C.I. AC 44132 CRO 28 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1926. I beg to submit to the Council my report on the health and sanitarv circumstances of the Borough during the year 1926. Seeing that, in accordance with the request of the Ministry of Health, a special review was made last year of the various aspects of Public Health work in the Borough, I have given a somewhat more limited survey in the following pages. The year has been one chiefly of consolidation of the extensions of work planned and put into effect by the Committee during immediately preceding years. It may be said in general that in retrospect the year can be regarded as a satisfactory one from the point of view of such consolidation. The new Clinic premises and Sick Nursery in Lodge Road, which came into use at the beginning of the year, have proved to be a ver\' real success, and their arrangements have added greatly to the possibility of orderly extension of the work in these directions. The extension of Cheam Sanatorium and the utilisation of the additional 35 beds provided there for tuberculous patients became effective late in the spring of the year, and the staffing, administration and domestic arrangements connected with the occupation of the additional beds were carried through smoothly and with no embarrassment to patients already under treatment. The genera] health of the Borough during the year was satisfactory, and there are happilv no notable outbreaks of illness to record. H. P. NEWSHOLME. Medical Officer of Health. 3 249 CONTENTS A. PUBLIC HEALTH REPORT. Page. Introductory 3 Statistical Summary 7 Section I.—Population, births, deaths, nursing facilities 8 ,, II.—Infectious diseases 14 ,, III.—Tuberculosis 22 ,, IV.—Maternity and child welfare 33 ,, V.—Mental deficiency 37 ,, VI.—Venereal diseases 41 ,, VII.— Housing and sanitary administration 42 ,, VIII.—Appendix with statistical tables 72 Page. Page. Acts, adoptive 42 Home Nursing 23 Ambulance service 19 Homework 49 Ante-natal clinic 30 Hospitals 10 Hostel, St. Mary's (maternity) 31 Housing 46 Bacteriological examination 20 Bakehouses 49 Births 7 Illegitimacy 35 Borough Hospital 16 Infant Welfare clinics, municipal 33 Bye-laws and regulations 42 ,, ,, ,, voluntary 33 Infant mortality 9 Infectious diseases 14 Clinics 10 Contacts, tuberculosis 23 Convalescent homes 35 Laboratory work 19 Cowkeepers 60 Local Acts 42 Cross-infections 18 Lodging houses, common 50 Croydon Corporation Act, 1924 42 Croydon Nursing Service 35 Massage clinic 34 Maternity home 31 Dairies, cowsheds and milkshops 60 Maternitv Homes, registration 30 Deaths 8 Measles 15 Diarrhoea, epidemic 16 Meat inspection 56 Diphtheria 14 Medical help records 31 Dispensary, tuberculosis 22 Meningitis 15 Dried milk 30 Mental deficiency 37 Medicines 23 Encephalitis lethargica 15 Midwives 31 Enteric fever 16 Milk, provision of 35 Expectant mothers 30 Milk and Cream Regulations 69 Milk, tuberculous 61 Milkshops 60 Factories & Workshops Acts 47 Mixed infections 18 Foods, inspection of 57 Mortality in child-birth 7 Foods & Drugs Acts, Sale of 65 Mothers' and Infants' Welfare Foster children 36 Association 33 Grangewood, special school 38 Notification of Births Acts 32 Nuisances 44 Health visitors, work of 32 Nursing arrangements 35 4 250 PAGE. Occupation Centre 39 Ophthalmia neonatorum 32 Outfits, maternity Poisons & Pharmacy Act 70 Population 7 Public Laboratory 21 Puerperal sepsis 32 Rag Flock Act 52 Rats & Mice (Destruction) Act 71 Return cases 15 Sanatorium, Cheam 26 Sanatoria, treatment in 24 Sanitary administration 42 Sanitary inspectors, work of 43 Scarlet fever 14 Shelters 24 Sick Nursery 33 Sickness, special causes of 14 Slaughterhouses 56 Smallpox 15 Smoke observations 52 PAGE. Sputum, examination 24 Staff 6 Statistical summary 7 Still-births 32 Tuberculosis—Care work 28 ,, contacts 23 ,, deaths 22 ,, notifications 22 ,, home nursing 23 ,, home visits 23 „ non-pulmonary 22 ,, pulmonary 22 Typhoid fever 16 Unmarried mothers 35 Venereal diseases 41 Vital statistics 8 Winds, prevailing 107 Whooping-cough 15 Workplaces 47 Workshops 47 X-ray examination 24 B.—SCHOOL MEDICAL REPORT. Accommodation 4 Adenoids 10 Blind children 28 Bursars 32 Central schools 31 Cleansing of children 10 Closure, school 8 Crippling defects 14 Deaf children 28 Defective children 6 Deformities 7 Dental disease 7 Dental treatment 13 Dull and backward children 30 Ear disease 12 Employment of children 32 Epileptic children 28 Eye clinic 11 Eye disease 6 Following up 9 Glands, enlarged 7 Grangewood, special school 30 Health visitors, work of 9 Heart disease 7 Hygiene of schools 5 Infectious diseases 8 Inspections, routine 5 Inspections, special 5 Lungs, diseases of 7 5 Malnutrition 6 Massage clinic 16 Mentally defective children 28 Minor ailments 10 Occupation Centre 29 Open-air classes 20 Parents_ attendance of 27 Physical training 21 Physically defective children 31 Playground classes 19 Re-examinations 5 Ringworm 10 School camps 20 School journeys 19 Schools, number of 4 Secondary schools 31 Skin affections 10 Special school, Grangewood 30 Staff 2 Statistical tables 33 Student teachers 32 Surveys, uncleanliness 9 Tonsils, enlarged 7 Treatment 10 Tuberculosis 7 Uncleanliness 6 Vision, defective 11 X-rays, treatment 10 251 STAFF The staff of the Public Health Department on December 31st, 1926, was as follows:— Medical Staff.— (a) Whole-time:— H. P. Newsholme, M.A., M.D., F.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 Deticiency Act. J. C. Saunders, M.B., Ch.B., B.A.O., D.P.H., Assistant Medical Officer of Health for Tuberculosis. E. 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. Constance E. Appleton, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H., Assistant Medical Officer, Maternity and Child Welfare, and School Medical Service. Olive B. Falk, M.B., B.S., Assistant -Medical Officer, Maternity and Child Welfare, and School Medical Service. 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:— Maury McDougall, M.B., C.M., Assistant Medical 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, B.A., M.B., F.R.C.S.—Ophthalmic Surgeon (School Medical Service). Rata of 8 local medical practitioners for surgical treatment of tonsils and adenoids. Dental Staff.— W. (Senior, L.D.S. J. K. R. Bryce, L.D.S. Inspectors.— ¶*§†R- J- Jackson, M.R.S.I., A.M.I.S.E., M.S.I.A., Chief Sanitary Inspector. ||§*† :F. F. Fulker, Deputy Chief Inspector ¶¶A. Low. *W. T. Hunt *J. C. Earwicker. §*A. H. Fitt *F. Riolwdson. §||/‡* :L. F. Selfe Sanitary Inspectors *C. J. Vincent. §||‡*H. E. White. §*G. G. Flint. *A. W. Gower. §*C. Whifcelev. §*V. S. Harris *F. R. Noakes. In addition, there are 5 disinfectorns, 1 rat-catcher, and 3 unqualified assistant. *Cert. Royal San. Inst. (Inspector of Nuisances). § ,, „ ,, (Meat and other Foods). ||Cert. London Exa.m. Board. ¶¶Sanitary Association of Scotland. /Sanitary Science applied to Buildings and Public Works, Royal San. Inst ‡Diploma Incorporated Institute of Hygiene. :Cert. Worshipful Company of Carpenters. ¶University of Liverpool, Meat & Food Inspector's Certificate. Health Visiting Staff— †‡¶*Edith M. Chapman, Supernumerary. §‡¶†M. Piekavance, Nurse i/c Minor Ailments Clinic. ||‡†A. E. King, Nurse i/c Dental Clinic. §†E. A. McDougall, Assistant to Medical Officer for Mental Deficiency work. †‡¶Alice May Carpenter ‡¶*§†C. Gordon. ‡¶*§†J.Thomson ||‡§†V. Cracknell §H*‡†E. M. Hobdey ‡¶†A. W. Waterman ||¶†V. Byrn ‡¶‡D. M. Huggins ||‡¶§C, A. Wilson ||‡†J. M. L. Chalk ‡||¶H. Stanley ‡¶A. Walker ||‡¶§U. Gordon. ‡¶M. Southgate 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). 6 252 Staff of Clinics — †Mav Appleton, Diploma of Chelsea College of Physical Education, Organiser and Supervisor of Physical Training (Girls) and Remedial Exercises Classes. †Winifred F. Bafson, 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). †Mrs. Connor, Organizer, Tuberculosis and Orthopaedic Care Work. †G. H. Belmore, Female Assistant to the Dental Surgeons. Croydon 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, 1926 (Registrar-General's Estimate)—205,900. Number of Inhabited Houses (1921) 41,923. Rateable value—£1,475,013 12s. 6d. (1st April, 1926). Sum represented by a penny rate—£5,630 (net) (Estimated 1926-27). 2. Extracts from Vital Statistics for the Year. Births— Males. Females. Total. Birth-rate Legitimate 1688 1641 3329 Illegitimate 76 72 148 16.9 Totals 1764 1713 3477 Deaths—2,269. Death-rate—11.0. Number of women dying in, or in consequence of, child-birth:— From Sepsis—11. From other causes—13. Deaths of infants under one year of age per 1,000 births (infant mortality)—61. Legitimate rate—56. Illegitimate rate—169. Nunber of deaths from Measles (all ages)—13. ,, ,, Whooping Cough (all ages)—9. ,, ,, Diarrhoea (under 2 years of age)—26. 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. 7 253 SECTION I.—POPULATION. The population in June, 1926, as estimated by the RegistrarGeneral, was 205,900, an increase of 6,600 on the previous year, and of 15,023 since 1921. BIRTHS. 3,477 births were registered during the year, grouped as follows in respect of sex and legitimacy (see Appendix, Table 1.): Births- Males. Females. Total. Legitimate 1688 1641 3329 Illegitimate 76 72 148 1764 . .. 1713 .. . 3477 The following table sets out a comparison between the birth rate for Croydon, for London, for the large towns, and for country as a whole during recent years:— 1924. 1925. 1926 Birth-rate, Croydon 17.6 17.1 16.9 ,, 105 large towns, including London 19.4 18.8 18.2 ,, London 18.7 18.0 17.1 ,, England & Wales 18.8 18.3 17.8 The birth-rate per 1,000 of the population was thus 16.9. The successive birth-rates in the five years 1922-6 were: 18.2; 17.4; 17.6 ; 17.1, and 16.9. Of the total Croydon births in 1926, 4.2 per cent. were illegitimate, compared with 3.8 per cent. in 1925. DEATHS 2,269 deaths of Croydon residents were registered in respect of the year 1926 (Appendix, Table 1.), giving a death-rate of 11.0 per 1,000 head of population. The corresponding rates for the five years 1922-26 were : 12.4; 10.4; 11.6; 10.9; 11.0. The following table compares the death-rate during recent years in Croydon and other areas:— 1924. 1925. 1926. Death-rate, Croydon 11.6 10.9 11.0 ,, 105 large towns, including London 12.3 12.2 11.6 ,, London 12.1 11.7 11.6 ,, England & Wales 12.2 12.2 11.6 8 254 INFANT MORTALITY. 211 deaths of Croydon infants under one year of age occurred in 1926 (Appendix, Table 1.), giving an infant mortality (number of deaths under one year of age per 1,000 births) of 61, compared with 55 in 1925. The infant mortality for the live years 1922-26 was: 64, 52, 56, 55, 61. The following gives a comparison with corresponding infant mortality rates in other areas:— 1924. 1925. 1926. Infant mortality, Croydon 56 55 61 ,, 105 large towns, including London 80 79 73 ,, London 69 67 64 ,, England & Wales 75 75 70 Infant Mortality among illegitimate children.—The infant mortality among illegitimate children in 1926 (Appendix, Table I.) was 169, in 1925, 180. The following table summarises the rates in recent years:— Illegitimate Y ear. rate. 1920 159 1921 111 1922 170 1923 253 1924 203 1925 180 1926 169 NURSING ARRANGEMENTS, CLINICS, HOSPITALS AND OTHER INSTITUTIONS AVAILABLE IN THE TOWN A.—Professional Nursing in the Home. The particulars set out in the report for 1925 hold good, and need not here be repeated. B.—Mid wives. No practising midwives are employed or subsidised bv the local authority. 72 midwives practised in the Borough in 1926. 9 255 C.—Clinics and Treatment Cantrae. Name and Situation. Nature of Accommodation By whom provided. MATERNITY & CHILD WELFARE. Central †Municipal Inft. Centre, Lodge Road, Croydon. 2-stbrey building, the ground floor for clinics, the first floor for infants' wards. Local Authority Central Croydon, Parish Hall, Sylverdale Road, Croydon . Accommodation for con sultations, weighing of babies, waiting room, etc. 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 Croydon Woodside, St. Luke's Hall, Spring Lane, Woodside. do Mother' and Upper Norwood, St. Margaret's Hall, Naseby Road, U. Norwood. do Infants' Welfare Thornton Heath, St. Alban's Hall, Whitehorse Lane, Thornton Heath. do Association south Croydon, Wesleyan Church Hall, Bartlet St., South Croydon. do. West Croydon, Strathmore Hall, Strathmore Road, Croydon. do Norbury, Wesleyan Schoolroom, London Road, Nor bury. do J (b) Ante-natal Clink †Lodge Road, Croydon. 3 rooms in Central Clinic building. Local Authority. (c) Manage Clinic †Lodge Road, Croydon. Rooms in Central Clinic building. Local Authority 10 266 Clinics and Treatment Centres (continued).- Name and Situation. Nature of Accommodation By whom provided. (d) Sick Nursery †Lodge Road, Croydon. First floor of Central Clinic building: 2 wards (12 cots) for infants, ward of 2 beds for mothers and 1 isolation cubicle. Local Authority DAY NURSERIES. ORTHOPAEDIC. NIL. Croydon General Hospital. Hospital Committee. SCHOOL CLINC8 †Re-inspection Clinic. Lodge Road, Croydon. In Central Clinic building. Local Authority. †Minor Ailments Treatment Clinic, Lodge Road, Croydon. do. do. †Eye Clinic, Lodge Road, Croydon. do. do. †Dental Clinic, Lodge Road, Croydon. do. do. Clinic for Defective Children, Town Hall, Croydon. room in Public Health Department do X-ray Clinic, 83, Park Lane, Croydon. Surgery of Dr. Critch- ley, part-time X-ray Specialist. Massage Clinic, Welcome Hall, Scarbrook Road, Croydon. - Spinal Remedial Exercises Clinic, Welcome Hall, Scarbrook Road. Croydon. One room. Local Authority Breathing Exercises Clinic, Welcome Hall, Scarbrook Road, Croydon. Tonsils and Adenoids Clinic, Croydon General Hospital. Waiting, operating and recovery room, kitchen (for use of stores) and room (in which are sinks) do Synthetic Sunlight, Croydon General Hospital. Cleansing Station, Factory Lane, Croy don 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 11 257 (D) Hospitals Provided or Subsidised by the Local Authority— (1) Tuocrculosis— Borough Sanatorium.—85 beds for the treatment of early, intermediate and advanced cases, allocated as follows, viz.:—Surrey 40, Croydon 40, Kent 5. (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— (а) Sick Nursery, upper storey of the Clinic premises in Lodge Road. Provides accommodation for twelve sick or ailing children under 5 years of age, in addition to an isolation cubicle, and a ward for the accommodation of two nursing mothers. (b) Borough Hospital. In addition to the ordinary notifiable diseases, selected cases of ophthalmia neonatorum, infantile 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 tihose 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 maternitv home recentlyestablished 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. 19 258 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. 13 259 SECTION II.—ACUTE INFECTIOUS DISEASES. 1.—GENERAL PREVALENCE. (a) Notifications. The number of notifications of scarlet fever and diphtheria was materially greater than in 1925. The cases of scarlet fever were on the whole mild in type; those of diphtheria were of severe Form in many instances. (b) Deaths. 32 deaths were recorded from diphtheria, 44 from influenza, 9 from whooping cough, and 13 from measles. (Appendix, Table V.). 2.—SCARLET FEVER. Out of a total of 525 cases notified as suffering from scarlet fever, 439 were admitted to the Borough Hospital or other institutions, the remaining 86 being treated at home. 22 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. No deaths occurred from scarlet fever at the Borough Hospital. The average duration of stay of scarlet fever patients in the Borough Hospital was 36.3 days. Hospital Return Cases—Scarlet Fever. Only 1 return case of scarlet fever was reported, following on the return home of a patient from the Borough Hospital after treatment for the disease. The "infecting" case showed no signs suggestive of infectivity on examination at home. Home Return Cases—Scarlet Fever. No return cases were traced during the year in connection with patients who were treated at home. 3.—DIPHTHERIA. Out of 321 cases notified on account of diphtheria, 310 were treated at the Borough Hospital or other Institutions and 11 at home; while 41 cases were admitted from Penge U.D. The disease was in many cases of a markedly severe type. 26 patients were admitted for conditions suspected to be diphtheria, but found to be other diseases. 14 260 28 deaths, including Penge cases, occurred from diphtheria at the Borough Hospital; 4 of these were suffering from the laryngeal form of the disease. The average duration of slay of diphtheria cases in Hospital was 17.5 days. Tracheotomy was performed in 4 cases, with recovery in 2 instances. Hospital Return Cases—Diphtheria. There were 2 hospital return cases of diphtheria during the year. Home Return Cases—Diphtheria. No return cases were traced in connection with the few patients remaining at home for treatment. 4—SMALLPOX. No cases occurred in Croydon during the year. 5—CEREBROSPINAL MENINGITIS. I case was notified during the year, hut after admission to the Borough Hospital was found to be suffering from tuberculous meningitis. 6—ENCEFHALITIS LETHARGICA. II cases were notified, and 8 were admitted to the Borough Hospital. The diagnosis was confirmed in 6 instances. 7—MEASLES. There was a considerable wave of measles early in the year. The cases were on the whole mild in type. 1.1 deatls were registered from the disease. 31 patients who could not be properly nursed at home were admitted to the Borough Hospital on account of measles. 8—WHOOPING COUGH. Whooping cough continued low in prevalence throughout the year. 7 cases were admitted to the Borough Hospital for treatment. 9 deaths occurred during the year. 15 261 9—EPIDEMIC DIARRHOEA. No great prevalence of this disease was noted during the year. 26 children under the age of 2 years died of the disease. 5 children were admitted to the Borough Hospital for treatment, of whom 2 died. 10—OPHTHALMIA NEONATORUM. 20 cases were notified during the year, and 5 of these were admitted to the Borough Hospital for treatment. Further particulars in regard to ophthalmia neonatorum are given in the maternity and child welfare section of the report. 11—ENTERIC GROUP INFECTION. 7 cases of enteric fever (including paratyphoid fever) were notified during the year. In 3 cases, of paratyphoid B fever, the diagnosis was confirmed bacteriologically. One of these was secondary to another of the cases; the origin of the other two could not be traced. WORK OF THE BOROUGH HOSPITAL. The Borough Hospital for infectious diseases contains 170 beds. The number of patients admitted for treatment was 882. The following table sets out the number of patients admitted, and the conditions from which thev were suffering, during 1926, and previous years:— Patients admitted from Croydon C. B. and Penge U.D. on a diagnosis of:— Cases admitted during 1917. Cases admitted during 1918. Cases admitted during 1919. Cases admitted during 1920. Cases admitted during 1931. Cases admitted during 1922. Cases admitted during 1923. Cases admitted during 1924. Cases admitted during 1925. Cases admitted during 1926. Scarlct Fever 201 386 532 583 738 728 350 261 264 426 (1)* Diphtheria 207 179 433 540 456 349 206 219 124 347 (2) Cerebro Sp. Meningitis 38 23 3 1 3 4 1 4 2 1 (3) Pulmonary Tuberculosis 40 37 44 63 64 58 66 35 25 7 Enteric Fever 6 13 4 12 12 3 8 3 9 3 (4) Paratyphoid B Fever ... ... ... ... ... ... ... ... 24 1 Puerperal Fever 2 1 4 7 2 2 1 4 3 11 (5) Morbilli (Measles) 25 17 6 4 10 7 10 31 Rubella(German Measles) 12 2 3 1 2 4 1 5 5 1 (6) Mumps 20 6 4 1 3 ... ... ... ... 1 Erysipelas 18 10 6 10 5 6 4 1 6 5 Encephalitis Lethargica ... ... ... ... ... ... 5 12 8 9(7) Ophthalmia Neonatorum ... ... ... ... ... ... ... ... 10 5 (8) Other diseases 10 37 29 24 28 14 22 14 40 35 (9) Total 579 711 1068 1246 1313 1168 674 565 530 882 16 262 (1) Includes 14 cases of other diseases : 1 admitted as scarlet fever but really diphtheria. 2 do. do. crythema. 2 do. do. acute dermatitis. 1 do. do. no disease. 1 do. do. tonsilitis. 3 do. do. German measles. 1 admitted as scarlet fever and German measles but really German measles. 3 admitted for observation, but no disease. (2) Includes 26 cases of other diseases : 18 sent in as diphtheria hut really tonsilitis. 1 do. do. chicken pox. 1 do. do. influenza. 1 do. do. syphilis. 1 do. do. rhinorrhcea. 1 do. do. rheumatism. 1 do. do. cerebellar abscess. 1 do. do. bronchitis. 1 sent in for observation but no disease. (3) One case admitted as cerebro-spinal meningitis but really tubercular meningitis. (4) Three cases sent in as enteric fever were really 1 case of tubercular kidney, 1 case of mucous colitis, and 1 case of measles. (5) Includes 5 cases of other disease sent in as puerperal fever: 1 case of mastitis, 1 case of puerperal pyrexia and 3 cases of constipation. (6) One case admitted as rubella was really a case of marasmus. (7) Includes 2 cases of other disease: 2 sent in as sleepy sickness but really tubercular meningitis cases. (8) Includes 2 cases of other disease: 1 sent in as ophthalmia really junctivitis and 1 reallv blepheritis. (9) Includes 1 case sent in as poliomyelitis but really tubercular kidney. 1 case of tubercular meningitis. 1 case of meningitis. 1 case of enteritis. 2 cases of tonsilitis. 5 cases of marasmus and enteritis (gastro). 1 case of bronchitis. 1 case of otorrhœa. 1 case of pemphigus. 12 cases no disease found. 1 case of croup. The following table shows the highest and lowest number of beds occupied on any one night during each month of the year 1926. Month. Beds Occupied. Month. Beds Occupied. Highest. Lowest. Highest. Lowest. January 71 59 July 98 72 February 78 56 August 70 51 March 96 74 September 70 50 April 100 71 October 90 70 May 130 80 November 132 87 June 92 December 141 108 17 263 The average daily number of beds occupied amounted to 92.3, as compared with 65.4 for the previous year. The following table indicates the number of admissions from the Borough and from the Penge U. D. during 1926:— Districts. Remaining at end of 1925. Admitted during 1926. Discharged during 1926. Died during 1926 Remaining a: end of 1926. County Borough of Croydon 63 815 718 42 118 Penge Urban Dis. Council (non-pai[er cases) 3 67 57 2 11 Total 66 882 775 44 129 Table VI. in the Appendix gives details of the patients admitted and discharged during the year Mixed Infection. 28 cases on admission to the Borough Hospital were found to shew evidence of concurrent infection:— 2 had scarlet fever and diphtheria. 2 ,, mumps and diphtheria. 6 ,, whooping cough and diphtheria. 1 ,, scarlet fever and diphtheria and mumps. 6 ,, chicken pox and scarlet fever. 3 ,, scarlet fever and measles. 3 ,, scarlet fever and German measles. 2 ,, scarlet fever and mumps. 2 ,, scarlet fever and whooping cough. 1 ,, rubella and whooping cough Cross Infection. 8 cases developed a second disease subsequent to admission to the Borough Hospital, i.e., 6 cases of scarlet fever developed chicken pox, 2 cases of diphtheria developed mumps. Health of Staff at Borough Hospital. The following illnesses occurred amongst the Staff:— Scarlet fever, 1; diphtheria, 3. All the cases recovered. Schick Test. This test was applied throughout the year to the nursing and domestic staffs, with a view to ascertaining those susceptible to diphtheria, and preventing their employment in diphtheria wards until immunised by treatmeant with toxin-antitoxin. 34 Schick tests were performed; 9 were positive, and these persons were treated by toxin-antitoxin. 18 264 Ambulance Service. Two motor ambulances (Wolseley and Ford) are kept at the Borough Hospital for conveyance of patients suffering from infectious diseases. 878 patients were conveyed and 1,044 journeys made. BOROUGH HOSPITAL LABORATORY REPORT. The following are particulars of the work carried out during the year at the Borough Hospital Laboratory:— Examinations for Diphtheria. For Medical Practitioners. For M.O.H. For Wards (including Nose and Throat Swabs). Grand Total. — + Total — + Total 1467 116 583 2043 45 2088 3684 7355 Outfits sent to the Town Hall. Diphtheria. Tubercle Enteric. C.S. M. Total. 3949 1231 81 — 5168 Blood Serum prepared. 641 dozen tubes at 5/- per dozen = £160 5s. Od. Special Media. Agar Agar 3,250cc Peptone Litmus l,000cc Peptone Broth 2,500cc Endos Media 500cc Petroffs Media 100cc Lactose Litmus Agar 700cc Litmus Milk 500cc Russell's Double Sugar Media 500cc Hiss Serum Water l,200cc Gelatine 500°° Tuberculosis—Examination of Sputum. For Medical Practitioners For Tuberculosis Dispensary. For Borough Hospital. Grand Total. — + Total. — + Total. — + Total. — + Total 425 126 551 516 91 607 19 5 24 960 222 1182 19 265 Blood. Samples. Wards. For organisms 1 ,, Para B 1 (isolated in pure culture). „ B. Dysenteriæ 1 (—) Enteric Group.—Examination of blood samples by Agglutination Re-action. For Medical Practitioners. For M.O.H. For the Borough Hospital. Grand Total. — + | Total. — + Total. — + Total. — + Total. 30 3 33 7 ... 7 5 3 8 42 6 48 In each case the serum was tested against B. Typhosus, paratyphoid A and paratyphoid B. All the above positives gave agglutination for Para. B. 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. 9 ... 9 2 ... 2 I ... I ... ... ... 12 2 14 12 2 14 22 2 24 14 2 16 In all positive cases Para. B. was isolated in pure culture. Miscellaneous Examinations. Drs. Wards. Grand Total — + T — + T - + T Gonococci . 3—2—5 4 6—10 7—8—15 Wards. — + T Cerebro spinal Fluid for T.B. 1—2—3 Cerebro Spinal Fluid for Organisms 5 Drs. Ward. Pus for Organisms 2 5 „ T.B. — 1( + ) Drs. Ward. M.O.H. Urine for Organisms 1 9 — T.B l(-) — 1(-) ,, Casts — 1 — Faeces for Organisms 1 — Human Milk 1 Swab, Vincent's Angina 1 (+) Swab for Organisms — 1 20 266 Public Laboratory. Particulars are given in my reports for 1924 and 1925 as to the scheme for the joint provision by the Croydon General Hospital and the Corporation of a Public Laboratory and staff; the Laboratory to be for the examination of specimens in connection with infectious disease, and also of material sent in by medical 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. I am glad to be able to report that the erection and equipment of the new Laboratory was sufficiently advanced for work to be commenced there in April of the present year, under the direction of Dr. H. W. Southgate as pathologist. I hope to be able to deal in detail with the work and the premises in my next report. 21 267 SECTION III.—TUBERCULOSIS. 1.—NOTIFICATIONS. 384 patients were notified for the first time in 1926 as suffering from tuberculosis (Appendix Table V.), as compared with 409 in 1925, 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 128 116 244 Non-pulmonary ,, 78 62 140 206 178 384 In addition, other patients came to the notice of the Tuberculosis Officer during the year through channels other than formal notification. In all, 283 new cases of pulmonary and 143 of other tuberculosis were traced during the year (Appendix, Table VII.). 2.—DEATHS. 208 deaths from tuberculosis were recorded (Appendix, Table V.), distributed as follows:— Males. Females. Total. Pulmonary tuberculosis 82 89 171 Non-pulmonary ,, 18 19 37 100 108 208 This is equivalent to a death-rate from tuberculosis of 1.0 per 1,000 of population. The corresponding rate in 1925 was 0.92, in 1924 was 0.96, and in 1923 was 0.98. Of the 208 deaths from tuberculosis, 14 were notified within one week of death, 6 after death, and 44 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. (a) New Patients. 971 new patients were seen during the year, as compared with 947 in 1925, 940 in 1924, 706 in 1923, 702 in 1922, and 712 in 1921. Of the 971 new cases, 297 were referred by local doctors for diagnosis or advice, 38 by hospitals, 104 by school medical staff 22 268 or by the medical officers of Infant Centres, 68 attended independently, 20 were transfers from other areas, 429 were seen as "contacts," 11 were pensioners, and 4 miscellaneous cases. Of these 971 patients, 343 were diagnosed as tuberculous, 167 were kept under observation to settle the diagnosis, and 461 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 7,904, as compared with 8,394 in 1925, 8,414 in 1924, 6,789 in 1923, 6,454 in 1922, and 7,576 in 1921. (c) Contact Cases. Of the 971 new patients seen at the dispensary during the year 429 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. The arrangements in regard to the provision of milk, of cod liver oil, etc., have continued on the basis set out in last year's report, and need not again be detailed. (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. Such patients received a total of 2,049 visits during the year for the purpose of home-nursing. (f) Supervision of Home Conditions. The health visitor for the district obtains particulars as to the patient, the home circumstances, possible sources of infection, and the names of any other residents with symptoms suggestive of the disease. The patient and contacts with suspicious symptoms are then in suitable cases seen at the dispensary. Quarterly visits are paid by the health visitor to ascertain the health of patients and contacts, and advice is given where required on measures aimed at the prevention of infection of the remainder of the household. A total of 3,362 such visits were made during the year, as against 3,845 in 1925 and 4,666 in 1924. 13 269 In addition to the supervision exercised by health visitors, 497 visits were paid to the homes by the Tuberculosis Officer during the year, as compared with 289 in 1925. (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. 167 patients were kept under observation pending definite diagnosis; 87 of these were adults and 80 children. (b) Examination of Sputum. 551 specimens of sputum were sent in by private practitioners and 607 from the dispensary for examination at the Borough Hospital Laboratory, while 24 examinations were made in respect of cases undergoing treatment for tuberculosis at the Borough Hospital. (c) X-ray Examination. 26 patients underwent X-ray examination at the Croydon General Hospital or elsewhere, at the request of the Tuberculosis Officer, during 1926. 5.—INSTITUTIONAL TREATMENT. Number of Beds Occupied. During 1926 the average number of beds occupied throughthe year in all tuberculosis institutions was 152, allocated as follows:— Average number of beds occupied throughout the year 1926. Type of Institution. Men. Women. Children under 15. Total. (a) Sanatoria for Pulmonary Tuberculosis (including Cheam Sanatorium) 42 39 8 89 (b) Hospital for Pulmonary Tuberculosis (beds at Borough Sanatorium) 10 7 17 (c) Sanatoria or Hospitals for- NonPulmonary Tuberculosis 11 6 29 46 All Institutions 63 52 37 152 24 270 Allocation of Beds. 1.—Of the 106 beds occupied in sanatoria for pulmonary tuberculosis:— (a) 25 for men and 15 for women were at the Borough torium, Cheam; (b) 14 for women at Larch field Sanatorium, Caterham; (c) an average of 17 (9 for men, 8 for women) at Grosvenor Sanatorium (Ashford, Kent); (d) an average of 9 (5 for men, 4 for women) at Eversfield Chest Hospital, St. Leonards-on-Sea; (e) an average of 6 for men at Fairlight Sanatorium, Hastings; (f) an average of 7 (3 for men, 4 for women) at Brompton Sanatorium, Frimley; (g) an average of 5 (4 for men, 1 for women) at various other sanatoria; (h) 8 for children—5 being at Harpenden Sanatorium, 1 at Church Army Sanatorium, Fleet, and 2 elsewhere. The only beds retained specifically for Croydon patients were the 14 at Larchfield Sanatorium and 40 at Cheam Sanatorium. During the year the scheme for occupying the patients with various forms of hand work—raffia work, basketry and weaving— was brought into effect and an instructress appointed. The scheme is proving most valuable in relieving the monotony of institutional life and in giving patients a definite object and interest. The patients welcome and enjoy 'the work, and its effect in removing listlessness and self-absorption is obvious to all who come into contact with them. The articles are in part sold to the patients and their visitors, in part they were disposed of by utilising a stall at the annual exhibition of the Surrey Handicraft Association in Crovdon. A certain number of articles have also been sold through the Tuberculosis Dispensary. II.—Of the 46 beds occupied by patients with nom-pulmonary tuberculosis, (a) 8 were at the Royal Sea-Bathing Hospital, Margate; (b) 10 at St. Anthony's Hospital, Cheam; (c) 1 at Heatherwood Hospital, Ascot; 25 271 (d) 1 at Lord Mayor Treloar's Hospital, Alton; (e) 1 at the Alexandra Hospital for Hip Diseases; (f) 14 at St. Nicholas' Hospital for Children, Birchington; (g) 5 at St. Nicholas' and St. Martin's Hospital, Pyrford; (h) 6 at other institutions. None of these beds were definitely retained for Croydon patients. Of these 46 beds for non-pulmonary tuberculosis, on an average 33 were occupied by cases of surgical tuberculosis (of spine, joints, or bone), and 13 by cases of glandular or other nonpulmonarv tuberculosis. Number of Patients under Treatment. During 1926, 219 patients were admitted to sanatoria for pulmonary tuberculosis. Of these, 121 were men—of whom 25 were invalided ex-Service men —94 were women, and 4 were children. A total of 397 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 Patient under treatment in Institutions, 1926 Type of Institution. Men. Women Children under 15. Total. (a) Sanatoria for Pulmonary Tuberculosis (including Cheam Sanatorium) 173 121 15 309 (c) Sanatoria or Hospitals tor NonPulmonary Tuberculosis 21 13 54 88 All Institutions 184 134 69 397 6.—CROYDON BOROUGH SANATORIUM, CHEAM. The Joint Smallpox Hospital buildings at Cheam have continued to use throughout 1926 as a sanatorium for tuberculous patients from Croydon, Surrey and Kent, the Borough Council being responsible for the administration. The extensions of the administration work and other alterations needed to increase the accommodation from 50 to 85 beds were completed, and the additional beds fitted in April, 1926. The Sanatorium now contains 55 beds for men, 30 for women; 40 of these beds being allocated to Croydon C.B. (— for men and-for women), 40 to the Surrey C.C. and 5 to Kent C.C. 26 The following table is a summary of the immediate results of treatment during 1926:- Clinical classification and results of treatment of cases discharged during 1926. Not included in average length of stay. Total discharges and deaths under each group. Group. No. of Cases. Arrested. a Much improved b Improved Stationary or worse. Average length of stay. Irregular discharge c Deaths, I. F.arly 36 3 13 18 2 15 weeks 14 — 50 II. Moderately advanced 50 1 8 30 11 19.7 weeks 7 6 63 III. Far advanced 24 — 2 7 15 22.7 weeks 9 37 70 Totals 110 4 23 55 28 30 43 183 (not tuber- culo-s) 184 (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—signe 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. Totals surrey C.C. Ken C.C. Croydon C.B... Authority. During the year 219 patients were admitted, the discharges and deaths for the same period being 184. 50 30 5 15 Reniaining at and of year 1925 219 96 17 106 Admitted during year 1926. 141 64 15 62 Discharged during year 1926. 43 22 2 19 Died during year 1926. 85 40 5 40 Remaining at end of year 1926. 272 273 7.—TUBERCULOSIS CARE WORK. The arrangements in regard to tuberculosis care work came under review during the early months of the year, and the work was adjusted as follows:—The Public Health Committee took over the work of the Tuberculosis Care Committee from the Council of Social Service, and became directly responsible for care work in relation to the tuberculous patient, or of his family, apart from financial help; while the Council of Social Service undertook to look into and assist wherever practicable the family of the patient, seeing that public funds can be applied only to the patient himself. For that purpose the Council of Social Service was to receive from the Care Committee particulars as to the household needs and circumstances, and in turn would give access to their files for the information of the Care Committee. This arrangement came into satisfactory working in July. 8.—SYNTHETIC SUNLIGHT TREATMENT. Arrangements are in force with the Croydon General Hospital for the attendance of children, under the Maternity and Child Welfare, the School Medical, and the Tuberculosis Schemes, for synthetic sunlight treatment at the Hospital Light Clinic, such cases attending during 1926, making a total of 2,446 attendances. The conditions under treatment were those arising from malnutrition, general debility, rickets, early glandular tuberculosis, and similar conditions. 9.—ORTHOPEDIC SCHEME. The Orthopædic Clinic, opened at the Croydon General Hospital in 1925, has steadily extended its activity during 1926. 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 1/6 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. 28 274 (c) In-patient Treatment.—By admission to the St. Nicholas and St. Martin Orthopædic Hospital, Pyrford, Surrey, or for cases needing only short periods of treatment to a ward in the General Hospital, under the direct care of the Orthopædic surgeon. Full particulars of these special clinics are set out subsequently in the School Medical Report for the year. During the year 83 patients were seen under the maternity and child welfare scheme, 180 under the school medical, and 57 under the tuberculosis scheme; and These made a total of 2,011 attendances. 9 patients were treated at Pyrford Orthopædic Hospital and 11 in the wards of the Croydon General Hospital under the Corporation Scheme. 10.—DENTAL TREATMENT—TUBERCULOUS PATIENTS. Marked progress has been made in the dental treatment of tubercular patients, this being in part provided at special sessions held at the School dental clinic for patients not entitled to dental treatment under the Insurance Act, and in part by the opening of a treatment centre at Cheam Sanatorium, visited once a fortnight by the Dental Surgeon, Mr. Senior. The results of treatment at the Sanatorium have been particularly gratifying, the dental treatment having in some cases been a clear factor in the improvement of the patient's general condition. 29 The particulars of treatment are as follows: — Clinic. Cheam Sanatorium Number examined 37 67 Number referred for treatment 32 67 Number treated 29 51 Attendances 81 — Fillings 4 31 Extractions 104 164 Gas administrations 15 — Dressings 4 12 Other operations 31 29 Dentures supplied 11 5 275 SECTION IV.—MATERNITY AND CHILD WELFARE. 1.—ANTE-NATAL WORK. (a) Ante-natal Clinic. The Ante-natal Clinic, held in the new Sick Nursery and Clinics building, has been held for three sessions in each week throughout the year. During 1926, 659 expectant mothers made a total of 2,504 attendances, each mother attending 3.8 times on an average. The average weekly attendance at the clinic was 52. The growth of the work of the Clinic is shewn in the following figures:— 1922. 1923. 1924. 1925. 1926. Number of mothers attending 413 448 500 609 659 Number of attendances 1913 1835 2007 2496 2504 Weekly attendance 38 39 39 48 52 (b) Attendances of Expectant Mothers at Welfare Centres. During the year, 541 expectant mothers received advice and assistance at the various Welfare Centres, and made a total of 1,667 attendances. (c) Home Visits to Expectant Mothers. 687 visits were paid to the homes of expectant mothers by health visitors or medical officers. (d) Feeding of Expectant Mothers. In appropriate cases fresh or dried milk needed on medical grounds during the last three months of pregnancy is provided, at or below cost price, or free, according to the circumstances of the family; while the Croydon Mothers' and Infants' Welfare Association provide mid-day meals for necessitous expectant mothers, needing this on medical grounds, where the mothers are known to the Association and attending one of the Infant Welfare Centres. (e) Registration and Inspection of Maternity Homes. Under the Croydon Corporation Act, 1924, registration of maternity homes became compulsory as from January 1st, 1925. 41 maternity homes have been registered and are kept under supervision. These maternity homes give a total accommodation of 187 beds, distributed as follows :— 30 276 Maternity homes registered for: 1 bed—5 6 beds—1 10 beds—1 2 beds—10 7 beds—4 11 beds—1 3 beds—6 8 beds—1 12 beds—1 4 beds—5 9 beds—1 20 beds—1 5 beds—4 Out of the 41 homes, 34 had certified midwives on their staffs. 2.—AT BIRTH. (a) The Work of Midwives. During the year, 72 midwives notified their intention to practise within the Borough—an increase of 13 over the number for the previous year. 65 of these held the certificate of the Central Midwives Board, 4 of the London Obstetrical Society, while 3 were in "bona-fide" practice in 1901. No midwives in the Borough are subsidised by the local authority. During the year midwives notified a total of 1,723 live births and 53 still births. Of the total births notified during the year, 57.0 per cent. were notified by midwives. In 219 instances the midwives summoned medical help for a variety of conditions affecting mother or child, while 27 other notifications in connection with still births, artificial feeding, etc., were received from midwives. The Inspector of Midwives, Dr. Olive Falk, paid periodical visits of inspection to midwives during the year, in addition to special visits for enquiry into cases of sepsis, ophthalmia neonatorum, etc. (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. 294 confinements were conducted at St. Mary's Hostel during the year. Of these, 277 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 8 were admitted as emergency cases without previous booking; 28 booked as normal cases had by the time of admission become difficult or abnormal cases. 31 277 (c) Puerperal Pyrexia, etc. 22 cases of puerperal pyrexia were notified, compared with 8 in 1925. 11 of the cases proved fatal. The increase in the number of cases of puerperal pyrexia was dependent on the more extended and more precise definition of the conditions laid clown by the Ministry of Health during the vear in regard to the question of notification. 18 deaths occurred from other maternal accidents and diseases of pregnancy or parturition, as against 8 in 1925. 11 cases notified as suffering from puerperal fever were admitted to the Borough Hospital for treatment during the year. (d) Ophthalmia Neonatorum. 20 cases of ophthalmia neonatorum were notified, as compared with 22 in 1925. 13 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: — Still Cases Treated Vision Vision Total attending At In Notified. Home. Hospital, paired, paired. ness. Deaths, pital. Removed. 20 13 7 14 1 — 2 2 1 (e) Still-births. 106 still-births were notified during the year, or 3.4 per cent. of the total notifications of births. 3.—THE INFANT AND THE YOUNG CHILD. (a) Notification of Births. 3,050 notifications of live births were received during the year out of a total of 3,569 registered, so that 85.5 per cent. of the births were notified. 27 per cent. of The notifications were made by medical practitioners, 57 per cent. by midwives, and 16 per cent. by relatives, etc. Of the 3,569 children born alive, 1,803 were boys and 1,766 girls. (b) Home Visits Under the Notification of Births Act. During the year the health visitors paid 3,735 first visits and 7,149 subsequent visits to children under the age of 12 months; and 997 first visits and 11,456 subsequent visits to children between the ages of 12 months and 5 years; a total of 23,337 visits, as against 19,868 in 1925. 32 278 The following table gives particulars of the visits carried out under the Notification of Births Act since 1922: — 1922. 1923. 1924. 1925. 1926. Number of Health Visitors for M. and C. W. equivalent of: 6 6 6.5 6.5 6.5 First visit to children under 12 months of age 3179 3028 3275 3521 3735 Subsequent visits to children under 12 months of age 6028 5145 5331 6276 7149 First visits to children 1—5 years of age 946 1114 1152 1199 997 Subsequent visits to children 1 — 5 years of age 5400 6530 3129 8872 11456 Total 15,553 15,817 17,887 19,868 23,337 (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, 8 are open once a week, 2 twice a week. (d) Municipal Infant Welfare Centre. The Municipal Infant Welfare Centre was transferred at the beginning of 192G to the new premises erected in Lodge Road, and was held twice weekly throughout the year in the building. During 1920 there were recorded at the Welfare Centres in the Borough (Appendix, Table VIII.) 20,458 attendances of children under 1 year of age, 21,297 attendances of children aged 1 to 5 years, 38,023 attendances of mothers. The medical officers had 10,401 interviews respecting children under 1 year, and 9,135 interviews over children aged 1 to 5. In addition, as mentioned in another section, 1,667 attendances were made by expectant mothers. (e) Sick Nursery. At the beginning of 1926 the extended Sick Nursery premises, consisting of 12 cots, 1 observation cubicle, and a ward 33 279 of two beds for nursing mothers, forming the first floor of the clinic building erected in Lodge Road by the Corporation, came into use, and have proved a very valuable asset to the child welfare work of the Borough. 22 mothers and 109 children were admitted during the year. The average stay was 12.5 days in the case of the former, and 37.7 days in respect of the children. H.R.H. Princess Mary graciously consented to open the clinic and sick nursery block, and the ceremony of its formal opening took place on the 18th May. Early in 1927 a generous gift of a Hanovia quartz mercury vapour lamp, with full appointments for synthetic sunlight treatment, was received from Mrs. Lewis and the mothers and workers at the South Croydon Infant Welfare Centre. This most welcome gift will be of the greatest value in the treatment of children attending the Sick Nursery and the Lodge Road Clinics. (f) Massage Clinic. The massage clinic for children under the age of 5 years was transferred to the Lodge Road clinic at the beginning of 1926. Three afternoon sessions were held in each week until June, when the number of sessions was increased to 5. 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, received treatment at the clinic. 1,861 attendances were made at the massage clinic during the year. (g) 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 ifor necessitous expectant and nursing mouthers, on the recommendation of the medical officers. 34 280 The following tables give particulars as to the provision in 1926 of fresh milk through all the centres:— Issue of Fresh Milk Through Infant Welfare Centres. Supplied to Families. No. of Pints. Corporation Liability. £ s. d. Milk at l½d. 25332 193 4 8½ Milk Free 39419 542 10 10½ Total number of Pints supplied 64751 735 15 7 Total Number of Families 248. Average supplied to each case, 261.09 pints. Average cost of supply per head, £2 19s. 4d. Average number of pints supplied weekly 1245. (h) Admission to Convalescent Homes. The Croydon Mothers' and Infants' Welfare Association continues to send mothers and debilitated children to convalescent homes in the country or at the seaside, on recommendations received from the medical officers of the Infant Welfare Centres. During the year 48 mothers, and 79 children tinder 5 years of age, were sent away to convalescent homes. (i) Home Nursing. No cases were reported to me during the year for home nursing under the arrangements made with the Croydon Nursing Service. A certain number of cases of measles, whooping cough, ophthalmia neonatorum, puerperal fever, epidemic diarrhoea and infantile paralysis were reported as being nursed at home under unsatisfactory conditions; but it was found in each case advisable to remove them to the Borough Hospital. (j) Care of Illegitimate Infants. The Babies' Help Committee of the Croydon Mothers' and Infants' Welfare Association has continued to keep in touch with unmarried mothers and to assist them to remain with their children instead of handing them over to the care of others. 36 281 For the following particulars I am indebted to Mrs. Philpot: Babies' Help Committee. Thirty-eight cases were considered by this Committee in 1926. In one case investigation proved that help was unnecessary and live cases were thought unsuitable for help by this Committee, as the baby arid mother were already separated. Four cases were referred to other Committees for help. The others were helped by gifts of baby clothes and grants to enable mothers and babies to remain together. All grants are paid at the Welfare Centres so that our babies are under the supervision of the doctors and health visitors. All the babies have made good progress, although several were weakly when born. Seven of our mothers are boarded-out with motherly landladies. All others are in their own homes and we find that our grants and our friendly interest rouse the members of the family to co-operate in caring for the little newcomer who soon wins an established position in the family circle. The amounts given vary according to circumstances, one case only requiring help with a perambulator and another only clothes and friendly advice. In two cases affiliation orders are collected and paid over to the mothers. Two mothers married in the year. The Committee is grateful for several gifts of babies clothes which are always appreciated. (k) Dental Treatment—Expectant and Nursing Mothers and Young Children. The scheme of dental treatment, through the school dental surgeons and school dental clinics, has markedly expanded during the year. 11 sessions were devoted to inspections and talks at Welfare Centres, and 105 to treatments. In regard to treatments there was in particular a great increase in the number of expectant mothers treated and of the dentures supplied. The mothers paid the ordinary charges made at the school clinic, and paid in nearly every case the full cost of the dentures. The particulars of cases treated are as follows : — Expectant Mothers. Nursing Mothers. Children under 5 years. Number examined 129 204 305 Number referred for treatment 129 195 226 Number treated 97 150 168 Attendances 349 564 228 Fillings 36 62 148 Extractions 400 715 301 Gas administrations 66 129 89 Dressings 15 44 32 Other operations 93 210 2 Dentures supplied 87 86 282 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 6 „ 5-16 „ 50 „ over 16 241 297 2.—Education Cases : — Aged 7-16 years 117 414 Distribution. The 414 cases of mental defectives are distributed as follows: — (a) Statutory Cases :— In certified institutions 100 In Croydon Mental Hospital 12 In Poor Law Institutions 6 Under guardianship at home 19 In a place of safety 6 Lender supervision, resident at home 154 297 37 283 (b) Education Cases : — In certified residential schools 6 On roll of Grangewood Special School 76 At private or elementary schools 18 Resident at home 17 117 414 Examination and Visits by the Medical Officers. Statutory Cases 59 Education Cases 128 187 Visits by the Mental Deficiency Visitor. Statutory Cases 1078 Education Cases 883 1961 Additions to List of Statutory Cases During 1926. During the year 19 names have been added to the list of statutory cases—7 being new cases, 19 reported on reaching the age of 16, and 5 certified as ineducable—and 8 have been removed, owing to death (4), or to removal (4) from the Borough. Statutory Cases dealt with during 1926. Sent to institutions 3 1 To place of safety, pending institutional care 7 (including 2 girls sent later to Institutions). Home on probation 1 Transferred from one institution to another 3 Education Case,s dealt with during 1926. Particulars are given in the school medical section of the report. GRANGEWOOD SPECIAL SCHOOL. At the end of the year 76 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. 38 284 GRANGEWOOD SPECIAL M.D. SCHOOL. Mentally Defective Children. On roll of Special School at December 31st, 70. During the year 11 new admissions were made, to replace 15 children who left the school during the same period. The reasons for discharge were as follows:— Allowed to leave for special reasons 7 Over school age 4 Removed from Borough 4 The School Medical Officers carried out 88 special examinations at the school, 66 of these being physical and 22 mental tests. 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 morning and 18 afternoon 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 cooperation with the Special School these children get a two-course dinner each day for 1s. 6d. weekly, or 4d. per day. 39 40 285 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. The average attendance is 8. It is hoped to increase the numbers attending these classes during the present year. There were thus 35 children attending during the year. new cases were admitted and 7 left during the year. Average morning attendance 15 Average afternoon attendance 18 Girls' Occupation Class (senior girls) 8 Number of Pupils on Register: Full-time 24 Part-time Left during the year : Full-time pupils 4 Part-time „3 New Pupils admitted : Full-time 4 Part-time 3 A small sale of work was held during the summer, at which a demonstration of marching, games, and music by a jazz banc was given by the children. After cost of materials, and all expenses had been deducted, a profit of £2 was realised, and orders for work were booked to the amount of thirty shillings. A Christmas party was held in December, at which 73 children and friends were present. Tea was served to all, and each child received a Christmas present before leaving. 286 SECTION VI.—VENEREAL DISEASES. Treatment is provided by the Corporation under two schemes. (a) Clinic at Croydon General Hospital. A clinic, open on Wednesday afternoons for women and children, and on Saturday afternoons for men, is held in a section or the Out-patient 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 1922-26 :— 1922. 1923. 1924. 1925 1926. New male patients 105 80 101 116 141 New female patients 63 89 125 156 178 Attendances, male patients 2425 1826 1774 2713 2360 Attendances, female patients 898 1023 982 1230 1351 (b) Clinics Provided Under the London Scheme. Croydon is a party to the general London scheme, under which clinics for the treatment of veneral 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 scheme. The particulars of attendances of Croydon patients under the general scheme from 1922 onwards are as follows:— 1922. I923 1924. 1925. 1926. New patients 153 175 163 138 130 Total attendances 2304 2816 2899 2648 2767 (c) Pathological Examinations. Pathological examinations were carried out at the laboratories of London hospitals for Croydon patients as follows:— 1922. 1923 1924. 1925. 1926. Tests for Clinics 908 432 551 642 542 Tests lot practitioners 209 612 882 1069 799 41 287 SECTION VII. HOUSING AND 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. 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 Act, 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. Public Health Act, 1925. Sections 14, 17, 18, 19, 23 to 26 'inclusive) 28, 30, 31, 33, 35, 41, 42, 43, 45 and 47 to 55 (inclusive). Regulations. 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. „ Conduct of persons using Public veniences, 1926. 42 288 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) 3874 No. of houses inspected under the Housing (Inspection of District Regulations, 1910) 2534 No. of houses inspected under the Rent Restrictions Act, 1920 40 No. of houses inspected where zymotic diseases have occurred 600 House drains tested with smoke (primary) 984 House drains tested on application 112 No. of smoke tests during repair 574 No. of water tests during repair 326 Final test of drains after repair 101 Final test of drains when completely re-laid 36 Lengths of new drains tested with water yards 1256 Inspections of Stables and animal manure pits 372 „ Yards and passages 690 „ Urinals 680 „ Pig Styes 88 „ Theatres, Cinemas, etc. 219 „ Schools 100 „ Common Lodging Houses, including night visits 183 „ Houses let in Lodgings 125 „ Tents and Vans 21 „ Premises where offensive trades are conducted 423 Smoke Observations 14 No. of visits re Infectious Diseases 1400 Inspections of Shops (under Shop Acts) 737 „ „ (under Poisons and Pharmacy Act) 8 „ Dairies 341 „ Cowsheds 122 „ Milkshops 592 „ Premises where food is prepared or sold 5159 „ Slaughterhouses 1539 „ Factories, including Factory Laundries 464 „ Workshops, including Workshop Laundries and „ Bakehouses 821 „ Workplaces other than outworkers' premises 37 „ Outworkers 182 Visits to employers of Outworkers 6 Reinspections of work in progress 22480 Sundry Inspections 4741 Sundry Visits 8294 Examination of building plans 967 Complaints from public investigated 3129 Informal notices outstanding 31/13/25 2259 „ „ served 9192 „ „ complied 7636 No. of Informal Notices referred for Statutory Orders 1523 Informal notices outstanding (including 565 overcrowding) 2292 Statutory Notices outstanding 31/12/25 233 „ „ served 1335 „ „ abated 1224 Total number of complaints received 3365 Interviews with callers 4441 I.etters received 4197 Letters and other intimations, etc. sent (not including notices) 8440 43 289 Nuisances and Other Matters Dealt With by the Sanitary Inspectors During 1926. Houses. Defective plasterwork 1224 Bad smells (dry irot, dead vermin, etc.) 16 Requiring repair, cleasing and whitewashing 2282 Defective drains 471 Damp 1433 Defective downspouts 241 Insufficient ventilation under floors 126 Dirty floors 43 Defective floors 650 Defective gutters 1024 Overcrowded houses occupied by families (notices) 531 Defective roofs 1407 Stairs and passages dirty 11 Defective sinks 607 Defective sanitary fittings (other) 1017 Defective sashcords 1343 Insufficiently lighted 2 Without proper water supply 23 Defective windows 619 Damp or flooded cellars or rooms 5 Dustbins required 1171 Sundry other nuisances 1990 Factories, Workshops, and Workplaces Only. Insufficient w.c. accommodation 28 Defective 113 No separate sanitary accommodation for sexes 5 Requiring cleansing and whitewashing 212 Drainage of floors 13 Insufficient ventilation 14 Infringement of drinking water supply regulations 14 Sundry other nuisances 174 Dustbins 76 Other Nuisances Discovered. Animals improperly kept 47 Drains found stopped 355 Defective manure receptacles 31 Want of manure receptacles 26 Defective urinals 55 Dirty 74 Defective drinking water cisterns 172 Smoke nuisances 8 Offensive accumulations 176 Deposits of materials causing damp 3 Infringements of Shops Acts 168 Infringements of Bye-laws and Regulations 283 Infringements of Milk and Dairies Acts and Orders 71 Infringements of Croydon Corporation Act, 1925. Food cupboards necessary 456 Verminous conditions 120 Urinals, w.c.'s, drains, etc., ventilating into food stores 22 Filth, etc., accumulating in food store 199 Human food in sleeping places 5 44 290 Infringements of P.H.A. (Amendment) Act, 1907. Yard surfaces defective 672 Rainwater pipes acting as ventilating pipes to drains 8 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 1926 requests were made in connection with 75 private houses. 2 schools. Total—77. The following defects were ascertained in consequence of these inspections:— Defective or choked drains 12 Defective' gullies 5 Defective soil pipes 2 Obstructed ventilation pipes 20 Defective sink waste pipes 10 Defective w.c.'s 14 Defective roofs 4 Defective downspouts 6 Defective gutters 1 Defective paving 1 Dampness 7 Sundry defects 29 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 28 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. Using part of stable for sleeping and living (Other accommodation found—case with drawn) 0 2 6 0 2 6 Infringements of Houses Let in Lodgings Bye-laws (Work carried out—case withdrawn) - Failing to abate a nuisance - 1 7 6 1 7 6 do — 2 2 0 2 2 0 45 291 HOUSING. The following table gives particulars as to housing during 1926 under the headings prescribed by the Ministry of Health. Housing, 1926. Number of houses erected during the year :— (a) Total 1416 (b) With State assistance under the Housing Acts 1919 or 1923 : (i) By the Local Authority 280 (ii) By other bodies or persons 4 1.—Unfit Dwelling Houses :— Inspection (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 3874 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 2534 (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 2973 2.—Remedy of Defects without service of Formal Notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 1042 3.—Action under Statutory Powers:— A. Proceedings under Section 8 of the Housing Act, 1925:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 1 (2) Number of dwelling houses which were rendered fit— (а) By owners Nil. (b) By Local Authority in default of owners Nil. (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. B. Proceedings under Public Health Acts— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 801 (2) Number of dwelling houses in which defects were remedied— (а) By owners *571 (b) By Local Authority in default of owners Nil. C. Proceedings under Sections 11, 14, and 15 of the Housing Act, 1925— (1) Number of representations made with a view to the making of Closing Orders 2 (2) Number of dwelling houses in respect of which Closing Orders were made 2 46 292 (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit Nil. (4) Number of dwelling houses in respect of which Demolition Orders were made Nil. (5) Number of dwelling houses demolished in pursuance of Demolition Orders Nil. (6) Number of dwelling houses demolished voluntarily ... Nil. * This number does not include 208 notices served in the latter part of 192S and complied with in 1926. OVERCROWDING. During the course of systematic inspection of 3,874 houses of the working classes between 1st January and 3ist December, 1926, 386, or 9.9 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. 712 families occupied these 386 houses and 439 or 61.6 per cent. of these families in overcrowded houses were found to be overcrowded. In 117 houses of the 386 houses it was found possible to abate overcrowding without producing corresponding overcrowding elsewhere. 531 notices were served to abate overcrowding. FACTORIES, WORKSHOPS, AND WORKPLACES. 1. Inspection. Premises. Inspections. Number of Written Notices. Prosecutions FACTORIES. (including Factory Laundries) 464 130 ... WORKSHOPS. (including Workshop Laundries and Bakehouses) 821 50 ... WORK PLACES. (other than Outworkers' premises) 37 1 ... Total 1322 181 ... 47 293 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 212 212 ... ... Want of Ventilation 14 9 ... ... Overcrowding ... ... ... ... Want of Drainage of floors 13 12 ... ... Other Nuisances 225 203 ... ... Sanitary Accommodation— Insufficient 28 25 ... ... Unsuitable or Defective 132 124 ... ... Not separate for sexes 5 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 ... ... 18 ... Total 629 589 18 ... 3. List of Registered Workshops. Trades. Totals. Bakers and Confectioners 83 Tailors 94 Dressmakers 51 Building Trades 56 Milliners 36 Miscellaneous trades 62 Upholsterers 26 Laundries 11 Cycle works 19 Blacksmiths 10 Bootmakers 26 Watchmakers 14 Motor Engineers 29 Coachbuilders 8 Photographers 11 Picture Framers 7 Umbrellas 5 Saddlers 6 Ladder and Barrow Makers 3 Wig-makers 4 48 294 Scale Makers 3 13IirKl Makers 4 Furriers 3 Marine Stores 7 Cabinet Maker 6 French Polishers 2 Butchers 3 Sign Writers 6 4. Bakehouses. The control of Bakehouses is dealt with under the Factory and Workshop Act and the Public Health Act and Croydon Corporation Act, 1924. For details of Croydon Corporation Act see under Food Inspection, page Number of bakehouses on Register 31st December, 1926 104 Number of underground bakehouses (included in above). 8 Visits made to bakehouses during the year 821 Defects found 113 Notices issued 64 Notices complied 58 5. Horn*1 Work. Lists of home workers are sent in twice yearly. 173 of these lists containing the names of 397 outworkers residing within the Borough were received from employers during the year. 182 visits were paid to outworkers, and 4 visits were paid to premises of employers of outworkers to examine lists and for other purposes. NATURE OF EMPLOYMENT OF WORKERS ON THE REGISTER, 31st DECEMBER, 1926. Nature of Work. Number employed. Outwork in infected premises. Outwork in unsatisfactory premises. Remarks. Making, cleaning, altering and repairing wearing apparel 209 ... ... ... Upholstery work 4 ... ... ... Cardboard box making 1 ... ... ... Tennis ball sewing 1 ... ... ... Brushes 1 ... ... ... Umbrellas 1 ... ... ... Blind repairs 1 ... ... ... Table linen 1 ... ... ... Carding buttons 3 ... ... ... Lace goods 2 ... ... ... 224 ... ... ... 49 295 REGISTERED AND LICENSED PREMISES IN THE BOROUGH, 31st DECEMBER, 1926. Slaughterhouses (not including Public) 7 Bakehouses 104 Common Lodging Houses 11 Houses Let in Lodgings 65 Dairies and Milkshops 197 Cowsheds 30 Offensive Trades 106 Wholesale Dealers in margarine, etc. 35 Shop Hours Acts. 737 visits were made during the year, including week-day and evening patrols and Sunday evening patrols, for the purpose of delecting any infringements of the Acts. 168 infringements found. 165 cautions given. Proceedings were taken in the following instances:— 1.—Selling a bottle of sauce at 2.45 p.m. (Wednesday). Fined £1. Costs 10/6. 2.—Selling chocolates at 9.50 p.m. (Friday). Fined 10/- 3.—Selling a tin of milk at 8.25 p.m. (Thursday) Fined 10/- 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 three 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.; the cost of a weekly ticket is 5s. for seven nights. The number of men accommodated during the year was 36,512. The average number of men lodgers amounted to 100 per night throughout the year. The receipts and expenditure for the last six years 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 9 1350 10 7 1925 1346 16 6 1485 0 1 1926 1338 8 7 1639 2 8 50 296 2.—Private Common Lodging Houses There are 11 common lodging houses on the register. During 1926 172 day and 11 night inspections were made. Notices were served for the following conditions:— Defective plasterwork. Dirty walls and ceilings. Defective windows, sashcords and floors. Defective sanitary fittings. Defective roofs and gutters. Verminous conditions. Dampness. The following table gives the situation of and the accommodation in the common lodging houses:— Premises. No. of Rooms. Accommodation. 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. 1, Tamworth Road 5 21 men. 11 61 182 men and women. HOUSES LET IN LODGINGS. There are 65 houses registered under the Bye-laws. 125 visits were made for inspection purposes 91 notices were served for various amendments. 79 notices were complied with. The following table gives the situation of these premises:— Road. No. of houses let in Lodgings. Beulah Grove 1 Princess Road 1 Queen's Road (Croydon) 1 Ely Road 7 Forster Road 13 Holmesdale Road 4 Wilford Road 31 Clyde Road 1 Donald Road 1 Canterbury Road 1 Selhurst Road 1 Whitehorse Lane 1 Nursery Road 1 Mayday Road 1 51 297 Notices were served for the following conditions:— Defective floors, walls and ceilings. Insufficient and defective sanitary accommodation. Washing accommodation required. Cooking accommodation required. Food storage accommodation required. Cleansing and limewashing. Dirty and defective stairs and passages. Balusters missing or defective. Drains stopped or defective. Defective sanitary fittings. Defective roofs, gutters and downspouts. Want of domestic cleanliness. Defective windows and sashcords. Yard paving dirty or defective. Defective dustbins. Dampness. OFFENSIVE TRADES. Bye-laws relating to Offensive Trades were adopted during the latter part of the year 1925. 423 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 41 Gut Scrapers 2 Fish Friers 61 Rabbit Skin Drier 1 Fellmonger 1 106 RAG FLOCK ACT, 1912. Four samples were obtained from two firms and subjected to analysis, the results being as follows:— No. 1 contained 30 parts of Chlorine per 100,000 „ 2 „ 23 „ „ „ „ 3 „ 16 „ „ „ „ 4 „ 12 „ „ „ All the samples conformed to the standard of cleanliness prescribed under the Rag Flock Act, 1911. The legal maximum of Chlorine allowed is 30 parts per 100,000. SMOKE OBSERVATIONS. During the year 14 observations were made of factory chimneys for the purposes of detecting offences under The Act. Eight notices were sent and amendments carried out to stop the nuisance. 52 398 AMUSEMENT HOUSES. 219 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 ventilate w.c.'s. Limewash w.c. walls and ceilings and cleanse pans. Affix notices to doors of lavatories. Repair roof, gutters and downspouts. Repair defective paving. Provide efficient flush to conveniences. KEEPING OF ANIMAES. 88 visits were made in connection with the keeping of animals. There are 05 premises where pigs are kept in the borough. One notice was served to discontinue the keeping of pigs owing to the premises being within 100 feet of a dwelling, 11 further notices were served to abate nuisances arising from various causes in connection with the keeping of pigs, and 35 notices were served to abate nuisances arising from the keeping of other animals. 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 meat dressed therein. 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. Hotel and cafe kitchens and eating houses have had a good deal of attention, and it is found that suggestions for improvement are favourably received and adopted. 53 299 Bakehouses have been regularly inspected and many improvements carried out during the year. The ingredients used and the processes are kept under inspection to encourage as far as possible the production of wholesome, clean foodstuffs. The manufacture or sale of ice-cream is carried on in 236 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. Premises where cooked meats and other meat products are prepared and sold received frequent inspection. Other premises where foodstuffs of various kinds were sold also received routine inspection, and a table, showing the various premises on the register, is set out below. Statement of premises in the borough at which foodstuffs are known to be sold, manufactured and stored:— General Shops 118 Grocers and Provision Shops 486 Greengrocers and Fruiterers 223 Confectioners, Bakers and Pie Makers 325 Ice-cream Shops 236 Hotel and Restaurant Kitchens and Dining Rooms 128 Butchers 201 Fishmongers (including fried fish shops) 104 Ham and Beef Shops 37 Sweet Manufacturers 3 Other food premises 1 1862 In addition to the above there are the following food premises referred to in other paragraphs of this report:—slaughterhouses and dairies, cowsheds and milkshops on the registers. Further there are 133 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. In earning out the inspection of food premises the co-operation of the various traders has been of great assistance. In view of the Public Health (Preservatives in Food) Regulations a number of traders are now installing refrigerating apparatus. 54 301 4 „ carcases and offals. Jaundice. 1 „ carcase and offal. Cirrhosis and peritonitis. 28 „ various parts. Traumatism, etc. 176 „ various offals. Inflammatory conditions, etc. 164 „ plucks. „ „ 16 sheep carcases and offal. Emaciation, etc. 14 „ various parts. Abscesses, Inflammatory conditions, 43 „ plucks. Parasitical, etc. [etc. 184 „ various offals. „ „ TOTAL WEIGHT DESTROYED 26,906 lbs. PRIVATE SLAUGHTERHOUSES AND MEAT INSPECTION. At the end of 1926 there were 7 registered slaughterhouses in the Borough. Of these 5 are in use. The number of visits paid to the private slaughterhouses for the purposes of inspecting the meat durinsr 1926 was 1,539. 300 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 utilises one building on the premises. Of the twelve slaughterhouses four, 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. The following animals were slaughtered at the Public Slaughterhouses during 1926. Pitlake. Public Slaughterhouses. Cattle. Sheep. Pigs Calves. Total. Public section 557 5919 731 75 7282 Private section 156 2728 13247 4357 20488 Totals 713 8647 13978 4432 27770 The whole of the meat and offal is examined before it leaves the premises. The following meat and offal from the Public Slaughterhouses was surrendered and destroyed during the year 1926:— Description. Cause. 6 beef carcases and offal. General tuberculosis. 8 „ forequarters. localised „ 1 hindquarters and 14 parts. „ „ 102 sets beef lungs. „ „ 16 beef heads. „ „ 71 „ various offals. „ „ 7 „ carcases and offal. Septicaemia. 2 „ „ „ Actinomycosis and emaciation. 6 „ heads and tongues. Actinomycosis. 2 „ quarters and 8 parts. Traumatism. 127 „ various offals. Abscesses, Inflammatory conditions. 3 veal carcases and offals. Asphyxia. 14 „ parts. Various causes. 4 „ various parts. Tubercular. 8 „ various offals. Various causes. 10 pig carcases and offals. General tuberculosis. 6 „ quarters. Localised „ 13 „ various parts. „ „ 132 „ heads. „ 89 „ plucks. „ 42 „ various offals. „ „ 7 „ carcases and offals. Septicaemia. 3 „ „ „ Swine fever. 1 „ carcase and offal. Swine erysipelas. 55 301 4 „ carcases and offals. Jaundice. 1 „ carcase and offal. Cirrhosis and peritonitis. 28 „ various parts. Traumatism, etc. 176 „ various offals. Inflammatory conditions, etc. 164 „ plucks. „ „ 16 sheep carcases and offal. Emaciation, etc. 14 „ various parts. Abscesses, Inflammatory conditions, 43 „ plucks. Parasitical, etc. [etc. 184 „ various offals. „ „ TOTAL WEIGHT DESTROYED 26,906 lbs. PRIVATE SLAUGHTERHOUSES AND MEAT INSPECTION. At the end of 1926 there were 7 registered slaughterhouses in the Borough. Of these 5 are in use. The number of visits paid to the private slaughterhouses for the purposes of inspecting the meat durinsr 1926 was 1,539. The number of animals slaughtered in the private slaughterhouses during the year was:— Cattle. Sheep. Pigs. Calves. Total. 911 7356 6230 3698 18,195 The following meat and offal from private slaughterhouses was surrendered and destroyed during 1926:— Description. Cause. 2 beef carcases and offal. Generalised tuberculosis. 2 „ forequarters. Localised „ 23 „ offals (sundry). „ „ 8 „ heads. „ „ 1 „ carcase and offal. Septic metritis. 112 „ livers or parts. Parasitical, albscesses, etc. 6 sets beef lungs. Inflammatory conditions, etc. 3 beef parts. Traumatism. 2 veal carcases and offal. Generalised tuberculosis. 2 „ livers. Localised „ 1 „ pluck. „ „ 1 „ carcase and offal. Unsound. 1 „ „ „ Navel ill. 3 sets veal lungs. Pleurisy. 3 pig carcases and offal. Generalised tuberculosis. 2 „ forequarters. Localised „ 29 „ heads. „ „ 33 „ plucks. „ „ 6 „ carcases and offals. Inflammatory conditions, etc. 53 „ offals (various). „ „ 41 „ plucks. „ „ 7 „ parts. „ „ 6 sheep carcases and offals. „ „ 21 „ plucks. „ „ 5 „ parts. Unsound. 84 „ livers. Parasitical, etc. TOTAL WEIGHT DESTROYED 8,118 lbs. 56 302 Total number of animals slaughtered for human consumption in the Borough during 1926:— Cattle. Sheep. Pigs. Calves. Total. 1,624 16,003 20,208 8,130 45,965 Summary of whole carcases destroyed, with the reasons for such destruction. Class of Animal. Tuberculosis. Septicaemia. Actinomycosis & Emaciation. Asphyxiation. Swine Fever. Swine Erysipelas. Jaundice. Cirrhosis & Peritonitis. Emaciation, various causes. Unsound. Navel Ill. Inflammatory Conditions. Septic Metritis. Total carcases. Cattle 8 7 2 1 18 Sheep 16 11 6 33 Pigs 13 7 3 1 4 1 6 35 Calves 2 3 2 1 8 Totals 23 14 2 3 3 1 4 1 16 13 1 12 1 94 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 (including heads). All or part of organs destroyed. Total. Cattle (including calves) 10 29 126 165 Pigs 13 182 164 359 Total 23 211 290 524 GENERAL FOOD INSPECTION. The following table gives a summary of the inspections made during the year (not including visits made to slaughterhouses, or dairies, cowsheds and milkshops):— Butchers 1085 Fishmongers 481 Grocers 914 Greengrocers 487 Game Dealers 12 57 303 Cooked and Prepared Meat Shops 241 Markets 514 Hawkers' Carts and Barrows 79 Hotel and Cafe Kitchens 480 Ice-cream Manufacturers and Vendors 545 Other premises 321 5159 The following articles of food were surrendered and destroyed during 1926:— 102 beef parts and trimmings (Imported) Unsound. 1 veal carcase and 1 part „ do. 2 calf plucks „ do. 24 lots ox kidneys „ do. 114 ox tails „ do. 27 ox livers „ do. 19½ doz. .sheep hearts, etc. „ do. 11 parts mutton „ do 11 lamb carcases, 12 forequarters and 43 parts do. 4½ cases pig kidneys (Imported) do. 97 lbs. bacon do. 26 lbs. sausage, etc. do. 1 bag winkles do. 112 lbs. haddocks do. 98 lbs. skate and codfish do. 12 boxes sultanas do. 256 lbs. raisons and currants do. 42 lbs. grapes do. 115 lbs. apples do. 36 lbs. cherries do. 17 baskets strawberries, red currants, etc. do. 1 crate bananas do. 4 bdls. rhubarb do. 1652 lbs. Brussel sprouts and cauliflowers do. 139 lbs. onions do. 480 lbs. celery do. 4 crates lettuce do. 660 lbs. potatoes do. 1 bag chestnuts do. 82 tins, etc., meat paste do. 934 tins sardines, salmon, etc. do. 1149 tins loganberries, strawberries, etc. do. 208 tins, etc., peas, tomatoes, soup, etc. do. 275 tins milk do. 160 jars jam and marmalade do. 139 pkts. dried eggs, suet, etc. do. 4 boxes lard, etc. do. 436 eggs do. 1693 lbs. cocoanut ice do. 36 lbs. sweets do. 100 lbs. soup squares and sundries do. 27 rabbits do. 13 chickens do. TOTAL WEIGHT DESTROYED 17,858 lbs. 58 304 General Summary of Meat and other articles destroyed during the year 1926.— articles. Weight in lbs. Remarks. Diseased. Unsound. Total. Beef 14,241 4,857 19,073 Including 18 carcases. Mutton 1,211 1,327 2,638 „ 33 „ Pork 6,953 143 7,0966 35 Veal 523 457 980 8 Offal 10,989 1,602 12,591 „ imported offal. Fish ... 448 448 Cod, skate, haddocks, etc. Fruit & Vegetables ... 4,001 4,001 Currants, cherries, cauliflowers etc. Egg ... 57 57 436 eggs Rabbits & Poultry ... 81 81 . 27 rabbits, 13 chickens. Sweetmeats, &c. ... 2,159 2,159 Including cocoanut ice. Tinned Goods 3,868 3,858 2,648 tins, 160 jars, etc. 33,892 18,990 52,882 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 proportion is produced in the borough, due largely to the absorption oi land for building purposes and the decreasing amount available for pasture. The Milk and Dairies (Consolidation) Act, 1915, and the Milk and Dairies Orders gave additional powers to deal with milk premises. The various premises in the borough dealing with milk received careful attention during the year and a considerable number of improvements were carried out, including the building of a number of new dairies and the remodelling of other premises on modern lines. These alterations are required before registration of the premises is granted. The provision of covered counter pans has made rapid progress during the year and in nearly all milkshops the approved type has been substituted for the miscellaneous types previously employed. One firm retails bottled milk exclusively, another is gradually substituting the sale of bottled milk for loose, and it is interesting to note that this bottled milk is produced under a licence (Pasteurised) and sold as such without any increase in price. 59 305 There has been a very large increase in the sale of bottled milk in the borough during the year, due not only to a public demand, but also to the desire of the trade to provide an article of food more in accordance with modern hygienic methods. It is worthy of note that the number of premises at which milk of various grades is sold under the Milk (Special Designations) Order, 1923, has increased during the year by 59. It is satisfactory to note that, as judged by the analyses, the average quality of milk retailed in the borough during the past year has been of a higher standard than in the previous year. MILK AND DAIRIES (CONSOLIDATION) ACT, 1915, THE MILK AND DAIRIES AMENDMENT ACT, 1922, AND THE MILK AND DAIRIES ORDERS, 1926. Cowkeepers, Dairymen and Purveyors of Milk. The following statement shows the number ot Cowkeepers, cowsheds, dairies and purveyors of milk premises on the register:— Cowkeepers on register (1926) 9 „ added to the register (1926) – discontinued (1926) 1 Nett. 8 Cowsheds on register (1925) 31 „ added to register (1926) — ., discontinued (1926) 1 Nett. 30 Number of cows provided for 162 Average number of cows in sheds (1926) 147 No. of dairies and purveyor of milk premises on register (1925) 209 No. of dairies and purveyor of milk premises added to Register (1926) 18 No. of dairies and purveyor of milk premises discontinued during 1926 30 197 Grand total of cowsheds, dairies and purveyor of milk premises on register, 31st December, 1926 227 During the year 1,055 inspections were made of dairies, cowsheds and milkshops. 60 306 Milk (Special Designations) Order, 1923. The following licences were granted during the year 1926 under this Order and were in force on the 31st December, 1926:— Description of Licences. No. (1) Producers' Licences to use the designation "Grade A" 1 (2) Dealers' Licences to use the designation "Certified" 23 (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 20 (5) Dealers' Licences to use the designation "Grade A Pasteurised" (a) Shops — (6) Dealers' Licences to use the designation "Pasteurised ": (a) Pasteurising establishments — (b) Shops 42 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 examined under the Milk (Special Designations) Order, 1923:— Certified Milk. Licensed country producers supplying milk to licensed local dairymen 7 Grade A (Tuberculin Tested) and Grade A Milks. Licensed Croydon producer of Grade A Milk 9 Licensed country producer of Grade A (Tuberculin Tested) milk supplying milk to a licensed local dairyman 5 In each case of Certified, Grade A (Tuberculin Tested) and Grade A milks the samples were found to conform with the requirements of the Order. 61 307 The following tables summarise the results of the bacteriogical examinations of Certified, Grade A (Tuberculin Tested) and Grade A samples, from 1st January to 31st December, 1926:— CERTIFIED MILK. Present. Absent. Oyer 30.000 per c.c. Under 30,000 per c.c. Present in 1/10 c.c. Not present in 1/10 c.e. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Tubercle bacillus 7 Total number of bacteria 7 Bacillus Coli 7 Blood 7 Pus 7 Detritus 7 7 7 7 7 7 7 The above 7 Certified Milk samples contained total bacteria per c.c. as follows:— 1,000 — 5,000 3 5,000 — 10,000 2 10,000 — 20,000 — 20,000 — 30,000 2 7 Under the Regulations Certified Milk must not contain more than 30,000 bacteria per c.c. GRADE A (TUBERCULIN TESTED) AND GRADE A MILKS. 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 ... 14 Total number of bacteria ... 14 bacillus coli ... 14 Blood ... 14 Pus ... 14 Detritus ... 14 14 14 14 14 14 14 62 308 The 14 Grade A (Tuberculin) and Grade A Milks contained bacteria per c.c. as follows:– 1,000 — 5,000 8 5,000 — 10,000 4 10,000 — 20,000 1 120,000 —150,000 1 14 Under the Regulations Grade A (Tuberculin Tested) or Grade A milk must not contain more than 200,000 bacteria per c.c. PROVISIONS AS TO MILK SUPPLY. During the year 247 primary samples of ordinary milk were procured and submitted to examination for tuberculosis in accordance with the Milk and Dairies (Consolidation) Act, 1915. These samples were taken as follows:— Samples taken at cowsheds in the Borough 24 Samples in course of delivery from country cowsheds to local dairymen and purveyors of milk in the Borough 73 Samples taken at dairymen's premises in the Borough 20 Samples taken in course of delivery by local dairymen or milk sellers on their rounds in different parts of the Borough 128 Other samples taken 2 247 Of the 247 samples two were found to be tuberculous. One of these samples was stated to be from milk produced in Surrey. An examination of the herd at the farm was made by the County authorities. As the milk in question was from a large dairy in the Borough of Croydon who also purchased milk from other sources, there was a possibility of the milk from this farm being mixed. This would seem to be the case as no positive results arose from any of the investigations made. The second sample in question was found to be from milk produced in East Sussex. Notification was forwarded to the County Medical Officer who had an investigation carried out which showed that on the particular farm tuberculosis was found after the animal had been slaughtered under the Tuberculosis Order, 1925. 63 309 The following table summarises the results of the bacteriological examination of ordinary milk samples taken under the Milk and Dairies (Consolidation) Act, 1915, from 1st January to 31st December. 1926:— 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. Tuberclc bacillus 2 245 Total No. of bacteria 19 228 Bacillus Coli 102 145 Blood ... 247 Pus ... 247 Detritus ... 247 2 245 19 228 102 145 ... 247 ... 247 ... 247 The above 247 samples of ordinary milk contained total bacteria per c.c. as follows:— 1,000 — 5,000 8 5,000 — 10,000 25 10,000 — 20,000 34 20,000 — 30,000 20 30,000 — 40,000 18 40,000 — 50,000 25 50,000 — 100,000 78 100,000 — 150,000 17 150,000 — 200,000 3 200,000 — 250,000 1 250,000 — 750,000 9 750,000 — 1,000,000 4 1,000,000 — 2,000,000 5 247 There is no standard fixed for total bacteria per c.c. in ordinary commercial milk, but comparing the results with the Grade A standard, i.e. 200,000 per c.c., it will be seen that 228 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. 64 310 The 247 samples taken under the Milk and Dairies (Consolidation) Act, 1915, were samples of milk which had been produced in the following areas:— Areas. No. obtained. No. Tuberculous. Percentage. Croydon 24 Dorset 2 — — Kent 12 — — Surrey 4 1 25% Sussex 55 1 l.8% *Unclassified 150 — Totals 247 2 — *These samples could not be classified owing to the fact that it was mixed milk of large dairy firms or wholesale purveyors of milk, who obtain 'their milk from practically all the areas mentioned in the above table. SALE OF FOOD AND DRUGS ACT. During the year 290 samples of milk (280 new and 10 condensed) and 335 other samples were taken. In three instances the vendors were prosecuted, eleven were warned, four were covered by a declaration, and in sixteen instances no action was deemed necessary. 65 311 1.—Summary of Samples. During 1926 samples were obtained and submitted to the Public Analyst, as follows:— Sample of Total Samples. Genuine. Not Genuine. Prosecutions. Convictions. Caution. Milk 280 270 10 3 3 7 Condensed milk 10 10 – – – – Cream 3 2 1 – 1 „ preserved 3 3 – – Aspirin tablets 1 1 – – – Arrowroot 6 6 – – – – Baking Powder 10 10 – – – – Banana Cream 1 – 1 – – – Boric Ointment 1 1 – – – – Brawn 8 7 1 – – – Bread 6 6 – – – – Bun Flour 2 2 – – – – Butter 17 16 1 – – 1 Camphorated Oil 4 4 – – – – Castor Oil 2 1 1 – – – Cheese 7 7 – – – – Clipper Peas 1 1 – – – – Cocoa 12 12 – – – – Coffee 12 12 – – – – „ and Chicory 1 1 – – – – Coffee Essence 3 3 – – – – Confection of Senna 1 1 – – – Corn Flour 2 1 – – – Cream of Tartar 4 4 – – – Curry Powder 2 2 – – – – Essence of Almonds 2 2 – – — – Faggots 1 1 – – – – Fish Paste 2 2 – – — – Flour 9 9 – – — – Ginger Ale 3 3 – – — – Golden Syrup & Treacle 8 8 – – — – Ground Ginger 5 5 – – — – Ground Rice 6 6 – – – – Honey 4 4 – - — – IceCream 10 15 4 - — – Jam 13 13 – - — – Jonathan Apples 2 2 – - — – Lard 12 12 – - — – lemonade 3 3 – - – – Lemon Squash 3 1 2 - – – Lime Juice Cordial 2 2 – – — – Lime Water 1 1 – – — – Liquorice Powder Compd. 4 4 – – — – Madeira Cake Mixture 1 1 – – — – Magnesia Light Calcnd 1 1 – – — – Malt Vinegar 9 9 – - — – Margarine 12 12 – - — – Meat Pies 1 1 – – — – Milk of Sulphur 2 2 – – — – Pickles (various) 8 8 – - — – Mixed Spice 2 2 – - — – Oil of Sweet Almonds 2 2 – – — – Olive Oil 5 5 – – .. – Pepper 5 5 – – — – Rocbelle Salt 1 1 - — – Sausages 21 15 6 - — – Shredded Beef Suet 5 5 – – – Sponge cakes 13 13 – - — – Sponge mixture 2 2 – - — – Sugar of Milk 1 1 – - — – Sweets 5 5 – - — – Sweet Spirits of Nitre 4 4 – – – Syrup of Rhubarb 1 1 – – - – Tea 9 7 2 – - 2 Tinned Asparagus 1 1 – – — – Tinned Peas 6 1 5 – - – Tinned Tomatoes 3 3 – – - – Veal and Ham Sausage 1 1 – – - – Whiskey 5 5 – – - – Zinc Ointment 1 1 — — — – Totals 625 591 34 3 3 11 66 312 2.—Result of Analysis of New Milk Samples. SOLIDS NOT FAT. ("Legal standard is 8.5%). 7.5 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 9.0 9.1 9.2 9.3 9.4 * 1 1 1 2 4 11 27 49 77 58 24 13 5 2 2 Total 277 MILK FAT. ('Legal standard is 3%). 2.1 2.3 2.7 2.8 2.9 3.0 3.1 3.2 3.3 3.4 3.5 3.6 * 2 1 1 1 4 7 7 15 31 27 42 57 3.7 3.8 3.9 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 22 16 12 11 8 3 5 1 2 1 1 Total 277 Total Samples of New Milk 277 „ „ Separated Milk 2 „ „ (Informal) 1 280 Country Milk in course of delivery at Railway Stations 4 On Milk Rounds (Sundays) 30 „ (Week-days) 231 At Shops 8 Taken at Institutions 7 280 AVERAGE COMPOSITION OF ALL MILK SAMPLES. Milk Fat 3.54% Solids not Fat 8.80% Percentage of Milk Samples below legal standard: 3.2% 3.—Adulterated Samples. The following is a detailed statement of the adulterated samples and action taken:— No. Sample. Adulteration or Deficiency. Remarks. 1046. Tea Contained 0.015% magnetic iron or steel particles. Vendor warned. 1110. New Milk 3% deficient of milk fat Vendor warned. 1125. Pork Sausages Contained 0.22% Boric Acid. No action. 1160. Castor Oil Hubl. No. 70% Iodine absorbed Sp. Gr. 0.967. No action. 1202. New Milk 1% added water Vendor warned. 1210. Tinned Peas Contained copper 2 grains per pound. No action. Declaration on tin. 1266. Tinned Peas Contained Copper 0.006% No action. Declaration on tin. 67 313 1305. Ice Cream Contained Boric Acid 0.11% No action. 1306. Ice Cream Contained Boric Acid 0.08% No action. 1341. Butter Contained 16.1% Water (Excess 1%). Vendor warned. 1348. Ice Cream Contained Boric Acid 0.02% No action. 1384. Tinned Peas Contained Copper 0.005% No action. Declaration on tin. 1399. Banana Cream Contained Salicylic Acid 280 parts per million. No action. 1434. New Milk 3% added water Vendor warned. Another sample taken which was genuine. 1435. New Milk 1% added water Vendor warned. Another sample taken which was genuine. 1471. New Milk Slight deficiency of milk fat. Vendor warned. 1485. Pork Sausage Contained Boric Acid 0.06% No action. 1487. Ice Cream Contained 0.02% Boric Acid No action. 1515. New Milk Contained 11% added water. Vendor fined £1 and costs. 1537. New Milk Extraneous and visible dirt 1 part per 100,000 by volume. Vendor warned. (Informal sample). 1547. New Milk 7% deficient of milk fat Vendor warned & explanation accepted. 1556. Tea Metallic iron and magnetic Oxide of Iron 0.04% Vendor warned. Further samples proved genuine. (Informal sample). 1566. Cream Contained Boric Acid 0.1% Vendor warned. Same hand can had been used for delivering 'Preserved' and 'Unpreserved' Cream. Another sample taken — genuine. 1570. Beef Sausage Sulphur dioxide 1600parts per million. No action. 1578. Tinned Peas Contained Copper 0.006% No action. Declaration on tin. 1591. Beef Sausage Sulphur dioxide 500 parts per million. No action. 1596. Lemon Squash Sulphur dioxide 130 parts per million. No action. 1621. Lemon Squash Benzoic Acid 500 parts per million. No action. 1628. Tinned Peas Contained Copper 0.004% No action. Explanation accepted. 1651. New Milk 28% deficient of milk fat Vendor fined £5 and 1653. New Milk 27% deficient of milk fat costs in each case. 1660. Brawn Boric Acid 0.08% No action. 1661. Beef Sausage Sulphur dioxide 65 parts per million. No action. 1662. Beef Sausage Sulphur dioxide 450 parts per million. No action. 68 314 MILK AND CREAM REGULATIONS, 1912 AND 1917. Report for the year ended 31st December, 192b:— 1.—Milk and Cream not soid as Preserved. Number of samples examined for the presence of a preservative. Number in which a preservative was reported to be present. MILK 280 Nil. CREAM 3 1* In one instance Boric Acid to the extent of 0.1 per cent. was found in cream not sold as preserved cream. A satisfactory explanation was furnished, and no further action 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 3 (ii) Statements incorrect Nil. Total 3 (b) Determinations made of milk fat in cream sold as preserved cream:— (i) Above 35 per cent. 3 (ii) Below 35 per cent. Nil. Total 3 (c) Instances where (apart from analysis) the ments 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. 69 315 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 1926 was seven and in addition five licences were renewed and two additional licences were 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. DISINFECTION. 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. The following articles were disinfected at the Disinfecting Station during the year:— No. of Articles. By steam 21,051 By formalin gas 1,625 By formalin spray 447 23,123 In addition 884 articles were destroyed on request. Disinfection after infectious or contagious disease was carried out in 2,131 rooms at 1,519 houses. 10 classrooms at 8 schools. 2 huts. 7 hospital wards. 2 vehicles. 1 motor ambulance. 70 316 Cleansing of Verminous Persons, etc. During the year 11 adults and 3 children were cleansed for verminous conditions, 1 adult and 9 children for scabies, 2 adults for ring worm and 2 adults and 38 children after contact with infectious disease. RATS AND MICE DESTRUCTION. The rat catcher is a permanent member of the staff and no charge is made for his services. Rats are destroyed by the following methods:—dogs, ferrets, poison baits, traps, and rat varnish smeared on cardboard. Close co-operation is carried out between the rat catcher and the District Sanitary Inspectors or District Food Inspectors. The following is a summary of the visits paid during 1926 under the Rats and Mice (Destruction) Act, 1919:— Premises. No. of Visits Made. No. of Poison and other Baits laid. No. of Rats killed Private Houses 1220 Butchers 55 Fishmongers 8 Other premises where food is prepared or sold 93 2467 1775 Other shops 87 Stables 15 Other premises 151 Total 1629 2467 1775 71 317 SECTION VIII.—APPENDIX TO PUBLIC HEALTH REPORT, 1926. containing the following tables:— Table 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. (K).—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. „ XL—Meteorological record. „ XII.—Prevailing direction of wind. 73 TABLE I.—Vital Statistics of whole Borough during 1926 and previous years. Year. Population estimated to Middle of each Year. Births. Total Deaths Reg. in the District. Transfer1 able Deaths Nett deaths belonging to the District. Births and Deaths. Illegitimate Children Uncorrected Number. Nett. of Non-residents registered in the District. of Reside its 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 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 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 11.1 196 49 250 1918. 188,755‡ 2632 2626 13.9 2687 15.9 388 245 202 76 2544 15.1 205 25 122 1919. 191,922 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 2064 10.7 171 19 111 1922. 192,300 3616 3605 18.2 2469 12.8 337 255 224 64 2387 12.4 147 25 170 1923. 193,400 3446 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 1925. 199,300 3521 3406 17.1 2262 11.4 336 243 187 66 2169 10.9 130 24 180 Average for 10 years 190,768 3433 3381 17.7 2292 12.4 307 221 228 68 2206 11.7 176 32 181 1926. 205,900 3569 3477 16.9 2340 11.4 318 247 211 61 2269 11.0 148 25 169 * Rates calculated per 1.000 of estimated population. †Registrar General's estimate of civilian population. Registrar General's estimate of civilian population for death rate, 168,462. „ 184,239. § „ „ „ „ .. .. 191,580. 318 319 TABLE II. Year. Puerperal Sepsis. Other maternal accidents & diseases of pregnancy and parturition. Cancer Pneumonia (all forms, except influenzal pneumonia). Influenza. Bronchitis and other respiratory diseases (excluding pneumonia and tuberculosis). 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 1818 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 1926 11 3.16 13 3.74 330 1.60 149 .72 44 .21 123 .60 74 320 TABLE III. County Borough of Croydon— Whole Borough. INFANT MORTALITY, 1926 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 59 9 4 8 80 47 41 25 18 211 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 2 1 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 3 1 1 ... 5 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... 1 ... ... ... 1 Tuberculous Meningitis ... ... ... ... ... 1 ... 4 2 7 Abdominal Tuberculosis ... ... ... ... ... ... 1 ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis(not tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 3 ... ... 1 5 2 1 ... ... 8 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 1 1 4 3 ... ... 8 Pneumonia (all forms) ... ... 2 1 3 5 10 3 7 28 Diarrhoea, Enteritis & Gastro Enteritis 1 ... ... ... 1 6 7 9 2 25 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... 1 2 ... 1 4 Rickets ... ... ... ... ... ... ... 1 ... 1 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 10 ... 1 ... 11 ... 1 ... ... 12 Congenital Malformations 8 1 ... 1 10 7 2 ... 1 20 Premature Birth 30 3 1 2 36 4 ... ... ... 40 Atrophy, Debility and Marasmus 1 2 ... 2 5 7 10 4 3 29 Other causes 4 2 ... ... 6 6 3 1 1 17 59 9 4 8 80 47 41 25 18 211 Nett Births in the year legitimate, 3329. Nett Deaths in the year lgitimate infants, 186. illegitimate, 148. legitimate infants, 25. 75 76 TABLE III.—continued. INFANT MORTALITY. Deaths in UPPER NORWOOD WARD. NORBURY WARD. CAUSES OF DEATH Under 1 Week. 1-2 Weeks. 1-3 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 5 ... 2 ... 7 ... 2 2 2 13 4 1 ... ... 5 2 1 ... 2 10 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... 1 ... 1 ... ... ... 2 3 ... ... ... ... ... ... ... ... ... 1 Diarrhoea, Enteritis & Gastro Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Atelectasis 1 ... ... ... 1 ... • ... ... 1 .. ... ... ... ... ... ... ... ... ... Congenital Malformations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 4 ... 1 ... 5 ... ... ... ... 5 2 1 ... ... 3 ... ... ... ... 3 Atrophy, Debility and Marasmus ... ... ... ... ... ... 2 2 ... 4 1 ... ... ... 1 1 1 ... ... 3 Other causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... 2 ... 7 ... 2 ... 2 13 4 1 ... ... 5 2 1 ... 2 10 *Gross Births in the year legitimate 234. Nett Deaths in the year legitimate infants, 10. Gross legitimat, illegitimate, 17 0. Netl 3. Deaths f legitimate infants 10. illegitimate 6. illegitimate infants, 3. Births te, I illegitimate infan ... 321 *The figures of inward and outward transfers are not available for the ward 77 TABLE III. — continued. INFANT MORTALITY. Deaths in WEST THORNTON WARD. BENSHAM 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 One 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 Cause Certified 6 1 ... ... 7 3 3 1 1 15 4 ... ... 1 5 7 2 1 ... 15 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 ... ... ... 1 Pneumonia all forms) ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 ... ... 1 Diarrhoea, Enteritis & Gastro Enteritis 1 ... ... ... 1 ... ... ... 1 3 ... ... ... ... ... 1 ... 1 ... 2 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... ... ... ... 2 Congenital Malformations ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... ... ... 3 Premature Birth ... ... ... ... 4 ... ... ... ... 4 2 ... ... ... 2 2 ... ... ... 4 Atrophy, Debility and Marasmus ... 1 ... ... 1 1 ... ... ... 2 ... ... ... ... ... ... 1 ... ... 1 Other causes 1 ... ... ... 1 ... 1 ... ... 2 ... ... ... ... ... 1 ... ... ... 1 6 1 ... ... 7 3 3 1 1 15 4 ... ... 5 7 2 1 ... 15 *Gross Births in the year legitimate, 447. Nett Deaths in the year legitimate infants, 15. Gross Births legitimate, 211. nett Death legitimate infants, 13 illegitimate , 80†. illegitimate infants, . illegitimate, 6. illegitimate infants 2. 322 * The figures of inward and outward transfers are not available for the wards. † The heavy illegitimate figure is due to the inclusion of births at the Mayday Road Hospital. 78 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 4 ... ... ... 4 1 2 ... ... 7 7 ... 1 1 9 5 1 2 3 20 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 ... 1 ... ... 2 ... ... ... ... ... 1 ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 Pneumonia (all forms) ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 ... 1 1 3 Diarrhoea, Enteritis & Gastro Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 Congenital Malformations 1 ... ... ... 1 ... 1 ... ... 2 3 ... ... ... 3 ... ... ... ... 3 Premature Birth 2 ... ... ... 2 ... ... ... ... 2 4 ... ... ... 4 ... ... ... ... 4 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 Other causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 3 4 ... ... ... 4 1 2 ... ... 7 7 ... 1 1 9 5 l 2 3 20 *Gross Births in the year legitimate, 179. Nett Deaths in the year legitimate infants, 6. Gross Births legitimate, 221. Nett Deaths legitimate infants, 18. illegitimate, 3. illegitimate infants, 1. illegitimate, 27. illegitimate infants, 2. 323 The figures of inward and outward transfers are not available for the wards. 79 TABLE III.—continued. INFANT MORTALITY. Deaths in WOODSIDE WARD. EAST 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 l Year. All Causes Certified 2 1 ... ... 3 ... 3 2 2 10 2 ... ... ... 2 ... 1 1 ... 4 uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... ... ... ... 2 ... ... 2 ... ... ... ... ... ... ... ... ... ... Diarrhoea, Enteritis& Gastro Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... 1 ... 1 2 ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 2 ... ... ... 2 ... ... ... ... 2 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 Premature Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, and Marasmus ... ... ... ... ... ... ... 1 1 2 ... ... ... ... ... ... ... ... ... ... Other causes ... 1 ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 2 1 ... ... 3 ... 3 2 2 10 2 ... ... ... 2 ... 1 1 ... 4 *Gross Births in the year legitimate. 194. Nett Deaths in the Year legitimate infants 7. Gross legitimate, 180. N ett Deaths legitinate infants, 4. illegitimate, 4. illegitimate infants 3. Births illegitimate. 1. illegitimate infants, — 324 *The figures of inward and outward transfers are not available for the wards. 80 325 TABLE III.—continued. INFANT MORTALITY. Deaths in ADDISCOMBE WARD. WHITEHORSE MANOR WARD. CAUSES OK 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 ... ... ... 3 2 2 ... 1 8 8 2 1 2 13 10 8 6 3 40 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 2 1 ... ... ... 3 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... 2 3 Pneumonia (all forms) ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ... 1 ... 1 ... 3 5 Diarrhoea, Enteritis & Gastro Enteritis ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 3 3 3 ... 9 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 2 ... ... ... 2 ... ... ... ... 2 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... 1 2 ... ... ... 3 Premature Birth ... ... ... ... ... ... ... ... ... ... 6 ... ... ... 6 ... ... ... ... 6 Atrophy, Debility and Marasmus ... ... ... ... ... ... 1 ... ... 1 ... 1 ... 1 2 2 2 ... ... 6 Other causes 1 ... ... ... 1 1 ... ... ... 2 ... ... ... ... ... ... 1 ... ... 1 3 ... ... 3 2 2 ... 1 80 8 2 1 2 13 10 8 6 3 40 *Gross Births in the year legitimate. 138. Nett Deaths in the year legitimate infants, 7. Gross Births legitimate, 341. Nell Deaths legitimate infants, 39. illegitimate, 3 illegitimate infants, 1. illegitimate, 10. illegitimate infants, 1. *The figures of inward and outward transfers are not available for the wards. 81 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 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths umder 1 Year. Under 1 Week. 1-2 Weeks. 2-3 Weeka. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Month#. 6-9 Months. 9-12 Months. Total Deaths under 1 Year. All Causes Certified 4 1 ... ... 5 5 1 4 3 18 4 2 ... 1 7 4 4 2 ... 17 Uncertified . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... ... ... 1 1 1 ... 3 ... ... ... ... ... ... 1 1 ... 2 Diarrhoea Enteritis & Gastro Enteritis ... ... ... ... 1 ... 2 1 4 ... ... ... ... ... ... 2 ... ... 2 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Rickets ... ... ... ... ... ... ... ... ... . ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Malformations 2 ... ... ... 2 1 ... ... ... 3 ... ... ... ... ... ... 1 ... ... 1 Premature Birth 1 1 ... ... 2 ... ... ... ... 2 3 ... ... ... 3 ... ... ... ... 3 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 1 1 ... ... ... 2 Other causes ... ... ... ... ... 1 ... ... ... 1 1 1 ... ... 2 2 ... ... ... 4 4 1 ... ... 5 5 1 4 3 18 4 2 ... 1 7 4 4 2 ... 17 326 *Gross Births in the year legitimate, 535. illegitimate, 10. Nett Deaths in the year legitimate infants, 17. illegitimate infants, 1. Gross Births legitimate, 181. illegitimate, 1. Nett Heaths legitimate infants, 15. illegitimate infants, 2. *The figures of inward and outward transfers are not available for the wards. 82 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. To-tal under 1 Month. 1-3 Month8. 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... 1 1 ... 3 5 5 5 5 1 16 5 ... ... ... 5 3 6 3 1 18 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chick en-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions i ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 ... ... ... 1 Pneumonia (all forms) ... ... ... 1 1 ... 1 ... ... 2 ... ... ... ... ... ... 1 1 1 3 Diarrhoea, Enteritis & Gastro Enteritis ... ... ... ... ... 1 1 ... ... 2 ... ... ... ... ... ... 1 1 ... 2 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... 2 Congenital Malformations ... ... ... ... ... 2 ... ... ... 2 1 ... ... ... 1 ... ... ... ... 1 Premature Birth ... 1 ... 2 3 1 ... ... ... 4 2 ... ... ... 2 1 ... ... ... 3 Atrophy, Debility and Marasmus ... ... ... ... ... 1 1 1 ... 3 ... ... ... ... ... ... 2 ... ... 2 Other causes ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ... 2 1 1 ... 3 5 5 5 1 ... 16 5 ... ... ... 5 3 6 3 1 18 327 *Gross Births in the year legitimate, 161. illegitimate, 7. Nett Deaths in the year legitimate infants, 16, illegitimate infants,— Gross Births legitimate, 211. illegitimate, 5. Nett Deaths legitimate infants, 9. illegitimate infants, 9. *The figuies of inward and outward transfers are not available for the wards. 83 TABLE IV. Causes of, and ages at, death during year ending December 31st. 1926. excluding deaths of non-residents which occurred in the Borough, and adding neaths of Croydon residents known to have occurred outside the district No. CAUSE LOCALITIES. Institution Street Deaths which could not he distributed. i 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. Nor bury. 1 W. Thornton. Bensham Mnr. Thornton Hth. 1 8th. Norwood. Woodside. East. 1 Addiscombe. Whitehorse Mnr Broad Green. Central. Wad don. South. I. — General Diseases. M F M F M M h M F M t- M F M F 1 Enteric Fever ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 2 (1) ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 (A B.) Relapsing Fever (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 ... ... 4 ... 1 ... 2 1 ... ... 1 ... 4 (1) ... 13 9 4 ... 3 3 ... 4 ... 2 1 ... ... ... ... ... ... ... ... 7 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 Whoopeng Cough ... ... 1 ... 1 1 ... 1 ... 3 2 ... ... ... ... 2 (1) ... 9 7 2 4 1 2 1 1 ... ... ... ... ... ... ... ... ... ... ... 9 (A) Diphtheria (B.C.) Croup 12 2 2 ... 3 1 2 1 ... 2 2 1 4 ... ... 28(1) 1 32 15 17 ... ... 1 ... 6 6 8 11 ... ... ... ... ... ... ... ... (B) Membranous laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Influenza. 7 7 4 4 3 4 ... 2 3 4 1 1 2 2 ... 7 (2) ... 44 26 18 ... ... 1 ... 1 ... 2 ... 5 3 10 1 10 11 11 Miliary Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Asiatic Cholara ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Cholera Nostras ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Yellow Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Leprosy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Erysipelas 1 ... 1 ... ... ... ... ... ... 1 ... ... 1 1 ... 6 (2) ... 5 4 1 1 ... ... ... ... ... ... ... ... ... 1 1 ... ... 2 ... 328 84 19 (A.B.C.D.) other Epidemic Diseases (A) Mumps ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) German Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Varicella ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other Diseases included under 19 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 (A B C.) Pyaemia, Septicaemia (A) Pyaemia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Septicaemia ... 1 ... ... 1 1 ... 1 ... ... ... ... ... ... ... 5(2) ... 4 2 2 ... ... ... ... ... ... ... ... ... ... ... 1 2 1 ... (C) Vaccinia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 Anthrax (Splenic Fever) . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Rabies . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 24 Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 25 (A.B.) Mycoses (A) Actinomycosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other Mycoses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 Pellagra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Beri- beri ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28 (A.B) Pulmonary Tuberculosis Inot acute) (A) Pulmonary Tuberculosis 15 7 10 8 13 7 10 9 10 11 17 7 9 8 2 83(13) 4 143 72 71 ... ... ... ... ... ... ... 10 22 38 30 22 14 2 5 (B) Phthisis (not defined as tuberculous) 2 1 3 1 1 1 ... 1 1 6 2 3 1 1 ... 3 1 24 9 15 ... ... ... ... ... ... ... ... 1 1 4 7 4 5 2 29 (A) Acute Phthisis ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 2 1 1 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... (B) Acute Miliary Tuberculosis ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... 2 ... 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... 30 Tuberculous Meningitis ... 2 2 2 ... ... 2 ... 1 1 4 1 2 ... 13 (3) ... 17 11 6 3 4 4 ... 1 2 2 ... 1 ... ... ... ... ... ... ... 31 (A.B.) Tuberculosis of Peritoneum and Intestines (A) Tabes Mesenterica ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... (B) Other Peritoneal and Intestinal Tubercle 1 1 ... 1 ... 1 1 1 1 ... 2 2 1 9 ... 12 5 7 1 ... 2 ... 1 1 1 3 ... 1 ... 1 1 ... ... 32 Tuberculosis of Spinal Column ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 33 Tuberculosis of Joints ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 34 (A B.C.) Tuberculosis of other Organs (A) Lupus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Scrofula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other Tuberculosis included under 34 ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 35 Disseminated Tuberculosis 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... 2 ... 3 1 2 ... ... ... ... ... ... 1 1 1 ... ... ... ... 36 (A.B.) Rickets, Softening of Bones (A) Rickets ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other forms of Bone Softening ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 339 85 TABLE IV.—continued. No. CAUSE LOCALITIES. Institution & Street Deaths which could not be distributed. Total Institution Deaths distributed i and not distributed. Inquest Cases. Total all Ages. Males all Ages. Females all Ages. I 0 1. 1-2. 2-5. 5-15. 15-25. 25-45. I 45-66. 65 and upwards Up. Norwood. Norbury. W. Thornton. j Ben sham Mnr. Thornton Hth. 8th. Norwood. Woodside. East. Addiscombe. Whitehorse Mnr Broad Green. Central. W addon. South. 37 Svphilis M F M F M F M F M F M F M F M F 1 ... ... ... ... ... 2 ... ... ... ... 1 1 ... ... 7 (3) ... 5 4 1 3 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 38 (A B.C.) Other Venereal Di.-eases (A) Soft Chancre ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... l (Bl Conococcus Infection ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Purulent Ophthalmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 39 Cancer of the Buccal Cavity 1 ... ... 1 1 ... 2 ... 1 2 1 2 ... 1 ... 8 (1) 1 12 11 1 ... ... ... ... ... ... ... ... ... ... ... ... 6 ... 5 1 40 Cancer of the Stomach, Liver, &c. 2 3 8 7 9 7 5 8 5 4 7 5 7 5 ... 37 (7) 2 82 45 37 ... ... ... ... ... ... ... 1 ... ... 2 4 24 9 19 23 41 Cancer of the Peritoneum, Intestines & Rectum 11 4 2 9 4 5 5 9 3 6 6 5 10 4 ... 44 (8) ... 83 36 47 ... ... ... ... ... ... ... ... ... ... 3 2 19 13 14 32 42 Cancer of the Female Genital Organs 1 4 3 1 2 2 3 3 2 4 2 6 2 6 ... 22 (3) ... 41 ... 41 ... ... ... ... ... ... ... ... ... ... ... 6 ... 20 ... 15 43 Cancer of the Breast 1 3 1 2 1 3 4 2 3 2 2 4 4 6 ... 17 (4) ... 38 2 36 ... ... ... ... ... ... ... ... ... ... ... 2 1 18 1 16 44 Cancer of the Skin ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 4 (2) ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 45 Cancer of other or unspecified Organs 6 5 8 7 1 4 2 5 7 4 3 10 5 5 ... 43 (6) 1 72 50 22 ... ... 2 ... 1 ... ... 1 5 3 18 13 24 5 46 (A. B.C.) Other Tumours (situation undefined) (A) Angioma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Osteo-arthritis 1 ... ... 1 3 ... ... 1 1 ... 1 2 3 ... ... 5(1) ... 13 3 10 ... ... ... ... ... ... ... ... ... ... 1 ... ... 3 2 7 (C) Other Tumours included under 46 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 47 Rheumatic Fever 1 ... 1 ... ... 3 1 ... ... 1 2 1 ... 1 ... 2 ... 11 4 7 ... ... ... ... ... ... 2 2 2 1 ... ... ... 2 ... 2 48 (A.B.) Chronic Rheumatism, Osteo-arthritis (A) Chronic Rheumatism ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... (B) Osteoarthritis 1 ... ... 1 3 ... 1 1 ... 1 2 3 ... ... 5 (1) ... 13 3 10 ... ... ... ... ... ... ... ... ... ... 1 ... ... 3 2 7 (C) Gout ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 2(1) ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 49 Scurvy . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 Diabetes 2 ... 2 1 1 5 ... 2 1 ... ... 2 ... ... ... 9 (4) 1 16 8 8 ... ... ... ... ... ... ... ... 1 ... 2 1 2 4 3 3 51 Exophthalmic Goltre ... ... ... ... 1 1 1 ... ... ... 1 2 ... ... ... 3 ... 6 1 5 ... ... ... ... ... ... ... ... ... ... 1 3 ... 2 ... ... 52 Addison's Disease ... 1 ... ... 1 ... ... ... ... ... 1 1 ... ... ... 1 ... 4 1 3 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 53 (A.B. Leucocvthsemia, Lyrnphadenoma (A) Leucocythaimia (Leucaemia) ... 2 ... ... 2 1 ... ... ... 1 ... ... 2 ... 1 ... 4(2) ... 9 7 2 ... ... ... ... 2 ... 1 ... ... ... 2 ... ... 1 2 1 (B) Lyrnphadenoma ... ... ... ... ... 3 1 ... ... ... ... ... 1 1 ... 6 (2) ... 6 6 ... ... ... ... ... ... ... ... ... 2 ... 2 ... 2 ... ... ... 330 86 54 Anaemia, Chlorosis 1 1 1 ... ... ... ... 1 ... 1 3 1 1 1 ... 4 ... 11 4 7 ... ... ... ... 1 ... ... ... ... ... ... 1 5 3 1 55 (A. B.C.D.) Other General Diseases (A) Diabetes Insipidus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Purpura ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 2 ... 2 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (C) Haemophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (1) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other Diseases included under 55 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 56 Alcoholism (acute or chronic) ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 2 (1) ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... I ... 1 57 (A.B.) Chronic lead poisoning (A) Occupational lead poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Non-occupational lead poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 58 Other chronic occupational poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 59 Other chronic poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... II.—Diseases of the Nervous System and of the Organs of Special Sense. 60 Encephalitis ... ... ... ... 1 1 ... ... 1 ... 2 ... ... ... ... 3 (1) ... 5 3 2 ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 61 (A) Cerebro spinal fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 61 (B.C.) Meningitis, other forms or undefined (B) Posterior basal meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Meningitis, other forms . ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 1 2 ... 2 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 62 Locomotor Ataxy . 1 ... 2 ... ... ... ... 2 2 ... ... ... ... ... 6 (1) ... 7 6 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 4 1 63 (A.B.) Other diseases of the spinal cord (A) Diseases formerly classed to " Other nervous affections" ... ... ... 1 ... ... 2 ... ... 1 1 1 1 1 ... 6 (3) ... 8 4 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 3 3 (B) Other diseases included under 63 4 ... 2 1 ... 2 .. 1 .. 1 ... 2 ... 1 ... 8 (2) 1 14 6 8 ... ... ... ... ... ... ... ... ... ... 1 3 3 3 2 2 64 (A.B.C.D.E.) Cerebral haemorrhage, Apoplexy (A) Apoplexy ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... (B) Serous apoplexv and oedema of brain ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Cerebral congestion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Cerebral atheroma ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... (E) Cerebral haemorrhage 10 9 7 8 12 17 8 5 7 10 5 11 2 5 1 47(12) 8 117 44 73 ... ... ... ... ... ... ... ... ... ... 1 2 14 23 29 48 65 Softening of brain ... 1 ... ... ... ... 1 ... ... ... 1 ... ... ... .3 ... 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 66 (A.B.C.I Paralysis without specified cause (A) Hemiplegia ... l ... 1 1 ... ... ... ... ... ... 1 1 ... 1 ... 5 3 2 ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 2 (B) Paraplegia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other forms of paralysis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 331 00 TABLE IV—continued. No. CAUSE. LOCALITIES. Institution & Street Deaths which could not, he distributed. Total Institution Deaths distributed and not, distributed. Inquest Cases. Total all Ages. Males all Ages. Females all Ages. 0-1. 1-2. 2-5. 5-15. 15-25. 25-45- 45-65. 65 and upwards. CJp. Norwood. Nor bury. W. Thornton. Bentham Mnr. Thornton Hth. 8th. Norwood. Woodside. East. AddiBcombe. Whitehorse Mnr Broad Green. CentraJ. Waddon. South. M F M r M * M F M M F M F M F 67 General paralysis of the insane ... ... 1 1 1 ... ... ... 1 2 ... 1 ... 1 10 (2) ... 8 5 3 ... ... ... ... ... ... ... ... ... ... 4 2 1 1 ... ... 68 Other forms of mental alienation ... 1 1 1 1 3 ... 1 ... 1 1 1 1 2 ... 15 (1) ... 14 4 10 ... ... ... ... ... ... ... ... 1 1 1 2 5 1 3 69 Epilepsy 1 ... 1 1 ... ... ... ... ... 1 ... ... ... 1 6(1) ... 5 3 2 ... ... ... ... ... 1 ... ... 2 1 ... 1 ... ... 70 (A.B.)ConvuIsions (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 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other infantile convulsions ... ... ... ... 1 1 ... ... ... ... ... 1 1 ... ... 2 (1) 4 7 4 3 4 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 72 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 73 (A.B.I Hysteria, Neuralgia, Neuritis (A) Hysteria, Neuralgia, Sciatica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Neuritis 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (1) ... 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 74 (A. B. C.D.) Other diseases of the nervous system (A) Idiocy, Imbecility ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... (B) Cretinism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Cerevral tumour ... ... 3 ... ... 1 ... ... ... ... ... 1 ... ... 1 ... 5 3 2 . ... ... ... ... ... 1 ... ... 1 1 1 1 ... ... ... (D) Other diseases included under 74 .. ... ... ... ... 1 ... ... ... ... 1 1 1 ... ... 5 ... 6 3 3 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 3 75 Diseases of the eyes and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 76 (A) Mastoid disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 76 (B) Other diseases of the ears ... 1 ... 1 ... 2 1 1 ... ... ... 1 ... ... 8(2) 2 7 6 1 1 ... ... ... ... ... 1 1 1 ... 2 ... 1 ... ... ... III.—Diseases of the Circulatory Svsttm. 77 Pericarditis ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 78 (A.B.C.) Acute endocarditis (A) Acute myocarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Infective endocarditis 1 ... ... 2 ... ... 1 ... 1 ... 1 ... ... ... ... 8(2) ... 6 2 4 ... ... ... ... ... ... ... ... 1 ... 1 3 ... 1 ... ... (C) Other acute endocarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 332 88 79 (A) Valvular disease 3 2 5 8 7 11 6 4 4 11 4 3 10 8 ... 25(10) 10 86 46 40 ... ... ... ... ... ... ... ... 1 ... 8 4 13 14 24 22 79 (B) Fatty degeneration of the heart 2 ... 1 ... ... 1 1 ... 1 ... ... ... 1 ... ... 1 4 7 3 4 ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 3 79 (C) Other organic disease of the heart 11 11 6 9 12 16 20 9 13 16 6 17 15 15 ... 32 (9) 19 176 66 110 ... ... ... ... ... ... ... ... ... ... 1 3 11 14 54 93 80 Angina pectoris ... 1 ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... 4 3 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 81 (A) Aneurysm 1 ... ... ... ... 3 2 ... ... ... ... ... 1 ... ... 1 4 7 2 5 ... ... ... ... ... ... ... ... ... ... ... 1 1 1 4 81 (B) Arterial sclerosis 13 6 11 8 4 15 8 13 16 12 15 5 24 18 1 126(40) 25 169 82 87 ... ... ... ... ... ... ... ... ... ... 2 ... 13 10 67 77 81 (C) Other diseases of arteries ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 82 (A) Cerebral embolism and thrombosis ... 2 3 1 3 5 ... ... 1 ... ... 2 ... 2 ... 9 (2) ... 19 7 12 ... ... ... ... ... ... ... ... ... ... 1 ... 1 4 5 8 82 (B) Other embolism and thrombosis ... ... ... ... ... 2 . ... ... ... ... ... ... ... ... 1 (1) ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 83 (A.B.CD) Diseases of the veins (Varices Hremoirhoids. Phlebitis. &c.) (A) Phlebitis ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... (B) Varix ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 2 ... 2 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... (C) Pylephlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Varicocele ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 (A) Status lymphaticus ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 2 2 1 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 84 (B) Other diseases of the lymphatic system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 86 (A.B.C.) Haemorrhage ; other diseases of the circulatory system (A) Functional disease of the heart ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (B) Epistaxis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other diseases included under 85 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... IV.—Diseases of the Respiratory System. 86 Diseases of the nasal fossae ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (1) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 87 (A. B.C.) Diseases of the larynx (A) Laryngismus stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other diseases of larynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 88 Diseases of the thyroid body ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... 3 (2) ... 3 ... 8 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 89 & (A.B.) Bronchitis (A) Bronchiectasis, Bronchial Catarrh,&c ... ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... 2 ... 3 2 1 ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... 90 (B) Other bronchitis 7 5 5 7 5 9 5 3 4 18 12 1 7 9 1 14 (2) 1 97 42 55 5 3 1 1 ... 1 ... 1 ... ... ... 1 8 7 28 41 91 Broncho-pneumonia 3 4 2 1 6 10 2 3 3 10 12 3 7 7 ... 21 (8) 7 73 25 48 11 12 4 5 2 4 1 1 ... ... 1 ... 4 5 2 21 92 (A.B.) Lobar and undefined. (A) Lobar pneumonia 2 3 4 3 3 1 7 ... 1 3 5 7 3 7 ... 27 (7) 6 49 32 17 2 2 ... ... 1 ... ... ... 1 1 5 4 17 4 6 6 (B) Pneumonia (type not stated) 3 1 ... ... ... 2 1 1 ... 3 2 2 1 ... ... 9(3) ... 16 9 7 1 ... ... ... ... 1 1 ... ... ... 2 3 4 1 1 2 333 89 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. 25-65. 65 and upwards. Up. Norwood. Norbury. W. Thornton. Ben sham Mar. Thornton Hth. 8th. Norwood. Woodside. Elast. Addiscombe. Whitehorse Mnr Broad Green. Central. Wad-don. South. 93 (A.B.) Pleurisy M F M F M F M F M F M F M 1" M F (A) Empyema ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... (B) Other pleurisy ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... 1 ... 3 1 2 ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... 94 (A.B.C.D.) Pulmonary congestion, Pulmonary apoplexy (A) Pulmonary apoplexy and infarction ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (H) Pulmonary cedema and congestion ... ... .. ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Hypostatic pneumonia 2 ... 1 1 1 1 ... ... 1 3 ... 1 ... ... ... 7 (1) ... 11 4 7 ... ... ... ... ... ... ... ... ... ... ... ... ... 4 7 (D) Collapse of lung (3 months and over) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . 95 Gangrene of the lung ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 96 Asthma 1 1 2 2 ... 1 1 ... ... ... ... ... 2 1 ... 2 ... 11 8 3 ... ... ... ... ... ... ... ... ... ... ... ... 4 2 4 1 97 Pulmonarv emphysema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 98 (A) Fibroid disease of lung ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 98 (B) Other diseases of the respiratory system 1 ... ... ... 1 ... ... 1 ... ... 1 ... ... ... 3 1 4 3 1 ... ... ... ... ... ... ... ... 1 ... 1 2 .. .. 99 V.—Diseases of the Digestive System. (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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 100 (A.B.C.) Diseases of pharynx, Tonsillitis (A) Tonsillitis ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... 1 2 3 2 1 ... ... ... ... 1 ... 1 ... ... 1 ... ... ... (B) Ludwig's angina ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Other diseases of the pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 101 Diseases of cesophagus ... ... 1 ... ... ... ... 1 ... ... ... 1 ... ... 2 ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 102 Perforating ulcer of stomach 1 1 2 ... 1 ... ... ... 1 2 1 1 ... 1 ... 8 (3) 1 11 8 3 ... ... ... ... ... ... ... ... ... ... 1 ... 4 2 3 1 334 no 103 (A) Inflammation of stomach 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 3 1 2 ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... 103 (B) Other diseases of the stomach 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 104 (A B.C.D.E.F.G. H.) Diarrhoea and enteritis & (A) Infective enteritis ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 2 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 105 (B) Diarrhoea—Not returned as infective ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 2 1 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Enteritis—Not returned as infective 1 ... 1 ... ... ... ... ... ... 2 2 ... ... ... 2 6 2 4 2 3 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... (D) Gastro-enteritis—Not returned as infective ... ... 1 ... ... 1 2 1 1 6 2 2 2 2 ... 8(1) ... 20 9 11 5 9 1 ... 2 1 ... ... ... ... ... ... ... ... 1 1 (E) Dyspepsia, under 2 years ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 2 2 1 1 1 l ... ... ... ... ... ... ... ... ... ... ... ... ... ... (F) Colic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (G) Ulceration of intestines ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... (H) Duodenal ulcer ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 106 Ankylostomiasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 107 Other intestinal paiasites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 108 Appendicitis 1 2 2 1 ... ... ... 1 2 ... 5 ... ... 15(2) ... 14 10 4 ... ... ... ... 1 ... 2 ... 4 1 1 2 2 1 ... ... 109 (A) Hernia 2 ... 1 ... 1 1 1 ... 1 ... ... 2 1 2 ... 10(3) ... 12 7 5 1 ... ... 1 ... ... ... ... ... ... ... ... 1 5 4 109 (B) Intestinal obstruction 1 ... 1 ... 1 1 1 ... ... 1 ... 1 1 ... ... 12 (6) 3 8 6 2 1 ... ... ... ... ... ... ... ... ... 1 ... 1 2 3 ... 110 Other diseases of the intestines ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 111 Acute yellow atrophy of liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 112 Hydatid of liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 113 I (A. B.C.) Cirrhosis of the liver (A) Cirrhosis of the liver (not returned as alcoholic) ... ... ... 1 2 ... ... ... ... ... ... 2 (1) ... 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... (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 ... ... ... ... 2 ... 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 115 Other diseases of the liver ... ... ... ... ... 2 ... 1 ... 1 1 1 1 ... 5 (1) ... 7 2 5 ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 4 116 (A. B.) Diseases of the spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases of the spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 117 Peritonitis (cause unstated) ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 2 2 ... 2 ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 118 (A. B.) Other diseases of the digestive system (A) Abdominal abscess, Sub-phrenic abscess ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . . . (B) Other diseases included under 118 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 335 91 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. F°males all Ages. 0-1. 1-2. 2-5. 5-15. 15-25. 25 45. 45-65. 65 and upwards. Up. Norwood. Norbury. W. Thornton. Ben sham Mnr. Thornton Hth. 8th. Norwood. Woodside. East. Addiscombe. Wlhitehjorae Mnr Broad Green. Central. W addon. South. VI. —Non- Venereal Diseases of the Genitourinary System and Annexa. M F M F M F M F M F M F M F M F 119 Acute nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (1) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 120 (A. B.) Bright's disease (A) Brieht's disease as in 1001 list 3 5 7 3 4 3 ... 5 6 8 7 6 1 10 ... 50(13) 4 68 31 37 ... ... ... ... ... ... 1 ... 1 4 4 14 19 13 12 i B/ Nephritis (unqualified), 10 years and over and Ursemia 1 ... ... ... 1 ... 1 ... ... 2 3 1 1 3 ... 5 1 13 3 10 ... ... ... ... ... ... ... ... ... 1 ... 3 2 5 1 1 121 Chyluria ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 (A.B.C.D.) Other diseases of the kidney and annexa (A) Abscess of kidney ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Cystic disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Suppression of urine ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Other diseases included under 122 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 123 Calculi of the urinary passages ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... 3(1) ... 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 124 Diseases of the bladder ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... 1 ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 .. 125 (A.B.) Diseases of the urethra, Urinary abscess, &c. (A) Perineal abscess ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases of urethra, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (1) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Diseases of the prostate ... 1 2 1 ... 1 ... 1 1 2 1 . 1 ... ... 10 (2) ... 11 11 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 10 ... 127 Non-venereal diseases of male genital organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 (A.B.) Uterine haemorrhage (non-puerperal) (A) Menorrhagia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other uterine haemorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 129 Uterine tumour (non-cancerous) 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... 2... 2 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 336 92 130 (A.B.) Other diseases of the uterus (A) Disorder of menstruation (except mer.orrhagial ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Other diseases included under 130 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 131 Ovarian cyst, tumour (non-cancerous) ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... 3 ... 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... 132 (A.B.) Other disens.jof 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) ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 134 VII. — The Puerperal State. (A-B.C. D.E.) Accidents of pregnancy 1 ... 1 ... ... ... 1 ... ... ... ... ... ... 3 1 3 ... 3 ... ... ... ... ... ... ... ... ... ...1... ... 2 ... ... ... ... (B) Haemorrhage of pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Uncontrollable vomiting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Ectopic gestation ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 2 1 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... (E) Other accidents of pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 135 Puerperal haemorrhage ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... 1 1 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... 136 Other accidents of pregnancy ... ... 2 1 1 ... ... ... 1 ... ... ... ... ... ... 5 ... 5 ... 5 ... ... ... ... ... ... ... ... ... ... ... 5 ... ... ... ... 137 Puerperal fever 1 1 ... 1 1 ... 3 ... 1 ... 1 1 1 ... ... 9(1) ... 11 ... 11 ... ... ... ... ... ... ... ... ... 2 ... 9 ... ... ... ... 138 (A.B.C.) Puerperal albuminuria and convulsions (A) Puerperal nephritis and ureamia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Puerperal albuminuria & Bright's disease ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Puerperal convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 (2) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 139 (A.B.) Puerperal phlegmasia alba dolens, embolism, and sudden death (A) Puerperal phlegmasia alba dolens, ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Puerperal embolism and sudden death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 140 Puerperal insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 141 Puerperal diseases of the breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 337 93 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. 8th. Norwood. Wood-side. East. Addiscombe. Whitehorae Mnr Broad Green. Central. Wad don. South. VIII.—Diseases or 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 3 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 6(2) ... 5 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 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 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 144 (A. B.)Phlegmon, acute abscess (A) Phlegmon ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... 3 (1) ... 3 1 2 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 (B) Acute abscess ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 145 (A. B.C. D).) Diseases of the integumentary system (A) Ulcer, Bedsore ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... (B) Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Pemphigus ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 ... 2 1 1 ... 1 . ... ... ... ... ... ... ... ... ... 1 ... ... ... (D) Other disease of integumentary system ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 IX. — Diseases of the Bones and of the Organs of Locomotion. 146 Diseases of the bones 1 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 5 (1) 1 5 3 2 1 ... ... ... ... ... 1 ... ... 2 1 ... ... ... ... ... 147 Diseases of the joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 148 Amputations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Other diseases of locomotor system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 150 X. —Malformations. (A. B.C. D.) Congenital malformations (A) Congenital hydrocephalus ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B) Phimosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Congenital malformation of heart ... ... 1 1 2 ... 1 1 1 2 1 ... 1 ... 4 (1) ... 11 4 7 4 5 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... (D) Other congenital malformations ... ... ... 2 ... 3 ... ... ... 3 1 ... 2 ... ... 7 (1) ... 11 11 ... 10 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 338 94 XI.—Diseases of Early Infancy. 151 (A) Premature birth 5 3 4 4 2 4 ... ... ... 6 2 3 4 3 ... 18 (5) 1 40 22 18 22 18 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 151 (B.C.D. E.) Infantile debility, Icterus & Sclerema (B) Infantile atrophy, debility and marasmus 4 3 2 1 ... 2 2 ... 1 6 1 2 3 2 ... 17 2 29 15 14 15 14 ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Icterus neonatorum ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 2 ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Sclerema and oedema neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Want of breasi milk ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... 5 (2) ... 3 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 152 (A.B.C.D.) Other diseases peculiar to early infancy (A) Diseases of umbilicus,&c ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... (B)Atelectasis 1 ... ... 2 ... 1 2 1 2 1 ... ... ... 2 ... 7(1) 4 12 8 4 8 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Injuries at birth ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 2 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Cyanosis neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 153 Lack of care ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 154 XII. — Old Age. (A.B.) Old age (A) Senile dementia 1 1 1 3 2 2 3 1 2 2 1 1 2 3 ... 43(20) 2 25 7 18 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 18 (B) Senile decay 3 5 6 7 2 2 2 1 6 3 2 5 3 3 ... 22(10) 1 50 20 30 ... ... ... ... ... ... ... ... ... ... ... ... ... 20 30 155 XIII.—Affections produced by External Causes. Suicide by poision ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 4 (3) 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 156 Suicide by asphyxia ... 4 ... 1 3 4 ... ... 2 ... 2 1 ... ... ... 1 17 17 11 6 ... ... ... ... ... ... ... ... 1 ... 2 2 6 2 2 2 157 Suicide by hanging or strangulation ... ... 1 ... 1 1 ... ... 2 ... ... ... 1 ... ... ... 6 6 4 2 ... ... ... ... ... ... ... ... ... 1 1 1 2 ... 1 ... 158 Suicide by drowning ... ... ... 1 ... ... ... ... ... ... ... 1 1 1 ... 1 4 4 2 2 ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... ... 1 159 Suicide by firearms ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 3 (1) 2 2 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 160 Suicide by cutting and piercing instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 161 Suicide bv jumping from high place 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 162 Suicide by crushing ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 2 2 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 163 Other suicides ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 164 Poisoning by food ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 165 Other acute poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1(1) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 166 Conflagration ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 167 Burns (conflagration excepted) 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 6 (3) 3 3 1 2 ... 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 168 Absorption of deleterious gases (conflagration excepted) ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 2 (2) 2 2 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 169 ... ... 1 ... 2 1 ... ... 2 ... ... ... ... ... ... ... 6 6 5 1 ... ... ... ... ... ... 1 ... 1 ... 1 1 1 ... 1 ... 170 Injury by firearms . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 171 Injury by cutting or piercing instruments ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 339 95 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. 8th. Norwood. Woodnide. East. Addiscombe. Whitehoree Mnr Broad Green. Central. Wad don. South. 172 Injury by fall M 1 M F M F M F M F M F M F M h ... 1 2 4 3 ... 2 2 2 2 ... 2 ... ... 15 (5) 20 20 12 8 ... ... ... ... ... ... 1 ... ... ... 2 2 1 7 7 173 Injury in mines and quarries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... 174 Injury by machines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 175 Injury by other crushing (vehicles, railways, landslides, &c.) 5 3 3 1 1 3 2 2 2 2 ... 2 3 9 ... 51 (17) 38 38 30 8 ... ... ... 1 2 3 ... 8 ... 10 2 4 4 4 ... 176 Injury by animals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 177 Starvation ... ... ... ... ... ... ... . ... ... ... ... ... ... ... .. ... ... ... ... ... . ... ... ... ... ... ... ... ... ... ... ... ... ... 178 Excessive cold ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 179 Effects of heat ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . ... ... ... ... ... ... ... ... ... 180 Lightning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 181 Electricity (lightning excepted) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 182 Homicide by firearms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 183 Homicide by cutting or piercing instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . ... ... ... ... ... . .. ... ... ... ... ... ... ... ... ... 184 Homicide by other means .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 (1) ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 185 Fractures (cause not specified) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 186 Othei violence XIV.—III-Defined Causes. ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2(1) 1 1 1 ... ... ... ... ... ... ... ... ... ... . ... ... 1 ... ... ... 187 Dropsy ... .. ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 188 (A) Syncope (aged I year and under 70) ... ... ... ... .. ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 188 (B) Sudden death (not otherwise defined) ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 .. 189 (A) Heart failure (aged I year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . ... ... ... ... ... ... ... 189 (B.C.D.E.) Other ill-defined causes (B) Atrophy, debility, marasmus (aged I year and under 7o) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (C) Teething ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (D) Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (E) Other ill defined deaths 1 ... ... ... ... ... ... 1 ... ... ... ... ] 1 2 1 1 ... ... ... ... ... ... 1 ... ... ... ... 1 ... 189 (F) Cau<e not specified . ... ... ... ... ... ... ... ... ... ... ... ... ... 2 (2) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 180 126 155 149 144 205 135 117 152 215 169 160 179 175 8 1226(305) 246 2269 1090 1179 122 90 21 | 9 27 24 31 27 40 41 129 145 293 | 271 427 572 340 The total Institution Deaths include those of strangers occurring within Institutions in the Borough. The numbers so included are in brackets. Deaths of such strangers are excluded from all other columns of the table, as are all deaths of non-residents occurring in the Borough. TABLE V. Cases of Infectious Disease notified and Deaths from Infectious Diseases during the Year 1926. Notifiable Disease. Cases notified in whole District. Total Cases notified in each Locality. Total Cases Removed to Hospitals ok Sanatoria Total Cases Treated at Home Deaths in Whole District (Home-treated oa=es, shown separate'y in brackets, bat included in the total deaths) At Ages—Years. Upper Norwood. Norbury. West Thornton. Ben sham Manor. Thornton Heath. 'South Norwood. Woodside. Eiast. Ad-discomibe. Whitehorse Manor. Broad Green. Central. Waddon. South. Institution cases 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. At all Ages Under 1 1 2 3 4 5 10 15 20 35 45 65 and upward Unrecorded Ages Small-pox .. .. .. .. .. ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera (C) Plague (P) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 321 2 6 11 16 28 150 70 15 19 2 i .. 1 35 13 45 6 53 13 20 7 12 32 32 16 17 1 19 310 11 32 (5) .. 1 1 4(1) 7(1) 14(3) 5 .. .. .. .. .. .. Erysipelas 78 1 .. .. .. .. 2 2 6 17 29 19 2 1 1 15 3 4 7 2 2 2 6 6 1 5 1 22 38 40 5 (1) 1 .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 525 1 7 17 23 43 285 102 20 19 7 .. 1 22 34 23 50 70 33 19 38 19 54 30 21 21 44 47 439 86 .. .. .. .. .. .. .. .. .. 1 1 2 (1) .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever (including Paratyphoid) 7 .. .. .. l 1 1 2 .. .. 1 .. .. 1 2 .. 1 .. 1 .. 1 .. 1 .. .. .. .. 1 .. 5 2 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. Puerperal Fever 22 .. .. .. .. .. .. .. .. 13 5 .. .. 4 .. 1 .. .. .. 3 2 1 1 2 1 .. 2 .. 9 18 4 11(3) .. .. .. .. .. .. .. .. 8 (3) 3 .. .. .. Cerebro-spinal Meningitis ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 20 20 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 3 1 4 1 .. 1 2 2 2 1 .. 1 7 13 .. .. .. .. .. .. .. .. .. .. .. Pneumonia 50 1 3 .. 1 .. 6 2 5 11 5 13 3 .. 1 3 2 3 2 10 8 1 6 4 3 1 2 4 9 41 146 (93) 28 (17) 9 (7) 3 (1) 3 (3) 2 (1) 3 (2) . .. 10 (4) 7 (4) 35(26) 46(28) .. Malaria 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 (1) .. .. .. Dysentery 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis lethargica 1 1 1 .. .. .. .. .. .. 2 3 1 3 1 .. .. 1 .. 2 .. 2 2 .. 3 .. 1 .. .. .. .. 8 3 4 (2) .. .. .. .. .. .. .. .. .. .. .. Posterior basic meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 (1) .. 3 (1) .. .. Anterior poliomyelitis 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pulmonary Tuberculosis : Male 128 .. .. .. 1 .. .. 15 44 27 37 4 .. 12 6 10 3 9 12 8 7 9 11 15 6 12 8 .. 102 26 82 (42) .. .. .. .. .. .. .. 3(1) 28 (14) 23 (13) 26 (13) 2(1) .. Female 116 .. .. .. .. 1 1 1 18 53 23 17 2 .. 8 5 5 10 8 10 10 6 9 16 9 7 5 7 1 88 28 89 (53) .. .. .. .. 1 .. .. 9(5) 39 (22) 13 (8) 20 (13) 7(5) .. Total 244 .. .. .. 2 1 1 33 97 50 54 6 .. 20 11 15 13 17 22 18 13 18 27 24 13 17 15 1 190 54 171 (95) .. .. .. .. 1 .. .. 12 (6) 67 (36) 36 (21) 46 (26) 9 (6) .. Non-Pulmonary Tuberculosis: Male 78 4 7 3 4 2 30 14 6 6 1 1 .. .. 3 1 7 5 3 10 2 3 5 13 10 9 5 2 .. 13 65 18 (8) 4(2) 6(2) 1 .. 1(1) 1 2(2) 1 1 .. .. 1 (1) .. Female 62 1 5 2 .. 6 25 9 2 8 1 2 1 .. 2 1 2 5 3 6 5 3 3 6 7 8 8 1 2 16 46 19 (5) 4 (2) 1 2 1 2(1) 1 1 2(1) 3 1 (1) 1 .. Total 140 5 12 5 4 8 55 23 8 14 2 3 1 .. 5 2 9 10 6 16 7 6 8 19 17 17 13 3 2 29 111 37 (13) 8(4) 7(2) 3 2(1) 3(1) 3(2) 2 3 (1) 3 1 (1) 2(1) .. Totals 1421 32 28 33 45 82 500 202 83 183 90 104 30 9 87 66 111 90 155 110 80 69 71 146 117 71 76 67 105 1053 368 408 (212) 37 (21) 17 (9) 7 (1) 7(4) 12 (3) 20 (6) 8 (2) 14 (6) 90 (45) 51 (26) 86 (54) 59 (36) In the aoove I able, Deaths of Non-Residents occurring in the Borough are excluded 341 TABLE VI. Admissions and Discharges, Borough Hospital, Crovdon, during 1926. (Patients from Croydon C. B. ;ind Penge U.D.) Disease. Remaining at end of 19-25. Admitted during 19-26. Discharged during 1926. Died during 1926. Remaining at end of 1926. Scarlet Fever 23 409 368 ... 64 Admitted to Hospital as Scarlet Fever and found to be other disease ... 14 14 ... ... Admitted to Hospital for ob-ervation (including contact) ... 3 3 ... Diphtheria 26 321 268 28 51 Admitted as Diphtheria and found to be other disease ... 25 24 1 ... Admitted for observation (including contact) ... 1 1 .. ... Cerebro-Spinal Meningitis ... ... ... ... ... Admitted as Cerebro-Spiral Meningitis and found to be other disease ... 1 ... 1 .. Enteric Fever 1 ... 1 ... ... Admitted as Enteric and found to be other diseases ... 3 3 .. ... Paratyphoid (B) Fever) 3 1 4 ... ... Pulmonary Tuberculosis 10 7 13 4 ... Puerperal Fever ... 6 4 2 ... Admitted as Puerperal Fever, but found to be other disease 5 5 . ... Rubella (German Measles) .. ... ... ... Admitted as Rubella and found to be other disease ... ... 1 1 ... ... Erysipelas 1 5 6 ... ... Encephalitis Lethargica 6 4 2 ... Admitted as Encephalitis and found to other disease ... 2 ... 2 ... Anterior Poliomyelitis ... 1 1 ... ... Admitted as Anterior Poliomyelitis, and found to be other disease ... 1 1 ... ... Other Diseases : T. B. Meningitis ... 1 . 1 ... ? Meningitis ... 1 ... ... 1 ? Enteritis ... 1 ... ... 1 Mumps 1 1 2 ... ... Whooping Cough .. 7 7 ... ... Ophthalmia Neonatorum ... 5 5 ... ... Measles 1 31 32 ... ... Croup ... 1 1 ... ... Tonsillitis ... 2 2 ... ... Marasmus and Gnstro-Enteritis ... 5 3 2 ... Bronchitis ... 1 1 ... ... Otorrhcea ... 1 ... ... 1 Pempligus ... 1 1 No disease ... 12 12 ... ... Totals 66 882 786 44 118 96 342 TABLE VII. Tuberculosis—New cases ascertained, and deaths, during the year 1926. 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 ... ... 4 1 ... ... 4 4 63 50 1 1 1 16 14 ... 1 8 4 246 39 5 ... 1 31 25 ... ... 1 2 1900 66 10 1 1 14 9 ... ... 2 1 833 33 15 16 20 6 2 3 9 1 1 315 7 20 19 23 4 6 8 14 1 1 217 8 25 30 40 2 3 20 25 ... 1 163 13 35 33 27 1 1 23 13 ... 3 172 10 45 27 15 1 1 18 10 ... 1 152 14 55 16 6 ... 1 8 10 ... ... 128 33 65 and upwards 4 2 ... 1 2 7 1 1 157 45 Totals 147 136 79 64 82 89 18 19 205 20 "Including all primary notifications (whether Form A or Form B), or other n*n coming to the knowledge of the Medical Officer of Health during the year. 97 343 TABLE VII (A). The work of the Tubercu'osis Dispensary during the year 1926;— 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 crises examined during the year (ex eluding coniacts)— (a) Definitely tuberculous 105 84 1 1 12 11 23 22 117 95 24 23 259 (ib) Doubtfully tuberculous — — — — — — — — 29 36 44 20 129 (c) Non-tuberculous — — — — — — — — 24 38 33 39 134 B.—Contacts examined during the year— (a) Definitely tuberculous 3 7 1 2 — — 11 8 3 7 12 10 32 (b) Doubtfully tuberculous — — — — — — — — 11 50 46 33 140 (c) Non-tuberculous — — — — — — — — 24 87 67 79 257 C. — Cases written off the Dispensary Register as— (a) Cured 7 11 2 2 — 1 18 7 7 12 20 9 48 (ib) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) — — — — — — — — 79 194 206 214 693 D.—Number of persons on Dispensary Register on Dec. 31st— (a) Diagnosis completed 500 400 54 54 41 67 394 269 541 467 448 323 1779 (B) Diagnosis not completed — — — — — — — — 32 55 51 29 167 1. Number of persons on Dispensary Register on January 1st 1,865 2. Number of patients transferreJ from other areas and of " lost sight of" cases returned 20 3. Number of patients transferred to other areas and cases " lost sight of" 35 4. Died during the year 114 5. Number of observation casrs under A (b) and B (b) above in which period of observation exceeded two months 77 6. Number of attendances at the Dispensary (including Contacts) 7,904 7. Number of attendances of non-pulmonary cases at Orthopaedic Out-stations for treatment or supervision 204 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for («) " Light" treatment 450 (£) Other special forms of treatment 67 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 44 10. Number of consultations with medical practitioner; — (a) At Ijomes of applicants 36 (3) Otherwise 459 11. Number of other visits by Tuberculosis Officer to homes 497 12. umber of visits by Nurses or Health Visitors to homes for Dispensary purposes 5.411 13. Number of (a) Specimer s of sputum, etc., examined 1,182 (b) X-ray examinations made in connection with Dispensary work 26 14. Nunber of insured persons on Dispensary Register on the 31st December 446 15. Number of insured persons under Domiciliary Treatment on the 31st December 232 16. Nu nber of reports received during the year in respect of insured persons— (a) Form G.P. 17 10 (b)Form G. P. 36 570 98 344 TABLE VII (B). RESIDEN TIAL INSTITUTIONS FOR TUBERCULOSIS. (A) Average number of beds available for patients during the year 1926. Observation. Pulmonary Tuberculosis. Non-PulmonaJy Tuberculosis. Total " Sanatorium " Beds. "Hos pital " Beds. Disease of Bon"s and Joints. Other Conditions. Adult Males ... 42 10 10 1 63 Adult Females ... 39 7 4 2 52 Children under 15 ... 8 ... 19 10 37 Total ... 89 17 33 13 152 (B) Return showing the extent of residential treatment during the year 1926. In Institutions on Jan. 1. Admitted duuring the year. Dischargeo during the year. Died in the Institution. In Instilutions on Dec. 31. Number of Patients. Adults. M. 62 131 115 20 58 F. 32 102 72 10 52 Children. M. 20 18 21 1 16 F. 20 11 15 1 15 Number of Observation Cases. Adults. M. ... 3 3 ... ... F. ... 1 1 ... ... Children. M. ... ... ... ... ... F. ... ... ... ... ... Total 134 266 227 32 141 99 345 TABLE VII (C). The immediate results of treatment of patients and of observation of doubtful cases discharged from Residential Institutions during the year 1926 : — Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Under 3 months. 3—6 months. 3—12 months. More than 12 months. Total. M. F. Ch. M. F. Ch. M. F. C h. M. F. Ch. Pulmonary Tuberculosis. Class T. B. minus. Quiescent 3 3 — 5 — 2 2 1 1 — — — 17 Improved 2 1 — 2 4 2 — — — — — — 11 No material improvement 2 2 — 1 — — — — — — — — 5 Died in Institution 1 — — — — — — — — — — — 1 Class T. B. plus, Group 1. Quiescent 6 1 — 6 4 — 4 4 2 — — — 27 Improved 4 2 — 3 6 — — 1 — — — — 16 No material improvement 1 1 — — — — — — — — — — 2 Died in Institution 1 — — — — — 1 — — — — — 2 Class T.B. plus, Group 2. Quiescent 1 — — 4 1 — 1 3 — 2 — — 12 Improved 6 2 — 11 5 — 5 2 — — — 1 32 No material improvement 3 1 — 5 3 — 1 — — 1 — — 14 Died in Institution — — — — — — — — — — — — — Class T.B. pins,Group 3. Quiescent — — — — — — — — — — — — — Improved 3 1 — 6 1 — 4 5 — 1 1 — 22 No material improvement 6 4 1 1 6 — 2 3 — 2 — 1 26 Died in Institution 8 3 — 2 2 — 3 2 — 3 3 — 26 Non-Pulmonary Tuberculossis. Bones and Joints. Quiescent or Arrested — — — — — — — — — 1 1 2 4 Improved 3 — 1 — — 1 1 — — 1 — 1 8 No material improvement 2 1 — — — — — — — — 1 — 4 Died in Institution — — — — — — — — 1 — — — 1 Abdominal. Quiescent or Artested — — — — — — — — 1 — — — 1 Improved — — — — — — — — — — — — — No material improvement — — — — — — — — — — — — — Died in Institution 1 — — — — — — — 1 — — — 2 Other Organs. Quiescent or Arrested — — — — — — — — — — — — — Improved — 1 — — — — — — — — — — 1 No material improvement — — — — — — — — — 1 — — 1 Died in Institution — — — — — — — — — — — — — Peripheral Glands. — — — — — 3 — — 7 — — 1 11 Improved — — 1 — — 4 — — 3 — — 1 9 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 — — — — — — 1 — — — — — 1 Non-tuberculous _ — — — 2 1 — 3 Doubtful — — — — — — — — — — — — — 100 346 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 ot the Dispensary at the end of 1926 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. 1926. Class T. B. minus. Class T. B. plus. Class T.B. minus. Class T. B. plus. Group 1. Group 2. Groip 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T. B. plus). Discharged as cured. Adults. M. 44 1 ... ... 1 ... ... ... ... ... F. 51 ... ... ... ... ... ... ... ... ... Children. M. 24 ... ... ... ... ... ... ... ... ... F. 24 ... ... ... ... ... ... ... ... ... Alive. Disease arrested. Adults. M. 146 17 8 ... 26 ... ... ... ... ... F. 160 11 1 1 13 ... ... ... ... ... Children. M. 45 ... ... ... ... ... ... ... ... ... F. 42 ... ... ... ... ... ... ... ... ... Disease not arrested. Adults. M. 65 35 44 40 119 20 37 37 7 81 F. 30 28 33 28 89 36 19 27 7 53 Children. M. 1 1 1 1 3 2 ... ... ... ... F. 4 1 1 3 5 1 ... ... ... ... condition not ascertained during the year 48 11 5 3 19 ... ... ... ... ... Lost sight of or otherwise removed from Dispensary Register 4 4 7 2 13 4 2 1 2 5 Dead. Aduits. M. 2 9 10 22 41 2 ... 5 6 11 F. 6 2 3 24 29 1 1 3 8 12 Children. M. 1 ... ... ... ... ... ... ... ... ... F. ... ... ... 2 2 ... ... ... ... ... Totals 697 120 113 127 360 66 59 73 30 162 101 347 TABLE VII (E). non-pulmonary tuberculosis. Annual return as required by Ministry of Hea'th showing in summary form the condition of all patients whose case records are in the possession of the Dispensary at the end of 1926, arranged according to fhe 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). 1'revious to 1926. 1926. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. liones and Joints Abdominal. Other Organs. Perip eral Glands. | Total. Ai.ive. Discharged as cured. Adults. M. 1 ... ... ... 1 ... ... ... ... ... F. 2 2 1 1 6 ... ... ... ... ... Children. M. ... ... ... 62 62 ... ... ... ... ... F. 2 1 ... 26 29 ... ... ... ... ... Disease arrested. Adults. M. 8 1 1 3 13 ... ... ... 1 1 F. 8 4 2 9 23 1 ... ... 1 2 Children. M. 8 1 ... 172 181 1 ... ... 6 7 F. 18 ... 1 132 151 1 ... 1 3 5 Disease not arrested. Adults. M. 5 6 11 6 i 3 10 F. 6 2 8 9 25 2 1 2 6 11 Children. M. 10 2 3 87 102 5 3 2 34 44 F. 7 2 ... 49 58 ... 2 ... 26 28 Transferrfd to Pulmonary .. ... ... ... ... ... ... ... ... ... Cndition not ascertained during the year 7 2 5 85 99 ... ... .. ... ... Lost sight of or otherwise removed from Dispensary Register 1 1 ... 6 8 ... ... ... 1 1 Dead. Adults. M. ... 1 ... 1 2 ... ... ... ... ... F. 1 ... ... ... 1 ... ... ... ... ... Children. M. ... 1 ... ... 1 ... ... ... ... ... F. ... ... ... ... ... ... 2 1 ... 3 Totals 84 20 27 642 773 16 9 6 81 112 102 348 TABLE VIII. Work of Croydon Maternity and Child Welfare Centres and of Health Visitors, 1926, INFANTS CENTRES Municipal Centre (Lodge Road). Central Croydon (Sylverdale Roal'. South Croydon (Bartlett Street). East Croydon (Lr. Addisc be Rd.) Woodside ' (St. Luke's Hall, Spring Lane). South Norwood (Selhurst Road). Upper Norwood (St. Margaret's. Naseby Road). Thornton Heath (St. Paul's Hall). Thornton Heath (St. Alban's Hall. Whitehorse Lane). West Croydon (Strathmore Road). Norbury. TOTAL. Infants Undkr 1 Year: Attendances— (a) 1 New Cases 308 111 109 151 139 190 67 S5 228 141 93 1622 2. Old Cases 2971 1391 1051 1632 1704 2653 1029 1275 3230 1894 1006 19836 Total 3279 1502 160 1783 1843 2843 1096 1360 3458 2035 1099 20458 Seen by Doctor 1649 735 623 821 923 1577 603 722 1562 619 567 10401 Children 1—5 YRS. of Agr : (b) 1. New Cases 99 44 43 65 47 82 24 34 101 39 54 632 2. Old Cases 1995 1325 1592 1554 1100 3571 1515 1475 3271 1873 1394 20665 Total 2094 1369 1635 1619 1147 3653 1539 1509 3372 1912 1448 21297 Seen by Doctor 1139 669 618 681 548 1552 697 758 1456 646 371 9135 Attendance of Mothers (a) & (b) 4949 2596 2402 2989 2824 5568 2055 2536 6303 3493 2308 38023 Expectant Mothers Attendances— (C) 1. New Cases 109 48 45 52 32 95 11 17 90 29 13 541 2. Old Cases 185 71 156 76 43 195 73 54 202 38 33 1126 Total 294 119 201 128 75 290 84 71 292 67 46 1667 Home Visits 92 38 107 52 57 6 113 37 53 96 36 687 Visiting of Childr'n (d) Under 12 months 1. First Visits 317 610 158 378 245 224 406 313 335 577 163 3735 2. Subsequent Visits 658 2026 558 954 206 355 500 405 474 615 338 7149 3. No. of Children seen 780 2190 530 1120 460 498 767 635 717 948 431 9076 (e)From I-5y'rs. of age 1. First Visits 200 15 10 64 3 4 228 138 224 82 29 997 2. Subsequent Visits 1141 2579 672 1943 358 451 680 499 758 1697 378 11456 3. No. of children seen 1265 1996 538 1611 262 348 901 544 869 1394 331 10059 (f) re Infant Deaths 23 38 16 16 20 17 17 5 14 64 9 239 {g) ,, Still births 5 8 5 6 5 7 12 9 14 11 4 86 (h) Special Visits 31 58 41 170 1 6 105 14 37 236 3 702 (i) Unsuccessful visits 326 897 266 884 244 455 265 275 265 546 353 4776 103 349 TABLE IX. VENEREAL DISEASES. Return relating to persons who were treated at the Croydon General Hospital Clinic, 1922, 1923, 1924. 1925, and 1926 1926. 1925. 1924. 1923. 1922. M. F. M. F. M. F. M. F. M. F. Number of persons dealt with at or in connection with the out patient Clinic for the first time and found to be suffering from:— Syphilis 30 49 24 34 29 42 23 34 28 30 Soft Chancre 1 - - - 3 — 1 — 4 — Gonorrhœa 60 34 57 26 44 32 40 20 53 13 Not suffering from venereal disease 50 109 35 96 25 51 16 35 20 20 141 192 116 156 101 125 80 89 105 63 Of these the number of patients from Croydon was 178 222 121 80 88 Number of persons discharged from the outpatient Clinic after completion of treatment for:- Syphilis - 6 7 4 3 9 12 14 2 4 Soft Chancre — — - - — — — — 1 — Gonorrhœa 12 10 18 2 15 4 16 8 18 6 Conditions other than Venereal ... — — — — — — 16 35 17 11 12 16 25 6 18 13 44 57 38 21 Number 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 35 41 19 27 17 21 29 43 35 22 Soft Chancre — — - - 2 — 1 — 2 — Gonorrhœa 54 23 29 23 23 13 49 19 44 8 Conditions other than Venereal 50 109 ... — — — — — 3 9 339 173 48 50 42 34 79 62 84 39 Total attendances of all persons at the out patient Clinic who were suffering from:- Syphilis 578 892 554 626 498 601 609 647 685 657 Soft Chancre 3 — 9 - 45 - 27 — 16 — Gonorrhœa 1674 248 2096 409 1186 284 1160 317 1683 173 Not suffering from venereal disease 105 211 54 195 45 97 30 59 41 68 2360 1351 2713 1230 1774 982 1826 1023 2425 898 Of these the following were the attendances of Croydon patients 2753 2727 1735 1950 2408 Aggregate number of "in-patient days" of treatment given to persons suffering from:— Syphilis — — 211 214 — 52 — — — - • Gonorrhœa — — — 29 — — — — — - — — 211 243 — 52 — - — — Croydon "in patient" days - 287 52 Number of persons treated with Salvarsan substitutes 131 181 122 119 92 103 78 79 42 44 Number of doses of Salvarsan substitutes given Croydon 838 676 516 401 382 — 552 268 185 190 Examinations of pathological material:— Specimens from persons attending at the Treatment Centre which were sent for ination to an independent laboratory:- For detection of spirochaetes — - - — — ,, „ gonococci 183 175 136 100 139 ,, Wassermann reaction 313 274 258 187 266 ,, Others - — — - - 496 449 394 287 405 104 350 TABLE X VENE REAL DISEASES. Summary of Work done by the London Hospitals during the Year 1926. London Middlesex. Essex Surrey. Kent. Herts. Bucks. East Ham. West Ham. Croydon. Total. "Other Places." Grand Total New Patients — Syphilis 4,181 335 177 129 115 28 35 39 131 23 5,193 545 5,738 Soft Chancre 197 8 3 4 7 2 1 2 11 ... 235 68 303 Gonorrhoea 8,581 821 419 318 180 87 45 104 223 56 10,834 849 11,683 Not Venereal 6,733 609 364 293 177 76 43 84 234 51 8,664 324 8,988 Total 19,692 1,773 963 744 479 193 124 229 599 130 24,926 1,786 26,712 Total Attendances 569,938 38,744 15,007 17,826 7,883 3,578 1,748 4,608 9,990 2,767 672,089 14,986 687,075 No. of In-patient days 58,469 3,383 2,743 1,989 3,780 1,502 1,408 779 1,355 330 75,738 25,997 101,735 Salvarsan Subs. doses 37,325 3,791 1,693 1,510 894 385 333 326 1,053 218 47,528 1,787 49,315 PATHOLOGICAL EXAMINATIONS. For or at Centre- Spirochaetes 755 34 2 8 6 5 ... 1 18 1 830 85 915 Gonococci 44,703 2,193 1,765 941 1,040 286 113 527 1,009 248 52,825 1,638 54,463 Wassermann 24,621 1,674 996 877 537 249 139 185 491 164 29,933 1,294 31,227 Others 11,145 746 291 879 292 50 85 24 32 129 13,673 265 13,938 Total 81,224 4,647 3,054 2,705 1,875 590 337 737 1,550 542 97,26l 3,282 100,543 For Practitioners. Spirochaetes 19 7 ... 7 ... ... ... 1 ... 34 ... 34 Gonococci 3,187 266 162 734 22 17 21 15 17 353 4,794 18 4,812 Wassermann 16,021 1,504 932 587 109 77 103 183 495 438 20,449 258 20,707 Others 1,433 31 15 433 23 6 9 1 3 8 1,962 50 2,012 Total 20,660 1,808 1,109 1,761 154 100 133 199 516 799 27,239 326 27,565 u CJi TABLE XI. METEOROLOGICAL RECORD—YEAR 1926. Rain Gauge 5-in. in diameter, 1-ft. above ground, 146 ft. above sea level Temperature taken in the shade of a Stevenson's Screen, 4-ft. from the ground. The Ground Thermometer is suspended in an iron tube, the bulb being 4-ft. below the level of the ground. Months. 1926. 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 Rain fell. Amount collected in Inches. Difference from average 90 years at Greenwich All Highest. All Lowest. January 52° 15° 44°.9 35°.6 40°.2 + 1°.7 42°.5 37°.7 in — .038 19 in. 2.96 in. + 1.17 February 58° 28° 50°.3 41°.2 45°.7 + 6°.2 43°.3 42°.3 — .008 19 2.35 + 0.82 March 60° 29° 51°.1 38°.7 44°.9 + 3°.2 45°.0 41°.6 — .058 3 0.21 — 1.30 April 72° 37° 56°.5 42°.3 49°.4 + 2°.2 46°.7 45°.1 — .014 17 4.36 + 2.70 May 76° 35° 59°.1 45°.3 52°.2 — 0°.9 48°.5 46°.4 — .044 13 1.06 — 0.82 June 76° 42° 66°.1 49°.7 57°.9 — 1°.5 53°.6 51°.7 - .026 16 3.30 + 1.27 July 87° 49° 72°.2 55°.7 63°.9 + 1°.4 57°.6 57°.1 — ..002 16 2.05 - 0.36 August 80° 46° 71°.6 54°.6 63°.1 + 1°.5 58°.4 56°.3 — .031 10 1.52 — 0.86 September 84° 39° 67°.7 53°.0 60°.3 + 3°.1 58°.6 55°.1 — .048 11 1.20 — 1.0 October 70° 27° 53°.9 41°.8 47°.8 — 2°.2 52°.8 43°.5 — .108 13 2.96 + 0.23 November 55° 27° 49°.2 39°.6 44°.4 + 1°.2 47°.8 41°.9 — .061 24 5.02 + 2.73 December 50° 29° 44°.4 35°.0 39°.7 — 44°.4 35°.9 — .078 9 0.34 — 1.69 Meant and Totals for Year. 87° 15° 57°.2 44°.3 50°.7 + 1°.3 49°.9 46°.2 — .043 170 27.33 + 3.04 The 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. 106 352 TABLE XII. Prevailing direction of the Wind at Croydon in 1926. Number of Days each Month. 1926. N.E E. S.E. S. S.W. W. N.W. N. January 3 1 3 9 11 3 1 ... February 6 1 1 9 7 3 ... 1 March 7 3 1 ... 6 12 2 ... April 5 3 2 2 9 3 5 1 May 8 5 1 1 9 4 1 2 June 2 4 1 3 9 6 3 2 July 2 7 1 2 8 5 3 3 August 1 1 4 ... 16 4 3 2 September 1 2 1 6 7 9 4 ... October 3 7 2 4 4 4 4 3 November ... 4 4 9 12 1 ... ... December 6 ... ... 1 5 11 5 3 Totals 44 38 21 46 103 65 31 17 82 67 168 48 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 107 353 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER. For the Year Ending December 31st, 1926. GENERAL. The following pages contain a summary of the work carried out in connection with the School Medical Service in Croydon during 1926. The year has been one of steady adjustment and growth of activities already in being at the beginning of the year, rather than of notable extension in any individual fresh direction. The chief exception to this has been in relation to the prevention and treatment of crippling conditions, particulars of which are given in the body of the report, and the dental scheme, which is developing with astonishing vigour. In spite of the constantly extending demands on the time of the staff in other directions, there is evident a general increase in the work done, as well as in the effectiveness of that work, as compared with previous vears. Full recognition should be given to the keen work of medical, dental, nursing and clerical staff, as well as to the ungrudging help of teachers and of many officers of the education service, which have made this possible. H. P. NEWSHOLME, School Medical Officer. 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. 108 354 (b) Part-time Officers. The following part-time specialists are engaged in school medical work for the Education Committee:-One X-ray specialist, one ophthalmic surgeon, and a rota of eight surgeons undertaking nose and throat work. 2.—Dental.—Up to April, 1926, one whole-time and one parttime dental surgeon; for the rest of the year, two whole-time dentists, in connection with the extension of the dental scheme. 3.—Nursing.—Fourteen health visitors are each allotted a district 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. 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 services thus rendered by Miss Voss have been of the greatest value to the children in attendance. One assistant, without nursing training, is employed in the dental clinics. The clerical staff consists of four clerks, working under 'he 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. 109 355 (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. At the beginning of 1926 the new Sick Nursery premises in Lodge Road were opened, consisting of 12 beds in two wards for debilitated young children, one isolation cubicle, and a ward of two beds for nursing mothers and their babies. Particulars of the valuable work done here will be included 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. 48 mothers, and 79 children under five years of age were thus admitted to convalescent homes during the year. A massage clinic is provided by the Public Health Committee for the treatment of children under five suffering from rickets, infantile paralysis, and general conditions of debility. SCHOOL MEDICAL SERVICE IN RELATION TO THE PUBLIC ELEMENTARY SCHOOLS. (a) No. of Schools and Accommodation. In 1926 there were in Croydon: (а) 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 1926 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, 1926, was 24,200, as compared with 24,074 in 1925. 110 356 (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 schools 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 from 1st January, 1926, to 31st December, 1926, are as follows:— Routine Inspection. Under the Regulations of the Board of Education: Children admitted for the first time during the year 2793 Children comprising the intermediate group 2044 Children between the ages of 12 and 14 years and other age groups 3506 Total 8343 Other routine inspections 54 Inspection of Selected Children. Referred for defects suspected by head teachers, attendance officers, school nurses, care committees, etc. 2504 Other cases— (i) Fitness for employment in accordance with Bye-laws regulating the employment of young persons— Examined 319 Fit 316 Unfit 3 (ii) Candidates as bursars and student teachers 36 (iii) Children examined under "The Employment of Children in Entertainments Rules, 1920" Seen 10 Granted 10 Defective Children Re-examined. 8341 (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. 111 357 (c) The early ascertainment of crippling defects is effected through routine medical inspection at the schools; through the examination of children at a special clinic for the physically defective; through information received from health visitors, school attendance officers and local voluntary associations; through child welfare centres; through the tuberculosis dispensary; and lastly through the Orthopedic 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 11b, at the end of this report. Out of the 8,397 children examined as routine cases, 1,554, or 18.5 per cent., required treatment for conditions other than uncleanliness and dental diseases. (a) Uncleanliness. The routine cleanliness surveys made by the health visitors are the best guide to the condition attained in the various schools. The health visitors during the course of their school surveys for uncleanliness made 59,164 inspections of children, and found head vermin in 445, and nits alone in 3,444. Thus, on the basis of these inspections, 6.5 per cent. of the children seen showed evidence of infestation, as against 8.0 per cent. in 1925, and 9.5 per cent. in 1924. (b) Malnutrition. 73 children were found during routine inspection to need treatment for malnutrition, and 160 were referred for observation. Thus, out of the 8,397 children examined as routine cases, approximately 2.8 per cent. showed evidence of malnutrition. (c) Defective Vision and External Eye Disease. 536 children, or 6.4 per cent. of those seen during routine inspection, were found to show defective eyesight requiring treatment. In addition, 35 children, seen as routine cases, were found to be suffering from squint, and 29 (0.3 per cent.) had external eye disease requiring treatment. (d) Ear Disease. 27 children, or 0.3 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. 112 358 (c) Enlarged Tonsils and Adenoids. Of the children examined during routine inspection, 609 (7.2 per cent.) had enlarged tonsils and adenoids requiring treatment, while 895 (10.7 per cent.) were affected in slighter degree. (f) Lymphatic Glands. In 31 children, seen as routine cases, the cervical glands were enlarged to an extent needing treatment, while in 330 other cases the children were kept under observation. (g) Dental Disease. 848 children (10.1 per cent.) were referred for treatment on account of dental decay. An accurate picture of the prevalence of dental caries among school children can be obtained by reference to the section of the report dealing with dental treatment. (h) Heart and Circulation. 13 children were found to be in need of treatment for organic heart disease; and 123 were under observation for heart disease which had reahed a stage of equilibrium. 58 children, or 0.7 per cent. were referred for treatment on account of anaemia. (i) Diseases of the Lungs (non-tuberculous) were in 22 children (0.3 per cent.) found sufficiently marked to need treatment. (f) Tuberculosis. Apart from 2 cases of suspected tuberculosis of the lungs, one case of tuberculosis of the skin and one of joint tuberculosis, referred for treatment, the great majority of the cases traced were those of glandular tuberculosis. 37 cases (0.4per cent.) were referred for treatment, and 50 (0.6 per cent.) for further observation. (k) Deformities. 224 cases (or 2.7 per cent.) of spinal curvature were found during routine medical inspection and were referred for treatment, and 408 slighter cases (4.8 per cent.) were noted for further observation. The attendance of children with spinal curvature at the Remedial Exercises Clinic, and at the special corrective classes at four schools has been a large factor in the increase in the proportion of those children traced and treated at an earlier stage in the condition than previously. 113 359 INFECTIOUS DISEASES. The year was not marked by any exceptional prevalence of infectious disease, apart from a considerable wave of measles early in the year. Scarlet fever and diphtheria, while somewhat more prevalent, were still markedly below epidemic line. The following table gives a summary of the notices sent out from the Public Health Department to various schools in connection with cases of infectious or contagious disease:— Illness. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter Total Scarlet Fever 35 89 34 106 264 Diphtheria 36 39 45 72 192 Measles 1005 216 6 43 1270 ,, (German) 103 114 12 3 232 Mumps 232 138 43 150 563 Whooping Cough 129 124 104 40 397 Chicken-pox 135 214 101 192 642 Sore throat 14 25 9 33 81 Ringworm (scalp) 12 7 14 7 40 ,, (body) 21 19 4 15 59 Impetigo 118 109 72 118 417 Scabies 6 — 3 13 22 Eye disease 7 2 3 7 19 Other Diseases 68 65 54 102 289 Totals 1921 1161 504 901 4487 The Infants' Department of the Rockmount School was closed for a period during the year by order of the Medical Officer of Health on account of the local prevalence of measles. Under the revised regulations issued by the Board of Education, certificates covering periods of low attendances at he undernamed schools were issued for the following dates:— Period. Week Ending. School and Dept. Reason for Low Attendance. 23/2/26 Winterbourne I. Epidemic illness 9/1/26 to 23/1/26 Purley Oaks J. & I. Do. Do. Do. St. Peter's Infants Do. 114 360 FOLLOWING UP. Fourteen district health visitors are connected with the work of school medical inspection and of following up children suffering from defects. 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 is a summary of the work done by the health visitors in connection with this part of their duties:— Visits to Elementary and Secondary Schools for medical inspection 545 Number of children prepared for medical inspection 19242 Home visits (following up) arising out of medical inspection 5752 Home visits arising out of dental inspection 1029 Other home visits (excluding those for infectious diseases) 3240 It will be seen that 10,021 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; an increase of 1,300 over the number for 1925. 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 10 to 11 visits was paid to each school for that purpose by the health visitor, and 59,164 examinations of children carried out. In 3,889 of these, or 6.5 per cent., the children were found to show verminous conditions in some degree 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; but children were excluded and dealt with in accordance with the Committee's Standing Orders in regard to such conditions. 115 361 Cleansing at Borough Disinfecting Station. 9 children were cleansed at the Disinfecting Station during the year for scabies, and 2 on account of body vermin, while a number received attention following contact with infectious disease. The personal clothing and bedding undergo steam disinfection, while the child receives a cleansing bath under the supervision of a health visitor. The room occupied by the child is also disinfected, and facilities given for cleansing other members of the household. MEDICAL TREATMENT. The new clinic premises in Lodge Road came into use in January, 1926, the clinics formerly housed at 228, London Road being then transferred. 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 premises have shewn themselves admirably adapted to the various activities carried on there. (a) Minor Ailments. During the year 912 children made a total of 5,142 attendances in connection with affections of the skin, various eve and ear conditions, and other minor ailments. Ringworm.—75 cases of ringworm of the scalp received treatment; in 32 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 that purpose. Uncleanliness.—Particulars in regard to treatment for uncleanly conditions are given in the preceding section. (b) Tonsils and Adenoids. A clinic for the operative treatment of children with enlarged tonsils and adenoids is field at the Croydon General Hospital. The operations and the administration of anaesthetics art undertaken bv eight local medical practitioners working in pairs, and in rota for periods of three months. 116 362 During the year 286 children underwent operation at the clinic on account of enlarged tonsils or of adenoids. 258 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 some two weeks before admission to the class. In addition a number of children underwent breathing exercises before operation, in accordance with a routine authorised by the Committee during the course of the year. (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 3,964. (d) Vision and External Eye Diseases. The Eye Clinic was held throughout the year at Lodge 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 as nurse. 624 children underwent a refraction test during the year at the Eye Clinic, and in 489 of these spectacles were prescribed. 500 obtained spectacles under the Committee's scheme during the course of the year, the excess of spectacles provided over those prescribed being due to duplication in a few cases where children broke their glasses. In addition, 4 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 Eye Clinic during the year:— Errors of Refraction— Hypermetropia 134 Hypermetropic astigmatism 230 Myopia 124 Myopic astigmatism 89 Mixed astigmatism 83 Emmetropia (glasses not required) 83 117 363 Other Conditions— Strabismu (convergent) 54 Ditto (divergent) 8 Conjunctivitis 2 Blepharitis 2 Keratitis 1 Corneal nebula 7 Congenital cataract 1 Ptosis (congenital) 1 Leucoma 1 Nystagmus (lateral) 8 Retinal detachment 1 Optic atrophy 1 Iritis 3 Microphthalmos 1 Conical cornea 1 Phthisis bulbi 1 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. (e) Ear Disease. 193 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. Provision has been made in the Estimates for 1927-28 for the introduction of treatment by ionisation, which has been found so successful in some other areas. (f) Dental Defects. Out of the total of 7,564 children found to need dental treatment, 4,629 actually received such treatment at the Dental Clinic, of whom 911 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. As from April, Mr. T. K. R. Bryce took up his duties as the second whole-time dental surgeon. The work of dental inspection and treatment, and the scope of the scheme, expanded steadily throughout the year, and fulfilled the anticipations of the 118 364 gressive expansion outlined in my report on the subject in 1923. This has been largely due to the energy and enthusiasm of the dental surgeon, Mr. W. G. Senior, to whom I am indebted for the report on the year's work, from which the following extracts are taken. Dental Inspection. During the year dental inspection, re-inspections, and treatment was confined to children of the age groups 5, 6, 7, 8 and 9 years, together with a certain number of children sent for special or urgent reasons. 9,393 children were examined in these five age-groups, and of these 68.3 per cent. had defective teeth, as against 75 per cent. in 1925 and 82 per cent. in 1924. This reduction in the prevalence of dental disease is a measure of the benefit resulting from the dental scheme. The following is an analysis of the condition of the teeth of all children examined by Mr. Senior during 1924-26, and shews a steady improvement in the conditions found:— Al1 children examined. Healthy. — 4 Teeth Decayed. + 4 Teeth Decayed. 1924 20.4% 34.5% 45.1% 1925 26.4% 36.3% 37.3% 1926 39.0% 37.4% 23.6% Children who received some treatment previously. 1924 44.6% 37.5% 17.9% 1925 57.6% 33.2% 9.2% 1926 58.3% 33.2% 8.5% Children who completed treatment previously. 1924 62.0% 35.0% 3.0% 1925 72.6% 26.4% 1.0% 1926 71.8% 26.4% 1.8% Children who neglected to complete or refused treatment. 1924 0.3% 33.5% 66.2% 1925 — 43.0% 57.0% 1926 — 493% 50.7% Dental Treatment. 5,793 children were offered treatment from routine dental inspections, and 3,481 accepted—60.0% compared with 57.8% during 1925, and 43% in 1924. 119 365 Special Cases. 1,148 "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 Tuberculosis Officer, (d) children referred by Head Teachers as needing treatment for acute conditions. Special Forms of Treatment. 1 case of cleft palate. 6 simple regulations. In 3 cases partial dentures were provided to replace inciser teeth lost for various reasons. Summary of Treatment. The following table gives particulars as to the work done ir certain directions at each session in 1925 and 1926:— 1925. 1926. Number of New Cases per session 7.7 8.3 ,, Attendances ,, 11.9 11.9 ,, Fillings „ 7.6 5.7 ,, Extractions ,, 11.8 13.5 ,, Other Operations 0.8 1.1 ,, "Gas" Cases during the year 475 1495 For details of the school dental work done during the year, reference should be made to Table IV. in the Appendix. Preventive and Educative Measures. The talks to parents after school inspections, and at the chair side, were continued throughout the year. Tooth brushes have been supplied (at cost price) both at the dental clinic and at Maternity and Child Welfare Centres. Particulars will be given in the general Public Health Report as to the extended dental work under the Maternity and Child Welfare and the Tuberculosis Schemes. Crippling Defects and Orthopaedics. Apart from conditions such as club-foot, with which a child is born—but which can be greatly improved or cured granted sufficiently early treatment—the three main diseases causing crippling are rickets, infantile paralysis and tuberculosis; while other crippling arises from conditions of debility. 120 366 A.—Prevention. Much work has been done by the Corporation as Public Health Authority for years past in the prevention of these causes of crippling: (1) Health visitors by their advice in the homes on diet, exercise, open-air and general hygiene, and Infant Welfare Centres, by the similar advice there given to expectant and nursing mothers and in regardd to their young children, must have had a marked influence in reducing the risks of crippling through rickets. (2) The improvement in the milk supply, the systematic sampling of milk for tuberculosis, associated with the system of commercial pasteurising, have—whatever the arguments for or against the advisability of the latter—had an important effect in reducing the risks of infection by tuberculous milk; while the Corporation's tuberculosis scheme, with its supervision of patients at the tuberculosis dispensary and in their homes, and by the treatment and education in control of infection afforded through treatment in institutions, must have had a similar influence in decreasing the chances of infection from person to person. (3) A third factor in crippling, viz., infantile paralysis, is affected by the compulsory notification of such cases, by the facilities for consultation with medical practitioners, and particularly by the expert advice available through the Orthopedic Clinic. While this does not prevent the disease, early treatment is the best means of preventing permanent crippling being produced by it.. (4) The work of Welfare Centres, of teachers, and of the school medical and nursing staff tends, by constant watch for the early stages of such conditions as spinal curvature and flat-foot, to prevent crippling arising through these defects, while the systematic physical training in force in the schools must be a great means of prevention of these defects. B.—Treatment. Apart from treatment through the private practitioners and through hospitals, the following facilities are provided by or in association with the Corporation:— (a) Orthopedic Clinic at the Croydon General Hospital, at which an experienced orthopedic surgeon sees children referred by the Public Health Department, at a fixed charge by the Hospital per patient per session. Children under 5 are seen under the Corporation's maternity and child welfare scheme, those between 5 and 16 under the Education Committee's scheme, while cases of tuberculous crippling, whatever their age, are seen under the Corporation's tuberculosis scheme. 121 367 During 1926, the number of children seen under these three groups, and the number of their attendances, was as follows : No. of Children. Attendances M. and W. Scheme 72 515 School Medical ,, 132 1211 Tuberculosis ,, 40 270 244 1996 The conditions on account of which these children were seen are as follows:— M. & C. W. School Medical Service. Tuberculosis. Congenital deformities 7 7 — Rickets 30 12 — Spinal conditions (other than tuberculosis) - 27 - Foot conditions (clubfoot and similar formities) 10 21 - Paralyses:— Infantile 8 21 — Other paralysis 5 20 — Miscellaneous 12 27 — Surgical tuberculosis — — 40 72 135 40 (b) Clinics for Massage and Remedial Exercises. (1) Through the Education Committee.—Clinics dealing with various types of crippling defects are conducted in a room allotted for the purpose at Welcome Hall, Scarbrook Hill. During the year arrangements were modified in such a way that the slighter cases needing class instruction were referred to these clinics, the more severe cases needing individual treatment being referred to the Hospital Clinic. This differentiation, though it is unavoidably not quite complete, will tend to prevent overlapping between the two clinics. (a) Spinal Remedial Class, Scarbrook Hill, in which children with 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 122 368 regular intervals to ascertain the progress made in each case. The class is held on four afternoons in each week. The following particulars refer to the work done at the clinics:— No. of children treated during the year 85 No. discharged as not requiring further treatment 44 No. discharged owing to irregular attendance 5 No. discharged, inadvisable to continue 2 No. discharged, left district or transferred to other clinics 5 No. discontinuing on leaving school 3 No. attending clinic on December 31st, 1926 26 Total attendances during the year 1852 This clinic draws its cases in part from children referred from routine 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. Davidson Girls. British Girls. Ingram Girls. Tavistock Girls. *St. Andrew's Girls. Winterbourne Girls. *This Class has since been discontinued. 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, appropriate cases being drafted from time to time to the central remedial exercises clinic. (b) Massage and General Remedial Clinic .—A massage and remedial exercises clinic is conducted at Welcome Hall by Miss Batson as masseuse, in close association with Miss Appleton's spinal remedial clinic, and with the kind assistance of two voluntary trained helpers, Mrs. Childs and Miss Voss. The following classes were held:— "Flat-foot" Class—4 times a week—attended by 32 children. "Mobility" Class—4 times a week—attended by 48 children. "Breathing" Class—6 times a week—attended by 258 children. 123 369 The following are details of children treated at the Massage Section of the clinic:— Infantile paralysis 25 Hemiplegia 8 Other paralysis 4 Club-foot 6 Tubercular joints (quiescent), with wasting 5 Rickets and general malnutrition 10 In addition a considerable number of the children suffering from spinal curvature or flat-foot have had massage as a part of the general treatment. Beyond the remedial exercises and massage given at the clinics named above, a regular course of massage and remedial exercises has been given three times a week at the school for physically defective children in Winterbourne Road. Through the kind help of Miss Voss, whose trained aid has been greatly appreciated, the number of sessions during the later part of the year were increased to five per week. (2) Through Public Health Committee.—A massage and remedial exercises clinic for children under 5 is provided by the Public Health Committee at the Lodge Road Clinic. Here again, to avoid so far as possible duplication with the Hospital clinic, only the slighter cases are treated, not needing special apparatus for treatment. (3) Through the Croydon General Hospital.—Clinics for massage and remedial exercises, and for electrical treatment, are provided at the Croydon General Hospital, and work in association with the Orthopedic Clinic. Treatment is provided on the same basis of payment as for the Orthopedic Clinic, and the more severe cases of deformity or defect are referred to the Hospital for such treatment. C.—Treatment in Institutions. Suitable cases are sent, through the Orthopedic Clinic, to the St. Nicholas and St. Martin Orthopedic Hospital, Pyrford, where prolonged treatment is needed; others requiring short periods of treatment are admitted to the Croydon General Hospital under 124 370 the care of the orthopaedic surgeon. During 1926, 9 children were sent to Pyrford, and 11 were admitted to the Croydon General Hospital. D.—Orthopaedic Apparatus. Splints and other apparatus are provided, with appropriate contributions, complete or in part, by parents, on the recommendation of the orthopedic surgeon. E.—Education. Through its school of 40 places for physically defective children, in Winterbourne Road, the Education Commmittee is able to provide for many of these crippled children a type of education more nearly suited to their needs and capacities than that in the ordinary school, while the provision of a mid-day meal and the facilities for open-air work during the summer are clearly to the benefit of the children. The comments made in a later paragraph, in regard to the dull and backward child, apply with force to the crippled child; and attention to the mental attitude of the crippled child is a factor of fundamental importance in dealing with the vital effect of the crippling on his character. OPEN-AIR EDUCATION. (a) 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. I need scarcely say how greatly an extension, where possible, to other schools of similar arrangements would be repaid, both in the health and in the capacity for education of the delicate child. (b) 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 mainly restricted to places in the locality, e.g., the Aerodrome, Public Library, Whitgift Almshouses, the Old Palace, and various industrial works. Permission, however, has been given during the past year for educational visits to various places of interest outside Croydon, e.g., the Zoo, London Museum, etc. 125 371 (c) School Gamps. A school camp was again 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, which 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. Blankets, tents, stretchers, etc., for sleeping purposes, and a fully equipped cookhouse have been provided; also satisfactory deep trench closet accommodation of army pattern. 480 boys and girls from the elementary schools went to the Camp during the summer months, in parties of 20 or 40, each party for a week. The following are the Departments which sent parties:— Girls' School. Boys' School. The Ecclesbourne. The Whitehorge Manor. ,, Woodside. ,, Oval ,, Oval. ,, Portland. ,, Croydon British. ,, Rectory Manor. ,, Tavistock. ,, Sydenham. ,, Winterbourne. ,, Davidson. ,, West Thornton. ,, West Thornton. ,, Rectory Manor. ,, Ingram. ,, Croydon British. Most attractive types of instruction in science, history, geology, natural history, etc., in addition to ordinary school subjects, are given to the children at the camp. (d) Open-Air Schools or Classrooms. Although there are at present no open-air residential or day schools, or open-air classrooms, the scheme for educational development in Croydon includes the provision of such a school in 1928-29, and proposals to this end will be formulated in due course. I have previously drawn attention to the need for an open-air school for the considerable group of anemic, debilitated children —numbering over 250—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. 126 372 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:— Physical education in our schools includes not only the formal physical exercise lessons, as in former years, but games of all kinds, dancing, swimming, athletic sports and camping. Again the work has been hampered by weather conditions, for many of the schools are still entirely dependent on the playground, and there were many days when this was unsuitable owing to inclement weather. During the year provision to various schools of a certain amount of equipment in the form of team bands, bean bags, and jumping ropes helped considerably. This equipment was supplied as an outcome of a questionnaire sent to the schools in June. All Girls and Senior Mixed departments except two again attended the swimming baths during the summer season, and five hundred and twenty five girls were taught to swim a width for the first time. The swimming arrangements for all schools were inconvenienced by the General Strike and consequent coal stoppage, as the times at the baths had to be curtailed. Especially was this the case with the schools using Thornton Heath baths, which were closed entirely during May and June. In spite of this shortage of accommodation, however, I am happv to report there is verv little difference from 1925, either in the number of beginners taught to swim or the number of certificates gained for swimming 30 or 50 yards, and there is an actual increase in the number of Life Saving Certificates, as will be seen from the appended list. The number of Royal Life Saving Society Bronze Medallions gained is a record one, and for the first time a Croydon Elementary School girl obtained the Award of Merit of the Royal Life Saving Society, and another girl obtained the Teachers' Certificate of the same Society. These results probably owe much to the free tickets again kindly granted to each school by the Baths Committee, thus enabling swimmers to obtain extra practice 127 373 1925. 1926. Croydon Elementary Schools Swimming Association Certificates (for swimming 30 yards) 349 326 London Schools' Swimming Association (50 yards) 272 263 Elementary Life Saving 71 78 Advanced Life Saving 34 38 Proficiency Certificates of Royal Life Saving Society 19 19 Bronze Medallions R.L.S.S. 5 11 Award of Merit R.L.S.S. — 1 Teachers' Certificate R.L.S.S. — 1 The congestion at the Thornton Heath Baths is still great, and an extra session for girls at this bath is very desirable. Only one session is available, and five of our largest girls' schools have to be fitted in. Fifteen girls' departments held swimming galas of their own in addition to taking part in the Inter-schools Gala. Sixteen schools took advantage of the privilege of using the Recreation Grounds for Organised Games lessons, but the attendance was again somewhat irregular, as it is inadvisable to take the girls if the weather is at all unsettled, owing to the considerable walk from the school and the lack of suitable shelter in case of rain. The Netball section of the Croydon Elementary Schools Athletic Association arranged two Tournaments—Senior and Junior. The Senior Cup, presented by Harry Lewis, Esq., was won by Tavistock, as was also the Junior Cup, presented by the headmistresses of Winterbourne and Tavistock Schools. The Annual Athletic Sports arranged by the Croydon Elementary Schools Athletic Association was held at the Crystal Palace on June 30th. Several Girls' Schools also held sports of their own. The following Courses and Demonstrations for Teachers were held during the year:— 1. A course of six lessons in Physical Exercises, Games and Dances for Teachers in Senior departments. 128 374 2. Course of five lessons in Physical Exercises, Games and Dances for Teachers in Infants' departments. 3. A Demonstration of Class Methods in the Teaching of Swimming, arranged by the Croydon Elementary Schools Swimming Association, at the Central Baths, April 22nd. This took place in school hours, and one teacher from every senior department was allowed to attend. 4. An Intensive Course for Women Teachers in Girls' and Junior Mixed departments. This course was the first of its kind held in Croydon. Thirty-three teachers attended for ten mornings, June 14th-25th, and the time-table included physical exercises, short lectures, demonstrations with classes of children, dancing and playground games. 5. A second Intensive Course, similar to No. 4, was held, October 18th to November 2nd (the half term holiday intervening), at which 24 teachers were present. Those who attended these courses speak enthusiastically of the benefits derived and the results are apparent in increased enthusiasm and improved work in the schools from which they attended. 6. On Saturday, June 26th, all teachers were invited to attend a special exhibition of films illustrating school physical training and swimming, at the Palladium Cinema. This performance was well attended. 7. On July 13th an inter-team Games' Competition was held between the women teachers and men teachers. Intensive courses and an enjoyable evening resulted. 8. On October 12th a reunion class was held for those who attended the first Women's Course, and it is hoped to hold further reunions of this description from time to time, and so to keep those who attend in touch with up-to-date methods and fresh ideas. The East Surrey branch of the English Folk Dance Society has conducted classes in Country, Morris and Sword dances throughout the year at Winterbourne School, and these classes have been well attended by Croydon teachers with the result that Country dancing is now well taught in the majority of girls' departments. Boys and girls from twelve schools provided a programme of English Country dances at the League of Nations 129 375 Union Fete on Saturday, June 20th, while several hundred boys and girls from Croydon schools took part in the Folk Dance Festival arranged by the East Surrey branch of the E.F.D.S., at South Nutfield on Saturday, July 10th. Visits were paid to the Women's and Girls' gymnastic classes in connection with the Central Polytechnic and Evening Institutes throughout the season. Eight girls' schools held school camps at Pilgrim Fort during the summer, and from some schools a second partv was sent later in the season. One school arranged a very successful week-end camp for old scholars. Corrective Classes have been held in seven girls' schools during the year. One class had to be discontinued after the summer vacation owing to lack of a suitable room, and another class was closed temporarily owing to shortage of staff, but has now been resumed satisfactorily. Thus it will be seen that Physical Education in the elementary schools of the Borough is slowly but surely progressing towards that wider outlook which refuses to regard it as merely a subject in the school time-table, but recognises that it forms an integral part in the development of every child, and that "mental education can but be accomplished only when physical health and development are satisfactory." We are striving that physical training shall become a living force in the schools and an equipment for after life. I am glad to record here my thankful appreciation to all—Baths superintendents, the officials of the East Surrey branch of the E.F.D.S., and the various branches of the C.E.S.A.A., and, very emphatically, to the teachers in our schools —who are aiding me to this end. MAY APPLETON. (b) Physical Training in Boys' Departments. I am indebted to Mr. Drew, Assistant Inspector of Schools, for the following statement:— (i) The allotment of time devoted to physical training on the time-tables of Boys' Schools remains substantially the same as in the report for last year. It has been found possible, however, during the last school year to include a daily physical training period for certain classes which 130 376 formerly, owing to difficulties of organisation, were only able to obtain three lessons per week. Where these difficulties still exist it is hoped that, by careful arrangement, the ideal of a daily period may be achieved. (ii) Two Courses for men teachers have been held during the past school year. The first Course was held at the Selhurst Grammar School for Boys from 14th to 25th June. Twentyfour teachers from the Croydon Elementary Schools attended this Course, one representative coming from each Boys' Department. The Course was held in the mornings, from 9.15 to 12 noon, and consisted of work suitable for boys' classes and following the lines of the Board of Education's Syllabus of Physical Training. The second Course was held in the Welcome Hall, Scarbrook Road, Croydon, from 15th to 26th November. Twenty teachers attended and, although there were four less in attendance than at the first Course, the practical result is that two representatives from the large majority of the Boys' Departments of the Croydon Schools have had a more extended opportunity of considering the best methods of pursuing the work of physical training, and where uniformity of practice is desirable this has been achieved. (iii) In the last report reference was made to the possibilities of providing recreative activities and simple sports events suitable for the school playground. A list of such simple activities, together with some simple playground games, was considered at the Courses mentioned above. It was welcomed with great interest and has been found the means of giving much more variety to the ordinary physical training lesson. (iv) Football in Boys' Schools continues to aim at an educative influence in the school life. The six competitive events mentioned in the last report continue to be the basis of many struggles before the winning team in each competition is "ound. In the Croydon Schools' Charitv Cup Competition attendance at the match provided the sum of £70, which was handed over to the Hospitals and certain Juvenile Organisation Committees. 131 377 The Croydon Boys' Town Team has, at the time of making this report, reached the semi-final in the Surrey Schools Championship. The Croydon Old Boys' Club (for ex-scholars) has also reached the semi-final in the Surrey County Youths' Cup. Further provision of playing fields would be of immense advantage. (v) The great interest taken in Swimming has been well maintained during the past season in spite of the curtailment of Baths' facilities, due to the lack of heating, and the Boys' Schools shared in the gaining of over a thousand certificates for various stages of proficiency. In the Croydon Elementary Schools Swimming Gala, trophies were won as follows:— Crittenden Cup Boy Junior Champion 66 2-3 yds. 60 3-5 secs. Squire Cup Boy L.S.S.A. Branch Champion 100 yds. 1 min. 32secs. Wotton Shield Boys' Junior Team 1 min. 584-5secs. Whitehorse Dolphin Shield Boys' Senior Team l min. 492-5secs. (vi) In the Schools Cricket League 19 schools entered the Competition, 10 in the northern division and 9 in the southern. The winning team in the northern division scored 32 points out of 36. In the southern division the winning team scored 28 points. The finals were played on the afternoon of July 16th, when the various trophies were competed for. (vii) The Annual Sports Meeting at the Crystal Palace was held, as usual, during the Summer Term, and was attended by members of the Education Committee, officers and parents. 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, 133 378 Attendance Officers and Care Committees are considered by the School Canteen Sub-Committee. No. of children who received free meals 265 No. of free meals provided 13694 No. of children who received free milk 286 No. who received milk on part payment 71 No. who received milk on full payment 125 The meals are provided at local dining rooms, and consist of two courses—meat and vegetables and a milk pudding. Milk is supplied and consumed at school, under the supervision of the class teacher. CO-OPERATION OF PARENTS. The presence of parents is welcomed at the routine medical inspections, as it gives the Medical Officer the opportunity of giving personal help and advice. During 1926 60 per cent. of the children were accompanied by parents or guardians at routine medical inspections at Elementary Schools. CO-OPERATION OF TEACHERS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. It is a pleasure to bear witness to the ungrudging and eager co-operation of teachers in the school medical work. The teacher is clearly the pivot on which the effectiveness of the work depends, and this is freely recognised by them, with the happiest results. The school attendance officers are similarly in constant touch with the school medical service, with the members of whom there is close mutual co-operation. The voluntary School Care Committees have continued their work of assisting in the provision of treatment, and their interest is not infrequently a deciding factor in success in seeking treatment. I he Croydon Council of Social Service constantly gives information and assistance in many directions in dealing with necessitous cases for whom provision could not otherwise readily be made. Close co-operation is maintained with the Inspector of the National Association for the Prevention of Cruelty to Children, who has been the means in a number of instances of dealing with neglected children and difficult households. 133 379 BLIND, DEAF, EPILEPTIC AND PHYSICALLY DEFECTIVE CHILDREN. Table III., at the end of this report shews that the numbers known as are follows : — Blind 22* Deaf 12* Mentally defective (and still under care of Education Committee 114 Epileptic—severe grade 9 slighter grade 13 Physically defective— Infectious pulmonary and glandular tuberculosis 5 Non-infectious, but active glandular tuberculosis 94 Active non-pulmonary tuberculosis 35 Delicate (pre-tubercular, anæmia, etc.) 127 Crippled (other than tuberculosis) 159 (*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. Mentally Defective Children. It will be seen from Table III. at the end of the report that there are 114 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, 76 were on the roll of the Grangewood Special School at the end of the year. Clinic for Mentally Defective Children. 95 children were examined at the Clinic held at the Town Hall, involving 106 examinations, with the following results:— results:— 1.—(a) Certified as mentally defective 23 —(b) Confirmed as mentally defective 7 2.—Found to be dull and backward 48 (retarded 1—2 years, 24; retarded 2—3 years, 20; over 3 years, 4.) 3.—Found to be physically defective 6 4.—Found to be of normal intelligence 7 5.—Referred for re-examination 4 134 380 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 18 (ii) Recommended for residential schools 5 (iii) Referred to local Control Authority as ineducable 4 (iv) Placed under supervision at home 3 2.—Dull and backward children:— (a) Recommended for special class 32 (b) To continue at ordinary school 12 (c) To attend ordinary school and have special tuition at home 4 3.—Physical defectives:— (a) Recommended for an Epileptic Colony 1 (b) To attend a class for physically defective children 2 (c) To have physical treatment and attend ordinary school 3 4.—Normal children:— To attend ordinary school 7 5.—Diagnosis deferred:— (i) To be re-examined after physical treatment or further attendance at school 4 Occupation Centre. Number of pupils on register, 1/1/1926 35 Full time 24 Part time 11 Average attendance—mornings 15 Average attendance—afternoons 18 Left during 1926— Full time pupils 4 Part time pupils 3 Admitted during year— Full time pupils 4 Part time pupils 3 135 381 The classes for low-grade mentally defective children and adolescents were continued throughout the year at the Occupation Centre in Grangewood Park. The Occupation Centre deals with children under school age; children of school age, but unsuitable for a special school; and patients over school age, whether or not they have been at a special school. The children under 16, of whom there are 24 on the register, attend for both morning and afternoon sessions on five days a week, and receive the same midday 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 for three sessions per week. The latter group during the year have comprised 11 girls. The Occupation Centre has been of the greatest value, not only in itself, but as an adjunct to the work of the Education Committee, in that it provides facilities for children who would otherwise receive no form of systematic instruction. Classes for Dull and Backward Children. Special Classes for dull and backward children are established in the following schools:— Beulah Boys'. West Thornton Infants'. Davidson Boys'. Ecclesbourne Boys' and Girls'. Ingram Boys.' Rectory Manor Infants'. North Park Girls'. Portland Infants'. Svdenham Boys'. Tavistock Girls'. Whitehorse Manor Boys' and Girls'. Winterbourne Infants'. Woodside Girls'. South Norwood Girls'. Norbury Manor Senior Mixed. I should like to emphasise the great value of such classes, and to express a hope that they may be extended to a great many other schools in the Borough. These special classes, especially where a child can revert to the ordinary class for his stronger subjects, help the dull and backward child to recover his self-confidence— so readily lost when he compares himself with the normal child— and in so doing assist him to use and develop powers which are often left lying dormant through sheer lack of encouragement. 136 382 PHYSICALLY DEFECTIVE CHILDREN. The school of 40 places for physically defective children in Winterbourne Road has been full throughout the year. The special manual type of instruction has been successfully in operation. Hot mid-day meals, cooked on the premises, are provided for the children. During the warmer months most of the day is spent in the open-air, so that the children have great opportunities of physical and mental improvement. Miss Batson and a voluntary trained helper, Miss Voss, attend for a total of four sessions a week to give massage and remedial exercises for individual children. All the children suffering from crippling conditions have been examined and advised by the orthopaedic surgeon at the Hospital Clinic. NURSERY SCHOOLS. No Nursery Schools have been established in the Borough. CENTRAL SCHOOLS. Medical inspection at the Central Schools (John Ruskin School for Bovs and Lady Edridge School for Girls) have continued as in previous years, the children at these schools being subjected to annual examination. 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 1926, the examination of girls being carried out by women medical officers. 874 pupils at secondary schools underwent routine medical inspection during the year. In addition, 178 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 5.0 per cent. of those undergoing routine inspection were referred for treatment for defective eyesight; 0.7 per cent. for anremia; and 5.0 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. 137 383 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 children and young persons under 16 years of age. 319 applicants for employment certificates were examined. In 3 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. 36 candidates who desired to become bursars and student teachers were medically examined during the year. H. P. NEWSHOLME. March, 1927. 138 384 Appendix C. A.—ELEMENTARY SCHOOLS. TABLE I.—Return of Medical Inspections. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 2793 Intermediates 2044 Leavers 3506 Total 8343 Number of other Routine Inspections 54 B.—Other Inspections. Number of Special Inspections 2504 Number of Re-inspections 8341 Total 10845 Total visits to Elementary Schools 500 139 385 TABLE II A. —Return of Defects round by Medical Inspection in the Year ended 31st December, 1926. DEFECT OR DISEASE Routine Inspections Number of defects. Special Inspections. No. of defects. Requiring treatment. Requiring to be kept under observation but nut requiring treatment Requiring treatment. Requiring to be kept under observation but not requiring treatment. (1) (2 (3) (4) (5) Malnutrition 73 160 15 6 Uncleanliness 10 317 4 1 (See Table IV.—Group V.) Skin— Ringworm: Scalp 8 ... 1 ... Body 1 ... ... ... Scabies 3 ... 1 ... Impetigo 16 5 16 ... Other diseases (non-tuberculous) 14 5 2 2 Eye— Blepharitis 17 9 4 ... Conjunctivitis 5 ... 3 ... Keratitis ... ... ... ... Corneal opacities ... ... ... ... Defective vision (excluding squint) 536 246 171 11 Squint 35 6 4 1 Other conditions 7 3 6 1 Ear— Defective hearing 27 13 9 2 Otitis media 21 10 21 2 Other ear diseases 7 1 2 1 Nose & Throat— Enlarged tonsils only 256 672 34 25 Adenoids only 98 127 13 7 Enlarged tonsils & adenoids 255 96 39 2 Other conditions 99 240 18 16 Enlarged Cervical Glands— (Non-tuberculous) 31 330 7 14 Defective Speech 4 6 6 8 Teeth —Dental Diseases (See Table IV.—Group IV. 848 105 98 1 Heart & Circulation— Heart disease: Organic 13 123 ... 6 Functional 14 249 1 20 Anæmia 53 179 10 10 Lungs— Bronchitis 19 60 2 2 Other non-tuberculous diseases 3 15 1 2 Tuberculosis— Pulmonary—Definite ... ... ... ... ,, Suspected 2 5 1 1 Non-pulmonary—Glands 37 50 5 2 ,, Spine ... 1 ... ... ,, Hip ... ... 1 ... ,, Other Bones & Joints .. 1 ... ... ... ,, Skin 1 ... ... ... ,, Other Forms 2 1 ... ... Nervous System — Epilepsy ... 11 ... 3 Chorea 3 8 6 5 Other conditions 1 22 1 6 Deformities — Rickets 6 2 1 1 Spinal curvature 224 408 18 8 Other forms 54 28 12 1 Other Defects & Diseases 57 147 33 23 140 386 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) Code Groups- Entrants 2793 450 16.1 Intermediates 2041 381 18.6 Leavers 3506 712 20.3 Total (Code Groups) 8343 1543 18.5 Other Routine Inspections 54 11 20.4 141 387 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 Schools or Classes for the Blind 3 4 17 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 blinded. Attending Certified Schools or Classes for the Blind 1 6 7 Attending Public Elementary Schools 4 2 6 At other Institutions ... ... ... At no School or Institution ... ... ... 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 2 4 6 Attending Public Elementary Schools ... 1 1 At other Institutions 1 ... 1 At no School or Institution ... ... ... (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 2 At other Institutions ... ... ... At no School or Institutions ... ... 1 1 MENTALLY DEFECTIVE. FeebleMinded (cases not notifiable to the Local Control Authority). Attending Certified Schools for Mentally Defective Children 42 40 82 Attending Public Elementary Schools 5 4 9 At other Institutions 1 ... 1 At no School or Institution 7 10 17 Notified to the Local Control Authority during the year. Feebleminded 1 ... 1 Imbeciles 2 2 4 Idiots ... ... ... EPILEPTICS. Suffering from severe Epilepsy. Attending Certified Special Schools for Epileptics 4 1 5 In Institutions other than Certified Special Schools 1 ... 1 Attending Public Elementary Schools ... 1 1 At no School or Institution 2 ... 2 Suffering from Epilepsy which is not severe. Attending Public Elementary Schools 7 5 12 At no School or Institution ... 1 1 142 388 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 2 1 3 At other Institutions ... ... ... At no School or Institution 1 1 2 Non-Infectious but Active Pulmonary and Glandular Tuberculosis. At Sanatorium or Sanatorium Schools approved by the Ministry of Health or the Board 3 4 7 At Certified Residential OpenAir Schools ... ... ... At Certified Day Open-Air Schools ... ... ... At Public Elementary Schools 49 33 82 At other Institutions 1 1 2 At no School or Institution 1 2 3 PHYSICALLY DEFECTIVE. Delicate Children e.g., pre- or latent tuberculosis, malnutrition, debility, anæmia etc. At Certified Residential OpenAir Schools ... ... ... At Certified Day Open-Air Schools ... ... ... At Public Elementary Schools 76 49 125 At other Institutions ... ... ... At no School or Institution 1 1 2 Active NonPulmonary Tuberculosis. At Sanatorium or Hospital Schools approved by the Ministry of Health or the Board 8 7 15 At Public Elementary Schools 10 6 16 At other Institutions ... ... ... At no School or Institution 3 2 4 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 4 2 6 At Certified Residential Cripple Schools ... ... ... At Certified Day Cripple Schools 22 28 50 At Public Elementary Schools 48 38 86 At other Institutions 4 2 6 At no School or Institution 2 9 11 143 389 TABLE IV.—Return of Defects Treated During the Year Ended 31st December, 1926. 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 75 1 76 ,, Body 20 ... 20 Scabies 11 ... 11 Impetigo 221 ... 221 Other skin diseases 120 5 125 Minor Eye Defects— (External and other, but excluding cases falling in Group II) 109 4 113 Minor Ear Defects 193 ... 193 Miscellaneous— (e.g. Minor injuries, bruises, sores, chilblains, etc.) 163 ... 163 Total| 912 10 922 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 Authority'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) 624 25 1 650 Other defect or disease of the eyes (excluding those recorded in Group 1) 4 ... ... 4 Total 628 25 1 654 Total number of children for whom spectacles were prescribed— (а) Under the Authority's scheme 489 (b) Otherwise 28 Total number of children who obtained or received spectacles— (a) Under the Authority's scheme 500 (b) Otherwise 22 144 390 Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received operative treatment. Received other forms of treatment- Total number treated. Under the Authority's scheme in clinic or hospital. By private practitioner or hospital apart from the Authority's scheme. TOTAL. (1) (2) (3 ) (4) (5) 286 38 324 13 337 TABLE IV. GROUP IV.—Dental Defects. (1) Number of children who were (a) Inspected by the dentist:— Routine age groups. Aged 5—6 1846 Total—9393 „ 6—7 3226 „ 7—8 1693 „ 8—9 1280 „ 9—10 1328 „ 10—11 20 „ 11 -12 — „ 12—13 — „ 13—14 — „ 14—15 - „ 15—16 — Specials 1148 Grand total 10541 (b) Found to require treatment 7564 (c) Actually treated 4629 (d) Re-treated during the year as the result of odical examination 911 (2) Half-days devoted to inspection 104 „ „ treatment 606* 710 (3) Attendance made by children for treatment 6679 (4) Fillings—Permanent teeth 643 Temporary teeth 2557 3200 (5) Extractions—Permanent teeth 630 Temporary teeth 6953 7583 (6) Administrations of general anaesthetics for extractions 1495 (7) Other operations—Permanent teeth 105 Temporary teeth 505 610 *Including 46 sessions where dental surgeon acted as anaesthetist. 145 391 GROUP V.—Uncleanliness and Verminous Conditions. (1) Average number of visits per School made during the year by the school nurses 10—11 (2) Total number of examinations of children in the schools by School Nurses 59164 (3) Number of children found unclean (on periodical examinations) 3889 (4) Number of children cleansed under arrangements made by the Local Education Authority 2 (5) Number of cases in which legal proceedings were taken— (а) Under the Education Act, 1921 — (b) Under School Attendance Bye-laws — SECONDARY. II.—SECONDARY SCHOOLS. TABLE I.—Return of Medical Inspections. A.—Routine Medical Inspections. II and under 192 12 192 13 155 14 I52 15 108 16 63 17 12 18 and over — 874 B.—Other Inspections. Number of Special Inspections 4 Number of Re-inspections 174 Total 178 Visits to Secondary Schools 45 146 392 SECONDARY TABLE II.—A.—Return of Defects Found by Medical Inspection in the Year Ended 31st December, 1926. DEFECT or DISEASE Routine Inspections. Number of defects. Special Inspections. 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 2 3 ... ... Uncleanliness 1 5 ... ... (See Table IV.—Group V.) Skin— Ringworm Scalp ... ... ... ... Body ... ... ... ... Scabies ... ... ... ... Impetigo ... ... ... ... Other diseases (non tuberculous) ... 1 ... ... Eye— Blepharitis ... 1 ... ... Conjunctivitis ... ... ... ... Keratitis ... ... ... ... Corneal opacities ... ... ... ... Defective vision (excluding squint). 42 36 ... ... Squint 1 ... ... ... Other conditions ... ... ... ... Ear— Defective hearing 1 ... ... ... Otitis media ... ... ... ... Other eat diseases ... ... ... ... Nose and Throat— Enlarged tonsils only ... 17 ... ... Adenoids only ... 2 ... ... Enlarged tonsils and adenoids ... 2 ... ... Other conditions 1 10 1 1 Enlarged Cervical Glands (Non Tuberculous) 4 11 ... ... Defective Speech ... ... ... ... Teeth—Dental Disease (See Table IV.—Group IV). 58 10 ... ... Heart and Circulation— Heart Disease — Organic ... 23 ... ... Functional 1 25 ... ... Anæmia 6 7 ... ... Lungs— Bronchitis ... 1 ... ... Other non-tuberculous diseases ... ... ... ... tuberculosis— Pulmonary— Definite ... ... ... ... Suspected ... ... ... ... Respiratory—Non-pulmonary Glands ... 2 ... ... Spine ... ... ... ... Hip ... ... ... ... Other bones & joints ... ... ... ... Skin ... ... ... ... Other forms ... ... ... ... ... ... ... Nervous System— Epilepsy ... 1 ... ... Chorea ... ... ... ... ... ... Other conditions 1 8 ... ... Deformities— Rickets ... ... ... ... Spinal curvature 44 42 ... ... Other forms 10 3 ... ... Other Defects and Diseases 5 24 1 ... 147 393 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 192 23 12.0 12 192 14 7.3 13 155 25 16.1 14 152 15 10.0 15 108 22 20.4 16 63 8 12.7 17 12 5 41.7 18 and over ... ... ... 874 112 12.8 SECONDARY TABLE IV.—Return of Defects treated during the year ended 31st December, 1926. 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. (d (2) (3) (4) Skin— Ringworm (scalp) ... ... ... „ (body) ... ... ... Scabies ... 1 1 Impetigo ... ... ... Other skin disease ... 2 2 Minor Eye Defects— (External and other, but excluding cases falling in Group II) ... 1 1 Minor Ear Defects— ... 2 2 Miscellaneous— (e.g. minor injuries, bruises, lores, chilblains, etc.) ... ... ... Total. ... 6 6 148 394 Group II.—Defective Vision and Squint (excluding minor eye defects treated as minor ailments.—Gioup 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 scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of refraction (including squint) 1 37 • •• 38 Other defects or disease of the eyes (excluding those recorded in Group I.) ... ... ... ... Total 1 37 ... 38 Total number of children for whom spectacles were prescribed:— (а) Under the Authority's scheme 1 (b) Otherwise 35 Total number of children who obtained or received spectacles:— (a) Under the Authority's scheme 1 (b) Otherwise 35 Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received operative treatment. Received other forms of treatment. Total number treated. Under the Authority's scheme in clinic or hospital. By private practitioner or hospital apart from the Authority's scheme. TOTAL. (1) (2) (3) (4) (5) ... 3 3 ... 3 TABLE IV.—Group IV. No Dental Treatment provided for Secondary Schools. Group V. No Uncleanliness Surveys in Secondary Schools. 149 395 150 396 151