1 County Borough of crondon CRO 23 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and SCHOOL MEDICAL OFFICER For the Year 1921. R. VEITCH CLARK, M.A., MB., Ch.B., B.Sc., D.P.B. CROYDON: printed by s. H. purnel.l, "times" offices, croydon and walling!on. 2 3 Contents. PAGE Introductory letter 7 SECTION I. General Statistics 8 Vital Statistics 8 Notifiable Infectious Diseases 9 Causes of Sickness 10 Nursing Arrangements 10 Midwives 10 Clinics and Treatment Centres 11 Hospitals provided or subsidised by the Local Authority 13 Institutional Provision for Unmarried Mothers 13 Ambulance Facilities 13 Laboratory Work 14 Adoptive Acts, Bye Laws and Regulations 14 Sanitary Administration 14 Public Health Staff" 15 Housing 16 SECTION II. Table I. Vital Statistics of whole district, during 1921 and previous years 18 11. Cases of Infectious Disease notified during 1921 19 Charts showing Weekly Notifications of cases of Diphtheria and Scarlet Fever III. Causes of, and Ages at, Death during 1921 20 IIIa. Causes of Deaths from Influenza and certain other conditions during 1921 33 Chart showing principal causes of death during 35 1921 IV. Infant Mortality during 1921 36 Chart shewing Infant Mortality Rate for Croydon compared with the rate for England and Wales 45 V. Cases notified and deaths from the principal zymotic diseases for the year 192 1 and preceding years 46 VI. Vital Statistics of separate localities in 1921 and previous years 47 VII. Meteorological Observations for 1921 48 VIIa. Meteorological Observations for 1921 49 SECTION III. Maternity and Infant Welfare :— Infant Mortality 50 Diarrhœa 50 Infant Centres 51 Provision of Fresh Milk at the Centres 51 Maternity Hostel 52 Ante-Natal Clinic 52 Sick Nursery 53 Notification of Births Act, 1907 53 Midwives 53 Sick Room Requisites 54 Statistical Summary 55 4 page. SECTION IV. Tuberculosis Work :— General Summary of Cases dealt with through the Tuberculosis Dispensary and work done in connection with them 56 Sanatorium and Hospital Treatment 64 Croydon Borough Sanatorium 65 SECTION V. Venereal Disease :— Returns as to persons treated during the year 68 SECTION VI. Mental Deficiency:— Returns as to cases dealt with 71 SECTION VII. Sanitary Inspecting Staff, Work of the:— Inspections made 76 Nuisances discovered 77 Municipal and other Common Lodging Houses 78 Houses let in lodgings 79 Factory and Workshops Act :— Factories 79 Workshops 79 Homework 80 Bakehouses 80 Workplaces 80 Smoke Observations 80 Rag Flock Act 80 Slaughterhouses and the Inspection of Meat and Other Foods:— Summary of Inspections 81 Details as to animals slaughtered 82 Summary of meat and other foods destroyed as unfit 83 Tuberculosis in meat 84 Dairies, Cowsheds, and Milkshops Order 84 Tuberculosis in milk 84 Food and Drugs Acts :— Prosecutions 86 Details of samples taken, 1921 87 Details of samples taken, 1906-J921 88 Milk and Cream Regulations 89 Poisons and Pharmacy Act 90 Fertilisers and Feeding Stuffs Act 90 Rats and Mice (Destruction) Act 90 SECTION VIII. Borough Hospital, Work of the :— Detailed analysis of expenditure 92 Maximum and minimum number of beds occupied 92 Admissions, 1921 93 Admissions, details of comparative, 1910-1921 93 5 page. Admissions, analysis of, 1921 94 Admissions, fatality fof each disease 95 Illness of Staff 96 Ambulance Service . . 96 Borough Laboratory, Work of the : — Examinations made for Diphtheria 96 ,, ,, Tuberculosis 97 ,, ,, Enteric (Typhoid Fever) 98 SECTION IX. School Medical Officer's Report :— Staff 99 Co-ordination 99 School Medical Service in Relation to the Public Elementary Schools :— Number of schools and accommodation 99 School Building's and accommodation 99 School Hygiene 100 Medical Inspection :— Routine inspection 100 Inspection of selected children 100 Defective children re-examined 100 Table—Total number of children examined (routine) 101 Findings of Medical Inspection :— Uncleanliness 103 Cleansing Station 103 Clothing 103 Average Heights and Weights 103 Malnutrition 104 Vision and external eye disease 104 Enlarged tonsils and adenoids 104 Lymphatic Glands 104 Ear Disease 104 Defective Teeth 104 Affections of the Heart 106 Affections of the Lung 106 Tuberculosis 106 Nervous Diseases 106 Deformities 106 Ringworm 107 Skin Affections 107 Mental Conditions 107 Infectious Disease :— School Closure 107 Following Up :— Work of the Health Visitors 108 Medical Treatment :— Minor Ailments 109 Uncleanliness 109 Enlarged Tonsils and Adenoids 110 Tuberculosis 111 Vision and External Eye Disease 111 Dental Defects 112 Crippling Defects and Orthopoedics 114 6 page. Open Air Education 115 Physical Training 116 Provision of Meals 118 Co-Operation of Parents 118 Co-Operation of Teachers 118 Co-Operation of School Attendance Officers 119 Co-Operation of Voluntary Bodies 119 Blind, Deaf, Defective and Epileptic Children 119 Mentally Defective Children 120 Grangewood Special M.D. School 120 Physically Defective Children 121 Speech Defects Class121 Nlrsery Schools 123 Secondary Schools 123 Continuation Schools 123 Employment of Children and Young Persons 123 Miscellaneous :— Teaching of Infant Care 123 Appendix. Public Elementary Schools. A. Table 1. Number of Children Inspected 124 2. Return of Defects found in the course of medical inspection 125 3. Numerical Return of all Exceptional Children. 126 4. Treatment of Defects of Children ;— (a) Minor Ailments 128 (b) Visual Defect 128 (c) Defects of Nose and Throat 128 (d) Treatment of Dental Defects 129 (e) Treatment of Uncleanliness 130 5. Summary of treatment of Defects 131 6. Summary relating to children medically inspected. 132 Secondary Schools. B. Table x. Number of Children inspected 133 2. Return of Defects found in the course of medical inspection. 1^4 3. See Appendix A, Table 3. 4. Treatment of Defects of Children :— (a) Minor Ailments. 135 (b) Visual Defect 135 (c) Defects of Nose and Throat 135 (d) Treatment of Dental Defects 135 5. Summary of treatment of defects 6. Summary relating to children medically inspected 136 7 Public Health Department, Town Hall, Croydon, 6th July, IQ22. To the Mayor, Aldermen and Councillors of the County Borough of Croydon. Mr. Mayor, Ladies and Gentlemen, I beg to submit my Annual Report for 1921. The report differs in its arrangement to some extent from those which have recently been presented to the Council in that the requirements of the Ministry of Health have been altered. The Ministry by Circular 269, dated 28th December, 1921, have required that annual reports on public health matters shall consist of what are called "ordinary" reports for four years, and every fifth year of a "survey" report. The ordinary reports are to be of a less extensive character. The quinquennial survey reports are to be of the nature of a public health review of the preceding five years. In this way a more thorough picture of the progress of public health work and of health conditions will be presented. The first survey report will be due in 1925. The year 1921 has provided two new records in the borough, viz. : the lowest death rate—10.7—and the highest number of cases of scarlet fever and diphtheria recorded in any one year, viz. : 1,338. The pressure upon the accommodation in the Borough Isolation Hospital has been very heavy, necessitating much overcrowding in the wards, and in the latter end of the year making it impossible to remove all the cases of notifiable infectious disease which should have been removed from their homes. The Public Health Committee have had under consideration the extension of the Borough Hospital, and in the interests of the public health of the town this is a need which must be met at a very early date. I would also urge once more the great inadequacy of the sick nursery at 228, London Road, both as regards the nature of the accommodation and the number of cots for ailing infants, an inadequacy which seriously hampers the infant welfare work of the Borough. The post-war accumulation of defective housing continues to make heavy inroads upon the time of the sanitary inspectors, and there is no doubt but that the staff must be increased to enable this work to be done efficiently. It should be noted that no addition has been made to the staff of inspectors since 1904, during which time the population of the Borough has increased by 50,000. No new developments of public health work fall to be recorded now. I respectfully urge upon the Council, however, the needs expressed in the preceding paragraphs as soon as financial circumstances permit of their being attained. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, R. VEITCH CLARK, Medical Officer of Health. 8 County Borough of Croydon. REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1921 SECTION I. SUMMARY OF PARTICULARS REQUIRED BY CIRCULAR 269 OF THE MINISTRY OF HEALTH DATED 28-12-21. 1. General Statistics. Area (acres)—9012. Population (Census 1921)—190,877. Population, June, 1921 (Registrar General's Estimate)—191,500. Number of Inhabited Houses (1921)—41,923. Rateable value—^1,223,303. Sum represented by a penny rate.—^4,418. 2. Extracts from Vital Statistics for the Year. Births— Males. Females. Total. Birth Rate. Legitimate 1815 1715 3530 Illegitimate 84 99 183 18.9 Totals 1899 1814 3713 Deaths—2,054. Death rate—10.7. Number of women dying in, or in consequence of, childbirth :— From Sepsis, 4. From other causes, 10. Number of deaths of infants under one year of age per 1,000 births—74. Legitimate rate, 71; Illegitimate rate, in. Number of deaths from Measles (all ages)—6. ,, Whooping cough (all ages)—22. ,, Diarrhoea (under 2 years of age)—44. 3.-NOTIFIABLE DISEASES DURING THE YEAR. disease. Total cases notified, † Cases admitted to Hospital. Total deaths at all ages. Age Groups of Deaths. Under 1. 1 and under 2 2 and under 3 3 and under 4 4 and under 5 5 and under 10 10 and under 15 15 and under 20 20 and under 35 35 and under 45 45 and under 65 65 and over. Diphtheria 483 419 22 .. 3 2 1 4 9 .. 1 .. .. .. .. Scarlet Fever 856 711 4 .. .. .. .. .. .. .. 1 .. .. .. .. Enteric (including Paratyphoid) 10 6 1 .. .. .. .. .. .. .. 1 .. .. .. .. Puerperal Fever 8 2 4 .. .. .. .. .. .. .. .. 3 1 .. .. Pneumonia 66 2 138 35 11 2 2 .. 3 .. 1 6 13 31 29 Erysipelas 43 7 4 2 .. .. .. .. .. .. l .. .. 1 .. Cerebro Spinal Meningitis 1 1 8 1 1 1 .. .. .. .. 2 .. 1 2 Malaria 3 .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 4 .. 2 .. .. .. .. .. .. .. .. .. 1 1 .. Anterior Poliomyelitis 6 •• 8 .. .. .. .. .. .. .. .. .. 1 3 4 Tuberculosis— (a) Pulmonary Males 217 410 178 74 .. .. .. .. .. 2 1 11 31 15 14 .. Females 193 79 .. .. .. .. .. 2 3 3 32 18 18 3 (b) Non-Pulmonary Males 811 163 46 17 5 3 .. .. .. 3 2 2 1 .. 1 .. Females 82) 14 2 .. .. •• •• 3 2 2 4 1 .. .. Totals 2052 1372 375 45 18 5 3 5 22 17 25 77 51 71 36 † For Age Groups of Notifications see Table II (Page 19). 9 10 OPHTHALMIA NEONATORUM. cases. Notified. Treated. Vision unimpaired. Vision impaired Total blindness. Deaths. Left District, etc. At home. In hospital 26 18 8 20 1 2 fin neither case however did the death occur from this disease). 3 4 Causes of Sickness. No special causes of sickness fall to be discussed. It is worthy of note, however, that in 1921, the ordinary notifiable infectious diseases reached a higher numerical level than ever before. The incidence of influenza in the early part of the year in the town coincided with that over the whole country. It was not noteworthy in any particular way other than that the disease was generally of a mild type characterised by frequent relapses, but with a low mortality rate. During the year two outbreaks of epidemic jaundice were investigated; the blood of rats found in the houses or in adjoining premises was examined, but no parasites were found. None of the cases were fatal. 5. Summary (for reference) of Nursing Arrangements, Hospitals and other Institutions available for the district. (A) Professional Nursing in the Home.—(a) General.—Croydon Nursing Service. During 1921 there was established in Croydon a nursing service on lines which were advocated by the Medical Officer of Health some years ago. This is at present of relatively small dimensions, but is growing, and the organisation is such that with growth the service will supply the needs of the whole population of the town in future. It is especially to be noted that the service is being developed on lines which will make it very largely self-supporting. The major portion of the clientele is being arranged for through an insurance scheme and provident clubs. This will cover in time the whole working class population and the group of the population immediately above that. The service, however, covers all classes of the community, those able to do so paying fees on the ordinary recognised scales. The nurses provided are visiting nurses and do not live in the patients' houses. (b) For Infectious Diseases.—One health visitor is specifically appointed to the Public Health Department for the nursing of tuberculosis cases in their own homes. No other provision of home nursing is done by the Department, but the health visitors either in connection with maternity and infant work, or school work, regularly advise the parents as to the nursing and other general care of children. (B) Midwives.—No midwives are employed, or subsidised, by the Public Health Authority. There are thirty-five midwives practising in the Borough. (See page 53). 11 (C) CLINICS AND TREATMENT CENTRES. Name and Situation. Nature of Accommodation By whom provided. MATERNITY & CHILD WELFARE, (a) Centres Municipal Inft. Centre, 228, London Road, Croydon. 12-roomed house held on lease by Corporation and used as Municipal Infant Centre, Sick Nursery, Minor Ailments and Special Inspection C1inicSchool Medical Service. Local Authority. Central Croydon, Parish Hall, Sylverdale Road, Croydon. Accommodation for consultations, weighing of babies, waiting room, etc. Croydon Mothers' and. Infants' Welfare Association. Thornton Heath, Grange Hall, Mersham Road, Thornton Heath. do. East Croydon, Wesleyan Schoolroom, L. Addiseombe Road, Croydon. do. South Norwood, Holy Innocent's Parish Room, Selhurst Road, S. Norwood. do. Woodside, St. Luke's Hall, Spring Lane, Woodside. do. Upper Norwood, St. Margaret's Hall, Naseby Road, U. Norwood. do. Thornton Heath, St. Alban's Hall, Whitehorse Lane, Thornton Heath. do. South Croydon, Wesleyan Church Hall, Bartlett St., Soutli Croydon. do. West Croydon. Mission Hall, Johnson Road, Croydon. do. (b) Ante-Natal Clinic 33, St. James' Road, Croydon. 2 rooms leased from Croydon Mothers' and Infants' Welfare Association in premises used by them as Nurses' Hostel and Store. Local Authority. (c) Massage Clinic 228, London Road As above. Local Authority. 12 CLINICS AND TREATMENT CENTRES (Continued). Name and Situation. Nature of Accommodation By whom provided. (d) Sick Nursery 228, London Road, Croydon. One large room (5 cots) and accommodation for nursing and domestic staff. Local Authority. DAY NURSERIES. NIL. SCHOOL CLINICS. Re-inspection Clinic, 228, London Road, Croydon. 2 rooms. Local Authority. Minor Ailments Treatment Centre, 228, London Road, Croydon. Do. do. Eye Clinic, Town Hall, Croydon. 2 rooms in Public Health Department. do. Dental Clinic, Town Hall, Croydon. Same rooms as above. do X-Ray Clinic, 83, Park Lane, Croydon. Surgery of Dr. Critfl!ley, part-time X-Ray Specialist. do. Massage Clinic, Central Polytechnic, Scarbrook Road, Croydon. One room. do. Spinal Remedial Exercises Clinic, Central Polytechnic, Scarbrook Road, Croydon. One room. do. Breathing Exercises Clinic, Central Polytechnic, Scarbrook Road, Croydon. One room. do. Tonsils and Adenoid Clinic, Croydon General Hospital. Waiting, Operating and Recovery Room. do Cleansing Station, Factory Lane, Croydon 2 waitings rooms and 4 baths. do. TUBERCULOSIS. Tuberculosis Dispensary, 13, Katharine Street, Croydon. Waiting room, consulting room, doctors' nurses' and clerks' rooms. do. VENEREAL DISEASES. V.D. Clinic, Croydon General Hospital. A portion of the OutPatients' Dept. do 13 (I)) Hospitals provided or subsidised by the Local Authority:— (1) Tuberculosis— (a) Borough Hospital. 17 Beds are provided for advanced cases of tuberculosis of which 5 are in shelters; 9 are for female cases and 8 for men. (b) Borough Sanatorium.—Fifty beds for the treatment of early, intermediate and advanced cases, allocated as follows, viz. Surrey 30, Croydon 15, Kent 5. These are all for male patients. (2) Maternity— St. Mary's Hostel, St. James' Road, Croydon.—This institution is conducted under the auspices of the Croydon Mothers' and Infants' Welfare Association. Seventeen beds (each with its cot) are provided. The hostel is largely subsidised by the local authority. (3) Children— (a) Sick Nursery.—This is attached to the Municipal Infant Centre at 228, London Road, and provides accommodation for five sick or ailing children under 5 years of age. (b) Borough Hospital.—Cases of ophthalmia neonatorum and infantile diarrhoea are treated in the Borough Hospital. (4) Fever— Borough Hospital. Waddon Marsh Lanc. -The nominal accommodation is for 170 patients, and the cases admitted are those suffering from the ordinary notifiable infectious diseases. During the latter part of 1921 there were upwards of 230 patients under treatment at one time, and the Corporation are considering the question of providing additional accommodation at an early date. (5) Smallpox— The Croydon and Districts Smallpox Hospital is now used as a Sanatorium (see ante). Arrangements have been made with the Surrey County Council to reccive into their Clandon and Whitmoor Hospitals any cases of smallpox that would ordinarily have been admitted to the Joint Hospital at North Cheam. (6) Other— Croydon General Hospital.—Two clinics arc held in connection with the Public Health Department's activities at this hospital, viz. :—(a) Tonsils and Adenoids Clinic, and (b) Venereal Diseases Clinic. The local authority subsidises the General Hospital for the work done in both of these clinics. In the case of the Tonsils and Adenoids Clinic this subsidy only represents rent and cleaning. (E) Institutional provision for unmarried mothers, illegitimate infants and homeless children.—A few cases of illegitimate children are dealt with by the Croydon Mothers and Infants Welfare Association by being sent to institutions which receive such cases, but none of these institutions are within the Borough. Unmarried mothers are admitted to St. Mary's Hostel for their first confinement only. (F) Ambulance Facilities.—(a) For Infectious Cases.—A motor ambulance is prov ided for the removal of infectious cases from the area of the County Borough and from that of Penge Urban District (See page 96). 14 (b) For non-infectious and accident cases.—Two motor ambulances for non-infectious cases and accidents are kept at the Fire Station, the ambulance and fire service being run in conjunction with one another under the Chief Fire Officer. During 1921 1,282 Ambulance Calls were answered, and first aid was rendered in 399 instances, 6. LABORATORY WORK. Full details of this are given in that section of the report dealing with the Borough Hospital. (Page 96). 7. List of Adoptive Acts, Bye-laws, and Local Regulations relating to Public Health in force in the district, with date of adoption. Local Acts. 1884—Croydon Corporation Act. 1895 1900 ,, ,, ,, 1905 ,, ,, ,, 1920 ,, ,, ,, 1921—Croydon Corporation Water Act. General Adoptive Acts. Baths & Washhouses Acts, 1846-1899. Public Health Acts Amendment Act, 1890, Part 3 (Sees. 16-50), (Sect. 19 repealed bv Croydon Corporation Act, 1905, Sec. 34). Infectious Diseases (Prevention) Act, 1890. Regulations. Regulations as to Dairies, Cowsheds and Milk Shops, 1900. Regulations as to connections with sewers, 1911. Bye-Laws. With respect to Nuisances, 1885. With respect to Common Lodging Houses, 1885. With respect to Tents, Sheds and similar structures used for human habitation, 1903. With respect to Slaughterhouses, 1914. With respect to New Streets and Buildings, 1920. With respect to Houses intended or used for occupation of the Working Classes and let in lodgings or occupied by members of more than one family, 1921. 8. SANITARY ADMINISTRATION. (See Page 76). 15 9. PUBLIC HEALTH STAFF. MEDICAL— †R. Veitch Clark, M.A., M.B., Ch.B., B.Kc.. D.I'.H., Medical Officer of Health, School Medical Officer, General Medical Superintendent and Visiting Physician, Croydon Borough Isolation Hospital and Croydon Borough Sanatorium, Chief Tuberculosis Officer, Medical Officer under the Mental Deficiency Act, Supervising Officer for Venereal Diseases Scheme, Mental Adviser, Croydon Mothers' and Infants' Welfare Scheme, Medical Adviser to Croydon Mothers' and Infants' Welfare Association. †Kerr Simpson. M.D., M.R.C.P., D.P.H., Deputy Medical Officer of Health, Deputy School Medical Officer, Medical Officer under the Mental Deficiency Act. † Frank C. Morgan, M.R.C.S., L.R.C.P., D.P.H., Assistant Medical Officer of Health for Tuberculosis and Visiting Physician for Tuberculosis, Croydon Borough Isolation Hospital. George Cochrane, M.A.. M.B., Ch.B., D.P.H., Resident Medical Superintendent Croydon Borough Hospital, and Assistant Medical Officer of Health. †Fredk. J. Pierce, M.R.C.S., L.R.C.P., D.P.H., Resident Medical Superintendent Croydon Borough Sanatorium. †Ian C. MacKay, M B., Ch.B., D.P.H., Assistant Medical Officer of Health and Assistant School Medical Officer. G. W. Elder, M B., Ch.B., D.P.H., Assistant Resident Medical Officer, Borough Hospital. †Dorothy Margaret Emslie, M.B., Ch.B., Senior Assistant Medical Officer, †Maternity and Child Welfare. †Marie Moralt, M.B., B.S., M.R.C.S., L.R.C.P., Assistant Medical Officer, Maternity and Child Welfare. †Dorothy C. Logan, M.D., B.S., Assistant Medical Officer, Maternity and Child Welfare—Ante-Natal Cliuic (part-time officer). †Mary McDougall, M B., C.M., Assistant Medical Officer, Maternity and Child Welfare (part-time). †H. G. Critchley, M.A., M.D., X-Ray Specialist for the treatment of ringworm (part-time). †Charles Wray, F.R.C.S., Ophthalmic Surgeon (part-time). †In addition to the foregoing, eight local medical practitioners attend the Clinic for the Treatment of Tonsils and Adenoids in rotation in pairs. DENTAL— † A. B. Oddie, L.D.S.. School Dental Officer (part-time). †C. A. Lightfoot, L.D.S., ,, ,, ,, ANALYTICAL— Lester Reed, F.C.S., F.T.C., Borough Analyst (part time). INSPECTORIAL STAFF— *†T. H. Culver, Chief Sanitary Inspector and Inspector under the Food and Drugs Acts, Shops Acts. Rag Flock Act, Feeding Stuffs and Fertilisers Act, and Poisons Acts. ||§†F. F. Fulker, Deputy Chief Inspector. " Alexander Low, Inspector of Meat and other Foods. *†Joseph H. Bull, Inspector of Factory and Workshops. *J. C. Earwicker.} *F. Richardson.} *W. T. Hunt.} §*G. G. Flint. }Sanitary Inspectors. *C. J. Vincent.} §*A. H. Fitt.} *L. F. Selfe.} In addition to the foregoing, there are also 5 disinfectors, 1 rat catcher, and 3 unqualified assistants. ‡Diploma Incorporated Institute of Hygiene. *Cert. Royal San. Inst. (Inspector of Nuisances). § ,, „ ,, „ (Meat and Other Foods). || „ London Exam. Board. ¶Sanitary Association of Scotland. 16 HEALTH VISITING STAFF— ‡¶**Edith M. Chapman, Inspector of Midwives and Nurse i/c Minor Ailments Clinic. ||‡†A. E. King, Nurse i/c Dental and Eye Clinics. §†E. A. McDougall, Assistant to Medical Officer for Mental Deficiency work. ||‡§†V. Cracknell.} ||¶†V. Byrn.} ||‡†J. M. L. Chalk.} Health Visitors for General Public Health Work ‡†G- Davis.} and school Medical Service. D¶§†A. Massie.} †¶†W. Waterman.} ‡¶†D. M. Huggins.} ||‡¶§ † U. Gordon.} ‡¶*§†C. Gordon.} ‡¶*A.Taylor.} ||‡¶§†C.A.'wilson. } Health Visitors for Maternity and Child Welfare. ||‡† A. J. Pressly. } ‡¶ § † J. Thomson.} D‡†E. M. Bradford, Tuberculosis Nurse. D‡¶†K. Fowler, Tuberculosis Nurse. ‡ General trained. ||F ever „ DCert. Apothecaries' Hall (Dispensing). *Cert. Royal San. Inst. (Inspector of Nuisances). § „ „ ,, ,, (Health Visitor). ¶Cert. C.M.B. STAFF OF CLINIC FOR REMEDIAL EXERCISES, AND MASSAGE— †May Appleton, South Kensington, Cert, for Physiology and Hygiene, Chelsea College Diploma, Organiser and Supervisor of Physical Training (Girls) and Remedial Exercises Classes. † Marguerite Cooke, I.S.T.M., Masseuse for School Medical Service. †H. Jenner, Cert. I.S.T.M., Masseuse for Maternity and Child Welfare work (part-time). CROYDON BOROUGH HOSPITAL, CROYDON BOROUGH SANATORIUM, AND SICK NURSERY— Nursing and Domestic Staffs. CLERICAL STAFF— Nineteen full-time clerks. †Exchequer contributions are received in respect of salaries of these officers. 10.—HOUSING. Number of new houses erected during the year : — (a) Total 970 (b) As part of a municipal housing scheme 781 I. Unfit Dwelling Houses— Inspection—(1) Total number of dwelling houses inspected for housing defects (under PublicHealth or Housing Acts) 3855 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 2438 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. 17 (4) 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 3460 2. Remedy of Defects without Service of Formal Notices— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their Officers 2817 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 (2) Number of dwelling houses which were rendered fit: — (a) By Owners (b) By Local Authority in default of owners (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 Public Health Acts : — (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 643 (2) Number of dwelling houses in which defects were remedied : — (a) By Owners 447 (b) By Local Authority in default of owners Nil. C. Proceedings under Sections 17 and 18 of the Housing, Town Planning, Etc., 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 pursuance of Demolition Orders Nil. 18 SECTION II. TABLE I. Vital Statistics of whole District during 1921 and previous years. Year. Population estimated to Middle of each Year. Uncorrected Number. Births. Total Deaths Reg. in the District. Transferable Deaths Nett deaths belonging to the District. of Non-residents registered in the District. of Residents not registered in the District Under 1 Year of Age. At all Ages. 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 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 24o 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 1921. 191,500 3713 3631 18.9 2115 11.0 283 222 269 74 2064 10.7 * Rates calculated per 1,000 of estimated population. †Registrar General's estimate of civilian population. ‡Registrar General's estimate of civilian population for death rate, 168,462. || ,, ,, ,, ,, ,, death rate, 184,239 § „ ,, „ „ 191,580 Census, 1921. Total population at all ages, 190,877. Number of structurally seperate sets of premises intended or used for habitation, 41,923 (of which 1,283 were vacant when the census was taken in June.) Average number of persons per house, 4 7. Area of District in acres (exclusive of area covered by water), 9,012. Weekly notifications of cases of SCARLET FEVER during: the year 1921. Weekly notifications of cases of DIPHTHERIA during the year 1921 19 TABLE II. Cases of Infectious Disease notified during the Year 1921. Notifiable Disease. Casks notified in whole District. Uurecorded ages. Total Cases notified in each Locality. Total Cases Removed to Hospitals or Sanatoria. At all Ages. At Ages—Years. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. Institution cases which could not be distributed. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65 65 & upwd. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera (C) Plague (P) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 488 2 55 335 56 29 6 .. .. 71 62 19 52 55 130 22 72 .. 419 Erysipelas 43 1 .. 4 5 15 13 .. .. 13 .. 3 12 4 6 3 .. 7 Scarlet Fever 855 1 93 605 96 55 5 .. .. 167 142 45 79 |176 113 39 94 .. 711 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 10 .. .. 1 2 6 1 .. .. '2 .. .. 1 1 3 2 1 .. 6 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 8 .. .. .. 3 5 .. .. .. .. 2 .. .. .. 3 .. 1 .. 2 Cerebro-spinal Meningitis 1 .. 1 .. .. .. .. .. .... .. .. .. .. .. 1 .. .. .. 1 Ophthalmia Neonatorum 26 26 .. .. .. .. .. .. .. 15 .. 2 .. 5 4 .. .. .. 8 Pulmonary Tuberculosis 410 .. 5 40 110 208 52 .. .. 89 41 39 45 27 80 34 58 .. 178 Other forms of Tuberculosis 163 2 25 99 20 8 1 .. .. 44 17 17 '20 13 23 9 12 .. 40 Pneumonia 60 3 4 16 11 14 12 .. .. 17 13 1 10 8 10 6 4 .. .. Malaria 3 .. .. .. .. 3 .. .. .. 1 .. .. .. 1 .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis lethargica 4 .. .. .. 1 1 2 .. .. .. 1 .. .. 3 .. .. .. .. .. Posterior basic meningitis .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. Anterior poliomyelitis 6 1 3 .. 1 .. 1 .. .. 1 1 .. 1 2 1 .. .. .. .. Totals 2078 36 186 1100 305 344 93 14 .. 422 279 126 220 295 375 111 245 5 1380 20 TABLE III Causes of, and ages at, Death during Year ending December 31st, 1921, excluding Deaths of Strangers at the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Purley Cottage Hospital, Norwood Cottage Hospital, 99, Central Hill (Servants' Reformatory), etc., and adding Deaths of Croydon Residents known to have occurred outside the District. No. CAUSE LOCALITIES. Institution & Street Deaths which could not be distributed. Total Institution Deaths distributed and not distributed Inquest Cases. Total all Ages. Males all Ages. Females all Ages. 0-1. 1-2. 2-5. 5-15. 15-25. 25-45. 45-65. 65 and upwards. J West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. I.—General Diseases. 1 Enteric Fever 1 ... ... ... ... ... ... ... ... (2) ... 1 1 ... ... ... ... ... 1 ... ... ... 2 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 (A B.) Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Mediterranean Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Small-pox (A) Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Not vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Doubtful ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... 6 Measles 4 ... ... ... 1 ... ... ... ... (1) ... 6 3 3 3 3 ... ... ... ... ... ... 7 Scarlet Fever ... 1 ... 1 ... 1 1 ... ... 4(1) ... 4 2 2 ... ... ... 3 1 ... ... ... 8 Whooping Cough 5 7 1 ... 3 4 1 1 ... ... 22 11 11 14 4 4 ... ... ... ... ... 9 (A) Diphtheria ... 2 1 2 4 9 3 1 ... 19(3) ... 22 12 10 ... 5 7 10 ... ... ... ... (B C.) Croup (B) Membranous laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Croup ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... ... ... ... 10 Influenza 6 4 7 3 10 4 3 2 ... 1(2) ... 39 18 21 3 ... ... ... 4 ... 9 ... 11 Miliary Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Cholera Nostras ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Dysentery ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... 1 ... 15 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Yellow Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Leprosy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Erysipelas 1 ... 1 ... 1 ... 1 ... ... ... ... 4 3 2 2 ... ... ... 1 ... 1 ... 19 (A.B.C.D.) other Epidemic Diseases (A) Mumps ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) German Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Varicella ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other Diseases included under 19 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 (A.B.C.) Pyaemia, Septicæmia (A) Pyaemia ... ... ... ... ... ... ... 1 1 2 ... 2 1 1 ... ... ... ... ... 1 1 ... (B) Septicaemia ... 1 1 ... ... ... ... ... ... 1 ... 2 1 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.) Pulmonary Tuberculosis (not acute) (A) Pulmonary Tuberculosis 21 19 21 13 9 24 8 8 ... 52(14) 2 123 59 64 ... ... ... 10 33 56 23 1 (B) Phthisis (not defined as tuberculous) 7 7 1 2 2 6 1 4 ... 7 (1) ... 30 15 15 ... ... ... ... 12 9 8 1 29 (A) Acute Phthisis 1 ... ... ... ... 1 ... ... ... (1) ... 2 ... 2 ... ... ... ... ... 2 ... ... (B) Acute Miliary Tuberculosis ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 30 Tuberculous Meningitis 2 2 ... 3 1 ... 1 3 ... 3(3) 3 12 6 6 3 2 ... 5 2 ... ... ... 81 (A.B.) Tuberculosis oF Peritoneum and Intestines (A) Tabes Mesenterica ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... (B) Other Peritoneal and Intestinal Tubercle 2 ... ... 1 ... 1 1 ... ... 2 ... 5 2 3 1 ... ... 1 1 2 ... ... 32 Tuberculosis of Spinal Column ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... 33 Tuberculosis of Joints ... 1 ... 2 ... ... ... ... 1 2(2) ... 4 2 2 ... ... ... 1 1 2 ... ... 34 (A. B.C.) Tuberculosis of other Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (A) Lupus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Scrofula 1 1 ... ... ... ... ... ... ... 2 ... 2 2 ... 1 1 ... ... ... ... ... ... 35 (C) Other Tuberculosis included under 34 Disseminated Tuberculosis ... ... 1 ... ... 1 1 ... ... 1 ... 3 2 1 1 ... ... 1 1 ... ... ... 36 (A.B.) Rickets, Softening of Bones (A) Rickets ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... 1 ... (B) Other forms of Bone Softening ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 21 TABLE III—continued. No. CAUSE LOCALITIES. Institution & Street Deaths which could not be distribnted. Total Institution Deaths distributed and not distributed. Inquest Cases. Total all Ages. Males all Ages. Females all Ages. 0-1. 1.2. 2-5. 5-15. 15-25. 25-45. 45-65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. 37 Syphilis ... 1 ... ... 2 1 ... ... ... 3(1) ... 4 3 1 3 ...... ... ... ... ... 1 ... 38 (A B.C.) Other Venereal Diseases (A) Soft Chancre ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Gonococcus Infection ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Purulent Ophthalmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 39 Cancer of the Buccal Cavity 2 2 ... ... 2 2 2 1 ... 6 (2) ... 11 10 1 ... ... ... ... ... ... 7 4 40 Cancer of the Stomach, Liver, &c. 6 11 8 7 5 9 2 4 ... 10 (4) ... 52 23 29 ... ... ... ... ... ... 26 26 41 Cancer of the Peritoneum, Intestines & Rectum 4 11 12 8 4 9 1 8 ... 18 (3) 2 57 26 31 ... ... ... ... ... 2 20 35 42 Cancer of the Female Genital Organs 5 4 3 1 3 5 ... 2 ... 9 (4) ... 23 ... 23 ... ... ... ... ... 3 13 7 43 Cancer of the Breast 3 5 5 3 3 5 3 ... ... 12 (3) ... 27 ... 27 ...... ... ......... ... ... 3 9 15 44 Cancer of the Skin 1 ... ... 1 1 ... ... ... ... 1 ... 3 2 1 ... ... ... ... ... ... 1 2 45 Cancer of other or unspecified Organs 3 13 5 7 6 5 2 4 ... 18(10) 1 45 26 19 ... ... ... 1 1 7 22 14 46 (A.B.C.) Other Tumours (situation undefined) (A) Angioma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Adenoma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other Tumours included under 46 ... ... ... ... ... ... 1 ... ... 1 ... 2 1 1 ... ... ... ... ... ... 2 ... 47 Rheumatic Fever 3 2 1 3 ... 2 1 ... ... 4 ... 12 5 7 ... ... 1 ... 2 1 3 2 48 (A.B.) Chronic Rheumatism, Osteo arthritis (A) Chronic Rheumatism ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 (B) Osteo arthritis ... 2 1 1 ... 2 ... 1 ... 3 (1) ... 9 3 6 ... ... ... ... ... 1 2 6 (C) Gout ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 49 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 Diabetes ... 4 1 3 3 4 1 1 ... 8 1 24 9 15 ... ... 1 ... 2 3 11 7 51 Exophthalmic Goitre ... ... 1 1 ... ... 1 ... ... 1 1 3 1 2 ... ... ... ... ... ... 3 ... 52 Addison's Disease ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 53 (A.B. Leucocythaemia, Lymphadenoma (A) Leucocythctmia (Leucaemia) ... 1 ... ... ... ... ... 2 ... 1 ... 3 3 ... 1 ... 1 ... ... 1 ... ... (B) Lymphadenoma ... 1 1 1 1 1 ... ... ... 3 ... 5 5 ... 1 ... ... ... 1 1 2 ... 22 23 54 Anaemia, Chlorosis ... ... 1 4 3 1 1 3 ... 4 ... 13 7 6 ... ... ... 1 2 3 4 3 55 (A.B C.D.) Other General Diseases (A) Diabetes Insipidus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Purpura ... ... ... 1 ... ... ... ... ... (1) ... 1 1 ... ... ... ... ... ... ... ... ... (C) Haemophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other Diseases included under 55 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 56 Alcoholism (acute or chronic) 1 1 ... ... ... ... ... ... ... 1 1 2 2 ... ... ... ... ... ... ... 2 ... 57 (A.B.) Chronic lead poisoning (A) Occupational lead poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (U) Non-occupational lead poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 58 Other chronic occupational poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 59 Other chronic poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... II.—Diseases of the Nervous System and of the Organs of Special Sense. 60 Encephalitis ... ... ... ... 1 1 ... ... ... 1 (1) 1 2 1 1 ... ... ... ... ... 1 1 ... 61 ( A) Cerebro spinal fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ......... ... 61 (B.C.) Meningitis, other forms or undefined (B) Posterior basal meningitis ... ... ... 2 ... 1 ... ... ... 2 ... 3 1 2 1 1 ... ... ... ... 1 ... (C) Meningitis, other forms 1 1 ... 2 ... 3 ... 1 ... 5(2) ... 8 5 3 1 1 1 2 ... 1 2 ... 62 Locomotor Ataxy 1 1 1 ... 1 ... 1 ... ... 2 ... 5 3 2 ... ... ... ... ... 1 3 1 63 (A.B.) Other diseases of the spinal cord (A) Diseases formerly classed to " Other nervous affections".. 1 1 ... 2 ... ... 1 ... ... 3(1) ... 5 3 2 ... ... ... ... ... ... 2 3 (B) Other diseases included under 63 3 1 ... 2 1 1 ... ... ... 2(1) ... 8 4 4 ... ... ... ... ... 1 3 4 64 (A.B.C.D.E.) Cerebral haemorrhage, Apoplexy (A) Apoplexy 2 1 1 ... 1 3 ... ... 1 2 ... 9 2 7 ... ... ... ... 1 ... ... 4 (B) Serous apoplexy and œdema of brain ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Cerebral congestion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Cerebral atheroma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Cerebral hæmorrhage 22 11 15 19 11 17 5 13 ... 36(21) 7 113 49 64 3 ... ... 1 ... 6 24 79 65 Softening of brain 2 3 ... 1 ... 1 ... ... ... 6(1) ... 7 7 ... ... ... ... ... ... 1 4 2 66 (A.B.C.) Paralysis without specified cause (A) Hemiplegia 1 3 1 4 ... ... ... 1 ... ... ... 10 3 7 ... ... ... ... ... ... 1 9 (B) Paraplegia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other forms of paralysis ... ... ... ... ... ... 1 ... ... 1 (1) ... 1 1 ... ... ... ... ... ... ... ... 1 24 TABLE III—continued. No. CAUSE. LOCALITIES. Institution & Street Deaths which could not, be distributed. Total Institution Deaths distributed and not distributed. Inquest Cases Total all Ages. Males all Ages. Females all Ages. 0-1. 1-2. 2-5. 5-15. 15-25. 25-45. 45-65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. 67 General paralysis of the insane 1 2 ... 2 ... ... ... ... ... 5 ... 5 4 1 ......... ... ... ... ... 2 3 ... 68 Other forms of mental alienation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 69 Epilepsy ... 1 5 1 ... 1 3 ... 1 ... 10 ... 12 4 8 ... ... 1 1 ... 2 4 1 70 (A.B. (Convulsions (non-puerperal; 5 yrs & over) (A) Epileptiform convulsions ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... (B) Others included under 70 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 71 (A.B.) Infantile convulsions (under 5 years) (A) Convulsions with teething ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... (B) Other infantile convulsions 3 ... 2 2 ... ... ... 4 ... 1 1 13 11 2 11 2 ... ... ... ... ... ... 72 Chorea ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... 1 ... ... ... ... 73 (A.B.) Hysteria, Neuralgia, Neuritis (A) Hysteria, Neuralgia, Sciatica ... ... ... ... ... 1 ... ... ... 1 ... 1 1 ... ... ... ... ... ... 1 ... ... (B) Neuritis 1 ... ... ... 1 ... 2 1 ... 1 ... 5 2 3 ... ... ... ... ... ... 1 4 74 (A.B.C.D.) Other diseases of the nervous system (A) Idiocy, Imbecility 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... (B) Cretinism ......... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... (C) Cerebral tumour 3 ... ... ... 2 ... ... ... ... 4 1 5 3 2 ... ... 1 ... ... 2 ... ... (D) Other diseases included under 74 2 ... ... ... 1 ... ... ... ... 4 (1) 1 6 1 5 ... ... ... ... ... 1 2 3 75 Diseases of the eyes and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 76 (A) Mastoid disease 1 ... ... ... 1 ... ... ......... ... 3(1) ... 4 3 1 1 ... ... 2 ... ... 1 ... 76 (B) Other diseases of the ears 1 ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... 1 ... ... ... III.—Diseases of the Circulatory System. 77 Pericarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 78 (A.B.C.) Acute endocarditis (A) Acute myocarditis ... ... ... 3 ... ... ... ... ... ... ... 3 1 2 ... ... ... ... ... ... 2 1 (B) Infective endocarditis ... ... ... ... 1 ... 1 ... ... 1 ... 2 2 ... ... ... ... ... ... 2 ... ... (C) Other acute endocarditis 2 4 ... ... 1 1 1 ... ... 3 ... 9 7 2 ... ... ... 4 1 3 1 ... 79 (A) Valvular disease 26 23 12 15 8 23 5 15 1 22(10) 18 128 57 71 ... ... 1 2 3 11 39 72 79 (B Fatty degeneration of the heart 4 3 ... 3 ..1 2 3 2 ... 1 13 18 6 12 ... ... ... 1 ...... 1 11 5 79 (C) Other organic disease of the heart 7 10 7 7 11 7 5 9 ... 8(8) 6 63 29 34 ... ... ... ... ... 4 13 46 80 Angina pectoris ... 3 ... ... 3 ... ... ... 1 2 6 3 3 ... ... ... ... ... ... 4 2 81 (A) Aneurysm 1 1 1 2 ... 3 ... ... (1) 4 8 8 ... ... ... ... ... ... ... 5 3 81 (B) Arterial sclerosis 18 34 10 18 8 21 14 6 1 80(48) 6 130 51 79 ... ... ... ... ... 1 13 116 81 (C) Other diseases of arteries 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 82 (A) Cerebral embolism and thrombosis 4 3 2 1 2 3 1 2 ... 2 (1) ... 18 6 12 ... ... ... ... ... 1 4 13 82 (B) Other embolism and thrombosis ... ... ... ... ... 1 ... ... (1) ... 1 1 ... ... ... ... ... ... 1 ... 83 (A.B.C.D) Diseases of the veins (Varices Haemoirhoids, Phlebitis, &c.) (A) Phlebitis ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 1 2 (B) Varix ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... (C) Pylephlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Varicocele ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 (A) Status lymphaticus 1 ... 2 ... ... ... 1 ... ... 3 3 4 3 1 ... ... 1 3 ... ... ... ... 84 (B) Other diseases of the lymphatic system 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 85 (A.B.C.) Haemorrhage ; other diseases of the circulatory system (A) Functional disease of the heart 1 1 ... ... ... 2 ... ... 1 ... 4 4 ... 1 ... ... ... ... ... ... 2 (B) Epistaxis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other diseases included under 85 ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... IV.—Diseases of the Respiratory System. 86 Diseases of the nasal fossae ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... 87 (A.B.C.) Diseases of the larynx (A) l aryngismus stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) I aryngitis ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... (C) Other diseases of larynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 88 Diseases of the thyroid body 1 ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... 1 ... 89 (A.B.) Bronchitis & (A) Bronchiectasis, Bronchial Catarrh, &c. ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... 90 (B) Other bronchitis 33 24 15 13 16 24 7 11 ... 33( 10) 5 143 68 75 16 3 ... 1 ... 5 31 87 91 Broncho-pneumonia 16 8 6 3 3 8 2 13 ... 7 (5) 9 59 27 32 29 10 2 4 ... 3 3 8 92 (A.B.) Lobar and undefined. (A) l obar pneumonia 4 6 4 7 5 8 r. 1 3 1 10 (3) 11 39 22 17 2 1 1 2 3 8 14 8 (B) Pneumonia (type not stated) ... 7 7 6 4 2 8 ... 6 ... 12 (4) 3 40 25 15 4 ... 2 1 2 6 14 11 25 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. 0-1. 1-2. 2-5. 5-15. 15-25. 25-45. 45-65. 65 and upwards. West. North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. 93 ( A. B.) Pleurisy (A) F.mpyema ... ... ... ... ... ... 1 ... ... 1 ... 1 1 ... ... ... ... 1 ... ... ... ... (H) Other pleurisy 3 3 ... ... 1 1 1 1 ::: 1 4 10 3 7 ... ... ... ... ... 1 5 4 94 A.B.C.D.) Pulmonary congestion, Pulmonary apoplexy (A) Pulmonary apoplexy and infarction ... ... ... ... ... ... ... ... ......... ... ... ... ... ... ... ... ... ... ... ... ... (B) Pulmonary oedema and congestion 2 ... 1 ... 1 ... ... ... ... ... 2 4 2 2 1 ... ... ... ... ... 2 1 (C) Hypostatic pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Collapse of lung (3 months and over) .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 95 Gangrene of the lung ... ... ... ... ... ... ... ......... ........ ... ... ... ... ... ... ... ... ... ... ... ... ... 96 Asthma 4 1 ... 3 ... 1 ... ... ... 1 ... 10 5 5 ... ... ... ... ... 2 3 5 97 Pulmonary emphysema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 98 (A) Fibroid disease of lung ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... 98 (B) Other diseases of the respiratory system 2 1 ... 1 1 1 ... ... ... 1 1 6 3 3 ... ... ... ... 1 1 2 2 V.—Diseases ej the Digestive System. 99 (A) Diseases of the teeth and gums ... 1 ... ... ... .... ... ... ... (1) ... 1 ... 1 ... ... ... ... ... ... 1 ... 99 (B C D.) Other diseases of the mouth and annexa (b) Thrush, Aphthous Stomatitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ......... (c) Parotitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (d) Other diseases included under 99 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 100 (A B.C.) Diseases of pharynx, Tonsillitis (A) Tonsillitis 1 ... 1 ... ... 2 ... ... ... ... 1 4 ... 4 ... ... 2 2 ... ... ... ... (B) Ludwig's angina ... ... 1 ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... 1 (C) Other diseases of the pharynx ... ... ... ...... 1 ... ... ... ... ... 1 ... 1 1 ... ... ... ... 1 ... ... ... ... 101 Diseases of oesophagus ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 102 Perforating ulcer of stomach 2 ... 2 1 1 1 ... ... ... 3(1) ... 7 2 5 ... ... ... ... ...... 1 4 2 27 103 (A ) Inflammation of stomach 7 1 ... 2 1 ... 1 6 ... 5 (3) ... 18 7 11 10 ... ... ... ... ... 1 7 103 (13) Other diseases of the stomach ... 1 ... ... ... ... ... 1 ... 1 ... 2 2 ... ... 1 ... ... ... ... 1 ... *104 (A B.C.D.E.F.G. H.) Diarrhoea and enteritis & (A) Infective enteritis 6 2 1 ... .1 1 2 ... ... 3 (1) 1 13 6 7 9 1 ... ... ... ... ... 3 105 (B) Diarrhœa—Not returned as infective 4 1 1 ... 1 1 2 ... ... 2 ... 10 9 1 8 1 ... ... ... ... ... 1 (C) Enteritis—Not returned as infective 8 3 3 1 2 3 3 ... ... 14(1) ... 23 9 14 14 1 ... ... ... 1 6 1 (D) Gastro-enteritis—Not returned as infective 3 ... 1 ... 2 5 1 1 ... 1 (1) ... 13 6 7 10 ... ... ... ... ... ... 3 (E) Dyspepsia, under 2 years ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... (F) Colic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (G) Ulceration of intestines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (H) Duodenal ulcer ... ... ... 1 ... ... 1 ... ... 1 ... 3 3 ... ... ... ... ... ... 2 1 ... 106 Ankylostomiasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 107 Other intestinal parasites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 108 Appendicitis 1 l ... 1 1 2 1 1 ... 8(7) ... 9 3 6 ... ... 3 1 2 2 1 ... 109 (A) Hernia 2 2 ... ... ... 2 ... ... ... 4 (2) ... 6 2 4 1 ... ... ... ... ... 3 2 109 (Bj Intestinal obstruction 2 2 ... 2 2 2 ... 2 ... 6(4) ... 12 7 5 1 ... ... ... ... 1 4 5 110 Other diseases of the intestines 1 ... ... ... ... 1 ... ... ... (1) ... 3 ... 3 1 ... ... ... ... 1 ... 1 111 Acute yellow atrophy of liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 112 Hydatid of liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 113 (A.B.C.) Cirrhosis of the liver (A) Cirrhosis of the liver (not returned as alcoholic) 2 3 1 2 ... 2 ... ... ... 2(4) ... 10 5 5 ... ... ... ... ... 3 5 2 (B) Cirrhosisof the liver (returned as alcoholic) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Diseases formerly classed to " Other diseases of liver and gall bladder'* ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 114 Biliary calculi 1 1 1 ... 1 1 ... ... ... 2 ... 5 1 4 ... ... ... ... ... ... 1 4 115 Other diseases of the liver 1 1 1 2 ... 2 ... ... ... 2(2) ... 7 6 1 ... ... ... ... ... 1 3 3 116 (A.B.) Diseases of the spleen (A) Infarction of spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (Bj Other diseases of the spleen ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 117 Peritonitis (cause unstated) ... 1 ... 1 ... ... ... ... ... 2 ... 2 1 1 ... ... 1 ... ... 1 ... ... 118 (A.B.) Other diseases of the digestive system (A) Abdominal abscess, Sub-phrenic abscess ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases included under 118 ... ... ... ... ... ... ... 1 ... 1 ... 1 1 ... ... ... ... ... ... ... 1 ... 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. F°males all Ages. 0-1. 1-2. 2-5. 5-15. 15-25. 25 45. 45-65. 65 and upwards. West North Central. East South. South Norwood. Upper Norwood. Thornton Heath. VI.—Non- Venereal Diseases of the Genitourinary System and Annexa. 119 Acute nephritis 1 3 1 2 ... 1 1 1 ... 5(2) ... 9 7 2 ... 1 ... 1 1 2 3 1 120 (A. 13.) Bricht's disease (A) Bright's disease as in 1901 list 10 6 2 9 9 3 ... 2 ... 7 (,3) 1 41 19 22 ... ... ... ... ... 4 17 20 1B; Nephritis (unqualified), 10 years and over and Ursemia 3 ... 5 ... 1 ... ... ... ... (2) ... 9 4 5 ... ... ... ... ... 2 4 3 121 Chyluria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 (A.B.C.D) Other diseases of the kidney and annexa (A) Abscess of kidney ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Cystic disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Suppression of urine ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other diseases included under 122 ... 2 1 ... ... ... ... ... ... (1) ... 3 2 1 ... ... ... ... ... ... ... 3 123 Calculi of the urinary passages ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 124 Diseases of the bladder 1 3 ... 1 1 1 ... ... 1 4 (4) ... 8 7 1 ... ... ... ... ... ... 3 5 125 (A.B.) Diseases of the urethra, Urinary abscess, &c. (A) Perineal abscess ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases of urethra, &c. ... ......... ......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Diseases of the prostate ... 1 ... ... 4 1 1 ... ... (1) ... 7 7 ... ... ... ... ... ... ... 3 4 127 Non-venereal diseases of male genital organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 (A.B.) Uterine haemorrhage (non-puerperal) (A) Menorrhagia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other uterine haemorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 129 Uterine tumour (non-cancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...•... ... ... ... ... ... ... ... 29 130 (A.B.) Other diseases of the uterus (A) Disorder of menstruation (except mer.orrhagia) ... ... ... ... ... ... ... ... ... ... ... ......... ... ... ... ... ... ... ... ... ... ... (B) Other diseases included under 130 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... 1 ... ... 131 Ovarian cyst, tumour (non-cancerous) ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 132 (A.B.) Other diseases of the female genital organs (A) Diseases of ovary (excluding ovarian tumour) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases included under 132 ... ... ... ... ... 1 ... 1 ... 2 ... 2 ... 2 ... ... ... ... ... 2 ... ... 133 Non-puerperal diseases of the breast (noncancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... VII. — The Puerperal State. 134 (A B.C. D. E.) Accidents of pregnancy (A) Abortion ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... (B) Haemorrhage of pregnancy ... ... ... ... ... ... ... 1 ... ... 1 1 ... 1 ... ... ... ... 1 ... ... ... (C). Uncontrollable vomiting ... ... ... ... ... ... ... ... ... ... ......... ... ... ... ... ... ... ... ... ... ... ... (D) Ectopic: gestation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Other accidents of pregnancy ... ... ... ... ... ......... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 135 Puerperal hæmorrhage 1 ... ... ... ... 1 ... ... ... 1 1 2 ... 2 ... ... ... ... ... 2 ... ... 136 Other accidents of childbirth ... ... ... ... ... ... 1 ... ... l ... 1 ... 1 ... ... ... ... ... 1 ... ... 137 Puerperal fever 1 1 1 ... ... ... ... 1 ... 4 ... 4 ... 4 ... ... ... ... 1 3 ... ... 138 (A.B.C'.) Puerperal albuminuria and convulsions (A) Puerperal nephritis and uraemia ... 1 ... ... ... ... 1 ... ... 2 ... 2 ... 2 ... ... ... ... ... 2 ... ... (B) Puerperal albuminuria & Bright's disease ... ... ... ... ... ... ... ... ... ... ......... ... ... ... ... ... ... ... ... ... ... (C) Puerperal convulsions 1 ... 1 ... 1 ... ... ... ... 2 ... 3 ... 3 ... ... ... ... 1 2 ... ... 139 (A.B.) Puerperal phlegmasia alba dolens, embolism, and sudden death - (A) Puerperal phlegmasia alba dolens, phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Puerperal embolism and sudden death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 140 Puerperal insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 141 Puerperal diseases of the breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30 TABLE III—continued. No. CAUSE. LOCALITIES. Institution & Street Deaths which could not be distributed. Total Institution Deaths 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. 1 j North. Central. East. South. South Norwood. Upper Norwood. Thornton Heath. VIII.—Diseases of the Skin and of the Cellular Tissue. 142 (A) Senile gangrene ... ... ... ... ... 2 ... ... ... 1 (3) ... 2 1 1 ... ... ... ... ... ... ... 2 142 (B C.D.) Gangrene, other types (13) Noma, Gangrene of mouth ... ... ... 1 ... ... ... ... ... 1 ... 1 1 ... ... ... 1 ... ... ... ... ... (C) Noma pudendi ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other gangrene ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 143 Carbuncle, Boil 1 ... ... ... ... 1 ... ... ... ... ... 2 2 ... ... ... ... ... ... ... 1 1 144 (A.B.)Phlegmon, acute abscess (A) Phlegmon l 1 ... ... ... ... ... ... ... 2 (2) ... 2 ... 2 ... ... ... ... ... ... ... 2 (B) Acute abscess ... ... ... ... ... 2 ... ... ... 2 (2) ... 2 1 1 ... ... ... 1 1 ... ... ... 145 (A. B.C. D.) Diseases of the integumentary system (A) Ulcer, Bedsore 1 1 ... ... ... ... ... ... ... 1 ... 2 1 1 ... ... ... ... ... ... 1 1 (B) Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Pemphigus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other disease of integumentary system ... ... 1 ... ... 1 ... ... ... 1 ... 2 2 ... 2 ... ... ... ... ... ... ... IX. — Diseases of the Bones and of the Organs of Locomotion. 146 Diseases of the bones 2 1 ... 1 1 1 1 ... ... 6 ... 7 4 3 ... ... ... 4 ... 1 1 1 147 Diseases of the joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 148 Amputations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Other diseases of locomotor system 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 X.—Malformations. 150 (A. B.C.D.) Congenital malformations (A) Congenital hydrocephalus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Phimosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Congenital malformation of heart 2 1 ... ... 1 ... ... 1 ... 2 ... 5 3 2 5 ... ... ... ... ... ... (D) Other congenital malformations ... ... ... ... ... ... 1 ... ... 1 ... 1 ... l 1 ... ... ... ... ... ... ... 31 XI.—Diseases of Early Infancy. 151 (A) Premature birth 12 11 5 4 4 3 I 7 ... 10 (4) 1 47 24 23 47 ... ... ... ... ... ... ... 151 (B.C.D.E.) Infantile debility, Icterus & Sclerema (B) [nfantile atrophy, debility and marasmus 8 3 4 6 9 1 7 4 ... 20(16) 2 42 24 18 42 ... ... ... ... ... ... (C) Icterus neonatorum 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... (D) Sclerema and oedema neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Want of breast milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 152 (A.B.C.D.) Other diseases peculiar to early infancy (A) Diseases of umbilicus, &c. ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... (P) Atelectasis 1 1 1 1 1 1 ... ... ... 3 ... 6 5. 1 6 ... ... ... ... ... ... ... (C) Injuries at birth ... 1 ... ... 1 ... ... ... ... (2) ... 2 2 ... 2 ... ... ... ... ... ... ... (D) Cyanosis neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 153 Lack of care ... 1 1 ... ... ... ... ... ... 1 2 2 1 1 2 ... ... ... ... ... ... ... XII.—Old Age. 154 (A.B ) Old age (A) Senile dementia 1 ... 1 ... 2 ... ... ... ... 2(1) ... 4 1 3 ... ... ... ... ... ... ... 4 (B) Senile decay 16 14 9 16 7 5 5 6 ... 8(11) 2 78 24 54 ... ... ... ... ... ... 1 77 XIII.—Affections produced by External Causes. 155 Suicide by poison ... 1 1 2 1 2 ... 1 ... ... 4 (1) 8 8 5 3 ... ... ... ... 1 2 5 ... 156 Suicide by asphyxia 2 ... 1 ... ... 1 ... ... ... (1) 4 4 2 2 ... ... ... ... 1 1 2 ... 157 Suicide by hanging or strangulation ... 1 ... 1 ... ... ... ... ... ... 1 5 5 4 1 ... ... ... ... 1 1 3 ... 158 Suicide by drowning ... ... 1 1 ... 1 1 ... ... 4 4 4 4 ... ... ... ... ... ... 4 ... ... 159 Suicide by firearms ... ... ... ... ... 2 ... ... ... ... ... 2 2 ... ... ... ... ... ... ... 1 ... 160 Suicide by cutting and piercing instruments ... 1 ... ... ... 2 ... ... ... 4 6 6 6 ... ... ... ... ... ... 1 5 ... 161 Suicide by jumping from high place ... ... ... ... ... ... ... ... ... ... (1) ... ... ... ... ... ... ... ... ... ... ... ... 162 Suicide by crushing ... ... ... ... ... 1 ... ... ... 1 (1) 1 1 1 ... ... ... ...... ... 1 ... • •• 163 Other suicides ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 164 Poisoning by food ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 165 Other acute poisonings ... 1 ... ... ... 1 ... ... ... 2 2 2 2 ... ... ... 1 ... 1 ... ... 166 Conflagration ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 167 Burns (conflagration excepted) 1 ... ... 1 ... 1 ... ... ... 2(2) 3 3 2 1 1 ... 1 1 ...... ... ... 168 Absorption of deleterious gases (conflagration excepted) ... ... ... 1 ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... 1 ... ... 169 Accidental drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 170 Injury by firearms . ... ... .......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 171 Injury by cutting or piercing instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ......... ... ... ... ... ... ... ... ...+ 32 TABLE III —continued No. CAUSE LOCALITIES. Institution & Street Deaths which could not be distributed. Total Institution Deaths distributed and not distributed. Inquest Cases. Total all Ages. Males all Ages. Females all Ages. 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 4 1 1 ... ... 1 ... ... ... 2(1) 7 7 3 4 ... ... ... ... ... 1 2 4 173 Injury in mines and quarries ......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 174 Injury by machines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ......... ... ... ... 175 Injury by other crushing (vehicles, railways, landslides, &c.) 3 2 1 2 ... 2 1 1 ... 6(8) 12 12 10 2 ... ... 2 3 1 2 3 1 176 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) ... ... ... ... ... ... 1 ... ... 1(2) 1 1 1 ... ... ... ... ... ... 1 ... ... 186 Other violence ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... XIV.—Ill-Defined Causes. 187 Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 188 (A) Syncope (aged 1 year and under 70) 1 ... ... ... 1 ... ... ... ... ... 1 2 ... 2 ... ... ... ... 1 ... 1 ... 188 (B) Sudden death (not otherwise defined) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 189 (A) Heart failure (aged 1 year and under 70) 1 1 ... ... 3 ... 1 2 ... 3 ... 8 3 5 ... ... ... ... ... ... 4 4 189 (B.C.D E.) Other ill-defined causes (B) Atrophy, debility, marasmus (aged 1 year and under 7oj ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 (C) Teething ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Other ill-defined deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 189 (F) Cause not specified 1 ... 1 ... ... ... ... ... ... ... 1 2 ... 2 ... 1 ... ... ... ... 1 ... Totals 395 349 225 248 222 305 126 176 8 658(283) 180 2054 979 1075 269 41 40 78 95 228 496 809 The total Institution Deaths include those of strangers occurring within the Borough. Deaths of such strangers occurring at the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Purley Cottage Hospital, Norwood Cottage Hospital, and 99, Central Hill (Servants' Reformatory), are excluded from all other columns of the Table. The numbers so excluded are in brackets. 33 TABLE III A. DEATHS FROM INFLUENZA AND CERTAIN OTHER CONDITIONS 1921. Week Ending Influenza. Pneumonia. BronchoPneumonia. Phthisis. Other Reip. Diseases. Cerebrospinal Fever. Measles. Whooping Couirh. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. January 8 1 2 2 2 .2 1 ... ... 2 3 ... ... ... ... 1 ... „ 15 1 2 ... 1 2 ... ... 1 1 ... ... ... ... ... ... ... „ 22 ... ... ... ... 3 ... 1 ... 1 3 ... ... ... ... ... „ 29 ... ... 2 ... 2 1 ... 1 ... 2 ... ... ... ... 1 ... February 5 ... ... 2 ... ... 1 ... 1 1 1 ... ... ... ... ... ... „ 12 ... ... 2 1 ... 3 ... ... 1 1 ... ... ... ... 1 ... „ 19 ... ... 2 ... 1 2 1 1 4 6 ... ... ... ... 1 1 „ 26 1 1 ... 1 2 2 2 ... 3 2 ... ... ... ... 1 1 March 5 1 1 3 ... ... 1 ... ... 4 2 ... ... ... ... ... 1 „ 12 1 2 ... ... 1 2 ... 1 3 5 ... ... ... ... ... 1 „ 19 1 ... 1 1 ... 1 ... ... 5 7 ... ... ... ... ... 2 „ 26 1 2 ... ... 1 ... ... ... 3 1 ... ... ... ... ... ... April 2 1 ... ... 1 2 ... ... ... 2 3 ... ... ... ... ... ... „ 9 1 2 ... ... ... 2 ... ... ... 2 ... ... ... 1 1 1 „ 16 ... ... 1 ... ... 2 ... ... 1 2 ... ... ... 1 ... ... „ 23 ... ... 1 1 ... 1 ... ... 4 ... ... ... ... ... 1 ... „ 30 ... ... 1 1 ... 1 ... 1 3 ... ... ...... ... ... 1 Mav 7 2 1 ... 1 ... 1 1 ... 1 1 ... ... ... ... ... ... „ 14 ... 1 ... ... ... 1 1 ... 2 3 ... ... ... ... ... ... „ 21 ... ... ... ... ... 2 ... ... ... 1 ... ... ... ... ... ... „ 28 ... ... 1 ... ... ... ... ... ... 2 ... ... ... ... ... 2 June 4 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... „ 11 ... ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... „ 18 ... ... ... 1 ... ... ... ... 1 2 ... ... ... ... ... ... „ 25 1 ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... 1 TABLE IIIa.—Continutd. 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 2 1 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... „ 9 ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... „ 16 ... ... ... 1 ... 1 ... ... ... 2 ... ... ... ... ... ... „ 23 ... ... ... 2 2 1 ... ... 1 ... ... ... ... ... ... ... „ 30 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... August 6 ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... „ 13 ... ... ... ... 1 ... 1 ... 1 1 ... ... ... ... ... ... „ 20 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... „ 27 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... September 3 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... „ 10 ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... „ 17 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... „ 24 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... October 1 ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... „ 8 ... ... ... 2 1 ... ... ... 1 2 ... ... ... ... ... ... „ 16 ... ... 1 1 ... ... ... 1 2 ... ... ... ... ... ... ... „ 22 ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... „ 29 ... ... ... ... 1 ... ... 1 2 3 ... ... ... ... ... ... November 5 ... ... ... ... ... ... ... ... 3 1 ... ... ... ... ... ... „ 12 ... ... ... ... 1 ... ... 1 1 2 ... ... ... ... ... ... „ 19 ... 1 ... ... 1 ... ... ... 3 1 ... ... ... ... ... ... „ 26 ... ... 3 1 ... ... ... ... 2 6 ... ... ... ... ... December 3 ... 1 1 ... ... ... ... ... 4 6 ... ... ... ... ... ... „ 10 ... 1 4 1 ... 1 ... ... 2 3 ... ... ... ... ... ... „ 17 ... ... 3 2 1 1 ... ... 2 4 ... ... ... ... ... ... „ 24 ... ... 3 1 ... ... ... ...... 4 3 ... ... 1 1 1 ... „ 31 ... 3 2 1 1 2 4 ... 1 2 ... ... ... ... ... ... 18 21 47 32 27 32 15 17 80 89 ... ... 3 3 11 11 03 35 36 TABLE IV. County Borough of Croydon— Whole Borough. INFANT MORTALITY. 1921. 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 61 19 8 31 119 47 42 35 26 269 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... 1 ... 1 1 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... 3 3 5 ... 5 1 14 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... 2 2 ... ... ... ... 2 Tuberculous Meningitis ... ... ... ... ... 1 1 1 ... 3 Abdominal Tuberculosis ... ... ... ... ... ... ... 2 ... 2 Other Tuberculous Diseases ... ... ... ... ... ... 2 ... ... 2 Meningitis (not Tuberculous) ... ... ... ... ... 1 ... ... 1 2 Convulsions 3 5 ... ... 8 1 1 ... 1 11 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 ... 2 3 3 5 2 3 16 Pneumonia (all forms) 2 1 ... 5 8 10 6 2 9 35 Diarrhoea ... ...... ... 1 1 1 4 3 1 10 Enteritis and Gastro Enteritis ... 1 2 4 7 6 8 7 3 31 Gastritis ... ... ... 2 2 2 4 2 ... 10 Syphilis ... 1 ... ... 1 ... 1 1 ... 3 Rickets ... ... ... ... ... ... ... ... 1 1 Suffocation, overlying ... ... ... ... ... ... ... ... ... Injury at Birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 6 ... ... ... 6 ... ... ... ... 6 Congenital Malformations ... ... ... 1 1 4 ... ... 1 6 Premature Birth 39 6 1 1 47 ... ... ... ... 47 Atrophy, Debility and Marasmus ... 4 2 2 7 15 12 6 7 2 42 Other causes ... 5 2 3 3 13 4 2 2 21 61 19 8 31 119 47 42 35 26 269 legitimate 3530. legitimate infants, 250 Births in the year Nett Deaths in the year of illegitimate 183. illegitimate infants 19. 37 TABLE IV.—Continued. County Borough of Croydon—West Ward. INFANT MORTALITY. 1921. 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 Weeke. Total under 1 Month. 1-3 Monthe. 3-6 Monthe. 6-9 Monthe. 9-12 Monthe. Total Deaths Under 1 Year. All Causes. Certified 16 4 1 9 30 9 14 10 7 70 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... 1 ... ... ... 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 ... ... 1 2 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... 1 1 ... .. ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... 1 ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... 1 ... ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 2 ... ... ... 2 ... ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ......... ... ... Bronchitis ... 1 ... 1 2 ... 2 ... ... 4 Pneumonia all forms) ... 1 ... 1 2 3 2 ... 3 10 Diarrhœa ... ... ... ... ... 1 2 2 1 6 Enteritis and Gastro Enteritis ... ... ... 3 3 1 2 1 1 8 Gastritis ... ... ... ... ... ... 3 1 ... 4 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... ... ... 1 1 1 ... ... ... 2 Premature Birth 12 ... ... ... 12 ... ... ... ... 12 Atrophy, Debility and Marasmus ... 1 1 1 1 4 1 1 2 1 9 Other causes ... 1 ... 1 2 ... 1 1 ... 4 16 4 1 9 30 9 14 10 7 70 Births in the year legitimate, 1032. illegitimate, 39. Nett Deaths in the year legitimate infants, 89. illegitimate infants, 1. 38 TABLE IV. — Continued. County Borough of Croydon — North Hard. INFANT MORTALITY. 1921. Nett Deaths from stated causes at various Ages under One Year of Age CAUSES OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under 1 Year. All Causes Certified 12 4 ... 7 23 2 5 5 5 40 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... 3 3 ... ... ... ... 3 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... 1 ... ... 1 ... ... ... 1 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 1 1 ... 1 1 ... 3 Pneumonia (all forms) ... ... ... 1 1 1 1 2 1 6 Diarrhœa ... ... ... ... ... ... 1 1 ... 2 Enteritis and Castro Enteritis ... 1 ... ... 1 ... 1 ... ... 2 Gastritis ... ... ... 1 1 ... ... ... ... 1 Syphilis ... ... ... ... ... ... ... 1 ... 1 Rickets ... ... ... ... ... ... ... ... 1 1 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... ... ... ... ... 1 ... ... 1 2 Premature Birth 7 2 ... 1 10 ... ... ... ... 10 Atrophy, Debility and Marasmus 2 ... ... ... 2 ... l ... ... 3 Other causes 1 ... ... ... 1 ... ... ... 1 2 12 4 ... 1 23 2 5 5 5 40 (legitimate 579. Nett Deaths in the year illegitimate 75. legitimate infants 35. illegitimate infants 5. 39 TABLE IV.— Continued County Borough of Croydon—CentraI Ward. INFANT MORTALITY 1923. Nett Deaths from stated causes at various Ages under One Year of Age. CAUSES OF DEATH. Under 1 Week. 1-3 Weeks. , 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Month*. Total Deaths Under One Year- All Causes. Certified ... 6 1 1 3 11 4 4 4 3 26 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... 1 ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... 1 1 ... ... ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... . . . Other Tuberculous Diseases ... ... ... ... ... ... 1 ... ... 1 Meningitis (not Tuberculoids) ... ... ... ... ... ... ... ... ...... ... Convulsions ... ... ... ... ... ... 1 ... ... 1 LaryngitiS ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... 1 1 ... 1 ... 2 4 Diarrhœa ... ... ... 1 1 ... ... ... ... 1 Enteritis and Gastric Enteritis ... ... ... ... ... 2 1 1 ... 4 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 1 ... ... ... 1 ... ... ......... ... 1 Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth 4 1 ... ... 5 ... ... ... ... 5 Atrophy, Debility and Marasmus ... ... ... ... ... 2 ... 1 1 4 Other causes 1 ... 1 ... 2 ... ... 1 ... 3 6 1 1 3 11 4 4 4 3 26 ( legitimate, 269. I legitimate infants, 24. Births in the year-! Nett Deaths in the year -J \ illegitimate, 10. ( illegitimate infants, 2. 40 TABLE IV.— Continued. County Borough o1 Croydon—East Ward. INFANT MORTALITY. 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 x Year. All Causes. Certified 6 3 2 1 12 6 2 ... 3 23 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... V\ hooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ......... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... 1 ... ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (no/ Tuberculous) ... ... ... ... ... 1 ... ... 1 2 Convulsions ... ... ... ... 1 ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ...... ... Bronchitis ... ... ... ... ... 1 ... ... ... 3 Pneumonia (all forms) ... ... ... ... ... 1 ... ... ... 1 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis and Gastro-Enteritis ... ... 1 ... 1 1 ... ... ... 2 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth 3 1 ... ... 4 ... ... ... ... 4 Atrophy, Debility and Marasmus ... ... 1 1 1 3 2 1 ... ... 6 Other causes 2 ... ... ... 2 ... ... ... ... 2 6 3 2 1 12 6 2 ... 3 23 legitimate, 306. Births in the year illegitimate, 7. Legitinate infants, 23. illegitimate infants, 41 TABLE IV.—Continued. County Borough of Croydon—South Ward. INFANT MORTALITY. 1921. 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 Monthe. 6-9 Months. 9-12 Monthe. Total Deaths Under 1 Year. All Causes. Certified 6 1 ... 4 11 9 6 1 ... 28 Uncertified ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ...... ... ... ... ... 3 ... ... ... 3 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (;/<?/ Tuberculous) ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... 2 2 ... ... ... ... 2 Diarrhœa ... ... ... ... ... 1 ... ... 1 Enteritis and Gasiro Enteritis ... ... ... ... 1 1 ... ... 2 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... 1 ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying .. ... ... ... ... ... ... ... ... ... ... Injury at birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 1 ... ... ... 1 ... ... ... ... l Congenital Malformations ... ... ... ... ... 1 ... ... ... l Premature Birth 4 ... ... ... 4 ... ... ... ... 4 Atrophy, Debility, and Marasmus ... ... ... 2 2 4 2 l ... 9 Other causes ... 1 ... ... 1 ... 1 ... 1 3 6 1 ... 4 11 9 6 l 1 28 legitimate. 367. legitimate infants, 24. Births in the year Nett Deaths in 'he year illegitimate, 15 illegitimate infants, 4. 42 TABLE IV.—Continued. County Borough of Croydon—South Norwood. INFANT MORTALITY. 1921. Nett Deaths from stated Causes at various Ages under One Year of Age. CAUSFS OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths Under 1 Year. All Causes Certified 4 1 3 l 9 6 5 8 4 32 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ...... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 ... 2 ... 8 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... 1 ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... 1 ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 2 1 1 4 Pneumonia (all forms) ... ... ... ... ... 2 ... ... 1 3 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis and Gastro Enteritis ... ... ... 1 1 1 2 4 1 9 Gastritis ... ... ... ... ... 1 ... ... ... 1 Syphilis ... 1 ... ... 1 ... ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... ... ... ... ... ... ... ... ... ... Premature Birth 2 ... ... ... 3 ... ... ... ... 3 Atrophy, Debility and Marasmus 1 ... ... ... 1 ... ... ... ... 1 Other causes ... ... 2 ... 2 ... 1 ... ... 3 4 1 3 l 9 6 5 8 4 32 l legitimate, 463. I legitimate infants, 31. Births in the yeaM Nett Deaths in the year -j ( illegitimate, 21. ( illegitimate infants, ]. 43 TABLE IV.— Continued. Count> Borough of Croydon—Upper Norwood. INFANT MORTALITY. 1921. Nett Deaths from stated Causes at varous 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 1 ... ... 3 5 5 3 4 ... 17 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ...... ... ... Chicken-pox ... ... ... ... ...... ... ... ... ...... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... 1 ... 1 Diphtheria and Croup ... ... ... ... ... ... ...... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tubeiculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... ... ... \ Pneumonia (all forms) ... ... ... ... ... 1 ... ... ... 1 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteiitis and Gastro Enteritis ... ... 1 ... 1 ... 1 1 ... 3 Gastritis ... ... ... ... ... ... 1 ... ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying . ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... ... ... ... ... ... ... ... ... ... Prematuie Birth 1 ... ... ... 1 ... ... ... ... 1 Atrophy, Debility, and Marasmus ... ... ... 2 2 3 i 2 ... 8 Other causes ... ... ... 1 1 ... ... ... ... 1 1 ... 1 3 5 5 3 4 ... 17 ( legitimate, 147. f legitimate infants, 13. Births in the year j Nett Deaths in the year j ( illegitimate, 7. I illegitimate infants, 4. 44 TABLE IV.— Continued. County Borough of Croydon—Thornton Heath. INFANT MORTALITY. 1921. Nett Deaths from statod 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 10 5 ... 3 18 6 2 3 4 33 Uncertified ... ... ... ... ... ... ... ... ... ...... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet fever ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ......... ... ... ... 1 ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... 1 ... ... ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous') ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 4 ... ... ... ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... ... ... 1 Pneumonia (all forms) 2 ... ... ... 2 2 2 ... 2 8 Diarrhoea ... ... ... ... ... ... ... ... ... ... Enteritis and Gastro Enteritis ... ... ... ... ... ... ... ... 1 1 Gastritis ... ... ... 1 1 1 ... 1 ... 3 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... ... ... ... ... 1 ... ... ... 1 Premature Birth 6 2 ... ... 8 ... ... ... ... 8 Atrophy, Debility and Marasmus ... ... ... 1 1 ... ... 1 ... 2 Other causes 1 ... ... 1 2 ... ... ... 1 3 10 5 ... 3 18 6 2 3 4 33 legitimate, 307. legitimate infants 31. Births in the year Nett Deaths in the year illegitimate, 9. illegitimate infants, 2. 45 Chart shewing Infant Mortality Rate for Croydon compared with the rate for England and Wales. Dotted lines indicate England and Wales. Black „ „ CROYDON. Infantile Mortality is measured by the proportion of deaths under one year to one thousand births 46 TABLE V. Table showing the number of cases notified and deaths from the principal zymotic diseases for the Year 1921 and ten preceding Years. Disease. 1921. 1920. 1919. 1918. 1917. 1916. 1915. 1914. 1918. 1912. 1911. 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 1 3 3 3 4 .. 25 1 18 .. 29 1 24 9 .. .. .. .. .. .. .. .. Poliomyelitis 6 2 1 1 2 .. .. .. 1 .. 2 .. 4 1 .. .. .. .. .. .. .. .. Small Pox .. .. .. .. 9 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 855 4 638 7 603 11 414 6 191 2 297 4 414 5 748 5 470 3 476 2 468 7 Diphtheria and (1) Memb.Croup 483 23 558 26 429 36 179 2 191 9 312 4 195 14 226 18 451 16 767 25 514 37 (2) Erysipelas 13 4 74 3 61 2 44 3 56 3 52 1 82 3 96 7 107 6 84 « 79 5 Puerperal Fever 8 4 14 6 4 3 4 3 3 1 7 1 12 5 9 3 6 4 10 3 12 4 Enteric Fever 10 1 12 4 5 .. 15 2 6 13 .. 22 3 20 5 32 6 32 7 24 7 Simple Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis (3) 573 184 480 195 440 217 378 204 397 157 326 223 550 238 503 192 519 202 312 140 240 165 Non-notifiable. Measles (4) .. 6 .. 22 .. .. 1057 2 2944 29 462 .. .. 108 .. 8 .. 58 .. 31 .. 29 Rubella .. ...... .. .. .. .. 93 .. 2439 .. 636 .. .. .. .. .. .. .. .. .. .. .. Diarrh6a and Enteritis .. 59 .. 36 .. 24 .. 48 .. 41 .. 50 .. 62 .. 67 .. 85 .. 58 .. 147 Whooping Cough .. 22 .. 2 .. 1 .. 10 .. 9 .. 27 .. 12 .. 24 .. 23 .. 13 .. 38 Influenza .. 39 .. 43 .. 139 .. 478 .. 20 .. 46 .. 45 .. 15 .. 26 .. 18 .. 14 Broncnitis, Pneumonia, and Pleurisy 66 292 § .. 335 185† 353‡ .. 362 .. 302 .. 329 .. 399 .. 313 .. 297 .. 250 .. 280 (1) Notifiable since May, 1897. (2) Notifiable since January, 1900. (3) Voluntary Notification, 1903-09. Poor Law Cases, Compalsorily 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 143, Broncho-Pneumonia 59, Pneumonia 79, Pleurisy 11=292. In the above Table deaths of Non-residents occurring at the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Norwood Cottage Hospital, Purley Cottage Hospital, 99, Central Hill (Servants Reformatory) etc., are excluded. Prior to 1903 correction was only made for the first three institutions. 47 TABLE VI.—Vital Statistics of separate Wards in 1921 and previous years. Names or Localities. 1. North Ward. 2. West Ward 3. Central Ward. 4. East Ward. 5. South Ward 6. South Norwood Ward. 7- Upper Norwood Sub-Division. 8. Thorntok Heath Sub-Division. 9. Undistributed Institution Births and Deaths. YEAR Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 Year] Population estimate 1 to middle of each year. Births Registered, Deaths at all ages. Deaths under 1 Year. Population estimated to middle of each year. Births Registered Deaths at all ages. Deaths under 1 Year. Population estimated to middle of each year. Births Registered, Deaths at all ages, Deaths under 1 Year. Population estimated to middle of each year. Births Registered. Deaths at all ages. Deaths under 1 Year.! Population estimated to middle of each year. | Births Registered. Deaths at all ages. Deaths under 1 Year. Population estimated to middle of each year. Births Registered. Deaths at all ages. Deaths under 1 Year, Population estimated to middle of each year. Births Registered. Deaths at a1! ages. Deaths under 1 Year. Population estimated to middle of each year. Births Registered. | Deaths at all ages. Deaths under 1 Year a b c d a b c d a b c d a b c d a b c d a b c d a b c d a b c d b c d 1911 29,701 091 275 54 33,592 800 473 107 16,167 295 199 32 20,175 377 217 42 18.998 360 209 42 25,609 572 325 65 8,128 112 105 10 18,081 430 190 43 111 29 2 1019 30,450 683 273 46 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 18,527 416 174 35 140 34 ... 1013 31,117 781 349 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 98 8 18,982 425 182 37 107 21 ... 1914 31,869 729 302 45 37,302 841 490 95 16.021 290 175 27 21,837 468 214 32 19,690 353 218 28 27.498 628 304 42 8,298 109 101 10 19,441 496 159 40 113 21 ... 1916 30,693 869 451 52 36.276 844 553 82 16 985 264 236 25 21,236 447 254 31 19,148 308 248 29 26,732 659 348 43 8,069 144 99 7 18,906 385 208 38 79 18 ... 1916 30,659 729 550 44 35,935 769 488 97 15,949 246 182 14 21,041 458 203 29 18,970 309 190 19 26.485 589 245 33 7,905 112 115 9 18,731 377 168 36 61 19 ... 1917 32 810 656 597 56 38,406 634 468 65 16,036 197 186 23 22,515 367 212 22 10,276 248 172 23 28,292 451 252 22 8,664 81 94 4 20,019 312 182 34 68 44 .. 1918 29,562 516 666 42 34,604 704 582 57 14,449 206 200 13 20,340 303 298 30 18,268 232 211 17 25,492 349 292 19 7,717 84 118 3 18.030 239 172 21 66 6 ... 1919 32,330 570 382 35 37,845 850 444 60 15,802 239 203 20 22,245 281 272 30 19,979 250 236 24 27.879 439 303 25 8,440 110 116 8 19,719 269 197 17 80 19 .. 1920 33,618 665 349 45 39,353 1259 452 71 16,432 327 215 20 23,132 410 224 16 20,775 372 257 33 28,990 669 330 45 8.776 201 122 16 20,504 447 168 29 84 17 .. Averages of Years 1911 to 1920. 31,311 659 419 49 36 470 833 484 81 15,903 269 200 24 21,459 392 232 30 19,444 314 218 28 27,005 643 300 39 8,220 120 107 9 19,094 380 179 33 91 23 0.2 1021 33,604 550 349 40 39,337 1071 395 70 16,425 279 225 26 23,122 373 248 23 20,766 382 222 28 28.978 484 305 32 8.772 154 126 17 20,496 316 176 33 104 8 .. NOTES.—Deaths of residents occurring beyond the district are included in sub-columns C of this table, and those of non-residents occurring at the Workhouse, Workhouse Infirmary, Borough Hospital, General Hospital, Norwood Cottage Hospital, Purley Cottage Hospital, and 99, Central Hill (Servants' Reformatory) are excluded. Deaths of residents occurring in Public Institutions are allotted to the respective localities, according to the addresses of the deceased, and all deaths of Croydon residents whose exact home could not be ascertained, are included in Blook 9. 48 TABLE VII. METEOROLOGICAL RECORD—YEAR 1921. 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 ground level. Months 19.21. Temperature of Air during 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 at 9 p.m. and 3 p.m. Rainfall- Highest. Lowest. Mean of No. of Days on which Rain fell. Amount collected in Inches. Difference from average 90 years at Greenwich AU Highest. All Lowest. ! January 67° 29° 50°.1 41° 2 45°.8 + 7°.1 45°.6 45°.0 in -.006 18 in. 1.68 in. -0.11 February 62° 26° 47°.8 34°.3 41°.0 + 1°.6 43°.9 40°.0 -.040 5 0.12 -.1.41 March 69° 28° 53°.9 37°.6 45°.7 + 4°.0 41°.7 45°.6 +.010 13 1.14 - 0.37 April 74° 29° 59°.1 38°.1 48°.6 + l°.2 47°.0 48°.1 +.013 10 1.41 -.0.19 May 80° 35° 66°.0 45° 0 55° 5 + 2°.3 51°.0 55°.3 +.063 14 1.30 - 0.58 June 86° 38° 71°8 49°.4 60°.6 + 1°.1 55°.7 59°.7 + .068 3 0.14 -1.89 July 93° 46° 80° 5 55° 9 68° 2 + 5°.6 60°.6 67°.0 +.132 2 0.09 -2.32 August 82° 42° 71°.0 53°.9 62°.4 +0°.8 61°.3 61°.8 + .009 10 1.08 -1.30 September 85° 38° 70° 2 48°.7 59°.4 + 2°.4 59°.1 59°.4 +.006 7 1.47 -0.73 October 82° 31° 66°.5 46°.8 56°.6 + 7°.2 55°.6 55°.7 +.001 7 0.57 -21.6 November 58° 21° 45°.1 32°.3 38°.7 -4°.7 48°.8 38°.7 -.110 9 1.85 -0.44 December 58° 29° 49°.3 39°.1 44°.2 + 4°.5 45°.7 41°.3 -.047 15 1.04 -0.90 Means and Totals for Year. 93° 21° 60°.9 43°.5 52°.2 + 2°.7 51°.5 51°.4 +.008 113 11.95 -12.40 The Rainlall for the Year 1921 was 14 38 inches below the average of 50 years at Croydon, and the number of days on which rain fell was 49 below the average. H. CORDEN, Croydon. 49 TABLE VIIA. Prevailing direetion of the Wind at Croydon in 1921. Number of Days each Month. 1921. N.E E. S.E. S. S.W. W. N.W. N. January ... ... ... 2 20 7 2 ... February 4 5 4 4 ... 4 5 2 March ... ... ... 7 14 8 1 1 April 5 7 1 1 3 4 4 5 May 6 2 2 4 9 3 3 2 June 11 3 ... ... 1 7 7 1 July 3 5 2 3 13 1 2 9 August 3 1 ... 3 14 7 2 1 September 3 7 2 2 6 5 5 ... October ... ... 5 7 6 3 8 2 November 2 9 8 2 4 2 3 ... December 2 2 ... 3 13 8 3 ... Totals 39 41 24 38 103 59 45 16 80 62 162 61 The 10 years average 1867 to 1870, as embodied in Paper on 10 years Meteorology at Croydon, read to the Croydon Microscopical and Natural History Club, was:— N.E. and E. Winds, yearly average 93 7 S.E. and S. „ „ 63.7 S.W. and W. „ „ „ 131.9 N.W. and W. „ „ 73.8 H. CORDEN, Croydon. 50 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 74 in 1921, as compared with 63 in 1920, 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 11)11, 87 in 1910, 79 in 1909, 99 in 1908. During the year of 1921 the rate for England and Wales was 83, while in the 96 large towns it was 87, and in the 148 smaller towns 84, and in London 80. The figures for the various Wards were:— Births Deaths under 1 rear. Death-rate per 1000 Births (all causes). Death-rate per 1000 births from ' diarrhœal' diseases. Upper Norwood Sub-division 154 17 110 19 North Ward 654 40 61 6 Thornton Heath Sub-division 316 33 104 3 East Ward 373 23 61 5 Borough 3713 269 74 11 Central Ward 279 26 93 18 South Ward 382 28 73 6 West Ward 1071 70 65 13 South Norwood Ward 484 32 66 18 The following table shows the fluctuations since 1892 in the infantile mortality from "all causes,"from" diarrhœal diseases," and from "causes other than diarrhœal." Years. Total Infantile Mortality from all causes. Infantile Molality from ''diarrhœal" diseases Infantile Mortality from other than " diarrhœal" 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 1921 74 11 63 51 INFANT CENTRES. The total number of infants seen at the Municipal Infant Centre in the year 1921 has been:— New Cases 471 Total Attendances 4931 The other nine centres which are in part conducted by the Voluntary Association have to some extent .suffered in their attendances throughout the year from various causes. It is satisfactory to note, however, that the numbers are again on the increase. The subjoined table gives details of the attendances at the Centres. The work of maternity and child welfare is coming to be considerably hampered by the excessive amount of visiting and clerical work devolving upon the health visitors in connection with domestic enquiry circumstances. This part of the milk and food grants section of the work is to a very large extent waste time in that the people who are carrying it out are trained specifically for their professional work and the professional side of their activities is very seriously hampered by the repeated and prolonged visits which have to be made to obtain purely automatic returns of family income, etc. It has been difficult, indeed, at times to keep the visits and re-visits to new births properly up to date in consequence of the amount of work which milk distribution has entailed in this way. Foster Children. During 1921 special arrangements were made with the Guardians that foster children should be seen at least once a quarter at the centres. These quarterly special clinics for foster children have worked admirably and not only have the children been seen there, but the good relationships so established have resulted in many of the foster children being brought regularly to the weekly meetings of the centres. Massage Clinic. This is held three times weekly, and is still insufficient to cover the number of cases requiring such treatment. Voluntary Association. The Croydon Mothers and Infants Welfare Association has done some very good pioneer work in the town in providing, for a limited number of cases, convalescent treatment after illness, and in also providing help for cases of illegitimate children and their mothers. Provision of Fresh Milk at the Centres. The provfsion of milk was restricted during 1921 in accordance with the requirements laid down by the Ministry. The following statement shews the main details, viz.:— 52 MILK SUPPLIED TO MOTHERS AND INFANTS. Supplied to Families. No. of Quarts. Received from Families. Corporation Liability. TOTALS, £ s. d. £ s. d. £ s. d. Milk at 3d 14308¼ 178 17 2¼ 380 6 1¼ 559 3 3½ Milk at 6d 3350¾ 83 15 4½ 48 7 1¾ 132 2 6½ Milk Free 18561 - 717 8 2¼ 717 8 2¼ Total number of Quarts supplied 36220 262 12 6¾ 1146 1 5¼ 1408 14 0 Total Number of Families 473. Average supplied to each family, 76 57 quarts. Average cost of supply to each family, £2 19s. 6¾d Maternity Hostel. St. Mary's Maternity Hostel continues to do most excellent work. The general arrangements are the same as last year. 331 births occurred in the institution in 1921, as against 326 in 1920. The number of cases refused admission continues to be large enough to run a Hostel more than twice the size of the existing one. The following table gives the returns of the cases dealt with. Women admitted. Confinements. Births. Women Discharged. Total. Normal. Com plicated. Total. Alive. Stillborn. Nonviable. 346 323 223 100 331 323 8 - 347 EXPLANATORY NOTES. 1 maternal death during the year. Twins born on eight occasions. Ccesarean section performed in 2 cases. 14 women were in Hostel on 1st January, 1922. 16 women were in Hostel on 31st December, 1920 Ante-Natal Clinic. The meetings of this clinic have been increased to twice weekly as the rush of work could not be overtaken otherwise. The total number of expectant mothers attending was 440; the total attendances were 1660; and the average weekly attendance was 32. In addition to this special clinic a considerable amount of ante-natal work is done at the ordinary centres. As in previous years, the clinic worked in close cooperation with the Centres and with the Hostel, sending cases to the latter institution for pre-natal treatment when necessary. 53 Sick Nursery. No change in the administration of this part of the work is to be recorded. The need of better premises is felt more and more every year. The work of looking after infants in the existing circumstances is one of extreme difficulty, and is undoubtedly quite inadequate for a town the size of Croydon. The absence of proper accommodation for food storage, proper washing accommodation, and the impossibility of any kind of open-air treatment for the children, or of even garden exercise for children over one year constitute drawbacks which are only overcome by the greatest skill on the part of the doctors and nurses responsible for this work. Below are given the statistics for 1921. Sick Nursery, 228, London Road. Number of cases at Nursery at end of 1920 4 Number admitted during 1921 57 Number discharged during 1921 57 Number died during 1921 Number remaining at end of 1921 4 Notification of Births Act, 1907. During the past year 3,428 notifications were received. These births were notified as follows:— Notified by medical men 874 Notified by parents 714 Notified by certified midwives 1744 3332 Stillborn births notified 96 3428 Midwives. During the year 317 visits were paid to midwives by the Inspector of Midwives for the purpose of obtaining information or inspection. At the end of 1920 32 midwives were registered as practising in Croydon, and during 1921 four new names were added, and with one name having been removed from the list, a total of 35 remained on the register at the end of 1921. The rules of the Central Midwives Board require medical help to be called in by the midwife in a number of specified conditions, and 137 records of sending for such medical help were received. The following table gives a summary of these cases:— Fur Mother—Before Birth. Faintness 5 Ante-Partum Hemorrhage 4 9 During Labour. Prolonged Labour 20 Abnormal Presentations 18 38 54 After Birth. Adherent Placenta 7 Abortion 5 Ruptured perineum 28 Eclampsia 1 Asthma 1 Pleurisy 1 Laryngitis 1 Rise of Temperature 6 50 For Infant. Feebleness 10 Ophthalmia Neonatorum 15 Phimosis 5 Convulsions 4 Deformity 4 Injury 1 Stillbirth 1 40 Total 137 Under the Midwives Act, 1918, the Local Supervising Authority is responsible for the payment of fees of doctors called in by midwives. The fees so paid during the year amounted to £59 5s. An income scale for the purposes of determining cases in which the whole or any portion of the fees payable to doctors as aforesaid should be recovered was adopted by the Maternity and Child Welfare Sub-Committee, and of the above total of £59 5s. the patients were asked to contribute £21 6s. 6d. SICK ROOM REQUISITES. The sick room requisites are still available for use in the Borough as detailed in the report for 1920. 55 Statistical Returns of Maternity and Child Welfare Centres. INFANT CENTRES Municipal Centre (228, London Road). Central Croydon (Sylverdale Road). South (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 j (St. Alban's Hall. 1 Whitehorse Lane). West Croydon (Johnson Road). TOTAL. Infants Under 1 Year: Attendances— (a) 1. New Cases 326 101 96 149 120 220 62 117 215 163 1569 2. Old Cases 2893 1372 1166 1613 1171 3147 903 1159 2708 2444 18576 Total 3219 1473 1262 1762 1291 3367 965 1276 2923 2607 20145 Seen by Doctor 1606 623 528 625 546 1679 467 S04 1657 991 9526 Children 1—5 yrs. of Agk: (b) 1. New Cases 145 22 36 41 39 72 28 39 86 65 573 2. Old Cases 1367 833 1240 780 779 2961 1467 1462 1857 1446 14392 Total 1712 855 1276 821 3033 1495 1501 1943 1511 14965 Seen by Doctor 1011 340 541 265 339 1015 192 471 756 512 5542 Attendance of Mothers (a) & (b) 4266 2046 2157 2263 1799 5313 1854 2145 3987 3259 29089 Expectant Mothers Attendances— (a) 1. New Cases 136 43 41 38 12 94 18 31 100 65 578 2. Old Cases . 250 194 276 6l 67 247 100 94 263 257 1809 Total 386 237 317 99 79 341 118 125 363 322 2387 Home Visits 122 103 99 37 26 169 55 47 60 235 953 Visiting of Childr'n (d) Under 12 months 1. First Visits 724 274 295 287 170 326 94 311 195 524 3200 2. Subsequent Visits 1363 526 502 756 676 664 272 772 429 1133 7093 3. No. of Children seen 1602 491 511 731 604 763 248 702 331 1137 7120 (e)From 1.5 y’rs of age 1. First Visits 366 128 149 22 20 21 5 81 46 246 1o84 2. Subsequent Visits 547 486 467 360 301 611 269 511 225 893 4670 3. No. of children seen 909 480 490 414 342 668 207 595 251 879 5235 (f) re Infant Deaths 69 23 43 23 7 35 15 22 16 73 326 56 SECTION IV. TUBERCULOSIS WORK. The general arrangement of the tuberculosis work of the town has remained unchanged during 1921. The only alteration was the entering into a contract by the Corporation with the Hermitage Sanatorium, Whitwell, Isle of Wight, for the provision of fifteen beds for male cases of early phthisis in place of a similar previously existing contract with Grosvenor Sanatorium. Notifications. Total primary notifications, 1921—573. Mortality. The number of deaths which occurred during the year was as follows, viz.:— Pulmonary 159 Non-Pulmonary 25 Total 184 This is equal to a rate of .9 per 1,000 of the population. Of the cases dying in 1921, the following table shows the years in which the primary notifications were received: — Year. Cases Notified. 1913 1 1914 - 1915 2 1916 7 1917 5 1918 10 1919 17 1920 25 1921 58 Un-notified 59 184 All forms of tuberculosis have been compulsorily notifiable since 1st January, 1912, but as will be seen from the foregoing figures a large number of the cases occurring remain unnotified. The first intimation of these cases is the death card from the Registrar. It is impossible for the Medical Officer of Health to take adequate action and to advise properly the Local Health 57 Authority as to the necessary developments of the Tuberculosis Scheme unless information as to the existence of the disease be made reasonably accurate. A communication drawing attention to this and requesting the personal co-operation of the medical profession has been sent to each medical practitioner in the Borough. This (lack of notification unquestionably, to a considerable extent, is due to the indefinite wording of the Tuberculosis Regulations. Attendances at Dispensary. During 1921 the total number of attendances made at the Dispensary was 7,576 as compared with 7,050 in the previous year. New Cases Seen at Dispensary. During the year 712 new cases were dealt with as compared with 805 in 1920. 325 cases were referred to the Dispensary by local practitioners as compared with 298 in 1920. Fewer cases were referred by the School Medical Service—94 as against 171—and by the Ministry of Pensions—33 as against 116 for these respective years. 292 of the new cases were diagnosed definitely as tuberculosis, 76 were diagnosed as non-tubercular. 344 cases were kepi under observation as suspicious. The apparent discrepancy between the total cases notified and the new cases diagnosed is due to the fact that a large number of old cases under observation were diagnosed and notified. Contacts. Of the 712 new cases— 161 were contacts as against 102 contacts examined in 1920. Of these 15 were diagnosed as tubercular. 58 were diagnosed as non-tubercular; and 88 suspicious and kept under observation. This is a very small number of contacts as compared with newcases. The examination of contacts is by far the most valuable means of discovery of cases of tuberculosis in the early curable stage and it is essentially the very pivot of the present preventive medical work in this section. The contacts examined should number several times the number of new cases. It is exceptionally difficult work and requires skill and experience of a very high order. There is no doubt that more good could be done by the systematic and continuous observation of contacts than bv any of 58 the other present methods of defence against tuberculosis. To carry this examination of contacts out thoroughly is impossible with the present staff. Another Assistant Tuberculosis Officer would be required to do anything like justice to this very important branch of the work. It is to be remembered that the earliness of the discovery of tuberculosis in these contact cases enormously enhances the chances of effective and lasting good being derived from treatment. Sputum. 659 specimens of sputum were sent from the Dispensary for examination for tubercle bacilli. 109 of these were positive and 550 were negative. Extra Nourishment. Owing to the transference of powers of Insurance Committees in connection with tuberculosis which took effect on May 1st an additional £500 had been introduced into the estimates for the purpose of meeting the expenditure on extra nourishment which had hitherto been given from Insurance Funds to necessitous insured people. Upon receipt however of the Ministry's memorandum limiting the grant earning expenditure in this respect to £2 per 1,000 of the population the Council resolved that the expenditure on extra nourishment should be kept within that limit. The number of people in receipt of milk consequently had to be very greatly reduced and only exceptionally necessitous cases were so supplied. There is no doubt that a great deal of actual want on the part of patients had been considerably diminished in the past by the milk grants which had been made, and that a large proportion of these cases have consequently been deprived of such help when it was in the physical sense most urgently needd. The really ill tubercular person cannot earn a proper livelihood and the less the nourishment available the less efficient does he become as a working member of the community so that a vicious circle is set up. This applies to a very large number of cases of tuberculosis in the ordinary working-class population and it is undoubtedly aggravated by any conditions which give rise to diminished means of sustenance. The amount allowed in the estimates for extra nourishment was £750. On the basis of the Ministry's approved rate of £2 per 1,000 of the population, the amount worked upon has been £380. Consultations. 88 patients were seen in consultation in their own homes in 1921 as compared with 72 such cases in 1920. 59 In addition to these consultations a very considerable number of cases was sent to the Dispensary by general practitioners for diagnosis. After each such examination is made a letter is cent to the doctor and a copy filed with the case sheet. During 1921 the number of such letters was 433. Means of Diagnosis. The diagnosis of tuberculosis is in many instances a matter of extreme difficulty. The use of tuberculin as a diagnostic aid has been practically given up as its value appears to be doubtful, e.g., two suspicious cases during 1920 were tested by tuberculin up to .01 inj. Tuberculin. No focal or general reaction resulted in these cases, and on that basis the opinion was justified that the cases were non-tubercular. During the present year the sputa of these two oases have both been found to be positive, and the sounds in the chests were such as to indicate fairly long-standing tuberculosis. The need of some beds for diagnostic purposes is very keenly felt. This in most large towns is an integral part of the tuberculosis scheme, but it has not so far been found possible to provide these with the limited accommodation available in Croydon. Also the need of X-Ray Apparatus in the Department is very definitely felt; the value of X-Ray examination of the chest for the purpose of diagnosis is very great and it has only been possible, owing to the expense of such work, to have a small number of such examinations made each year. In 1920 12 such examinations were made and in 1921 34. The provision of an X-Ray apparatus in the Department itself would not only provide such means of diagnosis, but would enable the treatment of ringworm in school children to be carried out by our own staff. Dispensary Records. During the past two years the mode of record of the cases has been altered from the card and book system to the dossier system so that now every case has its record complete and is immediately available in itself. This has entailed a very large amount of extra work which has been carried out principally by the Health Visitor actually attached to the Dispensary. The whole work of the dispensary has been very greatly facilitated by this change. Shelters. Sixteen shelters are in use throughout the Borough. They are practically all used for cases which have had sanatorium treatment; they are periodically inspected by the Tuberculosis Officer and the Health Visitors. The shelters are much appreciated by the patients using them. 60 Institutional Treatment. Borough Hospital.—The accommodation here is for advanced cases only, and consists of 12 beds and 5 shelters. These were originally arranged so that six beds were available for women and eleven for men. During this past year, however, the disposition of the beds has been changed so that now there are nine beds for women and eight for men. 79 persons were treated in this ward in 1921 as compared with 73 in 1920. Of these, 41 were males and 38 females. The deaths totalled 20. This is a low death rate considering the advanced condition of the cases admitted. The beds were used chiefly for cases who were considered most dangerous as infective agents in their own homes. Borough Sanatorium, Cheam.—A separate report on this Institution is given on page 65. Sanatoria.—337 cases were sent to sanatoria in 1921 as compared with 335 in 1920. Of these 159 were men, of whom 82 were invalided ex-Service men; 90 were women and 88 were children. Over 40 per cent, more children were sent to sanatoria than in 1920. Table on page gives a summary of the result of sanatorium treatment during the year. Only cases which completed a period of such treatment during 1921 are included in this table. Home Visiting of Cases of Tuberculosis. Two Health Visitors devote their whole time to tuberculosis. One of these is entirely engaged in the Dispensary; the other visits all the newly notified cases and does other home visits as required. The district health visiting staff pay regular re-visits to cases of tuberculosis in their own areas. The total number of visits paid was 3,666. The total number of visits to new cases was 1,674 made up as follows:— First visits 714 Unsuccessful visits 127 Subsequent visits 833 Total 1674 First visits are the primary visits paid to newly notified cases and to certain new cases attending dispensary for observation. Unsuccessful visits are those where entrance has not been obtained. Subsequent visits are visits paid to newly notified cases which have been previously visited during the year. A considerable number of the cases of tuberculosis require nursing attention in their own homes; this has been afforded so far as our staff permits of it. The visiting staff have also taken many speciments of sputum and made temperature records of the cases to assist in diagnosis. 61 Summary of Notifications during the period from the 2nd January, 1921, to the 31st December, 1921, in the County Borough of Croydon. Notifications on Form A, Notification on Form B. Total Notifications on Form B. No. of Notifications on Form C. Number of Primary Notifications. Total Notifications on Form A- No. of Primary Notifications. Poor Law Institutions. Sanatoria Age periods. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Primary Notifications. Under 5 • 5 to 10 10 to 15 Total Primary Notifications. Pulmonary Males ... 4 l6 7 21 29 70 36 17 10 1 211 240 ... 1 5 6 6 129 (86) ,, females ... 1 8 9 24 36 51 36 15 5 2 187 211 ... 3 3 6 6 70 (27) Non-pulmonary Males ... 15 27 18 4 6 2 1 ... ... ... 73 73 1 5 2 8 8 2 „ „ Females 2 9 34 17 4 6 3 2 1 ... ... 78 83 ... 2 1 3 4 6 Patients notified as suffering from both pulmonary and non-pulmonary disease have been included among the pulmonary returns only. 62 Table showing origin of Cases seen at the Dispensary for the first time in 1921. Cause of person attending Dispensary. Insured. Uninsured-* Grand Total. Men. Women. Total. Men. Women Cbild'n Total. (1) Referred by local doctors or hospital for diag nosis, treatment or advice 130 77 207 17 48 53 118 325 (2) Ditto ditto by School Medical Officers & from Infant Clinics 1 ... 1 ... 9 84 93 94 (3) Ditto ditto from other, chiefly charitable, sources 2 7 9 7 31 52 90 99 (4) Seen as “Contacts” 5 5 10 8 25 118 151 161 (5) Ministry of Pensions 26 ... 26 7 ... ... 7 33 164 89 253 39 113 307 459 712 *This includes dependents of insured persons Table showing the way in which new cases were dealt with in 1921. Insured. Uninsured. Orand Total. Men. Women. Total. Men. Women Cbild'n Total. (l) Diagnosed as tuberculous: (a) Treated through the Dispensary 83 48 131 28 39 94 161 292 (b) Treated elsewhere (2) Diagnosis not settledKept under observation 77 39 116 9 65 154 228 344 (3) Diagnosed not tuberculous 4 2 6 2 9 59 70 76 164 89 253 39 113 307 459 712 63 Table showing details of Medical Examinations made by the Assistant Medical Officer for Tuberculosis, 1921. Period. 1921. 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 817 1410 2227 7 4 11 2238 62 145 207 April 1st to June 30th 699 1159 1858 16 9 25 1883 77 107 184 July 1st to Sept. 30th 657 1021 1678 14 7 21 1699 63 105 168 Oct. 1st to Dec. 31st 666 U47 1813 19 12 31 1844 51 102 153 Totals 2839 4737 7576 56 32 88 7664 253 459 712 Note.—In addition to the medical examinations shown in this table the Medical Officer also visited and examined the tuber culous patients at the Borough Hospital twice weekly throughout the year. 64 SANATORIUM AND HOSPITAL TREATMENT: SUMMARY OF CASES TREATED AT SANATORIA, 1921. M. w. C. T1. (A) Persons in Sanatoria, etc. on Jan. 1st, 1921 26 29 12 67 (B) Persons admitted to Sanatoria 1921 133 61 76 270 *159 *90 88 337* (C) Persons discharged from Sanatoria 1921 112 62 52 226 (D) Persons who died in Sanatoria 1921 4 1 - 5 116 63 52 231 (E) Persons in Sanatoria on December 31st, 1921 43 27 36 106 * Of these there were 147 Insured Men. 65 Insured Women. 82 Ex-Service Men. SUMMARY OF CASES TREATED AT THE BOROUGH HOSPITAL, 1921. M W C. T1. (A) Persons at the Borough Hospital on Jan. 1st, 1921 6 8 - 14 (B) Persons admitted to Hospital in 1921 35 26 4 65 *41 *34 4 *79 (C) Persons discharged from Borough Hospital 1921 25 17 2 44 (D) Persons who died in the Borough Hospital 1921 12 7 1. 20 37 24 3 64 (E) Persons in Borough Hospital on Dec. 31st, 1921 4 10 1 15 *Of these :—32 men and 16 women were insured persons, and of the insured men 11 were ex-service men. Condition on 31st December, 1921, of Cases treated at and discharged from Institutions during the year 1921. Full Work. Ligrht Work. Work, parttime. Condition unaltered— not at work. Deteriorated. Again in Sanatorium Now in Hospital. Died eince discharge. Removed to other districte. Total No. of casee. Pulmonary:— Men 20 10 6 22 24 3 1 11 7 104 Women 15 10 3 6 9 1 2 3 7 56 Non-pulmonary:— Men 2 1 ... 2 3 ... ... ... ... 8 Women 2 1 ... ... 1 ... ... 1 1 6 Children—32 cases of Pulmonary Tuberculosis, of which 26 were fit for ordinary School. 20 cases of non-pulmonary tuberculosis, of which 1 died since discharge, 1 is again in Hospital, 1 has left the district, and the remainder are fit for school. 65 CROYDON BOROUGH SANATORIUM. The Smallpox Hospital belonging to the Croydon and Districts Joint Smallpox Hospital Board is leased to the Corporation of Croydon for a period of five years from 1919 for the treatment of Tuberculosis. In it there are 50 beds which are allocated as follows, viz.:— Surrey County Council 30 Kent County Council 5 Croydon Borough Council 15 50 These beds have been 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 gives particulars of the admissions, discharges and deaths during the year, viz.:— District. Remaining at end of year 1920. Admitted during year 1921. Discharged during year 1921. Died during year 1921. Remaining at end of year 1921. Croydon C, B. 15 50 49 1 15 KentC. C. 5 23 21 2 5 Surrey C. C. 29 105 88 16 30 Total 49 178 158 19 50 A very large proportion of the cases required both hospital and sanatorium treatment, many being exclusively hospital cases. 66 The following table is a clinical classification (Turban Gerhardt), and shows the results of treatment of the patients discharged:— Clinical classification and results of treatment of 142 cases discharged during 1921. Not included in average length of stay. Total discharges and deaths under each group. Group. No. of Cases. Arrested. Much improved Improved Stationary or worse. Average length of stay. Discharged for various reasons. Deaths, I. Early 30 10 12 7 I 129 weeks 4 .. 34 II. Moderately advanced 60 7 19 27 7 I3.5 weeks 8 2 70 III. Far advanced 52 - 6 20 26 13. 4 17 73 Total 142 17 37 54 34 16 19 177 67 The classification is the one generally adopted and the only possible one where the types of cases merge so closely into one another during a brief stay in a sanatorium. The standard "fit for work" may be applied to those oases discharged under "arrested" or "much improved" but only equal to the exercise grade reached on discharge. During the short period of treatment (approximately three months) only a small number of patients reached the exercise grade which would justify the standard "fit for work" without qualification. Administratively 1921 has been a very successful year at the sanatorium; the atmosphere of the institution has been very happy and this in no small measure has been due to the excellent administration of Dr. Pierce, the Resident Medical Superintendent, and Miss Williams, the Matron. During the year a small summer house which was useless owing to its situation in the grounds, was removed, placed on a concrete bed, re-lined, and provided with windows, all by the labour of the sanatorium staff and patients. This now constitutes a very desirable shelter for two beds. The graded exercises undertaken by patients as treatment have been systematised and made adaptable to the Sanatorium. Provision has also been made for work under cover when the weather is unfavourable for outside work. A considerable amount of garden work is done by the patients and the immediate surroundings of the shelters have been very greatly improved by flower beds and rockeries made in this way. The principal point to be emphasised in regard to the work is that a very large proportion of the cases admitted have been either true bed cases, or have been hospital cases for a long time before they could be transferred to the sanatorium type, and treated as sanatorium cases. This has thrown a very severe strain upon the staff which is kept absolutely at the numerical minimum, and the excellence and cheerfulness with which the work has been done reflects the greatest credit upon the whole of the nursing and domestic staff of the Institution. 68 SECTION V. VENEREAL DISEASE. A joint scheme in which Croydon takes 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 other table gives details of the work carried out at the Croydon General Hospital Venereal Diseases Clinic during 1921. The treatment of male patients and arrangements for daily lavage have both been provided during 1921 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 1921 was 337 as against 391 in 1920 and 262 in 1919, while the total attendances for 1921 amounted to 3263, a large increase over the figure of 1470 for 1920. The number attending the clinics in London decreased by 62; those attending the local clinic increased by 8. The number of pathological examinations made for private practitioners—547 in 1921—shews a substantial increase compared with 193 in 1920 and 190 in 1919. A propaganda campaign was carried out in Croydon in conjunction with the National Council for Combating Venereal Disease in January with good results. 69 VENEREAL DISEASES. Annual Summary Tear 1921. London. Middlesex. Essex. Surrey. Kent. Herts. Bucks. East Ha m. West Ham- Croydon. All Districts. l. No. of persons dealt with at 01 in connection with the clinic for the first time and found to be suffering from— Syphilis 6,145 559 271 199 162 53 36 71 240 64 7,800 Soft chancre 313 31 12 7 6 1 ... 17 1 391 Gonorrhœa 8,284 614 361 210 177 72 32 129 313 58 10,250 Not found to be suffering from Venereal Disease 4,474 432 229 175 97 40 24 55 349 27 5,902 Total 19,216 1,636 873 591 442 166 92 258 919 150 24,343* Total Attendances 400,416 33,547 12,242 11,124 7,381 2,248 1.697 3,928 9,294 2,604 484,481 2. No. of "in-patient" days of Treatment 54,244 2,981 2,830 2,042 2,3" 1,073 408 452 1,038 351 67,730 3- No. of doses of Salvarsan substitutes given 57 342 4,850 2,198 2,730 1.296 476 311 604 1,334 400 71,541 *In addition, 1,075 cases were dealt with from " counties outside the scheme," the majority of which were merchant seamen from all parts of the world. The total number of new patients dealt with at the Clinics for the year was therefore 24.343 1,075 25,418 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 30 1 ... ... ... ... ... ... 1 ... 32 For detection of gonococci 2,111 99 73 59 11 7 4 15 51 218 12,648 For Wassermann re-action 13,146 456 702 428 124 49 28 101 276 326 15,636 Other examinations 98 8 6 ... 1 ... ... 1 2 3 119 Total 15.385 564 781 487 136 56 32 117 330 547 18,435 70 VENEREAL DISEASES. Return relating to persons who were treated at the Croydon Genera' Hospital, 1921 and 1920. 1921. 1920. 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 Gonorrhoea 2 - 2 1 Syphilis 48 31 28 27 Soft Chancre 2 1 5 - Gonorrhoea 49 19 40 25 Not suffering from venereal disease 16 19 26 25 117 70 101 78 Number of persons discharged from the out-patient Clinic after completion of treatment for: — Syphilis 1 1 1 1 Soft Chancre - - - - Gonorrhoea 8 2 - 1 9 3 1 2 Number of persons who ceased to attend the outpatient Clinic without completing treatment or after completion of treatment but before final tests as to cure, and who were suffering from:— Syphilis 21 27 9 15 Soft Chancre 4 1 3 - Gonorrhœa 34 25 7 9 59 53 19 24 Total attendances of all persons at the out patient Clinic who were sulfering from:— Syphilis 739 692 225 491 Soft Chancre 3 11 29 - Gonorrhoea 1441 268 423 165 Not suffering from venereal disease 41 68 74 63 2224 1039 751 719 Aggregate number of "in-patient days" of treatment given to persons suffering from:— Syphilis 32 - 20 - Gonorrhcea - - - - 32 - 20 - Number of persons treated with Salvarsan substitutes 59 48 - 9 Number of doses of Salvarsan substitutes given 370 154 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 162 33 „ Wassermann reaction 250 115 „ Others - - 412 148 71 SECTION VI. MENTAL DEFICIENCY. Mental Deficiency work in the Borough falls into two divisions:— I. The Statutory cases, comprising mentally defective children under five, ineducable children of school age, and all mentally defective persons over the age of sixteen. II. The Education cases, consisting of all educable defectives between five and sixteen years of age. The total number of mental defectives known by medical examination in the Borough is: — Statutory cases 171 Education cases 119 Total 290 Statutory Cases— (а) 0—5 4 (б) 5—16 41 (c) Over 16 126 171 In Certified Institutions 69 In Croydon Mental Hospital 11 In Poor Law Institutions 13 Under Guardianship—at home 9 Resident at Home 69 171 Education Cases— In Certified Institutions 7 In Poor Law & Church Army Homes 2 On Roll of Special School 83 Resident at Home 27 119 Examinations and Visits made by the Medical Officers during 1921:- Statutory 105 Education 146 251 No. of Visits paid by the Mental Deficiency Visitor:— Statutory 835 Education 941 1776 72 I. Statutory Cases. The total known number of these cases in or belonging to the Borough is 171. Of these 93 are in Residential Institutions (including Poor Law Homes) and 78 are under supervision at home. There are nine cases of lads and girls over sixteen who have been placed under Guardianship at home, and these cases are visited every three months by the Medical Officer, and every month by the Mental Deficiency Visitor. They are also visited at least twice per annum by an Inspector from the Board of Control. For about five months—November, 1920 to March, 1921— lessons in raffia bag and basket making were given to four girls and one lad by a voluntary worker, with good results. The work came to an end at Easter, but in the Autumn a weaving class was started at 13, Katharine Street, at which six young women are taught rug making on small hand-looms. This class continues to meet each Friday afternoon, and is looked forward to with great enthusiasm by teacher and pupils. The work done has been of very satisfactory quality and has proved to be saleable—one of the girls has dressed herself out of the proceeds of her basket making. Considerable progress has been made during the current year, and the report for 1922 will, it is anticipated, clearly show the need for the permanent establishment of a training industrial centre for mental defectives in the town. Four children under five years of age have been kept under medical observation and regular supervision during the year. The Medical Officer made 105 examinations and medical visits and the Mental Deficiency Visitor 835 visits to Statutory cases during the year. Six new Statutory cases were added to the list by certificate, six ineducable oases were notified by the Local Education Authority and eleven Education cases passed to the Statutory list on attaining the age of sixteen. Seven males and six females were sent to Residential Institutions during the year, eleven cases were transferred from Queeen's Road to other Institutions on the expiry of the contract with the Guardians, and two other transfers were made from other Institutions. Two Statutory cases have removed from the Borough, and there has been one death in 1921. 73 1921. CASES DEALT WITH. Nature of Order (whether for Institutional treatment or for Guardianship) and remarks. Date of Order. Name. Sex. Age. 2nd March A. Y. F. 27 Institutional. Whittington Hall. 18th March E. C. F. 36 Institutional. Admitted London Lock Hospital 18th March; transferred to Queen s Road Institution, Croydon, May, 1921; re-transferred Caterham, 14th July, 1921. 24th March E. F. M. 16 Institutional. Caterham Mental Hospital. 24th March A. F. F. 14, Institutional. Fountain Mental Hospital, Tooting. 23rd May E. A. C. M. 8 Institutional. Stoke Park Colcny, Bristol. 27th June A. C. M. 15 Institutional. Sandlebriage. 3rd August K. G. N. F. 17 Institutional. Stoke Park Colony. 3rd August S. C. S. M. 18 Institutional Princess Christian. Farm Colony, Hildenboro', Kent. Order made for contribution by mother of 7/6 per week. 23rd Sept. J. F. M. 22 Institutional. Monkton Hall Home. Order made for contribution by father of 5/- p. w. 14th October C. R. S. M. 21 Institutional. Royal Earlswood Institution. Parents contributing 15s, per annum. 24th October I.. E. F M. 9 Institutional. Stoke Park Colony Government pension 7/6. 15th December D. E. S. F. 10 Institutional. Fountain Mental Hospital, Tooting. Order made for contribution by father of 5/- per week. 20th December E. C. F. 14 Institutional. Darenth Industrial Colony. Order made for contribution by father of 4/- p.w. CASES TRANSFERRED. 5th February B. R. B. F. 16 Institutional. Transferred from Queen's Road to Whittington Hall. 5th February E. I. W. F. 35 Institutional. ditto. 8th March C. K. F. 61 Institutional. Transferred to Ulverston Poor Law Institution from Queen's Road. Re-transferred to Sevenoaks Poor Law Institution December, 1921 1st April S. M M. 7 Institutional Transferred from Queen's Road to St. Francis Special R.C. School, Buntingford, Herts. 21st April J. D. M. 54 Institutional. Transferred from Darenth Industrial Colony to Rampton State Institution. 12th July O. M. S. F. 8 Institutional. Transferred from Queen's Road to Fountain Mental Hospital, Tooting. 14th July F. P. M. 23 Institutional. Transferred from Queen's Road to Caterham Mental Hospital. 14th July C. H. M. 15 ditto. ditto. 14th July J. O. B. M. 9 ditto ditto. 14th July E. D. G. M. 9 ditto. ditto. 14th July G.J. M. 18 ditto. ditto. 14th July C.R.W. M. 16 ditto. ditto. 22nd July E Y. F. 16 Institutional. From Darenth Industrial Colony to Farmfield State Institution, re-transferred to Rampton State Institution 13th December, 1921. 74 II. Education Cases. The mentally defective children under the care of the Education Committee number 119. Of these 83 are either attending or have been certified as suitable for Grangewood Special M.D. School. The Deputy School Medical Officer examines school children who are reported as backward or abnormal on two afternoons each week. During the year, 146 such examinations have been made and 108 new cases were tested. Of these new cases 31 were certified as mentally defective, 44 were reported to be dull and backward, 10 were returned as normal, 15 were referred to hospitals or school clinics for physical treatment before further examination, and 8 were to be tried at ordinary school for a time before reexamination and diagnosis. Periodical visits were paid to Grangewood Special School by the Medical Officers, when special examinations were made to test progress in individual cases. The total number of visits paid to Education cases by the Mental Deficiency Visitor was 941. During the year 11 Education cases attained 16 years of age, and so passed to the care of the Statutory Committee, and 6 children under 16 were transferred to the Statntory list as Ineducable. Two Education cases (one boy and one girl), were sent to Monyhull Residential School in December, one child among the Education cases died in November, and one left the Borough. Five boys and one girl, pupils at the Special School, have, on the recommendation of the medical officer, been allowed to leave before the age of 16 in order to take up work at home. Of the 146 children who were examined, 38 were special examinations at Grangewood Special M.D. School. Of 108 new cases examined— A 31 were certified as mentally defective. B 44 were found to be dull and backward. (10 retarded under 2 years). (17 ,, 2 years). 7 „ 2—3 years). 10 ,, 3 years and over 3). C 10 were found to be of average intelligence. D 15 were referred for physical treatment. E 8 were referred for school observation, and some education before diagnosis. 75 These cases were disposed of as follows, viz.:— A 26 were recommended for the Special School. 3 ,, ,, to be under supervision at home. 2 ,, ,, for Institutional Treatrrrem. B 25 were recommended for Special Class. 5 were returned to ordinary class with special supervision recommended. 14 were to be re-examined after physical treatment. C 10 were dismissed as normal. D 15 were not to be classified until after clinical or Hospital treatment. E 8 to be re-examined after observation at school. 76 SECTION VII. WORK OR THE SANITARY INSPECTING STAFF. INSPECTIONS MADE BY THE SANITARY INSPECTORS DURING THE YEAR ENDING 31st DECEMBER, 1921. No. of visits re infectious disease 1646 House drains tested with smoke (primary) 1099 House drains tested on application 102 No. of smoke tests during repair 481 No. of water tests during repair 251 Inspection of premises where offensive trades are conducted 4 Inspections of Factories 273 „ „ Workshops 590 „ „ Bakehouses 472 „ „ Outworkers 226 Visits to employers of outworkers 36 Inspections of Kitchens where food is prepared 48 Inspections of Greengrocers 447 „ „ Fishmongers 293 „ „ Ice cream shops 45 „ „ Schools 138 „ „ Yards 1266 „ „ Stables 468 „ „ Common Lodging Houses 532 „ „ Houses let in Lodgings 66 „ „ Urinals 1297 Smoke observations 79 Re-inspections of work in progress 10952 Sundry inspections 1750 „ visits 504 Complaints from public investigated 2002 No. of Houses inspected under the Housing (Insp. of Dist.) Regs., 1910 2438 No. of houses inspected under Rent Restrictions Act, 1920 287 No. of houses inspected where zymotic diseases have occurred *1130 *These houses, although inspected as a result of the occurrence of infectious disease, were inspected as completely as any done for housing purposes originally. 77 NUISANCES, Etc., DISCOVERED BY THE SANITARY INSPECTORS DURING THE YEAR ENDING 31st DECEMBER, 1921. HOUSES— Defective ashbins 773 Requiring cleansing and whitewashing 1853 Defective drains 118 Damp 625 Defective downspouts 258 Defective gutters 416 Overcrowded 39 Defective roofs 781 Defective sanitary fittings 1230 House drains relaid 24 „ „ repaired 115 FACTORIES, WORKSHOPS AND WORKPLACES ONLY— W.C.'s insufficiently screened 4 Insufficient W.C. accommodation 26 Defective W.C. accommodation 22 Want of intervening ventilated space to W.C.'s 5 Want of ashbins 4 Requiring cleansing and whitewashing 74 Overcrowded 2 Defective paving 1 Want of ventilation of stoves 18 Infringement of drinking water supply regulations 2 Sundry other nuisances 22 GENERAL— Animals improperly kept 19 Drains found stopped 391 Defective manure receptacles 8 Defective urinals 7 Smoke nuisances 4 Defective yard surfaces 308 Infringements of Bye-Laws and Regulations 187 Offensive accumulations 41 Sundry other nuisances 1389 Informal notices outstanding 31-12-20 875 Informal notices served 4280 „ „ complied 3652 ,, „ outstanding 860 Referred to Committee 643 78 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 26,782 men and 2,387 women, making a total of 29,169. The average number of lodgers amounted to 73 men and 6 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. 1915 787 9 1 737 17 10 1916 . 722 16 1 682 15 10 1917 678 15 4 698 4 1 1918 781 1 7 854 3 0 1919 834 0 5 916 15 3 1920 1083 10 7 1216 14 9 1921 1126 0 0 1404 0 0 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:— Premies. No. of Room?. Accommodation. 11 & 12, Princess Road 12 54 men and 8 married couples. 9, Prosp ct Place 7 18 men and 5 m irried 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 532 visits. Minor infringements of bye-laws were detected on 50 occasions, but in no case were they sufficiently serious for legal proceedings to be taken. 79 HOUSES LET IN LODGINGS. There are 47 houses registered under the bye-laws. During the year these "houses received 66 visits. On no occasions were offences discovered for which prosecutions were necessary. At the present moment the following houses are registered as houses let in lodgings:— Wilford Road 20 Forster Road 12 Holmesdale Road 4 Ely Road 8 Beulah Grove 1 Queen's Road 1 Princess Road 1 47 FACTORY & WORKSHOPS ACT. FACTORIES. Visits were made to Factories, as follows:— In reference to sanitary accommodation 143 ,, ,, new occupation 35 ,, ,, defective sanitary accommodation 56 ,, „ extra w.c. at iron foundry 7 „ ,, timber works 6 ,, ,, engineers 1 ,, ,, printers 4 ,, ,, pill manufacturers 3 ,, ,, joinery works 10 ,, ,, stationery works 5 Sausage makers 3 Total 273 WORKSHOPS. The number of workshops on register is 719. The number of visits paid by the Inspector is 590. 80 HOMEWORK. 109 lists were received from employers, containing the names of 267 outworkers residing in the Borough. 156 further names were received from the Medical Officers of Health of various neighbouring districts, and the names of 41 outworkers residing outside the Borough were similarly despatched to the Medical Officer of Health for the district concerned. 226 visits were paid to outworkers. 36 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 65 Retail and 36 Factory and Wholesale Bakehouses in occupation, of which 8 were underground. 472 visits were made by the Inspector during the year, and 44 nuisances discovered and abated. WORKPLACES. At the end of the year there were 58 workplaces on the register; 48 visits were made, and 9 nuisances discovered and abated. Thirty-two notices served were duly complied with; the remainder of the matters requiring attention were satisfactorily dealt with by verbal notice. Fifty communications were sent to H.M. Inspector of Factories in accordance with the various requirements of the Act. SMOKE OBSERVATIONS. There were 79 observations made. RAG FLOCK ACT, 1912. Fifteen samples were taken under this Act during 1921 and in 5 instances the vendors were cautioned. 81 SLAUGHTER HOUSES AND THE INSPECTION OF MEAT AND OTHER FOODS. The Inspection of meat has been carried out as in previous years. There are 10 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 1921. In Dec 1921. Registered 14 12 10 Licensed ... ... ... Total 14 12 10 Two slaughterhouses have been demolished; one for the extension of wholesale meat depot, and the other for the erection of refrigerators. The following tables give a summary of the work done during the year:— Summary of Inspections during 1921. Date 1921. Slaughterhouses- Butchers. Fishmongers- Markets- Cowkeepers- Dairies. Other Premises- Total January 149 106 43 10 3 15 22 348 February 127 92 37 8 8 27 17 316 March 114 90 32 8 3 15 14 276 April 105 78 24 6 3 19 12 249 May 92 . 71 27 6 3 20 9 228 June 169 134 52 12 10 54 30 461 July 126 74 35 8 4 26 14 287 August and September 239 154 59 18 13 52 30 565 October 60 31 11 4 — 2 10 118 November 108 89 42 8 8 20 18 293 December 275 204 89 18 5 43 25 659 Totals 1564 1123 451 108 60 293 201 3800 82 The two following tables shew the number of animals slaughtered at the Public Slaughter Houses, Pitlake, during the year 1921, and a summary of the totals for the last ten years 1921. Slaughterhouses Cattle. Sheep. Pigs. Calves. Total. Public 118 2868 2132 125 5243 Private 313 1633 15259 2709 19914 Totals 431 4501 17391 2834 25157 Summary for ten years, 1912 to 1921. Year. Cattle. Sheep. Pigs. Calves. Total. 1912 727 7874 19765 4017 32383 1913 458 4863 15282 3003 23606 1914 589 4171 13281 2667 20708 1915 1000 5339 23406 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 1921 431 4501 17391 2834 25157 Totals 10545 51356 149493 40366 251760 83 Summary of Meat and other articles of food destroyed as unfit for food with total weight:— I92I. ARTICLES. Weight in lbs. Remarks. Diseased. Unsound. Total. Beef 5.824 5,618 11,442 Including 14 carcases. Mutton 191 2.647 2,838 ,, 53 ,, Pork 8,576 506 9,084 ,, 42 ,, Veal 40 30 70 ,, 2 „ Offal 5,812 4,788 10,600 ,, imported offal. Fish 1,602 1,602 Cod, Escalops, Haddock, Herrings, Kippers, Mackerel, Plaice, and Winkles. Other Articles 5,817 5,817 Apples, Bacon,Chicken Dates, Eggs, Flour, Peas, Pears, Potatoes, Rabbits, Sprouts, Tomatoes, and Tinned Goods. Total lbs. 20,445 21,008 41,453 Including 111 carcases. Summary of whole carcases condemned, with the reasons for such condemnation:— 1921. Class of Animal. Tuberculosis. Peritonitis. Pneumonia. Pleurisy. Metritis. Enteritis. Jaundice. Actinomycosis. Emaciated, various causes. Immature. Injuries. Decomposition. Total carcases. Cattle 9 .. .. .. 2 .. .. 1 .. .. .. 2 14 Sheep .. 1 .. 1 1 .. .. .. .. .. l 49 53 Pigs 23 5 2 1 .. .. 5 .. l .. .. 5 42 Calves .. .. .. .. .. 1 .. .. .. l .. .. 2 Totals 32 6 2 2 3 1 5 1 1 1 1 56 111 84 Summitry of Carcases in which Tuberculosis was found in the course of inspection and how such carcases were disposed of :— 1921. Animals affected. Carcase and all internal organs destroyed. Part of carcase and all organs destroyed. All or part of organs destroyed. Total. Cattle 9 1 13 23 Pigs 23 228 85 336 Total 32 229 98 359 DAIRIES, COWSHEDS & MILKSHOPS ORDER. Cowkeepers on Register (1920) 10 added (1921) 0 Cowsheds on Register (1920) 19 added (1921) 0 Number of Cows provided for 180 Approximate number of cows (1921) 120 Dairvmen & Milk Purveyors on Register 135 „ added (1920) 23 ,, ,, removed 32 Number of Premises 198 CROYDON CORPORATION ACT, 1900. PROVISION AS TO SUPPLY OF MILK. During the year twelve primary and eleven secondary samples of milk were procured and submitted for examination for tuberculosis in accordance with the above mentioned provisions. The twelve primary samples included one from milk produced in the Borough and eleven from country-produced milk—seven from Surrey, three from Sussex and one from Dorset. The examination of the samples of Borough and Dorset milks gave a negative result. One of the Sussex Milks was found Tuberculous. Further investigation of this case was referred to the Medical Officer of Health of the District in which the farm was situated as in the interval between the procuring of the sample and the result of the examination obtained the milk from this farm had ceased to come to Croydon and was understood to be consigned to a seaside town in the same district as the farm. 85 The seven Surrey Milks were all procured at one farm. The cows on this farm had previous to the procuring of the samples been tested with Tuberculin and a number of them had re-acted. The cows were first-class dairy cows in good condition. The udders were normal. No clinical evidence of tuberculosis was found. The cows were housed in well-constructed modern sheds. On the occasion of procuring the primary samples, the ows were divided into groups a sample being taken from the mixed milk of the cows in each group. One of the samples on examination was found tuberculous, and secondary samples from the milk of this group were also tuberculous. All the suspected cows were isolated for the purpose of being fattened for slaughter, and at the end of the year five of them had been slaughtered—in each of the five cases tuberculous lesions were found in various organs but in no case were the lesions extensive. The following table shows the number of primary samples of town and country milks submitted for examination with the number and percentage of samples in which tuberculosis was found:— Year. Town Milk. No. Positive. Per, centage. Country Milk. No. Positive. Percentage. 1900 40 2 5 — — — 1901 1 — — 87 5 5.7 1902 — — — 6 — — 1904 30 1 3.3 — — — 1908 25 1 4 21 3 14.2 1911 16 1 6.2 39 6 15.4 1912 14 1 7.1 31 1 3.2 1913 14 4 28.5 49 4 8.1 1914 12 1 8.3 45 5 11.1 1915 19 1 5.2 53 2 3.8 1916 7 1 14.2 26 3 11.5 *1917-1920 — — . — — — — 1921 1 — — 11 2 18.1 Totals 179 13 7.3 368 81 8.4 *No Samples taken owing to war difficulties. Total Town and Country Milks 547 ,, Positive samples 44 Percentage Tubercular 8% 86 SALE OF FOOD AND DRUGS ACTS. During the year 187 samples of milk (178 new and 9 skimmed or separated) were taken. In 17 cases the samples were below the standard suggested by the Ministry of Agriculture. Proceedings were instituted in respect of 9 of these samples, and 2 of other articles, and fines and costs were imposed on the vendors to the extent of £28 13s. 6d. The other S samples were only slightly below the standard suggested by the Ministry of Agriculture. In 4 cases the vendors were written to asking for an explanation, and in all cases subsequent samples were taken. The following is a detailed statement concerning the prosecutions undertaken during 1921:— PROSECUTIONS, 1921. Date of Purchase Defendant. Charge. Result. Penalty. Costs. 1921 £ s d. £ s. d Jan 15 W. H. Selling Cheese 82 per cent. foreign fat in its fat Convicted 3 0 0 0 10 6 Feb. 11 A. F. Selling Milk 15 per cent deficient of fat ,, 5 0 0 3 1 0 „ 15 A. G. Selling Milk containing 56 percent. of added water and 39 per cent. deficient of fat and 28 per cent. added water and 5 per cent. deficient of fat Withdrawn - 5 5 0 May 22 E. C. Selling Milk containing 2 per cent. added water ,, - - „ 23 A. M. A. Selling Milk deficient of 10 per cent. of its fat Convicted 1 0 0 1 16 0 „ 29 A. G. Selling Milk deficient of 15 per cent. of fat ,, 3 0 0 0 15 0 June 26 T. H. Selling Milk containing 2 per cent. added water and being 2 per cent. deficient of fat Dismissed - - July 10 N. & Son Selling Milk containing 2 per cent. added water Withdrawn — - ,, R. W. G. Selling Coffee containing 50 per cent, chicory Convicted 1 0 0 0 15 0 „ 24 N. & Son Selling Milk containing 4 per cent. added water Withdrawn — — Aug. 10 A. E. L. Selling Milk containing 7 per cent. and 6 per cent, added water Convictcd 1 0 0 2 5 0 Total 14 0 0 14 13 6 87 Food and Drugs Acts. Total Number of Samples taken during the year 1921. Sample of Total Samples. Genuine. Not Genuine. Prosecutions. Convictions. Cautions Milk 178 160 18 9 5 4 ,, Separated or Skimmed 9 9 — — — — Butter 24 24 — — — — Beer 11 11 — — — — Cream 6 6 — — — — Cheese 3 2 1 1 1 — Coffee 22 19 3 1 1 1 Pepper 9 9 — — — — Lard 7 7 — — — — Vinegar 9 9 — — — — Baking Powder 4 4 — — — — Cocoa 10 10 — — — — Margarine 7 7 — — — — Dripping 8 8 — — — — Whiskey 1 1 — — — — Olive Oil 8 8 — — — — Beef Sausages 6 6 — — — — Pork Sausages 1 1 — — — — Meat Paste 9 8 1 — — — Tinned Peas 2 — 2 — — - Corn Flour 7 7 — — — — Flour 4 4 — — — — Jam 4 2 2 — — — Marmalade 3 3 - - - - Totals 352 325 27 11 7 5 *C onsignment seized. Country Milk in course of delivery at railway stations 42 On Milk rounds Sunday mornings 55 ,, ,, Weekdays 90 Total 187 88 Food and Drugs Acts. Particulars of Samples taken during the sixteen years 1906 1921 inclusive:— Year. Number of Samples taken. Number Genuine. •Number Adulterated. Percentage of Adulterated. Presentions. Total amount of Fines and Costs imposed. £ s. d. 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 338 297 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 1921 352 326 26 7.9 11 28 13 6 *The term adulterated includes samples found to be not up to standard. 89 MILK AND CREAM REGULATIONS, 1912. The following is a copy of the Report sent to the Minister of Health 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, 1921. 1. Milk; and Cream not sold as Preserved Cream. (a) (b) Number of samples examined for the presence of a preservative. Number in which a preservative was reported to be present. MILK 187 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. 90 POISONS AND PHARMACY ACT, 1908. The Poisons & Pharmacy Act, 1908, came into operation on the 1st April, 1909. The object of the Act is to regulate the sale of certain poisonous substances, and to amend the Pharmacy Acts. The numbers of licenses renewed under this Act during the year 1921 was seven. Prior to the renewals of these licenses being granted all the premises were inspected and found to comply with the provisions of the Act. FERTILISERS AND FEEDING STUFFS ACT, 1905. Seven samples were taken under this Act during the year. Six of the samples proved to be satisfactory, and one was found to contain slightly less than the guaranteed percentages of Ammonia and Phosphates. RATS AND MICE (DESTRUCTION) ACT, 1919. The rat-catcher is a permanent member of the staff. The rats are destroyed by dogs, ferrets, or poison baits. The following is a summary of the number of visits, etc., made under the above Act during the year:— No. of visits made 1528 No. of poison baits laid 2149 No. of rats killed 2091 DISINFECTION. The following articles were disinfected at the Disinfecting Station, viz.:— Number of Articles. By steam 22,174 ,, formalin lamp 1,181 ,, formalin spray 283 ,, sulphur 3 ,, izal fluid 4 23,645 234 articles were also destroyed. 91 Premises, etc., Disinfected. Rooms. Hospital Wards. School Departments. School Class rooms. Vehicles. Pond for Mosquitoes. 2743 12 23 16 2 1 Cleansing of Persons at Disinfecting Station during the Year 1921 Adults. School Children. Children under School age. Head Vermin — — — Scabies 7 27 — Body Vermin 19 9 2 After Contact with Infectious Disease — — — . 26 36 2 92 SECTION VIII. WORK OF THE BUOROUGH HOSPITAL The total nominal accommodation at the Borough Hospital is 170 beds, in addition to which there are five shelters. During the latter period of the year the accommodation at the Hospital was severely taxed. 1 he figures given below demonstrate the continuous heavy use to which the Wards were put. The total number of cases (1313) admitted during the year is the highest on record. It should be remembered that the total figures at any time alone do not indicate truly the pressure upon the accommodation as not infrequently it is found that a rush in one disease causes great pressure for some months on the wards which can be allocated to the treatment of that disease while the other wards may be running at quite ordinary pressure. In the beginning and latter portion of the year all the wards in the Hospital were very much overcrowded, and in the last month and a half of 1921 many cases of infectious disease had to be left in their homes, for which beds could not be provided in the Hospital at all. Not only is the pressure felt severely upon the patient beds but the overcrowding of the wards makes the work excessively hard upon nursing and domestic staff, in spite of the fact that the sleeping accommodation for the nurses has been used to its utmost limit. Unquestionably, in part at least, due to this very heavy work, no fewer than 15 cases of scarlet fever and diphtheria alone occurred amongst the nursing staff during the year—a very heavy incidence. The need for a properly planned and executed extension of the Hospital is pressing, and should be taken in hand as soon as the general economic circumstances make it possible. The re habilitation of an old ward— Block G—and the addition of a converted army hut have already been referred to. The following table shows the highest and lowest number of beds occupied on any one night during each month of the year 1921. Month. Beds Occupied. Month. Beds Occupied. Highest. Lowest. Highest. Lowest. January 192 127 July 145 110 February 149 128 August 135 113 March .. 150 129 September 122 106 April 132 104 October 209 116 May 133 107 November 239 211 June 135 98 December 232 195 During 1921 the average daily number of cases under treatment amounted to 145.0 as compared with 156.0 of the previous year. CROYDON BOROUGH HOSPITAL. Detailed Analysis of Expenditure under all Heads for the Year ending March 31st, 1922, and 10 preceding Years. Year ended March. Average No. of Patients. Provisions. Alcohol. Surgery and Dispensary. Domestic, including Coal and Gas. Establishment aud Miscellaneous Charges. Salaries and Wages. Total Ordinary Expenditure. Total Average Cost per Bed occupied. Sinkne Fund and Interest, and Capital Expenditure from Revenue Total Average Cost per Bed occupied including Sinking Fund & Interest, etc. Total. Average Cost per Bed occupied. Total. Average Cost per Bed occupied. Total. Average Cost per Bed occupied. Total. Average Ccst per Bed occupied. Establishment Charges and Repairs. Miscellaneous Charges. Total. Average Cost per Bed occupied. Medical Dispensing, Nursing & other. Average Cost per Bed occupied. £ s. d. £ s. d. £ s. d. s. d. £ s. d. £ s. d £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ S. d. £ s. d. £ s. d £ s. d. £ s. d. £ s. d. 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 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 2774 12 0 103 19 1 1914 143 3279 12 2 22 18 8 14 12 0 2 1 574 19 8 4 0 4 2467 3 4 17 5 1 2406 1 5 306 4 5 2712 5 10 18 19 4 2970 8 9 20 15 5 12019 1 9 84 11 0 3058 16 9 105 8 9 1915 131 3455 18 1 26 7 7 17 15 9 2 8 410 5 2 3 2 8 2530 5 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 2 8 451 11 11 4 17 2 2713 3 4 29 3 6 1368 1 2 742 7 11 2110 9 1 22 13 10 2751 17 11 29 11 10 11433 11 11 122 18 10 3184 16 3 157 3 9 1918 84 3735 0 1 44 9 3 26 4 8 6 3 556 1 4 6 12 5 3303 3 8 39 6 6 1477 15 9 761 3 8 2238 19 5 26 13 1 2759 0 4 32 16 11 12618 9 6 150 4 5 3177 7 5 188 0 11 1919 92 4261 15 6 46 6 6 33 10 0 6 7 745 13 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 153 6448 12 6 41 6 9 47 5 6 6 1 1459 15 2 9 7 25418 17 8 34 14 9 3278 19 5 1051 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 1922 157 6319 16 8 40 5 1 43 7 0 5 6 499 15 7 3 3 8 6088 14 5 38 15 7 3421 3 5 805 6 2 4226 9 7 26 18 5 7553 15 0 48 2 3 24731 18 3 157 10 6 †4680 13 11 187 6 9 Receipts 1921-1922, from various sources £ s d £ s d. †Sinking Fund and Interest 2702 15 11 5250 13 7 Additional Accommodation 1977 18 0 £4680 13 11 93 The following table gives the total number admitted from the Borough and other Districts during the year 1921. Districts. Remaining at end of 1920. Admitted during 1921. Discharged during 1921. Died during 1921. Remaining at end of 1921. Penge Urban D.C., nonpauper cases 20 75 86 . 4 5 County Borough of Croydon 168 1238 1160 56 190 Total 188 1313 1246 60 195 The following table shows the comparative admissions during 1921 and previous years. 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. Cases admitted during 1921. Scarlet Fever 624 381 365 417 603 413 295 201 386 532 583 738 (1) Diphtheria 222 430 600 402 211 200 313 207 179 433 540 456 (2) Cerebro Sp. Meningitis — — — — — 67 24 38 23 3 1 3(31 Pulmonary Phthisis — — — . 48 56 61 44 40 37 44 63 64 Enteric Fever 15 18 16 28 15 13 10 6 13 4 12 12 Puerperal Fever — — — 1 2 4 2 2 1 4 7 2 Morbilli - - - - - 9 17 25 17 6 4 — Rubella - - — — — - - 12 2 3 1 2 Mumps - - - - - - - 20 6 4 1 3 Erysipelas — — — — — — - 18 10 6 10 5 Other diseases 47 29 25 6 10 11 33 10 37 29 24 28 (4) Total 908 858 1006 902 947 778 738 579 711 1068 1246 1313 (1) Includes 3 cases of Rubella. ,, 1 cases of Tonsillitis. ,, 2 cases of Scabies. ,, 1 c?se of Urticaria. ,, 1 case of I'haryngitis. ,, 4 cases of Fourth Disease. ,, .3 cases in which no disease could be diagnosed. (2) ,, 3 cases of Tonsillitis. ,, 1 case of Measles. ,, 1 case of Cellulitis Face. (3) ,, 1 case of Marasmus. ,, 1 case of Intestinal Toxaemia. ,, 1 case in which no disease could be diagnosed. (4) ,, 10 cases of Infantile Diarrhoea. ,, 8 cases of Ophthalmia Neonatorum.* ,, 4 cases of Whooping Cough. ,, 1 case of Varicella. ,, 1 case of Malaria (diagnosed Meningitis) ,, 1 ca e of Peritonitis. ,, 1 case of Food Poisoning. ,, 1 case of Quinsy. ,, 1 case of Encephalitis. *3 Mothers with babies (Ophthalmia Neonatorum). 94 The following table gives the number of patients admitted for each disease, an analysis of the admissions, and the number discharged or who have died in the year 1921:— Disease Remaining at end of 1920. Admitted during 1921. Discharged during 1921. Died during 1921. Remaining at end of 1921. Scarlet Fever 91 720 697 4 110 Admitted to Hospital as Scarlet Fever and found to be other disease ... 15 15 ... ... Admitted to Hospital for observation (including contact) 1 3 4 ... ... Diphtheria 77 451 434 24 70 Admitted as Diphtheria and found to be other disease 1 5 6 ... ... Admitted for observation (including contact) 1 ... 1 ... ... Cerebro-Spinal Meningitis ... ... ... ... ... Admitted as Cerebro-Spinal Meningitis and found to be other disease ... 2 2 ... ... Admitted for observation (including contact) ... 1 1 ... ... Enteric Fever 1 12 11 2 ... Admitted as Enteric and found to be other disease ... ... ... ... ... Admitted for observation (including contact) ... ... ... ... ... Pulmonary Tuberculosis 15 64 44 20 15 Admitted for Pulmonary Tuberculosis and found to be other disease ... ... ... ... ... Admitted for observation (including contact) ... ... ... ... ... Puerperal Fever ... 2 ... 2 ... Admitted as Puerperal Fever and found to be other disease ... ... ... ... ... Admitted for observation (including contact) ... ... ... ... ... Rubella ... 2 2 ... ... Admitted as Rubella and found to be other disease ... ... ... ... ... Erysipelas 1 5 6 ... ... Admitted as Erysipelas and found to be other disease ... ... ... ... ... Mumps ... 3 3 ... ... Admitted as mumps and found to be other disease. ... ... ... ... ... Other Diseases : ... ... ... ... ... Infantile Diarrhoea ... 10 5 5 ... Ophthalmia Neonitorum ... 8 8 ... ... Whooping Cough ... 4 2 2 ... Varicella. ... 1 1 ... ... Malaria (diagnosed Meningitis) ... 1 ... 1 ... Peritonitis ... 1 1 ... ... Food Poisoning. ... 1 1 ... ... Quinsy ... 1 1 ... ... Encephalitis ... 1 1 ... ... Totals 188 1313 1246 60 195 95 The following table gives the case mortality for all cases and for each of the principal diseases treated at the Hospital:— 1913 1914 1915 1916. 1917 1918. 1919. 1920. 1921 All Cases 2.9 3.1 .89 72 7.0 8.1 7.4 3.6 4.5 Scarlet Fever .8 .7 .9 1.8 1.0 2.0 2.0 1.3 .55 Diphtheria 3.02 6.4 4.02 4.65 4.1 13.2 8.7 3.9 5.3 Pulmonary Phthisis 12.5 12.6 37.2 40.0 48.6 35.3 52.2 12.9 31.2 Enteric Fever 19.2 20.0 33.3 100.0 — 9.0 — 25.0 16.6 Infantile Diarrhœa — — — — 33.3 — 50.0 40.0 500 Notified as Diphtheria or for observation for Diphtheria— Result. Diphtheria and Scarlet Fever 28 28 discharged „ ,, Chicken Pox 1 1 remaining in Hospital at end of year. ,, ,, Rubella 1 1 discharged. „ Mumps 5 s „ Notified as Scarlet Fever or for observation for Scarlet Fever— Result. Scarlet Fever and Diphtheria 39 36 discharged 1 died 2 remaining ,, „ Cerebro Cyst 1 1 died ,, ,, Pertussis 1 1 ,, „ „ Bronchopneumonia 2 1 „ 1 died „ „ Varicella 2 2 „ „ „ Whooping Cough 6 6 „ „ „ Albuminuria 1 1 „ Illnesses amongst the Staff— Scarlet Fever 5 5 discharged Diphtheria 10 10 „ Mumps 2 2 ,, 96 AMBULANCE SERVICE. Patients have been removed during the year both by motor and horse ambulance The motor ambulance was out of commission for four months for overhauling. The figures given below therefore refer to the period of 8 months for the motor ambulance and for the period of the whole year for the horse ambulance. No. of Journeys 998 No of Patients carried 921 Mileage 5,984 Petrol used 454 galls. Mileage per gallon of petrol 13.2 The figures relating to the Horse Ambulance are as follows:— No. of Journeys 570 No. of Patients carried 381 No. of Days Horse used 207 In the latter part of the year the horse had to be destroyed Since then the motor ambulance has alone been used, WORK OF THE BOROUGH LABORATORY. The work done in the Laboratory consists of (a) Examinations made of cases in the hospital. (b) „ „ „ „ „ „ town, either for the M.O.H., or for private practitioners. It is one of the most important and most efficient parts of the Public Health Department. Examinations for Diphtheria. For Doctors. For M.O.H. For Wards (including Nose and Throat Swabs). Grand Total. — + Total — + T otal 1714 219 1933 1660 127 1787 7260 10980 Outfits sent to the Town Hall. Diphtheria. Tubercle Enteric. Total. 3,383 1,135 9 4,521 Blood Serum prepated. 558 dozen tubes at 5/- per dozen = £139 10s. 0d. Special Media prepared. 1,000 c.c. Agar Agar. 97 TUBERCULOSIS. Results of Examinations for Tuberculosis. 1921. Examinations for Borough Examinations for Hospital. Total. All Examinations. All Examinations. All Examinations. + — Total + — Total + — Total January 11 51 62 2 3 5 13 54 67 February 11 51 62 3 1 4 14 52 66 March 12 98 110 — 4 4 12 102 114 April 19 76 95 4 — 4 23 76 99 May 24 99 123 4 1 5 28 100 128 June 12 51 63 2 3 5 14 54 68 July 14 41 55 5 1 6 19 42 61 August 18 46 64 2 1 3 20 47 67 September 15 83 98 2 2 4 17 85 102 October 12 60 72 9 1 10 21 61 82 November 12 90 102 2 — 2 14 90 104 December 7 51 58 -- 1 1 7 52 59 First Quarter 34 200 234 5 8 13 39 208 247 Second ,, 55 226 281 10 4 14 65 230 295 Third ,, 47 170 217 9 4 13 56 174 230 Fourth ,, 31 201 232 11 2 13 42 203 245 Total 167 797 964 35 18 53 202 815 1017 98 ENTERIC (TYPHOID) FEVER. Results of Examinations for Diseases simulating Enteric Fever. 1921. Examinations for Borough. Examinations for Hospital. Total. Agglutinative Reactions. Agglutinative Reactions. Agglutinative Reactions for all Purposes. + — Total + — Total + — Total January — 2 2 — - — — 2 2 February — 1 1 — — — — 1 1 March — 1 1 — 1 1 — 2 2 April — — - — - — - — — May 1 2 3 — - — 1 2 3 Tune — 2 2 — - — — 2 2 July — 1 1 - 2 2 — 3 3 August 1 1 2 4 — 4 5 1 6 September — 1 1 1 — 1 1 1 2 October — — - - - — — - — November 1 — 1 1 1 2 2 1 3 December 1 4 5 — — — 1 4 5 First Quarter - 4 4 - 1 1 - 5 5 Second ,, 1 4 5 — — - 1 4 5 Third „ 1 3 4 5 2 7 6 5 11 Fourth ,, 2 4 6 1 1 2 3 5 8 Total 4 15 19 6 4 10 10 19 29 MISCELLANEOUS EXAMINATIONS. 1 Enteric Stool 1 Anthrax. 6 Gonococci. 99 SECTION IX. REPORT TO THE EDUCATION COMMITTEE. 1. STAFF. The staff engaged in medical work amongst school children is composed of whole and part-time officers. In addition to the School Medical Officer, who is also Medical Officer of Health, the staff consists of three whole-time Medical Officers, one part-time X-Ray Specialist, one part-time Ophthalmic Surgeon, eight parttime Nose and Throat Surgeons, two part-time Dentists, and nine School Nurses. The Organizer of Physical Training in the Elementary Schools acts 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 1920. Towards the end of that year also an Elementary school teacher, after receiving special training at Manchester, was appointed and has undertaken the treatment of children suffering from certain forms of speech defect during the past year. Dr. W. N. W. Kennedy, Deputy School Medical Officer, resigned in August, and Dr. K. Simpson was appointed in September to fill the vacancy. 2. CO-ORDINATION. The School Medical Service is an integral part of the Public Health work of the town, and is therefore in natural co-ordination with all other sections of the department as mentioned in previous reports. 3. SCHOOL MEDICAL SERVICE IN RELATION TO THE PUBLIC ELEMENTARY SCHOOLS. (a) No. of Schools and Accommodation. In 1921 there were in Croydon: (a) 20 provided schools, including 52 departments. (b) 13 non-provided schools, including 24 departments. (c) 2 Central Schools, including 2 departments. The total provision in 1921 in the borough for elementary school children thus amounted to 35 schools, with 78 departments. The number of children on the register on December 31st, 1921, was 26,128, as compared with 26,088 in 1920. (b) School Buildings and Accommodation. Additional accommodation in the form of huts of the army pattern has been provided at the following schools:— Accommodation Stanford Road Domestic Subjects Room 18 Ecclesbourne Road Boys, Handicraft Room 20 Ecclesbourne Road Boys, Class Room 50 100 (c) School Hygiene. During the past year no alterations or improvements to the Sanitary arrangements at schools under the Education Committee were carried out, apart from a few necessary minor repairs to drains, rain water pipes and sanitary fittings. 4. MEDICAL INSPECTION. Reference should here be made to Table I. Appendix A. (a) The classes of children medically inspected in Croydon and the number so examined in each class, 1st January, 1921, to 31st December, 1921, are as follows:— Routine Inspection. Under the Regulations of the Board of Education : Children admitted for the first time during the year 5304 Children between the ages of eight and nine years 459 Children between the ages of 12 and 14 years and other age groups 2317 Total 8080 Inspection of Selected Children. Obviously defective and submitted by Head Teachers, Attendance Officers, School Nurses, Care Committees, etc. 1465 Not obviously defective:— (i.) Fitness for employment in accordance with Bye-laws regulating the employment of young persons 192 (ii.) Candidates as bursars and student teachers 32 Defective children re-examined 300 All routine and many special inspections were made on the school premises. Other special inspections involving more careful examinations were made at the Inspection Clinic, 228, London Road, a Special Clinic for this purpose being held on two sessions per week, at which all cases requiring more detailed examination than was possible in school were seen. Cases for juvenile employment, children having milk in school, and all subjects of cardiac or nervous affections or arrested tuberculosis, etc., are dealt with also at this inspection. 101 The following table shows the total number of children examined at routine inspections during 1921 classified according tc 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) 10 216 - 121 „ „ „ 8 — 144 85 Boston Road „ „ 6 167 — 34 „ „ „ 6 — 115 51 Brighton Road „ „ 6 124 — 50 „ „ „ 4 — 86 68 Davidson Road „ „ 9 262 — 180 „ „ „ 8 — 127 101 Dering Place ,, „ 5 99 — 51 „ „ „ 4 — 120 88 Ecclesbourne Rd. „ „ 9 185 — 124 „ „ „ 7 - 198 138 Ingram Road , „ 9 209 — 130 „ „ „ 7 — 195 155 Mitcham Road „ „ 6 159 - 58 „ „ „ 5 — 149 71 Oval Road „ „ 7 154 — 94 „ „ „ 6 — 168 118 Portland Road „ „ 11 265 — 131 „ „ „ 8 — 236 191 Princess Road ,, „ 6 160 - 70 „ „ „ 6 — 172 83 South Norwood „ ,, 8 158 - 43 „ „ „ 6 - 186 67 Spring Lane „ „ 1 9 — 9 „ „ „ 1 — 10 9 Stanford Road „ „ 3 48 - 39 „ „ „ 2 — 73 67 Sydenham Road ,, ,, 8 185 — 102 „ „ „ 7 — 176 97 Tamworth Road „ „ 6 174 — 50 „ „ „ 3 — 35 28 Tavistock Grove „ ,, 8 204 — 60 „ „ „ 6 — 163 98 Upper Norwood ,, „ 3 78 — 58 „ „ „ 2 — 66 36 Whitehorse Rd. „ „ 8 127 — 99 „ „ „ 5 — 122 68 WinterbourneRd. „ „ 6 182 — 118 „ „ „ 6 — 226 167 Woodside „ „ 9 218 — 108 „ „ „ 7 — 187 149 Grangewood Special „ 1 1 — 1 „ „ „ - - - - Day Central „ „ 1 24 - - „ „ „ 1 — 27 22 Totals 261 3408 2981 3687 102 Council (Non-Provided) Schools:— All Saints' School (All Departments) 2 45 — 29 „ „ „ 2 — 50 37 Christ Church ,, „ 6 150 - 60 „ „ „ 5 — 113 74 (Wildbore's) „ „ - — — — „ „ „ — — — — Holy Trinity „ „ 2 52 — 36 „ „ „ 3 — 60 56 Parish Church ,, ,, 5 197 — 127 „ „ „ 7 - 98 61 St. Andrew's „ „ 6 122 — 70 „ „ „ 4 — 122 93 St. Joseph's ,, „ 1 14 — 14 „ „ „ 1 — 16 16 St. Mark's ,, „ 2 11 — 8 „ „ „ 1 — 57 33 St. Mary's ,, ,, 3 95 — 34 „ „ „ 3 — 72 37 St. Michael's ,, ,, 3 44 — 29 „ „ „ 1 — 51 31 St. Saviour's ,, ,, 2 58 - 51 „ „ „ 2 — 49 38 Arch. Tenison's „ „ 2 32 — 18 „ „ „ 1 — 47 35 St. Peter's ,, ,, 2 53 — 40 „ „ „ 3 — 62 58 Shirley „ „ „ 1 12 — 2 „ „ „ 1 — 9 5 Totals (for Non-Provided) 71 885 806 1092 Totals (for Provided) 61 3408 2981 3687 Totals (for Provided and NonProvided) 332 4293 3787 4779 8080 (b) The Board's schedule of medical inspection has been followed in its entirely. (c) The following- are the sources from which early ascertainment of crippling defects have been obtained:— (1) As a result of medical inspection, cither 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. 103 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 1921. Some of the noteworthy defects so discovered are considered more particularly below. Uncleanliness. Out of 8,080 children examined at Routine Inspections, 47 or 0.58 per cent. were found to harbour body vermin; 61 or 0.57 per cent. had head vermin; 709 or 8.7 per cent. were found to have nits in the hair although no adult lice were seen; 15 or 0.18 per cent. had simply dirty heads: whilst 86 or 1.0 per cent. were described as dirty generally. Compared with last year, the figures show a slight decrease and the improvement which had been made during previous years with the exception of the year 1920 is again being manifested. Apart from the Routine examinations, Uncleanliness Inspections were conducted by the School Nurses at the various Council Schools. 16,817 children came under review, 9 had body vermin, 278 head vermin, and 1,940, whilst having no adult lice, were found to harbour the eggs in the hair. Slightly over 1/8 th of these children gave evidence of vermin infestation. Cleansing Station. Eight children were cleansed on account of body vermin. Scabies is less prevalent than in 1920; 8 children were treated for this condition. In every case of body vermin and scabies personal clothing, bedding and the room occupied by the child infected are disinfected on the same day as arrangements have been made to cleanse the child at the Station. Facilities are also offered for cleansing any or all of the remaining members of the family. Cleansing of verminous heads alone is not undertaken as a routine measure, mainly owing to lack of accommodation. Clothing. Children with dirty clothing numbered 22, or 0.27 per cent. Children with defective footgear numbered 18 or 0.22 per cent. Footgear which afforded insufficient protection has been observed in a considerable number of other children, although the condition is not sufficient to warrant these cases being included under the heading of defective footgear. In most instances it appeared to be the result of financial stress in families. 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 41.9 39.2 38.4 8 48.4 47.8 51.9 53.5 13 57.4 57.1 79.6 76.0 104 Malnutrition amongst school children is decreasing. Whilst in the previous year 351 (5.2 per cent.) came under observation on this account, 125 (or 1.5 per cent.) were observed during the year 1921. In the 1920 report the principal causes of malnutrition were summarised, and it is only necessary to emphasise again that apart from the want of food, all the ordinary physical causes of malnutrition are powerfully combatted by fresh air. Playground classes and open windows in the schoolrooms should be the rule, not the exception. The provision of open-air schools is long overdue in Croydon, and is an urgent necessity for the welfare of the school children. Vision and External Eye Disease. 892 Children had defective vision and III were found to be suffering from some form of external eye disease, such as ulcers and inflamed eyelids. Such children were treated at the Minor Ailments Clinic and, where necessary, referred to the Ophthalmic Surgeon. Enlarged Tonsils and Adenoids. 1,264 Children, or 15.6 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. Lymphatic Glands. Glands in the neck were found enlarged in 1,640 children, or 20.3 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. 84 Children, or 1.0 per cent., were deaf and 63, or .78 per cent., suffered from car disease. The main causes of deafness are wax, adenoids and middle ear disease, the latter showing itself by perforation of the .drum and discharge, and apart from trauma, usually follows Scarlet Fever, Measles and occasionally Diphtheria. Special arrangements for dealing with deafness and middle ear disease are much needed as suitable early treatment frequently makes all the difference between efficiency and inefficiency in adult life. Defective Teeth. 3,235 Children, or 40.0 per cent., were found at Routine Medical Inspections to have four or less than four decaying teeth, and 1,040 children, or 12.9 per cent., more than four defective teeth. Slightly more than half the children examined therefore had carious teeth. 105 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 43 9 71 57.7 5-6 383 167 516 48.4 6-7 235 113 251 41.9 7-8 54 20 69 48.2 8-9 427 162 321 35.2 9-10 40 17 50 46.7 10-11 6 4 28 73.6 11-12 11 4 14 48.2 12-13 326 56 411 51.8 13-14 159 15 272 60.9 14-15 22 ... 1 43.5 Totals 1706 567 2020 47.1 Total number of boys inspected 4293 GIRLS. 3-4 ... ... 1 100.0 4-5 32 7 64 62.1 5-6 382 130 478 48.2 6-7 263 118 230 37.6 7-8 70 43 66 36.8 8-9 255 106 234 19.3 9-10 78 23 85 45.7 10-11 15 2 42 71.1 11-12 14 2 26 61.9 12-13 286 28 371 54.1 13-14 117 13 172 56.9 14-15 17 1 15 45.4 15-16 ... ... 1 100.0 Totals 1529 473 1785 47.1 Total number of girls inspected 3787 106 The present school dental service is not capable of coping with the situation. Inspections and Dental Treatment are practically limited to the age group 6-7 years, except in special cases when the child's health is found to be affected directly as the result of dental disease such as acute pyorrhoea alveolaris. In addition septic conditions of the teeth are treated in children selected for removal of tonsils or adenoids and occasionally in those suffering from tuberculosis. Affections of the Heart. 133 Children, or 1.6 per cent., were found to have permanently damaged hearts, caused in many cases by attacks of acute or subacute rheumatism. 152 Children, or 1.8 per cent., had temporary and mild heart affections of a functional character associated with anæmia 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. 526 Children, or 6.5 per cent., suffered from anæmia. Affections of the Lung were found in 173 children, or 2.1 per cent. Most were suffering from bronchitis or mild forms of bronchial catarrh. Tuberculosis. 78 Children, of .96 per cent., were found to be suffering from tuberculous infection in one or the other of its manifestations. Of these, 15 children were suffering from tuberculosis of the lungs whilst 25 were suspected of having the disease in the lungs in an early stage, including intestinal tuberculosis. Apart from 1 case of spinal tuberculosis and 2 cases of tuberculous hip joints, the remaining cases were tuberculous infection of the neck and axillary glands. All cases have been referred to the Assistant M.O.H. for Tuberculosis for treatment or disposal. Nervous Diseases. 9 Children were found suffering from epilepsy and 19 from chorea (St. Vitus' dance), a condition which is associated with rheumatism, but sometimes follows scarlet fever, or occasionally may be contracted in school from an affected child as result of imitation. Deformities. 62 Children were found deformed as a result of rickets contracted in infancy. 296 Children suffered from marked degrees of spinal curvature. 40 Children were found crippled as a result of infantile paralysis. 107 Ringworm. 45 Children were found to have the ringworm fungus in the hair of the head and 12 were infected with body ringworm. Skin Affections. Scabies or itch was found in 18 children, and impetigo or infectious scabs in 82 children. Mental Conditions. 98 Suspected mentally subnormal children were submitted by head teachers as routine or special cases at the various School Medical Inspections, such being one of the sources through which these cases come to the knowledge of the School Medical Officer. It is not possible 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 therefore 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 120. 6. INFECTIOUS DISEASE. At Routine Inspections 17 cases were found. In addition, 14 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, Health Visitors or School Attendance Officers. Notices of infectious diseases were despatched to the respective schools bv the Public Health Department in 4,554 cases as described hereunder:— Illness. 1st Quarter. 2nd. Quarter. 3rd Quarter 4th Quarter. Total. Scarlet Fever 59 81 100 245 485 Diphtheria 67 71 47 96 281 Measles 22 30 3 74 129 ,, (German) — 4 11 3 18 Mumps 370 320 71 104 865 Whooping Cough 365 320 62 15 762 Chicken-pox 155 60 31 100 346 Sore Throat 38 33 39 77 187 Ringworm (Scalp) 37 29 11 17 94 ,, (body) 28 19 8 18 73 Impetigo 123 93 55 82 353 Scabies 34 11 10 7 62 Eye Cases 14 8 15 15 52 Other diseases 258 212 123 253 846 Body vermin — — — 1 1 Totals 1570 1291 586 1107 4554 108 School Closure. In accordance with Article 45 (b) of the Code the following schools were closed:— School. Department. Disease. Closure. From To St. Saviour's Girls Measles March 21st April 8th »» Infants Measles ,, 21 st „ 8th Arch. Tenison s Girls Scarlet Fever Septem. 27th October 7th St. Peter's Infants Scarlet Fever „ 27th „ 7th South Norwood Infants Chicken Pox October 7th November 4th Portland Road Infants Measles „ 27th „ 25th South Norwood Infants Measles Novem. 28th December 23rd School premises were disinfected when necessary. In all 23 school departments and 16 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 school nurses 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 treatment either from private medical practitioners, hospitals, or at the different treatment clinics established by the Education Committee in the Borough. The nurses also follow up cases which are not responding and endeavour to get the defaulting parents to obtain the necessary attention to the child. 109 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 282 99 Diphtheria 334 376 Erysipelas 2 1 Measles 146 13 German Measles 43 13 Mumps 1031 60 Whooping Cough 943 66 Chicken Pox 445 28 Sore Throat 447 275 Ringworm (scalp) 82 338 ,, (body) 97 99 Verminous Heads 3 2 Verminous Bodies - — Impetigo 845 1221 Scabies 103 258 Infectious Eye Disease 93 156 Other Diseases 1541 873 6437 3878 Visits paid to Elementary Schools for Medical Inspection 332 - Number of Children prepared for Medical Inspection:—Newly Inspected 8080 - Re-inspected 300 - Specially Inspected 1465 - Other Visits to Elementary Schools 139 - Hom Visits arising out of Medical Inspection 1992 1904 Home Visits for other information 1096 263 Cultures taken 1472 123 8. MEDICAL TREATMENT. Minor Ailments. There is one clinic at 228, London Road available for the treatment of minor ailments. It is open daily. One of the medical staff is present thrice weekly to direct treatment and to make special examinations. A nurse is in attendance every day to carry out necessary treatment. 1,024 Children were examined or treated for different conditions; there were 3,557 attendances. Table IV. (A) Appendix A, indicates the amount and nature of the work at the Centre. 70 Children out ofthe total of 75 suffering from ringworm of the scalp were subjected to X-ray treatment. Uncleanliness. A brief account of the treatment of uncleanliness is given in Table IV. (E), Appendix A. 110 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. The clinic was open on one or two afternoons each week to meet the numbers of cases referred for and awaiting treatment according to the pressure of cases or their urgency for treatment. The actual operations and administration of anaesthetics are undertaken by eight local medical practitioners working in pairs and in rota for three-monthly periods. 307 Cases were treated at The clinic, and, as in previous years, all those having dental caries were, prior to the operation, treated by the Dental Officers at the School Dental Clinic. The number of children treated for dental caries prior to operation at the throat clinic was 310. During the year classes were held in which instruction in the correct methods of breathing was given to children referred from School Medical inspection as mouth breathers from causes not remediable at the Throat Clinic, and those who had recently been treated at the Throat Clinic. These classes were held in a large room at the Central Polytechnic and conducted by Miss Cooke. This form of after-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 affection of the throat and nose. 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. The 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 year the class met on 421 occasions, 200 children were treated following operations for tonsils and adenoids, while 37 mouth breathing children were also treated. 111 Tuberculosis. The closest co-operation exists between the School Medical Service and the Tuberculosis Dispensary. The advice of the Asst. M.O.H. for Tuberculosis is sought in regard to every case or every suspected case of the disease found by school medical inspectors amongst children attending school. 72 Children were in this way referred to the Tuberculosis Officer for corroborative diagnosis and subsequent treatment or disposal. Out of this number, 3 were found after a period of observation to have no signs of the disease. In addition, 26 children of school age were referred to the Dispensary from other sources and 130 contacts of the disease examined. The total number of attendances at the Dispensary of children of school age during the year amounted to 3,422. 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. 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 574, and the total number of attendances at the clinic 1,329. Cases of external eye disease, such as conjunctivitis, blepharitis, corneal ulcers, are seen in the first instance at the minor ailments clinic and when necessary referred for more specialist treatment to the ophthalmic surgeon. Spectacles are not provided, but parents may obtain glasses at reduced rates from an optician in the town, or free in certain cases which are referred for assistance to the After-Care Committee. A summary of the treatment of visual defect is given in Table IV. (B), Appendix A. 112 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 Inspection of Schools (Children 5—9 years of age) School. Children Examined. Teeth all sound. Teeth Defective. Percent'ge with Sound Teeth. Boys. Girls Total. Boys. Girls. Boys. Girls. Boys. Girls. Beulah Road 65 69 134 19 23 46 46 29.2 33.3 Boston Road 62 58 120 18 12 44 46 29.0 20.7 Brighton Road 69 46 115 9 7 60 39 13.4 15.2 Davidson Road 67 69 136 14 13 53 56 20.9 18.8 Dering Place 31 30 61 7 3 24 27 22.5 10.0 Ecclesbournc Road 62 67 129 15 12 47 55 24.3 17.9 Ingram Road 53 40 93 13 9 40 31 24.5 22.5 Mitcham Road 55 66 121 11 3 44 63 20.0 4.5 Oval Road 41 56 97 5 11 36 45 12. 1 19.6 Portland Road 50 86 136 14 20 36 66 28.0 23.2 Princess Road 49 49 98 10 11 39 38 20.4 22.4 South Norwood 47 23 70 6 4 41 19 12.8 17.4 Stanford Road 90 89 179 21 27 69 67 23.3 30.3 Sydenham Road 25 18 43 4 5 21 13 16.0 277 Tamworth Road 37 14 51 5 3 32 11 13.5 21.4 Tavistock Grove 58 62 120 8 6 50 56 13.8 9.6 Upper Norwood 35 30 65 7 5 28 25 20.0 16.6 Whitehorse Road 7 15 22 2 3 5 12 28.6 20.0 Winterbourne Road 10 11 21 5 2 5 9 50.0 18.1 Woodside 130 108 238 38 27 92 81 29.2 25.0 All Saint's 21 17 38 2 ... 19 17 9.5 ... Christ Church, Longley Rd. 85 70 155 11 9 74 61 12.9 12.8 Christ Church, Boston Rd. 9 12 21 3 1 6 11 33.3 8.3 Holy Trinity 18 61 79 3 11 15 50 16.6 18.0 Parish Church 21 55 76 6 5 15 50 28.5 9.1 St. Andrew's 25 27 52 3 3 22 24 12.0 11.1 St. Andrew's Old Town 11 16 27 ... ... 11 16 ... ... St. Joseph's 6 5 11 4 1 2 4 66.6 20.0 St. Mark's 13 31 44 3 5 10 26 23.0 16.1 St. Mary's 43 42 85 3 3 40 39 7.0 7.1 St. Saviour's 54 52 106 16 16 38 36 29.6 30.7 Archbishop Tenison's 34 34 68 6 2 28 32 17.6 5.9 St. Peter's 25 32 57 9 4 16 28 36.0 12.5 Shirley 17 7 24 ... 2 17 5 ... 28.6 Totals 1425 1467 2892 300 268 1125 1204 21.0 18.2 Dental Re-inspection of Schools. []Date School Children with teeth all sound at previous inspection. Children who were treated at the Dental Clinic for cariee discovered at previous inspection. Children found to have defective teeth at primary inspection, but who have not been treated at the Dental Clinio. At re-inspection. At re-inspection. 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 reoeived no dental treatment Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls Boys. Girls. Boys. Girls. Boys. Girls. 1921. Jan. 24 Mitcham Road 4 2 1 ... 5 4 ... ... ... ... ... ... ... ... 60 24 Princess Road 7 3 ... 1 3 3 3 3 ... 1 ... 1 ... ... 16 24 *7 Winter bourne Road 4 4 ... 1 6 3 1 1 4 2 3 1 1 ... 12 6 »» 31 St. Andrew's 2 9 .. 3 3 2 ... ... ... 1 ... 1 ... ... 4 9 Feb. 1 Sydenham Road 3 5 1 ... 6 3 1 ... 1 1 1 1 1 ... 8 12 ,, 10 Christ Church (Boston) ... ... ... ... 3 1 1 ... ... ... ... ... ... ... 8 18 ,, 11 Stanford Road 2 2 1 ... 3 4 1 ... 2 2 ... 2 2 ... 2 1 11 *4 Tavistock Grove ... ... ... ... 3 ... 1 ... ... ... ... ... ... ... 12 10 .1 15 All Saints' 3 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 15 Upper Norwood 1 3 ... ... 3 2 ... ... ... ... ... ... 1 ... 3 5 .1 15 St. Joseph's ... 1 ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... 11 21 Christ Church 3 5 1 1 ... ... ... ... 1 ... 1 ... ... ... 15 16 .1 23 Brighton Road 4 6 1 1 3 1 ... ... ... ... ... ... ... ... 10 12 11 25 Oval Road 2 2 1 1 2 1 ... 1 ... ... ... ... ... ... 4 9 Mar. 8 South Norwood 6 6 3 6 6 ... ... ... ... ... ... ... ... ... ... 8 St. M irk's 4 1 ... ... 2 1 ... ... ... ... ... ... ... ... ... ... 11 i6 Davidson Road 5 2 ... ... 4 3 2 1 ... 1 ... 1 ... ... 16 9 .. 23 Holy Trinity 1 5 ... ... 1 6 ... ... ... 1 ... 1 ... ... 6 10 .. 23 Parish Church ... 5 ... 1 3 2 2 2 ... ... ... ... ... ... 8 8 May 3 St. Savionr's 11 4 ... 3 4 9 ... 1 ... ... ... ... ... ... 13 18 >• i° Beulah Road 7 5 1 ... 3 5 ... 1 ... 1 ... ... ... 19 7 .. 3' Portland Road 6 2 ... 1 4 8 2 2 ... ... ... ... ... ... 18 11 .. 3° Mitcham Road 1 7 ... 3 ... ... ... ... ... ... ... ... ... ... 10 19 lune 7 Ecclesbourne Road 11 8 2 1 4 10 1 1 ... ... ... ... ... ... 12 11 .1 Tennison's ... 5 1 2 1 ... ... ... ... ... ... ... ... 3 ... July 1 W oodside 6 6 1 ... 3 6 2 ... ... ... ... ... ... ... 18 14 June 27 Dering Place 3 2 1 ... 6 3 ... 2 2 2 2 2 ... ... 13 15 July 20 Ingram Road 5 7 ... ... 2 2 1 .. ... ... ... ... ... ... 16 20 11 21 Boston Road 5 5 ... ... ... ... ... .. ... 3 ... ... ... ... 12 12 Sept. 7 Tamworth Road 5 1 2 1 ... 2 ... 1 ... ... ... ... ... ... 22 10 9 Whitehorse Road 12 23 5 6 20 10 1 1 5 3 5 3 ... ... 67 45 .. '5 Princess Road ... ... ... ... 2 2 2 ... ... ... ... ... ... ... 5 8 1. 21 Brighton Road 3 3 2 3 1 ... ... ... ... 1 ... 1 ... ... 20 6 .. 3<> Sydenham Road 14 8 2 4 6 6 ... ... 1 2 ... 2 1 ... 42 24 Oct. 13 Tavistock Grove 5 6 8 4 3 1 ... ... 1 1 1 1 ... ... 20 18 ,. 18 Winterbourne Road 25 20 7 6 14 12 ... 1 3 4 3 2 ... ... 25 23 Nov. 4 Rockmount Road 3 3 3 ... ... ... ... ... ... ... ... ... ... ... 13 4 11 11 All Saints' 1 ... ... ... 2 3 ... ... ... ... ... ... ... .. 7 10 11 ii St. Joseph's ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 9 Oval Road 2 4 1 2 4 6 1 2 ... 1 ... 1 ... ... 7 11 .. 23 Stanford Road.. 9 13 ... 3 5 7 1 ... 1 1 ... 1 1 ... 18 12 .. 3° South Norwood 2 ... ... ... ... 3 ... 1 ... 1 ... 1 ... ... 15 4 »l 1* St. Mary's 2 1 1 1 ... ... ... ... ... ... ... ... ... ... 19 10 Dec. 7 St. Mark's ... 1 ... 2 1 4 ... 1 ... ... ... ... ... ... 1 8 „ 18 St. Saviour s 6 4 2 1 8 6 ... ... 1 1 1 1 ... ... 7 5 .. '4 Holy Trinity ... 3 ... 1 1 5 ... ... ... ... ... ... ... ... 3 24 .. "5 Beulah Road 20 4 1 1 12 7 ... 1 2 ... ... ... 2 ... 24 ... .. 14 Davidson Road I 5 ... ... 7 6 3 ... ... ... ... ... ... ... 8 9 113 The work of the Dental Clinic 1921. No. of Permanent Teeth. No. of Temporary Teeth. Total Number 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). Filled. Extracted (2). Filled. Permanent Teeth. Temporary Teeth. Hoys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Routine Inspections 16 17 62 75 1415 1405 301 247 363 322 28 20 25 13 50 47 430 457 After re-inspection ... ... 14 6 285 105 48 20 62 26 ... 1 3 2 3 ... 75 38 Specials 6 1 ... ... 74 65 9 2 14 2 3 3 4 ... 2 15 12 24 Tonsils and Adenoids Cases 2 11 3 8 267 239 35 25 38 33 5 12 2 1 8 1 135 106 Backward Class Cases ... ... ... ... 2 4 ... ... ... ... ... ... ... ... 3 2 7 7 Totals 24 29 84 89 2043 1818 393 294 477 383 36 36 34 16 66 65 659 632 No. of half-days devoted to inspection 45 „ „ „treatment 292 Total number of attendances made by children at the Clinic 3266 Number of new cases treated during the year:— Routine 797 After re-inspection 146 Specials 48 Tonsils and Adenoids Cases 145 Backward Class Cases 11 1147 114 Out of 2,329 children referred for dental treatment, the parents or guardians of 1,147, or 49 per cent., made use of the opportunity offered, an improvement of 14 per cent. over the preceeding year. As in other departments of the School Medical Service, School Nurses follow up at the homes of children with defective teeth, and thereby ensure a larger attendance of children at the Dental Clinic who otherwise would not obtain treatment through a hospital or privately. Crippling Defects and Orthopœdics. As in previous years the treatment by remedial exercises of children suffering from spinal curvature was carried out under the supervision of the medical staff 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 (1st degree only) 55 ,, discharged as not requiring further treatment 29 ,, discharged for other reasons, e.g., for hospital treatment, over school age, etc. 12 ,, attending on December 31st, 1921 24 Total number of attendances during 1921 1662 As far as possible only the more severe cases of spinal curvature are treated at this, clinic, classes having been formed at Whitehorse Road School and St. Andrew's School in which children suffering from milder degrees of curvature were 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. Admissions to and discharges from these classes are made lay the Medical Officer at his monthly visits. In connection with the causation of the milder degrees of scoliosis, although figures for the full year are not obtainable, it is significant to notice that many of these subjects suffer from minor differences in the length of the two lower limbs. Other causative factors are associated with the acquisition of faulty attitudes in sitting, writing, etc., traceable in some instances to the use of the older types of school desk. Under Miss Cooke as masseuse and Miss Appleton, the holding of breathing exercise classes and the Spinal Remedial Class are conducted 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. 115 During the year 75 cases were treated by massage:— Paralysis (infantile) 13 Spastic conditions and birth palsies 9 Scoliosis (2nd and 3rd degrees) 32 Talipes 1 Flat Foot 6 Rickets 4 Torticollis 3 Cong. Distn. Hip 1 Friedreich's Ataxy 1 Thomsen's Disease 1 Fractures (old) 2 Progress. Muscular Atrophy 1 Post. Diphtheritic Paralysis 1 Total 75 Certain of these cases also received remedial exercises, which were carried out under the supervision of Miss Cooke. Whilst, where necessary, others were recommended to various hospitals for operation, or for special treatment such as electrical. The provision of electrical treatment locally is a real need, and its absence makes the treatment of many atrophic muscular conditions much less satisfactory than it otherwise should be. A summary of the treatment of the defects as shown in Tables IV. (A. B. C. and 1).) is given in Table V., Appendix A, whilst Table VI, Appendix A, supplies a summary relating to children medically inspected at. the Routine inspections, 1921. There are at present 70 children known to us, and almost certainlv there are many more, who are suffering from physical defects requiring the daily use of surgical appliances, a proportion of whom are unable to attend ordinary schools. Notwithstanding this, the Borough still lacks the provision of a School for Cripple Children—a deficiency in the elementary school provision which was pointed out many years ago, and which should be met at the earliest possible date. 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, and though this has been adopted in a few instances, it is of necessity limited to dry weather in the summer months. As recommended in former reports, a much greater use might be made of the recreation grounds—so abundantly supplied in the Borough—as teaching centres. Open-air classes should be held in these to the greatest extent possible. 116 10. PHYSICAL TRAINING OF GIRLS. 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, 1922. Ladies and Gentlemen, I beg to submit the report of my work as Organiser of Physical Training for the year 1921. The outstanding feature of the work in the Elementary Schools for the year was the introduction of the daily physical training lesson. Every class now has a daily twenty-minute" period devoted to Physical Training in one of its branches. The general weekly arrangement provides for three physical exercises, one organised games, and one folk dancing lesson. During the summer months swimming is included for as many senior scholars as can be arranged for at the Baths. Thus endeavour is made to interpret aright the real meaning of Physical Training which, as the Chief Medical Officer of the Board of Education says, " means not the old form of school drill, but an efficient system of education of the body which encourages the concurrent development of healthy physique, keen intelligence and sound character." Definite progress has been made during the past year towards the recognition of Organised Games as a necessary and valuable part of the training of school children in that Standards VI. and VII. of sixteen Girls' and Senior Mixed Departments have been trained in this subject in the public recreation grounds of the town. The ordinary instruction of the other children in organised games has been given in the playgrounds as hitherto, but the increased possibilities of the recreation grounds has been of the greatest advantage to the older classes. I submitted a special report in July, 1921, on the working of this scheme, so would here only repeat my belief that great benefit both physically and morally is derived from such play. Miss Palmer, one of His Majesty's Inspectors of Physical Training, spent several days in Croydon in March, visiting many of the schools and evening institutes. Four Inter-form Physical Exercise Competitions were held during the year at Davidson Road Girls' School, Winterbourne Road Girls' School, Sydenham Road Girls' School, and All Saints' Girls' and Infants' School. I also judged the Inter-form competition at the Selhurst Grammar School for Girls. A demonstration for parents' was arranged by the Head Mistress of Ecclesbourne Road Girls' School. Various classes showed physical exercises, dancing and organised games, and I spoke to the parents on the aims and effect of the Physical Training given in the school and the need of suitable clothing for the lessons, illustrating with specimen garments and shoes. Thirty Girls' and Senior Mixed Departments attended the Swimming Baths during the summer. The time-table was so arranged that, with one or two exceptions, only one school was in 117 the Bath at a time. This made the teaching very much easier, and was appreciated by scholars, teachers and baths Superinten dents alike. The schools using South Norwood and Thornton Heath baths had a very short season, as the baths were not available till late in the season owing to the coal strike. Many schools arranged a small swimming gala of their own at the end of the season, in addition to taking part in the one arranged by the Croydon Elementary Schools Athletic Association. Instead of visiting the schools only when a Physical Training lesson is scheduled on the time-table, I now spend a whole session in one department, notifying my visit beforehand. In this way I am able to see many more classes and to gain a more general view of the Physical Education of the school as a whole. The gymnastic classes at the Evening Institutes were continued as before and, for the first time, a women's gymnastic class was held in connection with the Central Polytechnic. Two classes were held also in connection with Old Scholars' Associations. The following Teachers' Courses were held during the year : 1. Twelve lessons in Physical Exercises for Teachers in Senior Departments. 2. Six lessons in Physical Exercises for Teachers in Senior Departments, on work suitable for girls in Standard 7. Both these courses were conducted by me at Tavistock Grove School. 3. Six lessons in Dances and Rhythmic movements suitable for Infants' Departments. This course was held at Winterbourne Road School, and was conducted by Miss Crowdy. 4.—Eight lessons in Dances suitable for Senior Departments, conducted by Miss Orr at Tavistock Grove School. As usual, all these courses were well attended, and I cannot speak too highly of the enthusiastic response of the teachers to any courses of Physical Education I am able to arrange. As in former years, I devoted four sessions weekly to the Spinal Remedial Clinic, particulars of which are given in the report of the School Medical Officer. Since my report of 1920, classes have been formed at Whitehorse Road and St. Andrew's Girls' Schools for the treatment of round shoulders and poor posture generally. Each of these classes is conducted by a member of the school staff and educational gymnastics only are taken, but it is hoped that the special daily, individual attention which can be given to a small class of this description may be sufficient treatment for those children who, though of poor physique, are not suffering from definite spinal curvature. These classes were started at the suggestion of Dr. Barrie Lambert, a Medical Officer of the Ministry of Health, and are modelled on the lines of those carried out in certain L.C.C. Schools, one of which was visited bv Dr. Kennedy and myself before the Croydon classes were started. The girls in these two classes are examined regularly by the School Medical Officer, and those with any serious defect are drafted on to the Spinal Remedial Clinic. MAY APPLETON, Organiser of Physical Training. 118 10a. PHYSICAL TRAINING OF BOYS. With respect to the Physical Training in the Boys' Departments with which Miss Appleton's report does not deal, the Committee made arrangements in June, 1921, for Mr. W. A. Long, Physical Training Instructor at the Selhurst Grammar School for Boys, to visit all the Boys' Departments throughout the Borough for one half day a week. Twenty-six Boys' Departments attend the swimming baths during the summer under arrangements similar to those provided for the girls, whilst seventeen departments have availed themselves of the privilege offered for organised games in the public recreation grounds. 11. PROVISION OF MEALS. The selection of suitable children is made usually from recommendations submitted by the School Medical Officer, School Teachers, Attendance Officers and Care-Committees. Recommendations are considered and approved by the School Canteen SubCommittee. 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. 443 children were given free dinners. 16383 free dinners were provided. 143 children received free milk. 223 children received milk on part payment, and 94 children received milk, full payment for which was made by parents or guardians. It is noticeable, compared with last year, that the number of free dinners is little more than half that for the previous year. Milk was usually supplied on the recommendation of the School Medical Officer. Recommendations for milk supply are also made by the Tuberculosis and the Maternity and Child Welfare Medical Officers. To avoid the duplication of milk recommendations, a milk Register is kept at the Central Office of the Public Health Department, and all recommendations made from the various sections of the Department are in this way checked and single issues ensured. 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 59.1 per cent. responded, as compared with 50.9 per cent. in 1920. 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 119 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. CO-OPERATION 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 National Association for the Prevention of Cruelty to Children. 16. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Table III., Appendix A, gives a numerical and classified account of exceptional defective children under the age of 16. Nominal registers from which this table is obtained are being transferred and compiled after another system, so that it is not unlikely that several exceptional children have 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. Among 21 of the former, 8 children, and among 15 of the latter, 5 children, it will be noticed, attend special schools. 120 MENTALLY DEFECTIVE CHILDREN. The work connected with the examination and certification of these children is shared by the School Medical Officer and the Deputy School Medical Officer, both for this purpose being Certifying Officers. 146 children were examined, 38 of which were special examinations at Grangewood Special M.D. School. Of the 108 new cases examined:— A. 31 were certified as mentally defective. B. 44 were found to be dull and backward (10 retarted under 2 years, 17 retarded 2 years, 7 retarded 2-3 years, and 10 retarded 3 years). C. 10 were found to be of average intelligence. D. 15 were referred for physical treatment. E. 8 were referred for school observation and some education before diagnosis. 108 These cases were disposed of as follows, viz.:— A. 26 were recommended for the Special School. 3 were recommended to be under supervision at home. 2 were recommended for Institutional treatment. B. 25 were recommended for special class. 5 were returned to ordinary class with special supervision recommended. 14 were to be re-examined after physical treatment. C. 10 were dismissed as normal. D. 15 were not to be classified until after clinical or hospital treatment. E. 8 were to be re-examined after observation at school. 108 GRANGEWOOD SPECIAL M.D. SCHOOL. The number of children receiving instruction at Grangewood Special School has been maintained at the same level as in 1920. 121 The following is a summary of the number of children who attended:— Number of children on Register on 31st December, 1920 75 Number of children admitted to class during 1921 16 Number of children discharged and re-admitted to Council Schools, 1921 1 Number of children discharged for unsuitability 2 Number of children left to take up employment 5 Number of children left over age 5 Number of children left—left district 1 Number of children on Register, December 31st, 1921 77 Special classes for dull and backward children have been formed so far in the following Schools:-Boston Road Boys' (2 classes), Boston Road Girls, Ecclesbourne Road (2 classes), Princess Road Girls', Tamworth Road Junior Mixed and Infants'. Due to the want of accommodation the Inspector has not been able to arrange similar accommodation in the non-provided schools. Dull and backward children are delayed mentally for 1, 2 or even 3 years compared with normal children. A greater delay usually amounts to a finding of mental deficiency. PHYSICALLY DEFECTIVE CHILDREN. The treatment of these children has been discussed under other headings. SPEECH DEFECTS CLASS. Report of Work for Year Ending 31st December, 1921. The work of this class began on January 17th, 1921, at the Tamworth Road Council School with a group of 11 children of ages ranging from 11 to 14 years, chosen by Dr. Kennedy, late Deputy School Medical Officer. Class instructions were given throughout the year by Mme. Blazer, who had previously been given the opportunity for studying the treatment for stammering children at the Manchester Education Authorities Special Classes, with a view to placing this new class under her direction. Later on, viz., at the end of April, the classes were held at the Central Polytechnic. The method followed, known as the Berquand Method, included breathing, vocal, and articulation exercises as well as a certain intoned kind of reading which is the link or transition from chanting to slow speech. The stammerer aims at a gradual speeding-up of the smooth drawling mode of speech thus acquired, till it approaches the normal. The curriculum included also the ordinary school subjects, such as English, Needlework, Singing and Drawing. 122 The course of treatment usually lasted 8 weeks. In conformity with the instructions of the Board of Education for the "following up" of cases which had completed a course at the Speech Defects Class, a definite time was arranged by the Chief Inspector of the Education Committee, during which the schools from which candidates were drawn, were visited, so as to ascertain the condition (as regards stammering) of those who had received instruction. Any children who were found to have lapsed were recommended to return for a fortnight's revision course at the end of the ordinary eight weeks' course. Of three cases which did not yield to treatment, two were cases of stammering seemingly due to a spasm of the glottis; the third, a special defect case resulting from deafness. Speech Defects Class, 1921. No. of cases treated during the year 47 ,, cured 30 ,, improved 8 ,, not improved 3 ,, left without having completed the full course 6 No. of cases subsequently referred after one course of treatment, and requiring a second course, i.e., cases cured, and subsequently relapsed 9 Length of sessions held 2¼ hours mornings. Length of sessions held 2 hours afternoons. Average days attended by each case throughout the year 35 Special cases 3 Routine cases 44 No. sessions held Figures unobtainable at present. Age Groups. Males. Females. Boys of 14 years 5 Girls of 14 years 2 „ 13 „ 13 „ 13 „ 3 ,, 12 ,, 7 ,, 12 ,, 3 ,, 11 ,, 5 ,, 11 ,, 2 ,, 10 ,, 5 „ 10 „ 2 „ 9 „ 0 „ 9 „ 0 ,, 8 ,, 0 „ 8 ,, 0 0132 7 „ 0 „ 7 „ 0 35 12 123 17 NURSERY SCHOOLS. No Nursery Schools have yet been established in the Borough. 18. SECONDARY SCHOOLS. In 1921 the pupils of the three Higher Schools of the Education Committee, the Borough Boys' School, the Borough Girls' School, and the Old Palace Girls' School were medically inspected. 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. 240 boys and 183 girls were examined at the routine inspections,making a total of 423. In addition 6 children were re-examined. A statement of the defects found and treatment carried out is given in Appendix B. In the case of the Secondary Schools except under very exceptional circumstances the following up of defects in children is not carried out, nor are the pupils offered the facilities for treatment afforded by the various school clinics. 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. In 3 instances only was it considered necessary to refuse a certificate. Children granted certificates are seen from time to time at re-inspections in the schools. 21. MISCELLANEOUS. 32 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. 124 Appendix A. TABLE I.—Number of Children Inspected 1st January, 1921 to 31st December, 1921. A.—Routine Medical Inspections. Entrants. Leavers. Grand Total. Age 3 4 5 6 Other Ages. Total. Intermediate Group. 12 13 14 Other Ages. Total Boys - 122 1063 597 1049 2831 171 787 445 38 21 1291 4293 Girls 1 102 988 610 772 2473 288 687 304 34 1 1026 3787 Totals 1 224 2051 1207 1821 5304 459 1474 749 72 22 2317 8080 B.—Special Inspections. Special Cases. Re-examinations, i.e., number of children re-examined. Boys 922 150 Girls 543 150 Totals 1465 300 C.—Total Number of individual children inspected by the Medical Officer, whether as Routine or Special Cases. 9845 125 Appendix A. TABLE II. — Return of Defects found in the Course of Medical Inspection in 1921. defect or disease. Routine Inspections "Specials." Number referred for treatment. Number requiring to be kept under observation but not referred for treatment. Number referred for treatment. Number reuiring to be kept under observation but not referred for treatment. Malnutrition 26 8 17 8 Uncleanliness— Head 18 ... 1 ... ,, Body 3 ... ... ... Skin— Ringworm—Head 24 ... 30 4 ,, Body 1 8 ... Scabies 4 ... 4 3 Impetigo 10 1 13 ... Other Diseases 21 5 12 4 Eye — Blepharitis 30 3 9 3 Conjunctivitis 2 ... 3 2 Keratitis 1 ... ... ... Corneal Ulcer ... ... 1 ... Corneal Opacities 1 ... 3 ... Defective Vision 339 111 268 51 Squint 51 5 26 ... Other Conditions 12 30 12 4 Ear— Defective Hearing 26 9 17 7 Otitis Media 17 5 15 12 Other Ear Diseases 5 ... 3 1 Nose & Throat— Enlarged Tonsils 263 99 40 9 Adenoids 115 45 54 18 Enlarged Tonsils & Adenoids 83 24 24 2 Other Conditions 22 11 13 12 Enlarged Cervical Glands 37 109 3 11 Defective Speech 1 3 7 3 Teeth —Dental Diseases ... ... ... ... Heart & Circulation- Heart Disease—Organic 27 70 4 16 ,, Functional 24 62 11 13 Anæmia 162 81 40 14 Lungs— Bronchitis 45 57 7 6 Other Non-Tubercular Diseases 2 7 1 4 Tuberculosis— Pulmonary—Definite 3 1 3 ... Suspected 8 19 6 14 Non-Pulmonary —Glands 26 17 9 4 ,, Spine ... ... ... 1 ,, Hip ... 1 ... 1 ,, Other Bones & Joints 1 1 1 1 ,, Skin ... ... ... ... ,, Other Forms 5 3 1 2 Nervous System — Epilepsy ... 2 3 ... Chorea 4 3 5 4 Other Conditions 3 7 1 3 Deformities— Rickets 14 4 2 2 Spinal Curvature 108 65 17 7 Other Forms 21 14 11 13 Other Defects & Diseases 184 112 52 46 Number of Individual Children having defects which required treatment or to be kept under observation 3186 126 Appendix A. TABLE III.—Numerical Return of all Exceptional Children in the Area in 1921. Boys. Girls. Total. BLIND (including partially blind) within the meaning of the Elementary Education Blind and Deaf Children) Act, 1893. Attending Public Elementary Schools 4 3 7 Attending Certified Schools for the Blind 6 2 8 Not at School 4 2 6 DEAF AND DUMB (including partially deaf) within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893. Attending Public Elementary Schools 4 3 7 Attending Certified Schools for the Deaf 1 4 5 Not at School 0 3 3 MENTALLY DEFICIENT. FerbleMinded. Attending Public Elementary Schools 1 1 2 Attending Certified Schools for Mentally Defective Children 51 32 83 Notified to the Local Control Authority by the Local Education Authority during the year 9 1 10 Not at School 7 10 17 Imbeciles. Notified to the Local Control Authority by the Local Education Authority during the year 2 2 4 At School ... ... ... Not at School ... 2 3 5 Idiots. Notified to the Local Control Authority by the Local Education Authority during the year ... ... ... EPILEPTICS. Attending Public Elementary Schools 26 9 35 Attending Certified Schools for Epileptics 4 1 5 In Institutions other than Certified Schools 2 1 3 Not at School 10 15 25 127 Appendix A. Table III.—Continued. Boys. Girls. Total PHYSICALLY DEFECTIVE. Pulmonary Tuberculosis Attending Public Elementary Schools 150 113 253 Attending Certified Schools for Physically Defective Children 8 9 17 In Institutions other than Certified Schools 2 3 5 Not at School 2 7 9 Crippling due to Tuberculosis. Attending Public Elementary Schools 4 8 12 Attending Certified Schools for Physically Defective Children ... 2 2 In Institutions other than Certified Schools 2 8 10 Not at School 1 ... 1 Crippling due to causes other than Tuberculosis, i.e., Paralysis, Rickets, Traumatism. Attending Public Elementary Schools 28 55 83 Attending Certified Schools for Physically Defective Children 3 1 4 In Institutions other than Certified Schools 1 3 4 Not at School 10 7 17 Other Physical Defectives. Attending Public Elementary Schools 12 11 23 Attending Open-Air Schools ... ... ... Attending Certified Schools for Physically Defective Children 1 ... 1 Not at School 2 3 6 DULL OR BACKWARD. Retarded 2 years 6 11 17 2-3 2 5 7 3 „ 5 4 10 128 Appendix A. TABLE IV.—Treatment of Defects of Children During 1921. 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 54 75 ... 75 Ringworm, body 8 14 ... 14 Scabies 8 23 6 29 Impetigo 23 33 3 36 Minor Injuries 1 ... 1 1 Other Skin Diseases 33 ... 3 3 Ear Disease 83 90 33 123 Eye Disease (external and other) 74 6 3 9 Miscellaneous 796 783 220 1003 B.—Treatment of Visual Defect. Referred for Refraction. NUMBER OF CHILDREN. 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. 684 574 37 13 624 376 ... 86 97 228 C.—Treatment of Defects of Nose and Throat. Referred for treatment. NUMBER OF CHILDREN Received other forms of treatment. Received Operative Treatment. Under Local Education Authority's Scheme Clinic or Hospital. By Private Practitioner or Hospital. TOTAL. 614 307 76 383 17 129 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 ii 12 13 14 (a,) Inspected by Dentist — 1606 - 1286 - — — - — - — 2892 (b) Referred for Treatment ... ... ... 2329 ... ... ... — 2329 (c) Actually Treated ... ... ... 1099 ... ... ... 48 1147 (d) Re treated (result of periodical examination) ... ... ... 73 ... ... ... — 73 (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 administrations of general anaesthetics included in (4) and (6). No. of other operations. Extracted. Filled. Extracted. Filled. Permanent Teeth. Temporary Teeth. 1 2 3 4 5 6 7 8 9 10 11 45 292 3266 53 173 3861 687 860 72 50 126 130 Appendix A. E.—Treatment of Uncleanliness. (a) Average number of visits per annum made by the School Nurses to each school 1 (b) Total number of examinations made of children by School Nurses in the year in the schools 16817 (c) The number of individual children found unclean Nits 1940 Head Vermin 278 • Body ,, 9 Total 2227 (d) Arrangements made by the Local Authority for cleansing, and the number of children cleansed under these arrangements At Cleansing Station, Lane, Croydon. Body Vermin Factory 8 Total 8 (e) Legal proceedings taken under the Children Act 1908, or the School Attendance Bye-laws - 131 Appendix 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 1080 1024 269 1293 Visual Defects 684 574 50 624 Defects of Nose and Throat 614 307 76 383 Dental Defects 2329 1147 ... 1147 Other Defects (Tuberculosis) 183 ... 183 183 Total 4890 3052 578 3630 132 Appendix A. TABLE VI —Summary Relating to Children Medically Inspected at the Routine Inspections during the Year 1921. (1) The total number children medically inspected at the Routine Inspections 8080 (2) The number of children in (1) suffering from Malnutrition 125 Skin Disease 141 Defective Vision (including Squint) 892 Eye Disease 111 Defective Hearing 84 Ear Disease 63 Nose and Throat Disease 1264 Enlarged Cervical Glands (non-tubercular) 1640 Defective Speech 15 Dental Disease 21 Heart Disease—Organic 133 „ ,, Functional 152 Anæmia 526 Lung Disease (non-tubercular) 173 Tuberculosis - Pulmonary—Definite 15 ., Suspected 25 Non-Pulmonary 63 Diseases of the Nervous System 40 Deformities 316 Other Defects and Diseases 476 (3) The number of children in (1) suffering from defects (other than unclcanliness or defective clothing or footgear) who require to be kept under observation (but not referred for treatment) 918 (4) The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, etc.) 1173 (5) The number of children in (4) who received treatment for one or more defects (excluding uncleanliness, defective clothing etc.) 1190 133 Appendix B SECONDARY SCHOOLS. TABLE 1.—Number of Children Inspected 1st January, 1921 to 31st December, 1921 A.—Routine Medical Inspection. Age 3 4 5 6 7-11 12 13 14 Other Ages. Total Grand Total. Boys — — — — 72 63 32 23 50 240 240 Girls — — — — 95 14 6 10 58 183 183 Totals — — 167 77 38 33 108 423 423 B.—Special Inspections. Special Cases. Re-examinations, i.e., number of children re-examined. Boys — — Girls — 6 Totals — 6 Total number of individual Children inspected by the Medical Officer, whether as Routine or Special Cases. Number of individual children inspected:— 429 134 Appendix B. TABLE II.—Return of Defects Found in the Course of Medical Inspection in 1921. 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 ... 1 ... ... Uncleanliness—Head ... ... ... ... Body ... ... ... ... Skin— Ringworm—Head ... ... ... ... Body ... ... ... ... Scabies ... ... ... ... Impetigo ... ... ... ... Other Diseases (non-tubercular) 2 ... ... ... Eye— Blepharitis ... ... ... ... Conjunctivitis ... ... ... ... Keratitis ... ... ... ... Corneal Ulcer ... ... ... ... Corneal Opacities ... ... ... ... Defective Vision 58 ... ... ... Squint ... ... ... ... Other Conditions ... ... ... ... Ear— ... ... ... ... Defective Hearing 6 1 ... ... Otitis Media ... ... ... ... Other Ear Diseases ... ... ... ... Nose and Throat Enlarged Tonsils 13 12 ... ... Adenoids 2 ... ... ... Enlarged Tonsils and Adenoids 2 1 ... ... Other Conditions 3 5 ... ... Enlarged Cervical Glands 8 ... ... ... Defective Speech ... ... ... ... Heart and Circulation— Heart Disease—Organic 11 13 ... ... Functional 2 17 ... ... Anæmia 7 51 ... ... Lungs— Bronchitis ... 8 ... ... Other non-tubercular Diseases ... ... ... ... Tuberculosis— Pulmonary—Definite 1 3 ... ... Suspected 4 9 ... ... Non-pulmonary—Glands ... 8 2 ... Spine ... ... ...... ... Hip ... ... ... ... Other bones & joints ... ... ... ... Skin ... ... ... ... Other Forms ... ... ... ... Nervous System— ... ... Epilepsy ... ... ... ... Chorea ... ... ... ... Other Conditions ... 8 ... ... Deformities— Rickets ... ... ... ... Spinal Curvature 81 14 ... ... Other Forms ... 7 ... ... Other Defects and Diseases ... 20 ... ... Chest Expansion 1½-in. or under 23 ... ... ... Defective Teeth 71 ... ... ... Number of Individual Children having Defects which required Treatment or to be kept under Observation 113 135 Appendix B. TABLE IV.—Treatment of Defects of Children in 1921. 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 3 ... 1 1 Ear Disease 7 ... 3 3 Eye Disease (external or other) ... ... ... ... Miscellaneous 4 ... 4 4 B.—Treatment of Visual Defect. Referred for Refraction. NUMBER OF CHILDREN. Submitted to Refraction. For whom glasses were provided. For whom glasses were prescribed. 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. 58 20 ... ... 20 ... 13 ... 1 6 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. 28 ... 2 2 ... D.—Treatment of Dental Defects. NIL. 136 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 14 ... 8 8 Visual Drfects 58 20 ... 20 Defects of Noss & Throat 28 ... 2 2 Dental Defects ... ... ... ... Other Defects ... ... ... ... Total 100 20 10 30 TABLE VI.—Summary Relating to Children Medically Inspected at the Routine Inspections During the Year 1921. (1) The total number of children medically inspected at the Routine Inspections 423 (2) The number of children in (1) suffering from:— Malnutrition 6 Skin Disease 8 Defective Vision (including Squint) 85 Eye Disease 5 Defective Hearing 16 Ear Disease 10 Nose and Throat Disease 62 Enlarged Cervical Glands (non-Tubercular) 31 Defective Speech ... Dental Disease ... Heart Disease—Organic ... ,, ,, Functional 7 Anæmia 48 Lung Disease (non-Tubercular)... 4 Tuberculosis—Pulmonary (definite) ... „ ,, (suspected) 3 ,, Non-Pulmonary ... Disease of the Nervous System 12 Deformities 77 Other Defects and Diseases 72 (3) The number of children in (1) suffering from delects (other than uncleanliness or defective clothing or footgear) who require to be kept under observation (but not referred for treatment) 68 (4) The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, etc.) 74 (6) The number of children in (4) who received treatment for one or more defects (excluding uncleanliness, defective clothing, etc.) 13