CRO37 Comtn Borough of Crogdon. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1935 OSCAR M. HOLDEN, M.D., D.P.H. CROYDON: Printed by the "Croydon Times," Ltd . 101, High Street 2 PUBLIC HEALTH COMMITTEE. NOVEMBER, 1934—35. The Worshipful the Mayor (Alderman James Trumble, J.P.). Alderman Mrs. B.J. Roberts (Chairman). Councillor Major F.W. Rees, L.R.I.B.A. (ViceChairman). Alderman W.H. Jarvis. Alderman H.J. Morland, M.A., J.P. Councillor E.E.L. Arkell. Councillor L. A. Aston. Councillor Ernest Edward Constable. Councillor Mrs. Dale. Councillor Miss M. H. Glazier. Councillor Henry Lock Kendell. Councillor George Lewin. Councillor H. T. Muggeridge, J.P. Councillor W. H. Parry. Councillor Major Petrie, O.B.E. Councillor H. Regan. Councillor Mrs. Squire, J.P. For purposes of Maternity and Child Welfare— Mesdames Bailey, Chalke, Green, Horn, and Southwell. 3 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1935. To the Chairman and Members of the Public Health Committee. Ladies and Gentlemen, I have the honour to present herewith my Eighth Annual Report, being the thirty-sixth 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 1492 of the Ministry of Health, dated l8th October, 1935, and the report is an ordinary, not a survey report. vital statistics. The Birth Rate (13.6) was slightly higher than for 1934, and was 1.1 per 1,000 less than for the whole of England and Wales, whilst the Death Rate (10.1) showed a decline compared with 1934 . It was 1.3 per 1,000 less than for the whole of England and Wales, and was the lowest yet recorded for Croydon. It is satisfactory to record a further diminution in the infant mortality rate, the figure for 1935 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 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 decrease in incidence. The mortality also declined from 0.24 to 0.07 per 1,000 of the population. 4 The chief causes of death were substantially the same as in 1934; diseases of the Heart and Circulatory system, Cancer and Respiratory diseases causing more than 60 percent, of the total deaths. The report, being divided into sections, presents the statistical details of each phase of the work under the appropriate headings. As regards Mayday Hospital, 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 coming rapidly into line with general hospital practice. Work has been pursued energetically in the inspection and representation of individual unfit houses. Delay in action, however, has been caused by re-housing difficulties. There is every indication that this will soon be remedied. The clearance area of Old Town has been demolished and new houses built on the site. The Dickenson's Place Clearance area has also been dealt with, and the Ely Road Improvement Area houses put into proper repair. Leighton Street East and the area in the Triangle, Upper Norwood, were approved as clearance areas. One of the paramount difficulties experienced has been with overcrowding in large houses which are divided into tenements. This is becoming more prevalent, but it may be possible to take effective action under the provisions of the Housing Act, 1935. There will, however, have to be constant vigilance to see that the overcrowding clauses are not contravened. A section has again been devoted to the Obstetric Service conducted by Officers of the Council. This scheme is one of the 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. The statistical details given in the appropriate section show that it is being more fully utilized and that it is exerting an increasingly beneficial effect upon maternal morbidity and mortality. The scope of the sections with their detailed statistics indicate the extent to which the Public Health Service has become an integral part of the civic economy. There are few aspects in the lives of citizens which do not, in some way or other, come within its activities. As the density of population increases it becomes more than ever imperative to maintain a high level of sannitation 5 anand of efficiency if the present position is to be maintained. The greatest obstacles to further progress and to a proper valuation of the Health services which the Corporation maintains is lack of knowledge of what is actually done and the ends aimed at. It is better, and in the end more economical, to prevent than to cure. This object must always be kept in mind. It will be fatal to success if the more spectacular curative functions, which have been transferred to Health Authorities under the Local Government Act, are allowed to overshadow the original function prevention. It is hoped that a perusal of the contents of this report will show how thoroughly the Corporation endeavours to safeguard the health of its citizens. For the full attainment of success, the cooperation of the citizens themselves is a necessity. By no means all the activities undertaken are necessitated by law, but experience and common-sense have shown they have, nevertheless, their component parts to play in making an effective whole. 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. All the staff of the department have carried out their duties a satisfactory manner, and I would like to place before the committee my indebtedness to them for the way in which the work has been done and for their loyalty to me during the year. I am, Yours faithfully, OSCAR M. HOLDEN, Medlical Officer of Health 6 CONTENTS. A.—PUBLIC HEALTH REPORT. PAGE Acts, Adoptive 195 Ambulance Service 16 Amusement Houses 210 Animals, Keeping of 211 Ante-natal Clinic 144 Aerodrome 189 Babies Help Committee 175 Bacteriological Examination 83 Bakehouses 206 Births 24 Blind Persons 191 Borough Hospital 14,70 Bye-laws and Regulations 196 Cancer 117 Cerebro-Spinal Meningitis 79 Chicken Pox 54 Closet Accommodation 13 Contacts, Tuberculosis 104 Cowkeepers 222 Croydon Nursing Service 104 Children Acts 177 Convalescence 175 CoombeCliff Convalescent Hosp. 11,176 Creche 176 Dairies, Cowsheds and Milkshops 220 Deaths 24 Dental Treatment—M. & C.W. 72 Diphtheria 52,58,74 Disinfection 212 Disinfestation 213 Dispensary, Tuberculosis 86 Dried Milk 169 Drainage and Sewage 13 Enteric Fever 78 Erysipelas 79 Expectant Mothers 144 Factories & Workshops Acts 204 Fertilisers & Feeding Stuffs Act 211 Foods, Inspection of 214,219 Food & Drugs Acts 214, 229 Foster-Mothers 177 Foster-Children 177 Gynaecological Clinic 158 Health Visitors, Work of 168 Home Nursing 104 Homework 206 Hospitals 13 Hospital, St. Mary's (Maternity) 14, 142 Houses Let in Lodgings 209 Housing 202 Housing Act. 1930 202 PAGE Immunisation Clinic 59 Infant Welfare Clinics, Municipal163 „ „ ,, Voluntary 163 Infant Mortality 132 Infectious Diseases 51 Laboratory Work 81,83,146 Local Acts 195 Local Government Act 20 Lodging Houses, Common 208 Massage Clinic 171,188 Maternity Homes 141 Maternity Homes, Registration 141 Mayday Hospital 4,31,144 Measles 53,79 Meat Inspection 217 Medical Help Records 139 Meteorology 30 Mental Deficiency 179 Midwives 138 Midwives Act, Section 14 141 Milk, Provision of 169 Milk, Examination of 84,220 Milk, Tuberculous 224 Milkshops 222 Mortality in Child-birth 126 Mothers' and Infants' Welfare Association 163 Mumps 54 Neo-natal Deaths 133 Notification of Births Acts 126 Nuisances 198 Nursing Arrangements 104 „ Homes 141 N.S.P.C.C 16 Observation Nursery 14,170 Obstetrical Unit 142 Occupation Centre (Grange Wood) 183 Offensive Trades 210 Ophthalmia Neonatorum 79,131 Orthopaedic Department 185 Overcrowding 204 Parrots (Prohibition of Imports) Reg. 214 Poisons & Pharmacy Act 211 Poliomyelitis 79 Poor Law Relief 18 Population 29 Post-natal Clinic 158 Public Laboratory 83 Puerperal Sepsis and Pyrexia 78,128,1 Queen's Road Homes 17 Rag Flock Acts 210 Rats & Mice (Destruction) Act 213 Rent Restriction Acts 202 Rivers and Stieams 13 7 PAGE Sanatorium, Cheam 109 Sanatoria, Treatment in 100 Sanitary Administration 195 Sanitary Certificates 202 Sanitary Inspectors, Work of 196 Scavenging 13 Scarlet Fever 51,57,72 Schools 211 St.Christopher's Special School 182 Stop Hours Acts 207 Slaughterhouses 216 Social Conditions 12 Small Pox 14 Smoke Observations 210 Sputum, Examination 98 Staff 8 Still-births 130 St. Mary's Maternity Hospital 14, 142 Swimming Pool 233 Tuberculosis—After Care 108 „ Cheam Sanatorium 109 „ Contacts 104 Deaths 89 PACE Tuberculosis—Dental Treatment 110 „Notifications 86 „Home Nursing 104 ,,Home Visits 1C3 „ Housing 105 „ Tables 113 „ Pneumothorax 86,109 „ Institutional Treatment 100 Unmarried Mothers 129, 176 Ultra-Violet Light 190 Vaccination 85 Venereal Diseases 120 Verminous Persons 213 Vital Statistics 10, 22 Watercourses 211 Water Supply12 Whooping Cough 52, 79 Workplaces 205 Workshops 205 X-ray Examination 98, 109, 146, 187 B.—SCHOOL MEDICAL REPORT. PAGE Accommodation 246 Adenoids 255,269 Hind Children 289 Cleansing of Children 250 Clinics 235,268 Clothing and Footgear 250 Committee 234 Cost 245 Crippling Defects 271 Deaf Children 256,290 Defective Children 289 Deformities 257 Dental Disease 272 Detal Treatment 272 Domestic Subjects 298 Ear Clinic 281 Ear Disease 256 Epileptic Children 290 Exclusions 264 Eye Clinic 271 Eye Disease 257 following up 267 Health Visitors, Work of 267 Heights and Weights 251,299 Infectious Diseases 266 Inspection Clinic 270 Inspections, Routine 247 Inspections, Special 247 Juvenile Employment 292 PACE Lungs, Diseases of 254 Malnutrition 250 Massage Clinic 271 Meals, Provision of 293 Mentally Defective Children 290, 293 Milk, etc, Provision of 245, 251, 292 Minor Ailments 268 Nutrition 25 Orthopaedic Work 271 Orthodontic Service 278 Physical Training 295 Physically Defective Children 290 Remedial Exercises 271 Rheumatism clinic283 Sanitary Accommodation 240 School Camps 291 Schools, Special 289 Secondary Schools 298 Skin Affections 257 Speech 257, 290 Staff 234 Statistical Tables 301 Surveys, Uncleanliness 250 St. Christopher's 293 St. Giles 272 St. Luke's 289 Tonsils, Enlarged 255, 269 Treatment 268 Tuberculosis 255 Uncleanliness 250 Vision, Defective 257,271 8 STAFF OF THE HEALTH DEPARTMENT. The staff of the Public Health Department on the 31st December, 1935, was as follows:— Medical Staff.— (a) Whole-time:— Oscar M. Holden, M.D., D.P.H.. Medical Officer of Health, School Medial 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. Gunn, 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 anl Assistant School Medical Officer. (Left January, 1935— Dr. Martine appointed.) J. W. Pickup. M.D., D.P.H.. Assistant Medical Officer of Health and Assistant School Medical Officer. W. R. Martine, M.B.E., M.B., Ch.B., 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. Ailocn I. 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. Rosa Morrison, M.B., Ch.B., D.P.H., Assistant Medical Officer of Health (Maternity and Child Welfare) and Assistant 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 (Croydon Air Port). Janet D. E. Michael, M.R.C.S., L.R.C.P., Assistant Medical Officer, Maternity and Child Welfare. (Left June, 1935—Dr. R. Morrison appointed full time.) 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: .T. K. R. Bryce, L.D.S., T\. C. B. Webster, L.DS(Left September, 1935), G. M. Davie, L.D.S. Inspectors.— R. J. Jackson, M.R.S.T. A.M.T.S.E., M.S.T.A., Chief Sanitary Inspector, F. F. Fulker, A.R.S.I., A.T.S.E., M.S.T.A., Deputy Chief Inspector. 17 District Sanitary Inspectors. In addition, there are 7 disinfeetrs, 1 rat-catcher, and 4 assistants to the Sanitary Inspectors. Health Visiting Staff.— 22 District Health Visitors; 3 Special Visitors; 1 Tuberculosis Nurse; Almoners and 3 Dental Attendants. Also 2 whole-time Masseuses and Remedial Gymnasts. 9 Clerical Staff.— Twenty-seven 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. Transferred Officers under Local Government Act, 1929.— MAYDAY HOSPITALArnold 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.R.C.S., L.R.C.P., Assistant Medical Officer. (left October, 1935.) John Ewart Edson, M.B., Ch.B.. B.Sc.. M.Sc., Assistant Medical Officer. Archibald M. Robertson, M.B., CliB., Assistant Medical Officer. Dental Surgeon.— Eric Herbert Laurence, L.D.S. 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 Archibald Dukes, M.B., B.Sc., M.R.C.S., L.R.C.P. (resigned). 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. & L.M Panel of medical practitioners appointed for Addiscombe and Central Wards vice Dr. T. A. Dukes. Public Vaccinators.— William Vaudrey 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., Ophthalmic 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. 10 SUMMARY OF VITAL STATISTICS FOR 1935. Area 12,617 acres. Population (Census 1931), 233,115. Population (estimated middle of 1935), 242,100. Number of Inhabited Houses (1931 Census), 56,429. Overcrowding Census (1936), 65,550. Rateable Value (1st April, 1935), £2,247,243. Product of a Penny Rate (1935), £8,679. Rate in the £ (1934-35), 10/- Gross expenditure on Health Services (administered bv Medical Officer of Health) £139,555 16 5 Income on Health Services (excluding transfers) 13,206 17 8 Net expenditure on Health Services £126,348 18 9 Expressed as a Penny Rate, 14.56 pence in the pound. Live Births—M.F. Total. Legitimate 1,654 1,489 3,143 Illegitimate 82 63 145 Birth-rate per 1,000 of the estimated resident population, 13.6. Still Births—103. Rate per 1,000 total (live and still) births, 30.4. Deaths—2,453. Death-rate per 1,000 of the estimated resident population, 10.1. Deaths from diseases and accidents of pregnancy and childbirth : From sepsis, 7: other causes, 3. Maternal mortality: 2.9 per 1,000 total live and still births. 11 Death-rate of Infants under one year of age— All infants per 1,000 live births 45 Legitimate infants (125 deaths) per 1,000 legitimate live births 40 IIIegitimate infants (22 deaths) per 1,000 illegitimate live births 152 Deaths from Measles (all ages) — ,, ,,Whooping Cough (all ages) 2 ,, ,,Diarrhoea (under 2 years of age) 17 ,, ,,Diphtheria (all ages) 12 Per 1,000 of the population. Deaths from diseases of Cardiac and Circulatory System (including Cerebral Haemorrhage) ... ... ... 4.21 ,, ,, diseases of the Respiratory System (including Tuberculosis) 1.80 ,, ,, diseases of Renal System 0.27 ,, ,, diseases of Digestive System 0.67 ,, Suicide and Accidents 0.46 „ ,, Old Age 0.13 12 SECTION I. SOCIAL CONDITIONS, HOSPITAL ACCOMMODATION AND VITAL STATISTICS. Croydon, though still a dormitory town for London, is rapidly developing industries and trades of its own. The chief industries are iron foundries, bell foundries, engineering and building. The London Terminal Aerodrome is within the County Borough boundary. 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 1935 is 242,100. 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 (ireen, Waddon, Selhurst, and Addington. A portion of the northern side of the Borough obtains water supplies from the Metropolitan Water Board. 1 am indebted to the Borough Engineer, Mr. C. E. Boast, 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, 11.7 cleg. ,, Permanent, 4.0 deg. No B. Coli in 100 c.c. No Streptococci in 100 c.c. No Acid Organisms in 100 c.c. 13 The supply during the year was from the Corporation's Wells 1,903,666,000 Metropolitan Water Board in Bulk 714,797,000 2,618,463,000 gallons. This works out, on an average population basis of 248,000 (1935), at a consumption of 28.9 gallons per diem per head, a slight decrease per head in spite of the dry summer. Rivers and Streams. There are only small streams or ditches. These have been kept in a good state. Drainage and Sewage. Extensions of the system have been made to keep pace with the growth of the Borough and the outside areas draining into the Borough. About 48,000 has been expended in maintenance and laying of new main sewers and surface water drains and a loan for £ 15,500 has been sanctioned by the Ministry of Health for further extensions. At the sewage disposal works at Beddington, three Activated Sludge plants are in operation dealing with 3½ to 5 million gallons per day. 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 Authority. (1) Tuberculosis. Borough Sanatorium, North Cheam. 93 beds are provided for the treatment of early, intermediate advanced cases. 14 (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 £1,549. (3) Children. (a) Observation Nursery, Lodge Road. These premises occupy the upper storey of tbe 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) Coornbe 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. (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. General Hospitals. Mayday Hospital—Local Authority's General Hospital. During the year a new three-storey ward block of 66 beds was opened at Mayday Hospital. This block is intended for acute 15 medical and surgical cases. Owing, however, to the dislocation of accommodation caused by alterations and additions to other parts of the hospital, it has not yet been possible to use this block for the purposes intended. Owing to the vacation of the old Maternity Block, Ward Block E is being used as a Lying-in and Gynaecological unit until the new Maternity Block is ready for occupation. The total number of beds provided at present is : — Male (Medical and Surgical) 96 Female (Medical and Surgical) 184 Children 60 Lying-in and Gynaecological 66 Mental—Male 32 Female 32 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)Orthopa3dic Clinic: (c) Venereal Diseases Clinic; (d) Ultra-Violet Bay 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 53 surgical 21 medical Female Beds 52 surgical 21 medical Children's Beds 30 Private Beds 23 A total of 200 beds. The number of in-patients treated during 1935 was 2,956; the average stay of each in hospital being 18.64 days. The number of out-patient attendances, including casualties, was 136,013. The Purley and District War Memorial Hospital. This is situated on the Brighton Road close to the boundary between Croydon and Purley. It is supported entirely by voluntaryaid 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. 16 The Norwood and District Cottage Hospital. Males (Surgical and Medical) 15 beds; Female (Surgical and Medical) 15 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, as well as to a maternity home at Upper Norwood, established by the Free Church Council. One other Voluntary Institution also offers facilities for unmarried mothers, namely, The Mission of Hope, Birdhurst Lodge. The Mission of Hope also receives illegitimate children from various districts, as a preliminary to 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 7 cases were dealt with. The reasons for reference were: general neglect, 4; neglect to obtain medical or ophthalmic attention, 3. 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 and operating from the 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 Ambulance Brigade. (d) One motor ambulance provided by the Public Assistance Committee and operating from Queens Road Homes. 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 146 (b) For Women 185 (c) For Children (under 16 years of age 7 238 The number of beds available has been increased by 238 during the year. Table I. Table showing the classification of the accommodation and the number of beds occupied on the 31st December, 1935. Classification. Number of Wards. Men. Women. Children under 16 yrs. of age. Total. Provided Occupied. Provided Occu. pied. Provided Occupied. Provided Occupied. Chronic Sick 4 50 49 50 50 - - 100 99 Mental (Lunacy Act, 1890) 4 8 8 40 32 - - 48 40 Mental Defectives 2 - - - - 7 7 7 7 Age and Infirm 16 88 82 95 83 — — 183 165 Totals 26 146 139 185 165 7 7 338 311 IN-PATIENTS. Total number of admissions (including infants born in hospital) : 63. Total number of deaths : 43. Total number of discharges (including infants born in hospital): 20. Duration of stay of patients— (a) Tour weeks or less: 15. (b) Exceeding four weeks but under thirteen weeks: 9. (c) Thirteen weeks or more: 39. dumber of beds occupied— (a) Average during the year: 97. (b) Highest: 100 (on 8/1/35). (c) Lowest: 93 (on 28-6-35). 18 Classification of In-Patients who were discharged from or who died in the Institution during the year ended 31st December 1935— Men and Women Disease Groups. Discharged. Died. Influenza 1 1 Tuberculosis (non-pulmonary) 1 - Malignant disease 1 - Rheumatism— Chronic Arthritis 3 - Venereal Disease 1 - Mental Diseases— Senile Dementia - 1 Senile Decay 3 20 Disease of the Nervous System and Sense Organs 2 - ,, ,, Respiratory System 2 5 ,, ,, Circulatory System 4 .. 15 ,, ,, Digestive System 1 - ,, ,, Genito urinary System 1 — ,, ,, Skin 2 — Totals 22 .41 POOR LAW RELIEF. No. of residents in Croydon County Borough Area in receipt if outdoor poor relief on the 1st January, 1935 5,113 persons ; 1,904 cases (including able- lst July, 1935 ... 4,176 ,, 1,784 ,, „ bodied . 1st January, 1936 5,651 ,, 2,209 ,, ,, Number of Croydon poor persons relieved in the Mayday Hospital on 1st January, 1936, and in the Queen's Road Homes on the same date— Mayday Hospital 94 Queen's Road Homes 409 Expenditure on Out-relief to Croydon cases during the 12 months ended 30th September, 1935. Half-year ended 31st March, 1935 .£37,0:23 17 6 Half-year ended 30th Sept., 1935 £35,294 6 6 During the year the District Medical Officer for No. 3 Medical District resigned, and a Panel Medical Service Scheme evolved to take his place. This scheme commenced on April 1st 1935, and the Public Assistance Committee issued the following report upon its working for the remainder of 1935: — The whole of the medical practitioners within the (comprising the Addiscombe, East and Central wards of the 19 Borough) were invited to accept service under the scheme, and 10 doctors were admitted to the Council's panel of practitioners. One withdrew from the scheme at the end of October and the panel now comprises 9 doctors. The former District Medical Officer was one of the practitioners admitted to the scheme and a large number of relief recipients have chosen to remain under his medical care. At present these comprise about one-third of the total number of persons who have chosen doctors. The arrangements have worked smoothly, and in consequence of the system adopted of requiring all fresh applicants for relief other than able-bodied unemployed, to choose a medical attendant at the time the application is made, there has been no delay in the provision of medical attention when required Able-bodied unemployed, who seldom require the services of a doctor except, e.g., for a wife or child, obtain a Relieving Officer's Medical Order on the doctor of their choice as and when required. In the absence of exact statistical information as to the working of the district under the arrangements hitherto in force, comparisons ire difficult, but the following particulars are submitted:— Average number of separate patients attended during each of the quarters ended June, September and December 147 Particulars of services rendered: Attendances at patients homes 815 Attendances on a second person in the same house at the same visit 85 2,013 Attendances on patients at the surgery 915 Medical Certificates issued 198 total number of prescriptions written April to December, 1935 Approx. 1,800 Total number issued during corresponding period of the previous year 1,097 Estimated cost of drugs, dressings and dispensing for the year to 31st March, 1936 £81 Estimated cost for the same period of the previous year £62 Estimated amount of per capita payment to doctors in respect of patients actually attended (ascertainable at 31/3/1936) 3/- Estimated average payment per service 1.2 pence In comparing these figures the increased relief should be taken into account. 20 The chief advantage of the scheme apart from the right of choice of doctor lies in the submission of the Medical record cards to the Medical Officer of Health at the end of each month, enabling the extraction of particulars which form clinical records of all public assistance patients treated in the district. These record cards (except where treatment has terminated) are returned to the practitioners. The following is a comparison of the estimated annual cost of the scheme and the estimated cost under the previous arrangement : Previous Arrangement. Panel Medical Scheme. ££ D.M.O.'s Salary150 Pool for Payment of Drugs, Dressings and Practitioners 200 Dispensing 62 Drugs, Dressings and Dispensing 81 £212 1281 LOCAL GOVERNMENT ACT, 1929. In Croydon the delegated duties under this Act 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 grants made to Voluntary Associations by the Council under the Local Government Act, 1928, during 1935-6 were as follows:— Croydon Mothers' and infants' Welfare Association— 1935/6 £ (a) Maternity 4,500 (b) Infant Welfare Centres 850 (c) Convalesence 600 (d) Care-work (Unmarried Mothers) 150 (e) Home Helps 100 £6,200 21 Other Grants— 1935/6 £ The Retreat, Ross Road 650 Wilford Road Creche 100 Croydon Rescue and Preventive Association 100 "The Shrubberies" 230 £7,280 Less Hospital Contributions. 22 SECTION II. VITAL STATISTICS. Marriages—The number of marriages solemnised was 2,132, compared with 2,125 in 1934; 2,244 in 1933; 2,134 in 1932; 2,212 in 1931; and 2,112 in 1930. The marriage rate was 8.8 per 1,000 of the population , 1,073 were solemnised in Established Churches. 276 in other places of worship, 780 in the Register Office; 3 ceremonies were performed under Jewish ritual. Births—The births registered were 3,143 legitimate and 14-5 illegitimate. The birth-rate consequently was 13.6. For England and Wales the rate was 14.7. and in the Great Towns it was 14.8. The illegitimate births in Croydon were 4.4% of the total, compared with 4.7% in 1934, 4.2% in 1933, 4.9% in 1932, 4.8% in 1931, and 5.1% in 1930. The live male births numbered 1,736, the female 1,552, being a proportion of 1,120 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 (19.2), Thornton Heath (18.2), and South Norwood (17.0). Those with the lowest were: Norbury (6.7), Upper Norwood (6.9), South (9.4), and Central (9.8). Deaths—The deaths numbered 2,453, compared with 2,571 in 1934. For 1935 the death-rate was 10.1. For 1934 it was 10./. The death-rate for England and Wales was 11.7, and for the Great Towns 11.8. For London the death-rate was 11.4. The male death-rate was 10.4, the female 9.8 for the Borough. There were 173 inquests held by Coroners in respect of Croydon residents during 1935, and 114 findings by Coroners after postmortem examination without inquest. Wards with the highest death-rates were: South Norwood (13.7), Waddon (12.2), and Addiscombe (11.8); lowest in Upper Norwood (7.0), Norbury (7.1), West Thornton (8.5), Thornton Heath (9.2), and Woodside (9.4). Natural Increase—The excess of births over deaths was 835, or 3,4 per 1,000 of the population. 23 Table I. WAR DH. Estimated Population Births. Deaths. Birth Rate. Death Rate. Deaths under I yea 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 (1935). Natural Increase or Decrease of 1 Population. Upper Norwood 22577 151 157 6.7 7.0 26 — 0.09 0.71 0.44 — 2.57 0.71 0.80 20 6 Norbury 16137 111 115 6.9 7.1 63 — 0.18 0.68 0.43 0.06 2.35 0.68 112 29 4 West Thornton 20246 234 172 11.6 8.5 47 — 0.15 0 .52 0.44 0.15 3.61 0.15 1.19 42 62 Bensham Manor 16237 187 182 11.5 11.2 32 0.12 0 .12 0.92 0.62 0 06 4 13 0 86 1-84 50 5 Thornton Heath 15754 287 145 18 2 9.2 31 — 0.06 0.51 0.53 0.13 4.00 0.70 0.95 51 142 South Norwood 17874 304 245 17 0 137 40 — 0.06 0.90 0.95 0.17 5.82 0.84 1.85 29 59 Woodside 15794 158 149 10.0 9.4 57 0.10 0.32 0.70 0.70 0.06 4.12 0.57 1.27 37 9 East 18196 189 192 10.4 10.6 63 — 0.05 0.49 0.27 — 4.34 0.88 1.70 10 3 Addiscombe 14587 195 172 13.4 11.8 62 0.07 0.14 0.82 0.62 0.21 6.10 0.48 1.03 49 23 Whitehorse Manor 16903 274 162 16.2 9.6 47 0.06 0 .18 0.83 0 .59 — 3.67 0.53 1.18 63 112 Broad Green 15508 196 170 12.6 11.0 51 0.13 0.06 0.64 0.84 0.32 4.19 0 .84 1.35 69 26 Central 12318 121 118 9'8 9.6 66 — 0.08 0.81 0.65 0.16 3.41 0.73 0.97 33 3 Waddon 22033 423 268 19 2 12.2 54 0.27 0 .05 0.86 1.04 0.09 4.90 0.54 1.31 22 155 South 15035 144 167 9 4 11.1 56 0.07 0.13 0.73 0.13 — 4.92 0.53 1 86 13 23 Addington 2901 83 30 28-6 10.3 48 0.34 0.34 — 0.34 — 3.10 — 1.38 1 53 The Borough 242100 3288* 2453* 13.6 10.1 45 0.07 0.12 0. 73 0.61 0.09 4.21 0.67 1.33 19 835 * These are the corrected figures. 24 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 Central (66), Norbury and Hast (63), and Addiscombe (62); lowest in Upper Norwood (26), Thornton Heath (31), and Bensham Manor (32). The Infantile Mortality rate was above the average for the whole Borough in the following Wards: Norbury, West Thornton, Woodside, East, Addiscombe, Whitehorse Manor, Broad Green, Central, Waddon and South. Birth-rates were highest in Waddon, Thornton Heath, and South Norwood; lowest in Upper Norwood, Norbury, South, and Central. The general death-rate was highest in South Norwood, Waddon, and Addiscombe; lowest in Upper Norwood, Norbury, West Thornton, Thornton Heath, and Woodside. The death-rate was above the average for the whole Borough in the following Wards: Bensham Manor, South Norwood, East, Addiscombe, Broad Green, Waddon, and South. Addington, owing to its relatively scanty population, has not been included for purposes of comparison. The birth-rate is an increase on last year, which was the lowest recorded up to that time. The death-rate from Diarrhoea was highest in Woodside, Wl itehorse Manor, and Norbury; from Bronchitis and Pneumonia in South Norwood and Woodside; from Pulmonary Tiuberculoses in Waddon, South Norwood, and Broad Green; from Non-Pulmonary Tuberculosis in Broad Green and Addiscombe; from Diseases of the Heart and Circulation in Addiscombe, South Norwood and Waddon.; from Nervous Diseases in East and Bensham Manor: from Cancer in South, South Norwood, and Bensham Manor. 25 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. of Non-residents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At ail Ages. Uncorrected Number. Nett. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 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 1935 242,100 3576 3288 13.6 2413 10.0 256 296 147 45 2453 10.1 26 Table III. 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 1160 93 4 9 23 42 43 60 115 218 286 267 F 1285 53 4 12 23 30 49 70 110 169 273 492 1 Typhoid and paratyphoid fevers M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 2 Measles M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 3 Scarlet fever M ... ... ... ... ... ... ... ... ... ... ... ... I F ... ... ... ... ... ... ... ... ... ... ... ... 4 Whooping cough M 2 ... 1 1 ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 5 Diphtheria M 4 ... ... 3 1 ... ... ... ... ... ... ... F 8 ... ... 2 4 2 ... ... ... ... ... ... I 6 Influenza M 15 1 ... ... ... 1 ... ... ... 3 3 6 F 10 ... ... ... ... ... ... 1 2 1 4 2 7 Encephalitis lethargica M 1 ... ... ... ... ... ... ... ... 1 ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 8 Cerebro-spinal fever M 3 1 ... ... ... ... ... 1 1 ... ... ... F ... ... ... ... ... ... ... ... .... ... ... ... 9 Tuberculosis of respiratory system M 87 ... ... ... ... 18 18 17 16 12 4 2 F 61 ... ... ... ... 17 22 11 2 4 2 3 10 Other tuberculous diseases M 9 1 ... ... 2 2 ... 1 1 ... 2 ... F 19 1 2 1 2 2 4 1 3 2 1 ... 11 Syphilis M 5 1 ... ... ... ... ... ... 2 2 ... ... F 1 ... ... ... ... ... ... 1 ... ... ... ... 12 General paralysis of the insane, tabes dorsalis M F 5 2 ... ... ... ... ... ... 1 ... 3 1 .... ... 13 Cancer, malignant disease M 144 ... ... 1 1 2 ... 4 22 40 52 22 F 182 ... ... ... ... ... 2 16 31 41 55 37 14 Diabetes M 8... ... ... 1 ... ... ... ... 3 2 2 F 15 ... ... ... ... 1 ... ... 1 2 6 5 15 Cerebral haemorrhage, etc M 29 ... ... ... ... ... ... 1 4 5 12 7 F 57 ... ... ... ... ... ... 1 1 10 20 25 16 Heart Disease M 340 ... ... ... 2 1 1 10 19 54 117 136 F 440 ... ... 1 2 ... 4 8 27 35 97 266 17 Aneurysm M 8 ... ... ... ... ... ... 1 ... 5 2 ... F 1 ... ... ... ... ... ... ... ... 10 22 23 18 Other circulatory diseases M 57 ... ... ... ... ... ... ... 2 10 26 39 F 88 ... ... ... ... ... ... ... 6 17 5 6 19 Bronchitis M 19 1 ... ... ... ... 1 ... 1 5 1 18 F 26 2 ... ... ... 1 ... 1 1 2 15 10 20 Pneumonia (all forms) M 71 13 ... 1 ... 2 2 1 9 18 9 18 F 49 4 1 2 1 1 ... 2 4 7 2 2 21 Other respiratory diseases M 7 ... ... ... ... ... ... 1 1 1 2 2 F 6 ... ... 1 ... ... ... ••• 1 ... 5 1 22 Peptic ulcer M 21 ... ... ... ... ... 1 2 8 4 2 1 F 9 ... ... ... ... ... ... 1 1 4 1 ... 23 Diarrhoea, etc M 12 7 l ... ... 1 ... 1 ... 1 1 5 F 17 8 1 ... ... ... ... ... 2 ... 1 ...... 24 Appendicitis M 13 ... ... ... 2 1 1 3 2 3 1 1 ...... F 5 ... ... ... ... 1 ... ... 2 1 ... ... 25 Cirrhosis of liver M ... ... ... ... ... ... ... ... ... 9 ... ... F 2 ... ... ... ... ... ... ... 2 ... 1 26 Other diseases of liver, etc M 1 • •• ... ... ... ... ... ... ... ... 3 3 F 15 ... ... ... ... ... 2 1 6 7 3 27 Other digestive diseases M 41 6 1 1 2 2 4 3 3 9 3 9 F 25 ... ... ... 3 ... 2 3 2 7 9 4 28 Acute and chronic nephritis M 29 ... ... ... ... 1 ... 4 4 7 14 4 F 37 ... ... ... 1 2 ... 2 7 / ... ... 29 Puerperal sepsis F 7 ... ... ... ... 1 3 3 ... ... ... ... 30 Other puerperal causes F 1 ... ... ... ... ... 1 ... ... ... ... ... 31 Congenital debility, premature birth, malformation, etc. M 59 58 ... ... ... ... ... 1 ... ... ... ... F 28 28 ... ... ... ... ... ... ... 1 ... 9 32 Senility M 10 ... ... ... ... ... ... ... ... 1 3 19 F 22 ... ... ... ... ... ... ... ... 4 2 ... 33 Suicide M 15 ... ... ... ... 3 3 ... 3 7 ... ... F 11 ... ... ... ... ... 2 2 ... 7 2 9 34 Other violence M 44 ... ... 2 4 4 7 3 6 3 6 17 F 41 2 ... 1 3 ... 3 4 2 3 20 24 35 Other defined diseases M 101 4 1 ... 8 4 4 5 11 20 20 24 F 100 8 ... 4 7 2 6 9 14 15 17 18 36 Causes ill-defined, or unknown M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 27 Comments on the Registrar-General's Table of Total Deaths by Cause and Age and Sex. The chief cause of death, both in males and females, was Heart Disease, and its heaviest incidence was in ages over 45 years. The next important cause of death was Cancer, which resembled Heart Disease in causing most deaths in females and in its highest incidence after 45 years. Pneumonia also exacted a heavy toll with a higher incidence in males. The age period 5-25 showed the lowest number of deaths from this cause. The fatality of Pneumonia during the first year of life should be noted. With the exception of the group of conditions, Congenital Debility, Premature Birth, Malformation, etc., it was the greatest cause of death at this age. Other illuminating and important causes of death are other circulatory diseases, which fell particularly heavily on women over 55 years. Tuberculosis, which was more fatal in the male sex, and which, in both sexes, caused the highest number of deaths in the young adult age period of 15-35 years was the greatest cause of death among the young adult population. Deaths from violence, contrary to the experience in 1934. fell about equally on both sexes, and also showed a decline. Cerebral Hamorrhage and Nephritis were a more usual cause of death in women than men, whilst Digestive diseases fell more heavily on men. Deaths from Zymotic diseases were relatively insignificant in number. To sum up, the most dangerous time of life up to the 45th year is the first year: from 45 years onward the incidence of death rises, fairly slowly at first, but rapidly after the 55th year. Comparisons with 1934. There was a notable decline in the deaths from the Zymotic diseases, there being no deaths from Measles and Scarlet Fever, and only 2 from Whooping Cough. These three conditions caused deaths in 1934. Diphtheria also showed a decline in fatality of over 50%. Pulmonary Tuberculosis, however, caused 12 more deaths. There was a conspicuous decline in the number of deaths attributed to Cancer, from 374 in 1934 to 326 in 1935. Deaths from Heart Disease, however, increased by 85. Pneumonia deaths showed a decline of 20, and those due to Bronchitis a decline of 22. Deaths from Digestive diseases, including appendicitis, increased by 14. Deaths from Suicide and Violence declined from 135 to 111. The year 1935 was a healthier year than 1934. In spite of the increased population and a probable increase in the average age of the population, due to the low birth rate, the total number of deaths where 82 fewer in men and 64 in women than in 1934. 28 The percentage of deaths under 1 year of age to total deaths was 6.0%. Deaths under 15 years,, 9.1%; deaths under 65 years, 46.1%; deaths over 65 years, 53.9%. The corresponding figures for 1934 were 5.6 ; 10.4 ; 47.7 ; and 52.3. Table IV. CLASSIFICATION OF DEATHS ACCORDING TO DISEASE OVER A PERIOD OF 12 YEARS. Cause of Death. 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 l934 19 35 Total Deaths Total Deaths. Total Deaths. Total Deaths. Total Deaths. Total Deaths Total Deaths. Total Deaths. Total Deaths. Total Deaths. Total Deaths. Total Denths Death. Rate. Enteric Fever 2 ... 1 2 ... 1 ... ... 2 ... l ... ... Malaria. ... 1 1 ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 4 7 13 6 30 1 22 ... 2 13 14 ... ... Scarlet Fever 2 1 ... 3 5 4 2 3 ... ... 3 ... ... Whooping Cough 11 9 9 21 14 24 3 9 12 3 18 2 0.008 Diphtheria and Croup 8 8 32 10 32 23 14 5 11 17 21 12 0.050 Influenza (including Influe nzal pneumonia) 89 63 44 118 38 199 32 84 100 103 28 25 0.013 Dysentery ... ... ... ... ... ... 1 1 ... ... ... ... ... Erysipelas 4 5 5 5 3 8 7 4 3 8 5 2 0.008 Cerebro-Spinal lever 2 ... ... ... 2 ... 2 3 2 2 3 1 0.012 Pulmona y Tuberculosis 157 151 171 165 167 170 154 155 144 162 144 148 0.611 Tuberculous Meningitis 12 17 17 10 13 10 7 11 9 10 6 9 0.037 Other Tuberculous Dirases 18 13 20 28 26 19 14 11 13 12 '7 14 0.058 1 .QOft Cancer, Malignant Disease 292 319 330 344 327 330 339 34. 341 374 371 321 1. 326 Rheumatic Fever S 8 11 6 6 5 4 7 4 4 6 9 0-037 Meningitis 6 6 2 9 11 17 14 15 9 ... 9 14 0.058 Organic Heart Diseases 305 273 281 346 405 308 375 49 469 627 591 781 3.222 Bronchitis, Acute and Chronic 142 130 100 92 92 226 125 20 145 130 93 45 0.186 Pneumonia 182 140 138 200 158 272 199 258 238 210 199 120 0.496 Other Diseases of the Respiratory Organs 33 32 34 33 33 21 16 20 15 22 24 29 0.120 Diarrhoea and Enteritis 32 36 34 24 28 45 32 15 25 26 18 29 0.120 Appendicitis and Typhlitis 28 20 14 17 16 27 23 23 28 44 23 48 0.003 Cirrhosis of Liver 7 12 3 9 11 10 5 5 8 6 5 2 0.008 Alcoholism 3 1 2 3 3 4 3 1 1 ... 5 2 0.008 Nephritis and Bright's Disease 70 65 81 77 79 117 45 60 81 78 75 66 0.271 Puerperal Fever 2 5 11 4 2 6 1 8 2 7 5 7 0.029 Other Diseases and Accidents n.n/yi of Pregnancy & Parturition 8 8 13 5 11 5 6 14 5 6 8 1 0.004 Congenital Debility and Malformation . 37 36 52 30 26 42 42 46 27 19 33 87 0.359 Premature Birth 54 42 40 48 32 47 40 49 48 47 34 Violent deaths (excluding Suicide) 66 65 71 83 75 64 74 92 75 70 91 8.1 0.357 Suicide 23 23 33 30 35 29 19 33 43 30 37 26 0.107 Other Defined Diseases 670 672 703 720 664 748 713 706 684 677 688 567 2.342 Diseases Ill-defined or unknown ... 1 3 4 10 ... 4 1 10 8 3 ... ... Total 2280 2169 2269 2452 2354 2792 2337 2674 2556 2721 2571 2453 10.1 1 Populatiorv 1 (_ thou/a *vis) 242 2 40 a-39 83/ 2^5 £ V/\ A • «'\ I ° TT^-^VW—* ■■ •'•. . /: • i ; ;• • I* : V*/, • /wv- -i/^ i\j?x0r°°°°L r\a v>'v \/\a.v. -v • \ • • . ° • 1 " i r T • • • J * , \ V « I I I I ' • * * H q _ c ^ «-ri>ol-.a;)e^_ rr C pvg-CVfU-iO^jq 0>g — »<n<f <0©»~C0-0 — CtKi*iO<Or».0Q aj^ — n■*,r> y " ^ r' J 2 o a 29 per 1,000 population. Circulatory System (including Atheroma and Cerebral Haemorrhage) 1,020 or 4.21 Cancer 326 1.34 Respiratory System (not Tubercular) 178 0.74 Tuberculosis (all forms) 176 0.74 Diseases of the Digestive System (excluding Cancer and Tuberculosis) 161 0.67 Diseases of the Nervous System (not Tubercular 160 0.66 Diseases of Renal System 66 0.27 Infectious Diseases (excluding Tuberculosis but including Influenza 43 0.18 Suicides and Violent Deaths 1ll 0.46 Old Age 32 0.13 Congenital Debility and Prematurity 87 0.36 The greatest single group of causes of death as in 1934 was diseases of the Circulatory system, and of this group Organic Heart Disease was the most prominent member (780 deaths). Rheumaism 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. Arterio-sclerosis (96 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 Hæ morrhage, which caused, incidentally, 86 deaths, is one of the sequelae of Arterio-sclerosis, combined with excessive blood pressure. Arterio-sclerosis and Cerebral Hæ morrhage between them caused 182 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 it to have risen to 233,115, whilst for 1935 the estimated population is 242,100. The growth of Croydon has been rapid and continuous; even during the war years the increase was not arrested, while since the war its growth has been accelerated. Such an increase of population gives rise to peculiar health problems, not 1935 showed a decrease in the general death-rate, an increase in the birth-rate and a further decline in the infant mortality rate, which reached the lowest yet recorded in Croydon. Taking diseases of bodily systems and group diseases to which deaths were definitely assigned we find:— Months. Air Temperature in Degrees Fahrenheit. bright Sunshine. Hrs. per day. Table V. METEOROLOGICAL RECORD Means of Mean of A. & B. Rainfall Total. A. Max. B. Min. Daily Mean Percentage. °F. °F. °F. in. mm. hrs. January 43.7 37.4 40.5 1.13 29 0.82 10 February 47.9 39.6 43.7 3.19 81 1.85 19 March 51.0 38.0 44.5 0.21 5 3.62 31 April 54.0 41.6 47.8 2.93 74 3.51 25 May 59.6 43.6 51.6 1.44 37 5.13 33 June 68.5 53.5 61.0 2.66 68 7.32 44 July 74.9 55.9 65.4 1.33 34 8.75 55 August 73.2 54.3 63.7 3.10 79 6.19 43 September 65.9 52.0 58.9 3.51 89 5.46 43 October 56.7 45.4 51.1 3.63 92 3.23 30 November 50.6 41.5 46.1 4.77 121 1.50 17 December 42.7 36.5 39.6 4.11 104 0.98 12 \leans and Totals for Year 57.4 44.9 51.1 32.01 813 4.04 33 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 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 31 SECTION III. MAYDAY HOSPITAL. Staff—Medical Superintendent: Arnold Gilray, M.B., Ch.B., 3 other Resident Medical Staff. 8 Consulting Visiting Staff. Specialised Services—Orthopaedic, Gynaecological, Dental, X-Ray, Ultra-Violet Light, Massage, Ophthalmic, Ear, Nose and Throat. No. of Trained Nurses 46 (plus X-Ray and Massage 3). Probationer Nurses 72 Assistant Nurses 7 Male Attendants 7 Table I. Summary of Statistics. 1. Total number of admissions (including infants born in hospital 4872 2. Number of women confined in hospital 647 3. Number of live births 616 4. Number of deaths among the newly-born (under 4 weeks) 27 5. Total number of deaths among the children under one year (including those under No. 4) 52 6. Number of still births 37 7. Number of maternal deaths among women admitted to hospital for confinement 1 8. Total number of deaths 726 9. Total number of discharges (including infants born in hospital) 4125 10. Duration of stay of patients included in Nos. 8 and 9: (a) Under four weeks 3296 (b) Four weeks and under thirteen weeks 1248 (c) Thirteen weeks and more 307 11. Number of beds occupied (a) average during the year 478 (b) highest 546 on 21/2/35; (c) lowest 407 on 25/8/35. 12. -Number of surgical operations under G.A. (excluding dental operations) 706 13. plus under spinal anaesthetic -Number of abdominal sections 62 316 32 Classification of In-Patients who were Discharged from or who Died in the Institution during the year ended 31st December, 1935. Table II. Children (under 16) Men and Women. Discharged. Died. Discharged. Died A.- Acute infectious disease 25 — 14 2 B.- Influenza 1 — 3 - C.- Tuberculosis : Pulmonary 3 1 50 44 Non-Pul monary 4 2 12 9 D.- Malignant Disease — — 42 80 E.- Rheumatism, Acute rheumatism (rheumatic fever) together with sub-acute rheumatism and chorea 9 1 26 2 Non-articular manifestations of rheumatism (muscular rheumatism, fibrositis, lumbago, and sciatica) — — 2 — Arthritis 3 — 39 2 F.- Venereal Disease — — 11 1 G.- -Puerperal pyrexia — — 26 - H.- Puerperal fever (a) Women confined in (b)hospital — — 4 - (c) Other cases — — 9 1 I.— Other diseases and accidents connected with Pregnancy and childbirth — — 138 2 J- -Mental disease (Senile Dementia) — — — 2 (Other) 7 — 221 6 K.- -Senile Decay — — 41 47 L.- -Accidental injury and violence 55 1 245 24 M.- -Diseases of the Nervous System and Sense organs 17 3 145 34 N. ,, „ Respiratory System 91 6 188 66 0. „ „ Circulatory System 33 6 175 243 P. ,, ,, Digestive System 107 14 390 44 Q. „ „ Genito-Urinary System 11 — 370 29 R. ,, ,, Skin 79 1 126 3 S.- Other Diseases 62 — 73 3 T.- Mothers and children discharged from Maternity Wards and not included in above. (I ) 589 - 533 - U.- Patients not included under the above headings 42 - 44 - Totals 1198 35 2927 664 33 •27 deaths of infants born in th e Hospital are not included in the foregoins table. Total Number of Patients During the Years 1935 and 1935. 1935. 1934. Cured 2900 2551 Relieved 867 781 Unrelieved 358 371 Died 726 699 4851 4402 Which is an increase of 449 upon 1934. 34 Table III. Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Alimentary. Gastritis 10 3 1 1 - - - - 15 Hernia - — - — 26 6 4 1 37 Threadworms 1 - - - - - - - 1 Enteritis 16 1 1 7 — - — - 25 Haemorrhoids - - - - 12 - — - 12 Appendicitis - - - - 158 22 1 - 181 Diverticulitis of Colon - - - - - 1 - - 1 Cholecystitis - - - - 8 4 2 1 15 Swallowed foreign body - - - - 4 — — - 4 Catarrhal jaundice 1 1 - - - - - - 2 Constipation 15 14 - - - - - - 29 Dyspepsia 3 5 1 - - - - - 9 Intestinal obstruction - - - - 4 1 — 8 13 Cholelithiasis - - — — 2 2 2 2 8 Pyorrhoea - — - — 1 2 — - 3 Hydrocele femoral canal - - - - - - 1 - 1 Salivary calculus - - — — 2 — — - 2 Gastric ulcer 15 13 4 7 3 1 - 1 44 Duodenal ulcer 2 6 - 2 6 1 — 1 18 Adhesions after operation - - - — 1 2 1 — 4 Colitis 1 5 - 1 - - — — 7 Peritonitis - - - - - - - 12 12 Stomatitis 2 - - 1 - - - — 3 Chill 2 - - - - - — — 2 Teething 1 - - - — - — — 1 17 Alcoholism 4 13 - - - - — — Visceroptosis 2 2 — - — - — — 4 Glossitis 1 — — — - - - - 1 35 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Ischio-rectal abscess — — — — 3 2 — — 5 Fistula-in-ano — — — — 1 1 — — 2 Ascites — — — 3 — — — — 3 Pyloric stenosis — — — 1 — — — — 1 Alveolar abscess — — — — 5 1 1 — 7 Dental caries — — — — 7 1 — — 8 Diabetes mellitus 3 6 — 3 — — — — 12 Intestinal colic 9 7 - - - - - - 16 Cirrhosis of the liver — 2 — — — — — — 2 Intussusception — — — — — — — 1 1 Congenital enlargement of colon — — 1 — — — — 1 529 Bones. Arthritis 10 16 8 1 - - - - 35 Osteo-arthritis 1 8 2 - - - - - 1 Sciatica 1 2 - - - - - - 3 Lumbago 4 — - - - - - - 4 Acute rheumatism 20 11 1 2 — — — — 34 Right coxa vara — 1 — — - — - - 1 Congenital talipes - 1 - - - - - - 1 Gout - 1 - - - - - - 1 Infective arthritis 1 - - - 1 - - - 2 Osteo-myelitis — — — — 1 5 2 - 8 Fibrositis 3 2 — — — — — - 5 Bursitis 4 - - - 2 - - - 6 Periostitis R. Tibia - - - - 1 - - - 1 Polio-myelitis 1 - - - - - - - 1 Pleurodynia 1 - - - - - - - Muscular dystrophy — — 1 — — — — — 1 30 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Paget's Disease — 1 — - - - - - 1 Lympho sarcoma — — — — — — — 1 1 Flat feet — — — — — 1 — — 1 Teno-synovitis - - - - 1 - - - 1 119 Carcinoma. Stomach — — — — — 2 2 20 24 Ovary — — — — — — — 2 2 Uterus — — — — 2 — 4 11 17 Bronchus — — — — — — — 2 2 Lower jaw — — — — — — 2 3 5 Breast — — — — 2 1 3 8 14 Pancreas — — — — — — 1 4 5 Lung — — — — — — 2 5 7 Tongue — — — — — — — 3 3 Pharynx — — — — — - — 2 2 Vulva — — — — — — 1 - 1 Oesophagus — — — — — — - 3 3 Larynx — — — — — — - 1 1 Prostate — — — — — — 1 2 3 Liver — — — — — — 1 1 2 Bowel — — — — 2 5 9 12 28 Kidney — — — — — — - 1 1 Sarcoma of skull — — — — — — - 1 1 Face — — — — — 1 - - 1 122 37 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Eve. Conjunctivitis — — — — 2 — — — 2 Cataract — — — — 1 — — — 1 Glaucoma — — — — 1 — - — 1 Corneal ulcer — — — — — 1 1 — 2 6 Circulatory (Blood). Pernicious Anaemia 1 1 — 1 — — — — 3 Anaemia 1 8 1 2 — — — — 12 Lymphatic Anaemia — - 1 3 — — — — 4 Hodgkin's Disease — — — 1 — — — — 1 20 Circulatory (Heart and Vessels). Hyperpiesia 1 3 — — — — 4 Gangrene — — — 3 — - 3 Epistaxis 2 1 - - - - - - 3 Cerebral embolism — 1 - 3 - - - - 4 Varicose veins — — — - — 2 - - 2 Phlebitis 4 2 - 1 - - - - 7 Thrombosis - 3 1 2 - - - - 6 Myelogenous leukaemia 1 - 1 - - - - - 2 Myocarditis 1 10 - 17 - - - - 28 Endocarditis — 4 4 3 - - - - 11 Auricular fibrillation 1 5 - 7 - - - - 13 Arterio-sclerosis - 16 6 8 - - - - 30 Mitral & Aortic rgurgitation - 2 - - - - - - 2 Myocardial degeneration - 20 4 167 - - - — 191 38 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Mitral stenosis 2 10 1 1 — — - - 14 Stoke Adams Syndrome — — 1 — — — - - 1 Angina Pectoris — 1 - - - - - - 1 Coronary Atheroma — — — 1 — — — - 1 Tachycardia — 1 - - - - - - 1 Congenital Heart Disease — — — 2 — — — - 2 326 Constitutional and General. Collapse 6 4 1 - - - - - 11 Convulsions 1 - - - - - - - 1 Obesity — 1 - - - - - - 1 Marasmus 6 — — 3 — — — - 9 Debility 7 8 1 1 — — - - 17 Nutritional disorder 7 1 1 1 — — - — 10 Rickets 2 - - - - - - - 2 Toxaemia — — — 1 — — - - 1 Dietetic errors 1 - - - - - - — 1 Septicaemia - - - - - - - 1 1 2 Pyaemia — — — 2 — — - — Inanition — — — 2 — — - - 2 Pyrexia of unknown origin 1 - - - - - - - 1 59 Ear, Nose & Throat. Otitis Media - - - - 22 9 1 - 32 Tonsillitis 21 3 2 - 72 2 - 1 101 39 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Mastoiditis — — — — 10 1 — — 11 Sinusitis — - — — 4 2 — — 6 Deflected nasal septum — — — — 1 1 — — 2 Nasal polypus — — — — 1 — — — 1 Rhinitis — — 1 — — — — - 1 154 Gynaecological. Ovarian cyst — — — — 7 — — — 7 Ovarian cyst with acute torsion — — — — 2 — — — 2 Cystic ovaries — — — — 3 — — — 3 Acute salpingitis - - - - - 5 — — 5 Chronic Salpingo-oophoritis — — — - 3 1 — — 4 Pyo-salpinx — — — — 2 1 — — 3 Tuberculous salpingitis — — — — 1 — — — 1 Chronic Metritis (Fibrosis) — — — — 5 3 — — 8 Chorion-epithelioma of uterus - - - - - - - 1 1 Polypoidal endometritis — — — — 2 3 — — 5 Uterine polypus — — — — 2 - — — 2 Retroflexion — — — — 2 — — — 2 Uterine Fibromyomata — — — — 9 1 1 — 11 Chronic Cervicitis and Fibrosis uteri - - - - 2 - - - 2 Chronic cervicitis — — - — 15 2 - — 17 Erosion of cervix - — 3 — — — 3 Cervical polypus — — — — 1 — — — 1 Deficient Pelvic Floor — — - — 3 2 — — 5 Defitient Pelvic Floor and Cervicitis — — — — 12 1 1 — 14 40 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Vaginitis - - - - - 2 - - 2 Vaginal Cyst — — — — 3 — - - 3 Atresia of Vagina — — — — 1 1 - - 2 Rigid Hymen — — — — 2 — — - 2 Urethral caruncle — — — — 1 1 — - 2 Bartholin's Cyst — — — — 1 — — - 1 Bartholin's Abscess — — — — — — - 3 Pyelo-cystitis — — — — 1 1 — - 2 Stress incontinence — — — — - - — - 1 Pruritus Vulvae - - - - - - 1 - 1 Dysmenorrhoea — — — — 1 — - - 1 Adolescent Menorrhagia — — — — 1 — - - 1 Ventral Hernia — — — — 1 — - - 1 Sterility — — — — 1 — 2 - 3 Investigation of renal Function - - - - - 3 — - 3 124 Maternity. Deliveries (viable child) — - — — 647 - - - 647 Live births — — — — 592 — - 24 616 Deliveries (non-viable foetus) — — — — 116 — - 2 118 Ectopic pregnancy — — — — 4 — - — 4 Delivered before admission — — — — 24 — - — 24 Maternity cases undelivered — — — — 45 — — 1 46 Admitted as Puerperal Sepsis per se — — — — 7 — - 2 9 1464 41 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Genito-Urinary. Prostate Enlargement — — — — 3 6 3 7 19 Gangrenous Penis — — — — 1 — — — 1 Uraemia — 1 — 4 — — — — 5 Orchitis — — — — 3 1 1 — 5 Supra-pubic fistula — — — — 2 — 1 — 3 Haematuria 2 4 1 - — — — — 7 Retention 3 2 — — — 5 — — 10 Nephritis 5 3 2 6 — — — — 16 Pyelitis 14 6 — — — — — — 20 Ureteric calculus — — — — 1 1 — — 2 Pyelo-nephritis 1 — 1 2 — — — — 4 Cystitis 2 3 1 — — 1 — — 7 Epididymo-orchitis — — — — 2 2 — — 4 Noturnal enuresis — 1 — — — — — — 1 Renal calculus — — — — 3 2 1 — 6 Bacilluria — — — — — 1 — — 1 Paraphimosis 1 — — — — — — — 1 Urethral stricture 2 1 — — — — — — 3 Dysuria 1 — — — — — — — 1 Movable kidney — 1 — — _ _ — — 1 Phimosis — — — — 9 — — — 9 Hydrocele — — — — 1 — — — 1 127 Glands and Lymphatic System. Adenitis 14 11 2 27 Exophthalmic goitre 2 — — — — — — 1 3 42 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Hyperthyroidism 1 - - - - - - 1 Axillary Abscess — — — — 9 1 — - 10 Mesenteric glands. (calcified) — 2 - - - - - - 2 43 Infectious. Diphtheria — — 10 - - - - - 10 Influenza 5 - - - - - - - 5 Mumps — — 12 - - - - - 12 Cerebro Spinal Meningitis — 1 3 1 — — — - 5 Tetanus — — — 1 — — — - 1 Ringworm 1 2 - - - - - — 3 Erysipelas — — 1 — — — — — 1 Scarlet Fever — 2 — — — — — — 2 Measles — — 4 — — — — - 4 Whooping cough — — 3 — — — — — 3 Paratyphoid Fever — — 1 — — — - - 1 47 Mental. Certified — — 102 — — — - - 102 Epilepsy — 11 8 1 — — - - 20 Mental Defective — 1 7 — — — — — 8 Mental Uncertified 4 72 29 8 — — - — 113 243 43 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Nervous and Sensory. Chorea 6 3 1 - - - - - 10 Hemiplegia - 9 3 3 - - - - 15 Spina Bifida - - - 1 - - - - 1 Tabes Dorsalis — 2 1 2 — — — — 5 Amnesia — 2 - - - - - - 2 Cerebral haemorrhage — 4 3 55 — — — — 02 Disseminated sclerosis — — — 4 — — — — 4 Neurasthenia 2 12 3 - - - - - 17 Meningitis — — — 5 — — — — 5 Neurosis 2 13 2 — — — — — 17 Neuralgia 1 1 - - - - - - 2 Headache — 1 - - - - - — 1 Paralysis Agitans — 4 2 5 - — — - 11 Cerebral tumour — — - _ — — 3 — 3 Cerebral thrombosis — 2 — 10 — — — — 12 Neuritis 1 4 - - - - - - 5 Cerebral embolism — 2 — — — — — — 2 Cerebellar abscess — — — — — 1 — 2 3 Subarachnoid haemorrhage 1 — — 1 — — — — 2 Post encephalitis — 2 1 - - - - - 3 Congenital athetosis — 1 - - - - - - 1 Hysteria — 7 2 - - - - - 9 Hydrocephalus 1 - - 1 - - - - 2 Nervous debility 1 2 - - - - - - 3 197 Poisoning 11 3 — 2 — — — — 16 44 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Respiratory. Pneumonia 133 27 4 45 — — — - 203 Bronchitis 104 58 5 11 — — — - 178 Pleurisy 18 4 — 1 — — — - 23 Asthma 4 5 — 1 — — — - 10 Pulmonary Embolism 1 — — 3 — — - - 4 Bronchiectasis 2 7 — 2 — — - - 11 Pneumothorax — 1 - - - - - - 1 Bronchial catarrh 2 2 - - - - - - 4 Empyema 5 — - 3 - - - - 8 Haemothorax — 1 — — — — - 1 Bronchial cyst — 1 — — — — - - 1 Pulmonary abscess — — — 1 — - - — 1 451 Senility — 24 18 48 — - — - 90 Skin. . Dermatitis 14 3 - - - - - - 17 Impetigo 34 3 - - - - - - 37 Pruritus 1 - - - - - - - 1 Boils and abscesses — — — - 36 4 — - 40 Ulcers and ulceration — — — — 10 3 — 1 14 Burns and scalds 5 3 — 2 — — — - 10 Eczema 6 2 — 1 — - — - 9 Cellulitis — — — — 12 1 — 1 14 Septic Spots 18 3 — — — — - — 21 Scabies 3 - - - - - — — 3 Purpura 1 - - - - - — — 1 45 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Die d Erythema Nodosum 3 - - - - - - - 3 Urticaria 2 - - - - - - - 2 Onychogryphosis — — — — 2 — — — 2 Intertrigo 1 - - - - - - - 1 Psoriasis — 1 - - - - - - 1 Sunburn — 1 - - - - - - 1 Carbuncles — — — — 6 2 — 1 9 Varicose ulcers — — — — 6 4 — — 10 196 Pulonary Tuberculosis 1 39 14 47 — — — — 101 Non-Pulmonary Tuberculosis. Meningitis — — — 3 — — — — 3 Sacro-iliac joints - - - - - 1 — — 1 Mesenteric glands - - - - - 2 1 — 3 lleo-caecal — — — — — — — 1 1 Peritonitis — — — — — 1 — 1 2 Spine — — — — 1 — — 2 3 Foot — — — — — 1 1 — 2 Kidney — — — — 1 — 1 — 2 Sternoclavicular arthritis — — — — 1 — — — 1 Rib — — — — 1 — — — 1 Knee — — — — — 2 — — - Lupus — — — — — 1 — — 1 Testicle - - - - - — — 1 1 Tuberculoma R. cerebral hemisphere — — — — — — — 1 1 24 46 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Venereal. Syphilis — 5 1 1 — — — - 7 Gonorrhoea — 3 - - - - - - 3 10 Violence. Bruises 26 1 1 - - - - - 28 Dislocations — — — — 9 2 - - II Wounds — — — — 19 3 — - 27 Fractured limbs — — — — 76 44 5 18 143 Fractured skull — — — — 5 2 — 3 10 Fractured jaw - - - - - 1 — - 1 Fractured pelvis — — — — 3 — - - 3 Concussion — — — — 40 17 - - 57 Minor injuries — — — — 48 25 3 - 76 Sprains — — — — 4 3 — — 7 Lacerations — — — — 11 4 — 2 17 Electric shock — 1 — — — — — — 1 381 47 Operation Performed. Number. ABDOMINAL. Suture of Perforated Duodenal Ulcer 5 Suture of Perforated Gastric Ulcer 2 Appendicectomy 138 Drainage of appendix abscess Reduction of intussusception Drainage for general peritonitis 3 Excision of Haemorrhoids 4 Abdominis Paracentesis 5 Herniotomy 23 Resection of pelvic colon 4 Jujenostomy 2 Caecostomy Gastrectomy Ileostomy Cholecystostomy 3 Cholecystectomy 10 Colostomy 6 Sigmoidoscopy 13 For acute obstruction 4 Enterectomy 2 Laparotomy (Carcinatomosis, etc.) 16 Repair incisional hernia Fistula-in-ano 1 264 BONES and joints. Reduction of joints 22 Application of Plasters ... ... 28 For osteo-myelitis 11 Wiring of bones ... ... ... ... ... ... ••• 20 Manipulation of limbs 1® Resection of Rib ® Amputation of limbs Fixing of Caliper 2 Removal of R. Molar and Sequestra 1 111 ear, nose and throat. Removal of Polypus 2 Tonsillectomy 76 Mastoidectomy ... ... ... ... ... ... ... ••• 16 Tracheotomy Resection of Deflected Septum ... ... ... ••• ••• 1 Removal of Salivary Calculi ... ... ... ... ••• ••• 3 99 48 Operations Performed. Number eye. Iridectomy 1 Extraction of Lens 1 2 gynaecological. Excision of Urethral Caruncle 2 Plastic hymenectomy 2 Cystoscopy and Pyelography 3 Excision of Bartholin's cyst 3 Excision of vaginal cyst 3 Anterior colporrhaphy 1 Anterior and posterior colpo-perineorrhaph 3 Anterior and posterior colpo-perineorrhaphy and amputation of cervix 12 Amputation of cervix 6 Cauterization of cervix 6 Trachelorrhaphy 1 Removal of tissue for section 4 Dilatation of cervix 1 Dilatation and curettage 6 Exploration of uterus 6 Ventro-suspension of uterus 2 Myomectomy 3 Wertheim's Hysterectomy 1 Total hysterectomy 8 Sub-total hysterectomy 11 Salpingectomy 1 Laparotomy for ovarian carcinoma 1 Salpingo-oophorectomy 3 Oophorectomy 3 Ovariotomy 9 Blood transfusion 1 Examination under anaesthesia : salpingography, etc 4 106 obstetrical 31 Forceps delivery 31 Breech extraction 9 Internal version 4 Embryotomy 1 Manual removal of Placenta 6 Vaginal packing 4 Anaesthesia for examination, external version, etc 19 Abortion, evacuation of uterus and glycerine drainage 71 Induction of abortion per vaginum 4 Abdominal hysterotomy and sterilization 7 For ectopic gestation 4 Caesarian section 10 Surgical induction of labour 20 Drainage of puerperal peritonitis 1 Blood transfusion 19 210 49 Operation Performed. Number. GENITO-URINARY. Pyelography 4 Cystoscopy 34 Dilatation of Urethral Stricture 5 Supra-pubic Prostatectomy 7 Supra-pubic Puncture 3 Orchidectomy 1 Cystostomy 15 Circumcision 8 Epididymectomy 1 Catheterization of Ureters 3 Removal of calculi 4 Nephrectomy 1 Passage of Urethral Bougies 6 Cauterization urethral caruncle 2 For Hydrocele 1 95 MISCELLANEOUS. Aspiration of Chest 64 A.P. Refills 25 Incisions (Abscesses, whitlows, cellulitis, etc.) 106 Lumbar Punctures 45 Venesection 1 Avulsion of Nails 3 Lipiodal Injections 1 Application of Tannic Acid 1 Thiersch skin graft 3 Suture of wounds 19 Thoracotomy 1 Removal of breast 4 Thyroidectomy 2 No. of patients who had teeth extracted, Mayday Hospital 278 No. of patients who had teeth extracted, Queen's Road Homes 55 608 Total 1495 Number of major operations 678 Number of minor operations 484 Number of dental extractions 333 Total 1495 The number of major operations performed showed an increase of 285 on 1934; the number of minor operations decreased by 89. NUMBER OF X-RAY EXAMINATIONS MADE AND FILMS TAKEN DURING THE YEAR. Spines 113 Long Bones 790 Pelvis 20 50 Skull 155 Chest (including lungs) 385 Barium Meals 199 Barium Enemata 26 Urinary Tract 196 Gall Bladder 105 Teeth 140 Abdominal ? Foreign Body 16 Maternity Cases 226 Total 2311 Actual number of cases dealt with: 968. The actual number of cases X-Rayed decreased by 178, but the number of X-Ray examinations and Films increased by 445. NUMBER OF TREATMENTS GIVEN IN THE MASSAGE DEPARTMENT. 1935. 1934. Massage 7764 5301 Exercises 7033 4413 Radiant Heat 1673 1198 Electrical 542 584 Diathermy 463 409 U.V. Light 446 419 Actual number of patients treated: 827. The actual number of patients increased by 92, upon 1934; whilst, as cab be seen from the comparative figures, there were very substantial increases in the number of treatments by Massage and Exercises. This is due largely to the increased number of accident cases dealt with. DETAILS re MENTAL PATIENTS FOR THE YEAR. Male. Female. Admitted 188 221 Certified and sent to C.M.H. 40 62 Discharged not certified 108 112 148 174 Deaths: Male 36, Female 37. NUMBER OF PATIENTS SEEN BY OPHTHALMIC SURGEON DURING THE YEAR 212 NUMBER OF SPECIMENS SENT TO THE COUNCIL'S LABORATORY DURING 1935. 2275 NUMBER OF POSTMORTEMS ORDERED BY THE CORONER AND PERFORMED AT MAYDAY HOSPITAL. Outside Cases 224 Mayday Hospital Cases 52 Total 276 NUMBER OF POSTMORTEMS NOT ORDERED BY CORONER 48 51 section iv. prevalence and control of infectious disease. Table I. gives the figures for ages and Wards. Scarlet Fever was less prevalent than in 1934; the largest incidence has been in Waddon, Broad Green, and West Thornton Wards. Based on the estimated ward populations, the case rate for these wards was respectively, 917, 438, and 385 per 100,000 of the population. The age group 5-15 years, as usual, suffered most; cases in this group comprising 54.1% of the total. Diphtheria was also less prevalent than in 1934; most cases occurred in Waddon (74) and Upper Norwood (50). Once again the age group 5-15 years gives the highest figures. No cases of Small Pox occurred during the year. There were 18 cases of Puerperal Fever and 47 of Puerperal Pyrexia; 32 occurred in the age group 16-25 years and 33 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 twelve 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 reached, following a rapid rise, the third week in November. Throughout the year there has been a steady incidence with no epidemic waves. The period of lowest incidence was May and June. The average weekly number of cases cases 15.05 being 4.45 lower than in 1934. 52 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 steadv 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. In 1934, there was a minor wave of increased incidence during February, March and April, with a minimum incidence at the end of July. A fairly sharp rise took place during October, November and December, and persisted until the end of the year. In 1935 the incidence was low throughout the year and there were no pronounced waves of incidence. The weekly average of cases was 5.86, as compared with 8.4 in 1934. 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 53 commencing early in February and persisting until the beginning of August; the second beginning in late October and continuing 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. In 1935 the incidence of Whooping Cough rose in a series of sharp waves throughout 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 1934 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. In 1935 a minor wave occurred during February and March, and then declined until early in November, when there was a sudden sharp rise which reached its maximum at the end of the year. This foretold the severe epidemic which swept over Croydon during the first quarter of 1936. 54 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 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. Chicken Pox showed a minor wave during May, June and July, and a major wave during November and December, the incidence remaining high till the end of the year. 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. The major incidence foretold in 1934, occurred in 1935. The peak was reached in March, when the high number of 317 cases during the week ending March 30th was reached. The epidemic continued until the end of July. After the schools summer holidays, the cases dropped very markedly, and the rest of the year showed the usual low incidence. 55 TABLE I. CASES OF NOTIFIED INFECTIOUS DISEASE, 1935. 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. 1934. At all Ages. At ages—years. Upper Norwood. Norbury. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (inc. Membranous Croup) 304 1 86 170 29 15 3 ... 50 13 23 8 7 14 19 18 11 39 15 9 74 3 1 277 12 229 212 Erysipelas 70 2 2 6 4 23 21 12 14 ... 7 4 3 5 9 6 1 4 8 1 7 1 ... 29 2 48 68 Scarlet Fever 775 2 226 419 68 47 12 1 57 55 78 35 31 45 18 57 35 41 68 19 202 18 16 715 ... 479 524 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever (including Paratyphoid) 13 ... 1 2 2 4 4 ... ... ... 3 1 ... 2 ... 1 ... ... ... ... 1 3 2 9 ... 2 1 Puerperal Fever 18 ... ... ... 7 11 ... ... 1 ... 9 ... ... 2 ... ... 1 2 1 ... 1 1 ... 11 7 ... 15 Puerperal Pyrexia 47 ... ... ... 25 22 ... ... ... ... 29 1 1 1 ... 1 ... 2 9 ... 1 1 1 3 ... ... 36 Cerebro-Spinal Meningitis 4 ... ... 1 1 2 ... ... ... ... 3 ... ... ... ... 1 ... ... ... ... ... ... ... 5 1 2 1 Ophthalmia Neonatorum 13 13 ... ... ... ... ... ... ... ... 5 ... 3 1 ... ... ... ... 3 ... 1 ... ... 6 ... 7 6 Poliomyelitis 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 3 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ac. Primary and Ac. Inf. Pneumonia 55 1 4 3 6 17 18 6 3 4 3 3 6 3 4 3 2 8 3 ... 12 1 ... ... 10*† 38 23 Folio Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... * Influenzal Pneumonia only. † Not accommodated at Borough Hospital. 56 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. 1935 1934 Small Pox — — — — — — — Diphtheria 1.25 1.83 10 227 35 32 304 Erysipelas 0.29 0.48 — 52 11 7 70 Scarlet Fever 3.201 4.17 15 597 99 64 775 Enteric Fever (inc. Paratyphoid) 0.053 0.012 — 7 5 1 13 Puerperal Fever 0.074 0.062 — 7 — 11 18 Puerperal Pyrexia 0.194 0.15 — 8 1 38 47 Cerebro-Spinal Meningitis 0.016 0.012 — — 1 3 4 Ophthalmia Neonatorum 0.05 0.054 — 5 — 8 13 Poliomyelitis 0.004 0.016 — 1 — — 1 Encephalitis Lethargica — — — — — — — Acute Primary or Acute Influenzal Pneumonia 0.22 0.25 1 48 6 — 55 Dysentery — 0.004 — — — — — Polio-encephalitis — — — — — — — 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 1916 297 169 4 1.3 283 6 2.1 1917 191 102 2 1.05 196 2 1.02 1918 414 219 6 1.4 376 8 2.1 1919 603 314 11 1.8 522 11 2.1 1920 638 332 7 1.09 535 8 1.4 1921 855 416 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 1935 775 320 ... ... 755 1 0.1 * 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 a decrease in the number of cases notified and admitted to Hospital in 1935 as compared with 1934. The type was mild and the case mortality was nil. The attack rate (Col. 3) for England and Wales was 296. Croydon shows a rather higher figure. 58 Table IV. DIPHTHERIA. YEAR. Cases notified in Croydon. Attack Rate Per 100,0C0 of Population. No. of Deaths. Percentage of Deaths to Cases notified. All Cases Admitted to Hospital with a diagnosis of Diphtheria. No. admitted. No. of Deaths. Percentage of Deaths to Cases Treated* 1 2 3 4 5 6 7 8 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 1935 304 125 12 3.9 301 12 3.9 * Cases from Penge are included in Cols. 6 to 8. The incidence of Diphtheria showed a decrease in 1935, and the mortality was 3.9%. 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 160. Croydon's rate was therefore lower than for the whole country. 59 diphtheria immunization clinic. I am indebted to Dr. W. R. Martine, the Assistant Medical Officer of Health, who has done the clinical work of this clinic, for the following particulars. From the ever-continued demand of parents that their children should have prophylactic treatment against Diphtheria, it would appear that this Clinic has come to stay. The only propaganda undertaken has been to inform parents at School Medical Examinations, at School Clinics, and at Infant Welfare Centres, that the treatment is available for their children if they so desire. The principle of immunizing those requesting treatment, and not in any way attempting to convert those antagonistic or apathetic, has been adhered to. The effects of, and results from, "immunization" are clearly explained to each parent on first attendance at the Clinic, and on Schick Test subsequent to immunization, parents are given definitely to understand that it is impossible to guarantee that any individual immunized, and found on examination thereafter to be Schick negative, will never contract Diphtheria, but that, should this occur, the attack will be mild in character without risk to the individual of the grave complications which render the disease such a serious one. An acquired immunity may slowly be lost or reduced, and the resistance of the individual may subsequently break down before an especially virulent infection; yet the attack is mild by comparison with that of the Schick Positive or unprotected child. A gratifying feature of the work has been the number of families introduced to the Clinic by friends and neighbours who have had or are having treatment. It might also be noted here that there has been little or no difficulty experienced in gaining the co-operation of the parents and children to ensure the completion of treatment, once begun. The policy of allowing immunization to do its own propaganda is definitely showing success. After an incomplete year's work in 1934, during which a second weekly session had been found necessary, the current year commenced with 265 children whose treatment had not been completed. The numbers on the waiting list increased so rapidly that it became imperative, by the month of October, to hold a third session each week. All sessions were held at the Lodge Road Clinic until November, when one was transferred to the Selhurst Road Clinic, in an endeavour to cope with a sudden increased demand, brought about by two small localised epidemics of Diphtheria in schools, in that area. 60 The following details give a summary of the work done: Total attendances throughout the year 5,636 Total number of sessions held during the year 97 Highest attendance at any one session 92 Lowest attendance at any one session 14 Average attendance per session 58.1 During the year 1417 children and 14 mothers attended for treatment. While no parents have been offered Immunization, those requesting a Schick Test have received this, and, if found susceptible, immunized thereafter. Of the children who attended, 944 were schoolchildren, a table showing their distribution throughout the schools of the Borough being attached; while 473 children, under the age of 5 years and not attending school, came under treatment. This number is disappointingly small, as it is definitely advantageous for a child to be immunized before attending school. The opportunities of contact with infection become greater there and it is felt that if it was possible to immunize the greater proportion of entrants, Diphtheria would become of very minor importance as an infection of school life. 644 Primary Schick Tests were carried out, while this test was dispensed with in the case of 508 children. 947 in all completed an immunizing course of Toxoid-antitoxin-mixture (T.A.M.), while 11 mothers or older children underwent a similar series of injections of Toxoid-antitoxin-Floccules (T.A.F.), 2,960 injections of T.A.M., and 35 of T.A.F. being given throughout the year. I. Classification of Those Who Attended Clinic. Definite school cases 944 Definite M. and C.W. cases 265 Under 5 years but not sent from M. and C.W. 198 Nursery school 10 Adults 14 1,431 II. Distribution Among Schools of Children Treated, 1935. As it is felt that immunization without subsequent Schick Testing is of no definite value, and perhaps even a source of danger, an effort has been made to carry this out in the case of everyone immunized at the Clinic. Post-immunization tests were performed at an interval of three months or more after the third injection, 61 773 after T.A.M., and 8 after T.A.F. The latter all proved to be negative; of the former 747 were negative, 15 were positive, and 11 left the district without having the test read. The Positive reactors each received one further injection of T.A.M., following upon which 12 were retested at 2-3 months, and 11 proved to be negative. The 12th was again positive, and is still under treatment; it is probable that this child is one in whom it may be impossible to create the Schick-negative state. The remaining 3 children have still to receive a further test. As a result of the numbers awaiting treatment, it was possible to repeat only 51 Schick Tests at an interval of from one month to one year. Of these, 28 were confirmatory in originally Schick negative children, while 23 were repeats in Schick positives whose treatment had rendered them Schick negative at three months. All had retained their immunity. III. Summary of 634 Primary Schick Tests.* +ve. %. —ve. %. Total. Under 5 years 46 96 2 4 48 „ 6 „ 87 87 13 13 100 „ 7 „ 68 85 12 15 80 „ 8 ,, 77 86 13 14 90 „ 9 „ 73 83 15 17 88 „ 10 „ 44 78 12 22 56 All ages over 10 years 105 61 67 39 172 500 76 134 24 634 *Ten Schick Tests not included in this table were carried out too late in the year for it to be possible to have their "Reading." IV. Repeat Schick Tests. State before Repeat Test. at 1/12 2/12 3/12 4/12 5/12 6/12 8/12 9/12 10/12 1 year Schick Negative 7 1 8 3 2 3 — — 1 3 Schick Positive become Negative after Treatment — — — — — 17 1 2 — 3 The immunizing course employed was one of three injections of 1.0cc. T.A.M. (or T.A.F.), given for the most part at fortnightly or, occasionally, weekly intervals, while Schick tests were almost always read at the end of 7 days. To make as many readings as possible valid, 19 children, who failed to attend for reading on account of illness, were visited in their own homes for this purpose. 62 Reactions to immunizing agents were few and slight. 18 children were reported as complaining after injections of T.A.M. All followed the first injection except one which occurred after the second dose. They were as follows: (1) Local and general—5, where local redness with slight tenderness and a sensation of malaise, and in one case axillary adenitis, were the features complained of. (2) Local—10, two of which were redness and swelling in the arm persisting for 3 or 4 days, while 8 showed a mild reddening at the site of injection at about 48 hours, and lasting for about one day. (3) General—3, in two of which the injection appeared to bring on a typical attack of asthma (there had been previous asthma in both, not noted before commencement of treatment), and in the third an acute headache next day which cleared off within 24 hours. It is perhaps of interest to note that 14 of the 18 cases occurred in children over 7 and 4 in children of 5 and under. One mother reacted unfavourably to her third dose of T.A.F., having an axillary adenitis; this may have been aggravated by housework immediately after the injection. 7 Pseudo Reactions were noted as having occurred, none of these being serious. Intercurrent and Subsequent Diphtheria. A family epidemic of Diphtheria occurring concurrently with Immunization is of interest. J., aged 8, was Schick-tested and found negative; S. and B., aged 5 and 6 respectively, were not tested and received their first and second doses of T.A.M. W., aged 12, did not attend, though of school age, and was neither Schick-tested nor given any injection. S. and B. attended for their final dose and were found to have been suffering for 4 days from what their mother described as "ulcerated throats." Examination revealed typical diphtheritic membrane in each case, without any apparent discomfort or evidence of toxaemia, though in one child the membrane was already sloughing off one tonsil. The two children were removed to hospital forthwith, and Bacteriological examination showed in both the presence of the Diphtheria Bacillus. The child J. was swabbed on several occasions, and kept under strict observation, but was each time reported negative and shewed no signs of contracting the disease. W., however, developed Diphtheria within a few days and had a 63 relatively sharp attack. From this we may assume that a partial immunity had already been developed in S. and B. as such complete absence of toxaemia would not be expected in cases showing such a degree of throat infection, and on the 5th day of the disease. There were no cases of Diphtheria notified during the year as having arisen in children immunized at the Clinic and on subsequent Schick test found to be negative. There were 624 children whose treatment had not been completed at the end of the year. V. immunization—summary of treatment No. Attending 1/1/35. No. Given Primary Schick Test. No. Positive on Primary Schick Test. % Positive on Primary Schick Test. No. Not given Primary Schick Test. No. completed Treatment (T.A.M. and T.A.F.). 265 644 (10 not yet read) 500 76 508 958 No. Retested after Treatment. No. Negative on Retest after Treatment. % Negative on Retest after Treatment. No. Uncompleted at . 31/12/35. No. left District before end of year or Defaulted. 781 766 98.8 624 23 11 completed. l2 uncompleted. The conclusions to be drawn from the year's working of the Clinic are (1) that T.A.M. is a satisfactory immunizing agent where rapidity of development of an immunity is not absolutely imperative; and that, in a large clinic, where all ages are treated, its relative freedom from reactions at any age, and the sound results given by it, are strong recommendations for its use. (2) That the 64 small proportion of children of under 5 years brought forward for treatment, as compared with school children, is to be regretted. This fact is, however, easily explained, in that more parents hear of the treatment through the school medical service than through the Maternity and Child Welfare Scheme, and that in the latter case, parents are still perhaps apprehensive of the thought of injections in very young children. (3) That certain areas have come forward rather more wholeheartedly than others, a majority of the children coming from homes which one may describe as above average, with a resultant high percentage of Schick Positive Reactions. Small localised outbreaks of Diphtheria have had the effect of increasing the numbers of children brought forward from the areas involved. The "One Shot" method has not been tried at the Clinic, as there has been no demand. Difficulty in effecting the necessary attendances has not arisen, whilst the present uncertainty of the duration of immunization conferred by this method, and the possibility of severe local reactions have been deemed to be sufficient reasons not to alter the well tried methods that have been followed since the inception of the Clinic. "One Shot" immunization, uncontrolled by Schick testing, as is now being practised by some medical practitioners, is unscientific and is likely, if utilised on a wide scale, to bring the whole procedure of protective action against Diphtheria, into disrepute. 65 II. Distribution of School Children who have attended the Immunization Clinic since its Inauguration. Completed treatment during 1934. Attended Clinic during 1935. Total attended Clinic to end 1935. Completed treatment during 1934. Attended Clinic during 1935. Total attended Clinic to end 1935. Ashburton 4 19 23 All Saints' 53 39 92 Benson 1 5 6 Tenison's 1 3 4 Beulah Road 10 45 55 Christ Church 2 20 22 British 2 3 5 Holy Trinity — 5 5 Davidson 1 11 12 Parish Church 3 24 27 Duppas — 17 17 St. Andrew's 1 7 8 St. George's — 2 2 St. Joseph's — — — Ecclesbourne — 17 17 St. Mark's 1 4 5 Elmwood 2 10 12 Addington — — — Gonville 8 55 63 St. Mary's 3 11 14 Howard — 4 4 St. Peter's — 3 3 Ingram 8 21 29 St. Saviour's — 6 6 Kensington 1 30 31 Shirley — 3 3 Kingsley 14 65 79 Lanfrane 2 10 12 John Ruskin — 2 2 Norbury Manor 2 28 30 Lady Edridge 1 6 7 Oval 2 31 33 Heath Clark — 10 10 Portland — 46 46 St. Michael's — 1 1 Purley Oaks 2 3 5 Selhurst Gram. 4 4 8 Rockmount 1 20 21 Croydon High S. — 9 9 Norwood 3 22 25 Coloma — 9 9 Suffolk Road 1 7 8 Old Palace 9 3 12 Sydenham 1 7 8 Whitgift — 2 2 Tavistock — 6 6 Polytechnics 1 1 2 Waddon 12 37 49 W.Thornton 3 48 51 Private 6 26 32 Whitehorse Man 1 9 10 Winterbourne 1 85 86 Unknown 4 40 44 Woodside 10 41 51 St. Christopher's 1 2 3 Total 183 944 1127 St. Luke's — — — St. Giles' 1 — 1 66 IMMUNIZATION AT RESIDENTIAL SCHOOLS AND HOMES. Table I. (for the period January 1st, 1935, to October 1st, 1935). Toxoid-Antitoxin (T.A.M.) only used. Name. No. of Primary SchickT. No. Pos. Percent. Pos. No. T.A.M. Retested. No. Neg. Percent. Neg. Uncom pleted. Defaulted. Fidelis Convent, Central Hill 81 73 90.1 71 54 53 98.2 3 19 Infirm. Convent, Central Hill 37 34 91.9 27 25 25 100 4 5 Russell School — — — 1 1 1 100 14 2 P.A.C., Queen's Road — — — 4 — — — 11 5 P.A.C. Homes, 386, London Rd. 7 5 71.4 8 21 20 95.2 — 1 St. Jude's Home, Dagnall Park 2 2 100 2 2 2 100 — — 127 114 89.7 113 103 101 98.0 32 32 Fidelis Convent, Central Hill, Upper Norwood. Eighty-one new cases were dealt with in the manner indicated above with three consecutive injections of 1 c.c. of T.A.M. (Toxoid Antitoxin Mixture) at weekly intervals. After primary Schick Testing 73 were positive. Of the 8 negative to the Test, 7 were adults comprising nuns and sisters. The repeat Schick Test after treatment revealed a successful immunization of 53 out of 54. The remaining case had rather a severe local and focal reaction, with moderate general reaction. Thus it was necessary to give five injections of smaller quantities of T.A.M. Schick Retest after 3 months was positive, so a sixth injection of l.c.c. of T.A.M. was given. A further Schick Retest will be carried out after a period of 2 months has elapsed since the last injection. Since the reaction to this last injection was negligible it is indicative that immunity has probably been attained, and it is anticipated that the second Schick Retest will be negative. 67 There have not been any cases of Diphtheria or positive nose or throat swabs since systematic immunization was instituted, in spite of the fact that there are a large number of "day girls" attending the High School, and so outside infection is liable to be introduced. The high figure of defaulting due to failure to complete treatment is explained by the departure of several nuns from the Convent. Children's Infirmary, Central Hill Convent, Upper Norwood. Here the remarkable result of 100% successful immunization was recorded in 25 cases which were Schick Retested after immunization. No cases of Diphtheria or positive nose or throat swabs occurred during this period. Russell School, P.A.C. Homes at Queen's Road and 386, London Road, and St. Jude's Homes for Girls at Dagnall Park. Immunization was carried out as indicated in Table I. with successful results, and no ill-effects were noted following the injections. No cases of Diphtheria or positive nose or throat swabs occurred during this period. Table II. (for the period October 1st, 1935, to December 31st, 1935). Alum precipitated toxoid (A.T.) only used. No. of Primary SchickT. No. Pos. Percent. Pos. No. T.A.M. Retested. No. Neg. Percent. Neg. Uncom pleted. Defaulted. Fidelis Convent, Central Hill 10 7 70 7 — — — 7 — Infirmary Convent, Hill 27 25 92.6 28 — — — 28 — Russell school 29 26 89.7 25 23 20 87 — 3 Boys' Home 106, Beulah Hill 34 21 61.8 17 14 11 78.6 7 4 St. Jude's Home, Dagnall park 34 24 70.6 22 22 20 90.9 4 8 P.A.C., Queen's Road 12 12 100 12 — — — 12 3 P.A.C., 386, London Rd. 26 25 96.2 25 — — — 25 3 172 140 81.4 136 59 51 86.4 83 21 These figures are additional to those in Table I. 68 method of immunization using one injection of diphtheria toxoid alum precipitated. Fidelis Convent, Central Hill, Upper Norwood. Seven cases were treated, and these showed no ill-effects. Sufficient time has not elapsed since the injection to proceed with the Schick Retest. No cases of Diphtheria or positive nose or throat swabs occurred during this period. Children's Infirmary, Fidelis Convent, Central Hill, Upper Norwood. 28 cases were treated, and of these one child hud slight local and focal reactions with general malaise and headache lasting 36 hours, otherwise there were no resultant ill effects. Sufficient time has not elapsed to proceed with the Schick Retest. One case of Diphtheria occurred during this period. This was a child, J.G., aged 3½ years, who was admitted to the Infirmary Nursery on December 8th, 1935. New admissions are immunized in small groups and unfortunately this child was admitted immediately following the immunization of a group of new children and was not immunized. She was removed to the Borough Hospital on December 25th suffering from faucial and laryngeal diphtheria. A tracheotomy was performed and large doses of antitoxin were given. She has now recovered. Five other children who were sleeping in the same room had been immunized previously and were negative when Schick Retested. Swabs were taken of the noses and throats of these contacts and all showed the presence of Diphtheria organisms. They were removed to the Hospital as a matter of precaution, but none developed clinical Diphtheria, and they have all now returned to the Convent Infirmary. This demonstrates strikingly the protective influence of the previous immunization. Russell School. 25 boys were injected and 23 were Schick Retested after an interval of 8 weeks. (Two boys had left school). 69 20 out of the 23 were negative (87%) and two were weakly positive. The third was definitely positive and was given a second injection of alum toxoid. A further Schick Test made late in January, 1936, proved all three to be negative. No cases of Diphtheria or positive nose and throat swabs occurred during this period. St, Jude's Homes For Girls, Dagnall Park. Out of 22 girls treated with alum toxoid 22 were Schick Retested and 20 were negative (91%). The two with slightly positive reactions are to be further Schick Retested early next year, when it is hoped that the process of immunization will have fully developed and negative results will be obtained. No cases of Diphtheria or positive nose and throat swabs occurred during this period. P.A.C. Homes at Queen's Road and 386, London Road. 12 and 25 cases respectively were treated with alum toxoid. Two cases developed local and focal reactions lasting 48 hours, but no general reactions resulted. Sufficient time had not elapsed at the end of the year to proceed with Schick Retesting. No cases of Diphtheria occurred during this period. Boys' Home, 106, Beulah Hill. Following an outbreak of Diphtheria systematic immunization was commenced. 17 boys were injected with alum toxoid and 14 were Schick Retested. After 8 weeks, 11 were negative (78.6%), one doubtful, one weakly positive, and one definitely positive. After a further period of six weeks a second Schick Retest showed one negative, one doubtful, and one positive. The case, which was persistently positive, had had an acute attack of faucial Diphtheria 6 months previously, for which he had been given large doses of diphtheria antitoxin, and obviously he is one of those cases in whom it is extremely difficult to stimulate the formation of antibodies to a Diphtheria infection. He has been given a further injection of alum toxoid, and a further Schick Retest will be carried out after 2 months has elapsed. 70 In one case the boy was ill 24 hours after the injection. He had slight local and focal reactions with temperature of 101.4 degrees, vomiting, and headache. Tonsils, uvula and palate were markedly congested, and 48 hours after the injection he showed all the signs and symptoms of an acute tonsillitis. This would appear to he a concomitant infection unconnected with the immunization. No cases of Diphtheria have occurred during this period. Although the results of immunization using one injection of Diphtheria toxoid alum precipitated do not appear to be quite so successful as those of Toxoid Antitoxin Mixture the total figures available are not sufficiently large on which to base any final conclusions, and the percentage success is sufficiently high to warrant a continuance of this method. The obvious advantages both in the saving of time and money to doctor and patient are outstanding, and when the results from a larger number of cases are available where it has been possible to allow at least 3 months time to elapse before Schick Retesting is carried out, the percentage success of fully immunized cases will perhaps be sufficiently high for this method to displace the previous one of three injections of Toxoid Antitoxin Mixture. Excluding those cases referred to in the section dealing with the Children's Infirmary of the Fidelis Convent, Central Hill, Upper Norwood (with reference to Table II.) which is an entirely enclosed community, it is interesting to note that although in most of the Homes the boys and girls attend outside schools, yet no cases of Diphtheria or positive nose and throat swabs have been reported. Thus the danger of the occurrence of "carriers," which in theory is a very real one, proved in practice to be unfounded in the series of cases reported upon above. BOROUGH HOSPITAL. Table V. gives a summary of all cases treated at the Hospital during 1935. 1,452 patients were admitted and discharged during the year, whilst including patients in at the commencement of 1935 (242), 1,694 cases were dealt with. Twenty-one died, giving a case mortality for the whole Hospital of 1.4%, a decrease of 1.1% on 1934. The average number of days of each patient in Hospital for all classes of patients was 24.2 as against 28.5 in 1934. Penge Urban District Council has an agreement with the Corporation to send their cases to the Hospital During 1935 a total of 68 cases was admitted, these are included in the Table. 71 The Hospital is a recognised training school for Fever nurses. During the year 2 probationers passed the preliminary examination. The accommodation of the Hospital remained as in 1934, but as the number of admissions has kept up, all the wards, including the emergency ones, were kept open during the year. During the year, 25 cases were operated on for tonsils and adenoids and 4 for acute mastoiditis, 10 cases for exploration of uterus and glycerine drainage, 3 cases had blood transfusion. A complete new fire alarm system has been installed throughout the Hospital during the year. Complaint for which admitted. Patients remaining in Hospital on 1st January, 1935. Patients admitted and discharged in 1935. Patients remaining in Hospital on 1st January, 1936. Analysis of all Cases admitted in 1935, whether discharged or not during the year. Table V. Total. Recovered. Died. Total. Recovered. Died. Total. Recovered. Died. Total. Recovered. Died. Case Mortality. Average No. of days in Hospital. Scarlet Fever 137 137 ... 755 672 1 82 82 ... 755 754 1 .1 37.3 Diphtheria 102 102 ... 465 409 12 44 44 ... 465 453 12 2.5 38.2 Enteric Fever ... ... ... 11 10 ... 1 1 ... 11 11 ... ... 35 Puerperal Fever 1 1 ... 14 10 2 2 2 ... 14 12 2 14.3 22 Erysipelas 1 1 ... 29 26 2 1 1 ... 29 27 2 6.9 16 Measles ... ... ... 27 20 ... 7 7 ... 27 27 ... ... 22 Rubella ... ... ... 3 2 ... 1 1 ... 3 3 ... ... 14 Ringworm ... ... ... 1 1 ... ... ... ... 1 1 ... ... 1 C.S.M. ... ... ... 5 3 2 ... ... ... 5 3 2 40.0 13 Whooping Cough ... ... ... 25 21 1 3 3 ... 25 24 1 4.0 40 Chicken Pox ... ... ... 27 18 ... 9 9 ... 27 27 ... ... 22 Ophthalmia ... ... ... 6 6 ... ... ... ... 6 6 ... ... 18 Mumps ... ... ... 58 58 ... ... ... ... 58 58 ... ... 20 Infantile Palsy 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Tonsillitis ... ... ... 2 2 ... ... ... ... 2 2 ... ... 14 Influenzal Pneumonia ... ... ... 1 1 ... ... ... ... 1 1 ... ... 36 Stomatitis ... ... ... 1 1 ... ... ... ... 1 1 ... ... 10 No Disease ... ... ... 22 20 ... 2 2 ... 22 22 ... ... ... Totals 242 241 1 1452 1280 20 152 152 ... 1452 1432 20 ... ... 72 SCARLET FEVER. The total number of cases of Scarlet Fever admitted during the year was 755 a decrease of 213 on 1934. 715 cases were admitted from the Borough and 40 from Penge. The type of the disease during the year was generally mild, but there were once again a number of adult cases. 15 cases sent in as Scarlet Fever were not suffering from the disease. The following complications and sequelae occurred amongst the true Scarlet Fever cases. Table VI. Cases who had serum. Cases who did not have serum. Total Cases 317 428 Adenitis 7 48 Otorrhoea 7 34 Rhinorrhoea 10 35 Albuminuria — 4 Nephritis — 4 Rheumatism 2 7 Relapses 5 8 Secondary Sore Throat 3 10 Abscesses and Boils 5 8 Septicaemia 1 2 Quinsy 1 2 Diphtheria — 4 Mastoid 1 1 The average stay in hospital of serum cases was 34.8 days, of non-serum cases 39.8 days. One death occurred amongst the Scarlet Fever cases due to Streptococcal Septicaemia. The number of complications amongst the 423 non-serum cases was 39.4% whereas the complications amongst the 317 serum cases was 13,2%, a pronounced result in favour of serum cases. 73 Ages and Sexes of Scarlet Fever Patients Admitted. Table VII. Age. Males. Females. Totals. Percentage 0—1 2 1 3 0.40 1—2 12 13 25 3.31 2—3 24 28 52 6.89 3-4 37 29 66 8.74 4—5 41 34 75 9.93 5—10 124 171 295 39.07 10—15 53 61 114 15.10 15-20 15 23 38 5.03 20—30 13 30 43 5.69 30 or over 12 32 44 5.83 Total, 1935 333 422 755 Total, 1934 440 528 968 Monthly Admission of Scarlet Fever Patients to the Hospital. Table VIII. Month. Cases admitted. Cases notified. 1934. 1935. January 85 76 91 February 101 62 67 March 88 86 80 April 58 55 52 May 69 46 50 June 65 62 54 July 66 63 59 August 66 47 55 September 72 60 61 October 81 67 76 November 125 67 68 December 92 64 62 Total 968 755 775 74 DIPHTHERIA. 465 cases were admitted with a diagnosis of Diphtheria, a decrease of 81 cases on 1934. Of these, 14 were found not to be cases of Diphtheria, and 150 were cases of positive swab without clinical symptoms, leaving 301 cases of true clinical Diphtheria. Analysis of the 301 cases:— Faucial Diphtheria 269 Nasal Diphtheria 20 Laryngeal Diphtheria 7 Faucial and Nasal Diphtheria 3 Faucial and Laryngeal Diphtheria 2 Total 301 Of the Laryngeal cases, tracheotomy was necessary in 4 cases. Of these, one was moribund on admission, two died 2 days later from increasing heart failure, and one recovered. The following complications and sequelae occurred amongst the Diphtheria patients:— Otorrhœa 4 Rhinorrhœa 10 Adenitis 6 Heart Failure 12 Secondary Throat 2 Quinsy 2 Paralysis:— Palatal Pharyngeal 18 Eyes 5 Facial 1 75 Ages and Sexes of Diphtheria Cases Admitted. Table IX. Age. Males. Females. Totals. Percentage. 0-1 - 1 1 0.21 1—2 5 7 12 2.58 2—3 16 7 23 4.95 3—4 17 17 34 7.31 4—5 35 33 68 14.62 5—10 108 101 209 44.94 10—15 31 25 56 12.04 15—20 5 12 17 3.66 20—30 10 20 30 6.45 30 or over 3 12 15 3.23 Total, 1935 230 235 465 - Total, 1934 298 248 546 - The type of Diphtheria which occurred in 1935 was, as a whole, less severe than in 1934, but as in that year there was an increase in virulence towards the end of the year. The death rate was 3.9 per cent., as compared with 5.2 per cent. in 1934. The average stay in hospital of Diphtheria cases was 38.2 days. admissions of Diphtheria Cases to Borough Hospital in 1935. Table X. Month. Cases notified. Cases admitted. 1935. 1934. January 58 84 38 February 26 33 36 March 16 44 51 April 27 30 41 May 28 30 27 June 9 23 32 July 15 26 26 August 24 37 38 September 21 45 49 October 35 44 48 November 27 48 77 December 18 21 83 Total 304 465 546 76 Particulars of Fatal Cases of Diphtheria. Table XI. Name. Day of Disease. Condition on Admission. Subsequent progress. Date of Death Days after admission. (1) E.P. (F) 13 yrs. 4 Sloughing membrane over whole pharynx. Bull neck. Rhinorrhoea ++ Condition grew steadily worse and started cardiac vomiting 4 days after admission. Increasing heart failure with restlessness, and death. 8 (2) T.C. (F) 3½ yrs. 4 Membrane over both tonsils; glands of neck ++. Shewed signs of heart failure 12 days after admission, which increased, became very restless and died from this. 41 (3) M.D. (M) 11/12 yrs. 3 Bilateral recession and stridor ; throat clean; breathing distressed. Tracheotomy performed soon after admission with relief, but pulse persistently rapid and weak after this. Died a few hours later from heart failure. 5 hours (4) K.L. (F) 3 yrs. 2 Membrane over both tonsils. Bull neck. Developed cardiac vomiting on 9th day after admission and heart failure increased; collapsed suddenly next day. 10 (5) M.E. (M) 4 yrs. 3 Moribund on admission; cyanosis and bilateral recession; membrane over left tonsil. Tracheotomy performed on admission but child collapsed soon after. ½ hour (6) L.D. (F) 18½ yrs. 4 Sloughing membrane over whole of pharynx extending to palate. Bull neck and cyanosis; profuse rhinorrhoea; marked toxemia. Throat took over 8 days to clear up. Developed palatal paresis a week after admission and heart failure next day; collapsed suddenly 9 days after admission. 9 (7) A.R. (M) 2 yrs. 3 Croupy with slight recession; membrane on tonsils. After admission child became more restless and tracheotomy was performed one hour later with relief. 4 77 Name. Day of Disease. Condition on Admission. Subsequent progress. Date of Death Days after admission. 8) E.C. (F) 6 yrs. 2 Sloughing membrane over whole pharynx; glands of neck + + . Foetor marked; toxemia ++. Child became restless with signs of heart failure on 4th day after admission; dying from this on 5th day from admission. 5 (9) A.R. 2 yrs. 3 Croupy slight recession specks on tonsils; colour fair. Recession increased after admission and tracheotomy performed with relief. Developed signs of heart failure subsequently and this increased till death on fourth day after admission. 4 (10) M.C. 15 yrs. 3 Extensive membrane over whole pharynx; cyanosis and foetor; bull neck; marked toxemia. Patient shewed signs of heart failure for some weeks after admission. She subsequently developed severe pharyngeal paralysis with marked salivation and died from this 45 days later. She had previously valvular heart disease. 45 (11) R.A. 6 yrs. 2 Membrane over both tonsils, glands of neck + +, toxemia + +.. Patient developed signs of heart failure 3 days after admission with vomitting and drowsiness. These signs increased till death on 4th day. 4 (12) M.M. 3 yrs. 5 Sloughing membrane over pharynx, colour poor, bull neck. Patient had signs of heart failure on admission, and these increased steadily until death on 3rd day. 3 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 three of the fatal cases received serum before admission. Intra-venous and intra-muscular injections of serum were given in does between 24,000-100,000 units. Intra-venous 78 tion of serum combined with intra-muscular injection seems the best method for ensuring rapid absorption in the system. No ill effects were ever noticed when this was tried. For cases in whom toxemia was marked, the administration of 20 c.c. 50% sterile glucose solution intra-venously, combined with glucose solution in large quantities orally appeared to be most satisfactory in improving the pulse and general condition. "Coramine," given in doses of 0.5 cc to 1.7 c.c. intra-muscularly as a heart stimulant, was also satisfactory, as an alternative or given in combination with injections of 1 c.c. Camphor in oil. Adrenalin Hydrochloride 1-1,000 solution in sub-cutaneous doses of 0.5 to 1 c.c. also proved beneficial in toxic cases with marked cardiac weakness. Typhoid and Para-Typhoid Fever. Only three cases of Typhoid Fever were admitted, and in all three the diagnosis was confirmed. Eight cases of Para-Typhoid Fever were admitted and in these also the diagnosis confirmed. All the cases recovered. Puerperal Fever. Three cases were admitted with a diagnosis of Puerperal Pyrexia and eleven with a diagnosis of Puerperal Fever. The analysis of these cases was as follows:— In one cases the diagnosis was not confirmed. In five cases the infection was limited to the uterus, vagina or perineum. In five cases the infection had reached the pelvic cellular tissues, ovaries, fallopian tubes, pelvic peritoneum, etc. In three cases the infection had spread beyond the pelvis to cause general peritonitis, septicaemia, etc. Of these three, two died. The cases of Puerperal Fever and Puerperal Pyrexia were admitted under the Maternity and Child Welfare Scheme, the unit at the Borough Hospital forming a link in that scheme. 79 Erysipelas. There were 29 cases of Erysipelas admitted, a decrease of 17 cases on 1934. The disease was of average severity. There were two fatal cases, both in senile subjects as a terminal condition. Measles. There were 27 cases of Measles admitted, a decrease of 34 cases in 1934. The disease was of average severity, but no deaths occurred amongst them. Whooping Cough. There were 25 cases of Whooping Cough admitted, a decrease of 49 cases on 1934. There was one fatal cases owing to BronchoPneumonia. Cerebro-Spinal Meningitis. Five cases were admitted, but in only three was the diagnosis confirmed. One case was diagnosed as meningism following influenza, the other proved to be suffering from tubercular meningitis, and died. One case of Cerebro-Spinal Meningitis proved fatal, dying a few days after admission. Ophthalmia Neonatorum. Six cases were admitted, but only in one was the diagnosis confirmed, the other cases being diagnosed simple conjunctivitis. Infantile Paralysis (Poliomyelitis). One case was admitted with the above diagnosis, but proved to be a case of acute Rheumatic Endocarditis. Death occurred through cerebral embolism. 80 Age-Group 0—1 1—2 2—5 5—15 15—25 25—35 35—45 45 &over Totals Deaths Table XII. Other Diseases. Disease M F M F M F M F M F M F M F M F Enteric Fever ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 3 ... Paratyphoid B ... ... ... ... 1 ... ... ... ... 2 ... 1 ... 1 1 ... 8 ... Puerperal Fever ... ... ... ... ... ... ... ... ... 4 ... 5 ... 2 ... ... 11 ... Puerperal Pyrexia ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... 3 ... Erysipelas ... 1 ... ... ... ... ... 2 3 ... ... 4 4 1 6 6 29 ... Measles 2 1 1 2 1 8 6 4 1 1 ... ... ... ... ... ... 27 ... Rubella 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 3 ... Cerebro-Spinal Meningitis ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 5 2 Whooping Cough 3 2 3 3 6 3 4 1 ... ... ... ... ... ... ... ... 25 1 Chicken Pox 1 ... 2 3 7 4 4 6 ... ... ... ... ... ... ... ... 27 ... Ophthalmia 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 ... Mumps 1 1 1 2 5 18 14 8 ... 4 ... 4 ... ... ... ... 58 ... Stomatitis ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Tonsillitis ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 ... Influenzal Pnuemonia ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Ringworm ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... No disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 ... Totals 11 8 7 10 20 34 29 27 5 14 3 17 6 4 8 7 232 7 81 Table XIII. Out of Borough Cases. Disease. Males. Females. Totals. Deaths. Scarlet Fever 19 21 40 — Diphtheria 14 10 24 — Measles — 1 1 — Rubella — 1 1 — Typhoid Fever — 2 2 — Totals 33 35 68 — Croydon Borough Hospital Laboratory Report. Table XIV. DIPHTHERIA. Examination of Nose and Throat Swabs. New Cases Swabbed on Admission. During Convalescence. Negatives. Total Swabs Examined. + • + — 233 494 7,777 8,504 ENTERIC (Widals). — + Total. 4 1 5 Positive was a Para.-Typhoid B. case. FACES EXAMINED FOR ENTERIC AND DYSENTERY GROUPS. — + Total. 26 — 26 82 Other Examinations. Cerebro-Spinal Fluids: 4. Meningococcus present. Cerebro-Spinal Fluids: 5. Examined for organisms. Urines examined for organisms, etc.: 16. Blood Cultures: 4. Streptococcus Haemolyticus Longus present. 3 remained sterile. Pus examined for organisms: 7 (4 Streptococcus isolated, 3 Staphylococcus present). Fluids from Chests: 3. Each specimen contained Streptococcus. Lochia specimens for Haemolytic Streptococci: 8. 3 positive, 5 negative. Swabs examined for Gonococcus: 6. 2 positive, 4 negative. 1 sputum for T.B. negative. Hair examined for Ringworm (negative). 2 specimen bloods examined for Dysentery Group (negative). 1 Pericardial Fluid. Streptococcus Haemolyticus Longus present. 1 specimen Faeces examined for T.B. (negative). Culture Media. Prepared in the Laboratory. Table XV. Loffler's Blood Serum 718 doz. tubes Peptone Broth 8,000cc Agar Agar 4,500cc Endo's Media 2,500cc Litmus Milk 500cc Peptone Water l,000cc 83 BACTERIOLOGICAL EXAMINATIONS. I am indebted to the Borough Pathologist, Dr H. W. Southgate, for the figures given in the appended tables: For private practitioners .Mayday Hos.. For Borough Hospital For Tab. Dispensary For School Medical Other Instns. of Corporation Other Institutions Total Table XVI. At the Laboratory, Croydon General Hospital. Pos. Neg. Pos. Neg. Pos.. Neg. Pos. Neg Pos. Neg Pos. Neg. Pos. Neg. Pos. Neg. Swabs for Diphtheria 219 1627 18 816 ... 6 ... 1 145 6069 ... 3 19 572 431 9094 Virulence tests for Diphtheria 1 ... 2 ... 4 2 ... ... 1 ... ... ... 2 1 10 3 Sputum for Tub Bac. 98 528 2.55 312 ... ... 330 461 ... ... ... ... 10 52 693 1351 Pus for Tub Bac. ... 5 15 573 ... 1 ... ... ... ... 6 85 ... ... 21 664 Pus for Gonococci ... 1 19 50 ... ... ... ... ... ... 3 30 ... ... 22 81 Pus for other organisms ... 1 ... 643 ... 3 ... ... ... ... ... 89 ... ... ... 736 Blood for Typhoid Groups 5 9 1 3 ... ... ... ... ... ... ... ... ... 6 6 18 Blood for Wassermann ... 1 26 13.3 ... 2 ... ... ... ... ... ... ... ... 26 136 Material for Spirochaetes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Faeces for Typhoid Group ... 1 1 18 ... 2 ... ... ... ... ... 2 ... ... 1 23 Hair for Ringworm ... ... ... ... 5 ... ... ... ... ... ... 1 1 2 ... 3 6 Examination of Urine 2 342 1 ... ... ... 82 ... 427 Examination of Pleural Fluid ... 41 ... ... ... ... 10 ... 51 Examination of C.S. Fluid ... ... 51 ... ... ... ... ... ... 51 Other Examinations 1 481 ... ... ... ... 27 ... 509 84 The number of swabs examined for Diphtheria increased by 802. The number of various examinations for Mayday Hospital also increased. The year, in fact, showed an all round increase in the number of various specimens submitted for examination. Examinations Done Under National Health Insurance Act. Table XVII. Nature of Examination. Nature of Examination. Pus for Gonococci 11 (7 pos.) Urine for Chemical Exam. 7 Pus for other organisms 9 Urine for Microscopal Exam. 7 Pus for Tubercle B. 8 (1 pos.) Urine for Tubercle B. 7 Blood for Wasserman 18 (1 pos.) Urine for Cultural Exam. 7 Complete Blood Counts. 6 Other Examinations 12 Bacteriological Examination of Milk. Table XXIX. Number of Samples submitted for Counts. 506 Number under 10,000 per cc 157 No. over 10,000 but under 50,000 per cc 174 Over 50,000 but under 100,000 per cc 58 Over 100,000 but under 500,000 per cc 63 Over 500,000 but under 1,000,000 per cc 7 Over 1,000,000 per cc 47 Bacillus Coli Content— Not found in 0.1 cc 251 ,, ,, 0.01 cc 137 ,, ,, 0.001 cc 49 Present in 0.001 cc 69 Higher dilutions not made. Tubercle Bacilli— Number of samples of milk submitted 506 Number found by positive inoculation test 11 The number of milk examinations increased by 37 85 VACCINATION ACTS. I am indebted to Mr. Hoggins, 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 Unvaccinated. P. P.O. Transferred tootherV Os. Not traced Removals. In Default. Overage when Registered. South Sub-District 1420 472 5 660 53 31 40 26 138 1 West „ 1388 382 3 751 51 15 13 63 108 2 North ,, 829 309 4 397 18 13 6 14 67 1 3643 1163 12 1808 122 59 59 103 313 4 During the year 2,423 Forms Q were sent to parents, and 48G Forms K and 269 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. 778 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, 1935:— 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 ago. 1 year and upwards. Total. Croydon No. 1 Area 122 17 139 4 No. 2 Area 156 11 167 3 No. 3 Area 82 4 86 5 No. 4 Area 100 13 113 3 No. 5 Area 218 23 241 10 Addington 8 1 9 - Queen's Road Homes 5 - 5 - Mayday Road Hospital 2 1 3 - Children's Homes - - - - Shirley Schools — — — — 693 70 763 25 86 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. The only redeeming feature is its central situation. Sessions are held daily in the morning 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 private doctors, hospitals, etc., also cases and contacts 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 ioses 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 unaple to undertake artificial pneumothorax refills and the Council has to pay for these to be done at a London hospital. 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 nineteen cases of Pulmonary Tuberculosis and 36 of Non-Pulmonary Tuberculosis were notified on Form A (primary notifications), of these 125 males and 94 females were Pulmonary cases, 20 males and 16 females Non-Pulmonary. In addition 50 Pulmonary cases and 28 Non-Pulmonary came to our notice as new cases otherwise than by notification. 87 The total number of new cases of tuberculosis coming to the knowledge of the Medical Officer of Health during 1935 by notification or otherwise, was 333, as compared with 325 in 1934, 346 in 1933, 369 in 1932, 412 in 1931, 387 in 1930, and 390 in 1929. 269 of these cases were Pulmonary Tuberculosis. 150 in males and 119 in females. There were 9 more cases of Pulmonary Tuberculosis in males, and 10 fewer in females than in 1934. There were 26 cases of Non-Pulmonary Tuberculosis among children under 15 years as compared with 21 in 1934. The number of cases in adults was 38 as compared with 34 in 1934. Of the cases notified in 1935, 24 males and 17 females died from the Pulmonary form of the disease during the year, equal to 18.7% of those notified, and 2 males and 3 females from the Non-Pulmonary. The incidence rate of Tuberculosis of all forms was 1.38 per 1,000 of the population; for Pulmonary Tuberculosis 1.11 and for Non-Pulmonary 0.27 per 1,000 population. The Notification rate was 1.05 per 1,000. In 1934, the corresponding figures were 1.35; 1.12 and 0.23 per 1,000. The Notification rate was 1.03. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications during the period from the 1st January, 1935, to the 31st December, 1935:— Table I. 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 6 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 1 ... 1 3 8 16 31 27 25 11 2 125 134 „ Females ... 1 ... ... 9 22 28 20 7 4 3 94 115 Non-pulmonary Males ... 3 4 4 3 1 1 1 1 1 1 20 21 „ „ Females ... 1 2 ... 1 2 4 5 1 ... ... 16 20 88 Table II. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from the 1st January, 1935, to the 31st December, 1935, otherwise than by formal notification . Age periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 26 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Cases Pulmonary Males ... ... 1 ... 2 3 9 1 4 1 1 25 ,, Females ... ... ... ... 2 2 5 10 1 1 1 3 25 Non-Pulmonary M ales ... ... 2 2 1 2 1 1 ... ... ... 9 ,, ,, Females 1 2 4 1 ... 2 3 3 1 2 ... 19 The source or sources from which information as to the above mentioned cases was obtained are shown below:— Source of Information. No. of Cases. Pulmonary. NonPulmonary. Death Returns from local Registrars 13 11 Transferable Deaths from Registrar General 3 1 "Transfers" from other areas (other than transferable deaths) 30 13 Posthumous notifications 1 1 Other Sources —Form I. and II. 3 2 Notification Register. Number of cases of Tuberculosis remaining on the Notification register on the 31st December, 1935:— Table III. PULMONARY non-pulmonary Total Cases Males Females Total Males Females Total 591 488 1,079 119 144 263 1342 89 Number of cases removed from the Registers during the year and the reasons for such removal. Pulmonary. Non-Pulmonary. Total Cases. Males. Females. Total. Males. Females. Total. 1. Withdrawal of Notification 5 6 11 5 3 8 19 2. Recovery from the Disease 14 15 29 21 13 34 63 3. Death 86 62 148 8 15 23 171 Interval Between Notification and Death From Pulmonary Tuberculosis in Cases Dying in 1935. 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 148 deaths during 1935, 31 (20.9%) were either not notified at all or only notified within a month prior to death. In 1934, this figure was 32 or 22.2%. Of these, 17 were not notified during life; 2 of whom were cases of fulminating or complicated cases of Tuberculosis; and 8 cases were certified by the Coroner. Three others did not die in the Croydon area. In 27.0% notification preceded death by less than six months. Table IV. Not Notified Under 1 week 1-2 weeks 2 4 weekls 12 months 2 3 months 3-6 months 6 12 months 17 5 7 2 9 6 11 13 One Year Two Years Three Years Four Years Five Years Six Years Seven Years Eight years and over 20 19 13 1 10 4 1 10 90 For Non-Pulmonary Tuberculosis the proportion of non-notified fatal cases to the total deaths from this form of the disease was 56.5%. In other words, out of a total of 23 deaths,13 were not notified during life; only 2 of these 13 cases died at home, the cause of death being ascertained after a post-mortem examination. Of the total deaths from Tuberculosis of all forms, 30 or 17.5% were not notified prior to death, compared with 14.01% in 1934. 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. 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. Ages at Death from Pulmonary Tuberculosis. Table V. Year. 0—5 5—15 15—25 25—45 45—65 Over 65 Total 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 2s 69 40 5 144 1935 1 ... 37 67 33 10 148 91 The most fatal period is between 25 and 4.5 years; under 15, Pulmonary Tuberculosis is not a prominent cause of death. The age incidence and fatality of Pulmonary Tuberculosis are the great causes of the immense economic importance of this disease. In 1935 the death-rate from all forms of Tuberculosis was 0.71 per 1,000 population. „ ,, Pulmonary Tuberculosis 0.61 ,, ,, ,, Non-Pulmonary Tuberculosis 0.09 ,, Similar figures for 1934 were 0.65, 0.6 and 0.05. Deaths from Non-Pulmonary Tuberculosis. During 1935, 23 deaths were certified to be due to Non-Pulmonary Tuberculosis, compared with 13 in 1934; 22 in 1933; 22 in 1932; 19 in 1931; 21 in 1930; 29 in 1929; 39 in 1928; 38 in 1927; 39 in 1926: and 33 in 1925. The deaths were due to:— Males Females Total Tuberculous Meningitis 2 6 8 Tb. Peritonitis — 3 3 Tb. Kidneys, Bladder and Spine — 2 2 Tb. Intestines — 2 2 Tb. Spine 2 — 2 Miliary and General Tb. - 2 2 Tb. Kidney 2 1 3 Tb. Epididymo-orchitis 1 — 1 7 16 23 92 Table VI. TUBERCULOSIS. (Summary of Notifications and Deaths at various age periods). Age periods. 1935 Population at age period, (est mated) Pulmonary, Non-Pulmonary. New Cases. All Cases. New Cases. All Cases. Number. Incidence Rate. Deaths. Death Kate (based on 1935 figures). Number. Incidence Kate. Deaths. Death Kate (based on 1935 est. figs.) M F M F M F M F M F M F M F M F M F Under one year 2145 1969 1 ... 0.47 ... 1 ... 0.47 ... ... 1 ... 0.51 ... 1 ... 0.51 1—5 years 6944 7309 ... 1 ... 0.14 ... ... ... ... 3 3 0.43 0.41 ... 3 ... 0.41 6—10 „ 11347 10440 2 ... 0.18 ... ... ... ... ... 6 6 0.53 0.57 2 2 0 18 0.19 10—15 „ 12008 11428 3 2 0.25 0.18 ... ... ... ... 6 1 0.49 0.09 ... ... ... ... 15—20 „ 9878 10657 10 11 1.01 1.03 7 5 0.71 0.47 4 1 0.40 0.09 1 1 0.10 0.09 20—25 ,, 7666 9920 19 27 2.48 2.72 12 13 1.57 1.31 3 4 0.39 0.40 ... ... ... ... 25-35 „ 15675 20634 40 38 2.55 1.84 18 21 1.15 l.02 2 7 0.13 0.34 ... 3 ... 0.15 35—45 ,, 17461 21271 31 21 1.78 0.99 17 11 0.97 0.52 2 8 0.11 0.38 1 ... 0.06 ... 45-55 13942 16002 29 8 2.08 0 50 16 2 1.15 0.12 1 2 0.07 0.12 1 3 0.07 0.19 55—65 ,, 8316 10150 12 5 1.44 0.49 12 3 1.44 0.30 1 2 0.12 0.19 ... 2 ... 0.20 65 and upwards 6355 10583 3 6 0.47 0.57 5 5 0.79 0.47 1 ... 0.16 ... 2 1 0.31 0 09 Totals 111737 130363 150 119 1.34 0.91 88 60 0.79 0.46 29 35 0.26 0.27 7 16 0.06 0.12 In the above table the death rate is based upon the total deaths in 1935 and not 011 deaths in New Cases only. 93 Pulmonary Tuberculosis. In 1935 there were more deaths from Pulmonary Tuberculosis up to the 35th year of life than in 1934. The age group 20—25 years had the greatest number of deaths, greater in fact than in any other age group. From the 25th year onwards there was a gradual fall in the number of deaths, but there were 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 20—25 age group. After the 35th 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 1935 in the age groups 15 to 35 years was the same as in 1934, but whereas in 1934 the greater proportion occurred in the 15—25 years group, in 1935 the greater proportion was in the 25—35 group. The greater proportion of new cases of notified 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. This year the greater proportion of new cases of NonPulmonary Tuberculosis occurred in adults, 59.3% in adults and 40.6% in children up to 15 years. Of the cases occurring in children, 57.6% were in boys, whereas in adults the greater proportion of the cases were in women—63.1%. 34.7% of the deaths occurred under the age of 10 years compared with 38.4% in 1934. 94 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 the total population of 242,100. The death rate for the whole Borough was 0.71. Table VII. Ward. Pensity of Population persons per acre. ary Non-Pulmonary Total Incidence Rate per 1000 Death Rate per 1000 Upper Norwood 20 21 6 27 1.2 0.41 Norbury 29 24 5 29 1.7 0.49 West Thornton 42 18 8 26 1.3 0.59 Bensham Minor 50 20 2 22 1.4 0.68 Thornton Heath 51 16 6 22 1.4 0.95 South Norwood 29 22 9 31 1.7 1.12 Woodside 37 20 5 25 1.6 0.76 East 10 24 3 27 1.5 0.27 Addiscombe 49 16 2 18 1.2 0.82 Whitehorse Manor 63 17 3 20 1.2 0.59 Broad Green 69 21 3 24 1.5 1.13 Central 33 9 3 12 1.0 0.81 Waddon 22 24 3 27 1.2 1.13 South 13 12 4 16 1.1 0.13 Addington 1 3 1 4 1.4 0.34 No fixed abode ... 2 1 3 ... ... 269 64 333 1.38 0.71 The Wards showing the highest incidence of new patients in 1935 were: Norbury and South Norwood (1.7). The highest death-rates were in Broad Green (1.16), Waddon (1.13), and South Norwood (1.12). With the relatively small figures available, these rates are subject to wide annual variations. 95 Table VIII. The diagnoses of the new cases entered in Notification Register during 1935 were as follows:— Male. Female. Spine 4 4 Knee — 1 Rt. Shoulder Joint 1 — Foot 1 1 Abdomen 8 6 Uterus — 1 Salpingitis — 1 Testicle 1 — Meninges 2 6 Kidney and Urinary Tract 5 5 Miliary - 2 Lupus 1 1 Glands 6 7 29 35 CLASSIFICATION OF NEW PATIENTS. Pulmonary Tuberculosis. During 1935, 194 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 33.0% T.B. plus 1 (early cases, sputum positive) 9 or 4.6% T.B. plus 2 (intermediate cases, sputum positive) 76 or 39.2% T.B. plus 3 (advanced cases, sputum positive) 45 or 23.2% 194 or 100.0% It is well known that Tuberculosis officers do not see many of the new cases in the early stages of the disease. 1935 was worse in this respect than 1934 ; only 37.6% of the cases were first seen at a stage when a definite arrest of the disease could reasonably be hoped for. 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 without careful physical and X-ray 96 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 62.4% of the new cases were more or less advanced in the disease. Non-Pulmonary Tuberculosis. There were '23 cases examined at the Clinic and found to have Non-Pulmonary Tuberculosis in the following forms:— Bones and Joints 8 Abdominal 2 Other Organs 8 Peripheral Glands 5 23 Tables XVII. and XVIII. summarise the condition of all patients whose records are at the Clinic at the end of 1935. These tables show that of patients who came under treatment for Pulmonary Tuberculosis before 1926, 394 adults and 107 children have been discharged as recovered. Of these all but 16 were early cases. Of the 1926 cases, 23 adults, of the 1927 cases, 24 adults and 2 children, of the 1928 cases, 25 adults, and of the 1929 cases, 6 adults and 3 children have recovered. Of patients who first attended in 1935, 6 have been lost sight of or otherwise removed from the Clinic Register. Of the 1934 cases 42 were lost sight of. Of patients who attended prior to 1926, 258 adults and 14 children are known to have died; since 1926, 901 adults and 18 children are known to have died. Of patients attending for the first time in 1935, 33 have died. It will be seen that in the years 1926 to 1935 there have only been 55 cases of Pulmonary Tuberculosis in children—16 of these had a positive sputum, and of the latter only 3 are alive. It is fortunate that such cases are very rare as remarkably few ever recover. 97 In sufferers from Non-Pulmonary Tuberculosis who first attended prior to 1926, 45 adults and 565 children have been discharged as recovered, and of those first attending in 1926 and following years, 37 adults and 143 children. 14 adults and 9 children died in the pre-1926 class; 33 adults and 18 children died in the 1926 and following years group. 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 208 cases of suspected Tuberculosis were referred by private medical practitioners; 67 were diagnosed as suffering from Tuberculosis and were subsequently notified. In addition, 45 children were referred by the School Medical Service, and 33 cases from the Maternity and Child Welfare section of the Public Health Department. 83.9% of all notified cases were sent lor examination to the Clinic or were seen at the request of the medical attendant at the patient's home, as compared with 84.2% in 1934, and 79.3% in 1933. The number of reports sent in by Insurance medical practitioners on their domiciliary cases (Form G.P. 36) was 527. This is a duty laid on all Medical men accepting service under the National Health Insurance Act. Pregnancy and Tuberculosis. Women suffering from Pulmonary Tuberculosis who become pregnant are referred to the Assistant Medical Officer of Health for Obstetrics and usually recommended for admission to Mayday Hospital under his care. After their confinement these patients are advised to enter a sanatorium. 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 Hospital for confinement. The Clinic Register of Cases. The number of cases of Tuberculosis under the supervision of the Clinic at the end of the year was 864. This is equivalent to 3.57 persons per 1,000 of the population. 98 The Clinic Register is revised annually, so as to make it a correct record of the cases in the Borough who are under the supervision of the clinic. By this yearly revision the Register is kept a "live" one. During the year 124 Clinic cases died; of this number, 33 or 26.6% were seen for the first time in 1935. 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 1935 are as follows:— For Clinic For General Practitioners. For Mayday Hospital. Totals. Positive (i.e., tubercle bacilli present) 327 110 262 699 Negative (i.e., tubercle bacilli absent) 454 573 301 1,328 Total 781 683 563 2,027 For each 100 new cases and contacts examined at the Clinic 95 specimens of sputum were examined. 1935, however, shows a decrease 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 99 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 Bronchiectasis, 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. 369 X-ray examinations were made during the year, an increase of 38 over 1934. This is equivalent to 45.2 for every 100 new cases and contacts seen, and compares with a rate of 40.4 for every 100 new cases and contacts seen in 1934, and 30.4 for every 100 new cases and contacts seen in 1933. 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 in the above figures Extra Nourishment. Provision of special nourishment in the form of milk was granted to a number of selected cases for varying periods. 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, lot fluently one finds there is no available space for a shelter in the garden or yard attached to the patient's house. When convenient to be used they form a useful continuation of Sanatorium practice for a conscientious patient. 100 INSTITUTIONAL TREATMENT. Table IX. Cases of Pulmonary Tuberculosis Treated in Institutions, 1935. In at beginning of 1935 Admitted during 1935 Discharged during 1935 Died during 1935 In at ti of 1935 Adults Adults Adults | Adults Adults M F C M F C M F C M F C M F C Croy. Boro' San., Cheam 44 29 ... 84 77 ... 72 62 ... 7 8 ... 49 36 ... Mayday Hospital 12 9 1 50 49 7 20 34 4 27 15 1 15 9 3 Grosvenor 1 3 ... 1 ... ... 1 3 ... ... ... ... 1 ... ... Burrow Hill Colony ... ... 1 ... ... 1 ... ... 1 ... ... ... ... ... 1 Brompton 7 4 ... 5 8 1 10 9 1 1 1 ... 1 2 ... Papworth 1 ... ... 1 ... ... 1 ... ... ... ... ... 1 ... ... East Anglian San. ... ... 2 ... ... ... ... ... 2 ... ... ... ... ... ... R.N.H.C., Ventnor ... 1 ... 1 ... ... ... 1 ... ... ... ... 1 ... ... National Temperance Hospital ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... Royal National San. Bournemouth ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... Midhurst ... 1 ... 1 1 ... ... 2 ... ... ... ... 1 ... ... Eversfield Chest Hospital ... ... ... 2 ... ... ... ... ... ... ... ... 1 ... ... Preston Hall Colony ... ... ... 2 ... ... ... ... ... ... ... ... 2 ... ... National Children's San. Harpenden ... ... ... ... ... 2 ... ... 1 ... ... ... ... ... 1 65 47 4 148 136 11 106 111 9 35 24 1 72 48 3 This Table shows that, compared with last year, tour more patients were admitted during the year and nine more cases remained in institutions at the end of the year. 101 Table X Cases of Non-Pulmonary Tuberculosis Treated in Institutions, 1935. In on 1st Jan., 1935 Admitted during 1935 Discharged during 1935 Died during 1935 In on 31st Dec., 1935 Adults Adults Adults Adults Adults M F C M F C M F C M F C M F C Kayday Hospital 1 5 1 4 3 1 1 6 1 1 1 ... 3 1 1 Royal Sea Bathing Hosp. 5 4 1 4 5 2 5 2 2 ... ... ... 4 7 1 All Saints' Hosp. ... ... ... 1 1 ... ... ... ... ... ... ... 1 1 ... St. Nicholas Hosp. ... ... 2 ... ... 3 ... ... 3 ... ... ... ... ... 2 Tait Convalescent Home ... 3 ... ... 1 ... ... 4 ... ... ... ... ... ... ... Treloar Cripples' Hosp ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 King George's San. 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Caydon General Hosp ... ... ... 1 1 1 1 ... 1 ... ... ... ... 1 ... Pyford ... ... 9 ... ... 4 ... ... 1 ... ... ... ... ... 12 Heatherwood Hospital ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... Heritage Craft School ... ... 2 ... ... ... ... ... 1 ... ... ... ... ... 1 Royal National Orthopaedic Hospital ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Mead Cripples' Col. ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 7 13 17 10 11 12 8 13 11 1 1 ... 8 10 18 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 26.1% were classified as early cases; the Percentage of early cases receiving treatment in institutions was in women, 13.5%; in men, 10.3%; 41.1% of the total cases were intermediate cases, the males showing an excess in this group-23.8% males to 17.2% females—and 32.7% were definitely advanced. Of the total Pulmonary cases treated in Institutions 77.5% were potentially infectious. 109 males, 99 females and 6 children, suffering from Pulmonary Tuberculosis, were discharged from or died in Institutions in connection with the Croydon Scheme during 1935. 102 Types of Cases Treated. In Class T.B. Minus, 10 males, 11 females, and 3 children were discharged with the disease in a quiescent condition, i.e., 50% of the total cases in this class; 4 males, 13 females and 1 child were not in a quiescent condition, 37.5%; 4 males, 1 female and 1 child died, 12.5%. In Class T.B. Plus, Group I., the corresponding figures were 2 males and 2 females quiescent, 50%; 2 males and 2 females were not qniescent, 50%; there were no deaths in this group. In Class T.B. Plus, Group II., 11 males and 11 females quiescent, 25%; 37 males and 22 females not quiescent, 67%; and 3 males and 4 females died, 7.9%. In Class T.B. Pius, Group III., or advanced group, 1 female was discharged quiescent; 21 males, 10 females and 1 child not qniescent, 54.2%; and 15 males and 16 females died, 44.2%. Taking all groups together, 23.8% of cases were discharged as qniescent; 55.6% as not qniescent; and 20.5% died. A slight increase is recorded in the percentage of infectious 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. Non-Pulmonary Tuberculosis.—25 patients were discharged during the year, and 68% of these were quiescent. 2 adults died, 8%. Tuberculosis deaths in Cheam Sanatorium and Mayday Hospital during 1935 according to sex and stage of the disease:— Classification. CHEAM. MAYDAY. Males. Females. Males. Females. Child. T.B. minus 2 — 2 1 1 T.B. plus 1 — — — — T.B. plus 2 2 3 1 1 — T.B. plus 3 3 5 23 13 Total 7 8 26 15 1 103 The Tuberculosis Officer paid 47 visits to Mayday Hospital, in a consultative capacity, and there examined 145 patients. Although considerable advances have been made, more particularly in the surgical treatment of Pulmonary Tuberculosis, during the past ten years, a comparison of the death rate of pa-tients undergoing treatment now and ten years ago does not show any great advantage. Surgical methods undoubtedly help a certain proportion of cases to recover sufficiently to leave Sanatoria and possibly to commence work ; but the selection of cases likely to befit permanently is a matter of high skill and experience. Unwise choice of patients for surgical treatment may hasten the onset of a fatal issue. The long period of unproductiveness of the Tuberculosis patient undergoing treatment and, in the majority of cases, his impaired market value, even at the end of successful treatment, cast a great strain on his financial resources. This has been inadequately recognised in the various National Health Insurance Acts and Regulations, which are too inflexible to meet the full needs of these unfortunate people. The Tuberculosis Clinic and Home Visiting. The subjoined table gives a summary of the work done in connection with the Clinic. 472 new cases were examined during the year; this is equal to 276 for each 100 deaths from the disease. 206, or 120 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 343 contacts were examined, equal to 200 for each 100 deaths, compared with 323 in 1934, or '205 per 100 deaths. Of these, 8 were considered to be Tuberculous. This is equal to a Tuberculosis rate per 1,000 contacts of 23.3, compared with 1.38 per 1,000 of the general population. In 192 adult contacts examined the Tuberculosis rate per 1000 contacts was 36.4. Included in the 8 contacts found to be Tuberculous are 4 who had been under observation from previous years. The total number of attendances at the Clinic was 5,026. The Tuberculosis Officer paid 195 home visits, and the District Health 104 Visitors 3,182 visits for Clinic purposes. In addition, the Health Visitors made 280 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, In arrangement with that organisation, and 582 such visits were made during the year. Contact Examination. Contacts are those persons who are living with, or have been in prolonged and intimate association with a case of Tuberculosis The object of the examination is two-fold. Firstly, to ascertain if the contact has become infected and. secondly, to discover if the origin of the disease in the patient may be found in his associates. Not very infrequently a member of a family who has been thought for years to have been suffering from Bronchitis, is in reality suffering from Tuberculosis, and through the lack of proper precautions has infected one or more individuals around him. 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. 617 appointments for examination were offered to new contacts during 1935, but only 343 new contacts attended and were examined. The importance of contact examination as a tme preventive measure is not appreciated by the public. In this matter the family practitioner could be of much assistance. SUMMARY OF CLINIC STATISTICS FOR 1935. No. of persons on Clinic Register, January 1st, 1935 924 ,, Notified Cases examined for the first time 79 ,, Cases sent for an opinion 314 ,, First attendances, including 38 transfers in 853 ,, Consulations of T.O. with private practitioners 32 ,, Visits paid by T.O. to homes of patients 195 „ Visits paid by T.O. to Cheam Sanatorium 10 „ Visits paid by T.O. to Mayday Hospital 47 ,, Patients examined bv T.O. at Mayday Hospital 145 „ Visits paid to homes of patients by Health Visitors and Nurses 4,044 ,, Attendances of patients at the Clinic— Men 1,734 Women 2,225 Children 1,067 Total 5,026 105 No of patients under Domiciliary Treatment at end of year— Pulmonary 175 Non-Pulmonary 8 Total 183 No. of reports received from Panel Practitioners (G.P.36) 527 ,, Report forms sent to Panel Practitioners (G.P.36) 715 ,, Report received from Panel Practitioners on Forms G.P.17 and 35 2 ,, X-rays taken 369 ,, Reports made to Ministry of Pensions by the T.O. on general progress of Tuberculosis Discharged Ex-Service men 10 ,, Cases referred for "Light" Treatment 3 ,, Cases referred to Orthopaedic Clinic 17 „ Cases receiving extra nourishment at end of year 43 Housing Statistics of Patients. Table XI. Patients occupying a separate bedroom. Patients occupying a separate bed but not a separate bedroom. Patients not occupying a separate bed. Totals. Number of Pulmonary cases: Under 15 years 18 4 2 24 15 years and over 469 90 352 911 487 94 354 935 Number of Non-Pulmonary cases: Under 15 years 36 26 18 80 15 years and over 47 18 42 107 83 44 60 187 Totals 570 138 414 1,122 The above table gives a summary of the housing conditions found in notified cases. It is seen that 52.1% of the Pulmonary cases and 44.4% of the Non-Pulmonary cases were occupying a separate bedroom. In 37.8% of the Pulmonary and 32.1% of the Non-Pulmonary the sleeping arrangements were not satisfactory inasmuch as the patient did not have a separate bed. 106 Council Houses for Tuberculous Families. A new scheme has been initiated in the past year for the above purpose. It is a very important part of any Care scheme as a means of maintaining health and preventing the occurrence of Tuberculosis. The tenancy of Council houses to Tuberculous families is subject to co-operation on the part of the latter, but the system of supervision applied does not involve any undesirable restrictions on those who are well intentioned. Up to the end of the year 4 families had been rehoused under the scheme. 107 PULMONARY TUBERCULOSIS Table XII. Shewing the Condition at the end of 1935 of cases discharged from Sanatoria during the years indicated. 1931. 1932. 1933. 1934. 1935. 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 4 76=58.9% 2 66=55.0% 2 38= 44.7% 2 39=37.5% 14=14.7% 10 233= 43.7% 51.6% 45.3% 33.1% 31.3% 10.7°/o 35.3% Working or Fit for Work 20 32=24.8% 25 33= 27.5% 29 28= 32.9% 21 31=29.8% 29 51 =53.7% 124 175 = 32.8% 33.5% 38.6% 47.1% 39.7% 61.% 43.4% Not able to Work 2 21 = 16.3% 3 21 = 17.5% 5 19=22.3% 4 34=32.7% 7 30=31.6% 21 125=23.4% 14.8% 16.0% 19.8% 29.0% 28.3% 21.2% Left District 12 17 10 37 12 22 7 15 4 13 45 94 38 146 40 147 48 107 34 119 40 108 200 627 108 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 43.4% 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 32.8%, or almost one third, are working or fit for work. 627, or 75.8% of the total cases discharged, were T.B. + cases; 139, or 16.8% of the total cases discharged, have removed from the Borough, and as we have no information about their condition at the end of 1935, they have been ignored in working out the above percentages. Tuberculosis Care Committee Report. During the year 1935 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 and unfamilar 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. The matter of insurance premiums is particularly difficult. Patients may have paid for many years but owing to lengthy periods of Sanatorium treatment, benefits and membership may lapse and the patients on being pronounced fit for work are unable to join any society owing to the nature of their disability. 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. The Care Committee's work is becoming better known, as is evidenced by the steady year by year increase in the number of patients coming for advice. 1,025 interviews involving advice and assistance took place during the year, and 93 families were helped financially. Financial inquiries numbered over 176, and £304 9s. 2d. was disbursed. 109 CHEAM SANATORIUM. The Sanatorium is situated in North Cheam and has accommodation for 93 adult patients of both sexes. The beds are allocated us follows: Men, 53; Women, 40. Authority. In-patients on Jan. lst 1935 Admitted during year 1935. Discharged during year 1935 including deaths In on jan. 1st 1930. Died during year 1935 M F M F M F M F M F Croydon C. B. 44 29 8.1 79 80 72 49 36 7 8 No. of Artificial Pneumothorax cases begun 23 No. of Refills given 980 No. of X-Ray Screenings 1,173 No. of Films taken 285 No. of Sputum tests 851 No. of Gas Replacements 30 Immediate Results of Treatment. Group Total num ber of cases discharged 1935. Quiescent Improved No 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 22 6 6 1 6 ... ... 1 ... 113 3 10 Class T.B. Plus. Group I 6 3 1 1 3 1 ... ... ... ... 94 2 1 ,, ,, ,, Group II 23 12 1 1 16 6 1 1 1 205 4 4 " ,, ,, Group III 25 22 ... ... 10 5 8 5 5 8 204 2 4 Observation Non T.B. 3 1 ... ... ... ... ... ... ... ... ... ... 68 60 8 8 30 18 9 6 7 8 11 19 At the beginning of 1935 there were 73 patients in Cheam. During the year 164 were admitted and 137 discharged, whilst 15 thus leaving 85 patients in at the beginning of 1936. 110 There were 6 observation cases sent in: 3 males and 3 females. Of the 3 males 3 were not tubercular, and of the 3 females 1 was not tubercular; therefore, there were 4 observations in nontuberculars which are shown above. The 2 that were tubercular are in with the tubercular cases and are not shown as observation. Artificial Pneumothorax cases discharged but still under treatment, 12 males, 12 females (see above), making total discharges: males 80, females 72. These 24 Artificial Pneumothorax cases only refer to cases discharged in 1935; those discharged in 1934 and still having refills have not been included. DENTAL REPORT. All the patients admitted to the Sanatorium were dentally inspected. Those in the acute wards were treated only when in pain, but patients in the ordinary wards were referred for all necessary treatment. Only those in the acute stages of Tuberculosis were treated in the wards; the other patients attended the special dental surgery in the Sanatorium. Patients were treated only if, in the opinion of the Resident Medical Superintendent, they were sufficiently fit. As the patients to be treated are not, on the whole, very fit, the amount of work undertaken for each patient was made dependent on the patient's general condition. The number of teeth extracted at each visit was never more than three, and in very septic conditions only one tooth was removed at a time. All extractions, and also many cases of conservative treatment, were done under local anaesthesia. The aim of the scheme is to render as many patients as possible dentally fit before they leave the Sanatorium. The patient's period of stay in the Sanatorium is an ideal time for dental treatment, because there is ample opportunity for rest before and after treatment. A good set of teeth is also of importance in the treatment of Pulmonary Tuberculosis, which, especially in the more advanced stages, is largely a matter of rest and digestion. 111 Review of Work Done. 1935. 1934. Males. Females. Total. Males. Females. Total. Number Examined 58 59 117 40 39 79 Referred for Treatment 41 44 85 40 37 77 Treated 41 44 85 40 37 77 Attendances 246 219 465 218 190 408 Extractions 143 196 339 181 139 320 Fillings 73 67 140 45 45 90 Dressings 25 15 40 34 28 62 Scalings and Gum Treatments 42 33 75 33 36 69 Denture Dressings 31 19 50 37 20 57 Dentures Fitted 8 5 13 11 7 18 Sessions : 42. X-ray Cases: 4. The report of the work done is satisfactory. More patients were examined and more were treated. Attendances showed a noticeable increase, and the number of fillings rose from 90 in 1934 to 140 in 1935. The slight increase in extractions is to be expected, because more were referred for treatment. It was gratifying that most of the patients took advantage of the opportunity to attend the dental treatment centre for attention. Treatment of Tubercular Patients at Lodge Road Clinic. These patients are treated at Lodge Road Treatment Centre on Wednesday afternoons from 4 to 5 p.m. The clinics are thoroughly disinfected after each session. Most of the patients treated are referred by the Tuberculosis Officer, but some are patients discharged from Cheam Sanatorium before the treatment was completed. Review of Work Done. 1935. Males. Females. Total. Referred from Dispensary 7 32 39 Treatment continued from Cheam 7 7 14 Attendances 69 138 207 Extractions 30 105 135 Fillings 5 7 12 Dressings 1 5 6 Scalings 1 10 11 Denture Dressings 39 82 121 Dentures Fitted 19 29 48 112 It is unfortunate that many of the patients referred require extraction of teeth. A large number have had very little treatment, if any, for many years, and consequently their teeth are beyond conservative measures. In these circumstances it is better for the patients to have all septic teeth removed, and dentures fitted, so that they are able to masticate efficiently. Two Tubercular patients were treated in Mayday Hospital and three were referred for dental radiograph. The amount of dental treatment for each patient is decided by the Tuberculosis Officer's report on the patient's general condition. It is, of course, useless to undertake extensive treatment for a patient when the prognosis of the case is poor, and treatment for this type of patient must be limited to relief of pain. The amount taken in attendance fees was £2 8s. 8d. 113 Annual Returns made to the Ministry of Health for the Year 1935. Table XIII. (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 101 77 6 — 4 10 7 1 105 87 13 1 206 (b) Diagnosis not completed — — — — — — — — 5 7 6 4 22 (c) Non-tuberculous — — — — — — — — 60 93 50 41 244 B.-Contacts examined during year:— (a) Definitely tuberculous 1 6 — 1 — — — — 1 6 — 1 8 (b) Diagnosis not completed — — — — — — — — — 4 — — 4 (c) Non-tuberculous — — — — — — — — 74 107 77 73 331 C.—Cases written off the Dispensary Register as:— (a) Recovered 12 12 3 1 6 7 12 7 18 19 15 8 60 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 136 211 132 118 597 D.-Number of Cases on Dispensary Register on December 31st:- (a) Definitely tuberculous... 384 300 16 19 29 50 37 29 413 350 53 48 864 (b) Diagnosis not completed — — — — — — — — 5 11 6 4 26 1. Number of cases on Dispensary Register on January 1st 924 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 55 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 123 4. Cases written off during the year as Dead (all causes) 124 5. Number of attendances at the Dispensary (including Contacts) 5 026 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 183 7. Number of consultations with medical practitioners:— 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 195 (a) Personal 32 (b) Other 537 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3,764 10. Number of:— (a) Specimens of sputum, etc., examined 781 (ft) X-ray examinations made in connection with Dispensary work 369 11. Number of "Recovered" cases restored to Dispensary Register, above 1 12. Number of "T.B. plus" cases on Dispensary Register on 31st December 455 114 (8) Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment) Provided by the Council One Provided by Voluntary Bodies Nil 4Table XIV. (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 (In C.B. of Croydon) Beds reserved for Tuberculosi s cases are used for Pulmonary or Non-Pulmonary patients, as Vequired. 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 — 9 7 1 1 Adult females — 12 11 — 1 Children — 5 3 — 2 Total — 26 21 1 4 Number of patients suffering from pulmonary tuberculosis: Adult males 65 142 103 33 71 Adult females 47 131 106 24 48 Children 4 8 8 1 3 Total 116 281 217 58 122 Number of patients suffering from non-pulmonary tuber- Adult males 7 10 8 1 8 Adult females 13 10 13 1 9 Children 17 12 11 — 18 Total 37 32 32 2 35 Grand Total 153 339 270 61 161 115 Table XV. (F) 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 6 1 1 — 1 — — — — — 3 6 2 Non-tuberculous 1 1 1 4 4 — — — — — — — 5 5 1 Doubtful — — — — — — — — — — — — — — — Totals 3 7 2 5 4 1 — — — — — — 8 11 3 One man died in institution while under observation, the cause of death being certified as: Carcinoma of Lung. P.M. Table XVI. (G) Return showing the Immediate results of treatment of definitely tuberculous patients discharged during the year from Institutions approved for the treatment of Tuberculosis. SECTION I.—Pulmonary Tuberculosis. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Grand Totals Under 3 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 — 4 2 1 1 8 2 2 — — 10 11 3 24 Not quiescent 2 7 — 1 3 — 1 3 — — — 1 4 13 1 18 Died in Institution 3 1 1 — — — — — — 1 — — 4 1 1 6 Class T.B. plus Group I. Quiescent — — — — 1 — 1 1 — 1 — — 2 2 — 4 Not quiescent — 1 — 1 — — — 1 — 1 — — 2 2 — 4 Died in Institution — — — — — — — — — — — — — — — — Class T.B. plus Group II, Quiescent — 2 — 2 1 — 6 6 — 3 2 — 11 11 — 22 Not quiescent 8 7 — 8 7 — 10 5 — 11 3 — 37 22 — 59 Died in Institution — — — 1 1 — — 2 — 2 1 — 3 4 — 7 Class T.B. plus Group III Quiescent — — — — — — — — — — — — — 1 — 1 Not quiescent 9 6 1 4 8 — 4 2 — 4 — 21 16 1 38 Died in Institution 6 5 — 4 6 — 4 1 — 1 4 — 15 16 — 31 Total (pulmonary) 31 30 2 25 29 1 27 30 2 26 10 1 109 99 6 214 116 SECTION II.—Non-Pulmonary Tuberculosis. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Under 3m'ths but exceeding 28 days 3-6 months. 6-12 months. More than 12 months. Totals. Grand Total M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Bones and Joints. Quiescent — — — 1 1 — 1 1 — 3 1 2 5 3 2 1 Not quiescent — 1 — — — — — 2 — — — 1 — 3 1 — Died in Institution — — — — — — — — — 1 — — 1 — — 1 Abdominal. Quiescent — — — — — 1 — — — — — 1 — — 2 2 Not quiescent — — 1 — — — — — — — — — — — 1 1 Died in Institution — — — — — — — — — — — — — — — — Other Organs. Quiescent — — — — — — — 1 — — — — — 1 — — Not quiescent — — — — — — — — — — — — — — — — Died in Institution — — — — — — — — — — 1 — — 1 — — Peripheral glands. Quiescent — — 1 — — — — 1 — — — 2 — 1 3 4 Not quiescent — — — — — — — 1 — — — — — 1 — 1 Died in Institution — — — — — — — — — — — — — — — — Totals (non-pulmonary) — 1 2 1 1 1 1 6 — 4 2 6 6 10 9 25 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. 1935. 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 | 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 (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) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B.plus) (a) Remaining on Dispensary Register on December 31st. Disease Arrested Adults M 4 6 4 1 11 1 1 2 — 3 1 2 — — 2 — 4 1 — 5 5 3 3 — 6 13 4 3 — 7 9 1 6 2 9 7 1 3 — 4 1 — 1 — 1 — — — — — — — — — — F 4 4 6 — 10 1 — 1 — 1 1 — 1 — 1 4 — — — — 4 1 1 — 2 11 — 3 — 3 10 — 3 _ 3 9 ;— 1 — 1 4 1 — — 1 — — — — — — — — — — Children 1 — — — — — — — — — — — — — — 2 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Disease not Arrested Adults M — 8 7 1 16 — 1 1 — 2 — 4 — — 4 1 2 7 — 9 1 2 6 1 9 — 2 9 — 11 2 3 13 1 17 5 5 24 2 31 9 9 22 1 32 14 6 20 2 34 25 6 37 13 56 F 3 6 5 — 11 — 1 — 1 — 1 3 1 5 — — 2 1 3 — — 6 — 6 1 1 6 1 8 3 — 14 — 14 7 2 12 4 18 15 2 19 3 24 18 2 14 1 17 23 3 28 8 39 Children — — 1 — 1 — — — — — — — — — — — — — — — 1 — — — — 2 — — — — — — — — — 1 — — — — 1 — — — — 3 1 1 — 2 5 — — 1 1 Condition not ascertained during the year — — 2 — 2 — — — — — — 1 2 — 3 — — — — — 2 — 3 — 3 1 — 1 — 1 2 — 2 — 2 — — 1 — 1 3 — — — . — 4 — 2 — 2 — — — — — Total on Dispensary Register at 31st December 12 24 25 2 51 2 2 5 — 7 2 8 6 1 15 7 6 10 1 17 14 6 19 1 26 32 7 22 1 30 31 4 28 3 45 32 8 41 6 55 34 12 42 4 58 39 9 43 3 55 59 9 65 22 96 (b) Not now on Dispensary Register and reasons for removal therefrom. Adults Discharged as Recovered M 179 24 6 1 31 7 7 1 — 8 9 6 — — 6 3 — 2 — 2 2 — — — — 3 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — F 162 13 6 3 22 7 1 — — 1 7 2 — — 2 17 2 1 — 3 4 — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children 106 1 — — 1 — — — — — 2 — — — — — — — — — 3 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 217 43 49 9 101 31 18 30 7 55 19 20 18 1 39 34 15 17 — 32 36 8 28 — 36 29 14 25 8 57 31 5 37 6 48 26 4 29 2 35 19 3 22 1 26 18 2 19 3 24 1 — 4 1 5 Dead Adults - M 20 31 51 51 133 4 25 27 12 64 2 11 34 8 53 1 5 31 8 44 3 4 41 16 61 7 — 38 11 49 5 2 28 31 61 2 3 31 20 54 5 — 16 16 32 3 — 12 19 31 3 — 4 12 16 F 17 5 25 58 88 10 15 21 14 50 2 3 22 15 40 4 2 32 8 42 3 3 31 9 43 5 2 26 11 39 4 1 26 23 50 8 2 26 8 36 1 2 15 10 27 3 1 0 14 21 — — 3 10 13 Children 3 1 4 6 11 — — 1 — 1 — — 2 2 4 1 — — — — 1 — 1 — 1 — — — 2 2 — — 1 — 1 1 1 — — 1 1 — — — — — — — 3 3 1 — — — — Total written off Dispensary Register 704 118 141 128 387 59 66 80 33 179 41 42 76 26 144 60 24 83 16 123 52 15 101 25 141 45 16 99 32 147 40 8 92 60 160 37 10 86 30 126 26 5 53 27 85 24 3 37 39 79 5 — 11 23 34 Grand Totals 716 142 166 130 438 61 68 85 33 186 43 50 82 27 159 67 30 93 17 140 66 21 120 26 167 77 23 121 33 177 71 12 130 63 205 69 18 127 36 181 60 17 95 31 143 63 12 80 42 134 64 9 76 45 130 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. 1935. 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 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 (a) Remaining on Dispensary Register on December 31st. Disease Arrested Adults M 1 — 1 — 2 1 — — — 1 — — 1 — 1 — — — — — — — 1 — 1 — 1 — — 1 2 — — — 2 2 1 — 1 4 — 1 — 1 2 2 1 — — 3 — — — F — — 3 1 4 — — — 1 1 1 — — — 1 — — — — — — — 2 1 3 — 1 — 1 2 1 — — — 1 3 1 1 — 5 — 1 — — 1 2 2 1 3 8 — — — Children 2 — — — 2 — — — 2 2 1 — — — 1 4 — — 1 5 3 2 — 2 7 4 — — 3 7 3 2 — 3 8 1 1 — 2 4 — — 1 1 2 — 1 — — 1 — - Disease not Arrested Adults M — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — — — — — — — — — — — — 2 — 2 2 — — — 2 — — 1 — 1 2 — 2 F 2 — — — 2 — — — — — — — — — — 1 — — — 1 — — 1 — 1 — — — — — 1 — — — 1 — — — — — 1 1 — — 2 3 — 1 1 5 3 — 6 Children 3 — — — 3 — — — — — 1 — — — 1 1 — — 1 2 1 — — — 1 1 — — — 1 2 — — 2 2 — — — 2 3 — — — 3 1 — — 1 2 3 2 — Condition not ascertained during the year — — 1 — 1 — — — — — — — — — — — — — — — — — — — — — — — 1 1 — — — — — 1 — 1 — 2 — — — — — — — — 1 1 — — — Total on Dispensary Register at 31st December 8 — 5 1 14 1 — — 3 4 3 — 1 — 4 6 — — 2 8 5 2 4 3 14 5 2 — 5 12 9 2 — 3 14 9 3 4 3 19 6 3 1 2 12 8 4 3 6 21 8 2 8 Transferred to Pulmonary 1 — — — 1 — — — — — — — — — — — — — — — — 1 — — 1 — 1 — — 1 — 1 — — 1 — — — — — 1 — — — 1 1 — — — 1 — — — (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M 8 — 4 2 14 3 — — — 3 2 1 — 1 4 1 — — — 1 — 1 — — 1 1 — 1 — 2 1 1 — — 2 — — — 1 1 — — — — — — — — — — — — — F 14 5 4 8 31 2 — — 4 6 2 1 — 3 6 — — — 3 3 1 — 2 1 4 — 1 — 1 2 1 — — 1 2 — — — — — — — — — — — — — — — — — — Children 41 4 5 515 565 7 3 2 53 65 3 1 — 33 37 3 — — 19 22 2 — 1 3 6 1 1 — 8 10 — — — 3 3 — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 20 11 11 133 175 4 6 4 26 40 6 3 3 20 32 5 1 — 6 12 4 — 3 3 10 8 — 2 5 15 3 2 2 2 9 4 1 — 3 8 4 2 1 4 11 3 — — 4 7 — — — Dead Adults M 3 1 3 1 8 2 — 1 1 4 2 — 1 — 3 3 1 1 — 5 1 — — — 1 — — — — — — — 1 — 1 4 — 1 — 5 — — — — — — — — — — — — — F 3 — 2 1 6 1 — — 1 2 — 1 — — 1 1 — 2 — 3 — 1 — — 1 1 — 1 — 2 — 2 — 2 — — — — — — 1 — — 1 1 — — 1 2 — — — Children 5 1 1 2 9 — 2 1 3 6 — — 1 — 1 2 2 1 2 7 — — — — — — 1 — — 1 — — — — — — — — — — — — 1 1 2 1 — — — 1 — — — Total written off Dispensary Register 94 22 30 662 808 19 11 8 88 126 15 7 5 57 84 15 4 4 30 53 8 2 6 7 23 11 3 4 14 32 5 5 3 6 19 8 1 1 4 14 4 3 2 5 14 5 — — 5 10 — — — Grand Totals of (a) and(6)(excluding those transferred to Pulmonary). 102 22 35 663 822 20 11 8 91 130 18 7 6 57 88 21 4 4 32 61 13 4 10 10 37 16 5 4 19 44 14 7 3 9 33 17 4 5 7 33 10 6 3 7 26 13 4 3 11 31 8 2 8 117 SECTION VI. CANCER. Deaths from Cancer numbered 321 as compared with 371 in 1934; 374 in 1933; 341 in 1932; 342 in 1931; 339 in 1930; 330 in 1929, 327 in 1928; 344 in 1927; 330 in 1926; and 319 in 1925. Death-rates per 1,000 of the population for the previous 10 years are as follows: — 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) 1929—1.48 (330) 1934—1.54 (371) (For 1935 the rate is 1.33 (321). Deaths From Cancer in Municipal Wards. Table I. Word. Male. Female. Total. Death-rate. Estimated Population. Mid 1935. Male. Female. Upper Norwood 5 13 18 0.80 10213 12364 Norbury 8 10 18 1.12 7305 8832 West Thornton 6 18 24 1.19 9488 10758 Bensham Manor 18 12 30 1.84 7587 8650 Thornton Heath 9 6 15 0.95 7516 8238 South Norwood 16 17 33 1.85 8150 9724 Woodside 9 11 20 1.27 7499 8295 East 14 17 31 1.70 8000 10136 Addiscombe 5 10 15 1.03 6749 7838 Whitehorse Mnr 8 12 20 1.18 8067 8836 Broad Green 10 11 21 1.35 7370 8138 Central 6 6 12 0.97 5482 6836 Waddon 13 16 29 1.31 10482 11551 South 10 18 28 1.86 6390 8645 Addington 3 2 4 1.38 1439 1462 No fixed abode, etc. 2 1 3 - - - Total 141 180 321 1.33 111737 130363 113 Table II. Deaths from Cancer occurred at the following ages:— Age period. Male. Female. Total. Calculated population at this age period. Incidence per 1000 persons living. Under 25 years 4 — 4 101709 .039 25 and under 35 years — 2 2 36309 .055 35 and under 45 years 3 16 19 38733 .491 45 and under 65 years 62 72 134 48411 2.768 65 years and over 72 90 162 16938 9.564 141 180 321 242100 1.336 Table III. Sites of Fatal Cancer. Site. Male. Female. Total. Percentage of Total. Brain 1 1 2 .62 Skin i 2 3 .93 Tongue and Mouth 9 1 10 3.12 Lip 3 — 3 .93 Oesophagus 8 2 10 3.12 Stomach 25 29 54 16.82 Liver 3 5 8 249 Bowel 13 24 37 11.53 Rectum 18 7 25 7.79 Bladder 7 1 8 2.49 Prostate 6 6 1.87 Larynx 2 1 3 .93 U teru's — 24 24 748 Breast — 4o 45 14.02 Ovary — 8 8 2.49 Pancreas 4 8 12 8.74 Gall Bladder and Du 1 3 4 1.25 Bones 4 5 9 2.80 Mediastinum — — — Lungs 19 8 27 841 Kidneys 3 2 5 1.56 Glands 5 1 6 1.87 Other Reproductive 1 2 3 .93 Pharynx 4 — 4 1.25 Eye Not defined 1 3 1 1 4 .31 1.25 141 180 321 119 Comments on Foregoing Table. The two main groups of organs attacked in both sexes are the alimentary system and the reproductive system. In males 46.9 per cent. of the total deaths fall within these groups and in females 83.9 per cent. In males Cancer of the digestive system is the commonest situation, amounting to 46.8 per cent. In females it was 40 per cent. Cancer of the reproductive system caused 43.9 per cent. of the total deaths in females and was the most prevalent type. Cancer of the larynx, tongue and mouth is commoner in males than females, 11 deaths occurring in males as compared with 2 in females. The organs most often attacked in descending order of incidence are, in males the Rectum and Bowels (22.0 per cent.); the Stomach (17.7 per cent.); the Lungs (13.5 per cent.); the Tongue and Mouth (6.4 per cent.); in females, the Breast (25.0 per cent.); the Bowels and Rectum (17.2 per cent.); Stomach (16.1 per cent.); and the Uterus (13.3 per cent.). This is slightly different from the incidence in 1934. The main incidence of Cancer is, in both sexes, on two groups 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 been elucidated. The Cancer cell is an ordinary tissue cell which has become invested with abnormal properties. Why this should happen is not yet understood. 120 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. Irrigation facilities are available daily. 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. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1935. New male patients 141 145 121 101 196 263 235 242 297 287a New female patients 192 160 158 94 171 205 241 214 232 213a Attendances, male patients 2360 2643 3502 3581 505 4923 4691 4578 5858 5548a Attendances, female patients 1351 1417 1632 2127 3029 3271 2724 2677 3962 5977a a Includes 236 new cases and 4850 total attendances by patients from outside areas. Attendances of Croydon Patients at various London Hospitals under the General Scheme. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1935. New patients 130 132 139 131 125 139 119 134 103 132 Total attendances 2767 3160 3080 3089 3150 2384 2835 2407 2222 2006 121 Of the 132 new patients in 1935, 9 had syphilis, 36 gonorrhoea, and 87 were not suffering from venereal disease. Pathological Examinations at London Hospitals for Croydon Patients. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1935. Tests for Clinics 542 540 716 924 715 829 900 855 968 1029 Tests for practitioners 799 667 570 932 2197 3198 1680 1775 1877 2221 One Croydon patient was admitted to an approved hostel under the L.C.C. scheme. Table II. Attendances of Patients at Venereal Diseases Clinic at the Croydon General Hospital. 1930. 1931. 1932. 1933. 1934. 1935. Authority. Inpa tients (days). Outpa tients. Inpa tients (days.) Outpa tients. Inpa tients (days). Outpa tients. Inpa tients (days). Outpa tients. Inpa tients (days). Outpa tients. Inpa tients (days). Outpa tients. Croydon ... 6159 ... 6395 159 5405 ... 5615 56 6659 301 6675 Surrey C.C. ... 1686 ... 1491 ... 1512 ... 1280 10 2227 63 3859 Kent C.C. ... 184 ... 232 ... 74 ... 87 ... 109 ... 232 London C.C ... 46 ... 72 ... 426 ... 255 6 794 ... 757 Sussex C.C. ... 4 ... 4 ... 19 ... 18 ... 31 ... 2 8079 8194 159 7436 ... 7255 72 9820 364 11525 122 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 1 15 ... 43 840 84 38 Guy's 2 5 ... 20 415 ... 24 King's College 5 2 ... 4 150 ... 6 Great Ormond Street ... ... ... 10 12 ... ... Royal Free ... 3 ... 1 19 ... ... South London Hospital for Women ... 5 ... 4 146 18 ... Whitechapel Clinic (L.C.C.) ... ... ... 1 66 ... ... St. Paul's ... 3 ... 3 189 ... ... Westminster Hospital 1 3 ... 1 169 ... 25 Total 9 36 ... 87 2006 102 93 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 3 ... 167 ... 123 ... 139 ... 432 Great Ormond Street ... ... 2 ... 15 1 10 ... 28 South London Hospital for Women ... ... 37 11 6 2 8 ... 64 Royal Free ... ... ... ... 2 ... 2 ... 4 King's College ... ... 4 ... 20 ... 3 ... 27 Whitechapel Clinic, L.C.C. ... ... 30 ... 3 ... 7 ... 40 Westminster Hospital ... ... ... ... 2 ... 4 ... 6 Guy's Hospital 3 ... 298 839 44 566 70 799 2619 St. Paul's ... ... 10 3 7 ... 10 ... 30 Total 6 ... 548 853 222 569 253 799 3250 123 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, 1925. Syphilis Soft Chancre Gonorrhoea Conditions other than venereal Totals m f m f m f m f m F Ttls 1. Number of cases on 1st January under treatment or observation 44 55 ... ... 44 35 2 2 90 92 182 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 1 1 ... ... 2 2 ... ... 3 3 6 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 4 1 ... ... ... ... ... ... 4 1 5 „ secondary 2 1 ... ... ... ... ... ... 2 1 3 latent in 1st year of infection 2 6 ... ... ... ... ... ... 2 6 8 „ all later stages 16 12 ... ... ... ... ... ... 16 12 28 „ congenital 7 9 ... ... ... ... ... ... 7 9 16 Soft Chancre ... ... ... ... ... ... ... ... ... ... ... Gonorrhoea,1 st year of infection ... ... ... ... 119 49 ... ... 119 49 168 „ later ... ... ... ... 9 4 ... ... 9 4 13 Conditions other than venereal ... ... ... ... ... ... 98 108 98 108 206 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 18 11 ... ... 12 12 ... ... 20 23 53 Totals of Items 1, 2, 3 and 4 94 96 ... ... 186 102 100 110 380 308 688 5. Number of cases discharged after completion of treatment and final tests of cure (see Item 15) 12 15 ... ... 90 36 98 108 200 159 359 6. Number of cases which ceased to attend before completion of treatment and were, on first attendance suffering from:— Syphilis, primary 4 ... ... ... ... ... ... ... 4 ... 4 „ secondary 2 3 ... ... ... ... ... ... 2 3 5 „ latent in 1st year of infection ... ... ... ... ... ... ... ... ... ... ... „ all later stages 10 10 ... ... ... ... ... ... 10 10 20 „ congenital ... 5 ... ... ... ... ... ... ... 5 5 Soft Chancre ... ... ... ... ... ... ... ... ... ... ... Gonorrhoea, 1st year of infection ... ... ... ... 28 14 ... ... 28 14 42 „ later ... ... ... ... 1 3 ... ... 1 3 4 7 Number of cases which ceased to attend after completion of treatment but before final tests of cure (see Item 15) 1 ... ... 12 8 ... ... 13 8 21 8. Number of cases transferred to other centres or to institutions, or to care of private practitioners. 6 5 ... ... 3 6 ... ... 9 11 20 9 Number of cases remaining under treatment or observation on 31st December 59 58 ... ... 52 35 2 2 113 95 208 Totals of Items 5, 6, 7, 8 and 9 (These totals should agree with those of Items 1, 2, 94 96 ... ... 186 102 100 110 380 308 688 10. Number of cases in the following stages of syphilis included in Item 6 which failed to complete one course of treatment:- Syphilis, primary 1 ... ... ... ... ... ... ... 1 ... 1 „ secondary ... 1 ... ... ... ... ... ... ... 1 1 „ latent in 1st year of infection ... ... ... ... ... ... ... ... ... ... ... „ all later stages 6 5 ... ... ... ... ... ... 6 5 11 „ congenital ... 2 ... ... ... ... ... ... ... 2 2 11.Number of attendances:— (a) for individual attention of the medical officers 997 1131 ... ... 1218 591 208 155 2423 1877 4300 (b) for intermediate treatment, e.g., irrigation, dressing 7 11 ... ... 3096 4050 22 39 3125 4100 7225 Total Attendances 1004 1142 ... 4314 4641 230 194 5548 5977 11525 124  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 3 2 ... ... 4 2 ... ... 7 4 11 (b) Aggregate number of "in-patient days" of treatment given 153 82 ... ... 89 40 ... ... 242 122 364 Under 1 year 1 and under 5 years 5 and under 15 years 15 years and over Totals 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 2 1 ... 4 2 2 3 2 7 9 Approved Arsenobenzene Compounds Mercury Bismuth 14. Chief preparations used in treatment of Syphilis: (a) Names of preparations Stabilarsan Sulphostab ... Bismostab Quinostab (b) Total number of injections given (outpatients and in-patients) 1266 ... 1697 15. Are the tests recommended in Memo. V21 as amended by Memo. V21 Afollowed 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 16. 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 examination to an approved laboratory ... 604 535 Kahn 526 212 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 41 38 1 9 ... 89 Soft Chancre ... ... ... ... ... ... Gonorrhoea 117 66 9 13 ... 205 Conditions other than venereal 106 76 6 16 2 206 Total 264 180 16 38 2 500 B. Total number of attendances of all patients residing in each area 6675 3859 232 757 2 11525 C. Aggregate number of "In-patient days" of all patients residing in each area 301 63 ... ... ... 364 D. Number of doses of arsenobenzene compounds given in the out-patient Clinic and In-patient Department to patients residing in each area 660 505 10 91 ... 1266 125 The Croydon Branch of the British Social Hygiene Council has been active during the year, and I am indebted to the Hon. Secretary, Mrs. F. W. Rees, for the following report. The Council give a grant of £50 towards the expenses of this branch. The following is a report of the work carried out during the past year. A public meeting was held in the Public Halls in George Street, at which a film, entitled "Trial by Marriage" was given, the speaker on this occasion being Dr. Drummond Shiels, M.C., and at which His Worship the Mayor took the chair. This meeting was extremely well attended. Conferences have been held with the parents of both boys and girls, when Dr. Feldman and Dr. N. Davey took charge of these conferences. Considerable interest was shown by the number of questions asked. These conferences have been an undoubted success. An afternoon talk was given to the West Ward of the Women's Citizens Union by Miss Swaisland, B.Sc., on "Problems affecting the up-bringing of children." A similar talk was arranged for the East Ward of the Women's Citizens Union, when the speaker was Miss Helen Bennett, and also one for the Women's Class of the Croydon Adult School, the speaker being Miss Swaisland, B.Sc. In addition to the above a certain amount of definite propaganda work has been carried out in co-operation with the Libraries, and suitable literature has been distributed in the schools by co-operation with the Education Officer, Head Masters and Head Mistresses. 126 SECTION VIII. MATERNITY AND CHILD WELFARE. 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 Births. Still Births. Total. Midwives 2,614 73 2,687 Doctors, Parents and others 814 33 847 Total 3,428 106 3,534 As the total number of births and still births registered during 1935 was 3,693 (Live 3,576, Still 117), 148 births and 11 still births were not notified in accordance with the provisions of the Act. Maternal Mortality. There were 10 deaths directly due to pregnancy, as compared with 13 in 1934. The maternal mortality rate was consequently 2.9 per 1,000 births compared with 3.9 per 1,000 in 1934. In other words one mother died for every 339 babies born. The deaths directly due to pregnancy were caused by puerperal sepsis 7 cases (3 of which followed abortion), eclampsia 1 case, broncho-pneumonia following caesarean section 1 case, and postpartum haemorrhage 1 case. Two of the 10 cases were Croydon residents delivered and treated outside the borough. There were also four deaths from heart disease, pulmonary tuberculosis, lobar pneumonia complicating insanity, and violence, in cases in which a pregnancy was co-existant. 127 The Registrar General's figures for deaths directly due to pregnancy was as follows:— Total deaths allocated to Borough of Croydon, 8; maternal mortality 2.36 per 1,000 births; in the previous paragraph the deaths are given as 10. This includes 2 deaths which the Registrar General did not include as deaths directly due to pregnancy, but which in the light of local knowledge have been included in my report. Table I. Puerperal Toxaemias. Haemorrhages. Other Causes. YEAR. BIRTHS. Puerperal Infection. Eclampsia. Hyperemesis. Ectopic Gestation. Placenta Praevia. Post-partum Haemorrhage. Pulmonary Embolism. Caesarean 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 1911 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 1921 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 6.8 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 1935 3288 7 1 ... ... ... 1 ... 1 ... ... ... ... 10 3.0 45 89 26 4 6 12 18 16 5 6 7 7 19 214 *It has recently become the practice to give the maternal death rate live1,000 live and still births. The above table gives the rate per 1,000 live births. Below are given the rates per 1,000 total births since 1931. 128  Puerperal Toxaemias. Haemorrhages. Other Causes. YEAR. BIRTHS Live and Still. Puerperal Infection. Eclampsia. Hyperemesis. Ectopic Gestation. Piacenta Praevia. Post-partum Haemorrhage. Pulmonary Embolism. Caesarean Section. Shock. Heart Disease. Syncope. Renal Trouble. |Other Causes. TOTAL. Maternal Mortality, Infant Mortality. 1931 3501 11 3 2 3 1 2 1 ... ... ... ... ... 23 6.6 57 1932 3429 2 3 ... ... ... ... ... ... ... ... ... 1 7 2.0 49 1933 3249 5 2 1 1 ... ... 1 ... ... ... 1 1 12 3.7 47 1934 3304 5 3 ... 1 2 ... ... ... 1 ... ... 1 13 3.9 46 1935 3391 7 1 ... ... ... 1 ... 1 ... ... ... ... 10 2.9 45 Totals (1919- 1935) 89 26 4 6 12 18 16 5 6 7 7 18 214 Puerperal Fever and Puerperal Pyrexia. Eighteen cases of Puerperal Fever and 47 cases of Puerperal Pyrexia were notified. This is a rate of 5.3 per 1,000 births (live and still births) for the former and 13.9 per 1,000 for the latter. The death-rates were:—Puerperal Fever, 2.1 per 1,000 births. There were no deaths attributed to Puerperal Pyrexia. Table II. The following Table gives fuller details concerning these cases. Puerperal Fever. Puerperal Pyrexia. a— No. of cases notified 18 47 „ ,, attended at home 12 12 (1) By doctor alone 1 1 (2) By doctor and maternity nurse 7 7 (3) By midwife alone 2 4 (4) Confinement unattended 2 - B— No. of cases attended in an Institution 4 32 C— „ „ attended in a Nursing Home 2 3 d— 5 „ „ treated at Home 1 e— 36 „ „ treated at Hospital 13 F— 1 „ „treated at Nursing Homes — G— „ „ treated at Home and Hospital 4 5 H— „ „who died 3 3 129 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 £39 2s. 6d. was allowed. Accommodation for Confinement. The following Table gives information concerning the accom- modation utilized for confinements. Number. Percentage. In Private Houses 1,691 45.8 In Public Institutions 1,350 36.6 Registered Maternity Homes 650 17.6 There is a distinct trend towards confinement taking place in an Institution or Maternity Home. 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 1935, 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 34 Average duration of stay 5/6 months No. of cases delivered by (a) Midwives 30 (b) Doctor 2 No. of cases in which medical assistance was sought by o midwife 10 No of cases notified as (a) Puerperal Fever, (b) Puerperal Pyrexia Nil No. of cases notified of Ophthalmia Neonatorum 1 No. of cases notified as Pemphigus Neonatorum None No. of maternal deaths Nil No. of infant deaths (a) Still-born Nil (b) within 10 days of birth Nil 130 Most of the infants were breast fed till 3 months old (2 had supplementary feeds much earlier), but many remained in the home long after they had been entirely weaned. 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. Still Births. During 1935, 117 still births were registered in respect of Croydon, but of these 23 were outward transfers to other districts. There were 9 inward transfers, giving a total of 103 for the area. Of these 65 were male babies and 38 female; 1 male and 3 female were illegitimate. The proportion of still births to living children was as 1 to 32. The still birth rate was 3.0 of the total registered births. The rate in 1934 was 3.6%. The still birth rate, on the same basis as for Infant Mortality, was 30.0 per 1,000 births. STILL BIRTHS, 1935. Notified by Midwives, Home Cases 13 „ Doctors, Home Cases 9 „ Institutions (Doctors or Midwives) 44* Attended by Midwives alone 26 „ Doctors alone 20 „ Midwives and Doctors 40 Occurred at 9 months 47 „ 8 months 16 „ 6-7 months 9 *Including registered Maternity Homes. An Analysis of 72 Still Births Occurring During the Year. Of the 72 still births investigated 48 were males and 24 females. Type of Delivery.—In 37 cases the confinement was difficult or prolonged. Normal confinement was noted in 26 cases; no information was obtainable in 9 cases. 131 Age of Mother.—Under 20 years, 2; between 20 and 29 years, 28; between 30 and 39 years, 35 ; between 40 and 49 years, 7. The Health of the Mother during her pregnancy was stated to be good in 55 cases and indifferent or poor in 11 cases; no particulars were obtained in 6 cases. In 8 cases, however, the mother had had a shock or a fall before the still birth. In 33 instances the mother had attended the Ante-Natal Clinic. 39 cases had never attended the Clinic. Attendance at Confinement.—Thirty-one of the still births investigated occurred in the Mayday Hospital; 10 in St. Mary's Hospital; 18 were attended in their own homes by a private medical practitioner either alone or in conjunction with a midwife; 8 were attended by a midwife alone, and 1 birth occurred before any skilled help was available ; 4 occurred in private nursing homes. Forceps were reported to have been utilised in 18 of the cases. In 47 cases the baby was born at full term; in 16 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 39 eases, abnormal in 9, whilst in 24 no record was available. The still birth was the first pregnancy in 32 instances; the 2nd in 11; the 3rd in 13; the 4th in 7; the 5th in 2; the 6th in 2; the 7th in 1; the 8th in 2; and beyond in 2. Previous still births had occurred in 2 cases. Ophthalmia Neonatorum. Thirteen cases were notified during 1935. 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 now brought to the attention of the Authority. The following table gives the notifications in Croydon during the past eleven years :— Table III. 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 No.of cases Rate per 1000 22 20 18 7 5 19 14 21 10 13 13 births 6.5 5.8 5.7 2.8 1.5 5.4 5 6 6.3 3.2 4.0 3.9 132 Results of Treatment. Table IV. Cases treated. Vision Unimpaired. Vision Impaired. Lied. Removed Remaining under Treatment. Notified At home In hospital 13 5 8 12 - - 1 - Infant Mortality. The Infantile Mortality rate was 45 per 1,000 births. This is 1 per 1,000 births less than in 1934, and is the lowest rate yet recorded in the Borough. For the past 5 years the numbers of infant deaths have been: 1931, 196; 1932, 161; 1933, 148; 1934, 145; 1935, 147; 103 deaths of infants occurred in institutions, including Registered Nursing Homes. Neo-Natal Mortality. Number of deaths within the first month of life:— Table V. Year. No. of Deaths. No. of Births. Rate. 1927 83 3174 26/1000 live births. 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 „ „ „ 1935 83 3288 25 „ „ „ 133 Among the 147 deaths, 93 occurred in boy babies and 54 in girls. Of the births, 1,736 were males and 1,552 females. The infantile mortality rate for the two sexes was, therefore:—Boys, 54; girls, 35. The rate of infant mortality amongst illegitimate children was 152 per 1,000. The rate in legitimate children was 40 per 1,000. The following table gives the causes of death during the first month of life:— I. Complications of Labour. Trauma at Birth 4 4 11. Foetal States. Congenital Heart Malformation 6 Other Congenital Deformities 9 Atelectasis 7 Congenital Debility 1 Syphilis 1 Icterus Neonatorum 3 - 27 III. Prematurity 40 40 IV. Post-Natal Causes 12 - 12 83 The rate of infantile mortality for England and Wales in 1935 was 57, and for the 121 large towns 62. The rate for Croydon is therefore considerably lower than the average rate. An analysis of Table VI. shows that, of the total infant deaths, 23.1% occurred on the first day of life and 56.5% 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. If it was not for the persistently high rate of this mortality the total infant mortality figure would be better than it is, Table VI. Deaths under one year, arranged in days, weeks and months. causes of death. 1st day. 2nd day. 3rd day. 4th day. 5th day. 6th day. 7th day. 1st-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 34 19 3 5 4 1 ... 6 5 6 83 19 7 6 8 6 3 3 4 4 3 1 147 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 2 Convulsions 1 ... ... ... 1 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... 1 ... ... 4 Pneumonia (all forms) ... ... ... ... ... 1 ... 1 1 1 4 4 ... 1 2 2 1 ... 1 ... 1 ... 16 Diarhœa and Enteritis ... ... ... ... ... ... ... ... ... ... ... 5 1 2 3 1 2 ... ... 1 1 1 17 Gastritis ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 2 Syphi1is 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Malformations 5 3 2 1 1 ... ... 1 ... 2 15 3 1 2 1 1 ... ... ... ... ... ... 23 Premature Birth 23 11 ... 2 1 ... ... ... 1 2 40 3 ... ... ... ... ... ... ... ... ... ... 43 Atrophy, Atelectasis, Debility, and Marasmus 2 3 ... 1 1 ... ... 1 ... ... 8 1 3 ... ... ... ... ... ... ... ... ... 12 Injury at birth ... 2 ... ... ... ... ... 1 1 ... 4 ... ... ... ... ... ... ... ... ... ... ... 4 Other causes 2 ... 1 1 ... ... ... 2 2 ... 8 1 1 1 1 1 ... 2 2 1 1 ... 19 136 Deaths Under One Month. An analysis of Table VI. shows that 23.1% of the infant deaths occurred before the baby was 24 hours old; 44.9% during the first week of life; and 56.5% before the end of the first month. In 1934 the corresponding figures were 17.9%, 35.1%, and 46.9%. 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 48.2% of deaths under 1 month of life. In the same group can be placed debility which was the cause of 9.6%. Injury at birth is rather different, inasmuch as it is, by skilled ante-natal and natal attention, avoidable; injury caused 4.8% of the deaths. Deaths under one month due to congenital deformities constituted 18.1% 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. Deaths Under Three Months. One hundred and nine babies died during the first three months of life, a percentage of the total infant deaths of 74%, and an infant mortality rate of 33 per 1,000 births. As the total infantile mortality rate was 45, it is seen that over 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: Diarrhœa, 6 deaths; Pneumonia, Congenital Deformity and Congenital Debility, 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 (28.9%) and Pneumonia (21.0%). These two conditions, year by year, figure as the most prominent causes of death at this age period. the Pneumonia deaths occurred in the following months:— January 6, March 3, June 1, July 1, November 1, and December 4. Taking the figures in the table as a whole, the outstanding features are:— (1) The predominance of premature birth, and conditions classified debility and marasmus. Between them they accounted for 37.4% of the total deaths, and contributed 16.7 deaths per 1,000 towards the infantile mortality rate. 136 (2) Next to these come Pneumonia and Diarrhoea with 22.4% of the total deaths and a contribution of 10.0 per 1,000 to the infantile mortality rate. (3) Congenital Deformity, inconsistent with viability beyond the first year, was responsible for 23 deaths, 15.6% of the total deaths, and contributed 7 per 1,000 towards the infantile mortality rate. There were no deaths from the acute Zymotic diseases in infants under 1 year of age. In the tabulated deaths of children under 1 year of age, the child who died was a first child in 37.6%; a second child in 15.0%; a third child in 11.8%; a fourth child in 14.0%; a fifth child in 9.7%; a sixth child in 5.4%; a seventh child 3.2%; an eighth in 2.2% ; and a ninth in 1.1%. The following table gives the chief causes of infant deaths, as compared with 1934:— Table VII. Percentage Deaths per Total Infantale Deaths. Deaths per 1,000 Births. 1935. 1934. 1935. 1934. Premature Births 29.3 23.4 13.1 10.6 Respiratory Diseases 13.6 20.7 6.1 9.4 Infectious Diseases (inc. Tuberculosis) 1.4 6.8 0.6 3.1 Atelectasis, Debility and Marasmus 8.2 15.1 3.6 6.9 Diseases of Digestion 12.9 6.8 5.8 3.1 Accidental & Congenital 18.4 17.9 8.2 8.1 137 Maternity and Child Welfare—Deaths of Infants under one year of age. Table VIII. Births Deaths 1935 1934 1933 1932 Mortality per 1000 Births General Birth Rate General Death Rate Mortality per 1000 Births General Birth Rate General Death Rate Mortality per 1000 Births General Birth Rate General Heath Rate Mortality per 1000 Births General Birth Rate General Death Rate January 307 15 49 13.3 10.7 42 14.3 14.6 78 14.5 17.9 79 15.5 15.9 February 271 17 63 14.7 12.9 45 14.6 12.0 72 14.2 19.5 49 14.9 16.3 March 282 15 53 15.3 12.0 49 14.3 14.2 48 15.0 11.8 45 15.0 14.0 April 277 9 32 15.0 10.4 36 16.5 11.3 61 16.3 10.9 39 16.8 10.4 May 383 11 29 16.6 10.2 45 13.2 9.2 19 15.1 8.6 33 16.0 9.6 June 282 10 35 15.3 8.4 28 15.6 7.4 24 16.6 7.9 15 18.0 8.3 July 327 10 31 17.7 7.8 33 13.0 8.6 20 14.2 7.6 26 17.3 7.7 August 365 7 19 15.8 8.1 21 16.6 8.1 12 15.2 7.1 43 16.9 8.5 September 268 5 19 14.5 8.8 24 13.8 8.1 35 14.7 7.7 42 13.8 8.6 October 323 17 52 14.0 8.5 31 14.0 9.0 36 12.9 9.4 27 14.2 8.6 November 250 16 64 13.5 8.7 39 14.5 10.8 45 11.5 10.6 31 14.9 9.0 December 213 15 70 11.5 12.3 33 15.0 10.2 54 11.8 14.7 60 12.5 10.9 The Birth Rate was highest in July, May and August, and the Infantile Mortality was lowest during August, September, May, July, and April. The Death Rate was highest in February, December and March. Infantile Mortality was highest during December, November and February. 138 Infantile Mortality in Wards from 1928 to 1935. Table IX. 1928 1929 1930 1931 1932 1933 1934 1935 Average over 8 years. Upper Norwood 80 70 108 80 76 57 33 26 68 Norbury 37 20 48 39 27 30 37 63 38 Wot Thornton 94 63 29 66 75 33 59 47 58 Bensham Manor 45 55 39 72 28 19 62 32 44 Thornton Heath 75 99 66 66 69 44 42 31 62 South Norwood 53 54 61 48 32 42 52 40 47 Woodside 42 59 40 37 30 50 66 57 48 East 25 63 40 30 68 46 30 63 45 Addiscombe 45 71 33 47 31 35 43 62 46 Whitehorse Manor 59 74 62 74 48 62 60 47 61 Broad Green 48 76 38 46 60 57 41 51 52 Central 58 42 51 91 22 15 30 66 47 Waddon 46 63 56 53 55 63 50 54 55 South 66 61 25 63 34 91 71 56 58 Addington ... ... ... ... ... ... 15 36 ... The Wards with the highest average infant mortality over an eight years period are: Upper Norwood, Thornton Heath, and Whitehorse Manor; the lowest averages are recorded in Norbury, Bensham Manor and East and Addiscombe. Midwives Acts, 1902 and 1918. 113 midwives notified the Local Supervising Authority of their intention to practise within the Borough during 1935; 40 ceased practising in the Borough and 1 died, so that 72 remained on the Register at the end of the year. Of these 70 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 1 held the certificate of the London Obstetrical Society. Confinements Attended by Midwives. Cases attended by midwives alone 2,184 i.e., 61.8% of Cases attended by midwives when a doctor was total births also engaged 645 Cases attended by midwives when a doctor was also summoned 434 Total 3,263 i.e., 92.3% of total births 139 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 25 Other causes 14 Abortion 7 - 46 For Complications during Labour Breech 3 Hand - Face 1 Foot 2 Extended Breech 13 Occipito-Posterior 2 Transverse 3 Prolapsed Cord 1 Head 1 Undiagnosed 7 - 33 Obstructed Labour 5 5 Delayed Labour— Uterine Inertia 19 Prolonged 36 ... Delayed 23 - 78 Haemorrhage— Ante-Partum 23 Post-Partum 10 - 33 Other Causes— Adherent Placenta 7 Illness of Mother 10 Retained Placenta 1 Twins - Torn Perineum 107 Eclampsia 1 126 For Complications during Puerperium : Pyrexia 18 Pain in Breasts 6 Pain in Legs 10 Other causes 5 - 39 For Complications in regard to the Baby : Inflammation of Eyes 43 Jaundice 3 Still-birth 2 Convulsions 1 Feebleness 4 Deformities 3 Premature Birth 3 Other causes 15 74 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 object of this is that even the poorest mother can engage the Services of a competent midwife, whilst the latter will have no cause 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 £64 2s. 6d. was paid out during the year. 140 In accordance with Rule 12a of the Central Midwives Board, the following reasons for the discontinuance of breast feeding were received:— Illness of Mother 6 Mother returning to business Insufficient Milk 5 life 2 Total 13 Inspection of Midwives. Dr. Jenkin-Lloyd, the Inspector of Midwives, interviewed 5 midwives at the Town Hall. 115 visits were paid by her to the homes of midwives. Of these visits 24 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, especially the ante-natal records were incomplete. 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. 150 mothers were sent by midwives for this purpose. When the midwife does not attend she is informed by letter of the findings at the Clinic. Disinfection of Midwives Bags, Etc. This is done by the Local Supervising Authority, free of charge for any midwife asking for it. In 10 instances midwives availed themselves of these facilities. 141 Table XIII. Nursing Homes (Registration) Act, 1927. Maternity Homes. Other Nursing Homes. Combined Maternity and other Nursing Homes. Total. No. of Homes on Register, on 31/12/34 14 20 24 58 No. of Applications for Registration during 1935 2 8 3 13 No. of Homes registered during 1935 2 7 3 12 No. of Orders made: (a) Refusing Registration - 1 - 1 (4) Cancelling Registration 2 4 6 12 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 31/12/35 14 23 21 58 No. of Beds available 67 304 (a) Mat. beds 52 (a) 119 (b) Other Beds 85 (b) 389 Doctors' Accounts Under Section 14 (1) of the Midwives Act, 1918. 243 accounts were received from doctors for services rendered under the provisions of this section. This compares with 172 in 1934; 140 in 1933; 153 in 1932; 136 in 1931; and 149 in 1930. The total amount of the accounts was £329 14s. 6d. £133 16s. 3d. was ultimately recovered from the patients. In 1934 the amount paid to doctors was £248 14s.; in 1933, £225; and in 1932, £230 1s. 6d. 142 THE OBSTETRIC SERVICE. The obstetric service was fully described in the Annual Report for 1933. 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, 9 of the 11 maternal deaths in 1934, and 7 of the 10 deaths in 1935. Taking the Registrar-General's figures for maternal mortality (deaths directly due to pregnancy) the rate for England and Wales for 1935 is 3.93 per 1,000 births. In Croydon there has been a fall from 3.63 per 1,000 in 1934 to 2.36 in 1935. In Booked cases treated by the Obstetric Service the rate for 1935 was 0.9 per 1,000 births. . Of the cases treated to a conclusion at the Post-Natal Clinic during 1935, 92 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 1934 was 92.8 per cent. The number of patients delivered in Mayday Hospital showed an increase of 25 per cent, on the total for 1934, 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 a nominal 22 beds, was 646. The number delivered in St. Mary's Maternity Hospital, with 30 beds, was 546. A Minnitt Gas-air analygesia apparatus has been provided for patients at Mayday Hospital, and its use has been greatly appreciated by many of the mothers. A Post-graduate refresher course of lectures and demonstrations by Obstetric specialists was giveD to the midwives of Croydon and was well attended. GENERAL STATISTICS FOR 1935. Registrar General's Returns. Number of Live Births allocated to the Borough of Croydon 3,288 Number of Still Births allocated to the Borough of Croydon 103 Total 3,391 143 Number of Maternal Deaths (directly due to pregnancy) 8 Number of cases notified as Puerperal Fever 18 Number of cases notified as Puerperal Pyrexia 47 Statistics Prepared by the Obstetric Service. Number of Expectant Mothers who attended the Borough Antenatal Clinics 1,992 Number of cases delivered in Mayday Hospital as Booked cases 557 Number of cases delivered in Mayday Hospital as Emergency cases 214 Total cases delivered in Mayday Hospital 771 Number of cases delivered in St. Mary's Maternity Hospital as Booked cases 545 Number of cases delivered in St. Mary's Maternity Hospital as Emergency case 1 Total cases delivered in St. Mary's Maternity Hospital 546 Number of cases admitted to the Puerperal Infection Unit, Borough Hospital and Mayday Hospital Isolation Wards, including 30 from Mayday Hospital and 4 from St. Mary's Maternity Hospital 51 Number of Maternal Deaths* in Borough of Croydon 10 Number of Maternal Deaths in Booked cases from Borough Ante-natal Clinics 1 Number of Maternal Deaths† in Emergency cases at Mayday Hospital 3 Number of Maternal Deaths in cases admitted as Puerperal Sepsis per se 3 Total Maternal Death† in beds of the Obstetric Service 7 The total number of patients treated by the Obstetric Service was:— (a) In Mayday Hospital 805 (b) In St. Mary's Maternity Hospital 551 (c) In the Borough Hospital Puerperal Infection Unit and Mayday Hospital Isolation Wards, excluding 30 from (a) and 4 from (b) 15 (d) At the Ante-natal Clinics and delivered outside the above Hospitals (about) 270 (e) At the Post-natal Clinics, excluding those included in (a), (b), (c), and (d), and including 90 delivered in 1935 124 (f) At the Ante-natal Clinics and undelivered on December 31st, 1935 548 Total 2,313 *Including 2 deaths not recorded by the Registrar-General as directly due to pregnancy. †Including 1 death not recorded by the Registrar-General as directly due to pregnancy. 144 ANTE-NATAL SUPERVISION. 1934. 1935. Number of sessions at Ante-natal Clinics held 254 255 Number of individuals who attended 1,793 1,992 Number of previous year's cases continuing attendance 356 410 Number of new cases 1,437 1,582 Number of cases undelivered on 31st December 430 548 Total attendances made 10,105 11,839 Average attendances per session 39.8 46.4 Proportion of old to new cases per session— New 5.7 6.2 Old 34.1 40.2 Number of cases delivered in Hospital as Booked cases 1,012 1,097 Number of cases delivered at other places under the care of private doctors or midwives (about) 254 270 Number of patients found not to be pregnant 25 27 Number of patients referred to Hospital for Antenatal treatment 211 274 The conditions for which these were admitted can be ascertained by reference to the "Booked" columns of the Numerical Summary of Cases on page 149. It is seen that the new cases have increased by 145 and the total attendances by 1,734. This increase has caused a severe strain on the accommodation available at Lodge Road, and overcrowding has resulted. Extra sessions have not been possible to be arranged owing to limitations of available staff and accommodation. It is interesting to note that the number of births occurring in institutions and previously attending the Clinic has risen, and the number confined privately has also increased. Major Ante-Natal Conditions Treated at the Ante-Natal Clinic. Breech Presentation. Cases. Breech presentation diagnosed 138 Spontaneous version 13 External version successful 1ll (5 recurred) External version not successful 14 Allowed to go to term as Breech 6 Referred to Hospital for external version under anaesthesia 10 Of these : Version under anaesthesia successful 6 Version under anaesthesia not successful 4 Not recognised as Breech before labour 5 Dental Treatment. Number of cases referred to Borough Dental Surgeons 207 Number of cases referred to Private Dental Surgeons 165 Number of cases refusing dental treatment 91 Number of cases seen too late for necessary dental treatment 66 145 The inability of the Dental Service to deal with all the mothers anxious to obtain treatment is regrettable, inasmuch as it reacts upon the attitude of mothers. There are, however, insufficient dentists for sufficient supervision to be accomplished. Tuberculosis. Referred by Tuberculosis Officer because of pregnancy 10 Referred to Tuberculosis Officer for opinion on lung condition 19 Venereal Disease. GONORRHOEA—Total cases 9 Transferred to Borough V.D. Clinic 2 Transferred to Mayday Hospital 7 SYPHILIS—Total cases 15 Transferred to Borough V.D. Clinic 12 Transferred to Mayday Hospital 3 These cases are delivered in Mayday Hospital in Isolation Wards, and transferred to the Borough V.D. Clinic on discharge. Four of the cases were undelivered at the end of the year. Other Conditions Treated as Out-Patients. Chronic rheumatic carditis 11 Parenchymatous goitre 3 Retroverted gravid uterus 7 Scabies 6 Psoriasis 1 Midwives' Cases. Many midwives' cases were sent when pregnancy was about 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. Expectant mothers who cancelled hospital bookings are included in this group. These cases may be summarised as follows : — Total number of miwives' cases during 1935 365 Number of cases sent for one consultation only 128 (35%) Number of cases supervised entirely 237 (65%) Number of first pregnancies 130 (35½%) „ second „ 70 (19%) „ third „ 57 (153½%) „ fourth „ 33 (9%) „ fifth „ 28 (8%) „ sixth „ or more 47 (13%) Number of legitimate pregnancies 346 (95%) Number of illegitimate pregnancies 19 (5%) Number of cases referred to Hospital for Ante-natal treatment, discharged undelivered and not readmitted for delivery 3 146 Number of cases ordered into Hospital for delivery on medical grounds 19 The indications in the 19 cases were— Albuminuria or hypertension 4 Contracted pelvis 4 Ante-partum hæmorrhage 4 Chronic rheumatic carditis 1 Thrombo-phlebitis 1 Placenta praevia 1 Syphilis 1 Tuberculosis 1 Breech 1 Previous Cæsarean section 1 SPECIAL INVESTIGATIONS. Special investigation 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 100 Blood for Kahn Reaction 62 Blood for Gonococcus Fixation Test 43 Blood for Culture 4 Blood for Urea Content 5 Blood for Sugar Content 2 Blood for Van den Burgh Reaction 2 Blood for Cell Count, etc. 8 Catheter urine for Routine Examination 294 Urine for Aschheim-Zondek Test 14 Urine for Urea Concentration Test 8 Lochia for Culture 36 Sputum for Examination 8 Pus for Identification of Organism 1 Urethral smears for Gonococci, etc. 12 Cervical smears for Gonococci, etc. 10 Conjunctival smears 4 Histological sections 7 Cerebro-spinal fluid for Examination 2 X-Ray Examinations (Mayday Hospital X-Ray Department). 130 cases were referred from Ante-natal Clinics and 193 films were used. Reasons for reference were:— Breech for attitude, etc 55 For presentation, attitude, etc.41 Twins 29 Renal calculus 1 Maturity 1 Spinal or pelvic bone changes 2 Foetal death 1 147 31 cases were referred from the Maternity Wards at Mayday Hospital and 49 films were used. Reasons for reference were: Breech for attitude, etc 6 For presentation 8 For maturity 3 Twins 4 For foetal parts 3 Renal calculus 2 Spinal or pelvic bone changes 2 Foetal death 3 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 551 546 1,097 (2) Delivered in hospital before 28th week 6 0 6 (3) Admitted after delivery 10 5 15 (4) Discharged undelivered after ante-natal treatment and not subsequently delivered in hospital 8 0 8 (a) Died undelivered 0 0 0 (6) Ectopic pregnancy 1 0 1 Totals 576 551 1,127 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, except one case which had been seen by a medical officer at home and has been included in the Booked cases for convenience. Mayday Hospital. (1) Before Labour— (a) Delivered in hospital after 28th week 32 (b) Delivered in hospital before 28th week 14 (c) Discharged undelivered 12 (d) Died 1 (2) In Labour— (a) Delivered in hospital after 28th week 63 (b) Delivered in hospital before 28th week 99 (c) Died 0 (3) After Delivery 15 (4) Ectopic Pregnancy 3 Total 239 148 A comparison of the patients delivered in the two hospitals as regards parity, legitimacy and the number of attendances made at the Ante-natal Clinics. The 1934 comparison included deliveries before 28 weeks gestation, but from this table they are excluded:- St. Mayday Mayday Mary's Mat. Hospital. Hospital. Hospital. Booked. Emergency. Booked. Totals. First pregnancy 270 (49%) 49 (52%) 332 (61%) 651 (54½%) Second „ 129 (23%) 16 (17%) 123 (22½%) 268 (22½%) Third „ 66 (12%) 12 (12½%) 57 (10½%) 135 (11½%) Fourth ,, 34 (6%) 9 (9½%) 17 (3%) 60 (5%) Fifth ,, 18 (3%) 2 (2%) 12 (2%) 32 (2¾%) Sixth ,, 10 (2%) 3 (3%) 4 (¾%) 17 (1½%) Seventh „ 9 (1½%) 2 (2%) 1 (1-5%) 12 (1%) Eighth „ 4 (¾%) 1 (1%) 0 (-) 5 (½%) Ninth „ 2 (1-3%) 0 (-) 0 (-) 2 (1-6% Tenth pregnancy or more 9 (1½%) 1 (1%) 0 (—) 10 (1%) Totals 551 95 546 1,192 Legitimate 509 (92%) 72 (76%) 541 (99%) 1,122 (94%) Illegitimate 42 (8%) 23 (24%) 5 (1%) 70 (6%) Average attendance at Antenatal Clinic per patient delivered 7.5 0.4 10.2 - 149 Table X. A Numerical Summary of cases admitted for treatment, delivered in Hospital, or admitted after delivery. Some cases appear in more than on ecategory in the summary. Mayday Hospital Booked. Mayday Hospital Emergency. St. Mary's Maternity Hospital Booked. Total. 1. Conditions chiefly Ante-Natal. Albuminuria 55 20 50 125 Eclampsia 1 7 1 9 Persistent vomiting of pregnancy 8 5 — 13 Chronic cervicitis 4 — — 4 Acute pyelitis 3 7 1 11 Other urinary infection 5 2 3 10 Malnutrition, debility, simple anaemia, etc. 21 1 10 32 Ante-partum thrombo-phlebitis 4 — 2 6 Breech presentation for version 7 — 3 10 Disproportion 16 6 14 36 Post-maturity — — 1 1 Retroverted gravid uterus 1 — - 1 2. Intercurrent Diseases. Chronic nephritis — 5 — 5 Pulmonary tuberculosis 1 6 — 7 Venereal disease 12 5 — 17 Pneumonia — 0 Chronic rheumatic carditis 3 3 - 6 Exophthalmic goitre 1 — — 1 Insanity 2 2 — 4 3. Conditions chiefly Natal. Presentations at Delivery— Anterior positions of the vertex 496 70 472 1038 Posterior positions of the vertex 27 9 60 96 Breech 21 11 16 48 160  Mayday Hospital Booked. Mayday Hospital Emergency. St. Mary's Maternity Hospital Booked. Total. Shoulder 1 1 1 3 Face and Brow 3 2 2 7 Complex 1 — — 1 Caesarean section 7 3 1 11 Twins 6 1 5 12 Accidental haemorrhage 8 3 3 14 Placenta praevia 5 8 1 14 Hydramnios 5 — 2 7 Prolapse of cord 1 2 — 3 Retained placenta 6 1 11 18 Post-partum haemorrhage 9 4 15 28 B.B.A 10 15 5 30 Lacerated perineum 152 37 150 339 Obstructed labour — 8 - 8 Precipitate labour 1 1 1 3 Premature labour 45 19 14 78 Abortion 16 120 - 136 Ectopic pregnancy 1 3 — i 4. Conditions chiefly Post-Natal excluding re-admissions from Post-Natal Clinic. Retroversion 12 6 34 52 Delayed involution 70 8 75 153 Post-partum nephritis 3 9 - 12 Breast abscess 1 1 2 4 Notified pyrexia or fever 18 11 10 39 In addition 6 cases of Puerperal Fever per se were admitted to Mayday) Hospital Isolation Wards and 11 cases to the Puerperal Infection Unit at Borough Hospital. 151 Cardiac Disease. There were seven cases. None died. One infant was stillborn among the 5 births, a mortality of 20 per cent. Hydramnios. There were seven cases: five "Booked" cases at Mayday Hospital, and two "Booked" cases at St. Mary's Maternity Hospital. No mother died. Six infants were still-born, a mortality of 75 per cent. Albuminuria. Every patient attending the Ante-natal Clinic has the urine tested and the blood pressure recorded at each visit. All oases 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 (milk and egg yolk), 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. St. Mary's Mayday Mayday Maternity Hospital Hospital Hospital Total. Booked. ' Emergency. Booked. Number of cases 55 20 50 125 Number of stillbirths and infant deaths 6 8 10 24 Foetal and infant mortality 11% 53% 19% 20% Number of maternal deaths — — — — Eclampsia (9 cases). Mayday Mayday St. Mary's Hospital Hospital Mat. Hosp. Booked. Emergency. Booked. Total. Number of cases 1 7 1 9 Maternal deaths 0 1 0 1 Maternal mortality 0 14% 0 11% Number of foetal and infant deaths 0 5 0 5 Foetal and infant tality 0 71% 0 56% 152 Accidental Antepartum Haemorrhage (14 cases). Mayday Mayday St. Mary's Hospital Hospital Mat. Hosp. Booked. Emergency. Booked. Total. Number of cases 8 3 3 14 Number of stillbirths and infant deaths 2 2 (twins) 1 5 Foetal and infant mortality 25% 50% 33% 36% There was no maternal death. Placenta Praevia (14 cases). Mayday Mayday St. Mary's Hospital Hospital Mat. Hosp. Booked. Emergency. Booked. Total. Number of cases 5 8 1 14 Number of stillbirths and infant deaths 4 4 1 9 Foetal and infant mortality 80% 50% 100% 64% There was no maternal death. Contracted Pelvis (including relative disproportion between the pelvis and foetal head). 36 cases of contracted pelvis or disproportion were treated during the year. There were no maternal deaths. In 30 "Booked cases there were 3 infant deaths (10 per cent.), and in 6 "Emergency" cases there were 3 infant deaths (50 per cent.). No cases were treated by induction of premature labour. St. Mary's Mayday Mayday Maternity Hospital Hospital Hospital Total. Method of Treatment. Booked. Emergency. Booked. No.of Infant No.of Infant No.of Infant No.of Infant Cases. Deaths Cases. Deaths Cases. Deaths Cases. Deaths Spontaneous delivery 10 1 2 2 11 1 23 4 Forceps delivery 2 1 2 0 2 0 Embryotomy 0 0 1 1 0 0 Caesarean section 4 0 1 0 1 Total 16 2 6 3 14 1 36 6 153 Vertex Presentations at Delivery. The number of deliveries in which the occiput was anterior at the beginning of labour was 1,038. The number of deliveries in which the occiput was posterior at the beginning of labour was 96. Breech Delivery (48 cases). (For Ante-natal treatment of breech causes, see page 144). Mayday Hospital Booked. Mayday Hospital Emergency. St. Mary's Maternity Hospital Booked. Total. Number of breech deliveries 21 11 16 48 Number of stillbirths and infant deaths 7 6 4 17 Foetal and infant mortality 33% 55% 25% 35% Maternal deaths 0 0 0 0 An uncomplicated breech delivery is one where an additional risk to the life of the foetus is not present—such conditions as Ante-Partum Hæmorrhage, Prematurity, Monstrosity, etc. Mayday Hospital Booked Mayday Hospital Emergency. St. Mary's Maternity Hospital Booked. Total. Number of uncomplicated breech cases 8 4 10 22 Number of stillbirths and infant mortality 1 1 1 3 Foetal and infant mortality 12½% 25% 10% 14% Number of complicated breech cases 13 7 6 26 Number of stillbirths and infant deaths 6 5 3 4 Foetal and infant mortality 46% 71% 50% 54% 154 Face and Brow Presentations (7 cases of Face and none of Brow). There were three cases of Face Presentation "Booked" at Mayday Hospital; two "Emergency" cases at Mayday Hospital; and two among the St. Mary's Maternity Hospital "Booked" cases. No mother died. One infant was stillborn and one died: a mortality of 29 per cent. Shoulder Presentations (3 cases). There was a "Booked" case at each hospital and an "Emergency" at Mayday Hospital. No mother died. One infant was still born: a mortality of 33 per cent. Complex Presentation. One "Booked" case at Mayday Hospital had a stillborn baby. The mother recovered. Prolapse of Cord (3 cases). At Mayday Hospital there were one "Booked" and two "Emergency" cases. No mother died. The infants were stillborn. Post-Partum Haemorrhage (28 cases). There were nine cases in Mayday Hospital "Booked" cases; four in Mayday Hospital "Emergency" cases; and 14 in St. Mary's Maternity Hospital "Booked" cases. There was one maternal death, a "Booked" case at St. Mary's Maternity Hospital. Maternal mortality 3.6 per cent. Twins died, an infant mortality of 7 per cent. Abortion. The service dealt with 136 cases of Abortion during the year. All were treated at Mayday Hospital (16 "Booked" cases arid 120 "Emergency"). There were 2 maternal deaths. In addition, 2 cases of Incomplete Abortion were admitted to Mayday Hospital Isolation Wards as Puerperal Sepsis, and 2 cases to the Borough Hospital Puerperal Infection Unit, and are recorded in the Report of the Puerperal Isolation Wards (one maternal death). 155 Conditions for which Abortion was induced:— Chronic nephritis 2 cases Renal tuberculosis 1 case Pulmonary tuberculosis 4 cases Recurrent pregnancy toxaemia 2 cases Chronic rheumatic carditis 1 case Hyperemesis gravidarum 1 case Ectopic Pregnancy. Four cases of Ectopic Pregnancy were admitted to Mayday Hospital. There was no maternal death. Laceration of Perineum. The perineum was lacerated in 339 cases. Table X. Place of Delivery and Category. 1st and 2nd degree. 3rd degree. Total. Mayday Hospital—Booked 148 4 152 Mayday Hospital—Emergency 37 0 37 St. Mary's Maternity Hospital—Booked 149 1 150 339 Induction of Labour. Labour was induced 23 times: 5 were medicinal and 18 instrumental. 8 were in Mayday Hospital "Booked" cases ; 8 in Mayday Hospital "Emergency" cases; and 7 in St. Mary's Maternity Hospital "Booked" cases. No mother died. Three infants were stillborn and 4 died, an infant mortality of 29 per cent. Forceps Delivery. Forceps were applied 75 times (22 Mayday Hospital "Booked," 9 Mayday Hospital "Emergency," and 44 St. Mary's Maternity Hospital "Booked" cases). In two cases at Mayday Hospital (one in each category) forceps were applied after induction of labour. There was no maternal death. 156 In Mayday Hospital "Booked" cases 4 babies were stillborn, an infant mortality of 18 per cent. In Mayday Hospital "Emergency" cases one was stillborn and one died, an infant mortality of 22 per cent. At St. Mary's Maternity Hospital, 3 babies were stillborn, an infant mortality of 7 per cent. The main reasons for Forceps Deliveries were: Rigid soft parts, 33; Posterior position, delayed rotation, 27; Disproportion, 5; Foetal distress, 5 ; Various other causes, 5. Caesarean Section. Caesarean Section was performed 11 times: 7 "Booked" and 3 "Emergency" cases at Mayday Hospital, and 1 "Booked" case at St. Mary's Maternity Hospital. In 7 cases the indication was contracted pelvis and disproportion, 1 pre-eclamptic toxaemia, 1 placenta praevia, 1 previous obstetric trauma since repaired, and 1 heart disease. There was no maternal death and no stillbirth. One baby died at Mayday Hospital. Bipolar and Internal Version (6 cases). At both hospitals there were two "Booked" cases treated by internal version, one for shoulder presentation and the other for placenta praevia. Two "Emergency" cases at Mayday Hospital were treated for shoulder presentation. No mother died. Three babies were stillborn and one died, a mortality of 67 per cent. Embryotomy. Embryotomy was performed once in a Mayday Hospital "Emergency" case admitted for obstructed labour. There was no maternal death. Manual Removal of Placenta. Manual removal was performed 17 times. There were six "Booked" cases at Mayday Hospital and eleven at St. Marys Maternity Hospital. No mother died. 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. 157 In the 1,103 "Booked" deliveries there were 28 cases of pyrexia and no deaths without a rise of temperature. The morbidity rate for "Booked" cases was 2.54 per cent. (Mayday Hospital 3.23 per cent., St. Mary's Maternity Hospital 1.83 per cent.). In the 216 "Emergency" deliveries at Mayday Hospital there were 11 cases of pyrexia and 1 death without a rise of temperature. The morbidity rate for Mayday Hospital "Emergency" cases was 5.56 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." Blood Transfusion (25 cases). The citrate method was employed, and donors were supplied by the Blood Transfusion Service of the British Red Cross Society. 1 were "Booked" cases and 10 "Emergency" cases at Mayday Hospital and there was one "Booked" case at St. Mary's Maternity Hospital. One Mayday "Emergency" case and the St. Mary's Booked" case died. In both of these haemorrhage was the indication for the transfusion, and the patient died some time later of sepsis. There were also 7 blood transfusions given to patients admitted for puerperal sepsis per se ; and all these patients recovered. Infants. Mayday Mayday St. Mary's Hospital. Hospital. Mat. Hosp. Booked. Emergency. Booked. Total. Per cent. Number of Infants in hospital on 1st January, 1935 15 2 17 34 — Total number of live births, stillbirths and infants admitted with mother (B.B.A.) 564 106 556 1,226 100 Number of Infants in hospital on 31st December, 1935 17 3 19 39 — Living—alive on discharge from pital 529 77 531 1,137 ( + 5) 93.1 Stillborn (fresh) 12 13 5 30 2.4 Stillborn (macerated) 7 5 5 17 1.4 Died (born alive, but died in hospital) 14 10 13 37 3.0 158 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 606 infants discharged from Mayday Hospital, 348 were up to or over birth weight (57 per cent.). Of 531 infants discharged from St. Mary's Maternity Hospital, 365 were up to or over birth weight (69 per cent.). Twins and Triplets. There were 12 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 6 1 5 12 Number of infants discharged alive 9 0 7 16 Number of stillbirths and infant deaths 3 2 3 8 Foetal and infant mortality 25% 100% 30% 33% *One delivered before admission. POST-NATAL AND GYNAECOLOGICAL CLINIC. In 1935, 68 per cent.of "Booked" cases delivered in the hospitals attended the Post-Natal Clinic six weeks after their confinements. This is practically the same as in 1934. Number of Sessions held 104 Number of individuals presented 1,097 Number of subsequent attendances 387 Total attendances 1,484 Average attendance per session 14.3 Number of Post-Natal cases 867 Number of Gynaecological cases 230 159 Table XI. POST-NATAL CASES. After confinement at Totals. Mayday Hospital. St. Mary's Hospital. Elsewhere. Total cases 361 442 64 867 Cases found to be normal 286 370 34 690 Cases found to be abnormal. 75 72 30 177 Cases treated as Out-patients 60 61 27 148 Cases admitted to Mayday Hospital 7 5 3 15 Table XII. CLASSIFICATION OF ABNORMAL POST-NATAL CASES. Case Group. Source of cases attending Percentage of Abnormals. Percentage of all cases attending. Mayday Hospital. St. Mary's Hospital. Elsewhere Retroversion and Delayed Involution 34 36 8 44.1 9.0 Delayed Involution 9 8 7 13.6 2.8 Trauma 9 13 5 15.3 3.1 Infection 11 3 7 11.9 2.4 Chronic Nephritis 6 4 0 .56 1.2 Other 6 8 3 9.6 2.0 Totals 75 72 30 100.0 20.5 END RESULTS. 862 cases were treated to their termination (other than death) during the year, and the results were classed as follows:— result I.—Health unimpaired as a result of recent confinement (i.e., no symptoms and no anatomical or functional disability). (92%). 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). (6.3%). 160 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). (1.6%). Mayday St. Mary's Hospital. Hospital. Elsewhere. Totals. Result I. 327 419 48 794 Result II. 26 15 13 54 Result III. 7 7 0 14 Totals, treated to conclusion 360 441 61 862 Maternal Mortality (Obstetric Service). These cases fall 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 161). Seven deaths occurred of mothers dealt with by the service, three of these, however, cases of sepsis, only came under the service after the onset of sepsis. 3 deaths occurred in "Emergency" cases, and 1 in a "Booked" case. The maternal mortality of "Booked cases, i.e., cases under the continued supervision of the service was 0.9 per 1,000. This is a sufficient commentary upon the value of such supervision in controlling maternal mortality. The Registrar-General's figures for deaths directly due to pregnancy were as follows:— Total Maternal Deaths allocated to Borough of Croydon 8 Maternal Mortality 2.36 per 1.000 161 report of the puerperal isolation wards. 51 cases were treated in isolation for puerperal infection, 14 of them in the Borough Hospital Puerperal Infection Unit and 37 in Isolation Wards at Mayday Hospital. There were 6 deaths (11.8 per cent.). SOURCES OF THE CASES. From Mayday Hospital— Cases. Deaths. "Booked" cases 18 0 "Emergency" cases 12 2 From St. Mary's Maternity Hospital 4 1 From other hospitals 0 0 From private doctors, deliveries in nursing homes 2 0 From private doctors, deliveries at home 15 3 DAY OF ADMISSION AFTER LABOUR. Before 0 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th After No. of cases 013 12 10 3 4 5 2 00 0 11 43 cases followed Labour with 3 deaths (7.0 per cent.). 8 cases followed Abortion with 3 deaths (37.5 per cent.). The 51 cases treated may be classified as follows:— Cases. Deaths. Mortality Rate. (1) Patients with infection of the genital tract 33 6 18% (a) Infection limited to uterus, vagina and perineum 15 0 0 (b) Infection involving pelvic cellular tissues, ovaries, Fallopian tubes, pelvic peritoneum or veins 10 1 10% (c) Infection of the birth canal spread beyond the pelvis (general peritonitis, septicsemia, etc.) 8 5 62½ % (2) Patients with infective conditions not originating in the genital tract 18 0 0 Factors Bearing on Aetiology. Mo. of cases with infection. genital No. of cases with infection. non-genital Uncomplicated labour 10 6 Long labour 2 3 Surgical induction of labour 1 2 Instrumental delivery 8 5 Spontaneous abortion 4 1 Evacuation of abortion 2 1 Manual removal of placenta 8 1 Excessive bleeding 4 3 Severe lacerations 2 0 Other interference 4 3 162 Parity of the Cases. Over Para 1 2 3 4 5 6 7 8 9 10 10 No. of cases 30 6 3 3 1 3 2 10 1 1 The large proportion of cases drawn from deliveries in Mavday Hospital is accounted for by 4 cases of Abortion and 14 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 29 patients who could not afford to pay a private consultant. The cases were as follows: Threatened abortion, eclampsia, obstructed labour, pseudocyesis, premature infant, puerperal peritonitis, pregnancy and fibroids, post-abortum sepsis, thrombophlebitis of superficial veins, toxic albuminuria of pregnancy, long labour due to contracted pelvis, puerperal pyelitis, post-partum haemorrhage, disproportion, delayed involution, hyperemesis gravidarum, hyperemesis gravidarum, eclampsia, ante-partum haemorrhage, abortion subinvolution, pre-eclampsia, Bartholinitis, obstructed labour, pregnancy and chronic nephritis, haemorrhage following abortion, prolonged labour, uterine sepsis, albuminuria of pregnancy, threatened abortion. In addition, he was asked by the Medical Superintendent of Mayday Hospital to give an opinion on the obstetric and gynaecological aspects of 39 cases in the medical and surgical wards of the hospital. The preceeding pages deal with the maternity service in the clinical control of the Assistant M.O.H. for Obstetrics. In the following paragraphs some aspects of the general maternity work of the borough are reviewed. 103 maternity and child welfare consultations. 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 21 sessions per week are held and at all of these a doctor and a nurse on the staff of the Health Department attend. During 1935, 2,224 new cases under 1 year of age, and 857 over a year of age attended for the first time; this is an increase of 34 in the first class and a decrease of 162 in the second class. The total attendances of infants and young children from 0.5 years increased from 72,839 in 1934 to 79,299 in 1935. Consultations with doctors decreased in numbers from 24,721 to 23,924. 195 expectant mothers were seen, a decrease of 117 on 1934, and a total of 852 visits to the centres were paid by them. The total of all visits to the Centres was 80,151, an increase of 6,174 over 1934. The highest average attendance of mothers and babies at each session was recorded at Municipal (111.7), West Croydon (95.6), and Waddon (94.0). 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. 164 Table XIV. Attendances at Infant Centres—19-35. Municipal. Boston Road. St. Andrew's. 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 1935. Total 1934. Total 1933. Total 1932. Total 1931. Infants : New cases under 1 year 378 109 116 115 111 104 184 189 59 48 195 98 82 106 98 103 129 2224 2190 2194 2278 2217 No. of re-attendances 5462 1472 1745 1726 1882 1643 2530 3384 968 930 3196 1728 1849 1979 1963 1632 2146 36235 33227 36620 35161 33237 New cases over 1 year 140 43 31 35 34 45 77 68 52 19 81 45 20 32 34 61 40 857 1019 1027 1052 895 No. of re-attendances 4941 2131 1816 2468 1452 1632 2636 3479 1602 1405 3658 1874 1649 2634 2077 2631 1898 39983 36403 37622 34645 31434 Attendances of children 0-5 10921 3755 3708 4344 3479 3424 5427 7120 2681 2402 7130 3745 3600 4751 4172 4427 4213 79299 72839 77463 73136 67783 Consultations with Doctor 2765 978 1078 1329 764 1280 1833 2566 963 959 2359 1137 954 1527 914 1345 1173 23924 24721 25251 24652 23068 No. of Sessions 99 50 47 49 47 47 61 100 49 50 98 48 49 50 50 48 49 991 978 979 972 928 Expectant Mothers: No. of new cases 71 1 1 8 8 1 7 22 7 4 27 12 11 1 2 8 4 195 312 305 334 398 No. of re-attendence 66 39 6 32 31 2 50 91 22 19 78 23 36 27 42 78 15 657 826 906 1035 1036 Total attendance of pectant Mothers 137 40 7 40 39 3 57 113 29 23 105 35 47 28 44 86 19 852 1138 1211 1369 1436 Total attendances 11058 3795 3715 4384 3518 3427 5484 7233 2710 2425 7235 3780 3647 4779 4216 4513 4232 80151 73977 78674 74505 69219 Average attendance per Session 1935 1 1 1 .7 75.9 79.0 89.5 74.9 72.9 89.9 72.3 55.3 48.5 73 8 78.7 74.4 95.6 84.3 94.0 86.4 *80.9 1934 98.0 73.3 68.0 1 87.0 57.4 62.2 108.9 69.5 49.8 52.9 69.0 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 74.3 62.7 88.2 98.0 59.7 ... *74.6 165 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 XV. 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 Regd. Maternity Homes St. Mary's Hospital Other Institutions 93 16 77 7 45 30 11 57 33 3 3288 46 4 9 3 2,224 babies under one year of age attended the Clinics for the first time during 1935. Within the same period 3,288 babies were born and 147 died; 54 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 93 babies tabulated who died, 16 had attended a clinic in Croydon and 77 had not attended, i.e., 17 per cent. of the deaths were in clinic babies and 83 per cent. in non-clinic babies. Of the 3,288 babies born, approximately 67.6 per cent. attended or would attend on calculation based on past attendances. The infantile mortality, estimated on this basis is only 6.9 per 1,(100 births for the clinic babies, and 48.6 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, Aproximately 80 per cent, 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, 68 per cent, 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; 70 per 166 cent. of babies under 1 year were being breast fed at their first visit, this figure being less than 1934 (72); 57.7 per cent. of the ailing babies were suffering from digestive troubles, 9.5 percent. from respiratory trouble, and 2.9 per cent. from rickets. The individual centres showing the highest percentage of babies found healthy on their first visit were East Croydon (97) and Waddon (94). Municipal and Shirley, with 91 and 88 respectively, were next. The centre showing the highest percentage of babies found ailing on their first visit was All Saints, followed by St. Andrew's and Upper Norwood. Breast feeding seemed most usual in babies attending Waddon, West Croydon, All Saints', St. Alban's, and Municipal Centres, and least usual in cases attending Norbury, South Norwood, Woodside, and St. Jude's Centres. In children over one year of age, attending for the first time, the highest percentages healthy were shown by Municipal (89), Waddon and East Croydon (88), and Woodside (81); the highest percentages Found unhealthy were at All Saints (71), St. Oswald's (67), St. Andrew's (50), and Shirley and St. Alban's (48). The largest number of first attendances was recorded at the Municipal Centre, followed by St. Alban's, East Croydon, and South Norwood. These Centres hold two sessions weekly. 167 The Conditions of Babies on First Attendance at a Maternity and Child Welfare Centre. Table XVI. Babies Under One Year. Children Over One Year. No. found healthy on 1st visit. Percentage. No.found ailing on 1st visit. Diigestive 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. Mun.cipal (2) 287 91 29 13 1 2 13 229 72 67 20 84 89 10 3 5 0 2 1 91 97 0 1 1 410 St. Albans (2) 133 72 51 28 1 6 16 134 73 40 10 35 52 32 3 6 6 17 0 58 87 0 0 9 251 Boston Road 70 75 23 10 0 2 11 65 70 19 9 24 67 12 0 0 4 8 0 36 100 0 0 0 129 West Croydon 81 86 13 9 0 2 2 73 78 18 3 24 69 11 1 0 1 10 1 31 89 0 1 2 129 Norbury 66 78 19 15 0 1 6 54 64 24 7 21 68 10 1 1 1 6 0 30 97 0 0 1 116 St. Paul's 64 74 22 17 3 1 1 60 70 24 2 24 69 11 2 1 1 7 0 33 94 0 0 2 121 All Saints 19 41 27 17 1 4 5 34 74 11 1 7 29 17 0 9 2 6 0 24 100 0 0 0 70 Shirley 98 88 14 4 0 1 9 78 70 19 15 13 52 12 0 2 1 9 0 25 100 0 0 0 137 South Croydon 87 76 28 18 2 5 16 77 67 16 22 23 66 12 2 1 3 6 0 34 97 0 0 1 150 South Norwood(2) 137 80 34 24 3 2 5 112 66 38 11 33 61 21 4 3 3 11 0 47 87 0 0 7 225 St. Andrew's 58 57 44 29 0 3 12 75 74 24 3 11 50 11 0 6 5 0 0 22 100 0 0 0 124 Upper Norwood 31 57 23 11 0 3 9 37 69 11 6 26 59 18 3 3 2 10 0 41 93 0 0 3 98 Waddon 68 94 4 3 0 0 1 60 83 9 3 28 88 4 1 0 1 11 0 28 88 0 1 3 104 East Croydon 2) 158 97 7 3 0 1 3 117 71 35 13 70 88 10 1 1 1 7 0 80 100 0 0 0 245 Woodside 100 85 18 10 0 2 6 78 66 25 15 25 81 6 0 0 2 4 0 31 100 0 0 0 149 St. Oswald's 49 66 25 10 0 1 14 50 68 18 6 6 33 12 2 4 0 6 0 16 89 0 0 1 92 St. Jude's 86 75 28 15 1 3 9 75 66 21 18 25 57 19 1 3 4 11 0 44 100 0 0 0 158 Totals 1592 80 409 236 12 39 138 1408 70 419 164 479 68 228 24 45 37 131 2 671 95 0 3 30 2708 168 Table XVII. The Work of the Health Visitors.—Maternity and Child Welfare Only. .I c.w. II. R.A. III. D.H. IV. bw. V. A.WW. VI. J.T. VII M.So. VIII. A.P. IX. V.B. X. A.W. XI. j.c. XII. e.h. XIII. I,.p. XIV. A.H. XV. A.c. XVI. K.r. xvii. v.c. xviii. m.c. xix. r.s. xx. C.Wa. XXI. m.Su. XXII. G.T. XXIII. E.P. xxiv. p.c. Totals Sessions attended at Infant Welfare Centres 90 49 … 45 10 59 43 41 53 51 53 41 19 54 3 46 91 54 53 72 … 18 44 30 1019 Visits to Expectant Mothers. First visits 36 6 2 4 26 12 13 … 11 8 17 14 3 1 1 9 3 29 3 5 12 5 11 11 242 Re-visits. 28 7 … 5 8 6 6 1 22 … 14 56 2 ... 2 … … 4 … 6 1 2 … 39 209 Infants under 1 year. First visits 204 83 69 133 107 216 93 157 318 257 175 158 142 182 4 172 163 279 166 100 96 34 264 83 3675 Re-visits 342 175 158 77 195 309 134 227 378 255 439 863 160 548 25 186 364 774 441 382 91 250 185 679 7637 Children 1—2 years. First visits 7 3 7 3 … 4 2 2 14 … 11 29 21 3 1 2 9 5 2 7 … 2 21 3 158 Re-visits 373 212 154 166 173 327 119 140 277 274 318 714 207 354 22 144 404 681 348 400 142 219 172 663 7003 Children 2—5 years. First visits 2 … … 4 … 8 5 1 4 … 4 4 3 2 1 1 9 9 15 4 1 10 7 13 107 Re-visits 786 656 126 296 470 495 489 415 302 481 212 989 170 555 30 453 602 634 699 297 167 178 357 774 10633 Ophthalmia Neonatorum. First visits 1 … … … … … … … … 2 … … … … … … 1 2 3 … … … … 1 10 Revisits … … … … 1 … … … 3 … … … ... … … … ... 3 … … … 3 … … 10 Still Births 4 3 3 25 7 6 6 … 3 8 1 2 … 2 … 3 6 10 8 2 3 1 9 3 115 Milk (Mothers'and Children's Order) 3 8 … 66 3 7 4 … 2 3 8 … 11 1 … 7 2 … 33 19 2 17 … 1 202 Puerperal Fever and Pyrexia Visits … … … 2 … … 1 … … … … … … … … … … … … … … … … … 3 Houses where deaths of Infants occurred 4 3 2 13 10 13 2 5 7 5 3 … … 8 … 12 5 8 6 3 2 … 13 … 124 Miscellaneous Visits 29 14 … 315 17 100 102 20 13 22 3 23 36 17 … 97 7 18 18 10 69 3 12 2 947 Ineffective Visits 392 175 271 473 434 385 314 235 478 262 393 239 165 308 10 208 532 287 835 257 530 118 116 244 7661 Post Natal Visits ... ... ... … … … … … 76 60 … … … … … … … … … … … … … … 136 Totals—3 935 2211 1345 792 1582 1451 1888 1290 1208 1908 1637 1598 3096 920 1981 96 1294 2107 2743 2597 1492 1116 842 1167 2516 38872 1934 2754 1740 1288 1944 1446 2391 1577 1492 1764 2132 1670 3392 ... 2181 2801 1738 2435 2770 3175 200 1534 3740 1378 ... 45641 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 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 XVIII. On Dec. 31st, 1934. New cases during the year. Cases discontinued. On Dec. 31st, 1935. Free 374 680 747 307 Half-price 50 168 146 72 Total 424 848 893 379 In cases where there has been a change from free milk to milk at half-price it has been counted as a new case. The year showed a decrease of 45 in assisted milk cases. Assisted Fluid Milk Scheme. The amount of milk granted was 129,591 pints. In 1934 it was 121,395 pints. Supplied to Families. No. of Pints. Corporation Liability. £ s. d. Milk at l½d. pint 17,755 134 6 7 Milk Free 111,836 1,555 8 10 129,591 £1,689 15 5 Dried Milks for Year. 1 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 an increase from 1934 in the amount of dried milk given free of 1,017 170 packets, of 4-35 packets sold at half-price; and of 172 packets at cost price. Table XIX. Mothers and Infants Welfare Association. (19 sessions per week) Municipal Centre. (2 sessions per week). Free. Halfprice. Full price. Free. Halfprice Full price. January 346 95 948 65 2 170 February 295 89 752 62 ... 176 March 308 106 737 72 1 198 April 286 127 692 68 ... 236 May 453 162 654 54 ... 243 June 238 149 610 71 2 222 July 402 179 901 66 13 254 August 346 136 841 62 19 233 September 351 115 884 70 18 226 October 428 159 1081 92 13 200 November 419 72 1282 81 2 194 December. 435 85 1187 74 8 192 Totals 4307 1474 10569 837 78 2544 Observation Nursery.—Summary of Work Done. No. of mothers admitted 3 No. of cases in on 1st January, 1935 12 No. of cases admitted during 1935 96 Average duration of stay 26 days No. of cases discharged 98 (a) In good health 80 (b) Improved 11 (c) No improvement (taken out by parents against doctor's advice) 4 Referred to other Institutions 3 No. of cases who died 0 No. in at end of 1935 10 I case referred to Infants' Hospital, Vincent Square—pyloric stenosis. 1 case referred to the Belgrave Hospital—hydrocephalus. I case referred to Mayday Hospital—ischio-rectal abscess. Reasons for Admission. Failure to thrive 19 Re-establishment of breast Rachitis 11 feeding 2 Marasmus 6 Weaning 2 Alimentary disorders 8 Enteritis 7 Mismanagement 5 Anaemia 4 Malnutrition 18 Injury to knee 1 Bronchitis 2 Pyelitis 1 Congenital heart 1 Constipation 1 Vomiting 1 Colitis 1 Prematurity 5 171 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 Orthopedic Clinic and from London Hospitals. The following Table summarises the work done, and indicates the type of case referred. Total number of female patients 37 ,, ,, male patients 67 Total 104 Table XX. Conditions for which referred. Males. Females. Total. Mouth Breathing 1 1 2 Secondary Amyotonia 1 — 1 General backwardness 9 2 11 Weak legs 11 4 15 Bow legs 16 11 27 Knock-knees 26 15 41 Flat-feet Hemiplegia 1 — 1 Torticollis 1 1 2 Scar tissue — 1 1 Talipes — 1 1 Weak abdominal muscles 1 1 2 Totals 67 37 104 Total number of sessions 253 ,, ,, attendances 1,917 Average attendance per session 8 Cases still under treatment at end of 1935 37 172 DENTAL TREATMENT OF MATERNITY AND CHILD WELFARE PATIENTS. Three dental officers devote one-eleventh of their time to the treatment of expectant and nursing mothers and young children. This small amount of time is inadequate to deal with the large number of cases awaiting treatment, and in the circumstances it has been impossible to treat all the cases referred by the medical officers. Out of 761 expectant and nursing mothers and young children referred for treatment 537, or 71 per cent. were actually treated. This is an improvement on last year, when 52 percent, were treated. Table XXI. Expectant. Nursing. Young Children. Total. 1935 1934. Number Examined 145 182 207 534 514 Referred for Treatment 135 171 203 513 492 Attendances 375 929 381 1685 1681 Fillings 40 135 90 205 212 Extractions 486 882 731 2099 2274 "Gas" Cases 63 99 121 283 381 Local Anaesthesia 03 142 53 298 294 Scalings 39 66 7 112 93 Dressings 75 59 25 159 140 Denture Dressings 86 346 — 432 336 Gum Treatment 8 26 2 36 40 AgNo - 1 6 7 8 Treatments completed 32 86 177 295 308 Sessions at Centres—5. Sessions treatment—130. Number of Dentures fitted—138. Appointments sent—2,320. Appointments kept—1,730. 74.55% appointments kept. 173 The record of inspections and treatments compares favourably with that of the previous year, and it is satisfactory that the conservative treatments have increased. The number of fillings inserted was 265, which is an increase of 53. The extractions have been reduced from 2,274 in 1934 to 2,099 this year. Three more sessions were devoted to treatment. Once again it has been impossible for the dental officers to visit all the Centres to examine the young children and advise mothers regarding the dental troubles of their infants. At the Centres the mothers are given a short talk by the dental officer, who explains the value of correct diet, shows various charts depicting healthy and diseased structures, and distributes pamphlets on the dental care of the infant. It is still evident that many mothers have not yet realised that with the eruption of teeth food of a nature that will exercise these teeth and the jaws should be given. The sucking of dummies and thumbs continues to be prevalent, and the dental officers still have to treat a number of infants of two years and sometimes younger for conditions brought about through these bad habits. The expectant mothers treated represented 44 per cent. of the total number of women treated, which, although slightly lower than last year is, nevertheless, satisfactory when compared with the average of previous years. 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 35.9 „ „ 1935 37.0 37.5 25.5 These figures show that a very much larger percentage of mothers was treated in the early months of pregnancy. This result is gratifying and points to a breaking down of the prejudice against dental treatment, which is still, however, prevalent among ante-natal patients. 174 Nursing Mothers. Age of baby when mother was first seen: — 1—3 months 4—6 months 7—9 months Over 9 months % Mothers seen in 1932 35.7 26.2 18.3 19.8 „ „ 1933 38.7 32.0 18.6 10.7 „ „ 1934 45.0 24.5 24.5 6.0 „ „ 1935 38.0 32.0 23.0 7.0 The higher percentage of nursing mothers seen soon after the babies were born were referred during the expectant period, but owing to congestion of cases were not called up earlier for treatment. Those women who delayed seeking advice till late in the nursing period have been treated for the removal of septic teeth only. Most of them, however, were emergency cases, and treatment was for the relief of pain. Many mothers tolerate sepsis in their mouths for years, but with the added strain of pregnancy there is a danger of a breakdown of resistance which may cause pyrexia, and it is, therefore, desirable that all pregnant women should be dentally examined and treated as early as possible. The Pre-School Child. The number of toddlers examined and treated shows a slight reduction. The extraction of teeth for these children is less in number than in the previous year, as is also the number of fillings. It is unfortunate that while so much of dental disease may be prevented by proper prophylactic methods, mothers, as a whole, still appear to take little interest in the dental condition of their children until toothache occurs. It would appear that further education and time must be expended before the teeth of the pre-school children will show any marked improvement. Many are given food of the type that "breeds" caries, and frequently mouth sanitation is not considered worth while, so it is hardly to be wondered at that the dental officers often see varying stages of dental disease in children of two years old and sometimes younger. 175 The Infant Welfare Centres at which patients were examined, or from which they were referred, are given in the following list:- 1934. 1935. 1934. 1935. Ante-Natal 275 224 Post-Natal 14 16 Addiscombe (East) 48 46 St. Alban's 48 35 Municipal 64 66 St. Andrew's 51 35 Shirley 7 14 Waddon 44 47 Norbury 18 26 West Croydon 32 21 Upper Norwood 19 27 Roston Road 32 36 Moffat Road 13 6 St. Jude's 20 25 South Croydon 44 30 St. Paul's — 17 Woodside 37 14 The Retreat 5 16 South Norwood 69 42 Nursery School 12 9 St. Oswald's 9 9 The amount taken in attendance fees was £50 2s. 4d. The Babies' Help Committee of the Croydon Mothers' and Infants' Welfare Association. 1 am indebted to Mrs. W. Philpot for the particulars presented herewith. At the beginning of the year the Committee had 10 cases on the books; 10 new cases were helped during 1935; 6 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 156 Children sent away alone to Convalescent Homes— (a) to Coombe Cliff 26 (b) to other Homes 4 30 176 A grant of £600 was made by the Council to the Association for this work in 1935. The year is the financial year. Children under 5 Total Cost of sent to number other forms of Homes. of weeks. Cost. Convalescence. £ s. d. £ s. d. 1928—1929 18 86 107 10 0 261 10 7 1929—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 1933—1934 56 378 287 6 11 387 0 2 1934—1935 48 337 279 10 10 470 3 4 1935 (April 1st to Dec. 21st) 25 240 184 10 10 389 16 0 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. Wilford Road, Lighthouse Mission Creche. The Council give an annual grant of £100 towards the cost of this Creche. A total of 6,649 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. 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: 139. Total number of cases discharged: 163. No. of patient days: 63.4 per patient (1935 cases). 177 Table XXII. Age groups of cases admitted. 0—4 5—8 9—12 Over 12 Total Male 9 36 19 5 69 Female 11 32 23 4 70 Total 20 68 42 9 139 Average length of stay in similar age groups. 0—4 5—8 9—12 Over 12 Total (days) Male 87.5 64.3 63.7 46.2 64.9 Female 72.9 69.5 52.1 49.8 61.5 Total 80 2 66.9 57.9 48.0 63.2 Condition on discharge. 0—4 5—8 9—12 Over 12 Total M. F. M. F. M. F. M. F. M. F. Improved 6 6 23 14 15 9 3 2 47 31 Much Improved 2 4 9 9 9 16 2 2 22 31 No change 2 2 5 6 6 3 — 13 11 Discharged at parent's request 3 3 — 1 — — 1 3 5 Total 13 15 3, 30 30 28 5 5 85 78 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. 178 The Tables below give figures for 1935. Table XXIII. FOSTER CHILDREN No. as at Dec, 31st, 1934 Notice of Reception of Children during the year Notice of Removal to— Children Adopted Died Children r«iching age of 9 No. as at December 3lst, 1935 Parent Another area with Foster Parent Another Foster Mother Public Institution 286 252 123 4 62 28 23 3 10 285 Table XXIV. FOSTER MOTHERS. Nos. at Dec. 31st, 1934 Applications for Registration during the year Removals during the year Registration cancelled for other reasons No. as at December 31ft, J935 With Child Without Child 250 52 3 4 141 154 The Health Visitors paid 2,668 visits to foster mothers for the purposes of supervision. 179 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 of the Occupation Centre, with three helpers. There are two main administrative groups of mentally defective, 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 years 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 main sources of notifications of school children suspected to be suffering from mental defects are received from School Teachers and the School Enquiry Officers. Sources of informalion regarding cases not coming within the category of school children are mainly the Infant Welfare Centres, Health Visitors, probation Officers, Private Practitioners and Social Workers. Number of known Mentally Defective Persons in the Borough— 1. Statutory Cases— Aged 0—5 years 4 Aged 5—16 years 84 Over 16 years 406 , Total 494 180 II. Education Cases— Aged 7—16 years 154 Combined Total 648 Compared with 1934, the Statutory cases show an increase of 34 and the Education cases an increase of 6. Two of the cases under Statutory supervision have been removed from the list and 2 have died. The Statutory cases are distributed as follows:— In Certified Institutions 139 In Places of Safety and Approved Homes 6 On Leave from Institutions 7 Under Statutory Supervision at Home 249 Under Guardianship 49 In Mental Hospitals 13 Oases under Public Assistance 20 Observation Cases 11 There is a steady increase m the number of cases under Statutory Supervision at home, due to some extent to the difficulty of finding suitable residential accommodation. No new cases are now being dealt with by the Public Assistance Committee, as the Council now follow the policy that the Mental Ddfinency Committee is the correct Committee to be responsible for the care and supervision of mentally defectives. The Education cases were distributed as follows:— In Certified Residential Schools 9 In Certified Day Schools 106 At Private Schools 4 At Council Schools (awaiting vacancies at St. Christopher's) 25 At no school; resident at home 1 Released for work 9 During the year, the Certifying Medical Officers made tions and paid visits to the number of 100 to Statutory cases and 301 to Education cases—a total of 401, an increase of 17 over 1934. The Mental Deficiency Visitors paid 2,050 visits to statutory cases and 2,150 to Education cases, 4,200 visits in all, an increase over 1934 of 966 visits. 181 During the year, 34 names have been added to the Statutory List:—17 of these being notified from the Local Education Authority, and the remaining 17 from other sources. 4 names tore been removed from the list—2 having died, and 2 being deleted as requiring no further supervision. 3 cases chargeable toother Local Authorities are under supervision in the Borough. Notified Cases. Of the 17 cases notified by the Local Education Authority— 1 is now in a Certified Institution; 7 are attending the Occupational Centre; 3 are at work; 6 are at home, 3 of whom are awaiting vacancies in an Institution. During 1935, twenty-three Statutory cases were dealt with as follows, viz:— Sent to Certified Institutions 9 Sent to an Approved Home 1 Placed under Guardianship 4 Leave granted to care of brother 1 Sent to Croydon Mental Hospital 1 Varying Orders— (a) Change of Guardian 1 (b) From one Institution to another 1 (c) From Guardianship to Institution 1 (d) From Institution to Guardianship 3 6 Orders Closed 1 23 The number of cases sent to Certified Institutions shows a decrease of five. It is hoped when the Botley's Park Colony of the Surrey County Council is available, two desirable steps can be taken. Firstly, that more cases can be sent to an institution, and secondly, that cases now placed in institutions a long distance from Croydon will be withdrawn from those institutions and all placed nearer Croydon, in the Colony. 182 Guardianship Cases. There are 49 cases under Statutory guardianship—28 of these under the care of relatives, and 21 with guardians who are not relations. 7 males and 6 females are at work. 18 cases are out of the Borough; 12 under the Brighton Guardianship Society, 1 in Maidstone, 1 in Godalming, 1 in Streatham, 1 in Anerley, 1 in Essex, and 1 in Suffolk. 4 hoys and 2 girls attend the Occupation Centre at Grangewood. 19 of the guardianship cases are doing useful work and 15 are quite unemployable. 4 new cases have been placed under guardianship—3 of these in the Borough and 1 at Anerley. 240 visits have been paid to guardianship cases (hiring the year. Cases on Leave from Institutions. There are 7 cases on licence from institutions; 4 are boys, and of these 1 is in regular employment and 3 are in Mayday Hospital. These 3 cases are on licence because their parents complained of the distance they had to travel when they were away in the various institutions. Three are girls in regular work. There are 7 cases in Queen's Road Homes under a temporary licence from the Board of Control who were "On Leave" last year. St. Christopher's Special School. The year 1935 opened with 105 scholars on the roll. During the year 25 children were admitted, and 24 left, leaving 106 names on the Register on December 31st. Further particulars regarding the special school are included in the School Medical Section of this report. (See page 293). Town Hall Clinic for Mentally Defective and Backward Children. 96 children were examined during 1935. The classifications arrived at, together with the recommendations made, are summarised as under:— I. (a) Certified as Mentally Defective 41 (b) Confirmed as Mentally Defective 8 - 49 Recommendations— (a) Recommended for Special Day School 35 (b) Recommended for Residential Schools 2 (c) Referred to Occupation Centre or Institution 11 (d) Observation at home 1 49 183 II. Found to be dull and backward 24 (a) Referred to a Special Class 16 (b) Further trial in Ordinary Class 5 (c) To have physical treatment 1 (d) Change of school recommended 1 (e) Deferred pro tem 1 24 III. Found to be Physically Defective 3 (a) To continue at ordinary school, and have Medical ment 1 (b) To attend a Myope school 1 (c) Decision Deferred 1 — 3 IV. (n) Considered to be of normal intelligence and referred to ordinary school 6 (b) Referred to Child Guidance Clinic 1 (c) Recommended to Education Committee for ship away from home 2 (d) Change of home recommended 11 — 10 V. Decision Deferred and for re-examination later 10 VI. Mental and physical examinations at St. Christopher's School 153 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. Younger children attend daily mornings and afternoons (10 sessions), the senior girls on Monday, Wednesday and Friday afternoons from 2 to 4 p.m. (3 sessions), and the senior boys on Tuesday and Thursday from 2 to 3.30 p.m. (2 sessions). The premises are not very suitable, as there are insufficient rooms available to allow of proper separation of the different grades of children, and the premises are situated in a public park, a circumstance which limits the amount of outdoor activity somewhat severely. The Mental Deficiency Committee are considering the matter of alternative and more suitable accommodation. The Centre is divided into three classes, each in charge of a teacher who is responsible for her class to the Supervisor. 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 and memory training, colour, sound, numbers, elements of stitching and rug making. 184 As handicrafts are taught cork bead mat making, paper winding, mats, raffia weaving, knitting, ravelling, wool sorting. In addition balancing exercises, team games, and country dancing are indulged in. 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, and baskets are made. Country dancing, drill and singing are also taught. The senior boys learn basket making, making wool rugs, sea gross 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 70 parents, tea being provided together with presents off the Christmas tree for the children. Two open days for parents were also held. 1935. Details. Full Time. Part Time. No. on register January 1st, 1935 49 13 No. of pupils who left during the year 4 3 No. of pupils admitted during the year 9 No. of pupils on register January 1st, 1936 54 11 Total attendances 8,321 597 Average morning attendance (whole time class) 38 - Average afternoon attendance, senior girls' class 3 „ „ „ senior boys' class 3 Sessions held 217 200 Girls' Afternoon Class— Total attendances 408 Sessions held 126 Boys' Afternoon Class— Total attendances 189 Sessions held 74 There has been a steady increase in the number of children on the register during the past 3 years. 185 SECTION X. ORTHOPÆDIC DEPARTMENT. Cases referred for Orthopædic treatment from the various 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 live years, referred by Medical Officers at the Welfare Centres. Table I. Summary of Cases Attending the Orthopœdic Clinic. Jan. 1st, 1935. New Cases. 1935. Cases Discharged, 1935. Cases on books, Dec. 31st, 1935. M.C.W S.M.S. Tuberc. M.w. S.M.S. Tuberc. M.C.w S.M.S Tuberc. M.C.W. s.M.s Tuberc. 240 300 58 124 177 17 170 221 17 194 256 58 598 318 408 508 186 Table II. Cases Seen by the Orthopœdic Surgeon. Defect School. M.C.W. Tuberculosis. Total. Cases. Visits paid. Cases. Visits paid. Cases. Visits paid. Cases. Visits paid Infantile Paralysis 33 71 7 24 ... ... 40 95 Curvature or postural defects 59 93 4 5 ... ... 63 98 Pes Cavus 8 25 ... ... ... ... 8 25 Pes Planus* 184 223 96 100 ... ... 280 323 Talipes 8 16 38 105 ... ... 46 121 Genu Valgum 29 32 105 131 ... ... 134 163 Obstetrical Paralysis 13 17 6 23 ... ... 19 40 Joint Disease 4 7 1 1 40A 29S 6M 47 52 6 80 113 Injuries 40 61 12 22 ... ... 52 83 Rickets 6 6 33 54 ... ... 39 60 Wry Neck 7 7 7 10 ... ... 14 17 Spastic Paraplegia 15 34 3 6 ... ... 18 40 Other Deformities 71 124 52 89 ... ... 123 213 477 716 364 570 75 105 916 1391 *Includes cases of ankle valgus, spasmodic valgus, and other predisposing causes of flat feet. Summarised, the Table shows 477 school children attended and made 716 attendances; 364 babies made 570 attendances; and 75 tuberculosis cases made 105 attendances; a total of 916 rases, making 1,391 attendances. The following Table shows the number of cases referred direct from the Orthopaedic Clinic for massage, Swedish remedial, and electrical treatment, and also X-Ray examination at the Croydon General Hospital. 187 Table III. Cases referred from Orthopœdic Clinic for Remedial Treatment and X-Ray at Croydon General Hospital. Defects School Case . M.C.W. Cases Tuberculosis Cases Total Cases No. of Treatments X-Rays Cases No. of Treatmen's X-Rays Cases No. of Treatments X-Rays Casts No. of Treatments X-Raye Infantile Paralysis 4 209 ... 5 106 ... ... ... ... 9 315 ... Curvature or postural defects 18 209 2 ... ... ... ... ... ••• 18 209 2 Pes Planus 13 116 1 ... ... ... ... ... ... 13 116 1 Talipes 1 4 ... 15 186 1 ... ... ... 16 190 1 Genu Valgum 2 11 1 9 78 ... ... ... ... 11 89 1 Obstetrical Paralysis 2 59 ... 2 77 ... ... ... ... 4 136 ... Joint Disease 1 ... 1 1 ... 1 18 16 19 20 16 21 Injuries 11 68 6 1 ... 1 ... ... ... 12 68 7 Rickets 1 5 ... 3 ... 3 ... ... ... 4 5 3 Wry Neck 4 67 ... 1 14 ... ... ... ... 5 81 ... Spastic Paraplegia 2 51 ... ... ... ... ... ... ••• 2 51 ... Other Deformities 24 74 20 10 25 14 ... ... 34 99 34 83 873 31 47 486 20 18 16 19 148 1375 70 Table IV. Cases Sent to Residential Institutions. School Cases M.C.W. Cases Tuberculosis Cases Total No. in on Jan. 1ft. 1936. 1 Name of Institution No. in on Jan. 1st. 1935 Admitted Discharged No. in on Jan. 1st, 1935. Admitted Discharged No. in on Jan. 1st, 1935. Admitted Discharged No. in on Jan. 1st, 1935. Admitted Discharged Pyrford 3 3 2 2 4 2 10 5 1 15 12 5 22 Croydon General 1 13 13 ... 8 6 ... 4 3 1 25 22 4 Heritage Craft Schools ... 1 ... ... ... ... ... ... ... ... l ... 1 4 17 15 2 12 8 10 9 4 16 38 27 17 188 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, 1935. Admitted. Discharged In on Jan. 1st, 1936. Cured. Much Improved. Improved. Hemiplegia ... 3 ... 3 ... ... Infantile Paralysis ... 6 ... 4 ... 3 Talipes ... 2 ... 1 ... 1 Tuberc. Joint Disease 10 8 1 ... 2 15 Observation Joint Disease 2 7 1 2 2 4 Rickets 4 1 1 ... ... 4 Wry Neck ... 1 1 ... ... ... Knock Knees ... 3 2 ... 1 ... Flat Feet ... 1 ... 1 ... ... Other Deformities ... 6 2 2 1 1 16 38 8 13 6 S7 The percentage of cures in cases discharged was 30%, whilst 48% 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, 1936 508 Total number actually in receipt of massage, electrical, Swedish remedial treatment, on January 1st, 1936 37 New splints and appliances supplied 88 Repair of existing appliances 26 Part cost met by parents 16% Full cost met by parents 43% Full cost met by Local Authority 41% Number of cases in which Hospital contributions were authorised 32 Mrs. D. B. Connor, the Organiser of this Department, attended 48 Clinic sessions, interviewed 2,364 people, made 311 enquiries into financial conditions of families, and sent nut 739 letters in connection with her 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. 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 medical officer was on duty for 6 hours per day during the summer months, i.e., from April to September, and 2 hours daily during the winter months. Towards the end of the year, however, arrangements were made for an all the year round sixhour daily duty. This was necessitated by the increased traffic and the growing independence of aircraft on weather conditions. The arrangements made at the Aerodrome for the convenience of passengers and for the examination of aliens are satisfactory, and work smoothly and efficiently. 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, 1935. Number cf Planks. Arrived from Amster- Else- Total: Arr. 6,027 Seen. 2,532 Paris. 2,711 dam. 1,418 Brussels. 1,174 where. 724 Passengers. Attendances British. 33,582 Others. 24,967 Inspected. 26,264 Exd. 114 of M.O. 326 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, as the following figures show: 1643 more planes arrived, and the number of passengers arriving increased by 11,392. 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 Maternity and Child Welfare Department (44), the School Medical Service (32), and the Tuberculosis Dispensary (5). The following Table gives a summary of the attendances marle:— Table I. Department. No. of Cases. Aggregate duration of treatment in weeks. Aggregate No. of Sessions Attended. No. .if Patients discharged. Nd. continuing treatment end of 1935. School Medical 32 .367 930 27 5 M. &C.W. 44 393 1019 38 6 Tuberculosis 5 28 69 4 1 81 788 2018 69 12 The Table under gives the complaints treated and the results achieved in completed cases. Nine cases ceased attending before completion of treatment, one case contracted Scarlet Fever, and three cases left the Borough. Table II. Condition, School Cases. M. C. W. Cases. Tool. Much Improved. Improved. Slight Impr. I.S.Q. Much Improved. Improved. Slight Impr. I.S.Q. Debility 3 7 2 ... 6 4 1 ... 23 Asthma ... ... ... ... ... 1 ... ... 1 Bronchitis 2 1 ... ... 2 2 ... ... 7 Glands 3 2 ... ... ... ... 1 ... 6 Rickets ... ... ... ... 5 3 ... ... 8 Miscellaneous 2 4 ... ... ... ... 1 ... 7 10 14 2 ... 13 10 3 ... 52 191 School Cases. Five school cases were still attending the Clinic at the end of the year. These were suffering from the following conditions, viz.:—General Debility, 3; Pulmonary Catarrh, 1; Bronchitis, 1. Maternity and Child Welfare Cases. Six 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; Pickets, 1; Bronchitis, 2. Four cases were discharged, of whom 2 suffering from Adenitis were much improved, and 2 from Sinusitis showed only slight improvement. Of the School cases, 20 were boys and 12 girls; the Maternity and Child Welfare cases, 25 boys and 19 girls; and the Tuberculosis patients, 2 male and 3 female. All the cases referred to the Clinic had been carefully selected as likely to benefit; of those discharged, 43.2% after completion of treatment, were much improved, 26.3% were improved, and 30.5% were not benefited. These figures show that this treatment 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 69 of the cases; the latter alone in 9 cases, and both lamps in 3 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. BLIND PERSONS ACT, 1920. The scheme under Section 102 (1) of the Local Government Act, 1929, came into force on April 1st, 1930. It has continued unchanged. I nder 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. 192 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 Medical Officer of Health. I am indebted to the Secretary of the Voluntary Association for the figures below:— Number of blind on liegister 375 Number of blind who benefit from instruction in Braille or Moon Type (including those who already read) 58 Number of blind who benefit from part-time instruction 32 Number in remunerative handicrafts— (a) Home workers 31 (b) In workshops 10 (c) St. Dunstan's 13 (d) Workers not included in scheme 6 Home Teacher 1 The Health Visitors paid 830 visits to blind persons during the year. The following Table, compiled for the Ministry of Health, shows: (a) the number of blind persons registered; (b) the ages at which blindness occurred; (c) the method of training; (d) the occupations of employed blind persons; (e) the defective blind; and (f) the unemployable blind persons in homes, mental hospitals or institutions. 193 194 M.=Males F.=Females. T.=Total. WELFARE OF THE BLIND—REGISTRATION. As at 31/3/36.TABLE I. Name of Authority: CROYDON. Age period 0—1 Age period 1—5 Age period 5—16 Age period 16—21 Age period 21—40 Age period 40—50 Age period 50—65 Age period 65—70 Age period 70 and over (i) Total of all age groups (ii) Age unknown M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. - — 2 - 2 7 4 11 4 3 7 29 27 50 25 19! 44 32 31 63 41 37 78 42 78 120 (i) 182 (i) 109 (i) 381 (ii) - (ii) 2 (ii) 2 TABLE II.—AGES AT WHICH BLINDNESS OCCURRED. (The total of this Table should agree with the total of Table I.) Age period 0—1 Age period 1—5 Age period 5—10 Age period 10—20 Age period 20—30 Age period 30—40 Age period 40—50 Age period 50—60 Age period 60—70 Age period Age period M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 23 15 38 1 11 12 7 9 16 12 6 18 16 14 30 24 19 43 16 24 40 22 24 46 21 25 46 15 22 37 25 32 57 TABLE III.—Children of School Age, 5—16. Normal Mentally Defective Physically Defective M. F. M. F. M. F. In Schools for the Blind 7 3 — — — — Other Schools — — — — — — Sot at School — — — 1 — - TABLE IV.—Training and Employment. Age Period 16 and upwards. Employed Undergoing Training. (h) (i) (j) (k) By Blind Organisations (c) (d) (e) (f) (g) All others not included in (a) and (b) Total Employed Industrial Secondary Professional and University Trained but. unemployed No training but trainable Unemployable Total (a) Workshops (b) Home M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 5 4 9 21 12 33 26 2 28 52 18 70 3 3 6 - - - - - - - - - - - - 118 176 294 173 197 370 TABLE Y.—Occupations of Employed Blind Persons included in (d) of Table IY. Agents, Collectors, &c. Basket Workers Bedding (including Divans & Ottomans) and Upholstering Boot Repairers Braille Copyists and Proof Readers Brush Makers Carpenters and Woodworkers Cbairseaters Clerks and Typists Coal Bag Makers Dealers, Tea Agents, Newsagents, ShopKeepers Firewood Workers Gardeners Hawkers, Newsvendors, &c. Home Teachers Knitters Labourers Massage Mat Makers Ministers of Religion Musicians and Music Teachers Netting Makers Porters, Packers, Cleaners Poultry Farmers School Teachers Ships Fender (Fendoff) Makers Telephone Operators Tuners Weavers Miscellaneous i Total Makers Mattress Machinists Upholsterers Hand Machine Within Institution for the Blind — 5 - - - - - - - - - - - - - - 1 3 - - - - - - - - - - - - - - 13 In approved Home Workers Schemes - 2 - - - - - - - 5 - - - 1 - - - - 11 - -1 - - - - - - - - 13 - - - 33 Others (not pastime workers) - - — — — 1 - — — — 1 7 — — — — — — 1 2 2 2 3 — - - — 5 — — — 24 Total - 7 — — — 1 — — — 5 1 — 7 1 — - 1 — 14 — i 3 2 2 4 — — 3 — 5 13 — — 70 TABLE VI.—Physically and Mentally Defective (including those given in Table III.) (a) Mentally Defective. (b) Physically Defective. (c) (i) Deaf (ii) Deaf-mute Combinations Combinations Combinations Combinations Total M. F. T. M. F, T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 3 1 4 2 3 5 (i) 8 (ii) - (i) 6 (ii) 1 (i) 14 (ii) 1 1 - 1 - - - - - - - - - 14 110 24 TABLE VII.—Unemployable persons resident in Homes for the Blind, Mental Hospitals or Poor Law Institutions. Homes for the Blind Mental Hospitals Poor Law Institutions M. F. T. M. F. T. M. F. T. — 6 6 1 1 2 5 16 21 195 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, 1935, of the work carried out by the Sanitary Inspectors 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. Crovdon 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 Ac:, 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). 190 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, 192.3. 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. „ Improvement Areas, 1935. 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) 4910 No. of houses inspected under the Housing (Consolidated lations) 1925 2957 No. of Houses inspected under the Rent Restriction Acts 104 No. of Houses inspected where zymotic diseases have occurred 741 197 House drains tested with smoke (primary) 1919 House drains tested with smoke (on application) 28 No. of smoke tests during repair 528 Inspection of drainage work during construction 3720 No. of water tests during repair 430 Final tests of drains after repair 65 Final tests of drains when completely relaid 65 Length of new drains tested with water yards 2085 Inspection of yards, stables and manure pits 668 „ Passages 61 „ Public Conveniences 3549 „ Pigstyes 62 „ Tents, Vans, and similar structures 28 „ Theatres, Cinemas, Halls, etc. 139 „ Ponds and Ditches 39 „ Schools and School Lavatories 201 „ Common Lodging Houses (including night visits) 164 „ Houses let in lodgings 130 „ Premises where offensive trades are conducted 187 „ Aviaries 6 Smoke Observations 46 No. of Visits re Infectious Diseases 1787 Inspections of Shops (under Shops Acts) 4287 Special Early Closing Patrols 82 Special Evening Inspections under Shop Hours Act 152 Inspections under Fertilisers and Feeding Stuffs Act 61 „ under Pharmacy and Poisons Act 18 „ Dairies 403 „ Farms and Cowsheds 150 „ Milkshops 485 „ Premises where food is prepared or sold 6867 „ Slaughterhouses 969 „ Factories 388 „ Factory Laundries 30 i. Workshops 452 „ Workshop Laundries 9 ,, Workplaces 163 „ Factory Bakehouses 299 „ Workshop Bakehouses 126 ,. Outworkers Premises 31 Baths Inspections 8 Water Samples examined 15 Visits to Employers of Outworkers 7 Reinspertions of Work in Progress 29522 Sundry Inspections and Visits 6281 Appointments kept with Owners, Builders, etc 3398 Complaints from public investigated (for purposes other than inspection of House) 4087 Examination of Building Plans 50 Informal Notices outstanding 31/12/34 3092 „ „ served 11794 „ „ complied 10051 No. of Informal Notices referred for Statutory Orders 729 informal Notices outstanding (including 332 overcrowding) 4106 statutory Notices outstanding 31/12/34 192 „ „ served 718 Total number of complaints received 624 Total number of complaints received 3468 interviews with callers 4611 Letters received 6058 Letters and other intimations, etc., sent (not including notices) 7086 198 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1935 and for which action was taken to enforce compliance:— (1) NUISANCES AND HOUSING DEFECTS AT HOUSES, &c. Insufficient means of ventilation— Defective sashcords 1707 „ windows 1386 Want of windows or ventilators 44 Conditions causing dampness— Defective roofs 1606 „ gutters 833 „ downspouts 461 „ walls, etc. 1205 Deposits of refuse causing dampness 3 Want of proper damp proof course 126 Other internal defects and nuisances— Defective plaster Cleansing and limewashing required 2418 Defective floors 914 Insufficient ventilation under floor 58 Defective stoves and fireplaces 790 Defective sanitary fittings— Defective sinks 406 „ waste pipes 411 Abolition of drinking water cisterns 43 Defective w.c.'s 1276 ,, drainage 999 Stoppage in drains Domestic nuisances— Want of cleanliness 41 Dirty w.c. pans 28 Other nuisances and infringements— Bad smells 19 Offensive accumulations 190 Insufficient accommodation for sub-tenants 17 Defective manure receptacles 15 Want of manure receptacles 10 Defective sanitary conveniences 41 Dirty sanitary conveniences 37 Smoke nuisances17 Sundry nuisances or defects1153 Limewashing of stables13 Defective stables 4 Defective stable drainage 3 Accumulation of manure 8 Particulars not inserted in Rent Rook (Housing Act) 114 „ „ „ „ (Rent Restriction Act) 199 (2) FACTORIES, WORKSHOPS & WORKPLACES— Cleansing and whitewashing required 70 Additional ventilation 9 Dustbins required 22 Repairs to Moors 1 Drainage of floors 1 Repairs to paving 8 Overcrowding 1 Ventilation of stoves 1 Infringements of drinking water supply regulations 5 Sundry other nuisances or defects 20 Abstract not exhibited 4 W.c.'s— Insufficiently screened 1 Insufficient 7 Defective 44 Not kept clean 34 Not separate for sexes 1 Want of intervening ventilated space 2 (3) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924— Food cupboards defective or required 343 Dustbins required 1316 Verminous conditions 185 (4) INFRINGEMENTS OF PUBLIC HEALTH ACT, 1925 (S.72—75) AND INFRINGEMENTS OF FOOD BYE- LAWS— Cleansing or repair of walls and ceilings 200 „ „ repair of floors, utensils, fixtures, etc. 127 Dirty or defective w.c. accommodation 140 Food storage accommodation required 7 Animals kept in food store 3 Refuse bins uncovered 6 Accumulation in food store 53 Food in uncovered vehicles or baskets 9 Food improperly kept or manufactured 10 Premises not suitable for storage or manufacture of food 17 Want of provision of towels 2 Provision of cloak room accommodation 48 Overalls required 19 Illegal wrapping of food 10 Household washing in food store 7 Want of ventilation in food store 15 „ interventing ventilated space between w.c. and food store 13 Defective swill bin 1 Drain inlet in food store 2 Dirty yards 59 Insufficient sink accommodation and water supply 10 rood premises used for sleeping purposes 2 (5) INFRINGEMENTS OF PUBLIC HEALTH ACTS (AMENDMENT) ACT, 1907- Defective yard paving 816 200 (6) INFRINGEMENTS OF SHOPS ACTS— Insufficient w.c. accommodation 146 Defective w.c. accommodation and insufficient lighting etc. 124 Reasonable temperature required 55 Insufficient washing facilities 60 Insufficient accommodation for assistants' meals 21 Notices not exhibited in accordance with 1913 Act 4 Notices not exhibited in accordance with 1934 Act 1748 Assistants Weekly Half-Holiday Notices required, etc. 494 Mixed Shop Notices required 280 Infringements after general closing hour 27 Infringements of 1934 Act in regard to young person 36 (7) INFRINGEMENTS OF COMMON LODGING HOUSE BYELAWS Room not numbered 1 Dustbins required 1 Defective plaster 1 Defective windows and sashcords 2 Defective sanitary accommodation 2 Defective floors 2 (8) INFRINGEMENTS OF HOUSES LET IN LODGINGS BYELAWS— Additional cooking and sink accommodation 9 Want of food storage accommodation 15 Provision of washing accommodation 12 Want of w.c. accommodation 4 „ artificial lighting to common staircase 5 Handrail required to stairs 3 Cleansing required 11 Defective windows and sashcords 2 Provision of dustbins 5 (9) INFRINGEMENTS OF OFFENSIVE TRADE BYELAWS. Fishfrying premises— Limewashing required 1 Offensive accumulations 4 Defective roofs 1 Other premises— Dirty or defective w.c. accommodation 2 Cleansing and whitewashing required 6 Dirty floors 1 Defective yard paving 2 (10) INSPECTION OF AMUSEMENT HOUSES— Defective sanitary fittings 28 Defective drains 5 Defective plaster 1 W.c. required cleansing 5 W.c. insufficiently lighted 8 Insufficient ventilation 3 Notices to be fixed to door of lavatories 2 (11) KEEPING OF ANIMALS— Pigstves within 100 feet of dwelling 1 Other nuisances in connection with the keeping of pigs 14 Nuisances arising from the keeping of other animals 25 (12) INSPECTION OF WATERCOURSES, etc.— Cleansing of watercourses and ponds 4 201 (13) INFRINGEMENTS OF PHARMACY & POISONS, &c., ACT— Article not labelled in accordance with the Act 1 (14) INFRINGEMENTS OF FERTILISERS & FEEDING STUFFS ACT, Sec. 1 (1) (11) 5 (15) INFRINGEMENTS OF RATS & MICE DESTRUCTION Infestation of rats on premises where food is prepared or sold 10 Accumulations of refuse, etc., harbouring rats 7 Defective drainage 2 Structural defects allowing ingress of rats into dwelling houses 17 (16) INFRINGEMENTS OF MERCHANDISE MARKS ACT & AGRICULTURAL PRODUCE & MARKING ACT— Apples not marked 134 Tomatoes „ 119 Eggs „ „ 7 Salmon „ „ Unoirte Butter not marked 4 Currants „23 Sultanas „ 21 Raisins „ 16 Bacon „ 4 (17) INSPECTION OF SCHOOL LAVATORIES- Defective Sanitary fittings 1 (18) INFRINGEMENTS OF OTHER BYELAWS- Washing down shop fronts 1 Noisy animals 14 offensive washing up water thrown over footpath 9 Fouling footpaths by dogs 6 Infringements in slaughterhouses 1 Milk bottles on public highway 4 (19)INFRINGEMENTS OF PUBLIC HEALTH (MEAT) REGULATION- Porter’s head and neck uncovered 1 Cleansing of utensils, tables, etc. 6 Meat displayed in front of shop 2 Bins required for offal 2 Accumulation of offal1 (20)INFRINGEMENTS OF FOOD AND (ADUL TERATION) ACT, 1928- Margarine not marked 6 202 (21) INFRINGEMENTS OF MILK & DAIRIES REGULATIONS, &c.— Defective dairy floors and paving 4 „ sanitary fittings 3 Dirty dairies 9 „ conveniences 1 Unsuitable storage for bottle discs 1 Insufficient ventilation in dairies 1 Illegal bottling of milk1 Vehicles not labelled 2 Drain opening into dairy 1 Cowshed requiring limewashing 2 Cowshed insufficiently lighted 1 Defective floor to cowshed 1 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 1935 requests were made in connection with 28 houses. The following defects were ascertained in consequence of these inspections:— Defective gutters 1 „ downspouts 2 „ drains 15 „ sanitary fittings 6 „ w.c.'s 2 „ yard paving 1 Dampness 2 Offensive accumulation 1 Rent Restriction Acts. A number of applications were received for certificates ns to the condition of repair of the houses concerned. In 34 instances where the Acts applied certificates were granted. In 12 instances certificates were given to owners stating that the work had been carried out. HOUSING. 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 1935, 91 houses had been approved for demolition, and demolition orders had been made; 55 houses had been actually demolished, the tenants being re-housed, when they desired, by the Council; 259 persons were displaced. 203 The following table gives particulars as to Housing during 1935 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) 4,910 (b) Number of inspections made for the purpose 4,910 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 2,957 (b) Number of inspections made for the purpose 2,957 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 57 (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 3,062 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 2,927 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 322 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners †121 (6) By local authority in default of owners 20 B. Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 130 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners *81 (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 57 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 68 204 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 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit *This number does not include 41 houses in regard to which notices were served in 1934 and complied with in 1935. † Not including 45 houses concerning which notices were served in 1934 and complied with in 1935. OVERCROWDING. During- 1935 overcrowding was abated in 49 families. The Housing Act, 1935, required a survey to be made to discover the amount of overcrowding. This survey was carried out in the latter part of the year and early in 1936. 66,397 families were investigated, and 610 families containing 3,501½ persons were found to be overcrowded. This Act made considerable changes in the method of dealing with overcrowding. Table I. FACTORIES, WORKSHOPS, AND WORKPLACES. 1. Inspection. Premises. Number of Inspections. Written Notices. Prosecutions FACTORIES. (including Factory Laundrie.) 418 43 ... WORKSHOPS. (including Workshop Laundries) 461 101 ... WORK PLACES. (other than Outworkers premises) 163 23 ... Total 1042 167 ... 205 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 70 57 ... ... Want of Ventilation 9 2 ... ... Overcrowding 1 1 ... ... Want of Drainage otf Floors 1 ... ... ... Other Nuisances 61 56 ... ... Sanitary Accommodation— Insufficient 7 6 ... ... Unsuitable or Defective 81 73 ... ... Not separate for sexes 1 1 ... ... 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 1 Transfer of Powers Order, 1921) ... ... ... ... Reports to H. M. Inspector ... ... 5 ... Total 231 196 6 ... 3. List of Registered Workshops. Trades. Totals. Bakers and Confectioners 56 Basket and Rug Maker 1 Blacksmiths 15 Blind Makers 1 Bookbinders 2 Bootmakers 80 Bottle Washer 1 Brush Makers 3 Building Trades 45 China Rivetters 2 Coach Builders 12 Cycle Works 25 Dressmakers 82 Dyers and Cleaners 17 Electricians 20 Engineers 14 Fancy Goods Manufacturers 17 206 Floris 1 French Polishers 2 Furriers 5 Ladder and Barrow Makers, etc 3 Laundries 17 Marine Stores 6 Milliners 20 Monumental Masons 10 Motor Engineers 101 Opticians 3 Picture Framers 6 Photographers 8 Plumbers 6 Saddlers 5 Scale Makers 2 Sheet Metal Workers 4 Sign Writers 17 Sports Goods Makers 5 Tailors 88 Tea Packer 1 Toy Makers 2 Umbrella Makers 4 Upholsterers 48 Watchmakers 22 Wig Makers 2 Wire Mattress Makers 1 Woodworkers 48 I. 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, 1935 100 Number of underground bakehouses (included in above) 6 Visits made to bakehouses during the year 425 Defects found 82 Notices issued 75 Notices complied 54 5. Home Work. Lists of home-workers are sent in twice yearly, and last year contained the names of 108 outworkers residing within the Borough. 31 visits were paid to outworkers and 7 visits were paid to premises of employers of outworkers to examine lists and for other purposes. 207 Table III. NATURE OF EMPLOYMENT OF WORKERS ON THE REGISTER, 31st DECEMBER, 1935. Nature of Work. Number employed. Outwork in infected premises. Outwork in unsatisfactory premises. Remarks. Making, cleaning, altering and repairing wearing apparel 82 ... ... ... Upholstery work 2 .. .. ... Lace goods .. .. .. .. Other classes of work 24 .. .. ... 108 ... ... ... REGISTERED AND LICENSED PREMISES IN THE BOROUGH, 31st DECEMBER, 1935. Slaughterhouses (not including Public) 3 Bakehouses 100 Common Lodging Houses 9 Houses Let in Lodgings 91 Dairies and Milkshops 408 Cowsheds 20 Offensive Trades 107 Wholesale Dealers in Margarine, etc. 35 Registered Workshops 830 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 135 SHOPS ACTS. The Shops Act, 1934, contains provisions for dealing with the health and comfort of persons employed and also regarding ventilation, temperature, sanitary conveniences, washing facilities and the facilities for taking meals in shops. This is an advance on the previous legislation, and has naturally entailed a considerable amount of extra work on the staff. 4,521 inspections were made, and a number of infringements were found, as set out on Page 200. In 6 instances proceedings were instituted in connection with '"'sale of goods after the hours laid down, and fines and costs , amounting to £3 2s. 6d. were incurred. 208 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 nightlv letting to lodgers. In addition there are three oubicles 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 Is., the cost of a weekly ticket is 6s. for seven nights. The number of men accommodated during the year was 32,522. The number of men lodgers exceeded 89 per night throughout the year. The receipts and expenditure for the last ten years are as follows: — Receipts. Expenditure. £ s. d. £ s. d. 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 1935 1488 11 5 1420 14 9 2. Private Common Lodging Houses. There are 9 common lodging houses on the register. During 1935, 101 day and 63 night inspections were made. Notices were served for the conditions and defects as set out in the summary of defects found (paragraph 7). 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 209 HOUSES LET IN LODGINGS. There are 91 houses registered under the Byelaws. 130 visits were made for inspection purposes. 29 notices were served for various amendments. 27 notices were complied with. Table V. The following Table gives the situation of these premises:— Road. No. of Houses Let in Lodgings. Beulah Grove 2 Princess 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 2 Whitehorsc Lane 1 Nursery Road 1 St. James' Road 1 Queen's Road, South Norwood 1 Lodge Road 1 Tamworth Road 2 Bert Road 1 Bensham Manor Road 1 Albert Road 1 Clyde Road 4 Brighton Road 1 Canning Road 2 Grosvenor Road 1 Clifton Road 1 Derby Road 2 Belgrave Road 6 Pawsons Road 1 Windmill Road 4 Heathfield Road 1 Harrington Road 1 St. Peter's Road 2 Alexandra Road 1 Whitehorse Road 3 Grange Road 1 Penge Road 4 Newark Road 1 Addison Road 1 Selhurst Road 1 Wellesley Road 1 Auckland Road 1 Notices were served for the conditions and defects as set out in the summary of defects found (paragraph 8). 210 OFFENSIVE TRADES. Byelaws relating to Offensive Trades were adopted during the latter part of the year 1925. 187 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 33 Gut Scrapers 2 Fish Friers 70 Rabbit Skin Drier 1 Fellmonger 1 107 RAG FLOCK ACTS, 1911 AND 1928. Seven samples were obtained and subjected to analysis, the results being as follows: — No. 1 contained 19 p;uts of Chlorine per 100,000 „ 2 ,, 10 „ „ „ „ 3 „ 14 „ „ „ „ 4 „15 „ „ „ 5 „ 11 „ „ „ „ 6 „ 8 „ „ „ 7 „ 14 „ „ „ The seven samples conformed to the standard of cleanliness prescribed under the Rag Flock Regulations, 1012, made under the Rag Flock Act, 1911. The legal maximum of chlorine allowed is 30 parts per 100,000. SMOKE OBSERVATIONS. During the year 46 observations were made of factory chimneys for the purpose of detecting offences under the Act. Two notices were sent and amendments carried out to stop the nuisance. AMUSEMENT HOUSES. 1.39 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). 211 KEEPING OF ANIMALS. 87 inspections were made in connection with the keeping of animals. There were 28 premises, including institutions, where pigs were known to be kept in the Borough. 15 notices were served to abate nuisances arising from various causes in connection with the keeping of pigs, and 25 notices were served to abate nuisances arising from the keeping of other animals. SCHOOLS. 201 inspections of schools and school lavatories were made during 1935. The water supply in all cases is from the mains. INSPECTION OF WATERCOURSES, ETC. During the year 39 visits were made to ditches, watercourses, etc., in order to see whether there were any infringements of the several Acts, etc. In four 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. The number of licences renewed under the Act was six, and in addition six 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-one inspections of premises where fertilisers and feeding stuffs were sold were carried out during the year. Five infringements of the Act were found. Reinspections were made at a later date and the infringements found to have been rectified. Two samples of Feeding Stuffs were taken during the year. 312 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 44,836 articles By Formalin gas 3,678 ,, By Formalin spray 831 „ 49,345 „ In addition 953 articles were destroyed on request. Disinfection after infectious or contagious disease was carried out in 3,129 rooms at 2,074 houses. 29 class rooms. 12 hospital wards. 2 vehicles. 1 shelter. 10 bags. 4 school departments. 2 prams. Disinfecting of bedding and other upholstered goods is carried out for traders who deliver to and collect the articles from the Station. For this service a charge is made. During 1935, 803 such articles were disinfected, the receipts for this work amounting to £35 19s. Od. 213 DISINFESTATION. Disinfestation by Hydrogen Cyanide is carried out in certain cases before tenants occupy Corporation houses. Two specially built furniture vans are used. The furniture and effects are collected and taken to the Disinfecting Station, here the contents, still in the vans, are treated with Cyanide for the required time. The van doors are then opened and the air extracted by means of fans in the van roof. The whole of the furniture, etc., is now removed to the open air, any packed goods are opened out, clothes shaken and upholstered furniture beaten to remove any traces of gas. Frequent chemical tests are made to ascertain that no gas is left in the articles. The furniture and effects are repacked into the vans and delivered to the new address. The air in the van and also the articles are chemically tested at the place of delivery. No bedding is treated by Hydrogen Cyanide, this is passed through a steam disinfector and delivered in a second van to the house. One day is taken to carry out the removal, disinfestation and delivery of each household's effects. One hundred and seventeen cases were dealt with during the course of 1935 without any ill effects to any person, either householder or operator. Non-chemical gas masks are used by the operators. In place of the usual chemical element a long armoured tube is supplied to the mask. This tube is provided with a spike to secure the end in a safe position away from the gas. CLEANSING OF VERMINOUS PERSONS, ETC. During the year 12 adults and 187 children were cleansed for verminous conditions, and 52 adults and 20 children for scabies, also 5 adults after contact with infectious disease. RATS AND MICE DESTRUCTION. The rat-catcher is a permanent member of the staff, and no charger is made for his services. Rates 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. 214 The following is a summary of the visits paid during 1935 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 1521 Butchers 36 Other premises where food is prepared or sold 241 2620 1289 Other premises 201 Total 1999 2620 1289 In addition to the above, 1,372 rats were killed at Corporation refuse tips by employees of another department. PARROTS (PROHIBITION OF IMPORT) REGULATIONS, 1930. At the request of the Authorities at the Croydon Airport six budgerigars were destroyed during the year. FOOD SUPPLY. The supervision and inspection of the food supplies is carried out by fifteen of the district inspectors, who are qualified in food inspection. 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. 215 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. 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 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 38,617 animals slaughtered for human consumption, these figures being an increase of 877 on those for the year 1934. The following table shows the premises in the Borough at which foodstuffs are known to be sold, manufactured or stored:- General Shops 200 Grocers and Provision Shops 668 Greengrocers and Fruiterers 496 Confectioners, Bakers and Pie Makers 635 Ice-Cream Shops 310 Hotel and Restaurant Kitchens and Dining Rooms 304 Butchers 219 Fishmongers (including Fried Fish Shops) 147 Ham and Beef Shops 83 Sweet Manufacturers 10 Other Food Premises 19 3,091 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 210 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 1935: — Pitlake. c Slaughterhouses. Cattle. Shtep. Pigs. Calves. Total. Public section 111 124 1141 821 2197 Private section 958 9382 15023 3958 29321 Totals 1069 9506 16164 4779 31518 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 1935:- Description. Cause. 13 beef carcases and offal General tuberculosis. 3 „ forequarters Localised tuberculosis. 2 ,, hindquarter „ „ 7 „ parts „ . „ 12 „ Offals, complete Tuberculosis. 8 „ carcases and offals Inflammatory, emaciated, etc. 64 sets beef lungs Localised tuberculosis. 36 beef heads „ „ „ 17 „ various offals „ „ 2 „ heads, 1 tongue Actinomycosis. 217 Description. 48 „ various offals 3 veal carcases 2 „ parts 12 „ plucks 3 „ various offals 9 „ carcases 10 „ various offals 4 „ plucks 7 „ various parts 4 „ forequarters 23 pig carcases and offals 6 „ forequarters 12 „ various parts 198 „ heads 33 „ plucks 20 „ various offals 88 „ offals, complete 39 „ carcases and offals 28 „ carcases and offals 152 „ plucks 15 „ heads 165 „ various offals and 41 parts 64 „ carcases and offals 10 sheep carcases and offals 1 „ forequarter and 4 parts 8 „ plucks 5 „ various offals Total weight destroyed Cause. Inflammatory conditions, etc. General tuberculosis. Tubercular. „ „ „ „ Immaturity, etc. Inflammatory, etc. Inflammatory conditions. „, „ „ „ General tuberculosis. Localised tuberculosis. „ „ „ „ „ „ „ „ Tubercular. Swine fever. Inflammatory conditions, etc. „ „ „ „ „ „ Oedema and emaciation. Inflammatory, etc. Inflammatory, traumatic, etc. Parasitical, etc. „ „ 37,247 lbs. PRIVATE SLAUGHTERHOUSES AND MEAT INSPECTION At the end of 1935 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 1935 was 9G9. Table VIII. The number of animals slaughtered in the Private Slaughterhouses during the year was: — Cattle Sheep. Pigs. Calves. Total. 99 1544 3600 1856 7,099 218 The following meat and offal from Private Slaughterhouses was surrendered and destroyed during 1935: — Description, Cause. 2 beef heads Localised tuberculosis. 2 „ various offals „ ,, 2 „ livers Inflammatory conditions, etc. 1 veal head Localised tuberculosis. 5 „ plucks „ „ 1 „ sundry offal „ „ 3 „ sundry offals Inflammatory, parasitical. 1 pig carcase and offal General tuberculosis. 2 „ forequarters Localised tuberculosis. 13 „ heads and 4 parts „ „ 6 „ plucks „ „ 8 „ sundry offals „ „ 23 „ plucks Inflammatory, etc. 37 „ offals (various) „ „ 2 pig carcases Moribund. 2 sheep offals (various) Parasitical, etc. Total weight destroyed : 1,256 lbs. Table IX. Total number of animals slaughtered for human consumption in the Borough during 1935: — Cattle. Sheep. Pigs. Calves. Total. 1,168 11,050 19,764 6,635 38,617 Table X. Summary of whole carcases destroyed with the reasons for such destruction. Class of Animal. Tuberculosis. Emaciated and Dropsical. Inflammatory Conditions. Immaturity, etc. Moribund, etc. Swine Fever. Total carcases. Cattle 13 ••• 8 ... ... ... 21 Calves 3 ... ... 9 ... ... 12 Sheep ... 6 4 ... 1 ... 11 Pigs 24 64 23 ... 2 39 157 Totals 40 70 40 9 3 39 201 219 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 is of carcase destroyed (including heads) All or parts of organs destroyed. Total. Cattle (includ ing calves) 16 46 47 109 Pigs 24 219 151 397 Total 40 265 201 506 General Food Inspection. The following table gives a summary of the inspections made during the year (not including visits made to slaughterhouses or dairies, cowsheds and milkshops): — Butchers 1799 Fishmongers 221 Fried Fish Shops 228 Grocers 922 Greengrocers 636 Poultry and Game Dealers 35 Cooked and Prepared Meat Shops 234 Bakers' Premises 186 Confectioners' Premises 673 Markets 631 Hawkers' Carts and Barrows 236 Hotel and other Kitchens, etc 391 Ice Cream Manufacturers and Vendors 262 General Shops 367 Other premises 56 6,867 The following articles of food were surrendered and destroyed during 1935:— 4 beef hindquarters (Imported) Unsound 82 „ parts and trimmings „ „ 110 lbs. beef kidneys „ „ 9 lbs. beef livers, etc „ „ 1 mutton carcase „ „ 9 „ Parts „ „ 81 lbs. lambs' liver, etc. „ „ 59 lbs. pork „ „ 180 lbs. pig livers „ „ 15 lbs. rabbits „ 101 lbs. ham and bacon „ 184 lbs. smoked fish fillets, etc „ 220 202 tins salmon, etc. „ 1429 tins, etc., plums, cherries, pineapple, etc „ 85 lbs. grape fruit „ 480 lbs oranges „ 60 lbs. pears „ 157 tins milk and cream „ 23 lbs. flour„ 35 jars jam, etc „ 98 jars pickles, etc. „ 39 jars meat paste,etc. „ 28 tins soup „ 18 lbs. suet „ 35 tins beef, etc. „ Total weight destroyed : 6,799 lbs. Table XII. General Summary of Meat and other articles destroyed during the year 1935. ARTICLES. Weight in lbs. Remarks. Diseased. Unsound. Total. Beef 12,344 2,713 15,057 Including 21 carcases. Veal 310 165 475 12 „ Mutton 263 307 570 „ 11 „ Pork 16,595 151½ 16,746½ „ 157 „ Offal 8,468½ 430 8,898½ „ imported offal. Fish ... 185 185 Fish fillets, etc. Fruit & Vegetables ... 634 634 Pears, oranges, etc. Tinned Goods ... 2,658} 2,658½ 1,851 tins, 172 jars, etc. Sundries ... 77 77 Rabbits, etc. 37,980½ 7,321 45,301½ MILK. The milk supply of the Borough is derived principally from the south, south-east and south-west counties and arrives either by rail or road. 221 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. 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 20,679 gallons of milk are sold daily in the Borough. Of this amount 93 per cent. is bottled, just under 7 per cent. is loose, which is sold wholesale, and the remaining small portion, being namely, 69 gallons, is retailed as loose milk. These figures are interesting in view of the fact that twelve 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. Sterilised milk continues to be sold in the Borough. Carton milk is sold in the Borough from three producers. In addition, a local producer uses this method for part of his milk. This method, which appears to be gaining favour, entirely eliminates the bottle, the carton being destroyed after the milk is removed. 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 Inspector. The methods of production and distribution are discussed and suggestions made; these, when adopted, have produced excellent results. The majority of milk retailed in the Borough is uniformly of excellent quality. The milk, however, sent in by the farmer to the wholesalers continues to give trouble owing to the unnecessarily high bacterial count, 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. 222 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 (1934) 11 ,, added to the register (1935) — ,, discontinued (1935) 1 Net 10 Cowsheds on register (1934) 20 ,, added to the register (1935) — ,, discontinued (1935) 9 Net 20 Number of cows provided for 275 Average number of cows in sheds (1935) 253 No. of dairies and purveyors of milk on register (1934) 424 NTo. of dairies and purveyors of milk added to register (1935) 51 No. of dairies and purveyors of milk discontinued during 1935 67 Net 408 Grand total of cowsheds, dairies and purveyors of milk on register, 31st December, 1935 428 During the year 1,038 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. 223 Milk (Special Designations) Order, 1923. The following licences were granted during the year under this Order and were in force on the 31st December, 1935 : — Description 0f Licences. No.. (1) Producers' Licences to use the designation "Grade A" 2 (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 26 (4) Dealers' Licences to use the designation "Grade A"— (a) Bottling establishments (b) Shops 4 (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 59 (7) Dealers' Supplementary Licences to use the designation— (a) Certified 3 (b) Grade A T. T 5 (c) Grade A 1 (d) Pasteurised 4 Inspection of these licensed premises has been carried out regularly during the year to see that the conditions of the licences were observed. During the year the following samples of milk were examined under the Milk (Special Designations) Order, 1923: — Certified Milk. licensed country producers supplying milk to licensed local dairymen 10 224 Grade A (Tuberculin Tested) and Grade A Milks. Licensed country producers of Grade A (Tuberculin Tested) milk supplying milk to licensed local dairymen 6 Licensed country producer of Grade A milk supplying milk to a licensed local dairyman ... ... 4 Pasteurised Milk. Samples from Licensed Dealers ... 140 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, 1935 : — 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. I Pre«ent. Absent. Present. Absent. F.xccediDg a trace. Noi exceeding j I a trace. Tubercle bacillus ... 10 Total number of bacteria ... 10 Bacillus Coli 2 8 Blood ... 10 Pus ... 10 Detritus ... 10 ... 10 ... 10 2 8 ... 10 ... 10 ... 10 The above 10 Certified Milk samples contained total bacteria per c. c. as follows:— 0—1,000 2 1,000—5,000 2 5,000—10,000 2 10,000—15,000 3 15,000—20,000 1 10 225 Under the Regulations Certified Milk must not contain more than 30,000 bacteria per c.c. Table XIV. GRADE A (TUBERCULIN TESTED) AND GRADE MILKS. Present. Absent. Over 200,000 per c.c. Under 200.000 per c.c. Present in 1/100 c.c. Not present in 1/100 c.c. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Tubercle brcillus ... 10 Total number of bacteria ... 10 Bacillus coli 1 9 Blood ... 10 I'us ... 10 Detritus ... 10 ... 10 ... 10 1 9 ... 10 ... 10 ... 10 The 10 Grade A (Tuberculin Tested) and Grade A milks contained bacteria per c.c. as follows : — 0—1,000 1 1,000—5,000 2 5,000—10,000 2 10,000—20,000 3 30,000—40,000 1 80,000—90,000 1 10 Under the Regulations Grade A (Tuberculin Tested) or Grade 11 milk must not contain more than 200,000 bacteria per c.c. I he following tables summarise the results of the bacterioogical examinations of Pasteurised milk samples from 1st January to 31st December, 1935 : — 226 Table XV PASTEURISED MILK, (licences granted under the Milk (Special Designations) Order, 1923). Present. Absent. Over 100,000 per c. c. Under l00,000' per c. c. Present. Absent. Present. Absent. Present. Absent. Exceeding a I trace. Not exceeding] a trace. Tubercle bacillus ... 140 Total number of bacteria 13 127 Bacillus coli 37 103 Blood ... 140 Pus ... 140 Detritus ... 140 ... 140 13 127 37 103 ... 140 ... 140 ... 140 The above 140 Pasteurised Milk Samples contained bacteria per c. c. as follows:— Under 1,000 3 1,000—5,000 29 5,000—10,000 35 10,000—20,000 24 20,000—30,000 7 30,000—50,000 18 50,000—100,000 11 Over 100,000 13 140 Under the Regulations Pasteurised Milk must not contain more than 100,000 bacteria per c. c. Six samples of Sterilized Milk were taken during 1935. Bacillus Coli was absent, but the samples contained bacteria per c. c. as follows:— Under 1,000 6 , Milk and Dairies Orders, 1926. Proceedings were instituted against a roundsman for filling and closing milk bottles on other than registered premises, and a fine with costs incurred, amounting to £2 10s. 6d. PROVISION AS TO MILK SUPPLY. During the year 340 samples of ordinary milk were procured and submitted to examination for tuberculosis in accordance with the Milk and Dairies (Consolidation) Act, 1915. 227 These samples were taken as follows:— Samples taken at cowsheds in the Borough 79 Samples in course of delivery from country cowsheds to local dairymen and purveyors of milk in the Borough 28 Samples taken at dairymen's premises in the Borough 68 Samples taken in course of delivery by local dairymen or milk sellers on their rounds in different parts of the Borough 151 Other samples taken 14 340 Eleven 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 three cows were slaughtered under the Tuberculosis Order, 1925, and found to be affected. One sample was from a supply 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 one animal was dealt with under the Tuberculosis Order, 1925. Two samples were taken from supplies coming from Surrey, and after a considerable number of cows had been examined, two animals were found affected with tuberculosis and dealt with under the Order. One sample was taken from a supply from Kent, and after investigation one animal was found affected with tuberculosis and dealt with under the Order. The following Table summarises the results of the bacteriological examination of ordinary milk samples, taken under the Milk and Dairies (Consolidation) Act, 1915, from 1st January to '1st December, 1935 : — Table XVI. ORDINARY MILK. Present. Absent. Over 200,000 per c. c. Under 200,000 per c. c. Present in 1/1C0 c .c. Absent from 1/100 c .c. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Tubercle bacillus 11 329 Total No. of bacteria 74 266 "•cillus Coli 105 235 Blood ... 340 pus ... 340 detritus ... 340 11 329 74 266 105 235 ... 340 ... 310 ... 340 228 The 340 samples of Ordinary Milk contained total bacteria per c. c. as follows:— 0—1,000 7 1,000—5,000 45 5,000—10,000 25 10,000—20,000 45 20,000—30,000 36 30,000—40,000 15 40,000—50,000 19 50,000—100,000 43 100,000—150,000 21 150,000—200,000 10 200,000—250,000 8 250,000—500,000 14 500,000—750,000 4 750,000—1,000,000 4 1.000,000—2,000,000 6 Over 2,000,000 38 340 There is no standard fixed for total bacteria per c. c. in ordinary commercial milk, but comparing the results with (he Grade A standard, i.e., 200,000 per c. c., it will be seen that 266 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 340 samples taken under the Milk and Dairies (Consolidation) Act, 1915, were samples of milk which had been produced in the following areas:— Table XVII. Areas. No. obtained. No. Tuberculous. Croydon 79 7 Kent 9 1 Surrey 17 2 Sussex 16 1 *Unclassified 219 — Totals 340 11 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. 229 FOOD AND DRUGS (ADULTERATION) ACT, 1928. During the year 342 samples of milk (340 new, 1 separated, 1 condensed) and 442 other samples were taken. In two instances prosecutions were instituted. In one case lines were inflicted which, with the costs incurred, amounted to 116 6s. 0d. In the other instance the case was dismissed on payment of costs, amounting to £3 Is. 0d. In 12 instances the vendors were warned. 20 samples of Ice Cream were taken during the year. The Public Analyst reports that 7 of these samples contained fat in amounts varying from 2.0 per cent, to 7.7 per cent. The remaining 13 contained fat in amounts varying from 10.0 percent, to 16.7 per cent. There is no legal standard for fat in Ice Cream. 10 percent, issuggested as a reasonable minimum amount. Bearing in mind this figure, it will be seen that the majority of the samples of Ice Cream were well above this suggested standard. 230 Summary of Samples. During 1935 samples were obtained and submitted to the Public Analyst as follows:— Table XVIII. Samples of Total Samples. Genuine. Not Genuine. Prosecutions. Convictions. Cautions. Milk 340 321 19 2 1 5 Condensed Milk, Full Cream Sweetened (Inf.) 1 1 – - - - Separated Milk 1 1 — — — — Arrowroot 8 8 — — — — Aspirin Tablets 4 4 — — — — Bacon 6 6 — — — — Baking Powder 8 8 — — — — Black Pepper 1 1 — — — — Black Treacle 4 4 — — — — Boric Ointment 2 2 — — — — Brawn 12 12 — — — — Bread 10 10 — — — — Bunflour 1 1 — — — — Butter 13 13 — — — — Castor Oil 10 10 — — — — Cocoa 10 10 — — — — Cod Liver Oil 9 9 — — — — Coffee 6 6 — — — — „ and Chicory 3 3 — — — — „ and Chicory Extract 3 3 — — — — Comp. Powder of Liquorice 2 2 — — — — Comp. Syrup of Figs. 4 4 — — — — Comp. Tincture of Rhubarb 4 4 — — — — Corn Flour 6 6 — — — — Cream of Tartar 8 8 — — — — Custard Powder 2 2 — — — — Demerara Sugar 1 1 — — — — Dripping 6 6 — — — — Faggots 6 6 — — — — Fish Paste 8 8 — — — — Flour (incl. 1 inf.) 11 11 — — — — Fruit Juice 1 1 — — — — Ginger Beer 3 3 — — — — Glycerine 6 6 — — — - Golden Syrup 4 4 — — — - Green Ginger Wine 1 1 — — — - Ground Almonds 6 6 — — — — Ground Ginger 8 8 — — — - Ground Rice 4 4 — — — - Honey 9 9 — — — — Ice Cream 20 20 — — — - Jam 13 9 4 — — 4 Kaola 1 1 — — - Lemonade 2 2 — — - Lemonade Powder 2 2 — — - Lemon Cheese 1 1 — — - Lemon Squash 1 1 — — - Margarine 11 11 — — — - Meat Paste 8 8 — — - Meat Pie (inf.) 1 1 — — - Meat Roll (inf.) 1 1 — — - Mincemeat 8 8 — — - - Mustard Mixture 3 3 — — - Mustard, Prepared 1 1 — — - - Carried forward 625 602 23 2 1 9 231 Samples of Total Samples. Genuine. Not Genuine. Prosecutions. Convictions. Cautions. Brought forward 625 602 23 2 1 9 Olive Oil 6 6 - — — - Pearl Barley 4 4 - — — — Pepper 5 5 - — — — Pickles, Mixed 4 4 - — — — Pickled Onions 2 2 - — — — Rissoles 1 1 - — — — Sausage, Beef 15 15 - — — — „ „ (Preserved) 2 2 - — — — „ Cambridge 1 1 - — — — „ Liver 1 1 - — — — „ Luncheon 12 12 - — — — „ Pork 10 9 - — — 1 „ „ (Preserved) 1 1 - — — — „ Smoked 1 — - — — 1 Saveloys 5 5 - — — — Shredded Suet 7 6 - — — 1 Spirit of Iodine 1 1 - — — — Sugar 1 1 - — — — Sweets 15 15 - — — — Tea 11 11 - — — — Tinned Asparagus 6 6 - — — — Tinned Beans 7 7 - — — — Tincture of Iodine 2 2 - — — — Tinned Peas 10 10 - — — — Vinegar 3 3 - — — — Vinegar, Malt 10 9 1 — — — Whiskey 4 4 - — — — Confection of Senna 3 3 - — — — Lard 9 9 - — — — Totals 784 757 27 2 1 12 2. Result of Analysis of New Milk Samples. SOLIDS NOT FAT.# (Legal standard is 8.5%). 7.8 8.0 8.1 8.2 8.3 8.5* 8.C 8.7 8.8 8.9 9.0 9.1 9.3 Total 340 1 1 1 1 2 8 46 70 80 98 25 6 1 MILK FAT.* (Legal standard is 3%). 1.6 2.5 2.8 2.9 3.0 * 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 I 1 2 4 4 8 15 45 63 59 33 35 22 3.9 4.0 4.1 4.2 4.3 4.4 4.5 4.7 4.8 4.9 6.6 Total 340 1 13 11 11 3 2 3 1 1 1 1 Total Samples of New Milk: .340. 232 The Samples of Milk (including Separated Milk) for analysis were obtained as follows:— Country Milk in course of delivery by train to Local Dairymen 1 Country Milk in course of delivery by motor lorry to Local Dairymen 22 On Milk Rounds (Sundays) 14 ,, ,, (Week-days) 223 Cowsheds - At Shops 58 Taken at Institutions 20 "Appeal to Cow" Samples taken at farms outside Borough 2 340 AVERAGE COMPOSITION OF NEW MILK SAMPLES. Solids not Fat 8.8% Milk Fat 3.5% Percentage of New Milk Samples below legal standard: 5.6% Adulterated Samples. The following is a detailed statement of the adulterated samples and action taken:— No. Sample. Adulteration or Deficiency. Remarks. 1135. Milk 3 percent. added water. Vendor warned. Further samples genuine. 67-70. 1145-1147. Milk A small percentage of added water. Samples in course of delivery. Appeal samples proved genuine. 1185. Milk 3 per cent. deficiency in fat. This supply has now ceased. 20. Milk 5 per cent. deficiency in fat. Producer of this milk was cautioned. 29. Milk 8 percent. added water. The vendors of this inilk were prosecuted. Fines and costs amounting to £16 6s. were incurred. 34. Malt Vinegar Sulphur dioxide— 0.002 percent. equal to 20 parts per million by Wholesalers explanation accepted. 124. Jam, Red Plum. weight. Contained 26 per cent. of red plum fruit. Not of full fruit standard. Manufacturers warned. 179. Jam, Raspberry. Contained 38 per cent. of raspberry fruit. Not of full fruit standard. Manufacturers warned. 209. Milk 4 per cent. deficiency in solids other than milk fat Vendor warned. supply now ceased. 233 No. Sample. Adulteration or Deficiency. Remarks. 213. Milk 3 per cent. deficiency in milk fat. Vendor warned. 214. Milk 3 per cent, deficiency in milk fat. 229. Milk 17 per cent. deficiency in milk fat. Appeal to cow sample proved below minimum. The producers of this milk were given legal warning. 230. Milk 5 per cent, added water. 351. Milk 3 per cent. deficiency in milk fat. 472. Milk' 3 percent. deficiency in milk solids other than milk fat. 133. Smoked Sausage. Sulphur dioxide— 0.003 per cent. equal to 30 parts per million by weight. Vendor warned. 313. Jam Strawberry. Contained sulphur dioxide 0.0108 per cent., equal to 108 parts per million by weight. Manufacturers warned. til. Jam, Red Plum. Deficient in soluble solids to the extent of not less than four percent. Manufacturers warned. 537. Milk 44 per cent. deficiency in milk fat. Proceedings taken and costs of £3 Is. incurred. 667. Pork Sausage Sulphur dioxide— 0.012 per cent., equal to 120 parts per million by weight. Vendor warned. 600. Chopped Suet Contained 15 per cent. Rice Flour. Vendor warned. Open—Air Swimming Pool—Purley Way. The Corporation opened a large swimming pool in Purley Way, near the Aerodrome, in July. Purification of the water is by means of mechanical filters, and ozone, with a chlorination Plant as a stand-by. Regular bacteriological examinations were carried out by the Public Health Department to gauge the purity the water and the effectiveness of the purification processes. It was found that ozonsation was insufficient to maintain a proper standard alone when the load became heavy; and chlorination had to be carried out. This kept the water in a satisfactory condition. it is doubtful if ozonisation, as applied in this case, will suffice alone, as the actual period of contact between the ozone and the water is short. 234 MEMBERS OF THE EDUCATION COMMITTEE. NOVEMBER, 1934-35. The Mayor (Alderman J. Trumble, J.P.). Alderman A. Petere, C.B.E., J.P. (Chairman). P. Squire, Esq. (Vice-chairman). Alderman T. Betteridge, J. P. Councillor Major F. W. Bees. Alderman W. H. Jarvis. Councillor H. Regan. Alderman H. J. Morland, M. A., J. P. Councillor Dr. A. Sandison, O.BF. 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-Adml. J. H. 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 Herbert Roberts, M.A. (Oxon.), 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 Melical 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: John W. Pickup, M.D., Ch.B., D.P.H. Wm. Robert Martine, M.B.E., M.B., 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. Rosa Morrison, M.B., Ch.B., 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 G. M. Davie, LPS Remedial Gymnasts: Miss P. Davey and Miss M. K. Thomas (part-time). Mental Deficiency Visitor: Miss E. McQuade (part-time). Assistant Mental Deficiency Visitor: Miss S. A. Abley (part-time). Orthopaedic Work Organiser: Mrs. D. B. Connor (part-time). School Nurses: 22 district nurses (part-time). Clerk6: Four full-time and eight part-time. 235 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., and more frequently as necessary. MINOR AILMENTS Treatment of Minor Diseases of Skin, etc. Lodge Road. Selhurst Road. Duppas School. 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. DENTAI Dental Treatment. Lodge Road and Selhurst Road. 1 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. Bv appointment ORTHOPEDIC T reatment oC 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 Deformities. St. 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 Tube culosis and Examination of Contacts. 13, Katharine Street. Tues., Wed., Thurs., Fri. and Sat., a.m. Mon. and Fri., p.m. RHEUMATISM Examination . Lodge Road. Wed., 2 p. m., & Thurs., 9 a.m. immunization Protection against Diphtheria Lodge Road. Selhurst Road. Mon. and Tues., 2 p.m. Thurs., 2 p. m. 236 County Borough of Croydon. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER For the Year ending December 31st, 1935. Ladies and Gentlemen, I have the honour to present to you my Eighth Annual Report on the work carried out by the School Medical Service. I he 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 effect of the re-arrangement of the times of the year when the three statutory groups are examined, and which led to a temporary fall in routine medical inspections last year, has now practically cleared up. During 1935, 8,329) children were examined, as compared with 6,352 in 1934. Routine school medical inspection has now been in force for a quarter of a century, and there has been little change in the methods of its conduction. There is a growing opinion that the time is overdue for some national modification of the present system 237 of routine school medical inspection. A discussion at the Annual Meeting of the Royal Sanitary Institute, opened by me, clearly indicated the feeling that routine medical inspections of set groups of children, three times during their school life, does not meet the fundamental objects of a School Medical Service. The present method was undoubtedly the best when introduced, but the mass of facts so obtained should now be analysed for the country as a whole and a new, more elastic system of medical supervision devised. As the School Medical Service is a national service, the reforms must come from the central authority. 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 Orthopædic and Postural defects, and this has been included again this year. One addition was made to the medical staff in 1935, Dr. Rosa Morrison commencing her duties in July. Dr. Dormer resigned his post in January, and his place was filled by the appointment of Dr. W. Martine in March. The complete Sanitary Survey of the Schools, which was included in my last report, has been revised. This table shows interesting differences as between the schools. The survey, however, embraced all aspects of school hygiene, including lighting, ventilation, size of class-rooms, etc. For the sake of brevity much of this has had to be omitted from this report. 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. 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. Very few children attend Infant Welfare Centres after the age of 3 years, and, unfortunately, there is no method comparable with that of 'he School Medical Service for parents to obtain treatment for defects that may arise. 238 The continued co-operation of the Head Teachers and of the School Enquiry Officers has been a valuable help without which much of the medical work and following up would have been difficult of proper fulfilment. 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. 7 cases have been dealt with, and of these 3 have been brought to a satisfactory conclusion, whilst 4 still remain under supervision. The inspector paid 40 visits during the year. 239 Structural Work and Decorations Carried Out in Schools. I 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— Ashburton Junior and Infants. Elmwood. Gonville. Howard. Tavistock Infants' and Special Subjects Centre. Waddon. f Internal Painting and Distempering at the following Schools— Ashburton Junior. Elmwood. Howard. Tavistock Infants' and Special Subjects Centre. Waddon. Whitehorse Manor. Woodside. South Norwood Polytechnic. St. Mark's. St. Michael's. St. Saviour's. Parish Church Senior Boys. 240 Sanitary Accommodation. School. Approx. No. of scholars. No. of W.C.! Type of closet. Urinal space. No. of wash basins No. of towels in use at time of insp. No. of towels used ea. wk. Ashburton Sen. Mixed Boys 195 4 Pedestal sep. cistn. 20 ft. A.F. *9 2 4 Girls 234 10 Do. do. — *9 2 4 Jun. Mixed J Boys 200 4 Do. do. 20 ft. A.F. *6 2 4 Girls 260 10 Do. do. — *6 2 4 Benson Infants B. 75 3 Do. do. 20 ft. A.F. )5 2 2 G. 81 7 Do. do. — Beulah Junior Boys 408 6 Do. do. 45 ft. A.F. 13 3 3 Junior Girls 400 20 Do. do. — 13 3 3 Infants b. 182 4 Do. do. 24 ft. A.F. 18 1 2 G. 189 11 Do. do. — * John Ruskin Boys 405 21 Do. do. 42 ft. A.F. 3 Wg. Tr'ghs 6 14 Davidson Senior Boys 197 5 Do. do. 36 ft. A.F. 2 tr'ghs 2 3 Senior Girls 197 14 Do. do. — Do. 2 3 J. G.&. b. 124 3 Do. do. 20 ft. A.F. Wshg. tr'ghs 2 2 2 i. G. 222 6 Do. do. Duppas Junior Boys 100 4 Do. do. 15ft. 6in.A.F. 6 3 †8 Junior Girls 113 8 Do. do. 6 4 †12 Infants B. 152 3 Do. do. 15* ft. A.F. 1 8 3 t8 G. 168 6 Do. do. — Ecclesbourne Junior Boys 330 (6 I 2 Trough. Pedestal. 42½ ft. stop cock 10 4 8 Senior Girls 331 (9 Tr'gh A.F. - 6 4 8 ^ 7 Ped'l A.F. 2tr'gh Infants b. 112 2 Tr'gh A.F. 24 ft. stop cock i - 2 tr'ghs 2 4 G. 142 6 Tr'gh A.F. Elmwood Senior <S J. B. s. 254 4 Pedestal 25 ft. A.F. 9 2 8 J. 160 3 sep. c'stn. 16 ft. A.F. 6 2 S. <S J. G. S. 1 325 8 Do. do. 7 l 10 J. 8 Do. do. — 6 1 Infants B. 1 308 4 Do. do. 26 ft. A.F. 16 2 4 and 12 hnd. G. 10 Do. do. (inft. sze.) Gonville Junior Boys 123 3 Do. do. 14 ft. A.F. 5 2 * Junior Girls ) 127 9 Do. do. 5 4 * Infants G. 1 - 1 B. 74 2 Do. do. 12 ft. A.F. 4 2 ‡ * Plus 1 sink. † More if necessary. ‡ Towels changed as required. 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 123 5 Pedestal sep. c'stn. 20 ft. A.F. 4 1 2 Junior Girls 121 7 Do. do. — 4 1 2 Infant B. 28 3 Do. do. 10 ft. A.F. 3 1 2 Infant G. 28 4 Do. do. — 3 1 2 Ingram S nior Boys 295 5 Do. do. 28 ft. A.F. 4 4 †6 Senior Girls 219 12 Do. do. — 4 2 †6 Infants B. 143 3 Do. do. 24 ft. A.F. 1 tr'gh 1 do. 1 3 G. 98 6 Do. do. 1 3 Kensington Avenue Junior Boys 135 3 Do. do. 12 ft. A.F. 5 1 2 Junior Girls 132 7 Do. do. 6 1 2 Infants B. 54 2 Do. do. 6 ft. A.F. 1 5 1 2 G. 54 4 — 1 Kingsley Senior Boys 410 6 Do. do. 20 ft. A.F. 14 2 4 Senior Girls 428 18 Do. do. — 14 2 ‡2 Junior Mixed B. 188 4 Do. do. 17 ft. A.F. 16 4 ‡4 G. 190 10 Do. do. — Infants B. 4 Do. do. 17 ft. A.F. 16 2 ‡3 G. 382 10 Do. do. — Lanlranc Senior Boys 298 6 Do. do. 41 ft. A.F. 16 4 6 Senior Girls 300 16 Do. do. — 16 4 8 Norbury Manor Senior Boys 284 5 Do. do. 40 ft. A.F. Tr'ghs 2 8 Senior Girls ' 288 1 1 14 Do. do. - 2 ditto 2 7 Junior Girls 6 Do. do. - J. B. $ I. 296 6 Do. do. 18 ft. A.F. 21 3 6 J. G. $ i. 268 14 Do. do. — Oval Senior Boys 200 4 Do. do. 15 ft. A.F. 10 2 4 Senior Girls 150 8 Do. do. — 10 2 4 J. B. & G. B. 4 inc. inf. b 10 inc. inf. g Do. do. 21 ft. A.F. 8 2 4 G. 200 Do. do. Inf. B. $ G. 196 Do. do. — 10 2 4 Portland Senior Boys 304 7 Do. A.F. 29 ft. stop cock 2 tr'ghs 5 ft. 2 2 Senior Girls 241 10 Do. do. — Do. 2 2 Infants B. 331 2 Do. do. 24 ft. | stop cock 2 tr'ghs 6 ft. G. 7 Do. do. 2 2 2 Troughs. f More if necessary. $ Towels changed when nccessary. 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- Purley Oaks S.B. 116 6 Ped.Sep.Cis 33 ft. A.F. 3 2 *4 S.O. 79 9 Do. do _ 2 2 *4 J. B. & G. B 93 Shared with Se Inior B'-ys I4 i 3 *6 G 85 Shar ed with Se ;nior Girls Infants B 76 4 Ped. sep. :14ft.6in. A.F. 4 3 4 G 73 4 cistern — Rockmount S. & J.B 189 4 Do. do. 22 ft. A.F. 7 2 †6 S. & J. G. 125 10 Do. do. 7 2 †6 Inft. B. 96 1 Do. A.F. 21 ft. A.F. 3 1 †5 Inft. G. 89 5 Do. A.F. 4 1 †5 South Norwood Jnr. B. 350 7 Do. sep. cistern 36 ft. A.F 10 4 6 Jnr. G. 215 10 Do. do. 6 4 8 Infants B. 125 3 Do. do. 27 ft. A.F. 4 4 8 G. 91 5 Do. do. — 4 Sydenham Jnr. Boys 307 6 Do. do. 33 ft. A.F. 5 2 4 J. G. 375 16 Do. do. 34 ft. A.F. 8 2 4 Infants 4 Tavistock Snr. Boys 279 7 Do. do. 54 ft. A.F. 2 tr'ghs 2 4 Snr. Girls 281 17 Do. do. Do. 2 8 Infants B. 104 2 Do. do. 7 ft. A.F. 1 7 2 4 G. 86 5 Do. do. — Waddon Snr. Boys 312 4 Do. do. 20 ft. A.F. 8 1 5 Snr. Girls 318 10 Do. do. 10 2 14 j. b. B. 163 7 Do. do. 22ft. 6in.AF. 6 2 4 & G. G. 162 10 Do. do. — 6 Infants B. 123 3 Do. do. 13 ft. A.F. 3 1 4 G. 129 7 Do. do. — 6 1 West Thornton J. B. 279 9 Do. do. 30 ft. A.F. 9 2 4 J.G. 286 13 Do. do. 7 2 5 Infants B. 179 3 Do. do. 23 ft. A.F. 4 2 4 G. 158 6 Do. do. — 4 Whitehorse Manor S.B. 235 10 Do. do. 32 ft. A.F. 15 5 5 J.G. 274 16 Do. do. — 7 3 0 Infants B. 197 4 Do. do. 26 ft. A.F. 1 5 2 3 G. 134 8 Do. do. — Winterbourne J. B. 401 7 Do. do. 27 ft. A.F. 2 wsg tr'ghs 2 4 J. G. 355 10 Do. do. 2 do. 2 4 Infants B. 173 3 Do. do. 24 ft. A.F. 1 tr'h 1 2 4 G. 192 6 Do. do. — 1 do. J * Towels changed approx. every other day. † More towels if required. 243 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 412 9 Pedestal sep. cist. 37 ft. A.F. *7 5 10 Jnr. Girls 297 13 Do. do. — 10 4 20 Infants B. 117 5 Do. do. 9 ft. A.F. 1 5 4 20 G. 128 7 Do. do. — 1 Health Clark Cent. B. 209 5 Do. do. 22 ft. stop cock 8 4 10 Cent. G. 204 10 Do. do. — 8 4 10 Croydon British Senior Girls 214 9 Do. do. — 2 bins and 2 tr'ghs 5 10 Lady Edridge Cent. G. 337 8 Do. do. - 4 7 28 St. Christophers B. 60 9 Do. do. 31 ft. A.F. 2 1 G. 47 8 Do. do. — 3 3 15 I. — — Do. do. — 3 I St. Giles B. 37 3 Do. do. 9 ft. A.F. 'i 1 small towel to ea. child renewed f'tnightly G. 40 5 Do. do. — 3 St. Luke's Mype B. 20 1 Do. do. 8 ft. A.F. 2 1 4 G. 15 2 Do. do. — 2 1 St. George's Hall B. 54 1 Do. do. 6ft. hand flushed 1 2 .1 2 2 G. 53 2 Do. do. Suffolk RoadTemporary Infants B. 77 1 Standard pattern and height space for 3 persons l4 5 5 G. 63 3 — All Saints S.B. 38 1 Pedestal sep. cist. 6 ft. hand flushed cist. 2 1 3 S.G. 34 2 Do. do. — 2 1 3 J.B. 112 3 Do. do. 61 ft. A.F. 2 2 8 J.G. 103 5 (J.G. 6 I-G.) Do. do. 2 2 6 Infants 97 3 (Inf. boys) Do. do. 8 ft. A.F. 2 2 4 Church J.M $ I • J.B. 123 4 Do. do. 16 ft. A.F. 3 3 6 J.G. 189 14 Do. do. — Inf. B. 57 7 Do. do. Inf. G. 65 * Plus 1 sink. 244 Sanitary Accommodation. School. Approx. No. of scholars. No. of W.C.S Type of closet. Urinal space. No. of wash basin No.o towels in us at time of insp No. of towels used ea. wk. Holy Trinity J. G. & i. G. 236 11 Pedestal sep. cist. 6 2 5 Parish Church S. J. B. 247 4 Do. do. 21 ft. A.F. 6 2 4 J. G. & i. 313 16 Do. do. 11 ft. A.F. 5 2 4 St. Andrew's S. & J. B. 186 3 Do. do. 25 ft. A.F. 5 2 2 S. & J. G. 134 9 Do. do. — 7 2 2 Infants B. 54 2 Do. do. 8 ft. A.F. 1 6 2 2 G. 40 4 Do. do. — 1 St. Joseph's Boys 36 3 Do. do. 8 ft. stop tap 2 1 2 Girls 40 \ — 3 1 2 Infants B. 74 1 6 Do. do. - 2 1 1 G. 79 — St. Mark's J. G. & i. B. 30 2 — 5 ft. A.F. 3 2 4 g. 139 5 Do. do. — St. Mary's (Addington) J. M. & I. Junior B. 19 3 Do. do. 12 ft. A.F. 3 1 2 Junior G. 12 4 Do. do. Infants B. 12 Share d with Ju nior Boys 3 1 2 g. 14 Shared with Junior Girls St. Mary's R.C Mixed B. 159 4 Do. do. 16 ft. A.F. 6 2 4 Infants B. 39 2 Do. do. 8 ft. A.F. Mixed G. 185 9 Do. do. 6 (2 inft.) 2 6 (inc. 2 inft) St. Peter's Inf. B. 58 3 sts. troughA.F. 4 ft. A.F. 3 1 1 Inf. G. 57 Do. Do. do. — 1 1 1 St. Saviour's J. M. B. 76 4 Do. do. 23 ft. A.F. 4 4 8 G. 87 7 Do. do. — Infants 111 2 Do. do. 7 ft. 3 4 8 Shirley J. Mxd. B. 75 3 Pedestal sep. cist. Do. do. 10i ft. stop 1 2 G. 54 4 — 2 Infants B. 55 2 Do. do. 4 ft. A.F. 2 G. 26 3 Do. do. 1 2 Archbishop Tenison's Central B. 213 4 Do. do. 18 ft. A.F. 9 4 4 Senior G. 160 8 Do. do. — 5 2 4 St. Michael's Central G. 233 9 Do. do. — 3 3 6 •Towels changed more frequently if required. 215 The schools as a whole still exhibit a rather confused standard of sanitary accommodation, accentuated by the educational reorganisation carried out under the Hadow plan. 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. There has been an improvement in the number of towels provided for the children's use in several of the schools. The Committee have now considered the subject and have decided to allow3roller towels per week per 50 children. This is an excellent forward step in the inculcation of cleanliness in the children. A clean towel is a better object lesson than a sodden dirty one, and, although extra initial and maintenance costs will be incurred, they will be well spent. Cost of the School Medical Service. The gross cost of the medical, dental and nursing services was £10,523; from this an income of £631 should be deducted, making a nett cost of £9,892. The rateable value of the Borough in 1935 was £2,247,243. The Government grant is 50 per ceru. of the expenditure, hence the actual cost to the rates was £4,946, a rate of 0.54 pence. The nett cost of these services to the rates for 1935 per child on the school registers was 4s. 2.3d. Ihe figures do not include £300 for Medical Inspection higher Education) and for Blind persons £802. Costt of Special Schools. Schools maintained by the Council £6,165; Contributions to schools under other authorities, £3,441; Loans charges, £553; 1 erexpenses (travelling, etc.), £7; Income from parents' contributions and other receipts, £601; giving an actual cost of £9,565, of which £4,783 was payable out of local rates, giving a rate of pence. cost of Milk and Meals. Milk and meals cost £1,411 10s. 10d.; Income from parents' Contribution £30 11s. 0d.; giving an actual cost of £1,380 246 There has been a slight decrease in the cost of the actual medical services rendered in the Public Elementary Schools from 0.58 in 1934 to 0.54 of a penny rate in 1935. The cost of maintenance in Special Schools has also decreased from a rate of 0.57 to 0.52 pence. The cost of milk and meals has decreased by £470, a total decrease in the last two years of £900. 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 237. The average attendance was 90 per cent. This decrease in the number of children on the school registers is interesting, as the population of Croydon continues tn increase. Table I. No. of Schools. Average number on the Registers. Average attendance. Averagi attendant! per cent. Senior Boys 10 C. 3175 2976 94 2 N.P. 462 440 95 Senior Girls 11 C. 3190 2932 92 2 N.P. 398 376 94 Senior Mixed 6 C. 2507 2341 93 4 N.P 1347 1226 91 Junior Boys 7 C. 2497 2320 93 Junior Girls 8 C. 2752 2486 90 3 N.P. 713 642 90 Junior Mixed 10 C. 4245 3815 90 4 N.P. 974 839 86 Infants (261 under 5) 14 C. 3807 3197 84 2 N.P. 189 155 82 Schools— Church of England 13 4083 3678 90 Roman Catholic 2 Council 29 22173 20067 91 Total 44 26256 23745 90 " c."—Council. ' n.p."—Non-Provided. 247 Medical Inspection in Schools. The work of medical inspection is spread over all the stall 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. Pickup 7/llths; Dr. Martine 6/11ths; Dr. Jenkin-Lloyd 2/llths; Dr. McMahon 3/llths; Dr. Morrison 5/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 bv head teachers, attendance officers, school nurses, etc., are classified as "specials." There-arrangements made in the time when the various groups are examined, mentioned in the 1934 report have been continued, 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 age of 7 years) and any children left over from the Intermediates group, are examined. By this method it is felt that fewer children are liable to be overlooked. The temporary drop in the number of routine medical inspections of group children noticed in 1934 has now disappeared, and, addition, the inspections have also increased. The new scheme would appear, therefore, to be working well. Unfortunately, it is impossible to re-examine these children as they ought to be reexamined, namely, each year, owing to the claims of the statutory groups. To do this would reqire a larger medical staff than is now available. Table II. gives a summary of the number of children examied in the various classes in the different schools, together with the parental attendance at the examinations. A total of 8,342 children were examined as compared with 6,352 in 1934, and 5,952 parents attended the examinations. The percentage attendance 248 of parents in the Entrants group was for boys 81.5 per cent., and girls 82.0 per cent.; in the Intermediate group, boys 69.1 percent., girls 76.4 per cent.; and in the Leavers group, boys 36.5 per cent,, girls 53.1 per cent. 8,719 re-inspections were made as against 8,286 in 1934, and 6,980 in 1933. There has been a drop in the number of parents attending at medical inspections, most noticeable in the Leaver group. This is unfortunate, as perhaps this examination has the greatest bearing upon the child's future life. Choice of occupation may require medical advice if that choice is to be made wisely. Square pegs in round holes are found too often. Many of these misfits might be avoided by a pre-study of a child's habits, aptitudes and inclinations. Herein lies a fruitful field for school psychological medicine. Unfortunately, there is little time, under present conditions, to spare for this subject. For results of value to be obtained, observation must be close and prolonged. The abolishment of routine medical inspections, and their replacement by a more fluid system of medical supervision, has been strongly advocated in some quarters. Although it is conceded that the present rigid group system has in some respects outgrown its usefulness, yet a too fluid system might, in actual working practice, allow children to pass through the sieve of quasi-medical supervision who should be held back for detailed medical examination. The time has, however, come when the medical side of the Board of Education might, with advantage study all the pros and cons of the subject closely with the end in view of evolving a system more in touch with modern medical thought than is the present system, which has been unchanged since its inception a quarter of a century ago. 249 The total percentage of parents attending was 71.3, as against 70.3 last year. This shows an increasing interest by parents in medical examinations: a trend which is to be welcomed. Table II. Name of School. Entrants 5 to 6 years of age. Intermediate 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. M. F. M. F. M F. M. F. M. F. M. F. 1 Ashburton 50 60 47 33 36 31 39 23 35 39 2 2 ... ... ... ... 2 Benson 22 18 18 17 7 15 6 13 ... ... ... ... ... ... ... ... 3 Beulah 99 121 86 110 48 19 41 19 ... ... ... ... ... ... ... ... 4 Croydon British ... ... ... ... ... ... ... ... 32 95 12 51 ... ... ... ... 5 Davidson 48 31 44 24 13 34 11 21 53 93 19 56 ... ... ... ... 6 Duppas 91 97 82 72 25 26 20 21 ... ... ... ... ... ... ... ... 7 Ecclesbourne 67 71 62 63 57 21 57 13 ... 46 ... 34 ... ... ... ... 8 Elmwood 50 53 40 46 87 17 44 17 75 47 26 24 ... ... ... ... 9 Gonville 32 45 8 38 41 30 14 13 ... ... ... ... ... ... ... ... 10 Howard 21 26 20 20 52 37 29 19 ... ... ... ... ... ... ... ... 11 Ingram 42 25 38 21 ... ... ... ... 73 44 41 25 ... ... ... ... 12 Kensington 27 23 26 22 35 35 15 29 ... ... ... ... ... ... ... ... 13 Kingsley 89 88 66 76 62 45 39 35 19 47 11 14 ... ... ... ... 14 Lanfranc ... ... ... ... ... ... ... ... 43 99 20 70 ... ... ... ... 15 Norbury Manor 65 58 62 56 48 44 43 36 71 69 25 49 ... ... ... ... 16 Oval Road 37 44 32 29 36 27 27 24 24 23 16 20 ... ... ... ... 17 Portland 103 89 65 50 29 28 19 28 22 64 ... 23 ... ... ... ... 18 Parley Oaks 20 39 18 30 40 43 20 31 15 8 4 2 ... ... ... ... 19 Rockmount 49 47 32 36 25 55 21 41 24 20 12 13 ... ... ... ... 20 St. George's ... ... ... ... 32 32 17 11 ... ... ... ... ... ... ... ... 21 South Norwood 56 48 40 34 67 34 47 25 ... 46 ... 32 ... ... ... ... 22 S.N'wood Tern. 42 36 40 34 ... ... ... ... ... ... ... ... ... ... ... ... 23 Sydenham 61 31 46 27 80 75 41 53 ... ... ... ... ... 4 ... 3 24 Tavistock 44 33 38 29 24 8 16 5 52 36 19 15 ... ... ... ... 25 Waddon 54 48 51 45 10 35 8 34 25 40 6 27 ... ... ... ... 26 West Thornton 88 88 69 80 77 31 52 21 ... 23 ... ... 1 ... ... ... 27 Whitehorse 49 62 40 53 28 63 17 46 82 ... 34 ... ... 4 ... 4 23 Winterbourne 134 141 122 136 92 120 74 101 ... ... ... ... ... ... ... ... 29 Woodside 125 123 89 92 162 142 122 122 ... ... ... ... 4 ... ... ... 30 Aldington 7 9 6 9 10 6 6 3 ... ... ... ... ... ... ... ... 31 All Saints' 33 46 33 41 22 24 22 25 9 2 9 2 ... ... ... ... 32 Christ Church 42 43 36 41 32 35 29 32 ... ... ... ... ... ... ... ... 33 Holy Trinity ... 48 ... 46 ... 45 ... 33 ... ... ... ... ... ... ... ... 34 Parish Church 64 68 55 46 42 35 23 33 10 ... 6 ... ... ... ... ... 35 St. Andrew's 28 17 24 16 18 28 9 18 46 48 8 15 ... ... ... ... 36 St. Joseph's 10 9 10 7 13 11 10 5 1 6 ... 3 ... ... ... ... 37 St. Mark' 24 36 12 19 1 22 1 18 ... ... ... ... ... ... ... ... 38 St. Mary's 30 25 16 18 44 36 18 19 39 38 4 14 ... ... ... ... 39 St. Peter's 31 32 24 29 4 ... 2 ... ... ... ... ... ... ... ... ... 40 St. Saviour's 57 30 40 21 22 19 17 11 ... ... ... ... ... ... ... ... 41 Shirley 42 18 38 14 20 15 20 13 ... ... ... ... ... ... ... ... 42. Tenision's Gl ... ... ... ... ... ... ... ... ... 25 ... 18 ... ... ... ... 1933 1926 1575 1580 1439 1323 996 1011 750 958 274 509 5 8 - 7 3859 3155 2762 2007 1708 783 13 7 Percentage of Parents Present at Medical Inspections Entrants Boys 81.5 81.8 71.3 „ Girls 82.0 Intermediate Boys 69.2 72.7 „ Girls 76.4 Leavers Boys 36.5 45.8 „ Girls 531 Other Ages Boys - 53.8 „ Girls 87.5 260 FINDINGS AT ROUTINE MEDICAL INSPECTIONS. Uncleanliness. For uncleanliness surveys the health visitors made 589 visits to schools. At the primary inspections they found vermin in 177 and nits alone in 2,046 children. On these inspections, 3.4 per cent. of the children showed evidence of infestation as against 3.9 in 1934 and 3.6 in 1933. 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. During the year a new scheme was evolved and put into practice, tightening up the whole of this work, and establishing a cleansing station with an employee in charge. Previously, children found verminous attended the Minor Ailments Clinic. The health visitors now have the power to take children found to be persistently verminous direct from the school to the Cleansing Station. Authority for this step is provided by Section 87 (2) of the Education Act, 1921. Clothing and Footgear. At routine medical inspections 99.0 per cent. of the boys and 99.2 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 6.3 per cent. of the boys and 7.2 per cent. of the girls were below normal nutrition for the area. In the Intermediate group 8.5 per cent. of the boys and 7.5 per cent. of the girls were under average; in the Leavers group 5.3 per cent. of the boys and 5.4 per cent. girls, giving in the whole school groups examined 6.9 per cent. boys and 6.9 per cent. girls. With respect to this subject, more definite standards of what is considered to mean Malnutrition have been laid down in an endeavour to eliminate, as far as possible, the varying human factor in the estimation of physical condition which is most difficult to define. The words Nutrition and Malnutrition vary greatly in their significance and meaning with the persons making the investigations. 251 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 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 1935, 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 12,000 bottles of milk were consumed per day, a decrease of 4,000 bottles a day. 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 1935. The full value of this Table wiii not be obtained until similar records for ten consecutive years have been analysed; when this is completed the rate of growth can be followed, so far as Crovdon children are concerned, throughon; school life. 252 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. 1931 104 41.3 40.3 42.8 43.6 39.1 35.3 69 40.5 38.1 42.6 42.6 38.5 34.2 1930 976 42.9 42.1 47.0 52.0 38.8 33.8 946 42.6 40.8 46.9 51.4 38.4 33.1 1929 668 44.0 44.0 48.5 54.2 40.3 35.6 723 43.6 42.5 47.7 52.0 40.0 34.6 1928 168 46.3 48.1 49.4 55.8 44.0 42.3 189 46.5 48.0 48.5 53.7 44.2 42.2 1927 696 49.6 55.6 54.3 70.0 45.1 45.3 661 49.1 53.8 53.4 68.1 44.8 43.6 1926 618 50.9 58.8 55.3 72.8 47.1 47.7 534 50.5 57.2 54.8 75.0 46.6 46.5 1925 137 52.2 63.0 55.5 74.1 49.2 52.5 87 52.1 62.2 54.7 73.7 49.2 51.1 1924 8 53.9 68.0 56.0 70.0 51.0 63.0 52 54.3 70.3 58.8 90.1 51.9 58.7 1923 351 55.8 76.3 61.1 101.5 51.0 58.8 480 56.9 78.9 63.4 111.9 51.8 58.3 1922 306 57.6 82.8 62.4 105.1 52.7 66.9 314 58.4 86.5 64.4 111.0 52.4 61.9 1921 92 60.3 93.8 64.5 119.8 55.5 74.2 62 59.9 91.9 63.1 108.6 56.7 77.6 1920 61.4 104.4 62.8 116.0 59.0 84.0 8 63.3 108.0 65.0 129.0 61.5 85.0 1919 15 63.3 115.5 65.0 168.0 61.5 68.0 263 Children Born in 1930.—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 0.7 lbs. more and their average minimum height 0.4 inches taller than the corresponding figures for the girls. The average maximum weight of the boys is 0.6 lbs. more and their average maximum height 0.1 inches taller than for the girls. Children Born in 1929.—The boys are 0.4 inches taller and 1.5 lbs. heavier on the average than the girls. The average minimum weight of the boys is 1.0 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 2.2 lbs. more and their average maximum height 0.8 inches taller than for the girls. Children Born in 1927.—The boys are 0.5 inches taller and 1.8 lbs. heavier on the average than the girls. The average minimum weight of the boys is 1.7 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 1.9 lbs. more than the girls and their average maximum height is 0.9 inches taller than the girls. Children Born in 1922 and 1923.—The boys in this group were 0.9 inches shorter and 2.6 lbs. lighter on the average than the girls. The average minimum weight of the boys is 2.3 lbs. more and their average minimum height 0.4 ins. shorter than the girls. The average maximum weight of the boys is 8.6 lbs. lighter and their average maximum height 2.2 ins. shorter than for the girls. In this group as a whole the boys are shorter and lighter than the girls, but the former are a more uniform group : 'he girls exhibiting greater fluctuations around the mean average. RANGE OF VARIATION. Height. inches. Weight. pounds. Born in 1930: Boys 8.2 18.2 Girls 8.5 18.3 Born in 1929: Boys 8.2 18.6 Girls 7.7 17.4 Born in 1927: Boys 9.2 24.7 Girls 4.3 11.5 Born in 1922 and 1923: Boys 9.9 40.9 Girls 11.7 51.8 254 The average maxima 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 rapidlv between 8 and 12 years of age. During the period of growth from 5 years to 8 years the bovs gained on the average 13.5 lbs. in weight and 6.7 inches in height. The girls gained 13.0 lbs. in weight and 6.5 inches in height. From 8 years to 12 years the corresponding gains are 20.7 lbs. for boys and 25.1 lbs. for girls; 6.2 inches for boys and 7.8 inches for girls. During the period of growth from 5 years until the end of the 12th year the boys increased by 12.9 inches in height and 34.2 lbs. in weight; the boys increased 14.3 inches in height and 38.1 lbs. in weight. There is a marked variation in the physique of both boys and girls in the different schools of the Borough. This is shown specially in weight. Heart and Circulatory System. At routine medical inspections among the Entrant group 25 boys and 31 girls were found to have organic disease. In the Intermediate group, the figures were 63 boys and 38 girls, and in the Leaver group 21 boys and 44 girls. Functional disease was found in 94 boys and 96 girls in the Entrants; 93 boys and 113 girls in the Intermediate; 61 boys and 65 girls in the Leaver group. Anæmia was present in 69 boys and 84 girls in the Entrant group; 43 boys and 39 girls in the Intermediate; and 12 boys and 37 girls in the Leavers. The percentage of all Heart and Circulatory defects among children examined at routine medical inspection was 12.3. Chest Complaints (Other than Tuberculosis). In all the groups combined 4.6 per cent. of the boys and 3.8 per cent. of the girls had some minor affection of the lungs. This was usually a mild Bronchitis. 255 Tuberculosis. Forty-five children were referred to the Tuberculosis Officer for further examination. One case was 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. 267 children were under such surveillance at the beginning of the year, 98 were added during the year, 77 were discharged, leaving 288 under observation at the end of the year. Seven cases of pulmonary Tuberculosis and 19 cases of nonpulmonary Tuberculosis in children of school age were notified to the Medical Officer of Health during the year. One child died of pulmonary Tuberculosis and four of non-pulmonary Tuberculosis. The ages at death of these cases were:—Pulmonary, 15 years; Non-Pulmonary, 6 years (two) 7 years and 9 years. Three non-pulmonary deaths were certified to be due to Tuberculous Meningitis and 1 from Tuberculous Meningitis and Acute Miliary Tuberculosis. Taking the total school population as 26,256, the mortality rate from Pulmonary Tuberculosis in school children was 3.8 per 100,000, and the incidence rate 26.7 per 100,000. For Non-pulmonary Tuberculosis the respective figures were 15.2 and 72.4. Nose and Throat. In all the groups 909 boys and 864 girls had enlarged tonsils; 44 boys and 52 girls had adenoids only; 555 boys and 532 girls had adenoids and enlarged tonsils; 101 boys and 63 girls were mouth breathers; 671 boys and 476 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 5.3 per cent. of all school children examined in the three groups were in need of surgical attention to the throat and nose. The number of children referred for adenoids and enlarged tonsils varies from year to year within small limits. In 1934, dealing with another group of children, the figure was 4.8 per cent The importance of training in correct methods of breathing after the removal of adenoids and tonsils cannot be too stronglv emphasised. All cases are invited to attend Breathing Exercises Classes held at St. Andrew's Hall and 140 cases attended. This is 256 41 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 24.3 per cent. had enlarged tonsils; 1.7 per cent. had adenoids alone; 19.2 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 22.7 per cent., 0.8 per cent., 8.5 per cent., and 11.9 per cent.; and in the Leaver group, 12.1 per cent., 0.5 per cent.. 6.6 per cent., and 9.1 per cent. The percentages for the three groups in relation to the total number of children examined, were 21.3 per cent., 1.2 per cent., 5.0 per cent., and 13.8 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 49.2 45.5 19.2 15.2 Intermediates 31.3 35.1 13.6 10.0 Leavers 24.4 17.8 13.9 5.3 Other Ages — 37.5 — 12.5 Does not include mouth breathers, but includes other defects of nose and throat. Defective Hearing. The commonest causes of deafness in children are middle ear disease and adenoids. Routine medical inspection showed that 0.2 per cent. Entrants, 0.4 per cent. Intermediates, and O.i per cent. Leavers in the children examined had defective hearing. 257 Speech Defects. The special class is held twice weekly, and is conducted by two qualified lady teachers. During 1935, 31 children attended. A special report upon the results of the class is given on page 58. Routine medical inspection findings showed in the Entrant group 0.6 per cent. children defective, in the Intermediate group 0.5 per cent., and 0.4 per cent. in the Leaver group: figures very similar to 1934. 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 2.0 per cent. incidence in boys and 1.5 per cent. in girls; Intermediate boys 0.7 per cent. and girls 1.1 per cent.; Leavers 1.1 per cent. boys and 1.5 per cent. girls; a total in all groups of 1.4 per cent. boys and 1.3 per cent. girls. Deformities. Among children examined at Routine Medical Inspection 0.8 per cent. of the boys and 0.5 per cent. of the girls showed evidences of rickets; 2.4 per cent. boys and 2.7 per cent. girls had some abnormal degree of spinal curvature, and 4.2 per cent. boys and 5.l per cent. girls showed some other physical deformity. External Eye Diseases. Squint was present in 1.5 per cent. of all children examined in the various groups and was most frequently found in the Entrant group (1.8 per cent. boys and 2.2 per cent. girls). Its incidence declined as age advanced. Blepharitis occurred in 0.7 per cent. of all the children. Conjunctivitis was present in 0.1 per cent. of all the children, and other external eye defects were noted in 0.2 per cent. The total percentages of eye defects in the various groups was 2.9 for Entrants; 2.3 for Intermediates; and 1.9 for Leavers. For 1934 the corresponding figures were 5.2, 2.8 and 2.6. Vision. The Entrant group is not examined for visual acuity at routine medical inspection. If a child is wearing corrective glases, the vision is tested with the glasses worn at the time of examination. 258 In the Intermediate group 6.4 per cent. of the boys and 7.8 per cent. of the girls were referred for treatment or observation for defective vision, and in the Leaver group 10.5 per cent. of the boys and 11.8 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 1371 95 3 1248 94.3 692 92.3 887 92.6 94.3 93.6 6/6ths. or 6/9ths L1367 95.0 1250 94.5 688 91.7 877 91 5 93.9 93.2 6/12ths or6/24th K 59 4.1 72 5.5 51 6.8 61 6.4 5.0 5.8 L 64 4.4 68 5.1 54 7.2 69 7.2 5.4 6.0 6/36(1)5. or worse R 9 0 6 3 0.2 7 0.9 10 1.0 0.7 0.6 L 8 0.6 5 0.4 8 1.1 12 13 0.7 0.8 Table VI. TEETH. Entrants. Intermediates. Leavers. Boys Girls. Boys. Girls. Boys. Girls. No. % No. % No. % No. % No. % No. % Perfect set of Teeth 1023 52.9 1020 53.0 974 67.7 936 70.8 537 71.6 707 73.8 One to four decayed 526 27.2 484 25.1 293 20.4 261 19.7 187 24.9 227 23.7 Four or more decayed 384 19.9 422 21.9 172 11.9 126 9.5 26 3.5 24 2.5 Total 1933 1926 1439 1323 750 958 It is interesting to note that 5,208 children of all groups, or 62.4 per cent., were said to have sound teeth at medical inspection. The percentage of sound teeth found by the Dental Inspectors was 31 per cent. The examination made by the dentists is more searching than that made by the medical inspectors, who tire instructed to concentrate rather on purely medical signs. The need for systematic instruction on the care of the teeth is certainy indicated. 259 The proper care of the teeth before the 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 FINDINGS AT ROUTINE EXAMINATIONS. (Percentages.) Condition Entants. Intermediates. Leavers. Other Ages All Groups Boy. Girl. Boys Girls Boys Girls Boys Girls Boys Girls Cleanliness— (Percentage clean) Head 99.9 99.3 99.8 99.9 99.9 99.9 100.0 100.0 99.9 99.6 Body 99.8 99.8 99 9 99.8 100.0 100.0 100.0 100.0 99.9 99.9 Clothing (satisfactory) 98.9 99.1 98.9 99.8 99.7 98.6 100.0 100.0 99.0 99.2 Footgear do. 98.8 99.2 98.8 99.8 99.2 98.6 100.0 100.0 98.9 99.3 Nutrition (normal) 93.7 92.8 91.5 92.5 94.7 94.6 100.0 100.0 93.1 93.1 Defects— Circulatory System 9.7 11.0 13.8 13.6 12 5 15.2 ... 25.0 11.7 12.8 Pulmonary system (defects not T.B.) 6.8 6.1 3.1 2 4 1 7 1.0 ... ... 4.6 3.8 Skin Disease 2.0 1.5 0.7 1.1 1.1 1.5 ... ... 1.4 1.3 Defects of Nose and Throat. 52.1 47.8 34 1 36.5 25.1 18.0 ... 37.5 40.9 37.4 Enlarged Cervical Glands 19.2 15.2 13.6 10.0 13 9 5.3 ... 12.5 163. 11.3 External Eye Disease 0.9 0.8 1.0 0.8 1.5 1.3 ... ... 1.0 0.9 Defective Vision 0.3 0.3 6.4 7.8 10.5 11.8 ... ... 4.3 5.3 Defective Hearing 0.3 0.1 0.5 0.2 0 7 0.6 ... ... 0.4 0.2 Speech Defects 0.9 0.3 0.6 0.3 0.7 ... ... ... 0.7 0.2 Dental Disease (more than lour decayed) 19.9 21.9 12.0 9.0 3.5 2.5 ... 12.5 14.1 13.6 Dull and Backward 0.4 0.3 1.5 0.4 1.1 0.6 ... 12.5 0.9 0.4 The above Table gives in a concise form the findings at Routine Medical Inspections. 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 the worst, and the Leaver group the best. l'or nutrition, the Intermediate group (aged 8) gave the worst figures, whilst as a group the Leavers (12—13 years) showed the best findings. The percentages, as compared with last year, show a distinct improvement in the standard. Taking all the groups examined subnormal nutrition was recorded in 6.9 per cent. of the children as contrasted with 19.1 per cent. in 19-34. 260 Enlarged cervical glands were recorded most often in the Entrants group in both sexes; a finding of interest as a pointer to the need for the pre-school age medical supervision which is lacking at the present time. 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. There is no doubt that school work does lead to a breakdown of normal vision in a fairly high proportion of school children. Although difficult of exact proof, there is some reason to believe that a larger proportion of the adult popoulation now wear spectacles than was the case in by-gone years. This, in itself, may only mean that more care is taken to preserve eyesight than formerly—an outcome of the educational and practical activities of the School Medical Service. 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, however, lower than for last year. The average standard of cleanliness showed a welcome improvement. The incidence of various defects on the different age groups is an instructive finding. There is a steady rise in those defects which might arise from educational stress, and a steady fall in defects readily amenable to measures operated under the School Medical Services. 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 routine medical inspections for treatment or observation and who were consequently thought to be in need of spectacles. 261 Table VIII. School. Intermediates. Leavers. School. Intermediaties Leavers. Boys Girls Boys Girls Boy Girls Boys Girls Ashburton 13.9 6.5 17.1 10.3 Sydenham 5.0 12.0 ... ... Benson — 13.3 ... ... Tavistock 12.5 37.5 13.5 27.7 Beulah 4.2 10.5 ... ... Waddon ... 5.7 16.0 15.0 Croydon British ... ... 9.4 16.8 West Thornton 2.6 6 5 ... - Davidson — 8.8 5.7 9.7 Whitehorse Manor — 6.3 7.3 ... Duppas 8.0 — ... ... Winterbourne 3.3 3.3 ... ... Ecclesbourne 3.5 — ... 6.5 Woodside 6.8 6.3 ... ... Elmwood 2.3 — 8.0 — Addington — — ... ... Gonville — 10.0 ... ... All Saints' 13.6 — 11.1 50.0 Howard 3.8 8.1 ... ... Christ Church 12.5 5.7 ... ... Ingram ... ... 19.2 18.2 Holy Trinity ... 11.1 ... ... Kensington 8.6 - ... ... Parish Church 11.9 — 20.0 ... Kingsley 6.5 8.8 10.5 21.3 St. Andrew's 5.6 7.1 6.5 12.5 Lanfranc ... ... 16.3 6.1 St. Joseph's — 9.1 — — N'orburv Manor.. fiL8 13.6 4.2 7.2 St. Mark's — 9.1 - - Oval 2.8 22. 2 8.3 4 3 St. Mary's 9.1 8.3 10.3 13.2 Portland 17.2 14.3 9.1 17.2 St. Peter's — ... ... ... Purley Oaks 10.0 4.7 20.0 12.5 St. Saviour's 4.5 10.5 ... ... Rockmount 8.0 3.6 4.2 15.0 Shirley 20.0 40.0 ... ... St. George s 3.1 9.4 ... ... Tenison's Girls ... ... ... 4.0 South Norwood 13.4 14.7 ... 15.2 South Norwood Temporary ... ... ... ... Note.—Where a dash is placed, childicn were examined, but no visual defects were found. The true meaning of this Table will not be apparent until the findings for 9 years are summarised. In this time an Entrant group will have passed through the whole school period. 262 Table IX. Return of Defects Found in the Course of Medical Inspection 1935. Defects. Boys. Girls. No. requiring Treatment. No. referred for Observation. Percentage of total Examined. No. requiring Treatment. No. referred for Observation Percentage of total Examined. Malnutrition 65 44 2.64 42 69 2.63 Uncleanliness— Head 2 ... 0.05 ... 1 0.02 Body Skin Disease 4 2 0.15 9 4 0.31 Eye Diseases— Defective Vision 163 14 4.29 200 22 5.27 Squint 34 9 1.04 34 13 1.12 External Eye Trouble 10 2 0.29 2 3 0.12 Ear Diseases— Deafness 5 3 0.19 6 1 0.17 Otitis Media 3 4 0.17 7 3 0.24 Other Diseases 2 ... 0.05 1 ... 0.02 Nose and Throat— Enlarged Tonsils only 87 177 6.40 61 176 5.62 Adenoids only 10 12 0.53 13 17 0.71 Enlarged Tonsils & Adenoids 229 148 9.11 191 148 8.04 Other Conditions 29 18 1.14 19 21 0.95 Enlarged Cervical Glands (not T.B.) ... 28 0.68 ... 23 0.54 Dental Defects 29 6 0.85 38 1 0.93 Speech Defects 12 9 0.51 4 5 0.21 Heart and Circulation— Organic 17 67 2.14 7 77 1.99 Functional 5 65 1.70 6 80 2.04 Anæmia 5 49 1.31 9 47 1.33 Bronchitis 8 51 1.43 14 37 1.21 Other Non-T.B. 2 14 0.39 2 10 0.28 Pulmonary Tuberculosis 5 5 0.24 3 9 0.28 Other Tuberculosis 1 10 0.27 2 3 0.12 Nervous System Disordf.rs (including Epilepsy, Chorea, etc.) 9 39 1.14 7 54 1.45 Deformities— Rickets 2 2 0.10 4 1 0.12 Spinal Curvature 44 33 1.87 42 44 2.04 Others 41 24 1.58 69 38 2.54 Other Defects and Diseases 38 46 204 48 33 1.02 Totals 861 880 42.19 840 940 42.22 Total Children Examined 4127 4215 263 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 1934. Entrants 3859 590 15.3 13.0 Intermediates 2762 547 19.8 14.4 Leavers 1708 360 21.1 15.7 Other Ages 13 2 15.4 26.7 8342 1499 18.0 14.2 The fact that 15.3 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 systematic 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. A 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 departure from normal is so insidious that irreparable consequences have supervened before the parent notices anything amiss. Initial slight defects, if unremedied, often lead to further defects as the child grows. 264 Table XI. CHIEF CAUSES OF EXCLUSIONS FROM SCHOOL. Condition. Exclusions during 1935. Percentage of total exclusions. Exclusions during 1934. Percentage of total exclusions. Ringworm—Head 2 0.02 10 0.17 ,, Body 36 0.35 20 0.34 Verminous Conditions 2223 21.76 616 10.50 Impetigo 267 2.61 239 4.07 Scabies 37 0.36 27 0.46 Scarlet Fever 417 4.08 528 9.00 Measles 619 6.06 1373 23.43 Diphtheria 286 2.80 333 5.68 Whooping Cough 311 3.04 723 12.34 Chicken Pox 841 8.23 548 9.35 Mumps 3561 34.85 73 1.24 Tuberculosis (all forms) 28 0.27 21 0.35 External Eye Disease 24 0.23 13 0.22 Sore Throat 236 2.31 207 3.53 Other Causes 1330 13.02 1129 19.27 10218 ... 5860 ... It must be remembered that the figures for exclusions are not related in any way to the figures obtained in routine medical inspections. There were 4,358 more children excluded from school on account of various illnesses than in 1934. The chief causes of exclusion were Infectious Diseases, 59.06 per cent., practically the same figure as for 1934. The Infectious Diseases constituting the major cause of these exclusions changed, however. Mumps was very prevalent, after several years quiescence, whilst Measles followed its usual biennial course. Exclusions on account of verminous conditions were higher than in 1934 or 1933, and constituted 21.76 per cent. of the total exclusions. The health visitors examined 65,698 children in the schools in connection with their primary inspections for the personal cleanliness of the scholars. Impetigo was more prevalent than in 1934. 265 Table XII. Name of School. School population. Notifiable Diseases. Conditions notified by Teachers and School Attendance Officers. Percenage 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 (scalu). Indefinite Sickness. Ill. Not Infectious. Conjunctivitis Ashborton 694 13 2 1 2 3 ... 159 ... ... ... ... ... 1 19 ... 20.0 Benson 156 3 ... ... ... 37 ... ... ... ... ... ... ... 3 6 ... 25.6 Beulsh 1183 13 4 ... 18 11 59 286 1 17 15 1 ... 3 71 3 33.0 Croydon British 372 5 2 ... ... ... 6 1 1 3 1 ... 2 7 ... 3.5 Davidson 738 8 ... ... 1 ... 35 151 ... 10 5 6 ... 8 25 ... 26.4 Puppa 530 21 25 1 46 5 29 88 2 14 13 ... 1 ... 73 2 40.4 Ecclesbourne 918 4 1 ... 4 2 9 92 1 2 4 1 ... 4 22 ... 12.2 Elmwood 1052 7 20 ... 22 5 21 111 2 24 9 ... ... 15 41 1 17.7 Gonville 389 8 1 ... 28 5 16 26 ... 1 6 1 ... 4 30 1 21.3 Howard 300 7 ... ... ... 1 1 13 ... 1 1 ... ... 2 6 ... 7.3 Ingram 76.5 4 1 ... 1 1 32 71 1 2 1 ... ... 9 32 ... 14.4 Kensington Av 375 18 ... ... 1 ... 56 30 ... ... 1 ... ... 3 10 ... 28.0 Kingsley 1604 45 23 ... 45 15 99 287 4 28 28 2 ... 16 87 ... 32.0 Lanfranc 611 5 1 ... ... ... 3 28 ... 5 8 2 ... 2 17 ... 6.1 Norbury Manor 1148 18 10 2 1 35 3 21 1 7 6 ... ... 5 13 ... 7.7 Oval 745 16 21 ... 60 14 6 127 2 18 8 1 ... 11 78 1 32.8 Portland 886 8 19 1 11 2 33 153 ... 5 3 ... ... 5 23 3 25.5 Purley Oaks 523 4 ... ... 68 1 28 63 ... 10 1 ... ... 2 21 ... 31.4 Rockmount 505 13 45 ... ... 10 5 3 2 3 10 ... ... 2 ... ... 15.0 South Norwood 787 5 3 ... 7 ... 22 137 1 8 3 ... ... 5 18 ... 22.1 do. (Temp). 138 1 5 ... ... 13 8 22 ... 4 2 ... ... 2 16 1 35.5 Sydenham 682 12 20 ... 23 18 22 114 2 17 6 ... ... 18 22 ... 30.6 Tavistock 759 4 11 ... 64 19 20 94 2 7 15 2 ... 16 16 1 27.9 Waddon 1186 11 19 ... 2 28 216 5 8 14 ... ... 10 51 1 23.3 WestThornton 897 14 11 ... 7 39 169 384 3 7 28 3 ... 11 65 2 69.6 Whitthorse Manor 846 7 4 ... 71 ... 13 63 1 11 4 4 ... 10 36 ... 18.7 Winterbourne 1115 21 4 ... 2 26 5 73 1 2 4 ... ... 16 56 1 11.7 Woodside 949 8 4 ... 9 3 13 219 ... 6 2 3 ... 11 34 2 270 Heath Clark 412 4 ... ... ... ... 4 5 ... ... ... ... ... ... ... ... 3.2 John Ruskin 410 2 2 ... ... ... 1 10 ... ... ... ... ... ... 3 ... 3.7 Lady Edridge 339 2 ... ... ... ... 1 7 ... ... ... ... ... ... 1 ... 2.9 St. Christopher's 108 1 3 ... ... 1 ... 11 ... 5 ... 2 ... ... 5 ... 14.8 St. Giles 78 1 ... ... ... ... ... 7 ... 2 ... ... ... ... 14 ... 10.3 Myopic Class 33 ... ... ... ... ... 2 2 1 1 ... ... ... ... ... ... 12.1 Addington St. Mary's 58 ... ... ... ... ... ... ... ... 2 2 ... ... 2 2 ... ... All Saints 388 3 ... ... 42 ... 36 26 ... ... ... ... ... 1 11 ... 27.6 Arch. Tenison's 374 1 ... ... 1 ... 1 ... ... ... ... ... ... 1 4 ... 0.8 Christ Church 432 27 5 ... 48 12 1 125 1 7 4 ... ... 6 48 2 50.5 Holy Trinity 234 3 ... ... ... 1 7 48 1 1 ... 1 ... 6 16 1 25.2 Parish Church 560 24 6 ... 7 1 21 94 2 6 8 3 ... 9 41 ... 27.3 St. Andrew's 419 3 2 ... 4 4 2 37 ... 4 4 ... ... 2 3 ... 12.4 St.Joseph's 225 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0.4 Sr. Mark's 166 5 2 ... 3 ... 4 49 ... 3 1 ... 1 5 9 2 38.0 St. Marys 389 2 2 ... 5 13 2 51 ... 5 7 1 ... 12 16 ... 19.3 St. Peter's 115 1 ... ... 12 4 19 12 ... ... 3 ... ... 3 10 ... 41.7 St. Saviour s 276 7 1 ... 1 ... 1 3 ... 2 1 2 ... ... 3 ... 4.7 Shirley † 208 13 7 ... 1 10 ... 2 ... ... ... ... ... ... ... ... 15.9 St. Michael's 239 1 ... ... ... ... ... 8 ... ... 1 ... ... ... ... ... 3.7 Selhurst Grammar 990 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0.8 St. George's 107 5 ... ... 2 ... 4 27 ... 11 5 ... ... ... 6 ... 35.5 Totals 417 286 5 619 311 841 3561 37 267 236 36 2 243 1087 24 *Croydon British Boys' School closed 261h July, 1935. †Including Shirley Residential School. 266 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 West Thornton (69.6) and Christ Church (50.5), due chiefly to Mumps and Chicken Pox; next were St. Peter's (41.7) and Duppas (40.4), also due chiefly to Mumps find Chicken Pox. The lowest incidence was in St. Joseph's (0.4), Selhurst Grammar (0.8), and Archbishop Tenison's (0.8). In view of the age distribution of the two latter schools this was to be expected. Scarlet Fever. Four hundred and seventeen cases were notified from the schools, 111 less than in 1934. Kingsley (45), Christ Church (27) and Parish Church (24) had the most cases. Diphtheria. Two hundred and eighty-six cases were notified from schools. This was 47 less than in 1934. The Rockmount with 45 cases, Duppas with 25 cases, Kingsley with 23 cases, and Oval with 21 cases, had the highest individual numbers. Mumps. Three thousand five hundred and sixty-one cases were notified from schools. West Thornton (334), Kingsley (287), Beulah (286), Woodside (219), and Waddon (216) had the highest individual numbers. Chicken Pox. Eight hundred and forty-one cases occurred in schools and were notified therefrom, 293 more than last year. West Thornton (169), Kingsley (99), Beulah (59), and Kensington Avenue (56) showed the highest incidence. Whooping Cough. Three hundred and eleven notifications were received from schools, 410 less than in 1934. The highest numbers for individual schools were: West Thornton (39), Benson (37), and Norbury Manor (35). Measles. Six hundred and nineteen cases occurred in schools. Those showing the highest incidence were Whitehorse Manor (71), Purley Oaks (68), Tavistock (64), and Oval (60). 207 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 the 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 22 Health Visitors, who devote 5/llths of their time to school work. 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 inquiry 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. The new procedure will, it is hoped, deal more effectively with these. School Visits. The following Table summarises the visits paid, etc., in connection with these duties:— Visits to Schools re Cleanliness 41 Visits to School Departments re Cleanliness 589 Number of children inspected for cleanliness (first inspection) 65,608 Number of children inspected (subsequent inspections) 4,756 Number of occasions in which children found unclean (first inspection) 2,223 Number of occasions in which children found unclean (subsequent inspections) 2,172 In addition, 1,00-1 "other visits" to schools were made. 268 Home Visits. Concerning defects found at routine medical inspections 14,55 Subsequent visits re defects found at routine medical inspections 582 Visits re special cases 1,019 Visits to dental cases 87 Visits in connection with infectious cases and other visits (including 118 visits concerning uncleanliness) 16,779 These figures show a decrease of 640 in the number of children inspected for cleanliness; an increase of 2,506 in visits paid in connection with infectious cases and other visits for miscellaneous reasons; a decrease of 153 in the following-up visits to dental cases, and an increase of 151 in visits to special cases; a decrease of 465 in the visits made regarding defects found at routine medical inspections, and an increase of 48 in the home visits regarding uncleanliness. TREATMENT.. The Work of the School Clinics. Table XIII. Summary of Attendances. 1935. 1934 Increase or Decrease. Minor Ailments Clinics 9275 8607 +668 Inspection Clinic 1685 1597 +88 Dental Clinics 13611 13352 +359 Ophthalmic Clinic 3144 2982 +162 Orthopedic Clinic 1620 2437 —817 Remedial Exercises Clinic 8051 7052 +999 Ear, Nose and Throat Clinic 965 542 +423 Ionization Clinic 311 390 —79 Rheumatism Clinic 456 288 +168 39118 37247 +1871 The Minor Ailments Clinics. Clinics are held each morning at Lodge Road, Selhurst Road, and, since October, at Duppas School. One nurse is in attendance for the whole session, and a doctor attends when possible to see cases referred to him. He does not spend 269 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 these Clinics is to render first aid and to treat the minor disabilities peculiar to school children, and to advise what further measures may be necessary. At the subsidiary Clinic held at 206, Selhurst Road on five days weekly, 567 children made 2,924 attendances, and at the Duppas School 183 children made 623 attendances. Table XIV. Complaint. 1935. 1934. Cases. Attendances. Average No. of Attendances per case. Cases. Attendances. Average No. of Attendances per case. Ringworm of Scalp 6 40 6.7 6 24 4.0 ,, Body 32 249 7.8 15 152 10.1 Scabies 42 171 4.1 44 175 4.0 Impetigo 262 1605 6.1 221 1388 6.3 Other Skin Diseases 167 542 3.2 82 209 2.5 Otorrhoea and other Ear defects 236 1533 6.5 195 2020 10.4 External Eye Disease 256 1245 4.9 215 1044 4.9 Miscellaneous 1090 3988 3.7 593 3595 6.1 2091 9373 4.5 1371 8607 6.3 From this Table it is seen that the average number of attendances per child decreased from 6.3 to 4.5; the total attendances increased by 766, and the number of individual cases increased by Otorrhœa, which used to be one of the most intractable conditions, has become, with revised methods of treatment, no longer the long drawn-out affair it used to be. Impetigo still remains troublesome, while in the cases of scabies attending the improvement noted in last year's report was maintained. Adenoids and Elarged Tonsils. During 1935, 167 cases of tonsils only, 25 cases of adenoids only, and 421 cases of adenoids and enlarged tonsils, a total of 613 cases, were recommended for treatment. In 336 cases the Local Education Authority was requested to arrange for the operation. 270 There were 65 sessions at the Croydon General Hospital. The work is done by a rota of 4 general medical practitioners working in pairs, as surgeon and anaesthetist, for periods of three 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. 336 children were operated upon, an increase of 133 on 1934. 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. During the year no parent accepted this responsibility. If needful, children are kept longer. All children are conveyed home by ambulance. In all there were 275 non-attendances. Of the 336 children operated on 140 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 41 per cent. compared with 53 per cent. in 1934. 58 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. A few cases were operated upon in Mayday Hospital. Only the following conditions are considered to warrant the reference of a child for operation: — (a) Tonsils which are enlarged and septic, especially if in conjunction therewith the tonsillar glands are also enlarged. (b) Obstruction to breathing through one or both nostrils, (c) The presence of mouth breathing. 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 bv school attendance officers for an opinion as to their fitness or 271 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. 1,685 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 refraction 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 868 9 877 647 9 568 9 Secondary Schools 135 13 148 100 13 99 13 1003 22 1025 747 22 667 22 This Clinic showed a considerable increase upon 1934. Orthopædic Work. The Orthopaedic Scheme continues on the same lines as described in my report for 1931. The units comprising the scheme are:—(a) The Out-patient 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. 1935. 1934. Attendances. Sessions. Av. att. Attendances. Sessions. Av. att. Spinal 2,482 527 4.7 2,646 594 4.5 Massage 114 114 1.0 53 53 1.0 Flat Feet 1,685 240 7.0 1,898 228 8.3 Breathing 2,100 189 11.1 1,250 175 7.1 6,381 1,070 5,847 1,050 272 St. Giles' School, Addington. Total number of sessions 203 Total number of attendances 1670 Average attendance per session 8 Total number of females 18 Total number of males 11 Total number of patients 29 Still under treatment 25 Complaints. Male. Female. Total. Flat Foot and K.K. — 4 4 Scoliosis 1 2 3 Kyphosis 2 2 4 Spastic Diplegia 1 1 2 Hemiplegia 1 — 1 Infantile Paralysis 3 6 9 Lordosis 1 1 2 Athetosis — 1 1 Inco-ordination 1 — 1 Muscular dystrophy — 1 1 Paresis 1 — 1 11 18 29 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 school dental service is staffed by three dental officers. Their duties include the inspection and treatment of all children attending the public elementary and central schools and scholarship children attending the secondary schools. and also of those patients referred under Maternity and Child Welfare, Tuberculosis and Mental Deficiency Schemes, and children attending special schools for the partially sighted and physically defective. Children suffering from dental deformities are referred to the Special Orthodontic Clinic. Several visits have been made by the dental officers to Mayday Hospital. The report of work done under the various schemes appears elsewhere. There has been only one change in personnel: Mr. K. C. B. Webster, who accepted an appointment to the Hendon Borough Council, resigned in September, and Mr. G. M. Davie was appointed to fill the vacancy. 273 The complement of the staff is the same as in 1934. The appointment of a third assistant dental officer has been sanctioned by the Education Committee. This new appointment will materially help to reduce the congestion of treatments and enable a greater number of children to be inspected. The number of children attending the public elementary schools is 26,391; therefore, each dental officer has approximately 9,000 children allotted to him for inspection and treatment. This number is considerably more than one dental officer can cope with, and consequently it has been impossible to inspect all the children once during the year. The appointment of a third assistant dental officer will reduce the number per dental officer to about 6,500, which, although still more than each dentist should supervise, will, nevertheless, enable the school dental officers to make a larger contribution to the health of the school child. Inspection. The actual number of children inspected was 15,046, approximately 60 per cent. of the total school roll. Once again the congestion of treatment has prevented more sessions being set apart for inspection. Sessions devoted to inspection totalled 83, and 181 children were inspected per session. The reason for the drop in the number of children inspected and actually treated is because so many children have required several attendances to complete treatment. Although the number of children actually treated is smaller the volume of conservative treatment is greater. When inspections are held at intervals of eighteen months the amount of work to be done for those needing treatment is often considerable and more sessions have to be set apart to complete the treatments, and, therefore, there are fewer sessions available for further inspections and treatments. The total number referred with dental defects was 10,450, i.e., 69 per cent., compared with 72 per cent. in 1934. This is a welcome reduction in the incidence of dental disease, and it may be that the present method adopted in reducing the inspections to a more reasonable number, so that the dental officers can carry out earlier and more thorough treatment, is achieving its purpose. Table XVII. Percentage of healthy dentitions in the various Age Groups. 5 6 7 8 9 10 11 12 13 14 15 Girls 18 15 25 33 43 38 33 31 20 29 41 Boys 30 27 27 34 43 40 31 33 25 22 28 274 This table shows that the incidence of dental caries was greater in the five and six-year-old entrant girls than in the boys. In the nine-year-old groups there were 43 per cent. healthy, but with the eruption of more teeth the percentage of healthy dentitions declined until the fifteenth year is reached, when an improvement occurred. Treatment. The aggregate of the treatment sessions was 1,148; this is an increase of 23 sessions on the previous year's total. The total number of children treated during the past year was 7,116, compared with 7,300 in 1934. The total number of fillings in permanent teeth was 5,712, as against 5,723 in 1934, and fillings in temporary teeth numbered 336 as against 548 in 1934. The gross total of fillings was 6,048 compared with 6,271 in 1934. This similarity suggests that the present staff has practically reached the highwater-mark of fillings attainable. The extraction of permanent teeth increased from 2,005 in 1934 to 2,307 in 1935. It is difficult to reduce the number of extractions while inspections are held at 18-months intervals, and the same reason applies to the increase in extraction of temporary teeth from 9,865 in 1934 to 10,130 in 1935. The number of fillings per 100 children treated increased from 78 in 1934 to 80 in 1935. It is a matter for satisfaction that conservative treatment has increased so much during the last few years. In 1930 permanent fillings totalled 32 per 100 children treated, so that the figures for 1935 represent a great improvement. The extraction of permanent teeth per 100 children treated was 32, which is slightly more than in 1934, when the percentage was 28. In addition to permanent fillings a large number of teeth have been temporarily filled with zinc oxide to preserve the vitality of the pulp. Other conservative measurers included 35 root canal treatments, also 61 gum treatments, 230 scalings and prophylactic cleanings, 37 applications of silver nitrate and 13 dressings in temporary teeth. Several exposed nerves have been capped, and it is gratifying to report that after a long period of observation the teeth have responded to the usual vitality tests. Local anaesthesia was administered on 3,447 occasions not only for extraction of teeth hut also for the preparation of painful cavities. In the case of multiple extractions nitrous oxide is invariably given, and 1,904 administrations were carried out. 275 The amount of conservative treatment of deciduous teeth again declined. It is impossible to spend sufficient time on reparative measures for the milk dentition with the present staff. Attendances. The charges made for treatment are 8d. per attendance, and when gas is administered 2s. The total number of attendances for the year was 13,611, which is a slight increase compared with 1934, when the total was 13,352. Children of indigent parents are treated free. The sum of £424 10s. 7d. was received in payment for attendances made by children, and £9 3s. 6d. was received from voluntary box contributions. Special Cases. These cases include children referred by school medical officers, cases requiring treatment before operation for removal of tonsils and adenoids, children referred by the Tuberculosis Officer and cases for the relief of pain referred by head teachers. Children whose parents have refused treatment for three consecutive years are taken not to desire treatment under the school medical service and head teachers are notified of the names of such children and are requested not to issue emergency treatment forms. The number of special cases dealt with was 1,864 as against 1,755 in 1934. It is impossible to reduce the number of specials to a low figure unless every child is inspected each year and treated if required. Cases X-Rayed. Children referred for X-Ray examination of the teeth have been sent to Mayday Hospital, and in all 72 cases were radiographed. These cases include children sent to the Clinic suffering from traumatic injuries of the teeth and surrounding bone or with teeth in which the exposed nerves have been capped, necessitating a radiograph to check up the line of treatment. Radiographs have been taken to ascertain presence or absence of supernumerary teeth, and in special cases needing root canal treatment. Special Inspection and Treatment. Special treatments consisted of the following: five dentures to replace lost upper incisors, two crowns fitted and 20 root fillings in single rooted teeth. 276 The treatment of scholarship children attending secondary schools was as follows: Attendances 141 Other operations 30 New cases 59 Scalings 11 Permanent fillings 76 Gas cases 9 Extraction of permanent teeth 33 Local anaesthesia 31 Cases completed 41 Ditto, temporary teeth 3 Scholarship children are treated at Lodge Road and Selhurst Road Clinics. Nine patients were referred under the mental deficiency scheme; two had teeth extracted under nitrous oxide anaesthesia and seven received conservative treatment. Summary of School Children Inspected and Treated During the Year. Patients examined 16,910 Patients treated 7,476 Attendances 13,611 Fillings 6,048 Extractions 12,410 "Gas" cases 1,904 Other operations 2,751 Local anaesthesia 3,447 Sessions Held. Inspections 83 Treatment 1,148 Administration 16 Orthodontia 39 Gas administration 135 Total sessions 1,421 In addition, 172 sessions were occupied in other than school work. The dental officers devoted 80 sessions and the assistant medical officers 55 sessions to gas administrations. Selhurst Road Clinic. This Clinic has been in existence for over four years and the record of work done has proved its need. Additional clinics for Norbury and Waddon would relieve the congestion of cases at the Lodge Road treatment centre and would be the means of the children saving a considerable amount of school time which is lost through the distance these children have at present to travel. A clinic in the Waddon district will be established in the coming year. 277 Summary of Work Done. 1934. 1935. Attendances 4,351 4,609 Extractions 3,910 4,061 Fillings 2,150 2,033 Patients treated 2,179 2,185 Other operations 323 577 "Gas" cases 581 678 Local anaesthesia 1,322 881 New cases 2,670 2,655 Sessions held: Inspection—46. Treatment—381. Gas sessions—55. Ambulant Cases. Six children were referred to hospital for special treatment for the draining of alveolar abscesses. In each case the parents of the children had previously refused dental treatment. Preventive and Educative Measures. With the object of stimulating interest in mouth hygiene the Dental Board of the United Kingdom was invited for the second time to display the exhibit specially arranged for school children. Children from 11 years upwards are shown models of comparative dental anatomy and healthy and diseased conditions of the teeth. The exhibit is explained by a very capable demonstrator, and the children are invited to ask questions. The showing of the models successfully claimed the children's interest, and it was felt that the exhibit undoubtedly proved instructive and was very much appreciated. Many teachers expressed their appreciation of its excellence. It should be stated that no charge is made for the demonstration by the Dental Board, the only cost to the Authority being for the conveyance of models to and from the schools. Several of the schools at which the exhibit was shown were inspected soon afterwards; unfortunately the number of acceptances for treatment was not materially increased. Dental health propaganda takes some time to be fully appreciated by the parents, and it is hoped that when these schools are again inspected the results of the good work accomplished by this exhibit will be more evident. Is is hoped to have another visit from the Dental Board representative next year. 278 The most important thing in teaching dental propaganda is to interest parents, and it is felt that if parents were invited to see the demonstration it would help considerably in increasing the consents to treatment. The teachers and dental officers have continued their efforts to educate parents and children. The dental officers have given talks to parents at the inspection of the five-and-six-year groups and it is very satisfactory to note that 565 mothers attended. In connection with this propaganda the health visitors have interviewed many parents who had refused treatment, and the results obtained have been encouraging. THE ORTHODONTIC SERVICE. The existence of perfect function of the jaws and teeth is imperative to general health, and a scheme which has for its object the correction of dental deformities should always have a place in the service of dental treatment for school children, as it is true preventive work. The aims of orthodontic treatment are to correct aberrations of growth in jaw formation and to improve the aesthetic appearance. Both these aims are important to the health of the child, whether it be for treatment of the malformation of the jaws or for the cosmetic effect. The treatment of abnormally developed jaws is primarily important, and it is hardly necessary to emphasise that the restoration of perfect harmony of the facial characteristics plays a great part psychologically on the social and personal problems of a child's life. The parents of school children are taking a great interest in the scheme, and many attend for advice immediately dental defects are seen in the child. With this type of parent it is reasonable to expect co-operation and a successful conclusion to treatment. Failures may be traced to the lack of this indispensable co-operation between parent and dental surgeon. A large number of cases treated have been those of mouthbreathing, and in most instances this has been of dental origin. Many of these mouth-breathers have been supplied with oral screens and special lip exercisers to improve the approximation of the lips and to encourage normal breathing, and sometimes this treatment runs concomitantly with the wearing of special appliances. 279 Several cases of speech defects which were thought to be associated with malocclusion of the jaws have, following orthodontic treatment, improved considerably This evidence appears to support the recommendation that all cases referred for speech training at the speech defects class should be first examined by a dental officer to ascertain if the defect is in any way connected with dental deformity. An orthodontic scheme deals firstly with prevention, secondly with early treatment, and finally with the correction of deformities by special appliances. As regards prevention, this is chiefly medical, but the dental officers when they visit the child welfare centres are provided with an opportunity to assist in this very necessary part of prophylactic instruction. Advice would cover, among other items, the question of suitable diet for the child, the education of the parent in the dangers of bad habits, such as thumb, finger and toe sucking, and the art of correct breathing and sleeping. The early treatment of deformities includes the correction, by suitable exercises, of the perverted action of the mouth muscles, the judicious removal of temporary teeth which are likely to cause mal-position of the permanent teeth, and the use of special apparatus such as oral screens and lip exercisers to stop mouth breathing. With regard to orthodontic treatment the age for treatment varies, but, as a general rule, if the deformity is severe it is not desirable to attempt treatment after 11 years of age. Some cases of mal-position of the teeth can be treated quite successfully at a later age; in fact, many cases of close bite cannot be treated effectively until all the premolar teeth have erupted. The stage of development of the child is the factor upon which the time for commencing or postponing treatment is based. A survey of the incidence of malocclusion was taken during the year, and it was found that out of 15,067 children examined 578 had definite dental deformities, i.e., 3.7 per cent. of those children inspected. It is, of course, impossible for all these cases to be treated each year, and only those of very marked deformity, in which it was felt that the child would suffer aesthetically, and those in whom the risk of danger to the general health could not be overruled, were selected for treatment. 280 A comparison of the incidence of dental deformities and physical deformities in school children shows that the incidence of malocclusion in the school child is almost as high as that of other deformities of the body. The need of an orthodontic clinic is thus evident. The number of sessions devoted to orthodontia totalled 39, and 504 attendances were made, which averages 16 cases per session. The number of children under treatment during the year was 203, i.e., 2.7 per cent. of the total number treated at all clinic sessions, and it can therefore be said that the Orthodontic Clinic is maintaining the proper perspective in relation to other work of the school dental service. To facilitate the working of the orthodontic sessions and to allow as many new cases as possible to be treated, verbal appointments are made after the ordinary routine session cases have been dealt with. The number of such appointments was 1,546. During the year 63 cases were completed and 190 removable and 10 fixed appliances inserted. The total number of children treated since the inception of the scheme is 581—of this number 167 were treated by extraction only and 414 children by orthopraxy (dental appliances). In the orthodontic treatment by the extraction of teeth only the number of permanent teeth removed totalled 41. There are some cases which require X-Ray diagnosis, and these are sent to Mayday Hospital. In all, nine cases were radiographed. The scheme has been in operation for over four years and has provided treatment for a large number of children of indigent parents who would have been unable to attend a private practitioner or dental hospital because of the expense. It has been the policy to refer any cases in which it was felt that the parent could afford treatment to the private practitioner. Although the conservation of the teeth is the chief aim of the school dental service the value of orthodontic treatment as an aid to conservative dentistry is undoubted. The filling of teeth in overcrowded mouths is largely a palliative measure, and further treatment is required very soon, unless one of the chief causes of decalcification of teeth is removed. The charge made for treatment is 15s. per child, and this covers the cost of all the appliances required. It has been found possible to ran this scheme without incurring additional 281 ture, and with the exception of the dental surgeons' time the scheme is self-supporting. The dental surgeons undertake all the treatment required, and it is very gratifying that such a system has worked extremely well. The scheme is one of the most comprehensive in operation at the present time and fulfils practically all the fundamental requirements of an orthodontic service. EAR CLINIC. 1935. 1934. Number of Sessions held 41 46 Number of first attendances 73 84 Number of re-attendances 239 306 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 otorrhœa past or present, or deafness of more than a trivial or temporary nature 16 (2) Deafness only.—Some of these were due to old otitis media 10 (3) Otorrhoea, active, quiescent or cured 47 Group 2.—10 cases.—Three were cases of nerve deafness and were referred to a special school. Seven were of the catarrhal type and were referred for treatment such as removal of adenoids, breathing exercises, etc., whenever possible. Most of these are recent cases and are still under treatment. Group 3.—(a) Found dry and requiring no treatment 16 (b) Found dry but recommended for accessory treatment such as tonsillectomy 1 (c) Active cases 30 There was a diminution in the numbers attending the Ear Clinic during the year, and the waiting list seldom had more than two or three names at one time. Whether or not this means a real diminution in incidence it is impossible to say. Possibly the diminution is not in incidence so much as in chronicity, for one 282 knows that earlier and more efficient treatment is being obtained now, and many cases clear up before reaching the Ear Clinic. Although otorrhœa remains a difficult disease to cure it is being approached in a more active and hopeful way now than formerly. It is also reasonable to assume that the earlier and better treatment of septic tonsils and adenoids will prevent a certain amount of otorrhœa. The comparative mildness of scarlet fever is another factor which must operate favourably. The thirty active cases were treated as follows:— Two were ionised and the discharge ceased; in one case after one application, in the other after two. Nine were treated by the iodine and boric powder, and all cleared up. Eight cleared up without any special treatment. Five were referred for removal of tonsils and adenoids. Three were referred to the Croydon General Hospital. Two are still under treatment. One left the Borough. Besides the two new active cases referred to above, eight others were referred to the General Hospital. All attended. Ionisation of a few cases in the Borough Hospital has been done during the year. The chief impression gained is that the treatment of otorrhœa in a fever hospital and at a school clinic are two very different things. At a school clinic one applies ionisation once a week, and a dry ear after two, three, or four applications is considered satisfactory. In the fever hospital every week added to the normal period in hospital is serious, both to the hospital and the patient or his relatives; so that a dry ear after, say, three weekly applications, is a different matter. In hospital it is possible to apply the careful daily cleansing and application of drops or powder that cannot be so readily applied outside. However, one ionisation in favourable cases often suffices, and it is worth while applying it after the acute stage has passed, if there are no complicating factors, such as enlarged tonsils or adenoids. The iodine and boracic treatment carried out is as follows:- The powder consists of iodine resublim. grs. 3.6 and boric acid powder to one ounce. The iodine is rubbed down in a mortar with a few drops of spiritus vini rect. until solution is effected, and this is gradually incorporated with the boric acid. The powder 283 is made up in amounts of not more than two ounces at a time, as it deteriorates on keeping, and it is kept in a glass-stoppered amber-coloured bottle. A Rauchfuss scoop-pattern insufflator is used. A fundamental for success is thorough cleansing of the ear prior to the insufflation. RHEUMATISM CLINIC. As has been stressed in previous reports, this Clinic is not in any sense a "treatment centre," but is concerned with the diagnosis, supervision, advice, and re-examinations of all types of rheumatic infections in children. The bulk of the children have been drawn from school children coming under medical inspection, either at school or at an Inspection Clinic. In addition, some cases have been referred from the Tuberculosis Dispensary and the Maternity and Child Welfare Centres. 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. As a consequence of steady propaganda, parents are becoming increasingly aware that "growing pains" in children must be taken seriously. Some have written to the Head Teacher concerning their child's "pains," and ask for an appointment for the Clinic. This is an indication that the Clinic is becoming more widely known and appreciated. Is is important in cases of heart disease that parents should be advised immediately, so that further cardiac damage may be 284 prevented, but it is of equal importance 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. Children are sometimes condemned to a life of inactivity because a murmur has been heard over the cardiac region; when, in fact, they could with advantage and with proper supervision have followed a normal life. Difficult and severe cases have been referred to the Out. Patients' Department at the Croydon General Hospital, where Dr. Preston, as in previous years, has very kindly given his assistance and advice. In certain acute and severe cases, modification of the school curriculum has been necessitated and special arrangements have been made so that there should be no interruption in the child's education. The Coombe Cliff Convalescent Home continues to prove 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. Almost without exception, heart cases showed conspicuous benefit. Owing to the increase in the numbers of attendances and requests for examination, it has been necessary to hold two Clinics per week during the last six months of the year. 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. Table XIX. Cases Examined at Rheumatism Clinic. 1933 1934. 1935. Primary 71 119 160 Re-examinations 109 169 246 180 288 406 Rheumatic 65(91.5%) 108 (90.8%) 143 (89.4%) Non-Rheumatic 6 (8.5%) > 11 (9.2%) 17 (10.6%) 71 119 160 285 Classification of Rheumatic Cases— Primarv. Re-examinations. Sex—Males 62 (43.4%) 101 (40.6%) Females 81 (56.6%) 145 (59.4%) Total 143 246 Age when Examined— Ages 4 5 6 7 8 9 10 11 12 13 14 15 16 Primary 1 5 15 12 19 21 17 9 21 15 5 2 1 Re-examinations — 1 5 6 7 24 32 42 51 55 18 3 2 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 referring to the digestive system and intestinal tract, e.g. abdominal pains, constipation and lack of appetite 44 cases Group II.—Symptoms suggesting the presence of a toxaemia, e.g., aching limbs, lassitude, headache 95 cases Group III.—Symptoms suggesting a disturbance of the nervous system, e.g., irritability, disturbed sleep, nocturnal eneuresis, fidgetiness 71 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 •he type of case observed. Grouping of Cases.* 1934. 1935. Mild and Potential 71 (65.7%) 102 (71.4%) Definite Active 25 (23.2%) 26 (18.1%) Definite Quiescent 12 (11.1%) 15 (10.5%) (*Classification of Dr. R. Miller.) 286 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: 143 cases. Rheumatic Pains 110 (76.9%) Rheumatic Fever 16 (11.2%) Chorea 38 (26.6%) Carditis, Definite 99 (69.2%)† †Slight 58 (40.6%) †Marked 41 (28.6%) Carditis, Suspected 18 (12.6%) Tonsillitis 21(14.6%) Rheumatic Fever Cases. There were 16 children who gave a definite history of Rheumatic Fever. Of these, 3 had sound hearts, and 13 had definite carditis. Chorea Cases. There were 16 cases of Chorea and 12 of a Prechoreiform type. Of these, 7 had definite carditis, 13 slight or suspected, and 8 sound hearts. Family Histories. In the case of 29 families (20.3 per cent.), either the father or the mother had had rheumatic fever or chorea. In 12 other cases (8.4 per cent.) a history of rheumatic fever was obtained in near relatives of the parents. In the case of 27 children (18.9 per cent.) their brothers or sisters gave a history of rheumatism or chorea. 287 Skin Conditions. Recorded in 101 cases. Fair 61 (60%) Dark 40 (40%) Moist skin and a history of liability to sweating was recorded in 21 cases. A history of flushing and rashes in 17 cases. Nervous Conditions. Recorded in 123 cases. Children recorded as highly strung 97 (78.8%) Headaches 72 (58.6%)† †Occasional 34 (27.7%) †Frequent 38 (30.9%) Night Terrors, etc. 61 (50.2%)§ §Slight 44 (35.8%) §Severe 17 (14.4%) Enuresis 18 (14.6%) Twitchings 36 (29.3%) Often a combination of more than one of the above symptoms was manifested. Catarrhs. A history of various catarrhs, not tonsillitis, was reported in 26 cases (18.2 per cent.). The increase in this percentage is probably due to the difficulty in ascertaining from parents the meaning of "catarrh." Tonsillectomy. Operation reported in 25 cases (17.5 per cent.). Re-Examinations. 246 re-inspections were carried out. In 24 (9.8 per cent.) of these the conditions had become worse; 12 (4.9 per cent.) were considered to be non-rheumatic; 49 (19.9 per cent.) stationary; 118 (47.9 per cent.) were definitely improved; and 43 (17.5 per cent.) quiescent. 288 Environment and Other Conditions in Rheumatism Clinic Cases. Reported in 105 cases. Wards.—Cases were drawn from all Wards in the Borough with the exception of Norbury. Woodside 9 Thornton Heath 10 Addiscombe 8 Bensham Manor 7 South Norwood 5 South 3 Upper Norwood 3 West Thornton 12 Addington 1 Waddon 26 Whitehorse Manor 8 East 4 Broad Green 8 Central 4 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. 84 of the houses were sufficiently drained and 15 were well drained; in 9 drainage was problematical. Houses which were perfectly dry and did not show any signs of dampness numbered 96, whilst 11 showed traces of damp; 1 was damp; and no house was specified as very damp. A notice was served on one owner. Aspect. 105 cases reported. The aspects of the houses were as follows:— S.E. 16 S.W. 18 E. 8 N.E. 13 N.W. 19 S. 11 N. 7 W. 13 The bulk of houses in which cases occurred were ordinary terrace houses (66), or semi-detached (38), detached (1), and definite overcrowding was found in 3 families. It is interesting to compare the percentage of cases occurring in terrace and semi-detached houses in 1934 and 1935. there was a decrease from 80.5 per cent. to 62.9 per cent. and an increase from 19.5 per cent. to 37.1 per cent. respectively. This is almost entirely due to the increasing accommodation provided by the Corporation in their new housing estates. 289 Economic Status. The economic status of the families from whom patients were examined was as follows:— Poor in 9; average working class, 65; better working class, 19; clerical work, 8; and superior, 4. The interior home conditions were classified as follows:— Clean, 68; moderately clean, 29; superior, 8; unsatisfactory, nil. 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). St. Luke's Special School For Partially Sighted Children. At the end of the year there were 34 children in attendance. Of these, 23 were cases of myopia, 9 were non-myopes, and 2 had myopia combined with some other ocular defect. The curriculum is that usually laid down for the myope and partially sighted, respectively, but is under constant review, and changes are introduced according to experience. Both boys and girls have attended domestic science classes, and the system of mixing the children with those in the ordinary elementary school for certain lessons, introduced last year, has been continued. Again physical exercises, suitably restricted for certain children, are 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 290 and for after-care, but this is often difficult, especially with the dull child from a poor home. The subsequent ophthalmic supervision of the children is assisted by the circumstance that the Ophthalmic Surgeon to the School is also the Ophthalmic Surgeon attached to the Mayday and Croydon General Hospitals. Deaf Children. Six boys and 9 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, G boys and 9 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 the Lingfield Epileptic Colony. 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; 1 girl is at Knotty Ash M.D. School, Liverpool; 2 boys at Sandlebridge, Cheshire; 1 boy at Besford Court, Worcestershire; and 1 girl at Allerton Priory, Liverpool. 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; at Treloar's Cripple Hospital, Alton, 1 girl. The Committee maintained 1 girl at West Wickham Heart Home, a special school for cardiac cripples; 1 boy at Edgar Lee Heart Home, Willesden; 1 girl at Cheyne Hospital, Chelsea; and 1 boy and 2 girls at Lancing Convalescent Home for Cardiac cases. SPEECH DEFECTS CLASS. The special bi-weekly class, conducted by two trained speech teachers, has continued through the year and has been fully attended throughout. Each teacher can only treat adequately a 291 limited number of children, as each case has to be dealt with individually. The results have fully justified the Committee's decision to establish these classes. Male. Female. No. of children under treatment on Jan. 1st 11 1 No. of children under treatment on Dec. 31st 14 3 No. of children referred for Psychological investigation 4 No. of children referred to other Clinics— (a) Adenoids and Tonsils 2 (b) Dental 2 (c) Orthopædic 1 (d) Other Clinics 2 One child (included in the above numbers (d) ) was referred to the West End Hospital for Nervous Diseases for in-patient treatment. Eleven children suffering from Stammer were discharged during the year. Of these, 5 were cured; 2 were relieved; 2 were referred for psychological treatment; and 2 ceased attending before completion of treatment. Three children suffering from other speech defects also ceased treatment during the year. The conditions were : Psychic Deafness, Hysterical Aphonia, and Tongue-tie; two of the children were relieved, the third ceased attending before treatment was finished. The children attending the Clinic on January 1st, 1936, were suffering from the following speech defects:— Stammer, 5; Lalling, 6; Slight Idioglossia, 2; Cleft Palate, 2; Spastic Palate, 1; Hemi-paresis with aphasia, 1. Total: 17. SCHOOL CAMPS. A school camp was held, as usual, 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. 292 605 boys and girls from the elementary schools went to the Camp during 1935 in parties, each party going for one week. All the children are medically inspected before proceeding to camp. The following are the schools which sent parties:— Ashburton, 41 boys, 13 girls; Davidson, 30 girls; Oval, 38 boys, 29 girls; Portland, 30 boys, 39 girls; Ecclesbourne, 21 boys; Howard, 20 boys; Kingsley, 40 boys, 49 girls; Norbury Manor, 39 boys, 80 girls; Waddon, 40 girls; Sydenham, 42 boys; Croydon British, 30 girls; Tavistock, 24 boys. JUVENILE EMPLOYMENT RETURN. The following numbers of children were examined by the medical officers during 1935 as to their fitness to follow the parttime employment indicated. There has been an increase of 112 in the delivery of goods for shopkeepers; of 95 in the delivery of newspapers, and 8 in the delivery of milk:— 1935. 1934. 1933. 1932. 1931 Delivery of Goods for Shopkeepers 208 96 105 119 102 Delivery of Newspapers 285 190 163 178 227 Delivery of Milk 42 34 24 37 33 535 320 292 334 362 Eleven girls and 2 boys were medically examined, and subsequently licensed by the Education Authority to take part in public entertainments. 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:— Davidson, Ecclesbourne, Elmwood, Ingram, Kinsgley, 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 extra nourishment are made by the School Medical Officers, Teachers, Enquiry Officers and Care Committees and are considered by the Attendance Sub-Committee. Re-examinations are made every three months, if practicable, by the medical officers in cases referred on medical grounds, when renewal or discontinuance is 293 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 has undoubtedly had beneficial results. By arrangement with the Milk Marketing Board, some 12,000 bottles of milk, containing onethird of a pint, are delivered daily at the schools at a cost of ½d. per bottle. This supply is available for all elementary school children irrespective of any medical recommendation. 1934. 1935. No. of Children who received Free Dinners 725 431 „ Free Dinners provided 87,273 53,407 No. of Children who received pints pints „ „ Free Milk 134—10,615 129—12,439 „ „ Milk (part payment) 14—1,181 20—1,094 „ „ Milk (whole payment) 9—173 29—883 issues issues „ „ Free Malt 19—2,321 18—2,014 „ „ Malt (whole payment) 23—2,227 23—2,553 ST. CHRISTOPHER'S SPECIAL. SCHOOL. I am indebted to Mr. H. J. Edmonds, the Head Master, for the following report:— During 1935 there were 21 children admitted and 20 left the school. There were 106 on the school roll on 31st December, 1936. The school is now full: that is, the average attendance for 1935 has exceeded the accommodation, but it is anticipated that early in 1936 an extension will be made, allowing for the admission of another 25 children. With regard to attendance, it is worthy of note that 39 children made perfect attendances during the year. Good steady work has been done in all subjects, but, perhaps the best advance has been made in Physical Training. This consists of Organised Games, Set Exercises, and Country Dancing. It is our aim, as far as is possible, to emulate the work carried out by the children in the elementary schools. All classes have worked splendidly, and a new class in Gymnastics for the senior boys has been started, and has proved very popular. The teaching of Woodwork has been re-organised: a specially qualified woodwork master has been appointed, and good work on definite lines is now being carried out. 294 Regarding outside activities, the usual summer excursion to Littlehampton took place on July 3rd, when 47 children attended. A glorious day was spent at the sea. Then, on July 23rd and 30th, visits were made to the Tower of London. Mention must also be made of a visit to the Whitgift School on July 9th, by invitation of Mr. and Mrs. Gurner. 50 children attended, and, after inspecting the school and grounds, sat down to a bountiful tea. The annual prize-giving and concert was held on December 20th, when many parents and friends attended. I must, before closing this report, extend my thanks to the staffs and children of the John Ruskin School and the Kingsley School for many gifts of toys and clothing, as well as for many acts of kindness to our children. Statement of the Number of Children Notified during the year by the local education authority to the local Mental Deficiency Authority. Total number of children notified: 17. These children are notified as being ineducable in a Special School for Mentally Defective or Backward Children. Analysis of the above Total. Diagnosis. Boys. Girls. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots - - (b) Imbeciles 1 4 (c) Others 6 1 (ii) Children unable to be instructed in a Special School without detriment to the interests of other children: (a) Moral defectives 1 - (b) Others - - 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 3 1 3. Feeble-minded children notified under Article 3, i.e., "special circumstances" cases - - 4. Children who in addition to being mentally defective were blind or deaf - - Grand Total 11 6 295 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 Syllabus of Physical Training for 1933 has now been in operation sufficiently long to form some opinion of its effects. Generally there has been an increased interest on the part of both teachers and pupils. The greater freedom of the work is resulting in more vigorous exercise and in greater enjoyment of the lessons. It appears to be developing greater suppleness and better posture both in and out of the definite Physical Training lessons. The problem of obtaining suitable clothes for these lessons is not fully solved. In some Senior Boys' Departments, the boys change normally into vests, short and shoes, but in some of the poorer areas the pupils experience difficulty even in obtaining suitable footwear. Several schools have arranged Physical Training demonstrations to which they have invited the parents of the children. Where this plan has been adopted, it has been found that the parents co-operate more readily with the school in the matter of suitable dress. The hiring of the new omnibus has enabled an extension of •he organised games facilities to be effected. Greater use can be made of the more distant playing fields. School sports are held by practically all departments. There has been a considerable advance in the number of swimming certificates gained. These are three times as numerous as they were ten years ago. More schools are holding annual swimming galas to which the general public are invited. Life Saving awards show an increase on last year. The interest in sword, morris and country dancing has been maintained. The recent development of this healthy and graceful from of physical activity is a pleasing feature of the work of the schools. Teachers have attended courses in Sword and Morris Dancing, swimming and general gymnastics. 296 The Croydon Schools Athletic Association has continued its excellent work. It has sections for cricket, football, boxing, swimming, athletics and country dancing. The work of organising and supervising inter-schools competitions in these branches of athletics is voluntarily undertaken by the teachers and is worthy of the highest praise. Girls. (Central, Senior and Junior Mixed, Senior and Junior Girls and Infants). The year was one of steady work on the "Syllabus of Physical Training, 1933," which is now well established in all schools. It is good to note increased vitality, joyous alertness and resultant improvement in posture of the majority of the children. In accordance with the Education Committee's scheme (whereby all Junior Schools shall be equipped with jumping stands and mats, for agility work, within three years) twelve more Junior Departments were thus supplied in 1935 and it is anticipated that the remaining ones will be equipped in 1936. In addition, seven Senior Girls' Department received a second gymnastic mat, so that now all Central and Senior Departments have two such mats, towards the four suggested by the Board of Education as necessary equipment for classes of 40 pupils of Senior School age. A certain amount of portable equipment, such as balls, ropes, quoit rings, team markers, etc., was supplied to each department as before. Swimming.—It has not yet been found possible to arrange bath accommodation for the Benson, St. George's Hall and Addington Village Junior Schools, but, with these exceptions, all Central, Senior and Junior Departments sent classes to the swimming baths during the season May to October and the attendance was well maintained throughout. Over one thousand girls learned to "swim a width" for the first time and the number of certificates gained (which dropped in 1934 owing to the restricted use of the baths during the drought) increased very satisfactorily—indeed in some cases, notably in Elementary and Advanced Life Saving and Royal Life Saving Society awards, records were created—367 girls gaining Elementary, 215 Advanced Life Saving Certificates, 130 Intermediate Certificates, 42 Bronze Medallions, 1 Bar to Medallion, 7 Second Class Instructor's Certificates and 2 Silver Awards of the Royal Life Saving Society. Twenty schools arranged Swimming Galas at the end of the season, in addition to the Inter-Schools Gala organised by the Croydon Schools Athletic Association. 297 Organised Games and Athletics.—Twenty-nine departments were able to make use of playing fields or recreation grounds for girls' organised lessons. Those schools with their own playing field attached gain most value in this way, as all classes in the school are able to use the field when suitable. Shirley Road field was used as often as transport by the Committee's omnibus was available. It is hoped, with the advent of an additional vehicle, that more classes will be able to enjoy the amenities of this really beautiful field and also that at Clifton Road. The Syllabus of Physical Training gives many opportunities for class practice of simple athletics, and Sports afternoons are becoming an established item in many departments. Thirty-two schools arranged Sports afternoons or Inter-House Games Contests. Folk Dancing.—All schools, with the exception of seven, included the teaching of Folk Dancing in the Physical Training curnculum. It should be noted that in five of these departments no suitable indoor accommodation was available, this being the reason for the non-inclusion of this subject. Corrective Classes for children with faulty posture were continued in seven schools as before. School Journeys and Camping Parties.— Girls from eight departments enjoyed camping at Pilgrim Fort during the season, whilst parties of girls from eight schools participated in school journeys to Scotland, Seaford (2), Broadstairs and Paris. "Refresher Courses" for Teachers held during the year included: (a) Scottish Country Dancing—Two Courses. (b) Physical Training for Infants Schools. (c) Physical Training for Junior Schools. (d) Organised Games—Senior and Central Schools. As in former years, all branches of Physical Training have been encouraged and stimulated by the work, out of school hours, of the voluntary associations, particularly the Croydon Schools Athletic Association with its sections for Swimming, Netball, Athletics and Folk Dancing. The East Surrey Branch of the English Folk Dance and Song Society also continues to give inspiration and encouragement to teachers and scholars alike. the Organiser of Physical Training expresses her grateful thanks to all concerned in the physical welfare of the children of Croydon for their help and encouragement throughout the year. 298 INSTRUCTION IN SPECIAL SUBJECTS. In the time-table for the year ending 31st March, 1936, 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). British Girls, Polytechnic (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. SECONDARY SCHOOLS. The usual arrangements for the medical examination of secondary school children were continued in 1935; 1,318 children were examined, 629 of whom were boys and 689 girls. Table II. of Appendix gives the detailed findings. 109 boys (17.3 per cent.) and 135 girls (19.6 per cent.) were found to require treatment, the most usual defect being 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. SECONDARY SCHOOLS HEIGHTS AND WEIGHTS. BOYS. G IRLS. 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 ... ... ... ... ... ... ... 3 42.7 40.7 43.0 42.0 42.0 39.0 1929 ... ... ... ... ... ... ... 4 45.6 45.3 47.5 52.0 43.0 39.0 1928 ... ... ... ... ... ... ... 1 49.5 54.0 ... ... ... ... 1927 ... ... ... ... ... ... ... 3 52.3 60.5 56.5 66.5 48.5 55.0 1926 ... ... ... ... ... ... ... 8 52.8 66.0 56.0 99.0 46.0 49.0 1925 10 56.7 80.6 64.0 104.0 53.0 67.3 26 55.2 71.3 60.3 91.3 51.3 55.5 1924 93 56.1 77.4 60.4 103.5 51.2 59.1 147 57.0 80.2 63.2 124.2 51.9 57.2 1923 140 57.1 81.2 65.8 111.4 53.2 62.2 155 58.4 85.0 64.2 121.6 54.2 63.3 1922 164 58.6 87.0 68.0 128.9 52.5 63.6 72 59.7 91.1 65.2 123.1 55.2 66.7 1921 91 62.1 101.8 67.7 127.6 56.5 80.1 37 62.0 102.3 65.2 122.4 57.1 76.6 1920 77 64.6 113.2 70.5 140.1 58.5 79.9 129 63.1 111.6 67.9 142.1 58.7 84.5 1919 24 66.1 123.9 69.6 160.2 63.0 102.8 70 63.5 117.1 67.4 147.5 59.4 92.7 1918 5 67.4 136.0 71.0 173.5 61.5 98.5 18 63.7 114.2 68.0 150.0 58.5 90.0 1916 ... ... ... ... ... ... ... 5 64.0 118.3 65.0 142.5 61.5 107.5 299 Table XX. 300 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. 1 wish to acknowledge my indebtedness to the Education Officer and members of his staff for their helpful co-operation. The burden of the work has fallen upon the Assistant Medical Officers, Health Visitors, and the Clerical Staff, to all of whom I desire to record mv thanks for their loyalty and co-operation. I am, Yours faithfully, OSCAR M. HOLDEN, School Medical Officer. 301 Table I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups: Year 1935. Year 1934. Entrants 3859 2670 Second Age Group 2762 1888 Third Age Group 1708 1779 Total 8329 6337 Number of other Routine Inspections 13 15 Grand Total 8342 6352 B.—Other Inspections. Year 1935. Year 1934. Number of Special Inspections 5499 5243 Number of Re-Inspections 8719 8286 Total 14218 13529 C.—Children Found to Require Treatment. Number of individual children found at Routine Medical Inspection to require treatment (excluding Uncleanliness and Dental Diseases). Year 1935. Year 1934. Prescribed Groups: Entrants 590 347 Second Age Group 547 271 Third Age Group 360 279 Total (Prescribed Groups) 1497 897 Other Routine Inspections 2 2 Grand Total 1499 399 Total Visits to Elementary Schools 446 373 302 TABLE II. A.—Return of Defects found by Medical Inspection in the Year ended 31 st December, 1935. DEFECT OR DISEASE. (1) Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. (2) Requiring to be kept under observation, but not requiring Treatment. (3) Requiring Treatment. (4) Requiring to be kept under observation, but not requiring Treatment. (5) Skin— (1) Ringworm : Scalp (2) Body ... ... 2 ... (3) Scabies 3 ... 1 ... (4) Impetigo 4 1 2 ... (5) Other Diseases (Non-Tuberculous 6 5 1 2 Total (Heads 1 to 5) 13 6 6 2 Eye— (6) Blepharitis 6 3 2 ... (7) Conjunctivitis 2 2 2 ... (8) Keratitis ... ... ... ... (9) Corneal Opacities 2 ... ... ... (10) Other Conditions (excluding Defective Vision and Squint) 2 ... 3 ... Total (Heads 6 to 10) 12 5 7 ... (11) Defective Vision (excluding Squint) 363 36 109 2 (12) Squint 68 22 14 ... Ear— (13) Defective Hearing 11 4 7 1 (14) Otitis Media 10 7 9 2 (15) Other Ear Diseases 3 ... 1 2 Nose and Throat— (16) Chronic Tonsillitis only 148 353 11 1 (17 Adenoids only 23 29 3 ... (18) Chronic Tonsillitis and Adenoids 420 296 39 8 (19) Other Conditions 48 39 9 1 (20) Enlarged Cervical Glands (Non-Tuberculous) ... 51 2 1 (21) Defective Speech 16 4 4 1 Heart and Circulation— Heart Disease : H (22) Organic 24 144 6 13 (23) Functional 11 145 ... 9 (24)Anaemia 14 96 2 2 303 TABLE II—continued. DEFECT OR DISEASE. (1) Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. (2) Requiring to be kept under observation, but not requiring Treatment. (3) Requiring Treatment. (4) Requiring to be kept under observation, but not requiring Treatment. (5) Lungs— (25) Bronchitis 22 88 2 1 (26) Other Non-Tuberculous Diseases 4 24 ... • •• Tuberculosis— Pulmonary : (27) Definite ... ... ... ... (28) Suspected 8 14 1 4 Non-Pulmonary: (29) Glands 1 7 ... ... (30) Bones and Joints 2 1 ... ... (31) Skin ... ... ... ... (32) Other Forms ... 5 ... ... Total (Heads 29 to 32) 3 13 Nervous System— (33) Epilepsy 1 12 1 3 (34) Chorea 8 32 8 8 (35) Other Conditions 7 48 1 2 Deformities— (36) Rickets 6 3 ... 1 (37) Spinal Curvature 86 77 7 (38) Other Forms 110 62 17 ... (39) Other Defects and Diseases (excluding Uncleanliness and Dental Diseases 86 79 30 8 Total 1,525 1,689 296 78 b.—Classification of the Nutrition of Children during the Year in the Routine Age Group Inspected 5. Age-groups. Number of Children Inspected. A (Excellent). B (Normal). C (Slightly subnormal). d (Bad). No. % No. % No. | % No. % Entrants 3859 351 9.1 3248 84.2 244 6.3 16 0.4 Second Age-group 2762 274 9.9 2267 82.1 207 7.5 14 0.5 Third Age-group 1708 143 8.4 1473 86.2 92 5.4 ... ... Other Routine Inspec- tions 13 2 15.4 11 84.6 ... ... ... ... total 8342 770 9.2 6999 83.9 543 6.5 30 0.4 In this Section only children who are so blind that they can only be appropriately taugh 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 ... ... 1 11 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 taueht in a school for the Dartiallv blind are included. Children who are able by means of suitable glasses to read the ordinary school book! 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. ... 34 10 ... 1 45 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. 15 ... ... ... 15 PARTIALLY DEAF CHILDREN. Only children who can 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. ... ... 6 ... ... 6 304 TABLE III. Return of all Exceptional Children In the Area. Children Suffering from Multiple Defects. Number of children suffering from combination of defects 2 BLIND CHILDREN. A blind child is a child who is too blind to be able to read the ordinary school books used by children. 306 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 fro m instruction in Special Schools for mentally 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 At At At Schools for Public Private no School or Institution. Total. Mentally Elementary Schools. Defective Schools. Children. 115 25 4 1 145 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. Total. 4 2 ... 1 7 PHYSICALLY DEFECTIVE CHILDREN. Physically Defective children are children who, by reason of physical defect, are "capable of receiving proper benefit from the instruction in the ordinary Public Elementary ools, but are not incapable by reason of that defect of receiving benefit from instruction 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 a cripplied 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. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 1 1 2 2 6 306 II.—Children Suffering from Non-Pulmonary Tuberculosis. (This category includes tuberculosis of all sites other than those shown in (1) above.) At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 17 6 1 2 26 B. Delicate Children. This Section is confined to children (except those included in other groups) whose genera 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. Total. 11 9 ... 1 21 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 At Certified Public Elementary Schools. At other Institutions. At no School Institutions. Total- Special Schools. 40 7 ... 6 53 I D. Children with Heart Disease. This Section is confined to children whose defect is so severe as to necessitate tlie 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. 31 13 ... 3 47 307 TABLE IV. Treatment Tables. Group I.—Minor Ailments (excluding Uncleanliness, for which see Table VI). 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: (i) X-Ray Treatment 2 ... 2 (ii) Other Treatment 4 ... 4 Ringworm-Body 32 ... 32 Scabies 42 ... 42 Impetigo 261 ... 261 Other Skin Disease 164 ... 164 Minor Eye Defects— External and other, but excluding cases falling in Group II 228 ... 228 Minor Ear Defects 252 ... 252 Miscellaneous— Minor Injuries, Bruises, Sores, Chilblains, etc. 1070 ... 1070 Total 2055 ... 2055 Group II,—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Number of Defects dealt with. Under the Authority's Scheme. Otherwise. Total. Errors of Refraction (including squint) 868 9 877 Other defect or disease of the eyes (excluding those recorded in Group I) ... ... ... Total 868 9 877 No.of Children for whom spectacles were (a) Prescribed 647 9 656 (b) Obtained 568 9 577 308 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) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) ... 7 327 ... 15 1 38 ... 15 8 365 ... ... 388 (i) Tonsils only. (ii) Adenoids only. (ii) Tonsils and adenoids. of the nose and throat. (iv) Other defects GROUP IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme. Total mimbf treated. Residential treatment with education. (i) Residential treatment without education. (ii) Non-residential treatment at an orthopaedic clinic. (iii) Number of children treated 18 13 506 521 TABLE V.—Dental Inspection and Treatment. (1) Number of children inspected by the Dentist— (a) Routine age-groups: Age 5 6 7 8 9 10 11 12 13 14 up. Total. Number 903 1534 1543 1261 1551 1743 1779 1517 1540 1675 15046 (b) Specials '<*" (c) Total (Routine and Specials) 16910 (2) Number found to require treatment 12314 (3) Number actually treated 7116 (4) Attendances made by children for treatment 13611 (5) Half-days devoted to: (7) Extractions: Inspection 83 Permanent Teeth 2307 Treatment 1148 Temporary Teeth 10130 Total 1231 Total 12437 (8) Administrations of general anaesthetics for extractions 1904 (6) Fillings: (9) Other Operations: Permanent Teeth 5712 Permanent Teeth 2705 Temporary Teeth 336 Temporary Teeth 46 Total 6048 Total 2751 TABLE VI.—Uncleanliness and Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurses 12.5 (ii) Total number of examinations of children in the Schools by School Nurses 70454 (iii) Number of individual children found unclean 2223 (ivj Number of children cleansed under arrangements made by the Local Education Authority 185 (v) Number of cases in which legal proceedings were taken : 3 (a) Under the Education Act, 1921 (b) Under School Attendance Byelaws ... 309 SECONDARY SCHOOLS. Year ended 31sf December, 1935. Table I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Code Group Inspections— Year 1935. Year 1934. Age 11 or under 283 357 12 326 287 13 237 352 14 127 297 15 212 211 16 105 165 17 23 41 18 or over 5 14 Total 1,318 1,724 B.—Other Inspections. Year 1935. Year 1934. Number of Special Inspections 25 39 Number of Re-inspections 193 198 Total 218 237 Visits to Secondary Schools 70 86 310 SECONDARY TABLE II.—A.—Return of Dkfkcts Found by Medical Inspection in the Year Ended 31st December, 1935. DEFECT ok disease (1) Routinp. Inspections. Number of defects. Special Inspections. Number of defects. Requiring treatment. (2) Requiring to be kept under observation but not requiring treatment. (3) Requiring treatment. (4) Requiring to be kept under observation but not requiring treat ment. (6) Malnutrition 6 15 ... 1 Unclcanliness. ... ... ... ... (See Table IV.—Group V.) Skin— Ringworm Scalp ... ... ... ... Body ... ... ... ... Scabies ... ... ... ... Impetigo ... ... ... ... Other diseases (non tuberculous) 1 2 1 ... Eye— Blepharitis ... 2 ... ... Conjunctivitis ... ... ... ... Keratitis ... ... ... ... Corneal opacities 1 ... ... ... Defective vision (excluding squint). 136 29 9 ... Squint 5 2 ... ... Other conditions ... 1 ... ... Ear — Defective hearing ... 1 ... ... Otitis media ... ... ... ... Other eai diseases ... ... ... ... Nose and Throat— Enlarged tonsils only 19 49 ... 1 Adenoids only 2 1 ... ... Enlarged tonsils and adenoids 1 3 ... ... Other conditions 2 ... ... ... Enlarged Cervical Glands (Non Tuberculous) ... ... ... ... Defective Speech ... 3 ... ... Teeth—Dental Disease ... ... ... ... Heart and Circulation-- Heart Disease — Organic 1 34 ... 2 Functional ... 24 ... 3 Anremia 2 13 ... ... Lungs— Bronchitis ... 4 ... ... Other non-tuberculous diseases ... 1 ... ... Tuberculosis— Pulmonarv— Definite ... ... ... ... Suspected ... 4 ... ... Non-pulmonary— Glands ... ... ... ... Spine ... ... ... ... Hip ... ... ... ... Other bones & joints ... ... ... ... Skin ... ... ... ... Other forms ... ... ... ... Nervous System— Epilepsy ... 1 ... ... Chorea ... 3 ... ... Other conditions 1 2 ... ... Deformities— Rickets ... 1 ... ... Spinal curvature 41 23 ... ... Other forms 22 18 ... 1 Other Defects and Diseases 4 18 ... ... 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) 11 or under 283 42 14.8 12 326 53 16.3 13 237 37 15.6 14 127 19 15.0 15 212 38 17.9 16 105 17 16.2 17 23 3 13.0 18 and over 5 1 20.0 1318 210 15.9 TABLE IV.—Return of Defects treated during the year ended 31st December, 1935 Group I.—Minor Ailments. 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 3 ... 3 Minor Eye Defects — (External and other but excluding cases failing in Group ii). 8 ... 8 Minor Ear Defects- 4 ... 4 Miscellaneous- (e.g minor injuries bruises, Sores, chillblains, etc.) 20 ... 20 Total. 36 ... 36 312 SECONDARY Group II.—Defective Vision and Squint (excluding minor eye defects treated as minor ailments.—Group I.) Defect or Diseases (I) NUMBER OF DEFECTS DEALT WITH. Under Authority's Sch« me. (2) Submitted to refraction by private practitioner or at Hoppital apart from the Authority's scheme. (3) Otherwise- (4) Total. (5) Year 1934 (6) Errors of refraction (including squint) 135 13 ... 148 147 Other defects or disease of the eyes (excluding those recorded in Group I.) ... ... ... ... ... Total 135 13 ... 148 147 Total number of children for whom spectacles were prescribed:— (а) Under the Authority's scheme 100 (б) Otherwise 13 Total number of children who obtained or received spectacles:— (a) Under the Authority's scheme 99 (b) Otherwise 13 Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received operative treatment. Received other forme of treatment. (4) Total number created. (5) Year 1934 (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) - - 2 - - 1 1 - - 1 3 - — 4 6 (1) Tonsils only; (2) Adenoids only; (3) Tonsils and Adenoids; (4) Other Defects of Nose and Throat,