CRO 22 County Borough of Croydon. of the MEDICAL OFFICER OF HEALTH and SCHOOL MEDICAL OFFICER For the Year 1920. R. VEITCH CLARK, M.A., M.B., Ch.B., B.Sc., D.P.H. CROYDON: PRINTED AT THE "CROYDON TIMES" OFFICE, 108, HIGH STREET 2 Contents. PAGE Vital Statistics, Summary of 7 SECTION I. Natural and Social Conditions of the District:— Climate 8 Social Conditions 8 Hospital Accommodation 9 Sanitary Circumstances of the District Water 12 Rivers and Streams 14 Drainage and Sewerage 14 Closet Accommodation 14 Scavenging 14 Sanitary Inspection of the District 15 Housing 15 Infectious Disease, Prevalence of and Control Over:— Scarlet Fever 17 Diphtheria 17 Measles 17 Enteric Fever 17 Smallpox 17 Influenza 17 Pneumonia 18 Malaria, Dysentery, and Encephalitis lethargica 18 Tuberculosis 18 Ophthalmia neonatorum 18 Health Visitors' Work, Record of 18 Disinfection, Record of 19 Sick Room Requisites 20 SECTION II. Table I. Vital Statistics °f whole district during 1920 and previous years 22 II. Cases of Infectious Disease notified during 1920 23 III. Causes of, and Ages at, Death during 1920 24 11 In. Causes of Deaths from Influenza and certain other conditions during 1920 37 Chart showing principal causes of death during 1920 IV. Infant Mortality during 1920 39 V. Cases notified and deaths from the principal zymotic diseases for the year 1920 and preceding years 48 VI. Vital Statistics of separate localities in 1920 and previous years 49 VII. Meteorological Observations for 1920 VIIa, Meteorological Observations for 1920 V, 3 page. SECTION III. Maternity and Infant Welfare:— Infant Mortality 52 Diarrhoea 53 Infant Centres 53 Provision of Fresh Milk at the Centres 56 Maternity Hostel 56 Ante-Natal Clinic 57 Sick Nursery 57 Feeding of Infants 57 Notifications of Births Act, 1907 59 Midwives 59 SECTION IV. Tuberculosis Work:— General Summary of Cases dealt with through the Tuberculosis Dispensary and work done in connection with them 59 Sanatorium and Hospital Treatment 65 SECTION V. Venereal Disease:— Returns as to persons treated during the year 66 SECTION VI. Mental Deficiency:— Returns as to cases dealt with 69 SECTION VII. Sanitary Inspecting Staff, Work of the:— Inspections 7° Table giving details of general sanitary work 7' Combined drainage 72 House drains re-laid 72 Examination of drains 72 Notices and Council Orders 72 Municipal and other Common Lodging Houses 72 Houses let in lodgings 73 Factory and Workshop Act:— Factories 74 Workshops 74 Homework 74 Bakehouses 74 Workplaces 75 Smoke Nuisances 75 Rag Flock Act 75 Slaughterhouses and the Inspection of Meat and Other Foods:— Summary of Inspections 76 Details as to animals slaughtered 76 Summary of meat and other foods destroyed as unfit 78 Tuberculosis in meat 79 Tuberculosis in milk 79 Dairies, Cowsheds, and Milkshops Order 79 4 page. Food and Drugs Acts:— Prosecutions 80 Milk and Cream Regulations 81 Details of samples taken, 1920 82 Details of samples taken, 1905-1920 83 SECTION VIII. Borough Hospital, Work of the:— Detailed analysis of expenditure 84 Maximum and minimum number of beds occupied 84 Admissions, 1920 84 Admissions, details of comparative, 1909-1920 85 Admissions, analysis of, 1920 86 Admissions, fatality for each disease 87 Illness of Staff 88 Work of Laboratory:— Examinations made for Cerebro-spinal meningitis 89 ,, ,, Tuberculosis 90 ,, ,, Enteric (Typhoid Fever) 91 SECTION IX. School Medical Officer's Report:— Staff 92 Co-ordination 93 School Medical Service in Relation to the Public Elementary Schools:— Number of schools and accommodation 93 School Buildings and Accommodation 93 School Hygiene 93 Medical Inspection:— Routine inspection 95 Inspection of selected children 95 Defective children re-examined 95 Table—Total number of children examined (routine) 96 Findings of Medical Inspection:— Uncleanliness 98 Cleansing Station 98 Clothing 98 Average Heights and Weights .. 99 Malnutrition 99 Vision and external eye disease 99 Enlarged tonsils and adenoids 99 Lymphatic Glands 100 Ear Disease 100 Defective Teeth 100 Affections of the Heart 101 Affections of the Lung 101 Tuberculosis 101 Nervous Diseases 102 Deformities 102 Ringworm 102 Skin Affections 102 Mental Conditions 102 Infectious Disease:— School Closure 103 5 page. Following Up :— Work of the Health Visitors 103 Medical Treatment :— Minor Ailments 104 Uncleanliness 105 Enlarged Tonsils and Adenoids 105 Tuberculosis 106 Vision and External Eye Disease 106 Dental Defects 107 Crippling Defects and Orthopoedics no Open Air Education in Physical Training hi Provision of Meals 114 Co-Operation of Parents 114 Co-Operation of Teachers 115 Co-Operation of School Attendance Officers 115 Co-Operation of Voluntary Bodies 115 Blind, Deaf, Defective and Epileptic Children 115 Mentally Defective Children 116 Grangewood Special M.D. School 116 Physically Defectve Children 117 Class for Stammerers 117 Nursery Schools 117 Secondary Schools 117 Continuation Schools 117 Employment of Children and Young Persons 117 Miscellaneous :— Teaching of Infant Care 118 Appendix. Public Elementary Schools. A. Table 1. Number of Children Inspected 119 2. Return of Defects found in the course of medical inspection 120 3. Numerical Return of all Exceptional Children. 121 4. Treatment of Defects of Children :— (a) Minor Ailments 123 (b) Visual Defect 123 (c) Defects of Nose and Throat 123 (d) Treatment of Dental defects 124 (e) Treatment of Uncleanliness 125 5. Summary of treatment of Defects 126 6. Summary relating to children medically inspected. 127 6 page. Secondary Schools. B. Table 1. Number of Children inspected 128 2. Return of Defects found in the course of medical inspection. 129 3. See Appendix A, Table 3. 4. Treatment of Defects of Children:— (a) Minor Ailments. 130 (b) Visual Defect 130 (c) Defects of Nose and Throat 130 (d) Treatment of Dental Defects 130 5. Summary of treatment of defects 131 6. Summary relating to children medically inspected 131 7 SUMMARY OF VITAL STATISTICS. Population—Census of 1911—169,551. Estimated Population, June, 1920—191,820 (Registrar-General's Estimate of Civilian Population). Births—4,351 (nett). Birth-Rate, per 1000—22.6. Deaths—2,134 (nett). Death Rate, per 1,000 living, 11.1. (See note § at foot of Table I., page 22). Deaths under 1 year of age—275. Infantile Mortality, per 1,000 births—63. Zymotic Death Rate—.5 per 1,000 population. Death Rate from all Tuberculous Diseases (including Phthisis)— 1.0 per 1,000 population. Acreage of the Borough—9,012. Density of population—21.3 per acre. Rateable Value—£1,142,984. Amount produced by 1d. Rate—£4,324. 8 County Borough of Croydon. REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1920. 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 9,012. 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 Croydon 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 bv 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 well-being of its inhabitants from the public health point of view. 9 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— Report and Statistics of Patients treated during the Hospital Year 1919-20. I. In-Patienls. 1919-20. 1918-19. Admissions from July 1st, 1919, to June 30th, 1920 1316 1294 Patients in Hospital July 1st, 1919 82 90 Total 1398 1384 Cases of Accident or Emergency admitted free 895 862 Cases Admitted by Governors' Letters 182 184 Medical Free Cases 34 36 Discharged Soldiers (Pensioners) 205 212 Total 1316 1294 Males 675 741 Females 641 553 Total 1316 1294 The Average Stav in Hospital of each In-patient 21.4 days 22 days The Average Number of Beds Occupied 85 88 II. Casualty Department. (a) Free: Fractures 256 172 Dislocations 30 21 Wounds, Minor Injuries, etc. 4240 3687 (b) By Governors' Letters: Tonsils and Adenoids 371 253 Phimosis 108 86 Total 5005 4219 Total Attendances of Casualty Out-Patients 26,358 10 III. Out-Patient Department. Medical and Surgical. Total Number of New Cases 1882 1526 Renewal of Old Letters 1572 1411 Total 3454 2937 Ophthalmic. Total Number of New Cases 1704 1585 Renewal of Old Letters 1017 972 Total 2721 2557 Ear, Nose, and Throat. Total Number of New Cases 609 503 Renewal of Old Letters 215 202 Total 824 705 Dental. Total Number of New Cases 347 277 Gas (N40) Administrations 520 462 Total Attendance of Out-Patients. Medical and Surgical 13111 9799 Ophthalmic 6427 5694 Ear, Nose and Throat 2732 2064 Dental 801 574 Casualty 26358 — Massage 3343 — Total 52772 18131 Total Number of Patients treated during the Year. In-patients 1398 1384 Casualty Patients 5005 4219 Out-patients (including Renewed Letters) 7346 6476 Massage Patients 160 — Total 13909 12079 In-Patients. Summary of Results. Cases Cured and Relieved 1218 1197 Cases Unrelieved 30 28 Remaining Under Treatment 79 67 Died 71 92 Total 1398 1384 Report of the X-Ray Department. Period Year ending. Patients examined. Skiagrams taken. Patients treated. Attendances for treatment June 30th, 1916 919 1062 59 252 „ 1917 941 1114 48 270 „ 1918 1105 1433 60 381 „ 1919 1164 1751 51 388 „ 1920 1501 2313 67 448 11 Norwood Cottage Hospital— Numbers in 1919. Numbers in 1920. 1. Number of Beds available for use 32 32 2. Average number of Patients resident daily throughout the year, as counted and recorded daily 25.6 23.7 3. Number of In-Patients in the Hospital at beginning of year 27 19 4. Do. admitted during year 505 437 5. Do. in the Hospital at the end of year 19 25 6. Average number of days each Patient was resident 18.21 — Ascertained by dividing the yearly total of daily counts by the number of patients treated to a conclusion. The following figures give a comparison of the results of the last two years:— 1919. 1920. Cured 335 313 Relieved 129 85 Unrelieved 13 6 Died 36 27 Number remaining at end of year 19 25 532 456 Purley Cottage Hospital. Total Number of beds : 10. The number of cases treated in the wards during 1920 was 293. Of these 87 were detained for less than a day, leaving 206 occupying the regular beds. The average number of days each patient spent in Hospital was 17 5. There has been a considerable increase in the number of patients treated in the Hospital as compared with last year. 1919. 1920. In-patients 223 293 Casualties 152 218 making a total this year of 511, against 375 last. Crfydon Union Infirmary. Total number of beds: 410. Male Wards (6) 192 Female Wards (5) 166 Children's Wards (1) 60* Lying-in-Ward (1) 22 440 Number of patients admitted during year 1920—1803. Average duration of stay about 82 days. *Includes "Waingates"' annexe. 12 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 84). 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. 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 56. 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 body—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. 13 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 sea 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 4J-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 4,270 square yards. The water passes through two feet of fine sand and one foot of small gravel. There is also a softening plant capable of softening 6,000 gallons of water per hour for use at the Croydon Mental Hospital. This water is pumped by two pumping engines each capable of discharging 3,000 gallons per hour into the tank in the Clock Tower at the Hospital. Stroud Green Well.—The well is sunk to a depth of 390|-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, 1905. 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 16§-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. 14 The valves are placed in a house built over the entrance to the resrvoir. Th 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 Metropolitan 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 Kenley Valley. 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 disposd 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 proceeding to provide another destructor to deal with this section of the refuse. 15 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 1920 the staff of inspectors was at 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 70—72. HOUSING. The following return shows the summary of housing work in the town during 1920. The detailed record of inspections of all kinds made by the Sanitary Inspecting Staff is to be found on page I. HOUSING CONDITIONS. 1. Estimated population, 191,820. 2. General death-rate, 11.1. 3. Death-rate from tuberculosis, 1.0. 4. Infantile mortality, 63. 1. Number of dwelling houses of all classes, 41,986 (1919 estimate). 2. Number of working-class dwelling houses, 35,000 (approx.). 3. Number of new working-class houses erected, 267. II. UNFIT DWELLING HOUSES. 1. Inspection— a. Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 3544 b. Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 2390 c. Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. d. Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 3961 16 2. Remedy for Defects without Service of Formal Notices— a. Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 3366 3. Action under Statutory Powers— A. Proceedings under Section 28 of the Housing, Town Planning, Etc., Act, 1919:— 1. Number of dwelling houses in respect of which notices were served requiring repairs 1 2. Number of dwelling houses which were rendered fit— A. By Owners 1 B. By Local Authority in default of owners Nil. 3. Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. B. Proceedings under the Public Health Acts:— 1. Number of dwelling houses in respect of which notices were served requiring defects to be remedied 435 2. Number of dwelling houses in which defects were remedied:— A. By owners 345 B. By Local Authority in default of owners Nil. C. Proceedings under Sections 17 and 18 of the Housing and Town Planning Act, 1909— , 1. Number of representations made with a view to the making of Closing Orders Nil. 2. Number of dwelling houses in respect of which Closing Orders were made Nil. 3. Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit Nil. 4. Number of dwelling houses in respect of which Demolition Orders were made Nil. 5. Number of dwelling houses demolished in suance of Demolition Orders Nil. III. UNHEALTHY AREAS. Areas represented to the Local Authority with a view to Improvement Schemes under (a) Part I. or (b) Part II. of the Act of 1890. 1. Name of area Nil. 2. Acreage Nil. 3. Number of working-class houses in area Nil, Weekly notifications of SCARLET FEVER during the year 1920. Weekly notifications of DIPHTHERIA during the year 1920 17 4. Number of working-class persons to be displaced Nil. Number of houses not complying with the Building byelaws erected with the consent of the Local Authority under Section 25 of the Housing, Town Planning, Etc., Act, 1919 1 Staff engaged on housing work with, briefly, the duties of each officer. Sanitary Inspectors engaged in general Inspection of Districts 6 PREVALENCE OF AND CONTROL OYER INFECTIOUS DISEASES. Scarlet Fever. 638 cases of scarlet fever were notified in 1920, as against 603 the previous year. Death occurred in 7 cases. The need for further hospital accommodation for scarlet fever was again urgently experienced in the winter months. Diphtheria. 558 cases of diphtheria were notified in 1920, as against 429 for 1919. Death occurred in 26 cases. The hospital accommodation for this disease was severelv taxed and the provision of further accommodation felt to be urgent. Diphtheria Anti-toxin was supplied to practitioners on request as has been the practice for many years. 189 phials were issued in this manner, 34 of these phials were issued free of charge for the treatment of necessitous patients, but the remainder were paid for at cost price. Measles and German Measles. This disease is no longer notifiable, and no accurate knowledge of its incidence is available. 22 deaths only were recorded as dur to measles, none to German measles. Enteric Fever. Only 12 cases were notified during the year, as against 5 in 1919. 4 deaths occurred. Smallpox. No cases of smallpox were notified during the year. Influenza. Table III.a, page 37, shews the weekly deaths from influenza, along with the deaths from certain other diseases which are epidemiologically of interest in relation to influenza. 43 deaths occurred from Influenza during the year. Anti-Influenza vaccine was supplied on request to practitioners in the town, and returns-— so far as obtain from these practitioners—shew that twenty-one doctors used the vaccine for 118 patients, and that 215 injections were made. 18 Pneumonia. 98 cases of acute primary pneumonia and influenzal pneumonia were notified. Of deaths from pneumonia, 37 were due to lobar pneumonia, 69 to broncho pneumonia and 54 to pneumonia of which the type was not mentioned. Malaria, Dysentery, Encephalitis Lethargica. 21 cases of malaria were notified, with 0 deaths. 4 cases of dysentery were notified, with 2 deaths. All cases of these two diseases were introduced from abroad. None arose in the town originally. 4 cases of encephalitis lethargica were notified, with 1 death. Tuberculosis. The general work at the tuberculosis dispensary is fully detailed in the section of the tables dealing with tubercle. A total of 805 new cases were medically examined during the year, and the total number of medical examinations made was 7,122. 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 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 1920 was 335, and at the Borough Hospital 73. 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. Ophthalmia Neonatorum, 1920. During the year 39 cases of ophthalmia neonatorum were notified. Of these 29 recovered, 2 died, 2 left the district, 3 were not seen (1 parent objected, 2 notified from Infirmary), 1 left eye slightly affected, and 2 both eyes slightly affected. 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 efficiently performed. 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. Mrs. Rylance and Miss Cracknell. Miss Hugging. Miss Davis. Miss Byrn. Miss Massie. Miss Waterman. Misses Hughes, Bradford & Carter. Miss Chapman. School Cases. Other Cases. School Cases. Other Cases School Case. Other Cases. School Cases. Other Cases. School Cases. Other Cases. School Cases. Other Casec. School Cases. Other Cases. School Cases. Other Cases School Cases. Other Cases. 1st visits. Uns. visits. Subsequent visits. 1st visits. Uns. visits. Subsequent visits. 1st visits. Uns. visits. Subequent visits. 1st visits. Uns. visits. subsequent visits. 1st visits. Uns. visits. Subsequent visits 1st visits Uns. visits. Subsequent visits. 1st visits. Uns. visits. Subsequent visits. 1st visits. Uns. visits. Subsequent visits. 1st visits. Uns. visits. Subsequent visits. 1st visits. Uns. visits. Subsequent visits. 1st visits Uns. 1 visits. Subsequent visits. 1st visits Uns. visits. Subsequent visits. 1st visits. Uns, visits. Subsequent visits. 1st visits. Uns. visits. Subsequent visits 1st visits. Uns. visits. Subsequent visits. 1st visits. Uns. visits. Subsequent visits. 1st visits. Uns. visits. Subsequent visits. 1st visits. Uns. vtsits. Subsequent visits. Scarlet Fever 25 9 22 ... ... ... 2 ... ... ... ... ... 6 ... 13 1 ... 1 3 ... ... ... ... ... 16 5 7 ... ... ... 12 4 11 ... ... ... 7 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 89 31 75 ... ... ... ... ... 2 ... ... ... 73 4 93 13 ... 4 2 ... 5 ... ... ... 66 1 59 ... ... ... 69 26 92 ... ... 82 5 75 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 11 2 1 ... ... ... 5 ... ... ... ... ... 2 ... ... 4 ... ... 4 ... ... ... ... ... 8 ... 9 ... ... ... 6 1 1 ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 316 25 13 ... ... ... 174 ... ... ... ... ... 335 9 9 25 ... ... 180 ... 8 ... ... ... 249 8 5 ... ... ... 199 17 34 ... ... ... 44 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... German Measles 8 ... ... ... ... ... 7 ... 1 ... ... ... 2 ... ... ... ... ... 26 ... 1 ... ... ... 8 ... ... ... ... ... 2 1 1 ... ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mumps 182 38 22 ... ... ... 78 1 ... ... ... ... 8 1 1 ... ... ... 4 ... ... ... ... ... 29 ... ... ... ... ... 49 10 30 ... ... ... 44 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 30 28 23 ... ... ... 14 4 2 ... ... ... 23 3 1 5 ... ... 53 ... 16 ... ... ... 49 3 2 ... ... ... 46 11 11 ... ... ... 81 ... 16 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (ac, primary) 11 ... ... 2 ... ... 3 ... ... ... ... ... 2 ... 1 4 ... ... 14 ... 2 ... ... ... 14 ... ... ... ... ... 9 4 3 ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ,, (ac. influenzal) 2 ... ... ... ... ... 6 ... ... ... ... ... 2 ... 2 ... ... ... 6 ... 3 ... ... ... 5 ... ... ... ... ... ... ... 2 ... ... ... 4 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken pox 122 25 12 ... ... ... 42 ... ... ... ... ... 51 2 8 7 ... ... 69 ... 7 ... ... ... 79 1 ... ... ... ... 72 13 13 ... ... ... 15 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sore Throat 115 8 15 ... ... ... 12 1 ... ... ... ... 68 7 64 ... ... ... 98 ... 19 ... ... ... 163 16 150 ... ... ... 142 16 139 ... ... ... 93 ... 37 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ringworm (scalp) 19 15 43 ... ... ... 12 3 11 ... ... ... 17 12 205 2 ... ... 10 ... 62 ... ... ... 41 13 171 ... ... ... 34 5 47 ... ... ... 11 5 21 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ,, (body) 19 11 26 ... ... ... 6 ... 10 ... ... ... 18 1 21 ... ... ... 25 46 ... ... ... 15 1 37 ... ... ... 28 1 54 ... ... ... 7 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Verminous Heads 14 5 4 ... ... ... 2 ... 1 ... ... ... 5 ... ... 1 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Verminous Bodies 21 17 16 ... ... ... ... ... 3 ... ... ... 2 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 1 5 ... ... ... 3 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Impetigo Contagiosa 373 156 334 ... ... ... 158 3 96 ... ... ... 170 49 341 6 ... 1 328 9 386 ... ... ... 179 43 256 ... ... ... 183 35 463 ... ... ... 100 ... 78 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scabies 25 39 104 ... ... ... 15 ... 15 ... ... ... 9 5 47 2 ... 4 50 1 122 ... ... ... 14 3 36 ... ... ... 40 12 131 ... ... ... 12 ... 14 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Infectious Eye Disease 19 14 42 ... ... ... 18 ... 5 ... ... ... 14 2 56 ... ... ... 46 ... 89 ... ... ... 9 1 33 ... ... ... 17 3 21 ... ... ... 8 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other diseases 501 88 103 1 ... ... 500 7 11 ... ... ... 272 44 225 2 ... ... 237 10 206 ... ... ... 328 29 146 ... ... ... 309 39 309 9 ... 1 94 ... 21 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1902 511 855 3 ... ... 1054 19 157 6 ... 6 1079 140 1088 72 1 10 1158 9 972 1 ... ... 1272 124 911 ... ... ... 1220 200 1369 9 2 1 615 16 286 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1st visits. Uns. visits. Subsequ't visits. 1st visits. Uns. visits. Subsequ't visits. 1st visits. Uns. visits. Subseq'ut visits. 1st visits. Uns. visits Subsequ't visits. 1st visits. Uns. visits. Subseq'nt visits. 1st visits. Uns. visits. Subsequ't visits 1st visits. Uns. visits. Subsequ't visits. 1st visits. Uns. visits. Subsequ't visits 1st visits. Uns. visits. Subseq'nt visits. Tuberculosis cases visited 3 60 299 71 30 54 29 41 233 15 2 356 3 30 274 13 37 266 122 ... 192 402 117 931 ... ... 129 Visits to Elementary and Secondary Schools for Medical Inspections 84 ... ... 85 ... ... 81 ... ... 85 ... ... 76 ... ... 70 ... ... 29 ... ... ... ... ... ... ... ... Newly Inspected 1310 ... ... 1021 ... ... 1078 ... ... 1096 ... ... 1010 ... ... 787 ... ... 445 ... ... ... ... ... ... ... ... Re-inspected 59 ... ... 73 ... ... 57 ... ... 109 ... ... 35 ... ... 41 ... ... 92 ... ... ... ... ... ... ... ... Specially Inspected 273 ... ... 99 ... ... 160 ... ... 127 ... ... 262 ... ... 153 ... ... 90 ... ... ... ... ... ... ... ... Other Visits to Elementary Schools 59 ... ... 1 ... ... 38 ... 5 8 ... ... 45 ... 2 1 ... ... 5 ... ... ... ... ... ... ... ... Home Visits arising out of Medical Inspection 381 114 171 58 3 14 512 84 362 418 29 331 398 52 170 270 43 216 243 7 58 ... ... ... ... ... ... Home Visits for other information 223 53 40 13 4 24 269 64 129 243 9 84 95 13 33 68 9 44 86 ... 1 ... ... ... ... ... ... Cultures taken 175 1 ... 55 ... ... 222 ... 35 210 ... 9 269 ... ... 259 ... 10 247 ... ... ... ... ... ... ... ... 19 DISINFECTION. The following table shews the disinfection carried out during 1920:— Destroyed. Articles. Disinfected by Total. Steam. Formalin Lamp. Formalin Sray. 3 • Beds 973 ... ... 973 5 Blankets 2877 ... ... 2877 .. Blouses 110 3 ... 113 1 Bolsters 919 ... ... 919 15 Books (other than Library) ... 423 ... 423 ... Books (Library) ... 679 ... 679 2 Boots ... ... 436 436 ... Capes 10 ... ... 10 ... Caps 103 ... 7 110 ... Carpets 19 ... ... 19 ... Cloaks 3 ... ... 3 2 Coats 401 ... 10 411 ... Corsets 101 ... ... 101 ... Curtains 67 ... ... 67 9 Cushions 484 ... ... 484 ... Costumes 84 1 ... 85 3 Counterpanes or Quilts 1024 ... ... 1024 ... Dresses 144 ... ... 144 1 Dressing Gowns 133 ... ... 133 ... Handkerchiefs 162 ... ... 162 ... Hearthrugs ... ... ... ... 1 Jackets 178 ... ... 178 ... Mats 34 ... ... 34 16 Mattresses 1516 ... ... 1516 ... Neckerchiefs ... ... ... ... 12 Palliasses 308 ... ... 308 ... Petticoats 229 ... ... 229 9 Pillows 2976 ... ... 2976 ... Rugs 176 ... 2 178 ... Shawls 139 ... ... 139 1 Sheets 665 ... ... 665 5 shirts 291 ... ... 291 ... Skirts 98 ... ... 98 ... Stockings (hocks 609 ... ... 609 ... Towels 251 ... ... 251 1 Trousers 265 ... ... 265 ... Underclothing 397 ... ... 397 1 Vests 210 ... ... 210 1 Waistcoats 164 ... ... 164 20 Other articles 2008 ... 15 2023 Total 108 Total 18128 1106 470 19704 Premises, etc., Disinfected. Rooms. Hospital Wards. School Departments. School Clast rooms. Vehicles. School Lavatories. 2688 3 42 21 - - 20 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 1920 Adults. School Children. Children under School age. Head Vermin — 2 — Scabies 22 109 5 Body Vermin 19 26 10 After Contact with Infectious Disease — 1 — 41 138 15 SICK ROOM REQUISITES. Under the powers contained in the Public Health Act, 1875, the Corporation have since 1919 kept an outfit of sick room requisites for loan, when necessary, to families in the borough. The following list shows the articles kept and the use made of the same: Name of Article. Number. Deposit Required. Bed Pans 12 (large) l/6d. Bed Pans 4 (small) l/0d. Urinals 6 l/0d. Waterproof Sheeting 14 yards l/0d. per yard. Water Bed 1 10/0d. Air pillows 4 (circular) 2/0d. Air pillows 1 (square) 2/6d. Feeding Cups 6 6d. Douche Cans, complete 3 l/0d. Breast relievers 3 6d. Enema Syringes 4 6d. Glycerine Syringe 1 (½-0z.) 9d. Glycerine Syringe 1 (1-z.) l/0d. Crutches 1 (pair) 2/0d. Bed cradles 2 l/0d. Hot water bottles 2 l/0d. Hot water bottles 1 (rubber) 1 /3d. Hot water bottles 4 (stone) 9d. Inhaler 2 (tin) l0d. Bronchitis kettles 1 9d. Bronchitis kettles 2 l/6d. Bed rest 1 3/0d. 74 21 Of the articles detailed above, the following were out on loan during this year:— Article. Number of deposits paid. Air pillows, circular 17 Bedpans 6 Breast Reliever 2 Waterproof Sheeting 2 Douche cans 2 Enema Syringes 4 Best Rest 4 Hot water bottles 2 Urinals 3 Bronchitis kettles 1 Inhaler 2 Water bed 2 22 SECTION II. TABLE I. Vital Statistics of whole District during 1920 and previous years. Year. Population estimated to Middle of each Year. births. Total Deaths Reg. in the District. Transferable Deaths Nett deaths belonging to the District. of Non-residents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Uncorrected Number. Nett. Number. Rate.* Number. Rate.* Number. Rate per 1,000 Nett Births. 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 1920 § 191,820 4434 4351 22.6 2225 11.6 299 209 275 63 2134 11.1 * 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 § „ „ „ „ „ „ „ 191,580 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. 23 TABLE II. Cases of Infectious Disease notified during the Year 1920. Notifiable Disease. Cases 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 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera (C) Plague (P) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 558 6 123 334 56 32 7 .. .. 133 71 43 57 66 130 9 49 .. 499 Erysipelas 74 1 1 6 10 28 24 3 1 10 12 4 10 10 14 4 10 .. 8 Scarlet Fever 638 6 142 390 63 37 .. .. .. 173 108 41 56 36 171 13 40 .. 528 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 12 .. .. 3 5 4 .. .. .. 1 2 .. .. 2 3 .. 4 .. 7 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 14 .. .. .. 3 11 .. .. .. 4 4 .. 1 1 2 2 .. .. 4 Cerebro-spinal Meningitis 3 1 1 1 .. .. .. .. .. 1 .. .. 1 .. .. .. 1 .. 2 Ophthalmia Neonatorum 39 39 .. .. .. .. .. .. .. 19 2 3 1 4 8 .. 2 .. 3 Pulmonary Tuberculosis 396 .. 4 55 100 170 43 9 15 88 35 44 35 28 62 15 55 4 187 Other forms of Tuberculosis 84 .. 11 49 10 9 2 .. .. 28 2 11 4 3 20 2 12 2 25 Pneumonia 98 1 8 16 9 33 19 12 .. 18 16 7 17 6 27 3 4 .. .. Malaria 21 .. .. .. 7 13 .. 1 .. 8 4 .. .. 6 2 .. 1 .. .. Dysentery 4 .. .. .. 2 .. .. .. .. .. 2 .. 1 .. 1 .. .. .. .. Encephalitis lethargica 4 1 .. 1 .. 1 .. .. .. 1 .. .. 1 .. 2 .. .. .. .. Posterior basic meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anterio poliomylitis 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. Totals 1946 55 291 855 265 338 96 25 21 484 258 153 184 162 472 48 179 6 1263 The Borough (Fever) Isolation Hospital is situated in the West Ward, The Croydon and Districts Smallpox Hospital is at North Cheam, 24 TABLE III Causes of, and ages at, Death during Year ending December 31st, 1920, 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 he distributed. Total Institution Deaths distributed and not distributed. Inquest Cases. Total all Ages. Males all Ages. Females all Ages. 0-1. 2-2. 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 3 ... ... ... ... ... 1 ... 2 ... 4 2 2 ... ... ... 1 1 1 1 ... 2 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 (A B.) Relapsing Fever (A) Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Mediterranean Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Small-pox (A) Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... IB) Not vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Doubtful ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Measles 6 2 1 ... 10 2 1 ... ... 2(2) ... 22 13 9 3 7 7 4 1 ... ... ... 7 Scarlet Fever 5 ... ... ... ... 1 1 ... ... 7 ... 7 4 3 ... ... 4 2 1 ... ... ... 8 Whooping Cough 1 ... ... ... ... ... 1 ... ... ... ... 2 1 1 ... 2 ... ... ... ... ... ... 9 (A) Diphtheria 2 3 1 1 5 10 4 ... ... 24 (4) 1 26 9 17 ... ... 6 18 ... ... 2 ... (B.C.) Croup (B) Membranous laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Influenza 11 5 6 7 3 6 3 ... ... 3(5) ... 43 25 18 ... 1 2 6 1 13 12 8 11 Miliary Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Cholera Nostras ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Dysentery ... ... 1 1 ... ... ... ... ... 1 ... 2 2 ... ... ... ... ... ... ..1 1 ... 15 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Yellow Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Leprosy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Erysipelas 1 ... ... 1 ... ... 1 ... ... ... ... 3 1 2 ... ... ... ... 2 1 ... ... 25 19 (A.B.C.D.) other Epidemic Diseases (A) Mumps ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) German Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Varicell ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other Diseases included under 19 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 (A.B.C.) Pyaemia, Septicæmia (A) Pyaemia ... 1 ... 1 ... ... ... ... ... 1 1 2 2 ... ... ... ... ... 1 ... 1 ... (B) Septiæmia 1 2 ... ... ... ... 1 ... ... 3 (2) 2 3 3 ... ... 1 ... ... ... 1 ... ... (C) Vaccinia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 Anthrax (Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Rabies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 24 Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25 (A.B.) Mycoses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Actinomycosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other Mycoses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 Pellagra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Beri-Beri ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28 (A.B. Pulmonarv Tuberculosis (not acute) (A) Pulmonary Tuberculosis 38 24 13 16 12 22 ... 6 1 55(13) 4 132 67 65 1 ... 2 11 24 59 29 6 (B) Phthisis (not defined as tuberculous) 10 3 4 1 ... 5 ... 1 ... 2 (2) ... 24 14 10 ... ... 1 8 9 5 1 29 (A) Acute Phthisis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Acute Miliary Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30 Tuberculous Meningitis 7 3 ... ... 1 3 1 1 ... 6 (2) 1 16 10 6 3 1 3 8 ... 1 ... ... 31 A.B.) Tuberculosis of Peritoneum and Intestines (A) Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other Peritoneal and Intestinal Tubercle 3 2 ... ... 2 ... 2 2 ... 11 (1) ... 11 5 6 1 ... 4 ... 1 2 2 ... 32 Tuberculosis of Spinal Column 1 1 ... ... 1 ... 1 ... ... 3 (1) ... 4 3 1 ... ... ... 1 1 2 ... ... 33 Tuberculosis of Joints ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... 34 (A B.C.) Tuberculosis of other Organs 1 (A) Lupus ... ... ... ... ... ... ... 1 ... 1 (1) ... 1 ... 1 ... ... ... ... ... 1 ... ... B. Scrofula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... (C) Other Tuberculosis included under 34 ... ... 1 ... 1 ... 1 ... ... 2(1) ... 3 1 2 ... ... ... ... ... 1 1 1 35 Disseminated Tuberculosis 1 ... 1 ... 1 ... ... ... ... 1 ... 3 1 2 ... 1 ... 1 ... ... ... 1 36 (A.B.) Rickets, Softening of Bones (A) Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other forms of Bone Softening ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 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. 01. 1-2. 2-5. 5-15. 15-25. 25-45. 45-65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood- Thornton Heath. 37 Syphilis 1 1 2 1 ... 1 ... ... ... 4(1) ... 6 5 1 4 ... ... ... ... ... 2 ... 38 (A.B.C.) Other Venereal Diseases (A) Soft Chancre ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Gonococcus Infection ... ... ... ... ... ... 1 ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... (C) Purulent Ophthalmia ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 39 Cancer of the Buccal Cavity 3 ... 1 2 1 ... ... ... ... 2 (1) ... 7 6 1 ... ... ... ... ... ... 3 4 40 Cancer of the Stomach, Liver, &c. 13 11 10 10 4 14 1 2 ... 13 (8) ... 65 39 26 ... ... ... ... ... 8 27 30 41 Cancer of the Peritoneum, Intestines & Rectum 5 8 3 6 7 8 6 ... ... 20(11) ... 43 20 23 ... ... ... ... ... 2 18 23 42 Cancer of the Female Genital Organs 4 5 3 4 4 1 4 1 1 5(1) ... 27 ... 27 ... ... ... ... ... 2 17 8 43 Cancer of the Breast 4 4 2 3 4 2 ... 1 ... 6(4) ... 20 ... 20 ... ... ... ... ... 3 11 6 44 Cancer of the Skin 2 2 ... 1 3 ... ... ... ... 5 ... 8 5 3 ... ... ... ... ... 1 1 6 45 Cancer of other or unspecified Organs 7 9 5 8 5 10 4 ... ... 14 (8) ... 48 25 23 ...... 1 1 ... ... 5 26 15 46 (A.B.C.) Other Tumours (situation undefined) (A) Angioma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Adenoma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other Tumours included under 46 ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... 47 Rheumatic Fever 3 ... ... 1 ... ... ... ... ... 2(1) ... 5 2 3 ... ... ... 1 1 ... 2 1 48 (A.M.C.)Chronic Rheumatism, Osteo-arthritis (A) Chronic Rheumatism 1 ... ... 1 ... ... ... ... ... ... ... 2 1 1 ... ... ... ... ... ... ... 2 (B) Osteo-arthritis 4 2 1 3 ... 2 1 ... ... 3 ... 13 4 9 ... ... ... ... ... ... 5 8 (C) Gout ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 49 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 Diabetes ... 2 ... 3 8 3 1 ... ... 1(2) ... 23 15 8 ... ... ... ... 2 1 9 11 51 Exophthalmic Goitre ... ... ... 1 ... 1 ... ... ... 1 ... 2 ... 2 ... ... ... ... ... 1 1 ... 52 Addison's Disease ... l ... ... ... ... 1 ... ... 1 (1) ... 2 2 ... ... ... ... 1 1 ... ... ... 53 (A.B. Leucocythæmia, Lymphadenoma (A) Leucocythæmia (Leucæmia) ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... (B) Lymphadenoma ... ... ... ... ... l ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... 27 54 Anaemia, Chlorosis 1 1 ... 3 ... 1 1 ... ... 3 (2) 1 7 5 2 ... 1 ... 1 ... 2 2 1 55 (A.B.C.D.) Oilier General Diseases (A) Diabetes Insipidus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Purpura ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Haemophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other Diseases included under 55 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 56 Alcoholism (acute or chronic) ... ... ... ... 1 ... ... ... ... ... ... 1 ... 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.- Disease of the Nervous System and of the Organs of he Special Sense. 60 Encephalitis 1 ... ... 1 ... ... ... ... ... 1 ... 2 ... 2 1 ... ... ... ... ... 1 ... 61 ( A) Cerebro spinal fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 61 (B.C.) Meningitis, other forms or undefined ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Posterior basal meningitis ... 1 ... ... ... 1 ... ... 1 3 (1) 1 3 2 1 ... 1 ... ... 1 ... 1 ... (C) Meningitis, other forms 2 ... 3 2 ... 2 ... 1 ... 3 ... 10 8 2 3 3 ... 3 1 ... ... ... 62 Locomotor Ataxy 1 1 ... ... ... ... 1 ... ... 1(2) ... 3 3 ... ... ... ... ... ... ... 2 1 63 (A.B.) Other diseases of the spinal cord ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Diseases formerly classed to "Other nervous affections". 4 1 2 1 1 3 1 1 ... 3 ... 14 6 8 ... ... ... 1 ... 3 3 7 (B) Other diseases included under 63 1 1 1 ... 2 ... 1 2 ... 3 ... 8 4 4 ... ... ... 2 1 ... 3 2 64 (A.B.C.D.E.) Cerebral haemorrhage, Apoplexy (A) Apoplexy 4 ... ... 1 ... 2 1 ... ... 2(1) ... 8 5 3 ... ... ... ... ... ... 2 6 (B) Serous apoplexy and oedema of brain ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... (C) Cerebral congestion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Cerebral atheroma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Cerebral hæmorrhage 18 23 9 15 13 19 9 9 3 37(29) 13 118 53 65 ... ... ... ... 1 6 43 68 65 Softening of brain ... 1 ... 2 1 ... 2 ... 1 3 ... 7 2 5 ... ... ... ... ... ... 3 4 66 (A.B.C.) Paralysis without specified cause (A) Hemiplegia 1 ... ... 2 ... 1 ... 1 ... 2 ... 5 2 3 ... ... ... ... ... 1 ... 4 (B) Paraplegia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other forms of paralysis 1 1 ... ... 1 ... ... ... ... ... ... 3 1 2 ... ... ... ... ... 1 ... 2 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. 45-65. 65 and upwards. West. North. Central. East. South. South Norwod. Upper Norwood. Thornton Heath. 67 General paralysis of the insane 1 2 2 2 2 1 1 ... ... 11 ... 11 10 1 ... ... ... ... ... 7 3 1 68 Other forms of mental alienation ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... 69 Epilepsy 1 3 ... ... 1 1 ... 2 ... 6(2) ... 8 6 2 ... ... ... 1 3 2 2 ... 70 (A.B. (Convulsions (non-puerperal; 5 yrs & over) (A) Epileptiform convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Others included under 70 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 71 (A.B.) Infantile convulsions (under 5 years) (A Convulsions with teething ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other infantile convulsions 4 2 ... ... ... 7 ... ... ... 1 ... 17 13 4 17 ... ... ... ... ... ... ... 72 Chorea ... ... ... ... ... 1 ... ... ... 1 ... 1 1 ... ... ... ... 1 ... ... ... ... 73 (A.B.) Hysteria, Neuralgia, Neuritis (A) Hysteria, Neuralgia, Sciatica 1 1 ... ... ... ... ... ... ... 1 ... 2 ... 2 ... ... ... ... ... 1 ... 1 (B) Neuritis ... 1 ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... 1 ... ... 74 (A.B.C.D.) Other diseases of the nervous system (A) Idiocy, Imbecility ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... (B) Cretinism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Cerebral tumour 1 2 ... 1 ... ... ... ... ... 4 (2) ... 8 2 6 ... ... ... ... ... 5 2 ... (D) Other diseases included under 74 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 75 Diseases of the eyes and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 76 (A) Mastoid disease ... 1 1 ... ... ... ... ... ... 2 ... 2 ... 2 ... ... 1 ... 1 ... ... ... 76 (B) Other diseases of the ears ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... 1 ... ... III.—Diseases of the Circulatory System. 77 Pericarditis ... ... ... ... ... ... ... 3 ... 2 1 3 2 1 ... ... ... 1 ... ... 2 ... 78 (A.B.C.) Acute endocarditis (A) Acute myocarditis ... 1 ... ... ... ... ... 1 ... 1 ... 2 ... 2 ... ... ... ... ... 1 1 ... (B) Infective endocarditis ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... 1 ... ... (C) Other acute endocarditis 1 2 ... ... ... 1 ... ... ... (1) ... 4 1 3 ... ... ... 1 2 ... 1 ... 29 79 (A) Valvular disease 32 25 13 14 17 26 7 13 1 31 (18 24 148 67 81 .. ... ... ... 6 13 45 84 79 (B) Fatty degeneration of the heart 5 2 5 .. 2 2 1 1 ... 1 10 18 8 10 ... ... ... ... ... 1 7 10 79 (C) Other organic disease of the heart 9 14 9 16 6 17 3 5 ... 12 5) 9 79 34 45 ... ... ... 1 ... 6 23 49 80 Angina pectoris 1 1 ... ... 1 ... ... ... ... 1 ... 3 1 2 ... ... ... ... ... 1 2 81 (A) Aneurysm 1 1 ... ... 1 1 ... 1 ... 2 3 5 4 1 ... ... ... ... ... 1 2 2 81 (B) Arterial sclerosis 14 26 16 13 13 14 6 5 ... 67( ) 5 107 35 72 ... ... ... ... ... ... 8 99 81 (C) Other diseases of arteries ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 82 (A) Cerebral embolism and thrombosis ... ... 2 ... 4 1 ... ... ... 1 ... 7 1 6 ... ... ... 1 ... ... 1 5 82 (B) Other embolism and thrombosis ... 1 1 ... ... 2 1 ... ... 1 ... 5 1 4 ... ... ... ... ... ... 5 ... 83 (A.B.C.D ) Diseases of the veins (Varices Hæmorhoids, Phlebitis, &c.) (A) Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Varix ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Pylephlebitis ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 (D) Varicocele ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 (A) Status lymphaticus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 (B) Other diseases of the lymphatic system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 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 Respiratorv System. 86 Diseases of the nasal fossæ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 87 (A. B.C.) Diseases of the larynx (A) Laryngismus stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Laryngitis ... ... ... ... 1 1 ... 1 ... ... ... 3 1 2 ... ... 3 ... ... ... ... ... (C) Other diseases of larynx ... ... ... ... ... 1 ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... 1 ... 88 Diseases of the thyroid body ... 1 ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... 1 ... 89 (A.B.) Bronchitis & (A) Bronchiectasis, Bronchial Catarrh, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 90 (B) Other bronchitis 48 25 9 8 21 23 9 17 3 31(19 4 163 73 90 23 4 2 4 ... 1 33 93 91 Broncho-pneumonia 14 10 5 8 7 6 3 16 ... 11 (7) 12 69 36 33 26 6 10 7 ... 1 4 15 92 (A.B.) Lobar and undefined. (A) Lobar pneumonia 3 7 3 5 3 9 1 6 ... 3 (3) 10 37 23 14 ... ... ... 2 1 9 16 9 (B) Pneumonia (type not stated) 15 12 2 5 3 8 1 8 ... 6 (2) 1 54 29 25 4 3 4 1 3 12 14 13 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. 94 (A. B.) Pleurisy (A) Empyema 1 ... 1 1 ... 1 ... ... ... 3 1 4 4 ... ... 1 ... ... ... 2 1 ... (B) Other pleurisy ... 7 ... ... 1 ... ... ... ... 1 (1) 1 8 5 3 ... ... ... 1 ... 1 3 3 A.B.C.D.) Pulmonary congestion, Pulmonary apoplexy (A) Pulmonary apoplexy and infarction ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Pulmonary oedema and congestion ... 1 ... ... 1 1 ... ... ... 1 1 3 ... 3 ... 2 ... ... ... ... ... 1 (C) Hypostatic pneumonia ... ... ... ... ... 1 ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... 1 (D) Collapse of lung (3 months and over) ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... 95 Gangrene of the lung ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 96 Asthma 3 1 3 1 1 4 1 ... 1(1) ... 14 7 7 ... ... ... ... ... ... 6 8 97 Pulmonary emphysema ... ... ... 1 1 ... ... ... ... ... ... 2 1 1 ... ... ... ... ... ... ... 2 98 (A) Fibroid disease of lung 1 ... ... ... 1 1 ... ... 1 3 ... 3 ... ... ... ... ... ... 1 2 98 (B) Other diseases of the respiratory system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... V.—Diseases of the Digestive System. 99 (A) Diseases of the teeth and gums 1 ... 1 ... ... ... ... ... ... ... ... 2 2 ... 2 ... ... ... ... ... ... 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 1 1 2 ... 2 ... ... ... ... ... ... 6 3 3 ... ... 2 1 ... 2 1 ... (B) Ludwig's angina ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other diseases of the pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 101 Diseases of oesophagus ... ... ... ... ... ... 1 ... ... 1 ... 1 1 ... ... ... ... ... ... 1 102 Perforating ulcer of stomach ... 2 1 ... 2 1 ... ... ... 12 1 6 6 ... ... ... ... ... ... ... 6 ... 31 103 (A) Inflammation of stomach 1 2 1 ... ... 2 1 2 ... 2(2) 1 12 5 7 6 ... ... ... ... 1 3 2 103 (B) Other diseases of the stomach 1 ... ... ... ... 1 ... 1 ... 1 ... 3 2 1 ... ... ... ... ... ... 1 2 *104 & 105 (A.B.C.D.E.F.G. H.) Diarrhæa and enteritis (A) Infective enteritis ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... (B) Diarrhæa—Not returned as infective 1 2 1 2 2 3 1 ... ... 3(4) ... 12 6 6 10 1 ... 1 ... ... ... ... (C) Enteritis—Net returned as infective 4 2 1 ... 1 1 ... ... 1 4 (1) ... 10 5 5 6 ... ... ... ... ... 1 3 ( D) Gastro-enteritis—Not returned as infective 1 1 ... ... 8 1 ... 2 ... 3(11) ... 13 9 4 10 2 ... ... ... ... ... 1 (E) Dyspepsia, urder 2 years ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (F) Colic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (G) Ulceration of intestines 1 ... ... ... ... ... ... 1 ... 1 ... 2 ... 2 ... ... ... ... 1 ... 1 ... (H) Duodenal ulcer 1 ... ... 1 ... ... ... ... ... (1) ... 2 1 1 ... ... ... ... ... 1 ... 1 106 Ankylostomiasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 107 Other intestinal parasites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 108 Appendicitis 3 2 2 1 1 2 3 ... ... 10 (3) ... 14 6 8 ... ... ... 4 2 4 3 1 109 (A) Hernia 2 ... 1 2 l 3 ... 1 ... 3 (3) 2 10 5 5 1 ... ... ... ... ... 4 5 109 (B) Intestinal obstruction 2 6 4 5 ... 3 ... ... ... 9 2 20 9 11 2 2 ... ... 1 2 1 12 110 Other diseases of the intestines ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 111 Acute yellow atrophy of liver 1 1 ... ... ... ... ... 1 ... 2 ... 3 2 1 ... ... ... ... 1 2 ... ... 112 Hydatid of liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 113 (A.B.C.) Cirrhosis of the liver (A) Cirrhosis of the liver (not returned as alcoholic) 2 2 1 1 1 2 ... ... ... 1 ... 9 6 3 ... ... ... ... ... ... 8 1 (B) Cirrhosis of the liver (returned as alcoholic) ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... .. ... ... ... 1 ... (C) Diseases formerly classed to " Other diseases of liver and gall bladder" 1 ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... 1 ... 114 Biliary calculi ... ... ... ... 1 1 ... ... ... ... ... 2 1 1 ... ... ... ... ... ... 1 1 115 Other diseases of the liver ... 1 ... ... 3 ... ... ... ... (2) 1 4 1 3 ... ... ... 1 ... ... 1 2 116 (A.B.) Diseases of the spleen (A) Infarction of spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases of the spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 117 Peritonitis (cause unstated) ... ... 1 ... 1 1 ... ... ... 1 (1) ... 3 1 2 ... ... ... ... ... ... 3 ... 118 ( A. B.) Other diseases of the digestive system (A) Ablominal abscess, Sub-phrenic abscess ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases included under 118 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 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. F. males all Ages. 0-1. l-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 1 ... ... ... ... ... ... 1 ... (2) ... 2 2 ... ... ... ... ... ... ... 2 ... 120 (A. B.) Bright's disease (A) Blight's disease as in 1901 list 8 3 4 8 4 5 3 3 ... 7(2) 1 38 20 18 ... ... ... 1 ... 4 14 19 (B) Nephritis , unqualified), 10 years and over and Uræmia 3 4 2 1 2 2 1 ... ... 6(3) ... 15 8 7 ... ... ... 1 ... 6 4 4 121 Chyluria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 (A.B.C.D) Other diseases of the kidney and annexa (A) Abscess of kidney ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... (B) Cystic disease ... ... ... ... ... ... ... 1 ... 1 1 1 1 ... ... ... ... ... 1 ... ... ... (C) Suppression of urine ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other diseases included under 122 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 123 Calculi of the urinary passages ... 1 1 ... ... ... ... ... ... 2 ... 2 2 ... ... ... ... ... ... ... ... 2 124 Diseases of the bladder 2 2 1 1 ... 1 ... ... ... 2 (2) ... 7 5 2 ... ... ... ... ... ... 5 2 125 (A.B.) Diseases of the urethra, Urinary abscess, &c. (A) Perineal abscess ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases of urethra, &c. ... ... ... ... 1 ... ... 1 ... 2(1) ... 2 2 ... ... ... ... ... ... ... ... 2 126 Diseases of the prostate 2 1 1 1 1 ... ... ... ... (1) ... 6 6 ... ... ... ... ... ... ... ... 6 129 Non-venereal diseases of male genital organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 (A.B.) Uterine hæmorrhage (non-puerperal) (A) Menorrhagia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other uterine hæmorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 129 Uterine tumour (non-cancerous) ... ... ... 1 ... 1 ... ... ... 1 ... 2 ... 2 ... ... ... ... ... 1 1 ... 33 130 (A.B.) Other diseases of the uterus (A Disorder of menstruation (except merorrhagia) 1 ... ... ... ... 1 ... ... ... ... ... 2 ... 2 ... ... ... ... 1 1 ... ... (B) Other diseases included under 130 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Ovarian cyst, tumour (non-cancerous) 1 ... ... ... 2 ... ... ... 1 ... ... 4 ... 4 ... ... ... ... ... 1 2 1 132 (A.B.) Other disease of the female genital organs (A) Diseases of ovary (excluding ovarian tumour) ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases included under 132 ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 133 Non-puerperal diseases of the breast (noncancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... VII.—The Puerperal State. 194 (A. B.C. D.E.) Accidents of pregnancy (A) Abortion ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... (B) Hæmorrhage of pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Uncontrollable vomiting 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... 1 ... ... (D) Ectopic gestation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Other accidents of pregnancy 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... 135 Puerperal hæmorrhage 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... 136 Other accidents of childbirth 2 ... 1 ... ... ... ... ... ... 1 ... 3 ... 3 ... ... ... ... 1 2 ... ... 137 Puerperal fever 3 ... ... 1 ... 1 1 ... ... 3 (1) ... 6 ... 6 ... ... ... ... ... 6 ... ... 138 (A.B.C.) Puerperal albuminuria and convulsions (A) Puerperal nephritis and uræmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Puerperal albuminuria & Bright's disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Puerperal convulsions ... ... ... 1 ... 1 ... ... ... 2(3) ... 2 ... 2 ... ... ... ... ... 2 ... ... 139 (A.B.) Puerperal phlegmasia alba dolens, embolism, and sudden death (A) Puerperal phlegmasia alba dolens, phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Puerperal embolism and sudden death ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... 140 Puerperal insanity ... ... ... ... ... 1 ... 1 ... 2 ... 2 ... 2 ... ... ... ... ... 2 ... ... 141 Puerperal diseases of the breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 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. 1-2. 2-5. 5-15. 15-25. 25-45. 45-65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. VIII.—Diseases or the Skin and of the Cellular Tissue. 142 (A) Senile gangrene 1 ... ... 1 ... 1 ... ... ... 1 1 3 1 2 ... ... ... ... ... ... 1 2 142 (B.C.D.) Gangrene, other types (B) Noma, Gangrene of mouth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Noma pudendi ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other gangrene 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... 1 ... 143 Carbunicle, Boil ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... ... ... 144 (A.B.) Phlegmon, acute abscess (A) Phlegmon ... ... 1 ... 1 ... ... 2 ... 1 ... 4 2 2 ... ... ... ... ... ... 3 1 (B) Acute abscess 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... 1 ... ... 145 (A. B.C. D.) Diseases of the integumentary system (A) Ulcer, Bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Pemphigus ... ... ... ... ... 1 ... 1 ... 2(1) ... 2 1 1 1 ... 1 ... ... ... ... ... (D) Other disease of integumentary system ... ... ... ... 1 1 ... ... ... ... ... 2 1 1 ... ... 1 ... ... 1 ... ... IX.— Diseases of the Bones and of the Organs of Locomotion. 146 Diseases of the bones l 1 1 ... ... ... ... ... ... 3 ... 3 3 ... ... ... ... 1 1 ... 1 ... 147 Diseases of the joints l ... ... ... ... ... ... ... ... 1 1 1 1 ... ... ... ... ... 1 ... ... ... 148 Amputations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Other diseases of locomotor system ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... X. —Malformations. 150 (A. B.C.D.) Congenital malformations (A) Congenital hydrocephalus ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... (B) Phimosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Congenital malformation of heart ... 2 ... ... ... 1 ... ... ... ... ... 3 2 1 2 ... ... 1 ... ... ... ... (D) Other congenital malformations 2 3 ... ... ... ... 2 ... ... 3 ... 7 5 2 1 ... ... ... ... ... ... ... 35 XI.—Diseases of Early Infancy. 151 (A) Premature birth 19 9 4 ... 7 11 4 7 ... 7(5) 1 61 33 28 61 ... ... ... ... ... ... ... 151 (B.C.D.E.) Infantile debility, Icterus & Sclerema (B) Infantile atrophy, debility and marasmus 10 7 4 6 8 5 5 3 4 19(9) ... 52 33 19 52 ... ... ... ... ... ... ... (C) Icterus neonatorum ... 2 ... ... 1 2 ... ... ... ... ... 5 1 4 5 ... ... ... ... ... ... ... (D) Sclerema and ædema neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Want of breast milk ... ... 1 ... ... ... ... ... ... 1 ... 1 1 ... 1 ... ... ... ... ... ... ... 152 (A.B.C.D.) Other diseases peculiar to early infancy (A) Diseases of umbilicus, &c. ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... (B) Atelectasis 1 ... 1 1 ... 2 ... 1 ... 1 1 6 4 2 6 ... ... ... ... ... ... ... (C) Injuries at birth 2 1 ... ... 1 ... ... ... ... ... 1 4 3 1 4 ... ... ... ... ... ... ... (D) Cyanosis neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 153 Lack of care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... XII. — Old Age. 154 (A. B.) Old age (A) Senile dementia ... ... 1 ... 2 ... ... ... ... 1 ... 3 ... 3 ... ... ... ... ... ... ... 3 (B) Senile decay 15 15 17 10 13 7 4 12 4(11) ... 93 33 60 ... ... ... ... ... ... ... 93 XIII.—Affections produced by External Causes. 155 Suicide by poison 1 ... ... ... ... 1 ... ... ... ... 2 2 1 1 ... ... ... ... 1 ... 1 ... 156 Suicide by asphyxia 2 ... 1 ... ... 2 1 ... ... (1) 6 6 1 5 ... ... ... ... 2 1 3 ... 157 Suicide by hanging or strangulation ... ... 2 ... ... 1 ... ... ... ... 3 3 2 1 ... ... ... ... ... ... 1 2 158 Suicide by drowning 1 ... 1 ... 1 ... ... ... ... 2 3 3 1 2 ... ... ... ... ... 2 1 ... 159 Suicide by firearms ... ... ... ... ... ... 1 1 ... 1 2 2 2 ... ... ... ... ... ... 2 ... ... 160 Suicide by cutting and piercing instruments ... ... ... 1 ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... 1 ... ... 161 Suicide by jumping from high place ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 162 Suicide by crushing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 163 Other suicides ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 164 Poisoning by food ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 165 Other acute poisonings ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 166 Conflagration ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 167 Burns (conflagration excepted) 1 ... ... ... 1 1 ... 1 ... 3(1) 4 4 3 1 ... ... 2 ... ... ... ... 2 168 Absorption of deleterious gases (conflagration excepted) 1 ... 1 ... ... 1 ... l ... l 4 4 1 3 3 ... ... ... ... l ... ... 169 Accidental drowning ... 1 ... ... ... ... 5 ... ... 5 6 6 4 2 ... 3 ... ... 1 2 ... ... 170 Injury by firearms ... ... ... ... ... ... 1 ... ... ... 1 1 1 ... ... ... ... ... ... 1 ... ... 171 Injury by cutting or piercing instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 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. 172 Injury by fall ... 3 ... ... 1 ... 1 ... 3 5 5 1 4 ... ... ... ... ... ... 1 4 173 Injury in mines and quarries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 174 Injury by machines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 175 Injury by other crushing (vehicles, railways, landslides, &c.) 4 1 2 1 2 ... ... 1 ... 8 (6) 11 11 9 2 ... 1 ... 3 1 2 2 2 176 Injury by animals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 177 Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 178 Excessive cold ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 179 Effects of heat ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 180 Lightning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 181 Electricity (lightning excepted) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 182 Homicide by firearms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 183 Homicide by cutting or piercing instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 184 Homicide by other means ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 185 Fractures (cause not specified) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 186 Other violence ... ... 2 ... ... ... ... ... ... 1 1 2 1 1 ... ... 1 ... ... 1 ... ... XIV.—III-Defined Causes. 187 Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 188 (A) Syncope (aged 1 year and under 70) 2 ... ... ... 1 ... ... ... ... 1 ... 3 2 1 ... ... ... ... ... 2 1 ... 188 (B) Sudden death (not otherwise defined) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 189 (A) Heart failure (aged 1 year and under 70) 3 1 2 ... ... ... ... ... ... ... 1 6 ... 6 ... ... ... ... ... 2 3 1 189 (B.C.D.E.) Other ill-defined causes (B) Atrophy, debility, marasmus (aged 1 year and under 70) 1 ... ... ... ... ... ... ... ... 1 (2) 1 1 ... ... 1 ... ... ... ... ... ... (C) Teething ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Pyrexia ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 (E) Other ill defined deaths ... ... ... 1 2 ... ... ... ... ... 2 3 1 2 2 ... ... ... ... ... 1 ... 189 (F) Cause not specified 1 ... 1 ... ... 2 ... 1 ... 4 3 5 4 1 2 ... ... ... 1 2 ... ... Totals 452 349 215 224 257 330 122 168 17 619 (299) 179 2134 1031 1103 275 44 56 99 83 260 509 808 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 column of the Table. The numbers so excluded are in brackets. 37 TABLE IIIA. DEATHS FROM INFLUENZA AND CERTAIN OTHER CONDITIONS 1920. Week Ending. Influenza. Pneumonia. BronchoPneumonia. Phthisis. Other Resp. Diseases. Cerebrospinal Fever. Measles. Whooping Couch. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. January 3 ... ... 1 1 ... ... ... ... ... 3 ... ... 1 1 ... „ 10 1 2 1 2 1 ... ... ... 3 6 ... ... 1 ... ... ... „ 17 1 ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... „ 24 ... 1 ... ... 2 1 1 ... 4 4 ... ... ... ... ... ... „ 31 ... ... 1 ... 1 2 1 ... 2 5 ... ... ... 1 ... ... February 7 ... 1 ... 1 2 1 1 1 1 2 ... ... ... ... ... ... „ 14 ... ... 3 ... ... ... ... 1 6 3 ... ... ... ... ... ... „ 21 2 ... 3 ... 3 1 ... 1 2 ... ... ... ... 1 ... ... „ 28 3 1 1 4 1 3 ... ... 3 1 ... ... 1 ... ... ... March 6 ... 2 ... 3 1 4 ... 1 1 8 ... ... 1 ... ... ... „ 13 ... ... 2 4 1 1 1 ... 6 4 ... ... 1 1 ... ... „ 20 2 ... ... 4 1 2 ... 1 2 2 ... ... ... 2 ... ... „ 27 6 ... 3 1 ... 1 1 ... 3 4 ... ... 1 ... ... ... April 3 1 2 1 1 2 ... ... ... ... 4 ... ... 1 1 ... ... „ 10 ... 1 ... ... ... 2 ... ... 1 3 ... ... 1 ... ... ... „ 17 2 ... 1 1 2 1 2 ... 2 4 ... ... 1 ... ... ... „ 24 ... ... 3 ... ... 1 ... ... 6 2 ... ... ... ... ... ... May 1 1 1 1 2 1 ... 1 l 3 3 ... ... 1 ... 1 ... „ 8 ... ... 3 ... 2 ... 1 ... 1 1 ... ... l ... ... ... „ 15 1 ... 2 1 ... ... ... ... 2 2 ... ... ... ... ... ... „ 22 1 ... ... 1 ... ... ... ... ... 1 ... ... 2 1 ... ... „ 29 ... ... 1 ... ... ... ... ... 2 2 ... ... ... ... ... ... June 5 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... „ 12 ... 1 1 ... 1 ... ... ... 2 ... ... ... ... 1 ... ... „ 19 1 ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... „ 26 ... ... 2 ... ... ... ... ... 1 1 ... ... ... ... ... ... 38 TABLE IIIa.— Continued. Week Ending. Influenza. Pneumonia. BronchoPneumonia. Phthisis. Other Resp. Diseases. Cerebrospinal Fever. Measles. Whooping Cough. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. July 3 ... ... 1 ... ... ... ... ... 3 1 ... ... ... ... ... ... „ 10 ... ... ... ... 1 1 ... 1 1 ... ... ... ... ... ... ... „ 17 ... ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... „ 24 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... „ 31 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... August 7 ... ... 1 ... ... ... ... 1 2 ... ... ... ... ... ... ... „ 14 ... 1 1 ... ... ... 1 1 ... 1 ... ... ... ... ... ... „ 21 ... 1 • • • ... 2 ... ... ... 1 ... ... ... ... ... ... ... „ 28 ... 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... September 4 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... „ 11 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... „ 18 ... ... ... 1 ... ... ... ... 3 ... ... ... ... ... ... ... „ 25 ... ... 1 1 ... 1 ... ... 2 2 ... ... ... ... ... ... October 2 ... ... 1 ... 2 ... ... ... ... 2 ... ... ... ... ... ... „ 9 ... ... ... ... ... ... ... ... 3 1 ... ... ... ... ... ... „ 16 ... ... ... 1 ... ... ... ... ... 2 ... ... ... ... ... ... „ 23 ... ... 1 1 1 1 ... ... ... 2 ... ... ... ... ... ... „ 30 ... ... ... 1 ... ... ... ... 2 2 ... ... ... ... ... ... November 6 1 ... ... 1 2 ... 1 ... 2 2 ... ... ... ... ... ... „ 13 ... ... ... ... ... 1 ... ... 2 3 ... ... ... ... ... ... „ 20 ... 2 2 2 ... 2 1 ... ... 2 ... ... ... ... ... 1 „ 27 1 ... 1 ... 2 1 ... ... 3 4 ... ... ... ... ... ... December 4 ... ... 1 ... ... ... ... ... ... 2 ... ... ... ... ... ... „ 11 ... ... 2 ... ... 1 ... 5 2 ... ... ... ... ... ... „ 18 ... ... ... 1 1 1 ... 1 3 5 ... ... ... ... ... ... „ 25 1 ... 2 2 3 2 1 ... 3 6 ... ... ... ... ... ... January 1,1921 ... ... 3 ... 1 1 ... ... 2 3 ... ... ... ... ... ... 25 18 52 39 36 33 14 10 93 110 ... ... 13 9 1 1 39 TABLE IV. County Borough of Croydon— Whole Borough. INFANT MORTALITY. 1920. 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 79 27 15 18 139 65 33 24 14 275 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox • • • ... • • • ... • • • • • • ... • • • ... ... Chicken-pox ... ... • • • ... • • • ... • • • • • • ... ... Measles • • • • • • ... ... • • • ... ... 1 2 3 Scarlet Fever ... ... ... ... • • • • • • ... ... ... ... Whooping Cough • • • • • • • • • ... • • • • • • ... ... ... • • • Diphtheria and Croup • • • ... ... ... ... ... • • • • • • • • • ... Erysipelas ... ... • • • ... • • • ... ... ... ... ... Tuberculous Meningitis • • • ... • • • • • • • • • ... 1 • • • 2 3 Abdominal Tuberculosis • • • ... • • • ... • • • 1 • • • • • • • • • 1 Other Tuberculous Diseases 1 • • • ... • • • 1 ... • • • • • • ... 1 Meningitis (not Tuberculous) • • • 1 1 2 • • • 1 • • • • • • 3 Convulsions 3 5 1 1 10 5 1 1 ... 17 Laryngitis ... • • • • • • • • • • • • • • • • • • • • • • • • ... Bronchitis • • • 1 1 • • • 2 6 8 5 2 23 Pneumonia (all forms) ... 1 3 2 6 12 4 3 5 30 Diarrhœa 2 • • • 1 3 4 1 2 • • • 10 Enteritis and Gastro Enteritis 1 ... 1 •• 2 6 4 5 ... 17 Gastritis 1 2 • • • 1 4 2 ... • • • ... 6 Syphilis • • • 1 • • • • • • 1 3 ... ... ... 4 Rickets • • • • • • ... ... ... • • • • • • • • • ... ... Suffocation, overlying • • • • • • 1 • • • 1 1 • • • ... ... 2 Injury at Birth 4 • • • • • • • • • 4 ... ... • • • • • • 4 Atelectasis 5 ... • • • 1 6 • • • • • • ... • • • 6 Congenital Malformations 4 1 • • • • • • 5 3 1 • • • • • • 9 Premature Birth 41 5 5 5 56 2 1 1 1 61 Atrophy, Debility and Marasmus 12 4 2 5 23 17 7 4 1 52 Other causes 7 4 1 1 13 3 4 2 1 23 79 27 15 18 139 65 33 24 14 275 legitimate 4228. Births in the year illegitimate 206. legitimate infants, 244 Nett Deaths in the year of illegitimate infants 31. 40 TABLE IV.—Continued. County Borough of Croydon— West Ward. INFANT MORTALITY. 1920. 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 24 5 3 2 34 9 11 11 6 71 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... 1 ... 1 2 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... 1 ... ... 1 ... 1 ... ... 2 Convulsions 1 1 ... ... 2 1 ... 1 ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 2 5 4 1 12 Pneumonia (all forms) ... ... ... ... ... 2 ... 2 2 6 Diarrhœa ... ... ... ... ... ... 1 ... ... 1 Enteritis and Gastro Enteritis 1 ... 1 ... 2 ... ... 2 ... 4 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... 1 ... ... ... 1 Injury at Birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations 1 ... ... ... 1 ... 1 ... ... 2 Premature Birth 14 2 1 1 18 1 ... ... ... 19 Atrophy, Debility and Marasmus 3 1 ... 1 5 2 1 1 1 10 Other causes 1 ... 1 ... 2 ... 1 1 l 5 24 5 3 2 34 9 11 11 6 71 legitimate, 1207. Births in the year illegitimite, 52. legitimate infants, 65. Nett Deaths in the year illegitimate infants, 6. 41 TABLE IV. — Continued. County Borough of Croydon—North Ward. INFANT MORTALITY. 1920. 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 14 6 4 1 25 13 2 1 4 45 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... 1 2 ... ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 ... ... 1 1 ... ... 1 3 Pneumonia (all forms) ... ... 1 ... 1 ... ... ... 2 3 Diarrhœa ... 1 ... ... 1 1 ... ... ... 2 Enteritis and Gastro Enteritis ... ... ... ... ... 2 1 ... ... 3 Gastritis 1 ... ... ... 1 1 ... ... ... 2 Syphilis ... 1 ... ... 1 ... ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 2 ... ... ... 2 3 ... ... ... 5 Premature Birth 6 2 1 ... 9 ... ... ... ... 9 Atrophy, Debility and Marasmus 1 1 2 ... 4 5 ... 1 ... 10 Other causes 2 ... ... ... 2 ... 1 ... ... 3 14 6 4 1 25 13 2 1 4 45 legitimate 685. Births in the year illegitimate 64. legitimate infants 44. Nett Deaths in the year illegitimate infants 1. 42 TABLE IV. — Continued . County Borough of Croydon—Central Ward. INFANT MORTALITY. 1920. 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 ... 1 2 8 5 6 ... 1 20 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... ... ... 1 Pneumonia (all forms) ... ... ... ... ... ... 3 ... ... 3 Diarrhœa ... ... ... 1 1 ... ... ... ... 1 Enteritis and Gastric Enteritis ... ... ... ... ... 1 ... ... ... 1 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... 1 ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, everlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth 2 ... 1 ... 3 ... 1 ... ... 4 Atrophy, Debility and Marasmus 2 ... ... ... 2 1 1 ... ... 4 Other causes ... ... ... 1 1 1 1 ... ... 3 5 ... 1 2 8 5 6 ... 1 20 legitimate, 321. Births in the year illegitimate, 6. legitimate infants, 17. Nett Deaths in the year illegitimate infants, 3. 43 TABLE IV.— Continued. County Borough of Croydon— East Ward. INFANT MORTALITY. 1920. Nett Deaths from stated Causes at various ages under One Year of Age. CAUSES OF DEATH. Under 1 W<ek. 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 5 1 ... 1 7 8 1 ... ... 16 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 ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... 1 1 3 ... ... ... 4 Diarrhœa ... ... ... ... ... 1 ... ... ... 1 Enteritis ... ... ... ... ... ... ... ... ... ... Gastritis ... 1 ... ... 1 ... ... ... ... 1 Syphilis ... ... ... ... ... 1 ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth ... ... ... ... ... ... ... ... ... ... Atrophy, Debility and Marasmus 2 ... ... ... 2 3 1 ... ... 6 Other causes 2 ... ... ... 2 ... ... ... ... 2 5 1 ... 1 7 8 l ... ... 16 legitimate, 402. legitimate infants, 15. Births in the year Nett Deaths in the year illegitimate, 8, illegitimate infants, 1 44 TABLE IV.— Continued. County Borough of Croydon—South Ward. INFANT MORTALITY. 1920. Nett Deaths from stated Causes at various Ages uuder One Year of Age. CAUSES OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 We eke. 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 6 14 8 5 2 33 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 1 ... 1 1 ... ... ... 2 Pneumonia (all forms) ... ... ... 1 1 1 ... ... ... 2 Diarrhœa ... ... ... ... ... ... ... 1 ... 1 Enteritis and Gastro Enteritis ... ... ... ... ... 2 3 1 ... 6 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth 2 ... ... 3 5 ... ... 1 1 7 Atrophy, Debility, and Marasmus 1 ... ... 2 3 3 2 1 ... 9 Other causes ... 3 ... ... 3 1 ... ... ... 4 4 3 1 6 14 8 5 4 2 33 legitimate, 350. legitimate infants, 19. Births in the year Nett Deaths in 'he year illegitimate, 22. illegitimate infants, 14. 45 TABLE IV.— Continued. County Borough of Croydon- South Norwood. INFANT MORTALITY. 1920. 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 14 7 1 3 25 13 2 4 1 45 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... 1 1 ... ... ... ... 1 Convulsions 1 3 ... ... 4 3 ... ... ... 7 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... ... ... 1 Pneumonia (all forms) ... ... ... ... ... 2 ... ... 1 3 Diarrhœa ... 1 ... ... 1 2 ... ... ... 3 Enteritis and Gastro Enteritis ... ... ... ... ... ... ... 2 ... 2 Gastritis ... 1 ... ... 1 ... ... ... ... 1 Syphilis ... ... ... ... ... 1 ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... 1 ... ... ... ... 1 Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 1 ... ... 1 2 ... ... ... ... 2 Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth 9 1 ... ... 10 1 ... ... ... 11 Atrophy, Debility and Marasmus 1 ... ... 1 2 2 1 ... ... 5 Other causes 2 l ... ... 3 1 1 1 ... 6 14 7 1 3 25 13 2 4 1 45 Births in the year legitimate, 636 Nett Deaths in the year legitimate infants, 41 illegitimate 33 illegitimate infants, 4. 46 TABLE IV.— Continued. County Borough of Croydon— Upper Norwood. INFANT MORTALITY. 1920. 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 5 2 1 2 10 1 2 3 ... 16 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 ... ... ... ... ... 1 1 ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... 1 ... 1 Pneumonia (all forms) ... ... ... ... ... ... ... 1 ... 1 Diarrhœa ... ... ... ... ... ... ... l ... 1 Enteritis and Gastric Enteritis ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying . ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 1 1 ... ... 2 ... ... ... ... 2 Premature Birth 2 ... 1 1 4 ... ... ... ... 4 Atrophy, Debility, and Marasmus 2 1 ... l 4 ... 1 ... ... 5 Other causes ... ... ... ... ... ... ... ... ... ... 5 2 1 2 10 l 2 3 ... 16 Birth in the year legitimate, 193. Nett Deaths n the year legitimate infants, 15. illegitimate, 8. illegitimate infants, 1. 47 TABLE IV.— Continued. County Borough of Croydon— Thornton Heath. INFANT MORTALITY. 1920. 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 8 3 4 1 16 8 4 1 ... 29 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... 1 ... ... ... 1 Other Tuberculous Diseases 1 ... ... ... 1 ... ... ... ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... 1 1 ... 2 ... ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 3 ... ... 3 Pneumonia (all forms) ... 1 2 ... 3 4 1 ... ... 8 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis and Gastric Enteritis ... ... ... ... ... 1 ... ... ... 1 Gastritis ... ... ... 1 1 1 ... ... ... 2 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth 6 ... 1 ... 7 ... ... ... ... 7 Atrophy, Debility and Marasmus ... 1 ... ... 1 1 ... 1 ... 3 Other causes ... ... ... ... ... ... ... ... ... ... 8 3 4 1 16 8 4 1 ... 29 legitimate. 434. legitimate infants, 28. Births in the year Nett Deaths in the year illegitimate, 13. illegitimate infants, 1. TABLE V. Table showing the number of cases notified and deaths from the principal zymotic diseases for the Year 1920 and ten preceding Years. Disease. 1920. 1919. 1918. 1917. 1916. 1915. 1914. 1913. 1912. 1911. 1910. Cases. Deaths Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Notifiable. Cerebro-Spinal Meningitis 3 3 4 .. 25 1 18 29 1 24 9 .. .. .. .. .. .. .. .. .. .. Poliomyelitis 1 I .. .. .. .. 1 .. 2 .. 4 1 .. .. .. .. .. .. .. .. .. .. Small Pox .. .. 9 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 638 7 603 11 414 6 191 2 297 4 414 5 748 5 470 3 476 2 468 7 759 7 Diphtheria and (i) Memb. Croup 558 26 429 36 179 2 191 9 312 4 195 14 226 18 451 16 767 25 514 37 267 21 (2) Erysipelas 74 3 61 2 44 3 56 3 52 1 82 3 96 7 107 6 84 6 79 5 69 1 Puerperal Fever 14 6 4 3 4 3 3 1 7 1 12 5 9 3 6 4 10 3 12 4 8 1 Enteric Fever 12 4 5 .. 15 2 6 .. 13 .. 22 3 20 5 32 6 32 7 24 7 26 .. Simple Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis (3) 480 195 440 217 378 204 397 157 326 223 550 238 503 192 519 202 312 140 240 165 130 135 Non-notifiable. Measles (4) .. 22 .. .. 1057 2 2944 29 462 .. .. 108 .. 8 .. 58 .. 31 .. 29 .. 31 Rubella .. .. .. .. 93 .. 2439 .. 636 .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa and Enteritis .. 36 .. 24 .. 48 .. 41 .. 50 .. 62 .. 67 .. 85 .. 58 .. 147 .. 51 Whooping Cough .. 2 .. 1 .. 10 .. 9 .. 27 .. 12 .. 24 .. 23 .. 13 .. 38 .. 20 Influenza .. 43 .. 139 .. 478 .. 20 .. 46 .. 45 .. 15 .. 26 .. 18 .. 14 .. 25 Bronchitis, *Pneumonia, and Pleurisy 335 § 185† 353‡ .. 362 .. 302 .. 329 .. 399 .. 313 .. 297 .. 250 .. 280 .. 251 (1) Notifiable since May 1897. (2) Notifiable since January, 1909. (3) Voluntary Notification, 1905-09. 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) Not now notifiable. Notifiable, i.e., acute primary pneumonia and influenzal pneumonia only. † Pneumonia only. ‡136 Pneumonia. § Bronchitis 163, Broncho-Pneumonia 69, Pneumonia 91, Pleurisy 12 = 335. 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. 48 NOTES.—Deaths of residents occurring beyond the district are included in eub-colunns C of this table, and those of non-residents occurring at the WorkhouBe, Workhouse Infirmary, Borough Hospital, General Hospital, Norwood Cottage H wpital, 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 addressee of the deceased, and all deaths of Oroydon residents whose exact home oould not be ascertained, are included in Block 9. • Including North Ward. TABLE VI.— Vital Statistics of separate Wards in 1920 and previous years. Names or Localities. 1, North Ward, 2. West Ward 3. Central Ward. 4. East Ward. 5. South Ward South Norwood Ward. 7. Upper Norwood Sub-Division. 8. Thornton Heath Sub-Division. 1. Undistributed Institution Births and Deaths. YEAR Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 Year Population estimated to middle of each year. Births Registered. Deaths at all ages. Deaths under 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. 1 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 0 c 0 M b C d a a c d a s e d a a a a a c a s c d 0 c d 010 *54,458 1480 603 149 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 29,701 091 275 51 33,502 800 473 107 16,167 295 109 31 20,175 377 217 42 18.998 360 209 42 25,000 572 325 65 8,128 112 105 10 18,081 430 100 43 111 29 3 1012 30,450 68S 273 34,964 829 436 88 16,119 298 190 25 20,743 417 199 27 19,111 370 203 24 26.228 577 281 39 8,115 131 103 14 18,527 410 174 35 140 34 .. 1013 31,117 781 340 69 36,424 800 451 90 16,070 332 216 36 21,323 402 226 37 19,226 337 234 37 26,850 594 319 54 8,102 112 93 8 18,982 425 185 37 107 21 .. 1014 31,869 720 302 45 37,302 841 400 95 16.021 290 175 27 21.837 468 214 32 19,690 353 218 28 27.408 626 304 42 8,298 109 101 10 19,411 406 159 40 113 21 .. 1015 30,093 060 451 52 36.276 844 553 82 15 985 264 236 25 21,236 447 254 31 19,148 308 248 20 26.732 559 348 43 8,009 141 90 7 18,906 38f> 208 38 79 18 .. 1916 30.659 729 550 44 35,935 769 488 97 15,949 216 182 14 21,041 458 203 20 18,970 309 100 19 20.485 589 245 33 7,995 112 115 9 18,731 377 15J- 36 61 10 .. 1017 32 810 656 597 56 36,406 634 108 65 16,030 107 186 23 22,515 357 212 22 20,275 248 172 23 28 292 451 252 22 8.604 81 91 4 20.019 312 182 34 68 44 .. 1018 •2 ,562 516 665 42 34,601 704 582 67 14,449 205 200 13 20,240 303 298 30 18,268 232 211 17 2 ,402 349 292 19 7,717 84 118 3 18,030 239 171 21 66 6 .. 1019 32,330 570 382 35 37,845 850 444 60 15,802 239 203 20 22,245 281 272 30 19,979 250 236 21 27,879 439 303 25 8,440 110 116 8 19,710 960 197 17 80 19 .. Averages of Years 1909 to 1918. .. .. .. .. .. .. .. .. 10,167 269 197 24 20,813 403 221 32 19,526 326 206 27 26,203 5,52 287 10 8,175 117 102 8 18,772 401 176 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 1920 33,618 665 349 45 39,353 1259 452 71 16,432 327 215 20 23,132 410 224 10 20,775 372 257 33 28,990 669 330 45 8.776 201 122 10 20,504 447 168 29 84 17 .. 49 TABLE VII. METEOROLOGICAL RECORD—YEAR 1920. 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 1920. 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 56" 22° 47°.6 39°.3 43°.4 + 5°.0 43° 6 37°.9 in. — 049 13 in. 2.30 in. + 0.51 February 62° 28° 50°.6 37°.9 44°.2 + 7°.7 43°.5 41°.2 — .022 8 0.53 — 1.0 March 67° 25° 54°.0 37°.8 45°.8 + 4°.1 43°.9 41°.9 — .015 15 1.66 + 0.15 April 64° 34° 54°.5 42°.4 48°.4 + 1°.0 47°.4 44°.8 — .028 22 2.43 + 1.83 May 80° 33° 65°.3 45°.7 65°.5 + 2°.3 49°.7 49°.6 Nil 7 0.39 — 1.49 June 77° 36° 69°.9 51°.2 60° 5 + 1°.0 55°'5 55°.9 + .011 10 1.92 — 0.11 July 76° 45° 66°.7 52°.1 59° 4 — 3°.2 57°.3 56°.5 — .011 17 3.65 + 1.24 August 74° 41° 66°.0 50°1 58° 0 — 3°.6 56°.9 55°.1 — .026 7 1.55 — 0.83 September 74° 41° 65°.3 48°.4 56°.8 — 0°.2 55°.4 55°.0 — .009 12 2.84 + 0.64 October 75° 31° 61°.9 44°.6 53°.2 + 3°.8 54°.1 51°.0 — .035 9 0.88 — 1.85 November 58° 23° 50°.5 34°.4 42°.4 — 1°.0 48°.2 42°.2 — .062 13 1.16 — 1.18 December 56° 13° 44°.4 37°.0 40°.7 + 1°.0 44°.5 40°.1 — .036 20 1.98 + 0.04 Meant and Totals for the Year. 80° 13° 58°.0 43°.1 50°.7 + 1°.1 50°.0 47°.6 — .023 153 21.29 — 2.99 The Rainfall for the Year was 5.15 inches below the average of 54 years at Croydon, and the number of days on which it rained was 153 or 10 days below the average. H. CORDEN, Croydon. 50 51 TABLE VIIA. Prevailing direction of the Wind at Croydon in 1920. Number of Days each Month. 1920. N. E E. S.E. S S.W. W. N.W. N. January ... 4 ... 1 4 17 3 1 1 February ... 5 2 3 1 16 2 ... ... March ... ... 3 2 3 15 5 3 ... April ... ... 1 ... ... 22 4 2 1 May ... ... 2 4 2 16 4 3 ... June ... 2 4 5 1 7 5 1 5 July ... ... ... ... 3 14 12 1 1 August ... 4 2 ... 2 3 10 4 6 September ... 1 3 3 2 7 10 2 2 October ... ... 16 4 10 1 ... ... ... November ... ... 6 4 6 6 3 4 1 December ... 6 2 1 4 8 2 4 4 Totals 22 41 27 38 132 60 25 21 63 60 192 46 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. K. and E. Winds, yearly average 93 7 S. K. and S. ,, ,, ,, 63.7 S.W. and W. ,. 131.9 N.W. and W. ,, ,, ,, 73.8 H. CORDEN, Croydon. 52 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 63, as compared with 73 in 1919, 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, 99 in 1908. During the year of 1920 the rate for England and Wales was 80, while in the 96 large towns it was 85, and in the 148 smaller towns 80, and in London 75. The infant mortality rate of 63 is a record low rate for the borough by no fewer than 10 points. The figures for the various Wards were:— Births Deaths under 1 year. Death-rate per 1000 Births (all causes). Death-rate per 1000 births from diarrhœl diseases. Upper Norwood Sub-division 201 16 79 5 North Ward 749 45 60 7 Thornton Heath Sub-division 447 29 65 2 East Ward 410 16 39 2 Borough 4434 275 63 7 Central Ward 327 20 61 6 South Ward 372 33 88 19 West Ward 1259 71 56 4 South Norwood Ward 669 45 67 8 The following table shows the fluctuations since 1892 in the infantil 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 Morality from other than "diarrheal" diseases. 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 1920 63 7 56 53 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 1920 diarrhoea and epidemic enteritis accounted for 10 deaths of infants under one year of age, 17 others being due to enteritis or gastro-enteritis, making a total of 27 deaths from "diarrhœal" diseases. A further 9 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 Monday and Thursday afternoons. At the medical consultations there have been during the year 1920 approximately 55 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 1920 has been:— New Cases 502 Total Attendances 5735 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. 54 Chart shewing Infant Mortality Rate for Croydon compared with Bthe 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. 55 The following table gives the numbers seen at the ten centres in the town during 1920. INFANT CENTRES Municipal Centre (228, London Road). Central Croydon (Sylverdale Road). South Croydon (Bartlett Street). East Croydon (Lr. Addisc'be Rd.) Woodside (St. Luke's Hall, Spring Lane). South Norwood (Selhurst Road). Upper Norwood (St. Margaret's, Naseby Road). Thornton Heath (Mersham Road). Thornton Heath (St. Alban's Hall. Whitehorse Lane). West Croydon 1 (Johnson Road). TOTAL. Infants Under 1 Year: Attendances— (a) 1. New Cases 407 142 145 161 135 289 96 125 197 205 1902 2. Old Cases 3782 1559 1807 1715 1546 3593 1038 1437 2805 3247 22529 Total 4189 1701 1952 1876 1681 3882 1134 1562 3002 3452 24431 Seen by Doctor 1927 675 554 627 684 1294 486 1082 1277 1331 9937 Children 1—5 yrs. of Age: (b) 1. New Cases 95 38 59 38 58 84 40 42 65 114 633 2. Old Cases 1451 1227 1314 816 1356 2865 1542 1080 1464 1400 14515 Total 1546 1265 1373 854 1414 2949 1582 1122 1529 1514 15148 Seen by Doctor 688 437 417 276 411 437 335 220 404 336 3961 Attendance of Mothers (a) & (b) 5078 24S0 2691 2373 2394 5453 2080 2087 3807 3996 32439 Expectant Mothers Attendances— (c) 1. New Cases 155 37 65 32 33 99 40 21 59 52 593 2. Old Cases .. 349 249 379 121 193 3°9 122 112 186 215 2255 Total 504 2S6 464 153 226 408 162 133 245 267 2848 Home Visits 104 63 79 42 43 133 72 52 73 91 752 Visiting of Childr'n (d) Under 12 months 1. First Visits 905 329 331 281 288 449 192 354 362 491 3982 2. Subsequent Visits 1047 435 475 509 565 489 378 555 5S9 756 5S98 3. No, of Children seen 1597 421 432 572 511 868 562 589 646 893 7091 (ii)From 1-5 y'rs. of age 1. First Visits 229 188 212 45 154 108 103 175 177 281 1672 2. Subsequent Visits 512 3i3 320 209 235 565 4S2 292 318 599 3845 3. No. of children seen 733 309 310 212 228 739 615 403 437 663 4649 (c) re Infant Deaths 44 19 23 9 8 39 18 33 37 41 271 56 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. At all the Centres records are kept of both infants and toddlers. Provision of Fresh Milk at the Centres. Milk is supplied under the same system of control as described in last year's report. The following statement shews the main details of the supply and the liabilities : — MILK SUPPLIED TO MOTHERS AND INFANTS. 1st April 1920 to 31st March, 1921. Supplied to Families. No. of Quarts. Received from Families. Corporation Liability. TOTALS, Milk at 3d. 16089½ £ s. d. £ s. d £ s. d. 201 2 4½ 419 13 6 020 15 10½ Milk at 6d, 2640¼ 66 0 1½ 08 17 4 134 17 5½ Milk Free 10308¾ — 437 0 8¾ 437 0 8¾ Total number of Quarts supplied 29038½ 267 2 6 925 11 6¾ 1192 14 0¾ Total Number of Families 356. Average supplied to each family, 81.57 quarts. Average cost of supply to each family, £3 1s. 8½d. (at 9.08d. per quart Maternity Hostel. The Hostel continues to provide to a limited extent one of the most urgent needs of the town. All cases are admitted by way of the centres or the ante-natalclinic except emergencies. 325 births occurred in the institution in 1920 as against 269 in 1919. The details are given in the subjoined statement. Every month as many cases have to be refused admission as are taken in. There is great need for the extension of this work. 57 St. Mary's Maternity Hostel. Admissions, Discharges, Etc., for Period April 1st, 1920, to March 31st, 1921. Women admitted. confinements. Births. Women Discharged. Total. Normal. Complicated. Total. Alive. Stillborn. Nonviable. 325 322 220 102 325 313 11 1 (not a birth). 318 EXPLANATORY NOTES. 9 women in Hostel on April 1st, 1920, admitted during previous March. 16 women in Hostel on April 1st, 1921 3 women admitted for ante-natal treatment only. 0 women admitted for post-natal treatment. Twins born on three occasions. Cesarean section performed in 2 cases. One case of miscarriage. No maternal deaths during 1920-21. Ante Natal Clinic. This Clinic has continued to meet once weekly. The total number of expectant mothers attending was 152. 932 attendances were made during the year. The average weekly attendance was 18. 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 ante-natal advice is given in the routine work of the maternity and infant centres. Arrangements have been made which still more closely link up this Clinic with the work of the Hostel. 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 1920. Sick Nursery, 228, London Road. Number of cases at Nursery at end of 1919 4 Number admitted during 1920 55 Number discharged during 1920 50 Number died during 1920 5 Number remaining at end of 1920 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. 58 TABLE A. Infants dying from Diarrhoea] Diseases. 0-6 months. Infants dying from other than Diarrhœal Diseases. 0-6 months. Infants surviving 6 months.- Total investigated. Breast Fed only 16 75 1698 1789 Breast and subsequently Cow's milk ... 3 115 118 Ditto Condensed Milk 1 3 49 53 Ditto Other foods ... 1 5 190 196 Breast & simultaneously Cow's Milk 1 1 48 50 Ditto Condensed Milk ... 1 45 46 Ditto Other foods ... ... 110 110 Entirely Hand Fed— Cow's Milk 7 11 38 56 Ditto Condensed Milk 2 12 37 51 Ditto Other foods 14 15 89 118 Number investigated 42 126 2419 2587 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. 69.1 per cent. 38.1 per cent. 59.5 Breast and subsequently Cow's Milk... 4.6 ... 2.4 Ditto Condensed Milk ... 2.0 2.4 2.4 Ditto Other foods 7.6 2.4 4.0 Breast and simultaneously Cow's Milk 1.9 2.4 .8 Ditto Condensed Milk ... 1.8 ... .8 Ditto Other foods ... 4.3 ... ... Entirely Hand Fed—Cow's Milk 2.2 16.7 8.7 Ditto Condensed Milk 1.9 4.7 9.5 Ditto Other foods 4.6 33.3 11.9 100.0 100.0 100.0 Table B shows that 38.1 per cent. of infant deaths from diarrhœal diseases occurred amongst breast-fed children, and the remaining 61.9 per cent. amongst children who were either entirely hand fed or had artificial kinds of food as well as breast fed. 59 Notification of Births Act. 1037. 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 4,000 notifications were received. These births were notified as follows:— Notified by medical men 998 Notified by parents 919 Notified by certified midwives 1960 3877 Stillborn births notified 123 4000 Midwives. During the year 301 visits were paid to midwives by the Inspector of Midwives for the purpose of information or inspection. At the end of 1919, 28 midwives were registered as practising in Crovdon, and during 1920 four new names were added, leaving 32 on the register at the end of 1920. SECTION IV. TUBERCULOSIS WORK. The following paragraphs give a general summary of the arrangements made for dealing with tuberculosis, and are arranged seriatim to correspond with the headings in Circular No. 168 of the Ministry of Health : — The Medical Officer of Health is Chief Administrative Officer for Tuberculosis. The Specialist Clinical Tuberculosis Officer ranks as an Assistant Medical Officer of Health for Tuberculosis. His .principal work is at the Dispensary, but he also acts as Consulting Physician to the Tuberculosis Ward in the Croydon Borough Isolation Hospital. There is one Tuberculosis Dispensary situate at 13, Katharine Street, Croydon, attached to which, in addition to the above-mentioned Clinical Tuberculosis Officer, there are two nurses and three clerks. The residential institutions at which tuberculous patients are treated under the town scheme are:— Larch field Sanatorium, Caterham—14 beds for women —leased to the Corporation by contract. 60 Grosvenor Sanatorium, Ashford, Kent—20 beds—both male and female—leased to the Corporation by contract. Various other sanatoria and hospitals where beds are not contracted for, but the occupied beds number on an average 56. Croydon Borough Isolation Hospital—belonging to the local authority—17 beds—male and femaleResident Medical Officer, Dr. Kerr Simpson. Nursing staff provided out of the general staff of the Hospital—one sister specially attached to the tuberculosis ward. Croydon Borough Sanatorium, North Cheam—belonging to the local authority—50 beds. These beds are divided as follows 15 for Croydon cases, 30 for Surrey cases, and 5 for Kent cases. Resident Medical Officer: Dr. T. Dawson. Cases from all sources are seen at the Tuberculosis Dispensary by the Clinical Tuberculosis Officer. The principal sources from which patients come are:— (a) Private medical practitioners. (b) School medical officers. (c) Croydon General Hospital, etc. In general practice cases are not seen excepting after consultation with the private medical practitioner unless there be no actual family medical man attached to the case. There is close liaison between the Tuberculosis Section of the Department and all other branches of the Public Health Service. School children and other persons seen in any section of the Department suspected to be suffering from tuberculosis are referred direct to the Dispensary for consultation and decision. The co-operation between the sources mentioned has always been smooth and successful. Where the diagnosis of a case is doubtful the patient is kept under regular observation both directly through the Dispensary and indirectly by communication with the general medical practitioners in the town. 61 Contacts are examined systematically as far as possible, more particularly when the nurse is visiting home cases of tuberculosis. Any contact giving ground for suspicion of early incidence of tuberculosis is referred for examination to the Dispensary. There is no doubt, however, that when the suitable time for extension of the work arrives further medical assistance will be required to enable the Department to examine and watch systematically home contact of known cases. The only special method of examination of cases which has been employed is examination by X-rays. The outstanding feature in my opinion of the scheme for tuberculosis is that without a very complete and effective system of after-care of tuberculous patients, the effects of sanatorium and hospital treatment, however good they may be in themselves, are largely lost. No system of after-care is of much value unless it has considerable financial backing secured. No dental treatment is provided by the Local Authority specifically for tuberculous patients. One nurse does actual nursing of advanced cases at their homes. Approximately forty cases received extra nourishment in the form of milk regularly. Cases of non-pulmonary tuberculosis are referred for treatment to the Royal Sea Bathing Hospital and similar institutions. Six shelters were provided for the use of patients in their gardens. These were increased in 1921 by the addition of ten shelters. The arrangements for After-care in Croydon were originally provided for by the establishment of an After-care Committee. It was, however, found that the Committee as a body was not really effective on account of the lack of adequate financial backing. It is an extremely difficult thing to get voluntary support for this work. The Committee, after a year or two's existence ceased to exist as such, and the After-care of tuberculosis patients has developed into individual interest on the part of the staff of the Public Health Department and of people who are disposed to give such help and advice. Patients are advised as to the kind of occupation they should undertake after return from sanatorium treatment, and so far as is possible help is given to the patients to obtain such suitable form of activity. It cannot, however, be too strongly emphasised, that adequate after-care depends upon assured financial support. 62 Table showing origin of Cases seen at the Dispensary for the first time in 1920. Cause of person attending Dispensary. Insured. Uninsured* Grand Total Men. Woman Total. Men. Women Child'n Total. (i) Referred, by local doctors or hospital for diagnosis, treatment or advice 65 77 142 20 68 68 156 298 (2) Ditto ditto by School Medical Officers or from Infant Clinics ... 3 3 ... 4 164 168 171 (3) / itto ditto from other chiefly charitable, sources 22 10 32 S 29 39 76 108 [4) Seen as "Contacts 5 9 14 4 21 73 98 112 (5) Ministry of Pensions 114 ... 114 2 ... ... 2 116 206 99 305 34 122 344 500 805 * This includes dependents of insured persons Table showing the way in which new cases were dealt with in 1920. Insured. Uninsured. Grand Total. Men. Women. Total. Men. Women Cild'n Total. (1) Diagnosed as tuberculous: (a) Treated through the Dispensary 135 75 210 11 37 76 124 334 (b) Treated elsewhere 12 6 18 6 25 20 54 72 (2) Diagnosis not settled- Kept under observation 31 8 39 12 49 186 247 286 (3) Diagnosed not tuberculous 28 10 38 5 8 62 75 113 206 99 305 34 122 344 500 805 Table showing details of Medical Examinations made by the Medical Officer to the Tuberculosis Dispensary, 1920. Period. 1920. 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 674 1178 1852 9 9 18 1870 90 139 229 April 1st to June 30th 660 1108 1768 17 5 22 1790 81 114 195 July 1st to Sept. 30th 588 996 1584 8 9 17 1601 64 92 156 Oct. 1st to Dec. 31st 726 I 120 1846 9 6 15 1801 70 155 225 Totals 2648 4402 7050 43 29 72 7122 305 500 805 Note.—In addition to the medical examinations shown in this table the Medical Officer also visited and examined the tuberculous patients at the Borough Hospital twice weekly throughout the year. 63 64 The proportion of known tuberculosis in the Borough which is dealt with through the Dispensary continues to to be satisfactorily high, as is shown by the following figures:— (1) Total Primary Notigcations, 1920 480* (2) Total new cases seen at Dispensary and diagnosed as tuberculosis, 1920 406 Therefore approximately 84 per cent. of the cases notified in the Borough in 1920 were seen by the Medical Officer to the Tuberculosis Dispensary. *(This figure includes "other forms of tuberculosis" in addition to pulmonary tuberculosis.) In 1920 334 new cases were treated through, as well as being seen, at the Dispensary. CROYDON BOROUGH SANATORIUM. The fifty beds at the Croydon Borough Sanatorium are kept continuously full with the exception of course of an occasional intervening day or two arising out of the departure and arrival of patients. The following table shews the distribution of the beds amongst the three authorities who contribute towards the maintenance of the patients:— District. Remaining at end of year 1919. Admitted during year 1920. Discharged during year 1920. Died during year 1920. Remaining at end of year 1920. Croydon C, B. 7 57 48 1 15 Kent C. C. 0 21 16 0 5 Surrey C. C. 18 107 81 15 29 Total 25 185 145 16 49 65 SANATORIUM AND HOSPITAL TREATMENT: SUMMARY OF CASES TREATED AT SANATORIA, 1920. M. w. C. Tl. (A) Persons in Sanatoria on Jan. 1st, 1920 30 18 11 59 (B) Persons admitted to Sanatoria 1920 134 91 51 276 164 109 62 335† (C) Persons discharged from Sanatoria 1920 135 80 49 264 (D) Persons who died in Sanatoria 1920 3 — 1 4 138 80 50 268 (E) Persons in Sanatoria on December 31st, 1920 26 29 12 67 The total individuals receiving treatment in Sanatoria during 1920 is therefore:— Men 164 355† Women 109 Children 62 The total individuals sent to Sanatoria in 1920 is:— Men 134 276† Women 91 Children 5. † 124 men and 46 women were "insured persons." Of the "insured men" 93 were ex-service men. SUMMARY OF CASES TREATED AT THE BOROUGH HOSPITAL, 1920. M w c. T1 (A) Persons at the Borough Hospital on Jan. 1st, 1920 6 4 - 10 (B) Persons admitted to Hospital in 1920 36 26 1 63 42 30 1 73: (C) Persons discharged from Borough Hospital 1920 30 20 - 50 (D) Persons who died in the Borough Hospital 1920 5 2 1 8 35 22 1 58 (E) Persons in Borough Hospital on Dec. 31st, 1920 7 8 - 15 Total individuals receiving treatment at the Borough Hospital in 1920 is Men 42 73‡ Women 30 Child 1 The total individuals admitted to the Borough Hospital in 1920 is Men 36 63 Women . 26 Child 1 ‡ 35 men and 14 woman were "insured person." Of the insured men 18 were ex- service men 66 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 1920. The treatment of male patients and arrangements for daily lavage have both been provided during 1920 at Croydon General Hospital Clinic. The increase in the number attending the local treatment centre is principally due to this extension of the arrangements. The total number of cases dealt with from Croydon in 1920 was 391, as against 262 in 1919, and 190 in 1918. The number attending the clinics in London increased by 24; those attending the local clinic increased by 105. The number of pathological examinations made for private practitioners—1913 in 1920, as against 1909 in 1919, and 45 in 1918—does not continue to shew the increase which was characteristic of 1919, VENEREAL DISEASES. Annual Summary Year 1920 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 7,917 704 392 285 206 89 58 121 324 80 10,176 Soft chancre 570 26 19 12 21 ... 2 4 26 3 683 Gonorrhœa 10,127 872 443 293 181 87 53 164 363 71 12,655 Not found to be suffering from Venereal Disease 4,998 534 237 165 113 39 32 72 229 58 6,477 Total 23.612 2,136 1,091 755 522 215 145 361 942 212 29,991* Total Attendances 365.478 34.011 12,386 12,190 7,282 2.436 1.946 3,434 10,278 2,480 451,921 4. No. of "in-patient" days of Treatment 54.529 1,846 2,9?4 1,900 3,505 1,324 1,209 332 963 405 68,937 6. No. of doses of Salvarsan substitutes given 51,266 4,635 2,164 2,666 1,565 643 603 603 1,662 552 66,359 "In addition, 1,055 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 r.ew patients dealt with at the Clinics for the year was therefore ... 29,991 1.055 31,046 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 26 1 2 ... ... ... ... ... ... 29 For detection of gorococci 1,611 149 113 57 3 12 ... 16 11 55 2,027 For Wasser mann re-action 9513 537 750 411 67 32 22 136 268 138 11,874 Other examinations 84 ... ... ... ... ... ... ... ... ... 84 Total 11,234 686 864 470 70 44 22 152 279 193 14,014 67 68 VENEREAL DISEASES. Return relating to persons residing in the County Borough of Croydon who were treated at the Croydon General Hospital, 1920 and 1919. 1920. 1919. 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 and Gonorrhœa 2 1 — — Syphilis 28 27 — 34 Soft Chancre 5 — — — Gonorrhœa 40 25 — 18 Not suffering from venereal disease 26 25 — 22 101 78 — 74 Number of persons discharged from the out-patient Clinic after completion of treatment for :— Syphilis 1 1 — 12 Soft Chancre — — — — Gonorrhœa — 1 — — 1 2 — 12 Number of persons who ceased to attend the outpatient Clinic without completing treatment and who were suffering from : — Syphilis 9 15 — 4 Sort Chancre 3 — — — Gonorrhœa 7 9 — 1 19 24 — 5 Total attendances of all persons at the out patient Clinic who were suffering from Syphilis 225 491 — 339 Soft Chancre 29 — — — Gonorrhœa 423 165 — 111 Not suffering from venereal disease 74 63 — 101 751 719 — 551 Aggregate number of "in-patient days" of treatment given to persons suffering from :— Syphilis 20 — — 67 Gonorrhœa — — — — 20 — — 67 Number of persons treated with Salvarsan substitutes — 9 — 21 Number of doses of Salvarsan substitutes given 154 91 Examinations of pathological material :— Specimens from persons attending at the Treatment Centre which were sent for examination to an independent laboratory :— For detection of spirochetes — — — — ,, ,, gonococci — 33 — 12 ,, Wassermann reaction — 115 — 41 „ Others — — — 12 — 148 — 65 69 SECTION VI. MENTAL DEFICIENCY, 1920. 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. 15th January H. F. L. M. 16 Institutional. Royal Earlswood Institution. 24th January D. I. R. F. 21 Institutional. Earlswood. Order made for contribution of ten guineas p.a. by father towards maintenance. 26th January G. S. M. 10 Institutional. Stoke Park Colony. Under Section 2 (1) (b) (ii) M. D. Act. 2nd March N. A. T. F. 20 Institutional. Stoke Park Colony. 2nd March A. F. F. 50 Placed under Guardianship. 9th March E. P. M. 19 Institutional. Hampton State Institution. Order made 1st June for contribution by father of 5/- p.w. towards maintenance. Under Section 2 (1) (b) (ii) M D. Act. 10th March W. H. M. 7 Institutional. Earlswood. Cos of maintenance borne by father. 26th March C. L. M. 16 Institutional. Darenth Industrial Colony. On behalf of Hertford Local Authority. 26th March C. P. M. 16 Institutional. Darenth Industrial Colony. 30th \pril E. J. W. F. 35 Institutional. Queen's Road Institution. Order made for contribution by father of 5/- p.w. towards maintenance. 11th May H. P. F. 16 Institutional. Darenth Industrial Colony. Order made for contribution by father of 3/- p.w. towards maintenance. 18th May F. H. W. M. 26 Placed under Guardianship. 9lh June W. S. M. 17 Institutional. Darenth Industrial Colony. Under Section 2 (1) (b) (ii)' M. D. Act. 11th June S. H. M. 17 Institutional. Stoke Park Colony. Order made for contribution by father of 5/- p.w. towards maintenance. 20th July V. W. F. 16 Institutional. Princess Christian Farm Colony. Order made for contribution by father of 5/p.w. towards maintenance. 20th July C. M. M. 45 Placed under Guardianship. 14th August A, C. F. 16 Institutional. Caterham Mental Mental Hospital. Order made for contribution by father of 10/p.w. towards maintenance. 18th Sept. C. H. M. 4 Institutional. Fountain Mental Hospital, Tooting. Order made for contribution by father of 10/- p.w. towards maintenance. 2nd October C. H. F. 61 Institutional. Queen's Road Institution. 20th October I. H. F. 17 Institutional. Stoke Park Colony. Order made for contribution by father of 2/6 p.w. towards maintenance. 24th November W. R. M. 5 Institutional. Fountain Mental Hospital, Tooting. 2nd December G. R. F. 16 Placed under Guardianship. 8th December E. H. M. 13 Institutional. Stoke Park Colony. 70 Total number of Defectives known by medical examination in the Borough 256 Statutory Cases 144 (a) 0—5 years 4 (b) 5—16 „ 35 (c) Over 16 „ 105 In Certified Institutions 56 In Croydon Mental Hospital 11 In Poor Law Institutions 10 Resident at Home 58 Resident at Home under Guardianship 9 Education Cases For a summary of these see Appendix A., Table 3 (School Medical Report page 121. Total Number of Examinations made by the Medical Officers during 1920 248 Statutory Cases 134 Education Cases 114 During the year 1920 there have been three deaths, all statutory cases at Institutions—two of these were children under five years of age. Three cases have been transferred to Croydon Mental Hospital, under the Lunacy Act. Seven cases have removed from the Borough. Twenty-four new cases were admitted to Grangewood Special M. D. School during the year. Two cases were certified as imbeciles, and two cases came under the care of the Statutory Committee because of special circumstances. 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. 2,390 house-to-house inspections were made. These numbers are in addition to 1,154 inspections of houses where infectious diseases have been notified, and 73 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, 3,961 preliminary notices were served during the year. 71 Work done by the Sanitary Inspectors during the Year ending 31st December, 1920. NATURE OF CASES DEALT WITH Deputy Chief Insp. Culver. Insp. Earwicker Insp. Peck. Insp. Richatdson Insp. Bull. Insp. Vincent. Insp. Flint. Insp. Hunt. Total House to House Inspection 518 54 335 433 ... 470 303 277 2390 No. of Houses inspected where zymotic diseases have occurred 77 153 121 298 .. 198 172 135 1154 No. of Visits of enquiry re infectious disease 113 205 152 401 .. 207 194 179 1451 House drains tested with smoke (primary) 71 170 95 246 .. 183 201 137 1103 ,, ,, „ on application 16 24 5 5 .. 2 5 16 73 Drains found defective 25 18 13 22 .. 10 47 22 157 House drains re-laid 17 2 6 4 .. 2 18 5 54 ,, ,, repaired 12 .. 40 46 .. 2 37 27 164 No. of smoke tests during repair 48 143 74 101 .. 43 67 79 555 ,, water ,, 39 120 24 21 .. 8 42 56 310 Damp-proof courses inserted .. .. 2 3 .. .. 8 20 33 Yards paved .. .. 19 .. .. 8 15 42 Inspection of Premises where offensive trades are conducted .. .. .. .. .. .. .. .. .. Inspections of Factories and Workshops, etc 1 .. .. .. 1194 .. .. .. 1195 ,, ,, Greengrocers, Fishmongers & Ice Cream Shops 110 193 138 33 .. 193 176 150 993 ,, ,, Schools 11 .. 49 11 .. 63 3 22 159 ,, ,, Shops 65 .. .. 1 .. .. .. 13 79 ,, ,, Bakehouses .. .. .. .. 546 .. .. .. 546 ,, ,, Yards and Stables 38 497 306 81 .. 274 296 573 2065 ,, ,, Common Lodging Houses .. .. .. .. 493 .. .. .. 493 „ ,, „ night visits .. .. .. .. 10 .. .. .. 10 ,, ,, Houses let in Lodgings .. .. .. .. .. .. 59 .. 59 „ ,, ,, night visits .. .. .. .. .. .. .. .. .. ,, ,, Urinals 135 117 358 121 .. 221 192 460 1604 Smoke observations .. .. .. .. 19 .. .. .. 19 Re-inspections of work in progress 953 1457 1550 1701 .. 1127 1383 1491 9662 Sundry inspections 285 693 627 438 .. 265 173 321 2802 Complaints from public investigated 396 343 86 282 .. 214 306 248 1845 NUISANCES DISCOVERED. Houses requiring Cleansing & Whitewashing 222 175 137 314 .. 152 187 184 1371 ,, Overcrowded 4 5 8 4 .. 14 5 .. 40 Leaky Roofs 89 121 74 125 .. 39 158 103 709 Dampness in Houses 68 101 123 64 .. 30 127 76 589 Drains found stopped 65 83 37 75 .. 46 50 51 407 Drains and Sanitary Fittings found defective 163 177 162 237 .. 93 223 129 1184 Defective Yard Surfaces 53 34 5 50 .. 9 43 31 225 ,, Eaves and Downspouts 149 89 58 150 .. 38 114 54 652 ,, Manure Receptacles .. 6 .. .. .. .. 1 .. 7 ,, Urinals 1 3 .. .. .. .. 1 .. 5 ,, Ashbins 153 216 205 218 .. 63 160 84 1099 Smoke Nuisances .. .. .. .. .. .. .. .. .. Animals improperly kept 6 18 .. 5 .. 1 2 .. 32 Infringements of Bye-laws and Regulations 1 8 2 .. 142 .. .. .. 153 Offensive Accumulations 19 16 2 7 .. 3 .. .. 47 Sundry other Nuisances 13 48 182 360 .. .. 230 194 1063 Total number of Nuisances 1006 1136 995 1609 142 488 1301 906 7583 Informal notices in abeyance 31st December, 1919 125 68 51 109 .. 23 155 184 715 Informal Notices served 538 368 565 825 32 541 655 437 3961 ,, complied with 461 294 456 747 32 496 472 408 3366 ,, in abeyance 145 94 97 163 .. 32 225 119 875 Referred to Committee 57 48 63 24 .. .. 113 94 435 72 Combined drainage.—The number of systems of combined drainage dealt with as single private drains during the year was 3. This work was carried out under the provisions of the Croydon Corporation Act, 1905. The cost of carrying out the necessary works amounted to £65, and was borne by the owners instead of by the inhabitants at large. House drains relaid.—In 54 instances the whole of the house drains were relaid, and 164 house drains were repaired or partially relaid. Examination of drains.—73 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 Statutory Orders.—Most of the nuisances discovered were remedied on receipt of informal notices, but in 435 cases Statutory Orders had to be applied for. Two hundred and seventy-eight 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 29,030 men and 2,826 women, making a total of 31,856. The average number of lodgers amounted to 79 men and 8 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. 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 1 854 3 0 1919 834 0 5 916 15 3 1920 1083 10 7 1216 14 9 73 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 503 visits, while 10 houses received night visits. Minor infringements of bye-laws were detected on 38 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 year these houses received 59 visits. On no occasion were offences discovered for which prosecutions were necessary. At the present moment the following houses are registered as houses let in lodgings : — Wilford Road 25 Forster Road 12 Holmesdale Road 4 Ely Road 8 49 74 FACTORY AND WORKSHOP ACT. FACTORIES. 391 visits were made to Factories. 245 in reference to sanitary accommodation. 20 „ ,, cleanliness of earth closets. 21 ,, ,, new occupation. 10 ,, ,, new drinking water regulations. 50 „ ,, defective sanitary accommodation. 13 ,, ,, extra w.c. at motor works. 2 ,, ,, ,, iron foundry. 25 sundry visits. 391 Total. WORKSHOPS. The number of workshops on register is 708. The number of visits paid by the Inspector is 581. HOMEWORK. 103 lists were received from employers, containing the names of 287 outworkers residing in the Borough. 191 further names were received from the Medical Officers of Health of various neighbouring districts, and the names of 37 outworkers residing outside the Borough were similarly despatched to the Medical Officer of Health for the district concerned. 167 visits were paid to outworkers. 32 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 8 were underground. 546 visits were made by the Inspector during the year, and 43 nuisances discovered and abated. 75 WORKPLACES. At the end of the year there were 69 workplaces on the register, 55 visits to eating-house kitchens have been made, and 9 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. — 3 — — — — 3 Cleansing, etc. — 9 2 27 8 8 54 Insufficient W.C. accommodation 2 10 — — 1 — 13 Defective ditto 23 19 — 1 — — 43 Overcrowding — — — — — — — Dustbins — — — — — — — Paving — — — — — — — Want of ventilation of stoves — 5 — — — — 5 Want of intervening ventilated space — — — — — — — Drinking water supply 4 — — — — — 4 Sundrysdefects 1 3 16 — — 20 30 49 2 44 9 8 142 Preliminary Notices served— Factories 9 Workshops 19 Workplaces 4 Bakehouses 32 These 32 notices were duly complied with ; the remainder of the matters requiring attention were satisfactorily dealt with by verbal notice. Sixtv-five communications were sent to H.M. Inspector of Factories in accordance with the various requirements of the Act. SMOKE NUISANCES. There were 19 observations made. RAG FLOCK ACT, 1912. No samples were taken under this Act during 1920. 76 SLAUGHTER HOUSES AND THE INSPECTION OF MEAT AND OTHER FOODS. The Inspection of meat has been carried out as in previous years. There are 12 registered slaughterhouses in the Borough, in addition to the Municipal slaughterhouses at Pitlake, which consist of 12 slaughter houses with lairs. In 1914 In Jan. 1920. In Dec 1920. Registered 14 12 12 Licensed ... ... ... Total 14 12 12 The following table gives a summary of the work done during the year :— Summary of Inspections during 1920. Date. 1920. Slaughterhouses. Butchers. Fishmongers. Markets. Cowkeepers. Dairies. Other Premises. Total. January 124 94 30 11 8 23 34 324 February 130 99 34 8 7 18 30 326 March 166 136 41 10 11 41 17 422 April 136 96 37 10 20 54 13 366 May 79 60 31 6 5 15 9 205 June 164 106 46 10 2 36 27 391 July 118 78 25 8 3 20 17 269 August and September 287 212 93 22 23 81 46 764 October 148 114 39 8 5 29 15 358 November 97 60 27 6 5 23 11 229 December 149 106 43 10 3 15 22 348 Totals 1598 1161 446 109 92 355 241 4002 77 The two following tables shew the number of animals slaughtered at the Public Slaughter Houses, Pitlake, during the year 1920, and a summary of the totals for the last ten years :— 1920. Slaughterhouses Cattle. Sheep. Figs. Calves. Total. Public 509 1396 2604 135 4644 Private 248 1279 7883 2786 12196 Totals 757 2675 10487 2921 16840 Summary for ten years, 1911 to 1920. Year. Cattle. Sheep. Pigs. Calves. Total. 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 1920 757 2675 10487 2921 16840 Totals ... 10749 56579 151473 41493 260294 78 Summary of Meat and other articles of food destroyed as unfit for food with total weight :— 1920. ARTICLES. Weight in lbs. Remarks. Diseased. Unsound. Total. Beef 16,047 3,440 16,047 Including 28 carcases. Mutton 510 5,419 5,929 ,, 128 Pork 5,480 250 5,730 ,, 19 ,, Veal 212 191 403 ,, 9 ,, Offal 7,643 1,553 9,196 ,, foreign frozen offal. Fish ... 3,374 3,374 Cod, Catfish, Dabs, Herrings, Haddock, Kippers, Megrims, Mackerel, Plaice, Saithe, Skate and Winkles. Other Articles 8,389 8,389 Bacon, Ham, Rabbits, Chickens, Eggs, Cheese, Apples, Dates, Figs, Raisins, Tomatoes & Tinned Goods. Total lbs. 26,452 22,616 49,068 Including 184 carcases. Summary of whole carcases condemned, with the reasons for such condemnation :— 1920. Class of Animal. Tuberculosis. Peritonitis. Pneumonia. Pleurisy. Metritis. Enteritis. Jaundice. Actinomycosis. Emaciated, various causes. Immature. Injuries. Decomposition. Total carcases. Cattle 13 2 1 1 2 3 .. 1 3 .. 2 .. 28 Sheep .. .. 2 1 .. .. .. .. 12 .. .. 113 128 Pigs 16 .. .. .. .. 1 l .. .. .. .. 1 19 Calves .. .. .. .. .. 4 .. .. .. 5 .. .. 9 Totals 29 2 3 2 2 8 1 1 15 5 2 114 184 79 Summary of Carcases in which Tuberculosis was found in the course of inspection and how such carcases were disposed of:— 1920. Animals affected. Carcase and all internal organs destroyed. Part of carcase and all organs destroyed. All or part of organs destroyed. Total. Cattle 13 2 35 50 Pigs 16 184 61 261 Total 29 186 96 311 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 (1919) 13 added (1920) 0 Cowsheds on Register (1919) 22 „ added (1920) 0 Number of Cows provided for 277 Approximate number of Cows (1920) 146 Dairymen and Milk Purveyors on Register 144 ,, „ added (1920) 26 Number of Premises 197 80 SALE OF FOOD AND DRUGS ACTS. During the year 240 samples of milk (207 new and 33 skimmed or separated) were taken. In 18 cases the samples were below the standard suggested by the Board of Agriculture. Proceedings were instituted in respect of 4 of these samples, and fines and costs were imposed on the vendors to the extent of £32 15s. 6d. The other 14 samples were only slightly below the standard suggested by the Board of Agriculture. In 11 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 1920 : — PROSECUTIONS, 1920. Date of Purchase. Defendant. Charge. Result. Penalty. Costs. 1920 £ s d. £ s. d. Mar. 25 A. J. Selling Milk containing 11 percent. of added water Convicted 20 0 0 3 3 0 May 5 H. W. P. Selling Milk 12 per cent. deficient of fat Withdrawn. – 1 1 0 Dec. 5 A. F. Contravening the Milk Order, 1920 Selling Separated Milk which had been coloured Convicted 2 0 0 1 1 0 23 A. E. D. Selling Milk 25 per cent deficient of fat ,, 5 0 0 10 6 Total 27 0 0 5 15 6 81 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, 1920. 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 240 Nil. CREAM 6 Nil. 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 requirement 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.—No preserved cream was on sale in the shops. 82 Food and Drugs Acts. Total Number of Samples taken during the year 1920. Sample of Total Samples. Genuine, Not Genuine. Prosecutions. Convictions. Cautions Milk 207 193 14 2 1 11 „ Separated or Skimmed 33 29 4 2 2 — Butter 14 13 1 Informal Sample. — Drs ' Prescriptions 11 11 — — — — Cream 6 6 — — — — Cheese 2 1 1 Informal Sample. — Coffee 7 7 — — — — Pepper 6 6 — — — — Honey 2 2 — — — — Suet 1 1 — — — — Totals 289 269 20 4 3 11 Country Milk in course of delivery at railway station 58 On Milk rounds Sunday mornings 42 ,, ,, Weekdays 140 Total 240 83 Food and Drugs Acts. Particulars of Samples taken during the sixteen years 1905 1920 inclusive :— Year. Number of Samples taken. Number Genuine. •Number Adulterated. Percentage of Adulterated. Prosecutions. Total amount of Fines and Costs imposed. £ s. d. 1905 356 320 36 10.0 8 36 13 0 1906 400 351 49 12.3 6 15 12 6 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 19 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 1920 289 269 20 6.9 4 32 15 6 * The term adulterated includes samples found to be not up to standard. 84 SECTION VIII. 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 1920. Month. Beds Occupied. Month. Beds Occupied. Highest. Lowest. Highest. Lowest January 215 183 July 138 111 February •219 191 August 135 106 March 204 164 September 105 79 April 167 130 October 173 101 May 163 141 November 185 163 June 163 132 December 213 165 During 1920 the average daily number of cases under treatment amounted to 156.0 as compared with 132.8 of the previous year. The following table gives the total number admitted from the Borough and other Districts during the year 1920. Districts. Remaining at end of 1919. Admitted during 1920. Discharged during 1920. Died during 1920. Remaining at end of 1920. Penge Urban D.C., nonpauper cases 11 89 78 2 20 The Borough of Croydon 186 1157 1132 43 168 Total 197 1246 1210 45 188 CROYDON BOROUGH HOSPITAL. Detailed Analysis of Expenditure under all Heads for the Year ending March 31st, 1921, and 10 preceding Years. Year ending March. Average No. of Patients. Provisions. Alcohol. Surgery and Dispensary.* Domestc, including Coal and Gas. Establishment and Miscellaneous Charges. Salares and Wages. Total. Average Cost per Bed occupied. Total. Average Cost per Bed occupied. Total. Average Cost per Bed occupied. Total. Average Cost per Bed occupied. Establishment Charges and Repairs. Miscellaneous Charges. Total. Average Cost per Bed occupied. Medica Dispensing, Nursing & otner. Average Cost per Bed occupied. Total Ordinary Expenditure. Total Average Cost per Bed occupied. Sinking Fund and Interest. Total Average Cost per Bed occupied including Sinking Fund & Interest. £ 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. 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 8 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 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 1919 131 3455 18 1 26 7 7 17 15 9 2 8 410 5 2 3 2 8 2530 5 1 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 3 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 1459 15 2 9 7 2 5418 17 8 34 14 9 3278 19 5 105 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 1921 143 6856 13 3 47 18 10 46 14 6 6 6 946 4 8 6 12 5 6424 16 5 44 18 7 3012 8 4 816 0 1 3828 8 5 26 15 6 8535 15 7 59 13 10 26638 12 10 186 5 8 3171 8 9 208 9 3 £ s. d. Receipts, 1920-21, from various sources . 6037 17 6 *This includes a very considerable expenditure incurred in the Hospital laboratory in respect of laboratory work done for the town extraneous to the Hospital. 85 The following table shows the comparative admissions during 1920 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 during 1917. Cases admitted during 1918. Cases admitted during 1919. Cases admitted during 1920. Scarlet Fever 608 624 381 365 417 653 413 295 201 386 532 583 (1) Diphtheria 292 222 430 600 402 211 200 313 207 179 433 540 (2) Cerebro Sp. Meningitis — — — — — — 67 24 38 23 3 1 Pulmonary Phthisis 11 — — — 48 56 61 44 40 37 44 63 Enteric Fever — 15 18 16 28 15 13 10 6 13 4 12 Puerperal Fever — — — — 1 2 4 2 2 1 4 7(3) Morbilli — — — — — — 9 17 25 17 6 4 Rubella — — — — — — — — 12 2 3 1 Mumps — — — — — — — — 20 6 4 1 Erysipelas — — — — — — — — 18 10 6 10 Other diseases 45 47 29 25 6 10 11 33 10 37 29 24 Total 956 908 858 1006 902 947 778 738 579 711 1068 1246 (1) Includes 11 cases of Rubella. „ 3 cases of Tonsillitis. ,, 3 cases of Influenza. ,, 1 case of Measles. „ 1 case of'Dermatitis. „ 1 case of Teething Rash. 1 case of Gonococcal Rheumatism. ,, 1 case of Desquamation from congenital sores. ,, 13 cases in which no disease could be diagnosed. (2) ,, 5 cases of Tonsillitis. ,, 3 cases of Measles. ,, 1 case of Herpes. ,, 1 case in which no disease could be diagnosed. (3) ,, 1 case of Pyosalpinx. The following Table gives the number of patients admitted fat each disease, an analysis of the admissions, and the number discharged or who have died in the year 1920 :— Disease. Remaining at end of 1919. Admitted during 1920. Discharged during 1920. Died during 1920. Remaining at end of 1920. Scarlet Fever 109 535 545 8 91 Admitted to Hospital as Scarlet Fever and found to be other disease ... 35 35 ... ... Admitted to Hospital for observation (including contact) 1 13 13 ... 1 Diphtheria 71 529 502 21 77 Admitted as Diphtheria and found to be other disease 1 10 10 ... 1 Admitted for observation (including contact) 1 1 1 ... 1 Cerebro-Spinal Meningitis ... 1 ... 1 ... Admitted as Cerebro-Spiral Meningitis and found to be other disease ... ... ... ... ... Admitted for observation (including contact) ... ... ... ... ... Enteric Fever 2 12 10 3 1 Admitted as Enteric and found to be other disease ... ... ... ... ... Admitted for observation (including contact) ... ... ... ... ... Pulmonary Tuberculosis 10 62 49 8 15 Admitted for Pulmonary Tuberculosis and found to be other disease ... ... ... ... ... Admitted for observation (including contact) ... 1 1 ... ... Puerperal Fever 1 5 ... 1 ... Admitted as Puerperal Fever and found to be other disease ... 1 1 ... ... Admitted for observation (including contact) ... 1 1 ... ... Morbilli ... 4 4 ... ... Admitted as Morbilli and found to be other disease ... ... ... ... ... Rubella ... 1 1 ... ... Admitted as Rubella and found to be other disease ... ... ... ... ... Erysipelas ... 10 9 ... 1 Admitted as Erysipelas and found to be other disease ... ... ... ... ... Mumps ... 1 1 ... ... Admitted as mumps and found to be other disease. ... ... ... ... ... Other Diseases 1 24 22 3 ... Totals 197 1246 1210 45 188 86 87 The following table gives the fatality for each disease :— 1912. 1913. 1914. 1915. 1916. 1917. 1918. 1919. 1920. Scarlet Fever 1.1 .8 .7 .9 1.8 1.0 2.1 2.0 1.3 Diphtheria 3.6 3.02 6.4 4.02 4.65 4.1 13.2 8.7 3.9 Enteric Fever 25.0 19.2 20.0 33.3 100.0 — 9.0 — 25.0 Cerebro Sp. Menin. — — — 54.0 13.0 37.9 40.0 — 100.0 Pulmonary Phthisis — 12.5 12.6 37.2 40.0 48.6 35.3 52.2 12.9 Puerperal Fever — — — 60.0 100.0 — — — 20.0 Morbilli — — — 11.1 — 4.3 — — — Mumps — — — — — — — — — Erysipelas — — — — — 6.5 — — — Other Diseases — — — — — 11.1 8.0 24.1 12.5 All Cases 3.2 2.9 3.1 .89 7.2 7.0 8.1 7.4 3.6 Under other diseases are included :— Result. Infantile Diarrhœa 5 3 discharged; 2 died Enteritis 2 2 ,, Ophthalmia Neonatorum 4 4 ,, Influenza 2 2 ,, Whooping Cough 2 2 ,, Nephritis 2 2 „ Myelitis 1 1 ,, Meningitis 1 1 died Tonsillitis 1 1 discharged Carbuncle 1 1 No disease* 3 3 24 * 3 mothers with babies (ophthalmia neonatorum). Notified as Diphtheria or for observation for Diphtheria— Result. Diphtheria and Scarlet Fever 8 7 discharged ; 1 died „ ,, Measles 11 11 ,, „ ,, Chicken Pox 1 1 ,, „ „ Scabies 3 3 ,, ,, „ Rubella 1 1 ,, „ ,, Pneumonia 2 1 ,, 1 died „ „ Mumps 2 1 ,, 1 remains 88 Notified as Scarlet Fever or for observation for Scarlet Fever— Result. Scarlet Fever and Diphtheria 12 12 discharged ,, „ Diphtheria and Measles 1 1 ,, „ ,, Pneumonia and Measles 1 1 ,, „ ,, Diphtheria and Scabies 1 1 ,, ,, „ Chicken-pox 13 13 ,, ,, „ Measles 10 9 „ 1 died „ „ and Mumps 4 4 ,, „ ,, Bronchopneumonia 1 1 ,, ,, „ Pneumonia 2 2 ,, „ „ Rubella 1 1 ,, ,, „ Albuminuria 1 1 ,, ,, ,, Cellulitis 1 1 ,, „ ,, Nephritis 1 1 ,, „ Appendicitis 1 1 died Notified as Enteric or for observation for Enteric— Enteric Fever and Pneumonia 1 1 died Illnesses amongst the Staff-— Scarlet Fever 5 3 discharged ; 2 remains Diphtheria 6 5 „ 1 remains Nephritis 2 2 ,, Mumps 1 1 ,, Carbuncle 1 1 „ Influenza 2 2 Tonsillitis 2 2 „ 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 4385 1494 312 1806 1664 178 1842 89 Outfits sent to the Town Hall. Diphtheria. Tubercle Enteric. Cerebro Spinal Meningitis. Total. 3,583 914 82 46 4,625 Blood Serum prepared. 365 dozen tubes at 5/- per dozen = £91 5s. od. Special Media prepared. 1 litre Peptone Media. 2,500 ,, Agar Agar. 1,500 „ Neutral Red Agar. 1,000 ,, Brilliant Green Broth. 500 „ Gelatine Media. 500 ,, Bile Salt Media (MacConkey's) 200 ,, Litmus Milk Media. CEREBROSPINAL MENINGITIS. Results of Examinations for Cerebro-Spinal Meningitis. 1920. Examinations for Borough. Examinations for Hospital. Total. All Examinations. All Examinations. All Examinations. + — Total + — Total + — Total January 11 32 43 1 — 1 12 32 44 February — 2 2 — — — — 2 2 March — 2 2 — — — — 2 2 April — — — — — — — — — May — 7 7 — — — — 7 7 June — — — — — — — — — July — — — — — — — — — August — — — — — — — — — September — — — — — — — — — October — — — — — — — — — November — — — — — — — — — December — 6 6 — — — — 6 6 First Quarter 11 36 47 1 — 1 12 36 48 Second ,, — 7 7 — — — — 7 7 Third „ — — — — — — — — — Fourth ,, — 6 6 — — — — 6 6 Total 11 49 60 1 — — 12 49 61 90 TUBERCULOSIS. Results of Examinations for Tuberculosis. 1920. Examinations for Borough Examinations for Hospital. Total. All Examinations. All Examinations. All Examinations. + — Total + — Total + — Total January 7 59 66 1 1 2 8 60 68 February 9 156 165 1 4 5 10 160 170 March 13 97 110 3 3 6 16 100 116 April 15 82 97 1 2 3 16 84 100 May 9 60 69 4 2 6 13 62 75 June 8 63 71 3 2 5 11 65 76 July 6 47 53 2 10 12 8 57 65 August 5 23 28 — 2 2 5 25 30 September 10 74 84 2 7 9 12 81 93 October 9 59 68 4 5 9 13 64 77 November 10 57 67 2 6 8 12 63 75 December 6 48 54 2 3 5 8 51 59 First Quarter 29 312 341 5 8 13 34 320 354 Second ,, 32 205 237 8 6 14 40 211 251 Third ,, 21 144 165 4 19 23 25 163 188 Fourth ,, 25 164 189 8 14 22 33 178 211 Total 107 825 932 25 47 72 132 872 1004 91 ENTERIC (TYPHOID) FEVER. Results of Examinations for Diseases simulating Enteric fever. Examinations for borough. Examinations for Hospital. Total. 1920. Agglutinative Reactions. Agglutinative Reactions. Agglutinative Reactions for all Purposes. - Total - — Total - - Total January - 1 1 — — — — 1 1 February - 2 2 — — — — 2 2 March — 1 1 — — — — 1 1 April — 2 2 — 3 3 — 5 5 May 1 4 5 — — — 1 4 5 June 2 2 4 — — — 2 2 4 July 1 2 3 1 2 3 2 4 6 August — 5 5 2 I 3 2 6 8 September — 2 2 — 1 1 — 3 3 October 1 3 4 — — 1 3 4 November 2 3 5 — I 1 2 4 6 December — 2 2 — 2 2 — 4 4 First Quarter 4 4 — — 4 4 Second ä 3 8 11 — 3 3 3 11 14 Third „ 1 9 10 3 4 7 4 13 17 Fourth „ 3 8 11 — 3 3 3 11 14 Total 7 29 36 3 10 13 10 39 49 MISCELLANEOUS EXAMINATIONS. Since October 27th, 1920, 148 urines have been tested by Lugol's reaction, and for the presence of Diacetic Acid for diagnostic purposes. 1 Swab for organisms present. 1 Vincent's Angina. 2 Puerperal Fever. 4 Tubercular Meningitis. 2 Enteric Stools 4 Staphylococcic Vaccines. 3 Tubercular Urines. 92 SECTION IX. REPORT TO THE EDUCATION COMMITTEE. 1. STAFF. For the first time since the outbreak of war the staff engaged in medical work amongst school children was entirely permanent. In addition to the School Medical Officer, who is also Medical Officer of Health, the staff consisted of three whole-time Medical Officers, one part-time X-Ray Specialist, one part-time Ophthalmic Surgeon, eight part-time Nose and Throat Surgeons, two part-time Dentists, and nine School Nurses. The Organizer of Physical Training in the Elementary Schools acted also as supervisor of remedial exercises. The Medical Officers devote part of their time only to school work. A Masseuse holding certificates in Massage, Medical Electricity and Remedial Exercises was appointed in the latter part of the year. Towards the end of the year also an Elementary school teacher, after receiving special training at Manchester, was appointed to undertake the treatment of children suffering from certain forms of speech defect. Dr. H. Gordon Smith resigned in April, and Dr. Inn C. Mackay was appointed in August to fill the vacancy. At the commencement of the year the work of the school medical service was re-organized. Hitherto the medical inspection schedules had, on completion at routine inspections, been retained in boxes at the schools. The Chief Medical Officer of the Board of Education in his Annual Report for the year 1918 indicated that certain statistical information would be desired from School Medical Officers when submitting their Annual Reports for 1920 and subsequent years. To facilitate the extraction of the necessary figures and, moreover, to enable the medical staff to have ready access for the purpose of reference to the health record of any child who had been examined while attending elementary schools, a scheme for re-organization by which all inspection schedules became filed in my office was submitted to, and subsequently approved by, the Education Authority. The scheme demanded some additional clerical work on the part of the Head Teachers, and it is a pleasure for me to record here the willing co operation of the teachers in this respect. 93 2. CO-ORDINATION. The relationship between the general education staff and the school medical staff continues to be harmonious. The work of medical inspections is carried out smoothly largely owing to the ready co-operation of the teachers. The Attendance Officers render most valuable assistance in ascertaining defective children, in reporting suspicious cases of infectious diseases and non-notifiable infections, and in bringing to the notice of the medical staff cases of prolonged absence from school. The School Medical Service is in most intimate relationship with the Tuberculosis Dispensary. In addition to definite cases of the disease all children who, after careful examination by the School Medical Staff, appear to be suffering from early tuberculosis are referred to the Clinical Tuberculosis Officer for advice and such treatment as is necessary. The medical records of children who have attended the Maternity and Child Welfare Centre and who have attained the age of five years are transferred automatically to the School Medical Service 3. SCHOOL MEDICAL SERVICE IN RELATION TO THE PUBLIC ELEMENTARY SCHOOLS. (а) No. of Schools and Accommodation. In 1920 there were in Croydon: (а) 22 provided schools, including 57 departments. (b) 15 non-provided schools, including 33 departments. The total provision in 1920 in the borough for elementary school children amounted to 37 schools, with 90 departments. The number of children on the register on December 31st, 1920, was 26,088, as compared with 25,432 in 1919. (b) School Buildings and Accommodation. Additional accommodation in the form of huts of the army pattern has been provided at the following schools Accommodation. Davidson Road Handicraft Class 40 „ „ Cookery Room 18 Woodside Boys' 120 „ Girls' 120 Ingram Road Bovs' i64 „ „ Girls' 120 „ „ Handicraft Room — Boston Road Boys' 120 „ „ Girls' 120 Whitehorse Road Girls' 120 „ Infants' 135 South Norwood Junior Mixed 120 94 (c) School Hygiene. The following is a statement of the sanitary work carried out during the year:— All the schools were visited periodically and the undermentioned work was carried out:— Centra! Polytechnic, Scarbrook Hill. Drains laid in for waste water from two huts erected in vard Parish Church Schools. Rainwater pipes renewed vvhere defective. Water supply to girls' offices increased. Girls'' High School, U'ellesley Road. Drains from two W.C.'s relaid. Ventilation pipe of drain cleared and repaired. Wood side Schools. New iron buildings—gullies for waste from lavatory basins connected to inspection chambers on existing system. Infant Boys'- trough W.C. of three divisions taken out and replaced with short hopper pans with separate flushing cisterns, connected to existing branch drain. Public ventilation pipe reinstated. Oval Road Schools. New drains and W C.'s for infants. Tavistock Grove School. Rainwater pipes unstopped. St. Andrew's Boys' School. Doors and seats of W.C.'s repaired. Obstruction removed from ventilation pipe. Princess Road Schools. Front section receiving waste from lavatory basins relaid with manhole and ventilation. Main soil section repaired where defective. Lavatory basins wrongly connected with surface water drains transferred to soil sections. Syphon trapped gullies provided to yard drain. Ventilation pipes cleared. The Crescent Schools. Drains from fittings in temporary buildings at rear dis. connected. 95 While hone Road Schools. New iron building erected in infant's playground. 4-in. drain for lavatory basin waste laid from gully to connect with drain of caretaker's house. Ecclesbourne Road Schools. Infants' urinal Drain in connection with same and range of W.C.'s were repaired and a new syphon trap placed on end of the range of W.C.'s Boston Road Schools. As a result of a smoke test a defective gully was found ; this has been replaced with a new one and drains have been flushed. Mitcham Road Schools. Flushing apparatus repaired, new seats provided and fixed to the offices. 4. MEDICAL INSPECTION. Reference should here be made to Table I. Appendix A. (a) The classes of children medicallv inspected in Croydon and the number so examined in each class, 1st January, 1920 to 31st December, 1920, are as follows:— Routine Inspection. Under the Regulations of the Board of Education : Children admitted for the first time during the year 357° Children between the ag»s of eight and nine years 1102 Children between the ages of 12 and 14 years and other age groups 2075 Total 6747 Inspection of Selected Children. Obviously defective and submitted by Head Teachers, Attendance Officers, School Nurses, Care Committees, etc. I I 70 Not obviously defective :— (i) Fitness for employment in accordance with Bye-laws regulating the employment of young persons ... 600 (ii) Candidates as bursars and student teachers 38 Defective children re-examined 466 All routine and many special inspections were made on the school premises. Other special inspections involving more careful examina tions were made at the Inspection Clinic, 228, London Road. 96 The following table shows the total number of children examined at routine inspections during 1920 classified according to the schools attended, the number of inspections held in each department, 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) „ 12 159 - 95 „ „ „ 14 — 184 111 Boston Road „ „ 14 192 - 70 „ „ „ 11 — 155 87 Brighton Road „ „ 10 149 - 41 „ „ „ 7 — 100 59 Davidson Road „ „ 8 88 - 75 „ „ „ 8 — 96 64 Dering Place „ „ 7 86 - 51 „ „ „ 7 — 75 63 Ecclesbourne Rd. „ „ 11 164 — 58 „ „ „ 9 — 114 06 Ingram Road „ „ 13 204 — 101 „ „ „ 11 — 180 115 Mitcham Road „ „ 15 232 — 160 „ „ „ 11 — 114 88 Oval Road „ „ 8 120 — 4 „ „ „ 9 - 138 94 Portland Road „ „ 14 200 — 115 „ „ „14 - 183 137 Princess Road „ „ 8 119 — 45 „ „ „ 8 - 97 47 South Norwood „ „ 8 168 — 64 „ „ „ 9 - 136 101 Spring Lane „ „ 2 22 — 21 „ „ „ 2 - 23 18 Stanford Road „ „ 2 36 - 33 „ „ „ 3 - 59 52 Sydenham Road „ „ 11 143 — 83 „ „ 13 - 176 i07 Tamworth Road „ „ 8 94 - 46 „ „ „ 5 - 38 19 Tavistock Grove „ „ 6 59 - 34 „ „ „ 6 - 78 47 Upper Norwood „ „ 10 90 - 55 „ „ „ 7 — 56 32 Whitehorse Rd. „ „ 18 33o — 208 „ „ „ 15 — 255 182 Winterbourne Rd. „ „ 8 116 — 111 „ „ „ 8 — 94 80 Woodside „ „ 11 135 — 104 „ „ „ 10 — I 1O 88 Grangewood Special „ 2 28 — — „ „ „ 1 — 4 — Day Central „ „ 1 48 — 10 „ „ „ 1 — 23 16 Totals 396 2982 2488 3267 97 Council (Non-Provided) School:— All Saints' School (All Departments) 4 29 — 17 „ „ „ 1 — 11 8 Christ Church „ „ 9 95 — 22 „ „ „ 13 — 141 51 (Wildbore's) „ „ 3 31 — 4 „ „ „ 3 — 29 11 Holy Trinity „ „ 4 23 — 17 „ „ „ 4 — 70 59 Parish Church „ „ 10 134 — 86 „ „ „ 11 — 170 112 St. Andrew's „ „ 6 33 — 22 „ „ „ 6 - 66 43 St. Joseph's „ „ 1 14 — 6 „ „ „ 1 — 13 7 St. Mark's „ „ 2 19 — 18 „ „ „ 2 — 27 31 St. Mary's „ „ 3 22 - 18 „ „ „ 3 — 14 13 St. Michael's „ „ 5 24 — 21 „ „ „ 5 — 61 46 St. Saviour's „ „ 3 42 — 17 „ „ „ 4 — 47 30 Arch. Tenison's „ „ 1 21 — 7 „ „ „ 2 — 49 33 St. Peter's „ „ 3 33 — 26 „ „ „ 3 — 40 31 Shirley „ „ 1 14 — 5 „ „ „ 1 — 5 3 Totals (for Non-Provided) 14 534 743 769 Totals (for Provided) 596 2982 2488 3267 Totals (for Provided and Non- Provided) 510 3516 8231 4036 6747 (b) The Board's schedule of medical inspection has been followed in its entirety. (c) The following are the sources from which early ascertainment of crippling defects has been obtained:— (1) As a result of medical inspection, either routine or special, at the schools. (2) From information obtained both by the Health Visitors and the School Attendance Officers as a result of their district work in the Borough. (3) From the various Maternity and Infant Welfare Centres with which the School Medical Service works in close administrative contact (4) From the Tuberculosis section of the Public Health Department, and (5) From the Croydon Civic Service League, a local voluntary association which provides valuable and willing assistance. 98 (d) During the last part of the year under review arrangements were made whereby the attendances of children presenting themselves for inspection or treatment at any of the approved Clinics in the Borough would be reckoned for the purpose of ascertaining the average attendance at school in accordance with the regulations of Articles 43 and 44 of the Provisional Code of Regulations, 1919. 5. FINDINGS OF MEDICAL INSPECTION. Table II., Appendix A, gives a return of defects found in the course of medical inspection, both at routine and special examinations, in 1920. Some of the noteworthy defects so discovered are considered more particularly below. Uncleanliness. Out of 6747 children examined at Routine Inspections, 43 of 0 6; per cent. were found to harbour body vermin; 38 or 0.56 per cent. had head vermin; 613 or 9.8 per cent. were found to have the eggs or the louse in the hair although no adult lice were seen; 38 or 0.56 per cent. had simply dirty heads: whilst 117 or 1.7 per cent. were described as dirty generally. Compared with last year, the figures show an increase and the steady improvement which has been made during previous years has received a check. Demobilization was practically completed in 1920, and there is little doubt that the overcrowded housing conditions became aggravated, and so favoured the spread of vermin infestation. The teachers have been whole-hearted in their endeavour to raise the standard of cleanliness and have always co-operated willingly with the School Nurses at the Uncleanliness Inspections which have been carried out at certain selected schools. Apart from the Routine examinations, Uncleanliness Inspections were conducted by the School Nurses at 21 of the Council Schools. 11938 children came under review, 33 had body vermin, 419 head vermin, and 2028, whilst having no adult lice, were found to harbour the eggs in the hair. Slightly over one-fifth of these children gave evidence of vermin infestation. Cleansing Station. Twenty-six children were cleansed on account of body vermin and two for head vermin. Scabies still continues to be prevalent, and 47 children were treated for this condition. Clothing. Children with dirty clothing numbered 46 or 0.68 per cent. Children with defective footgear numbered 70 or 10 per cent. More children with insufficiently protected feet were observed, a condition no doubt to be associated with the inflated cost of the necessaries of life. 99 Average 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 42.5 42.1 40.5 39.0 8 48.4 47.6 51.1 50.7 13 56.3 57.9 77.2 86.3 Malnutrition amongst school children is increasing. Whilst in the previous year 137 (2.3 per cent.) came under observation on this account slightly more than twice as many (351, or 5.2 per cent.) were observed during this year. In spite of the fact that nourishing food has become more plentiful it is not unlikely that the conditions of unemployment have in many cases deprived families, and particularly the larger families, of adequate and sufficient nourishment. A not uncommon diet is one which consists of white bread and margarine varied with a small portion of meat once or twice weekly. Such a diet is known to be insufficient for the needs of the growing child. In addition to insufficient and non-nourishing food there are other causes of mal-nourishment, the result of disease, such, for example, as enlarged tonsils, adenoids, carious teeth, early tuberculosis, intestinal worms, whooping cough and measles. Much is being done for such children by early and adequate treatment at the Throat and Dental Clinics and the Tuberculosis Dispensary and by the provision of milk for the convalescent and insufficiently nourished child. The provision of open-air schools will go a great way to help these children, and until such schools materialise the opportunity should be taken of establishing open-air classes in the school playgrounds and recreation grounds with which the Borough is well equipped. Vision and External Eye Disease. 739 Children had defective vision and 202 were found to be suffering from some form of external eye disease, such as squint, ulcers and inflamed eyelids. Where necessary the children were treated by the Ophthalmic Surgeon. 13.9 per cent of the children examined presented visual defects. Enlarged Tonsils and Adenoids. 1,533 Children, or 22.7 per cent., were found suffering from unhealthy conditions of the throat or naso-pharynx. Adenoids tend to make a child deaf, and thus interfere seriously with the progress of the child in school. Enlarged tonsils render a child liable to infection by diseases such as rheumatism, scarlet fever and diphtheria. 100 Lymphatic Glands. Glands in the neck were found enlarged in 619 children, or 9.1 per cent. Enlargements due to infection by the bacillus of tubercle are not here included. Amongst the most common causes of glandular enlargement in the region of the neck are decaying teeth, enlarged tonsils and adenoids, ear discharge and verminous conditions of the head. As soon as the specific cause is treated the glands quickly subside. Ear Disease. 77 Children, or 1.1 per cent., were deaf and 94, or 1.4 per cent.' suffered from ear disease. The main causes of deafness are wax. adenoids, and measles and scarlet fever, the latter tending to produce middle ear disease showing itself by perforation of the drum and discharge. Defective Teeth. 2,677 Children, or 39.5 per cent., were found at Routine Medical Inspections to have four or less than four decaying teeth, and 1,139 children, or 16.9 per cent., more than four defective teeth. Slightly more than half the children examined therefore had carious teeth. The following tables shows the numbers of children in each age group suffering from dental caries and the percentage in each group having sound teeth:— BOYS. Age Group. 1— 4 Decayed Teeth. Over 4 Decayed Teeth. Number with sound Teeth. Percent'ge with sound Teeth. 3.4 ... ... ... ... 4.5 14 7 32 60.2 5.6 247 123 443 54.4 6.7 233 181 274 39.8 7.8 99 74 113 39.5 8.9 231 133 135 27.0 9.10 40 25 26 28.5 10.11 5 2 8 54.0 11.12 3 ... 10 77.0 12.13 238 35 364 57.3 13.14 143 8 244 62.0 14.15 13 2 11 42.0 Totals 1266 590 1660 47.2 Total number of boys inspected 3516 101 GIRLS. 3.4 1 ... 1 50.0 4.5 14 3 37 08.5 5.6 230 103 346 50.9 6.7 305 189 212 30.0 7.8 118 53 118 40.8 8.9 309 138 156 25.8 9.10 64 25 84 27.6 10.11 26 2 18 39.1 11.12 4 ... 11 73.3 12.13 218 21 210 46.7 13.14 115 12 108 45.9 14.15 7 3 20 66.6 Totals 1411 549 1271 39.3 Total number of girls inspected 3231 The present school dental service is not coping with the situation. Apathy on the part of the parents is still widespread. Skilled private dental treatment is expensive, and parents living in the outlying districts of the Borough do not find it convenient to make use of the facilities at the Town Hall. In previous reports the necessity for establishing subsidiary centres has been emphasised. Affections of the Heart. 122 Children, or 1.8 per cent., were found to have permanently damaged hearts, caused in many cases by attacks of acute or sub-acute rheumatism. 195 children, or 2.8 per cent., had temporary and mild heart affections associated with anaemia or slight debility. When such conditions are discovered teachers are at once advised to modify or suspend the physical side of the child's education. 278 children, or 4.1 per cent., suffered from anæmia. Affections of the Lung were found in 219 children, or 3.2 percent. Most were suffering from bronchitis or mild forms of bronchial catarrh. Tuberculosis. 84 Children, or 12 per cent., were found to be suffering from tuberculosis infection in one or other of its manifestations. Of these, 10 children were suffering from tuberculosis of the lungs whilst 65 were suspected of having the disease in the lungs in an early stage. 46 Children had tuberculous glands, 1 had tuberculosis of the spinal column, 1 had tuberculous infection of the hip joint and 3 of other bones and joints, 3 had tuberculosis of the skin, and 11 had the disease in other forms. All cases, both actual and suspected, were referred to the Clinical Tuberculosis Officer for treatment or disposal. 102 Nervous Diseases. 8 children were found suffering from epilepsy and 8 from chorea (St. Vitus' dance), a condition which is associated with rheumatism. Deformities. 85 Children were found deformed as a result of rickets contracted in infancy. 141 Children suffered from marked degrees of spinal curvature. 14 Children were found crippled as a result of infantile paralysis. 36 Children were deformed through injury by accident, etc. Ringworm. 12 Children were found to have the ringworm fungus in the hair of the head and 4 were infected with the fungus associated with the body. Skin Affections. Scabies or itch was found in 17 children, and impetigo or infectious scabs in 21 children. Menial Conditions. 40 Children were found to be mentally sub-normal. It is not possible, as a rule, at a routine medical inspection where each child is reviewed only for a few minutes to arrive at a definite diagnosis of mental deficiency. Suspected cases are subjected to more particular examination later by one of the certifying officers. An account of the work connected with this portion of School Medical inspection is set forth on page 27. 6. INFECTIOUS DISEASE. At Routine Inspections 7 cases were found. In addition, 15 special visits were made by the medical staff to certain schools where there had been an unusual local prevalence of any infectious disease. Children suspected to be suffering from infectious diseases are excluded from attendance at school either by the Head Teachers or School Attendance Officers. Notices of infectious diseases were despatched to the respective schools by the Public Health Department in 5,082 cases as described hereunder:— Illness. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Scarlet Fever 98 76 47 111 332 Diphtheria 75 64 62 119 320 Measles 570 480 25 I2 1087 Mumps 45 100 25 110 280 Whooping Cough 21 72 69 85 241 Chicken pox 139 66 26 92 323 Sore Throat 86 38 36 103 263 Ringworm (Scalp) 40 39 30 31 140 „ (body) 37 28 20 23 108 Impetigo 253 159 96 150 658 Scabies 52 28 18 39 137 Eye Cases 33 22 15 19 89 Other diseases 495 221 141 241 1098 Totals 1944 1393 610 1135 5082 103 School Closure. In accordance with Article 45 (b) of the Code the following schools were closed:— School. Department. Disease. Closure. From To Mitcham Road Infants Chicken Pox January 9th February 6th Whitehorse Road Infants Measles „ 14th „ 6th Princess Road Infants Measles „ 14th „ 6th Spring Lane - Chicken Pox „ 29th „ 27 th Ingram Road Infants Measles „ 29th „ 20th Arch. Tenison's Girls Diphtheria February 4th March 5th South Norwood Infants Measles „ 11 th „ 5th Christ Church Infants Measles „ 12th „ 5th Parish Church Infants Measles 27th „ 19th St. Peter's Infants Measles March 2nd „ 19th Sydenham Road Infants Measles „ 12th „ 31st Mitcham Road Infants Measles „ 12th „ 31st All Saints' Girls & Infants Measles „ 12th „ 31st Portland Road Infants Measles „ 16th „ 31st Christ Church (Boston Road) Infants Measles „ 16th „ 31st Brighton Road Infants Measles „ 18th „ 31st Oval Road Infants Measles „ 22nd „31st Winterbourne Rd. Infants Measles „ 22nd „ 31st Tam worth Road Junior, Infants Measles „ 24th „ 31st St. Joseph's Mixed & Infants Measles „ 24th „ 31st St. Michael's Mixed & Infants Scarlet Fever November 22nd December 13th South Norwood Infants Diphtheria „ 29th „ 23rd School premises were disinfected when necessary. In all, 42 school departments and 21 school classrooms were disinfected during the year. 7. FOLLOWING UP. There are nine school nurses, two of whom assist at the Clinics only. The other seven attend at school medical inspections, visit the homes of children found to be defective at medical inspections or suspected to be suffering from infectious disease. Each of these seven 104 school nurses carries on other health visiting work, and has a district of her own in which she is well acquainted with the schools, children and parents. The parents of those defective children whom the Medical Inspector considers require treatment or observation are visited at their homes by the School Nurses within a few days of the inspection at which the defects were observed, with a view to encouraging the parents to obtain the appropriate medical advice or tratment either from private medical practitioners, hospitals, or at the different treatment clinics established by the Education Committee in the Borough. The work of the district school nurses is summarised in the following table:— Visits to Houses where the following Diseases have occurred. School Cases. 1st Visits Subsequent Visits. Scarlet Fever 76 75 Diphtheria 381 468 Measles 1497 German Measles 57 4 Mumps 394 108 Whooping Cough 296 120 Chicken Pox 450 81 Sore Throat 691 472 Ringworm (scalp) 144 613 „ (body) 118 214 Verminous Heads 26 15 Verminous Bodies 29 48 Impetigo 1491 2249 Scabies 165 529 Infectious Eye Disease 131 269 Other Diseases 2241 1238 8187 6639 Visits paid to Elementary Schools for Medical Inspection 510 Number of Children prepared for Medical Inspection:—Newly Inspected 6747 Re-inspected 466 Specially Inspected I70 Other Visits to Elementary Schools 157 7 Home Visits arising out of Medical Inspection 2280 I108 Home Visits for other information 997 407 Cultures taken 1437 45 105 1,546 children were examined or treated for different conditions; there were 3,962 attendances. Table IV. (a), Appendix A, indicates the amount and nature of the work at the Centre. Under "Miscellaneous" are included:— Cases of rheumatism 25 Enlarged glands 35 Enlarged tonsils and adenoids 139 Other affections of nose and throat and other ear affections 151 Heart disease 37 Lung disease 44 Nervous diseases 22 Debility and anæmia 137 In addition, 100 children for whom milk in school had been prescribed were re-examined. There was also a large number of children referred from the Tuberculosis Dispensary for observation by the School Medical Inspectors. 85 children out of the total of 137 suffering from ringworm of the scalp were subjected to X-ray treatment. Unclcanhness. A brief account of the treatment of uncleanliness is given in Table IV (E), Appendix A. Enlarged Tonsils and Adenoids. (Table IV. (C), Appendix A). The clinic for the operative treatment of these conditions continued to be held at the Croydon General Hospital in accommodation loaned to the Education Committee. During the greater portion of the year the clinic was open on one afternoon each week, but to meet the large number of cases referred for and awaiting treatment an additional weekly session was arranged. The actual operations and administration of anæsthetics are undertaken by eight local medical practitioners working in pairs and in rota for three monthly periods. 303 cases were treated at the clinic, and, as in the previous years, all those having dental caries were, prior to the operation, treated by the Denial Officers at the School Dental Clinic. The number of children treated for dental caries prior to operation at the throat clinic was 304. In the latter part of the year classes were commenced in which instruction in the correct methods of breathing was given to children who had recently been treated at the Throat Clinic. These classes are held 111 a large room at the Central Polytechnic and conducted by Miss Cooke. This form of alter-care is a most important part of the treatment of enlarged tonsils and adenoids, not only in teaching the children again to breathe properly, but in assisting their quick return to health after the more or less extended periods of general debility consequent upon obstructive affections of the throat and nose. 106 Each child after operation is expected to attend the class daily during a period of four weeks, the exercises lasting for twenty minutes to half-an-hour. Parents are summoned to attend on the first and last days of the instructional period when a medical officer is present for interview. Parents are shown the nature of the exercises and requested to encourage the children to carry out the exercises at home. 1 be results have been highly satisfactory, and parents generally are enthusiastic in their praise of the effects—both of the operation and the after-treatment—on the well-being of the children. Ear discharges clear up, deafness diminishes in degree or entirely disappears, languor, want of appetite and mental dullness give place to alertness, brightness and a healthy desire for food. During the last three months of the year the class met on 121 occasions, 68 children were treated and made 1,015 attendances. Tuberculosis. The closest co-operation exists been the School Medical Service and the Tuberculosis Dispensary. The advice of the Clinical Tuberculosis Officer is sought in regard to every case or every suspected case of the disease found by school medical inspectors amongst children attending school. 154 children were in this way relerred to the Tuberculosis Officer for corroborative diagnosis and subsequent treatment or disposal. Out of this number, 39 were found after a period of observation to have no signs of the disease. In addition, 61 children of school age were referred to the Dispensary from other sources and 36 contacts of the disease examined. The total number of attendances at the Dispensary of children of school age during the year amounted to 3,109. The question of exclusion from attendance at school is left to the discretion of the Tuberculosis Officer, who arranges for sanatorium or hospital treatment when necessary and prescribes milk, cod liver oil, and drugs which are supplied from the Dispensary A most important part of the treatment is the advice given to parents of tuberculous children with the object of ensuring as far as possible the maintenance of proper hygienic treatment in the homes. Health Visitors visit the homes to encourage and advise the parents in this respect. Children who have been under treatment at the Dispensary and in whom the disease has been arrested are referred back to the School Medical Officer, who arranges for their examination from time to time at the inspection clinic and supervises their after-care. In the last nine months of the year 146 children were kept under observation by the School Medical Inspectors. Vision and External Eye Diseases. The Eye Clinic continued to be held two mornings weekly at the Town Hall. The total number of children examined for refraction errors was 602, and the total number of attendances at the clinic 1,183. Most of the cases of external eye disease, such as conjunctivitis, blepharitis, corneal ulcers, were treated by the Ophthalmic Surgeon, the remaining few being seen at the Minor Ailments Clinic. Spectacles are not provided, but parents may obtain glasses at reduced rates from an optician in the town. A summary of the treatment of visual defect is given in Table IV. (B), Appendix A. 107 Dental Defects. Table IV. (D), Appendix A, gives a summary of the work done by the two part time Dental Officers, both in regard to inspection and treatment. The following tables are self explanatory, and indicate in greater detail the scope and findings of school dental inspection and the results of treatment. Dental Inspecticn of Schools (Children 5—9 years of age) School. Children Examined. Teeth all Sound. Teeth Defective. Percentge with Sound Teeth. Boys. Girls Total. Boys. Girls. Boys. Girls. Boys. Girls. Beulah Road 130 117 247 27 21 103 96 20.8 17.9 Boston Road 111 81 192 18 12 93 09 16.2 4.8 Brighton Road 56 58 114 110 17 46 41 7.8 29.3 Davidson Road 66 68 134 11 9 55 59 16.6 13.2 Dering Place 80 70 150 17 7 63 63 21.2 10.0 Ecclesbourne Road 145 85 230 32 18 113 67 22.1 21.1 Ingram Road 61 66 127 13 19 48 47 21.3 28.8 Mitcham Road 145 85 230 17 14 128 71 117 16.4 Oval Road 42 43 85 9 9 33 34 21.2 20.9 Portland Road 81 88 169 16 9 65 79 19.7 10.2 Princess Road 120 90 210 26 11 94 79 21.6 12.2 South Norwood 70 61 131 11 11 59 50 15.7 17.1 Spring Lane 10 8 18 4 3 6 5 40.0 37.7 Stanford Road 24 12 36 3 2 21 10 12.5 16.5 Sydenham Road 87 74 161 13 15 74 59 14.9 20.2 Tamworth Road 77 17 94 8 2 69 15 10.4 11.8 Tavistock Grove 111 92 203 20 17 91 75 18.0 18.5 Upper Norwood 14 18 32 1 5 13 13 7.1 27.8 Whitehorse Road 176 154 330 31 43 145 111 17.6 27.9 Winterbourne Road 132 114 246 42 35 00 79 31.8 30.7 Woodside 110 92 202 25 17 85 75 217 18.4 Grangewood Special School All Saint's 11 9 20 1 1 10 8 91 11.1 13 13 26 5 2 8 11 38.4 15.4 Christ Church, Longley Rd. 39 41 80 5 7 34 34 12.8 17.0 Christ Church, Boston Rd. 24 33 57 4 4 20 29 166 12.1 Holy Trinity 21 52 73 3 9 18 43 14.3 17.3 Parish Church 172 99 271 24 17 148 82 13.9 17.1 St. Andrew's 33 36 69 9 10 24 26 27.3 27.7 St. Andrew's Old Town 8 7 15 1 ... 7 7 12.5 ... St. Joseph's 5 5 10 ... 1 5 4 ... 20.0 St. Mark's 24 36 60 6 6 18 30 25.0 l5.6 St. Mary's ... ... ... ... ... ... ... ... ... St. Michael's 12 12 24 5 1 7 II 417 8.3 St. Saviour's 62 73 135 16 23 46 50 257 31.5 Archbishop Tenison's 12 13 25 1 5 11 8 83 38.4 St. Peter's 61 62 123 9 16 52 46 147 25.8 Shirley ... ... ... ... ... ... ... ... ... Totals 2345 1984 4329 443 398 1902 1586 18.8 20.1 108 Dental Re-inspection of Schools. [###/Date. School. Children with teeth all sound at previous inspection. At re-inspection. Children who were treated at the Dental Clinic for caries discovered at previous inspection. At re-inspection. 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. 1920. Jan. 12 Dering Place 2 4 ... ... 3 ... ... ... ... ... ... ... ... ... 2 6 „ 14 Davidson Road 1 3 2 2 7 ... ... ... ... ... .... ... ... 23 18 „ 29 Parish Church ... ... ... ... 6 2 ... ... ... ... ... .... ... ... 10 34 Mar. 24 Tamworth Road 2 1 ... ... ... 2 1 ... ... ... ... ... ... ... 14 5 „ 26 Spring Lane 1 1 ... ... 1 3 ... ... 1 ... ... ... ... ... 6 5 May 13 Grange Wood 5 2 ... 1 3 2 1 ... ... ... ... ... ... ... 7 3 „ 17 St. Peter's ... ... 4 12 ... ... ... ... ... ... ... ... ... ... ... ... „ 18 Winter bourne Road 11 3 1 ... 12 11 1 4 ... 1 ... ... ... ... 13 9 „ 19 Whitehorse Road 8 5 ... 2 3 6 ... ... 1 1 1 1 ... ... 21 23 June 1 Sydenham Road 3 7 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... „ 33 Stanford Road 1 ... 1 ... 4 2 1 ... 1 ... ... ... 1 ... 4 5 „ 30 Princess Road 5 3 2 ... ... ... ... ... ... ... ... ... ... ... 24 21 July 7 Tavistock Grove 3 2 2 2 3 3 ... ... ... ... ... ... ... ... 27 20 „ 19 St. Andrew's 3 ... 4 ... ... ... ... ... ... ... ... ... ... ... 7 6 Sept. 1 Oval Road 1 ... 2 1 1 2 ... 2 ... ... ... ... ... ... 12 8 „ 2 Brighton Road 4 5 ... 1 1 ... 2 3 ... ... 1 ... ... ... 11 13 „ 3 South Norwood 1 3 ... ... 5 5 ... ... ... ... ... ... ... ... 23 13 „ 3 St. Mary's ... ... ... ... 1 2 ... ... ... ... ... ... ... ... 3 5 „ 16 Davidson Road 3 2 1 2 3 2 1 ... ... ... ... ... ... ... 8 13 „ 16 Beulah Road 1 ... ... ... 2 1 ... ... ... ... ... ... ... ... 7 6 „ 29 Holy Trinity ... ... ... ... 2 3 ... ... 1 ... 1 ... ... ... 4 3 Oct. 1 Portland Road 6 4 1 1 6 10 1 2 1 1 1 1 ... ... 20 19 „ 6 Boston Road 1 3 ... ... ... ... ... ... ... ... ... ... ... ... 26 13 „ 7 Parish Church 7 10 1 ... 6 8 1 ... ... 2 ... 2 ... ... 14 17 „ 15 Woodside 8 6 1 1 8 5 3 4 ... ... ... ... ... ... 20 17 „ 19 Ingram Road 6 4 2 1 1 ... ... ... 1 2 1 1 ... 1 14 13 Nov. 4 Dering Place 5 ... ... ... 5 ... ... ... ... ... ... ... ... ... 20 16 „ 12 Ecclesbourne Road 17 6 1 ... 12 6 3 ... ... ... ... ... ... ... 36 7 Dec. 13 St. Peter's 2 1 ... ... ... 1 ... ... ... ... ... ... ... ... 5 4 109 The work of the Dental Clinic 1920. No. of Permanent Teeth. No. of Temporary Teeth. Trial Nuumber of Fillings. No. of administrations of general Anaesthetic included in (1) and (2). No. of other Operations. Total number of children who failed to keep appointment at Dental Clinic. Extracted (1). 1 tiled. Extracted (2). Filled. Permanent Teeth. Temporary Teeth. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boy. Girls. Routine Inspections 7 2 20 15 1432 988 378 427 398 442 42 42 2 4 57 80 434 372 After re-inspection ... ... 2 1 115 88 31 38 33 39 ... ... ... 3 1 ... 25 29 Specials 17 6 6 ... 59 61 3 6 9 6 10 7 ... ... ... ... 16 9 Tonsils and Adenoids Cases 9 13 12 12 469 394 80 105 92 117 9 19 9 2 15 5 180 189 Backward Class Cases 5 2 4 2 7 2 ... ... 4 2 2 2 ... ... ... ... 1 ... Totals 38 23 44 30 2082 1533 492 576 536 606 63 70 11 9 73 85 656 599 No. of half-days devoted to inspection 63 „ „ „ treatment 252 Total number of atten ances made by children at the Clinic 3435 Number of new cases treated during the year:— Routine 831 After re-inspection 81 Specials 56 Tonsils and Adenoids Cases 304 Backward Class Cases 7 1279 110 Out of 3,488 children referred for treatment, the parents or guardians of only 1,223, or 35 per cent., made use of the opportunity offered. A re-organization of the work of the School Nurses has recently been carried out, so that following-up at the homes of children with defective teeth has been improved, and it is hoped thereby to ensure a larger attendance of children at the Dental Clinic. Crippling Defects and Orthopadics. As in previous years the treatment by remedial exercises of children suffering from spinal curvature was carried out by the Organizer of Physical Training. The class was held on four afternoons weekly. The following table gives an account of the work done by Miss Appleton at this clinic:— Number of children treated during the year 48 „ discharged as not requiring further treatment 17 „ discharged for other reasons, e.g., for hospital treatment, over school age, etc. 18 „ attending on December 31st, 1920 7 Total number of attendances during 1920 1380 Only the more severe cases of spinal curvature are treated at this clinic, but classes have now been formed at Whitehorse Road School and St. Andrew's School in which children suffering from milder degrees of curvature will be given daily remedial treatment under the direction of two specially selected lady teachers, and under the supervision of the Medical Officer and the Supervisor of Physical Training. With the appointment of Miss Cooke as masseuse and the establishment of breathing exercise classes the accommodation in the Treatment Centre at 228, London Road, became inadequate, and consequently in September the Spinal Remedial Class was transferred to larger premises at the Central Polytechnic. Here in a large room it is possible for remedial exercises and massage to be carried out concurrently. The breathing exercise classes are held in the early part of the morning so as not to interfere with the work of the other two clinics. During the last four months of the year 19 cases were treated by massage:— Paralysis (infantile and birth palsies) 9 Spastic conditions 2 Scoliosis 7 Talipes 1 Total 19 Certain of these cases also received remedial exercises, which were carried out under the supervision of Miss Cooke. These children were still receiving treatment at the end of the year, and in many cases marked improvement was noted. A summary of the treatment of the defects as shown in Tables IV. (A, B, C & D) is given in Table V. Appendix A: whilst Table VI., Appendix A, supplies a summary relating to children medically inspected at the routine inspections, 1920. 1ll 9. OPEN-AIR EDUCATION. In spite of the fact that there is a large number of children in this Borough suffering from early tuberculosis, debilitating conditions, catarrhal infections of the lungs, mal-nourishment, etc., no open-air education of any description has yet been provided. The simplest and the least costly form of open-air education is the open-air class, and there are many schools in Croydon with playground area sufficient to permit of the establishment of such classes. The Borough is well provided with recreation grounds and it should not be difficult to utilise these open-air spaces to provide outdoor education for selected children. 10. PHYSICAL TRAINING. Below is given the report of the Organizer of Physical Training, to which the attention of the Committee is particularly directed. To the Education Committee. March, 1921. Ladies and Gentlemen, I beg to submit the report of my work as Organizer of Physical Training for the year 1920. The work in the Elementary Schools has been encouraging in spite of many difficulties. Physical training has been carried on in accordance with the revised "Syllabus of Physical Training 1919," and "Syllabus of Physical Exercises for Children under seven years of age," issued by the Board of Education early in 1920. As mentioned in my report of 1919, I had been preparing the way for the introduction of these two books by Courses (four in all) for both Senior and Infants' Teachers in the Autumn of 1919 and the Spring of 1920, so that as soon as copies of this Syllabus were available we were able to introduce it into the schools at once. On March 19th I arranged a Demonstration to which the Head Teachers of all departments were invited. Typical lessons were conducted with classes of Infants, Standards 1, 2, 3, 4 and 5, and 6 and 7, and the same children also demonstrated suitable dances. This Demonstration, which was attended by practically every Head Teacher, as well as one of His Majesty's Inspectors, one member of the Education Committee and the Medical Officer of Health, was followed by a Conference in the afternoon as to the most effective methods of making the new Syllabus of real value in the schools. Several resolutions, arising out of consideration of the Board of Education Circular 1138, issued with the Syllabus, were passed and were submitted to the Education Committee in due course. At the request of the Head Teachers this Demonstration was repeated for the Class Teachers on two evenings. At least 400 attended these two demonstrations—a proof, I think, of the enthusiasm and earnest desire of the teachers to promote the physical welfare of the children in their care. 112 At the request of the Medical Officer of Health, two Demonstrations of Physical Training were also arranged in connection with Health Week, May 3rd—8th, at the Gas Company's Hall in Katharine Street. Three schools took part, and the Demonstrations, which included physical exercises, games and dances, were well attended both by parents and the public generally. 1 would like, here, to express my gratitude to the teachers who aided me in all these Demonstrations and who, by their unfailing co-operation and enthusiasm, made it possible for them to be arranged. The Chief Medical Officer of the Board of Education again refers in his Annual Report, 1919, to the difficulties of unsuitable clothing. We have certainly encountered this difficulty, especially this year, when suitable material has been almost prohibitive in price; but great progress has been made in the provision of suitable shoes, and the number of schools where the children wear shoes, either home-made or proper gymnastic ones, has increased considerably. In many schools the parents are giving loyal support and encouragement under difficult home circumstances—in fact, I think one of the most hopeful features of the year's work is the interest taken by many of the parents in the Physical Training carried on in the schools. I hope it may be possible during the coming year to give them more opportunities, by way of Demonstrations, etc., to see the work that is being accomplished At all the Demonstrations, quoted earlier in this Report, a table was arranged on which were shown suitable garments for wear during physical training which, with one or two exceptions, had been made by children in school. Equipment for the proper carrying out of the training is still inadequate, but the schools have made efforts to supply what is absolutely necessary, e.g., bean bags, team colours, ropes, balls, etc. In most cases the children are supplying their own colours, etc. The Organizer of Handicraft is giving valuable help by letting the boys at the Handicraft Centres make jumping stands for use in the schools. A daily period for physical training is not yet universal, although it is found on the time tables of most of the schools where the value of this training is realised. Considerable disappointment was felt at the decision of the Education Committee not to allow the older scholars 10 use the recreation grounds for their organised games. At the request of the Committee, the Head Teachers and I had drawn up a scheme by which the boys and the girls in the upper standards of those schools near to recreation grounds would be able to have their games' lessons there rather than in the smaller space of the playground, and we were looking forward hopefully to the benefits which would accrue thereby. May I respectfully urge that the Committee will reconsider their decision on this matter, and if it is found impossible to provide any equipment for use in the recreation grounds, permission may at least be granted to use the recreation grounds for such organised games as can be taken without apparatus or with apparatus provided by the schools themselves? I would again quote from the Report of the Chief Medical Officer of the Board of Education: "Games may prove of almost equal importance with the more formal lessons for children. 113 First, they have the direct physical value, and in many cases keep the child in the open-air .... again they have considerable educational possibility in the training of character and the qualities which make for useful citizenship, such as healthy rivalry, co-operation, courage, endurance, public spirit, fair play, loyalty and working together in groups; lastly, many of these activities provide lasting interests for leisure hours in after life, which in itself may prove to be an effective agency of health and strength. With the shortening of the hours of labour this question of the healthy occupation of leisure is of the utmost importance." Many schools are now using the team system as suggested in the Syllabus in all physical training lessons, especially games, and the co-operative spirit resulting is most encouraging, and is felt not only in the physical training but in the general curriculum of the school also. During the summer months I arranged a course of six lessons in games for the teachers of the senior departments. The games practised were mostly those mentioned in the Board of Education pamphlet "Suggestions in regard to Games." The class, which was a large one, (nearly 80 teachers attending) was held in the playground of Tavistock Grove Schools. The decision of the Committee that swimming be included in the subjects of the time-table brought this subject under my direct organisation for the first time in 1920. It was found possible, under these new conditions to relieve the congestion at the Baths caused by several schools having to attend at the same time, and thus to make conditions for the leaching of this subject much easier. As permission to use the Baths in school hours was not given till the season had already commenced it was not possible to do all that was advisable, but, in conjunction with the Inspector, I am hopeful that the organisation of swimming may be complete for the season of 192 1. Owing to the courtesy and help of the Amateur Swimming Association I was able to arrange a course of six lessons for the teachers of the girls' departments on the Organisation of Swimming Lessons on the lines of their new Handbook of Swimming Instruction —the method recommended by the Board of Education in the Syllabus of Physical Training. As the Baths were only available for this course during school hours, permission was granted by the Committee for one teacher from each Senior, Mixed and Girls' departments to attend for six lessons in school hours. Mrs Austin, Hon. Secretary of the Southern District Education Committee of the Amateur Swimming Association, most generously gave her services for this course which proved a most helpful one. At the request of the local Secretary of the N.U.T. a second course, out of school hours, was arranged, but as the Baths were not available for such a course during the summer season it was not started until the weather was cold and unsettled, and after three lessons it was decided to postpone the rest of the course till the spring. Four teachers holding the diploma of Reading Physical Training College are now working in the Elementary Schools with marked success. It has not been found possible, owing to staffing and other difficulties, to make them responsible for the entire physical training of the departments in which they are working, but they are taking as 114 much as possible, and their enthusiasm and influence re-act on the work of the whole school. They are also taking gymnastic classes at the Evening Institutes. The gymnastic classes at the Evening Institutes have been carried on on the same lines as in 1919. At the request of the pupils some of the classes were continued through the summer term, and one Evening Institute conducted a most successful swimming club. As hitherto, 1 devoted four sessions weekly to the Spinal Remedial Clinic. In September, 1920, the Clinic was removed from 228, London Road to Room 15, Central Polytechnic, as the accommodation available at the former was inadequate to allow Miss Cooke, the newly appointed full-time Masseuse, working at the same time. The particulars of the Clinic are given in the Report of the Medical Officer of Health. Dr. Barrie Lambert, a Medical Officer of the Ministry of Health, visited the Clinic in December. In conclusion, I would like to testify to the valuable support and co-operation I have this year, as always, received from all in my efforts to promote the physical welfare of the children under our care. I am, Ladies and Gentlemen, Your obedient servant MAY APPLETON. 11. PROVISION OF MEALS. The selection of suitable children is made usually from mendations submitted by school teachers, Attendance Officers and Care-Committees. Recommendations are considered and approved by the School Canteen Sub Committee. Children are fed at local dining-rooms by arrangement with the respective proprietors. The dinners consist of two courses, meat and a milk pudding, and are supervised from time to time by one of the School Attendance Officers. 516 children were given free dinners. 31515 free dinners were provided. 203 children received free milk. 115 children received milk on part payment, and 72 children received milk, full payment for which was made by parents or guardians. Milk was usually supplied on the recommendation of the School Medical Officer. Recommendations for milk supply are also made bv the Tuberculosis Officer and the Maternity and Child Welfare Medical Officers, and accordingly steps have been taken to ensure that the supply of milk is in no case duplicated Similar care is taken, in the absence of specific recommendation, to avoid supplying milk to a child already in receipt of meals, or meals to a child already receiving milk. 12. CO-OPERATION OF PARENTS. As in past years, the attendance of parents at the routine medical inspections was invited, and 50 9 per cent. responded, as com pared with 55.1 per cent. in 1919. 115 13. CO-OPERATION OF TEACHERS. Much of the success of school medical inspection is due to the sympathetic assistance of the teachers. In all schools the greatest personal interest is shown and valuable information made available regarding the children. Through the tactful influence of the teachers difficult parents are induced to obtain or accept treatment for their defective children. Thanks are due in no small measure for the invaluable assistance which teachers so whole-heartedly render. 14. COOPERATION OF SCHOOL ATTENDANCE OFFICERS. From the School Attendance Officers much useful and essential assistance is most willingly given to the School Medical Officer and his staff In their investigations of causes of absence, infectious diseases which otherwise might have been overlooked are brought to the notice of the Medical Officer. To a large extent information regarding physically or reputed mentally defective children reaches the Medical Officer as a result of their activities, whilst frequently the treatment of children suffering from certain diseases, e.g., ringworm, scabies, etc., is expedited through their influence with the parents. The closest and most happy co-ordination exists between Attendance Officers and the members of the School Medical Staff. 15. CO-OPERATION OF VOLUNTARY BODIES. Valuable information in regard to crippled and other defective children has been supplied from time to time to the School Medical Officer and Tuberculosis Officer by the Croydon Civic Service League. This Association has also in many instances arranged for the supply of surgical appliances and convalescent home treatment. Close contact is maintained with the local branch of the Nationa Association for the Prevention of Cruelty to Children. 16. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Table 111., Appendix A, gives a numerical and classified account of exceptional defective children under the age of 16. The registers from which this table has been completed have as far as possible been revised, but at the same time it is not unlikely that several exceptional children having escaped notice and have not been included. The sources of ascertainment are (1) School Medical Inspections. (2) Home visitations by School Nurses, Health Visitors, School Attendance Officers, and Maternity and Child Welfare Health Visitors. (3) The Tuberculosis Dispensary. (4) Maternity and Child Welfare Centres, and (5) The Croydon Civic Service League. Blind and deaf children, after certification by the School Medical Officer, are admitted to Special Schools, day or residential. 116 MENTALLY DEFECTIVE CHILDREN. The work connected with the examination and certification has been considerably accelerated by the appointment of Dr. W. N. W. Kennedy, the Deputy School Medical Officer, as an additional certifying officer. 93 children reputed to be mentally deficient were examined. Of this number 34 were certified as mentally defective, 2 being ineducable, and 3 suffering also from epilepsy. 42 proved to be dull and backward, 17 retarded 1 to 2 years, 22 retarded 2 to 3 years, and 3 retarded more than 3 years. 2 were physically defective only. 1 suffered from epilepsy only. 11 were referred for observation, and 3 were normal children. 93 These cases were disposed of as Follows:- 3 were returned to an ordinary class at an elementary school. 23 were returned to an ordinary class at an elementary school with special supervision. 26 were referred for instruction at an elementary school in a special class for dull and backward children under the Public Elementary School Code. 6 were recommended for treatment in a certified institution. 21 were admitted to Grangewood Special Day School for mentally deficient children. 3 were referred for treatment of physical defects, and 11 were placed under observation pending re-examination at a later date. 93 GRANGEWOOD SPECIAL M.D. SCHOOL. The number of children receiving instruction at Grangewood Special School has during the year showed a marked increase. The following is a summary of the number of children who attended:- Number of children on Register on 31st December, 1919 58 Number of children admitted to class during 1920 35 Number of children discharged and re-admitted to Council Schools, 1920 - Number of children discharged for unsuitabihty 8 Number of children left over age 8 Number of children on Register, December 31st, 1920 77 Special classes for dull and backward children have been formed in many of the provided schools, but due to the want of accommodation the Inspector has not been able to arrange similar accommodation in the non provided schools. 117 PHYSICALLY DEFECTIVE CHILDREN. The treatment of these children has been discussed under other headings. Class for Stammerers. Arrangements have been made lo form a class for stammerers, and the first meeting of the class will be held in January, 1921. Miss W;dshe, one of the Education Committee's teachers, has been given the opportunity of studying the treatment for stammering children at the Manchester Education Authority's special classes with a view to placing this new class under her direction. The results of treatment will be fully discussed in the report for 1921. 17. NURSERY SCHOOLS. No Nursery Schools have yet been established in the Borough. 18. SECONDARY SCHOOLS. In 1920 the pupils of the two Higher Schools of the Education Committee, the Borough Boys' School and the Borough Girls' School, were medically inspected for the first time. The examinations did not begin until September. Later, at the request of the management of Old Palace Girls' School, the Committee arranged for the provision of medical inspection at this school. In this case the examinations did not begin until December. The examination of the girls was carried out by one of the women medical officers. The work was limited to the complete examination of newly admitted pupils, of pupils aged 12 and 15 years, and of those pupils likely to leave school before the end of the year. 199 boys and 413 girls were examined at the routine inspections, making a total of 612. In addition 63 children were re-examined. A statement of the defects found and treatment carried out is given in Appendix B. Information in regard to the treatment of those children presenting defects was incomplete since it was not possible in the short time available before the expiration of the year to arrange for the re inspection of more than 63 of the 612 pupils examined. 19. CONTINUATION SCHOOLS. There are no Continuation Schools in the Borough. 20. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. Milk and newspaper deliveries, general errands, hawking and newspaper selling are the popular forms of employment amongst children and young persons under 16 years of age, and at present those with which the school medical service is only concerned 118 In no instance was it considered necessary to refuse a certificate. Children granted certificates are seen from time to time at reinspections in the schools. 21. MISCELLANEOUS. 38 young persons who desired to become Bursars and Student Teachers were medically examined during the year. Teaching of Infant Care. As in past years, the Infant Care Class has been conducted at Tavistock Grove and Beulah Road Schools, instruction being given by one of the Health Visitors. R. VEITCH CLARK, School Medical Officer. 119 Appendix A. TABLE I.-Number of Children Inspected 1st January to 31st December, 1920. A. - Routine Medical Inspections. Entrants. Leavers. Age 3 4 5 6 Other Ages. Total. Intermediate Group. 12 13 14 Other Ages. Total Grand Total Boys - 53 813 688 286 1840 499 637 395 26 119 1676 3516 Girls 2 54 679 706 289 1730 603 449 235 30 184 1501 3231 Totals 2 107 1492 1394 575 3570 1102 1086 630 56 303 3177 6747 B.-Special Inspections. Special Cases. Re-examinations, i.e., number of children re-examined. Boys 734 267 Girls 436 199 Totals 1170 466 C.-Total Number of individual children inspected by the Medical Officer, whether as Routine or Special Cases. 8383 120 Appendix A. TABLE II. —Return of Defects found in the Cours; of Medical Insptction in 1920. defect or disease. Routine Inspections. "Specials" Number referred for treatment. Number requiring to be kept under observation but not referred for treatment. Number referred tor treatment. Number requiring to be kept ui-der observation but not referred for treatment. Malnutrition 50 5 14 1 Uncleanliness—Head 2 ... ... ... „ Body 26 ... ... ... Skin— Ringworm—Head 26 ... 106 1 ,, Body 5 ... 30 ... Scabies 41 ... 36 ... Impetigo 45 ... 38 ... Other Diseases 17 7 21 ... Eye— Blepharitis ... 8 ... 3 ... Conjunctivitis 8 ... 2 ... Keratitis ... ... 2 ... Corneal Ulcer 1 ... ... ... Corneal Opacities 1 ... ... ... Defective Vision 319 7 227 ... Squint 39 2 16 ... Other Conditions 29 24 ... Ear— Defective Hearing 6 ... 1 ... Otitis Media 32 1 10 ... Other Ear Diseases 70 ... 21 ... Nose & Throat— Enlarged Tonsils 167 63 16 1 Adenoids 113 22 37 5 Enlarged Tonsils & Adenoids 290 19 30 5 Other Conditions 4 4 2 ... Enlarged Cervical Glands 12 6 ... 1 Defective Speech 7 ... 10 2 Teeth —Dental Diseases ... Heart & Circulation— Heart Disease—Organic 28 18 15 10 „ Functicnal 20 28 5 2 Anaemia 88 12 25 6 Lungs— Bronchitis 29 26 5 ... Other Non-Tubercular Diseases 4 2 ... ... Tuberculosis— Pulmonary—Definite 19 1 13 5 ,, Suspected Non-Pulmonary—Glands 32 6 25 3 12 9 9 ... ,, Spine ... ... ... ... „ Hip 3 ... ... ... ,, Other Bones & Joints 1 ... ... ... ,, Skin ... ... ... ... ,, Other Forms 1 ... ... ... Nervous System— Epilepsy ... 1 4 5 Chorea 4 ... ... 6 Other Conditions 3 2 8 1 Deformities— Rickets 10 ... ... ... Spinal Curvature 72 7 16 ... Other Forms 9 3 4 ... Other Defects & Diseases 61 27 24 8 Number of Individual Children having defects which required treatment or to he kept under observation 3097 121 Appendix A. TABLE III.—Numerical Retupn of all Exceptional Children in the Area in 1920. Boys. Girls. Total. BLIND (including partially blind) within the meaning of the Ele mentary Education Blind and Deaf Children) Act, 1893. Attending Public Elementary Schools 2 3 5 Attending Certified Schools for the Blind 6 3 9 Not at School 6 2 8 DEAF AND DUMB (including partially deaf) within the meaning of the Elementary Education (Blind and Deaf Children) Act. 1893. Attending Public Elementary Schools 3 1 4 Attending Certified Schools for the Deaf 3 5 8 Not at School 1 5 6 MENTALLY DEFICIENT. Minded. Attending Public Elementary Schools 1 1 2 Atiending Certified Schools for Mentally Defective Children 47 30 77 Notified to the Local Control Authority by the Local Education Authority during the year 4 4 8 Not at School 4 6 10 Imbeciles. Notified to the Local Control Authority by the Local Education Authority during the year 1 1 2 At School — — — Not at School ... 8 8 16 Idiots. Notified to the Local Control Authority by the Local Education Authority during the year - - - EPILEPTICS. Attending I'ublic Elementary Schools 12 9 21 Attending Certified School- for Epileptics 4 1 5 In Institutions other than Certified Schools 2 1 3 Not at School ... 13 15 28 122 Appendix A. Table III.-Continued. [### Boys. Girls. Total. PHYSICALLY DEFECTIVE Pulmonary Tuberculosis Attending Public Elementary Schools 22 28 50 Attending Certified Schools for Physically Defective Children - 1 1 In Institutions other than Certified Schools - - - Not at School 5 4 9 Crippling duk to losis. Attending Public Elementary Schools 8 4 12 Attending Certified Schools for Physically Defective Children 1 - 1 In Institutions other than Certified Schools - - - Not at School 2 2 4 Crippling due to causes other than Tuberculosis, i.e.. Paralysis, Rickets, Traumatism. Attending Public Elementary Schools 5 9 14 Attending Certified Schools for Physically Defective Children 1 - J In Institutions other than Certified Schools - - - Not at School 4 7 11 Other Physical Defectives. Attending Public Elementary Schools 6 4 10 Attending Open-Air Schools - - - Attending Certified Schools for Physically Defective Children - 1 1 Not at School 5 8 13 DULL OR BACKWARD. Retarded 2 years 5 5 ,0 „ 23 „ 10 11 31 „ 3 „ 3 7 10 123 Appendix A. TABLE IV.—Treatment of Defects of Children During 1920. A.—Treatment of Minor Ailments. Disease or Defect. Number of children Referred for Treatment. Treated. Under Local Education Authority's Scheme. Otherwise. Total. Skin— Ringworm, head 132 137 ... 137 Ringworm, bodv 35 38 ... 38 Scabies 77 114 ... 114 Impetigo 84 94 ... 94 Minor Injuries 17 17 ... 17 Other Skin Diseases 21 40 ... 40 Ear Disease 140 75 4 79 Eyr Disease (external and other) 47 26 26 Miscellaneous 701 1005 8 1013 B.—Treatment of Visual Defect. NUMBER OF CHILDREN. Referred for Refraction. Submitted to Refraction. For whom glasses were prescribed. For whom glasses were provided. Recommended for treatment other than by glasses. Received other forms of treatment. For whom no treatment was considered necessary. Under Local Education Authority's Scheme Clinic or Hospital. By Private Practitioner or Hospital. Otherwise. TOTAL. 632 602 7 4 613 192 35 233 107 154 C.—Treatment of Defects of Nose and Throat. Referred for treatment. NUMBER OF CHILDREN Received Operative Treatment. Received other forms of treatment. Under Local Education Authority's Scheme Clinic or Hospital. By Private Practitioner or Hospital. TOTAL. 659 303 18 321 - 124 Appendix A. TABLE IV. D.-Treatment of Dental Defects. (1) Number of children dealt with. AGE GROUPS. "Specials" Total. 5 6 7 8 9 10 11 12 13 14 (a) Inspected by Dentist - 3089 - 1240 - - - - - - - 4329 (b) Referre 1 for Treatment ... ... ... 3488 ... ... ... ... - 3488 (c) Actually Treated ... ... ... 1223 ... ... ... ... 56 1279 (d) Re-treated (result of periodical examination) ... ... ... 81 ... ... ... 81 (2). Particulars of time given and of operations undertaken. No. of half-days devoted to inspection. No. of half-days devoted to treatment. Total No of Attendances made by the children at the Clinics. No. of Permanent Teeth. No. of Temporary Teeth. Total No. of Fillings. No. of adminisirations of general anaesthetics included in (4) and (6). No. of other operations. Extracted. Filled. T, Extracted. Filled. Permanent Teeth. Temporary Teeth. 1 2 3 4 5 6 7 8 9 10 11 63 252 3435 61 74 3615 1068 1142 133 20 158 125 Appendix A. E.—Treatment of Uncleanltness. (а) Average number of visits per annum made by the School Nurses to each school (b) Total number of examinations made of children by School Nurses in the year in the schools 11938 (c) The number of individual children found unclean Nits 2028 Head Vermin 419 Body ,, 33 Total 2480 (d) Arrangements made by the Local Authority for At Cleansing Station, Factory cleansing, and the number of children cleansed Lane, Croydon, under these arrangements Head Vermin 2 Body ,, 26 Total 28 (e) Legal proceedings taken under the Children Act 1 Prosecution under the School 1908, or the School Attendance Bye-laws Attendance Bye-laws. Fine of 10/- imposed. 126 Appkndix A. TABLE V.—Summary of Treatment of Defects as shown in Table IV. (A, B, C and D). Disease or Defect. NUMBER OF CHILDREN Referred for Treatment. Treated. Under Local Education Authority's Scheme. Otherwise. total. Minor Ailments 1254 1546 12 1558 Visual Defects 632 602 11 613 Defects of Nose and Throat 059 303 18 321 Dental Defects 3488 1279 1279 Other Defects (Tuberculosis) 319 319 319 Total 6352 3730 360 4090 127 Appendix A. TABLE VI — Summary Relating to Children Medically Inspected at the Routine Inspections during the Year 1920. (1) The total number children medically inspected at the Routine Inspections 6747 (2) The number of children in (1) suffering from:- Malnutrition 351 Skin Disease 104 Defective Vision (including Squint) 739 Eye Disease 202 Defective Hearing 77 Ear Disease 94 Nose and Throat Disease 1533 Enlarged Cervical Glands (non tubercular) 6:9 Defective Speech 66 Der.tal Disease 65 Heart Disease—Organic 122 „ Functional 195 Anaimia 278 Lung Disease (non tubercular) 219 Tuberculosis - Pulmonary - Definite 10 „ Suspected 65 Non-Pulmonary 65 Diseases of the Nervous System 46 Deformities 276 Other Defects and Diseases 270 (3) The number of children in (1) suffering from defects (other than uncleanliness or defective clothing or footgear) who require to be kept under observation (but not referred for treatment) 551 (4) The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, etc.) 1756 (5) The number of children in (4) who received treatment for one or more defects (excluding uncleanliness, defective clothing etc.) 725 128 Appendix B SECONDARY SCHOOLS. TABLE I.-Number of Children Inspected 1st January, 1920 to 31st December, 1920. A.-Routine Medical Inspection. Entrants. Leavers. Age 3 4 5 6 Other Ages. Total Intermediate Group. 8 12 13 14 Other Ages. Total Grand Total. Boys - - - - - - - 75 48 35 41 199 199 Girls - - - - - - - 83 112 41 177 413 413 Totals - - - - - - - 158 160 70 218 612 612 B. -Special Inspections. Special Cases. Re-examinations, i.e., number of children re-examined. Boys ... - Girls 1 63 Totals 1 63 Total number of individual Children inspected by the Medical Officer, whether as Routine or Special Cases Number of individual children inspected : 676 129 Appendix B. TABLE II.—Return of Defects Found in the Course of Medical Inspection in 1920. disease or defect. Routine Inspections. "Specials.'' Number referred for Treatment. Number requiring to be kept under observation but not referred for Treatment. Number referred for Treatment. Number requiring to be kept under observation but not referred for Treatment. Malnutrition 2 1 ... ... Uncleanliness—Head ... ... ... ... Body ... ... ... ... Skin — Ringworm—Head ... ... ... ... Body ... ... ... ... Scabies ... ... ... ... Impetigo ... ... ... ... Other Diseases (non-tubercular) 1 ... ... ... Eyr— Blepharitis ... ... ... ... Conjunctivitis ... ... ... ... Keratitis ... ... ... ... Corneal Ulcer ... ... ... ... Corneal Opacities ... ... ... ... Defective Vision 92 1 ... ... Squint ... ... ... ... Other Conditions ... ... ... ... Ear— ... ... ... ... Defective Hearing 7 1 1 ... Otitis Media ... ... ... ... Other Ear Diseases ... ... ... ... Nose and Throat ... Enlarged Tonsils 10 17 ... ... Adenids 1 ... ... ... Enlarged Tonsils and Adenoids 1 ... ... ... Other Conditions 2 9 ... ... Enlarged Cervical Glands 1 ... ... ::: Defective Speech ... ... ... ... Heart and Circulation— Heart Disease—Organic 6 8 ... ... Funciional ... 17 ... ... Anaemia 4 29 ... ... Lung- Bronchitis ... 2 ... ... Other non-tubercular Diseases 1 1 ... ... Tuberculosis— Pulmonary—Definite ... 2 ... ... Suspected 7 7 ... ... Non-pulmonary—Glands ... 4 ... ... Spine ... ... ... ... Hip ... ... ... ... Other bones & joints ... ... ... ... Skin ... ... ... ... Other Forms ... ... ... ... Nervous System— Epilepsy ... ... ... ... Chorea ... 1 ... ... Other Conditions ... 7 ... ... Deformities— Rickets ... ... ... ... Spinal Curvature 179 16 ... ... Other Forms ... 4 ... ... Other Defects and Diseases ... 12 ... ... Chest Expansion l½in. or under 18 ... ... ... Defective Teeth 54 ... ... ... Number of Individual Children having Defects which required Treatment or to be kept under Observation 491 130 Appendix B. TABLE IV.—Treatment of Defects of Children in 1920. A.—Treatment of Minor Ailments. Disease or Defect. NUMBER OF CHILDREN. Referred for Treatment. Treated. Under Local Education Authority's Scheme. Otherwise TOTAL Skin — Ringworm (head) ... ... ... ... ,, (body) ... ... ... ... Scabies ... ... ... ... Impetigo ... ... ... ... Minor Injuries ... ... ... ... Other Skin Disease 1 ... ... ... Ear Disease 8 ... ... ... Eye Disease (external or other) ... ... ... ... Miscellaneous 11 ... 1 1 B.—Treatment of Visual Defect. NUMBER OF CHILDREN. Referred for Refraction. Submitted to Refraction. For whom glaeeee were provided. For whom glaeeee were preecribed. Recom me nded for treatment other than by glaeeee. Received other forme of treatment. For whom no treatment wae coneidered neceeeary Under Local Education Authority's Scheme,Clinic or Hospital. By Private Practitioner or Hospital. Otherwise. TOTAL. 92 ... 1 ... 1 ... ... ... ... ... C.—Treatment of Defects of Nose and Throat. Referred for treatment. NUMBER OF CHILDREN. Received Operative Treatment. Received other forms of treatment. Under Local Education Authority's Scheme, Clinic or Hospital. By Private Practitioner or Hospital. TOTAL. 14 ... 5 5 ... D.—Treatment of Dental Defects. NIL. 131 Appendix B. TABLE V.—Summary of Treatment of Defects as Shown in Table IV (A, B and C). Disease or Defect. NUMBER OF CHILDREN. Referred for Treatment. Treated. Under Local Education Authority's Scheme. Otherwise. Total. Minor Ailments 20 ... 1 1 Visual Defects 92 ... 1 1 Defects of Nose & Throat 14 ... 5 5 Dental Defects ... ... ... ... Other Defects ... ... ... ... Total 126 ... 7 7 TABLE VI.—Summary Relating to Children Medically Inspected at the Routine Inspections During the Year 1920. (1) The total number of children medically inspected at the Routine Inspections 612 (2) The number of children in (1) suffering from:— Malnutrition 114 Skin Disease 14 Uefective Vision (including Squint) 108 Eye Disease 10 Defective Hearing 12 Ear Disease 1 Nose and Throat Disease 66 Enlarged Cervical Glands (non-Tubercular) 7 Defective Speech 2 Dental Disease 10 Heart Disease—Organic 22 ,, ,, Functional 51 Anaemia 52 Lung disease (non-Tubercular) 5 Tuberculosis—Pulmonary (definite) 2 „ ,, (suspected) 11 ,, Non-Pulmonary 28 Disease of the Nervous System. 56 Deformities 241 Other Defects and Diseases (3) The number of children in (1) suffering from delects (other than uncleanliness or defective clothing or footgear) who require to be kept under tion (but not referred lor treatment) 144 (4) The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, etc.) 347 (5) The number of children in (4) who received treatment for one or more defects (excluding uncleanliness, defective clothing, etc.) 7 132