CRO 36 County Borough of Croydon. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1934 OSCAR M. HOLDEN, M.D., D.P.H. CROYDON: Printed by the "Croydon Times," Ltd., 104, High Street. 2 PUBLIC HEALTH COMMITTEE. NOVEMBER, 1933—34. The Worshipful the Mayor (Alderman James Trumble, J.P.). Councillor Mrs. Roberts (Chairman). Councillor Major F. 'W. Rees, L.R.I.B.A. (ViceChairman). Alderman Albert Jackson. Alderman H. J. Morland, M.A., J.P. Alderman W. B. Southwell, J.P. Councillor E. E. L. Arkell. Councillor Ernest Edward Constable. Councillor Mrs. Dale. Councillor Charles Herbert Gibson. Councillor Miss M. H. Glazier. Councillor Mrs. Heighton, J.P. (Deceased). Councillor B. Holden. Councillor Harry Stewart Izzett. Councillor George Lewin. Councillor W. H. Parry. Councillor Mrs. Squire, J.P. For purposes of Maternity and Child Welfare— Mesdames Horn, Leech, Southwell, and the Misses Amos and Slimmon. 3 COUNTY BOROUGH QF CROYDON. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and SCHOOL MEDICAL OFFICER For the Year 1934. To the Chairman and Members of the Public Health Comviiltee. Ladies and Gentlemen, I have the honour to present herewith my Seventh Annual Report, being the thirty-fifth of the series, on the health of Croydon. The general arrangement follows that of the last report. The contents have been compiled in compliance with Circular 1417 of the Ministry of Health, dated 25th October, 1934, and the report is an ordinary, not a survey report. VITAL STATISTICS. The Birth Rate (13.2) was the same as for 1933, which was the lowest figure vet recorded, and was 1.6 per 1,000 less than for the whole of England and Wales, whilst the Death Rate (10.7) showed a decline compared with 1933. It was 1 per 1,000 less than that for the whole of England and Wales, and was the lowest yet recorded for Croydon. The steadily diminishing Birth Rate is leading to a gradual rise in the average age of the population, and in consequence any further permanent reduction in the Death Rate is unlikely. It is satisfactory to record a further diminution in the infant mortality rate, the figure for 1934 being the lowest yet recorded. This rate is usually taken as being the truest indication of the general healthiness of a district, and Croydon has one of the lowest infantile mortality rates among the large towns. In view of the town's changing character from being largely residential to industrialisation, the continued reduction in the loss of infant life is gratifying. The common infectious diseases showed a considerable increase in incidence. The mortality rose from 0.17 to 0.24 per 1,000 of the population. Infectious diseases exhibit more or less cyclical 4 waves of incidence. and so far as Scarlet Fever and Diphtheria are concerned. the indications of a commencement of a wave of higher incidence noticed in 1933 were borne out in 1934. Measles exhibits a two-year cycle as a general rule. but Croydon is peculiar in that the incidence does not occur in the whole of ithe Borough yearly. but in the Northern portion in one year and in the Southern portion the next year. and as in 1933 the peak of the wave occurred during the first half of the year. Influenza caused no anxiety and was less prevalent than in 1933. The chief causes of death were substantially the same as in 1933; diseases of the Heart and Circulatory system. Cancer and Respiratory diseases causing more than 50 per cent. of the total deaths. The report. being divided into sections. presents the statistical details of each phase of the work under the appropriate headings. The Section dealing with Mayday Hospital has been slightly enlarged. The changing character of the work can be seen in the enumeration of the conditions for which patients were admitted and of the operations performed. The number of emergency and accident cases has increased. The Hospital is. both in character and in administration. coming rapidly into line with general hospital practice. The prominent place taken by Slum Clearance in the public eye has warranted a statement of the progress made with respect to the Five Years Programme which was submitted to the Minister of Health in September. 1933. Work has been pursued energetically in the inspection and representation of improvement areas and individual unfit houses. Delay in action. however. was caused by re-housing difficulties. There is every indication that this will soon be remedied. The clearance area of Old Town has been partially demolished and new houses built on the site. The scheme has not been completed at the end of the year. Another of the difficulties experienced has been with overcrowding in large houses which are divided into tenements. This is becoming more prevalent. and it is not possible to do anything effective under present housing legislation. If the Housing Bill. 1935. becomes law overcrowding will become an offence. Its detection will entail constant vigilance on the part of the inspectorial staff. A definition of overcrowding is also laid down. more drastic than that utilised in Croydon. so that there will be overcrowding. where. under present standards. it does not now exist. A section has again been devoted to the Obstetric Service conducted by Officers of the Council. This scheme is one of the 4a most comprehensive in operation and fulfils practically all the fundamental requirements of an adequate maternity service, as formulated in the final report of the Departmental Committee of the Ministry of Health on Maternal Mortality. Its influence on maternal mortality and morbidity in Croydon will depend upon the use made of its facilities by that section of the population for whom it is intended. The figures given, and the scope of the sections detailed indicate to what an extent the Public Health Service has become an integral part of the civic economy. There are few aspects in the life of citizens which are not, in some way or other, ooncerned in its activities. As the density of population increases it becomes more than ever imperative to maintain a high level of sanitation and of efficiency if the present position of the Public Health is to be maintained. Lack of interest in, and ignorance of, the duties of health authorities, are the greatest obstacles to further progress and proper valuation of the value of the services which they maintain. It is better, and in the end more eoonomical, to prevent than to cure. This object must always be kept in mind, and it will be fatal to success if the curative functions, which have been transferred to Health Authorities under the Local Government Act, are allowed to overshadow the original function of prevention. I wish to tender my thanks to the Chairmen and Members of the Public Health Committee, the Mental Deficiency Committee, the Housing Committee, and the various Sub-Committees, for the sympathetic consideration they have given to any proposals submitted to them, and for the interest they have taken in the work of the department. The staff of the department have carried out their duties in a satisfactory manner, and I would like to mention the Deputy Medical Officer of Health, Dr. W. B. Watson, whose continued co-operation at all times has been of great value; the Chief Sanitary Inspector, Mr. R. J. Jackson; and the clerical staff, whose duties steadily increase year by year as new legislation is promulgated and put into praotice. I am, Yours faithfully, OSCAR M. HOLDEN, Medical Officer of Health 5 CONTENTS. A.—PUBLIC HEALTH REPORT. page Acts, Adoptive 193 Ambulance Service 16 Amusement Houses 210 Animals, Keeping of 210 Ante-natal Clinic 129 Aerodrome 189 Babies Help Committee 175 Bacteriological Examination 76 Bakehouses 205 Births 9,19 Blind Persons 192 Borough Hospital 14,63 Bye-laws and Regulations 194 Cancer 114 Cerebro-Spinal Meningitis 73 Chicken Pox 53 Closet Accommodation 13 Contacts, Tuberculosis 96 Cowkeepers 221 Croydon Nursing Service 97 Children Acts 177 Convalescence 175 Coombe Cliff Convalescent Hosp. 13,176 Creche 176 Dairies, Cowsheds and Milkshops 221 Deaths 23 Dental Treatment—M. & C.W. 172 Diphtheria 52,58,67 Disinfection 211 Dispensary, Tuberculosis 79, 102 Dried Milk 169 Drainage and Sewage 12 Dysentery 73 Encephalitis Lethargica 73 Enteric Fever 72 Erysipelas 73 Expectant Mothers 173 Factories & Workshops Acts 204 Fertilisers & Feeding Stuffs Act 211 Foods, Inspection of 212,218 Food & Drugs Acts 214, 227 Foster-Mothers 177 Foster-Children 177 Gynaecological Clinic 144 Health Visitors, Work of 167, 168 Home Nursing 97 Homework 206 Hospitals 13 Hospital, St. Mary's (Maternity) 13, 132 Houses Let in Lodgings 208 Housing 201 Housing Act, 1930 201 page Illegitimacy 149 Immunisation Clinic 59 Infant Welfare Clinics, Municipal 123,163 „ „ „ Voluntary 123, 163 Infant Mortality 152 Infectious Diseases 51 Laboratory Work 75, 76, 131 Local Acts 193 Local Government Act 18 Lodging Houses, Common 207 Massage Clinic 171, 188 Maternity Homes 161 Maternity Homes, Registration 161 Mayday Hospital 31, 132 Measles 53,73 Meat Inspection 216 Medical Help Records 159 Meteorology 30 Mental Deficiency 178 Midwives 158 Midwives Act, Section 14 161 Milk, Provision of 169 Milk, Examination of 77,219 Milk, Tuberculous 223 Milkshops 221 Mortality in Child-birth 124,146 Mothers' and Infants' Welfare Association 162 Mumps 54 Neo-natal Deaths 152 Notification of Births Acts 123 Nuisances 196 Nursing Arrangements 97 „ Homes 161 Observation Nursery 13,170 Obstetrical Unit 126 Occupation Centre (Grange Wood) 183 Offensive Trades 209 Ophthalmia Neonatorum 73, 151 Orthopaedic Department 185 Overcrowding 203 Poisons & Pharmacy Act 210 Poliomyelitis 73 Poor Law Relief 16 Population 29 Post-natal Clinic 144 Public Laboratory 76 Puerperal Sepsis and Pyrexia 72,125,147 Queen's Road Homes 17 Rag Flock Acts 209 Rats & Mice (Destruction) Act 212 Rent Restriction Acts 200 Rivers and Streams 12 6 page Sanatorium, Cheam 11l Sanatoria, Treatment in 93 Sanitary Administration 193 Sanitary Certificates 200 Sanitary Inspectors, Work of 196 Scavenging 13 Scarlet Fever 51,57,65 Schools 210 St. Christopher's Special School 182 Shop Hours Acts 207 Slaughterhouses 215 Social Conditions 11 Small Pox 14 Smoke Observations 210 Sputum, Examination 91 Staff 7 Still-births 150 St. Mary's Maternity Hospital 13, 132 Tuberculosis—After Care 100 „ Cheam Sanatorium 1ll „ Contacts 96 „ Deaths 83 page Tuberculosis—Dental Treatment 101,112 „ Notifications 79 „ Home Nursing 97 „ Home Visits 96 Tables 102 „ Pneumothorax 79,112 „ Institutional Treatment 93 Unmarried Mothers 149, 176 Ultra-Violet Light 190 Vaccination 77 Venereal Diseases 117 Verminous Persons 212 Vital Statistics 9, 19 Watercourses 210 Water Supply 11 Whooping Cough 52, 73 Workplaces 204 Workshops 204 X-ray Examination 92, 131, 187 B.—SCHOOL MEDICAL REPORT. page Accommodation 244 Adenoids 254, 267 Blind Children 289 Cleansing of Children 248 Clinics 233, 266 Clothing and Footgear 248 Committee 232 Cost 243 Crippling Defects 269 Deaf Children 255 Defective Children 289 Deformities 255 Dental Disease 273 Dental Treatment 270 Domestic Subjects 297 Ear Clinic 282 Ear Disease 255 Epileptic Children 289 Exclusions 262 Eye Clinic 269 Eye Disease 255 Following up 265 Health Visitors, Work of 265 Heights and Weights 249, 298 Infectious Diseases 264 Inspection Clinic 269 Inspections, Routine 245 Inspections, Special 245 Juvenile Employment 291 page Lungs, Diseases of 253 Malnutrition 248 Massage Clinic 269 Meals, Provision of 291 Mentally Defective Children 293 Milk, etc., Provision of 249, 291 Minor Ailments 266 Nutrition 248 Open-air Classes 289 Orthopaedic Work 269 Orthodontic Service 279 Physical Training 294 Physically Defective Children 290 Remedial Exercises 269 Rheumatism clinic 284 Sanitary Accommodation 238 School Camps 291 Schools, Special 289,292 Secondary Schools 297 Skin Affections 255 Speech 255 Staff 232 Statistical Tables 300 Surveys, Uncleanliness 248 Tonsils, Enlarged 254, 267 Treatment 266 Tuberculosis 253 Uncleanliness 248 Vision, Defective 255 7 STAFF OF THE HEALTH DEPARTMENT. The staff of the Public Health Department on the 31st December, 1934, was a« follows:— Medical Staff.— (a) Whole-time:- Oscar M. Holden, M.D., D.P.H., Medical Officer of Health, School Medical Officer, and Medical Officer under the Mental Deficiency Acts, etc. Wm. B. Watson, L.R.C.P., L.R.C.S., D.P.H., Deputy Medical Officer of Health, Deputy School Medical Officer and Medical Officer under the Mental Deficiency Acts. J. C. McMillan, M.B., Ch.B., B.A.O., B.Sc., D.P.H., Assistant Medical Officer of Health for Tuberculosis. A. L. Cjunn, M.D., F.R.C.S. (Ed.), B.Sc., M.C.O.G., Assistant Medical Officer of Health for Obstetrics. B. Anthony Dormer, M.D., D.P.H., B.Hy., Assistant Medical Officer of Health and Assistant School Medical Officer. J. W. Pickup, M.D., D.P.H., Assistant Medical Officer of Health and Assistant School Medical Officer. Iris A. Jenkin-Lloyd, M.R.C.S., L.R.C.P., D.P.H., Assistant Medical Officer of Health, Maternity and Child Welfare, and School Medical Officer. Aileen 1. McMahon, M.R.C.S., L.R.C.P., D.P.H., Assistant Medical Officer of Health, Maternity and Child Welfare, and School Medical Officer. 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. H. W. Southgate, M.B., B.S., B.Sc., Pathologist. (b) Part-time :— J. R. Draper, B.A., M.B., Medical Inspector of Aliens. Janet D. E. Michael, M.R.C.S., LR.C.P., Assistant Medical Offiicer, Maternity and Child Welfare. J. S. Bookless, B.A., M.B., F.R.C.S.—Ophthalmic Surgeon (School Medical Service). Rota of 4 local medical practitioners for surgical treatment of tonsils and adenoids. Dental Staff.— Senior Dental Surgeon: J. F. Pilbeam, L.D.S. Assistant Dental Surgeons: J. K. R. Bryce, L.D.S., K. C. B. Webster, 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, A.R.S.I., A.I.S.E., M.S.I.A., Deputy Chief Inspector. 14 District Sanitary Inspectors. In addition, there are 4 disinfeclors, 1 rat-catcher, and 7 assistants to the Sanitary Inspectors. Health Visiting Staff.— 21 District Health Visitors; 3 Special Visitors; 1 Tuberculosis Nurse; 1 Almoner and 3 Dental Attendants. Also 2 whole-time Masseuses and Remedial Gymnasts. Clerical Staff.— Twenty-four full-time clerks. Veterinary Inspector (Part-time).— Peter R. A. Thrale, O.B.E., M.R.C.V.S. Analyst (Part-time).— Edward Hinks, B.Sc., F.I.C., F.C.S. 8 Transferred Officers under Local Government Act, 1929.— MAYDAY HOSPITAL— Arnold Gilray, M.B., Ch.B. (N.Z.), Medical Superintendent. John Joseph Walsh, M.B., Ch.B., F.R.C.S. (Eng.), Assistant Medical Superintendent. Edmund Trafford Clifton, M.B.C.S., L.R.C.P., Assistant Medical Officer. John Ewart Edson, M.B., Ch.B., B.Sc., M.Sc., Assistant Medical Officer. District Medical Officers.— William Vaudrey Braddon, M.B., Ch.B., L.S.A. Ernest Philip Chennells, M.B., M.R.C.S., L.R.C.P. Thomas Archibaldi Dukes, M.B., B.Sc., M.R.C.S., L.R.C.P. Henry Fleming Hamilton, M.B., Ch.B., F.R.C.S. Charles Aloysius McGuire, M.B., Ch.B. Alan Pride, M.D. Stewart Septimus Simmons, M.R.C.S., L.R.C.P. Austin Stafford, L.R.C.P.I. & L.M., L.R.C.S.I, k L.M. Public Vaccinators.— William Yaudrey Braddon, M.B., Ch.B., L.S.A. Patrick Francis O'Hagan, L.R.C.P., L.R.C.S. Walter Hugh Montgomery Smith, M.R.C.S., L.R.C.P. Harold Trafford, M.R.C.S., L.R.C.P. Sydney Duke Turner, M.D., D.P.H. Gilbert Charrington Wellish, M.B., Ch.M., F.R.C.S. Vaccination Officer.— Gerald H. Huggins, Cert. R.S.I. Mayday Hospital, Croydon Borough Hospital, Croydon Borough Sanatorium, Observation Nursery, Coombe Cliff Convalescent Home. Nursing and Domestic Staffs. Consultants to the Public Health Department.— Thomas Warwick Preston, M.D., M.R.C.P., Physician. Ernest Marshall Cowell, D.S.O.. M.D., F.R.C.S., Surgeon. Alan Herapath Todd, M.S., F.R.C.S., Orthopaedic Surgeon. John Smeed Bookless, B.A., M.B., F.R.C.S., Opthalmic Surgeon. Archer Ryland, F.R.C.S., Ear, Nose and Throat Surgeon. David Low Greig, M.R.C.S., L.R.C.P., D.M.R.E., Radiologist. Dental Surgeons.— Eric Herbert Laurence, L.D.S. 9 SUMMARY OF VITAL STATISTICS FOR 1934. Area 12,617 acres. Population (Census 1931), 233,115. Population (estimated middle of 1934), 240,600. Number of Inhabited Houses (1931 Census), 56,429. Rateable Value (1st April, 1934), £2,186,960. Product of a Penny Rate (1934), £8,189. Rate in the £ (1933-34), 10/2. Gross expenditure on Health Services (administered by Medical Officer of Health) £125,609 2 10 Income on Health Services (including transfers) £12,039 18 10 Net expenditure on Health Services £113,569 4 0 Expressed as a Penny Rate, 13.86 pence in the pound. Live Births— M. F. Total. Legitimate 1,585 1,450 3,035 Illegitimate 68 82 150 Birth-rate per 1,000 of the estimated resident population, 13.2. Still Births—119. Rate per 1,000 total1 (live and still) births, 36.0. Deaths—2,571. Death-rate per 1,000 of the estimated resident population, 10.7. Deaths from diseases and accidents of pregnancy and childbirth : From sepsis, 5; other causes, 8. Maternity mortality : 3.9 per 1,000 births. Death-rate of Infants under one year of age:- All infants per 1,000 live births 46 Legitimate infants per 1,000 legitimate live births 42 Illegitimate infants per l,000illegitimaite live births 113 10 Deaths from Measles (all ages) 14 ,, ,, Whooping Cough (all ages) 18 ,, ,, Diarrhoea (under 2 years of age) 12 „ ,, Diphtheria (all ages) 24 Per 1,000 of the population. Deaths from diseases of Cardiac and Circulatory System (including Cerebral Hæmorrhage) 3.54 ,, ,, diseases of the Respiratory System (including Tuberculosis) 1.96 ,, ,, diseases of Renal System 0.46 ,, ,, diseases of Digestive System 0.62 ,, ,, Suicide and Accidents 0.53 ,, Old Age 0.32 11 SECTION I. SOCIAL CONDITIONS, HOSPITAL ACCOMMODATION AND VITAL STATISTICS. Croydon is largely a dormitory town, but is becoming increasingly industrialised. The chief industries are iron foundries (bell casting), engineering and building. The London Terminal Aerodrome is within the County Borough boundary. Croydon is an aggregation of townships, each of which shows its own characteristics. Indifferent housing conditions are met with in various districts, and there are individual streets in nearly every ward in which the standard of house property is lower than the average. Various miscellaneous industrial undertakings are scattered throughout the Borough, not always in desirable situations. There is at present no power to prohibit factories being placed anywhere in areas which are not scheduled under Town Planning. As Town Planning deals with immediate and future development, it does not affect old-established areas, and the proximity of factories to residential areas has caused complaints from time to time. The population is growing rapidly. The increase of population revealed in the 1931 census was 21.8% on that for 1921. This was the highest rate of increase for any town having a population of over 100,000 at the 1921 census. The 1931 Census gave a total enumerated population of 233,115. The estimated population as at the middle of 1934 is 240,600. In the 1931 Census returns 5.59 was the average number of rooms per dwelling and 1.16 the average number of families in each dwelling, which gives 1.27 rooms per person In 1931, 3.35% of the population was living more than two persons per room, a decrease of nearly 1% on the 1921 Census. Water. The water supply is drawn from deep wells in the chalk. These wells are situated at Surrey Street, Stroud Green, Waddon, Selhurst, and Addington. A portion of the northern side of the Borough obtains water supplies from the Metropolitan Water Board. 12 I am indebted to the Borough Engineer, Mr. G. F. Carter, for the following information:— A constant supply of water was maintained throughout the year, and has been satisfactory both in quality and quantity. Monthly analyses of the water were made at the five pumping stations, and in many cases at more frequent intervals. The Corporation's wells are all in the chalk, and a sample analysis is as follows:— Clear and bright. Hardness—Temporary, 16.8 deg. „ Permanent, 3.7 deg. No B. Coli in 100 c.c. No Streptococci. No acid in 100 c.c. The supply during the year was from the Corporation's Wells 1,988,432,652 Metropolitan Water Board in Bulk 627,153,000 2,615,585,652 gallons. This works out, on an average population basis of 245,000 (1934), at a consumption of 29.24 gallons per diem per head. The low rainfall and consequent drought entailed warning being issued to the public to economise supplies and in the latter part of the year it was found necessary to prohibit the use of water for gardens and sports grounds. Rivers and Streams. There are only small streams or ditches. These have been kept in a good state. Drainage and Sewage. Extensions of the sewerage system have been made to keep pace with the growth of the Borough, in particular in the new area of Addington which was added to the Borough in 1928. Over £50,000 has been expended in maintenance and laying of new main sewers and surface water drains and a further loan for £35,000 for additional sewage work in the Borough is being sought. At the sewage disposal works at Beddington, three Activated Sludge plants are in operation dealing with 3½ to 5 million gallons per day. 13 Closet Accommodation. All the buildings are provided with water closets connected to a proper sewerage system excepting a few cases of houses and bungalows situate in remote positions, in which the sewage goes to cesspits. Owing to topographical reasons, certain large houses in Upper Norwood have their own sewage purification plants. Scavenging. Complete and up-to-date methods are in operation for scavenging and refuse disposal. There are two Refuse Destructors, and at one of these a new Salvage Plant has been constructed for separating paper, tins, etc., before passing to the furnaces. Hospitals Provided or Subsidised by the Local Auffiority. (1) Tuberculosis. Borough Sanatorium, North Cheam. 93 beds are provided for the treatment of early, intermediate and advanced cases. (2) Maternity. St. Mary's Maternity Hospital, St. James' Road, Croydon. This Hospital is conducted under the auspices of the Croydon Mothers' and Infants' Welfare Association. Thirty-two beds (with cots attached) are provided. The Hospital receives an annual subsidy of £4,500 from the Council as 30 of the beds are reserved for cases referred by them. The Local Authority collects patients' fees which amounted approximately to £1,700. (3) Children. (a) Observation Nursery, Lodge Road. These premises occupy the upper storey of the buildings erected by the Council. Accommodation is provided for 14 sick children under 5 years of age, and a ward for the reception of two nursing mothers. (b) Coombe Cliff Convalescent Hospital. This Home is for the reception of infants and children convalescing from acute illnesses. It is available for any child resident in the Borough and approved as suitable. The majority of the cases are referred from the Public Health and School Medical Departments, but cases are also admitted from Mayday and other Hospitals and at the request of private medical practitioners. 14 (4) Fever. The Borough Hospital, Purley Way. The nominal accommodation is for 220 patients. Cases of all the notifiable infectious diseases are admitted other than tuberculosis. (5) Small Pox. The Croydon and District Joint Small Pox Hospital Board's Hospital is now used as the Borough Sanatorium. Arrangements have been made with the Surrey County Council to receive into their Clandon Hospital cases of small pox arising in Croydon. Other Hospitals. Croydon General Hospital. A voluntary institution at which the Council holds four clinics conducted mainly by members of the staff of the Hospital. These are: (a) Tonsils and Adenoids Clinic; (b) Orthopaedic Clinic; (c) Venereal Diseases Clinic; (d) Ultra-Violet Ray Clinic. The Council's Pathological and Bacteriological Laboratory is also within the curtilage of the Hospital; the buildings being provided by the Hospital; the staff, equipment, etc., by the Corporation. I am indebted to the Secretary, Mr. G-. H. Dams, for the following information:— Male Beds 55 surgical 21 medical Female Beds 53 surgical 21 medical Children's Beds 22 Private Beds 23 A total of 195 beds. The number of in-patients treated during 1934 was 2,283; the average stay of each in hospital being 17.73 days. The number of out-patient attendances, including casualties, was 131,331. The bed accommodation has been increased by 65 beds, making the total complement 195 beds, the whole of which will be available during the year 1935. 15 Mayday Hospital (Public Health Committee). The institution provides the following accommodation. Male Beds Surgical 32 Medical 64 Tuberculosis 32 Mental 32 Female Beds Surgical 32 Gynaecological and Ante-natal 36 Medical 92 Tuberculosis 32 Mental 32 Children's Beds 60 Maternity Beds 22 with 14 cots additionally. Total 466 beds. The Purley and District War Memorial Hospital. This is situated on the Brighton Boad close to the boundary between Croydon and Purley. It is supported entirely by voluntary aid and offers the following provision:— Males (surgical and medical) 10 beds; Female (surgical and medical) 20 beds; Children 8 beds; Maternity 6 beds; together with 6 private wards; a total of 50 beds. The Norwood and District Cottage Hospital. Males (surgical and medical) 1.5 beds; Female (surgical and medical) 1.5 beds. In addition there are two private wards; a total of 32 beds. Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children. Provision is made at Mayday Hospital and at various Children's Homes. Unmarried mothers are admitted to Mayday Hospital; and to St. Mary's Maternity Hospital for the first confinement only, as well as to a maternity home at Norwood, established by the Free Church Council. Two other Voluntary Institutions also offer facilities for unmarried mothers, namely, The Mission of Hope, Birdhurst Lodge, and the Bescue and Preventive Home, 34, Morland Boad, Croydon. The Mission of Hope also receives illegitimate children from various districts, as a preliminary to 16 establishing them with foster mothers or adopting parents. The Babies Help Committee of the Croydon Mothers' and Infants' Welfare Association is especially concerned with individual cases of unmarried mothers and their children. The National Society for the Prevention of Cruelty to Children. This Society, through their Inspector, Mr. Brown, has helped the department in various ways. During the year 8 cases were dealt with. The reasons for reference were: neglect to obtain medical or dental attention, 7 ; for miscellaneous reasons, 1. AMBULANCE FACILITIES (1) Two Motor Ambulances are provided by the Council for the removal of infectious cases from the Borough and Penge. (2) For non-infectious, surgical or medical cases— (a) One motor ambulance provided by the Council for the removal of cases to the Mayday Hospital. (b) Four motor ambulances provided by the Council operating from the Chief Fire Station, Park Lane. (c) Three motor ambulances operating from the Addiscombe Division of the St. John's Ambulance Brigade. POOR LAW RELIEF. No. of residents in Croydon County Borough Area in receipt of outdoor poor relief on the 1st January, 1934 4,089 persons ; 1,545 cases (including ablelst July, 1934 3,787 „ 1,501 „ „ bodied). 1st January, 1935 5,113 ,, 1,904 ,, ,, Number of Croydon poor persons relieved in the Mayday Hospital on 1st January, 1935, and in the Queen's Boad Homes on the same date— Mayday Hospital 131 Queen's Boad Homes 431 Expenditure on Out-relief to Croydon cases during the 12 months ended 30th September, 1934. Half-year ended 31st March, 1934 £30,401 7 0 Half-year ended 30th Sept., 1934 £28,982 5 8 17 QUEEN'S ROAD HOMES. This is an Institution maintained under the Poor Law Act. Beds available for Sick, Maternity and Mental Cases— (a) For Men 50 (b) For Women 50 100 Table I. Table showing the classification of the accommodation and the number of beds occupied on the 31st December, 1934. Classification Number of Wards. Men. Women. Total. Provided Occupied. Provided. Occupied. Provided Occu. pied. Chronic Sick . 4 50 48 50 49 100 97 IN-PATIENTS. Total number of admissions (including infants born in hospital): 71. Total number of deaths : 43 (includes Institution), 6 Surrey. Total number of discharges (including infants born in hospital) : 70. Duration of stay of patients— (a) Four weeks or less : 22. (b) Exceeding four weeks but under thirteen weeks : 6. (c) Thirteen weeks or more: 42. Number of beds occupied— (a) Average during the year : 97. (b) Highest: 100 (on 19/5/34). (c) Lowest: 93 (on 11/10/34). Classification of In-Patients who were discharged from or who died in the Institution during the year ended 31st December, 1934— Disease Groups. Men and Women. Discharged. Died. Influenza 1 - Tuberculosis (non-pulmonary) 1 - Rheumatism— Chronic arthritis 2 - Mental Diseases— Senile Dementia 2 2 Senile Decay ... 3 11 Accidental injury and violence 1 - Disease of the Nervous System and Sense Organs 2 2 ,, ,, Respiratory System 5 1 „ ,, Circulatory System 7 26 ,, ,, Genito urinary System 2 1 Skin 1 0 Totals 27 43 18 LOCAL GOVERNMENT ACT, 1929. In Croydon the delegated duties under this Aot comprise the carrying out of the duties under the Children's Acts and the Vaccination Acts, for which the Public Health Committee is now responsible. In addition modified arrangements were made in connection with Maternity, Tuberculosis, and Mentally Deficient patients. The Mayday Hospital was appropriated by the Public Health Committee under Section 137 of the Public Health Act, 1875, on April 1st, 1932. The cessation of the percentage grants from the Ministry of Health and the substitution of block grants affected the social services far more than any other sphere of the Council's work. As indicated in the various relevant portions of this report, the voluntary agencies carrying out work of public health interest now receive direct from the Council assistance which was formerly given by the Ministry of Health. The grants were originally fixed for a three year period, and were .revised and renewed for a further four years as from April 1st, 1933. The grants for the last five years have been as follows : — Croydon Mothers' and Infants' Welfare Association— 1930/31. £ 1931/2. £ 1932/3. £ 1933/4. £ 1934/5.  £ (a) Maternity Hospital 2,700 3,600 2,350* 4,500 4,500 (b) Infant Welfare Centres 700 700 750 850 850 (c) Convalesence 300 350 400 500 550 (d) Care.work (Unmarried Mothers 100 100 100 150 150 (e) Home Helps 50 75 100 100 100 £23,850 £4,825 £3,700 £6,100† £6,150† Other Grants— The Retreat, Ross 1930/31. £ 1931/2. £ 1932/3. £ 1933/4. £ 1934/5. £  Road 787 650 650 650 650 Wilford Road Creche Croydon Rescue and 100 100 100 100 100 Preventive Assoc — 100 100 100 100 "The Shrubberies" — — — 230 230 £4,737 £5,675 £4,550 £7,180 £7,230 "Originally fixed at £3,000 and reduction of £1,250 agreed to by Association. tLess Hospital Contributions. 19 SECTION II. VITAL STATISTICS. Marriages.—The number of marriages solemnised was 2,125, compared with 2,244 in 1933; 2,134 in 1932; 2,212 in 1931; 2,112 in 1930; and 1,982 in 1929. The marriage rate was 9 per 1,000 of the population; 1,025 were solemnised in Established Churches, 280 in other places of worship, 818 in the Register Office; 2 ceremonies were performed under Jewish ritual. Births.—The births registered were 3,035 legitimate and 150 illegitimate. The birth.rate consequently was 13.2. For England and Wales the rate was 14.8, and in the 121 Great Towns it was 14.7. The illegitimate births in Croydon were 4.7% of the total, compared with 4.2% in 1933, 4.9% in 1932, 4.8% in 1931, 5.1% in 1930, and 4.8% in 1929.. The total male births numbered 1,653, the female 1,532 being a proportion of 1,079 males to 1,000 females. The subjoined table gives the vital statistics for the Wards in the Town. It is seen that the Wards with the highest birth.rates were Waddon (17.3), Thornton Heath (16.6), and South Norwood (16.2). Those with the lowest were: Norbury (6.7), Upper Norwood (8.1), East (9.3), and South (9.4). Deaths.—The deaths numbered 2,571, compared with 2,721 in 1933. For 1934 the death.rate was 10.7. For 1933 it was 11.3. The death.rate for England and Wales was 11.8, and for the 121 Great Towns 11.8. For London the death.rate was 11.9. The male death.rate was 11.2, the female 10.4 for the Borough. There were 220 inquests held by Coroners in respect of Croydon residents during 1934, and 123 findings by Coroners after postmortem examination without inquest. Wards with the highest death.rates were: Whitehorse Manor (13.2), South and Waddon (12.7) ; lowest in East (8.2), West Thornton (9.1), Upper Norwood and Central (9.2). Natural Increase.—The excess of births over deaths was 614, or 2.6 per 1,000 of the population. Immigration is playing a larger part than natural increase in the rapid increase of population. In the nature of things this is a difficult factor to estimate with any accuracy and in time leads to deductions based on total population being only approximate. In such a rapidly growing district, a five.yearly census is most necessary if statistics are to be reasonably accurate. Table I. WARDS. Estimated Population. Births. Deaths. Birth Rate. Death Rate. Deaths under 1 year per 1,000 Births. Death Rate from Six Zymotic Diseases (excluding Diarrhoea) Death Rate from Diarrhoea. Death Rate from Bronchitis and Pneumonia. Death Rate from Pulmonary Tuberculosis. Death Rate from Non.Pulmonary Tuberculosis. Death Rate from Heart and Circulation Diseases. Death Rate from Nervous Diseases. Death Rate from Cancer. Estimated persons per acre (1934). Natural Increase or Decrease of Population.  Upper Norwood 22439 181 207 8.1 9.2 33 0.09 0.04 1.07 0.36 — 2.99 0.49 1.60 20.2 —26 Norbury 16037 108 150 6.7 9.4 37 0.06 — 0.87 0.94 0.06 2.74 0.50 1.18 29.5 .42 West Thornton 20121 256 183 12.7 91 59 0.10 0.10 1.09 0.50 0.05 2.63 0.30 1.59 42.3 73 Bensbam Manor 16129 192 182 11.9 11.3 63 0.06 0.25 1.30 0.56 0.06 3.40 0.56 1.80 49.9 10 Thornton Heath 15657 260 169 16.6 10.8 43 0.39 — 1.66 0.77 — 3.00 0.64 1.41 50.6 91 South Norwood 17765 288 226 16.2 12.7 52 0.45 0.06 1.79 0.38 — 4.67 0.62 1.80 28.9 62 Woodside 15696 167 152 10.6 9.7 66 0.25 — 1.47 0.70 — 3.57 0.38 1.27 36.8 15 East 18084 169 149 9.3 8.2 30 0.22 0.06 0.88 0.06 — 3.21 0.44 1.50 9.7 20 Addiscombe 14497 184 155 12.7 10.7 43 0.07 0.07 0.55 0.48 0.14 4.00 0.41 1.80 48.9 29 Whitehorse Manor 16799 252 222 15.0 13.2 60 0.42 0.18 2.02 0.65 0.18 4.58 0.29 1.49 63.1 30 Broad Green 15412 218 160 14.3 10.4 41 0.26 0.06 1.04 0.84 — 3.38 0.35 1.17 69.1 58 Central 12242 135 112 ll.0 9.2 30 0.33 0.08 0.73 0.41 0.24 3.43 0.24 1.14 33.4 23 Waddon 21898 370 277 17.3 12.7 50 0.59 0.05 1.23 1.14 0.05 3.93 0.55 1.78 22.3 102 South 14941 141 189 9.4 12.7 71 0.07 0.14 1.00 0.67 0.07 3.88 1.07 1.61 12.6 —48 Addington 2883 66 29 23.9 10 .1 15 — — 1.39 0.35 — 3.80 0.35 1.39 0.80 37 The Borough 240600 3185* 2571* 13.2 10.7 46 0.24 0.07 1.21 0.60 0.05 3.55 0.49 1.54 19.0 614 * These are the corrected figures. 21 Comments on Table I. Corrections have been made for deaths of infants in institutions. A death under such circumstances has been allocated to the Ward in which the parents reside. Infantile mortality was highest in South (71), Woodside (66), Bensham Manor (63), Whitehorse Manor (60); lowest in Adding. ton (15), East and Central (30). The Infantile Mortality rate was above the average for the whole Borough in the following Wards: West Thornton, Bensham Manor, South Norwood, Woodside, Whitehorse Manor, Waddon, and South. Birth-rates were highest in Waddon, Thornton Heath, and South Norwood; lowest in Norbury, Upper Norwood, East, South, and Woodside. The general death.rate was highest in Whitehorse Manor, South Norwood, Waddon, and South ; lowest in Upper Norwood and Central, East and West Thornton. The death.rate was above the average for the whole Borough in the following Wards: Bensham Manor, Thornton Heath, South Norwood, Whitehorse Manor, Waddon and South. Most persons to the acre in Broad Green, White horse Manor, Thornton Heath, and Bensham Manor; least in East, South, and Upper Norwood. Addington, owing to its relatively scanty population, has not been included for purposes of comparison. The birth.rate is the same as last year, which was the lowest recorded up to that time. The death.rate from Zymotic diseases was highest in Waddon, South Norwood, and Whitehorse Manor; from Diarrhoea in Bensham Manor, Whitehorse Manor, and South ; from Bronchitis and Pneumonia in Whitehorse Manor, South Norwood, and Thornton Heath; from Pulmonary Tuberculosis in Waddon, Norbury, and Broad Green; from Non.Pulmonary Tuberculosis in Central and Whitehorse Manor; from Diseases of the Heart and Circulation in South Norwood, Whitehorse Manor, and Addiscombe; from Nervous Diseases in South and Thornton Heath; from Cancer in Bensham Manor, South Norwood, and Addiscombe. 22 Table II. Year. Population estimated to Middle of each Year. Births. Total Deaths Reg. in the District. Transferable Deaths Nett deaths belonging to the District. ot Non.residents registered in the District. of Residents not registered in the District Under 1 Year of Age. At all Ages. Uncorrected Number. Nett. Number. Rate. Number. Rate. Number. Kate per 1,000 Nett Births. Number. Rate.  1922 192,300 3616 3505 18.2 2469 12 8 357 255 224 64 2387 12.4 1923 193,400 3445 3370 17.4 2082 12.5 284 209 176 52 2007 10.4 1924 196,000 3536 3456 17.6 2384 12.1 317 213 195 56 2280 11.6 1925 199,300 3521 3406 17.1 2262 11.4 336 243 187 55 2169 10.9 1926 205,900 3569 3477 16.9 2340 11.4 318 247 211 61 2269 11.0 1927 211,700 3329 3174 15.0 2542 12.1 384 294 176 55 2452 11.6 1928 214,800 3501 3374 15.7 2439 11.4 389 301 178 53 2354 11.0 1929 222,300 3553 3399 15.3 2954 13.3 463 301 221 65 2792 12.5 1930 222,300 3703 3514 15.8 2407 10.8 364 294 171 48 2337 10.5 1931 233,800 3601 3400 14.5 2719 11.6 331 300 196 58 2674 11.4 1932 237,186 3607 3311 14.0 2500 10.5 242 298 161 49 2556 10.8 1933 239,950 3391 3147 13.2 2612 10.9 257 366 148 47 2721 11.3 1934 240,600 3508 3185 13.2 2451 10.2 219 339 145 46 2571 10.7 23 Table III. DEATHS REGISTERED DURING THE CALENDAR YEAR 1934. CLASSIFIED BY AGE AND CAUSE. CAUSES OF DEATH I Nett Deaths at the subjoined ages of "Residents," whether occurring within or without the District. Total Deaths whether of " Residents " or " non. Residents " in Institutions in the District.  All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 years and upwards. 2 3 4 5 6 7 8 9 10 11 12 13 All Causes Certified 2571 145 26 38 60 84 101 119 254 413 1331 1006 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 1 ... ... ... ... ... ... ... 1 ... ... 1 Small Pox ... ... ... ... ... ... ... ... ... ... ... ... Measles 14 3 2 4 5 ... ... ... ... ... ... 4 Scarlet Fever 3 ... ... 2 1 ... ... ... ... ... ... 4 Whooping Cough 18 5 4 8 1 ... ... ... ... ... ... 11 Diphtheria and Croup 24 1 ... 5 16 ... ... 1 1 ... ... 20 Influenza (excl. Influenzal Pneu'nia) 15 ... 1 ... ... ... 1 1 ... 4 8 1 Erysipela 5 ... ... ... ... ... ... ... ... 1 4 3 Tetanus 2 ... ... 1 1 ... ... ... ... ... ... 2 Pulmonary Tuberculosis 144 1 ... ... 1 28 37 32 20 20 5 48 Tuberculous Meningitis 6 ... ... 2 3 ... ... 1 ... ... ... 5 Other Tuberculous Disease 7 ... 1 1 1 1 2 ... 1 ... ... 6 Cancer, Malignant Disease 371 ... ... 1 ... ... 5 18 67 96 184 154 Acute Rheumatism and Rheumatic Fever 6 ... ... ... 1 3 ... 1 1 ... ... 2 Cerebro.Spinal Meningitis 3 ... ... ... 1 2 ... ... ... ... ... 2 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... Other Forms of Meningitis (not T. B.) 9 ... ... ... 4 ... 1 ... 2 ... 2 3 Poliomyelitis 1 ... 1 ... ... ... ... ... ... ... ... ... Locomotor Ataxy 4 ... ... ... ... ... ... ... ... 3 1 ... General Paralysis of the Insane 3 ... ... ... ... ... ... 1 1 1 ... ... Cerebral Haemorrhage 186 ... ... ... ... ... 2 1 7 26 150 62 Other Diseases of the Nervous Sys'm 111 ... ... ... 1 1 3 3 15 19 69 26 Senile Decay 78 ... ... ... ... ... ... ... ... ... 78 23 Diabetes 24 ... ... ... ... 1 1 ... ... 3 19 12 Organic Heart Disease 591 ... ... 1 1 9 7 11 41 90 431 206 Arterio.Sclerosis 47 ... ... ... ... ... ... ... 2 9 36 27 Aneurism 1 ... ... ... ... ... ... 1 ... ... ... ... Other Diseases of the Circulatory System ... 28 ... ... ... 3 3 3 ... 5 3 11 11 Bronchitis, Acute 25 3 ... ... ... ... ... ... 2 ... 20 3 Bronchitis, Chronic 68 ... ... ... ... 2 1 ... 4 11 50 13 Influenzal Pneumonia 13 ... ... ... ... 2 1 ... 3 2 5 1 Pneumonia (other forms) 199 27 10 8 4 7 4 12 16 34 77 94 Other Diseases of the Respiratory System 24 ... ... ... 1 2 2 1 2 7 9 4 Diarrhoea and Enteritis 18 10 2 ... ... ... 1 1 1 ... 3 10 Appendicitis, Typhlitis, and Peritonitis 23 ... ... 2 2 1 3 1 5 5 4 18 Cirrhosis of the Liver 5 ... ... ... ... ... ... ... 3 ... 2 ... Alcoholism 5 ... ... ... ... ... ... 1 1 2 1 ... Other Diseases of the Digestive Sy'm Nephritis and Blight's Disease 75 ... 1 ... 2 1 2 5 10 18 36 41 75 ... ... ... ... ... 4 3 10 17 41 14 Other Diseases of the Urinary Sys'm Puerperal Fever 37 ... ... ... ... ... 1 2 1 7 26 23 5 ... ... ... ... 1 2 2 ... ... ... 5 Puerperal Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases and Accidents of Pregnancy and Parturition 8 ... ... ... ... 1 3 4 ... ... ... 6 Congenital Debility and Malforma'n Premature Birth 33 31 2 ... ... ... ... ... ... ... ... 17 34 34 ... ... ... ... ... ... ... ... ... 19 Venereal Diseases 6 ... ... ... ... ... ... 2 1 3 ... 5 Other Diseases of the Reproductive System (Non.Malignant) 12 ... ... ... ... ... 1 4 2 2 3 7 Violent Deaths (excluding Suicide) 91 ... 1 2 6 13 6 4 14 12 33 60 37 ... ... ... ... 5 6 1 11 10 4 9 All other Defined Diseases 73 30 1 1 5 1 2 4 4 7 18 23 Diseases Ill-defined or unknown 3 ... ... ... ... ... ... 1 ... 1 1 1 All Causes 2571 145 26 38 60 84 101 119 254 413 1331 1006 The deaths entered in the last column include deaths of non.residents of the Borough. 24 Comparisons With 1933. (i) Measles was again prevalent during the first half of the year and once again all the deaths occurred in children under 15 years of age. (ii) Whooping Cough was more prevalent and caused 18 deaths, as compared with 3 the previous year, (iii) Deaths from Diphtheria showed a further increase, from 17 in 1933 to 24 during the year under review, (iv) Influenza, on the other hand, caused death in only 28 cases, as compared with 103 the previous year, the majority of these deaths were in persons over 55 years of age. (v) Deaths from Pulmonary Tuberculosis showed a slight decline; the age group 15 years to 45 years accounted for 91 of the deaths. It is interesting to note that deaths from this condition occur earlier in women than in men, though more men die from it. (vi) Deaths from Cancer remained much the same but with Cancer, more deaths occurred in women than in men. (vii) The main cause of death was Organic Disease of the Heart, (viii) Deaths from respiratory troubles, e.g., Pneumonia and Bronchitis, declined, a result probably of the very small incidence of Influenza, (ix) A further decrease in the deaths attributed to Infantile Diarrhoea. This is satisfactory in view of the hot and abnormally dry summer, (x) Deaths from diseases of the Urinary system remained much the same, (xi) The number of suicides increased by 7, whilst the number of deaths due to violence increased by 16. Suicide and violence accounted for 128 deaths, i.e., nearly as many as those caused by Pulmonary Tuberculosis. Comments on Table III. (i) Cancer is the main cause of death between the ages of 45 and 65 years. Above 65 years of age the chief cause of death is Organic Heart Disease (431) and this is followed by dancer (184), Cerebral Hæmorrhage (150), and Pneumonia (77). Pneumonia, as in previous years showed its maxima at the two extremes of life. The most dangerous time of life up to the 45th year, is the first year. Violent death, as might be expected, occurred most frequently among old people over 65 years, though the age group 15.24 years came next in incidence. Suidide was commonest between the ages of 45 and 65, and was equally divided among the sexes. There are some points of difference between Table III. and the short list of causes of death supplied by the Registrar.General. 25 These differences are due to a difference in classification of the primary cause of death when more than one cause is given on the death certificate. Although definite instructions on how death certificates should be filled in are contained in the books of certificates, medical practitioners vary widely in their interpretation of these instructions. The Registrar.General's Table is included for purposes of comparison. It will be observed that the widest discrepancies occur in the deaths attributed to Heart Disease and other Circulatory diseases; Pneumonia and Bronchitis, Senility and other Digestive diseases. 26 Table IV. REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX. Causes of Death. Sex All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75.  All Causes M 1242 87 12 26 25 47 53 50 133 231 298 280 f 1349 58 13 15 34 37 47 69 121 188 282 485 1 Typhoid and paratyphoid fevers M 1 ... ... ... ... ... ... ... 1 ... ... ... f ... ... ... ... ... ... ... ... ... ... ... ... 2 Measles M 10 3 1 4 2 ... ... ... ... ... ... ... f 4 ... 1 1 2 ... ... ... ... ... ... ... 3 Scarlet fever M ... ... ... ... ... ... ... ... ... ... ... ... f 1 ... ... ... 1 ... ... ... ... ... ... ... 4 Whooping cough M 8 2 2 4 ... ... ... ... ... ... ... ... f 11 3 2 4 2 ... ... ... ... ... ... ... 5 Diphtheria M 13 1 ... 3 9 ... ... ... ... ... ... ... f 12 ... ... 3 7 ... ... 1 1 ... ... ... 6 Influenza M 15 ... ... ... ... 2 ... ... 3 1 1 3 f 19 ... ... ... ... 1 ... 1 ... 4 7 6 7 Encephalitis lethargica M 1 ... ... ... ... ... ... ... ... ... ... ... F 2 ... ... ... ... ... ... ... ... 1 ... ... 8 Cerebro.spinal fever M 2 ... ... ... ... 2 ... ... ... ... ... ... F 1 ... ... ... 1 ... ... ... ... ... ... ... 9 Tuberculosis of respiratory system M 76 ... ... ... ... 9 16 20 15 13 1 1 f 60 ... ... ... 1 16 18 12 3 7 2 10 Other tuberculous diseases M 13 ... ... 1 3 3 2 1 2 ... 1 ... F 7 ... ... 1 1 1 2 ... ... ... ... 1 11 Syphilis M 4 ... ... ... ... ... ... ... 3 1 ... ... F 4 ... ... ... ... ... ... 1 1 2 ... ... 12 General paralysis of the insane, tabes dorsalis M 5 ... ... ... ... ... ... ... 1 3 1 ... f 3 ... ... ... ... ... 1 1 ... 1 ... ... 13 Cancer, malignant disease M 173 ... ... ... ... ... 3 4 24 47 57 38 f 201 ... ... ... ... ... 2 15 41 52 45 45 14 Diabetes M 9 ... ... ... ... 1 ... ... ... ... 5 3 f 21 ... ... ... ... ... 1 ... ... 6 6 8 15 Cerebral haemorrhage, etc. M 33 ... ... ... ... ... ... ... 2 4 11 16 f 56 ... ... ... ... ... 6 5 14 31 16 Heart Disease M 313 ... ... ... ... 4 3 2 26 58 110 110 F 382 ... ... ... ... 1 4 12 16 36 101 210 17 Aneurysm M 8 ... ... ... ... ... ... 1 ... 4 1 2 f 5 ... ... ... ... ... 1 1 2 1 18 Other circulatory diseases M 63 ... ... ... ... ... ... ... 1 15 26 21 F 93 ... ... ... ... ... 4 10 36 43 19 Bronchitis M 34 1 ... ... ... ... 1 ... 2 3 12 14 F 33 3 ... ... ... 2 ... ... 1 1 5 21 20 Pneumonia (all forms) M 91 14 5 7 1 5 1 5 10 24 9 10 F 74 12 6 2 2 1 1 6 4 6 12 22 21 Other respiratory diseases M 11 1 ... ... ... ... 1 ... 2 2 2 3 F 11 2 ... ... ... ... ... ... 1 1 1 6 22 Peptic ulcer M 23 ... ... ... ... ... 1 3 4 7 6 2 F 11 ... ... ... ... ... 1 1 2 ... 3 4 23 Diarrhoea, etc. M 9 6 ... ... ... ... 1 ... ... 1 ... ... F 7 2 ... 1 ... ... ... 1 1 ... 1 1 24 Appendicitis M 9 ... ... 2 ... ... 2 1 1 1 1 1 F 8 ... ... ... ... ... ... ... 2 3 1 ... 25 Cirrhosis of liver M 6 ... ... ... ... ... ... 3 ... 1 2 ... F 5 ... ... ... ... ... ... ... 3 ... 1 1 26 Other diseases of liver, etc. M 5 ... ... ... ... ... ... ... ... 3 1 1 F 11 ... ... ... ... ... 1 ... 2 4 1 3 27 Other digestive diseases M 19 1 ... ... ... 2 1 ... 2 6 3 4 F 34 ... 1 ... ... 2 1 2 3 6 10 7 28 Acute and chronic nephritis M 35 ... ... ... ... ... 4 1 6 6 8 10 F 48 ... ... ... ... 1 2 2 6 14 11 12 29 Puerperal sepsis F 5 ... ... ... ... 2 2 1 ... ... ... ... 30 Other puerperal causes F 6 ... ... ... ... ... 2 4 31 Congenital debility, premature birth, malformation, etc. M 52 51 ... 1 ... ... ... ... ... ... ... ... F 32 31 ... 1 ... ... ... ... ... ... ... ... 32 Senility M 12 ... ... ... ... ... 4 i 26 F 27 ... ... ... ... ... ... ... ... ... 1 33 Suicide M 19 ... ... ... ... 2 4 1 2 7 3 ... F 18 ... ... ... ... 3 2 9 3 1 ... 34 Other violence M 57 ... ... 1 2 12 5 4 14 6 7 6 F 41 ... 2 1 4 ... ... 1 1 7 4 21 35 Other defined diseases M 113 5 1 1 8 5 6 4 12 18 26 27 F 96 4 ... ... 7 7 5 7 14 17 21 14 36 Causes ill.defined, or unknown M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 27 The percentage of deaths under 1 year of age to total deaths was 5.6. Deaths under 15 years, 10.4%; deaths under 65 years, 47.7%; deaths over 65 years, 52.3%. The corresponding figures for 1933 were 5.4; 9.6 ; 49.3; and 50.7. Table V. classification of deaths according to disease over a period of 12 years. Cause of Death. 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 19 34 Total Deaths 1 otal Deaths. Total Death. Total Deaths. Total Deaths. Total Deaths. Total Deaths. Total Deaths. Total Deaths. Total Deaths Total Deaths. Total Deaths Death Rate.  Enteric Fever ... 2 ... 1 2 ... 1 ... ... 2 ... 1 0.004 Malaria ... ... 1 1 ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 9 4 7 13 6 30 1 22 ... 2 13 14 0.058 Scarlet Fever 2 2 1 ... 3 5 4 2 3 ... ... 3 0.012 Whooping Cough 11 11 9 9 21 14 24 3 9 12 3 18 0.075 Diphtheria and Croup 21 8 8 32 10 32 23 14 5 11 17 24 0.100 Influenza (including Influenzal pneumonia) 20 89 63 44 118 38 199 32 84 100 103 28 0.116 Dysentery ... ... ... ... ... ... ... 1 1 ... ... ... ... Erysipelas 2 4 5 5 5 3 8 7 4 3 8 5 0.021 Cerebro-Spinal Fever ... 2 ... ... ... 2 ... 2 3 2 2 3 0.012 Pulmonary Tuberculosis 153 157 151 171 165 167 170 154 155 144 162 144 0.599 Tuberculous Meningitis 22 12 17 17 10 13 10 7 11 9 10 6 0.025 Other Tuberculous Disease 15 19 13 20 28 26 19 14 11 13 12 7 0.029 Cancer, Malignant Disease 259 293 319 330 344 327 330 339 342 341 374 371 1.542 Rheumatic Fever 5 9 8 11 6 6 5 4 7 4 4 6 0.025 Meningitis 8 6 6 273 2 9 11 17 14 15 9 7 9 0.037 Organic Heart Disease 254 305 281 346 405 308 375 490 469 627 591 2.456 Bronchitis, Acute and Chronic Pneumonia 139 142 130 100 92 92 226 125 200 145 130 93 0.387 144 182 140 138 200 158 272 199 258 238 210 199 0.827 0.100 Other Diseases of the Respiratory Organs 36 33 32 34 33 33 21 16 20 15 22 24 Diarrhœa and Enteritis 36 32 36 34 24 28 45 32 15 25 26 18 0.075 Appendicitis and Typhlitis 21 28 20 14 17 16 27 23 23 28 44 23 0.096 Cirrhosis of Liver 11 7 12 3 9 11 10 5 5 8 6 5 0.021 Alcoholism 3 3 1 2 3 3 4 3 1 1 ... 5 0.021 Nephritis and Bright"s Disease 59 70 65 81 77 79 117 45 60 81 78 75 0.312 Puerperal Fever 4 2 5 11 4 2 6 1 8 2 7 5 0.021 Other Diseases and Accidents of Pregnancy & Parturition 6 8 8 13 5 11 5 6 14 5 5 8 0.033 Congenital Debility and Malformation. 32 37 36 52 30 26 42 42 49 27 19 33 0.137 Premature Birth 39 54 42 40 48 32 47 40 49 48 47 70 34 0.141 Violent deaths (excluding Suicide) 49 66 65 71 83 75 64 74 92 75 91 0.378 Suicide 23 23 23 33 30 35 29 19 33 43 30 37 0.154 Other Defined Diseases 624 670 672 703 720 664 748 713 706 684 677 688 2.860 Diseases Ill-defined or unknown ... ... 1 3 4 10 10 4 1 10 8 3 0.012 Total 2007 2280 2169 2269 2452 2354 2792 2337 2674 25562721 2571 10.686 28 1934 showed a decrease in the general death.rate, a stationary birth.rate and a further decline in the infant mortality rate, which reached the lowest yet recorded in Croydon. In view of the decreasing birth.rate, the average age of the whole population is steadily rising; consequently, sooner or later there will be an increase in the death.rate quite apart from Public Health conditions. It would seem this point has been reached, and any further decline in the death.rate is not to be expected. Causes of Death. The chief causes of death during 1934 were:—Organic heart disease, 591 deaths, death.raite 2.46; Cancer, 371 deaths, death.rate 1.54; All forms of Tuberculosis, 157 deaths, death.rate 0.65; Pneumonia (including influenzal pneumonia), 212 deaths, death. rate 0.88; Arterio Sclerosis and Cerebral Haemorrhage, 233 deaths, death.rate 0.97. Taking diseases of bodily systems and group diseases to which deaths were definitely assigned we find:— Circulatory System (including Atheroma per 1,000 population.  and Cerebral Haemorrhage) 853 or 3.54 Cancer 371 1.54 Respiratory System (not Tubercular) 316 1.31 Tuberculosis (all forms) 157 0.65 Diseases of the Digestive System (excluding Cancer and Tuberculosis) 150 0.62 Diseases of the Nervous System (not Tubercular 127 0.53 Diseases of Renal System 112 0.46 Infectious Diseases (excluding Tuberculosis but including Influenza) 84 0.35 Suicides and Violent Deaths 128 0.53 Old Age 78 0.32 Congenital Debility and Prematurity 67 0.28 The greatest single group of causes of death as in 1933 was diseases of the Circulatory system, and of this group Organic Heart Disease was the most prominent member (591 deaths). Rheumatism in childhood is indubitably a cause of cardiac breakdown later in life, more particularly if the original attack of rheumatism. has been overlooked or disregarded. 29 Arteriosclerosis (47 deaths) is the second big cause of death in this group. This is a thickening and diminution in the elasticity of the walls of the arteries and is an expression either of prolonged stress or unwise living. Cerebral Haemorrhage, which caused, incidentally, 186 deaths, is one of the sequelae of Arterio.sclerosis, combined with excessive blood, pressure. Arterio.sclerosis and Cerebral Haemorrhage between them caused 233 deaths. POPULATION. Explanation of Graphs. The estimated population is shown by a continuous black line from 1860 onwards, the letter C denoting a census year. In 1860 Croydon's population was a little over 30,000; in 1931 the census showed it to have risen to 233,115, whilst for 1934 the estimated population is 240,600. The growth of Croydon has been rapid and continuous; even during the war years the increase was not arrested, whilst since the war its growth has been accelerated. Such an increase of population gives rise to peculiar health problems, not the least of which is the inhabitants do not always appreciate that within a space of 60 years their town has grown from a village to one of the great and important towns of England. With the extension of civil aviation, Croydon's importance is likely to become greater each year. The trend of industrialism to the south and the relatively low rates are also exerting an influence. 30 Table VI. METEOROLOGICAL RECORD. Months. Air Temperature in Degrees Fahrenheit. Rainfall Total. Bright Sunshine. Hrs. per day. Percenage.  Means of Mean of A. & B. A. Max. B. Min. Daily/Mean °F. °F. °F. in. mm. hrs. January 44.3 36.1 40.2 2.04 52 1.63 19 February 43.9 33.9 38.9 0.30 8 2.75 28 March 48.9 37.0 42.9 2.57 66 3.74 32 April 55.1 42.9 49.5 2.65 68 3.93 29 May 63.4 49.9 56.6 0.60 15 6.78 44 June 69.9 56.2 63.0 1.02 26 6.45 39 July 76.0 60.8 68.4 2.49 63 9.29 58 August 69.3 55.9 62.6 2.50 64 5.95 41 September 69.0 52.0 60.5 1.57 40 6.30 50 October 58.6 49.6 54.1 1.69 43 2.41 22 November 47.9 41.4 44.6 2.58 66 1.08 12 December 50.7 45.7 48.2 6.41 162 0.62 8 Means and Totals for Year 58.1 46.8 52.4 26.42 673 4.24 32 The observations were made at the Aerodrome, which is 217 feet above mean sea level. 31 SECTION III. MAYDAY HOSPITAL. The policy of the Council in bringing Mayday Hospital more into line with General Hospitals has been furthered by the appointment during the year of five visiting consulting medical staff. In order to co-ordinate the whole work of the Health Department these gentlemen are appointed as Consultants to the Department and their services are consequently available at the other institutions of the Committee. The Consultants have paid the following visits to Mayday Hospital:— Consulting Physician (Dr. Preston) 11 visits — Consulting Surgeon (Mr. Cowell) 15 visits 3 operations Consulting Orthopaedic Surgeon (Mr. Todd) 16 visits 1 operation Consulting Ophthalmic Surgeon (Mr Bookless) 56 visits 3 operations Consulting Ear, Nose and Throat Surgeon (Mr. Ryland) 14 visits 5 operations Dr. Greig, the visiting Radiologist, paid 103 visits during the year. The alterations and additions, as detailed in my report for 1933 have been proceeded with. At the end of the year the new central heating station and heating system had been completed, but has not yet been put into operation; whilst the new ward block of 66 beds was well advanced, the programme is, however, somewhat behind-hand and the time table originally decided upon will have to be considerably modified. Owing to the existing X.Ray apparatus showing unmistakable signs of decrepitude, new plant will be provided, and the erection of the new special departments block will be expedited. The Medical Staff consists of the Medical Superintendent, 3 other Resident Medical Staff, 6 Visiting Consultant Staff, and a Visiting Dentist. The Assistant Medical Officer of Health for Obstetrics is in charge of the Obstetrical and Gynaecological cases. Specialised Services.—Orthopaedic, Gynaecological, Dental, X.Rays, Ultra.Violet Light, Massage, Ophthalmic, Ear, Nose and Throat. No. of Trained Nurses 30 (including 18 Sisters). ,, Probationer ,, 72 ,, Assistant ,, 7 , Male Attendants 7 32 Number of Beds provided for Sick, Maternity and Mental cases:— (a) for Men 160 (b) for Women 246 (c) for Children 60 (under 16 years of age) Total 466 Table I. No. of Wards. MEN. WOMEN. CHILDREN. TOTAL. Provided. Occupied. Provided. Occupied. Provided. Occupied. Provided. Occupied.  Medical 2 32 23 32 32 ... ... 64 55 Surgical 2 32 28 32 22 ... ... 64 50 Chronic Sick 3 32 30 64 75 ... ... 96 105 *Children 2 ... ... ... ... 60 41 60 41 ‡Tuberculosis 2 32 25 32 33 ... 64 58 Maternity 1 ... ... 22 15 ... **15 22 30 Mental 2 32 30 32 30 ... ... 64 60 Gynaecological 1 ... ... 32 32 ... ... 32 32 Total 15 160 136 246 239 60 56 466 †431 * Plus 4 dayrooms attached to adult wards. ** Infants, †Number of beds occupied on December 31st, 1934. †Only some 50% of the beds allocated for Tuberculosis are occupied by Tuberculosis patients. Table II 1.—Total number of admissions (including infants born in hospital 3896 2.—Number of women confined in hospital 515 3.—Number of live births 485 4.—Number of still births 38 5.—Number of deaths among the newly.born (under 4 weeks) 16 6.—Total number of deaths among the children under one year (including those under No. 5) 43 7.—Number of maternal deaths among women admitted to hospital for confinement 5 8.—Total number of deaths 699 9.—Total number of discharges (including infants born in hospital) 3703 10.—Duration of stay of patients included in Nos. 8 and 9 : (a) Under four weeks 2889 (b) Four weeks and under thirteen weeks 1201 (c) Thirteen weeks and more 312 11.—Number of beds occupied (a) average during the year (b) highest 536 on 16/4/34 ; (c) lowest 407 on 12/8/34. 479 12.—Number of surgical operations under G.A. (excluding dental operations) 688 13.—Number of abdominal sections 319 33 Table III Children (under 16) Men and Women. Discharged. Died. Discharged. Died.  A.—Acute infectious disease 22 — 10 1 B.—Influenza 1 — 8 4 C.—Tuberculosis: Pulmonary 5 — 65 39 Non.Pulmonary 5 3 12 2 D.—Malignant Diseases — — 43 102 E.—Rheumatism, Acute rheumatism (rheumatic fever) together with sub.acute rheumatism and chorea 23 1 46 4 Non.articular manifestations of so.called rheumatism (muscular rheumatism, fibrositis, lumbago, and sciatica) - - 4 - Chronic arthritis 1 — 32 2 F.—Venereal Disease 1 — 18 1 G.—Puerperal fever (other cases) — — 11 3 H.—Puerperal pyrexia — 19 — I.—Other diseases and accidents connected with child bearing - — 243 5 J.—Mental diseases 14 — 233 5 K.—Senile Decay — — 51 47 L.—Accidental injury and violence 51 — 231 20 M.—Diseases of the Nervous System 17 3 97 38 N. „ „ Respiratory System 93 24 132 88 0. „ „ Circulatory System 10 4 125 190 P. ,, „ Digestive System 130 15 394 58 Q. „ „ Genito.Urinary System 17 2 86 26 R „ Skin 82 1 106 3 S.—Other Diseases 71 — 87 8 T.—Mothers and children discharged from Maternity Wards 485 — 558 — U.—Any persons not falling under any of the above headings 34 — 30 — Totals 1062 53 2641 646 Classification of In.Patients who were Discharged from or who Died in the Institution during the year ended 31st December, 1934. 34 Total Number of Patients : Cured 2551 Relieved 781 Unrelieved 371 Died 699 Grand Total 4402 35 Table IV. Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Alimentary. Gastritis 7 10 1 - - - - - 18 Hernia — — — — 30 4 3 6 43 Enteritis 13 1 — 5 — — — — 19 Pyloric Stenosis 1 — — — — — — — 1 Colic 1 - - - - - - - 1 Haemorrhoids — — — — 7 4 1 — 12 Appendicitis — — — — 136 9 — 6 151 Diverticulitis of Colon — 2 — 1 — — — — 3 Cholecystitis — — — — 7 11 — 2 20 Gallstones - - - - - 4 2 1 7 Tonsillitis 37 3 — 1 27 1 — — 69 Constipation 20 4 2 - - - - - 26 Dyspepsia 3 - - - - - - - 3 Intestinal Obstruction — — — — 3 — — 12 15 Jaundice 3 - - - - - - - 3 Pyorrhoea 1 — 2 — 2 1 — — 6 Pancreatic Tumour — — — — 1 — — — 1 Pancreatitis — — — — 1 — — — 1 Intestinal Stasis 1 1 - - - - - - 2 Gastric Ulcer 7 7 2 — 6 — — 5 27 Duodenal Ulcer 4 8 — — 3 6 1 3 25 Adhesions after Operation — - — — 4 3 — 1 8 Colitis 6 2 3 1 — — — — 12 Peritonitis 2 1 — 1 2 — — 2 8 Cirrhosis of Liver — 3 - - - - - - 3 Renal Colic 1 3 - - - - - - 4 Oral Sepsis — — — — 2 — — — 2 Teething 2 - - - - - - - 2 36 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Dental Abscess — — — — 5 — — 5 Alcoholism 5 3 - - - - - - 8 Faecal Fistula — — — — 1 — — — 1 Stomatitis 2 - - - - - - - 2 Chill 3 — 1 — — — — — 4 Visceroptosis — 1 - - - - — - 1 Intussusception — — — — 2 — — — 2 Ischio.rectal abscess — — — — 6 — — — 6 Gastric catarrh 1 - - - - - - - 1 Icterus Neonatorum — — — 1 — — — — 1 Fistula.in.Ano — — — — 2 — — — 2 Pelvic cyst — — — — 1 — — — 1 Imperforate anus - - - - - - - 1 1 Quinsy 2 - - - - - - - 2 529 Bones, Joints, Etc. Rheumatoid Arthritis 5 19 3 2 — 1 — — 30 Osteo.arthritis — — — — — 3 — — 3 Acute Rheumatism 32 30 1 5 — — — — 68 Infective Arthritis — — — — 1 1 1 — 3 Osteo.myelitis — — — — 4 6 1 — 11 Fibrositis 1 - - - - - — — 1 Congenital Hip Disease — — 1 — — — — — 1 Muscular Atrophy — 1 1 - - - - - 2 Periostitis — — — — 1 — — 1 2 Bursitis — — — — 4 — — — 4 Synovitis — — — — 3 1 — — 4 Muscular Dystrophy — — 1 — — — — — 1 Torticollis — — — 1 — — — — 1 131 37 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Carcinoma. Stomach — — — — — — 5 5 10 Gall Bladder — — — — — — 1 4 5 Ovary — — — — — — - 2 2 Cervix Uteri — — — — 2 1 2 1 6 Rectum — — — — — 2 4 8 14 Oesophagus — — — — 3 — — 3 Caecum — — — — — — — 3 3 Larynx — — — — — — 1 2 3 Bronchus — — — — — — — 1 1 Prostate — — — — 1 1 — 2 4 Kidney — — — — — — 1 — 1 Lower Jaw — — — — — — 2 1 3 Leg — — — — — 1 — 2 3 Colon — — — — 1 — — 6 7 Breast — — — — — 1 3 10 14 Pancreas — — — — — — — 5 5 Spine — — — — — — 1 1 2 Face — — — — — 1 — 1 2 Uterus — — — — 2 — — 2 4 Lung — — — — — — — 4 4 Mediastinum - - - - - - - 1 1 Tongue — — — — — — — 2 2 Larynx — — — — — — - 2 2 Ear — — — - - - 1 - 1 Cervical Glands — — — — — 1 1 4 6 Fauces — — — — — — — 1 1 Sarcoma left Tonsil — — — — - 1 - - 1 Sarcoma Tibia — — — - - - 1 - 1 Chorionepithelioma — — — — - — — 1 1 112 38 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Blood. Haemorrhage Neonatorum 1 - - - - - - - 1 Hodgkin's Disease — — 1 - - - - - 1 Anaemia 2 6 4 2 — — — — 14 Circulatory. Hyperpiesia 11 1 1 — — — — — 13 Epistaxis 5 — 2 - - - - - 7 Gangrene — 1 — 5 — — — — 6 Cerebral Haemorrhage 2 3 1 41 — — — — 47 Phlebitis 4 3 - - - - - - 7 Thrombosis 2 5 3 7 — — — — 17 Cerebral Embolism 2 — — 1 — — — — 3 Myocarditis — 8 1 8 — — — — 17 Mitral Disease — 6 — 4 — — — — 10 Pericarditis — 1 - - - - - - 1 Endocarditis 1 6 — 5 — — — — 12 Varicose Veins 2 4 1 - - - - - 7 Myocardial Degen — 19 1 102 — — — — 122 Arterio Sclerosis — 5 1 46 — — — — 52 Cardiac Hypertrophy — 1 — — — — — — 1 Aortic Disease — 1 — 2 — — — — 3 Congenital Heart — 2 1 1 — — — — 4 Auricular Fibrillation — 7 - - - - - - 7 Mitral Incompetence — 2 — 1 — — — — 3 Mitral Regurgitation — 2 — 2 — — — — 4 Congestive Heart Failure — 1 - - - - - - 1 Angina — 1 - - - - - - 1 Subarachnoid haemorrhage 2 — — 1 — — — — 3 364 39 Diagnoses In Cases T reated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died General. Collapse 6 2 - - - - - - 8 Diabetes 3 15 — 9 — — — — 27 Marasmus 5 2 — 5 — — — — 12 Debility 7 4 - - - - - - 11 Nutritional Disorder 14 — — 1 — — — — 15 Septicaemia — — 1 — 1 — — 3 5 Amyloid Disease 1 - - - - - - - 1 Cellulitis — — — — 15 3 — — 18 97 Glands and Lymphatic System. Lymphangitis 5 - - - - - - - 5 Adenitis 9 — 1 — 11 — — — 21 Myxoedema — — 1 - - - - - 1 Exophthalmic goitre — — 1 — — — — — 1 Hyperthyroidism 1 — — — — — — — 1 29 Ear, Nose and Throat. Sinusitis — — — — 2 — — — 2 Infected Antrum 1 — — — — — — — 1 Otitis Media — — — — 15 8 2 2 27 Sphenoidal Abscess - - - - - - - 1 1 Mastoiditis — — — — 18 4 — — 22 Boils in Ear — — — — 2 1 — — 3 Meatitis — — — — 1 — — — 1 57 40 Diagnoses In Cases Treated % Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Eye. Glaucoma 1 — — — 3 — — — 4 Cataract — 1 — — — 1 — — 2 Conjunctivitis 2 1 - - - - - - 3 Corneal Ulcer 1 - - - - - - - 1 Blepharitis 1 - - - - - - - 1 Dacrocystitis 1 - - - - - - - 1 12 Genito.Urinary. Prostate Enlargement — — — — 1 9 2 9 21 Uraemia — 2 — 10 — — — — 12 Urethral Stricture — — — — 3 1 — 2 6 Retention of Urine — — 1 — — — — — 1 Undescended Testicles — — — — 1 — 1 — 2 Nephritis 11 5 2 7 — — — — 25 Pyelitis 10 4 - - - - - - 14 Enuresis — — 1 — — — — — 1 Cyst of Epididymis — 1 - - - - - - 1 Rt. Spermatocele — — — — 1 — — — 1 Pyelo-nephritis 2 — — 1 — — — — 3 Injury to Scrotum — — — — 2 — — — 2 Cystitis 2 3 1 1 — — — — 7 Congenital Cystic Kidneys — — — 1 — — — — 1 Hydrocele - - - - - - - 1 1 Epididymo-orchitis — — — — 3 1 — — 4 Phimosis — — — — 3 1 — — 4 Urethritis — 1 - - - - - - 1 Papilloma of Bladder - - - - - 1 — — 1 Hydro-nephrosis — 1 - - - - - - 1 Perineal Abscess — — — — 1 — — — 1 110 41 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Gynaecological. Ovarian Cyst — — — — 3 — — — 3 Ovarian Cyst with Acute Torsion — — — — 3 — — — 3 Cystic Ovaries — — — — — 1 — — 1 Acute Salpingitis — — — — 1 2 — — 3 Chronic Salpingo-oophoritis — — — — 2 — — — 2 Pyo-salpinx — — — — 3 1 — — 4 Tuberculous Salpingitis — — — — — 1 — — 1 Chronic Metritis — — — — 5 — — — 5 Chorion-epithelioma of uterus — — — — 1 — — — 1 Polypoidal Endometritis — — — — 6 — — — 6 Endometrioma — — — — 2 — — — 2 Uterine Polypus — — — — 1 — — — 1 Retroflexion — — — — 2 — — — 2 Senile Endometritis - - - - - 4 — — 4 Uterine Fibromyomata — — — — 13 — — 1 14 Chronic cervicitis — — — — 12 2 — — 14 Erosion of cervix — — — — 1 — — — 1 Cervical Polypus — — — 1 — — — 1 Deficient Pelvic Floor — — — — 4 2 — — 6 Deficient Pelvic Floor and Cervicitis — — — 11 — — — 11 Vaginal Cyst — — — — 2 — — — 2 Atresia of Vagina — — — — 1 — — — 1 Urethral Caruncle - - - - - 3 — — 3 Bartholin's Cyst — — — — 2 — — — 2 Bartholin's Abscess — — — — 2 — — — 2 Vulval trauma — — — — 1 — — — 1 Pruritus Vulvae — — — — 1 — 2 — 3 Sterility - - - - - 5 — — 5 Investigation of Renal Function - - - - - 1 - - 1 42 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Menopausal Neurosis — — — — 1 — — — 1 Tabetic retention of Urine - - - - - - - 1 1 Vulvo-vaginitis — — — — 1 — 1 — 2 109 Infectious. Influenza 6 1 — 1 — — — — 8 Scarlet Fever — 2 7 - - - - - 9 Pertussis 1 1 8 — — — — — 10 Erysipelas — — 6 - - - - - 6 Measles — 7 4 - - - - - 11 Opthalmia Neonatorum I — 1 - - - - - 2 Diphtheria — 2 8 - - - - - 10 Cerebro-Spinal Fever — — 1 — — — — — 1 Chickenpox — — 1 1 — — — — 2 Typhoid Fever — — — 1 — — — — 1 60 Mental. Epilepsy — 17 6 1 — — — — 24 M.D. — 4 15 - - - - - 19 G.P.I. — — 3 - - - - - 3 Certified — — 128 - - - - - 128 Uncertified 20 40 10 - - - - - 70 D.T.s 1 - - - - - - - 1 Melancholia — 1 - - - - - - 1 246 Nervous and Sensory. Neurasthenia 2 20 1 - - - - - 23 Nervous Breakdown — 2 - - - - - - 2 Neuritis 1 1 — — — — — — 2 Motor Neurone Disease — — 1 — — — — — 1 43 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Bell's Palsy 1 - - - - - - - 1 Chorea 13 2 — — — — — — 15 Hysteria 6 7 - - - - - - 13 Paralysis Agitans — 1 1 1 — — — — 3 Anxiety Neurosis — 3 - - - - - - 3 Locomotor Ataxis — — 1 — — — — — 1 Hemiplegia — 10 6 7 — — — — 23 Neuralgia 1 1 - - - - - - 2 Cerebral Softening — 1 1 1 — — — — 3 Cerebellar Abscess — — — 1 — — — — 1 Meningitis 1 — — 3 — — — — 4 Tabes Dorsalis — 1 — 1 — — — — 2 Paralysis — 1 - - - - - - 1 Cerebral Tumour — — 2 2 — — — — 4 Disseminated Sclerosis — — — 1 — — — — 1 Meningocele — — — 1 — — — — 1 Diplegia — 1 - - - - - - 1 Cerebral Arterio-sclerosis — — 1 — — — — — 1 Post-encephalitis — 2 2 1 — — — — 5 Sciatica 4 - - - - - - - 4 117 Poisoning 6 - - 2 - - - - 8 Mercurial Stomatitis 1 — — — — — — — 1 9 Respiratory. Pneumonia — — — — 96 36 3 70 205 Bronchitis — — — — 108 60 4 43 215 Pleurisy 10 2 2 - - - - - 14 Growth — — 1 - - - - - 1 Pneumothorax 1 1 - - - - - - 2 44 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Pulmonary Oedema — — — 1 — — — — 1 Emphysema 1 1 - - - - - - 2 Pleural Effusion 1 3 - - - - - - 4 Asthma 2 12 1 5 — — — — 20 Bronchial Catarrh 2 1 - - - - - - 3 Lung Abscess 1 1 - - - - - - 2 Pulmonary Embolus — — — 2 — — — — 2 Empyema — — — — 3 — — — 3 Bronchiectasis — 4 — 2 — — — — 6 480 Senility — 26 19 53 — — — — 98 98 Skin. Psoriasis — 2 - - - - - - 2 Varicose Eczema — 2 - - - - - - 2 Abscesses — — — — 21 — — — 21 Boils — — — — 7 — — — 7 Burns and Scalds 10 5 1 1 — — — — 17 Abrasions 6 - - - - - - - 6 Erythema Nodosum 1 1 - - - - - - 2 Whitlow — — — — 2 1 — 1 4 Cysts — — — — 3 — — — 3 Urticaria 1 - - - - - - - 1 Scabies 6 3 - - - - - - 9 Varicose Ulceration 13 19 - - - - - - 32 Ringworm 1 - - - - - - - 1 Septic Toe 6 - - - - - - - 6 Eczema 6 3 - - - - - - 9 Purpura 2 - - - - - - - 2 Impetigo 35 2 1 - - - - - 38 46 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Dermatitis 14 - 1 1 - - - - 16 Lichen Planus — 1 — — — — — — 1 Septic Spots 6 - - - - - - - 6 Pemphigus Neonatorum 1 — — 1 — — — — 2 Ulcers — — — — 1 2 — — 3 Carbuncle — — — — 5 3 — — 8 Pediculi Capitis 1 - - - - - - - 1 Pruritus 1 - - - - - - - 1 200 Tuberculosis. Pulmonary 1 52 17 39 — — — — 109 109 Non-Pulmonary— Meningitis — — 1 3 — — — — 4 Sacro-iliac joints — 1 - - - - - - 1 Spine — — — — — — 1 — 1 Ankle — — — — — 2 — — 2 Intestinal — — — — — — — 1 1 Lupus — — — — — 1 1 — 2 Adenitis — — — — — 1 — — 1 Knee — — — — 1 — — — 1 Rib — - — — — 1 — — 1 Ileo-caecal Glands — — — — — 2 — — 2 Mesenteric Glands — — — — — 2 - - 2 Trochanter — — — — — 1 - - 1 Kidney — — — — — — 1 — 1 Peritonitis — — — — — 1 — 1 2 22 46 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Venereal. Gonorrhea — 6 - - - - - - 6 Syphilitic meningitis — 1 - - - - - - 1 Syphilis — 11 2 2 — — — — 15 Gonococcal Rheumatism 1 - - - - - - - 1 Violence. 23 Bruises — — — — 13 2 — — 15 Dislocations — — — — 4 1 1 — 6 Wounds — — — — 26 — — — 26 Fractured Limbs — — — — 81 14 5 6 106 Fractured Skull — — — — 12 — 1 — 13 Fractured Pelvis — — — — 3 — — — 3 Concussion — — — — 44 15 3 2 64 Minor Injuries — — — — 20 4 4 — 28 Sprains — — — — 1 1 — 1 3 Lacerations — — — — 10 — 1 — 11 Traumatic Meningeal Haemorrhage - - - - - - - 1 1 Fractured Spine — — — — 3 — — — 3 Foreign Body 1 1 — — — — 2 — 4 283 Maternity. Deliveries (viable child) — — — — 511 — — 4 515 Live Births — — — — 470 — — 16 486 Deliveries (Non-viable Foetus) — — — — 108 — — 108 Ectopic Pregnancy — — — — 4 — — 1 5 Delivered before Admission — — — — 18 — — — 18 Maternity Cases Undelivered — — — — 57 — — 2 59 Admitted as Puerperal Sepsis per se 11 — — 3 14 1205 47 Operation Performed. Number. GYNAECOLOGICAL. Excision of Urethral caruncle 2 Cystoscopy and pyelography 4 Excision of Bartholin's cyst 2 Excision of vaginal cyst 2 Anterior and posterior colpo-perineorrhaphy 4 Anterior and posterior colpo-perineorrhaphy and amputation of cervix 11 Amputation of cervix 10 Trachelorrhaphy 1 Removal of tissue for section 2 Dilatation of cervix 6 Dilatation and curettage 3 Exploration of uterus 6 Ventrosuspension of uterus 4 Myomectomy 5 Wertheim's Hysterectomy 3 Total hysterectomy 15 Sub-total hysterectomy 7 Salpingectomy 2 Laparotomy for tubercular salpingitis 1 Salpingo-oophorectomy 3 Oophorectomy 1 Ovariotomy 6 Blood transfusion 4 Examination under anaesthesia, etc. 15 119 obstetrical. Forceps delivery 27 Breech extraction 3 Internal version 2 Embryotomy 3 Manual removal of placenta 10 Vaginal packing 2 Anaesthesia for examination, external version, etc. 16 Abortion, evacuation of uterus, and glycerine drainage 73 Induction of abortion per vaginam 1 Abdominal hysterotomy and sterilisation 4 Evacuation of vesicular mole 2 For ectopic gestation 5 Caesarean section 8 Caesarean hysterectomy 1 Surgical induction of labour 22 Drainage of puerperal peritonitis 3 Blood transfusion 10 192 48 Operation Performed. Number. ABDOMINNAL. Suture of perforated duodenal ulcer 10 Suture of perforated gastric ulcer 7 Appendicectomy 147 Drainage of Appendix abscess 8 Drainage for general peritonitis 1 Excision of haemorrhoids 4 Abdominis paracentesis 5 Herniotomy 34 Jujenostomy 1 Caecostomy 1 Gastrectomy 3 Ileostomy 1 Cholecystectomy 5 Colostomy 5 Sigmoidoscopy 7 For acute obstruction 8 Closure of faecal fistula 1 Drainage for pancreatitis 1 Laparotomy (Carcinomatosis, etc.) 14 Cholecystenterostomy 1 Fistula-in-ano 1 Repair incisional hernia 3 268 EAR, NOSE AND THROAT. Tonsillectomy 31 Mastoidectomy 20 Re-opening old radical mastoid 1 Puncture and drainage of maxillary antrum 3 Resection and drainage ethmoid sinuses 3 EYE. Trephining and Iridectomy 1 Extraction left lens 1 Evisceration of eye 1 BONES AND JOINTS. Sequestectomy 3 Manipulation of limbs 7 Insertion of extension and transfixion pins 10 Resection of rib 4 For Osteo-myelitis 7 Reduction of joints 11 Irrigation of right knee 4 Wiring of bones 3 Application of plasters 15 Trephining depressed fracture of skull 1 Trephining R. tibia 1 Setting fractures 2 Amputation of limbs 2 Plating fractures 1 132 49 Operation Performed. Number. GENITO-URIINARY. Dilatation of Urethral Stricture 4 Cystoscopy 22 Pyelography 5 Supra-pubic prostatectomy 4 Supra-pubic puncture 1 Urethrotomy 2 Removal spermatocele 1 Cystostomy 8 Circumcision 7 Excision of undescended testicle 1 Exploration of kidney 1 Catheterisation of ureters 2 KQ MISCELLANEOUS. Lumbar puncture 26 Exploration and aspiration of chest 44 A.P. refills 17 Incisions (abscesses, whitlows, etc.) 82 Removal of cyst 1 Lipiodal injections 2 Thiersch graft 2 Blood transfusion 11 Avulsion of finger nail 2 Suture of wounds 7 Application of tannic acid 2 Removal of foreign body 1 Number of patients who had teeth extracted Mayday Hospital 269 Number of patients who had teeth extracted Queen's Road Homes 67 533 Total 1302 Number of major operations 393 Number of minor operations 573 Number of dental extractions 336 Total 1302 NUMBER OF X-RAY FILMS TAKEN DURING THE YEAR 1934. Spines 114 Long Bones 575 Pelvis 41 Skull 186 Chest (including lungs) 383 Barium Meals 174 Barium Enemata 28 Urinary Tract 85 Gall Bladder 38 Teeth 87 Abdominal? F.B 12 Maternity Cases 203 Total 1926 Actual number of cases treated: 1,146. 50 NUMBER OF TREATMENTS GIVEN DURING THE YEAR 1934. Massage 5301 Exercises 4413 Radiant Heat 1198 Electrical Treatment 584 Diathermy 409 Ultra Violet Light 419 Total 12324 Number of Patients: 735. DETAILS RE MENTAL PATIENTS FOR THE YEAR 1934. Male. Female. Admitted 186 228 Certified and sent to C.M.H. 43 76 Discharged not certified 81 105 Total Cases 124 181 Deaths : Male 29, Female 26. NUMBER OF SPECIMENS SENT TO THE COUNCIL LABORATORY DURING 1934. 2711 NUMBER OF POSTMORTEMS ORDERED BY THE CORONER AND PER-FORMED AT MAYDAY HOSPITAL. Outside Cases 243 Mayday Hospital Cases 55 Total 298 NUMBER OF POSTMORTERMS NOT ORDERED BY CORONER 49 51 SECTION IV. PREVALENCE AND CONTROL OF INFECTIOUS DISEASE. Table I. gives the figures for ages and Wards. Scarlet Fever was more prevalent than in 1933; the largest incidence has been in Waddon, West Thornton and Upper Norwood Wards. Based on the estimated ward populations, the case rate for these wards was respectively, 895, 561 and 432 per 100,000 of the population. The age group 5-15 years, as usual, suffered most; cases in this group comprising 59.7% of the total. Diphtheria was also more prevalent than in 1933; most cases occurred in Waddon (119) and West Thornton (74). Once again the age group 5-15 years give the highest figures. No cases of Small Pox occurred during the year. There were 15 cases of Puerperal Fever and 36 of Puerperal Pyrexia; 17 occurred in the age group 16-25 years and 34 in the age group 26-45 years. A majority of the cases occurred in women having their first confinement. The incidence of the commoner infectious diseases in Croydon during the past eleven years is of interest. Scarlet Fever has shown a succession of shallow waves of incidence with a distinct trend towards an aggregate increase. The periods of maximum intensity have been in 1924, June and July; 1925, March, April and May; 1926, May, June and July; 1927, April, May and June; 1928, January and February, with another in November and December; 1929, a gradual increase throughout the year without any intermissions. 1930 and 1931, the incidence was relatively constant, with a slight decline in the number of cases in August and September. During 1932 there was a steady increase in cases until the begininng of May, when the incidence fell rapidly and remained low until the beginning of a new wave in November. In 1933 the incidence remained fairly steady throughout the year. In 1934 there were two peaks of incidence, the first and smaller came in the second week in March following a steady rise from the beginning of the year; the incidence then dropped rapidly and remained constant until the second peak was reaohed, following a rapid rise, the third week in November. The greatest number of cases in one week 52 was 40 during the week ending November 24th. The weekly average of cases throughout the year was 19.5, being 9.0 higher than in 1933. Diphtheria.—During 1924 there was a small but steady incidence throughout the year; in 1925 a trough occurred in the curve and very few cases were notified, but towards the end of the year the notifications began to increase steadily, the curve reaching its apex in November and December, 1926; the curve then declined through 1927 until the last quarter, when the trend became upwards once more, reaching its apex in January, 1928; this was followed by a slight fall, followed by a slight rise until December, 1928, when another fall commenced, reaching its minimum in July, 1929, from when the curve rose steadily to its maximum in November. In 1930 Diphtheria was not troublesome, though there was a small rise in the number of cases in October, reaching a maximum of 22 during the week ending October 18th. In 1931 the highest number of cases arose in February and the last two weeks of March. In 1932 there was a slight rise in March and again in mid-September and the end of November. During 1933, there was a steady upward trend in incidence as the year advanced, with only a slight remission during April and May; a small wave of increased incidence spread over the first half of the year and was succeeded by a more intense wave covering October, November and December. The weekly average of cases was 8.4 as compared with 4.1 in 1933. Whooping Cough.—From being inconspicuous in 1924, the curve rose gradually to a maximum in May, June and July, 1925, then fell rapidly to a minimum in November and December, then rose very gradually to a lower maximum in September, 1926; once again the curve fell abruptly to a minimum in January, 1927, rose in June and July, and fell again gradually to a minimum in November and December, then rose steadily to the highest level of the period under review in January, 1929, from when it fell steadily to the end of the year. Throughout 1930 it remained quite inconspicuous, until December, when there were indications of the commencement of a wave of increased incidence which persisted in 1931 until the end of July, after which the number of cases dropped considerably. December showed a small rise in cases. A wave of increased incidence occurred in 1932, commencing the second week in April and persisting until the end of July. Two small waves showed themselves during 1933, the first commencing early in February and persisting until the beginning of August; the second beginning in late October and continuing 53 until the end of the year. In 1934 two waves were also experienced; the first with its peak at the end of January, and the second with its peak at the middle of April. From then a moderate incidence was present until the beginning of August, when the numbers dropped rapidly, the incidence remaining very low for the rest of the year. Measles was very prevalent in April and May, 1924, then dropped suddenly, but showed a small rebound during September, October and November, after when it died away until a sudden rise in May, June and July, 1925, and was followed, after a fall, by a further and more prolonged rise from October, 1925, to May, 1926. During 1927 there was very little Measles in Croydon; a small rise in October, November and December, however, heralded a very big incidence of cases—the highest during the period under review—during the first six months of 1928, Practically no cases occurred after this exacerbation, until March, 1929, but during this month, and April, May and June, 1929, a number of cases occurred from when the incidence dropped away until the end of the year. Another wave of considerable intensity commenced abruptly during the last week of February, 1930, reaching its maximum in the second week of March and dying away gradually until terminating at the end of June. During 1931, Measles was quite inconspicuous; but in 1932 there was a sharp rise in cases in the second week in April which reached a maximum in the last week in June, falling then rapidly. The beginning of another wave showed itself at the end of November and the cases were steadily increasing in number for the rest of the year. The measles waves, therefore, were as follows : the first half of 1924, the second half of 1925, and the first quarter of 1926; the first half of 1928, the first half of 1929, the first half of 1930, and the first half of 1932. Measles was rather prevalent during the first quarter of 1933, dropping rapidly during the second quarter and not becoming noticeable again until December. The characteristics of the Measles curves were their abrupt rises and rather less abrupt falls. Measles was again prevalent during the first half of the year with peak incidences in February and May. A very rapid decline at the end of July was followed by a low incidence for the rest of the year. Chicken Pox.—A small wave of cases occurred during the first half of 1924, followed by a higher wave covering the last quarter of 1924 and the first half of 1925; another irregular wave was experienced during the first half of 1926, followed by a secondary in the last quarter. During 1927 and 1928 there was a 54 fairly high and steady incidence with a peak in October and November, 1927. Another wave came during the latter half of 1929 with its maximum in December; this wave continued into 1930, gradually declining to a minimum at the end of July. Another wave commenced in November and continued until the end of the year. In 1931 Chicken Pox was prevalent until the end of June, when the number of cases declined and remained low until November, when the cases again rose. During 1932 the incidence remained steady until the end of March, when a rise occurred, persisting until the end of August. After the vacation the disease practically died out for the remainder of the year. Chicken Pox rose during the first half of 1933 to reach a maximum early in July. It then dropped rapidly and did not show any signs of recrudescence until the end of November. In 1934 a moderate wave of incidence covered January to the end of March, and was followed by a sudden rise during May. The incidence then dropped, but a small rise was manifest in December. Mumps occurred in a series of waves from 1924 to 1928 inclusive, but was not at all prevalent in 1929. In 1930, however, a rather severe incidence was noted throughout the first half of the year. In 1931 there was an irregular and gradual decline thoughout the year, and in 1932 the incidence was very low. The very low incidence of Mumps continued during 1933 and until November, 1934; a rise then commenced and continued during December, indicating the onset of a major incidence in 1935. The waves showed their maxima in March, 1924; May, 1925; March, 1926; May, 1927; March, 1928 and May, 1930, and their minima in September, 1924; September, 1925; September, 1926; and September, 1927. Table I. CASES OF NOTIFIED INFECTIOUS DISEASE, 1934. Notifiable Disease. Cases notified in the whole District. Total cases notified in each Ward. Total cases removed to Borough Hospital. Total Deaths in the Borough. 1933. At all Ages. At ages—years. Upper Norwood. Norbur West Thornton. Bensham Manor. Thornton Heath. South Norwood. Woodside. East. Addiscombe. Whitehorse Manor. Broad Green. Central. Waddon. South. Addington. Under 1 Year. 1—5 6—15 16—25 26—45 46—65 66 and up. M F Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (inc. Membranous Croup) 441 4 117 259 30 26 4 1 24 8 74 20 32 13 14 18 11 48 33 12 119 14 1 524 24 102 120 Erysipelas 116 1 5 4 9 23 58 16 4 8 22 12 6 6 6 11 3 9 10 5 10 4 46 5 47 58 Scarlet Fever 1003 6 241 599 92 59 7 ... 96 69 113 62 47 50 53 62 30 68 50 21 196 67 19 902 3 283 350 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever (including Paratyphoid) 3 ... ... 1 1 ... 1 ... ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... 3 1 13 11 Puerperal Fever 15 ... ... ... 4 11 ... ... 1 ... 9 1 ... ... ... 2 ... 1 1 ... ... ... ... 10 5 ... 13 Puerperal Pyrexia 36 ... ... ... 13 23 ... ... 2 ... 22 1 1 ... ... 2 ... 1 3 2 1 1 ... ... ... ... 39 Cerebro-Spinal Meningitis 3 ... ... 2 ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... l ... ... 3 3 3 ... Ophthalmia Neonatorum 13 13 ... ... ... ... ... ... 1 ... 5 1 ... ... ... ... ... 2 1 1 ... 2 ... 2 ... 4 6 Poliomyelitis 4 ... 1 3 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 2 ... ... ... ... 3 1 4 ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 Dysentery 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 6 6 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ac. Primary and Ac. Inf. Pneumonia 61 1 9 6 7 17 16 5 7 ... 4 6 3 8 6 7 2 4 1 1 4 7 1 13*† 39 34 Polio Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 *Influenzal Pneumonia only. †Not accommodated at Borough Hospital. 55 66 Table II. Notified Disease. Incidence Rate per 1,000 population. Housing Conditions. Case occurring in Institutions in the Borough. Total cases notified. 1-3 rooms. 4-5 rooms. Over 5 rooms. 1934 1933 Small Pox — 0.012 — — — — — Diphtheria 1.83 0.92 3 382 16 40 441 Erysipelas 0.48 0.44 2 91 7 16 116 Scarlet Fever 4.17 2.65 8 828 65 102 1003 Enteric Fever (inc. Paratyphoid) 0.012 0.096 — 2 — 1 3 Puerperal Fever 0.062 0.054 — 6 — 9 15 Puerperal Pyrexia 0.15 0.162 — 10 2 24 36 Cerebro-Spinal Meningitis 0.012 0.012 — 2 — 1 3 Ophthalmia Neonatorum 0.054 0.042 — 7 — 6 13 Poliomyelitis 0.016 0.016 — 2 1 1 4 Encephalitis Lethargica — 0.012 — — — — — Acute Primary or Acute Influenzal Pneumonia 0.25 0.305 3 50 7 1 61 Dysentery 0.004 0.048 — — — 1 1 Polioencephalitis — 0.004 — — — — — The highest incidence of notifiable infectious diseases was in houses of 4-5 rooms. The 1931 Census showed that houses of 1-3 rooms formed 4.7% of the total number of houses; those of 4-5 ♦ rooms 51.4% and those with over 5 rooms 43.9.% 57 Table III. SCARLET FEVER. YEAR Cases notified in Croydon. Attack Rate Per 100,000 of Population. No. of Deaths. Percentage of Deaths to Cases notified. All Cases Admitted to Hospital with a Diagnosis of Scarlet Fever. No. Admitted. No. of Deaths. Percentage of Deaths to cases Treated* 1 2 3 4 5 6 7 8 1908 534 338 5 .9 497 8 1.6 1609 727 451 9 1.2 608 11 1.8 1910 759 454 7 .9 624 7 1.1 1911 468 274 7 1.5 377 5 1.3 1912 476 273 2 •4 365 4 1.09 1913 470 263 3 .6 411 4 9 1914 748 411 5 •6 638 5 •7 1915 414 233 5 1.2 391 4 1.02 1916 297 169 4 1.3 283 6 2.1 1917 191 102 2 1.05 196 2 1.02 1918 414 219 6 1.4 37 8 2.1 1919 603 314 11 1.8 522 11 2.1 1920 638 332 7 1.09 535 8 1.4 1921 855 446 4 •4 720 4 .5 1922 800 416 6 •7 691 6 .8 1923 379 195 2 •5 340 ... ... 1924 289 147 2 •6 237 2 .8 1925 347 174 1 •2 248 2 •8 1926 525 254 ... ... 409 ... ... 1927 717 338 3 .4 686 3 .4 1928 552 259 4 •7 574 8 1.3 1929 759 335 4 •54 714 3 0.42 1930 681 306 2 .29 679 2 0.29 1931 527 225 3 .57 528 2 0.38 1932 441 186 1† •23 387 1 0.26 1933 633 264 ... ... 599 1 0.17 1934 1003 416 3 •29 968 5 0.51 Cases admitted to the Borough Hospital from Penge are included in arriving at the figures in Cols. 6 to 8. † Death not due to Scarlet Fever. There was an increase in the number of cases notified and admitted to Hospital in 1934 as compared with 1933. The type was mild and the case mortality was nil. The attack rate (Col. 3) for England and Wales was 376. Croydon shows a rather higher figure. 58 Table IV. DIPHTHERIA. YEAR. Cases notified in Croydon. Attack Rate , Per 100,000 of Population. No. of Deaths. Percentage of Deaths to Cases notified. All Cases Admitted to Hospital with a diagnosis of Diphtheria. No. \dmitted. No. of Deaths. Percentage of Deaths to Oases Treated* 1 2 3 4 5 6 7 8 1908 405 256 37 9.1 354 29 8.2 1909 356 220 24 6.7 292 24 8.2 1910 267 159 21 7.8 222 15 6.7 1911 514 301 37 7.2 430 35 8.1 1912 767 440 25 3.2 600 22 3.6 1913 451 253 16 3.5 389 13 3.3 1914 226 124 18 7.9 186 19 10.2 1915 195 109 14 7.1 188 8 4.2 1916 312 177 4 1.2 303 15 4.9 1917 191 102 9 4.7 194 8 4.1 1918 179 94 2 1.1 158 21 1.3 1919 429 223 36 8.3 388 38 •7 1920 558 290 26 4.6 529 21 3.9 1921 483 252 23 4.7 451 24 5.3 1922 358 186 27 7.5 329 21 6.3 1923 196 101 21 10.7 202 18 8.9 1924 222 113 8 3.6 196 7 3.5 1925 104 52 8 7.6 114 11 9.6 1926 321 155 32 9.9 321 28 8.7 1927 262 123 10 3.8 300 8 2.6 1928 476 224 32 6.7 493 31 6.2 1929 435 194 23 5.3 470 23 4.9 1930 394 177 14 5.3 462 12 2.6 1931 221 94 5 2.2 219 7 3.2 1932 116 49 9 7.8 162 9 5.6 1933 222 93 17 7.7 236 18 7.6 1034 524 217 24 4.5 546 19 3.4 *Cases from Penge are included in Col«. 6 to 8. 59 The incidence of diphtheria showed a considerable increase in 1934, and the mortality was 4.5%. The type of the disease was moderately severe. One hundred and fifty cases of bacteriological Diphtheria were admitted but these are not included as Diphtheria as they exhibited no clinical symptoms. The case rate (Col. 3) for England and Wales was 170. Croydon's rate was therefore higher than for the whole country. Immunisation Clinic. The Clinic commenced on 5th February and is held at Lodge Road Clinic. It deals only with Anti-Diphtheritic immunisation. At first only one session a week was held, but owing to the lengthening waiting list and increasing number of applications a second Clinic was begun at the end of November. The demand has continued to grow and a third Clinic will have to be arranged in the near future. The total number of children seen at the Clinic during the year was 509. Of these 339 were over 5 years of age and 170 were 5 years or under. Five hundred and seventy-four Schick tests were performed and of these 389 were Anterior and 185 Posterior tests. One thousand two hundred and sixty injections of toxoid-antitoxin mixture were given. No propaganda has been undertaken other than informing mothers that facilities were available if they desired their children immunising. The principle has been to immunise those who desired it, but not to endeavour to convert those who were apathetic or hostile. For immunisation to exert a pronounced effect upon Diphtheria incidence—which incidentally has not been excessive in Croydon—at least some 60% of the total susceptibles in the population must be rendered immune, and it was felt such a result was hardly to be anticipated even as the result of intensive propaganda. Diphtheria has been stamped out in various of the "closed" communities comprised in residential schools in the borough and this has been achieved by the Schick testing of all the inmates and the immunisation of those found susceptible. As indicated, however, the numbers have steadily increased as the Clinic became known The average number of children attending per session at the beginning of the year was 20; the later sessions were called upon to deal with between 60 and 70. The average over the whole year was 36 per session. 60 There was no case of marked upset or prolonged illness; the only effects noted were that 3 children fainted, two during the performance of the first Schick test, and one during the injection of the first dose of toxoid-anti-toxin mixture. All three recovered rapidly and the fainting was certainly due to psychological causes and not to any effect of the material used. Fourteen parents reported that their children had a "stiff arm" for one or two days, but there was no local inflammatory reaction and no generalised symptoms. Three children had some localised inflammatory reaction around the site of injection, which subsided rapidly and did not cause any marked constitutional disturbance. Five children required a second course of injections as they were still Schick positive at the end of the first series of three injections. The material used was toxoid-antitoxin mixture (T.A.M.) and 3 doses of 1 c.c. was injected at weekly or fortnightly intervals into the muscles of the upper arm. Strictest aseptic precautions were taken. The procedure is practically painless and children very soon lost all their apprehension; there is no difficulty in obtaining their attendance. IMMUNISATION AT SCHOOLS. The Convent—Central Hill, Upper Norwood. One hundred and twenty-three new cases were dealt with on the same lines as given above, and 113 retests of previously immunised or Schick tested children were made. Of the latter 51 cases had been Schick tested and immunised in 1931. All these cases were negative on retest. Fifty-two cases were negative on primary test in 1931 and were again negative in 1934. No illeffects arose. There has been no case of Diphtheria in the Convent since systematic immunisation was commenced. Gordon Boys Home and the Russell School, Ballards. Immunisation work continued in these institutions and the details are given in Table V. No cases of any ill-effects occurred. There have been no cases of Diphtheria reported since systematic immunisation commenced. 61 The Children's Homes—Public Assistance Committee. Immunisation was commenced during the year and during its inception a small outbreak of Diphtheric infection arose. It is of interest to give the position of the cases in relation to immunisation and the details are appended hereto. The first case who exhibited clinical symptoms of Diphtheria had been found Schick positive and developed the disease two days after the first dose of toxoid-antitoxin. It is obvious that, in as much as immunisation had only just commenced, the incidence of Diphtheria in this case does not denote any breakdown in immunisation. The second case was a contact of the previous one. This boy had a positive nasal swab but was otherwise quite well. At no time did any clinical symptoms arise. He was Schick negative. The third case showed a positive throat swab but was otherwise quite well and had no clinical symptoms of Diphtheria. He also was Schick negative. The fourth case was exactly similar to the third. The fifth case showed mild Diphtheria symptoms and had a positive throat swab. This child had had 3 injections of toxoidantitoxin but had left the Homes before being re-Schicked. His original Schick had been positive and probably if he had been retested it would have been found that he was still positive and consequently required a second course of injections. The sixth case was in all respects similar to case No. 2. CASES SCHICK TESTED. Individuals who have attended Clinic:— Definite School cases 370 Definite M. and C.W. cases 73 Under 5 years of age but not sent from M. and C.W 60 Nursery School 9 Public Assistance 62 Ballards 28 The Convent 236 838 Table V. GROUP. No. Schick tested. {Primary). No. Pos. Percent. Pos. No. given full course T.A.M. No. Retested. No. Neg. on re test. Percent. Neg. Uncompleted at end of year. Left District before end of year or defaulted. Clinic— Primary Schick 389 326 83.8 291 174 169 97.1 140 24 No Ant. Schick (120) (88) (11) (11) (107) P.A.C. Homes 25 10 40.0 7 23 23 100 4 1 P.A.C., Queen's Road — — — 7 — — — 9 2 Russell School 25 22 88.0 21 8 8 100 16 1 Gordon Boys' Homes 10 7 70.0 6 4 4 100 2 1 Convent, Central Hill 123 61 49.6 56 148 145 98.0 26 Totals 572 (+120 no Ant. Schick test.) 426 74.5 476 368 360 97.8 304 29 62 63 BOROUGH HOSPITAL. The Table gives a summary of all cases treated at the Hospital during 1934. 1,756 patients were admitted and discharged during the year, whilst, including patients in at the commencement of 1934 (132), 1,888 cases were dealt with. Fortysix died, giving a case mortality for the whole Hospital of 2.5%, a decrease of 0.6% on 1933. The average number of days of each patient in Hospital for all classes of patients was 28.5, as against 31.2 in 1933. Penge Urban District Council has an agreement with the Corporation to send their cases to Hospital. During 1934 a total of 91 cases was admitted; these are included in the Table. The Hospital is a recognised Training School for Fever Nurses. During the year three probationers passed the preliminary and one the final examination of the General Nursing Council. The accommodation in the Hospital remains as in 1933, but owing to the great increase in the number of admissions, which were 628 more than in 1933, all the wards, including the emergency ones, were kept open throughout the year. During the year 20 cases were operated on for tonsils and adenoids in the recently built operating theatre. Complaint for which Admitted. Patients remaining in Hospital on Jan. 1st, 1934. Patients admitted and discharged in 1934. Patients remaining in Hospital on Jan. 1st, 1935. Analysis of all Cases admitted in 1934 whether discharged or not during the year. Table VI Total. Recovered Died. Total. Recovered Died. Total. Recovered Died. Total Recovered Died. Case Mortality. Average No. of days in Hospital. Scarlet Fever 89 89 968 826 5 137 137 ... 968 963 5 0.5 37 Diphtheria 35 33 2 546 425 19 102 102 ... 546 527 19 3.5 35 Enteric Fever 1 1 ... 3 3 ... ... ... ... 3 3 ... ... 27 Puerperal Fever ... ... ... 12 10 1 1 1 ... 12 11 1 8.3 29 Erysipelas 5 5 ... 46 42 3 1 1 ... 46 43 3 7.4 17 Measles 1 1 ... 61 57 4 ... ... ... 61 57 4 6.6 23 Rubella ... ... ... 9 9 ... ... ... ... 9 9 ... ... 15 Encephalitis Lethargica ... ... ... 1 ... 1 ... ... ... 1 ... 1 100.0 18 C.S.M ... ... ... 3 2 1 ... ... ... 3 2 1 33.3 26 Whooping Cough 1 1 ... 74 64 10 ... ... ... 74 64 10 13.3 33 Chicken Pox ... ... ... 10 10 ... ... ... ... 10 10 ... ... 19 Ophthalmia Neonatorum ... ... ... 2 2 ... ... ... ... 2 2 ... ... 15 Mumps ... ... ... 2 2 ... ... ... ... 2 2 ... ... 10 Infantile Paralysis ... ... ... 2 1 ... ... 1 ... 2 2 ... ... 8 Dysentery ... ... ... 1 1 ... ... ... ... 1 1 ... ... 11 Marasmus ... ... ... ... ... ... ... ... ... ... ... ... ... ... No Disease ... ... ... 16 16 ... ... ... ... 16 16 ... ... ... Total 132 130 2 1756 1470 44 242 242 1756 1712 44 64 66 SCARLET FEYER. The total number of cases of Scarlet Fever admitted during the year was 968, an increase of 369 in 1933. 902 cases were admitted from the Borough and 66 cases from Penge. The type of the disease during the year was of average severity, there being many adult cases, as shewn in the subsequent table. 27 cases sent in as Scarlet Fever were not suffering from this disease. The following complications and sequelae occurred am the 941 true cases of the disease, of whom 288 received s treatment:— Table VII. Serum Cases. Non- Serum Cases. Total Cases 288 653 Adenitis 22 25 Otorrhoea 14 40 Rhinorrhoea 6 27 Albuminuria — 1 Nephritis 2 3 Rheumatism 6 7 Relapses 4 6 Secondary Sore Throat 4 4 Abscesses and Boils 4 5 Endocarditis 2 3 Septicaemia 3 — Quinsy — 1 Diphtheria 2 2 Encephalitis 1 — Mastoid 1 - Average stay in Hospital—Serum cases, 36 days; non-serum cases 39 days. Seventeen cases sent in as scarlet fever were found not to be suffering from the disease, whilst 10 others were not cases of Scarlet Fever, but as follows:— Measles, 2; Rubella, 1; Chickenpox, 1; German Measles, 1; Teething, 2; Exfoliative Dermatitis, 1; Septic Rash, 1; and Food Rash, 1. 66 Five deaths occurred amongst the Scarlet Fever cases; one fatal case was due to streptococcal septicaemia; the second was complicated by measles, developing a rapidly spreading cellulitis of neck; the third died from encephalitis lethargica, which was evident soon after admission; one was complicated by lobar pneumonia; and another by heart disease. The death-rate of Scarlet Fever was 0.3 per cent. The number of complications amongst the 653 non-serum cases was 18.9 per cent., whereas the complications amongst the 288 serum cases was 24.7 per cent. Ages and Sexes of Scarlet Fever Patients Admitted. The following table shows the ages and sexes of Scarlet Fever patients admitted:— Table VIII. Age. Males. Females. Totals. 0—1 4 3 7 243 25.1% 1—2 8 16 24 2—3 25 26 51 3—4 31 40 71 4—5 43 47 90 5-10 192 204 396 567 58.6% 10—15 72 99 171 15—20 28 31 59 158 16.3% 20—30 17 38 55 30 & over 20 24 44 Total 1934 440 528 968 Total 1933 258 322 580 Monthly Admissions of Scarlet Fever Patients to the Hospital. Table IX. Month. Cases ad mitted. Cases notified. 1933. 1934. January 44 85 90 February 47 101 101 March 51 88 101 April 40 58 64 May 58 69 75 June 49 65 75 July 55 66 68 August 24 66 66 September 44 72 65 October 52 81 80 November 58 125 125 December 77 92 93 Total 599 968 1,003 N.B.—Cases notified are for the Borough only: admissions include cases from outside Borough. 67 DIPHTHERIA. 546 cases were admitted with a diagnosis of diphtheria, an increase of 310 cases on 1933. Of these 29 were found not to be cases of diphtheria, and 150 were cases of positive swabs without clinical symptoms, leaving 367 cases of true diphtheria. Analysis of the 367 cases:— Faucial diphtheria 318 Nasal diphtheria 39 Laryngeal diphtheria 5 Faucial and nasal diphtheria 4 Faucial and laryngeal diphtheria 1 367 Of the five laryngeal cases, tracheotomy was necessary in three cases; of these, two died, one being moribund on admission, the other, being complicated by broncho-pneumonia, only lived for two days after operation. The following complications and sequelae occurred amongst the Diphtheria patients:— Otorrhoea 9; rhinorrhoea 17; adenitis 13; heart failure 10; secondary throat 5; tonsillitis 2; quinsy 1; palatal paralysis 12; eye paralysis 6; facial paralysis 1; leg paralysis 1. Ages and Sexes of Diphtheria Cases Admitted. Table X. Age. Males. Females. Totals. Deaths. Mortality. % 0-1 9 1 10 - - 151 (27.5%) 1-2 9 11 20 - - 2-3 19 11 30 - - 3-4 29 11 40 2 5.0 4-5 30 21 51 3 5.9 314 (57.5%) 81(15.0%) 5-10 126 94 220 11 5.0 10-15 53 41 94 2 2.1 15-20 7 18 25 - - 20-30 12 24 36 - — 30 & over 4 16 20 1 5.0 Total 1934 298 248 546 19 5.2* total 1933 126 110 236 14 7.4 *These figures are based on the death-rate of the true Diphtheria cases. For all cases admitted as Diphtheria the rates were 1934, 3.4, and 1933, 5.9. 68 The type of Diphtheria which occurred in 1934 was as severe as that of 1933, but towards the end of the year there was a decided increase in virulence. The death rate was 5.2 per cent., as compared with 7.4 per cent. during the previous year. Admissions of Diphtheria Cases to the Borough Hospital in 1934. Table XI. Month. Cases notified. Cases 1934. admitted. 1933. January 28 38 19 February 33 36 12 March 43 51 16 April 30 41 16 May 29 27 8 June 28 32 17 Julv 22 26 17 August 25 38 17 September 39 49 29 October 37 48 30 November 61 77 28 December 66 s3 27 Total 441 546 236 The difference between the number of admissions and notifications is due to (a) cases from Penge, (b) the admission of a number of "carrier" cases without clinical symptoms. Particulars of Fatal Cases. Table XII. Name. Day of Disease. Condition on Admission. Subsequent progress. Date of Death Days after ad. mission. (l)H.B. (F) 5 yrs. 7 Moribund, croupy and cyanosed. Some recession. Glands of neck + +. Received no serum before admission. Tracheotomy performed on admission but child collapsed. 1 hour (2) T.B. (M) 3½ yrs. 4 Marked stridor and recission; some broncho-pneumonia cyanosis. No serum given before admission. Tracheotomy performed on admission with relief, but respirations and temperature kept up. Became very restless and cyanosed 2 days later and died through rapid heart failure. 3 days (3) M.B. (F) 9 yrs. 5 Moribund on admission. Sloughing membrane over whole of pharynx. Bull neck. Heart sounds almost imperceptible; very restless. No serum given before admission. Restlessness increased, colour and pulse poor. Died 2½ hours after admission. hours (4) J.C. (F) 511/12 yrs. 5 Extensive membrane over whole pharynx. Foetor +. Bull neck. Profuse rhinorrhoea. Serum given before once. Given 28,000 units of serum intra-venously and 16,000 units intra-muscularly on admission. Started vomiting and showing signs of heart failure 6 days after admission. Died by increasing heart failure. 12 days (6) D.C. (F) 5 yrs. 4 Extensive membrane over whole pharynx; foetor; much oedema of throat; glands of neck + +; colour poor. Heart sounds soft and rapid. Given 8,000 units before admission. Collapsed suddenly after injection of serum given on day after admission. 2 days 69 70 Name. Day of Disease. Condition on Admission. Subsequent progress. Date of Death Days after ad. mission. (6) D.D. (F) 37 yrs. 2 Extensive membrane over whole pharynx; glands of neck + +; cyanosis. Heart sounds rapid and soft. No serum given before admission. Collapsed suddenly on 3rd day of admission. 3 days (7) J.F. (F) 4 yrs. 3 Extensive membrane over whole pharynx. Bull neck. Profuse rhinorrhoea cyanosis. No serum given before admission. Developed signs of heart failure on day after admission, and died through this increasing on 3rd day after admission. 3 days (8) K.H. (M) 5 yrs. 3 Extensive membrane over whole pharynx. Glands of neck + +; foetor; pallor. No serum given before admission. Given 12,000 units intravenously and 28,000 intra - muscular on 2nd day, having had 24,000 units previously. Started showing signs of heart failure 3 days after admission, which increased steadily. 6 days (9) J.H. (F) 7 yrs. 11 Late case; acute toxaemia; very cyanosed; difficult breathing. No serum given before admission. Died a few minutes after admission. 5 mins. (10) P.M. (F) 11 yrs. 4 Extensive membrane over whole pharynx. Bull neck; rhinorrhoea; foetor and cyanosis marked. No serum given before admission. Given 12,000 units and 32,000 intramuscularly on admission. Developed epistaxis on 3rd day after admission, also showed signs of heart failure, which increased steadily till death. 7 days (11) P.S. (M) 6 yrs. ? Had been unwell for 3 weeks before admission and showed signs of heart failure on admission, though throat clean. 8,000 units given before admission. The signs of heart failure present on admission steadily increased, with marked vomiting. Collapsed suddenly on 3rd day after admission. 3 days 71 Name. Day of Disease. Condition on Admission. Subsequent progress. Date of Death Days after ad. mission. (12) A.S. (M) 9 yrs. 5 Membrane over whole pharynx. Bull neck. Profuse rhinorrhoea. Colour poor. No serum given before admission. Collapsed suddenly 1 hour after admission. 1 hour (13) D.S. (M) 8 yrs. 4 Sloughing membrane over whole pharynx. Bull neck; rhinorrhoea and foetor toxaemia. No serum given before admission. Given 32,000 units, of which 28,000 intravenously on admission. Showed signs of heart failure on admission, which steadily increased. 6 hours (14) D.T. (M) 611/12 yrs. 4 Extensive membrane over whole pharynx. Glands of neck + +. Cyanosis. No serum given before admission. Developed palatal paralysis on 9th day. Eye paralysis on 30th day; inter-costal paralysis on 34th day; also right facial palsy, and finally diaphragmatic palsy on 35th day, causing death. 47 days (15) M.W. (F) 11 yrs. 4 Late case. Sloughing membrane over both tonsils—bull neck. Membrane in nostrils. No serum given before admission. Developed signs of heart failure on 2nd day after admission, also epistaxis (severe). The heart failure increased steadily till death. 11 days (16) R.W. (M) 8 yrs. 3 Membrane over both tonsils; left glands + +; signs of morbus cordis on admission; mitral disease. No serum given before admission. The signs of heart failure present on admission increased with vomiting, and restlessness till death on 20th day after admission. 20 days (17) A.W. (M) 7 yrs. 5 Whole pharynx covered with sloughing membrane. Bull neck; purulent rhinorrhoea; colour poor and foetor. No serum given before admission. Showed signs of heart failure on admission; very restless. Heart sounds soft and rapid. Collapsed suddenly on day after admission. 17 days (18) P.W. (F) 7 yrs. 4 Membrane over both tonsils and uvula; cyanosis and some recession. Rales over left lung—broncho pneumonia. No serum given before admission. Owing to increasing restlessness tracheotomy performed soon after admission with relief. Signs persisted over one lung, and increasing heart failure caused death. 3 days 72 The late administration of serum does not exert much influence on the course of the disease. Diphtheria toxin rapidly becomes fixed in the tissues, and when once fixed, anti-toxin has no effect in counteracting its poisonous effects. Only two cases received serum1 before admission. Intramuscular and intra-venous injections of serum were given in doses between 24,000—80,000 units, one case receiving 28,000 units intra-venously. The majority of the fatal cases tabulated above were admitted after the 3rd day of disease, so that the beneficial effect of early administration was not possible. Intra-venous administration of serum, combined with intramuscular injections seems the best method for ensuring rapid absorption into the system. No ill-effects were noticed when this was tried. In seven cases seen late in the disease the combination of intra-venous injection of serum with 20 c.c. sterile 50 per cent. glucose appears to be most satisfactory, as it improves the pulse and general condition. Enteric Fever. Only three cases of Enteric Fever were admitted, compared with eight cases in 1933. In two the diagnosis was confirmed, but one proved a case of simple enteritis. Puerperal Fever Twelve cases of this disease were admitted, as compared with 13 cases during 1933. In two cases the diagnosis was not confirmed. Of the other ten: In two the infection was limited to uterus, vagina and perineum; Seven cases involved the pelvic cellular tissue, ovaries+ +tubes + pelvic veins; One case was a general peritoneal infection with septicaemia, which proved fatal. 73 Erysipelas. There were 46 cases of erysipelas admitted, a decrease of 22 cases on 1933. The disease was of average severity. Two fatal cases occurred, one in an infant when the inflammation became generalised; in the other, a senile case, it was a terminal condition. Measles. There were 61 cases of measles admitted during the year, a decrease of four on 1933. The disease was of average severity, and there were 4 fatal cases due to broncho-pneumonia. Whooping Cough. There were 74 cases of Whooping Couch admitted, an increase of 59 on 1933. The disease was severe in character, and 10 cases proved fatal, owing to broncho-pneumonia. Cerebro-Spinal Meningitis. Three cases of cerebro spinal meningitis occurred during the year, and one proved fatal. In each case the diagnosis was confirmed. Encephalitis Lethargica. One case only was admitted and proved to be cerebro-spinal meningitis: death ensued. Infantile Paralysis (Poliomyelitis). There were two cases of this disease admitted during the year. Dysentery. One case of this disease was admitted, who had previously had dysentry. Ophthalmia Neonatorum. Two cases were admitted, but in only one was the diagnosis on admission confirmed: the other proved to be one of simple ophthalmia. 74 Table XIII. Other Diseases. Deaths ... ... 1 ... 3 4 ... 1 1 10 ... ... ... ... ... ... 20 64 Totals 3 ... 12 ... 46 61 9 1 1 3 71 10 2 2 2 i 16 242 up. F ... ... ... ... 8 1 ... .. ... ... ... ... ... ... ... ... 9 45 Si M ... ... ... ... 19 ... ... ... ... 1 ... ... ... ... ... 20 -45 F ... ... 3 ... 1 ... ... ... ... ... ... ... ... ... ... ... 4 35- M ... ... ... ... 5 1 ... ... ... ... ... ... ... ... ... 6 -35 F ... ... 9 ... 1 ... ... ... ... ... ... ... ••• ... ... ... 10 25- M| ... ... ... 1 ... ... ... 2 ... ... ... ... ... 1 ... 4 -25 F 1 ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... 4 15- M 2 ... ... ... 2 1 ... 1 1 ... ... ... ... ... ... ... 7 -15 F ... ... ... ... 2 6 4 ... ... 1 2 ... 1 1 ... ... 17 30 5- M ... ... ... ... 2 6 1 ... ... 2 2 ... ... ... ... ... 13 -5 F ... ... ... ... 1 6 1 ... ... 16 2 ... 1 ... ... ... 27 132 2- M ... ... ... ... 2 17 2 ... ... 12 2 ... ... 1 ... ... 36 -2 F ... ... ... ... ... 7 ... ... ... 13 ... ... ... ... ... ... 20 1- M ... ... ... ... ... 7 ... ... ... 12 ... ... ... ... ... ... 19 -1 F ... ... ... ... 1 4 ... ... ... 8 ... 2 ... ... ... ... 15 0- M ... ... ... ... ... 5 ... ... ... 10 ... ... - ... ... ... 15 roup Disease Enteric Fever Paratyphoid B Puerperal Fever Puerperal Pyrexia Erysipelas Measles Rubella Encephalitis Lethargica Cerebro-Spinal Meningitis Whoopinp Cough Chick on Pox Ophthalmia Neonatorum Mumps Infantile Palsy Dysentery No disease Totals Table XIV. Out of Borough Cases. Disease. Males. Females. Totals. Deaths. Scarlet Fever 30 36 66 1 Diphtheria 10 12 22 1 Puerperal Fever — 2 2 — Baby with Mother — — 1 — 76 Croydon Borough Hospital Laboratory Report. Table XV. DIPHTHERIA. Swabs examined, including Nose and Throat. Total Convalescent Cases. On Admission. Grand Total. Negative. Positive. Positive. 7,302 310 263 7,875 ENTERIC—WIDAL AGGLUTINATION TEST. — + Total. 2 3 5 AH positives, B. Typhoid, and from 1 case only. F/ECES EXAMINED FOR ENTERIC GROUP. — + Total. 10 — 10 CEREBRO-SPINAL FLUIDS EXAMINED FOR MENINGOCOCCI. — + Total. 0 5 6 Other Examinations. Cerebrospinal Fluids for organisms: 10. Pericardial Fluid (Sterile). Eye Swabs examined for Gonococci : 8 (all negative). One Vaginal Swab examined for Gonococci (negative). Urines examined for organisms: 9. Blood Cultures for organisms: 2 (1 Sterile, 1 Hemolytic Streptococcus grown). Specimens of Lochia cultured for Haemolyitic Streptococcus : 5 (4 gave pure cultures, 1 sterile). Sputum examined1 for T.B. : 1 (negative). Pus cultured for organisms: 3 (Haemolytic Streptococcus grown from each specimen). Culture Media. Loffler's Blood Serum 656 doz. tubes Agar Agar 3,000cc Peptone Broth ... 3,480cc Gelatine ... 150cc Peptone Water ... 750cc Litmus Milk 500cc <v OS C/3 0 c 3* "-1 Ofq B) » 5? 3 - W 2 3 t> ~ S- o ® 5 s 31 O- W <7q S 2 8 ~ b CTQ re £ H ° g 03 > 3 2 r 5' § -to h |W » -A g o g ■o " 2 0> 3" 58 5 2. > S* o H dcfq <-* ~ s 2 p: - !? CT" Ol 5* O • in p 1 X < For private piactitioners Mayday Hos. For Borough Hospital For Tab. Dispemary For School Medical Other Instns. of Corporation Other Institutions Total X pf. sr ® r & cr o 3 ct* O <3 o 3 g- H 3 £ o 5 CP s> X 3 < — M a' o CO 13 £L Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg Pos. Neg. Pos. Neg. Pos. Neg Swabs for Diphtheria 263 1851 20 797 198 5309 14 271 495 8228 Virulence tests for Diphtheria 4 1 1 1 1 15 1 ... 2 1 23 4 Sputum for Tub Bac. 117 570 276 299 ... 271 406 1 17 68 681 1344 Pus for Tub. Bac. 6 18 564 1 1 3 69 4 21 645 Pus for Gonococci 23 53 4 33 27 86 Pus for other organisms 7 622 2 1 75 2 709 Blood for Typhoid Groups ... 19 1 6 ... ... 7 1 32 Blood for Wasserrnann 1 3 23 164 ... ... 1 3 24 171 Material for Spirochaetes ... Faeces for Typhoid Group .. 4 2 26 1 " 2 31 Hair for Ringworm ... 3 2 ... 1 1 5 Examination of Urine 2 330 1 1 64 2 400 Examination of Pleural Fluid 2 28 6 36 Examination of C,S, Fluici ... 36 36 Other Examinations ... 10 642 4 27 683 77 Examinations Done Under National Health Insurance Act. Table XVII. Nature of Examination. Nature of Examination. Pus for Gonococci 8 (2 pos.) Urine for Chemical Exam. 1 Pus for other organisms 5 Urine for Microscopical Exam. 1 Pus for Tubercle B. 3 Urine for Tubercle B 1 Blood for Wasserman 12 (7 pos.) Urine for Cultural Exam. 1 Complete Blood counts 5 Other Examinations 7 Bacteriological Examination of Milk. Table XXIX. Number of Samples submitted for Counts 469 Number under 10,000 per cc 181 No. over 10,000 but under 50,000 per cc 120 Over 50,000 but under 100,000 per cc 46 Over 100,000 but under 500,000 per cc 75 Over 500,000 but under 1,000,000 per cc 14 Over 1,000,000 per cc 27 Bacillus Coli Content— Not found in 0.1 cc 205 ,, „ 0.01 cc 99 „ „ 0.001 cc 72 Present in 0.001 cc 93 Higher dilutions not made. Tubercle Bacilli— Number of samples of milk submitted 469 Number found positive by inoculation test 9 VACCINATION ACTS. I am indebted to Mr. Huggins, the Vaccination Officer, for the particulars in the returns in subjoined Tables. Table XVIII. Registration Sub-Districts in V.O. District. Births Registered. Vaccinated. Insusceptible Statutory Declarations Died Un. vaccinated. P.P.O. Transferred tootherV.Os. Not traced Removals. In Default. Overage when Registered. South Sub-District 1134 443 5 467 36 25 54 33 70 1 West 1435 396 2 760 55 21 8 83 109 1 North 781 267 11 367 27 5 9 25 69 1 3350 1106 18 1594 118 51 71 141 248 3 78 During the year 2,282. Forms Q were sent to parents, and 525 Forms K and 75 Forms K "Final Notices." Form Q is the form drawing attention to the requirements of the Vaccination Acts and Form K refers to cases in default. 859 names were sent on the H lists to Public Vaccinators to be visited. Return showing the Numbers of Persons vaccinated and re-vaccinated at the cost of the Rates by the Medical Officer of the Public Assistance Institutions and the Public Vaccinators during the year ended 30th September, 1934:— Table XIX. Name of Public Assistance Institution or Vaccination District. Numbers of successful Primary Vaccinations of persons. No. successful revaccinations, i.e., successful vaccinations of persons who had been successfully vaccinated at some previous time. Under 1 year of age. 1 year and upwards. Total. Crovdon No. 1 Area 130 13 143 3 No. 2 Area 115 13 128 2 No. 3 Area 68 3 71 4 No. 4 Area 116 19 135 4 No. 5 Area 216 19 235 5 Addington 10 1 11 — Oueen's Road Homes — — - — Maydav Road Hospital — 1 1 — Children's Homes — — — — Shirley Schools - - - - 655 69 724 18 79 SECTION V. PREVENTION AND CONTROL. OF TUBERCULOSIS. The Tuberculosis Clinic is situated at 13, Katharine Street. The premises are not suitable, being cramped and noisy. Sessions are held daily in the mornings and afternoons except on Monday mornings and Thursday afternoons. An evening session is held on Tuesdays. The Clinic is primarily a diagnostic and advisory centre. To it come patients sent by doctors, cases under observation and cases under treatment at home. From it patients are drafted to various Sanatoria and Hospitals or back to their private practitioner. I am indebted to Dr. J. C. McMillan, the Assistant Medical Officer of Health for Tuberculosis, for the greater part of this section of the report. An efficient Clinic dealing with Tuberculosis should have an X-ray plant on the premises. Although the facilities for obtaining X-ray reports and films are good, the medical officer in charge of the Clinic loses the great advantage of making his own screen observations and taking his X-rays. The patients also are put to some inconvenience by the present arrangements. For the carrying out of Collapse Therapy X-ray control is absolutely essential, consequently the Clinic is unable to undertake artificial Pneumothorax refills. As this treatment is being used at the Cheam Sanatorium it would be advantageous to the patients if they could, on their discharge from the Sanatorium, obtain necessary refills in Croydon, instead of, as at present, having to go up to London or to Cheam. Notification of Tuberculosis. Two hundred and ten cases of Pulmonary Tuberculosis and 38 of Non-Pulmonary Tuberculosis were notified on Form A (primary notifications), of these 113 males and 97 females were Pulmonary cases, 14 males and 24 females Non-Pulmonary. In addition 60 Pulmonary cases and 17 Non-Pulmonary came to our notice as new cases otherwise than by notification. 80 Notification in Previous Years. Table I. Pulmonary NonPulmonary 1926 244 140 1927 231 97 1928 314 75 1929 250 68 1930 262 54 1931 282 48 1932 254 50 1933 233 33 1934 210 38 The total number of new cases of tuberculosis coming to the knowledge of the Medical Officer of Health during 1934 by notification or otherwise, was 325, as compared with 346 in 1933, 369 in 1932, 412 in 1931, 387 in 1930, 390 in 1929 and 449 in 1928. 270 of these cases were Pulmonary Tuberculosis. 141 in males and 129 in females. There were 4 more cases of Pulmonary Tuberculosis in males, and 30 fewer in females than in 1933. There were 21 cases of Non-Pulmonary Tuberculosis among children under 15 years as compared with 25 in 1933. The number of cases in adults was 34 as compared with 25 in 1933. Of the cases notified in 1934, 27 males and 16 females died from the Pulmonary form of the disease during the year, equal to 20.4% of those notified, and 3 males and 1 female from the NonPulmonary. The incidence rate of Tuberculosis of all forms was 1.35% per 1,000 of the population; for Pulmonary Tuberculosis 1.12 and for Non-Pulmonary 0.23 per 1,000 population. The Notification rate was 1.03 per 1,000. 81 Public Health (Tuberculosis) Regulations 1930. Summary of Notifications during the period from the 1st January, 1934, to the 31st December, 1934:— Table II. Age periods Notifications on Form A. No. of Primary Notifications of new cases of tuberculosis. Total Notifications on Form A, 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total (all ages) Pulmonary Males ... ... 2 5 18 14 25 19 19 9 2 113 125 ,, Females ... 1 3 6 22 15 23 16 5 6 ... 97 115 Non-pulmonary Males ... 6 1 1 1 2 2 ... 1 ... ... 14 17 ,, ,, Females 1 1 2 2 7 6 2 1 1 ... 1 24 27 Table III. New cases of Tuberculosis corning to the knowledge of the Medical Officer of Health during the period from the 1st January, 1934, to the 31st December, 1934, otherwise than by formal notification. Age periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Cases Pulmonary Males ... ... ... ... ... 4 8 5 8 i 2 28 Females ... ... ... ... 1 4 11 5 5 3 2 32 Non-Pulmonary Males ... 1 ... 3 2 1 ... 1 1 ... ... 9 Females ... 1 1 1 2 1 1 ... ... 1 ... 8 The source or sources from which information as to the abovementioned cases was obtained are shown below.— Source of Information. No. of Cases. Pulmonary. NonPulmonary. Death Returns from local Registrars 12 4 Transferable Deaths from Registrar General 2 3 Transfers "from other areas (other than transferable deaths) 40 9 Posthumous notifications 1 1 Other Sources-Form I 5 ... 82 Notification Register. Number of cases of Tuberculosis remaining on the Notification register on the 31st December, 1934:— Table IV. pulmonary NON-PULMONARY Total Cases Males Females Total Males Females Total 603 510 1,113 135 149 284 1, 397 Number of cases removed from the Registers during the yea and the reasons for such removal. Pulmonary. Non-Pulmonary. Total Cases. Males. Females. Total. Males. Females. Total. 1. Withdrawal of Notification 5 15 20 3 3 6 26 2. Recovery from the Disease 6 25 31 18 14 32 63 3. Death 85 71 156 9 6 15 171 The periodic medical examination of the whole population, as is now applied to public Elementary School children would, in the case of this one disease alone, probably be an economic asset. In 26.4% notification preceded death by less than six months. For Non-pulmonary Tuberculosis the proportion of non-notified fatal cases to the total deaths from this form of the disease was 61.5%. In other words, out of a total of 13 deaths, 8 were not notified during life; only 1 of these 8 cases died at home. The other 7 cases died in Hospital. Of the total deaths from Tuberculosis of all forms, 22 or 14.01%, were not notified prior to death, compared with 12.5% in 1933. Interval Between Notification and Death From Pulmonary Tuberculosis in Cases Dying in 1934. The following Table shows the intervals of time elapsing between the date of notification of a patient as suffering from Pulmonary Tuberculosis and the date of his death from that complaint. In the total of 144 deaths during 1934, 32 (22.2%) were either not notified at all or only notified within a month prior to 83 death. In 1933 this figure was 29 or 17.9%. Of these, 14 were not notified during life; 4 of whom were cases of fulminating or complicated cases of Tuberculosis; and 4 cases were certified by the Coroner. The success of a Tuberculosis Scheme may be judged on the number of persons dying from Tuberculosis without having been notified, or only notified shortly before death. The Croydon figure is a fairly satisfactory one but it can be improved upon. In a certain number of predisposed persons periodic medical examination might lead to apprehension. The early detection of disease is, nevertheless, of paramount importance. Table V. Not Notified Under 1 week 1-2 weeks 2-4 weeks 1-2 months 2 3 months 3-6 months 6-12 months 14 4 5 9 6 6 8 13 . One Year Two Years Three Years Four Years Five Year Six Years Seven Years Eight years and over 18 14 15 5 8 4 4 11 Ages at Death from Pulmonary Tuberculosis. Table VI. Year. 0—5 5—15 15—25 25—45 45—65 Over 65 Total 1924 ... 2 40 66 36 5 149 1925 ... 4 30 60 44 10 148 1926 ... ... 34 81 45 9 169 1927 1 1 39 76 41 7 165 1928 2 1 38 79 37 10 167 1929 3 2 41 76 41 7 170 1930 1 3 40 57 45 8 154 1931 6 1 33 65 41 9 155 1932 1 1 39 65 32 6 144 1933 ... 1 34 82 41 4 162 1934 1 1 28 69 40 5 144 84 The most fatal period is between 25 and 45 years; under 15, Pulmonary Tuberculosis is not a prominent cause of death, its fatality is greatest during the most productive and active periods of life, and herein lies much of its social and economic importance. The total deaths from Pulmonary Tuberculosis remain very steady, but as the population is steadily increasing the death-rate is consequently slowly decreasing. In 1934 the death-rate from all forms of Tuberculosis was 0.65 per 1,000 population. ,, ,, Pulmonary Tuberculosis 0.6 ,, ,, ,, Non-Pulmonary Tuberculosis 0.05 ,, Similar figures for 1933 were 0.77; 0.68 and 0.09. Deaths from Non-Pulmonary Tuberculosis. During 1934, 13 deaths were certified to be due to Non-Pulmonary Tuberculosis, compared with 22 in 1933; 22 in 1932; 19 in 1931; 21 in 1930; 29 in 1929; 39 in 1928; 38 in 1927; 39 in 1926; 33 in 1925; and 33 in 1924. The deaths were due to:— Males Females Total Tuberculous Meningitis 3 2 5 Tb. Peritonitis 1 — 1 Tb. Kidneys, Bladder and Spine 1 — 1 Tb. Intestines — 1 1 Tb. Spine 1 — 1 Miliary and General Tb. 3 — 3 Tb. Hip and Knee — 1 1 9 4 13 Table VII. shows the incidence rate and death rate of all forms of Tuberculosis for the various wards of the Borough, based on ward populations calculated from a total population of 240,600. The death rate for the whole Borough was 0.65. 85 Table VII. The following were the Wards from which new patients came:— Ward. Density of Population persons per acre. Pulmonary Non-Pulmonary Total Incidence Rate per 1000 Death Kate per 1000 Upper Norwood 20.2 29 1 30 1.3 0.36 Norbury 29.5 23 5 28 1.7 1.00 West Thornton 42.3 21 4 25 1.2 0.55 Bensham Manor 49.9 18 1 19 1.1 0.62 Thornton Heath 50.6 15 3 18 1.1 0.77 South Norwood 28.9 18 3 21 1.2 0.38 Woodside 36.8 16 2 18 1.1 0.70 East 9.7 16 3 19 1.0 0.06 Adtliscombe 48.9 16 6 22 1.5 0.62 Whitehorse Manor 63.1 19 6 25 1.5 0.83 Broad Green 69.1 25 5 30 1,9 0.84 Central 33.4 9 4 13 1.0 0.65 Waddon 22.3 32 7 39 1.8 1.19 South 12.6 9 4 13 0.9 0.74 Addington 0.8 1 1 2 0.7 0.35 No fixed abode ... 3 ... 3 ... ... 270 55 325 1.35 0.65 The Wards showing the highest incidence of new patients in 1934 were: Broad Green (1.9), and Waddon (1.8). The highest death-rates were in Waddon (1.19) and Norbury (1.00). With the relatively small figures available, these rates are subject to wide annual variations. 86 Table VIII. TUBERCULOSIS. (Summary of Notifications and Deaths at various age periods). Age periods. 1934 Population at age period, (estimated) Pulmonary, Non-Pulmonary. New Cases. All Cases. New Cases. All Cases. Number. Incidence Rate. Deaths. Death Kate (based on 1934 figures). Number. Incidence Rate. Deaths. Death Kate (based on 1934 est. figs.) M F M F M F M F M F M F M F M F M F Under one year 2131 1957 ... 1 ... 0.51 ... 1 ... 0.51 ... 1 ... 0.51 ... ... ... ... 1—5 years 6900 7264 ... 1 ... 0.13 ... ... ... ... 7 2 1.01 0.27 2 2 0.29 0.27 5—10 „ 11276 10376 2 3 0.18 0.29 ... ... ... ... 1 3 0.09 0.29 1 ... 0 09 ... 10—15 11932 11358 5 6 0 42 0.53 ... 1 ... 0.08 4 3 0.34 0.26 2 1 0.17 0.08 15—20 „ 9816 10592 18 23 1.83 2.17 2 7 0.20 0.66 3 9 0.30 0.85 1 ... 0.10 ... 20—25 „ 7618 9859 18 19 2.36 1.92 9 10 1.18 1.01 3 7 0.39 0.71 ... ... ... ... 25—35 „ 15576 20508 33 34 2.12 1.66 17 20 1.09 0.79 2 3 0.13 0.14 1 1 0.65 0.05 35—45 „ 17351 21142 24 21 1.38 0.91 20 12 1.15 0.56 1 1 0.05 0.05 1 ... 0.05 ... 45-55 „ 13854 15905 27 10 1.95 0 63 17 3 1.22 0.31 2 1 0.14 0.06 1 ... 0.07 ... 55—65 „ 8264 10088 10 9 1.21 0.89 13 7 1.57 0.69 ... 1 ... 0.10 ... ... ... ... 65 and upwards 6315 10518 4 2 0.63 0.19 3 2 0.47 0.19 ... 1 ... 0.09 ... ... ... ... Totals 111033 129567 141 129 1.27 0.99 81 63 0.73 0.48 23 32 021 0.25 9 4 0.08 0.03 In the above table the death rate is based upon the total deaths in 1934, and not on deaths in New Cases only. 87 Pulmonary Tuberculosis. In 1934 there were fewer deaths from Pulmonary Tuberculosis up to the 55th year of life than in 1933. The age group 25—30 had the greatest number of deaths, greater in fact that in any other age group. From the 30th year onwards there was a gradual fall in the number of deaths, but showing two fairly definite but smaller peaks, one in the 40—45 age group and the other in the 55—65 age group. With regard to the sexes, in both sexes the highest peak was reached in the 25—30 age group. After the 40th year the male deaths exceed those in females. This is probably connected with the fact that women lead a more sheltered existence than men in the later years of life. The number of new cases of Pulmonary Tuberculosis in 1934 was greatest in the age group 15—25 years, as in 1933, but only amounted to 71.5% of the number in this age group in 1933. In the age group 25—35 the number slightly exceeds those for 1933. The greater proportion of new cases of pulmonary tuberculosis were in the age groups comprising 20 to 35 years. In the age groups 15 to 35 years there was a greater number of new cases among women but after 35 years there was a greater number in men. There is a close similarity between the age distribution of new cases and of deaths from Pulmonary Tuberculosis. This year the peak of new cases was in the 25—35 age group. The figures indicate that Pulmonary Tuberculosis is a rare disease in the first ten years of life. Non-Pulmonary Tuberculosis. Non-pulmonary Tuberculosis shows its highest incidence under the 20th year of life; the greatest number of cases occurring in the 15-20 years group. 38.4% of the deaths occurred under the of 10 years compared with 50% in 1933. 88 Table IX. The diagnosis of the new cases entered in Notification Register during 1934 were as follows:— Male. Female. Spine - 3 Spine, Glands and Abdomen — 1 Left Lower Jaw 1 — Left Elbow 1 — Sternum, Right Thigh and Left Knee. — 1 Rib 1 — Right Sacro-iliac Joint — 1 Hip 4 1 Left Thigh — 1 Right Knee — 2 Prepatella Bursa — 1 Tibia and Ankle 1 — Abdomen 1 1 Intestines — 1 Peritoneum 2 2 Mesenteric Glands — 2 Salpingitis — 1 Epididymis 1 — Meninges 4 2 Kidney, Bladder and Spine 1 — Miliary 1 — Glands 5 12 23 32 CLASSIFICATION OF NEW PATIENTS. Pulmonary Tuberculosis. During 1934, 190 new patients were examined at the Clinic and were found to be in the undermentioned stages of the disease on the first examination:— T.B. minus (sputum negative or absent) 64 or 34.4% T.B. plus 1 (early cases, sputum positive) 10 or 5.4% T.B. plus 2 (intermediate cases, sputum positive) 72 or 38.7% T.B plus 3 (advanced cases, sputum positive) 40 or 21.5% 186 or 100.0% 89 It is well known that Tuberculosis officers do not see many of the new cases in the early stages of the disease. The trouble about early diagnosis is that the disease can hardly ever be detected until it has begun to produce symptoms and not always with certainty even then. The insidious onset of Pulmonary Tuberculosis and the fact that often considerable damage to the lungs is present before any definite symptoms develop makes it very difficult to detect it in its early stages. In the majority of cases, once symptoms have developed, the disease cannot be regarded as in an early stage. The initiative to seek treatment when ill rests with the patient himself, and the remedy partly lies in the education of the public as to the symptoms and common dangers of Tuberculosis and the need for securing early treatment. It is unfortunate that 60.2% of the new cases were more or less advanced in the disease. Non-Pulmonary Tuberculosis. There were 28 cases examined at the Clinic and found to have Non-pulmonary Tuberculosis in the following forms:— Bones and Joints 14 Abdominal 3 Other Organs 1 Peripheral Glands 10 28 Tables XVII. and XVIII. summarise the condition of all patients whose records are at the Clinic at the end of 1934. These tables show that of patients who came under treatment for Pulmonary Tuberculosis before 1926, 386 adults and 106 children have been discharged as recovered. Of these all but 15 were early cases. Of the 1926 cases, 22 adults, of the 1927 cases 23 adults and 2 children, and of the 1928 cases 20 adults, have recovered. Of patients who first attended in 1934, 10 have been lost sight or otherwise removed from the Clinic Register. Of the 1933 cases 33 were lost sight of. Of patients who attended prior to 1926, 249 adults and 14 children are known to have died; since 1926, 792 adults and 16 children are known to have died. Of patients attending for the first time in 1934 37 have died. 90 It will be seen that in the years 1926 to 1934 there have only been 48 cases of Pulmonary Tuberculosis in children—14 of these had a positive sputum, and of the latter only 2 are alive. It is fortunate that such cases are very rare as remarkably few ever recover. In sufferers from Non-pulmonary Tuberculosis who first attended prior to 1926, 43 adults and 562 children have been discharged as recovered, and of those first attending in 1926 and following years, 26 adults and 127 children. 13 adults and 9 children died in the pre-1926 class; 30 adults and 17 children died in the 1926 and following years group. One adult and one child attending for the first time in 1934 died during the year. The contrast in the numbers recovered, arrested and died, as also the different incidence in adults and children, as between the Pulmonary and Non-pulmonary types of the disease, is most marked. Co-ordination with Medical Practitioners, and Other Branches of the Health Department. During the year 184 cases of suspected Tuberculosis were referred by private medical practitioners for the Tuberculosis Officer's opinion; 58 were diagnosed as suffering from Tuberculosis and were subsequently notified. In addition, 51 children were referred by the School Medical Service, and 23 cases from the Maternity and Child Welfare section of the Public Health Department. 84.2% of all notified cases were sent for examination to the Clinic or were seen at the request of the medical attendant at the patient's home, as compared with 79.3% in 1933, 78.9% in 1932, 81.2% in 1931 and 72.7% in 1930. The number of reports sent in by Insurance medical practitioners on their domiciliary cases (Form G.P. 36) was 558. This is a duty laid on all Medical men accepting service under the 'National Health Insurnnce Act. Pregnancy and Tuberculosis. Women suffering from Pulmonary Tuberculosis who become pregnant are referred to the Assistant Medical Officer of Health 91 for Obstetrics and recommended for admission to the Mayday Hospital under his care. After their confinement these patients are transferred to a sanatorium to the mutual benefit of the mother and baby. If interference with the course of pregnancy is not considered necessary or advisable and the patient requires sanatorium treatment this is arranged for a period prior to admission to the Hospital. The Clinic Register of Cases. The number of cases of tuberculosis under the supervision of the Clinic at the end of the year was 904. This is equivalent to 3.75 persons per 1,000 of the population. The Clinic Register has been revised yearly during the past seven years, so as to make it a correct record of the cases in the Borough who are under the supervision of the Clinic. This has necessitated a lot of work in following up old cases, some of whom had not been seen for a number of years. By this yearly revision the Eegister is kept a "live" one. During the year 124 Clinic cases died; of this number, 39 or 31.4% were seen for the first time in 1934. Examination of Sputum. This is done by the Council's Bacteriologist in the Laboratory at the Croydon General Hospital. The results of examinations made in 1934 are as follows:— For Clinic For General Practitioners. For Mayday Hospital. Totals. Positive (i.e., tubercle bacilli present) 264 138 273 675 Negative (i.e., tubercle bacilli absent) 392 647 301 1,340 Total 656 785 574 2,015 For each 100 new cases and contacts examined at the 'nic 80 specimens of sputum were examined. 92 The 785 examinations include a number from the Croydon General Hospital, in addition to those sent in by General Practitioners. 1934, however, shows a slight increase in the number of examinations of sputa made for General Practitioners. It is difficult to understand why this simple test is not always made in any doubtful chest condition. Too much reliance should not be placed upon one negative sputum examination. In any case in which it is considered advisable to have the sputum examined, at least three specimens should be submitted if the result is returned as negative. X-ray Work. A greater number of doubtful and difficult cases were sent for radiological examinations than in previous years. Each year this specialised examination is being increasingly used. By this means the number of beds necessary for the observation of such cases has been reduced and cases of Bronclnectasis, Pulmonary tumour, etc., were discovered which otherwise would have been classed as suffering from Pulmonary Tuberculosis. Without a good X-ray plate, properly interpreted, suspected tuberculosis can never be ruled out. Ordinary physical examination can find tuberculosis, but it cannot, except rarely, find early tuberculosis. It cannot demonstrate pathological changes and cannot follow accurately the progress of disease or of healing. X-ray plates, however, must be well made and accurately interpreted or they become a source of diagnostic errors. 331 X-Ray examinations were made during the year, an increase of 73 over 1933. This is equivalent to 40.4 for every 100 new cases and contacts seen, and compares with a rate of 30.4 for every 100 new cases and contacts seen in 1933, and 22.6 for every 100 new cases and contacts seen in 1932. In addition a certain number of cases who have already been examined at various Hospitals are referred to the Clinic. There were also a number of new cases examined in Mayday Hospital whose X-Ray examinations are not counted. Extra Nourishment. Provision of special nourishment in the form of milk was granted to a number of selected cases for varying periods. 93 Sleeping Shelters. The loan of such shelters is made to suitable cases. That is, to patients in an infectious condition or on account of overcrowding, hut frequently one finds there is no available space for a shelter in the garden or yard attached to the patient's house. Lack of privacy sometimes is also an obstacle. When convenient to be used they form a useful continuation of Sanatorium practice for a conscientious patient. INSTITUTIONAL TREATMENT. Table X. Cases of Pulmonary Tuberculosis Treated in Institutions, 1935. In at beginning of 1934 Admitted during 1934 Discharged during 1934 Died during 1934 In at end of 1934 Adults Adults Adults Adults Adults m F C m F C m F C m F C m F C Croy. Boro' San., Cheam 43 34 ... 80 70 ... 69 68 ... 10 7 ... 44 29 ... Mayday Hospital 17 9 ... 46 46 8 24 31 7 27 15 ... 12 9 1 Grosvenor 1 ... ... 3 4 ... 3 1 ... ... ... ... 1 3 ... Burrow Hill Colony ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Brompton 3 3 1 16 8 ... 11 7 1 ... ... ... 7 4 ... Papworth 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... East Anglian San. ... ... 1 ... ... 3 ... ... 2 ... ... ... ... ... 2 R.N.H.C., Ventnor ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... National Temperance Hospital ... ... ... 1 1 ... 1 1 ... ... ... ... ... ... ... Midhurst ... ... ... ... 2 ... ... 1 ... ... ... ... ... 1 ... Prior Place 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Surrey County San. ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 66 46 2 146 133 12 109 110 10 38 22 ... 65 47 4 This Table shows that, compared with last year, one more patient was admitted during the year and two more cases remained in institutions at the end of the year. 94 Table XI. Cases of Non-Pulmonary Tuberculosis Treated in Institutions, 1934. In on 1st Jan., 1934 Admitted during 1934 Discharged during 1934 Died during 1934 In on 31stDec., 1934 Adults Adults Adults Adults Adults M F c M F C M F c M F c M F c Mayday Hospital 1 2 1 1 7 2 1 4 2 ... ... ... 1 5 1 Royal Sea Bathing Hosp. 6 1 ... 3 3 1 4 ... ... ... ... ... 5 4 1 St. Anthony's Hosp. 1 ... ... 1 ... ... 2 ... ... ... ... ... ... ... ... St. Nicholas Hosp. ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 2 Tait Convalescent Home ... ... ... ... 5 ... ... 2 ... ... ... ... ... 3 ... Treloar Cripples' Hosp ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... King George's San. 2 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... Croydon General Hosp. ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... Pyrford ... ... 10 ... ... 4 ... ... 4 ... ... 1 ... ... 1 Heatherwood Hospital ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Heritage Craft School ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 Royal National dic Hospital ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Victoria Home, Margate ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... Leatherhead Cripples' Col. ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 10 4 14 5 16 11 8 7 7 ... ... 1 7 13 17 The Immediate Results of Institutional Treatment. Table XVI. Form T. 145 (G) of the Ministry of Health summarises the immediate results of treatment of patients discharged from institutions during the year. From this table it is seen that among the Pulmonary cases 25.1% were classified as early cases; the percentage of early cases receiving treatment in institutions was in women, 11.0%; in men, 12.5%; 51.3% of the total cases were intermediate cases, the females showing an excess in this group—24.0% males to 26.7% females—and 23.5% were definitely advanced. Of the total Pulmonary cases treated in Institutions 79% were potentially infectious. 99 males, 87 females and 5 children, suffering for Pulmonary Tuberculosis, were discharged from or died in Institutions in connection with the Croydon Scheme during 1934. 95 Types of Cases Treated. In Class T.B. Minus, 7 males, 8 females and 3 children were discharged with the disease in a quiescent condition, i.e., 45% of the total cases in this class; 6 males and 12 females were not in a quiescent condition, 45% ; 3 males and 1 female died, 10%. In Class T.B. Plus, Group I., the corresponding figures were 5 males quiescent, 62.5% ; 3 males were not quiescent, 37.5%; there were no deaths in, this group. In Class T.B. Plus, Group II., 6 males and 7 females quiescent, 13.2%; 35 males, 38 females, and 1 child not quiescent, 75.5%; and 5 males and 6 females died, 11.2%. In Class T.B. Plus, Group III., or advanced group, no cases were discharged quiescent; 17 males, 8 females, and 1 ohild not quiescent, 57.7%; and 12 males and 7 females died, 42.2%. Taking all groups together, 18.8% of cases were discharged as quiescent; 63.3% as not quiescent; and 17.8% died. An increase is recorded in the percentage of infectious cases, mostly advanced cases, dying in institutions. From the public health point of view this is to be desired as it keeps these patients away from their homes at a time when they are most infectious and most dangerous to those with whom they would normally come into contact. This factor, in conjunction with the removal of the strain and worry of nursing these cases at home, should help to reduce the incidence of new cases among the contacts. Non-Pulmonary Tuberculosis.—17 patients were discharged during the year, and 64.7% of these were quiescent. In addition one child died in an institution. Tuberculosis deaths in Cheam Sanatorium and Mayday Hospital during 1934, according to sex and stage of the disease:- Classification. CHEAM. MAYDAY. Males. Females. Males. Females. T.B. minus 1 1 2 - T.B. plus 1 Nil T.B. plus 2 3 3 5 4 T.B. plus 3 6 3 20 11 Total 10 7 27 15 96 General Observations on the Results of Treatment. The greatest factors making for success are patience on the part of the sufferer and helpful optimism on the part of his medical adviser. All who are unfortunately attacked sufficiently severely to cause symptoms should reconcile themselves to the fact that for the rest of their lives they will have to be circumspect. No Tuberculous person, able to work, should lead a life of idleness, but the occupation must be governed by the medical needs. The greater number of Tubercular persons are unable to compete on equal footing with healthy persons. If this is remembered and the principle of subsidization of these patients was accepted, they could be made productive units of industry, with benefit to themselves and the community. Subsidization of blind persons has been universally approved, and it is difficult to understand the non-recognition of the principle in another class of handicapped persons. Sickness benefit under the National Health Insurance Act could serve as subsidy for tubercular persons and, in those medically certified as fit to do work of some kind, should be given conditionally on the patient endeavouring to do suitable work. It is gradually becoming recognised that Sanatorium treatment of Pulmonary Tuberculosis requires to be supplemented by other methods of treatment. Eventually it will probably be necessary to have a Surgeon who has specialised in thoracic surgery as a Consultant on the staff of every sanatorium. The Tuberculosis Officer paid 57 visits to Mayday Hospital, in a consultative capacity, and there examined 168 patients. The Tuberculosis Clinic and Home Visiting. The subjoined table gives a summary of the work done in connection with the Clinic. 496 new cases were examined during the year; this is equal to 315.9 for each 100 deaths from the disease. 201, or 128 for each 100 deaths, were found to be definitely tuberculous. The contacts of definite cases are urged to attend the Clinic for examination (and subsequent supervision). This is an important preventive measure. During the year 323 contacts were examined, equal to 205 for each 100 deaths, compared with 383 in 1933, or 208 per 100 deaths. Of these, 8 were considered to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 24.7, compared with 1.35 per 1,000 of the general population. In 201 adult contacts examined the tuberculosis rate 97 per 1,000 contacts was 34.8 Included in the 8 contacts found to be tuberculous is 1 who had been under observation from previous years. The total number of attendances at the Clinic was 5,120. The Tuberculosis Officer paid 228 home visits, and the District Health Visitors 3,127 visits for Clinic purposes. In addition, the Health Visitors made 275 primary visits for the purpose of the Notification Register. Patients requiring home nursing or surgical dressings are attended to by nurses from the Croydon Nursing Service, by arrangement with that organisation, and 475 such visits were made during the year. Contact Examination. The value of an isolated examination is to detect a carrier, possibly some elderly member of the household who is supposed to have chronic bronchitis. This is prevention. The second object of contact examination is the cure of the individual by detecting the disease in its early stages. For this purpose an isolated examination is not sufficient, and frequent re-examinations are necessary, as the onset of tuberculosis is often insidious. It is advisable to get a complete examination of all contacts and not only those who have developed symptoms. If the individual continues to live in contact with the patient, repeated examinations with radiography seem to be necessary if the supervision is to have any value at all. 761 appointments for examination were offered to new contacts during 1934, but only 323 new contacts attended and were examined. SUMMARY OF CLINIC STATISTICS FOR 1935. No. of persons on Clinic Register, January 1st, 1934 963 „ Notified Cases examined for the first time 77 „ Cases sent for an opinion 292 „ First attendances, including 46 transfers in 865 „ Consultations of T.O. with private practitioners 32 „ Visits paid by T.O. to homes of patients 228 „ Visits paid by T.O. to Cheam Sanatorium 6 „ Visits paid by T.O. to Mayday Hospital 57 „ Patients examined by T.O. at Mayday Hospital 168 „ Visits paid to homes of patients by Health Visitors and Nurses 3,877 „ Attendances of patients at the Clinic- Men 1,647 Women 2,240 Children 1,233 Total 5,120 98 No. of patients under Domiciliary Treatment at end of year— Pulmonary 204 Non-Pulmonary 5 Total 209 No. of reports received from Panel Practitioners (G.P.36) 558 ,, Report forms sent to Panel Practitioners (G.P.36) 803 ,, Reports received from Panel Practitioners on Forms G.P.17 and 35 1 ,, X-rays taken 331 ,, Reports made to Ministry of Pensions by the T.O. on general progress of Tuberculous Discharged Ex-Service men 17 ,, Cases referred for "Light" Treatment 5 ,, Cases referred to Orthopaedic Clinic 10 ,, Cases receiving extra nourishment at end of year 48 Housing Statistics of Patients. Table XII. Patients occupying a separate bedroom. Patients occupying a separate lied but not a separate bedroom. Patients not occupying a separate bed. Totals Number of Pulmonary cases: Under 15 years 20 3 2 25 15 years and over 462 101 325 888 482 104 327 913 Number of Non-Pulmonary eases: Under 15 years 49 24 40 113 15 years and over 33 31 23 87 82 55 63 200 Totals 564 159 390 1,113 The above table gives a summary of the housing conditions found in notified cases. It is seen that 52.7% of the pulmonary cases and 41% of the non-pulmonary cases wen? occupying a separate bedroom. In 35.8% of the pulmonary and 31.5% of the non-pulmonary the sleeping arrangements were not satisfactory inasmuch as the patient did not have a separate bed. No specialised provision has as yet been made by the Council to deal with Tubercular persons living under overcrowded or other unsuitable conditions. The matter is, however, to be considered in the near future. 99 PULMONARY TUBERCULOSIS Table XIII. Shewing the Condition at the end of 1934 of cases discharged from Sanatoria during the years indicated. 1930. 1931. 1932. 1933. 1934. Totals. t.b. t.b. + t.b. t.b. + t.b. t.b. + t.b. T.b. + t.b. t.b. + T.b. t.b. + Dead 5 77=72.6% 4 69= 52.3% 2 56= 44.8% 2 29=32.9% 17=14.4% 13 248= 43.6% 63.6% 46.3% 37.7% 24.6% 11.3% 36.5% Working or Fit for Work 18 15=14.2% 18 30=22.7% 27 36=28.8% 29 31=35.2% 26 39 =33.9% 118 151 = 26.5% 25.6% 30.8% 40.9% 47.6% 43. % 37.6% Not able to Work ... 14=13.2% 2 33= 25.0% ... 33=26.4% 7 28=31.8% 6 62 = 52.5% 15 170=29.9% 10.8% 22.4% 21.4% 27.8% 45.3% 28.9% Left District 9 23 12 14 10 23 10 19 2 1 43 80 32 129 36 146 39 148 48 107 34 119 189 649 100 Of the cases whose records are at the Clinic, it will be seen that of the total number that received sanatorium treatment during the past five years only 37.6% are working or fit for work. The remainder are dead or too ill to work. In those cases with a positive sputum, i.e., those in whom tubercle bacilli have been found in the sputum, only 26.5%, or just over a quarter, are working or fit for work. 649, or 77.4% of the total cases discharged, were T.B. + cases; 123, or 14.7% of the total cases discharged, have removed from the Borough, and as we have no information about their condiition at the end of 1934, they have been ignored in working out the above percentages. From consideration of the above Table and similar reports that have been obtained in previous years, it would appear that the time is not far distant when it might be advisable for another Royal Commission to be held, to assess the value of present Tuberculosis schemes and also to consider whether any alterations could be made which would lead to greater success. Tuberculosis Care Committee Report. During the year 1934 more use than formerly was made of the facilities afforded by the Tuberculosis Care Committee. Assistance and advice are particularly valuable at early stages of disability, for not only is the patient suffering from the shock of finding himself Tubercular but he has to grapple with a collection of difficult anJ unfamiliar problems at a time when he is mentally and physically upset. There are domestic problems, such as keeping the home together and the disposal of children when the patient is away; financial problems, such as the continuance of building society instalments and insurance premiums, and the like. Some require direct financial assistance, but there are a number of difficulties soluble by the patients themselves if they only knew the right course of action. There are many opportunities for helping patients at this stage by sympathetic advice and assistance, and it is satisfactory to note that knowledge of the Committee's work is filtering through the Borough. As a tangible result of their efforts, 932 interviews involving advice and assistance took place during the year, and 83 families were helped financially. Financial inquiries numbered over 198, and £336 was disbursed. 101 Dental Treatment The fact that tubercle bacilli have been found frequently in the pulps of teeth and also in the gingival pockets goes to support the theory that cases of tubercular adenitis may owe their origin to infected teeth, the infection travelling from the teeth along the lymphatic vessels and becoming arrested in the cervical glands The maintenance of a high level of nutrition is one of the primary aims in the treatment of Tuberculosis The teeth are an important unit in the digestive system upon the adequacy of which nutrition so largely depends The teeth in Tuberculous patients are peculiarly liable to caries, possibly due to their reduced calcium content, so that constant supervision by a dentist is actually a necessary part of any scheme of treatment It is essential that treatment for Tuberculous patients should be carried out in easy stages, and that extraction of teeth for each patient should be limited to two or three at the most at each sitting In this way only is it possible for dental treatment to be done efficiently without aggravating the patient's general condition Considering the difficulties under which dental treatment is carried out, and in that patients when called up may not feel fit, with the result that treatment has to be postponed for sometimes a week or even longer, the increase in the number of treatments for the year is very gratifying Patients Referred From Tuberculosis Dispensary Males Females Totals 1933 1934 1933 1934 1933 1934 Attendances 34 87 57 119 91 206 Extractions 48 52 51 90 99 142 Fillings 3 14 12 9 15 23 Dressings - 3 4 6 4 9 Scalings 1 4 10 6 11 10 Denture Dressings 11 43 13 49 24 92 Dentures Fitted 3 15 8 20 11 35 No of Cases referred—30 No of Cases X-rayed—3 £3 15s 2d was received from patients for treatment 102 Table XIV. (A) Return showing the work of the Dispensary. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total Adults. Children. Adults. Children. Adults. Children M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts): (a) Definitely tuberculous. 89 75 4 5 5 18 2 3 94 93 6 8 201 (b) Diagnosis not completed - - - - - - - - 3 5 2 3 13 (c) Non-tuberculous - - - - - - - - 63 96 63 60 282 B.—Contacts examined during year:— (a) Definitely tuberculous 3 4 1 - - - - - 3 4 1 - 8 (b) Diagnosis not completed - - - - - - - - 1 4 1 1 7 (c) Non-tuberculous - - - - - - - - 76 113 59 60 308 C.—Cases written off the Dispensary Register as:- (a) Recovered 7 24 1 2 1 2 17 13 8 26 18 15 67 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 144 225 123 122 614 D.—Number of Cases on Dispensary Register on December 31st:- (a) Definitely tuberculous 392 311 17 18 37 50 44 35 429 361 61 53 904 (b) Diagnosis not completed - - - - - - - - 4 9 3 4 20 1. Number of cases on Dispensary Register on January 1st 963 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 58 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 111 4. Cases written off during the year as Dead (all causes) 124 5. Number of attendances at the Dispensary (including Contacts) 5,120 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 209 7. Number of consultations with medical practitioners:— 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 228 (a) Personal 32 (b) Other 564 10. Number:- 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3,602 (a) Specimens of sputum, etc., examined 656 (b) X-ray examinations made in connection with Dispensary work 331 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (ft) above 2 2. Number of "T.B. plus" cases on Dispensary Register on 31st December 476 103 (B) Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment) Provided by the Council Nil Provided by Voluntary Bodies Nil (C) Number of beds available for the treatment of Tuberculosis on the 31st December In Institutions belonging to the Council Name of Institution. For Pulmonary Cases For Non-Pulmonary Cases Total. Adults Children under 15 Adults Children under 15 Croydon Borough Sanatorium, North Cheam, Surrey 93 ... ... ... 93 Mayday Hospital, Mayday Road, Thornton Heath Beds used for reserved for pulmonary tients, as Tuberculosis or Non-Pul required. cases are monary 64 (d) Return showing the extent of Residential Treatment and Observation during the year In Institutions (other than Poor Law Institutions) approved for the treatment of Tuberculosis In Institutions on Jan. 1st. (1) Admitted during the year (2) Discharged during the year. (3) Died in the Institutions. (4) In Institutions on Dec. 31st. (5) Number of doubtfully tuberculous cases admitted for observation: Adult males 3 5 7 1 - Adult females - 5 4 1 - Children - 2 2 - - Total 3 12 13 2 - Number of patients suffering from pulmonary tuberculosis: Adult males 63 146 107 37 65 Adult females 46 131 109 21 47 Children 2 10 8 — 4 Total 111 287 224 58 116 Number of patients suffering from non-pulmonary tuberculosis: Adult males 10 5 8 - 7 Adult females 4 16 7 - 13 Children 14 11 7 1 17 Total 28 32 22 1 37 Grand Total 142 331 259 61 153 104 Table XV. Return showing the results of observation of doubtfully tuberculous cases discharged during the year from Institutions approved for the treatment of Tuberculosis. Diagnosis on discharge from observation. For Pulmonary Tuberculosis. For Non-Pulmonary Tuberculosis. Totals. Stay under 4 weeks. Stay over 4 weeks. Stay under 4 weeks. Stay over 4 weeks. m. F. Ch. m. F. Ch. m. F. Ch. m. F. Ch. m. F. Ch. Tuberculous 2 1 - 2 - - - - - - - - 4 1 - Non-tuberculous 2 3 1 2 1 1 - - - - - - 4 4 2 Doubtful - - - - - - - - - - - - - - - Totals 4 4 1 4 1 1 - - - - - - 8 5 2 1 Man and 1 woman die3 in Institutions while under observation, the can of death being: Man—Hypostatic pneumonia, fibroid myocardial degeneration, heart failure P.M. Woman—Carcinoma of Mediastinal. P.M. 105 Table XVI. Return showing the Immediate results of treatment of definitely tuberculous patients discharged during the year from Institutions approved for the treatment of Tuberculosis. Pulmonary Tuberculosis. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Grand Total Under3 m'ths but exceeding 28 days 3-6 months. 6-12 months. More than 12 months. Totals. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch Class T.B. minus. Quiescent 3 - 1 2 6 1 2 2 1 - - - 7 8 3 18 Not quiescent Died in 1 4 - 3 2 - 1 5 - 1 1 - 6 12 - 18 Institution 1 - - 1 - - - 1 - 1 - - 3 1 - 4 Class T.B. plus Group I. Quiescent - - - 2 - - 2 - - 1 - - 5 - - 5 Not quiescent Died in - - - 2 - - - - - 1 - - 3 - - 3 Institution - - - - - - - - - - - - - - - - Class T.B. plus Group II. Quiescent - 1 - 1 3 - 2 3 - 3 - - 6 7 -- 13 Not quiescent Died in 3 12 - 13 10 1 15 13 - 4 3 - 35 38 1 74 Institution 2 2 — 2 1 — — 1 — 1 2 — 5 6 — 11 Class T.B. plus Group III. Quiescent - - - - - - - - - - - - - - - - Not quiescent Died in 6 3 1 5 2 - 3 1 - 3 2 - 17 8 1 26 Institution 7 3 - 4 2 - 1 1 -- - 1 12 7 - 19 Totals (pulmonary) 23 25 2 35 26 2 26 27 1 15 9 - 99 87 5 191 106 Non-Pulmonary Tuberculosis. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. GRAND Total Under 3m'ths but exceeding 28 days 3-6 months. 6-12 months. More than 12 months. Totals. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Bones and Joints. Quiescent - - - - - 1 - - 1 3 1 2 3 1 4 1 Not quiescent Died in - - - 1 - - - - - - - - 1 - - 1 Institution - - - - - - - - 1 - - - - - 1 1 Abdominal. Quiescent - - - - 1 - - - - - - - - 1 - 1 Not quiescent Died in - 1 - - 2 - - - - - - - - 3 - 1 Institution - - - - - - - - - - - - - - - - Other Organs. Quiescent - - - - - - - - - - - - - - - - Not quiescent Died in - - - - - - 1 - - - - - 1 - - 1 Institution - - - - - - - - - - - - - - - - Peripheral glands. Quiescent - - - - - - 2 - - - - - 2 - - 2 Not quiescent Died in - - - - - - - 1 - - - - - 1 - 1 Institution - - - - - - - - - - - - - - - - Totals (non-pulmonary) - 1 - 1 3 ' 3 1 2 3 1 2 7 6 5 18 107 108 TABLE XVII. PULMONARY TUBERCULOSIS. Condition at the time of the last record made during the year to which the return relates. Previous to 1926 1926 1927 1928 1929 1930 1931 1932 1933. 1934. Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (ClassT.B. plus) Group 1 Group 2 Group 3 Total (ClassT.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (ClassT.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (ClassT.B. plus) Group 1 Group 2 Group 3 Total (ClassT.B. plus) (a) Remaining on Dispensary Register on December 31st. Adults Disease Arrested M 4 5 6 1 12 1 1 1 - 2 - 3 1 - 4 - 3 5 - 8 7 2 4 - 6 14 3 3 - 6 8 1 3 2 6 3 - 2 - 2 - - - - - - - - - - F 3 5 5 - 10 1 - 1 - 1 2 - 2 - 2 5 2 1 - 3 7 2 2 - 4 13 - 5 - 5 8 - 3 - 3 3 - - - - - - - - - - - - - - Children 2 - - - - - - - - - - - - - - 1 - - - - 3 - - - - 4 - - - - 2 - - - - - - - - - - - - - - - - - - - Disease not Arrested Adults M - 13 9 1 23 1 2 1 - 3 2 4 - - 4 1 3 7 1 11 1 3 9 1 13 2 4 12 - 16 4 2 23 1 26 7 7 31 6 44 18 10 25 2 37 33 6 31 9 46 F 3 6 10 2 18 - - 1 - 1 - 1 3 1 5 - - 1 1 2 - 1 8 - 9 1 1 9 1 11 4 - 16 1 17 16 2 15 5 22 20 3 25 3 31 28 3 27 6 36 Children - - 1 - 1 - - - - - - - - - - - - - - - 1 - - - - 3 - - - - 3 - - - - 3 1 - - 1 3 - - - - 5 - 1 - 1 Condition not ascertained during the year 3 3 1 - 4 - 2 - 2 - - - - - - 1 1 - 2 2 1 - - 1 5 - 2 - 2 7 2 1 - 3 3 2 2 - 4 2 - 5 1 6 - - - - - Total on Dispensary Register at 31st December 15 32 32 4 68 3 3 6 - 9 4 8 6 1 15 7 9 15 2 26 21 9 23 1 33 42 8 31 1 40 36 5 46 4 55 35 12 50 11 73 43 13 55 6 74 56 9 59 15 83 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M 178 23 5 1 29 6 7 1 - 8 8 6 - - 6 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F 159 11 6 3 20 7 1 - - 1 7 2 - - 2 16 1 - - 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 105 1 - - 1 - - - - - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 218 41 47 9 97 31 18 29 7 54 18 20 18 1 39 34 14 16 - 30 36 7 28 - 35 24 12 30 8 50 25 3 30 6 39 23 2 27 2 31 15 1 16 1 18 4 1 4 1 6 Dead Adults M 20 28 49 51 128 4 24 27 12 63 2 11 34 8 53 1 4 30 7 41 3 39 16 58 7 - 35 11 46 5 2 2b 31 59 2 1 25 11 43 4 - 11 13 24 2 - 6 12 18 F 17 5 23 56 84 10 15 21 14 50 2 3 22 15 40 4 2 32 8 42 3 2 29 9 40 5 2 25 11 38 4 1 25 22 48 8 2 22 6 30 - 1 9 9 19 2 - 3 9 12 Children 3 1 4 6 11 - - 1 - 1 - - 2 2 4 1 - - - - 1 - 1 - 1 - - - 2 2 - - 1 - 1 1 - - - - 1 - - - - - - - 3 3 Total written off Dispensary 700 110 134 126 370 58 65 79 33 177 39 42 76 26 144 59 21 78 15 114 44 12 97 25 134 36 14 90 32 136 34 6 82 59 147 34 5 74 25 104 20 2 36 23 61 8 1 13 25 39 Grand Totals 715 142 166 130 438 61 68 85 33 186 43 50 82 27 159 66 30 93 17 140 65 21 120 26 167 78 22 121 33 176 70 11 128 63 202 69 17 124 36 177 63 15 91 29 135 64 10 72 40 122 109 110 TABLE XVIII. NON-PULMONARY TUBERCULOSIS. Condition at the time of the last record made during the year to which the return relates. Previous to 1926 1926 1927 1928 1929 1930 1931 1932. 1933. 1934. Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bonse and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands (a) Remaining on Dispensary Register on December 31st. Disease Arrested Adults M 1 - - - 1 i - - - 1 - - 1 - 1 - - - - - 1 i 1 - 3 - 1 - 1 4 1 - - 5 3 1 - 2 6 1 1 - 1 3 1 - - - F - - 2 2 4 - - - - - 2 - - - 2 - - - - - - - 3 1 4 - 1 - 1 2 1 - - 1 2 2 1 1 - 4 - 1 - - 1 - 1 - 1 Children 3 1 - 1 5 - - - 2 2 3 - - - 3 6 - - 4 10 3 - - 3 6 6 - - 8 14 3 1 - 3 7 - 1 - 2 3 - - - 2 2 - - - - Adults Disease M - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 - - 2 - - - - - 2 - 2 - 4 2 - - 1 3 2 - - - not Arrested F 2 - 2 - 4 - - - - - - - 1 - 1 - - - - - - - 2 - 2 - - - - - 1 - - - 1 1 - - - 1 1 2 - - 3 6 1 1 4 Children 3 - - - 3 - - - - - - - - - - 2 - - - 2 1 - - - 1 1 - - - 1 2 - - 1 3 3 - - - 3 2 - 1 - 3 2 1 - 1 Condition not ascertained during the year 1 - - - 1 1 - - - 1 1 - - - 1 - - - 2 2 - 1 - - 1 - 1 - 1 2 - - 1 - 1 - - 1 1 2 1 1 - 1 3 - - - - Total on Dispensary Register at 31st December 10 1 4 3 18 2 - - 2 4 6 - 2 - 8 8 - - 6 14 5 2 6 4 17 8 3 1 10 22 11 2 1 5 19 11 3 4 5 23 7 5 1 5 18 11 3 1 8 Transferred to Pulmonary 1 - - - 1 - - - - - - - - - - - - - - - - 1 - - 1 - 1 - - 1 - - - - - - - - - - - - - - - - - - - (b Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M 7 - 4 2 13 3 - - - 3 2 1 - 1 4 1 - - - - - - - - - 1 - - - 1 - - - - - - - - - - - - - - - - - - - F 14 5 4 7 30 2 - - 4 6 1 1 - 3 5 - - - 3 3 1 - - 1 2 - - - 1 1 - - - - - - - - - - - - - - - - - - -1 Children 39 4 5 514 562 6 3 2 53 64 1 1 - 33 35 1 - - 15 16 2 - 1 2 5 - 1 - 4 5 - - - 2 2 - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 20 10 12 133 175 4 6 4 26 40 6 3 2 20 31 4 1 - 6 11 4 - 3 3 10 6 - 2 4 12 3 2 1 2 8 4 1 - 2 7 3 - 1 2 6 2 - - 1 Dead Adults M 3 1 3 1 8 2 - 1 1 4 2 - 1 - 3 3 1 1 - 5 1 - - - 1 - - - - - - - 1 - 1 - - 1 - 3 - - - - - - - - - F 3 - 1 1 5 1 - - 1 2 - 1 - - 1 1 - 2 - 3 - 1 - - 1 1 - 1 - 2 - 2 - - 2 - - - - - - 1 - - 1 - - - 1 Children 5 1 1 2 9 - 2 1 3 6 - - 1 - 1 2 2 1 2 7 - - - - - - 1 - - 1 - - - - - - - - - - - - 1 - 1 - - -. - Total written off Dispensary Register 91 21 30 660 802 18 11 8 88 125 12 7 4 57 80 12 4 4 26 46 8 1 4 6 19 8 2 3 9 22 3 4 2 4 13 6 1 1 2 10 3 1 2 2 8 3 - 2 Grand Totals of (a) and(b(excluding those transferred to Pulmonary). 101 22 34 663 820 20 11 8 90 129 18 7 6 57 88 20 4 4 32 60 13 3 10 10 36 16 5 4 19 44 14 6 3 9 32 17 4 5 7 33 10 6 3 7 26 14 3 1 10 111 CHEAM SANATORIUM. Table XIX, Authority. In-patients on Jan. 1st, 19.34, Admitted during year 1934. Discharged during year 1934. including deaths * In on Jan. 1st 1935. * Died during year 1934 m f m f m f m f m f Croydon C. B. 43 34 81 70 80 75 44 29 10 7 No. of Artificial Pneumothorax cases begun 25 No. of Refills given 987 No. of X-Ray Screenings 1,081 No. of Films taken 222 No. of Sputum tests 981 No.of Gas Replacements 26 Immediate Results of Treatment. Table XX. Group Total num ber of cases discharged 1934. Quiescent Improved N o Material Improvement. Died in institution Average duration of stay in days Discharged before completion of treatment M F M F M F M F M F M F Class T.B. Minus 11 14 7 2 1 6 2 1 ... ... 153 1 5 Class T.B. Plus. Group 1 9 1 1 ... 4 ... 3 ... ... ... 153 1 1 " " " Group II 27 36 ... ... 20 24 5 2 ... 2 216 2 8 " " " Group III 22 13 ... • • • 5 1 7 3 10 5 172 ... 4 Observation Non T.B. 3 1 ... ... ... ... ... ... ... ... ... ... 72 65 8 2 30 31 17 6 10 7 4 18 At the beginning of 1934 there were 77 patients in Cheam. uring the year 151 were admitted and 138 discharged, whilst 17 died, thus leaving 73 patients in at the beginning of 1935. 112 There were 8 observation cases sent in: 4 males and 4 females. Of the 4 males 3 were not tubercular, and of the 4 females 1 was not tubercular; therefore, there were 4 observations in non-tuberculars which are shown above. The 4 that were tubercular are in with the tubercular cases and are not shown as observation. Artificial Pneumothorax cases discharged but still under treatment, 8 males, 10 females (see above), making total discharges : males 80, females 75. These 18 Artificial Pneumothorax cases only refer to cases discharged in 1934; those discharged in 1933 and still having refills have not been included. Dental Report. Nearly all the patients were examined, treatment being provided in all cases necessary. Completed treatment was undertaken for the suitable patients, while those whose general condition demanded as little dental interference as possible were treated for the relief of pain only. Patients were only treated when the Medical Officer reported that they were sufficiently fit. A few cases were dealt with in the wards, but most of the patients attended the special dental surgery in the hospital. It should be pointed out that the cases reviewed were treated for the extraction of teeth. The number of extractions carried out at each sitting was restricted according to the patient's general condition, and the maximum number of teeth extracted at one visit was three. It is particularly desirable that at each visit work of an extensive nature should be avoided, and the value of such a procedure is proved by the figures quoted above. Only three patients showed an increase in temperature following the removal of septic teeth, and in 25 cases there was no change. As regards the pulse rates, it will be observed that in 27 cases the pulse remained the same, and only five cases showed a variation. It is of interest to point out that five cases classified as Advanced showed no increase in temperature or pulse rate. It is imperative to avoid the risk of the patient's general condition being lowered by the rapid absorption of toxins through multiple extractions. 113 Review of Work Done 1934 1933 Males Females Total Males Females Total Number Examined 40 39 79 34 19 53 Referred for Treatment 40 37 77 27 14 41 Treated 40 37 77 34 19 53 Attendances 218 190 408 189 174 363 Extractions 181 139 320 123 80 203 Fillings 45 45 90 31 40 71 Dressings 34 28 62 4 7 11 Scalings & Gum ments 33 36 69 45 49 94 Denture Dressings 37 20 57 18 34 52 Dentures Fitted 11 7 18 6 9 15 Sessions: 37 Sessions: 36 Although it may appear in the review of work done that the number of attendances is high in comparison with the number treated, this is due to the policy of festinae lente mentioned above It will be observed that the volume of work and the number of patients treated have increased during the year compared with 1933 It is gratifying to note that more conservative treatment has been accomplished and that the number of attendances has improved The teeth of tubercular patients are particularly liable to dental disease, and for that reason reparative treatment is very often impossible 114 SECTION VI. CANCER. Deaths from Cancer numbered 371 as compared with 374 in 1933; 341 in 1932; 342 in 1931; 339 in 1930; 330 in 1929; 327 in 1928; 344 in 1927 ; 330 in 1926 ; 319 in 1925. Death-rates per 1,000 of the population for the previous 10 years are as follows:- 1924—1.50 (293) 1929—1.48 (330) 1925—1.60 (319) 1930—1.52 (339) 1926—1.60 (330; 1931—1.46 (342) 1927—1.62 (344) 1932—1.44 (341) 1928—1.54 (327) 1933—1.56 (374) For 1934 the rate is 1.54 (371). Deaths From Cancer in Municipal Wards. Table I. Ward. Male. Female Total Death-rate Estimated Population Mid Male. 1934. Female Upper Norwood 13 23 36 1.60 10151 12288 Norbury 7 12 19 1.18 7260 8777 West Thornton 12 20 32 1.59 9429 10693 Bensham Manor 11 18 29 1.80 7540 8589 Thornton Heath 14 8 22 1.41 7470 8187 South Norwood 12 20 32 1.80 8100 9665 Woodside 12 10 22 1.27 7452 8244 East 17 10 27 1.50 7951 10133 Addiscombe 10 16 26 1.80 6707 7790 Whitehorse Mnr 13 12 25 1.49 8017 8782 Broad Green 8 10 18 1.17 7324 8088 Central 6 8 14 1.14 5448 6794 Waddon 17 22 39 1.78 10416 11482 South 12 12 24 1.61 6350 8591 Addington 3 1 4 1.39 1430 1453 No fixed abode. 2 - 2 - - - Total 169 202 371 1.54 111045 129555 115 Table II. Deaths from Cancer occurred at the following ages:- Age period. Male. Female. Total. Calculated population at this age period. Incidence per 1,000 persons living. Under 25 years - 1 1 101079 .010 25 and under 35 years 3 2 5 36084 .139 35 and under 45 years 4 14 18 38493 .468 45 and under 65 years 68 95 163 48111 3.388 65 years and over 94 90 184 16833 10.931 169 202 371 240,600 1.542 Table III. Sites of Fatal Cancer. Site. Male. Female. Total. Percentage of Total. Brain - - - - Skin 2 3 5 1.35 Tongue and Mouth 11 2 13 3.50 Lip — — — — Oesophagus 8 1 9 2.43 Stomach 35 31 66 17.79 Liver 9 6 15 4.04 Bowel 26 30 56 15.09 Rectum 14 11 25 6.74 Bladder 6 - 6 1.62 Prostate 12 - 12 3.23 Larynx 9 2 11 2.97 Uterus - 27 27 7.28 Breast - 46 46 12.39 Ovary - 12 12 3.23 Pancreas 10 2 12 3.23 Gall Bladder and Duct. 3 10 13 3.50 Bones 4 2 6 1.62 Mediastinum - 3 3 0.81 Lungs 15 4 19 5.12 Kidnevs 1 4 5 1.35 Glands 2 2 4 1.08 Other Reproductive 1 2 3 0.81 Pharynx 1 1 2 0.54 Not defined - 1 1 0.27 169 202 371 110 Comments on Foregoing Tables. (1) Deaths from Cancer increase as age advances; this is in accordance with established facts. (2) Mortality is about evenly distributed between the two sexes at all ages, making allowance for the preponderance of females in the general population. (3) The two main groups of organs attacked in both sexes are the alimentary system and the reproductive system. In males 72.1% of the total deaths fall within these groups and in females 83.2%. In males Cancer of the digestive system is the commones situation, amounting to 60.9%. In females it was 40.1%. Cancer of the reproductive system caused 43.1% of the total deaths in females and was the most prevalent type. Cancer of the laryns. tongue and mouth is commoner in males than females, 20 deaths occurring in males as compared with 4 in females. The organs most often attacked in descending order of incidence are, in males the Rectum and Bowels (22.4%); the Stomach (20.7%); the Lrangs (8.9%); the Prostate (7.1%); in females, the Breast (22.7%); the Bowels and Rectum (20.3%); Stomach (15.3%) and the Uterus (13.3%). This is slightly different from the incidence in 1933. The main incidence of Cancer is, in both sexes, on two group of organs, both having a common characteristic, namely, periods of active cell degeneration and regeneration. Although much research has been made and is continuing into the causation of Cancer, the reason why certain cells suddenly become abnormally active and reproduce themselves excessively with resultant invasion of surrounding tissues, has not yet beeelucidated. The Cancer cell is an ordinary tissue cell which become invested with abnormal properties. Why this sho»l happen is not yet understood. 117 SECTION VII. VENEREAL DISEASES. The scheme in operation in the Borough consists of the Clinics held at the Croydon General Hospital. Males attend on Saturday afternoons and Thursday evenings, women and children on Wednesday afternoons. The Clinic is conducted by Dr. P. W. Hamond, who is not otherwise connected with the Health Department. Croydon is also one of the participating authorities in the London County Council's scheme, under which clinics for the treatment of venereal diseases are provided at a large number of London Hospitals, and at resident hostels; the cost being apportioned among the ten participating authorities in the scheme on a basis of user. Table I. Attendances at the Croydon Clinic. 1925. 1926. 1927 1928. 1929 1930. 1951. 1932. 1933. 1934. patients 116 141 145 121 101 I96 263 235 242 297 a New female patients 156 192 160 158 94 171 205 241 214 232 a Attendances, male Patients 2713 2360 2643 3502 3581 5050 4923 4691 4578 5858a Attendances, female patients 1230 1351 1417 1632 2127 3029 3271 2724 2677 3962a a Includes 56 new cases and 3161 total attendances by patients from outside areas. Attendances of Croydon Patients at various London Hospitals under the General Scheme. 1925. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. New patients 138 130 132 139 131 125 139 119 134 103 attendances 2648 2767 3160 3080 3089 3150 2384 2835 2407 2222 Of the 103 new patients in 1934, 7 had syphilis, 28 gonorrhoea, and 68 were not suffering from venereal disease. 118 No Croydon patients were admitted to approved hostels under the L.C.C. scheme. Tests For practitioners Tests for Clinics Pathological Examinations at London Hospitals for Croydon Patients. 1069 642 1925. 799 542 1926. 667 540 1927. 570 716 1928. 932 924 1929. 2197 715 1930. 3198 829 1931. 1680 900 1932. 1775 855 1933. 1877 968 1934 Attendances of Patients at Venereal Diseases Clinic at the Croydon General Hospital. Table II. Authority 1929 1930 1931 1932 1933 1934 Inpatients (days) Outpatients Inpatients (days) OutPatients Inpatients (days) Out Patients InPatients (days) OutPatients Inpatients (days) OutPatients. Inpatients (days) OutPatients Croydon 132 3998 ... 6159 ... 6395 159 5405 ... 5615 56 6659 Surrey C. C. 46 1676 ... 1686 ... 1491 ... 1512 ... 1280 10 2227 Kent C. C. ... 11 ... 184 ... 232 ... 74 ... 87 ... 109 London C.C. ... 23 ... 46 ... 72 ... 426 ... 255 6 794 Other Authori ties ... ... ... 4 ... 4 ... 19 ... 18 ... 31 178 5708 ... 8079 ... 8194 159 7436 ... 7255 72 9820 119 Table III. Croydon Cases attending London Hospitals. Hospital Cases seen for the first time. Conditions other than Venereal Total No. of Attendances Aggregate No. of Inpatient Days No. of doses of N.A.B. compounds Syphilis Gonorrhoea Soft Chancre St. Thomas's 3 6 ... 41 1193 25 57 Guy's 4 7 ... 11 575 10 32 King's College ... ... ... 3 103 ... ... Great Ormond Street ... ... ... 11 83 ... ... Royal Free ... ... ... ... 7 ... ... S.London Hospital for Women ... ... ... ... 5 ... ... Whitechapel Clinic (L.C.C.) ... l ... 2 167 ... ... St. Paul's ... ... ... ... 24 ... ... Westminster Hospital ... 2 ... ... 55 ... ... Children's Home, Waddon ... 2 ... ... ... 364 ... Total 7 28 ... 68 2222 399 89 Table IV. Bacteriological Examinations carried out at London Hospitals for Croydon Patients. Hospital Detection of Spirochetes Detection of Gonococci Wassermann Re-action Other Exams. Total For Clinic For Priv. Prac. For Clinic For Prac. For Clinic For Prac. For Clinic For Prac St. Thomas's 1 ... 260 99 131 ... 60 ... 552 Great Ormond Street ... ... 1 ... 24 2 30 ... 57 South London HosPital for Women ... ... 14 1 3 2 ... ... 20 Royal Free ... ... ... ... 8 ... 1 ... 9 King's College ... ... 18 ... 19 ... ... ... 37 Whitechapel Clinic, L.C.C. ... ... 59 ... 1 ... 4 ... 64 Westminster Hosp. ... ... 5 ... ... 5 ... 2 12 Guys Hospital 1 ... 196 932 78 711 13 122 2053 Seame's 1 ... 18 ... 22 ... ... ... 41 Total 3 ... 571 1032 286 721 108 124 2845 120 Table V. Return relating to all persons who were treated at the Treatment Centre at Croydon General Hospital during the year ended the 31st December, 1934. Syphilis Soft Chancre Gonorrhoea Conditions other than venereal Totals M F M F M F M F M F 1. Number of cases on 1st January under treatment or observation 42 49 ... ... 39 22 3 3 84 74 2. Number of cases removed from the register during any previous year which returned during the year under report for treatment or observation of the same infection 2 1 ... ... 3 3 ... ... 5 4 3. Number of cases dealt with for the first time during the year under report (exclusive of cases under Item 4) suffering from :— Syphilis, primary 8 ... ... ... ... ... ... ... 8 ... „ secondary 3 6 ... ... ... ... ... ... 3 6 „ latent in 1st year of infection ... 4 ... ... ... ... ... ... ... 4 „ all later stages 9 13 ... ... ... ... ... ... 9 13 „ congenital 1 3 ... ... ... ... ... ... 1 3 Soft Chancre ... ... ... ... ... ... ... ... ... ... Gonorrhoea,1st year of infection ... ... ... ... 130 53 ... ... 130 53 „ later ... ... ... ... 9 6 ... ... 9 6 Conditions other than venereal ... ... ... ... ... ... 104 124 104 124 4. Number of cases dealt with for the first time during the year under report known to have received treatment at other Centres for the same infection 16 9 ... ... 17 14 ... ... 33 23 Totals of Items 1, 2, 3 and 4 81 85 ... ... 198 98 107 127 386 310 5. Number of cases discharged after completion of treatment and final tests of cure (see Item 15) 18 7 ... ... 80 23 105 125 203 155 6. Number of cases which ceased to attend before completion of treatment and were, on first attendance suffering from:— Syphilis, primary ... ... ... ... ... ... ... ... ... ... „ secondary 1 ... ... ... ... ... ... ... 1 ... „ latent in 1st year of infection ... ... ... ... ... ... ... ... ... ... „ all later stages 7 13 ... ... ... ... ... ... 7 13 „ congenital 1 2 ... ... ... ... ... ... 1 2 Soft Chancre ... ... ... ... ... ... ... ... ... ... Gonorrhoea, 1st year of infection ... ... ... ... 39 13 ... ... 39 13 later ... ... ... ... ... 4 ... ... ... 4 7. Number of cases which ceased to attend after completion of treatment but before final tests of cure (see Item 15) 3 ... ... ... 24 13 ... ... 27 13 8. Number of cases transferred to other centres or to institutions, or to care of private practitioners. 7 8 ... ... 11 10 ... ... 18 18 9. Number of cases remaining under treatment or observation on 31st December 44 55 ... ... 44 35 2 2 90 92 Totals of Items 5, 6, 7, 8 and 9 (These totals should agree with those of Items 1, 2, 3 and 4) 81 85 ... ... 198 98 107 127 386 310 10. Number of cases in the following stages of syphilis included in Item 6 which failed to complete one course of treatment:— Syphilis, primary ... ... ... ... ... ... ... ... ... ... „ secondary ... ... ... ... ... ... ... ... ... ... „ latent in 1st year of infection ... ... ... ... ... ... ... ... ... ... „ all later stages 3 2 ... ... ... ... ... ... 3 2 „ congenital ... ... ... ... ... ... ... ... ... ... 11. Number of attendances :— (a) for individual attention of the medical officers 1188 1177 ... ... 1208 428 199 185 2595 1790 (b) for intermediate treatment, e.g., irrigation, dressing 28 15 ... ... 3070 2030 165 127 3263 2172 Total Attendances 1216 1192 ... ... 4278 2458 364 312 5858 3962 121 Syphilis Soft Chancre Gonorrhoea Conditions other than venereal Totals M F. M F M F M F M F Ttls 12. In-patients:– (a) Total number of persons admitted for treatment during the year 1 1 ... ... 2 3 ... ... 3 4 7 (b) Aggregate number or " in-patient days " of treatment given 3 15 ... ... 9 45 ... ... 12 60 72 Under 1 year 1 and under 5 years 5 and under 15 years 15 years and Totals over M F M F M F M F M F 13. Number of cases of congenital syphilis in Item 3 above classified according to age periods ... 1 ... ... ... ... 1 2 1 3 Approved Arsenobenzene Compounds Mercury Bismuth 14. Chief preparations used in treatment of Syphilis : (a) Names of preparations Stabilarsan Sulphostab ... Quinostab Bismostab (b) Total number of injections given (outpatients and in-patients) 849 ... 959 15. Are the tests recommended in Memo. V21 as amended by Memo. V21A followed in deciding as to the discharge of the patient after treatment and observation for syphilis and gonorrhoea ? Yes. Microscopical Serum Tests for spirochetes for gonococci Wassermann Others for Syphilis for Gonorrhoea Pathological Work:- (a) Number of specimens examined at and by the medical officer of the treatment centre ... ... ... ... ... (b) Number of specimens from patients attending at the treatment centre sent for tion to an approved laboraty ... 681 365 Kahn 153 53 122 Table VI. Statement showing the services rendered at the Treatment Centre during the year, classified according to the areas in which the patients resided. Name of County or County Borough (or Country in the case of persons residing elsewhere than in England and Wales) to be inserted in these headings. Croydon Surrey Kent London Sussex Total A. Number of cases in Item 3 and 4 from each area found to be suffering from :— Syphilis 46 17 1 8 ... 72 Soft Chancre ... ... ... ... ... ... Gonorrhoea 117 79 6 26 1 229 Conditions other than venereal 162 48 9 9 ... 228 Total 325 144 16 43 1 529 B. Total number of attendances of all patients residing in each area 6659 2227 109 794 31 9820 C. Aggregate number of " In-patient days" of all patients residing in each area 56 10 ... 6 ... 72 D. Number of doses of arsenobenzene compounds given in the out-patient Clinic and In-patient Department to patients residing in each area 595 225 2 27 ... 849 123 SECTION VIII. MATERNITY AND CHILD WELFARE. Table I. INFANT CENTRES AND CLINICS. Address Whether Sessions are held weekly, fortnightly, etc. Day and time of Meeting * Present arrangements for medical supervision Municipal, Lodge Road, Croydon Twice wkly. Mon. & Thur. A Doctor and Nurse are in attendance at each Session. Boston Road, Mission Hall Weekly Thur. Sylverdale Road Parish Hall „ Mon. Wesleyan School Room, Bartlett Street „ Thur. Parish Hall, Wickham Road, Shirley „ Mon. St. Luke's Hall, Spring Lane „ Fri. Wesleyan School Room, Lower Addiscombe Road „ Tues. Holy Innocents Parish Room, South Norwood Twice wkly. Tues. & Fri Forester's Hall, Westow Street, S. E. 19 Weekly Wed. All Saints' Parish Hall, Moffatt Road, Thornton Heath „ Tues. St. Alban's Hall, Whitehorse Lane Twice wkly. Wed. & Fri. St. Paul's Hall, Norfolk Road, Thornton Heath Weekly Mon. Salvation Army Hall. Whitehorse Road „ Fri. Wesleyan School Room, London Road, S.W. 16 „ Wed. St. George's Hall, Barrow Road, Waddon „ Wed. St. Oswald's Hall, Green Lane, Thornton Heath „ Thur. St. Jude's Hall, Thornton Road „ Tues. * 2 p.m. Notification of Births Act, 1915. This Act requires all births to be notified to the Medical Officer of Health within 36 hours of their occurrence. The whole system of health visiting rests on this Act. Notifications were received from— Live Still Births. Births. Total. Midwives 2,484 91 2,575 Doctors, Parents and others 798 24 822 Total 3,282 115 3,397 As the total number of births and still births registered during 1934 was 3,636 (Live 3,508, Still 128), 226 births and 13 still births were not notified in accordance with the provisions of the Act. 124 The relevant section of the Act lays down that it is the duty of the father of the child or of any person in attendance upon the mother at the time of, or within thirty-six hours after the birth, to give notice in writing of the birth to the Medical Officer of Health of the district in which the child is born, and any person who fails to give notice of a birth in accordance with the Act shall be liable to a penalty. Maternal Mortality. There were 13 deaths directly due to pregnancy, as compared with 12 in 1933. The maternal mortality rate was consequently 3.9 per 1,000 total births, compared with 3.8 per 1,000 in 1933. In other words, one mother died for every 300 living babies born. The deaths directly associated with pregnancy were caused by: Puerperal Eclampsia, 3 cases; Puerperal Septicemia, 5 cases; Ectopic Gestation, 1 case; Placenta Praevia, 2; Shock, 1; Atrophy of Liver, 1. In the Table below only deaths directly due to pregnancy are included. Table II. Puerperal Toxaemias. Hæmorrhages. Other Causes. YEAR. BIRTHS. Puerperal Infection. Eclampsia. Hyperemesis. Ectopic Gestation. Placenta Praevia. Post-partum Haemorrhage. Pulmonary Embolism. Caesarian Section. Shock. Heart Disease. Syncope. Renal Trouble. Other Causes. TOTAL. Maternal Mortality. Infant Mortality. 1919 2965 5 1 ... ... ... ... ... ... ... ... ... ... 6 2.0 73 1920 4351 6 2 ... ... 2 ... 2 ... ... 3 1 2 18 4.1 63 1921 3631 4 2 ... ... 1 2 ... ... 2 ... 3 ... 14 3.9 74 1922 3505 8 1 ... ... 1 1 1 ... ... 2 ... 1 15 4.3 64 1923 3373 4 2 ... ... 1 ... ... 2 ... ... ... 1 10 3.0 52 1924 3456 2 1 ... ... ... 3 2 ... ... 1 ... ... 9 2.6 56 1925 3406 5 1 ... ... ... 3 2 1 ... ... 1 ... 13 3.8 55 1926 3477 13 ... ... ... 2 1 1 1 2 1 ... 3 24 6.9 61 1927 3174 5 ... ... ... 1 ... 1 ... ... ... 1 1 9 2.9 55 1928 3374 2 4 ... ... ... 1 3 ... ... ... ... 3 13 3.9 53 1929 3399 4 ... 1 1 1 2 1 ... ... ... ... 1 11 3.2 65 1930 3514 1 ... ... ... ... 2 1 ... ... ... ... 3 7 2.0 48 1931 3400 11 3 2 3 1 2 1 ... ... ... ... ... 23 6.2 57 1932 3311 2 3 ... ... ... ... ... ... 1 ... ... 1 7 2.1 49 1933 3147 5 2 1 1 ... ... 1 ... ... ... 1 1 12 3.8 47 1934 3185 5 3 ... 1 2 ... ... ... 1 ... ... 1 13 3.9 46 82 25 4 6 12 17 16 4 6 7 7 19 204 125 Puerperal Fever and Puerperal Pyrexia. Fifteen cases of Puerperal Fever and 36 cases of Puerperal Pyrexia were notified. This is a rate of 3.9 per 1,000 births (live and still births) for the former and 10.8 per 1,000 for the latter. The death-rates were:—Puerperal Fever, 1.21 per 1,000 births. There were no deaths attributed to Puerperal Pyrexia. The following Table gives fuller details concerning these cases. Table III. Puerperal Fever. Puerperal Pyrexia. No. of cases notified 15 36 „ „ attended by doctor alone at confinement — 1 „ „ attended by doctor and midwife — 1 „ „ attended by midwife alone 10 26 „ B.B.A. 6 8 „ „ attended in an institution 2 19 „ „ attended in Private Nursing Homes 1 7 „ „ treated at home only 1 4 „ „ treated at hospital 2 27 „ „ treated at Private Nursing Home 1 5 „ „ treated partly at home and partly in hospital 11 18 „ „ who died 4 — Under Section 2 (1) of the Midwives and Maternity Homes Act, 1926, a midwife is enabled to claim compensation for loss of practice on account of suspension from work to prevent the possible spread of infection. No applications were received. The Committee also assist necessitous patients in the payment of the midwife's fee. 26 applications were made for assistance by midwives on behalf of the patients, and a total sum of £37 19s. was allowed. Table IV. Accommodation for Confinement. The following Table gives information concerning the accommodation utilized for confinements. Number. Percentage. In Private Houses 1,698 46.7 In Public Institutions 1,281 35.2 Registered Maternity Homes 657 18.1 There is a distinct trend towards confinement taking place in Institution or Maternity Home. 126 THE OBSTETRIC SERVICE. The obstetric service was fully described in the Annual Report for 1933. The chief object of the service is to avoid abnormality in pregnancy and child-birth, and to prevent consequent death or ill-health of mother and child. It is the quality of the Ante-Natal supervision which determines to what extent certain abnormalities will be prevented, and for this reason the results of In-patient treatment are always classified into the two groups—Booked cases cared for at the Ante-Natal Clinics and Emergency cases admitted to the Council's beds without previous supervision in the AnteNatal Clinics. Some of the Mayday Hospital Booked cases are sent to the Ante-Natal Clinics by doctors and midwives because of abnormalities and complications. Many of the Emergency cases are seriously ill when they are received into hospital. The extent to which the Council provides for the serious cases may be judged by the fact that in 1933 all the 12 maternal deaths in Croydon occurred in the Council's beds and 9 of the 11 maternal deaths in 1934. Taking the Registrar-General's figures for maternal mortality (deaths directly due to pregnancy) the rate for England and Wales for 1934 is 4.41 per 1,000 births. In Croydon there has been a slight fall from 3.70 per 1,000 in 1933 to 3.63 per 1,000 in 1934. In Booked cases treated by the Obstetric Service the rate for 1934 was 2.96 per 1,000 births. The Staff are far from satisfied with this, and their constant application to a system of Ante-Natal supervision is intended to reduce the number of deaths to the minimum. The co-operation of the expectant mothers themselves is necessary for this. Of the cases treated to a conclusion at the Post-Natal Clinic during 1934, 92.8 per cent. were classified as " Health Unimpaired." This signifies that anatomically and functionally their condition was the same as before their pregnancies. The corresponding figure for 1933 was 84.6 per cent. 127 Several improvements were made during the year. An additional Health Visitor was provided to assist at the Ante-Natal Clinics. Her appointment has allowed the Lady Medical Officer to give more time to the medical and obstetrical examination of the cases. Buist's pads were applied to cases of posterior positions at 38 weeks throughout the year. During 1935 this treatment will not be given, and the results of the two years will be compared. A large proportion of expectant mothers now books in the third or fourth month of pregnancy and is supervised during the remainder of the time. Of the large number of cases referred for dental treatment early in pregnancy the Dental Department was not able to deal with more than half owing to other demands on its services. The prevention of breech presentation was highly successful, and the infant mortality rate for cases treated by version happened to be lower than that for vertex cases that had not had version performed. Early in the year a Masseuse was appointed to St. Mary's Maternity Hospital to give the lying-in mothers daily exercises, so that now all the In-patients treated by the service receive this benefit. The number of patients delivered in Mayday Hospital showed an increase of 24 per cent. on the total for 1933, and the strain on maternity accommodation, inadequate from the first, is now excessive. The number of cases delivered of viable babies in Mayday Hospital, with 22 beds, was 515. The number delivered in St. Mary's Maternity Hospital, with 30 beds, was 562. The other great deficiency in the service is that of a Mothercraft Class, run by trained mothercraft workers. A small Mothers' Club, organised by voluntary helpers, has been started. It provides sewing classes that partly remedy this deficiency. These notes would not be complete without recording a special debt of gratitude to the British Red Cross Society, who supplied a large number of the blood donors used for the 14 blood transfusions performed during the year. 128 GENERAL STATISTICS FOR 1935. Registrar General's Returns. Number of Live Births allocated to the Borough of Croydon 3,185 Number of Still Births allocated to the Borough of Croydon 119 Total 3,304 Number of Maternal Deaths (directly due to pregnancy) 11 Number of cases notified as Puerperal Fever 15 Number of cases notified as Puerperal Pyrexia 36 Statistics Prepared by the Obstetric Service. Number of Expectant Mothers who attended the Borough Ante- Natal Clinics 1,793 Number of eases delivered in Mayday Hospital as Booked cases 450 Number of cases delivered in Mayday Hospital as Emergency cases 183 Total cases delivered in Mayday Hospital 633 Number of cases delivered in St. Mary's Maternity Hospital as Booked cases 562 Number of cases delivered in St. Mary's Maternity Hospital as Emergency cases — Total cases delivered in St. Mary's Maternity Hospital 562 Number of cases admitted to the Puerperal Infection Unit, Borough Hospital and Mayday Hospital Isolation Wards, including 22 from Mayday Hospital and none from St. Mary's Maternity Hospital 47 Number of Maternal Deaths* in Borough of Croydon Number of Maternal Deaths in Booked cases from Borough Ante-Natal Clinics 4 Number of Maternal Deaths in Emergency cases at Mayday Hospital 4 Number of Maternal Deaths in cases admitted as Puerperal Sepsis per se 3 Total Maternal Deaths* in beds of the Obstetric Service 11 The total number of patients treated by the Obstetric Service was :— (a) In Mayday Hospital 720 (b) In St. Mary's Maternity Hospital 565 (c) In the Borough Hospital Puerperal Infection Unit and Mayday Hospital Isolation Wards, excluding 22 from (a) 25 (d) At the Ante-Natal Clinics and delivered outside the above hospitals (about) 254 (e) At the Post-Natal Clinics, excluding those included in (a), (b), (c) and (d) 20 (/) At the Ante-Natal Clinics and undelivered on December 31st, 1934 430 Total 1,996 *Including 2 deaths not recorded by the Registrar-General as directly due to pregnancy. 129 ANTE-NATAL SUPERVISION. 1933. 1934. Number of sessions of Ante-Natal Clinics held 252 254 Number of individuals who attended 1,645 1,793 Number of previous year's cases continuing attendance 322 356 Number of new cases 1,323 1,437 Number of cases undelivered on 31st December 388 430 Total attendances made 8,518 10,105 Average attendance per session 33.8 39.8 Proportion of old to new cases per session— New 5.25 5.7 Old 28.55 34.1 Number of cases delivered in Hospital as Booked cases 966 1,012 Number of cases delivered at other places under the care of private doctors or midwives (about) 380 254 Number of patients found not to be pregnant 33 25 Number of patients referred to Hospital for AnteNatal treatment 169 211 The conditions for which these were admitted can be ascertained by reference to the "Booked" columns of the Numerical Summary of Cases on pages 133. It is seen that the new cases have increased by 114 and the total attendances by 1,587. This increase has caused a severe strain on the accommodation available at Lodge Road, and occasional overcrowding has resulted. It is interesting to note that the number of births occurring in institutions and previously attending the Clinic has risen, but the number confined privately has decreased Major Ante-Natal Conditions Treated at the Ante-Natal Clinic. Breech Presentation. Cases. Breech presentation diagnosed135 External version successful 118 (2 recurred) External version not successful 15 Allowed to go to term as Breech 5 Referred to Hospital for external version under anæsthesia14 Of these: Version under anaesthesia successful 7 Version under anaesthesia not successful 7 Not recognised as Breech before labour 3 Posterior Positions of the Vertex. Successful correction with Buist's pads at about 38 weeks 49 Buist's pads unsuccessful 9 Correction not attempted 13 Dental Treatment. Number of cases referred to Borough Dental Surgeons 237 Number of cases referred to Private Dental Surgeons 170 Number of cases refusing dental treatment 61 umber of cases seen too late for necessary dental treatment 22 130 It is unfortunate that the number of patients refusing treatment is so high. The value of good teeth both during pregnancy and after is not yet appreciated by many women. The inability of the Dental Service to deal with all the mothers anxious to obtain treatment is doubly regrettable, inasmuch as it reacts upon the attitude of mothers. Tuberculosis. Referred by Tuberculosis Officer because of pregnancy 5 Referred to Tuberculosis Officer for opinion on lung condition 11 Venereal Disease. GONORRHOEA—Total cases 4 Transferred to Borough V.D. Clinic 1 Transferred to Mayday Hospital 3 SYPHILIS—Total cases 6 Transferred to Borough V.D. Clinic 2 Transferred to Mayday Hospital 4 All the cases were delivered in Mayday Hospital in Isolation Wards, and all were transferred to the Borough V.D. Clinic on discharge. Other Conditions Treated as Out-Patients. Chronic Rheumatic Carditis 9 Parenchymatous Goitre 6 Cyst-adenoma of Thyroid 3 Retroverted Gravid Uterus 2 Cervical Polypus 2 Prepatellar Bursitis 2 Scabies 1 Psoriasis 1 Midwives' Cases. Many midwives' cases were sent when pregnancy was about 36 weeks advanced for a single consultation. A somewhat larger number was supervised entirely at the Ante-Natal Clinic after they had made their own arrangements for delivery at home in the care of doctors or midwives. These cases may be summarised as follows:— Total midwives' cases during 1934 303 Number of cases sent for one consultation only 141 (47%) Number of cases supervised entirely 162 (53%) Number of primigravidæ 117 (39%) Number of multigravidæ 186 (61%) Number of legitimate pregnancies 299 (99%) Number of illegitimate pregnancies 4 (1%) 131 Number of cases referred to Hospital fot Ante-Natal treatment, discharged undelivered, and not readmitted for delivery 3 Number of cases ordered into Hospital for delivery on medical grounds 7 The indications in the 7 cases were— Albuminuria 2 Pyelitis 1 Chronic Rheumatic Carditis 1 Ante-Partum Haemorrhage 1 Home conditions unsuitable 2 SPECIAL INVESTIGATIONS. Special investigations were carried out on Ante-Natal patients attending the Clinics, and on patients in St. Mary's Maternity Hospital and Mayday Hospital Maternity Wards. Pathological Investigations. Blood for Wassermann and Kahn Reaction 65 Blood for Gonococcus Fixation Test 12 Blood for Culture 8 Blood for Urea Content 2 Blood for Sugar Content 1 Blood for Van den Burgh Reaction 2 Blood for Cell Count, etc. 10 Catheter urine for Routine Examination 206 Urine for Aschheim-Zondek Test 9 Urine for Urea Concentration Test 2 Lochia for Culture 23 Sputum for Examination 16 Pus for Identification of Organism 2 Urethral smears for Gonococci, etc 20 Cervical smears for Gonococci, etc 13 Conjunctival smears 2 Histological sections 9 X-Ray Examinations (Mayday Hospital X-Ray Department). 126 cases were referred from Ante-Natal Clinics and 173 films were used. Reasons for reference were Breech for attitude, etc 41 For presentation, attitude, etc. 61 Twins 19 Renal Calculus 2 Maturity 2 Fracture of Sacrum 1 20 cases were referred from the Maternity Wards at Mayday Hospital and 32 films were used. Reasons for reference were:— Breech for attitude, etc 6 For presentation 7 Anencephaly 2 Twins 2 For foetal parts 1 Pyelography 2 132 IN-PATIENT TREATMENT. A.—Patients "Booked" in the Ante-Natal Department - Mayday Hospital. St. Mary's Maternity Hospital. Total. (1) Delivered in Hospital after 28th week 445 562 1,007 (2) Delivered in Hospital before 28th week 5 0 5 (3) Admitted after delivery 5 2 7 (4) Discharged undelivered after Ante-Natal treatment and not subsequently delivered in Hospital 4 1 5 (5) Died undelivered 1 0 1 Totals 460 565 1,025 B.—"Emergency" patients sent into Hospital with some complications by outside doctors or midwives. No Emergency cases were admitted to St. Mary's Maternity Hospital Mayday Hospital. (1) Before Labour— (a) Delivered in Hospital after 28th week 35 (b) Delivered in Hospital before 28th week 7 (c) Discharged undelivered 26 (d) Died 1 (2) In Labour— (a) Delivered in Hospital after 28th week 35 (fc) Delivered in Hospital before 28th week 106 (c) Died 1 (3) After Delivery 26 (4) Ectopic Pregnancy 5 Total 242 A comparison of the patients delivered in the two Hospitals as regards parity, legitimacy and number of attendances at the Ante-Natal Clinics : — Mayday Hospital. Booked. Mayday Hospital. Emergency. St. Mary's Mat. Hospital. Booked. Totals. Primigravidæ 189(42%) 62(34%) 322(57%) 573 (48%) Multigravidæ 261(58%) 121(66%) 240(43%) 622(52%) Legitimate 416(92%) 162(89%) 555(99%) 1,133(95%) Illegitimate 34(8%) 21(11%) 7 (1%) 62(5%) Average attendance at AnteNatal Clinic per patient 6.6 0.2 8.0 6.2 133 Table V. A Numerical Summary of cases admitted for treatment, delivered in Hospital, or admitted after delivery. Some cases appear in more than one category in the Summary. Mayday Hospital Booked. Mayday Hospital Emergency. St. Mary's Maternity Hospital Booked. Total. 1. Conditions chiefly Ante-Natal. Albuminuria 42 20 42 104 Eclampsia 4 5 1 10 Persistent Vomiting of Pregnancy 5 5 1 11 Chorea Gravidarum — 1 — 1 Acute Pyelitis 4 8 2 14 Other Urinary Infection 4 1 3 8 Malnutrition, Debility, Simple Anaemia, etc 13 4 7 24 Ante-partum Thrombo-phlebitis — 2 — 2 Breech presentation for version 8 2 3 13 Disproportion 15 5 11 31 Post-maturity 2 — 5 7 Retroverted Gravid Uterus — 2 — 2 2. Intercurrent Diseases. Chronic Nephritis 3 3 — 6 Pulmonary Tuberculosis 3 2 — 5 Venereal Disease 4 5 — 9 Pneumonia — — — 0 Chronic Rheumatic Carditis 5 1 — 6 Exophthalmic Goitre 1 1 — 2 Insanity — 3 — 3 3. Conditions chiefly Natal. Presentations at Delivery— Anterior Positions of the Vertex 394 47 509 950 Posterior Positions of the Vertex 34 9 38 81 Breech 10 16 20 46 134  Mayday Hospital Booked. Mayday Hospital Emergency. Si. Mary's Maternity Hospital Booked. Total. Shoulder — 2 — 2 Face and Brow 4 1 1 6 Complex — 1 — 1 Caesarean Section 8 1 5 14 Twins 5 4 11 20 Accidental Haemorrhage 5 6 1 12 Placenta Praevia 5 6 3 14 Hydramnios 2 3 3 8 Prolapse of Cord 3 3 3 9 Retained Placenta 3 6 3 12 Post-Partum Haemorrhage 5 3 10 18 B.B.A 5 26 2 33 Lacerated Perineum 83 16 149 248 Obstructed Labour 1 6 — 7 Precipitate Labour 1 1 2 4 Premature Labour 33 23 28 84 Abortion 14 115 — 129 Ectopic Pregnancy — 5 — 5 4. Conditions chiefly Post-Natal excluding re-admissions from Post-Natal Clinic. Retroversion 7 3 27 37 Delayed Involution 29 2 40 71 Post-partum Nephritis 2 10 2 14 Breast Abscess 3 4 — 7 Puerperal Pyrexia 10 3 3 16 Puerperal Fever 2 7 — 9 In addition 14 cases of Puerperal Fever per se were admitted to Mayday Hospital Isolation Wards and 11 cases to the Puerperal Infection Unit at the Borough Hospital. 135 Cardiac Disease. There were seven cases. One mother died, a "Booked" case at Mayday Hospital: a mortality of 14.3 per cent. One infant was undelivered when the mother died, and one was still-born : a mortality of 40 per cent. Two abortions make mortality 2 out of 5. Hydramnios. There were eight cases: two "Booked" and three "Emergency" cases at Mayday Hospital, and three "Booked" cases at St. Mary's Maternity Hospital. No mother died. Five infants were still-born, a mortality of 71.4 per cent. Albuminuria. Every patient attending the Ante-Natal Clinic has the urine tested and the blood pressure recorded at each visit. All cases of Albuminuria (confirmed by catheter specimen) or hypertension with a diastolic blood pressure of 90 or over, are admitted to Hospital. The routine treatment adopted in Hospital was rest, meat-free diet with a high vitamin and calcium content, copious fluids, alkalies and aperients. If the symptoms and signs did not disappear in about 10 days, or if they became progressively worse, labour was induced in Mayday Hospital cases; and in St. Mary's Maternity Hospital, cases were handed over to the rota Medical Officer with this recommendation. 136 Table VI. Albuminuria. Mayday Hospital Booked. Mayday Hospital Emergency. St. Mary's Maternity Hospital Booked. Total. Number of Cases 42 20 42 104 Number of Stillbirths and Infant Deaths 4 6 3 13 Foetal and Infant Mortality 9.5% 40.0% 7.3% 13.3% Number of Maternal Deaths — — — 0 Number of Cases— Responded to treatment and delivered spontaneously near term 10 3 24 47 Responded to treatment and discharged to return abnormal 2 0 4 6 Responded to treatment and discharged to return normal 3 0 6 9 Responded to treatment and discharged—not readmitted 0 3 3 6 Spontaneous premature labour or abortion 3 4 0 7 Not responding to treatment and labour induced 13* 7 8† 28‡ Not responding to treatment, abortion per vaginam induced 0 1 0 1 Not responding to treatment, hysterotomy or hysterectomy performed 1 2 0 3 Not responding to treatment, Caesarean section performed 2 0 0 2 * Includes 2 re-admissions † Includes 3 re-admissions ‡ Includes 5 re-admissions Eclampsia (10 cases). Mayday Hospital Booked. Mayday Hospital Emergency. St. Mary's Mat. Hosp. Booked. Total. Number of Cases 4 5 1 10 Maternal Deaths 1 1 0 2 Maternal Mortality 25% 20% 0 20% Number of Foetal and Infant Deaths 1 2 1 4 Foetal and Infant Mortality 25% 40% 100% 40% 137 Accidental Ante-Partum Haemorrhage (12 cases). Mayday Hospital Booked. Mayday Hospital Emergency. St. Mary's Mat. Hosp. Booked. Total. Number of Cases 5 6 1 12 Number of Stillbirths and Infant Deaths 2 5 0 7 Foetal and Infant Mortality 40% 83.3% 0 58.8% There was one maternal death in a Mayday Hospital "Emergency" case, a mortality of 8.3 per cent. Placenta Praevia (14 cases). Mayday Hospital Booked. Mayday Hospital Emergency St. Mary's Mat. Hosp. . Booked. Total. Number of Cases 5 6 3 14 Number of Stillbirths and Infant Deaths 3 6 1 10 Foetal and Infant Mortality 60% 85.7% 33.3% 66.7% There was one maternal death in a Mayday Hospital "Booked" case, a mortality of 7.1 per cent. Contracted Pelvis (including relative disproportion between the pelvis and foetal head). 31 cases of Contracted Pelvis or Disproportion were treated during the year. There were no maternal deaths. In 26 "Booked" cases there was one infant death (3.9 per cent.), and in 5 "Emergency" cases there were 4 infant deaths (80 per cent). Table VII. Method of Treatment. Mayday Hospital Booked. Mayday Hospital Emergency. St. Mary's Maternity Hospital Boohed. Total. No.of Cases. Infant Deaths No.of Cases. Infant Deaths No.of Cases. Infant Deaths No.of Cases. Infant Deaths Spontaneous Delivery 7 – – – 4 – 11 0 Induction Forceps Delivery 1 – – – 1 1 2 1 Forceps Delivery (not induced) 3 – 5 4 2 – 10 4 Induction, Spontaneous Delivery 0 — — — 1 — 1 0 Caesarean Section 4 — — — 3 — 7 0 Total 15 — 5 4 11 1 31 5 138 Vertex Presentations at Delivery. The number of deliveries in which the occiput was anterior at the beginning of labour, including 49 corrected before labour by Buist's pads, was 950. The number of deliveries in which the occiput was posterior at the beginning of labour was 81. Breech Delivery (46 cases). (For Ante-Natal treatment of breech cases, see page 129). Table VIII. Mayday Hospital Booked. Mayday Hospital Emergency. St. Mary's Maternity Hospital Booked. Total. Number of Breech Deliveries 10 16 20 46 Number of Stillbirths and Infant Deaths 0 11 6 17 Foetal and Infant Mortality 0 68.8% 30% 37% Maternal Deaths 0 1 0 1 An uncomplicated breech delivery is one where an additional risk to the life of the foetus is not present—such conditions as Ante-Patrum, Hæmorrhage, Prematurity, Monstrosity, etc. Table IX. Mayday Hospital Booked. Mayday Hospital Emergency. St. Mary's Maternity Hospital Booked. Total. Number of Uncomplicated Breech Cases 6 4 7 17 Number of Stillbirths and Infant Mortality 0 2 0 2 Foetal and Infant Mortality 0 50% 0 11.8% Number of Complicated Breech Cases 4 12 13 29 Number of Stillbirths and Infant Deaths 0 9 6 5 Foetal and Infant Mortality 0 75% 46.2% 51.7% 139 Face and Brow Presentations (6 cases). There were three cases of Face Presentation and one of Brow "Booked" at Mayday Hospital; one Face Presentation "Emergency" case at Mayday Hospital; and one Face Presentation among the St. Mary's Maternity Hospital "Booked" cases. No mother died. Three infants were stillborn and one died : a mortality of 66.7 per cent. Shoulder Presentations. There were two "Emergency" cases at Mayday Hospital. No mother died. Both infants were stillborn : a mortality of 100 per cent. Complex Presentation. One "Emergency" case at Mayday Hospital had a stillborn baby. Infant mortality, 100 per cent. No maternal death. Prolapse of Cord (9 cases). There were three cases in each of the three categories : Mayday Hospital " Booked," " Emergency," and St. Mary's Maternity Hospital " Booked." No mother died. Seven infants were stillborn : a mortality of 77.8 per cent. Post-Partum Haemorrhage (18 cases). There were five cases in Mayday Hospital "Booked" cases; three in Mayday Hospital "Emergency" cases; and 10 in St. Mary's Maternity Hospital "Booked" cases. There were no maternal deaths. Two infants were still-born : a mortality of 10.5 per cent. Abortion. The service dealt with 129 cases of Abortion during the year. All were treated at Mayday Hospital (14 "Booked" cases and 115 "Emergency"). There were no maternal deaths. In addition, 8 cases of Incomplete Abortion were admitted to Mayday Hospital Isolation Wards as Puerperal Sepsis, and 1 case to the Borough Hospital Puerperal Infection Unit, and are recorded in the Report of the Puerperal Isolation Wards (one maternal death). Conditions for which Abortion was induced: — Chronic Nephritis 4 cases Renal Tuberculosis 1 case Thyrotoxicosis 1 case 140 Ectopic Pregnancy. Five cases of Ectopic Pregnancy were admitted to Mayday Hospital as "Emergency" cases. There was one maternal death, giving a maternal mortality of 20 per cent. Laceration of Perineum. The perineum was lacerated in 248 cases. Table X. Place of Delivery and Category. 1st and 2nd degree. 3rd degree. Total. Mayday Hospital—Booked 82 1 83 Mayday Hospital—Emergency 15 1 16 St. Mary's Maternity Hospital—Booked 147 2 149 248 Induction of Labour. Labour was induced 44 times: 12 were medicinal and 32 instrumental. 16 were in Mayday Hospital "Booked" cases; 8 in Mayday Hospital "Emergency" cases; and 20 in St. Mary's Maternity Hospital "Booked" cases. No mother died. Seven infants were stillborn and 2 died, an infant mortality of 19.6 per cent. Forceps Delivery. Forceps were applied 61 times (18 Mayday Hospital " Booked," 6 Mayday Hospital " Emergency," and 37 St. Mary's Maternity Hospital "Booked" cases). In three cases (one in each category) forceps were applied after induction of labour. There was one maternal death in a St. Mary's Maternity Hospital case (Acute Yellow Atrophy of the Liver). In Mayday Hospital "Booked" cases 2 babies were stillborn, an infant mortality of 11.1 per cent. In Mayday Hospital "Emergency" cases 3 babies were stillborn, an infant mortality of 50 per cent. At St. Mary's Maternity Hospital, 1 baby was stillborn and 2 died, an infant mortality of 8.1 per cent. 141 Table XI. ANALYSIS OF FORCEPS CASES. No. of Cases. Indication. Result. Mother. Child. L. D. L. S.B. D. Mayday Hospital Booked. 4 Disproportion 4 — 4 — — 6 Rigid Soft Parts 6 — 5 1 — 5 Posterior Position, Delayed Rotation 5 — 5 — — 2 Brow or Face Presentation Delay 2 — 1 1 — 1 Eclampsia 1 — 1 — — Mayday Hospital Emergency. 3 Disproportion 3 — 1 2 — 2 Posterior Position, Delayed Rotation 2 — 1 1 — 1 Rigid Soft Parts 1 — 1 — — St. Mary's Maternity Hospital Booked. 4 Disproportion 4 — 2 — 2 1 Persistent Occipito-Posterior 1 — 1 — — 15 Rigid Soft Parts 15 — 15 — — 9 Foetal Distress 9 — 8 1 — 5 Posterior Position, Delayed Rotation 4 1 4 — — 2 Threatened Inertia 2 — 2 — — 1 Maternal Distress 1 — 1 — — 142 Caesarean Section. Caesarean Section was performed 14 times 8 "Booked" and 1 "Emergency" case at Mayday Hospital, and 5 "Booked" cases at St. Mary's Maternity Hospital. In 7 cases the indication was Contracted Pelvis and Disproportion, 4 Pre-eclamptic Toxaemia, 2 Previous Caesarean Section, and 1 Placenta Praevia. There was no maternal death and no still-birth. One baby died at Mayday Hospital. Caesarean Hysterectomy was performed once for Preeclamptic Toxaemia at 24 weeks in an "Emergency" case at Mayday Hospital. Bipolar and Internal Version (3 cases). Two "Emergency" cases at Mayday Hospital were thus treated for Shoulder Presentation, and one "Booked" case at St. Mary's Maternity Hospital was for Placenta Praevia. No mother died. All the babies were stillborn. Embryotomy. Embryotomy was performed three times, once in a Mayday Hospital "Booked" case and twice in Mayday Hospital "Emergency" cases admitted for obstructed labour. There was no maternal death. Manual Removal of Placenta. Manual Removal was performed 12 times. There were three "Booked" cases at both Mayday Hospital and St. Mary's Maternity Hospital. Of six "Emergency" cases at Mayday Hospital, five were delivered before admission. No mother died. One case in each category became pyrexial. Maternal Morbidity. All cases of pyrexia and all maternal deaths after delivery are included as morbid, except cases dealt with for the first time as Puerperal Sepsis after delivery elsewhere. These are given in the Report of the Puerperal Isolation Wards. 143 In the 1,025 "Booked" cases there were 15 cases of pyrexia and 2 deaths without a rise of temperature. The morbidity rate for "Booked" cases was 1.66 per cent. (Mayday Hospital 2.83 per cent., St. Mary's Maternity Hospital 0.71 per cent.). In the 242 "Emergency" cases at Mayday Hospital there were 10 cases of pyrexia and 2 deaths without a rise of temperature. The morbidity rate for Mayday Hospital "Emergency" cases was 4.96 per cent. The Strasbourg Convention standard of pyrexia, as adopted by the Ministry of Health, has been used, namely, "A temperature of 100.4 deg. F. or more, sustained during a period of 24 hours or recurring during that period." Infants. Mayday Mayday St. Mary's Hospital. Hospital. Mat. Hosp. Booked. Emergency. Booked. Total. Per cent. Number of Infants in Hospital on 1st January, 1934 15 2 17 34 — Total number of Live Births, StillBirths and Infants admitted with mother (B.B.A.) 455 85 574 1,114 100 Number of Infants in Hospital on 31st December, 1934 15 2 17 34 — Living—alive on discharge from Hospital 428 57 554 1,039 93.3 Stillborn (fresh) 12 16 9 37 3.3 Stillborn (macerated). 3 7 7 17 1.5 Died (born alive, but died in Hospital) 12 5 4 21 1.9 Infant Feeding and Weight on Discharge from Hospital. In both Hospitals normal infants were breast-fed every four hours, omitting the early morning feed. Of 476 infants discharged from Mayday Hospital, 311 were up to or over birth weight (65.3 per cent.). Of 558 infants discharged from St. Mary's Maternity Hospital, 354 were up to or over birth weight (63.4 per cent.). 144 Twins and Triplets. There were 20 cases of Twins and none of Triplets. There was no maternal death. Mayday Mayday St. Mary's Hospital Hospital Mat. Hosp. Booked. Emergency. Booked. Total. Number of Cases 5 4 11 20 Number of Infants discharged alive 9 4 21 34 Number of Stillbirths and Infant Deaths 1 4* 1 6 Foetal and Infant Mortality 10% 50% 4.5% 15% *Two delivered before admission. Ophthalmia Neonatorum. There were 5 cases of Ophthalmia: 3 in Mayday Hospital "Booked" cases, 1 in a Mayday Hospital "Emergency" case, and 1 in a St. Mary's Maternity Hospital "Booked" case. The Mayday Hospital "Booked" cases responded quickly to treatment, only the lids being affected. The St. Mary's Maternity Hospital case was transferred to the Borough Hospital, and the Mayday Hospital "Emergency" case to St. Margaret's Hospital, London, N.W. In no case was vision subsequently impaired. POST-NATAL AND GYNAECOLOGICAL CLINIC. It will be seen from the Numerical Summary of Cases on page 133 that a considerable number of patients was treated during the lying-in period for abnormal conditions which necessitated a stay in hospital longer than the customary 14 days. The fall in the incidence of abnormality among the cases attending the PostNatal Clinic is probably partly due to this treatment. The increasing number of those who attend the Post-Natal Clinic would also lower the percentage of abnormalities, because it is generally assumed that the incidence of abnormality in those who absent themselves is smaller than in those who do attend. In 1934 70 per cent. of "Booked" cases delivered in the hospitals attended the Post-Natal Clinic six weeks after their confinements. Number of Sessions held 101 Number of individuals presented 981 Number of subsequent attendances 403 Total attendances 1,381 Average attendance per session 13.7 Number of Post-Natal cases 799 Number of Gynæcological cases 182 145 Table XII. POST-NATAL CASES. After confinement at Mayday Hospital. St. Mary's Hospital. Elsewhere. Total. Total Cases 302 454 43 799 Cases found to be normal 246 343 28 617 Cases found to be abnormal. 56 111 15 182 Cases treated as Out-patients 38 93 13 144 Cases admitted to Mayday Hospital 13 2 2 17 Table XIII. CLASSIFICATION OF ABNORMAL POST-NATAL CASES. Source of cases attending Case Group. Mayday Hospital. St. Mary's Hospital. Elsewhere. Percentage of Abnormals. Percentage of all cases attending. Retroversion and Delayed Involution 21 57 5 45.6 10.4 Delayed Involution 11 20 4 19.2 4.4 Trauma 11 23 4 20.9 4.8 Infection 7 4 1 6.6 1.5 Chronic Nephritis 4 2 0 3.3 .8 Other 2 5 1 4.4 1.0 Totals 56 111 15 100.0 22.9 END RESULTS. 773 cases were treated to their termination (other than death) during the year, and the results were classified as follows:— Result I.—Health unimpaired as a result of recent confinement (i.e., no symptoms and no anatomical or functional disability). (91%). Result II.—Health slightly impaired as a result of recent confinement (i.e., no symptoms or disability, but anatomical damage likely to lead to disability in the future, particularly if increased by further pregnancies. This group includes cases impaired by previous confinements and further impaired by the recent confinement so as to make the total impairment, due to all previous confinements, equal to that described in Result III). (6.5%). Result III.—Health seriously impaired as a result of recent confinement (i.e., symptoms or disability present due to trauma, infection, etc., or damage to vital organs, as in chronic nephritis). (2.5%). 146 Mayday St. Mary's Hospital. Hospital. Elsewhere. Totals. Result I 270 401 36 707 Result II 17 30 3 50 Result III 5 10 1 16 Totals, treated to conclusion 292 441 40 773 Maternal Mortality. These cases fail into three categories. The first includes all "Booked" cases (i.e., those who had attended the Ante-Natal Clinic on two occasions, whether they were delivered in the Council's beds or not). The second consists of those admitted to Hospital as "Emergency" cases (i.e., they had not attended the Ante-Natal Clinics on more than one occasion, if at all). The third category is made up of cases admitted after delivery as Puerperal Sepsis per se and treated at Mayday Hospital or in the Borough Hospital Puerperal Infection Unit. This last group is dealt with in the Report of the Puerperal Isolation Wards (see page 147). The Registrar-General's figures for deaths directly due to pregnancy were as follows:— Total Maternal Deaths allocated to Borough of Croydon 11 Maternal Mortality 3.63 per 1,000 These 11 deaths were distributed as follows:— Obstetric Service— Mortality. "Booked" cases 3 2.96 per 1,000 " Emergency" cases 3 12.40 per 1,000 Established Puerperal Sepsis 3 Not dealt with in any way by Obstetric Service 2 The above figures are quoted for comparison with others from the same source. The following figures include all cases whether due to, or associated with, pregnancy: — Deaths. Mortality. (1) "Booked" cases 4 3.90 per 1,000 (2) "Emergency" cases 4 16.53 per 1,000 All cases 8 6.31 per 1,000 (3) Established Puerperal Sepsis 3 120.00 per 1,000 147 The Maternal Deaths were due to the following conditions:— BOOKED. (1) Puerperal Septicaemia. (2) Eclampsia. (3) Sub-acute Bacterial Endocarditis. Placenta Praevia. (4) Acute Yellow Atrophy of the Liver. EMERGENCY. (5) Puerperal Septicaemia. Chronic Nephritis. (6) Accidental Haemorrhage. (7) Ruptured Ectopic Gestation. (8) Eclampsia. Chronic Nephritis. ESTABLISHED PUERPERAL SEPSIS. (9) Septicaemia. General Peritonitis. (10) Septicaemia. General Peritonitis. Abortion. (11) General Peritonitis. Ruptured Vagina. Contracted Pelvis. REPORT OF THE PUERPERAL ISOLATION WARDS. 47 cases were treated in isolation for puerperal infection, 12 of them in the Borough Hospital Puerperal Infection Unit and 35 in Isolation Wards at Mayday Hospital. There were 5 deaths (10.6 per cent.). SOURCES OF THE CASES. From Mayday Hospital—Cases. Deaths. "Booked" cases 12 1 "Emergency" cases 10 1 From St. Mary's Maternity Hospital 0 0 From other Hospitals 1 0 From Private Doctors, deliveries in Nursing Homes 4 0 From Private Doctors, deliveries at home 20 3 DAY OF ADMISSION AFTER LABOUR. Before 0 1st 2nd 2rd 4th 5th 6th 7th 8th 9th 10th After No. of cases 1 — 1 7 8 6 3 7 1 1 4 2 6 33 cases followed Labour with 4 deaths (12.12 per cent.). 14 cases followed Abortion with 1 death (7.14 per cent.). The 47 cases treated may be classified as follows:— Mortality Cases. Deaths. Rate. (1) Patients with infection of the genital tract 32 5 16% (a) Infection limited to uterus, vagina and perineum 12 0 0 (b) Infection involving pelvic cellular tissues, ovaries, Fallopian tubes, pelvic peritoneum or veins 11 0 0 (c) Infection of the birth canal spread beyond the pelvis (general peritonitis, septicemia, etc.) 10 5 50% (2) Patients with infective conditions not originating in the genital tract 14 0 0 148 Factors Bearing on Aetiology. (1) No. of cases (2) No. of cases with genital with non-genital infection. infection. Uncomplicated labour 9 10 Long labour 2 0 Surgical induction of labour 0 0 Instrumental delivery 8 0 Spontaneous abortion 9 1 Evacuation of abortion 4 0 Manual removal of placenta 2 0 Excessive bleeding 6 1 Severe lacerations 3 0 Other interference 4 2 Parity of the Cases. Over Para1 2 3 4 5 6 7 8 9 10 10 No. of cases 1 8 9 6 4 5 1 1 2 0 0 1 The large proportion of cases drawn from deliveries in Mayday Hospital is accounted for by 5 cases of Abortion and 11 cases in Group 2 (non-genital infection) who were isolated on the first day of a rise of temperature. This policy of isolating a case immediately, and often before a diagnosis is made, is necessary, because it is impossible at present completely to isolate a case within the maternity department. OBSTETRIC CONSULTATIONS. As Consulting Obstetrician to the Borough, the Assistant Medical Officer of Health for Obstetrics was called in by medical practitioners to see 31 patients who could not afford to pay a private consultant. The cases were as follows:—Puerperal Septicaemia, Puerperal Peritonitis, Generally Contracted Pelvis, Pregnancy Toxaemia and Jaundice, Toxæmia in an unsuspected pregnancy in as elderly primigravida, Incomplete Abortion, Ectopic Gestation, Puerperal Septicaemia, Complex Presentation and Prolapse of Cord, Pre-eclampsia, Uterine Sepsis, Puerperal Parametritis, Ante-Patrum Haemorrhage, Pre-eclampsia, Suspected Tuberculous Salpingitis, Puerperal Mastitis, Ruptured Vagina and General Peritonitis, Long Labour due to Contracted Pelvis, Puerperal Parametritis, Adherent Placenta and Post-Partum Haemorrhage, Pseudocyesis, Threatened Abortion, Prolonged Labour, 149 Post-Partum Hemorrhage, Puerperal Pyelitis, Pregnancy and large Fibroids, Pregnancy following Cesarean Section for Eclampsia, Puerperal Pyelitis, Inevitable Abortion, Puerperal Mastitis, Puerperal Septicæmia. In addition, he was asked by the Medical Superintendent of Mayday Hospital to give an opinion on the obstetric and gynaecological aspects of 35 cases in the medical and surgical wards of the Hospital. The Retreat, Ross Road. This is a home for unmarried mothers and their babies conducted by the National Free Church Women's Council, and aided by an annual grant of £650 from the Croydon Council. Besides the Matron and Nursing Staff, an honorary lady medical officer attends the Home when necessary. The following figures give the main details regarding the work carried out in 1934, and I am indebted to Dr. Sutherland, the Hon. Medical Officer of the Home, for them :— No. of beds for patients 20 No. of cases admitted 31 Average duration of stay 3/4months No. of cases delivered by (a) Midwives 23 (b) Doctor 4 No. of cases in which medical assistance was sought by a midwife 18 No. of cases notified as (a) Puerperal Fever, (6) Puerperal Pyrexia Nil No. of infants not entirely breast fed while in the institution 2 No. of cases notified of Ophthalrqia Neonatorum 1 No. of cases notified as Pemphigus Neonatorum None No. of maternal deaths 1 No. of infant deaths (a) Still-born 3 (6) within 10 days of birth 1 (Two still-births followed long labour, and 1 was a breech presentation; one died an hour after birth due to prematurity). As is seen the duration of stay much exceeds that in ordinary maternity homes. The girls are kept, with their babies, until suitable situations can be secured for them, and when necessary foster-mothers are found for the babies. Whilst the girls are in the Home they are employed in domestic work. Some of them go out to daily work, but reside in the Home. It is becoming increasingly difficult to get the girls to stay the requisite period; many of them wanting (to take up their former work or new work after two months' stay. 150 Still Births. During 1934, 128 still births were registered in respect of Croydon, but of these 17 were outward transfers to other districts. There were 8 inward transfers, giving a total of 119 for the area. Of these 61 were male babies and 58 female; 1 male and 2 female were illegitimate. The proportion of still births to living children was as 1 to 27. The still birth rate was 3.6 of the total registered births. The rate in 1933 was 2.8%. The still birth rate, on the same basis as for Infant Mortality was 36.0 per 1,000 births. STILL BIRTHS, 1934. Notified by Midwives, Home Cases 23 „ Doctors, Home Cases 17 „ Institutions (Doctors or Midwives) 48* Attended by Midwives alone 46 „ Doctors alone 14 „ Midwives and Doctors 28 Occurred at 9 months 63 „ 8 months 15 „ 6-7 months 11 *Including registered Maternity Homes. An Analysis of 88 Still Births Occurring During the Year. Of the 88 still births investigated 50 were males and 38 females. Type of Delivery.—In 49 cases the confinement was difficult or prolonged. Normal confinement was noted in 24 cases; no information was obtainable in 15 cases. Age of Mother.—Between 20 and 29 years, 39; between 30 and 39 years, 38; between 40 and 49 years, 8. The Health of the Mother during her pregnancy was stated to be good in 56 cases and indifferent or poor in 14 cases; no particulars were obtained in 18 cases. In 13 cases, however, the mother had had a shock or a fall before the still birth. In 23 instances the mother had attended the Ante-Natal Clinic. 65 cases had never attended the Clinic. Attendance at Confinement.—Twenty-eight of the still births investigated occurred in the Mayday Hospital; 13 in St. Mary's Hospital; 21 were attended in their own homes by a private 151 medical practitioner either alone or in conjunction with a midwife; 16 were attended by a midwife alone, and 3 births occurred before any skilled help was available; 6 occurred in private nursing homes. Forceps were reported to have been utilised in 22 of the cases. In 65 cases the baby was born at full term; in 14 during the 8th month of gestation; in 8 during the 7th month; and in 1 under 7 months. The baby was apparently a normal child in 58 cases, abnormal in 10, whilst in 20 no record was available. The still birth was the first pregnancy in 35 instances; the 2nd in 15; the 3rd in 12; the 4ith in 13; the 5th in 2; the 6th in 5; the 7th in 3; the 8th in 2; and beyond in 1. Previous still births had occurred in 10 cases. Ophthalmia Neonatorum. Thirteen cases were notified during 1934. Under the Ophthalmia Neonatorum Regulations, 1926, notification by midwives ceased. Prior to 1926 the number of notifications remained fairly uniform, and it would appear as if only the most severe cases are low brought to the attention of the Authority. The following table gives the notifications in Croydon during the past eleven years:— Table XIV. 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 No of cases 21 22 20 18 7 5 19 14 21 10 13 Rate per 1000 births 6.1 6.5 5.8 5.7 2.8 1.5 5.4 5.6 6 3 3.2 4.0 Results of Treatment. Table XV. Cases treated. Vision Unimpaired. Vision Impaired. Died Removed Remaining under Treatment. Notified, At home. In hospital 13 7 6 11 — — 2 — 152 Infant Mortality. The Infantile Mortality rate was 46 per 1,000 births. This is 1 per 1,000 births less than in 1933, and is the lowest rate yet recorded in the Borough. For the past 5 years the numbers of infant deaths have been: 1930, 171; 1931, 196; 1932, 161; 1933, 148; 1934, 145; 73 deaths of infants occurred in institutions, including Registered Nursing Homes. Neo-Natal Mortality. Table XVI. Number of deaths within the first month of life:— Year. No. of Deaths. No. of Births. Rate. 1926 80 3477 23/1000 live births. 1927 83 3174 26 „ „ „ 1928 66 3374 20 „ „ „ 1929 88 3399 26 „ „ „ 1930 82 3514 23 „ „ „ 1931 88 3400 26 „ „ „ 1932 82 3311 25 „ „ „ 1933 83 3147 26 „ „ „ „ 1934 68 3185 21 „ „ „ „ Among the 145 deaths, 87 occurred in boy babies and 5S in girls. Of the births 1,653 were males and 1,532 females. The infantile mortality rate for the two sexes was, therefore:—Boys, 53; girls, 38. The rate of infant mortality amongst illegitimate children was 113 per 1,000. The rate in legitimate children was 42 per 1,000. 153 The following table gives the causes of death during the first month of life : — 1. Complications of Labour— Cerebral Haemorrhage 2 Trauma at Birth 2 4 11. Foetal States— Congenital Heart Malformation 7 Other Congenital Deformities 6 Atelectasis 11 Congenital Debility and Marasmus 2 Asphyxia Neonatorum 2 28 111. Prematurity 29 — 29 IV. Post-Natal Causes 7 7 68 The rate of infantile mortality for England and Wales in 1934 was 59, and for the 121 large towns 63. The rate for Croydon is therefore considerably lower than the average rate. An analysis of Table XVII. shows that, of the total infant deaths, 17.9% occurred on the first day of life and 46.9% before the completion of the first month, and it is probable that these deaths were due to causes operating before birth except in so far as accidents of birth (4) were concerned. Table XVII. Deaths under one year, arranged in days, weeks and months. CAUSES OF DEATH. 1st day. 2nd day. 3rd day. 4tb day. 5th day. 6th day. 7th day. lst-2nd wk. 2nd-3rd wk. 3rd-4th wk. Under 1 month. 1-2 mths. 2-3 mths. 3-4 mths. 4-5 mths. 5-6 mths. 6-7 mths. 7-8 mths. 8-9 mths. 9-10 mths. 10-11 mths. 11-12 mths. TOTAL. All Causes Certified 26 7 7 3 5 2 1 9 4 4 68 16 15 11 5 11 4 4 2 4 1 4 145 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... 1 ... ... ... ... 1 5 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... l ... ... ... ... ... ... ... ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... 1 2 3 ... ... ... ... ... ... ... ... ... ... ... 3 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... ... 6 2 7 1 4 1 2 ... 2 ... 2 27 Diarrhœa and Enteritis ... ... ... ... ... ... ... ... ... ... ... 2 2 1 2 ... 1 ... 1 1 ... ... 10 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Malformations 2 ... 2 1 4 ... 1 3 ... ... 13 1 3 ... 1 3 ... 1 ... ... ... ... 22 Prematuie Birth 16 6 2 2 ... ... ... 2 1 ... 29 3 1 1 ... ... ... ... ... ... ... ... 34 Atrophy, Atelectasis Debility prarasmus 5 ... 2 ... 1 2 ... 2 ... 2 14 2 3 1 ... 1 1 ... ... ... ... ... 22 Injury at birth 1 1 1 ... ... ... ... 1 ... ... 4 ... ... ... ... ... ... ... ... ... ... ... 4 Other causes 1 ... ... ... ... ... ... 1 2 ... 4 1 2 ... 1 3 ... 1 ... ... ... ... 12 154 155 Deaths Under One Month. An analysis of Table XVII. shows that 17.9% of the infant deaths occurred before the baby was 24 hours old; 35.1% during the first week of life; and 46.9% before the end of the first month. In 1933 the corresponding figures were 18.9%, 34.4%, and 56.1%. These figures relate to infant deaths due to causes probably operating before birth. The chief individual cause was premature birth, which was the assigned cause in 42.6% of deaths under 1 month of life. In the same group can be placed debility which was the cause of 20.5%. Injury at birth is rather different, inasmuch as it is, by skilled ante-natal and natal attention, avoidable; injury caused 5.8% of the deaths. Deaths under one month due to congenital deformities constituted 19.1% of the whole during this age period. It is interesting to see that conditions probably brought on by faulty feeding played practically no part in this mortality. This group of deaths contributed 21.3 per 1,000 births towards the total infantile mortality rate. Deaths Under Three Months. Ninety-nine babies died during the first three months of life, a percentage of the total infant deaths of 68%, and an infant mortality rate of 31 per 1,000 births. As the total infantile mortality rate was 46, it is seen that two-thirds of that rate was due to deaths in infants under 3 months of age. A perusal of the causes of death between the end of the period dealt with in the preceding section, and the end of the third month shows the chief of these to be: Pneumonia, 8 deaths; Debility, 5 deaths; Diarrhoea, Congenital Deformity and Premature Birth, 4 each. The effects of improper feeding, and exposure to infection, are commencing to make themselves felt. Deaths between the 4th month and the end of the first year of life were caused chiefly by Diarrhoea (13.0%) and Pneumonia (41.3%). The Pneumonia deaths occurred in the following months:— January 4, February 3, March 3, April 2, May 4, June 0, July 4, August 1, September 2, October 2, November 0, and December 2; total, 27. Taking the figures in the table as a whole, the outstanding features are:– (1) The predominance of premature birth, and conditions Classified as debility and marasmus. Between them they 156 accounted for 38.6% of the total deaths, and contributed 17.5 deaths per 1,000 births towards the infantile mortality rate. (2) Next to these come Pneumonia and Diarrhoea with 25.5% of the total deaths and a contribution of 11.6 per 1,000 to the infantile mortality rate. (3) The influence of pre-natal causes is exerted mainly during the first two months of life, whilst the influence of environment and nurture, after that time. The causes of death change after the second month in a quite distinct manner. (4) Whooping Cough caused 5 deaths. In 1933 it caused one death. There were 3 deaths from Measles. (5) In the tabulated deaths of children under 1 year of age, the child who died was a first child in 25.9%; a second child in 20.0%; a third child in 9.2%; a fourth child in 8.3%; a fifth child in 5.0% a sixth child in 5.8%; a seventh child in 5.8%; an eighth in 1.7%; and a tenth in 0.8%. In 17.5% of total deaths no data were forthcoming owing to the parents having moved, or for other reasons. The following table gives the chief causes of infant deaths, as compared with 1933:— Table XVIII. Percentage Deaths per Total Infantile Deaths. Deaths per 1,000 Births. 1933. 1934. 1933. 1934. Premature Births 31.8 23.4 14.9 10.6 Respiratory Diseases 18.9 20.7 8.9 9.1 Infectious Diseases (inc. Tuberculosis) 5.4 6.8 2.5 3.1 Atelectasis, Debility and Marasmus 9.5 15.1 4.4 6.9 Diseases of Digestion 12.2 6.8 5.7 3.1 Accidental & Congenital 11.5 17.9 5.4 8.1 Table XIX. Births Deaths 1934 1933 1932 1931 Mortality per 1000 Births General Birth Rate General Death Rate Mortality per 1000 Births General Birth Rate General Death Rate Mortality per 1000 Birth's General Birth Rate General Death Rate Mortality per 1000 Births General Birth Rate General Death Rate January 262 11 42 14.3 14.6 78 14.5 17.9 79 15.5 15.9 88 15.1 20.0 February 268 19 45 14.6 12.0 72 14.2 19.5 49 14.9 16.3 101 16.8 18.7 March 328 16 49 14.3 14.2 48 15 0 11.8 45 15.0 14.0 109 13.9 17.5 April 304 13 36 16.5 11.3 61 16.3 10.9 39 16.8 10.4 55 18.7 13.8 May 309 14 45 13.2 9.2 19 15.1 8.6 33 16.0 9.6 38 15.7 10.1 June 288 10 28 15.6 7.4 24 16.6 7.9 15 18.0 8.3 67 16.3 12.3 July 241 11 33 13.0 8.6 20 14.2 7.6 26 17.3 7.7 41 16.2 9.5 August 383 11 21 16.6 8.1 12 15.2 7.1 43 16.9 8.5 14 17.2 10.3 September 254 6 24 13.8 8.1 35 14.7 7.7 42 13.8 8.6 20 14.9 9.0 October 259 11 31 14.0 9.0 36 12.9 9.4 27 14.2 8.6 52 18.6 12.3 November 336 13 39 14.5 10.8 45 11.5 10.6 31 14.9 9.0 61 14.9 12 3 December 276 10 33 15.0 10.2 54 11.8 14.7 60 12.5 10.9 87 17.4 16.8 157 Maternity and Child Welfare—Deaths of Infants under one year of age. The Birth Rate was highest in August, April, June and December, and the Infantile Mortality was lowest during August, September, October, July and December. The Death Rate was highest in January, February, March and April. Infantile Mortality was highest during March, February, May and January. 158 Infantile Mortality in Wards from 1927 to 1934 Table XX. 1927 1928 1929 1930 1931 1932 1933 1934 Average over 8 years. Upper Norwood 73 80 70 108 80 76 57 33 72 Norbury 27 37 20 48 39 27 30 37 33 West Thornton 34 94 63 29 66 75 33 59 56 Bensham Manor 97 45 55 39 72 28 19 62 52 Thornton Heath 60 75 99 66 66 69 44 42 65 South Norwood 39 53 54 51 48 32 42 52 46 Woodside 57 42 59 40 37 30 50 66 47 East 32 25 63 40 30 68 46 30 41 Addiscombe 58 45 71 33 47 31 35 43 45 Whitehorse Manor 75 59 74 62 74 48 62 60 64 Broad Green 50 48 76 38 46 60 57 41 52 Central 29 58 42 51 91 22 15 30 42 Waddon 46 46 63 56 53 55 63 50 54 South 68 66 61 25 63 34 91 71 59 Addington ... ... ... ... ... ... ... 15 ... The Wards with the highest average infant mortality over an eight year period are: Upper Norwood, Thornton Heath, and Whitehorse Manor; the lowest averages are recorded in Norbury, East and Central. Midwives Acts, 1902 and 1918. 105 midwives notified the Local Supervising Authority of their intention to practise within the Borough during 1934; 27 ceased practising in the Borough, so that 78 remained on the Register at the end of the year. Of these 75 were trained and held the certificate of the Central Midwives Board, and 1 was a bona-fide midwife, i.e., she was in practice as a midwife at the time of the passing of the Midwives Act, 1902, while 2 held the certificate of the London Obstetrical Society. Confinements Attended by Midwives. Cases attended by midwives alone2,215 i.e., 65.2% of Cases attended by midwives when a doctor was total births also engaged 625 Cases attended by midwives when a doctor was also summoned 347 Total 3,187 i.e., 93.8°/o total births 159 The Rules of the Central Midwives Board lay down that the Local Supervising Authority must be informed, within 36 hours, by a midwife if she has summoned medical help during pregnancy, in a confinement or within ten days afterwards. The following table gives details of the reasons for sending for medical aid. For Complications during Pregnancy : Albuminuria 11 Other causes 8 Abortion 1 20 For Complications during Labour : Breech 5 Hand 1 Face 2 Foot 1 Extended Breech 4 Occipito-Posterior 4 Transverse 1 Prolapsed Cord 2 Head 4 Undiagnosed 6 30 Obstructed Labour 5 5 Delayed Labour— Uterine Inertia 17 Prolonged 38 Delayed 37 92 Hœmorrhage— Ante-Partum 13 Post-Partum 7 20 Other Causes— Adherent Placenta 3 Illness of Mother 15 Retained Placenta 5 Twins 4 Torn Perineum 64 Eclampsia 2 93 For Complications during Puerperium : Pyrexia 20 Pain in Breasts 3 Pain in Legs 7 Other causes 2 32 For Complications in regard to the Baby : Inflammation of Eyes 17 Jaundice 2 Still-birth 3 Convulsions 1 Feebleness 3 Deformities 5 Premature Birth 4 Other causes 18 53 The Council assists in the payment of the midwife's fees for attendance on a necessitous patient in her confinement. No attempt is made in such cases to recover from the patient. The 160 object of this is that even the poorest mother can engage the services of a competent midwife, whilst the latter will have no cause to hesitate to attend on the grounds that she will probably receive no payment for her services. Midwives are also compensated if they lose a case through admission to a hospital or maternity home on the advice of the Ante-Natal Clinic. The sum of £70 7s. Od. was paid out during the year. In accordance with Rule 12a of the Central Midwives Board, the following reasons for the discontinuance of breast feeding were received:— Illness of Mother 3 Mother returning to business Insufficient Milk 3 life 3 Total 9 Inspection of Midwives. Dr. Jenkin-Lloyd succeeded Dr. Falk as the Inspector of Midwives in May; she interviewed one midwife at the Town Hall. 150 visits were paid by Drs. Falk and Lloyd to the homes of midwives. Of these visits 73 proved ineffective, the midwife being out. The cleanliness of the midwives' homes and the condition of their bags were on the whole satisfactory. The keeping of case records and temperature charts were not always up-to-date. The Rules of the Central Midwives Board impose an obligation on all certified midwives to take ante-natal records or in lieu thereof to send their cases to an ante-natal clinic, where the records may be made. Midwives have been urged to avail themselves of these facilities and, if possible, to attend themselves with their patient. When the midwife does not attend she is informed by letter of the findings at the Clinic. The midwives have availed themselves of the facilities offered; 188 mothers were sent for this purpose. Disinfection of Midwives Bags, Etc. This is done by the Local Sypervising Authority, free of charge for any midwife asking for it. In 9 instances midwives availed themselves of these facilities. 161 Nursing Homes (Registration) Act, 1927. Maternity Homes. Other Nursing Homes. Combined Maternity and other Nursing Homes. Total. No. of Homes on Register, on 31/12/33 14 13 25 52 No. of Applications for Registration during 1934 1 8 – 9 No. of Homes registered during 1934 1 8 – 9 No. of Orders made : (a) Refusing Registration — — – — (b) Cancelling Registration 1 1 1 3 No. of Appeals against such Orders – – – – No. of Cases in which Orders have been : (a) Confirmed on Appeal — — — — (b) Disallowed — — — — No. of Applications for exemption from registration — — No. of Cases in which exemption has been : (a) Granted — — — — (b) Withdrawn — — (c) Refused — — — — No. of Homes on Register on 31/12/34 14 20 24 58 No. of Beds available 65 226 (a) Mat. beds 52 (a) 117 (b) Other Beds 89 (6) 315 Doctors' Accounts Under Section 14 (1) of the Midwives Act, 1918. 172 accounts were received from doctors for services rendered under the provisions of this section. This compares with 140 in 1933; 153 in 1932; 136 in 1931; 149 in 1930; and 112 in 1929. The total amount of the accounts was £248 14s. 0d. £81 14s. 3d. was ultimately recovered from the patients. In 1933 the amount Paid to doctors was £225; in 1932, £230 1s. 6d.; and in 1931, £224 5s. 6d. 162 The Maternity and Child Welfare Clinics. There are 17 Maternity and Child Welfare Centres, 16 of which are conducted by the Croydon Mothers' and Infants' Welfare Association, and 1 by the Local Authority. A total of 20 sessions per week are held and at all of these a dootor and a nurse on the staff of the Health Department attend. During 1934, 2,190 new cases under 1 year of age, and 1,019 over a year of age attended for the first time; this is a decrease of 4 in the first class and of 8 in the second class. The total attendances of babies and infants from 0.5 years decreased from 77,463 in 1933 to 72,839 in 1934. Consultations with doctors decreased in numbers from 25,251 to 24,721. 312 expectant mothers were seen, an increase of 5 on 1933, and ai total of 1,138 visits to the centres were paid by them. The total of all visits to the Centres was 73,977, a decrease of 4,697 over 1933. The highest average attendance of mothers and babies at each session was recorded at Lower Addiscombe Road (108.9), West Croydon (106.4), and Municipal (98.0). Such large numbers, although indicating an appreciation on the part of the mothers, throw a great strain on the organisation of the centres. It is impossible for the doctor to devote as much time as is desirable to individual cases, whilst the nurse cannot talk to each mother at the length which is sometimes needed. Table XXI. Attendance at Infant centres-1934 Municipal. Boston Road. Sylverdale Road South Croydon. Shirley. Woodside. Lr. Addiscombe Road. South Norwood. Westow Street. Moffatt Road. St. Alban's. St. Paul's. St. Oswald's. West Croydon. Norbury. Waddon. St. Jude's. Total 1934. Total 1933. Total 1932. Total 1931. Total 1930. Infants : New cases under 1 year 361 98 105 122 90 110 183 191 70 74 178 89 78 127 96 109 109 2190 2194 2278 2217 2148 No. of re-attendances 5078 1330 1753 1916 1431 1544 2365 3056 1025 967 2807 1465 1472 1898 1933 1463 1724 33227 36620 35161 33237 31418 New cases over 1 year 145 46 40 54 37 52 87 96 48 21 61 26 29 40 46 139 52 1019 1027 1052 895 708 No. of re-attendances 4198 2083 1338 2120 1160 1273 2441 3354 1186 1358 3609 1735 1397 3033 2027 2280 1811 36403 37622 34645 31434 28025 Attendances of children 0-5 9782 3557 3236 4212 2718 2979 5076 6697 2329 2420 6655 3315 2976 5098 4102 3991 3696 72839 77463 73136 67783 62299 Consultations with Doctor 2862 1085 1057 1248 879 1305 1638 2441 1031 1193 2472 1212 960 1897 971 1341 1129 24721 25251 24652 23068 21697 No. of Sessions 101 49 48 49 48 48 48 98 49 48 98 49 49 51 49 48 48 978 979 972 928 927 Expectant Mothers : No. of new cases 62 — 4 14 9 8 35 28 26 18 28 19 15 5 14 16 11 312 305 334 398 531 No. of re-attendances 55 38 22 38 28 – 116 86 85 103 81 39 24 20 29 37 25 826 906 1035 1038 1121 Total attendances of Expectant Mothers 117 38 26 52 37 8 151 114 111 121 109 58 39 25 43 53 36 1138 1211 1369 1436 1652 Total attendances 9899 3595 3262 4264 2755 2987 5227 6811 2440 2541 6764 3373 3015 5123 4145 4044 3732 73977 78674 74505 69219 63951 Average attendance per Session 1934 98.0 73.3 68.0 87.0 57.4 62.2 108.9 69.5 49 8 52.9 69.9 68.8 61.5 100.4 84.6 84.3 77.8 *75.6 1933 98.7 75.7 70.0 77.9 47.3 73.4 108.6 83.4 69.3 63.3 82.3 72.6 62.5 107.8 96.5 75.1 75.5 *80.4 1932 88.0 79.2 71.4 71.1 46.4 79.4 97.1 78.4 74.4 66.6 74.6 68.0 67.7 98.1 102.3 70.6 52.9 ... *76.7 1931 82.7 68.0 67.3 76.0 48.0 78.0 76.7 87.0 75.7 55.1 73.2 743 62.7 88.2 98.0 59.7 ... ... ... *74.6 1930 81.2 58.7 68.4 78.0 37.7 66.4 70.9 78.5 73.6 55.8 72.4 74.3 40.3 78.3 93.1 50.0 ... ... ... ... *69.0 * Total average attendance each week at all the Centres. 163 164 The following table is intended to show the deaths of babies who at one time or another during their first year attended a clinic, as compared with deaths among those who never attended. If a baby only attended once it is included in the clinic returns:- Table XXII. Deaths Attended M. & c. W. centre Attended at Birth by Full Time Baby Births during the same period Deaths in Institutions Yes No Doctor Midwife Doctor & Midwife Not Known, etc Yes No Not Known Mayday Hospital Observation Nursery Regd. Maternity Homes St. Mary's Hospital Other Institutions 99 29 70 18 48 25 10 63 36 — 3185 35 3 1 2 8 2,190 babies under one year of age attended the Clinics for the first time during 1934. Within the same period 3,185 babies were born and 145 died; 46 of these latter are not included in the above table, as information concerning them was not obtainable. Although the clinic attendance figures and the births and deaths figures do not cover exactly the same periods, the attendances of new cases at the clinics do not fluctuate so greatly as to cause serious error. Of the 99 babies tabulated who died, 29 had attended a Clinic in Croydon and 70 had not attended, i.e., 29% of the deaths were in clinic babies and 70% in non-clinic babies. Of the 3,185 babies born, approximately 70% attended or would attend on calculation based on past attendances. The infantile mortality, estimated on this basis is only 13.1 per 1,000 births for the clinic babies, and 75.2 per 1,000 births for non-clinic babies. The following table is interesting, especially when the figures for under 1 year are contrasted with those for over 1 year. Approximately 77% of the former group of babies were found healthy on their first visit and were presumably brought because their mothers desired expert opinion and advice quite apart from treatment; in the latter group, 76% were found healthy on the first visit, which may be interpreted to mean that when a mother first attends a clinic with a child over a year old she does so because of some difficulty in management; 72% of babies under 1 165 year were being breast fed at their first visit, this figure being more than 1933 (69); 41.2% of the ailing babies were suffering from digestive troubles, 7.8% from respiratory trouble, and 1.6% from rickets. The individual centres showing the highest percentage of babies found healthy on their first visit were Waddon (96) and East Croydon (95). Woodside and Municipal, with 93 and 92 respectively, were next. The centres showing the highest percentage of babies found ailing on their first visit were St. Paul's, South Norwood, and St. Alban's, followed by Sylverdale Road, St. Oswald's and Upper Norwood. Breast feeding seemed most usual in babies living in the Waddon, South Croydon, St. Alban's, Boston Road and Sylverdale Road districts, and least usual in the South Norwood, St. Oswald's, and Norbury districts. In children over one year of age, attending for the first time, the highest precentages healthy were shown by Municipal (96), East Croydon (93), and Woodside (91); the highest percentages found unhealthy were at Sylverdale (58), Upper Norwood (47), Norbury (40), All Saints' (40), and St. Oswald's (40). The largest number of first attendances was recorded at the Municipal Centre, followed by East Croydon, South Norwood, and South Croydon. The Municipal and South Norwood Centres hold two sessions weekly. The Conditions of Babies on First Attendance at a Maternity and Child Welfare Centre. Table XXIII. Babies Under One Year. Children Over One Year. No. found healthy on 1st visit. Percentage. No. found ailing on 1st visit Digestive Troubles. Rickets. Respiratory Troubles Other Causes. Babies on Breast Feeding only. Percentage. Babies Bottle fed only. Babies partly breast and partly bottle fed. No. found healthy on 1st visit. Percentage. No. found ailing on 1st visit. Digestive Troubles. Rickets. Respiratory Troubles Other Causes. No. still on Breast at 1st visit. No. Weaned and on solid food. Percentage. No. not Weaned and on bottle entirely No. on solid food and the Breast. No. on solid food and the bottle. Total first attendances tabulated. Municipal (2) 308 92 15 11 0 1 3 221 71 42 50 120 96 5 3 1 0 1 5 117 91 11 1 0 453 3t. Albans (2) 82 55 67 22 0 1 44 106 76 33 10 33 66 17 0 3 4 10 0 50 100 0 0 0 199 Boston Road 81 85 14 5 2 4 3 72 76 19 4 28 76 9 1 3 3 2 0 26 93 0 1 1 132 West Croydon 85 71 35 15 1 8 11 90 75 21 9 35 78 10 1 6 2 1 0 43 98 0 0 1 165 Norbury 63 84 12 2 1 2 7 49 65 8 18 22 60 15 2 2 0 11 0 33 89 0 2 2 112 St. Paul's 33 35 62 18 0 3 41 64 67 27 4 13 62 8 1 0 1 6 0 20 95 0 0 1 116 All Saints 49 72 20 6 0 0 14 49 71 15 5 15 60 10 0 4 2 4 0 25 100 0 0 0 94 Shirley 62 76 20 12 0 1 7 55 67 21 6 23 82 5 0 0 2 3 0 28 100 0 0 0 110 South Croydon 121 77 36 18 1 5 12 125 80 22 10 35 73 13 1 2 3 7 0 39 81 1 0 8 205 South Norwood(2) 81 48 88 35 0 4 49 99 58 41 29 48 55 40 6 1 13 20 0 88 100 0 0 0 257 Sylverdale Road 54 61 35 22 0 1 12 68 76 18 3 13 42 18 0 5 3 10 0 31 100 0 0 0 120 Upper Norwood 39 68 18 7 1 3 7 38 67 13 6 18 53 16 0 8 0 8 0 34 100 0 0 0 91 Waddon 100 96 4 3 0 0 1 86 83 13 5 55 87 5 1 1 1 2 2 58 100 0 0 0 166 East Croydon 171 95 8 0 0 1 7 134 75 23 22 82 93 6 0 1 2 3 2 84 98 0 1 1 269 Woodside 103 93 8 5 0 1 2 81 73 20 10 40 91 4 0 0 0 4 0 40 100 0 0 0 155 St. Oswald's 47 67 23 12 1 2 8 44 63 18 8 15 60 10 1 2 0 7 0 25 100 0 0 0 95 St. Jude's 103 86 17 6 1 1 9 90 75 7 23 55 85 10 4 0 3 3 0 57 88 1 0 7 185 Totals 1585 77 482 199 8 38 237 1471 72 361 222 350 76 201 21 39 39 102 9 798 93 13 5 21 2924 166 Clinic Sessions Attended by Health Visitors. Table XXIV. Nature of Clinic. Health Visitor—District Number. I. II. II. IV v. VI. VII. VIII. ix. x. xi. xii. xiii. xiv xv, xvi. xvii xviii XIX. xx. xxi. xxii Total. Maternity & Child Welfare Clinics 100 48 17 47 28 47 50 46 49 53 47 45 ... 51 76 47 94 50 47 34 39 13 1028 Ante-natal and Post-natal Clinics ... 1 ... 13 10 ... 47 ... 1 66 ... ... 253 ... ... ... ... ... 11 ... 13 15 430 * Temporary visitors. 167 168 Table XXV. The Work of the Health Visitors.—Home Visiting.—Maternity and Child Welfare Only. I. C.W. II. R.A. III. D.H. IV. B.W. V. A.W.W. VI. j.t. VII M.S. VIII. A..P. IX. V.B. X. A.W. XI. J.C. XII. E.H. XIII. C.G. XIV. AH. XV. A.C. XVI. K.T. XVII. v.c. XVIII. M.C. XIX. R.S. XX.* K.H. XXI. M.S. XXII. G.T. XXIII. e.p. Totals Visits to Expectant Mothers. First visits 50 4 5 8 22 19 6 1 13 14 6 18 3 4 51 12 1 69 4 2 29 6 11 358 Re-visits 27 1 8 5 4 9 17 ... 6 2 3 46 ... ... 51 2 3 16 ... 3 11 11 1 226 Infants under 1 year. First visits 212 95 116 113 132 200 92 138 222 248 165 156 15 215 147 205 170 295 188 13 138 209 160 3644 Re-visits 453 262 290 167 198 319 135 268 386 362 468 932 15 644 718 264 476 687 552 27 211 1052 235 9121 Children 1—2 years. First visits 4 2 4 2 2 8 6 15 5 ... 28 21 ... 3 29 13 11 4 6 3 30 13 8 217 Re-visits 442 287 263 236 170 355 218 142 207 381 337 679 22 386 60 217 527 699 561 26 248 877 214 8124 Children 2—5 years. First visits 10 ... ... 8 ... 6 2 4 14 ... 7 14 ... 4 20 12 5 3 4 ... 28 15 8 164 Re-visits 1029 817 236 670 414 771 589 521 367 691 218 1210 17 591 816 650 645 701 891 73 199 884 486 13486 Ophthalmia Neonatorum. First visits ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 5 Re visits ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 3 ... 6 Still Births 13 4 2 8 2 11 3 1 7 3 3 ... 1 9 2 8 4 7 10 ... 3 7 6 114 Milk (Mothers'and Children's Order) 10 26 31 20 ... 7 3 1 8 5 2 12 ... 2 12 11 ... 5 56 9 4 68 2 294 Puerperal Fever and Pyrexia Visits ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Houses where deaths of Infants occurred 12 5 3 11 7 7 4 3 7 16 3 ... 2 10 1 9 11 6 12 2 4 7 10 152 Miscellaneous Visits 15 9 2 270 14 106 101 4 35 15 6 13 4 25 30 116 4 16 4 3 36 10 4 841 Ineffective Visits 477 228 328 426 481 535 400 394 424 319 424 291 20 288 294 219 578 262 887 39 591 577 233 8715 Post Natal Visits ... ... ... ... ... 38 ... ... 60 76 ... ... ... ... ... ... ... ... ... ... ... ... ... 174 Totals— 1934 2754 1740 1288 1944 1446 2391 1577 1492 1764 2132 1670 3392 99 2181 2801 1738 2435 2770 3175 200 1534 3740 1378 45641 19S3 2806 1620 1904 2063 1824 2259 1992 1584 1736 2361 1887 2921 1588 2078 1903 1813 1956 3111 3453 42162 *Temporarily employed. 169 Milk (Mothers and Children) Order. The table below gives the number of families who were in receipt of assistance under the provisions of the above-named order during the year. The Borough Council pay for all dried milks sold below cost price or given free whether it is ordered at the Voluntary Centres or at the Municipal Centre. All wet milk ordered under cost price is also paid for by the Council. Table XXVI. On Dec. 31st, 1933. New cases during the year. Cases discontinued. On Dec. 31st, 1934. Free 366 630 622 374 Half-price 76 151 177 50 Total 442 781 799 424 In cases where there has been a change from free milk to milk at half-price it has been counted as a new case. Assisted Fluid Milk Scheme. The amount of free milk granted was 121,395 pints. In 1933 it was 121,392 pints. Supplied to Families. No. of Pints. Corporation Liability. £ s. d. Milk at l½d. pint 24,746 175 2 1 Milk Free 96,649 1,287 7 9 121,395 £1,462 9 10 Wed Milks for Year 1935. I am much indebted to Mrs. Horn, Hon. Secretary of the Croydon Mothers' and Infants' Welfare Association, for the figures relating to dried milk sold or given at all the Centres, with the exception of the Municipal Centre. There is a decrease from 1933 in the amount of dried milk given free of 1,286 packets, of 168 packets sold at half-price; and of 1,217 packets at cost price. 170 Table XXVII. Mothers and Infants Welfare Association. (18 sessions per week). Municipal Centre. (2 sessions per week). Free. Halfprice. Full price. Free. Halfprice Full price. January 289 74 1005 114 14 224 February 276 95 845 74 15 217 March 332 102 744 95 16 286 April 232 85 669 51 10 215 May 252 49 786 36 16 231 June 255 57 747 47 15 198 July 198 78 1000 65 24 229 August 230 86 892 46 18 189 September 210 112 967 46 16 176 October 276 110 955 62 21 192 November 328 87 940 78 12 159 December 312 104 847 110 2 159 Totals 3290 1039 10397 824 179 2475 Observation Nursery. 96 babies and three mothers were admitted as compared with 110 babies and 8 mothers in 1933. The average length of stay was 28 days, as compared with 30 days in 1933. The following Table gives particulars: — No. of cases in on 1st January, 1934 10 No. of cases admitted during 1934 96 Average duration of stay 28 days No. of cases discharged 88 (a) In good health 76 (6) Improved 8 (c) No improvement (3 taken out against medical advice) 4 Transferred to other Institutions 6 No. of cases who died 3 No. in at end of 1934 9 One case transferred to Great Ormond Street Hospital- Pyloric stenosis. One case transferred to Croydon General Hospital—Glioma. Four cases transferred to Borough Hospital—Pertussis. The causes of death were: — Prematurity 2 Pneumonia 1 The chief reasons for the admission of cases were: — Failure to thrive 32 Prematurity 3 Rachitis 16 Re-establishment of breast Marasmus 6 feeding 3 Alimentary disorders . 8 Weaning troubles 3 Mismanagement 8 Enteritis 2 Debility 5 Anaemia 1 Malnutrition 4 Pyloric stenosis 1 Bronchitis 4 Total 96 171 Massage Clinic. The Massage Clinic in connection with the Maternity and Child Welfare Scheme is held at Lodge Road on five afternoons a week. Cases are referred thereto by the doctors at the Infant Welfare Centres. A few cases are also referred from the Orthopaedic Clinic and from London Hospitals. The following Table summarises the work done, and indicates the type of case referred. Total number of female patients 43 „ ,, male patients 56 Total 99 Table XXVIII. Conditions for which referred. Males. Females. Total. Mouth Breathing 1 1 2 Secondary Amyotonia 1 ... 1 General backwardness 3 ... 3 Infantile Paralysis 1 ... 1 Weak legs 15 17 32 Bow legs 17 10 27 Knock-knees 13 9 22 Flat-feet Lordosis ... 1 1 Torticollis ... 1 1 Scar tissue ... 1 1 Valgus ankles 2 1 3 Spastic Paraplegia 2 ... 2 Weak back 1 ... 1 Congenital dislocation of hip ... 1 1 Constipation ... 1 1 Totals 56 43 99 Total number of sessions 237 ,, ,, attendances 1,625 Average attendance per session 7 Cases still under treatment at end of 1934 28 172 Dental Treatment of Maternity and Child Welfare Patients. Expectant and nursing mothers and young children requiring treatment are referred by the Medical Officers attending the anteand post-natal Clinics. The dental surgeons visit the Centres when possible to examine the teeth of nursing mothers and young children. The opportunity is taken of giving instruction to mothers on the care of the teeth, the talks being illustrated with the aid of charts, and great interest is shown. Unfortunately, the visits to Centres during the year have been few. This is the more to be regretted, inasmuch as these visits are particularly useful in giving the dental surgeons scope for informal talks to mothers on matters of dental interest. Table XXIX. Expectant. Nursing. Young Children. Total. 1934. 1933. Number Examined 135 131 248 514 551 Referred for Treatment 135 128 229 492 504 Attendances 417 780 484 1681 1742 Fillings 31 68 113 212 377 Extractions 660 823 791 2274 2402 " Gas " Cases 98 131 152 381 357 Local Anaesthesia 110 102 82 294 303 Scalings 44 47 2 93 77 Dressings 49 75 16 140 171 Denture Dressings 57 279 — 336 269 Gum Treatment 22 16 2 40 27 AgNo — — 8 8 43 Treatments completed 34 96 178 308 - Sessions at Centres—5. Sessions treatment—130. Number of Dentures fitted—126. 173 This Table shows the volume of work carried out for the expectant and nursing mothers and young children. The number treated, attendances made, and the number of extractions are slightly lower than last year. It is to be regretted that the amount of conservative treatment also was less than in 1933, but it must be pointed out that many mothers’ teeth are in such a poor state that conservative treatment is often impossible. During the vear 126 dentures were fitted, compared with 95 in the previous year; this is further proof of the defective state of the mothers’ teeth. EXPECTANT MOTHERS. Month of pregnancy at which mother first examined: — Up to 3 months. 4-6 months. 7 & 8 months. % of cases seen in 1932 10.3 53.9 35.8 „ „ 1933 12.9 56.7 30.4 „ „ 1934 11.2 42.9 45.8 The above Table shows that the percentage of mothers treated during the early months of pregnancy is slightly lower than in 1933. In the period 4-6 months there is a marked reduction, and, finally, in the last months of pregnancy, more mothers were treated than in the previous year. For a dental scheme to be effective in safeguarding the health of the unborn child the largest percentage of mothers treated should be in the two earlier groups. It is of great importance that immediately pregnancy is confirmed patients should be dentally examined, and it is equally important that dental sepsis, if present, should be removed without delay. Imperfect nutrition arising from digestive derangement, lowered resistance due to septic absorption, and loss of sleep from toothache are some of the conditions which may arise from dental neglect. Unfortunately, a number of expectant mothers referred from the Ante-Natal Centres for dental treatment in the early stages of pregnancy have had to wait an undue time for an appointment, and at the end of the year there were still 140 ante-natal cases awaiting treatment. When patients are referred for treatment after their first visit to the medical officer they are quite prepared to have the necessary treatment, but if a considerable period elapses before an 174 appointment is received their enthusiasm naturally wanes. This is an undesirable state of affairs and is yet another argument for an increase in the staff of dental surgeons. There is often some reluctance on the part of mothers to dental treatment during the later months of pregnancy. NURSING MOTHERS. Age of baby when mother was first seen: — 1-3 months. 4-6 months. 7-9 months. Over 9 months. % Mothers seen 1932 35.7 36.2 18.3 9.8 „ „ 1933 38.7 32.0 18.6 10.7 „ „ 1934 45.0 24.5 24.5 6.0 These figures show that more mothers were seen immediately after their babies were born than in previous years. The majority of these had been referred for treatment prior to confinement. Only 6% of cases were treated during the latter months of the nursing period. These were chiefly emergency cases, and, in view of the fact that mothers who cease to nurse their babies are ineligible for treatment, only work for the relief of pain was undertaken. The Pre-School Child. The number of toddlers examined was more than in 1933. The number of extractions, unfortunately, has increased, and there is a reduction in the amount of conservative work, due to the fact that many mothers mistakenly wait for an indication of pain before they bring their young children for treatment. These results suggest that more propaganda is needed at the Centres to educate the mothers in matters of dental hygiene. The Centres at which patients were examined, or from which they were referred, are given in the following list: — 1933. 1934. 1933. 1934. Ante-Natal 146 275 Post-Natal — 14 Addiscombe (East) 29 48 St. Alban's 51 48 Municipal 50 64 Sylverdale Road 23 51 Shirley 4 7 Waddon 23 44 Norbury 10 18 West Croydon 12 32 Upper Norwood 25 19 Boston Road 23 32 Moffat Road 31 13 St. Jude's 19 20 South Croydon 24 44 The Retreat 5 6 Woodside 31 37 Milton House 4 8 12 South Norwood 48 69 Nursery School — St. Oswald's 10 9 175 Out of 870 expectant and nursing mothers and young children referred for treatment, only 451, or 52%, were actually treated, a percentage open to considerable improvement. The sum of £59 17s. l0d. was received in payment for the attendances made by mothers and children at Lodge Road and Selhurst Road Clinics. The Babies' Help Committee of the Croydon Mothers and Infants' Welfare Association. I am indebted to Mrs. W. Philpot for the particulars presented herewith. At the beginning of the year the Committee had 9 cases on the books; 22 cases were helped during 1934; 9 remained on the books. The help given varied according to the need and was given at the Welfare Centres through the Health Visitors. The Council give an annual grant of £150. Convalescence Committee of the Croydon Mothers' and Infants' Welfare Association. This Committee undertakes the arrangements for convalescence in cases of mothers and children referred for that purpose by the medical officers at the various Infant Welfare Clinics. I am indebted to the Convalescence Secretary, for the data given. Children sent away with their mothers to Cottages or Homes 157 Children sent away alone to Convalescent Homes— (a) to Coombe Cliff 30 (b) to other Homes 10 40 A grant of £550 was made by the Council to the Association for this work in 1934. I am indebted to Mrs. W. Horn, Hon. Secretary of the Association, for the following: particulars of the most entailed by the Association. The year is the financial year: — Children under 5 sent to Homes. Total No. of weeks. Cost. Cost of other forms of convalescence. £ S. d. £ S. d. 1928—1929 18 86 107 10 0 261 10 7 !929—1930 15 68 80 0 0 99 12 6 1930—1931 31 217 201 7 6 173 0 0 1931—1932 42 341 296 6 1 378 7 6 1932—1933 47 361 322 18 11 379 7 7 !933—1934 56 378 287 6 11 387 0 2 1934(Apl. 1st to Dec. 31 40 261 225 7 0 444 10 4 176 Croydon Rescue and Preventive Association. This Association has a Home at 34, Morland Road. As the Council now make a yearly financial grant of £100 towards its conduction, it is periodically inspected by the Council’s officers. Prospective mothers from this Home attend the Municipal AnteNatal Clinic at Lodge Road. I am indebted to the Superintendent, Miss Grigg Tucker, for the subjoined particulars. Number of beds in Home, 12. Six beds are reserved for mothers and babies and 4 are reserved for expectant mothers. Total number of cases admitted in 1934 (a) Expectant mothers 15 (b) Mothers and babies 11 Wilford Road, Lighthouse Mission Creche. The Council give an annual grant of £100 towards the cost of this Creche. A total of 6,591 attendances was recorded. The premises in which the Creche is conducted are cramped and unsuitable, but steps are being taken to erect new premises. COOMBE CLIFF CONVALESCENT HOME, This home has carried out a useful function during the year and has enabled a number of children to be returned to school much sooner than they would have been otherwise. The following is a summary of the cases dealt with. Cases under 5 years of age were sent by the Croydon Mothers' and Infants' Welfare Association who contributed 15s. weekly towards their maintenance. No. of cases admitted during year: 131. Total number of cases discharged: 153. No. of patient days: 65.7 per patient (1934 cases). Table XXX. Age groups of cases admitted:— 0-4 5—8 9—12 Over 12 Total Male 10 33 19 5 67 Female 10 29 22 3 64 Total 20 62 41 8 131 177 Average length of stay in similar age groups:— 0—1 6—8 9—12 Over 12 Total (days) Male 96.6 66.0 55.3 44.4 66.1 Female 76.2 67.8 57.9 47.3 64.7 Total 86 4 66.8 56.7 45.5 65.7 Condition on Discharge:— 0—1 5—8 9- -12 Over 12 Total M. F. M. F. M. F. M. F. M. F. Improved 7 6 21 14 12 11 2 2 42 33 Much Improved 1 3 10 12 8 12 2 2 21 29 No change 3 2 4 7 5 — — — 12 9 Discharged at parent's request 1 2 1 2 — 1 — — 2 5 Total 12 13 36 35 25 24 4 4 77 76 CHILDREN ACTS, 1908—1933. Since April 1st, 1930, this Act has been administered by the Health Department. The work has been delegated to the Health Visitors who are made responsible to the Medical Officer of Health for all foster children and foster mothers in their respective districts. The Tables below give figures for 1934. Table XXXI. FOSTER CHILDREN No. as at Dec, 31st, 1933 Notice of Reception of Children during the year Notice of Removal to— Children Adopted Died Children reaching age of 9 No. as at December 3lst, 1934 Parent Another area with Foster Parent Another Foster Mother Public Institution 271 282 119 8 76 31 28 3 5 286 Table XXXII. FOSTER MOTHERS. No. at Dec- 31st, 1933 Applications for Removals during the year Registration cancelled for other reasons No. as at December 31st, 1934 Registration during the year With Child Without Child 207 62 5 2 12 250 The Health Visitors paid 3,056 visits to Foster Mothers for the purposes of supervision. 178 SECTION IX. MENTAL DEFICIENCY. The staff of the department dealing with the mentally defective consists of the Medical Officer of Health and the Deputy Medical Officer who are certifying officers; two whole-time visitors; the supervisor at the Occupational Centre, with three helpers. In April, 1929, the Council established a small home at 5, Morland Road, for the reception of 20 low grade mentally deficient boys under the age of 16 years. This institution closed on September 15th, 1934, the Croydon cases remaining being transferred to the Queen's Road Institution. There are two main administrative groups of mentally defectives, viz.:— (a) The Statutory Cases, who consist of certified mental defectives under 7 and over 16 years of age; 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, 1913, as being incapable of further education at a Special School or of being incapable of such education without detriment to other children. (b) Education Cases, who consist of mentally defective children between the ages of 7 and 16 who are capable of instruction in a Special School. The former group are dealt with by the Mental Deficiency Committee, and the latter by the Education Committee. The largest number of notifications of children suspected to be suffering from mental defects are received from School Teachers and the School Attendance Officers. Sources of information regarding cases not coming within the category of school children are mainly the Infant Welfare Centres, Health Visitors, and Probation Officers. 179 Table I. Number of known Mentally Defective Persons in the Borough— I. Statutory Cases — 1933. 1934. aged 0—5 years 4 4 „ 5-16 ,, 71 65 Over 16 years 385 391 Total 460 460 II. Education Cases— Aged 7—16 years 152 148 Combined Total 612 608 Compared with 1933, the Statutory cases show no increase and the Education cases a decrease of 4. The Statutory cases would have shown an increase, but 16 cases on Supervision have been removed from the list, and 8 Public Assistance cases under Guardianship, included in the 1933 fignres, have been omitted in this year's figures. The Statutory cases are distributed as follows:— 1933. 1934. In Certified Institutions 125 127 In Places of Safety and Approved Homes 4 6 On Leave from Institutions 9 14 Under Statutory Supervision at Home 217 219 Under Guardianship 47 46 In Mental Hospitals 13 13 Cases Under Public Assistance 28 20 Observation Cases 17 15 460 460 180 The Education cases were distributed as follows:— 1933. 1934. In Certified Residential Schools 10 7 In Certified Day Schools 110 105 At Private Schools 5 3 At Council Schools (19 waiting for vacancies at St. Christopher's) 14 21 At no school, resident at home 13 12 In other Institutions — — 152 148 During the year the Certifying Medical Officers made examinations and paid visits to the number of 91 to Statutory cases, and 293 to Education cases—a total of 384. The Mental Deficiency Act Visitors paid 2,127 visits to Statutory cases, and 1,107 to Education cases—3,234 visits in all. Statutory Cases. During the year 37 names have been added to the Statutory List—30 of these being notified from the Local Education Authority, and seven coming from other sources. 37 names have been removed from the list—ten having left the Borough, four having died, seven being released from Order, and sixteen being deleted from the lists as requiring no further supervision, 2 cases chargeable to other local authorities are under supervision in the Borough. Notified Cases. Of the 30 cases notified by the Local Education Authority 5 are now in certified institutions; 11 are attending, or about to attend, the Occupational Centre ; 2 are in a Place of Safety, awaiting transfer to an Institution ; 10 are under Statutory supervision; 1 has been certified under the Lunacy Act, and 1 has left the Borough. 181 During 1934 sixty Statutory cases were dealt with as follows, viz.:— Sent to Certified Institutions 14 Sent to an Approved Home 1 Placed under Guardianship 6 Leave granted— (а) to care of parents 2 (б) to other Institutions 12 14 Sent to a place of Safety 2 Sent to Croydon Mental Hospital 2 Varying Orders— (a) Change of Guardian 6 (b) From one Institution to another 8 14 Orders Closed 7 60 The number of cases sent to Certified Institutions shows an increase of ten. Guardianship Gases. There are 46 cases under Statutory guardianship 24 of these under the care of relatives, and 22 with guardians who are not relations. 7 males and 6 females are at work; 18 cases are out of the Borough; 13 under the Brighton Guardianship Society, one with a Guardian in Essex, one in Suffolk, one in Maidstone, one in Godalming and one in Streatham. Five boys and five girls attend the Occupation Centre at Grangewood; 19 of the guardianship cases are doing useful work and 15 are quite unemployable. Five new cases have been placed under Guardianship—two of these in the Borough, 1 at Brighton, 1 at Godalming, and 1 at Streatham. Four Guardianship cases have been sent to Institutional care, two of these having been on leave from Guardianship for some time. Two lads and one girl have been released from Guardianship. One man has been transferred to Guardianship at Brighton, after many years in Institutions. 231 visits have been paid to Guardianship cases during the year. 182 Cases on Leave from Institutions. There are 14 cases on licence from institutions. 12 are boys, and of these one is in regular employment, two in Mayday Hospital, 7 in Queen's Road Homes, and 2 with parents. Two are girls—in regular work. 6, Morland Road. The Institution at 6, Morland Eoad was closed on September 15th. 7 Croydon cases were transferred on August 30th on leave to Mayday Hospital—later they were removed to a Ward in the Queen's Road Homes. Two boys were granted long leave to the care of their parents, and five cases from Lindsey Local Authority were removed to Caistor Institution, Lincoln, on the 15th September. Earlier in the summer vacancies at Cell Barnes Colony were obtained for two boys from 6, Morland Eoad. St. Christopher's Special School. The year 1934 opened with 112 scholars on the roll. During the year 14 children were admitted, and 21 left, leaving 105 names on the Eegister on December 31st. Further particulars regarding the special school are included in the School Medical Section of this report (see page 292). Town Hall Clinic for Mentally Defective and Backward Children, 93 children were examined during 1934. The classifications arrived at, together with the recommendations made, are summarised as under:— I. (a) Certified as Mentally Defective 42 (b) Confirmed as Mentally Defective 9 51 Recommendations— (a) Recommended for Special Day School 26 (b) Recommended for Residential Schools - (c) Referred to Occupation Centre or Institution 16 (d) Special examinations re work, etc. 9 — 51 II. Found to be dull and backward 18 (a) Referred to a Special Class 18 (b) Further trial in Ordinary Class - —18 183 III. Found to be Physically Defective 2 (a) No School pro tem—Supervision at home 2 — 2 IV. (a) Considered to be of normal intelligence and referred to ordinary school 5 (b) Considered to be of normal intelligence, but special observation required re conduct 3 (c) Referred to Child Guidance Clinic 2 — 10 V. Referred for re-examination 12 — 12 VI. Mental and physical examinations at St. Christopher's School 146 Grangewood Occupation Centre. The Occupation Centre is under the control of the Mental Deficiency Committee, and deals only with cases ineducable in a Special School. The Centre is open for five days a week from 9.30 a.m. to 3.30 p.m. and occupies rooms on the first floor of Grangewood Museum. The special school which formerly occupied these rooms removed to new premises at the old Rectory Manor School, Mitcharm Road, towards the end of 1933. Younger children attend daily mornings and afternoons (10 sessions) and the senior girls on Monday, Wednesday and Friday afternoons from 2 to 4 p.m. (3 sessions). Senior boys on Tuesday and Thursday from 2 to 3.30. The premises are not very suitable, as there are insufficient rooms available to allow of proper separation of the different grades of children. The premises vacated by the special school have been occupied by the Centre, by the permission of the Roads Committee, who however, have only granted the lease for one year. The Mental Deficiency Committee are considering the matter of alternative and more suitable accommodation. The Centre is divided into three classes for whom an individual teacher is responsible. The staff consists of a supervisor and three assistants. The subjects taught to the Junior Class are, rhythmic movement drill band, rhythmic singing games, singing, sense training memory, colour, sound, numbers, elements of stitching and rug Making. As handicrafts are taught cork bead mat making, paper winding, mats, raffia weaving, knitting, ravelling, wool sorting. in addition balancing exercises, team games, and countrf dancing are indulged in. 184 The senior girls have instruction in hemstitching, English embroidery, wool embroidery, knitting of babies' woollies, vests, socks, making of plain frocks for children, overalls, plain sewing of pillow slips, tea cloths. As handicraft work, papier mache bowls, sea grass stools, baskets, simple pewter work, are made. Country dancing, drill and singing are also taught. The senior boys learn basket making, making wool rugs, sea grass stools, raffia and cane work, papier mache bowls. All grades have domestic duty in preparing meals, washing up, polishing, etc. The Christmas Party was held as usual and was attended by 56 parents, tea being provided together with presents off the Christmas tree for the children. Three open days for parents were also held. Parents contributed liberally towards the party by giving cakes, crackers, etc. 1934. Details. Full Time. Part Time. No. on register January 1st, 1934 47 13 No. of pupils who left during year 16 2 No. of pupils admitted during year 18 — No. of pupils on register January 1st, 1935 49 11 Total attendances 7,955 969 Average morning attendance 36 (whole-time class) Average afternoon attendance senior girls’ class 6 „ „ „ boys’ „ 2 Sessions held 217 216 Girls’ Afternoon Class— Total attendances 798 Sessions held 130 Boys’ Afternoon Class— Total attendances 171 Sessions held 86 185 SECTION X. ORTHOPAEDIC DEPARTMENT. Cases referred for Orthopaedic treatment from the Tuberculosis, the School Medical and other branches of the Public Health Department's work are seen and treated by Mr. A. Todd at the Croydon General Hospital every Thursday. The arrangement is based financially on payment to the Hospital, per attendance. The cases are referred to the Mayday Hospital, and various well-known Orthopaedic institutions for in-patient treatment. The after-care organiser of the Department attends at each session. In addition to the Clinic at the General Hospital, concerning which only the tables below apply, there are Remedial Exercises Clinics conducted under the School Medical Scheme (referred to in the School Report) and a Massage Clinic for children under five years, referred by Medical Officers at the Welfare Centres. Table I. Summary of Cases Attending the Orthopaedic Clinic. Jan. 1st, 1934. New Cases, 1934. Cases Discharged, 1934. Cases on books, Dec. 31st, 1934. M.C.W, S.M.S. Tuberc. M.C.W. S.M S. Tuberc. M.C.W S.M.S Tuberc. M.C.W. S.M.S. Tuberc. 192 379 63 153 185 10 105 164 15 240 300 58 534 348 284 598 The Clinic continues to expand steadily. On January 1st 1928, there were 229 cases on the books; by January, 1935, this figure had risen to 598; on January 1st, 1932, 458; on January 1st, 1933, 483; and on January 1st, 1934, 534; 284 cases were discharged as compared with 305 in 1933, and there were 348 new cases compared with 356 in the latter year. Cases of Bone, Joint and Abdominal Tuberculosis in childhood are steadily declining, and the number of new cases attributed to Tuberculosis declined from 51 in 1929 to 42 in 1930, t0 31 in 1931, to 13 in 1932. In 1933 there was a small increase in the number, which was 21. In 1934 the number had declined to 10. 186 They would, in all probability, decline more rapidly if any milk found to contain Tubercle Bacilli could be condemned as unfit for human consumption. Table II. Cases seen by the Orthopaedic Surgeon. Defect. School. M.C.W. Tuberculosis. Total. Cases. Visits paid. Cases. Visits paid. Cases. Visits paid. Cases. Visits paid Infantile Paralysis 29 61 10 31 ... ... 39 92 Scoliosis 50 113 4 12 ... ... 54 125 Pes Cavus 3 8 ... ... ... ... 3 8 Pes Planus 196 272 83 118 ... ... 279 390 Talipes* 7 10 41 124 ... ... 48 134 Genu Valgum 25 32 92 152 ... ... 117 184 Obstetrical Paralysis 14 22 4 10 ... ... 18 32 3 10 ... ... 37a 46 76 119 Joint Disease 31s 58 5m 5 Injuries 34 57 13 22 ... ... 47 79 Rickets 7 11 39 57 ... ... 46 68 Wry Neck 10 23 4 6 ... ... 14 28 Spastic Paraplegia 13 16 6 7 ... ... 19 23 Other Deformities 73 110 49 89 ... ... 122 199 464 744 345 628 73 109 882 1481 •Includes cases of ankle valgus, spasmodic valgus, and other predisposing causes of flat feet. Summarised, the Table shows 464 school children attended and made 744 attendances; 345 babies made 628 attendances; and 73 tuberculosis cases made 109 attendances; a total of 882 cases, making 1,481 attendances. The following- Table shows the number of cases referred direct from the Orthopasdic Clinic for massage, Swedish remedial) and electrical treatment, and also X-Ray examination at the Croydon General Hospital. 187 Table III. Cases referred from Orthopaedic Clinic for Kemedial Treatment and X-ray at Croydon General Hospital. Defects School Cases M.C.W. Cases Tuberculosis Cases Total Cases No. of Treatments X-Rays Cases No. of Treat- men's X-Rays Cases No. of Treatments X-Rays Cases No. of Treatments X-Rays Infantile Paralysis 8 150 ... 4 126 ... ... ... ... 12 276 ... Scoliosis 26 703 4 1 8 ... ... ... ... 27 711 1 Pes Cavus 1 26 1 1 26 ... ... ... ... 2 52 1 Pes Planus 25 346 ... 5 72 ... ... ... ... 30 418 ... Talipes 2 6 1 9 415 1 ... ... ... 11 421 2 Genu Valgum 5 27 ... 6 76 ... ... ... ... 8 103 ... Obstetrical Paralysis 2 60 ... 1 4 1 ... ... ... 3 64 1 Joint Disease 3 ... 3 ... ... ... 18 33 11 21 33 24 Injuries 6 61 6 2 11 2 ... ... ... 8 72 8 Rickets 1 16 ... 1 12 2 ... ... ... 2 28 2 Wry Neck 5 148 2 2 41 ... ... ... ... 7 189 2 Spastic Paraplegia 2 29 ... ... ... ... ... ... ... 2 29 ... Other Deformities 11 89 15 6 54 3 ... ... ... 17 143 18 95 1661 32 37 845 9 18 33 21 150 2539 62 Table IV. Cases Sent to Residential Institutions. Name of Institution School Cases M.C.W. Cases Tuberculosis Cases Total No. in on Jan. lst, 1935. No. in on Jan. 1st, 1934. Admitted Discharged No. in on Jan. 1st, 1934. Admitted Discharged No. in on Jan. 1st, 1934. Admitted Discharged No. in on Jan. 1st, 1934. Admitted Discharged Pyrford 5 2 4 2 3 3 11 5 6 18 10 13 15 Croydon. General 1 8 8 ... 2 2 ... 3 3 1 13 13 1 6 10 12 2 5 5 11 8 9 19 23 26 16 188 The following Table shows the conditions for which patients were admitted to Hospitals and the results of treatment. Table V. Condition. In on Jan. 1st, 1934. Admitted. Discharged In on Jan. lst, 1935. Cured. Much Improved. Improved. Died. Infantile Paralysis 1 ... ... ... 1 ... ... Talipes ... 4 ... 3 1 ... ... Tuberc. Joint Disease 12 8 3 5 1 1 10 Observation Joint Disease 4 7 5 4 ... ... 2 Rickets 1 3 ... ... ... ... 4 Wry Neck ... 1 1 ... ... ... ... Other Deformities 1 ... 1 ... ... ... ... 19 23 10 12 3 16 The percentage of cures for the whole series of cases was 38.4%, whilst 41.7% were much improved. Table to show number of cases for whom appliances were ordered and how the expenses thereof were met: — Total cases on books of the Clinic, January 1st, 1935 598 Total number actually in receipt of massage, electrical, Swedish remedial treatment, on January 1st, 1935 38 New splints and appliances supplied 87 Repair of existing appliances 19 Part cost met by parents 16% Full cost met by parents 46% Full cost met by Local Authority 38% Number of cases in which Hospital contributions were authorised 16 Mrs. D. B. Connor, the Organiser of this Department, attended 48 Clinic sessions, interviewed 2,252 people, made 320 enquiries into financial conditions of families, and sent out 1,050 letters in connection with her work. Mrs. Connor's work, though interesting, calls for a considerable degree of tact and sympathy, and, I am happy to record, the success of the Orthopaedic work carried out by the Local Authority is largely attributable to her aptness for the work. Maternity and Child Welfare Massage Clinic, Lodge Road. One of the whole-time masseuses devotes 5 sessions a week to this work. The remainder of her time is devoted to the children at St. Giles’ School which she attends each morning. 189 SECTION XI. CROYDON AERODROME. Aliens Acts. The London Terminal Aerodrome is situated in the area of Croydon. Medical duties in connection with the Aliens Acts are carried out on behalf of the Ministry of Health by a part-time medical officer on the staff of the Medical Officer of Health. The duties of a medical officer at an Aerodrome differ considerably from those at a seaport; the type of passenger using air transport not being of the kind dealt with by sea-borne traffic. The majority of passengers are business people or tourists. The Medical Officer is on duty six hours daily from April to September inclusive, and two hours daily during the six winter months. He is under the administrative control of the Medical Officer of Health. The arrangements made at the Aerodrome for the convenience of passengers and for the examination of aliens are satistory. The arrangements work smoothly and efficiently, and much of this is due to the cordial co-operation and help at all times received from H.M. Immigration Officers, H.M. Customs Officers, and the management staff of the Aerodrome. The Table below gives a summary of the traffic during the year. Table I. LONDON TERMINAL AERODROME. Aliens Act, 1930. Medical Officer's Return for the year ending 31st December, 1934. Number of Planes. Arrived from Ait. Seen. Paris. Amsterdam. Brussels. Elsewhere. Total: 4,984 2,168 2,544 1,472 723 245 Passengers. Attendances of M.O. British. Others. Inspected. Exd. 27,200 19,357 21,703 52 ... 277 These figures show a considerable increase on last year’s figures both in the number of machines arriving and departing and in the number of passengers carried. This expeditious and safe method of travel is becoming steadily more popular. 190 SECTION XII.—MISCELLANEOUS. ULTRA-VIOLET LIGHT CLINIC. The Clinic is held at the Croydon General Hospital on two days a week under the superintendence of Dr. F. HernamanJohnson. Cases were referred from the Tuberculosis Dispensary (5), the Maternity and Child Welfare Department (34), and the School Medical Service (36). The following Table gives a summary of the attendances made: — Table I. Department. No. of Cases. Aggregate duration of treatment in weeks. Aggregate No. of Sessions Attended. No. of Patients discharged. No. continuing treatment end of 1934. School Medical 36 438 1219 32 4 m. &C.W. 34 239 783 27 7 Tuberculosis 5 54 133 3 2 75 731 2135 62 13 The Table under gives the complaints treated and the results achieved in completed cases. Thirteen cases ceased attending before completion of treatment, one went to a Convalescent Home, one was transferred to a London Hospital, and two cases left the Borough. Table II. Condition, School Cases. M. SC. W. Cases. Total. Much Improved. Improved. Slight Impr. I.s.q. Much Improved. Improved. Slight Impr, I.S.Q. Debility 9 9 ... 1 5 3 ... ... 27 Asthma 1 ... ... ... ... ... ... ... 1 Bronchitis 1 ... ... ... 2 ... ... ... 3 Glands 2 1 ... ... ... ... ... ... 3 Rickets ... ... ... ... 3 1 ... ... 4 Miscellaneous 1 2 ... ... ... 2 ... ... 5 14 12 ... 1 10 6 ... ... 43 191 School Cases. Four school cases were still attending the Clinic at the end of the year. These were suffering from the following conditions, viz.:—General Debility, 2; Pulmonary Catarrh, 1; Anaemia and Debility, 1. Maternity and Child Welfare Cases. Seven Maternity and Child Welfare cases were still attending the Clinic at the end of the year. These were suffering from the following conditions, viz.:—Debility, 3; Rickets, 2; Bronchitis, 1; Cervical Adenitis, 1. Table III. Much Improved Improvement Slight Improvement I.S.Q. Still attending at end of 1931 Total Adenitis 1 1 ... ... 1 3 Sinusitis ... ... 1 ... 1 2 1 1 1 ... 2 5 Of the School cases, 21 were boys and 15 girls; the Maternity and Child Welfare cases, 15 boys and 19 girls; and the Tuberculosis patients, 3 male and 2 female. There is a tendency sometimes to exaggerate the therapeutic importance of this form of treatment. All the cases referred to the Clinic had been carefully selected as likely to benefit; of those discharged, 57.8% after completion of treatment, were much improved, 11.4% were improved, and 30.8% were not benefited. these figures show that it is by no means a panacea, though, under expert supervision of dosage, exposure, etc., it is capable of assisting natural forces to bring about improvement in bodily health. In unskilled hands it is capable of causing bodily damage. Two types of lamps were used—the Mercury Vapour and the Carbon Arc; the former alone was used in 56 of the cases; the latter alone in 11 cases, and both lamps in 8 cases. The use of artificial sunlight lamps in bathrooms is fraught with considerable risk and their installation should only be made under strict expert supervision. 192 BLIND PERSONS ACT, 1920. Under Section 102 (1) of the Local Government Act, 1929, the Minister of Health was required to make a scheme providing for payments of contributions of such amounts as might be specified in the scheme to any voluntary association which provided services for the welfare of the blind, by the Councils of Counties and County Boroughs in which are resident blind persons for whose benefit the services are provided. The scheme, which came into force on April 1st, 1930, has continued during 1934. Under this scheme the Council pays grants to twelve societies, among which by far the largest grant is made to the Croydon Voluntary Association for the Blind. The visitation of home teachers, employees of workshops, home workers and inmates of homes subject to grant are now carried out by the Medical Officer of Health who reports from time to time to the Blind Persons Act Committee. Close co-operation has been maintained with the Croydon Voluntary Association for the Blind. The Blind persons residing in Croydon are now visited at regular and frequent intervals by the Health Visitors and any circumstances in their reports justifying further investigation, are followed up by the Deputy Medical Officer of Health. I am indebted to the Secretary of the Voluntary Association for the figures below:— Number of blind on Register 352 Number of blind who benefit from instruction in Braille or Moon Type (including those who already read) 74 Number of blind who benefit from part-time instruction 18 Number in remunerative handicrafts— (a) Home workers 26 (b) In workshops 7 Home Teacher 1 The Health Visitors paid 882 visits to blind persons during the year. The Medical Officer also paid home visits to blind persons during the year. 193 SECTION XIII. SANITARY CIRCUMSTANCES. To the Medical Officer of Health. I beg to submit in accordance with the Sanitary Officers’ Order, 1922, a report for the year ending December 31st, 1934, of the work carried out by the Sanitary Inspeotors and other officers under my supervision. ROBERT J. JACKSON, Chief Sanitary Inspector. 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. 1927. ,, ,, 1930. ,, ,, 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). 194 Regulations. Regulations as to connections with sewers, 1911. ,, for securing the proper ventilation and ing of rooms to which Section 18 (1) of the Housing Act, 1925, applies and the Protection thereof against Dampness, Effluvia or Exhalation. ,, for Public Slaughterhouses, 1923. Byelaws. With respect to Common Lodging Houses, 1931. ,, Tents, Vans, Sheds and similar structures used for human habitation, 1931. ,, New Streets and Buildings, 1929. ,, Offensive Trades, 1925. ,, Conduct of Persons using Public ences, 1926. ,, Street Trading, 1927. ,, Slaughterhouses, 1934. ,, Cleanliness of Food, 1929. ,, Smoke. Public Health (Smoke Abatement) Act, 1926. ,, Houses Let in Lodgings, 1931. ,, The Prevention of Nuisances arising from Snow, Rubbish, etc., and for the Prevention of Keeping of Animals so as to be Injurious to Health, 1931. ,, The Good Rule and Government of the County Borough of Croydon and for the Prevention of Nuisances, 1931. ,, Nuisances from Dogs, 1932. 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) 5207 No. of houses inspected under the Housing (Consolidated Regulations) 1926 3008 No. of Houses inspected under the Rent Restriction Acts 144 No. of Houses inspected where zymotic diseases have occurred 976 House drains tested with smoke (primary) 1726 House drains tested with smoke (on application) 42 No. of smoke tests during repair 608 195 Inspection of drainage work during construction 4197 No. of water tests during repair 512 Final tests of drains after repair 69 Final tests of drains when completely relaid 46 Length of new drains tested with water yards 2818 Inspections of yards, stables and manure pits 619 ,, Passages 150 ,, Public Conveniences 846 ,, Pigstyes 63 ,, Tents, Vans, and similar structures 41 ,, Theatres, Cinemas, Halls, etc. 122 ,, Ponds and Ditches 62 ,, Schools and School Lavatories 73 ,, Common Lodging Houses (including night visits) 93 ,, Houses let in lodgings 135 ,, Premises where offensive trades are conducted 241 Smoke Observations 15 No. of Visits re Infectious Diseases 2374 Inspections of Shops (under Shops Acts) 2136 Special Early Closing Patrols 109 Special Evening Inspections under Shops Hours’ Act 73 inspections 'under Fertilisers and Feeding Stuffs Act 69 ,, under Pharmacy and Poisons Act 20 ,, Dairies 286 ,, Farms and Cowsheds 108 ,, Milkshops 696 ,, Premises where food is prepared or sold 7873 ,, Slaughterhouses 798 ,, Factories 573 ,, Factory Laundries 21 ,, Workshops 668 ,, Workshop Laundries 14 ,, Workplaces 246 ,, Factory Bakehouses 265 ,, Workshop Bakehouses 102 ,, Outworkers Premises 106 Baths Inspections 3 Water Samples taken 4 Visits to Employers of Outworkers 12 Reinspections of Work in Progress 26552 Sundry Inspections and Visits 5218 Appointments kept with Owners, Builders, etc. 3223 Complaints from public investigated (for purposes other than inspection of House) 3991 Examination of Building Plans 150 Informal Notices outstanding 31/12/33 2791 ,, ,, served 9872 ,, ,, complied 8822 No. of Informal Notices referred for Statutory Orders 749 Informal Notices outstanding (including 321 overcrowding) 3092 Statutory Notices outstanding 31/12/33 174 ,, ,, served 609 ,, ,, complied 591 Total number of complaints received 3988 Interviews with callers 5315 Letters received 4574 Letters and other intimations, etc., sent (not including notices) 8486 198 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1934 and for which action was taken to enforce compliance:— (1) NUISANCES AND HOUSING DEFECTS AT HOUSES, &c. Insufficient means of ventilation— Defective sashcords 1632 ,, windows 1266 Want of windows or ventilators 59 Conditions causing dampness— Defective roofs 136 ,, gutters 736 ,, downspouts 366 ,, walls, etc. 1136 Deposits of refuse causing dampness 3 Want of proper damp proof course 95 Other internal defects and nuisances— Defective plaster 1922 Cleansing and limewashing required 2481 Defective floors 787 Insufficient ventilation under floor 66 Defective stoves and fireplaces 779 Defective sanitary fittings— Defective sinks 329 ,, waste pipes 385 Abolition of drinking water cisterns 24 Defective w.c.’s 1202 drainage 926 Stoppage in drains 276 Domestic nuisances— Want of cleanliness 44 Dirty w.c. pans 26 Other nuisances and infringements— Bad smells 12 Offensive accumulations 136 Insufficient accommodation for sub-tenants 13 Defective manure receptacles 11 Want of manure receptacles 11 Defective sanitary conveniences 26 Dirty sanitary conveniences 10 Smoke nuisances 2 Sundry nuisances or defects 1395 Limewashing of stables 2 Defective stables 2 Defective stable drainage 3 Accumulation of manure 133 Particulars not inserted in Rent Book (Housing Act) 132 ,, ,, ,, ,, (Rent Restriction Act) 190 197 (2) FACTORIES, WORKSHOPS & WORKPLACES— Cleansing and whitewashing required 135 Additional ventilation 15 Dustbins required 41 Repairs to floors 7 Repairs to paving 13 Overcrowding 2 Infringements of drinking water supply regulations 7 Sundry other nuisances or defects 60 Outworkers lists not in accordance with Act 1 Abstract not exhibited 3 W.c.’s— Insufficiently screened 2 Insufficient 5 Defective 111 Not kept clean 70 Not separate for sexes 3 Want of intervening ventilated space 6 (3) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924— Food cupboards defective or required 263 Dustbins required 1173 Verminous conditions 172 (4) INFRINGEMENTS OF PUBLIC HEALTH ACT, 1925 (S.72—75) AND INFRINGEMENTS OF FOOD BYELAWS— Cleansing or repair of walls and ceilings 153 ,, ,, floors, utensils, fixtures, etc 143 Dirty or defective w.c.’s 119 Food storage bins required 10 Animals kept in food store 19 Drain inlet in food store 5 Accumulation in food store 73 Trade waste improperly kept 42 Food in uncovered vehicles or baskets 6 Food improperly kept or manufactured 38 Premises not suitable for food stored 21 Want of provision of towels 12 Provision of cloak room accommodation 31 Overalls required 4 Illegal wrapping of food 6 Household washing in food store 5 Want of ventilation in food store 11 ’’ intervening ventilated space between w.c. and food store 10 Defective or unsuitable floors 20 Insufficient w.c. accommodation 8 Defective sanitary fittings 18 „ yard paving 33 ,, sink accommodation and water supply 14 Other infringements 64 (5) INFRINGEMENTS OF PUBLIC HEALTH ACTS (AMENDMENT) ACT, 1907— Defective yard paving 809 Rain water pipes used as ventilation pipes 1 198 (6) INFRINGEMENTS OF SHOPS ACTS— Mixed shop notices required 124 Assistants Weekly Half-Holiday notices required 138 Employment of Young Persons notices required 66 Infringements of Weekly Half-holiday Closing Order 1 ,, ,, evening closure 7 ,, „ meal times 6 Employment of Young Persons during Half-day Session 4 (7) INFRINGEMENTS OF COMMON LODGING HOUSE BYELAWS Yard Paving 2 Dustbins required 1 Dirty conditions 8 Defective sashcords 4 (8) INFRINGEMENTS OF HOUSES LET IN LODGINGS BYELAWS— Additional cooking and sink accommodation 7 Want of food storage accommodation 11 Provision of washing accommodation 10 Want of w.c. accommodation 1 ,, artificial lighting to common staircase 8 External fire escapes required 4 Handrail required to stairs 2 Cleansing required 20 Defective windows and sashcords 19 Insufficient area to windows or ventilators 4 (9) INFRINGEMENTS OF OFFENSIVE TRADE BYELAWS. Fishfiying premises—- Limewashing required 7 Cleansing of utensils and bins 4 Other premises— Offensive accumulation 7 Cleansing and whitewashing required 8 Sorting rags on public highway 1 (10) INSPECTION OF AMUSEMENT HOUSES— Defective sanitary fittings 13 Insufficient w.c. accommodation 1 Cleansing and lime washing 3 W.c. required cleansing 1 W.C. insufficiently lighted 6 Want of intervening ventilated space 1 Notices to be fixed to door of lavatories 5 (11) KEEPING OF ANIMALS— Other nuisances in connection with the keeping of pigs 16 Nuisances arising from the keeping of other animals 34 (12) INSPECTION OF WATERCOURSES, etc.— Cleansing of watercourses 2 (13) INFRINGEMENTS OF PHARMACY & POISONS, &c., ACT- Article not labelled in accordance with the Act 1 199 (14) INFRINGEMENTS OF FERTILISERS & FEEDING STUFFS ACT, Sec. 1 (1) (11) 10 (15) INFRINGEMENTS OF RATS & MICE DESTRUCTION ACT— Infestations of rats In yards of business premises 7 ,, ,, on premises where food is prepared or sold 12 Accumulations of refuse, etc., harbouring rats 1 Domestic accumulations harbouring rats 1 Rats on premises where animals are kept 2 Defective drainage 10 Structural defects allowing ingress of rats into dwelling houses 17 (16) INFRINGEMENTS OF MERCHANDISE MARKS ACT & AGRICULTURAL PRODUCE & MARKING ACT— Apples not marked 86 Tomatoes ” 88 Eggs ” 4 Salmon ” 4 Imported Butter not marked 5 Currants ” 19 Sultanas ” 14 Raisins ” 13 Bacon ” 1 Honey ” 1 (17) INSPECTION OF SCHOOL LAVATORIES— Defective Sanitary fittings 11 Defective Drains 3 Structural defects in school lavatories 2 (18) INFRINGEMENTS OF OTHER BYELAWS— Noisy loud speakers 1 Noisy animals 9 Refuse deposited in streets 3 Offensive washing up water thrown over footpath 22 Fouling footpaths by dogs 1 Infringements in slaughterhouses 3 Milk bottles on public highway 2 Weeds on waste land 1 (19) INFRINGEMENTS OF PUBLIC HEALTH (MEAT) REGULATIONS— Cleansing of utensils, tables, etc. 5 Meat displayed in front of shop 3 Basket containing meat not covered 1 (20) INFRINGEMENTS OF FOOD AND DRUGS (ADULTERATION) ACT, 1928— Margarine not marked 5 (21) SALE OF FOOD ORDER, 1921— Meat not marked 32 200 (22) INFRINGEMENTS OF MILK & DAIRIES REGULATIONS, &c— Defective walls and ceilings 3 ” dairy floors and paving 4 ” sanitary fittings 1 Dirty dairies 6 ” utensils in dairies 2 ” conveniences 1 Unsuitaible storage for bottles 1 Milk improperly kept 3 Illegal bottling of milk 1 Vehicles not labelled 2 Bottles not labelled 1 Cowshed requiring limewashing 4 Accumulation of manure in cowshed 1 Selling milk on unregistered premises 1 Churns not washed out before returning 2 SANITARY CERTIFICATES On application, an intending or actual occupier or owner, 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 is made of the premises and the drains are tested. During 1934 requests were made in connection with 40 houses. 2 schools. Total 42. The following defects were ascertained in consequence of these inspections :— Defective gutters 1 „ downspouts 4 „ drains 23 „ sanitary fittings 15 „ drinking water cisterns 2 „ dustbins 1 „ plasterwork 1 „ yard paving 2 Dampness 6 Insufficient ventilation under floor 1 RENT RESTRICTION ACTS. A number of applications were received for certificates as to the condition of repair of the houses concerned. In 55 instances where the Acts applied certificates were granted. In 12 instances certificates were given to owners stating that the work had been carried out. 201 HOUSING ACT, 1930. Five Years Slum Clearance Programme. Clearance Areas The following Areas have, up to the present, been scheduled as clearance Areas:— No. of houses in Area. No. of persons displaced or to be displaced. (1)Old Town 108 490 (2)Leight°n Street East 34 157 (3)Stoney Lane & Victory Place, U.N. 22 74 The old town Area was cleared and 92 new houses have been erected, or are in course of erection, during the year. These houess are intentded to re-house 438 persons. 12 houses have also been built at Waddon as replacements for some demolished in the Old town clearance Area. These houses provide accommodation for 54 Persons. The necessary Local Enquiries with respect to the Leighton Street East and Stoney Lane areas had not been held at the end of the year. Improvement Areas. The following Improvement Areas have been approved by the council Houses. No. of on Houses for Demolition. No. of persons to be displaced Demoltiion or Overcrowding. (1) Dickenson's Place 20 9 29 (2) Ely Road & Holmesdale Road 46 8 97 (3) Leighton Street East & West 107 11 121 (4) Albion Street 36 2 18 (5) Napier Road & Magdala Road 67 None 26 (6) Wilford Road & Forster Road 161 None 55 At the end of the year, with respect to the Ely Road area, the owners of 6 of the houses scheduled for demolition had given Undertaking to make the houses fit, and work was in hand upon them and upon all the other properties in the area. In connection with a group of 10 houses in Holmesdale Road, the owner requested the Corporation to submit estimates for the work required. A useful amount of work has been done in this area, and the housing conditions have been much improved. 202 In Dickenson's Place none of the houses had been demolished by the end of the year, but repairs were well forward with those houses not scheduled for demolition. Progress with respect to the other areas has not been very rapid, as it was not possible to re-house the families to be dispossessed; but the lack of new houses was being made good, and it is probable that most of the tenants will be able to be re-housed early in 1935. It is proposed to re-house chiefly on (a) Ham Farm (92 houses); (b) Bridge Place (24 flats); (c) Old Cattle Market, Selsdon Road (24 flats); (d) Leighton Street East (20 flats); (e) Davidson Road (64 houses and 72 flats). In connection with the Old Town clearance, re-housing has been effected at Waddon (12 houses) and in new houses on the cleared area (92 houses). Individual Unfit Houses- In the Five Year Plan it was estimated that some 150 individual unfit houses were subject to be dealt with in the Borough. Up to the end of 1934, 43 houses had been approved for demolition, and demolition orders had been made; 13 houses had been actually demolished, the tenants being re-housed, when they desired, by the Council; 55 persons were displaced. The following table gives particulars as to Housing during 1934 under the headings prescribed by the Ministry of Health 1.—Inspection of Dwelling-houses during the year:- (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 5,207 (b) Number of inspections made for the purpose 5,207 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 3,008 (b) Number of inspections made for the purpose 3,008 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3,251 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 3,251 2.—Remedy of Defects during the year without service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 2,872 203 3. Action under Statutory Powers during the Year:— A. Proceedings under sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 169 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners †55 (b) By local authority in default of owners 3 B. Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 164 (2) Number of dwelling houses in which defects were remedied after service of formal notices: — (a) By owners 123 (b) By local authority in default of owners Nil C. Proceedings under sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which Demolition Orders were made 27 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 13 (3) Insanitary houses have been demolished in anticipation of formal procedure under Section 19 1 D. Proceedings under section 20 of the Housing Act, 1930: — (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil *This number does not include 26 houses in regard to which notices were served in 1933 and complied with in 1934. †Not including 43 houses concerning which notices were served in 1933 and complied with in 1934. OVERCROWDING. During the course of a systematic inspection of 5,207 houses between 1st January and 31st December, 1934, 94 or 1.8 per cent. were found to contain one or more overcrowded rooms. A family is considered to be overcrowded if the total accommodation, after allowing one room as a living room, in addition to the necessary bedroom accommodation, does not provide floor area for each member of the family of 40 square feet for persons over 5 years and 30 square feet for persons under 5 years, or the accommodation does not permit of the sexes being properly divided. 128 families occupied these 94 houses and 97, or 75.7 per cent. these families were found to be overcrowded. In 64 houses of the 94 houses it was found possible to abate overcrowding without producing corresponding overcrowding elsewhere. 97 notices were served to abate overcrowding. 204 Table I. FACTORIES, WORKSHOPS, AND WORKPLACES. 1. Inspection. Premises. Inspections. Number of Written Notices. Prosecutions FACTORIES. (including Factory Laundries) 594 113 ... WORKSHOPS. (including Workshop Laundries) 682 157 ... WORK PLACES. (other than Outworkers premises) 246 52 ... Total 1522 322 ... Table II. 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 135 110 ... ... Want of Ventilation 15 12 ... ... Overcrowding 2 2 ... ... Want of Drainage of Floors ... ... ... ... Other Nuisances 132 121 ... ... Sanitary Accommodation— Insufficient 5 4 ... ... Unsuitable or Defective 189 166 ... ... Not separate for sexes 3 3 ... ... Offences under the Factory and Workshops Acts— Illegal occupation of underground bakehouses ... ... ... ... Other offences — (excluding offences relating to outwork 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 481 418 18 ... 205 3. List of Registered Workshops. Trades. Totals. Bakers and Confectioners 51 Basket and Rug Maker 1 Blacksmiths 15 Blind Makers 2 Bookbinder 1 Bootmakers 79 Bottle Washer 1 Brush Makers 3 Building Trades 55 China Rivetters 2 Coach Builders 13 Cycle Works 24 Dressmakers 66 Dyers and Cleaners 14 Electricians 15 Embroidery 1 Engineers 9 Fancy Goods Manufacturers 11 Florists 2 French Polishers 1 Furriers 3 Ladder and Barrow Makers, etc 5 Laundries 18 Marine Stores 6 Milliners 19 Monumental Masons 6 Motor Engineers 98 Optician 1 Picture Framer 6 Photographers 8 Saddlers 5 Scale Makers 2 Sheet Metal Workers 8 Sign Writers 9 Sports Goods Makers 4 Tailors 85 Tea Packers 1 Toy Makers 1 Umbrella Makers 2 Upholsterers 43 Watchmakers 20 Wig Makers 2 Wire Mattress Makers 1 Woodworkers 46 4.Bakehouses. The control of Bakehouses is dealt with under the Factory and Workshops Act, the Public Health Acts, Croydon Corporation Act, 1924, and Cleanliness of Food Byelaws. For details of Croydon Corporation Act, see under Food Inspection. Number of bakehouses on Register, 31st December, 1934 110 Number of underground bakehouses (included in above) 6 Visits made to bakehouses during the year 367 Defects found 119 Notices issued 102 Notices complied 99 206 5. Home Work. Lists of home-workers are sent in twice yearly, and last year contained the names of 110 outworkers residing within the Borough. 106 visits were paid to outworkers and 12 visits were paid to premises of employers of outworkers to examine lists and for other purposes. Table III. NATURE OF EMPLOYMENT OF WORKERS ON THE REGISTER, 31st DECEMBER, 1934. Nature of Work. Number employed. Outwork in infected premises. Outwork in unsatisfactory premises. Remarks. Making, cleaning, altering and repairing wearing apparel 92 1 ... ... Upholstery work 4 ... ... ... Lace goods ... ... ... ... Other classes of work 14 ... ... ... 110 1 ... ... REGISTERED AND LICENSED PREMISES IN THE BOROUGH, 31st DECEMBER, 1935. Slaughterhouses (not including Public) 3 Bakehouses 110 Common Lodging Houses 9 Houses Let in Lodgings 77 Dairies and Milkshops 424 Cowsheds 29 Offensive Trades 112 Wholesale Dealers in Margarine, etc. 36 Registered Workshops 765 Premises registered under Artificial Cream Act, 1929 0 Premises registered for preparation or manufacture of potted, pressed, pickled or preserved meat, fish, or other food intended for the purpose of sale for human food 130 206 207 SHOP HOURS ACTS. 2,318 visits and patrols were made during the year, including week-day and evening patrols and Sunday evening patrols. Infringements of the Acts ascertained as the result of these inspections are set out in the summary of infringements (paragraph 6). 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 1s., the cost of a weekly ticket is 6s. for seven nights. The number of men accommodated during the year was 31,898. The number of men lodgers exceeded 87 per night throughout the year. The receipts and expenditure for the last ten years are as follows : — Receipts. Expenditure. £ s. d. £ s. d. 1925 1346 16 6 1485 0 1 1926 1338 8 7 1639 2 8 1927 1362 14 7 1591 17 0 1928 1346 2 8 1516 7 11 1929 1329 5 1 1483 1 5 1930 1324 10 8 1477 13 6 1931 1385 6 4 1711 19 6 1932 1517 8 4 1547 5 5 1933 1437 2 6 1544 7 10 1934 1469 16 1 1695 8 9 2 Private Common Lodging Houses. There were 11 common lodging houses on the register at the beginning of 1934, but two were discontinued during the year. During 1934, 58 day and 35 night inspections were made. Notices were served for the conditions and defects as set out in the summary of defects found (paragraph 7). 208 Table IV. 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 19, 20, 21, 22, 23 & 24, Lahore Road 30 75 men and women. 11 and 12, Princess Road 10 39 men and women 9 43 131 men and women HOUSES LET IN LODGINGS. There are 77 houses registered under the Byelaws. 135 visits were made for inspection purposes. 34 notices were served for various amendments. 21 notices were complied with. Table V. The following Table gives the situation of these premises Road. No. of Houses Let in Lodgings. Beulah'Grove 1 Frincess Road 1 Queen's Road, Croydon 2 Ely Road 5 Forster Road 8 Holmesdale Road 3 Wilford Road 16 Donald Road 1 Canterbury Road 1 London Road 1 Whitehorse Lane 1 Nursery Road 1 St. James' Road 1 Queen's Road, South Norwood 1 Lodge Road 1 Sydenham Road 1 Tamworth Road 2 Bert Road 1 Bensham Manor Road 1 209 Road NO. of Houses Let in lodgings Derby Road 2 Belgrave Road 6 Pawsons Road 1 Windmill Road 3 Heathfield Road 1 Harrington Road 1 St. Peter's Road 2 Alexandra Road 1 Whitehorse Road 3 Grange Road 1 Penge Road 3 Newark Road 1 Addison Road 1 Selhurst Road 1 Grosvenor Road 1 Notices were served for the conditions and defects as set out in the summary of defects found (paragraph 8). OFFENSIVE TRADES. Byelaws relating to Offensive Trades were adopted during the latter part of the year 192-5. 241 inspections were made of premises where such trades were carried on and notices issued requiring amendments ;in accordance with the Byelaws. The following are on the register :— Rag and Bone Dealers 38 Gut Scrapers 2 Fish Friers 70 Rabbit Skin Drier 1 Fellmonger 1 112 RAG FLOCK ACTS, 1911 AND 1928. Six samples were obtained and subjected to analysis, the results being as follows: — No. 1 contained 8 parts of Chlorine per 100,000 2 „ 10 „ „ „ „ 3 20 „ „ „ „ 4 „ 13 „ „ „ „ 5 „ 11 „ „ „ „ 6 „ 10 „ „ „ The six samples conformed to the standard of cleanliness Prescribed under the Bag Flock regulations, 1912, made under The Rag Flock Act, 1911. The Legal Maximum of chloride allowed is 30 parts per 100,000. 210 SMOKE OBSERVATIONS. During the year 15 observations were made of factory chimneys for the purpose of detecting offences under the Act. Two notices were sent and amendments carried out ito stop the nuisance. AMUSEMENT HOUSES. 122 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, structure and cleanliness of the dressing rooms. A report is submitted to the Licensing Authorities annually. Notices were issued for the conditions and defects as set out in the summary of defects found (paragraph 10). KEEPING OF ANIMALS. 97 inspections were made in connection with the keeping of animals. There were 33 premises, including institutions, where pigs were known to be kept in the Borough. 18 notices were served to abate nuisances arising from various causes in connection with the keeping of pigs, and 34 notices were served to abate nuisances arising from the keeping of other animals. SCHOOLS. 73 inspections of schools and school lavatories were made during 1934. In three instances the drains were found defective, and there were 11 instances of defective sanitary fittings, and two lavatories structurally defective. The water supply in all cases is from the mains. INSPECTION OF WATERCOURSES, ETC. During the year 62 visits were made to ditches, watercourses, etc., in order to see whether there were any infringements of the several Acts, etc. In two instances notices were served to remove accumulations from ditches. PHARMACY AND POISONS ACT, 1933. This Act consolidates the Poisons and Pharmacy Acts from the year 1852. The object is to regulate the sale of certain poisonous substances and the Act contains important provisions. 211 The number of licences renewed under the Act was seven, and in addition seven licences were renewed under the Order-inCouncil dated November 10th, 1911, to assistants in the employ of persons already holding licences. One infringement of the Act was found. FERTILISERS AND FEEDING STUFFS ACT, 1926. Sixty-nine inspections of premises where fertilisers and feeding stuffs were sold were carried out during the year. Ten infringements of the Act were found. Reinspections were made at a later date and the infringements found to have been rectified. DISINFECTION. The Borough Disinfecting Station is situate at Factory Lane. Two steam disinfectors are in use and are supplied with steam from the refuse destructor. A Cleansing Station, consisting of reception rooms, 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:— By Steam 43,640 articles By Formalin gas 3,358 „ By Formalin spray 612 „ 47,610 „ In addition 825 articles were destroyed on request. Disinfection after infectious or contagious disease was carried out in 2,435 rooms at 2,333 houses. 43 class rooms. 15 hospital wards. 1 vehicle. 1 shelter. 9 bags. 2 cloakrooms. 1 school hall. 3 school departments. 212 CLEANSING OF VERMINOUS PERSONS, ETC. During the year 7 adults and 2 children were cleansed for verminous conditions, and 18 adults and 19 children for scabies, also one adult after contact with infectious disease. RATS AND MICE DESTRUCTION. The rat-catcher is a permanent member of the staff, and n o charge is made for his services. Rats are destroyed by the following methods: Dogs, poison baits, traps, and rat varnish smeared on cardboard. Close co-operation is carried out between the rat-catcher and the District Sanitary Inspectors. The following is a summary of the visits paid during 1931 under the Rats and Mice (Destruction) Act, 1919: — Table VI. Premises. No. of Visits made. No. of Poison and' other baits laid. No. of Rats Killed. Private Houses 1305 Butchers 56 3438 1202 Other premises where food is prepared or sold 210 Other premises 316 Total 1887 3438 1202 In addition to the above, 1,573 rats were killed at Corporation refuse tips by employees of another department. FOOD SUPPLY. The supervision and inspection of the food supplies is carried out by twelve of the district inspectors, who are qualified in food inspection. 213 The work is supervised by the Chief Sanitary Inspector and the Deputy Chief Inspector, who also hold the necessary qualifications. Each district inspector is responsible for the examination of all foodstuffs, exposed or deposited, or in preparation for sale in shops, wholesale and retail markets, hotel and cafe kitchens, etc. together with the methods used in the preparation of the foodstuffs, the storage places and premises. This method of inspection, along with frequent sampling of all articles of food, is intended to procure for the public a wholesome supply of pure, unadulterated food. This desirable condition entails an enormous amount of detail work at all times of the year, especially intensified during the hot months, and it is only by constant vigilance that this can be maintained. The traders of the town have by their co-operation helped in the task, and I am sure desire to supply pure, wholesome food to the public. On the other hand the householder can help considerably in attaining the best standard by purchasing clean food, at the same time insisting that it has not been handled by unauthorised persons or exposed to injurious contamination such as flies and dust. It is, moreover, of great importance that householders should take equal precautions in the home. Foodstuffs should be bought in small quantities and kept in a clean, well-ventilated food pantry, screened from flies. Refrigeration, as a method of storage, gains further ground, not only in the shops but in the home. This method of low temperature storage ensures a fresher article with practically no waste. A larger number of articles are packed in hygienic containers and this method facilitates handling and prevents contamination. The wrapping of bread and cakes, as delivered to houses in the borough, has not kept pace with other hygienic measures. This desirable method would soon materialise if the public were to demand it. 214 Additional legislation continues to impose new tasks on the inspectorate. In addition to the actual examination of all foodstuffs the inspectors also observe if the marking of the foodstuffs, required by the various acts and orders, is being complied with. The Merchandise Marks Act requires an indication of the origin of certain imported goods. Orders under the Act have been made dealing with imported fresh apples, honey, raw tomatoes, oat products, currants, sultanas, raisins, eggs, salmon, butter, etc. In addition Regulations regarding condensed and dried milk have been adopted, while other foodstuffs require marking under the Milk (Special Designations) Order, Food and Drugs Acts, Artificial Cream Act, Public Health (Preservatives) Regulations, Sale of Food Orders, etc. The necessity for a wholesome meat supply entails the examination of meat, not only in the shops, but also in the wholesale markets. Carcases coming into the borough, but dressed elsewhere, are subjected to minute examination. The private slaughterhouses are visited and the dressed meat is inspected before being passed out for human consumption, either in the borough or elsewhere. In order that a proper supervision of the food supplies in the borough be maintained it is necessary for the inspectors to be on duty long after ordinary hours of working. The Public Slaughterhouses are under the control of the Superintendent, who also acts under the supervision of the Chief Sanitary Inspector. During the year there were 37,740 animals slaughtered for human consumption, these figures being a decrease of 5,875 on those for the year 1933. The following table shows the premises in the Borough at which foodstuffs are known to be sold, manufactured or stored;- General Shops 208 Grocers and Provision Shops 614 Greengrocers and Fruiterers 467 Confectioners, Bakers and Pie Makers 615 Ice-Cream Shops 301 Hotel and Restaurant Kitchens and Dining Rooms 280 Butchers 220 Fishmongers (including Fried Fish Shops) 145 Ham and Beef Shops 74 Sweet Manufacturers 10 Other Food Premises 17 2,951 215 In addition to the premises in the above table, 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 a large number of 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, etc., for the selling of foodstuffs, but it is difficult to estimate the actual number in use, as this varies daily. All these barrows and vehicles, wherever found, are inspected by the food inspectors. PUBLIC SLAUGHTERHOUSES, PITLAKE, AND MEAT INSPECTION. These slaughterhouses, although the buildings were not originally intended for such, comprise twelve slaughterhouses with lairage attached. In addition a gut cleaning firm utilises one building on the premises. Of the twelve slaughterhouses nine 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. Table VII. The following animals were slaughtered at the Public Slaughterhouses during 1934: — Pitlake. Public Slaughterhouses Cattle. Sheep. Pigs. Calves. Total. Public section 112 174 1930 438 2654 Private section 660 11001 12582 3673 27916 Totals 772 11175 14512 4111 30570 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 1934: — Description. Cause. 6 beef carcases and offal General tuberculosis. 1 „ forequarters Localised tuberculosis. 1 „ hindquarter „ „ 216 Description. Cause. 4 sets beef lungs Inflammatory, etc. 23 „ beef lungs Localised tuberculosis. 13 beef heads „ „ 36 „ various offals „ „ 3 ,, heads and tongues Actinomycosis. 3 ,, parts Inflammatory conditions, etc. 67 ,, various offals „ „ 2 veal carcases General tuberculosis. 16 ,, plucks Tubercular. 13 ,, various offals „ 5 „ heads „ 11 ,, various offals Inflammatory, etc. 3 ,, carcases and offal Jaundice. 2 ,, carcases Traumatism. 1 ,, pluck Inflammatory condition. 12 ,, heads Various causes. 2 ,, veal forequarters Inflammatory. 9 pig carcases and offals General tuberculosis. 1 ,, quarter Localised tuberculosis. 3 ,, various parts „ „ 187 ,, heads „ „ 99 ,, plucks „ „ 71 ,, various offals „ „ 28 „ carcases and offals Swine fever. 13 ,, carcases and offals Inflammatory conditions, etc. 7 ,, quarters „ „ 394 ,, plucks „ „ 10 ,, heads „ „ 285 ,, various offals and 18 parts „ „ 7 sheep carcases and offals Inflammatory, etc. 1 ,, forequarter and 16 parts Inflammatory, traumatic, etc. 22 ,, plucks Parasitical, etc. 43 ,, various offals „ „ 1 „ carcase and offal Emaciation and Dropsical. Total weight destroyed: 18,013 lbs. PRIYATE SLAUGHTERHOUSES AND MEAT INSPECTION At the end of 1934 there were 3 registered slaughterhouses in the Borough. Registered Private Slaughterhouses have in recent years gradually been reduced from 6 to 3. In two instances they have been accommodated at the Public Slaughterhouses. The number of visits paid to the Private Slaughterhouses for the purpose of inspecting the meat during 1934 was 798. Table VIII. The number of animals slaughtered in the Private Slaughterhouses during the year was: — Cattle Sheep. Pigs. CaWes. Total. 89 1655 3131 2295 7,170 217 The following meat and offal from Private Slaughterhouses was surrendered and destroyed during 1934: — Description. Cause. 1 set beef lungs Localised tuberculosis. 1 „ beef lungs Inflammatory conditions, etc. 2 beef various offals „ „ 1 veal carcase and offal General tuberculosis. 2 ,, plucks Localised tuberculosis. 1 pig carcase and offal General tuberculosis. 37 „ heads and 4 parts Localised tuberculosis. 24 „ plucks „ „ 10 „ sundry offals „ „ 15 „ plucks Inflammatory, etc. 33 „ offals (various) „ „ 4 sheep offals (various) Parasitical, etc. Total weight destroyed: 1,104 lbs. Table IX. Total number of animals slaughtered for human consumption in the Borough during 1934: — Cattle. Sheep. Pigs. Calves. Total. 861 12,830 17,643 6,406 37,740 Table X. Summary of whole carcases destroyed with the reasons for such destruction. Class of Animal. Tuberculosis. Emaciated and Dropsical. Inflammatory Conditions. Traumatism. Jaundice. Swine Fever. Asphyxiation. Total carcases. Cattle 6 ... ... ... ... ... ... 6 Calves 3 ... ... 2 3 ... ... 8 Sheep ... 1 3 2 ... ... 2 8 Pigs 10 2 7 ... ... 28 4 51 Totals 19 3 10 4 3 28 6 73 218 Table XI. 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 parts of organs destroyed. Total. Cattle (including calves) 9 13 33 55 Pigs 10 224 133 367 Total. 19 237 166 422 General Food Inspection. The following table gives a summary of the inspections made during the year (not including visits made to slaughterhouses ot dairies, cowsheds and milkshops):— Butchers 1980 Fishmongers 277 Fried Fish Shops 177 Grocers 1032 Greengrocers 642 Poultry and Game Dealers 90 Cooked and Prepared Meat Shops 297 Bakers' Premises 323 Confectioners' Premises 616 Markets 960 Hawkers' Carts and Barrows 149 Hotel and other Kitchens, etc 590 Ice Cream Manufacturers and Vendors 248 General Shops 408 Other premises 84 7,873 The following articles of food were surrendered and destroyed during 1934 : — 6 beef hindquarters (Imported) Unsound 79 ,, parts and trimmings ,, ,, 20 lbs. salt beef ,, ,, 121 lbs. beef kidneys ,, ,, 100 lbs. beef livers, etc. ,, ,, 1 beef tongue „ ,, 4 mutton parts ,, ,, 57 lbs. lambs' liver, etc. ,, ,, 4 pork parts ,, ,, 87 lbs. pig kidneys, livers, etc.,, 31 rabbits ,, 219 1774 lbs. mackerel, skate, etc Unsound 245 tins salmon, etc. „ 299 tins sardines „ 2181 tins, etc., plums, cherries, strawberries, etc,, 224 lbs. grape fruit „ 224 lbs. oranges ,, 5376 lbs. potatoes „ 14 lbs. parsnips „ 10 lbs. carrots ,, 120 lbs. pears ,, 145 tins milk and cream ,, 226 lbs. sugar confectionery, etc.,, 35 jars jam, etc. ,, 16 jars pickles, etc. „ 18 jars meat paste, etc „ 2 lbs. brawn ,, 7 packets suet, etc. „ 33 tins beef, ham, etc,, Total weight destroyed: 14,569f lbs. Table XII. General Summary of Meat and other articles destroyed during the year 1934. articles. Weight in lbs. i Remarks. Diseased. Unsound. Total. Beef 3,597 2,086 5,683 Including 6 carcascs. Veal 341 146 487 ,, 8 „ Mutton 161 218 379 ,, 8 „ Pork 7,878 696 8,574 ,, 51 „ Offal 5,9491 566 6,5151 „ imported offal. Fish ... 1,774 1,774 Haddocks, Cod, etc. Fruit & Vegetables ... 5,968 5,968 Potatoes, Oranges, etc. Tinned Goods ... 4,013$ 4,0131 2,894 tins, 78 jars. Sundries 293 293 Sugar Confectionery, etc. 17,926½ 15,760½ 33,686½ MILK. The milk supply of the Borough is derived principally from 'hs south, south-east and south-wesit counties and arrives either by rail or road. 220 Only a small proportion is produced in the borough, due largely to the absorption of land for building" purposes and the decreasing amount of available pasture land. The Milk and Dairies (Consolidation) Act, 1915, and the Milt and Dairies Orders gave additional powers to deal with milt premises. Dairies, milkshops and cowsheds have received continuous inspection. In the case of dairies separate premises are required for the storage of milk and also for the washing of utensils. Alterations have been carried out to existing dairies in conformity with modern practice. Mechanical refrigeration and cooling is used by increasing numbers of dairymen in the Borough as part of their equipment. Enquiries show that approximately 18,679 gallons of milt are sold daily in the Borough. Of this amount 90% is bottled, 2% is retailed as loose milk, the remaining 8% being sold wholesale to large consumers. These figures are interesting in view of the fact that eleven years ago the whole of the milk sold was distributed loose. The sale of this type of milk, whether in shops or on the rounds, is discouraged. Of the total milk sold daily in the Borough, 13,881 gallons is graded milk. This figure is extremely gratifying and draws attention to the remarkable changes which have taken place in the treatment and distribution of our milk supplies. Sterilised milk continues to be sold in the Borough. An innovation is the introduction of milk sold in waxed cartons; this method ensures that by ingenious machinery the carton is made and filled with milk and delivered ready sealed. During this operation it is untouched by hand. This method, which entirely eliminates the costly bottle, appears to appeal to the public, judging by the increasing amount which is being sold, It will be interesting to watch the progress of this new method of distribution. Large numbers of samples have been obtained both for chemical and bacteriological analysis during the year. When a sample of milk is not up to a reasonable standard of bacterial purity the supplier, whether retailer or producer, is notified. At the same time he is invited to interview the Chief Sanitary. 221 Inspector. The methods of production and distribution are discussed and suggestions made; these, when adopted, have produced excellent results. It is interesting to note that the bacteriological examination in all grades of milk shows a reduced total bacterial count on the previous year, and the majority of milk distributed in the Borough is uniformly of excellent quality. This, unfortunately, does not apply to the milk as it is delivered by the farmer, which shows unnecessarily high bacterial counts, etc. This low standard makes it necessary for the vendors to provide and maintain elaborate and expensive plant to eliminate something which should be kept out at the source. 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 of Cowkeepers, Cowsheds, Dairies and Purveyor of Milk premises on the register:— Cowkeepers on register (1933) 9 ,, added to the register (1934) 2 ,, discontinued (1934) Net 11 Cowsheds on register (1933) 26 ,, added to the register (1934) 3 ,, discontinued (1934) Net ... 29 Number of cows provided for 273 Average number of cows in sheds (1934) 260 No. of dairies and purveyors of milk on register (1933) 365 No. of dairies and purveyors of milk added to register (1934) 97 No. of dairies and purveyors of milk discontinued during 1934 38 Net 424 Grand total of cowsheds, dairies and purveyors of milk on register, 31st December, 1934 453 During the year 1,090 inspections were made of dairies, cowsheds and milkshops. Mr. P. Thrale, the part-time veterinary surgeon, makes quarterly reports on his visits to the farms and his examination of the cattle thereon. Milk (Special Designations) Order, 1923. The following licences were granted during the year under this Order and were in force on the 31st December, 1934 Description of Licences. No (1) Producers' Licences to use the designation "Grade A" (2) Dealers' Licences to use the designation "Certified" 18 (3) Dealers' Licences to use the designation "Grade A" (Tuberculin tested) (a) Bottling establishments 1 (b) Shops 25 (4) Dealers' Licences to use the designation "Grade A"— (a) Bottling establishments (b) Shops 2 (5) Dealers' Licences to use the designation "Grade A Pasteurised"— (a) Shops 5 (6) Dealers' Licences to use the designation "Pasteurised"— (a) Pasteurising establishments 2 (b) Shops 51 (7) Dealers' Supplementary Licences to use the designation— (a) Certified 2 (b) Grade A T.T 4 (c) Grade A 2 (d) Pasteurised 3 Inspection of these licensed premises has been carried out regularly during the year to see that the conditions of the licences were observed. 222 223 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 country producers of Grade A (Tuberculin Tested) milk supplying milk to licensed local dairymen 11 Licensed country producer of Grade A milk supplying milk to a licensed local dairyman Pasteurised Milk. Samples from Licensed Dealers 129 The following tables summarise the result of the bacteriological examinations of Certified, Grade A (Tuberculin Tested), Grade A and Pasteurised samples, from 1st January to 31st December, 1934 :— Table XIII. CERTIFIED MILK. Present. Absent. Over 30,000 per c.c. Under 30,000 per c.c. Present in 1/10 c.c. Not present in 1/10 c.c. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Tubercle bacillus ... 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 : — 0—1,000 3 1,000—5,000 3 20,000—30,000 1 7 224 Under the Regulations Certified Milk must not contain more than 30,000 bacteria per c.c. Table XIV. GRADE A (TUBERCULIN TESTED) AND GRADE a MILKS. Present. Absent. Over 200,000 per o.c. Under 200.000 per c.o. Present in 1/100 c.c. Not present in 1/100 c.c. Present. Absent. Present. Absent. Exceeding a 1 trace. Not exceeding traces Tubercle bacillus ... 11 Total number of bacteria ... 11 Bacillus coli ... 11 Blood ... ... 11 Pus ... Detritus 11 ... 11 ... 11 ... 11 ... 11 ... 11 ... a ... 11 The 11 Grade A (Tuberculin Tested) and Grade A milks contained bacteria per c.c. as follows : — 0—1,0003 1,000—5,000 1 5,000—10,000 4 30,000—50,000 1 100,000—200,000 2 11 Under the Regulations Grade A (Tuberculin Tested) or Grade A milk must not contain more than 200,000 bacteria per c.c. The following tables summarise the results of the bacteriological examinations of Pasteurised milk samples from Ist January to 31st December, 1934 :— Table XV. PASTEURISED MILK, (licences granted under the Milk (Special Designations) Order, 1923). Present. Absent. Over 100.000 per c.c. Under 100,000 per c.o. Present. Absent. Present. Absent. Present. Absent. Exceeding a \ trace. | Not exceeding a trace Tubercle bacillus ... 129 Total number of bacteria 3 126 Bacillus coli 34 95 Blood ... 129 Pus .... 129 Detritus .... 129 ... 129 ... 126 34 95 ... 129 .... 129 .... 129 225 The above 129 Pasteurised Milk Samples contained bacteria per c.c. as follows : — Under 1,000 14 1,000—5,000 59 5,000—10,000 25 10,000—20,000 20 20,000—30,000 5 30,000—50,000 1 50,000—100,000 2 Over 100,000 3 129 Under the Regulations Pasteurised Milk must not contain more than 100,000 bacteria per c.c. One sample of Sterilized Milk was taken during 1934. Bacillus Coli was absent, and the bacterial content was 10 per c.c. PROVISION AS TO MILK SUPPLY. During the year 321 simples 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 55 Samples in course of delivery from country cowsheds to local dairymen and purveyors of milk in the Borough 20 Samples taken at dairymen's premises in the Borough 66 Samples taken in course of delivery by local dairymen or milk sellers on their rounds in different parts of the Borough 174 Other samples taken 6 321 Nine samples proved to be tuberculous, but of these four were obtained in group or individual testing of cows on a farm in the Borough, in consequence of which two cows were slaughtered under the Tuberculous Order, 1925, and found to be affected. Three samples were from supplies coming from Sussex; a considerable number of cows were examined by the Authority's veterinary Officers, suspected animals isolated, and samples taken. As the result of their investigations two animals were dealt 226 with under the Tuberculosis Order, 1925. One sample was taken from a supply coming from Surrey, and after a considerable number of cows had been examined, one animal was found affected with tuberculosis and dealt with under the Order. In one instance it was found impossible to trace the source owing to mixed supplies. The following Table summarises the results of the bacteriological examination of ordinary milk samples, taken under the Milk and Dairies (Consolidation) Act, 19.15, from 1st January to 31st December, 1934: — Table XVI. ORDINARY MILK. Present. Absent. Over 200,000 per o.o. Under 200,000 per o.o. Present in 1/100 c.c. Absent from 1/1C0 c.c. Present. Absent. Present. Absent. Exceeding a I trace. Not exceeding a trace Tubercle bacillus 9 312 Total No. of bacteria ... 73 248 Bacillus Coli ... 152 169 Blood ... ... 321 ... Pus 321 Detritus ... 321 9 312 73 248 152 169 ... 321 ... 321 ... 321 The 321 samples of Ordinary Milk contained total bacteria per c.c. as follows: — 0 1,000 10 1,000—5,000 32 5,000—10,000 24 10,000—20,000 33 20,000—30,000 30 30,000—40,000 14 40,000—50,000 21 50,000—100,000 45 100,000—150,000 28 150,000—200,000 11 200,000—250,000 9 250,000—500,000 26 500,000—750,000 9 750,000—1,000,000 5 1,000,000—2,000,000 4 Over 2,000,000 23 321 227 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 248 of the samples contained total bacteria in accordance with that standard. It has to be remembered that a proportion of this milk has been subjected to commercial pasteurisation. The 321 samples taken under the Milk and Dairies (Consolidation) Aat, 1915, were samples of milk which had been produced in the following areas : — Table XVII. Areas. No. obtained. No. Tuberculous. Croydon .. 55 4 Kent 8 Surrey ... ... 11 1 Sussex ... ... 17 3 Somerset 2 'Unclassified 228 1 Totals 321 9 *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. FOOD AND DRUGS (ADULTERATION) ACT, 1928. During the vear 335 samples of milk (331 new, 3 separated, 1 condensed) and 444 other samples were taken. In 10 instances the vendors were warned. 19 samples of Ice Cream were taken during the year. The Public Analyst reports that 7 of these samples contained fait in amounts varying from 1.3% to 3.3%. The remaining 12 contained fotin amounts varying from 10.2% to 18.4%. There is no legal standard for fat in Ice Cream. 10 per cent is suggested as a reasonable minimum amount. Bearing in mind this figure, it will be seen that the majority of the samples of Ice ceam were well above this suggested standard. 228 Summary of Samples. During 1934 samples were obtained and submitted to the Public Analyst as follows:— Table XVIII. Samples of Total Samples. Genuine. Not Genuine. Prosecutions. Convictions. Cautions. Milk 331 321 10 - - 6 Condensed Mach. Skimmed (Inf.) 1 1 - - - - Separated Milk 3 3 — — — Cream 2 2 — — — Arrowroot 8 8 — — — Aspirin Tablets 4 2 2 — — — Bacon 5 5 — — — — Baking Powder 7 7 — — — Black Treacle 6 6 — — — Boracic Ointment 1 1 — — — Brawn 10 10 — — — — Bread 8 8 — — — Butter 17 16 1 — — Castor Oil 8 8 — — — Cocoa 7 7 — — — Cod Liver Oil 5 5 — — — Coffee 4 4 — — — „ and Chicory 5 5 — — — „ Essence with Chicory 3 3 — — — Comp. Powder of Liquorice 4 4 — — — Comp. Syrup of Figs. 4 4 — — — Comp. Tincture of Rhubarb 4 4 — — — Confection of Senna 3 3 — — — Corn Flour 5 5 — — — Cream of Artichoke 1 1 — — — Cream of Tartar 7 7 — — — Demerara Sugar 2 2 — — — Dripping 6 6 — — — — Faggots 6 6 — — Fish Paste 8 8 — — — Flour 8 8 — — — Ginger Ale 2 2 — — — Ginger Beer 6 6 — — Glycerine 7 6 1 — Golden Syrup 5 5 — — — Ground Almonds 6 6 — — —— Ground Cinnamon 2 I 1 — 1 Ground Ginger 6 6 — — — Ground Rice 7 7 — — — Honey 12 12 — — — — Ice Cream 19 19 — — — Jam 15 14 1 — — 1 Kaola 1 1 — — — Lard 11 11 — — — Lemonade 1 1 — — — Lemonade Powder 3 3 — — — Lemon Squash 1 1 — — — Margarine 10 10 — — — Meat Paste 9 9 — — — Mincemeat 5 5 — — —' Mustard Mixture 5 5 — — "— Olive Oil 3 3 ~— — — — Carried forward 629 613 16 — — 8 229 Samples of Total Samples. Genuine. Not Genuine. Prosecutions. Convictions. Cautions. Brought forward 629 613 16 - - 8 Pearl Barley 4 4 — — — — Pepper 5 5 — — — — Pickled Onions 4 4 — — — — Pickles, Mixed 4 4 — — — — Polonies 1 1 — — — — Raisin Wine 1 1 — — — — Rissoles 2 2 — .— — — Sausage, Beef 15 15 — — — — „ „ (Preserved) 1 1 — — — — „ Luncheon 10 10 — — — — „ Pork 12 11 1 — — 1 „ „ (Preserved) 3 3 — — — — Saveloys 9 9 — — — — Sherbert 1 1 — — — — Shredded Suet 5 5 — — — — Spice,, Mixed 2 2 — — — — Steak and Kidney Pate with Mushrooms 1 1 - - - - Sweets 19 17 2 — — 1 Tea 12 12 - — — — Tinned Asparagus 5 5 — — — — Tinned Beans 6 6 - — — — Tinned Peas 14 14 - — — Vinegar 1 1 - — — — Vinegar, Malt 10 10 — — — Whiskey 3 3 - — - - Totals 779 760 19 — — 10 Result of Analysis of New Milk Samples. SOLIDS NOT FAT.* (Legal standard is 8.5%). ,8-3 8.4 8.5* 8.6 8.7 8.8 8.9 9.0 9.1 9.2 9.3 9.4 9.5 — Total 331 4 3 19 33 59 97 72 31 7 1 3 1 1 MILK FAT.* (Legal standard is 3%). 2-8 2.9 3.0* 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 1 3 0 11 18 48 73 61 36 33 16 3.9 4.0 4.1 4.2 4.3 4.4 4.8 Total 331 10 8 4 4 2 2 1 Total Samples of New Milk : 331 230 The Samples of Milk (including Separated Milk) for analysis were obtained as follows : — Country Milk in course of delivery by train to Local Dairymen — Country Milk in course of delivery by motor lorry to Local Dairymen 14 On Milk Round| (Sundays) 12 ,, „ (Week-days) 223 Cowsheds At Shops 69 Taken at Institutions 16 "Appeal to Cow" Samples taken at farms outside Borough 334 AVERAGE COMPOSITION OF NEW MILK SAMPLES. Solids not Fat 8.8% Milk Fat 3.5% Percentage of New Milk Samples below legal standard: 3.0% Adulterated Samples. The following is a detailed statement of the adulterated samples and action taken: — No. Sample. Adulteration or Deficiency. Remarks. 388. New Milk 6 per cent, deficient in fat. Further samples taken proved genuine. Vendor warned. 392. New Milk 1 per cent, of added water. Vendor warned. 396. New Milk 2 per cent, of added water. Vendor warned. 475. New Milk 4 per cent, deficient in fat. Vendor warned. 487. Black Currant Jam (Full Fruit Standard). Contained 28 per cent of Black Currant Fruit. Not of full fruit standard. Matter taken up with the manufacturers, who were warned. 490. Ground Cinnamon. The sample con-tained only a trace of cinnamon. Remainder of stock surrendered to 1ocal authority, and was destroyed. Vendor warned. 718. Aspirin Tab¬. lets (5 gr.) A deficiency of 0.6 grain of acetylsalicylic acid per tablet. See sample No. 851 * low. 669. New Milk 3 percent, deficient in fat. Further samples proved genuine. Vendor warned. 231 So. Sample. Adulteration or Deficiency. Remarks. 619. New Milk Genuine as judged by the Sale of Milk Regulations, but by freezing point test the sample contained 5 per cent, of added water. No action. Further samples proved genuine. 851. Aspirin Tab- . lets (5 gr.) A deficiency of 0.4 grain of acetylsalicylic acid per tablet. The manufacturers were communicated with and explanation given and accepted. 811. Boiled Sweets. Contained 0.015 per cent. of sulphur dioxide, equal to 150 parts per million bv weight. Vendor warned. 754. Butter Contained 16.7 percent, of water. The wholesalers were communicated with, and explanation given and accepted. 741. New Milk 1 percent, of added water. Further samples taken proved genuine. Vendor warned. 882. New Milk 2 percent, of added water. See Sample 883. 883. New Milk 2 percent, of added water. Subsequent samples proved genuine. 932. Boiled Sweets. Contained 0.029 per cent. of sulphur dioxide, equal to 290 parts per million by weight. Source of supply could not be traced. No further action. 1067. Glycerine Not of B.P. standard as regards specific gravity, refractive index and colour. The matter was taken up with the manufacturers and the explanation given accepted. 1085. New Milk 2 percent, deficient in fat. This milk was from a local farm. Further samples proved genuine. 1118. Pork Sausage. Contained sulphur dioxide, 0.019 per cent., equal to 190 parts per million by weight. Vendor cautioned for failure to give notice of preservative. 232 MEMBERS OF THE EDUCATION COMMITTEE. NOVEMBER, 1933-34. The Mayor (Alderman J. Trumble, J.P.). Alderman A. Peters, C.B.E., J.P. (Chairman). P. Squire, Esq. (Vice-Chairman). Alderman T. Betteridge, J.P. Councillor Major F. W. Rees. Alderman W. H. Jarvis. Councillor H. Began. Alderman H. J. Morland, M.A., J.P. Councillor Dr. A. Sandison, O.B.E. Alderman T. W. Wood Roberts, J.P. V. Boys, Esq. Alderman W. West. W. A. Clarke, Esq. Councillor E. E. L. Arkell, J.P. Mrs. R. L. Gurner. Councillor A. J. Carpenter, J.P. Mrs. M. A. Hinks. Councillor A. H. Harding. Miss A. M. Jackson, M.A. Councillor Eng.-Rear-Admiral Harrison. Capt. H. Lethbridge-Abell, F.Z.S. Councillor W. G. Higgins. Mrs. M. M. Wood Roberts. Councillor H. L. Kendell. G. Robinson, Esq. Councillor G. Lewin. Rev. G. M. Scott, M.A. Councillor J. Marshall. Rev. H. E. Spelman. Councillor Major J. Petrie, O.B.E. The Lord Bishop of Croydon. J. M. Newnham, O.B.E., D.L., LL.D., Clerk to the Local Education Authority. R. B. Morgan, M.A., M.Litt., Education Officer. STAFF OF THE SCHOOL MEDICAL SERVICE. Medical Officer of Health and School Medical Officer: Oscar M. Holden, M.D., D.P.H. Deputy Medical Officer of Health and Deputy School Medical Officer: W. B. Watson, L.R.C.P., L.R.C.S., D.P.H. Assistant Medical Officers of Health and Assistant School Medical Officers Basil A. Dormer, M.B., B.S., D.P.H., B.Hy. John W. Pickup, M.D., Ch.B., D.P.H. Iris Jenkin-Lloyd, M.R.C.S., L.R.C.P., D.P.H. Aileen I. McMahon, M.R.C.S., L.R.C.P., D.P.H. Specialist Part-Time Medical Officers: J. S. Bookless, F.R.C.S. (Ophthalmic Surgeon). Rota of 4 local medical practitioners for surgical treatment of tonsils and adenoids. In addition there is a Consulting Physician, a Consulting Surgeon. a Consulting Laryngologist and Otologist and a Consulting Orthopaedic Surgeon, who are classified as Consultants to the Public Health Department and whose services are available for school medical cases if the need arises. Senior Dental Surgeon: J. F. Pilbeam, L.D.S. Assistant Dental Surgeons: J. K. R. Bryce, L.D.S., and K. C. B. Webster, Remedial Gymnasts: Miss F. Davey and Miss M. K. Thomas (part-time). Mental Deficiency Visitor: Miss E. A. McDougall (part-time). Assistant Mental Deficiency Visitor: Miss E. McQuade (part-time). Orthopaedic Work Organiser: Mrs. D. B.Connor (part-time). School Nurses: Two at clinics, 21 district nurses (part-time). Clerks: Four full-time and eight part-time. 233 SCHOOL CLINICS Name. Purpose, Where held. Times. INSPECTION Special examination of cases referred by teachers, school attendance officers and school nurses and on application of parents. Municipal Clinic, Lodge Road. Wed. and Sat., 9 a.m. minor ailments Treatment of Minor Diseases of Skin, etc. Lodge Road. Selhurst Road. Daily, 9 a.m. Mon., Tues., Wed., Thurs. and Fri., 9 a.m. ophthalmic Treatment of Visual Defects. Lodge Road. Tues. and Fri., 9 a.m. Dental Dental Treatment. Lodge Road and Selhurst Road. Daily, 9 a.m. and 2 p.m. ear Treatment of Chronic Ear Discharge. Lodge Road. Fridays, 2 p.m. Defective children Examination Town Hall. As required. x-ray Treatment of Ringworm. Dr. Greig's Surgery. By appointment. Orthopedic Treatment of, Crippling Defects. General Hospital. Thurs., 10 a.m. Throat Operative Treatment of Enlarged Tonsils and Adenoids do. Mon. and Wed., 2 p.m. Synthetic Sunlight Treatment of Rickets, etc. do. Tues., 2 p.m. & Fri., 9 a.m. Remedial Exercises Treatment of Defotmities. . Andrew's Hall, Pump Pail. Daily. Cleansing station Treatment of Scabies and Cleansing of Verminous Cases. Factory Lane. Arranged as required. Tuberculosis Dispensary Treatment of Tuberculosis and Examination of Contacts. 13, Katharine Street. Tues., Wed., Thurs., Fri. and Sat., a.m. Mon. and Fri., Rheumatism Examination . Lodge Road. p.m. Wed., 2 p.m., and alternate Thurs., 9 a.m. Immunization Protection against Diphtheria Lodge Road. Mon. and Tues., 2 p.m. 234 County Borough of Croydon. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER For the Year ending December 31st, 1934. Ladies and Gentlemen, I have the honour to present to you my Seventh Annual Report on the work carried out by the School Medical Service. The form of the report follows that adopted previously, and includes the requirements as set out in Form 6M (Schedule) of the Board of Education. The number of children examined in the routine medical inspection group is fewer than last year; this is due to a rearrangement of the times of the year when the groups are examined and the postponement of the examination of the Leaver Group from 12-vear-olds to 13-year-olds. It was felt the final examination was likely to be more valuable one year before the child left school, than if made two years before, as had been the practice formerly. A much-needed and delayed re-inspection was, however, carried out to a greater degree than last year. Routine school medical inspection has now been in force for a quarter of a century, and there has been little change in the 235 methods of its conduction. The time is now due perhaps to reconsider present methods and to spend less time on the healthy, but concentrate more closely on those ascertained to be defective in some particular and follow them through their school life by yearly inspections. This is not possible now unless there is an increase in medical staff. Sufficient statistical material has been collected by the School Medical Service in England for valuable deductions to be made, and it is suggested that a departmental or other official committee of the Board of Education might be able to do for the medical side what the Hadow Committee has done for the educational if the records were analysed. Certain of the Croydon records were examined by the London School of Economics, and a summary of the findings is included in the report. School Medical Inspections have brought about a fundamental change in the attitude of the public towards health. A continuation of present methods is not likely to lead to any advancement of public opinion, and there is undoubtedly a tendency growing up for those engaged in the work to lose sight of the general principles of the service, namely, the education of the growing citizen in the care and maintenance of his health, in the routine examination of large numbers of children for purely statistical purposes. It would be a mistaken policy to abolish routine medical inspections entirely, but there are many points in favour of some modification thereof. In the Board of Education's Tables for 1933 a new group of cases was incorporated in Table IV. in respect of the treatment of Orthopedic and Postural defects, and this has been included again this year. Two changes occurred in the medical staff during the year : Dr. 0. B. Falk resigned early in the year, and her place was filled by the appointment of Dr. A. I. McMahon; whilst the vacancy caused by the resignation of Dr. F. W. Gavin in 1931 was filled by Dr. J. W. Pickup. A very complete Sanitary Survey of the Schools, which has been in progress for two years, was completed, and a new table, dealing with the sanitary arrangements, has been included. This table shows interesting differences as between the schools. The survey, however, embraced all aspects of school hygiene, 236 ing lighting, ventilation, size of class-rooms, etc. For the sake of brevity much of this has had to be omitted from this report; the more clamant defects have been reported to the proper authorities, and have been remedied. Co-ordination with Other Health Services. Close co-operation exists between the Public Health Department and the School Medical Service, as all the officers of the latter service are also engaged for a part of their time in Public Health work. Endeavours have been continued to obtain a closer continuity between the Maiternity and Child Welfare work and the School Medical Service, but there appear to be inherent difficulties under the present system. If the facilities offered by the School Medical Service, in the way of routine medical and dental examinations, could be extended to the pre-school child much closer working, with consequent decrease in the number of defects found in the Entrant group of school children, would accrue. At present there does not seem, however, much chance of such an extension. The gap which exists between the supervision of the Maternity and Child Welfare Service and the commencement of the School Medical supervision, is a most unfortunate one, leading, as the figures in my report show clearly, to an unduly high incidence of defects found in the five year old group. Very few children attend Infant Welfare Centres after the age of 3 years, and, unfortunately, there is no method comparable with that of the School Medical Service for parents to obtain treatment for defects that may arise. The continued co-operation of the Head Teachers and of the School Attendance Officers has been a valuable help without which much of the medical work and following up would have been difficult of proper fulfilment. As can be seen bv the figures in Table I. parents have attended at the routine medical inspections whenever home duties allowed, and their presence at the examination is helpful because the doctor can explain personallv any instructions he desires carried out. The Voluntary School Care Committees, and the Croydon Council of Social Service have also co-operated in the work. The Society for the Prevention of Cruelty to Children have, through Mr. Brown, their inspector, rendered assistance with a few difficult cases. 8 cases have been dealt with, and of these 5 have been brought to a satisfactory conclusion, whilst 3 still remain under supervision. The inspector paid 60 visits during the year. 237 Structural Work and Decorations Carried Out in Schools. 1 am indebted to the Education Officer for the following particulars of work carried out at the various schools during the past year: — External Painting at the following— Davidson. Ecclesbourne. Heath Clark. Ingram. Norbury Manor. St. Christopher's. Internal Painting and Distempering at the following Schools— Croydon British. Davidson. Ecclesbourne. Heath Clark. St. Andrew's. New Schools or Departments Opened— The Benson, Shirley. The Duppas, Waddon. Alterations and Additions at the following Schools— Howard—Central Heating Installed. Oval—Extension of Playground. Portland (temporary buildings)—Central Heating Installed. Purley Oaks—Central Heating Installed. Rockmount do. Sydenham do. Sydenham—Lavatory and w.c., Junior Department. Christ Church—Additional Playground. Holy Trinity—Repairs to Premises. West Thornton—Central Heating Installed. Whitehorse Manor do. Woodside do. St. Luke's do. Sanitary Accommodation. School. Approx. No. of scholars. No. of W.C.s Type of closet. Urinal space. No. of wash basins No. of towels in use at time of insp. No. of tail! used ea wk. Ashburton Senior Boys 202 4 Pedestal sep. cistn. 20 ft. A.F. 9 4 4 Senior Girls J. &I. B. J. & I. G. 219 10 Do. do. — 9 4 t 242 4 Do. do. 20 ft. A.F. 6 4 4 200 10 Do. do. — 6 4 1 Benson Infants B. 66 3 Do. do. 20 ft. A.F. 5 2 2 G. 84 7 Do. do. — Beulah Junior Boys 438 6 Do. do. 45 ft. A.F. 13 3 3 Junior Girls 384 20 Do. do. — 13 3 3 Infants B. 180 4 Do. do. 24 ft. A.F. 18 1 ! G. 199 11 Do. do. — Croydon British Senior Boys 181 5 Do. do. 32 ft. A.F. 2 Wg. Tr'ghs 2 6 Senior Girls 223 11 - - 2 do. 2 8 Davidson Senior Boys 186 5 Do. do. 36 ft. A.F. 2 tr'ghs 2 3 Senior Girls 173 14 Do. do. - Do. 2 3 J.G. & I. B. 223 3 Do. do. 20 ft. A.F. Wshg. 2 2 G. 113 6 Do. do. tr'ghs 2 Duppas Junior Boys 102 4 Do. do. 18 ft. A.F. 6 2 4 Junior Girls 108 8 Do. do. - 6 2 4 Infants ' B. 145 3 Do. do. 15½. A.F. 8 2 2 |G. 147 6 Do. do. - 10 2 Ecclesbourne Junior Boys 346 6 Trough. 4½ ft. 10 2 2 Pedestal. stop cock Senior Girls 336 (9 Tr'gh A.F. - 6 3 7 Ped'l A.F. ) 2tr'gh Infants B. 104 2 Tr'gh A.F. 24 ft. 2 2 2 G. 117 6 Tr'gh A.F. stop cock Emwood Senior & J. B. S. 222 4 Pedestal 25 ft. A.F. 9 2 8 J. 147 3 sep. c'stn. 16 ft. A.F. 6 2 Senior & J. G. S 306 8 Do. do. - 7 1 15 j 8 Do. do. — 6 1 - Infants B 384 4 Do. do. 25 ft. A.F. 16 2 4 G 10 Do. do. (inft. sze.) - 12 .hud Gonville Junior Boys 119 3 Do. do. 14 ft. A.F. 5 1 3 Junior Girls 188 9 Do. do. — 5 1 2 Infants G. — i .. 2 B. 77 2 Do. do. 12 ft. A.F. ) 4 239 Sanitary Accommodation. School. Approx. No. of scholars. No. of W.C.s Type of closet. Urinal space. No. of wash basins No.of towels in use at time of insp. No of towels used ea. wk. Howard Junior Boys 130 5 Pedestal sep. c'stn. 20 ft. A.F. 4 1 2 Junior Girls 153 7 Do. do. — 4 1 2 Infant B. 30 3 Do. do. 10 ft. A.F. 3 1 2 Infant . 33 4 Do. do. — 3 1 2 Ingram Senior Boys 309 5 Do. do. 28 ft. A.F. 4 4 8 Senior Girls 233 12 Do. do. — 4 2 10 Infants j B. 142 3 Do. do. 24 ft. A.F. 1 1 4 G. 99 6 Do. do. — tr gn 1 do. 1 Kensington Avenue Junior Boys 130 3 Do. do. 12 ft. A.F. 5 1 2 Junior Girls 126 7 Do. do. — 6 1 2 Infants B. 55 2 Do. do. 6 ft. A.F. 1 5 1 2 G. 53 4 — Kingsley . Senior Boys 400 6 Do. do. 20 ft. A.F. 14 2 4 Senior Girls 416 18 Do. do. — 14 2 6 Junior Mixed B. 196 4 Do. do. 17 ft. A.F. 16 4 4 G. 188 10 Do. do. — Infants B. 197 4 Do. do. 17 ft. A.F. 16 2 3 G. 220 10 Do. do. — Lanfranc Senior Boys 292 6 Do. do. 41 ft. A.F. 16 4 6 Senior Girls 272 16 Do. do. — 16 4 8 Norbury Manor . Senior Boys 266 5 Do. do. 40 ft. A.F. Tr'ghs 2ft. 6in. 2 2 8 Senior Girls 273 14 Do. do. — - 2 7 Junior Girls 6 Do. do. — J. B. <S I. 319 6 Do. do. 18 ft. A.F. 21 3 6 J. G. <£ I. 281 14 Do. do. — Oval . Senior Boys 180 4 Do. do. 15 ft. A.F. 10 2 4 Senior Girls 133 8 Do. do. — 10 2 6 J. B. & G. B 117 4 inc. Do. do. 21 ft. A.F. 8 2 4 G 78 10 inc. inf. g Do. do. - Inf. B. & G. 200 Do. do. — 10 2 4 Portland . Senior Boys 275 7 Do. A.F. 28 ft. stop cock 2 tr'ghs 5 ft. 2 2 Senior Girls 240 10 Do. do. — Do. 1 2 Infants B. 308 2 Do. do. 22 ft. 2 tr'ghs 6 ft. 1 2 G. 7 Do. do. stop cock 240 Sanitary Accommodation. School. Approx. No. of scholars. No. of W.C.s Type of closet. Urinal space. No. of wash basins No.o towels in use at time of insp. No. of toils used ea wk. Purley Oaks S.B. 107 6 Ped.Sep.Cis 33 ft. A.F. 3 2 4 S.G. 76 9 Do. do — 2 2 4 J. B. & G. B 90 Shar ed with Se nior Boys 4 3 6 G. 83 Shar ed with Se nior Girls Infants B. 77 4 Ped. sep. 17 ft. A.F. 1 4 2 4 G. 73 4 cistern — 1 Rockmount S. & J. B 182 4 Do. do. 22 ft. A.F. 7 2 6 S. & J. G. 140 10 Do. do. — 7 2 1 Inft. B. 109 1 Do. A.F. 21 ft. A.F. 3 1 2 Inft. G. 82 5 Do. A.F. — 4 1 2 South Norwood Jnr. B. 367 7 Do. sep. cistern 32 ft. A.F 10 4 s Jnr. G. 305 10 Do. do. — 6 2 8 Infants B. 98 3 Do. do. 27 ft. A.F. 4 2 7 G. 54 5 Do. do. — 4 Sydenham Jnr. Boys 314 6 Do. do. | 33 ft. A.F. 5 2 4 J.G. Infants J 396 16 4 Do. do. 34 ft. A.F. 8 2 4 5 Tavistock Snr. Boys 233 7 Do. do. b4 ft. A.F. 2 tr'ghs 2 Snr. Gilrs 306 17 Do. do. — Do. 2 8 Infants B. 97 2 Do. do. 7 ft. A.F. 7 2 4 g. 98 b Do. do. — . Waddon Snr. Boys 301 4 Do. do. 20 ft. A.F. 8 2 8 Snr. Girls 306 10 Do. do. - 10 2 14 J. B. B. 185 7 Do. do. 22ft. 6in.AF. 2 2 & G. .G 180 10 Do. do. — 6.' 2 Infants R 93 3 Do. do. 13 ft. A.F. 3 G. 114 7 Do. do. - 6 H West Thornton J. B. 290 9 Do. do. 30 ft. A.F. 9 2 4 4 4 J.G. 318 13 Do. do. — 7 4 2 2 Infants B. 172 3 Do. do. 23 ft. A.F. G. 154 5 Do. do. — 4 6 4 3 Whitehorse Manor S.B. 218 10 Do. do. 32 ft. A.F. 15 6 J.G. 281 16 Do. do. — 7 4 Infants B. 217 4 Do. do. 26 ft. A.F. 5 2 G. 155 8 Do. do. — 4 4 4 Winterbourne J. B. 417 7 Do. do. 27 ft. A.F. 2 wsg tr'ghs 2 J. G. 367 10 Do. do. — 2 do. 1 tr'h 2 Infants G. B 188 3 Do. do. 24 ft. A.F. G. 177 6 Do. do. — 1 do. sanitary accommodation. School. Approx. No. of scholars. No. of W.C.s Type of closet. Urinal space. No. of wash basins No.of towels in use at time of insp. No. of towels used ea. wk. Woodside Jnr. Boys 402 9 Pedestal sep. cist. 37 ft. A.F. 6 2 5 Jnr. Girls 278 13 Do. do. — 10 3 5 Infants B. G. 112 113 5 7 Do. do. Do. do. 9 ft. A.F. p 1 2 Heath Clark Cent. B. 210 5 Do. do. 22 ft. stop cock 8 4 10 Cent. G. 193 10 Do. do. — 8 4 10 John Ruskin Cent. B. 357 8 - 46 ft. A.F. 2 tr'ghs 7 13 Lady Edridge Cent. G. 295 8 Do. do. — 4 7 8 St. Christophers B. 60 9 Do. do. 31 ft. A.F. 2 3 15 G. 47 8 Do. do. — 3 I. - Do. do. — 3 St. Giles B. 36 3 Do. do. 10 ft. A.F. 3 1 small towel to ea. child renewed f'tnightly G. 42 5 Do. do. — 3 St. Luke's Myope B. 10 1 Do. do. 8 ft. a.F. 2 1 4 G. 7 2 Do. do. — 2 1 St. George's Hall B. 57 1 Do. do. 6ft. hand flushed 12 1 2 2 G. 37 2 Do. do. — Suffolk Road Temporary Infants B. 66 1 Standard pattern and height space for 3 persons 4 2 2 G. 56 3 - All Saints S.B. 44 1 Pedestal sep. cist. 6 ft. hand flushed cist. 2 1 1 S.G. 36 2 Do. do. — 2 1 1 J.B. 115 3 Do. do. 6½ ft. A.F. 2 1 1 J.G. 97 5 (J.G. & I.G.) Do. do. 2 1 1 Infants 95 3 (Inf. boys) Do. do. 8 ft. A.F. 2 1 1 christ Church J.M. & I. J.B. 138 4 Do. do. 16i ft. A.F. \ 3 ? 7 J.G. 190 14 Do. do. — Inf. B. 67 7 Do. do. Inf. G. 57 242 San itary Accommodation. School. Approx. No. of scholars. No. of W.C.s Type of closet. Urinal space. No. of wash basins No.of towels in use at time of insp. No. of towels used ea wk. Holy Trinity J. G. & S I. 252 11 Pedestal sep. cist. — 6 2 5 Parish Church S. & S J. B. 228 4 Do. do. 21 ft. A.F. 4 1 1 J. G. <S I. 324 16 Do. do. 11 ft. A.F. 7 3 f St. Andrew's S. & J. B. 155 3 Do. do. 25 ft. A.F. 5 2 2 S. & J. G. 125 9 Do. do. 7 2 1 Infants B. 56 2 Do. do. 8 ft. A.F. 1 6 2 1 G. 55 4 Do. do. — 1 St. Joseph's Boys 44 3 Do. do. 8 ft. stop tap 2 1 1 Girls 51 — 3 1 1 Infants B. 75 6 Do. do. - 2 1 1 G. 59 - St. Mark's J. G.. & I. B. 27 2 — 5 ft. A.F. 3 2 4 G. 137 5 Do. do. — St. Mary's (Addington) J. M.& I. Junior B 18 3 Do. do. 12 ft. A.F. 13 1 - Junior G 19 4 Do. do. — 1 Infants B. 3 1 G. St. Mary's R.C Mixed B. 167 4 Do. do. 16 ft. A.F. 6 1 5 Infants B. 38 2 Do. do. 8 ft. A.F. " Mixed G. 190 9 Do. do. - 6 2 inft.) 2 8 (inc. 2 inft) St. Peter's Inf. B. 73 3 sts. trough A. F. 4 ft. A.F. 3 1 1 Inf. G. 51 Do. Do. do. — 1 1 1 St. Saviour's J. M. B. 92 4 Do. do. 22 ft. A.F. 4 2 3 G. 122 7 Do. do. — Infants 86 2 Do. do. 7 ft. 3 2 4 Shirley J. Mxd. B. 91 3 Pedestal 10J ft. stop 2 1 1 G. 55 4 Do. do. 2 1 Infants B. 32 2 Do. do. 4 ft. A.F. 2 1 G. 29 3 Do. do. — Archbishop Tenison's Central B. 209 4 Do. do. 18 ft. A.F. 9 4 4 Senior G. 150 8 Do. do. — 5 2 4 St. Michael's Central G. 198 7 Do. do. — 3 3 1 243 The chief points which this table brings out are:—(1) The varying standards of sanitary provision in the schools. Reorganisation of schools, changes in the numbers attending, have led to a rather chaotic relationship between the number of conveniences provided to the number of children. (2) Insufficient provision of towels. Children are notoriously careless in washing their hands thoroughly, with the result that much of the dirt loosened by soap and water finds its way on to the towel. I consider there should be at least one roller towel to 50 children, and the towels should be clean each day. Only a few schools have trough closets, but the sooner these are replaced by modern pedestal closets, hand flushed, the better hygienically. Closets with automatic flushes engender careless habits, which are reflected in the stoppage of closets so often happening in private houses, and so often found to be due to improper use. Cost of the School Medical Service. The gross cost of the medical, dental and nursing services was £10,229; from this an income of £621 should be deducted, making a nett cost of £9,608. The rateable value of the Borough in 1934 was £2,064,772. The Government grant is 50 per cent, of the expenditure, hence the actual cost to the rates was £4,804, a rate of 0.58 pence. The nett cost of these services to the rates for 1934 per child on the school registers was 3s. 6.6d. The figures do not include £300 for Medical Inspection (Higher Education) and for Blind persons £655. Cost of Special Schools. Schools maintained by the Council £5,831; Contributions to schools under other authorities, £3,871; Loans charges, £499; Other expenses (travelling, etc.), £10; Income from parents' contributions and other receipts, £770; giving an actual cost of £9,441, of which £4,720 was payable out of local rates, giving a rate of 0.57 pence. 244 Cost of Milk and Meals. Milk and meals cost £1,871 2s. 10d.; Income from parents' contributions, £20 3s. 0d.; giving an actual cost of £1,850 19s. 10d. There has been an increase in the cost of the actual medical services rendered in the Public Elementary Schools from 0.54 in 1933 to 0.58 of a penny rate in 1934. The cost of maintenance Special Schools has risen from 0.51 of a penny rate in 1933 to 1.09 in 1934. The cost of milk and meals has decreased by £439. The Elementary Schools are now classified under the Hadow Scheme as Senior, boys, girls and mixed; Junior, boys, girls and mixed and Infants. The Table below gives the number of schools and the number of pupils in attendance thereat. The school population as given by the average number on the registers has decreased by 804. The average attendance was 91 per cent. This decrease in the number of children on the school registers is interesting, as the population of Croydon has increased from 239,950 to 240,600 (Registrar-General's estimates) over the same period. Table I. No. of Schools. Average number on the Registers. Average attendance. Average attendance per cent. Senior Boys 11 c. 3316 3098 93 2 n.p. 451 422 94 Senior Girls 11 c. 3268 2989 92 2 n.p. 371 354 95 Senior Mixed 6 c. 2474 2327 95 4 n.p. 1311 1184 90 Junior Boys 7 c. 2574 2398 93 Junior Girls 8 c. 2806 2581 92 3 n.p. 728 663 91 Junior Mixed 10 C. 4104 3748 91 4 n.p. 984 877 87 Infants (204 under 5) 14 C. 3683 3214 87 2 n.p. 209 186 89 Schools— Church of England 13 4054 3686 91 Roman Catholic 2 Council 30 22225 20355 92 Total 45 26279 24041 91 "C."—Council. "N.P."—Non-Provided. 245 Medical Inspection, in Schools. The work of medical inspection is spread over all the staff of Assistant Medical Officers, excepting those acting as Resident Medical Officers in Institutions, or as specialist officers. The Deputy Medical Officer, Dr. Watson, devoted 6/llths of his time to school medical duties; Dr. McMahon 3/llths; Dr. Jenkin-Lloyd 2/llths; Dr. Dormer 8/lliths; Dr. Pickup 8/llths. The groups examined have been entrants, usually aged 5-7 years; intermediates 8 years; and leavers 12-14 years. These are the three statutory groups. Examinations of children outside these groups are classified as "others." Children brought forward by head teachers, attendance officers, school nurses, etc., are classified as "specials." Rearrangements have been made in the time when the various groups are examined, and the Leaver age group has been raised to those children whose thirteenth birthday occurs in the year of examination. This group is examined now in the first quarter of the year. During the second and third quarters the Intermediate group (children 8-9 years of age) are examined, together with any of the Leaver group not examined earlier in the year. During the last quarter the Entrants group (i.e., all children admitted during the year who have not been examined since admission and who have not reached the age of 7 years) and any children left over from the Intermediates group, are examined. This alteration has caused a temporary drop in the number of routine medical inspections of group children, but has thereby enabled an increased number of re-inspections of sub-normal children to be done. Unfortunately, it is impossible to re-examine these children as they ought to be re-examined, namely, each year, owing to the claims of the statutory group. This would require a larger medical staff than is now available. Table II. gives a summary of the number of children examined in the various classes in the different schools, together with the parental attendance at the examinations. A total of 6,352 children were examined as compared with 8,936 in 1933, and 4,466 Parents attended the examinations. The percentage attendance of 246 parents in the entrants group was for boys 81 per cent., and girls 81.6 per cent; in the intermediate group, boys 73 per cent., girls 68.2 per cent.; and in the leavers group, boys 47 per cent., girls 61.9 per cent. On the other hand, 8,286 re-inspections were made as against 6,980 in 1933. As would be expected the percentage of parents attending is lowest in the leaver group, though this is unfortunate, for at this examination the medical officer can give the parent advice as to suitable future employment. With the present lack of continuity between the school medical services and the medical examination of young persons under the Factory Acts, advice given at the school leaving examinations assumes some degree of importance. 247 The total percentage of parents attending was T0.3, as against 64.1 last year. This shows an increasing interest by parents in medical examinations: a trend which is to be welcomed. Table 11 Name of School. Entrants 5 to 6 years of age. Intermediates. 8 to 9 years of age. Leavers. Other Ages. Number Examined Parents present. Number Examined Parents present. Number Examined Parents present. Number Examined Parents present. M. F. M. F- I M. F. M. F. M f. M. F. M. F. M. f. 1 Ashburlon 37 16 34 14 34 34 28 32 45 45 34 29 ... ... ... ... 2 Benson 22 23 22 22 ... ... ... ... ... ... ... ... ... ... ... ... 3 Beulah 64 35 40 28 52 21 33 14 ... ... ... ... ... ... ... ... 4 Croydon British ... ... ... ... ... ... ... ... 49 50 22 27 ... ... ... ... 5 Davidson 33 38 28 33 14 11 10 11 82 11 29 5 ... ... ... ... 6 Duppas 12 28 6 25 ... 1 ... 1 ... ... ... ... ... ... ... ... 7 Ecclesbourne 47 35 47 31 40 23 30 15 ... 52 ... 23 ... ... ... ... 8 Elmwood 83 85 61 62 51 71 28 20 49 25 10 10 ... ... ... ... 9 Gonville 47 36 44 36 22 11 16 9 ... ... ... ... ... ... ... ... 10 Howard 14 21 14 20 22 23 14 15 ... ... ... ... ... ... ... ... 11 Ingram 42 26 31 21 23 22 19 18 72 56 38 38 ... ... ... ... 12 Kensington 30 34 28 33 27 33 25 28 ... ... ... ... ... ... ... ... 13 Kingsley 65 65 34 52 87 89 52 56 83 81 38 73 ... ... ... ... 14 Lanfranc ... ... ... ... ... ... ... ... 66 79 24 55 ... ... ... ... 15 Norbury Manor 92 70 84 63 48 22 42 lb 48 87 28 63 ... ... ... ... 16 Oval 39 44 34 39 28 33 16 25 49 33 32 17 ... ... ... ... 17 Portland 56 46 42 43 23 19 22 17 95 66 40 36 ... ... ... ... 18 Purley Oaks 28 36 15 26 18 15 10 11 37 24 9 10 ... ... ... ... 19 Rockmount 25 24 19 21 36 25 27 22 56 6 32 2 ... ... ... ... 20 South Norwood 65 65 53 50 22 33 18 15 ... ... ... ... ... ... ... ... 21 Tern. S.N'wood 41 29 35 26 ... ... ... ... ... ... ... ... ... ... ... ... 22 Sydenham 71 59 39 46 26 2 20 1 ... ... ... ... ... ... ... ... 23 Tavistock 43 46 40 36 21 21 14 7 48 91 16 48 ... ... ... ... 24 Waddon 29 36 28 26 8 8 5 6 79 54 53 40 ... ... ... ... 25 West Thornton 80 58 57 47 34 69 28 47 ... ... ... ... ... ... ... ... 26 Whitehorse 69 68 63 47 47 51 39 26 51 ... 23. ... ... 13 ... 5 27 Winterbourne 52 71 52 64 50 42 41 37 ... ... ... ... ... ... ... ... 28 Woodside 6 12 6 6 70 21 49 12 ... ... ... ... ... ... ... ... 29 Addington 6 ... 5 ... ... 4 ... 2 ... ... ... ... ... ... ... ... 30 All Saints' 25 ... 21 ... 22 33 18 26 18 23 14 7 ... ... ... ... 31 Christ Church 24 37 23 36 12 31 8 24 ... ... ... ... ... ... ... ... 32 Holy Trinity ... 23 ... 20 ... 13 ... 8 ... ... ... ... ... ... ... ... 33 Parish Church 18 19 17 18 45 45 33 4C 12 ... 8 ... ... ... ... ... 34 St. Andrew's 25 25 23 22 19 17 11 8 ... ... ... ... ... ... ... ... 35 St. Joseph's 14 11 9 7 ... 3 ... 1 8 1 ... 1 ... ... ... ... 36 St. Mark's 17 15 6 ... 5 17 2 12 ... ... ... ... ... ... ... ... 37 St. Mary's 23 26 20 18 5 19 4 12 24 ... 6 ... ... ... ... ... 38 St. Peter's 4 11 9 9 13 7 7 10 ... ... ... ... ... ... ... ... 39 St. Saviour's ... 19 ... 10 10 9 7 3 ... ... ... ... ... ... ... ... 40 Shirley 14 16 14 10 29 27 27 22 ... ... ... ... ... ... ... ... 41 Tenisnn's Gl. ... ... ... ... ... ... ... ... ... 24 ... 16 ... ... ... ... 1362 1308 1103 1067 963 925 703 631 971 808 456 500 2 13 1 5 2670 2170 1888 1334 1779 956 15 6 Percentage of Parents Present at Medical Inspections. Entrants Boys 81.0 81.3 70.3 „ Girls 81.6 Intermediate Boys 73.0 70.7 „ Girls 68.2 Leavers Boys 47.0 53.7 „ Girls 61.9 Other Ages Boys 50.0 40.0 „ Girls 38.5 248 FINDINGS AT ROUTINE MEDICAL INSPECTIONS Uncleanliness. For uncleanliness surveys the health visitors made 514 visits to schools. At the primary inspections they found vermin in 314 and nits alone in 2,326 children. On these inspections, 3.9 per cent. of the children showed evidence of infestation as against 3.6 in 1933 and 4.0 in 1932. In connection with these findings it must be stated that as children in unsatisfactory families are subject to repeated examinations, they naturally raise the total percentage found unclean. Certain schools have persistently unsatisfactory records; though it is pleasing to note that some which used to give high uncleanliness figures showed a pronounced improvement. Clothing and Footgear. At routine medical inspections 99.1 per cent. of the boys and 98.5 per cent. girls were clothed and shod properly. Close scrutiny has been exerted by the medical inspectors and the findings are satisfactory. Nutrition. In the entrants 17.4 per cent. of the boys and 14.5 per cent, of the girls were below normal nutrition for the area. In the intermediate group 21.1 per cent. of the boys and 21.3 per cent. of the girls were under average; in the leavers group 25.5 per cent. of boys and 17.8 per cent. girls, giving in the whole school groups examined 20.9 per cent. boys and 17.4 per cent. girls. The figures are higher than in 1933. These figures appear to point to the effects of prolonged unemployment among the parents. The findings should be taken in conjujnction with the more elaborate analysis contained in Table III. The subject of child nutrition is a complex one and is dependent on many and diverse factors. Efficient mother-care is the dominant influence. This means a sensible realisation of the child as a growing, active being, who, although needing protection, will not benefit by coddling, and whose thoughts should be directed towards health and not ill-health. Malnutrition may be due to improper food, although the total amount taken is adequate. Proteins and fats are expensive, carbohydrates relatively cheap. In times of financial stringency the cheapest foods are bought, and thus children obtain an undue 249 proportion of carbohydrate and too little protein and fat. Milk is undoubtedly the most valuable food to make good the protein and fat deficiency, though the milk must be above bacteriological suspicion. The fundamental fact which appears to emerge from the welter of theories and opinions so continuously put forward, is that a plain, straightforward diet on old established lines, containing meat once a day, green vegetables, bread and butter and milk, contains all the necessary food factors and main chemical groups necessary for proper nutrition. Whether a child gets a sufficient quantity is a combination of financial circumstances and skilful buying. One mother will cater for a growing family successfully on a low income, whilst another mother will fail hopelessly. The art of wise buying is one which might be developed in school education. Milk Marketing Board Scheme. During 1934, by arrangement with the Milk Marketing Board, milk was supplied to schools in bottles containing onethird of a pint at a cost of ½d. per bottle. Some 16,000 bottles of milk were consumed per day, shewing an increase of 11,000 per day over the previous year. The scheme has been criticised on the grounds that it is forming a bad habit of taking food between regular meals. A child, however, is an active and growing organisation, and can easily assimilate and make use of extra nourishment which in an adult might lead to digestive disturbances. Again, not a few children, unfortunately, go to school after an inadequate breakfast; and the small amount of milk in the middle of the morning comes as a useful prop until dinner-time. All the milk supplied is Pasteurised milk, and the sources of supply are subject to constant supervision by the Medical Officer of Health, through the Sanitary Inspectors. Any falling off in quality or cleanliness is enquired into as soon as detected, and should any source prove consistently below standard, the supply from this source would be suspended. Heights and Weights. Table III. gives the results of an enquiry made to ascertain the average heights and weights of all children examined at routine inspections of 1934. The full value of this table will not be obtained until similar records for ten consecutive vears have been analysed; when this is completed the rate of growth can be followed, so far as Croydon children are concerned, throughout school life. Table III, HEIGHTS AND WEIGHTS. boys. GIRLS Year of Birth. Number Examined Average Height in inches. Average Weight in lbs. Average maximum Height in inches. Average maximum Weight in lbs. Average minimum Height in inches. Average minimum Weight in lbs Number Examined. Average Height in inches. Average Weight in lbs. Average maximum Height in inches. Average maximum Weight in lbs. Average minimum Height in inches. Average minimum Weight in lbs. 1930 24 41.0 39.9 41.8 41.3 40.5 39.1 25 39.9 37.2 41.9 40.7 39.9 35.8 1929 666 43.1 42.5 46.6 51.3 39.5 35.9 691 42.8 41.2 46.1 49.9 39.2 33.6 1928 503 44.5 44.6 47.7 52.5 41.5 38.2 441 44.1 43.5 47.3 51.6 40.9 36.2 1927 124 46.5 48.3 48.5 54.9 44.7 44.9 115 46.3 47.1 47.9 52.6 44.8 43.5 1926 617 49.2 54.0 53.4 65.9 45.0 44.6 557 48.9 52.8 52.9 64.6 45.7 44.1 1925 294 50.4 57.6 54.2 69.4 47.9 50.8 276 50.3 56.4 53.5 66.5 46.8 47.0 1924 81 51.9 62.4 53.6 67.8 50.1 66.4 104 52.0 60.9 54.1 68.9 50.5 57.4 1923 13 53.6 68 3 56.7 76.3 53.4 67.4 15 55.8 71.8 57.6 78.9 54.6 68.2 1922 710 55.6 76.0 61.4 109.8 49.9 57.7 613 56.3 76.9 62.3 113.6 51.4 58.0 1921 180 57.0 79.5 60.4 96.1 52.9 62.5 170 68.6 87.5 61.8 118.8 54.5 68.8 1920 1 20 59.0 88.1 61.8 101.5 59.4 82.5 27 61.1 97.0 63.1 100.8 59.6 80.1 1919 1 61.3 95.0 250 251 Children Born in 1929.—The boys are 0.3 inches taller and 1.3 lbs. heavier on the average than the girls. The average minimum weight of the boys is 2.3 lbs. more and their average minimum height 0.3 inches taller than the corresponding figures for the girls. The average maximum weight of the boys is 1.4 lbs. more and their average maximum height 0.5 inches taller than for the girls. Children Born in 1928.—The boys are 0.4 inches taller and 1.1 lbs. heavier on the average than the girls. The average minimum weight of the boys is 2.0 lbs. more and their average minimum height 0.6 inches taller than the corresponding figures for the girls. The average maximum weight of the boys is 0.9 lbs. more and their average maximum height 0.4 inches taller than for the girls. Children Born in 1926.—The boys are 0.3 inches taller and 1.2 lbs. heavier on the average than the girls. The average minimum weight of the boys is 0.5 lbs. more and their average minimum height 0.7 inches shorter than the corresponding figures for the girls. The average maximum weight of the boys is 1.3 lbs. more than the girls and their average maximum height is 0.5 inches taller than the girls. Children Born in 1922.—The boys in this group were 0.7 inches shorter and 0.9 lbs. lighter on the average than the girls. The average minimum weight of the boys is 0.3 lbs. less and their average minimum height 1.5 ins. shorter than the girls. The average minimum weight of the boys is 3.7 lbs. lighter and their average maximum height 0.9 ins. shorter than for the girls. In this group as a whole the bovs are shorter and lighter than the girls, but the former are a more uniform group : the girls exhibiting greater fluctuations around the mean average. RANGE OF VARIATION. Height. inches. Weight. pounds. Born in 1929: Boys 7.1 15.4 Girls 6.9 16.3 Born in 1928: Boys 3.4 14.3 Girls 6.4 14.4 Born in 1926: Boys 8.4 20.3 Girls 7.2 20.5 Born in 1922: Boys 11.5 52.1 Girls 10.9 55.5 252 The average minima of heights and weights are taken by selecting the shortest and lightest scholar in any particular group for each school and taking the average of the figures so obtained. The average maxima heights and weights are also obtained in the same way. The figures again show that the period of most rapid growth in stature is earlier in boys than in girls, the latter grow most rapidly and put on most weight during the last years of school life; boys, on the contrary, appear to grow most rapidly between 8 and 12 years of age. During the period of growth from 5 years to 8 years the boys gained on the average 11.5 lbs. in weight and 6.1 inches in height. The girls gained 11.6 lbs. in weight and 6.1 inches in height. From 8 years to 12 years the corresponding gains are 22.0 lbs. for boys and 24.1 lbs. for girls; 6.4 inches for boys and 7.4 inches for girls. During the period of growth from 5 years until the end of the 12th year the boys increased by 12.5 inches in height and 33.5 lbs. in weight; the girls increased 13.5 inches in height and 35.7 lbs. in weight. The records of 4,000 boys and girls of public elementary schools in Croydon born during the period 1916-1919 were analysed by the Galton Laboratory. The results gave consistent mean heights and weights of the values, 55.68 ins. for boys and 56.23 for girls, and 75.95 lbs. for boys and 76.94 lbs. for girls when the mean age had been reduced to the standard of 12 years. The apparent growth rates from measurements at a nearly constant age are, as might have been expected, not very consistent from year to year, varying in height from 1 to 2 ins. per year for the boys and from 2 to 3 ins. per vear for the girls, and from H to 8 lbs. in weight per year for the boys, and from 8 to 9½ lbs. in weight per year for the girls. The boys are less in stature and in weight than the girls at this age; and the excess in height of the girls is more than can be accounted for by the excess in weight. There is a marked variation in the phvsique of both boys and girls in the different schools of the Borough. This is shown specially in weight. 253 Heart and Circulatory System. At routine medical inspections among the entrant group 9 boys and 16 girls were found to have organic disease. In the Intermediate group, the figures were 36 boys and 38 girls, and in the Leaver group 16 boys and 10 girls. Functional disease was found in 98 boys and 76 girls in the Entrants; 70 boys and 85 girls in the Intermediate; 50 boys and 49 girls in the Leaver group. Anasmia was present in 123 boys and 101 girls in the Entrant group; 127 boys and 111 girls in the Intermediate; and 106 boys and 63 girls in the Leavers. The percentage of all Heart and Circulatory defects among children examined at routine medical inspection was 18.7. Chest Complaints (Other than Tuberculosis). In all the groups combined 0.5 per cent. of the boys and 0.5 per cent. of the girls had some minor affection of the lungs. This was usually a mild Bronchitis. Tuberculosis. Fifty-one children were referred to the Tuberculosis Officer for further examination. Two cases were diagnosed as definitely tuberculous on further examination. All contacts of known cases of Tuberculosis are kept under supervision and re-examined at each school medical inspection. 127 children were under such surveillance at the beginning of the year 229 were added during the year, 89 were discharged, leaving 267 under observation at the end of the year. 16 cases of pulmonary Tuberculosis and 11 cases of nonpulmonary Tuberculosis in children of school age were notified to the Medical Officer of Health during the year. Three children died of pulmonary Tuberculosis and 4 of non-pulmonary Tuberculosis. The ages at death of these cases were : Pulmonary, 14 and 15 (two) years; Non-Pulmonary 5, 11 (two) and 14 vears. 3 Non-Pulmonary deaths were certified to be due to Tuberculous Meningitis, and 1 from Acute Tuberculous Peritonitis. Taking the total school population as 26,279, the mortality rate from Pulmonary Tuberculosis in school children was 11 per 100,000, and the incidence rate 61 per 100,000. For Non-pulmonarv Tuberculosis the respective figures were 15 and 42. 254 Nose and Throat. In all the groups 581 boys and 518 girls had enlarged tonsils; 54 boys and 31 girls had adenoids only; 359 boys and 358 girls had adenoids and enlarged tonsils; 69 boys and 30 girls were mouth breathers; 752 boys and 486 girls exhibited enlarged glands in the neck. Taking the two groups of cases of adenoids, and enlarged tonsils with adenoids, as requiring operative measures, it is seen that 4.8 per cent. of all school children examined in the three groups were in need of surgical attention to the throat and nose. In 1933, dealing with another group of children, the figure was 8.6 per cent. The importance of training in correct methods of breathing after the removal of adenoids and tonsils cannot be too strongly emphasised. All cases are invited to attend Breathing Exercises Classes held at St. Andrew's Hall and 108 attendances were made. This is 50 per cent. of the children who were operated upon, and is a disappointing proportion. The distance of the Remedial Exercises Clinic from the homes of the children, together with the dangers of traffic, played a part in deterring parents from sending the children. Of all children examined at Routine Medical Inspection, in the Entrant group 21.0 per cent. had enlarged tonsils; 1.6 per cent. had adenoids alone; 16.6 per cent. enlarged tonsils and adenoids; and 17.2 per cent. had enlargement of the submaxillary or cervical glands. In the Intermediate group the respective percentages were 15.9 per cent., 1.4 per cent., 12.0 per cent. and 17.5 per cent.; and in the Leaver group, 13.3 per cent., 0.8 per cent., 2.5 per cent., and 25.3 per cent. The percentages for the three groups, in relation to the total number of children examined, were 17.3 per cent., 1.3 per cent., 11.3 per cent., and 19.6 per cent. Table IV. gives in summary the percentage of Nose and Throat defects and of enlarged glands in the various groups examined. Table IV. SUMMARY. Group. *Nose and Throat Defects. Enlarged Glands. Boys. Girls. Boys. Girls. Entrants 42.4 40.2 19.5 14.7 Intermediates 80.1 32.1 19.0 15.8 Leavers 19.9 15.8 31.2 18.3 Other Ages 50.0 30.8 — — *Does not include mouth breathers, but includes other defects of nose and throat. 255 Defective Hearing. The commonest causes of deafness in children are middle ear disease and adenoids. Routine medical inspection showed that 0.5% entrants, 0.3% intermediates and 0.4% leavers in the children examined had defective hearing. Speech Defects. A special class of stammerers and the treatment of other speech defects commenced in October. The class is held twice weekly, and is conducted by two qualified lady teachers. During 1934,13 children attended. The class has not been in being long enough to give any statistics. Routine medical inspection findings showed in the Entrant group 0.8% children defective, in the Intermediate group 0.4%, and 0.4% in the Leaver group. Skin Diseases. The findings show only the incidence in the groups examined at a specific examination and must not be taken to indicate the total incidence of skin disease in school children. Entrants gave 2.5 per cent. incidence in boys and 2.4 per cent. in girls; Intermediate boys 1.9 per cent and girls 1.5 per cent.; Leavers 3.0 per cent. boys and 2.8 per cent. girls; a total in all groups of 2.5 per cent. boys and 2.3 per cent. girls. Deformities. Among children examined at Routine Medical Inspection 0.9 per cent. of the boys and 0.5 per cent. of the girls showed evidences of rickets; 5.6 per cent. boys and 5.2 per cent. girls had some abnormal degree of spinal curvature, and 4.1 per cent. boys and 4.3 per cent. girls showed some other physical deformity. External Eye Diseases. Squint was present in 1.9 per cent. of all children examined in the various groups and was most frequently found in the Entrant group (3.4 per cent. boys and 3.1 per cent. girls). Its incidence declined as age advanced. Blepharitis occurred in 1.4 Per cent. of all the children. Conjunctivitis was present in 0.2 Per cent. of all the children, and other external eye defects were noted in 0.2 per cent. 256 The total percentages of eye defects in the various groups was 5.2 for Entrants; 2.8 for Intermediates; and 2.6 for Leavers. For 1933 the corresponding figures were 3.7, 3.5 and 2.7. Vision. The Entrant group is not examined for visual acuity at routine medical inspection. If a child is wearing corrective glasses, the vision is tested with the glasses worn at the time of examination. In the Intermediate group 7.0 per cent. of the boys and 5.2 per cent. of the girls were referred for treatment or observation for defective vision, and in the Leaver group 8.1 per cent. of the boys and 8.4 per cent. of the girls. The Leaver group of girls invariably gives the worst figures for vision. As a whole there is a slight upward trend in the total number of school children who require spectacles. Table V. Extent of Defect. Intermediates. Leavers. Total. Boys. Girls. Boys. Girls Boys. Girls. No. % No % No. % No. % % % Normal R 917 95.2 882 95.4 907 93.4 741 91.7 94 3 93.7 6/6ths. or 6/gths. L 905 94.0 872 94.3 910 93.7 750 92.8 93. 93.6 6/l2ths or 6/24ths R 44 4.6 41 4.4 55 5.7 61 7.5 5.1 5.9 L 51 5.3 50 5.4 54 5.6 57 7.1 5.4 6.2 6/36ths. or worse R 2 0.2 2 0.2 9 0.9 6 0.8 0.6 0.4 L 7 0.7 3 0.3 7 0.7 1 0.1 0.8 0.2 Table VI. TEETH. Entrants. Intermediates. Leaven. Boys. Girls. Boys. Girls. Boys. Girls. No. % No. % No. % No. % No. % No % Perfect set of Teeth 724 53.2 673 51.5 542 56.3 499 53.9 525 54.1 437 54.1 One to four decayed 451 33.1 457 34.9 333 34.6 309 33.4 379 39.0 320 36.9 Four or more decayed 187 13.7 178 13.6 88 9.1 117 12.7 67 6.9 51 6.3 Total 1362 1308 963 925 971 808 257 It is interesting to note that 3,400 children of all groups, or 53.7 per cent., were said to have sound teeth at medical inspection. The percentage of sound teeth found by the Dental Inspectors was 28 per cent. The need for systematic instruction on the care of the teeth is certainly indicated. It is seen, however, that at the more detailed dental examination made by the Dentists the percentage of sound dentitions is 28. The figures indicate that some 52 per cent. of children entering school have perfect sets of teeth. The proper care of the teeth before school age is reached would lead to much less attention being necessary during school age. The Leaver group gave the best findings, a result brought about by the work of the School Dental Service. Table VII. SUMMARY OF THE FINDINGS AT ROUTINE EXAMINATIONS. (Percentages.) Condition Entrants. Intermediates. leavers. Other Ages All Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Cleanliness— (Percentage clean) Head 99.2 98.2 99.7 97.3 99.1 98.4 ... ... 99.3 98.0 Body 99.4 98.9 99.3 99.6 99.6 99.4 ... ... 89.4 99.2 Clothing (satisfactory) 98.7 98.7 99.7 97.5 98.9 99.3 ... ... 99.0 98.5 Footgear do. 98.8 98.5 99.7 97.4 98.8 99.3 ... ... 99.1 98.4 Nutrition (normal) 82.6 85.5 78.9 78.7 74.5 82.2 50.0 84.6 79.1 82.6 Defects- Circulatory System 16.9 14.8 24.2 25.3 17.7 15.1 ... 38.5 19.2 18.1 pulmonary System (defects not T.B.) 0.5 0.1 0.6 0.9 0.3 0.6 ... 7.7 0.5 0.5 Skin Disease 2 5 2.4 1.9 1.5 3.0 2.8 ... ... 2.5 2.3 detects of Nose and Throat 44.8 41.4 32.7 33.2 21.0 16.2 50.0 46,2 34.3 32.3 Enlarged Cervical Glands 19.5 14.7 19.0 15.8 31.2 18.3 ... ... 22.8 15.9 External Eye Disease 5.3 5.0 3.0 2.5 3.0 2.1 ... ... 3.9 3.5 Defective Vision ... ... 7.0 5.2 8.1 8.4 ... 15.4 4.7 3.9 Defective Hearing 0.4 0.6 0.3 0.2 0.3 0.6 ... ... 0.4 0.5 Speech Defects 1.2 0.2 0.7 0.1 0.5 0.2 ... ... 0.9 0.2 Dental Disease (more than four decayed) 13.7 13 6 9.1 12.6 6.9 6.3 ... 7.7 10.4 11.4 Dull and Backward 0.9 0.5 1.9 1.1 1.2 0.9 ... ... 1.3 0.8 The above Table gives in a concise form the findings at Routine Medical Inspections. 258 Defects of the nose and throat are once again the commonest defects found and show an increase on last year's findings; the Entrant group is still worst, and the Leaver group the best. For nutrition, the Leaver boys gave the worst figures, whilst as a group the Entrants showed the best findings. The percentages, as compared with last year, show a distinct falling-off in the standard. Taking all the groups examined subnormal nutrition was recorded in 19.1% of the children as contrasted with 15% in 1933. Enlarged cervical glands were recorded most often in the Leaver group in both sexes, a finding probably due to the cumulative effects of dental caries, enlarged tonsils and deficient diet. The influence of school work on eyesight is shown by the higher figures for the Leaver group, and if these figures are contrasted with those for secondary school children, it is seen that the latter are even less favourable. This is not the actual amount of defective vision, as children whose vision is normal by the aid of spectacles, are classified as having normal vision. It is probably certain that there is a general deterioration in the standard of vision and that a steadily increasing proportion of the population wear glasses for the correction of visual defects. The number of children suffering from circulatory defects is high, and is mainly caused by the ravages of rheumatism upon the heart and its valves. The figure is higher than for last year. The average standard of cleanliness showed a slight decline, which was more noticeable among the girls. This drop is hard to explain except in any other way than that it is caused by parental carelessness. Quite a number of cases occur in children who live under good housing conditions with bathing and other modern facilities. The following Table was compiled from the findings at routine medical inspections, in order to ascertain the amount of visual defect in the particular children examined in the various schools. It relates only to children who were referred from 259 routine medical inspections for treatment or observation and who were consequently thought to be in need of spectacles. Table VIII. School. Intermediate*. Leavers. School. Intermediates. Leavers. Boys Giils Boys Girls Boys Girls Boys Girls Ashburton - 5.9 11.1 6.7 Sydenham 7.7 - ... ... Benson ... ... ... ... Tavistock 28.6 14.3 4.2 16.5 Beulah 1.9 14.3 ... ... Waddon — — 7.6 — Croydon British ... ... 4.1 10.0 West Thornton 14.7 2.9 ... ... Davidson — 9.1 7.3 18.2 Whitehorse Manor 6.4 9.8 3.9 ... Duppas ... — ... ... Winterbourne 4.0 2.4 ... ... Ecclesbourne — 4.3 ... 1.9 Woodside 5.7 — ... ... Elmwood 3.9 1.4 4.1 — Addington ... — ... ... Gonville 13.6 18.2 ... ... All Saints' — 6.1 5.6 4.3 Howard 9.1 - ... ... Christ Church — 3.2 ... ... Ingram 8.7 4.5 8.3 25.0 Holy Trinity ... 7.7 ... ... Kensington 7.4 3.0 ... ... Parish Church 4.4 4.4 16.7 ... Kingsley 10.3 6.7 10.8 9.9 St. Andrew's — — ... ... Lanfranc ... ... 10.6 3.8 St. Joseph's ... — - — Norbury Manor 4.2 4.5 10.4 6.9 St. Mark's — 5.9 ... ... Oval 14 3 — 2.0 6.1 St. Mary's - 15.8 20.8 ... Portland 4.3 5.3 11.6 7.6 St. Peter's - 14.3 ... ... Purley Oaks 5.6 6.7 8.1 — St. Saviour's — - ... ... Rockmount 5.6 4.0 7.1 16.7 Shirley 27.6 7.4 ... ... South Norwood 18.2 6.1 ... ... Tenison's Girls ... ... ... 8.3 Temporary South Norwood ... ... ... ... Note.—Where a dash is placed, children were examined, but no visual defects were found. 260 Table IX. Return of Defects Found in the Course of Medical Inspection 1934. Defects. Boys. Girls. No. requiring Treatment. No. referred for Observation. Percentage of total Examined. No. requiring Treatment. No. referred for Observation Percentage of total Malnutrition 26 36 1.88 19 30 1.60 Uncleanliness— Head ... ... ... 1 ... 0.03 Body Skin Disease 4 2 0.18 8 8 0.52 Eye Diseases— Defective Vision 146 8 4.67 111 7 3.86 Squint 42 9 1.55 25 11 1.11 External Eye Trouble 6 2 0.24 3 1 0.13 Ear Diseases— Deafness 2 ... 0 06 3 ... 0.10 Otitis Media 2 ... 006 5 ... 0.16 Other Diseases ... 1 0.03 1 1 0.07 Nose and Throat— Enlarged Tonsils only 40 86 3.82 38 112 4.91 Adenoids only 13 19 0.97 12 9 0.29 Enlarged Tonsils & Adenoids 103 84 5.87 97 92 5.19 Other Conditions 14 5 0.58 11 1 0.39 Enlarged Cervical Glands (not t.B.) 3 8 0.33 1 5 0.20 Dental Defects 29 ... 0.88 53 4 1.87 Speech Defects 12 10 0.67 2 1 0.10 Heart and Circulation— Organic 5 23 0.85 8 32 1.31 Functional 1 33 1.03 1 40 1.34 Anæmia 5 13 0.55 1 9 0.33 Bronchitis 10 25 1.06 8 24 1.05 Other Non T.B. 1 12 039 1 1 0.07 Pulmonary Tuberculosis 4 9 0.39 2 11 0.42 Other Tuberculosis ... ... ... 1 ... 0.03 Nervous System Disorders (including Epilepsy, Chorea, etc.) 4 10 0.42 5 6 0.36 Deformities — Rickets 1 2 0.09 ... 1 0.03 Spinal Curvature 34 20 1.64 33 27 1.96 Others 33 4 1.12 32 14 1.51 Other Defects and Diseases 12 58 2.12 18 51 2.26 Totals 552 479 31.26 500 498 32.68 Total Children Examined - 3998 3054 261 Table X. CHILDREN EXAMINED AT ROUTINE INSPECTIONS AND FOUND TO REQUIRE TREATMENT (EXCLUDING UNCLEANLINESS AND DENTAL DEFECTS). Group. No. of Children Inspected No. referred for treatment. Percentage referred for treatment Corresponding percentage for 1933. Entrants 2670 347 13.0 11.9 Intermediates 1888 371 14.4 11.8 Leavers 1779 279 15.7 16.9 Other Ages 15 4 26.7 14.9 6352 901 14.2 13.6 The fact that 13.0 per cent. of children examined shortly after entering school at 5 years of age required treatment of some kind is an adverse commentary upon the lack of any system of medical and dental supervision of the pre-school child. To leave medical and dental supervision in the hands of parents has been proved repeatedly to be insufficient. Besides, the parent cannot be expected to recognise those early departures from health which, if dealt with promptly, are easily put right. When a noticeable breakdown happens, the child is taken to a doctor, who endeavours to remedy a condition which should never have occurred. In other cases the study of cumulative departure from normal is so insidious that irreparable consequences have supervened before the parent takes any steps. Initial slight defects, if unremedied, often lead to further defects as the child grows. 262 Table XI. CHIEF CAUSES OF EXCLUSIONS FROM SCHOOL. Condition. Exclusions during 1934. Percentage of total exclusions. Exclusions during 1933. Percentage of total exclusions. Ringworm—Head 10 0.17 11 0.26 ,, Body 20 0.34 23 0.54 Verminous Conditions 616 10.50 542 12.71 Impetigo 239 4.07 230 5.39 Scabies 27 0.46 49 1.15 Scarlet Fever 528 9.00 282 6.61 Measles 1373 23.43 1215 28.48 Diphtheria 333 5.63 115 2.70 Whooping Cough 723 12.34 404 9.47 Chicken Pox 548 9.35 870 20.40 Mumps 73 1.24 66 1.55 Tuberculosis (all forms) 21 0.35 37 0.87 External Eye Disease 13 0.22 14 0.33 Sore Throat 207 3.53 203 4.76 Other Causes 1129 19.27 204 4.78 5860 ... 4265 ... There were 1,595 more children excluded from school on account of various illnesses than in 1933. The chief causes of exclusion were Infectious Diseases, 61.4 per cent. Exclusions on account of verminous conditions were higher than in 1933 or 1932, and constituted 10.50 per cent, of the total exclusions. The health visitors examined 66,796 children in the schools in connection with the personal cleanliness of the scholars. Impetigo was slightly more prevalent than in 1933. 263 Table XII. Name of School. School population. Notifiable Diseases. Conditions notified by Teachers and School Attendance Officers. Percentage incidence of Infectious Diseases in Schools. Scarlet Fever Diphtheria. Ac. Primary Pneumonia. Measles. Whooping Cough. Chicken Pox. Mumps. Scabies. Impetigo. Sore Throats. Ringworm (body). Ringworm (scalp). Indefinite Sickness. 111. Not Infectious. Conjunctivitis % Ashburton 870 10 1 ... 45 36 4 ... ... ... ... ... ... 8 21 ... 11.0 Benson 135 ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... 0.7 Beulah 1176 17 15 ... 74 24 43 ... 4 17 10 1 ... 21 30 3 14.7 Croydon British 429 8 2 ... 1 1 2 ... 2 ... 8 1 ... 3 4 ... 3.3 Davidson 724 10 3 ... 52 46 9 ... ... 5 2 1 ... 3 28 1 16.6 Duppas 532 12 5 ... 2 ... 1 ... ... 17 4 ... ... 11 32 ... 3.8 Ecclesbourne 916 16 9 ... 22 29 57 ... 3 9 3 2 3 12 23 2 14.5 Elmwood 1056 13 29 ... 48 29 4 ... ... 24 3 2 5 ... 41 2 11.6 Gonville 384 8 ... ... 26 30 57 ... ... 4 8 ... ... 12 19 ... 31.5 Howard 342 8 1 ... 1 3 ... ... ... 4 ... ... ... ... 8 ... 3.8 Ingram 810 9 11 ... 55 17 5 ... 4 5 12 1 ... 10 32 ... 12.0 Kensington Av. 374 3 3 ... 41 15 2 ... ... ... ... ... ... ... 6 ... 17.1 Kingsley 1622 41 51 ... 76 32 17 21 2 25 45 1 ... 14 62 ... 14.7 Lanfranc 620 11 5 1 1 1 4 1 ... 1 18 1 ... 5 10 ... 3.9 Norbury Manor 1128 24 3 ... 69 4 ... 20 ... 1 4 1 ... 12 25 1 1.1 Oval 706 8 3 ... 56 15 62 2 1 3 2 ... ... 9 48 ... 20.7 Portland 853 26 ... ... 63 62 23 2 1 4 2 ... ... 9 22 ... 20.6 Purley Oaks 514 11 8 ... 1 15 15 ... ... 3 5 ... ... 9 15 ... 9.7 Rock mount 520 12 4 ... 88 ... 4 ... 1 2 ... ... ... 6 13 ... 20.8 South Norwood 803 17 9 ... 28 25 5 ... ... ... 3 ... ... 4 12 ... 10.5 do. (Temp). 103 2 ... ... 20 24 1 ... 1 ... 5 ... ... 3 14 ... 45.6 Sydenham 714 23 7 ... 48 15 20 ... ... 10 5 2 ... 17 29 ... 15.8 Tavistock 7.56 10 5 ... 37 20 22 3 ... 4 7 1 ... 2 26 ... 12.4 Waddon 1167 40 33 1 43 28 18 ... ... 20 12 ... ... 7 93 ... 14.0 West Thornton 921 16 42 ... 57 31 20 6 ... 15 29 ... ... 15 44 1 18.7 Whitehorse Manor 880 21 8 1 58 1 6 1 3 5 2 1 ... 11 17 ... 10.9 Winterbourne 1122 33 12 ... 3 87 5 6 ... 4 ... ... ... 6 20 ... 13.0 Woodside 903 7 2 ... 97 44 21 1 ... ... ... ... ... 13 38 1 19.0 Heath Clark 413 2 2 ... 1 1 1 1 ... 1 ... ... ... ... 2 1 1.9 John Ruskin 415 3 ... ... ... ... 2 1 ... ... ... ... ... ... ... ... 1.4 Lady Edridge 318 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 0.3 St. Christopher's 90 3 4 ... ... ... 1 ... ... 3 1 1 ... ... 3 ... 8.9 St. Giles 62 1 2 ... ... ... ... ... ... ... 1 ... ... 2 2 ... 4.8 St. Luke's 17 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 5.9 Addington St. Mary's 37 ... ... ... 2 ... ... ... ... 7 1 ... ... 4 4 ... 5.4 All Saints' 381 8 4 ... 44 2 ... 1 ... ... 4 1 ... 3 10 ... 15.5 Arch. Tenison's 373 3 ... ... ... ... 1 ... ... 4 3 ... ... ... 2 ... 1.1 Christ Church 441 9 9 ... 51 17 1 1 1 1 1 1 ... 2 9 ... 20.0 Holy Trinity 249 6 2 ... 35 5 33 ... ... 1 ... 1 ... 1 13 ... 32.5 Parish Church 544 27 10 ... 18 7 56 ... ... 9 1 ... 1 21 7 ... 21.7 St. Andrew's 394 11 2 ... 2 1 9 1 1 15 5 ... ... 3 8 ... 6.6 St. Joseph's 231 ... ... ... 4 ... ... ... 1 ... ... ... ... ... ... ... 1.7 St. Mark s 167 1 1 ... 22 13 1 ... ... 2 ... ... ... ... 3 ... 22.8 St. Mary's 390 6 ... ... 5 20 1 3 ... 7 ... ... ... 2 4 ... 9.0 St. Peter's 124 8 1 ... 23 17 ... ... 1 1 ... ... ... 13 24 ... 39.5 St. Saviour's 298 8 8 ... 4 1 14 ... ... 2 1 ... ... 7 13 1 11.7 Shirley 208 11 14 ... 43 ... 1 2 ... 1 ... ... ... 3 6 ... 34.1 St. Michael's 217 ... 1 ... ... 2 ... ... 1 2 ... 1 ... ... ... ... 1.4 Selhurst Grammar 972 4 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 0.6 Totals 528 333 3 1367 721 548 73 27 238 207 20 10 285 844 13 264 The percentage incidence is calculated on the average school population over the year at each school. The highest incidence in relation to children in attendance at the school was in South Norwood Temporary (45.6) and St. Peter's (39.5), due chiefly to Measles and Whooping Cough; next were Shirley (34.1), Holy Trinity (32.5), and Gonville (31.5), due chiefly to Measles, Whooping Cough and Chicken Pox. The lowest incidence was in the Lady Edridge (0.3), Selhurst Grammar (0.6), Norbury Manor and Archbishop Tenison's (1.1), and St. Michael's and John Ruskin (1.4). In view of the age distribution of these schools this was to be expected. Scarlet Fever. Five hundred and twenty-eight cases were notified from the schools, 246 more than in 1933. Kingsley (41), Waddon (40), and Winterbourne (33) had the most cases. Diphtheria. Three hundred and thirty-three cases were notified from schools. This is double the number in 1933. The Kingsley with 51 cases, West Thornton with 42 cases, Waddon with 33 cases, and Elmwood with 29 cases, had the highest individual numbers. Mumps. Only 73 cases were notified from schools. Kingsley (21) and Norbury Manor (20) had the highest individual numbers. Chicken Pox. Five hundred and forty-eight cases occurred in schools and were notified therefrom, 322 less than last year. Oval (62), Ecclesbourne and Gonville (57), and Parish Church (56) showed the highest incidence. Whooping Cough. Seven hundred and twenty-three notifications were received from schools, 319 more than in 1933. The highest numbers for individual schools were: Winterbourne (87), Portland (62), Davidson (46), and Woodside (44). Measles. Thirteen hundred and seventy-three cases occurred in schools. Those showing the highest incidence were Woodside (97), 265 mount (88), Kingsley (76), and Beulah (74). The reorganisation of schools as advocated in the Hadow Report, with the consequent grouping of children of the most susceptible ages into Junior, Mixed and Infants Schools, has led to a higher incidence of all the common infectious diseases in these schools than occurred under the former arrangements. However desirable (he re-grouping recommended by the Hadow report may be educationally, it will probably be found not to be advantageous from the medical aspect. FOLLOWING UP. There are 19 Health Visitors, 18 of whom devote 5/llths of their time to school work, and one who is employed whole time in school clinics. In addition there are two masseuses, one of whom devotes all her time to school work and the other half her time, the other half being occupied with Maternity and Child Welfare. There are three whole-time dental assistants. The nurses also assist at routine and special medical inspections in the schools and pay periodical visits to schools for cleanliness surveys. With the helpful co-operation of the Chief School Attendance Officer and his staff, persistent offenders against cleanliness have been proceeded against in Court, others have been brought before the Committee and warned. There are still, however, certain families who consistently spoil the cleanliness records of some of the schools. School Visits. The following table summarises the visits paid, etc., in connection with these duties: — Visits to Schools re Cleanliness 46 Visits to School Departments re Cleanliness 514 Number of children inspected for cleanliness (first inspection) 66,796 Number of children inspected (subsequent inspections) 4,298 Number of occasions in which children found unclean (first inspection) 2,640 Number of occasions in which children found unclean (subsequent inspections) 2,894 In addition 1,518 "other visits" to Schools were made. 266 Home Visits. Concerning uncleanliness 70 Concerning defects found at routine medical inspections 1,568 Subsequent visits re defects found at routine medical inspections 1,047 Visits re special cases 868 Visits to dental cases 240 Visits in connection with infectious cases and other visits 14,273 These figures show an increase of 38 in the number of children inspected for cleanliness; an increase of 3,433 in visits paid in connection with infectious cases and other visits for miscellaneous reasons; a decrease of 93 in the following-up visits to dental cases, and a decrease of 261 in visits to special cases; decreases of 141 in the visits made regarding defects found at routine medical inspections, and of 6 in the home visits regarding uncleanliness. TREATMENT, The Work of the School Clinics. Table XIII. Summary of Attendances. 1934. 1933. Increase or Decrease. Minor Ailments Clinics 8607 11740 - 3133 Inspection Clinic 1597 1207 + 390 Dental Clinics 13352 13444 — 92 Ophthalmic Clinic 2982 2797 + 185 Orthopaedic Clinic 2437 2637 — 200 Remedial Exercises Clinic 7052 8003 — 951 Ear, Nose and Throat Clinic 542 1148 — 606 Ionization Clinic 390 386 + 4 Rheumatism Clinic 288 193 + 95 37247 41555 - 4308 The Minor Ailments Clinic. This Clinic is held each morning at the Lodge Road premises. One nurse is in attendance for the whole session and a doctor attends when possible to see cases referred to him. He 267 does not spend his whole morning here, however, going on either to a school for a medical inspection or to another Clinic. Medical cases or cases requiring surgical measures are referred to their private doctor or to hospitals. The aim of this Clinic is to render first aid and to treat the minor disabilities peculiar to school children, and to advise what further measures may be necessary. A subsidiary Clinic is held at 206, Selhurst Road on five days weekly. 445 children made 2,227 attendances during 1934. " Table XIV. Complaint. 1934. 1933. Cases. Attendances. Average No of Attendances per case. Cases Attendances. Average No. of Attendances per case. Ringworm of Scalp 6 24 4.0 18 74 4.1 ,, Body 15 152 10.1 28 151 5.4 Scabies 44 175 4.0 88 264 3.0 Impetigo 221 1388 6.3 257 1568 6.1 Other Skin Diseases 82 209 2.5 124 448 3.6 Otorrhœa and other Ear defects 195 2020 10.4 294 4332 14.7 External Eye Disease 215 1044 4.9 192 1258 6.5 Miscellaneous 593 3595 6.1 642 3645 5.7 1371 8607 6.3 1643 11740 7.1 From this table it is seen that the average number of attendances per child decreased from 7.1 to 6.3; the total attendances fell by 3,133, and the number of individual cases decreased by 272. Otorrhœa is one of the most difficult of all minor conditions in school children to cure, this being reflected in the large number of attendances made for the remedying of this defect. Impetigo still remains troublesome, but the cases of scabies attending showed a marked decrease in number. Adenoids and Enlarged Tonsils. During 1934, 78 cases of tonsils only, 25 cases of adenoids and, and 200 cases of adenoids and enlarged tonsils, a total of cases, were recommended for treatment. In 197 cases the Local Education Authority was requested to arrange for the operation. 268 There were 34 operating sessions at the Croydon General Hospital. The work is done by a rota of 4 general medical practitioners working in pairs, as surgeon and anjesthetist, for periods of 3 months, and remunerated by the Education Committee. All other expenses of the Clinic are also borne by the Committee. The cases were examined at the Throat Clinic the week prior to the operation. 203 children were operated upon, a decrease of 199 on 1933. The cases referred have all come within the terms of the three definitions given below. All cases are kept in hospital for at least one night after the operation unless the parent expressly desires otherwise and is prepared to take all responsibility. If needful, children are kept longer. All children are conveyed home by ambulance. 196 children were detained for the night after the operation. In all there were 143 non-attendances. Of the 203 children operated on 108 attended the Remedial Exercises Clinic for post-operative breathing exercises. This is a very important complement to the operation. The percentage of children operated on, who attended for exercises, was 53 percent, compared with 54 per cent, in 1933. 18 cases came to the knowledge of the department for whom the parents had obtained treatment from another source; the majority at a London hospital. In these cases the expenses are defrayed by the parent and not by the Local Education Authority. Only the following conditions are considered to warrant the reference of a child for operation:— (a) Tonsils which are enlarged and septic, especially if 'n conjunction therewith the tonsillar glands are also enlarged. (b) Obstruction to breathing through one or both nostrils. (c) The presence of mouth breathing. The strict observance of this standard has resulted in a big decrease in the number of children referred for operation. Provided the tonsils are not interfering with any normal function and are not a focus of septic poisoning, there is no proof that their removal 'is of any benefit to a child. 269 The Inspection Clinic. This is held on Wednesday and Saturday mornings. The object of the Inspection Clinic is (a) to examine children referred by parents or teachers for special examination; (b) children sent by school attendance officers for an opinion as to their fitness or otherwise to attend school; (c) children referred for examination under the provisions of the Education Act, 1918, Sec. 15; (d) cases in whom a further examination is desired after routine medical inspection; (e) children referred under the Juvenile Employment regulations. 1,597 attendances were made by children during the year. Treatment of Visual Defects. Table XV. Number of defects dealt with. Spectacles prescribed. Spectacles obtained. Under the Authority's Scheme. Submitted to letraction by private practitioner or Hospital apart from the Authority's scheme Otherwise. Total. Under the Authority's Scheme. Otherwise. Under the Authority's Scheme. Otherwise. Errors of Refraction— Elementary Schools 789 17 806 562 17 531 17 Secondary Schools 140 2 147 102 2 99 2 934 19 953 664 19 630 19 Orthopaedic Work. The orthopaedic scheme continues on the same lines as described in my report for 1931. The units comprising the scheme are (a) The outpatient clinic held by Mr. Alan Todd at the Croydon General Hospital; (b) The Remedial Exercises Clinic held in St. Andrew's Hall, Pump Pail; (c) The St. Giles' School, Addington. Table XVI. Spinal and Other Remedial Clinics. Aiteniiances. 1934. 1933. Sessions. Av. att. ances. Sessions. Av. att Spinal 2,646 594 4.5 3,009 607 5.0 Massage 53 53 1.0 59 59 1.0 Flat Feet 1,898 228 8.3 1,625 189 8.6 Breathing 1,250 175 7.1 2,182 241 9.0 5,847 1,050 6,875 1,096 270 St. Giles' School, Addington. Total number of sessions 195 Total number of attendances 1,205 Average attendance per session 6 Total number of females 14 Total number of males 17 Total number of patients 31 Still under treatment 22 Complaints. Male. Female. Total. Flat Foot — 1 1 Scoliosis 1 1 2 Kyphosis 3 1 4 Spastic Diplegia 2 1 3 Hemiplegia 1 2 3 Infantile Paralysis 6 5 11 Lordosis 1 1 2 Athetosis — 1 1 Inco-ordination 1 — 1 Muscular dystrophy — 1 1 Osteomyelitis 1 — 1 Paresis 1 — 1 17 14 31 THE SCHOOL DENTAL SERVICE. I am indebted to the Senior School Dental Surgeon, Mr. Pilbeam, for the particulars contained in this section of the report. The duties of the dental surgeons include the inspection and treatment of all children attending the public elementary and central schools, and of scholarship children attending the secondary schools. Treatment is also provided for patients referred under Maternity and Child Welfare, Tuberculosis, and Mental Deficiency schemes, and the report of the work done under the various schemes appears elsewhere. It is to be regretted that for the third successive year the school dental surgeons have been unable to inspect all the children and provide treatment for every child requiring it. Out of the total of 26,464 attending the above-mentioned schools in Croydon, 18,684 (or 68%) were inspected during the year, practically the same number as in 1933. This means that it takes approximatey 18 months to inspect all the children. It is, therefore, apparent that the inspections and treatment are nearly six months in arrear. 271 It will be realised that the existing procedure has considerable disadvantages, the chief of which are:— (а) The detrimental effect on the health of the children through delayed treatment. (б) The prejudicial effect on education. (c) The increased volume of work through delayed inspection and treatment. (d) The retardatory effect on the School Dental Service. Medical science has proved that untreated dental defects may have a very injurious effect on the health of the child, and consequently the School Dental Service constitutes a very important aid in safeguarding the general health of the children. A child cannot obtain the maximum benefit from education when suffering from dental defects, which have a direct effect'on its health. This isevidenced by the number of children referred for treatment. As regards (c) the progress of dental decay in its incipient stage may be controlled by conservative measures at regular intervals of not more than 12 months, but it will be appreciated that defects that are neglected for 18 months may require more extensive treatment. Again, in many instances dental defects, when treated immediately, can be remedied very often in one sitting, but as the number of infected teeth increases, the number of visits needed to complete treatment is considerably increased, necessitating loss of school time for the children concerned. Moreover, there is the psychological aspect to be taken into account. While a large number of children, perhaps, do not mind keeping several appointments to complete treatment, there are others who, by reason of temperament, find it difficult to attend several times. It is therefore desirable that defects should be remedied in the early stages. Finally, it is unfortunate to create the impression that whilst inspection and treatment is offered, it can only be carried out once m 18 months. It is now 23 years since the first Dental Clinic was initiated, and, with the subsequent years of development, parents have become accustomed to. think of the School Medical and Dental Services as forming part of the educational system. Apathy to dental treatment is far more likely to be met when delay is experienced in providing it. Unless the educational work which is continually in progress is followed up by early inspection, with the offer of treatment for those requiring it, the service will lose some of that public confidence which is so essential to public health schemes. 272 It is not possible for the present staff of three whole-time dental surgeons to inspect annually and treat all children requiring treatment, in the Public Elementary Schools, and these may be enumerated as follows:— Each dental surgeon has allocated to his care nearly 9,000 children, which is three times the number one dental surgeon can inspect and treat efficiently each year. The size of the staff required to inspect annually every child, and to treat those children referred with dental defects, may be based on material supplied in previous Reports. Assuming that all the 26,424 children attending the elementary schools were examined, 72 per cent, of this total, or approximately 19,000, would be referred for treatment, and the parents of about 60 per cent, of these children, or approximately 11,400, would consent to clinic treatment. Each dental surgeon treats annually approximately 2,400 children, and it is therefore apparent that a staff of at least five dental surgeons is necessary to oope adequately with the work. The dental surgeons' time has been reorganised so that every available session can be devoted to conservative dentistry, and the results for the year show that there has been considerable improvement in this direction, but this does little towards making up the deficiency. There has been a decided increase in the number of children referred for treatment during the last fewyears. In 1927,61 percent, of the children inspected were referred with defective teeth, and in 1934 the number had increased to 72 per cent. This increase alone means that over 2,000 more children required treatment in 1934 than in 1927, and would provide sufficient work for one dental surgeon for one year. There is also an increased demand for dental treatment on the part of parents. This is proved by the considerable increase of conservative work during the last few years. The fact that a larger number of children of indigent parents have been treated free, or at half the usual attendance fee, has resulted in more of these children having treatment, especially of a conservative nature. As a matter of interest, it may be mentoined that the amount of work to be done for children in this category is often considerably more than is required for the children of more prosperous parents. The teeth of these children undoubtedly show a marked tendency to dental disease. 273 Inspection. During the year 98 sessions were devoted to inspection, and 18,684 children were inspected, i.e., 190 children each session. Out of 18,684 children inspected, 13,480 were referred for treatment, i.e., 72 per cent., the same as in the previous year. lit is a matter of great concern that only one in four has a healthy dentition. Unfortunately, the 28 per cent, of children with sound dentitions cannot be viewed with the same prognosis as in the case of medical examinations. These are always potential patients for the dental surgeons, as the commencement of dental caries is so insidious that these children might require treatment at any time. The number referred for treatment varies in different schools. In some cases the number of healthy dentitions is as high as 43 per cent., and in others as low as 8 per cent. The schools showing a low incidence of disease are those in which children have had private and clinic treatment. These results show that if treatment is carried out in conjunction with proper oral hygiene on the part of the children, dental disease can be considerably reduced; on the other hand, where there is neglect of these precautions the incidence of disease is high. A child who has clean teeth and a good diet that requires thorough mastication to exercise the jaws and teeth will have a greater resistance to dental disease than a child who has not these advantages. This is proved at the inspection of children in the Public Assistance Committtee's Homes, whose diet is very varied and of a detergent nature; 61 per cent, of these children had perfectly healthy dentitions. The incidence of dental disease arises in three distinct phases in a child's life, namely, at 5, 9 and 13 years of age. The reason for the high percentage of disease in the five-yearold group is that the parents have not taken advantage of the facilities for treatment of the pre-school child, and have not realised the importance of a healthy temporary dentition. The six, seven and eight-year-old groups show a decline in disease. In the nineyear-old group dental caries again increases. This is porbablv accounted for by the fact that in the period between five and nine years of age the incidence of infectious diseases and various other childhood complaints is at a maximum. At 13 years of age there appears another advance of detail disease. This is, perhaps, due to complete eruption of all the teeth (excepting the third molars). with more teeth in the mouth there are more tooth surfaces liable to decay. The graph further shows that with thorough treatment and more concentration in rendering the Leavers group thy the amount of disease once again declines. To reduce 274 these periods of particularly active caries it would be necessary to inspect the five, nine and 13-year-old groups twice yearly. The following graph shows that in the six, seven, eight and nine-year-old groups of boys the percentage of healthy dentitions is greater than -in the case of girls. This is due possibly to the fact that girls' teeth usually erupt earlier than boys', and they have therefore at those ages more teeth liable to decay. The same thing is noticed in the 12-year-old group of boys. Girls have, as a rule, all their 12-year-o 1 d-mo 1 ars through at this age, whereas the boys' second molars are usually at the stage of eruption. The 14-year-old Leavers' group shows that the boys have a slightly better percentage of healthy dentitions compared with the girls. 275 Conservative Treatment of Permanent Teeth. The increase of conservative treatment during the last three years has been a welcome and noticeable feature; the number of fillings, as compared with 1930, has increased over 100 per cent. Such an increase has been made possible by concentrating more on the permanent than on the temporary dentition. The number of sessions devoted to inspection has also been reduced in order that more time could be devoted to conservative work. In consequence, the number of fillings has risen per 100 children treated from 32 in 1930 to 78 in 1934. The important part that orthodontic treatment has served as propaganda in teaching the value of conservative dentistry cannot be overlooked when considering such an increase in reparative treatments. In addition to fillings other conservative measures have been carried out, including zinc oxide and sedative dressings and root anal treatments; also 20 gum treatments, 114 scalings, 48 applications of silver nitrate, and 13 dressings to temporary teeth. A certain number of cappings of exposed nerves in permanent teeth were executed, and many of these cases have been X-rayed. A careful record is kept of the cases, which are periodically reexamined, and it is very gratifying to note that all have responded well to this treatment. The usual tests as to the vitality of the teeth have proved the value of this useful conservative measure, and a number of teeth have thus been saved from extraction. The Extraction of Permanent Teeth. It is to be expected that an increase in conservative work will mean a decrease in extractions. The records show that the extractions are lower this year than at any time since 1930, when 2,001 teeth were extracted, as compared with 2,005 in 1934. The "umber of permanent teeth extracted per 100 children treated was compared with 34 per 100 in 1933. Of the number of permanent extractions 41 teeth were removed for orthodontic purposes. Treatment of Temporary Teeth. Conservative treatment of the deciduous dentition has fcreased. The fillings in temporary teeth totalled 548. There has also been a reduction in the number of teeth extracted. during the year 9,865 teeth were removed because of their septic condition. 276 Attendances. The number of attendances for the year was 13,352, as compared with 13,444 in 1933. The attendance fee, of 6d. (Is. 6d. if gas is administered) was revised in April to 8d. per attendance and 2s. for gas. It appears ithat while the ordinary attendance fee has not made any appreciable difference to the number of children attending the Clinic, there has been a reduction in attendance for gas administration. Out of 13,457 children referred for treatment, the parents of 7,369 children consented to Clinic treatment, and 7,300 were actually treated. This number was a slight reduction on the previous year, but more treatment was carried out. 3,509 parents decided to have private treatment, and 2,582 failed ito return the forms or definitely refused treatment. £446 2s. Od. was received from patients for treatment. Special Cases. The number of children attending with head teachers' special emergency forms totalled 1,755. This is, fortunately, a reduction tion on last year's total of 1,816. The practice of notifying head teachers of names of children whose parents have refused treatment for three consecutive years has probably accounted for this reduction. The only efficient way of dealing with the abuse of special treatments is to check it at its source, and the procedure adopted is a great help to teachers and school dental surgeons. Summary of School Children Inspected and Treated During the Year. Patients examined 20,439 Patients treated 7,300 Attendances 13,352 Fillings 6,271 Extractions 11,953 "Gas" cases 1,863 Other operations 2,170 Locals 3,472 Sessions Held. Inspection 98 Treatment Administration 9 Orthodontia Gas administrations (by Total sessions dental surgeons ) 72 Gas administrations (by medical officers) 58 277 Following Up. The health visitors have interviewed a number of parents who had refused treatment, and the results obtained have been very satisfactory. Many of the visits have been in connection with the dental treatment of children prior to having throat operations, and also a number of special cases referred from the routine medical inspections. During the year 139 following up forms were issued. Ambulant Cases. Several cases of discharging abscesses and special cases in which it was felt that treatment would be more successfully carried out in hospital, were referred to Mayday Hospital. Cases X-rayed. Arrangements have been made for the X-ray of certain cases at the Mayday Hospital, and in all 41 cases were referred. These cases include children sent to the Clinic suffering from traumatic injuries of the teeth and surrounding bone; teeth in which cappings of exposed nerves have needed a radiograph to check up the line of treatment; to ascertain the presence or absence of supernumerary teeth, and special cases needing orthodontic treatment in which it is desired to see the position of the roots before starting treatment. Special Inspections and Treatments. A special inspection was carried out at Morland Road Home for Mentally Deficient Boys, and 15 children were examined. Special treatments consisted of the following:—4 dentures to replace lost incisors, 7 crown fitted, and 17 root fillings in singlerooted teeth. Extractions under gas were carried out for two children attending the Nursery School. Anaesthetics. An anaesthetic, either local or nitrous oxide, is given for the extraction of all teeth, with the exception of the very loose deciduous teeth. During the year 3,464 locals were given for extractions and for the treatment of difficult fillings, and for pulp extirpations. Gas cases totalled 1,863, compared with 2,125 in 1933. The dental surgeons devoted 72 sessions to the administration of nitrous oxide, and medical officers 58 sessions. 278 Preventive and Educative Measures. A great deal of work is done by the teachers and dental surgeons to educate parents and children in dental matters. At the routine inspections the dental surgeon gives a talk to parents at the end of the inspection. The mothers appear to be very interested in the remarks which are made, as evidenced by the many questions asked. During the year 19 talks were given and 635 mothers attended. This is a part of the work which needs extending, but under present conditions the staff has very little time to spare for propaganda. The talks have now been given for many years, but, unfortunately, the mothers the dental surgeons would most like to get in touch with do not come. Co-operation With Other Branches of the Service. Interdepartmental co-operation is essential for the efficient functioning of any scheme of prevention. The dental staff have had the co-operation of their medical colleagues, and have in turn co-operated with the medical officers when occasion arose. Selhurst Road Clinic. The review of the work at this Branch Clinic shows gratifying progress. The number of attendances has increased, and also the amount of conservative treatment and the number of individual patients treated. The 4,351 attendances prove the value of this Clinic, and the results show that the Clinic is accomplishing very useful work, which justifies its establishment in this neighbourhood. The wide area covered by the town, and the very real danger to children of traffic, if they have to travel long distances to a Clinic, makes the foundation of further Branch Clinics a matter requiring attention. It is, however, not possible with the present dental staff to carry out this necessary extension. An additional Clinic to serve the populous Waddon area is urgently required. Summary of Work Done. 1932. 1933. 1934. Attendances 3,604 3,831 4,351 Extractions 3,728 3,102 3,910 Fillings 1,667 2,002 2,150 Patients treated 2,006 1,811 2,179 Other operations 96 261 323 r f>1 "Gas" cases 779 553 581 Local anesthesia 490 999 1,322 New cases 2,280 2,520 2,670 279 Sessions held : Inspection—35. Treatment—377. Gas Sessions—58. 1932. 1933. 1934. Number of New Cases per Session 7.3 7.5 7.0 Attendances 11.6 .11.4 11.5 Extractions 12.02 9.2 10.3 Fillings 5.4 5.9 5.3 Other operations 0.31 0.77 0.8 Ratio of Fillings to Extractions 1:2.2 1:1.4 1:1.8 Dental Treatment of Scholarship Children Attending Secondary Schools. Attendances 133 Other operations 21 New cases 49 Scalings 4 Permanent fillings 80 Gas cases 17 Extractions of Perma- Local anesthetics 10 nent Teeth 30 Cases completed 28 Temporary Teeth 18 THE ORTHODONTIC SCHEME. The present orthodontic scheme has been in operation three years, and the number of cases treated and the results obtained have fully justified its inception. The diagnosis and treatment of all cases of irregularity of 'he teeth have been undertaken by the school dental surgeons. It was felt that such work should come within the province of school dentistry, and the three advantages of such a course are:— (1) That expenditure is not increased by the appointment of an orthodontic specialist. (2) That the school dental surgeons, by reason of their experience, are probably better equipped to treat cases more from the point of view of public health dentistry. (3) That it introduces more variation into the routine of the school dental surgeon. 280 It is very gratifying that such a system has worked extremely well, and that the dental surgeons have been able to treat all types of cases accepting treatment. The time devoted to orthodontia is restricted to one session per week, which is shared by two dental surgeons. With so little time for this work it is necessary to leave these sessions as free as possible for new cases, or cases under treatment which require new impressions for further appliances. This is achieved by giving verbal appointments for those cases requiring minor ad justments of appliances after the work of the routine sessions is completed. It is essential to prevent treatment of minor irregularities wasting the time of orthodontic sessions, which should be devoted to the treatment of more marked deformities. Many minor cases of irregularity correct themselves, and they should be eliminated beforehand to prevent congestion. It has been the practice before starting treatment to find out exactly the parents' attitude. It is useless to attempt orthodontia for a child unless the parent is really concerned about the deformity and is likely to appreciate treatment and to co-operate with the dental surgeon. In this work it is essential that the parent should be acquainted with the importance and nature of treatment, and also approximately the amount of time required to complete it. Prevention of Malocclusion starts in the very early days of a child's life, and schemes which provide treatment for the preschool child offer the dental surgeon a unique opportunity for preventive work. Cases may be observed at the Maternity and Child Welfare Centres of the perverted action of the muscles, which, if untreated, will undoubtedly produce deformity later in the child's life. Particularly is this seen in the maldevelopmentof the jaws, in mouth breathing and bad sucking habits, and sometimes in an abnormally large frsenum labium. These cases, when observed, may be referred for treatment at a subsequent and more suitable time. Review of Work Done. The total number of cases treated since the new scheme was commenced was 465, of which 331 have been treated with the ai of appliances, and 134 by extraction only. 281 The number of new cases referred for treatment during the year was 132. This is not the actual number of children suffering from all forms of irregularities, but those in which it was thought that the condition was severe enough to have a prejudicial effect on the health of the child. There are many more than this total with dental deformities, but as the time for treatment is strictly limited, it is desirable to refer only those cases in which the abnormality is very marked. The number under treatment during the year was 162, which includes some cases not completed in the previous year. Of this number 30 were treated by extraction only. These extraction cases are kept under observation for a considerable time in case further irregularity may result with the eruption of more teeth. The number of attendances was 1,629. Of this number 354 were routine appointments and 1,275 verbal appointments. The sessions devoted to orthodontic treatment totalled 43. Appliances Fitted. All the appliances fitted have been of ithe simple type. The number of removable appliances inserted was 194, and the six fixed appliances were in the nature of splints. X-ray Diagnosis. Cases presenting special difficulties were X-rayed. In these instances it was desired to ascertain the presence or absence of supernumerary teeth, or to see the position of the roots of teeth. In all, 25 cases were radiographed. Cost of the Scheme. The charge for cases treated by appliances is 15s. per child. Those cases treated by extraction pay only the attendance fee. Two-thirds of the orthodontic charge is paid to the dental mechanic for making the necessary apparatus, the remaining one'hird being placed in a fund for incidental expenses. Except as regards the dental surgeons' time, the scheme is definitely selfsupporting. The excellent results obtained have fully justified its inclusion as an ancillary unit of the routine work of the School Dental Service. Whilst it must be admitted that dental disease primarily associated with the teeth may cause more ill-health than untreated 282 dental irregularities, nevertheless, defects which produce abnormalities of the jaws and teeth may be psychologically harmful, and dental irregularities predispose to dental caries. The parents of children undergoing orthodontic treatment have evinced a genuine interest and offered useful co-operation. EAR CLINIC. 1934. 1933. Number of Sessions held 46 39 Number of first attendances 84 100 Number of re-attendances 306 286 There were no names on the waiting list at the end of the year. The classification of cases shows a similarity to that of previous years in the numbers in the respective groups, viz. (1) No evidence of otorrhoea past or present, or deafness of more than a trivial or temporary nature 13 (2) Deafness only. Some of these were due to old otitis media 12 (3) Otorrhoea, active, quiescent or cured 59 Group 2.—12 cases. Eleven were of the catarrhal type and one due to congenital absence of the outer ears. The latter is attending a special school for the partially deaf and is learning to speak. Of the catarrhal cases, three attained normal hearing, one after treatment by the Eustachian catheter, and two as the result of breathing exercises; three have been referred for a nose and throat operation, two of which are awaiting treatment, and one has refused; one was slight and was referred for home treatment; one was mentally defective and unsuitable for treatment; one is to have an operation for deviated septum in a year or two; one is under observation; and one requires a septic mouth attended to first. All are followed up, especially to see that correct breathing is established. Group 3.—(a) Found dry and requiring no treatment 16 (b) Found dry but recommended for accessory treatment such as tonsillectomy 4 (c) Active cases 39 283 An extended trial has been given to the iodine (0.75%) and boric powder. Unlike ionisation, there are practically no contraindications, it is quickly applied, and, at the least, it effects a big improvement in those complicated cases unsuitable for ionisation. Foul-smelling discharges, granulations, long-standing mastoid cases, etc., improve remarkably, so that, with few exceptions, the practice has been, after careful cleansing and investigation, to start treatment with the powder. The following figures indicate what is happening. There were 39 active cases examined, of which 9, almost inactive, received no special treatment, 5 drying up and 4 remaining under observation at the end of the year. Four cases were ionised, 2 with immediate success and 2 requiring a continuation of the treatment beyond the end of the year. Twenty-six received the iodine and boric treatment, of which 20 were discharged dry, 1 defaulted, and 5 were still under treatment. Those requiring accessory or operative treatment are referred accordingly, but the iodine and boric powder effects a great improvement in most cases, pending further action, and parents are always grateful for the amelioration, if only on account of the smell. This method is receiving favourable notice generally. Ionisation also continues to impress. But there are those who doubt the efficacy of all local applications and attribute improvement or "cure" to careful cleansing. In a disease so- apt to clear up, at least temporarily, without any special treatment, it is difficult to prove that any special method is successful. Anyone using either of these two methods, however, must have been impressed with the results, and, in the case of the powder, the astringent and antiseptic effect is easily appreciated in complicated cases. Strict preliminary cleansing is essential to success, certainly, but experience with plain boric powder has shown both ionisation and the iodine powder to have definite advantages. At present, therefore, the routine adopted at the Clinic is: thorough cleansing and investigation, classification, reference, if necessary, for treatment of accompanying defects, ionisation in cases of simple tympanic sepsis, and the use of iodine and boric powder in the more complicated cases, with further consideration later in those which do not completely clear up. Cases of undoubted attic or mastoid disease are, of course, referred to Hospital. 284 RHEUMATISM CLINIC This Clinic is not in any sense a "treatment centre," but is concerned with the diagnosis, supervision, advice and reexaminations of all types of rheumatic infections in children. A definite differentiation must be made between the chronic rheumatic arthritic pains of adults and the acute and sub-acute rheumatism of childhood. The manifestations in childhood are varied; the most common in the acute type being inflammation of the joints, Chorea, Tonsillitis, and affections of the muscle and valves of the heart; in the sub-acute and milder forms a series of mild sore throats, slight indefinite pains and aches in muscles and joints, frequently associated with a chronic insidious state of poor health. The most serious complication is that of heart disease, and it is in the prevention and supervision of these lesions that the Clinic has its major usefulness. Parents are becoming increasingly aware that "growing pains" are not an indication of healthy physique but are due to "rheumatics." Some now take the initiative in writing to the Head Teacher concerning their child's " pains," and ask for an appointment for the Clinic; an indication that the Clinic is becoming more widely known and appreciated. It is important in cases of heart disease that parents should be advised immediately, so that further cardiac damage may be prevented, but it is equally as important to be able to assure a parent whose child has some heart involvement that the degree and extent of the damage is not sufficiently serious to warrant treating the child as an invalid for life, and that with care and supervision a fairly normal life may be followed. Difficult and severe cases have been referred to the OutPatients' Department at the Croydon General Hospital, where Dr. Preston, as in previous years, has very kindly given his assistance and advice. The Coombe Cliff Convalescent Home continues to pnove an invaluable asset in cases where long periods of rest are required, more especially in those cases where home conditions are unsuitable and admission to a Home is desirable. 285 The statistics of the work accomplished have been drawn up on the same lines as those in previous reports, so that a comparison can be readily obtained. Cases Examined at Rheumatism Clinic. Primary 1932. 1933. 1934. 76 71 119 Re-examinations 151 109 169 Total 227 180 288 Rheumatic 65(85.5%) 65 (91.5% ) 108 (90.8%) Non-Rheumatic 11(14.5%) 6 (8.5%) 11 (9.2%) Total 76 71 119 Classification of Rheumatic cases— Sex—Males Primary. Re-examinations. 43 (39.7%) 75 (44.4%) Females 65 (60.3%) 94 (55.6%) Total 108 169 Age when examined:— Ages 5 6 7 8 9 10 11 12 13 14 15 Primary 3 6 11 14 15 12 10 23 10 3 0 Re-examinations 1 3 4 5 16 21 30 36 38 14 1 The increase in the numbers of young children referred to the Clinic is maintained and is evidence of the awakened interest and knowledge of parents. Grouping and Classification. This continues to follow the scheme laid down in my Report for 1931. Group I.—Symptoms referred to the digestive system and intestinal tract, e.g. abdominal pains, constipation and lack of appetite 28 cases Group II.—Symptoms suggesting the presence of a toxaemia, e.g., aching limbs, lassitude, headache 73 cases 286 Group III.—Symptoms suggesting a disturbance of the nervous system, e.g., irritability, disturbed sleep, nocturnal eneuresis, fidgetiness 53 cases Groups II. and III. include the majority of cases. In many cases there is nearly always a combination of the symptoms specified in Groups II. and III. varying in severity according to the type of case observed. *Grouping of 108 Cases. *1934. 1933. Mild and Potential 71 (65.7%) 32 (49.2%) Definite Active 25 (23.2%) 17 (26.2%) Definite Quiescent 12 (11.1%) 16 (24.6%) The relative increase in the group Mild and Potential is the result of the increased care and understanding of parents, and, in association with the decreased percentage in the group " Definite Active," is a very encouraging sign. The Mild and Potential included those cases showing the first initial symptoms of "growing pains" in highly-strung children, with or without slight cardiac involvement. The Definite and Active Group included, besides cases of frank rheumatic carditis, those with marked physical signs of Rheumatic Fever or Chorea. Group IV.—Rheumatic manifestations. Total: 108 cases. Rheumatic Pains 80 (74.1%) Rheumatic Fever 7 (6.5%) Chorea 18 (16.7%) Carditis, Definite 79 (73.1%)f † Slight 49 (45.4%) † Marked 30 (27.8%) Carditis, Suspected 11 (10.2%) Tonsillitis 23 (21.3%) Rheumatic Fever Cases. There were 7 children who gave a definite history of Rheumatic Fever. Of these, 1 had a sound heart and 6 had definite carditis. 287 Chorea oases. There were 18 cases of Chorea. Of these, 5 had definite carditis, 10 slight or suspected, and 3 sound hearts. Family Histories. In the case of 19 families (17.6%), either the father or the mother had had rheumatic fever or chorea. In 5 other cases (4.6%) a history of rheumatic fever was obtained in near relatives of the parents. In the case of 21 children (19.4%) their brothers or sisters gave a history of rheumatism or chorea. Skin Conditions. Recorded in 97 cases. Fair 65 (67%) Dark 32 (33%) Moist skin and an history of liability to sweating was recorded in 16 cases. A history of flushing and rashes in 19 cases. Nervous Conditions. Recorded in 108 cases. Children recorded as highly strung 89 (82.4%) Headaches 60 (55.5%)f † Occasional 26 (24.1%) † Frequent 34 (31.5%) Night terrors, etc 49 (45.4%)§ §Slight 36 (33.3%) § Severe 13 (12.4%) Enuresis 14 (13%) Twitchings 30 (28%) Often a combination of more than one of the above symptoms was manifested. Catarrhs. A history of various catarrhs, not tonsillitis, was reported in 12 cases (11.1%). Tonsillectomy. Operation reported in 13 cases (12%). 288 Re-Examinations. One hundred and sixty-nine (169) re-inspections were carried out. In 10 (62%) of these the condition had become worse; 14 (8%) were considered to be non-rheumatic; 32 (19%) stationary; 92 (54%) were definitely improved; and 21 (20%) quiescent. Environment and Other Conditions in Rheumatism Clinic Cases. Reported in 92 cases. Wards.—Cases were drawn from all Wards in the Borough, with the exception of Addington, as follows:— Woodside 10 Whitehorse Manor 10 West Thornton 6 Addiscombe. 4 Broad Green 2 Waddon 16 S. Norwood . 8 Thornton Heath . 9 East 8 Upp. Norwood 2 Bensham Manor. 6 Central 2 Norbury 7 South 2 Housing Conditions—Subsoil. No relationship was found to exist between the type of subsoil and the incidence of rheumatic infection. This finding confirms the conclusions of previous years. Drainage of Subsoil. Seventy of the houses were sufficiently drained and 8 were well drained; in 14 drainage was problematical. Houses which were perfectly dry and did not show any signs of dampness numbered 50, whilst 38 shewed traces of damp; 4 were damp; and no house was specified as very damp. Aspect. The aspects of the houses were as follows:— S.E. 11 S.W. 13 E. 15 N.E. 13 N.W. 9 S 8 N. 12 W. 11 The bulk of houses in which cases occurred were ordinary terrace houses (74), or semi-detached (18), and definite overcrowding was found in 4 families. Economic Status. The economic status of the families from whom patients were examined was as follows:— Poor in 14; average working class, 44; better working class, 21; clerical work, 9; and superior, 4. The interior home conditions were classified as follows:— Clean, 58; moderately clean, 23; superior, 8; unsatisfactory, 3. *Classification of Dr. R. Miller. 289 OPEN-AIR EDUCATION. Playground classes were held during the summer months at Woodside School. There was no extension of these classes during 1934. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Full statistical details are given in Table III. of the Tables required by the Board of Education, Appendix III. Blind Children. Seven boys and 3 girls are resident at special schools for the blind. The institutions which these children attend are as follows:—Royal Normal College for the Blind, 4 boys; Chorley Wood Blind College, 1 girl; Barclay Blind School, Brighton, 2 girls; Abbotskerswell, Devon, 1 boy; Sunshine Home, East Grinstead, 2 boys; (these are residential); 18 children attend the Special Class for Myopic Children. St, Luke's Special School For Partially Sighted Children. At the end of the year there were 18 children in attendance. Of these, 9 were cases of myopia, 6 were non-myopes, and 3 had myopia combined with some other ocular defect. On the basis of the figure suggested by the Committee of Inquiry into Problems relating to Partially Sighted Children (1934) Croydon should have about 26 elementary school children suitable for segregation in a special school of this type. Refusals are sometimes met with and are difficult to combat, the degree of difficulty depending on the type of ocular defect in question. Again, the clever myope who has a scholarship in front of him is often not referred. If, as is usual in these cases, he is the child of understanding parents and is under close ophthalmic supervision, with the necessary restrictions imposed, no harm may result, or, at least, a change °f regime can be advised if found necessary. The education of the parents and children about the nature of myopia and the means to retard its advancement is receiving attention, and an attempt is being made to admit young myopes for a temporary period for this purpose. . The curriculum is that usually laid down for the myope and the Partially sighted, respectively, but is under constant review, and changes are introduced according to experience. For example, during the past year both bovs and girls have attended domestic science classes, and now the system of mixing the 290 children with those in the ordinary elementary school for certain lessons has been introduced, although only on a small scale. Again, physical exercises, suitably restricted for certain children, are now in regular use, with a noticeable improvement in carriage and posture. Nominally the myopes leave school at 14 years of age, and the others at 16, but no strict rule can be enforced, and much depends on the type of case and the earning capacity. The Head Teacher is alive to the need for supervision in the selection of jobs and for after-care, but this is difficult, especially with the dull child from a poor home. The subsequent ophthalmic supervision of the children, a point mentioned by the Committee of Inquiry, is another problem, but in Croydon, where the Education Committee's Ophthalmic Surgeon is also Ophthalmic Surgeon to the General Hospital, one feels that old pupils will readily attend under him after leaving school. Deaf Children. Six boys and 6 girls are resident at special schools for the deaf; 1 boy attends a special day school. The institutions which these children attend are: Royal School for the Deaf, Margate, 6 boys and 6 girls (this is residential); L.C.C. Day (Deaf) School, 1 boy, at Hearnville Road, Balham. Epileptic Children. Two boys and 2 girls are resident at special schools, namely, at Lingfield Epileptic Colony, 2 boys and 2 girls. Mentally Defective Children. In addition to the day accommodation provided at St. Christopher's School, 3 girls are resident in the Monyhull M.D. School, Birmingham; 2 girls are at Knotty Ash M.D. School, Liverpool; 1 boy and 1 girl at Sandlebridge, Cheshire; and 1 boy at Besford Court, Worcestershire. Physically Defective Children. The Education Authority have, in addition to those accommodated at St. Giles' School, crippled children in the undermentioned special schools:—The Heritage Craft School, Chailey, 3 boys and 1 girl; Suntrap, Hayling Island, 1 girl. The Committee maintained 2 girls at West Wickham Hear' Home, a special school for cardiac cripples; 1 boy at Edgar Lee Heart Home, Willesden. 291 SCHOOL CAMPS. A school camp was again held during the summer months at Pilgrim Fort, near Caterham. The camp, which is provided with a piped water supply from the East Surrey Water Company, is provided with permanent buildings. Blankets, tents, stretchers, etc., for sleeping purposes, and a fully equipped cookhouse are provided. The sanitary arrangements have been replaced by a modern water flushed system. 489 boys and girls from the elementary schools went to the Camp during 1934 in parties, each party going for one week. All the children are medically inspected before proceeding to camp. The following are the departments which sent parties:— Ashburton, 42 boys, 14 girls; Davidson, 27 girls; Oval, 45 boys, 41 girls; Portland, 36 boys; Ecclesbourne, 24 boys; Howard, 28 bovs; Kingsley, 39 bovs and 51 girls; Lanfranc, 13 boys; Norbury Manor, 42 girls; West Thornton, 25 girls; Sydenham, 21 boys; Croydon British, 17 girls; Tavistock, 24 boys. JUYENILE EMPLOYMENT RETURN. The following numbers of children were examined by the medical officers during 1934 as to their fitness to follow the parttime employment indicated. There has been an increase of 27 in the delivery of newspapers and 10 in the delivery of milk:— 1934. 1933. 1932. 1931. 1930. Delivery of Goods for Shopkeepers 96 105 119 102 140 Delivery of Newspapers 190 163 178 227 328 Delivery of Milk 34 24 37 33 28 320 292 334 362 496 Seven girls and 1 boy were medically examined, and subsequently licensed by the Education Authority to take part in public fntertainments. THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT. The arrangements for the provision of meals have been continued during the past year. Children are now provided With free dinners at the Domestic Subjects Centres, as follows:— avidson, Ecclesbourne, Elmwood, Howard, Ingram, Kings- 292 ley, Sydenham, Tavistock and Waddon. Milk and cod liver oil and malt have also been provided for children suffering from malnutrition. This is given in school. Recommendations for exitra nourishment are made by the School Medica officer, Teachers, Attendance Officers and Care Committees and are considered by the School Canteen Sub-Committee. Re-examinations are made every three months, if practicable, by the medica in cases referred on medical grounds, when renewal or discontinuance is decided on. This recurrent examination acts also as a useful check on the general physical health of the child, enabling obvious defects to be pointed out to the parents for remedy. The scheme originally suggested by the National milk Publicity Council has been working smoothly, and undoubtedly had beneficial results. Since October 1st, by arrange- ment with the Milk Marketing Board, some 16,000 bottles schools containing one-third of a pint, are delivered daily at the schools at a cost of ½d. per bottle. This supply is availably for all elementary school children irrespective of any medical recommendation. 1933. 1934 No. of Children who received Free Dinners 96/ ' 8"> ,, „ Free Dinners provided 104,190 87,273 pints pints No. of Children who received Free Milk 120—9,249 134-10,615 ,, ,, Milk (part payment) 16—1,318 9-173 ,, ,, Milk (whole payment) 8—151 ,sSn3^ issues Free Malt 34—2,187 ,, ,, Malt (whole payment) ... 14—1,623 St. Christopher's Special M.D. School. for I am indebted to Mr. H. J. Edmonds, the Head 1 the following report:— The year opened with 112 children on the school $ have been 14 admissions and 21 children have left* children on the roll on December 31st, 1934. •<. tl,e This 13 Good progress has been made during the year. ]Vlitc efi first complete year to be passed in the new premises Road, and it is admitted by everyone that the .,chanif of great benefit to the children, both physically a ^sd1 ^ It will be readily recognised that children attending vary greatly in their mental development and a ^ ^e , Indeed, no two children are alike in this respect. & of the staff to lead each child to work up to its fu" a to develop a sense of confidence in itself. 1 1933. 1934. 725 No. of Children who received Free Dinners 967 87,273 pints ,, ,, Free Dinners provided 104,190 pints 134-10,615 No. of Children who received Free Milk 120—9,249 14-1,181 „ ,, Milk (part payment) 16—1,318 9-173 issues ,, ,, Milk (whole payment) 8—151 issues 19-2,321 ,, „ Free Malt 34—2,187 23-2,227 ,, „ Malt (whole payment) 14—1,623 293 The outstanding event of the year was a visit by two of His Majesty's Inspectors of Schools—Dr. F. Gale and Miss D. M. Hammonds-on October 26th. After a thorough inspection, lasting the whole day, the Inspectors expressed themselves as delighted with the social life of the school. They also added that the provision of the midday meal, and the training of the children at such, was a very valuable part of the school's work. In this connection it may be remarked that 12 girls go each week to the Kingsley Homecraft Centre, and it is proposed in 1935 to send also a small Party of boys for instruction in this subject. With regard to School Journeys, a very pleasant one was made by the seniors to Littlehampton on July 4th, and another was made by the Juniors on September 19th, 87 children taking part in these excursions. The Annual Concert and Display was held on December 19th before a crowded and appreciative audience. The concert was heldon new lines this year, enabling 87 per cent. of the children to take part. Before closing this report, I should like to express our gratitude and appreciation to the staffs and children of the Kingsley School and Church School for the very many acts of kindness and helpfulness extended to our children Mental Deficiency (Notification of Children) Regulations, 1928. Statement of the number of Children notified during the year ended 31st December, 1934, by the Local Education Authority to the Local Mental Deficiency Authority. Total number of children notified: 30. Analysis of the above Total. Diagnosis Boys. Girls. 1.-(i)Children incapable of receiving benefit or furtherbenefit from instruction in a Special School: (a) Idiots 1 - (b) Imbeciles 2 7 (c)Others 4 5 Children unable to be instucted in a Special School without detriment to the interests of other children: (a)Moral defectives - - (b) Others 2 - 294 2.—Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 4 4 3.—Feeble-minded children notified under Article 3, i.e., "special circumstances" cases - - 4.—Children who in addition to being mentally defective were blind 1 - Totals 14 16 PHYSICAL TRAINING IN SCHOOLS. Detailed reports have been presented by the Assistant Inspector of Schools and the Organiser of Physical Training to the Education Committee, and the following is only a precis of these reports. Boys. The chief event of the year has been the adoption throughout the Borough of the New Syllabus of Physical Training, recently issued by the Board of Education. It has stimulated renewed interest in the subject, and the teachers generally have appreciated its wider scope and the opportunities presented to the children for increasing their powers of self-control. During the year four demonstrations of the new work were given in various parts of the Borough, and were well attended by Head and Assistant Teachers. Discussions were held later regarding many theoretical and practical points of the new scheme of instruction. Each Senior School has at least one member of the staff who is qualified to teach the use of the portable Swedish apparatus with which every Senior School is now equipped. By far the greater part of the physical training is in the hands of these specialist teachers. In those cases where playground lessons are taken by the class teachers, the guidance and inspiration of these more highly qualified teachers are extremely useful. Generally, lighter clothing is being worn in both Junior and Senior Schools. In some of the latter most boys change completely into vests, shorts and plimsolls. Closing the Central Baths during the drought in the summer has had an adverse effect upon the swimming; there has been a considerable decrease in the number of certificates gained. 295 During the year 14 teachers gained the medallion of the Royal Life Saving Society. The classes in Sword and Morris Dancing have been continued and teachers have had opportunities (or improving their own personal technique. Practically every school holds its own sports meeting, while the Croydon Schools' Athletic Association has continued its excellent work in organising inter-school competitions in cricket, football, swimming, boxing, folk dancing and general athletics. This voluntary work on the part of the teachers is worthy of the highest praise. Girls. (Central, Senior and Junior Mixed, Senior and Junior Girls and Infants). The Syllabus of Physical Training, 1933, has received a whole-hearted welcome from both teachers and children, and the vigorous activity and joyous spirit of the new work is evident on every hand. The importance of correct posture is emphasised, not only during the physical training period, but throughout school hours. Marked progress has been made in the efforts of the children to provide suitable clothing and shoes for the physical training lessons, but it is still difficult to find means for the washing of hands, etc., after the lessons. which is necessitated by the touching of the ground in many of the exercises. All work is taken in the open-air whenever the weather is suitable. One encouraging feature of the year has been the increased support and co-operation of the parents in the physical training activities, and opportunities for them to see the children at work have been afforded in many schools. Swimming was carried on as usual during the summer, children attending the Baths from all Senior and Junior Departments except two. Owing to drought regulations, however, the accommodation available was considerably restricted and, in conaequence, the number of certificates gained showed a decrease. Swimming galas were held by 19 schools, in addition to the Inter-Schools Gala, organised by the Croydon Schools' Swimming Association. 296 Organised Games and Athletics.—Twenty-six departments were able to make use of Playing Fields or Recreation Grounds for Organised Games lessons, and 31 departments arranged Sports Afternoons or Inter-House Games Contests. Folk Dancing is taught in all Central, Senior and Junior Departments (except three), and a high standard has been maintained. Corrective Classes for children with faulty posture were continued in six schools during the year, and a new class (at Heath Clark Selective Central School) was started. In all seven classes the School Medical Officers when examining the pupils have expressed satisfaction at the results achieved. Seven Departments sent Girls' Camping Parties to Pilgrim Fort during the season, and girls from seven schools participated in School Journeys to Seaford. Herne Bay, Teignmouth, Isle of Wight, and Wimereux. "Refresher Courses" for Teachers held during the year included:— (a) Physical Training for Senior Schools (2 courses). (b) „ „ Junior Schools. (c) „ „ Infants' Schools. (d) Swimming, in preparation for the Teachers' Certificate of the Amateur Swimming Association. (e) Physical Exercises, suitable for Corrective Classes. Four Conference-Demonstrations on the work of the 1933 Syllabus were arranged for Class Teachers, on similar lines to the Head Teachers' Demonstration and Conference in 1933. At each of these demonstrations, to which one teacher from every department was invited, work by Infants, Junior Boys, Junior Girls, Senior Boys and Senior Girls was shown. The Physical Training carried on in school hours has been encouraged and augmented as in former years, by the voluntary and "out of school" activities of the Croydon Schools Athletic Association, with its sections for Swimming, Netball, Athletics and Folk Dancing, and the help of the teachers in this direction is here gratefully acknowledged. 297 INSTRUCTION IN SPECIAL SUBJECTS. In the time-table for the year ending 31st March, 1935, the following provision is made for the instruction of older girls in Special Subjects, e.g., Cookery, Homecraft, Housewifery, Domestic Science:— Intensive Housewifery Centres— Purley Oaks. Tavistock. Cookery and Homecraft Centres— Howard (Domestic Science). Ingram (Domestic Science and Homecraft). Sydenham (Cookery, Homecraft and Domestic Science) Special Rooms or Centres reserved, for School named— Ashburton (Domestic Science). Davidson (Domestic Science). Ecclesbourne (Domestic Science). Elmwood (Domestic Science). Kingsley (Domestic Science. Lanfranc (West Thornton Centre—Domestic Science). Oval (Domestic Science). Portland (Woodside Centre—Domestic Science). Tavistock (Domestic Science and Homecraft). Norbury Manor (Domestic Science). Rockmount (Domestic Science). Waddon (Domestic Science). Archbishop Tenison's (Domestic Science). Lady Edridge (Domestic Science). Heath Clark (Domestic Science). Centres for Domestic Subjects have now practically ceased to exist as such. Instead, special rooms or Centres are available for each Senior Girls' School, whereby the older girls in such schools are able to receive the necessary instruction in Domestic Subjects as part of the normal school curriculum and, generally speaking, on the school premises. An Intensive Housewifery Centre was opened in September last in one of the School Houses, adapted for the purpose, at the Purley Oaks School. SECONDARY SCHOOLS. The usual arrangements for the medical examination of secondary school children were continued in 1934; 1,724 children were examined, 892 of whom were boys and 832 girls. Table II. of Appendix gives the detailed findings. 104 boys (11.7 per cent.) and (116 girls (13.9 per cent.) were found to require treatment, the most usual defects being dental and defective vision. Although the figures are small, a table similar to that given for elementary school children and relating to heights and weights has been included below. 298 SECONDARY SCHOOLS. HEIGHTS AND WEIGHTS. BOYS. GIRLS. Table XXIV. Year of Birth. Number Examined. Average Height in inches. Average Weight in lbs. Average maximum Height in inches. Average maximum Weight in lbs. Average minimum Height in inches. Average minimum Weight in lbs. Number Examined. Average Height in inches. Average Weight in lbs. Average maximum Height in inches. Average maximum Weight in lbs. Average minimum Height in inches. Average minimum Weight in lbs. 1928 ... ... ... ... ... ... ... 5 45.4 46.6 47.0 51.0 45.0 41.0 1927 ... ... ... ... ... ... ... 1 49.0 43.0 49.0 43.0 49.0 43.0 1926 ... ... ... ... ... ... ... 12 50.0 58.3 54.0 80.0 46.0 51.0 1925 ... ... ... ... ... ... ... 11 52.1 61.0 54.0 70.0 50.0 49.0 1924 10 54.6 71.2 56.5 82.0 53.0 61.5 26 54.5 68.1 58.3 79.0 50.7 55.5 1923 106 56.5 78.4 61.0 121.5 51.2 62.2 197 57.1 77.3 63.7 119.0 52.2 55.0 1922 187 57.3 82.6 63.8 118.4 51.3 60.8 146 58.3 87.2 63.5 133.4 52.9 64.9 1921 196 58.7 87.5 65.5 119.0 52.3 67.0 126 60.3 94.3 62.9 116.1 54.2 65.5 1920 190 61.1 98.0 67.8 139.0 53.4 73.2 84 62.3 106.3 67.1 155.9 56.0 74.2 1919 145 64.7 113.8 72.7 152.6 58.2 80.9 78 62.6 105.8 66.4 134.1 57.0 76.6 1918 56 66.4 123.6 71.5 148.0 61.7 97.7 88 63.4 113.3 66.7 128.6 60.0 89.3 1917 22 68.2 136.2 72.0 156.0 63.0 106.0 11 64.0 119.0 67.0 131.5 61.0 104.5 1916 11 69.5 144.1 73.5 198.0 66.5 112.0 16 63.5 121.9 67.5 150.5 60.8 83.3 1915 1 66.5 141.0 ... ... ... ... 6 63.0 129.3 64.3 148.0 62.0 114.5 299 In conclusion, the report shows that much avoidable illness in school children is due to ignorance or neglect of simple physiological functions, and it is certain that if a child was fully instructed, before leaving school, in the fundamental principles of communal, personal, and domestic hygiene the health of the school children of the next generation would show a notable improvement. I beg to tender my thanks to you, ladies and gentlemen, for the consideration you have at all times extended to me. I wish to acknowledge my indebtedness to the Education Officer and members of his staff for their helpful co-operation. I desire also to bring to your notice the continued valuable services of Dr. Watson, the deputy medical officer, and others of my colleagues in the School Medical Service. I am, Yours faithfully, OSCAR M. HOLDEN, School Medical Officer. 300 ELEMENTARY SCHOOLS. Year ended 31st December, 1934. Table I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Code Group Inspections- Year 1934. Year 1933. Entrants 2670 2893 Intermediates 1888 2861 Leavers 1779 2867 Total 6337 8621 Number of other Routine Inspections 15 315 6352 8936 B.—Other Inspections. Year 1934. Year 1933. Number of Special Inspections 5243 4182 Number of Re-inspections 8286 6980 Total 13529 11162 Total Visits to Elementary Schools 373 426 301 TABLE II A.-Return of Defects found by Medical Inspection in the Year ended 31st December, 1934. defect or disease. (1) Routine Inspections Number of defects. Special Inspections. No. of defects. Requiring treatment. (2) Requiring to be kept under observation but not requiring treatment (3) Requiring treatment. (4) Requiring to be kept undar observation but not requiring treatment. (5) Malnutrition 45 66 12 3 Uncleanliness 1 1 ... ... (See Table IV.—Group V.) Skin— Ringworm: Scalp 1 ... 1 ... Body ... ... 1 ... Scabies 2 2 1 ... Impetigo 4 ... 2 ... Other diseases (non-tuberculous) 5 8 3 ... Eye- Blepharitis 4 2 1 1 Conjunctivitis 1 1 ... ... Keratitis ... ... ... ... Corneal Opacities ... ... ... ... Defective vision (excluding squint) 257 15 104 1 Squint 67 20 4 2 Other conditions 4 1 1 ... Ear— Defective hearing 5 ... 6 ... Otitis media 7 ... 4 2 Other ear diseases 1 2 4 ... Nose & Throat— Enlarged tonsils only 78 198 14 5 Adenoids only 25 28 1 ... Enlarged tonsils & adenoids 200 176 36 9 Other conditions 25 6 3 1 Enlarged Cervical Glands— (Non-tuberculous) 4 13 2 2 Defective Speech 14 11 6 Teeth-Dental Diseases 82 4 7 ... (See Table IV.—Group IV.) Heart & Circulation— Heart disease: Organic 13 55 1 9 Functional 2 73 1 3 Anaemia 6 22 1 2 Lungs— Bronchitis 18 49 ... 6 Other non-tuberculous diseases 41 2 ... 2 Tuberculosis— Pulmonary—Definite ... ... ... ... „ Suspected 6 20 1 3 Non-pulmonary—Glands . ... 2 ... 1 „ Spine ... ... ... ... „ Hip ... ... ... ... „ Other Bones & Joints ... ... ... ... „ Skin 1 ... ... ... „ Other Forms ... 1 ... ... Nervous System- Epilepsy 1 3 ... 2 Chorea 4 10 5 1 Other conditions 4 3 2 ... Deformities- Rickets 1 3 ... ... Spinal curvature 67 47 7 ... Other forms 65 18 7 ... Other Defects & Diseases 30 109 13 6 302 B.—Number of Individual Children Found at Routine Medical Inspection to Require Treatment (Excluding Uncleanliness and Dental Disease). Group. (1) Number of Children. Percentage of Children found to require treatment. (4) Year 1933. (5) Inspected. (2) Found to require treatment. (3) Code Groups— Entrants 2670 347 13.0 11.9 Intermediates 1888 271 14.4 11.8 Leavers 1779 279 15.7 16.9 Total (Code Groups) 6337 897 14.2 13.5 Other Routine Inspections 15 4 26.7 14.9 303 TABLE III. Return of all Exceptional Children in the Area. Children Suffering from Multiple Defects. Number of children suffering from combination of defects BLIND CHILDREN. A blind child is a child who is too blind to be able to read the ordinary school books used by children. In this Section only children who are so blind that they can only be appropriately taught in a school for blind children are included. At Certified Schools for the Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 10 ... ... ... 10 PARTIALLY BLIND CHILDREN. Only children who, though they cannot read ordinary school books or cannot read them without injury to their eyesight, have such power of vision that they can appropriately be taught in a school for the partially blind are included. Children who are able by means of suitable glasses to read the ordinary school books used by children without fatigue or injury to their vision are not included in this Table. At Certified Schools for the Blind. At Certified Schools for the Partially Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. ... 18 4 ... 1 23 DEAF CHILDREN. Only children who are so deaf that they can only be appropriately taught in a school for the deaf are included. At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 11 ... ... ... 11 PARTIALLY DEAF CHILDREN. Only children who appropriately be taught in a school for the partially deaf are included. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. ... 1 3 ... ... 4 304 MENTALLY DEFECTIVE CHILDREN. Feeble-Minded Children. Mentally Defective children are children who, not being imbecile and not being merely dull or backward, are incapable by reason of mental defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools but are not incapable by reason of that defect of receiving benefit from instruction in Special Schools for mentallv defective children This category includes only those children for whose education and maintenance the Local Education Authority are responsible, and excludes all children who have been notified to the Local Authority under the Mental Deficiency Act. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At Private Schools. At no School or Institution. Total. 112 21 2 12 147 EPILEPTIC CHILDREN. Children Suffering from Severe Epilepsy. Only children are included who are epileptic within the meaning of the Act, i.e., children who, not being idiots or imbeciles, are unfit by reason of severe epilepsy to attend the ordinary Public Elementary Schools. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. . 4 5 ... 1 10 PHYSICALLY DEFECTIVE CHILDREN. Physically Defective children are children who, by reason of physical defect, are incapable of receiving proper benefit from the instruction in the ordinary Public Elementary Schools, but are not incapable by reason of that defect of receiving benefit from instruction in Special Schools for physically defective children. A. Tuberculous Children. In this category are placed only cases diagnosed as tuberculous and requiring treatment for tuberculosis at a sanatorium, a dispensary, or elsewhere. Children suffering from crippling due to tuberculosis which is regarded as being no longer in need of treatment are recorded as crippled children, provided that the degree of crippling is such as to interfere materially with a child's normal mode of life. All other cases of tuberculosis regarded as being no longer in need of treatment are recorded as delicate children. I—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic. glands.) At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. nil nil nil nil nil 305 II.—Children Suffering from Non-Pulmonary Tuberculosis. (This category includes tuberculosis of all sites other than those shown in (I) above.) At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 3 9 5 2 19 B. Delicate Children. This Section is confined to children (except those included in other groups) whose general health renders it desirable that they should be specially selected for admission to an Open Air School. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. . 8 2 ... 2 12 C. Crippled Children. This Section is confined to children (other than those diagnosed as tuberculous and in need of treatment for that disease) who are suffering from a degree of crippling sufficiently severe to interfere materially with a child's normal mode of life, i.e., children who generally speaking are unable to take part, in any complete sense, in physical exercises or games or such activities of the School curriculum as gardening or forms of handwork usually engaged in by other children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 51 3 3 1 58 D. Children with Heart Disease. This Section is confined to children whose defect is so severe as to necessitate the Provision of educational facilities other than those of the Public Elementary School. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 24 11 2 8 45 306 TABLE IV. — Return of Defects Treated During the Year Ended 31st December, 1934. Group I.—Minor Ailments (excluding uncleanliness,for which see Group VI) Disease or Defect. (1) number of defects treated or under treatment during the year. Year 1933. (5) Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Skin—X-Ray Treatment 4 ... 4 Ringworm, Scalp Other 2 ... 2 18 Body 15 ... 15 28 Scabies 44 ... 44 88 Impetigo 220 ... 220 257 Other skin diseases 80 ... 80 124 Minor Eye Defects— (External and other, hut excluding cases falling in Group II) 213 ... 213 192 Minor Ear Defects 194 ... 194 294 Miscellaneous— (e.g. Minor injuries, bruises, sores, chilblains, etc.) 582 ... 582 634 Total 1354 ... 1354 1635 Group II—Defective Vision and Squint (excluding minor eye defects treated as minor ailments.—Group I.) Disease or Defect (1) NUMBER OF DEFECTS DEALT WITH. Year 1933 (6) Under the Authority's Scheme. (2) Submitted to refraction by private practitioner or at hospitals apart from the Authority's scheme. (3) Otherwise. (4) TOTAL. (5) Errors of refraction (including squint) 789 17 806 799 Other defect or disease of the eyes (excluding those recorded n Group 1) ... ... ... ... Total 789 17 806 799 Total number of children for whom spectacles were prescribed— Year 1933 (а) Under the Authority's scheme 562 593 (b) Otherwise 17 19 Total number of children who obtained or received spectacles— Year 1932 (a) Under the Authority's scheme 531 462 (b) Otherwise 17 307 Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received operative treatment. Received other forms of treatment. (4) Total number treated. (5) Under the Authority's scheme in clinic or hospital. (1) By private practitioner or hospital apart from the Authority's scheme. (2) TOTAL. (3) (i) (ii) (ii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) ... 215 - 16 181 - 5 - 13 - 5 16 194 - Year 1933 ... 454 3 46 350 - 14 - 40 1 17 46 390 1 i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and adenoids. (iv) Other defects of the nose and throat. GROUP IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme. (1) Total number treated. Residential treatment with education. (i) Residential treatment without education. (ii) Non-residential treatment at an orthopaedic clinic. (iii) Number of children treated 25 10 495 518 TABLE IV. GROUP V.—Dental Defects. (l)Number of Children who were— Year 1933 (a) Inspected by the dentist:— Total—18684 Aged 5-6 1130 986 „ 6-7 1759 1513 „ 7-8 1885 1728 „ 8-9 2110 1643 „ 9-10 2146 1832 Routine „ 10-11 2350 1935 Age „ 11-12 2134 1967 groups. „ 12-13 1763 2090 „ 13-14 1841 2715 „ 14-15 1316 1254 „ 15 up 250 424 Specials ... 1755 1816 Grand Total 20439 19903 Year 1933 (b) Found to require treatment 15212 14845 (c) Actually treated 7300 7773 (2) Half-days devoted to Inspection 98 109 „ „ Treatment 1125 1087 1223 1196 Attendances made by children for treatment 13352 13444 (3) Fillings—Permanent teeth 5723 4795 Temporary teeth 548 829 6271 5624 (5) Extractions—Permanent teeth 2076 2707 Temporary teeth 9877 10740 11953 13447 (6) Admonostration of general anaesthetics for extractions 1863 2125 Other operations—Permanent teeth 2089 2077 Temporary teeth 32 77 2121 2154 308 GROUP VI.—Uncleanliness and Verminous Conditions Year 1933 (i) Average number of visits per school made during the year by the School Nurses (including subsequent visits) 11.2 11.0 (ii) Total number of examinations of children in the Schools by School Nurses 66796 66758 (iii) Number of individual children found unclean on first examination 2326 1961 (iv) Number of children cleansed under arrangements made by the Local Education Authority 16 Nil (v) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 Nil - (b) Under School Attendance Bye-laws 6 5 309 SECONDARY SCHOOLS. Year ended 31st December, 1934. Table I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Code Group Inspections— Year 1934. Year 1933. Age 11 or under 357 221 12 287 290 13 352 286 14 297 265 15 211 219 16 165 96 17 41 62 18 or over 14 16 Total 1724 1455 B.—Other Inspections. Year 1934. Year 1933. Number of Special Inspections 39 129 Number of Re-inspections 198 327 Total 237 456 Visits to Secondary Schools 86 69 310 SECONDARY TABLE II.—A.—Return of Defects Found by Medical Inspection in the Year Ended 31st December, 1931. defect ok disease (1) Routine Inspections. Number of defects. Special Inspections. Number of defects. Requiring treatment. (2) Requiring tb be kept under observation but not requiring treatment. (3) Requiring treatment. (4) Requiring to be kept under observation but not requiring treatment. (5) Malnutrition 2 11 ... 1 Uncleanliness. (See Table IV.—Group V.) ... ... ... ... SKIN— Ringworm Scalp ... ... ... ... Body ... ... ... ... Scabies ... ... ... ... Impetigo ... ... ... ... Other diseases (non tuberculous) 2 ... ... ... Eye— Blepharitis ... 1 ... ... Conjunctivitis ... ... ... ... Keratitis ... ... ... ... Corneal opacities ... ... ... ... Defective vision (excluding squint). ... ... 19 ... Squint 1 ... 3 ... Other conditions ... 4 ... ... Ear — Defective hearing 3 2 ... ... Otitis media ... ... ... ... Other ear diseases ... ... ... ... Nose and Throat — Enlarged tonsils only 6 24 1 ... Adenoids only 1 ... ... ... Enlarged tonsils and adenoids 1 2 1 ... Other conditions ... 1 ... ... Enlarged Cervical Glands (Non Tuberculous) ... 3 ... ... Defective Speech 3 2 2 ... Teeth—Dental Disease 38 3 ... ... (See Table IV.—Group IV). Heart and Circulation— Heart Disease — Organic ... 24 ... ... Functional ... 15 ... ... Anaemia 4 11 1 ... Lungs— Bronchitis ... 3 ... ... Other non-tuberculous diseases ... 5 ... ... Tuberculosis— Pulmonary— Definite ... ... ... ... Suspected ... ... ... ... Non-pulmonary— Glands ... ... ... ... Spine ... ... ... ... Hip ... ... ... ... Other bones & joints ... ... ... ... Skin ... ... ... ... Other forms ... ... ... ... Nervous System— Epilepsy ... 4 ... ... Chorea 1 ... ... ... Other conditions ... 4 ... ... Deformities— ... ... ... ... Rickets ... ... ... ... Spinal curvature 61 40 2 ... Other forms 28 16 1 ... Other Defects and Diseases 2 15 ... 1 311 SECONDARY B.-Number of Individual Children Found at Routine Medical Inspection to Require Treatment (Excluding Uncleanliness and Dental Disease.) Group. (1) Number of Children. Percentage of children found to require treatment. (4) Inspected, (2) Found to require treatment. (3) or under 357 56 15.7 12 287 47 16.4 13 352 62 17.6 14 297 23 7.7 15 211 14 6.6 16 165 17 10.3 17 41 1 2.4 18 and over 14 ... ... 1724 220 128 TABLE IV.—Return of Defects treated during the year ended 31st December, 1934 Group I.-Minor Ailments (excluding uncleanliness, for which see Group V). Disease or Defect. (1) number of defects treated, or under treatment during the year. Under the Authority's scheme. (2) Otherwise. (3) Total. (4) Skin— Ringworm (scalp) ... ... ... „ (body) ... ... ... Scabies ... ... ... Impetigo 1 ... 1 Other skin disease 2 ... 2 Minor Eye Defects— (External and other, but excluding cases filling in Group II). 2 ... 2 Minor Ear Defects— 1 ... 1 Miscellaneous (e.g.- minor injuries, bruises, sores, chilblains, etc.) 11 ... 11 Total. 17 ... 17 312 SECONDARY Group II.—Defective Vision and Squint (excluding minor eye defects treated as minor ailments.—Group I.) Defect or Diseases (1) NUMBER OF DEFECTS DEALT WITH. Under Authority's Scheme. (2) Submitted to refraction by private practitioners or at Hospital apart from the Authority's scheme. (3) Otherwise. (4) Total. (5) Yen 1933 (6) Errors of refraction (including squint) 145 2 147 99 Other defects or disease of the eyes (excluding those recorded in Group I.) ... ... ... Total 145 2 147 99 Total number of children for whom spectacles were prescribed:— (a) Under the Authority's scheme 102 (b) Otherwise 2 Total number of children who obtained or received spectacles:— (a) Under the Authority's scheme 99 (b) Otherwise 2 Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received operative treatment. Received other forms of treatment. (4) Total number treated- (5) Year 1933 (6) Under the Authority's scheme in clinic or hospital. (1) By private practitioner or hospital apart from the Authority's schema. (2) TOTAL. (3) (1) (2) (3) (4) (1) (2) (3) (4) (1) (2) (3) (4) ... 6 8 - - 6 - - - - - - - 6 - (1) Tonsils only; (2) Adenoids only; (3) Tonsils and Adenoids; (4) Other Defects of Nose and Throat.