued. County Borough of Croydon—East Ward District. INFANTILE MORTALITY DURING THE YEAR 1910. Deaths from stated Causes in Weeks and Months under One Year of Age CAUSE OF DEATH. 1 Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths 1 Under One Year. All Causes. Certified 10 8 2 1 21 2 4 1 1 1 1 ... ... 1 1 ... 33 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 2 Diarrhœal Diseases. Diarrhœa, all forms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis (not tuberculous) ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... 2 Gastritis 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Washing Diseases. Premature Birth 8 4 1 ... 13 ... ... ... ... ... ... ... ... ... ... ... 13 Congenital Defects ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Injury at Birth 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Want of Breast milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility Marasmus ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 2 Tuberculous Diseases Tuberculous Meningitis ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 bronchitis ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 2 I.aryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Suffocation, overlying ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Other causes ... 2 ... ... 2 ... ... ... 1 ... ... ... ... ... ... ... 3 10 8 2 1 21 2 4 1 1 1 1 ... ... 1 1 ... 33 Population Estimated to middle of 1910—19,736. legitimate, 396. legitimate lnfants, 30. Births in the year Deaths in the year of illegitimate, 8. illegitimate in ants 3. Deaths from all Causes at all Ages 195. 42 TABLE V.—continued. County Borough of Croydon—South Ward District. INFANTILE MORTALITY DURING THE YEAR 1910. Heaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths Under One Year. All Causes. Certified 9 1 1 ... 11 3 1 3 2 1 3 2 ... ... 1 3 30 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 2 Diarrhœal Diseases. Diarthœa, all forms ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... 4 Enteritis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gastritis ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... Wasting Diseases. Premature Birth 7 1 ... ... 8 1 ... ... ... ... ... ... ... ... ... ... 9 Congenital Defects 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, asmus ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 2 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 3 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Cause 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 3 9 1 1 ... 11 3 1 3 2 1 3 2 ... ... 1 3 30 Population Estimated to middle of 1930-20 943. legitimate, 372. legitimae infants, 29. Deaths in the year of illegitimate, 4. illegitimate infants, 1. Deaths from all Causes at all Ages 180. 43 TABLE V.—continued. County Borough of Croydon—South Norwood Ward District. INFANTILE MORTALITY DURING THE YEAR 1910. Deaths from stated Causes in Weeks and Months under One Year of Age CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths Under One Year. All Causes. Certified 15 1 4 2 22 6 5 5 3 ... 1 ... 2 ... ... 1 45 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infections Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... l Darrhœl Diseases. Diarrhœa, all forms ... ... ... ... ... 1 ... 3 1 ... ... ... ... ... ... 1 6 Enteritis (not Tuberculous) ... ... ... ... ... 2 ... ... 1 ... ... ... ... ... ... ... 3 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wasting Diseases. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 7 ... ... ... 7 1 ... ... ... ... ... ... ... ... ... ... 8 Congenital Defects 4 1 1 1 7 ... ... ... ... ... ... ... ... ... ... ... 7 Injury at Birth 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Want of Breast milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility Marasmus ... ... ... 1 1 2 1 ... ... ... ... ... ... ... ... ... ... Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Other Tuberculous D' ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not 7uberculous) ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Convulsions ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 1 ... 1 ... 2 ... 1 ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other causes 3 ... 1 ... 4 ... ... 1 ... ... ... ... ... ... ... ... 5 15 1 4 2 22 6 5 5 3 ... 1 ... 2 ... ... 1 45 44 TABLE V.—continued County Borough of Croydon—Upper Norwood Ward District INFANTILE MORTALITY DURING THE YEAR 1910. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under I Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths Under One Year All Causes. Certified 3 ... ... ... 3 ... ... 1 1 1 ... ... ... ... ... ... 6 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœal Diseases. Diarrhœa, all forms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis (not Tuberculous) ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Washing Diseases. 2 Premature Birth 2 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... Congenital Defects ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk Atrophy, Debility, Marasmus ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Tuberculous Diseases Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Peritonitis: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculins) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... 3 ... ... 1 1 1 ... ... ... ... ... ... 6 45 TABLE V.—continued. County Borough of Croydon—Thornton Heath Ward District. INFANTILE MORTALITY DURING THE YEAR 1910. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths Under One Year. All Causes. Certified 8 3 8 22 6 2 5 3 ... 2 1 2 1 1 2 47 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœl Diseases. Diarrhœa, all forms ... ... ... ... ... 2 ... 2 1 ... 1 ... ... ... ... ... 6 Enteritis (not Tuberculous) ... ... l ... 1 ... ... ... ... ... ... ... 1 ... ... ... 2 Gastritis ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Wasting Diseases. Premature birth 5 2 2 1 10 ... ... ... ... ... ... ... ... ... ... ... 10 Congenital Defects 2 1 ... ... 3 ... ... ... ... ... ... ... ... ... ... ... 3 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Atrophy, Debility, Marasmus 1 ... 1 ... 2 2 I 1 1 ... ... ... ... ... 1 1 9 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Tuberculous Peritonitis: Tabes Mesenlerica ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Other Tuberculous D'ses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphi1is ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Bronchitis ... ... ... ... ... 1 ... ... ... ... 1 ... 1 1 ... ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... 1 1 1 ... ... ... ... ... 1 ... ... ... 1 4 Suffocation, overlying ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 Other Causes ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 8 3 8 3 22 6 2 5 3 ... 2 1 2 1 1 2 47 46 TABLE VI. I able showing the number of cases notified and deaths from the principal zymotic diseases for the Year 1910 and ten preceding Years. Disease. 1910. 1909. 1908. 1907. 1906. 1905. 1904. 1903. 1902. 1901. 1900. Cases. Deaths. Cases. Deaths Cases. Deaths Cases. Deaths. Cases. Deaths Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Notifiable. Small Pox .. .. .. .. .. .. .. .. 4 .. .. .. 3 .. 14 2 51 11 5 .. 1 .. Scarlet Fever 759 7 727 9 534 5 661 11 425 8 416 11 291 8 915 2 295 6 391 1 432 5 Diphtheria and (1) Memb.Croup 267 21 356 24 405 37 286 40 304 40 266 25 312 24 259 18 985 29 448 23 187 25 (2) Erysipelas 69 1 92 3 60 5 73 4 68 2 78 5 68 2 79 4 102 5 79 4 71 6 Puerperal Fever 8 1 16 5 10 5 7 4 9 2 11 5 9 3 7 1 8 5 9 3 12 8 Enteric Fever 26 .. 21 3 52 5 19 1 34 5 34 4 21 5 32 5 59 9 57 11 56 9 Simple Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 .. 5 .. .. .. 4 .. Non-notifiable. Diarrhœa and Epidemic or Zymotic Enteritis .. 27 .. 19 .. 52 .. 30 .. 142 .. 52 .. 95 .. 37 .. 73 .. 129 .. 88 Enteritis .. 24 .. 26 23 .. 26 .. 61 .. 22 .. 35 .. 14 .. 17 .. 37 .. 25 Measles .. 31 .. 21 .. 92 .. 8 .. 37 .. 24 .. 62 .. 96 .. 30 .. 21 .. 20 Whooping Cough 20 .. 30 .. 29 .. 32 .. 28 .. 31 .. 15 .. 58 .. 31 .. 25 .. 56 Influenza .. 25 .. 59 .. 52 .. 31 .. 20 .. 30 .. 27 .. 28 .. 58 .. 37 .. 106 Bronchitis, Pneumonia, and . Pleurisy .. 251 .. 323 .. 282 .. 316 .. 218 .. 302 .. 314 .. 247 .. 341 .. 983 .. 367 \Phthisis .. 135 .. 152 .. 150 .. 160 .. 173 .. 162 .. 142 .. 151 .. 112 .. 123 .. 135 (1) Notifiable since May, 1897. (2) Notifiable since January, 1900. In the above Table deaths of Non-residents occurring at the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Nor wood Cottage Hospital, Purley Cottage Hospital, and "89, Central Hill" (Servants Reformatory), are excluded. Prior to 1903 correction was only made for the first three institutions. 47 B.—SANITARY WORK OF THE YEAR. GENERAL SANITARY WORK. The usual summary is given in Table IX., which gives a fair idea of the various matters engaging the attention of the Sanitary Inspectors. During the year 5,66S house-to-house inspections were made, as compared with 5,127 in 1909. The number of systems of combined drainage dealt with as single private drains during the year was 50. This work was carried out under the provisions of the Croydon Corporation Act, 1905. The cost of carrying out the necessary works amounted to £536 is. 5d., and was borne by the owners instead of by the inhabitants at large. In 295 instances the whole of the house drains were re-laid, and 235 house drains were repaired or partially re-laid. 305 applications were received for the examination of the drains and sanitary condition of houses by occupiers or intending occupiers. In all these cases special reports were made by the district Inspectors, copies of which were forwarded to the applicants. In ail cases where defects were found, and in many cases where improvements were suggested, the work was carried out by the owners without the necessity of serving sanitary notices. Most of the nusiances discovered were remedied on receipt of informal notices, but in 201 eases, Council Orders had to be applied for. Of the 201 legal notices, 153 were complied with, and 48 were outstandidg at the end of the year. No prosecutions had to be undeitaken for non-compliance with ordinary nuisance notices. PAVING OF BACK YARDS. Nine hundred and five back yards have been paved during the year. There is a considerable increase over the number dealt with in the previous year and is a record of work of considerable sanitary value. 48 MUNICIPAL COMMON LODGING HOUSE. This Lodging House affords accommodation for 17 women and 84 men. The number of occupants during the year amounted to 25,668 men and 4,504 women. The average number of lodgers amounted to 70 men and 12 women per night. The receipts and expenditure (exclusive of sinking fund and interest) for the past five years were :— Receipts. Expenditure, £ s. d. £ s. d. 1906 804 5 8 665 6 10 1907 811 17 9 572 9 7 1908 753 0 9 624 7 5 1909 750 0 0 632 15 7 1910 956 3 6 765 13 2 OTHER COMMON LODGING HOUSES. There are ten other houses on the register. The following Table gives the situation of the ten registered houses and the accommodation provided therein :— Premises. No. of Rooms. Accommodation. 11 & 12, Princess Road 12 54 men and 8 married couples. 9, Prosprct Place (late Bell Yard) 6 14 men and 5 married couples. 19, 20, 21, 22, 23 & 24 Lahore Road 30 50 men, 10 women, and 6 married couples. “he Jolly Bleachers” Union Street 13 30 men. Nos. 19 to 24, Lahore Road.—These houses are under one management and worked as one establishment, as also are Nos. 11 and 12, Princess Road. Practically, therefore, only four common lodging houses now remain in the Borough, with a total accommodation for 196 adults, or if we add the Municipal Common Lodging House, a total of five houses with 259 single beds and 19 double beds. During the year common lodging houses received 579 visits, while 10 houses received night visits. Minor infringements of bye-laws were detected on 6 occasions, but in no case were they sufficiently serious for legal proceedings to be taken. 49 HOUSES LET IN LODGINGS. There are now 49 houses registered under the bye-laws. During the year these houses received 1,680 visits. On no occasion were offences discovered for which piosecutions were necessary At the present moment the following houses are registered as houses let in lodgings :— Houses. Wilford Road 18 Forster Road 12 Holmesdale Road 4 Ely Road 8 Queen's Road 2 Lion Road 1 Pawsons Road 3 Beulah Road 1 Princess Road 1 49 The results of registration and inspection have, on the whole, been satisfactory. HOUSING OF THE WORKING CLASSES ACT. No house was represented under Part II., Section 39, as unfit for human habitation. FACTORIES AND WORKSHOPS. FACTORY AND WORKSHOPS ACT. Section 132 of the Factory and Workshop Act, 1901, provides:— " The Medical Officer of Health of every District Council, shall, in his Annual Report to them, report specifically on the administration on this Act in workshops and workplaces, and lie shall send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State. The following is a summary of the work done under this Act in Croydon during 1910. 5° FACTORIES. For the most part, the law relating to Factories is administered by the Home Office. 125 visits were, however, made to Factories, 62 being in reference to sanitary accommodation, 44 in reference to cleanliness of earth closets, eight in reference to new occupation, three in reference to ventilated space in glass works, four in reference to smoke, three in reference to want of screens to w.c.'s at a steam laundry, and one in reference to complaint of noise from a steam laundry. All the defects noted were remedied during the year. WORKSHOPS. The number of workshops on the register, the various trades carried on therein, the number of workpeople employed, and the number of visits paid by the Inspector, are shown in Table X. The following is a list of the various matters requiring attention :— Factories. Workshops Laundries Bakehouses. Workplaces. Outworkers. Total Premises requiring repair - 1 — — — — 1 Cleansing, etc. _ 14 3 14 9 1 41 Insufficient W.C. accommodation 1 - 1 — — 2 Defective ditto 3 10 3 5 2 — 23 Overcrowding — 3 — — — — 3 Dustbins — 1 — 2 — — 3 Paving — — 2 1 — — 3 Insufficient ventilation — 5 — — — — 5 Offensive accumulation — — — 1 — — 1 3 35 8 24 11 1 82 Notices served— Factories 3 Workshops 32 Laundries 7 Bakehouses 20 Workplaces 11 Outworkers 1 74 51 All were remedied during the year with the exception of two which have now been complied with (May, 1911) Fifty-eight notices were sent to H.M. Inspector of Factories in accordance with the various requirements of the Act HOME WORK. One hundred and thirty-two lists were received from employers containing the names of 349 outworkers residing in the Borough. Seventy-nine further names were received from the Medical Officers of Health of various neighbouring districts, and the names of 6ft outworkers residing outside the Borough were similarly despatched to the Medical Officer of Health for the district concerned. In three instances legal proceedings were instituted against employers for failing to comply with the provisions of Section 107 of the Factory and Workshop Act after notice of default had been given. A fine of 15s. 6d. including costs was imposed in one case, 10s. 6d. including costs in another, while the third was withdrawn. One hundred and eighty-three visits were paid to outworker s BAKEHOUSES. At the end of the year there were 115 Bakehouses in occupation of which eight were underground. Eight hundred and fifty-four visits were made by the Inspector during the year, and 20 nuisances discovered and abated. WORKPLACES. At the end of the year there were 68 workplaces on the register. Ninety-six visits to eating-house kitchens have been made, and 11 notices served for cleansing, which have been complied with. SHOP HOURS AND SEATS IN SHOP ACTS entailed 271 visits, and resulted in the discovery of 4 infringements of the Acts, one being the non-exhibition of notices, one the want of seats for female assistants, and two for excessive hours. Written cautions were sent to the four offenders and subsequently complied with 52 SMOKE NUISANCES. Seventy observations were made, and 12 persons were cautioned. MEAT INSPECTION. There is one inspector appointed for meat inspection in the Borough, acting under the supervision of the Medical Officer of Health. This Inspector holds the Certificate of the Sanitary Association of Scotland as a Sanitary Inspector. The Meat Inspector is assisted so far as the Municipal Slaughterhouses are concerned, by the superintendent, who is an experienced slaughterman. In all cases of difficulty arising from difference of opinion or doubt the Medical Officer of Health is consulted. The Meat Inspector visits the private slaughterhouses as far as possible when slaughtering operations are going on, and at other times to ascertain whether the regulations as to removal of offal and general cleanliness are complied with. The following tabulated statements show the number of slaughterhouses and the visits paid to same ; the total amount of meat and other articles of food destroyed, and the reason for such procedure; the number of carcases in which tuberculosis was detected and the action taken. SLAUGHTERHOUSES. There are 15 registered Slaughterhouses in addition to the Municipal Slaughterhouses at Pitlake. The following are the approximate number of animals slaughtered at Pitlake :— Municipal. Beasts. Sheep. Pigs. Calvcs. Total. Private Slaughterhouses 223 5,994 13,991 2,079 22,287 Public 520 4,547 2.863 911 8,841 Total 743 10,541 16,8.54 2,990 31,128 S3 Summary of totals for last five years :— Beasts. Sheep. Pigs. Calves. Total. 1906 790 8 284 20,080 4,764 33,918 1907 734 7,080 19,099 5,617 32,530 1908 696 6,365 18,525 3,894 29,480 1909 579 7 256 20,106 2,480 30.421 1910 743 10 541 16,854 2,990 31,128 3,542 39 526 94,664 19,745 157,477 The visits paid by Inspector Low in connection with the milk and meat trades are shown in the following Table :— Nature of Premises WARD. • No. of Inspections. Total North. West, Central East. South, S. Nor' U. Nor. Slaughter-houses ... 785 496 21 157 52 46 1557 Hutchers 20 171 286 22 58 45 17 619 Fishmongers 23 40 80 21 10 31 26 231 Markets ... ... 51 ... 51 ... ... 102 Cowkeepers 28 21 17 18 32 3 21 140 Milk Purveyors 65 103 49 78 45 26 70 436 Other Premises ... 14 2 2 19 1 1 39 Total 136 1134 981 162 372 158 181 3124 54 MEAT AND FOOD The following is a summary of the meat and other articles of food destroyed as unfit for consumption during the year :— ARTICLES. Weight in lbs. Remarks. Diseased. Unsound. Total. Beef 11,671 10,746 22,417 Including 25 carcases. Mutton 622 939 1,561 „ 29 „ Pork 6,939 14 6,953 „ 20 „ Veal 132 341 473 „ 9 „ Offal 5,734 863 6,597 Fish 1,540 1,540 Codfish, Cod roe, Hake, Haddocks, Herrings, Kippers, and Soles. Apples, Currants, plums, Oranges, Sprouts, Potatoes, Tomatoes, Poultry. Other Articles 655 655 Total lbs. 25,098 15,098 40,196 Including 83 carcases. The whole carcases condemned were affected as undernoted :— Tuberculosis. Peritonitis. Pleuri y. Enteritis. Pneumonia. jaundice. Diarrhoea. | Septicaemia Parturient fever Pyaemia. Emaciated, various causes. Immatures. Injured, etc. Unsound, Total carcases. Total Weight of carcases in lbs. Cattle 16 l .. 1 .. .. .. 2 3 .. .. .. 25 11256 Sheep .. 2 2 .. 1 .. .. .. 2 1 10 .. 9 2 29 1411 Pigs 17 1 .. .. .. .. 1 .. .. .. .. .. .. 20 4427 Calves .. 2 .. .. .. .. 2 .. .. .. .. 3 2 .. 9 473 Totals 33 6 2 1 2 1 2 1 4 2 13 3 11 2 83 17567 55 Summary of tuberculous carcases found and action taken :— Animals affected. Action taken. Carcase and all internal organs destroyed. Part of carcase and all internal organs destroyed. All or part of internal organs destroyed. Total, Cattle 16 5 35 56 Pigs 17 118 44 179 Total 33 123 79 235 OFFENSIVE TRADES. Only three such trades are now carried on in the Borough, viz., one by a knacker and two by a gut-scraper. The premises have been visited from time to time during the year and found in a satisfactory condition. DAIRIES AND COWSHEDS. There were 36 cowsheds on the register at the end of the year, of which 34 were in occupation, as against 39 sheds and 34 in occupation in 1909. The registered cowsheds provide accommodation for 603 cows with 800 cubic feet per head. The number of cows in the registered sheds in December was 459. The number of Cowkeepers in the Borough is now 23, as compared with 27 in 1909. During the year 45 dairies were removed from, and 77 added to the register, leaving 300 on the register at the end of the year. Four applications for registration were refused, as the premises were unsuitable. Twenty-two notices were served during the year for various matters requiring attention on the premises of dairymen, all of which were complied with at the end of the year. ICE CREAM VENDORS. All premises where ice cream was known to be made were regularly visited during the season. All were found in a fairly satisfactory condition. On one oecasion only was it found necessary to serve notice during the year. 56 FOOD AND DRUGS ACTS. Table XI. gives the number of samples taken by Mr. Saunders during the year, the results of the analyses and the action taken thereon. PROSECUTIONS, 1910 Date. Defendant. Charge. Result. Penalty. Costs. £ s. d. £ s. d. Jan. 27 F. A. Selling Milk adulterated with 10 per cent. added water and 10 per cent. deficient in fat Convicted 5 0 0 0 17 0 Mar. 8 G. W. Selling; separated Milk adulterated witn 8 per cent. added water 11 1 0 0 0 11 6 „ 17 S. & Son Selling Milk 25 percent. deficient in fat Dismissed (Warranty proved) - - „ 17 E. D. Selling Milk 20 per cent. deficient in fat Convicted 1 0 0 0 10 6 „ 17 W. S. Selling Milk 10 per cent. deficient in fat „ 7 10 0 0 10 6 June 8 G. R. S. Selling Miik 16 per cent. deficient in fat and 4 per cent. added water „ 2 0 0 0 6 6 „ 8 A. W. L Selling Milk from vehicle without having name & address thereon „ 0 5 0 0 5 6 Sep. 29 L. Bros. Selling Skimmed Milk adulterated with 25 percent. adde i water „ 1 0 0 0 10 6 Nov. 4 N. & Son Selling Butter adulterated with 35 per cent. foreign fat „ 0 10 0 0 13 0 „ 5 G. T. Selling Butter adulterated w th 80 per cent. foreign fat „ 0 5 0 0 13 0 „ 27 A. K. Selling Skimmed Milk adulterated with 65 per cent. added water Withdrawn. (The poverty of family and the man naving left the milk business) Dec. 18 W. R. Selling Skimmed Milk adulterated with 15 per cent. added water Convicted 0 2 6 0 5 0 „18 A. II. P. Selling Milk adulterated with 8 per cent. added water „ 0 10 0 1 2 6 „ 30 R. D. Selling Milk 12 per cent deficient. in fat „ 5 0 0 3 6 6 Total 24 2 6 9 11 0 57 In 14 cases the samples of milk were slightly below the standard suggested by the Board of Agriculture. Being first offences, the vendors were written to calling their attention to the fact, and asking them for some explanation, further samples being taken subsequently. Of these 14 samples nine (new milks) contained added water to the extent of an average of 2 6 per cent., and five were deficient in fat to the extent of an average uf 8.6 per cent. Of the 12 prosecutions for selling adulterated milk, one defendant was a farmer and wholesale dealer, the sample being taken in course of delivery at the railway station. The other samples were all purchased in the streets on the various milk rounds. No preservatives were found in any of the milk. During the year 11 samples of cream were submitted for analysis. All were certified to be genuine and free from preservatives. Nine informal samples of Rice were taken during the year, of which eight were found to be adulterated by facing with small amounts of additional mineral matter varying from 0.05 per cent. to ro per cent. Eighty-seven informal, or test samples of Butter were purchased of which six proved to be not genuine. Subsequent official samples were taken in the adulterated instances, when in two cases the fraud was repeated, and prosecutions followed. Thirty-three informal samples of lard were purchased, all of which proved genuine. The test samples were mostly purchased by various women in small quantities with other articles, generally during the busy periods in the evenings. 58 The following table has been prepared from the certificates of the Borough Analyst (Mr. Lester Reed):— Total number of Samples of Milk collected and percentage below standard. TABLE VII. 1910. No. of Samples. No. below Standard. Percentage of Samples below Standard. Average percentage of fat of Genuine Samples. Taken in course of delivery to Retailers under contract. New Milk 67 2 3.0 3 44 Separated Milk 1 — — — Taken in course of delivery to Consumers under contract New Milk 14 - — 341 Taken on Milkmen's rounds. Sunday morning. New Milk. 51 3 6 0 3 56 Taken 011 Milkmen s round Sunday morning. Separated Milk 11 4 36 3 — Taken on Milkmen s rounds. Week day. New Milk 98 17 170 3 58 Taken on Milkmen's rounds. Week day. Separated Milk 9 2 2.22 — THE WORK OF THE HEALTH VISITORS. This is set out in detail in Table VIII., and again shows a large mass of useful work, conscientiously and efficiently performed. Owing to the increased demands on this department, it became necessary to make certain modifications in the duties of these officers. The Senior Health Visitor (Miss Tawney) who in 1909 was entrusted with the general supervision of the work, continues to exercise this supervision with advantage to all concerned. The number of visits paid has been much in excess of any previous year. HEALTH LECTURES. Thirty health lectures were given during the year by the Health Visitors. As explained in the Report to the Education Committee, arrangements have now been made to co-ordinate this branch of work with that of medical inspection. 59 6o TABLE VIII. HEALTH VISITORS.- -The following is a summary of the work done and visits paid by the five Health Visitors. Visits to Houses where the following Diseases have been reported. Miss Tawney. Miss Chapman. Miss Raw. Miss Sttvens. Miss King. Totals. School Cases. Other Cases. School Case". Other Cases. School Cases. Other Cases. School Cases. Other Cases. School Cases. Other Cases. School Cases. Other Cases. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits 2nd Visits. 1st Visits. 2 d Visits. 1st Visits. 2nd Visits. lst Visits. 2nd Virifs. lst Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visit?. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. Measles 223 12 ... ... 168 18 ... ... 307 6 8 8 177 10 ... ... 103 2 ... ... 978 48 8 8 German Measles 3 ... ... ... 1 ... ... ... ... ... ... . 2 ... ... ... 3 ... ... ... 9 ... ... ... Mumps 86 13 ... ... 96 7 ... ... 84 2 ... ... 199 14 ... ... 523 21 ... ... 988 57 ... ... Whooping Cough 93 17 ... ... 80 28 ... ... 93 ... ... ... 60 10 ... ... 171 5 ... ... 497 60 ... ... Chicken-pox 68 3 ... ... 144 11 ... ... 87 1 ... ... 85 3 ... ... 179 10 ... ... 563 28 ... ... Sore Throat 152 57 36 64 215 132 26 38 183 17 5 ... 132 71 25 68 173 39 5 9 855 316 97 180 Ringworm 40 116 ... ... 65 154 ... ... 71 56 ... ... 61 206 1 ... 89 118 ... ... 326 650 1 ... Verminous Heads 5 1 ... 1 ... ... ... 24 3 4 ... ... 8 1 ... 1 ... ... ... 31 11 6 ... Verminous Bodies 24 4 ... 1 1 ... ... ... 15 ... 3 ... ... ... ... ... 1 ... ... ... 41 4 3 1 Impetigo Contagiosa 56 76 ... ... 97 176 ... ... 169 165 ... ... 84 209 1 ... 79 213 ... ... 485 839 1 ... Scabies 7 9 ... ... 7 30 6 4 ... ... 9 18 ... ... 7 21 ... ... 36 82 ... ... Other diseases 98 66 11 7 162 91 27 32 187 43 74 30 58 64 23 11 265 84 2 1 770 348 137 81 Totals 855 373 48 72 1037 647 53 70 1226 297 94 39 867 613 51 79 1594 513 7 10 5579 2443 253 270 1st Visits, 2nd Visits. 1st Visits. 2nd Visits. lst Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. 1st Visits. 2nd Visits. Visits to houses where Infants have been born 533 379 729 541 1011 492 656 536 838 590 3767 2538 Visits to houses where Infants have died under one year of age 20 4 26 ... 67 2 45 4 43 ... 201 10 Addresses given re Infant feeding, etc. 23 ... ... ... ... 5 ... 2 ... 30 ... Phthisis cases visited 13 19 8 34 70 9 9 21 29 3 129 86 Visits paid to Elementary Schools for Medical Inspections 49 ... 64 ... 92 58 ... 61 ... 324 ... Other Visits to Elementary Schools 18 ... 5 ... 5 6 ... ... ... 34 ... Number of Children prepared for Medical Inspection—Newly Inspected 994 ... 1290 ... 1504 1266 ... 1421 ... 6475 ... Re-inspected 55 ... 224 ... 285 130 ... 171 ... 865 ... Specially Inspected 13 ... 50 ... 89 64 ... 55 ... 271 ... Home Visits arising out of Medical Inspection 72 13 112 44 107 43 65 10 132 40 488 150 Home Visits for other information 103 10 198 66 200 1 131 15 198 16 830 108 Cultures taken 381 ... 216 ... 293 284 ... 269 ... 1443 ... 61 TABLE IX. Work done by the Sanitary Inspectors during the Year ending December 31st, 1910. NATURE OF CASES DEALT WITH. Insp. Culver. Insp. Earwickerj Insp. Peck. Ins. Richardson Insp. Davis Insp. Bull. Insp. Fulker. Insp. Vincent. Insp. Flint. Insp. Hunt. Total House to House Inspection 1385 756 566 913 .. .. ... 767 630 651 5668 Visits to and inspections of houses where zymotic diseases have occurred 40 86 150 144 .. .. 1066 121 208 32 1853 Inspection of Premises where offensive trades are conducted .. .. .. .. .. .. .. .. .. .. .. Inspections of Factories and Workshops .. .. .. .. .. 1007 .. .. .. .. 1007 „ ,, Greengrocers, Fishmongers & Ice Cream Shops 173 397 306 242 .. .. .. 486 630 324 2588 „ „ Schools .. 2 3 2 .. .. 50 .. .. 1 58 „ „ Shops .. .. .. .. .. 271 .. .. .. 1 272 ,, ,, Bakehouses .. .. .. .. .. 854 .. .. .. .. 854 ,, ,, Yards and Stables 328 697 610 928 .. .. .. 769 875 443 4650 ,, ,, Common Lodging Houses .. .. .. .. .. 579 .. .. .. .. 579 „ ,, „ (night visits) .. .. .. .. .. 10 .. .. .. 10 ,, ,, Houses let in Lodgings .. .. .. .. .. .. .. 20 1660 .. 1680 „ „(night visits) .. .. .. .. .. .. .. .. .. .. .. ,, ,, Urinals 502 343 650 554 .. .. .. 709 642 545 3945 Smoke observations 1 .. .. .. .. 70 .. .. .. .. 71 House drains tested with smoke 439 596 255 270 .. .. .. 427 435 556 2978 „ „ ,, water 310 277 111 85 .. .. .. 52 35 137 1007 ,, ,, on application 38 34 85 75 .. .. .. 9 22 42 305 ,, drains re-laid 101 46 26 10 .. .. .. 45 14 53 295 ,, ,, repaired 25 72 21 67 .. .. .. 14 20 16 235 Re-inspections of work in progress 1213 2195 1577 1119 .. .. 3 1413 1746 1185 10451 Sundry inspections 423 786 630 273 .. 131 61 231 422 276 3233 Complaints from public investigated 202 164 71 80 .. .. 1 142 103 78 901 Rooms and contents disinfected .. .. .. .. 1234 .. .. .. .. .. 1234 Articles disinfected .. .. .. .. 12213 .. .. .. .. .. 12213 NUISANCES DISCOVERED. Premises requiring repair 35 343 123 143 .. 1 108 169 104 1026 ,, ,, Cleansing and Whitewashing 73 248 159 80 .. 46 .. 133 203 112 1054 ,, Overcrowded 9 12 .. 8 .. 6 .. 15 26 9 85 Drains found defective 120 85 54 55 .. .. .. 54 67 71 506 ,, ,, stopped 84 111 67 71 .. 8 1 83 99 52 576 Defective Sanitarv Fittings 237 232 247 273 .. 28 2 168 290 182 1659 ,, Yard Surfaces 116 272 88 37 .. 3 .. 130 168 91 905 ,, Eaves and Downspouts 141 131 58 49 .. .. .. 21 189 91 680 ,, Manure Receptacles 9 3 .. .. .. .. .. .. 21 .. 33 ,, Urinals 1 .. 2 3 .. .. 1 3 25 2 37 ,, Ashbins 127 200 168 100 .. 3 .. 154 268 109 1129 Smoke Nuisances .. .. .. .. .. 1 .. .. 1 .. 2 Animals improperly kept .. 2 3 3 .. .. .. 2 20 2 32 Infringements of Bye-laws and Regulations .. 7 1 .. .. 8 .. .. 12 5 33 Offensive Accumulations 2 17 14 7 .. .. .. .. 4 23 67 Sundry other Nuisances 1 33 114 21 .. 67 .. .. 28 7 271 Total number of Nuisances 955 1696 1098 850 .. 171 4 871 1490 860 7995 Informal Notices served 518 451 497 409 .. 82 .. 434 785 368 3544* Informal Notices complied with 495 410 457 384 .. 79 2 442 743 297 3309 „ ,, in abeyance 47 41 50 39 .. 12 .. 31 67 62 349 Referied to Commutee 41 54 44 24 .. 1 .. 5 4 28 201 * Not including 315 from the year 1909. 62 TABLE X. Workshops on Register, number of Employees, and visits paic during the year. TRADE No. of Workshops. No. of Employees. No. of Visits. Baking Powder Manufacturers 1 6 2 Blind Makers 4 6 4 Blacksmiths 6 12 10 Bottle washers 1 2 1 Bootmakers 16 27 17 Brushmakers 1 1 2 Builders 7 12 11 Cabinet Makers and Upholsterers 23 33 26 Cigarette Maker 1 2 1 Carriage Builders 11 30 33 Chemists 1 2 Confectioners 2 9 5 Collar Works 1 6 8 Cycle Works 26 51 31 Larpenters and Joiners 4 10 14 Dentists 6 8 6 Dressmakers and Milliners 215 1094 215 Dye Works 1 3 — Electricians & Engineers 3 9 4 Film Maker 1 5 2 Florist 4 4 10 Glass Works 3 16 2 Greenhouse & Ladder Makers 4 12 2 Ironmongers 7 16 7 Ivory Works 1 1 1 Laundries 54 266 83 Modeller 2 3 9 Naturalist 1 3 2 Pharmacy Works 1 12 1 Photographers 9 55 11 Piano Maker 1 3 1 Picture Frame Makers 4 12 3 Rubber Works 1 4 2 Saddlers 7 15 9 Scenic Artist 1 3 1 Sign Writers 4 14 5 Stonemasons 4 11 6 Scale Makers 2 4 1 Tailors 69 156 119 Umbrella Makers 4 6 8 Watchmakers 4 8 2 Wig Makers 4 7 2 Wood Merchants 3 12 4 Totals 526 1971 786 63 TABLE XI. Food and Drugs Acts Total Number of Samples taken during the year 1910. Sample of Total Samples Genuine. Not Genuine. Prosecutions. Convictions. Cautions Milk 230 208 22 7 6 13 Skimmed Milk .. 21 15 6 4 3 2 Butter 114 106 8 2 2 — Lard 37 37 — — — — Coffee 17 16 1 — — — Cream 11 11 — — — — Rice 9 1 8 — — — Margarine 8 8 — — — — Flour 8 8 — — - Cocoa 8 4 4 — — - Sausages 7 7 - — — — Bloater Paste 4 4 — — — — Chicken & Ham Paste. 2 2 — — — — Lobster Paste 1 1 — — — — Salmon Paste 1 1 — — — — Ham & Tongue Paste 1 1 — — — — Tablets for adding to Peas when soaking them 1 1 — — — — 480 431 4 13 11 15 64 TABLE XII. Particulars of Samples taken during the eleven years 1900 to 1910 inclusive :— Year. Number of Samples taken. Number Genuine. * Number Adulterated. Percentage of Adulterated. Prosecutions. Total amount of Fines and Costs imposed. 1900 246 230 16 6.5 5 £ s. d. 7 5 0 1901 299 274 25 8.3 3 6 6 0 1902 291 261 30 10.4 9 23 1 0 1903 294 268 26 8.8 4 5 16 0 1904 354 317 37 10.5 6 30 15 0 1905 356 320 36 10.0 8 36 13 6 1906 400 351 49 12.3 6 15 12 0 1907 448 413 35 7.8 13 86 8 0 1908 438 384 54 12.0 19 40 12 6 1909 455 424 31 6.8 7 55 13 0 1910 480 431 49 10.2 13 33 3 0 • The term a lulterated includes samples found to be not up to standard. 65 TABLE XIII. METEORO LOGIC AI RECORD—YEAR 1910. Rein Gauge 5-in. in diameter, 1-ft. above ground, 146-ft. above sea level. Temperature taken in the shade of a Stevenson's Screen, 4-ft. from the ground. The Ground Thermometer is suspended in an iron tube, the bulb being 4-ft. below the level of the ground. Months Temperature of Air during the Month. Mean Temperature of Air. Difference from average 50 years at Greenwich. Mean Temperature of Ground at 4-ft. Mean Temperature of the Dew Point. Mean Tensional Differen e between Ground and Dew Point at 9 a.m. and 3 p.m. Rainfall. Mean of No. of Days on which Rain fell. Amount collected in Inches. Difference from average 85 years at Greenwich Highest. Lowest. All Highest. All Lowest. January 55° 19° 43°.2 35°.0 39°.1 0° .6 42°.9 38°. 1 in — 0.046 16 in. 2.38 in. + .57 February 53° 27° 46°.2 36°.1 41°1 + 1°.6 41°.0 40°.4 007 25 3 .91 + 2.38 March 59° 28° 50°.5 35°.7 43°.1 + 1°.4 42°.3 40°.4 — 019 8 1.34 .17 April 64° 26° 52°.7 39°.6 46°.1 — 1°.1 440.4 44°.1 — 004 19 2.12 + -52 May 79° 30° 61°.3 46°.0 53°.6 + 0°.5 48°.8 50°.5 + 022 16 1.81 — .14 June 83° 45° 70°.4 52°.6 61°.5 + 2°.1 55°.4 57°.6 + 036 14 1.84 — .12 July 77° 47° 66°.6 52°.6 59°.6 — 2°.9 56°.3 54°.3 - 032 15 1. 99 — .46 August 79° 48° 69°.6 54°.1 61°.8 + 0°.2 57°.7 58°.0 + 005 15 3.10 + .78 September 74° 37° 64°.0 49°.3 56°. 6 — 0°.6 55°.9 53°.9 - 031 7 1.06 — 1.18 October 72° 40° 58°.4 48°.2 53°.3 + 3°.3 53°.9 50°.5 - 049 17 2.87 + .16 November 52° 23° 43°. 3 32°03 37°.8 — 5°.4 470.4 35°.3 - 122 14 3.42 + 1.14 December 53° 27° 47°.1 40°.1 43°.6 + 3°.9 44°.6 41°.8 .030 25 4.20 + 2. 24 Means and Totals for the Year. 83° 19° 56°.1 43°.5 49°.8 + 0°.3 49°.2 47° 1 .027 191 30.04 The Rainfall for the Year was 4*27 inches above, and the number of days on which rain fell 31 above the average of 46 years at Croydon. GEO. CORDEN, F.R. Met. Soc., Croydon. 66 C.—REPORT OF THE WORK OF THE BOROUGH HOSPITAL. The total nominal accommodation at the Borough Hospital amounts to 146 beds. The following Table shows the Highest and Lowest number of beds occupied on any one night during each month of the year 1910 :— TABLE H. 1. Month. Beds Occupied. Month. Beds Occupied. Highest. Lowest. Highest. Lowest. January 142 123 July 156 129 February 132 98 August 147 114 March 123 94 September 126 95 April 117 103 October 159 121 May 121 104 November 169 151 June 144 108 December 168 162 During igio the average daily number of cases under treatment amounted to 13x7 as compared with 142.4 in the previous year. The following Table gives the total number admitted from the Borough and other Districts during the year 1910 TABLE H. 11. Districts Remaining at end of 1909. Admitted during 1910. Discharged during 1910. Died during 1910. Remaining at end of 1910. *The Croydon Union, cases admitted from Penge - - - - - Penge Urban D.C., nonpauper cases 9 63 59 1 12 The Borough of Croydon 118 †845 814 25 124 * In the above table eases included under the Croydon Union are only those pauper patients who have contracted the disease in Penge. Patients resident in the Infirmary or Workhouse who become infected whilst residents in these Institutions are reckoned as Croydon cases. t Includes 4 admissions of the Staff suffering from scarlet fever. The total number of patients admitted was 908 as compared with 956 in 1909. 67 The following Table shows the comparative admissions during 1910 and previous years. TABLE H. III. Hospital diagnosis Cases admitted during 1905. Cases admitted during 1906. Cases admitted during 1907. Cases admitted during 1908. Cases admitted during 1909. Cases admitted during 1910. Scarlet Fever 352 338 562 497† 608 *624 Diphtheria 178 239 249 354 292 222 Enteric Fever 15 20 10 59 11 15 Puerperal Fever — — — — — _ Pulmonary Phthis's — — 1 — — - Other diseases 64 47 42 31 45 47 Total 609 644 864 941 956 908 f includes four casts sent in as Diphtheria. ‡Including 26 cafes. * „ 8 „ The following Table gives the number of patients admitted for each disease, the number discharged or died, and average duration of stay in hospital and probable detention in hospital, for the year 1910 :— TABLE H. iv. Disease. Remaining at end of 1909. Admitted during 1910. Discharged during 1910. Died during 1910. Remaining at end of 1910. Average Residence in days. Probable detention in Hospital in days. Fatal Cases. NonFatal Cases. NonFatal Cases. Fatal Cases. Scarlet Fever 97 624 636 7 78 28 6 56 4 47 19 Cases admitted to Hospital as but subsequently found not to be Scarlet Fever - 18 17 1 - - 8 1 2 - Diphtheria 26 222 179 15 54 81 55.7 46 7 Cases admitted to Hospital as but subsequently found not to be Diphtheria - 20 19 1 - 1 12 4 14 1 Enteric Fever 4 15 14 1 4 2 63.9 65 * Cases admitted to Hospital as but subsequently found not to be Enteric Fever - 8 7 1 - 19 9.8 1 † Other Admissions — 1 1 — — — - 42 — Total 127 908 873 26 136 - - — — * One case only. Lived two days. † One case only. Lived 19 days. 68 The following Table gives the fatality from each disease:— TABLE H. v. 1907. 1908. 1909. 1910. Scarlet Fever 2.5 1.6 1.8 1.1 Diphtheria 13.6 8.5 . 7.4 6.3 Enteric Fever 9.5 3.6 8.3 6.6 Other diseases 4.8 6.3 6.4 6.3 All cases 6.1 3.5 3.9 2.8 4. —Under " Other Diseases " are included the following :— Cases notified as Scarlet Fever but not Scarlet Fever:— Total 18 No. of Cases. Result. Stomatitis 1 Discharged. Measles 1 „ Erythema 5 „ Tonsillitis 2 „ No disease observed 9 „ Cases admitted as Diphtheria and found not to be Diphtheria :— Total 20 No. of Cases. Result. Whooping Cough 1 Discharged. Measles 1 „ Peritonsillar Abscess 1 „ Congenital Heart Disease 1 Died. Laryngitis and Broncho Pneumonia 1 Discharged. Tonsillitis 15 „ Cases admitted as Enteric Fever and found not to be so :— Total 8 No. of Cases. Result. Pyosalpynx 1 Discharged. Tubercular Peritonitis 1 Died. Meningitis 1 Discharged Ulcerative Colitis 1 Influenza 1 „ Appendix Abscess 1 „ Enteritis 1 „ Lateral Sinus and Jugular Thro bosis 1 „ Other Admissions:— Total 1 Infant at Breast 1 Discharged. T CROYDON E Detailed Analysis of Expenditure under all Heads fo ABLE XIV. 50R0UGH HOSPITAL. r the Year ending March 25th, 1910, and four preceding Years. Year ending March. Average No. of Patients. Provisions. Alcohol. Surgery aud Dispensary. Domestic, including Coal and Gas. Establishment and Miscellaneous Charges. Salaries and Wages. Total. Average Cost Per Bed occupied. Total. Average Cost per Bed occupied. Total. Average Cost per Bed occupied. Total. Average Cost per Bed occupied. Establishment Charges and Repa rs. ' M iscellaneous Charges. Total. Average Cost per Bed occupied. Medical Dispensing, Nursing & other. Average Cost per Bed occupied. Total Ordinary Expenditure. Total Average Cost per Bed. Sinking Fund and Interest. Total Cost per Patient, including Sinking Fund and Interest. £ s. d. £ s. d. £ s. d. s. d. £ s. d. £ s. d £ s. d. £ s. d. £ s. £ s. d. £ s. d. £ .s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. 1906 89 2529 0 0 28 8 4 27 16 6 6 3 612 1 9 6 17 6 1414 1 8 15 17 9 1097 19 10 262 12 0 1360 11 10 15 5 9 1995 2 7 22 8 4 7938 14 4 89 3 11 2272 3 1 114 14 6 1907 90 2254 19 6 25 5 1 13 17 7 3 1 536 16 11 5 19 3 1299 16 1 14 6 10 694 13 3 156 16 8 851 9 11 9 11 3 1920 6 0 21 1 9 6877 6 0 76 3 5 2272 3 1 101 8 4 1908 121 2588 1 7 21 7 9 5 16 0 0 11 393 16 3 3 5 4 1493 0 9 12 6 9 1074 16 9 197 9 9 1272 6 6 10 10 4 1997 17 1 16 10 3 7752 8 2 64 1 4 2272 3 1 82 16 11 1909 133 2586 11 8 19 9 0 13 5 10 2 0 501 10 8 3 15 4 1697 9 4 12 15 3 1260 10 11 128 18 10 1389 9 9 10 9 0 2361 9 5 17 15 1 8549 16 8 64 8 5 2101 10 9 80 1 8 1910 127 2523 3 7 17 6 6 7 4 1 0 430 13 11 3 7 9 1764 9 10 13 17 10 1363 17 10 460 9 4 1824 7 2 14 7 3 2220 4 3 17 9 7 8769 6 1 60 0 11 2101 10 9 85 11 11 During the year 1909-10 the sum of £2.1)84-15s. Od. was received from other Local Authorities. 6g TABLE H. vi Illness amongst the staff, 1910 :— 1 Scarlet Fever 4 cases. 2 Diphtheria „ 3 Other illnesses requiring treatment 10 „ Total 14 „ AMBULANCE. During the year 904 journeys were made in removing patients to the Borough Hospital, including 59 journeys to Penge and Anerley. The ambulance also made sundry other journeys in connection with the removal of patients to their homes, in addition to the collection of parcels from the Town Hall and other Offices. The sum of £54 6s. od. was received from the Penge Urban District Council and the Croydon Guardians for ambulance services rendered during the year. MAINTENANCE OF BUILDINGS. During 1910 an additional steam washing machine was erected in the Laundry. External painting was carried out in A, B, C & E Blocks, and internal and external painting in D Block. All Wards cleaned down. 70 D.—REPORT ON THE BOROUGH LABORATORY. For the following account of the work of the laboratory I am indebted to Dr. Peter, the Borough Bacteriologist and Senior Resident Medical Officer of the Borough Hospital. For the first few years of its existence comparative little us was made of the laboratory, as is shown by the following table:— Year. Specimens examined for Diphtheria, Enteric Fever, and Tuberculosis. Borough Cases (outside the Hospital. Hospital Cases. Totals. 1897 85 not recorded — 1898 125 not recorded — 1899 not recorded not recorded — 1900 199 248 447 1901 784 885 1669 1902 698 859 1557 1903 1089 1322 2411 1904 2027 2494 4521 1905 2276 4164 6440 1906 2257 2485 4742 1907 2105 5154 7259 1908 3621 4582 8203 1909 3247 4876 8123 1910 2635 3734 6369 The total number of specimens examined in 1910 is somewhat smaller than in 1909, thanks to the diminished prevalence of diphtheria and enteric fever. 71 CLINICAL BACTERIOLOGY. The following is a summary of the number of specimens examined for suspected diphtheria, enteric fever, or tuberculosis:— Suspected Diphtheria. Serum reaction for suspected Enteric Fever. Sputum for suspected Tuberculosis. 1910 1910 1910 Boro ugh Hospital. Borough Hospital Borough Hospital 2328 3701 43 25 264 8 Total 6029 68 272 DIPHTHERIA. During 1910, 6029 specimens were examined in the Laboratory. Of these specimens about one-sixth (1,052) were primary examinations for diagnostic purposes. The remaining specimens were from "contacts" who had been exposed to diphtheria or from the throats of convalescents. The latter were examined with a view of ascertaining whether the bacillus of diphtheria was absent from the throat or nose. In some cases this organism was very persistent, requiring many examinations extending over many weeks before it was found to have disappeared. Every case of scarlet fever admitted to the Hospital was also examined bacteriologically, in order to ascertain if diphtheria was present. Of these, 2.4 per cent. were found, on admission, to have bacilli indistinguishable from diphtheria in the nose, while 1.1 per cent. had similar bacilli in the throat. All these patients were specially isolated in order to guard against the introduction of diphtheria into the scarlet fever wards. A large number of the specimens examined were from cases of sore throat or nasal discharge occurring in children attending elementary schools. In some instances these "sore throats" turned out to be mild cases of diphtheria in which infection persisted for many weeks or months, though the children showed very little, if any, signs of ill-health. 72 ENTERIC (TYPHOID) FEVER. The total number of specimens from suspected enteric fever patients amounted to 68, of which were received 43 from medical men in the borough, and 25 examinations were made of patients in the Borough Hospital. The following table gives a summary of the serum re-actions obtained in the laboratory during 1910:— RESULTS OF EXAMINATIONS FOR DISEASES SIMULATING ENTERIC FEVER. 1910. Examinations for Borough. Examinations for Hospital. Total. Agglutinative Reactions. Agglutinative Reactions. Agglutinative Reactions for all purposes. + _ Total + — Total + — Total January 1 3 4 5 — 5 6 3 9 February 1 7 8 — — — 1 7 8 March 1 6 7 1 — 1 2 6 8 April — — — — — — — — — May — 4 4 2 3 5 2 7 9 June 1 1 2 — 2 2 1 3 4 July — 2 2 — — — — 2 2 August 3 4 7 1 1 2 4 5 9 September 1 4 5 1 1 2 2 5 7 October — 3 3 1 1 2 1 4 5 November — — — — 3 3 — 3 3 December — 1 1 1 2 3 1 3 4 First Quarter 3 16 19 6 — 6 9 16 25 Second ,, 1 5 6 2 5 7 3 10 13 Third ,, 4 10 14 2 2 4 6 12 18 Fourth ,, — 4 4 2 6 8 2 10 12 Total 8 35 43 12 13 25 20 48 68 73 TUBERCULOSIS. The number of specimens examined during the year amounted to 272, 8 of these being from patients already in the Hospital. Out of the total number of examinations 72 were found to contain the tubercle bacillus. The following table shows the number of specimens examined for the detection of B. Tuberculosis during 1910:— RESULTS OF EXAMINATIONS FOR TUBERCULOSIS. 1910. Examinations for the Borough. Examinations for the Hospital. Total. All Examinations. All Examinations. All Examinations. + — Total + — Total + — Total January 2 12 14 — — — 2 12 14 February 2 19 21 — 1 1 2 20 22 March 9 24 33 — — — 9 24 33 April 6 26 32 — — — 6 26 32 May 10 13 23 1 2 3 11 15 26 June 4 16 20 — — — 4 16 20 July 4 14 18 — 1 1 4 15 19 August 15 7 22 — — — 15 7 22 September 7 16 23 — — — 7 16 23 October 2 21 23 — 2 2 2 23 25 November 6 13 19 — — — 6 13 19 December 4 12 16 — 1 1 4 13 17 First Quarter 13 55 68 — 1 1 13 56 69 Second ,, 20 55 75 1 2 3 21 57 78 Third „ 26 37 63 — 1 1 26 38 64 Fourth ,, 12 46 58 — 3 3 12 49 61 Total 71 193 264 1 7 8 72 200 272 74 RINGWORM. The number of specimens examined for the presence of this parasite amounted to 27, of this number 5 were from patients in the Hospital. Of the total examinations 17 showed the presence of ringworm spores or mycelium and the majority were of the small spore variety. The number of specimens now examined at the laboratory is not so great as formerly, many other specimens being now examined at the Town Hall. MISCELLANEOUS EXAMINATIONS. Various other bacteriological and microscopical examinations were made during the year. These included the examinations of a large number of specimens of urine; of discharges for actinomyces, streptothrix, and anthrax; of sputum for pneumo-coccus; and strepto-coccus; and of various other specimens of blood and morbid fluids. PREPARATION OF MATERIAL. In addition to the actual examinations of specimens much time has been occupied in the preparation of material needed for bacteriological work. Thus suitable "outfits" for the transmission of specimens to the laboratory in accordance with the requirements of the Postmaster General require careful preparation. 2,489 Diphtheria, 336 Tuberculosis, 100 Enteric—Total 2,925 of these "outfits" were supplied during the year for use by the Public Health staff and the medical men of the borough. The making of serum culture media commenced in 1906 for use in the laboratory has been continued this year. The blood is obtained from the Public Slaughter House and prepared for use by the laboratory attendant (E. Hasler) under the direction of the medical officers. 679 dozen tubes of blood serum were prepared in 1910. 1'he material prepared in this way during 1910, if reckoned at the commercial price, viz., 3s. 6d. per dozen tubes, would have cost £118 16s. 6d. In this way a great saving is made in the working expenses of the laboratory. 75 E - REPORT TO THE EDUCATION COMMITTEE. I beg leave to present the following report; for the year 1910 on the work carried out by the staff of the Public Health Department, in connection with the Public Elementary Schools of the borough. This is the seventh annual report which 1 have submitted to the Committee, and the third furnished in accordance with the requirements of the Board of Education. The scope and arrangement of this report are in accordance with the suggestions of Circular 596 of the Hoard of Education. SCHOOL BUILDINGS. On December 31st, 1910, there were within the Croydon area:— 19 Provided Schools, including 55 departments, with recognised accommodation for 20,017 children, and 14 Non-Provided Schools, including 34 departments, with accommodation for 5,443 children, as compared with 5,345 in 1909. The total provision for Elementary School children in the borough therefore amounted to 33 schools, with 89 departments and accommodation for 25.460 children, as compared with 25,362 in 1909. The number of children on the register on December 31st, 1910, was 24,174. Tamworth Road School, which was reported in 1903 to be so unsatisfactory as to require closure, is still in use, but will eventually be re-built when the general scheme for re-organisation of the schools in this part of the borough matures No considerable changes in school buildings were made in 1910 but the accommodation of St. Mary's School was increased by 98 places. 76 In view of the necessity of providing one or more new schools in the immediate future, I would like to emphasize the desirability of giving due weight to the following general principles:— 1. The central halls and classrooms should be so constructed as to allow of free perflation instead of permitting the classrooms to ventilate into the central halls, as is at present the rule in Crovdon schools. 2. Further consideration of the adaptability of an impervious floor, so as to allow of more thorough cleansing of the surface. 3. The choice of a type of desk that offers the least possible obstacle to the sweeping and cleansing of the floors. 4. The substitution of suitably designed fixed cupboards in place of the moveable furniture which at present provides opportunities for the lodgment of dust. 5. The provision of adequate French windows in the central halls, so that the greatest possible amount of fresh air may be obtained under suitable conditions of the weather. 6. The sanitary conveniences should be brought into closer relation with the buildings, so that they might be under the more direct supervision of the head teachers. EQUIPMENT. Little advance has been made in the re-desking of the older schools. As previously pointed out, the existing desks are in many instances unsuitable, and do not allow of adjustment to the needs of the children. Failing any considerable expenditure, I would urge the importance of providing say 20 per cent. of single adjustable desks at those schools where the existing furniture is most unsuitable. The provision of, say, 5 per cent. of single adjustable desks should be regarded as a necessity in new schools. SANITARY CONVENIENCES. These are periodically inspected. The thirty-three schools in the borough are provided with:— 48 ranges of automatically flushed troughs. 8 ranges of automatically flushed separate closet pans. 39 ranges of wash-down closets with separate flushing cisterns to each closet. 77 The last arrangement is the only absolutely satisfactory one, and is now adopted in all new schools. The automatically flushed troughs are from many points of view unsatisfactory, and should be replaced as occasion offers. The troughs at Mitcham Road, Beulah Road, Birchanger Road, and Sydenham Road are the least satisfactory, and should receive attention at an early date. As previously reported, flushing apparatus is required for the urinals at Mitcham Road Boys', Beulah Road Infants', and Dering Place Infants' Schools. At the latter, the entrance from the playground might with advantage be screened from the public street. Flushing apparatus for the urinal at St. Mary's Boys' School is also required. ORGANIZATION AND CO-ORDINATION OF SCHOOL AND OTHER PUBLIC HEALTH WORK. The general organization remained the same as in 1908. The school medical officer was assisted by one whole time assistant medical officer (Dr. Sophie Jackson), together with a part time ophthalmic surgeon, who devotes two half-days per school week to the work. The whole time of one clerk, together with half the time of a second clerk, were taken up with school duties, as was also half the time of each of the five health visitors. Assistance was also rendered, when required, by other members of the public health staff, and especially by the senior resident medical officer at the borough hospital, who was not only responsible for the examination of the large number of bacteriological specimens sent from school children, but also assisted me, when required, in the examination of children at the Town Hall on Wednesday and Saturday mornings. Medical Inspection was limited to those children for whom the present code compelled us to make provision, together with a variable number of children presented for special examination at the suggestion of the teachers, attendance officers, attendance committee, or magistrates. In my last Annual Report I called attention to the loss of time that ensued when medical inspections were arranged for schools where there were not a sufficient number of children in attendance of that particular age which the Code required us to inspect during the school year. This difficulty was surmounted during 1910 by sending periodical post-cards to the head teachers asking them tc let us know the exact number of children that had matured for the medical inspection. When these returns are received the clerk in charge of the work arranges for medical inspections to be held at those departments where there is enough work to occupy the whole of a morning or afternoon session. Inspections have also to be fixed 78 with due regard to the convenience of the schools; for instance, in schools like Sydenham Road, which are crowded and have no teacher's room, we endeavour to get medical inspection done during the summer time, when a fine day may allow of the head teacher placing a classroom at our disposal by transference of the pupils to the playground. The inspections have also to be fitted in with the work of the health visitors, who cannot conveniently give more than one whole day per week to this work, and some of whom have special duties in connection with the school clinic. An endeavour is also made to select for early inspection any school the head master or head mistress of which has made a request for the special examination of scholars not coming within the group named in the Code. All these requirements have to be carefully adjusted in mapping out the work of the assistant medical officer, but I cannot speak too highly of the care with which this work has been done. It is partly owing to this improvement in our organisation that the number of children inspected during 1910 was considerably higher than in 1909. The arrangements for the work of the ophthalmic surgeon during 1910 were in accordance with the plan mentioned in my last Annual Report. All the schools in the borough were divided into two groups of about equal size. At those nearest the Town Hall the preliminary examination of the sight was made by the school medical officer or his assistant, and any children requiring special examination by the ophthalmic surgeon were referred to him at the Town Hall, where he was in attendance on Tuesday mornings. Eye work in the more distant schools was carried out by Mr. Wray as heretofore by visits to the respective schools. BOARD'S SCHEDULE OF MEDICAL INSPECTION. No change has been made in the schedule, which was adopted in its entirety. Speaking generally, the use of this schedule has been much the same as in 1908 and 1909. The duty cast upon Local Authorities by the Education (Administrative Provisions) Act, 1907, is to provide for the medical inspection of children attending Schools, and anything like a complete examination has only been made when the history or the general appearance of the. child indicated the necessity for so doing. As mentioned in previous reports, only quite a superficial inspection is possible in some of the schools, as there is no spare room in which the necessarv privacy and freedom from noise can be secured for a more thorough examination of the children. 79 ASSISTANCE TO THE SCHOOL MEDICAL OFFICER AND HIS ASSISTANT. The work of the Health Visitors is set out in detail in Table E. X. The teachers have continued to render willing and valuable assistance in the work of medical inspection, and I have once more to acknowledge the ready help rendered by the superintendent attendance officer (Mr. Jones) and his staff. Thanks to constant consultations between the attendance officers and the public health staff, it has been possible to carry on the work of the department Without friction and with increasing efficiency. ATTENDANCE OF PARENTS OR GUARDIANS. This has been secured as heretofore by written notices despatched by head teachers prior to the medical inspections. The parents or guardians of children inspected were present in 1,945 instances, out of 5,923 children inspected, or 33 per cent. This proportion was three per cent. lower than in 1909. In the infants' schools 1,357 parents or guardians were present at the inspection of 3,133 children, or 43 per cent., compared with 44 per cent. present in 1909. Many parents also attended at subsequent inspections to confer with the Medical Officers. DISTURBANCE OF SCHOOL ARRANGEMENTS. This has been inconsiderable in the newer schools where a special room can always be set aside for the purpose. In the older schools much inconvenience to all concerned is more or less inevitable, though the head teachers have done their best to mitigate it as far as possible. In my last report the following suggestion was made:— Now that a considerable number of children suffering from defective vision and other eye troubles are referred for further examination and treatment, I suggest that the Committee should obtain the consent of the Board of Education to reckon attendance at the medical department, at the Town Hall, as attendance at school. Though the gain in grant would be inconsiderable, such an arrangement would be popular with the children and with the teachers, as children who are in regular attendance, and are qualifving for attendance prizes, are very loth to attend at the Town Hall unless such attendance is counted. Article 44 (h) of the present Code permits such attendances to be reckoned for school purposes, and a similar recognition might be sought for children attending the class for remedial exercises at Whitehorse Road School. 80 Representations were made to the Board of Education in accordance with these suggestions, but the requirements of the Board of Education appeared to the Committee to be so stringent that it seemed hardly worth while to undertake the extra clerical work in view of the fact that the gain in grant would in any case be small. A compromise was therefore arrived at whereby the attendance of the children at the Town Hall would be reckoned as qualifying for attendance prizes. EXTENT AND SCOPE OF MEDICAL INSPECTION DURING THE YEAR. For the most part children have been selected for medical inspection in accordance with the requirements of Section 58 (b) of the Code. The following table shows the number of children whose medical inspection schedules were completed during 1910:— TABLE E. I. Total number inspected during 1910. Age. Number of Boys. Number of Girls. Total. 3-4 2 ... 2 4-5 153 148 301 5-6 915 924 1839 6-7 355 341 696 7-8 112 124 236 8-9 18 28 46 9-10 4 8 12 10-11 ... 1 1 11-12 19 7 26 12-13 521 456 977 13-14 803 862 1665 14-16 68 49 117 15-16 4 1 5 Total all ages 2974 2949 5923 81 Total number inspected during 1910 classified according to the schools attended at the end of the year:— Council Schools :— BOYS. GIRLS. Beulah Road Boys 101 — „ Girls — 81 „ Infants 58 62 Boston Road Boys 82 — „ Girls — 76 „ Infants 80 75 Brighton Road Boys 18 — „ Girls — 14 „ Infants 58 40 Davidson Road Boys 52 — „ Girls — 35 „ Infants 43 59 Dering Place Mixed 24 17 „ Infants 21 23 Ecclesbourne Road Boys 81 — „ Girls — 100 „ Infants 95 98 Ingram Road Boys 64 — „ Girls — 46 „ Infants 56 43 Mitcham Road Boys 74 — „ Girls — 83 „ Infants 98 81 Oval Road Mixed 19 — „ Girls — 65 „ Infants 59 36 Portland Road Boys 101 — „ Girls — 53 „ Infants 106 108 Princess Road Boys 49 — „ Girls — 40 „ Infants 42 40 South Norwood Boys 64 — „ Girls — 64 „ Infants 60 53 Sydenham Road Boys 64 — „ Girls — 69 „ Infants 45 46 Tamworth Road Boys 85 — Tavistock Grove Sen. Mixed 13 18 ,, Jun. Mxd. & Infts. 76 59 Upper Norwood Mixed 61 34 „ Infants 36 20 Whitehorse Road Boys 115 — „ Girls — 108 „ Infants 61 77 82 Council Schools (continued)— boys. girls. Winterbourrie Road Boys 74 – ,, Girls – 99 ,, Infants 101 74 Woodside Boys 68 – ,, Girls — 67 ,, Infants 69 76 Total 2373 2138 Council (Non-Provided) Schools:— boys. girls. All Saints' Boys 2 2 — ,, Girls — 18 ,, Infants 24 29 Christ Church Boys 17 – ,, Girls – 35 ,, Infants 44 55 (Wildbore's) Infants 15 20 Holy Trinity Mixed – 19 ,, Infants 18 45 Parish Church Sen. Boys 81 ,, Girls – 83 ,, Infants 76 104 St. Andrew's Boys 24 — ,, Girls – 18 ,, Infants 27 26 ,, (Old Town) Infants 15 7 St. Joseph's Mixed 7 23 ,, Infants 18 14 St. Mark's Girls – 20. ,, Infants 20 26 St. Mary's Mixed 9 21 ,, Infants 15 24 St. Michael's Mixed 8 ,, Infant 27 43 St. Saviour's ,, Boys 24 – ,, Girls – 33 ,, Infants 33 31 ArchbishopTenison's Boys 17 – ,, Girls – – St. Peter's Infants 54 64 Shirley Mixed 4 11 ,, Infants 10 12 Total 601 8ll boys. girls. Total Provided Schools 2373 2 1 38 „ Non-Provided Schools 601 811 2974 2949 Grand Total 5923 83 The corresponding total for 1909 was only 4,360. This increase was partly due to the improvement in the office organisation already referred to and part to my having undertaken the personal inspection of a considerable number of children in order that the requirements of the school Code should be complied with. In addition to the children whose medical inspection schedules were completed during the year, 865 children were re-inspected to ascertain progress and 832 children specially inspected at the request of the teachers or for other reasons. GENERAL DIRECTIONS TO PARENTS. In 1,318 instances written directions were sent to parents, while in 3,546 instances printed or verbal directions were given. THE WORK OF THE OPHTHALMIC SURGEON. The following table prepared by Mr. Wray shows the schools inspected by him for eye trouble, the conditions found, and the number of children concerning whom advice was offered:— TABLE E. II. Davidson Road. Ingram Road. Portland Road. South Norwood. St. Saviour's. St. Mark's. Shirley. Winterbourne Road. Whitehorse Road. Woodside. Total Abscess of lid .. .. .. .. .. .. .. .. .. 1 1 Anophthalmos .. .. .. 1 .. .. .. .. .. 1 2 Blepharitis .. 3 1 1 1 .. 1 1 33 1 42 Cataract 1 .. .. 2 .. .. .. .. .. .. 3 Coloboma .. .. .. 1 .. .. .. 1 1 .. 4 Conjunctivitis 2 6 8 12 .. 4 1 5 8 3 49 Cyst .. .. .. .. 1 .. .. .. .. .. 1 Chalazion .. .. 1 .. .. .. .. .. .. .. 1 Dermoid .. .. .. 1 .. .. .. .. .. .. l Epiphora .. 1 .. .. .. .. .. 1 2 1 5 Granuloma ; lower lid .. .. .. 1 .. .. .. .. .. .. l Hordeolum .. .. .. 1 .. 1 .. .. .. 1 3 Hemiatrophy; facial Buphthalmos; Tumour of sup. maxilla; same child .. .. .. .. .. .. .. .. 1 .. l Interstitial Keratitis .. .. .. .. .. .. .. .. 1 .. 1 Nebula 2 .. .. 3 .. 1 .. .. 2 .. 9 Nystagmus .. 1 1 2 .. .. .. .. 1 1 6 Phlyctenula .. 1 .. .. .. .. .. .. 1 .. '2 Ptosis .. .. .. .. .. .. .... 1 .. 1 Paresis .. .. .. 1 .. .. .. .. 1 .. 2 Strabismus 2 7 8 8 3 2 7 2 16 55 Shrunken globe .. .. .. 1 .. .. .. .. 1 .. 2 Ulcers, multiple .. .. .. .. .. .. .. .. 1 .. 1 Word Blindness .. .. .. .. .. .. .. 1 .. .. .. Refracted .. 20 .. 51 13 .. 7 64 32 .. 187 Glasses ordered .. 13 .. 31 4 .. 4 23 19 .. 94 Princess Road—Three special visits. In addition to the above schools, glasses have been ordered for children Beulah Road, Brighton Road, Ecclesbourne Road, Ingram Road, Mitcham Road, Sydenham Road, and South Norwood. 84 The following is a summary of the work done by Mr. Wray at the Town Hall:— Children refracted 332 Glasses were ordered for 248 Glasses not needing changing 4 Glasses not advised at present 51 Vision found normal 29 332 Of the glasses ordered 123 were urgently needed, and were as follows:— Myopia 15 „ malignant 7 Hypermetropia 14 Astigmatism, myopic 17 „ hypermetropic 28 Strabismus, interims 35 „ externus 3 „ periodical 2 „ alternating 2 123 Binocular vision exercises were ordered for 26 cases of Strabismus. In addition— Glasses were needed and ordered as follows:— Myopia 22 Hypermetropia 48 Astigmatism, myopic 6 ,, hypermetropic 20 ,, mixed 6 Anisometropia 23 125 Hospital advised for— Tubercular conjunctivitis 1 Strabismus, right eye, (interims) left eye (externus) 1 85 Other diseases treated and advised, were— Old facial paralysis 1 Ulcer cornea, recurrent 2 „ „ active 1 Conical cornea 1 Blepharitis 10 Conjunctivitis 16 „ contagious 5 Epiphora 3 Foreign body 1 Albino 2 Phlyctenula 5 Nystagmus 8 Nebula 9 Anterior synechia 1 Hyalitis 1 Alexia 1 Leucoma 1 Paresis, left external rectus 1 Choroido-retinitis 1 Coloboma of the macula 1 Coloboma 1 Molluscum contagiosum 1 Eversion of canaliculi with blepharitis 1 Retinitis Pigmentosa 1 Blepharitis with Rhinorrhoea 1 A girl, age 13, with malignant myopia and nystagmus was advised to give up school work. 86 HEIGHTS AND WEIGHTS The following tables give the average heights and weights of the children measured in 1910. The numbers are omitted for groups of less than ten. TABLE E. III. HEIGHTS OF BOYS. Age Number Examined. Height in Centimetres. Height in Inches. B.A. Anthropometric Committee, 1883. All Classes. Number Examined. Average Height Inches. 4-5 155 99.4 39.2 107 38.46 5-6 919 105.4 41.5 201 41.03 6-7 342 110.8 43.6 266 44.00 7-8 94 114.2 44.9 307 45.97 8-9 17 118.0 46.5 1524 47.05 11-12 19 138.6 54.6 1766 53.50 12-13 521 141.3 55.6 1981 54.99 13-14 801 144.3 57.0 2743 56.91 14-15 68 151.8 59.8 3428 59.33 HEIGHTS OF GIRLS 4-5 148 99.0 39.0 99 38.26 5-6 923 104.3 41.0 157 10.55 6-7 348 109.8 43.1 189 42.88 7-8 128 114.6 45.1 173 44.45 8-9 28 116.8 46.0 432 46.60 12-13 455 143.8 56.6 225 55.66 13-14 861 142.8 56.2 206 57.77 14-15 44 149.0 58.7 240 59.80 87 WEIGHTS. WEIGHTS OF BOYS. Age. Number Examined. Weight in Kilos. Weight in Pounds. B.A. Anthropometric Committee, 1883. All Classes. Number Examined. Average Weight. Pounds: 4-5 155 16.5 36.0 102 37.3 5-6 919 17.7 39.0 193 39.9 6-7 342 19.4 42.5 224 44.4 7-8 94 20.6 45.5 246 49.7 8-9 17 22.0 48.5 820 54.9 11-12 19 32.0 70.5 1599 72.0 12-13 521 33.2 73.2 1786 76.7 13-14 801 36.0 79.4 2443 82.6 14-15 68 39.0 85.8 2952 92.0 WEIGHTS OF GIRLS. 4.5 148 16.3 36.0 97 36.1 5.6 923 17.4 38.5 160 39.2 6.7 348 19.0 41.9 178 41.7 7.8 128 20.6 45.5 148 47.5 8.9 28 21-8 48.1 330 52.1 12.13 455 34.7 76.5 419 76.4 13.14 861 37.9 83.6 209 87.2 14.15 44 41.1 90.4 229 96.7 88 GENERAL RESULTS OF INSPECTIONS. With the exception of heights and weights, these are summarised in Table E IV. The defects noted at inspections are tabulated on the same lines as were adopted in my previous annual report. Though there are obvious difficulties in expressing the results of inspection in tabular form, it is worth while considering each of the main headings in detail. WANT OF CLEANLINESS. Condition of the Heads.—Of the 5,923 children inspected, 130 were infected with live vermin at the lime of inspection, and 1,334 other children had "nits," and 89 children had dirty heads apart from vermin. Though the proportion of children in whom vermin were detected at medical inspections remains the same as in 1909 there is a considerable rise in the number in whom "nits" were found, the proportion having risen from 17 to 25 per cent. This is very unsatisfactory, as the presence of "nits" is a better criterion of the average condition of the children than the number showing vermin, as most of the children are more or less specially cleansed for medical inspection. During the year there was some delay in getting the revised regulations into working order, but towards the end of the year we were more successful in getting convictions in some of the more flagrant cases. It is a striking fact that the percentage of unclean children varies greatly with different schools. While the average for all the girls' schools in the borough is 41 per cent., the proportion is as high as 85 per cent. in Princess Road, 75 per cent. at St. Michael's, 71 per cent. in Brighton Road, 70 per cent. at St. Mary's, and 66 per cent. in Whitehorse Road and Boston Road, and as low as 5 per cent. in Tenisori's Girls, 9 per cent. in Shirley, 11 percent in Holy Trinity, 12 per cent. in Dering Place, 22 per cent. in Tavistock Grove, and 23 per cent. in Ecclesbourne Road. The proportion of children found suffering from vermin of the body at medical inspections was '7 per cent., which is exactly the same proportion as in 1909. During the year the Corporation decided to provide baths at their new disinfecting station. It is believed that when these are ready there will be less difficulty in dealing with vermin of the body, as facilities will then be provided for the simultaneous cleansing of all the members of infected families. TABLE E IV. BOYS' SCHOOLS. Age. No. exd. Guardians present. Total No. in whom Defects found. Nature of Defects. Written Directions to parents Printed and verbal directions Want of Cleanliness. Clothing. Malnutriton. Sub-normal Vision. Extl. Eye Disease. Nasopharyngeal Obstrn. Ear Trouble Deformity and Spinal Dis. Affections to the Heart. Lung Trouble. Infectious or Contagious Disease. Mentally Defective Sundry Defects Teeth. Heads. Body. Clothing. Defective Footgear. Lateral Curvative. Other Deformities. Phthisis ? Phthisis- Other Lung Trouble. Urgent Defects. Other Defects of any kind. Verminous Nits only. Dirty. Verminous Dirty. Defective. Dirty. 11-12 19 3 18 ... ... ... ... 1 3 1 1 13 2 1 1 ... ... ... ... ... ... ... ... 5 3 11 5 10 12-13 521 96 488 2 43 7 4 9 58 49 40 271 56 29 136 5 1 11 9 ... ... 1 ... 125 66 328 156 267 13-14 803 98 644 7 47 11 7 17 86 28 57 340 75 33 208 12 1 12 12 ... ... ... 3 181 96 475 223 432 14-15 68 6 64 ... 1 ... ... ... 1 ... ... 21 7 1 14 2 ... 1 ... ... ... ... ... 10 11 42 22 30 15-16 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 3 3 1 1415 203 1218 9 91 18 11 27 148 48 98 645 140 64 359 20 2 25 21 ... ... *1 3 321 177 859 409 740 *Impetigo. *Impetigo. GIRLS' SCHOOLS. 11-12 7 1 5 1 2 ... ... ... 1 ... 1 5 ... 1 1 ... ... ... 1 ... ... ... ... 4 1 4 4 1 12-13 456 l60 445 6 211 5 ...... 2 40 5 25 226 54 16 118 10 8 5 6 ... ... 1 1 74 51 294 156 242 13-14 862 215 813 22 345 5 3 7 51 19 46 365 118 56 228 17 17 16 8 1 1 ... 1 167 96 504 300 424 14-15 49 9 48 1 11 ... 1 ... 4 1 5 13 9 2 16 ... ... 1 ... ... ... ... 3 10 7 30 21 18 15-16 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1375 385 1311 30 569 10 4 9 90 25 77 609 181 75 36 27 25 22 15 1 1 *1 5 255 155 832 481 685 INFANTS' (BOYS') SCHOOLS. 3-4 2 2 2 ... ... ... ... ... 1 ... 1 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 4-5 153 64 141 2 19 8 ... 4 19 11 15 74 4 5 42 ... ... 4 1 ... 5 2 ... 44 7 88 14 106 5-6 915 406 847 21 87 32 9 17 112 42 8l 366 21 34 284 17 2 25 12 ... 10 4 8 214 25 583 112 632 6-7 355 152 328 13 50 6 2 12 56 15 35 170 18 10 110 8 ... 6 5 ... 3 2 3 ... 22 236 65 214 7-8 112 45 100 3 15 1 ... 2 13 2 11 46 10 3 34 3 ... 2 1 1 1 ... 2 21 6 79 23 74 8-0 18 4 18 ... 3 1 ... ... 3 ... 2 11 1 ... 3 ... ... ... ... ... ... ... 1 4 1 15 1 17 9-10 4 ... 2 ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 1559 674 1438 39 174 48 11 35 205 71 145 670 54 52 473 28 2 37 19 1 19 *8 14 372 61 1004 215 1045 *Including Ringworm 3 Impetigo 4 Mumps 1. INFANTS' (GIRLS') SCHOOLS. 4-5 148 50 126 2 46 3 3 2 13 7 13 57 1 3 41 1 1 1 1 ... 2 ... ... 23 1 70 16 84 5-6 924 436 844 31 286 5 2 11 72 22 56 354 15 38 254 12 2 10 6 ... 11 6 ... 173 20 601 114 655 6-7 341 138 316 10 123 9 8 5 37 11 30 130 10 24 86 5 2 6 4 ... 1 2 1 8 2 9 238 57 227 7-8 124 42 115 2 35 ... 1 4 12 3 13 49 5 6 38 5 1 3 2 ... 1 1 1 30 3 80 21 89 8-9 28 9 28 ... 11 ... 2 ... 4 2 2 16 4 4 6 1 ... ... ... ... ... ... 1 6 ... 22 4 16 9-10 8 7 7 1 1 ... 1 ... ... 1 ... 4 1 ... 4 1 1 2 1 ... ... ... 1 3 1 4 1 4 10-11 1 1 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1574 683 1437 52 500 13 1 22 138 46 115 610 36 75 429 25 7 25 14 ... 15 *9 4 317 34 1016 213 1076 *Including Ringworm 6 Impetigo 2 Whooping Cough 1. TOTALS ALL AGES BOYS' AND GIRLS. 5923 1945 5404 130 1334 89 43 93 587 190 435 2534 411 266 1624 100 36 109 69 2 35 *19 26 1265 427 3711 1318 3546 *Including Ringworm 9 Impetigo 8 Whooping Cough 1 Mumps 1-. 89 CLOTHING. The number of children whose clothing was considered defective amounted to 587, most of whom were boys. This incidence is probably due to poverty, as there is more difficulty in making boys' clothes at home and not the same opportunity for adapting garments that have been used by elder members of the family. In spite of the considerable number of children going to school with defective clothing there is a striking improvement in the method adopted by those parents who are well enough off to buy suitable material and make their children's clothes at home. Many parents appear to have followed the advice given them in respect of this matter during the past two years. Much of this success is due to those head teachers who have kindly co-operated with us in this matter. MALNUTRITION. It is a pity that some definite meaning cannot be attached to this term. Some observers appear to be guided entirely by weight and classify children as badly nourished if they are below the standard weight. It has been shown in former years that the average weight of elementary school children is slightly below the British Association standard for England and Wales and considerably below the figures obtained for secondary school children in Croydon. If weight therefore was the sole criterion of malnutrition it is obvious that one could at once classify more than one half of our Croydon children as badly nourished. My own practice is to regard malnutrition as something rather more serious than this, and children whom I have personally examined are only marked badly nourished if in addition to being under weight there are symptoms such as listlessness, anaæmia or flabbiness, that will lead one to suspect that they are suffering from insufficient food, incipient or recent disease, or from an injudicious dietary. The large increase in the number of children classified as badly nourished in 1910 is due to a different standard having been adopted for the bulk of the children examined. EYE DISEASES. External eye diseases, such as conjunctivitis, inflammation of the lids, etc., were noted in 266 instances. Where necessary these children are referred for treatment by Mr. Wray at the Town Hall. Sub-normal vision was noted in 411 instances. All children requiring further examination are referred to the Ophthalmic Surgeon. 90 NASO-PHARYNGEAL OBSTRUCTION. Enlarged tonsils or adenoids were noted in 1,624 children. In many instances the mere fact that the tonsils were enlarged is of little practical importance, but parents are urged to secure treatment whenever the obstruction of the upper respiratory passages leads either to mouth breathing by night or day, and whenever there is a history of recurrent sore throat or of chronic or recurrent ear trouble. The exact number of children for whom operative treatment was urged was not ascertained at the time that the cards were analysed, but from figures supplied by the House Surgeons at the Croydon General Hospital, I find that 161 Croydon school children were operated upon at that institution. I have again to thank the House Surgeons for kindly supplying me with a list of patients treated week by week for tonsils and adenoids. This information is of practical value, as it enables us to write to the teachers and emphasise the importance of after treatment. EAR DISEASE. This was noted in 100 instances. DEFORMITIES. Laternal curvature of the spine was noted in 36 instances. The rational treatment for this condition consists of remedial exercises. As mentioned in the last Annual Report, Miss Appleton kindly volunteered to take three groups of children twice a week at Whitehorse Road centre for remedial exercises. The following is her report on the class :— Twenty-five girls have attended the classes during the year, and all have benefited by the exercises, although it has only been possible to give them two half-hours' treatment per week. Ten girls are at present being treated; two have been discharged as cured; four have left the district; five have left school, and the remaining four have discontinued their attendance at their parents desire. These children were periodically examined by Dr. Jackson, who reported that in every instance some improvement had taken place. The best thanks of the children and of the Committee is due to Miss Appleton for the ungruding way in which she has spent herself on this class. Other deformities were noted in 109 instances. For most of these children little could be done, but in several instances advice was given as to the choice of apparatus, etc. AFFECTIONS OF THE HEART. Affections of the heart were noted in 69 children. Many were simply the result of debility, but others were due to injury from rheumatism. Appropriate advice was given in either case. Most of the heart trouble in children and young adults is due to inflammation of rheumatic origin. Unfortunately, rheumatic fever in young children is very insidious, and in consequence is often overlooked by parents. In order to systematise the advice given when rheumatism is diagnosed I prepared the following leaflet, which is given to the parents and explained by the medical officers and health visitors. It has also been arranged with the attendance officers that parents may use their discretion in keeping rheumatic children from school when they have aches or pains if they are provided with one of these warning notices. COUNTY BOROUGH OF CROYDON. Control of Rheumatic Fever. Rheumatic attacks in children are very easily overlooked as the outward symptoms are usually quite trifling andlikely to escape the notice of parents. At the same time these slight attacks may permanently damage a child's heart and produce very serious results in later life. Hence it is very important that treatment should be secured immediately for rheumatism in its earliest stages and mildest forms. Symptoms which suggest that a child is suffering from the rheumatic poison:— (1). Growing pains—especially pain in the hamstrings. (2). Repeated sore throat or tonsillitis. (3). Attacks of irritability, night terrors, twitching of face or fingers, or clumsiness in children not usually troubled in these ways. (4). Certain rashes. Precautions that should be taken with rheumatic children:— (1). Keep limbs and body warmly but lightly clothed, preferably with woollen underclothing. See leaflet on clothing. (2). Put child to bed, and obtain medical advice ever feverishness, growing pains, sore throat or other symptoms of rheumatism are noticed. (3). Enlarged tonsils are better removed if a child suffers from repeated sore throats. H.M.R. Public Health Department, Croydon. 92 LUNG DISEASES. In 2 instances phthisis was diagnosed at the inspections. Other lung diseases were noted in 35 instances. COMMUNICABLE DISEASES. At the routine inspections communicable diseases were diagnosed in 19 instances. These included ringworm 9, impetigo contagiosa 8, whooping cough 1, and mumps 1. These numbers are, of course, in addition to the children who are specially examined on account of the known prevalence of some communicable disease in the school. MENTAL DEFECTS. Twenty-six children were noted to be mentally defective. In addition, a number of infants entered as "very dull" may prove, on further observation, to be mentally defective. DENTAL DEFECTS. The prevalence of dental trouble is shown by the following table. TABLE E. V. BOYS. Age. Number Examined. Urgent Defects of Teeth. Other Defects of Teeth. Number with sound Teeth. Percent'ge with sound Teeth. 3-4 2 ... 1 1 ... 4-5 153 7 88 58 37.9 5-6 915 25 583 305 33.4 6-7 355 22 236 97 27.3 7-8 112 6 79 27 94.1 8-9 18 1 15 2 11.1 9-10 4 ... 2 2 ... 10-11 ... ... ... ... ... 11-12 19 3 11 5 26.3 12-13 521 66 328 127 24.4 13-14 803 96 475 232 28.9 14-15 68 11 42 15 22.1 15-16 4 1 3 ... ... 93 GIRLS. 4.5 148 1 70 77 52 0 5.6 924 20 601 305 32.9 6.7 341 9 238 94 27 6 7.8 124 3 80 41 33 1 8.9 28 ... 22 6 21.4 9.10 8 1 4 3 37.5 10.11 1 ... 1 ... ... 11.12 7 1 4 2 28.6 12.13 456 51 294 111 24.3 13.14 862 96 504 262 30.4 14.15 49 7 30 12 24.5 15.16 1 ... ... 1 ... The figures for defective teeth are substantially the same as in 1909. No absolute accuracy can be claimed for them as it would take some considerable time to examine each child's mouth for incipient decay. The figures are, however, sufficiently accurate to once more emphasize the need for dental treatment for school children. METHODS EMPLOYED OR AVAILABLE FOR THE TREATMENT OF DEFECTS. During 1910 the Public Health Department continued to undertake the treatment of ringworm and minor skin complaints. RINGWORM The arrangements described in my previous annual reports have continued in force during the past year. 94 The following table shows the number of cases supervised by he Public Health Department during 1910:— TABLE E.VI. RINGWORM, 1910. Total numbei outstanding Jan. 10th, 1910 Scalp 66 Body 16 82 Total numbei reported during 1910 Scalp 243 Total number freed during 1910 Body- 111 354 436 Scalp 231 Body 123 354 354 Total number outstanding Jan. 6th, 1911 Scalp 78 Body 4 82 82 The more serious cases are again less frequent than in former years, and long outstanding attacks would be unknown were it not that some of the parents refused to have X-rays applied for children who are unlikely to be cured by drugs in any reasonable time. The number of children excluded from school at the end of the year was 82, as compared with 82 twelve months previously. Of the 243 new scalp cases 161 were treated at the Town Hall, 65 by application of X-rays, 96 by drugs, while a further 20 of the pievious year's cases were also given X-rays. 19 suspicious cases were also examined and proved not to have ringworm. Altogether 1465 attendances were made by children at the Town Hall in connection with the treatment of this disease. In respect to the question of X-ray treatment, we have now sufficient experience to make our figures of some value, and I find that from the beginning of this treatment down to the end of 1910 425 children have been treated by X-rays, and that the average time taken to complete the cure amounted to 73 days. This period seems somewhat lengthy, but it must be remembered that in the majority of cases submitted to X-rays the disease was widespread and likely to resist treatment. The time was also increased by the following considerations:— Occasionally X-rays had to be re-applied as another focus of disease had developed, or the first application was not sufficiently prolonged. In some instances the holiday season accounted for the delay in submitting the children for a freeing certificate. Occasionally children developed some other unhealthy condition of the scalp which had to be treated before freeing for school. 95 Intercurrent illness and failure to attend at the Town Hall accounted for other delays. Apart from these accidental considerations, most difficulty was caused by those children in whom the hair was so brittle that the diseased stumps broke off close to the surface of the scalp and could only be removed by the greatest patience. These cases have been very trying to the health visitors and are a source of much anxiety, as it is extremely difficult to make certain that a few stray stumps have not been left behind. Should this unfortunately have occurred there is considerable possibility that the disease will relapse and treatment have to be begun over again. It will be seen from the following table that one half the children treated were free from disease in 10 weeks. This is, therefore, the probable time that treatment will take:— TABLE E. VII. Interval between the first application of X-rays to the date of examination and when freed for school. Days No. of cases 14 — 28 34 28 — 42 60 42 — 56 83 56 — 70 54 70 — 84 60 84 — 98 41 98 — 112 37 112 — 126 15 126 — 140 18 140 — 154 7 154 — 168 3 168 — 182 2 182 — 196 4 196 — 210 4 210 - 224 2 224 — 238 — 238 — 252 I 96 I have also prepared the following table to show the age at which ringworm of the scalp usually begins: — TABLE E. VIII. RINGWORM OF THE SCALP. Age at which disease began. Male. Female. Total 3 — 1 1 4 5 2 7 5 28 23 51 6 25 33 58 7 18 18 36 8 19 14 33 9 12 23 35 10 8 3 11 6 0 12 12 10 6 16 13 3 1 4 14 1 — 1 135 130 265 It is important to note that of the 265 children affected no less than 147 were under seven years of age, and that the largest group of children was of the age of six. The figures show that if children escape ringworm in the infants school there is a considerable prospect of their escaping altogether, and that the number attacked after 12 years is inconsiderable. The table further suggests the importance of examining the older infants and also offers some important suggestions for treatment, which 1 propose dealing with elsewhere. TREATMENT OF EYE DEFECTS During 1910 Mr. Wray attended on one morning a week at the Town Hall. Children for whom glasses were required were advised to obtain them from Mr. J. F. Wolfle, who arranged with the Committee to supply school children at the following prices:— Spectacles with spherical lenses 1/9 „ „ piano-cylindrical lenses 2/9 ,, sphero-cylindrical lenses 3/9 97 In all cases where the parents were too poor to purchase spectacles the children were referred to the Guild of Help, which rendered very valuable services with respect to these cases. ACTION TAKEN TO PREVENT SPREAD OF INFECTIOUS DISEASES. The method of dealing with notifiable disease is dealt with in the report to the Sanitary Committee of the Council. During the year the undermentioned cases have been dealt with by the department:— TABLL E. ix. Cases of illness reported by School Teachers or Attendance Officers (including duplicate reports):— Illness as reported by Teachers or Attendance Officers. Ist Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Scarlet Fever 10 18 29 18 75 Diphtheria 3 7 3 12 25 Enteric Fever 1 1 - 2 Measles 396 466 87 51 1000 Mumps 344 429 194 156 1123 Whooping Cough 124 143 173 70 510 Chicken-pox 239 181 40 135 595 Sore Throat 144 214 267 218 843 Ringworm 16 19 21 23 79 Impetigo 34 56 40 17 147 Scabies 3 4 7 1 15 Other Cases 276 279 216 279 1050 Totals 1589 1817 1078 980 5464 Cases of illness reported to the Education Committee by the Public Health Department:— Illness. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Scarlet Fever 89 123 192 145 549 Diphtheria 43 47 28 75 193 Enteric Fever 1 5 I 1 9 Measles 319 467 27 44 857 Mumps 237 313 I20 94 764 Whooping Cough 130 138 137 69 474 Chicken-pox 197 189 33 106 525 Sore Throat 87 72 69 86 314 Ringworm (scalp) 90 72 48 33 243 „ (body) 35 39 22 15 111 Impetigo 109 117 80 98 404 Scabies 15 16 4 12 47 Infectious Eye Disease 4 ... 2 1 7 Other Cases 108 113 94 144 459 Totals 1464 1711 857 924 4956 In many instances the above reports dealt with the exclusion of several children, 98 WORK OF THE HEALTH VISITORS. The five health visitors have largely been employed in visiting houses where non-notifiable infectious diseases have been reported by school teachers, and in generally assisting in the work of medical inspection. The number of visits paid in connection with this part of their duty is shown in the following table:— TABLE E. x. 1st Visits. 2nd Visits. Measles 978 48 German Measles 9 - Mumps 9S8 57 Whooping Cough 497 60 Chicken-pox 563 28 Sore Throat 855 316 Ringworm 326 650 Verminous Heads 31 11 Verminous Bodies 41 4 Impetigo Contagiosa 485 839 Scabies 36 82 Other Diseases 770 348 Totals 5579 2443 Cultures taken 1443 - Visits paid to Elementary Schools 324 - Other visits to Elementary Schools 34 - Number of children prepared for medical inspection— - Newly inspected 6475 - Re-inspected 865 - Specially inspected 271 - Home visits arising out of medical inspection 488 I50 Home visits for other information 830 IO8 Since 1903 the Health Visitors have delivered addresses to suitable audiences on "The care of young infants and domestic hygiene." During the past winter it was thought desirable to somewhat vary this work, and to bring it more specifically into relation with a scheme for medical supervision of school children. It was therefore decided to arrange for the delivery of a short course of two lectures on "The health of the school child." In order to emphasize the relation of these lectures to medical inspection, it is intended to arrange for their delivery at various schools throughout the borough. So far, this has been attempted at Boston Road, Sydenham Road, Parish Church, St. Andrew's, and Ingram Road. 99 The lectures evoked considerable interest, and useful discussions followed. I hope as opportunity offers to arrange for similar conferences at the other schools in the borough. A syllabus of the lectures is reproduced in the appendix. SCHOOL CLOSURE. During the year 1910 fifteen infant schools were closed in accordance with Article 45 (fa) of the code. The prevalence of scarlet fever, measles, mumps, or whooping cough accounted for these closures. EXCLUSION OF CHILDREN FROM SCHOOL. During the year 27 children were excluded under Article 53 (b) of the code. This is in addition to the large number dealt with in accordance with the ordinary Standing Orders of the Committee. PHYSICALLY AND MENTALLY DEFECTIVE CHILDREN. At the end of the year the following Croydon children were under treatment in residential institutions outside the Borough:— Blind children 6 Deaf children 5 Mentally defective children 3 Epileptic children 3 At present no serious attempt is being made to deal with the problem of the mentally defective child. While the funds at the disposal of the Committee for educational purposes are so limited I do not feel that any useful purpose would be served by discussing any scheme for the establishment of a special school. Certainly as a matter of educational economics better return can be insured by expenditure on normal children. On the other hand, if the mentally defective are regarded, as they should be, from a social standpoint there is little doubt that permanent institutional care must eventually be provided. This would be one way of thinning the ranks of the unemployable. 100 AUXILIARY CLASS. In June, 1908, the Committee opened a small class at Whitehorse Road for the reception of children whose mental progress was retarded, and who could not be satisfactorily dealt with in ordinary schools. This class was intended for children whose education for one reason or another had been neglected, and for those who could not be taught to read and write without more individual attention than is possible in a ordinary class. On the other hand it was not intended to admit children who were obviously mentally defective, though it could not be expected that the selection of children would in all cases be made with absolute accuracy, and in a few instances children were purposely admitted on trial so that one might judge from experience what their mental condition really was. The following is the result up to the end of 1910. In all 25 children have been admitted. Seven have been transferred back to ordinary schools, five have left for other reasons, and thirteen were in attendance in December, 1910. NECESSITY FOR FURTHER TREATMENT. The arrangements for dealing with ophthalmic diseases are now fairly satisfactory. During the year under review, Mr. Wray attended on one morning of the week at the Town Hall, and spent another morning in the schools. As a result of the year's experience, it was found that better results were obtained from the time spent at the Town Hall, and the Committee therefore arranged that on and after January, 1911, the ophthalmic surgeon should as a rule work at the Town Hall, where he could undertake the further examination and treatment of selected children, and that he should only visit the schools when his attendance was required by some specia. smergency or difficulty. In my last report, the question of dental treatment was fully discussed, and 1 then expressed the opinion that a dental surgeon should be added to the public health staff, and that a beginning might well be made by the appointment of a part-time dental surgeon who would assist in inspections and undertake treatment of some of the more urgent cases. By proceeding in this wav, we should be able to ascertain the amount of time required for treating school children and the probable expense of a complete scheme. On consideration of this report, the Committee decided in the first instance they would endeavour to get the Guardians to undertake 101 the dental treatment of school children, and I was accordingly instructed to refer parents to the relieving officers. This was done in a very large number of instances, and almost without exception the parents refused to go to the relieving officers. In at least four instances, however, application was made to the relieving officers, but in each instance relief was refused. I confess that I am not surprised at the result, as, although it is clear that the Board of Guardians are legally responsible for the provision of any necessary medical or surgical attendance which the parents cannot obtain for themselves, they have no staff for dealing with dental out-patients, and if the responsibility is to be assumed by a local authority, it is obviously much more convenient that the work should be done by the Education Committee or by the Corporation, and not through the Poor Law. Should the Committee think it worth while, it might be well to consult local dentists as to the practicability of making arrangements on provident dispensary lines. I do not myself, however, regard that solution as a very hopeful one. EXAMINATION OF PUPIL TEACHER CANDIDATES. Thirty-nine young persons who desired to become pupil teachers were medically examined during the year, all of whom were passed. SPECIAL EXAMINATION OF TEACHERS. Fourteen teachers were interviewed on one or more occasions by the medical officer. In seven instances the interview had reference to the existence of infectious disease at the home of the teacher, while in seven cases the Committee required special reports concerning the health of the teacher. TRUANTS. Three children were examined before despatch to truant schools, and the necessary certificates given to the police. EXAMINATION OF CHILDREN UNFIT TO ATTEND SCHOOL. A large number of children referred by the Attendance Committee, attendance officers or teachers, in addition to others specially selected by the medical officers, attended at the Town Hall for medical examination. 102 Among those seen were the following, many being seen on several occasions:— Children seen for the first time in 1910— Diseases of the Lungs 33 Heart 6 Ear 9 Skin 15 Mentally defective children 9 Other nervous diseases 11 Deformities 5 Examined for special schools 22 Various diseases 45 155 Re-examination of children seen in 1909— Diseases of the Lungs 6 „ „ Heart 1 Other diseases 3 10 H MEREDITH RICHARDS, M.D., Medical Officer. 103 APPENDIX. Syllabus of Lectures to Parents. THE HEALTH OF THE SCHOOL CHILD. School children must be healthy if they are to make the best use of their school time. The attention of parents is therefore directed to the following rules for health. Care of the Skin.—The skin cannot be kept healthy unless a warm bath is given at least once a week. Daily cold sponging of the neck and chest strengthens healthy children and helps to ward off "'colds." The hands should be washed before each meal to avoid swallowing harmful dust and dirt. Care of the Teeth.—Decayed teeth injure digestion, and are harmful in other ways. Children should use a tooth brush the last thing each night. Clean teeth rarely decay. Read the leaflet on Teeth. Too much pappy food it bad for the teeth. Care of the Hair.—The hair of young children is best worn short. Older girls should have the hair tied back or plaited. Every child's hair should be carefully combed with a fine comb each week in order to guard against the risks of vermin. Clothing.—The most suitable outfit for a school boy consists of:— (1) A combination garment. (2) Knickerbockers. (3) Woollen stockings. (4) Jersey of knitted wool. (5) Lace boots. (6) Straw hat or cloth cap. The combination garment should have sleeves, and reach just below the knees. The best material is wool, either woven or one of the unshrinkable flannel mixtures. If flannelette is used it must be the kind that will not burn. Ordinary flannelette is dangerous. For children in the baby class the combination is best replaced by a vest and drawers. 104 The knickerbockers should be of corduroy or stout serge, and supported by braces, or by being buttoned to a bodice in the case of infants. Suspenders should be used for the stockings. A knitted vest is a useful addition in the winter time, when an overcoat is also required. While it is a mistake to endeavour to harden children by exposing the limbs, too many garments hinder the free movement of the body and the proper use of the lungs. Over-clothing also leads to sweating during exercise, and consequent risk of chills. The boots should be of the natural shape of the foot, straight on the inside edge, and allow plenty of room for the toes. Girls should be dressed in the same way as boys (suitable knickerbockers included), but with the addition of a kilt supported from the shoulders by a cotton bodice. If preferred, the jersey and kilt may be replaced by a long-sleeved yoke frock, reaching just below the knee, made of material suitable for the season. Patterns for making suitable garments for boys and girls may be borrowed from the Health Visitors. Sleep.—All underclothing should be changed at night. A child should be accustomed to sleep on its side, in a quiet room with an open window. Children in the infant school require twelve hours' sleep, and half-an-hour's rest in the middle of the day. Older children require at least ten hours. Medical advice should be sought for children who persistently snore at night. Care of the Eyes.—Children must not sew, read or write in a bad light. "When reading or working, children should sit with their feet on the floor, their backs straight, and the book or work not less than a foot from the eyes. Children who constantly work in awkward, twisted positions are likely to get twisted backbones. The attention of the head teacher should be directed to any child who cannot see properly, or has pain after reading, in order that the sight may be tested by the medical officer. The feeding of School Children.—Food is required for growth and to enable the body to do its work and keep up its warmth. 105 To enable food to perform its work it mast be chewed and digested, hence children require not only sufficient, suitable food, but regular meals and sufficient time for meals with subsequent rest for half an hour. Children should not eat standing and be hurried back to school directly they have finished the last morsel. The bowels must also be relieved each day. Three necessary kinds of Food which must all find their place in the daily supply;— (i) Starches and sugars. Such as potatoes, rice, sugar, etc (a) Fats. (3) Meat and meat substitutes. In selecting articles for diet we must consider:— (1) Their digestibility. (2) Their food value. (3) Their cost, i.e., the amount we can buy for a given sum. The real (strength giving) value of common food materials is best estimated by enquiring how much we can buy for say is., judged on this basis. Flour, bread, oatmeal and sugar are the four cheapest articles of food. Other really cheap foods are peas, lard, dripping, margarine and herrings. A satisfactory diet must contain all three great classes of food stuffs. Some articles of food, such as milk, contain all three. Meat and Meat substitutes.—"Pieces" of lean meat can be bought for 3d. a lb., and are just as nutritious as a joint which costs twice as much. Hence "pieces" made in a stew or meat pudding are twice as good value as a joint. 1o6 There are also other substitutes (some cheap and some dear) for joints of meat, thus a 5-lb. joint costing 2s. 6d. can be replaced by the consumption of:— 5-lbs. " pieces " at 3d 1 3 5-lbs. ox liver at 4d. 1 8 18 herrings 1 0 3-lbs. cheese at 6d 1 6 11 -lbs. flour at 7-lbs. for is, 1 7 7-lbs. oatmeal at 2½d. 1 6 15-lbs. bread at 1½d. 1 10 6-lbs. split peas 7 5-lbs. lentils at 2½d 1 0 8-lbs harricots 1 1 12 quarts milk at 4d. 4 0 12 quarts skim milk at 2d 2 0 61eggs at 1d, each 5 1 This table shews the wisdom of buying "pieces," herrings, cheese, peas and beans. Many of the foods in this table can not only take the place of a joint, but contain large amounts of other valuable food materials. Thus cheese contains as much fat as it does "meat," while peas and beans contain not only " meat," but more than half their weight of starch. Cheese, peas and beans should therefore be eaten in larger quantities than is now usual. The second class of food which requires consideration is Fat.—This includes butter, margarine and dripping, lard, suet. Margarine is as nutritious as butter, and only one-third the cost. Dripping is well worth buying. It is an extremely valuable food for children who will take it readily with bread or toast or as dripping pudding. Suet pudding should be given to children who dislike fat meat. Starch and Sugars.—Sugar, bread, rice, oatmeal, etc., are usually eaten in sufficient quantity. It should be noted that jam is not a cheap substitute for butter. There is as much real food in 1-lb. of butter as in 3-lb. of jam. If cost is an object it is cheaper and better to substitute margarine or dripping for butter. Fats must be given to growing children, and cannot be replaced by sugars and starch. Avoid patent foods, which are invariably dear. Cook potatoes in their jackets in order to improve their flavour and make use of all the food. 1o7 Fluids for Children—Milk is the best drink for a growing child. Skim milk is valuable if full milk cannot be spared. If any other beverage is given let it be cocoa, and not tea or coffee. Water should be given at dinner. Beer or spirits should never be given except under medical advice in case of illness. Cooking.—Not only choose the right material, but make it digestible and appetising by proper cooking. Advice may be sought from the Health Visitors, who will give you directions concerning the preparation of cheap, nourishing dishes, which have all been carefully selected for the purpose. 108 COUNTY BOROUGH OF CROYDON. SCARLET FEVER OR SCARLATINA. HOME CASE. Children from this house must not attend day or Sunday School until permission is given by the Medical Officer of Health. All cases of "sore throat," "lumps in the neck," or of "peeling skin " occurring in the household are probably scarlatinal, and should be immediately reported to your Medical Attendant. Suspicion should also be roused by any sudden attack of illness, especially if beginning with vomiting. Public Library Books must be taken to the Health Department, Town Hall, and no books borrowed until the house has been disinfected. If treated at home the patient must be confined to one room, and no one except the person in charge allowed to enter the roo?n. All unnecessary furniture should be removed from the sick room forthwith, and the floor and furniture should be frequently wiped with a damp cloth. Fresh air must be freely admitted, a fire being lighted if necessary. Attendants should wear washable dresses, should wash their hands immediately after attending the sick person, and should always wash their hands and faces and change their shoes and outer clothes before going off duty. No domestic animal should be allowed to enter the sick room. No children should be allowed to visit the infected house. A patient suffering from this disease is generally DANGEROUS TO OTHERS for six or eight weeks, and must not be allowed to mix with other people until the Medical Attendant certifies that there is no danger. There is risk of infection while there is any discharge from car or nose, or while the throat remains sore or unhealthy. disinfection. 1.—All soiled linen should be at once placed in a tub of water to which a handful of ordinary washing soda has been added, soaked for twelve hours, and then boiled in a copper. Materials which cannot be boiled should be soaked for one hour in liquid disinfectant, and then washed. lo9 2.—Special cups, saucers, and spoons should be used for the patient, and any spare food from the sick room destroyed. 3.—Discharges from ear, nose, or mouth should be received on a rag, which should be at once burnt, as also should any dust collected in the room. 4.—During recovery the patient should have a warm bath every dav, unless the doctor orders otherwise. The body should be freely lathered with soap, special precaution being taken to thoroughly cleanse the hair and seal]). 5.—When the patient is free from infection, the Corporation undertake the disinfection of the sick room, bedding, etc., free of cost. The accompanying card should be returned when the patient is free from infection. Disinfectants are supplied free to home cases once a week on calling at the Health Department, Town Hall, between the hours of 9 a.m. and 5 p.m. (Saturdays 9 a.m. till 1 p.m.) H. MEREDITH RICHARDS, M.I)., Medical Officer of Health. Town Hall, Croydon. A penalty of is attached to the exposure of infected persons and things. COUNTY BOROUGH OF CROYDON. DIPHTHERIA AND MEMBRANOUS CROUP. HOME CASE. Children from this house must not attend day or Sunday school until permission is given by the Medical Officer of Health. All cases of croup, "sore throat" or "lumps in the neck" occurring in the household are probably diphtheritic, and should be immediately reported to your Medical Attendant. Any suspicious cases can be examined bacteriologically at the Borough Laboratory, free of charge. Public Library Books must be taken to the Health Department, Town Hall, and no books borrowed until the house has been disinfected. 110 If treated at home the patient must be confined to one room, and no one except the person in charge allcnved to enter the room. All unnecessary furniture should be removed from the sick room forthwith, and the floor and furniture should be frequently wiped with a damp cloth. Fresh air must be freely admitted, a fire being lighted if necessary. Attendants should wear washable dresses, should wash their hands immediately after attending the sick person, and should always wash their hands and faces and change their shoes and outer clothes before going off duty. No domestic animal should be allowed to enter the sick room. A patient suffering from this disease is generally DANGEROUS TO OTHERS for a period of at least three weeks, and must not be allowed to mix with other people during that period, or while there is any sore throat, or any discharge from ear or nose, or 'while diphtheria germs can be detected in the throat. Examinations for the detection of diphtheria germs are made at tiie Borough Laboratory, free of cost. The necessary arrangements will be made by your Medical Attendant. disinfection. 1.—All soiled linen should be at once placed in a tub of water to which a handful of ordinary washing soda has been added, soaked for twelve hours, and then boiled in a copper. Materials which cannot be boiled should be soaked for one hour in liquid disinfectant, and then washed. 2.—Special cups, saucers and spoons should be used for the patient, and any spare food from the sick room destroyed. 3. —Discharges from ear, nose or mouth should be received on a rag, which should be at once burnt, as should also any dust collected in the room. 4.—When the patient is free from infection, the Corporation undertake the disinfection of the sick room, bedding, etc., free of cost. The accompanying card should be returned when the patient is free from infection. Disinfectants are supplied free to home cases once a week on calling at the Health Department, Town Hall, between the hours of 9 a.m. and 5 p.m. (Saturdays 9 a.m. till 1 p.m.) H. MEREDITH RICHARDS, M.D., Medical Officer of Health. Town Hall, Croydon. A penalty of £5 is attached to the exposure of infected persons and things. 111 COUNTY BOROUGH OF CROYDON. TYPHOID (ENTERIC) FEVER. HOME CASE. All cases of "diarrhoea," "severe headache" or "feverishness" occurring in the household should be immediately reported to your Medical Attendant. Any suspicious cases can be examined bacteriologically at the Borough Laboratory, free of charge. Public Library Books must be taken to the Health Department Town Hall, and no books borrowed until the house has been disinfected. If treated at home the patient must be confined to one room, and no one except the person in charge allowed to enter the room. All unnecessary furniture should be removed from the sick room forthwith, and the floor and furniture should be frequently wiped with a damp cloth. Fresh air must be freely admitted, a fire being lighted if necessary. Attendants should wear washable dresses, and should always wash their hands and faces and change their shoes and outer clothes before going off duty. Scrupulous cleanliness is essential. Nurses should keep their nails short, and should scrub their hands and disinfect them immediately after attending the patient. No domestic animal should be allowed to enter the sick room. A patient suffering from this disease is generally DANGEROUS TO OTHERS for a period of a fortnight after return to ordinary food. disinfection. 1.—All soiled linen should be at once placed in a tub of water to which a handful of ordinary washing soda has been added, soaked for twelve hours, and then boiled in a copper. Materials which cannot be boiled should be soaked for one hour in liquid disinfectant, and then washed. 2.— Special cups, saucers and spoons should be used for the patient, and any spare food from the sick room destroyed. 3.—Everything passing from the patient should be received into a mixture of water and disinfectant, sufficient being used to completely cover it, and be allowed to stand for half-an-hour before being thrown away, the vessel being covered with a cloth soaked in the disinfectant. Nothing coming from the patient must be thrown into the ash-bin, or upon the surface of the soil, or into the drains without disinfection, 112 4—Discharges from ear, nose or mouth should be received on a rag, which should be at once burnt, as also should any dust collected in the room. 5.—When the patient is free from infection, the Corporation undertake the disinfection of the sick room, bedding, etc., free of cost. The accompanying card should be returned when the patient is free from infection. Disinfectants are supplied free to home cases once a week on application to the Health Department, Town Hall, between the hours of 9 a.m. and 5 p.m. (Saturdays 9 a.m. till 1 p.m.) H. MEREDITH RICHARDS, M.D., Medical Officer of Health. Town Hall, Croydon. A penalty of jQj is attached to the exposure of infected persons and things. COUNTY BOROUGH OF CROYDON. PUERPERAL FEVER. Directions as to the Disinfection of Midwives and Maternity Nurses. No Midwife or Nurse in attendance on a patient suffering from Puerperal Fever or other infectious illness should visit or attend any other patient. Whenever a Midwife or Nurse has been in attendance upon a patient suffering from Puerperal Fever or from any other illness supposed or suspected to be infectious, she should conform to the following methods of disinfection at the conclusion of the case:— 1.—All washable clothing should be steeped in water to which a little soda has been added and then boiled. Gloves should be boiled. 2.—All other clothing should be disinfected at the Public Disinfecting Station. This will be done free of cost by the Corporation. Application should be made at the Town Hall. 3.—The Nurse's bag should be disinfected by washing thoroughly inside and out with 1 in 1,000 perchloride of mercury solution. 4.—All instruments and nail-brushes should be boiled. 113 5.—A complete bath should be taken, soap being freely used. The nails should be cut short and the hands first scrubbed and then immersed for five minutes in 1 in 1,000 perchloride of mercury solution. Midwives and Nurses must not resume work until they have satisfied the Corporation that the requirements of the Medical Officer of Health as regards disinfection and other precautions have been complied with. H. MEREDITH RICHARDS, M.D., Medical Officer of Health. Public Health Department, Town Hall. COUNTY BOROUGH OF CROYDON. PUERPERAL FEVER & OTHER ACCIDENTS OF CHILDBIRTH. These are best avoided by attending to the following simple rules during pregnancy:— Diet should be plain, easy of digestion, nutritious, and taken at regular intervals. Milk should be taken freely, and beer, wine, or spirits only sparingly and under medical advice. Exercise should be moderate in amount, and in the fresh air. Violent exercise and fatigue should be avoided. Rest should be taken daily in the afternoons, and mental excitement avoided. Clothing should be loose and warm, woollens being worn next the skin. Bathifig should be carefully attended to, especially towards the end of pregnancy. The Bowels should act daily—cascara is a useful simple laxative. Infectious Disease. Pregnant women should avoid contact with any kind of infectious disease, and with patients suffering from discharging sores. The Nipples during the last two months of pregnancy should be bathed with boiled warm water, and glycerine of borax applied daily. When taken in labour the patient should have a warm bath, plenty of soap and water being used, and fresh clean underclothing ba put on. 114 The lying-in room. The room should be scrupulously clean, the window and grate register opened. In cold weather a small fire is necessary. The room should not have been recently used for any case of infectious disease. If there is any doubt about this the room will be disinfected free of charge on application to the Medical Officer of Health. Two wash basins, a nail brush, soap and hot water, an efficient antiseptic, scissors, thread, and plenty of clean towels, and a binder with safety pins, should be prepared ready beforehand. The patient should lie on a firm mattress with a clean mackintosh and sheets. maternity nurse. The nurse must be scrupulously clean in every way, and should not have been recently engaged in nursing any case of puerperal fever or other infectious disease. All maternity nurses are advised to procure a copy of the instructions issued by the Central Midwives' Board, and to follow the rules given therein in respect to clothing, disinfection of hands, disinfection of appliances, and disinfection of the patient. COUNTY BOROUGH OF CROYDON. RINGWORM. The Medical Officer is authorised to treat free of charge children attending Public Elementary Schools who are suffering from Ringworm. Unless your child is being treated by your own medical attendant at your expense, you should arrange with the Health Visitor for the case to be seen by one of the Medical Officers, who will instruct you how to proceed. It is expected that parents will carefully follow instructions, so that a cure may be effected as promptly as possible. Medical certificates of freedom from infection should be obtained from the medical attendant when cases under private doctors are cured. Chidren cannot be re-admitted to school unless this certificate is given to the Attendance Officer, or the child is examined and found free at the Town Hall on Wednesday or Saturday mornings at 9. H. MEREDITH RICHARDS, M.D., Medical Officer. Public Health Department, Town Hall, Croydon. 115 COUNTY BOROUGH OF CROYDON. INFECTIOUS SCABS AND SORES (IMPETIGO CONTAGIOSA). If the scabs are on the head, cut the hair for quarter-of-an-inch round the scabs, cover them with strips of rag soaked in olive oil until they can be removed. If the scabs are on the face, remove them by bathing with hot water. Then apply dilute white precipitate ointment (ten grains to the ounce), which can be procured from any chemist. It is no use applying the ointment until the scabs have been removed. Any case of impetigo should be cured in a week. If it will not yield to above treatment it is imperative that medical advice should be obtained, as there may be some more serious affection. COUNTY BOROUGH OF CROYDON. MEASLES. Measles is one of the most fatal diseases of children. It is also catching. Most deaths may be prevented by careful nursing. To assist recovery of patient. In every case seek medical advice. Most deaths are due to children being exposed to unhealthy conditions while suffering from measles. Measles patients should be warmly clad, and kept in a warm but well ventilated room until they have quite recovered. The whole body, including arms and legs, should be clothed in flannel. Remember that pure air is as necessary as warmth. The air of a dirty, stuffy room poisons the lungs, and is more dangerous than cold or even draughts. To Prevent Spread. Separate the patient from all other children for at least three weeks after the appearance of the rash. Measles usually begins with sneezing, coughing, running at the eyes and nose. All colds should, therefore, be looked upon with suspicion when Measles is prevalent. Keep apart any child so suffering for four days, when, if the disease is Measles, the rash will have appeared. Under no circumstances must a child be sent back to school until the end of four days even if it appears better. 116 When the last case has recovered, disinfect the sick room by washing everything you can with soap and hot water; what you cannot wash should be aired in the garden. Keep the windows freely open, and take care that the sick child's clothes are washed before return to school. Other children who have not previously had the disease must be kept at home for at least three weeks from the appearance of the rash. Those who have already had Measles may be allowed to attend the Boys' or Girls' Schools, but not the Infant School. H. MEREDITH RICHARDS, M.D., Medical Officer of Health. Town Hall, Croydon. A penalty of £5 is attached to the exposure of infected persons and things. COUNTY BOROUGH OF CROYDON. WHOOPING COUGH. Whooping Cough is one of the most fatal diseases if children. It is also catching. Most deaths may be prevented by careful nursing. To assist Recovery of Patient. In every case seek medical advice. Most deaths are due to children being exposed to unhealthy conditions while suffering from Whooping Cough. Patients should be warmly clad, and kept in a warm but well-ventilated room for at least six weeks. The whole body, including arms and legs should be clothed in flannel. Remember that pure air is as uecessary as warmth. The air of a dirty, stuffy room poisons the lungs, and is more dangerous than cold or even draughts. To Prevent Spread. Separate the patient from all other children for as long as the whoop continues, and not less than five weeks from the commencement of the whooping, and do not allow him to return to school until completely recovered. Whooping Cough usually begins like an ordinary feverish cold, and is infectious from the start. All colds should therefore be looked upon with suspicion when Whooping Cough is prevalent. When the last case has recovered, disinfect the sick room by washing everything you can with soap and hot water; what you cannot wash should be aired in the garden. Keep the windows freely open, and take care that the sick child's clothes are washed before return to school, 117 Other children who have not previously had the disease must be kept at home for at least a fortnight, and may then return to school provided they have no cough and are not infants. Those who have already had Whooping Cough may be allowed to attend the Boys' or Girls' Schools, but not the Infant School. H. MEREDITH RICHARDS, M.D., Medical Officer of Health. Town Hall, Croy on. A penalty of £5 is attached to the exposure of infected persons and things COUNTY BOROUGH OF CROYDON. SUMMER DIARRHCEA. This disease is most fatal, especially to children under one year of age, and in August, September, and October. In all cases medical advice should be obtained without delay. As the disease introduced into the body principally by food, no food should be eaten except what is perfectly fresh. Special attention should be given to the Milk for Children. It should not be kept in the house for more than twelve hours. It should be boiled shortly before being given to the child. It should be kept in a cool well-ventilated place, in vessels that have been well cleaned and scalded. The feeding bottle should be scalded and carefully cleansed each time it is used. A boat shaped bottle with a reversible teat and without tubing should be used. All houses should be kept clean and well ventilated. The windows and doors should be kept open as much as possible. The floors of the rooms should be scrubbed with soap and water at frequent intervals, and the walls of closets, passages, and cellars should be limewashed frequently. Closet pans should be always kept clean, and back yards frequently swilled with water where possible. Animal and Vegetable Refuse should be burned in the kitchen grate instead of being put into the Dustbin. See that the Ashbin is regularly emptied. Nuisances should be reported at the Public Health Department at once. *For further particulars consult the pamphlet on Infant Feeding, which can be obtained free at the Public Health Department. H. MEREDITH RICHARDS, M.D., Medical Officer of Health. Public Health Department, Town Hall, 118 COUNTY BOROUGH OF CROYDON. THE CONTROL OF RHEUMATIC FEVER. Rheumatic attacks in children are very easily overlooked, as the outward symptoms are usually quite trifling and likely to escape the notice of parents. At the same time these slight attacks may permanently damage a child's heart and produce very serious results in later life. Hence it is very important that treatment should be secured immediately for rheumatism in its earliest stages and mildest forms. Symptoms which suggest that a child is suffering from the rheumatic poison:— (1). Growing pains—especially pain in the hamstrings. (2). Attacks of irritability, night terrors, twitching of face or fingers, or clumsiness in children not usually troubled in these ways. (4). Certain rashes. Precautions that should be taken with rheumatic children:— (1). Keep limbs and body warmly but lightly clothed, particularly with woollen underclothing. See leaflet on clothing. (2). Put child to bed, and obtain medical advice whenever feverishness, growing pains, sore throat or other symptoms of rheumatism are noticed. (3). Enlarged tonsils are better removed if a child suffers from repeated sore throats. H. MEREDITH RICHARDS, M.D., Medical Officer of Health. Public Health Department, Croydon. COUNTY BOROUGH OF CROYDON. CHILDREN'S TEETH. 1. The Teeth must be kept clean. 2. Use a small tooth-brush with stiff bristles. Use a little soap and some precipitated chalk. Rinse the mouth several times with cold water. 3. Brush all the teeth thoroughly, especially the back ones. Brush the top and both sides of the teeth. 4. Clean the teeth immediately before going to bed. Take no food of any sort afterwards. Clean the teeth again in the morning. 119 5. Clean teeth do not deca 6. If the food is too soft it is apt to cling about the teeth where it decays and damages the teeth. Chewing not only helps to digest the food but keeps the teeth clean. 7. Decayed teeth should receive attention as they give rise to indigestion and other troubles. Decayed temporary teeth may injure the permanent set. 8. Improperly fed infants are apt to have bad teeth. Study the handbill on infant feeding. Public Health Department. COUNTY BOROUGH OF CROYDON. THE CLOTHING OF SCHOOL CHILDREN. BOYS.—The most suitable outfit for a boy consists of:— (1) A combination garment. (2) Knickerbockers. (3) Woollen stockings. (4) Jersey of Knitted Wool. (5) Lace boots. (6) Straw hat or cloth cap. The combination garment should have sleeves and reach just below the knees. The best material is wool, either woven or one of the unshrinkable flannel mixtures. If flannelette is used it must be the kind that will not burn. Ordinary flanelette is dangerous. For children in the baby class the combination is best replaced by a vest and drawers. The knickerbockers should be of corduroy or stout serge, and supported by braces, or by being buttoned to a bodice in the case of infants. Suspenders should be used for the stockings. A knitted vest is a useful addition in the winter time, when an overcoat is also required. While it is a mistake to endeavour to harden children by exposing the limbs, too many garments hinder the flee movement of the body and the proper use of the lungs. Over-clothing also leads to sweating during exercise, and consequent risk of chills. The boots should be of the natural shape of the foot, straight on the inside edge, and allow plenty of room at the toes. CURLS should be dressed in the same way as boys (suitable knickerbockers included), but with the addition of a kilt supported from the shoulders by a cotton bodice. If preferred the jersey may be replaced by a long-sleeved yoke frock reaching just below the knee, made of material suitable for the season. Patterns for making suitable garments for boys and girls may be borrowed from the Health Visitors. Public Health Department, Town Hall. 120 COUNTY BOROUGH OF CROYDON. THE CLOTHING OF INFANTS. A young infant should be lightly but warmly clad in woollen material, The garments required are:— (1) Long-sleeved Vest. (2) Binder. (3) Napkin. (4) Long Flannel. (5) Gown. The vest should be knitted or made of flannel. It must have sleeves to the wrist, and be made to open down the front with flaps to close over each other. The binder can be a knitted belt to be slipped on from the feet, or a double fold of flannel, to be tied with tapes or ribbons. Its object is to keep the stomach warm, and it must not be tight. The napkins should be of best Turkish towelling. The long flannel must be made to fit closely up to the throat, and should be double-breasted. At the foot, it can be folded over, and fastened with buttons or safety pins, or it may be drawn up with a string like a bag. If these garments are all made to fasten down the front, they can be placed in position, with the vest sleeves drawn through the armholes of the long flannel, and the baby being laid face downwards on the mother's knee, his arms can be inserted into the sleeves, then turn him over, and fasten the garments in front without further moving the child. The gown should be made of some light material and have long sleeves. When the child is short-coated, the long-sleeved vest and binder should still be worn, and knitted drawers with legs and feet attached, or long stockings and a flannel square, should be put on over the napkins. A knitted or flannel petticoat with sleeveless bodice of the same material, and a long-sleeved frock of some warm stuff are also required. It is a great mistake to try and harden infants by letting them expose their arms and legs in cold weather. At night, the child only requires a vest and flannel nightgown with long sleeves, but a different vest from that worn in the day should be used. Patterns for cutting out the garments, and directions for knitting, can be borrowed from the Health Visitors. Ordinary Flannelette is a dangerous material. Public Health Department, Town Hall. 121 COUNTY BOROUGH OF CROYDON, THE FEEDING AND CARE OF INFANTS. feeding. 1.—The best food for a young infant is its mother's milk. Every infatit should therefore be suckled, if possible, unless the mother has medical advice to the contrary. 2.—Suckle once every two hours during the day, and once every four hours during the night, until baby is about six weeks old, when every three hours will be often enough As it grows older feed it less often, until at seven months it should be fed every three-and-a half hours by day, and once by night. It is important for both mother and child that the suckling should always be at regular intervals, and not whenever the child cries. Crying is often a sign of pain from too frequent feeding. 3.—If the mother has not enough milk to satisfy the child it should still be suckled, but should in addition have one or more feeds of milk and barley water as described in Rule 7. There is no danger in mixing the Milks. 4.—During the suckling period the mother should take plenty of good, plain, nourishing food, but should avoid beer, wines and spirits, unless under advice. The mother should wash her nipples each time before and after suckling, and also wash out the baby's mouth. By these means, thrush and cracked nipples may be avoided. weaning. 5.—Select a time when the child is free from any illness. Do not wean an infant during July, August or September, when there is so much risk of Diarrhoea. hand feeding. the bottle. 6.—Bottles without tubes should be used. Two should be provided. They should simply be fitted with a large indiarubber teat, which can be turned inside out for washing. A round hole should be bored in the teat with a heated needle, the hole being of such a size that the milk flows out in drops when the bottle is held upside down. After use the bottle should he rinsed 122 and scalded, and allowed to drain while the other bottle is being used. Once a day each botile and teat should be boiled. This can be done without breaking the bottle, by putting it in a saucepan full of cold water and gradually bringing to the boil. A piece of clean rug should be put under the bottle to prevent it resting on the bottom of the pan. the food. 7.—Specially prepared mixtures of milk and cream are the best substitute for mother's milk ; most infants, however, will thrive on cow's milk mixed with barley water, if constant care is taken to prepare it properly and to use a suitable form of bottle. Only milk that is perfectly fresh and of good quality should be used for the baby's food. Before use the milk should be at the temperature of the hand, i.e., 98 degrees Fahrenheit, or blood heat. If the child does not thrive on cow's milk and barley water, medical advice should be sought. 8.—Barley Water is made by boiling two teaspoonfuls of patent barley in a pint of water. Always prepare fresh at least once a day. Add this to the milk and boil the mixture. It should be sweetened with a small lump of sugar added to each bottle. 9. TABLE OF FEEDS. Age of Child. How often fed. Average quantity for each feed. Milk. Barley Water. Under 1 week Every 2 hours (by day) 1 tablespoon 2 tablespoons 2—6 weeks Every 2 hours „ 2 „ 4 „ 6 wks.—3 moths. Every 2½ hours „ 5 „ 5 „ 3—6 months Every 3 hours „ 8 „ 4 „ It is well to let the quantity largely depend on the appetite. The best test that a child is being properly fed is its weight. This should be ascertained from week to week, and advice obtained if the child is not steadily gaining weight. At six months a healthy child will take 1½ pints of milk in 24 hours. At nine months it will take two pints of milk in 24 hours. A child that is overfed and does not digest food wastes like one starved. 10.—When the baby has reached seven months, the use of the bottle should be discontinued, and the child should be fed with a spoon or from a Cup. The strength of the food should now be increased till the baby takes pure milk, which should, however, still be boiled. At two meals (night and morning) a small quantity of prepared food, such as Benger's, Mellin's, Savory and Moore's, Nursery biscuits or grated rusks may be added to the milk. 123 Ordinary bread and milk or porridge should not be given at this agr, but a little wheat flour, baked in the oven until it is .nicely browned, may be given with the milk if the other foods cannot be obtained. All infant foods should be given in small quantities at first, and only to infants over seven months old. 11.—At 12 months a lightly boiled egg, a little broth, a few crumbs soaked in red gravy, a little milk pudding, porridge, bread and milk, or small pieces of bread and butter may be added to the diet. 12.—At 18 months a little finely minced meat, pounded fish or mashed potatoes with gravy may be given at one meal in the day. Never give an infant "what we have ourselves," cheese, bacon, tea or beer, nor soothing syrups, and teething powders. Wine or spirits should only be given under medical advice. If the baby is not thriving, see what a slight change in the strength of the food or kind of food will do. Do not allow it to be continually gnawing at a piece of bread or biscuit. If the baby continues to ail, seek medical advice. clothing. 13.—A young infant should be lightly, but warmly clad in flannel. Binders are unnecessary after the naval has healed. When the baby is short coated, the feet and legs should not be left bare. Older children also should always have tneir arms and legs, as well as their bodies, warmly clothed with flannel. It is a great mistake to try and harden infants by letting them expose their arms; and legs in cold weather. cleanliness. 14—Wash all over in warm water once a day before a fire. Dry very carefully. If the folds of the skin are red, use some drying powder such as boracic acid, zinc and starch, or Lycopodium. Never let a wet napkin remain on for a minute. fresh air. 15.—The window should be kept open night and day throughout the year. The baby will not "catch cold" or suffer in any way if properly clothed. Let the baby be in the open air every day when the weather is fine. If you are not able to send anyone out with the baby, let it lie out in a cot or perambulator in the garden. 124 sleep. 16.—Every infant should sleep in a cot by itself. It is very dangerous to allow an infant to sleep in the same bed with an older person. Many children lose their lives every year by beir.g overlaid by their mothers. fire. 17.—No child should be left alone within reach of a lamp or fire. Suitable fireguards can be obtained for a small cost. Clothes should not be made of imflammable flannelette. baby comforters. 18.- Comfoiters or dummies should not be used. They become dirty, and thus cause sickness and diarrhcea. Their use also deforms the mouth, and leads to growth at the back of the nose as the child grows older. eyesight. 19.—The eyes of a newly born baby should be very carefully cleansed with clean warm water and a clean rag immediately after birth. Should any redness of, or discharge from, the eyes come on, you should immediately seek medical advice, carefully wiping and washing the eyes by squeezing clean warm water from a clean rag till the doctor comes. The rag should be thrown away after use, and a new piece used each time. On no account drop milk or anything but water into the eyes. Affections of the eyes in newly-born infants often lead to blindness if neglected. H. MEREDITH RICHARDS, M.D, Medical Officer of Health. Town Hall, Croydon. 125 CROYDON HEALTH LECTURES. SOME USEFUL RECIPES. How to cook peas, beans or lentils.—Dried peas, haricot beans, and lentils contain as much flesh-forming material as meat, and are much cheaper. They must be soaked over-night and will then take about two hours to cook. No salt must be added till they are cooked, or they will not get soft. As they contain no fat, some fat bacon or dripping, or a suet pudding, should form part of the meal. Lentil or'pea soup.—Soak a pint of split peas or lentils all night in enough water to cover them. Slice two onions (a carrot and a turnip, if you have them) put in a saucepan with a bit of dripping and fry a few minutes. Add the lentils, and two quarts of water, or liquor in which meat or bacon has been boiled. Boil about two hours, till soft, and serve with fried bread. Bones or bacon rind improve the soup. No salt should be added till the lentils are soft. It is an improvement to pass them through a sieve. A mixture of peas and haricot beans can be used for a change. Cost about 3½d. Shees head pie.—Clean the head and put it into enough cold water to cover it, with vegetables if you have any. Simmer gently till the meat will leave the bones. Chop up the meat and mix it with bread-crumbs or soaked crusts, some chopped onions, and some of the broth. Put it into a pie-dish, cover it with breadcrumbs and some bits of dripping and brown it in the oven. Cost about 8d. Scotch Broth.—Take the broth in which the sheep's head has been cooked, cut up some vegetables or onions, add a cupful of rice or pearl barley, and boil till the rice is soft. Savoury rice.—Boil ½Ib rice in two pints of milk and water til soft. (If skim milk is used a little dripping or chopped suet should be added). Grate ½lb. of dry cheese, and stir into the rice with pepper and salt. Or it may be put in a pie-dish in layers with cheese, and some bits of dripping on top, and browned in the oven. Macoroni can be used in thi same way. Cost about yd. Rice and lentil savoury.—A teacupfull each of rice 'and lentils, three onions chopped, pepper and salt. Cover them with water and cook- slowly, adding more water as required. A double saucepan (or a jar stood in a saucepan of water) is best, to avoid burning. Cost about 2d. Rice and oatmeal pudding.—Put a teacupfull of rice and a teaspoonfull of ½ coarse oatmeal in a saucepan, with enough water to cover all, and simmer till the rice is half cooked. Add 2 ozs. of chopped suet, some grated cheese, and bake in a pie-dish. Cost about 6½d. 126 Cheese and potato pie.—Put 1½lbs. of peeled potatoes and ozs. rice on to cook. Grate ½Ib cheese. Mash potatoes, and mix onethird of them with the cooked rice, the cheese, ½lb. bread-crumbs, 1½oz. margarine, one egg and some pepper and salt. Add some gravy, if mixture is not moist enough. Put it in a pie dish, and cover with rest of potatoes. Put some margarine in small pieces over top of pie. Bake a golden-brown colour in a quick oven. Cheese sauce.—Melt one tablespoonful of margarine in a saucepan (a double saucepan is best), then stir in one tablespoonful of flour, and mix well. When that is hot, add gradually a breakfastcupfull of milk, stirring well. While this is getting hot, grate, or chop up finely, aozs. of cheese, and stir it into the sauce, which will gradually thicken, and then be ready to use with macaroni, fish, &c. Macaroni cheese.—Boil 40ZS. macaroni in fast boiling water till it is soft (usually in about twenty minutes). Strain off the water, put the macaroni into a quart pie dish, pour over enough of the cheese sauce to cover. Bake till a nice pale-brown. Fish end Cheese pie.—Steam or boil 1 or albs, of fish till soft. Cut it in small pieces, place in a pie dish, and pour cheese sauce over. Some macaroni, cooked as in the last recipe, may be mixed with the fish, if liked. Place some bread-crumbs or mashed potato on top. Bake till brown. (When making cheese sauce, oatmeal porridge, or other things likely to burn, it is best to use a double saucepan, to be bought for 6½d., or a jug or large jampot stood in a saucepan of boiling water will do instead.) Plain suet pudding.— ½lb suet. ¾lb. ffour. A little salt and cold water. The pudding is much improved if 12 ozs. of flour and 3 of stale breadcrumbs is used instead of all flour. Shred the the suet finely, mix it with the flour and salt, and enough water to form a stiff paste, l ie it in a floured cloth, and place it in boiling water. Boil quickly for an hour and a quarter If you have currants stir them in. Cost about 3d. Oatcakes.—Mix some oatmeal to a stiff paste with a little water or milk. Roll out quite thin, and bake till crisp. Dripping pudding.—Rub ozs. of dripping and a pinch of salt into ½lb. of flour. Add one teaspoonful of baking powder. Mix into a paste with milk or water. Steam (or boil in a floured cloth) for two hours, Serve with treacle. Fig or date pudding.—Put a handfull of odd crusts or pieces of bread in a basin, pour over some boiling water, and cover till soft. Then press it, pour away the water and beat up the bread with a fork till there are 110 lumps left. Chop up a teacupfull of mutton 127 suet and two cups full of cooking figs or dates. Take out any date stones and hard tops and mix all well together with two cups full of flour and one of sugar. Add about one cup full of milk or water (the mixture should not be very stiff). Put it into a greased basin, tie a cloth well over it, put it into a saucepan of fast boiling water and keep it boiling for 3 hours. The pudding can be turned out whole on a dish, or sent up in the basin. H. MEREDITH RICHARDS, M.D. Medical Officer of Health. Town Hall, Croydon. COUNTY BOROUGH OF CROYDON. THE PREVENTION OF CONSUMPTION AND OTHER FORMS OF TUBERCULOSIS. Consumption is caused by the growth in the body of minute germs (tubercle baccilli). These germs will not develop in the bodies of those who are in robust health and are living under healthy conditions. The germs are derived from persons or animals suffering from consumption. The phlegm, spit, or expectoration of consumptive persons teems with the germs of consumption, as also may the milk of consumptive cows. instructions to those suffering from consumption. Early cases of consumption may be arrested, and all cases may be benelitted by the following precautions:— (1). Fresh air. Bedroom windows should be kept open during the day and especially at night, and no heavy curtains should obstruct the sunlight. If necessary the windows may be closed while dressing and undressing. The Chimney should be left open and not be stopped up. Stuffv rooms and railway carriages should be avoided. (2). The Diet should be ample. Avoid indigestible food. Alcohol is generally harmful, and should not be taken except undef medical advice. All milk should be scalded, 128 (3). Clothing should be sufficiently warm to enable patients to stand the necessary amount of fresh air in their living rooms and bedrooms. In the winter overcoats and wraps are often of more service in the house and workshop than when taking exercise out of doors. (4). The Phlegm coughed up by a consumptive person is dangevous when dried, because it becomes powdered into dust and is breathed with the air into the lungs, thus causing fresh infection in the patient and others. It is therefore dangerous as well as disgusting to spit on the floors or walls of dwelling houses, public rooms, or public conveyances. Consumptives should spit either into pieces of rag or paper, which should be at once burned, or into a mug containing water. The vessel should be emptied into the water closet once a day, and then scalded and recharged with water. Persons with a chronic cough should take the same precautions. (5). When out of doors consumptives should spit into a pocket spittoon or wide-mouthed bottle, well corked. They should never spit on the pavement, but failing the bottle the next best thing is to spit straight into one of the street gullies. (6). Consumptives must not kiss or be kissed on the mouth. (7). The house must be kept scrupulously clean. When cleansing the rooms, damp dusters and plenty of wet sawdust or tea leaves should be used. Boil the dusters. Burn the sawdust or tea leaves. Any dampness, smells, or unwholesome conditions should be reported to the Health Visitor. The room will be disinfected when necessary by the Sanitary Authority. (8). A handkerchief should be held over the mouth when coughing. All handkerchiefs must be boiled with a little soda before being sent to the wash. (9). A separate bedroom is desirable while there is any cough. advice to those wishing to avoid the disease. (1). Consumption is not inherited, and may be avoided even by those exposed to infection if the general health is good and simple precautions are taken. (2). Fresh air by night and by day is essential, both at home and at your place of business. Warm clothes will help you to make this pleasant. There is no danger or risk in breathing night air. 129 (3). Overcrowded Rooms and excesses of all kinds must be avoided. Your house and surroundings must be in every way clean and sanitary. (4) Promiscuous Spitting must be avoided by yourself and by your companions and fellow workers. (5). There is no danger in living with consumptives provided the suggested precautions are taken. Hospital nurses do not catch consumption in properly managed hospitals. Lastly, remembe that fresh air and sunshine tend to cure and prevent not only consumption, but many other diseases. Remember that it is as injurious to breathe the contaminated air of an unventilated room as to drink water contaminated with sewage. H. MEREDITH RICHARDS, M.D., Medical Officer of Health. Town Hall, Croydon. Note.—Patients should give ample notice to the Medical Officer of Health of their intention to remove, together with full address of their intended future residence.