CRO 21 1 County Borough of Croydon ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and SCHOOL MEDICAL OFFICER. For the Year 1919. R. VEITCH CLARK, M.A., M.B., Ch.B., B.Sc., D.P.H. printed at the CROYDON: "croydon times "office, 108, high street. 2 Contents. page Introductory Letter 5 Vital Statistics, Summary of 6 SECTION I. Natural and Social Conditions of the District:— Climate 7 Social Conditions 7 Hospital Accommodation 8 Sanitary Circumstances of the District:— Water 11 Rivers and Streams 12 Drainage and Sewerage 13 Closet Accommodation 13 Scavenging 13 Sanitary Inspection of the District 13 Housing 13 Infectious Disease, Prevalence of and control over :— Scarlet Fever 18 Diphtheria 18 Measles 19 Enteric Fever 19 Smallpox 19 Influenza 20 Pneumonia 20 Malaria, Dysentery, and Encephalitis lethargica 20 Tuberculosis 20 Health Visitors' Work, Record ot 21 Disinfection, Record of 22 SECTION II. Table I. Vital Statistics of whole district during 1919 and previous years 24 II. Cases of Infectious Disease notified during 1919 25 III. Causes of, and Ages at, Death during 1919 26 III.a Causes of Deaths from Influenza and certain other conditions during 1919 39 Chart showing principal causes of death during 1919 IV. Infant Mortality during 1919 41 V. Cases notified and deaths from the principal zymotic diseases for the year 1919 and preceding years 50 VI Vital Statistics of separate localities in 1919 and previous years 51 VII. Meteorological Observations for 1919 52 VIIa. Meteorological Observations for 1919 53 SECTION III. Maternity and Infant Welfare ;— Infant Mortality 54 Diarrhœa 56 Infant Centres 56 Provision of Fresh Milk at the Centres 58 Maternity Hostel 58 Ante-natal Clinic 59 Sick Nurse 59 Feeding of infants 59 Development of Work—Reports of Medical Officer of Health 61 Notifications of Births Act, 1907 75 Midwives 75 3 SECTION IV. PAGE Tuberculosis Work :— General Survey of Cases dealt with through the Tuberculosis Dispensary and work done in connection with them 76 Sanatorium and Hospital Treatment 78 SECTION V. Venereal Disease :— Returns as to persons treated during the year 79 SECTION VI. Mental Deficiency :— Returns as to cases dealt with 84 SECTION VII. Sanitary Inspecting Staff, work of the :— Inspections 86 Table giving details of general sanitary work 87 Combined drainage 88 House drains re-laid 88 Examination of drains 88 Notices and Council Orders 88 Municipal and other Common Lodging Houses 88 Houses let in lodgings 89 Factory and Workshop Act:— Factories 90 Workshops 90 Homework 9c Bakehouses 90 Workplaces 91 Smoke Nuisances 91 Rag Flock Act 91 Inspection of Meat and other Foods Summary of Inspections 92 Details as to animals slaughtered 93 Summary of meat and other foods destroyed as unfit 94 Tuberculosis in meat 95 Tuberculosis in milk 95 Dairies, Cowsheds, and Milkshops Order 95 Food and Drugs Acts :— Prosecutions 96 Milk and Cream Regulations 97 Details of samples taken, 1919 98 Details of samples taken, 1904—1919 99 SECTION VIII. Borough Hospital, Work of the Detailed analysis of expenditure 100 Maximum and minimum number of beds occupied 100 Admissions, 1919 100 Admissions, details of comparative, 1909—1919 101 Admissions, analysis of, 1919 102 Admissions, fatality for each disease 103 Illness of Staff 104 Work of Laboratory :— Examinations made for Cerebro-spinal meningitis 105 „ ,, Tuberculosis 106 ,, ,, Enteric (Typhoid Fever) 107 4 SECTION IX. page School Medical Officer's Report:— Introductory Letter 108 Staff and General Organization hi Schools in Table E I. Total number of children examined (routine) 112 ,, E II. Details as to children inspected 113 Attendances of Parents and directions to 115 ,, E III. Routine Inspections, classified according to age groups 116 General Results of Routine Medical Inspection :— Want of Cleanliness 118 Cleansing Station 118 Clothing 118 Malnutrition 119 Eye Diseases 119 Tonsils and Adenoids 119 Glands 120 Ear Disease 120 Deformities 120 Table showing nature of defects : — Affections of the Heart 121 Affections of the Lung 121 Mental Conditions 121 Dental defects 122 Mental Deficiency 123 Work of the Ophthalmic Surgeon 123 Work of the School Dentists :— Inspections of school children 125 Re-inspections of school children 126 Dental Clinic 128 Throat Clinic 131 Work of School Treatment Centre 132 Work of Spinal Remedial Class 133 Communicable Disease 133 Action taken to prevent spread of infectious disease 133 Work of the Health Visitors 134 School Closure 135 Physically and Mentally Defective Children sent to Institutions 136 Examination of Bursars, Student and Pupil Teachers 136 Teaching of Infant Care 136 Report of Organiser of Physical Training 137 5 Public Health Department, Town Hall, Croydon, September, 1920. To the Mayor, Aldermen and Councillors of the County Borough of Croydon. Mr. Mayor, Ladies and Gentlemen, I beg to submit the Report of the work carried out by the Public Health Department during the year 1919. The report contains certain information which has not been required until this year by the Ministry of Health, such as the note on the hospital accommodation for all purposes available in the town, etc. This is of particular interest, as it indicates the growth of the wider view which is now taken by thoughtful people of the responsibilities of health authorities for the whole welfare of the community. The closer the co-operation of purely preventive medicine and purely curative medicine, the better for the national health. The birth-rate was 15.4 and the death rate 11.7. Another epidemic of influenza visited the country in 1919, but less severe in type than in the preceding year. Croydon also experienced an outbreak of smallpox in the summer months. The disease was introduced from abroad. We were fortunately able to restrict the outbreak. Accounts of these will be found in the section and tables on Infectious Diseases. Later in the year the Smallpox Hospital was opened as a sanatorium for tuberculosis. The growth of public Health work has been very rapid during the past seven or eight years, and a much more accurate and extensive knowledge of the incidence of sickness and the lasting effects of such sickness upon the people is coming to us which will be of great value in the impending developments of the various sections of the work. I am, Your obedient Servant, R. VEITCH CLARK. 6 SUMMARY OF VITAL STATISTICS. Population—Census of 1911—169,551. Estimated Population, June, 1919—191,922 (Registrar General's Estimate of Civilian Population). Birth Rate, per 1,000, 15.4. Death Rate, per 1,000 living, 11.7. (See note J at foot of Table I., page 24). Infantile Mortality, per 1,000 births, 73. Acreage of the Borough—9,012. Density of population, 21.3 per acre. 7 County Borough of Croydon, REPORT of the MEDICAL OFFICER OF HEALTH For- the Year 1919. SECTION I. NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. Physical Features and General Character of the District. The town lies immediately south of London, the northern boundary being the southern boundary of the metropolis along that part extending from the Crystal Palace to western end of Streatham Common. The shape of the town is that of a pear with the stalk as the southern extremity. The acreage is 0,012. The soil is of clay, river gravel, chalk and sand. The clay lies chiefly in the northern and north-eastern parts of the Borough, the gravel in the central and western, and the chalk in the southern parts. The elevation extends from 135 feet above sea level at the lowest point to 379 feet at the highest. Climate. The climate of Crovdon is mild. The meteorological returns are given in Tables VII. and VIIa. Social Conditions. Croydon is very largely a residential town. A large part of the population goes daily to work in London. The local industries are mainly those arising out of domestic needs, e.g., shopkeeping, laundries, etc. There are several breweries and steelworks, an extensive business is carried on by the Croydon Gas Company which not only supplies gas to the town, but to large adjoining areas of the county of Surrey, and there is also a noted clock and bell making firm in the town. The recent establishment of the continental air-terminus at Croydon will probably considerably influence the development of the neighbouring areas. None of the works in the town, however, are of such extent as to have a noticeable influence either on the general character of the district or of the wellbeing of its inhabitants from the public health point of view. 8 Hospital Accommodation. The hospital accommodation consists of:— General— Croydon General Hospital. Norwood Cottage Hospital. Purley Cottage Hospital. Croydon Union Infirmary. Special— Croydon Borough Isolation Hospital. Croydon Borough Sanatorium, North Cheam. St. Mary's Maternity Hostel. Croydon General Hospital. Total number of beds, 106. Report and Statistics of Patients Treated during the Hospital Years 1918-1919 and 1917-1918. 1. Inpatients. 1918-19. 1917-18. Admissions from July 1st to June 30th 1294 1198 Patients in Hospital, 1st July 90 80 Total 1384 1278 Cases of Accident or Emergency admitted free 862 622 Cases admitted by Governors' letters 184 197 Medical Free Cases 36 25 Soldiers, Sailors and Discharged Soldiers 212 354 Total 1294 1198 Males 741 779 Females 553 419 Total 1294 1198 The average stay in Hospital of each in-patient 22 davs 27 davs The average number of beds occupied 88 101 II. Casualty Department (Free). Fractures 172 172 Tonsils and Adenoids ' 253 318 Phimosis 86 93 Dislocations 21 21 Wounds, Minor Injuries, etc 3687 3975 Total 4219 4579 III. Out-Patient Department. (Medical and Surgical). Total number of new cases 1526 1780 Renewal of Old Letters 1411 1416 Total 2937 3196 Ophthalmic. Total Number of New Cases 1585 1889 Renewal of Old Letters 972 887 Total 2557 2776 9 Ear, Nose and Throat. Total number of new Cases 503 520 Renewal of Old Letters 202 220 Total 705 740 Dental. Total Number of New Cases 277 391 Gas (N20) Administrations 462 567 Total Attendances of Out-Patients. Medical and Surgical 9799 10314 Ophthalmic 5694 6093 Ear, Nose and Throat 2064 2054 Dental 574 756 Total 18131 19217 Total Number of Patients treated during the Year. In-Patients 1384 1278 Casualty Patients 4219 4579 Out-Patients (including Renewed Letters) 6476 7103 Total 12079 12960 In-Patients. Summary of Results. Cases cured and relieved 1197 1103 Cases Unrelieved 28 19 Remaining Under Treatment 67 94 Died 92 62 Total 1384 1278 Soldiers, Sailors and Discharged Soldiers treated during the year 212 354 Report of the X-Ray Department. 1164 Patients were examined with the X-Rays, and 1,751 Skiagrams were taken. 51 Patients were treated with the X-Rays and made 338 attendances. Norwood Cottage Hospital. Numbers in 1919. Numbers in 1918. 1. Number of beds available for use 32 36 2. Average number of patients resident daily throughout the year as counted and recorded daily 25.6 34.4 3. Number of In-patients in the Hospital at beginning of year 36 27 4. Do. admitted during year 534 505 5. Do. in the Hospital at the end of year 27 19 6. Average number of days each patient was resident 23.13 18.21 (Ascertained by dividing the yearly total of daily counts by the number of patients treated to a conclusion). 10 Purley Cottage Hospital. Total Number of beds : 10. The number of cases treated in the wards during 1919 was 223. Of these 75 were detained for less than a day, leaving 148 occupying the regular beds. There were 104 surgical cases with one death, and 44 medical with three deaths. The average number of days each patient spent in Hospital was 17.1. Casualties 152 X-Ray examinations 36 There has been a considerable increase in the number of patients . treated in the Hospital as compared with last year. 1919. 1918. In-patients 168 223 Casualties 152 68 making a total this year of 411, against 236 last. Croydon Union Infirmary. Total number of beds : 440. Female Wards (6) 192 Male Wards (5) 160 Children's Wards (1) 34 Lying-in Ward (1) 24 Waingates' annexe 30 440 Number of patients admitted during year 1919—1862. Average duration of stay about 2 months. Croydon Borough Isolation Hospital. Total number of beds : 170. 24 of the beds are in cubicle wards, which are designed for the individual isolation of patients, such isolation is also carried out in the "special" wards attached to the main wards of the Hospital. 12 of the cubicle beds and in addition 5 shelters are used for the treatment of advanced cases of pulmonary tuberculosis (6 female and 11 male). The extension of the hospital to meet the growing needs of the town is receiving the consideration of the local authority. The work of the hospital is detailed in the Borough Hospital Report (see page 100). Croydon Borough Sanatorium, North Cheam. This was formerly the Croydon and Districts Joint Small-Pox Hospital, and has been converted into a Tuberculosis Sanatorium under a five years' Agreement with the Joint Small-pox Board. 50 beds are provided, of which 15 are for Croydon, 30 for Surrey and 5 for Kent. The Hospital was opened for the admission of tubercular patients in December. St. Mary's Maternity Hostel. This institution is conducted under the auspices of the Croydon Mothers' and Infants' Welfare Association. 17 beds (each with its cot) are provided. The hostel is largely subsidised by the local, health authority. Two members of the Council are on the hostel committee of which the Medical Officer of Health is chairman, in addition to which he acts as the general medical superintendent of the hostel, Statistical details of the work of the hostel are given on page 58, 11 SANITARY CIRCUMSTANCES OF THE DISTRICT. Water. The Corporation is the water authority for the whole borough. The supply is mainly derived from deep wells in the chalk, but the north-eastern part of the borough is supplied with water from the Metropolitan Water Board by agreement made with the latter bodv—this section of the water supply is intermittent in character. The following is a description of the water works:— LOW LEVEL. Surrey Street Wells.—The chief pumping station is in the Wandle Valley, close to Surrey Street, where there are four wells varying in size and in depth to 50-ft. below which they are all bored. When pumping is going on the level of the water in the wells is about 27-ft. below the surface of the ground, and when it ceases it rises to within 14-ft. The lift to the reservoir averages 160-ft. The first pair of pumping engines were set to work in December, 1851; they are now removed, the town having outgrown their size. The next pumping engine set to work was the 60-in. Cornish engine of 110-h.p., capable of lifting 134,000 gallons per hour into the low level reservoir, Park Hill. This was erected in 1867. In 1876 the compound horizontal engine, of 150-h.p., was fixed, which is capable of lifting 178,000 gallons per hour into the same reservoir. Pumping is usually going on continuously, including Sunday, and the quantity raised averages 100,000 gallons per hour. Waddon Well.—Pumping to supplement Surrey Street Wells commenced on July 21st, 1899, with temporary plant from boreholes. In 1911, permanent buildings were erected, and pumping plant brought into operation. The well is 8-ft. in diameter, sunk to a depth of 60-ft. and lined with cast iron cylinders, beyond which, to a total depth of 190-ft., it is 6-ft. 6-in. in diameter. The machinery- consists of three Cornish boilers and a cross compound condensing pumping engine capable of lifting 130,000 gallons per hour. Reservoir.—The low level reservoir, situated at Park Hill is a brick domed one, capable of containing 950,000 gallons. The overflow level is 293-ft. above set level. HIGH LEVEL. Addington Well.—The well is 10-ft. in diameter and 205-ft. deep, all in chalk. The well is not bored, but headings or tunnels 6-ft. high and 4½-ft. wide have been made chiefly about 150-ft. from the top. The total length of these is 813 yards, and they will hold with the lower part of the well about 502,000 gallons. Several important water-bearing fissures were cut through in the east headings, the first one yielding 600,000 gallons a day. The maximum yield is about two million gallons per day, and the minimum one million. Pumping to reservoir commenced in August, 1883. The pumping machinery consists of two engines each 125-h.p., of the "Woolfe" type, 5 steel boilers, double-acting well and lift pumps of the bucket and plunger pattern. Each engine is capable of lifting 77,760 gallons per hour 250-ft. high., through a 21-in. pipe into the covered reservoir on Addington Hills. In May, 1910, Filters were brought into use for treating the whole of the Addington supply. The three filters have a total area of 4270 square yards. The water passes through two feet of fine sand and one foot of small gravel. 12 There is also a softening plant capable of softening 6000 gallons of water per hour for use at the Croydon Mental Hospital. This water is pumped bytwo pumping engines each capable of discharging 3000 gallons per hour into the tank in the Clock Tower at the Hospital. Stroud Green Well.—The well is sunk to a depth of 390½-ft. from the surface, the lower 251-ft. in chalk. The well is lined to a depth of 144-ft. with iron cylinders, the successive diameters of which are 12-ft., 11-ft. and 10-ft., and the latter diameter is continued in the chalk. A 12-in. borehole is put down beyond to a depth of 537-ft. from the surface. Headings are driven at 230-ft. and also at 365-ft. from the surface. At the former depth 2,827-ft. 6-in., and at the latter depth, 1,395-ft. of headings have been driven ; both upwards and downwards boreholes are made in both sets of headings. The present yield of the Well is about 650,000 gallons per day. Pumping to mains commenced on the 11th July, 1005. In 1906, permanent buildings and plant were erected. The machinery consists of three steel boilers, a triple expansion engine of 250-h.p., two well pumps and a set of three-throw force pumps capable of lifting 65,000 gallons per hour into the Addington Reservoir. Reservoir.—This, situated at Addington Hills, is 420-ft. long, 124-ft. broad, and 162/3-ft. deep, and holds 5 million gallons. It is built entirely of concrete, and the ground over it has been planted with heather and gorse. The valves are placed in a house built over the entrance to the reservoir. The overflow is 465-ft. above sea level, and 87-ft. above Upper Norwood, the highest part of the borough. AREA OF SUPPLY. On the 29th of September, 1904, the Corporation took over that portion of the Borough previously supplied by the Lambeth Water Company, and recently by the Metropolitan Water Board, thus making the Corporation the water authority for the whole of the Borough. The new area is supplied with water obtained in bulk from the Metroplitan Water Board. NEW WORKS. New works are in progress as follows :— A low level service Reservoir at Russell Hill to hold ten million gallons. Waddon Pumping Station.—An Engine and Pumps capable of lifting 130,000 gallons an hour. Pumping Mains between Surrey Street Works, Waddon Works, and Russell Hill. Rivers and Streams. There are few watercourses in the Borough, and only minor nuisances—very easily remedied—arise in connection with them. The most interesting of the watercourses is that of one of the sources of the Wandle and characterised by the flow of the bourne (the overflow of the underground water of the chalk) from the Kvenley Valley. 13 Drainage and Sewerage. The whole of the town is on the water-carriage system. The sewage is conveyed to and treated at two separate installations—the Beddington Sewage Works and Irrigation Farm situated just beyond the western boundary of the town and the Norwood Sewage Works and Irrigation Farm situated in the middle of the eastern boundary of the town. The treatment is effected in tanks followed by filtration through sprinkler beds and then by land irrigation. Closet Accommodation. The closet accommodation consists throughout of water-closets with the exception of 15 earth closets. In each of the latter instances there is adequate reason for their existence. Scavenging. The use of covered metal ashbins is general throughout the town. Domestic refuse is removed once weekly. The refuse is disposed of principally at the Corporation Destructor and at a large shoot on the Norwood Sewage Farm. Many complaints have in recent years been received of nuisance arising from this deposit, and the Corporation are proceding to provide another destructor to deal with this section of the refuse. Sanitary Inspection of the District. The general inspection of the district had to be largely lessened during the war owing to shortage of staff, especially the routine house-to-house inspection. During 1919 the staff of inspectors was restored to its pre-war size and the normal activities resumed. The accumulation of work, however, resulting from the war conditions is such that it will take a considerable time before current work can cover all demands. Difficulties of labour and in the obtaining of material also hamper owners, but the progress made is generally satisfactory. The details of this section of the department's work are given on pages 86. HOUSING. The following details are extracted from the returns prepared during the year shewing the present position of housing in Croydon and the Corporation's schemes for the erection of new houses. Section I. Particulars of Prevailing Conditions. POPULATION. 4. Pre-war population (1914) (estimated) 181,956 5. Average annual increase of population for the five years before the war 4,850 6. Estimated present population 186,917 7. Anticipated increase or decrease of workingclass population due to industrial changes Probably larger than before the War, but impossible to ebti mate 14 EXISTING HOUSING ACCOMMODATION. 8. Number of dwelling-houses in the district 41,700 9. Number of working-class houses of the types given in the reply to question 15 (approximately) 35,000 There are 22,000 houses where the rates are compounded for, that is, of a rateable value that does not exceed £20. 10. Average number of working-class houses built annually during the five vears before the war 650 11. Number of working-class houses built between January 1st, 1915, and December 31st, 1918 550 12. Number of empty buildings which might be— (a) Made suitable, by repairs or alterations, for housing the working classes; or (b) Converted into flats for the working classes 80 OVERCROWDING. 13. Tenements with more than two occupants per room— Number of Tenements (in tenement of buildings) 1 Total number of occupiers 5 14. Number of houses intended for one family only which are now occupied (without having been specially adapted) by two or more families 4,000 RENTS. 15. Particulars of prevailing rents of the various types of working-class houses in the district:— Type of House. Weekly Rent including Rales. (a) Houses with living room, scullery and two 5/- to 7/- very bedrooms few in number. (b) Living room, scullery and three bedrooms (c) Parlour, living room, scullery and two bedrooms 7/- to 9/- (d) Parlour, living room, scullerv and three bedrooms 9/- to 18/- (e) Parlour, living room, scullery and four bedrooms 13/6 to 32/6 (/) Tenements in block buildings 1/6 to 2/6 per room (g) Other working-class dwellings (specifying) - 15 Section II. Estimate of Housing Needs. No. of Houses. 1. Working-class houses required during the next three years to (a) Meet the unsatisfied demand for houses (taking account of growth of population, overcrowding, etc.) 5,000 (b) Re-house persons to be displaced by the clearance of unhealthy areas (c) Replace other dwellings which are unfit for human habitation and cannot be made fit a few individual houses (d) Replace obstructive or other buildings (now inhabited and not included under heading (c)) which should be demolished (e) Replace other houses which, although they cannot at present be regarded as unfit for human habitation, fall definitely below a reasonable standard (f) Meet anticipated deficiencies, e.g., arising from new industrial development Total 2. Deduct (a) Working-class houses which it is anticipated will be set free during the next three years as the result of any probable decrease in the population (b) Working-class houses likely to be built during the next three years by persons other than the Local Authority Total Net estimate of number of houses required Section III—Areas which are being, or may have to be, dealt with as unhealthy under Part I. or Part II. of the Act of 1890. None. 16 Section IV.—Insanitary Houses (other than houses in unhealthy areas of which particulars are given in Section III.) Prevailing Conditions. (1) How mny inhabited houses are there in the district which are not and cannot be made fit for human habitation ? None (2) Number of persons inhabiting these houses? — (3) How many houses are already subject to (a) Closing Orders? 8 (b) Demolition Orders? None (4) How many houses are seriously defective and Practically can be made habitable? can not be dealt with as ordinary nuisances. Proposed Action. (5) What immediate action is contemplated by the Local Authority with regard to (a) Houses which are not and cannot be made fit for human habitation ? See 3a (b) Houses which are seriously defective but can be made habitable? See 4 (6) Within what time is it contemplated that ditions will be such as to warrant the demolition of the houses which are not and Within a cannot be made fit for human habitation? year Section V. A map was prepared in accordance with the requirements of the Ministry of Health shewing in different colours the sections of the town requiring action under the Housing Acts. No areas exist needing schemes or which are expected to need schemes under parts 1 and 2 of the Act of 1890. Considerable areas, while not needing schemes, contain defective houses which could be dealt with by other measures. The following areas, although in fair sanitary condition, fall definitely below a ultimate standard at which it is reasonable to aim, or contain a large proportion of houses which fall below such standard: — 1. Paddock Gardens. 2. Stoney Buildings. 3. Parchmore Road. 4. Willett Road. 5. Pridham Road West. 6. Nursery Road. 7. Ely Road. 8. Coventry Road. 9. Forster Road. 10. Holland Road. 11. Leighton Street. 12. Dickinson's Lane. 13. Salisbury Road. 14. Old Town. 17 Section VI.—Scheme of the Croydon Town Council for the provision of New Houses under Section I. of the Housing, Town Planning, etc., Act, 1919. 'The Scheme should include any proposals which have already been submitted for approval as assisted schemes. 1. Approximate number of new houses to be provided:— (a) Houses with living room, scullery and two bedrooms 0 (b) Living room, scullery and three bedrooms 1000 (c) Parlour, living room, scullery and two bedrooms 0 (d) Parlour, living room, scullery and three bedrooms 300 (e) Parlour, living room, scullery and four bedrooms 200 (f) Block dwellings. (Number:— ) Number of separate tenements 0 (g) Other dwellings (specifying type):— 0 Total number of houses and separate tenements 1,500 2. Approximate number of existing empty houses to be acquired and:— (i) Made suitable for housing the working classes 0 (ii) Converted into flats for the working classes 50 Many of these houses were used for billeting, and have been recently vacated by the Military. Approximate number of families to be housed under (i) and (ii) 150 3. Approximate acreage of land to be acquired 175 4. Average number of houses per acre 12 (on land utilised) 5. Approximate localities in which land is to be acquired :— Woodside Waddon Norbury 18 6. Time within which it is proposed that the scheme (or if the scheme is to be carried out by instalments, each part of the scheme) is to be carried into effect:— Part of Scheme. Approximate date for completion. Woodside October, 1920. Waddon November, 1921. Norbury July, 1922. There is a very serious amount of overcrowding in existence now in the Borough. This is the natural sequence of the shortage of houses. It has been practically impossible to deal with overcrowding in the customary manner as a nuisance, and it has been made a practice at the present time to deal with only such extremely serious cases as urgently demand attention, and these only to deal with as the means of better accommodation for the people can be found. It will be observed that eight houses are dealt with under Closing Orders. These houses have been seriously damaged by wilful misconduct of persons in the neighbourhood, and have been taken over by the Corporation and reconstructed. They are being managed by the Corporation now by means of a residential caretaker responsible for the general conduct of the tenants. No other Closing Orders were made during the year, and no other representations were received or made that any house was unfit for human habitation. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. Scarlet Fever. 603 cases of scarlet fever were notified in 1919, as against 414 the previous year. Death occurred in 11 cases. The incidence was mainly in the fall of the year and the pressure on the hospital accommodation was severe at that period. (See accompanyingdiagram of the weekly incidence of scarlet fever in the borough.) Towards the end of the year there was a remarkable number of cases of double infection, i.e., scarlet and measles, scarlet and chicken pox and scarlet and diphtheria occurring simultaneously in the individual. Diphtheria. 429 cases of diphtheria were notified in 1919, as against 179 for 1918. Death occurred in 37 cases. The heaviest incidence was in the autumn. (See accompanying diagram of weekly incidence.) As in scarlet, there was an unusual amount of mixed infection. The hospital accommodation for this disease was also very severely taxed. Weekly notifications of SCARLET FEVER during the year 1919. Notes. Close vertical ruling indicates school holidays. 19 Measles and German Measles. Only 501 cases of these diseases were notified in 1919, as compared with 1,057 cases of measles, 93 of German measles in 1918. a deaths only were recorded as due to measles, none to German measles. Enteric Fever. Only 5 cases were notified during the year, as against 17 in 1918. No deaths occurred. Smallpox. 9 cases of smallpox occurred in Croydon during the year. The infection was introduced by a demobilised soldier (an R.A.M.C. man), who had been in contact with a case of smallpox in a troop train travelling from Taranto to Le Havre. He arrived home on April 12th, and the first case developed in the person of his wife on April 25th. He himself never had the disease. Six cases in all occurred in this family, but one of them—a girl in domestic service—turned ill in her employer's home in the neighbouring district of Penge. Of the other four cases, two occurred in the house adjoining that occupied by the original cases, and the other two in the persons of the doctor who first attended the cases and his wife. Two of the cases were unmodified smallpox in unvaccinated children—both were exceedingly severe and confluent in type—one died (the only fatal case) and the other escaped death bv the narrowest margin. The other cases were modified smallpox, the patients having been vaccinated in infancy. One case was vaccinated after having been infected and ran a very mild course—the rash consisting of only three spots. Energetic measures were taken to quell the outbreak. Vaccination or re-vaccination was offered to all those who had been in contact with the disease. Also the whole staff of the Public Health Department, including the staff of the Borough Isolation Hospital and those who required it at the Smallpox Hospital were revaccinated. All contacts were kept under daily supervision. Rigorous disinfection was carried out. The Ministry of Health and all neighbouring medical officers of health were kept informed of the details of the outbreak. The cases were treated at the Smallpox Hospital, Cheam, under myself as the temporary Medical Superintendent. It was this outbreak which caused the delay in opening Cheam for tuberculosis. It is of vital importance that the attention of the public be once more directed to the need of vaccination in infancy and of re-vaccination in adolescence. Vaccination is the only protection against smallpox, and the great increase in the number of exemptions constitutes a grave menace to the public health. 20 Influenza. During 1919 another outbreak of influenza occurred. Although the epidemic was extensive, the type of disease was much less severe than during the last quarter of 1918. The outbreak occurred in February and March, and reached its height in the two weeks ending March 1st and March 8th respectively in each of which weeks the deaths numbered 24. During the twelve months 139 deaths were attributed to this disease. It is unnecessary to detail the work done during the epidemic, as the same measures were adopted as were described in full in the report for 1918. Table III.a, page 39 shews the weekly deaths from influenza, along with the deaths from certain other diseases which are epidemiologicaly of interest in relation to influenza. Deaths from respiratory diseases in general were higher in February and March than at any other period of the year. Pneumonia. 185 cases of acute primary pneumonia and influenzal pneumonia were notified. Of deaths from pneumonia 27 were due to lobar pneumonia, 58 to broncho pneumonia and 51 to pneumonia of which the type was not mentioned. Malaria, Dysentery, Encephalitis Lethargica. 74 cases of malaria were notified, with 2 deaths. 11 ceases of dysentery were notified, with no deaths. All cases of these two diseases were introduced from abroad. None arose in the town originally. 9 cases of encephalitis lethargica were notified, with 3 deaths. Tuberculosis. The principal addition to the tuberculosis work in the town during the year was the opening of the Smallpox Hospital at Cheam as a Tuberculosis Sanatorium. This is already referred to on page 10. The general work at the tuberculosis dispensary is fully detailed in the section of the tables dealing with tubercle. A total of 636 new cases were medically examined during the year, and the total number of medical examinations made was 7,454. This in view of the necessarily very careful nature of the examinations means a large volume of work. In spite of this, it is impossible to give adequate attention to the "contacts" with cases of tuberculosis—one of the most important of the preventive sections of this HEALTH VISITORS. —The following is a summary of the work done and visits paid by the Health Visitors. Visits to Houses where the following Diseases have been reported. Miss Chalk Miss Pirie & Miss Goodman Miss Waterman (1) Miss Massie. Miss Davis Miss Byrn Mrs. Rylance Mrs. Rylance. School Cases. Other Cases. School Cases. Other Cases School Cases. Other liases. Schoc 1 Cases. Othe r Cases. Schoo Cases. Other Cases. School Cases. Other Cases. School Cases. Other Cases. School Cases. Other Case?. 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 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 1 6 3 5 1 9 7 7 5 iphtheria 100 54 28 4 14 20 2 2 83 41 122 117 Erysipelas 19 3 1 13 1 9 1 10 1 3 5 Measles 235 26 3 es 18 116 25 47 50 19 146 5 German Measles 16 2 7 2 1 11 3 2 1 Mumps 27 4 2 y 4 12 21 4 1 93 3 Whooping Cough 3 4 10 2 4 30 2 1 4 6 Chicken pox 72 9 29 97 16 95 6 114 3 66 8 134 Sore Phi oat 130 38 38 11 163 119 49 23 161 191 64 53 3 Ringwotm (scalp) 30 90 11 8 33 49 63 149 91 30 208 37 80 „ (body) 24 58 .1 2 15 31 32 33 19 30 19 31 16 26 Verminous Heads 1 1 1 4 1 2 4 10 Verminous Bodies 6 9 3 1 1 4 2 3 1 Impetigo Contagiosa 300 371 37 26 190 372 342 464 199 482 193 436 297 268 Scabies 81 117 20 G 96 78 62 119 65 214 16 74 117 159 Infectious Eye Disease 43 62 44 21 66 50 19 34 26 33 34 8 Other diseases 369 164 ... "7 S 288 34S i.. 302 134 482 263 258 147 679 143 ... Totals 1450 1009 ... 246 65 ... ... 985 1086 116S 1007 12 80 1363 861 1151 1628 705 1st visits. Subsequent visits. 1st visits. Subsequent visits. Subsequent visits 1st visits. Subsequent visit.. 1st visits. Subsequent visits. lst visits. Subsequent visits. 1st visits. Subsequent visits. 1st visits. Subsequent visit . Visit to houses where Infant have been born 4 7 21 13 98 65 Visits to houses, where Infants have died under one year of age 1 2 Tuberculosis cases visited 25 313 312 m 86 03 2 401 64 471 2 414 454 80 292 Addresses given (Domestic Subject Centre) 17 Estimate d total attendance at do ... 172 Visit paid to Elementary Schools fcr Medical Inspections 36 53 45 47 60 41 57 Number of Children prepared for Medical Inspection - Newlv Inspected 605 951 737 717 1106 663 1013 Re-inspected 34 202 157 43 176 80 81 Specially Inspected . 27 2 40 26 20 45 21 Other Visits to Elementary Schools 47 1 13 2 3 2 41 26 31 3 6 Home Visits arising out of Medical Inspection 216 68 52 166 162 308 83 307 263 138 203 37 7 Home visits for other information 120 12 44 61 6 101 460 107 g 21 2 106 45 33 Cultures taken 228 56 190 2 74 8 241 168 103 140 41 Special Inspections or Attendances at Clinics ... ( * ) 214 physically defectives seen, 21 field of public health work. It is certain that if we are to keep proper supervision of tubercular disease in the borough the staff apportioned for this duty will have to be increased at an early date. The total number of cases who received treatment at Sanatoria and other outside institutions in 1919 was 271, and at the Borough Hospital 57. The shortage of houses gives rise to most serious difficulties in arranging suitable living conditions at home for tuberculous persons just as it is doing in relation to all other infectious diseases. THE WORK OF THE HEALTH VISITORS. This is set out in the accompanying table and again shows a large mass of useful work, conscientiously and efficientlv performed. DISINFECTION. The following table shews the disinfection carried out during 1919:— Destroyed. Articles. Disinfected by Total. Steam. Formalin Lamp. Formalin Spray, Izal Fluid. 22 Beds 753 ... ... ... 753 10 Blankets 2371 ... ... ... 2371 ... Blouses 49 ... ... ... 49 ... Bolsters 735 ... ... ... 735 ... Books (other than Libraiy) 302 ... ... 302 ... Books (Library) 357 ... ... 357 4 Boots 4 ... 20 ... 24 ... Capes 6 ... ... ... 6 1 Caps 26 ... ... ... 26 1 Carpets 23 ... ... ... 23 ... Cloaks ... ... ... 1 Coats 235 ... ... ... 235 ... Corsets 27 ... ... ... 27 2 Curtains 90 ... ... ... 90 3 Cushions 432 ... ... ... 432 ... Costumes 12 ... ... ... 12 3 Counterpanes or Quilts 900 ... ... ... 900 ... Dresses 62 ... ... ... 62 1 Dressing Gowns 160 ... ... ... 160 ... Handkerchiefs 203 ... ... ... 203 ... Hearthrugs 9 ... ... ... 9 ... Jackets 106 ... ... ... 106 ... Mats 1 ... ... ... 1 25 Mattresses 1088 ... ... ... 1088 ... Neckerchiefs 21 ... ... ... 21 12 Palliasses 157 ... ... ... 157 10 Petticoats 49 ... ... ... 49 18 Pillows 2468 ... ... ... 2468 2 Rugs 149 ... ... ... 149 2 Shawls 116 ... ... ... 116 2 Sheets 646 ... ... ... 646 ... Shirts 178 ... ... ... 178 ... Skirts 49 ... ... ... 49 ... Stockings (Socks 271 ... ... ... 271 ... Towels 180 ... ... ... 180 1 Trousers 118 ... ... ... 118 ••• Underclothing 116 ... ... ... 116 2 Vests 139 ... ... ... 139 1 Waistcoats 75 ... ... ... 75 153 Other articles 1853 ... ... ...... 1853 Total 279 Total 13877 659 20 ... 14556 Premises, etc., Disinfected. Rooms. Hospital Wards. School Departments. School Class rooms. Vehicles. School Lavatories. 2426 7 52 3 8 22 23 The disinfectors were also engaged from time to time in the removal of condemned foodstuffs to the Destructor, and also in journeys to the Borough Hospital in connection with laundry. Approximately four journeys per week in all. Cleansing of Persons at Disinfecting Station during the Year 1919 Adults. School Children. Children under School age. Scabies 8 49 3 Body Vermin 25 17 — 33 66 3 24 SECTION II. TABLE I. Vital Statistics of whole District during 1919 and previous years. Year. Population estimated to Middle of each Year. Uncorrected Number. Births. Total Deaths Reg. In the District. Transferable Deaths Nett deaths belonging to the District. of Non.residents registered in the District. ot Residents not registered in the District. Under 1 Year of Age. At all Ages. Nett. Number. Rate.* Number. Rate per 1,000 Nett Births. Number. Rate* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 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 1915. 177,345 3699 3704 20.8 2463 13.8 269 221 307 83 2415 13.6 1916. 175,765 3589 3636 20.6 2207 12.5 253 197 281 77 2151 12.2 1917† 186,917 2836 2861 15.3 2207 11.8 262 219 249 87 2164 11.09 1918† 188,755 2632 2626 13.9 2687 15.9 388 245 202 76 2544 15.1 1919// 191,922 3008 2965 15.4 2287 12.4 312 197 219 73 2172 11.7 Rates calculated per 1,000 of estimated population. †Registrar General's estimate of civilian population. ‡Registrar General's estimate of civilian population for death rate, 168,462. // „ „ „ „ „ death rate, 184,239. 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. 25 TABLE II. Cases of Infectious Disease notified during the Year 1919. Notifiable Disease Casks notified in whole District. Total Cases notified in each Locality. Total Cases Removed to Hospitals or Sanatoria. At Ages—Years. Unrecorded ages. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. Institution cases which could not be distributed. At all Ages. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 & upw d. Small-pox 9 .. 1 2 1 4 1 .. .. 2 .. 7 .. .. .. .. .. .. 9 Cholera (C) Plague (P) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles and German Measles 501 8 164 811 10 6 .. .. 2 124 133 29 37 25 60 20 73 .. 3 Diphtheria 429 2 117 257 98 2? .. 1 1 70 32 15 34 131 95 ?a .. 397 Erysipeas as 61 1 4 3 5 16 25 7 .. 14 10 3 8 5 11 5 5 .. 4 Scaret Fever 603 o 109 414 48 27 .. .. .. 86 76 39 117 33 141 55 56 .. 500 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 5 .. .. 1 .. 3 .. .. .. 4 .. .. .. 1 .. .. .. .. 3 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 4 .. .. .. 1 3 .. .. .. 2 1 .. .. .. 1 .. .. .. 1 Cerebro-spinal Meningitis 4 .. .. 2 .. 2 .. .. .. .. 1 1 .. .. 1 .. 1 .. 3 Ophthalmia Neonatorum 29 29 .. .. .. .. .. .. .. 14 3 2 .. 2 6 .. 2 .. 1 Pulmonary Tuberculosis 390 .. 2 55 107 170 48 2 6 91 71 34 44 41 58 14 37 .. 197 Other forms of Tuberculosis 50 1 16 18 3 9 1 .. 2 14 8 6 3 2 9 1 7 .. 27 Pneumonia 185 3 14 '24 35 61 33 12 3 40 16 27 23 17 38 19 5 .. 6 Malaria 74 .. .. .. 18 55 1 .. .. 22 11 4 7 5 12 1 12 .. .. Dysentery 11 .. .. .. 3 8 .. .. .. 5 1 1 3 1 .. .. .. .. Encephalitis lethargica. 9 .. .. .. 2 4 3 .. .. 3 2 .. 1 .. 1 1 1 .. .. Posterior basic meningitis 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. Anterio poliomylitis 2 .. .. 1 1 .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. Totals 2367 49 427 1089 262 390 113 22 15 491 366 168 277 263 434 139 229 .. 1151 The Borough (Fever) Isolation Hospital is situated in the West Ward. The Croydon and Districts Smallpox Hospital is at North Cheam. 26 TABLE III Causes of, and ages at, Death during Year ending December 31st, 1919, 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) ... ... ... ... ... ... ... ... ... ... ... ... 2 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 (A B.) Relapsing Fever (A) Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Mediterranean Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Malaria ... 2 ... ... ... ... ... ... ... (1) "1 2 2 ... ... ... ... ... ... 1 1 ... 5 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Not vaccinated ... ... 1 ... ... ... ... ... ... 1 ... ...1 1 ... ... ... ... ... ... ... ... ... (C) Doubtful ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Measles 3 ... ... ... ... ... ... ... ... ... ... 3 2 1 ... 2 ... ... ... ... ... ... 7 Scarlet Fever 2 3 1 3 ... ... ... 2 ... 11 ... 11 6 5 1 2 ... ... 1 ... ... ... 8 Whooping Cough ... ... ... ... ... 1 ... ... ... 1 ... 1 ... 1 1 ... ... ... ... ... ... ... 9 (A) Diphtheria 7 "2 2 2 11 8 2 (2) ... 32(12) ■■■ 36 15 21 2 16 17 1 ... ... ... (B C.) Croup (13) Membranous laryngitis 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... ... ... ... (C) Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Influenza 26 19 22 26 8 20 "7 9 22(26) ... 139 65 74 ... 3 ... 9 22 42 32 21 11 Miliary l ever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Cholera Nostras ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Dysentery ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 15 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Yellow Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Leprosy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Erysipelas ... 1 ... ... ... ... ... 1 ... 2 ... 2 2 ... ... ... ... ... ... ... 1 1 27 19 (A.B.C.D.) other Epidemic Diseases (A) Mumps 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... (B) German Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Varicella ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other Diseases included under 19 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 (A.B.C.) Pyæmia, Septicæmia (A) Pyæmia ... ... ... ... 1 2 ... ... ... 2 ... 3 2 1 2 1 ... ... ... ... ... ... (B) Septicsemia ... ... ... ... ... ... 1 ... ... 1(1) 1 1 1 ... ... ... ... ... ... ... ... 1 (C) Vaccinia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 Anthrax (Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Rabies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 24 Tetanus ... ... 1 ... ... ... ... ... ... 1 1 1 1 ... ... ... ... 1 ... ... ... ... 25 (A.B.) Mycoses (A) Actinomycosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other Mycoses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 Pellagra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Beri-beri ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28 (A B. Pulmonary Tuberculosis (not acute) (A) Pulmonary Tuberculosis 39 25 12 17 17 27 8 15 3 59( ) 4 163 88 75 1 1 ... 9 31 77 36 8 (B) Phthisis (not defined as tuberculous) 3 6 2 1 1 1 ... 9 ... 6(1) 1 23 11 12 ... ... ... 3 3 11 5 1 29 (A) Acute Phthisis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Acute Miliary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30 Tuberculous Meningitis 3 3 1 2 1 5 ... 1 ... 3 ... 16 7 9 1 7 2 6 ... ... ... ... 31 (A.B.)Tuberculosis of Peritoneum and Intestines (A) Tabes Mesenterica ... 1 ... ... ... ... 1 ... ... 1(1) ... 2 1 1 ... 1 1 ... ... ... ... ... (B) Other Peritoneal and Intestinal Tubercle 3 2 ... ... ... ... ... ... 1 2 ... 6 5 1 ... ... 3 ... ... 1 2 ... 32 Tuberculosis of Spinal Column ... ... ... ... ... ... 1 ... ... 1 ... 1 1 ... ... ... ... ... 1 1 ... ... 33 Tuberculosis of Joints ... 2 ... ... ... ... ... ... ... 1 ... 2 2 ... ... ... ... ... 1 ... ... ... 34 (A. B.C.) Tuberculosis of other Organs (A) Lupus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Scrofula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other Tuberculosis included under 34 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 35 Disseminated Tuberculosis 1 ... 1 ... ... 1 1 ... ... 3 (2) ... 4 2 2 ... 1 1 ... ... ... ... 36 (A.B.) Rickets, Softening of Bones (A) Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other forms of Bone Softening ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28 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. 25-65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. 37 Syphilis 1 ... ... 2 2 1 ... ... ... 3 ... 6 2 4 5 ... ... ... ... ... 1 ... 38 (A.B.C.) Other Venereal Diseases (A) Soft Chancre ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Gonococcus Infection ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Purulent Ophthalmia ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 39 Cancer of the Buccal Cavity 1 3 2 3 2 ... 1 2 ... (2.2) ... 14 8 6 ... ... ... ... 1 1 4 8 40 Cancer of the Stomach, Liver, &c. 9 2 5 10 4 5 4 4 ... 13(12) ... 50 29 21 ... ... ... ... ... 3 24 23 41 Cancer of the Peritoneum, Intestines & Rectum 11 8 4 8 7 8 5 4 ... 16 (5) ... 55 19 36 ... ... ... ... ... 4 28 23 42 Cancer of the Female Genital Organs 2 6 3 3 1 6 4 2 1 12 (4) ... 28 ... 28 ... ... ... ... ... 3 18 7 43 Cancer of the Breast 3 2 2 2 6 2 3 4 ... 4 (3) ... 24 ... 24 ... ... ... ... ... 3 12 9 44 Cancer of the Skin ... 2 1 ... 1 ... ... ... ... 1(2) ... 4 3 1 ... ... ... ... ... ... 1 3 45 Cancer of other or unspecified Organs 8 13 9 7 7 8 3 5 ... 19 (4) ... 60 45 15 ... 1 ... 2 ... 5 23 29 46 (A.B.C.) Other Tumours (situation undefined) (A) Angioma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Adenoma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other Tumours included under 46 ... ... ... 2 ... ... ... ... ... 1 ... 3 ... 3 ... ... 1 ... ... 1 ... 1 47 Rheumatic Fever 2 1 ... ... ... ... ... ... ... 2 ... 3 ... 3 ... ... ... ... ... 1 ... 2 48 (A.B.) Chronic Rheumatism, Osteo-arthritis (A) Chronic Rheumatism ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... (B) Osteo-arthritis ... ... 1 ... ... ... ... 1 ... 1 ... 2 1 1 ... ... ... ... ... ... ... ... (C) Gout ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 49 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 Diabetes 5 2 ... 4 3 4 ... 3 ... 1 (3) ... 22 9 13 ... ... ... ... 1 6 7 ... 51 Exophthalmic Goitre ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 52 Addison's Disease ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... 53 (A.B.) Leucocythæmia, Lymphadenoma (A) Leucocythæmia (Leucaemia) ... ... ... ... 1 1 ... ... ... 2 ... 2 1 1 ... ... ... ... ... 1 1 ... (B) Lymphadenoma ... ... ... 1 ... ... ... ... ... (1) ... 1 ... 1 ... ... ... ... ... 1 ... ... 29 54 Antemia, Chlorosis 2 2 4 2 1 ... 1 2 ... 2(3) ... 14 6 8 ... ... ... ... ... 2 5 7 55 (A.B.C.D.) Other General Diseases (A) Diabetes Insipidus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Purpura ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Haemophilia ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... (D) Other Diseases included under 55 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 56 Alcoholism (acute or chronic) ... 1 ... 1 ... ... ... ... ... (1) ... 2 1 1 ... ... ... ... ... ... ... ... 57 (A. B.) Chronic lead poisoning (A) Occupational lead poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Non-occupational lead poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 58 Other chronic occupational poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 59 Other chronic poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... II.—Diseases of the Nervous System and of the Organs of Special Sense. 60 Encephalitis 2 ... ... 2 ... 3 1 ... ... 4 (1) ... 8 4 4 ... ... ... 1 1 4 1 1 61 ( A) Cerebro spinal fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 61 (B.C.) Meningitis, other forms or undefined (B) Posterior basal meningitis ... ... ... 1 ... ... 1 1 ... 2 ... 3 1 2 ... ... 1 1 ... 1 ... ... (C) Meningitis, other forms 2 1 ... 2 2 ... ... 3 ... 1 (2) ... 10 7 3 1 1 2 1 ... 2 2 1 62 Locomotor Ataxy ... 1 ... 1 ... 2 ... ... ... 2(1) ... 4 3 1 ... ... ... ... ... 3 ... 1 63 (A.B.) Other diseases of the spinal cord (A) Diseases formerly classed to "Other nervous affections" ... 2 ... ... ... 1 2 ... ... (1) ... 5 2 3 ... ... ... ... ... ... 1 4 (B) Other diseases included under 63 1 ... 2 ... ... 1 2 1 ... 4 (2) ... 7 4 3 ... ... 1 ... ... 2 4 ... 64 (A.B.C.D.F.) Cerebral hæmorrhage, Apoplexy (A) Apoplexy ... 3 ... 1 ... 1 ... ... ... 1 ... 5 1 4 ... ... ... ... ... ... 2 3 (B) Serous apoplexy and oedema of brain ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Cerebral congestion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Cerebral atheroma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Cerebral haemorrhage 21 25 12 16 11 19 5 12 1 40(23) 10 122 57 65 ... ... ... ... 2 5 30 85 65 Softening of brain ... 1 ... 2 1 ... 1 ... ... 2 (2) ... 5 2 3 ... ... ... ... ... ... 3 2 66 (A.B.C.) Paralysis without specified cause (A) Hemiplegia 1 1 ... 1 ... ... ... ... ... (1) ... 3 1 1 ... ... ... ... ... ... ... 3 ( B) Paraplegia ... ... 1 ... 1 ... ... ... ... 1 ... 2 1 1 ... ... ... ... ... 1 ... 1 (C) Other forms of paralysis 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 30 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 3 ... 1 4 2 ... ... ... ... 9 ... 10 8 2 ... ... ... ... ... 3 7 68 Other forms of mental alienation ... ... ... ... ... ... ... ... ... (2) ... ... ... ... ... ... ... ... ... ... ... ... 69 Epilepsy 3 3 ... ... ... ... ... ... ... 6(1) ... 6 3 3 ... ... ... ... 2 1 2 1 70 (A.B. Convulsions (non puerperal; 5 yrs. & over) (A) Epileptiform convulsions ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... (B) Others included under 70 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 71 (A.B.) Infantile convulsions (under 5 years) (A) Convulsions with teething ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other infantile convulsions 3 2 2 2 ... 1 ... ... ... 1 ... 12 9 3 11 1 ... ... ... ... ... ... 72 Chorea ... ... ... ... ... ... 1 ... ... 1(1) ... 1 ... 1 ... ... ... 1 ... ... ... ... 73 (A.B.I Hysteria, Neuralgia, Neuritis (A) Hysteria, Neuralgia, Sciatica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Neuritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 74 (A.B.C.D.) Other diseases of the nervous system (A) Idiocy, Imbecility ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Cretinism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Cerebral tumour ... 2 ... 1 ... ... ... ... ... 1 ... 3 1 2 ... ... ... 1 ... 2 ... ... (D) Other diseases included under 74 1 1 ... ... ... ... 1 ... ... 1 ... 3 2 1 1 ... ... ... ... 2 ... ... 75 Diseases of the eyes and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 76 (A) Mastoid disease ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 76 (B) Other diseases of the ears 2 2 ... ... ... ... 1 ... ... 3(3) ... 5 1 4 1 1 1 1 ... 1 ... ... III.—Diseases of the Circulatory System. 77 Pericarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 78 (A.B.C.) Acute endocarditis (A) Acute myocarditis ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... (B) Infective endocarditis ... 2 ... ... 1 ... ... ... ... 2 ... 3 1 2 ... ... ... ... 1 1 1 ... (C) Other acute endocarditis 1 1 ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... ... 1 ... 1 ... 31 79 (A) Valvular disease 26 20 12 20 13 16 6 16 3 28 17 16 132 63 69 ... ... ... 2 7 17 25 81 79 (B) Fatty degeneration of the heart 3 5 1 2 4 2 ... 2 ... 2 (3) 12 19 9 10 ... ... ... ... ... ... 5 14 79 (C) Other organic disease of the heart 7 10 7 9 11 17 ... 8 ... 7 (7) 4 69 29 40 ... ... ... 1 1 9 17 41 80 Angina pectoris 1 ... 1 ... ... ... ... ... ... 1 2 2 1 1 ... ... ... ... ... ... 1 1 81 (A) Aneurysm ... ... ... 2 ... ... ... ... ... 1 ... 2 2 ... ... ... ... ... ... ... 2 ... 81 (B) Arterial sclerosis 26 37 12 7 12 17 7 6 3 88(4 ) 1 127 46 81 ... ... ... ... ... 1 11 115 81 (C) Other diseases of arteries 1 1 ... ... ... ... ... ... ... 2 ... 2 2 ... ... ... ... ... ... 1 ... 1 82 (A) Cerebral embolism and thrombosis 6 3 3 1 3 5 ... ... ... 3 ... 21 7 14 ... ... ... ... ... 1 3 17 82 (B) Other embolism and thrombosis ... ... ... 1 1 ... ... ... ... ... ... 2 1 1 ... ... ... ... ... ... ... 2 83 (A.B.C.D) Diseases of the veins (Varices Hæmorrhoids, Phlebitis, &c.) (A) Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Varix ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Pylephlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Varicocele ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 (A) Status lymphaticus ... ... ... ... 1 ... ... ... ... ... 1 1 1 1 1 ... ... ... ... ... ... ... 84 (B) Other diseases of the lymphatic system ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 85 (A. B.C) Hæmorrhage; other diseases of the circulatory system (A! Functional disease of the heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Epistaxis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other diseases included under 85 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... IV.—Diseases of the, Respiratory System. 86 Diseases of the nasal fosse ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 87 (A. B.C ) Diseases of the larynx (A) Laryngismus stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) I aryngitis ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... 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 59 40 14 19 25 25 6 20 1 43(24) 9 209 89 120 20 2 2 1 ... 6 33 145 91 Bronchopneumonia 16 8 6 5 8 8 3 3 1 12 (6) ... 58 25 33 14 6 9 3 1 5 6 14 92 (A.B.) Lobar and undefined. (A) Lobar pneumonia 3 4 3 1 2 5 1 8 ... 3 8 27 15 12 2 1 1 3 1 4 9 6 (B) Pneumonia (type not stated) 12 5 4 10 6 7 2 4 1 12(7) 4 51 23 28 3 1 5 2 3 11 10 16 32 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. -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)... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other pleurisy 2 1 1 1 1 1 1 ... ... 1 1 8 4 4 ... ... ... ... 1 3 3 1 94 (A.B.C.D.) Pulmonary congestion, Pulmonary apoplexy (A) Pulmonary apoplexy and infarction ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... (B) Pulmonary œdema and congestion 2 ... ... 1 ... 1 ... ... ... ... 1 4 1 ... 1 1 ... 1 ... ... 1 ... (C) Hypostatic pneumonia ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 (D) Collapse of lung (3 months and over) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 95 Gangrene of the lung ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... 96 Asthma 2 ... 2 5 1 1 1 ... ... (1) ... 12 7 5 ... ... ... ... ... ... 7 5 97 Pulmonary emphysema 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 98 (A) Fibroid disease of lung ... ... ... ... ... 1 ... ... ... (1) ... 1 1 ... ... ... ... ... ... ... ... 1 98 (B) Other diseases of the respiratory system ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 V.—Diseases of the Digestive System. 99 (A) Diseases of the teeth and gums ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... 99 (B C.D.) Other diseases of the mouth and annexa (b) Thrush, Aphthous Stomatitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Parotitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (d) Other diseases included under 99 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 100 (A.B.C.) Diseases of pharynx, Tonsillitis (A) Tonsillitis ... ... ... ... ... ... ... 2 ... (1) ... 2 2 ... ... ... 2 ... ... ... ... ... (B) Ludwig's angina ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 (C) Other diseases of the pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 101 Diseases of oesophagus ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 102 Perforating ulcer of stomach 1 2 ... 1 ... 1 1 2 ... 6 (2) 1 8 6 2 ... ... ... ... ... 2 3 3 33 103 (A) Inflammation of stomach 3 1 1 ... ... ... ... 3 ... 2(3) 1 8 2 6 4 ... ... ... ... ... 2 2 103 (B) Other diseases of the stomach ... ... ... ... 1 ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... 2 2 104 (A B.C.D.E.F.G.H.) Diarrhœa and enteritis & (A) Infective enteritis 1 1 ... ... 1 1 ... 3 ... 4 ... 7 3 4 7 ... ... ... ... ... ... ... 105 (B) Diarrhoea—Not returned as infective 1 2 ... ... ... ... ... ... ... ... ... 4 3 1 3 1 ... ... ... ... ... ... (C) Enteritis—Not returned as infective ... 1 1 1 ... ... ... 1 ... ... 1 4 2 2 2 2 ... ... ... ... ... ... (D) Gastro-enteritis—Not returned as infective 2 ... l 3 2 ... 1 ... ... 3 (1) 1 9 5 4 9 ... ... ... ... ... ... ... (E) Dyspepsia, under 2 years ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (F) Colic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (G) Ulceration of intestines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (H) Duodenal ulcer ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... 106 Ankylostomiasis ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... 107 Other intestinal parasites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 108 Appendicitis 6 4 ... 1 ... 2 ... ... ... 11(3) ... 13 8 5 ... ... 1 1 3 3 4 1 109 (A) Hernia 2 1 1 ... 2 1 1 1 ... 6 (3) ... 9 5 4 1 ... ... ... ... 1 ... 7 109 (B) Intestinal obstruction 1 5 3 1 1 2 ... ... ... 5 (1) ... 13 7 6 1 ... ... l ... 1 ... 7 110 Other diseases of the intestines ... ... ... 1 ... ... ... ... ... 1(1) ... 1 ... 1 ... ... ... ... ... ... ... 1 111 Acute yellow atrophy of liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 112 Hydatid of liver ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 113 (A.B.C.) Cirrhosis of the liver (A) Cirrhosis of the liver (not returned as alcoholic) 1 2 1 1 3 ... ... ... (l) ... 8 4 4 ... ... ... ... ... 1 2 5 (B) Cirrhosis of the liver (returned as alcoholic) ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... (C) Diseases formerly classed to "Other ... 1 diseases of liver and gall bladder " ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 114 Biliary calculi ... 1 ... ... ... ... ... 1 ... ... ... 2 ... 2 ... ... ... ... ... ... ... 2 115 Other diseases of the liver 1 ... ... ... ... ... ... 2 ... 1 ... 3 3 ... ... ... ... ... ... ... ... 2 116 (A.B.) Diseases of the spleen (A) Infarction of spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases of the spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 117 Peritonitis (cause unstated) 1 2 2 ... ... ... ... ... ... 3 ... 5 2 3 ... ... ... ... ... ... ... ... 118 (A. B.) Other diseases of the digestive system (A) Abdominal abscess, Sub-phrenic abscess ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases included under 118 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 34 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. 1-5. 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 ... ... 2 2 1 4 2 1 ... 4 2 12 7 5 ... ... 1 2 ... 5 1 3 120 (A. B.) Bright's disease (A) Bright's disease as in 1.)of list 8 4 2 4 3 8 ... 3 ... 11 (3) 4 32 22 10 ... ... 1 1 1 1 16 12 (B) Nephritis (unqualified), to years and over and Unæmia ... 2 ... 2 1 ... ... 1 ... 1 (1) ... 6 2 4 ... ... ... ... ... 2 1 3 121 Chyluria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 (A.B.C.D.) Other diseases of the kidney and annexa (A) Abscess of kidney ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Cystic disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Suppression of urine ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D Other diseases included under 122 ... ... 1 ... 1 ... ... ... ... 1 ... 2 2 ... ... ... ... ... ... ... ... 2 123 Calculi of the urinary passages ... ... ... ... ... 2 ... ... ... 1 ... 2 1 1 ... ... ... ... ... ... ... 2 124 Diseases Of the bladder 1 1 ... 1 ... 1 ... ... ... 3 ... 4 4 ... ... ... ... 1 ... ... ... 3 125 (A.B.) Diseases of the urethra, Urinary abscess, &c. (A) Perineal abscess 1 ... 1 1 1 ... ... ... ... 2 ... 4 4 ... ... ... ... ... ... ... 1 3 (B) Other diseases of urethra, &c. ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 126 Diseases of the prostate 1 ... ... ... ... 1 2 ... ... 1 (2) ... 4 4 ... ... ... ... ... ... ... ... 4 127 Non-venereal diseases Of male genital organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 (A.B.) Uterine haemorrhage (non-puerperal) (A) Menorrhagia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other uterine hæmorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 129 Uterine tumour (non-cancerous; ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 35 130 (A. B.) Other diseases of the uterus (A Disorder of menstruation (except merorrhagia) ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... (B) Other diseases included under 130 ... 1 ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 131 Ovarian cyst, tumour (non-cancerous) ... 1 ... ... ... ... ... 1 ... 1 ... 2 ... 2 ... ... ... ... ... ... ... 2 132 (A.B.) Other disease of the female genital organs (A) Diseases of ovary (excluding ovarian tumour) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases included under 132 ... ... ... ... ... 2 ... ... ... 2(1) ... 2 ... 2 ... ... ... ... ... 2 ... ... 133 Non-puerperal diseases of the breast (noncancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... VII. — The Puerperal State. 134 (A B.C. I). E.) Accidents of pregnancy (A) Abortion 1 ... ... 1 ... ... ... ... ... 1 ... 2 ... 2 ... ... ... ... 1 1 ... ... (B) Hemorrhage of pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Uncontrollable vomiting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D)) Ectopic gestation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Other accidents of pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 135 Puerperal haemorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 136 Other accidents of childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 137 Puerperal fever 1 1 ... 1 ... ... ... ... ... 2(1) ... 3 ... 3 ... ... ... ... 1 2 ... ... 138 (A.B.C.) Puerperal albuminuria and convulsions (A) Puerperal nephritis and uraemia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Puerperal anlbuminuria & Bright's disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Puerperal convulsions ... ... ... ... ... ... ... 1 ... ... ... 1 ... 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 36 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 of the Skin and of the Cellular Tissue. 142 (A) Senile gangrene 3 1 1 ... ... ... ... ... ... ... ... 5 2 3 ... ... ... ... ... ... ... 5 142 (B C.D.) Gangrene, other types (B) Noma, Gangrene of mouth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Noma pudendi ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... 1 (D) Other gangrene ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 143 Carbunicle, Boil ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 144 (A.B.) Phlegmon, acute abscess (A) Phlegmon ... ... ... ... ... 1 ... ... ... 1 (1) ... 1 ... 1 ... ... ... ... ... ... ... 1 (B) Acute abscess ... ... 1 ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... 1 ... 145 (A) Ulcer, Bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Pemphigus ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... (D) Other disease of integumentary system 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 IX. - Diseases of the Bones and of the Organs of Locomotion. 146 Diseases of the bones ... ... ... 2 ... 1 1 ... ... 4 ... 4 4 ... 1 ... ... ... ... ... 2 l 147 Diseases of the joints 1 1 ... 1 ... ... ... ... ... 2 ... 3 2 1 ... ... ... ... ... ... 1 2 148 Amputations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Other diseases of locomotor system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... X.—Malformations. 150 (A. B.C.D.) Congenital malformations (A) Congenital hydrocephalus ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... I ... ... ... ... ... (B) Phimosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Congenital malformation of heart ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... (D) Other congenital malformations l 1 1 1 ... ... ... ... ... 2 ... 5 3 2 5 ... ... ... ... ... ... ... 37 XI.—Diseases of Early Infancy. 151 (A) Premature birth 18 9 5 8 7 7 3 5 1 3(4) 6 63 38 25 63 ... ... ... ... ... ... ... 151 (B.C.D.E.) Infantile debility, Icterus &Sclerema (B) Infantile atrophy, debility and marasmus 10 6 1 7 2 6 2 1 9(3) 1 35 20 15 35 ... ... ... ... ... ... ... (C) Icterus neonatorum ... ... ... ... I ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... (D) Sclerema and œdeina neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Want of breast milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 152 (A.B.C.D) Other diseases peculiar to early infancy (A) Diseases of umbilicus, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B)Atelectasis 3 2 ... ... 1 2 1 1 ... 2 5 10 7 3 10 ... ... ... ... ... ... ... (C) Injuries at birth ... 1 ... ... 1 ... ... ... ... (1) ... 2 2 ... 2 ... ... ... ... ... ... ... (D) Cyanosis neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 153 Lack of care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... XII.—Old Age. 154 (A.B.) Old age (A) Senile dementia ... ... ... ... ... ... 2 ... ... ... ... 2 1 1 ... ... ... ... ... ... ... 2 (B) Senile decay 11 19 11 13 18 11 9 9 ... 9 (2) 8 101 29 72 ... ... ... ... ... ... ... 101 XIII.—Affections produced by External Causes. 155 Suicide by poison ... ... l 1 ... ... ... ... ... ... 2 2 ... 2 ... ... ... ... 1 1 ... ... 156 Suicide by asphyxia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 157 Suicide by hanging or strangulation ... ... ... ... 1 ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... 1 ... 158 Suicide by drowning ... ... ... ... ... 1 ... ... ... 1 l I I ... ... ... ... ... ... ... 1 ... 159 Suicide by firearms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 160 Suicide by cutting and piercing nstruments 1 1 ... ... ... ... ... 1 ... 2 3 3 3 ... ... ... ... ... ... 1 1 1 161 Suicide by jumping from high place ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 162 Suicide by crushing ... 2 ::: ... ... ... 1 ... ... 3 3 3 2 1 ... ... ... ... ... 2 ... 1 163 Other suicides ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 164 Poisoning by food ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 165 Other acute poisonings 1 1 ... ... ... ... ... ... ... 1 1 2 2 ... ... ... ... ... ... ... 2 ... 166 Conflagration ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 167 Burns (conflagration excepted) 3 ... ... 1 ... 1 ... ... ... 4(3) 5 5 2 3 ... ... ... 1 ... 1 1 2 168 Absorption of deleterious gases (conflagration excepted) ... 1 ... ... 1 ... ... ... ... ... 1 2 1 1 1 ... ... ... ... 1 ... ... 169 Accidental drowning 2 ... ... ... ... ... ... ... ... 2 2 2 1 1 ... ... ... ... ... 1 ... ... 170 Injury by firearms 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... 1 ... ... 171 Injury by cutting or piercing instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 38 TABLE III—continued No. CAUSE. LOCALITIES. Institution & Street Deaths which could not be distributed. Total Institution Deaths distributed aud 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. 55 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood. . Thornton Heath. 172 Injury by fall 6 3 2 1 1 3 2 2 ... 12 (4) 20 20 4 16 ... ... ... 1 1 2 5 11 173 Injury in mines and quarries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 174 Injury by machines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 175 Injury by other crushing (vehicles, railways, landslides, &c.) 3 1 1 3 ... 1 ... ... ... 8 (5) 9 9 8 1 ... ... 1 1 1 1 2 3 176 Injury by animals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 177 Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 178 Excessive cold 1 ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... 1 179 Effects of heat ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... 180 Lightning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 181 Electricity (lightning excepted) ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 182 Homicide by firearms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 183 Homicide by cutting or piercing instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 184 Homicide by other means ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 185 Fractures (cause not specified) ... ... ... ... ... 1 ... ... ... 1 1 1 ... 1 ... ... ... ... ... ... ... 1 186 Other violence 1 ... ... ... ... ... ... 1 ... ... 1 2 2 ... ... ... ... ... 1 1 ... ... XIV.—Ill-Defined Causes. 187 Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 188 (A) Syncope (aged 1 year and under 70) 1 ... 1 ... ... ... 1 ... ... ... 2 3 2 1 ... ... ... ... ... 1 2 ... 188 (B) Sudden death (not otherwise defined) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 189 (A) Heart failure (aged 1 year and under 70) 1 ... 1 ... ... ... ... ... ... ... 2 2 1 1 ... ... ... 1 ... ... ... 1 189 (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 ... ... ... ... 1 ... ... ... ... 1 ... 1 ... 1 ... ... ... ... 1 ... ... ... (E) Other ill defined deaths ... ... 1 ... ... ... ... ... ... 1 ... 1 ... 1 1 ... ... ... ... ... ... ... 189 (F) Cause not specified ... ... ... ... 1 ... 2 ... ... 1 (1) 1 3 1 2 1 ... 1 ... ... ... 1 ... Totals 444 382 203 272 236 303 116 197 19 632 (312) 164 2172 1023 1149 219 38 69 85 95 294 454 918 The total Institution Deaths include those of strangers occurring within the Borough. Deaths of such strangers occurring at the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Purley Cottage Hospital, Norwood' Cottage Hospital, and 99, Central Hill (Servants' Reformatory), are excluded from all other columns of the Table. The numbers so excluded are in brackets. 39 TABLE IIIA. DEATHS FROM INFLUENZA AND CERTAIN OTHER CONDITIONS, 1919. Week ending Influenza. Pneumonia. Bronchopneumonia. Phthisis. Other Resp. Diseases. CerebroSp. F. Measles. Whooping Cough. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Jan. 4th 1 2 - - - - - 1 1 - - - - - - - „ 11th — 2 — 2 — 1 1 2 4 2 - - - - - - „ 18th — 5 2 — 1 1 3 5 4 3 - - - - - - ,, 25 th — — 1 1 1 1 1 2 2 3 - - - - - - Feb. 1st - - — — 3 1 8 2 6 3 - - - - - - „ 8 th 5 3 2 3 1 1 7 1 6 10 - - - - - 1 ,, 15th 6 4 6 3 2 1 2 1 6 9 - - - - - - ,, 22nd 4 5 1 1 2 2 6 — 11 9 - - - - - - Mar. 1st 13 11 1 5 1 1 1 4 5 11 — —. — — — — „ 8th 11 13 3 2 1 5 — 2 5 9 - - - - - - „ 15 th 6 9 — 2 — 2 1 2 2 4 - - - - - - „ 22nd 4 2 — — — 1 7 4 6 7 - - - - - „ 29th — 3 1 — — 2 2 1 3 4 — - - - - - Apr. 5th 2 5 1 — 1 — 3 5 - - - - - - - - ,, 12th 1 1 — 1 1 3 1 2 3 2 — - - - - - „ 19th 1 2 — — — — 1 2 — — - - - - - - „ 26 th 1 1 — — 1 2 2 1 1 - - - - - - - May 3rd 1 1 — 1 — 1 2 1 4 9 - - - - - — „ 10th 1 — 2 — — — — 1 4 1 - - - - - - „ 17th — 1 — — — 1 2 3 4 2 - - - - - - ., 24 th — — — 1 — — 2 — 1 1 - - - - - - „ 31st 1 1 — 2 1 — 1 4 — — — — — 1 - — June 7th — — — — — — 1 — 1 — — — — — - - „ 14 th - - — 1 — — — 4 — 2 - - - - - - „ 21st - - - - - - - 2 1 3 - - - - - - „ 28 th — — 3 — 1 1 3 - - - - - - - - - 40 TABLE IIIA.—Continued. Week ending. Influenza. Pneumonia. BronchoPneumonia. Phthisis. Other Resp. Diseases. CerebroSp. F. Measles. Whooping Couch. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. J uly 5th - - - - - - 3 - - - - - - - - - „ 12th — — 1 — — — 1 1 - - - - - - - - „ 19th 1 — 2 2 1 — 2 — 1 — - - - - - - „ 26th — — 1 — — — 1 1 3 — - - - - - - Aug. 2nd — — 1 — — 1 1 2 3 2 - - - - - - „ 9th — — — 1 — — 4 5 — 1 - - - - - - „ 16 th 1 — — 2 2 — 2 1 1 1 - - - - - - „ 23rd — — — — — — 2 2 — — - - - - - - ,,30th - - - - - - 1 1 1 1 - - - - - - Sept. 6th - - - - - -- - 1 - - - - - - - - „ 13th — — 1 1 — — 1 1 — — - - - - - - 20 th — 1 - - - - - - 1 1 - - - - - - ,, 27th — — -— — — — 2 — 1 1 - - - - - - Oct. 4th — — 1 — 1 — 1 3 — 1 - - - - - - „ 11th - - - - - - 1 1 — 1 - - - - - - „ 18 th — — — 2 — 1 — 2 — 2 - - - - - - ,, 25 th — — — — 1 — 2 4 2 5 — - - - - - Nov. 1st 1 — 3 2 1 — 4 1 — 3 - - - - - - „ 8th — — — 1 1 1 2 1 2 4 - — 1 — — - „ 15th 1 — — 1 — 1 1 4 — 5 - - - - - - „ 22nd 1 — 1 — — 1 2 — 1 4 — — - — — - „ 29th — — — 1 1 1 — 2 2 2 - - - - - - Dec. 6th 1 1 3 — —- — 4 1 1 2 - - - - - - „ 13 th — — 1 — — — 1 — 3 3 - - 1 — — — „ 20 th 2 - - - - - 3 1 1 1 - - - - - - „ 27 th — — — 2 — — 1 — 1 2 - - - — — — 66 73 38 40 25 33 99 87 105 136 — — 2 1 — 1 41 TABLE IV. County Borough of Croydon— Whole Borough. INFANT MORTALITY. 1919. 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. 1 3-4 Weeks. Total under 1 Month. I 3 Months. 3-6 Months. 1 6-9 Months. 9-i2 Months Total Deaths under 1 Year. All Causes. Certified 63 20 10 11 104 49 33 14 19 219 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... 1 1 Whooping Cough ... ... ... ... ... ... ... ... 1 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... 1 ... ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... 1 ... ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... 1 1 Convulsions 3 ... ... ... 5 5 2 ... 1 13 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 1 1 2 6 7 4 2 21 Pneumonia (all forms) ... ... ... ... ... 5 6 3 6 20 Diarrhœa ... ... ... 2 2 ... 4 1 1 8 Enteritis ... ... ... ... ... 4 4 1 1 10 Gastritis ... ... ... 1 1 1 1 ... ... 3 Syphilis... ... ... 1 1 2 1 1 1 ... 5 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 2 ... ... ... 3 ... ... ... ... 3 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 2 ... ... ... 4 ... ... ... ... 4 Congenital Malformations 3 ... ... ... 3 ... ... 1 ... 4 Premature Birth 41 5 3 3 52 7 ... ... ... 59 Atrophy, Debility and Marasmus 4 6 2 2 14 12 3 2 3 34 Other causes 7 4 3 1 15 8 3 1 2 29 63 20 10 11 104 49 33 14 19 219 legitimate 2783. Nett Births in the year-! Nett Deaths in the year of V illegitimate 225. legitimate infants, 185. illegitimate infants 34. 42 TABLE IV.—Continued. County Borough of Croydon— West Watd. INFANT MORTALITY. 1919. Nett Deaths from stated causes at various Ages nnder 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 20 6 2 2 30 11 10 3 6 60 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ...... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... 1 1 Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... 1 2 ... ... ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 2 3 2 ... 7 Pneumonia tall forms) ... ... ... ... ... 3 2 1 2 / 8 Diarrhœa ... ... ... ... ... ... 1 ... 1 2 Enteritis ... ... ... ... ... ... 1 ... ... 1 Gastritis ... ... ... ... ... ... 1 ... ... 1 Syphilis ... ... ... ... l ... ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 1 ... ... ... l ... ... ... ... 1 Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 1 ... ... ... l ... ... ... ... 1 Congenital Malformations 1 ... ... ... l ... ... ... ... 1 Premature Birth 13 ... ... 1 14 1 ... ... ... 15 Atrophy, Debility and Marasmus 1 3 1 ... 5 2 2 ... ... 9 Other causes 3 2 ... 1 6 1 ... ... 1 8 20 6 2 2 30 11 10 3 6 60 legitimate, 782. legitimate infants, 49. Nett Births in the year Nett Deaths in the year illegitimate, 68. illegitimate infants, 11. 43 TABLE IV. — Continued. County Borough of Croydon—North Ward. INFANT MORTALITY. 1939. 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 12 5 1 ... 18 3 7 3 4 35 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 2 1 ... ... ... ... ... ... ... 3 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 2 ... 1 3 Pneumonia (all forms) ... ... ... ... ... ... 1 1 1 3 Diarrhœa ... ... ... ... ... ... 1 ... ... 1 Enteritis ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets. ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 1 1 ... ... 2 ... ... ... ... 2 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... ... ... ... ... ... ... 1 ... 1 Premature Birth 5 ... 1 ... 6 2 ... ... ... 8 Atrophy, Debility and Marasmus 2 1 ... ... 3 1 1 ... 2 7 Other causes ... 2 ... ... 2 ... 2 1 ... 5 12 5 1 ... 18 3 7 3 4 35 (Nett Births legitimate 484. Nett Deaths in the year illegitimate 86. legitimate infants 33. illegitimate infants 2. 44 TABLE IV. — Continued County Borough of Croydon—Central Ward. INFANT MORTALITY 1919. 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 5 ... 2 2 9 6 ... 3 2 20 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... 2 ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... 1 1 ... 1 ... 3 Pneumonia ( all forms) ... ... ... ... ... 1 ... 1 1 3 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... 1 ... ... 1 2 Gastritis ... ... ... ... 1 ... ... ... ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, everlaying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 2 ... ... ... 2 ... ... ... ... 2 Premature Birth 3 ... ... ... 5 ... ... ... ... 5 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... 1 ... 1 Other causes ... ... ... ... ... 1 ... ... ... 1 5 ... 2 2 0 6 ... 3 2 20 legitimate, 231. Nett Births in the year illegitimate, 8. legitimate infants, 17. Nett Deaths in the year illegitimate infants, 3. 45 TABLE IV.—Continued. County Borough of Croydon—East Ward. INFANT MORTALITY. 1919. 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 1 ... 1 11 12 3 2 2 30 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... 1 1 Convulsions ... ... ... ... ... 1 1 ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 1 1 1 1 ... ... 3 Pneumonia (all forms) ... ... ... ... ... 1 1 ... ... 2 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... 3 ... 1 ... 4 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... 1 ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth 8 ... ... ... 8 ... ... ... ... 8 Atrophy, Debility and Marasmus 1 1 ... ... 2 5 ... ... ... 7 Other causes ... ... ... ... ... 1 ... ... 1 2 9 l ... 1 11 12 3 2 2 30 legitimate, 274. legitimate infants, 28. Nett Births in the year Nett Deaths in the year illegitimate, 7. illegitimate infants, 2. 46 TABLE IV.—Continued. County Borough of Croydon—South Ward. INFANT MORTALITY. 1919. 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 4 3 1 1 9 4 8 ... 3 24 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... 1 ... ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... ... ... ... 2 ... 2 4 Diarrhœa ... ... ... ... ... ... 1 ... ... 1 Enteritis ... ... ... ... ... ... 2 ... ... 2 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... 1 1 ... 1 ... ... 2 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth ... ... ... ... 5 2 ... ... ... 7 Atrophy, Debility, and Marasmus ... ... ... ... ... 1 ... ... 1 2 Other causes 2 ... 1 ... 3 1 1 ... ... 5 4 3 1 1 9 4 8 ... 3 24 legitimate, 237. Nett Births in the year illegitimate, 13. legitimate infants, 15. Nett Deaths in the year illegitimate infants, 9. 47 TABLE IV.—Continued. County Borough of Croydon—South Norwood. INFANT MORTALITY. 1919. Nett Deaths from sated Causes at various Ages under One Year og 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 6 4 3 2 15 4 3 1 2 25 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 (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... 1 1 2 Pneumonia (all forms) ... ... ... ... ... ... 1 ... ... 1 Diarrhœa ... ... ... ... ... ... 1 ... ... 1 Enteritis ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... 1 ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... 2 ... ... 2 ... ... ... ... 2 Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth 5 1 ... 1 7 ... ... ... ... 7 Atrophy, Debility and Marasmus ... 1 1 l 3 2 ... ... ... 5 Other causes ... ... 2 ... 2 1 ... ... ... 3 6 4 3 2 15 4 3 1 2 25 Nett Births in the year legitimate, 411. illegitimate, 28. legitimate infants, 22. Nett Deaths in the year illegitimate infants, 3. 48 TABLE IV.— Continued. County Borough of Croydon—Upper Norwood. INFANT MORTALITY. 1919. Neitrt. Deaths from seated Causes at vaniouis Ages under One Year of Age. CAUSES OF DEATH. U nder 1 W eek 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 3 1 ... 1 5 2 1 ... ... 8 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pex ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculos) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... 1 ... ... 1 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ...... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth 1 ... ... ... 2 1 ... ... ... 3 Atrophy, Debility, and Marasmus ... ... ... 1 1 l ... ... ... 2 Other causes 2 ... ... ... 2 ... ... ... ... 2 3 1 ... 1 5 2 1 ... ... 8 (Nett Births in the year legitimate, 106. illegitimate, 4. legitimate infants, 7. Nett Deaths in the year illegitimate infants, 1 49 TABLE IV.— Continued. County Borough of Croydon—Thornton Heath. INFANT MORTALITY. 1919. Nett Deaths from stated Causes at various Ages under One Year of Age. CAUSES OF DEATH. Under 1 W eek 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 1 ... 1 2 7 7 1 2 ... 17 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not 7ubtrculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... 1 ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... 2 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... Diarrhœa ... ... ... 2 2 ... ... 1 ... 3 Enteritis ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... 1 ... ... ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth 4 ... 1 ... 5 1 ... ... ... 6 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... 1 ... 1 Other causes ... ... ... ... ... 3 ... ... ... 3 4 ... 1 2 7 7 1 2 ... 17 legitimate, 258. Nett Births in the year illegitimate, 11. legitimate infants 14. Nett Deaths in the year illegitimate infants, 3. 60 TABLE V. Table showing the number of cases notified and deaths from the principal zymotic diseases for the Year 1919 and ten preceding Years. Disease. 1919. 1918. 1917. 191G. 1915. 1914. 1918. 1912. 1911. 1910. 1909. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cerebro-Spinal Meningitis 4 .. 25 1 18 .. 29 1 24 9 .. .. .. .. .. .. .. .. .. .. .. .. Poliomyelitis 2 .. .. .. 1 .. 2 .. 4 1 .. .. .. .. .. .. .. .. .. .. .. .. Notifiable. Small Pox 9 1 .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 603 11 414 6 191 2 297 4 414 5 748 5 470 3 476 2 468 7 759 7 727 9 Diphtheria and (i) Memb.Croup 429 36 179 2 191 9 312 4 195 14 226 18 451 16 767 25 514 37 267 21 356 24 (2) Erysipelas 61 2 44 3 56 3 52 1 82 3 96 7 107 6 84 6 79 5 69 1 92 3 Puerperal Fever 4 3 4 3 3 1 7 1 12 5 9 3 6 4 10 3 12 4 8 1 16 5 Enteric Fever 5 .. 15 2 6 .. 13 .. 22 3 20 5 32 6 32 7 24 7 26 .. 21 3 Simple Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis (3) 440 217 378 204 397 157 326 223 550 238 503 192 519 202 312 140 240 165 130 135 139 152 Measles (4) 501 3 1057 2 2944 29 462 .. .. 108 .. 8 .. 58 .. 31 .. 29 .. 31 .. 21 Rubella 93 .. 2439 .. 636 .. .. .. .. .. .. .. .. .. .. .. .. .. .. Non-notifiable Diarrhoea and Enteritis .. 24 .. 48 .. 41 .. 50 .. 62 .. 67 .. 85 .. 58 .. 147 .. 51 .. 45 Whooping Cough .. 1 .. 10 .. 9 .. 27 .. 12 .. 24 .. 23 .. 13 .. 38 .. 20 .. 30 Influenza .. 139 .. 478 .. 20 .. 46 .. 45 .. 15 .. 26 .. 18 .. 14 .. 25 .. 59 Bronchitis, *Pneumonia, and Pleurisy 185♦ 353♣ .. 362 .. 302 .. 329 .. 399 .. 313 .. 297 .. 250 .. 280 .. 251 .. 323 (1) Notifiable since May, 1897. (2) Notifiable since January, 1900. (3) Voluntary Notification, 1903-09 Poor Law Cases, Compulsorily Notifiable since 1st Jan., 1909. Cases Treated in Hospital, Compulsorily Notifiable since 1st May, 1911. All cases of Pulmonary Tuberculosis notifiable since 1st January, 1912. All forms of Tuberculosis notifiable since 1st February, 1913. (4) Notifiable since January 1st. 1916. * Notifiable, i.e., acute primary pneumonia and influenzal pneumonia only. t Pneumonia only. ♣136 Pneumonia. 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. 51 TABLE VI.—Vital Statistics of separate Wards in 1919 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 Sub-Division. 9. Undistributri? Institution Births and Deaths. YEAR Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 Year] Population estimate 1 to middle of each year. Births Registered. Deaths at all ages. Deaths under l 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 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 e d a " c a a b c d a b c d a b c d a b c d b c d 1909 .. .. .. .. *63,125 1560 721 142 17,394 266 211 24 19,185 396 189 33 20,636 371 198 27 24,195 654 267 39 8.377 161 87 8 18,176 455 184 40 85 23 .. 1010 .. .. .. .. *54.468 1480 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 54 33,592 800 473 107 16,167 295 199 32 20,175 377 217 42 18.998 360 209 42 25,609 672 325 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 16,119 298 190 25 20,743 417 199 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 1914 31,869 729 302 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 .. 1915 30,093 669 451 52 36,276 844 553 82 16 985 264 236 25 21,236 447 254 31 19,148 309 248 29 26.732 559 348 43 8,069 144 99 7 18,906 385 208 38 79 18 .. 1916 30,659 729 550 44 35,935 769 488 97 15,949 246 182 14 21,041 458 203 29 18,970 309 ]90 19 26.485 589 245 33 7,995 112 115 9 18,731 377 168 36 61 19 .. 1917 32 810 656 597 56 38,406 634 4H8 65 16,036 197 186 23 22,615 357 212 22 20,275 248 172 23 28,292 451 252 22 8,664 1 94 4 20,019 312 182 34 68 44 .. 1918 2^,562 516 665 42 34,604 704 58 57 14,449 205 200 13 20,340 303 298 30 18,268 232 211 17 25.492 349 292 19 7,717 84 118 3 18,030 239 172 21 60 6 .. Averages of Years 1909 to 1918. .. .. .. .. .. .. .. .. 16,167 269 197 24 20,813 403 221 32 19,526 326 206 27 26,203 552 287 40 8,175 117 102 8 18,772 401 178 37 91 24 0.2 Averages of Years 1911 to 1918 30,895 669 433 51 35,938 778 493 85 Averages of Years 1904 to 1910 inclusive. .. .. .. .. 50,541 1476 718 172 1919 32,330 570 382 35 37,845 850 444 6C 15,802 239 203 20 22,245 281 272 30 19,97 250 236 24 27,879 439 303 25 8,440 110 116 8 19,719 269 197 17 80 19 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. 52 TABLE VII. METEOROLOGICAL RECORD—YEAR 1919 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. 1919. Temperature of Air during the Month. Mean Temperature of Air. Difference from average 50 years at Greenwich. Mean Temperature of Ground at 4-ft. Mean Temperature of the Dew Point. Mean Tensional Difference between Ground and Dew Point Rainfall. Highest. Lowest. Mean of No. of Days on which Rain fell. Amount in Inches. Difference from average 90 years at Greenwich All Highest. All Lowest. January 53° 25° 42°.8 34°.2 38°.5 0°.0 43° .6 36°.0 in. — .071 25 in. 3.24 in. + 1.45 February 52° 11° 41°.8 31°.3 36°.5 — 3°.0 39°.7 32° .6 — .054 15 2.56 + 1.03 March 56° 27° 47°.3 34°.2 40°.7 — 1°.0 41°.9 36°.2 — .051 22 3.61 + 2.10 April 70° 27° 55°.2 38°.7 46°.9 — 0°.5 44°.1 41°.4 — .028 15 2.96 + 1.36 May 31° 40° 71°.0 46°. 4 58° .4 + 5°.3 49°.3 51°.7 + .032 1 0 .05 — 1.83 June 85° 38° 72°.0 49°.2 60°.6 + l°.2 55°.4 54°.2 — .018 8 1.30 — .73 July 81° 42° 66°.2 50° .9 58°.5 — 4°.1 55°.3 53°.4 — .028 15 2.24 — .17 August 87° 44° 75° .2 54°. 6 64°.9 + 3°.3 57° .6 58°.7 + .022 10 2 .91 + .53 September 85° 31° 68° .1 46°.1 59° .6 + 2°.4 57°.0 52° .5 — .068 10 1.21 — .99 October 64° 30° 53°.9 37°.7 45°.7 — 4°.5 50°.7 43°.0 —. 093 9 0.87 — 1.86 November 57° 25° 43°.0 36°.1 39°.5 — 3°.7 45° .1 36° .3 —. 086 19 0 .99 — 1.80 December 54° 24° 46° .7 38°.6 42°.6 + 2°.9 43° .8 41°.1 — .022 26 4 .22 + 2.28 Means and Totals for the Year. 87° 11° on Feb. 9th 56° .9 41°.5 49°.3 — 0°.2 48°.6 44°.7 —0 .038 175 26 .16 + 1.88 The Rainfall for the Year was 0.28 inch below the average of 54 years at Croydon, and the number of days on which it rained was 175 or 12 days above the average. GEO. CORDEN, F.R. Met. Soc., Croydon. 53 TABLE VIIA. Prevailing direction of the Wind at Croydon in 1919. Number of Days each Month. 1919. N.E. E. S.E. S. S.W. W. N.W. N. January 4 2 6 9 7 1 1 1 February 7 8 4 3 2 1 3 0 March 7 0 3 4 4 6 4 3 April 6 0 1 2 8 6 3 4 May 7 8 2 5 3 4 1 1 June 2 1 0 6 5 10 4 2 July 3 0 0 2 4 6 9 7 Augus 0 0 0 5 10 11 3 2 September 2 2 1 7 2 12 2 2 October 6 1 3 4 2 4 4 7 November 9 2 0 2 4 5 5 3 December 0 0 1 7 18 1 1 3 Totals 53 24 21 56 69 67 40 35 77 77 136 75 The 10 years average 1867 to 1876, as embodied in Paper on 10 years Meteorology at Croydon, read to the Croydon Microscopical and Natural History Club, was:— N.E. and E. Winds, yearly average 93.7 S.E.and S. ,, ,, ,, 63.7 S.W. and W. „ ,, „ 131.9 N.W. and W. ,, ,, 73.8 GEO. CORDEN, F.R. Met, Soc., Croydon. 54 SECTION III. MATERNITY AND CHILD WELFARE. Infantile Mortality is measured by the proportion of deaths under one year to 1,000 births, and amounted to 73, as compared with 76 in 1918, 87 in 1917, 77 in 1916, 83 in 1915, 79 in 1914, 94 in 1913, 77 in 1912, 105 in 1911, 87 in 1910, 79 in 1909, and 99 in 1908. During the year 1919 the rate for England and Wales was 89, while in the 96 large towns it was 93, and in the 148 smaller towns 90. and in London 85. The figures for the various Wards were :— Death-rate Births. Deaths under 1 year. Death-rate per 1000 Births (all causes) per 1000 births from 'diarrhœal' . diseases. Upper Norwood Subdivision 110 8 72 9 North Ward 570 35 62 2 Thornton Heath Subdivision 269 17 63 11 East Ward 281 30 107 14 Borough 3008 219 73 6 Central Ward 239 20 83 9 South Ward 250 24 96 12 West Ward 850 60 71 4 South Norwood Ward 439 25 56 2 The following table shows the fluctuations since 1892 in the infantile mortality from " all causes," from " diarrhœal diseases," and from " causes other than diarrhœal." Years. Total Infantile Mortality from all causes. Infantile Mortality from" diarrhœal" diseases. Infantile Mortality from other than "diarrhceal" disease. 1893—1897 142 25 117 1898—1902 143 38 105 1903 104 9 95 1904 128 29 99 1905 96 14 82 1906 125 42 83 1907 94 10 84 1908 99 12 87 1909 79 7 72 1910 87 10 77 1911 105 33 72 1912 77 11 66 1913 94 16 78 1914 79 12 67 1915 83 8 75 1916 77 7 70 1917 87 12 75 1918 76 7 69 1919 73 6 67 55 Chart shewing Infant Mortality Rate for Croydon compared with the rate for England and Wales. Dotted lines indicate England and Wales. Black „ „ CROYDON. Infantile Mortality is measured by the proportion of deaths under one year to one thousand births. 56 DIARRHOEA AND EPIDEMIC ENTERITIS. Deaths classified in the tables supplied by the RegistrarGeneral as diarrhoea, epidemic enteritis, enteritis and gastroenteritis, have been included as " diarrhœal " deaths: as this classification corresponds with that adopted in former years, comparisons made on the resultant figures are valid. During 1919 diarrhoea and epidemic enteritis accounted for 10 deaths of infants under one year of age, 11 others being due to enteritis or gastro-enteritis, making a total of 21 deaths from " diarrhœal " diseases. A further 3 deaths at ages from one year and upwards were due to these diseases. INFANT CENTRES. The Borough Centre is held in the same place—228, London Road—as the School Treatment Centre and the Spinal Remedial Class and Sick Nursery. The Infant Centre work consists of two medical consultations weekly on Tuesday and Friday afternoons. At the medical consultations there have been during the year 1919 approximately thirty-seven children attending each afternoon. The progress made by the children is extremely gratifying in practically all instances. Acute illnesses are not dealt with, being referred to hospital or private medical men. Expectant mothers are also seen and advised as to their welfare. Infant foods and, to a small extent, special foods for mothers are obtainable at the Centre. These are supplied free of cost only to the very poorest people. A charge is made to others, not exceeding the cost price of the article. Simple medicines are also prescribed and dispensed. The total number of infants seen at this Centre in the year 1919 has been:— New Cases 434 Total Attendances 3915 The Centre was opened in the latter part of 1914. One of the Lady Health Visitors acts as the Nurse to the Centre. The Croydon Mothers and Infants Welfare Association runs nine other centres in the town. The Association provides the premises and the voluntary workers who assist very greatly at the meeting of the centres. The town provides the nursing and medical staff for these centres. The work done by the association has maintained a high level of efficiency. The co-operation between the Association and the Public Health Department is of the closest and pleasantest nature. 57 The following table gives the numbers seen at the ten centres in the town during 1919. TOTAL.. Municipal Centre (228, London Road). Central Croydon (Sylverdale Road). South Croydon (Bartlett Street). East Croydon (Lr. Addisc'be Kd.) Woodside (St. Luke's Hall, Spring Lane). South Norwood (Selhurst Road). Upper Norwood (Westow Street). Thornton Heath (Mersham Road). Thornton Heath (St. Alban's Hall. Whitehorse Lane). West Croydon (Johnson Road). INFANT CENTRES. Under 12 Months : (a) 1. New Cases 1179 273 94 112 79 83 37 77 69 135 120 2. Old Cases 12609 1988 1151 960 1091 1342 1769 1008 608 1418 1274 (b) Attendances 13788 2261 1245 1072 1170 1425 1906 1085 677 553 394 Over 12 Months : (a) 1. New Cases 724 161 47 45 31 54 96 80 67 94 49 2. Old Cases 13346 1493 969 1234 725 1595 2419 1717 1238 1115 841 (6) Attendances 14070 1654 1016 1279 756 1649 2515 1797 I3°5 1209 890 Seen by Doctor 9927 1931 985 706 481 769 1123 1007 869 1064 992 Expectant Mothers: (a) Attendances 1705 182 215 285 93 129 206 127 148 74 146 (b) Home Visits 687 75 46 59 21 128 115 53 61. 64 65 Visiting of Children from birth to 5 years of age : I. First Visits 3130 516 323 369 91 364 374 146 315 313 319 2. Subsequent Visits 4592 796 551 600 239 559 489 320 366 284 398 At all the Centres in the town the children are regularly seen by a doctor. At least once a week all those that really require medical advice are seen, and all the infants under twelve months are seen not less often than once a month. It has at times been difficult to maintain this full service owing to the restrictions of the staff and the continued growth of the work, but on the whole the results of the work are as above stated. At a considerable number of the Centres there are conducted auxiliary forms of activity, such as the demonstration of good modern hygienic infant clothing, penny banks, talks to mothers, etc. 58 At all the Centres records are kept of both infants and toddlers. Provision of Fresh Milk at the Centres. Throughout 1919 the same scheme for the supply of fresh milk to mothers and infants was in force as existed in the preceding twelve months. A sum of ,£500 was provided in the estimates for this expenditure. The mothers pay 3d. per quart, and the balance is met bv the Corporation. In necessitous cases the milk is given free, but these are few in number. The working details of the scheme are briefly these:—Each morning, at the Central Office, are received the lists of milk recommendations made at the previous day's centres; the orders are sent out to the most convenient suitable dairies; the dairyman on delivery of the milk obtains a receipt from the mother of the quantity delivered and the accounts are not passed for payment until these delivery receipts are produced by the dairies. After the recommendations are made at the centre the Maternitv and Child Welfare health visitors visit the homes and obtain very full information as to the home circumstances—these are carefully scrutinised by the medical staff, and the cases confirmed or otherwise as the home circumstances demand. Maternity Hostel. The Hostel has had a most successful year's work, and its popularity and the need for such an institution is demonstrated bv the fact that almost as many cases had to be refused each month as would have filled another institution of like size. Only 8 still births out of 269 children born, and the life of not a single mother lost is a record of which the staff of the hostel may well be proud. The cases received into the Hostel are all admitted via the centres, excepting cases of urgency and cases sent direct by doctors. (See also page 10). ST. MARY'S MATERNITY HOSTEL. Admissions, Discharges, Etc., for Period April 1st, 1919, to M arch 31st, 1920. Women admitted. Confinements. Births. Women Discharged. Total. Normal. Complicated. Total. Alive. Stillborn. Nonviable. 272 265 188 77 269 261 8 1 (not a birth). 262 EXPLANATORY NOTES. 9 women admitted before April 1st, 1919, and discharged in April, 1919. 1 ,, ,, March, 1919, and confined April, 1919. 1 ,, ,, after abortion and discharged 1 ,, ,, with symptoms of commencing abortion—child non-viable. 1 ,, ,, in puerperium and discharged—birth not included in statistics. 1 ,, ,, for observation and discharged without being confined. 2 ,, ,, for hyperemesis gravidarum and discharged without confinement. 1 ,, ,, for ante-partum hæmorrhage and discharged without confinement. Twins on five occasions. 59 Antenatal Clinic. This clinic has continued to meet once weekly. The total number of expectant mothers attending was 247. The average weekly attendance was 12. The mothers are principally sent to the clinic through the maternity and infant centres and the maternity hostel. The larger proportion of the cases are subsequently confined in the maternity hostel. Cases of venereal disease are sent for treatment to one of the clinics for these conditions. A considerable amount of antenatal advice is given in the routine work of the maternity and infant centres. Sick Nursery. The sick nursery has been continued as in former years. The disadvantageous conditions set out last year as attaching to these premises still hold so that this very valuable piece of work—one of the most important adjuncts of the infant work of the town—continues to be seriously hampered. We urgently require greatly extended and improved accommodation for this type of ailing child. Below are given the statistics for the nursery for 1919. Sick Nursery, 228, London Road. Number of Cases at Nursery at end of 1918 6 Number admitted during 1919 33 Number discharged during 1919 33 Number died during 1919 2 Number remaining at end of 1919 4 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. 60 TABLE A. Infants dying from Diarrhœal Diseases. 0-6 months. Infants dying from other than Diarrhœal Diseases. 0-6 months. Infants surviving 6 months. Total investigated. Breast Fed only 5 46 579 630 Breast and subsequently Cow's milk 3 33 36 Ditto Condensed Milk 2 ... 29 31 Ditto Other foods 4 3 35 42 Breast & simultaneously Cow's Milk ... ... 2 19 21 Ditto Condensed Milk ... 3 16 19 Ditto Other foods ... 5 27 32 Entirely Hand Fed— Cow's Milk 3 4 15 22 Ditto Condensed Milk 2 3 17 22 Ditto Other foods 9 4 39 52 Number investigated 25 73 809 907 TABLE B.—The same information expressed in percentages. Of all infants investigated under 6 months. Of infants dying from Diarrhœal Diseases. 0-6 months. Of infants dying from other than Diarrhœal Diseases. Breast Fed only per cent. 69.4 per cent. 20.0 per cent. 630 Breast and subsequently Cow's Milk 4.0 ... 4.1 Ditto Condensed Milk 3.4 8.0 ... Ditto Other foods 4.6 16.0 4.1 Breast and simultaneously Cow's Milk 2.3 ... 2.7 Ditto Condensed Milk 2.0 ... 4.1 Ditto Other foods 3.5 ... 6.9 Entirely Hand Fed—Cow's Milk 2.4 12.0 5.5 Ditto Condensed Milk 2.4 8.0 41 Ditto Other foods 60 36.0 5.5 100 100 100 61 Table B shows that 20 per cent. of infant deaths from diarrhœal diseases occurred amongst breast-fed children, and the remaining 80 per cent. amongst children who were either entirely hand fed or had artificial kinds of food as well as breast fed. DEVELOPMENT OF INFANT AND MATERNITY WORK ALONG WITH SCHOOL MEDICAL WORK AND NURSERY SCHOOLS. Below are given two reports submitted to the Council by the Medical Officer of Health on this subject. Public Health Department, Town Hall, Croydon. 5th June, 1919. To the Public Health Committee. Ladies and Gentlemen, I beg to submit the following report upon maternity and child welfare work within the County Borough of Croydon and a scheme for the general development of this work:— About sixteen years ago Croydon appointed its first lady Health Visitors, whose duties included the visitation of infants. This was the first direct effort made here to control infant welfare. In 1914, following upon a report from the Medical Officer of Health on infant mortality in Croydon, with special reference to the West Ward, the first Infant Welfare Centre was opened at 228, London Road. In the following and subsequent years the Croydon Mothers and Infants Welfare Association opened nine other such centres, with medical and nursing staff, in the Borough ; and also established a Maternity Hostel at Croydon Grove, which is now transferred to St. Mary's, St. James' Road, which was purchased and specially adapted for use as a Hospital by the Mayor in July, 1918. In 1916 the Corporation instituted an Infant Sick Nursery (providing six cots) at 228, London Road. In 1917 a milk coupon scheme was begun for the nourishment of necessitous mothers and children, and in 1918 the Corporation took over the entire medical and nursing services of the Maternity and Infant Centres throughout the town, established an Ante-natal Clinic, and guaranteed the fees of medical practitioners called in by midwives to complicated necessitous cases of confinement. The Corporation also materially contributes to the upkeep of the Maternity Hostel. 62 The position in Maternity and Infant Welfare work in Croydon now is:— (a) Carried Out by the County Borough Council. (1) The complete maintenance of one Maternity and Infant Centre. (2) The supply of dried milk for mothers and infants at the London Road Centre. (3) The supply of doctors and nurses for all the Maternity and Infant Centres in the town and for home visiting of such cases. (4) The maintenance of an Ante-natal Clinic. (5) The supply of fresh milk for necessitous mothers and infants. (6) The payment of doctors' fees when called in to cated confinements by midwives. (7) The maintenance of an Infant Sick Nursery. (8) An annual subsidy of £l,500 towards the cost of the Maternity Hospital. (b) Carried out by the Croydon Mothers and Infants Welfare Association. (1) The maintenance—excepting the services of doctors and nurses—of nine Maternity and Infant Centres. This includes the provision of dried milk for mothers and infants at these Centres, and the work of voluntary helpers at the Centres. (2) The provision of a Maternity Hostel for the Borough. (c) Work in Hand or Under Consideration. (1) By the Council— The removal of the Infant Sick Nursery into larger premises where both children and mothers can be admitted. (2) By the Association— The provision of mothers' helps. The 1918 August circular of the Local Government Board indicates the various directions in which local authorities are expected to develop the Maternity and Infant work in their districts. These are given on the left-hand sides of the next two pages; on the right is given the position of affairs in Croydon in each case. 63 L.G.B. Recommendations. 1. A subsidised midwifery service where this is necessary in a district. 2. Payment of doctor's fees for necessitous midwifery. 3. The appointment of Health Visitors for Maternity and Infant work to the extent of one Health Visitor for every 400 births perannum. 4. The appointment of Health Visitors as Infant Protection Visitors under the Children Act, 1908, where this is possible. 5. Provision of Home Nursing for : (а) Expectant mothers. (b) Maternity nursing. (c) Cases of Puerperal fever. (d) Cases of measles, ing cough, epidemic diarrhœa, and ophthalmia neonatorum. 6. The provision of clinics for the dental treatment of expectant mothers, and children under 5, and for the treatment of cases of ophthalmia neonatorum. 7. The provision of cots if considered advisable at Centres. 8. The provision of educational instruction in hygiene to mothers and to workers in Maternity and Infant work. 9. Provision of accommodation for both normal and abnormal confinements. 10. Provision of home helps or other arrangements for assistance in cases of domestic difficulty during Iving-in period. Present Position in Croydon. 1. This is not, so far as I know required in Croydon. 2. This is already arranged for. 3. Croydon has four full-time visitors. The number of births in peace time ran about 4,000 per annum. More will be required, but the Board's ratio is higher than is in my opinion needed in Croydon, owing to the class of our population. 4. This is not at present possible, as new Infant Protection Visitors were appointed by the Guardians just before the Local Government Board's circular came out. I have arranged with the Poor Law Authorities for the attendance of foster children at the centres. 5. We do not provide nursing for expectant mothers or for maternity nursing at home. Cases of puerperal fever, epidemic diarrhoea and opthalmia neonatorum are admitted to the Borough Hospital. Nursing of measles and whooping cough the Council endeavoured to provide for, but owing to the war conditions, I could not obtain any contracts with nursing institutions in the town. 6. Nothing done in Crovdon for this dental treatment. Ophthalmia admitted to the Borough Hospital. 7. Not necessary with the development of the Sick Nursery anticipated. 8. Talks to mothers already given by Health Visitors at some Centres—this will be extended when the Centres are improved. 9. Provided for by the Association's Maternity Hostel. 10. Being arranged by the Association 64 L.G.B. Recommendations. 11. Provision of Hospital for infants up to 5 years of age. 12. Provision of food and milk for mothers and children. 13. Provision of Creches and Day Nurseries, or foster mothers, under supervision of the Medical Officer of Health. 14. Provision of Convalescent Homes for children and mothers. 15. Provision of homes for children of widows and for illegitimate children. 16. The provision of experimental work on such lines as may be approved by any local authority. 17. Steps to be taken to impress upon druggists, midwives and health visitors, the dangers of the use of diachylon or other lead compound as an Abortifiacient. For all this work the Government is prepared to pay a grant of 50 per cent. on the costs incurred, subject to the approval of the Board being obtained before any expenditure is incurred on new work or extensions of existing work. Present Position in Croydon. 11. Non-existent, excepting in the children's ward at Croydon General Hospital, which does not meet the needs of the town. 12. Arranged, so far as milk is concerned, by the Borough and the Association. No other food provided. 13. Two creches, privately run, exist in Croydon. The premises are unsuitable for the proper health conditions of infants and young children. 14. None at present in Croydon. 15 „ „ „ 16. „ „ „ 17. Arranged by Medical Officer of Health. GENERAL OUTLINE OF SCHEME OF DEVELOPMENT. It is important that any scheme of development of this work should take cognisance of the needs of the different parts of the town with respect to public medical service for all children, whether under, or of, school age, and that the service required under this maternity scheme for treatment of mothers should also be taken into account. This would involve a joint consideration of such a scheme by the Public Health Committee and the Education Committee, as the latter is involved in so far as the extension of school treatment centres and the provision of Nursery Schools is concerned. Broadly speaking the complete scheme should provide for centres so situated in the different parts of the town that each will 65 serve adequately the needs of the district in which it is placed, not only with regard to the supervision of infancy and child life up to five years of age, but also the necessary medical treatment of school children and the dental treatment of mothers with any other development in this direction which Government regulations may impose upon us in the future. Further the scheme should make adequate provision for a Sick Nursery for Infants and Young Children and a Convalescent Home for Mothers. This is one single Institution, quite distinct and separate from any Centre. These recommendations are amplified in the succeeding paragraphs. Children's Sick Nursery and Mothers' Convalescent Home. The Board in their circular have laid special stress upon the need of this provision in several paragraphs, and I know personally from members of the medical staff of the Local Government Board that this is looked upon as a very important and necessary section of the Maternity and Child Welfare scheme in the Borough. The Sick Nurserv now at London Road was originally designed to provide 6 cots, but, owing to the very limited space, it has been found that 5 cots is the maximum which can be accommodated ; even that is one more than there should be according to the Local Government Board's recommendation. The cots have been kept constantly full, and the medical officers of the centres have frequently expressed to me the need of greater accommodation for the treatment of the ordinary dietetic and other ailments of infancy and young childhood. The cases admitted are not cases of acute illness such as would properly go to a fully equipped hospital. They are mostly cases of dietetic or co-related ailments for which careful supervision, nursing and feeding and hygienic surroundings are essential. These conditions are not otherwise obtainable in a very considerable number of cases, as the mothers, however well meaning, are untrained, and the home conditions do not provide the necessary satisfactory surroundings for the recovery of health. The children themselves are not intrinsically unfit, they are principally children whose health is wrong from improper rearing. It is, in mv opinion, quite certain that there is an immediate need for an institution of the kind recommended, and it is clearly evident that only an institution situated in exceptionally healthy surroundings can properly fulfil the function of such a home as this is meant to be. There are some points which ought to receive special attention in selecting a site for such an institution. The site should be high, airy and sunny, so arranged that the inmates may be treated 66 out of doors as much as possible. The work of the Centres is bound to be incomplete and the results as expressed in terms of the physical welfare of the younger generation, unsatisfactory, unless provision of this kind is made where the recommendations of the medical staff of the Centres can be carried out properly. That such an institution is a necessary part of the work is more than borne out in my opinion by the following returns, viz.:— (1) An analysis of nearly 30,000 birth and death returns, covering the years 1908 to 1917, shows:— (a) That under one year the infant mortality averages 88 deaths per 1,000 births, and (b) That between the years of one and two there are 19 deaths per 1,000 births. In comparison it should be noted that the general death rate in Croydon runs from 10 to 12 per 1,000 population. (2) An analysis of the condition of 490 children seen at one of the Centres shows that 195 or 39 per cent. of these were defective in one or more respects. Approximately 1,400 children were examined at the Centres in the Borough during the last financial year, which gives an estimated total of 546 of these children defective in one or more respects. (3) The medical inspection of school children newly admitted to school shows the existence of defects as follows : — Period. Age. Number of children examined. Total number in whom defects found. Percentage 1909 to 5—6 17256 14612 84 1918 6—7 6682 5788 87 These figures include defects of clothing, dirtiness, and verminous conditions, but excluding these the following percentage of actual physical defects in the child is obtained, viz.:— Age 5—6 years 56 per cent. Age 6—7 years 58 per cent. These physical defects have arisen in the children during their infantile and pre-school years. (4) In my report for 1914 on Infant Mortality it was shown that infantile deaths were due to dietetic and co-related conditions to the extent of 42.4 per cent. These are especially conditions which can effectively be dealt with in such an institution as that under consideration. 67 The number of children found to be defective in the Centres shows how this work is beginning to demonstrate the need for a reduction of the sickness incidence of children, apart from the consideration of infant mortality. The very high percentage of defects in children at the beginning of school life again demonstrates the essential need of a proper medical supervision and control of the pre-school years of child life. No statistics are available as to the number of mothers requiring treatment at such an institution as that suggested, but the evidence given me by the medical officers attending the Centres and the Health Visiting staff generally is overwhelmingly demonstrative of such a need. Many cases have been brought to my notice of families where the mother is unable, through general ill-health, to give proper attention to her children. Re-Organisation of Centres. In considering the re-organisation of the various Centres in the town, the following matters have specially to be borne in mind, although not every Centre will require to be fully provided with every section of the accommodation mentioned: — (1) The rapidly increasing attendance of mothers and infants at the Centres in the purely maternal and child welfare section of the work. (2) The need for Subsidiary School Treatment Centres, inclusive of one or two Subsidiary Dental Centres. (3) The need of provision for the dental treatment of mothers. (4) The need for Creches. (5) The provision of Nursery Schools. Infant Centres. The attendances at the Infants' Centres are continuously increasing. The attendances rose from 13,724 in 1917 to 22,500 in 1918. One part of the work which has hitherto not been properly carried out is the instruction of mothers in classes as to the proper rearing and clothing of infants, the making of children's garments, etc. These are essentially parts of a Maternity and Infant Centre's work and the present premises do not, in the majority of instances, allow of this being effectively done. School Treatment Centres. The need of Subsidiary School Treatment Centres is, in my opinion, demonstrated by the following figures which have been 68 obtained by the analysis of the attendances made during the six months ended 30th April last at the existing School Treatment Centre, 228, London Road. The attendances are divided according to the Wards from which the patients come:— Ward. School population of the Ward. Attendances at treatment Centre. Percentage. West 4569 630 13 North 3999 469 11 Central 2596 283 10 East 908 78 8 South Norwood 5341 257 4 South 2555 99 3 Upper Norwood:— (a) Thornton Heath part 3886 140 3 (b) Remainder 1022 30 3 From this return it will be seen that the only wards which appear to be satisfactorily served by the existing Centre are the West, North, Central, and possibly the East. The Upper and South Norwood and South Wards have their needs far from adequately met. I am of opinion that so far as school treatment service is concerned Subsidiary Centres are required in Upper Norwood and in South Norwood, and also in the southern part of the Borough. These wherever they are provided should be combined with Infant and Maternity Centres. At one of the Norwood Centres also there should be a Subsidiary Dental Treatment Centre. The need for this is borne out by the great difficulty experienced in getting people from the Norwood regions to attend at the Dental Clinic in the Town Hall for the treatment of the teeth of school children. This difficulty will be still greater when the teeth of the children under school age are to be dealt with. Creches. Creches exist in Croydon in Wilford Road and at Pitlake Bridge. Both of these have been carried on by voluntary subscriptions and during the war have been approved by the Government Department concerned. This past year, however, the Government inspectors have made adverse reports upon them, not so much with reference to the conduct of the Creches as to the accommodation. I am of opinion that the Creches are unsuitably housed. The need for such provision in the two areas mentioned has been demonstrated by the use made of the existing institutions and I feel that 69 this responsibility should be undertaken by the local authority. In both cases the subscriptions have seriously diminished and the Creches are therefore much handicapped in their work. A Creche formerly existed in Brighton Road, South Croydon, but had to be given up last year for want of funds. Nursery Schools. The provision of Nursery Schools, which forms part of the new powers under the Education Act, 1918, might well be undertaken in the first instance in the Princess Road and Mitcham Road areas. These are the areas served by the Creches mentioned in the previous paragraph. The provision of a Nursery School and a Creche as quite separate institutions would, in my opinion, be a mistake as the work is so intimately co-related. One site should be obtained for both institutions in each district. On this site accommodation should also be found for the Maternity and Child Welfare Centre for the District. Home for Unmarried Mothers and Their Children. The following report was separately submitted to the Committee upon this subject, consequent upon receipt of a letter from a voluntary body who desired to undertake such work, viz.:— " Re HOSTEL FOR UNMARRIED MOTHERS AND THEIR INFANTS. " I submit with this report figures showing the birth and death rates and infant mortality of legitimate and illegitimate children for the years 1900 to 1917 inclusive. The last horizontal line of the Table gives averages for that period of years, and it will be seen that the illegitimate births form quite a large number each year, and that amongst those the mortality is 2.5 times as high as in the case of legitimate children. This condition of affairs exists throughout the whole of the country. It is well known that the death rate amongst illegitimate children is very much higher than that amongst those born in wedlock. " I summarise shortly the points bearing upon the establishment of the proposed institution:— (1) Provision of such a home is part of the Maternity and Child Welfare Scheme as approved by the Local Government Board. (2) The mortality amongst illegitimate children is 2.5 times that amongst legitimate. (3) Unmarried mothers, in practically every case, have to work for the maintenance of themselves and their child. The child, therefore, has to be put out to nurse, either with a foster mother or some friend. It is exceedingly difficult to find foster mothers, more especially now, and in my own experience the foster mother system is not conducive to good results. 4) Unless something is done to help unmarried women who have borne a child and such help be given in the early period of the child's infancy, not only does the child suffer, but in a large proportion of cases the mother takes up an immoral life. She inevitably becomes infected with venereal disease and is thenceforward an active focus for the spread of these conditions. Such diseases are verv largelv responsible for mental deficiency, insanity, and many other illnesses which fill our big institutions. Money expended upon the retention of unmarried mothers in a domestic form of life with their own children should repay itself therefore many times. 70 " I strong urge upon the Committee the important of dealing with this section of Maternity and Child Welfare. It is part of the work which will repay itself very soon, even judged only from the material standpoint of money. It is also a section of the work in which the human element is above all necessary, and I do not think that the town can reasonably expect to be successful without some help from interested ladies in the matter. It is, however, for the Committee to decide, as a matter of policy, whether the town itself should actually start the institution and bear all the expense, making it, therefore, an officially conducted place with the help of voluntary ladies, or alternatively, whether the institution should be run by a voluntary body such as is now making application, with help from the Council." Births, Birth Rates, Infantile Deaths and Death Rates for Past 18 Years for the County Borough of Croydon. Year. Births. Birth Kate. centage of Illeg. Births. Deaths under 1 year. Infantile Mortality Rate per 1000 Births. Leg. Ill. Total. Leg. Ill Total. Leg. Ill. Total. 1900 3132 138 3270 24.9 per cent. 4.2 432 132 1901 3413 165 3578 26.5 4.6 501 140 1902 3394 182 3576 25.9 5.1 476 133 1903 3587 139 3726 26*4 3.7 386 104 1904 35S3 186 3769 26'1 4.9 483 128 190S 3714 180 3894 26*4 4.6 372 96 1906 3690 196 3886 257 5.0 409 76 485 110 388 125 1907 3770 197 3967 25.7 5.0 337 34 371 86 172 94 1908 3835 182 4017 25.5 4.6 351 47 398 91 258 99 1909 3740 198 3938 24.4 4.5 278 35 313 74 177 79 1910 3630 180 3810 22.8 4.7 307 24 331 84 133 87 1911 3578 182 3760 220 4.8 351 44 395 98 241 105 1912 3655 206 3861 22.1 5.3 262 36 298 71 174 77 1913 3686 204 3890 21.8 5.1 339 29 368 92 142 94 1914 3819 208 4027 22.0 4.5 287 32 319 75 154 79 1915 3496 203 3699 20.8 5.4 271 36 307 77 177 83 1916 3427 162 3589 20.6 4.5 242 39 281 70 240 77 1917 2654 182 2836 15.3 6.4 200 49 249 75 269 87 Totals— 63,803 3290 67093 ... ... 3634 481 6765 ... ... ... Average— 3545 182 3727 23.6 4.8 *3.3 *40 376 *83 *212 101 * For twelve years only. 71 Recommendations to the Committee. 1.—I feel it imperatively necessary that as soon as possible steps should be taken to establish an adequate Sick Nursery for Children and Convalescent Home for Mothers. 2.—Re-organisation of the Centres is needed, but. can only be proceeded with gradually. I feel that there should be established as soon as possible, in Upper Norwood and South Norwood, Centres at which both the maternity and infant work and the treatment of school children can be carried on. At one of these Centres also a Dental Clinic should be equipped to serve these two areas. 3.—Creches and Nursery Schools should be established in the Princess Road and Mitcbam Road areas. 4.—Unmarried mothers and children. The recommendation in this matter is referred to in the special report above quoted. It is impossible to outline definitely all the changes which may be necessary in the re-organisation of the Centres. It is quite likely it may be advantageous later on to amalgamate the two Centres held at St. Albans' Hall, at the junction of Whitehorse Road and Grange Road, and Grange Hall, Mersham Road, but these and similar matters, in my opinion, might well be considered and reported upon separately, as the growth of the scheme indicates the best way of meeting the needs of the districts. I am, Ladies and Gentlemen, Yours faithfully, R. VEITCH CLARK, Medical Officer of Health. Public Health Department, Town Hall, Croydon. 17th September, 1919. To the Maternity and Child Welfare Sub-Committee. Ladies and Gentlemen, In amplification of my previous report to the Public Health Committee, dated 5th June, 1919, on maternity and child welfare I beg to submit for your consideration the following proposals as to the re-organisation of the Centres in the Town. 72 At present the Centres are ten in number: two of these have medical consultations twice weekly. The complete scheme for the working of a Centre requires that for every professional meeting there should be another meeting at which the mothers attending may be instructed in the general rearing of children and in the co-related work usually designated as " Mothercraft," e.g., sewing, knitting, etc. This latter portion of the work has not been at all fully developed in Croydon heretofore, and it is partly with the view of attaining this development that I advise the Committee to provide premises for the different Centres, which shall be used only for town medical purposes. At present, all the Centres, with the exception of that at 228, London Road, meet in Public Halls or similar buildings, which are rented for the afternoon or afternoons of the meetings. There are many other occasions upon which it is necessary or desirable to obtain admission to the records find materials kept in these premises, and, as things are now, it is a matter of extreme difficulty to obtain such admission. It is a matter of extreme difficulty in practically all of the Centres to get as extensive use of the premises in which the Centres meet as is necessary for the proper conduct of the work. In several of the Centres also the premises are extremely unsuited for the work now that the attendances and concomitant activities have grown to such an extent. The attendances at the Centres are now all running from forty to seventy in the Session—in a word, the work has become so large and requires such constant supervision that the time has certainly come, in my opinion, for establishing these Centres in premises which are under our own control. To economise as far as possible I advise that the ten Centres should meet in seven sets of premises. For this purpose, the following Centres should be grouped in pairs so that each pair may meet in the same building, viz.:— (1) South Norwood Centre and Woodside Centre. (2) St. Alban's Centre and Grange Hall Centre. (3) Old Town Centre and South Croydon Centre. The present sites of the Centres are shown in red on the map accompanying this report, and the proposed sites are shown in green. The Committee will also recollect that reference was made to the Creches now existing in Croydon. These are two in number —one at Wilford Road and the other at Pitlake. A third did exist in South Croydon, but has been given up for want of funds. The premises in which the Creches are carried out are unsuitable, and exception has been taken to them by the Government medical inspectors. These Creches provide for a definite need in the districts in which they exist, and I think the Committee ought to 82 73 include them in their consideration of the Centres as these are finally established. Also, the Clinics now carried on in the Town Hall, viz., Dental and Eye Clinics, take up a complete week of time, and should be transferred from the Town Hall to the main Centre in the middle of the town. In addition to centralising the Clinical medical work of the Department this will give the additional advantage of freeing accommodation in the Town Hall. The following list shows what, in my opinion, the various Centres should finally be and the activities carried on at each such Centre:— Centre. Approximate Desirable Site. Activities. 1. Municipal Centre (Main centre) Near to, but not on main Road, and not far from West Croydon Station. (?) Parsons Mead or Derby Road Maternity and Infant Centre. Massage Clinic (Infants, Children under school age, and School Children). Dental Clinic (all Children and Mothers). Eye Clinic (School Children). Minor Ailments Clinic (School Children). Spinal Remedial Class (School Children). *Creche. 2. Combined Old Town and South Croydon Centres Southern end of Southbridge Road Maternity and Infant Centre. (?) Creche. 3. Johnson Road Centre Same block of buildings as Princess Road Nursery School Maternity and Infant Centre. Creche (replacing Wilford Road Creche. 4. Combined St. Alban's and Grange Hall Centres North of Thornton Heath Clock Maternity and Infant Centre. (?) Minor Ailments (School Children). 5. Upper Norwood Oaknoll, or its neighbourhood Maternity and Infant Centre. Minor Ailments (School Children). 6. South Norwood Centre and Woodside Centre Portland Road, midway between Woodside and Norwood Junction Stations, or in the same' block of buildings as the suggested Nursery School at the Schools in Portland Road Maternity and Infant Centre. Minor Ailments Clinic (School Children). Dental Clinic (Mothers, Children and Infants). Massage Clinic (Infants and Children). Spinal Remedial Class. 7. East Croydon Centre In the neighbourhood of the present site Maternity and Infant Centre. *As an alternative the Committee might consider the establishment of a Creche in conjunction with the suggested Nursery School at Mitcham Road Council School. In either case the Creche would replace the existing one at Pitlake. 74 The organisation suggested in the preceding Table would mean the acquisition of six or seven sets of premises, either by the conversion of existing buildings or by new buildings. It is clear that at the present juncture it would be difficult to obtain a building in every case suitable for the purpose, but it is better that the scheme should be placed before the Committee in its entirety. In my opinion, the Committee should direct its attention more particularly at the present time to the Centres at:— (a) Upper Norwood, where premises can now be obtained. (b) Johnson Road; Land is available behind the Princess Road School and buildings of a semi-temporary nature might be put up. (c) The main Centre in West Croydon—the existing Centre, 288, London Road, is very crowded, and the removal of the Dental and Eye Clinics would remove pressure from the Town Hall accommodation to some extent. Sick Nursery.—The complaints from neighbours as to nuisance from Sick Nursery have been revived recently, and again threats of legal proceedings have been made. It is quite impossible to restore ailing children to health without a garden space into which they can be taken in good weather. This cannot be done at present owing to the complaints and threats made, and I do not feel it possible to continue much longer this work in the present manner. I feel strongly that in the end the best action of the Corporation will be to provide a Convalescent Home for Mothers and Ailing Infants on the Russell Hill Site. A considerable period of time is bound to elapse before this can be in working order, and an intermediate stage during which Sick Nursery should be accommodated in an adapted house should be realised at the earliest possible moment. Yours faithfully, R. VEITCH CLARK. N.R.—The map showing the existing and proposed sites of Centres referred to herein will be exhibited at the meeting. 75 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 2,739 notifications were received. These births were notified as follows:— Notified by medical men 735 Notified by parents 674 Notified by certified midwives 1,258 2,667 Stillborn births notified 72 Grand Total 2,739 MIDWIVES. During the year 201 visits were paid to midwives by the Inspector of Midwives for the purpose of information or inspection. At the end of 1918, 30 midwives were registered as practising in Croydon, and during 1919 four new names were added. Six left the district or ceased practising, leaving 28 on the register at the end of 1919. 76 SECTION IV. TUBERCULOSIS WORK. General Survey of Cases dealt with through the Dispensary and work done in connection with them. Table showing origin of Cases seen at the Dispensary for the first time in 1919. Cause of person attending Dispensary. Insured. Uninsured* Grand Total. Men. Women Child'n Total. Men. Women Child'd Total. (1) Referred by local doctors or hospital for diagnosis, treatment or advice 98 53 ... 151 11 73 77 161 312 (2) Ditto ditto by School Medical Officers & from Infant Clinics ... ... ... ... ... 5 100 105 105 (3) Ditto ditto from other, chiefly charitable, sources 6 10 ... 16 3 11 38 52 68 (4) Seen as " Contacts" 7 3 ... 10 I 11 61 73 83 (5) Army Medical Boards 63 ... ... 63 5 ... ... 5 68 174 66 ... 240 20 100 276 396 636 * This includes dependents of insured persons Table showing the way in which new cases were dealt with in 1919. Insured. Uninsured- Men. Women Child'n Total. Men. Women Child'n Total. Grand Total (1) Diagnosed as tuberculous : (a) Treated through the Dispensary 129 51 ... 180 6 31 59 96 276 (b) Treated elsewhere 4 2 ... 6 4 26 12 42 48 (2) Diagnosis not settledKept under observation 21 5 ... 26 8 41 162 211 237 (3) Diagnosed not tuberculous 20 8 ... 28 2 2 43 47 75 174 66 ... 240 20 100 276 396 636 ■ 77 Table showing details of Medical Examinations made by the Medical Officer to the Tuberculosis Dispensary, 1919. Period. 1919. Total Medical Examinations made. Grand Total. New Cases Examined. At the Dispensary. Patients Houses. Insured. NonInsured. Total. Insured. NonInsured. Total. Insured. NonInsured. Total. Jan. 1st to March 31st 509 1471 1980 21 21 42 2022 51 71 122 April 1st to June 30th 524 1465 1989 12 9 21 2010 65 112 177 July 1st to Sept. 30th 561 1087 1648 ... 14 14 1662 66 101 167 Oct. 1st to Dec. 31st 587 1148 1735 10 15 25 1760 58 112 170 Totals 2181 5171 7352 43 59 102 7454 240 396 636 Notb.—In addition to the medical examinations shown in this table the Medical Officer also visited and examined the tuber culous patients at the Borough Hospital twice weekly throughout the year. [The average number of examinations made per day (including visits) was '26 3, and the average number of new cases seen per day was 2 2. 78 The proportion of known tuberculosis in the Borough which is dealt with through the Dispensary continues to be satisfactorily high, as is shown by the following figures :— (1) Total Primary Notifications, 1919 440 (2) Total new cases seen at Dispensary and diagnosed as tuberculous, 1919 324 324 Therefore approximately 74 per cent. of the cases notified in the Borough in 1919 were seen by the Medical Officer to the Tuberculosis Dispensary. * (This figure includes " other forms of tuberculosis " in addition to pulmonary tuberculosis. In 1919 276 new cases were treated through, as well as being seen, at the Dispensary. SANATORIUM AND HOSPITAL TREATMENT: SUMMARY OF CASES TREATED AT SANATORIA, 1919. M. w. c. T1. (A) Persons in Sanatoria on Jan. 1st, 1919 27 18 9 54 (B) Persons admitted to Sanatoria 1919 l05 78 34 217 132 96 43 271† (C) Persons discharged from Sanatoria 1919 101 76 31 208 (D) Persons who died in Sanatoria 1919 1 2 1 4 102 78 32 212 (E) Persons in Sanatoria on December 31st, 1919 30 18 11 59 The total individuals receiving treatment in Sanatoria during 1919 is therefore:— Men 132 Women 96 Children 43 2711 The total individuals sent to Sanatoria in 1919 is:— Men 105 Women 78 Children 34 217† † 105 men and 46 women were “ insured persons.” Of the “ insured men ” 68 were ex-service men. SUMMARY OF CASES TREATED AT THE BOROUGH HOSPITAL, 1919. M w c. Tl. (A) Persons at the Borough Hospital on Jan. 1st, 1919 6 7 — 13 (B) Persons admitted to Hospital in 1919 33 11 — 44 39 18 57‡ (C) Persons discharged from Borough Hospital 1919 19 5 – 24 (D) Persons who died in the Borough Hospital 1919 14 9 — 23 33 14 – 47 (E) Persons in Borough Hospital on Dec. 31st, 1919 6 4 – 10 Total individuals receiving treatment at the Borough Hospital in 1919 is Men 39 Women 18 57‡ The total individuals admitted to the Borough Hospital in 1919 is Men 33 Women 11 44 ‡ 36 men and 11 women were " insured persons." Of the insured men 16 were ex-service men. 79 SECTION V. VENEREAL DISEASE. A joint scheme in which Croydon takes a part, and which consists of maintenance of clinics at practically all the big London Hospitals, has continued to run successfully. The Medical Officers of the joint authorities have met at frequent intervals during the year in London and discussed points which have arisen in connection with this scheme. The main Table subjoined refers to this scheme. The smaller Table gives details of the work carried out at the Croydon General Hospital Venereal Diseases Clinic during 1919. It was unfortunately not possible to arrange for the treatment of male patients at Croydon General Hospital during 1919. This has, however, been effected in the early part of 1920, as well as the establishment of arrangements for daily lavage. The total number of cases dealt with from Croydon in 1919 was 262, as against 190 in 1918. The number attending the clinics in London increased by 85; those attending the local clinic diminished by 13. A gratifying feature of the returns is the increased number of pathological examinations made for private practitioners—190 in 1919, as against 45 in 1918. 80 VENEREAL DISEASES. Annual Summary Year 1919 London. Middlesex. Essex. Surrey. Kent. Herts. Bucks. East Ham. West Ham. Croydon. All Districts. I. No. of persons dealt with at or in connection with the clinic for the first time and found to be suffering from— Syphilis 7,128 645 352 321 230 94 54 113 384 63 9,384 Soft chancre 331 19 18 12 16 6 5 2 21 2 432 Gonorrhœa 9,635 982 476 345 232 85 50 173 473 81 12,532 Not found to be suffering from Venereal Disease 3,814 407 196 162 119 50 20 46 160 42 5,016 Total 20,908 2,053 1,042 840 597 235 129 334 1,038 188 27,364* Total Attendances 232,659 23,710 9,813 9,127 5,620 1.955 1,330 2,848 9,302 1,702 298,066 4. No. of "in-patient" days of Treatment 54,431 2,242 2,125 3,174 3,042 892 763 271 1,010 473 68,423 6. No. of doses of Salvarsan substitutes given 41,894 3,817 1,835 1,826 1,409 462 414 472 1,405 443 53,977 *In addition, 901 cases were dealt with from " counties outside the scheme," the majority of which were merchant seamen from all parts of the world. The total number of new patients dealt with at the Clinics for the year was therefore 27,364 901 28,265 PATHOLOGICAL EXAMINATIONS. Nature of Test. London. Middlesex. Essex. Surrey. Kent. Herts. Bucks. East Ham. West Ham. Croydon. All Districts. For Practitioners. For detection of spirochetes 25 4 1 4 ... ... 1 ... 1 ... 36 For detection of gonococci 1,026 245 40 67 4 13 1 45 3 23 1,467 For Wassermann re-action 7,124 297 537 216 164 31 12 121 209 167 8,878 Other examinations 83 ... ... ... ... ... ... ... ... ... 83 Total 8,258 546 578 287 168 44 14 166 213 190 10,464 81 VENEREAL DISEASES. RETURN relating to persons residing in the County Borough of Croydon who were treated at the Croydon General Hospital, 1919. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. 1918. Total. M. F. M. F. M F M. F. M. F M. F. Number of persons dealt with at or in connection with the out-patient Clinic for the first time and found to be— Suffering from syphilis – 10 1 10 1 5 1 6 – 34 — 55 „ soft chancre – — – — — – – – – – – – „ gonorrhœa — 1 — 9 — 7 – 1 – 18 — 19 Not suffering from venereal diseases – 5 – 6 1 3 1 6 – 22 – 13 — 16 1 25 2 15 2 13 — 74 — 87 Number of persons discharged from the outpatient Clinic after completion of treatment for— Syphilis — – — 5 – 4 – 3 – 12 – 5 Soft chancre – – – – – – – – – – – – Gonorrhœa — — — – — — – – – – — 2 – – – – – – – – – – – – — — — 5 — 4 – 3 – 12 – 7 82  1st Qtr. 2nd Qtr. 3rd Qtr. 4th Otr. Total. 1918. Total M. F. M. F. M. F. M. F. M. F. M. F. Number of persons who ceased to attend the outoutpatient Clinic without completing treatment and who were suffering from— Syphilis — 1 — 1 – – — 2 — 4 – 8 Soft chancre – – – – – – – – – – – – Gonorrhœa — 1 – – – – – – — 1 — 5 – 2 – 1 – – – 2 – 5 – 13 Total attendances of all persons at the outpatient Clinic who were— Suffering from syphilis — 90 – 99 — 88 – 62 — 339 — 299 „ soft chancre – – – – – – – – – – – – „ gonorrhœa — 10 – 37 – 46 — 18 — 111 – 75 Not found to be suffering from venereal disease — 54 – 15 – 9 — 23 — 101 — 27 – 154 – 151 — 143 — 103 – 551 — 401 Aggregate number of " In-patient days " of treatment given to persons suffering from— Syphilis — 24 — 27 — 12 — 4 — 67 — 303 Gonorrhœa — – — – — – — – — — — 277 – 24 — 27 – 12 – 4 — 67 — 580 83 Number of persons treated with Salvarsan substitutes — 10 ... — 11 ... — — ... — — ... — 21 ... – 13 Number of doses of Salvarsan substitutes given — 29 ... — 34 ... — 15 ... — 13 ... — 91 ... – 56 Examinations of Pathological material— (a) Specimens from persons attending at the Treatment Centre which were examined at this Centre— For detection of spirochetes – – ... – – ... – – ... – – ... – – ... – – „ ,, gonococci – – ... – – ... – – ... – – ... – – ... — – „ Wassermann reaction – – ... – – ... – – ... – – ... – – ... — – Others – – ... – – ... – – ... – – ... – – ... — — (b) Specimens from persons attending at the Treatment centre which were sent for examination to an independent laboratory— For detection of spirochetes – – ... – – ... – – ... – – ... – – ... – – „ ,, gonococci — — ... — 3 ... — 4 ... — 5 ... — 12 ... — 13 ,, Wassermann reaction — 4 ... — 16 ... — 12 ... — 9 ... — 41 ... — 51 Others — 12 ... — — ... — — ... — — ... — 12 ... — — 16 ... — 19 ... — 16 ... — 14 ... — 65 ... — 71 84 SECTION VI. MENTAL DEFICIENCY. CASES DEALT WITH. Date of Order. Defective Sex. Age at time of Order Nature of Order (whether for Institutional treatment or for Guardianship ) and remarks. 16th January 1919 C. S. M. 16 Transferred from Fountain Mental Hospital to Darenth Indus trial Colony. 18th January 1919 C. R. W. M. 16 Institutional (Queen's Road, Croydon). 30th January 1919 E. N. M. 8 Institutional (Earlswood). Order made for contribution of 10s. per week by father towards maintenance. 8th March 1919 R. Y M. 8 Institutional (Earlswood). Cost of maintenance borne by father. 10th April 1919 F. F. M. 14 Ins titutional (Earlswood) Cost of maintenance borne by father. 9th May 1919 A. W. F 27 Institutional (Caterham Asylum). 9th May 1919 F.J. M 22 Institutional (Darenth Industrial Colony). 28th May 1919 K. S. F 11 Institutional (Fountain Mental Hospital). Order made for contribution of 10s. per week by father towards maintenance. 11th June 1919 R. F. F 16 Institutional (Darenth Industrial Colony). 3rd July 1919 E. L. P. F 18 Institutional (Darenth Industrial Colony). 23rd July 1919 G. T. F 17 Institutional (Winslow Union Institution) on behalf of Bucks Local Authority. 14th October 1919 E. Y. F 16 Institutional (Darenth Industrial Colony). 28th October 1919 L, P. F 26 Institutional (Darenth Industrial Colony). 30th October 1919 L. W. F 26 Institutional (Princess Christian Farm Colony. Cost of maintenance borne by father. 9th December 1919 M. C. L. F 10 Institutional (Fountain Mental Hospital). Discharged to parent 24th January, 1920. 9th December 1919 E.F. F 8 Institutional (Fountain Mental Hospital) 85 Total. Total number of Mental Defectives known by medical examination in the Borough 228 Statutory Cases 110 (a) 0—5 years 7 cases. (b) 5—16, Ineducable 33 ,, (c) Over 16 70 ,, In Certified Institutions 43 In Croydon Mental Hospital 7 In Poor Law Institutes 8 Resident at Home 47 At Home, under Guardianship 5 Education Cases 118 In Certified Institutions 8 In Poor Law Institutes 2 Resident at Home 108 (60 of these on Roll of Grangewood Special M.D. School.) Epileptic Cases 40 Epileptic cases not Mentally Defective 28 Epileptic cases certified as M.D. 12 In Epilpetic Colonies and Certified Institutions 13 Resident at Home (12 excluded from school) 27 Examinations made by the Medical Officer during the year—51 Statutory cases; 116 Education, and 14 Epileptic 181 Supplementary Figures. There have been 6 deaths (all statutory cases), 4 in Institutions and 2 at home. During the year 13 Education cases have attained the age of.16, 10 cases have been certified as Ineducable, 6 of the latter being cases at Grange Wood Special M.D. School, certified in December. 86 SECTION VII. WORK OF THE SANITARY INSPECTING STAFF. GENERAL SANITARY WORK. A summary of the work done by the Sanitary Inspectors during the year is given on the next page. One of the District Inspectors returned to duty from the Army in March and one in April, thus bringing the Inspecting staff up to pre-war strength. The routine house-to-house inspection was considerably increased during the remainder of the year as a consequence. As a result 2,024 house-to-house inspections were made. These numbers are in addition to 918 inspections of houses where infectious diseases have been notified, and 104 inspections on request of larger houses, where the drains were tested and special reports sent to occupiers, prospective occupiers, or owners. As a result of these inspections, 2,771 preliminary notices were served during the year. 87 Work done by the Sanitary Inspectors during the Year ending 31st December, 1919. NATURE OF CASES DEALT WITH Deputy Chief Insp. Culver. Insp Fulker. Insp. Earwicker Insp. Peck. Insp. Richardson Insp. Bull. Insp. Vincent. Insp. Flint. Insp. Hunt. Total. House to House Inspection 316 .. 177 84 466 ... 435 261 285 2024 No. of Houses inspected where zymotic diseases have occurred 26 17 155 129 229 .. 123 91 148 918 No. of Visits of enquiry re infectious disease 261 780 173 222 322 .. 118 212 155 2223 House drains tested with smoke (primary) 53 .. 140 128 203 .. 114 104 150 892 ,, ,, ,, on application 19 .. 22 13 10 .. 5 3 32 104 Drains found defective 14 .. 14 25 15 .. 13 28 14 123 House drains re-laid .. .. .. 1 2 .. 2 15 5 25 ,, ,, repaired 1 .. .. 44 38 .. 4 19 25 111 No. of smoke tests during repair 18 .. 74 69 54 .. 10 65 58 348 ,, water ,, 35 .. 73 11 7 .. 6 43 30 205 Damp-proof courses inserted .. .. .. .. .. .. .. .. .. .. Yards paved .. .. .. .. 6 .. .. 5 2 13 Inspection of Premises where offensive trades are conducted .. .. .. .. .. .. .. .. .. .. Inspections of Factories and Workshops, etc .. .. .. .. .. 1225 .. .. .. 1225 ,, ,, Greengrocers, Fishmongers & Ice Cream Shops 70 147 141 10 .. 307 121 207 1003 ,, ,, Schools 29 8 4 61 11 .. 39 4 58 214 ,, ,, Shops 151 .. .. .. .. .. .. .. .. 151 ,, ,, Bakehouses .. .. .. .. .. 587 .. .. .. 587 ,, ,, Yards and Stables 65 291 279 114 .. 327 355 580 2011 ,, ,, Common Lodging Houses .. .. .. .. .. 557 .. .. .. 557 ,, ,, ,, night visits .. .. .. .. .. 10 .. .. .. 10 ,, ,, Houses let in Lodgings .. .. .. .. 76 .. 85 326 .. 487 ,, ,, ,, ,, night visits .. .. .. .. .. .. .. .. .. .. ,, ,, Urinals 302 .. 119 369 196 .. 280 95 452 1813 Smoke observations .. .. .. .. .. .. .. .. .. .. Re-inspections of work in progress 581 .. 1125 1348 1443 .. 808 899 1257 7411 Sundry inspections 611 102 222 547 167 .. 197 190 290 2626 Complaints from public investigated 306 1 19S 82 256 .. 147 198 189 2374 NUISANCES DISCOVERED. Houses requiring Cleansing & Whitewashing 204 .. 192 75 238 .. 140 109 231 1189 ,, Overcrowded 37 .. 10 4 12 .. 14 16 4 97 Leaky Roofs 60 .. 133 57 145 .. 54 80 100 629 Dampness in Houses 31 .. 126 77 71 .. 80 27 54 468 112 .. 69 59 98 .. 118 78 82 616 Drains and Sanitary Fittings found defective 89 .. 138 156 266 .. 113 173 170 1105 Defective Yard Surfaces 62 .. '27 6 19 .. 21 18 33 186 ,, Eaves and Downspouts .. 63 .. 71 40 165 .. 38 88 69 534 ,, Manure Receptacles 1 .. .. 4 1 2 8 ,, Urinals 60 .. 4 1 .. 3 1 1 70 ,, Ashbins 60 .. 47 184 124 .. 61 153 104 733 Smoke Nuisances .. .. .. .. .. .. 5 .. .. 5 Animals improperly kept 4 .. 3 2 5 .. 1 9 .. 24 Infringements of Bye-laws and Regulations .. .. 6 1 .. 28 .. 1 2 38 Offensive Accumulations 33 .. 12 2 1 .. 2 6 1 57 Sundry other Nuisances 1 .. 78 122 282 80 .. 82 193 838 Total numbet of Nuisances 817 .. 918 786 1426 108 654 842 1046 6597 Informal notices in abeyance 31st December, 1918 78 .. .. 26 97 .. 43 .. 270 314 Informal Notices served 334 .. 253 406 603 23 376 379 397 2771 ,, ,, complied with 238 .. 166 320 555 23 364 242 304 2212 ,, ,, in abeyance 125 .. 68 61 109 .. 23 155 184 715 Referred to Committee 49 19 61 36 .. 32 82 79 358 88 Combined drainage.—The number of systems of combined drainage dealt with as single private drains during the year was 4. This work was carried out under the provisions of the Croydon Corporation Act, 1905. The cost of carrying out the necessary works amounted to £74 10s. 5d., and was borne by the owners instead of by the inhabitants at large. House drains relaid.—In 25 instances the whole of the house drains were relaid, and 131 house drains were repaired or partially relaid. Examination of drains.—104 written applications were received for the examination of the drains and sanitary condition of houses by occupiers or intending occupiers. In all cases special reports were made by the District Inspectors, copies of which were forwarded to the applicants. Where defects were found, and in many cases where improvements were suggested, the work was carried out by the owners without the necessity of serving sanitary notices. Notices and Council Orders.—Most of the nuisances discovered were remedied on receipt of informal notices, but in 358 cases Council Orders had to be applied for. Two hundred and thirty were complied with at the end of the year. MUNICIPAL COMMON LODGING HOUSE. This Lodging House affords accommodation for 17 women and 84 men. The number of nightly occupants during the year amounted to 29,703 men and 3,455 women, making a total of 33,158. The average number of lodgers amounted to 81 men and 9 women per night. The receipts and expenditure (exclusive of sinking fund and interest) for the past seven years were : — Receipts. Expenditure. £ s. d. £ s. d. 1913 765 6 7 623 14 4 1914 822 4 9 735 8 9 1915 787 9 1 737 17 10 1916 722 16 1 682 15 10 1917 678 15 4 698 4 1 1918 781 1 7 854 3 0 1919 834 0 5 916 15 3 89 OTHER COMMON LODGING HOUSES. There are ten other houses on the register. The following Table gives the situation of the ten registered houses and the accommodation provided therein: — Premises. No. of Rooms. Accommodation. 11 & 12, Princess Road 12 54 men and 8 married couples. 9, Prospect Place 7 18 men and 5 married couples. 19. 20, 21, 22, 23 & 24, Lahore Road 30 50 men, 10 women, and 6 married couples. 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. During the year common lodging houses received 557 visits, while 10 houses received night visits. Minor infringements of bye-laws were detected on 28 occasions, but in no case were they sufficiently serious for legal proceedings to be taken. HOUSES LET IN LODGINGS. There are 49 houses registered under the bye-laws. During the vear these houses received 487 visits. On no occasion were offences discovered for which prosecutions were necessary. At the present moment the following houses are registered .is houses let in lodgings : — Wilford Road 25 Forster Road 12 Holmesdale Road 4 Ely Road 8 49 90 FACTORY AND WORKSHOP ACT. FACTORIES. 358 visits were made to Factories. 99 in reference to sanitary accommodation. 20 ,, ,. cleanliness of earth closets. 40 ,, ,, new occupation. 19 ,, ,, new drinking water regulations. 44 ,, ,, defective sanitary accommodation. 18 ,, ,, extra w.c. at motor works. 7 ,, ,, ,, engineers. 3 ,, ,, „ boat builders. 4 „ ,, „ brewers. 12 „ ,, ,, confectioners. 2 ,, ,, ,, carriage works. 8 ,, ,, ventilated space at gold leaf works. 4 ,, ,, screening of w.c.'s at clock makers. 3 ,, ,, ,, ,, photographic printers. 2 „ „ ,, „ engineers. 2 „ „ „ „ plating works. 4 ,, ,, defective well at steam laundry. 67 sundry visits. 358 Total. WORKSHOPS. The number of workshops on register is 660. The number of visits paid by the Inspector is 576. HOMEWORK. 108 lists were received from employers, containing the names of 272 outworkers residing in the Borough. 187 further names were received from the Medical Officers of Health of various neighbouring districts, and the names of 44 outworkers residing outside the Borough were similarly despatched to the Medical Officer of Health for the district concerned. 228 visits were paid to outworkers. 48 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 77 Bakehouses in occupation, of which 7 were underground. 587 visits were made by the Inspector during the year, and 51 nuisances discovered and abated. 91 WORKPLACES. At the end of the year there were 69 workplaces on the register, 36 visits to eating-house kitchens have been made, and 4 nuisances discovered and abated. The following is a list of the various matters which required attention :— Factories. Workshops Laundries Bakehouses. Workplaces. Outworkers. Total Screening of W.C's. 4 2 — — — — 6 Cleansing, etc. — 12 — 27 2 1 42 Insufficient W.C. accommodation 7 4 — — — — 11 Defective ditto 44 14 8 12 — — 78 Overcrowding — 1 — — — 1 Dustbins — — — — — — — Paving — — — — — – — Want of ventilation of stoves — 8 — — — 8 Want of intervening ventilated space 1 2 — — — — 3 Drinking water supply 19 — — — — — 19 Sundry defects 8 14 3 12 2 — 39 83 57 11 51 4 1 207 Preliminary Notices served— Factories 11 Workshops 9 Workplace 1 Bakehouses 2 23 These 23 notices were duly complied with ; the remainder of the matters requiring attention were satisfactorily dealt with by verbal notice. Sixty communications were sent to H.M. Inspector of Factories in accordance with the various requirements of the Act. SMOKE NUISANCES. There were no complaints of smoke nuisances. RAG FLOCK ACT, 1912. Fourteen inspections were made of premises occupied by upholsterers and bedding manufacturers. Very little private work was done in the workshops at the beginning of the year as a consequence of the war. 92 Eight samples were taken and submitted to the Public Analyst with the following results:— One proved satisfactory, the amount of Chlorine being below the limit allowed by the Act. Four were slightly above, the manufacturers being warned in these cases. Three were unsatisfactory, but in one case it was proved a mattress had been sent in for a remake in its own tick. The other two were taken from workshops of demobilised soldiers in a small wav of business as upholsterers, no bedding being made. The explanations given, however, proved satisfactory. INSPECTION OF MEAT AND OTHER FOODS. The Inspection of meat has been carried out as in previous years. There are 12 registered slaughter houses in the Borough, in addition to the Municipal slaughter houses at Pitlake, which consist of 12 slaughter houses with lairs. The portion of the Public slaughter house premises rented bv the Ministry of Food for the slaughter of calves was given up at tile end of May. During the period January to May inclusive 4,813 calves were slaughtered, their carcases and offals being consigned to Smithfield Market for disposal by the Board of Control. The following table gives a summary of the work done during the year : — Summary of inspections during igig. Date1919. Slaughterhouses. Butchers. Fishmongers. Markets. Cowkeepers. Dairies. Other Premises. Total. January 143 96 41 10 6 19 21 336 February 129 101 33 8 4 18 21 314 March... 159 124 32 10 8 27 14 374 April ... 94 70 26 6 3 7 15 221 May 108 79 31 8 5 16 17 264 June 178 104 43 12 22 38 36 433 July 99 80 26 7 5 12 17 246 August and September 203 158 49 14 16 46 25 oil October 105 54 23 8 9 16 37 252 November 117 69 27 8 7 15 40 283 December 225 148 52 17 12 34 59 547 Totals 1560 1083 383 108 97 248 302 3781 93 The two following tables shew the number of animals slaughtered at the Public Slaughter Houses, Pitlake, during the year 1919, and a summary of the totals for the last ten years:— 1919. Slaughterhouses. Cattle. Sheep. Pigs. Calves. Total Public 838 849 4876 171 6734 Private 223 633 34 7846 8736 Totals 1061 1482 4910 8017 15470* Included in the above figures are 4,813 Calves slaughtered by the Ministry of Food, the carcases and offals being consigned to Smithfield Market for disposal by the Board of Control. Summary for ten years, 1910 to 1919. Year. Cattle. 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 1915 1000 5339 22406 2539 31284 1916 1261 8332 26181 2661 38435 1917 2044 9904 18152 4604 34704 1918 2217 2215 1638 7103 13173 1919 1061 1482 4910 8017 15470 Totals 10735 64445 157840 41562 274582 94 Summary of Meat and other articles of food destroyed as unfit for food with total weight:— 1919. ARTICLES. Weight in lbs. Remarks. Diseased. Unsound. Total. Beef 16,107 4,396 20,503 Including 33 carcases. Mutton 389 3,941 4,330 „ 60 „ Pork 4,056 ... 4,056 „ 15 „ Veal 659 183 842 „ 23 ,, Offal 5,755 5,604 11,359 ,, foreign frozen offal. Fish ... 3,230 3,230 Bream, Bloaters. Crabs, Codling, Haddock, Herring, Kippers, Mackerel, Shrimps, Whiting and Winkles Other Articles ... 45,718 45,718 Bacon, Brawn, Corned Beef, Dates, Flour. Figs, Fruit, Tinned Hares, Hams, Milk (tinned), Marmalade, Raisins, Rabbits, Sprouts & Tomatoes Total lbs. 26,966 63,072 90,038 Including 131 carcases. Summary of whole carcases condemned, with the reasons for such condemnation:— 1919. Class of Animal. Tuberculosis. Peritonitis. Pneumonia. Pleurisy. Metritis. Enteritis. Jaundice. Swine Fever. Emaciated, various causes. Immature. Injuries. Decomposition. Total carcases. Cattle 17 2 2 •• 3 2 •• •• 5 •• 2 •• 33 Sheep • • 1 1 1 •• •• 1 •• 8 •• 4 44 60 Pigs 13 • • • • • • • • • • 1 1 • • • • • • • • 15 Calves 2 • • • • • • • • 11 2 • • • • 7 • • 1 23 Totals 32 3 3 1 3 13 4 1 13 7 6 45 131 95 Summary of Carcases in which Tuberculosis was found in the course of inspection and how such carcases were disposed of :— 1919. Animals affected. Carcase and all internal organs destroyed, Part of carcase and all organs destroyed. All or part of organs destroyed. Total. Cattle 19 8 38 65 Pigs 13 105 33 151 Total 32 113 71 216 TUBERCULOSIS IN MILK. No samples of milk were taken on account of the impossibility of getting examinations made. DAIRIES, COWSHEDS & MILK SHOPS ORDER. Cowkeepers on Register (1918) 27 added (1919) 0 Cowsheds on Register (1918) 38 ,, added (1919) 0 Number of Cows provided for 520 Approximate number of Cows (1919) 156 Dairymen and Milk Purveyors on Register 262 ,, ,, added (1919) 12 Number of Premises 314 There were no removals from the Register during the year, as business has been temporarily suspended in the case of several cowkeepers, and a considerable number of milk purveyors, and may be resumed at any time. 96 SALE OF FOOD AND DRUGS ACTS. During the year 339 samples of milk (335 new and 4 skimmed or separated) were taken. In 24 cases the samples were below the standard suggested by the Board of Agriculture. Proceedings were instituted in respect of 9 of these samples, and fines and costs were imposed on the vendors to the extent of £45 0s. Od. The other 15 samples were only slightly below the standard suggested by the Board of Agriculture. In 8 cases the vendors were written to asking for an explanation, and in all cases subsequent samples were taken. The following is a statement concerning the prosecutions undertaken during 1919:— PROSECUTIONS, 1919. Date of Purchase. Defendant. Charge. Result. Penalty. Costs. 1919 £ s d. £ s. d Feb. 26 G. K. Selling Milk containing 3 per cent. of added water Convicted 10 0 0 10 6 „ 26 R. D. S. Selling Milk 19 per cent. deficient of fat ” 1 0 0 2 12 6 May 2 G. C. Selling Milk containing 3 per cent added water ” 2 0 0 10 6 „ 14 H. T. G. Selling Milk containing 4 per cent. of added water Case dismissed — — „ 23 G. T. N. Selling Milk containing 10 percent of added water Convicted 10 0 0 1 11 6 June 16 C. H B. Selling Milk containing 5 percent of added water ” 0 0 10 6 Aug. 13 W. A. G. L. G. Man & wife. Selling skimmed milk containing 1 per cert. added water. Aug. 13 Selling Milk 39 per cent. deficient of fat. ” 10 10 0 1 4 14 6 Ang. 13 Selling milk 42 per cent. deficient of fat. Total 34 10 0 10 10 0 97 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) REGULATONS, 1912. Report for the Year ended 31st December, 1919. 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 present. MILK 339 Nil. CREAM Nil. No samples taken during the year 1919. 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 preservation were correct. (i) Correct statements made Nil. (ii) Statements incorrect Nil. Total Nil. (b) Determinations made of milk fat in cream sold as preserved cream. (i) Above 35 per cent. Nil. (ii) Below 35 per cent. Nil. Total Nil. (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 substances.—Any evidence of their addition to cream or to preserved cream. Action taken where found. Nil. 4. Other observations, if any. Nil. 98 Food and Drugs Acts. Total Number of Samples taken during the year 1919. Sample of Total Samples. Genuine, Not Genuine. Prosecutions. Convictions. Cautions Milk 335 312 23 8 7 8 . Separated or Skimmed 4 3 1 1 1 — Margarine — — — — — — Butter — — — — — — Drs.' Prescriptions — — — — — — Self-raising Flour — — — — — — Dripping — — — — — — Bacon — — — — — — Sausages — — — — — — Sausage Meat — — — — — — Soup Powder — — — — — — Condensed Milk — — — — — — Totals 339 315 24 9 8 8 Country Milk in course of delivery at railway station 112 On Milk rounds Sunday mornings16 ,, ,, Weekdays 211 Total 339 99 Food and Drugs Acts. Particulars of Samples taken during the sixteen years 1904 1919 inclusive :— Year. Number of Samples taken. Number Genuine. Number Adulterated. Percentage of Adulterated. Prosecutions. Total amount of Fines and Costs imposed. 1904 354 317 37 10.5 6 £ s. d. 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 1915 504 427 77 15.2 18 105 11 0 1916 388 297 41 12.1 22 85 3 6 1917 356 305 51 14.3 16 227 11 0 1918 414 360 54 13 0 17 175 13 6 1919 339 315 24 7.6 9 45 0 0 * The term adulterated includes samples found to be not up to standard. 100 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 1919. Month. Beds Occupied. Month. Beds Occupied. Highest. Lowest. Highest. Lowest. January 113 93 July 130 108 February 115 90 August 122 106 March 101 88 September 130 112 April 119 99 October 214 137 May 120 107 November 235 202 June 123 111 December 224 189 During 1919 the average daily number of cases under treatment amounted to 132.8 as compared with 93 8 of the previous year. The following table gives the total number admitted from the Borough and other Districts during the year 1919. Districts. Remaining at end of 1918. Admitted during 1919. Discharged during 1919. Died during 1919. Remaining at end of 1919. Crystal Palace (Royal Naval Division) 2 – 2 – – Penge Urban D.C., nonpauper cases 8 67 54 5 11 The Borough of Croydon 90 1001 831 74 186 Total 95 1068 887 79 197 SECTION VIII. CROYDON BOROUGH HOSPITAL. Detailed Analysis of Expenditure under all Heads for the Year ending March 31st, 1920, and 10 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. Tota Ordinary Expenditure. Total Average Cost per Bed occupied. Sinkin 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 Cos per Bed occupied. Total. Average Cost per Bed occupied. Establishment Charges and Repa rs. Miscellaneous Charges. Total. Average Cos per Bed occupied. Medica Dispensing, Nursing & other. Average Cost per Bed occupied. £ 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. 1910 127 2523 3 7 19 1 7 6 6 7 4 1 o 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 11 0 3058 16 9 105 8 9 1915 131 3455 18 1 26 7 7 17 15 9 2 8 410 5 2 3 2 8 2530 5 8 19 6 4 2433 0 9 558 9 2 2991 9 11 22 16 8 2984 17 9 22 15 9 12390 12 4 94 11 8 3095 5 0 118 4 3 1916 96 3628 19 3 37 16 1 23 7 4 4 10 439 4 3 4 11 6 2566 10 8 26 14 8 1709 12 8 498 11 5 2208 4 1 23 0 1 2937 19 8 30 12 1 11804 5 3 122 19 3 3156 3 8 155 16 9 1917 93 3393 18 2 36 9 10 12 11 6 2 8 451 11 11 4 17 2 2713 3 4 29 3 6 1368 1 2 742 7 11 2110 9 1 22 13 10 2751 17 11 29 11 10 11433 11 11 122 18 10 3184 16 3 157 3 9 1918 84 3735 0 1 44 9 3 26 4 8 6 3 556 1 4 6 12 5 3303 3 8 39 6 6 1477 15 9 761 3 8 2238 19 5 26 13 1 2759 0 4 32 16 11 12618 9 6 150 4 5 3177 7 5 188 0 11 1919 92 4261 15 6 46 6 6 33 10 0 6 7 745 19 0 8 2 2 3977 4 7 43 4 7 1489 6 1 723 13 0 2212 19 1 24 1 1 3080 6 11 33 9 8 14308 15 1 155 10 7 3167 12 6 189 19 2 1920 156 6448 12 6 41 6 9 47 5 6 6 1 145 15 2 9 7 2 5418 17 8 34 14 9 3278 19 5 1050 2 8 4329 2 1 27 15 0 6401 15 9 41 0 9 24105 8 8 154 10 6 3157 17 6 174 15 4 £ s. d. Receipts 1919-20, from various sources 4153 16 0 101 The following table shows the comparative admissions during 1919 and previous years. Cases admitted during 1909. Cases admitted during 1910. Cases admitted during 1911. Cases admitted during 1912. Cases admitted during 1913. Cases admitted during 1914. Cases admitted during 1915. Cases admitted during 1916. Cases admitted daring 1917. Cases admitted during 1918. Case® adm tted during 1919. Scarlet Fever 608 624 381 365 417 653 413 295 201 386 532 (1) Diphtheria 292 222 430 600 402 211 200 313 207 179 433 (2) Cerebro Sp. Meningitis — — — — — — 67 24 38 23 3 Pulmonary Phthisis 11 — — — 48 56 61 44 40 37 44 Enteric Fever — 15 18 16 28 15 13 10 6 13 4 (3) Puerperal Fever — — — — 1 2 4 2 2 1 4 Morbilli — — — — — — 9 17 25 17 6 Rubella — — — — — — — — 12 2 3 Mumps — — — — — — — — 20 6 4 (4) Erysipelas — — — — — — — — 18 10 6 Other diseases 45 47 29 25 6 10 11 33 10 37 29 Total 956 908 858 1006 902 947 778 738 579 711 1068 (1) Includes 4 cases of Diphtheria. ,, 2 cases of Chicken Pox. ,, 2 cases of Pseudo Scarlet Fever. ,, 7 cases of Measles. ,, 2 cases of No disease. ,, 1 case of Sore Throat. ,, 1 case of Skin Disease. „ 1 case of Scabies. (2) ,, 10 cases of Scarlet Fever. ,, 3 cases of Sore Throat. „ 2 cases of Quinsy. ,, 1 case of Pneumonia. ,, 1 case of Syphilis. „ 1 case of Scabies. ,, 1 case of Debility. ,, 1 case of Meningitis. „ 1 case of Tonsillitis. (3) ,, 1 case of Enteritis. (4) ,, 2 cases of Sore Throat. 102 The following table gives the number of patients admitted for each disease, an analysis of the admissions, and the number discharged or who have died in the year 1919:— Disease. Remaining at end of 1918. Admitted during 1919. Discharged during 1919. Died during 1919. Remaining at end of 1919. Scarlet Fever 63 522 465 11 109 Admitted to Hospital as Scarlet Fever and found to be other disease ... 9 9 ... ... Admitted to Hospital for observation (including contact) ... 1 ... ... 1 Diphtheria 13 388 292 38 71 Admitted as Diphtheria and found to be other disease ... 15 14 ... 1 Admitted for observation (including contact) ... 30 29 ... 1 Cerebro-Spinal Meningitis 3 3 6 ... ... Admitted as Cerebro-Spinal Meningitis and found to be other disease ... ... ... ... ... Admitted for observation (including contact) ... ... ... ... ... Enteric Fever ... 3 1 ... 2 Admitted as Enteric and found to be other disease ... 1 1 ... ... Admitted for observation (including contact) ... ... ... ... ... Pulmonary Tuberculosis 13 44 24 23 10 Admitted for Pulmonary Tuberculosis and found to be other disease ... ... ... ... ... Admitted for observation (including contact) ... ... ... ... ... Puerperal Fever ... 4 3 ... 1 Admitted as Puerperal Fever and found to be other disease ... ... ... ... ... Admitted for observation (including contact) ... ... ... ... ... Morbilli ... 6 6 ... ... Admitted as Morbilli and found to be other disease ... ... ... ... ... Rubella ... 3 3 ... ... Admitted as Rubella and found to be other disease ... ... ... ... ... Erysipelas 1 6 7 ... ... Admitted as Erysipelas and found to other disease ... ... ... ... ... Mumps ... 2 2 ... ... Admitted as mumps and found to be other disease. ... 2 2 ... ... Other Diseases 2 29 23 7 1 Totals 95 1068 887 79 197 103 The following table gives the fatality for each disease:— 1912 1913 1914 19I5. 1916. 1917. 1918. 1919. Scarlet Fever 1.1 .8 .7 .9 1.8 1.0 2.1 2.0 Diphtheria 3.6 3.02 6.4 4.02 4.65 4.1 13.2 8.7 Enteric Fever 25.0 19.2 20.0 33.3 100.0 0.0 9.0 — Cerebro Sp. Fever — — — 54.0 13.0 37.9 40.0 — Pulmonary Tuber — 12.5 12.6 37.2 40.0 48.6 35.3 52.2 Puerperal Fever — — — 60.0 100.0 0.0 0.0 — Morbilli — — — 11.1 0.0 4.3 0.0 — Mumps — — — — — 0.0 0.0 — Erysipelas — — — — — 6.5 0.0 — Other Diseases — — — — — 11.1 8.0 24.1 All Cases 3.2 2.9 3.1 •89 7.2 7.0 8.1 7.4 Under other diseases are included:— Result. Impetigo 1 1 Discharged. Pneumonia 3 1 „ (2) died. Ophthalmia Neonatorum 3 3 „ Influenza 3 3 „ Dysentery 1 1 „ Varicella 2 1 „ Nephritis 1 1 „ Sore Throat 1 1 „ Epidemic diarrhæa 8 4 „ (4) died. Marasumus 2 1 „ (1) died. Rheumatism 1 1 „ No disease* 3 3 „ 29 * 2 babies with mothers (puerperal fever cases). I mother with baby (ophthalmia neonatorum). Notified as Diphtheria or for observation for Diphtheria— Result. Diphtheria 1 Discharged. Sore Throat 4 „ Quinsy 2 „ Syphilis 1 „ Scarlet Fever 3 1 „ (1) died (1) remains Debility 1 Discharged. Diphtheria & Meningitis 2 2 died Diphtheria and Scarlet Fever 1 Discharged. Diphtheria & Scabies 1 ,, Tonsillitis 1 ,, No disease observed 2 ,, 104 Notified as Scarlet Fever or for observation for Scarlet Fever— Scarlet Fever 1 Discharged. Pseudo Scarlet Fever 2 ,, Scarlet Fever and Diphtheria i ,, Scarlet Fever and Morbilli 2 ,, Scarlet Fever, Morbilli and Diphtheria 1 Died Morbilli 2 Discharged. Sore Throat 1 ,, Scabies 1 ,, Skin Disease 1 ,, No disease observed 2 ,, Notified as Dysentery or for observation for Dysentery. Dysentery 1 Discharged. Notified as Mumps or for observation for Mumps— Sore Throat 2 Discharged. Notified as Enteric or for observation for Enteric — Enteritis 1 Discharged. Illnesses amongst the Staff— Scarlet Fever 5 Discnarged. Diphtheria 5 ,, Pneumonia 1 Died Nephritis 1 Discharged. Sore Throat 1 ,, Rheumatism 1 ,, WORK OF THE BOROUGH LABORATORY. The work of the Laboratory continues to be of the greatest value to the Borough. Examinations for Diphtheria. For Doctors. For M.O.H. For Wards (including Nose and Throat Swabs). + — Total + — Total 2,253 106 1,136 1,242 61 1,505 1,566 105 Outfits sent to the Town Hall. Diphtheria. Tubercle. Enteric. Total 3.300 653 18 3.971 Blood Serum. Tubes made—367 dozen. Commercial prize £91 15s. 0d. Special Media prepared. 1 litre " Agar Agar. 1 „ " Peptone Broth. CEREBRO-SPINAL MENINGITIS. Results of Examinations for Cerebro-Spinal Meningitis. 1919. Examinations for Borough. Examinations for Hospital. Total. All Examinations. All Examinations. All Examinations. + — Total + — Total + — Total January — — — — 8 8 — 8 8 February — 10 10 2 — 2 2 10 12 March — 1 1 — 1 i — 2 2 April — 10 10 — 2 2 — 12 12 May — 1 1 — — — — 1 i June — 1 1 — — — — 1 i July — — — — — — — — August — 4 4 — — — — 4 4 September — — — — — — — — — October — — — — — — — — — November — — — — — — — — — December 3 7 10 — — — 3 7 10 First Quarter 11 11 2 9 11 2 20 22 Second ,, — 12 12 — 2 2 — 14 14 Third ,, — 4 4 — — — — 4 4 Fourth ,, 3 7 10 — — — 3 7 10 Total 3 34 37 2 11 13 5 45 50 106 TUBERCULOSIS. Results of Examinations for Tuberculosis. 1919. Examinations for Borough Examinations for Hospital. Total. All Examinations. All Examinations. All Examinations. + — Total + — Total + — Total January — 22 22 — 6 6 — 28 28 February — 21 21 1 3 4 1 24 25 March 1 19 20 3 — 3 4 19 23 April 3 25 28 1 2 3 4 27 31 May 8 38 46 3 1 4 11 39 50 June 9 51 60 4 — 4 13 51 64 July 7 37 44 2 1 3 9 38 47 August 3 18 21 7 — 7 10 18 28 September 12 33 45 — 1 1 12 34 46 October 8 52 60 1 1 2 9 53 62 November 7 68 75 — 3 3 7 71 78 December 5 18 23 — 3 3 5 21 26 First Quarter 1 62 63 4 9 13 5 71 76 Second ,, 20 114 134 8 3 11 28 117 145 Third „ 22 88 110 9 2 11 31 90 121 Fourth ,, 20 138 158 I 7 8 21 145 166 Total 63 402 465 22 21 43 85 423 508 107 ENTERIC (TYPHOID) FEVER. Results of Examinations for Diseases simulating Enteric Fever. 1919. Examinations for Borough. Examinations for Hospital. Total. Agglutinative Reactions. Agglutinative Reactions. Agglutinative Reactions for all Purposes. + — Total + — Total + — Total January — 1 1 — — — — 1 1 February — 2 2 — — — — 2 2 March — — — — — — — — — April — — — — 2 2 — 2 2 May — 2 2 — 1 1 — 3 3 June — 1 i — — — — 1 1 July — 2 2 — — — — 2 2 August — — — — — — — — — September — 2 2 — — — — 2 2 October — — — — — — — — — November — — — — — — — — — December — 6 6 — — — 6 6 First Quarter 3 3 — 3 3 Second ,, — 3 3 — 3 3 — 6 6 Third ,, — 4 4 — — — — 4 4 Fourth ,, — 6 6 — — — — 6 6 Total — 16 16 — 3 — — 19 19 108 SECTION IX. Public Health Department, Croydon. July, 192o. To The Education Committee. Mr. Chairman, Ladies and Gentlemen,— I beg to submit to you my report for the year 1919 of the School Medical work in Croydon. It will be observed that the total number of examinations of children (including the routine and special inspections and the more extended inspections at the London Road Centre) is 7,806. The total number of routine inspections is 5,792, and in these 3,196 cases of defect of one kind or another were found, i .e. 55.2 per cent. The School Medical Service during 1919 was restored nearly to its normal degree of activity in the latter part of the year, and it is hoped that practically normal results and conditions will be revealed in the Annual Report for 1920. It was my intention to dwell specially this year upon a considerable number of features which the inspection of the Croydon School children has brought to light, but as these have recently been specially under the consideration of the Education Committee in the report made by me for the medical section of the scheme prepared under the 1918 Education Act, I summarise only very briefly the points which would have otherwise required more extended discussion. The main needs which the medical work amongst these children reveals are (1) an increase in the preventive activities of the Education Authority and (2) an increase in the provision made for treatment of existing defects. These two groups of the work are essentially inter-dependent, and it is not advisable to discuss the principle underlying them separately. Thus, for instance, in the present report 105 partially deaf children have been noted in the inspections, and a large number of cases of ear trouble have been dealt with at the Treatment Centre. The disadvantage of ear discharge or defective hearing both physically and educationally is very great, and the two lines upon which the Education Authority should proceed are clearly those of the establishment of special classes for partially deaf children and the appointment of a part-time Ear Specialist. Stuttering and stammering in school children has also engaged my attention. Action has been taken during this current year by 109 the Education Authority in connection with this, and an account of the facts and of the proposed remedy will be included in the report for 1920. The Committee is also actively interesting itself in the provision of special classes for mentally defective children, and it is, therefore, unnecessary to do more than note this need. I would, however, emphasise the great importance of the establishment of classes in the ordinary schools for backward children. It has been universally found throughout the country—and Croydon is no exception—that in the examination by the medical staff of children referred for special mental reasons there is a considerable number of cases where continuous special observation is desirable before a definite and final conclusion as to the mental grade of the child is arrived at. At present—with one or two exceptions—there is nothing between the ordinary school and the school for mentally defective children. On the one hand, special observation of a child is exceedingly difficult in the ordinary class, and on the other, admission of the child to a special class can only be done after definite certification of mental deficiency. The establishment of backward classes is, therefore, in my opinion, not only a thing which will be of very great value from the point of view of the child involved, but is a really much needed provision. The physically defective child constitutes the largest group with which the Medical Staff has to deal, and without forgetting the need for a very pronounced extension of the existing provision for treatment (outlined in my special reports on Maternity and Child Welfare of 5th June and 17th September, 1919) I would particularly direct the attention of the Committee to the essential importance of making such provision as (without disturbing the educational advantages open to the children) will at the same time provide for them physical conditions antagonistic to the ordinary illnesses from which so many suffer. Amongst the defects recorded, for example, are 197 lung conditions—other than tubercle —anaemias, enlarged glands, bronchial catarrh, enlarged tonsils, adenoids, pharyngitis, etc.—many of which conditions have their origin in very simple beginnings such as common colds. The lastnamed is an infectious disease, and not only common colds, but practically all of the conditions mentioned will be greatly reduced in incidence if the public would only realise that open-air conditions which are used for the cure of many of our worst ills can equally be used, and to much greater advantage, for the maintenance of good health and the prevention of the onset of such illnesses. The Committee cannot too strongly visualise the great boon which they would confer upon the coming generation if, in a wise 110 sight, they adopt every means of making the ordinary schools practically open-air, and for the purposes of remedying the already produced physical defects provide actual open-air schools—both day and residential. Not only will this improve the physical development and vitality of the rising generation, but it will inculcate upon them the advantages of fresh air living in the most direct and practical manner possible—an educational result second to none attainable by a local authority. The dental work of the Department is being actively carried on, but it is quite impossible to cover the needs of the school population with the present arrangements. Additional dental services are urgently required. One definite fact showing the need of extended dental service is to be found in the number of children formerly observed to have sound teeth, but on re-inspection exhibiting the onset of dental decay. The dental service should be evolved gradually to the extent necessary to follow the 6—7 years age group through their school life. Extension of all forms of treatment can only be carried into effect if additional premises are obtained. Embodied in the report is a special report of the Organiser of Physical Training—Miss Appleton—and I would emphasise the great importance of this side of the Committee's work in relation to the physical welfare of the school population—not only during the elementary school period but in the schools attended during adolescence—a time when bodily and mental growth is extremely active owing to the evolution of the attributes of adult life, and, therefore, demanding the best physical surroundings available. It only remains to note the marked success of the special clinic for the treatment of tonsils and adenoids, and to observe the hope that we shall obtain still further success in the after-treatment of these other ailments from the recent appointment (during 1920) of an additional skilled masseuse and teacher of remedial exercises. I have to acknowledge, as on every other occasion, the great courtesy and assistance received from the Committee not only by myself, but by every member of the staff concerned in the work. I am, Ladies and Gentlemen, Your obedient Servant, R. VEITCH CLARK. 111 REPORT ON SCHOOL MEDICAL WORK. THE STAFF AND GENERAL ORGANISATION OF THE WORK. The Medical Inspection Staff consists of Dr. W. N. W. Kennedy, Deputy School Medical Officer, and Dr. H. Gordon Smith, Assistant School Medical Officer, who were demobilised during the year and resumed their duties in September and March respectively. Both of these officers devote part of their time only to school work. Eight Health Visitors also gave the major portion of their time to the School Medical Service. For the first quarter of the year the staff arrangements were as in 1918. SCHOOLS. No. of Schools and Accommodation. In 1919 there were in Croydon : (а) 22 provided schools, including 56 departments. (б) 15 non-provided schools, including 34 departments. The total provision in 1919 in the borough for elementary school children amounted to 37 schools, with 90 departments. The number of children on the register on December 31st, 1919, was 25,432, as compared with 25,200 in 1918. School Buildings and Accommodation. The schools that were taken over as military hospitals have been vacated by the military authorities and are now re occupied as schools. Sanitary Work. The sanitation of the schools has been attended to during the year as before. Certain defects in connection with lighting, ventilation and other matters will be embodied in a separate report. 112 TABLE E. I. TOTAL NUMBER OF CHILDREN EXAMINED (ROUTINE EXAMINATIONS) DURING 1919. Age. Number of Boys. Number of Girls. Total. 3.4 4.5 47 56 103 5.6 657 536 1193 6.7 490 447 937 7.8 186 125 311 8.9 334 288 622 9.10 62 88 150 10.11 13 41 54 11.12 22 35 57 12.13 722 886 1608 13.14 319 372 691 14.15 24 42 66 Total all ages 2876 + 2916 = 5792 113 TABLE E. II. Showing total number of children, inspected—routine inspections— during 1919, classified according to the schools attended, the number of inspections held in each department during the year, and the number of parents or guardians present:— School. No. of Inspections held. No. of Children Inspected No. of Parents or Guardians present. BOYS. GIRLS. Council Schools :— Beulah Road School (All departments) 6 129 — 72 „ „ „ 9 — 122 84 Boston Road „ „ 3 68 — 28 „ „ „ 4 — 77 41 Brighton Road „ ,, 6 120 — 73 „ „ „ 7 — 98 42 Davidson Road „ „ 4 79 — 42 „ „ „ 4 — 58 38 Dering Place ,, „ 5 58 — 47 „ „ „ 4 — 66 47 Ecclesbourne Rd. „ ,, 4 61 — 30 „ „ „ 4 — 62 19 Ingram Road „ „ 4 80 — 46 „ „ „ 4 — 64 31 Mitcham Road „ ,, 11 173 — 58 „ „ „ 9 — 111 48 Oval Road „ „ 3 73 — 45 „ „ „ 6 — 128 87 Portland Road „ „ 9 171 — 107 „ „ „ 11 — 161 119 Princess Road „ „ 6 83 — 26 „ „ „ 8 — 143 71 South Norwood „ ,, 10 186 — ' 73 „ „ „ 9 — 165 53 Stanford Road ,, „ 4 48 — 38 „ „ 4 — 52 41 Sydenham Road ,, ., 4 54 — 24 „ „ „ 7 — 133 76 Tamworth Road „ „ 1 23 — 9 Tavistock Grove ,, ,, 7 138 — 62 „ „ „ 5 — 83 37 Upper Norwood ,, ,, 7 127 — 34 „ „ „ 5 — 57 24 Whitehorse Rd. ., ,, 4 89 — 36 „ „ „ 4 — 98 42 Winterbourne Rd. „ „ 12 231 — 168 „ „ „ 10 — 193 161 Woodside ,, ,, 10 194 — 106 „ „ „ 8 — 130 100 Totals 242 2185 2001 2285 114 council (non-providkd) schools:— All Saints' School (All Departments) 4 72 — 47 „ „ „ S — 81 44 Christ Church „ „ 5 89 — 39 „ „ „ 6 — 1o4 51 (Wildbore's) „ ,, 4 44 — 30 „ „ „ 4 — 49 16 Holy Trinity ,, ,, 2 25 — 16 „ „ „ 5 — 90 58 Parish Church „ ,, 7 150 — 88 „ „ „ 8 — 121 91 St. Andrew's ,, „ 3 52 — 19 „ „ „ 5 — 101 72 (Old Town) „ „ 2 22 — 8 „ „ „ 2 — 16 6 St. Joseph's ,, ,, 1 9 — 4 „ „ „ 1 — 8 4 St. Mark's ,, ,, 1 7 — 6 „ „ „ 3 — 51 16 St. Mary's „ „ — — — — „ „ „ i — 27 10 St. Michael's ,, „ i 8 — 8 „ „ „ 3 — 48 34 St. Saviour's „ ,, 4 96 — 47 „ „ „ 4 — 90 64 Arch. Tenison's ,, „ 4 61 — 22 and St. Peter's „ „ 4 — 63 41 Shirley „ „ 1 21 — 10 „ „ „ 2 — 39 15 Spring Lane ,, ,, 2 17 — 14 „ „ „ 2 — 27 19 Elmwood Hall „ „ 1 18 — 1 2 „ „ „ — — — — Totals (for Non-Provided) 97 691 51s 911 Totals (for Provided) 242 2185 2001 2285 Totals (for Provided and NonProvided) 339 2876 2915 3196 5792 In addition to these 5,792 children examined as Routine cases, 773 children were re-inspected at School, 181 children were specially inspected at School, and 1060 children were specially examined at the Treatment Centre, making a grand total of 7,806 examinations made. 115 ATTENDANCE OF PARENTS OR GUARDIANS. As in previous years, shortly before an inspection is due, notices have been sent by the Head Teacher to the parents or guardians asking them to be present. In 3,196 instances 551 per cent. advantage was taken of the invitation. Notices are not usually sent when a child is to have a special or re-examination. A slightly lower percentage of parents came to see their children examined in 1919 than in 1918. There is no indication however that parents are losing their interest in medical inspections. DIRECTIONS TO PARENTS. Written or verbal intimations were sent or given to parents in 2,346 instances. Printed directions were given in 2,216 cases. 116 TABLE E III. Shewing at each age the number of boys and girls inspected in all departments at each school also the number of boys and girls re-inspected and specially inspected at each school. Council Provided Schools. ROUTINE INSPECTIONS. ReInspected. Specially Inspected. Total. Ages:— 3-4 4-5 3-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 Beulah Road Boys ... 4 16 21 2 10 3 ... 5 48 18 2 4 ... 133 ,, Girls ... 15 13 5 1 30 6 2 1 38 ... 11 12 5 139 Boston Road Boys ... ... 5 35 4 ... ... ... ... 9 15 ... 4 6 78 ,, Girls ... ... 4 16 7 ... 3 ... 1 38 8 ... 1 8 86 Brighton Road Boys ... 12 22 12 16 30 6 ... 1 17 4 ... 15 8 143 ,, Girls ... 14 30 7 ... 14 ... 1 2 28 2 ... 17 2 117 Davidson Road Boys ... 5 13 4 7 13 ... ... ... 29 8 ... 21 13 113 , Girls ... 2 5 4 4 9 1 2 1 25 5 ... 15 3 76 Dering Place Boys ... ... 16 11 5 11 2 ... ... 11 2 ... 16 1 75 ,, Girls ... 5 12 2 3 ... ... ... 37 6 1 9 2 77 Ecclesbourne Road Boys ... ... 8 5 4 8 2 2 1 21 8 2 3 ... 64 ,, Girls ... ... 1 4 ... 6 3 ... ... 35 12 1 3 ... 65 Ingram Road Boys ... 5 16 1 4 ... 2 ... 1 31 16 4 5 5 90 ,, Girls ... 5 7 2 ... ... 2 ... ... 34 14 ... ... ... 64 Mitcham Road Boys ... 13 28 23 2 1 10 9 3 65 19 ... 45 3 221 ,, Girls ... 8 24 25 6 2 ... ... ... 32 14 ... 20 6 137 Oval Road Boys ... ... 15 31 2 ... ... ... ... 6 18 1 20 ... 93 ,, Girls ... 1 12 r5 2 11 11 1 59 '5 1 20 8 156 Portland Road Boys ... ... 56 14 3 8 ... ... 2 78 9 1 28 1 200 ,, Girls ... ... 45 21 5 1 ... ... 7 67 12 3 25 6 192 Princess Road Boys ... 1 34 23 10 3 ... ... ... 8 4 ... 7 ... 90 ,, Girls ... 1 32 34 ... 12 10 4 2 21 27 ... 23 4 170 South Norwood Boys ... 3 33 16 10 54 4 ... 3 52 11 ... 13 2 201 Girls ... 1 41 17 8 37 2 3 2 48 6 3° 5 200 Stanford Road Boys ... ... 8 16 4 10 1 ... ... 8 1 ... 4 3 55 ,, Girls ... ... 5 9 8 13 3 ... 1 13 ... ... 10 2 64 Sydenham Road Boys ... ... 12 15 3 2 ... ... ... 12 10 ... 4 3 61 ,, Girls ... ... 13 15 6 1 ... 1 ... 25 64 8 35 ... 168 Tamworth Road Boys ... ... ... ... ... ... ... ... ... 4 16 3 ... ... 23 Tavistock Grove Boys ... ... 41 31 4 15 2 ... ... 36 9 ... 33 17 188 ,, Girls ... ... 32 26 3 ... ... ... .. 19 3 ... 24 8 115 Upper Norwood Boys ... 4 8 7 3 24 2 .. 3 39 36 1 ... ... 127 ,, Girls ... 8 8 ... 4 3 1 1 ... 13 18 1 3 ... 60 Whitchorse Road Boys ... ... ... 8 31 29 ... ... ... 8 10 3 7 ... 96 ,, Girls ... ... ... ... 9 2 2 ... 1 51 33 ... 5 2 105 Winterbourne Road Boys ... ... 65 33 15 24 8 ... 2 73 11 ... 15 ... 246 ,, Girls ... ... 38 55 8 1 1 ... 1 72 16 1 8 1 202 Woodside Boys ... ... 48 32 7 35 6 1 ... 55 10 ... 25 5 224 , Girls ... ... 39 30 11 12 ... ... 3 33 2 ... 21 4 155 Totals (Provided Schools) ... 102 798 635 220 434 93 26 44 1298 492 44 550 133 4869 117 TABLE E III. continued. Council (Non-Provided) Schools. ROUTINE INSPECTIONS. ReInspected specially Inspected Total. Ages:— 3-4 4-5 5-6 6-7 7-6 8-9 9-10 10-11 11-12 12-13 13-14 14 13 All Saints' Hoys ... ... 15 17 14 20 ... ... ... 6 ... ... 2 ... 74 Girls ... ... 7 22 8 6 2 11 1 13 11 ... 7 1 89 Christ Church Boys ... 5 27 7 1 ... ... ... 43 6 ... 4 ... 93 „ Girls ... ... 8 20 3 11 14 5 2 28 12 I 1 1 106 ,, (Wildbores) Boys ... ... 30 12 2 ... ... ... ... ... ... ... 1 ... 45 " " Girls ... ... 30 17 2 ... ... ... ... ... ... ... 2 ... 51 Holy Trinity Boys ... ... 7 17 1 ... ... ... ... ... ... ... 2 2 29 ,, Girls ... ... 6 l6 1 19 2 ... ... 13 29 4 30 2 122 Parish Church Boys ... ... 35 24 6 16 ... ... ... 16 48 5 10 10 170 ,, Girls ... ... 25 31 6 18 1 ... 1 35 4 42 7 170 St. Andrew's Boys ... ... 16 10 1 2 3 ... 1 15 3 1 6 3 61 ,, Girls ... ... 8 13 ... 20 ... 1 3 34 6 ... 9 3 113 ,, (Old Town) Boys ... ... 17 2 2 ... ... 1 ... ... ... ... 7 ... 29 ,, ,, Girls ... ... 10 3 1 1 1 ... ... ... ... ... 7 ... 23 St. Joseph's Boys ... ... 9 ... ... ... ... ... ... ... ... ... ... ... 9 ,, Girls ... ... 8 ... ... ... ... ... ... ... ... ... ... ... 8 St. Mark's Boys ... 5 2 ... ... ... ... ... ... ... ... 1 ... 8 ,, Girls ... ... 4 2 2 7 ... 1 2 23 10 ... 18 1 70 St. Mary's Boys ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 4 ,, Girls ... ... ... ... ... 13 ... ... ... 10 3 1 1 ... 28 St. Michael's Boys ... ... 8 ... ... ... ... ... ... ... ... ... 5 ... 13 ,, Girls ... ... 3 ... 1 25 2 1 ... 7 7 2 14 ... 62 St. Saviour's Boys ... ... 31 l6 5 9 3 ... ... 17 14 1 9 2 107 Girls ... ... 35 I 2 ... ... 1 1 15 28 7 8 2 100 Archbishop Tenison's Boys ... ... 17 12 . 4 ... ... ... ... 15 13 ... 15 4 80 and St. Peter's Girls ... ... 23 14 4 3 2 1 2 14 ... ... 8 6 77 Shirley Boys ... ... 10 7 3 1 ... ... ... ... ... ... ... ... 21 ,, Girls ... ... 1 1 10 6 4 6 ... 6 5 ... 3 ... 42 Spring Lane Boys ... ... 8 6 3 ... ... ... ... ... ... ... 4 4 25 ,, Gills ... ... 14 10 1 2 ... ... ... ... ... ... 3 ... 30 Elmwood Hall Boys ... ... ... ... 2 8 8 ... ... ... ... ... ... ... 18 ,, Girls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals Non - Prov. Schools ... 1 395 302 91 188 57 28 13 310 199 22 223 48 1877 Totals Provided Schools ... 102 798 635 220 434 93 26 44 1298 4.12 44 550 133 4869 Grand Totals ... 103 "93 937 311 622 150 54 57 1608 691 66 773 18 6746 118 GENERAL RESULTS OF ROUTINE MEDICAL INSPECTIONS. HEIGHTS AND WEIGHTS. The following table gives the averages of the children examined at three age periods in ten of the schools in Croydon:— Age. Average Height in Inches. Average Weight in Pounds. Boys. Girls. Boys. Girls. 5 40 9 41.9 38.5 38.0 8 48 8 48.4 50.7 56.0 13 567 55'5 79.4 82.5 WANT OF CLEANLINESS. Of the 5,792 children examined, 22 = 38% had vermin in the head. 494 = 8'5% ,, nits ,, ,, 85 = 1.4% ,, dirty heads without vermin or nits. Among the 5,792 children 2 only were found with body vermin and 184 = 3.1 % were described as dirty. These figures are slightly better than those of the preceding year. On the whole there continues to be a steady improvement; it is exceptional to see the markedly verminous head that was quite common a few years ago. Very considerable help has been given by the teachers in raising the standard of cleanliness They have great facilities for approaching the children and their parents, and most teachers have made the best of their opportunities. CLEANSING STATION. During the year 17 school-children were cleansed at the station 011 account of body-vermin. 49 school-children were similarly treated as they were suffering from scabies (the itch). This condition was more prevalent during the war, many families having been infected by contact with soldiers. CLOTHING. Children with defective clothing numbered 22 = .37 per cent. „ ,, dirty „ 98 = 1.6 „ „ „ defective footgear „ 23 = .39 „ It is much more common to find children with too much clothing than too little. The child is nearly always specially prepared for medical inspection and figures describing cleanliness and clothing are somewhat misleading. 119 MALNUTRITION. 137 children, viz., 79 girls and 58 boys = 2.3% were found to be poorly nourished. This is an improvement on last year's results, which is probably due to the increase of rations. Nevertheless, the nutrition of the children is far from satisfactory. There seems to be a larger proportion of children with "fair" nutrition and a correspondingly less number of children having "excellent" nutrition. This is very noticeable in some schools where few of the young children—those from 5—8 years old—have a really healthy appearance. Several of the teachers say that they notice a lack of brightness and energy in the children, which they associate with insufficiency of certain articles of diet such as milk, butter and eggs. Apart from the question of food there are other causes of malnutrition. Children with enlarged tonsils and adenoids frequently have a poor physique and are included among the poorly nourished. In a few cases tuberculosis accounts for the poor nutrition. Much may be done for such children as these by early and adequate medical and other treatment, thus :— (а) Any obvious defect such as enlarged tonsils or adenoids should be attended to. The establishment of the Throat Clinic has facilitated this. (b) The diet may be increased. In suitable cases, milk is supplied to be consumed in school for a period of not less than three months. An increase in weight at the end of this period has frequently indicated that the child has made progress. In other cases cod liver oil and malt is provided at the Treatment Centre at cost price. (c) Open air living conditions may be provided. In a few cases the child' is excluded from school. Equally good results or better are obtained in open-air classes. In these classes a child does its lessons out of doors and is encouraged to rest or exercise itself as the occasion demands. Such a class exists at Woodside School, where encouraging results have been obtained. The class is not necessarily restricted to the poorly nourished ; children with bronchitis, asthma, heart disease, and other complaints often improve under these conditions. EYE DISEASES. 66 children were found suffering from external diseases of the eye, uhich include such conditions as squint, inflamed eyelids, and ulcers. 774 children = 13.3% had sub-normal vision. When considered necessary these children are referred to the ophthalmic surgeon for special examination and subsequent treatment if needed. TONSILS AND ADENOIDS. In 389 children the tonsils were slightly enlarged. ,,271 „ „ „ „ markedly „ ,, 234 „ adenoids were present. That is 894 children or 15.4% had unhealthy conditions of the throat and nasopharynx. 120 The long-standing cases can nearly always be detected at a glance by the child's typical facial appearance. These cases are not so frequently seen now that medical inspections are held more systematically and that teachers are familiar with the signs of obstruction to breathing. The treatment is not always surgical. Mild cases often improve considerably if the child can be broken of the habit of mouth-breathing. For the marked cases, especially those associated with deafness, surgical treatment at an early date is recommended. The Throat Clinic established in 1918 at the Croydon General Hospital continues to provide satisfactory treatment. If the child has decayed teeth it first receives treatment at the hands of one of the school dentists. When the child's mouth has been made clean, arrangements are made for the child to go to the Throat Clinic. This institution saves the parents much trouble and expense. Formerly many of the children were taken to London hospitals, which often have long waiting lists. The table on page 25 shows the operations performed at the Clinic. GLANDS. Glands in the neck were found slightly enlarged in 265 children> markedly so in 178 Total per cent., 7.6 In a few cases the enlargement was tubercular in origin; these children are nearly always referred to the Tuberculosis Dispensary for treatment and observation. Much more frequently enlarged glands are associated with enlarged tonsils and adenoids, ear discharge, decayed teeth, or vermin and nits in the head. In the latter conditions the glands quickly diminish when the cause is removed. EAR DISEASE. 50 children — .86% were found to be suffering from ear disease, and 105 — 1.8% were deaf. Wax in the ear accounts for many cases of deafness which can be readily cured. The serious and most persistent cases are associated with enlarged tonsils and adenoids, or date back to an infectious illness such as scarlet fever or diphtheria, which both affect the throat and often the ears. If necessary the throat must receive treatment as well as the ears; consequently many of these children are sent to the Throat Clinic. At the Treatment Centre numerous cases of ear disease are treated. Parents often syringe a child's ears irregularly and imperfectly, and the discharge n ay persist for many months. In very obstinate cases an operation on the ear may be needed at the hands of a specialist. DEFORMITIES. Spinal curvature was present in 48 children. Deformities of various types such as club foot, hip disease, occurred in 99. The spinal cases, except those due to tuberculosis, are nearly always recommended for special exercises. There are too many children to be accommodated in Miss Appleton's Remedial Class, and a certain number obtain their exercises at school. There are numerous children suffering from deformities caused by infantile paralysis, rickets, and other diseases, who would be benefited by a course of massage or electricity. At present this is not provided by the Local Education Authority, and there is no institution in Croydon where it can be obtained. TABLE E IV. Age. Number Examined. Parents or Guardians Present. Total Number in whom Defects found. Nature of Defects. Want of Cleanliness. Clothing. Vision. External Eye Disease, Malnutrition. Teeth. Tonsils. Glands. Adenoids present. Ear Trouble. Mentally Defective. Mentally Subnormal. Heart Affections. Lung Trouble. Deformity and Spinal Dis. Communicable Disease. Sundry Defects If employee Written and Verbal directions to Parents. Printed directions Heads. Body. Clothing. Defecttive Foocgear. 6/9 6/12 and worse. One to Four Decayed. More than Four Decayed Ear disease. Deaf, ness. Phthisis. Bronchitis Other Lung Disease. Spinal Curvature. Other Deformities. Ver. Nits only. Dirty. Ver. Dirty. Defective Dirty. + + + Palpable + General Hygienic Advice. Medical or Surgical Treatment. ROYS SCHOOLS. 3-4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4-5 47 34 23 ... 1 ... ... ... ... ... 1 ... ... 1 ... 12 2 4 2 4 3 2 ... ... ... ... ... ... 1 ... ... ... ... 2 ... 5 3 16 5-6 657 443 478 5 15 13 23 4 14 1 ... 3 7 25 220 135 69 57 36 25 45 4 15 ... 6 16 ... 16 26 2 9 0 33 ... 105 154 253 6-7 490 307 369 ... 17 12 ... 18 2 9 2 2 2 8 12 176 133 45 29 25 28 28 3 7 2 2 13 4 9 14 ... 11 2 21 ... 70 93 195 7-8 186 122 149 2 8 12 17 7 11 2 I 3 4 65 02 13 11 21 11 13 3 3 1 ... 3 ... ... 1 1 3 2 11 ... 27 45 63 8-9 334 169 254 ... 11 9 ... 18 1 12 1 50 22 5 10 175 57 17 21 14 16 13 6 8 ... ... 9 ... 4 9 ... 6 1 18 ... 80 111 182 9-10 62 28 47 ... 1 3 ... 2 ... ... ... 4 2 1 ... 24 13 3 2 2 2 3 1 3 ... ... 3 ... ... 2 ... ... ... 1 ... 10 12 37 10-11 13 8 12 ... ... 1 ... 2 ... 1 ... 1 2 1 ... 9 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 2 10 11-12 22 7 18 ... ... ... ... ... ... ... 2 4 ... ... 9 4 ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... 1 1 ... ... 4 7 11 12-13 722 268 493 ... 5 4 13 4 9 5 84 69 5 4 275 44 32 16 30 4 12 4 15 ... 5 21 2 2 11 5 8 3 32 3 106 174 211 13-14 319 84 217 1 12 4 ... 11 ... 5 4 30 24 5 3 129 1 1 13 7 8 3 8 2 5 1 1 5 1 3 4 ... 9 1 8 7 38 58 114 14-15 24 5 15 ... ... ... ... ... ... ... ... 1 3 ... ... 11 1 1 1 ... ... ... 2 . ... 33 ... ... ... ... 1 ... 1 ... 1 3 7 15-16 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 2876 1475 2075 8 70 58 1 104 18 61 16 175 134 34 58 1103 464 198 140 140 03 127 25 59 4 14 73 7 35 67 8 49 15 127 10 447 662 1099 Per. cent. 100. 51.2 72.1 0.2 2.4 2.0 .03 3.6 0.6 2.1 0.5 6.08 4.6 1.1 2.01 38.4 l6.1 6.8 5.0 4.8 3.2 4.4 0.8 2.4 0.1 0.4 2.5 0.2 1.2 2.3 0.2 1.7 0.5 4.4 0.3 15.5 23.0 38.2 GIRLS' SCHOOLS. 4-5 56 39 35 1 7 ... ... 2 ... 1 ... ... ... ... 1 14 5 3 4 ... 1 2 1 ... ... ... 3 ... 1 1 ... ... ... 4 ... 6 7 21 5-6 536 363 376 1 74 4 ... 9 2 3 2 ... 1 7 21 198 105 40 34 31 15 30 6 13 2 1 19 4 5 21 2 10 5 16 ... 87 180 194 6-7 447 316 349 4 59 5 1 14 ... 9 1 1 2 3 12 178 123 41 25 28 21 18 6 10 1 ... 11 2 5 10 4 7 1 15 1 83 100 196 7-2 125 91 95 2 14 ... ... 3 1 1 ... 1 1 3 2 45 32 15 6 14 9 6 2 4 1 3 3 1 1 3 ... ... ... 9 ... 27 34 47 8-9 288 169 239 1 58 4 ... 7 ... 4 ... 46 22 3 17 146 74 17 16 7 10 14 3 4 3 5 14 ... ... 8 2 2 2 15 ... 72 108 124 9-10 88 50 57 ... 6 ... ... 2 ... 1 7 17 ... 4 44 17 5 3 5 2 7 1 3 1 2 4 2 2 3 2 1 ... 7 ... 19 28 35 10-11 41 19 30 ... 4 ... ... ... ... ... ... 6 4 ... 1 14 4 ... 1 ... ... 1 ... ... ... ... 3 ... 1 4 1 ... ... 1 ... 10 9 27 11-12 35 19 29 ... 12 ... ... 1 ... 1 1 5 6 2 2 18 2 3 1 1 ... 1 1 1 ... ... 2 ... ... 1 1 2 ... 3 ... 15 20 18 12-13 886 438 610 2 133 6 ... 31 1 10 1 145 104 11 16 369 46 42 25 32 21 20 5 6 ... 2 44 3 2 16 l6 18 3 71 ... 149 215 330 13-14 372 191 273 3 55 7 ... 11 ... 7 2 55 35 3 3 175 18 24 10 7 6 8 ... 4 1 2 18 ... 4 6 8 8 1 17 ... 57 51 122 14-15 42 26 30 ... 2 1 ... ... ... ... ... 6 1 ... ... 17 2 1 ... ... ... ... 1 ... ... 5 ... ... 1 4 2 ... 1 ... 6 4 15-16 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. . ... ... ... ... ... ... ... ... ... ... ... ... ... Total 2916 1721 2123 14 424 27 1 80 4 37 7 272 193 32 79 1218 428 191 125 125 85 107 25 46 9 15 126 12 21 74 40 50 12 159 1 531 706 1117 Per cent. 100. 59.??? 72.8 0.4 14.5 0.9 .03 2.7 0.1 1.2 0.2 9.3 6.6 1.1 2.7 41.7 14.6 6.5 4.2 4.2 2.9 3.6 0.8 1.5 0.3 0.5 4.3 0.4 0.7 2.5 1.3 1.7 0.4 5.4 .03 18.2 24.2 38.2 TOTALS FOR BOYS AND GIRLS. 5792 3196 4198 22 494 85 2 184 22 98 23 447 327 66 137 2323 892 389 271 265 178 234 50 105 13 29 199 19 56 141 48 99 27 286 11 978 1368 2216 Per cent. 100. 55.2 72.4 0.3 8.5 1.4 .03 3.1 0.3 l.6 0.3 7.7 5.6 1.1 2.3 40.1 15.4 6.7 4.6 4.6 3.0 4.0 0.8 1.8 0.2 0.4 3.4 0.3 0.9 2.4 0.8 1.7 0.4 4.9 0.1 16.8 23.6 38.2 121 AFFECTIONS OF THE HEART were found in 199 children= 3 4%, and for the most part caused little or no inconvenience to the child. The mild conditions are usually temporary and associated with anaemia or slight debility from any cause. It is the practice to re-examine these children at intervals lest a mild condition develop into one more serious. In the severe heart conditions the heart-valves are nearly always permanently injured and most frequently from rheumatism. This disease is often obscure in its symptoms and is unidentified ; nevertheless, the heart may be affected. When rheumatism is suspected in a child a pamphlet is handed to the mother indicating the symptoms of the disease and the precautions that should be taken. In the mild cases of heart disease it is often found inadvisable to use the term weak heart to a parent There is a tendency to treat the child as an invalid and keep it at home on slight pretexts. The teacher is usually informed, as it is sometimes necessary to modify the physical exercises of the child. AFFECTIONS OF THE LUNG were found in 216 children. 19 of these were suffering from pulmonary tuberculosis. These cases are nearly always sent to the Tuberculosis Dispensary Sometimes the child is excluded from school, but exclusion may cause no improvement unless home conditions are very satisfactory. The child's presence at school causes no risk to other children if the case is one of closed tubercle. Bronchial catarrh is the condition most frequently found, and is usually an extension of an ordinary cold. Many of these children become anaemic and flabby, but derive benefit from cod-liver oil and malt, especially in conjunction with plenty of fresh air This type of child is nearly always suitable for an open-air class ; probably the lung condition is attributable to or aggravated by over-heated or illventilated living conditions. MENTAL CONDITIONS. At routine inspections 13 children were classed as mentally defective and 29 as mentally sub-normal. Children suspected of being mentally defective are referred to the School Medical Officer for special examination. The most common cause of backwardness in children is enlarged tonsils and adenoids. The removal of these often causes the most gratifying improvement in the child's mental condition. It is impossible at a routine medical examination to detect every case of mental deficiency, as many are of a mild type or again may only be cases of mental backwardness. Special classes for these types should be established. 122 DENTAL DEFECTS. The following table reveals the prevalence of dental caries as found at school medical inspections. FABLE E. VII. BOYS. Age Group. 1 -4 Decayed Teeth. Over 4 Decayed Teeth. Number with sound Teeth. Percentage with sound Teeth. 3.4 ... ... ... ... 4.5 12 2 33 70.2 5.6 220 135 302 45.9 6.7 176 133 181 36.9 7.8 65 62 59 31.7 8 9 175 57 102 30.5 9.10 24 13 25 40.3 10.11 9 2 2 15.8 11.12 9 4 9 40.9 12.13 275 44 403 55.8 13.14 129 11 179 56.1 14.15 11 1 12 50.0 Totals 1105 464 1307 45.4 Total number of boys inpected 2876 GIRLS. 1.5 14 5 37 66.0 5.6 198 105 233 43.4 6.7 178 123 146 32.8 7.8 45 32 48 38.4 8.9 146 74 68 23.6 9.10 44 17 27 30.6 10.11 14 4 23 56.0 11.12 18 2 15 42.8 12.13 369 46 471 53.1 13.14 175 18 179 48.1 11.15 17 2 23 54.7 Totals 1218 428 1270 43.5 Total number of girls inspected 2916 123 MENTAL DEFICIENCY. During the year the special class for backward children has been replaced by a special school for mentally defective children. The numbers taught at this class during 1919 are given below. GRANGEWOOI) SPECIAL SCHOOL. The following summary shows the number of children taught at this school during the year: — Number of children on Register on 31st December, 1918 54 Number of children admitted to class during 1919 15 Number of children discharged and re-admitted to Council Schools, 1919 2 Number of children discharged for unsuitability 3 Number of children on Register, December 31st, 1919 58 Number of children left district during 1919 2 Number of children left over age 1 Number of children left for other reasons . 3 EDUCATION CASES. In certified institutions 8 ,, Poor-law ,, 2 Resident at home 108 (58 of these are on the roll of Grangewood Special School). During the year 13 Education cases have attained the age of 16, and rooters have been certified as ineducable. THE WORK OF THE OPHTHALMIC SURGEON. The number of refractions done in 1919 was 588; in 1918 the number was 494. The total number of children examined for eye trouble in 1919 was 638, as contrasted with 531 in 1918. The following is a summary of the cases seen in the eye clinic at the Town Hall:— Total No. of children examined 638 „ ,, „ attendances 1238 TABLE E. viii. Children refracted 588 Glasses were ordered for 394 Glasses not needing changing 62 Glasses needed changing 11 Glasses not advised at present 81 Had normal vision 40 588 Glasses were needed and ordered as follows Myopia 89 Myopic Astigmatism 33 Hypermetropia 97 Hypermetropic Astigmatism 68 Anisometropia 3° Mixed Astigmatism 8 Strabismus internus 65 „ alternating 3 ,, periodic 1 394 124 Of the glasses ordered 103 were urgently needed and were as follows: — Myopia 16 Myopic Astigmatism 4 Hypermetropia 6 Hypermetropic Astigmatism 8 Strabismus, internus 65 ,, alternating 3 „ periodic 1 103 Other diseases treated and advised upon were:— Conjunctivitis 92 „ contagious 11 Blepharitis 21 Ulcer of cornea 11 „ multiple 1 Phlyctenula 18 Epiphora 5 Nystagmus 10 Nebula 7 Pannus 2 Keratitis 2 ,, interstitial 10 Glaucoma 1 Hordeolum '3 Paresis 1 Symmetrical paresis of both externi 2 Strabismus internus 2 Lachrymal ducts closed 1 Chalazion 8 Keratitis—old with strabismus externus 1 Kerato-iritis 1 Cataract, post-capsular 1 Cateract, lamella 1 Contused globe 1 Sub-conjunctival ecchymosis 1 Microphthalmos 1 Operation on canaliculus 1 Pigmentary retinitis 2 Congenital cataract 1 Eczema 1 Ptosis 1 Abscess of lid 1 Old tubercular chloroiditis 1 Remains of capsulo-pupillary membrane 1 Blepharochalasis 1 Total 235 Hospital was advised for 6 children, dark glasses for 1 and special school for I. 125 THE WORK OP THE SCHOOL DENTISTS. TABLE E. ix. Dental Inspection of Schools (Children 6—7 years of age) School. Children Examined. Teeth all sound. Teeth Defective. Percent'ge with Sound Teeth. Boys. Girls Total. Boys. Girls. Boys. Girls. Boys. Girls. Beulah Road 28 46 74 5 8 23 38 17.8 22.2 Boston Road 43 38 81 7 . 9 36 29 16.2 23.6 Brighton Road 37 26 63 5 5 32 21 13.4 19.2 Davidson Road 36 32 68 4 3 32 29 11.1 9.3 Dering Place 12 21 33 1 5 11 16 8.3 23.8 Ecclesbourne Road 41 3° 71 3 3 38 27 7.3 10.0 Ingram Road 56 59 115 8 6 48 53 14.2 10.1 Mitcham Road 63 59 122 14 10 49 49 22.2 16.9 Oval Road 33 23 55 4 3 29 20 12.1 13.0 Portland Road 68 48 116 15 8 53 40 22.0 16.9 Princess Road 106 96 202 23 15 83 81 21.7 15.6 South Norwood 28 32 60 3 7 25 25 10.7 21.8 Stanford Road 52 39 91 9 3 43 36 17.3 7.7 Sydenham Road 81 80 161 11 12 70 68 13.5 15.0 Tamworth Road 23 18 41 3 3 20 15 13.4 16.6 Tavistock Grove 36 32 68 6 4 30 28 16.6 12.5 Upper Norwood 29 22 51 4 5 25 17 14.0 22.7 Whitehorse Road 114 121 235 20 21 94 100 17.5 17.3 Grangewood Special School 23 17 40 7 6 16 11 30.4 35.2 Winterbourne Road 110 100 210 25 18 85 82 22.7 l8.0 Woodside 58 50 108 14 10 44 40 24.1 20 .0 All Saint's 14 22 36 4 6 10 16 28.5 27.2 Christ-' hurch, Longley Rd. 29 21 50 2 3 27 18 6.8 14.2 Christ Church, Boston Rd. 19 16 35 4 2 15 14 21.0 12.5 Holy Trinity 24 23 47 6 6 18 17 25.0 26.0 Parish Church 53 54 107 9 3 44 51 16.9 5.5 St. Andrew s 22 20 42 2 7 20 13 9.0 35.0 St. Andrew's Old Town 6 9 15 ... 1 6 8 ... 11 .1 St. Joseph's 3 7 10 2 2 1 5 66.0 29.0 St. Mark's 10 21 31 1 4 9 17 10.0 19.0 St. Mary's ... 12 10 22 1 2 11 8 8.3 20.0 St. Michael's 11 10 21 3 1 8 9 27.2 10.0 St. Saviour's 27 39 66 10 7 17 32 37 .0 18.0 St. Peter's 20 40 60 3 4 17 36 15.0 10.0 Shirley 9 4 13 2 ... 7 4 24.4 .. Spring Lane 19 16 35 1 1 18 15 5.2 6.2 Totals 1355 1301 2656 241 213 1114 1088 17.7 16.3 126 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-inspeotion. Children found to have defective teeth at primary inspection, but who have not been treated at the Dental Clinic. At re-inspection. All sound. Requiring treatment. Requiring no further treatment Requiring further treatment Children treated privately. Children treated privately and now requiring further treatment. Children treated privately and not requiring further treatment. Children who have received no dental treatment. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. 1919. Jan. 17 St. Saviour's 1 3 ... ... 1 ... ... ... ... ... ... ... ... ... 6 12* ,, 21 Ecclesbournc Road 2 ... ... 1 4 ... ... ... ... ... ... ... ... ... 9 19* ,, 16 St. Mary's 2 ... ... 1 ... ... ... ... ... ... ... ... ... ... 11 9 ,, 16 Tavistock Grove 1 2 ... 2 2 ... ... ... ... ... ... ... 1 ... 22 26 ,, 20 Oval Road 2 4 ... ... ... ... ... ... ... ... ... ... ... ... 4 15a ,, 20 Woodside 3 2 2 4 ... ... ... ... ... ... 1 1 ... ... 23 25 ,, 20 Birchanger Road 4 2 2 3 ... ... ... ... ... ... ... ... ... ... 34 25 „ 23 Brighton Road 1 1 3 ... ... ... ... ... ... ... ... ... ... 24 12** ,, 23 Christ Church ... ... 1 ... ... ... ... ... ... ... ... ... ... 10 5** June 26 Whitehorse Road 8 7 ... 2 5 7 ... ... 1 1 1 1 ... ... 36 23 July 3 St. Peter's 4 4 ... 1 ... ... ... ... ... ... ... ... ... ... 15 28b ,, 3 Brignton Road 3 4 1 ... ... ... ... ... ... ... ... ... ... ... 18 14c ,, 3 Ecclesbourne Road 2 1 1 ... 4 6 ... ... ... ... ... ... ... ... 18 8 ,, 7 St. Andrew's Infants' I 7 1 1 ... ... ... ... ... ... ... ... ... ... 15 14 ,, 7 St. Andrew's, Old Town ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 6 ,, 9 Oval Road 5 3 1 ... ... ... ... ... ... ... ... ... ... ... 24 18 ,, 9 Tavistock Grove 3 2 1 1 ... ... ... ... ... ... ... ... ... ... 22 17 ,, 10 Stanford Road 1 2 ... ... 2 4 ... ... ... ... ... ... ... ... 5 Sep. 5 Winterbourne Road 6 3 1 3 10 3 ... 2 ... ... ... ... ... ... 10 28* ,, 5 Beulah Road 4 5 1 ... ... ... ... 1 ... 1 ... ... ... 20 29d ,, 10 South Norwood 1 7 ... 3 ... ... ... ... ... ... ... ... ... ... 39 29 ,, 10 Woodside 10 5 1 3 ... ... ... ... ... ... ... ... ... ... 24 23 ,, 23 St Mark's 1 2 ... 1 1 1 ... ... ... ... ... ... ... ... 10 5 ,, 23 Portland Road 7 6 5 2 10 8 ... ... 2 ... 2 ... ... ... 31 19 Oct. 10 St. Saviour's 4 3 1 ... 1 ... ... ... ... ... ... ... ... ... 5 11* „ 10 Princess Road 11 7 3 ... ... 3 ... ... 1 ... 1 ... ... ... 31 29 ,, 14 Holy Trinity 5 4 ... ... 3 1 ... ... ... ... ... ... ... ... 7 1l‡ ,, 14 Sydenham Road ... 2 ... ... 9 5 ... ... ... 1 ... 1 ... ... 16 20 ,, 17 All Saints ... ... ... ... 1 1 ... ... ... 1 ... 1 ... ... 5 8† ,, 17 Rockmounl Road 4 4 ... ... 4 3 1 ... 1 5 1 5 ... ... 12 4 ,, 17 St. Joseph's 1 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ,, 27 Christ Church 2 3 ... ... 1 1 ... ... ... ... ... ... ... ... 14 16 ,, 27 Boston Road 6 5 1 3 2 ... 2 ... ... ... ... ... ... ... 29 25 ,, 27 Christ Church, Boston Road 1 5 ... 1 ... ... ... ... ... ... ... ... ... ... 14 11 ,, 28 Ingram Road 5 4 1 1 1 ... ... ... 1 ... 1 ... ... ... 34 35 ,, 29 Stanford Road 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... 17 6 Nov. 24 St. Mary's ... 2 ... ... ... ... ... 1 ... ... ... ... ... ... 9 5*** ,, 24 Mitcham Road 11 3 2 1 ... ... ... ... ... ... ... ... ... ... 38 28 127 * Many absent. ** Some absent. *** 5 girls 2 boys absent. † Many left or absent. ‡ Many being treated. a 6 absent. b 4 absent c 10 absent d 12-14 absent >—I LO 00 TABLE E xi. 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. Roys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. January 56 89 11 22 3 1 79 133 11 5 ... 7 60 children did not attend. February 92 100 17 32 1 4 145 131 ... 1 1 5 108 children did not attend. March 48 74 7 38 8 2 69 67 ... 14 3 11 66 children did not attend. 1 refused treatment April 87 97 14 21 8 5 126 119 7 16 3 3 76 children did not attend. 3 refused treatment. May 124 151 56 57 5 9 154 166 6 31 18 24 83 children did not attend. 3 refused treatment. June 119 88 30 36 4 3 184 24 ... 10 5 7 79 children did not attend. July 67 72 3° 23 5 2 67 75 2 4 7 9 63 children did not attend. 2 refused treatment. August ... ... ... ... ... No Clinics ... ... ... ... Sept. 162 115 42 17 5 ... 234 208 5 6 13 9 121 children did not attend. 3 refused treatment. October 152 137 62 57 11 3 184 149 13 14 11 14 119 children did not attend. 4 refused treatment. Nov. 155 147 61 53 12 6 209 215 11 5 8 12 107 children did not attend. 1 refused treatment- Dec. 114 91 34 36 1 5 '55 105 8 9 2 4 Si children did not attend Total for year 1176 1161 364 392 63 40 1606 1492 63 115 76 105 943 did not attend. 17 refused. TABLE E xi.—Continued. Cases treated for dental caries as preparation for operation on tonsils and adenoids. 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 ... ... ... ... ... ... ... ... ... ... ... ... February ... ... ... ... ... ... ... ... ... ... ... ... March ... ... ... ... ... ... ... ... ... ... ... ... April ... ... ... ... ... ... ... ... ... ... ... ... May .58 37 31 7 ... 10 63 56 4 ... 2 3 32 children did not attend. June 24 19 5 9 ... ... 34 20 3 1 ... 1 1 refused treatment. 45 children did not attend. July 30 18 12 9 1 ... 39 19 ... ... 2 1 1 refused treatment. 39 children did not attend. August ... ... ... ... ... No Clinics ... ... ... ... ... September 28 40 3 4 3 ... 59 63 ... ... 2 1 40 children did not attend. October 26 18 10 12 ... 2 22 18 ... ... 1 1 1 refused treatment. 26 children did not attend. November .. 30 13 9 5 7 ... 39 16 1 ... 1 2 1 refused treatment. 14 children did not attend. December 26 21 II 1 ... ... 31 28 1 1 ... ... 1 refused treatment. 33 children did not attend. Total for year 222 166 81 47 11 12 287 220 9 2 8 9 229 did not attend. 5 refused. 129 Spccial Cases. January ... ... ... ... ... ... ... ... ... ... ... ... February ... ... ... ... ... ... ... ... ... ... ... ... March ... ... ... ... ... ... ... ... ... ... ... ... Apiil ... ... ... ... ... ... ... ... ... ... ... ... May 17 17 . 4 5 2 2 19 8 6 ... 4 7 5 children did not attend. June 5 7 2 4 2 ... ... 4 4 1 ... 1 6 children did not attend. July 20 5 16 5 ... ... 11 2 4 ... 1 ... 6 children did not attend. August No Clinfcs September 12 16 2 1 ... 3 26 20 ... ... 2 ... 19 children did not attend. 1 refused treatment. October 5 8 ... ... ... ... 2 7 ... 2 ... ... 5 children did not attend. November 16 7 3 4 6 ... 11 4 ... ... 3 2 15 children did not attend. December 13 12 2 1 3 1 14 7 3 ... 2 3 5 children did not attend. Total for year 88 72 34 20 13 6 83 5' 17 3 12 13 61 did not attend. 1 refused. Grand total i486 1399 479 459 87 58 1976 1764 89 120 96 127 1233 did not attend. 23 refused. 130 131 THROAT CLINIC. (See also page r.4). The 1 hroat Clinic has been continued during 1919 under the same circumstances as in 1918. An important change in its actual working however is that all children who are to be operated on for enlarged tonsils or adenoids must, if dental caries be present, first have their teeth attended to. The details of this dental work appears in Table E xi (b). The returns of the cases dealt with are given in the following table:— Date. Appointments made. Operated upon. Remarks. Cases done by House Surgeon at Croydon Gen'l. Hospital. January 19 10 9 did not come. February 44 24 11 did not come. 7 teeth to be attended to. 2 operations postponed. March 39 16 18 did not come. 3 teeth to be attended to. 2 operations postponed. April ... 20 6 12 did not come. 2 teeth to be attended to. May 38 23 8 did not come. 2 teeth to be attended to. 2 operations not necessary. 2 to be operated again. 1 operation postponed. June 33 17 8 aid not come. 4 operations not necessary. 4 to be operated again. July 51 34 14 did not come. 10 operations. 2 pestponod. 1 operation not necessary. August Schools and Clinics vacation. September 41 27 11 did not come. 10 operation*, 2 postponed. 1 operation not necessary. October 48 38 8 did not come 1 operation. 2 postponed. November 40 36 2 did not come. 2 operations. 2 postponed. December 23 23 Nil. 2 operations. 396 254 142 25 Analysis of cases in column 3 :— 101 did not come 14 teeth required attention. 13 operations postponed. 8 operations not necessary, 6 to be operated again. 142 132 SCHOOL TREATMENT CENTRE anp SPINAL REMEDIAL WORK. TREATMENT OF SCHOOL CHILDREN. Total number of new cases 1060 Total number of attendances 4926 The Centre is as heretofore open daily for the treatment of minor ailments. One of the medical staff is present on two mornings each week and a nurse every morning to carry out the treatment advised. In the school year the new cases averaged 26.5 per week. RINGWORM. Ringworm in school children has been treated at the School Treatment Centre, and also by Dr. Critchley when X-ray treatment was advised and accepted. TABLE E. xiii. Totals. Total No. of children treated Scalp 268 Body 44 312 No. of attendances Scalp 1569 Body 56 1625 No. of cases X-rayed 94 Total attendances for X-ray treatment 188 No. of cases treated by Drugs Scalp 174 Body 44 218 SPECIAL EXAMINATION OF CHILDREN AT THE SCHOOL TREATMENT CENTRE. Number of Children who have attended at the request of the Education Committee's officers or of teachers or parents and who were found on examination to be suffering from the following diseases, viz. :— Diseases of Lungs 78 ,, Heart 15 ,, Ear, Throat and Nose 223 „ Skin (Scabies 76, Impetigo 129) 205 Ringworm— Scalp 173 Body 33 206 * Mentally Defective Children 6 Diseases of Nervous System 35 Spinal Affection 10 Eye Diseases or Defects J7 Glands 37 Rheumatism 16 Debility 29 Anaemia 14 Various 162 Infectious Diseases- 1 Chicken Pox 1 7 2 Diphtheria 4 Scarlet Fever 1060 * This is exclusive of children examined in accordance with ihe requirements of the Mental Deficiency Act. 133 SPINAL REMEDIAL CLASS. Children treated during year : 39 girls, 4 boys. Discharged, 20 (not requiring further treatment). Discharged, 1 (not advisable to continue). Discharged, 1 (owing to irregular attendance). Left school, 5. Left district, 2. Still attending class, 14. Total attendances during year, 1390. COMMUNICABLE DISEASE. At Routine Inspections 27 cases were found. The diseases in question were:—Impetigo 7, Ringworm 2, Scabies 4, Eczema 1, and 13 not described. In addition special visits have been made to certain schools by one of the medical staff when there has been an unusual local prevalence of any infectious disease. Children with slight symptoms have been found in school as the result of a general examination of the scholars, and by bacteriological examination of selected cases diphtheria carriers have been detected. It is now the practice when a school'has been closed for infectious disease for one of the school doctors to visit the school when it reopens to discover and exclude any hitherto unrecognised cases of the disease or any child shewing suspicious signs of infection. ACTION TAKEN TO PREVENT SPREAD OF INFECTIOUS DISEASES. TABLE E. xv. 3,600 notices of illness (including duplicate notices) were received from School Teachers or Attendance Officers during 1919. Notices of infectious diseases were despatched to the respective schools by the Public Health Department to the respective schools in 4,278 cases as described below Illness. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Scarlet Fever 47 58 69 132 306 Diphtheria 22 48 55 114 239 Influenza 74 5 — I 180 Measles 13 7 30 225 275 Mumps 12 22 5 67 106 Whooping Cough 4 11 14 3 32 Chicken-pox 74 149 82 151 456 Sore Throat 30 34 54 204 322 Ringworm (Scalp) 40 70 20 32 162 „ (body) 44 27 12 20 Impetigo 126 09 136 257 728 Scabies 131 66 21 59 377 Eye Cases 20 22 20 48 110 Other diseases 89 217 146 43° 882 Totals 926 945 664 1743 4278 134 WORK OF THE HEALTH VISITORS. There are eight health visitors, two of whom assist at the clinics only. The other six assist at medical inspections, visit the homes of children suspected to be suffering from infectious disease or in order to follow up defects found at medical inspections, etc. Each of these health visitors has n district of her own, and therefore is well acquainted with the schools, children and parents in her district. The work of the health visitors is summarised in the following table, with the exception of the clinic work. TABLE E. xvi. Visits to Houses where the following Diseases have occurred. School Cases. 1st Visits. Subsequent Visits. Scarlet Fever 33 11 Diphtheria 349 238 Measles 665 93 German Measles 40 5 Mumps 16g 12 Whooping Cough 54 12 Chicken Pox 607 42 Sore Throat 658 451 Ringworm (scalp) 211 678 ,, (body) 129 211 Verminous Heads 11 13 Verminous Bodies 17 13 Impetigo 1558 2419 Scabies 387 767 Infectious Eye Disease 232 208 Other Diseases 2445 1207 7564 6380 Visits paid to Elementary Schools for Medical Inspection 339 - Number of Children prepared for Medical Inspection:—Newly Inspected 5792 - Re inspected 773 — Specially Inspected 181 — Other Visits to Elementary Schools '7 5 — Home Visits arising out of Medical Inspection 2116 — Home Visits for other information 1020 Cultures taken 1251 — 135 SCHOOL CLOSURE. During the year 1919 the following schools were closed in accordance with Article 45 (b) of the Code TABLE E. xvii. School. Department. Class. Disease. Date of Closure. Length of Closure. Woodside Infants Influenza March 10th 12 days, Woodside Girls — Influenza March 7th 15 days. Christ Church (Boston Road) Infants - Chicken Pox, May 5th 26 days. Spring Lane Infants — Sickness Scarlet Fever May 15th 23 days. Woodside Infants — Whooping Cough June 16 th 29 days. Portland Road Infants - Chicken Fox June 25th 29 days. Rockmount Road Mixed & Infants — Measles July 14th 10 d ivs. Brighton Road Infants — Diphtheria September 30th 11 days. Brighton Road Infants — Diphtheria October 13th 12 days. Brighton Road Girls — Diphtheria October 16ih 16 days. Brighton Road Boys - Diphtheria October 16th i£ days. Brighton Road Infants — Diphtheria October 27th 5 days. Brighton Road Boys - Diphtheria November 3rd 5 days. Brighton Road Girls - Diphtheria November 3rd 5 days. Brighton Road Infants - Diphtheria November 3rd S days St. Saviour's Girls & Infants - Measles October 24th 10 day Ingram Road Infants - Mumps October 31st 29 days. Ecclesbourne Rd. Infants — Measles November 6th 30 days. Portland Road Infants - Chicken Pox November 6th 30 days. Boston Road Infants — Measles November 6th 30 days. St. Michael's Mixed & Infant — Measles November 17th 26 days. Christ Church Infants — Chicken Pcx November 18th 25 days. Beulah Road Infants — Diphtheria November 19th 13 days. Beulah Road Infants — Diphtheria December 1st f2 days Woodside Infants — Scarlet Fever November 25th 25 days. Tavistock Grove Junior, Mixed, and Infants Mixed & Infants - Measles December 1st 19 days. Holy Trinity ... - Measles December 12th 8 days 136 PHYSICALLY AND MENTALLY DEFECTIVE CHILDREN SENT TO INSTITUTIONS. At the end of the year 1919 the following Croydon children were under treatment in residential institutions:— Blind 9 Deaf 8 Mentally defective 9 Epileptic 5 BLIND (including partially blind). Boys. Girls. Total. Attending Public Elementary Schools 5 3 8 „ Certified Schools for the Blind 4 5 9 Not at School 3 — 3 EXAMINATION OF BURSARS, STUDENT AND PUPIL TEACHERS. Thirty-one young persons who desired to become Bursars and Student Teachers were medically examined during the year. TEACHING OF INFANT CARE. The Infant Care Class has been continued at the Tavistock Grove and Beulah Road Schools. It is conducted by one of the Health Visitors. 137 REPORT OF THE ORGANISER OF PHYSICAL TRAINING. To the Education Committee. February, I920. Ladies and Gentlemen, I beg to submit the Report of my work as Organiser of Physical Training for the year 1919. As in former years, my time has been devoted to:— (1) Visiting the Senior Mixed, Girls', Junior Mixed and Infants' departments of the Elementary Schools for the purpose of advising the teachers on the Physical Training given in these schools. (j) Holding classes for the Teachers and Student Teachers in the Elementary Schools. (3) Visiting the gymnastic classes held in connection with the Girls' Evening Institutes and the Juvenile Unemployment Centies. (4) Attending at the School Treatment Centre, 228. London Road, four sessions weekly for the purpose of giving Remedial Exercises to children requiring such special treatment. The work in the Elementary Schools has continued on much the same lines as hitherto. As only about half my time can be devoted to this branch of the work I am not able to visit and help each teacher as often as I should like, but I endeavour to see every class in the departments under my supervision at least once a year. In 1919 I paid four hundred and five visits to the schools. When seeing the physical exercises of a class, I also endeavour to help the teacher as to the treatment of any children of especially poor physique and posture, and advise as to the general Physical Training of the class. In general, I find a keen desire on the part of the teachers to encourage and promote the physical welfare of the children, and time and thought is expended in making the physical training lessons of real benefit to every child. I am strongly of the opinion that more opportunities should be given in the teaching of organised games and the right type of dancing (folk and national dances of various countries). Many schools are doing good work in these two directions under difficult conditions. The provision of suitable playing fields for organised games is still an urgent one. During the year a few schools, situated near public recreation grounds, obtained permission to use these for the organised games' lessons, but the experiment was not entirely successful, owing to the difficulty experienced in getting the ground marked out and the necessary equipment supplied. In one case the ground granted was in such a rough state that running games could not be taken. Even if it were possible to arrange that every school conveniently near a recreation ground should have proper accommodation there for organised games, there would still remain a number of schools too far from any recreation ground to be able to use it. 138 In connection \vith the Physical Training in the Elementary Schools I would call the attention of t e Committee to the following recommendations of the Chiet Medical Officer of the Board of Education in his Report for 1918 :— (a) " An increase in the time allotted to physical exercises and games, a daily lesson of 20 minutes being regarded as a minimum ; (b) An improvement in the accommodation for physical exercises either by means of adequately lighted and ventilated playground sheds or by the provision of halls, playgrounds, etc.; {c) Proper and sufficient equipment and apparatus for indoor and outdoor games ; (d) Attention to the clothing, and particularly to the shoes of the children ; (e) The provision of playing fields in connection with schools." May I respectfully point out that these recommendations are practically identical with those I made in my last Report, and may I urge that they may receive the sympathetic attention of the Committee. The Spinal Remedial Classes were conducted on the same lines as in 1918. Children treated during year ... Girls, 39 ; Boys, 4 Discharged (not requiring further treatment) 20 „ (not advisable to continue) 1 „ (owing to irregular attendance) 1 Left School 5 Left district 2 Still attending class 14 Total attendances during year 1390 At visits to the gymnastic classes in connection with the Girls Evening Institutes, I everywhere found keen and enthusiastic classes. At the opening of the Autumn Session, 1919, arrangements were made for four classes in gymnastics, but so keen was the response of the girls to join these classes that other classes had to be formed, and, at the time of writing, eight gymnastic classes are being held weekly. This year five of the classes are being conducted on definitely Swedish lines, as it is felt that in this way the physical training can be better linked up with that of the Elementary Schools. I should have liked to have been able to give more of my time to visiting and encouraging these classes, as I feel they form a most important part of any scheme of physical training, providing, as they do, opportunities of healthy recreation and a right hygienic atmosphere during the critical years of adolescence." Unfortunately, I was not free many evenings when the classes were in progress, owing to the Teachers' classes falling at the same time. For the same reason I was only able to visit the gymnastic classes, held in connection with the Juvenile Unemployment Centres, during the Spring Vacation of the Elementary Schools, as I was always working at the Spinal Remedial Class when these classes were held. With reference to the success of the gymnastic classes held in connection with the Evening Institutes, may I venture the hope that the Committee will see its way to the establishment of such classes at the Polytechnics, as I am sure the need exists. . 139 The following courses were arranged for the Teachers during the year:— 1. A course of nine lessons in dances suitable for use in senior schools. This was conducted by Miss Idle, of Streatham Hill High School, and was much appreciated—in fact more applications were received than it was possible to entertain, and I reluctantly had to refuse admission to several teachers who applied too late. 2. A course of six lessons on the Organisation of Games Lessons and Playing Fields conducted by Miss Edgell, late Games Mistress at Chelsea College of Physical Education. These lessons were held during the light summer evenings. A short lecture on the theory and teaching of the more organised games, such as net-ball, rounders, capstan ball, etc., was followed by an hour's practice in the playgrounds attached to Winterbourne Road School. Unfortunately, owing to the weather, play out of doors was impossible on two of these evenings, but on these two occasions indoor gymnastic games were taken in the hall of the Infants' School. This class was also well attended, the maximum of sixty being easily reached before the final date of application. 3. A course of twelve lessons in the Theory and Practice of Physical Training for the teachers of the Infants' Schools; and 4. A course of 25 lessons in the Theory and Practice of Physical Training for the teachers in senior departments. These courses were started in the autumn of 1919 and are in progress at the time of writing. It was expected that the new Syllabus of Physical Exercises promised by the Board of Education would be published in September, and accordingly arrangements were made for its study at these courses So remarkable was the response of the teachers to the invitation to attend these courses that two classes have had to be held each night, thus making four courses instead of two. Although the publication of the syllabus has been delayed up to the time of writing, I was able to obtain an advance proof copy from the Board of Education, with permission to use it at the classes, so the the courses have been carried out as arranged. 5. A course of 25 lessons for the student teachers. This course is also in progress at the time of writing. I think the splendid attendance at all these courses furnishes evidence of the desire of the teachers to take their share in the promotion of the physical welfare of the children, and I am hopeful that the Committee will see its way to granting increased facilities for physical training, not only in the narrow sense of physical exercises, but in the larger sphere of games, swimming, dancing, and all wholesome athletic training as embodied in Section 17 of the Education Act, 1918. I am confident that all concerned in the physical education of young people in Croydon will make full use of such opportunities. Yours faithfully, MAY APPLETON. 140