E CRO 27 County Borough of Croydon. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1925. H. P. NEWSHOLME, M.R.C.P.,BSc.,D.P.H. CROYDON: Printed at the "Croydon Times" Office, 108, High Street. County Borough of Crondon. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1925. H. P. NEWSHOLME, M. A., M.D., M.R.C.P.,BSc.,D.P.H. CROYDON: Printed at the "Croydon Times" Office, 108, High Street. 3 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT. OF THE MEDICAL OFFICER OF HEALTH. AND SCHOOL MEDICAL OFFICER. For the Year 1925. I beg to submit to the Council my report on the health and sanitary circumstances of the Borough during the year 1925. I he present report, in accordance with the request of the Ministry of Health, is a "survey" report, attempting some general survey of the Public Health activities of the borough, with particular reference to their extension during the past five years. It has been the practice of my predecessors, which 1 have followed, to give a full annual statement of the work, so that the form of the report is not materially different from that adopted in previous years. There has been steady expansion of Public Health work during 1925, accompanied by consolidation of developments initiated during the previous year. Progress was made with the provision of the admirable clinic premises in Lodge Road, which were taken into occupation in January, 1926; and with the extension of Cheam Sanatorium, which was opened on the enlarged scale in April, 1926. The year was marked by a generally satisfactory level of health, the only feature calling for special note being an outbreak of food-borne paratyphoid fever, an account of which is given in the report. Attention may also be directed to an analysis of the Croydon death-rates at various ages and for various diseases over a long series of years; to a report dealing with the difficult question of birth control; and to a section in the school medical report, in which an analysis is attempted of the changes in the health of the school child during recent years, and of existing factors inimical to his well-being and educability. H. P. NEWSHOLME, Mcdical Officer of Health. 4 CONTENTS. A.—PUBLIC HEALTH REPORT. Page. Introductory 3 Statistical Summary 7 Section I.—Population, births, deaths, nursing facilities 8 „ II.—Infectious diseases 21 „ III.—Tuberculosis 45 „ IV.—Maternity and child welfare 53 „ V.—Mental deficiency 64 „ VI.—Venereal diseases 67 „ VII.—Housing 68 „ VIII.—Sanitary administration 69 „ IX.—Appendix with statistical tables 102 Page Acts, adoptive 69 Ambulance service 42 Ante-natal clinic 53 Bacteriological examination 43 Bakehouses 76 Births 56 Birth control, report 61 Borough Hospital 40 Bye-laws and regulations 69 Clinics 14 Contacts, tuberculosis 46 Convalescent homes 59 Cowkeepers 89 Cross-infections 42 Croydon Corporation Act, 1924 81 Croydon Nursing Service 13 Dairies, cowsheds and milkshops 89 Deaths 7 Diarrhoea, epidemic 23 Diphtheria 22 Dispensary, tuberculosis 45 Dried milk 59 Encephalitis lethargica 22 Enteric fever 23 Expectant mothers 53 Factories & Workshops Acts 76 Foods, inspection of 87 Foods & Drugs Acts, Sale of 94 Foster children 58 Grangewood, special school 65 Health visitors, work of 53, 57 Page. Home Nursing 13, 46 Homework 76 Hospitals 67 Hostel, St. Mary's (maternity) 55 Housing 73 Illegitimacy 9 Infant Welfare clinics, municipal 57 „ „ „ voluntary 57 Infant mortality 12 Infectious diseases 21 Laboratory work 43 Local Acts 69 Lodging houses, common 77 Massage clinic 58 Maternity home 55 Maternity Homes, registration 54 Measles 23 Meat inspection 85 Medical help records 55 Meningitis 22 Mental deficiency 64 Medicines 46 Midwives 13, 54 Milk, provision of 58 Milk and Cream Regulations 98 Milk, tuberculous 89 Milkshops 90 Mixed infections 42 Mortality in child-birth 7 Mothers' and Infants' Welfare Association 57 Notification of Births Acts 56 Nuisances 70 Nursing arrangements 13 5 PAGE. Occupation Centre 66 Ophthalmia neonatorum 23 Outfits, maternity 54 Paratyphoid fever, special report 23 Poisons & Pharmacy Act 99 Population 7 Public Laboratory 44 Puerperal sepsis 55 Rag Flock Act 79 Rats & Mice (Destruction) Act 100 Return cases 21 Sanatorium, Cheam 50 Sanatoria, treatment in 48 Sanitary administration 69 Sanitary inspectors, work of 70 Scarlet fever 21 Shelters 47 Sick Nursery 58 Sickness, special causes of 13 Slaughterhouses 83 Smallpox 22 Smoke observations 80 PAGE. Sputum, examination 47 Staff 6 Statistical summary 7 Still-births 56 Tuberculosis—Care work 51 „ contacts 46 „ deaths 45 „ notifications 45 „ home nursing 46 „ home visits 46, 47 „ non-pulmonary 45 „ pulmonary 45 Typhoid fever 23 Unmarried mothers 16 Venereal diseases 67 Vital statistics 7 Water Supply 19 Winds, prevailing 37 Whooping-cough 23 Workplaces 75 Workshops 75 X-ray examination 48 B.—SCHOOL MEDICAL REPORT. Accommodation 149 Adenoids 151 Blind children 172 Bursars 177 Central schools 175 Cinema, effect of 145 Cleansing of children 155 Closure, school 153 Crippling defects 161 Deaf children 159 Defective children 150 Deformities 151 Dental disease 151 Dental treatment 157 Dull and backward children 175 Ear disease 151 Employment of children 176 Epileptic children 173 Eye clinic 156 Eye disease 151 Following up 154 Glands, enlarged 151 Grangewood, special school 173 Health visitors, work of 154 Heart disease 151 Hygiene of schools 149 Infectious diseases 152 Inspections, routine 149 Inspections, special 150 Lungs, diseases of 151 Malnutrition 151 Massage clinic 162 Mentally defective children 173 Minor ailments 155 Occupation Centre 174 Open-air classes 165 Parents, attendance of 172 Physical training 165 Physically defective children 150 Playground classes 164 Re-examinations 150 Ringworm 155 School camps 164 School journeys 164 Schools, number of 149 Secondary schools 176 Skin affections 155 Special school, Grangewood 173 Staff 147 Statistical tables 178 Student teachers 177 Surveys, uncleanliness 150 Tonsils, enlarged 155 Treatment 155 Tuberculosis 151, 156 Uncleanliness 151 Vision, defective 156 X-rays, treatment 155 6 STAFF The staff of the Public Health Department on December 31st, 1925, was as follows:— Medical Staff.— (a) Whole-time:— H. P. Newsholme, M.A., M.D., M R C.P., B.Sc., D.P.H., Medical Officer of Health, School Medical Officer, and Medical Officer under Mental Deficiency Act. W. H. Brodie, M.B., Ch.B., D.P.H., Deputy Medical Officer of Health, Deputy School Medical Officer, and Medical Officer under Mental Deficiency Act. J. C. Minders. M.B., Ch.B., B.A.O., D.P.H., Assistant Medical Officer of Health for Tuberculosis. 15. W. C. Thomas, M.D., B.S.. M.R.C.S., L.R.C.P., B.Sc., D.P.H., Assistant. Medical Officer of Health and School Medical Officer. Margaret D. Emslie, M.B. Ch.B., Assistant Medical Officer, Maternity and Child Welfare. Olive B. Falk, M.B., B.S., Assistant Medical Officer, Maternity and Child Welfare. J. Todesco, M.D., M.R.C.S., L.R.C.P., D.P.H., Resident Medical Superintendent, Borough (Fever) Hospital. R C. Poyser, M.R.C.S., L.R.C.P., Resident Medical Superintendent, Croydon Borough Sanatorium. (b) Part-time:— Mary McDougall, M.B., C.M., Assistant Medica'. Officer, Maternity and Child Welfare. H. G. Critchley, M.A., M.D., D.P.H.—X-ray treatment of ringworm (School Medical Service). J. S. Bookless, F.R.C.S.—Ophthalmic Surgeon (School Medical Service). Rota of 8 local medical practitioners for surgical treatment of tonsils and adenoids. Dental Staff.— w. g. senior, l.d.s. J. K. R. Bryce, L.D.S. Inspectors.— **§† R. J. Jackson, M.R.S.I.. A.M.X.S.E., M.S.I.A., Chief Sanitary Inspector. ║§*† F. F. Fulker. Deputy Chief Inspector. ¶¶A. Low. *†. H. Bull. *J. c. Farwicker. *F. Richardson. *c. T. Vincent. §*G. G. Flint. *§C. Whiteley. *W. T. Hunt. §*A. H. Fitt. §║/‡*:L. F. Selfe. §||‡*H. E. White. *A. W. Gower. §*V. S. Harris *F. Noakes. Sanitary Inspectors In addition, there are 5 disinfectors, 1 rat-catcher, and 3 unqualified assistants. *Cert. Royal San. Inst. (Inspector of Nuisances). § ,, ,, ,, (Meat and other Foods). ||Cert. London Exam. Board. ¶¶Sanitary Association of Scotland. /Sanitary Science applied to Buildings and Public Works, Poyal San. Inst. ‡Diploma Incorporated Institute of Hygiene. :Cert. Worshipful Company of Carpenters. ¶University of Liverpool, Meat & Food Inspector's Certificate. Health Visiting Staff— †‡¶*Fdith M. Chapman. Supernumerary. ‡¶§†J.Thomson, Nurse :/c Minor Ailments Clinic. ||‡†A. F. King. Nurse i/c Dental Clinic. §†F. A. McDongall Assistant to Medica: Officer for Mental Deficiency work. ||‡§†V.Cracknell ||¶†V. Byrn ||‡†J. M. L. Chalk ||‡¶§†U. Gordon. †¶*§†C. Gordon. §¶*‡†E. M. Hobdey. ‡¶D. M. Huggins §‡¶†M. Pickavance ||‡†A. J. Pressly ‡||¶H. Stanley ‡¶M. Southgate ‡¶†A. W. Waterman ||‡¶§†C. A. Wilson ‡¶A. Walker D‡†E. M. Bradford. Tuberculosis Dispensary Nurse. D‡¶†K. Fowler, Tuberculosis Nurse. ‡General trained. *Cert. Royal San. Inst. (Inspector of Nuisances) ||Fever ,, § ,, ,, ,, ,, (Health Visitor). ¶Cert. C.M.B. D.Cert. Apothecaries' Hall (Dispensing). 7 Staff of Clinics— †May Appleton, Diploma of Chelsea College of Physical Education, Organiser and Supervisor of Physical Training (Girls) and Remedial Exercises Classes. †Winifred F. Batson, C.S.M.M.G. (Certificates in massage, medical electricity, and Swedish remedial exercises), Masseuse, School Medical Service. †Lucy J. Peake, C.S.M.M.G. (Certificates in massage, medical electricity, and Swedish remedial exercises), Masseuse, Maternity and Child Welfare (part-time). †D. Baxter Hallatt, Organizer, Tuberculosis and Orthopaedic Cure Work. †G. H. Belmore, Female Assistant to the Dental Surgeons. Croydcn Borough Hospital, Croydon Borough Sanatorium, and Sick Nursery— Nursing and Domestic Staffs. Clerical Staff— Twenty full-time clerks. † Exchequer contributions are received in respect of salaries of these officers. STATISTICAL SUMMARY. 1. General Statistics. Area (acres).—9,012 Population (Census 1921).—190,877. Population, June, 1925 (Registrar General's Estimate).—199,300 Number of Inhabited Houses (1921).—41,923. Rateable value.—£1,412,297 12s. 6d. Sum represented by a penny rate.—£5,495 (net). 2. Extracts from Vital Statistics for the Year. Births— Males. Females. Total. Birth-rate Legitimate 1681 1595 3276 Illegitimate 65 65 130 17.1 Totals 1746 1660 3406 Deaths—2,109. Death-rate 10.9. Number of women dying in, or in consequence of, childbirth:— From Sepsis, 5. From other causes, 8. Deaths of infants under one year of age per 1,000 births (infant mortality)—55. Legitimate rate, 49, Illegitimate rate, 203. Number of deaths from Measles (all ages)—7. ,, Whooping Cough (all ages)—9. ,, Diarrhoea (under 2 years of age)—30. Other particulars required by the Ministry of Health under Circular 540, of 18th December, 1924, will be found in the body of the report and can be traced through the index. 8 SECTION I. POPULATION, BIRTHS, DEATHS; HOSPITAL, CLINIC AND NURSING FACILITIES; WATER SUPPLIES, SEWERAGE. SCAVENGING. The County Borough of Croydon lies immediately to the south of London, on which it abuts at its northern extremity. In general outline the borough resembles an inverted pear, extending nearly six miles from north to south and four and a half miles at its broadest portion from east to west. The wide rounded base to the north consists of Norbury to the north-west, South Norwood and a portion of Upper Norwood to the north-east, with Thornton Heath between and to the south of these. The neck of the pear consists of West Croydon and Waddon to the west, and Addiscombe and Shirley to the east; while the apex in the extreme south is formed by South Croydon. To the west of Croydon lie in succession Lambeth M.B., Wandsworth M.B., Mitcham U.D., and Beddington and Wallington U.D., passing from north to south; to the east, running similarly from north to south, are Penge U.D., Beckenham U.D., Godstone R.D., and Coulsdon and Purley U.D. PHYSICAL FEATURES AND GEOLOGY. The northern portion of the Borough is hilly, consisting of London clay, capped in places with gravel. The central area is on the whole flat, in the western section comprised largely of gravel at the surface, in the eastern section of clay intermixed with areas of gravel. The southern portion, narrowing as it extends to the south, consists of a central valley-bed of gravel, flanked by sloping sides of chalk, forming in particular a rampart to the west. The town contains the beginnings of the River Wandle, which arises in the neighbourhood of Wandle Park, in the southwest area of the town, and passes soon beyond its boundary. SOCIAL CONDITIONS. I he most densely populated portion of the town lies at the centre. Pleasant residential areas lie to the east (Addiscombe and Shirley), north (Upper Norwood), north-west, and south. Croydon is largely a residential town, serving to a considerable extent as a dormitory for persons working in London. While it has a number of industries, none can be regarded as a distinctive feature of the town and as employing a notable proportion of the industrial population. 9 POPULATION. The population in June, 1925, as estimated by the RegistrarGeneral, was 199,300, an increase of 3,300 on the previous year, and of 8,423 since 1921. BIRTHS. 3,406 births were registered during the year, grouped as follows in respect of sex and legitimacy (see Appendix, Table I.): Births— Males. Females. Total. Legitimate 16181 1596 3276 Illegitmate 65 65 130 1746 1660 3406 The birth-rate per 1,000 of the population was thus 17.1. The successive birth-rates in the five years 1921-5 were: 18.9; 18.2; 17.4; 17.6, and 17.1. The following table sets out a comparison between the birthrate for Croydon, for London, for the large towns, and for the country as a whole during during recent years:— 1923. 1924.  Birth-rate, Croydon 17.4 17.6 17.1 ,, 105 large towns, including London 20.4 19.4 18.8 ,, London 20.2 18.7 18.0 ,, England & Wales 19.7 18.8 18.3 Of the total Croydon births in 1925, 3.8 per cent. were illegitimate, compared with 4.8 per cent. in 1924. DEATHS. 2,169 deaths of Croydon residents were registered in respect of the year 1925 (Appendix, Table I.), giving a death-rate of 10.9 per 1,000 head of population. The corresponding rates for the five years 1921-25 were:—10.7; 12.4; 10.4; 11.6; 10.9. The following table compares the death-rate during recent years in Croydon and other areas:— 1923 1924. 1925. Death rate, Croydon 10.4 11.6 10.9 ,, 105 large towns, including London 11.6 12.3 12.2 ,, London 11.2 12.1 11.7 ,, England & Wales 11.6 12.2 12.2 10 CHANGES IN THE DEATH RATES FROM VARIOUS DISEASES AND AT VARIOUS AGES SINCE 1881. Dr. A. A. Turner, while Deputy Medical Officer of Health for the borough, made a study of changes in the Croydon death-rate since 1881; and I am glad to be able to make use of his detailed investigation and analysis for the following summary, which refers to the forty-three years 1881-1923. Unfortunately the cost of illustrating the changes by means of charts makes such a course prohibitive for the purpose of this report. The statistical data from which fuller particulars of the changes can be obtained are given in Table A. 1.—The general death-rate for all ages together has dropped steadily since 1881. All the main infectious and constitutional diseases have shared in the decline, with the exception of pneumonia, the death-rate from which has remained stationary, and cancer, the death-rate from which rose steadily, though with a tendency to remain stationary in recent years. 2.—The death-rate has shown no tendency to rise in any agegroup; and the decline in the general death-rate at all ages together has been associated with: (a) A very marked decrease in the death-rate for infants under one year of age (infant mortality). The decrease did not begin till 1900 and was not pronounced till 1905. It was shared by the following diseases, the date representing the approximate commencement of the drop: bronchitis (1895); diarrhœa (1900); tuberculosis, non-pulmonary (1905); congenital debility, malformation and premature birth (1910); measles (irregular decrease). Pneumonia has not shared in the decrease. The most serious diseases in recent years, in descending order of importance in regard to the death-rate in infancy, have been : congenital debility and premature birth, diarrhœa, pneumonia, bronchitis, whooping cough, tuberculosis (non-pulmonary), and measles. (b) A substantial decrease in the death-rate for children from 1—5 years of age. The decrease began about 1890, and was rapid and even from 1896; it involved all the chief diseases except pneumonia. The diseases causing most deaths in recent years at ages 1—5 years are as follows, in descending order of importance: pneumonia, tuberculosis (non-pulmonary), measles, whooping cough, bronchitis, diphtheria. 11 (c) A very slight decrease in the death-rate at ages 5—15 years. At these ages the death-rate has always been low, with correspondingly small scope for improvement. The diseases of chief moment in recent years, in descending order of importance, have been: Tuberculosis (nonpulmonary), diphtheria, tuberculosis (pulmonary), pneumonia, measles. (d) A stationary death-rate at ages 15—25 years. This rate has also been uniformly low. A tendency to drop slightly from diseases other than tuberculosis has been prevented by a slight rise in mortality from pulmonary tuberculosis for both sexes, and more especially for females. Pulmonary tuberculosis causes about one-half of all deaths at these ages; and the death-rate from this disease, remaining level from 1888 to 1900, dropped slightly till 1916, rose during and has continued higher since the war. Various reasons have been put forward to explain this feature, which is not peculiar to Croydon; but the matter needs further investigation. (e) A slight decrease in the death-rate at ages 25—65 years. The more important diseases in recent years affecting the death-rate were as follows, in diminishing order of importance; in considering them the wide range of ages in this group must be remembered: Cancer, pulmonary tuberculosis, pneumonia, nephritis, bronchitis. The death-rate from cancer rose, that from pneumonia remained stationary, that from pulmonary tuberculosis diminished considerably, and that from nephritis and from bronchitis declined slightly but steadily. (/) A considerable decrease in the death-rate for persons over 65 years of age. There has been a decrease in mortality from nephritis, bronchitis, and pulmonary tuberculosis; a stationary death-rate from pneumonia, and a rising death-rate from cancer, though there has been no definite rise in the latter since 1911. 3.—The death-rates for males exceed those for females at all age-periods and for all diseases, with the following exceptions:— (a) The female death-rate is higher than that for males at ages 5—15 years (f) from all causes together, (ft) from pulmonary tuberculosis and from diphtheria. No certain reason can be given for this peculiarity, though it may be suggested that the indoor life of the girl, as compared 12 with the boy of the same age, may accenuate the special stresses arising during this age-period from the onset of puberty. At no other age is the death-rate from pulmonary tuberculosis higher among females than among males, though it approaches the same level as the male death-rate from this disease at ages 15—25 years. (b) The death-rates from cancer at ages 25—45 and 45—65 are higher for females than for males. (c) The death-rates from whooping cough are also higher among females than among males. It should also be noted that (d) although the death-rate from pulmonary tuberculosis among females at ages 15—25 years is lower than that among males, there has been a tendency, more marked among females than among males, for a rise in the deathrate from this disease at these years. The adverse change among women, which is not peculiar to Croydon, has been attributed, among other reasons, to the change from domestic to industrial work; but the reason is still not sufficiently clear. With this exception, both sexes have shared equally in the fall of the general death-rate, and of the death-rates for the various age-groups and for the various diseases under consideration. INFANT MORTALITY. 185 deaths of Croydon Infants under one year of age occurred in 1925 (Appendix, Table I.), giving an infant mortality (number of deaths under one year of age per 1,000 births) of 55, compared with 56 in 1923. The infant mortality for the five years 1921-25 was:—74, 64, 52, 56, 55. The following gives a comparison with corresponding infant mortality rates in other areas:— 1923 1924. 1925. Infant mortality, Croydon 52 56 55 ,, 105 large towns, including London 72 80 79 ,, London 60 69 67 ,, England & Wales 69 75 75 Infant Mortality among illegitimate children.—The infant mortality among illegitimate children in 1925 (Appendix, Table I.), 13 was 180, in 1924, 203. I he following table summarises the rates for a series of years:— Year. Infant Mortality— Illegitimate children. Illegitimate children. Year. 1914 175 1920 159 1915 188 1921 111 1916 206 1922 170 1917 250 1923 253 1918 122 1924 203 1919 160 1925 180 SPECIAL CAUSES OF SICKNESS. Reference will be made subsequently to a special outbreak of paratyphoid (B) fever occurring during the summer months of the year. NURSING ARRANGEMENTS, CLINICS, HOSPITALS AND OTHER INSTITUTIONS AVAILABLE IN THE TOWN. A.—Professional Nursing in the Home. (i) General.—The Croydon Nursing Service was established in 1921. It provides a staff of trained nurses to attend the sick at their homes. The services of the nurses are obtainable either by joining in an insurance scheme, whereby an annual payment ensures attendance on husband, wife, and children under 18 years of age; or through provident clubs; or, on occasion, by the payment of fees on the ordinary recognised scales. (ii) For infectious diseases, e.g., measles, etc.—Arrangements have been made for the home nursing of cases of measles, whooping cough, ophthalmia neonatorum, puerperal fever, epidemic diarrhoea, and infantile paralysis by the Croydon Nursing Service, at a fixed charge to the Corporation of 2s. per visit, where the case is referred by the Medical Officer of Health on account of necessitous conditions and inadequate home attention, and where circumstances prevent removal to a hospital. The health visitors systematically visit the homes and give advice to parents as to the nursing and general care of such children. One health visitor is engaged in the home nursing of bedridden tuberculous patients. B.—Mid wives No practising midwives are employed or subsidised by the local authority. 59 midwives practised in the Borough in 1925. 14 C.—Clinics and Treatment Centres. Name and Situation. Nature of Accommodation By whom provided. MATERNITY & CHILD WELFARE, (a) Centres Municipal Inft. Centre, London Road, Croydon. 12-roomed house held on lease by Corporation and used as Municipal Infant Centre, Sick Nursery, Minor Ailments and Special Inspection C 1 i n i c— School 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, St. Paul's Hall, Norfolk Road, Thornton Heath. do. East Croydon, Wesleyan Schoolroom, L. Addiscombe 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., South Croydon. do. West Croydon, Strathmore Hall, do. Strathmore Road, Croydon. Norbury, Wesleyan Schoolroom, London Road, Not bury. 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' Hoetel. Local Authority. (c) Massage Clinic †228, London Road, Croydon. As above. Local Authority. 15 Clinics and Treatment Centres continued.— Name and Situation. Nature of Accommodation By whom provided. (d) Sick Nursery †228, London Road, Croydon. One large room (4 cots) and accommodation for nursing and domestic staff. Local Authority. DAY NURSERIES. NIL. ORTHOPAEDIC. Croydon General Hospital. Hospital Committee. SCHOOL CLINCS. †Re-inspection Clinic. 228, London Road, Croydon. 2 rooms. Local Authority. † Minor Ailments Treatment Clinic, 228, London Road, Croydon. do. do. † Kye Clinic, 228, London Road, Croydon. do. do. † Dental Clinic, 13, Katharine Street, Croydon. do. do Clinic for Defective Children, Town Hall, Croydon. 1 room in Public Health Department. do X-ray Clinic, 83, Park Lane, Croydon. Surgery of Dr. Critchley, part-time X-ray Specialist. Massage Clinic, Welcome Hall, Scarbrook Road, Croydon. One room. Local Authority Spinal Remedial Exercises Clinic, Welcome Hall, Scarbrook Road. Croydon. Breathing Exercises Clinic, Welcome Hall, Scarbrook Road, Croydon. Tonails and Adenoids Clinic, Croydon General Hospital. Waiting, operating and recovery room, kitchen (for use of stores} and room (in which are sinks) do. Cleansing Station, Factory Lane, Croydon 2 waiting 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 † In December these clinics were transferred to new premises in Lodge Road, West Croydon. 16 (D) Hospitals Provider 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. Arrangements are being made for an enlargement of the institution to 85 beds—40 for Croydon, 40 for Surrey C.C., and 5 for Kent C.C. (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 now (1926) part of the Clinic premises in Lodge Road and provides accommodation for twelve sick or ailing children under 5 years of age, in addition to an observation ward, and a ward for the accom. modation of two nursing mothers. (b) Borough Hospital.—Selected cases of ophthalmia neonatorum, infan. tile diarrhoea, measles, whooping cough, etc., are treated in the Borough Hospital. (4) Fever— Borough Hospital, Purley Way.—The nominal accommodation is for 170 patients, and the cases admitted are mainly those suffering from the ordinary notifiable infectious diseases. (5) Smallpox— The Croydon and Districts Joint Smallpox Hospital is now used as a Sanatorium (see above). Arrangements have been made with the Surrey County Council to receive into their Clandon Hospital any cases of smallpox that would ordinarily have been admitted to the Joint Hospital at North Cheam. (6) Other— Croydon General Hospital.—Four clinics are held at this hospital in connection with the Public Health Department's activities, viz.:—(a) Tonsils and Adenoids Clinic, (b) Venereal Diseases Clinic. (c) Orthopaedic Clinic, (d) Light Clinic. (E) Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children.—Provision is made by the Guardians at Mayday Road Hospital and at various children's homes; unmarried mothers are admitted for confinement to Mayday Road Hospital, to St. Mary's Hostel for the first confinement only, as well as to a large maternity home recently established in South Norwood for the express purpose of dealing with the unmarried mothers. A voluntary institution in Croydon receives large numbers of illegitimate children from various parts of the country, as a preliminary to establishing them with adopting parents or fostermothers. 17 The Babies' Help Committee of the Croydon Mothers' and Infants' Welfare Association is specially concerned in dealing with individual cases of unmarried mothers and their children. (F) Ambulance Facilities for Infectious. Cases.—Two motor ambulances are provided for the removal of infectious cases from the area of the County Borough and from that of Penge Urban District. WATER SUPPLY. I am indebted to the Borough Engineer for the following statement as to the water supplies, rivers and streams, and sewerage of the Borough:— The water resources of the Corporation are as follows: Five Pumping Stations drawing water from the chalk (four in the Borough and one in the Parish of Addington), together with a supply of 500 million gallons per annum in bulk from the Metropolitan Water Board for the supply of the northern part of the Borough being about one-fifth of the whole supply to the Borough. All supplies are distributed by the Corporation. The total resources at low springs are:— From the Croydon Wells 6,150,000 galls. per day. From the Metropolitan Water Board 1,670,000 do. Total 7,820,000 do. The consumption of water in 1925 was 2,499,855,649 gallons, equal to an average of 6,848,920 gallons per day. The water supply is constant. All houses are supplied internally, excepting that in about 40 cases they are supplied by means of standpipes. The Surrey Street Wells were established in 1851 and comprises four bored wells syphoned together and lined with watertight tubes to a minimum depth of 50-ft., below which they are bored. The yield at these works is 2¼ million gallons daily on the average. The Addington Well was established in 1888 and comprises a well 205-ft. deep lined with brickwork to a depth of 70-ft., with headings 6-ft. by 4½ft. chiefly about 150-ft. from the top, 813 yards in length and holding, with the lower part of the well, 502,000 gallons. In 1910 slow sand filters were brought into use for 18 ing the whole of this supply with an area of 4,270 square yards. The yield of this well is about 1¾ million gallons daily, with a minimum of under 1 million gallons. The Waddon Well was established in 1899 and comprises two bored wells each 200-ft. deep and lined with cast-iron cylinders to a depth of 70-ft. from the floor level, below which they are in bare chalk. There are no headings. The water obtained from this well is limited by Act of Parliament to 50 million gallons in a period of thirty days. The Stroud Green Well was established in 1905 and comprises a well 391-ft. deep and lined with cast-iron cylinders to a depth of 144-ft., below which it is in bare chalk. A borehole is put down for a further distance of 146-ft., making the total depth 537-ft. Headings are driven at 230-ft. and 365-ft. down to a total length of 1,407 yards. The yield of this well is about 650,000 gallons per day. The Selhurst Well was purchased from the Metropolitan Water Board in 1922. It had not been used for a number of years, but new pumping plant has been provided and water is now being pumped into the town's supply. The depth of this well is 385-ft. and it is lined with brickwork (90-ft.) and cast-iron cylinders (88-ft.) to a depth of 178-ft., below which it is bare chalk. Headings are driven at depths of 218-ft. and 358-ft. from the top of a total length of 1,264 yards. The yield is about 500,000 gallons per day. The Surrey Street Works is in the centre of the town and has always been surrounded by houses. Pumping never ceases and a good and pure water is obtained. The water from each pumping station is analysed each month and always found to be of excellent quality and has no plumbe-solvent action. RIVERS AND STREAMS. The River Wandle, Norbury Brook (the head of the River Graveney, a tributary of the River Wandle), and the River Ravensbourne all take their rise in the Borough. The sewerage of the Borough is on the partially separate system; consequently these streams are all utilised for surface water drainage purposes. 19 DRAINAGE AND SEWERAGE. There is a system of surface water drainage in the Borough, discharging as follows:— To River Wandle 3,340 acres. Norbury Brook 3,230 „ River Ravensbourne 1,880 „ Penge, by Norwood Lake 300 „ Effra Sewer of the London County Council 262 „ As to sewerage, this is discharged as follows:— To Beddington Sewage Farm:— Acres. Population. From the Borough 6,200 150,300 From outside districts of— Coulsdon and Purley 6,915 24,000 Whyteleafe and Warlingham (part) 1,055 2,500 Carshalton 114 No figures available. To South Norwood Sewage Farm:— From the Borough 2,510 44,000 From outside districts— Addington (part) About 20 cottages 100 & 6 large houses. To London County Council Sewers— Upper Norwood (part) 294 5,600 The Beddington Sewage Farm has an area of 690 acres, of which 484 acres are irrigable, and the South Norwood Sewage Farm has an area of 189 acres, of which 130 acres are irrigable. REFUSE REMOVAL AND DISPOSAL. I have to thank the Borough Road Surveyor for the following summary of the method of refuse removal and disposal:— Collection.—The collection of house refuse is by direct labour, and on an average 17 motor vehicles are engaged—15 5-ton steam and 2 3½-ton electric. The general collection is once weekly; and at hotels, boarding-houses, and certain business premises daily or two or three times weekly according to circumstances. Disposal.—Approximately 140 tons of refuse are collected daily, the disposal being as follows:— Destructor 70 tons. Pulveriser 20 „ Shoot 50 „ 20 Dust Prevention.—In addition to the tar-surface treatment, a dust preventive preparation is extensively used with satisfactory results. Owing to the modern method of road-surfacing, tarsurfacing and dust preventive treatment, very little street watering is necessary, but when required an electric wagon fitted with an interchangeable watering tank is employed. 21 SECTION II—ACUTE INFECTIOUS DISEASES. 1.—GENERAL PREVALENCE. (a) Notifications. The number of notifications of scarlet fever and diphtheria continued at a low level throughout 1925 (Appendix, Table V.). There was a marked decrease in the number of notifications of pneumonia, from 108 in 1924 to 52 in 1925. A number of cases of paratyphoid fever were notified, and their origin is discussed in a report on a subsequent page. (b) Deaths. 8 deaths were recorded from diphtheria, 63 from influenza, 9 from whooping cough, 7 from measles, and 1 from scarlet fever. (Appendix, Table V.). 2.—SCARLET FEVER. Out of a total of 347 cases notified as suffering from scarlet fever, 292 were admitted to the Borough Hospital or other institutions, the remaining 74 being treated at home. 20 cases were also admitted to the hospital from the urban district of Penge, in accordance with an agreement with that authority. The disease was in general of a mild type. 2 deaths occurred at the Borough Hospital, from the septic form of the disease; one being from the Penge Urban District. The average duration of stay of scarlet fever patients in the Borough Hospital was 43.3 days. Hospital Return Cases—Scarlet Fever. 6 return cases of scarlet fever were reported, following on the return home of an equal number of patients from the Borough Hospital after treatment for the disease. Of the 6 "infecting" cases, 5 showed no signs suggestive of infectivity on examination at their homes; 1 had nasal discharge when later seen at home. Home Return Cases—Scarlet Fever. No return cases were traced during the year in connection with the small number of patients treated at home. 22 3.—DIPHTHERIA. Out of 104 cases notified on account of diphtheria, 100 were treated at the Borough Hospital and 4 treated at home; while 28 cases were admitted from Penge U.D. In addition, 10 patients were admitted for conditions suspected to be diphtheria, but finally diagnosed as follows:—7, tonsilitis; 1, Vincent's angina; 1, laryngitis; and 1, measles. 11 deaths, including Penge cases, occurred from diphtheria at the Borough Hospital; 7 of these were suffering from the laryngeal form of the disease. The average duration of stay of diphtheria cases in hospital was 47.7 days. Tracheotomy was performed in 7 cases, with recovery in 2 instances; the majority were admitted at a very late stage of the disease, 2 being moribund on admission, 3 dying subsequently of heart failure. Hospital Return Cases Diphtheria. There were no hospital return cases of diphtheria during the year. Home Return Cases—Diphtheria. No return cases were traced in connection with the few patients treated at home. 4—SMALLPOX. No cases occurred in Croydon during the year. A number of patients suffering from conditions suggestive of smallpox were seen in consultation with medical practitioners, and contact of cases of smallpox reaching the various ports were kept under observation on the basis of reports from the port authorities. 5.—CEREBRO-SPINAL MENINGITIS. 2 cases were notified during the year, but after admission to the Borough Hospital were found to be suffering, in one case from encephalitis lethargica, in the other from an infection of the kidney. 6.—ENCEPHALITIS LETHARGICA. 20 cases were notified, and 8 were admitted to the Borough Hospital. The diagnosis was confirmed in 5 instances in respect of the above admissions. 23 7.—MEASLES. Measles was neither particularly prevalent nor of a severe type during the year, though there was an appreciable increase in prevalence towards the end of the year. Seven deaths were registered from the disease. 10 patients who could not be properly nursed at home were admitted to the Borough Hospital on account of measles. 8.—WHOOPING COUGH. Whooping cough was low in prevalence. 5 cases were admitted to the Borough Hospital for treatment. 9 deaths occurred during the year. 9.—EPIDEMIC DIARRHOEA. This condition was not the cause of any extensive amount of illness among young children during the year. 30 children under the age of 2 years died of the disease. 11 children were admitted to the Borough Hospital for treatment, of whom 6 died. 10.—OPHTHALMIA NEONATORUM. 22 cases were notified during the year, and 10 of these were admitted to the Borough Hospital for treatment. Admission was in all cases to a cubicle in the Isolation Block (J), and mothers were, where willing, admitted with their children in order to avoid the need for weaning at so early an age. Further particulars in regard to ophthalmia neonatorum are given in the maternity and child welfare section of the report. 11.—ENTERIC GROUP INFECTION. 38 cases of enteric fever (including paratyphoid fever) were notified during the year. The following report gives details of the factors involving the large group of cases of paratyphoid (???) fever occurring as a specific outbreak:— REPORT ON AN OUTBREAK OF FOOD-BORNE PARATYPHOID (B) FEVER AFFECTING CROYDON AND NEIGHBOURING DISTRICTS. To the Public Health Committee. I submit the following report on an outbreak of paratyphoid B fever coming to light in Croydon early in September, 1925, and affecting in varying degree other districts in the neighbourhood of the borough. 31 cases of paratyphoid (B) fever occurring among persons resident in Croydon are known to be directly connected with this outbreak; information received from other 24 medical officers of health, either directly or through the kind co-operation of the Ministry of Health, has shown that no less than 44 cases have been attributed to the same source in other areas affected, and there is little doubt that this is by no means a full tally. In addition, there must have occurred a considerable number with less severe symptoms in persons who failed to seek medical advice, or received treatment for transient diarrhoea, etc., without the possibility of the presence of paratyphoid fever being recognised. The delay in presenting this report has been due to my own absence from dutv through an illness which commenced shortly after the detection and removal of the chief factor in the outbreak, the subsequent administrative control being in the capable hands of Dr. W. H. Brodie, Deputy Medical Officer of Health. I have felt is desirable in attempting to give an account of a very complicated investigation to describe in sequence the following-up of false as well as of genuine clues, and the report will illustrate the fallacies inherent in conclusions based on incomplete data, though naturally action in the public interest may have to be taken on such imperfect information as is available at the time. First information of outbreak. On September 5th, 1925, a case of paratyphoid (B) fever—a disease similar to, but usually somewhat milder than, typhoid fever—was notified, as a result of a positive blood agglutination test, and was admitted to the Borough Fever Hospital. From the blood of this patient, Miss X, a pure culture of the organism causing paratyphoid (B) fever was grown. Miss X gave a history of having returned from a seaside holiday of a fortnight's duration, one week before the onset of her illness on August 29th. In view of the normal incubation period of seven to fourteen days for this disease, it was at first assumed that infection had occurred during her absence on this holiday. When, however, it was ascertained that she was employed at a confectioner's shop, a visit paid to the latter, largely for the purpose of safeguarding the health of other employees and of customers, revealed a remarkable state of affairs. It was founds— (a) That Miss X was head assistant at the shop, and that her illness— which began suddenly on August 29th with headache, abdominal pain, and diarrhœa—was not the only case of illness among the shop staff; (b) That nine out of a total staff of fifteen employed in various capacities at the shop—including the manager and one of his sons—had had symptoms similar in type, though varying in severity, with onset between August 31st and September 2nd; and (c) That four members of the manager's household not employed at the shop, and living in a house entirely distinct from and not in the immediate neighbourhood of the shop, had developed precisely similar symptoms between August 30th and September 1st. Of the nine persons among the shop staff showing these symptoms, five—including the original patient, Miss X—were assistants in the shop and restaurant for light refreshments attached to it, and all of these were, on the day on which the investigation began, absent with illness, beginning in the case of Miss X on August 29th, in two others on September 1st, and in the remaining two on September 2nd. The illness, which had in the latter four cases been labelled as influenza, was later proved by blood agglutination tests to be paratyphoid (B) fever. The bookkeeper at the shop, who had gone on holiday on August 31st, fell ill on that day, and when subsequently admitted to the Borough Fever Hospital, was suffering from a well marked attack of the same disease. The manager had slight transient indisposition on September 2nd, an errand boy began to be unwell on August 31st, and a second— a son of the manager—on September 2nd. 25 Symptoms. In the more marked of these, and of subsequent cases, the symptoms were strikingly alike—severe headache, often occipital in position, abdominal pains, nausea or vomiting, chilliness with subsequent fever of 100° F., lasting for one to three weeks, early diarrhoea, often with constipation later, and profound initial lassitude and debility. An eruption, similar to that found in typhoid fever, but more abundant and coarser in character, was a very constant feature. Epistaxis (nose bleeding) within the first few days of the illness was also a frequent feature. Most of the cases were sharply ill. None of the Croydon cases ended fatally, though some had severe complications, including sharp haemorrhage from the bowels. Incubation period. Although it is anticipating the sequence of events, it is convenient to state at this stage that the incubation period, from the moment of infection to that of the earliest symptoms, varied from one to seven days, in no instance known to me exceeding the latter period, and in only two cases exceeding five days. This is a decidedly shorter incubation period than is often found in this disease. Source of infection. The almost simultaneous occurrence of cases of illness among the pastryshop staff pointed towards a common source of infection, probably through food or drink. The many alternative sources and methods of infection which might have needed investigation were fortunately limited by the fact that a second group of cases had occurred, at precisely the same time, in the house of the manager of the shop. It was reasonable to assume a common basis of infection for the two groups, and enquiry into the factors common to both showed that these were as follows:— (a) The manager himself. His illness began on September 2nd, i.e., later than that of most of the members of his household (August 29th-September 2nd), so that he was unlikely to have personally conveyed the infection from the shop to his house. (b) The manager's son. His illness began on September 2nd, and the same argument therefore applies in his case. (c) Milk Supply. The pastryshop received milk from three dealers, one of whom also supplied the manager's house. Enquiry at the milk shop into the health of the employees, and the absence of any evidence of widespread illness among customers; served by the dairy, made this an unlikely source of infection. This conclusion was confirmed when the next case of paratyphoid infection coming to light was found to obtain milk from another source. Enquiry into subsequent cases showed that there was no particular milk supply common to all. (d) Water. This also could be set aside as the source of infection, in view of the absence of any generalised epidemic in the area served by the same water supply. (e) Provisions. The provisions regularly brought from the shop for the manager's house were bread, madeira cakes, small fancy cakes, and veal and ham pies. Turning now to the provisions which might be consumed by members of the shop staff, it was found that the staff had all their meals at the shop; that these meals were served in a staff room on the first floor of the premises, the ground floor being entirely for the purposes of shop and refreshment rooms; that joints of meat, vegetables, and simple puddings were cooked on the stove in the staff room, these foods being both for staff and for customers, 26 and that all fancy pastry, meat pies, cakes and bread issued from the shop, whether for customers or for staff, were cooked at a central bakehouse not connected with the shop. It was further found that the meals served to the staff included bread, cooked meat, vegetables, sometimes ham and veal pies, but never fancy cakes, and it was said to be unusual for the staff to buy such fancy cakes for themselves. The provisions in common between the shop and the manager's house were thus limited to bread and meat pies. Of these, the pies would be a more likely means of conveying a gross degree of infection than the bread. Enquiry now showed that the staff had had a veal and ham pie, one of a batch baked on August 27th, for their breakfast at the shop on August 28th. Miss X had developed her first symptoms on August 29th, and other members of the staff at various dates from August 31st to September 1st. The manager's household had had a veal and ham pie, baked on August 25th, at midday on Friday, August 28th; a daughter developed symptoms on August 29th, and other members of the family between August 31st and September 2nd. Bread from the shop had also been eaten, both by the shop staff and by the manager's household. It was clear, therefore, that there were grounds for suspecting the meat pies, of two bakings, viz., those of Tuesday, August 25th, and of Thursday, August 27th, or possibly the bread, sold at the shop. The suspicion of the pies was confirmed when news was received, through a medical man practising in the district, that six members of a private household living near the shop had simultaneously developed paratyphoid (B) fever, with onset in three cases on August 29th, and in three on August 30th, after eating on the night of August 28th a veal and ham pie obtained from the shop in question. Almost simultaneously with the receipt of this information I saw, in consultation with the Medical Officer of Health of an adjoining area, a household of five persons suffering from anomalous illness, which we agreed, and which subsequent tests proved, to be paratyphoid (B) fever. These five persons had bought and eaten a veal and ham pie from the same shop on August 26th, and had developed symptoms of illness at dates between August 29th and 31st. Attention was thus concentrated on the veal and ham pies as the probable source of infection, and on the manner in which these might possibly have been infected. Manner of infection of meat pies. The meat pies were not prepared at the shop, but at a central bakehouse serving a number of branch shops, situated in various parts of Croydon and neighbouring districts. The pies were then delivered ready-made at the shop, and were sold over the counter to customers, while occasionally a pie was taken from the storeroom in the shop to the staff room for the meals of the staff. The details of the investigations into the various possible chances of infection and into the health of each employee at the shop need not be given. Briefly, the main possibilities of infection appeared to be:— (1) Contamination of pies at the shop by the assistant serving them to customers, the same assistant possibly picking out a pie from the storeroom to send upstairs to the staff room. This appeared to be a very unlikely method of infection; the occurrence of groups of cases suggested massive infection of the interior of the pies rather than the slighter contamination of the exterior which would occur in handling. 27 (2) Contamination of pies by mice or rats. This hypothesis arose out of the fact that a bacterial virus was in regular use at the shop for the extermination of rats and mice. Outbreaks of illness identical in symptoms with paratyphoid fever, and stated to have actually been this disease, have been recorded on more than one occasion, arising out of contamination of foods by the droppings of rats or mice suffering with intestinal illness due to poisoning by bacterial rat virus. It was felt that here again contamination of the pies at the shop would probably not be sufficiently massive to account for a considerable number of cases arising simultaneously, especially as no evidence could be obtained of the presence of mice, or of pies having been nibbled. When, however, the manager of the shop explained that the same bacterial virus was used at the central bakehouse and at other branch shops, the possibility of this channel of infection had to be followed up. (3) Contamination of pies in transit from the bakehouse to the shop. (4) Contamination of the pies at the central bakehouse, or contamination of some ingredient before delivery at the bakehouses. This alternative would imply the likelihood of cases of paratyphoid fever occurring in connection with other branch shops receiving deliveries of pies from the oentral bakehouse. Lines of investigation into source of infection of meat pies. It thus became necessary to ascertain the general distribution of the branch shops served from the central bakehouse; to look into the incidence of paratyphoid fever in the areas likely to be served by these shops, and to investigate the processes of manufacture, and the health of the employees, at the central bakehouse. At the same time, the procedure in regard to the use of rat virus by the firm needed investigation. It may be added here that meanwhile a visit had been paid to the head office of the manufacturers of the virus. Every assistance was received from the latter, who supplied a stock of the virus to be submitted to bacteriological and serological tests. These tests were carried out at the laboratory of the Borough Fever Hospital, and, by the courtesy of the Ministry of Health, samples of the virus were also submitted to detailed examination in the Ministry's laboratory. At the same time, a warning letter was sent to medical practitioners in the Borough, and the Ministry of Health were notified of the position. I had further the welcome opportunity of discussing the position in detail with the officers of the appropriate medical department at the Ministry of Health. I propose to summarise in sequence the main points arising out of the various lines of enquiry set out above:— Area served by the Bakery.—The premises belonging to the firm of bakers consisted of two central bakehouses and the head office, situated in Croydon; and of a considerable number of branch shops, situated partly in Croydon, and partly in neighbouring areas. One of the two central bakehouses was concerned solely with the baking of bread, and its staff, equipment, supplies of flour and other requisites, and processes of manufacture were entirely distinct and separate from that of the other central bakehouse, which was devoted to the preparation of meat pies and of a variety of fancy and plain cakes. Incidence of enteric fever in the areas likely to be served by the confectioners.—The weekly list of notifications of infectious disease in each sanitary area supplied by the Ministry of Health groups notifications of typhoid and paratyphoid fever together under the common heading of enteric fever. 28 The notifications of enteric fever in the districts which might very probably have been served by the various branches of the firm of confectioners were tabulated week by week from the beginning of the year, as follows:— Sept. 5 1 2 ... ... ... ... 2 ... 5 „ 29 2 ... 2 1 ... ... 1 2 8 „ 22 ... ... ... 5 2 ... ... 1 8 „ 15 ... 1 1 1 1 ... ... 1 5 „ 8 ... ... ... 1 1 ... ... 2 4 Aug. 1 ... ... 1 ... ... 1 ... ... 2 „ 25 1 ... ... ... ... ... ... ... 1 „ 18 ... ... ... ... ... ... ... ... ... „ 11 ... ... ... ... ... ... ... ... ... July 4 ... ... ... ... ... ... ... ... ... „ 27 ... 1 ... ... 1 ... ... ... 2 ,, 20 ... 1 ... ... 1 ... ... ... 2 „ 13 ... ... 1 ... 1 ... ... ... 2 June 6 ... ... ... ... ... ... ... ... ... „ 30 ... ... ... ... ... ... ... ... ... „ 23 ... ... ... ... ... ... ... ... ... „ 16 ... 1 ... ... ... ... ... ... 1 „ 9 ... ... ... ... ... ... 1 ... 1 May. 2 ... 1 ... ... ... ... ... 1 2 „ 25 ... ... ... ... 2 ... ... ... 2 „ 18 ... 2 ... ... ... 1 ... ... 3 „ 11 ... ... ... ... ... ... ... ... ... Ap. 4 ... ... 2 ... ... ... ... ... 2 ,, 28 ... ... ... ... ... ... ... ... ... „ 21 ... ... ... ... 1 ... ... ... 1 „ 14 ... ... ... ... ... ... ... ... 1 Mch. 7 ... 1 ... ... ... ... ... 1 2 „ 28 ... ... ... ... ... ... 1 ... 1 „ 21 ... 1 ... 1 ... ... ... ... 2 „ 14 ... ... ... 1 ... ... ... ... 1 Feb. 7 ... ... ... ... ... ... ... ... ... „ 31 ... ... ... 1 ... ... ... ... 1 „ 24 ... ... ... ... ... ... ... ... ... „ 17 ... 2 ... ... 1 ... ... ... 3 Jan. 10 ... ... ... ... 1 ... ... ... 1 Notifications of Enteric Fever during week ending: Croydon District A District B District C District D District E District F District G The table clearly suggests a material and rapid increase in the number of notifications of enteric fever, from a date early in August. This affected nearly all the districts likely to have been served from the firm's shops, and curiously enough affected Croydon less obviously than some of the other districts. There was at the moment no knowledge as to whether the increase in enteric fever notification, was due, in fact, to an increase in paratyphoid (B) fever; it was merely suggestive, and lent colour to the view that the foodstuffs carrying infection were infected when they left the central bakery 29 for distribution to the various branches. This could be tested only by detailed enquiry in the several districts, and the medical department of the Ministry of Health were good enough to arrange for one of the medical officers of the Ministry, Dr. E. Wilkinson, to collaborate with the medical officers of health of the various districts outside Croydon likely to be concerned, in order to see whether any link could be established between cases of paratyphoid fever which had occurred within recent weeks in these districts, and the consumption of any type of provisions from one or other branch of the firm implicated. Pending the receipt of this information, or of fresh cases arising in connection with other branches, visits of investigation were paid to the central bakeries, for the purpose of enquiring into the possibility of contamination of the ingredients of the veal and ham pies at some stage in the process of manufacture or delivery. It is to be remembered that at this stage there were no grounds for suspicion as to other types of confectionery conveying the specific infection. General circumstances at the Central Bakeries. (A) Bread Bakery. The bakery concerned in the baking of bread needs only the briefest reference. No point of note arose out of the inspection, and nothing was found to suggest that the bread was connected with the outbreak of paratyphoid fever, or that the members of this bakery staff had any connection with the outbreak. The most positive and complete assurance was given as to this staff being entirely distinct and separate from that for the bakery concerned in the manufacture of meat pies and fancy cakes. (B) Bakery for Meat Pies and Fancy Cakes. Premises.—The premises were, in general, modern in type, well lighted and ventilated, and evidently maintained at a good level of cleanliness. Only two points resulting from the first survey of the premises need here be noted. (a) The sanitary arrangements were defective, in that no wash basin was provided for the use of the male staff before returning to the bakery after a visit to the lavatory, the only washing facilities—which they were stated to use—being the sink in which various utensils, crockery and cutlery from the bakery were left to soak in hot water during the process of cleaning. (b) Bacteria! rat virus was laid down as a routine once a fortnight at several points in the bakery, and certain baking ingredients, especially the daily stock of flour stored in bins in the bakehouse, and the powdered gelatine used in the preparation of meat pies and of certain other articles, as well as a small proportion of the pies stored overnight on the premises, were insufficiently protected against contamination by rats or mice suffering from the effects of the virus. It may be added that samples of the flour and gelatine were submitted for bacteriological examination at the laboratory of the Ministry of Health and at that of the Borough Hospital, but with negative results as regards the organism of paratyphoid (B) fever. Staff.—Particulars, purporting to be complete, were obtained from the firm as to the staff at work on the meat pies at the time when the two batches of meat pies up to this point implicated had been baked, viz., on August 25th and 27th; as to members of staff engaged in the preparation of meat pies absent owing to illness or holiday; as to other members of the staff, whether present or absent, and periods and causes of absence; as to members discharged within recent months, and temporary staff during recent months. These particulars were not all obtained at once, and it will be seen that the inadvertent omission of one name from the list by the firm gave rise to a good deal of unnecessary difficulty in the investigation. The net result of the enquiry into the health of the staff at the present stage was to cause suspicion as to one individual, all the rest presenting, so 30 far as could be seen, a clean bill of health, and giving no special features needing comment. The exception was a girl who, for the particular week which included the dates on which the two batches of meat pies thus far incriminated were baked, had taken the place of the employee usually responsible for the filling of the meat pies with gelatine. This coincidence as to dates in connection with an operation which, as shown below, was a critical one in the manufacture of the pies, at once threw suspicion on the temporarily transferred employee as a likely source of infection. The closest enquiry into her antecedents and history gave, however, no reason to suspect her health, and examination of her blood, and subsequently of stools and urine, gave entirely negative results as regards any paratyphoid infection. It should be added that the blood of every member of the staff, so far as then known to us, was examined for paratyphoid infection, as were also the stools and urine of certain members most closely connected with the process of pie-making, but in all cases with negative results. The search for a human source of infection had therefore, for a while, to be left at this negative stage. Process of manufacture of meat pies.—Veal and ham pies were the only type of meat pie made. Two batches were baked each week, on Tuesdays and Thursdays respectively. These were issued immediately after each baking to the various branch shops, except that a small number were stored overnight at the bakery owing to difficulties of transport to three branches. The greatest individual number of pies were sent each week to the branch with which all the initial cases had been connected. During the week which included the bakings of August 25th and 27th, this branch received nearly four times as many as the average number of pies issued to any other branch. It is necessary, for reasons which will become apparent, to give a brief description of the process of manufacture of the veal and ham pies. The veal and the ham, obtained respectively from two Croydon butchers, were chopped, minced by machine and mixed by hand ; to these were added a paste, made of stale bread, rubbed into crumbs by hand, and mixed by hand with water and herbs, the whole being mixed by hand into a large heap and weighed out into suitable portions. Dough, made by mixing flour, water, lard, and yeast in a mechanical mixer, was rolled out by hand, cut, and filled into tins as a lining for the bottom and sides. The portions of meat paste were placed in the dough-lined tins. A cap of dough was applied, painted over with egg solution made from frozen whole eggs, and two vents made in this cap. The tins were then placed on metal trays and heated in a brick oven at about 400° F. for two hours. Meanwhile, a bone stock made from bones (supplied by a Croydon butcher), with water and salt, was prepared by boiling the mixture in a metal utensil for 45 minutes, and then allowing to simmer for two hours. The bone stock was run into a large basin, powdered gelatine—swollen with water—added and allowed to melt without further heating, a seasoning of salt and pepper stirred in, and the hot mixture run into a large jug and poured by means of a funnel through the vent-hole into the baked pies till these were filled with jelly. The pies were then placed on metal trays, taken into an adjoining room, there placed by hand on wooden trays covered with paper, and the wooden trays, with their contents loaded on to motor vans, which conveyed them to the various branch shops, the trays being then removed from the van and taken into the shop, the pies being stored on the trays without further handling until sold to the customer. The veal, ham and bones were traced back to the butcher's shop supplying them, but nothing of note was discovered; it was obviously impossible to ascertain whether the particular supplies used for the batches of pies baked on August 25th and 27th were sound. Similarly, nothing of 31 ance was found in connection with other ingredients or with the various stages of the manufacture, apart from the points set out in the next paragraph. While there was a good deal of handling of materials at various stages of the process of manufacture, the risks seemed to be rendered largely negligible by the degree and duration of exposure to heat during the baking. One obvious exception to this was to be noted in the process of adding the gelatine bone stock to the pies. Here there was no heating subsequent to the addition of the gelatine and seasoning to the hot bone stock, as a preliminary to running the mixture into the cavity of the pie. Further, the gelatine bone stock mixture was made in a metal vessel, drained at the bottom by a tap which, unless subjected to the most careful and thorough cleansing after use, would be liable to retain a trace of the stock, so that an infected stock could conceivably, by this means, contaminate subsequent supplies of stock run out from the same vessel. While ordinary care was used in cleansing this vessel, the chanoe of pollution through this source was evidently not apparent to the employees responsible, so that this method of possible contamination could not be ruled out of court. Thus several possibilities of contamination were here evident:— (1) Pollution through infected veal, ham, or bones—unlikely, owing to the length of boiling and subsequent simmering (approaching the boiling point) to which the stock was subjected. (2) Pollution during the process of adding the gelatine, the latter having conceivably been infected, either (a) before arrival in the bakery : Dr. Wilkinson, of the Ministry of Health, was good enough to undertake investigation of the processes of manufacture and storage of the gelatine at the factory in London which supplied it to the Croydon firm ; (b) during storage at the bakery. The particular supply of powdered gelatine in use at the time of manufacture of the infected pies (August 25th27th) had been in use—and had been the only stock in use—for a number of months previously. It was stored in a large uncovered tin, the mouth of which was close to the end of a shelf on which jam, cakes, and disused utensils were stored—i.e., was in a position accessible to, and likely to be visited by mice, which might thus be a factor in contaminating it by the deposit of infected excreta. Further, the tin in which the powdered gelatine was stored had previously been used for powdered whole egg, and had been dry cleaned, but not washed or scalded after removal of the powered egg and before introduction of the gelatine. In some previous outbreaks of paratyphoid (B) fever, the prepared egg used in the process of manufacture of incriminated foodstuffs was under suspicion, owing to the fact that the white of egg may be infected during the act of laying by a fowl suffering from intestinal disease. Here, therefore, was still another—perhaps rather remote—possibility of contamination of the gelatine; (c) by the hands of the employee responsible for getting the gelatine from the storage tin, for mixing it with water, and for adding it to the hot bone stock. It has already been noted that during the baking of the two batches of pies so far incriminated, a worker transferred temporarily from other work in the bakery had been concerned in this particular process, during the absence of the regular hand on holiday; but that no evidence of illness in this temporary hand could be discovered. It will be seen later that another means of human contamination of the gelatine at this stage was, in fact, possible though this was not recognised at the time of the investigation, owing to the list of employees having been incomplete in one particular. 32 (3) Pollution during the addition of salt and popper to the hot gelatine bone stock. The chance of pollution of the salt and pepper during storage was infinitesimal, but there were opportunities of infection during their sprinkling, by spoon or sometimes by hand, into the gelatine bone stock. (4) Pollution during the process of filling the pies with the gelatine bone stock. Such pollution might arise through contact with the hands of an infected worker, or by the use of a contaminated funnel through which to introduce the jelly into the pie. One funnel was reserved for the purpose. Ordinary care was used in cleansing it, and it was stored loose in a cupboard containing at the time of inspection an open jar of jam and some confectionery. The cupboard was easy of access to mice, so that there was a chance of contamination of the funnel, not only by the hands of the worker, but also by contact with a rat or mouse sick from the effect of bacterial virus. (5) Pollution of flour through infection from sick rats or mice, either at the flour mills or warehouse, or in the bakery store, or in the service tins at the bakehouse. The risk of infection seemed remote, owing to the subsequent heat to which the dough was exposed in the ovens. It was nevertheless felt worth while to make enquiry of the millers, and of the warehouse supplying the flour to the Croydon bakery, as to their methods of rat extermination. No bacterial virus was used by either, nor was there access for mice to the stored flour at the bakery, except in respect of flour in the service bins in the bakehouse. These bins had lids, but it was doubtful whether they were always kept covered when the bakehouse was not in use; and if not, they were readily accessible to mice running along the tables in the bakehouse. (6) Pollution through faulty cleansing of utensils used in the bakery. It has been already mentioned that the sink in which utensils were washed up was the only sink in which male employees could wash their hands after using the lavatory; further, the water used for washing utensils was hot, but not necessarily boiling, so that there would only be a probability, but not a certainty, of infecting organisms in the sink being destroyed. Thus, up to the present stage, while there was left an uneasy feeling that there was a strong probability of infection by human agency, nevertheless careful enquiries of each employee at the bakery, and of the antecedents of others reported by the firm, as well as blood examination of all the employees at work and of certain temporary employees seen at their homes, gave no clue to the infecting source. At the same time, definite suspicion was thrown on chances of pollution during a late stage in the manufacture of the pies, and in particular on the chance of the gelatine having been infective, having itself possibly been infected by bacterial rat virus through the agency of rats or mice in the bakery—this always on the assumption of the correctness of previous investigations as to the association between certain bacterial rat viruses and cases of paratyphoid (B) fever, and the further assumption, which was being subjected to bacteriological tests, that the bacterial rat virus here used was identical with the bacillus of paratyphoid (B). In any case, the trend of the enquiry was to suggest contamination at the bakery rather than at a branch shop, and to open up the possibility of cases arising through other hranches, as well as through other types of confectionery made at the same bakery. Further evidence of area implicated in outbreak.—At this stage, information was received in quick succession of some fresh cases of illness, proving to be paratyphoid (B) fever, where the patient had eaten ham and veal pies supplied from the central bakery of the same firm to two other branches. This definitely showed that the infection did not arise in the 33 branches, but at, or in connection with, the centra! bakery. This point was established three days after the inquiry was begun, and just at the time when the next batch of pies baked at the central bakery was about to be despatched to the various branches. The Borough Hospital Sub-Committee of the Public Health Committee, which met on that date, decided to ask the firm to withhold this batch of pies from sale owing to the risk of this supply also being infective; and to facilitate rapid control of this stock, purchased the whole stock of pies, irrespective of whether these were to be sold within the borough or elsewhere. The pies were promptly handed over by the firm to the Public Health Department for destruction. A few were selected for bacterial examination at the Ministry's laboratories and at the Borough Hospital. The results of these examinations, as of that of samples of gelatine and of flour from the bakehouse, were in all cases negative in regard to the organisms of paratyphoid fever. Infection by confectionery other than meat pies. (1) The next stage in the enquiry arose from the notification of a case of suspicious illness in Croydon by a medical practitioner. The patient, a child, had an illness clinically suggestive of paratyphoid (B) fever, and this was confirmed by a blood test. The child had not had any meat pies, but had eaten on August 29th (three days before the onset of her illness) a fancy cake crowned with a gelatinous material. This cake had been bought from a branch of the same firm of confectioners distinct from any branch so far involved. Enquiry at the bakery showed that this type of fancy cake was made there; that the gelatinous material covering its apex did, in fact, contain gelatine with some whipped cream (sugar and cream, whisked), and that this type of cake and the meat pies were the only articles in the manufacture of which powdered gelatine was used in the bakery. The other ingredients common to these two were flour, lard and water, and certain of the employees were engaged in making both. Thus, attention was again rivetted on the chance of the gelatine being infected through human or animal sources. At this stage, after a full discussion of the position with the firm and an explanation of the fact that only a provisional hypothesis of the source and means of infection could be made, the latter voluntarily adopted the following precautions suggested by me:—(a) The emptying, scraping, and cleansing of the storage flour bins, prior to their being refilled with fresh flour; (b) the provision of a bone-stock receptacle without a tap, to be emptied by pivot action, and the adoption of special precautions in cleaning the utensil ; (c) special care in cleansing and storage of funnel used for filling pies with gelatine; (d) lining cupboards containing jam, pastry, etc., with zinc to protect against mice; (e) to replace bacterial rat virus by other less objectionable methods of rat and mice extermination; (f) to keep all lard, margarine, sugar, and similar foodstuffs inaccessible to mice; (g) to use automatically closing lids for flour bins, sugar and gelatine casks, and other receptacles containing food materials; (h) to destroy existing stock of powdered gelatine (already nearing its end), and certain other minor points. The firm had already dealt with the insufficient washing accommodation for male staff previously mentioned. (2) The view that the stock of gelatine, contaminated in some way not ascertained, was the agency carrying infection, now received a severe blow. Cases of paratyphoid (B) fever were reported which on investigation showed that they had had neither meat pies nor the special type of cake covered with gelatine; but that they had obtained from various branches of the same firm other fancy cakes which had one feature in common, viz., the presence on or within the cake of a layer of " butter-cream " flavoured in various ways. Enquiry at the bakery showed that these cakes did not contain gelatine, that the only ingredients which they had in common with the meat pies and the 34 jelly" cakes hitherto implicated were flour and water, and that the "buttercream" consisted of margarine and sugar. The process by which butter-cream was made showed some points of interest. The margarine and sugar were churned together in a dough-mixer, and then emptied out—partly by gravity and partly scooped out by the hand of the maker—into a large mixing pan, where flavouring and colouring agents were beaten in with a spoon. No suspicious feature arose in regard to the preparation of the rest of the cake-substance, to which a layer of butter-cream was added, and it is unnecessary to give details here. All that need be noted is the exclusion of gelatine as an infecting agency, and the renewed possibility of human contamination. Exclusion of bacterial rat virus as infecting agent. Almost simultaneously with the removal of the shadow of suspicion against the gelatine came reports from the Ministry of Health laboratories and from the Borough Hospital that the bacterial virus did not correspond in cultural features with the organism isolated from the blood of the first known patient, Miss X, nor was it agglutinated by Miss X's blood serum, which was known, by test against a number of other proved cases, to be rich in paratyphoid (B) antibodies—in other words, the bacterial virus used at the bakery was not the organism of paratyphoid (B) fever. Detection of human source of infection. The whole position had, therefore, again to be reviewed and the false clues discarded. The lack of direct evidence of human infection, associated with the indirect evidence of its likelihood, continued to be disturbing. In order that the employees engaged in making the various types of confectionerymight be collated, the firm were asked to indicate appropriate particulars on the lists which they had provided of their various employees. It was then found that there had been inadvertently omitted from the list the name of the foreman pastrycook, who was away on holiday at Southend-on-Sea at the time of the enquiry. Enquiry showed that this man was known to have had a temporary illness, involving frequent visits to the lavatory, early in August. He had been on duty during the period in which all the confectionery so far incriminated had been made at the bakerv, and was capable of having helped in one way or another in their preparation. A telephone message to the Medical Officer of Health of Southend-onSea, giving particulars and asking for an examination of the man and of his blood, received very prompt response, and a reply was obtained on the next day (September 15th)—eight days from the beginning of the enquiry—showing that the man's history was very suggestive of an enteric group infection, and that his blood gave a strongly positive reaction in regard to paratyphoid (B) fever. The man was to return to Croydon on September 18th. Measures were taken to see that he did not return to work; he was to see me directly on his return. Seeing that all the articles he might have helped to make up to the time of his departure on holiday had by now been sold or otherwise disposed of at the various branch shops, that no other member of the staff could be found at all suspicious of having had paratyphoid infection, and that no other source of infection and no other infected material could be traced at the bakery, it was felt to be safe and advisable to take up the position set out in letter No. 3 of the 17th September, to medical practitioners, set out in the appendix. Source of infection of foreman pastrycook. Pending the return of the foreman pastrycook, it was ascertained that, apart from general supervision, he was personally responsible for making the paste of the ham and veal pies. During, the week which included August 35 25th-27th, he took the unusual course of helping the temporary hand engaged in fdling in the pies with gelatine, by himself adding pepper and salt—and it was understood that he had on occasion done this bv hand. Assuming him to have been infective, this direct contact, by handling, at a stage of the manufacture where there was no subsequent heating to destroy infection, would readily account for the sudden outburst of cases of paratyphoid fever connected with the two batches of meat pies, in the preparation of which he assisted in a way which was not his usual practice; the object of his assistance being clearly the laudable one of assisting a worker unaccustomed to a particular process, and the result of his assistance being just as clearly the likely chance of infecting the pies at a critical stage in their preparation. This foreman pastrycook was also responsible for making the buttercream and whipped cream for the various types of fancy cakes which had produced infection. He was, therefore a sufficient cause for, at any rate, the bulk of the outbreak, and his return was awaited with interest, in order that the source of his own infection should be traced. Meanwhile, it was felt desirable that the firm should deal with the processes in pie manufacture not subjected to subsequent heating, and should establish a routine whereby the seasoned gelatine bone stock should be kept boiling for at least twenty minutes after preparation. This precaution was at once tested, found practicable, and adopted by the firm. An interview with the foreman pastrycook on his return on September 18th yielded the following interesting information which, while throwing much light on his own share in the outbreak, raised perplexing problems, never fully solved, as to the course of events prior to his own illness. For convenience, the foreman pastrycook is referred to as Z:— Z and Mrs. Z., a married couple without children, lived in a cottage on the bakery premises. Z has been foreman pastrycook with the firm for some twelve years. Neither he nor Mrs. Z had had in their past history any illness suggestive of enteric group infection. From July 23rd to August 3rd, 1&25, there were staying as visitors at Z's cottage a family of relations from another part of London, consisting of father, mother, and two children, together with Z's own mother. To celebrate the occasion, Z arranged for a specially large veal and ham pic to be baked for him at the bakery, on Thursday, July 30th. This was brought to his cottage on Saturday, August 1st, together with a cream gateau, also made at the bakery, and both articles were eaten on that day by Z and Mrs. and the five guests. The latter returned to their home on August 3rd. Two of them developed abdominal symptoms on August 3rd, and two on August 4th, one child escaping all symptoms. It seems very probable that these were cases of paratyphoid (B) fever, though, judging from correspondence with the Medical Officer of Health of the district, they did not appear to have been notified as such. Z himself developed diarrhoea on August 4th, with moderately severe headache. The diarrhcea continued for two days, after which he felt fairly well again. He kept at work throughout. In spite of his own light-hearted description of his indisposition, he must have been seriously unwell, as the manager of the firm had a lively recollection of the fact that the man was much indisposed. It was thus clear that the foreman pastrycook had suffered from a mild and unrecognised attack of paratyphoid (B) fever, that he had been capable of infecting foodstuffs from August 4th, the onset of his indisposition, until September 5th, when he ceased work to go on holiday, and that he did in all probability account for the sudden outbreak of cases infected from pies and other foodstuffs prepared during the week August 24th to 29th, when he was in close contact with the processes of preparation. On the assumption, based on the 36 examination of all the rest of the staff, that he was the sole active infecting agent from the middle of August onwards, it was concluded that no fresh cases arising directly from infected pastry would occur subsequent to September 10th to 12th, i.e., about five days after the date on which the foreman pastrycook ceased work, five days having been the longest incubation period then recorded, and allowing for some storage in the shops. These cases would consult their doctors about September 17th-25th. It was, in fact, found that no cases of food infection occurred with onset such as to imply infection by pastry baked subsequent to September 5th. Only a few cases—four in all—occurred in Croydon with a date of infection later than September 5th. Of these, two were traced to infection from a previous patient who had been infected through some form of pastry taken before September 5th, while the origin could not be traced in the remaining two. The batch of pies purchased by the Committee as a precaution was baked on September 10th, and was therefore, in all probability, harmless, though this does not render the precaution a superfluous one in relation to the knowledge then obtainable. By the time the next batch was due to be baked (September 15th), definite information as to the nature of the foreman pastrycook's illness had been obtained from Southend, and the sale of the pies was consequently allowed; and no cases of paratyphoid fever were traced to these. A satisfactory explanation of the bulk of the cases from early in August onwards had thus been traced. But the source of the infection of the foreman pastrycook himself brought the enquiry back in a surprising way to the bakery, through the meat pie or the cream gateau, one or other of which was the cause of his illness. Which of them was infected, and in what way? Some light was thrown on the health of the staff by the foreman pastrycook, who volunteered the information that one of the men (Y) employed in the bakehouse, who was away on holiday from August 3rd to August 8th, had abdominal pain for two days from August 5th, with some diarrhoea. This may have been pure coincidence, or there may have been some significance in the indisposition corresponding in date with "Z's" illness, and suggesting a possible common origin. "Y" had had no pastry or pies from the bakery; he had taken tea, in common with other employees, in a manner to be described below, and this may conceivably be a link in the chain of causation. Another employee (T) stated by Z to have had a bilious attack with headache on July 12th-13th, denied the statement; neither in his case, nor that of Y, could any bacteriological evidence of paratyphoid infection be obtained. These vague illnesses suggested the possibility of some unknown member of the staff having been ill at some previous date—perhaps in July—and of having (a) infected possibly Y and T through some common channel, and (b) infected the pie or the cream gateau, which was the source of Z's illness. The possibility of such earlier infection was supported by the fact that the information received from another district suggested that there had been at least one case associated with pastry bought from the firm concerned on or about July 24th. It may be said that it was not possible to trace any unsound ingredients in either the pie or the cake causing Z's illness, although the whole procedure of their preparation was discussed in the greatest detail. The only common channel through which infection from one worker could be conveycd to others, except through pastry, appeared to be the rather remote possibility of infection through tea. A bucket of tea was brewed twice a day, and the workers dipped their mugs into this when they wanted a drink; often the tea was almost cold before the bottom of the bucket was reached. Assuming that one man with fouled hands had contaminated the tea while dipping his mug into the bucket, it would be feasible, though not extremelv probable, for indisposition such as that attributed to Y and T to have arisen from the same source, and for one or other, or some other member 37 of the staff similarly affected, to contaminate the pie baked for the foreman pastrycook. This is obviously pure conjecture, and does not in any case reveal the original source of the outbreak, which could not be further traced. This has been the common experience in similar outbreaks of food-borne paratyphoid fever elsewhere; and there is cause for satisfaction that apparently the only factor in the continuance of the outbreak was detected and the outbreak checked. The foreman pastrycook was kept under observation for a number of weeks, during which he was not allowed to work. Examinations of his stools and urine were made in due course, in each instance with negative results, suggesting that he was not a carrier, but the victim only of an ordinary mild outbreak of the disease, with transient infectivity to others. He did not return to work with the firm concerned, but left the town. While there is no suggestion in this instance that the man remained at all infective, it is clear that such a man, trained in bakery as a speciality and without other means of livelihood, might, through no fault of his own, develop enteric fever, remain a carrier of the disease, and so be debarred from returning to his trade without prospects of other occupation. Some system of unemployment insurance in the trade would be a wise safeguard to meet such difficult cases. Summary.—This outbreak of paratyphoid (B) fever, affecting probably scores of individuals spread over half-a-dozen sanitary districts, was traced definitely to veal and ham pies and to fancy cakes infected at a late stage of their preparation by a pastrycook who had suffered from an unrecognised attack of the illness. The source of his own illness could not be traced; that source was within the bakery, through either infected materials or an infective person, and it may have accounted for a few scattered cases of paratyphoid (B) fever arising in areas outside Croydon, with dates of infection late in July and early in August. 75 cases were known to be in all probability associated with the outbreak. The earliest of these was probablyinfected about July 24th; 62 of the 75 cases were probably infected between August 4th (by which date the foreman pastrycook was a possible source of infection) and September 5th, on which date he ceased to work, and of these 33 were probably due to meat pies, 21 to other confectionery, and 8 to infection from a previous case; 4 cases were infected subsequent to September 5th, and of these 2 were due to infection from a previous case. In no individual case could infection be traced to pastry from this firm baked at a date subsequent to the withdrawal of the infective pastrycook from his work. Conclusions. The outbreak brought into relief a number of problems needing the serious consideration of the confectionery trade :— (1) The need for the most rigid insistence on proper washing arrangements for the staff, and a clear understanding with the latter on the subject of cleanliness of person. (2) The need for supervision of the methods of cleansing utensils in such a way as to avoid risks of contamination during the process. (3) The need for investigation of all trade processes which involve the personal handling of foodstuffs, where there is no subsequent heating of the latter to a temperature and for a period certain to destroy contaminating organisms. This applies to such processes as the filling-in of pies with gelatine stock, the removal of butter cream from mixing machines and its working-up and subsequent piping on to cakes; the preparation of whipped cream, etc. Every effort should be made to devise means whereby every process involving personal handling is followed by a sufficient heating of the foodstuff handled to prevent risks of retention of infection. 38 (1) Although bacterial rat virus had no part in the outbreak in question, it appears inadvisable that any form of bacterial poison likely to cause sick, as well as dead, rats and mice should be used within the precincts of bakeries or confectioners' shops. (5) All foodstuffs and other ingredients used in baking should be protected against rats and mice by automatically acting covers or other means not depending on human initiative. (6) In view of the possibility of an employee becoming at some time a carrier of infectious disease, and therefore unfit to continue in the confectionery trade, while untrained for other employment, the trade might with advantage consider the adoption of some form of industrial insurance allowing for the maintenance of such an individual, so long as he remained in an infectious state. H. P. NEWSHOLME, Medical Officer of Health. March, 1926. APPENDIX.—Letters addressed to Medical Practitioners in Croydon in regard to the outbreak. To Medical Men and Women practising in Croydon. I. 10th September, 1925. Dear Sir (or Madam), My attention has been drawn during the past few days to a series of, so far, some fifteen cases of sudden acute illness, occurring in Upper Norwood and in the immediately adjacent parts of Lambeth and of Penge, verv suggestive of acute food poisoning. Two of these cases have now been shown by the agglutination test to be suffering from paratyphoid (B) fever; others are being subjected to the same test. The source of infection is now under investigation. I send this note to say that the enquiry would be greatlv helped if you would be good enough to let me know the name, address, approximate date of onset, and foodstuff (if any) apparently involved, in regard to any patient now or recently under your care showing symptoms as below, and if you would allow me to consult with you as to their possible relation to the cases here in question. The onset of the cases so far known to me lie between August 27th and September 2nd. I do not at present know of any except in the district named above, but it is quite possible that they may be occurring elsewhere. The onset in nearly all cases has been sudden. A patient, well one day, on the next and immediately succeeding days, shows a rapid extension of the following symptoms:—Acute headache, usually occipital; extreme lassitude, with aching limbs and back; shivering, or a feeling of being flushed; colicky abdominal pains; some nausea, often vomiting; in some diarrhoea, in others constipation; epistaxis a few days after onset in several cases. The patients have temperatures of 100° to 102°, and have the general appearance seen in a fairly mild case of typhoid fever. Some are quite seriously ill, a few have been ambulant in type. The fever in the milder ones has lasted for a few days, but several are running a typhoidal course. I cannot say with what frequency rashes have occurred. In the one case definitely notified as paratyphoid (B), there has been the eruption—common in this disease—profuse, discrete, piny-red spots, coarser and more profuse than, but otherwise similar to, those of typhoid fever. 39 II. 11th September, 192o. Dear Sir (or Madam), The evidence which has accumulated since my letter to you of yesterday's date is sufficient to justify a definite conclusion as to the article of food involved in the cases of food poisoning due to B. paratyphosus (B), referred to in that letter. The cases are associated with a meal of shop-made veal and ham pie, the earliest symptoms (general lassitude and aching limbs) appearing within one to three or four days, and the more severe symptoms, which make the patient take to bed, beginning within three to five days, of the date on which the pie was eaten. The cases at present are nearly all centred around two batches of these pies, sold between Tuesday, August 25th, and Monday, August 31st. It cannot vet be said—until the end of this week or the earlier part of next week—whether the next batch, sold from the shops concerned between Tuesday, September 1st, and Thursday, September 3rd, inclusive, was also infected. The early determination of this will depend on the promptitude with which medical practitioners draw my attention to suspicious illness under their care. Appropriate measures are being taken in regard to issue of the pies subsequent to the 10th instant, and there appears no reason why such veal and ham pies, as are from this morning on sale in shops, should be avoided. I shall be glad to have Widal tests applied to any specimens of blood which you send up to the Borough Hospital, and wish to urge the importance of applying this test where suspicion of paratyphoid (B) arises. A markedly positive reaction has been obtained on the eighth day after the earliest symptoms in several cases in the present series, and very probably the reaction may be evident at a still earlier stage. In regard to the question of symptoms, I have seen several cases of suspicious illness—all clinically paratyphoid fever—since my previous letter, and in all these cases an eruption of discrete pink spots has been noted, in one or two identical with those of typhoid, in others slightly larger and more profuse than is usual in the latter disease. I would again urge the importance of early notice to myself at the Town Hall, Croydon (telephone Croydon 1964), at my house (Croydon 1713), or failing these, the Resident Medical Superintendent at the Borough Hospital (Thornton Heath 1767). III. 17th September, 1925. Dear Sir (or Madam), I am now able to send some further particulars with regard to the outbreak of food poisoning due to B. Paratyphosus B. On enquiry into the history of the cases to which medical practitioners were good enough to draw my attention, it became clear that, although the first considerable batch of cases was entirely due to the eating of veal and ham pies, there were also a proportion of cases due to eating other articles of confectionery prepared by the same firm. On comparing these, it was found that no single food constituent of the pastry was common to all of the confectionery involved, except flour itself. Investigation of all the employees brought to light a pastrycook who has been away on holiday throughout the period of the enquiry, and he has now been shown to be suffering from an unrecognised attack of paratyphoid (B) fever while at work. His blood gives a positive agglutination against paratyphoid (B), and his history is typical. This man has been on holiday since September 5th, and proper 40 measures will be taken in regard to him on his return to Croydon. The last articles of food which he took part in preparing were made on September 5th. Allowing for an incubation period of five days, which has been the maximum in the series so far observed, the last patients infected through confectionery would have an onset on September 10th to the 12th, allowing for some period of storage in shops; and consequently, the last batch of cases likely to arise are probably now reporting themselves to their doctors. There may still, of course, be further cases arising through secondary infection from previous unrecognised cases, but these are not likely to be large in number. Every precaution suggested by me has been taken by the firm of confectioners, and there appears to me to be to likelihood of a continuance of infection from that source. I am indebted to practitioners who have so kindly drawn my attention to cases, and have thereby made it possible to trace out the source of the infection. Yours faithfully, H. P. NEWSHOLME, Mcdical Officer of Health. It may be added that the substance of the main conclusions arising out of the epidemic, set out on page , was referred for consideration to the Bakery and Confectionery Section of the London Chamber of Commerce, the National Association of Master Bakers, and the Croydon Master Bakers' Association. WORK OF THE BOROUGH HOSPITAL. The Borough Hospital for infectious diseases contains 170 beds, 12 of which, in a separate block, were utilised throughout the year for the treatment of tuberculosis. In addition, 5 shelters are provided for other tuberculous patients. The number of patients admitted for treatment was again much below the average. The following table sets out the number of patients admitted, and the conditions from which they were suffering, during 1925, and previous years:— Patients admitted from Croydon C. B. and Penge U.D. on a diagnosis of:— Cases admitted during 1916. Case admitted during 1917. Cases admitted during 1918. Cases admitted during 1919. Cases admitted during 1920. Cases admitted during 1921. Cases admitted during 1922. Cases admitted during 1923. Cases admitted during 1924. Cases admitted during 1925. Scarlet Fever 295 201 386 532 583 738 728 350 261 264 (1)* Diphtheria 313 207 179 433 540 456 349 206 219 124 (2) Cerebro Sp. Meningitis 24 38 23 3 1 3 4 1 4 2 (3) Pulmonary Tuberculosis 44 40 37 44 63 64 58 66 35 25 Enteric Fever 10 6 13 4 12 12 3 8 3 9 (4) Paratyphoid B Fever ... ... ... ... ... ... ... ... ... 24 Puerperal Fever 2 2 1 4 7 2 2 1 4 3 (5) Morbilli (Measles) 17 25 17 6 4 ... ... 10 7 10 Rubella(German Measles) ... 12 2 3 1 2 4 1 5 5 (6) Mumps ... 20 6 4 1 3 ... ... ... ... ... Erysipelas ... 18 10 6 10 5 6 4 1 6 Encephalitis Lethargica ... ... ... ... ... ... ... 5 12 9 (7) ‡Othalmia Neonatorum ... ... ... ... ... ... ... ... ... 10 (8) Other diseases 33 10 37 29 24 28 14 22 14 40 (9) Total 738 579 711 1068 1246 1313 1168 674 565 530 41 * The numbers in brackets refer to the following notes:— ‡Prior to 1925 cases admitted in respect of this disease were inc luded under "other diseases." (1) Includes 9 cases of other diseases: 1 suffering from scarlet fever and mumps. 1 suffering from scarlet fever and diphtheria. 1 suffering from scarlet fever and chickenpox. 1 admitted as scarlet fever but actually diphtheria. 2 do. do. measles. 2 do. do. German measles. 1 do. do. tonsilitis. (2) Includes 10 cases of other diseases : 7 cases admitted as diphtheria but actually tonsilitis. 1 case do. do. Vincent's angina. 1 case do. do. laryngitis. 1 case do. do. measles. (3) Diagnosis not confirmed ; one was a case of encephalitis lethargica, and the other of surgical kidney. (4) Includes one case of debility and 5 cases of paratyphoid B. (5) Includes one case of scarlet fever sent in as puerperal fever. (6) Includes one case of measles sent in as German measles. (7) Includes one case of rheumatism, one case of sunstroke, and one in which no definite diagnosis could be made. (8) Includes four cases of conjunctivitis, not true ophthalmia. (9) Includes the following : 3 cases of meningitis (1 tubercular), 5 whooping cough, 3 septic tonsilitis, 1 otorrhœa, 1 pneumonia, 1 cellulitis of neck, 2 chickenpox, 11 enteritis and marasmus, 2 mumps, 11 with no appreciable disease. The average daily number of beds occupied amounted to 65.4, as compared with 75.9 for the previous year. The following table shows the highest and lowest number of beds occupied on any one night during each month of the year 1925. Month. Beds Occupied. Month. Beds Occupied. Highest. Lowest. Highest. Lowest. January 78 65 July 71 50 February 74 62 August 67 52 March 71 58 September 74 42 April 69 57 October 91 75 May 68 47 November 88 75 June 49 33 December 78 67 42 The following table indicates the number of admissions from the Borough and from the Pentge U. D. during 1925:— Districts. Remaining at end of 1924. Admitted during 1925. Discharged during 1925. Died during 1925 Remaining at end of 1025. County Borough of Croydon 72 476 459 26 6S Penge Urban Dis. Council (non-pauper cases) 3 54 49 5 3 Total 75 530 508 31 60 Table VI. in the Appendix gives details of the patients admitted and discharged during the year. Mixed Infection. 11 patients on admission to the Borough Hospital were found to show evidence of two concurrent infections: 3 had scarlet fever with diphtheria, 2 scarlet fever with chickenpox, 1 had scarlet fever and mumps, 1 had scarlet fever and rubella, 1 had measles and whooping cough, 2 diphtheria with chickenpox, 1 diphtheria with measles. Cross-Infection. 2 cases developed a second disease subsequent to admission to the Borough Hospital. Health of Staff at Borough Hospital. The following illnesses occurred among the staff:— Scarlet fever, 3; bronchitis and heart disease (fatal), 1; diphtheria, 1. Schick Test. This test was applied throughout the year to new members of the nursing and domestic staffs, with a view to ascertaining those susceptible to diphtheria, and preventing their employment in diphtheria wards until immunised by treatment with toxinantitoxin. The single case of diphtheria among the staff was that of a wardmaid who had not undergone the Schick test. Ambulance Service. 2 Motor ambulances (Wolseley and Ford) are kept at the Borough Hospital for conveyance of patients with infectious disease. 544 patients were conveyed and 680 journeys were made. 43 BOROUGH HOSPITAL LABORATORY REPORT. Bacteriological examination is undertaken of swabs, sputum, blood, etc., sent in by practitioners or by the Public Health staff, or taken from patients in the hospital. It will be seen below that, in addition to other miscellaneous work, 3,451 swabs were examined for diphtheria, and 1,189 specimens of sputum for the tubercle bacillus:— Examinations for Diphtheria. For Medical Practitioners. For M.O.H. For Wards (including Nose and Throat Swabs). Grand Total. — + Total — + Total 1147 52 1199 455 10 465 1787 3451 Outfits sent to the Town Hall. Diphtheria. Tubercle Enteric. C.S. M. Total 1640 1155 120 — 2915 Blood Serum prepared. 403½ dozen tubes at 5/- per dozen = £100 17s. 6d. Tuberculosis—Examination of Sputum. For Medical Practitioners. For Tuberculosis Dispensary. For Borough Hospital. Grand Total. + – Total. + — Total. + — Total. + – Total 381 92 473 531 106 637 54 25 79 966 223 1189 Enteric Group.—Examination of blood samples by Agglutination Re-action. For Medical Practitioners. For M O.H. For the Borough Hospital. Grand Total. Incomplete Agglut'n. + — Total. Incomp. Agglut'n + — Total. + — Total. Incomp. Agglut'n + — Total. 5 25 64 94 1 9 52 62 12 12 24 6 46 128 180 In each case the serum was tested against B. Typhosus, paratyphoid A and paratyphoid B. 44 All the above positives gave agglutination for Para. B. except one case which gave group agglutination for Para. B. and B. Typhoid. Examinations of Faeces and Urine for Enteric Group. For Medical Practitioners. For M.O.H. For the Borough Hospital. Grand Total. Faeces. Urine. Faeces. Urine. Faeces. Urine. Faeces. Urine. + – Ttl + – Ttl. + – Ttl. + – Ttl + – Ttl. + – Ttl. + – Ttl. + – Ttl. 2 7 9 4 4 1 20 21 ... 21 21 6 62 68 2 57 59 9 89 98 2 82 84 In all positive cases Para. B. was isolated in pure culture with the exception of one specimen of faeces, which yielded B. Typhosus. Miscellaneous examinations: Pus for T.B. 2 Pus for Organisms 10 Abscess (Axilla) Para B 1 Urines for Organisms 23 Pleural Fluid for Organisms 1 Pleural Fluid for T.B. 1 Cerebro spinal fluid for organisms 6 Swabs for organisms 4 Swabs for gonococci 22 Swabs for Vincent's Angina 4 Blood for organisms 2 Pies for Para B 4 Flour for Para B Gelatine for Para B Rat Virus Blood tests against Para B and rat virus 7 Blood test against Para B isolated from a patient in hospital. Provision of Public Laboratory. The report for 1924 gave particulars of an arrangement made with the Croydon General Hospital for the joint provision of a laboratory and of a pathologist; the laboratory to be for the examination of specimens in connection with infectious disease, and also material sent in by practitioners for diagnosis in connection with insured persons or their dependents; the pathologist to be available for consultation with practitioners at the homes of their patients. Progress was made during the year with the preparation of plans and with the commencement of the new building for the purpose. It is hoped that this will be completed and the work of the laboratory begun by March, 1927. 45 SECTION III.—TUBERCULOSIS. J.- NOTIFICATIONS. 409 patients were notified for the first time in 1925 as suffering from tuberculosis (Appendix Table V.), as compared with 329 in 1924, 414 in 1923, 463 in 1922, and 573 in 1921. The number was made up as follows:— Males. Females. Total. Pulmonary tuberculosis 117 91 208 Non-pulmonary ,, 117 84 201 234 175 409 In addition, other patients came to the notice of the Tuberculosis Officer during the year through channels other than formal notification. In all, 248 new cases of pulmonary and 151 of other tuberculosis were traced during the year (Appendix, Table VII.). 2.—DEATHS. 181 deaths from tuberculosis were recorded (Appendix, Table V.), distributed as follows:— Pulmonary tuberculosis 89 62 151 Non-pulmonary ,, 18 12 30 107 74 181 I his is equivalent to a death-rate from tuberculosis of 0.92 per per 1,000 of population. The corresponding rate in 1924 was 0.96, and in 1923 was 0.98. Of the 181 deaths from tuberculosis, 8 were notified within one week of death, 9 after death, and 45 were not notified. Particulars as to the age and sex of new cases ascertained during the year, and the efficiency of notification at various age periods, are set out in 'Table VII. in the Appendix. 3.—WORK OF TUBERCULOSIS DISPENSARY. The Tuberculosis Dispensary occupies the ground and first floors of 13, Katharine Street, and consists of an office, two waiting rooms, a consulting room, a dark room, and the medical officer s room. The dispensary has been open for the examination of patients or of contacts on 10 sessions in each week (5 morning, 4 afternoon, 1 evening). 46 (a) New Patients. 947 new patients were seen during the year, as compared with 940 in 1924, 706 in 1923, 702 in 1922, and 712 in 1921. Of the 947 new cases, 265 were referred by local doctors for diagnosis or advice, 44 by hospitals, 133 by school medical staff or by the medical officers of Infant Centres, 57 attended independently, 25 were transfers from other areas, 402 were seen as "contacts," 10 were pensioners, and 11 miscellaneous cases. Of these 947 patients, 267 were diagnosed as tuberculous, 239 were kept under observation to settle the diagnosis, and 441 were found not to be tuberculous. (b) Continued Supervision of Patients'. Old cases were kept systematically under observation and supervision during the year. The total number of attendances made at the dispensary was 8,394, as compared with 8,414 in 1924, 6,789 in 1923, 6,454 in 1922, and 7,576 in 1921. (c) Contact Cases. Of the 947 new patients seen at the dispensary during the year 402 were contacts of other known patients, brought up for examination for that reason, in order to assist the detection of the disease at the earliest stage possible. (d) Provision of Foodstuffs, Medicine, and Apparatus. Milk is provided in necessitous cases, where such provision is needed to prevent deterioration in the patient's condition pending admission to a sanatorium, or where with such provision there are reasonable grounds to anticipate a cure of the disease. In the case of school children the milk recommended is provided bv the Education Committee at school, subject to periodic re-examination of the children. Medicine to a small extent, cod liver oil and malt in larger amount are issued chiefly to children and to a few uninsured adults. Insured patients and pensioners receive such drugs as are necessarv through their panel doctors. The cost price is charged for drugs issued from the dispensary in all except necessitous cases. (e) Home Nursing. One nurse is entirely engaged in the nursing at home of bedridden patients requiring special assistance and supervision, including the keeping of temperature records for diagnostic purposes, and the obtaining of sputum when required. 47 Such patients received a total of 1,885 visits during the year for the purpose of home-nursing. (f) Supervision of Home Conditions. The health visitor for the district visits on receipt of notification of a case—except where the medical practitioner notifying has requested that no visit be paid—and obtains particulars as to the patient, the home circumstances, possible sources of infection, and the names of any other residents, indicating in particular those with symptoms suggestive of the disease. The patient is then in suitable cases seen at the dispensary, and steps are taken by the Tuberculosis Officer to examine or to encourage the examination of the contacts showing suspicious symptoms. At intervals not exceeding three months—and in special cases at shorter intervals—the report card is automatically returned to the health visitor for a re-visit, at which the health of patients and contacts is ascertained, and advice given where required on measures aimed at the prevention of infection of the remainder of the household. 472 first visits, 795 unsuccessful visits with failure to obtain entry, 253 special visits, and 2,325 subsequent visits were paid bv the health visitors; a total of 3,845 visits, as against 4,666 in 1924 and 2,313 in 1923. In addition to the supervision exercised by health visitors, 289 visits were paid to the homes by the Tuberculosis Officer during the year, as compared with 349 in 1924. (g) Issue and Supervision of Shelters. 16 shelters are in regular use in various parts of the town by patients who have been educated in their use while at a sanatorium, and whose home conditions are such that additional accommodation is needed to prevent risk of infection to others in the household. 4.—DIAGNOSIS OF TUBERCULOSIS. (a) General. 239 patients were kept under observation pending definite diagnosis; 147 of these were adults and 92 children. (b) Examination of Sputum. 473 specimens of sputum were tent in by private practitioners and 637 from the dispensary for examination at the Borough Hospital Labaratory. 48 (c) X-ray Examination. Patients needing X-ray examination as an aid towards diagnosis are referred by the Tuberculosis Officer to the X-ray department at the Croydon General Hospital. 19 patients were referred for such examination during 1925. 5.—INSTITUTIONAL TREATMENT. Number of Beds Occupied. During 1925 the average number of beds occupied throughout the year in all tuberculosis institutions was 136, allocated as fallows:— Average number of beds occupied throughout the year 1925. Type of Institution. Men. Women. Children under 15. Tolal. (a) Sanatoria for Pulmonary Tuberculosis (including Cheam Sanatorium) 40 26 9 75 (b) Hospital for Pulmonary Tuberculosis (beds at Borough Fever Hospital) 8 7 2 17 (c) Sanatoria or Hospitals for NonPulmonary Tuberculosis 8 8 28 44 All Institutions 56 41 39 136 Allocation of Beds. 1.—Of the 75 beds occupied in sanatoria for pulmonary tuberculosis. (a) 15 for men were at the Borough Sanatorium, Cheam; (b) 14 for women at Larchfield Sanatorium, Caterham; (c) an average of 17 (10 for men, 7 for women) at Grosvenor Sanatorium (Ashford, Kent); (d) an average of 20 (15 for men, 5 for women) at various other sanatoria; (e) 7 for children—6 being at Harpenden and 1 at Church Army Sanatorium, Fleet. The only beds retained specifically for Croydon patients were the 14 at Larchfield Sanatorium and 15 at Cheam Sanatorium. 49 II.—The 17 beds occupied by hospital cases of pulmonary tuberculosis were all in a special block at the Borough Fever Hospital—9 beds for women and 3 beds and 5 shelters for men. Only Croydon patients are admitted to these beds. III.—Of the 44 beds occupied bv patients with non-pulmonary tuberculosis, (a) 13 were at the Royal Sea-Bathing Hospital, Margate; (b) 12 at St. Anthony's Hospital, Cheam ; (c) 3 at Heatherwood Hospital, Ascot; (d) 2 at Lord Mayor Treloar's Hospital, Alton; (c) 2 at the Alexandra Hospital for Hip Diseases; (/) 10 at St. Nicholas' Hospital for Children, Birchington ; (g) 2 at other institutions. None of these beds were definitely retained for Croydon patients. Of these 44 beds for non-pulmonary tuberculosis, on an average 23 were occupied by cases of surgical tuberculosis (of spine, joints, or bone), and 21 by cases of glandular or other nonpulmonary tuberculosis. Number of Patients under Treatment. During 1925, 157 patients were admitted to sanatoria for pulmonary tuberculosis. Of these, 96 were men—of whom 29 were invalided ex-Service men—42 were women, and 19 were children. A total of 392 Croydon patients (including those in institutions at the beginning of the year) received institutional treatment for various forms of tuberculosis under the Council's arrangements, in accordance with the following table : — Number of Patients under treatment in Institutions, 1925. Type of Institution. Men. Women. Children under 16. Total. (a) Sanatoria for Pulmonary Tuberculosis (including Cheam Sanatorium) 143 71 30 214 (b) Hospital for Pulmonary Tuberculoses (beds at Borough Fever Hospital) 16 20 5 41 (c) Sanatoria or Hospitals tor NonPulmonary Tuberculosis 18 14 75 107 All Institutions 177 105 110 392 50 6.—CROYDON BOROUGH SANATORIUM, CHEAM. The Joint Smallpox Hospital buildings at Cheam have continued in use throughout 1925 as a sanatorium for tuberculous patients from Croydon, Surrey and Kent, the Borough Council being responsible for the administration. During the year 152 patients were admitted, the discharges and deaths for the same period being 150. The particulars as to the number of patients admitted by each authority are as follow,: District, Remaining at end of year 1924. Admitted during year 1925. Discharged during year 1925. Died during year 1925. Remaining at end of year 1925. Croydon C. B. 15 40 35 5 15 Kent C. C. 5 13 12 1 5 Surrey C. C. 28 99 70 27 30 Totals 48 152 117 33 50 The following table is a summary of the immediate results of treatment during 1925 : — Total discharges and deaths under each group. 18 58 71 147* Not included in avemge length of stay. Deaths. — 4 29 33 Irregular discharge c — 3 11 14 Clinical classification and results of treatment of cases discharged during 1925. Average length of stay. 14 3 weeks 19 weeks 19.8 weeks Stationary or worse. — 8 11 19 Improved 9 32 20 61 Much improved b 7 10 - 17 Arrested. a 2 1 — 3 No. of Cases. 18 51 31 100 Group. I. Early II. Moderately advanced III. Far advanced Totals (a) "Arrested " means general health completely restored; signs in the lung compatible with a healed lesion, bacilli absent. (b) "Much improved " means general health very good—Gigns in lung diminished, bacilli may be present. (c) Irregular discharges include patients who, for domestic or financial reasons. desired to return home, those discharged for misconduct, e.g., breaking rules, etc., and patients who found climatic conditions too severe. None of these cases remained for the recognised three months. *In addition, 3 unclassified cases were discharged. 51 Progress was made during the year in regard to the extension of the Borough Sanatorium. In April, 1926, the extensions were [completed and the Sanatorium opened for the additional patients. If now contains 85 beds, 55 being for men and 30 for women. Of these beds, 40 are allocated to Croydon C.B., 40 to Surrey C.C., and 5 to Kent C.C. patients. 7.—TUBERCULOSIS CARE WORK. In April the arrangement came into effect whereby the Croydon Council of Social Service undertook the work of Tuberculosis Care Committee for the Corporation. Between that date and the end of the year 123 tuberculous households were assisted in various directions by the Care Committee, after consideration of a report on the medical aspects of the case by the Tuberculosis Officer, and on the social aspects by the Organiser for tuberculosis care work and by the ward representatives in touch with the household. The funds for the work were derived in part from a grant made by the Corporation, the remainder being obtained through the Red Cross or similar social agencies, or from the funds of the Council of Social Service. Adjustments of the arrangement with a view to ensuring its fullest development were under review at the time of preparation of this report. 8.—SYNTHETIC SUNLIGHT TREATMENT. Arrangements are also made with Croydon General Hospital during the year for the attendance of children, under the Materity and Child Welfare, the School Medical, and the Tuberculosis Schemes, at the Hospital for synthetic sunlight treatment at the Hospital Light Clinic. The scheme had not fully developed within the year. 38 cases had been in attendance for a period of some weeks by the end of the year, making a total of 1,585 attendances. One half of these have shown an appreciable degree of improvement, and a number of these marked degrees of improvement. The conditions under treatment were those existing from malnutrition, general debility, rickets, suspected early tuberculosis, and similar conditions. 9.—ORTHOPAEDIC SCHEME. Arising out of co-operation between the Corporation and the managers of the Croydon General Hospital, the latter established 52 during 1925 an orthopædic clinic at the Hospital, under the charge of an orthopedic specialist, Mr. A. Todd. Croydon patients referred by private practitioners, or through the Public Health Department, are seen and advised at the clinic. The cases referred through the Public Health Department consist of (a) children under 5, under the maternity and child welfare scheme, (b) children of school age, under the school medical arrangements, (c) tuberculous cripples of any age, under the tuberculosis scheme. A fixed charge of l/6d. per attendance is made to the Corporation in respect of any patients thus referred. Treatment is provided as follows : — (a) Massage and Remedial Exercises.—Either at the mittee's massage clinic, or in certain cases at the massage clinic established at the Croydon General Hospital; (b) Electrical.—At the Hospital clinic. (c) Inpatient treatment.—By admission to the St. Nicholas and St. Martin Orthopaedic Hospital, Surrey. During the five months in which the scheme was in operation, 18 patients were seen under the maternity and child welfare scheme, 79 under the school medical, and 22 under the tuberculosis scheme; and these made a total of 694 attendances. The scheme, which is still in process of development, will fulfil a very valuable function in the early diagnosis of the causes of crippling at a stage allowing of cure of the deformity, while it will lead to the more general adoption of measures tending towards the eradication of factors which produce physical deformities. 53 SECTION IV.—MATERNITY AND CHILD WELFARE . 1— GENERAL. The developments occurring during the period 1921-25 have included the following : — (a) Extension of Ante-natal Clinic from 2 to 3 sessions per week. (b) Extension of number of Infant Welfare Centres from 10 to 11. (c) Unification of duties of health visitors, to include nity and child welfare work, school nursing, and tuberculosis visiting. (d) Extension of Sick Nursery from 4 to 12 beds, and provision of a building to house the Sick Nursery and a number of clinics. This was effected early in 1926. (e) Appointment by the Croydon Mothers' and Infants' Welfare Association of a Babies' Help Committee, which with the assistance of a grant from the Corporation does valuable work in connection with the care of illegitimate children. 2.—ANTE-NATAL WORK. (a) Ante-uatal Clinic. The Ante-natal Clinic, at 33, St. James' Road, Croydon, has been held for three sessions in each week throughout the year. During 1925, 609 expectant mothers made a total of 2,496 attendances, each mother attending 4.1 times on an average. The average weekly attendance at the clinic was 48. The growth of the work of the Clinic is shewn in the following figures: — 1921. 1922. 1923. 1924. 1925. Number of mothers attending 440 413 448 500 609 Number of attendances 1660 1913 1835 2007 2496 Weekly attendance 32 38 39 39 48 (b) Attendances of Expectant Mothers at Welfare Centres. During the year, 509 expectant mothers received advice and assistance at the various Welfare Centres, and made a total of 1,758 attendances. (c) Home Visits to Expectant Mothers, 778 visits were paid to the homes of expectant mothers by health visitors or medical officers. 54 (d) Feeding of Expectant Mothers. In a considerable number of cases fresh or dried milk needed on medical grounds during the last three months of pregnancy was provided, at or below cost price, or free, according to the circumstances of the family; while the Croydon Mothers and Infants' Welfare Association in a number of cases provided mid-day meals for necessitous expectant mothers, on the recommendation of the medical officers. (e) Maternity Outfits. Realising the unsatisfactory conditions under which confinements must often be conducted in the poorer homes, the Committee decided to provide on request, at wholesale cost price, suitable maternity outfits containing the essentials for a confinement. These became available to medical practitioners and midwives for their patients early in 1925; there has not, however, up to the present been any great demand for these outfits. (f) Registration and Inspection of Maternity Homes. Under the Croydon Corporation Act, 1924, registration of maternity homes became compulsory as from January 1st, 1925. 34 maternity homes were registered and kept under supervision during the year. These maternity homes gave a total accommodation of 128 beds, distributed as follows:— Maternity homes registered for: 1 bed —7 5 beds—4 9 beds—1 2 beds—9 6 beds—1 11 beds—1 3 beds—2 7 beds—4 12 beds—1 4 beds—4 Out of the 34 homes, 25 had certified midwives on their staffs, j 3.—AT BIRTH. (a) The Work of Midwives. During the year, 59 midwives notified their intention to prac tise within the Borough—an increase of 1 over the number for the previous year. 50 of these held the certificate of the Centra Midwives Board, 4 of the London Obstetrical Society, while 5 wer< in " bona fide " practice in 1901. No midwives in the Borough are subsidised by the loca authority. During the year midwives notified a total of 1,791 live birth and 48 still births. Of the total births notified during the year 56.4 per cent. were notified by midwives. 55 In 191 instances the midwives summoned medical help for a variety of conditions affecting mother or child, while 29 other notifications in connection with still births, artificial feeding, etc., were received from midwives. Dr. Olive Falk was appointed Inspector of Midwives during the year, in succession to Miss Chapman, who was unable to continue the work owing to ill-health. The Inspector of Midwives paid 100 visits of inspection during the year, in addition to special visits for enquiry into cases of sepsis, ophthalmia neonatorum, etc. During October and November a course of six lectures to midwives was arranged by the Public Health Committee. The lectures were given by Dr. J. A. Willett, of the City of London Maternity Hospital. The subjects covered were : Ante-natal supervision ; prolonged labour; ante-partum hemorrhage; asphyxia neonatorum; antiseptics; and puerperal fever. The lectures were well attended, and were greatly appreciated by the midwives of the Borough. (b) Maternity Home—St. Mary's Hostel. 17 beds are provided at St. Mary's Hostel by the Croydon Mothers' and Infants' Welfare Association. Of these, 15 are retained by the Corporation, priority being given to abnormal and to necessitous cases. A subsidy of £1,800 per annum is paid towards the charges of the institution by the Corporation. 306 confinements were conducted at St. Mary's Hostel during the year. Of these, 290 were booked before admission as normal " cases, priority being given to those in necessitous circumstances or with bad home conditions; 6 were booked before admission as difficult or abnormal cases; while 10 were admitted as emergency cases without previous booking; 25 booked as normal cases had by the time of admission become difficult or abnormal cases. (c) Puerperal Sepsis, etc. 8 cases of puerperal sepsis were notified, compared with 9 in 1924. Six of the eight cases proved fatal. Two were attended by midwives. 56 7 deaths occurred from other maternal accidents and diseases of pregnancy or parturition, as against 8 in 1924. 3 cases of puerperal fever were admitted to the Borough Hospital for treatment during the year. (d) Ophthalmia Neonatorum. 22 cases of ophthalmia neonatorum were notified, as compared with 21 in 1924. 7 of these occurred in the practice of midwives, the remainder in that of medical practitioners. The following table gives details of the condition of the eyesight of these children at the end of the year : — Cases Treated. Vision Vision Total Notified. At Home. In Hospital. Unimpaired. Impaired. Blindness. Deaths. 22 10 12 18 3 —1 (e) Still-births. 102 still-births were notified during the year, or 3.2 per cent. of the total notifications of births. 4.—THE INFANT AND THE YOUNG CHILD. (a) Notification of Births. 3,091 notifications of live births were received during the year out of a total of 3,521 registered, so that 87.8 per cent. of the births were notified. Nearly 35 per cent. of the notifications were made by medical practitioners, 56 per cent. by midwives, and 9 per cent. by relatives, etc. Of the 3,521 children born alive, 1,813 were boys and 1,708 girls. (b) Home Visits Under the Notification of Births Act. The work of the health visitors was considerably hampered during the year by ill-health, one district health visitor having to be withdrawn for a number of months to replace the nurse usually in charge of the clinic, who was absent for prolonged ill-health. On Miss Chapman's retirement, Mrs. Walker was appointed to fill the vacancy, and an additional health visitor, Miss Southgate, took up her duties in September. Miss Stanley took the place of Miss Massie, on the resignation of the latter. During the year the health visitors paid 3,521 first visits and 6,276 subsequent visits to children under the age of 12 months; and 1,199 first visits and 8,872 subsequent visits to children between the ages of 12 months and 5 years. 57 The following table gives particulars of the visits carried out under the Notification of Births Act since 1921 : — 1921. 1922. 1923. 1924. 1925. Number of Health Visitors for M. and C. W. equivalent of: 6 6 6 6.5 6.5 First Tisit to children under 12 months ot age 3200 3'79 3028 3275 3521 Subsequent visits to children under 12 months of age 7093 6028 5145 5331 6276 First visits to children 1—5 years of age 1084 946 1114 1152 1199 Subsequent visits to children 1—5 years of age 4670 5400 6530 8129 S872 Total 16,047 15,553 15,817 17,887 19,868 (c) Voluntary Infant Welfare Centres. 10 centres have been established by the Croydon Mothers' and Infants' Welfare Association, the medical officer and the health visitor as nurse-superintendent being provided by the local authority. Of these 10 Welfare Centres, 7 are open once a week, 3 twice a week. (d) Municipal Infant Welfare Centre. The Municipal Infant Welfare Centre was held throughout the year at 228, London Road, but was transferred at the beginning of 1926 to the new premises erected in Lodge Road. During 1923 there were recorded at the Welfare Centres in the Borough (Appendix, Table VIII.):—19,754 attendances of children under 1 year of age, 19,900 attendances of children aged 1 to 5 years, 35,099 attendances of mothers. The medical officers had 11,241 interviews respecting children under 1 year, and 9,604 interviews over children aged 1 to 5. In addition, as mentioned in another section, 1,758 attendances were made by expectant mothers. 58 (e) Sick Nursery. Throughout the year the 4 beds provided at 228, London Road, were used as a sick nursery for children suffering from nutritional disorder. At the beginning of 1926 the extended Sick Nursery premises, consisting of 12 cots, 1 observation cubicle, and a ward of two beds for nursing mothers, forming the first floor of the Clinic building erected in Lodge Road by the Corporation, came into use, to the great advantage of these sick children. Four children were in the Sick Nursery on the 1st January, 1925, and 57 children were admitted during the year; 61 were discharged. The average stay was 22.3 days. (f) Foster Children. Numbers of foster children are brought to the ordinary sessions of the various Infant Welfare Centres. In addition, special clinics for foster children were held once a quarter, at which there were 12 attendances by foster children under 1 and 79 by those between 1 and 5 years of age. (g) Massage Clinic. The massage clinic for children under the age of 5 years was continued at the clinic premises at 228, London Road for three afternoon sessions each week, for the treatment of children suffering from infantile paralysis, various types of muscular weakness, and debility after rickets or after one or other of the acute illnesses to which young children are exposed. 1306 attendances were made by 72 cases at the massage clinic during the year. (h) Provision of Milk and Foodstuffs. The Council is responsible for the issue of fresh milk at all infant Welfare Centres, whether voluntary or municipal, and for the issue of dried milk and other preparations at the municipal centre. The Croydon Mothers' and Infants' Welfare Association arranges for the provision of dried milk, etc., at the voluntary centres, and also provide mid-day meals for necessitous expectant and nursing mothers, on the recommendation of the medical officers. 59 The following tables give particulars as to the provision in 1925 of fresh milk through all the centres and of dried milk through the Municipal centre : — Issue of Fresh Milk Through Infant Welfare Centres. Supplied to Families. No. of Quarts. Corporation Liability. £ s. d Milk a 3d. 15529¾ 229 0 0 Milk Fre 21490½ 575 11 7 Total number of Quarts supplied 37020¼ 804 11 7 Total Number of Families 471. Average supplied to each case, 78 6 quarts. Average cost of supply to each family, £2 2s. 7£d. Average number of families supplied weekly 150. ,, ,, quarts „ 712. Issue of Dried Milk Through Municipal Infant Welfare Centre. As in previous years, a considerable amount of dried milk has been issued either, free or at cost price. (i) Admission to Convalescent Homes. The Croydon Mothers' and Infants' Welfare Association has continued to be responsible for sending mothers and debilitated children to convalescent homes in the country or at the seaside. The admissions are based on recommendations received from the medical officers of the Infant Welfare Centres. During the year 71 mothers, and 132 children under 5 years of age, were sent away to convalescent homes. (j) Home Nursing. Arrangements are now in effect for the home nursing, by the staff of the Croydon Nursing Service, of selected cases of measles, whooping cough, ophthalmia neonatorum, puerperal fever, epidemic diarrhoea and infantile paralysis, where the home arrangements were found to be unsatisfactory and the patients could not be removed to a hospital. 60 (k) Care of Illegitimate Infants. The Croydon Mothers' and Infants' Welfare Association in 1924 established its Babies' Help Committee of ladies prepared by personal enquiry and help to assist unmarried mothers to remain with their children instead of handing them over to the care of others. I am glad to be able to give the following particulars, provided by the kindness of Mrs. Philpott : — Babies' Help Committee. During 1925 this Committee has dealt with 38 mothers. Some have needed very little help—the provision of a cot or perambulator or the promise to keep the baby in clothes being sufficient—others needed financial help of varying amounts. Two of our mothers married within the year. Five cases were referred to other societies which it was considered could give more suitable help than our Committee could. Eight mothers and babies were boarded in cottages with kindly landladies, but the others have continued to live with the parents. We find that when the girls' parents realise that others are willing to befriend the young mothers that they generally then offer to do their part. Seventeen cases have been helped from the Corporation fund. All the babies under the care of the Committee have progressed favourably, although several were very weakly when they first came to our notice. Two or three have passed out of our hands, but as far as we know there have been no deaths. The babies have benefited enormously through being with their mothers and being naturally fed, and we feel that although the Committee is still in the experimental stage, it is working on the right lines. (1) Birth Control. The question of instruction in birth control came before the Committee during the year, and it was recognised that the desirability of instruction in the matter was a point needing careful consideration from various aspects, though at the moment the definite veto of the Ministry of Health did not make any immediate action practicable. The question again came up for revision early in 1926, as a result of a communication from another local authority. I give below the report presented on the subject arising out of that communication. The Committee informed the Ministry that it would be prepared to follow the conservative line set out in the report, in the event of instruction in birth control in suitable instances becoming at some future time the duty of the local authority. 61 Report on Birth Control Instruction by Public Authorities. In view of the resolution forwarded by "-" Council for endorsement by this Committee, I feel it necessary to make the following statement of my own views in the matter, while recognising that the question is peculiarly one for individual opinion, and one in which judgment must be based less on medical grounds than on experience of married life in relation to diverse social conditions. I must ask the indulgence of the Committee in legard both to the length and to the character of the report, features which are unavoidable in view of the complexity of the subject. 1. Is birth control necessary or desirable? The main argument for birth control is the increasing stress of industrial and social conditions, making it correspondingly difficult for parents to bring up children under proper conditions of health and with sufficient amenities for their self-development, except by some measure of spacing between successive children. It has in this connection to be remembered that the chief " amenity " for the self-development of a child is the continual contact with other children not far apart in age and development; and the process of spacing out, seeing that it can be controlled only in one direction and not in the other, may very easilv result in such a gap between successive children as to make each prac. tically an only child so far as development by contact with other children in the household is concerned. The benefit to formation of character derived bv children in large families in most cases far outweighs the disadvantages which they may suffer from conditions which superficially may appear to be in the nature of privation. The privation, such as it is, is physical, and oan be remedied by help from outside ; but there is to set against it the all-round development of character which can be produced best by the rough and tumble in a large family. I feel, therefore, that this argument in favour of birth control can readily be magnified. The argument commonly linked with it, that a succession of children means severe physical and mental strain on the mother, is undoubtedly true under existing conditions ; but here again, outside assistance is capable of minimising the physical strain, while the closer and more understanding co-operation of the father would do much to relieve the mental strain, even under the conditions of aggregation found in the workingclass home. I feel, therefore, that these arguments for birth control are, as generally applied, on the whole, more specious than sound. The proper course from the standpoint of the general welfare is to deal as rapidly and as thoroughly as possible with the adverse conditions of wages, of household economy, of housing, of ignorance, and of physical and mental ill-health which are the basis of the family difficulties, rather than weakly to surrender to these adverse conditions by advising control of births. The general production of small families is the easiest short cut to the temporary palliation of existing social conditions ; but it is in my opinion vital that this easy course should not be followed, rather than the more difficult course involved in dealing with the evils out of which the problem arises. Setting this forward as the view which should be stressed, it must never, theless be granted that under existing conditions there must be among the poorer working classes a considerable number of families where the stress is such that some degree of birth control is inevitable, if they are to be prevented from sinking in the struggle ;and it has to be decided what type of birth control they can adopt. It is however, of some significance, as an indication of the relatively small extent to which birth control can be applied even in the poorest classes, without a risk of bringing the population to a standstill, that in 3,201 consecutive households seen in house-to-house visitation in fifty of the poorest streets in Croydon the average number of individuals per household was less than 4.1 (4.08), showing the small margin even now over a stationary population—for four persons per household would, allowing for inevitable deaths, imply a dwindling population. 62 2. How is birth control to be applied? There are two alternative methods for the application of birth control— (a) self restraint; and (b) mechanical contraceptive methods. (a) Control by self-restraint.—This is clearly the ideal method, leaving both parents with a sense of personal dignity and with no possibility of impairment of mutual respect. It is recognised that under the conditions of crowding and lack of a sufficient number of rooms in working-class households such a course may be difficult to adopt. It is, however, easy to exaggerate this difficulty, and actual inspection of housing conditions from this point of view shows that, in a large proportion of the cases in which at first sight the application of self-restraint is impracticable, simple adjustments are actually within the reach of the parents. The use of separate beds instead of the double beds commonly in use, together with an adjustment of the sleeping arrangements in the various rooms in working-class households, could, in a surprisingly large proportion of the cases in which instruction is often regarded as necessary, allow the establishment of birth control by self-restraint without recourse to other methods. My own feeling is that the only method of birth control which a public authority could in general encourage is that of selfrestraint, for reasons mentioned in the next paragraph. (b) Birth Control by mechanical contra-conceptive methods.—The main difficulties in applying this method are:— 1. The information given cannot be limited to those particularly needing it, but is certain to leak through to others, both married and unmarried, to whom its application means degradation. 2. Unless there is the most intimate knowledge of the home circumstances and of the relations between husband and wife, and of the possibilities of establishing birth control (where this is necessary) by self-restraint, a vast deal of irreparable harm may be done by changing the mental attitude of husband and wife to one another. I feel that this, although a very difficult matter to define, is a fundamentally important consideration; and that the basic danger to national life arising from the adoption of mechanical means of birth control on anything like a national scale depends not so much on the risk of a stationary population as on that of a materialistic bias in the national attitude towards sex and marriage. Even with individuals who adopt mechanical contraceptive methods from the highest point of view there must, I think, be inevitably some degree of hardening, i.e., a loss of mutual respect owing to the fact that both parties recognise that they have not taken the ideal course. Although each party may make allowance for this, and to that extent minimise the moral damage, the adoption of such. a course on an increasingly large scale by individuals not moved by such higher motives would be a national calamity, not merely from the point of view of diminishing the population but from the far more important standpoint of lowering the general moral standard. The part to be played by the Public Authority.—It is clear that if instruction in contraceptive methods is to be given by Public Authorities in the limited group of cases needing it, this must be only after careful investigation into family circumstances and after personal discussion with both parents by the medical officer undertaking the work. This throws a heavy burden of responsibility ultimately on to the medical officer, who will need to have social experience and experience of the problems of married life as well as medical insight. I feel that any general authority given to local authorities to give instruction in birth control would result in grave damage if such power were put into the hands of medical officers not in every respect suited for the work. If instruction is to be given by the officers of public authorities in methods of contraception other than that of self-restraint, stringent safeguards will be needed, among which the following should be included:— 63 1. The most careful selection of medical officers suited for the work. 2. Advicc to be given only at the Centres attended by these medical officers. I should personally incline wherever possible to the instructions being given at the Ante-Natal rather than at the Child Welfare Centre. 3. Personal knowledge by the medical officer of the home circumstances and |>ersonal discussion with both parents of the possibility of applying methods of self-restraint if birth control appears necessary and of the removal of hindrances to the application of this course, before any thought is entertained of instruction in mechanical contraception. 4. Such advice, where given, to be associated always with the clearest warning to parents as to the dangers to the proper development of children under spacing out, born at too long intervals from each other, and also a warning as to the possible dangers to mutual esteem when the methods of birth control are unwisely used by the parents. Given safeguards of this type, a Public Authority prepared to act with every caution could play a very useful part in developing a healthy attitude and in imparting helpful information on this subject. 64 SECTION V. MENTAL DEFICIENCY. The Staff in the Public Health Department dealing with the mentally defective consists of one whole-time visitor and of the Medical Officer of Health and the Deputy Medical Officer of Health, who are the certifying officers under the Mental Deficiency Act. The following statement deals with two groups of cases: — (a) Statutory Cases, consisting of mental defectives under 7 or over 16 years known to require special care and supervision; ineducable mentally defective children between the ages of 7 and 16 years; and children referred to the local control authority, under the Mental Deficiency Act, as being either incapable of further education in a special school, or of being incapable of such education without detriment to other children. All these cases are dealt with under the Mental Deficiency Act. (b) Education Cases, consisting of mentally defective children between the age of 7 and 16 capable of education in special schools. These are dealt with by the Education authority. Number of the Mentally Defective. The total number of mentally defective in the Borough known by medical examination is :— 1.—Statutory Cases : — Aged 0-5 years 4 „ 5-16 „ 48 ,, over 16 ,, 234 286 2.—Education Cases: — Aged 7-16 years 1ll 397 Distribution. The 397 cases of mental defectives are distributed as follows:— (a) Statutory Cases:— In certified institutions 101 In Croydon Mental Hospital 12 In Poor Law institutions 6 Under guardianship at home 18 In a place of safety 1 Under supervision, resident at home 148 286 65 (b) Education Cases:— In certified residential schools 4 On roll of Grangewood Special School 79 At private or elementary schools 14 Resident at home 14 111 397 Examination and Yisits by the Medical Officers. Statutory Cases 81 Education Cases 114 195 Visits by the Mental Deficiency Visitor. Statutory Cases 1276 Education Cases 782 2058 Additions to List of Statutory Cases during 1925. During the year 35 names have been added to the list of statutory cases—10 being new cases, 18 reported on reaching the age of 16, and 7 certified as ineducable—and 11 have been removed, owing to death (7), or to removal (4) from the Borough. Statutory Cases dealt with during 1925. Sent to institutions 8 Placed under guardianship 4 To place of safety, pending institutional care 1 Assisted finfiancially under permissives powers 1 Home on probation 5 Transferred from one institution to another 3 Education Cases dealt with during 1925. Particulars are given in the school medical section of the report. GRANGEWOOD SPECIAL SCHOOL. At the end of the year 79 children were in attendance at Grangewood Special School. Systematic medical examination of the children was made during the year in respect of their physical condition and mental progress. 66 The children receive a midday meal at the school, at a charge of 4d. per head per day, or 1s. 6d. per week; nearly all the children pay the cost of the meal. MENTAL DEFICIENCY CLINIC. A clinic is held at the Town Hall for the examination of children and others referred for investigation on account of backwardness or suspected mental deficiency. Particulars as to the numbers seen and the action taken will be found in the school medical report. OCCUPATION CENTRE. The Centre is open for five days each week, from 9.30 a.m. to 3.30 p.m., and occupies rooms on the ground floor of Grangewood Museum, the first floor being occupied by the Special School. The younger children attend daily morning and afternoon, and the senior girls on Monday, Wednesday, and Friday afternoons from 2 to 2.30. The staff consists of a supervisor and two assistants, while an assistant to the school work is also provided. Class I. (Low-Grade Children).—The average attendance has been 15 daily out of 24 on the register. The subjects taught are : easy hand occupation, drill, sense training, singing, polishing and easy household work, such as setting a table, sweeping up crumbs, clearing table, etc. Through co-operation with the Special School these children get a two-course dinner each day for 1s. 6d. weekly, or 4d. per day. Class II., for girls over 16, is held on three afternoons weekly. Instruction is given in plain sewing, hemstitching, raffia mats and basket making, and rug making. 11 girls are in regular attendance. It is hoped to increase the numbers attending these classes during the present year. 1 here were thus 35 children attending during the year. 10 new cases were admitted and 7 left during the year. A small sale of the work of the pupils was held in July. As a result, £5 was handed to the Borough Treasurer. A Christmas Party was held in December, attended by 65 children, parents, and by members of the Mental Deficiency Committee. 67 SECTION YI.—VENEREAL DISEASES. Treatment is provided by the Corporation under two schemes : (a) Clinic at Croyden General Hospital. A Clinic, open on Wednesday afternoons for women and children, and on Saturday afternoons for men, is held in a section of the Outpatient Department of the Croydon General Hospital, rented by the Corporation for this purpose. Particulars as to attendances are set out in the Appendix Table IX. The following data show the work of the Clinic during each of the years 1921-25: — 1921. 1922. 1923. 1924. 1925. New male patients 117 105 80 101 116 New female patients 70 63 89 125 156 Attendances, male patients 2224 2425 1826 1774 2713 Attendances, female patients 1039 898 1023 982 1230 (b) Clinics Provided Under the London Scheme. Croydon is a party to the general London scheme, under which clinics for the treatment of venereal disease are provided at a large number of London hospitals, and at resident hostels, the cost being apportioned among the ten County Councils and County Borough Councils which share in the schema. I he particulars of attendances of Croydon patients under the general scheme from 1921 onwards are as follows: — 1921. 1922. 1923. 1924. 1925. New patients 150 153 175 163 138 Total attendances 2064 2304 2816 2899 2648 (c) Pathological Examinations. Pathological examinations were carried out at the laboratories of London hospitals for Croydon patients as follows: — 1921. 1922. 1923. 1924. 1925. Tests for Clinics ? 90S 432 551 642 Tests for practitioners 547 209 612 882 1069 68 SECTION VII.—HOUSING. In spite of the steadily increasing activity both of private and of public enterprise in the provision of houses, there is still much leeway to be made up, and much individual misery and mental and physical strain to be set right by extension of housing accommodation. The number of working-class houses completed by the Corporation during 1925—127—is far from being a full measure of the programme of expansion adopted during the course of the year, and the further very considerable growth of that programme during the present year should appreciably relieve the existing housing shortage. Particulars as to housing inspection, over-crowding, and the detection and remedy of housing defects are set out in the next section, and need not be duplicated here. Town Planning.— Steady progress has been made with the Corporation's Town Planning Scheme. The Croydon (South) Town Planning Scheme, covering 930 acres in Croydon, in the neighbourhood of Duppas Hill and the Waddon Estate, is in operation, having received the final approval of the Ministry of Health. The Croydon (North) Town Planning Sche ne, dealing with 805 acres of land in the neighbourhood of Not bury and Upper Norwood, was approved by the Ministry of Health in March, 1926. Both schemes define the zoning of houses as to donsity, the allocation of open spaces, the areas to be allotted to factories and to shops, the planning of main roads, and make other provision for securing public health and convenience. The general lines thus laid down will be of incalculable benefit, in regard both to health and to the general amenity !of life, as the areas come under development. 69 SECTION VIII.—SANITARY ADMINISTRATION. I am indebted to the Chief Sanitary Inspector for the preparation of this Section, summarising the work of the staff of sanitary inspectors and other officers of the Sanitary Inspectors' Department working under his supervision. Throughout the year there has been steady development as well as consolidation in connection with the various activities referred to below : — List of Adoptive Acts and Local Acts and Regulations Relating to Public Health. Local Acts. 1884. Croydon Corporation Act. 1895. 1900. 1905. 1920. 1921. Croydon Corporation Water Act. 1924. Croydon Corporation Act. General Adoptive Acts. Baths and Washhouses Acts, 1846-1899. Public Health Acts Amendment Act, 1890, Part 3 (Sections 16—50). (Section 19 repealed by Croydon Corporation Act, 1905, Section 34). Infectious Diseases (Prevention) Act, 1890. Public Health Acts Amendment Act, 1907, Sections 19, 20, 21, 24, 25, 28, 33, 35, 36, 51, 55, and Part V. Regulations. Regulations as to Dairies, Cowsheds, and Milkshops, 1900. Regulations as to connection with sewers, 1911. Bye-Laws. With respect to Common Lodging Houses, 1885. ,, Nuisances, 1885. ,, Tents, Vans, Sheds, and similar structures used for human habitation, 1903. ,, Slaughterhouses, 1914. ,, New Streets and Buildings, 1920. ,, Houses intended or used for occupation of the Working Classes, and let in lodgings or occupied by members of more than one family, 1921. ,, Offensive Trades, 1925, 70 Summary of Inspections Made by the Sanitary Inspectors and Other Departmental Work. Total no. of houses inspected for Housing defects (under Public Health or Housing Acts) 3492 No. of houses inspected under the Housing (Inspection of District Regulations, 1910) 2235 No. of houses inspected under the Rent Restrictions Act, 1920 45 No. of houses inspected where zymotic diseases have occurred 300 House drains tested with smoke (primary) 518 House drains tested on application 120 No. of smoke tests during repair 306 No. of water tests during repair 228 Final test of drains after repair 58 Final test of drains when completely relaid 26 Lengths of new drains tested with water yards 1075 Inspections of Stables and animal manure pits 338 ,, Yards and passages 678 ,, Urinals 466 „ Pig Styes 167 ,, Theatres, Cinemas, etc 266 „ Schools 21 ,, Common Lodging Houses, including night visits 229 ,, Houses let in Lodgings 120 ,, Tents and Vans 42 ,, Premises where offensive trades are conducted 297 Smoke Observations 12 No. of visits re Infectious Diseases 838 Inspection of Shops (under Shop Acts) 885 ,, ,, (under Poisons and Pharmacy Act) 8 ,, Dairies 312 ,, Cowsheds 116 ,, Milkshops 444 ,, Premises where food is prepared or sold 4518 ,, Slaughterhouses 1496 ,, Factories including Factory Laundries 458 ,, Workshops, including Workshop Laundries and Bakehouses 805 ,, Workplaoes other than outworkers' premises 146 ,, Outworkers 228 Visits to employers of Outworkers 38 Reinspections of work in progress 17660 Sundry Inspections 2414 Sundry visits 10036 Examination of building plans 760 Complaints from public investigated (other than inspection of house) 2481 Informal notices outstanding 31/12/24 1822 „ „ served 8705 „ „ complied 8268 „ „ outstanding (including 375 overcrowding) 2259 Statutory Notices outstanding 31/12/24 356 „ „ served 1248 „ „ abated 1371 Total number of complaints received 3342 Interviews with callers 2984 Letters received 4154 Letters sent 3217 71 Nuisances and Other Matters Dealt With by the Sanitary Inspectors During 1925. Houses. Befective plasterwork 887 Bad smells (dry rot, dead vermin, etc.) 16 Requiring repair, cleansing and whitewashing 1698 Defective drains 275 Damp 1218 Defective downspouts 192 insufficient ventilation under floors 54 Dirty floors 35 Defective floors 478 Defective gutters 744 Overcrowded houses occupied by 373 families 187 Defective roofs 1308 Stairs and passages dirty 8 Defective sinks 420 Deffective sanitary fittings 794 Insufficiently ventilated 399 Insufficiently lighted 8 Without proper water supply 215 Defective windows 602 Damp or flooded cellars or rooms 8 Dustbins required 1445 Sndry other nuisances 1443 Factories, Workshops, and Workplaces only. Insufficient W.C. accommodation 59 Defective ,, ,, 104 No separate sanitary accommodation for sexes 4 Requiring cleansing and whitewashing 197 Overcrowded 3 Insufficient ventilation 25 Infringement of drinking water supply regulations 1 Hndry other nuisances 268 Other Nuisances Discovered. Animals improperly kept 49 Drains found stopped 419 Defective manure receptacles 18 Want of manure receptacles 14 Defective urinals 41 Dirty „ 21 Hfective drinking water cisterns 14 Smoke nuisances 7 Offensive accumulations 176 Deposits of materials causing damp 2 Infringements of Shops Acts 223 Infringements of Byelaws and Regulations 495 Infringements of Croydon Corporation Act, 1924. Food cupboards necessary 653 Verminous conditions 75 Urinals, W.C.'s, drains, etc., ventilating into food store 84 Filth, etc., accumulating in food store 20 Infringements of P.H.A. (Amendment) Act, 1907. Yard surfaces defective 664 Rain water pipes acting as ventilating pipes to drains 2 Filth, &c., accumulating in food store 20 72 SANITARY CERTIFICATES, On application, an intending or actual occupier may have a Sanitary Survey made of the house, to ascertain whether there are conditions existing which may be injurious to health or requiring attention. In each case an examination of the premises is made and the drains tested. During 1925 requests were made in connection with 76 private houses. 3 schools. TOTAL—79. The following defects were ascertained in consequence of these inspections :— Defective ventilation pipes to drains 19 Defective W.C.'s 15 Defective rainwater down pipes and gutters 5 Defective drains, gullies, etc. 23 Damp condition of walls 19 Dirty walls and ceilings of W.C.'s 3 Defective roofs and floors 5 Defective plasterwork 6 Dirty walls 4 Defective yard paving 1 Defective window sashcords 2 Defective sinks and waste pipes 8 Defective (or want of) dustbins 5 Defective inspection chambers of drains 3 Sundry other defects 11 On completion of the works required a Sanitary Certificate is issued to the applicant. RENT RESTRICTION ACTS. A number of applications have been received for certificates as to the sanitary condition of the houses concerned. In 45 instances where the Acts applied certificates were granted. Legal Proceedings taken regarding Nuisances, etc. :— Offence. Result. Total. Fines. Costs. £ s. d. £ s. d. £ s. d. Failing to abate a nuisance ... 2 2 0 2 2 0 73 HOUSING. The following table gives particulars as to housing during 1925 under the headings prescribed by the Ministry of Health : — Housing, 1925. Number of houses erected during the year:— (a) Total 1632 (b) With State assistance under the Housing Acts, 1919 or 1923— (i) By the local authority 127 (ii) By other bodies or persons 1 1. Unfit Dwelling Houses— Inspection (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 3492 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regula. tions, 1925 2235 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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 2808 2. Remedy of Defects without service of Formal Notices:— No. of defective dwelling houses rendered fit in consequence of informal aotion by the Local Authority or their officers 1287 3. Action under Statutory Powers:— A. Proceedings under Section 3 of the Housing Act, 1925. (1) No. of dwelling houses in respect of which notices were served requiring repairs 1 (2) No. of dwelling houses which were rendered fit— (а) By owners — (b) By Local Authority in default of owners 1 (3) No. 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) No. of dwelling houses in respect of which notices were served requiring defects to be remedied 879 (2) No. of dwelling houses in which defects were remedied— (a) By owners 701 (b) By Local Authority in default of owners Nil. C. Proceedings under Sections 11, 14, and 15 of the Housing Act, 1925. (1) No. of representations made with a view to the making of Closing Orders 2 74 (2) No. of dwelling houses in respect of which Closing Orders were made 2 (3) No. of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit Nil. (4) No. of dwelling houses in respect of which Demolition Orders were made Nil. (5) No. of dwelling houses demolished in pursuance of Demolition Orders Nil. (G) No. of dwelling houses demolished voluntarily 2 * This number does not include 336 notices served in the latter part of 1924 and complied with in 1926. OVERCROWDIING. During the course of systematic inspection of 3,492 houses of the working classes between 1st January and 31st December, 1925, 187, or 5.3 per cent., were found to contain one or more overcrowded rooms. The standard of overcrowding was on the basis of a minimum of 360 cubic feet air space in sleeping rooms for persons over 10 years, or 400 cubic feet where the room is both a living and sleeping room ; and 250 cubic feet per person under 10— this being the standard fixed in the local bye-laws for houses let in lodgings. 373 families occupied these 187 houses, and 219, or 58.7 per cent, of these families in overcrowded houses were found to be overcrowded. In 53 houses of the 187 houses it was found possible to abate the overcrowding without producing corresponding overcrowding elsewhere. 241 notices were served to abate overcrowding. FACTORIES, WORKSHOPS AND WORKPLACES. 1.—Inspection. Preinises. Inspections. Number of Written Notices. Prosecutions. FACTORIES. (including Factory Laundries) 458 91 ... WORKSHOPS. (including Workshop Laundries and Bakehouses) 805 202 ... WORK PLACES. (other than Outworkers' premises) 146 87 ... Total 1409 380 ... 75 2.—Defects found in Factories, Workshops and Workplaces. Particulars. No. of Defects. Referred to H.M. Inspector. Prosecutions. Found. Remedied. Nuisances under the Public Health Acts— Want of Cleanliness 197 164 ... ... Want of Ventilation 25 20 ... ... Overcrowding a 1 ... ... Want of Drainage of Moors 3 1 ... ... Other Nuisances '265 232 ... ... Sanitary Accommodation— Insufficient 59 55 ... ... Unsuitable or Defective 104 81 ... ... Not separate for sexes 4 4 ... ... Offences under the Factory and Workshops Acts— Illegal occupation of underground bakehouses Other offences — (excluding offences relating to outwoik and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers Order, 1921) ... ... ... ... Reports to H. M. Inspector 5 5 45 ... Total 665 563 45 ... 3.—List of Registered Workshops. Trades. Totals. Bakers and Confectioners' 86 Tailors 94 Dressmakers 59 Building Trades 45 Milliners 38 Miscellaneous trades 48 Upholsterers 30 Laundries 12 Cycle works 19 Blacksmiths 10 Bootmakers 25 Watchmakers 13 Motor Engineers 22 Coachbuilders 8 Photographers 9 Picture Kramers 6 Umbrellas 5 Saddlers 5 Signwriters 3 Ladder and Barrow Makers 3 Wig.making 4 76 Trades. Totals. Scale makers 3 Blind makers 4 Furriers 3 Marine Stores 5 Cabinet makers 5 French Polishers 1 Butchers 2 4.—Bakehouses. The control of Bakehouses is dealt with under the Factory anc Workshops Act and the Public Health Act and Croydon Corporation Act, 1924. For details of Croydon Corporation Act see undei Food Inspection, page 82. No. of bakehouses on Register 31st December, 1925 105 No. of underground bakehouses (included in above) 9 Visits made to Bakehouses during the year 355 Defeots found 100 Notices issued 83 Notices complied 75 Considerable improvements have been carried out in connection with bakehouses during the year. One noteworthy feature i; the provision of washing facilities and towels for the worker; employed. 5.—Home Work. Lists of home workers are sent in twice yearly. 260 lists containing the names of 224 outworkers residing within the Borough were received from employers and Local Authorities. 228 visit; were paid to outworkers, 38 visits were paid to premises ol employers of outworkers to examine lists and for other purposes. NATURE OF EMPLOYMENT OF WORKERS ON THE REGISTER, 31st DECEMBER, 1925. Nature of Work. Number employ-d. Outwork in infected premises. Outwork in unsatisfactory premises. Remarks. Making, cleaning, altering and repairing wearing apparel 202 ... ... ... Upholstery work 3 ... ... ... Cardboard box making 1 ... ... ... Tennis ball sewing 1 ... ... ... Brushes 1 ... ... ... Umbrellas 1 ... ... ... Blind repairs 1 ... ... ... Table linen 1 ... ... ... 211 ... ... ... 77 REGISTERED AND LICENSED PREMISES IN THE BOROUGH, 31st DECEMBER, 1925. Slaughterhouses (not including Public) 7 Bakehouses 114 Common Lodging Houses 10 Houses let in Lodgings 72 Dairies and Milkshops 223 Cowsheds 31 Offensive Trades 112 Wholesale Dealers in margarine, etc. 36 Shop Hours Acts. 685 visits were made during the year, including week day and evening patrols and Sunday evening patrols, for the purpose of detecting any infringements of the Acts. 223 infringements found. 220 cautions given. Proceedings were taken in the following instances : — 1. Selling chocolates after 8 p.m. (Sunday). Fined 10/-. 2. Selling chocolates after 8 p.m. (Sunday). Fined 10/-. Costs 10/.. 3. Chemist. Selling toothbrush after 8 p.m. Fined £1. Total—£2 10s. Od. COMMON LODGING HOUSES, 1.—Municipal Lodging House. The Municipal Lodging House (built by the Corporation owing to displacement of private common lodging houses due to improvement scheme) is situate at Pitlake, and contains 101 cubicle beds for nightly letting to lodgers. In addition, there are 3 cubicles allotted to members of the Municipal Lodging House staff, making a total of 104 cubicles on the premises. The charge per night to lodgers is 9d. Weekly ticket is 5/- for seven nights. The premises have been adapted with due regard to comfort. Two day rooms are provided, and one large kitchen and scullery, so that the lodgers can prepare and cook their own food. The Municipal Lodging House is provided with six baths fitted with hot and cold water; a charge of one penny is made for a bath and a towel is included in that charge, the lodger providing his own soap. In addition to ordinary baths, six foot baths with hot and cold water are available for use at any time, free of cost. 78 The number of men accommodated during the year was 36,292. The average number of men lodgers amounted to 99 per night throughout the year. The receipts and expenditure for the last five vears are as follows : — Receipts. Expenditure. £ s. d. £ s. d. 1921 1119 5 1 1425 6 3 1922 1027 17 10 1279 13 4 1923 1081 4 2 1288 1 3 1924 1182 11 2 1350 10 7 1925 1346 16 6 1485 0 1 2.—Private Common Lodging Houses. There are 10 common lodging houses on the register. During 1925, 208 day and 21 night inspections were made. Notices were served for the following conditions : — Cleansing of dirty walls. Defective cisterns. Cleansing of w.c. seats. Drains stopped. Nuisance caused by dampness. Verminous conditions. Choked rain water gutters. Dirty w.c. pans. Dirty floors. The following table gives the situation of and the accommodation in the common lodging houses : — Premises. No. of Rooms. Accom modation. 9, Prospect Place 3 17 men and women. 52, Union Street 13 30 men. 19, 20, 21, 22, 23 and 24, Lahore Road.. 30 75 men and women. 11 and 12, Princess Road 10 39 men and women. 10 56 161 men and women. HOUSES LET IN LODGINGS. 1 here are 72 houses registered under the Bye-laws. 120 visits were made for inspection purposes. 173 notices were served for various amendments. 125 notices were complied with. 79 The following table gives the situation of these premises : — Road. No. of houses let in lodgings. Clifford Road 1 Beulah Grove 1 Prinoess Road 1 Queen's Road (Croydon) 1 Ely Road 10 Forster Road 15 Holmesdale Road 9 Wilford Road 30 Clyde Road 1 Donald Road 1 Canterbury Road 1 Selhurst Road 1 Notices were served for the following conditions:— Cleansing and whitewashing required. Abating nuisances caused by dampness. Defective down spouts. Defective floors. Overcrowding to be abated. Defective roofs. Defective sanitary fittings. Defective windows. Dirty floors. Other defects. OFFENSIVE TRADES. Bye-laws relating to Offensive Trades were adopted during the latter part of the year 1925. 297 Inspections were made of premises where such trades were carried on and notices issued requiring amendments in accordance with the bye-laws. The following are on the Register : — Rag and Bone Dealers 46 Gut Scraper 2 Fish Frier 61 Tripe Boiler 1 Rabbit Skin Drier 1 Fellmonger 1 Total 112 RAG FLOCK ACT, 1912. Six samples were obtained from five firms and subjected to analysis, the results being as follows:— No. 1 contained 23 parts of Chlorine per 100,000 ,, 2 ,, 51 ,, ,, ,, ,, 3 ,, 20 ,, ,, ,, ,, 4 ,, 11 ,, ,, ,, ,, 5 ,, 25 ,, ,, ,, ,, 6 ,, 14 ,, ,, ,, 80 The legal maximum of Chlorine allowed is 30 parts per 100,000. In regard to sample No. 2 a satisfactory explanation was given in this case. SMOKE OBSERVATIONS. During the year 12 observations were made of factory chimneys for the purposes of detecting offences under the Act. 3 notices were sent and amendments carried out to stop the nuisance. AMUSEMENT HOUSES. 266 visits were made to theatres, music halls, cinemas and premises where stage plays are given. Attention was given to the ventilation of the halls, sanitary conveniences, structures and cleanliness of the dressing rooms. A report is submitted to the Licensing Authorities annually. Notices were issued requiring the carrying out of the following amendments :— To remove accumulation of refuse. Repair w.c. seats. „ lavatory basins. ,, floor. ,, w.c. flushing cistern. Remove stoppage from drains. Cleanse w.c. walls. KEEPING OF ANIMALS. 167 visits were made in connection with the keeping of animals. There are 79 premises where pigs are kept in the Borough. 3 notices were served to discontinue the keeping of pigs owing to the premises being within 100 feet of a dwelling, 12 further notices were served to abate nuisances arising from various causes in connection with the keeping of pigs, and 34 notices were served to abate nuisances arising from the keeping of other animals. SHEDS AND OTHER ERECTIONS IN YARDS OF DWELLING HOUSES, ETC. The erections of sheds, fowl houses, chicken runs and rabbit houses, in the back yards of dwelling houses and other premises appears to be on the increase, and the powers governing such are certainly not sufficient to cope with the conditions which often arise and which become a menace to the health of the community. The sheds, which are frequently constructed of old timber, packing cases and other unsuitable materials, are in some instances 81 so numerous as to leave very little of the original yard surface uncovered, thereby obstructing the free air space to the house or adjoining houses. At the same time many of these erections are a harbour for rats and mice to such an extent that difficulty is often experienced in ridding the localities of these pests. It would be of great advantage were powers available for controlling the erection of such sheds, for ensuring that they fulfil definite standards of construction and arrangement, and for allowing of their subsequent compulsory removal if allowed to lapse into an insanitary condition. SUPERVISION OF FOOD SUPPLIES. The Borough is divided into three districts with one inspector in each under the supervision of the Chief Sanitary Inspector, who also holds the necessary qualifications. The inspectors carry out the examinations of all foodstuffs exposed or deposited for sale or in preparation for sale in shops, wholesale and retail markets, manufactories, hotel and cafe kitchens, eating houses, hawkers' carts, etc., also the supervision of the private slaughterhouses and the inspection of the meat dressed therein. Further, in order to avoid duplication of visits, the food inspectors carry out the inspection of the premises they visit for sanitary conditions and other matters under the Public Health and Local Acts. The public slaughterhouses are under the control of the Superintendent, who also acts under the supervision of the Chief Sanitary Inspector. The Public Health (Meat) Regulations have added to the activity of the department during the year. Much useful work has been done and a considerable number of amendments carried out. The owners of private slaughterhouses have co-operated and the work of inspection has been conducted without hitch. A considerable amount of slaughtering is carried on to a late hour, and in order that the whole of the meat should be examined before sale it was found necessary to have an official on duty until slaughtering was finished. The three food inspectors carry on this duty in rotation, each taking one week in three. Meat marking is not carried out in the Borough. 82 With regard to the retail shops which come within the scope of the meat regulations, while many improvements have been carried out in the premises, in some instances the open window remains the problem. A number of traders have provided closed windows to their shops, and there is no doubt that the appearance of the meat and the cleanliness are enhanced by this method. Other shopkeepers have apparently adopted a waiting attitude in regarii to the closed window, and a further pronouncement by the Ministry would appear necessary to bring them into line with modern methods of exposing foodstuffs for sale. It is further I desirable that similar precautions should be made compulsory in regard to the wares on sale by greengrocers, fishmongers and other similar traders. The Croydon Corporation Act, 1924, contains useful powers which deal with the inspection of foodstuffs in all its stages. Many of the sections are similar to those contained in the Public Health (Meat) Regulations which came into force on April 1st, 1925. One notable exception is that while the Regulations refer to meat, the Corporation Act includes any article, whether solid or liquid, intended or adapted for the food of man and gives power to take samples of any materials, commodities or articles of food on sale or in preparation for sale in the manner prescribed under the Sale of Food and Drugs Acts. These additional powers have enabled the Corporation to require improvements to be carried out in a large number of premises, all of which have assisted towards the better conduct of these businesses. Hotel and cafe kitchens and eating houses also received increased attention, and suggestions for improvement—including j many structural alterations—were favourably received and adopted. . The food in the course of preparation was also carefully inspected. Bakehouses have been regularly inspected and many amend- j ments carried out during the year. It is interesting to observe the | increase in the amount of wrapped bread which is sold in the Borough, and this could usefully be extended still further. The manufacture or sale of ice-cream is carried on in 272 premises. Inspection of these places is made under the Croydon Corporation Act, 1900, which contains provisions for the regulation of the business. Much of this commodity is now wrapped in hygienic covers at the source of manufacture. I remises where cooked meats and other meat products arc prepared and sold received frequent inspection, and careful 83 tion was paid to the whole process to ensure a wholesome article of food being sold. Other premises where foodstuffs of various kinds were sold also received routine inspection, and a table showing the various premises on the register will be found below. In making these inspections one is struck by the large variety of foodstuffs which are put up by the manufacturers in cartons and wrappers. This is a serious attempt to provide an article of food in a manner which not only preserves its freshness but also prevents many possible sources of contamination. Statement of Different Premises in the Borough where Foodstuffs are sold, manufactured and stored which are on the Register kept in the Department:— General Shops 76 Grocers and Provision Shops 383 Greengrooers and Fruiterers 171 Confectioners, Bakers and Pie Makers 337 Ice-Cream Shops 272 Hotel and Restaurant Kitchens and Dining Rooms 162 Butchers 189 Fishmongers (including fried fish shops) 98 Ham and Beef Shops 22 Sweet Manufacturers 5 1715 In addition to the above there are the following food premises, i.e., slaughterhouses and dairies, cowsheds and milk shops on the registers, but particulars of these premises will be found in the report under the headings specifically applying to such. Further, there are 123 stalls and barrows used for food purposes in different areas in the Borough and forming street markets. There are also barrows and other vehicles which are used by hawkers, &c., for the selling of foodstuffs, but it is difficult to estimate the actual number in use, as this varies daily. All these barrows and vehicles, wherever found, are inspected by the Food Inspectors. PUBLIC SLAUGHTERHOUSES, PITLAKE, AND MEAT INSPECTION. These slaughterhouses, although the buildings were not originally intended for such, comprise twelve slaughterhouses with lairage attached. In addition a gut cleaning firm utilise one building on the premises. Of the twelve slaughterhouses, five with lairage attached, are let on agreement to tenant butchers and the remainder are used for public slaughtering, for which head rate tolls are charged. 84 The following animals were slaughtered at the Public Slaughterhouses durifig 1925. Pitlake. Public Slaughterhouses Cattle. Shtep. Pigs. Calves Total-[/##] Public scction 554 2104 1170 130 3958 Private section 236 871 23573 2819 27499 Totals 790 2975 24743 2949 31457 The whole of the meat and offal is examined before it leav the premises. The following meat and offal from the Public Slaughterhouses was surrendered and destroyed during the year 1925 : — Description. Cause. 16 beef carcases and offal. Generalised tuberculosis. 10 ,, forequarters and 4 parts. Localised ,, ,, 81 sets beef lungs. ,, ,, 13 beef heads. ,, ,, 25 „ various offals. ,, ,, 2 „ carcases and offal. Septicaemia. 2 „ ,> Emaciation. 1 „ carcase and offal. Johne's disease and emaciation. 4 „ quarters. Traumatism. 7 ,, heads and tongues. Actinomycosis. 5 „ tongues. ,, 103 ,, offals (various). Abscesses, inflammatory condition; 1 veal carcase and offal. Tuberculosis. 3 ,, ,, ,, Immaturity. 4 ,, ,, ,, Various causes. 1 ,, pluck. Tubercular. 1 ,, heart and 1 pluck. Inflammation. 13 pig carcases and offal. Generalised tuberculosis. 14 ,, quarters. Localised tuberculosis. 4 ,, various parts. ,, ,, 383 ,, heads. ,, ,, 285 „ plucks. ,, ,, 110 ,, offals (various). ,, ,, 7 ,, carcases and offal. Infiamrr.ato. y conditions. 3 ,, quarters. Abscesses, &c. 1 ,, carcase and offal. Swine fever. 1 ,, ,, ,, Swine erysipelas. 6 ,, heads. Traumatism, etc. 21 ,, parts (various). ,, ,, 293 „ plucks. Inflammatory conditions, etc. 178 ,, offals (various). ,, cirrhosis, etc. S sheep carcases and offal. Emaciation, etc. 6 ,, parts (various). Traumatism, etc. 4 ,, plucks. Parasitical, etc. 70 ,, offals (various). ,, ,, TOTAL WEIGHT DESTROYED 31,321 lbs. 85 PRIVATE SLAUGHTERHOUSES AND MEAT INSPECTION. At the end of 1925 there were 7 registered slaughterhouses in the Borough. Of these five are in use. The number of visits paid to the private slaughterhouses for the purpose of inspecting the meat during 1925 was 1,496. The number of animals slaughtered in the private slaughterhouses during the year were : — Cattle Sheep. Pigs. Calves. Total. 769 5598 t)913 2474 15,751 The following meat and offal from private slaughterhouses and shops was surrendered and destroyed during 1925 : — Description. Cause. 1 forequarter and 3 parts beef. Localised tuberculosis. 14 sets beef offal. ,, ,, 82 „ livers. Parasitical, abscesses, etc. 10 „ „ lungs. Inflammatory conditions, etc. 3 ,, ,, offal. Various conditions. 8 ,, tongues. Actinomycosis, etc. 2 parts beef. Traumatism. 1 veal carcase and offal. Generalised tuberculosis. 2 ,, livers. Localised „ 3 ,, carcases and offal. Inflammatory conditions. 6 pig ,, ,, Generalised tuberculosis. 1 ,, forequarter and 1 part. Localised ,, 48 ,, heads. ,, ,, 44 ,, offals. ,, ,, 4 ,, carcases and offal. Inflammatory conditions. 169 ,, plucks. ,, ,, 89 ,, offal (various). Inflammatory, cirrhosis, etc. 1 ,, part. Inflammatory. 5 sheep carcases and offal. Inflammatory conditions, etc. 4 ,, parts. ,, ,, 30 „ plucks. ,, ,, 25 ,, livers. Parasitical, etc. TOTAL WEIGHT DESTROYED ... 5,861 lbs. 86 Total number of animals slaughtered for human consumption in the Borough during 1925 :— Cattle. Sheep. Pigs. Cal*es. Total. 1559 8573 31,656 5423 47,211 Summary of whole carcases destroyed, with the reasons for such destruction. Class of Animal. Tuberculosis. Septicaemia. Emaciation, various causes. Johne's Disease. Immaturity. Inflammatory Conditions. Swine Fever. Swine Erysipelas. Asphyxiation. Jaundice. Emphysema. Total carcases. Cattle 16 2 2 1 ... ... ... ... ... ... ... 21 Sheep ... ... 8 ... ... 5 ... ... 3 ... ... 16 Pigs 19 ... ... ... ... 11 1 1 3 ... ... 34 Calves 2 ... ... ... 3 4 ... ... 1 ... ... 12 Totals 37 2 10 ... 3 20 1 1 6 1 1 83 Summary of carcases in which tuberculosis was found in the course of inspection and method of disposal : — Animals affected. Carcase and all internal organs destroyed, Quarters or parts of carcase destroyed. All or part of organs destroyed. Total. Cattle (including 2 calves) 18 18 105 141 Pigs 19 20 431 470 Total 37 38 536 611 The following table gives a summary of the inspections made during the year (not including visits made to slaughterhouses):— Butchers 1083 Fishmongers 427 Grocers 794 Greengrocers 416 Game Dealers 22 Cooked and prepared meat shops 108 Markets 276 Hawkers' carts and barrows 214 Hotel and cafe kitchens 405 Ice-Cream Manufacturers and Vendors 284 Other premises 489 4518 87 GENERAL FOOD INSPECTION. The following articles of food were surrendered and destroyed during 1925 : :— 35 beef quarters and parts (Imported) Unsound. 7 lots ox kidneys and tails ,, do. 42 ox livers and 5 hearts ,, do. 3 sheep carcases ,, do. 11 sheep parts ,, do. 6 sheep plucks ,, do. 1 lot sheep kidneys ,, do. 2 pig carcases ,, do. 9 „ plucks „ do. 2 cases pork loins ,, do. 1 lot bacon ,, do. 11 lots tripe ,, do. 31 lbs. sausage, etc. do. 308 lbs. winkles do. 140 lbs. codfish do. 1 box herrings do. 91 packets dates, etc. do. 240 lbs. damsons do 119 lbs. apples, etc. do. 1 crate bananas do. 367 lbs. tomatoes do. 3 bags peas do. 677 tins, &c., meat paste, corned beef and mutton do. 2197 ,, sardines, salmon, etc. do 984 ,, loganberries, strawberries, &c. do. 500 ,, &c., peas, tomatoes and soup, &c do. 714 ,, milk do. 194 jars, &c., jam and marmalade, and pickles do. 134 ,, mincemeat, soup, &c. do. 414 eggs do. 508 lbs. chocolates and sweets do. 7 boxes glucose, honeycomb, &c. do. 1 barrel molasses do. 125 lbs. butter, lard and cheese do. 12 tins biscuits, &c. do. 106 packets cocoa essence and dried eggs do. 71 lbs. soup squares and sundries do. 106 lbs. cake flour do. 155 packets suet, &c. do. 28 rabbits do. TOTAL WEIGHT DESTROYED 14,991 lbs. 88 General Summary of Meat and other articles destroyed during th2 year 1925:— ARTICLES. Weiglil in lbs. Remarks. Diseased. Unsound. Total. Beef 11,778 1,668 13,446 Including 21 carcases. Mutton 715 426 1,141 ,, 16 ,, Pork 12,149 763 12,91'2 „ 34 ,, Veal 636 115 751 ,, 12 „ Offal 12,355 1,380 13,735 ,, imported ollal. Fi«h ... 556 556 Cod, herrings,kippers, Fruit & Vegetables ... 1,102 1,102 Damsons, Apples, Tomatoes, Peas, etc. Eggs ... 40 40 414 eggs. Rabbits ... 83 83 28 rabbits. Sweetmeats, &c. ... 1,852 1,852 Including one barrel molasses, two boxes glucose. Tinned Goods ... 6,565 6, *55 5,182 tins 427 jars. 37,633 14,540 52,173 MILK. The milk supply of the Borough is derived principally from the south, south-east and south-west counties, the greater proportion being rail-borne. Only a small percentage is produced in the Borough, due largely to the decreasing amount of land (owing to building operations) available for pasture. The various premises in the Borough dealing with milk received careful attention during the year, and in consequence a considerable number of amendments were carried out, including the building of new dairies and the remodelling of other premises on modern lines. The provision of covered ventilated counter pans in milk shops has made good progress during the year. One firm retails bottled milk exclusively, but it is interesting to note that almost without exception all other milk vendors also supply bottled milk, and it seems probable that in the near future milk will be retailed almost entirely in this manner. 98 DAIRIES, COWSHEDS AND MILKSHOPS ORDER, AND THE MILK AND DAIRIES AMENDMENT ACT, 1922, Cowkeepers, Dairymen and Purveyors of Milk. The following statement shows the number of Cowkeepers, cowsheds, dairies and purveyors of milk premises on the register : — Cowkeepers on register (1924) 10 ,, added to the register (1925) — ,, discontinued (1925) 1 Nett ... 9 Cowsheds on register (1924) 33 ,, added to register (1925) — ,, discontinued (1925) 9 Nett 31 Number of cows provided for 171 Average number of cows in sheds (1925) 152 No. of dairies and purveyor of milk premises on register (1924) 223 No. of dairies and purveyor of milk premises added to Register (1925) 15 No. of dairies and purveyor of milk premises discontinued during 1925 29 209 Grand total of cowsheds, dairies and purveyor of milk premises on register, 31st December, 1925 240 During the year 872 inspections were made of dairies, cow- sheds and milkshops. Milk (Special Designations) Order, 1923. The following licences were granted during the year 192.") 1 under this Order and were in force on the 31st December, 1925 : Description of Licences. No. (1) Producers' Licences to use the designation " Grade A " 1 (2) Dealers' Licences to use the designation " Certified " 21 90 (3) Dealers' Licences to use the designation " Grade A " (Tuberculin tested): (a) Bottling establishments — (b) Shops 4 (4) Dealers' Licences to use the designation " Grade A " : (a) Bottling establishments 1 (b) Shops 4 (-5) Dealers' Licences to use the designation " Grade A Pasteurised " (a) Shops 1 (6) Dealers' Licences to use the designation " Pasteurised ": (a) Pasteurising establishments — (b) Shops 1 Inspection of these licensed premises have been carried out regularly during the year to see that the conditions of the licences were observed. During the year the following samples of milk were examinee under the Milk (Special Designations) Order, 1923 :— Certified Milk. Licensed country producers supplying milk to licensed local dairymen G Grade A. Samples taken from a Croydon licensed producer i Samples taken from a Croydon dairyman licensed to bottle Grade A milk received from a licensed country producer 1 In each case of Certified and Grade A milk the samples were found to conform with the requirements of the Order. 91 The following tables summarise the results of the bacteriological examinations of Certified and Grade A samples from 1st January to 31st December, 1925 :— CERTIFIED MILK. Present. Absent. Over 30,000 per c.c. Under 30,000 per c.c. Present in 1/10 c.c. ■ Not present in 1/10 c.c. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Tubercle bacillus ... 6 Total number of bacteria ... 6 Bacillus Coli .. 6 Blood ... 6 Pus ... 6 Detritus ... 6 6 6 6 6 6 6 The above six certified milk samples contained total bacteria per c.c. as follows : — 1,000 — 5,000 2 5,000 — 10,000 2 10,000 — 20,000 1 20,000 — 30,000 1 6 Under the regulations, certified milk must not contain more than 30,000 bacteria per c.c. GRADE A MILK. Present. Absent. Over 200,000 per c.c. Under 200.000 per c.c. Present in 1/100 c.c. Not present in 1/100 c.c. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding | a trace. Tubercle bacillus ... 8 Total number of bacteria ... 8 Bacillus coli ... 8 Blood ... 8 Pus ... 8 Detritus ... 8 8 8 8 8 8 8 92 The above eight Grade A samples contained total bacteria per c.c. as follows :— 1,000 — 5,000 4 5,000 — 10,000 4 8 Under the Regulations, Grade A milk must not contain more than 200,000 bacteria per c.c. CROYDON CORPORATION ACT, 1900. PROVISIONS AS TO MILK SUPPLY. During the year 94 primary and 5 secondary samples of ordinary milk were procured and submitted to examination for Tuberculosis in accordance with the above Act. These samples were taken as follows : — Primary samples taken at cowsheds in the Borough S Secondary ,, ,, „ ,, 5 Samples in course of delivery from country cowsheds to local dairymen and purveyors of milk in the Borough 47 Samples taken at dairymen's premises in the Borough of milk from country cowsheds 1 Samples taken in course of delivery by local dairymen or milk sellers on their rounds in different parts of the Borough 37 Other samples taken 1 99 Of the 94 primary samples 1 was found to be tuberculous. This sample had been obtained from a local cowkeeper in the Borough and was the mixed milk of 24 cows. A further visit was paid accompanied by the Borough Veterinary Inspector, who examined the whole of the cattle. One aged cow was certified to be affected with tuberculous udder and subsequently slaughtered; compensation at J value—£7—was paid under the Milk and Dairies Consolidation Act, 1925. 5 further samples of milk were examined from the same farm and were certified to be free from tubercle bacillus. 93 The following table summarises the results of the bacteriological examination of ordinary milk samples taken under the Croydon Corporation Act, 1900, from 1st January to 31st December, 1925 : — ORDINARY MILK. Present. Absent. Over 200,000 per c.c. Under 200,000 per c.c. Present in 100 c.c. Absent from 100 c.c. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Tubercle bacillus 1 98 Total No. of bacteria 12 87 Bacillus Coli 32 67 Blood ... 99 Pus ... 99 Detritus ... 99 99 99 99 99 99 99 The above 99 samples of ordinary milk contained total bacteria per c.c. as follows :— 1,000 — 5,000 1 5,000 — 10,000 6 10,000 — 20,000 21 20,000 — 30,000 26 30,000 — 40,000 4 40,000 — 50,000 4 50,000 — 100,000 11 100,000 — 150,000 5 150,000 — 200,000 9 200,000 — 250,000 3 250,000 — 750,000 8 750,000 — 1,000,000 1 . 99 There is no standard fixed for total bacteria per cc. in ordinary commercial milk, but comparing the results with the Grade A standard, i.e., 200,000 per cc., it will be seen that 87 of the samples contained total bacteria below that standard. It has to be remembered that a large proportion of this milk has been subjected to commercial pasteurisation. 94 The 99 samples taken under the Croydon Corporation Act, 1900, were samples of milk which had been produced in the following areas: — Areas. No. obtained. Xo. Tuberculous. Percentage. Croydon 13 1 7.7 Dorset 1 — — Kent 14 — — Somerset 5 — — Surrey 4 — — Sussex 28 — — Unclassified 34 — - Totals 99 1 1.01 *These samples could not be classified owing to the fact that it was mixed milk of large dairy firms who obtain their milk from practically all the areas mentioned in the above table. SALE OF FOOD AND DRUGS ACT. During the year 134 samples of milk (131 new and 3 condensed) and 468 other samples were taken. In 20 instances the vendors were warned, seven were covered by a declaration, and in 25 instances no action was deemed necessary. 95 1.—Summary of Samples. During 1925 samples were obtained and submitted to the Public Analyst, as follows : — Sample of Total Samples. Genuine. Not Genuine. Prosecutions. Convictions. Caution*. Milk l3l 124 7 7 Condensed milk — Full cream 2 2 — — — — Condensed milk—machine skimmed 1 1 — — — — Cream 6 3 3 — 1 ,, preserved 5 5 — — — — Butter 32 32 — — — Coffee 17 17 — — ,, and Chicory 1 1 — — Bread 11 11 — — — Bread and Butter 18 16 2 — 2 Bread and Margarine 1 1 — — — — Vinegar (malt) 13 11 2 — — 2 Vinegar (wood) 1 1 — — — — Cocoa 11 11 — — — Tea 10 9 1 — — Coffee & Chicory Essence 4 4 — — — Jam 21 19 2 — — 1 Golden syrup 12 12 — — — — Treacle 2 2 — — Sponge calces 18 17 1 — — 1 Sponge cake mixtures 13 13 — — — — Ground Kice 7 7 — _ — Hour 12 12 — — — Egg substitute 1 1 — — — Custard Powder 4 1 3 — Baking l'owder 12 12 — — — Lard 21 21 — — — — Margarine 18 17 1 — — 1 Sweets 8 8 — — Arrowroot 7 7 — — Cheese 10 10 — — Mineral water 18 18 — — Mustard 5 5 — — Ground Ginger 5 5 — — — — Black Pepper 4 4 — — — Curry Powder 2 2 — — — Olive Oil 9 9 — — Liquorice Powder 6 6 — — — Cream Cheese 4 1 3 — — — Salmon & Shrimp Paste 1 — 1 — — — Turkey and Tongue 1 1 — — — — Castor Oil 2 2 — — — — Tinned Salmon 3 3 — — — Tinned Pineapple 1 1 — — — Tinned Asparagus 1 — 1 — — 1 Tinned Peas 8 1 7 — — Tinned Apricots 1 1 — — — Cream of Tartar K 5 — — — Rum and Coffee 1 1 — — — Sweet Spirits of Nitre 5 5 — — — Calves Foot Jelly 2 2 — — — Fish Paste 1 — 1 — — Pickles 7 7 — — — Lemon Cheese 9 8 1 — — Chicken & Ham Paste 1 1 — — — Sausages •24 20 4 — — Prescriptions 13 9 4 — — 4 Chicken Rolls 1 1 — — — Malt and Oil I 1 — — — Lemon Curd 2 2 — — — Veal and Ham Pies 3 2 1 — — Brawn 8 4 4 — — Lime Juice 4 4 — — — Ice Cream 9 6 3 — — — Lemonade Powder 2 2 — — — Sherbert 1 1 — — Saveloys 2 2 — — — Totals 602 550 52 — — 20 96 2. Result of Analysis of Milk Samples. SOLIDS NOT FAT. 8.2 8..3 8.4 *8.5 8.6 8.7 8.8 8.9 9.0 9.1 9.2 9.8 Total 3 3 7 12 11 10 23 32 21 6 3 1 131 NOTE.—* Legal Standard is 8.5%. MILK FAT. 2.7 2 .9 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 4.1 4.3 4.5 4.6 Total 1 1 7 6 17 26 17 18 9 8 9 2 4 3 1 1 1 131 NOTE.—*Legal Standard is 3%. County Milk in course of delivery at railway stations 30 On milk rounds,, Sunday mornings 19 On milk rounds, week-days 80 At shops 2 131 Average Composition of all Milk Samples. MILK FAT 3.45% SOLIDS NOT FAT 8.79% PERCENTAGE of Total Milk Samples below Legal Standard ... 10.6% 3. Adulterated Samples. The following is a detailed statement of the adulterated samples and action taken : — No. Sample. Adulteration or Deficiency. Remarks. 443. Malt Vinegar Contained not more than 10% Malt Vinegar Vendor warned. 477. Malt Vinegar Contained not more than 20% Malt Vinegar ,, 483. Custard Powder Sugar 25% Farina 75% No action. 511 New Milk Added water 3% Vendor warned. 575. Bread & Butter . Bread 95% Margarine 5% ,, 581. Bread & Butter . Bread 92% Margarine 8% ,, 591. Custard Powder Moisture 11.8% Farina 88.2% No action. 594. Custard Powder Moisture 11.5% Farina 88.5% ,, 611. Tinned Asparagus Tin 2.7 grains per lb. Vendor warned. 612. Tinned Peas Copper 0.35 grains per lb. Declaration on tin: no action. 622. Prescription Deficiency Potassium Acetate 13% Warned. 640. Jam Benzoic Acid 2.8 grains per lb. No action. 659. Tinned Peas Copper 0.35 grains per lb. Declaration on tin: no action 664. Tinned Peas Copper 0.49 grains per lb. Declaration on tin: no action 666. Prescription Slight inaccuracy Warned. 677. Prescription ,, ,, ,, 670. Prescription ,, ,, ,, 673. Margarine Water 17.3% Vendor warned. 97 776. Ice Cream Boric Acid 0.04% No action. 777. Ice Cream 0.05% ,, 800. Ice Cream 0.05% ,, 714. Sponge Cake Boric Acid 0.1% or 7 grains to the lb. Vendor warned. 645. New Milk Deficiency—fat 9% ,, 727. Jam A red dye was indicated ,, 819. Brawn Boric Acid 0.03% or 2.1 grains per lb. No action. 900. Brawn Boric Acid 0.04% or 2.8 grains per lb. ,, 820. Sausage Boric Acid 0.21% or 14.7 grains per lb. ,, 899. Sausage Boric Acid 0.22% or 15.4 grains per lb. ,, 902. Veal & Ham Pie Boric Acid 0.04% or 2.8 grains per lb. ,, 843. New Milk Added water 2% Vendor warned : further samples taken. 847. New Milk ,, ,, Vendor warned : further samples taken. 872. New Milk ,, ,, Vendor warned : further samples taken. 874. New Milk ,, ,, Vendor warned : further samples taken. 879. New Milk ,, ,, Vendor warned : further samples taken. 912. Lemon Cheese Salicvlic Acid 0.026% No action. 916. Brawn Boric Acid 0.05% or 3.5 grains per lb. ,, 917. Fish Paste Boric Acid 0.13% or 9.1 grains per lb. ,, 918. Sausage Boric Acid 0.08% or 5.6 grains per lb. ,, 969. Tea Magnetic particles 0.0057% ,, 971 Cream Cheese No evidence of cream ,, 972. Salmon and Shrimp Paste Boric Acid 0.08% or 5.6 grains per lb. ,, 980. Brawn Boric Acid 0.05% or 3.5 grains per lb. ,, 988. Cream Cheese No evidence of cream. ,, 992. Cream Cheese ,, ,, ,, 994. Tinned Peas Copper 0.006% or 0.42 grains per lb. Declaration on tin: no action 997. Tinned Peas Copper 0.006% or 0.42 grains per lb. Declaration on tin : no action 999. Cream A sample of preserved cream Explanation accepted. 1000. Cream Contained a trace of Boric Acid No action. 1002. Cream Contained a trace of Boric Acid ,, 1008. Sausage Boric Acid 0.115% or 8 grains per lb. ,, 1010. Tinned Peas Copper 0.006% or 0.42 grains per lb. Declaration cn tin. no action. 1011. Tinned Peas Copper 0.007% or 0.49 grains per lb. Declaration on tin : no action. 98 MILK AND CREAM REGULATIONS, 1912 and 1917. Report for the year ended 31st December, 1925 :— 1.—Milk and Cream not sold as Preserved Cream. Number of samples examined for the presence ot a preservative. Number in which a preservative was reported to be present. MILK 134 Nil. CREAM 6 3* * In one instance Boric Acid to the extent of 0.4 per cent, was found in cream not sold as preserved cream. A satisfactory explanation was furnished and no further action taken. In two instances a trace of Boric Acid was found but was considered by the Analyst as too small to be of service as a preservative. No action was taken. 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 5 (ii) Statements incorrect Nil. Total 5 (b) Determinations made of milk fat in cream sold as preserved cream : — (i) Above 35 per cent 5 (ii) Below 35 per cent. Nil. Total 5 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Art. v. (1) and the proviso in Art. v. (2) of the Regulations have not been observed Nil. (d) Particulars of each case in which the Regulations have not been complied with, and action taken Nil. 3.—Thickening substances. Any evidence of their addition to cream or to preserved cream. Action where found Nil. 4.—Other Observations Nil. 99 POISONS AND PHARMACY ACT, 1908. The Poisons and Pharmacy Act, 1908, came into operation on April 1st, 1909. The object is to regulate the sale of certain poisonous substances and to amend the Pharmacy Act. The number of licences renewed under the Act during 1925 was six and one new licence was granted during the course of the year. In addition four licences were renewed and one additional licence was granted under the Order-in-Council dated November 10th, 1911, to assistants in the employ of persons already holding licences. Inspections of the premises were carried out periodically, when no infringements of the Act were found. FERTILISERS AND FEEDING STUFFS ACT, 1906. During the year no samples were submitted for analysis under this Act. The Borough Disinfecting Station is situate in Factory Lane. Two steam disinfectors are in use and are supplied with steam from the Refuse Destructor. A cleansing station consisting of reception room, four baths and discharge room is attached to the disinfecting station, and is used for dealing with verminous conditions in children and adults. DISINFECTION. The following articles were disinfected at the Disinfecting Station during the year:— No. of articles. By steam 16,752 By formalin gas 1,176 By formalin spray 92 18,020 In addition 630 articles were destroyed on request. 100 Disinfection after infectious or contagious disease was carried out in 1,862 rooms at 1,204 houses. 38 classrooms at 14 schools. 1 hut. 11 hospital wards. 4 vehicles. 1 T.B. shelter. 1 perambulator. also 1 ditch (mosquitoes). 1 pond (mosquitoes). Cleansing of Varmineus Persons, etc. During the year eight adults were cleansed for verminous conditions, 9 adults and 7 children for scabies, and one adult after contact with infectious disease. RATS AND MICE DESTRUCTION. The rat catcher is a permanent member of the staff. Rats are destroyed by the following methods:—Dogs, ferrets, poison baits, traps, and rat varnish smeared on cardboard. During the year a large amount of attention was directed to the work of the rat catcher to make this more efficient, especially when large premises and crowded localities are concerned. As an experiment, assistance by one of the assistants to the Sanitary Inspectors was arranged where such conditions mentioned above were present, so that appointments could be made by the rat catcher with the occupiers to clear out sheds and for the removal of other impediments liable to impede the work, and with a view to making their visit as successful as possible, as far as the " catch " was concerned. In some cases the District Sanitary or District Food Inspector was present at the same time to carry out inspections with a view to the abatement of nuisances, testing of suspicious drains liable to harbour rats and to the removal of conditions which were objectionable. The summary of the work of rat destruction during the three years 1923, 1924 and 1925 is as follows:— 1923 1924. 1925. No. of Visits made 1140 1629 1535 No. of Poison and other Baits laid 1092 1508 2913 No. of Rats killed 1692 2073 2447 101 The fact that a larger number of rats were killed during 1925 with fewer visits than during the year 1924 suggests that the work was efficiently carried out and the new method of working yielding good results. It should be remembered that daily activity in killing rats in the Borough lessens the number awaiting capture and so tends automatically to decrease the number subsequently caught. The following is a summary of the visits paid during 1925 under the Rats and Mice (Destruction) Act, 1919:— RATS AND MICE (DESTRUCTION) ACT, 1919. Premises. No. of Visits Made. No of Poison and other Baits laid. No. of Rats killed. Private Houses 1107 50 Fishmongers 10 Other premises where food is prepared or sold 129 2913 2447 Other shops 78 Stables 14 Other premises 147 Total 1535 2913 2447 102 SECTION IX.—APPENDIX TO PUBLIC HEALTH, REPORT 1925. containing the following tables: — Table A.—Death-rates, Croydon, 1881-1923. ,, I.—Population, births, deaths, infant mortality, illegitimate births and deaths. ,, II.—Puerperal sepsis; accidents of childbirth; cancer; pneumonia; influenza. ,, III.—Infant mortality—whole borough and each ward. ,, IV.—Causes of, and ages at, death. ,, V.—Infectious diseases—notifications and deaths. ,, VI.—Borough Hospital—admissions and discharges. ,, VII.—Tuberculosis—new cases ascertained, and deaths. ,, VII. (A).—Work of Tuberculosis Dispensary. ,, VII. (B).—Residential Institutions for Tuberculosis—beds. ,, VII. (C).—Results of Treatment in Sanatoria. ,, VII. (D).—Conditions of patients on Dispensary Register— pulmonary tuberculosis. ,, VII. (E.)—Conditions of patients on Dispensary Register— non-pulmonary tuberculosis. ,, VIII.—Work of Infant Welfare Centres and of Health Visitors. ,, IX.—Venereal diseases—Croydon General Hospital clinic. ,, X. Venereal diseases—London County scheme. ,, XI.—Meteorological record. ,, XII.—Prevailing direction of wind. TABLE A.—CRUY DON DEATH KATES, 1881—1923. DEATH RATES AT:— ALL AGES. 0—1 YEAR. 1—5 YEARS. 5—15 YEARS. 15—25 YEARS. 25—65 YEARS. (25—60 Years when in Black). 65 YEARS AND UPWARDS. (60 Years and Upwards where in Black). Year . Population. Death Rate. Population. Total Death Rate. D.R. Congen., debility, premature, birth, formation D.R. Diarrhoea. D.R. Pneumonia. D.R. Bronchitis D.R. Whooping Cough. D.R. Tuberc. (non-pulm.). D.R. Measles. Population. Total D.R. D. R. Pneumonia. D.R. Tuberc. (non-pulm.) D.R. Measles. D.R. Whooping Cough. D.R. Bronchitis. D.R. Diphtheria. Population. Total D.R. D.R. Tuberc. (non-pulm.). D.R. Diphtheria. D.R. Pulm. Tuberc. D.R. Pulm. Tuberc. males D.R. Pulm. Tuberc. females D.R. Pneumonia. Population. Total D.R. D.R. Pulm. Tuberc. D.R. Pulm. Tuberc. males D.R. Pulm. Tuberc. females D.R. Pneumonia. D.R. Tuberc. (non-Pulm.) Population. Total D.R. D.R. Cancer. D.R. Pulm. Tuberc. D.R. Pneumonia. D.R. Nephritis. D.R. Bronchitis. Population. Total D.R. D.R. Cancer. D.R. Cancer, males. D.R. Cancer females. D.R. Bronchitis. D.R. Pneumonia. D.R. Nephritis. D.R. Influenza. D.R. Other Respiratory Diseases. D.R. Pulm. Tuberc. 1881 78,953 16.2 2311 139 40.0 15.6 5.2 14.7 3.9 9.1 2.1 8109 19.4 2.1 2.1 1.1 1.6 2.7 0.8 17141 3.1 0.5 0.1 0.4 — — 0.1 15722 4.4 2.0 — — 0.06 — 30352 — — — — — — 5318 — — — — — — — — — — 1882 81,327 17.3 2319 171 52.0 14.7 6.9 27.2 3.8 8.6 5.1 8231 23.7 2.0 3.4 3.2 0.7 2.6 0.1 17723 2.4 0.2 0.1 0.2 — — 0.1 16159 4.5 1.7 — — 0.1 0.1 31368 — — — — — — 5515 — — — — — — — — — — 1883 83,701 14.9 2327 128 37.8 12.9 5.6 18.0 2.5 6.4 2.5 8354 19.0 1.3 3.2 0.8 1.5 3.4 0.7 18305 2.3 0.4 — 0.2 — — — 16597 3.4 1.3 — — 0.1 0.1 32385 — — — — — — 5712 — — — — — — — — — — 1884 86,075 16.4 2335 164 40.0 23.6 4.3 15.4 1.7 17.3 1.7 8476 21.6 2.3 2.8 0.4 0.4 1.8 0.7 18887 — — — — — — — 17034 — — — — — — 33401 — — — — — — 5910 65.5 4.5 — — 8.5 2.6 2.8 0.1 1.7 1.5 1885 88,499 16.9 2313 139 41.0 14.1 3.8 14.5 4.7 13.4 9.3 8599 27.2 2.3 4.2 7.3 2.5 3.1 0.7 19470 — — — — — — — 17482 — — — — — — 34418 — — — — — — 6107 65.5 4.4 — — 2.6 5.2 3.6 — 1.6 0.6 1886 90,824 14.5 2351 132 37.0 21.3 5.1 18.7 7.6 6.8 0.4 8722 18.4 1.3 3.5 0.1 2.4 2.6 1.0 20053 — — — — — — — 17919 — — — — — 35435 — — — — — — 6304 70.0 7.0 — — 9.8 2.0 3.6 — 2.0 1.8 1887 93,198 14.7 2358 127 34.4 20.2 5.5 12.7 8.0 5.9 2.5 88???4 24.0 1.9 1.9 4.8 4.0 2.7 1.8 20636 2.6 0.3 0.5 0.1 — — 0.1 18357 3.1 1.1 — — 0.05 0.1 36451 9.7 0.8 2.0 0.5 0.6 0.5 6502 63.0 4.7 — — 10.5 1.2 4.7 — 0.4 1.2 1888 95,572 13.2 2363 112 £0.0 7.6 3.8 15.6 4.2 9.7 3.8 8967 18.1 1.3 2.7 1.5 1.6 3.0 0.8 21219 2.2 0.4 0.2 0.3 — — 0.04 18794 2.8 0.9 — — 0.2 0.2 37468 9.1 0.8 2.2 0.4 0.3 0.3 6699 58.5 3.1 — — 8.3 2.8 3.5 — 1.5 1.1 1889 97,946 13.9 2374 130 41.0 13.5 5.9 13.5 6.7 11.8 2.9 9089 18.2 1.4 2.1 2.2 2.7 2.3 0.9 21802 2.9 0.9 0.2 0.4 — — 0.1 19232 3.0 1.3 — — 0.1 0.1 38484 8.9 0.8 2.0 0.6 0.2 0.4 6896 61.0 5.5 — — 8.2 2.0 5.2 — — 2.1 1890 100,320 16.7 2381 160 48.0 11.8 7.1 18.9 9.2 6.3 8.0 9212 29.4 2.5 2.7 6.9 3.5 2.9 2.2 22385 3.7 0.4 0.8 0.3 — — 0.1 19659 3.2 0.9 — — 0.1 0.1 39501 9.5 0.6 2.2 0.7 0.1 0.5 7093 71.0 5.0 — — 10.2 1.7 2.8 — 1.1 2.9 1891 102,695 15.1 2389 129 45.0 10.0 7.9 15.1 4.2 6.2 0.4 9334 13.9 1.2 2.9 0.4 1.0 2.5 0.8 22968 3.4 0.7 0.4 0.6 — — 0.1 20096 3.2 0.7 — — 0.2 0.2 40517 10.8 1.0 2.5 0.6 0.5 0.5 7391 72.5 5.0 — — 13.3 3.3 3.8 2.9 1.9 1.4 1892 105,3,815 16.4 2???45 142 48.5 13.5 8.7 14.3 9.1 11.0 5.8 9512 24.0 3.1 1.2 3.9 3.3 2.6 1.5 23346 3.1 0.6 0.8 0.2 — — 0.1 20754 4.1 1.4 — — 0.3 0.2 42368 10.6 1.0 2.0 0.5 0.5 0.7 7657 71.5 5.7 — — 14.5 3.4 3.4 3.7 0.4 1.5 1893 108,935 17.0 2503 178 58.4 28.0 8.8 18.4 4.8 11.6 1.2 9689 21.1 2.4 2.0 1.5 1.3 1.8 3.5 23725 5.0 0.8 1.9 0.3 — — 0.1 21412 3.8 1.3 — — 0.3 0.1 43949 9.9 0.6 1.9 0.7 0.5 0.4 7923 70.5 6.2 — — 10.4 2.7 3.6 2.9 1.0 1.3 1894 112,055 13.8 2561 134 39.4 6.6 12.5 18.7 11.7 9.3 4.6 9868 21.0 3.7 2.5 2.8 3.2 1.7 1.9 24103 2.7 0.3 0.8 0.2 — — — 21971 2.9 0.8 — — 0.1 0.1 44530 8.7 0.5 2.0 0.3 0.5 0.3 8189 59.0 4.8 — — 7.2 2.6 3.3 1.8 0.2 0.9 1895 115,175 14.7 2619 152 37.1 19.5 10.3 12.2 5.7 14.9 1.9 10015 13.2 2.1 1.5 0.6 1.1 1.5 1.1 24581 2.6 0.5 0.3 0.2 — — 0.2 22729 2.6 1.3 — — 0.1 0.04 46111 9.1 0.9 2.1 0.8 0.3 0.4 8455 72.0 6.3 — — 11.8 3.5 3.4 5.4 0.2 1.8 1896 118,295 14.5 2677 171 48.7 24.0 18.3 17.6 12.0 9.0 4.1 10223 20.6 3.2 2.0 4.4 2.7 1.7 1.4 24860 2.3 0.5 0.6 0.2 — — 0.1 23388 3.5 1.3 — — 0.1 0.1 47692 8.5 0.7 1.9 0.6 03 0.4 8721 55.5 5.7 — — 7.0 3.4 2.5 0.5 0.8 0.9 1897 121,415 13.3 2735 155 49.0 40.3 5.5 12.4 5.1 10.6 1.4 10401 13.6 0.8 2.8 1.2 1.5 1.4 0.1 25238 2.4 0.4 0.1 0.2 — — — 24046 2.8 1.1 — — 0.04 0.2 49273 8.1 0.8 1.5 0.4 0.4 0.2 8987 58.5 6.4 — — 5.8 3.0 2.9 0.6 0.3 0.6 1898 124,535 14.3 2793 173 39.8 61.6 7.1 12.2 3.9 7.9 2.5 10580 17.7 2.2 2.3 2.3 2.0 1.1 1.0 25617 2.2 0.2 0.3 0.3 — — 0.1 24705 2.4 0.7 — — 0.1 0.2 54907 9.2 1.0 1.8 0.4 0.6 0.4 5932 82.0 7.7 — — 10.8 3.5 3.7 4.0 1.0 0.5 1899 127,655 15.6 2851 175 44.8 55.5 11.9 14.0 7.3 7.7 1.0 10757 16.9 2.1 2.1 1.2 1.7 1.3 0.9 25995 2.3 0.5 0.2 0.5 — — 0.07 25363 3.2 1.0 — — 0.2 0.2 56591 12.2 0.9 1.8 0.8 0.5 0.4 6096 94.5 5.7 — — 15.2 5.6 3.7 5.7 0.8 1.4 1900 130,775 14.7 2909 149 40.3 23.4 9.6 15.5 6.5 6.2 1.7 10934 14.8 2.3 1.5 1.1 2.6 1.2 1.0 26373 2.7 0.4 0.4 0.1 — — 0.1 26021 3.7 1.2 — — 0.1 0.1 58274 10.6 0.9 1.5 1.0 0.4 0.6 6258 86.5 8.9 — — 14.2 5.4 2.8 8.1 1.4 0.1 1901 133,895 13.1 2967 168 48.5 36.0 11.7 12.0 5.3 6.0 1.3 11114 12.5 2.5 1.3 1.4 0.7 1.1 0.9 26752 2.2 0.5 0.3 0.1 — — — 26681 2.0 0.5 — — 0.1 0.1 59959 8.3 0.9 1.5 0.4 0 4 0.4 6422 77.0 7.3 — — 11.5 3.4 2.1 2.1 14 0.6 1902 137,460 14.1 3003 159 51.5 17.4 12.7 15.4 5.6 9.3 3.0 11433 16.5 3.1 1.9 1.4 1.2 1.0 1.3 27416 2.4 0.05 0.3 0.1 — — 0.2 26789 3.0 0.8 — — 0.1 0.1 62080 8.7 1.0 1.1 0.5 0.4 0.5 6738 85.0 8.5 — — 13.6 4.0 4.3 3.8 1.0 0.6 1903 141,026 11.8 3040 127 43.2 5.6 13.8 7.9 11.5 7.9 1.6 1172 12.6 2.4 1.7 1.6 1.7 0.3 0.7 28079 1.6 0.3 0.2 0.2 — — 0.03 26996 2.4 0.9 — — 0.3 0.2 64243 8.8 1.3 1.6 0.4 0.6 0.4 7054 64.5 7.5 — — 6.2 2.9 2.7 2.2 1.0 0.9 1904 144,591 13.8 3076 160 47.3 19.3 10.7 12.0 3.0 5.6 6.0 12070 13.7 1.8 1.9 3.2 0.5 0.9 0.4 28743 2.8 0.1 0.5 0.1 — — 0.2 27004 2.6 0.4 — — 0.1 0.4 66325 9.8 1.4 1.6 0.6 0.5 0.4 7371 76.5 8.5 — — 13.8 2.8 3.2 1.7 0.5 0.9 1905 148,156 12.7 3112 120 45.5 6.7 9.6 9.0 6.7 4.8 2.2 12389 11.3 2.2 0.9 1.1 0.7 0.5 1.0 29407 2.3 0.4 0.4 0.1 — — 0.1 27111 2.9 1.2 — — 0.2 0.2 68448 9.1 1.2 1.7 0.6 0.4 0.3 7687 76.0 6.4 — — 10.3 4.1 3.1 1.8 0.7 0.6 1906 151,687 13.4 3150 159 51.7 14.1 8.5 4.6 0.3 5.2 2.6 12708 16.3 2.4 2.1 2.0 2.1 0.8 1.2 30070 2.6 0.2 0.7 0.1 — — 0.1 27219 2.8 1.2 — — 0.07 0.1 70570 9.0 1.3 1.6 0.4 0.3 0.2 8003 68.0 6.0 — — 7.7 2.3 3.3 1.1 0.5 1.3 1907 155,288 12.2 3186 116 42.3 4.1 14.8 10.8 5.9 1.5 0.3 13027 11.1 1.9 0.3 0.5 0.8 0.4 1.5 30734 2.3 0.06 0.5 0.1 — — 0.1 27327 2.7 0.8 — — 0.2 0.07 72694 8.8 1.2 1.6 0.5 0.4 0.3 8320 71.5 6.8 — — 9.2 3.8 4.1 2.0 0.7 0.9 1908 158,853 12.9 3223 131 50.6 9.2 14.8 5.9 3.3 4.3 6.9 13346 17.6 2.7 0.9 4.4 1.3 0.6 1.3 31398 2.8 0.3 0.5 0.1 — — 0.2 27434 2.3 0.9 — — 0.1 0.07 74815 8.1 0.9 1.4 0.3 0.5 0.3 8636 72.0 8.3 — — 7.5 2.4 2.6 2.9 0.7 0.9 1909 162,419 11.6 3259 96 41.7 3.3 10.4 7.0 4.0 2.1 2.4 13664 9.0 1.4 0.9 0.7 1.2 0.6 0.4 32062 1.8 0.4 0.5 0.3 — — 0.1 57542 2.1 0.8 — — 0.07 0.1 76928 8.1 1.3 1.3 0.05 0.2 0.4 8952 74.5 6.9 — — 13.4 4.2 3.2 4.1 1.7 0.7 1910 165,984 10.7 3295 101 48.0 5.4 11.2 6.3 2.7 3.3 1.2 13983 9.7 1.3 1.5 1.9 0.7 0.5 0.9 32725 1.5 0.1 0.2 0.2 — — 0.4 27649 2.8 1.0 — — 0.03 0.2 79060 7.5 1.1 1.1 0.4 0.3 0.3 9269 63.5 7.0 — 8.9 2.8 3.2 1.1 0.7 0.8 1911 169,551 12.0 3333 119 34.5 35.0 9.6 5.1 5.4 4.2 2.7 14303 12.5 1.8 1.8 1.2 1.4 0.6 0.9 33389 2.6 0.3 0.6 0.2 0.34 0.17 0.06 27756 2.6 1.1 1.3 0.97 0.07 0.1 81183 7.9 1.2 1.4 0.6 0.4 0.1 9586 69.0 8.9 9.0 8.7 10.6 2.3 2.8 0.3 1.1 0.6 1912 171,664 11.1 3342 90 36.6 12.3 8.7 4.8 1.8 2.4 2.4 13969 8.6 1.0 0.4 1.5 0.4 0.2 0.8 33681 2.0 0.3 0.3 0.1 0.18 0.17 0.08 28059 2.4 1.0 1.28 0.83 0.1 0.3 82698 8.0 1.2 1.3 0.3 0.4 0.2 9914 69.5 9.7 9.8 9.6 7.4 3.4 2.1 1.1 1.4 0.8 1913 173,777 12.0 3351 111 38.0 20.0 9.2 5.6 4.2 2.9 2.3 13635 11.1 2.0 1.1 2.7 0.6 0.4 0.4 33974 2.2 0.2 0.2 0.2 — 0.4 0.08 28360 2.4 0.9 0.71 1.2 0.3 0.1 81214 8.4 1.5 1.2 0.4 0.3 0.2 10213 68.0 8.4 7.7 8.8 8.8 3.2 3.1 1.2 0.7 0.9 1914 175,890 11.4 3360 95 35.4 16.5 8.6 4.5 3.5 1.2 1.2 13301 7.9 1.4 0.8 0.4 0.7 0.4 0.02 34267 1.8 0.1 — 0.2 0.06 0.4 0.1 28663 2.7 1.0 1.4 0.8 0.1 0.07 83728 7.0 1.0 1.3 0.5 0.2 0.3 10571 72.0 10.1 10.7 9.7 8.6 3.6 2.7 0.3 1.7 0.7 1915 178,003 13.6 3370 83 29.0 11.8 11.3 3.7 0.8 1.8 4.5 12967 15.4 2.6 1.2 3.0 0.7 1.6 0.4 34560 3.0 0.4 0.2 0.1 0.06 0.28 0.2 28965 2.6 0.7 0.86 0.68 0.03 0.2 87244 8.9 1.1 1.7 0.6 0.2 0.3 10900 86.0 8.8 11.0 2.5 14.3 4.3 3.8 2.0 1.3 0.9 1916 180,117 11.9 3378 85 30.0 9.5 10.1 6.2 4.1 1.5 — 12632 7.1 1.7 1.2 — 1.2 0.1 0.4 34852 2.2 0.2 0.2 0.3 0.11 0.57 0.1 29267 2.6 1.3 0.77 1.8 0.1 0.06 88758 8.3 1.3 1.2 0.6 0.3 0.2 11228 78.0 9.7 9.4 10.7 11.4 4.0 2.1 4.1 1.3 0.4 1917 182,230 12.0 3388 73 27.4 9.7 7.1 5.0 0.8 2.9 0.8 12297 9.2 1.4 1.5 2.1 0.6 0.2 0.4 35145 2.3 0.3 0.1 0.2 0.34 0.17 0.2 29570 2.3 1.3 1.05 1.5 0.1 0.06 90274 8.6 1.5 1.6 0.5 0.3 0.2 11555 78.0 9.2 12.0 7.5 10.2 2.5 3.5 1.2 1.4 0.6 1918 184,343 13.5 3397 59 20.9 5.6 7.1 3.1 4.7 1.7 0.3 11963 17.5 2 6 1.5 1.9 1.4 1.0 0.7 35438 3.8 0.4 0.3 0.4 0.28 0.56 0.2 29874 5.1 1.4 1.3 1.8 0.2 0.1 91788 10.5 1.4 1.8 0.6 0.2 0.2 11884 70.0 9.0 9.0 9.0 6.3 2.3 1.9 4.1 1.5 1.0 1919 186,456 11.9 3407 63 29.3 6.4 6.4 4.4 0.3 0.3 0.3 11629 8.8 1.6 1.2 0.3 — 0.4 1.5 35730 2.5 0.2 0.5 0.2 0.17 0.33 0.3 30175 3.4 1.3 1.4 1.3 0.1 0.06 93304 8.0 1.3 1.4 0.4 0.2 0.3 12212 78.0 8.6 11.3 6.9 10.8 3.3 1.4 1.9 0.6 0.8 1920 188,569 10.1 3415 78 30.7 9.5 9.2 6.1 — 0.8 1.1 11295 7.8 1.8 0.7 1.1 0.1 0.1 0.4 36021 2.7 0.2 0.4 0.3 0.22 0.55 0.3 30477 2.6 0.9 1.0 1.0 0.1 0.03 91818 7.6 1.1 1.0 0.6 0.2 0.2 12541 65.7 8.1 8.9 7.4 7.2 3.2 1.9 1.0 1.1 0.7 1921 190,684 10.7 3425 77 25.3 13.1 10.8 3.8 4.1 2.3 0.8 10960 6.4 1.1 0.3 0.2 0.8 0.2 0.9 36316 2.2 0.2 0.3 0.2 0.16 0.27 0.2 30779 3.2 1.6 2.26 1.0 0.1 0.01 96335 7.1 1.1 1.0 0.5 0.3 0.1 12869 65.8 8.9 7.7 9.7 7.7 2.4 2.0 1.4 1.0 0.2 1922 192,797 12.4 3434 64 24.0 4.0 12.8 3.2 1.4 1.7 1.4 10626 9.6 3.1 0.4 1.6 0.5 0.3 0.6 36599 2.2 0.2 0.4 0.1 0.05 0.27 0.1 31082 2.8 1.1 0.87 1.39 0.2 0.1 97850 8.9 1.4 1.3 0.4 0.2 0.2 13198 77.5 9.0 7.3 10.0 9.7 4.6 1.0 4.2 0.9 0.5 1923 194,910 10.3 3444 51 21.2 5.5 8.4 1.1 1.7 1.0 0.6 10292 6.2 1.3 0.1 0.4 0.5 0.1 0.6 36892 1.7 0.3 0.3 0.1 0.05 0.1 0.1 31384 3.6 1.7 1.8 1.66 0.2 0.01 99365 7.0 1.4 0.9 0.5 0.4 0.1 13562 66.0 8.9 11.5 7.2 6.3 3.7 2.6 0.3 1.1 0.7 NOTES:— DEATHS.—The rccords of deaths from 1911 onwards are taken from the Annual Reports of the Registrar-General, and for this period alone has it been possible to analyse the rates for the two sexes separately. Prior to 1911 the data as to deaths cannot be obtained from the reports of the Registrar-General, but have been taken from successive annual reports of Medical Officers of Health for Croydon. Evidence is found in the figures that there has been some slight variation in the method of allocating deaths to the several headings this applies, for example, to the item Congenital Debility, etc., to which, prior to 1911, more deaths were attributed locally than appears to have been the practice of the Registrar-General since that year. AGE-GROUPS.—The age groups, at which the deaths have been classified varied somewhat in the earlier years; for example, in the period 1887-1897, 25-60 years, is given as one group, and from 1898 onwards this group is given as 25-65 years; again, from 1884-1897 the highest group is given as over 60 years, and from 1898 onwards as over 65 years. Prior to 1887 some of the groups varied from year to year, and this accounts for certain gaps in the tables. POPULATION.—The population at the age periods 0-1, 1-5, 5-15, 15-25, 25-65, and over 65 have been calculated by assuming an arithmetical progression between the successive census population of 1881, 1891, 1901, 1911, and 1921. This method is not, of course, strictly accurate, but is sufficiently so for this purpose. During the war years and immediately after (1914-1920) the population for the years 15-65 are not trustworthy, so that the death rates during that period should not be regarded as being necessarily accurate; the death rates in infancy and in children under 5 will similarly be somewhat irregular during these years through fluctuation in the birth rates not indicated by the method of calculation from the census of 1911 and 1921. It has been felt that it would involve too much labour to attempt any correction on these points. Owing to the populations at the various age periods being relatively small, the rates show relatively large savings from year to year, and it is required that some degree of uncertainty must be attached to any deductions drawn from them. 103 TABLE I.—Vital Statistics of whole Borough during 1925 a a previous year. Year. Population estimated to Middle of each Year. Births. Total Deaths Reg. in the District. Transferable Deaths Nett deaths belonging to the District. Births and Deaths. Illegitimate Children of Non-residents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Nett Births. Nett Deaths under 1 year. Death-rate under 1 year of age per 1000 illegitimate births Uncorrected Number. Nett. Number. Rate.* Number. Rate per 1,000 Nett Births. Number. Rate* N umber. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1915. 177,345 3699 3704 20.8 2463 13.8 269 221 307 83 2415 13.6 191 36 188 1916. 175,765 3589 3636 20.6 2207 12.5 253 197 281 77 2151 12.2 189 39 206 1917. 186,917† 2836 2861 15.3 2207 11.8 262 219 249 87 2164 11.09 196 49 250 1918. 188,755// 2632 2626 13.9 2687 15.9 388 24a 202 76 2544 15.1 205 25 122 1919. 191,92211 3008 2965 15.4 2287 12.4 312 197 219 73 2172 11.7 212 34 160 1920. 191,820§ 4434 4351 22.6 2225 11.6 299 209 275 63 2134 11.1 195 31 159 1921. 191,500 3713 3631 18.9 2115 11.0 283 222 269 74 2054 10.7 171 19 111 1922. 192,300 3616 3505 18.2 2469 12.8 337 255 224 64 2387 12.4 147 25 170 1923. 193,400 3445 3370 17.4 2082 12.5 284 209 176 52 2007 10.4 146 37 253 1924. 196,000 3536 3456 17.6 2384 12.1 317 213 195 56 2280 11.6 167 34 203 Average for 10 years 188,572 3451 3410 18.0 2312 12.6 300 218 240 70 2231 12.0 182 33 182 1925. 199,300 3521 3406 17.1 2262 11.4 336 243 185 55 2169 10.9 130 24 180 * Rates calculattd per 1,000 of estimated population, t Registrar General's estimate of civilian population. J Registrar General's estimate of civilian population for death rate. 168,462. II „ >. ,, „ „ „ 184,239. * „ . „ ,, „ „ ., 191,580. 104 TABLE II. Year. Puerperal Sepsis. Other maternal accidents & diseases of pregnancy and parturition. Cancer Pneumonia all forms, except influenzal pneumonia). Influenza. Bronchitis and otl respiratory disease (excluding pneum and ruberculosis Deaths. Death-rate per 1000 births. Deaths. Death-rate per 1000 births. Deaths. Death-rate Deaths. Death-rate Deaths. Death-rate Deaths. Death-rate 1913 4 1.02 12 3.08 206 1.15 146 .82 26 .14 169 .95 1914 3 .74 7 1.74 193 1.06 161 .88 15 .08 173 .95 1915 5 1.34 5 1.34 198 1.11 180 1.01 45 .25 254 1.43 1916 8 2.20 1 27 226 1.28 157 .89 47 .26 197 1.12 1917 1 .34 8 2.80 233 1.24 137 .73 20 .10 203 1.08 1916 3 1.14 8 3.04 228 1.35 204 1.21 478 2.83 179 1.06 1919 3 1.01 4 1.34 235 1.27 136 .73 139 .75 241 1.30 1920 6 1.37 12 2.75 218 1.13 160 .83 43 .22 203 1.05 1921 4 1.10 10 2.75 218 1.13 138 .72 39 .20 177 .92 1922 6 1.71 10 2.85 252 1.31 183 .95 101 .52 234 1.21 1923 4 1.01 6 1.78 259 1.33 144 .74 20 .13 175 .90 1924 2 .58 8 2.31 293 1.49 182 .93 89 .45 175 .89 1925 5 1.47 8 2.31 319 1.60 145 .73 63 .31 157 .78 105 TABLE III. County Borough of Croydon— Whole Borough. INFANT MORTALITY, 1925 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 41 13 12 2 68 34 39 25 19 185 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 ... 1 2 4 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... 1 ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... 2 1 3 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 1 Meningitis (not Tuberculous) ... ... ... ... ... ... 2 ... ... 2 Convulsions ... 1 1 ... 2 1 ... ... 1 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 3 4 2 1 10 Pneumonia (all forms) 1 ... 2 ... 3 3 4 10 5 25 Diarrhoea, Enteritis & Gastro Enteritis ... ... ... ... ... 8 14 3 3 28 Gastritis 2 1 ... ... 3 ... ... ... ... 3 Syphilis ... ... ... ... ... 1 1 ... ... 2 Rickets ... ... ... ... ... ... ... 1 ... 1 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth 3 ... ... ... 3 ... ... ... ... 3 Atelectasis 3 2 ... ... 5 ... ... ... ... 5 Congenital Malformations 3 2 1 1 7 6 3 1 ... 16 Premature Birth 26 2 6 ... 34 6 2 ... ... 42 Atrophy, Debility and Marasmus 1 2 1 ... 4 5 3 ... 2 14 Other causes 2 3 1 1 7 1 5 5 3 21 41 13 12 2 68 34 39 25 19 185 Nett Births in the year legitimate, 3276. illegitimate, 130. Nett Deaths in the year legitimate infants 161. illegitimate infants, 24. 106 TABLE III.—continued. INFANT MORTALITY. Deaths in UPPER NORWOOD WARD. NORBURY WARD. CAUSES OF DEATH. Under 1 Week. 1-2 Weeks. a 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. 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-ia Months. Total Deaths under 1 Year. All Causes Certified 2 l 2 1 6 2 3 1 1 13 2 1 ... ... 3 2 ... 2 ... 7 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... 1 ... 1 ... 1 ... 1 3 ... ... ... ... ... ... ... 2 ... 2 Diarrhoea, Enteritis & Gastro Enteritis ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... 1 ... ... ... ... 1 Atelectasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 Premature Birth 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 1 Atrophy, Debility and Marasmus ... ... ... 1 ... 2 1 ... ... ... 3 ... ... ... ... ... ... ... ... ... ... Other causes ... ... ... ... 1 1 ... 1 ... ... 2 ... 1 ... ... 1 ... ... ... ... 1 2 1 2 1 6 2 3 1 1 13 2 1 ... ... 3 2 ... 2 ... 7 *Gross Births in the year legitimate 255. illegitimate 4. Nett Deaths in the year legitimate infants, 12. illegitimate infants 1. Gross legitimate, 153. Births illegitimate, 3. Nett Deaths legitimate infants, 7. illegitimate infants, *The figures of inward and outward transfers are not available for the ward . 107 TABLE III.-continued. INFANT MORTALITY. Deaths in WEST THORNTON WARD. BENSHAM MANOR WARD. CAUSES OK DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under I Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Month. Toml Deaths Under One Year. Under 1 Wek. 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 4 ... 2 I 7 1 2 2 1 13 2 1 2 ... 5 2 ... 3 2 12 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... 1 ... ... 1 ... 2 Diarrhoea, Enteritis & Gastro Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... ... ... 1 1 ... ... ... ... 1 ... 1 ... ... 1 1 ... ... ... 2 Premature Birth 4 ... 2 ... 6 1 ... ... ... 7 1 ... 2 ... 3 1 ... ... ... 4 Atrophy, Debility and Marasmus ... ... ... ... ... ... 1 ... 1 2 ... ... ... ... ... ... ... ... ... ... Other causes ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 2 ... 2 4 2 I 7 I 2 2 1 13 a 1 2 5 2 3 2 12 *Gross Births in the year legitimate, 395. illegitimate, 73†. Nett Deaths in the year legitimate infants, 11. illegitimate infants, 2. Gross Births legitimate, 210. illegitimate, 8. Nett Deaths legitimate infants, 11. illegitimate infants, 1. *The figures of inward and outward transfers are not available for the wards. †The heavy illegitimate figure is owing to the inclusion of births at the Mayday Road Hospital. 108 TABLE III .—continued* INFANT MORTALITY. Deaths in THORNTON HEATH WARD. SOUTH NORWOOD WARD 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. 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 3 1 ... ... 4 3 3 4 3 17 2 3 1 ... 6 5 1 1 3 16 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... 1 1 2 ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis [not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... 1 ... ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... 1 l 3 ... ... ... ... ... 2 ... ... ... 2 Pneumonia all forms) ... ... ... ... ... ... ... 1 l 2 ... ... ... ... ... ... 1 1 ... 2 Diarrhoea, Enteritis & Gastro Enteritis ... ... ... ... ... 1 ... ... ... 3 ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 2 Premature Birth 2 ... ... ... 2 ... ... ... ... 2 1 1 ... ... 2 ... ... ... ... 2 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 l ... ... 1 3 Other causes 1 ... ... ... 1 1 1 ... ... 3 ... ... ... ... ... ... ... ... 2 2 3 1 ... ... 4 3 3 4 3 17 2 3 1 ... 6 5 1 1 3 16 #Gross Births in the year legitimate, 233. illegitimate, 6. Nett Deaths in the year legitimate infants, 17. illegitimate infants, Gross Births legitimate, 176. illegitimate, 13. Nett Deaths legitimate infants, 15. illegitimate infants, 1. 109 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 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 Onuses Certified 2 1 1 ... 4 1 ... ... ... 5 2 ... ... ... 2 2 ... ... ... 4 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 Diarthœa, Enteritis&Gastro Enteritis ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Malormations 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 Prenatu???e Birth 1 ... ... ... 2 ... ... ... ... 2 ... ... ... ... 2 ... ... ... ... 2 Atrophy, Debility, and Marasmus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... 4 1 ... ... ... 5 2 ... ... ... 2 2 ... ... ... 4 *Gross Buths in the year legitimate. 220. illegitimate, 7. Nett Deaths in the year legitimate infants. 5. illegitimate intants, — Gross Births legitimate, 171. illegitimate, 1. Nett Deaths legitimate infants, illegitimate infants, 110 TABLE III.—continued. INFANT MORTALITY. Deaths in ADDISCOMBE WARD, WHITEHORSE MANOR WARD. 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. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total tinder 1 Momth. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under 1 Year. All Causes Certified 5 ... ... ... 5 ... 2 3 ... 10 2 2 3 ... 7 1 12 3 6 29 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 2 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 3 Diarrhoea, Enteritis & Gastro Enteritis ... ... ... ... ... ... 1 1 ... 2 ... ... ... ... ... ... 5 2 2 9 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 Congenital Malformations 1 ... ... ... 1 ... 1 ... ... 2 ... ... ... ... ... ... 1 ... ... 1 Premature Birth 3 ... ... ... 3 ... ... ... ... 3 ... ... ... ... ... ... ... ... ... 3 Atrophy, Debility and Marasmus 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 Other causes ... ... ... ... ... ... ... 2 ... 2 ... 1 1 ... 2 ... 2 1 1 6 5 ... ... ... 5 ... 2 3 ... 10 2 2 3 ... 7 1 12 3 6 29 *Gross Births in the year legitimate, 176. illegitimate. 4. Nett Deaths in the year legitimate infants, 10. illegitimate infants, Gross legitimate, 292. Births illegitimate, 6. Nett Deaths legitimate infants, 27. illegitimate infants, 2. *The figures of inward and outward transfers are not available for ???. 111 TABLE III.—continued, INFANT MORTALITY. Deaths in BROAD GREEN WARD. CENTRAL WARD. CAUSES OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Wteeks. Total under 1 Month. 1-3 Months. 3-45 Months. 6-9 Months. 9-12 Months. Total Deaths umder 1 Year. 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 ... ... ... 4 4 2 1 2 13 4 ... ... 4 4 1 2 1 12 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... ... ... 1 ... 1 1 3 ... ... ... ... ... 1 1 2 ... 4 Diarrhoea. Enteritis & Gastro Enteritis ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 ... ... 1 2 Gastritis 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Congenital Malformations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Premature Birth 2 ... ... ... 2 ... ... ... ... 4 3 ... ... ... ... ... ... ... ... 3 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Other causes ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 4 ... ... ... 4 4 2 1 2 13 4 ... ... ... 4 4 1 2 1 12 *Gross Births in the year J legitimate, 523. illegitimate, 12. Nett Deaths in the year legitimate infants, 13. illegitimate infants, . Gross Births legitimate, 182. illegitimate, 5. Nett Deaths legitimate infants, 10. illegitimate infants, 2. *The figures of inward and outward transfers are not available for the wards. 112 TABLE III.—continued. INFANT MORTALITY. Deaths in WADDON WARD. SOUTH WARD. CAUSES OF DEATH. Under 1 Week 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Momths. 3-6 Months 6-9 Months. 9-12 Months. Total Deaths under 1 Year. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths Under-1 Year All Causes Certified 5 2 1 ... 8 1 1 2 ... 12 2 1 ... ... 3 6 12 1 ... 22 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 ... ... 1 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 Pneumonia (all forms) ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... Diarrhoea, Enteritis & Gastro Enteritis ... ... ... ... ... 1 ... ... ... l ... ... ... ... ... 2 5 ... ... 7 Gastritis 1 ... ... ... 1 ... ... ... ... l ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth 1 ... ... ... 1 ... ... ... ... l ... ... ... ... ... ... ... ... ... ... Atelectasis 1 1 ... ... 2 ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... Congenital Malformations 1 1 ... ... 2 ... ... 1 ... 3 ... ... ... ... ... ... ... ... ... ... Premature Birth 1 ... ... 2 ... ... ... ... 2 2 ... ... ... 2 2 2 ... ... 6 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... 3 Other causes ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 5 2 1 ... 8 17 1 2 ... 12 2 1 ... ... 3 6 12 1 ... 22 *Gross Births in the year legitimate, 162. illegitimate, 6. Nett Deaths in the year j legitimate infants, 11. illegitimate infants, 1 Gross Births legitimate, 220. (illegitimate, 5. Nett Deaths legitimate infants, 8.* illegitimate infants, 14. * Thee ??? of inwirad and outwarda are not available for the wards. 113 TABLE IV. Causes of, and ages at, death during year ending December 31st, 1925, excluding deaths of non-residents which occurred in the Borough, 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 . Up. Norwood. Norbury. W. Thornton. Bensham Mnr. Thornton Hth. 8th. Norwood. Woodside. East. Addiscombe. Whitehorse Mnr Broad Green. Central. Waddon. South. M F M F M F M F M F M F M F M F I. — General Diseases. 1 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2(2) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 (A B.) Relapsing Pever (A) Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Mediterranean Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Malaria ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 5 Small-pox (A) Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Not vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Doubtful ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Measles ... ... ... ... ... ... ... ... ... 3 1 2 1 ... ... ... ... 7 5 2 ... ... 3 1 1 1 1 ... ... ... ... ... ... ... ... ... 7 Scarlet Fever ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 (1) ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 8 Whooping Cough ... ... 1 1 3 ... ... ... ... ... 2 ... 1 1 ... 1 (1) ... 9 2 7 ... 4 2 1 ... ... ... 2 ... ... ... ... ... ... ... ... 9 (A) Diphtheria ... ... 2 ... ... 1 1 ... 1 2 ... 1 ... ... ... 13 (7) ... 8 4 4 ... ... ... 1 1 1 3 2 ... ... ... ... ... ... ... ... (BC.) Croup (B) Membranous laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Influenza 8 2 5 5 3 6 4 5 3 5 3 2 6 6 ... 11 (3) ... 63 29 34 ... ... ... ... 1 2 ... ... 1 2 6 9 9 2 12 19 11 Miliary Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Cholera Nostras ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Yellow Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Leprosy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Erysipelas ... ... ... ... 1 ... ... ... ... ... ... 3 ... 1 ... 3 ... 5 3 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 3 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, Septicaemia (A) Pyæmia ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... (B) Septicaemia 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2(1) ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (C) Vaccinia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 Anthrax (Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Rabies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 24 Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25 (A.B.) Mvcoses (A) Actinomycosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other Mycoses ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 26 Pellagra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Beri beri ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28 (A.B.) Pulmonary Tuberculosis (not acute) (A) Pulmonary Tuberculosis 11 9 6 1 10 4 10 7 7 10 12 13 11 6 ... 64(16 ... 117 75 42 ... ... ... ... ... ... ... 2 13 12 30 17 27 8 5 3 (B) Phthisis (not defined at tuberculous) 1 2 2 3 1 1 ... ... ... 5 3 1 3 5 ... 4 ... 27 13 14 ... ... ... ... ... ... 1 ... 3 2 5 7 4 ... 2 29 (A) Acute Phthisis ... ... ... 2 ... ... 1 ... 1 ... ... ... ... ... ... ... ... 4 ... 4 ... ... ... ... ... ... ... 1 ... ... ... 1 ... 2 ... ... (B) Acute Miliary Tuberculosis 1 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 4(1) ... 3 1 2 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 30 Tuberculous Meningitis 1 ... 1 ... 2 ... 2 ... 3 2 2 1 1 2 ... 9 ... 17 11 b 2 1 2 ... 2 4 ... 1 ... ... 1 ... ... ... ... 31 (A.B.)Tuberculosis of Peritoneum and Intestine (A) Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other Peritoneal and Intestinal Tubercle ... ... 1 ... 1 ... 2 ... ... ... ... ... ... ... ... 3 (2) ... 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 32 Tuberculosis of Spinal Column ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 2(1) ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 33 Tuberculosis of Joints ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 34 (A B.C.) Tuberculosis of other Organs (A) Lupus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (1) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Scrofula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other Tuberculosis included under 34 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 35 Disseminated Tuberculosis 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... 2 (1) ... 4 2 2 ... ... ... ... ... 1 2 ... ... ... 1 ... ... ... ... 36 (A.B.) Rickets, Softening of Bones (A) Rickets ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... (B) Other forms of Bone Softening ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 114 115 TABLE IV.—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. j 65 and upwards Ud. Norwood. Norbury. W. Thornton. Bensham Mnr. Thornton Hth. 8th. Norwood. Woodside. East. Addiscombe. Whitehorse Mnr. Broad Green. Central. Waddon. South. M F M F M F M F M F M F M F M F 37 Syphilis ... ... 1 ... ... 1 ... ... ... 1 2 ... ... 1 ... 6(1) 1 6 5 1 2 ... ... ... 1 1 ... ... ... ... ... ... 1 ... 1 ... 38 (A B.C.) Other Venereal Diseases (A) Soft Chancre ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Gonococcus infection (C) Purulent Ophthalmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 39 Cancer of the Buccal Cavity ... 11 1 1 ... ... 1 1 1 2 5 2 3 ... 9 (5) 1 18 14 4 ... ... ... ... ... ... ... ... ... ... ... 1 9 ... 5 3 40 Cancer of the Stomach, Liver, &c. 11 61 3 5 6 11 8 3 4 7 6 7 8 10 ... 43 (1) 1 95 49 46 1 ... ... ... ... ... ... ... 1 ... 3 1 20 22 24 2 3 41 Cancer of the Peritoneum, Intestines & Rectum 5 1 6 5 8 7 4 4 4 8 4 4 11 3 ... 25 (11) ... 64 25 39 ... ... ... ... ... ... ... ... ... ... ... 2 8 17 12 25 42 Cancer of the Female Genital Organs ? 3 2 3 1 4 2 2 2 3 2 2 ... 1 ... 18 (6) ... 29 ... 29 ... ... ... ... ... ... ... ... ... ... ... 8 18 ... 3 43 Cancer of the Breast 8 1 1 2 3 4 2 1 4 2 4 ... 4 6 1 14 (3) ... 43 ... 43 ... ... ... ... ... ... ... ... ... ... ... 5 ... 23 ... 15 44 Cancer of the Skin ... ... ... ... ... ... ... 1 1 ... 1 1 ... 1 1 2 (1) ... 6 2 4 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 3 45 Cancer of other or unspecified Organs 5 3 3 6 3 9 6 2 5 6 4 5 4 3 ... 34 (8) 1 64 35 29 ... ... ... 1 ... ... ... ... ... ... 8 6 12 9 15 13 46 (A.B.C.) Other Tumours (situation undefined) (A) Angioma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Adenoma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other Tumours included under 46 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 2 2 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 47 Rheumatic Fever 1 1 2 ... ... ... ... ... ... 1 1 2 ... ... ... 3 (1) ... 8 4 4 ... ... ... ... ... ... ... 1 2 ... 1 1 ... 1 1 1 48 (A.B.) Chronic Rheumatism, Osteoarthritis (A) Chronic Rheumatism ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 (B) Osteo-arthritis ... ... ... ... ... 2 ... 1 ... 5 1 ... ... 3 ... 8 (2) ... 12 1 11 ... ... ... ... ... ... ... ... ... ... ... ... 1 5 ... 6 (C) Gout ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 (1) ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 49 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...-... ... ... ... ... ... ... ... ... ... 50 Diabetes ... 1 1 1 ... 2 2 2 1 3 1 1 1 1 ... 8 (5) ... 17 10 7 ... ... ... ... ... ... 1 ... 1 ... 1 1 4 1 3 5 51 Exophthalmic Goltre ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 ... 4(1) ... 3 ... 3 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... 52 Addison's Disease ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... 2 ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 53 (A.B.) Leucocythæmia, Lymphadenoma (A) Leucocythæmia (Leucaemia) ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (B) Lymphadenoma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 116 54 Anæmia, Chlorosis 1 2 2 1 ... 1 2 ... 1 ... 2 1 2 1 ... 6 ... 16 5 11 2 ... ... ... ... ... ... ... ... 1 ... 1 2 5 1 4 55 (A. B.C. D.) Other General Diseases (A) Diabetes Insipidus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Purpura ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (1) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Hæmophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other Diseases included under 55 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 56 Alcoholism (acute or chronic) ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 57 (A. B.) Chronic lead poisoning (A) Occupational lead poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (It) Non-occupational lead poisoning ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 l 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 58 Other chronic occupational poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 59 Other chronic poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... II.—Diseases of the Nervous System and of the Organs of Special Sense. 60 Encephalitis 2 2 1 1 ... 2 ... 1 1 ... 1 1 ... ... ... 10 (1) 1 12 5 7 ... ... ... 1 ... ... 1 2 1 1 1 1 1 1 1 1 61 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 61 (B.C.) Meningitis, other forms or undefined (B) Posterior basal meningitis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Meningitis, other forms ... ... ... ... ... 1 ... ... 1 ... ... ... 2 1 ... 4 (2) 1 5 2 3 1 ... ... 1 ... ... ... ... ... ... ... 1 1 1 ... ... 62 Locomotor Ataxy ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 3 (1) ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 63 (A.B.) Other diseases of the spinal cord (A) Diseases formerly classed to "Other nervous affections" ... ... ... ... 2 ... 1 ... 1 ... ... ... 1 ... ... 2 ... 5 2 3 ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 1 (B) Other diseases included under 63 1 1 ... ... ... 1 1 1 ... 1 ... ... ... ... ... 1 1 6 2 4 ... ... ... ... ... ... 1 ... ... ... 1 2 ... 1 1 64 (A.B.C.D.E.) Cerebral haemorrhage, Apoplexy (A) Apoplexy 2 ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... 1 (1) ... 5 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 3 (B) Serous apoplexy and oedema of brain ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Cerebral congestion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Cerebral atheroma ... ... ...1... ... ... 2 ... ... ... ... ... ... ... ... ... 5 (3) 1 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... (E) Cerebral haemorrhage 13 4 2 10 4 8 7 7 3 14 9 6 5 11 ... 35 (9) 3 103 40 63 1 1 ... ... ... ... ... ... ... ... 3 1 9 16 27 ... 65 Softening of brain ... ... ... 1 ... 2 ... 1 1 ... ... 1 ... ... ... ... ... 6 2 4 ... ... ... ....... ... ... ... ... ... ... 1 1 1 3 66 (A.B.C.) Paralysis without specified cause (A) Hemiplegia ... 1 ... ... 1 1 1 ... 3 1 ... 2 ... ... ... 3(1) ... 1 5 6 ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 3 4 (B) Paraplegia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other forms of paralysis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 117 TABLE IV—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. 1 Up-Norwood. Norbury. W. Thornton. Bensham Mnr. Thornton Hth. 8th. Norwood. Woodside. East. Addiscombe. Whitehorse Mnr Broad Green. Central. Waddon. South. M F M F M F M F M F M F M F M F 67 General paralysis of the insane ... ... ... 3 1 2 2 ... 2 3 2 2 ... 1 ... 22 (5) 18 12 6 ... ... ... ... ... ... ... ... ... ... 6 2 4 3 2 1 68 Other forms of mental alienation ... ... 1 1 ... ... ... ... ... ... ... ... 1 ... ... 5 (2) ... 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 69 Epilepsy ... ... ... 2 ... ... 1 ... 1 1 ... ... 1 ... ... 5 ... 6 2 4 1 ... ... ... ... 1 1 ... ... 2 ... ... ... 1 ... ... 70 (A.B. (Convulsions (non-puerperal; 5 yrs. & over) (A) Epileptiform convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Others included under 70 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 71 (A.B.) Infantile convulsions (under 5 years) (A) Convulsions with teething ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other infantile convulsions ... ... ... ... 1 1 ... ... ... 1 1 ... ... ... ... ... ... 4 2 2 1 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 72 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 73 (A.B.) Hysteria, Neuralgia, Neuritis (A) Hysteria, Neuralgia, Sciatica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Neuritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 74 (A.B.C.D.) Other diseases of the nervous system (A) Idiocy, Imbecility ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Cretinism ... ... ... ... ... ... ... ... ... l ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Cerebral tumour ... ... ... ... ... ... ... 1 1 ... 1 2 ... 1 ... 4 ... 6 3 3 1 2 3 (D) Other diseases included under 74 1 1 1 1 2 2 2 ... 9 ... 10 5 5 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 3 5 75 Diseases of the eves and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 76 (A) Mastoid disease 1 ... 1 1 1 ... 1 ... ... ... ... ... ... ... ... 5 ... 5 ... 5 ... ... ... ... ... ... ... 5 ... ... ... ... ... ... ... ... 76 (B) Other diseases of the ears ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 2 ... 2 1 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... III.—Diseases of the Circulatory System. 77 Pericarditis ... ... ... 1 ... ... ... 1 1 ... ... ... 1 ... ... 3 1 4 3 1 ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... 1 78 (A.B.C.) Acute endocarditis (A) Acute myocarditis ... 1 ... ... ... ... ... 1 ... 1 ... 2 ... 1 ... 2 (1) ... 6 3 3 ... ... ... ... ... ... ... ... ... ... 1 1 2 12 ... ... 1 ... ... 1 1 ... ... ... ... ... ... 1 ... 1 ... 3 (1) ... 5 3 2 ... ... ... ... ... ... ... ... ... ... 1 1 2 1 ... ... (C) Other acute endocarditis 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 1 3 1 2 ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... 118 79 ( A) Valvular disease 3 1 11 8 6 15 7 7 4 14 12 7 1 7 ... 26 (8) 5 103 47 56 ... ... ... ... ... ... ... ... 1 1 7 3 16 20 23 32 79 (B) Fatty degeneration of the heart 1 1 3 ... 1 ... ... ... ... ... ... 1 3 ... ... 3 2 10 4 6 ... ... ... ... ... ...... ... ... ... ...... ... ... 3 1 1 5 79 (C) Other organic disease of the heart 9 6 7 7 15 15 12 12 6 8 8 9 8 15 ... 26(16) 25 137 59 78 ... ... ... ... ... ... ... 1 ... ... 1 16 10 42 66 80 Angina pectoris 1 ... ... ... ... 1 ... ... 1 ... 1 ... 1 ... ... 1 ... 5 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 6 81 (A) Aneurysm ... ... 2 1 ... ... ... ... 1 2 ... ... ... 1 ... 2 1 7 5 2 ... ... ... ... ... ... ... ... ... ... 1 ... 3 1 1 1 81 IB) Arterial sclerosis 6 8 9 10 7 5 8 6 11 10 8 14 9 14 2 88(31) 23 127 56 71 ... ... ... ... ... ... ... ... ... ... 1 ... 14 3 41 68 81 (C) Other diseases of arteries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 82 (A) Cerebral embolism and thrombosis 3 ... ... ... 2 2 2 2 1 1 ... 2 2 7 ... 6 ... 24 11 13 ... ... ... ... ... ... ... ... ... 1 ... ... 2 3 9 9 82 (B) Other embolism and thrombosis ... ... ... ... ... 1 ... ... 2 ... ... ... ... 1 ... 3 1 4 2 2 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 1 83 (A.B.C.I)) Diseases of the veins (Varices Hæmorrhoids, Phlebitis, &c.) (A) Phlebitis ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... (B) Varix ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Pylephlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Varicocele ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 (A) Status lymphaticus 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 2 ... 2 ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 (B) Other diseases of the lymphatic system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 85 (A. B.C) Haemorrhage; other diseases of the circulatory system (A) Functional disease of the heart ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 (1) ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (B) Epistaxis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other diseases included under 85 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... IV.—Diseases of the Respiratorty system. 86 Diseases of the nasal fossae ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 87 (A. B.C.) Diseases of the larynx (A) l aryngismus stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Laryngitis ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... (C) Other diieases of larynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 88 Diseases of the thyroid body ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 3 ... 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... 89 & 90 (A.B.) Bronchitis (A) Bronchiectasis, Bronchial Catarrh, &c. ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2(1) ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... (B) Other bronchitis 8 6 14 9 8 7 5 3 8 14 20 12 10 4 1 34(12) ... 129 55 74 7 3 ... 1 2 ... ... ... ... ... 1 2 12 10 33 58 91 Broncho-pneumonia 7 1 6 4 3 1 5 2 4 14 12 8 3 5 ... 33 (7) 12 75 40 35 12 10 6 5 3 5 3 1 ... ... ... ... 5 2 11 12 92 (A.B.) Lobar and undefined. 1 (A) Lobar pneumonia 4 2 6 4 1 4 6 2 1 4 7 ... 3 4 ... 27 (9) 7 48 32 16 2 1 2 ... ... ... ... ... ... ... 2 1 12 7, 13 6 (B) Pneumonia (type not stated) 1 3 2 ... 1 ... 1 1 1 3 1 1 1 1 ... 3 ... 17 8 9 ... ... 1 ... ... ... ... ... ... ... 1 2 5 ... 1 7 119 TABLE IV—continued. No CAUSE. LOCALITIES. Institution & Street Deaths which could not he 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. Up-Norwood. Norbury. W. Thornton. Bensham Mar. Thornton Hth. Sth. Norwood. Woodiide. East. Addiscombe. Whitehorse Mnr Broad Green. Central. Waddon. South. 1 I M F M F M F M F M F M F M F M F 93 (A.B.) Pleurisy 1 (A) Empyema ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... 4(1) 1 3 1 2 ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... (B) Other pleurisy ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... 1 1 5 3 2 ... ... ... ... ... ... 1 ... ... ... 1 1 1 1 ... ... 94 (A.B.C.D.) Pulmonary congestion, Pulmonary apoplexy (A) Pulmonary apoplexy and infarction ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... (B) Pulmonary œdema and congestion ... ... ... 1 ... 1 ... ... ... ...3 1 ... ... ... ... 1 ... 6 4 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 2 (C) Hypostatic pneumonia 1 ... ... ... ... ... 1 ... 1 1 ... ... 1 ... ... 4 (2) ... 5 9 3 ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... (D) Collapse of lung (3 months and over) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 95 Gangrene of the lung ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 96 Asthma ... 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... 2(1) ... 4 3 1 ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... 97 Pulmonary emphysema ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 98 (A) Fibroid disease of lung 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 93 (B) Other diseases of the respiratory system ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... V.—Diseases of the Digestive System. 99 (A) Diseases of the teeth and gums ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 99 (B.C.D.) Other diseases of the mouth and annexa (B) Thrush, Aphthous Stomatitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Parotitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other diseases included under 99 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 100 (A.B.C.) Diseases of pharynx, Tonsillitis (A) Tonsillitis ... 1 2 1 ... ... ... ... ... 2 1 ... ... ... ... 5(1) 2 7 3 4 ... ... ... ... ... ... ... 1 1 1 2 1 ... ... ... 1 (B) Ludwig's angina ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (1) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other diseases of the pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 101 Diseases of oesophagus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 102 Perforating ulcer of stomach ... ... 3 1 2 1 ... 1 1 3 2 1 ... ... 1 12 (3) 1 16 10 6 ... ... ... ... ... ... ... ... ... ... ... 1 5 3 ... 2 120 103 (A) Inflammation of stomach 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 3 2 1 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 103 (B) Other diseases of the stomach 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 1 3 2 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... *104 & 105 (A B.C.D. E.F.G.H.) Diarrhœa and enteritis (A) Infective enteritis ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (13) Diarrhœa—Not returned as infective 1 ... ... ... 1 ... 2 ... ... ... 1 ... ... 1 ... 5 ... 6 2 4 1 3 1 1 ... ... ... ... ... ... ... ... ... ... ... ... (C) Enteritis—Not returned as infective ... ... ... ... ... 1 ... ... 1 2 ... ... ... 2 ... 2 ... 6 3 3 3 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 (D) Gastro-enteritis—Not returned as infective ... 1 ... ... 3 ... ... ... 1 6 1 2 1 5 ... 12(1) ... 20 10 10 10 9 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... (E) Dyspepsia, under 2 years ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (F) Colic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (G) Ulceration of intestines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (H) Duodenal ulcer ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 ... 3 ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... 106 Ankylostomiasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 107 Other intestinal parasites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 108 Appendicitis 6 1 1 ... ... 3 ... ... 2 3 ... 1 1 2 ... 26 ( 8) ... 20 7 13 ... ... ... ... 1 2 ... 2 2 4 2 2 2 2 1 ... 109 (A) Hernia 1 ... 1 1 1 ... 2 1 ... 1 ... 1 ... 1 ... 9 (1) ... 10 7 3 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 5 3 109 (B) Intestinal obstruction ... ... 1 ... ... ... 1 1 2 ... ... ... ... ... ... 8(2) ... 8 5 3 2 ... ... ... ... ... 1 ... ... ... ... ... 1 1 1 2 110 Other diseases of the intestines ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 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) ... ... ... 1 ... ... 1 ... 1 ... 2 1 ... 3 ... 4 (1) ... 12 6 6 ... ... ... ... ... ... ... ... ... ... 1 2 3 3 3 (B) Cirrhosis of the liver (returned as alcoholic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Diseases formerly classed to "Other diseases of liver and gall bladder" ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 114 Biliary calculi 1 ... ... ... ... ... 1 ... 1 ... ... 1 ... ... ... 4 (2) ... 4 3 1 ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... 1 115 Other diseases of the liver ... 1 1 1 ... 1 1 ... 2 ... 1 1 ... 7 (2) ... 10 7 3 ... ... ... ... ... ... ... ... ... ... 1 1 2 1 4 1 116 (A. B.) Diseases of the spleen (A) Infarction of spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases of the spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 117 Peritonitis (cause unstated) ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 4(4) ... 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 118 (A. B.) Other diseases of the digestive system (A) Abdominal abscess, Sub-phrenic abscess ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases included under 118 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 121 TABLE IV.—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. Up. Norwood. Norbury. W. Thornton. Bensham Mnr. Thornton Hth. Sth. Norwood. Woodside. East. Addiscombe. Whitehorse Mnr. Broad Green. Central. Waddon. South. M F M F F M F M F M F M F M F VI.—Non- Venereal Diseases of the Genitourinary System and Annexa. 119 Acute nephritis ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 3(1) ... 2 2 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 120 (A.B.) Bright's disease (A) Bright's disease as in 1901 list 3 2 4 1 4 3 3 2 2 6 10 3 4 4 ... 40(16) 7 51 23 28 ... ... ... ... ... 1 ... ... ... 2 4 3 12 13 7 9 (B) Nephritis (unqualified), 10 years and over and Uræmia 4 ... 1 1 1 1 ... ... 1 1 ... 1 1 ... ... 4 ... 12 9 3 ... ... ... ... ... ... ... ... 1 ... ... 5 ... 4 2 121 Chyluria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 (A.B.C.D) Other diseases of the kidney and annexa (A) Abscess of kidney ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . ... ... ... ... ... ... ... ... (B) Cystic disease ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... (C) Suppression of urine ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other disease includede under 122 ... ... ... ... ... 1 ... 1 ... 1 ... ... 1 ... ... 3 ... 4 3 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 ... 123 Calculi of the urinary passages 2 . ... ... 1 ... ... ... ... 2 1 ... ... ... ... 4 ... 6 2 4 ... ... ... ... ... ... ... ... ... 1 ... 1 1 2 1 . 121 Dieases of the blader ... ... ... ... ... ... ... ... 2 1 ... 1 ... ... ... 1 ... 4 3 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 125 (A.B.) Diseases of the urethra, Urinary abscess, &c. (A) Perineal abscess ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases of urethra, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 (4) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Diseases of the prostate 1 ... ... 1 ... 1 3 1 ... 1 3 2 3 1 ... 18 (5) ... 17 17 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 ... 127 Non-venereal diseases of male genital organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 (A.B.) Uterine hæmorrhage (non-puerperal) (A) Menorrhagia ... ... ... ... ... ... ... . ... ... ... ... . ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... (B) Other uterine hæmorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 129 Uterine tumour (non-cancerous) ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 130 (A. B.) Other diseases of the uterus (A Disorder of menstruation (except merorrhagia) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B)Other diseases included under 130 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Ovarian cyst, tumour (non-cancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 132 (A.B.) Other diseases of the female genital organs (A) Diseases of ovary (excluding ovarian tumour) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases included under 132 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 133 Non-puerperal diseases of the breast (noncancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... VII. — The Puerperal State. 134 (A. B. C. D. E.) Accidents of pregnancy (A) Abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Hæmorrhage of pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Uncontrollable vomiting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (1) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Ectopic gestation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Other accidents of pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 135 Puerperal haemorrhage ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 136 Other accidents of childbirth 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 137 Puerperal fever ... ... ... 2 ... ... ... ... ... ... 1 ... 1 1 ... 4(1) ... 5 ... 5 ... ... ... ... ... ... ... ... ... 2 ... 3 ... ... ... ... 138 (A.B.C.) Puerperal albuminuria and convulsions (A) Puerperal nephritis and uraemia ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... B) Puerperal albuminuria & Bright's disease ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... C) Puerperal convulsions ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 139 (A. B.) Puerperal phlegmasia alba dolens, embolism, and sudden death (A) Puerperal phlegmasia alba dolens, phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Puerperal embolism and sudden death 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 140 Puerperal insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 141 Puerperal diseases of the breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 TABLE IV. —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. Up. Norwood. N or bury. W. Thornton. Bensham Mnr. Thornton Hth. Sth. Norwood. Woodside. East. Addiscornbe. Whitehorse Mnr Broad Green. Central. Wad don. South. VIII.—Diseases of the Skin and of the Cellular Tissue. M F M F M F M F M F M F M F M F 142 (A) Senile gangrene ... ... 1 ... 2 1 ... ... ... ... 1 ... ... ... ... 4 (1) ... 5 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 2 142 (B.C.D.) Gangrene, other types (B) Noma, Gangrene of mouth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Noma pudendi ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other gangrene ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 143 Carbuncle, Boil ... 1 ... ... ... ... 1 ... ... 1 ... 1 ... ... ... 2 ... 4 1 3 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... 144 (A.B.)Phlegmon, acute abscess (A) Phlegmon ... ... ... ... ... 1 1 ... ... 1 1 ... ... ... ... 4(1) ... ... 4 ... 1 ... 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... (IS) Acute abscess ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 145 (A. B.C. D).) Diseases of the integumentary system (A) Ulcer, Bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C ) Pemphigus ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other disease of integumentary system ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 (1) 1 2 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 146 IX. - Diseases of the Bones and of the Organs of Locomotion. Diseases of the bones ... ... 1 ... 1 ... ... ... ... ... 3 ... ... 1 ... 5 ... 6 5 1 ... ... 1 ... ... ... ... 1 1 ... ... 2 ... 1 ... 147 Diseases of the joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 148 Amputations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Other diseases of locomotor system ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 150 X. —Malformations. (A. B.C. D.) Congenital malformations (A) Congenital hydrocephalus ... ... ... ... ... ... 1 ... ... ... ... 1 1 1 ... ... ... 4 ... 4 ... 3 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... (B) Phimosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Congenital malformation of heart 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 5 3 2 2 1 ... ... ... ... 2 ... ... ... ... ... ... ... ... (D) Other congenital malformations 1 1 1 2 ... 2 1 1 ... ... ... ... 2 ... ... 8 (1) ... 11 8 3 8 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 113 151 XI.—Diseases of Early Infancy. (A) Premature birth 1 1 7 4 2 2 2 2 3 3 4 3 2 6 ... 16(5) 1 42 22 20 22 20 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 151 (B.C.D.E.) Infantile debility, Icterus & Sclerema (B) Infantile atrophy, debility and marasmus 3 ... 2 ... ... 3 ... ... 1 2 1 1 ... 3 ... 10(1) ... 16 5 11 5 9 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... (C) Icterus neonatorum ... ... ... ... 2 ... ... ... ... 1 ... ... ... ... ... ... ... 3 1 2 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Sclerema neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Want of breast milk ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 152 (A.B.C.D.) Other diseases peculiar to early infancy (A) Diseases of umbilicus, &c. 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Atelectasis ... ... ... ... ... 1 ... ... ... 1 1 ... 2 ... ... 3 ... 5 4 1 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Injuries at birth 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 3 1 2 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Cyanosis neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 153 Lack of care ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 154 XII. — Old Age. (A.B ) Old age (A) Senile dementia 3 1 ... 1 4 1 1 1 3 3 3 1 4 1 ... 29 (9) ... 27 12 16 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 15 (B) Senile decay 10 4 6 5 2 6 3 4 8 3 4 1 4 2 ... 17(6) 1 62 17 45 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 45 XIII.—Affections produced by External Causes. 155 Suicide by poison 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 2 3 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 156 Suicide by asphyxia 1 3 1 1 1 7 7 4 3 4 3 157 Suicide by hanging or strangulation ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 2 2 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 158 Suicide by drowning ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 2 2 ... 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 159 Suicide by firearms ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 160 Suicidc by cutting and piercing instruments ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... ... 2 (1) 3 3 2 1 ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... 161 Suicide by jumping from high place ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... 1 (1) 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 162 Suicide by crushing ... ... ... 1 ... ... ... 1 ... ... ... ... 1 1 ... ... 1 4 4 ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... ... ... 163 Other suicides ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 164 Poisoning by food ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 165 Other acute poisonings ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... 3(1) 3 3 2 1 ... ... ... ... ... 1 ... ... ... ... 1 ... 1 ... ... ... 166 Conflagration ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 167 Burns (conflagration excepted) ... ... ... ... 1 1 ... ... ... 1 ... ... 1 ... ... 4 5 5 2 3 1 ... ... ... ... ... ... ... ... 1 1 1 ... 1 ... ... 168 Absorption of deleterious gases (conflagration excepted) ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 169 Accidental drowning ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 2 2 2 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 170 Injury by firearms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (1) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 171 Injury by cutting or piercing instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 124 TABLE IV —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. 55 and upwards. Dp. Norwood. Norbury. W. Thornton. Bensh&m Mnr. Thornton Hth. 8th. Norwood. Woodside. East. Addiscombe. Whitehoree Mnr Broad Green. Central. Waddon. South. M F M K M F M F M F M F M F M F 172 Injury by fall 1 1 2 2 1 2 ... 1 1 3 1 4 2 1 ... 23 (6) 22 22 12 10 ... ... ... ... ... ... ... ... ... ... 3 1 4 ... 5 9 173 Injury in maine and quarries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 174 Injury bv machines ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 175 Injury by other crushing (vehicles, railways, landslides, &c.) 1 2 3 1 ... 1 2 1 3 2 2 3 ... 3 ... 24 (11) 24 24 18 6 ... ... ... ... ... 1 4 ... 2 ... 1 1 9 2 2 2 176 Injury by animals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 177 Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 178 Excessive cold ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 179 Effects of heat ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 1 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 180 Lightning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 181 Electricity (lightning excepted) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 182 Homicide by firearms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 183 Homicide bv cutting or piercing instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 184 Homicide by other means ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 185 Fractures (cause not specified) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 186 Other violence 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 2 3 3 3 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... 187 XIV. —III-Defined Causes. Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 188 (A) Syncope (aged 1year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 188 (B) Sudden death (not otherwise defined) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 189 (A) Heart failure (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (1) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 189 (B.C.D.E.) Other ill-defined causes (B) Atrophy, debility, marasmus (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Teething ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Other ill defined deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 189 (F) Cause not specified ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Totals 173 95 155 138 139 168 149 104 139 225 196 162 141 177 8 1080(312) 199 2169 1034 1135 104 81 23 16 16 25 29 26 36 40 119 119 300 251 409 575 125 TABLE V. Cases of Infectious Disease notified and Deaths from Infectious Diseases during the Year 1925. Notifiable Disease. Cases notified in whole District. Total Cases notified in each Locality. Total Cases Removed to Hospitals or Sanatoria Total Cases Treated at Home Deaths in Whole District (Home-treted cases, shown separately in bracket, but included in the total death) At all Ages At Ages—Years. Upper Norwood. Norbury. West Thornton. Bensiham Manor. Thornton Heath. South. Norwood. Woodside. East. Addisoom.be. Whitehorse Manor. Broad Green. Central. Waddon- South. Institution casea which could not be distributed At all ages Under 1 1 2 3 4 5 10 15 20 35 45 65 and upward unrecorded ages. Under 1 1 2 3 4 6 10 15 20 35 45 65 and. upward Unrecorded Agea Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera (C) Plague (P) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 104 2 5 5 9 6 35 21 3 11 4 2 .. 1 5 10 9 7 5 4 10 2 13 13 6 6 6 2 6 100 4 8 (2) .. .. .. .. 1 .. 3 (1) 2 (1) .. .. .. .. .. Erysipelas 55 1 2 .. .. .. 1 1 4 3 13 15 14 1 3 1 2 l 4 5 4 3 3 4 4 3 5 3 10 20 35 5 (2) 1(1) .. .. .. .. .. .. .. .. .. 1 3(1) .. Scarlet Fever 347 1 5 12 27 33 161 62 25 15 4 1 .. 1 22 46 22 19 34 12 37 14 15 9 11 19 8 5 74 292 55 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Group 38 1 2 .. 1 2 4 4 6 13 2 2 .. 1 6 2 .. .. 1 12 6 .. 1 .. .. 1 3 6 .. 29 9 .. .. .. .. .. .. .. .. .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Relapsing Fever 8 .. .. .. .. .. .. .. 1 7 .. .. .. .. .. .. 1 1 .. 1 .. .. .. 1 .. 1 1 .. 4 4 5 (1) .. .. .. .. .. .. 1 3(1) 1 .. .. .. Puerperal Fever ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Meningitis 22 22 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 3 1 2 .. .. 3 1 4 2 1 1 1 12 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 52 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 3 1 2 .. .. 3 3 1 1 3 1 4 48 145 (96) 25 (18) 15 (13) 8(5) 1 (1) .. 2(2) 2(1) .. 2(1) 4(3) 31 (20) 55 (32) .. Pneumonia .. .. 2 1 1 .. 3 3 2 9 9 17 4 .. 1 3 .. 2 3 8 13 7 3 3 3 1 1 3 1 4 48 1(1) .. .. 8(5) .. .. 1 (1) .. .. .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis lethargica 20 .. 1 .. .. 1 1 4 2 3 1 5 2 .. 2 3 1 1 1 3 .. 1 2 1 1 1 1 1 1 12 8 10 (3) .. 1 .. .. .. .. 1 2 1 1 2 (1) 2 (2) .. Posterior basic meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. Anterior poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 (1) .. .. .. .. .. .. 1 (1) .. .. .. .. .. .. Pulmonary Tuberculosis : Male 117 .. .. .. .. 1 4 3 10 48 21 27 3 .. 5 7 3 .. 28 16 .. 14 4 11 3 14 5 5 2 100 17 89 (54) .. 1 .. .. .. .. 1 4(3) 27 (15) 20 (13) 31(21) 5(2) .. Female 91 .. .. .. .. .. 1 5 12 37 21 9 6 .. 6 7 3 3 13 18 1 8 5 7 3 13 2 2 66 25 62 (38) .. .. 1 .. .. .. 4(3) 4(1) 23 (16) 12 (5) 13 (10) 5 (3) .. Total 208 .. .. .. .. 1 5 8 22 85 42 36 9 .. 11 14 6 3 41 34 1 22 9 18 6 27 7 7 2 166 42 151 (92) .. 1 1 .. .. .. 5(3) 8(4) 50 (31) 32 (18) 44 (31) 10 (5) .. Non-Pulmonary Tuberculosis : Male 117 2 .. 3 4 5 65 24 6 6 .. 1 1 .. 1 2 2 .. 30 10 6 9 6 11 3 26 5 4 2 26 91 18 (11) 2(2) 2(1) 2 (1) .. .. 4(3) 3(3) 1 .. 1 1 2(2) .. Female 84 1 1 4 3 4 39 17 3 4 5 2 1 .. 2 6 1 .. 20 7 3 7 2 6 3 15 2 7 3 28 56 12 (5) 1 .. 3(1) 1(1) l .. 1 (1) .. .. 3 (2) 1 1 .. Total 201 3 1 7 7 9 104 41 9 10 5 3 2 .. 3 8 3 .. 50 17 9 16 8 17 6 41 7 11 5 54 147 30 (16) 3(2) 2(1) 5 (2) l (1) l 4(3) 4 (3) 1 .. 4 (2) 2 3(2) .. Total 1055 31 18 25 45 52 314 144 74 156 80 81 31 4 53 87 47 37 140 98 80 65 57 68 42 101 40 40 100 693 362 358 (214) 30 (21) 19 (14) 15 (7) 3(2) 3 7(6) 16(9) 14 (5) 56 (33 42 (23) 80 (52) 73 (42) • 126 TABLE VI. Admissions and Discharges, Borough Hospital, Croydon, during 1925. (Patients from Croydon C. B. and Penge U.D.) Disease. Remaining at end of 1924. Admitted during 1925. Discharged during 1925. Died during 1925. Remaining at end of 1925. Scarlet Fever 34 248 257 2 23 Admitted to Hospital as Scarlet Fever and found to be other disease ... 9 9 ... ... Admitted to Hospital for observation (including contact) ... 7 7 ... ... Diphtheria 24 114 101 11 26 Admitted as Diphtheria and found to be other disease ... 10 10 ... ... Admitted for observation (including contact) ... ... ... ... ... Cerebro-Spinal Meningitis ... ... ... ... ... Admitted as Cerebro-Spinal Meningitis and found to be other disease ... 2 2 ... ... Admitted for observation (including contact) ... ... ... ... ... Enteric Fever ... 3 2 ... 1 Admitted as Enteric and found to be other diseases ... 6 6 ... ... Admitted for observation (including contact) ... ... ... ... ... Paratyphoid (B) Fever) ... 24 21 ... 3 Pulmonary Tuberculosis 14 25 22 7 10 Puerperal Fever ... 2 2 ... ... Admitted as Puerperal Fever, but found to be other disease ... 1 1 ... ... Rubella ... 4 4 ... ... Admitted as Rubella and found to be other disease ... 1 1 ... ... Erysipelas ... 6 5 ... 1 Admitted as Erysipelas and found to be other disease ... ... ... ... ... Encephalitis Lethargica ... 5 4 1 ... Admitted as Encephalitis and found to other disease ... 3 3 ... ... Other Diseases: ... 3 1 2 ... Meningitis 1 5 5 1 ... Pertussis ... 1 1 ... ... Septic Tonsilitis ... 3 3 ... ... Measles ... 10 9 ... 1 Ophthalmia Neonatorum ... 6 6 ... ... Admitted as Oph. Neon., but found to be other dieases ... 4 4 ... ... Marasmus and Enteritis 2 11 7 6 ... Cases in which no disease could be diagnosed ... 11 11 ... ... Pneumonia ... 1 1 ... ... Cellulitis ... 1 ... 1 ... Chicken Pox ... 2 2 ... ... Mumps ... 2 1 ... 1 Totals 75 530 508 31 66 TABLE VII. Tuberculosis—New cases ascertained, and deaths, during the year 1925. Age Periods. New Cases.* Deaths. Notification rate per 100 tuberculosis deaths. Non-notified tuberculosis deaths per 100 total tuberculosis deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. 0 ... ... 2 1 1 ... 2 1 75 100 1 1 ... 12 12 ... 1 4 5 250 60 5 5 1 66 40 ... ... 4 ... 2800 75 10 4 6 25 17 1 4 3 1 677 33 15 10 13 7 5 4 4 1 ... 389 45 20 19 18 4 3 12 10 ... ... 200 23 25 32 24 3 2 15 13 ... ... 218 18 35 22 24 ... 5 20 12 1 3 318 8 45 24 5 ... 2 18 9 ... ... 115 4 55 9 4 1 ... 13 4 1 1 74 21 65 and upwards 4 6 1 1 5 5 2 1 92 62 Totals 130 101 121 88 89 62 18 12 243 25 *Including all primary notifications (whether Form A or Form B), or other new cases coming to the knowledge of the Medical Officer of Health during the year. 127 128 TABLE VII (A). The work of the Tuberculosis Dispensary during the year 1925:— Diagnosis. Pulmonary. Non-Pulmonary. Totals. Adults. Children Adults. Children Adults. Children M. F. M. F. M. F. M. F. M. F. M. F, A.—New cases examined during the year (excluding contacts)— (a) Definitely tuberculous 60 48 6 10 12 8 41 29 72 56 47 39 214 (b) Doubtfully tuberculous — — — — — — — — 50 48 21 33 152 (c) Non-tuberculous — — — — — — — — 35 52 52 40 179 B.—Contacts examined during the year- fa) Definitely tuberculous — 2 1 2 1 — 26 21 1 2 27 23 53 (b) Doubtfully tuberculous — — — — — — — — 11 38 26 12 87 (c) Non-tuberculous — — — — — — — — 19 77 80 86 262 C.—Cases written off the Dispensary Register as— (a) Cured 38 42 21 22 1 5 45 23 39 47 60 45 197 (b) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) — — — — — — — — 59 137 135 128 450 D.—Number of persons on Dispensary Register on Dec. 31st— (a) Diagnosis completed 436 350 59 59 33 54 350 230 469 404 409 289 1571 (b) Diagnosis not completed — — — — — — — — 44 62 99 89 294 1. Number of persons on Dispensary Register on January 1st 2,032 2. Number of patients transferred from other areas and of "lost sight of" cases returned 27 3. Number of patients transferred to other areas and cases "lost sight of" 301 4. Died during the year 184 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded two months 216 6. Number of attendances at the Dispensary (including Contacts) 8,394 7. Number of attendances of non-pulmonary cases at Orthopædic Out-stations for treatment or supervision 36 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (a) "Light"treatment 1,464 (b) Other special forms of treatment 36 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 53 10. Number of consultations with medical practitioners— (a) At homes of applicants 13 (b) Otherwise 94 11. Number of other visits by Tuberculosis Officer to homes 276 12. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 5,730 13. Number of (a) Specimer s of sputum. etc., examined l,155 (b) X-ray examinations made in connection with Dispensary work 19 14. Number of insured persons on Dispensary Register on the 31st December 654 15. Number of insured persons under Domiciliary Treatment on the 31st December 209 16. Number of reports received during the year in respect of insured persons— (a) Form G.P.17 13 (b) Form G.P. 36 701 129 TABLE VII (B). RESIDENTIAL INSTITUTIONS FOR TUBERCULOSIS. (A) Average number of beds available for patients during the year 1925. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Total Observation. "Sanatorium " Beds. "Hospital " Beds. Disease of Bones and Joints. Other Conditions. Adult Males ... 40 8 7 1 56 Adult Females ... 26 7 3 5 41 Children under 15 ... 9 2 13 15 39 Total ... 75 17 23 21 136 (B) Return showing the extent of residential treatment during the year 1925. In Institutions on Jan. 1. Admitted during the year. Discharged during the year. Died in the Institutions. In Institutions on Dec. 31. Number of Patients. Adults. M. 58 119 103 12 62 F. 41 63 71 2 31 Children. M. 25 33 38 ... 20 F. 22 30 34 ... 18 Number of Observation Cases. Adults. M. ... ... ... ... ... F. ... 1 1 ... ... Children. M. ... ... ... ... ... F. ... ... ... ... ... Total 146 246 247 14 131 130 TABLE VII (C) The immediate results of treatment of patients and of observation of doubtful cases discharged from Residential Institutions during the year 1925: — Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Under 3 months. 3—6 months. 6—12 months. More than 12 months. Total. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Pulmonary Tuberculosis. Class T.B. minus. Quiescent 1 1 — 5 5 — 2 — — — — — 14 Improved 1 — — 1 4 — 2 — — — — — 8 No material improvement — 1 — 2 — — 1 — — — — — 4 Died in Institution — — — — — — — — — — — — — Class T. B. plus, Group 1. Quiescent 6 4 — 7 3 — 6 1 — 1 — 1 — Improved 1 — — 2 — — 2 6 1 — — — — No material improvement — — — — — — — — — — — — 2 Died in Institution — — — — — — — — — — — — — Class T.B. |plus,Group 2. Quiescent 3 2 — 10 3 1 1 4 — 1 — — 2.5 Improved 3 1 — 2 3 — 3 — — 1 — — 13 No material improvment 1 1 — 3 — — — — — — — — 5 Died in Institution — — — — — — — — — — — — — Class T.B. pius,Group 3. Quiescent 1 — — 1 1 — 1 3 — — — — 7 Improved 1 1 — 5 1 — 2 4 — — 2 2 18 No material improvement 3 1 — 10 5 — 4 2 — — — — 25 Died in Institution 6 2 — 3 1 — 1 — — 1 — — 14 Non-Pulmonary Tuberculossis. Bones and Joints. Quiescent or Arrested — 1 2 — — 1 — — — 1 — 9 14 Improved — 1 2 — 1 — — — — 1 1 — 6 No material improvement — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — Abdominal. Quiescent or Arsested 1 — 1 1 1 — — — — — — — 4 Improved — — — — — — — — — — — — — No material improvement — — 1 — — — — — — — — — 1 Died in Institution — — — — — — 1 — — — — — 1 Other Organs. Quiescent or Arrested — — — — — — — — — — — — — Improved 1 — — — 2 — — — — — — — 3 No material improvement — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — Peripheral Glands. Quiescent or Arrested 1 — 9 — 1 24 — — 18 — 1 — 54 Improved 1 — — — — — — — — — — — 1 No material improvement — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — Observation for purpose of diagnosis. Under 1 week. 1—2 weeks. 2—4 weeks. More than 4 weeks. Tuberculous — — — — — — — — — — — — — Non-tuberculous — — — — — — — 1 — — — — 1 Doubtful — — — — — — — — — — — — — 131 TABLE VII (D). PULMONARY TUBERCULOSIS. Annual return required by the Ministry of Health showing in summary form the condition of all patients whose case records are in the possession of the Dispensary at the end of 1925. arranged according to the years in which the patients first came under Public Medical Treatment for pulmonary tuberculosis, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates. (1925)- Prerious to 1926. Class T. B. minus. Class T.B. plus. (Grouped together). Group 1. Group 2. Group 3. Total (Class T.B. plus). Alive. Discharged as cured. Adults. M. 37 1 ... ... 1 F. 42 ... ... ... ... Children. M. 21 ... ... ... ... F. 22 ... ... ... ... Disease arrested. Adults. M. Hit 15 4 2 21 F. 166 10 ... 1 11 Children. M. 48 ... 1 ... 1 F. 44 ... ... ... ... Disease not arrested. Adults. M. 123 65 60 54 179 F. 53 22 41 57 120 Children. M. 7 ... 2 1 3 F. 9 1 1 4 6 Deai>. Aduits. M. Not availaole. F. Children. M. F. Lost sight ok or otherwise removed from Dispensary Register Totals 685 114 109 119 342 132 TABLE VII (E). NON-PULMONARY TUBERCULOSIS. Annual return as required by Ministry of Health showing in summary form the condition of all patients whose case records are in the possession of the Dispensary at the end of 1925, arranged according to the years in which the patients first came under Public Medical Treatment, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates. (1925). Previous to 1926. (Grouped together). Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Alive. Discharged as cured. Adults. M. 1 ... ... ... 1 F. 2 2 1 ... 5 Children. M. ... ... ... 45 45 F. 2 1 ... 20 23 Disease arrested. Adults. M. 7 1 2 2 12 F. 7 3 2 10 22 Children. M. 6 ... ... 157 163 F. 16 ... ... 105 121 Disease not arrested. Adults. M. 7 ... 9 5 21 F. 10 3 9 10 32 Children. M. 10 3 4 170 187 F. 7 3 2 97 109 Dead. Adults. M. F. Children. M. F. Transferred to Pulmonary Lost sight of or otherwise removed from Dispensary Register Totals 75 16 29 621 741 183 TABLE VIII. Work of Croydon Maternity and Child Welfare Centres and of Health Visitors, 1925. INFANTS CENTRES Foster Clinics. Municipal Centre (228, London Road). Central Croydon (Sylverdale Road). South Croydon (Bartlett Street). East Croydon (Lr. Addisc'be Rd.) Woodside (St. Luke's Hall, Spring Lane). South Norwood (Selhurst Road). Upper Norwood (St. Margaret's, Naseby Koad). Thornton Heath (St. Paul's Hall). Thornton Heath (St. Alban's Hall. Whitehorse Lane). West Croydon (Johnson Road). Norbury. TOTAL. infants under 1 year: Attendances— (a) 1. New Cases 1 229 86 100 149 101 176 51 83 202 145 76 1399 2. Old Cases 11 2523 1234 1206 1428 11207 2485 674 1156 2788 2611 1032 18355 Total 12 2752 1320 1306 1577 1308 2661 725 1239 2990 2756 1108 19754 Seen by Doctor 12 1792 704 648 996 848 1397 412 729 1675 1372 656 11241 children 1—5 yrs. of age : (b) 1. New Cases 7 87 27 37 63 33 66 25 39 78 63 37 562 2. Old Cases 72 1730 1099 1605 1226 822 3441 1626 1659 2896 2128 1034 19338 Total 79 1817 1126 1642 1289 855 3507 1651 1698 2974 2191 1071 19900 Seen by Doctor 66 1176 480 656 593 555 1417 637 798 1645 1160 421 9604 Attendance of Mothers (a) & (b) 34 4229 2269 2494 2468 2175 5304 1851 2487 5467 4375 1944 35099 expectant mothers , Attendances— (c) 1. New Cases 125 44 46 59 28 63 15 27 60 36 6 509 2. Old Cases 235 106 204 75 61 80 107 83 184 86 28 1249 Total 360 150 250 134 89 43 122 110 244 123 34 1758 Home Visits 104 199 104 150 108 105 7 778 visiting of childr'n (d) Under 12 months 1. First Visits 450 498 553 663 556 801 139 3521 2. Subsequent Visits 489 1483 704 1104 685 1811 101 6276 3. No. of Children seen 73s 1733 1039 1550 1137 2105 197 8302 (e)From l-5y'rs. of age 1. First Visits 394 56 127 240 230 43 9 1199 2. Subsequent Visits 871 1634 1159 1371 1121 2446 170 8872 3. No. of children seen 1137 1467 1039 1363 1279 2145 144 8574 (f) re Infant Deaths 37 45 16 30 28 69 4 229 (g) ,, Still births 5 6 18 11 8 33 2 83 (h) Special Visits 64 69 59 60 58 196 3 509 (i) Unsuccessful visits 238 564 915 542 433 975 159 3667 134 TABLE IX. VENEREAL DISEASES. Return relating to persons who were treated at the Croydon General Hospital Clinic, 1921, 1922, 1923, 1924 and 1925. 1925. 1924. 1923. 1922. 1921. M. F. M. F. M. F. M. F. M. F. umber of persons dealt with at or in connection with the out patient Clinic for the first time and found to be suffering from:— — — — — — — — — 2 — Syphilis 24 34 29 42 23 34 28 30 48 31 Soft Chance — — 3 — 1 — 4 — 2 1 Gonorrhœa 57 26 44 32 40 20 53 13 49 19 Not suffering from venereal disease 35 96 25 51 16 35 20 20 16 19 116 156 101 125 80 89 105 63 117 70 Of these the number of patients from Croydon was 222 121 80 88 134 Number of persons discharged from the outpatient Clinic after completion of treatment for:— Syphilis 7 4 3 9 12 14 2 4 1 1 Soft Chancre — — — — — — 1 — — — Gonorrhœa 18 2 15 4 16 8 18 6 8 2 Conditions other than Venereal — — — — 16 35 17 11 — — 25 6 18 13 44 57 38 21 9 3 umber of persons who ceased to attend the out-patient Clinic without completing treatment or after completion of treatment but before final tests as to cure, and who were suffering from: — Syphilis 19 27 17 21 29 43 35 22 21 27 Soft Chancre — — 2 — 1 — 2 — 4 1 Gonorrhœa 29 23 23 13 49 19 44 8 34 25 Conditions other than Venereal — — — — — — 3 9 — — 48 50 42 34 79 62 84 39 59 53 Total attendances of all persons at the out patient Clinic who were suffering from:— Syphilis 554 626 498 601 609 647 685 657 739 692 Soft Chancre 9 — 45 — 27 — 18 — 3 11 Gonorrhœa 2096 409 1186 284 1160 317 1683 173 1441 268 Not suffering from venereal disease 54 195 45 97 30 59 41 68 41 68 2713 1230 1774 982 1826 1023 2425 898 2224 1039 Of these the following were the attendances of Crovdon patients 2727 1735 1950 2408 2488 Aggregate number of "in-patient days of treatment given to persons suffering from:— Syphilis 211 214 — 52 — — — — 32 — Gonorrhœa — 29 — — — — — — — — 211 243 — 52 — — — — 32 — ???oydon ''in-patient" days 287 52 32 Number of persons treated with Salvarsan substitutes 122 119 92 103 78 79 42 44 59 48 Number of doses of Salvarsan substitutes given 676 516 401 382 370 ???oydon 552 268 185 190 290 Examinations of pathological material: secimens from persons attending at the Treatment Centre which were sent for examination to an independent laboratory:— For detection of spirochaetes — — — — — ,, ,, gonococci 175 136 100 139 162 ,, Wassermann reaction 274 258 187 266 250 ,, Others — — — — — 449 394 287 405 412 TABLE X. VENEREAL DISEASES.—Summary of Work done by the London Hospitals during the Year 1925 London. Middlesex. Essex. Surrey. Kent. Herts. Bucks. East Ham. West Ham. Croydon. Total. "Other Places." Grand Total New Patients - Syphilis 4,284 375 216 152 143 56 31 44 120 33 5,454 448 5,902 Soft Chancre 169 9 8 11 3 2 ... 5 5 ... 212 67 279 Gonorrhœa 8,605 677 336 294 203 82 34 86 198 35 10,550 771 11,321 Not Venereal 6,508 638 339 245 152 65 35 97 238 70 8,387 293 8,680 Total 19,566 1,699 899 702 501 205 100 232 561 138 24,603 1,579 26,182 Total Attendances 539 353 33,633 15,143 15,144 7,933 3,167 1,303 4,314 10,039 2,648 632,677 13,454 646,131 No. of In-patient days 65,902 3,342 2,819 1,471 3,349 1,589 1,155 385 1,227 96 81,335 21,119 102,454 Salvarsan Subs, doses 38,149 3,575 1,738 1,521 1,010 471 215 318 921 319 48,237 2,459 50,696 PATHOLOGICAL EXAMINATIONS For or at Centre— Spirochaetes 1,153 50 6 34 1 8 5 5 4 2 1,268 62 1,330 Gonococci 48,923 2,034 1,670 1,297 l,037 347 178 437 910 317 57,150 1,652 58,802 Wassermann 25,014 1,597 930 960 585 304 125 207 495 209 30,426 1,177 31,603 Others 11,918 572 237 801 236 90 71 32 39 114 14,110 219 14,329 Total 87,008 4,253 2,843 3,092 1,859 749 379 681 1,448 642 102,954 3,110 106,064 For Practitioners. Spirochaetes 20 2 ... 8 ... ... ... ... ... ... 30 ... 30 Gonococci 2,386 251 140 453 35 6 4 30 15 602 3,922 5 3,927 Wassermann 15,636 2,011 955 571 101 49 100 172 480 465 20,540 170 20,710 Others 1,416 47 22 132 18 7 3 1 2 2 1,650 29 1,679 Total 19,458 2,311 1,117 1,164 154 62 107 203 497 1,069 26,142 204 26,346 135 136 METEOROLOGICAL RECORD—YEAR 1925. Rain Gauge 5.in. in diameter, 1.ft. above ground, 146.ft. above sea level Temperature taken in the shade o! a Stevenson's Screen, 4.ft. from the ground. The Ground Thermometer is suspended in an iron tube, the bulb being 4.ft. below the level of the ground. Months 1925. 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 a.m. and 3 p.m. Rainfall. Highest. Lowest. Mean of No. of Days on which Kain fell. Amount collected in Inches. Difference from average 50 years at Greenwich AH Highest. All Lowest. January 54° 25° 46°.5 37°.1 41°.8 + 3°.3 43°.6 38°.6 in. — .046 18 in. 1.70 in. — 0.09 February 55° 31° 47°.1 37°.4 42°.2 + 2°.5 43°.8 38°.2 — .052 19 3.98 + 2.45 March 55° 23° 47°.3 35°.2 41°.2 — 0°.5 42°.7 35°.0 — .067 11 0.68 — 0.83 April 64° 30° 54°.8 39°.3 47°.0 — 0°.2 45°.1 41°.4 — .037 16 2.30 + 0.70 May 79° 35° 63°.6 47°.1 55°.8 + 2°.7 49°.4 48°.1 — .012 16 1.57 — 0.31 June 87° 44° 72°.5 51°.1 61°.8 + 2°.4 55°.5 51°.7 — .053 2 0.12 — 1.91 July 85° 48° 73°.2 55°.6 64°.4 + 1°.9 58°.4 56°.6 — .025 13 3.56 + 1.15 August 77° 47° 68°.0 54°.4 61°.2 — 0°.4 58°.8 56°.9 — .031 15 2.36 — 0.02 September 66° 39° 59°.9 46°.8 63°.3 — 3.9 55°.5 49°.5 — 082 22 2.45 + 0.25 October 69° 31° 58°.8 46°.6 52°.2 + 2°.2 53°.7 49°.2 — .054 15 2.69 — 0.04 November 60° 23° 45°.4 35°.4 40°.4 — 2°.8 48.5 37°.0 — .113 14 2.25 — 0.04 December 55° 24° 42°.6 34°.4 38°.5 — 1°.2 42°.3 35°.1 — .058 14 2.21 + 0.27 Means and Total* for Year. 87° 23° 56°.6 43°.2 49°.9 + 0°.5 49°.7 44°.7 — .052 175 25.87 + 1.59 I he Rainfall at Croydon was 1.83 inches above, and number of days on which rain fell was 13 above the average of 50 years at Croydon. H. W. CORDEN Croydon. 137 TABLE XII. Prevailing direction of the Wind at Croydon in 1925. Number of Days each Month. 1925. N.E. E. S.E. S S.W. W. N.W. N. January ... 4 4 5 16 2 ... ... February ... 1 2 3 16 3 3 ... March 6 ... ... 1 1 9 8 6 April 4 ... 2 3 8 10 2 1 May 1 3 2 7 14 3 1 ... June 3 5 1 2 2 6 5 6 July 4 4 5 ... 11 2 4 1 August 3 1 3 6 7 7 4 ... September ... ... 2 4 5 11 5 3 October 5 3 2 1 11 6 2 1 November 7 4 1 2 4 3 7 2 December 4 ... 1 2 7 13 3 1 Totals 37 25 25 36 102 75 44 21 62 r 61 177 65 The 10 years average 1867 to 1876, as embodied in Paper on 10 years Meteorology at Croydon, read to the Croydon Microscopical and Natural History Club, was :— N.E. and E. Winds, yearly average 93.7 S.E. and S. „ 63 7 S.W. and W. ,, „ 131.9 N.W. and N. ,, „ 73.8 H. W. CORDEN, Croydon 138 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER. For the Year Ending December 31st, 1925. GENERAL. While the following pages set out particulars of the activities of the school medical service throughout the year, I have felt it desirable to precede these particulars by a more general statement on certain aspects of the health of the school child. The Ministry of Health have requested Medical Officers of Health to see that their reports for the year 1925 give a general survey of the progress made in Public Health affairs within their district during the previous five years. I have applied the same principle in outline to the present report in the following paragraphs. H. P. NEWSHOLME, School Medical Officer. March, 1926. Development of School Medical Work, 1921—1925. Medical Supervision in School.—During the five years under review, there has been a progressive increase in the number of children examined in school, and in particular an increase in the direction of the examination of special children presented for examination by parents, or brought forward by teachers, attendance officers, or health visitors on account of suspected physical defects. The particulars are summarised in the table on page 4. The continued improvement in the supervision of children found to be suffering from physical defects is indicated by the steady increase in the number of re-examinations recorded year by year. Medical Treatment.—The increasing appreciation of the treatment provided at the various clinics established by the Education Committee is similarly shewn by the increasing attendances, until in some cases the maximum capacity of a clinic on its present basis has been reached. The work of the school clinics will be markedly 139 facilitated by the provision of the admirable clinic premises opened in Lodge Road at the beginning of 1926. In 1925 two additional forms of treatment were made available for school childrensynthetic sunlight treatment for the delicate child, and orthopaedic treatment for the cripple child. Dental Supervision and Treatment.— The development in the facilities for dental inspection and treatment has been the most striking individual feature of the past five years. The rapid increase indicated in the figures given below is but a feeble measure of the benefit which the town is now receiving, and will continue in increasing measure to receive, from this beneficent scheme, which is dealing not only with the school child, but also with the child below school age at the time when dental decay first shows itself, and with the expectant mother, whose own state of health largely determines the liability of the child to dental decay. The Abnormal Child.— During the past two years the register of physically and mentally defective children has been revised and brought up to date, with the result—a natural one, though unexpected at first sight—that the numbers on the register were materially decreased instead of increased. This was found to be the case in spite of the addition of names of fresh children brought to light through the co-operation of teachers, attendance officers, and health visitors. There must always tend to accumulate in such a register the names of children who have left the town, left school, died, or even recovered from the physical disability to an extent making it desirable to regard them as healthy rather than as defective children. The value of frequent systematic revision of such registers is thus emphasised. The "backward" classes established during recent years in an increasing number of schools have also played a most helpful part in the development of the child who is on the border line of mental defect, or who is backward only through physical defect or retarded development. In this connection it may perhaps be noted that the Occupation Centre opened in 1924 by the Mental Deficiency Committee has done much to assist the lower grade of mentally defective child with whom the Education Committee could not themselves deal. Supervision of Personal Cleanliness.— The table given below shows the steady extension in the surveys of school children made by health visitors for the purpose of detecting uncleanly conditions. It is reassuring to note the corresponding steady decrease in the prevalence of verminous conditions resulting from the co-operation between teachers, parents, health visitors and the children themselves. 340 The particulars referred to in the preceding paragraphs are set out in the following table:— 1921 1922 1923 1924 1925 Number of children medically examined:— Elementary Schools. Routine Cases 8080 7892 7090 7186 8171 Special Cases 1465 672 1132 3610 2345 Re-examinations 300 1497 3133 5997 6770 Secondary Schools. Routine Cases 423 469 933 909 974 Re-examinations 6 188 145 260 180 Number of children treated at:— Minor Ailments Clinic *1024 452 469 657 666 Eye Clinic: Refraction test 574 420 666 594 625 Spectacles obtained Thrtat Clinic 307 221 169 out of 479 prescribed 193 453 out of 507 prescribed 252 477 out of 499 prescribed 197 Dental Children inspected 2892 2831 4580 4955 6727 Children treated 1210 984 1611 1883 3357 Uncleanliness surveys—children seen 16,817 19,468 27,733 47,033 48,465 °/0 Verminous 13.2% 11.5% 12.1% 9.5% 8.0% Register of abnormal children: Mentally deficient of school age 112 134 122 119 101 Blind 21 12 14 11 15 Deaf 15 9 9 12 11 Epileptic 68 71 46 23 26 Pulmonary (with gland) Tuberculosis 313 112 98 113 Non-pulmonary Tuberculosis 564 18 16 33 Delicate (suitable for open-air school) 353 185 188 Crippled 133 129 140 112 130 * Including Inspection Clinic Attendances. 141 Changes in Physical Fitness Resulting From School Medical Work. An analysis of the prevalence of various types of physical defects during the five years in question was found to be of little value, partly because of the shortness of the period, but chiefly because of the unavoidable differences in the personal equation resulting from changes in medical staff. It is in general not possible to put forward definite statistical proof of a diminution in the prevalence of various physical defects as a result of school medcal work, though it is obvious that the cure of defects already existing and found during medical inspection can result in nothing but good, and itself prevents the subsequent occurrence of graver and more lasting disabilities. The fundamental fact to be borne in mind, in assessing the value of the preventive aspect of school medical work, is that many of the more glaring disabilities, which would chiefly appeal as suitable standards for measuring progress in prevention, have in fact developed before the child reaches school age, so that prevention, except of further growth of the defect, is impossible to the school medical service as such. The child has to be dealt with before he reaches school. Herein lies the importance of the step taken in 1924 by the Education Committee, in conjunction with the Public Health Committee, in co-ordinating the work of the School Nurse with that of the Infant and Child Health Visitor, so that now each Health Visitor, as well as each Medical Officer, is concerned in the supervision of the health of the child from infancy onward, without a break at the age of admission to school. It is possible, however, to use another test of improving physical fitness, viz., the heights and weights of school children. A member of the Education Committee was good enough to draw my attention to the fact that Dr. Meredith Richards, in his report for 1905 as School Medical Officer, set out the " median " heights and weights of groups of children attending the Oval Road and the Princess Road Schools, the latter receiving some of the poorest children in the borough, and the former school dealing with a more middle-class type of child. I have compared these records below with those similarly ascertained for the same schools for 1924 and 1925 separately. The type of child admitted to these schools does not appear to have changed materially in the interval. Allowing for the unavoidable errors and variations inherent in small numbers, the figures show a clear general increase both in height and in weight, among both boys and girls, in these two schools when the present records are compared with those of twenty years ago. No doubt a large number of factors are concerned in this improvement; but the school medical service—associating with this the work of teachers, attendance officers and others—with its steady education of the individual parent in matters promoting the health of the school child, can fairly claim a place of honour among the agencies instrumental in the change. 142 BOYS. OVAL ROAD SCHOOLS. PRINCESS ROAD SCHOOLS. 1905 1924 1925 1905 1924 1925 A.—HEIGHTS* Age (years) No, exd. Median height (ins.) No. exd. Median height (ins.) No. exd. Median height (ins). No. exd. Median height (ins.) No. exd. Median height (ins.) No. exd. Median height (ins.) 4 ... ... ... ... ... ... 29 38.0 13 39.5 ... ... 5 39 410 31 42.5 41 42.9 15 40.5 32 41.0 27 40.1 7 ... ... ... ... ... ... 24 44.2 ... ... 15 45.6 8 49 48.5 10 (insufft.) 21 47.6 31 46.0 53 47.2 23 46.4 11 55 54.5 ... ... 21 55.9 23 51.0 ... ... 35 53.5 12 70 55.0 55 56.6 14 56.3 10 53.5 75 54.2 18 54.3 B—WEIGHTS* Age (years) No. exd. Median weight (lbs.) No. exd. Median weight (lbs.) No. exd. Median weight (lbs.) No. exd. M edian weight (lbs.) No. exd. Median weight (lbs.) No. exd. Median weigh (lbs.) 4 ... ... ... ... ... ... 29 357 13 34.0 8 (insufft.) 5 39 40.0 31 40.5 41 41.5 15 38.0 32 38.0 27 38.5 6 ... ... ... ... ... ... 29 42.0 ... ... 12 43.0 7 ... ... ... ... ... ... 24 46.5 ... ... 16 50.7 8 49 52.5 10 53.0 21 52.9 31 52.0 53 50.7 22 51.8 11 55 69.0 ... ... 21 75.0 23 65.0 ... ... 26 68.3 12 GIRLS 70 717 55 77.6 14 75.0 30 71.5 75 70.7 26 70.6 A.—HEIGHTS* Age (years) No. exd. Median height (ins.) No. exd. Median height (ins.) No. exd. Median height (ins.) No. exd. Median heighr (ins.) No. exd. Median height (ins.) No. exd. Median height (ins.) 4 ... ... ... ... ... ... 16 37.5 27 39.5 9 (insufft.) 6 41 41.0 26 42.0 30 431 29 40.0 44 41.0 18 40.9 7 54 45.7 ... ... 13 45.6 28 44.0 ... ... 20 46.0 8 52 46.7 ... ... 10 47 6 26 46 2 41 47.2 21 47 6 9 ... ... ... ... ... ... 33 48.0 ... ... 12 47.6 11 57 53.0 ... ... 14 56.7 20 52.9 ... ... 17 54.3 12 52 54.0 51 56.7 23 57.1 20 54.0 40 55.5 22 57.1 B.—WEIGHTS* Age (years) No. exd. Median weight (lbs.) No. exd. Median weight (lbs.) No. exd. Median weight (lbs.) No. exd. Median weight (lbs.) No. exd. Median weight (lbs.) No. exd. Median weight (lbs.) 4 ... ... ... ... ... ... 16 32.9 27 35.0 8 (insufft. 5 41 38.5 26 40.0 31 43.0 19 37.2 44 37.2 18 40.8 7 ... ... ... ... ... ... 28 44.2 ... ... 19 48.5 8 52 49.5 ... ... 20 52.9 26 48.2 41 50.7 24 48.5 11 57 65.5 ... ... 14 72.8 20 63.0 ... ... 15 66.1 12 52 71.2 51 77.5 21 75.0 20 63.0 40 71.0 23 77.2 *Median: Each series is arranged in order of magnitude, and the middle member of the group tabulated as the median average. 143 Special Factors Bearing on the Well-being of the School Child. The immediate purpose, so far as the school medical service is concerned, of work for the physical welfare of the children is clearly to render them as fit as possible to benefit by the education preferred to them by the Education Authority. It is therefore not out of place to refer to certain aspects of the question over which the Committee may not have direct control, but in which nevertheless they have a vital interest: — 1.—Many of the physical defects found during school medical inspection are already present when the child begins to attend school. They have developed in the years before the Education Authority can exercise any direct influence—during the years in which to a steadily increasing extent the Public Health Authority is exerting its influence through its Maternity and Child Welfare schemes. It is clear that the Education Committee is very directly concerned in the sound development of infant and child welfare work, which has as its ideal the development of a physically healthy child, by advice tending towards the prevention of ill-health and by removal of factors injurious to health, such assistance necessarily commencing even before the birth of the child if it is to be fully effective. 2.—Education in school is hampered, not merely by the child's physical defects, but also to a far greater degree by the child's mental disabilities, arising out of its faulty upbringing in infancy and in early childhood. I refer, not to gross defects in mental capacity, but to faults in character, lack of concentration, a faulty view of discipline or of freedom, habits of thought which tinge the child's whole attitude towards and capacity for education. These defects, again, are usually present in the child when he first reaches school. They have arisen through faults in training during the early years of life. Such faults in training have largely arisen through the ignorance of parents of the part which they should play in the child's development. The Education Authority, which is so directly concerned in the results, is powerless directly to interfere, though it can do much through its training of the older boys and girls; and here again the the only public body directly capable of taking part in the problem is the Public Health Authority, which has the chance, again through its Maternity and Child Welfare work, of coming into touch with parents at the very time when they are experiencing difficulties and recognising their own lack of knowledge in regard to the all-round development of their children. Child psychology, the study of the development of the 144 child's mind, has made great strides in recent years, making what was once an abstruse science readily explicable in simple terms even to the uneducated parent if the latter is receptive. There are growing indications that within the next few years maternity and child welfare work will become increasingly concerned with the mental as well as with the physical development of the child, and through its contact both with mothers and with fathers will be able to give organised and systematic help to parents in teaching them the course of normal mental as well as normal physical growth of their children. Knowledge of the normal is one of the surest safeguards against the development of the abnormal. In all such developments the education authority must be most directly interested. 3.—The conditions referred to above are primarily conditions arising before admission to school. There are, however, conditions arising during school life, militating against healthy physical and mental development, with all of which the education authority is directly concerned, and some of which it can control. Of conditions bearing on the physical health of the school child I need only refer to (a) The need for establishing in every school-room conditions of ventilation as closely approximating to those of the open air as possible. In existing schools a large proportion of the teachers recognise the importance of this factor, and do their best to render it effective. It is to be hoped that new schools as they are provided will be of a type allowing truly open-air conditions, and capable of adjustment to meet extremes of weather. Beyond this, an increase in the number of playground classes during the summer months is greatly to be desired; while still more urgently necessary is the provision of an open-air school for those delicate children who do not flourish in the ordinary school, but who are capable of flourishing there after a period of recuperation with education under completely open-air conditions. (b) Among older children, during the years of rapid growth, spinal curvature is a not infrequent condition. While this is not solely due to the use of desks of antique type, or to the use of desks too small in pattern, seeing that the faulty posture is much more a product of ineffective control and supervision at home than at school, there is no doubt that the modern type of desk tends to assist the child in preventing the grosser degree of deformity. It is therefore desirable that the replacement of the older type of desks which the Committee has been proceeding with for some years past should be continued at the greatest possible speed. 145 (c) Regular daily physical training is a material factor in preventing deformities such as that noted in the previous paragraph, as well as other defects. In this connection it is to be noted that there are a considerable number of school departments —although a minority of the whole—in which there is no provision for a short daily period of physical exercises. While this can never replace organised games, the latter in their turn do not fully make up for the lack of daily exercises. In regard to conditions arising during school life affecting the mental health of the school child, I wish to refer in particular to two: — (a) Insufficient Sleep.— I have no doubt that under the conditions of aggregation in the poorer homes there are a considerable number of children who are suffering from the effects of insufficient sleep. Even a slight deficiency in this respect must produce stunting of physical and of mental development, creating a sense of strain which must have far-reaching effects on the child's character. The remedy is not primarily in the hands of the Education Authority. Teachers do much, and could possibly do even more, to draw the attention of individual parents to this danger, in particular at times when it appears to be affecting their children in particular. (b) The Influence of the Cinema.—The influence of the cinema is perhaps rather a remote one to be discussed in a school medical report; yet there seems no other official channel for drawing the attention of the Education Authority to a factor which is far from trivial in the way in which it may accentuate or even negative much of the work of character-formation towards which the educational system is directed. It is important to recognise that the cinema film, by the circumstances under which it is displayed, is capable of a dual effect—on the conscious mind, and also on the subconscious mind. The effect on the child's conscious mind is generally recognised. I am anxious to emphasise the relation of the cinema to the sub-conscious mind by reason of its bearing on the child's character. All the circumstances under which an exciting film is seen—the darkness; the quiet; the sense of expectancy among a crowd intent on the same object; the concentration of the one active sense, sight, on a very bright clearly defined patch of flickering light—all favour an actual hypnotic condition, particularly in the sensitive introspective type of child, who with careful supervision may become a most useful type of future citizen. Bv hypnosis, the suggestion, or the fear, conveyed by the film, passes below the consciousness to affect the sub-conscious stratum of the 146 mind. It is this action on the sub-conscious mind to which 1 wish particularly to draw attention, seeing that whenever the message of the cinema film has reached the sub-conscious level, it cannot be rooted out by the conscious mind, but remains in the substratum of the mind without the knowledge of the individual, either possibly as an incentive to great deeds or—and much more probably with the type of film commonly shewn—as a core of evil, influencing the character by some particular element of fear, or apprehension, or crime, or vice, or by a wrong perspective of questions of sex, or of social relations in various groups of the community. Such a core of evil, lying at the roots of the character, is a veritable foreign body introduced into the mind. It has either to be walled in and sealed off, during which the mental development may be retarded, irregular and unbalanced, and the mental condition strained, owing to a portion of the mental activities being engaged constantly in holding down and crushing the intrusive element; or, if the effort at walling in is not successful, the whole mental life may be warped, giving rise perhaps to individuals varying from one with unbalanced appetites or with a sense of hampering inferiority up to a moral defective or conceivably to one who in later life will be admitted to a mental hospital for gross mental defect. I do not think that it would be an exaggeration to say that the intense hypnotic effect produced on the sub-conscious mind by a powerful and terrifying cinema film may be sufficient to alter entirely the type of a sensitive child's character; while its effect in a smaller degree must be of every-day occurrence. Possibly an illustration may serve to make the matter a little plainer. I have recently seen a girl of twenty years of age, who a few years ago saw, without the knowledge of her relations, a well-known film of high " artistic " merit, depicting scenes of war and desolation. This girl, up to the time of seeing the film had shewn no signs of gross mental aberration, being regarded merely rsa sensitive, introspective, self-absorbed child, backward in school, very possibly by reason of her self-absorption. From the moment of seeing the film her character, according to her relatives, was fundamentally altered. Alternating with periods of a few days during which she is as bright and cheery as she used once to be, there are prolonged periods in which she is in a state of extreme mental confusion, amounting almost to stupor, in which she is incapable even of the simplest physical actions. Presumably during these periods her mind is almost entirely engaged in trying to hold down the fearful element intruded into her sub-conscious mind by the film. This girl has now been referred for appropriate treatment, though I cannot as 147 yet say with what result. This is an extreme illustration of a case in which the mental condition in large measure succumbed to the strain; it is not difficult to imagine other cases in which, with partial victory oven the intruding element, a warped character results. I have deliberately entered into this somewhat elaborate statement of the influences of the cinema, because I feel that the present unhealthy type of film is to an appreciable extent undoing the work of parents and of education authorities in building up children with sturdy characters. Happily there are signs that a healthy type of film capable of being as beneficial as the other is harmful is being more frequently displayed. By co-operative action education authorities could do much to hasten the day when the type of film here criticised would not be allowed in any picture-theatre. STAFF. 1.—Medical. (a) Whole-time Officers. The Medical Officer of Health is also School Medical Officer, and in that capacity supervises the work of the school medical service. One Deputy and three Assistant Medical Officers each devote a portion of their time to school medical work. (b) Part-time Officers. The following part-time specialists are engaged in school medical work for the Education, Committee:—One X-rav specialist, one ophthalmic surgeon, and a rota of eight surgeons undertaking nose and throat work. 2.—Dental.—One whole-time and one part-time dental surgeon. The latter was replaced by a second whole-time dental surgeon in March, 1926—to take up duty in April—in connection with the extension of the dental scheme. 3.- Nursing.— Fourteen health visitors are each allotted a district, coinciding in area with a ward of the borough, in which they are responsible for every aspect of health visiting under the Education and the Public Health Committees. In addition to these, one health visitor attends the dental clinic, and a second undertakes work in connection with the minor ailments clinic and the throat clinic, with general supervision of the various clinics now in Lodge Road; while two of the district health visitors undertake work at the X-ray clinic and the light clinic. 148 4.—Other.— The organiser of physical training for girls in elementary schools acts as supervisor of the Remedial Exercises Clinic. A whole-time masseuse conducts the work of the Massage and Breathers' Clinics. Early in 1926 an offer of voluntary assistance at the clinic was received from a trained masseuse, and gratefully accepted. The clerical staff consists of four clerks, working under the general supervision of the chief clerk of the department. CO-ORDINATION WITH OTHER HEALTH SERVICES. (a) Infant and Child Welfare.—The school medical work is an integral part of the general public health work of the Borough. The medical officers and health visitors engaged in the work of school medical inspection are also actively engaged in the maternity and child welfare work of the town. (b) Nursery Schools.—No nursery schools have been established in the Borough by the Education Committee. (c) The Care of Debilitated Children Under School Age.— The physical condition of children under school age is watched on the one hand through the eleven Infant Welfare Centres, and on the other by visits to the homes by the health visitors working under the maternity and child welfare scheme. The Sick Nursery, containing 4 beds, provided by the Public Health Committee, for debilitated young children needing medical supervision, was replaced early in 1926 by an enlarged Sick Nursery of 12 beds, particulars as to which will be given in the general Public Health Report. Young children needing a course of treatment in a convalescent home are referred, with a medical report, to the Croydon Mothers' and Infants' Welfare Association. 71 mothers, and 132 children under live years of age were thus admitted to convalescent homes during the year. A contribution was paid to the Association by the Council during the year in connection with this work. A massage clinic is provided by the Public Health Committee for the treatment of children suffering from rickets, infantile paralysis, and general conditions of debility. 149 SCHOOL MEDICAL SERVICE IN RELATION TO THE PUBLIC ELEMENTARY SCHOOLS. (a) No. of Schools and Accommodation. In 1925 there were in Croydon : (a) 20 provided schools, including 51 departments. (b) 13 non-provided schools, including 21 departments. (c) 2 Central Schools, including 2 departments. (d) 2 Special Schools (for mentally defective and physically defective), with 2 departments. The total provision in 1925 in the borough for elementary school children thus amounted to 35 schools, with 74 departments, and 2 special schools. The number of children on the register on December 31st. 1925, was 24,074, as compared with 23,953 in 1924. (b) School Hygiene. During the course of the year systematic reports were made by medical officers on the hygienic aspects of the interior and of the precincts of each school visited by them, and matters needing attention were dealt with through the appropriate channels. MEDICAL INSPECTION. (a) The classes of children medically inspected in Croydon and the number examined in each class, 1st January, 1925, to 31st December, 1925, are as follows : — Routine Inspection. Under the Regulations of the Board of Education : Children admitted for the first time during the year : 3153 Children comprising the intermediate group 1880 Children between the ages of 12 and 14 years and other age groups 3138 Total 8171 Other routine inspections 98 150 Inspection of Selected Children. Referred for defects suspected by head teachers, attendance officers, school nurses, care committees, etc. 2345 Other cases— (i) Fitness for employment in accordance with Bye-laws regulating the employment of young persons— Examined 375 Fit 373 Unfit 2 (ii) Candidates as bursars and student teachers ... 33 (iii) Children examined under " The Employment of Children in Entertainments Rules, 1920 "— Seen — Granted — Defective Chidren re-examined 6770 (a) Routine medical inspection was conducted in all cases on the elementary school premises. (b) The Board of Education's schedule of medical inspection has been followed in its entirety. (c) The early ascertainment of crippling defects is affected through routine medical inspection at the schools; through the examination of children at a special clinic for the physically defective, held at first at 228, London Road, and since the middle of the year at the Town Hall; through information received from health visitors, school attendance officers and local voluntary associations; through child welfare centres; through the tuberculosis dispensary. To these must be added the Orthopaedic Clinic established in July, 1925, at the Croydon General Hospital, by the co-operation of the Hospital Board with the Corporation. FINDINGS OF MEDICAL INSPECTION. Details of the defects found during medical inspection are set out in Table 11A and I Ib, at the end of this report. Out of the 8,269 children examined as routine cases, 1,278, or 15.4 per cent., required treatment for conditions other than uncleanliness and dental diseases. (a) Uncleanliness. Routine medical inspection does not, for obvious reasons, afford a good measure of the prevalence of uncleanly conditions. 151 The routine cleanliness surveys made by the health visitors are a better guide to the condition attained in the various schools. The health visitors during the course of their school surveys for uncleanliness made 48,465 inspections of children, and found head vermin in 355, and nits alone in 3,538. Thus, on the basis of these inspections, 8.0 per cent, of the children seen showed evidence of infestation, as against 9.5 per cent, in 1924. (b) Malnutrition. 159 children were found during routine inspection to need treatment for malnutrition, and 110 were referred for observation. Thus, out of the 8,269 children examined as routine cases, approximately 3.2 per cent, showed evidence of malnutrition. (c) Defective Vision and External Eye Disease. 413 children, or 5.0 per cent, of those seen during routine inspection, were found to show defective eyesight requiring treatment. In addition, 42 children, seen as routine cases, were found to be suffering from squint, and 30 (0.4 per cent.) had external eye disease requiring treatment. (d) Ear Disease. 60 children, or 0.7 per cent, of those examined during routine inspection, had markedly defective hearing, and 21 (0.2 per cent.) showed evidence of a notable degree of ear disease. (e) Enlarged Tonsils and Adenoids. Of the children examined during routine inspection, 210 (2.5 per cent.) had enlarged tonsils and adenoids requiring treatment, while 763 (8.8 per cent.) were affected in slighter degree. (/) Lymphatic Glands. in 18 children, seen as routine cases, the cervical glands were enlarged to an extent needing treatment, while in 216 other cases the children were kept under observation. (g) Dental Disease. 492 children (6.0 per cent.) were referred for treatment on account of dental decay. This, of course, does not give an accurate picture of the prevalence of dental caries among school children, which is more fully depicted in the section of the report dealing with dental treatment. 152 (h) Heart and Circulation. The number of children found to be in need of treatment for organic heart disease was small (1). A considerable number (123) were found to be the subjects of heart disease, which had reached a stage of balance, and were placed under observation. 77 children, or 1.7 per cent, were referred for treatment on account of anaemia. (t) Diseases of the Lungs(non-tuberculous) were in 41 children (0.5 per cent.) found sufficiently marked to need treatment. (;') Tuberculosis. Apart from 2 cases of definite and 4 of suspected tuberculosis of the lungs, and 1 of joint tuberculosis, referred for treatment, the great majority of the cases traced were those of glandular tuberculosis. 33 cases (0.4 per cent.) were referred for treatment, and 67 (0.8 per cent.) for further observation. These were all in the first instance sent to the tuberculosis dispensary for special examination. (k) Deformities. 71 cases (or 0.9 per cent.) of spinal curvature were found during routine medical inspection and were referred for treatment, and 260 slighter cases (3.1 per cent.) were noted for further obsevation. This prevalence has in some instances been associated, in the opinion of the inspecting medical officers, with the continued use of obsolete types of school desks in individual schools, though this can obviously be only one of several contributory factors. These older desks are gradually being replaced by others of a modern type. The attendance of children with spinal curvature at the Remedial Exercises Clinic, and at the special corrective classes at four schools has no doubt proved a stimulus in the diagnosis of the condition at a comparatively early stage of its development. INFECTIOUS DISEASES. Whooping cough and chicken pox were markedly more prevalent than in 1924; mumps slightly more prevalent. The prevalence of other infectious diseases was low throughout the year. 153 The following table gives a summary of the notices sent oul from the Public Health Department to various schools in connection with cases of infectious or contagious disease :— 1st 2nd 3rd 4th Illness. Quarter. Quarter. Quarter. Quarter. Total Scarlet Fever 31 30 30 36 127 Diphtheria 9 1 7 23 40 Measles 8 132 196 602 938 ,, (German) o . s. 16 16 16 50 Mumps 23 L 435 50 157 873 Whooping Cough 185 313 83 90 671 Chicken-pox 344 352 22 85 803 Sore throat 13 4 5 11 33 Ringworm (scalp) 14 23 8 5 50 „ (body) 26 16 9 25 76 Impetigo 93 90 69 124 376 Scabies 9 8 1 5 23 Eye disease 4 4 2 5 15 Other Diseases 50 62 42 63 217 Totals 1019 1486 540 1247 4292 No schools were closed during 1925 by order of the Medical Officer of Health. Under the revised regulations issued by the Board of Education, certificates covering periods of low attendances at the undernamed schools were issued for the following dates : — TVeek Ending. School and Dept. Reason for Low Attendance. 27/2/25 Winterbourne I. Epidemic illness 23/5/25 Rectory Manor 1. Measles 30/5/25 Rectory Manor I. „ 13/6/25 Rectory Manor I. „ 10/7/25 St. Saviour's J.M. & I. „ 17/7/25 St. Saviour's J.M. & I. „ Parish Church J.G. & I. „ 24/7/25 Parish Church J.G. & I. „ Christ Church J.M. & I. „ W. Thornton I. „ St. Saviour's J.M. & I. „ 2/10/25 Sydenham J.M. & I. „ 9/10/25 Sydenham J.M. & I. „ 16/10/25 Sydenham J.M. & I. „ 14/11/25 Tavistock J.M. & I. „ 21/11/25 Tavistock J.M. & I. „ 28/11/25 Tavistock J.M. & I. „ 5/12/25 Tavistock J.M. & I. „ 12/12/25 Davidson Infants „ Davidson Infants „ 19/12/25 Davidson Infants „ 154 FOLLOWING UP. From January to June, thirteen health visitors were concerned in following up school children suffering from physical defects, with a view to their improvement or remedy. In July an additional health visitor was appointed, who commenced duty in September, so that from that month there were 14 district health visitors. Each health visitor is responsible for the work in her own ward. In the first place the health visitor helps to prepare the children for medical inspection, and ascertains from the medical officer the nature of any defects found. Immediately after each medical inspection at a school, information is sent to the parents of children requiring medical attention, and this is reinforced where advisable by visits to the home by the health visitor. The following table indicates the large amount of work done by the health visitors in connection with this part of their duties : — Visits to Elementary and Secondary Schools for medical inspection 517 Number of children prepared for medical inspection 18540 Home visits (following up) arising out of medical inspection 4601 Home visits arising out of dental inspection 1882 Other home visits (excluding those for infectious diseases) 2257 It will be seen that 8,740 visits were paid to the homes by the health visitors in the endeavour to ensure that proper treatment was provided for the remedy of physical defects. Surveys for Condition of Uncleanliness. Systematic surveys were made of all departments of all public elementary schools in the Borough throughout the year. An average of from 9 to 10 visits was paid to each school for that purpose by the health visitor, and 48,465 examinations of children carried out. In 3,893 of these, or 8.0 per cent., the children were found to show in some degree verminous conditions of the head or body. The procedure set out in the Committee's Standing Orders in respect of such conditions was adopted in these as in the corresponding cases traced by head teachers. No legal proceedings were taken during the year in connection with such cases, either under the Education Act, 1921, or under the School Attendance Bye-laws. 155 Cleansing at Borough Disinfecting Station. 4 children were cleansed at the Disinfecting Station during the year for scabies. The personal clothing and bedding underwent steam disinfection, while the child received a cleansing bath under the supervision of a health visitor. The room occupied by the child was also disinfected, and facilities given for cleansing other members of the household. MEDICAL TREATMENT. The minor ailments clinic was situated during the year at 228, London Road, in premises used also for an eye clinic, infant welfare centre, a massage clinic, and a sick nursery. In view of the termination of the lease, a scheme was approved for the erection of a two-storey brick building on vacant land at the junction of St. James* Road and Lodge Road, adjoining the maternity home, St. Mary's Hostel. These premises were opened in January, 1926. The ground floor accommodates the minor ailments clinic, inspection clinic, eye clinic, two dental clinics, infant welfare centre, ante-natal clinic, and massage clinic. The upper floor provides a sick nursery of 12 beds for ailing young children, an isolation cubicle, a ward of two beds for nursing mothers, and accommodation for staff. The provision of these premises has added notably to the facilities for effective school medical and maternity and child welfare work. (а) Minor Ailments. During the year 666 children made a total of 4,505 attendances in connection with affections of the skin, various eye and ear conditions, and other minor ailments. Ringworm.—93 cases of ringworm of the scalp received treatment; in 38 of these X-ray treatment was provided by the Committee. The treatment is given by a part-time X-ray specialist, the children attending at his surgery for the purpose. Uncleanliness.—Particulars in regard to treatment for uncleanly conditions are given in the preceding section. (б) Tonsils and Adenoids. A clinic for the operative treatment of children with enlarged tonsils and adenoids is held at the Croydon General Hospital. The operations and the administration of anesthetics are undertaken by eight local medical practitioners working in pairs, and in rota for periods of three months. The routine in connection with this clinic was set out in detail in the report for 1924. 156 During the year 197 children underwent operation at the clinic on account of enlarged tonsils or of adenoids. 170 children attended the breathers' class during the year, nearly all of whom had undergone operations for tonsils and adenoids at the throat clinic or at various London Hospitals somr two weeks before admission to the class. A marked improvement in weight, chest expansion and general physique is to be noted in nearly all cases at the end of the course of instruction. (c) Tuberculosis. All children in whom the presence of tuberculosis is suspected are referred to the tuberculosis dispensary for further examination, and for such advice, treatment or continued observation as may be appropriate. The total number of attendances at the tuberculosis dispensary by children of school age was 4,791, as compared with 4,742 in 1923. Sanatorium or hospital treatment was provided in suitable cases. In others, milk or cod liver oil was prescribed. Advice was given to parents at the dispensary by the Tuberculosis Officer, and at the homes by visits of the health visitors. (d) Vision and External Eye Diseases. The Eye Clinic was held throughout the year at 228, London Road. The clinic is held on two mornings each week, and is conducted by a part-time ophthalmic specialist, with the assistance of one of the health visitors. 615 children underwent a refraction test during the year at the eye clinic, and in 493 of these spectacles were prescribed. 423 of these obtained spectacles under the Committee's scheme during the course of the year. In addition, 10 children underwent examination at the eye clinic and received advice for other defects or diseases of the eye. The following table gives details of the defects found in children examined at the eve clinic during the year : — Errors of Refraction— Corneal nebula 6 Hypermetropia 169 Congenital cataract 6 Hypermetropic astigmatism 237 Ptosis, paralytic 1 Myopia 94 ,, congenital 2 Myopic astigmatism 98 Leucoma 1 Mixed astigmatism 84 Nystagmus, lateral 5 Emmetropia (glasses not „ rotatory 2 required) 69 Optic atrophy 2 Other Conditions— Choroido retinitis 3 Strabismus, convergent 90 Corneal ulcer 1 ,, divergent 6 Retinal detachment 1 Conjunctivitis 9 Microphthalmos 1 Blepharitis 4 Keratitis 6 . These figures cannot be compared exactly with those set out in Table IV., Group 2, in the Appendix, as in a number of instances children were suffering from multiple visual defects. Particulars as to the routine adopted at the Eye Clinic were set out in the report for 1924. (e) Ear Disease. . 157 children received treatment at the School Clinic on account of ear diseases; the great majority of these were suffering from ear discharge. These children attended daily for treatment by gentle syringing with antiseptic lotions. Chronic ear discharge is a source of serious disabilty to the child, not merely involving prolonged absence from school, but by its very nature rendering the child objectionable to others, while its association with deafness and with risks of grave disease of bone and even of meningitis make it a condition needing serious attention. In the report of 1923 reference was made to a form of electrical treatment (ionisation) adopted in some areas for particular types of the condition with a considerable degree of success, usually after a very short period of treatment. I feel that, now that the new clinic premises are in use, the time has arrived when the application of this method of treatment should be considered, in the interests both of health and of education. Dental Defects. Out of the total of 5,203 children found to need dental treatment, 3,228 actually received such treatment at the Dental Clinic, of whom 129 were re-treated during the year as a result of reexamination in school. Details as to the number of attendances, number of extractions and fillings, etc., are given in Table IV., Group 4, at the end of the report. I would draw attention to the marked change in the activity of the dental work, arising primarily from the thoroughness and enthusiasm with which Mr. Senior, the Committee's senior dental surgeon, has applied himself to the work of bringing the dental scheme into effective operation. Throughout the year dental inspection and treatment was carried out by one whole-time dental surgeon (Mr. Senior) and one part-time dental surgeon (Mr. Oddie). Early in 1926 the Committee decided to proceed to the next stage of zhe development of the dental scheme, and a second whole-time dentist was appointed —to take up duty in April—in place of Mr. Oddie. It will not be out of place to refer to the fine pioneer work done by Mr. Oddie ip developing the work of school dentistry in Croydon up to the point at which fuller service was required than could possibly be given 158 by an officer engaged also in private practice. Mr. Oddie was responsible for seeing that the initial steps in school dentistry were properly laid down, and it is due in considerable measure to his personal interest in the work, and his popularity with the children, that the work developed a solid foundation during its earlier stages. I am indebted to Mr. Senior for a report on the year's work, from which the following extracts are taken. Dental Inspection,—During the year dental inspection, reinspections, and treatment was confined to children of the agegroups 5, 6, 7 and 8 years, together with a certain number of children sent for special or urgent reasons. 6,211 children were examined in these four age-groups, and of these 75 per cent, had defective teeth, as against 82 per cent, in 1924. This reduction in the number of children requiring treatment reflects the result of treatment received by the children of 6 and 7 year groups in 1924. The report for 1924 contained an analysis of the condition of the teeth of all children examined bv Mr. Senior. A similar analysis of examinations during 1925, compared with that of 1924, shews : — All children examined. Healthy. — 4 Teeth Decayed. + 4 Teeth Decayed 1924 20.4% ... 34.5% .. 45.1% 1925 26.4% ... 36.3% 37.3% Children who received some treatment previously. 1924 44.6% ... 37.5% 17.9% 1925 57.6% ... 33.2% 9.2% Children who completed treatment previously. 1924 62.0% ... ' 35.0% 3.0% 1925 72.6% ... 26.4% 1.0% Children who neglected or refused treatment previously. 1924 0.3% ... 33.5% 66.2% 1925 — ... 43.0% 57.0% These figures demonstrate clearly the importance of children completing treatment, and they also shew the improvement in the condition of children treated previously. Dental Treatment. 4,687 children were referred for treatment from routine dental inspections, 2,712 accepted—57.8% compared with 43% during 1924. This increase in the number of parents accepting treatment is good, and would be quite satisfactory if it could be shewn that the remaining 42.2% had received treatment privately, as many of them 159 state they intend to do. As a rough test 266 children were re-examined whose parents had made the above statement, 20 were in good condition, 80 had less than four teeth decayed, 166 had four or more teeth decayed. It would appear, therefore, that in most of these refusals the unfortunate children receive no treatment whatever. Special Cases. 516 " special " cases received treatment. These comprised (a) children referred by the School Medical Officer as urgently requiring attention, (b) children who required dental treatment prior to having an operation for the removal of their tonsils and adenoids, (c) cases sent by the Tuberculous Officer. Special Forms of Treatment. 1.—A number of children sustained injuries to the teeth through falling in the school playgrounds. The injuries were mostly fractures of the front permanent teeth, and necessitated root treatment and crowning, which improved the appearance of the patient and prevented future disfigurement. This procedure has been carried out in 6 cases. 2.—Three cases of Cleft palate were examined. In two cases the parents were advised, and treatment deferred. The remaining case, a boy of twelve years, who owing to this defect has been unable to attend school, is at present under treatment. 3.—Simple regulations, to effect the straightening of individual teeth, have been carried out by means of ligature-wire and inclined planes. The total number of such cases was 14. Compared with the previous year, the total number of treatments given, shews an increase over and above the increase in the number of treatment sessions : — There was also a marked increase in the number of gas cases and " other operations." Number of New Cases per session ... ,, Attendances „ Fillings ,, Extractions ,, 1924. 4.1 10.4 6.8 10.8 1925. 7.7 11.9 7.6 11.8 For details of the school dental work done during the year, reference should be made to Table IV. in the appendix. 160 Preventive and Educative Measures— The talks to parents after school inspections, and at the chair side, have been continued as in 1924. In addition, tooth brushes have been supplied (at cost price) both at the dental clinic and at M. and C.W. Centres. In " The Health of the School Child, 1924," the Chief Medical Officer stresses the very great value of preventive work, and suggests that school dental officers should devote part of their time to talks in school to the scholars and the teachers dealing with oral hygiene. One knows from past experience that this is of value, especially if the children write essays on the subject of the talks. I would suggest that this might be fitted into our scheme as opportunity arises. Maternity and Child Welfare Dental Scheme. The past year has seen the development of this scheme which was initiated late in 1924. The volume of cases has been at times so much out of proportion to the time allotted to this work, that there had to be a waiting list. Treatment clinics therefore were held during school holidays enabling cases to be treated. With the appointment of another full-time dental surgeon, the needs of this scheme will be more fully met. Details of treatment and the provision of de follows : — ntures are as Maternity and Child Welfare Dental Scheme. Mothers. Young Children. Number of cases examined at Centres ... 193 221 ,, ,, requiring treatment ... 161 101 ,, ,, referred from M.O.'s ... 71 76 ,, „ treated ./ 202 130 Attendances made at clinic ... ... 562 205 Gas Cases ... ... ... ••• 100 88 Extractions ... ... ... ••• 708 106 Fillings ... ... ... 95 201 Dressings 93 34 Dentures supplied ... 53 Repairs ... ' Sessions devoted to inspections 20 ,, ,, treatment 75 Treatment of Adult Tuberculous Patients. Owing to the fact that most of the patients under this scheme are entitled to some form of dental benefit under National Health Insurance, the number treated has not been very great. Most of the patients who were treated were unable to attend on Saturday mornings (the only available session) and had to be treated at the 161 conclusion of school sessions, therefore the number of sessions shewn as having been wholly devoted to this scheme, appears very small. A number of cases were treated at the Borough Hospital and at Larchfield Sanatorium, and it is proposed in the present year to extend this to the Cheam Sanatorium. 1 Dental Clinic—Tuberculous Patients : Number of cases referred for examination 47 ,, „ treated 41 ,, treatment sessions 5 ,, attendances 65 Administrations of general anaesthetics 4 Extractions 104 Fillings 30 Scalings 7 Dressings 16 Denture Dressings 7 Dentures supplied 2 2 Borough Hospital, Waddon—Tuberculous Patients : Number of visits 15 ,, cases—new 10 „ —okl 7 — 17 Administrations of nitrous oxide 2 Extractions 10 Fillings 6 Dressings 15 ,, (Denture) 5 Dentures supplied 4 3 Larchfield—Tuberculous Patients : Number of visits 1 ,, cases 2 Administrations of nitrous oxide 2 Extractions 10 Dentures supplied 1 Repair to denture 1 Crippling Defects and Orthopaedics. Three clinics dealing with various types of crippling defects are conducted in a room allotted for the purpose at Welcome Hall, Scarbrook Hill :— (a) Spinal Remedial Class, in which children with various degrees of spinal curvature receive corrective exercises and treatment at the hands of Miss Appleton, the organiser of physical training, under the general supervision of a medical officer who attends at regular intervals to ascertain the progress made in each 162 case. The class is held on four afternoons in each week. The following particulars refer to the work done at the clinic : — No. of children treated during the year 70 No. discharged as not requiring further treatment 25 No. discharged owing to irregular attendance 3 No. discharged, inadvisable to continue 3 No. discharged, left district or transferred to other clinics 2 No. discontinuing on leaving school 6 No. attending clinic on December 31st, 1925 31 Total attendances during the year 1698 This clinic draws its cases in Dart from children referred from routined medical inspections in the schools, or from the school clinic, and in part from corrective exercise classes, which were conducted at the following schools : — Ecclesbourne Girls. British Girls. Tavistock Girls. Winterbourne Girls. These corrective classes are arranged by the Head Teachers, and include children picked out by the class teachers on account of round shoulders, flat chest, curved backs, mouth-breathing, flat feet, etc. The children are seen and suitable cases approved for the class by the medical officers, who inspect them in association with the organiser of physical training. The class is held for twenty minutes daily. The more intractable cases are drafted from time to time to the central remedial exercises clinic. (b) Massage Clinic.—A massage clinic is conducted at Welcome Hall by Miss Batson as masseuse, in close association with Miss Appleton's spinal remedial clinic. Children suffering from the effects of infantile paralysis, club foot, spinal curvature, and various forms of muscular atrophy and dystrophy receive a combination of massage and exercise. During the summer term many of the children on suitable days had their treatment in a screened portion of the playground at Welcome Hall, being gradually and increasingly exposed to the rays of the sun. The experiment, carried out under medical supervision, was felt to be satisfactory in its results. 163 The following details of children treated may be given :— Infantile paralysis 26 Hemiplegia 7 Other paralysis 3 Pseudohypertrophic dystrophy 1 Torticollis 4 Congenital dislocation of hip 1 Scoliosis 27 Old fractures with complications 3 Club foot 4 Flat foot 20 Rickets 8 Tubercular joints (quiescent), with wasting 7 General debility and other conditions 11 122 I have to record with the warmest appreciation the voluntary help given for a considerable part of the year by Mrs. Childs—help which has been invaluable to Miss Batson in carrying on the work of the clinic. The Committee also gratefully accepted the voluntary services proferred early in January, 1926, by Miss Voss, a trained masseuse, in connection with this clinic; and her assistance is proving of the greatest advantage to the clinic. (c) Breathing Class.—A breathing class is also held by Miss Batson in the same room as the above-named clinics, 170 children attending during the year. The class has a very important place in establishing the habit of healthy breathing required to confirm the immediate benefit conferred by the operation for the removal of adenoids. (d) Other Classes.—A " flat-foot " class has been held during the year, as has also a " crawling " class, the latter attended bv children with comparatively slight degrees of spinal curvature. Arrangements were made during the year for a regular course of massage and remedial exercises to be given at the School for Physically Defective Children opened early in the year in Winterbourne Road. Orthopaedic Scheme.—It is satisfactory to be able to report that the Orthopaedic Scheme referred to in my last report was approved by the Council and came into operation during the year. The scheme provides for . 164 (a) An Orthopcedic Clinic, established at the Croydon General Hospital, attended by an experienced orthopaedic surgeon, and affording advice and treatment for school children, for children under school age under the Corporation's Maternity and Child Welfare scheme, and for tuberculous patients. (b) Hospital treatment for suitable cases at the St. Nicholas and St. Martin Orthopaedic Hospital, Pyrford. (c) Special treatment, massage, synthetic sunlight, X-rays, or remedial exercises, either through the Corporation's clinics, or at the Croydon General Hospital. OPEN-AIR EDUCATION. (а) Playground Classes. A playground class was held during the summer months at the Infants' Department of the Woodside School, some 30 children selected from those with some physical disability receiving instruction in a shed in the playground. An extension of this provision to other schools is most desirable in the interests of the health and the capacity for education of the weakly children in the school. (б) School Journeys. A large number of the Senior Departments take advantage of Article 44 of the Code to pay visits during school hours to places of educational interest. These visits are naturally restricted to places in the locality, e.g., the Aerodrome, Public Library, Whitgift Almshouses, the Old Palace, and various industrial works. (c) School Camps. A school camp was held during the summer months at Pilgrim Fort, near Caterham—an elevated site, well wooded, on gravel soil, lying on the crest of the escarpment of the North Downs, looking down over the plain of the Weald to the south. The camp is provided with a piped water supply from the East Surrey Water Company, is provided with permanent buildings which have been found readily adaptable for sleeping quarters, messroom, etc.; a fully equipped cookhouse has been provided ; also satisfactory deep trench closet accommodation of army pattern. 165 350 boys and girls from the elementary schools went to the Camp during the summer months, in batches of 20,. each batch for a week. a week. The following are the Departments which sent parties:— Boys' School. Girls' School. The Whitehorse Manor. The Ecclesbourne. „ Oval. „ Woodside. ,, Portland. ,, Oval. ,, Rectory Manor. ,, Norbury Manor. ,, Norbury Manor. ,, Croydon British. ,, Sydenham. „ Tavistock. ,, Davidson. ,, Winterbourne. ,, West Thornton. Particulars as to the type of instruction given are contained in my report for 1924. (d) Open-air Schools or Classrooms. There are at present no open-air residential or day schools, or open-air classrooms. The provision of an open-air school is greatly to be desired, and would be of the greatest benefit to a considerable group of anaemic, debilitated children who, by reason of their unsatisfactory health, cannot derive proper benefit by education in the ordinary elementary school. The great majority of these children would be completely restored to health by transfer for a period to an open-air school. It is unfortunate that, for financial reasons, the question of making such provision, which was under serious consideration during 1924, has had to fall temporarily into abeyance. PHYSICAL TRAINING. (a) Girls' and Infants' Departments. The physical training is conducted by the teachers in the schools, and is supervised by the Organiser of Physical Training, Miss Appleton, from whose report the following extracts are given: — It may be added that in 30 Departments Physical Training includes a daily lesson of 20 minutes' duration; in 6 Departments a daily lesson of 15 minutes; in 8 Departments 4 lessons a week; in 12 Departments 3 lessons a week ; and in 3 Departments varying periods per week. It is to be hoped that the daily lesson will be regarded as the standard to be aimed at by all schools. 166 Extracts from Report for 1925 of Miss May Appleton, Organiser of Physical Training, Girls' Senior Mixed, Junior Mixed and Infants' Departments. As in 1924, six sessions weekly were devoted to physical education in the schools and four sessions to the Remedial Exercises Clinic. The work has proceeded on much the same lines as in 1924 and there is little fresh to report. Many schools are still considerably hampered by the lack of suitable indoor accommodation for the physical training lessons in bad weather, and the ingenuity of the teachers has been taxed to keep the class-room lessons fresh and interesting. Several schools have now provided themselves with gramophones and the teaching of Country Dancing has been considerably helped thereby. Slowly, but surely, many of the difficulties of suitable clothing are being overcome. In the majority of senior schools children make an effort to wear gymnastic shoes, while in many schools the wearing of tunics as school uniform is becoming increasingly the practice. The provision of equipment for games and physical exercises —e.g., netballs, bran bags, balls, team bands, etc., is still a difficulty especially in the poorer schools. This year, for the first time, an Inter-Schools Games Party was held on Saturday afternoon, February 28th. Eighteen schools sent teams and the party was much enjoyed by all who took part. The games chosen were varied in type and the competitive element was emphasised as little as possible. It was felt that the meeting of the schools in this way did much to foster a joyful spirit in play. Ten schools provided a programme of national dances, including English, Irish,( Scotch, Welsh, French, Danish, Dutch, Flemish, Spanish, Serbian, and Scandinavian dances, at the League of Nations Union Fete in June. All the Girls' and Senior Mixed Departments, with the exception of St. Joseph's and Shirley, attended the swimming baths during the summer season and 577 girls learned to swim a width for the first time. The provision of 20 pairs of special floats to each bath (three-quarters of the cost of which was borne by the Education Committee) greatly facilitated the teaching of this subject, and all previous records were broken both in the number of children taught to swim and in certificates gained. In this connec- 167 tion, mention must also be made of the grant of free tickets to each school by the Baths Committee. The tickets were awarded weekly, by the teachers in charge of the swimming, to the scholars making most progress and did much to encourage the girls to make every effort to improve their swimming. It will be seen from the following details, that the increase in the number of certificates gained in 1925, as compared with 1924 is an appreciable one : — 1925. 1924. Croydon Elementary Schools Swimming Association (for swimming 30 yds.) 349 230 London Schools' Swimming Association (50 yds.) 272 198 Elementary Life Saving 71 38 Advanced Life Saving 34 30 Proficiency Certificates of Royal Life Saving Society 19 3 Bronze Medallions of Royal Life Saving Society 5 3 The utmost courtesy and consideration is afforded by the Baths Superintendents, who do all they can to assist in the working of the Swimming Timetable, but it is impossible to provide as much accommodation as is needed for all the schools who wish to attend. This lack of accommodation is especially pressing at Thornton Heath Baths, where only one afternoon is allotted to the Girls' Schools. When it is pointed out that at least five of the largest girls' schools lie in this district it will be realised that the granting of the Baths for, an additional session is most desirable. The President of the Southern Counties Amateur Swimming Association, in his report of the Girls' Life Saving Competition, at which he acted as judge, says :— " I have never seen better work anywhere. It reflects very highly indeed on those who have been engaged in teaching." I can fully endorse this opinion, and I value very highly the devoted work of the teachers both in swimming and the many other branches of physical education—games, folk dancing, camping, etc.—to which many hours of out-of-school time is devoted. The Chief Medical Officer of the Board of Education, in his annual report for 1924, states: — " The effect of physical training on life and interest outside the school is not the least of the advantages which .may be looked for. One reason for supervised, instructed and organised exercise, including ' play ' inside the curriculum, is to instil a genuine fondness for games, sports and openair pursuits which will remain with the young man or woman when school life is over and show the way to health, recreation, occupation and hobbies. 168 Much can be done by the full and proper use of the official school tables of physical exercises, but some of the other branches of Physical Education, such as organised games, swimming and camping are particularly useful in this respect." It is in this connection that I feel the various activities of the C.E.S.A.A. are so valuable, and I am glad to have the opportunity once more of expressing my appreciation of its work. Attendance at the Recreation Grounds for Organised Games' lessons was again irregular during the year owing to the unsettled weather, but the schools enjoying this privilege are unanimously of the opinion that the training is valuable. Netball continues to be the most popular out-of-school game. The Secretary of the Netball Section of the C.E.S.A.A. reports that, in 1925, twenty schools belonged to the League. The four top teams, Winterbourne, Croydon British, South Norwood and Tavistock, took part in the Annual Tournament— Winterbourne becoming the holders of the Harry Lewis Cup. Eight schools formed Junior teams and played friendly matches. The Annual Athletic Sports of the C.E.S.S.A.A. were again held at the Crystal Palace in July. The following Courses and Demonstrations for teachers were held during the year: — 1.—A short course of lessons in Folk Dances of Many Lands, for teachers in senior departments. 2.—A course of six lessons in Physical Exercises, Games and Dances for teachers in infants' schools. 3.—Four demonstrations of Physical Exercises, Games and Dances, for teachers in senior departments. These demonstrations, at which the practical work was taken with a class of children, were arranged for those teachers who are unable, for physical reasons, to take an active part in a physical training course. Visits were paid to the Women's and Girls' Gymnastic Classes in connection with the Central Polytechnic and the Evening Institutes throughout the season. The Selhurst Grammar School for Girls held an Interform Physical Training Competition at which I acted as judge. Corrective Classes, in four girls' departments, have been carried on throughout the year and good progress has been made. 169 At the request of Mr. Todd, the surgeon to the Orthopædic Clinic, corrective classes were arranged in three more Girls' departments. It is hoped that these additional classes will start work early in 1926. (h) Physical Training in Boys' Departments. For the first time I am able to include a report on the physical training in Boys' Departments, for which I am indebted to Mr. Alfred Drew, Assistant Inspector of Schools: — The Board of Education's Syllabus of Physical Training is followed in all Boys' Departments and the stipulated minimum period of sixty minutes per week is adhered to by all Boys' Schools. Ten schools have a constant allotment of 60 minutes for all classes, while 15 schools have an increased amount for certain classes up to a maximum of lhr. 40mins. In general the work in the Boys' Schools consists of Physical Exercises proper, simple relief and recreative activities interspersed among these, games capable of being played in the playground or school hall, and organised games and sports generally conducted by the teachers outside school hours. It is hoped that during the coming school year some additions may be made to the relief and recreative activities and that some simple sports events may be introduced, suitable for the school playground to meet the needs of schools where a visit to a recreation ground is not frequent owing to its inaccessibility. With regard to the very creditable work done by the teachers in outside games the past year has been most encouraging. The seventeenth Annual Sports Meeting was held at the Crystal Palace on July 1st. There were 1,230 entrants (including girls) and 71 events were competed in well up to time and without a hitch. Among the boys the highest number of points scored by any one school was 44. Comment on the Sports must not be passed over without reference to the fact that children from the Croydon Elementary Schools took part in three other Sports meetings held during the year. At the invitation of the Surbiton and District Elementary Schools Athletic Association, boys from the Croydon schools took part in Inter District Hurdles and Team Races on June 26th at Tolworth Recreation Ground, Surbiton. 170. This year has seen the formation of the Surrey Elementary Schools Athletic Association, to which the Croydon Sports Section of the C.E.S.A.A. has become affiliated. At the County Sports Meeting held on July 18th, the Croydon boys took second place with 19 points. Football is, of course, most popular among the outside activities. Unfortunately only one school has a playing field for its own exclusive use, but much good organised work is being done by the use of the recreation grounds and by the loan of club grounds. The use of the Lodge Road ground, by permission of the Education Committee, has been invaluable for inter, semi-final, and final matches of the various competitions. These competitions are as follows:— (a) A Junior League. (b) A Senior League. (c) A Junior Cup Competition. (d) A Senior Cup Competition. (e) A Charity Cup Competition. (f) A Six-a-side Tournament. In addition, a Boys' Town Team competes in the Surrey Schools Competitions, and has done remarkably well during the past four years. During the past year a Croydon Old Boys' Football Club has been formed for lads of 14 years of age and upward, who have left the Elementary School. The "A" Team of this club is doing well and has reached the semi-final of the Surrey County Youths' Cup Competition for lads under 17 on August 31st. There is a pressing need for the further provision of grounds to meet the needs of the increasing number of boys who wish to play owing to the rapid devolopment of some form of house or team system in the schools. The past season has been a record one for swimming. The following records have been set up:— (a) The highest number of children taught to swim. (b) The highest number of certificates gained (50% increase over 1924). (c) The highest number of children and departments peting. (d) A record time was made in two championship events at the Annual Swimming Gala. 171 The following Certificates have been gained in Boys' Departments during the past season: — (a) Croydon Elementary Schools Swimming tion Certificate (60 yds.) 239 (b) London Elementary Schools Swimming Association Certificate (60 yds.) 292 (c) Elementary Life Saving Certificate12 I he preliminary Competition for the Swimming Gala was held on Saturday, September 26th, and the Gala on Wednesday, September 30th. The Croydon Elementary Schools Cricket Association consists of a League of 20 Boys' Schools. There are two divisions North and South, and two final matches. The first teams in the two divisions play for the "Courlander Cup" and "Peet Trophy," the winners receiving the cup and the runners-up the trophy. The second teams in both divisions play for the "Wilson Cup," and there is a "Fender Trophy" awarded to the team receiving the highest number of votes of the competing teams for excellence in fielding. Honours caps are awarded to successful teams in InterDistrict matches, though only one Inter-District match was possible last season. PROVISION OF MEALS. The arrangements for the provision of meals have been on the same lines as in previous years. The recommendations for extra nourishment made by the School Medical Officer, Teachers, Attendance Officers and Care Committees are considered by the School Canteen Sub-Comn ittee. No. of children who received free meals 237 No. of free meals prov ded 15824 No. of children who received free milk 307 No. who received milk on part payment 129 No. who received milk on full payment 206 The meals are provided at local dining rooms, and consist of two courses—meat and a milk pudding. Milk is supplied and consumed at school, under the supervision of the class teacher. The use of a card index register at the Public Health Office avoids the duplication of milk recommendations by school medical, tuberculosis, and child welfare officers. 172 CO-OPERATION OF PARENTS. Parents are invited to attend at the routine medical inspections, and their presence is welcomed, as it gives the medical officer the opportunity of giving personal help and advice. Suggestions can thus be made both for the remedy of existing defects in the child and also for the prevention of future ill-health in directions indicated by the result of the medical inspection. During 1925 62 per cent, of the children were accompanied by parents or guardians at routine medical inspections at Elementary Schools, while 36 per cent, were accompanied in respect of inspections at Secondary Schools. CO-OPERATION OF TEACHERS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. I have again to record, with the greatest appreciation, the close and cordial co-operation which exists between teachers, school attendance officers and the public health department in making school medical work effective. The success of the work is ultimately dependent on the teacher. The latter is at the centre of school medical work, the immediate purpose of which is to fit the child for the education which the teacher is waiting to give; and teachers happily recognise its value to that end. The school attendance officers are constantly giving most ungrudging help in drawing attention to children who might otherwise escape medical supervision. The voluntary School Care Committees have continued to encourage and assist in the provision of treatment, and succeed in individual cases in obtaining consent to treatment where previous efforts had failed. The Croydon Council of Social Service has given much information and assistance in many directions in dealing with necessitous cases for whom provision could not readily be made. Close co-operation is maintained with the Inspector of the National Association for the Prevention of Cruelty to Children. BLIND, DEAF EPILEPTIC AND PHYSICALLY DEFECTIVE CHILDREN. The register of physically defective children has been revised ;i nH sr> far as Dossible brouerht up to date. From Table III., at the end of this report, it will be seen that the numbers are as follows:— Blind 15* Deaf 11* 173 Mentally defective (and still under care of Education Committee 111 Epileptic—severe grade 11 slighter grade 15 Physically defective— Infectious pulmonary and glandular tuberculosis 7 Non-infectious, but active glandular tuberculosis 106 Active non-pulmonary tuberculosis 33 Delicate (pre-tubercular, anaemia, etc.) 188 Crippled (other than tuberculosis) 130 (*i.e., blind and deaf in regard to capacity for education in an ordinary school). Table III. in the Appendix indicates the extent to which suitable educational provision has been made for these children. For the first time an entry is included of the number of children receiving education at the school for physically defective children, opened by the Committee in Winterbourne Road early in 1924. The school is doing valuable service already, and its potentialities are very great. Mentally Defective Children. It will be seen from Table III. at the end of the report that there are 111 mentally defective children of school age in the Borough known to the school medical department as capable of some degree of education in a special school. Of these, 79 were on the roll of the Grangewood Special School at the end of December, 1925. 14 new children were admitted to the school during the year, to replace 19 who left the school during the same period. . The reasons for discharge from the school were as follows:— Over school age 8 Removed from Borough 1 Allowed to leave for special reasons 9 Excluded for misbehaviour 1 19 Particulars as to the mid-day meal given to the children ate given in the report for 1924. 174 Clnic for Mentally Defective Children. 73 children were examined at the Clinic held at the Town Hall, this involving 79 examinations, with the following results:— 1.—(a) Certified as mentally defective 25 —(b) Confirmed as mentally defective 4 2.—Found to be dull and backward 32 (retarded 1—2 years, 6; retarded 2—3 years, 18; over 3 years, 8.) 3.—Found to be of normal intelligence 2 4.—Referred for re-examination 10 These cases were disposed of as follows, the reference number corresponding with the classification used above:— 1.—Mental defectives:— (a) & (b) (i) Recommended for special day school 12 (ii) Recommended for residential schools 2 (iii) Referred to local Control Authority as ineducable 5 (iv) For supervision at home 6 (v) To continue at special day school 4 2.—Dull and backward children— (a) Recommended for special class 28 (b) To continue at ordinary school 4 3.—Normal children— To continue at ordinary school 2 4.—Diagnosis deferred— (i) To be re-examined after physical treatment 10 Occupation Centre. The classes for low-grade mentally defective children and adolescents were continued throughout the year at the Occupation Centre opened at Grangewood by the Mental Deficiency Committee in 1924. The Occupation Centre deals with three groups of defectives—children of or under school age, of whom some 24 are on the register; boys over 16, of whom 4 have attended; and girls over 16, of whom 10 have attended. The younger children attend for both morning and afternoon sessions on five days a week, and receive the same mid-day meal as the children attending the special school for the mentally defective, held on the first floor of the same building; those aged over 16 attend, the girls for three and the boys for two afternoon sessions per week. Further details will be found in the appropriate section of the Public Health report. It need only be said here that the effect of the Occupation Centre on those in attendance has been most beneficial, and that it is a most valuable adjunct to the work of the Education Committee. 175 Classes for Dull and Backward Children. Special Classes for dull and backward children have been established in the following schools:— West Thornton Hoys' and Infants'. Davidson Boys'. Ecclesbourne Boys' and Girls'. Ingram Boys. Rectory Manor Boys'. Sydenham Boys'. Tavistock Girls'. Whitehorse Manor Boys' and Girls'. Winterbourne Girls' and Infants'. Woodside Girls'. South Norwood Girls'. Norbury Manor Senior Mixed. After taking a modified curriculum in these classes children are drafted into the ordinary classes of the schools, as and when they reach the required standard. PHYSICALLY DEFECTIVE CHILDREN. Early in 1925 a school for 40 physically defective children was opened on a site adjoining the Winterbourne Road Council School. The school consists of two class-rooms opening by double doors on to a playground to the south, admirably adapted for open-air classes during the summer months; a teacher's room, which is utilised also for massage and a certain amount of remedial exercises work; and a kitchen at which a two-course mid-day meal is provided on each school day. At first a certain proportion of delicate children were admitted as well as cripples, but it was later found advisable to utilise the school wholly for children suffering from crippling defects. Arrangements have been established for the provision of massage and remedial exercises at the school; and the school has been linked up, and will co-operate to a steadily increasing extent, with the Orthopasdic Scheme, the development of which was commenced in the middle of 1925. NURSERY SCHOOLS. No Nursery Schools have been established in the Borough. CENTRAL SCHOOLS. The arrangements made in September for the medical inspection at the Central Schools (John Ruskin School for Boys and Lady Edridge School for Girls) set out in last year's report have 176 continued in force throughout 1925. An annual inspection is made of all children in attendance at these schools, following thus the procedure laid down by the Board of Education in regard to Secondary Schools. SECONDARY SCHOOLS. The pupils at the Selhurst Grammar School for Boys, the Selhurst Grammar School for Girls, and the Old Palace Girls' School were medically examined during 1925. The examination of the girls was carried out by women medical officers. The arrangements as to medical inspection were set out in a previous report, and need not be repeated here. 974 pupils at secondary schools underwent routine medical inspection during the year. In addition, 180 children were reexamined for defects noted at previous visits. The results of medical inspection are set out in the tables dealing with secondary schools at the end of this report. It will be seen that 7.4 per cent, of those undergoing routine inspection were referred for treatment for defective eyesight; 0.2 per cent, for enlarged or unhealthy tonsils or adenoids; 1.0 per cent, for anæmia; and 2.5 per cent, for spinal curvature. In all 12.8 per cent, of those seen as routine cases were found to require treatment for one or more physical defects. It will be noted from the Tables that among children attending elementary schools 15.5 per cent, needed such treatment. On the other hand, only 5 per cent, of elementary school children needed treatment for defective vision, as against 7.4 per cent, in secondary schools; while the proportions with spinal curvature were also less in the former. Treatment is not provided at the Committee's clinics for children attending the secondary schools. CONTINUATION SCHOOLS. There are no continuation schools in the Borough. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. Milk and newspaper deliveries, general errands, hawking and newspaper selling are the popular forms of employment amongst 177 children and young persons under 16 years of age. 375 applicants for employment certificates were examined. In 2 instances it was necessary to refuse a certificate, on grounds of health. The children granted certificates are kept under supervision, and undergo periodic re-inspection. MISCELLANEOUS. Bursars and Student Teachers. 33 candidates who desired to become bursars and student teachers were medically examined during the year. H. P. NEWSHOLME. March, 1926. 178 Appendix C. A.—ELEMENTARY SCHOOLS. TABLE I.—Return of Medical Inspections. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 3153 Intermediates 1880 Leavers 3138 Total 8171 Number of other Routine Inspections 98 B.—Other Inspections. Number of Special Inspections 2345 Number of Re-inspections 6770 Total 9115 179 TABLE II A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1925. Defect or disease. Routine Inspections Number of defects. Special Inspections. No. of defects* Requiring treatment. Requiring to Be kept under observation but not requiring treatment Requiring treatment. Requiring to be kept under observation but not requiring treatment. (1) (2) (3) (4) (5) Malnutrition 159 110 21 3 Uncleanliness 12 277 ... 4 (See Table IV.—Group V.) Skin— Ringworm: Scalp 2 ... 2 3 Body 2 ... 4 Scabies 3 ... ... ... Impetigo 25 ... 7 1 Other diseases (non-tuberculous) 11 16 8 3 Eye— Blepharitis 23 9 7 2 Conjunctivitis 4 4 5 ... Keratitis Corneal opacities Defective vision (excluding squint) 418 98 169 5 Squint 42 12 9 1 Other conditions 23 ... 2 2 Ear— Defective hearing 60 17 21 9 Otitis media 21 9 9 2 Other ear diseases 5 1 ... ... Nose & Throat— Enlarged tonsils only 78 620 14 21 Adenoids only 40 91 12 6 Enlarged tonsils & adenoids 92 62 29 12 Other conditions 48 220 16 21 Enlarged Cervical Glands— (Non-tuberculous) 18 216 6 13 Defective Speech 18 7 8 12 Teeth —Dental Diseases 492 284 78 2 (See Table IV.—Group IV. Heart & Circulation— Heart disease: Organic 1 123 1 5 Functional 3 119 9 Anaemia 77 236 31 17 Lungs— Bronchitis 37 119 7 1 Other non-tuberculous diseases 4 12 ... 1 Tuberculosis— Pulmonary—Definite 2 ... 1 ... ,, Suspected 4 14 2 ... Non-pulmonary—Glands 33 67 11 7 ,, Spin* ,, Hip ... 1 ... ... ,, Other Bones & Joints 1 12 ... 1 Skin ... ,, Other Foims 1 ... 2 3 Nervous System- Epilepsy 3 12 3 2 Chorea 5 22 5 7 Other conditions ... 26 4 6 Deformities— Rickets ... 1 ... ... Spinal curvature 71 260 9 12 Other forms 30 32 25 ... Other Defects & Diseases 69 135 46 22 180 B.—Number of Individual Children Found at Routine Medical Inspection to Require Treatment (Excluding Unclean lines and Dental Disease). Group. Number of Children. Percentage of Children found to require treatment. Inspected. Found to require treatment. (0 (2) (3) (4) Code Groups— Entrants 3153 470 14.9 Intermediates 18s0 404 21.5 Leavers 3138 391 12.5 Total (Code Groups) 8171 1265 15.5 Other Routine Inspections 98 13 13.3 181 TABLE III. Return of all Exceptional Children in the Area. Boys. Girls. Total. BLIND (including partially blind). (i) Suitable for training in a school or class for the totally blind. Attending Certified School* or Classes for the Blind 2 4 6 Attending Public Elementary Schools ... ... ... At other Institutions ... ... ... At no School or Institution 1 2 3 (ii) Suitable for training in a school or class for the partially blinded. Attending Certified Schools or Classes for the Blind ... 3 3 Attending Public Elementary Schools ... ... ... At other Institutions ... ... ... At no School or Institution 3 ... 3 DEAF (including deaf and dumb, and partially deaf). (i) Suitable for training in a school or class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf 4 3 7 Attending Public Elementary Schools ... ... ... At other Institutions ... ... ... At no School or Institution 1 1 2 (ii) Suitable for training in a school or class for the partially deaf. Attending Certified Schools or Classes for the Deaf ... 1 1 Attending Public Elementary Schools ... 1 1 At other Institutions ... ... ... At no School or Institutions ... ... ... MENTALLY DEFECTIVE. Feebleminded (cases not notifiable to the Local Control Authority. Attending Certified Schools for Mentally Defective Children Attending Public Elementary Schools 47 3 36 3 83 6 At other Institutions 3 5 8 At no School or Institution 10 4 4 Notified to the Local Control Authority during the year. Feebleminded 2 2 4 Imbeciles 2 1 3 Idiots ... ... ... EPILEPTICS. Suffering from severe Epilepsy. Attending Certified Special Schools for Epileptics 3 ... 3 In Institutions other than Certified Special Schools ... ... ... Attending Public Elementary Schools 3 1 4 At no School or Institution 2 2 4 Suffering from Epilepsy which is not severe. Attending Public Elementary Schools 8 4 12 At no School or Institution ... 3 3 182 Table III.— Continued. Boys. Girls. Total Infectious Pulmonary and Glandular Tuberculosis At Sanatorium or Sanatorium Schools approved by the Ministry of Health or the Board 3 1 4 At other Institutions ... ... ... At no School or Institution 2 1 3 Non-Infectious but Active Pui.- monary and Glandular Tuberculosis. At Sanatorium or Sanatorium Schools approved by the Ministry of Health or the Board 5 6 11 At Certified Residential OpenAir Schools ... ... ... At Certified Day Open-Air Schools ... ... ... At Public Elementary Schools 58 31 84 At other Institutions 2 2 4 At no School or Institution 8 1 7 PHYSICALLY DEFECTIVE. Delicate Children e.g., pre- or latent tuberculosis, malnutrition, debility, anaemia etc. At Certified Residential OpenAir Schools ... ... ... At Certified Day Open Air Schools ... ... ... At Public Elementary Schools 103 68 171 At other Institutions 4 ... 4 At no School or Institution 6 ... 13 Activk NonPulmonary Tuberculosis. At Sanatorium or Hospital Schools approved by the Ministry of Health or the Board 7 8 15 At Public Elementary Schools 3 5 11 At other Institutions ... ... ... At no School or Institution 1 6 7 Crippled Children (other than those with active tuberculous disease), e.g., children suffering from paralysis, etc, and including those with severe heart disease. At Certified Hospital Schools 3 ... 3 At Certified Residential Cripple Schools ... ... ... At Certified Day Cripple Schools 22 23 45 At Public Elementary Schools 34 26 60 At other Institutions 2 1 1 At no School or Institution 4 18 19 183 TABLE IV.—Return of Defects Treated During the Year Ended 31st December, 1925. Group I.—Minor Ailments (excluding uncleanliness, for which see Group V). Disease or Defect. Number of defects treated or under treatment during the year. Under the Anthority's Scheme. Otherwise. Total. (1) (3) (31 (4) Skin— Ringworm, Scalp 93 ... 93 Body 53 ... 53 Scabies 6 ... 6 Impetigo 145 ... 145 Other skin diseases 75 ... 75 Minor Era Defects— (External and other, hut excluding cases falling in Group II) 85 6 91 Minor Ear Defects 157 16 173 Miscellaneous— (e.g Minor injuries, bruises, sores, chilblains, etc.) 52 ... 62 Total 666 22 688 Group II. — Defective Vision and Squint (excluding minor eye defects treated as minor ailments.—Group I.) Disease or Defect NUMBER OF DEFECTS DEALT WITH. Under the Anthority's Scheme. Submitted to refraction by private practitioner or at hospitals apart from the Authority s scheme. Otherwise. TOTAL. (1) (2) (3) (4) (5) Errors of refraction (including squint) 615 10 3 628 Other defect or disease of the eyes (excluding those recorded in Group 1) 10 ... ... 10 Total 625 10 3 638 184 Total number of children for whom spectacles were prescribed — (a) Under the Authority's scheme 493 (b) Otherwise 6 Total number of children who obtained or received spectacles — (a) Under the Authority's scheme 423 (b) Otherwise 54 Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS Received operative treatment. Under the Authority's scheme In clinic or hospital. By private practitioner or hospital apart from the Authority's scheme. TOTAL. Received other forms of treatment. Total number treated. (1) (2) (3) (4) (5) 197 31 228 60 288 TABLE IV. GROUP IV.—Dental Defects. (1) Number of children who were:— (a) Inspected by the dentist:— Routine age groups. Aged 5— 6 1795 „ 6— 7 2294 „ 7— 8 964 „ 8— 9 1158 „ 9—10 — „ 10—11 — Total—6211 „ 11—12 — „ 12—13 — „ 13—14 — „ 14—15 — „ 16—16 — Specials ... 616 Grand Total 6727 (b) Found to require treatment 5203 (c) Actually treated 3228 (d) Re-treated during the year as the result of periodical examination 129 (2) Half-days devoted to inspection 104 ,, „ treatment 418 522 (8) Attendance made by children for treatment 4636 (4) Fillings—Permanent teeth 529 Temporary teeth 2679 3208 (5) Extractions—-Permanent teeth 250 Temporary teeth 4513 4763 (6) Administrations of general anaesthetics for extractions 475 (7) Other operations—Permanent teeth 80 Temporary teeth 253 833 185 GROUP V.—Uncleanliness and Verminous Conditions. (1) Average number of visits per School made during the year by the Sohool Nurses (2) Total number of examinations of children in the schools by School Nurses 48465 (3) Number of children ound unclean 3893 (4) Number of children cleansed under arrangements made by the Local Education Authority (5) Number of oases in which legal proceedings were taken— (a) Under the Education Act, 1921 — (b) Under Sohool Attendance Bye-laws — SECONDARY. II.—SECONDARY SCHOOLS. TABLE I.—Return of Medical Inspections. A.—Routine Medical Inspections. 11 and under 237 12 174 188 14 184 119 16 54 17 18 18 and over — 974 B.—Other Inspections. Number of Special Inspections 2 Number of Re-inspections 180 Total 182 — 186 SECONDARY TABLE II.—A.—Return of Defects Found by Medical Inspection in the Year Ended 31st December, 1925. Defect or disease Routine Inspections. Special Inspections. Number of defects. Number of defects. Requiring treatment. Requiring to be kept under observation but not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment. (1) (2) (3) (4) (5) Malnutrition 7 7 ... ... Uncleanliness. ... ... ... ... (See Table IV.—Group V.) ... ... ... ... Skin— ... ... ... ... Ringworm ... ... ... ... Scalp ... ... ... ... Body ... ... ... ... Scabies ... ... ... ... Impetigo ... ... ... ... Other diseases (non tuberculous) 3 4 ... ... Eyf.— Blepharitis 1 2 ... ... Conjunctivitis ... ... ... ... Keratitis ... ... ... ... Corneal opacities ... ... ... ... Defective vision (excluding squint) 72 32 ... ... Squint 1 1 ... ... Other conditions ... ... ... ... Ear — Defective hearing 2 ... ... ... Otitis media 1 1 ... ... Other ear diseases ... ... ... ... Nose and Throat - ... ... ... ... Enlarged tonsils only 2 24 ... ... Adenoids only ... 4 ... ... Enlarged tonsils and adenoids ... ... ... ... Other conditions 3 12 ... ... Enlarged Cervical Glands 1 2 ... ... (Non Tuberculous ) ... ... ... ... Defective Speech ... ... ... ... Teeth—Dental Disease 39 16 ... ... (See Table IV.—Group IV). ... ... ... ... Heart and Circulation— Heart Disease — ... ... ... ... Organic ... 36 ... ... Functional ... 31 ... ... Anæmia 10 14 ... ... Lungs— ... ... ... ... Bronchitis 1 1 ... ... Other non-tuberculous diseases ... 1 ... ... Tuberculosis— ... ... ... ... Pulmonary— ... ... ... ... Definite ... ... ... ... Suspected 1 ... ... ... Respiratory—Non-pulmonary ... ... ... ... Glands ... 1 ... ... Spine ... ... ... ... Hip ... ... ... ... Other bones & joints ... 1 ... ... Skin ... ... ... ... Other forms ... ... ... ... Nervous System— ... ... ... ... Epilepsy Chorea ... 1 ... ... Other conditions ... 3 ... ... Deformities— ... ... ... ... Rickets Spinal curvature 24 63 ... ... Other forms 6 9 ... ... Other Defects and Diseases 1 23 ... 1 187 SECONDARY, B.—Number of Individual Children Found at Routine Medical Inspection to Require Treatment (Excluding Uncleanliness and Dental Disease). Group. Number of Children. Percentage of children found to require treatment. Inspected. Found to require treatment. (1) (2) (3) (4) 11 or under 237 16 6.7 12 174 24 13.8 13 188 32 17.0 14 184 32 17.4 15 119 10 8.4 16 54 9 16.7 17 18 2 11.1 18 and over 974 125 12.8 SECONDARY TABLE IV.—Return of Defects treated during the year ended 31st December, 1925. Group I.—Minor Ailments (excluding uncleanliness, for which see Group V). Disease or Defect. NUMBER OF DEFECTS TREATED, OR UNDER TREATMENT DURING THE YEAR. Under the Authority's scheme. Otherwise. Total. (1) (2) (3) (4) Skin— ... ... ... Ringworm (scalp) ... ... ... (body) ... ... ... Scabies ... ... ... Impetigo ... ... ... Other skin disease ... 2 2 Minor Eye Defects ... ... ... (External and other, but excluding cases falling in Group II) ... ... ... Minor Ear Defects— ... 1 1 Miscellaneous— (e.g. minor injuries, bruises, sores, chilblains, etc.) ... ... ... Total. ... 3 3 188 Group II.—Defective Vision and Squint (excluding minor eye defects treated as minor ailments.—Group I.) Defect or Diseases NUMBER OF DEFECTS DEALT WITH. Under Authority's Scheme. Submitted to refraction by private practitioners or at hospital apart from the Authority's seheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of refraction (including squint) 1 40 ... 41 Other defects or disease of the eyes (excluding those recorded in Group I.) ... ... ... ... Total 1 40 ... 41 Total number of children for whom spectacles were prescribed:— (a) Under the Authority's scheme 1 (b) Otherwise 31 Total number of children who obtained or received spectacles:— (a) Under the Authority's scheme 1 (b) Otherwise 31 Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received operative treatment. Received other forme of treatment. Total number treated. Under the Authority's scheme in clinic or hospital. By private practitioner or hospital apart from the Authority's schema. TOTAL. (1) (2) (3) (4) (5) 1 1 2 2 4 TABLE IV.—Group IV. No Dental Treatment provided for Secondary Schools Group V No Uncleanliness Surveys in Secondary Schools 189 190 191