CRO 16 Country Borough of Crondon ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER. FOR THE YEAR 1914. R. VEITCH CLARK, M A., M B., ChB, B.Sc., D.P CROYDON : PRINTED AT THE "CROYDON TIMES" OFFICE, 108, HIGH STREET. 1915. 3 TABLE OF CONTENTS. PAGE, Introductory letter 7 Sanitary Committee—List of Members 8 Staff of the Public Health Department 8-9 Summary of Annual Health Report 10 A.—Vital Statistics— Population . u Area .. 12 Births 12 Deaths 13 Ward Death Rates 13 Death Certification 14 Inquests 14 Assigned causes of Deaths 14 B.—Infant Work— Infant Mortality .. 15 Diarrhoea and Epidemic Enteritis . 15 Method of Feeding 16 Notification of Births Act (1907) 17 Infant Mortality, West Ward 18 Establishment of Infant and Children's Centre 25 Staff of the Centre 25 Work of the Centre .. 25 Midwives' Act, 1902 . 25 C.—Infectious Diseases— Smallpox—Cases—Hospital—Vaccination 26 Measles .. 26 Scarlet Fever .. 27 „ Outbreak in St. Joseph's Convent 27 „ Return Cases . 27 Influenza 28 Whooping Cough 28 Diphtheria and Membranous Croup 29 Enteric Fever 30 Tuberculosis 32-103 Puerperal Fever 32 Ophthalmia Neonatorum 32 Erysipelas 33 Cerebro Spinal Meningitis and Acute Poliomyelitis 33 Anthrax 33 4 D.—General Matters— page Changes in Staff 34 Co-operation with Naval and Military Forces 34 Water Purification—Special enquiry into the bacteriological purification of water .. 35 Tuberculosis and Milk 37 Disinfection 41 Cleansing of Persons 42 Mental Deficiency Act, 1913 42 Customs and Inland Revenue Acts 50 The work of the Health Visitors 50 Health Lectures .. 53 Local Government Board Returns— Table I. Vital Statistics of whole district during 1914 and previous years 54 Table II. Cases of Infectious Disease notified during I9I4 55 Table III. Causes of, and Ages at, Death during 1914 56 Table IV. Infantile Mortality during 1914, Deaths from stated causes in weeks and months under one year of age 69 Table V. Cases notified and deaths from the principal zymotic diseases for the year 1914 and preceding years 78 Table VI. Vital Statistics of separate localities in [914 and previous years 79 E.—Work of Sanitary Inspecting Staff— Inspections 80 Notices Served 80 Paving of Back Yards 81 Municipal Common Lodging House 81 Houses Let in Lodgings 82 Housing, Town Planning, etc., Act, 1909 82 Factory and Workshops Act 84 Smoke Nuisances 86 Slaughterhouses 87 Meat Inspection 86-90 Dairies and Cowsheds 91 Food and Drugs Acts 93 Milk and Cream Regulations 94 Rag Flock Act ' 96 0g Table VII. Samples of Milk Collected 96 Table VIII. Summary of work done by the Sanitary Insoectors 98 5 Table IX. Workshops on Register, number of Employees, and visits paid during 1914 99 Table X. Food and Drugs Acts. Number of samples taken during 1914 100 Table XI. Food and Drugs Acts. Particulars of samples taken during 1914 and previous years 101 Table XII. Meteorological Record for 1914 102 F.—Tuberculosis— Tuberculosis Scheme . . 103 General Remarks 103 General Survey of cases dealt with through the Tuberculosis Dispensary and work done in connection with them 106 Sanatorium and Hospital Treatment 111 Dispensary Treatment 114 Tables— T. 1 Summary of notifications in 1914 105 T. 2 Table shewing origin of cases seen at the Dispensary for the first time in 1914 . 106 T. 3 Table shewing the way in which new cases were dealt with in 1914 107 T. 4 Analysis of Children (under 16) examined for the first time at the Dispensary in 1914 107 T. 5 Table shewing results of examinations of " contacts " in 1914 108 T. 6 Table shewing details of medical examinations made by the Medical Officer to the Tuberculosis Dispensary 109 T, 7 Summary of cases treated at Sanatoria, 1914 in T. 8 Summary of cases treated at Borough Hospital, 1914 112 T 9 Table shewing further progress of persons first treated in and discharged from Sanatoria in 1913 1155 T. 10 Table shewing further progress of persons first treated at and discharged from the Borough Hospital, 1913 116 T. 11 Table shewing results of treatment in persons discharged from Sanatoria in 1914 118 T. 12 Table shewing results of treatment of persons discharged from the Borough Hospital in 1914 119 T. 13 Table shewing results of treatment at Dispensary alone, 1913-14 120 6 PAOE. T. 14 Table shewing result of Dispensary treatment alone, 1914 121 T. 15 Table shewing results of treatment amongst children, 1914 122 G.—Work of the Borough Hospital Table XIII. Borough Hospital Expenditure facing p. 128 H.—Work of the Borough Laboratory 118 I.—Report on School Medical Work 133 Appendix 171 7 Public Health Department, Town Hall, Croydon, iyth July, 1915. Mr. Mayor and Gentlemen, I beg to present the Annual Public Health Report for thei County Borough of Croydon for the year igi4. From the report it is evident that the activities of the department are being continued and are vigorously growing along all the lines indicated by modern science and experience as those from which the greatest practical benefit to the welfare of the community is to be looked for. Thus during the twelve months with which the report is concerned, in addition to the continuance of the existing work, there has been established an Infant Centre in one of the more densely populated areas of the borough; in the same building a Centre for the Treatment of Minor Ailments of School Children has been developed from the " Skin Clinic " formerly held at the Town Hall; the scheme for dealing with tuberculosis has grown to very full activity; and the administration of the Mental Deficiency Act has been entered upon so far as the exigencies of the present times permit. For the preparation of the parts of the report relating to tuberculosis, to school medical work and to the work of the Borough Hospital, I am indebted to Drs. Sandison, Jervis and Todesco respectively. My sincerest thanks are due to these gentlemen and to all the members of the staff for the loyal and ungrudging help which I have experienced from them throughout the year. I have to thank the members of the Council for the courtesy and consideration shewn to the department and to myself. I am, Yours faithfully, R. VEITCH CLARK, Medical Officer of Health and School Medical Officer. 8 COUNTY BOROUGH OF CROYDON. Sanirarp Committee, 1913=14. Chairman—Mr. Councillor Hussey, J.P. Vice-Chairman—Mr. Councillor Peck, J.P. The Mayor—(Mr. Alderman F. Denning, J.P.) Mr. Alderman Allen, J.P. King, J.P. „ Lillico, J.P. „ Price. Mr. Councillor Adams. „ Chapman, Mr. Councillor Lewis. „ Morland. „ Moss. „ Southwell. ,, Stevenson. Staff or tlx public ftealtb Department. Medical Officer of Health and School Medical Officer, R. Veitch Clark, M.A., M B., Ch.B., B.Sc. (Edin.) D.P.H. (Oxon.) Medical Officer 10 the Tuberculosis Dispensary, Alexander Sandison, M.B., B.C., B.A. (Cantab.), B.Sc. (Lond.) Assistant Medical Officers of Health and Assistant School Medical Officers. John Johnstone Jervis, M.D. (Edin)., D.P.H. (Lond.) W. N. W. Kennedy, M.B., Ch.B. (Edin.), D.P.H. (Edin.) Senior Resident Medical Officer and Bacteriologist, Borough Hospital, James Todesco, M.D. (Flor.) M.R.C.S., L.R.C.P. (Lond.), D.P.H. (Lond.) Assistant Resident Medical Officer, Borough Hospital, A. Leitch, M.B., Ch.B. (Glasgow), D.P.H. (Camb.) Matron of Borough Isolation Hospital, Miss Stevenson. 9 |P. Saunders, Chief Sanitary Inspector and Inspector under Food & Drugs Acts. |Thos. H. Culver, Deputy Chief and District Inspector. |lt}fredk. f. Fulker, Inspector for Infectious Diseases. §A. Low, C.S.A., Inspector of Meat, Dairies, Cowsheds and Milkshops. iJos. H. Bull, Inspector under the Factory and Workshops Act. }J. C. Earwicker, District Inspector. }A. D. Peck, „ ,, }F. Richardson, ,, ,, +C. J. Vincent, ,, tW. T. Hunt, j|JG. G. Flint, ,, ,, W. J. Davis, S. Baxter, . y Disinfectors. G. Hasler, W. Morgan, Bertram W. Cummins, Chief Clerk. jlJA. B. Oliver, 1 A. G. Hadler, L. F. Selfe, H. E. White, Clerks. A. E. Butler, A. C. Olphert, T. H. Hawkins. 1IJ*Miss Chapman, Inspector of Midwives. HJ*Miss Bolton, UMiss Chalk, HtMiss Gaul, I Health Visitors. UMiss King, UfMiss Pirie, l*Miss Waterman. ^Certificate of Royal Sanitary Institute for Inspectors of Nuisances. tCeitificate of Sanitary Inspectors Examination Board, London. liCertificate of Royal Sanitary Institute in Meat and Food Inspection. § Certificate of Sanitary Association of Scotland. "Certificate of Central Midwives Board. ^Certificated Nurse. 10 SUMMARY OF ANNUAL HEALTH REPORT FOR 1914. 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 Effra 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 no feet at Mitcham Road; average about 250 feet above ordnance datum. Population—Census of 1911—169,551. Estimated Population, June 1914—181,956. Inhabited Houses—Census of 1911—34,363. Estimated Inhabited Houses, June 1914—39,224. Rateable Value, ^1,163,160. General District Rate 3s. 6d. in the Poor Rate, including Education Rate, 3s. iod. in the VITAL STATISTICS, 1914. Birth Rate, per 1,000 living, 22.0. Death Rate, per 1,000 living, 10.9. Infantile Mortality, per 1,000 births, 79. Isolation Hospitals—For ordinary infectious diseases at Waddon Marsh Lane. For small pox at North Cheam. Water Supply—From deep wells in the chalk, and from the Thames. 11 County Borough of Croydon. REPORT OF THE MEDICAL OFFICER OF HEALTH. For the Year 1914. Section A.—VITAL STATISTICS. THE POPULATION at the Census of igoi was 133,895, and had increased at the Census of 1911 to 169,551, of whom 77,059 were males and 92,492 were females. The population at the middle of 1914 according to the mode of estimation which has been employed for a very considerable period now was 181,956. It is this population upon which all the rates have" been calculated throughout the report. The Registrar General, however, has introduced a new method of calculation, and according to this his estimate of the population of the Borough for 1914 is 178,511. This latter figure has not been taken in this report, firstly, because the estimated population of 1911 was verv close indeed to that revealed by actual enumeration at the census, and there is in the existing circumstances in the Borough no evidence that the rate of increase of population has shewn any alteration. The method employed, therefore, in the intercensal period (1901-n) would appear to be that which would give the most accurate result in the case of the County Borough of Croydon. Further, I have estimated the population upon the basis of the number of inhabited houses at June, 1914, giving the result of 185,935, an estimate which comes very close to that made by the method already in use. An estimate based upon the number of children attending the Council Schools as compared with the number attending during the various years of the past decennium also gives a figure considerably higher than that of the Registrar General's new method. To accept the new estimate made by the Registrar General would therefore be to work upon a basis which is not only probably less accurate for the particular case of Croydon (although there is no doubt that it will apply more accurately to the country as a whole and to other local districts) it would give a wrong impression of the vital statistics of the district controlled by the local authority here. 12 INHABITED HOUSES.—The number of inhabited houses cannot be ascertained with accuracy. At the last census, in April, 1911, it was 34,363, while 2,880 houses were empty at that date. During 1914, 721 houses have been passed by the Borough Engineer as fit for occupation. The estimated number of inhabited houses in June, 1914, was 39,224. THE AREA of the Borough is 9,012 acres, and the density of the population 20.2 per acre. The appro Wards is as fo ximate acreage and the populat llows :— don per acre of the Areas in Acres. Wards. Population per acre estimated to June, 1914. 1660 Upper Norwood (sub.division) 16.7 Thornton Heath do. 980 South Norwood 28. 1 998 West 37.3 1181 Nrrth 26.9 404 Central 39.6 2209 East 9.8 1580 South 12.4 9012 THE BIRTHS registered during the year in the Borough numbered 4,027. Owing to the receipt from the Registrar.General of the number of births properly belonging to other districts and also of the number occurring elsewhere but properly belonging to Croydon, it is possible to obtain the corrected number for the Borough, namely, 4,007. Of those born, 2,017 were boys and 1,990 were girls. The birth rate equalled 22.0 per 1,000, as compared with 23.8 for England and Wales. Of the total births, 182, or 4.5 per cent, were illegitimate. The births were distributed as follows:— Total. Birth rate per 1,000 estimated population. Upper Norwood Sub.Division IO9 13.1 South Ward 353 17.9 Central Ward 290 18.1 East 468 21.4 BOROUGH 4027 22.0 South Norwood Ward 628 22.8 North Ward 729 22.8 Thornton Heath Sub.Division 496 25.5 West Ward 841 22.5 The Workhouse 83 Victoria House, 99, Central Hill (Servants. Reformatory) 30 Outward Transfers 58 Inward ,, 38 13 DEATHS.—During- the year, 2,041 deaths were registered in the Borough, or 11.2 per 1,000. One hundred and forty-six of the deaths registered in the Borough were those of strangers dying at the Workhouse or Infirmary, 29 of strangers dying at the Croydon General Hospital, 22 at the Cottage Hospital, Upper Norwood, 4 at the Purley Cottage Hospital, 1 at the Croydon Borough Hospital, 1 at 297, Whitehorse Lane (Nursing Home), 3 at 3, Tavistock Grove (Nursing Home), 2 at 40, Dingwall Road (Nursing Home), 4 at 2, Sydenham Road (Nursing Home), 2 at 12, Stanford Road (Nursing Home), 2 at 20, Bramley Hill (Nursing Home), 1 at 5, Campbell Road (Nursing Home), 5 at 99, Central Hill (Servants' Reformatory), 9 at other residences and 3 street deaths. If we deduct these 234 deaths and add 177 deaths of Croydon residents known to have occurred outside the district during the same period, we get a nett total of 1,984 deaths, which is equal to 10.9 per 1,000 as compared with 13.7 for England and Wales, 15.0 for the 97 great towns, 13.1 for the 145 smaller towns, 12.4 for England and Wales less the 242 towns. Corrections for deaths of strangers occurring within the Borough and of deaths of Croydon people dying outside the Borough are now returned by the Registrar-General. These were formerly obtained for Croydon through the courtesy of the Superintendent of Statistics, Somerset House, and the figures have been available since 1903. WARD DEATH-RATES.—Table VI. 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 nett death-rates for the four quarters of the year were :— 1914. Average for 1904-1913. 1 st Quarter 11.9 i4.6 2nd Quarter 10.4 II.2 3rd Quarter 9.5 IO.9 4th Quarter 12.4 11.9 Year 11.1 12.1 14 The Ward deaths for the year were as follows :— Deaths. Death-rate per 1,000. Thornton Heath Sub-Division !59 8.1 North Ward 302 9.4 East Ward 214 9.8 BOROUGH 1984 10.9 Central 175 10.9 South Ward 218 11.0 South Norwood Ward 3°4 11.0 Upper Norwood Sub-Division 101 12.1 West Ward 490 Undistributed Institution and Street Deaths 21 DEATH CERTIFICATION. All deaths in the Borough were certified by the Medical Attendant or by the Coroner. INQUESTS. were held in 193 instances, or 10.3 per cent, of the total deaths. THE ASSIGNED CAUSES OF DEATHS. are fully set out in Tables III., IV., and V. 15 Section B—INFANT WORK. INFANTILE MORTALITY is measured by the proportion of deaths under one year to 1,000 births, and amounted to 79, as compared with 94 in 1913, 77 in 1912, 105 in 1911, 87 in 1910, 79 in 1909, 99 in 1908, 86 in 1907, 125 in 1906, and 96 in 1905. During the year 1914 the rate for England and Wales was 105, while in the 97 large towns it was 114, and in the 145 smaller towns 104; in England and Wales, less the 242 towns, 93, and in London 104. The figures for the various Wards were :— Br ths. Deaths under i yc Death-rat<per 1000 Births lr. (all causes) Death-rate per 1000 births from " diarrho:al " diseases. Upper Norwood Sub division 139 IO 72 7 North Ward 812 45 55 8 Thornton Heath Sub division 496 40 80 12 East Ward 468 32 68 2 BOROUGH 4027 319 79 12 Central Ward 290 27 93 7 South Ward 353 28 79 8 West Ward 841 95 112 22 South Norwood Ward 628 42 67 14 The following table shows the fluctuations since 1892 in the infantile mortality from " all causes," from " diarrhoeal diseases," and from " causes other than diarrhoeal." Years. Total Infantile Mortality from all causes. Infantile Mortality from " diarrhoeal" diseases. Infantile Mortality from other than "diarrhoeal" disease 1893—1897 142 25 117 1898—1902 H3 38 105 1903 104 9 95 1904 128 29 99 1905 96 14 82 1906 125 42 83 1907 86 10 85 1908 99 12 87 1909 79 7 72 1910 87 10 77 1911 105 33 72 1912 77 I : 66 1913 94 16 78 1914 79 I 2 67 DIARRHCEA AND EPIDEMIC ENTERITIS. Deaths classified in the tables supplied by the RegistrarGeneral as diarrhoea, epidemic enteritis, enteritis and gastroenteritis, have been included as " diarrhoeal" deaths : as this classification corresponds with that adopted in former years, comparisons made on the resultant figures are valid. 16 During 1914 diarrhoea and epidemic enteritis accounted for 25 deaths of infants under one year of age, 19 others being due to enteritis or gastro-enteritis, making a total of 44 deaths from " diarrhoeal " diseases. A further 23 deaths at ages from one year or upwards were due to these diseases. The accompanying charts shew the seasonal distribution of the diarrhoeal deaths under one year of age, in the years 1913 and 1914. METHOD OF FEEDING. The following are the particulars as to feeding of infants 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 from Diarrhoea] Diseases. 0-6 months. Infants dying from other than Diarrhceal Diseases. 0-6 months. Infants surviving 6 morths. Total investigated. Breast Fed only 6 52 980 1038 Breast and subsequently Cow's milk 2 11 128 141 Ditto Condensed Milk ... 5 88 93 Ditto Other foods 2 13 114 129 Breast & simultaneously Cow's Milk • • • 4 26 30 Ditto Condensed Milk ... 1 31 32 Ditto Other foods ... 9 36 45 Entirely Hand Fed — Cow s Milk ... 6 10 35 51 Ditto Condensed Milk 6 8 30 44 Ditto Other foods 5 12 38 55 Number investigated 27 125 1506 1658 YEAR YEAR 1914. 17 TABLE B gives the same information expressed in percentages. Of all infants investigated under 6 months. per cent. Of infants dying from Diarrhceal Diseases. per cent. Of infants dying from other than Diarrhoeal Diseases. per cent. Breast Fed only 62.6 22.2 41.6 Breast and subsequently Cow's Milk 8.6 74 8.8 Ditto Condensed Milk 5.6 ... 4 .0 Ditto Other foods 7.8 7.4 10.4 Breast and simultaneously Cow's Milk 1.8 ... 3 .2 Ditto Condensed Milk 2.0 ...... •8 Ditto Other foods 2.7 ... 7 .2 Entirely Hand Fed—Cow's Milk 3 .0 2.2.2 8 0 Ditto Condensed Milk 2.6 22. 2 64 Ditto Other foods 3.3 18.6 9.6 100 100 100 Table B. shows that 22 per cent, of infant deaths from diarrhoeal diseases occurred amongst breast.fed children, and the remaining 78 per cent, amongst children who were either entirely hand fed or had artificial kinds of food as well as breast fed. 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 past year 3,382 notifications were received. These births were notified as follows :— Notified by medical men 814 Notified by parents 1,171 Notified by certified midwives . 1.318 3,303 Stillborn births notified 79 Total 3,382 18 The number of births which actually occurred in the borough during the year was 4,027. The number of births notified therefore amounted to 84 per cent, of the total. The following measures are adopted with a view to diminishing the mortality among voung infants. All houses where 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 1914, amounted to 5,342. In most instances it is not possible to make more than two visits during the first six months of life. Other means 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 of infants, the feeding and care of infants, and summer diarrhoea. Health lectures or talks to mothers have also been very generally given by members of the staff during the past 11 years, and as many as 420 addresses have been given during that period. 4 INFANT MORTALITY IN WEST WARD. During 1913 the Council directed that a special enquiry be made into the causes of infant mortality in the West Ward of the borough. The Medical Officer of Health made as exhaustive an investigatioQ into the subject as the available information permitted, and the resultant report was carefully considered by the Sanitary Committee and subsequently by the Council. It was thereupon resolved that an Infant Centre be established in a suitable situation where medical infant consultations might be held and mothers advised and instructed generally on the proper methods of rearing children. The report is given here in extenso, and is followed by a short account of the establishment and the early days of the working of the Infant and Children's Centre. 20th March, 1914. To the Sanitary Committee. Mr. Chairman and Gentlemen, I beg to submit the following report upon the infantile mortality in the West Ward of the Borough By Infantile Mortality is meant the number of deaths of infants under one year of age for every 1,000 births in the same locality. 19 In the Registrar General's Annual Summary for 1911, Croydon stands eighth in order of merit for infantile mortality for the years 1906 to 1910 amongst the 77 largest towns in England and Wales. The figures are :—' Average Infantile Mortality, 1906—1910. Hornsey 71 King's Norton 86 Leyton 87 Hastings 91 Bournemouth 92 Handsworth (Staffs) 94 Reading 95 Croydon 97 Croydon as a Borough, therefore, occupies a highly creditable position amongst the towns of the country in this respect. An analysis of the returns from the individual wards of the Borough, however, shows that the infantile mortality of the West Ward is not only markedly higher than that of Croydon as a whole, but is fairly consistently higher than the average for England and Wales. The statistical details necessary for the report are given in Tables A, B and C and in the accompanying Chart. Before the year 1906, the West Ward included a large area now forming the North Ward of the Borough. The figires relating to that period are therefore not comparable with the years 1906—1912, and are not given. INFANTILE MORTALITY (1906—1912). England and Wales; Croydon County Borough; the Individual Wards in Croydon. Table A. 1906 1907 1908 1909 1910 1911 1912 England and Wales 128 118 121 109 106 r3° 95 CROYDON BOROUGH 125 86 99 79 «7 10; 77 Upper Norwood Ward 47 62 38 S3 43 89 88 South Norwood Ward 97 86 94 59 82 112 67 South Ward 109 80 99 73 80 111 65 North Ward 110 84 99 77 56 78 58 EastWard 130 64 77 83 82 in 65 Central Ward 141 109 71 90 71 108 84 Thornton Heath Sub-District 45 99 108 88 99 100 86 West Ward 166 '33 133 IOI 135 124 106 20 InFanT Morfalitlj Pale, 0906-1912) in West Ward (Circi|don) Croudon froYaO England & Wales. 190k. 1907- 1908 1903 1910. 1911. 1912. Thick Lme denotes West" Ward Thin Line Croijdon Dolled Lme « England & Wales. 21 INFANTILE MORTALITY IN WEST WARD. Table B. YEAR. 1906 >907 1908 1909 1910 1911 1913 I9I3 Total. DEATHS. Legitimate ... 120 107 in 79 102 99 77 81 Illegitimate ... 24 12 11 13 10 8 11 9 144 119 122 92 112 107 88 90 874 BIRTHS. Legitimate 835 865 890 846 79c 769 799 757 Illegitimate ... 33 27 27 61 34 3' 3° 43 868 892 917 907 824 800 829 800 6837 INFANTILE MORTALITY. 166 '33 133 IOI !35 124 106 113 138 DISEASES. Smallpox ... O Chicken-pox O Measles 3 8 2 1 3 20 Scarlet Fever O Whooping Cough 3 5 3 2 3 8 3 27 Diphtheria and Croup 1 1 1 3 Erysipelas 0 Tuberculous Meningitis 4 2 4 1 1 3 18 Abdominal Tuberculosis 2 1 2 Other Tuberculous Diseases 2 2 1 1 6 *3 Meningitis 6 3 1 1 11 Convulsions ... 9 8 5 6 5 3 9 5i Laryngitis 1 1 Bronchitis 6 J4 5 9 9 *6 7 5 61 Pneumonia 7 13 11 9 9 7 8 7 7i Diarrhoea 39 4 T 2 4 1 30 4 10 94 Enteritis 11 7 4 8 6 11 10 5 62 Gastritis 1 8 1 4 3 1 3 19 Syphilis 2 2 1 2 1 3 10 Rickets 3 ... 2 Suffocition (overlying) 2 3 1 2 1 1 10 Injury at Birth 1 1 2 4 Atelectasis 3 1 3 Congenital Malformations 3 11 9 6 10 3 3 3 46 Premature Birth ... 20 20 r9 23 35 26 24 31 188 Atrophy, Debility and Marasmus... 24 T8 20 11 9 10 7 14 JI3 Other Causes 7 4 6 5 10 4 3 5 44 TOTALS 144 119 122 92 112 107 88 90 874 22 SPECIAL DISEASE GROUPS CAUSING INFANT MORTALITY (1906—1913). Table C. Disease Group. No. of Deaths. Percentage age of Infant Deaths. Average Infant Mortality Rate for the eight years. Infectious Diseases 50 57 7.3 Respiratory 132 15.1 19.3 Diarrhceal 177 20. 3 25.9 Atrophy Group ... 113 12.'9 16.5 Convulsions 51 5.8 7.5 Tuberculosis 45 5.1 6.6 Prematurity 188 21.5 27.5 In Table A and the chart we are enabled to make a comparison of the West Ward with the other wards of the Borough with the Borough as a whole and with England and Wales. In every year the West Ward has a distinctly higher rate of infant mortality than any other part of the Borough; it is consistently higher to a pronounced degree in this respect also than the average for the whole Borough, and in only two instances is it lower during these years than the average for England and Wales, viz., in 1909 and 1911. In both of these years the difference is only very slightly in favour of the West Ward. There is therefore no doubt but that the West Ward is the part of Croydon most responsible for the height of the infant mortality rate, and it is this part of the town which m ost requires special attention for the mitigation of the diseases which affect infancy. Tables B and C give us details of the different diseases which have caused the infantile deaths for the years 1906—1913. In Table B these are given individually; in Table C the diseases have been arranged in groups so that we may be able to determine as far as possible the causes which are at the bottom of this mortality. Infectious disease has a relatively small fatal incidence; these conditions affect children much more commonly in the years just preceding and during school life. It will be observed, moreover, that forty-seven of the deaths were due to measles and whooping cough. These diseases should be bracketed for practical purposes in this respect with respiratory diseases, as the fatal result is almost entirely due to lung and allied conditions. Deaths due to diseases of the diarrhœal group, to the atrophy group, and to convulsions, are usually associated with errors in feeding, or to conditions associated with the feeding which may in part yield to 23 proper measures of preventive control. Deaths from tuberculosis come under this latter heading also. Deaths from prematurity at first sight appear to be beyond any public means of control, but these to a certain extent may be lessened by teaching the mothers how to attend to their own personal health. The causes of these various groups of disease cannot be categorically defined, but there are certain which are now generally recognised; these we may classify into (1) conditions external to the individuals and (2) conditions of a personal nature. External conditions. Of these the most important are the provision of a pure milk supply, the provision of adequate housing conditions, and the maintenance of a high standard of cleanliness of the district. All of these are matters which receive the continuous attention of the Public Health Staff. The diarrhoeal group of disease, however, have a specially fatal incidence during the hot summer months, and I would take this opportunity of emphasizing the paramount importance of maintaining a high standard of cleanliness, especially in the poorer pans of the Borough during that period, and also of the great advantage .if thorough watering of the roads to keep down the dust. Personal conditions. These conditions depend practically entirely upon the individual mothers; unquestionably, every mother is in the deepest sense desirous of doing the best she can for her children, and in saying that a considerable degree of the infant mortality is due to error on the part of parents it is not in the very slightest degree intended to cast a slur upon any individual or group of individuals. The conditions of life (poverty, large families, etc.) often make it extremely difficult for the mothers in such districts as the West Ward to give that attention and care to the individual children which they would in other circumstances do. It is my experience and the experience of practically all medical officers of health who have had to deal with special schemes for the reduction of infant mortality that any advice and help is eagerly welcomed by the mothers for the sake of their children. It is inoi.ntestible that the incidence of many of these diseases, and particularly the diseases of the diarrhceal and atrophy groups, are directly consequent upon errors of diet or conditions which inevitably lead to these, and that this arises largely from want of knowledge on the part of parents and consequent want of an intelligent personal care of the infant. No amount of affectionate care can ward off the evils which arise in this manner. It has, in practical experience, been found that the most efficient means at our disposal of combatting infant mortality in the poorer districts of towns is to institute a centre or centres where the infants can be regularly examined by a medical man with the assistance of health visitors or nurses, where advice can be given when necessary for the welfare of the child, and where the mothers can be taught the principles which underlie the successful rearing of healthy children. These centres are generally termed "baby welcomes ' or "infant consultation centres." The first of these names is the more apt as there are many other directions in which the work may be developed beyond the purely professional consultations. It seems advisable to indicate in outline what would be done at such a baby welcome. Work done at a "Baby Welcome." Firstly, it is highly important that all baby welcomes should be administered from the Public Heaith Department, although it may be necessary to obtain voluntary assistance to carry out the work thoroughly. This latter point can only be determined by practical experience. 24 In the beginning probably only about three half days a week weald be taken up by the meetings at the actual Welcome. A house must be rented and suitably fitted out—this should not cost a great deal; to these premises the mothers bring the infants at least once a week, when they are regularly weighed, the condition of each child is specially considered, and where necessary medical advice as to feeding and general care of the infants is given. Tea is supplied to the mothers, and the opportunity is taken of giving them short talks as to care of children, general baby management, the advantages of personal cleanliness, and cleanliness in the household and the care of food. One afternoon a week may be devoted to a sewing meeting, and it is advantageous to establish also a clothing club, towards which the mothers subscribe, say, a penny per week to pay in part or in whole for children's garments. In the baby centres of which I have had personal experience these garments have been made by voluntary helpers. The meetings of the mothers which are thus obtained prove of great value from an educational standpoint, the interest of the parent is stimulated in the improvement of the child, and a healthy spirit of competition is engendered amongst the mothers. Provision may also be made at the centres for the distribution of infant foods either free or at nominal charges; these are of the greatest assistance, especially during the summer season. Every case of birth is at the present time, of course, visited by the health visitor for the district. This would continue to be so but the amount of work to be done by the health visitors causes a second visit very often to be unavoidably delayed. An important part of the work in connection with the "Baby Welcomes" therefore would be to establish more frequent advisory and friendly visits to the mothers. If the scheme of a Baby's Welcome for the West Ward be adopted I would advise that the services of Miss Chapman (who is at present a half-time health visitor) should be obtained full-time and that she should be directly attached to the Baby's Welcome for the purpose of helping at the meetings there and also to assist the Health Visitor of the ward in paying the subsequent visits to the mothers in their homes. This would probably suffice to carry out the work in its initial stages, and should additional help for visitations be required it might either be obtained by the appointment of another health visitor or by enlisting the services of voluntary workers who would carry out their duties under the supervision of the Public Health Department. With regard to the medical control of the Baby's Welcome I cannot at present guarantee one or two half days per week by any medical member of my staff for this work, my own time and the time of my qualified assistants being now completely occupied. In 1915, however, a new medical assistant will be required owing to the Government demands for a further school medical inspection, and the time of this new officer would, I think, allow of the supervision of the baby work referred to. If the appointment of this officer were made earlier than 1915 in view of this and other suggested extensions of the medical work of the Department, the Baby's Welcome might be instituted during the current year. I do not think that it could be done with the present medical staff. This system of Baby's Welcomes exists in many other large towns and is giving very satisfactory results. I do not doubt but that it would be equally successful in Croydon. I am, Gentlemen, Yours faithfully, R. VEITCH CLARK. INFANT AND CHILDREN's CENTRE, 228, London Road, Croydon. INFANT CENTRE—CONSULTATION ROOM. SCHOOL CHILDREN'S CENTRE—CONSULTATION ROOM. 25 Establishment of the Infant and Children Centre. At approximately the same time as an Infant Centre was determined upon the Council resolved to provide a special centre for the regular treatment of the minor ailments of school children. It was felt that the area to be served by the Infant Centre was precisely that in which the need for such a school treatment centre was most acute. It was also shown that both administratively and financially the combination of the two ventures under one roof would be advantageous. Under the aegis of a joint sub-committee of the Sanitary and Education Committees, therefore, the house at 228, London Road, was leased and suitably fitted out, and the premises were opened on November 24th, 1914. A photograph of the interior of the consulting room is shown opposite. Staff. The extra work arising out of the centre involved the appointment of an additional assistant medical officer—Dr. W N. W. Kennedy—and an extra health visitor. Work of the Centre. On two afternoons every week (Tuesdays and Fridays) medical infant consultations are held by one of the assistant medical officers. The infants are treated medically when that is necessary, and in each case the mother is advised on the special precautions to be observed for the welfare of the infant. The health visitor specially attached to the infant work visits the cases in their own homes to help and advise the mothers in the carrying out of the doctor's recommendations; she also holds an afternoon meeting weekly at the centre and gives talks to the mothers on infant rearing and correlated matters. As the centre was opened so late in the year there is little point in giving statistical details of the work—these will appear in the report for 1915—but up to the date of writing the number of patients brought up has not only continuously increased, but the parents bring them regularly each week, demonstrating not only the need for the centre, but also the practical efficiency of the work that is being done. During the five weeks from the opening of the centre to the end of 1914, forty-one (41) infants were regularly attending. The medical treatment of school children carried out on one floor of the centre is referred to in the Report on the Medical Inspection of School Children—page 167. MIDWIYES' ACT, 1902 Thirty-three midwives attended at the Infant and Children Centre, 228, London Road, for inspection, etc., during 1914. One hundred and forty visits were paid by Miss Chapman, the Inspector of Midwives, to the houses of 36 midwives. During the year 2 registered midwives withdrew from practice, 5 left the district, and 3 new names were added, leaving 38 on the register on December 31st, 1914. 26 Section C—INFECTIOUS DISEASE. SMALLPOX, has been absent from the Borough since April, 1906. CROYDON AND WIMBLEDON JOINT SMALLPOX HOSPITAL. The Smallpox Hospital District during 1914 as hitherto comprised the County Borough of Croydon, the Borough of Wimbledon, the Urban Districts of Penge and of Merton and Morden, and the Croydon Rural District. The Hospital has not been used for Smallpox since August, 1906. VACCINATION. During the year ending December 31st, 1914, the number of primary vaccinations in Croydon and Penge amounted to 1,797, as compared with 4,432 registered births. The number of infants vaccinated, therefore, amounted to 40 per cent. of the registered births, as compared with 43 per Cent. in 1913, 48 per cent. in 1912, 58 per Cent. in 1911, 58 per Cent. in 1910, 62 per Cent. in 1909, 62 per cent. 1908, 90 per Cent. in 1907, and 82 per Cent. in 1906. The percentage of infants vaccinated amongst registered births is the smallest yet recorded. In view of the undoubted fact that vaccination is the primary and important precaution against smallpox, the great decline in the vaccination is a matter to be regretted. It cannot be too strongly impressed upon the minds of the public in general that the practice of infant vaccination and re-vaccination later in life is the safest and most effective precaution against the disease at our disposal. Vaccination against small-pox is a thoroughly safe measure, and in view of the large migration of persons consequent upon the war its practice at this time more particularly should be universal and compulsory. MEASLES accounted for 8 deaths, as compared with 58 in 1913. This disease is not notifiable in the borough. 27 During the year notices were sent to Schools from the Public Health Department excluding 175 scholars actually suffering from measles, as compared with 1,105 in 1913. Seven of the deaths occurred in the Croydon Union Infirmary and one in the Royal Waterloo Hospital. Measles is one of the most serious diseases of infancy and it is desirable that the popular idea that measles is a slight illness should be combated ; it is one of the diseases of infancy which requires very careful attention and nursing on the part of the parents. SCARLET FEVER. Seven hundred and forty-eight cases were notified, as compared with 470 in iqi3. Of these 5 or .66 per cent, ended fatally. (See Tables II., IV., and V.). SCARLET FEVER IN ST. JOSEPH'S CONVENT. During the last five months of the year an outbreak of scarlet fever occurred in St. Joseph's Convent, Upper Norwood. Within the Convent is a school for approximately 350 girls who sleep in eight dormitories in the building. The outbreak began in August and by the end of the year 59 cases had been notified. The infection was of a most persistent and elusive type, the incubation period in several well-marked instances apparently extending over as long a period as eight days. No sooner had the infection been suppressed in one dormitory than it broke out afresh in another, and in the majority of instances no clue could be discovered as to how the infection had been conveyed from one group of girls to those next infected. The whole of the girls in the School were repeatedly examined medically, and any exhibiting the slightest suspicious signs isolated from the others, but in spite of these and all other strict precautions the disease persisted into the early part of the present year. The outbreak has now been definitely suppressed. All of the patients were removed to the Borough Hospital and made good recoveries. RETURN CASES OF SCARLET FEVER. In 17 instances after patients had been discharged from the Hospital subsequent cases arose, possibly infected by the discharged patients. These subsequent cases numbered 20. 28 The particular of patients suspected of having carried infection are given in the following table:- Discharged Patient. Notes as to any abnormality on Discharge. Onset and number of return case. Interval between discharge of patient and onset of return case. No. in Register Age. Sex. Date of Discharge. Days in Hospital. Length of illness. 292 7 M 17/2/14 31 34 Nil. 5/3/14 (209) 16 days 19/5/14 (398) 91 „ 106 16 M 23/2.14 17 21 Nil. 27/2/14 (280) 4 ,, 42 194 F 12/3/14 55 57 Nil. 20/3/14 (258) 8 ,, 52 5 M 19/3/14 54 56 Nil. 31/3/14 (316) 12 „ 113 10 M 26/3/14 47 49 Slight enlarged cervical glands. 2/4/14 (307) 7 „ 111 7 F 21/3/14 42 44 Enlarged cervical glands. 8/4/14 (325) 18 „ 160 8 M 4/4/14 43 45 Nil. 7/4/14 (327) 3 ,, 15/4/14 (331) 11 „ 233 4 M 4/4/14 21 23 Nil. 17/4/14 (350) 13 ,, 249 14 M 16/4/14 42 44 Enlarged cervical glands. 25/4/14 (home case) 9 „ 120 13 M 16/5/14 97 102 Nil. 22/5/14 (402) 6 „ 254 34 F 25/4/14 37 39 Nil. 24/5/14 (416) 29 „ 279 12 M 12/5/14 45 47 Nil. 30/5/14 (431) 18 „ 469 7 F 20/6/14 45 46 Nil 7/7/14 (508) 17 „ 525 9 F 8/9/14 44 46 Enlarged cervical glands. 17:9/14 (627 9 „ 540 3 M 29/9/14 53 55 Enlarged cervical glands. 6/10/14 (705) 7 „ 645 7 F 18/11 14 56 58 Enlarged cervical glands. 10/12/14 (892) 22 „ 773 6¼ F 15/12/14 49 52 Enlarged cervical glands. 23/12/14 (928) 8 „ 23/12/14 (929) 8 „ In the preparation of Tables of Return Cases a limit of a fortnight between the discharge of the supposed infecting case and the onset of the illness in the return case is sometimes adopted. If this limit were applied to the foregoing table only 13 cases would be included; if a limit of three weeks 17 cases would be included. INFLUENZA was the assigned cause of death in 15 instances, as compared with 26 in 1913. WHOOPING COUGH accounted for 24 deaths, 23 of which occurred in children under five years of age. The number of deaths in 1913 was 23. The number of cases is unknown. 521 children who were suffering from this disease were excluded from school, as compared with 358 in 1913. 29 DIPHTHERIA AND MEMBRANOUS CROUP. The number of cases notified amounted to 226, as compared with 451 in 1913, while 18 cases terminated fatally, as compared with 16 in 1913. The case mortality was 8.0 per cent. It was a routine practice to take throat or nose cultures from all contact cases of school age or under. Also a number of adults attended at the Town Hall to have cultures taken. No specially localised outbreak of this disease occurred. The quarterly incidence of cases and deaths for the ten years up to 1914 is shown in the following table: Diphtheria. Notified Case— 1905. 1906. 1907. 1908. 1909. 1910. 191 1. 1912. 1913.  1st quarter 100 do 93* 101 124 6l 115 111 100 106 2nd „ 42 42 49 89 75 57 105 190 81 44 3rd 44 54 59 92 78 40 87 307 105 34 4th 80 148 84 123 79 109 207 159 165 42 Registered deaths:- 1st quarter 13 13 21* 11 13 1 12 11 5 11 2nd „ 3 5 3 7 4 6 14 3 3 3 3rd 2 9 5 7 4 6 4 7 3 2 4th „ 8 13 11 12 3 8 7 4 5 2 *Not including a fatal case admitted to General Hospital from Mitcham and thence transferred to the Borough Hospital. RELATION OF DIPHTHERIA TO DRAINAGE DEFECTS. 226 notified cases occurred in 200 houses. In 2 instances the drains were not examined. The following is the result of the examination of the drains of the remaining 198 houses:- Number of houses where no defects were found:—152, or 76.7 per cent. Number of houses where serious defects were found:—7, or 3.5 per cent. Number of houses where slight defects were found:—39, or 19.7 per cent. The proportion of houses infected with diphtheria that were found to have serious defects in their drains was 3.5. This figure strengthens the previously expressed view that drainage defects are not an important factor in the causation of diphtheria. This, infection is practically entirely a personal one. 30 EARLY TREATMENT OF DIPHTHERIA. Investigation of fatal cases has again directed attention to the desirability of securing the prompt administration of antitoxin to patients suffering from diphtheria. Experience shows that the best results are obtained if antitoxin is administered as soon as diphtheria is suspected, and without waiting for bacteriological confirmation of the diagnosis. The Corporation supply antitoxin for the treatment of patients. ENTERIC FEVER. Twenty cases were notified, and five deaths from this disease were registered during the year. Thirteen cases were removed to the Borough Hospital. One of the 13 cases removed to the Borough Hospital was paratyphoid. There were thus 19 cases which required investigation. Of these, 5 were due to personal infection from preceding cases, in one case the disease appeared to have been contracted outside the Borough, while in 5 instances oysters, or fried fish, were possible sources of infection. In the remaining 8 cases the origin of the disease was indefinite. As the numbers for one year are small, the particulars have been taken out for the 15 years, 1900-1914 inclusive. PARTICULARS OF ENTERIC FEVER CASES. 1900-1914 inclusive. Cases Notified—530 (including 14 cases of Continued Fever). Removed to Borough Hospital.—319 cases (including four eases of Continued Fever). Sixty-nine (69) of the cases removed to the Borough Hospital and one (1) case admitted to Croydon General Hospital were found to be suffering from other diseases. Water Supply of the Cases Notified:- CROYDON 380 LAMBETH 141 Cases brought to Public Institutions in the Borough from outside Districts 9 Total 530 31 Concerning the Notified Cases the following facts were ascertained:- Suffering from other diseases, and not enteric fever 69 Doubtful diagnosis 2 Home case, diagnosis subsequently amended 3 Infected outside the Borough 65 Possibly infected by shellfish, watercress, etc. 61 Infected from other cases (twelve due to "carrier" case) 79 Other possible sources 3 282 Source of illness not traced 248 Total 530 In the table just given the one case of paratyphoid is included amongst the true typhoids. Of the 248 cases, the source of which was not traced, and which, therefore, might have been water-borne infection, 180 lived within the area of the "Croydon" supply, and 68 in the "Lambeth" area. The enteric fever incidence in the two areas was, therefore, 1.3 per 1,000 in the "Croydon" area, and 1.4 per 1,000 in the "Lambeth " area for the 15 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 number of cases of enteric fever are so small as they were in Croydon in 1914 the question of a water epidemic does not arise, but knowing what we do of the potential dangers of water infection, it is still essential that the efforts made by the Water Committee to safeguard further the public supplies should be in no way relaxed. This subject is dealt with in a special paragraph of the report on page 1531. Investigation was also made into the sanitary condition of premises in which cases of enteric fever occurred, which could not be traced to infection outside the borough. Again, as the numbers for 1914 are so small, particulars have been extracted for the ten years 1905—1914. 32 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 1 1906 27 27 4 6 1907 12 12 - 2 L908 31 30 5 6 The Convent at Upper Norwood was not tested. 1909 18 17 2 5 Croydon Union Infirmary not tested 1910 10 10 - 2 1911 22 21 1 7 Croydon Borough Hospital not tested. 1912 24 24 2 4 1913 1 20 19 1 5 - 1914 16 15 - 4 Croydon Borough Hospital not tested. 196 191 17 45 TUBERCULOSIS. (See special section on the Tuberculosis Scheme). PUERPERAL FEVER was notified on 9 occasions, in 6 of which a doctor was present at the confinement. Puerperal fever occurred in 3 cases attended by midwives. Three cases ended fatally. OPHTHALMIA NEONATORUM. This disease was made notifiable in Croydon in April, 1911. In giving instructions to midwives, special emphasis is laid on the care of the eyes and the necessity for immediate medical treatment on the least suspicion of any inflammatory condition being present. 33 Twenty-seven cases were notified during the year. During the year the Local Government Board by order made Ophthalmia Neonatorum compulsorily notifiable throughout England and Wales. Ophthalmia Neonatorum has been notifiable in Croydon since February, 1911. The only change produced in Croydon by this requirement was the issue of a new notification form on which certain information required by the Local Government Board in addition to that previously obtained is asked for. ERYSIPELAS. was notified on 96 occasions, and 7 cases ended fatally. CEREBRO SPINAL MENINGITIS AND ACUTE POLIOMYELITIS. There have been no cases of these diseases during 1914. ANTHRAX. In December, 1914, a small outbreak of anthrax occurred in the borough in connection with the meat provision trade. Five men were infected and two of the cases were fatal. Most strict disinfection was carried out at the premises concerned, and all removable material which might have been contaminated was burnt in the destructor. A very thorough and extensive series of enquiries were made at all places from which animals or carcases had been received by the firm. The enquiry extended over the whole of the South and West of England, but the actual source of infection was not traced. One of the medical inspectors of the Local Government Board who came to investigate the outbreak was satisfied that every possible precaution had been taken to prevent the spread of the disease. The occurrence of this condition is very rare in Croydon. 34 Section D—GENERAL MATTERS. CHANGES IN THE STAFF.—In the beginning of the year Dr. Jervis entered upon his new duties as Assistant Medical Officer of Health and Assistant School Medical Officer, and his place at the Borough Hospital was taken by Dr. Jas. Todesco. In July Dr. W. N. W. Kennedy was appointed an Assistant Medical Office of Health and Assistant School Medical Officer, and from September was an active member of the departmental staff. Dr. A. Leitch became Assistant Resident Medical Officer at the Borough Hospital in September; Miss Chapman (formerly on half-time) was engaged as a full-time health visitor, and another health visitor was added to the staff for school treatment work. The clerical staff was also increased by one. C) ) PERATION WITH NAVAL AND MILITARY FORCES. A large amount of work has been done in this connection. The forces with which we have been specially concerned during 1914 were the Royal Naval Brigade at the Crystal Palace, which although situated outside our area is within the area supplied by the Borough Fever Hospital; the troops stationed along the railway lines in the town; the troops at the Barracks in Mitcham Road and billeted in the neighbouring district, specially in the West Ward, and very considerable bodies of troops passing through the town and billeted for longer or shorter periods in various districts The principal directions in which the work in connection with His Majesty's forces have developed are as follows :— Infectious Conditions.—The reception in the Fever Hospital of all cases of notifiable infectious disease occurring amongst the Naval Brigade or military troops stationed within the area of Croydon and in some instances in camps in the neighbourhood when no other Fever Hospital accommodation was available for them. In all cases the Admiralty or War Office, respectively, are paying £2 per bed per week for cases treated in the Borough Hospital. A daily list of cases of infectious disease notified was sent to the Commanding Officers, or Medical Officers in Charge of Troops stationed in the Borough, and also to the Royal Naval Division at the Crystal Palace, and the Commandant of the Croydon Military Hospital. These officers were also supplied with maps of the Borough to enable them to observe readily the localities in which infectious disease was prevalent. Copies of the Local Government Board's weekly summary of cases of infectious disease occurring in England and Wales have also been supplied. In cases where members of His Majesty's Forces on leave have developed infectious disease, or had been in contact with cases of infectious disease, the Commanding Officer of the Regiment was notified by telegram, and the patient or contact detained until free from infection. 35 Disinfection and cleansing of persons and clothing and of the bed clothing and furniture used by men in the Forces.—This not only has been, carried out in consequence of the occurrence of infectious diseases, but to a very large extent also for the suppression of verminous conditions which have arisen amongst the men. The disinfection was in a large number of instances accompanied by cleansing baths of the persons of the men affected. Control and visiting of Billets.—The billets have principally been arranged by the military authorities through the police. The police in accordance with the arrangements made with the Medical Officer of Health have regularly—when fresh troops have been billeted—come over to the Public Health Department and struck out from the list of billets those houses in which any infectious condition whatever was known to have occurred at all recently or was actually in existence. The billets have also been regularly and systematically visited by the Sanitary Inspectors for general cleanliness and sanitary arrangements and for the purpose of learning of any infectious condition. Hutments on the railway lines.—These have been regularly inspected and an efficient sanitary control exercised. The work resulting from the presence of troops in our midst has very greatly increased the labour of all the members of the staff of the department, both medical and lay. I have pleasure in recording the great willingness which all the staff have displayed in carrying out the extra duties which have thus been imposed upon them. A very large amount of overtime has been worked by all the different sections of the department, and all these efforts have been made in the spirit of hearty co-operation. I have pleasure in recording the fact that my own personal relationships and the relationships of those members of the staff who have come directly into contact with the members of the Forces have been of the most friendly and agreeable nature. SPECIAL ENQUIRY INTO THE BACTERIOLOGICAL PURIFICATION OF WATER. Although Croydon is one of the most fortunate of the large towns of England and Wales in the possession of a water supply of remarkable natural purity, one of the wells yields a w_ater which —at long intervals—gives signs on bacteriological examination of a possibility of contamination. Although even on these occasions this water was much further from the danger zone than that often consumed by other similar communities, the Council were of opinion that steps should be taken to ensure a degree of purity as nearly as possible absolute. An extensive bacteriological investigation into certain methods of water-purification was carried 36 out by the Medical Officer, who was assisted in this particular work by Dr. L. Rajchman, of the London Hospital University College. The full account of the investigation is too detailed to be inserted here, but the following summarised report was made to the Council:- 16th February, 1914. I beg to submit the following report on the bacterial purification of the water supply of Croydon and the experimental enquiry recently carried out on the chlorine method of the bacterial purification of water. The scientific fact underlying the chlorine method of water purification is that free uncombined chlorine kills bacteria. The aim of the enquiry was (a) To test the practical efficiency of the chlorine treatment of water and (b) To determine the best practicable means of removing the chlorine from the water before distribution. (a) Chlorine Treatment.—Throughout the experiments the chlorine was added to the extent of one part of chlorine to one million parts of water or one-half part per million, as was desired. In every instance the water treated was previously charged with bacteria to an extent far beyond that which could ever occur in an ordinary water supply. The contamination took the form of pure cultures of intestinal bacteria, spore-bearing bacteria (the most resistant form of bacterial life), urine containing bacteria, water charged with human excreta, and surface road washings. The results of the experiments were in all cases highly satisfactory—the treatment by chlorine invariably destroyed all the organisms, the water at the end of the process being found to be bacteria-free. (b) Chlorine Removal.—The second stage of each experiment was an enquiry into the means of removal of the chlorine from the water before general distribution. Three methods were advocated, viz., the addition of an alumina compound to the water, or the addition of sodium hyposulphite to the water, or the filtration of the water through a layer of charcoal. The two methods first named are absolutely ineffective. The filtration through charcoal, on the other hand, has been entirely successful. It has appeared desirable to compare the results of this enquiry with those obtained by Prof. Hewlitt and Dr. Nankivell in the investigation carried out in Croydon by them a few years since into a combined process of water softening and bacterial purification. The bacteriological results obtained in this enquiry are markedly superior to those obtained by Drs. Hewlitt and Nankivell, and as all the tests applied were of the most searching nature, I unhesitatingly affirm that the chlorine method of treatment is the more efficient bacteriologically. In my opinion the chlorine method of water purification is a thoroughly efficient one, and may safely be used by the County Borough Authority for the treatment and purification of the Croydon water supply. 37 The work upon which this report was based was directed towards determining the value of chlorine as an agent for the bacteriological purification of potable water supplies, and the best method of removing chlorine from the water after the bacteriocidal effect had been attained. The Council, after due consideration, resolved that for the special purposes of this purification the chlorine method of treatment with provision for subsequent dechlorinisation should be introduced. Steps are accordingly being taken to carry this resolution into effect. TUBERCULOSIS AND MILK. During the year fifty-seven primary and twelve secondary samples of milk were procured and submitted for examination for tuberculosis in accordance with the provisions of the abovementioned Act. The fifty-seven primary samples included twelve samples procured from milk produced in the borough, and forty-five from milk produced outside the borough, mainly from the southern and western counties, and supplied to local dairymen, direct from the farms, or through the agency of wholesale dairy companies. Of the twelve samples representing the milk produced in the borough, one was found to be tuberculous, the other eleven showed no evidence of tuberculosis. The sample which proved to be tuberculous represented the mixed milk of fifteen cows. The cows in the herd concerned were examined by the veterinary surgeon; none of the cows were clinically tuberculous, all being good-class dairy cows, well nourished, and housed in a substantially constructed clean shed. Two of the cows, however, had slightly abnormal udders (one weak quarter). These weak quarters were not typical of tuberculosis, but were sufficiently abnormal to be regarded as suspicious. Secondary samples were obtained from the milk of these two cows and submitted for examination, when it was found that one of them was tuberculous; the other showed no evidence of tuberculosis. The cow from which the tuberculous sample was obtained was the less suspicious of the two. 38 This cow was slaughtered at the public slaughter-house, Pitlake, and found to be tuberculous, the carcase and all the organs being destroyed as unfit for food, The forty-five samples of country-produced milk were obtained at the various railway stations, or at the place of delivery in the case of road-carried milk from churns containing a total of seven hundred and four gallons of milk, each sample representing an average of seventeen and a half gallons. The result of the examination of these samples revealed the presence of tuberculosis in five cases, a somewhat high percentage. The following procedure was subsequently adopted in connection with these samples:- No.1. This farm was visited by the veterinary surgeon and sixteen cows were examined, three of which belonged to a neighbouring farmer, the milk from these three cows having been mixed with the milk produced on the farm visited in order to enable the farmer to fulfil the terms of his contract as to quantity. This case was further complicated through changes in the herd at both farms. As far as could be ascertained, however, the milk from which the tuberculous sample was obtained was the mixed milk of the sixteen cows examined. On the whole the cows were of fair quality, although several were aged and in rather poor condition; they were housed in a shed substantially constructed and well kept. None of the cows were clinically tuberculous, and all the udders were practically normal. Samples were obtained from the milk of six of the oldest and poorest cows, such cows in the absence of any more obvious symptoms being more likely to be tuberculous. The result of the examination of these samples was that no evidence of tuberculosis was found in either. Following on this result further samples were procured on delivery and submitted for examination, but no evidence of tuberculosis was found. 39 This inconclusive result may be attributed to the changes which took place in the herds during the interval (one month) between the procuring of the primary sample and the declaration of the result of the examination Nos. 2, 3 and 4. These three samples may be grouped together, as all the milk supplies from which they were obtained came from distant parts of the country, rendering the inspection of the herds by the veterinary surgeon a matter of difficulty, or at least of very considerable expense, consequently the local dairy concerned, the farmer, and the Medical Officer of Health for the district in which the farm was situated, were in each of these cases communicated with and the position, under the provisions of the Croydon Corporation Act, 1900, pointed out. The information obtained from one or other or all of the parties concerned enables the following statement to be made relative to these cases. No. 2.—It is known that the local dairy firm took action in this case, but nothing definite as to details of that action is available. The examination of further repeat samples (four in number) showed no evidence of tuberculosis. No. 3.—The Medical Officer of Health for the district in which the farm was situated, accompanied by a veterinary surgeon, visited this farm and examined the cows, two of which were clinically tuberculous, though an examination (microscopically) of samples of milk drawn from these cows failed to reveal the presence of tuberculosis. The Local Authority considered they had no power to deal with these cows, presumably owing to the suspension of the Tuberculosis Order, and that the udders were normal, or at least not tubercular. However, as in the opinion of the local Medical Officer of Health and the veterinary surgeon these cows were tuberculous, the Croydon dairy firm was communicated with and action taken by them resulted in the removal of the cows from the farm. 40 No. 4.—The Medical Officer of Health for this district also visited the farm concerned, accompanied by a veterinary surgeon, and examined the cows. His report indicated that the cows were of a good class and to all appearance free from tuberculosis, and that this farm was one of the best equipped and conducted dairy farms in the county. Further investigations by him revealed the fact that the farmer in question received from time to time milk from other farms which was mixed with the milk produced on his own farm. The Medical Officer of Health for the district was unable to ascertain definitely how tuberculosis came to be present in the milk, but suggested the possibility of the milk from outside farms as the cause, and it was ultimately arranged that the farmer would discontinue the practice of mixing other milks with that produced on his farm. Repeat samples of the milk from this farm and the farm referred to under No. 3 were obtained and submitted for examination, but no evidence of tuberculosis was found. No. 5. This farm was visited by the veterinary surgeon and twentythree cows examined. With the exception of one or two aged cows, they were all first-class dairy cattle, none of them showed any abnormal symptoms, and the housing accommodation was on modern principles. Four samples were obtained from the milk of the aged cows, as in the circumstances they were most likely to be tuberculous. The examination of these samples, however, failed to reveal any evidence of tuberculosis, and further samples obtained on delivery were also examined with a negative result. There had been no actual changes in the herd at this farm, but certain in-calf cows had been removed to another farm as they were "dry." In the ordinary course these cows will return to the dairy farm, and the examination of further samples of this milk may yet enable a more conclusive result to be obtained. 41 The following tabulated statement shows the number of primary samples of town produced milk and country produced milk, with the number and percentage of cases in which tuberculosis was found since 1900. Year. Town Milk. No. Positive. Per Centage. Country Milk. No. Positive. Per Centage. 1900 40 2 5 — — - 1901 1 — — 87 5 5.7 1902 — — 6 — - 1904 30 1 3.3 — — - 1908 25 1 4 21 3 14.2 1911 16 1 6.2 39 6 15.4 1912 14 1 7.1 31 1 3.2 1913 14 4 28.5 49 4 8.1 1914 12 1 8.3 45 5 11.1 Total 1900-14 152 11 7.2 278 24 8.6 Total: Town and Country 430 primary samples, 35 positive, or 8.2 per cent. DISINFECTION. During the year 2,248 rooms, 5 hospital wards and contents thereof, 14 school class rooms, 4 dormitories, 1 stable and yard, slaughterhouse, 63 departments of schools, 1 shed, 19 vehicles, and 22,125 articles were disinfected. The articles disinfected were as follows, viz.:—798 beds, 3,397 blankets, 189 blouses, 736 bolsters, 1,292 books (including 514 Library books), 364 boots, 100 bottles, 17 capes, 230 caps, 30 carpets, 748 coats, 8 corsets, 110 curtains, 387 cushions, 70 costumes, 1,094 counterpanes, 14 dresses, 168 dressing gowns, 246 handkerchiefs, 904 mattresses, 15 neckerchiefs, 447 palliasses, 73 petticoats, 2,341 pillows, 229 rugs, 165 shawls, 1,106 sheets, 429 shirts, 150 skirts, 924 stockings (socks), 202 towels, 400 trousers, 102 vests, 258 waistcoats, 4,382 other articles; total, 22,125. 42 Cleansing of Persons at Disinfecting Station during the Year 1914 Adults other than Soldiers. School Children. Children not of School Age but living in same houses as School Children. Soldiers. 1 *74 15 +139 4 out of these children were cleansed twice (counted twice). †26 baths provided but no body clothing disinfected. In every other case body clothing was disinfected. MENTAL DEFICIENCY. As required by the Mental Deficiency Act, 1913, a statutory committee was appointed by the Council and commenced its duties in March, 1914. The statistics of the work done during 1914 are not available actually for the period ending December 31st last, but a general account of the work of the Committee is best expressed byv the annual report, a copy of which is given below. COUNTY BOROUGH OF CROYDON. MENTAL DEFICIENCY COMMITTEE. FIRST ANNUAL REPORT For Year ended 31st March, 1915. HEADINGS OF REPORT. (a) Constitution of Committee. (b) Appointment of Visitors. (c) Appointment of Officers. (d) Sources of information of the existence of Mentally Defective persons. (e) Report of Medical Examinations. (f) Guardianship. (g) Supervision. (h) Institutions. (i) Finance 43 (a) CONSTITUTION OF COMMITTEE. 1.—The Mental Deficiency Committee for the County Borough of Croydon, constituted under the provisions of section 28 of the Mental Deficiency Act, 191.3, consists of 16 members appointed by the Council; the Standing Orders made by the Council on the 2nd March, 1914, providing that the 16 members shall be : One Ex-officio Member (the Mayor for the time being), Nine Members of the Council, and 6ix Members (called "Co-opted Members"), not being Members of the Council, but being Poor Law Guardians or other persons having special knowledge and experience with respect to the care, control and treatment of defectives, and that not less than two of such co-opted members shall be women. 2.—The first Committee was appointed on the 16th March, 1914, to hold office until the 9th November, 1915, and the Committee at the 31st March, 1915, was constituted as follows: — Members of the Council— The Mayor (ex-officio). Mr. Alderman King, J.P. (Chairman). „ „ Betteridge, J.P. „ „ Trumble, J.P. ,, Councillor Bradshaw. ,, „ Chapman. „ ,, Clarke (Vice-Chairman). ,, ,, Read, J.P. ,, ,, Smith, J.P. „ „ Trythill. Co-opted. Members- Mr. Chas. Heath Clark, J.P. Miss R. M. Drew. Mr. A. E. F. Denham. Mr. A. J. Camden Field. Dr. H. Hetley, J.P. Miss C. Mennell. 3.—At the first meeting of the Committee, held on the 31st March, 1914, Mr. Alderman King was elected Chairman and Mr. Councillor Clarke Vice-Chairman. 4.—A Finance Sub-Committee was appointed on the 31st March, 1914, consisting of:— The Chairman. Vice-Chairman. Miss Drew. Mr. C. Heath Clark. Mr. A. J. Camden Field. Mr. Alderman Betteridge. Mr. Councillor Trythall. 44 (b) APPOINTMENT OF VISITORS OF LICENSED HOUSES, &c. 5.—Under the provisions of see. 40 of the Act of 1913 the persons appointed under the Lunacy Acts, 1890—1911 to act as Visitors of Licensed Houses, with the addition of one or more women appointed in like manner as such Visitors, are the Visitors of Institutions for defectives under the Mental Deficiency Act. The following persons have been appointed by the Justices:— Thomas Betteridge, J.P. Henry Keatley Moore, J.P. Charles Hussey, J.P. Robert Veitch Clark, M.B. Miss Rosa Mary Drew. Miss Christabel Mennell. The Clerk of the Peace for the Borough has been appointed Clerk to the said Visitors. (c) APPOINTMENT OF OFFICERS. 6.—The Standing Orders provide that the Town Clerk for the time being shall be the Clerk to the Committee, and further provide that all such other Officers as shall be necessary for the purposes of the Act and for the conduct of the business of the Committee shall be appointed by the Council on the recommendation of the Committee. 7.—On the 25th May, 1914, on the recommendation of the Committee, the Council appointed Dr. R. Veiteh Clark, the Medical Officer for the Borough, as Medical Officer to the Committee, to hold office during the pleasure of the Council, and resolved that he be an approved Medical Practitioner for the purpose of signing certificates under section 3 of the Act, under which section defectives are dealt with at the instance of a parent or guardian. 8.—On the 29th March, 1915, on the recommendation of the Committee, the Council resolved that £100 per annum of the Town Clerk's salary and £100 of the Medical Officer's salary be apportioned in respect of their duties under the Mental Deficiency Act. (d) SOURCES OF INFORMATION OF THE EXISTENCE OF MENTALLY DEFICIENT PERSONS. 9.—Information as to the existence of alleged mentally deficient persons has been obtained throughout the year from many sources, principally from the School Medical Inspectors, Health Visitors, Sanitary Inspectors, School Attendance Officers, and private individuals interested in the defectives. Four cases of persons brought before the Borough Justices have been referred to the Medical Officer. (e) REPORT OF MEDICAL EXAMINATIONS. 10.—During the first year of the existence of the Committee a very large number of people have been examined for alleged mental deficiency The following is a summary of all people examined in whom such deficiency was found to exist. It will be observed that the 45 Education Committee cases are included in order to make the information as complete as possible so far as is at present available. Mental Deficiency Committee's cases:— Mentally defective persons at present in the Croydon Mental Hospital, Upper Warlingham, and stated by the Medical Superintendent to come within the scope of the Act 19 Non-educable cases of mental deficiency reported by Education Committee to Mental Deficiency Committee 14 Mental deficiency cases above the age of 16 years 31 — 64 Educcttion Committee cases:— Educable (high grade 28, low grade 29) 57 121 The total number of cases at present known, for which the Mental Deficiency Committee is responsible, is 64. 11.—Of the four cases referred by the Borough Magistrates to the Medical Officer, two were found not to be cases of mental deficiency within the meaning of the Act; one case has been sent to an Institution; and the other case is under remand pending a vacancy in a suitable Institution being found. 12.—Throughout the year a large amount of correspondence has taken place with the various Institutions recognised by the Board of Control with a view to obtaining the admission of some, at least, of the cases for which the Committee are responsible, to such Institutions. The replies in practcally every instance have been discouraging in so far as vacancies are practically non-existent, excepting in those Institutions where the cases admitted are of a high grade type or where the cost of maintenance is high. 13.—Generally speaking the high grade mentally defective is not a case which the Committee are legally obliged to deal with, and the efforts made have been directed towards obtaining suitable Institutions for cases coming within section 2 (1) of the Mental Deficiency Act, 1913. 14.—In addition to the criminal cases, the Committee are maintaining in an Institution one case which was automatically handed over by the Education Committee at the age of 16 years. Applications are at present beirg made for the admission of several other cases to suitable residential approved Institutions. 15.—According to the estimate of the Chief Medical Officer of the Board of Education, the total number of mentally deficient children of school age and of an educable type in Croydon would approximately be 125. The number in this group at present on the register of mentally defective children is 57. On this basis it is quite probable that the number of mentally defective people over the education age of 16 years in Crovdon is considerably greater than that known to us now, viz. 31 (exclusive of cases now in the Croydon Mental Hospital). 46 16.—The numbers given above may appear at first sight to be rather small as representative of a year's work, and it appears desirable to indicate briefly the type of work which is involved in examining such people. Appended to this report, therefore, is a copy of the form which is adopted by the Board of Education as the standard form for the report upon mentally deficient or alleged mentally deficient children of school age. This type of examination is exactly that which is applied to all such defective people whether they be over or under 16 years of age. Each person must be examined several times before a really properly balanced and considered judgment of the case can be given, and each of these examinations means on an average at least one hour's work. It will be appreciated therefore that the examination of approximately 100 individuals during the year means a very considerable expenditure of time and labour, and this list does not include those who were examined for alleged mental deficiency and found to be suffering from some other condition. It has been necessary to make the examinations of a considerable number of patients in the homes of the patients as the condition of the individual would not permit of the examination being carried out at the Town Hall. (I) GUARDIANSHIP. 17.—The Committee have during the year very carefully considered the question of placing cases under guardianship. It did not in the early stages appear advisable to them to take any steps to establish a voluntary agency to assist in this matter, as it was desired to obtain guardians if possible by the private efforts of the individuals interested in the work. This has not proved to be possible, and the Committee have now under consideration a proposal to constitute a voluntary association to help in the provision of guardians and in the general supervision of mentally defectives placed under guardianship. It appears to the Committee that one of the most valuable types of guardianship would be to make the parents the guardians under the Act and to assist them financially when this is required, so that the general conditions of life of the mentally defective individual may be ameliorated. (g) SUPERVISION. 18.—Under the Mental Deficiency Act Provisional Regulations, 1914, it will be necessary to appoint Officers of the Committee or other persons to visit all defectives who are not in Institutions or under guardianship, but are subject to be dealt with under the Act and are cases of such a character that in the opinion of the Committee supervision affords sufficient protection. The Committee have had this question under consideration, and will in due course recommend to the Council fhe appointment of Supervisors. (h) INSTITUTIONS. 19.—The Committee have taken part in Conferences convened by the Surrey County Council as to the provision of an Institution for that County and the neighbouring Counties and County Boroughs, but are not at present in a position to report usefully thereon. (t) FINANCE. 20.—The cost incurred by the Council in administering the Act is defrayed partly out of Government Funds and partly out of the Borough Fund. The Government contributes half the cost of performing the 47 obligatory duties in respect of the following matters, subject to the cost being kept within approved estimates and to the final approval of the accounts by the Board of Control: 1. Ascertaining the numbers of, supervising and dealing with defectives. 2. Provision of accommodation for, and maintenance of, defectives when sent under Orders to Certified Institutions. 3. Provision for Guardianship of defectives when placed under Guardianship by Orders. The grant under the above headings has to be limited in each financial year to the amount allocated to the Borough by the Board of Control. The amount allocated for the 9 months of the year from the 1st April to the 31st December, 1914, except so far as relates to " Criminal " Defectives, was £353. 21.—The amount of the Government contribution in "criminal" cases is, in general, the same as in other eases. Special arrangements have been approved by the Treasury in cases where a defective is ordered by the Secretary of State to be transferred from a Prison or other Establishment to a Certified Institution. Where a Court before which a defective is found guilty on a criminal charge makes an Order sending the defective to an Institution or placing him under guardianship, the Board of Control meets the cost of the defective's conveyance and of his maintenance for the first three months, after which the charges are shared equally by the Government and the Local Authority. 22.—The total expenditure to the 31st March, 1915, was as follows: £ s. d. Proportion of salary of Town Clerk as Clerk to the Committee 100 0 0 Proportion of salary of Medical Officer as Medical Officer to the Committee 100 0 0 Printing, Stationery, and Advertising 17 3 7 Expenses of maintenance 32 0 0 £249 3 7 of which the Government will bear one half, leaving the balance to be borne by the Borough Fund. F. W. M. KING, Chairman. May, 1915. 48 The following is a cooy of the Form of Report on a mentally deficient child as approved by the Board of Education:— REPORT ON CHILD EXAMINED FOR MENTAL DEFICIENCY. To the Local Education Authority for the of I have examined the undermentioned child for Mental Deficiency, and have to report as follows:— I. Name of Child (in full). Address. Date of Birth, and Sex. School (if any). II. Particulars of Home Conditions, Environment, School Attendance, and other factors. III. Family History (in regard to history of mental defect, epilepsy, alcoholism, &c.). IV. Personal History (a) Constitutional Defects, Injury at Birth, Malnutrition, Rickets, Congenital Syphilis, &c. (b) Diseases of Childhood. (c) Commencement of Teething. (d) Walking. (e) Speech. V. Physical Conditions:— (a) General (results of routine medical inspection). (b) Special:— (1) Speech: Defective articulation. (2) Sight: Blindness, total or partial, errors of refraction. (3) Hearing: Deaf-mutism, partial deafness, partial mutism. (4) Nose and throat : Enlarged tonsils, adenoids, mouth breathing. (5) Control of spinal reflexes and of salivation. (c) Stigmata:— (1) General retardation—Cretinoid development. (2) Cranium—Microcephaly, hydrocephaly, asymmetry, rickets, imperfect closure of fontanelles, simple hea3 measurement. (3) Hair—Double and treble vortices, wiry or supple. (4) Face—Irregularity of features. (5) Lower jaw—Protruding or receding. 49 (6) Eyes—Mongoloid, presence of epicanthic fold. (7) Ears—Size, setting, conformation, lateral symmetry, size of lobes, attachment of lobe to the cheek, supernumerary lobules. (8) Tongue—Enlarged, furrowed, papillæ enlarged. (9) Teeth—Irregular, absent, enlarged incisors. (10) Palate—Arched, narrow. (11) Fingers—Webbed, clubbed, defective in number or shape, supernumerary digits. (12) Limbs—Excessive length of upper limbs. VI. Mental Conditions: — [A'.B.—In assessing mental conditions, the tests designed by Binet and Simon are recommended. (a) Reactions of Motor Mechanism:— (1) Formation of Motor Ideas. (Execution of simple movements from imitation). (2) Storage of Motor Ideas. (Execution of simple familiar command by word of mouth). (3) Power of control, initiative, purpose, and concentration. Success of motor output. (Execution of familiar complex movement). (4) Motor Incompetence. Attitude in standingposition of head, spine, knees. Gait. Position of arms, hands, fingers, in horizontal extension. General balance. (5) Motor Instability. (Habits.) Rocking of body, rubbing hands, spitting, biting nails, or licking lips. (6) Motor Disturbance. Tremors (face, hand, tongue), Chorea, Epilepsy, Aphasia, Hemiplegia. (b) Reactions resulting from Sensory Stimulation:— (1) Attention—colour, shape, size, smell. (2) Formation of Memory Images: (а) Recognition, objects, sounds. (б) Recollection. (3) Association of Ideas. (4) Judgment (for example—length, size, distance). (5) Relationship (similarity, contrast, symbolism). General concepts (possession, self-protection, purpose, concentration, initiative). (c) Emotional Conditions:— Interest, excitement, aggression, co-operation, affection, &c. (positive or negative phases). 50 (d) Tests of Intelligence:— (1) Description of pictures, models, objects, familiar events. (2) Letters, words, reading (word blindness). (3) Counting, manipulation of simple numbers, simple money values. (4) Writing. (5) Manual Tests. (e) Will Power as tested under the above headings. (/) Moral characteristics not recorded in (a)—(e). VII. Diagnosis:— (a) Physically defective—stating defect. (b) Blind or partially blind. (c) Deaf-mute, semi-mute, or semi-deaf. (d) Epileptic. (e) Merely dull or backward. (/) Mentally defective (feeble-minded). (g) Imbecile. (h) Moral Imbecile. (i) Idiot. [In this group the symbols "a" to "i" are intended to be correlated when necessary.] VIII. Treatment recommended:— (with any necessary notes as to after-care, custody, and the degree and character of manual training and ordinary school teaching likely to be advisable). (1) An ordinary public elementary school. (With or without particular supervision or modification of curriculum). (2) A special class for dull or backward children. (3) A special school (state whether day or residential is recommended). (4) Unsuitable for a special school. CUSTOMS AND INLAND REYENUE ACTS. No application under Section 26, 53 and 54 Vict., c. 8, was received during the year. THE WORK OF THE HEALTH VISITORS. This is set out in detail in Table (H. V.). The large mass of the work done is in itself striking testimony to the SI S2 TABLE H. V. *HEALTH VISITORS.—The following is a summary of the work done and visits paid by the six Health \ isitors. Visits to Houses where the following Diseases have been reported. Miss Pirie. Miss Waterman. Miss King and Miss Shiner. Miss Chalk. Miss Bolton. Miss Gaul. Totals School Cases. Other Cases. School Cases. Other Cases. School Cases. Other Cases. School Cases. Other Cases School Cases. Other Cases. School Cases. Other Cases. School Cases. Other Cases 1st Visits. Subsequent Visits. 1st Visits. Subsequent Visits. 1st Visits bubsequent Visits. 1st Visits Subsequent Visits. 1st Visits. Subsequent Visits. 1st Visits. Subsequent Visits. 1st Visits. Subsequent Visits 1st Visits. Subsequent Visits. 1st Visits. Subsequent Visits. 1st Visits. Subsequent Visits. 1st Visits. Subsequent Visits. 1st Visits. Subsequent Visits. Scarlet Fever 27 12 ... ... 11 1 ... 14 1 ... ... 2 1 ... ... 20 8 ... ... 74 22 1 Diphtheria 20 10 ... ... 15 6 19 11 31 18 ... ... 21 18 ... ... 32 17 ... 1 119 69 19 12 Measles 14 1 ... ... 62 1 ... ... 41 9 ... ... 46 2 ... ... 42 1 ... ... 205 14 ... ... German Measles 4 ... ... ... 8 ... ... 6 ... ... ... 18 1 ... ... 2 ... ... ... 38 1 ... ... Mumps 105 15 ... ... 199 6 ... ... 123 4 ... ... 72 ... ... ... 76 3 ... ... 575 28 ... ... Whooping Cough 83 28 ... ... 219 35 ... ... 107 37 ... ... 128 8 ... ... 160 11 ... ... 697 119 ... ... Chicken pox 52 7 ... ... ... ... 156 7 ... ...... 135 4 ... ... 169 3 ... ... 701 22 ... ... Sore Throat 136 71 ... ... 390 127 3 ... 155 21 ... ... 207 104 ... ... 195 40 ... ... 1083 363 ... 1 Ringworm (scalp) 50 45 ... ... 42 21 ... 1 1 11 4 ... ... 25 4 ... ... 42 ... ... ... 170 74 ... ... ,, (body) 15 13 ... ... 14 22 ... ... 23 17 ... ...... 33 28 ... ... 26 ... ... ... 111 80 ... ... Verminous Heads 3 1 ... ... ... ... 1 ... ... 9 25 ... ... ... ... ... 13 26 ... ... Verminous Bodies 2 ... ... ... 8 2 ... ... 8 ... ... ... 6 2 ... ... 17 ... ... ... 41 4 ... ... Impetigo Contagiosa 111 178 ... ... 244 212 ... ... 156 172 ... ... 363 515 ... ... 227 169 ... ... 1101 1246 ... ... Scabies 6 7 ... ... 11 9 ... ... 14 33 ... ... 9 6 ... ... 9 2 ... ... 49 57 ... ... Infectious Eye Disease 26 20 ... ... 52 20 3 ... 72 52 ... ... 66 31 ... ... 84 80 ... ... 300 203 3 ... Other diseases 152 153 ... ... 268 61 1 5 294 48 ... ... 253 101 ... ... 337 104 ... ... 1304 467 1 5 Totals 806 561 ... ... 1732 523 27 17 1212 423 ... ... 1393 850 ... ... 1438 438 ... 1 6581 2795 27 18 1st Visits. Subsequ't Visits. 1st Visits. Subsequ't Visits. 1st Visits. Subsequ't Visits. 1st Visits. Subsequ't Visits. 1st Visits. Subsequ't Visits. 1st Visits. Subsequ't Visits. 1st Visits. Subsequ't Visits. Visits to houses where Infants have been born ... ... 444 366 413 33 488 349 556 470 935 989 2836 2506 Visits to houses where Infants have died under one year of age ... ... 26 ... 30 ... 27 ... 30 1 50 2 163 3 Tuberculosis cases visited 385 656 65 ... 24 91 6 ... ... ... 39 5 519 752 Visits paid to Elementary Schools for Medical Inspections ... ... 65 ... 37 ... 61 ... 69 ... 60 ... 292 ... Number of Children prepared for Medical Inspection—Newly Inspected ... ... 1487 ... 1847 ... 1545 ... 1640 ... 154b ... 8067 ... Re-inspected ... ... 298 ... 219 ... 167 ... 380 ... 392 ... 1456 ... Specially Inspected ... ... 137 ... 147 ... 154 ... 118 ... 97 ... 653 ... Other Visits to Elementary Schools ... ... 22 ... 4 ... 76 ... 13 ... ... 120 ... Home Visits arising out of Medical Inspection ... ... 357 ... 144 55 169 23 286 253 275 86 1231 417 Home Visits for other information ... ...... 51 ... 64 113 ... 107 21 96 2 431 23 Cultures taken ... ... 157 ... 119 ... 227 ... 310 ... 195 1008 ... * This Table does not include the midwives inspections for which see page 25. 53 untiring industry of the lady members of the staff. During 1914 the incidence of illness amongst the ladies was unusually heavy, and I have the sincerest pleasure in recording the ungrudging way in which the work of those on sick-leave was carried on by the remaining health visitors. HEALTH LECTURES. One of the most notable tendencies of public health work in late years has been that by which endeavours have been made to enlist the active sympathy and intelligent co-operation of the people in the production of a higher standard of physical and general welfare both of the individual and of the community. It is obvious that to secure a lasting improvement not only must the external circumstances of life be made better, but the actual personal practices and mode of life of the individual should be raised to the highest possible level. The latter aim can only be attained by causing each one to know personally what should be striven for and how undesirable and inimical personal conditions may be avoided or got rid of. Croydon has in past years been noteworthy for the number of parents' conferences, health talks, &c., which have been held with this object in view. The recommendations of the National Insurance Act for the institution of series of health lectures had thus been anticipated to some extent in the Borough. During the past year it was felt that what had previously been done in this respect could with advantage be extended, and I therefore arranged a series of health lectures, which have been delivered by the medical staff and the health visitors during the winter 1914-15. The lectures were extremely well attended, and were in every respect successful; quite a considerable number of children were brought for special examination by the parents in direct consequence of several of the lectures. The cost of the lectures was borne partly by the Sanitary Committee and partly by the Insurance Committee. The meetings were arranged so as to tap the whole borough, and were held in various schools for the use of which we are indebted to the Education Committee. A list of the lectures, with the dates upon which they were held, is given on page 169 of the School Medical Report. 54 TABLE I. For whole District, for Calendar Ye&r 1914. Year. Population estimated to Middle of each Year. Births. Total Deaths Reg. in the District. Transferable Deaths Nett deaths belonging to the District. of Non-residents registered in the District. of Residents not registered in the District Under 1 Year of Age. At all Ages. Uncorrected Number. Nett. Number. Rate.* Number Kate per 1,000 Nett Births. Number. Rate * N umber. Rate.* 1 2 3 4 5 6 7 8 9 10 ii 12 13 1906. 151,011 3886 25.7 2085 13.8 160 94 485 125 2019 13.4 1907. 154,342 3967 25.7 1953 12.5 149 97 371 94 1901 12.3 1908. 157,698 4017 25.5 2053 13.0 137 105 398 99 2021 12.8 1909. 161,078 3938 24.4 1974 12.3 165 70 313 79 1879 11.7 1910. 166,884 3810 22.8 1817 10.9 145 111 331 87 1783 10.7 1911. 170,451 3760 3748 22.0 2069 12.1 177 130 395 105 2022 11.9 1912. 174,257 3861 3859 22.1 1934 11.1 200 159 297 77 1893 10.8 1913. 178,094 3890 3895 21.8 2110 11.8 204 190 368 94 2096 11.7 1914. 181,956 4027 4007 22.0 2041 11.2 234 177 319 79 1984 10.9 * Rates calculated per 1,000 of estimated population. Census, 1911. Total population at all ages, 169,551. Number of inhabited houses, 34,363. Average number of persons per house, 4 9. Area of District in acres (exclusive of area covered by water), 9,012. 55 TABLE II. Cases of Infectious Disease notified during the Year 1914. Notifiable Disease. Cases notified in whole District. Total Cases notified in each Locality. Total Cases Removed to Hospitals or Sanatoria. At all Ages. At Ages—Years. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. Institution cases which could not be distributed. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 46 to 56 65 & upwad. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera (C) Plague (P) .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup 226 2 53 133 24 13 1 .. 43 46 12 23 11 39 11 41 .. 195 Erysipelas 96 6 2 1 7 36 35 9 23 17 6 5 7 18 1 19 .. 3 Scarlet Fever 748 6 207 452 50 29 4 97 152 59 53 62 149 87 89 629 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 20 .. 1 6 2 8 3 .. 2 5 1 2 3 2 .. 5 .. 13 Relapsing Fever (R) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 9 .. .. .. 3 6 .. .. 5 1 .. .. .. 1 .. 2 .. 2 Cerebro-spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 27 27 .. .. .. .. .. .. 10 3 1 2 1 4 3 3 .. .. Pulmonary Tuberculosis 361 2 14 47 78 175 40 5 87 57 26 37 35 62 10 37 10 169 Other forms of Tuberculosis 142 10 36 55 16 21 2 2 40 26 4 13 12 25 .. 15 7 18 Totals 1629 53 313 694 180 288 85 16 307 307 109 135 131 300 112 211 17 1029 The Borough (Fever) Isolation Hospital is situated in the West Ward. The Croydon and Wimbledon (Smallpox) Isolation Hospital is at North Cheam. 56 TABLE III Causes of, and ages at, Death during Year ending December 31st, 1914, excluding Deaths of Strangers at the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Purley Cottage Hospital, Norwood Cottage Hospital, 99, Central Hill (Servants' Reformatory), and adding Deaths of Croydon Residents known to have occurred outside the District. No. CAUSE* LOCALITIES." Institution & Street Deaths which could not be distributed. Total Institution Deaths distributed and not distributed. Inquest Cases. Total all Ages. Males all Ages. Females all Ages. 0-1. 1-2. 2-5. 5-15. 15-25. 25-45. 45-65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. I.—General Diseases. 1 Enteric Fever 1 1 1 ... ... 1 ... 1 ... 4 1 5 2 3 ... ... 1 1 1 2 2 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 (A B.) Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Relapsing Fever ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... (13) Mediterranean Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Not vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Doubtful ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Measles 4 1 ... 1 ... ... ... 1 ... 8(3) ... 8 4 4 2 4 2 7 Scarlet Fever 1 2 1 ... ... ... ... 1 ... 4 ... 5 2 3 ... ... 1 2 1 8 Whooping Cough 7 6 2 1 1 4 1 1 ... 7 ... 24 11 13 12 8 3 1 9 (A) Diphtheria 4 4 ... 2 ... 4 3 1 ... 18 (1) ... 18 10 8 ... 1 10 6 1 (B C.) Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Membranous laryngitis ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 (C) Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Influenza 5 ... ... 3 2 4 ... 1 ... 1 ... 15 9 ... ... ... 9 11 Miliary Jever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Cholera Nostras ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Yellow Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Leprosy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Erysipelas 1 1 ... ... 1 ... 2 2 ... 6(1) ... 7 5 2 3 ... 3 1 57 19 (A.B.C.D.) other Epidemic Diseases (A) Mumps ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... (B) German Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Varicella ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other Diseases included under 19 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 (A.B.C.) Pyaemia, Septicaemia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Pyaemia ... ... 1 ... ... ... ... ... ... 1 ... 1 ... 1 1 ... ... ... ... ... ... ... (B) Septicaemia ... 1 ... ... ... ... ... ... ... (2) ... 2 1 1 1 ... ... ... ... ... ... ... (C) Vaccinia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 Anthrax (Splenic Fever) ... ... 1 ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... 23 Rabies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 24 Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25 (A.B.) Mycoses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Actinomycosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other Mycoses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 Pellagra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Beri-beri ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28 (A.B. Pulmonary Tuberculosis (not acute) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Pulmonary Tuberculosis 36 23 14 10 19 28 12 12 3 54(20) 4 157 89 68 2 ... 4 9 28 66 39 9 (B) Phthisis (not defined as tuberculous). ... 1 ... ... ... 1 ... ... ... ... ... 2 2 ... ... ... ... ... ... 2 ... ... 29 (A) Acute Phthisis 2 ... ... ... ... 1 ... ... ... 3 ... 3 2 1 1 ... ... ... ... 2 ... ... (B) Acute Miliary Tuberculosis 2 ... 1 1 ... 1 ... ... ... 2 1 5 3 2 ... ... 1 ... ... 4 ... ... 30 Tuberculous Meningitis 2 3 2 2 3 2 6 (2) 14 10 4 1 4 6 2 1 31 (A.B.) Tuberculosis of Peritoneum and Intestines (A) Tabes Mesenterica 1 ... ... ... ... ... 1 1 ... 3 ... 3 1 2 1 ... ... 2 ... ... ... ... (B) Other Peritoneal and Intestinal Tubercle ... 3 ... ... ... ... ... ... ... 3 (1) ... 3 2 1 ... ... ... 1 ... 1 ... ... 32 Tuberculosis of Spinal Column ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... 33 Tuberculosis of Joints 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... 1 ... ... ... ... 34 (A. B.C.) Tuberculosis of other Organs (A) Lupus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B| Scrofula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other Tuberculosis included under 34 ... 1 ... ... 1 ... ... ... ... 1 ... 2 2 ... ... ... ... ... ... 1 ... ... 35 Disseminated Tuberculosis ... 1 ... ... 1 ... ... ... ... 1 (4) ... 2 1 1 ... ... ... ... 1 ... 1 ... 36 (A.B.) Rickets, Softening of Bones ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other forms of Bone Softening ... ... ... 1 ... ... ... ... ... 1 ... 1 ... 1 1 ... ... ... ... ... ... ... 58 TABLE III—continued. No. CAUSE. LOCALITIES. Institution & Street Deaths which could not distributed. Total Institution Deaths distributed and not distributed. Inquest Cases. Total all Ages. Males all Ages. Females all Ages. 0-1. 1-2. 2-5. 5-15. 15-25. 25-45. 45-65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood Thornton Heath. 37 Syphilis 1 1 ... ... ... ... ... ... ... 1(1) ... 2 1 1 1 1 ... ... ... ... ... ... 38 (A.B.C.) Other Venereal Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Soft Chancre ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Gonococcus Infection ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Purulent Ophthalmia ... ... ... ... ... ... ... ... ... 3(1) ... ... ... ... ... ... ... ... ... ... ... ... 39 Cancer of the Buccal Cavity 3 1 ... ... 1 1 ... ... ... ... ... 6 4 2 ... ... ... ... ... ... 5 1 40 Cancer of the Stomach, Liver, &c. 11 9 4 8 9 12 3 4 ... 9(4) ... 60 26 34 ... ... ... ... ... 5 18 37 41 Cancer of the Peritoneum, Intestines & Rectum 12 10 1 5 6 13 1 6 ... 9 (6) ... 54 28 26 ... ... ... ... ... 1 18 35 42 Cancer of the Female Genital Organs 4 1 ... ... 3 4 ... ... ... 3 (3) ... 12 ... 12 ... ... ... ... ... 3 4 5 43 Cancer of the Breast 6 4 2 6 4 3 1 6(3) 26 26 2 15 9 44 Cancer of the Skin 2 ... ... ... ... ... ... ... ... (1) ... 2 2 ... ... ... ... ... ... ... ... 2 45 Cancer of other or unspecified Organs 5 9 ... 3 8 2 3 2 1 12 (3) ... 33 16 17 ... ... ... ... 1 1 15 16 46 (A.B.C.) Other Tumours (situation undefined) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Angioma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Adenom ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... (C) Other Tumours included under 46 ... ... ... ... ... 2 ... ... ... ... ... 2 ... 2 ... ... ... ... ... 1 ... 1 47 Rheumatic Fever 2 ... 2 ... ... ... 1 1 ... 1(1) ... 6 3 3 ... ... ... ... 1 1 2 ... 48 (A.B.) Chronic Rheumatism, Osteo-arthritis ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... 2 (A) Chronic Rheumatism 1 1 ... ... ... 1 ... ... ... ... ... ... ... 3 ... ... ... ... ... ... 1 3 (B) Osteo-arthiitis 1 ... 1 1 ... ... ... ... ... ... ... 4 1 3 ... ... ... ... ... ... 1 3 (C) Gout ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 49 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 50 Diabetes. 5 1 2 1 2 2 2 ... ... 4 ... 15 7 8 ... ... ... ... 2 9 3 51 Exophthalmic Goitre 1 ... 1 ... 1 ... ... ... ... 1 (1) ... 3 1 2 ... ... ... ... 1 1 ... 1 52 Addison's Disease ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... 53 (A.B.) Leucocythcemia, Lymphadenoma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Leucocythciemia (Leuchsemia) 1 2 2 1 5 5 1 1 1 1 1 1 (B) Lymphadenoma ... 1 ... 1 ... ... ... ... ... ... 3 ... 3 ... ... ... ... ... 2 1 59 54 Anæmia, Chlorosis 4 4 1 5 2 1 1 ... 1 5 (1) ... 19 4 15 ... ... 1 ... ... 6 9 3 55 (A.B.C.D.) Other General Diseases ... ... ... ... ... ... ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... (A) Diabetes Insipidus 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 (B) Purpura ... ... ... ... ... 2 ... ... ... 1 ... 2 1 1 1 ... ... 1 ... ... ... ... (C) Hæmophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other Diseases included under 55 1 ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... 1 56 Alcoholism (acute or chronic) ... ... ... ... 1 1 ... ... ... 1 1 2 1 1 ... ... ... ... ... 2 ... ... 57 (A.B.) Chronic lead poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Occupationallead poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Non-occupational lead poisoning ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 58 Other chronic occupational poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 59 Other chronic poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... II.—Diseases of the Nervous System and of the Organs of Special Sense. 60 Encephalitis ... ... ... ... 1 1 ... ... ... 1 1 2 2 ... ... ... 1 1 ... ... ... ... 61 (A) Cerebro-spinal fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 61 (B.C.) Meningitis, other forms or undefined ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Posterior basal meningitis 1 ... ... ... ... ... ... 1 ... 2 ... 2 1 1 2 ... ... ... ... ... ... ... (C) Meningitis, other forms 1 3 ... ... 1 9 ... 1 ... 1 (2) 1 8 5 3 3 2 1 2 ... ... ... ... 62 Locomotor Ataxy ... 1 ... ... 1 ... ... 1 1 3 ... 4 3 1 ... ... ... ... ... 1 2 1 63 (A.B.) Other diseases of the spinal cord ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Diseases formerly classed to "Other nervous affections'' 1 1 ... 1 ... ... ... ... ... 1 (1) ... 3 1 2 ... ... ... ... 1 ... ... 2 (B) Other diseases included under 63 3 1 ... 1 1 2 ... ... ... 3 ... 8 4 4 ... ... ... ... 1 1 6 ... 64 (A.B.C.D.E.) Cerebral hemorrhage, Apoplexy (A) Apoplexy ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 (B) Serous apoplexy and cedema of brain ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Cerebral congestion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Cerebral atheroma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Cerebral hæmorrhage 33 19 15 7 10 17 8 5 ... 36(16) 9 114 58 56 ... ... ... ... 1 5 36 72 65 Softening of brain 3 ... ... 2 1 2 ... ... ... 5 ... 8 4 4 ... ... ......... ... ... ... 5 3 66 (A.B.C.) Paralysis without specified cause (A) Hemiplegia ... 1 ... ... ... ... ... 1 ... 1 ... 2 ... 2 ... ... ... ... ... ... 1 1 (B) Paraplegia 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 (C) Other forms of paralysis ... ... 1 1 ... ... ... ... ... 2 ... 2 2 ... ... ... ... ... ... 1 1 ... 6o TABLE III—continued. No. CAUSE. LOCALITIES. Institution & Street Deaths which could not be distributed. Total Institution Deaths distributed and not distributed. Inquest Cases. Total all Ages. Males all Ages. Females all Ages. 0-1. 1-2. 2-5. 5-15. 15-25. 25-45. 45-65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. 67 General paralysis of the insane 1 1 ... 1 ... ... 1 ... 1 5 ... 5 3 2 ... ... ... ... ... 4 1 1 2 68 Other forms of mental alienation 1 ... ... ... ... 1 ... 1 ... ... ... 3 ... 3 1 ... ... ... 4 ... 3 1 69 Epilepsy 2 2 1 1 ... 2 ... ... 3 5 2 11 7 4 1 ... ... ... ... ... ... ... 70 (A.B.) Convulsions (non-puerperal; 5 yrs. & over (A) Epileptiform convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Others included under 70 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... 71 (A.B.) Infantile convulsions (under 5 years) ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 ... ... ... ... ... ... (A) Convulsions with teething 1 ... 1 ... 1 ... ... ... ... ... 1 3 2 1 2 1 ... ... ... ... ... ... (B) Other infantile convulsions 6 4 6 2 2 4 2 4 ... 1(2) 7 30 16 14 25 2 3 ... ... ... ... ... 72 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 73 (A.B.) Hysteria, Neuralgia, Neuritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Hysteria, Neuralgia, Sciatica ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... 2 ... (B) Neuritis ... 1 ... ... 1 ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... 74 (A.B.C.D.) Other diseases of the nervous system (A) Idiocy, Imbecility ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Cretinism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... (C) Cerebral tumour 1 1 1 1 ... ... ... ... ... 3(1) ... 6 ... 6 ... ... ... ... ... ... 3 ... (D) Other diseases included under 74 ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 75 Diseases of the eyes and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 76 (A) Mastoid disease ... ... ... ... ... ... ... ... ... 1 ... 2 1 1 2 ... ... ... ... ... ... ... 76 (B) Other diseases of the ears ... 1 1 ... ... ... ... ... ... 1 (2) ... 2 1 1 1 ... ... ... ... 1 ... ... III.—Diseases of the Circulatory System. 77 Pericarditis 1 ... ... 1 1 1 ... ... ... 1 1 4 2 2 ... ... ... ... 1 2 1 ... 78 (A.B.C.) Acute endocarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Acute myocarditis ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... (B) Infective endocarditis ... ... ... 1 1 ... ... 2 ... 2 ... 4 3 1 ... ... ... ... ... 3 1 ... (C) Other acute endocarditis ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 61 79 (A) Valvular disease 24 17 12 10 15 11 ... 10 2 29(H) 11 101 50 51 ... ... ... 3 4 15 33 46 79 (B) Fatty degeneration of the heart 11 12 5 3 6 4 2 4 2 8 (3 16 49 24 25 ... ... ... 1 ... 2 14 32 79 (C) Other organic disease of the heart 3 1 ... 5 1 4 ... 2 ... 2 (1) 6 16 8 8 ... ... ... ... ... ... 4 12 80 Angina pectoris ... 1 ... ... 1 ... ... 1 ... ... 1 3 2 1 ... ... ... ... ... ... 1 2 81 (A) Aneurysm 3 ... 2 ... 1 ... ... ... ... ... ... 7 5 2 ... ... ... ... ... 2 3 2 81 (B) Arterial sclerosis 16 13 9 12 6 10 2 3 ... 38(29) 4 71 34 37 ... ... ... ... ... ... 7 64 81 (C) Other diseases of arteries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 82 (A) Cerebral embolism and thrombosis 1 3 1 4 5 1 4 ... ... (1) 1 19 6 13 ... ... ... 1 ... ... 3 15 82 (B) Other embolism and thrombosis 1 2 ... ... 1 1 5 ... ... 4 1 10 3 7 ... ... ... ... ... 1 5 4 83 (A.B.C.D) Diseases of the veins (Varices, Hemorrhoids, Phlebitis, &c.) (A) Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B)Varix ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Pylephlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Varicocele ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... 84 (A) Status lymphaticus 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... 1 ... ... ... ... ... 84 (B) Other diseases of the lymphatic system 1 ... ... ... ... ... ... 1 ... 1 ... 2 ... 2 2 ... ... ... ... ... ... ... 85 (A.B.C.) Haemorrhage; other diseases of the circulatory system (A) Functional disease of the heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Epistaxis ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... (C) Other diseases included umler 85 ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... IV.—Diseases of the Respiratory System. 86 Diseases of the nasal fossae ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 87 (A. B.C.) Diseases of the larynx (A; Laryngismus stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Laryngitis ... ... ...... ... 2 ... ... 1 ... ... ... 4 2 2 ... 1 2 1 ... ... ... ... (C) Other diseases of larynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 88 Diseases of the thyroid body ... ... ... ... ... 1 ... ... ... (1) ... 1 ... 1 ... ... ... ... ... ... ... 1 89 (A.B.) Bronchitis & (A) Bronchiectasis, Bronchial Catarrh, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 90 (B) Other bronchitis 31 16 11 14 22 24 7 13 1 29 (8) 8 142 70 72 17 3 4 1 ... 7 18 92 91 Broncho-pneumonia 21 8 4 10 3 8 1 7 22 (4) 3 62 38 24 21 9 4 2 i 3 12 10 92 (A.B.) Lobar and undefined. (A) l.obar pneumonia 23 7 6 15 7 14 5 12 2 25(7) 12 91 46 45 7 6 3 3 4 11 30 27 (B) Pneumonia (type not stated) 3 2 2 ... 1 ... ... ... ... 1 2 8 6 2 2 ... 1 1 ... 3 ... 1 62 TABLE III—continued. No CAUSE. LOCALITIES. Institution & Street Deaths which could not be distributed. Total Institution Deaths distributed and not distributed. Inquest Cases. Total all Ages. Males all Ages. Females all Ages. 0-1. 1-2. 2-5. 5-15. 15-25. 25-45. 45-65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. 93 (A.B.) Pleurisy (A) Empyema ... ... ... ... ... 1 1 1 ... ... 1 3 2 1 ... ... ... ... ... 2 1 ... (B) Other pleurisy 3 1 ... ... 2 ... 1 ... ... 2 1 7 2 5 ... ... ... ... 1 2 2 2 94 (A.B.C.D.) Pulmonary congestion, Pulmonary apoplexy (A) Pulmonary apoplexy and infarction ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Pulmonary oedema and congestion 1 1 2 ... ... ... ... ... ... 1 2 4 2 2 ... ... ... ... 1 ... 3 ... (C) Hypostatic pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Collapse of lung (3 months and over) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 95 Gangrene of the lung ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 96 Asthma 3 ... 1 ... ... 2 ... 1 ... ... ... 7 3 4 ... ... ... ... 1 ... 3 3 97 Pulmonary emphysema ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 98 (A) Fibroid disease of lung ... 1 1 ... ... 1 1 ... ... ... ... 4 1 3 ... ... ... ... ... ... 2 2 98 (B) Other diseases of the respiratory system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... V.—Diseases of the Digestive System. 99 (A) Diseases of the teeth and gums ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 99 (BC.D.) Other diseases of the mouth and annexa ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Thrush, Aphthous Stomatitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Parotitis ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other diseases included under ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 100 (A.B.C.) Diseases of pharynx, Tonsillitis (A) Tonsillitis ... 1 ... ... 1 1 ... ... ... 1(1) 1 3 3 ... ... 1 ... ... 1 1 ... ... (13) Ludwig's angina ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other diseases of the pharynx ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 101 Diseases of oesophagus ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 102 Perforating ulcer of stomach 2 ... ... 1 ... 3 1 2 ... 3(5) 2 ... 3 6 ... ... ... ... ... 2 4 3 63 103 (A) Inflammation of stomach 1 2 ... l 2 2 ... l ... ... ... 9 6 3 4 ... ... ... ... 1 1 3 103 (B) Other diseases of the stomach ... ... ... ... ... 1 ... ... ... 1 1 1 1 ... ... ... ... ... ... ... 1 ... *104 (A B.C.D.E.F.G. H.) Diarrhœa and enteritis & (A) Infective enteritis 8 2 2 ... 2 5 l 2 ... 7 (3) ... 22 15 7 18 4 ... ... ... ... ... ... 105 (B) Diarrhoea—Not returned as infective 6 1 ... ... ... 3 ... ... ... 1 (2) ... 10 7 3 7 1 ... ... ... ... ... 2 (C) Enteritis—Not returned as infective 3 2 1 ... 1 8 ... ... ... 4(1) ... 18 6 12 9 3 ... ... ... 1 2 3 (D) Gastro-enteritis—Not returned as infective 7 5 ... ... 2 2 ... ... ... 2 3 16 7 9 9 2 ... ... ... ... ... 3 (E) Dyspepsia, under 2 years ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... (F) Colic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (G) Ulceration of instestines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (H) Duodenal ulcer ... 1 1 ... ... 2 ... ... ... 2(3) ... 4 4 ... ... ... ... ... ... 1 ... 3 106 Ankylostomiasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 107 Other intestinal parasites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ......... ... 108 Appendicitis 3 1 1 2 3 3 ... ... ... 12(10) ... 15 10 5 ... ... ... ... ... 5 3 1 109 (A) Hernia 2 ... l ... 2 1 ... ... ... 4 (3) ... 6 3 3 1 ... ... ... ... ... 2 3 109 (B) Intestinal obstruction 3 2 2 ... 1 1 ... ... ... 6 (1) ... 9 2 7 2 ... ... ... ... 2 1 2 110 Other diseases of the intestines ... ... ... 1 ... 1 ... ... ... 1 ... 2 ... 2 1 ... ... ... ... 1 ... ... 111 Acute yellow atrophy of liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 112 Hydatid of liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 113 (A. B.C.) Cirrhosis of the liver (A) Cirrhosis of the liver 'not retu ned as alcoholic) 3 1 1 ... 1 1 ... ... ... 4 (1) ... 7 5 2 ... ... ... ... ... 2 2 3 (B) Cirrhosis of the liver (returned as alcoholic) 1 2 l 1 1 2 ... ... ... 4 (3) ... 8 6 2 ... ... ... ... ... ... 7 1 (C) Diseases formerly classed to "Other diseases of liver and gall bladder" ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 114 Biliary calculi 1 1 ... ... 1 1 ... ... ... 2(1) ... 4 2 2 ... ... ... ... ... ... 1 3 115 Other diseases of the liver ... 2 ... 1 l 3 ... ... ... ... ... 7 5 2 1 ... ... ... ... ... 1 5 116 (A.B.) Diseases of the spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Infarction of spleen . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... (B) Other diseases of the spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 117 Peritonitis (cause unstated) ... ... ... ... 1 ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... 1 ... 118 A. H.) Other diseases of the digestive system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Abdominal abscess, Sub-phrenic abscess ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases included under 118 ... ... ... 1 ... 1 ... ... ... 1 ... 2 2 ... ... ... ... ... 1 ... 1 64 TABLE III—continued. No. CAUSE. LOCALITIES. Institution & Street Deaths which could not be distributed. Total Institution Deaths distributed and not distributed. Inquest Cases. Total all Ages. Males all Ages. Females all Ages. 0-1. 1-2. 2-5. 5-15. 15-25. 25-45. 45-65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. VI.—Non- Venereal Diseases of the Genitourinary System and Annexa. 119 Acute nephritis 1 1 1 1 1 1 ... ... ... (3) ... 6 4 2 ... ... ... ... 1 ... 3 2 120 (A.B.) Hright's disease (A) Bright's disease as in 1901 list 10 8 10 6 2 5 3 3 ... 9(4) ... 47 18 29 ... ... ... 1 1 3 16 26 (B) Nephritis (unqualified), 10 years and over and Uraemia ... 1 ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... 1 121 Chyluria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 (A.B.C.D.) Other diseases of the kidney and annexa (A) Abscess of kidney ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... (B) Cystic disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Suppression of urine ... ... ... ... ... ... ... ... ... ... ... ... ••• ... ... ... ... 1 ... 1 1 (D) Other diseases included under 122 1 ... ... ... ... ... 1 ... ... 3 ... 3 1 2 ... ... ... ... 1 ... ... 1 123 Calculi of the urinary passages 1 ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... 1 4 124 Diseases of the bladder 3 1 1 1 4 6 5 1 A 4 125 (A.B.) Diseases of the urethra, Urinary abscess, &c. (A) Perineal abscess ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases of urethra, &c. ... 1 ... 1 ... ... ... ... ... 2 ... 2 2 ... ... ... ... ... ... ... 1 1 126 Diseases of the prostate 1 5 2 2 1 ... ... 1 ... 6(3) ... 16 16 ... ... ... ... ... ... 2 14 127 Non-venereal diseases of male genital organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 (A.B.) Uterine hæmorrhage (non-puerperal) (A) Menorrhagia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... (B) Other uterine haemorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ...... ... ... ... ... ... 129 Uterine tumour (non-cancerous; ... ... ... ... ... 1 ... ... 1 ... 1 ... 1 ... ... ... ... ... 1 ... ... 65 130 (A. B.) Other diseases of the uterus (A Disorder of menstruation (except merorrhagia) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases included under 130 ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Ovarian cyst, tumour (non-cancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 132 (A.B.) Other diseas:sof the female genital organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Diseases of ovary (excluding ovarian tumour) ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... (B) Other diseases included under 132 ... ... ... ... ... ... ... 1 ... 1 (1) ... 1 ... 1 ... ... ... ... 1 ... ... ... 133 Non-puerperal diseases of the breast (noncancerous) ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... VII. — The Puerperal State. 134 (A.B.C.D.E. Accidents of pregnancy (A) Abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ......... ... (B) Haemorrhage of pregnancy ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Uncontrollable vomiting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Ectopic gestation ... 1 ... ...... ... ... ... ... 2 ... 2 ... 2 ... ... ... ... ... 2 ... ... (E) Other accidents of pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 135 Puerperal haemorrhage 1 ... ... ... 1 ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... 2 ... ... 136 Other accidents of childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 137 Puerperal fever ... 1 ... ... ... ... ... 2 ... 1 ... 3 ... 3 ... ... ... ... 2 1 ... ... 138 (A.B.C.) Puerperal albuminuria and convulsions (A) Puerperal nephritis and uræmia ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... (B) Puerperal albuminuria & Bright's disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Puerperal convulsions ... ... 1 1 ... ... ... ... ... 1 4 2 ... 2 ... ... ... ... ... 1 1 ... 139 (A. B.) Puerperal phlegmasia alba dolens, embolism, and sudden death (A) Puerperal phlegmasia alba" dolens, phlebitis 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... 1 ... ... . (B) Puerperal embolism and sudden death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 140 Puerperal insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 141 Puerperal diseases of the breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... 66 TABLE III—continued. No. CAUSE LOCALITIES. Institution & Street Deaths which could not be distributed. Total Institution Deaths distributed and not distributed. Inquest Cases. Total all Ages. Males all Ages. Females all Ages. 0-1. 1-2. 2-5. 5-15. 15-25. 25-45. 45-65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. VIII.—Diseases or the Skin and of the Cellular Tissue. 142 (A) Senile gangrene ... 1 1 ... 1 1 ... ... ... 2 ... 4 3 1 ... ... ... ... ... ... ... 4 142 (B C.D.) Gangrene, other types (B) Noma, Gangrene of mouth ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... (C) Noma pudendi ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other gangrene ... ... 1 ... ... 1 ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... 2 ... 143 Carbuncle, Boil ... 1 ... ... 1 ... ... ... ... 1 (1) 1 2 2 ... ... ... ... ... ... ... 1 ... 144 (A.B.) Phlegmon, acute abscess ... ... ... ... ... ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... (A) Phlegmon ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... (B) Acute abscess 1 1 ... ... ... ... ... ... 2 (1) ... 2 1 1 ... ... ... ... ... 1 1 145 (A. B.C. D.) Diseases of the integumentary system (A) Ulcer, Bedsore 1 1 ... ... l ... ... ... ... 2(1) ... 3 2 1 ... ... ... ...... ... ... 2 1 (B) Eczema ... ... ... ... l ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ...... ... ... (C) Pemphigus (D) Other disease of integumentary system ...... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 IX. — Diseases of the Bones and of the Organs of Locomotion. 140 Diseases of the bones ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... 147 Diseases of the joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 148 Amputations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Other diseases of locomotor system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... X. —Malformation. 150 (A.B.C.D.) Congenital malformations (A) Congenital hydrocephalus 1 1 ... ... ... ... ...... ... ... 1 (1) ... 2 1 l 2 ... ... ... ... ... ... ... (B)Phimosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Congenital malformation of heart 2 1 1 2 ... 1 ... 1 ... ... 1 9 7 2 1 1 1 ... ... ... ... ... (D) Other congenital malformations 1 ... l 2 1 l ... 1 ... 3 ... 7 4 3 7 ... ... ... ... ... ... ... L 9 XI.—Diseases of Early Infancy. 151 (A) Premature birth 16 8 3 9 6 4 ... 5 ... 9 (4) 3 51 31 20 51 ... ... ... ... ... ... ... 151 (B.C.D.E.) Infantile debility, Icterus & Sclerema (B) Infantile atrophy, debility and marasmus 19 7 1 5 5 5 2 2 ... 13 (4) 2 46 32 14 45 ... ... ... ... ... ... ... (C) Icterus neonatorum 1 1 ... ... ... 2 ... ... ... ... ... 4 2 2 4. ... ... ... ... ... ... ... (D) Sclerema and œdema neonatorum ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Want of breast milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 152 (A.B.C.D.) Other diseases peculiar to early infancy (A) Diseases of umbilicus, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Atelectasis 2 5 ... 5 2 4 1 5 ... 3 ... 24 12 12 24 ... ... ... ... ... ... ... (C) Injuries at birth ... ... 2 ... 1 ... ... 1 ... (1) 1 4 1 3 4 ... ... ... ... ... ... ... (1)Cyanosis neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 153 Lack of care ... 1 ... ... ... ... ... ... ... ... 1 1 1 ... 1 ... ... ... ... ... ... ... XII. — Old Age. 154 (A. B ) Old age (A) Senile dementia ... ... 1 2 ... ... ... ... ... 1 ... 3 l 2 ... ... ... ... ... ... ... 3 (B) Senile decay 34 10 14 11 7 11 11 9 1 6(2) 4 108 44 64 ... ... ... ... ... ... ... 108 XIII.—Affections produced by External Causes. 155 Suicide by poison 1 2 1 1 1 ... ... ... ... 1 6 6 ... 6 ... ... ... ... 2 2 2 ... 156 Suicide by asphyxia ... ... ... ... ... 1 ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... 1 157 Suicide by hanging or strangulation ... ... ... 2 ... ... ... 1 ... 1 3 3 3 ... ... ... ... ... 1 ... 2 1 158 Suicide by drowning ... 1 ... ... ... ... ... ... ... 1 1 1 1 ... ... ... ... ... 1 ... 2 ... 159 Suicide by firearms ... 1 ... ... ... ... ... ... ... 1(1) 2 1 1 ... ... ... ... ... 1 ... 1 ... 160 Suicide by cutting and piercing instruments ... ... 1 ... ... 1 ... ... ... 1(1) 2 2 1 1 ... ... ... ... 1 1 1 ... 161 Suicide by jumping from high place ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 162 Suicide by crushing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 163 Other suicides ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... 164 Poisoning by food ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 165 Other acute poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... 166 Conflagration ... ... ... 1 ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... 1 ... 167 Burns (conflagration excepted) 2 1 ... ... 2 ... 1 ... ... 6 (3) 6 6 ... 3 ... 4 ... 1 ... 1 ... 168 Absorption of deleterious gases (conflagration excepted) 3 2 1 1 ... ... ... 1 ... (1) 8 8 6 2 7 ... ... ... ... ... 1 1 169 Accidental drowning 1 ... ... 2 ... 1 ... 1 ... 6 6 6 5 1 ... ... ... ... 2 2 2 1 170 Injury by firearms ... ... ... ... ... ... ... 1 ... 1 ... 1 1 ... ... ... ... ... 1 ... ... ... 71 Injury by cutting or piercing instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... 68 TABLE III—continued No. CAUSE. LOCALITIES. Institution & Street Deaths which could not be distributed. Total Institution Deaths distributed and not distributed. Inquest Cases. Total all Ages. Males all Ages. Females all Ages. 0-1. 1-2. 2-5. 5-15. 15-25. 25-45. 45-65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. 172 Injury by fall 7 3 1 2 1 3 3 ... ... 11 (8) 20 20 12 8 ... ... 1 4 1 3 4 7 173 Injury in mines and quarries ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ...... ... ... ... ... ... ... 174 Injury by machines ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ...... 175 Injury by other crushing (vehicles, railways, landslides, &c.) 2 1 ... ... 2 5 ... ... ... 8(4) 10 10 6 4 ... ... 3 1 2 2 2 176 Injury by animals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... 177 Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 178 Excessive cold ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 179 Effects of heat ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 180 Lightning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 181 Electricity (lightning excepted) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 182 Homicide by firearms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 183 Homicide by cutting or piercing instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... 184 Homicide by other means 2 ... ... ... ... ... ... ... ... 1 2 2 2 ... ... ... ... ... ... 1 ... ... 185 Fractures (cause not specified) 1 ... ... ... ... 1 ... ... ... 1 2 2 1 1 ... ... ... ... ... 1 ... 1 186 Other violence ... ... ...1 1 ... ... ... 1 ... 1(1) 2 2 2 ... ... ... ... ... 1 1 ... ... XIV. —III-Defined Causes. 187 Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ...... ... ... 188 (A) Syncope (aged 1 year and under 70) ... ... ... ... ... ... 1 ... ... 1 ... 1 1 ... ... ... ... ... ... ... 1 ... 188 (B) Sudden death (not otherwise defined) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 189 (A) Heart failure (aged 1 year and under 70) 1 1 1 i 189 (B.C.D.E.) Other ill-defined causes (B) Atrophy, debility, marasmus (aged 1 year and under 70) 1 ... ... ... ... ... ... ... (1) ... 1 1 ... ... ... ... ... ... ... ... 1 (C) Teething ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Other ill defined deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 189 (F) Cause not specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 490 302 175 214 218 304 101 159 21 592 (234) 193 1984 1015 969 319 61 55 61 79 222 435 752 The total Institution Deaths include those of strangers occuring within the Borough. Deaths of such strangers occurring at the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Purley Cottage Hospital, Norwood Cottage Hospital, and 99, Cental Hill (Servants' Reformatory), are excluded from all other columns of the Table. The numbers so excluded are in brackets. 69 TABLE IV. County Borough of Croydon—Whole Borough. INFANT MORTALITY. 1914. Nett Deaths from stated Causes at various Ages under One Year of Age. CAUSES OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths Under 1 Year. All Causes. Certified 75 22 15 15 127 66 74 26 26 319 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... 1 1 Measles ... ... ... ... ... ... 1 1 ... 2 Scarlet Fever ... Whooping Cough ... ... 1 1 4 4 ... 3 12 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... 2 ... ... 1 3 Tuberculous Meningitis ... ... ... ... ... ... ... 1 1 Abdominal Tuberculosis ... ... ... ... ... 1 ... ... 1 Other Tuberculous Diseases ... ... ... ... ... 1 ... i 1 3 Meningitis (not Tuberculous) ... ... ... ... ... ... 3 1 1 5 Convulsions 11 1 3 1 16 5 2 3 2 28 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 3 1 5 4 5 3 17 Pneumonia (all forms) ... ... ... ... ... 7 14 5 4 30 Diarrhœa ... 1 ... ... 1 4 2 ... ... 7 Enteritis ... ... "2 1 3 6 14 11 "2 36 Gastritis ... ... ... 1 1 3 1 ... ... 5 Syphilis ... ... ... ... ... ... ... 1 ... 1 Rickets ... ... ... ... ... ... 1 ... ... 1 Suffocation, overlying l ... i 2 2 3 ... ... 7 Injury at birth ... ... ... ... 22 ... ... 29 Atelectasis 18 4 ... ... 5 2 ... ... Congenital Malformations 5 3 1 ... 9 3 1 1 2 16 Premature Birth 33 8 1 4 46 4 1 51 Atrophy, Debility, and Marasmus 7 3 1 6 17 13 17 1 i 49 Other causes ... 1 3 ... 4 2 4 ... 4 14 75 22 15 15 127 66 74 26 26 319 Nett Births in the year legitimte, 3819. Nett Deaths in the year of legitimate infants 287. illegitimate, 208. illegitimate infant, 32 70 TABLE IV.—Continued. County Borough of Croydon— West Ward. INFANT MORTALITY. 1914. Nett Deaths from stated causes at various Ages under One Year of Age. CAUSES OF DEATH. Under 1 Week. 1-2 Waeks. 2-3 Weeks. 3-4 Weeks. Total under Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths Under One Year. All Causes. Certified 19 7 2 8 36 21 17 9 12 95 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... 1 1 ... ... 2 4 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... 1 ... ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 1 Meningitis (not Tuberculous) ... ... ... ... ... ... 1 ... 1 2 Convulsions 3 ... ... ... 3 2 ... ... ... 5 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 ... ... 2 1 1 ... 2 6 Pneumonia (all forms) ... ... ... ... ... 2 3 1 3 9 Diarrhœa ... ... ... ... ... 4 ... ... ... 4 Enteritis ... ... ... 1 1 3 4 7 ... 15 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... 1 1 1 ... ... Injury at Birth ... ... ... ... 1 1 1 ... ... 3 Atelectasis 1 ... ... ... 1 1 ... ... ... 2 Congenital Malformations 2 1 ... ... 3 ... ... ... ... 4 Premature Birth 10 4 ... 2 16 ... ... ... ... 10 Atrophy, Debility and Marasmus 3 1 ... 4 8 5 6 ... 1 20 Other causes ... ... ... ... ... 1 ... 1 2 19 7 2 8 36 21 17 9 12 95 Nett Births in the year legitimate, 809. Nett Deaths in the year of legitimate infants 83. illegitimate, 32. illegitimate infants, 12, 71 TABLE IV. County Borough of Croydon—North Ward. INFANT MORTALITY. 1914. Nett Deaths from stated Causes at various Ages under One Year of Age. CAUSES OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths Under 1 Year. All Causes. Certified 11 1 3 3 18 8 13 3 3 45 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 2 ... ... 3 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... 1 ... ... 1 ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis . . ... ... ... ... 1 1 2 ... 2 ... ... 5 Pneumonia (all forms) ... ... ... ... ... 2 1 ... ... 3 Diarrhœa ... ... ... ... ... ... 1 ... ... 1 Enteritis ... ... ... ... ... ... 2 ... 2 4 Gastritis ... ... ... l 1 1 ... ... ... 2 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... 1 ... ... 1 Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis 4 ... ... ... 4 ... 2 ... ... 6 Congenital Malformations ... ... l ... 1 ... ... 1 ... 2 Premature Birth 5 ... l ... 6 2 ... ... ... 8 Atrophy, Debility, and Marasmus 1 1 ... 1 3 2 2 ... ... 7 Other causes ... ... ... ... ... ... ... ... ... ... 11 1 3 3 18 8 13 3 3 45 Nett Births in the year legitimate, 146. Nett Deaths in the year of legitimate infants, 43 illegitimate, 66. illegitimate infants , 2. 72 TABLE IV. — Continued. County Borough of Croydon— Central Ward. INFANT MORTALITY. 1914. Nett Deaths from stated causes at various Ages under One Year of Age. CAUSES OF DEATH. Under 1 Week, 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12Months. Total Deaths Under One Year. All Causes. Certified 6 2 l 1 10 8 6 2 1 27 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ...... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 1 ... ... 2 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 1 l ... ... ... 1 ... ... 7 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... ... ... 1 ... ... 2 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... 1 ... ... 2 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... 1 ... ... 1 Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 2 ... ... ... 2 ... ... ... ... 2 Congenital Malformations 1 1 ... ... 2 ... ... ... ... 2 Premature Birth 2 ... ... 1 3 ... ... ... ... 3 Atrophy, Debility and Marasmus ... ... ... ... ... 3 1 ... ... 4 Other causes ... ... ... ... ... 1 ... ... 1 2 6 2 1 1 10 8 6 2 1 27 Nett Births in the year legitimate, 278. Nett Deaths in the year of legitimate infants 25. illegitimate, 12. illegilimate infants 2. 73 TABLE IV.—Continued. County Borough of Croydon—East Ward. INFANT MORTALITY. 1914. Nett Deaths from stated causes at various Ages under One Year of Age. CAUSES OF DEATH. Under 1 Week, 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths Under One Year. All Causes. Certified 11 8 1 1 16 3 7 4 2 32 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... .... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... 1 ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... 1 ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... ... ... 1 ... 1 ... ... Diarrhœ ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... ... 1 ... ... Gastritis ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 1 ... ... ... 1 ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 4 ... ... ... 4 1 ... ... ... 5 Congenital Malformations 1 ... ... ... 1 1 ... ... 1 3 Premature Birth 4 ... ... 1 8 ... ... 1 ... 9 Atrophy, Debility and Marasmus 1 ... 1 ... 2 ... ... ... ... 2 Other causes ... ... ... ... ... ... ... ... ... ... 11 3 1 1 16 3 7 4 2 32 Nett Births in the year legitimate, 4 46. Nett Deaths in the year of legitimate infants 28. illegitimate, 22. llegilimate infants , 4. 74 TABLE IV.— Continued. County Borough of Croydon—South Ward. INFANT MORTALITY. 1914. Nett Deaths from stated Causes at various Ages under One Year of Age. CAUSES OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths Under 1 Year. All Causes. Certified 7 1 2 ... 10 8 8 1 1 28 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... 1 ... ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... 1 ... ... 1 Convulsions 1 ... ... ... 1 1 ... ... ... 3 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 1 ... 1 1 ... ... ... 2 Pneumonia (all forms) ... ... ... ... ... 1 ... ... ... 1 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... 1 ... 1 ... 1 ... ... 2 Gastritis ... ... ... ... ... ... l ... ... 1 Svphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis 2 ... ... ... 2 1 ... ... ... 3 Congenital Malformations ... ... ... ... ... 1 ... ... ... 1 Premature Birth 4 1 ... ... 5 1 ... ... ... 6 Atrophy, Debility, and Marasmus ... ... ... ... ... 1 3 1 ... 5 Other causes ... ... ... ... ... ... 2 ... ... 2 7 l 2 ... 10 8 8 1 1 28 Nett Births in the year legitimate, 343. Nett Deaths in the year of legitimate infants, 26. illegitimate, 10. illegitimate infant, 2. 75 TABLE IV. — Continued. County Borough of Croydon—South Norwood. INFANT MORTALITY. 1914. Nett Deaths from stated causes at various Ages under One Year of Age. CAUSES OF DEATH. Under 1 Week, 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths Under One Year. All Causes. Certified 10 4 3 1 18 6 10 4 4 42 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... 1 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ...... ... ... ... ... Meningitis (no Tuberculons) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... 3 ... ... 1 ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... ... ... 1 Pneumonia (all forms) ... ... ... ... ... ... 2 1 ... 3 Diarrhœa ... 1 ... ... 1 ... 1 ... ... 2 Enteritis ... ... ... ... 1 1 3 2 ... 7 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 1 1 ... ... 3 1 ... ... ... 4 Congenital Malformations ... ... ... ... ... ... 1 ... ... 1 Premature Birth 3 ... ... ... 3 1 ... ... ... 4 Atrophy, Debility and Marasmus 2 1 ... 1 4 1 2 ... ... 7 Other causes ... 1 2 ... 3 1 1 ... 2 7 10 4 3 1 18 6 10 4 4 42 Neet Births in the year legitimate, 608. Nett Deaths in the year of legitimate infants 36. illegitimate, 20. illegitimate infants, 6. 76 TABLE IV.—Continued. County Borough of Croydon—Upper Norwood. INFANT MORTALITY. 1914. Nett Deaths from stated causes at various Ages under One Year of Age. CAUSES OF DEATH. Under 1 Week, 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths Under One Year. All Causes. Certified 2 ... 1 ... 3 2 5 ... ... 10 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 ... ... ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... 1 ... ... ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... 1 ... ... ... ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... 2 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... 1 ... ... 1 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth ... ... ... ... ... ... ... ... ... ... Atrophy, Debility and Marasmus ... ... ... ... ... ... 2 ... ... 2 Other causes ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 3 2 5 ... ... 10 Nett Births in the year legitimate, 104. Nett Deaths in the year of legitimate infants 8. , illegitimate, 35. llegilimate infants 2. 77 TABLE IV.— Continued. County Borough of Croydon—Thornton Heath. INFANT MORTALITY. 1914. Nett Deaths from stated Causes at various Ages under One Year of Age. CAUSES OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths Under 1 Year. All Causes. Certified 9 4 2 1 16 10 8 3 8 40 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... 1 1 Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... 1 ... ... 1 ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous). ... ... ... ... ... ... 1 1 ... 2 Convulsions ... ... 1 ... ... ... ... ... ... 3 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... ... ... 1 Pneumonia (all forms) ... ... ... ... ... 1 4 1 1 7 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... 1 2 1 ... 4 Gastritis ... ... ... ... ... 2 ... ... ... 2 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... 1 ... ... ... 1 Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis 2 3 ... ... 5 1 ... ... ... 6 Congenital Malformations 1 1 ... ... 2 1 ... ... ... 3 Premature Birth 5 ... ... ... 5 ... ... ... ... 5 Atrophy, Debility, and Marasmus ... ... ... ... ... 1 1 ... ... 2 Other causes ... ... 1 ... 1 ... ... ... ... 1 9 4 2 1 16 10 8 3 3 40 Nett Births in the year legitimate, 485. Nett Deaths in the year of legitimate infants, 88. illegitimate, 11. llegitimate infants, 21 78 TABLE V. Table showing the number of cases notified and deaths from the principal zymotic diseases for the Year 1914 and ten preceding Years. Disease. 1914. 1918. 1912. 1911. 1910. 1909. 1908. 1907. 1906. 1905. 1904. 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 .. Scarlet Fever 748 5 470 3 476 2 468 7 759 7 727 9 534 5 661 11 425 8 416 11 291 8 Diphtheria and (1) Memb.Croup 226 18 451 16 767 25 514 37 267 21 356 24 405 37 286 40 304 40 266 25 312 24 (2) Erysipelas 96 7 107 6 84 6 79 5 69 1 92 3 60 5 73 4 68 2 78 5 68 2 Puerperal Fever 9 3 6 4 10 3 12 4 8 1 16 5 10 5 7 4 9 2 11 5 9 3 Enteric Fever 20 5 32 6 32 7 24 7 26 .. 21 3 52 5 19 1 34 5 34 4 21 5 Simple Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis (3) 508 192 519 202 312 no 240 165 130 135 139 152 106 150 13 160 96 173 75 162 129 142 Non-notifiable. /Diarrhœa and Enteritis .. 67 .. 85 .. 58 .. 147 .. 51 .. 45 .. 75 .. 56 .. 203 .. 74 .. 130 Measles .. 8 .. 58 .. 31 .. 29 .. 31 .. 21 .. 92 .. 8 .. 37 .. 24 .. 62 Whooping Cough .. 24 .. 23 .. 13 .. 38 .. 20 .. 30 .. 29 .. 32 .. 28 .. 31 .. 15 Influenza .. 15 .. 26 .. 18 .. 14 .. 25 .. 59 .. 52 .. 31 .. 20 .. 30 .. 27 Bronchitis, Pneumonia, and .. Pleurisy .. 313 .. 297 .. 250 .. 280 .. 251 .. 323 .. 282 .. 316 .. 218 .. 302 .. 314 (1) Notifiable since May, 1897. (2) Notifiable since January, 1900. (3) Voluntary Notification, 1903-09. Poor Law Cases, Compulsorily Notifiable 1st Jan., 1909. Cases Treated in Hospital, Compulsorily Notifiable 1st May, 1911. All cases of Pulmonary Tuberculosis notifiable 1st January, 1912. All forms of Tuberculosis notifiable 1st February, 1913. In the above Table deaths of Non-residents occurring at the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Norwood Cottage Hospital, Purley Cottage Hospital, and 99, Central Hill (Servants Reformatory), are excluded. Prior to 1903 correction was only made for the first three institutions. 79 Vital Statistics of separate Wards in 1914 and previous years. Names or Localities 1. North Ward. 2. West Ward 3. Central Ward. 4. East Ward. 5. South Ward 6. South Norwood Ward. 7. Upper Norwood Sub-Division. 8. Thornton Heath Sud-Division. 9. Undistributed Institution Births and Deaths. 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 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 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. 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 b c d 1904 .. .. .. .. 46,741 1319 699 190 17,051 362 229 35 16,346 375 193 47 19,107 399 227 55 21,925 621 322 70 8,327 148 90 20 14,922 463 192 63 82 46 3 1005 .. .. .. .. 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 8,343 148 88 7 16,212 447 227 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 16,866 456 195 44 102 23 .. 1908* .. .. .. .. 51,801 1550 747 185 17,310 340 209 24 18,634 388 190 30 20,329 361 237 30 23,739 647 267 61 8,364 156 119 6 17,521 492 231 53 83 21 3 1909* .. .. .. .. 53,125 1560 721 142 17,394 266 211 24 19,185 396 189 33 20,636 371 198 27 24,195 654 267 39 8.377 151 87 8 18,176 455 184 40 85 23 .. 1910* .. .. .. .. 54,458 1489 693 149 17,478 298 179 21 19,736 404 195 33 20,943 376 180 30 24,651 548 239 45 8.388 139 102 6 18,831 474 168 47 82 27 .. 1911 29,701 691 275 51 33,592 800 473 107 16,167 295 199 32 20,175 377 217 42 18.998 360 290 42 25,609 572 325 65 8,128 112 105 10 18,081 430 190 43 111 29 2 1912 30,450 683 273 46 34 964 829 436 88 16,119 298 120 25 20,743 417 199 27 19,111 370 203 24 26,228 577 281 39 8,115 131 103 14 18,527 416 174 35 140 34 .. 1913 31,117 781 349 69 36,424 800 451 90 16,070 332 216 36 21,323 402 226 37 19,220 337 234 37 26,850 594 319 54 8,102 112 98 8 18,982 425 182 37 107 21 .. Averages of Years 1904 to 1913. 16,910 324 213 32 18,873 393 192 35 19,748 368 212 35 24,167 613 287 54 8,283 137 99 9 17,368 452 190 46 96 26 1 Averages of Years 1911 to 1913) 30,423 718 299 56 34,993 809 453 95 Averages of Years 1904 to 1910 inclusive. 50,541 1476 718 172 1914 31,809 729 302 45 37,302 841 490 95 16.021 290 175 27 21.837 468 214 32 19,690 353 218 28 27.498 628 304 42 8,298 109 101 10 19,441 496 159 40 .. 113 21 .. 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 99, 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 9. * Including North Ward. 80 Section E— WORK OF SANITARY INSPECTING STAFF. 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 Inspeetors. Inspections.—During the year 4,185 house-to-house inspections were made, as compared with 5,239 in 1913. W ith very few exceptions, the houses from which infectious diseases were notified, including tuberculosis, were thoroughly inspeeted and the drains examined. During the year 1,129 such houses were examined. Combined drainage.—The number of systems of combined drainage dealt with as single private drains during the year was 20. This work was carried out under the provisions of the Croydon Corporation Act, 1905. The cost of carrying out the necessary works amounted to £235 10s. 3d., and was borne by the owners instead of by the inhabitants at large. Horns* drains relaid,—In 159 instances the whole of the house drains were relaid, and 155 house drains were repaired or partially relaid Examination of drains.—142 written 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 appitcants: Where detects ere found. and in many cases where improvements were suggested, the work was carried out by the owners without the necessity of serving sanitary notices. Notice and Council Order— Most of the nuisances covered were remedied on receipt of informal notices, bet in 191 cases Council Orders had to he applied for. Of these 191 notices, and the 132 which ere outstanding at the end of 1913. 291 were complied leaving 32 outstanding at the end of the year. Legal Proccedings.—One prosecutions was undertaken for non-compliance with an ordinary nuisance notice, and defendant had to pay costs amounting to £1 6s 6d. As the deferent did not comply with the Court. Order to carry out the work specified by the notice, he was later fined £5 5s. and ordered to pay 8s. 6d. costs 81 Paving of back yards.—130 back yards have been paved during the year. MUNICIPAL COMMON LODGING HOUSE. This Lodging House affords accommodation for 17 women and 84 men. The number of occupants during the year amounted to 27,845 men and 3,730 women, making a total of 31,575. The average number of lodgers amounted to 76 men and 10 women per night. The receipts and expenditure (exclusive of sinking fund and interest) for the past six years were :— Receipts. Expenditure. £ 8. d. £ s. d. 1908 753 0 9 624 7 5 1909 750 0 0 632 15 7 1910 765 13 2 670 16 11 1911 802 12 7 610 7 11 1912 764 1 7 662 3 9 1913 765 6 7 623 14 4 1914 822 4 9 735 8 9 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 couple 9. Prospect Place 18 men and 5 married couple 19 20. 21, 22, 23 £ 24, Lahore Road 30 50 me-., 10 ' men. and 6 marked couple 52, 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 of 200 adults, or if we add the Municipal Common Lodging House, a total of five houses with 263 single beds and 19 double beds. 82 During the year common lodging houses received 550 visits, while 10 houses received night visits. Minor infringements of bye-laws were detected on 46 occasions, but in no case were they sufficiently serious for legal proceedings to be taken. HOUSES LET IN LODGINGS. There are now 66 houses registered under the bye-laws. During the year these houses received 791 day and 1 night visits. On no occasion were offences discovered for which prosecutions were necessary. At the present moment the following houses are registered as houses let in lodgings:— Houses. Wilford Road 33 Forster Road 12 Holmesdale Road 4 Ely Road 12 Lion Road 1 Pawsons Road 3 Princess Road, Croydon 1 66 The results of registration and inspection have, on the whole, been satisfactory. HOUSING, TOWN PLANNING, ETC., ACT, 1909. The following table gives the general housing particulars in respect of each district as estimated in the year 1911 :— HOUSE-TO-HOUSE INSPECTION. Summary. Inspector No. of Streets Total No. of Houses No. of Houses 10/- per week and under Culver 91 3313 1429 Earwicker 125 5953 3025 Peck 129 5195 2224 Richardson 120 5516 2620 Vincent 130 7739 2746 Flint 92 5293 2872 Hunt 135 4977 2235 Totals 822 37986 17151 83 It is seen from this Table that the number of houses comingwithin the meaning of the Housing Act Regulations was estimated at 17,151and as an average of 5,250 house-to-house inspections had been made during- the previous five years, it is clear that all cottage property would on the average be inspected about once in three years. This has always been the course adopted in £roydon. and in many instances whole streets are inspected at least twice a year. The following are the particulars of inspections made in 1914. HOUSE-TO-HOUSE Inspections made by the Sanitary Inspectors during the year ended 31st December, 1914. Inspector. House-to-House Inspection. Informal Notices served. Informal Notices complied with. Culver 626 447 456 Earwicker 369 176 237 Peck ... 607 492 470 Richardson 768 547 512 Vincent 608 387 338 Flint 526 663 666 Hunt 681 542 532 Total for the Year 4185 3254 3211 As a result of these inspections, 3,254 preliminary notices were served during the year, of which 3,211 were complied with. The numbers in this Table are in addition to 1129 inspections of houses where infectious diseases had been notified, and 142 inspections on request of larger houses where the drains were tested and special reports sent to occupiers, prospective occupiers, or owners. Full details of the general sanitary work are given in the Summary in Table VIII. Eighty-one cases of overcrowding were discovered, mostly in the poorer neighbourhoods; notices were in all cases served on the tenants and also on the landlords. In the majority of cases the overcrowding appeared to be of a temporary character, neighbours or friends having taken in another family, who were themselves in difficulties. House Closure. At the end of the year 1913 there were outstanding the cases of 23 houses for the closure of which action had been initiated. Sixteen were satisfactorily put in order and reoccupied. Closing orders were made in respect of 6; these were subsequently made fit for human habitation and reoccupied. The remaining one was voluntarily demolished. 84 Two houses were represented in 1914 to the Council as beingunfit for human habitation and Closing Orders were made. One house was demolished and the case of the other was still in hand at the end of the year. HOUSE-TO-HOUSE INSPECTIONS, 1914. Number of Living Rooms and Rent per House. No. of Rooms. rent per week. Total. 3/- and 3/6. 4/- and 4/6. 5/- and 5/6. 6/- and 6/6. 7/- and 7/6. 8/- and 8/6. 9/- and 9/6. 10/- 2 7 23 6 — 1 — — — 37 3 2 17 44 9 25 2 2 101 4 — 55 120 170 86 21 4 2 458 5 — 3 48 313 445 173 144 32 1158 6 — 1 23 78 350 435 169 143 1199 7 — — — — 14 35 41 52 142 8 — — — — — — 2 11 13 Totals 9 99 241 570 921 666 362 240 3108 TENEMENTS. No. of Rooms 2/- & 2/6. 3/- & 3/6. 4/- & 4/6. 5/- & 5/6. 6/- & 6/6. 7/- & 7/6. 8/ & 8/6. Total. 1 68 2 — — — — — 70 2 52 133 60 5 — — 1 251 3 2 88 155 86 8 1 1 341 4 2 4 23 25 1 - — 55 5 — — — 6 — — — 6 Totals 124 227 238 122 9 1 2 723 FACTORY AND WORKSHOP 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 of this Act in workhops and workplaces, and he shall send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State." 85 The following is a summary of the work done under this Act in Croydon during 1914. FACTORIES. For the most part, the law relating to Factories is administered by the Home Office. 188 visits were, however, made to Factories, 110 being in reference to sanitary accommodation, 33 in reference to cleanliness of earth closets, 13 in reference to new occupation, 6 in reference to alleged smoke nuisance, 4 in reference to extra sanitary accommodation at a boot factory; 10 in reference to extra sanitary accommodation at a wood chopper's, 7 in reference to intervening ventilated space at a signwriter's, and 5 in reference to intervening ventilated space at printing premises. WORKSHOPS. The number of workshops on the register and the various trades carried on therein, the number of workpeople employed, and the number of visits paid by the Inspector are shown in Table IX. The following is a list of the various matters which required attention:— Factories. Workshops Laundries Bakehouses. Workplaces. Outworkers. Total Screening of Women's W.C's. 1 — — — — — 1 Cleansing, etc. — 22 6 26 10 4 68 Insufficient W.C accommodation 2 3 — — — — 5 Defective ditto 2 14 2 2 6 2 28 Overcrowding — 4 - — — — 4 Dustbins 1 — — — — — 1 Paving — — 1 1 — — 2 Want of ventilation of stoves — 2 - — — - 2 Want of intervening ventilated space - 2 — — — — 2 Sundry defects - 12 — 8 — — 20 6 59 9 37 16 6 133 Preliminary Notices served— Factories 5 Workshops 13 Laundries 3 Bakehouses 8 Workplaces 5 Outworkers 1 35 86 These 35 notices were duly complied with: the remainder of the matters requiring attention were satisfactorily dealt with by verbal notice. Forty-eight communications were sent to H.M. Inspector of Factories in accordance with the various requirements of the Act. HOMEWORK. 166 lists were received from employers, containing the names of 403 outworkers residing in the Borough. 109 further names were received from the Medical Officers of Health of various neighbouring districts, and the names of 53 outworkers residing outside the Borough were similarly despatched to the Medical Officer of Health for the district concerned. 167 visits were paid to outworkers. 91 visits were made to premises of employers of outworkers for the purpose of examining lists and other particulars. BAKEHOUSES. At the end of the year there were 103 Bakehouses in occupation, of which 7 were underground. 672 visits were made by the Inspector during the year, and 37 nuisances discovered and abated. WORKPLACES. At the end of the year there were 96 workplaces on the register. 147 visits to eating-house kitchens have been made, and 16 notices served for cleansing and other defects, which have been complied with. SMOKE NUISANCES. Sixty-six observations were made, and 16 persons were cautioned. MEAT INSPECTION. There is one inspector appointed for meat inspection in the Borough, acting under the direction and supervision of the Medical Officer of Health. The Inspector is assisted so far as the Municipal Slaughter Houses are concerned by the Superintendent. 87 The Inspector holds the certificate of the Sanitary Association of Scotland. The superintendent of the Municipal Slaughter Houses holds the Certificate of the Royal Sanitary Institute in Meat and Food Inspection. All cases of difficulty arising from doubt or difference of opinion are decided by the Medical Officer of Health. The Meat Inspector visits the private slaughter houses as far as possible when slaughtering operations are in progress, and at other times, to ascertain whether the Bye-Laws as to removal of offal and general cleanliness are complied with. The following tabulated statements show the number of inspections made during the year, number of animals slaughtered in the Municipal Slaughter Houses, the total amount of meat and other articles of food destroyed, the reasons for which whole carcases and all organs were destroyed, the number of animals in which Tuberculosis was detected, and the action taken with regard to same. There are fourteen registered Slaughter Houses in the Borough in addition to the Municipal Slaughter Houses at Pitlake. One of the registered Slaughter Houses has been removed from the Register, as for some time it had been used for purposes other than slaughtering. 88 Six notices were served on the owners or occupiers of private slaughter houses during the year, relative to matters requiring attention under the Public Health Acts or the Slaughter House Bye-Laws, chiefly repairs to buildings or adjoining yards, all of which had been complied with at the end of the year. Summary of inspections as reported to Committee during the year I. Date. 1914. Slaughterhouses. Butchers. Fishmongers. Markets. Cowkeepers. Dairies. Other Premises. Total. January 24th 109 52 18 6 10 26 - 221 February 14th 94 50 18 6 7 25 — 200 March 14th 143 86 23 8 11 31 6 308 April 18th 159 70 22 10 6 36 9 312 May 9th 94 47 13 6 13 28 7 208 June 13th 156 67 25 10 17 52 7 334 July nth 126 49 29 8 15 34 5 266 September 5th 140 61 29 10 18 34 3 295 October 3rd 137 52 14 8 29 40 4 284 November 7th 171 72 30 10 32 54 5 374 , 28th 108 43 20 6 9 18 2 206 December 31st 197 52 29 10 10 24 5 327 1634 701 270 98 177 402 53 3335 89 The following- is the approximate number of animals slaughtered at the Public Slaughter Houses, Pitlake, and a summary for the last five years:— II. Slaughterhouses- Beasts. Sheep. Pigs. Calves. Total. Private 413 3274 13082 2648 19417 Public Totals ... 176 897 199 19 1291 589 4171 13281 2667 20708 Summary for last five years:— III. Year. Beasts Sheep. Pigs. Calves. Total. 1910 743 10541 16854 2990 31128 1911 635 9724 19371 3961 33691 1912 727 7874 19765 4017 32383 1913 458 4863 15282 3003 23606 1914 589 4171 13281 2667 20708 Total 3152 37173 84553 16638 141516 90 Summary of Meat and other articles destroyed as unfit for food during the year:— IV. ARTICLES. Weight in lbs. Remarks. Diseased. Unsound. Total. Beef 12,061 1,982 14,043 Including 26 carcases. Mutton 421 442 863 17 Pork 8,342 136 8,478 38 Veal 268 94 362 8 Offal 4,687 622 5,309 Fish 2,277 2,277 Cod, Codling, Cod roe, Cat Fish, Haddocks, Hake, Kippers Plaice, Whiting, and Winkles. Other Articles 72 72 Rabbits. Total lbs. 25,779 5,625 31,404 Including 89 carcases. Statement as to reasons for destruction of whole carcases and all internal organs:— V. Class of Animal. Tuberculosis. Peritonitis. Pneumonia. Metritis. Enteritis. Jaundice. Mammitis. Emaciated, various causes. Immature. Injured, etc. Unsound, Total carcases. Total Weight of carcases in lbs. Cattle 12 2 2 2 I 1 5 .. I .. 26 11841 Sheep .. .. 3 .. .. .. .. 8 .. I 5 17 600 Pigs 20 1 .. .. 2 6 .. 6 .. 1 2 38 5018 Calves 1 .. .. .. 3 .. .. .. 3 l •• 8 362 Totals 33 3 5 2 6 6 1 19 3 4 7 89 17821 91 Summary of Tuberculous Carcases found and how these wi'r», dealt with:— VI.+ Animals affected. Carcase and all internal organs destroyed, Part of carcase and all organs destroyed. All or part of organs destroyed. Total. Cattle 13 1 30 44 Pigs 20 136 25 181 Total 33 137 55 225 One Calf included under Cattle. DAIRIES AND COWSHEDS. There were 28 cowsheds on the register at the end of the year, of which 25 were in occupation, as against 24 registered sheds and 22 in occupation at the end of 1913. The cowsheds at present on the register provide accommodation for 450 cows, allowing 800 cubic feet of air space per head. T he number of cows in the registered sheds at the end of the year was 318. The number of Cowkeepers in the Borough is now 19, as against 15 at the end of 1913. Four cowsheds were registered during the year, providing accommodation for 21 cows at 800 cubic feet per head. One shed is a new building erected in connection with premises already on the register, and provides much improved accommodation for six cows. Another of the newly registered sheds is an old farm building which was a registered cowshed years ago. The building has now been thoroughly repaired and repaved. New channelling and impervious troughs have been provided. 92 The two other newly registered premises were smaller buildings adapted for use as cowsheds, the necessary repairs and alterations being carried out. In both cases the cows are kept primarily for the occupiers' own use. The three sheds not at present in occupation may be utilised at any time, cowkeeping being only temporarily discontinued. In one other case the cows are removed to farms in the country during the summer months, the registered shed being in use only during the winter months. During the year 22 dairymen and milk purveyors have been removed from the register on account of the business being discontinued or transferred, and 32 dairymen and milk purveyors (mostly purveyors) have been added, leaving 253 on the register at the end of the year. The number of dairy premises is 315. Three applications for registration were withdrawn as the condition of the premises or the nature of the other business carried on were such as made compliance with the regulations not possible. All three applications were those of milk purveyors. Thirty notices were served on dairymen and cowkeepers during the year for various matters under the provisions of the Dairies', Cowsheds and Milkshops' Order, and the regulations made thereunder by the local Authority, all of which were complied with at the end of the year. 93 FOOD AND DRUGS ACTS. Table XI. gives the number of samples taken by the Inspector under the Acts during the year, the results of the analyses and the action taken thereon. PROSECUTIONS, 1914. Date of Purchase. Defendant. Charge. Result. Penalty. Coits. 1914 £ s. d. £ s. d. Mar. 22 C. W. Selling Milk adulterated with 15 per cent, of additional water Convicted — 0 10 6 „ 22 E. G. Selling Milk adulterated with 3 per cent, of additional water and being 20 percent, deficient of its fat „ 0 10 0 0 16 0 April 5 A. F. Selling Milk (Separated) containing7 percent, of additional water „ 0 10 0 0 18 0 „ 10 C. C. Selling Milk adulteraced with 5 percent, of additional water „ 2 0 0 3 7 0 „ 26 E. C. Selling Milk being 15 per cent, deficient of its fat „ 1 0 0 0 17 0 ,, 26 F. C. Q, Selling Milk adulterated with 3 per cent, of additional water and being 8 per cent, deficient of its fat „ 1 0 0 0 17 0 June 12 F. S. Seliing Milk adulterated with 11 per cent, of additional water and being 12 per cent, deficient of its fat „ 2 0 0 0 18I 0 Sept. 18 W. S. Selling Butter ndulterated with 80 per cent, foreign fat „ 2 0 0 1 1 0 Nov. 9 J. S. Selling Milk adulterated with 3 per cent, of additional water „ — 1 3 6 Nov. 9 J. S. Selling- Milk adulterated with 8 per cent, of additional water „ — 0 16 0 Dec. 1 J, S. '... Selling Milk adulterated with 11 per cent, of additional water „ 0 0 3 9 6 „ 1 J. S. Selling Milk adulterated with 7 per cent, of additional water „ 4 0 0 1 0 0 1 J. s. Selling Milk adulterated with 5 per cent, of additional water „ 4 0 0 1 0 0 1 J. s. Selling Milk adulterated with 6 per cent, of additional water „ i 0 0 1 0 0 Total 25 0 0 17 13 6 94 During the year 234 samples of milk (215 new and 19 skimmed or separated) were taken. In 36 cases (32 new and 4 skimmed or separated) samples were below the standard suggested by the Board of Agriculture. Proceedings were instituted in respect of 13 of these samples, and fines and costs were imposed on the vendors to the extent of ^39 12s. 6d. Of the other 23 samples, 20 of the vendors were cautioned as the samples were only slightly below the suggested standard, the remaining three samples being informal or test samples. Twenty-two samples of cream .vere submitted for analysis during the year, three of which proved to be not genuine. The vendors were written to as required by Art. VI. of Part II. of the Milk and Cream Regulations, and the explanations were deemed satisfactory. 188 test or informal samples of butter were taken during the year, of which 19 proved to be not genuine, 10 on account of their containing over 0.5 per cent, of boric acid. In eight cases subsequent official samples were taken, of which seven proved genuine and one adulterated. During the year 66 samples of other articles were taken, which all proved to be genuine. The test samples were purchased in small quantities with other articles by women, generally during the busy periods in the evening. MILK AND CREAM REGULATIONS, 1912. The following is a copy of the Report sent to the Local Government Board under the above-mentioned Regulations, viz. : REPORT OF ADMINISTRATION IN CONNECTION WITH THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. Report for the Year ended 31st December, 1914. 1. Milk; and Cream not sold as Preserved Cream. (a) Number of samples examined for the presence of a preservative- (b) Number in which a preservative was reported to be plesent. MILK 234 Nil. CREAM 13 Three. 1. 0.31 per cent, of Boric acid. Vendor cautioned. 2. 0.2 per cent, of Boric acid. Vendor cautioned. 3. 0.48 per cent, of Boric acid. Vendor cautioned. 95 2. Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct. (i) Correct statements made 9 (ii) Statements incorrect 9 Total 9 (b) Determinations made of milk fat in cream sold as preserved cream. (i) Above 35 per cent 9 (ii) Below 35 per cent 9 T otal g (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Art. v. (1) and the proviso in Art. v. (2) of the Regulations have not been observed. Nil. (d) Particulars of each case in which the Regulations have not been complied with, and action taken. Nil. 3. Thickening substa?iccs. Any evidence of their addition to cream or to preserved cream. Action taken where found. Nil. 4. Other observations, if any. Nil. 96 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, and percentage of fat of Genuine Samples. TABLE VII. 1914 No. of Samples. No. below Standard. Percentage of Samples below Standard. Average percentage of fat of Genuine Samples. Taken in course of delivery under contract 61 10 16-39 3-84 ,, Skimmed or Separated 1 — — •27 Taken on Milkmen's rounds. Sunday mornings 87 8 9-19 3 65 „ Skimmed or Separated 13 4 30-77 208 Taken on Milkmen's rounds. Week days 67 14 20-89 3-69 ,, Skimmed or Separated 5 — — 1-72 New Milk 215 32 14-88 3-71 Separated Milk 19 4 2105 1-84 RAG FLOCK ACT, 1912. Ten inspections of premises occupied by Upholsterers and Bedding Manufacturers were made under the Act during the year. Eight samples of rag flock were taken and submitted to the Analyst. Five were reported to contain less than the amount of Chlorine allowed under the Act. 97 One was reported to contain 45 parts of Chlorine per 100,000 of the Flock. This sample was found to be part of the contents of a bed sent to the manufacturers for remake. No action was taken. One sample contained 133.5 parts of Chlorine per 100,000 parts of the Flock, and the other sample contained 160.2 parts of Chlorine per 100,000 parts of the Flock. These samples were taken from the contents of beds which had been sent to the manufacturers for remake, but as they were to have new covers they were considered to be new beds, having- regard to the definition given by the Judge in the case of Guildford Corporation v. Brown, 31 T.L.R. 92. The case came into Court, but unfortunately broke down, as the Analyst admitted he did not take the temperature of the water in which the Flock was washed. A subsequent sample taken at the same factory proved to be clean Flock. 98 TABLE VIII. Work done by the Sanitary Inspectors during the Year ending 27th December 1914. NATURE OF CASES DEALT WITH Deputy Chief Insp. Culver. Insp. Earwicker Insp. Peck. Insp. Richardson Insp. Bull. Insp. Fulker. Insp. Vincent. Insp. Flint. Insp. Hunt. Total House to House Inspection 626 369 607 768 .. .. 608 526 681 4185 No. of Houses inspected where zymotic diseases have occurred 83 139 171 216 .. .. 288 102 130 1129 No. of Visits of enquiry re infectious disease 31 125 231 252 .. 499 112 40 59 1349 House drains tested with smoke (primary) 105 2o4 404 414 .. .. 330 193 W 1997 ,, ,, ,, on application 38 16 28 12 .. .. 8 5 35 142 Drains found defective 143 16 28 37 .. .. y 12 28 273 House drains re-laid 42 .. 23 10 .. .. 13 34 37 159 ,, ,, repaired 18 .. 32 43 .. .. 14 28 20 155 No. of smoke tests during repair 129 128 209 185 .. .. 85 145 144 1025 „ water„ 308 111 126 56 .. .. 100 45 148 894 Damp-proof courses inserted 17 .. 1 3 .. .. 8 9 6 44 Yards paved 27 12 .. 32 .. .. 12 10 37 130 Inspection of Premises where offensive trades are conducted .. .. .. .. .. .. .. .. .. .. Inspections of Factories and Workshops, etc .. .. .. .. 1679 .. .. .. 1 1680 „ Greengrocers, Fishmongers & Ice Cream Shoos 162 193 238 149 .. .. 519 100 182 1543 ,, ,, Schools 22 12 43 4 .. 17 26 5 22 151 ,, ,, Shops 17 1 9 7 .. .. 7 6 7 54 ,, ,, Bakehouses .. .. .. .. 672 .. .. .. .. 672 ,, ,, Yards and Stables 201 412 497 386 .. .. 569 248 640 2953 ,, ,, Common Lodging Houses .. .. .. .. 549 .. .. .. 1 550 ,, ,, ,, night visits .. .. .. .. 10 10 ,, ,, Houses let in Lodgings .. .. .. .. .. .. 223 568 .. 791 ,, ,, ,, ,, night visits .. .. .. .. 1 .. .. .. .. 1 ,, ,, Urinals 405 112 465 398 .. .. 473 91 465 2409 Smoke observations 1 .. .. .. 65 .. .. .. .. 66 Re-inspections of work in progress 798 1101 1289 1520 .. .. 1630 1384 1523 9245 Sundry inspections 583 364 490 382 299 169 339 375 344 3345 Complaints from public investigated 180 47 74 109 .. .. 215 108 85 818 NUISANCES DISCOVERED. Houses requiring Cleansing & Whitewashing 207 93 102 203 68 .. 83 169 209 1134 ,, Overcrowded 10 5 11 4 .. 8 28 15 81 Leaky Roofs 35 43 37 52 .. .. 29 43 60 299 Dampness in Houses 50 45 60 26 .. .. 31 ;-8 50 300 Drains found stopped 86 48 43 81 9 2 108 81 51 509 Drains and Sanitary Fittings found defective 163 138 225 247 71 .. 135 131 172 1282 Defective Yard Surfaces 46 50 12 52 4 .. 79 13 38 294 ,, Eaves and Downspouts 93 27 36 77 .. .. 33 22 64 352 ,, Manure Receptacles 1 3 .. .. 3 1 2 10 ,, Urinals 5 .. .. .. .. .. .. .. 1 & ,, Ashbins 179 41 183 114 .. 85 136 177 915 Smoke Nuisances 1 .. .. .. 5 .. .. 1 7 Animals improperly kept 6 1 6 3 4 .. .. 5 2 27 Infringements of Bye-laws and Regulations 1 6 2 29 .. .. .. .. 38 Offensive Acc umulations 33 11 5 13 2 .. 2 10 5 81 Sundry other Nuisances 8 95 187 91 .. 10 158 150 699 Total number of Nuisances 915 509 815 1068 287 2 606 836 996 6034 Informal Notices served 447 176 492 547 43 .. 387 663 542 3297 ,, ,, complied with 456 237 470 512 52 .. 338 666 532 3263 ,, in abevance 47 28 45 71 5 .. 57 43 83 379 Referred to Committee 37 11 49 14 .. .. 20 34 26 191 Council orders in abevance (1913) 32 1 27 7 .. 21 12 32 132 69 12 76 21 .. .. 41 46 58 323 ,, ,, complied with 68 12 73 21 .. .. 32 36 49 291 Council orders in abeyance 1 .. 3 .. .. .. 9 10 9 32 99 TABLE IX. Workshops on Register, number of Employees, and visits paid during the year. TRADE No. of Workshops. No. of Employees. No. of Visits Aeroplane maker 1 2 2 Banana Works 1 2 4 Blind Makers 2 3 3 Blacksmiths 6 16 12 Bootmakers 20 42 46 Builders 4 10 6 Cabinet Makers and Upholsterers 31 77 45 Cigarette Maker 1 1 1 Carriage Builders 10 30 25 Chemists 1 2 1 Confectioners 2 7 2 Cycle Works 20 26 38 Dentists 4 11 3 Dressmakers and Milliners 275 947 446 Electricians & Engineers 3 9 3 Filmmaker 1 20 1 Florists i 4 1 Glass Works i 10 2 Greenhouse & Ladder Makers 2 11 7 Ironmongers 12 15 22 Jam Maker 1 4 16 Laundries 70 328 102 Modeller 1 1 1 Photographers 2 5 14 Piano Maker 1 2 1 Picture Frame Makers 1 6 1 Rag Pickers a 7 15 Saddlers 8 16 29 Scenic Artists 1 2 1. Sign Writers 4 12 22 Stonemasons 3 12 13 Scale Makers 2 4 2 Tailors 98 297 247 Toy Maker 1 8 2 Umbrella Makers 3 8 5 Watchmakers 5 15 18 Wicker Chair Makers 1 1 1 Wig Makers 2 5 2 Xmas Card Makers 2 17 16 Totals 606 1995 1177 IOO TABLE X. Food and Drugs Acts Total Number of Samples taken during the year 1914. Sample of Total Samples. Genuine. Not Genuine. Prosecutions. Convictions. eCaution*. Milk 215 183 32 12 12 17 ,, Skimmed or separated 19 15 4 1 1 3 Cream 22 19 3 — — 3 Butter 203 181 22 1 1 2 Margarine 1 1 — — — — Lard 12 12 — — — — Coffee 9 9 — — — — Condensed Milk 5 5 — — — — Machine Skimmed Condensed Milk 8 8 Baking Powder 11 11 — — — — Salt 1 1 — — — — Tartaric Acid 2 2 — — — — Citric Acid 3 3 — — — — Olive Oil 12 12 — — — — Camphorated Oil 2 2 — — — — Apples 1 — 1 — — — Totals 526 464 62 14 14 25 IOI TABLE XI. Food and Drugs Acts. Particulars of Samples taken during the fifteen years 1900.1 914 inclusive:— Year. Number of Samples taken. Number Genuine. •Number Adulterated. Percentage of Adulterated. Prosecutions. Total amount of Fines and Coitt imposed. £ s. d. 1900 246 230 16 6.5 5 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 1911 501 436 65 12.9 6 18 8 6 1912 525 473 52 9.9 13 35 10 0 1913 535 497 38 7.1 4 37 14 4 1914 526 464 62 11 8 14 42 13 6 * The term adulterated includes samples found to be not up to standard. I O 2 TABLE XII METEOROLOGICAL RECORD—YEAR 1914. Rain 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 TemDerature of Ground at 4.ft. Mean Temperature of the Dew Point. Mean Tensional Difference between Ground and Dew Point at 9 a.m. and 3 p.m. Rainfall. Highest. Lowest. Meau of No. of Days on which Rain fell. Amount collected in Inches. Difference from average 90 years at Greenwich All Highest. All Lowest. January 54° 20° 41°.5 33° .7 37° .6 — 0°.9 42°.1 35° 5 in .084 13 in. .61 in. — 1.18 February 58° 30° 50°.7 38° .9 44°.8 + 5°.3 43°.1 41° 9 .044 15 3.98 + 2.45 March 66° 29° 49°.8 37°'.7 43° .7 +2°. 0 43°.7 o O .055 27 4.34 + 2.83 April 77° 32° 61° .8 40°.6 51°.2 + 4°.0 45°.9 45° 3 .041 10 .92 — .68 M ay 88° 35° 65°.1 44° .6 54°.8 + l°.7 50°.2 48°.9 .064 10 1.22 — .65 June 89° 41' 74° .1 50°.9 62°. 5 + 3°.1 54°.3 54°.9 .056 11 .85 — 1.18 July 92° 45° 74° .9 54°.2 64°.5 + 2°. 0 59°. 4 57° 9 .066 15 1.51 — .90 August 82° 45° 74°. 0 54°.3 64°.1 + 2°.5 58°.4 58°'8 .049 11 1.63 — .75 September 81° 34° 69°.5 48°.6 59°.0 + 1°.8 57°.6 54°.5 .082 8 .60 — 1.60 Octobei 68° 34° 59° .1 45° .6 52°.3 + 2°.3 52°.8 49° .2 .069 10 1.41 — 1.32 November 61° 28° 51°. 4 39° .3 45° .3 + 2°.1 493.7 42°.5 .094 18 3.60 + 1.31 December 59° 26° 47°.5 38° .3 42° .9 + 3°.2 45°.5 41° 6 .064 25 8.00 + 6.06 Means and Totals or the Year. 92° 20° 59°.9 43° .9 51°.9 +2°.4 50°.2 47°.6 .064 173 28.67 + 4.39 The Rainfall for the Year was 2.57 inches above, and the number of days on which rain fell 10 above the average of 50 years at Croydon. GEO. CORDEN, F.R. Met. Soc., Croydon. io3 Section F—TUBERCULOSIS SCHEME. During the year 1914 the general arrangements under the Tuberculosis Scheme have remained as in the previous year. The Dispensary has acted as a focus of the work and the institutional accommodation has consisted of beds in sanatoria obtained as required and beds in the Borough Hospital. The treatment and general work consists therefore of dispensary, sanatoria and hospital treatment for all cases requiring supervision by the Public Health authority and of domiciliary treatment for insured persons, this latter being only available as a specific mode of dealing with tuberculosis under the National Insurance Act, 1911, which provides, of course, for the attendance of a panel practitioner under the provisions of the Act. The provision of extra nourishment—a most important adjunct to the treatment of tuberculosis—is provided for to a certain limited extent by the local authority for noninsured persons this being parallel with the provision of extra nourishment provided for by the legislature under the National Insurance Act. The number of beds available at the Borough Hospital for the treatment of phthisis is 17 (12 in Ward K. and 5 shelters). Six of the ward beds are reserved for females and the remaining 6 beds and 5 shelters are occupied by male patients. The sanatoria to which patients were sent were as follows, viz.:— Brompton Hospital. City Road Hospital, London. Clare Hall Sanatorium, South Mimms. Crooksbury Sanatorium, Surrey. Frimlev Sanatorium. Great Baddow Encampment, near Chelmsford. Ide Hill Sanatorium, Surrey. King Edward VII. Sanatorium, Midhurst. Lord Mayor Treloar's Cripples Home, Alton. Merivale Sanatorium, near Chelmsford. National Children's Home and Sanatorium, Harpenden. National Sanatorium, Benenden. Royal National Hospital for Consumption, Ventnor. Royal Sea Bathing Hospital, Margate. St. Catherine's Home, Ventnor. General Remarks.-—The year 1914 is the first year in which the Tuberculosis Dispensary has been in full working order throughout. The statistics relating thereto are therefore not strictly comparable with those published for 1913. The work has increased greatly in all directions, notably so in the provision of institutional and dispensary treatment for uninsured persons, 377 104 such persons having been seen in the year and 198 given active treatment. The majority of these were children and, since the problems of tuberculosis in children are of vital importance, the statistics relating to children have been separated out from the general mass and appear in detail in Tables T 4, T 15. It is as yet too early to express any definite opinion on the results of treatment, but as far as it is possible to judge, the proportion of return of a reasonable degree of working capacity amongst those treated has been satisfactorily high, and the Tables (Nos. T 9, T 10, T. 13) setting forth the further progress of persons treated in 1913 shew that a large number have been able to remain at work throughout the year. In estimating progress and results of treatment ability for work has been regarded as the main criterion since amongst the class of persons dealt with it is most important that they should be restored, as far as possible, to an earning capacity. The work done naturally varies considerably, but every effort is made to secure healthy occupations, and in a large number of cases occupations unsuitable for tuberculous persons have been given up and a comparatively open-air life adopted. A chief aim of the Dispensary has been to keep in touch with all persons who have come in contact with it. After a patient returns from a sanatorium or hospital he or she is urged to attend regularly at the .Dispensary for supervision, however apparently cured they may be. Every method possible (visits from the health visitors or the Medical Officer; personal letters from the Medical Officer, &c.) is used to ensure that every known tuberculous person in the Borough who has been seen by the Medical Officer is thereafter given every opportunity to receive advice and treatment whenever such is required, and that at all times a general supervision is exercised over those who have received treatment and have returned to work. In spite of obvious difficulties in carrying out this idea it has in the majority of cases been successfully attained, and it is satisfactory to record that, with but few exceptions, old patients return to the Dispensary for advice in the regulation of their habits of life. A large number of persons have been seen as "contacts " (vide table T 5). Many of these have proved suspicious, and they, together with similar doubtful cases seen apart from contact work, have been kept under careful supervision. They report themselves every few months for re-examination so long as any suspicion of tuberculosis remains, and in this way there is no doubt that many cases are detected in the earliest and most hopeful stage, and much useful advice can be given to prevent those persons peculiarly susceptible to tuberculosis from developing the disease. I05 Summary of Notifications. TABLE T. i. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 4th January, 1914, to the 2nd January, 1913, in the County Borough of Croydon. Age-periods Notifications on Form A. Notifications on Form B.† Number of Notifications on Form C- Number of Primary Notifications,* Total Notifications on Form A Number of Primary Notifications.* Total Notifications on Form B, Poor Law Institutions Sanatoria 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Primary Notifications Under 5 5 to 10 10 to 15 Total Primary Notifications Pulmonary Males 2 3 5 6 12 16 62 49 21 s 3 187 201 7 4 ii ] I 6 43 ,, Females 8 3 12 16 24 42 21 II 3 3 143 *54 6 8 14 14 S 27 Non-pulmonary Males 5 IO 9 5 3 2 5 2 I 1 43 44 14 2 16 16 2 3 ,, ,, Females 3 7 IO 12 5 3 12 2 1 55 53 IO 4 14 14 1 Col. (i) (2) (3) (4) (s) (6) (7) (8) (9) (10) (n) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) Patients notified as suffering from both pulmonary and non-pulmonary disease are included among the "pulmonary returns only *Primary notifications relate to patients who have not previously been notified in this or former years, either on Form A or on Form B, in the area to which the return relates. Any additional notification of a case which has been previously notified in the area is to be regarded as duplicate. (Note—No primary notifications are made on Form C). +A School Medical Inspector, or the Medical Officer of Health of a county, county borough, or other district, if acting as a School Medical Inspector, is required to notiiy cn Form B all eases of tuberculosis discovered in the course of inspection of children attending public elementary schools, whether or not these have previously been notified. Cols. 2-13. Only those cases which have been notified for the first time during the year on Form A in the area concerned, and which have never previously been notified in the area, either on Form A or on Form B, are included in these columns. Col. 14. The object of this column is to show the extent to which duplicate notification of the same case occurs on Form A, and all notifications on Form A, whether duplicate or not, are included in this column. Cols. 15.18. Only those cases which have been notified for the first time during the year on Form B in the area concerned, and which have never previously been notified in the area, either on Form A or Form B, are included in these columns. Col. 19. All notifications which have been made during the year on Form B in the area concerned, whether the cases have previously been notified in the area, or not, either on Form A or on Form B, are included in this column. Col. 21. Only notifications on Form C made by the Medical Officers of Sanatoria, as defined in the Tuberculosis Regulations, are entered in this column. 106 General Survey of Cases dealt with through the Dispensary and work done in connection with them. TABLE T. 2. Table showing origin of Cases seen at the Dispensary for the first time in 1914. Cause of person attending Dispensary. Insured. Uninsuced.† Grand Total. Men. Women Child'n Total. Men. Women Chiln'n Total. (1) Referred by local doctors or hospital for diag nosis, treatment or advice I53 70 ... 223 25 5° 5° 125 348 (2) Ditto ditto by School Medical Officers ... ... ... ... ... 2 68 70 70 (3) Ditto ditto from other, chiefly charitable, sources *IO 6 ... 16 8 30 23 61 77 (4) Seen as <4 Contacts" 4 3 ... 7 2 21 98 121 128 167 79 ... 246 35 I03 239 377 623 * Including 2 men treated by arrangement with the Surrey County Council, †This includes dependents of insured persons. This table shows the total number of new cases seen at the Dispensary in 1914 and the reason why each case was examined. It will be noted that the majority of cases were referred to the Dispensary either by their private doctor or, in the case of children, by the School Medical Officers. A certain number of cases are reported by charitable agencies, but before these are seen enquiry is always made as to whether a doctor is in attendance, and if so his consent is obtained before the case is seen. The remainder consist of "contacts," of which further details are given in Table T 5. The majority of these contacts are not receiving any medical attention, but wherever this is not the case the doctor ordinarily concerned with the case is first consulted. In this way the Dispensary works in complete harmony and co-operation with the local practitioners, and a continually increasing number of persons are sent by local doctors to the Medical Officer for diagnosis, treatment, or advice. IO-J TABLE T. 3. Table showing the way in which new cases were dealt with in 1914. Insured. Uninsured. Grand Total, Men. Women Child'n Total. Men. Women Child'n Total. (1) Diagnosed as tuberculous : (1a) Treated through the Dispensary 101 45 146 24 55 119 198 344 (b) Treated elsewhere... 4 1 5 7 11 7 25 30 (2) Diagnosis not settledKept under observation 5 5 10 1 8 23 32 42 (3) Diagnosed not tuberculous 57 28 85 3 29 90 122 207 623 in this table the 623 new cases seen in 1914 are analysed according to the result of their examination by the Medical Officer. A considerable proportion (207) were diagnosed as not tuberculous. These persons, however, were not lost sight of entirely, and were specially urged to return to the Dispensary for further examination if their future progress was not satisfactory. The majority willingly agreed to avail themselves of the opportunity for renewed examination if necessary. In 42 cases the diagnosis was unsettled at the end of the year, and the individuals were remaining under regular observation from the Dispensary. The remainder, 374 cases, were found to be definitely tuberculous, and, with the exception of 30 cases, were treated through the agency of the Dispensary. The 30 cases not so treated were either leaving the borough or preferred to make their own arrangements, being able to afford to do so. TABLE T. 4. Analysis of Children (under 16) examined for the first time at the Dispensary in 1914. Total cases examined. Diagnosed Tuberculous. Kept under observation. Diagnosed not Tuberculous. Pulmonary nonpulmonary. Boys 116 13 46 14 43 Girls 123 23 44 9 47 Totals 239 36 90 23 90 108 Owing to the much greater proportion of non-pulmonary tuberculosis and the greater difficulties of diagnosis in children as compared with adults, the details of the examinations made of children under 16 years of age in 1914 have here been separated out. The diagnostic classification must be regarded as provisional to some extent since amongst children it is usually difficult to classify accurately into "pulmonary" and "non-pulmonary" tuberculosis, as the majority of tuberculous children show signs in the lungs which may or may not be true pulmonary tuberculosis, and some suffer from both types of the disease. Differentiation between these two type? of disease is largely a matter of prolonged observation and treatment. In these tables, therefore, cases have been classified according to their most prominent features. The subsequent progress of the cases may necessitate rearrangement later on. TABLE T. 5. Table showing results of Examinations of "Contacts," 1914. Men. Women. Children. Total. fi) Fonnd to be Tuberculous 2 3 ?5 30 (2) Kept under observation as suspicious 5 11 16 (3) Found not Tuberculous 4 16 62 82 Total examined 6 24 98 128 Note.—The high proportion of contacts which were found to be tuberculous is partly explained by the fact that the cases examined were to a large extent selected on account of their appearance or previous medical history being directly suspicious of tubercular infection. It was not found possible to examine all the contacts in each family where tuberculosis was present, but nearly all suspicious contacts were examined. As the work of the Dispensary becomes increasingly organised, a larger proportion of the total contacts will be examined, and the high proportion of tuberculous contacts shown above will probably be reduced. 109 TABLE T. 6. Table showing details of Medical Examinations made by the Medical Officer to the Tuberculosis Dispensary, 1914. Period. 1914. Tdtal Medical Examinations made. New Cases Examined. Remarks. At the Dispensary. At Patients Houses. Grand Total Insured. NonInsured. Total. Insured. NonInsured. Total. Insured. NonInsured. Total. Jan. ist to March31st 332 292 624 31 27 58 682 89 123 212 Non - insured persons first became eligible for treatment on |an. Ist, 1914. April ist to June 30th 341 460 801 19 12 31 832 61 96 157 — July ist to Sept. 30th 325 429 754 25 8 33 787 46 66 112 The Medical Officer was absent on holiday during Sept., and the work was reduced as far as possibla in that month. Oct. ist to Dec. 31st 338 501 839 25 13 38 877 50 92 142 — Totals 1336 1682 3018 100 60 160 3178 246 377 623 Note. In addition to the medical examinations shown in this table the Medical Officer also visited and examined the tuberculous patients at the Borough Hospital twice weekly throughout the year. [The average number of examinations made per day (including visits) was 11.2, and the average number of new cases seen per day was 2.1]. 110 This table shows the actual work done by the Medical Officer in examining patients at the Dispensary and at their homes, and also the rate at which new cases were seen during the year. The first quarter of the year showed a marked influx of uninsured persons, chiefly children, since such persons first became eligible for treatment on January ist, 1914. Throughout the year, however, the number of new cases seen remained at a high level, averaging ove*- two a day, and the examinations made steadily increased as the total number of individuals in touch with the Dispensary became more numerous. The numbers of new cases and of necessary examinations have increased still further in 1915, and it is clear that the limits of the work of the Dispensary are still far from being reached. The proportion of known tuberculosis in the Borough which is dealt with through the Dispensary is satisfactorily high, as is shown by the following estimate :— (1) Total Primary Notifications, 1914 473 (2) Total new cases seen at Dispensary and diagnosed as tuberculous, 1914 374 Practically all the cases in (2) may be reckoned as included in (1). Therefore approximately 79 per cent, of the cases notified in the Borough in 1914 were seen by the Medical Officer to the Tuberculosis Dispensary. But approximately one-eighth of the notified cases in the Borough occur in houses of a rental estimated over £35, per annum, and in the majority of these cases treatment through the Dispensary is not required, and the Medical Officer only acts as consultant when called to see them. In 1914 344 new cases were treated through, as well as being seen, at the Dispensary. An estimate of the number of new cases which it was advisable should receive treatment from the public health authority in 1914 may be made as follows:— Total primary notifications (1914) 473 Less one-eighth occurring in houses of rental estimated over £35 per annum 59 Therefore new cases occurring in 1914 which presumably required treatment through the Dispensary 414 And actual cases treated through Dispensary 344 i.e., 82 per cent. 111 Thus allowing for unavoidable errors it may be assumed that during- 1914 approximately 80 per cent, of the fresh cases occurring amongst the class where Dispensary treatment was desirable were actually treated through the Dispensary. SANATORIUM AND HOSPITAL TREATMENT : TABLE T. 7. SUMMARY OF CASES TREATED AT SANATORIA, 1914. M. W. C. Tl. (A) Persons in Sanatoria on Jan. 1st, 1914 10 5 1 16 (B) Persons who were admitted to and discharged from Sanatoria during 1914 33 35 22 90 (C) Persons who were admitted to and died at Sanatoria during 1914 3 3 (D) Persons in Sanatoria on December 31st, 1914 19 13 13 45 Note.—One woman appears both in (A) and (B) and one in (B) and (C). (1.) The total individuals receiving treatment in Sanatoria during 1914 is therefore [A + B + C + D —2] Men ... ... ... ... 65 ^ Women ... ... ... ... 51 152 Children 36 J (ii.) The total individuals sent to Sanatoria in 1914 is [B + C 4- D — 1]. Men 55 j Women ... ... ... . 47 137 Children ... ... ... ... 35 j Remarks. (i.) 60 men and 33 women weri " insured persons." (ii.) 5 men were treated for less than one month in Sanatoria : 2 of these (Class C) died shortly after admission. In their case the place of treatment was the Brompton Hospital, not a " sanatorium " in the strict sense of the word. (iii.) Certain of these cases received more than one kind or period of institutional treatment in 1914 as follows :—■ 3 men had previously been treated at the Borough Hospital in 1914. 4 men were subsequently treated at the Borough Hospital in 1314. 1 woman was twice admitted to and discharged from a Sanatoria in 1914 and was then admitted! to the Borough Hospital. 1 woman was twice admitted to a Sanatorium in 1914, remaining there at the end of the year. (iv.) 11 of the children were boys and 24 were girls. 112 TABLE T. 8. SUMMARY OF CASES TREATED AT THE BOROUGH HOSPITAL, 1914. M. W. Tl. (A) Persons at the Borough Hospital on Jan. 1st, 1914 9 5 14 (B) Persons who were admitted to and discharged from the Borough Hospital during 1914 34 4 38 (C) Persons who were admitted to and died at the Borough Hospital during 1914 7 1 8 (D) Persons at the Borough Hospital on Dec. 31st, 1914 Note.—One woman appears in both (A) and (D). 7 6 13 Total individuals receiving treatment at the Borough Hospital in 1914 is [A + B + C + D — 1]: Men 57 1 Women 15 f and total individuals admitted to the Borough Hospital in 1914 is [B + C D — 1]: Men 48 Women 10 Remarks: (i.) 50 men and 12 women were "insured persons." (ii.) 2 men received less than one month's treatment. (iii.) 1 man in Class A died at the Borough Hospital during 1914. (iv.) 1 woman was admitted twice during 1914. (v.) 4 men and 1 woman had previously and 3 men subsequently- received treatment in a Sanatorium during 1914. (vi.) 1 woman was at the Borough Hospital throughout the year. In these tables the actual numbers of persons sent to Sanatoria and to the Borough Hospital at Waddon are shown. Certain persons received treatment both at sanatoria and at the Borough Hospital during the year, and thus appear in both tables, but the details regarding these persons are given in the notes appended to each table. In comparison with 1913 the noteworthy point is the number of children sent to sanatoria. Cases of non-pulmonary tuberculosis amongst children were sent to the Royal Sea Bathing Hospital at Margate, pulmonary cases being, with but few exceptions, sent to the National Children's Home and Sanatorium at Harpenden. 113 RESULTS OF TREATMENT: It is as yet too early to make other than general statements as to the results obtained by treatment, whether at Sanatoria, Hospital, or Dispensary alone. Tuberculosis is so persistent a disease, and the danger of relapse so great, that at least three or four years must elapse before the actual permanent results of treatment can be ascertained. In the following tables, however, an attempt is made to show at least the immediate results of treatment, and succeeding years will prove whether these results are merely temporary or not. In considering these tables the following points must be kept in mind:— (1) Cases treated in Sanatoria are chosen for such treatment as being either in an early and presumably favourable stage of the disease, or because previous experience has shown that such treatment is the best for a particular case. Hence the after-results of sanatorium treatment ought to be good, as the cases are specially selected on account of their favourable outlook. It must be remembered, however, that the social conditions of the patient on his return from the sanatorium may often destroy much of the good that has been done, and relapse is frequently due not to inefficient treatment, but to bad home conditions as regards housing, food and work. These difficulties are present in regard to all forms of treatment, and vitiate any accurate estimate of results. As far as possible the Dispensary endeavours, by constant supervision of the patient and his home, provision of additional nourishment, advice as to work, &c., to diminish these factors antagonistic to successful treatment, and to a large degree succeeds, but their presence must never be forgotten. (2) Cases treated at the Borough Hospital are usually either advanced or chronic in type, and actual arrest of the disease is rarely possible. Persons sent to Sanatoria are usually well enough to be out of bed, whereas those admitted to the Borough Hospital for the most part require prolonged treatment in bed. The five shelters for male patients, however, are used to a considerable extent for patients who have had a slight temporary relapse and require a short additional period of institutional treatment. The results of treatment at the Borough Hospital must therefore be judged from a different standpoint from those at Sanatoria, and the proportion of good results can never be high. 114 (3) DISPENSARY TREATMENT: With few exceptions, all tuberculous persons in receipt of any form of treatment attend the Dispensary either regularly or at prolonged intervals. The table showing results of Dispensary treatment, however, applies only to those persons who attended the Dispensary with regularity and were thus under the direct control of the Medical Officer. Cases which received Sanatorium or Institutional treatment are not included in the Dispensary table, their progress being recorded in the Sanatorium and Institutional tables respectively. Nearly all cases receiving such treatment, however, regularly attended the Dispensary either before or after such treatment. The treatment given at the Dispensary comprises the provision of malt and oil; medicines, thermometers, respirators, &c., and in many cases additional nourishment in the form, usually, of milk and eggs. In addition, each patient is repeatedly instructed in the hygiene of the disease and a careful watch is kept on their progress by frequent medical examinations, so that any signs of relapse may be promptly dealt with. The Dispensary, in short, endeavours to act as a centre not only for treatment of active tuberculosis, but also for the steady supervision of quiescent and arrested cases and for the searching out of "contacts." As far as possible no known case of tuberculosis in the Borough for which attention from the public authority is required is allowed to remain without regular and systematic medical supervision and advice. 115 TABLE T. 9. Table showing further progress of persons first treated in and discharged from Sanatoria in 1913. Condition on discharge from San. : Condition on Dec. 31st, 1913 : Condition on Dec. 31st, 1914 : M. W. T l. M. W. T l. M. W. T l. Fit for work 29 4 33 At work 25 3 28 At work 21 3 24 [4 of whom were admitted to B.H in 1914] Fit for work 1 0 1 Fit for work 1 0 1 Relapsed 1 0 1 Relapsed 5 0 5 Readmitted to San. 1 0 1 Left Croydon 1 1 2 Left Croydon 1 1 2 Deceased at San. 1 0 1 33 33 Improved 2 1 3 Further improvement 1 0 1 In statu quo 1 0 1 [Treated at B.H. 1913-14] Relapsed 1 0 1 Worse 0 1 1 Admitted to B. B 0 1 1 Deceased 1 0 1 3 3 In statu quo 5 2 7 Fit for work, having had treatment at B. H. 0 1 1 'At work 0 1 1 [Treated at B.H. 1913] At Boro' Hospital 0 1 1 In statu quo 1 0 1 In statu quo 2 0 2 Worse 1 1 2 [One treated at B.H. 1913-14] Worse 3 0 3 Deceased 3 0 3 7 7 Worse 5 0 5 In statu quo 2 0 2 Deceased 5 0 5 Admitted to B. H. and died there 1 0 1 Deceased 2 0 2 5 116 TABLE T. 10. Table showing further progress of persons first treated at and discharged from the Borough Hospital in 1913. Condition on discharge from B.H.: Condition on Dec. 31st, 1913: Condition on Dec. 31st, 1914 : M. W. T l. M. W. T l. M. W. T l. Fit for work 10 4* 14 At work 3 2* 5 At work 5 3 8 Two men had additional Institutions treatment in 1914] Fit for work 3 2 5 Relapsed 1 1 2 Relapsed and sent to Sanatorium 2 0 2 Deceased 2 0 2 Left Croydon 1 0 1 [*One having had treatment at a Sanatorium without improvement]. unfit for work 1 0 1 Found to be nontuberculous 1 0 1 [Spinal disease] Left Croydon 1 0 1 14 \ 14 Improved 7 1 8 Relapsed 1 0 1 In statu quo 1 1 2 [One readmitted to B.H. in 1914] [One readmitted to B.H. and died there 1914] Readmitted to B.H. 1 0 1 Relapsed 2 0 2 In statu quo 4 1 5 Deceased 3 0 3 Left Croydon 1 0 1 Left Croydon 1 0 1 8 8 In statu quo 3 1 4 In statu quo 2 0 2 In statu quo 1 0 1 Deceased 1 1 2 Deceased 2 1 3 4 4 Worse 1 1 2 Deceased 1 1 2 (Both discharged themselves). 117 In these tables the progress of persons treated in and discharged from Sanatoria or the Borough Hospital during 1913 is shown by their condition at the end of 1914 as compared with the end of 1913 and when they left the institution during 1913. In these, as in other tables showing results of treatment, ability for work is taken as the criterion of success, and no attempt has been made to sub-divide the cases according to their types of disease, home conditions, age, or other factors. The classification being thus on so broad a basis, it is especially satisfactory to note in the sanatorium table (T 9) that out of the 28 persons who were at work at the end of 1913, 24 were still at work at the end of 1914, and further, that in the Borough Hospital table (T 10), whereas at the end of 1913 5 persons were at work and 5 fit for work, at the end of 1914, 8 were actually at work and 2 still fit for work. 118 TABLE T. II. Table showing Results of Treatment in Persons discharged from Sanatoria during 1915. Condition on Discharge. Condition on December 31st, 1914. M. W. C. T L. M. W. C. T L. (i.) Fit for work or School 32 23 19 74 At work or school 27 18 19 64 Ditto after additional treatment at Borough Hospital 2 - 2 Fit for work 2 5 - 7 Deceased 1 — — 1 74 (ii.) Improved 5 13 3 21 At work 1 2 - 3 Further improvement - 5 2 7 Ditto after re-admission to Sanatorium and treatment at Borough Hospital - 1 - 1 In statu quo - 3 1 4 Re-admitted to San. - 1 - 1 Admitted to Borough Hospital 1 - - 1 Relapsed 2 1 - 3 Deceased, after treatment at Borough Hospital 1 - - 1 21 (iii.) In statu quo 1 1 - 2 Much improved 1 - - 1 Deceased - 1 - 1 2 (iv.) Worse 1 2 1 4 Much improved 1 - - 1 In statu quo - 1 - 1 Deceased - - 1 1 Left Croydon - 1 — 1 4 Note.— This table does not include 5 persons (men) who had less than one month's treatment. Two of these died shortly after admission; one died shortly after he had discharged himself from the Sanatorium. One man was in poor health on December 31st, 1914, and one was fit for work. 119 TABLE T. 12. Table showing Results of Treatment of Patients discharged from Borough Hospital during 1914. Condition on Discharge. Condition on December 31st, 1914. M. W. T L. M. W. T L. Fit for Work 19 3 22 At work 14 2 16 Do. after relapse and treatment at Sanatorium 1 0 1 Fit for work 1 0 1 Relapsed 2 1 3 Deceased 1 0 1 22 Improved 20 4 24 . At work 0 1 1 In statu quo 2 1 3 Relapsed 9 2 11 Left Croydon 1 0 1 Deceased 6 0 6 Admitted to San. 2 0 2 24 In statu quo 1 1 2 In statu quo 0 1 1 Deceased 1 0 1 2 Note.— In addition 2 men were admitted during 1914, but discharged themselves after only 2 weeks' treatment. One was in good health and has kept at work since; the other was acutely ill and died shortly after. These tables are based on the same principle as tables T 9 and 10 and are capable of continuation at the end of each year so as to show the further and final progress of each case. Certain cases in these two tables occur also in tables T 9 and 10, and are indicated in the remarks added to the latter tables. i 20 TABLE T. 13. Table showing Results of Treatment at Dispensary alone, 1913 1914. Condition when first seen : Condition on Dec. 31st, 1913 : Condition on Dec. 31st, 1914 : M. W. Tl. M. W. Tl M. W. Tl. (i) Good 8 0 8 At work 7 0 7 At work 6 0 6 Left Croydon 1 0 1 Relapsed 1 0 1 8 Left Croydon 1 0 1 8 (ii) Fair 8 5 13 At work 6 0 6 At work 4 0 4 Improved 0 l 1 In statu quo 0 4 4 In statu quo 0 4 4 Relapsed 2 0 2 Relapsed 2 0 2 Deceased 2 1 3 13 13 (iii) Poor 3 0 3 At work 1 0 1 At work 1 0 1 In statu quo 1 0 1 Worse 1 0 1 Deceased 1 0 1 Deceased 1 0 1 3 3 (iv) Acute 6 3 9 Deceased 6 3 9 Total Cases Men ... 25 33 (all insured persons). Women ... 8 121 TABLE T. 14. Table showing Results of Dispensary Treatment alone, 1914. Condition when first seen. Condition on December 31st, 1914. M. W. C. TL. M. W. C. TL. Good 11 11 8 30 At work 10 7 — 17 In statu quo 3 7 10 Relapsed - - 1 1 Left Croydon 1 1 — 2 30 Fair 17 25 71 113 At work 5 4 — 9 Good — — 29 29 Improved 4 11 40 55 In statu quo 4 10 2 16 Left Croydon 1 — — 1 Deceased 3 — — 3 113 Poor 6 7 9 22 At work 2 - - 2 Good - - 3 3 Improved 3 - 6 9 In statu quo — 4 — 4 Worse — 2 — 2 Deceased 1 1 — 2 22 Acute 10 4 0 14 Improved 1 - - 1 In statu quo 1 2 — 3 Deceased 8 2 — 10 14 Total Cases Men 44 179 Women 47 Children 88 Of these, 30 men and 12 women were "insured persons." In these tables the results of Dispensary treatment alone are shown, none of the cases having received treatment in a Sanatorium or at the Borough Hospital during the years 1913-14 in the case of table T 13 or 1914 in the case of table T 14. 122 TABLE T 15. Table showing Results of Treatment amongst Children, 1914. A.— Cases of Pulmonary Tuberculosis: (1) Cases sent to and discharged from Sanatoria during 1914— Condition on Discharge. Condition on December 31st, 1914. BOYS. girls. TL. BOYS. GIRLS. TL. Good 2 3 5 Good 2 3 5 Further improvement 1 — 1 Improved 2 — 2 In statu quo 1 — 1 Worse — 1 1 Deceased — 1 1 8 8 (2) Cases treated at Dispensary only— Condition when first seen. Condition on December 31st, 1914. BOYS. GIRLS. TL. BOYS. GIRLS. TL. Good 3 1 4 Good 2 6 8 Fair 4 6 10 Improved 4 6 10 Poor — 5 5 Worse 1 — 1 19 19 B.— Cases of Non-Pulmonary Tuberculosis (1) Cases sent to and discharged from Sanatoria during 1914— Condition on Discharge. Condition on December 31st, 1914. BOYS. GIRLS TL. BOYS. GIRLS. TL Good 3 10 13 Good 3 10 13 Improved — 1 1 Further improvement — 1 1 14 14 (2) Cases treated at Dispensary only— Condition when first seen. Condition on December 31st, 1914. BOYS. GIRLS. TL. BOYS. GIRLS. TL. Good 2 2 4 Good 18 13 31 Fair 38 23 61 Improved 24 12 36 Poor 2 2 4 Fair — 2 2 69 69 Note.— At the end of the year 13 children, were receiving treatment in Sanatoria and all were doing well. The results of treatment of children under 16 years of age are analysed in this table. All these cases were treated only during 1914, and they are classified according to the type of disease (pulmonary or non-pulmonary) and the treatment given, whether at Sanatoria or at the Dispensary alone. No tuberculous children are treated in the Borough Hospital. 123 Section G.— WORK OF THE BOROUGH HOSPITAL. The total nominal accommodation at the Borough Hospital is 170 beds. The following table shows the highest and lowest number of beds occupied on any one night during each month of the year 1914. TABLE H. 1. Month. Beds Occupied. Month. Beds Occupied. Highest. Lowest. Highest. Lowest. January 195 169 July 97 69 February 183 157 August 64 47 March 181 154 September 133 62 April 161 123 October 174 140 May 124 82 November 166 149 June 95 81 December 151 117 During 1914 the average daily number of cases under treatment amounted to 128.05, as compared with 125.5 in the previous year. The following table gives the total number admitted from the Borough and other Districts during the year 1914. TABLE H. II. Districts. Remaining at end of 1913. Admitted during 1914. Discharged during 1914. Died during 1914. Remaining at end of 1914. *The Croydon Union, cases admitted from Penge - - - - - Penge Urban D.C., nonpauper cases 21 13 28 0 5 The Borough of Croydon 184 †934 956 36 127 Total 205 947 984 36 132 *In the above table cases 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. † Includes 3 admissions of the Staff suffering from, scarlet fever (2), and enteric fever (1). 124 The total number of patients admitted was 947, as compared with 902 in 1913. The following table shows the comparative admissions during 1914 and previous years. TABLE H. III. Hospital diagnosis Cases admitted during 1908. Cases admitted during 1909. Cases admitted during 1910. Cases admitted during 1911. Cases admitted during 1912. Cases admitted during 1913. Cases admitted during 1914. Scarlet Fever 497 608 624 381 365 417 658 (1) Diphtheria 354 292 222 430 600 402 211 (2) Enteric Fever 59 11 15 18 16 28 15 (3) Puerperal Fever - - - - - 1 2(4) Pulmonary Phthisis - - - - - 48 56 Other diseases 31 45 47 29 25 6 10 (5) Total 941 956 908 858 1006 902 947 (1) Includes 1 case of Ichthyosis sent in as scarlet fever. „ 2 cases of Measles „ ,, „ 10 cases in which no disease was observed. ,, 2 cases of Erythema sent in as Scarlet Fever. „ 3 cases of Scarlet Fever complicated by Diphtheria. „ 1 case of Scarlet Fever complicated by Enteric Fever. (2) „ 20 cases of Tonsillitis sent in as Diphtheria „ 2 eases of Laryngitis „ ,, ,, 1 case of Rhinorrhæ ,, ,, ,, 2 cases of Broncho-Pneumonia „ „ 1 case of Diphtheria complicated by Appendicitis. ,, 1 case of Diphtheria complicated by Pregnancy. ,, 1 case of Diphtheria complicated by Measles. (3) ,, 1 case of Para-typhoid complicated by Phthisis. (4) „ 1 case of Anaemia sent in as Puerperal Fever. (5) ,, 1 ease of Septic Rash sent in as Measles. 125 The following table gives the number of patients admitted for each disease, the number discharged or died, and average duration of stay in hospital for the year 1914 :— TABLE H. IV. Disease. Remaining at end of 1913 Admitted during 1914. Discharged during 1914. Died during 1914. Remaining at end of 1914. Average Residence in days. Fatal Cases. NonFatal Cases. Scarlet Fever 92 638 630 5 95 11.2 51.6 Cases admitted to Hospital as but subsequently found not to be Scarlet Fever - 15 15 - - - - Diphtheria 97 186 243 19 21 7.3 42.6 Cases admitted to Hospital as but subsequently found not to be Diphtheria — 25 25 — - - - Enteric Fever 1 14 11 3 1 25. 43.3 Cases admitted to Hospital as but subsequently found not to be Enteric Fever - 1 1 - - - 62. Pulmonary Phthisis 15 56 49 9 13 92.1 103.01 Other Diseases - 12 10 - 2 - - Total 205 917 984 36 132 - - TABLE H V. The following table gives the fatality for each disease:— 1910. 1911. 1912. 1913. 1914. Scarlet Fever 1.1 0.7 1.1 .8 .7 Diphtheria 6.3 8.3 3.6 3.02 6.4 Enteric Fever 6.6 11.1 25.0 19.2 20 Pulmonary Phthisis - - - 12.5 12.6 Other Diseases 6.3 6.8 12.0 6.2 2.3 All Cases 2.8 5.0 3.2 2.9 3.1 Under other diseases are included the following :— Cases notified as Scarlet Fever but not Scarlet Fever— Result Ichthyosis 1 Discharged Measles 2 „ No disease observed 10 „ Erythema 2 „ 126 Notified as Diphtheria but found not to be Diphtheria— Result. Tonsillitis 20 Discharged. Laryngitis 2 „ Broncho-Pneumonia 2 „ Rhinorrhæ 1 „ Pericarditis 1 Died. Notified as Enteric but found not to be Enteric— Result. Meningitis 1 Discharged. Other admissions— Erysipelas 5 Measles 1 Ophthalmia 1 Croup 3 Total 10 TABLE H VI. Illnesses amongst the Staff— Scarlet Fever 2 cases. Rheumatic Fever 1 case. Enteric Fever 1 case. Other illnesses requiring treatment 11 cases. Total 15 cases. AMBULANCE. The new motor ambulance was first used on September 25th, 1914. 963 journeys were made, including 26 journeys to Penge and Anerley; of these 738 were made by the Horse Ambulance and 225 by Motor Ambulance. In addition, one case was removed from Epsom Downs Military Hospital, three were taken to the General Hospital, and one was taken home. In addition the Ambulance made numerous journeys to the Railway Station, Town Hall, Tuberculosis Dispensary, etc. 127 MAINTENANCE OF BUILDINGS. During the past year alterations have been carried out to "F" Ward, whereby the accommodation has been increased from 6 beds to ii beds, and supplementary heating installed by means of steamheated radiators on the atmospheric principle, the first block to be dealt with in this manner. Electric light has also been installed. Consequent upon the shrinkage of the clay soil, cracks have taken place in portions of the walls and floors of " F," Mortuary and Laundry Blocks, necessitating the underpinning of the foundations. A petrol store has been constructed near the laundry. The whole of the approach road has been reconstructed with tar-clinker macadam. The following painting, etc., works have been carried out:— Administrative Block, new wing, internal painting, etc.; bedrooms, bathrooms and corridors, nurses' and sisters' sitting rooms and laboratory. Do. do. old wing, doctor's dining room, a few bedrooms and servants' hall. Lodge, internal painting to porter's rooms. "Cb" Block—A new lavatory basin has been fitted in the lobby between the wards. The water mains have been coupled up near the laundry for fire extinguishing purposes. 128 Section H —WORK OF THE BOROUGH LABORATORY. The work of the Laboratory continues to be of the greatest value to the borough. No. of specimens examined in the Laboratory (1897—1914)— Specimens examined for Diphtheria, Enteric Fever, and Tuberculosis. Year. 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 I 904 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 1911 4774 5296 10070 1912 6584 6924 13508 1913 4230 4256 8486 1914 3537 2884 6421 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. 1914 1914 1914 Borough Hospital. Borough Hospital Borough Hospital 2856 2788 55 24 626 72 Total 5644 79 698 TABLE XIII. CROYDON BOROUGH HOSPITAL. Detailed Analysis of Expenditure under all Heads for the Year ending March 31st, 1913, and five preceding Years. Year ending. March. Average No. of Patients. Provisions. Alcohol. Surgery and Dispensary. Domestic, including Coal and Gas. Establishment and Miscellaneous Charges. Salaries and Wages. Total Average Cost per Bed occupied. Sinking Fund and Interest. Total Average Cost per Bed occupied including Sinking Fund & Interest. 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 Repairs. Miscellaneous Charges. Total. Average Cost per Bed occupied. Medical Dispensing, Nursing & other. Average Cost per Bed occupied. Total Ordinary Expenditure. £ s. d. £ s. d. £ s. d. s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. 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 19 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 69 0 11 2101 10 9 85 11 11 1911 134 2696 1 8 20 2 5 3 8 9 0 6 487 19 3 3 12 10 1703 9 8 12 14 3 1179 17 10 387 16 5 1567 14 3 11 14 0 2364 7 10 17 12 11 8823 1 5 65 16 11 2206 10 9 82 6 3 1912 134 2886 19 10 21 10 11 10 17 0 1 7 618 10 10 4 12 4 2062 18 3 15 7 10 2250 5 2 385 9 1 2635 14 3 19 13 4 2527 15 4 18 17 4 10742 15 6 80 3 4 2721 17 3 100 9 7 1913 134 3047 0 5 22 14 10 10 19 10 1 7 729 8 10 5 8 10 2215 6 11 16 10 8 1959 0 10 467 17 1 2426 17 11 18 2 3 2726 0 4 20 6 10 11155 14 3 83 5 0 2774 12 0 103 19 1 1914 143 3279 12 2 22 18 8 14 12 0 2 1 574 19 8 4 0 4 2467 3 4 17 5 1 2406 1 5 306 4 5 2712 5 10 18 19 4 2970 8 9 20 15 5 12019 1 9 84 0 11 3058 16 9 105 8 9 During the year 1913-14 the sum of £1820 2s. 7d. was received from other Local Authorities. 129 DIPHTHERIA. During 1914 5,644 specimens were examined in the Laboratory. Of these 1,482 were primary examinations for diagnostic purposes; the remaining were from contacts who had been exposed to diphtheria or from the throat and nose of convalescents. The latter were examined so as to ascertain if the bacillus of diphtheria was absent from the nose and throat. In some cases many examinations extending over several weeks were required before it was found to have disappeared. Every case of Scarlet Fever was also examined bacteriologically for the diphtheria bacillus, and patients giving a positive result were at once isolated to prevent the introduction of diphtheria in a scarlet fever ward. Many specimens from cases of sore throat or nasal discharge occurring in children attending elementary schools were also examined. RESULTS OF EXAMINATIONS FOR DIPHTHERIA. Swabs from patients in the Hospital. Swabs sent in by local Medical Practitioners, Swabs sent in by Medical Officer of Health and Health Visitors. Total number of swabs examined + Total. + — Total. January 543 18 219 237 9 219 228 1008 February 337 17 133 150 8 162 170 657 March 373 12 133 145 1 141 142 660 April 168 5 151 156 1 55 56 380 May 183 10 129 139 1 91 92 414 June 182 3 115 118 5 64 69 369 July 152 1 105 106 — 82 82 340 August 98 — 18 18 4 73 77 193 September 167 6 82 88 8 152 160 415 October 245 — 114 114 — 155 155 514 November 186 — 109 109 — 98 98 393 December 154 — 102 102 — 45 45 301 *Total 2788 72 1410 1482 37 1337 1374 5644 130 ENTERIC (TYPHOID) FEVER. The total of specimens from suspected Enteric Fever patients amounted to 79, of which 55 were received from medical men in the borough, and 24 examinations were made of patients in the Borough Hospital. The following table gives a summary of the serum reactions obtained in the laboratory during 1914. RESULTS OF EXAMINATIONS FOR DISEASES SIMULATING ENTERIC FEVER. 1914. Examinations for Borough. Examinations for Hospital. Total. Agglutinative Reactions. Agglutinative Reactions. Agglutinative Reactions for all purposes. + — Total + — Total + — Total January — 7 7 1 1 2 1 8 9 February 1 5 6 1 2 3 2 7 9 March 1 3 4 3 3 6 4 6 10 April — 9 9 — — — — 9 9 May — 2 2 2 3 5 2 5 7 June — 4 4 2 1 3 2 5 7 July — 7 7 1 — 1 1 7 8 August — 4 4 — 1 1 — 5 5 September 1 1 2 1 — 1 2 1 3 October 1 3 4 2 — 2 3 3 6 November — 5 5 — — — — 5 5 December — 1 1 — — — — 1 1 First Quarter 2 15 17 5 6 11 7 21 28 Second „ — 15 15 4 4 8 4 19 23 Third „ 1 12 13 2 1 3 3 13 16 Fourth „ 1 9 10 2 — 2 3 9 12 Total 4 51 55 13 11 24 17 62 79 131 TUBERCULOSIS. The number of specimens examined during the year amounted to 698, of which 72 were from patients already in the Hospital. Out of the total number 196 were found to contain the tubercle bacillus. The following table shows the number of specimens examined for the bacillus tuberculosis during 1914. RESULTS OF EXAMINATIONS FOR TUBERCULOSIS. 1914. Examinations for the Borough. Examinations for the Hospital. Total. All Examinations. All Examinations. All Examinations. + — Total + — Total + — Total January 14 64 78 5 — 5 19 64 83 February 15 53 68 6 — 6 21 53 74 March 15 59 74 5 — 5 20 59 79 April 5 61 66 3 1 4 8 62 70 May 12 46 58 2 4 6 14 50 64 June 12 36 48 6 — 6 18 36 54 July 10 31 41 11 1 12 21 32 53 August 19 26 45 7 — 7 26 26 52 September 12 28 40 2 — 2 14 28 42 October 9 37 46 4 8 12 13 45 58 November 9 22 31 — — — 9 22 31 December 8 23 31 5 2 7 13 25 38 First Quarter 44 176 220 16 — 16 60 176 236 Second „ 29 143 172 11 5 16 40 148 188 Third „ 41 85 126 20 1 21 61 86 147 Fourth „ 26 82 108 9 10 19 35 92 127 Total 140 486 626 56 16 72 196 502 698 132 RINGWORM. The number of specimens examined for the presence of this parasite amounted to three, which all proved negative. The number of specimens examined at the laboratory is not so great as formerly, the greater proportion being examined at the Town Hall. MISCELLANEOUS EXAMINATIONS. Various other bacteriological and microscopical examinations were made during the year, viz. : Urines : 35 for typhoid and other organisms. Pathological specimens : 3 for Gonococcus. 1 pus for Tubercle. 3 for Pneumococcus. 1 for Streptococcus. 4 Anthrax. 1 Cancer cells. PREPARATION OF MATERIAL. In addition to the actual examination of specimens, much time has been spent on preparing material for bacteriological works. Suitable " outfits " for the transmission of specimens to the laboratory in accordance with the requirements of the Postmaster-General require careful preparation. 3,396 (2,571 Diphtheria, 723 Enteric, 102 Tuberculosis) of these "outfits" were supplied during the year for the use of the Public Health staff and the medical men of the Borough. The making of serum culture media commenced in 19o6 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 senior laboratory attendant (Harold Ashby) under the direction of the medical officers. 476 dozen tubes of blood serum were prepared in 1914. The material prepared in this way, if reckoned at the commercial price, during 1914, i.e., 3s. 6d. per dozen tubes, would have cost £83 6s. In this way a great saving is made in the working expenses of the laboratory. In addition to the serum media mentioned above, the following were prepared during the year :— 6 litres of peptone broth. 2 litres of agar agar. 2 litres of McConkey's bile salt medium. 400 cc. of litmus milk. 200 cc. of peptone water. 1 litre of McConkey's agar. Also the following vaccines were prepared for use both in the Hospital and for cases in the Borough :— 3 typhoid vaccines. 6 staphylococcic vaccines. x mixed (staphylococcus and streptococcus). Total 10 133 Section I.— REPORT ON SCHOOL MEDICAL WORK. Public Health Department, Town Hall, Croydon. Ladies and Gentlemen, I have the honour of presenting the following report for the year 1914 of 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 eleventh annual report submitted to the Committee, and the seventh 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 Board of Education. SCHOOLS. Number of Schools and Accommodation. On December 31st, 1914, there were within the Croydon area : 20 Provided Schools, including 54 departments, with recognised accommodation for 21,091 children as compared with 20,911 in 1913. 14 Non-Provided Schools, including 34 departments, with accommodation for 5,538 children, as compared with 5,493 in 1913. The total provision for Elementary School children in the Borough therefore amounted to 34 schools, with 88 departments and accommodation for 26,629 children, as compared with 26,404 in 1913. The number of children on the register on December 31st, 1914, was 25,613, as compared with 24,905 in 1913. Changes in School Buildings and Accommodation. The changes in the school buildings and accommodation which have taken place during the year are as follows, viz. :— 134 Tamworth Road School. This School, which was closed in 1913, is at present being rebuilt, meanwhile the staff and scholars have continued to occupy rooms at the Central Polytechnic. Princess Road School. Two new class-rooms have been added to the Girls' Department, and the existing buildings have been altered and improved. Sydenham Road School. Additional cloak-room, staff-rooms, and room for medical inspection of children have been added. Upper Norwood School. The caretaker's house has been adapted for use as Staff Rooms. Tavistock Grove School. House adjoining equipped as a Combined Domestic Subjects Centre. Temporary Buildings. The temporary buildings at Boston Road and South Norwood Schools and also at Portland Road Mixed School are still in use. The use of the temporary building at the last named school will be discontinued when the new school at Long Lane is built. The building of this school has been postponed owing to the outbreak of War. Equipment. During 1914 considerable progress has been made in the re-desking of schools. The following desks have been supplied:- Boston Road Infants 5 Kindergarten tables and 15. chairs. Ingram Road Boys 8 dual desks. Oval Road Infants 1 Kindergarten table and 3 chairs. Portland Road Infants 16 Kindergarten tables and 48 chairs. 135 Princess Road Boys 27 dual desks. „„ Girls 52 dual desks. „ „ Infants 12 dual desks and 2 Kindergarten tables and 6 chairs. Upper Norwood Mixed 163 dual desks. „ „ Infants 4 Kindergarten tables and 14 chairs. St. Andrew's Infants 3 Kindergarten tables and 9 chairs. St. Joseph's Mixed and 25 dual desks. „ Infants St. Mary's Mixed and 74 dual desks. „ Infants St. Saviour's Girls 26 dual desks. It is of great importance to the well-being of school children of an abnormal size that suitable adjustable seats and desks should be provided for them. It is with special pleasure that I note therefore that we have fifteen special desks in use for school children suffering from spinal curvature : there is no doubt, however, that the number of special seats might with advantage be increased. Hygienic Condition of School Buildings. The School Medical Officers have inspected the school buildings throughout the year, and on this occasion it is more particularly desired to emphasise the need for thorough and efficient ventilation of the schools. The need for such recommendation does not exist, of course, in all instances, but it arises at times both in consequence of the neglect of attention to the existing means of ventilation on the part of the teaching staff and also in some cases from too great reliance upon semi-mechanical means of ventilation. Too great emphasis cannot be laid upon the value of the open window as a means of replacing used-up air in the class rooms. It is unquestionably the most efficient and best means of ventilation available in all cases, and the more nearly the school class room can be made to approximate open air conditions the better will the health of teachers and children be. Not at all infrequently on visits to schools the atmosphere of the class rooms has been found to be most oppressive upon entering. Such a condition always favours illness whether it be amongst adults or amongst children. The importance of a continuance of a supply of absolutely fresh air 136 becomes thoroughly apparent when it is realised that in all hospitals for the treatment of infectious disease the windows of the wards are kept open continuously in spite of the fact that there are always additional means of ventilation available. It is a recognised thing that abundant air supply is one of the most important factors in contributing towards rapid and complete recovery from the infectious fevers. Such a supply of fresh air is unquestionably quite as important a preventive measure as it is a curative one. It is, of course, undeniable that in the colder weather of winter it is a difficult matter to control the ventilation of the room and yet maintain it at a proper temperature. The tendency, however, is rather in the wrong direction of sacrificing fresh air to heat. The system of heating should be always such as to permit of the temperature of the room being maintained in all its parts at a proper height even though the windows are freely open. Ventilation is equally important and is very often equally disregarded in the cloak rooms and lobbies of the schools. The need for this is especially noticeable in wet weather. The provision oi heating apparatus for the drying of clothing is not sufficient to effect the purpose alone; there must be a constant exchange of the air of the cloak room to enable the moisture to be carried away. With regard to sanitary conveniences the trough closet system still exists in a considerable number of the schools. The Committee, however, I am pleased to say, have resolved during the past year to replace all of these trough closets with modern pedestal rim flushing closets. The hygienic advantages of the latter type of closet are conceded generally now, and the change is of additional importance in that the use of such modern conveniences inculcates upon the children habits of personal cleanliness in a manner which the older type of convenience does not do. The following is a report of the sanitary work carried out during the year 1914 :— St. Mary's School, Wellesley Road. Infants' Department. The sparge pipe to urinal has been repaired. The rod eye of interceptor trap has been securely fixed. Mixed Department. The drain near N.E. corner of Church has been cleaned out. The level of yard has been adjusted and the surface paved, with falls to yard gullies, so as to prevent the accumulation of surface water. Several rain-water pipes were cleaned out and repaired. 137 St. Andrew's School, Church Road, Croydon. Boys' Department. The drain has been cleaned out and flushed. Shirley School. Mixed Department. Four modern W.C.'s have been constructed to replace old trough closets, the drains being relaid to Inspection Chamber. All the schools have been regularly inspected and found to be kept in good general sanitary condition. ORGANIZATION AND CO-ORDINATION OF SCHOOL AND OTHER PUBLIC HEALTH WORK. In Croydon, as heretofore, the staff engaged in the school medical work is part of the staff engaged in the general public health work of the Borough. Experience is continually showing the value of this close interweaving of the work. Dr. J. Johnstone Jervis and Dr. W. N. W. Kennedy were the two assistant medical officers specially concerned with school medical work. Dr. Kennedy was appointed to the medical staff of the Department in the month of July, and commenced his duties in September. The increase in the Medical Staff was made necessary by the growth of the work of the Department, occasioned by the opening of the Infants' and Children's Centre at 228, London Road, and also by the contemplated extension of school medical inspection to meet the requirements of the Board of Education. As in previous years, Mr. Wray, the Ophthalmic Surgeon, has been responsible for the examination and treatment of school children suffering from diseases of the eyes or other defects of vision. The Dental work amongst the children of the schools has been undertaken throughout the year by Mr. A. Brearley Oddie, L.D.S., who devotes two half-days per week to this work. It was found, however, that'—even in the age group of 6-7 years—the number of children requiring dental treatment was greater than could be overtaken by one dentist in this limited time. The Committee therefore decided to requisition the services of a second Dentist, and in November Mr. Charles A. Lightfoot, L.D.S., was appointed on the understanding that he also should give two half-days per week to dental work. 138 Also in consequence of the increase of work of the department, the Committee appointed an additional Health Visitor. The total number of Health Visitors on the staff at the end of the year was therefore seven. In connection with the medical inspection of school children, Dr. Sandison, the Medical Officer to the Tuberculosis Dispensary, examines all children suspected by the School Medical Officer of suffering from tuberculosis in any of its forms. If definite signs of this disease are found, arrangements are made for the children affected to attend for treatment at the Tuberculosis Dispensary and thereafter, until they are able again to resume their school life, they remain under the supervision of the Medical Officer to the Dispensary. As in former years, the work of arranging for the holding of medical inspections at the various schools in the Borough has been very efficiently undertaken by the Chief Clerk of the Public Health Department. In addition, the whole time of one clerk and the part time of another, and also of one of the Inspectors, have been devoted to duties in connection with the medical work in the schools. The work of the Health Visitors is set out in detail on page 165. I have pleasure in putting on record the fact that the relationship between the general education staff and the school medical staff continues to be of the most harmonious description. The work of the medical inspections is carried out without hitch, and largely owing to the hearty co-operation of the teachers and school attendance officers, with a high degree of efficiency. The assistance rendered by the Attendance Officers is invaluable, and it has appeared to me desirable to give the following account of these services, viz.:— Measles, Mumps, Whooping-Cough, and Chicken Pox. The Attendance Officer visits families to investigate causes of absence from school, and where illness is suspected to be of an infectious nature the procedure is as follows, viz. : — (a) When a medical man is in attendance and a diagnosis has been made of measles, mumps, whooping-cough, or chicken pox, the Attendance Officer is instructed to exclude verbally the child and contacts without waiting for further confirmation by this Department. This saves at least a day in the exclusion of the child or of contacts when the latter is necessary, and greatly facilitates the work of the Department in the prevention of infection. It also facilitates school attendance when contacts may be allowed to go back to school. This exclusion is officially confirmed by me later on Form B. 139 (6) When a medical man is not in attendance the Attendance Officer is instructed not himself to exclude anyone, but to report on Form A to me the nature of the illness. The case is then visited by the Health Visitor (a fully qualified nurse), upon whose report, if confir matory, the child is excluded by the despatch of Form B to the Head Teacher. Notifiable infectious diseases and non-notifiable infections of indefinite duration (e.g., ringworm, sore throat, impetigo, etc.) In the case of these diseases similar procedure is adopted with the modification that instead of Form B, in which a definite period of exclusion is mentioned, Form E is sent off, in which the exclusion is until a medical certificate of freedom of infection is forwarded. Also during enquiries made (following upon the information which may be obtained from the Attendance Officer), if notifiable disease is suspected arrangements are made for a local practitioner to visit and a payment of 2s. 6d. per visit is made, plus, of course, the notification fee in cases where notification is made. Special cases for examination. Children who are absentees for a prolonged time are reported to the Education Committee by the Attendance Officer, and at the Committee's request these cases are examined by one of the medical staff of the Department, and a special report is sent by him as to reasonableness of absence and necessity for continued absence or otherwise. This procedure is also employed in cases when medical defects have been found in children, and it is suspected by the Education Department that medical attention, though promised, is not being obtained. It may be that in the latter cases legal proceedings are about to be instigated against the parents or a remand has been made by the magistrates for medical examination. Ringworm. Ringworm cases are either treated by the Department, or where the parents can afford it by private medical practitioners. In the latter instances the cases are visited not less than once per quarter by the Attendance Officer to ascertain whether medical treatment is actually being obtained or not, and report is made to the medical staff. No return to school is permitted except on receipt of " freeing notice " from the School Medical Department. Dental Treatment. The Attendance Officers enquire into cases where parents cannot afford to pay for dental treatment but are willing for treatment to be carried out by the School Dental Officer. 140 Diphtheria and Scarlet Fever. A letter (shown below) is sent to School Attendance Officer as well as teachers on notification of two cases of diphtheria or scarlet fever in any department of a public elementary school. DIPHTHERIA. Dear Sir (or Madam), With reference to the cases of Diphtheria among the children attending your school, I wish to draw your attention to the fact that the disease is most commonly spread by slight unrecognised cases, and especially by children in whom the nose is affected. I should be obliged if you would draw the attention of your staff to the following symptoms of Diphtheria, viz. :— (1) Sore throat, especially when accompanied by white patches on the tonsils or palate. (2) Enlarged glands (often mistaken for mumps). (3) Chronic discharge from nostrils, especially when confined to one side and causing soreness of the upper lip. Children suspected to be suffering from Diphtheria should be reported on Form A. and excluded until you receive Form B. or F. Yours truly, R. VEITCH CLARK. SCARLET FEVER. Dear Sir (or Madam), With reference to the cases of Scarlet Fever among the children attending your school, I wish to draw your attention to the fact that the disease is most commonly spread by slight unrecognised cases. I should be obliged under the circumstances if you would draw the attention of your staff to the importance of temporarily excluding from school and reporting all cases of sore throat or of peeling skin. The onset is usually sudden, with head-ache or vomiting, and any child exhibiting such symptoms should be promptly sent home. Yours truly, R. VEITCH CLARK. General Co-operation. The Attendance Officer affords willing assistance in tracing cases where addresses are changed or where other difficulties arise. Mental Deficiency. The Attendance Officers have supplied a large amount of information as to addresses, etc., of children suspected of this condition. 141 SCHOOL MEDICAL INSPECTIONS. EXTENT AND SCOPE OF MEDICAL INSPECTION. For the most part children have been selected for medical inspection in accordance with the requirements of Section 58 (b) of the Code. The School Medical Officers aim at inspecting from 25 to 30 children in each session, i.e., primary inspections, and in addition to these 10 others in whom defects had been found at previous inspections, i.e., re-inspections. Other children suspected by the teachers to be suffering from defects or disease may be brought forward at medical inspections for examination and advice. These are classified as " special cases." The arrangements for the continuance of the medical history of children who are transferred from one school to another are of great importance. In Croydon when a child is received into school from either another school in the Borough or from outside the Borough, the head teacher makes enquiry for and obtains the medical inspection card of the child from its previous school, and special enquiry is also made as to whether the child is at that time suffering from or excluded on account of its relation to any infectious or contagious condition. TOTAL NUMBER OF CHILDREN INSPECTED DURING 1914. The following table shows the number of children whose medical inspection schedules were completed during 19x4:— TABLE E. 1. Age Number of Boys. Number of Girls. Total. 4- 5 129 88 217 5 -6 1265 1185 2450 6-7 424 518 942 7-8 86 121 207 8-9 8 18 26 9-10 2 7 9 10-11 3 10 13 11-12 14 36 . 50 12-13 1106 1129 2235 13-14 798 1016 1844 14-15 20 54 74 Total all ages 3855 4212 8067 142 TABLE. 11. Showing total number of children inspected during 1914 classified according to the schools attended, also number of parents and guardians attending medical inspections and the number of inspections held in each department throughout the year:— No. of Inspections held. No. of Children Inspected. No. of Parents or Guardians Present. Council Schools :— BOYS. GIRLS. Beulah Road Boys 5 95 - 39 Girls 5 - 123 64 „ Infants 9 98 88 136 Boston Road Boys 4 108 — 40 „ Girls 3 — 78 37 „ Infants 9 84 110 115 Brighto,n Road Boys 4 94 — 30 „ Girls 2 — 53 24 „ Infants 6 60 69 69 Davidson Road Boys 5 123 — 67 „ Girls 5 — 132 81 „ Infants 7 98 65 130 Dering Place Mixed 4 34 38 31 „ Infants 2 24 23 31 Ecclesbourne Road Boys 5 128 — 44 „ Girls 5 — 138 76 „ Infants 10 131 117 156 Ingram Road Boys 5 78 — 28 „ Girls 6 — 89 43 „ Infants 9 89 109 157 Mitcham Road Boys 3 82 — 18 „ Girls 6 — 134 52 „ Infants 8 93 92 102 Oval Road Mixed 4 99 25 52 „ Girls 2 29 16 „ Infants 5 67 62 102 Portland Road Mixed 6 119 — 103 „ Girls 6 - 167 120 „ Infants 10 1 20 119 208 Princess Road Boys 1 120 - 6 „ Girls 1 30 17 3 „ Infants 8 62 64 47 South Norwood Boys 3 67 — 65 „ Girls 7 — 126 77 „ Infants 7 97 66 122 Stanford Road Sen. Mixed 2 31 21 28 „ Jun. Mxd. & Infts. 4 44 33 68 Sydenham Road Boys 2 50 — 12 „ Girls 4 - 63 24 „ Infants 4 50 43 71 Carried forward ... 203 2248 2293 2694 143 Brought forward 203 2248 2293 ] Tamworth Road Boys 5 116 — 36 Tavistock Grove Sen. Mixed 4 61 89 74 „ Jun. Mixd. & Infts. 8 70 75 77 Upper Norwood Mixed 3 43 40 13 „ Infants 4 33 39 59 Whilehorse Road Boys 3 69 — 10 „Girls 6 - 156 72 „ Infants 10 117 100 148 Winterbourne Road Boys 4 81 — 47 „ Girls 5 — 139 104 „ Infants 11 123 132 211 Woodside Boys 5 90 - 49 „ Girls 6 — 139 85 „ Infants 11 111 86 170 Total (Council Schools) 288 3162 3288 3849 Council (Non-Provided) Schools :— All Saints Boys 1 17 — 5 „ Girls 2 — 27 14 „ Infants 3 24 33 48 Christ Church Boys 2 50 — 30 „ Girls 2 — 38 25 „ Infants 4 45 41 48 „ (Wildbores) Infants 3 32 32 40 HolyTrinity Mixed 3 — 56 31 „ Infants 2 34 32 59 Parish Church Sen. Boys 3 77 — 29 „ Girls 5 - 111 66 „ Infants 6 62 84 91 St. Andrew's Boys 2 38 — 11 „ Girls 4 - 89 32 „ Infants 3 35 39 47 „ (Old Town) Mixed — — — — „ Infants — — — — St. Joseph's Mixed 1 10 7 7 „ Infants 2 9 16 17 St. Mark's Girls 2 — 39 24 „ Infants 2 21 33 77 St. Mary's Mixed 3 38 43 17 „ Infants 2 19 11 10 St. Michael's Mixed 1 - 23 8 „ Infants 1 7 24 21 St. Saviour's Boys 1 26 — - „ Girls 2 — 23 12 „ Infants 2 28 20 36 Carried forward ... 64 572 821 805 144 Brought forward 64 572 821 805 Archbishop Tenison's Boys 2 40 — 11 ,, Girls 2 — 46 26 St. Peter's Infants 5 59 33 66 Shirley Mixed 2 17 14 4 „ Infants 1 5 10 19 Total (Non-Provided Schools) 76 693 924 931 Total (Council Schools) 288 3162 3288 3049 3855 4212 Grand Totals 364 8067 4780 The corresponding total of children inspected for 1913 was 3,759. It must be noted, however, that the total for 1913 fell very considerably below the total of previous years owing to the fact that during the year there was a good deal of disorganization caused by changes in the medical staff. The marked increase shewn by the total of 1914 over that of 1913 is also due to the fact that in September a second Assistant Medical Officer took up his duties. In addition to the children whose medical inspection schedules were completed during 1914, and apart from children seen at the Town Han, 1,456 children were re-inspected and 653 specially inspected at the request of the teachers or for other reasons. (See Table E.iii.). 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 4,780 instances, out of 8,067 children inspected, or 5c).2 per cent. This proportion is 2 per cent. lower than in 1913, and 6 per cent. higher than in 1912 In the infants' schools 2,780 parents or guardians were present at the inspection of 3,851 children, or 72 per cent. compared with 65 per cent. present in 1913. The attendance of parents along with their children at medical inspections augurs well for the continued success of school medical inspections, and it is a matter of especial pleasure that the parents attend in very considerable numbers at the Treatment Centres when special examinations have to be made of the children. (See Table E.ii). GENERAL DIRECTIONS TO PARENTS. In 6,133 instances written and verbal directions were sent to parents, while in 6,621 instances printed directions were given. TABLE E in.—SHOWING THE TOTAL NUMBER OF CHILDREN INSPECTED, RE-INSPECTED AND SPECIALLY INSPECTED DURING 1914. Type of Inspection- Beulah. Boston. Brighton. Davidson, Dering. Ecclesbourne. Ingram. Mitcham. Oval. Portland. Princess. South Norwood Stanford Sydenham. Tamworth. Tavistock Gr've Upper Norwood Whitehorse. Winterbourne. Woodside. All Saints'. Christ Church. Wild bores Holy Trinity. Parish Church- St. Andrew's. St. Joseph's. St. Mark's St. Mary's Michael's. St. Saviour's- Tenison's. St Peer's Shirley. Total No. each Division. (Total No. ill each Division Total No. of all Inspectioons B. G. I. B. G. I B. G. I. B G. I. B. G. I. B. G. I. B. G. I. B. G I. B G. I. B. G I. B. G. I. B. G. I B. G. I. B. G. I. B. G. I. B. G. I. B. G. I. B. G. I. B. G. I. B. G. I. B. G. I. B. G. I. I. M. 1 B. G. I. B. G. I. M. I. G. I M. I. M. I. B. G. 1. B. G. I. M. I. Primary Boys. | 95 ... 98 108 ... 84 94 ... 60 123 ... 98 34 ... 24 128 ... 131 78 ... 89 82 ... 93 99 ... 67 119 ... '20 23 ... 62 67 ... 97 31 ... 44 50 ... 50 116 ... ... 61 ... 70 43 ... 33 69 ... 117 81 ... 123 90 ... 111 17 ... 24 50 ... 45 32 ... 34 77 ... ... 38 ... 35 10 9 ... 21 38 19 ... 7 26 ... 28 40 ... 59 17 5 3855 8067 10176 Girls. | ... 123 88 ... 78 110 ... 53 69 ... 132 65 ... 38 23 ... 138 117 ... 89 109 ... 134 92 ... 54 62 ... 167 119 ... 17 64 ... 126 66 ... 21 33 ... 63 43 ... ... ... ... 89 75 ... 40 39 ... 156 100 ... 139 132 ... 139 86 ... 27 33 ... 38 ... 32 56 32 ... 111 84 ... 89 39 7 16 39 33 43 ... ... 24 ... 23 20 ... 46 33 14 10 4212 ReInspections. Boys. 18 ... 46 49 ... 23 33 ... 6 30 - - 6 ... ... 14 ... 4 47 ... 21 10 ... 0 29 ... 3 17 ... 7 33 ... 5 1 ... ... ... ... ... ... 3 4 ... ... 9 ... 35 14 ... 5 31 ... 36 ... ... 5 23 ... 36 11 ... 16 10 ... 12 8 2 7 ... ... 45 5 ... 7 4 ... ... ... 11 3 ... ... ... ... ... 16 ... 5 ... 1 767 1.456 Girls ... 16 27 ... 19 29 ... 4 27 ... 10 9 ... ... ... ... 14 7 ... 36 24 ... 9 11 ... 1 23 ... 11 9 ... 7 8 ... 18 ... ... ... ... ... 30 6 ... ... ... ... 9 33 13 ... 18 ... 32 30 ... 5 6 ... 28 9 ... 8 ... ... 1 8 4 5 8 ... 27 20 ... 25 7 ... ... 11 ... ... ... ... ... ... 1 ... ... 6 6 ... 3 689 Special Inspections. Boys. ... ... 4 1 ... 15 ... ... 4 4 ... 10 ... ... ... ... ... 7 27 ... 3 5 ... ... 21 ... 2 9 ... 5 30 ... 2 2 ... 1 1 ... 1 ... ... ... 1 ... ... 9 ... 2 2 ... ... 9 ... ... 6 ... 6 5 ... 74 ... ... 3 2 ... ... 1 ... 1 7 ... 2 1 ... 5 1 ... ... 4 13 16 ... 1 ... ... 3 ... 2 ... ... 339 653 Girls ... 6 3 ... 5 18 ... ... 3 ... 28 3 ... ... ... ... 20 7 ... 3 1 ... 7 7 ... 3 5 ... 3 23 ... 8 6 ... 21 3 ... 5 ... ... 4 6 ... ... ... ... 4 ... ... 5 1 ... ... 1 5 4 ... 2 11 ... 1 ... ... 2 ... ... 1 1 ... 4 ... ... 11 3 ... ... 3 ... 13 31 ... ... ... 2 5 ... 1 ... ... 5 314 TABLE E iv. Age. Number Examined- Parents Guardians Present. Total Number in whom Defects found. Want of Cleanliness- Clothing. Nature of Defects. Vision. External Eye Disease. Malnu- trition Teeth. Tonsils. Glands. Adenoids present. Ear Trouble. Mentally Defective. Mentally Subnormal. Heart Affec- tions. Lung Trouble. Deformity and Spinal Dis. CommuniDisease. Sundry Defects If employed Written and Verbal directions to Parents. Printed directions Heads. Body. Clothing. Defective Footgear. 6/9 6/12 and worse. Decayed. More than Four Decayed Ear Disease. Deaf- ness Phthisis. Other Lung Disease. Spinal Curvature. Other Deformities. Ver. Nits only. Dirty. Ver. Dirty. Defective. Dirty. + ++ + ++ General Hygienic Medical or Surgical Treatment. INFANTS' (BOYS') SCHOOLS. 4-5 129 82 117 2 2 10 6 7 2 3 3 ... ... 3 2 53 43 15 15 11 19 11 4 2 ... 1 6 5 7 ... ... ... 9 ... 94 20 76 5-6 1265 963 1108 8 52 77 24 56 20 57 28 1 ... 24 45 529 398 136 96 l88 67 73 32 45 ... 15 55 3 84 7 6 7 92 ... 819 201 980 6-7 424 277 384 4 19 22 9 17 10 17 14 ... 1 8 21 203 137 52 41 65 21 19 6 11 4 3 16 ... 23 10 2 2 41 1 284 87 343 7-8 86 50 81 1 5 7 ... 1 2 2 1 ... ... 3 2 36 31 10 8 10 3 6 ... 1 ... ... 5 ... 5 ... 1 1 7 ... 50 14 68 8-9 8 7 6 ... 1 ... ... ... ... ... ... 1 ... ... ... 4 ... ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 2 7 9-10 2 1 2 ... 1 1 ... 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... 1 1914 1380 1698 15 80 117 2? 82 34 80 46 2 1 38 70 826 609 214 163 277 110 109 42 57 4 19 83 8 120 17 9 10 149 1 1254 324 1475 INFANTS' (GIRLS') SCHOOLS 4-5 88 52 79 2 21 1 2 2 2 1 ... ... ... 1 3 41 26 9 9 5 12 2 1 7 ... ... 2 ... 4 1 1 1 2 ... 44 10 55 5-6 1185 895 1056 18 215 18 24 36 16 44 20 ... 1 22 27 491 384 128 106 169 77 51 20 38 2 6 30 2 58 20 7 8 67 ... 758 185 897 6-7 518 355 399 6 110 7 5 14 6 20 12 1 ... 14 25 216 185 46 50 73 30 30 7 15 1 2 18 ... 24 14 4 4 34 ... 323 103 37' 7-8 121 81 105 ... 30 2 3 3 1 4 2 I 3 ... 60 34 10 16 21 6 7 1 9 1 ... 2 2 6 4 1 ... 6 ... 65 29 94 8-9 18 13 17 ... 5 ... ... ... ... ... ... 2 2 ... 1 6 10 3 2 2 ... 2 2 ... ... ....*« _ |... ... ... 1 ... ... ... ... ... 13 5 15 9-10 7 7 ... 2 1 ... ... ... ... ... 2 1 1 1 4 1 ... ... 1 ... ... ... 1 ... ... 1 1 ... 2 ... ... ... ... 4 2 7 1937 1400 1663 26 383 29 34 55 24 69 34 6 4 41 57 818 640 19b 183 271 125 92 31 70 4 8 53 5 93 41 13 13 109 ... 1207 334 1439 BOYS' SCHOOLS. 10-11 3 3 3 ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... 3 1 3 11-12 14 5 11 ... ... ... ... ... ... ... ... 1 1 ... 1 5 2 2 1 1 1 ... ... 1 ... ... ... ... 1 1 ... ... 3 4 3 3 9 12-13 1106 487 921 1 29 26 5 57 21 26 20 97 110 10 29 615 151 66 65 53 38 32 17 58 1 14 41 3 38 8 13 4 68 221 531 171 896 13-14 798 308 685 2 15 21 3 40 25 28 26 71 75 7 34 437 105 71 19 52 43 15 8 29 3 11 28 ... 37 8 15 6 51 169 352 101 690 14-15 20 6 20 ... ... ... ... 1 ... ... ... 1 3 ... ... 13 1 1 2 ... ... 1 ... ... ... ... 1 1 ... ... 1 ... 3 1 10 2 19 1041 800 1640 3 44 48 8 99 46 55 52 170 189 1 17 64 1070 259 142 87 106 82 48 25 88 4 25 71 4 78 17 29 10 125 395 899 278 1617 GIRLS' SCHOOLS. 10-11 10 5 9 ... ... 1 ... ... ... ... ... 1 3 ... 2 6 ... ... 1 2 2 1 ... ... ... ... ... 1 1 ... 1 ... 3 ... 8 2 10 11-12 36 26 30 ... 8 ... ... 1 ... ... ... 9 6 ... 2 23 3 3 3 3 ... 1 1 2 1 1 ... 2 ... ... 2 ... 3 1 26 5 35 12-13 1129 643 965 32 283 25 17 41 4 34 8 166 138 15 23 631 132 101 83 103 41 27 18 67 2 13 57 ... 28 56 6 5 77 8 723 236 1055 13-14 1046 484 857 6 288 11 6 27 3 16 6 138 122 13 21 567 139 112 54 88 58 31 11 46 3 13 40 5 20 41 15 7 69 10 589 183 939 14-15 54 33 46 ... 9 ... ... ... ... ... ... 11 11 ... 3 25 7 6 3 9 1 2 5 2 ... 2 2 ... 1 1 3 2 6 ... 42 23 51 2275 1191 1907 38 588 36 23 69 7 50 14 325 280 28 51 1252 28 222 144 205 102 62 35 1 17 6 29 99 8 50 98 27 14 158 19 1388 449 2090 TOTALS ALL AGES BOYS' AND GIRLS. 8067 4780 6908 82 1095 230 104 305 111 254 146 503 474 124 242 3966 1789 774 577 859 419 311 133 332 18 81 306 25 341 173 78 *47 541 415 4748 1385 6621 * Including, Diphtheria 4, Scarlet Fever 2, Tuberculosis 25. 145 GENERAL RESULTS OF INSPECTIONS. Defects found at inspections are given in Table E. iv.: no change in the headings has been made, the table being on similar lines to that used in the previous year. It is not possible to tabulate the results of advice given to parents as to the treatment of defects found at school medical inspections throughout the year 1914, but I have made arrangements whereby in another year these results can be classified and set forth in a table. HEIGHTS AND WEIGHTS. The average heights and weights of the children attending the various schools of the Borough was well maintained. The year, so far as trade conditions are concerned, was a good one, and that probably accounts largely for the generally good physical condition of the children. WANT OF CLEANLINESS. Condition of the Heads. Of the 8,067 children inspected, 82 heads were infected with live vermin at the time of inspection, and 1,095 other children had " nits" and 230 children had dirty heads apart from vermin. The proportion of children in whom head vermin was detected at medical inspections is about 1.01 per cent. of all children inspected, and the number in whom "nits" only were found 13.5 per cent. The incidence of "nits" is still greatest amongst the older girls, 26 per cent. of whom were infected with "nits." Nineteen per cent. of the infant girls were found to have "nits" in the head. The proportion of children found infected with vermin of the body at medical inspections was 1.29 per cent. The arrangements for the cleansing of verminous children at the cleansing station opened in the year 1912 have on the whole been found to work satisfactorily, the total number of children cleansed at the station during the 12 months is 70, and 4 of these were cleansed on two occasions, making 74 attendances in all. CLOTHING. The number of school children estimated as having insufficient clothing in 1914 was m, as compared with 68 in 1913. The much larger number is apparently due to the larger total of inspections made, but the percentage is also slightly increased 1.4 per cent. contrasted with 1.1 per cent. in 1913. 146 Clothing is now receiving greater attention from the teachers, and I note with pleasure that in one or two of the schools model sets of garment have been made to fit children of all ages. These garments are available as patterns for both parents and children, and they have, I am informed, been greatly taken advantage of and appreciated. Valuable help has been rendered in this matter by the school care committees in conjunction with the health visitors and teachers. MALNUTRITION. 242 cases (or 3 per cent.) of malnutrition have been noted during the year. This is a marked improvement as contrasted with 1913, when 10 per cent. of badly nourished children were observed amongst those inspected. The nutrition of a child varies according to its state of health and its home conditions. Cases of malnutrition are generally more numerous, amongst children of the poorer areas. The provision of free meals by the Education Authority has done much to improve the physique and general health of children belonging to the classes referred to, and is a very important factor in the reduction of the number of children suffering from malnutrition. EYE DISEASES. External eye diseases, such as conjunctivitis, inflammation of the lids, etc., were noted in 124 instances. This number does not include any of the cases of infectious conjunctivitis or " blight.-' Where necessary these children are referred to Mr. Wray for treatment at the Town Hall. Sub-normal vision was noted in 977 instances. All children requiring special examination (either for defective vision or for diseases of the eyes) are referred to the Ophthalmic Surgeon. INFECTIOUS CONJUNCTIVITIS. An outbreak of this disease occurred in the Princess Road Schools during the second quarter of the year. The number of cases occurring throughout the quarter was 138. As soon as the presence of the disease was discovered prompt and drastic measures were taken to prevent its spread. A treatment clinic was established at the School and a health visitor put in charge. This clinic was held every morning throughout the week with the exception of Sunday in order that the progress of the disease might be watched and to ensure regularity and thoroughness of treatment. The School Medical Officer visited the school frequently and examined ali the children with suspicious symptoms, and the moment a case 147 was discovered it was excluded from the class and instructed to attend the clinic for treatment. The homes of infected children were also visited and the mothers instructed as to how to treat the condition and how to prevent its spread. The contacts amongst younger children not of school age who had developed the disease were also treated at the clinic. In this way the infection was rapidly and effectively stamped out. Although this was the only important outbreak of infectious eye disease occurring amongst the children of the schools throughout the year, there were several smaller and less significant outbreaks which, by prompt exclusion and the application of proper curative measures, were quickly got in hand. These scattered cases were instructed to attend the clinic at the Town Hall for treatment when the parents themselves were unable to afford medical attention. It may be noted that throughout the year no schools were closed because of this disease, as it has been found that school closure as a method of successfully eradicating the trouble has proved quite a failure. TONSILS AND ADENOIDS. Tonsils were considerably enlarged in 577 cases, slightly in 774 cases. Adenoids were found in 311 cases, leading in the majority to nasal obstruction and mouth breathing. In all cases of enlarged tonsils and adenoids when these were causing definite obstruction of the respiratory passages parents and guardians were strongly urged to have them removed at once. Adenoids, either alone or in conjunction with enlarged tonsils, is one of the most frequent causes of arrest of mental and physical development in the child. This fact has been emphasized both to teachers and parents. Mouth breathing, apart from tonsils and adenoids, has also been observed in a number of cases, and instructions have been given to teachers and parents as to the best methods to be employed for the correction of this defect. From figures supplied by the House Surgeon at the Croydon General Hospital, I find that 165 Croydon school children were operated upon at that institution. I have again to thank the House Surgeon for kindly supplying 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 emphasize the importance of after treatment. 148 GLANDS. Glands of the neck were found to be markedly enlarged in 419 cases, slightly in 859 cases. This glandular enlargement is in many cases an accompaniment of enlarged tonsils and adenoids, and is directly due to infection from these sources. In many other instances, however, it is not due to these causes, but to a general infection such as tuberculosis. In the former case, that where enlargement is due to the condition of the tonsils and adenoids, removal of these has brought about almost immediate improvement; in the latter case, however, where the enlargement is due tc tuberculosis, the child has to be put under a very definite regime of health in order to get rid of the trouble. All cases in which tubercular glands have been found present to a marked degree have been referred to the Medical Officer of the Tuberculosis Dispensary, who has undertaken or supervised the further care and treatment of them. EAR DISEASE. This was noted in 133 instances and deafness in 332 instances. The syringing of ears where deafness was due to accumulated wax was in a few instances undertaken by the health visitors at the Town Hall, when it seemed probable that otherwise no treatment would be undertaken. More satisfactory and continuous treatment in cases of ear dicharge is desirable, and I have arranged for such treatment to be carried out daily at the Treatment Centre, No. 228, London Road, Croydon, by the health visitor in charge under the supervision of the Medical Officer. By this means I hope to reduce materially the number of children suffering from discharging ears. DEFORMITIES. Curvature of the spine was noted in 173 instances. Of the 173 cases, 106 in whom the deformity was slight were directed to have special exercises at school and in their own homes, and 67 in whom the deformity was more or less marked were referred for treatment to the special class at Whitehorse Road School. An account of the work of the special class, together with the results, will be found in Table E v. The number of cases of this deformity observed has enormously increased as compared with that found in previous years. It was felt that if the more severe cases of spinal deformity were to be prevented every case should be recognised and, if possible, dealt with at its very inception. Even the slightest signs of abnormal curvature have therefore been taken cognisance of, as is obvious from the large number of such children who have had simple exercises at the ordinary school or at home instead of being sent to the special remedial classes. 149 Miss Appleton, who in past years has voluntarily done much excellent work for these deformities, continued to undertake the treatment of three groups of children twice a week at Whitehorse Road Centre for remedial exercises. These children were periodically examined by the School Medical Officer, who found that in every instance improvement, more or less marked, had taken place. The best thanks of the children and of the Committee are due to Miss Appleton for the ungrudging way in which she has given her time and skill to this class. The following is her report on the class :— The classes have been held, as before, on Monday and Wednesday afternoons, each girl attending for half an hour twice weekly. During the year 32 cases have been treated. Of these cases, 8 have been discharged by the doctor as cured, 6 have improved so much that only occasional treatment is necessary, 2 have been sent on to London hospitals for further treatment, and 6 have left school, leaving 10 girls still in attendance in December, 1914. TABLE E. v. Table of Spinal Deformities. Department of School. Number of Children found at school medical inspections with spinal defects. Number referred to Remedial Class. Number treated at Remedial Class, 1914. Number still in attendance at Remedial Class on 31st December. Percentage of cases in which cure was effected. Percentage of cases in which cure was effected or improvement noticed. Boys 17 1 — — — — Girls 98 37 *32 16 25% 94% Infant Boys 17 4 — — — — „ Girls 41 25 — — — — 173 67 32 16 Boys and Girls in Mixed Department are recorded as attending Boys' or Girls' Departments. *Two referred o the National Orthopaedic Hospital for surgical treatment. Six left school before completion of course. 150 It will be noted from Table E v. that it has been quite impossible for Miss Appleton, with the limited time at her disposal for this work, to overtake the whole of the cases of spinal deformity requiring attention. I am hopeful, however, that in the year upon which we have now entered to be able to arrange for a room at the Treatment Centre, No. 228, London Road, Croydon, to be given up for Miss Appleton's use on four afternoons per week. The Treatment Centre being much nearer to the centre of the town, this arrangement will enable children debarred by reason of their distance from the present remedial classes in Whitehorse Road to attend. Miss Appleton will also be able to give double the time to this work in 1915. Other deformities were noted in 78 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 306 children. The heart has been examined as a routine practice in every case. Many of the defects discovered were trivial and had little effect on the health of the child. Some of these mild cases were associated with anasmia or debility, others were the result of severe illnesses such as pneumonia, or scarlet fever, or rheumatism. The more serious cases were almost without exception rheumatic in origin. Appropriate advice was given in each case, and the following leaflet on rheumatism was made use of wherever it was deemed advisable. It has 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, signed by the School Medical Officer. COUNTY BOROUGH OF CROYDON. 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 samp 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 tonsilitis. (3.) Attacks of irritability, night terrors, twitching of face or fingers, or clumsiness in children not usually troubled in these ways. (4.) Certain Rashes. 151 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 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 throat. Public Health Department, Croydon. LUNG DISEASES. Affections of the lungs were found in 366 instances. Of these the greater number was of the nature of bronchial catarrh, and not of serious import. Many of these catarrhal cases were very slight and of short duration; others were more persistent, and a few were quite chronic. The effect on the health of the children in the first and second groups is slight, but in the third there always results a good deal of constitutional disturbance affecting the growth and development of the body and giving rise to flabbiness, anaemia, and general lassitude. Medical attention was urged in all cases, and several children were excluded from school for varying periods. Pulmonary tuberculosis was found in a minority of the total cases of lung disease, 25 in all. These were referred to the Tuberculosis Dispensary and thereafter taken in hand by the Medical Officer of the Dispensary. Most of them have made exceedingly good progress, and many have been able to return to school and to renew their educational life. Further information on the incidence of tubercular disease of the lungs amongst school children will be found below. COMMUNICABLE DISEASES. At the routine inspections communicable diseases were diagnosed in 47 instances. These included diphtheria 4, scarlet fever 2, tuberculosis 25. 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. Verminous cases, having been already mentioned, are not included in this number. When any special focus of infectious trouble appeared to be in a school special visits to the school were made by the School Medical Officer or his assistants. TUBERCULOSIS. Tuberculosis is a disease which affects childhood to a very considerable extent and is one of the principal causes of illhealth amongst the children attending the schools. It may attack the bones, the joints, the lymphatic glands, the membranes surrounding the brain, or the lungs. In the subjoined table will be found the number of children of school age suffering from these various types of the disease, classified according to sex and age. It will be noted that the table includes not only cases discovered at school medical inspections, but also those notified by private medical 152 practitioners. All of these cases were referred for further examination and treatment to the Tuberculosis Dispensary. Many of them have attended the dispensary for varying periods, some are still attending, others have been sent to sanatoria, and a few have been treated at home by their own private medical advisers. TABLE E. vi. Cases of Tuberculosis amongst children of school age notified by the Assistant School Medical Officers and private Medical Practitioners during the year 1914 :— Age. Sex. Tubercu'osis of Lungs. Tuberculosis of Glands. Tuberculosis of Bones and Joints, Other Forms of Tuberculosis Total. 5-6 Boys 7 10 1 ... 18 Girls 3 5 ... 1 9 6-7 Boys 2 4 2 ... 8 Girls 2 3 ... ... 5 7-8 Boys 1 1 2 ... 4 Girls ... 2 3 ... 5 8-9 Boys 3 8 1 ... 7 Girls 3 2 ... ... 5 9-10 Boys ... 5 2 ... 7 Girls 3 2 2 ... 7 10-11 Roys 1 2 1 ... 4 Girls 2 1 ... ... 3 11-12 Boys 1 ... ... ... 1 Girls 3 3 ... ... 6 12-13 Boys 2 2 ... ... 4 Girls 3 4 1 ... 8 13-14 Boys 5 2 ... ... 7 Girls 9 3 1 ... 13 14-15 Boys 1 ... ... ... 1 Girls ... ... ... ... ... Total 51 54 16 1 122 Of the above, 58 cases were notified by the Assistant School Medical Officers, an i 64 by private Medical Practitioners. In addition to these a certain number of cases have been discovered amongst "contacts" at the Tuberculosis Dispensary. In future years these will appear in this table as well as in the full annual report. MENTAL CONDITIONS. Eighteen children were noted to be mentally defective. In addition, 81 others entered as mentally sub-normal may prove, on further observation, to be mentally defective. A number of epileptic children were inspected or re-inspected. 153 DENTAL DEFECTS. The prevalence of dental trouble is shown in the following table :— TABLE E. VII. BOYS. Age. Number Examined. 1-4 Decayed Teeth. Over 4 Decayed Teeth. Number with sound Teeth. Percentage with sound Teeth. 4-5 129 53 43 33 25.6 5-6 1265 529 398 338 26.7 6-7 424 203 137 84 19.8 7-8 86 36 31 19 22.0 8-9 8 4 ... 4 50.0 9-10 2 1 ... 1 50.0 10-11 3 ... ... 3 100.0 11-12 14 5 2 7 50.0 12-13 1106 615 151 340 30.7 13-14 798 437 105 256 32.1 14-15 20 13 1 6 30.0 Totals 3855 1896 868 1091 28.3 GIRLS 4-5 88 41 26 21 23.9 5-6 1185 491 384 310 26.2 6-7 518 216 185 117 20.6 7-8 121 60 34 27 22.3 8-9 18 6 10 2 11.1 9-10 7 4 1 2 28.5 10-11 10 6 ... 4 40.0 11-12 36 23 3 10 28.0 12-13 1129 631 132 366 32.4 13-14 1046 567 139 340 32.5 14-15 54 25 7 22 40.7 Totals 4212 2070 921 1221 28.9 154 The figures at the ages 5-7 and 12-14 are 'he most important as the large numbers examined at those ages give a more reliable average. The second annual report of the working of the school dental clinic is given in a later paragraph. JUVENILE EMPLOYMENT. During 1914 the majority of the older boys inspected were questioned by the Medical Officer as to employment; in a few instances the head teacher had voluntarily filled in the necessary information as to employment on the inspection cards beforehand. The nature of the work, and the hours of employment were also ascertained. A fairly large number of boys are employed in connection with shops as errand boys. Their hours of work vary. Some of them are employed on Saturdays only and some on other days of the week after school hours as well as Saturday. A number of boys are also engaged throughout the week in the delivery of newspapers and milk and in domestic work. This work is done chiefly in the early morning and at night after school hours. Employment of children is controlled by the Children's Act, 1903, and bye-laws relating thereto. In every case where a child has seemed to be suffering from ill effects as a result of employment, or where the employment is dangerous or unhealthy, the case has been reported to the Officer responsible for the administration of the above Act. As a result of the special attention directed by this Officer and his staff to offences against the Act and Bye-laws, there has been a very considerable reduction in the number of cases of illegal employment of children during the year. As has been found in previous years, it is evident that the early morning workers suffered from debility and heart-weakness to an extent disproportionate to their numbers. Questions elicited the information that the work was by no means invariably a matter of necessity, but was sometimes undertaken to earn pocket-money; such extra occupations were discouraged whenever signs of overstrain were apparent. MENTAL DEFICIENCY. During the year all children seen in medical inspections in whom there was reason to suspect mental deficiency or mental backwardness have been referred to the School Medical Officer for special examination. A very considerable number of such children were upon medical examination found to be suffering from affections other than mental deficiency which explained the apparent 155 lack of mental power for which they were reported. Our records do not show the exact number of children who were found to be definitely mentally deficient during the 12 months of 1914, but up to March, 1915, the total number of children of school age who were medically proved to exhibit this mental state is 71: of these 14 are children of the non-educable type and have been referred to the Mental Deficiency Committee of the Council to be dealt with by them. According to the accepted proportion of feeble-minded to the total school child population, the number of educable feebleminded children in Croydon should be approximately 125. It is evident, therefore, that there is still a considerable number of children of deficient mentality remaining to be examined and classified. Of the 57 educable mentally defective children already examined approximately 28 are high grade and 29 low grade in type. During the present year (1915) the Education Committee have under consideration the establishment of a non-residential school in the Borough for the education of mentally deficient children, and I anticipate that in the next annual report a more complete and detailed account of the mentally deficient school children for whom the Education Authority are responsible will be available, as well as, I trust, an account of the initial provision made by the local Education Authority for such children. I am pleased to take this opportunity of thanking the staff of the Education Authority for great assistance in bringing to my notice the children suffering from mental defect, more particularly the school attendance officers and the head masters and head mistresses where those children either were at the time of examination or had at some time in the past attended. GRANGEWOOD SPECIAL CLASS. This class, originally instituted for mentally backward children in connection with the Whitehorse Road Schools, has largely developed into a class for children who are really mentally defective. I append a report of the work of the class for the year 1914, and in connection with this I feel that special notice must be taken of the extremely capable manner in which the class has been conducted by Miss Holt throughout the year. Number of children on Register on 31st December, 1913 13 Number of children admitted to class during 1914 10 Number of children discharged from class and re-admitted to Council Schools, 1914 5 Number of children discharged from the class because of unsuitability or other reason 2 Number of children on Register of December 31st, 1914 16 156 THE WORK OF THE OPHTHALMIC SURGEON. Cases of defective eyesight amongst the school children have been referred to the Department by exactly the same methods as those described in the report for 1912; it is unnecessary, therefore, to enter into details except to say that the assistance rendered in this direction by the teaching staff continues to be of the greatest service. Mr. Wray has also made special visits to several schools with a view to himself personally discovering and remedying those cases of very pronounced optical defect in the eyes which form such a grave disadvantage in the education of children. The number of refractions done is more than in 1913; the figures being 156 for 1913 and 490 for 1914. In table E. viii. the vision taken into account has been that of the better eye. Children whose one eye was normal and the other markedly defective, though not included in the table, were referred to the Ophthalmic Surgeon. The following is a summary of the work done by Mr. Wray at the Town Hall:— Total No. of children examined 749 „ „ „ attendances 1,859 TABLE E. viii. Children refracted ... 490 Glasses were ordered for 423 Glasses not needing changing 5 Glasses not advised at present 47 47 Vision found normal 15 490 Glasses were needed and ordered as follows:— Myopia 83 Hypermetropia 129 Astigmatism, myopic 65 „ hypermetropic 69 Anisometropia 39 Strabismus 38 423 157 Hospital advised for nine cases. Of the glasses ordered 195 were] urgently needed and were as follows:— Myopia 53 Hypermetropia . 37 Astigmatism, myopic 44 ,, hypermetropic 19 Anisometropia 4 Strabismus, internus 34 „ externus 1 ,, alternating 3 195 Other diseases treated and advised, were: — Ulcer of cornea 13 Blepharitis 26 Conjunctivitis 152 „ contagious 113 follicular 1 Phlyctenula 40 Nystagmus 4 Nebula 2 „ dense 1 „ symmetrical 1 Hordeolum 6 Ophthalmia, Granular 2 Paresis (left ext. rect.) 4 Keratitis, Vascular 1 „ Interstial 1 Cataract, lamellar 2 Strabismus 1 Contusion of eyeball 1 Staphyloma 1 Lenticonus 1 Herpes 1 Spring Catarrh 1 Atrophy of optic nerve 1 Asthenopia 1 Disseminated choroditis 1 Retino choroditis 1 Dislocated lens 1 Leucoma 1 Tuberculosis of sac 1 Nictitatio 2 Pseudo-glioma 1 Carried forward 385 158 Brought forward 385 Large corneal staphyloma 1 Eczema palp. 1 Foreign body removed 1 Blow on eye 1 Contused globe 1 Muco-Purulent ophthalmia 9 Epiphora 2 Abscess of lachrymal sac. 1 402 WORK OF THE SCHOOL DENTISTS. This is the second annual report of the working of the dental clinic. The dental work amongst school children has been carried out during the past year on the lines indicated in the previous annual during the past year on the lines indicated in the annual report for 1912. Mr. A. Brearley Oddie, L.D.S., has devoted two afternoons per week throughout the school terms to the inspection and treatment of the teeth of school children between six and seven years of age. This age period was selected as it marks the beginning of the appearance of the permanent set of teeth, and it is important that at this time the mouth should be clean, so that the permanent teeth may have a good chance of remaining healthy. Towards the end of the year it was decided to extend the work of the School Dental Department, and the services of a second dentist, Mr. Charles Lightfoot, L.D.S., were engaged. He commenced his duties in November, and, like Mr. Oddie, devotes two half-days per week to the work. With this extra assistance it is possible to offer the advantages of skilled dental advice to a larger number of children, and I hope to be able to show still better results in the report of next year. I am pleased to be able to report that the support of the parents in this work has been satisfactory, and the benefits accruing to the children much appreciated. The subjoined tables are self-explanatory. During the current year—1915—dental re-inspection is being carried out much more fully and systematically. 159 TABLE E. ix. Dental Inspection of Schools. School. Children Examined. Teeth all sound. Teeth Defective. Percent'ge with Sound Teeth. Boys. Girls Total. Boys. Girls. Boys. Girls. Boys. Girls. Beulah Road Infants 54 45 99 5 4 49 41 9.61 8.88 Brighton Road Infants 43 35 78 12 10 31 25 27.91 28.57 Davidson Road Infants 55 53 108 8 8 47 45 14.5 15.1 Dering Place Infants 38 29 67 8 4 30 25 21.05 13.79 Ingram Road Infants 64 45 109 8 2 56 43 12.5 4.4 Oval Road Infants 51 52 103 24 19 27 33 47.06 36.54 Portland Road Infants 98 98 196 14 17 84 81 14.28 17.34 South Norwood Infants 42 41 83 8 8 34 33 19.04 19.51 Stanford Road Infants 39 35 74 4 1 35 34 10.2 2.8 Sydenham Road Infants 47 42 89 7 4 40 38 14.9 9.5 Tavistock Grove Infants 51 58 109 21 27 30 31 41.17 46.55 Upper Norwood Infants 13 25 38 3 4 10 21 23.0 16.0 Whitehorse Road Infants 57 62 119 10 9 47 53 17.5 14.5 Winterbourne Road Infts. 63 57 120 9 5 54 52 14.29 8.77 Woodside Infants 58 50 108 11 5 47 45 19.0 10.0 All Saints' Infants 12 20 32 2 2 10 18 16.6 10.0 Christ Church Infants 40 30 70 3 5 37 25 7.5 16.6 Parish Church Infants 43 47 90 15 12 28 35 34.88 25.53 St. Andrew's Infants 37 55 92 6 11 31 44 16.21 20.0 „ „ (Old Town) 11 6 17 3 3 8 3 27.27 50.0 St. Joseph's Infants 11 8 19 1 2 10 6 9.0 25.0 St. Mary's Infants 12 18 30 4 1 8 17 33.3 5.5 St. Michael's Infants 10 16 26 ... 2 10 14 ... 12.5 St. Peter's Infants 58 49 107 8 8 50 41 13.79 16.32 Shirley Infants 8 10 18 2 2 6 8 25.0 20.0 1015 986 2001 196 175 819 811 19.31 17.74 TABLE E. x. Dental Re-inspection of Schools. Date. School. Children with teeth all sound at previous inspection. At re-inspection. Children who were treated for caries, discovered at previous inspection. At re-inspection. All sound. Requiring treatment. Requiring no further treatment. Requiring further treatment. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. 1914. Sep. 22 Davidson Road Infants 2 4 1 2 3 1 1 2 Percentage 66.66% 33.33% 57.14% 42.85% 160 TABLE E. xi. Table of Schools inspected by the School Dental Officers during the year 1914, showing the number of children found with defective teeth and the number who received treatment at the Dental Clinic at the Town Hall. Date of Inspection, 1914. Name of School. (Infants' Departments.) Number of children examined, Number found with defective teeth. Number of children treated by the School Dental Officers at the Dental Clinic. February 27th St. Peter's 41 36 9 „ „ Dering Place 22 21 5 „ „ St. Andrew's, Southbridge Road 45 36 7 March 27th Woods de 108 92 24 April 21st Portland Road 109 92 29 „ 28th All Saints' 32 28 8 „ „ Upper Norwood 38 31 1 „ „ St. Joseph's 19 16 3 June 16th Ingram Road 109 99 20 „ 30th St. Mary's 30 25 5 „ „ Christ Church, Longley Road 70 62 7 July 8th St. Michael's 26 24 11 „ „ Stanford Road 74 69 27 September 22nd Davidson Road 108 92 17 October 6th Sydenham Road 89 78 21 „ 8th Oval Road 103 60 not completed „ 22nd Tavistock Grove 109 61 „ „ „ 29th Dering Place 45 34 „ „ „ „ St. Andrew's, Southbridge Road 47 39 „ „ „ „ St. Andrew's, Old Town 17 11 „ „ November 3rd Whitehorse Road 119 100 „ „ „ 12th Brighton Road 78 56 „ „ „ „ St. Peter's 66 55 „ „ December 3rd Shirley 18 14 „ „ „ „ South Norwood 83 67 „ „ „ 4th Portland Road 87 73 „ „ „ 18th Winterbourne Road 120 106 „ „ „ 21st Parish Church 90 63 „ „ „ 22nd Beulah Road 99 90 „ „ 24.2 per cent. of the children at the completed schools who were found to have defective teeth attended at the Dental Clinic for treatment by the School Dental Officers. I9I TABLE E. xii. DENTAL CLINIC. Particulars as to Fillings, etc. Date. Attendances. Fillings. Extractions. Dressings. Appointments for N2O Gas. Remarks. Ordinary. With "local' or N2O Gas. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. January 22 51 20 39 8 17 11 22 2 10 ... 6 February 30 48 20 28 9 12 26 54 10 10 1 5 March 25 34 32 42 6 7 1 1 5 5 4 7 40 children did not attend. April 15 18 6 17 8 6 5 22 4 3 ... 2 May 38 49 31 50 18 27 24 32 3 6 10 7 June 24 20 9 21 3 8 30 18 ... 1 8 7 24 do. do. July 28 28 13 24 8 12 33 21 1 ... 9 8 27 do. do. August — Sept. 62 74 19 37 13 11 80 78 4 22 16 14 36 do. do. October 80 51 40 30 7 1 72 58 4 3 12 8 31 do. do. Nov. 96 81 47 34 4 1 122 96 5 14 11 15 33 do. do. Dec. 38 52 14 28 3 8 45 42 1 12 2 3 26 do. do. I refused treatment. 458 506 251 350 87 110 449 444 39 86 73 82 162 TREATMENT OF DEFECTS FOUND IN SCHOOL CHILDREN. During the major part of 1914 the arrangements for the treatment of minor ailments amongst school children were similar to those in force previously, i.e., a clinic held twice weekly at the Town Hall for the treatment of ringworm and other minor skin conditions. It had been felt for some time, however, that an extension of this work was necessary. It is clear that many of the minor ailments revealed by the medical inspection of school children have, unless actively treated, a very harmful effect both upon the child's physical welfare and upon his educational progress. In some instances the poverty of the home or the indifference of the parents precludes the possibility of private treatment; in others the nature of the ailment not only necessitates medical advice, but skilled nursing attention to see that that advice is properly carried out. The Committee therefore resolved that a special Treatment Centre should be established to deal with these minor and contagious conditions in school children, particularly where, for the reasons given above, proper treatment was not available. By joint action with the Sanitary Committee—at that time engaged in the establishment of a centre for the treatment of infants—the house at 228, London Road, was taken on lease and fitted up as an "Infants' and Children's Centre." The premises were opened on November 24th, and have been in active use since that date. The treatment of school children is carried out in the ground floor rooms. On two mornings in the week one of the Assistant Medical Officers attends to see the cases, and a Health Visitor (who is a fully trained nurse) is there daily to carry out the treatment and to instruct parents. As the centre has only been active for so short a period in 1914, statistics are not given at present, but will be incorporated in the annual report for 1915. So far the work has been most successful. School children who require more thorough medical examination than can be given at the ordinary school inspections are examined at the centre by appointment. INFECTIOUS CONJUNCTIVITIS, TONSILS AND ADENOIDS. The treatment of infectious conjunctivitis, and of tonsils and adenoids, is referred to in previous paragraphs. 163 RINGWORM. As in former years, children suffering from ringworm attended the clinic held at the Town Hall on Wednesday and Saturday mornings. In November the clinic was transferred to the new centre at 228, London Road, and since that date treatment of these cases has been carried out there. The following table shows the number of cases supervised by the Public Health Department during 1914:— TABLE E. xiii. RINGWORM, 1914. Total number outstanding Jan. 1st, 1914 Scalp 45 Body 4 — 49 Total number reported during 1914 Scalp 133 Body 88 — 221 — 270 Total number freed during 1914 Scalp 127 Body 89 — 216 216 Total number outstanding Jan. 1st, 1915 Scalp 51 — Body 3 — 54 54 The more serious cases continue to diminish in number, and the total number of new scalp cases during 1914 was 133, as compared with 124 in 1913 and 172 in 1912. The number of children excluded from school at the end of the year was 54, as compared with 49 twelve months previously. Of the 133 new scalp cases, 119 were treated at the Town Hall (56 by application of X-rays, 63 by drugs). Altogether, 1,168 attendances were made by children at the Town Hall in connection with the treatment of this disease. 26 cases of ringworm of the skin were also treated. There is still a certain number of long standing severe cases, in which the parents have refused the application of X-rays, and in which neither directions for treatment nor precautions against spread are adequately observed by parents. These continue to be sources of infection. TABLE E. xiv. Treatment and freeing weeks. X-Rays treatment result 1914. No. of cases. 2 — 4 4 4 — 6 12 6 — 8 13 8 — 10 8 10 — 12 5 12 — 14 7 14 — 16 1 16 — 20 3 164 Two cases are at present waiting to be freed, and two have left the borough without being freed. More than two-thirds of the children were freed for school in eight weeks from the application of X-rays, a result which compares favourably with the average time of freeing in previous years. The longer period necessary in some cases was due usually to non-attendance or very irregular attendance for after-treatment. 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:— TABLE E. xv. 7,145 notices of illness (including duplicate notices) were received from School Teachers or Attendance Officers during 1914. 5,712 notices of illness were sent to the Education Committee by the Public Health Department. the Public Health Department. These notices dealt with, amongst others, 5,158 school children actually suffering from the infectious diseases mentioned in the Table:— Illness. 1st 2nd 3rd 4th Total Quarter. Quarter. Quarter. Quarter. Scarlet Fever 103 69 70 123 365 Diphtheria 50 17 18 25 110 Measles 48 34 16 77 175 Mumps 72 130 53 177 432 Whooping Cough 101 254 146 20 521 Chicken-pox 160 122 46 277 605 Sore Throat 74 49 45 78 246 Ringworm (scalp) 49 32 19 33 133 „ (body) 44 22 9 13 88 Impetigo 205 155 140 235 735 Scabies 10 19 6 7 42 Infectious Eye Disease 93 224 118 155 590 Other diseases 263 271 170 412 1116 Totals 1272 1398 856 1632 5158 The table has been modified to record only the number of actual sufferers from the infectious diseases therein mentioned, as it is thought that this information is of more practical use than a detailed record of the number of notices sent. 165 WORK OF THE HEALTH VISITORS. During the year part of the time of six to seven lady Health Visitors has been given up to school medical work. Their duties in this connection have mainly been attendance at school medical inspections, the visitation of children who are absent from school because of suspected infectious disease, and for the following up of those in whom defects have been discovered at the school medical inspections. Each district Health Visitor is responsible for the visitation of all the school children in her particular area. To cope with the extra work at the newly opened treatment centre an extra Health Visitor was appointed towards the end of the year, and she is devoting practically the whole of her time to the work there. Part of the time of the Health Visitors has been taken up in the clinics held at the Town Hall for the treatment of defects of the eyes and teeth. The work of the Health Visitors is set out in detail in the following Table (E. xvi). TABLE E. xvi. Visits to Houses where the following Diseases have occurred. School Cases. 1st Visits. 2nd Visits. Scarlet Fever 74 22 Diphtheria 119 69 Measles 205 14 German Measles 38 1 Mumps 575 28 Whooping Cough 697 119 Chicken Pox 701 22 Sore Throat 1083 363 Ringworm (scalp) 170 74 „ (body) 111 80 Verminous Heads 13 26 Verminous Bodies 41 4 Impetigo Contagiosa 1101 1246 Scabies 49 57 Infectious Eye Disease 300 203 Other diseases 1304 467 6581 2795 Visits paid to Elementary Schools for Medical Inspections 292 — Number of Children prepared for Medical Inspection :—Newly Inspected 8067 — Re-inspected 1456 — Specially Inspected 653 — Other Visits to Elementary Schools 120 — Home Visits arising out of Medical Inspection 1231 417 Home Visits for other information 431 23 Cultures taken 1008 — 166 The lectures which for a considerable number of years have been given by the Health Visitors to parents in the evenings at various schools throughout the winter were continued in the early part of this year. The attendances, however, were rather meagre, and these lectures have been incorporated during the winter of 1914-1915 in a series of public health lectures which I have organised with the help of the whole of the staff of the Department. A note on these lectures appears on page 169. On each of the four school care committees one of the Health Visitors voluntarily gave her services during the year. SCHOOL CLOSURE. During the year 1914 the following schools were closed in accordance with Article 45 (b) of the Code. TABLE E. xvii. School. Department. Disease. Date of Closure. Length of Closure. Beulah Road Infants Scarlet Fever February 2nd 3 weeks. All Saints' Girls & Infants Chicken Pox March 23rd 3 weeks. Portland Road Girls Scarlet Fever April 7th 3 weeks. Dering Place Infants Whooping Cough April 7th 3½ weeks. *Davidson Road Infants Whooping Cough July 14th 1 week. Princess Road Girls Sickness of one kind and another August 28th 2 weeks. do. Boys do. do. do. do. Infants do. do. do. Parish Church Infants Scarlet Fever September 25th 3 weeks. Portland Road Infants Chicken Pox October 23rd 4 weeks. Sydenham Road Infants Chicken Pox October 27th 3½ weeks. Davidson Road Infants Sickness of one kind and another November 23rd 2½ weeks. Princess Road Infants do. November 23 rd 2½ weeks. Christ Church (Wildbores) Infants Chicken Pox November 23rd 4 weeks. St. Mary's Infants Mumps December 30th 3 weeks. †Woodside Infants Measles and Mumps. December 14th 1 week. *Preceding four weeks vacation. †Preceding two weeks vacation. 167 EXCLUSION OF CHILDREN FROM SCHOOL. During the year 69 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 SENT TO INSTITUTIONS. At the end of the year the following Croydon children were under treatment in residential institutions outside the Borough:— Blind 8 Deaf 11 Mentally defective 3 Epileptic 1 NECESSITY FOR FURTHER TREATMENT. In view of the gravity of the present national crisis it is in my opinion not desirable to lay stress on further development of the medical work in connection with school children, as the medical and nursing community are so largely drawn upon for professional services in connection with the War. The necessity in times of peace of developing further this very important work is still with us, but I do not at present propose to say anything upon the subject. EXAMINATION OF BURSARS AND STUDENT TEACHERS. Thirty young persons who desired to become Bursars and Student-Teachers were medically examined during the year, and, with two exceptions, were passed. SPECIAL EXAMINATION OF CHILDREN AT THE TOWN HALL OR SCHOOL TREATMENT CENTRE. There is again an increase in the number of children seen at the Town Hall or at the Treatment Centre by the School Medical Officer at the request of the Education Committee's officers or of teachers or parents. Thus these inspections form no small proportion of the medical officers' work, as many of the children require very careful and thorough testing before an opinion can be 108 passed as to their fitness, mentally or physically, for school attendance. The number seen were as follows:— Children seen for the first time in 1914:— Diseases of Lungs 68 „ Heart 13 „ Ear, Throat and Nose 31 „ Skin 83 Ringworm : Scalp 82 Skin 26 — 108 *Mentally defective children 6 Mentally sub-normal 1 Spine 6 Rheumatism Nil. Admission to Schools, Convalescent Homes 11 Hurst House Orphans 6 Eye diseases or defects 4 Glands 20 Nerves 11 Tubercle 13 Various 98 479 * This is exclusive of children examined in accordance with the requirements of the Mental Deficiency Act. Total number of attendances, not including children seen by the dental or ophthalmic surgeons, 1,567. TEACHING OF INFANT CARE. The Infant Care Class, now held at Tavistock Grove School, has been continued on the lines given below. It appears desirable to repeat this general description of these classes, as in my opinion it is of the very greatest value that the future mothers should be educated to take an intelligent interest in the proper management of infants. Fifty-six girls from various schools in the Borough attended. The Medical Officer attended one afternoon weekly to see such infants as the mothers brought to him for advice on feeding and general care,; the infants were regularly weighed at each attendance and opportunities were given to the girl members of the class to take part in the 169 weighing of the infants. Records of the weights were kept. From 3.30 to 4 p.m. an address was given to the girls by the health visitor. (See syllabus of lectures on Infant Care in Appendix in addition to these addresses the Medical Officer spoke to he girls as time permitted on simple health precautions and matters of interest connected with them. A point was made of having the infants' parents present during the addresses to the girls, and they were thus in an indirect manner interested in and instructed on many useful matters. Instructions in clothing the babies were rendered practical by means of a doll model. During the year 1914 26 babies were brought to the consultations for demonstration purposes. It may be thought that the number of infants attending is very small, but it should be remembered that the primary object of the class is to educate the senior girls concerning infants and infant life—not in this instance to combat any special infantile condition in the district. LECTURES. During the winter of 1914-1915 I organised a series of lectures which was delivered in the evenings in selected schools in the Borough by the medical staff and by two of the Health Visitors. These lectures are devised to cover the general field of public health medical work in its broadest sense, inclusive of medical questions affecting school children. The cost of the lectures was defrayed by the local authority and the Insurance Committee jointly, but it is of interest to mention this here as the lectures are of very great educational value, and as they also have been delivered in premises belonging to the Education Authority. It will be observed from the list that the lectures were distributed as evenly as possible throughout the town, so that every part of the community might be within reasonable access of at least one of the lectures. The following is a list of the subjects lectured upon and the dates upon which the lectures were given, viz.:— Date. School. Subject. Nov. 24 Mitcham Road "The War against Consumption." Dec. 8 Portland Road "Tuberculosis in School Children." Jan. 14 Brighton Road "The War against Consumption." „ 26 Woodside "The Child: Its Ear, Nose & Throat." Feb. 2 Sydenham Road "The Care of the School Child." „ 9 Ecclesbourne Road "Tuberculosis in School Children." „ 25 Beulah Road " The War against Consumption." Mch. 2 South Norwood "The Care of Infants." „ 16 Winterbourne Road "The Child : Its Bodily Growth and Development." „ 25 Upper Norwood "The War against Consumption." 170 FEEDING OF NECESSITOUS CHILDREN. The School Canteen work was re-commenced during the last quarter of 1914, and the number of centres at which the feeding was carried out was approximately 11. In accordance with the memorandum of the Board of Education, the Medical Officer prepared a dietary which was approved by the Canteen Committee and formed, from the beginning of the winter of 1914-1915, the basis of the meals supplied to the children. As mentioned elsewhere in the report, the provision of these meals had a very noticeable and beneficial effect upon the physique and well-being of the children fed. I am, Ladies and Gentlemen, Your obedient servant, R. VEITCH CLARK, School Medical Officer and Medical Officer of Health. 171 APPENDIX. Teaching of Infant Care. 3—3.30 p.m. Weighing of infants and advising of mothers (one girl to attend weighing of each child). Writing of notes of last lecture. 3.30—4 p.m. Lecture to Girls. 4—4.30 p.m. Mothers' tea and practical work. SYLLABUS OF LECTURES ON INFANT CARE, ETC. 1. Care of Infants (Introductory). 2. Feeding. 3. Feeding (continued). 4. Clothing. 5. Cleanliness and training. 6. Sleep and exercise. 7. Weaning and Dentition. 8. Diseases of Infants. 9. Question on whole course. 10. Correction of questions. Summary. LECTURE 1. I INTRODUCTION. Infantile Mortality.—Many deaths preventible. Need of education in care of children as in other matters. Suffering and sickness amongst those who survive, also caused by ignorance. Consider condition of young infant.—Weakness of muscle (cannot turn, lift head, etc.). Softness of bone, delicacy of nerve, want of teeth, utter helplessness. 172 Needs of infants.—Food, sleep, suitable clothing, cleanliness, fresh air, tenderness in handling. Signs of health.—Increase in weight, sleep, contentment, satisfactory action of bowels. Natural development of infant.—Increased powers of sight, hearing, thinking. Appearance of the teeth, ability to walk and talk. Establishment of good habits.—Regularity in feeding, in sleeping, and in obeying the calls of nature, in bathing, teaching of self-control. Evil results of mismanagement.—Fretfulness, indigestion, thrush, skin disease, bronchitis, rickets, mouth breathing. Show table of Average Weights. LECTURE 2. FEEDING (1). Infants' powers of digestion. Size of stomach. Human milk the best food. How mother should procure good breast milk. Second best method of feeding, breast milk and cows' milk alternately. Why mother should not nurse at night only. No danger in supplementing breast milk with cows' milk. Average quantities of proteid, fat and sugar in human and cows' milk. How to make latter resemble human milk. Advantage of barley water over plain water. How to prepare barley water. Reason for boiling milk and water. Loss of fat in mixture compared to human milk, use of oil if required. Addition of sugar. The bottle: how to clean: danger of dirt. Third method bottle only. LECTURE 3. FEEDING (2). Frequency of feeding, need of regularity, quantity given at each meal. Variation of mixture and increase of quantity at various ages. Foods other than cows' milk. Dried milk—Condensed milk: how they are prepared, their disadvantages. Patent foods, their expense and uselessness. Bread and biscuits. Results of, and want of fat and too early use of starchy foods. LECTURE 4. CLOTHING. Objects of clothing, warmth and decency, not support. Stiff clothes no help to muscular development, nor preventive of evils from bad handling. Need of reform in infants' clothing. Wool 173 preferable to cotton, dangers of flannelette. Number and shape of garments. Method of putting them on. Need of changing clothing at night. Short-coating. Avoid exposure of limbs. LECTURE 5. CLEANLINESS AND TRAINING. Delicacy of infants' skin. Natural action of skin. Daily bath, its temperature, when and how to be given. Drying of the infant, use of powder. Cleansing of eyes, ophthalmia and its results. Cleansing of the mouth, thrush. Cleansing of ears and scalp. Need of care in holding infants, weakness of muscle and bone. Care not to startle or excite infant, delicacy of nerve. Training in habits of cleanliness. Regularity of action of bowels. LECTURE 6. SLEEP AND EXERCISE. Time to be spent in sleep. Fresh air day and night. Separate cot, how to make. Dangers of overlaying. Weight of bedclothes. Position of infant. Need of turning from side to side. Waking for food. Sleep in day-time. Importance of quiet. Training child to lie down. Importance of good habits. Exercise of muscles, crying and kicking. Crawling and learning to walk. Mouth breathing. Abuse of comforters. LECTURE 7. WEANING AND DENTITION. Age for weaning from breast or bottle: avoidance of hot weather for breast fed infant. Dangers of too prolonged nursing. Gradual method of weaning. Dangers of too much starch. Diet from 9 to 18 months of age. Dentition not a disease. Course of Dentition. Necessity for use and cleaning of teeth. LECTURE 8. DISEASES OF INFANTS. Ophthalmia.—Cause. Prevention. Signs. Treatment. Thrush.—Cause. Prevention. Signs. Treatment. Rickets.—Cause. Prevention. Signs. Treatment. Epidemic Diarrhæa.—Cause. Prevention Signs. Treatment. Tuberculosis.—Conveyance of contagion. Cooking of food. Dangers of expectoration. Signs of tubercle in infants. Flies and dust. 174 COUNTY BOROUGH OF CROYDON. SCARLET FEVER OR SCARLATINA. HOME CASE. Children from this house must not attend day or Sunday School or mix with other children 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. Notice should be sent to the Health Department if there are any Public Library Books in the house, and no books must be 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, 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 ear 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. 175 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 day, unless the doctor orders otherwise. The body should be freely lathered with soap, special precaution being taken to thoroughly cleanse the hair and scalp. 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. All utensils from the sick room should be thoroughly scalded. Disinfectants are supplied free to home cases once a week on calling at the Public Health Department, Town Hall, between the hours of 9 a.m. and 5 p.m. (Saturdays 9 a.m. till 1 p m.) A penalty of £5 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 or mix with other children 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. Diphtheria may also be limited to the nose. Bacteriological examinations are made free of charge on the request of the Medical Attendant. 176 Notice should be sent to the Public Health Department if there are any Public Library Books in the house, and no books must be 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, 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 a period of at least three 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 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 the 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 also should any dust collected in the room. 177 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 rom infection. All utensils from the sick room should be thoroughly scalded. 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.) A penalty of is attached to the exposure of infected persons and things. COUNTY BOROUGH OF CROYDON. TYPHOID (ENTERIC) FEVER. HOME CASE. All cases of ''diarrhœa," "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. Notice should be sent to the Public Health Department if there are any Public Library Books in the house, and no books must be 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. 178 No domestic animal should he allowed to enter the sick room. No children should be allowed to visit the infected honse. A patient suffering from this disease is generally DANGEROUS TO OTHERS for a period of a fortnight after return to ordinary food. DISINFECTION. 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 an 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. 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. All utensils from the sick room should be thoroughly scalded. Disinfectants are supplied free to home cases once a week on calling at the Public Health Department, Town Hall, between the hours of 9 a.m. and 5 p.m. (Saturdays 9 a.m. till 1 p.m.) A penalty of £5 is attached to the exposure of infected persons and things. 179 COUNTY BOROUGH OF CROYDON. PUERPERAL FEVER. Directions as to the disinjection 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 Public Health Department, 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. 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. 180 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. Bathing 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 put on. 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. 181 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 with respect to clothing 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. Children cannot be re-admitted to school unless this certificate is given to the Attendance Officer and Form F. subsequently received by the Head Teacher from the School Medical Officer, or the child is examined and found free at the School Treatment Centre, 228, London Road, on Monday or Thursday morning at 9 o'clock. 182 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. 183 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. No child suffering from a cold when measles is prevalent should be sent back to day or Sunday school until after four days from beginning of cold, even if cold appears better. 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. Patients suffering from measles must be excluded from day or Sunday school for at least three weeks from the appearance of the rash and until the general health is restored. Older children who have not previously had the disease must be kept at home for at least three weeks from the onset of the disease in the child first infected and may then return to day or Sunday school provided they are then free from symptoms. Those who have already had Measles may be allowed to attend the departments of the school for older scholars, but not the Infant's School. Infants living in infected houses must be excluded from school while there is infectious illness in the house. 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 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 Whooping Cough. 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. 184 To Prevent Spread Separate the patient from all other children and do not allow him to attend day or Sunday school or go into the street for as long as the whoop continues and not less than five weeks from the commencement of the whooping. 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. Older children who have not previously had the disease must be kept at home for at least three weeks from the onset of the disease in the child first infected, and may then return to day or Sunday school provided they are then free from symptoms. Those who have already had Whooping Cough may be allowed to attend the Departments of the School for older scholars, but not the Infant School. Infants living in infected houses must be excluded from school while there is infectious illness in the house. A penalty of £5 is attached to the exposure of infected persons and things COUNTY BOROUGH OF CROYDON. SUMMER DIARRHœA. This is the most fatal disease of infants. In all cases medical advice should be obtained without delay. No food should be eaten except what is perfectly fresh. Keep all food covered, especially the milk to be used by a baby. Milk should not be kept in the house for more than twelve hours Milk should be boiled shortly before being given to the child. Mill; should be kept standing in cold water in a cool wellventilated place, in vessels that have been well-cleansed and scalded * The feeding bottle should be without a tube and should be scalded and carefully cleansed each time it is used. *For further particulars consult the pamphlet on Infant Feeding, which can be obtained free at the Public Health Department. 185 Scrupulous personal cleanliness should be practiced. 1 he hands should always be washed before preparing any infant's food. 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 frequentlv. Closet pans should always be clean, and back yards frequentlv swilled with water where possible. Animal and Vegetable Rejuse snould be burned in the kitchen grate instead †being put into the Dustbin. See that the Ashbin is regularly emptied. Nuisances including the prevalence of house flies, should be reported to the Public Health Department, at once. formalin poison for flies. Mix one tablespoonful of formalin in 10 ounces (half-a-pint) of water or equal parts of milk and water and a little sugar. The formalin milk mixture should be exposed in shallow plates (a pint will make sufficient mixture for five or six plates), and by putting a piece of bread in the middle of the plate it furnishes more space for the flies to alight on and drink No vessel containing food or liquid should be left uncovered. The formalin is poison. The formalin and milk mixture must be placed beyond the reach of children and care must be taken that no one drinks it. COUNTY BOROUGH OF CROYDON. INFECTIOUS INFLAMMATION OF THF EYES. This is a condition which, though not dangerous to life, may have extremely serious results upon the eye-sight of the individual affected if proper treatment be not obtained. The earliest signs of the onset are blinking and rubbing of the eyes (due to the feeling of irritation) and the appearance (generally at the inner corner of the eye) of a small accumulation of mattery substance; very often the eyelids are found to be sticking to each other in the morning so that the eye cannot' be opened until the matter has been bathed away with tepid water. When the condition is more advanced, the eye appears blood-shot and often highly inflamed. The condition is very infectious, and every effort should be made to keep the patient separate from other members of the family, and to keep all articles used by the patient solely for his or her use. If this be not done, it is certain that the disease will infect other members of the household. 186 No child should be allowed to visit the infected house. Domestic animals should not be kept in infected households. Notice should be sent to the Public Health Department if there are any Public Library books in the house, and no book must be borrowed until the house is free from infection. Personal cleanliness must be strictly insured both in the patient and in those looking after the patient. The hands should be thoroughly washed after contact with the eyes or person of the patient. It is of the utmost importance that medical attention should be obtained whenever the disease shows itself. COUNTY BOROUGH OF CROYDON. CHILDREN'S TEETH. 1. The Teeth must be kept clean. 2. Use a small tooth-brush Use a little soap and some tated 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. Brush up and down as well as across 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. 5. Clean teeth do not decay. 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. 187 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 male 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 10 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 were all made to fasten down the front, they could be placed into 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. 188 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 a 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. COUNTY BOROUGH OF CROYDON. THE FEEDING AND CARE OF INFANTS. feeding. 1.—The best food for a young infant is his mother's milk. Every infant 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 three months 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. 189 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 Diarrhœa, 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 rinsed and scalded, and allowed to drain while the other bottle is being used. Once a day each bottle 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 rag 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 thin 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 traspoonsful of patent barley in a pint of water. Always prepare fresh at least once a day. Do not increase the quantity of barley or boil too long, and so make the barley water thick. Add this to the milk and boil the mixture. It should be sweetened with a small lump of sugar added to each bottle. ] go 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 mths Every 2½ hours ,, 5 5 ,, 3—6 months Every 3 hours „ 3 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 over-fed 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 (nigh, 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. Ordinary bread and milk or porridge should not be given at this age, 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. CARE OF THE TEETH. 13. — Baby should have 12 teeth by the time he is 12 to 15 month's old. These teeth want excercise and you should give a small piece of dry toast, or crusty bread, or hard biscuit twice a day, so that the teeth and the jaw muscles may have something to do. Due exercise is necessary for the growth of the jaw. Milk must still be the chief food, but too much pappy food is bad, as particles left between the teeth are apt to turn sour and cause decay. Therefore, brush the baby's teeth 191 with a little soap and water each evening, and never allow biscuits to be eaten in bed or any other food that will leave particles of flour or starch to remain between the teeth during the night. clothing. 14.—A young infant should be lightly, but warmly clad in flannel. Binders are unnecessary after the navel has healed. When the baby is short coated, the feet and legs should not he 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. 15.—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 or zinc and starch Never let a wet napkin remain on for a minute. fresh air. 16.— 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. sleep. 17.—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 being overlaid by their mothers. fire. 18 —No child should be left alone within reach of a lamp or fire. Suitable fireguards can be obtained tor a small cost. Clothes should not be made of inflammable flannelette. baby comforters. 19.—Comforters or dummies should not be used. They become dirty, and thus cause sickness and diarrhœa. Their use also derorms the mouth, and leads to growth at the back of the nose as the child grows older. Thumb sucking is also liable to deform the mouth. eyesight. 20.—The eyes ot a newly born baby should be very carefully cleansed with clean warm water and a clean rag immedately after birth. Should any redness of, or discharge from, the eyes come on, you should immediately seek medical advice, carefully wiping and washing the eves by squeezing clean warm water from a clean rag till the doctor comes. The rag should be thrown away after use, and anew 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. 192 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 benefitted 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. Stuffy 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 under medical advice. All milk should be scalded. (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 dangerous 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. 193 Consumptives should spit either into pieces of rag or paper, which should be at once burned, or into a mug containing disinfectant. The vessel should be emptied into the water closet once a day, and then scalded and recharged with disinfectant. 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). Consumptio 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. (3). Over crowded Rooms and excesses of all kinds must be avoided. Your house and surroundings must be in every way clean and sanitary. (4). Promiscuous Sfitting 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. 194 Lastly, remember 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. 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. 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. Sheep's 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 bread crumbs 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. 195 Savoury Rice.—Boil ¼lb. rice in two pints of milk and water till soft. (If skim milk is used a little dripping or chopped suet should be added.) Grate ¼lb. 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 the same way. Cost about 7d. Rice and Lentil Savoury.—A teacupful 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 teacupful of rice and a tea-spoonful of 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. Cheese and Potato Pie.—Put 1½lbs. of peeled potatoes and 2-ozs. rice on to cook. Grate ½1b. cheese. Mash potatoes, and mix one-third of them with the cooked rice, the cheese, ¼lb. 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 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 breakfast-cupful of milk, stirring well. While this is getting hot, grate or chop up finely, 2-ozs. 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 4-ozs. 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 and Cheese Pie.—Steam or boil 1 or 2 lbs. 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.) 196 Plain Suet Pudding.— ¼lb. suet. ¾lb. Hour. 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 suet finely, mix it with the flour and salt, and enough water to form a stiff paste. Tie 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 2-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 handful 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 no lumps left. Chop up a teacupful of mutton 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 three hours. The pudding can be turned out whole on a dish, or sent up in the basin. Health Report FOR 1914 OF THE Croydon Rural District BY THE Medical Officer of Health. WALLINGTON: William Ph.e, Ltd., 5 and 6, Danbury Terrace. Croydon Rural District Council. HEALTH REPORT FOR 1914. Gentlemen, In presenting my Report for the year 1914, I desire at once to place on record my keen appreciation of the services and of the loyalty of the Sanitary Inspectors, and of my personal Clerk—Mr. S. E. Crisp—as without that hearty co-operation it would have been well-nigh impossible for my duties as Medical Officer of Health to be satisfactorily carried out, as I was called up on active service in September, and consequently have been away from the Office during the last three months of the year under review. The general condition of the Croydon Rural District is very good as is evidenced by not only the low death rate now recorded of 10 '2 per thousand of population, but mainly by the very low average of during the last ten years. The care of newly-born and of all notified cases of Tuberculosis have been most efficiently supervised by your Health Visitor—Miss E. M. Pleister. Her unfailing tact, and practical knowledge have been of the greatest value in ameliorating the conditions under which, unfortunately, so many people have to live. I desire also to place on record the help which I have received from all members of the Council and from each individual member of the general staff of the Croydon Rural District Council during the many years in which I have been associated with them. I am, Gentlemen, Your obedient Servant, C. M. FEGEN, Medical Officer of Health. 4th February, 1915, CONTENTS. pages. I.—Area and Population 8 to 11 II.—Vital Statistics . 11 to 17 III.—Infectious Disease 17 to 20 IV.—Preventive Measures 20 to 22 V.—General 22 to 28 VI.—Inspector's Work 28 to 30 Appendices— Isolation Hospital 32 to 34 Statistical Tables. 35 to 53 Factory and Workshops Act 54 to 60 Index 61 to 64 REPORT I.—AREA AND POPULATION. The District consists of seven parishes, and the total area is 19,543 acres. The largest Parish is Coulsdon, with 4,314 acres, and the smallest Wallington, with 821 acres. At the time of the Census in 1911 the population was 65,136, but omitting the three large institutions, viz.:—The Cane Hill Asylum, the Holborn Workhouse, and the Holborn Schools, the total population was 61,127, of which number 28,741 were males and 32,386 were females. At the middle of 1914 the population was estimated to be 70,260, but, omitting all institutions, the corrected number was 65,714, of which number 30,935 were males and 34,779 were females. The number of inhabitants in the three large institutions has increased from 2,468 in 1891 to 4,546 in 1914. There has however, been a decrease of 541 since the middle of 1913. The number of occupied houses in the District was:- In 1881 8,780 „ 1891 4,845 ,, 1900 6,597 „ 1901 7,027 ,, 1902 7.694 „ 1903 8,816 ,, 1904 9,421 ,, 1905 10,498 „ 1906 11,614 „ 1907 18,086 „ 1908 11,862 ,, 1909 11,905 „ 1910 12,630 „ 1911 18,588 ,, 1912 14,104 „ 1913 14,899 „ 1914 14,746 8 It will be seen that there has been an increase of 9,901 in the number of houses occupied during the last 23 years. The subjoined table shows the number of houses in each parish from 1891 to 1914, and also the increases between the years 1891 and 1901, and also in each year from 1901 to 1914. 9 Parish. Number of Houses Increase Between 1891 and 1901 I Between 1901 land 1902 Between 1902 and 1903 Between 1903 and 1904 Between 1904 and 1905 Between 1905 and 1906 Between 190G and 1907 Between 1907 and 1908 Between 1908 and 1909 Between 1909 and 1910 Between 1910 and 1911 Between 1911 and 1912 Between 1912 and 1913 Between 1913 and 1914 In 1891 In 1901 In 1902 In 1903 In 1904 In 1905 In 1906 In 1907 In 1908 In 1909 In 1910 In 1911 In 1912 In 1913 Iu 1914 Addington 132 131 120 120 138 134 139 139 139 140 140 140 140 140 140 — 1 —11 - 18 —4 5 - - 1 - - - - - Beddington 442 751 825 933 1035 1169 1442 1480 1700 1858 2137 2202 2471 2477 2547 309 74 108 102 134 273 38 220 158 279 65 269 6 70 Coulsdon 537 818 903 1001 1244 1365 1512 1643 1720 1817 1943 2054 2096 2126 2255 281 85 98 243 121 147 131 77 97 126 111 42 30 129 Mitcham 2055 2743 2934 3076 3337 3806 4177 4874 5131 5359 5463 6120 6241 6431 6718 688 191 142 261 469 371 697 257 228 104 657 121 190 287 Morden 138 186 195 196 210 206 205 224 236 225 240 247 256 242 48 9 1 14 —4 —1 19 12 —11 15 7 9 — 14 — Sanderstead 96 203 211 250 309 342 425 492 545 577 616 660 690 716 746 107 8 39 59 33 83 67 53 32 39 44 30 20 30 Wallington 710 1063 1168 1272 1388 1464 1546 1564 1668 1714 1858 1918 1960 2009 2078 353 105 104 116 76 82 18 104 46 144 60 42 49 69 Woodmansterne 81 105 120 120 140 146 183 206 223 215 233 247 250 258 262 24 15 20 6 37 23 17 —8 18 14 3 8 4 4191 6000 6476 6968 7801 8632 9629 10622 11362 11905 12630 13588 14104 14399 14746 1809 476 492 833 831 997 993 740 543 725 958 516 295 589 10 It will be observed that considerable activity in the building trade has occurred at Mitcham with 287 more houses. Coulsdon with 129, Beddington with 70 and Wallington with 69. Throughout the District, generally, the average number of persons occupying each house in 1901 was 4.8, but for 1914 it has fallen to 4.4. The average number of persons to each inhabited house remains, as a general rule, fairly constant for each locality, though varying considerably in different parishes, according to the class of house erected. In many parts of the District "tenement" houses, or houses let in flats, have been built, and these houses have, of couse, a considerably larger number of inmates. This is particularly the case in Mitcham. The "natural increase" during the year was 872, as against 967 in the previous year. In 1897 the increase was 474 „ 1898 „ 392 1899 „ 879 „ 1900 ,, 460 „ 1901 ,, 548 „ 1902 „ 552 „ 1903 „ 780 „ 1904 „ 768 ,, 1905 ,, 879 „ 1906 „ 921 „ 1907 „ 986 „ 1908 ,, 903 „ 1909 „ 968 ,, 1910 „ 899 „ 1911 „ 818 „ 1912 ,, 981 „ 1913 ,, 967 „ 1914 ,, 872 And this has amounted to 16,129 since the census in 1891. The "natural increase" in 1913 was greatest in Mitcham with 508, Coulsdon and Beddington with 133 each. 11 II.—VITAL STATISTICS. Births. The number of Births registered as occurring within the District during the year was 1,510, as against 1571 last year, and 1505 in 1912. Of this number 27 children were registered as being illegitimate. This gives an illegitimate birth- rate of 1.7 per cent, of the total births, as against 1.9 last year No. of Illegitimate Births. Percentage. Beddington 1 0.4 Coulsdon 2 0.9 Mitcham 20 2.2 Sanderstead 1 1.9 Wallington 8 1.9 The birth-rate for the entire District was 23.5 per thousand of population, as against 24.4 last year and 23.9 in 1912. The birth-rate in England and Wales in 1914 was 23.8 per thousand of the population, which is 0.3 per thousand below the rate in 1913, and lower than the rate in any other year on record, due allowance being made for revised estimates of population. Compared with the average in the 10 years, 1904-1913, the birth rate in 1914 shows a decrease of 2.1 per thousand. Excess of Births over Deaths. Births in 1914. Deaths in 1914. Excess of Births, in 1914. Addington 9 11 —2 Beddington 212 79 133 Coulsdon 217 84 183 Mitcham 882 874 508 Sanderstead 53 25 28 Wallington 151 90 61 Woodmansteme 22 11 11 1546 674 872 12 Registered Births and Birth Rates. Parish. Estimated Population to middle of 1914. Registered Births. Birth Rates. 1910 1911 1912 1913 1914 1910 1911 1912 1913 1914 Addington 614 11 17 15 14 9 15.8 27.7 24.4 22.8 14.6 Beddington 10700 156 186 211 193 212 15.8 20.1 20.3 18.5 19.8 Coulsdon 9700 210 208 208 219 217 21.2 23.5 23.0 23.9 22.3 Mitcham 30902 844 875 829 907 882 29.7 30.6 28.8 30.6 28.5 Morden .. 30 21 26 6 .. 24.5 17.5 21.1 20.6 .. Sanderstead 3580 36 32 52 44 53 12.5 11.2 17.5 14.2 14.8 Wallington 8935 136 139 132 137 151 14.3 16.3 15.3 15.4 16.9 Woodmansterne 1283 43 33 32 51 22 36.2 27.2 26.1 40.2 17.1 65714 1466 1511 1505 1571 1546 23.0 24.7 23.9 24.4 23.5 Deaths. Exclusive of those deaths which occurred in Public Institutions situated within, the district, but belonging to other districts, the deaths registered during the year numbered 674. In this number are included those deaths which were transferred by the Registrar-General of persons who had died outside, but who belonged to this district. The number of these deaths was 171. These deaths chiefly occurred at the Workhouse, Workhouse Infirmary, and General Hospital at Croydon; the County Asylums at Brookwood and Netherne; the Cottage Hospital at Carshalton; and the Council's Isolation Hospital at Beddington Corner. The mortality corresponds to a death rate of 10.2 per thousand of population, as against 9.4 last year, 8.3 in 1912, as against an average of 9.8 during the ten years 1904-1913. 13 Mortality.* Parish. Estimated Population to middle of 1914. Deaths. Death Rates. 1910 1911 1912 1913 1914 1910 1911 1912 1913 1914 Addington 614 6 9 3 5 11 8.6 14.7 4.9 8.1 17.8 Beddington 10700 77 75 61 69 79 7.8 8.1 5.9 6.6 7.4 Coulsdon 9700 76 92 51 79 84 7.6 10.4 5.6 8.6 8.6 Mitcham 30902 282 398 280 349 374 9.9 13.9 9.8 11.8 12.1 Morden .. 12 8 25 5 .. 9.9 6.6 20.3 17.1 .. Sanderstead 3581 16 19 13 14 25 5.5 6.6 4.4 4.5 7.0 Wellington 8935 90 85 79 72 90 9.4 10.0 9.1 8.1 10.0 Woodmansterne 1283 8 7 12 11 11 6.7 5.8 9.8 8.6 8.5 65714 567 693 524 604 674 8.9 11.3 8.3 9.4 10.2 * Exclusive of deaths of non-residents occurring in public institutions in the District, but inclusive of deaths of residents occurring in public institutions outside the District. N.B.—The number of deaths occurring to non-residents in public institutions in the District in 1914 was 217. Mortality at Different Ages. In'antile Mortality.—The number of infants under the age of one year who died during 1914 was 126, as against 101 in 1913, 101 in 1912, 158 in 1911, and 98 in 1910, the infantile mortality rate, therefore, being 81 per thousand births, as against 77 last year, 67 in 1912, 104 in 1911, and an average of 93 in the ten years 1904-1913. The deaths of children under the age of one year, numbering 126, gives a percentage rate of 18*6 of the deaths at all ages, as against 20.0 in 1913, 19'2 in 1912, 22'8 in 1911. 14 The deaths of children between the ages of one and five years, numbering 55, gives a percentage of 8T of total deaths, as against 101 in 1913, 4"8 in 1912, and 12'2 in 1911. The deaths occurring in persons over 65 years of age, numbering 221, gives a percentage of 32.7 of total deaths, as against 28'8 in 1913, 32.6 in 1912, 24.5 in 1911, and 27.3 in 1910. Parish. Children under One Year. Children between One and Five. People over 65 Years. 1910 1911 1912 1913 1914 1910 1911 1912 1913 1914 1910 1911 1912 1913 1914 Addington .. 2 2 1 1 1 .. .. .. .. 2 3 1 2 4 Beddington 7 17 12 11 8 8 4 2 2 3 21 20 19 22 34 Coulsdon 12 16 6 17 11 3 6 2 4 6 15 29 18 21 26 Mitcham 62 113 71 81 92 29 73 17 49 40 72 74 76 87 109 Morden 3 1 2 1 .. 1 .. 1 .. .. 3 2 9 2 .. Sanderstead 1 2 3 .. 1 2 2 1 1 1 7 6 6 8 9 Wallington 10 6 3 8 12 5 2 1 5 4 31 34 40 27 35 Woodmansterne 3 1 2 2 1 .. .. 1 .. 1 1 2 2 5 4 Totals 98 158 101 121 126 49 87 25 61 55 155 170 171 174 221 15 Causes of Deaths. The deaths in 1914 included:— 2 from Measles. 8 ,, Scarlet Fever. 7,, Whooping Cough. 17 ,, Diphtheria. 24 „ Diarrhæa and Enteritis. 102 „ Lung Complaints. 2 ,, Puerperal Fever. 36 ,, Phthisis. 69 ,, Cancer (malignant disease). 8 ,, Alcoholism and Cirrhosis of Liver. 22 ,, Injuries (self-inflicted or otherwise). The Zymotic Death Rate is a term commonly applied to the rates of deaths occurring from the seven principal zymotic complaints:—Small Pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Diarrhæa, and "Fever"; which latter term includes Typhus, Typhoid (or Enteric), and Puerperal Fevers. During the year 1914 the deaths from these complaints numbered 55, the Zymotic Death Rate, therefore, being 0.8 per 1,000 of population, as against 1.04 in 1913, 0,6 in 1912, 2.0 in 1911, 1.1 in 1910. The deaths from Phthisis numbered 36, as against 38 in 1913, 46 in 1912, 46 in 1911, 46 in 1910. The Phthisical Death Rate is, therefore, 0.8 per thousand of population, as against 0.6 in 1913, 0.7 in 1912, 0.7 in 1911, 0.7 in 1910. The deaths from Pulmonary Diseases numbered 102, as against 89 in 1913, 65 in 1912, 91 in 1911, 93 in 1910. This gives a Death Rate of T5, as against 1.07 in 1913, 1.0 in 1912, 1.4 in 1911, 1.4 in 1910. 16 To various forms of injury, whether self-inflicted or otherwise, 22 deaths were due, in all of which cases inquests were held. This gives a Death Rate of 0'3, as against 0.2 in 1913, 0.3 in 1912, 0.2 in 1911, 0.4 in 1910. The Death Rate in England and Wales in 1914 was 13.7 per thousand of population, and this was 0.2 per thousand above the revised rate in 1913. Compared with the revised average rate in the ten years 1904-1913, the Death Rate in 1914 showed a decrease of 0.7 per thousand. Birth Rate, Death Rate, and Analysis of Mortality in the year 1914. Annual rate pek 1000 living. Birth-rate. Death-rate. Deaths from Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria Violence. England and Wales 23.9 13.7 0.05 0.00 0.24 0.03 0.21 0.15 0.58 96 Great Towns, including London 25.0 15.0 0.04 0.00 0.35 0.09 0.25 0.16 0.54 145 smaller Towns 23.9 13.1 0.05 0.oo 0.21 0.07 0.18 0.16 0.55 England and Wales, less the 241 Towns 22.2 12.4 0.05 0.00 0.12 0.06 0.17 0.14 0.65 London 21.3 14.4 0.03 0.00 0.31 0.07 0.20 0.16 0.59 Croydon Rural District 23.5 10.2 0.00 0.00 0.03 0.04 0.16 0.26 0.33 Deaths in Institutions. The Deaths in Institutions situate in the District numbered 217, as against 207 in 1913, 176 in 1912, 190 in 1911, 163 in 1910. 17 The deaths included:— 11 from Phthisis. 7 „ Cancer (malignant disease). 19 „ Lung Complaints. 51 ,, Heart Diseases. 74 ,, Brain Diseases. III.—INFECTIOUS DISEASE. The Infectious Diseases (Notification) Act has been in force in this District since the year 1890. In July of that year Measles was also included in the list of notifiable diseases, and continued to be a notifiable disease until June, 1909. In the summer of 1894 it was considered necessary that Diarrhæa should, for a short period, also be considered a notifiable disease. Owing to the epidemic of Small-Pox that existed in and around London, as well as in the Croydon Rural District, during the latter part of 1901 and the beginning of 1902, Chicken Pox was made a notifiable disease, and continued to be so until the end of July, 1903, and it was of great assistance in combating the outbreak of Small-Pox. During 1911 Chicken Pox was again made a notifiable disease for six months. In April, 1907, Cerebro-Spinal Meningitis was made a notifiable disease for twelve months, and on the 13th May, 1912, Cerebro-Spinal Fever and Acute Polyiomyelitis were made notifiable diseases. Ophthalmia neonatorum was made a notifiable disease on the 1st April, 1914. The Infectious Diseases (Prevention) Act, 1890, has been in force in this District since 1891. During the year 450 cases of Notifiable Disease (excluding Phthisis) were either notified to the Sanitary Department or came to its knowledge through the vigilence of its Inspectors, as against 327 in 1913, 408 in 1912, and 483 in 1910 18 Reference to Table II. at the end of the Report will show:— Firstly, cases notified in the whole District, with the ages ot incidence and the nature of the Infectious Disease. Secondly, the total number of cases (and nature of the disease) in each locality. Thirdly, the number of cases removed from each locality to the Isolation Hospital. Reference to Table IX. will show the number of cases notified since the adoption of the Notification Act. Scarlet Fever. An increase in the number of Scarlet Fever cases notified took place, viz., 242, as against 175 last year. The largest number of cases occurred in Mitcham, no less than 132 cases being notified from that parish. One hundred and ninety cases were removed to the Isolation Hospital, and three deaths were registered as occurring during the year. Diphtheria. During the year 141 cases of Diphtheria were notified. Although this is 50 more than in the previous year, it compares favourably with the number of cases notified daring 1912 and 1911, which were 145 and 166 respectively. One hundred and fifteen cases were removed to the Hospital. This disease had a fatal ending in 17 case. I again desire to point out that a supply of antitoxin has been placed at the services of all medical men practising within the district, and also arrangements have been made for bacteriological examinations free of charge. The Council has done this excellent service since 1901, and it was, I believe, one of the first, if not the first, to take such a step. 19 Puerperal Fever. Nine cases of Puerperal Fever were notified as occurring, as against 5 last year. Only two of the cases occurred in the practice of midwives. This complaint had a fatal ending in two cases. Erysipelas. Forty-five cases of Erysipelas were notified, as against 86 last year. Two cases were removed to the Isolation Hospital. Cerebo-Spinal Meningitis. One case ot Cerebro-Spinal Meningitis was notified during the year, as against 4 last year. This case occurred in a boy aged 10 months. For about eleven weeks previous to his admission to a London Hospital, he was attended by a local medical man, and also as an out-patient of the Hospital for teething trouble. The case had a fatal ending. Typhoid Fever. A very large decrease in the number of Typhoid Fever cases occurred, viz., 4, as against 16 last year, 15 in 1912, and 47 in 1911. In one case the complaint was probably contracted by the patient eating tainted mussels; in the other three cases the source of infection could not be traced. Infantile Summer Diarrhæa. The number of cases of deaths from Infantile Summer Diarrhæa remain about the same, viz., 19, as against 14 last year and 17 in 1912. This is probably due to the cool and wet conditions which have prevailed during the past three years. Five of the deaths occurred in Institutions outside the district. 20 Reference to Table 12 in the Appendix will show the circumstances, feeding and family history of the victims of this disease in 1914, and the parishes and roads invaded during the past 14 years will he found in Table 13. IV.—PREVENTIVE MEASURES. During the year 421 patients were admitted to the Isolation Hospital at Beddington Corner, including 106 patients from neighbouring authorities. The usual routine preventive and precautionary measures have been continued as in previous years to check the extension of infectious disease, with most satisfactory results. Isolation, disinfection and quarantine have been carried out under the careful and intelligent supervision of the Sanitary Staff, and outbreaks of infectious disease have been very materially limited. Unrecognised cases, as in previous years, have been the origin of most outbreaks, and such unrecognised cases are always likely to exist in all diseases, especially if the attack is of a very mild type. So mild indeed are some of these cases that the advice of a medical man is, by the parents of the patients, considered superfluous. These, unfortunately, are the cases which prove the nuclei of almost all epidemics. Immediately on notification being received of the existence of cases of Scarlet Fever, Diphtheria, Typhoid Fever, and Small Pox, it is the custom to offer hospital treatment, and, if the offer is accepted, the patient is at once removed to the Hospital; in no case should longer than two hours elapse after receiving the intimation of the existence of infectious disease in any house before the patient, if for removal, is in the Hospital especially is any delay is to be deprecated in all cases 21 of Diphtheria, as abstention from the administration of diphtheria antitoxin until a bacteriological examination proves positive lessens the chance of ultimate recovery very considerably. No harm can possibly be done by administering a dose of diphtheria antitoxin as soon as this disease is even suspected and a great gain accrues. As a rule however this administration is generally postponed until the patient reaches the Hospital. In all cases of Typhoid Fever which are not admitted to the Hospital, sanitary pails, of a special character furnished with air-tight screw lids, are left at the infected houses for the reception of all excreta and other waste products of the sick room. These pails are collected daily, and their contents are dealt with in the destructor at the Hospital. In every case of Notifiable Disease enquiries are made and recorded as to the number of persons in the house, where they are employed, milk supply, water supply, laundry, conditions of drains, etc., together with the history of the case and the probable cause of infection. Notice is at once sent to any school attended by children from infected houses, and these children are then excluded from school on my certificate, and are not allowed to return until due notice has been given to the school authorities of their freedom from possible infection. The courtesy of the Managers of Sunday Schools has been much appreciated in falling in with the suggestions that any Sunday School should also be closed during the same period as the ordinary schools. Disinfection of infected rooms is carried out by fumigation with sulphur dioxide or formic aldehyde, and of the bedding and the clothes by steam at the disinfecting station at the Isolation Hospital. Disinfectants are supplied 22 free of charge daring illness. After the rooms have been disinfected, the owners of the premises are required to strip and whitewash the ceilings and walls, under the supervision of the Sanitary Inspectors. This applies to all cases of Infectious Disease, and in the event of cases of Phthisis or Cancer occurring, on request, the rooms, as well as the bedding, clothing, etc., are from time to time disinfected. During the year 431 houses and 10597 articles were disinfected. The Council places at the disposal of all medical practitioners, free of charge, means of having the diagnosis of all cases of infectious or contagious disease confirmed or otherwise by bacteriological examination, and also, at the end of the illness, for determining whether the patient is free from the specific bacterium or not. During the year 964 such examinations have been made. While with regard to Diphtheria, it is the custom to consider each case infective until the bacteriological examinations shows the throat to be free from the true or pseudodiphtheritic bacillus. Antitoxin has for the last 17 years been supplied free of charge to all medical men practising in the district to use, either for patients in which the diagnosis is in suspense, or where the patients are nursed at home, or for prophylactic injections to inmates of invaded houses. V.—GENERAL. Water Courses.—All water courses within the district have been kept under tho constant supervision of your officers. 23 Legal Proceedings.—In the following cases legal proceedings have been taken:— Particulars. Results. Slaughtering on unlicensed premises Fined 5s. and costs. Carting offensive house refuse through the streets at Mitcham Fined 40s. Od. and 7s. 6d. costs. Slaughtering on unlicensed premises Fined 20s. Od. and 7s. 6d. costs. Ditto Fined 20s. Od. and 7s. 6d. costs. HOUSING OF THE WORKING CLASSES ACTS. During the year the undermentioned number of houses have been dealt with under the Housing of the Working Classes Acts:— Number of houses inspected 281 Number of houses considered so dangerous or injurious to health as to be unfit for habitation 69 Number of houses in previous group which were made fit for habitation without representation to Local Authority 37 Number of formal representations to Local Authority with a view to the issue of a Closing Order Number of Closing Orders made 9 Number of houses represented unfit for human habitation which were made fit without Closing Orders 2 Number of houses in which defects were remedied after the issue of Closing Orders Number of houses voluntary closed by owners 2 Number of houses voluntary demolished by owners 12 24 MEDICAL INSPECTION OF SCHOOL CHILDREN. The Medical Inspection of school children is carried out by the Education Department of the Surrey County Council, but on many occasions I have been called in to see children who have been suspected to be suffering from infectious or contagious disease, and my services are always available for this purpose on an application from the Heads of the various schools. Sixty-three children have been personally examined for school attendance purposes, and 137 visits have been paid to the homes of the scholars. Eighty-seven notifications of dirty homes were received from the School Nurse, and 131 visits were paid for this purpose, and in consequence of these visits four premises were disinfected, and 12 notices to cleanse were served. SCHOOLS. During the year 178 visits have been paid by the sanitary staff to the public elementary schools and school premises in the district, and their condition reflects credit on the Managers. During the year I have on 6 occasions recommended the closing of schools. HEALTH VISITOR. The following is a summary of the work done by the Health Visitor during the year. I desire to bear testimony to the excellent work done, and to the exemplary manner in which it is performed. Visits to houses where Infants have been born 1,581 Tuberculosis cases visited 819 Home visits to Children excluded from school 143 Visits to houses where Infants have died of Diarrhæa 21 25 REGULATED TRADES. Parish. Dairies. Cowsheds. Milkshops. Butcher's Shops. Slaughterhouses. Piggeries. Bakehouses. Total. Addington .. 3 .. .. .. 1 .. 4 Beddington 1 2 6 6 .. 2 5 22 Coulsdon 5 7 9 9 5 .. 4 39 Mitcham 10 10 21 17 7 74 17 162 Sanderstead 2 4 .. 1 .. .. .. 7 Wallington 3 1 6 5 3 2 4 24 Woodmansterne .. 2 .. .. .. .. .. 2 Totals 27 29 42 38 15 79 30 260 (1) Dairies, Cowsheds, and Milkshops. At the end of the year there were 98 premises registered under the Dairies, Cowsheds, and Milkshops Order, 1885, which is 5 less than in the previous year. During the year repeated visits have been paid to all dairies, cowsheds, and milkshops within the district, no less than 461 inspections being made, and in only 11 cases was it found necessary to complain as to uncleanliness or neglect of regulations. (2) Slaughterhouses. The number of butchers' shops and slaughterhouses remain much about the same, viz., 57 last year and 53 this year. All meat has been kept under constant supervision and over 232 lbs. have been destroyed as unfit for human consumption. During the year 252 visits of inspection were made, and in 6 instances complaint was made as to uncleanliness. (3) Bakehouses. The number of bakehouses within the district remain the same as they did in the previous year, viz. 30. During the year 174 visits of inspection were made, and on no occasion was it found necessary to make any complaint as to uncleanliness. 26 (4) Piggeries. There are 79 piggeries within the district, which is 4 more than in the previous year. All the piggeries receive very special attention from your officers, and practically no complaints were received. In 29 cases piggeries were repaired and improved under the direction of your officers. Sale of Food and Drugs Acts. The administration of the Sale of Food and Drugs Acts is carried out by the County Council of Surrey, and much attention is paid by the Inspector to this district. The following Table shows the number of samples analysed during the year. Articles. Analysed. Adulterated or Deteriorated. Prosecutions. Convictions. Formal. Informal. Total. Formal. Informal. Total. Milk 61 3 64 6 1 7 1 - Cream 5 — 5 1 - 1 - - Butter 8 35 43 - 3 3 - - Cheese 1 — 1 - - - - - Margarine 1 — 1 - — — - - Lard 2 — 2 - - - - - Bread — — - - - - - - Flour — — — - — — - - Tea 2 — 2 - — - - - Coffee 2 — 2 - — — - - Cocoa 2 — 2 - — — - - Sugar — — — - — — - - Mustard — — — — — — - - Confectionery & Jam - — - — — — - - Pepper 2 — 2 — — — - - Wine - - - - - - - - Beer - - - - - - - - Spirits - - - - - - - - Drugs - — - - - - -__ - Other Articles 11 - 11 2 — 2 - - Totals 97 38 135 9 4 13 1 — •Details of Other Articles Rice 2 - 2 - - - - - Pearl Barley 3 — 3 - - - - - Preserved Cream 2 — 2 2 — 2 - - Vinegar 1 — 1 — — — — - Olive Oil 2 — 2 — — — - - Baking Powder 1 - 1 - - - - - 27 SANITARY SURVEYOR'S DEPARTMENT. I am indebted to Mr. Chart for subjoined information:— Sewage Disposal. The Sewage Works at Byegrove Road, Mitcham, have been working to their utmost capacity and the Council have given much consideration to the scheme submitted to them for remodelling the works in the light of modern research. It is due no doubt to the fact that the supply of horse manure is limited by the introduction of motor traffic, that for the first time for many years there has been a demand for pressed sludge, and a considerable quantity has been dispatched by rail, and a small price obtained for it. New Streets and Buildings. The following Table sets out in detail the plans deposited for New Streets and Buildings during the year. New Streets. Public Blctgs. Houses. Motor Sheds. Other Bldgs. Total. Total Previous Year. Addington .. .. 2 .. 6 8 .. Beddington .. .. 58 10 27 95 123 Coulsdon .. 1 32 2 15 50 72 Mitcham 3 2 274 4 30 313 150 Sanderstead . . .. 34 10 2 26 59 Wallington .. .. 48 6 11 64 62 Woodmansterne .. .. 2 .. 2 4 10 Totals 3 3 430 31 93 560 476 As showing the progress of developement in the district the following are the totals for previous years:— 1905-5 1900 1906-7 2281 1907-8 1194 1908-9 881 1909-10 921 1910-11 877 1911-12 845 1912-13 521 1913-14 476 28 Making up of Private Streets. The Council have, during the year, made up seven streets in the District, involving the service of many hundreds of notices, and the execution of works to the value of £7,151. The following is a list of the streets completed :— Coulsdon.— Warren Koad. Downs Court Road. Mitcham.— Melrose Avenue. Birdliurst Road. Clive Road. Warren Road. Boundary Road. In addition to the above, the making up of Park Hill Road, Wallington, is in hand. INSPECTORS' WORK. Summary of Inspectors' Work for the Year 1914. White Payne Inspectors. Rabbetts Parker Total Total number of visits paid 2259 2359 3339 2252 10200 Number of complaints received and investigated 208 68 91 67 484 Number of premises inspected 427 880 973 1094 2874 Number of nuisances discovered 820 190 479 698 1682 Number of nuisances abated without report 316 135 880 496 1327 ,, ,, after report 4 50 105 66 225 Preliminary notices served 174 164 280 339 957 Legal notices served 4 20 39 23 80 Notices followed by legal proceedings - - - - - Character of Work Done— Houses dealt with under the Housing of the Working Classes Acts - - 8 - 8 Houses inspected under the Housing and Town Planning Act 20 75 106 80 281 29  White Inspectors. Payne Rabbetts Parker Total Houses repaired and cleansed generally 81 53 113 107 354 Ventilation of houses improved 3 6 8 1 18 Overcrowding abated 3 8 5 5 16 Defective roofs repaired 16 29 49 39 133 Houses under-pinned (damp proof course inserted; or damp walls remedied 17 40 26 38 121 Eaves guttering renewed or repaired 10 14 47 18 89 Water-closets renewed or repaired 61 12 23 22 118 Water-closets provided with water for flushing purposes 6 4 63 20 98 Privies or earth-closets re-constructed, improved or abolished — 5 — — 5 Houses supplied with water from the main — 9 4 8 16 Water.cisterns or tanks cleansed or covered 4 2 23 10 89 Yards of houses paved with impervious material 19 35 27 9 80 Paving of yards repaired 12 15 58 38 123 Floors of sculleries paved or repaired 15 5 37 14 71 Ashpits or dustbins provided 45 85 77 82 239 Additional w.c. provided — 1 — — 1 Cesspools abolished or filled up 1 8 1 — 10 Cesspools cleansed or emptied 8 110 — — 118 Houses at which drains were tested 60 53 33 42 188 Houses at which drains were found defective 45 82 18 5 95 Houses at which drains were re-constructed or new provided 2 12 8 4 26 Houses at which drains were cleansed, ventilated, trapped or repaired 68 80 175 65 378 Number of drain tests in course of work done under the two previous headings 86 45 20 23 174 Houses at which inspection chambers in drains were provided 2 8 6 - 16 Stables provided with drainage 1 — — — 1 30  White Inspectors Payne Rabbetts Parker Total Premises at which animals improperly kept were removed - 3 8 6 17 Number of inspections of food exposed for sale 352 98 126 70 646 Urinals cleansed or repaired 2 2 3 12 19 Smoke nuisances abated — — 3 — 3 Offensive accumulations removed 14 16 67 25 122 Piggeries repaired and improved 2 1 8 18 29 Infective houses disinfected and cleansed 117 91 165 58 431 Number of visits to infective houses 126 229 172 133 660 Number of visits to dairies and milkshops 180 118 84 79 461 Number of complaints as to uncleanliness and neglect of regulations 4 3 4 - 11 Number of visits to slaughterhouses 60 66 91 35 252 Number of complaints as to uncleanliness 1 1 4 - 6 Number of visits to bakehouses 83 26 40 25 174 Number of complaints as to uncleanliness - - - - - Number of visits to butchers' and fishmongers' shops 312 68 126 69 575 Number of drains opened up for examination (Section 41, P.H.A., 1875) - 2 2 20 24 Manure pits provided or repaired 4 2 1 1 8 Unsound food destroyed includes:—194 lbs. fish, 232 lbs. meat. Articles Disinfected. January 626 July 843 February 798 August 998 March 797 September 867 April 872 October 980 May 760 November 1,200 June 880 December 976 10,597 APPENDICES. 82 ISOLATION HOSPITAL. The Isolation Hospital, which is situated at Beddington Corner, Mitcham Junction, is the Joint Hospital for the Croydon Rural and Merton Urban District Councils, and was opened for the reception of patients at the beginning of March, 1899, since which date 4,730 patients have been admitted. Accommodation— At the time the Hospital was first opened, the population of the district being about 28,000, it was thought that it would be sufficient if accommodation was provided for 28 patients, viz., 10 Scarlet Fever cases, 10 Diphtheria cases, 4 Typhoid Fever cases, and 4 beds for observation purposes. The Shortage of beds, however, became more pronounced in each succeeding year, and in 1905, a very considerable enlargement took place by the addition of a Scarlet Fever pavilion of 22 beds. The hand laundry was also converted into a steam laundry, and some additional dormitory accommodation was provided in the Administrative Block. Owing to the great pressure which was placed upon the resources of the Hospital, and to the many occasions on which the Hospital was overcrowded, it was deemed essential that there should be a further enlargement, and in 1910, plans were passed for an extension to include a cubicle block for 12 patients, and also quarters for a Resident Medical Officer. This extension was opened in November, 1910. Staff.—The Staff of the Hospital consists of— 1 Resident Medical Officer. 1 Matron. 1 Assistant Matron. 13 Nurses. 3 Laundresses. 2 Engineers. 7 Servants. 6 Wardmaids. 1 Seamstress. 2 Gardeners. Porter and Portress. 33 Patients.—During the year 421 patients have been admitted, of which number 264 were Scarlet Fever 147 ,, Diphtheria 4 ,, Typhoid Fever 3 was Puerperal Fever 1 ,, Tuberculosis 2 were Erysipelas Thirty-five of these patients were admitted by arrangement with other authorities, and 71 were admitted from Merton. 34 Of the 421 patients admitted, 393 were discharged as cured, and 28 died, viz., 5 from Scarlet Fever (including one death from Tuberculous Meningitis, and one from acute rheumatism), 20 from Diphtheria, one from Puerperal Fever, one from Tuberculosis, and one from Erysipelas. Parish. Scarlet Fever. Diphtheria. Typhoid Fever. Puerperal Fever. Tuberculosis. Erysipelas. Total. Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Addington 2 .. .. .. .. .. .. .. .. .. .. .. 2 .. Beddington 22 1 8 .. .. .. .. .. .. .. 1 .. 31 1 Coulsdon 13 .. 19 2 .. .. .. .. .. .. .. .. 32 2 Mitcham 114 3† 54 9 4 .. 3 1 1 1 1 1 177 15 Sanderstead 2 2 .. .. .. .. .. .. .. .. .. 4 .. Wallington 24 .. 22 1 .. .. .. .. .. .. .. .. 46 1 Woodmansterne 13 .. 10 1 .. .. .. .. .. .. .. .. 23 I Merton 48* 1* 23 4 .. .. .. .. .. .. .. .. 71 5 Cases admitted by arrangement— Caterham 26 •• 9 3 .. .. •• .. .. .. .. .. 15 3 Totals 264 5 147 20 4 .. 3 1 1 1 2 1 421 28 * Patient died from Tuberculous Meningitis, † Including one death from Acute Rheumatism. 35 TABLE 1.—Vital Statistics of Whole District during 1914 and Previous Years. Year. 1 2 Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. 3 Uncorrected Number. Nett. Number. 6 Rate. 7 8 of Non-residents registered in the District. 9 of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. 4 Rate. 5 Number. 10 Rate per 1,000 Nett Births. 11 Number. 12 Rate. 13 1909 58300 .. 1513 25.0 649 10.7 208 104 130 85 545 9.0 1910 60000 .. 1466 23.0 630 9.9 163 100 98 67 567 8.9 1911 61127 .. 1511 24.7 724 11.8 190 159 158 104 693 11.3 1912 62768 1484 1505 23.9 700 11.1 176 153 101 67 524 8.3 1913 64127 1559 1571 24.4 811 12.6 207 152 121 77 604 9.4 1914 65714 1520 1546 23.5 720 10.9 171 217 126 81 674 10.2 36 Area of District in acres (land and inland water) 21018 Total population at all ages 651331 Number of inhabited houses 13588 Average number of persons per house 4.5 At Census of 1911. Institutions within the District receiving sick and infirm persons from outside the District— Cane Hill Lunatic Asylum, in the Parish of Coulsdon. Holborn Workhouse, in the Parish of Mitcham. Holborn Union Schools, in the Parish of Mitcham. Institutions outside the District receiving sick and infirm persons from the District— Surrey County Asylum, at Brookwood. Surrey County Asylum, at Netherne. Carshalton Cottage Hospital. at Carshalton. Croydon Rural District Isolation Hospital, at Carshalton. Joint Small Pox Hospital, in the Parish of Cheam. Croydon General Hospital, at Croydon. Croydon Infirmary and Workhouse, at Croydon. Other Institutions, the deaths in which have been distributed among the several localities in the District— Russell Hill School, in the Parish of Beddington. Royal Female Orphanage, in the Parish of Beddington. Reedham Orphanage, in the Parish of Coulsdon. 37 TABLE II.—Cases of Infectious Disease notified during the year 1914. Notifiable Diseases. Cases Notified in whole District. Total Cases Notified in each Locality. No. of Cases Removed to Hospital from each Locality. At all Ages. At Ages—Years. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Totals. Addington. Beddington. Coulsdon. Mitcham. Sanderstead. Wallington. Woodmanst'rne Addington. Beddington. Coulsdon. Mitcham. Sanderstead. Wallington. Woodmanst'rne Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 141 2 22 90 15 9 3 .. .. 28 19 57 3 23 11 .. 8 19 54 2 22 10 115 Erysipelas 45 .. 3 2, 4 12 15 2 1 6 10 23 2 2 1 .. 1 .. 1 .. .. .. 2 Scarlet Fever 242 2 44 157 28 10 1 .. 3 34 25 132 3 33 12 2 22 13 114 2 24 13 190 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 4 .. .. .. .. 4 .. .. .. .. .. 3 1 .. .. .. .. .. 4 .. .. .. 4 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 9 .. .. .. 2 7 .. .. .. .. .. 6 1 2 .. .. .. .. 3 .. .. .. 3 Cerebro-Spinal Meningitis 1 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 7 7 .. .. .. .. .. .. .. 2 .. 4 1 .. .. .. .. .. .. .. .. .. .. Pulmonary Tuberculosis 86 1 4 6 21 42 10 2 1 13 12 48 1 9 2 .. .. .. .. .. .. .. .. Other forms of Tuberculosis 24 .. 6 12 1 4 .. 1 .. 3 3 10 .. 6 2 .. .. .. 1 .. .. .. 1 Anthrax 1 .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. Totals 560 13 79 267 71 88 30 12 5 86 69 285 12 75 28 2 31 32 177 4 46 23 315 The Isolation Hospital is situated at Beddington Corner, Mitcham Junction, but is within the Carshalton Urban District. The Small Pox Hospital is situated at Cheam, and is the Joint Hospital for Croydon Borough, Wimbledon, Penge, Croydon Rural and Merton Councils. 33 TABLE III.—Causes of, and ages at, Death during 1913. 1 Causes of Death. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. Deaths at all ages of all "Residents" belonging to Localities. whether occurring in or beyond the District. Total Deaths whether of Residents or non" Residents'* in Public Institutions in the District. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 All ages. Under 1. 1 & under 2. 2 & under 5. 5 and under 15. 15 & under 25. 25 & under 45. 45 & under 65. 65 & upwards. Addington. Beddington. Coulsdon. Mitcham. Sanderstead. Wallington. Woodmanst'rne 18 19 Cane Hill Asylum Holborn Union Workhouse All causes Certified (c) 674 126 26 29 29 30 93 120 221 11 79 84 374 25 90 11 .. .. Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 2 .. 1 1 .. .. .. .. .. .. .. .. 2 .. .. .. .. .. Scarlet Fever 3 .. .. 1 2 .. .. .. .. .. 1 .. 2 .. .. .. .. .. Whooping Cough 7 3 4 .. .. .. .. .. .. .. .. .. 4 .. 3 .. .. .. Diphtheria and Croup 17 3 .. 9 5 .. .. .. .. .. 1 4 9 .. 1 2 .. .. Influenza 13 3 .. .. .. 2 2 4 2 .. 1 2 8 .. 2 .. .. .. Erysipelas 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. Phthisis (Pulmonary Tuberculosis) 36 1 2 .. 1 7 20 3 2 .. 6 5 18 3 3 1 8 3 Tuberculous Meningitis 6 1 .. 2 2 .. 1 .. .. .. 2 .. 3 .. .. 1 .. 1 Other Tubercular Diseases 14 3 .. 1 3 2 4 1 .. .. 2 2 9 1 .. .. 2 .. Cancer, malignant disease 69 .. .. .. 1 .. 12 25 31 .. 7 13 31 4 13 1 4 3 Rheumatic Fever 5 .. .. .. 1 1 2 1 .. .. .. 1 3 .. .. 1 .. .. Meningitis (See note (d)) 8 1 2 1 2 1 1 .. .. .. 2 .. 4 1 1 .. .. .. Organic Heart Disease 75 1 1 1 1 4 4 21 42 1 17 5 32 6 13 1 41 10 Bronchitis 47 10 5 1 .. 1 .. 7 23 3 4 2 32 .. 6 .. 6 6 Pneumonia (all forms) 41 10 4 5 .. 2 9 5 6 .. 4 3 28 1 4 1 5 .. Other Diseases of Respiratory Organs 14 .. .. .. .. .. 2 4 8 1 2 .. 9 .. 1 1 1 1 Diarrhoea and Enteritis (See note (e)) 24 19 4 .. 1 .. .. .. .. .. 1 1 21 .. 1 .. .. .. Appendicitis and Typhlitis 9 .. .. .. 2 3 2 2 .. 1 3 3 2 .. .. .. .... .. Cirrhosis of Liver 8 .. .. .. .. .. 1 6 1 .. .. .. 8 .. .. .. 4 .. Alcoholism .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Nephritis and Bright's Disease 21 .. .. .. 2 3 2 5 9 1 3 2 10 2 3 .. 18 .. Puerperal Fever 2 .. .. .. .. 1 1 .. .. .. .. .. 2 .. .. .. .. .. Other accidents and diseases of Pregnancy and Parturition 4 .. .. .. .. .. 4 .. .. .. 1 .. 3 .. .. .. .. .. Congenital Debility and Malformation, including Premature Birth 49 49 .. .. .. .. .. .. .. .. 2 7 36 .. 4 .. .. .. Violent Deaths, excluding Suicides .. 18 .. .. 4 1 2 2 6 3 .. 2 4 10 .. 2 .. .. .. Suicides 4 .. .. .. .. .. 3 1 .. .. 1 .. 3 .. .. .. .. .. Other Defined Diseases 123 8 .. 3 5 1 18 27 61 2 11 24 57 5 23 1 88 16 Diseases ill-defined or unknown 54 14 3 .. .. .. 2 2 33 2 6 6 27 2 10 1 .. .. Total 674 126 26 29 29 30 93 120 221 11 79 84 374 25 90 11 177 40 Sub-Entries included in above figures. (a) Cerebro-spinal Meningitis 1 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. (a) Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Brain Diseases 53 .. .. 1 .. .. 8 9 35 .. 6 7 27 2 11 .. 68 6 (а) All "Transferable Deaths" of residents, i.e., of persons resident in the District who have died outside it, are to be included with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who have died in the District, are in like manner to be excluded from these columns. For the precise meaning of the term "transferable deaths," see footnote to Table I. The total deaths in column 2 of Table III. should equal the figures for the year in column 12 of Table I. (b) All deaths occurring in institutions for the sick and infirm situated within the district, whether of residents or of non-residents, are to be entered in the last column of Table III. (c) All deaths certified by registered Medical Pract'tioners and all Inquest cases are to be classed as "Certified;" all other deaths are to be regarded as "Uncertified." {d) Exclusive of "Tuberculous (Meningitis (10), but inclusive of Cerebro-spinal Meningitis. (e) Title 19 should be used for deaths from Diarrhoea and Enteritis at all ages. (In the "Short List" deaths from Diarrhoea and Enteritis under 2 years are included under Title 19; those at 2 years and over being placed under Title 28.) 39 TABLE IV.—Infantile Mortality during the Year 1914. 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—3 Months. 3—6 Months. 6—9 Months. 9—12 Months. Totals Deaths under One Year. All causes Certified 30 2 6 7 45 21 31 8 21 126 Uncertified .. .. .. .. .. .. .. .. .. Small Pox .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. 1 1 1 .. 3 Diphtheria and Croup .. .. 1 .. 1 .. .. .. 2 3 Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. 1 .. .. 1 Abdominal Tuberculosis .. .. .. .. .. .. 2 .. .. 2 Other Tuberculous Diseases .. .. .. .. .. .. 1 .. 1 2 Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. 1 1 Convulsions .. .. .. 1 1 1 1 .. .. 3 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. 1 1 2 3 .. 4 10 Pneumonia (all forms) .. .. .. 1 1 3 3 1 4 10 Diarrhœa .. .. .. .. .. .. 4 .. 1 5 Enteritis .. .. .. .. .. 1 7 4 2 14 Gastritis .. .. .. .. .. .. .. .. 1 1 Syphilis .. .. .. 1 1 .. 1 1 .. 3 Rickets .. .. .. .. .. .. .. .. 1 1 Suffocation, overlying .. .. .. .. .. 1 .. .. .. 1 Injury at Birth 1 .. .. 1 .. .. .. .. 1 Atelectasis 1 .. .. .. 1 .. .. .. .. 1 Congenital Malformations 1 .. 1 .. 2 2 1 .. .. 5 Premature Birth 19 2 1 1 23 1 .. .. .. 24 Atrophy, Debility, and Marasmus 7 .. 2 2 11 7 1 1 3 23 Other Causes 1 .. 1 .. 2 4 5 .. 1 12 30 2 6 7 45 21 31 8 21 126 Nett Births in the year— Legitimate 1519. Illegitimate 27. Nett Deaths in the year of— Legitimate infants 117. Illegitimate infants 9. 40 Table V.—The Area in Acres, Inhabited Houses, Population, and Density of each Parish in the District in 1901 and 1914. Parish. Area in Acres. Inhabited Houses. Population. Density. Persons per acre. Persons per house. 1901. 1914. 1901. 1914. 1901. 1914. 1901. 1914. Persons. Males. Females. Persons. Males. Females. Addington 3604 131 140 642 337 305 614 290 324 .17 .17 4.9 4.3 Beddington 3128 751 2547 3846 1771 2075 10700 5085 5615 1.2 3.4 5.1 4.2 Coulsdon 4314 818 2255 4042 2005 2037 9700 4626 5074 9 2.2 4.9 4.3 Mitcham 2934 2743 6718 13493 6626 6867 30902 14380 16522 4.6 10.5 5.0 4.6 Sanderstead 3151 203 746 1001 462 539 3580 1676 1904 .3 1.1 4.9 4.8 Wallington 821 1063 2078 5152 2147 3005 8935 4261 4674 6.2 10.8 4.8 4.3 Woodmansterne 1591 105 262 534 252 282 1283 617 666 .3 .8 5.0 4.9 19543 5814 14746 28710 13600 15111 65714 30935 34779 1.4 3.3 4.9 4.4 In no instance are Institutions considered in this calculation. 41 TABLE VI.—Showing Parishes with Institutions. Parish. Area in Acres. Inhabited Houses. Population. Density of persons per acre. Average number of persons per house. 1901. 1914. 1901. 1914. 1901. 1914. 1901. 1914. Persons. Males. Females. Persons. Males. Females. Beddington 3128 751 2547 3846 1771 2075 10700 5085 5615 1.2 3.4 5.1 4.2 Royal Female Orphanage .. .. .. .. .. .. 136 — 136 Russell Hill School .. .. .. .. .. .. 361 198 163 11197 5283 5914 Coulsdon 4314 818 2255 4042 2005 2037 9700 4626 5074 .9 2.2 4.9 4.3 Cane Hill Asylum .. .. .. .. .. .. 2451 1022 1429 Reedham Orphanage .. .. .. .. .. .. 328 185 143 12479 5833 6646 Mitcham 2934 2743 6718 13493 6626 6867 3C902 14380 16522 4.6 10.5 5.0 4.6 Holborn Workhouse .. .. .. .. .. .. 847 588 259 „ Schools .. .. .. .. .. .. 423 254 169 32172 15222 16950 42 TABLE VII.—Showing the Annual Birth and Death Rates, and Death Rates of Infants for the Year 1914 and 10 preceding years. In the Year. Birth Rate per 1,000 of Population. Corrected Death Rate per 1,000 of Population. Children under 1 year per 1,000 of Registered Births. 1914 23.5 10.2 81 1913 24.4 9.4 77 1912 23.9 8.3 67 1911 24.7 11.3 104 1910 23.0 8.9 67 1909 25.0 9.0 85 1908 25.8 10.1 84 1907 24.6 9.7 103 1906 26.7 11.3 124 1905 25.7 9.6 98 1904 27.3 11.0 123 Average of 10 Years, 1904—1913. 25.1 9.8 93.2 43 TABLE VIII.—Showing the Population, Births and Deaths for the Year 1914, and 10 years preceding. GROSS NUMBERS. Year. Estimated Population. Registered Births. Corrected No. of Deaths. Deaths of Non-Residents in Institutions within the District. Total. Under 1 year. Under 5 years. 1914 65714 1546 674 126 55 217 1913 64127 1571 604 121 38 207 1912 62768 1505 524 101 25 176 1911 61127 1511 693 158 87 163 1910 60000 1466 567 98 49 163 1909 58300 1513 545 130 57 208 1908 57600 1487 584 126 75 161 1907 66300 1635 649 170 70 239 1906 59800 1600 679 199 88 204 1905 54763 1408 529 138 41 178 1904 47030 1284 521 158 42 210 Average of 10 years, 19041913 59181.5 1498.0 589.5 139.9 57.2 190.9 44 TABLE IX.—Ascertained Cases of Infectious Disease since the adoption of the Notification Act. 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 Small-pox .. 7 1 2 .. .. 3 .. .. .. .. 29 9 5 1 1 .. .. .. .. .. .. .. .. Scarlatina 85 117 316 99 51 65 262 144 84 115 81 161 131 125 181 189 317 209 212 242 169 185 175 242 Diphtheria 17 16 44 63 26 45 35 107 38 62 87 77 48 169 134 161 190 904 156 166 166 145 91 141 Membranous Croup .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. Typhoid Fever 9 12 24 12 18 14 13 15 19 15 13 14 11 9 18 33 15 16 9 16 47 15 16 4 Continued Fever .. .. 1 .. 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. .. .... .. Puerperal Fever 1 1 4 6 1 .. 2 2 .. 4 1 5 5 8 2 3 5 10 5 9 4 6 5 9 Anthrax .. .. .. .. .. .. .. .. .. .. .. .... .. .. .. .. 1 .. .. .. .. .. .. 1 †**Cerebro-spinal Meningitus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 6 .. 2 .. .. .. 4 1 Cholera .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 13 22 31 18 18 33 26 23 29 34 20 35 23 27 44 52 56 36 33 50 43 56 36 45 ***Measles 237 579 138 458 29 1083 172 1023 251 420 862 636 280 1085 679 954 326 999 472 .. .. .. .. .. Acute Diarrhœa .. .. .. 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. *Chicken Pox .. .. .. .. .. .. .. .. .. .. .. 162 188 .. .. .. .. .. .. .. 36 .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. 1 .. .. .. .. .. .. .. †Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. *Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7 Totals 362 754 560 664 144 1243 513 1314 421 650 1064 1119 695 1428 1076 1393 917 1474 883 483 465 408 327 450 *Chicken Pox was a notifiable disease until July 31st, 1903, and for six months in 1911. **Cerebro-spinal Meningitis was a notifiable disease from the 22nd April, 1907, to April, 1908. ***Measles ceased to be a notifiable disease on the 19th June, 1909. †Cerebro-Spinal Meningitis and Acute Poliomyelitis were made notifiable diseases on 13th May, 1912. *Ophthalmia Neonatorum was made a notifiable disease from 1st April, 1914. 45 TABLE X—Cases of Typhoid Fever (including Continued Fever) in each Parish since Notification was adopted. Addington Beddington Coulsdon Mitcham Sanderstead Wallington Woodmansterne Institutions The District * † ‡ † * * 1890 .. 6 .. 3 .. 4 .. 1 14 1891 .. 2 2 2 1 1 .. .. 8 1892 .. 2 .. 4 .. 3 .. 1 10 1893 .. 2 4 12 .. 1 .. l 21 1894 .. .. 4 2 .. 4 .. .. 10 1895 .. 1 1 6 .. 3 .. 3 15 1896 .. 1 2 9 1 2 .. .. 15 1897 .. 1 2 6 .. 3 .. .. 12 1898 .. .. 1 11 .. .. .. .. 13 1899 .. 1 2 4 2 1 4 .. 15 1900 .. 1 2 3 .. 3 3 .. 12 1901 .. .. 3 3 2 1 .. .. 9 1902 .. 2 1 3 2 2 .. .. 12 1903 .. .. 5 4 .. .. .. .. 9 1904 .. 1 .. 5 1 2 .. .. 9 1905 1 .. 1 8 .. .. .. 10 1906 .. 2 1 20 1 3 1 .. 28 1907 .. 1 2 10 .. .. .. .. 13 1908 .. 3 .. 11 .. 1 .. .. 16 1909 .. 1 .. 7 .. 1 .. .. 9 1910 .. .. 3 11 1 1 .. .. 16 1911 .. 4 3 36 3 1 .. .. 47 1912 .. 1 2 11 .. 1 .. .. 15 1913 .. 4 2 4 5 1 .. .. 16 1914 .. .. .. 3 1 .. .. .. 4 3 36 43 198 20 39 8 6 353 * Water supplied by Sutton Water Company. †„ „ „ East Surrey Water Company. ‡,, „ „ Metropolitan Water Board. Addington is principally supplied by the Croydon Corporation. 46 INFECTOUS DISEASE during 1914. Showing Disease; also place and month of incidence TYPHOID FEVER. Parishes. January. February. March. April. May. June. July. August. September. October. November. December. Grand Totals. Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington .. .. .. .. .. .. .. .. .. .. .. .. .. Coulsdon .. .. .. .. .. .. .. .. .. .. .. .. .. Cane Hilli Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Mitcham .. .. 2 .. .. .. .. .. .. 1 .. .. 3 Holborn Schools .. .. .. .. .. .. .... .. .. .. .. .. .. ,, Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Sanderstead .. .. .. .. .. .. .. .. 1 .. .. .. 1 Wallington .. .. .. .. .. .. .. .. .. .. .. .. .. Woodmansterne .. .. .. .. .. .. .. .. .. .. .. .. .. Totals .. .. 2 .. .. .. .. .. 1 1 .. .. 4 PUERPERAL FEVER. Parishes. January. February. March. April. May. June. July. August. September. October. November. December. Grand Totals. Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington .. .. .. .. .. .. .. .. .. .. .. .. .. Coulsdon .. .. .. .. .. .. .. .. .. .. .. .. .. Cane Hill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Mitcham 2 1 .. 1 .. .. 1 1 .. .. .. .. 6 Holborn Schools .. .. .. .. .. .. .. .. .. .. .. .. .. ,, Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Sanderstead .. .. .. .. .. .. .. .. .. .. 1 .. 1 Wallington .. .. .. .. 1 .. .. .. 1 .. .. .. 2 Woodmansterne .. .. .. .. .. .. .. .. .. .. .. .. .. Total 2 1 .. 1 1 .. 1 1 1 .. 1 .. 9 47 SCARLET FEVER. Parishes. January. February. March. April. May. June. July. August. September. October. November. December Grand Totals Addington .. .. .. .. 1 .. .. .. .. 1 1 .. 3 Beddington 4 2 4 6 4 1 1 2 3 2 1 4 34 Coulsdon 1 1 5 1 1 2 1 1 4 .. 2 6 25 Cane Hill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Mitcham 9 10 7 15 5 7 13 7 6 18 8 22 127 Holborn Schools 2 1 2 .. .. .. .. .. .. .. .. .. 5 ,, Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Sanderstead .. .. .. .. 1 1 .. .. .. 1 .. .. 3 Wallington 3 5 1 .. 1 2 1 2 3 5 8 2 33 Woodmansterne 1 2 1 2 .. .. 1 .. 5 .. .. .. 12 Totals 20 21 20 24 13 13 17 12 21 27 20 34 242 DIPHTHERIA. Parishes. January. February. March. April. May. June. July. August. September. October. November. December Grand Totals. Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington .. 6 3 8 2 1 .. .. 1 3 2 2 28 Coulsdon 3 1 1 .. 2 .. 1 .. 1 2 5 3 19 Cane Hill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Mitcham 11 5 5 5 5 4 3 5 .. 4 8 2 57 Holborn Schools .. .. .. .. .. .. .. .. .. .. .. .. .. ,, Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Sanderstead .. 1 .. .. .. .. .. .. .. 1 .. 1 3 Wallington 1 2 1 3 .. 1 1 1 3 2 6 2 23 Woodmansterne 2 1 2 1 .. 1 .. .. .. .. 2 2 11 Totals 17 16 12 17 9 7 5 6 5 12 23 12 141 48 ERYSIPELAS. Parishes. January. February. March. April. May. June. July. August. September. October. November. December. Grand Totals. Addington .. .. .. .. .. .. 1 .. .. .. .. .. 1 Beddington 1 .. 1 .. .. 1 .. .. .. 1 1 1 6 Coulsdon 1 1 .. 1 1 1 2 .. .. 1 1 .. 9 Cane Hill Asyl'm 1 .. .. .. .. .. .. .. .. .. .. .. 1 Mitcham 4 l 4 1 1 .. 2 1 3 1 2 2 22 Holborn Schools .. .. .. .. 1 .. .. .. .. .. .. .. 1 ,, Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Sanderstead .. .. .. .. .. .. .. .. .. .. 1 1 2 Wallington .. .. .. .. .. 1 1 .. .. .. .. .. 2 Woodmansterne .. .. .. .. .. .. .. .. .. .. .. 1 1 Totals 7 2 5 2 3 3 8 1 3 3 5 5 45 CEREBRO-SPINAL MENINGITIS. Parishes. January. February. March. April. May. June. July. August. September. October. November. December. Grand Totals. Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington .. .. .. .. .. .. .. .. .. .. .. .. .. Coulsdon .. .. .. .. .. .. .. .. .. .. .. .. .. Cane Hill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Mitcham .. .. 1 .. .. .. .. .. .. .. .. .. 1 Holborn Schools .. .. .. .. .. .. .. .. .. .. .. .. .. ,, Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Sanderstead .. .. .. .. .. .. .. .. .. .. .. .. .. Wallington .. .. .. .. .. .. .. .. .. .. .. .. .. Woodmansterne .. .. .. .. .. .. .. .. .. .. .. .. .. Totals .. .. 1 .. .. .. .. .. .. .. .. .. 1 49 ANTHRAX. Parishes January February March April May June July August September October November December Grand Totals Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington .. .. .. .. .. .. .. .. .. .. .. .. .. Coulsdon .. .. .. .. .. .. .. .. .. .. .. .. .. Cane Hill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Mitcham .. .. .. .. .. .. .. .. .. .. .. 1 1 Holborn Schools .. .. .. .. .. .. .. .. .. .. .. .. .. and Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. Sanderstead .. .. .. .. .. .. .. .. .. .. .. .. .. Wallington .. .. .. .. .. .. .. .. .. .. .. .. .. Woodmansterne .. .... .. .. .. .. .. .. .. .. .. .. Totals .. .. .. .. .. .. .. .. .. .. .. 1 1 OPHTHLAMIA NEONATORUM. Parishes January February March April May June July August September October November December Grand Totals. Addington .. .. .. .. .. .. .. .. .. .. .. .. .. Beddington .. .. .. .. .. 1 .. .. 1 .. .. .. 2 Coulsdon .. .. .. .. .. .. .. .. .. .. .. .. .. Cane Hill Asyl'm .. .. .. .. .. .. .. .. .. .. .. .. .. Mitcham .. .. .. 2 2 .. .. .. .. .. .. .. 4 Holborn Schools .. .. .. .. .. .. .. .. .. .. .. .. .. ,, Workhouse .. .. .. .. .. .. 1 .. .. .. .. .. .. Sanderstead .. .. .. .. .. .. .. .. .. .. .. .. 1 Wallington .. .. .. .. .. .. .. .. .. .. .. .. .. Woodmansterne .. .. .. .. .. .. .. .. .. .. .. .. .. Totals .. .. .. 2 2 1 1 .. 1 .. .. .. 7 50 TABLE XII.—Deaths from Infantile Summer Diarrhœa, showing Place of Incidence and Condition of Domestic Surroundings Address. Age. Sex. L. or III. Number in family and how many have died of similar complaints. How Fed : Cow, Breast or Tin Milk. Note conditions and cleanliness of Cooking Utensils. Condition of Remarks. Interior of House. Back and Front Yards. W.C's. Ashbourne Road, Mitcham 4 months M. Leg. Three other children in family Nestle's Milk and barley water. Utensiis clean Clean Paved and clean In good order Briscoe Road, Mitcham 2 months M. Leg. Unable to obtain particulars Chapel Road, Mitcham 3 months M. Leg. Deceased died outside district Church Road, Mitcham 3 months F. Leg. One other child Nestle's Milk. Utensils clean Clean Clean In good order Church Road, Mitcham 9 months F. Leg. Six other children Ridge's Food and Nestle's Miik. Utensils clean Very clean Clean and in good condition In good order Clive Road, Mitcham 5 months M. Leg. Deceased died outside district College Road, Mitcham 6 months M. Leg. No other children Cows' milk and barley water. Utensils not clean Fair Clean In good order Fieldgate Lane, Mitcham 5 months M. Leg. Parents only had one room and had moved before the Inspector called Finborough Road, Mitcham 11 months M. Leg. Six other children Cows' milk and barley water. Utensils dirty. Dirty Fair condition Out of order Grove Road, Mitcham 4 months M. Leg Five other children Nestle's Milk. Utensils clean Clean Clean and tidy In good order London Road, Mitcham 3 months M. Leg. Occupier had left the house before Inspector called Manor Road, Mitcham 10 months M. Leg. Deceased died outside district Marian Road, Mitcham 2 months F. Leg. Deceased died outside district Marian Road, Mitcham 7 months F. Leg. Unable to obtain particulars Oakwood Avenue, Mitcham 4 months M. Leg. Unable to obtain particulars Victory Road, Mitcham 8 months M. Leg. Deceased died outside district Western Road, Mitcham 5 months F. Leg. Eight other children Nestle's, Cows' milk and barley water. Utensils dirty. Dirty Fair condition Dirty and not in good order Deceased was a weak child from birth Western Road, Mitcham 6 months F. Illeg. Nestle's Milk. Utensils clean Clean Clean In good order Wolseley Road, Wallington 4 months M Leg. Three other children Dried milk. Utensils fairly clean. Fair Clean Out of order Notice served on owner to repair w.c. 51 TABLE XIII.—Table showing Total Deaths from Infantile Summer Diarrhoea, during the fourteen years, 1901—1914, in each Parish, and in every Street invaded:— ADDINGTON. 1. Alwen's Cottages. 1. Badger's Hole. 1. Keeper's Lodge. BEDDINGTON. 4. Bandon Hill. 1. Beddington Lane. 1. Foxley Lane. 1. Francis Road. 2. Guy Road. 1. Mellows Road. 1. Woodcote Valley Road. COULSDON. 1. Brighton Road. 1. Coulsdon. 1. Edward Road. 8. Ellen Avenue. 1. Godstone Road. 4. Lower Road, Kenley. 1. Roke Avenue, Kenley. 1. Sunnydene Road. MITCHAM. 1. Acre Road. 1. Allen's Cottages, Lonesome. 2. Allen's Terrace. 1. Aberdeen Road. 2. Ashbourne Road. 10. Bath Road. 8. Bailey Road. 8. Belgrave Road. 1. Benedict Walk. 2. Bond Road. 1. Boscombe Road. 5. Boundary Road. 2. Boyd Road. 1. Briscoe Road. 1. Broadway. 2. Bruce Road. 8. Byegrove Road. 1. Lewis Cottages. 8. Lewis Road. 4. Leonard Road. 6. London Road. 1. Lonesome. 8. Love Lane. 4. Lilian Road. 1. Lock's Lane. 4. Manor Road. 2. Maple Terrace. 4. Marian Road, Lonesome. 8. Miller Road. 2. Miles' Lane. 1. Nicholls' Cottages, Eastfields. 1. Norfolk Road. 1. Marlboro' Road. 2. Oakwood Avenue. 52 4. Caithness Road. 1. Cavendish Road. 7. Chapel Road. 1. Chestnut Road. 2. Church Buildings. 13. Church Road. 1. Church Street. 2. Clive Road. 5. College Road. 4. Commonside. 1. Concrete Cottages. 1. Courtney Road. 1. Cromer Road. 6. Denison Road. 2. Devonshire Road. 1. Durham Place. 1. Eastfields. 1. Fair Green. 1. Fieldgate Lane. 3. Firework Road. 6. Fortescue Road. 1. Fernlea Road. 3. Finborough Road. 3. Fountain Place. 8. Fountain Road. 3. Gladstone Road. 1. Grange Villas, Eastfields 6. Greyhound Terrace. 5. Grove Road. 2. Grove Terrace. 1. Hare wood Road. 7. Heaton Road. 3. High Street. 3. Homewood Road. 1. Lansdell Road. 4. Palestine Grove. 4. Park Avenue. 1. Park Road. 4. Phipp's Terrace. 1. Piccadilly. 1. Pitcairn Road. 2. Portland Road. 6. Princes Road. 1. Prussia Place. 10. Queen's Road. 1. Robinson Lane. 3. Robinson Road. 1. Romeo Villas. 1. St. Mark's Road. 1. Sarah Place. 7. Seaton Road. 3. Seeley Road. 3. Sibthorpe Road. 4. Smiith's Buildings. 1. Spencer Road. 1. Ravensbury Cottages. 1. Tramway Park. 3. Tramway Terrace. 6. Tynemouth Road. 1. University Road. 1. Upper Green. 1. Victory Road. 2. Walpole Road. 1. Waterfall Road. 2. Warren Road. 7. Western Road. 2. Westfields. 1. Whitford Gardens. 2. Willow View 53 MORDEN. 1. Bishop's Cottages. 1. Crown Road. SANDERSTEAD. 1. Kensington Terrace. 1. Mayfield Road. 1. Riddlesdown Road. 1. Silverdale Terrace. WALLINGTON. 2. Hackbridge. 2. Maldon Road. 2. Manor Road. 1. OxfordRoad. 2. Percy Road. 2. Ross Parade. 1. Seymour Road. 1. Wolseley Road. 2. Wood Street. WOODMANSTERNE. 1. Chipstead Valley Road. 1. Rutland Cottages. 1. St. Dunstan's Cottages. 1. Woodman Road. 54 FACTORY AND WORKSHOP ACT, 1901. The title of this Act is "An Act to consolidate with amendments the Factory and Workshop Acts." At the end of the year the number of Factories and Workshops on the Register numbered 276, which is 13 more than last year. All Factories, Workshops and Workplaces are frequently visited, and attention has been paid to maintaining them in such a condition as to comply with the requirements of the Act. During the year 545 inspections were made and in 65 instances, nuisances or irregularities were found, which were all remedied. In only 29 cases was it necessary to serve a written notice. Factories and Workshops. Trades Factories. Workshops. Total. No. of Employees. Laundries 10 19 29 342 Cycle Works 2 17 19 45 Carriage Makers and Wheelwrights 1 5 6 20 Distilleries and Essential Oils 1 2 3 18 Printing 4 3 7 60 Brickmaking 2 1 3 36 Carpenters and Builders 4 18 22 99 Shoeing Forges — 16 16 35 Dressmaking — 20 20 57 Bakeries 3 29 32 81 Harness Making — 4 4 4 Bootmaking & Bepairing — 25 25 .37 Bottle Washing & Marine Stores - 5 5 13 Snuff Mills 1 — 1 1 Buff, Parchment, and Chamois Leather, Patent Leather and Degreasing 3 1 4 147 55 Trades Factories. Workshops. Total. No or Employees. Dye Extractors 1 — 1 8 Chaff Cutting and Corn Grinding 2 - 2 8 Flour Mills 1 — 1 14 Bedding Manufacturers — 2 2 3 Cardboard ditto 1 — 1 44 Motor ditto 6 — 6 19 Brewers 1 — 1 12 Varnish Making 12 4 16 242 Confectionery Making 1 — 1 320 Saw Mills & Timber Yard 4 1 5 13 Artificial Horse Hair Manufacturers 1 - 1 28 Gas Works 1 — 1 200 Watch Making — 4 4 6 Firework Making 1 — 1 120 Mineral Water Makers 1 — ] 19 Chemical Works 2 — 2 28 Margarine Works 1 — 1 33 Iron Works 1 — 1 156 Cork Cutting 1 — 1 82 Organ Building - 1 1 1 Brush Making 1 3 4 9 Truss & Belt Making 1 1 2 38 Sack Making — 1 1 9 Golf Club Making — 2 2 4 Smelting Works 1 — 1 62 Engineering 2 — 2 56 Glove and Dry Cleaning- 2 4 6 31 Furniture Making — 1 1 1 Tailoring — 4 4 7 Art Printers on Iron, etc. 2 — 2 210 Tobacco Mills 1 — 1 75 Floor Cloth Makers 1 — 1 6 56 Trades. Factories. Workshops. Total. No. of Employees Incandescent Mantle Making 1 - 1 219 Tinplate Works — 1 1 35 Basket Making 1 — 1 32 Totals 82 194 276 3086 57 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory Laundries) 186 16 Workshops (including Workshop Laundries) 298 11 Workplaces (other than Outworkers' premises included in Part 3 of this Report 61 2 Total 545 29 58 2.—DEFECTS FOUND. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts—* Want of cleanliness 42 42 Want of ventilation 1 1 Overcrowding — - Want of drainage of floors — - Other nuisances 14 14 Sanitary accommodation insufficient 3 3 unsuitable or defective — - not separate for sexes 1 1 Offences under the Factory and Workshop Acts— Illegal occupation of underground bakehouse (s.101) — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 34 4 Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) — — Total 65 65 *Including those specified in sections 2, 3, 7, and 8 of tbc Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 59 3—HOME WORK NATURE OF WORK* OUTWORKERS' LISTS, SECTION 107. OUTWORK IN | UNWHOLESOME PREMISES, Sec. 108 OUTWORK IN INFECTED PREMISES, Sec 109,11 Lists received from Employers. Notice served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110), Prosecutions (Sections 109, 110) Twice in the year Once in the year Failing to keep or permit inspection of lists. Failing to send list. Lists.* Outworkers. † Lists. Outworkers.† Contractors Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) making, etc. 8 8 12 16 (2) cleaning and washing 2 2 1 1 1 1 Household linen Lace, lace curtains and nets Curtains and furniture hangings Furniture and upholstery Electro plate File making Brass & brass articles Fur pulling Cables and chains Anchors & grapnels Cart gear Locks, latches &keys Umbrellas, etc. Artificial flowers Nets, other than wire nets Tents Sacks Racquet and tennis balls Paper, etc., boxes, paper bags Brush making Pea picking Feather sorting Carding, &c. of buttons, &c. Stuffed toys Basket making Chocolates and sweetmeats Cosaques,Xmas crackers, stockings, &c. Textile weaving Total 10 2 8 13 1 16 1 1 *If an occupier gives out work of more than one of the classes specified in column 1, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be. against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes) A footnote should be added to show that this has been done. †The figures required in columns 2, 3 and 4 are the total number of lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer—in some previous returns o dd numbers have been inserted. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. . 60 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year Number. (1) (2) Laundries 19 Bakehouses 29 Varnish Making 4 Other Trades 224 Total number of Workshops on Register 276 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories Failure to affix Abstract of the Factory and Workshop Acts (s 133, 1901) 2 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (s. 5, 1901) Notified by H.M. Inspector Reports (of action taken) sent to H.M. Inspector Other Underground Bakehouses (s. 101):— Certificates granted during the year In use at the end of the year 1 61 INDEX. Accommodation, Isolation Hospital 32 Ages at Death 13,14,38 Anthrax 49 Appendices— Factory and Workshop Act 54—60 Infectious Diseases (number of cases, month, and parish) 46—49 Isolation Hospital 32—34 Tables I. to XIII. (see "T") 35—51 Area 7,40 Articles Disinfected 30 Bakehouses 25 Births in 1913 11—12 Births (1904 to 1913) 43 Birth Rates 12 Birth Rates (1904—1913) 42 Birth Rates (England and Wales) 11, 16 Buildings 27 Bye-Laws, Contravention of 23 Cancer, Disinfecting after 22 Cane Hill Asylum (inmates, deaths, &c.) 33, 41 Cases of Infectious Diseases (ages, parishes, &c.) 37, 46—48 Cases of Removal to Hospital 37 Cases of Typhoid Fever (1890—1914) 45 Causes of Death 15—17, 38, 3g Cerebro-spinal Meningitis 19 Contravention of Bye-Laws 23 Cowsheds, &c. 25 Dairies, Cowsheds, &c. 25 Deaths 12—17,38,39 Deaths (1904—1913) 43 Deaths from Zymotic Disease 15 Deaths in Isolation Hospital 84 Deaths, Causes of 15—17, 38, 38 Deaths, Ages at 13, 14, 88, 39 62 Deaths in Public Institutions 12, 16, 17, 38 Deaths and Death Rates from various causes (Zymotic Diseases, Phthisis, &c.) 15—16 Death Rates 12—16 Death Rates (1901—1913) 42 Death Rates (England and Wales) 16 Death Rates of Infants 18,14 Density of Population 40 Diarrhoea Deaths (Table XII. A XIII.) 50—53 Diphtheria 18 Diphtheria Cases (month and parish) 47 Disinfecting Articles 30 Disinfecting Houses 21 Erysipelas 19 Erysipelas Cases (month and parish) 48 Excess of Births over Deaths 10,11 Factory and Workshop Act 54—60 Health Visitor 24 Holborn School and Workhouse (Inmates, Deaths, &c.) 38, 41 Hospital, Isolation 32—34 Hospital, case's removed to 33, 34, 37 Houses (Number and Increase) 8—10 Housing of the Working Classes Act 23 Illegitimate Births 11 Increase in Number of Houses 8,9 Increase of Buildings 27 Infantile Mortality 13, 14, 38, 39 Infantile Summer Diarrhœa 19, 50—53 Infectious Diseases 17—20, 37, 44—48 Inspectors' Work 29—30 Institutions (Inmates, Deaths, &c.) 16, 17, 38, 39 Isolation Hospital— Accommodation 32 Patients admitted 33, 34 Staff 32 Deaths from various Infectious Diseases 33,34 Legal Proceedings 28 63 Medical Inspection of School Children 24 Milkshops, &c. 25 Mortality at different ages 13, 11,38 Mortality Rate (Infantile) 13,42 Mortality Rate (England and Wales) 16 Notified Cases of Infectious Disease 44 Ophthlamia Neonatorum 49 Patients admitted to Hospital 33,34 Phthisis, Disinfecting after 22 Phthisical Death Rate 15 Piggeries 26 Population 8,40 Population, Density 40 Preventive Measures 20—22 Public Institutions (Deaths, &c.) 16, 17, 38, 41 Puerperal Fever 19 Puerperal Fever Cases (month and parish) 46 Pulmonary Death Rate 15 Rates, Birth 11,12 Rates, Death 12—16 Regulated Trades 25, 26 Removals to Hospital 33, 34, 37 Sale of Food and Drugs Act 26 Scarlet Fever 18 Scarlet Fever Cases (month and parish) 47 Schools 24 Sewerage and Drainage 27 Slaughterhouses 25 Staff, Isolation Hospital 32 Table I.— Vital Statistics (1909—1914) 35, 36 Table II.— Infectious Disease Cases (ages, parishes, removals to Hospital) 37 Table III.— Causes of, and Ages at, Death 38 Table IV.— Deaths of Infants at ages 39 Table V.— Area, Houses, Population, Density (each parish) 40 Table VI.— Area, Houses, Population, Density (parishes with Institutions) 41 64 Table VII.— Birth, Death, and Infantile Death Rates (1904-1914) 42 Table VIII.— Population, Births, and Deaths (1904—1914) 48 Table IX.— Cases of Infectious Disease (1891—1914) 44 Table X.— Typhoid Fever Cases in each parish (1890—1914) 45 Table XII.— Deaths from Infantile Summer Diarrhœa 50 Table XIII.— Deaths from Infantile Summer Diarrhoea (parish and street) 51—53 Trades, Regulated 25, 26 Typhoid Fever 19 Typhoid Fever Cases (1890—1914) 45 Typhoid Fever Cases (month and parish) 46 Vital Statistics (Tables I. to XIII.) 35—53 Water Courses 22 Zymotic Death Rate 15 Zymotic Death Rate (England and Wales 16