AC 44132 Country Borough of Croydon. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1938 OSCAR M. HOLDEN, M.D., D.P.H. CROYDON: Printed by the "Croydon Times," Ltd., 104, High Street. CRO 40 County Borough of Croydon. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1938 OSCAR M. HOLDEN, M.D., D.P.H. CROYDON: Printed by the "Croydon Times," Ltd., 104, High Street. 2 PUBLIC HEALTH COMMITTEE. NOVEMBER, 1937—1938. The Worshipful the Mayor (Councillor E. C. Stuart Baker, C.I.E., O.B.E.). Alderman Mrs. B. J. Roberts (Chairman). Councillor G. Lewin (Vice-Chairman). Alderman C. H. Gibson. Alderman H. J. Morland, M.A., J.P. Councillor H. W. Anderton. Councillor E. E. L. Arkell. Councillor E. E. Constable. Councillor Mrs. P. J. Dale. Councillor F. Gardner. Councillor Miss M. H. Glazier. Councillor E. S. More. Councillor H. T. Muggeridge, J.P. Councillor Major J. Petrie, O.B.E. Councillor J. S. Pollard. Councillor H. Regan. Councillor Mrs. M. Squire, J.P. 3 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1938. To the Chairman and Members of the Public Health Committee. Ladies and Gentlemen, I have the honour to present herewith my eleventh Annual Report, being the thirty-ninth of the series, dealing with the various branches of work carried out under the Public Health, Housing, Food and Drugs, Mental Deficiency and other Acts and Orders. There is also incorporated my report, as School Medical Officer, to the Education Committee. The report is divided into Sections for convenience of reference and includes the information required by Circular 1728 of the Ministry of Health, dated October 25th, 1938. Epidemiology and Vital Statistics. As a contrast to 1937, the year 1938 was a remarkably healthy year in Croydon. The general death rate fell from 11.6 to 10.3 per 1,000 of the population; the infantile mortality rate from 60 per 1,000 live births to a new low level of 40, whilst the maternal mortality rate fell from 3.87 per 1,000 total births to 0.87. This latter is a remarkably low figure and was attained because in only three cases was death attributed to accidents of pregnancy and child birth. Of the general causes of death, Heart Disease and Diseases of the Circulatory system once again head the list with a slight increase over 1937. Diseases of the Respiratory System, however, declined from 1.56 per 1,000 of the population to 0.84. Deaths from communicable diseases were also fewer, Influenza declining from 71 deaths to 21; Diarrhoea from 38 to 4 23; Typhoid from 35 to 12; and Pneumonia from 1T9 to 13U. Pneumonia still remains the "Captain of the Men of Death," and it is unfortunate that there are not greater powers to deal with it, though the discovery of the Drug M. & B. 693 may exert an influence towards betterment and prove to be a valuable weapon in the fight against this widespread and fatal illness. It is, however, too soon yet to do more than hope. The deaths from Typhoid were all connected with the 1937 outbreak. Only two cases of Typhoid or Paratyphoid occurred during the year which had no connection whatever with the outbreak. In one the source of infection was traced to outside the Borough; in the other, a case of paratyphoid—no source of infection was found. Scarlet Fever showed a smaller incidence than in 1937, but Diphtheria remained much the same, causing 16 deaths as against 18 the previous year. It is unfortunate that relatively little use is made by parents of the process of immunization, facilities for which are freely available. In spite of efforts to bring the value of immunisation before parents only a small proportion avail themselves of it and Diphtheria continues to break out from time to time in various schools and districts of the Borough leading to an avoidable loss of life, incapacity and expense. It is significant that in those residential institutions, and in one day school, where immunisation has been accepted and the great majority of the children immunised, Diphtheria has caused no trouble. There is still to be recorded any death from Diphtheria in an immunised person. The mistaken activities of those who think it their duty to do all in their power to obstruct the progress of immunisation, has more to answer for than possibly the exponents of antiimmunisation are aware. They do not hear the opinions of parents who have refused immunisation upon such wrong advice and who subsequently have lost a child from the disease. A special section dealing with the progress of immunisation in the Borough is incorporated in that part of the report relating to infectious diseases. In the Table dealing with the distribution of school children who have attended the Immunisation Clinic (he effect of outbreaks of Diphtheria upon the number of children coming for Immunisation is clearly shown. Unfortunately, to wait until Diphtheria occurs is too late. The time for prevention is before, as the development of immunity in a child takes 2—3 months. Some of the cases of Diphtheria in children stated to have been immunised arose in those only partially immunised. 5 Among the non-notifiable diseases Measles showed an increase over 1937, as did Mumps, but Chicken Pox and Whooping Cough declined. Hospitals. Section III. of the Report gives, in rather fuller detail than in 1937, the work done at Mayday Hospital. No new Wards were opened during the year, the number of beds available for all cases, including maternity and mental cases, being 582.. The number of admissions rose slightly (214), but there were periods, chiefly during the first quarter and towards the end of the year, when there was undesirable overcrowding, especially in some of the women's wards and in the maternity wards. The average number of beds occupied from day to day rose from 499 to 524. The number of deaths declined from 876 in 1937 to 752 and the average duration of stay in the hospital also declined. These figures reflect the changing character of the work now being done as compared with the higher proportion of chronic cases which previously formed the bulk of the patients. Through the co-operation of the Libraries Committee a hospital library upon a proper footing was established durings the year, and during the 12 months of working 11,161 volumes have been issued to patients. This has proved a welcome amenity. The Committee has also been actively studying the problem of the shortage of women entering the hospital as probationers, and at the end of the year had progressed a considerable way towards the formation of a scheme to obtain girls upon leaving school, and to commence training them in those preliminary subjects necessary for a nurse to know before she can pass the general Nursing Council's Test Examination; and also to deal with subjects that can now be taken as a portion of Part I. of the Nursing Examination under the new regulations of the General Nursing Council. But for the International Crisis in September and its after effects the Scheme would have been completed in 1938; as it is, however, it is hoped to have it in working order during 1939. The Borough Hospital, when once the Typhoid outbreak had been dealt with, has not had a busy year as the incidence of infectious disease has not been heavy. The comments I made in the introduction to my 1937 report still hold good. The situation of the hospital is not a happy one, placed as it is next to a Sewage Farm and adjacent to large gas, electricity and other 6 manufacturing works. If the grounds were not so well wooded the unfavourable features of the site would be more noticeable. The hospital needs modernisation of many of its component units; whilst repairs have again been necessary to certain of the ward blocks owing to subsidence and cracking of walls. The full capacity of the hospital, using wards which are out of date, and temporary corrugated iron buildings, is 220 beds and these have to serve a population of some 266,000, i.e., less than one bed per 1,000 of the population. It is fortunate that the strict application of the principles of prevention which is carried out in dealing with cases of infectious disease—a strictness which not infrequently is commented upon by those who are affected thereby—has so far kept down the incidence of infectious disease to relatively small proportions. If a severe epidemic of Scarlet Fever, Diphtheria or other notifiable disease should unfortunately arise, the isolation accommodation provided at the hospital will prove insufficient. Tuberculosis. No new developments of major importance have occurred during the year. The slow decline in the number of new cases continued, and the incidence rate of Tuberculosis in Croydon, 1.11 per 1,000 of the population for pulmonary cases, and 0.25 for non-pulmonary compares very favourably with other centres of population. The problem of the young female adult, who develops pulmonary tuberculosis about the age of 20—25 years, was again in evidence, and a higher proportion of young women between these ages died than young men in the same age group. The fashion of slimming cannot be exonerated in this connection. The Committee have, during the year, had before them the question of the provision of a new Dispensary in place of the unsuitable one now in use, and also the establishment of a new Sanatorium. Both these matters were still under review at the end of the year, and although the dual need was generally recognised no definite progress had been made towards the accomplishment of these aims, when the year closed. Venereal Diseases. The number of new cases presenting themselves for treatment at the local clinic again rose, whilst the number of Croydon 7 cases treated at London hospitals showed a slight increase, rising from 128 in 1937 to 133 in 1938; of these, however, 82 were found not to be suffering from Venereal Disease. The local Branch of the British Hygiene Council has continued its propaganda work, and 11 public meetings of varying character were held during the year. This work is assisted by a grant of £50 from the Council. Maternity and Child Welfare. A feature of the maternity and child welfare statistics for the year was the remarkably low maternal mortality rate (0.87 per 1,000 births). This is the lowest rate yet recorded, but too much emphasis should not be placed upon it, as the number of births dealt with is relatively small, and deaths from causes arising from or connected with childbirth fluctuate considerably. It is, however, a very gratifying result of the year's work. The Infant mortality also reached a new low record of 40 per 1,000 births; the previous lowest being 41 in 1936. During the last 7 years this rate has only once risen above 50 per 1,000, namely, in 1937, when, owing to an undue incidence of diarrhoea, it rose to 60. The neo-natal mortality, i.e., deaths of infants within the first month of life, also reached a new low level (17 per 1,000 live births). The Municipal Midwifery service has expanded rapidly. At the beginning of 1938 there were 6 whole-time municipal midwives, but by the end of the year the number had risen to 10, and even this increase was insufficient, on the Ministry of Health's basis of 100 cases per midwife, to cope with the influx of cases. A strict supervision has been kept upon Nursing Homes in the town and on the whole the majority are correctly conducted. The Committee has not viewed favourably the establishment of single-bedded homes conducted by midwives who also have a district practice, and the number of these is diminishing. The Obstetrical Service has had a busy year, and a full account of the work done is given in the report. In addition, a technical report is also published as a separate publication. This latter report is based on the lines laid down by the College of Obstetricians and Gynaecologists, so that the results can be accurately compared with those obtained at well-known Maternity Hospitals throughout the country. It is sufficient to say that the Croydon service does not suffer by the comparison. 8 The Mothers' and Infants' Welfare Association opened a new Infant Welfare Centre on the new Addington Estate to meet the growing number of young families residing thereat. The need for this Centre was great, and it rapidly became too small, so that the Association had to obtain larger premises. A new high level record of attendances was reached; some impression of the use made by mothers of the Infant Welfare Centres may perhaps be obtained when it is seen that 80,629 attendances were made during the year, and of these 3,789 were new cases, 2,692 being under one year of age. The total number of births recorded in Croydon during 1938 was 3,335; it follows, therefore, that a high proportion of the babies born are taken by their mothers to an Infant Welfare Centre at least once during their first year of life. The average attendance per session over all the Centres was 84.6, again a record number, and one which necessitated, at certain of the Centres, the employment of two Health Visitors in order to deal satisfactorily with the work. Owing to a modification of the conditions laid down by the Ministry of Health under which milk could be supplied to nursing and expectant mothers and to young children, the amount of wet milk supplied free or at under cost price rose from 173,000 pints in 1937 to 261,000 pints, and the amount of dried milk from 11,480 packets in 1937 to 14,108 packets in 1938. Although the Public Health Act, 1936, consolidated public health law in many respects, it, unfortunately, did nothing to tighten up and make workable on a satisfactory basis the law relating to foster children. There are too many loopholes, and the legal procedure is too cumbersome for really satisfactory supervision to be maintained. In view of this position particularly careful attention has been given by the Health Visitors to this matter. Sanitary Inspection. Housing.—The Leighton Street Redevelopment Scheme reached its final stages and demolition of existing unfit houses in this area proceeded together with plans for the erection of new flats on the site. The Wilford and Forster Road Redevelopment Scheme also went forward, and sanction to deal with the area as a Redevelopment area was obtained after the usual local enquiry held by the Ministry of Health. At the same time a start was made on the inspection of houses in the Upper Norwood district in order to gather data for the representation of an area, including Eagle Hill, Crystal Terrace, Naseby Road and Spa 9 Hill, as a Redevelopment area. It is hoped to have all the details required for representation to the Council early in 1939. In addition there has been a steady representation of individual unfit houses throughout the town. This work, however, has been somewhat retarded by the lack of alternative accommodation. There is little profit in obtaining the Council's approval for the demolition of unfit property if such demolition cannot be carried out because of a lack of other accommodation of a suitable character, for the tenants who would be displaced. For a house to continue to be occupied for months after a demolition order has been made upon it is most unsatisfactory from all points of view. The problem of the basements mentioned in my 1937 report is still very real in Croydon, as is also the house originally intended for one family but converted, in some cases most imperfectly, into three or more flats. The overcrowding standard laid down in the Housing Act, 1936, does not function satisfactorily inasmuch as a kitchen has to be included as a room which may be used for sleeping. Work has commenced under the new provisions contained in the Public Health Act, 1936, for the inspection of offices, and during the year 63 inspections were made. It is pleasing to record that no difficulties have, as yet, arisen, although a number of defects requiring attention were discovered. The details contained in the report also show that the Chief Sanitary Inspector's department has fully maintained the close scrutiny it exerts upon the food supplies in the town. Croydon Airport. The Public Health (Aircraft) Regulations, 1938, laid new duties upon Local Authorities within whose boundaries airports were situated. Croydon is a sanitary aerodrome under Article 8 of the Aerial Convention, and as such the Council have to make available an organised medical service with a medical officer and at least one assistant officer acting under his direction; a place for medical inspection, a laboratory, facilities for the isolation, transport and care of the sick, for the isolation of contacts separately from the sick and for carrying out any other prophylactic measures, the apparatus necessary for carrying out disinfection, disinsecting, deratisation, etc., a sufficient supply of wholesome drinking water, and a proper and safe system for the disposal of excreta and refuse. 10 This work is additional to the work previously carried out for the Ministry of Health under the Aliens Orders. After consultation with the Ministry of Health the previous arrangement, whereby a part-time medical officer was employed for six hours daily, was terminated, and an additional wholetime assistant medical officer of health was appointed to reside at the Borough Isolation Hospital and to devote the major portion of his time to airport duties. Besides this medical officer there is a rota of four other whole-time assistant medical officers who take portions of their duty at the airport. By this means a medical officer is always on duty throughout the 24 hours, although he does not necessarily stay at the airport throughout the period of his duty time. As the Borough Hospital is within 7 minutes' car ride from the airport, if a medical officer is required at any time when one is not actually at the airport, the airport authorities—who week by week are given the rota list of doctors on duty and their telephone numbers—can readily obtain one. Vaccination Acts. During the year the practice has been followed of applying for summonses against defaulters who have not had their children vaccinated and who, in spite of repeated warnings, have failed to obtain the necessary statutory Declaration of Objection to Vaccination. The purpose of this has not been to enforce vaccination but to enforce compliance with the law. Even if Vaccination law is unsatisfactory, it is rendered even more so it persons feel that it can be disregarded without any consequences. Miscellaneous. Since the outbreak of Typhoid Fever in 1937, the Council have ordered that all employees of the Water Department and any new employees to that Department were to be medically examined and have a blood test (Widal) taken. Those showing positive blood tests were to have an additional examination to ascertain if they might be carriers of the organism. Two hundred and three examinations have been made during 1938. In addition the Medical Officer of Health has been instructed to examine all employees who did not desire examination by a private medical man, or who had no private doctor, for purposes of superannuation. For this purpose 155 examinations were made. 11 One hundred and thirty-three examinations were also made of temporary employees of the Borough Engineer's Department who were being transferred to the regular staff. It will be appreciated that this has thrown a certain amount of additional work on the medical staff. The Medical Officer of Health is also the Medical Referee for the purpose of the Cremation Acts and has acted as such since the Crematorium in Croydon commenced to function. During the year 288 certificates were submitted. Air Raid Precautions. New and unfamiliar duties have been placed upon Medical Officers of Health by the Government under the Regulations governing Civil Defence. Prior to the September crisis the medical aspects of Civil Defence had already been explored in Croydon. Eight First Aid Posts had been selected, with the cooperation of the Education Committee, at various public elementary schools, and adaptations upon a considerable scale carried out. Volunteers had been recruited, and when the September crisis came the numbers at the First Aid Posts were sufficient to man them. Unfortunately, apart from the trained personnel of the two Voluntary Societies,—the British Red Cross and the St. John Ambulance Brigade,—the rest of the volunteers were untrained. A week's intensive training was arranged by the help of the two societies who had made themselves equally responsible for the staffing of the posts, four being taken by each Society. The help of these Societies has been very valuable, and I should like especially to thank the British Red Cross for the ready help their local organisation has given in arranging lectures and demonstrations. Modifications have been made in the organisation of the Casualty Services since September. The Ministry of Health now has control of the Hospitals Organisation, the First Aid Posts, and the Ambulance Service, but the Home Office retains control of the Stretcher Parties. This artificial division does not make local organisation any easier, especially as the ideas of the Ministry of Health anent First Aid Posts and Ambulance Services are not the same as were those of the Home Office when the latter had control. The Medical Officer of Health has a small advisory committee, comprising the Chairman and Vice-Chairman of the Air Raids Precautions Committee and a representative of each of the Voluntary Societies, to assist him, and this Committee has proved 12 its value. Nevertheless, it must be conceded that much extra work and anxiety has been placed upon Medical Officers of Health of scheme-making authorities at a time when their staffs were already fully occupied. Also, the work under Civil Defence is quite foreign to Public Health work and, as it applies to the country as a whole, it does not seem unreasonable to enquire if Civil Defence should not be treated as a military matter and undertaken by the military authorities, though, doubtless, this would be a more costly arrangement. At the close of the year it became more and more apparent, as the number of circulars and instructions from the Central Government Departments rapidly increased, that A.R.P. was being regarded as the primary duty and activity of Local Authorities, and that it was a permanent addition to their growing burden of responsibilities. The consequent and inevitable slackening of preventive and social efforts must be a source of anxiety to all those who watch the accumulative beneficial effects of Public Health. In conclusion, Ladies and Gentlemen, it is my pleasing duty to acknowledge the help I have always received from you, and from the members of the Housing Committee, the Education Committee, the Mental Deficiency Committee, and also from the Air Raid Precautions Committee. To my staff for the hard work they have put in during the year and for the loyal and willing manner in which they have at all times met the extra duties they have been called upon to perform, I desire to express my gratitude and thanks. I am, Yours faithfully, OSCAR M. HOLDEN. 13 CONTENTS. A.—PUBLIC HEALTH REPORT. PAGE Acts, Adoptive 196 Airport 190,235 Ambulance Service 23 Amusement Houses 211 Animals, Keeping of 212 Ante-natal Clinic 148 Babies Help Committee 176 Bacteriological Examination 87, 101,125, 150 Bakehouses 207 Births 17, 29 Blind Persons 193 Borough Hospital 21,74 Bye-laws and Regulations 197,212 British Social Hygiene Council 128 Cancer 120 Cerebro-Spinal Meningitis 83 Children Acts 178 Closet Accommodation 20 Contacts, Tuberculosis 106 Committee 2 Cowkeepers 224 Croydon Nursing Service 106 Croydon General Hospital 22 Convalescence 176 Coombe Cliff Convalescent Hosp. 21,177 Creche 177 Dairies, Cowsheds and Milkshops 224 Deaths 17,29,33,35 Dental Treatment 171,173 Diphtheria 65,66, 78 Disinfection 213 Disinfestation 214 Dispensary, Tuberculosis 91 Dried Milk 170 Drainage and Sewage 20 Dysentery 83 Enteric Fever 82 Erysipelas 82 Expectant Mothers 148,173 Extra Nourishment 102 Factories & Workshops Acts 195', 205 Fertilisers & Feeding Stuffs Act 213 Foods, Inspection of 216, 221 Food & Drugs Acts 230 Foster-Mothers 178 Foster-Children 178 Gynaecological Clinic 161 Health Visitors, Work of 169 Home Helps 176 Home Nursing 106 Homework 207 Hospitals 20 Hospital, St. Mary's (Maternity) 20, 145 Houses Let in Lodgings 210 Housing 203 Housing Act 203 Ice Cream 230 Illegitimacy 22, 29, 132, 177 Immunization Clinic 66 Infant Welfare Clinics, Municipal 164 PAGE Infant Welfare Clinics, Voluntary 164 Infant Mortality 18, 134, 136, 166 Infantile Paralysis 83 Infectious Diseases 61 Inquests 29 Laboratory Work 42, 85, 87, 150 Local Acts 196 Local Government Act 28 Lodging Houses, Common 209 Marriages 29 Massage Clinics 42 171, 189 Maternity Homes 144 Maternity Homes, Registration 144 Mayday Hospital 21, 38, 145 Measles 88 Meat Inspection 217,222 Medical Help Records 142 Meteorology 37 Mental Deficiency, etc. 180 Midwives 140, 143 Midwives Acts 140 Milk, Provision of 170 Milk, Examination of 88,222 Milk, Tuberculous 225 Milkshops 224 Mortality in Child-birth 17,129,146 Mothers' and Infants' Welfare Association 164 Mumps 83 Municipal Lodging House 209 Municipal Midwives 141 National Free Church Women's Council 132 Neo-natal Deaths 135 Norwood Cottage Hospital 22 Notification of Births Acts 129 Nuisances 198,212 Nursing Arrangements 106 Nursing Homes 144 N.S.P.C.C 23 Obstetrical Unit 145 Occupation Centre 183 Offensive Trades 211 Offices, Inspection of 208 Ophthalmia Neonatorum 83, 134 Orthopaedic Department 186 Out of Borough Cases 85 Overcrowding 204 Parrots (Prohibition of Imports) Reg. 215 Pemphigus 83 Poisons & Pharmacy Act 212 Poliomyelitis 83 Poor Law Relief 25 Population 17 Post-natal Clinic 161 Public Laboratory 87 Puerperal Sepsis and Pyrexia 82,131,162 Purley War Memorial Hospital 22 Queen's Road Homes 23 Rag Flock Acts 211 Rats & Mice (Destruction) Act 215 Rescue Home 177 14 PAGE Rent Restriction Acts 203 Rivers and Streams 19,212 Sanatorium, Cheam 114 Sanatoria, Treatment in 103 Sanitary Administration 196 Sanitary Certificates 202 Sanitary Inspectors, Work of 197 Scavenging 20 Scarlet Fever 64,76 Schick Test 66 Schools 212 St. Christopher's Special School 183 Shop Hours Acts 200, 208 Slaughterhouses 217 Social Conditions 19 Small Pox 21 Smoke Observations 211 Sputum, Examination 87, 101 Staff 15 Still-births 17,132 St. Mary's Maternity Hospital 20, 145 Swimming Pool 235,237 Tomography 102 Tuberculosis—Care Committee 112 „ Cheam Sanatorium 114 „ Contacts 106 PAGE Tuberculosis—Deaths 94, 96, 98, 99 „ Dental Treatment 111 „ Notifications 91,98 „ Home Nursing 106 „ Home Visits 106 „ Housing 108 „ Tables 116 „ Pneumothorax 115 „ Institutional ment 103 Typhoid Fever 82 Unmarried Mothers 22, 29, 132, 177 Ultra-Violet Light 191 Vaccination 89 Venereal Diseases 123, 149 Verminous Persons 215 Vital Statistics 17, 29 Ward Statistics 30, 99, 120, 140 Watercourses 212 Water Supply 19 Whooping Cough 83 Workplaces 206 Workshops 206 X-ray Examination 41, 102, 150 B.—SCHOOL MEDICAL REPORT. PAGE Accommodation 252 Adenoids 259,271 Blind Children 290 Child, Guidance Clinic 289 Cleansing of Children 255, 269 Clinics 241,270 Clothing and Footgear 255 Committee 240 Cost 251 Crippling Defects 273 Deaf Children 259, 281,290 Deaths 300 Defective Children 290 Defective Hearing 259, 281, 290 Deformities 260 Dental Disease 261 Dental Treatment 274 Domestic Subjects 300 Ear Clinic 281 Ear Disease 259, 281, 290 Epileptic Children 290 Exclusions 266 Eye Clinic 272 Eye Disease 260, 272 Following up 269 Footgear 255 Health Visitors, Work of 269 Heart Defects 258 Heights and Weights 255, 302 Infectious Diseases 266 Inspection Clinic 272 Inspections, Routine 253 Inspections, Special 253 PAGE Juvenile Employment 293 Lungs, Diseases of 258 Malnutrition 255 Massage Clinic 273 Meals, Provision of 293 Mentally Defective Children 290 Milk, etc., Provision of 252, 293 Minor Ailments 270 Nutrition 255 Orthopaedic Work 273 Orthodontic Service 279 Physical Training 295 Physically Defective Children 273,291 Population 252 Remedial Exercises 273 Rheumatism Clinic 283 Sanitary Accommodation 245 School Camps 292 Schools, Special 273, 290, 294 Secondary Schools 301 Skin Affections 260 Special Subjects 300 Speech 260,291 Staff 240 Statistical Tables 303 Surveys, Uncleanliness 255,269 St. Christopher's 294 St. Giles 273 St. Luke's 290 Throat and Nose 259,271 Treatment 270 Tuberculosis 258 Uncleanliness 255,269 Vision, Defective 260 15 STAFF OF THE HEALTH DEPARTMENT. The staff of the Public Health Department on the 31st December, 1938, was as follows:— Medical Staff.— (a) Whole-time:— Oecaj M. Holden, M.D., D.P.H., Medical Officer of Health, School Medical Officer, and Medical Officer under the Mental Deficiency Acta, etc. D. D. Payne, M.D., B.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. Bufus C. Thomas, M.B.C.S., L.B.C.P., F.R.C.S.(Ed.), M.C.O.G., Assistant Medical Officer of Health for Obstetrics. John T. R. Lewis, M.D., D.P.H., Assistant Medical Officer of Health and Assistant School Medical Officer. E. H. Harte, M.B., Ch.B., D.P.H., Assistant Medical Officer of Health and Assistant School Medical Officer. (Commenced 1st May, 1938.) Iris A. Jenkin-Lloyd, M.R.C.S., L.R.C.P., D.P.H., Assistant Medical Officer of Health and Assistant School Medical Officer. Aileen I. McMahon, M.R.C.S., L.R.C.P., D.P.H., Assistant Medical Officer of Health and Assistant School Medical Officer. Rosa Morrison, M.B., Ch.B., D.P.H., Assistant Medical Officer of Health and Assistant School Medical Officer. J. Todeeco, M.D., M.R.C.S., L.R.C.P., D.P.H., Resident Medical Superintendent, Borough (Fever) Hospital. R. C. Poyser, M.R.C.S., L.R.C.P., Resident Medical Superintendent, Croydon Borough Sanatorium. (b) Part-time:— H. W. Southgate, M.B., B.S., B.Sc., Pathologist. J. R. Draper, B.A., M.B., Medical Inspector of Aliens (Croydon Air Port) (to 31-10-38). 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. Mayday Hospital.— Arnold Gilray, M.B., Ch.B. (N.Z.), Medical Superintendent. John Joseph Walsh, M.D., F.R.C.S. (Eng.), Assistant Medical Superintendent. John Ewart Edson, M.B., Ch.B., M.R.C.P., M.Sc., Assistant Medical Officer. Julius L. Rosenfield, M.B., Ch.B., B. A.O., Junior Resident Assistant Medical Officer (to 28-1-38). James T. Laurenson, Resident Surgical Officer (to 15-4-38). Wm. S. Rees, M.B., Ch.B., Junior Resident Assistant Medical Officer as (from 11-7-38). Frank R. Magarey, M.B., B.S., Junior Resident Assistant Medical Officer (as from 15-10-38). Catherine F. O'Connor, M.R.C.S., L.R.C.P., Assistant Bacteriologist and Pathologist. (Part-time.) 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. H. W. Southgate, M.B., B.S., B.Sc., Pathologist. Visiting Radiologist, Mayday Hospital.— David Low Grieg, M.R.C.S., L.R.C.P., D.M.R.E. 16 District Public Assistance Medical Officers.— William Vaudrey Braddon, M.B., Ch.B., L.S.A. Henry Fleming Hamilton, M.B., Ch.B., F.R.C.S. Charles Aloysius McGuire, M.B., Ch.B. Alan Pride, M.D. Austin Stafford, L.R.C.P.I. & L.M., L.R.C.S.I. & L.M Panel of medical practitioners appointed for Addiscombe, Central, East, South Norwood, Woodside, Thornton Heath, Waddon and South Wards. 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. Dental Staff.— Senior Dental Surgeon: P. G. Oliver, L.D.S. (commenced 1st September, 1938) Assistant Dental Surgeons: J. K. R. Bryce, L.D.S., W. A. Sowden Hills, L.D.S., Miss S. M. V. Hathorn, L.D.S. (commenced 23rd May, 1938), C. P. Urbani, L.D.S. (commenced 1st September, 1938). Dental Surgeon: Mayday Hospital: E. H. Laurence, L.D.S. (part-time). Inspectors.— R. J. Jackson, M.R.S.I., A.M.I.S.E., M.S.I.A., Chief Sanitary Inspector F. F. Fulker, A.R.S.I., A.I.S.E., M.S.I.A., Deputy Chief Inspector (to 1-11-38). 20 District Sanitary Inspectors. In addition, there are 7 disinfectors, and 6 assistants to the Sanitary Inspectors. Health Visiting Staff.— Alice M. Allford (Superintendent). 22 District Health Visitors; 2 Special Visitors; 1 Tuberculosis Nurse; 3 Almoners and 5 Dental Attendants. Also 2 whole-time Masseuses and Remedial Gymnasts Municipal Midwives.— Norah A. Rigby (Superintendent). 10 District Municipal Midwives. Clerical Staff.— B. W. Cummins (Chief Clerk). 32 full-time Clerks. Veterinary Inspector (Part-time).— Peter R. A. Thrale, O.B.E., M.R.C.V.S. Analyst (Part-time).— Edward Hiniks, B.Sc., F.I.C., F.C.S. Vaccination Officer.— Gerald H. Huggins, Cert. R.S.I. Mayday Hospital, Croydon Borough Hospital, Croydon Borough Sanatorium, Coombe Cliff Convalescent Home, and St. Mary's Hospital. Nursing and Domestic Staffs. Occupation Centre for Low Grade Mental Defectives.— Miss K. M. Stupart (Supervisor). 3 Assistants and One Guide. Pathological Laboratory.— 4 Laboratory Assistants. 17 SUMMARY OF VITAL STATISTICS FOR 1938. Area, 12,617 acres. Population (Census 1931), 233,115. Population (estimated middle of 1938), 243,400. Number of Inhabited Houses (1931 Census), 56,429. Overcrowding Census (1936), 65,550. Rateable Value (1st April, 1938), £2,413,024. Product of a Penny Rate (1938), £9,430. Rate in the £ (1937-38), 10/10. Gross expenditure on Health Services (administered by Medical Officer of Health) £193,401 11 11 Income on Health Services (excluding transfers) 19,111 1 2 Net expenditure on Health Services £174,290 10 9 Expressed as a Penny Rate, 18.48d. pence in the pound. Live Births— M. F. Total. Legitimate 1,611 1,561 3,172 Illegitimate 99 64 163 Birth-rate per 1,000 of the estimated resident population, 13.7. Still Births—95. Rate per 1,000 total (live and still) births, 27.7. Deaths—2,496. Death-rate per 1,000 of the estimated resident population, 10.3. Deaths from diseases and accidents of pregnancy and childbirth: From sepsis, 1; other causes, 2. Maternal mortality: 0.87 per 1,000 total live and still births. 16 Death-rate of Infants under one year of age— All infants per 1,000 live births 40 Legitimate infants (113 deaths) per 1,000 legitimate live births 36 Illegitimate infants (21 deaths) per 1,000 illegitimate live births 129 Deaths from Influenza 21 ,, ,, Measles (all ages) 8 ,, ,, Whooping Cough (all ages) 3 ,, ,, Diarrhœa (under 2 years of age) 23 ,, ,, Diphtheria (all ages) 16 ,, ,, Typhoid or Paratyphoid Fever 12 ,, ,, Pneumonia 130 Per 1,000 of the population. Deaths from diseases of Cardiac and Circulatory System (including Cerebral Hæmorrhage) 4.23 ,, ,, diseases of the Respiratory System (including Tuberculosis) 0.84 ,, ,, diseases of Renal System 0.30 ,, ,, diseases of Digestive System 0.57 ,, ,, Suicide and Accidents 0.50 ,, ,, Old Age 0.13 19 SECTION I. SOCIAL CONDITIONS, HOSPITAL ACCOMMODATION AND VITAL STATISTICS. The population of Croydon had for years shown a rapid and continuous increase. The increase now seems definitely to have ceased, at any rate temporarily. The 1931 Census gave a total enumerated population of 233,115. The estimated population as at the middle of 1937 was 242,300. For the middle of 1938 the population is given as 243,400 (R..-G.). Water. The water supply is drawn from deep wells in the chalk. These wells are situated at Surrey Street, Stroud Green, Waddon, Selhurst, and Addington. A portion of the northern side of the Borough obtains water supplies from the Metropolitan Water Board. A constant supply of water was maintained throughout the year from the Corporation's own wells and the supply from the Metropolitan Water Board. Corporation's Wells 2,001,436,107 Metropolitan Water Board in Bulk 843,329,000 2,844,765,107 gallons. Since the beginning of the year the Council authorised the Medical Officer of Health to take water samples from any source of public supply in Croydon and submit them to analysis by the Public Health Committee's analyst. These samples are quite independent of any samples taken by the Water Engineer and are not examined by the same analyst. A useful check is thus obtained. Since the appointment of a whole-time Water Engineer close collaboration has been maintained between the Public Health Department and the Wa.ter Department. The Medical Officer of Health has been called upon to examine all employees of the Water Undertaking and in certain cases detailed bacteriological examinations in hospital have been earned out. Rivers and Streams. There are only small streams or ditches. These have been kept in a good state. 20 In the Shirley and Addington area there were still 33 cesspools in existence at the end of the year. There was also one cesspool in the Upper Norwood area. Vigorous action has been taken during the year to abolish cesspools as far as possible, though it should be remembered that cesspools are a legitimate form of drainage disposal. 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 Borough. About £47,000 has been expended in maintenance and laying of new main foul water and surface water sewers. At the Sewage Disposal Works at Beddington, treatment is given in Sedimentation Tanks, three Activated Sludge Plants, and acres of Bacteria Beds. The sludge is treated in a sludge digestion plant with gas collection and heating. At the South Norwood Works, treatment is by sedimentation, and a sludge digestion plant is also in operation. Closet Accommodation. In the Shirley and Addington Area there were still 33 cesspools in existence at the end of the year. There was also one cesspool in the Upper Norwood Area. Vigorous action has been taken during the year to abolish cesspools as far as possible, though it should be remembered that cesspools are a legitimate form of drainage disposal. 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. 94 beds are provided for the treatment of early, intermediate and advanced cases in adults. (2) Maternity. St. Mary's Maternity Hospital, St. James' Road, Croydon. In this Hospital thirty-two beds (with cots attached) are provided. 21 (3) Children. Coombe Cliff Convalescent Hospital. This Home is for the reception of infants and children convalescing after acute illnesses. 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. There are 34 beds and cots. (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. No. of beds provided for sick, maternity and mental cases at 31.12.38. (a) For Men 234 (b) For Women 281 (c) For Children (under 16 years of age) 70 585 No. of Wards Men. Women. Children. Total. Provided. Occupied. Provided. Occupied. Provided. Occuipied. Provided. Occupied. Medical 2 32 32 32 22 — — 64 54 Surgical 5 54 49 80 56 — — 134 1 105 Ch. Sick 4 32 34 96 85 — — 128 119 Children 3 — — — — 80 75 80 75 Tuberculosis 2 32 35 32 25 — — 64 j 60 Maternity 2 — — 44 34 — — 44 34 Mental 2 32 21 32 31 — — 64 52 Isolation 1 — — 4.— — 4 — Totals 21 182 171 320 253 80 75 582 499 22 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)Orthopædic Clinic; (c) Venereal Diseases Clinic; (d) Ultra-Violet Ray Clinic. The Council's Pathological and Bacteriological Laboratory is also within the curtilage of the Hospital: the buildings being provided by the Hospital; the staff, equipment, etc., by the Corporation. ] am indebted to the Secretary, Mr. G. H. Dams, for the following information:— Male Beds 52 surgical 22 medical Ucmale Beds 51 surgical 22 medical Children's Beds 30 Private Beds 23 A total of 200 beds. The number of in-patients created during 1938 was 3,149; the average stay of each in hospital being 19.0 days. The number of out-patient attendances, including casualties, was 179,612. The Purley and District War Memorial Hospital. This is situated on the Brighton Road close to the boundary between Croydon and Purley. The provision remains as detailed in my 1937 annual report. The Norwood and District Cottage Hospital. The provision remains the same as detailed in my 1937 report. 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 South 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. 23 The National Society for the Prevention of Cruelty to Children. This Society, through their Inspectors, helped the department in various ways. During the year 11 cases of neglect were dealt with. These cases affected the welfare of 24 children, and entailed 66 visits by the Inspectors. 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) Two motor ambulances 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's Ambulance Brigade. (d) One motor ambulance provided by the Public Assistance Committee and operating from Queen's Road Homes. 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 55* (b) For Women 58† (c) For Children (under 16 years of age) 6 119 *Including 5 certified under Sec. 24 of the Lunacy Act. †lncluding 8 certified under Sec. 24 of the Lunacy Act. 24 Table I. Table showing the classification of the accommodation and the number of beds occupied on the 31st December, 1938. Classification. Number of Wards. Men. Women. Children under 16 yrs. of age. Total. Provided. Occupied. Provided Occupied. Provided Occupied. Provided Occupied. Chronic Sick 4 50 49 50 50 - - 100 99 Mental (Lunacy Act, 1890) 2 5 5 8 8 — — 13 13 Mental Defectives 1 — — — — 6 6 6 6 Totals 7 55 54 58 58 6 6 119 118 IN-PATIENTS. Total number of admissions: 92. Total number of deaths: 78. Total number of discharges: 12. Duration of stay of patients— (a) Four weeks or less: 16. (b) Exceeding four weeks but under thirteen weeks : 12. (c) Thirteen weeks or more: 62. Number of beds occupied— (a) Average during the year: 99. (b) Highest: 100 (on 12.2.38). (c) Lowest : 97 (on 4.12.38). 25 Classification of In-Patients who were discharged from or who died in the Institution during the year ended 31sf December, 1938— Men Discharged. and Women. Died. Disease Groups. Acute Infectious Disease — — Malignant disease 1 2 Mental Diseases— Senile Dementia — 1 Senile Decay 3 6 Disease of the Nervous System and Sense Organs 1 3 ,, „ Respiratory System 2 2 ,, „ Circulatory System 3 59 ,, ,, Digestive System — — ,, ,, Genito Urinary System — 1 Other Diseases 2 1 Other Persons — 3 Total 12 78 POOR LAW RELIEF. No. of residents in Croydon County Borough Area in receipt of outdoor poor relief on the— 1st January, 1938 4,092 persons; 2,104 cases (including aible- lst July, 1938 4,105 „ 2,150 ,, „ bodied). 1st January, 1939 4,695 „ 2,360 ,, ,, Number of Croydon poor persons relieved in the Mayday Hospital on 1st January, 1939, and in the Queen's Road Homes on the same date— Mayday Hospital 81 Queen's Road Homes 444 Expenditure on Out-relief to Croydon cases during the 12 months ended 30th September, 1938. Half-year ended 31st March, 1938 £43,626 19 4 Half-year ended 30th Sept., 1938 £43,113 19 1 During the year the District Medical Officer for the Number 5 Medical District resigned, and a Panel Medical Service Scheme, similar to those operating in the Numbers 2, 3 and 6 Medical Districts was evolved to take his place. This scheme commenced on May 1st, 1938. 26 No. 2 District. No. 3 District. Year to 31/3/39. Year to 31/3/39. Average number of separate patients attended during each quarter 224 246 Particulars of services rendered: Attendances at patients' homes 1,322 1,413 Attendances on a second person in the same house at the same visit 90 164 3,857 3,645 Attendances on patients at the surgery 2,184 1,793 Medical Certificates issued 261 275 Total number of prescriptions written 3,448 3,890 Total number issued during corresponding period of previous year 2,851 3,748 Estimated cost of drugs, dressings and dispensing £118 £134 Estimated cost for corresponding period of previous year £96 £126 Estimated amount of per capita payment to doctor? in respect of patients actually attended 2/2.2d 2/4.9d. Estimated average payment per service point .94d 1.16d. No. 2 DISTRICT. No. 3 DISTRICT. Previous arrangement. Panel Medical Scheme. Previous arrangement. Panel Medical Scheme. £ £ s. d. £ £ s. d. D.M.O.'s Salary 120 Pool for payment D.M.O.'s Salary 150 Pool for payment of Practitioners. 197 10 0 of Practitioners. 237 10 0 Drugs, Dressings and Drugs, Dressings, Drugs, Dressings and Drugs, Dressings, Dispensing 51 and Dispensing. 118 0 0 Dispensing 62 and Dispensing. 134 0 0 £171 £315 10 0 £212 £371 10 0 27 No. 5 District. No. 6 District. 11 mos. to 31/3/39. Year to 31/3/39. Average number of separate patients attended during each quarter 222 369 Particulars of services rendered: Attendances at patients' homes 996 1,280 Attendances on a second person in the same house at the same visit 159 2,553 119 5,012 Attendances on patients at the surgery 1,140 2,989 Medical Certificates issued 258 624 Total number of prescriptions written 2,562 (11 mos.) 4,178 Total number issued during corresponding period of previous year 1,826 (11 mos.) 2,976 Estimated cost of drugs, dressings and dispensing £88 (11 mos.) £144 Estimated cost for corresponding period of previous year £61 (11 mos.) £100 Estimated amount of per capita payment to doctors in respect of 2/2.9d. l/10.7d. patients actually attended Estimated average payment per service point 1.29d. 1.13d. No. 5 DISTRICT. No. 6 DISTRICT. Previous arrangement. Panel Medical Scheme. Previous arrangement. Panel Medical Scheme. £ s. d. £ s. d. £ £ D.M.O.'s Salary (11 Pool for payment of D.M.O.'s Salary 200 Pool for payment of mos. to 31-3-38) 183 6 8 Practitioners (11 Practitioners 280 mos. to 31-3-39) 183 6 8 Drugs, Dressings and Drugs, Dressings and Drugs, Dressings, Drugs, Dressings, Dispensing 45 Dispensing 144 & Dispensing (11 & Dispensing (11 mos. to 31-3-38) 61 0 0 mos. to 31-3-39) 88 0 0 £244 6 8 £271 6 8 £245 £424 (Panel Scheme in this District commenced 1/5/1938). 28 LOCAL GOVERNMENT ACT, 1929. In Croydon the delegated duties under the Local Government Act, 1929, comprise the carrying out of the duties under the Children's Act and the Vaccination Acts, for which the Public Health Committee has been responsible since 1931. 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 1938-9 were as follows:— Croydon Mothers' and Infants' Welfare Association— 1938/9 £ (a) Infant Welfare Centres 900 (b) Convalescence 500 (c) Care-work (Unmarried Mothers) 200 £1,600 Other Grants— 1938/9 £ The Retreat, Ross Road 650 Croydon Creche 300 Croydon Association of Moral Welfare 100 Children's Aid Society 230 £1,280 £2,880 29 SECTION II. VITAL STATISTICS. Marriages.—The number of marriages solemnised was 2,319 compared with 2,210 in 1937; 2,198 in 1936; 2,132 in 1935; 2,125 in 1934; 2,244 in 1933; and 2,134 in 1932. The marriage rate was 9.5 per 1,000 of the population; 1,192 were solemnised in Established Churches, 338 in other places of worship, 789 in the Register Office; no ceremony was performed under Jewish ritual. Births.—1The births registered were 3,172 legitimate and 163 illegitimate. The birth-rate consequently was 13.7. For England and Wales and in the Great Towns the rate was 14.9. The illegitimate births in Croydon were 4.9% of the total, compared with 4.6% in 1937, 5.5% in 1936, 4.4% in 1935, 4.7% in 1934, and 4.2% in 1933. The live male births numbered 1,710, the female 1,625, being a proportion of 1,052 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 Addington (20.0), South Norwood (18.2), Whitehorse Manor (16.7), and Waddon (15.0). Those with the lowest were: Norbury (9.3), Upper Norwood (10.7), and Woodside (11.4). Deaths.—The deaths numbered 2,486, compared with 2,800 in 1937. For 1938 the death-rate was 10.3. For 1937 it was 11.6. The death-rate for England and Wales was 11.6, and for the Great Towns 11.7. For London the death-rate was 11.4. The male death-rate was 11.8, the female 11.3 for the Borough. There were 162 inquests held by Coroners in respect of Croydon residents during 1938, and 153 findings by Coroners after postmortem examination without inquest. Wards with the highest death-rates were: South (13.9), Central (13.2), and Whitehorse Manor (12.6); lowest in Addington (5.6), Norbury (8.4), West Thornton (8.7), and Waddon (8.8). Natural Increase.—The excess of births over deaths was 849, or 3.5 per 1,000 of the population. 30 Table I. WARDS. Estimated Population. Births. Deaths. Birth Rate. Death Rate. Deaths under 1 year per 1,000 Births. Death Rate from Six Zymotic Diseases (excluding Diarrhoea) Death Rate from Diarrhoea. Death Rate from Bronchitis and Pneumonia. Death Rate from Pulmonary Tuberculosis. Death Rate from Non-Pulmonary Tuberculosis. Death Rate from Heart and Circulation Diseases. Death Rate from Nervous Diseases. Death Rate from Cancer. Estimated persons per acre . Natural Increase or Decrease of Population. Upper Norwood 16761 180 165 10.7 9.8 50 0.18 0.06 1.01 0.30 0.06 3.16 0.30 1.73 20 15 Norbury 16140 150 135 9.3 8.4 15 - 0.12 0.81 0.50 — 2.97 0.43 1.55 29 15 West Thornton 19578 268 170 13.7 8.7 36 0.15 0.10 0.61 0.36 0.15 3.37 0.25 1.23 42 98 Bensham Manor 16764 217 181 12.9 10.8 36 0.18 0.18 0.96 0.66 — 3.82 0.42 2.32 50 36 Thornton Heath 18024 256 178 14.2 9.1 64 0.44 0.11 0.94 0.67 0.1 3.61 0.33 1.39 51 78 South Norwood 17531 319 183 18.2 10.4 20 0.29 0.18 0.91 0.46 — 4.28 0.29 1.88 29 136 Woodside 16157 184 164 11.4 10.2 49 0.25 0.19 1.17 0.50 0.12 4.14 0.56 1.24 37 20 East 16193 229 149 14.1 9.2 38 0.19 0.06 0.68 0.25 — 4.45 0.62 1.11 10 80 Addiscombe 16335 220 160 13.5 9.8 45 0.61 0.43 0.37 0.31 0.12 4.16 0.43 1.84 49 60 Whitehorse Manor 16833 281 212 16.7 12.6 50 0.53 0.06 2.02 0.89 0.12 3.92 0.42 1.78 63 69 Broad Green 17208 251 189 14.6 11.0 3.5 0.12 0.29 1.10 0.29 0.12 4.36 0.52 1.40 69 62 Central 12434 176 164 14.2 13.2 26 0.24 0.08 1.29 0.64 0.16 4.83 0.72 1.85 33 12 Waddon 18214 273 161 15.0 8.8 59 0.49 0.16 1.15 0.44 0.05 2.91 0.27 1.15 22 112 South 15228 191 212 12.6 13.9 53 0.39 0.07 1.71 0.72 — 4.66 0.59 2.10 13 —21 Addington 10000 200 56 20.0 5.6 78 0.30 0.20 0.40 0.30 0.10 1.90 0.20 0.70 1 144 The Borough 243400 3335* 2496* 13.7 10.3 40 0.29 0.12 1.03 0.49 0.07 3.80 0.42 1.56 19 839 *These are the corrected, totals. 31 Comments on Table I. Cbrrections 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 Addington (78), Thornton Heath (64), and Waddon (59); lowest in Norbury (15), South Norwood (20), and Central (26). The Infantile Mortality rate was above the average for the whole Borough in the following Wards: Upper Norwood, Thornton Heath, Woodside, Addiscoinbe, Whitehorse Manor, Waddon, South, and Addington. Birth-rates were highest in South Norwood, Whitehorse Manor, and Waddon; lowest in Norbury, Upper Norwood, and Woodside. The general death-rate was highest in South, Central, and Whitehorse Manor; lowest in Addington, Norbury, and West Thornton. The death-rate was above the average for the whole Borough in the following Wards: Bensbam Manor, South Norwood, Whitehorse Manor, Broad Green, Central, and South. The death-rate from Diarrhoea was highest in Addiscoinbe and Addington; from Bronchitis and Pneumonia in Whitehorse Manor, Central, and South; friom Pulmonary Tuberculosis in Whitehorse Manor, South, and Thornton Heath; from Non-Pulmonary Tuberculosis in Central and West Thornton ; from Diseases of the Heart a.nd Circulation in Central, South, and East; from Nervous Diseases in Central and East; from Cancer in Bensham Manor and South. 32 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 all Ages. Uncorrected Number. Nett. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 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 1936 241,739 3357 3248 13.4 2515 10.6 245 320 134 41 2590 10.7 1937 242,300 3574 3263 13.5 2676 11.0 253 377 195 60 2800 11.6 1938 243,400 3680 3335 13.7 2409 9.9 245 322 135 40 2486 10.2 33 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 1214 71 10 12 26 31 46 68 133 208 312 297 F 1282 63 7 8 15 33 44 46 109 193 281 483 1 Typhoid and paratyphoid fevers M 5 ... ... ... ... 1 1 1 ... 2 ... ... F 7 ... ... ... ... 1 ... 1 2 2 1 ... 2 Measles M 4 1 2 1 ... ... ... ... ... ... ... ... F 4 1 2 1 ... ... ... ... ... ... ... ... 3 Scarlet fever M 1 ... ... ... 1 ... ... ... ... ... ... ... F 2 1 ... 1 ... ... ... ... ... ... ... ... 4 Whooping cough M 2 ... 2 ... ... ... ... ... ... ... ... ... F 1 1 ... ... ... ... ... ... ... ... ... ... 5 Diphtheria M 12 1 ... 3 8 ... ... ... ... ... ... ... F 4 ... ... ... 4 ... ... ... ... ... ... ... 6 Influenza M 14 1 ... ... 1 ... ... ... 2 3 3 4 F 7 ... ... ... 1 1 ... ... 1 ... 4 ... 7 Encephalitis lethargica M 2 ... ... ... ... ... 1 1 ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 8 Cerebro-spinal fever M 5 3 1 ... 1 ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 9 Tuberculosis of respiratory system M 67 ... ... ... ... 5 15 11 19 11 6 ... F 50 ... ... ... 2 16 15 5 5 5 2 ... 0 Other tuberculous diseases M 10 4 ... ... 3 2 ... ... 1 ... ... ... F 10 1 ... 1 1 1 2 2 1 ... ... 1 1 Syphilis M 4 1 ... ... ... ... ... ... 1 ... 2 ... F 2 ... ... ... ... ... ... 1 ... 1 ... ... 2 General paralysis of the insane, tabes dorsalis M 4 ... ... ... ... ... ... 1 1 ... 2 ... F ... ... ... ... ... ... ... ... ... ... ... ... 3 Cancer, malignant disease M 166 ... ... ... ... ... 4 5 15 42 74 26 F 221 ... ... ... ... ... 3 8 31 58 66 55 4 Diabetes M 11 ... ... ... ... ... ... 1 1 2 2 5 F 19 ... ... ... ... ... ... ... 1 3 5 10 5 Cerebral haemorrhage, etc. M 32 ... ... ... ... ... ... ... 4 3 10 15 F 59 ... ... ... ... ... 1 ... 2 13 14 29 6 Heart Disease M 346 ... ... ... 1 2 3 8 28 68 107 129 F 431 ... ... ... 1 1 4 7 23 52 99 244 7 Aneurysm M 6 ... ... ... 1 1 ... 1 ... 1 1 1 F 3 ... ... ... ... ... ... ... ... 1 2 ... 8 Other circulatory diseases M 73 ... ... ... ... ... ... ... 4 8 26 35 F 80 ... ... ... ... ... ... 2 5 7 22 44 9 Bronchitis M 27 1 ... 1 ... ... ... 2 4 3 4 12 F 22 3 1 ... ... ... ... ... 1 1 3 13 0 Pneumonia (all forms) M 70 9 3 1 1 2 ... 7 5 14 14 14 F 60 7 4 2 ... ... 2 4 7 10 12 12 1 Other respiratory diseases M 13 ... ... 1 ... 2 1 1 ... 2 2 4 F 12 ... ... ... 1 ... ... ... ... 2 2 7 2 Peptic ulcer M 21 ... ... ... ... ... ... 2 12 7 5 1 F 7 ... ... ... ... ... ... ... 1 1 2 3 3 Diarrhoea, etc. M 13 11 ... ... ... ... ... ... ... ... 1 1 F 16 12 ... ... ... ... 2 ... ... ... 1 1 24 Appendicitis M 10 ... ... ... ... 1 1 1 4 1 2 ... F 5 ... ... ... ... 1 1 1 1 ... 1 ... 5 Cirrhosis of liver M 6 ... ... ... ... ... ... 1 1 1 3 ... F 2 ... ... ... ... ... ... ... ... 1 1 ... !6 Other diseases of liver, etc M 1 ... ... ... ... ... ... 1 ... ... ... ... F 3 ... ... ... ... ... ... ... 1 ... 1 1 7 Other digestive diseases M 26 4 1 2 ... 1 ... 1 6 4 5 2 F 22 2 ... 1 2 1 ... 2 2 5 2 5 8 Acute and chronic nephritis M 31 ... ... ... 1 1 3 1 4 6 6 9 F 41 1 ... ... ... 1 2 2 4 8 11 12 29 Puerperal sepsis F 1 ... ... ... ... ... 1 ... ... ... ... ... 30 Other puerperal causes F 2 ... ... ... ... ... 1 1 ... ... ... ... 31 Congenital debility, premature birth, malformation, etc. M 33 32 ... 1 ... ... ... ... ... ... ... ... F 31 30 ... ... ... ... ... ... 1 ... ... ... 32 Senility M 9 ... ... ... ... ... ... ... ... ... 1 8 F 16 ... ... ... ... ... ... ... ... ... 1 15 33 Suicide M 28 ... ... ... ... 1 2 4 10 6 4 1 F 15 ... ... ... ... ... 5 ... 5 3 2 ... 34 Other violence M 49 ... ... ... 2 9 8 6 5 7 3 9 F 29 ... ... 1 ... 5 ... ... 1 2 4 16 35 Other defined diseases M 107 3 1 2 6 3 7 12 6 17 29 21 F 98 4 ... 1 3 5 5 10 14 18 23 15 36 Causes ill-defined, or unknown M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 34 Comments on the Registrar-General's Table of Total Deaths by Cause and Age and Sex. The chief cause of death, as in previous years, 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 exa-cted 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., and Diarrhoea, it was the greatest cause of death at this age. Other illuminating and important causes of death are Other Circulatory Diseases and Tuberculosis, which was more fatal in the male sex, and which, in both sexes, caused the highest numlber of deaths in the young adult age period of 15-35 years and was the greatest cause of death among the young adult population. It is interesting to note that as in 1937, the death incidence in women was greatest in the 15-25 year group. In men the highest incidence was in the older groups 25-55. Deaths from violence were more numerous in men but were less than in 1937. Cerebral Haemorrhage and Nephritis were a more usual cause of death in women than men, whilst Digestive diseases, including Peptic Ulcer, fell more heavily on men. Comparisons with 1937. There was a fall in the deaths from the Zymotic diseases excluding Typhoid Fever and Diphtheria. In 1938 there were 8 deaths from Measles and 3 from Scarlet Fever. Whooping Cough caused 3 deaths and Diphtheria 16 deaths. The deaths from Pulmonary Tuberculosis decreased by 19 in 1938. The number of deaths attributed to Cancer totalled 387 compared with 432 in 1937. Deaths from Heart Disease increased by 7. Pneumonia deaths showed a decrease of 49, and those due to Bronchitis a decrease of 1. Deaths from Digestive Diseases, including Appendicitis, increased by 33. Deaths from Suicide and Violence decreased from 132 to 121. The percentage of deaths under 1 year of age to total deaths was 5.4%. Deaths under 15 years, 8.5%; deaths under 65 years, 45.0%; deaths over 65 years, 55.0%. The corresponding figures for 1937 were 7.0%, 10.6%, 47.2%, and 52.8%. 35 Table IV. CLASSIFICATION OF DEATHS ACCORDING TO DISEASE OVER A PERIOD OF 10 YEARS. Cause of Death. 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 Death Rate. Total Deaths. Total Deaths Total Deaths. Total Deaths. Total Deaths. Total Deaths. Total Deaths. Total Deaths Total Deaths. Total Deaths. Enteric Fever 1 ... ... 2 ... 1 ... 4 35 12 0.049 Malaria ... ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... ... Measles 1 22 ... 2 13 14 ... 21 5 8 0.033 Scarlet Fever 4 2 3 ... ... 3 ... 2 3 3 0.012 Whooping Cough 24 3 9 12 3 18 2 15 5 3 0.012 Diphtheria and Croup 23 14 5 11 17 24 12 8 15 16 0.066 Influenza (including Influenzal pneumonia) 199 32 84 100 103 28 25 39 71 21 0.086 Dysentery ... 1 1 ... ... ... ... ... ... 1 0.004 Erysipelas 8 7 4 3 8 5 2 6 3 3 0.012 Cerebrospinal Fever ... 2 3 2 2 3 3 ... 3 5 0.020 Pulmonaiy Tuberculosis 170 154 155 144 162 144 148 132 140 117 0.481 Tuberculous Meningitis 10 7 11 9 10 6 9 19 15 20 0.082 Other Tuberculous Disease 19 14 11 13 12 7 14 Cancer, Malignant Disease 330 339 342 341 374 371 321 428 432 387 1.590 Rheumatic Fever 5 4 7 4 4 6 9 6 11 6 0.024 Meningitis 17 14 15 9 7 9 14 4 4 5 0.020 Organic Heart Disease 308 375 490 469 627 591 780 749 770 777 3.192 Bronchitis, Acute and Chronic 226 125 200 145 130 93 45 44 50 49 0.201 Pneumonia 272 199 258 238 210 199 120 185 179 130 0.534 Other Diseases of the Respiratory Organs 21 16 20 15 22 24 29 23 12 25 0.127 Diarrhœa and Enteritis 45 32 15 25 26 18 29 31 45 29 0.119 Appendicitis 27 23 23 28 44 23 48 18 23 15 0.062 Cirrhosis of Liver 10 5 5 8 6 5 2 8 9 8 0.033 Alcoholism 4 3 1 1 ... 5 2 ... 1 1 0.004 Nephritis and Bright's Disease 117 45 60 81 78 75 66 89 84 72 0.296 Puerperal Fever 6 1 8 2 7 5 7 5 1 1 0.004 Other Diseases and Accidents of Pregn «ncy & Parturition 5 6 14 5 5 8 1 7 11 2 0.008 Congenital Debility and Malformation . 42 42 49 27 19 33 87 63 105 64 0.263 Premature Birth 47 40 49 46 47 34 Violent deaths (excluding Suicide) 64 74 92 75 70 91 85 85 102 78 0.320 Suicide 29 19 33 43 30 37 26 29 30 43 0.177 Other Defined Diseases 748 713 706 684 677 688 567 570 634 595 2.445 Diseases Ill-defined orunknown 10 4 1 10 8 3 ... ... 2 ... ... Total 2792 2337 2674 2556 2721 2571 2453 2590 2800 2496 ... 1938 showed a decrease in the general death-rate, a slight increase in the birth-rate and a fall in the infant mortality rate to the lowest figure yet recorded. 36 Taking diseases of bodily systems and group diseases to which deaths were definitely assigned by the Registrar General, we find:— per 1,000 population. Circulatory System (including Atheroma and Cerebral Hæmorrhage) 1030 or 4.23 Cancer 387 1.59 Respiratory System (not Tubercular) 204 0.84 Tuberculosis (all forms) 137 0.56 Diseases of the Digestive- System (excluding Cancer and Tuberculosis) 138 0.57 Diseases of Renal System 72 0.30 Infectious Diseases (excluding Tuberculosis but including Influenza) 70 0.29 Suicides and Violent Deaths 121 0.50 Old Age 25 0.10 Congenital Debility, Prematurity and Malformation 64 0.26 The greatest single group of causes of death as in 1937 was diseases of the Circulatory system, and of this group Organic Heart Disease was the most prominent member (777 deaths). 37 Table V. METEOROLOGICAL RECORD. Months. Air Temperature in Degrees Fahrenheit. Rainfall Total. Bright Sunshine. Hrs. per day. Percentage of Possible Means of Mean of A. & B. A. Max. B. Min. Daily Mean °F. °F. °F. in. mm. hrs. January 47.2 40.1 43.7 2.57 65 1.24 15 Figures extracted from the Official Monthly Weather Reports of the Meteorological Office, S. Kensington. February 46.3 36.6 41.5 0.72 18 2.00 20 March 59.5 41.3 50.4 0.38 10 5.70 48 April 54.4 37.4 45.9 0.16 4 4.18 32 May 59.5 44.5 52.0 2.07 53 5.15 33 June 68.9 52.1 60.5 0.52 13 6.88 42 July 69.2 54.2 61.7 1.75 45 5.20 32 August 71.7 54.7 63.2 3.14 80 5.32 37 September 66.8 51.4 59.1 2.48 63 4.05 32 October 57.8 45.2 51.5 2.73 69 3.70 35 November 54.6 45.7 50.1 3.78 96 1.90 21 December 43.7 36.7 40.2 3.56 91 1.57 20 Figures obtained by 'phone from above. Means and Totals for Year 58.3 45.0 51.6 23.86 607 3.91 31 38 SECTION III. MAYDAY HOSPITAL. I am indebted to the Medical Superintendent, Dr. Arnold Gilray, for this section of the Eeport. Staffing—Medical Superintendent: Arnold Gilray, M.B., Ch.B. (N.Z.), Resident Medical Superintendent. 4 Other Resident Medical Staff. 4 Non-Resident Staff. 8 Consulting Staff. Specialised Services—Orthopaedic, Gynaecological, Dental, X- Ray, Massage, Ultra-Violet Light, Ophthalmic, Ear, Nose and Throat. No. of Trained Nurses 73 No. of Probationer Nurses 82 No. of Assistant Nurses 14 No. of Male Attendants 21 No. of Beds provided in the Institution for sick, maternity and mental cases at 31st December, 1938:— (a) For Men 182 (b) For Women 320 (c) For Children under 16 years of age 80 582 The Ward accommodation provided is as follows:— No. of beds provided. Total. Men. Women. Medical 32 32 64 Surgical 54 80 134 Chronic Sick 32 96 128 Tuberculosis 32 32 64 Maternity — 48 48 Mental 32 32 64 182 320 502 In addition there are 80 children's beds provided in 3 children's blocks. 39 Table I. (1) Total number of admissions (including infants born in hospital) 6,638 (2) Number of women confined in hospital 925 (3) Number of live births 899 (4) Number of still births 37 (5) Number of deaths among the newly-born (i.e., under 4 weeks of age) 21 (6) Total number of deaths among children under one year (including those given under (5) ) 54 (7) Number of Maternal deaths among women admitted to hospital for confinement 2 (8) Total number of deaths 752 (9) Total number of discharges (including infants born in hospital) 5,906 (10) Duration of stay of patients included in 8 and 9 above— (a) Under four weeks 5,059 (b) Four weeks and under thirteen weeks 1,286 (c) Thirteen weeks or more 313 (11) Number of beds occupied (excluding cots in maternity wards)— (a) Average during the year 524 (b) Highest 575 on 14-3-38. (c) Cowest 469 on 1-2-38. (12) Number of surgical operations under general anaesthetic (excluding dental operations) 1,093 (13) Number of adominal sections' 456 40 Table II. Classification of In-Patients who were Discharged from or who Died in the Institution during the year ended 31st December, 1938. Disease Groups. Children (under 16) Men and Women. Discharged. Died. Discharged. Died. A.—Acute infectious disease 127 - 106 3 B.—Influenza 3 - 10 — C.—Tuberculosis: Pulmonary 5 1 82 45 Non-Pulmonary 1 6 13 8 D.—Malignant Disease — - 62 128 E.—Rheumatism— (1) Acute rheumatism (rheumatic fever) together with sub-acute rheumatism and chorea 16 - 23 1 (2) Non-articular manifestations of so called "rheumatism" (muscular rheumatism, fibrositis, lumbago, and sciatica) 1 - 3 - (3) Chronic Arthritis 3 - 36 3 F.—Venereal Disease 2 — 8 3 G.—Puerperal pyrexia (ineluding cases classified - - 8 - Puerperal fever (a) Women confined in hospital - - - - (b) Other cases — — — — H.—-Other diseases and accidents connected with Pregnancy and childbirth — — 492 — I.—Mental diseases (a) Senile Dementia - - 274 2 (b) Other 12 — — — J.—Senile Decay — — 63 27 K.—Accidental injury and violence 81 1 278 14 In respect of cases not included above— L.—Diseases of the Nervous System and Sense organs 19 2 81 38 M. „ „ Respiratory System 124 19 178 80 N. „ „ Circulatory System 3 6 154 232 0. „ „ Digestive System 159 13 466 47 P. „ „ Genito-Urinary System 25 2 296 33 Q. „ ,, Skin 90 — 97 2 R.—Other Diseases 364 7 206 6 S.—Mothers and infants discharged from Maternity Wards and not included in above figures Mothers - - 954 - Infants 912 — — — T.—Any persons not falling under any of the above headings 55 21 14 2 Totals 2002 78 3904 674 41 NUMBER OF X-RAY FILMS TAKEN. Spine 276 Bones 1,188 Pelvis 57 Chest 1,495 Barium Meals 329 Barium Enemata 50 Renal 221 Gall-Bladder 100 Teeth 377 Abdominal ? FB 49 Maternity Cases 641 Skull 425 5,208 Total number of Cases X-rayed 2,794 DIAGNOSTIC. 1937. 1938. Oesophagus with Barium 6 7 Barium Meals 81 115 Barium Enemeta 11 25 Gall-Bladders (Plain) 7 19 Cholecystograms 16 17 Renal Tracts (Plain) 34 35 Pyelograms 19 32 Abdomen for F.B.'s, etc. 16 20 Maternity Cases 268 305 Hysterographies 2 1 Lungs (Mayday Hospital) 358 429 (Sick Staff) 6 16 (Staff on Appointment) — 100 (T.B. Dispensary) 482 622 (Others) 8 16 Lungs' after Lipiodol 4 4 Heart and Aorta 2 1 Skulls 64 113 Accessory Nasal Sinuses 17 22 Vertebral Column 61 94 Ribs 29 25 Pelvis 28 42 Long Bones 323 362 Short Bones 51 50 Joints 160 150 Teeth and Jaws 102 172 2155 2794 Examinations bv Portable Set 243 171 1937. 1938. Men's Wards 561 757 Women's Wards 471 577 Children's Wards 216 153 Maternity and Gynaecological Wards' 100 133 Staff 27 147 Total "In-Patients" 1375 1767 42 T.B. Dispensary (Men) 222 268 (Women) 225 310 (Children under 16) 36 49 Croydon Borough Hospital 16 8 Ante-Natal Clinic 161 198 St. Mary's Hospital 18 28 Queen's Road Homes 16 21 Dental Clinic 84 143 Others 2 2 Total "Out-Patients" 780 1027 Total 2155 2794 "Screen Examinations" 954 1331 MASSAGE 8,455 Exercises 3,108 Radiant Heat 2,942 Electrical 810 Diathermy 487 Ultra Violet Light 900 Wax 99 Infra Red 79 16,880 Total number of patients treated 453 MENTAL PATIENTS DEALT WITH DURING THE YEAR. Male. Female. Admitted 200 209 Certified and sent to Warlingham Park Hospital 17 44 As Voluntary Patients to Warlingham Park Hospital 30 16 Discharged not certified 99 102 SPECIMENS EXAMINED IN THE PATHOLOGICAL LABORATORY DURING THE YEAR. Positive. Negative. Swabs for Diphtheria 2 327 Sputa for T.B. 305 392 Pus for T.B. 6 6 Pus for Gonocooci 18 111 Urine for T.B 6 20 Faeces for T.B 1 9 Urine for B. Typhosus 31 450 Faeces for B. Typhosus 1 457 Blood—Widals 17 59 Hairs for Ringworm 70 23 Blood Cultures 9 25 Faeces for Occult Blood 128 137 Urine for Routine Examination 1,004 Pus for Organisms 73 Blood Urea Estimations 139 Blood Sufiar Estimations 30 Cerebro Spinal Fluids' 95 Urea Cone. Tests 97 Fractional Test Meals 26 Plueral Fluids 38 43 Blood Counts 398 Blood Groups 129 Haemoglobin Estimations 141 Compatibility Tests 51 Faeces for Organisms 101 Faecal Fat Estimations 4 Van den Bergh Re-action 12 Vaccines 4 Blood Sedimentation Rates 84 Glucose Tolerance Tests' 2 Blood Coagulation and Bleeding Time 3 Other Examinations—Unclassified 26 Total Number of Examinations 5,067 Number of Specimens sent to Croydon General Hospital 305 THERAPY DEPARTMENT. Condition for which Treatment was given. No. of Patients. No. of Applications. Cured. Relieved. Died. Transferred to other Hosps. Still under Treatment. Carcinoma of Breast 5 81 2 1 1 ... 1 „ „ Colon 1 8 ... ... 1 ... ... „ „ Rectum 1 12 ... ... 1 ... ... „ „ Lung 1 24 ... ... 1 ... ... „ „ Uterus 4 106 ... 3 1 ... 3 Sterilisation for:— Menorrhagia 5 60 5 ... ... ... ... „ Heart Disease 1 16 1 ... ... ... ... „ Reual Disease 1 8 1 ... ... ... ... „ Eclampsia 1 12 1 ... ... ... ... „ Numerous Pregnancies 1 8 1 ... ... ... ... Uterine Fibroids 1 8 ... 1 ... ... 1 Sarcoma of Kidney 1 10 ... ... 1 ... ... Sarcoma of Hip 1 48 ... 1 ... ... 1 Sarcoma of Acetabulum 1 62 ... 1 ... ... 1 Kraurosis Vulvae 1 24 1 ... ... ... ... Ringworm of Scalp 9 45 9 ... ... ... ... Total 35 532 21 7 6 ... 7 Corresponding Totals for 1937 30 478 6 4 8 2 10 44 NUMBER OF POST MORTEMS ORDERED BY THE CORONER AND PERFORMED AT MAYDAY HOSPITAL DURING THE YEAR. Outside Cases 230 Hospital Cases 60 NUMBER OF POST MORTEMS NOT ORDERED BY THE CORONER 90 OPERATIONS PERFORMED AT MAYDAY HOSPITAL DURING 1938. Number. ABDOMINAL. Appendicectomy 201 Suture of Perforated Duodenal Ulcer 7 Paul's Operation for Carcinoma Coli 2 Sigmoidoscopy 27 Herniotomy 55 Cholecystectomy 15 Laparotomy 38 Exploration of Common Bile Duct 2 Gastrectomy 2 Gastroenterostomy 1 Colostomy 27 For Pyloric Stenosis 5 Caecostomy 6 Intussusception 3 For Intestinal obstruction 6 For Gastric Ulcer 3 Resection of Colon 2 Gastro-jejunostomy 1 For Anal Fistula 2 Resection of Caecum 1 Ligature of Haemorrhoids 3 Excision of rectum 2 Removal of Anal Tag 2 413 BONES AND JOINTS. For Osteo-myelitis 6 Amputation of Limbs 5 Wiring of Bones 20 Resection of Rib 12 Application of Plaster 50 Removal of Sequestra 1 Reduction of Joints 11 Manipulation of Limbs 15 Excision of Patella 1 121 EAR, NOSE AND THROAT. Mastoidectomy 19 Tonsillectomy 249 For Nasal Polypi 1 Adenoidectomy 1 Resection of Nasal Septum 3 Insertion of Cannulae into Antrum 1 274 45 Number GENITO-URINARY. Cystoscopy 54 Circumcision 12 For Hydrocele 3 Nephrectomy 7 Prostatectomy 2 Cystostomy 8 For Extravasation of Urine 1 For Urethral Stricture 9 Nephrolithotomy 1 For Tumour of Kidney 1 98 GYNAECOLOGICAL. Examination under Anaesthetic 44 Total Hysterectomy 14 Subtotal Hysterectomy 14 Salpingo-oophorectomy 9 Dilatation and Curetage 129 Removal of Ovarian Cyst 3 Excision of portion of growth of Rectum 1 Salpingectomy 3 Incision of Breast Abscess 14 Ovariotomy 2 Excision of Bartholin's Abscess 2 Excision of Bartholin's Cyst 1 Insertion of Ring Pessary 3 Colpo-perineorrhaphy 15 Cauterization of Cervix 15 Baldy Webster Operation 7 Myomectomy 1 Ligature of Varicose Veins 2 Removal of Cervical Polypi 1 For Imperforate Hymen 1 Ant. Colporrhaphy 2 283 OBSTETRICAL. Caesarean Section 46 Evacuation of Uterus and Glycerine Pack 45 Perinaeorrhaphy 3 For Ectopic Gestation 4 Induction of Labour 7 For Retained Pruducts 8 113 40 Number. MISCELLANEOUS. Excision of glands 4 Blood Transfusion 47 Removal of Lipoma 1 Incisions (Abscesses, etc.) 112 Cleansing of Scalds and Burns 11 Amputation of Breast 2 Suture of Wounds 19 Thiersch Skin Graft 3 Excision of Wounds 7 Removal of Foreign Body 3 Iridectomy 1 Removal of subcutaneous fibroma 1 Lumbar Puncture 56 Aspiration of Chest 62 Paracentesis 15 Pyelogram 7 Excision of Lipoma 1 Excision of Plantar Warts 1 Exploration of Chest 11 Excision of Cartilage 3 Venesection 2 Suture of Tendon 1 Excision of Varicose Veins 1 371 Total 1,673 Number of patients who had teeth extracted 347 Total Number of Patients Discharged from Mayday Hospital, Year Ended 31.12.38. Cured 4,196 Relieved 1,203 Unrelieved 507 Died 752 6,658 47 Table III Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Alimentary. Appendicitis — — — — 209 14 1 6 230 Gastric ulcer 1 1 — 1 13 12 2 9 39 Duodenal ulcer 5 — — 2 16 10 1 2 36 Dyspepsia 5 6 1 — — — — — 12 Cholelithiasis — — — — 8 3 — 1 12 Intestinal obstruction — — — — 2 1 — 6 9 Colitis 8 2 — 1 — — — — 11 Hernia — — — — 47 12 5 4 68 Ischio rectal abscess — — — — 3 — — — 3 Constipation 29 11 - - - - - - 40 Haemorrhoids 2 — — — 3 — — — 5 Pelvic Adhesions — — — — 1 — — — 1 Cholecystitis — — — — 11 14 2 — 27 Appendicular Colic — 1 - - - - - - 1 Gastro enteritis 42 6 — 6 — — — — 54 Cyclic vomiting 1 1 — — — — — — 2 Gastritis 12 6 - - - - - - 18 Nervous Dysphagia 1 — — — — — — — 1 Alveolar Abscess — — — — — 2 — — 2 Diarrhoea — 1 - - - - - - 1 Cirrhosis of Liver — 3 — 2 — — — — 5 Intestinal colic — 3 - - - - - - 3 Intussusception — — — — 4 — — 1 5 Catarrhal jaundice 7 — 1 — — — — — 8 Pyloric stenosis — — — — 3 3 — 3 9 Prolapse of Rectum — — — — — 1 — — 1 Swallowed F.B 2 — 1 - - - - - 3 Intestinal haemorrhage — — — — 1 — — — 1 48 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Peptic Ulcer 2 8 - - - - - - 10 Fistula in Ano 1 1 - - - - - - 2 Tapeworm — 2 — — — — — — 2 Peritonsillar Abscess — — — — 1 — — — 1 Peritonitis — — — — 1 — 1 11 13 Pyloric Spasm 1 - - - - - - - 1 Stomatitis 7 1 - - - - - - 8 Adhesions — — — — — 2 — — 2 Pelvic Abscess — — — — 2 — 1 — 3 Volvulus of the Sigmoid colon - - - - - - - 1 1 Jaundice 5 1 - - - - - - 6 Impacted Submaxillary Calculus — — — — — 1 — — 1 Collapse 1 — — 1 — — — — 2 Secondary haemorrhage tooth socket . 2 - - - - - - - 2 Bones, Joints and Muscles. 661 Arthritis . 9 16 3 1 — — — — 29 Paget's Disease — — — 1 — — — — 1 Fibrositis 4 4 - - - - - - 8 Osteogenosis — 1 - - - - - - 1 Bursitis 3 1 - - - - - - 4 Rheumatism (acute and subacute) 28 16 1 - - - - - 45 Pleurodynia 1 — — — — — — — 1 Lumbago — 2 - - - - - - 2 Synovitis — — — — 2 1 — — 3 Osteo-myelitis - — — — 9 13 2 1 25 Sequestra of Tibia - — — — 1 — — — 1 Periostitis 1 - - - - - - - 1 Genu Valgum — — — - — 1 — — 1 Flat Feet — — 1 - - - - - 1 Osteo-arthritis — 9 — 2 — — — — 11 134 49 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Carcinoma. Breast - — — — 1 3 5 8 17 Stomach - - - - - 6 7 15 28 Rectum — — — — 1 5 4 13 23 Cervix Uteri - - - - - 4 5 8 17 Sarcoma - - - - - 1 — 2 3 Anus - - - - - - - 1 1 Ovary - - - - - 2 — 4 6 Prostate - - - - - - - 7 7 Tongue and Mouth - - - - - - - 2 2 Glands - - - - - 1 — 1 2 Larynx - - - - - - - 2 2 Oesophagus - - - - - 1 4 3 8 Colon — — — — 3 1 1 20 25 Gall-Bladder - - - - - - 1 3 4 Lung - - - - - 1 2 9 12 Bronchus - - - - - - - 1 1 Pylorus - - - - - - - 1 1 Liver - - - - - - - 9 9 Pancreas — — - - - - - 5 5 Sigmoid colon - - - - - - - 1 1 Caecum - - - - - - - 4 4 Tonsil - - - - - - - 4 4 Bowel - - - - - - - 1 1 Kidney - - - - - - - 1 1 Salivary glands — — — — — 1 — — 1 Epithelioma of nose, etc. - - - - - 1 2 1 4 Epithelioma of urethra - - - - - - 1 — 1 Rodent ulcer of face - - - - - - - 2 2 192 50 Diagnoses in Cases Treated Medical. Surgical. i i Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Circulatory (Blood). Anaemia 1 2 3 1 — — — — 7 Septicaemia — - 3 — — — — 3 Pyaemia — — - 1 — — — — 1 Leukaemia — — — 1 — — — — 1 Ischaemia — 1 - - - - - - 1 Haematocele 2 - - - - - - - 2 15 Circulatory (Heart and Vessels). Myocardial degeneration — 37 5 163 — — — — 205 Hyperpiesia — 11 - - - - - - 11 Epistaxis 4 1 - — - - - - 5 Arterio sclerosis 2 15 12 12 — — — — 41 Phlebitis 2 5 - — — — — — 7 Aortic stenosis — 1 - - - - - - 1 Varicose Veins 7 — 1 - - - - - 8 Endocarditis 1 1 4 3 - — — — 9 Lymphangitis 2 — - - - - - - 2 Thrombosis — — — 1 — — — — 1 Gangrene 2 2 — 1 — — — — 5 Myocarditis — 19 — 8 — — — — 27 Auricular fibrillation — 16 1 5 — — — — 22 Mitral stenosis — 5 1 2 — — — — 8 Mitral regurgitation — 1 — 1 — — — — 2 Valvular disease — 1 - - - - - - 1 Congenital Heart disease — — 1 3 — — — — 4 Subaracnoid Haemorrhage — 1 — 1 — — — — 2 361 51 Diagnoses in Cases Treated Medical. Surgical. Total. Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Constitutional. Diabetes mellitus 3 9 — 5 — — — — 17 Gangrene — 1 — 2 — — — — 3 Collapse 5 1 - - - - - - 6 Debility 4 10 - - - - - - 14 Nutritional disorder 7 2 - - - - - - 9 Convulsions 1 — 1 1 — — — — 3 Marasmus 12 1 1 4 — — — — 18 Malnutrition 8 8 - - - - - - 10 Rickets 3 - - - - - - - 3 89 Ear, Nose and Throat. Tonsillitis — — — — 259 8 3 — 270 Quinsy — — — — 7 — — — 7 Otitis Media — — — — 59 7 1 — 07 Labrythine Vertigo — — — — — 1 — — 1 Haematoma Nasal Septum — — — — 1 — — — 1 Otorrhoea — — — — 4 2 — — 6 Mastoiditis — — — — 20 1 — 1 22 Catarrh (Naso-Pharangeal) 4 - - - - - - - 4 Periostitis of Mastoid — — — — 1 — — — 1 Sinusitis — — — — 1 2 — 1 4 Deflected Nasal Septum — — — — 1 — 1 — 2 Post Operative Haemorrhage — — — — 2 — — — 2 Pharyngitis — — — — 2 — — — 2 Nasal Obstruction — — — — 1 — — — 1 390 52 Diagnoses in Cases Treated Medical. Surgical. Total. Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Eye. Iritis — 1 - - - - - - 1 Conjunctivitis 2 - - - - - - - 2 Corneal Ulcers - — — — 2 — — — 2 Iridocyclitis 1 - - - - - - - 1 Ocular Mucocele - - - - - - 1 — 1 Blepharospasm — - — — — 1 — — 1 Keratitis - 1 - - - - - - 1 9 Glands. Adenitis 28 5 2 - - - - - 35 Hodgkins Disease - - - - - - - 1 1 Cervical Abscess — — — — 4 — — — 4 Parotitis 1 - - - - - - - 1 Glandular Fever 1 - - - - - - - 1 Exophalmic Goitre — 1 - - - - - - 1 Hyperthyroidism — 1 - - - - - - 1 44 Genito Urinary. Nephritis 6 7 3 9 — — — — 25 Pyelitis 31 9 - - - - - - 40 Urethral Stricture — — — — — 11 - — 11 Enlarged Prostate — — — — 1 29 2 7 39 Phimosis — — — — 9 — — — 9 Urinary Calculus — — — — — 1 — — 1 Periurethral Abscess — — — — 1 — — — 1 Hydrocele ot Cord — — — — 1 — — — 1 Oxaluria 1 - - - - - - - 1 Pyelo-nephritis — — — 1 — — — — 1 Cystitis 3 6 - - - - - - 9 Urethritis 1 - - - - - - - 1 53 Diagnoses in Cases Treated Medical. Surgical. i i Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Papilloma of Bladder - — 3 - - - - - 3 Uraemia - — — 9 — — — — 9 Renal Colic 1 6 - - - - - - 7 Cholangitis — 1 - - - - - - 1 Vesical Calculus — — — — 1 1 1 — 3 Pyo-nephrosis 1 — — 1 — — — — 2 Hypernephroma of Kidney — — — — 2 — — — 2 Perineal Abscess — — — — 1 — — — 1 Epididymo-orchitis 2 3 - - - - - - 5 Hepatitis 1 — - - - - - - 1 Dysuria — 1 - - - - - - 1 Diverticulitis — — — — 1 1 — — 2 Perinephric Abscess — — — — 1 — — — 1 Parametritis — — — — — — 1 — 1 Faecal Fistula — — — — 1 — — — 1 Haematuria — 1 - - - - - - 1 Extravasation of Urine - - - - - - - 1 1 Hydrocele — — — — 1 1 — — 2 183 Gynaecological. Abortion — — — — 163 10 1 — 174 Dysparenia — — — — — 1 — — 1 Ruptured Perineum — — — — 1 — — — 1 Retained Products — — — — 7 1 — — 8 Dilitation and Curettage — — — — 1 1 — — 2 Paracentesis — — — — — 1 — — 1 Enteroptosois — — — — — 1 — — 1 Dermoid Cyst — — — — 2 — — — 2 Uterine Haemorrhage — — — — — 2 — — 2 Salpingo-oophoritis — — — — — 1 — — 1 54 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Deficient Pelvic Floor — — — — 16 2 — — 18 Cracked Nipples — — — — 1 — — — 1 Cystocele — — — — 1 — — — 1 Urethral Carbuncle — — — — 1 — — — 1 Fibrosis Uteri — — — — 15 6 3 — 24 Subinvolution — — — — 8 — — — 8 Salpingitis — — — — 5 10 — — 15 Cervicitis — — — — 4 13 — — 17 Investigation of Sterility — — — — 1 — 2 — 3 Varicosities of Vulva — — — — — 1 — — 1 Ovarian Dysfunction — — — — — 1 — — 1 Retroversion of Uterus — — — — 14 2 1 — 17 Pelvic Peritonitis — — — — 2 1 1 — 4 Hypertension — — — — 1 2 — — 3 Tort ion of Ovary — — — — 1 — — — 1 Prolapse Uteri — — — — 3 — 1 — 4 For Sterilization — — — — 2 5 — — 7 Endometritis — — — 3 2 — — 5 Menorrhagia — — — — 3 11 — — 14 Ovarian Cyst — — — — 14 3 3 1 21 Vaginitis — — — — 2 1 1 — 4 Infantile Uterus - - - - - - 1 — 1 Masti tis — — — — 12 7 — — 19 Bartholin's Abscess — — — — 4 — — — 4 Menrorrhagia — — — — 5 11 — — 16 Cervical Polypi — — — — 2 1 — — 3 Leucorrhoea - - - - - - 1 — 1 Dysmenorrhoea - - - - - - 1 — 1 Imperforate Hymen — — — — — 1 — — 1 Pelvic Congestion — — — — — 1 — — 1 410 55 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Infections. Influenza 14 4 - - - - - - 18 Puerperal Fyrexia 10 - - - - - - - 10 Puerperal Fever — — 1 - - - - - 1 Sonne Dysentery 1 — 2 - - - - - 3 Measles — — 8 - - - - - 8 Ophthalmia Neonatorum 1 — 2 - - - - - 3 Poliomyelitis 1 - - - - - - - 1 Typhoid Fever 123 12 2 3 — — — — 140 Diphtheria — — 2 — — — — — 2 Cerebro Spinal Meningitis... — — 6 - - - - - 6 Chicken Pox — 4 26 - - - - - 30 Erysipelas — — 3 — — — — — 3 Whooping Cough — 4 4 — — — — — 8 Scarlet Fever — — 3 — — — — — 3 Paratyphoid Fever — — 1 — — — — — 1 Typhoid Carrier 1 - - - - - - - 1 Mumps — — 1 — — — — — 1 German Measles — — 4 — — — — — 4 243 Maternity. Deliveries — — — — 954 — — 2 956 Live Births — — — — 912 — — 21 933 Delivered before admission — — — 8 — — — 8 For Version — — — - 16 4 6 — 26 Pyelitis of Pregnancy — — — - 4 6 — — 10 Albuminuria of Pregnancy — — — - 4 9 — — 13 False Labour Pains - - - - - 4 12 — 16 Ante Partum Haemorrhage — — — — 1 4 1 — 6 Ectopic Gestation — — — _ 5 2 — — 7 H.B.P. of Pregnancy — — — — 2 10 4 — 16 56 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Vomiting of Pregnancy — — — — 12 7 — — 19 Phlebitis of Pregnancy — — — — — 2 — — 2 Toxaemia of Pregnancy — — — — 3 — 1 — 4 Ante Natal Observation — — — — 4 36 43 — 83 2099 Mental. Uncertified 11 98 65 - - - - - 174 Certified — — 61 — — — — — 61 Epilepsy 2 17 8 1 — — — — 28 M.D — 1 11 — — — — — 12 Mongolism — — 1 - - - - - 1 276 Nervous and Sensory. Cerebral Haemorrhage — 4 1 33 — — — — 38 Meningitis 1 — 1 1 — — — — 3 Chorea 3 2 - - - - - - 5 Subarachnoid Haemorrhage 2 — — 4 — — — — 6 Spina Bifida — 1 1 - - - - - 2 Habit Vomiting 1 - - - - - - - 1 Hemiplegia — 4 3 6 — — — — 13 Neurasthenia 3 6 2 - - - - - 11 Hysteria 5 4 2 - - - - - 11 Cerebral thrombosis 1 8 2 16 — — — — 27 Cerebral Abscess or Tumour — 1 1 5 — — — — 7 Cerebral Embolism — - - 1 — — — — 1 Encephalitis — 1 - - - - - - 1 Post Diphtheretic Paralysis 1 - - - - - - - 1 Sciatica 1 6 1 - - - - - 8 57 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Hydrocephalus — 2 — 2 — — — — 4 Parkinsonism — 1 - - - - - - 1 Tumour of Lumbar Sacro Plexus — 1 1 - - - - - 2 Petit Mai — 1 — — — — - — 1 Transient Paresis 1 - - - - - - - 1 Glioma — — - 1 — — — — 1 Bells Palsy — 2 1 — _ — — — 3 Convulsions — 1 — 1 — — — — 2 Neurosis — 6 4 - - - - - 10 Meniere Syndrome — 1 — — — — — — 1 Disseminated Sclerosis — 3 2 4 — — — — 9 Tabes Dorsalis 1 — 1 — — — — — 2 Meningitis 1 — — 1 — — — — 2 Cerebellar Abscess - - - - - - 1 — 1 Spinal Tumour — — — 1 — — — — 1 Paralysis Agitans — — 2 2 — — — — 4 Coronary Thrombosis — — — 3 — — — — 3 G.P.I 3 1 - - - - - - 4 Neuritis — — 2 1 — — — — 3 Nervous Debility 1 1 - - - - - - 2 Splastic Paraplegia — 1 — — — — — — 1 193 Respiratory. Bronchitis 66 58 3 6 — — — — 133 Pneumonia 115 12 1 74 — — — — 202 Tracheitis 1 - - - - - - - 1 Pleural Effusion 1 2 — — — — — — 3 Bronchial Catarrh 2 - - - - - - — 2 Bronchiectasis 2 5 1 5 — — — — 13 Atelectasis — — — 1 — — — — 1 58 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Emphysema — — 1 1 — — — — 2 Pleurisy 8 5 - - - - - - 13 Asthma 3 14 - - - - - - 17 Empyema — — — — 5 — — 1 6 Pulmonary Embolism — — — 1 — — — — 1 394 Senility — 36 19 27 — — — — 82 Skin. Boils, Abscesses, etc. — — — — 54 11 — 1 66 Burns and Scalds — — — — 20 3 — 2 25 Eczema 13 10 - - - - - - 23 Impetigo 29 1 - - - - - - 30 Scabies 5 - - - - - - - 5 Dermatitis 4 3 - - - - - - 7 Epidermophytosis 3 - - - - - - - 3 Septic Spots 7 1 - - - - - - 8 Ringworm 21 6 - - - - - - 27 Eythema Nodosum 3 1 - - - - - - 4 Ingrowing Toe Nail — — — — 1 — — — 1 Cellulitis 14 2 — 1 — — — — 17 Lipoma — — — — 3 — — — 3 Pemphigus 2 1 - - - - - - 3 Naevus — — — — 1 — — — 1 Warts — — — — 1 — — — 1 Sinusitis — — — — 1 — — — 1 Pruritis — 1 - - - - - - 1 Herpes — — — — 1 1 1 — 3 Furunculosis - — — — 1 2 — — 3 Circinata 1 - - - - - - - 1 Urticaria 1 - - - - - - - 1 234 59 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Pulmonary Tuberculosis 2 43 42 46 - - - - 133 Non-Pulmonary Tuberculosis Spine - - - - - 5 2 2 9 Meninges — — — — — — 5 5 Pericardium — — — — — 1 — — 1 Glands — — — — 1 1 — 2 4 Hip — — — — — 1 — 1 2 Kidney — — — — 1 1 — 2 Miliary - - - - - - - 3 3 Testes — — — — — 1 — — 1 Suprarenal Glands - - - - - - - 1 1 28 Venereal. Gonorrhoea — 4 3 — — — — — 7 Syphilis 1 - 2 3 — — — — 6 13 Violence. • Fractured Limbs — — — — 72 46 3 10 131 Fractured Spine — — — — 3 3 — — 6 Fratured Skull — — — — 8 2 — 1 11 Fractured Ribs — — — — 7 3 — 1 11 Fractured Clavicle — — — — 3 1 — — 4 Malleoli (fractured) — — — — 1 3 — — 4 60 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Minor Injuries - — — — 53 20 1 — 74 Contusions and Abrasions — — — — 30 6 2 — 38 Concussion — — — — 46 11 — — 57 Foreign Body in Hand — — — — 1 — — — 1 Sprains — — — — 4 — — — 4 Fractured Os Caicis — — — — — 1 — — 1 Abdominal Injury — — — — 2 - — 1 3 Fractured Mandible — — — — 1 1 — — 2 Multiple Injuries - - - - - - - 1 1 Fractured Nose — — — — 1 — — — 1 Dislocation — — — — 4 — — — 4 Amputations — — — — — 1 — — 1 Lacerations, Wounds, etc. — — — — 7 1 — — 8 Shock — - — — 1 — — — 1 363 Miscellaneous. Poisoning — — — — 6 1 — 2 9 Alcoholism — — — — 4 4 1 — 9 N.A.D. (With Mother, etc.) — — — — 87 1 1 5 94 • 112 61 SECTION IY. PREVALENCE AND CONTROL OF INFECTIOUS DISEASE. Table I. gives the figures for ages and Wards. Scarlet Fever was less prevalent than in 1937; the largest incidence has been in Broad Green, Thornton Heath, and Waddon Wards. Based on the estimated ward populations, the case rate for these wards was respectively 436, 344 and 335 per 100,000 of the population. The age group 6-15 years, as usual, suffered most; cases in this group comprising 56 per cent, of the total. The incidence rate of Diphtheria was the same as in 1937; most cases occurred in Whitehorse Manor, Waddon, and Thornton Heath Wards. The age group 6-15 years gives the highest figures, constituting 57.5 per cent, of the total. No cases of Small Pox occurred during the year. There were 59 cases of Puerperal Pyrexia; 22 occurred in the age group 16-25 years and 37 in the age group 26-45 years. A majority of the cases occurred in women having their first confinement. Under the Public Health Act, 1936, Puerperal Fever is no longer notifiable as a clinical entity. All cases of rise of temperature over 100° F. occurring during the puerperium are now notifiable under the term Puerperal Pyrexia. 62 Table I. CASES OF NOTIFIED INFECTIOUS DISEASE, 1938. Notifiable Disease. Cases notified in the whole District. Total cases notified in each Ward. Total cases removed to Borough Hospital <S diagnosis confirmed. Total Deaths in the Borough. 1938. 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) 287 1 60 165 43 12 6 ... 17 11 16 18 35 25 7 16 16 56 29 3 30 6 2 235 16 136 151 Erysipelas 59 2 3 6 18 22 8 5 i 13 3 6 6 2 2 3 4 3 1 6 3 1 24 3 27 32 Scarlet Fever 522 1 159 293 39 29 ... 1 52 29 44 34 62 32 19 25 21 27 75 20 61 12 9 497 3 254 268 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever (including Paratyphoid) 5 ... ... 1 1 2 1 ... ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... 10 12 2 3 Puerperal Pyrexia 59 ... ... ... 22 37 ... ... ... 1 29 2 ... ... 1 2 4 1 15 3 1 ... ... 16 ... 59 Cerebro-Spinal Meningitis 7 4 1 ... 2 ... ... ... 1 ... 6 ... ... ... ... ... ... ... ... ... ... ... ... 6 5 7 ... Ophthalmia Neonatorum 20 20 ... ... ... ... ... ... 2 ... 8 ... 1 1 ... ... ... 3 3 1 ... ... ... 3 ... 14 6 Poliomyelitis 3 ... 1 2 ... ... ... ... ... ... ... ... l ... ... ... ... ... ... 1 ... ... 1 1 ... 2 1 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... Dysentery 6 ... ... 4 1 ... 1 ... ... ... ... ... ... ... ... 1 ... 2 ... 2 ... ... ... ... 1 2 4 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ac. Primary and Ac. Inf. Pneumonia 41 ... 4 6 2 7 18 4 4 ... 3 3 2 2 2 1 5 1 5 2 4 7 23 18 * Influenzal Pneumonia only. †Not accommodated at Borough Hospital. 63 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. 1938 1937 Small Pox - - - - - - - Diphtheria 1.19 1.19 12 214 40 21 287 Erysipelas 0.24 0.24 — 38 12 9 59 Scarlet Fever- 2.15 3.203 2 382 74 64 522 Enteric Fever (inc. Paratyphoid) 0.02 1.26 - 2 2 1 5 Puerperal Pyrexia 0.24 0.276 — 7 1 51 59 Cerebro-Spinal Meningitis 0.029 0.016 — — 1 6 7 Ophthalmia Neonatorum 0.082 0.086 — 9 — 11 20 Poliomyelitis 0.012 0.025 — 1 2 — 3 Encephalitis Lethargica - - - — - - - Acute Primary or Acute Influenzal Pneumonia 0.168 0.30 — 30 7 4 41 Dysentery 0.025 0.008 — — 4 2 6 Polio-encephalitis — — — — — — — The 1931 Census showed that houses of 1-3 rooms formed 4.7% of the total number of houses in Croydon ; those of 4-5 rooms 51.4% und those with over 5 rooms 43.9%. 64 Table III. SCARLET FEVER. YEAR Cases notified in Croydon. Attack Rate Per 100,000 of Population- No. of Deaths. Percentage of Death s| to Cases notified. All Cases Admitted to Hospital with a Diagnosis of Scarlet Fever. No. Admitted. No. of Deaths. Percentage of Deaths to Casea Treated*] 1 2 3 4 5 6 7 8 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 0.13 1936 655 271 2 0.31 631 2 0.32 1937 776 320 2 0.26 799 2 0.25 1938 522 214 3 0.57 624 4 0.64 * 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 1938 as compared with 1937. The case mortality was 0.57. The attack rate (Col. 3) for England and Wales was 241. Croydon shows a lower figure. 65 Table IV. DIPHTHERIA. YEAR. Cases notified in Croydon. Attack Rate Per 100,000 of Population. No. of Deaths. Percentage of Deaths to Cases notified. All Oases Admitted to Hospital with a diagnosis of Diphtheria. No. \dmitted. No. of Deaths. Percentage of Deaths to Cases Treated* 1 2 3 4 5 6 7 8 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 1834 524 217 24 4.5 546 19 3.4 1935 304 125 12 3.9 465 12 2.6 1936 183 76 8 4.4 282 6 2.1 1937 289 119 15 5.2 376 13 3.5 1938 287 118 16 5.6 408 17 4.2 * Cases from Penge are included in Cols. 6 to 8. The incidence of Diphtheria showed a slight decrease in 1938, and the mortality was 5.6 per cent. The type of the disease was moderately severe. The excessive number of cases admitted to hospital over those notified is due to the admission of positive swab cases who, however, were not cases of clinical Diphtheria and were admitted on precautionary grounds. One hundred and twenty-nine of these cases were admitted and are not included in Columns 2-4. The case rate (Col. 3) for England and Wales was 158. Croydon's rate was therefore lower than for the whole country. 66 IMMUNIZATION AGAINST DIPHTHERIA. Dr. J. Tudor Lewis, one of the whole-time Assistant Medical Officers of Health, has been in charge of this branch of Preventive work, and 1 am indebted to him for the details given below. The routine methods in use in the Immunization Clinic, which have been fully described in previous reports, remained, except fori one modification, unchanged in 1938. The small outbreaks of Diphtheria in Kingsley, Waddon and Duppas Schools in the latter months of 1937 and early 1938 was followed, as is usual, by a rush to gain protection against the disease, and clinics were opened at Kingsley and Duppas Schools. During the summer months, coincidently with a drop in the Diphtheria notifications, was a diminution in the number of applications for Immunization, and the Clinic usually held at Selhurst Road was closed, to be opened again later in the year. The modification referred to aibove was the introduction of Alum precipitated toxoid, in a dosage, initially, of 0.1 cc., followed in a fortnight by 0.5 cos., and later on of 0.25 cos., followed in one month by 0.5 ocs. Up to the end of 1938 some 200 cases had completed treatment by this method, and only one of them had been found to be still Schick positive. There is little doubt that this preparation, when given by two injections, is a much better antigen than those previously used. The liability to serious reactions is very little greater than with T.A.M., and by giving 0.25 ccs. as a first injection, those children who are sensitive to the compound can be eliminated. A.P.T. administered by the above technique is now in routine use. Investigations are at present being conducted of the data which has been collected during the period that the Immunization scheme has been working, with a view to determining the most efficient and economic procedure for use in antiDiphtheria Immunization Schemes. The Work For The Year. On January 1st, 1938, 511 were under treatment; of these 461 completed a course of T.A.M., 6 of T.A.F., 41 of A.P.T., and 6 defaulted. Tn 1938 1,541 new cases attended, 1,208 being given a Primary Schick Test, while 353 commenced treatment without any test. The new cases were derived from the following sources:— School cases 1,179 Infant Welfare cases 130 Others under 5 years 232 1 61 Of the 1,208 cases which were given a Primary Schick 832 were positive, a percentage of 69 ; 376 were negative, a percentage of 31. A more detailed table giving the results of Schick tests at ages is appended. 351 of the new 1938 cases completed a course of T.A.M., 49 of T.A.F., and 244 of A.P.T., a total of 644 completed cases. Cases are not considered completed if they have not been proved Schick negative by a re-test. 497 cases were unfinished on December 31st. 24 cases defaulted or left the district. The 508 cases carried over from 1937, together with 644 completed 1938 cases, give 1,152 cases that completed their treatment in 1938. The total number of cases that attended the Clinic in 1938 was 2,049. 5 cases carried over from 1937 were found to be Schick positive after three injections of prophylactic. Four were given another injection and on re-test were found to be negative. The fifth was a case to which reference was made in last year's report. After 7 injections of T.A.M. she became Schick negative. As stated above 644 of the 1938 cases completed treatment. Pour of the cases that received T.A.M. were still Schick positive after 3 injections, a Schick negative rate of 98.8%. Two cases that received T.A.F. were still Schick positive, a post-Schick negative rate of 98%. One case carried over from 1937 was Schick positive after two injections of A.P.T. All these cases were given a further injection and were found to be Schick negative three months later. The following figures give some further details of attendances Iat the Clinic. Total number of sessions held 115 Highest attendance at any one session 152 Lowest attendance at any one session 10 Average attendance per session 56 Reactions. Local Reaction to T.A.M.—10 mild reactions were recorded and 3 fairly severe ones, after the 1st injection. 2 mild reaction-) after the 2nd injection were recorded. One boy, who started treatment in 1937, experienced a severe reaction after the 2nd injection 68 Local Reactions to T.A.F.—One slight reaction recorded. Local Reaction to A.P.T.—21 slight reactions were recorded, and 6, more severe ones, all after the 1st injection. One of the latter was unusually severe but eventually settled down satisfactorily. Diphtheria. Previous.—38 cases gave a previous history of diphtheria infection. 34 were found to be Schick negative and 4 were Schick positive ; they were immunized with A.P.T. Inter-current.—No case of diphtheria during the process of immunization came to notice during 1938. Subsequent.—One case of diphtheria in an immunized person was reported in 1938; 3 were notified in 1937. The 1938 case was a moderately severe case, who made a complete recovery. The question of diphtheria in the innoculated was discussed in last year's report. In the particular case of diphtheria immunization the occasional case of diphtheria in the "immunized" is bound to occur, and should occasion no disquiet. The facts that they are the exception, that a severe case in an immunized subject is unusual, and fatal cases a rarity are sufficient to warrant the continuation of the schemes. Immunization is definitely a preventive and lifesaving procedure. In the following tables further information is given in summary form. Summary or Results of 1,208 Primary (Anterior) Schick Tests. Age Group. Positive. % Positive. Negative. % Negative. Total. Under 5 years 78 87 12 13 90 Over 5 under 6. 145 82 32 18 177 „ 6 „ 7 109 80 23 20 132 „ 7 „ 8 117 82 26 18 143 „ 8 „ 9 93 70 40 38 133 „ 9 „ 10. 83 65 45 35 128 „ 10 „ 14 207 51 198 49 405 Total 832 69 376 31 1,208 69 The process of acquisition of natural immunity seems definitely to gather speed in children over 7 yearn of age. This is due, so far as can be ascertained to the effects of numeral doses of infection j-eceived through contact with carriers. It is an uncontrolled and risky method of acquiring immunity as such immunity may be Obtained only by an attack of Diphtheria, with its attendant dangers. Summary of Attendances and Treatment, 1938. Under Treatment 1/1/38. Received T.A.M. Received T.A.F. Received A.P.T. Defaulted Given Primary Schick Test 1938. No. Pos. % Pos. No. not given Primary Schick. Total new cases 1938. 511 461 6 41 3 1208 832 69 353 1541 No. 1938 cases completed treatment. Received T.A.M Received T.A.F. Received A.T.P. No. given Posterior Schick. No. negative on Post. Schick. % negative on Post. Schick. Total cases : attended 1938. Under treatment 31/12/38 Defaulted or left district. 644 351 49 244 1152 1140 98.9 2049 497 24 Summary of the Work of the Clinic since its start. Year. Total attended for treatment. New cases attended. No. of sessions held. Av. attend per session. No. given Primary Schick. % Pos. on Primary Schick. No. given Posterior Schick. No. Neg. on Posterior Schick. % Neg. on Posterior Schick. No.completed treatm't Schick neg. 1934 509 509 ... 36 389 ... 185 ... ... 185 1935 1431 1151 97 58 634 76 781 766 98.8 781 1936 2285 1661 145 61 1215 78 1264 1254 99.2 1264 1937 1894 1286 122 58 1017 86 1222 1215 99.5 1222 1938 2049 1541 115 56 1208 69 1152 1140 98.9 1152 70 Origin and Source of Cases attending. Year. School. Inft. Welfare C. Others under 5 yrs. Total. Per cent. Total. Per cent. Total. Per cent. 1934 339 67 ... ... 170 33 1935 944 66.6 265 18.7 208 14.7 1936 1620 74.8 310 14.3 237 10.9 1937 928 72.2 155 12.0 203 15.8 1938 1179 76.5 130 8.4 232 15.1 Immunization by Private Medical Practitioners. The scheme whereby parents may have immunization carried out by their own practitioners, remained in force. Under this scheme the practitioner is supplied, by the Department, with necessary immunization material free of cost and is paid a fee of 12/6 to cover the giving of the injections. Ten children were immunized under this arrangement. 71 Distribution of School Children who have attended the Immunisation Clinic since its Inauguration. School Completed treatment or Schick negative in : New cases attended clinic in 1938 Total Schick negative to end of 1938 1934 1935 1936 1937 1938 Ashburton 4 8 28 105 8 9 153 Benson 1 5 1 ... 7 4 14 Bculah 10 28 21 26 46 106 131 British 2 1 1 ... ... 3 3 Davidson 1 7 8 4 7 8 27 Duppas ... 14 7 9 62 64 92 St. George's ... 2 ... 6 4 2 12 Ecclesbourne ... 9 15 17 13 17 54 Elmwood 2 5 8 24 4 4 43 Gonville 8 41 25 27 24 17 125 Howard ... 1 6 8 7 7 22 Ingram 8 14 18 16 17 43 73 Kensington 1 13 42 109 6 9 171 Kingsley 14 52 32 30 313 235 441 Lanfranc 2 9 3 2 2 1 18 Norbury Manor 2 14 31 66 20 15 133 Oval 2 23 21 15 8 5 69 Portland ... 10 53 23 5 9 91 Purley Oaks 2 3 ... 29 6 ... 40 Rockmount 1 5 49 11 4 8 70 South Norwood 3 10 39 15 4 5 71 Suffolk Rd. (Cypress) .. 1 3 3 2 10 17 19 Sydenham 1 2 10 4 ... 1 17 Tavistock ... 3 12 9 2 3 26 Waddon 12 26 16 11 192 210 257 West Thornton 3 33 20 16 11 5 83 Whitehorse Manor 1 5 6 6 22 23 40 Winterbourne 1 45 285 116 136 57 583 Woodside 10 15 72 26 16 23 139 St. Christopher's 1 2 2 ... 1 1 6 72 School. Completed treatment or Schick negative in: New cases attended clinic in 1938 Total Schick negative to end of 1938 1934 1935 1936 1937 1938 St. Luke's ... ... ... ... 1 1 1 St. Giles' 1 ... 1 2 ... 110 ... All Saints 53 33 38 28 17 19 169 Tenisons 1 2 2 2 ... ... 7 Christ Church 2 15 6 6 6 7 35 Holy Trinity ... 4 6 9 5 7 24 Parish Church 3 18 7 8 7 11 43 St. Andrew's 1 5 4 3 2 1 15 St. Joseph's ... ... 1 2 ... ... 3 St. Mark's 1 4 7 6 ... 3 18 Addington ... ... ... ... ... ... ... St. Mary's 3 8 2 1 8 8 22 St. Peter's ... 3 1 4 1 1 9 St. Saviour's ... 4 4 9 3 4 20 Shirley ... 2 2 ... ... ... 4 Monk's Orchard ... ... ... 9 5 6 14 John Ruskin ... ... 4 5 3 3 12 Lady Edridge 1 3 4 1 1 2 10 Heath Clark ... 6 7 35 4 ... 52 St. Michael's ... ... 3 6 2 2 11 Selhurst Grammar 4 3 7 10 3 4 27 Croydon High ... 8 1 3 ... ... 12 Coloma ... 5 6 2 ... 1 13 Old Palace 9 3 2 4 1 1 19 Whitgift ... 2 5 ... ... ... 7 Polytechnic 1 ... 2 1 2 3 6 Private 6 17 20 21 9 27 73 Unknown 4 33 3 7 33 47 80 73 IMMUNIZATION AT RESIDENTIAL SCHOOLS AND HOMES. The method used has been largely on the same lines as detailed in my report for 1937. Owing to a tendency shown by A.P.T. to give reactions in older children, T.A.M. has been used for older age groups, and T.A.F. for adults. No serious reactions were reported, one case of slight local reaction following 1st injection. The table below gives a detailed analysis of immunization done at the various schools and homes. It is almost inevitable, when dealing with large numbers of children in Residential Schools and Homes, to find that some are removed out of the Borough before treatment is completed. These changes of address have been noted and the Medical Officer or Health of the district concerned has been informed. Name of Institution. No. not completed, 1938. No. Primary Schick. No. Positive. % Positive. No. given A.P.T. No. retested. No. Negative. % Negative. Uncompleted. emoved from District. Fidelis Convent, Central Hill 7 17 16 94.1 13 11 11 100.0 12 1 Infirmary Convent, Central Hill 9 24 14 58.3 13 5 5 100.0 10 1 Russell School 10 24 19 78.1 19 19 18 94.7 11 2 Boys' Home, Beulah Hill 3 7 6 85.7 6 8 8 100.0 — 1 St. Jude's Home, Dagnall Park 2 6 5 83.3 5 4 4 100.0 3 — Clevedon Children's Home Tennison Rd. — 28 28 100. 28 - - - - - P.A.C., 386, London Road 14 35 3 88.6 31 11 11 100.0 12 8 45 141 119 84.4 115 58 57 99.3 48 13 74 BOROUGH HOSPITAL. Table V. gives a summary of all cases treated at the Hospital during 1938. 1,476 patients were admitted and discharged, which together with patients in at the commencement of 1938 (197), gives a total of 1,673 cases dealt with. Forty-one died, giving a case mortality for the Hospital of 24.5 per cent. as against 22.1 in 1937. The average number of days of each patient in Hospital for all classes of patients was 22.6 days as against 22.1 in 1937. Penge Urban District Council has an arrangement with the Corporation to send their cases to the Hospital. During 1938 a total of 160 cases was admitted, these are included in the Table. The Hospital is a recognised training school for nurses. During the year 3 probationers passed the preliminary examination and 7 the final examination. The accommodation of the Hospital remained as in 1937, but owing to a decline in Scarlet Fever cases during the last quarter of the year, one of the Scarlet Fever wards was kept closed during this period. During the year 7 cases were operated on for tonsils and adenoids and 8 for acute mastoiditis, and 6 cases had uterine drainage performed. 75 Table V. Complaint for which admitted. Patients remaining in Hospital on 1st January, 1938 Patients admitted and discharged in 1938 Patients admitted during 1938 and remaining in Hospital on 1st January, 1939 Analysis of Cases admitted whether discharged or not during the year. Total. Recovered. Died. Total. Recovered. Died. Total. Recovered. Died. Total. Recovered. Died. Case Mortality. | Average | No. of days | in Hospital. Scarlet Fever 71 70 1 624 620 4 50 50 ... 674 670 4 0.5 37.7 Diphtheria 78 77 1 408 391 17 53 53 ... 461 444 17 3.7 34.9 Enteric Fever 39 36 3 10 6 4 ... ... ... 10 6 4 40.0 45.3 Para Typhoid B 3 3 ... 1 1 ... 1 1 ... 2 2 ... 38 Puerperal Pyrexia ... ... ... 5 5 ... ... ... ... 5 5 ... ... 12.8 Puerperal Fever ... ... ... 11 11 ... ... ... ... 11 11 ... ... 28 Erysipelas ... ... ... 31 29 2 2 2 ... 33 31 2 6.3 12.5 Measles 1 1 ... 75 71 4 ... ... ... 75 71 4 5.5 17 Rubella ... ... ... 5 5 ... ... ... ... 5 5 ... ... 11 C.S.M. ... ... ... 8 4 4 ... ... ... 8 4 4 50.0 20.3 Whooping Cough 1 1 ... 47 43 4 ... ... ... 47 43 4 8.5 35 Chicken Pox ... ... ... 70 69 1 4 4 ... 74 73 1 0.1 23.6 Ophthalmia 1 ... ... 5 5 ... 2 2 ... 7 7 ... ... 27.2 Mumps 2 2 ... 11 11 ... 1 1 ... 12 12 ... ... 21.3 Tonsillitis ... ... ... 2 2 ... 1 1 ... 3 3 ... ... 9.5 Anterior-poliomyelitis ... ... ... 5 4 1 1 1 ... 6 5 ... 0.1 24.7 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pemphigus ... ... ... 7 7 ... ... ... ... 7 7 ... ... 7.2 Dysentery ... ... ... 11 11 ... ... ... ... 11 11 ... ... 9.6 Dermatitis ... ... ... 3 3 ... ... ... ... 3 3 ... ... 12 No Disease ... ... ... 22 22 ... ... ... ... 22 22 ... ... ... Acute Laryngitis 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Totals 197 192 5 1361 1320 41 115 115 ... 1476 1435 41 ... ... 76 SCARLET FEVER. The total number of Scarlet Fever oases admitted during the year was 624, a decrease of 175 on 1937. 497 cases were admitted from the Borough and 127 from Penge. The type of disease admitted during the year was of moderate severity. 18 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. Total Cases Serum Cases. NonSerum Cases. Total. 90 516 606 Adenitis 8 56 64 Otorrhœa 9 44 53 Rhinorrhœa 13 29 42 Albuminuria — 2 2 Nephritis 1 2 3 Rheumatism — 4 4 Relapses 1 6 7 Secondary Sore Throat 1 5 6 Abscesses and Boils 2 9 11 Mastoid — 2 2 Osteo-Myelitis — 1 1 The average stay in hospital of serum cases was 37.9 days and of non-serum cases 37.7 days. Four deaths occurred amongst the Scarlet Fever cases, one being really a case of faucial diphtheria, one being complicated by acute mastoid, one by broncho-pneumonia, and one by meningitis. The number of complications amongst the 516 non-serum cases was 160, whereas the complications amongst the serum cases was 35. Prontosil Album was tried in 56 cases and the results were favourable, particularly in clearing up persistent otorrhœa in some cases. 77 Ages and Sexes of Scarlet Fever Cases Admitted. Table VII. Age. Males. Females. Totals. Percentage. 0—1 - 2 2 0.32 1—2 9 11 20 3.21 2—3 22 16 38 6.09 3—4 19 25 44 7.05 4—5 49 38 87 13.94 5—10 129 152 281 45.03 10—15 39 39 78 12.50 15—20 13 14 27 4.33 20—30 6 19 25 4.01 30 or over 5 17 22 3.53 Total 1938 291 333 624 Total 1937 336 433 799 Monthly Admissions of Scarlet Fever Patients. Table VIII. Month. Cases 1937. admitted. 1938. Cases notified. 1938. January 28 69 57 February 40 57 55 March 49 73 75 April 79 62 63 May 60 63 52 June 91 44 45 July 107 55 46 August 29 30 15 September 60 42 27 October 131 57 33 November 75 34 24 December 50 39 31 Totals 799 624 523 78 DIPHTHERIA. 408 cases were admitted with a diagnosis of Diphtheria, an increase of 33 cases on 1937. Of these 12 were found not to be cases of Diphtheria and 129 were cases of positive swabs without clinical symptoms, leaving 267 cases of true clinical Diphtheria. There were 16 deaths, a mortality of 6%. Analysis of the 267 cases:— Faucial Diphtheria 246 Nasal Diphtheria 14 Laryngeal Diphtheria 4 Faucial and Nasal Diphtheria 2 Faucial and Laryngeal Diphtheria 1 Total 267 The following complications and sequelae occurred amongst the Diphtheria cases:— Otorrhœa 7 Rhinorrhœa 13 Adenitis 14 Heart Failure 15 Secondary Sore Throat 2 Paralysis— Palatal 19 Eyes 6 Facial 2 Diaphragm 1 Albuminuria 1 79 Ages and Sexes of Diphtheria Cases Admitted. Table IX. Age. Males. Females. Totals. Percentage. 0—1 1 0 1 0.25 1—2 7 5 12 2.94 2—3 13 11 24 5.88 3—4 12 7 19 4.66 4—5 11 8 19 4.66 5—10 108 83 191 46.81 10—15 21 38 59 14.46 15—20 17 22 39 9.56 20—30 6 20 26 6.37 30 or over 5 13 18 4.41 Total 19381 201 207 408 Total 1937 171 201 375 Monthly Admissions of Diphtheria Patients. Table X. Month. Cases admitted, including Non-Clinical Cases. Cases admitted. 1937. Notifications. 1938. January 40 36 30 February 31 30 26 March 39 30 27 April 12 13 12 May 22 16 15 June 25 10 23 July 11 28 5 August 21 15 11 September 39 27 37 October 63 81 42 November 60 51 37 December 39 38 23 Totals 408 375 288 The average number of days in Hospital for Diphtheria cases was 34.9 as opposed to 36 days in 1937. 80 Particulars of Fatal Cases of Diphtheria. Table XI. Name. Age Condition on Admission. Subsequent Progress. Time of Death after admission. l.y. (m) 3 yrs. Extensive membrane over both tonsils, cyanosis, glands of neck †† Developed signs of heart failure 5 days after admission, dying from this the following day. 7 days. b.s. (m) 2 11/12 yrs. Extensive membrane over both tonsils, with adenitis. Showed signs of heart failure on 3rd day after admission, which steadily increased, "gallop" rhythm ensued, died on 16th day. 16 days. M.b. (F) 5 1/12 yrs. Extensive membrane over both tonsils, bull - neck, marked cyanosis, foetor. Heart failure started on 3rd day with persistent vomiting, died from this. 9 days. S.h. (F) 12 yrs. Extensive membrane over both tonsils, glands of neck †† foetor. Showed signs of heart failure which increased steadily, died suddenly on 15th day. 15 days. m.l. (F) 8 yrs. Extensive membrane over both tonsils, cyanosis—bull-neck —foetor. Showed signs of heart on admission, very restless, dying the same day. 1 day. g.m. (m) 6 yrs. Extensive membrane over both tonsils, glands of neck †† v. toxic on admission, with heart failure signs, died 12 hours later. 12 hrs. r.i. (m) 2 yrs. Admitted after emergency tracheotomy before admission, breathing comfortably. Developed signs of bronchitis and very cyanosed, collapsed suddenly. 7 days. r.g. (m) 10 4/12 yrs. Extensive sloughing membrane both tonsils, rhinorrhœa †† adenitis ††, foetor. Showed signs of heart failure on admission, persistent vomiting, this increased steadily and proved fatal. 10 days. SI Name. Age on Admission. Condition on Admission. Subsequent Progress. Time of Death after admission. B.r. (f) 4 11/12 yrs. Extensive membrane over both tonsils, bull - neck, foetor, cyanosis. Increasing heart failure, with sudden collapse next day. 26 hrs. A.H. (m) 8 yrs. Extensive membrane over whole pharynx, glands of neck tt Signs of heart failure present on admission, rapidly increased, death ensued. 6 hrs. D.B. (m) 10 yrs. Extensive membrane over both tonsils, bull - neck, foetor, toxaemia †† Showed signs of heart failure on admission which increased, tendency to bleeding from nose and mouth. 4 days. B.c. (f) 8 yrs. Sloughing membrane over both tonsils, glands of neck, colour poor, v. toxic. Showed signs of heart failure on admission, became very restless, and died from heart failure. 3 days. A.D. (m) 7½ yrs. Extensive membrane with oedema of pharynx, glands of neck tt Marked signs of heart failure on admission, died suddenly from this. 1 day. L.B. (m) 9 1/12 yrs. Sloughing membrane over both tonsils, glands of neck tt, foetor, rhinorrhoea. Toxic on admission, constant vomiting, increasing heart failure, with restlessness, died from this. 11 days. M.D. (f) 6 10/12 yrs. Extensive sloughing membrane over tonsils, glands of neck, rhinorrhoea, cyanosis. Developed signs of heart failure with vomiting day after admission, this increased and proved fatal. 11 days. E.H. (m) 3 11/12 yrs. Sloughing membrane over both tonsils, profuse rhinorrhoea, glands of neck tt Showed signs of heart failure on admission with restlessness: heart rate dropped to 40 per minute, died from this. 5 days 82 Typhoid and Para-typhoid Oases. During the year 11 cases of Typhoid Fever or Para-typhoid Fever were admitted and in 10 the diagnosis was confirmed. One death occurred amongst the 10 cases, being a severe case with marked toxaemia. The unconfirmed case admitted as Typhoid Fever was a baby suffering from simple enteritis. There was one case of Para-typhoid Fever admitted. Of the 10 cases of Typhoid or Para-typhoid 8 were secondary cases arising from the 1937 outbreak. The other two cases were, one a case of Para-typhoid Fever and one a case of Typhoid, in whom no connection with the outbreak could be traced. Puerperal Fever. During the year there were 11 cases admitted as Puerperal Fever and 5 as Puerperal Pyrexia cases. No deaths occurred amongst these cases. 6 of the cases of Puerperal Fever were complicated by other diseases as follows:— 1 was complicated by thrombo-phlebitis of both legs. 1 was complicated by double pneumonia. 1 was complicated by cardiac disease (rheumatic). 1 was complicated by bacillus coli pyelitis. 1 was complicated by lactational mania. 1 was complicated by pleurisy. Erysipelas. There were 31 cases of Erysipelas admitted, 4 more than in 1937. In 7 of these the diagnosis was not confirmed, :hey were as follows:— 3 wTere cases of cellulitis of leg. 1 was a serum rash. 1 was a case of parotitis. 1 was a case of boils. 1 was a simple dermatitis. Excluding these cases there were 24 cases of true Erysipelas. The disease was of average severity. Two deaths occurred amongst them, one being complicated by cavernous sinus thrombosis, the other by general septicaemia. 83 Measles. There were 75 cases of Measles admitted, an increase of 21 cases on 1937. The disease was of average severity. Four deaths occurred, all due to broncho-pneumonia. Whooping Cough. There were 47 cases of Whooping Cough admitted, an increase of 25 on 1937. The disease was of average severity. There were 4 deaths. Cerebro-Spinal Meningitis. There were 8 cases of Cerebro-Spinal Meningitis admitted, but only in 6 of these was the diagnosis confirmed, the other 2 case3 were as follows:— 1 was a case of bacillus coli septicaemia. 1 was a case of mumps. Four deaths occurred amongst the 6 cases. Ophthalmia Neonatorum. Five cases were admitted. In 3 the diagnosis was confirmed. The others were cases of simple ophthalmia. All recovered without damage to eyesight. Infantile Paralysis (Poliomyelitis). Four cases were admitted as Infantile Paralysis but only in one was the diagnosis confirmed, the other 3 were as follows:— 1 was a case of epilepsy. 1 was an acute diffuse myelitis. 1 was a case of acute rheumatism. Dysentery. Eleven cases were admitted as dysentery but in eight the diagnosis was not confirmed. Of the 3 cases of dysentery one case was Sonne dysentery and 2 Shiga dysentery. Pemphigus. Seven cases were admitted diagnosed as Pemphigus, but in none was the diagnosis confirmed, they were all cases of staphylococcal dermatitis. Mumps. 11 cases of Mumps were admitted, but one was a case of abscess of jaw, not of Mumps. 84 Table XII. Other Diseases. Deaths 4 ... ... ... 2 4 ... 4 4 1 ... ... ... ... ... ... ... ... ... ... 20 Totals 10 1 11 5 31 75 5 8 47 70 5 11 ... 5 ... 7 11 3 2 22 329 45 & over f ... ... ... 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 m ... ... ... ... 8 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 9 35—45 f 1 ... 3 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 M ... ... ... ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 25—35 f 2 ... 5 3 5 ... ... ... ... 2 ... ... ... ... ... ... ... 1 2 ... 20 m 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 15—25 F 3 ... 3 2 1 1 ... ... ... 9 ... ... ... ... ... ... 6 2 ... ... 21 M ... ... ... ... 1 3 ... 1 ... ... ... 1 ... ... ... ... 1 ... ... ... 8 5—15 f 1 ... ... ... 1 6 2 ... 5 7 ... ... ... 2 ... ... 1 ... ... ... 25 M 1 ... ... ... ... 15 ... 1 1 14 ... 6 ... ... ... ... ... ... ... ... 39 2—5 f ... ... ... ... ... 16 1 ... 3 10 ... 3 ... ... ... ... ... ... ... ... 33 M ... ... ... ... ... 16 ... 1 8 16 ... ... ... ... ... ... 1 ... ... ... 42 1—2 f ... ... ... ... ... 6 ... ... 15 12 ... 1 ... 1 ... ... ... ... ... ... 35 M ... ... ... ... ... 7 ... 4 10 7 ... ... ... ... ... ... 1 ... ... ... 29 0—1 f ... ... ... ... 1 1 1 ... 5 ... 5 ... ... ... ... 5 ... 1 ... ... 19 m 1 ... ... ... 1 4 ... ... 2 ... ... ... ... ... ... 2 ... ... ... ... 10 Age Group Disease Enteric Fever Para-typhoid B Puerperal Fever Puerperal Pyrexia Erysipelas Measles Rubella C.S.M Whooping Cough Chicken Pox Ophthalmia Mumps Tonsillitis Anterior Poliomyelitis Encephalitis Lcthargica Pemphigus Dysentery, Sonne Dermatitis Tonsillitis No Disease Totals 35 Out of Borough Cases. Table XIII. Disease. Males. Females. Totals. Deaths. Scarlet Fever 55 72 127 — Diphtheria 13 19 32 3 Erysipelas — — — — Typhoid Fever — — — — Dysentery 1 — 1 — Croydon Borough Hospital Laboratory Report. Table XIV. DIPHTHERIA. NOSE AND THROAT SWABS EXAMINED. New Cases Positive on Admission. Convalescent Cases. Negatives. Total. 264 539 6,501 7,304 FAECES EXAMINED FOR ENTERIC AND DYSENTERY GROUPS. Faeces Positive for B. Typhosus. Faeces Positive for B. Typhosus Para. B. Negatives. Total. 7 3 114 124 URINES EXAMINED FOR ENTERIC GROUP. Urines Positive for B. Typhosus. Urines Positive for B. Typhosus Para. B. Negatives. Total. 6 1 66 73 WIDALS (Dreyer's Agglutination Test). Positives MB. Typhosus. Positives B. Typhosus Para. B. Negatives. Total. 3 1 3 7 86 MISCELLANEOUS EXAMINATIONS. 3 Specimens of Blood for Culture, all remained sterile. + — Total. 12 Swabs from Eyes, examined for Gonooocci 5—7-—12. 9 Vaginal Swabs, examined for presence of Gonoccocci 1—8— 9. 18 Specimens of Urines, examined for organisms, cas blood or pus cells. 6 Specimens of Pus, cultured for organisms, 5 Haemoly Streptococcus Longus grown, 1 Steri 3 Lochia Swabs for organisms, 2 B. Coli and Staphyloco present, 1 swab remained sterile. 3 Sputum's examined for presence of B. Tuberculosis, negative. 4 Specimens of Faeces, examined for presence of B. Tub culosis, all negative. 2 Cerebro-Spinal Fluids, examined and cultured for organist 1 Haemolytic Streptococcus Longus, 1 C.S.F. remained sterile. 1 Eye Swab, cultured for organisms, Haemolvtio Streptococo Longus isolated. 1 Swab from throat examined for Vincent's Angina positive CULTURE MEDIA PREPARED. Leoffler's Blood Serum—626 dozen tubes. Agar Agar—5,940 cos. Peptone Broth—13,000 cos. Peptone Water—4,500 ccs. Litmus Milk—250 ccs. Veal Broth—500 ccs. 87 BACTERIOLOGICAL EXAMINATIONS. I am indebted to the Borough Pathologist, Dr H. W. Southgate, for the figures given in the appended tables: TABLE A V. At the Laboratory, Croydon General Hospital. Total Neg. 7231 3 1506 43 74 65 174 217 232 10 104 4 22 235 Pos. 450 27 591 1 4 ... 9 28 ... 26 22 Other Institutions Neg. 368 ... 88 ... ... ... 4 2 ... ... ... ... ... ... 1 Pos. 10 3 14 ... ... ... ... ... ... ... ... Other Instns. of Corporation Neg. 119 ... ... 34 62 44 132 8 ... 50 1 9 43 ... 2 74 Pos. ... ... ... ... 4 ... ... ... ... ... 20 For School Medical Neg. 4933 ... ... ... ... ... ... ... ... ... 1 ... ... ... 16 Pos. 183 5 ... ... ... ... ... ... ... ... 2 For Tub. Dispensary Neg. 2 ... 785 ... ... ... ... ... ... ... ... ... ... ... ... Pos. ... ... 478 ... ... ... ... ... ... ... ... For Borough Hospital Neg. 9 2 ... 1 1 2 1 5 ... 2 ... ... ... 1 3 Pos. 7 17 ... ... ... ... 2 1 ... ... ... Mayday Hos. Neg. ... ... ... ... ... ... ... 194 ... ... ... 2 ... 18 125 Pos. ... ... ... ... ... ... ... 27 ... ... ... For private practitioners Neg. 1800 1 633 8 11 19 37 8 ... 180 ... 59 4 1 16 Pos. 250 2 99 1 ... ... 7 ... ... 26 ... Swabs for Diphtheria Virulence tests for Diphtheria Sputum for Tub. Bac. Pus for Tub. Bac. Pus for Gonococci. Pus for other organisms Blood for Typhoid Groups Blood for Wassermann Material for Spirochaetes Faeces for Typhoid Group Hair for Ringworm Examination of Urine Examination of Pleural Fluid Examination of C.S. Fluid Other Examinations 88 Examinations Done Under National Health Insurance Act. Table XYI. Nature of Examination. Nature of Examination. Pus for Gonococci 14 (3 pos.) Urine for Chemical Exam 1 Pus for other organisms 18 Urine for Microscopal Exam. 1 Pus for Tubercle B. 16 Urine for Tubercle B. 1 Blood for Wassermann 5 (1 pos.) Urine for Cultural Exam. 1 Complete Blood Counts 7 Other Examinations 1 Bacteriological Examination of Milk. Table XYII. Number of Samples submitted for Counts 480 Number under 10,000 per cc 217 Number over 10,000 but under 50,000 per cc 170 Over 50,000 but under 100,000 per cc. 24 Over 100,000 but under 500,000 per cc 47 Over 500,000 but under 1,000,000 per cc 5 Over 1,000,000 per cc 17 Tubercle Bacilli— Number of samples of milk submitted 498 Number found positive by inoculation test 9 The number of milk examinations decreased by 5 There are 52 samples still under investigation for Tubercle Bacilli. Milk Samples 480 milk samples submitted to the Methylene Blue Test, oi which 48 failed to satisfy. Of these 9 were further investigated and found satisfactory to the Bacillus Coli test. We are not satisfied that the Methylene Blue Test has any advantage over the old method of plate counts and some of the results obtained are anomalous. 39 VACCINATION ACTS. I am indebted to Mr. Huggins, the Vaccination Officer, for the particulars in the returns in subjoined Tables. Table XVIII. Registration Sub-Districts in V.O. District. Births Registered. Vaccinated. Insusceptible! Statutory Declarations Died Un vaccinated. p. p.o. Transferred tootherVOs. Not traced Removals. In Default. Overage when Registered. South Sub-District 1371 564 12 571 53 12 44 92 23 ... West ,, 1621 557 2 838 53 12 16 124 19 ... North ,, 626 229 3 308 17 5 5 38 18 3 3618 1350 17 1717 128 29 65 254 60 3 During the year 2,440 Forms Q were sent to parents, and 446 Forms K and 415 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. 911 names were sent on the H lists to Public Vaccinators to be visited. During the past year 12 summonses were taken against parents who had failed to comply with the Vaccination Acts. 3 were fined 5s. each; 1 fined 7s. ; 2 fined 10s. and 10s. costs; 3 withdrawn, children being vaccinated after summons had been served; 1 fined 5s. and 7s. 6d. costs; 1 adjourned ; 1 not served (moved and could not be traced). 90 Return showing the Numbers of Persons vaccinated and revaccinated 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, 1938:— Table XIX. Name of Public Assistance Institution or Vaccination District. Numbers of successful Primary Vaccinations of persons. No. successful revaccinations, i.e., successful vaccinations of persons who had been successfully vaccinated at some previous time. Under 1 year of age. 1 year and upwards. Total. Croydon No. 1 Area 163 25 188 13 No. 2 Area 145 18 163 9 No. 3 Area 79 10 89 2 No. 4 Area 100 17 117 6 No. 5 Area 266 32 298 5 Addington 53 - 53 4 Queen's Road Homes 5 - 5 - Mayday Road Hospital 4 1 5 2 Children's Homes - 3 3 - Shirley Schools — — — — 815 106 921 41 91 SECTION V. PREVENTION AND CONTROL OF TUBERCULOSIS. The Tuberculosis Clinic is situated at 13, Katharine Street. Sessions are held daily in the mornings and afternoons, except on Monday mornings and Thursday afternoons. An evening session is held on Tuesdays. The clinic is primarily a diagnostic, advisory and distributing 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 have on previous occasions called attention to the unsuitability of the present premises. It is to be hoped that the endeavours of the Committee to find alternative and more suitable accommodation will soon be successful. Croydon is large enough and important enough to consider seriously the erection of a Health Centre, as has already been done by several London Boroughs, and in towns in other parts of the country. I am indebted to Dr. J. C. McMillan, the Assistant Medical Officer of Health for Tuberculosis, for the statistical part of this section of the report. Notification of Tuberculosis, Two hundred and nine cases of Pulmonary Tuberculosis and 48 of Non-Pulmonary Tuberculosis were notified on Form A (primary notifications); of these 120 males and 89 females were Pulmonary cases, 30 males and 18 females Non-Pulmonary. In addition, 61 Pulmonary cases and 14 Non-Pulmonary came to our notice as new casesi otherwise than by notification. The total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during 1938 by notification or otherwises was 332, as compared with 338 in 1937, 311 in 1936, 333 in 193-5, 325 in 1934, 346 in 1933, and 369 in 1932. 270 of these were cases of Pulmonary Tuberculosis; 151 in males and 119 in females. There were 12 fewer cases of Pulmonary Tuberculosis in males, and 6 fewer in females than in 1937. There were 25 cases of Non-Pulmonary Tuberculosis among children under 15 years as compared with 22 in 1937. The number of cases in adults was 37 compared with 28 in 1937. 92 Of the cases notified in 1938, 18 males and 10 females died from the Pulmonary form of the disease during the year, equal to 13.4% of those notified, and 3 males and 3 females from the NonPulmonary form. The incidence rate of Tuiberculosis of all forms was 1.36 per 1.000 of the population; for Pulmonary Tuberculosis 1.11 and for Non-Pulmonary 0.25 per 1,000 population. This rate is low as compared with other large centres of population. The Notification rate was 1.05 per 1,000. In 1937, the corresponding figures were 1.39, 1.19 , 0.20 and 1.07 per 1,000. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications during the period from the 1st January, 1938, to the 31st December, 1938:— Table I. FORMAL NOTIFICATIONS. No. of Primary Notifications of new cases of tuberculosis. Total Notifications on Form A. Age periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total (all ages) Pulmonary Males ... 1 2 1 14 12 29 22 23 11 5 120 139 ,, Females ... ... 1 2 16 21 30 6 10 2 1 89 98 Non-pulmonary Males 1 ... 4 5 4 2 4 6 1 2 1 30 31 „ ,, Females ... 2 4 1 2 1 7 ... ... ... 1 18 21 Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from the 1st January, 1938, to the 31st December, 1938, otherwise than by formal notification. Table II. Age periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 65 55 to 65 65 and upwards Total Cases Pulmonary Males 1 ... 1 1 1 4 12 3 7 1 ... 31 ,, Females ... ... 1 1 2 3 15 3 2 2 ... 30 Non-Pulmonary Males 2 ... ... 1 1 2 ... ... ... ... ... 6 ,, ,, Females 1 2 ... 2 1 ... ... 1 1 ... ... 8 93 The sources from which information as to the above-mentioned cases was Obtained are shown below:— Sources of Information. No. of Cases. Pulmonary. NonPulmonary. Death Returns from local Registrars 8 2 Transferable Deaths from Registrar General 2 1 "Transfers" from other areas (other than transferable deaths) 47 7 Posthumous notifications 1 3 Other Sources—Form I. 3 1 Notification Register. Number of cases of Tuberculosis remaining on the Notification register in the 31st December, 1938:— Table III. PULMONARY NON-PULMONARY Total Cases Males Females Total Males Females Total 605 512 1,117 112 123 235 1,352 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 6 2 8 5 4 9 17 2. Recovery from the Disease 18 16 37 12 6 18 55 3. Death all causes 67 46 113 7 12 19 132 4. Otherwise 41 38 79 4 3 7 86 94 Interval Between Notification and Death From Pulmonary Tuberculosis in Cases Dying in 1938. 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 119 deaths during 1938, 22 (18.4%) were either not notified at all or only notified within a month prior to death. In 1937, this figure was 26 or 18.5%. Of these, 12 were not notified during life; and 5 cases were certified by the Coroner or after a post-mortem examination; 3 cases died in other areas; and 4 cases were not notified through a misunderstanding. In 24.3% notification preceded death by less than six months. Table IV. Not Notified Under 1 week 1-2 weeks 2-4 weeks 1-2 months 2-3 months 3-6 months 6-12 months 12 3 2 5 5 4 10 12 One Year Two Years Three Years Four Years Five Years Six Years Seven Years Eight years and over 15 15 8 5 2 3 1 17 For Non-Pulmonary Tuberculosis the proportion of non-notified fatal cases to the total deaths from this form of the disease was 44.4%. In other words, out of a total of 18 deaths, 8 were not notified during life; only 2 of these 8 cases died at home. Two of the other cases were certified after a post-mortem examination. Of the total deaths from Tuberculosis of all forms, 20 or 14.6%, were not notified prior to death, compared with 13.5% in 1937. 95 Ages at Death From Pulmonary Tuberculosis. Table V. Year. 0—5 5—15 15—25 25—45 45—65 Over 65 Total 1929 3 2 41 76 41 7 170 1930 1 3 40 57 45 8 154 1931 6 1 33 65 41 9 155 1932 1 1 39 65 32 6 144 1933 ... 1 34 82 41 4 162 1934 1 1 28 69 40 5 144 1935 1 ... 37 67 33 10 148 1936 2 3 23 52 38 10 128 1937 ... 2 35 55 40 8 140 1938 ... 3 22 46 40 8 119 In 1938 the death-rate from all forms of Tuberculosis was 0.56 per 1,000 population. The rate for Pulmonary Tuberculosis was 0.49 and the rate for Ron-Pulmonary Tuberculosis 0.07. Similar figures for 1937 were 0.64, 0.58 and 0.06. This death-rate is one of the lowest among the larger centres of population in England and Wales. Pulmonary Tuberculosis. In 1938 there were fewer deaths from Pulmonary Tuberculosis than in 1937, the greatest number occurring in the age group 25-35 years, whereas in 1937 the greatest) number occurred in the 35-45 years age group. Apart from the 25-35 and 4-5-55 age groups, there were fewer deaths in all the other age groups than in 1937. In females the highest peak was reached in the 15-25 age group. In males the highest peak was in the 45-55 age group. After the 25th year the male deaths exceed those in females at all ages. This is probably connected with the fact that women lead a more 96 sheltered existence than men in the later years of life. The higher proportion of deaths in young adult females is probably accounted for by the increasing numbers employed at these ages and by the lack of a proper adjustment to the more strenuous way of life in modern times. The slimming fashion also cannot be exonerated from blame. The number of new cases of Pulmonary Tuberculosis in 1938 in the age groups 15 to 35 years was greater than in 1937 and, as in 1937, the greatest number occurred in the 25-35 group. The greater proportion of new cases of Pulmonary Tuberculosis were in the age groups comprising 1-5-35 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. Deaths from Non-Pulmonary Tuberculosis. During 1938, 18 deaths were certified to be due to Non-Pulmonary Tuberculosis, compared with 15 in 1937; 16 in 1936; 23 in 1935; 13 in 1934; 22 in 1933; 22 in 1932; 19 in 1931; 21 in 1930; 29 in 1929, and 39 in 1928. The deaths were due to:— Males. Females. Total. Tuberculous Meningitis 4 3 7 Tb. Meningitis and Miliary Tb. — 1 1 Miliary and Generalised Tb. 2 — 2 Tb. Kidneys — 2 2 Tb. Kidneys, Bladder and Urethra 1 — 1 Tb. Spine — 2 2 Tb. Hip 1 l 2 Tb. Glands of Neck — 1 1 8 10 18 97 Non-Pulmonary Tuberculosis. This year the greater proportion of new cases of Non-Pulmonary Tuberculosis occurred in adults, 59.6%, and 40.3% in children up to 15 years. Of the cases occurring in children, 52% were in boys; in adults the greater proportion of the cases were in men—62.1%. 44.4% of the deaths occurred under the age of 10 years compared with 53.3 in 1937. It will be noted there were no deaths in 1938 from Abdominal Tuberculosis, no doubt due to the fact that most of the milk distributed in the borough is pasteurised. Table VI. The diagnoses of the new cases entered in the Notification Register during 1938 were as follows:— Male. Female. Shoulder 1 - Humerus - 1 Elbow 2 - Finger - 1 Hip 1 6 Knee 5 - Toe 1 - Rib 1 - Pubis 1 - Spine 4 2 Spine and Peritoneum 1 - Abdomen 2 4 Glands 4 4 Epididymis and Testicle 5 - Fallopian Tubes - 1 Kidney 2 2 Kidney and Bladder - 1 Meninges 5 4 Eyes 1 — 36 26 Table VII. TUBERCULOSIS. (Summary of Notifications and Deaths at various age periods). Age periods. 1938 Population at age period, (estimated) Pulmonary, Non-Pulmonary. New Cases, All Cases. New Cases. All Cases. Number. Incidence Rate. Deaths. Death Kate (based on 1938 figures). Number. Incidence Rate. Deaths. Death Rate (based on 1938 est. fig .) M F M F M F M F M F M F M F M F M F Under one year 2141 1964 1 ... 0.47 ... ... ... ... ... 3 1 1.40 0.51 ... 1 1.87 0.51 1— 5 years 6974 7343 1 ... 0.14 ... ... ... ... ... ... 4 ... 0.54 ... 1 ... 0.14 5—10 „ 11408 10497 3 2 0.26 0.19 1 1 0.09 0.09 4 4 0.35 0.38 2 ... 0.18 0.10 10—15 „ 12091 11491 2 3 0 17 0.26 ... 1 ... 0.09 6 3 0.50 0.26 ... 1 ... 0.09 15—20 ,, 9929 10715 15 18 1.51 1.68 ... 8 ... 0.75 5 3 0.50 0.28 1 ... 0.10 0.19 20—25 „ 7702 9973 16 24 2.08 2.41 5 9 0.65 0.90 4 1 0.52 0.10 1 1 0.13 0.10 25—35 ,, 15765 20761 41 45 2.60 2.17 15 14 0.95 0.67 4 7 0.25 0.34 ... 2 ... 0.10 35—45 „ 17563 21401 25 9 1.42 0.42 12 5 0.69 0.23 6 1 0.34 0.05 ... 2 ... 0.09 45—55 14011 1609 30 12 2.14 0.75 20 5 1.43 0.31 1 1 0.07 0.06 ... 1 ... 0.06 55—65 ,, 8356 10204 12 4 1.44 0.39 10 5 1.20 0.49 2 ... 0.24 ... ... ... ... ... 65 and upwards 6383 10631 5 2 0.78 0.19 6 2 0.94 0.19 1 1 0.16 0.09 ... 1 ... 0.09 Totals 112323 131077 151 119 1.34 0.91 69 50 0.61 0.38 36 26 0.32 0.20 8 10 0.07 0.08 99 I The Wards showing the highest incidence of new patients in 1938 were: Addiscomibe, Central and Addington (1.6). ■ The highest death-rates were in Whitehorse Manor (1.01), Central (0.80), and Thornton Heath (0.79). With the relatively small figures available, these rates are subject to wide annual variations. Table VIII. Incidence and Death-Rates in Wards. Ward. Density of Population persons per acre. New Cases Total Incidence Rate per 1000 Death Rate per 1000 Pulmonary Non-Pul monary Upper Norwood 20 17 2 19 1.1 0.36 Norbury 29 21 3 24 1.5 0.50 West Thornton 42 19 10 29 1.5 0.51 Bensham Manor 50 20 5 25 1.5 0.66 Thornton Heath 51 20 2 22 1.2 0.79 South Norwood 29 17 2 19 1.1 0.46 Woodside 37 16 4 20 1.2 0.62 East 10 20 4 24 1.5 0.25 Addiscombe 49 22 4 26 1.6 0.43 Whitehorse Manor 63 18 6 24 1.4 1.01 Broad Green 69 17 5 22 1.3 0.41 Antral 33 16 4 20 1.6 0.80 Waddon 22 16 4 20 1.1 0.49 South 13 19 3 22 1.4 0.72 Addington 3 12 4 16 1.6 0.40 No fixed abode ... ... ... ... ... ... 270 62 332 1.36 0.56 100 CLASSIFICATION OF NEW PATIENTS. Pulmonary Tuberculosis. During 1938, 189 new patients were examined at the Clini and were found to be in the undermentioned stages of the disess on the first examination:— T.B. minus (sputum negative or absent) 59 or 31.2% T.B. plus 1 (early cases, sputum positive) 9 or 4.7% T.B. plus 2 (intermediate cases, sputum positive) 75 or 39.6% T.B. plus 3 (advanced cases, sputum positive) 46 or 24.3% 189 or 100.0% This is 16 fewer than in 1937. It is well known that Tuberculosis Officers do not see many the new cases in the early stages of the disease. 1938 was the san in this respect as 1937; only 35.9% of the cases were first seen this stage. The initiative to seek treatment when ill rests with the patie himself, and the remedy lies in the education of the public as the symptoms and common dangers of Tuberculosis and the nell for securing early treatment. It is unfortunate that 63.9% of in new cases were more or less advanced in the disease, and had pass the stage when there was any certainty of arrest. Non-Pulmonary Tuberculosis. There were 26 cases examined at the Clinic and found to hare Non-Pulmonary Tuberculosis in the following forms:— Bones and Joints 14 Abdominal 2 Other Organs 6 Peripheral Glands 4 26 Table XX. and XXI. summarise the condition of all patier whose records are at the Clinic at the end of 1938. These table show that of patients who came under treatment for Pulrnons Tuberculosis before 1928, 463 adults and 109 children have be Lab 101 discharged as recovered. Of these all but 26 were early cases. Of the 1928 cases, 29 adults and 2 children; of the 1929 cases, 15 adults and 3 children; of the 1930 cases 26 adults and 7 children; of the 1931 cases 21 adults and 4 children; of the 1932 cases 7 adults and 1 child; and of the 1933 cases, 1 adult and 1 child have recovered. Of patients who first attended in 1938, 5 have been lost sight of or otherwise removed from the Clinic Register. Of the 1937 cases 33 were lost sight of. Of patients who attended prior to 1928, 505 adults and 20 children are known to have died; since 1928, 968 adults and 27 children are known to have died. Of patients attending for the first time in 1938, 19 adults and 1 child have died. It will be seen that in the years 1928 to 1938 (inclusive) there have been 27 deaths in children, and 17 of these were found to have a positive sputum. It will also be seen that during this period there is no record of recovery from the disease in a single child with a positive sputum. It is fortunate that such cases are very rare. In sufferers from Non-Pulmonary Tuberculosis who first attended prior to 1928, 68 adults and 671 children have been discharged as recovered, and of those first attending in 1928 and following years, 44 adults and 68 children. 26 adults and 17 children died in the pre-1928 class; 32 adults and 14 children died tin the 1928 and following years group. Co-ordination with Medical Practitioners, and Other Branches of I the Health Department. During the year 215 cases of suspected Tuberculosis were referred by private medical practitioners; 55 were diagnosed as suffering from Tuberculosis and were subsequently notified. In addition, 23 children were referred by the School Medical Service, and 23 cases from the Maternity and Child Welfare section of the Public Health Department. 83.6% of all notified cases were examined at the Clinic or were seen at the request of the medical attendant at the patient's home, as compared with 87% in 1937, 78.3% in 1936, 83.9% in 1935, 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 425. Examination of Sputum. This is done by the Council's part-time Bacteriologist in the Laboratory at the Croydon General Hospital. 102 The results of examinations made in 1938 are as follows:— For Clinic. For General Practitioners. Totals. Positive (i.e., tubercle bacilli present) 492 111 603 Negative ((i.e., tubercle bacilli absent) 790 718 1,508 Total 1,282 829 2,111 For each 100 new cases and contacts examined at the Clinic 154 specimens of sputum were examined. 1938 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 X-Ray Work. 620 X-ray examinations were made during the year, an increase of 73 over 1937. This is equivalent to 74.7 for every 100 new cases and contacts seen, and compares with a rate of 68.4 in 1937, 53.6 in 1936, 45.2 in 1935, 40.4 in 1934, and 30.4 in 1933 In addition a certain number of cases who have already been examined at various Hospitals are referred to the Clinic. The X-ray plant installed at Mayday Hospital has been available for X-ray examinations of Dispensary cases, and during the year most of the X-ray examinations were carried out at this Hospital. Tomography. During the past year or two a new method of radiology has been developed called tomography. By this method it is possible to take X-ray films of the lungs, etc., in sections or slices at any predetermined depth. In Croydon we have been fortunate in having one of the first tomographs in this country, which was devised by Dr. H. C. Colyer through whose kindness 23 cases were examined by this method in 1938. Extra Nourishment. Provision of special nourishment in the form of milk was granted to 79 selected cases for varying periods during the year and 50 cases were in receipt of extra nourishment at the end of the in year. I This Table shows that, compared with last year, 11 more patients were admitted during the year and 11 more cases remained in institutions at the end of the year. 103 Sleeping Shelters. The loan of such shelters is made to suitable cases. Four were loaned to new applicants during the year, 12 being in use in all at the end of the year. INSTITUTIONAL TREATMENT. Table IX. Pulmonary Cases Treated in Institutions, 1938. In at beginning of 1938 Admitted during 1938 Discharged during 1938 Died during 1938 In at end of 1938 Adults C Adults C Adults C Adults C Adults C M F M F M F M F M F oy. Boro' San., Cheam 54 40 1 68 58 ... 64 57 ... ... 2 ... 54 39 1 ayday Hospital 15 8 ... 79 55 5 41 39 4 31 13 1 22 11 ... osvenor ... ... ... 6 2 ... 1 ... ... 1 ... ... 4 2 ... orrow Hill Colony ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ompton 1 1 ... 15 6 ... 9 5 ... ... ... ... 5 1 ... pworth 1 ... ... 1 ... ... 1 ... ... ... ... ... 1 ... ... st Anglian San. ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... N.H.C., Ventnor ... 1 ... 1 ... ... ... 1 ... ... ... ... 1 ... ... oyal Chest Hospital 2 1 ... 9 16 1 9 13 ... ... ... ... 2 4 1 ng George's San. 1 ... ... 1 ... ... 1 ... ... ... ... ... 1 ... ... dhurst ... 2 ... ... ... ... ... 2 ... ... ... ... ... ... ... ersfield Chest Hospital 1 1 ... 3 2 ... 4 3 ... ... ... ... ... ... ... eston Hall Colony 1 ... ... 1 ... ... 1 ... ... ... ... ... 1 ... ... tional Children's San. Harpenden 1 ... 6 ... ... 2 ... ... 6 ... ... ... ... ... 2 rnish Riviera San. 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... tswold San ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... C.C. Hospitals ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ndon Chest Hospital ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ks. & Bucks. Joint San. ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... or Place ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 78 55 9 186 139 10 131 121 13 42 16 1 91 57 5 104 Table X. Non-Pulmonary Cases Treated in Institutions, 1938. In on 1st Jan., 1938 Admitted during 1938 Discharged during 1938 Died during 1938 In on 31st Dec., 1938 Adults C Adults C Adults Adults C Adults C M F M F M F C M F M F Mayday Hospital 1 1 ... 5 6 2 3 4 1 1 2 ... 2 1 1 Royal Sea Bathing Hosp. 5 4 2 4 2 3 5 3 2 ... ... ... 4 3 3 St. Thomas's Hosp. ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... St. Nicholas Hosp. ... ... 1 ... ... 2 ... ... 1 ... ... ... ... ... 2 Tait Convalescent Home ... 1 ... ... 4 ... ... 5 ... ... ... ... ... ... ... Treloar Cripples' Hosp. ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... Croydon Qeneral Hosp. 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... - Pyrford ... ... 6 ... ... ... ... ... 2 ... ... ... ... ... 3 Heritage Craft School ... ... 2 ... ... ... ... ... 1 ... ... ... ... ... 1 King George's San. 1 ... ... 3 ... ... 3 ... ... ... ... ... 1 ... ... 8 7 12 12 13 7 12 14 8 1 2 1 7 4 10 The Immediate Results of Institutional Treatment. Table XIX. 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 28.5% were classified as early cases: the percentage of early cases receiving treatment in institutions was in women, 10.3%; in men, 14.2%; 51.2% of the total cases were intermediate cases, the males showing an excess in this group—28.5% males to 22.6% females—and 20.1% were definitely advanced. Of the total Pulmonary cases treated in Institutions 73.8% were potentially infectious. 111 males, 83 females and 9 children, suffering from Pulmonary Tuberculosis, were discharged from or died in Institutions in connection with the Croydon Scheme during 1938. 105 Types of Cases Treated. In Class T.B., Minus, 21 males, 14 females, and 8 children were discharged with the disease in a quiescent condition, i.e., 81.1% of the total cases in this class; 4 males and 5 females were not in a quiescent condition, 17% ; 1 male died, 1.8%. In Class T.B. Plus, Group I., the corresponding- figures were 3 males and 1 female quiescent, 80%; 1 female not quiescent, 20%; there were no deaths in this group. In Class T.B. Plus, Group II., 11 males and 14 females quiescent, 24.0%; 38 males and 27 females not quiescent, 62.5%; and 9 males and 5 females died, 13.4%. In Class T.B., Plus, Group III., or advanced group, no case was discharged quiescent; 5 males and 10 females not quiescent, 36.5% ; and 19 males and 6 females and 1 child died, 63.4%. Taking all groups together, 35.4% of cases were discharged as quiescent; 44.3% as not quiescent; and 20.1% died. 54.5% of the deaths of open cases on the dispensary register occurred in Croydon institutions. Non-Pulmonary Tuberculosis.— 31 patients were discharged during the year, and 58% of these were quiescent. Deaths from Pulmonary Tuberculosis in Cheam Sanatorium and Mayday Hospital during 1938 according to sex and stage of disease:— CHEAM. MAYDAY. Adults. Adults. Child, Classification. Males. Females. Males. Females. Girl. T.B. minus — — 2 1 — T.B. plus 1 — — — — — T.B. plus 2 3 2 5 2 — T.B. plus 3 1 — 24 10 1 Total 4 2 31 13 1 The Clinic Register of Cases. The number of cases of Tuberculosis under the supervision of the Clinic at the end of the year was 882. This is equivalent to 3.62 persons per 1,000 of the population. 106 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. During the year 101 Clinic cases died; of this number, 26 or 25.7% were seen for the first time in 1938. The Tuberculosis Clinic and Home Visiting. The subjoined table gives a summary of the work done in connection with the Clinic. 488 new cases were examined during the year; this is equal to 356 for each 100 deaths from the disease. 205, or 150 for each 100 deaths, were found to be definitely Tuberculous. The total number of attendances at the Clinic was 4,753. The Tuberculosis Officer paid 160 home visits, and the District Health Visitors 2,913 visits for Clinic purposes. In addition, the Health Visitors made 335 primary visits for the purpose of the Notification Register. The Tuberculosis Officer paid 66 visits to Mayday Hospital, in a consultative capacity, and there examined 234 patients. Patients requiring home nursing or surgical dressings are attended to by nurses from the Croydon Nursing Service, by arrangement with that organisation, and 680 such visits were made during the year. Their assistance is a valuable adjunct in the care of domiciliary cases. Contact Examination. 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 341 contacts were examined, equal to 249 for each 100 deaths, compared with 296 in 1937, or 191 per 100 deaths. Of these, 7 were considered to be Tuberculous. This is equal to a Tuberculous rate per 1,000 contacts of 20.5, compared with 1.36 per 1,000 of the general population. Included in the 7 contacts found to be Tuberculous are 2 who had been under observation from previous years. 642 appointments for examination were offered to new contacts during 1938, but only 341 new contacts attended and were examined. 107 The importance of contact examination as a true preventive measure is not appreciated by the public. The number of contacts examined is low, due to the impossibility; of finding time with the medical staff available. In this matter the family practitioner could be of much assistance by advising contacts to accept the facilities for examination and observation at the Clinic. SUMMARY OF CLINIC STATISTICS FOR 1938. No. of persons on Clinic Register, January 1st, 1938 874 ,, Notified Cases examined for the first time 97 ,, Cases sent for an opinion 323 ,, First attendances, including 48 transfers in 877 ,, Consultations of T.O. with medical practitioners— (a) Panel 24 (b) Other 633 ,, Visits paid by T.O. to homes of patients 160 ,, Visits paid by T.O. to Cheam Sanatorium 11 ,, Visits paid by T.O. to Mayday Hospital 66 ,, Patients examined by T.O. at Mayday Hospital 234 ,, Visits paid to homes of patients by Health Visitors 2,913 ,, Visits paid to homes of patients by District Nurses 680 ,, Attendances of patients at the Clinic— Men 1,787 Women 2,177 Children 789 Total 4,753 No. of Insured paients under Domiciliary Treaitment at end of year— Pulmonary 186 Non-Pulmonary 13 Total 199 No. of reports received from Panel Practitioners (G.P.36) 425 „ Report forms sent to Panel Practitioners (G.P.36) 678 „ Reports received from Panel Practitioners on Forms G.P.17 6 „ Reports received from Panel Practitioners on Forms G.P.35 5 „ X-rays taken 620 „ Reports made to Ministry of Pensions by the T.O. on general progress of Tuberculosis Discharged Ex-Service men 5 „ Cases referred for "Light" Treatment 7 „ Cases referred to Onthopaedic Clinic 17 „ Cases receiving extra nourishment at end of year 50 108 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 13 13 2 28 15 years and over 526 86 316 928 539 99 318 956 Number of Non-Pulmonary Cases— Under 15 years 28 24 10 62 15 years and over . 57 11 42 110 85 35 52 172 Totals 624 134 370 1,128 The above table gives a summary of the housing conditions found in notified cases. It is seen that 56.3% of the Pulmonary cases and 49.4% of the Non-Pulmonary cases were occupying a separate bedroom. In 33.2% of the Pulmonary and 30.2% of the Non-Pulmonary the sleeping arrangements were not satisfactory inasmuch as the patient did not have a separate bed. This was not always because the means to ensure this were not available. Council Houses for Tuberculous families. A scheme was initiated in 1935 for giving preference' in the allocation of Council houses to families in whom a member is a Tuberculous person. 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 29 families had been rehoused under the scheme, and all had complied with the special requirements laid down in the scheme. 109 PULMONARY TUBERCULOSIS Table XII. Shewing the Condition at the end of 1938 of cases discharged from Sanatoria during the years indicated. 1934. 1935. 1936. 1937. 1938. 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 6 59=61.4% 4 43=51.2% 4 24=39.3% 1 27=27.2% ... 6=6.8% 15 159=37.1% 65.5% 41.9 % 32.2 % 20% 4.5 % 29.5% Working or Fit for Work 13 28=29.2% 21 30=35.7% 20 21=34.4% 33 37=37.4% 42 50=56.8% 129 166=38.8% 35.0% 45.5% 47.1% 50 % 69.1 % 50.1% Not able to Work 2 9=9.3% 3 11 = 13.1% 2 16=26.2% 7 35=35.3% 3 32=36.3% 17 103=24.1% 9.7% 12.5 % 20.7% 30% 26.3% 20.4% Left District 11 25 9 27 15 16 3 19 3 38 90 32 121 37 111 41 77 44 118 45 91 199 518 110 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 50.1% 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 38.8%, or just over one third, are working or fit for work. 518, or 72.2% of the total cases discharged, were T.B. + cases; 128, or 17.8% of the total oases discharged, have removed from the Borough, and as we have no information about their condition at the end of 1938, they have been ignored in working out the above percentages. It is instructive to compare the results obtained in oases discharged from Sanatoria during the five years 1934—1938, with those for 1929—1933, and this is done in the Table below. Result. Five years, 19291933. Five years, 19341938. 19291933. 19341938. T.B. - T.B. + T.B. - T.B. + Dead 11 252=44.7% 15 159= 37.1% J 263 174 36.9% 29.5% Working or fit for work 122 144=25.6% 129 166= 38.8% 266 295 37.3% 50.1 % Not able to work 17 167=29.6% 17 103= 24.1% 184 120 23.8% 20.4% Left District 32 93 38 90 125 128 Totals 182 656 199 518 838 717 This Table shows clearly the improved results obtained during the last five years, 12.8% more patients are fit for work and the number who died during the five years decreased by 7.4%. The decreased incidence is shown in the smaller total number of cases, and the greater relative proportion of T.B. — cases appears to indicate a tendency for cases to come earlier for treatment. 111 Dental Treatment of Patients Referred from the Tuberculosis Dispensary to Lodge Road. Patients referred from the Tuberculosis Dispensary are treated at Lodge Road Treatment Centre on Wednesday afternoons from 3.30 to 5 p.m., and after the treatments are carried out the Clinics are thoroughly disinfected. The majority of treated patients are referred by the Tuberculosis Officer, but some are patients discharged from Cheam before treatment is com pleted. Summary of Work Done. Males. Females. Total. Year 1937 Referred from Dispensary 9 17 26 17 Treatment cases continued from Cheam 4 8 12 14 Attendances 64 92 156 204 Extractions 44 44 88 111 Fillings 4 20 24 30 Dressings 5 5 10 10 Scalings 5 — 5 19 Denture Dressings 39 46 85 93 Dentures fitted 10 14 24 33 "Gas" Cases (on the recommendation of Tuberculosis Officer) 4 4 8 4 No. of Sessions Treatment: 22. The amount of £1 7s. 0d. was taken in attendance fees during the year at Lodge Road. Dental Report—Cheam Sanatorium. Dental treatment for Tuberculosis patients differs from that prescribed for ordinary patients. For instance, it is inadvisable to indulge in protracted treatments at one sitting, inasmuch as these people are definitely ill and their powers of endurance considerably reduced; moreover, fatigue caused by long treatments may aggravate the patients' condition. 112 Nearly 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 dental surgery in the Sanatorium. Patients were treated only if, in the opinion of the Resident Medical Superintendent, they were sufficiently fit. Review of Work Done. Males. Females. Total. Year 1937. Nuumber examined 49 51 100 137 Referred Treatment 47 49 96 136 Treated 41 43 84 105 Attendances 215 239 454 467 Extractions 102 96 198 343 Fillings 74 114 188 151 Dressings 28 30 58 75 Scalings 31 29 60 115 Denture Dressings 25 22 47 57 Dentures fitted 6 6 12 14 Mandibular Injections 13 13 26 — Repairs to Dentures 1 1 2 — No. of Sessions Treatment 42 ... ... 43 The work accomplished at Cheam during the year has well maintained the average of previous years. An encouraging feature is that conservative measures have formed a great part of the treatment. TUBERCULOSIS AFTER-CARE COMMITTEE. During the past year the scope of the Tuberculosis After-Care Committee's work has been enlarged to meet the needs of the contact members of the tuberculous household. The problems attendant on the disease are rarely, if ever, the problems of an 113 individual: they are the problems of a whole family and must be dealt with on the broader familiar basis. The national scheme dealing with the treatment and prevention of tuberculosis takes this factor most clearly into account, and it was thought to be right and fitting that the social work on tuberculosis in Croydon should be correlated with the great medical objective—prevention. To take one instance: the provision of extra nourishment. Prolonged illness is always liable to lower the standard of living; it is not only the patient who suffers from this, every member of the family is equally affected, but it is particularly unfortunate in the case of tuberculosis where certain food values are acknowledged to play an important part in the individual's resistance to the disease. Where the patient is the wage earner of the family, the position of the contact meinlbers of the household is particularly difficult. In the majority of cases application has to be made to Public Assistance authorities for relief, meanwhile ariangements are made for the patient to have institutional treatment, the source of infection is thus temporarily removed, the house in disinfected, and now is the time to build up the resistance of the contact members of the household, and this has to be done on an income reduced to subsistence level. Particularly in those cases where young children have been in contact with a massive infection, the After-Care Committee makes grants for extra nourishment for the child contacts whilst the patient is undergoing treatment, if the family income is so small that adequate nourishment cannot otherwise be provided. During this year £251 was spent for the relief of the tuberculous patients and their families. 105 cases received assistance directly from the Committee, apart from the very large numlber referred to the Public Assistance authorities and the Unemployment Assistance Board. Bedding was supplied in 17 cases, clothing in 54 cases, extra nourishment in 26 cases. Cash grants were made in 22 cases, the majority being to enable relatives to visit the patient if he was undergoing treatment at some distance from Croydon: allowances towards rent, insurance, and the cost of removal to a Council house, if recomlmended under the Tuberculosis Scheme, comprised the remainder. Our thanks are again due to the many funds who co-operate in assisting tuberculous patients , for the help and consideration shown by the Public Assistance Committee and the Unemployment Assistance Board, the immense amount of work and good will rendered to the tuberculous ex-Service men by the British Liegion and other Army funds. 114 CHEAM SANATORIUM. The Sanatorium is situated in North Cheam and has accommodation for 93 adults patients of both sexes. The beds are allocated as follows: Men, 53; Women, 40. Table XIII. In-patients on Jan. 1st, 1938. Admitted during year 1938. Discharged during year 1938, including deaths. In on Jan. 1st, 1939. Died during year 1938. M F M F M F M F M F 54 41 70 64 70 65 54 40 4 2 No. of Artificial Pneumothorax cases begun 38 No. of Refills given 1,895 No. of X-ray Screenings 2,083 No. of Films taken 520 No. of Sputum tests 883 No. of Gas Replacements 5 Immediate Results of Treatment. Table XIY. Group. Total number of cases discharged 1938. Quiescent. Improved. No Material Improve ment. Died in institution. Average duraof stay in days. Discharged before completion of treatment. M F M F M F M F M F M F Class t.b. Minus 20 13 17 6 2 5 ... ... ... ... 190 1 2 Class T.B. Plus— Group I 3 3 2 1 1 ... ... ... ... ... 155 ... 2 Group II 19 22 ... 2 11 12 5 3 ... 1 235 3 4 Group III 14 11 ... ... 3 2 6 7 4 1 276 1 1 Observation Non t.b. 2 1 ... ... ... ... ... ... ... ... ... ... ... 58 50 19 9 17 19 11 10 4 2 856 5 9 115 At the beginning of 1938 there were 95 patients in Cheam. During the year 134 were admitted and 129 discharged, whilst 6 died, thus leaving 94 patients in at the beginning of 1939. There were 5 observation cases sent in: 3 males and 2 females. Of the 3 males 2 were not tubercular, and of the 2 females 1 was not tubercular; therefore, there were 3 observation cases 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, 15 females (see above), making total discharges: males 70, females 65. These 27 Artificial Pneumothorax cases only refer to cases discharged in 1938; those discharged in 1937 and still having refills have not been included. Surgery is gradually taking a greater part in the treatment of Pulmonary Tuberculosis, and it is becoming increasingly difficult to arrange for the admission of patients to the few institutions available for this form of treatment. The delay incurred sometimes means that when the patient is admitted he is no longer suitable for this treatment. In any plans for a new Sanatorium, it will be essential to include a hospital block, provided with a properly equipped operating theatre. It will also be necessary to appoint a visiting thoracic surgeon and an anaesthetist, so that patients can have the benefit of the most successful form of treatment known to the medical profession. 116 Annual Returns made to the Ministry of Health for the Year 1938. Table XV. (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 103 75 1 2 9 6 5 4 112 81 6 6 205 (b) Diagnosis not completed - - - - - - - - 3 6 2 - 11 (c) Non-tuberculous - - - - - - - - 86 116 34 36 272 B.—Contacts examined during year :— (a) Definitely tuberculous 1 4 1 - - 1 - 1 4 1 1 7 (b) Diagnosis not completed - - - - - - - - 2 2 1 1 6 (c) Non-tuberculous - - - - - - - - 73 124 79 52 328 C.—Cases written off the Dispensary Register as:— (a) Recovered 17 15 2 5 7 2 3 3 24 17 5 8 54 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 168 252 114 93 627 D.—Number of Cases on Dispensary Register on December 31st:- (a) Definitely tuberculous 396 315 21 17 32 49 33 19 428 364 54 36 882 (b) Diagnosis not completed - - - - - - - - 5 8 3 1 17 1. Number of cases on Dispensary Register on January 1st 874 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 72 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of' 94 Cases written off during the year as Dead (all causes) 101 5. Number of attendances at the Dispensary (including Contacts) 4,753 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 199 7. Number of consultations with medical practitioners :— 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 160 (a) Personal 24 (ft) Other 033 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3,593 10. Number of:— (a) Specimens of sputum, etc., examined 1282 (b) X-ray examinations made in connection with Dispensary work 620 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A(b) above 3 2. Number of "T.B. plus" cases on Dispensary Register on 31st December 504 (B) 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 117 Table XVI. (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 94 ... ... ... 94 Mayday Hospital, Mayday Road, Thornton Heath (In C.B. of Croydon) Beds reserved for Tuberculosis cases are used for Pulmonary or Non-Pulmonary patients, as required. 64 "Number of beds available,." means the total number of beds In the Institution used for the purpose, whether they are all occupied or not, and whether they are occupied by patients from the area of the Authority, or are leased to or used by other Authorities. Table XVII. (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 tubercuious cases admitted for observation: Adult males — 8 7 — 1 Adult females — 9 9 — Children — 2 2 — — Total — 19 18 — 1 Number of patients suffering from pulmonary tuberculosis: Adult males 78 182 128 42 90 Adult females 55 132 114 16 57 Children 9 9 12 1 5 Total 142 323 254 59 152 Number of patients suffering from non-pulmonary tuberculosis : Adult males 8 12 12 1 7 Adult females 7 13 14 2 4 Children 12 7 8 I 10 Total 27 32 34 4 21 Grand Total 169 374 306 63 174 I IS Table XVIII. (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 1 1 — 1 1 1 1 — 1 — - 4 2 1 Non-tuberculous 2 1 — 1 5 1 - 1 — — — — 3 7 1 Doubtful - - - - - - - - - - - - - - - Totals 3 2 — 2 6 2 1 1 — 1 — — 7 9 2 Table XIX. (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. Under3m'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 2 1 — 7 9 3 8 4 2 4 — 3 21 14 8 Not quiescent 2 - - 1 4 - 1 1 - - - - 4 5 - Died in Institution - - - 1 - - - - - - - - 1 - - Class T.B. plus Group I. Quiescent — — — 2 — — 1 1 — — — 3 1 — Not quiescent - - - - 1 - - - - - - - - 1 - Died in Institution - - - - - - - - - - - - - - - Class T.B. plus Group II. Quiescent — 1 — 5 2 — 4 9 — 2 2 — 11 14 — Not quiescent 7 8 11 8 15 9 5 2 - 38 27 Died in Institution 3 1 — 3 — — 1 2 — 2 2 — 9 5 - Class T.B. plus Group III. Quiescent - - - - - - - - - - - - - - - Not quiescent 1 3 - - 3 - 2 4 - 2 - - 5 10 - Died in Institution 7 1 1 3 3 — 5 2 — 4 — — 19 6 1 Totals (pulmonary) 22 15 1 33 30 3 37 32 2 19 6 3 111 83 9 119 SECTION II.—Non-Pulmonary Tuberculosis. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Grand Totals Under3m'ths but exceeding 28 days 3-6 months. 6-12 months. More than 12 months. Totals. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Bones and Joints. Quiescent - - - - - 1 1 1 — 2 3 4 3 4 5 12 Not quiescent - 1 - 1 - 1 - - - - 2 - 1 3 1 5 Died in Institution - - - - 1 - - - - - - 1 - 1 1 2 Abdominal. Quiescent — — — 1 1 — — — — — — — 1 1 — 2 Not quiescent - - - - - - - - - - - - - - - - Died in Institution - - - - - - - - - - - - - - - - Other Organs. Quiescent - - - 1 - - - - - - - - 1 - - 1 Not quiescent 1 - - 2 1 - - - - 1 - - 4 1 - 5 Died in Institution - - - - - - - - - - - - - - - - Peripheral glands. Quiescent - - - - 1 - - - - - 1 1 — 2 1 3 Not quiescent - - - - - - - - - - - - - - - - Died in Institution - 1 - - - - - - - - - - 1 — 1 Totals (non-pulmonary) 1 2 - 5 4 2 1 1 — 3 6 6 10 13 8 31 TABLE XX. PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1938 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. Condition at the time of the last record made during the year to which the return relates. Previous to 1928 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 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 lass 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 (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 (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (ClassT.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 1 Group 3 Total (Class T.B.pIus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (ClassT.B. plus) Register on December-31st.- Disease Arrested Adults M 4 5 2 - 7 1 1 1 - 2 1 1 1 - 2 2 1 1 - 2 3 - 5 2 7 3 2 5 - 7 7 4 6 - 10 8 2 3 - 5 5 2 1 - 3 1 - 4 - 4 - - - - - - - - - - Adults F 3 1 3 - 4 1 - 1 - 1 1 - - - - - - 4 - 4 - - 4 - 4 10 - 3 - 3 8 1 3 1 5 9 1 4 - 5 5 1 1 - 2 2 1 - - 1 - - - - - - - - - - Children 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 3 - - - - - - - - - - - - - - - - - - - Disease not Arrested Adults M 1 6 6 1 13 - 1 2 1 4 - 1 2 - 3 - 3 6 - 9 - 2 2 - 4 1 1 10 - 11 - 5 8 1 14 2 - 10 1 11 2 2 21 1 24 10 2 16 3 21 20 7 46 8 61 24 6 43 16 65 Adults F 1 7 9 1 17 - - 1 - 1 - - 6 - 6 — — 5 — 5 — — 7 — 7 1 1 4 1 6 2 — 7 — 7 3 — 8 — 8 8 1 14 1 16 12 1 20 3 24 13 3 28 — 31 30 3 25 14 42 Children - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9 1 - - 1 5 - 2 - 2 2 - 1 — 1 Condition not ascertained during the year 1 - 1 - 1 - - - - - - - - - - 2 - 1 - 1 - - - - - 1 - 2 - 2 1 - - - - 1 2 1 - 3 2 - - - - - 1 1 - 2 1 - 2 - 2 - - - - Total on Dispensary Register at 31st December 11 19 21 2 42 2 2 5 1 8 3 2 9 - 11 4 4 17 - 21 5 2 18 2 22 17 4 24 1 29 20 10 24 2 36 27 6 26 1 33 27 6 37 2 45 34 6 41 6 53 39 10 78 8 96 56 9 69 30 108 and reasons for removal therefrom. Discharged as Recovered Adults M 197 43 12 1 56 3 1 2 - 3 4 2 1 - 3 10 2 2 - 4 6 - 3 - 3 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Adults F 180 17 10 3 30 19 3 1 - 4 8 - - - - 11 - 1 - 1 12 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 108 1 - - 1 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 267 81 103 17 201 35 15 15 - 30 37 10 31 - 41 30 15 34 7 56 35 6 44 7 57 30 7 36 3 46 31 5 36 1 42 27 7 23 3 33 30 4 23 3 30 15 2 13 1 16 12 3 16 2 21 2 - 2 1 3 Dead Adults M 26 73 120 72 265 1 7 37 8 52 6 5 46 17 68 7 1 42 11 54 6 4 36 31 71 4 4 39 22 1 65 5 - 26 17 43 4 - 22 21 43 5 2 19 27 48 1 - 8 19 27 2 - 7 16 23 - - 4 11 15 Adults F 30 26 71 87 184 4 2 33 9 44 3 3 33 9 45 5 2 30 14 46 4 1 29 25 55 10 3 31 10 44 5 2 20 13 35 5 1 14 16 31 - - 14 19 33 1 1 9 13 23 2 — 6 13 19 - - - 4 4 Children 3 1 8 8 17 1 - - - - 1 - 1 - 1 1 - - 2 2 - - 1 - 1 2 1 1 1 3 1 - - - - - - 1 3 4 2 - - 1 1 - - - 3 3 1 - 1 1 2 1 - - - - Total written off Dispensary Register 811 242 324 188 754 65 28 88 17 133 62 20 112 26 158 71 20 109 34 163 67 11 113 63 187 54 15 107 36 158 43 8 82 31 121 36 8 60 43 111 37 6 56 50 112 17 3 30 36 69 17 3 30 32 65 3 - 6 16 22 Grand Totals 822 261 345 190 796 67 30 93 18 141 65 22 121 26 169 75 24 126 34 184 72 13 131 65 209 71 19 131 37 187 63 18 106 33 157 63 14 86 44 144 64 12 93 52 157 51 9 71 42 122 56 13 108 40 161 59 9 75 46 130 Table XXI. NON-PULMONARY TUBERCULOSIS Supplementary Annual Return showing in summary form (a.) the condition at the end of 1938 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the return relates. Previous to 1928 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 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 Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands  (a) Remaining on Dispensary Register on December 31st. Disease Arrested Adults M 1 - 1 - 2 - - - - - - - - - - - - - - - - - - - - 1 - - - 1 1 - - - 1 1 - - 1 2 1 - - - 1 2 - - 1 3 - 1 2 — 3 1 - - - F 1 - 2 - 3 - - - - - - - 1 1 2 - - - - 1 - - - 1 1 1 1 - 3 - - — — 1 1 — 3 5 - 1 2 — 3 2 2 1 2 7 i — - 2 3 — — 1 - Children 5 - - - 5 i _ - — 1 - - - - - 1 - - - 1 1 - - - 1 - - - 1 1 3 - - - 3 2 - - 3 5 2 2 - 1 5 - - - 3 3 - - - 1 1 - - - Disease not Arrested Adults M — — — — - — — — - — — — 1 — 1 — 1 — — 1 — — - — - — 2 — 2 — — — — — — — — — — — — 1 — 1 — — 1 — 1 1 — 1 — 2 5 — 3 - F 1 - 2 - 3 - - - - - - - - - - - - - - - - - - 1 - - 1 2 - - - 2 2 — 1 — 3 - — 2 — 2 — - — — — 4 — - 1 5 1 — 1 - Children - - - - - 1 - - - 1 1 - - - 1 - - - - - 1 - - - 1 - - - - - 3 - - - 3 - - - - - 2 - - - 2 - - - - - 2 - - - 2 7 2 1 1 Condition not ascertained during the year - 1 1 - 2 - 1 - - 1 - - - - - - - - - - - - - 4 - - - - 1 1 - - - - - 1 - - 1 1 - - - 1 - - - 1 1 - - 1 - 1 - - - Total on Dispensary Register at 31st December 8 1 6 - 15 2 1 - - 3 1 - 2 1 4 1 1 - - 2 3 - - - 3 3 i 3 2 9 9 - - - 9 6 2 1 7 16 6 3 5 1 15 4 2 2 7 15 8 1 4 4 17 14 2 6 3 Transferred to Pulmonary 1 — — — 1 — — — — — 1 — — 1 — 1 — — 1 — 1 — - 1 — — — — _ 1 - _ 1 1 - - - - - - - - - - - - - - - - - - - - - - - | (b) Not now on Dispensary Register and reasons for removal therefrom. Discharge as Recovered Adults id M 14 1 5 3 23 1 — — - 1 — i 1 — 2 2 1 — 3 3 1 — - 4 2 i — 2 5 - - - - - 1 1 1 1 4 - - - - - - - - - - - - - - - - - - - F 18 6 4 17 45 - - - 3 3 1 — 3 1 5 1 2 — 3 6 3 — — l 4 1 2 — 3 1 1 — 2 — 1 _ — 1 — — — 1 1 _ _ _ _ _ — _ — _ - - — - Children 53 8 7 603 671 5 - - 21 26 4 i 1 5 11 4 1 - 12 17 2 1 - 6 9 - i - 1 2 — 1 2 3 — — — — — — - — — — — — — — — — — — — — - - - l Lost sight of, or otherwise removed from Dispensary Register 30 20 16 179 245 7 1 - 6 14 6 i 5 3 15 9 - 2 5 16 3 3 2 2 10 7 i - 3 11 2 2 1 4 9 6 1 1 4 12 5 - 2 3 10 - - 1 1 2 1 - - 2 3 - - - - Dead Adults - M 7 1 5 2 15 3 1 1 - 5 1 - - - 1 - - - - - - - 1 - 1 4 - 1 - 5 2 - - - 2 - - - - - - - - - - - - - - - - - - - - - - - - F 5 1 3 2 11 1 - 2 - 3 - 1 - - 1 1 - 1 - 2 - 2 - - 2 - - - - - - 3 - - 3 1 - - 1 2 - - 1 - 1 1 - - 1 2 - - 1 - 1 - - - - Children. 6 3 3 5 17 2 2 1 2 7 1 1 2 1 — — — 1 1 — — — 1 — — — — — — — 1 — 1 — — — - Total written off Dispensary Register 133 40 43 811 1027 19 4 4 32 59 12 4 10 9 35 17 4 4 20 45 11 7 3 9 30 15 3 3 6 27 5 6 3 7 21 9 3 2 6 20 6 - 3 4 13 1 - 1 2 4 1 - 2 2 5 - - - 1 Grand Totals of (a) and(e) (excluding those transferred to Pulmonary. 141 41 49 811 1042 21 5 4 32 62 13 4 12 10 39 18 5 4 20 47 14 7 3 9 33 18 4 6 8 36 14 6 3 7 30 15 5 3 13 36 12 3 8 5 28 5 2 I 3 9 19 9 1 6 6 22 14 2 6 4 120 SECTION VI. CANCER. The facilities available in the Croydon area for the diagnosis I and treatment of cancer are the same as were given in my Report I for 1937. No special propaganda has been undertaken. Deaths from Cancer numbered 380 as compared with 421 in 11937; 421 in 1936; 321 in 1935; 371 in 1934; 374 in 1933; 341 in 1932; 342 in 1931; 339 in 1930; 330 in 1929; 327 in 1928; and 344 in 1927. Death-rate per 1,000 of the population for the previous 11 years are as follows:— 1927—1.62 (344) 1933—1.56 (374) 1928—1.54 (327) 1934—1.54 (371) 1929—1.48 (330) 1935—1.33 (321) 1930—1.52 (339) 1936—1.75 (421) 1931—1.46 (342) 1937—1.74 (421) 1932—1.44 (341) 1938—1.56 (380) Deaths From Cancer in Municipal Wards. Table I. Ward Male. Female. Total. Death-rate. Estimated Mid Male. Population. 1938. Female. Upper Norwood 9 20 29 1.73 7683 9078 Norbury 12 13 25 1.55 7356 8784 West Thornton 8 16 24 1.23 8780 10798 Densham Manor 19 20 39 2.33 7889 8875 Shornton Heath 5 20 25 1.39 8477 9547 South Norwood 16 17 33 1.88 8035 9496 Woodside 6 14 20 1.24 7606 8551 East 8 10 18 1.11 7006 9187 Addiscombe 14 16 30 1.84 7491 8844 Whitehorse Mn 15 15 30 1.78 7986 8847 road Green 14 10 24 1.39 8219 8989 Central 8 15 23 1.85 5661 6773 Vaddon 8 13 21 1.15 8739 9475 South 19 13 32 2.10 6409 8819 Addington 3 4 7 0.70 4986 5014 To Fixed abode - - - - - - Total 164 216 380 1.56 112,323 131,077 121 Table II. Deaths from Cancer Occurred at the Following Ages:— Age period. Male. Female. Total. Calculated population at this age period. Incid perl pers livii Under 25 years - - 102247 - 25 and under 35 years 5 3 8 36506 0.21 35 and under 45 years 5 8 13 38947 0.33 45 and under 65 years 57 85 142 48671 2.91 65 years and over 97 120 217 17029 12.74 164 216 380 243,400 1.56 _ Table III. Sites of Fatal Cancer. Site. Male. Female. Total. Percentage of Total. Skin 3 3 6 1.579 Tongue and Mouth 8 - 8 2.105 Tonsil 4 1 5 1.316 Oesophagus 6 3 9 2.368 Stomach 28 32 60 15.789 Liver 1 10 11 2.890 Bowel 27 36 63 16.579 Rectum 21 19 40 10.527 Bladder 2 5 7 1.842 Prostate 12 - 12 3.158 Larynx 7 2 9 2.368 Uterus 1 20 20 5.263 Breast - 51 51 13.421 Ovary - 14 14 3.684 Pancreas 7 7 14 3.684 Gall Bladder and Duct 1 3 4 1.050 Bones 2 2 4 1.050 Lungs 20 5 25 6.579 Kidneys 4 - 4 1.050 Antrum 1 1 1 0.263 Lymphatic Glands 4 1 5 1.316 Pharynx 3 - 3 0.789 Genital Organs 2 2 4 1.050 Not defined 1 - 1 0.263 164 216 380 122 Comments on Foregoing Table. The organs most often attacked in descending order of incidence are, in males the Rectum and Bowels (29.3 per cent.); the Stomach (17.1 per cent.); the Lungs (12.2 per cent.); the Prostate (7.3 per cent.); in females, the Bowels and Rectum (25.0 per cent.); the Breast (23.6 per cent.); the Stomach (14.8 per cent.); and the Uterus (9.4 per cent.). 123 SECTION VII. VENEREAL DISEASES. No changes have been made in the Scheme as given in my Report for 1930. Table I. Attendances at the Croydon Clinic during past 10 years. 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1936. 1937. 1938. New male patients 101 196 263 235 242 297 287 300 395 416 New female patients Attendances 94 171 205 241 214 232 213 188 184 257 male patients Attendances, 3581 5050 4923 4691 4578 5858 5548 7525 8610 7318 female patients 2127 3029 3271 2724 2677 3962 5977 5226 5405 5365 a Includes 325 new cases and 3632 total attendances by patients from outside areas. Attendances of Croydon Patients at various London Hospitals under the General Scheme during past 10 years. 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1936. 1937. 1938. New patients 131 125 139 119 134 103 132 107 128 133 Total attendances - 3089 3150 2384 2835 2407 2222 2006 2587 3407 3299 Of the 806 new patients in 1938, 90 had syphilis, 245 gonorrhoea, and 467 were not suffering from venereal disease. Pathological Examinations at London Hospitals for Croydon Patients during the past 10 years. 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1936. 1937. 1938 Tests for Clinics 924 715 829 900 855 968 1029 810 1313 1172 Tests for practitioners 932 2197 3198 1680 1775 1877 2221 2613 2849 3603 124 Table II. Attendances of Patients at Venereal Diseases Clinic at the Croydon General Hospital during the past 5 years. Authority. 1934. 1935. 1936. 1937. 1938. 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 56 6659 301 6675 23 6280 ... 8822 120 9051 Surrey C.C. 10 2227 63 3859 44 4631 183 4234 94 2790 Kent C.C. ... 109 ... 232 ... 470 ... 367 ... 358 ondon C.C. 6 794 ... 757 ... 1370 ... 592 ... 484 Sussex C.C. ... 31 ... 2 ... ... ... ... ... ... 72 9820 364 11525 67 12751 183 14015 214 12683 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. Syphilis. Gonorrhoea. St. Thomas's 4 14 43 1253 29 Guy's 5 11 23 1078 69 King's College 8 1 4 468 27 Great Ormond Street ... ... 6 72 ... Royal Free ... 1 2 64 ... South London Hospital for Women 1 2 3 128 18 Whitechapel Clinic (L.C.C.) ... ... ... 99 ... Seamen's ... 1 ... 1 ... Westminster 1 2 1 136 ... Total 19 32 82 3299 143 126 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 Prac. For Clinic. For Prac. For Clinic. For Prac. For Clinic. For Prac. St. Thomas's 4 248 30 129 171 - 582 Great Ormond Street - 5 2 13 1 9 - 30 South London Hospital for Women 51 6 7 6 15 4 89 Royal Free 8 4 6 - 18 King's College 8 38 2 - 48 Whitechapel Clinic, L.C.C. 24 4 7 - 35 Westminster Hospital 18 10 2 13 2 45 Guy's Hospital 2 4 187 1363 63 846 126 1342 3933 Seamen's - - - - Miller - - Total 6 4 549 1401 268 855 349 1348 4780 126 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, 1938. 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 74 100 ... ... 114 80 5 18 193 198 391 2. umber of cases removed from the register during any previous year which returned during the year under report for treatment or observation of the me infection 1 3 ... ... ... ... ... ... 1 3 4 3. Number of cases dealt with for the first time during the year under report (exclusive of cases under item 4) suffering from:— Syphilis, primary 3 2 ... ... ... ... ... ... 3 2 5 „ secondary 4 ... ... ... ... ... ... 4 4 „ latent in 1st year of infection 2 "2 ... ... ... ... ... ... 2 2 4 „ all later stages 24 12 ... ... ... ... ... ... 24 12 36 „ congenital 6 16 ... ... ... ... ... ... 6 16 22 Soft Chancre ... ... ... ... ... ... ... ... ... ... ... Gonorrhoea, 1st year of infection ... ... ... ... 159 46 ... ... 159 46 205 „ later ... ... ... ... 7 5 ... ... 7 5 12 Conditions other than venereal ... ... ... ... 211 174 211 174 385 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 7 5 ... ... 14 6 ... ... 25 11 36 Totals of Items 1, 2, 3 and 4 121 140 ... ... 294 137 ?220 192 635 469 1104 5. Number of cases discharged after completion of treatment and final tests of cure or after diagnosis as non-venereal 6 15 ... ... 151 70 202 170 359 255 614 6. Number of cases which ceased to attend before completion of treatment and were, on first attendance suffering from:— Syphilis, primary 3 1 ... ... ... ... ... ... 3 1 4 ,, secondary ... 5 ... ... ... ... ... 5 5 „ latent in 1st year of infection 2 5 ... ... ... ... ... ... 2 5 7 „ all later stages 14 13 ... ... ... ... ... v 14 13 27 ,, congenital 3 9 ... ... ... ... ... ... 3 9 12 Soft chancre ... ... ... ... ... ... ... ... ... ... Gonorrhoea, 1st year of infection ... ... ... ... 56 20 ... ... 58 20 78 later ... ... ... ... 2 ... ... ... 2 ... 2 Number of cases which ceased to attend after com pletion of treatment but before final tests of cure 3 1 ... ... 16 3 ... ... 19 4 23 7. Number of cases transferred to other centres or to institutions, or to care of private practitioners 14 12 ... ... 10 9 ... 1 24 22 46 8. Number of cases remaining under treatment or observation on 31st December 76 79 ... ... 57 35 18 21 151 135 286 Totals of Items 5, 6, 7, 8 and 9 totals should agree with those of Items I, 2, 121 140 ... ... 294 137 220 192 635 469 1104 9. Number or cases in the following stages of syphilis included in Item 6 which failed to complete one course of treatment:- syphilis, primary 2 1 ... ... ... ... ... ... 2 1 3 ,, secondary ... ... ... ... ... ... ... ... ... ... ,, latent in 1st year of infection 1 3 ... ... ... ... ... ... 1 3 ,, all later stages ... 3 ... ... ... ... ... ... ... 3 4 ,, congenital ... 5 ... ... ... ... ... ... ... 5 3 5 10. Number of attendances:(a) for individual attention of the medical officers 1339 1452 ... ... 1600 436 648 442 3587 2330 5917 (b) for intermediate treatment, e.g., irrigation, dressing ... 1 ... ... 3438 2267 293 767 3731 3035 6766 Total Attendances 1339 1453 ... ... 5038 2703 941 1209 7318 5365 12683 127  Syphilis Soft Chancre Gonorrhoea Conditions other than venereal Totals M F M F M F M F M F 12. In-Patients:— (a) Total number of persons admitted for treatment during the year 3 2 ... ... 1 ... ... ... 4 2 (b) Aggregate number of " in-patient days" of treatment given 127 67 ... ... 20 ... ... ... 147 67 I 13. Number of cases of congenital syphilis in Item 3 above classified according to age periods 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 ... ... ... ... 2 2 4 14 6 If 14. Chief preparations used in treatment of Syphilis : Approved Arsenobenzene Compounds Mercury Bismutt (a) Names of preparations Sulphostab Stabilarsan ... Bismostat Throbism (b) Total number of injections given (outpatients and in-patients) 1329 ... 1821 15. Pathological Work Microscopical Cultural for gonorrhoea Serum Others for diagnosis of for syphilis for gonorrhoea for Syphilis for Gonorrhoea (a) Number of specimens examined at and by the medical officer of the treatment centre 1 18 ... ... ... ... (6) Number of specimens from patients attending at the treatment centre sent for examination to an approved laboratory 5 873 37 W.R.758 Kahn 744 610 ... 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 Total A. Number of cases in Item 3 and 4 from each area:— Syphilis 46 22 1 2 71 Soft Chancre ... ... ... Gonorrhoea 146 51 10 10 217 Conditions other than venereal 246 94 25 20 385 Total 438 167 36 32 673 B. Total number of attendances of all patients residing in each area 9051 2790 358 484 12683 C. Aggregate number of " In-patient days" of all patients residing in each area 120 94 ... ... 214 128 The Croydon Branch of the British Social Hygiene Council, which receives a grant of £50 annually from the Borough Council towards its expenses, carried out the following programme during the year. For these details I am indebted to the Honorary Secretary, Mrs. M. L. Massey:— "The opening meeting for the public was held on October 5th at the Town Hall. The address was given by Dr. E. Sloan Chesser on the subject of " Happy Marriage." A series of three lectures was given to the Golden Circle of the Y.W.C.A. by Miss Swaisland. Another series of three lectures was given to young men at the Y.M.C.A., Horniman Hall, by Dr. Drummon Shiels and Mr. Hawkins, on " The Place of Sex in Life." Three Parents' Conferences were held in different parts of Croydon, the subject of discussion being, " What to teach Children about Sex." These were well attended and proved to be most helpful. Lastly, a public meeting was held at the Large Public Hall, addressed by Dr. Doris Odium on "Sex and Responsibility." It was attended by about 650 people. At all the lectures free literature was distributed and selected publications sold." 129 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. Notifications were received from:— Live Births. Still Births. Total Midwives 2,846 75 2,921 Doctors, Parents and others 813 30 843 Total 3,659 105 3,764 It may be noticed that in a subsequent paragraph, the number of births recorded in various places where confinements took place was 3,794. This figure included births which had to be transferred to other areas for purposes of statistics. Again, the number of live births actually registered and assigned to Croydon by the Registrar General was 3,335 and it is upon this figure the infantile and maternal mortalities are calculated and not upon the gross figure of live births notified, viz. 3,659. Maternal Mortality. There were 3 deaths directly due to pregnancy, compared with 13 in 1937. The maternal mortality rate was 0.87 per 1,000 births, compared with 3.9 in 1937. In other words one mother died for every 1,112 live babies born. The deaths directly due to pregnancy were caused by:— (a) Cardiac Failure due to Mitral Stenosis and Caesarean Section ; (b) Bacillus Coli Septicaemia following spontaneous delivery and retained placenta; (c) Acute delirum during lactation. 130 Table I. YEAR. ♦BIRTHS. Puerperal Toxaemias. Haemorrhages. Other Causes. Puerperal Infection. Eclampsia. Hyperemesis. Ectopic Gestation. Plaoenta Praevia. Post.partum Haemorrhage. Pulmonary Embolism. Caesarean Section. ! Shock. Heart Disease. Syncope. Renal Trouble. Other Causes. TOTAL. Maternal Mortality. Infant Mortality. 1920 4351 6 2 ... ... 2 ... 2 ... ... 3 1 2 18 4.1 63 1921 3631 4 2 ... ... 1 2 ... ... 2 ... 3 ... 14 3.9 74 1922 3505 8 1 ... ... 1 1 1 ... ... 2 ... 1 15 4.3 64 1923 3373 4 2 ... ... 1 ... ... 2 ... ... ... 1 10 3.0 52 1924 3456 2 1 ... ... ... 3 2 ... ... 1 ... ... 9 2.6 56 1925 3406 5 1 ... ... ... 3 2 1 ... ... 1 ... 13 3.8 55 1926 3477 13 ... ... ... 2 1 1 1 2 1 ... 3 24 6.9 61 1927 3174 5 ... ... ... 1 ... 1 ... ... ... 1 1 9 2.9 55 1928 3374 2 4 ... ... ... 1 3 ... ... ... ... 3 13 3.9 53 1929 3399 4 ... 1 1 1 2 1 ... ... ... ... 1 11 3.2 65 1930 3514 1 ... ... ... ... 2 1 ... ... ... ... 3 7 2.0 48 1931 3400 11 3 2 3 1 2 1 ... ... ... ... ... 23 6.8 57 1932 3311 2 3 ... ... ... ... ... ... 1 ... ... 1 7 2.1 49 1933 3147 5 2 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 1936 3248 5 2 ... ... 2 ... 3 ... 1 ... ... ... 13 3.9 41 1937 3263 2 ... ... ... ... ... 5 ... 1 ... 3 2 13 4.0 60 1938 3335 1 ... ... ... ... ... ... ... ... 1 ... 1 3 0.9 40 92 27 4 6 14 18 24 5 8 8 10 21 237 It has recently become the practice to give the maternal death rate per 1,000 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. 131 YEAR. BIRTHS. Live and Still. TOTAL. Deaths. Maternal Mortality. Infant Mortality 1931 3501 23 6.6 57 1932 3429 7 2.0 49 1933 3249 12 3.7 47 1934 3304 13 3.9 46 1935 3391 10 2.9 45 1936 3373 13 3.9 41 1937 3357 13 3.9 60 1938 3430 3 0.87 40 Puerperal Fever and Puerperal Pyrexia. Fifty-nine cases of Puerperal Pyrexia were notified. This is a rate of 17.2 per 1,000 births (live and still births). The designation Puerperal Fever has been dropped under the Public Health Act, 1936, and all cases of temperature of 100.4° F. or over occurring for more than 48 hours during the puerperium are now designated Puerperal Pyrexia. Table II. The following Table gives fuller details concerning theses cases. a— Mo. of cases notified 59 b— ,, ,, treated at Home 8 C— ,, ,, treated at Hospital 42 d- ,, ,, treated at Nursing Home and Hospital 3 e— ,, ,. treated at Nursing Home 5 f— ,, ,, treated at Home and Hospital 1 Accommodation for Confinement. The following Table gives information concerning the accommodation utilized for confinements. Number. Percentage. In Private Houses 1,416 37.32 In Public Institutions 1,695 44.68 Registered Maternity Homes 683 18.00 132 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 1938, and I am indebted to Dr. Sutherland, the Hon. Medical Officer of the Home, for them:— No. of beds for patients 18 No. of cases admitted 48 Average duration of stay 41/2 monts No. of cases delivered by (a) Midwives 40 (6) Doctor 5 No. of cases in which medical assistance was sought by a midwife 26 No. of cases notified as Puerperal Pyrexia No. of cases notified as Pemphigus Neonatorum No. of maternal deaths No. of infant deaths (a) Still-born 3 (b) Within 10 days of birth 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 1938, 95 still births were registered in respect of Croydon. Of these 46 were male babies and 49 female; 3 male and 7 female were illegitimate. The proportion of still births to living children was as 1 to 35. The still birth rate was 2.8 per cent, of the total births, the same as in 1937. The still birth rate, on the same basis as for Infant Mortality, was 28.5 per 1,000 births. 133 An Analysis of 83 Still Births Occurring During the Year. Of the 83 still births investigated 40 were males and 42 females, while in one case sex was not stated. STILL BIRTHS, 1938. Attended by Midwives alone 31 „ Doctors alone 8 ,, Midwives and Doctors 42 Occurred at 9 months 56 „ 8 months 18 „ 6-7 months 9 Type of Delivery In 39 cases the confinement was difficult or prolonged. Normal confinement was noted in 33 cases; no information was obtainable in 11 cases. Age of Mother Under 20 years, 2 ; between 20 and 29 years, 36 ; between 30 and 39 years, 35 ; between 40 and 49 years, 8. The Health of the Mother during her pregnancy was stated to be good in 56 cases and indifferent or poor in 21 cases; no particulars were obtained in 6 cases. In 3 cases, however, the mother had had a shock or fall before the still birth. In 51 instances the mother had attended the Ante-Natal Clinic. 32 cases had never attended the Clinic. Attendance at Confinement. Twenty-seven of the still births investigated occurred in the Mayday Hospital; 9 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; 18 were attended by a midwife alone, and in 1 case the information was not available; 10 occurred in private nursing homes, etc. Forceps were reported to have been utilised in 17 of the cases. In 56 cases the baby was born at full term ; in 16 during the 8th month of gestation; in 9 during the 7th month. The baby was apparently a normal child in 64 cases, abnormal in 9, whilst in 10 no record was available. The still birth was the first pregnancy in 43 instances; the 2nd in 14 ; the 3rd in 8; the 4th in 5 ; the 5th in 7 ; the 6th in 2; the 7th in 3, and the 8th in 1. Previous still births had occurred in 4 cases. 134 Ophthalmia Neonatorum. Twenty cases were notified during 1938. The following table gives the notifications in Croydon during the past eleven years:— Table III. No. of cases Rate per 1000 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 7 5 19 14 21 10 13 13 20 21 20 births 2.8 1.5 5.4 5.6 6 3 3.2 4.0 3.9 6.2 6.4 6.0 Results of Treatment. Table IV. Cases treated. Vision Unimpaired. Vision Impaired. Died. Removed Remaining under Treatment. Notified. At home. fn hospital 14 2 — 4 — 20 7 11 Infant Mortality, The Infantile Mortality rate was 40 per 1,000 live births registered. This is 20 per 1,000 births less than in 1937 and is the lowest yet recorded. If calculated upon the number of live births notified the rate is even lower, viz., 36.6 per 1,000. For the past 5 years the numbers of infant deaths have been: 1934, 145; 1935, 147; 1936, 134; 1937, 195; 1938, 135. 94 deaths of infants occurred in institutions, including Registered Nursing Homes. Among the 135 deaths, 71 occurred in boy babies and 64 in girls. Of the births, 1,710 were males and 1,625 females. The infantile mortality rate for the two sexes was, therefore:—Boys, 42; girls, 39. The rate of infant mortality amongst illegitimate children was 129 per 1,000. The rate in legitimate children was 36 per 1,000. 135 Neo-Natal Mortality. Number of deaths within the first month of life:— Table V. Year. No. of Deaths. No. of Births. Rate. 1929 88 3399 26/1000 live births. 1930 02 3514 23 „ „ „ 1931 88 3400 26 „ „ „ 1932 82 3311 25 „ „ „ 1933 83 3147 26 „ „ „ 1934 68 3185 21 „ „ „ 1935 83 3288 25 „ „ „ 1930 64 3248 20 „ „ „ 1937 91 3263 28 „ „ „ 1938 50 3335 17 „ „ „ The following table gives the causes of death during the first month of life:— I. Complications of Labour. Trauma at Birth 2 11. Foetal States. — i. Congenital Heart Malformation 5 Other Congenital Deformities 4 Atelectasis 14 — 23 III. Prematurity 24 — 24 IV. Post-Natal Causes 7 — 7 56 The rate of infantile mortality for England and Wales in 1938 was 53, and for the 126 large towns 57. The rate for Croydon is therefore considerably lower than the. average rate. An analysis of Table VI. shows that, of the total infant deaths, 18.5 per cent, occurred on the first day of life and 41.5 per cent, 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 (2) were concerned. 136 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. lst-2nd wk. 2nd-3rd wk. 3rd-4th wk. Under 1 mnth. 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 24 8 4 2 1 1 7 4 4 55 13 9 8 14 8 6 4 9 2 3 3 134 Uncertified 1 1 1 Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... 1 5 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 2 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... 1 ... ... ... ... 4 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... 1 4 1 ... 2 1 3 1 ... ... ... ... 14 Diarrhoea and Enteritis ... ... ... ... ... ... ... ... ... ... 1 2 4 4 4 4 ... ... 2 ... 1 1 23 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenital Malformations 2 1 1 2 ... ... ... ... 2 ... 9 4 ... 2 ... 1 ... 1 1 ... 1 ... 19 Premature Birth 13 6 1 ... ... ... ... 2 ... 2 24 ... ... ... ... ... ... ... ... ... ... ... 24 Atrophy, Atelectasis, Debility, and Marasmus 9 1 ... ... ... ... 1 3 ... ... 14 ... 1 ... 3 ... ... ... ... ... ... ... 18 Injury at birth ... ... 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 Other causes 1 ... ... ... ... ... •• 1 2 ... 5 2 1 1 1 ... ... ... 2 ... ... ... 12 187 Deaths Under One Month. An analysis of Table VI. shows that 18.5 per cent. of the infant deaths occurred before the baby was 24 hours old; 30.4 per cent. during the first week of life; and 41.5 per cent, before the end of the first month. In 1937 the corresponding figures were 23.5 per cent., 34.2 per cent., and 46.4 per cent. These figures relate to infant deaths due to causes probably operating before birth. The chief individual cause was premature birth, which was the assigned cause in 42.9 per cent of deaths under 1 month of life. In the same group can foe placed debility which was the cause of 25 per cent. Injury at birth is rather different, inasmuch as it is, by skilled ante-natal and natal attention, avoidable; injury caused 3.6 per cent, of the deaths. Deaths under one month due to congenital deformities constituted 16.1 per cent. of the whole during this age period. Deaths Under Three Months. Seventy-eight babies died during the first three months of life, a percentage of the total infant deaths of 57.8, and an infant mortality rate of 23 per 1,000 births. As the total infantile mortality rate was 40, it is seen that more than one-half 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: Diarrhoea, 6 deaths, and Pneumonia, 5 deaths. Deaths between the 4th month and the end of the first year ot life numbered 57 and were caused chiefly by Diarrhoea (28.1 per cent.) and Pneumonia (14.0 per cent.). These two conditions, year by year, figure as the most prominent causes of death at this age period. The Pneumonia deaths in all babies under 1 year occurred in the following months:—January 4, February 2, March 3, April 1, June 1, October 1, November 1, and December 1. Taking the figures in the table as a whole, the outstanding features are:— (1) The predominance of Prematurity and conditions classified as Debility and Marasmus. Between them they accounted for 31.1 cent, of the total deaths, and contributed 12.6 deaths per 1,000 births towards the infantile mortality rate. 138 (2) Next to these come Pneumonia and Diarrhoea with 27.4 per cent. of the total deaths, and contributed 12.6 deaths per 1,000 to the infantile mortality rate. (3) Congenital Deformity, inconsistent with viability beyond the first year, was responsible for 19 deaths, 14.1 per cent. of the total deaths, and contributed 5.7 per 1,000 towards the infantile mortality rate. There were five 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 40.2 per cent.; a second child in 18.6 per cent.; a third child in 11.3 per cent.; a fourth child in 14.4 per cent.; a fifth child in 6.2 per cent.; a sixth in 5.2 per cent.; an eighth in 2.1 per cent.; a ninth in 1.0 per cent., and a tenth in 1.0 per cent. The following table gives the chief causes of infant deaths, is compared with 1937:— Table VII. Percentage Deaths per Total Infantile Deaths. Deaths per 1,000 Births. 1938. 1937. 1938. 1937. Premature Births 17.8 23.5 7.2 14.1 Respiratory Diseases (Pneumonia and Bronchitis) 13.3 19.9 5.4 12.0 *Infectious Diseases (inc. Tuberculosis) 10.4 3.6 4.2 2.5 Atelectasis, Debility and Marasmus 13.3 10.7 5.4 6.4 † Diseases of Digestion 19.3 20.9 7.8 12.6 Accidental and Congenital 15.6 18.0 6.3 9.2 Analysed these deaths were due to Measles 2; Tuberculosis 5; Cerebrospinal Fever 3; Whooping Cough 1; Scarlet Fever 1; Diphtheria 1; and Erysipelas 1. Analysed these deaths were due to Diarrhoea 23; Gastritis 1; Intussusception 1; and Tonsillitis 1. 139 Maternity and Child Welfare—Deaths of Infants under one year of age. Table VIII. Births Deaths 1938 1937 1936 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 Death Kate January 283 22 42 15.2 12.8 47 13.7 16 4 56 15.4 13.7 February 258 15 58 13.9 10.6 65 15.0 12.4 50 12.5 13.7 March 370 22 59 15.9 11.7 79 13.6 12.3 44 13.4 13.6 April 300 13 43 16.1 10.0 46 16.0 11.6 30 15.7 11.8 May 285 6 21 15.3 10.6 46 16.5 10.1 52 14.5 9.2 June 405 10 25 17.4 8.8 46 17.1 10.7 28 15 2 9.8 July 277 8 29 14.9 7.9 42 14.0 6.5 32 14.5 8.3 August 302 6 20 16.2 8.9 40 17.5 8.1 15 15.2 8.3 September 324 9 28 13.9 8.2 68 12.7 9.1 13 16.5 7.7 October 285 9 32 15.3 9.0 54 14.9 8.8 41 14.7 8.9 November 354 7 20 15.2 9.7 53 13.3 10.3 43 13.6 9.0 December 236 8 34 12.8 12.3 80 12.9 15.1 55 13.7 11.5 The Birth Rate was highest in June, August, April and March, and the Infant Mortality was lowest during August and November, May and June. The Death Rate was highest in January and December. Infant Mortality was highest during March and February. 140 Infantile Mortality in Wards from 1931 to 1938. Table IX. 1931 1932 1933 1934 1935 1936 1937 1938 Average over 8 years. Upper Norwood 80 76 57 33 26 53 70 50 56 Norbury 39 27 30 37 63 19 46 15 35 West Thornton 66 75 33 59 47 58 87 36 58 Bensham Manor 72 28 19 62 32 20 35 36 38 Thornton Heath 66 69 44 42 31 62 86 64 68 South Norwood 48 32 42 52 40 47 SO 20 41 Woodside 37 30 50 66 57 68 39 49 50 East 30 68 46 30 63 40 27 38 43 Addiscomde 47 31 35 43 62 44 66 45 47 Whitehorse Manor 74 48 62 60 47 62 89 50 62 Broad Green 46 60 57 41 51 40 69 35 £0 Central 91 22 15 30 66 60 38 26 44 Waddon 53 55 63 50 54 26 25 59 48 South 63 34 91 71 56 55 58 51 60 Addington 15 36 11 59 78 The Wards with the highest average infant mortality over an eight years period are:—Whitehorse Manor, South, Thornton Heath, and West Thornton; the lowest averages are recorded in Norbury, Bensham Manor, and South Norwood. Midwives Acts, 1902 and 1918. 110 midwives notified the Local Supervising Authority of the;r intention to practise within the Borough during 1938; 32 ceased practising in the Borough ; so that 78 remained on the Register at the end of the year. All these 78 were trained and held the certificate of the Central Midwives Board.. 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. Two applications were received and payments of £6 15s. 6d. made therein. Midwives are also compensated if they lose a case through admission to a hospital or maternity home on the advice of a doctor. The sum of £19 3s. was paid out during the year. 141 Municipal Midwives. Under the Mid wives Act, 1930, a commencement was made towards a comprehensive Service of Municipal Midwivew. Ob the basis of 70 midwifery cases ami 30 maternity cases per midwife, a full complement of 15 midwives would be required for the Borough. On July 1st, 1937, the service opened with 6 midwives and a. Superintendent Midwife. From the beginning the service has proved popular with mothers, and at the end of 1938, ten municipal midwives had been appointed. Cases attended by Midwives 681 Maternity cases 94 Cases booked by Midwives, January 1st, 1938, but not yet attended 15 Gases booked by Midwives, January 31st, 1938, but not yet attended 10 Number of live births 668 (8 Macerated)—Still-births 13 Maternal deaths None Number of cases for whom medical aid sought 211 Midwives cases attended clinic 3,798 Post-natal cases 215 Number of ante-natal visits by Midwives 4,010 Reasons for sending for medical aid:— Ante-Natal Complications (36)— Threatened miscarriages 3 Ante Partum bleeding 11 Pyelitis 2 Toxaemia 18 Painful legs 2 Natal (intra) Complications—delayed 2nd stage 20 Disproportion 5 No presentations made out 2 Extended breech 2 Adherent placenta 5 142 Medical Aid for the Baby— Post Partum bleediug 1 Ruptured perineum 82 Painful logs 8 Sticky eyes 30 Asphyxia 3 Prematurity 4 Retention of urine 1 Deformed feet 1 Birth mark 1 Still-births 6 Artificial feeding 2 Prelaena Neonatorum 1 Ancocephelic (Malformation) 1 211 Confinements Attended by Midwives (Including Municipal Midwives). Cases attended by midwives alone 2,548—i.e., 67.7% of total births Cases attended by midwives when a doctor was also engaged 545 Cases attended by midwives when a doctor was also summoned 508 Total 3,601—i.e., 95.4% of total births The Rules of the Central Mid wives 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: Abortion 5 Other causes 13 Albuminuria 19 37 143 For Complications during Labour: Breech 5 Hand 1 Face 4 Occipito-Posterior 3 Extended Breech 8 Transverse 3 Head 2 Undiagnosed 9 35 Obstructed Labour 8 8 Delayed Labour— Uterine Inertia 8 Prolonged 32 Delayed 19 59 Haemorrhage— Ante-Partum 39 Post-Partum 9 48 Utlier Causes—- Adherent Placenta 9 Illness of Mother 1 6 Retained Placenta 4 Twins Torn Perineum 168 Eclampsia 1 198 For Complications during Puerperium: Pyrexia 18 Pain in Breasts 5 Pain in Legs 11 Other causes 9 Toxaemia 2 45 For Complications in regard to the Baby : Inflammation of Eyes 50 Convulsions 2 Still-birth 2 Deformities 4 Feebleness 9 Other causes 7 Premature Birth 2 76 Other Reasons 2 In accordance with Bule 12a of the Central Midwives Board, the following reasons for the discontinuance of breast feeding were received:— Illness of Mother 17 Mother returning to business life 18 Insufficient Milk 18 Inverted Nipples 6 Other causes 3 Refusal of Mother to Feed 4 -- Total 66 Inspection of Midwives. Dr. Jenkin-Lloyd, the Inspector of Midwives, interviewed 3 midwives at the Town Hall. 64 visits were paid by her to the home of midwives. Of these visits 10 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 shows some improvement. 144 Disinfection of Midwives Bags, Etc. This is done by the Local Supervising Authority, free of charge for any midwife asking for it. In 18 instances midwives availed themselves of these facilities. Table X. Nursing Homes (Registration) Act, 1927. Maternity Homes. Other Nursing Homes. Combined Maternity and other Nursing Homes. Total. No. of Homes on Register, on 31/12/37 11 27 20 58 No. of Applications for Registration during 1938 1 2 - 3 No. of Homes registered during 1938 1 2 - 3 No. of Orders made: (a) Refusing Registration — — — — (b) Cancelling Registration — — — — No. of Appeals against such Orders - - - - No. of Cases in which Orders have teen: (a) Confirmed on Appeal - - - - lb) 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 31/12/38 12 25 19 56 No. of Beds available 65 341 (a) Mat. beds CO (a) 125 (b) Other Beds 74 (b) 415 Doctors' Accounts Under Section 14 (1) of the Midwives Act, 1918. 388 accounts were received from doctors for services rendered under the provisions of this section. This compares with 284 in 1937; 268 in 1936; 243 in 1935; 172 in 1934; and 140 in 1933. The total amount of the accounts was £501 9s. 6d. £64 10s. 9d. was ultimately recovered from the patients. In 1937 the amount Paid to doctors was £372 13s. 0d., and in 1936, £406 1s. 0d. 145 THE OBSTETRIC SERVICE. The Municipal Obstetric Service in Croydon may now be described as complete, in that it provides:— (a) In-patient accommodation for all booked cases whose pregnances become abnormal, whose confinements are likely to be abnormal, or whose home conditions are such as to make delivery in Hospital advisable. First pregnancies are, as far as possible, included in this group. (b) In-patient treatment for practically all the emergency midwifery of the Borough. (c) The services of a midwife for those cases whose confinements can be safely undertaken in their own homes. These are the booked cases of the Municipal Midwifery Service, and their numbers will increase as more and more normal cases are referred to the municipal midwives for delivery at home. The pressure on the accommodation at Mayday Hospital will thereby be considerably relieved. (d) In-patient accommodation, in the Isolation Wards at the Borough Hospital, for cases of sepsis, whether drawn from the Borough Maternity Hospitals or from outside practitioners and Nursing Homes. (e) In-patient accommodation, in the Gynaecological Wards of Mayday Hospital, for those cases who are in need of post-natal treatment for any abnormality resulting from their confinements. In February, 1937, the new Maternity Block at Mayday Hospital was put into commission. It consists of 44 beds for antenatal and lying-in cases, two labour theatres with two waiting wards, and four nurseries, all contained in the main building. In addition, there is a separate isolation block of 4 single wards. The new Department has proved very easy to administer, and all the equipment has been found satisfactory. The single-bedded wards, of which there are 8, have been of great value, as they permit operation cases, such as Caesarean section, to be separately nursed, and it has been possible to isolate immediately cases of pyrexia of doubtful origin, thus eliminating the danger of crossinfection. The nurseries are spacious, airy, well lighted and adequately heated, and afford ample accommodation. 146 Since November, 1937, St. Mary's Hospital has been entirely under the clinical guidance of the Assistant Medical Officer of Health for Obstetrics and there has been a whole time resident in the hospital. 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 ili 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, 7 of the 10 deaths in 1935, 10 of the 13 deaths in 1936, 11 of the 13 deaths in 1937, and 2 of the 3 deaths in 1938. Taking the Registrar-General's figures for maternal mortality (deaths directly due to pregnancy the rate for England and Wales for 1938 is 2.97 per 1,000 births. In Croydon the rate was 0.87. In Booked cases treated by the Obstetric Service the rate for 1938 was 0.7 pe 1,000 Hospital deliveries; nil per 1,000 Home deliveries, and 0.4 per 1,000 over all deliveries. Of the case3 treated to a conclusion at the Post-Natal Clinic (luring 1938, 87.5 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 1937 was 87.0 per cent. The number of patients delivered in Mayday Hospital showed slight decrease on the total for 1937, but the strain on maternity accommodation is at times very great. The number of cases delivered of viable babies in Mayday Hospital, with a nominal 48 beds, was 921. The number delivered in St. Mary's Maternity Hospital, with 30 beds, was 490. GENERAL STATISTICS FOR 1938. Registrar General's Returns. Number of Live Births allocated to the Borough of Crovdon 3,335 Number of Still Births allocated to the Borough of Croydon 95 Total 3,430 Number of Maternal Deaths (directly due to pregnancy) 3 Number of cases notified as Puerperal Pyrexia 26 147 Statistics Prepared by the Obstetric Service. Number of Expectant Mothers who attended the Borough Antenatal Clinics,,, 2,788 Number of eases delivered in Mayday Hospital as Booked cases Number of cases delivered in Mayday Hospital as emergency cases 304 Total cases delivered in Mayday Hospital 1,133 Number of cases delivered in St. Mary's Maternity Hospital as Booked cases 490 Number of cases delivered in St. Mary's Maternity Hospital as Emergency cases 0 Total cases delivered in St. Mary's Maternity Hospital 490 Number of cases delivered by Municipal Midwives 886 Total 2,509 Number of cases admitted to the Puerperal Infection Unit, Borough Hospital and Mayday Hospital Isolation Wards, including 21 from Mayday Hospital and 9 from St. Mary's Maternity Hospital 39 Number of Maternal Deaths in Borough of Croydon 3 Number of Maternal Deaths in Booked cases from Borough Ante-natal Clinics 1 Number of Maternal Deaths in Emergency cases at Mayday Hospital 1 Number of Maternal Deaths in cases admitted as Puerperal Sepsis per se 0 Total Maternal Deaths in beds of the Obstetric Service 2 The total number of patients treated by the Obstetric Service was:— (a) In Mayday Hospital 1,414 (b) In St. Mary's Maternity Hospital 560 (c) In the Borough Hospital Puerperal Infection Unit and Mayday Hospital Isolation Wards, excluding 21 from (a) and 9 from (b) 9 (d) At the Ante-natal Clinics and delivered outside the above Hospitals (about) (including Municipal Midwives' cases) 986 (e) At the Post-natal Clinics, excluding those included in (a), (b), (c), and (d) 270 (f) At the Ante-natal Clinics and undelivered on December 31st, 1938 583 Total 3,822 148 ANTE-NATAL SUPERVISION. 1937. 1938. Number of sessions at Ante-natal Clinics held 254 283 Number of individuals who attended 2,427 2,667 Number of previous year's cases continuing attendance 549 686 Number of new cases 1,878 1,981 Number of cases undelivered on 31st December 686 583 Total attendances made 14,233 12,992 Average attendances per session 56 46 Number of cases delivered in Hospital as Booked cases 1,391 1,319 Number of cases delivered by Municipal Mid- wives 180 886 Number of cases delivered at other places under the care of private doctors or midwives (about) 350 100 Number of patients found not to be pregnant 22 20 Number of patients referred to Hospital for Antenatal treatment 393 682 The conditions for which these were admitted can be ascertained by reference to the "Booked" columns of the Numerical summary of Cases on page The accommodation at Lodge Road has been considerably increased in 1938. 6 ante-natal clinics per week are now held for cases booked for Hospital delivery, and 2 clinics per week for home delivery. A post-natal clinic for cases delivered at home has also been instituted. As far as possible, when booking cases for Hospital delivery, preference is given to primiparae, abnormalities, and those whose home conditions are considered unsuitable. Cases who are thought likely to be normal and suitable for home delivery are referred to the Superintendent Municipal Midwife, who makes the necessary arrangements for ante-natal supervision and for the delivery. In all doubtful cases, the patient is referred to the Obstetrician. I The above arrangements, and the successful inauguration of the Domiciliary Midwifery Service, have relieved the congestion in the wards of the Maternity Department, Mayday Hospital, very considerably. During 1938, the Obstetric Service dealt with 2,336 out of the 3,430 births allocated to the Borough. 149 Major Ante-Natal Conditions Treated at the Ante-Natal Clinic. Breech Presentation. Cases. Breech presentation diagnosed 212 Spontaneous version 17 External version successful 162 External version not successful 19 Allowed to go to term as Breech 14 Not recognised as Breech before labour 11 Dental Treatment. Number of cases referred to Borough Dental Surgeons 398 Number of cases referred to Private Dental Surgeons 102 Number of cases refusing dental treatment 56 Number of cases seen too late for necessary dental treatment 39 Tuberculosis. Referred from Tuberculosis Officer because of pregnancy 1 Referred to Tuberculosis Officer for opinion on lung condition 5 Venereal Disease. GONORRHOEA—Total cases 5 Transferred to Borough V.D. Clinic 5 SYPHILIS—Total cases 0 Transferred to Borough V.D. Clinic 0 These cases are delivered in Mayday Hospital in Isolation Wards, and transferred to the Borough V.D. Clinic on discharge. Midwives' Cases. Many midwives' cases were sent when pregnancy was about 36 weeks advanced for a single consultation. A somewhat larger number was supervised entirely at the ante-natal Clinic after they had made their own arrangements for delivery at home in the care of doctors or midwives. Expectant mothers who cancelled hospital bookings are included in this group. These cases may be summarised as follows:— Total number of midwives' cases during 1938 (about) 100 Number of cases sent for one consultation only 45 Number of cases supervised entirely 55 150 SPECIAL INVESTIGATIONS. Special investigations were carried out on ante-natal patients attending the clinics, and on patients in St. Mary's Maternity Hospital and Mayday Hospital Maternity Wards. Pathological Investigations. Blood for Wassermann 90 Blood for Kahn Reaction 56 Blood for Gonococcus Fixation Test 48 Blood for Grouping 44 Blood for Culture 10 Blood for Urea Content 42 Blood for Widals 7 Blood for Cell Count, etc. 66 Catheter urine for Routine Examination 489 Urine for Aschheim-Zondek Test 72 Urine for Urea Concentration Test 66 Lochia for Culture 1 Sputum for Examination 1 Pus for Identification of Organism 9 Urethral smears for Gonococci, etc 57 Cervical smears for Gonococci, etc. 7 Conjunctival smears 23 Histological sections 42 Van den Burgh 3 Throat Swabs for Organisms 7 Faeces for Occult Blood, etc. 5 Urine for Tb. 1 Blood for Sugar Estimation 1 Blood for H6 Estimation 34 Compatibility Tests 9 Cerebro-Spinal Fluid 1 Breast Milk 3 X-Ray Examinations (Mayday Hospital X-Ray Department). 188 cases were referred from Ante-natal Clinics and 363 films were used. Reasons for reference were:— Breech for attitude, etc. 62 For presentation, attitude, etc. 38 Twins 46 Foetal death 4 ,, parts 7 Disproportion 24 Others 7 116 cases were referred from the Maternity and Gynaecological Wards at Mayday and St. Mary's Hospitals and 259 films were used. Reasons for reference were:— For presentation 56 Twins and Triplets 12 For foetal parts 7 Foetal death 4 Hydramnios 1 Breech? Extended legs 14 Disproportion 20 Hydrocephalus 1 Anencephaly 1 151 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 817 490 1,307 (2) Delivered in hospital before 28th week 12 0 12 (3) Admitted after delivery 8 0 8 (4) Discharged undelivered after ante-natal treatment and not subsequently delivered in hospital 0 0 0 (5) Died undelivered 0 0 0 (6) Ectopic pregnancy 0 0 0 Totals 837 490 1,327 13.—"Emergency" patients sent into Hospital with some complications by outside doctors or midwives. No "Emergency" cases were admitted to St. Mary's Maternity Hospital. Mayday Hospital.. (1) Before labour— (a) Discharged undelivered 0 (b) Delivered in hospital after 28th week 104 (c) Delivered in hospital before 28th week 186 (d) Died undelivered 0 (2) After Delivery 9 (3) Ectopic Pregnancy 5 Total 304 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. Deliveries before 28 weeks gestation are excluded:— Mayday Hospital. Booked. Mayday Hospital. Emergency. St. Mary 's Maternity Hospital. Booked. Totals. First pregnancy 411 74 295 780 Second „ 178 25 134 337 Third „ 78 8 40 126 Fourth „ 46 4 13 63 Fifth „ 25 5 6 36 Sixth „ 15 11 2 28 Seventh „ 9 7 0 16 Eighth „ 4 6 0 10 Ninth „ 3 1 0 4 Tenth pregnancy or more.. 6 5 0 11 Totals 775 146 490 1,411 Legitimate 743 128 481 1,352 Illegitimate 32 18 9 59 152 Table XI. A Numerical Summary of cases admitted for treatment, delivered in Hospital, or admitted after delivery. Some cases appear in more than one category in the summary. Mayday Hospital Booked. Mayday Hospital Emergency St. Mary's Maternity Hospital Booked. Total. 1. Conditions chiefly Ante-Natal. Albuminuria 176 20 85 281 Eclampsia 0 2 0 2 Persistent vomiting of pregnancy 14 0 0 14 Chronic cervicitis 3 0 0 3 Acute pyelitis 11 2 12 25 Malnutrition, debility, simple anaemia, etc. 34 0 4 38 Breech presentation for version 38 0 4 42 Disproportion 59 9 30 98 Post-maturity 0 0 0 0 Retroverted gravid uterus 0 1 0 1 2. Intercurrent Diseases. Chronic nephritis 4 2 0 6 Pulmonary tuberculosis 1 0 0 1 Venereal disease 5 0 0 5 Cardiac disease 11 11 2 24 Exophthalmic goitre 1 0 0 1 3. Conditions chiefly Natal. Presentations at Delivery— Anterior positions of the vertex 775 64 444 1283 Posterior positions of the vertex 30 2 24 56 Breech 28 21 13 62 153  Mayday Hospital Booked. Mayday Hospital Emergency. St. Mary's Maternity Hospital Booked. Total. Presentations at Delivery {continued) Shoulder 2 4 2 8 Face and Brow 1 1 3 5 Complex 0 0 0 0 Caesarean section 36 9 7 52 Triplets 0 1 0 1 Twins 12 1 7 20 Accidental haemorrhage 2 3 1 6 Placenta praevia 9 12 5 26 Hydramnios 14 0 4 18 Prolapse of cord 1 1 4 6 Retained placenta 3 4 3 10 Post-partum haemorrhage 11 3 30 44 B.B.A. 6 9 0 15 Lacerated perineum 199 22 182 403 Obstructed labour 2 4 2 8 Precipitate labour 0 0 0 0 Premature labour 94 11 36 141 Abortion 12 168 0 180 Ectopic pregnancy 0 5 0 5 Abdominal Hysterotomy 0 11 0 11 4. Conditions chiefly Post-Natal excluding re-admissions from Post-Natal Clinic. Retroversion 22 2 20 44 Delayed involution 43 7 39 89 Post-partum nephritis 0 0 0 0 Breast abscess 1 0 3 4 Notified pyrexia or fever 12 9* 9 30 In addition 9 case of Puerperal Fever per se were admitted to the Puerperal Infection Unit at the Borough Hospital. * Including 4 cases of septic abortion. 154 Cardiac Disease. There were 25 cases. One mother died. Three infants were stillborn and 1 died among the 16 births, a mortality of 25 per cent. In 7 cases, Hysterotomy and Sterilization was performed at about the third month, and in 4 cases abortion was induced. Hydramnios. There were 18 cases: 14 "Booked" cases at Mayday Hospital, and 4 "Booked" cases at St. Mary's Maternity Hospital. No mother died. Three infants were still-born and one died, a mortality of 19 per cent. There were three sets of twins. Albuminuria. Every patient attending the Ante-natal Clinic has the urine tested and the blood pressure recorded at each visit. All cases of Albuminuria (confirmed by catheter specimen) or hypertension with a diastolic blood pressure of 90 or over, are admitted to hospital. The routine treatment adopted in hospital was rest, meat-free diet with a high vitamin and calcium content (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. Mayday Hospital Booked. Mayday Hospital Emergency. St. Mary's Maternity Hospital Booked. Total. Number of cases 170 24 85 279 Number of stillbirths and infant deaths 7 4 2 13 Foetal and infant mortality 4% 18% 2% 5% Number of maternal deaths nil nil nil nil Eclampsia. Mayday Hospital. Booked. Mayday Hospital. Emergency. St. Mary's Maternity Hospital. Booked. Total. Number of cases 0 2 0 2 There were no maternal deaths'. One infant was still-born, the other died. 155 Accidental Ante-Partum Haemorrhage (6 cases). Mayday Hospital. Booked. Mayday Hospital. Emergency. St. Mary's Maternity Hospital. Booked. Total. Number of cases 2 3 1 6 Number of stillbirths and infant deaths 0 2 0 2 Foetal and infant tality 0% 66% 0% 33% There were no maternal deaths. Placenta Praevia (26 cases). Mayday Hospital. Booked. Mayday Hospital. Emergency. St. Mary's Maternity Hospital. Booked. Total. Number of cases 9 12 5 26 Number of stillbirths and infant deaths 3 4 1 8 Foetal and infant mortality 33% 33% 20% 30% No mother died. Contracted Pelvis (including relative disproportion between the pelvis and foetal head). 98 cases of contracted pelvis or disproportion were treated during the year. There were no maternal deaths. In 89 "Booked" cases there were 3 infant deaths (4 per cent.). In 9 "Emergency" cases there were 2 infant deaths. 40 cases were treated by surgical induction of premature labour and 32 by Caesarean Section. 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 26 1 0 0 9 0 35 1 Forceps delivery 17 2 3 0 10 1 30 3 Embryotomy 0 0 1 1 0 0 1 1 Caesarean section 23 0 4 0 5 0 32 0 Total 66 3 8 1 24 1 98 5 156 Vertex Presentations at Delivery. The number of deliveries in which the occiput was anterior at the beginning of labour was 1,283. The number of deliveries in which the occiput was posterior at the beginning of labour was 56. Breech Delivery (62 cases). (For Ante-natal treatment of breech cases, see page). Mayday Hospital Booked. Mayday Hospital Emergency. St. Mary's Maternity Hospital Booked. Total. Number of breech deliveries 28 21 13 62 Number of stillbirths and infant deaths 7 8 4 19 Foetal and infant mortality 25% 38% 30% 30% 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 Haemorrhage, Prematurity, Monstrosity, etc. Mayday Hospital Booked Mayday Hospital Emergency. St. Mary's Maternity Hospital Booked. Total. Number of uncomplicated breech cases 18 5 2 25 Number of stillbirths and infant mortality 2 0 1 3 Foetal and infant mortality 11% 0 50% 12% Number of complicated breech cases 10 16 11 37 Number of stillbirths and infant deaths 4 8 3 15 Foetal and infant mortality 40% 50% 27% 40% 157 Face and Brow Presentations (3 cases of Face and 2 of Brow). There was one case of Face Presentation "Booked" at Mayday Hospital; one "Emergency" case of Brow Presentation at Mayday Hospital; two of Face Presentation and one of Brow Presentation among the St. Mary's Maternity Hospital "Booked" cases. No mother died. Two infants were stillborn: a mortality of 40 per cent. Shoulder Presentations (8 cases). There were 2 "Booked" cases at Mayday Hospital, four Emergencies" at Mayday Hospital, and two "Booked" cases at St. Mary's Maternity Hospital. No mother died. Five infants were stillborn: a mortality of 62 per cent. Prolapse of Cord (6 cases). At Mayday Hospital there were one "Booked" and one "Emergency" cases, and four "Booked" cases at St. Mary's Maternity Hospital. No mother died. Four infants were stillborn, a mortality of 66 per cent. Post-Partum Haemorrhage (44 cases). There were eleven cases in Mayday Hospital "Booked" cases; three in Mayday Hospital "Emergency" cases; and thirty in St. Mary's Maternity Hospital "Booked" cases. There were no maternal deaths. Abortion. The service dealt with 180 cases of Abortion during the year. All were treated at Mayday Hospital (12 "Booked" cases and 168 "Emergency"). There were no maternal deaths. Conditions for which Abortion was induced:— 101 Chronic nephritis 3 cases Cardiac disease 4 cases Pulmonary tuberculosis 1 case 158 Abdominal Hysterotomy (11 cases). All were "Emergency" cases at Mayday Hospital, and Sterilization was performed in every case. The following were the conditions for which the operation was performed. Cardiac disease 7 cases Chronic nephritis 3 cases Toxaemia 1 cases There were no deaths. Laceration of Perineum. The perineum was lacerated in 403 cases. Table XII. Place of Delivery and Category. 1st and 2nd degree. 3rd degree. Total. Mayday Hospital—Booked 199 0 199 Mayday Hospital—Emergency 21 1 22 St. Mary's Maternity Hospital—Booked 181 1 182 403 Forceps Delivery. Forceps were applied 60 times (31 Mayday Hospital "Booked," 5 Mayday Hospital "Emergency" and 24 St. Mary's Maternity Hospital "Booked" cases). There was no maternal death. In Mayday Hospital "Booked" cases 1 baby was stillborn and 1 died, an infant mortality of 6 per cent. In Mayday Hospital "Emergency" cases 1 baby was stillborn and 1 baby died, an infant mortality of 40 per cent. At St. Mary's Maternity Hospital, 3 babies were stillborn and 1 died, an infant mortality of 17 per cent. The main reasons for Forceps Deliveries were: Posterior position, 71; Delayed 2nd stage, 43; Disproportion, 5; Uterine inertia, 2; Various other causes, 3. 159 Caesarean Section. Caesarean Section was performed 52 times: 39 "Booked" and "Emergency" cases at Mayday Hospital, and 7 "Booked" cases at St. Mary's Maternity Hospital. In 32 cases the indication was contracted pelvis and disproportion, 2 pre-eclamptic toxaemia, 7 placenta praevia, 6 heart disease, 1 primary inertia (twins), 2 fibroid uterus, 2 extended breech, 3 previous caesareans. There was 1 maternal death due to severe cardiac disease. There was 1 still birth, and one baby died. Bipolar and Internal Version (8 cases). At both hospitals there were 4 "Booked" cases treated by internal version for shoulder presentation, 2 at Mayday and 2 at St. Mary's. No mother died. 3 infants were stillborn. Four "Emergency" cases at Mayday Hospital were treated for shoulder presentation. No mother died. Three babies were stillborn, a mortality of 75 per cent. Embryotomy. Embryotomy was performed once in a Mayday Hospital "Emergency" case admitted for obstructed labour, and once in a St. Mary's "Booked" case. There were no maternal deaths. Manual Removal of Placenta. Manual removal was performed 10 times. There were 3 Booked " cases and 4 "Emergency" cases at Mayday Hospital, and 3 "Booked" cases at St. Mary's Hospital. There were no maternal deaths. 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. 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." 160 Blood Transfusion (33 obstetrical and 18 gynaecological cases). The citrate method was employed, and all except one donor were supplied by the Blood Transfusion Service of the British Bed Cross Society. One Mayday "Emergency" obstetrical case and one gynaecological case died. Infants. Mayday Hospital. Booked. Mayday Hospital. Emergency. St. Mary's Maternity Hospital. Booked. Total. Per cent. Number of Infants in hospital on 1st January, 1938 41 - 26 67 - Total number of live births, still-births, and infants admitted with mother (B.B.A.) 837 116 497 1,450 - Number of Infants in hospital on 31st December, 1938 21 - 20 41 - Living—alive on discharge from hospital 798 97 478 1,373 94.7 Stillborn 23 13 13 49 . 3.4 Died (born alive, but died in hospital) 16 6 6 28 1.24 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 895 infants discharged from Mayday Hospital, 727 were up to or over birth weight (81 per cent.). Of 478 infants discharged from St. Mary's Maternity Hospital, 335 were up to or over birth weight (70 per cent.). Twins and Triplets. There were 20 cases of Twins and one of 'Triplets. There was no maternal death. Mayday Hospital. Booked. Mayday Hospital. Emergency. St. Mary's Maternity Hospital. Booked. Total. Number of cases 13 1* 7 21 Number of infants discharged alive 24 2 12 38 Number of stillbirths and infant deaths 2 1 2 5 Foetel and infant mortality 7.7% 33% 14% 11.6% Triplets. One infant died. 161 POST-NATAL AND GYNAECOLOGICAL CLINIC. In 1938, 77 per cent. of "Booked" cases delivered in the hospitals attended the Post-Natal Clinic six weeks after their confinements. This is 14 per cent. more than in 1937. Number of Sessions held 102 Number of individuals presented 1,356 Number of subsequent attendances 982 Total attendances 2,382 Average attendance per session 23.4 Number of Post-Natal cases 1,086 Number of Gynaecological cases 270 END RESULTS. 946 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 confinment (i.e., no symptoms and no anatomical or functional disability). (87.5 per cent.). 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.). (12 per cent.). 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. (0 5 per cent.). Table XIII. Mayday Hospital. St. Mary's Hospital. Totals. Result I. 484 343 827 Result II. 70 40 110 Result III. 6 3 9 Totals, treated to conclusion 560 386 946 162 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 below). Two deaths occurred of mothers dealt with by the service. 1 death occurred in an "Emergency" case, and 1 in a Booked " case. The maternal mortality of "Booked" cases, i.e., cases under the continued supervision of the service was 0.7 per 1,000 Hospital deliveries, and 0.4 per 1,000 total deliveries including the Municipal Midwives' "Booked" cases. The Registrar-General's figures for deaths directly due to pregnancy were as follows:— Total Maternal Deaths allocated to Borough of Croydon 3 Maternal Mortality 0.87 per 1,000 births. The maternal mortality rate, both for the Borough as a whole and for the obstetric service, is the lowest on record. REPORT OF THE PUERPERAL ISOLATION WARDS. 39 cases were treated in isolation for puerperal infection, 14 of them in the Borough Hospital Puerperal Infection Unit and 25 in Isolation Wards at Mayday Hospital. There were no deaths. Table XIV. SOURCES OF THE CASES: From Mayday Hospital— Cases. Deaths. "Booked" cases 12 21 0 "Emergency" cases 9 From St. Mary's Maternity Hospital 9 0 From other Hospitals 0 0 From private doctors, deliveries in nursing homes From private doctors, deliveries at home 9 0 3-5 cases followed Labour with no deaths. 4 cases followed Abortion with no deaths. 163 The 39 cases treated may be classified as follows:— Cases. Deaths. Mortality Rate. (1) Patients with infection of the genital tract 34 0 0% (a) Infection limited to uterus, vagina and perineum 29 0 0% (b) Infection involving pelvic cellular tissues, ovaries, Fallopian tubes, pelvic peritoneum or veins 2 0 0% (c) Infection of the birth canal spread beyond the pelvis (general peritonitis, septicaemia, etc.) 3 0 0% (2) Patients with infective conditions not originating in the genital tract 5 0 0% Factors Bearing on Aetiology. No. of cases with infection (genital). No. of cases with infection (non-genital). Uncomplicated labour 9 2 Long labour 1 0 Surgical induction of labour 4 1 Instrumental delivery 4 2 Spontaneous abortion 0 0 Evacuation of abortion 4 0 Manual removal of placenta 2 0 Excessive bleeding 3 0 Severe lacerations 0 0 Other interference 3 0 Caesarean Section 4 0 OBSTETRIC CONSULTATIONS. As Consulting Obstetrician to the Borough, the Assistant Medical Officer of Health for Obstetrics was called in by medical practitioners to see 47 obstetrical and 36 gynaecological patients who could not afford to pay a private consultant. In addition, he was asked by the Medical Superintendent of Mayday Hospital to give an opinion on the obstetric and gynaecological aspects of 35 cases in the medical and surgical wards of the hospital. The preceding 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. 164 MATERNITY AND CHILD WELFARE CONSULTATIONS. There are 18 Maternity and Child Welfare Centres, 17 of which are conducted by the Croydon Mothers' and Infants' Welfare Association, and 1 by the Local Authority. A total of 22 sessions per week are held and at all of these a doctor and a nurse on the staff of the Health Department attend. A new Clinic was opened at Addington during the year. During 1938, 2,692 new cases under 1 year of age, and 1,097 over a year of age attended for the first time; this is an increase of 246 in the first class and 185 in the second class. The total attendances of infants and young children from 0—5 years increased from 79,851 in 1937 to 88,168 in 1938. Consultations with doctors increased in numbers from 23,024 to 24,548. 111 expectant mothers were seen, an increase of 10 on 1937, and a total of 615 visits to the Centres were paid by them. The total of all visits to the Centres was 88,783, an increase of 8,154 compared with 1937. The highest average attendance of mothers and babies at each session was recorded at Municipal (105.5), South Croydon and St. Paul's (103.1), and Woodside (96.1). Table XV. Attendances at Infant Centres—1938. Municipal. Boston Road. St. Andrew's. South Croydon. Shirley. Woodside. Lr. Addiscombe Road. South Norwood. Westow Street. St. Alban's. St. Paul's. St. Oswald's. West Croydon. Norbury. Waddon. St. Jude's. Selhurst. Addington. ‡ Total 1938. Total 1937. Total 1936. Total 1935. I Total 1934. Infants: New cases under 1 year 404 101 109 135 148 155 243 192 105 210 183 106 74 108 81 152 79 107 2692 2446 2234 2224 2190 No. of re-attendances 6016 1433 1935 2186 1798 1937 3981 3304 1460 3631 2496 1502 1446 2070 1407 2151 1489 700 40942 38585 35866 36235 33227 New cases over 1 year 109 51 29 40 46 72 96 77 70 79 77 43 22 50 26 41 44 125 1097 912 772 857 1019 No. of re-attendances 3960 2738 2269 2683 1859 2342 3587 3551 1662 4342 2193 1978 2235 1645 2358 1759 1570 706 43437 37903 37237 39983 36403 Attendances of children 0-5 10489 4323 4342 5044 3851 4506 7907 7124 3297 8262 4949 3529 3777 3873 3872 4103 3182 1638 88168 79851 76109 79299 72839 Consultations with Doctor 2634 1213 1120 1012 871 1146 2089 2499 1071 2351 1333 1006 1223 824 1234 1123 1127 609 24548 23024 23733 23924 24721 No. of Sessions 100 50 48 49 48 47 95 98 48 97 48 49 50 49 48 48 49 29 1050 1017 1030 991 978 Expectant Mothers: No. of new cases 11 1 - 4 19 4 14 6 6 9 - 10 1 1 11 1 - 13 111 101 231 195 312 No, of re-attendances 49 45 1 6 28 9 37 120 27 28 - 23 38 5 35 - 37 16 504 587 899 657 826 Total attendances of Expectant Mothers 60 46 1 10 47 13 51 126 33 37 — 33 39 6 46 1 37 29 615 773 1130 852 1138 Total attendances 10549 4369 4343 5054 3898 4519 7958 7250 3330 8299 4949 3662 3816 3879 3918 4104 3219 1667 88783 80629 77239 80151 73977 Average attendance per Session 1938 105.5 87.4 90.5 103.1 81.2 96.1 83.8 74.0 69.4 85.6 103.1 74.7 76.3 79.2 81.6 85.5 65.7 57.5 *84.6 1937 101.6 80.1 96.5 92.6 74.7 80.5 75.5 73.9 64.7 75.9 81.9 70.4 72.3 74.6 90.5 84.4 40.3 *79.3 1936 104.6 78.2 82.2 75.2 71.5 72.4 66.2 72.3 51.9 74.6 61.2 67.2 78.3 81.6 85.6 88.9 *75.0 1935 111.7 75.9 79.0 89.5 74.9 72 9 89.9 72.3 55.3 73.8 78.7 74.4 95.6 84.3 94.0 86.4 *80.9 1934 58.0 73.3 68.0 87.0 57.4 62.2 108.0 69.5 49.8 69.0 68.8 61.5 100.4 84.6 84.3 77. 8 75.6 165 166 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 XVI. 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 97 31 66 7 62 17 11 61 36 — 3335 41 11 7 5 2,692 babies under one year of age attended the Clinics for the first time during 1938. Within the same period 3,335 babies were born and 135 died; 38 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 precisely the same periods, the attendances of new cases at the clinics do not fluctuate so greatly as to cause serious error. Of the 97 babies tabulated who died, 31 had attended a clinic in Croydon and 66 had not attended, i.e., 32 per cent. of the deaths were in clinic babies and 68 per cent. in nonclinic babies. Of the 3,335 babies born, approximately 2,692 attended on calculation based on past attendances. The infantile mortality, estimated on this basis is only 12 per 1,000 births for the clinic babies, and 103 per 1,000 births for non-clinic babies. The following table is interesting, especially when the figures for under 1 year are contrasted with those for over 1 year. Approximately 83 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, 71 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; 65 per cent. of babies under 1 year were being breast fed at their first visit, this figure being less than 1937 (66); 57.6 per cent. of the ailing babies were suffering from digestive trouble, 11.2 per cent. from respiratory trouble, and 5.5 per cent. from rickets. 167 The individual centres showing the highest percentage of babies found healthy on their first visit were Waddon (95) and East Croydon and Municipal (94). The centres showing the highest percentage of babies found ailing on their first visit were St. Andrew's and St. Oswald's, followed by Upper Norwood and Addington. Breast feeding seemed most usual in babies attending Waddon, Municipal and West Croydon Centres, and least usual in cases attending Upper Norwood and Addington Centres. In children over one year of age, attending for the first time, the highest percentages healthy were shown by St. Paul's (87), and South Norwood and East Croydon (81); the highest percentages found unhealthy were at St. Oswald's (54), St. Andrew's (50), and Holy Trinity (47). The Conditions of Babies on First Attendance at a Maternity and Child Welfare Centre, Table XVII. Babies Under One Year. Children Over One Year. No. found healthy on 1st visit. Percentage. No. found ailing on 1st visit Digestive Troubles. Rickets. Respiratory Troubles Other Causes. Babies on Breast Feeding' only. Percentage. Babies Bottle fed only. Babies partly breast and partly bottle fed. No. found healthy on 1st visit. Percentage. No. found ailing on 1st visit. Digestive Troubles. Rickets. Respiratory Troubles Other Causes. No. still on Breast at 1st visit. No. Weaned and on solid food. Percentage. No. on solid food and the Breast. No. on solid food and the bottle. Total first attendances tabulated. Muncipal (2) 350 94 22 11 0 2 9 267 72 73 32 68 78 19 4 3 6 5 0 87 100 0 0 459 St. Albans (2) 164 79 43 23 1 4 14 130 63 59 11 48 72 19 3 1 2 13 0 60 90 0 4 274 Boston Road 69 78 19 9 1 4 5 58 66 25 5 12 60 8 1 1 1 5 0 15 75 0 5 108 West Croydon 54 71 22 15 1 2 4 53 70 17 6 9 60 6 1 0 1 4 0 14 93 0 1 91 Norbury 87 82 19 7 0 2 10 57 54 19 20 13 59 9 1 0 4 4 0 18 81 0 4 128 St. Paul's 148 88 21 6 4 5 6 92 54 69 8 59 87 9 3 1 6 3 0 64 97 0 4 237 Holy Trinity 45 71 18 11 1 4 2 38 60 21 4 16 53 14 11 1 2 0 0 30 100 0 0 93 Shirley 130 88 18 13 1 0 4 96 65 40 12 19 63 11 2 4 1 4 0 30 100 0 0 178 South Croydon 102 86 17 10 0 2 5 78 66 27 14 28 72 11 0 2 2 7 0 38 97 0 1 158 South Norwood(2) 148 88 21 12 3 4 2 144 61 39 13 63 81 15 4 4 4 3 0 71 91 0 7 247 St. Andrew's 53 56 42 35 0 1 6 65 68 15 15 11 50 11 0 0 1 10 0 20 91 0 2 117 Upper Norwood 56 61 36 20 2 6 8 40 43 38 14 35 66 18 0 5 1 12 1 51 96 0 1 145 Waddon 76 95 4 0 0 0 4 60 75 16 4 15 75 5 0 2 0 3 0 20 100 0 0 100 East Croydon (2). 251 94 17 9 0 3 5 183 68 60 25 89 81 21 2 2 0 17 0 110 100 0 0 378 Woodside 123 81 28 16 4 1 7 88 58 57 6 46 70 20 5 4 3 8 0 61 92 2 3 217 St. Oswald's 58 58 42 30 1 2 9 56 56 26 18 16 46 19 3 1 3 12 0 35 100 0 0 135 St. jude's 127 85 22 15 3 3 1 99 66 45 5 25 69 11 2 3 0 6 0 36 100 0 0 185 Addington 46 63 27 11 2 4 10 34 47 23 15 108 69 48 15 7 13 12 1 113 72 3 35 229 Totals 2087 83 438 253 24 49 111 1638 65 669 227 680 71 274 57 41 50 128 2 873 92 5 67 3479 168 Table XVIII. The Work of the Health Visitors.—Maternity and Child Welfare Only. I. II. III. IV. V. VI. VII. VIII. IX. X. XI. XII. XIII. XIV. XV. XVI. XVII. XVIII. XIX. XX. XXI. XXII. XXIII. XXIV. XXV. Totals. c.w. R.A. A.W. W. M.S. A.P. A.W. J.C. E.H. A.H. K.T. V.C. C. Wa. D.S. J.A. A.O. L.W. I.E. M. W. M.B. G.R. l.o. L.B. W. W. B.D. Others cessions attended at Infant Welfare Centres 94 57 91 27 ... 94 47 46 50 7 93 48 46 61 59 42 34 50 46 50 26 8 29 10 18 1133 Visits to Expectant Mothers. First visits 42 10 47 14 1 2 3 26 ... 21 5 1 2 2 2 6 4 8 ... ... 3 5 ... ... 2 206 Re-visits 19 2 9 6 ... ... 9 36 ... 2 4 3 ... ... 9 2 1 1 1 ... 3 2 ... ... ... 109 Infants under 1 year. First visits 157 85 199 87 171 218 175 175 138 128 115 109 235 119 219 98 206 189 114 304 63 65 50 24 78 3521 Re-visits 391 203 378 168 177 290 436 951 501 406 434 352 775 317 702 262 461 482 431 288 201 236 146 49 76 9113 Children 1-2 years. First visits 10 1 1 5 2 11 14 4 3 5 8 5 5 2 3 4 6 ... ... 5 3 ... 1 ... 20 118 Re-visits 308 215 386 144 101 341 383 662 330 371 466 245 494 239 598 212 602 424 315 267 173 196 108 23 72 7675 Children 2-5 years. First visits 7 ... ... 4 1 11 4 9 1 17 2 1 5 5 2 4 ... ... ... 5 1 1 2 ... 8 90 Re-visits 918 564 634 357 249 582 325 1152 447 909 662 363 796 511 630 409 607 626 474 212 207 486 137 40 252 12549 Ophthalmia Neonatorum. First visits ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... 1 3 1 3 ... 1 ... ... ... 12 Re-visits 3 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 8 ... 1 3 ... 1 ... ... ... 18 Still Births 6 2 4 3 3 6 2 2 4 3 6 4 1 1 4 1 6 5 18 11 2 1 2 ... 4 101 Milk (Mothers and Children's Order) ... 27 1 ... ... 1 10 6 ... ... 6 9 48 1 1 ... 10 51 20 12 16 1 16 ... 12 248 Houses where deaths of Infants occurred 7 7 16 6 2 12 2 5 3 8 5 5 6 4 ... 6 8 6 2 14 ... 1 1 ... 7 133 Miscellaneous Visits 25 1 77 44 15 9 6 8 18 85 2 28 2 7 ... 14 14 2 9 17 1 53 3 ... 11 451 Ineffective Visits 484 140 396 418 229 366 412 471 417 370 704 271 489 172 392 345 573 994 502 187 506 208 83 47 285 9461 Totals—1938 2471 1314 2239 1283 951 1944 1828 3553 1912 2332 2512 1446 2904 1441 2622 1406 2541 2841 1934 1378 1205 1265 578 193 845 44938 1937 2431 1203 1834 1369 1478 2305 1796 3132 2704 1311 2514 361 1840 96 1517 3616 1624 598 1477 2690 1981 1734 1596 2191 727 44125 169 170 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 XIX. On Dec. 31st, 1937. New cases during the year. Cases discontinued. On Dec. 31st, 1938. Free 446 1,391 1,169 663 Half-price 69 194 130 88 Total 515 1,585 1,349 751 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 an increase of 236 in assisted milk cases. Assisted Fluid Milk Scheme. The amount of milk granted was '261,000 pints In 1937 it was 173,000 pints. Table XX. Supplied to Families. No. of Pints. Corporation Liability. £ s. d. Milk at 1½d. pint 29,000 181 5 0 Milk Free 232,000 3,317 18 10 261,000 £3,499 3 10 Dried Milk (Coupon) Scheme. The amount of dried milk granted free or at half-price was 14,108 packets. In 1937 it was 11,480 packets. Table XXI. No. of Packets. Corporation Liability. £ s. d. Dried Milk at Half-price 1,540 113 4 3 Dried Milk Free 12,568 951 0 10 14,108 £1,064 5 1 171 In addition, during the year dried milk was obtained from the chemists at cost price, through the Coupon Scheme. Massage Clinic. The Massage Clinic in connection with the Maternity and Child Welfare Scheme is held at 47, St. James' Road on five afternoons a week. Cases are referred thereto by the doctors at the Infant Welfare Centres. A few cases are also referred from the Orthopaedic Clinic and from London Hospitals. Table XXII. Conditions for which referred. Males. Females. Total. Hammer-toe - 1 1 Talipes 3 1 4 Weak legs 6 6 12 Bow legs 37 14 51 General debility 2 1 3 Knock-knees and flat feet 20 22 42 Hemiplegia 1 — 1 Torticollis 2 1 3 Contracted thumbs — 1 1 Infantile paralysis 2 — 2 Spastic diplegia 2 — 2 Scoliosis - 2 2 75 49 124 Total number of sessions 254 „ „ attendances 1,558 Average attendance per session 7 Cases still under treatment at end of 1938 36 The following Table summarises the work done, and indicates the type of case referred. Total number of female patients 49 „ „ male patients 75 Total 124 Dental Treatment For Maternity And Child Welfare Patients. Expectant and nursing mothers and young children requiring treatment are referred by the medical officers from the Ante-Natal, Post-Natal, and Infant Welfare Clinics. 172 With the inauguration of a Municipal Midwives Service women are also referred from this source for treatment provided they are attending an Ante-Natal Clinic. Since May the equivalent of the whole time of one dental officer has been devoted to this work. This co-operation between medical and dental staff is extremely valuable as it increases the chances of getting the necessary treatment effected during the early stages of pregnancy, thus conferring the maximum benefit upon the patient. The old prejudice against having any dental treatment during the antenatal period still exists among the less well informed. The dental staff have, on every occasion, endeavoured to correct this mistaken attitude. A large amount of attention was also given on the post-natal side, though extreme care has to be observed in treating during the early nursing period. Operative work was in most cases limited to relief of pain, small conservations, and the fitting of dentures. The visits of the dental surgeons to the Welfare Centres do much to stimulate the interest of mothers in early dental care for their children. It is now possible to make such visits at considerably shorter intervals than formerly. Younger members of the family who are brought to the Centres with the baby are often induced to submit to an inspection of their mouth, disclosing teeth which, had they had to wait until their first school inspection, would have been doomed for extraction, but with prompt treatment can be saved. The treatment of the school and pre-school child are so inseparable that one cannot be attempted without the other. As mentioned in the School Dental Report the benefit of this work is already making itself felt and will, it is hoped, in the future do much to improve the unsatisfactory conditions encountered at school inspections of the Entrants Group. The improvement effected by the appointment of the wholetime dentist for this work has been very noticeable during the year. The number of children awaiting treatment has been reduced and it has enabled mothers referred during late pregnancy to be dealt with, instead of being forced to remain untreated until after their confinement. 173 The following Table gives a summary of work accomplished, and shows a welcome rise in conservative measures, especially for pre-school children: — Expectant. Nursing. Young Children. Total. 1938. 1937. Number Examined 282 208 366 856 725 Referred for Treatment 267 185 333 785 669 Attendances 869 1363 877 3109 2470 Fillings 228 259 392 879 681 Extractions 1289 1281 1109 3679 2705 "Gas" Cases 177 203 271 651 450 Local Anaesthesia 224 231 45 500 413 Scalings 84 82 7 173 129 Dressings 171 191 70 432 259 Denture Dressings 77 699 — 776 473 Gum Treatment 17 19 2 38 34 Silver Nitrate 1 4 184 189 22 Number of Sessions (Treatment) 336 Dentures Fitted 198 Inspections at Centres 22 Appointments kept 77% Expectant Mothers. The number of expectant mothers examined during the year was 282 against 239 last year. Of these 267 were referred for treatment compared with 225 in 1937. Attendances rose from 695 to 869. The number of fillings increased from 172 to 228; this increase in conservative work is gratifying. The number of teeth extracted also increased from 871 to 1,289. This figure is regrettably large, but owing to the very septic condition prevailing in many cases the only satisfactory measure to adopt was the removal of all remaining teeth. 174 A welcome factor during recent years has been the tendency for mothers to seek dental aid during the early months of gestation. Last year 64 per cent. were operated upon during the first six months of pregnancy. This figure would undoubtedly have been greater had there been time to deal with all applications for treatment. Nursing Mothers. Nursing mothers examined at the Clinic numbered 208 as compared with 161 in 1937. Many of these were referred during the ante-natal period, but could not be sent for owing to the long waiting list for treatment at the commencement of the year. Attendances increased from 1,077 to 1,363. Fillings rose from 216 to 259 and extractions from 917 to 1,281. As in the case of the expectant mothers the removal of teeth had to be performed on a large scale; this, however, in many mouths was the only possible form of treatment to offer. Age of Baby when Mother was First Seen. 1—3 mths. 30.7 4—6 mths. 35.3 7-9 mths. 27.0 9—12 mths. 6.9 The above Table is of particular interest in connection with the percentage of mothers referred with babies of seven to nine months. This figure of 27 per cent. compared with 44.5 per cent. last year shows a fall of over 17 per cent. It will be encouraging if this lower figure can be maintained in future, provided a corresponding rise is shown in treatment during the ante-natal period. The treatment of those referred in the late nursing period is confined to the elimination of pain and sepsis. The Pre-School Child. The number of young children examined was 366 against 335 last year. These children of 2½ to 4 years of age have often ceased to attend the Infant Welfare Centres and are therefore not directly influenced to any large extent by visits paid to the Centres by the dentists. They are, as mentioned previously, seen indirectly when brought with the baby, but for the most part they remain outside the Dental Scheme until they commence attending the infant departments. The best method of gaining access to this class of child would be by asking mothers, when a dental inspection has been arranged at an Infant Welfare Centre, to bring the toddlers and any other of their children under 5 years of age. 175 Attendances of those children treated in 1938 was 877 compared with 698 last year. Great appreciation of the Service was shown by parents of those treated, and there appears to be an increasing desire for conservative measures. The number of idlings inserted rose from 293 to 392 and treatments by the silver nitrate reduction method, which plays such an important part at this age increased from 20 in 1937 to 184 last year. Extractions numbered 1,109 against 917 last year. This figure may seem high, but in many mouths where calcification is extremely poor any attempt at conservative measures is not only impossible but definitely contra-indicated. Early extraction of temporary teeth, though it may produce undesirable results, is less damaging to the general health than the retention of septic foci in the mouth at an early age. By successive future treatment much can be done to minimise any consequent irregularities. The problem of the pre-school child is a big one, but a beginning has been made, and thus much may be ultimately achieved. The Centres at which patients were examined, or from which they were referred, are given in the following list:— Ante-Natal 391 Post-Natal 7 Municipal 92 East Croydon 79 Upper Norwood 19 West Croydon 18 South Norwood 47 South Croydon 49 St. Alban's 67 Woodside 26 Norbury 41 St. Paul's 23 St. Oswald's 33 St. Andrew's 34 Waddon 17 Shirley 25 Boston Road 43 St. Jude's 35 Holy Trinity 16 Addington 9 Nursery School 3 St. George's Hall 9 The Retreat 9 Total: 1,092 The amount received for attendance fees was £80 10s. 0d. as compared with £69 13s. 4d. in 1937. 176 Convalescence Committee of the Croydon Mothers' and InfantWelfare 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. Convalescent Homes. Total number of children under 5 sent to Convalescent Homes (all with mothers) 23 Total number of weeks 51 Cost, £85 13s. 8d. Number of mothers sent for convalescence 134 Number of children under 5 sent with their mothers to cottages (this includes 8 who went to relations) 139 A grant of £500 was ma.de by the Council to the Association for this work in 1938. The year is the financial year. Children under 5 sent to Homes. Total number of weeks. Cost. Cost of other forms of Convalescence. £ s. d. £ s. d. 1934—1935 48 337 279 10 10 470 3 4 1935—1936 25 240 212 11 6 427 9 0 1936—1937 35 255 198 11 1 353 0 8 1937—(April 1st to Dec. 31st) 6 25 30 2 4 389 7 1 Home Helps. From January 1st to December 31st, 521 mothers applied for Home Helps, and all applications were supplied. £209 18s. 3d. was collected in payment for their services. At the end of the year there were 32 names' of Home Helps on the register. This service has shown a very considerable growth during the year. Babies' Help Report. I am indebted to Mrs. Philpott for the following particulars:— "At the beginning of 1938 the Babies' Help Committee had seven cases on the books: at the end of the year there were five cases. During the year fifteen mothers and babies were helped. We have had one death amongst our babies and one wedding of a mother and father. The Committee would thank the Health Visitors for their co-operation in this work." 177 Croydon Rescue and Preventive Association. This Association has a Home for Girls at 34, Morland Road. As the Council now makes a yearly financial grant of £100 towards its conduction, it is periodically inspected by the Council's officers. The Home is of the nature of a Remand Home. No babies are kept in residence as was formerly the case. The Creche, Whitehorse Road. The Council give an annual grant of £300 towards the cost of Ibis Creche. A total of 7,723 attendances was recorded. New and modern premises have been built in Whitehorse Road and were opened early in 1937. Tbwards the cost of maintenance the Council make an annual grant of £300. Ccombe Cliff Convalescent Home. The following is a summary of the cases dealt with:— Number of cases admitted during the year—187. Total number of cases discharged—192. Number of patient days—54.2 per patient (1938 cases). Table XXIII. Age groups of cases admitted. [ 0—4 5—8 9—12 Over 12 Total Male 34 51 16 1 102 Female 28 34 22 1 85 Total 62 85 38 2 187 Average length of stay in similar age groups. 0-4 5—8 9—12 Over 12 Total ( ays) Male 30.6 61.8 79.0 Nil 57.1 Female 57.6 45.5 52.0 50.0 51.3 Total 44.1 53 6 65.5 50.0 54.2 178 Condition on discharge. 0—4 5—8 9—12 Over 12 Total M. F. M. F. M. F. M. F. M. F. Improved 12 11 13 13 5 8 — — 30 32 Much Improved 12 11 31 14 6 6 — — 49 31 No change 2 2 — 2 — — 1 — 3 4 Discharged at parent's request 5 2 3 2 — 2 — — 8 6 Total 31 26 47 31 11 16 1 - 90 73 PUBLIC HEALTH ACT, 1936. PART VII. This part of the Act deals with Foster Mothers and Foster Children. The Tables below give figures for 1938:— Table XXIV. FOSTER CHILDREN. No. as at Dec. 31st 1937 Notice of Reception of Children during the year Notice of removal to— Children Adopted Died Children reaching age of 9 No. as at Dec. 31st 1938 Parent Another area with Foster Parent Another Foster Mother Public Institution 324 288 144 17 68 42 24 4 10 303 The number of foster-children showed a decrease of 21 during the year. Table XXV. FOSTER MOTHERS. No. as at December 31st 1937 Applications for Registration during the year. Removals during the year Registratior cancelled for other reasons No. as at December 31st 1938 With Child Without child 179 53 6 — 76 150 The number of foster-mothers decreased by 29 during the year. 179 Conditions are occasionally found which are not satisfactory. The chief difficulties encountered are (a) the action of some fostermothers in adopting children, or taking a child's mother into her house and so evading the Act; (b) a tendency for foster-mothers to try and look after too many children with insufficient help; (c) where a foster-mother has children of her own to ignore these in her statements as to the number of foster-children she can look after. The Public Health Act, 1936, Part VII., has not effected any improvement in the unsatisfactory state of the law relating to foster-children. It does not give adequate powers to local authorities either in their supervision of the children, or in any proceedings which can be taken against foster-mothers. The Act does not require foster-mothers to be registered with the local authority, but only to notify their intention to take a foster-child. From time to time persons are found by the Health Visitors having the care of children for gain who have never notified the fact to the local authority as is required by the Act. Ignorance is always pleaded as the excuse. Again it would seem that all foster-children are taken under emergency action because it is the exception rather than the rule to receive the 7 days' notice required in the case of foster-children taken for the first time; 48 hours or less, or even after the reception of the child, is the most usual intimation. Unsuitable persons are taking foster-children, but effective action cannot be taken under the powers conferred on local authorities. There is urgent need for the legal position to be clarified and strengthened. The Health Visitors paid 2,616 visits to foster-mothers for the purpose of supervision. 180 SECTION IX. MENTAL DEFICIENCY. The staff of the department dealing with mental defectives consists of the Medical Officer of Health and the Deputy Medical Officer and one Assistant Medical Officer, who are certifying officers; two whole-time Visitors; the Supervisor of the Occupation Centre, with three helpers. The two main administrative groups of mentally defectives were given in my 1937 report. The statutory cases group are dealt with by the Mental Deficiency Committee, and the Education cases 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 information 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— I. Statutory Cases Aged 0—5 years 1 Aged 5—16 years 168 Over 16 years 538 Total 707 II. Education Cases— Aged 7—16 years 184 Combined total 891 Compared with 1937, the Statutory cases show an increase of 29 and the Education cases an increase of 27. 181 Three of the cases under Statutory supervision have died. Two died in an Institution and one under guardianship. The Statutory cases are distributed as follows:— In Certified Institutions 143 In Places of Safety and Approved Homes 5 On Leave from Institutions 6 Under Statutory Supervision at Home 360 Under Guardianship 60 In Mental Hospitals 19 Cases under Public Assistance 20 Observation Cases 94 The Education cases were distributed as follows:— In Certified Residential Schools 20 In Certified Day Schools 136 At Private Schools 4 At Council Schools (awaiting vacancies at St. Christopher's) 18 Released for work 6 During the year the Certifying Medical Officers made examinations and paid visits to the number of 123 to Statutory cases and 288 to Education cases—a total of 411, an increase of 48 compared with 1937. The Mental Deficiency Visitors paid 2,392 visits to Statutory cases and 1,704 Education cases, 4,096 visits in all, a decrease of 375 on 1937 figures. During the year 29 names have been added to the Statutory List—13 of these being notified from the Local Education Authority, and the remaining 16 from other sources. 18 names have been removed from the list. 7 cases chargeable to other Local Authorities are under supervision in the Borough. Notified Cases. Of the 13 cases notified by the Local Education Authority- 3 are attending the Occupational Centre; 10 are at work. 182 During 1938, twenty-three Statutory cases were dealt with as follows, viz.: Sent to Certified Institutions 7 Placed under Guardianship 7 Sent to Croydon Mental Hospital 2 Transferred from the Public Assistance Committee to the Mental Deficiency Committee 4 Varying Orders— (a) Change of Guardian 1 (b) From one Institution to another 1 2 Orders Closed 1 23 28 Orders were renewed during the year—7 of which were guardianships. The number of cases sent to Certified Institutions shows an increase of 1. Guardianship Cases. There are 61 cases under Statutory guardianship—34 of these under the care of relatives, and 27 with guardians who are not relations. 8 males and 6 females are at work. 26 cases are out of the Borough; 11 under the Brighton Guardianship Society; 1 in Maidstone; 1 in Godalming; 1 in Streatham; 1 in Anerley; 1 in Essex; 1 in Suffolk; 1 in Harrow; 1 in Selsdon. 3 boys and 1 girl attend the Occupation Centre at 604, London Road. 38 of the guardianship cases are doing useful work under supervision and 23 are quite unemployable. One of the patients is under supervision for the L.C.C. 7 new cases have been placed under guardianship. 353 visits have been paid to guardianship cases during the year. Cases on Leave from Institutions. There are 5 cases on licence from institutions and 1 boy in Mayday, and 4 girls, of whom 3 are in regular work and one is at home. 183 There are 7 cases in Queen's Road Homes under a temporary licence from the Board of Control. St. Christopher's Special School. The year 1938 opened with 136 scholars on the roll. During the year 15 children were admitted, and 15 left, leaving 136 names on the Register on December 31st. Further particulars regarding the Special School are included in the School Medical Section of this report. Town Hall Clinic for Mentally Defective, Backward and Abnormal Children. 123 children were examined during 1938. The classifications arrived at, together with the recommendations made are summarised as under:— I. (a) Certified as Mentally Defectitve 52 (b) Confirmed as Mentally Defective 10 62 Recommendations— (a) Recommended for Special Day School 49 (b) Recommended for Residential School 5 (c) Referred to Occupation Centre or Institution 5 (d) Observation at home 3 II. Found to be dull and backward 45 (a) Referred to a Special Class 38 (b) Further trial in Ordinary Class 6 (c) For trial in Ordinary Elementary School 1 III. Found to be Physically Defective 10 (а) To attend S. Luke's 3 (b) To attend St. Giles 3 (c) School and treatment for epilepsy 4 IV. Referred to Child Guidance Clinic 6 V. Mental and Physical examinations at St. Christopher's School 134 Occupation Centre. The Occupation Centre is under the control of the Mental Deficiency Committee, and deals only with cases ineducable in a Special School. No. on Register, January, 1938 58 No. on Register, December, 1938 47 Sessions Open (Whole Day) 213 Total Attendance for year 8,476 Average Attendance per session 39.74 Number of children left and excluded 16 Number of children admitted or re-admitted 5 184 During the year the children attending have been divided into 4 classes—each with its separate class room teacher. Boys numbering 17 (Miss Evans). Girls I. numbering 8 (Miss Voller). Girls II. numbering 10 (Miss Stupart). Babies numbering 12 (Miss Carter). Physical work is taken by Miss Evans as a "Special Subject," throughout the three older classes. Country Dancing also with Miss Voller to assist. The Boys' Class receive training according to each child's capability as follows: — Wood-work (Beginning), making of apparatus—simple trays. Handwork—wool, canvas rugs, sea-grass stools, stitches on canvas, basketry. Physical Training—C.A.M.W Scheme. General Activity. Country Dancing. Topical Subjects—Project work. Educational Games—as individual work in elementary form. Speech Training. Sense Training. Percussion Band. Girls' Class I. (Miss Voller) numbering 8. This class is composed of older girls of the whole day centre. This class receives instruction as follows:— Project Work—Topical Talk. Picture Talk—Nature Talk. Speech Training. Educational Games. Handwork. C.A.M.W. Needlework Scheme. Simple knitting—sewing stitches. Simple rugs. General Activity. Percussion Band. Educational Apparatus. Physical Work—Country Dancing. Girls' Class II. (Miss Stupart) numbering 10. Receive instruction as Class I. and Ball—Rhythmic Games. C.A.M.W. Needlework Scheme is worked through both classes as applicable. These children are not so advanced in sewing. Babies' Class (Miss Carter) numbering 12. This class is instructed with individual apparatus—are trained in habits, etc., also. General Activity—Sewing Board; Project Work—C.A.M.W. canvas needlework scheme; same applied to hessian; Singing Cames—wool work on weaving frames; Speech Training; Plasticene; Band. 186 All classes take 10 minutes rest on rugs—pillows, also 10 minutes outside play, weather permitting. Physical work is also taken outside when possible. Alternate weekly duties are given in turns in:— Kitchen duty, Setting dinner table, Clearing same, Cleaning silver, Waiting at table, Washing mugs, Sweeping and tidying dinner room after meals. Extra free milk is given in special cases as ordered by the Medical Officer. During the year the centre provided "free dinners" to 24 children who were financially unable to pay. This number was reduced to 21 at end of year. A nurse attends to examine heads once a month. This has greatly added to make the parents more careful in this matter. A medical examination is held yearly. A Sale of Work is held in the garden in the summer—many parents are keen to buy the children's work, even paying 1s. per week through the year. During this year the sales of large rugs of 25s. and one guinea, etc., have increased. Also that of sea-grass stools. The sales during the year realised £7. A demonstration of physical work is given in the summer to parents and visitors. The children were given a party and Christmas tree with presents and a tea at which 38 children and 30 parents and visitors attended. They also partook of a Christmas dinner of turkey, Christmas pudding, etc., which was greatly enjoyed. 186 SECTION X. ORTHOPAEDIC DEPARTMENT. Cases referred for Orthopaedic 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 torn the School Report) and a Massage Clinic for children under five years, referred Medical Officers at the Welfare Centres. Table I. Summary of Cases Attending the Orthopadic Clinic. Jan. 1st, 1938. New Cases, 1938. Cases Discharged, 1938. Cases on books, Dec. 31st, 1938. M.C.W. S.M.S. Tuberc. M.C.W. S.M.S. T uberc. M.C.W. S.M.S. T uberc. M.C.W. S.M.S. T uberc 163 229 48 94 124 17 103 191 15 154 162 50 440 235 309 366 187 Table II. Cases Seen by the Orthopaedic Surgeon. Defect. School. M.C.W. Tuberculosis. Total. Cases. Visits paid. Cases. Visits paid. Cases. Visits paid. Cases. Visits paid Infantile Paralysis 18 57 6 26 ... ... 24 83 Curvature or postural defects 30 92 1 2 ... ... 31 94 Pes Cavas 4 10 2 4 ... ... 6 14 Pes Planus 115 248 27 58 ... ... 142 306 Genu Valgum 25 41 76 171 ... ... 101 212 Talipes 6 23 11 64 ... ... 17 87 Obstetrical Paralysis 1 1 3 5 ... ... 4 6 Joint Disease 17 56 1 1 38a 110a 67 221 19s 52s 1m 2m Injuries 9 15 3 4 ... ... 12 19 Rickets 2 7 17 42 ... ... 19 49 Wry Neck 3 5 3 5 ... ... 6 10 Spastic Paraplegia 13 38 6 13 ... ... 19 51 Congenital dislocation of the Hip 4 10 3 11 ... ... 7 21 Other Deformities 39 75 20 32 ... ... 59 107 286 678 179 438 58 164 523 1280 Summarised, the Table shows 286 school children attended and made 678 attendances; 179 babies made 438 attendances; and 58 tuberculosis cases made 164 attendances; a total of 523 cases, making 1,280 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. 188 Table III. Cases referred from Orthopaedic Clinic for Remedial Treatment and X-Ray at Croydon General Hospital. ts School Case M.C.W Casts Tuberculosis Cases Total Cases No. of Treatments X-Rays Cases no. of Treatments X-Rays Cases No. of Treat ments X-Rays Cases No. of Treatments X-Rays Infantile Paralysis 1 8 ... 4 159 1 ... ... ... 5 167 1 Corvature or postural defects 17 277 6 ... ... ... ... ... ... 17 277 6 Pes Planus 9 109 1 3 24 ... ... ... ... 12 133 1 Cavus 1 16 ... ... ... ... ... ... ... 1 16 ... Talipes 2 23 1 5 227 3 ... ... ... 7 260 4 Genu Valgum 1 31 1 4 58 ... ... ... ... 5 89 1 Joint Disease 9 10 9 ... ... ... 24 26 7 33 36 16 Injuries 4 5 9 1 ... 1 ... ... ... 5 5 10 Rickets 1 59 ... ... ... ... ... ... ... 1 59 ... Dorticollis 1 20 ... 3 20 ... ... ... ... 4 40 ... Spastic Paraplegia 1 9 ... ... ... ... ... ... ... 1 9 ... Congenital dislocation of the Hip 2 10 1 2 ... 3 ... ... ... 4 10 4 Other Deformities 7 20 4 5 11 4 ... ... ... 12 31 8 56 597 32 27 499 12 24 26 7 107 1122 51 Table IV. Cases Sent to Residential Institutions. of Institution School Cases M.C.W. Cases Tuberculosis Case* Total No. in on Jan. 1st. 1939. No. in on Jan. 1st, 1938 Admitted Discharged No. in on Jan. 1st, 1938. Admitted Discharged ,No. in on Jan. 1st, 1938. Admitted Discharged No. in on Jan. 1st, 1938- Admitted Discharged Coryford 3 ... 2 1 ... 1 6 ... 3 10 ... 6 4 Croydon General Hospital 1 8 8 ... 4 4 2a lA 2a 3 13 14 2 Ieritage Craft School 2 4 1 ... 1 ... 2s ... 1s 4 5 2 7 Inner 3 ... 1 ... ... ... ... ... ... 3 ... 1 2 Ford Mayor Treloar's Hospital. ... ... ... ... ... ... 1s 1s 1s 1 1 1 1 1st Children's Home, Chip- aping Norton ... 1 ... ... ... ... ... ... ... ... 1 ... 1 Ingfield Morris Hospital ... 1 ... ... ... ... ... ... ... ... 1 ... 1 Layday ... 6 4 ... 4 3 4a 2s 1 5 19 16 8 7A 8a Hospital ... ... ... ... ... ... 2s 3s 2s 10 9 9 10 8a 6a 7a Archington ... 1 ... ... ... ... ... 1 ... ... 2 ... 2 10 21 16 1 9 8 2 21 25 36 51 49 38 Table V. Conditions for which Patients were admitted to Hospitals and the results of treatments. Condition. In on Jan. 1st, 1938. Admitted Discharged Died. In on Jan. 1st, 1939. Cured. Much Improved Improved I.S.q. Infantile Paralysis ... 1 ... ... ... ... ... 1 Tubercular Joint Disease 24 18 4 9 3 2 5 19 Other Joint Disease 7 7 1 3 ... ... ... 10 Hemiplegia ... 2 ... 2 ... ... ... ... Genu Valgum ... 2 2 ... ... ... ... ... Pes Cavus 1 1 ... 1 ... ... ... 1 Talipes 1 ... 1 ... ... ... ... ... Rickets ... 2 ... ... 1 1 ... ... Other Deformities ... 3 3 ... ... ... ... ... Spastic Paraplegia 5 1 ... ... 2 1 ... 3 Scoliosis ... 1 ... ... ... ... ... 1 Injury ... 2 ... ... ... ... ... 2 38 40 11 15 6 4 5 37 189 The percentage of cures in cases discharged was 31 per cent., whilst 42 per cent. 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 this Clinic, January 1st, 1939 366 Total number actually in receipt of massage, electrical, Swedish remedial treatment on January 1st, 1939 10 New splints and appliances supplied 189 Repairs to existing appliances 34 Part cost met by parents 24% Full cost met by parents 41.5% Full cost met by local authority 34.5% Maternity and Child Welfare Massage Clinic 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. 190 SECTION XI. CROYDON AIRPORT. 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 throughout the year. 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, 1938. Arrived from Number of Arr. Planes. Seen. Paris. Amsterdam. Brussels. Elsewhere. Total: 8,852 3,477 3,531 2,376 1,160 1,785 Passengers. British. Others Inspected. Exd. 39,204 38,459 31,798 355 These figures show a decrease on last year's figures both in the number of machines arriving and in the number of passengers carired. This expeditious and safe method of travel is becoming steadily more popular. 191 SECTION XII.—MISCELLANEOUS. ULTRA-VIOLET LIGHT CLINIC. The Clinic is held at the Croydon General Hospital on four days a week under the superintendence of Dr. F. HernamanJohnson. Cases were referred from the Maternity and Child Welfare Department (101), the School Medical Service (38), and the Tuberculosis Dispensary (6). The number of cases referred has increased by 53. The following Table gives a summary of the attendances made:— Table I. Department. No. of Cases. Aggregate duration of treatment in weeks. Aggregate No. of Sessions Attended. No. of Patients discharged. No. continuing treatment end of 1938 School Medical 38 243 731 29 9 m. &. c. w. 101 662 1987 56 45 Tuberculosis 6 95 286 — 6 145 1000 3004 85 60 The Table under gives the complaints treated and the results achieved in completed cases. Eighteen ceased attending before completion of treatment, and three cases left the Borough. Table II. Condition. School Cases. M. & C. W. Cases. T.B. Cases. Total Completed Cases. Much Improved. Improved. Slight Imp. I.S.Q. Much Improved. Improved. Slight Impt. I.S.Q. Much Improved. Improved. Slight Impt. I.S.Q. Debility 2 3 — I 14 3 1 2 — — — — 26 Bronchitis 4 — — — 2 3 2 - - - - - 11 Glands — — — 1 3 1 2 1 — - — — 8 Rickets — 1 — — 2 2 — — — - — — 5 Miscellaneous 7 3 - - 1 - 1 - - 1 1 — 14 13 7 — 2 22 9 6 3 — 1 1 — 64 192  Much Improved. Improved. Slight Impr. I.S.Q. Ceased Attending. Total. Debility 16 6 1 3 9 35 Asthma — — — — 1 1 Bronchitis 6 3 2 — — 11 Glands 3 1 2 2 3 11 Rickets 2 3 — — 9 14 Miscellaneous 8 3 1 — 1 13 35 16 6 5 23 85 School Cases. Six school cases were still attending the Clinic at the end of the year. These were suffering from the following conditions, viz.:—General Debility, 1; Bronchitis, 2; Anaemia and Asthenia, 2. Maternity and Child Welfare Cases. Twenty-one 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, 7; Rickets, 11; Bronchitis, 2; Anaemia, 1. Of the School cases, 23 were boys and 15 girls; the Maternity and Child Welfare cases, 62 boys and 39 girls; and the Tuberculosis patients, 4 males and 2 females. All the cases referred to the Clinic had been carefully selected as likely to benefit; of those discharged, after completion of treatment, 56 per cent. were much improved, 26 per cent. were improved, and 18 per cent. were not benefited. These figures show that this treatment, under expert supervision of dosage, exposure, etc., is capable of assisting natural forces to bring about improvement in bodily health. Two types of lamps were used—the Mercury Vapour and the Carbon Arc; the former alone was used in 61 of the cases; the latter alone in 19 cases, and both lamps in 5 cases. The use of artificial sunlight lamps in bathrooms is fraught with considerable risk and their installation should only be made under strict supervision. 193 BLIND PERSONS ACT, 1920. A revised scheme under Section 102 (1) of the Local Government Act, 1929, came into force on April 1st, 1937. Under this scheme the Council pays grants to twelve societies, amongst which by far the largest grant is made to the Croydon Voluntary Association for the Blind. 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. I am indebted to the Secretary of the Voluntary Association for the figures below:— Number of blind on Register 403 Number of blind who benefit from instruction in Braille or Moon Type (including those who already read) 89 Number of blind who benefit from pastime instruction 51 Number in remunerative handicrafts— (a) Home workers 35 (b) In workshops 6 (c) St. Dunstan's 10 (d) Workers not included in scheme 14 Home Teacher 1 The Health Visitors paid 835 visits to blind persons during the year. The following Table 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. 194 195 M. = Males. F. = Females. T.= Total. welfare of the blind—registration. As at 31/3/39. TABLE I. 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 1 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. - - - 1 1 2 8 4 12 4 1 5 27 26 53 26 19 45 51 j 59 110 24 23 47 46 81 127 (i) 187 (i) 214 (i) 401 (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 70 and oyer Age period 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. M. F. T. 25 15 40 6 11 17 10 8 18 13 7 20 15 14 29 28 21 49 21 29 50 19 28 47 14 33 47 14 31 45 22 19 41 TABLE III.—Children of School Age, 5—16. Normal Mentally Defective Physically Defective M. F. M. F. M. F. In Schools for the Blind 8 2 - - - - Other Schools - - - - - - Not at School - - - 1 - - TABLE IV.—Training and Employment. Age Period 16 and upwards. Employed Undergoing Training. (b) Trained but unemployed (i) No training but trainable (j) Unemployable (k) Total By Blind Organisations (c) All others not included in (a) and (b) (d) Total Employed (e) Industrial (f) Secondary (g) Professional and University (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. 4 2 6 23 12 35 23 4 27 50 18 68 3 1 4 1 - 1 - - - - - - 1 - I 125 193 318 178 211 389 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 Chairseaters Clerks and Typists Coal Bag Makers Dealers. Tea Agents, Newsagents, ShopKeepers Firewood Workers Hardeners 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 Total Mattrees Makers Machinists Upholsterers Hand Machine Within Institution for the Blind - 3 - - - - - - - - - - - - - - 1 - 1 - - - - 2 1 - - 3 - - - - 1 12 In approved Home Workers Schemes - 3 - - - 1 - - - 5 - - 1 - - - 10 1 1 - 1 - - - - - - 12 - - 35 Others (not pastime workers) - - - - - 1 - - - - - - 4 - - 1 - - 1 - 1 2 2 1 2 - 1 - - 4 - - - 21 Total - 6 - - - 2 - - - 5 1 - 4 1 - 1 1 _ 12 - 2 3 2 4 3 - 1 3 - 4 12 - ' 68 TABLE YI.— Physically and Mentally Defective (including those given in Table III.) (a) Mentally Defective. (b) Physically Defective. (c) (i) Deaf (ii) Deaf-mute Combinations of (a) and (b) Combinations of (a) and (c) Combinations of (b) and (c) Combinations of (a), (b), (c) 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. 2 1 3 - 4 4 (i) 3 (1) - (1) 3 - 2 2 - - - - - - - - - 5 9 14 (ii) - (ii) 2 (ii) 2 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. - 4 4 2 1 3 8 8 16 196 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, 1938, 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. Croydon Corporation Act. 1927. 1930. General Adoptive Acts. Public Health Acts Amendment Act, 1890, Part 3 (sections 28, 29, 30, 31, 34, 35, 37 to 46, 48, 49, 50 (part). Infectious Diseases (Prevention) Act, 1890 (part repealed). Public Health Acts Amendment Act, 1907, Sections 19, 20, 21, 28, 33. Public Health Act, 1925. Sections 14, 17, 18, 19, 23 to 26 (inclusive), 28, 30, 31, 33, 35. Regulations. Regulations as to connections with sewers, 1911. ,, for securing the proper ventilation and ing of rooms to which Section 18 (1) of the Housing Act, 1925, applies and the Protection thereof against Dampness, Effluvia or Exhalation. ,, for Public Slaughterhouses, 1923. 197 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 and 1936. ,, Nuisances from Dogs, 1932. ,, Improvement Areas, 1935. Summary of Inspections made by the Sanitary Inspector:, and other Departmental Work. Total No. of Houses inspected for housing defects (under Public Health or Housing Acts) 4917 No. of houses inspected under the Housing (Consolidated Regulations) 1925 3257 No. of Houses inspected under the Rent Restriction Acts 43 No. of Houses inspected where zymotic diseases have occurred 593 House drains tested with smoke (primary) 1483 House drains tested with smoke (on application) 32 No. of smoke tests during repair 435 Inspection of drainage work during construction 3850 No. of water tests during repair 1029 Final tests of drains after repair 107 Final tests of drains when completely relaid 95 Length of new drains tesited yards 2814 Inspection of yards, stables and manure pits 525 ,, Passages 231 ,, Public Conveniences 3953 ,, Pigstyes 104 ,, Tents, Vans, and similar structures 213 198 Theatres, Cinemas, Halls, etc. 219 ,, Ponds and Ditches 94 ,, Schools and School Lavatories 93 „ Common Lodging Houses (including night visits) 26 „ Houses let in lodgings 109 ,, Premises where offensive trades are conducted 109 „ Gipsy Encampments, camps, etc. 140 ,, Cesspools 211 „ Pail closets, privies 155 ,, Gathering grounds 386 Smoke Observations 105 No. of Visits re Infectious Diseases 1984 nspections of Shops (under Shops Acts) 4178 Special Early Closing Patrols 65 Sunday Patrols 146 Special Evening Patrols under Shop Hours Act 283 nspections under Fertilisers and Feeding Stuffs Act 17 ,, under Pharmacy and Poisons Act 79 ,, Dairies 190 ,, Farms and Cowsheds 168 ,, Milkshops 472 ,, Premises where food is prepared or sold 6630 „ Slaughterhouses 696 ,, Factories with mechanical power 863 „ Factories without mechanical power 753 ,, Other Premises, Factories Act 104 ,, Outworkers Premises 268 Baths Inspections 16O Open Air Swimming Pool samples 18 water Samples examined 102 visits to Employers of Outworkers 15 Reinspections of Work in Progress 31971 iundry Inspections and Visits 6932 Appointments kept with Owners, Builders, etc. 3238 Complaints from public investigated (for purposes other than inspection of House) 4565 Examination of Building Plans 190 Informal Notices outstanding 31/12/37 3141 „ ,, served 10766 ,, ,, complied 10171 No. of Informal Notices referred for Statutory Orders 801 nformal Notices outstanding 2935 Statutory Notices outstanding 31/12/37 160 ,, ,, served 524 ,, ,, complied 528 Total number of complaints received 3480 Interviews with callers 4034 Letters received 6628 Letters and other intimations, etc., sent (not including notices) 6602 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1938 and for which action was taken to enforce compliance:— 1) NUISANCES AND HOUSING DEFECTS AT HOUSES, Etc. Insufficient means of ventilation — Defective windows and sashcords 2041 Want of windows or ventilators. 44 199 Conditions causing dampness— Defective roofs 1342 „ gutters and downspouts 727 „ walls, etc. 355 Deposits of refuse causing dampness 10 Want of proper damp proof course 425 Other structural defects— Defective plaster 1276 Cleansing and limewashing required 2019 Defective floors 639 Insufficient ventilation under floor 28 Defective stoves and fireplaces 470 No concrete site under floors 23 Defective brickwork, cills, lintels, etc. 489 Defective drains, sanitary fittings, etc.— Defective sinks and waste pipes 674 Abolition of drinking water cisterns 31 Defective w.c.'s 769 ,, drainage 622 Stoppage in drains 151 Proper sanitary accommodation required on building sites 26 Cesspools requiring emptying 2 Dirty pail closets 1 Replacement of earth closet with w.c. 1 Domestic nuisances— Want of cleanliness 16 Dirty w.c. pans 22 Other nuisances and infringements— Removal of caravans 1 Sheds occupied for living purposes 2 Offensive accumulations 159 Insufficient accommodation for sub-tenants 4 Defective manure receptacles 9 Want of manure receptacles 4 Defective sanitary conveniences 24 Dirty sanitary conveniences 20 Smoke nuisances 10 Sundry nuisances or defects 439 Limewashing of stables 21 Defective stables 11 Particulars not inserted in Rent Book (Housing Act) 903 ,, ,, ,, ,, (Rent Restriction Act) 283 (2) FACTORIES, WORKSHOPS & WORKPLACES— Cleansing and whitewashing required 120 Additional ventilation 5 Repairs to floors 6 Drainage of floors 1 Overcrowding 1 Ventilation of stoves 22 Infringements of drinking water supply regulations 17 Sundry other nuisances or defects 19 Abstract not exhibited 15 Outworkers' List not in accordance with Act 3 Means of heating required 2 Thermometer required in workrooms 6 200 W.c. 's— Insufficiently screened 6 Insufficient 12 Defective and not kept clean 148 Not separate for sexes 1 Want of intervening ventilated space 4 (3) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924— Food cupboards defective or required 245 Dustbins required 717 Verminous conditions 165 (4) INFRINGEMENTS OF PUBLIC HEALTH ACT, 1925 (S.72—75) AND INFRINGEMENTS OF FOOD BYELAWS— Cleansing or repair of walls and ceilings 158 ,, ,, repairs of floors, utensils, fixtures, etc. 86 Dirty or defective w.c. accommodation 81 Food storage accommodation required 3 Animals kept in food store 3 Refuse bins uncovered 16 Accumulation in food store and yards adjacent 76 Food in uncovered vehicles or baskets 5 Food improperly kept or manufactured 33 Premises not suitable for storage or manufacture of food 8 Want of provision of towels 4 Provision of cloak room accommodation 21 Illegal wrapping of food 2 Household washing in food store 1 Want of ventilation in food store 18 ,, intervening ventilated space to w.c. 5 ,, additional w.c. accommodation 2 Drain inlets in food stores. 3 Offal bin required 1 Insufficient or defective sink accommodation and water supply 21 Defective sanitary fittings 2 Overalls required 2 (5) INFRINGEMENTS OF PUBLIC HEALTH ACT: PAVING, Etc. Defective yard paving 488 Rainwater pipe used as ventilation pipe 1 (6) INFRINGEMENTS OF SHOPS ACTS— Insufficient lighting to w.c. 134 Insufficient or defective w.c. accommodation 59 Reasonable temperature required 42 Provision of means of heating 31 Unsuitable or insufficient washing facilities 33 Insufficient ventilation in shop 1 Insufficient accommodation for assistants' meals 4 Seating accommodation required for females Meal times incorrect 3 Assistants Weekly Half-Holiday Notices required, etc. 199 Mixed Shop Notices required 128 No compensatory holiday in lieu of Sunday employment 2 Infringements after general closing hour 23 Infringement of Sunday trading 25 Young persons hours of employment infringed 17 Hours of employment forms not exhibited or incorrect 630 201 (7) INFRINGEMENTS OF COMMON LODGING HOUSE BYELAWS — (8) INFRINGEMENTS OF HOUSES LET IN LODGINGS BYELAWS— Additional ventilation required 1 Defective w.c. accommodation 2 Additional cooking and sink accommodation 4 Want of food storage accommodation 2 ,, artificial lighting to common staircase 2 Cleansing required 12 Defective windows and sashcords 8 Provision of dustbins 6 Verminous conditions 2 Want of domestic cleanliness 1 (9) INFRINGEMENTS OF OFFENSIVE TRADE BYELAWS— Fishfrying premises— Limewashing required 1 Other premises— Sorting of rags in passage 1 Dirty or defective w.c. accommodation 2 Cleansing and whitewashing required 13 Want of intervening ventilated space 1 Dirty or defective yard paving 1 Defective floors 2 (10) INSPECTION OF AMUSEMENT HOUSES— Defective sanitary fittings 2 W.c. defective 8 W.c. required cleansing 5 Notices to be fixed to door of lavatories 2 Dirtv walls and ceiling in dressing room 1 Ventilation required in dressing room 1 (11) KEEPING OF ANIMALS— Nuisances in connection with the keeping of pigs 4 Nuisances arising from the keeping of other animals 13 (12) INSPECTION OF WATERCOURSES, etc.— Cleansing of watercourses and ponds — (13) INFRINGEMENTS OF PHARMACY & POISONS, &c., ACT— Article not labelled in accordance with the Act (14) INFRINGEMENTS OF FERTILISERS & FEEDING STUFFS ACT, Sec. 1 (1) (11) — (15) INFRINGEMENTS OF RATS & MICE DESTRUCTION ACT— Infestation of rats on premises where food is prepared or sold 11 Accumulations of refuse, etc., harbouring rats 87 Defective drainage 16 Structural defects allowing ingress of rats in welling houses 28 Dilapidated sheds, etc., harbouring rats 14 Rats in business premises 12 202 (16) INFRINGEMENTS OF MERCHANDISE MARKS ACT & AGRICULTURAL PRODUCE & MARKING ACT— Apples not marked 38 Tomatoes „ 34 Eggs „ 1 Butter „ 4 Currants ,, 4 Sultanas ,, 4 Meat ,, 15 Honey ,, 1 (17) INSPECTION OF SCHOOL LAVATORIES— Dirty w.c. accommodation 3 Defective sanitary fittings 1 Defective drains 2 Defective w.c.'s 7 (18) INFRINGEMENTS OF OTHER BYELAWS— Washing down shop fronts 1 Noisy animals 10 Noisy instruments 2 Milk bottles on public highway 2 Foul water flowing over footpath 5 (19) INFRINGEMENTS OF PUBLIC HEALTH (MEAT) REGULATIONS— Carrying meat by meat porter without head covering 1 Meat placed on floor 1 Transport of uncovered meat 1 ,20) INFRINGEMENTS OF FOOD AND DRUGS (ADULTERATION) ACT, 1928— Margarine not marked 12 (21) INFRINGEMENTS OF MILK AND DAIRIES REGULATIONS, etc.— Cleansing of cows' flanks required 1 Defective sanitary fittings 2 Additional ventilation required 1 Offensive accumulations 3 Milk pail without proper lid 1 Dirty milk churn 1 Dirty bottle crate 1 Cleansing of walls and floors required 3 Defective farm yard paving 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. Daring 1938 requests were made in connection with 32 houses. 203 The following defects were ascertained in consequence of these inspections :— Defective downspout 1 ,, drains 11 ,, sanitary fittings 6 ,, w.c.'s 1 Defective roof 1 Rent Restriction Acts. A number of applications were received for certificates as to the condition of repair of the houses concerned In 16 instances where the Acts applied certificates were granted. In 4 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. A revised estimate now brings this total to 274. Up to the end of 1938, 171 houses had been approved for demolition, and demolition orders had been made; 135 houses had been actually demolished, the tenants being re-housed, when they desired, by the Council; 607 persons were displaced. In addition, 80 closing orders have been made and 56 parts of houses closed for human habtiation, 148 persons being displaced. The following tables give particulars as to Housing during 1938 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) 4,917 (b) Number of inspections made for the purpose 4,917 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 3,257 (b) Number of inspections made for the purpose 3,257 (3) Number of dwelling-houses found to be in a state so gerous or injurious to health as to be unfit for human habitation 34 (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 habitaion 2,974 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 2,708 204 3.— Action under Statutory Powers during the Year:— A. Proceedings under sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 373 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners †232 (b) By local authority in default of owners 19 B. Proceedings under Public Health Acts: — (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 7 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 4 (b) By local authority in default of owners — C. Proceedings under sections 11 and 13 of the Housing Act. 1936:— (1) Number of dwelling houses in respect of which Demolition Orders were made 34 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 23 D. Proceedings under Section 12 of the Housing Act, 1936: — (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 52 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — + Not including 118 houses concerning which notices were served prior to 1938. OVERCROWDING. Housing Act, 1936— Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 301 (ii) Number of families dwelling therein 301 (iii) Number of persons dwelling therein 1,905 (b) Number of new cases of overcrowding reported during the year 53 (c) (i) Number of cases of overcrowding relieved during the year 118 (ii) Number of persons concerned in such cases 649 (d) Particulars of any cases in which dwelling houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil 205 FACTORIES ACT, 1937. The new Factories Act came into force on July 1st, 1938. This caused considerable alterations of an additional character in regard to the work. The word "workshop" has now been left out and all places where persons are employed are now factories. Table I. FACTORIES. 1. Inspections. Premises. Number ot Inspections. Written Notices. Prosecutions. FACTORIES (with mechanical power) 863 209 ... FACTORIES (without mechlanioal power) 753 146 ... Other premises under the Act 104 26 ... Total 1,720 381 ... Table II. 2. Defects Found. Particulars. No of Defects. Referred to H.M. Inspector. Prosecutions. Found. Remedied. Want of Cleanliness 120 94 ... ... Overcrowding 1 1 ... ... Unreasonble Temperature 2 2 ... ... Inadequate Ventilation 5 5 ... ... Ineffective Drainage of Floors 1 1 ... ... Sanitary Converiences Insufficient 12 11 ... ... Unsuitable or Defective 158 156 ... ... Not separate for sexes 1 1 ... ... Other offences— (not including offences relating to homework or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops transfer of Powers Order, 1921) and re-enacted in the Third Schedule to the Factories Act, 1937), 88 73 ... ... Total 388 344 ... ... 206 3. List of Registered Workshops (Up to 1st July, 1938). Trades. Totals. Bakers and Confectioners 124 Banana Importers 1 Basket and Rug Maker 1 Blacksmiths 23 Blind Makers 4 Bookbinders 6 Bootmakers 224 Bottle Washer 1 Brewers and Battling 10 Brush Makers 3 Building Trades 179 Button Manufacturing 5 Cardboard Case Makers 5 Chaff Cutting 3 Chemical Works 6 Chimney Sweep 1 China Rivetters 3 Coach Builders 27 Cycle Works 37 Dentists 6 Dressmakers 123 Dyers and Cleaners 37 Electricians 56 Engineers 118 Fancy Goods Manufacturers 22 Fish Storage 1 Florist 18 French Polishers 4 Furriers 5 Kitchens 36 Isinglass Manufacturers 1 Ladder and Barrow Makers, etc. 4 Laundries 60 Leather work, etc. 19 Marine Stores 10 Metal Works 30 Milliners 31 Monumental Masons 15 Motor Engineers 273 Opticians 14 Patent Medicine Manufacturer 6 Perfumers 2 Photographers 20 Picture Framers 6 Printers 99 Rubber Stopper Makers 2 Sausage Makers 3 Scale Makers 1 Sheet Metal Workers 29 Sign Writers 23 Sports Goods Makers 14 Stables 6 Tailors 185 Tea Packer 8 Tobacco Refining 1 Toy Makers 53 Umbrella Makers 3 Upholsterers 65 Vulcanizers 3 Watchmakers 42 Wig Makers 3 Wire Mattress Makers Woodworkers 122 207 Bakehouses. The control of Bakehouses is dealt with under the Factories 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, 1938 95 Number of underground bakehouses (included in above) 6 Visits made to bakehouses during the year 154 Defects found 74 Notices issued and complied with 51 5. Home Work. Lists of home-workers are sent in twice yearly, and last year contained the names of 109 outworkers residing within the Borough; 268 visits were paid to outworkers and 15 visits were paid to premises of employers of outworkers to examine lists and for other purposes. Table III. NATURE OF EMPLOYMENT OF WORKERS ON THE REGISTER, 31st DECEMBER, 1937. Nature of Work. Number employed. Oulwork in infected premises. Outwork in unsalisfaclory prem ses. Remarks. Making, cleaning altering and repairing wearing apparel 65 ... 3 ... Upholstery work 9 ... ... ... Lace goods ... ... ... ... Other classes of work 35 ... 2 ... 109 ... 5 ... 208 REGISTERED AND LICENSED PREMISES IN THE BOROUGH, 31st DECEMBER, 1938. Slaughterhouses (.not including Public) 3 Bakehouses 95 Common Lodging Houses 2 Houses Let in Lodgings 86 Dairies and Milkshops 383 Cowsheds 15 Offensive Trades 105 Wholesale Dealers in Margarine, etc. 34 Registered Workshops (up to 1st July, 1938) 2,176 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 160 INSPECTION OF OFFICES—PUBLIC HEALTH ACT. During 1938 63 inspections of offices were carried out. This is a new branch of the work necessitated by the Public Health Act. A number of defects were found, including lack of sanitary accommodation for the sexes, cleansing of sanitary arrangements, redecorations required, and the remedy of a case of overcrowding. 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. The Shops (Sunday Trading Restriction) Act, 1936, which came into force during the year, restricted the sale of certain goods on Sunday, dealt with the hours which the assistants had to work, and introduced new requirements. The Retail Meat Dealers' Shops (Sunday Closing) Act, 1936, also came into force during the year and prohibited the sale of meat on Sundays, with certain exceptions. All the matters mentioned above are an advance on previous legislation and have entailed a considerable amount of extra work on the staff in order to see that the requirements were carried out. 209 4,672 inspections were made and a number of infringements were found, as set out on page 200. In 11 cases proceedings were taken for offences under the Acts and fines and costs amounting to £10 10s. 6d. were imposed. COMMON DODGING HOUSES. 1. Municipal Lodging House. The Municipal Lodging House (built by the Corporation owing to displacement of private common lodging houses due to improvement scheme) is situate at Pitlake, and contains 101 cubicle beds for nightly letting to lodgers. In addition there are three cubicles allotted to members of the Municipal Lodging House Staff, making a total of 104 cubicles on the premises. The charge per night to lodgers is Is., the cost of a weekly ticket is 6s. for seven nights. The number of men accommodated during the year was 27,369. The number of men lodgers exceeded 74 per night throughout the vear. The receipts and expenditure for the last The receipts and expenditure for the last ten years are as follows :— Receipts. Expenditure. £ s. d. £ s. d. 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 1936 1446 0 2 1381 19 2 1937 1378 14 8 1348 7 2 1938 1253 2 0 1580 6 5 2. Private Common Lodging Houses. There are 2 common lodging houses on the register. During 1938 22 day and 4 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. 11 and 12, Princess Road ,, 10 38 men and women. 210 HOUSES LET IN LODGINGS. There are 86 houses registered under the Byelaws. 109 visits were made for inspection purposes. 38 notices were served for various amendments. 36 notices were complied with. Table V. The following Table gives the situation of these premises :— No. of Houses Road. Let in Lodgings. Beulah Grove 2 Princess Road 1 Queen's Road, Croydon 2 Ely Road 5 Forster Road 8 Wilford Road 16 Canterbury Road 1 Whitehorse Lane 1 Nursery Road 1 St. James' Road 1 Regina Road 1 Lodge Road 1 Tarn worth Road 2 Bert Road 1 Bensham Manor Road 1 Albert Road 1 Clyde Road 4 Brighton Road 1 Canning Road 2 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 3 Newark Road 1 Selhurst Road 1 Wellesley Road 1 Auckland Road 1 South Norwood Hill 1 Furze Road 1 Donald Road 1 Sydenham Road 1 Notices were served for the conditions and defects as set out in the summary of defects found (paragraph 8). 211 OFFENSIVE TRADES. Byelaws relating to Offensive Trades were adopted during the latter part of the year 1925. 109 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 31 Gut Scrapers 2 Fish Friers 70 Rabbit Skin Drier 1 Fellmonger 1 105 RAG FLOCK ACTS, 1911 AND 1928. Six samples were obtained and subjected to analysis, the results being as follows :— No. 1 contained 18 parts of Chlorine per 100,000 2 ,, 3 ,, 9 ,, ,, ,, 9 ,, ,, ,, 4 ,, 15 ,, ,, ,, 5 ,,11 ,, ,, ,, ,, 6 ,, 19 ,, ,, ,, The six samples conformed to the standard of cleanliness prescribed under the Rag Flock Regulations, 1912, made under the Rag Flock Act, 1911. The legal maximum of chlorine allowed is 30 parts per 100,000. SMOKE OBSERVATIONS. During the year 105 observations were made of factory chimneys for the purpose of detecting offences under the Act. Ten notices were sent and amendments carried out to stop the nuisance. AMUSEMENT HOUSES. 219 visits were made to theatres, music halls, cinemas, and premises where stage plays are given. Attention was given to the ventilation of the halls, sanitary conveniences, 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). 212 KEEPING OF ANIMALS 117 inspections were made in connection with the keeping of animals. There were 17 premises, including institutions, where pigs were known to be kept in the Borough. 4 notices were served to abate nuisances arising from various causes in connection with the keeping of pigs, and 13 notices were served to abate nuisances arising from the keeping of other animals. BYELAW— NUISANCES FROM DOGS. In connection with the fouling of footpaths by dogs a number of warnings have been given. In five instances proceedings were taken and fines amounting to £2 were incurred. NOISY ANIMALS BYELAW. Action was taken in 10 instances and the nuisance was abated. In one instance proceedings were taken resulting in a fine with costs amounting to £2 13s. Od. SCHOOLS. 93 inspections of schools and school lavatories were made during 1938. The water supply in all cases is from the mains. INSPECTION OF WATERCOURSES, ETC. During the year 94 visits were made to ditches, watercourses, etc., in order to see whether there were any infringements of the several Acts, etc. PHARMACY AND POISONS ACT, 1933. The 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. During the year the number of applications granted for the entry of names on the List of Persons entitled to sell Poisons under Part II. of this Act was 23, and application was made and granted for entry in the List of the names of 46 deputies. In addition, 258 applications were made for retention of names on the List for a further period of twelve months. No infringements of the Act were found. 213 FERTILISERS AND FEEDING STUFFS ACT, 1926. Seventeen inspections of premises where fertilisers and feeding stuffs were sold were carried out during the year, and no infringement of the Act was found. 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. A woman attendant deals with school children and women. The following articles were disinfected at the Disinfecting Station during the year :— By Steam 62,050 articles By Formalin gas 4,092 ,, By Formalin spray 1,366 ,, 67,508 „ In addition 833 articles were destroyed on request. Disinfection after infectious or contagious disease was carried out in 1,955 rooms at 1,505 houses 23 class rooms 18 w.c.'s 102 hospital wards 26 hospital and other rooms 11 vehicles 10 bags 1 school department 5 shelters 1 aeroplane 2 lobbies 1 hall. Disinfecting of bedding and other upholstered goods is carried out for traders who deliver to and collect articles from the Station. For this service a charge is made. During 1938, 1,060 such articles were disinfected, the receipts for this work amounting to £45 13s. Od. 214 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. Bedding is treated by steam disinfection 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 ten cases were dealt with during the course of 1938 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. DISINFESTATION OF HOUSES (OTHER THAN OF CONTENTS) FOR BED BUGS, ETC. Houses are disinfested by means of sulphur and spraying with various types of vermicides. Cyanide is not used in houses, but is used for furnishings. This latter process is carried out in the special vans. Number of Council houses— (1) Infested 30 (2) Disinfested 30 Number of houses other than Council houses— Disinfested 3 Number of houses, other than Council houses, disinfested by owners or tenants—165. 215 CLEANSING OF VERMINOUS PERSONS, ETC. During the year 11 adults and 145 children were cleansed for verminous conditions; 42 adults and 103 children for scabies, and 4 adults after contact with infectious disease. RATS AND MICE DESTRUCTION. The rat-catcher is a permanent member of the staff, and no charge is made for his services. Rats are destroyed by the following methods : Dogs, poison baits, traps, and rat varnish smeared on cardboard. Close co-operation is carried out between the rat-catcher and the District Sanitary Inspectors. The following is a summary of the visits paid during 1938 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 1452 1121 467 Butchers 17 Other premises where food is prepared or sold 111 Other premises 207 Total 1787 1121 467 In addition to the above, 1,802 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 Airpor visits were made, but no birds were destroyed. 216 FOOD SUPPLY. The supervision and inspection of the food supplies is carried out by eighteen 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 action is taken to procure for the public a wholesome supply of pure, unadulterated food, and it entails a great amount of detail work at all times of the year, especially intensified during the hot months, for it is only by constant vigilance that a satisfactory standard can be maintained. 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. Examination of foodstuffs at the Croydon Airport has also been carried out as required. 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 this work there are no set hours of duty. 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 32,834 animals slaughtered for human consumption. 217 The following table shows the premises in the Borough at which foodstuffs are known to be sold, manufactured or stored:— General Shops 180 Grocers and Provision Shops 656 Greengrocers and Fruiterers 489 Confectioners, Bakers and Pie Makers 669 Ice-Cream Shops 374 Hotel and Restaurant Kitchens and Dining Rooms 355 Butchers 239 Fishmongers (including Fried Fish Shops) 169 Ham and Beef Shops 86 Sweet Manufacturers 11 Other Food Premises 31 3,2-59 In addition to the premises in the above table, there are the following food premises, referred to in other paragraphs of this repurt:— Slaughterhouses and dairies, cowsheds and milkshops on the registers. Further, there are a large number of stalls and barrows used for food purposes in different areas in the Borough and forming street markets. There are also barrows and other vehicles which are used by hawkers, etc., for the selling of foodstuffs, but it is difficult to estimate the actual number in use, as this varies daily. All these barrows and vehicles, wherever found, are inspected by the food inspectors. A watch has been kept especially for street traders who frequent the public Elementary Schools when the children are going in or coming out, and who trade toys, sweets, etc., for old clothing. Proceedings were taken in one instance, and a fine, with costs, incurred of £1 0s. 6d. 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. 218 Table VII. The following animals were slaughtered at the I'ubli Slaughterhouses during 1938:— Pitlake. Public Slaughterhouses Cattle- Sheep. Pigs- Calves. Total. Public section 54 1099 1062 144 2359 Private section 595 7790 13518 1912 23815 Totals ... 649 8889 14580 2056 26174 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 1938:— Description. Cause. 7 beef carcases and offals General tuberculosis. 2 „ forequarters Localised tuberculosis. 2 ,, parts „ „ 12 ,, offals, complete Tuberculosis. 48 sets beef lungs Localised tuberculosis. 17 beef heads „ „ 18 ,, various offals „ „ 1 ,, head Actinomycosis. 4 ,, various parts Inflammatory, etc. 33 ,, various offals Inflammatory conditions, etc. 4 veal carcases and offals General tuberculosis. 2 ,, heads Tubercular. 4 ,, offals, complete ,, 10 ,, plucks ,, 4 ,, carcases Immaturity, etc. 5 ,, various offals, etc Inflammatory, etc. 2 ,, various parts ,, „ 23 pig carcases and offals General tuberculosis. 4 ,, various parts Localised tuberculosis. 141 ,, heads ,, ,, 3 ,, plucks ,, ,, 0 ,, various offals ,, „ 128 ,, offals, complete Tubercular. 20 ,, carcases and offals Swine fever. 23 „ carcases and offals Inflammatory conditions, etc. 130 ,, pluck ,, ,, 9 ,, heads ,, ,, 486 ,, various offals and 8 parts ,, ,, 9 ,, carcases and offals Oedema and emaciation. 4 sheep carcases and offals Inflammatory, etc. 3 ,, parts Inflammatory, traumalic, etc. 3 ,, plucks Parasitical, etc. 21 ,, various offals ,, ,, Total weight destroyed : 24,088 lbs. 226 219 PRIVATE SLAUGHTERHOUSES AND MEAT INSPECTION At the end of 1938 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 1938 was 696. Table VIII. The number of animals slaughtered in the Private Slaughterhouses during the year was:— Cattle Sheep. Pigs. Caves. Total. 89 1559 3690 1322 6,660 The following meat and offal from Private Slaughterhouses was surrendered and destroyed during 1938:— Description. Cause. 1 beef carcase and offal General tuberculosis. 1 ,, forequarter Localised tuberculosis. 1 ,, head „ „ 4 ,, sundry offals Inflammatory, etc. 1 ,, head and tongue Actinomycosis. 4 veal plucks Localised tuberculosis. 4 „ sundry offals Inflammatory. 1 pig carcase and offal General tuberculosis. 86 ,, heads Localised tuberculosis. 13 ,, plucks „ „ 42 ,, sundry offals „ „ 1 pig carcase Inflammatory, etc. 10 ,, plucks Inflammatory, etc. 63 ,, offals (various) „ „ 2 ,, parts „ „ 15 sheep sundry offals Parasitical, etc. Total weight destroyed : 2,636 lbs. Table IX. Total number of animals slaughtered for human consumption in the Borough during 1938:— Cattle. Sheep. Pigs. Calves. Total. 738 10,448 18,270 3,378 32.834 220 Table X. Summary of whole carcases destroyed with the reasons for such destruction. Class of Animal. Tuberculosis. Emaciated and Dropsical. Inflammatory Conditions. Immaturity, etc. Swine Fever. Acute swine erysipelas Jaundice t Total carcases. Cattle 8 ... ... ... ... ... ... 8 Calves 4 ... 1 3 ... ... ... 8 Sheep 3 1 2 ... ... ... 6 Pigs 24 9 15 6 26 2 1 83 Totals 36 12 17 11 26 2 1 105 Table XI. Carcases Inspected and Condemned. Cattle. Calves. Sheep and Lambs. Pigs. Number killed 738 3,378 10,448 18,270 Number inspected 738 3,378 10,448 18,270 All diseases except tuberculosis: Whole carcases condemned - 4 6 59 Carcases of which some part or organ was condemned 33 8 42 705 Percentage of the number inspected affected with disease other than tuberculosis 4.4 0.35 0.45 4.1 Tuberculosis only: Whole carcases condemned 8 4 - 24 Carcases of which some part or organ was condemned 70 18 - 286 Percentage of the number inspected affected with tuberculosis 10.5 0.65 - 1.6 221 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 2,222 Fishmongers 192 Fried Fish Shops 183 Grocers 740 Greengrocers 477 Poultry and Game Dealers 126 Cooked and Prepared Meat Shops 204 Bakers' Premises 154 Confectioners' Premises 632 Markets 500 Hawkers' Carts and Barrows 90 Hotel and other Kitchens, etc 436 Ice Cream Manufacturers and Vendors 285 General Shops 334 Other premises 55 6,630 The following articles of food were surrendered and destroyed during 1938 : — 104 beef parts and trimmings (Imported) Unsound 22 lbs. beef kidneys „ „ 66 lbs. beef livers „ „ 153 lbs. ox tails, etc. „ „ 30 lbs. calf livers „ „ 2 veal parts „ „ 28 mutton parts „ „ 2 lamb carcases „ „ 982 lbs. lambs' liver, etc. „ „ 17 pork parts „ „ 202 lbs. pig livers, etc. „ „ 224 lbs. rabbits „ „ 364 lbs. cod, herrings, etc. „ „ 679 lbs. butter, cheese, eggs, etc. „ 231 tins salmon, etc. „ 758 tins, etc., pineapple, plums, tomatoes, etc. „ 93 lbs. prunes, currants, etc. „ 91 tins milk and cream „ 39 bottles soup, sauce, etc. „ 22 tins beef, etc „ 67 packets cereals, etc. „ 41 lbs. sweets „ Total weight destroyed : 7,967 lbs. 222 Table XII. General Summary of Meat and other articles destroyed during the year 1938. ARTICLES. Weight in lbs. Remarks. Diseased. Unsound. Total. Beef 6,161 2,797 8,958 Including 8 carcases. Veal 357 132 489 „ 8 „ Mutton 132 346J 478* „ 6 „ Pork 12,725 681 13,406 „ 83 „ Offal 6,988 1383J 8,37 li „ imported offal. Fish ... 364 364 Cod, herrings, etc. Fruit & Vegetables ... 93 93 Currants, etc. Tinned Goods ... 1,540 1,540 1073 tins, 75 jars, etc. Sundries ... 991 991 Butter, cheese, etc. 26,363 8,328 34,691 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. Only a very small proportion is produced in the Borough, due to the absorption of land for building purposes and the consequent decreasing amount of pasture land. Dairies, milkshops and cowsheds have received continuous inspection. In the case of dairies separate premises are required 223 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 22,947 gallons of milk are sold daily in the Borough. Of this amount 96 per cent. is bottled, just under 4 per cent. is loose, which is sold wholesale, and the remaining small portion, namely, 25 gallons, is retailed as loose milk. These figures are interesting in view of the fact that fourteen 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, local producers use this method for part of their milk distribution. 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. 224 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 Purveyors of Milk premises on the register:— Cowkeepers on register (1937) 10 ,, added to the register (1938) — ,, discontinued (1938) 1 Net 9 Cowkeepers on register (1937) 20 ,, added to the register (1938) — ,, discontinued (1938) 5 Net 15 Number of cows provided for 204 Average number of cows in sheds (1938) 165 No. of dairies and purveyors of milk on register (1937) 404 No. of dairies and purveyors of milk added to register (1938) 41 No. of dairies and purveyors of milk discontinued during 1938 62 Net 383 Grand total of cowsheds, dairies and purveyors of milk on register, 31st December, 1938 398 During the year 830 inspections were made of dairies, cowsheds and milkshops. Mr. P. Thrale, the part-time veterinary surgeon, makes quarterly reports on his visits to the farms and his examination of the cattle thereon. Milk and Dairies Order, 1926. Proceedings were taken against a roundsman in respect of a contravention of the above Order, i.e., the filling of two bottles with cream on other than registered premises. A fine of £1 was incurred. 225 Milk (Special Designations) Order, 1936. The following licences were granted during the year under this Order:— Description of Licences. No. (1) Producers' Licences to use the designation "Accredited" 2 (2) Dealers' Licences to use the designation "Tuberculin-Tested"— (a) Bottling establishments 1 (b) Shops 21 (3) Dealers' Licences to use the designation "Accredited"— (a) Bottling establishments (b) Shops 1 (4) Dealers' Licences to use the designation "Pasteurised"— (a) Pasteurising establishments 3 (b) Shops 59 (5) Dealers' Supplementary Licences to use the designation— (a) Tuberculin-Tested 3 (b) Accredited 1 (c) Pasteurised 2 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 were examined under the Milk (Special Designations) Order, 1936:— Tuberculin Tested Milk— Licensed country producers supplying milk to licensed local dairymen 5 Accredited Milk— Licensed local producers supplying milk to a licensed dairyman 22 Pasteurised Milk— Samples from licensed dealers 172 The following tables summarise the result of the bacteriological examinations of Tuberculin Tested, Accredited and Pasteurised samples during the year:— '226 Table XIII. TUBERCULIN TESTED (Licences granted under the Milk (Special Designations) Order, 1936). Present. Absent. Present in 1/100 m.l. Absent. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Satisfied test. Tubercle bacillus 5 Bacillus Coli 5 Blood 5 Pus 5 Detritus 5 Methylene Blue Test ... 5 5 5 5 5 ... 5 5 The above 5 Tuberculin Tested milk samples contained total bacteria per m.l. as follows : — Under 5,000 ... 5 Under the Regulations Tuberculin Tested Milk shall satisfy a methylene blue reduction test and contain no coliform bacillus in one hundredth of a millilitre. Table XIV. ACCREDITED MILK (Licences granted under the Milk (Special Designations) Order, 1936). Present. Absent. Present in 1/100 m.l. Absent. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. i Satisfied. Not satisfied. Tubercle bacillus t2 20 Bacillus Coli 1 10 Blood 3 8 Pus ... 11 Detritus 11 Methylene Blue Test ... 10 1 2 *20 i 10 3 8 11 11 10 1 *This figure includes 11 samples examined tor piesente ui iuuuu, ' tTwo °samples from a local Accredited Producer's farm proved to be tuberculous. After systematic sampling of the herd a cow was found to be giving tuberculous milk and was slaughtered under e Tuberculosis Order. 227 The following tables summarise the results of the bacteriological examinations of Pasteurised Milk Samples during the year :— Table XV. PASTEURISED MILK (Licences granted under the Milk (Special Designations) Order, 1936). Present. Absent. Over 100,000 per m.l. Under 100,000 per m .l. Present. Absent. Present. Absent. Present. Absent. Tubercle bacillus ... 2 Total number of bacteria 11 161 Blood ... 172 Pus ... 172 Detritus ... 172 ... 172 11 161 .... 172 ... 172 ... 172 The above 172 Pasteurised Milk Samples contained bacteria per m.l. as follows :— Under 1,000 4 1,000—5,000 36 5,000—10,000 35 10,000—20,000 40 20,000—30,000 18 30,000—50,000 19 50,000—100,000 9 Over 100,000 11 172 Under the Regulations Pasteurised Milk must not contain more than 100,000 bacteria per millilitre. 228 PROVISION AS TO MILK SUPPLY. During the year 295 samples of ordinary milk were procured and submitted to examination for tuberculosis in accordance with the Milk and Dairies (Consolidation) Act, 1915. These samples were taken as follows:— Samples taken at cowsheds in the Borough 18 Samples in course of delivery from country cowsheds to local dairymen and purveyors of milk in the Borough 49 Samples taken at dairymen's premises in the Borough 111 Samples taken in course of delivery by local dairymen or milk sellers on their rounds in different parts of the Borough 117 295 Eight samples proved to be tuberculous. Five samples were from supplies coming from Kent, one from Surrey, and two from local farms. A considerable number of cows were examined by the Authorities' Veterinary Officers, suspected animals isolated, and samples taken. As the result of their investigations four animals were dealt with under the Tuberculosis Order, 1925. The following Table summarises the results of the bacteriological examination of ordinary milk samples, taken under the Milk and Dairies (Consolidation) Act, 1915, from 1st January to 31st December, 1938:— Table XVI. ORDINARY MILK Present. Absent. Over 100,000 per m.l. Under 100.000 per m.l. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Satisfied. Not Satisfied Tubercle bacillus 8 287 Total number of bacteria 53 235 Blood 3 285 Pus 6 282 Detritus .... 289 Methylene Blue Test 261 27 8 287 53 235 3 285 6 282 ... 288 261 27 229 The 288 samples of Ordinary Milk contained total bacteria per m.l. as follows:— 0—1,000 24 1,000—5,000 60 5,000-10,000 47 10,000—20,000 35 20,000—30,000 28 30,000—40,000 13 40,000—50,000 14 50,000—100,000 14 100,000—150,00 11 150,000—200,000 6 200,000—250,000 8 250,000—500,000 11 500,000—750,000 3 750,000—1,000,000 1 1,000,000—2,000,000 5 Over 2,000,000 8 288 Seven samples were taken for inoculation test only. There is no standard fixed for total bacteria per millilitre in ordinary commercial milk, but for the purposes of comparison a maximum count of 100,000 per m.l. is taken. It will be seen that 235 of the samples contained total bacteria in accordance with that comparison. It has to be remembered that a proportion of this milk has been subjected to commercial pasteurisation. Four samples of sterilised milk were taken during the year and contained bacteria per millilitre as follows:— 100 3 400 1 4 280 The 295 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 18 2 Kent 19 5 Surrey 3 1 Sussex 27 — *Unclassified 228 — Totals 295 8 *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. BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM. In addition to chemical analysis as shown under the Food and Drugs Act section, bacteriological examination of ice cream was carried out in 21 instances, mainly at producers' premises. Suggestions were made to the producers as to the conduct of the business, the provision of new or additional plant was made, and considerable improvements were indicated in consequence of the action taken. FOOD AND DRUGS (ADULTERATION) ACT, 1928. During the year 385 samples of milk (383 new, 2 condensed) and 483 other samples were taken. In 7 instances the vendors were warned. Fourteen samples of Ice Cream were taken duirng the year. The Public Analyst reports that 3 of these samples contained fat in amounts varying from 2.8 per cent. to 9.2 per cent.; 9 contained fat in amounts varying from 10.0 per cent. to 13 per cent.; and 2 had little or no fat content derived from milk. 231 There is no legal standard for fat in Ice Cream. 10 per cent, is suggested as a reasonable minimum amount. Bearing in mind this figure, it will be seen that the majority of the samples of Ice Cream were above this suggested standard. summary of Samples. During 1938 samples were obtained and submitted to the Public Analyst as follows:— Table XVIII. Samples of Total Samples Genuine. Not Genuine. Prosecutions. Conviction Cautions. Milk 383 365 18 1 1 4 Condensed Milk, (Inf.) 2 2 — — — — Arrowroot 8 8 — — — — Aspirin Tablets 8 o — — -r- — Bacon 6 6 — — - — Baking Powder 6 6 — — - — Beer 4 4 — — - — Black Pudding 1 1 — — - — Black Treacle 4 4 — — - — Boric Ointment 2 2 - — - — Brawn 16 16 - — - — Bread 12 12 — - - — Bun Flour 2 2 - - - — Butter 15 15 - — - — Camphorated Oil 3 3 — — - — Candied Peel 1 1 - — - — Castor Oil 6 6 - - - — Chopped Suet 2 2 — — - — Chopped Suet with rice flour 3 3 — — - — Cocoa 11 11 - - - — Coffee 6 6 - - - — Coffee and Chicory 3 3 - — - — Coffee Essence 6 6 - - - — Comp. Liquorice Powder 2 2 - — - — Comp. Syrup of Figs 5 3 2 — - 1 Comp. Tincture of Rhubarb 4 4 — — - — Confection of Senna 3 3 - - - — Corn Flour 5 5 - - - — Cream of Tartar 8 8 - - - — Custard Powder 3 3 - - - — Demerara Sugar 9 9 - - - — Dripping 11 11 - -— - — Faggots 4 4 - - - — Fish Paste 9 9 - - - — Flour 9 9 - - - — Qin 2 2 - - - — Ginger Ale 4 4 - - - — Ginger Beer 5 5 - - - — Golden Syrup 3 3 - - - — Ground Almonds 9 9 - - - — Ground Ginger 7 7 - - - — Ground Rice 8 8 - - - — Ham 2 2 - - - — Honey 9 9 - - - — Ice Cream (including 5 informal). 14 12 2 -— 1 Jam 14 12 2 — -— 1 Carried forward 659 635 24 1 1 7 232 Table XVIII. (Continued). Samples of Total Samples. Genuine. Not Genuine. Prosecutions. Convictions. Cautions. Brought forward 659 635 24 1 1 7 Lard 7 7 — — — — Lard Substitute 1 1 — — — — Lemonade 1 1 — — — — Lemonade Powder 3 3 — — — — Lemon Curd 4 4 — — — — Lemon Squash 2 2 — — — — Malt Vinegar 9 9 — — — — Margarine 11 11 — — — — Meat Paste 9 9 — — — — Meat Pie (informal) 1 1 — — — — Mincemeat 4 4 — — — — Mixed Herbs 1 1 — — — — Mixed Pickles 5 5 — — — — Mixed Spice 2 2 — — — — Mustard Mixture 5 5 — — — — Olive Oil 8 8 — — — — Pearl Barley 9 9 — — — — Pepper, White 5 5 — — — — Pepper, Black 2 2 — — — — Pickled Onions 8 8 — — — — Raisin Wine 1 1 — — — — Rissoles 2 2 — — — — Sausage, 1 1 — — — — „ Beef 9 9 — — — — „ Beef Pres. 4 4 — — — — „ Luncheon 9 9 — — — — „ Pork 12 12 — — — — „ Pork Pres. 2 2 — — — — „ Preserved 1 1 — — — — Saveloys 7 7 — — — — Sponge Mixture 2 2 — — — — Sweets 11 11 — — — — Tapioca 4 4 — — — — Tea 11 11 — — — — Tincture of Iodine 4 4 — — — — Tinned Asparagus 7 7 — — — — Tinned Beans 7 7 — — — — Tinned Cream 4 4 — — — — Tinned Peas 11 11 — — — — Vinegar 1 1 — — — — Whisky 2 2 - - - Totals 868 844 24 1 1 7 233 2. Result of Analysis of New Milk Samples. SOLIDS NOT FAT* (Legal standard is 8.5%). 7.8 7.9 8.1 8.3 8.4 8.5* 8.6 8.7 8.8 8.9 9.0 9.1 9.2 9.3 Total 383 1 1 2 5 5 10 48 152 115 27 12 2 2 1 MILK FAT.* (Legal standard is 3%). 2.5 2.6 2.7 2.9 3.0* 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 1 1 1 2 7 8 27 75 78 55 43 36 17 18 4 4.1 4.2 4.5 4.6 4.9 5.0 6.5 Total 1 383 1 2 2 2 1 1 1 Total Samples of New Milk : 383. The Samples of Milk for analysis were obtained as follows : — Country Milk in course of delivery by train to Local Dairymen — Country Milk in course of delivery by motor lorry to Local Dairymen 26 On Milk Rounds 219 "Appeal to Cow" samples 9 At Shops 105 Taken at Institutions 22 Other samples 2 383 AVERAGE COMPOSITION OF NEW MILK SAMPLES. Solids not Fat 8.72% Milk Fat 3.5% Percentage of New Milk Samples below legal standard: 4.69% Adulterated Samples. The following is a detailed statement of the adulterated samples and action taken:— No. Sample. Adulteration or Deficiency. Remarks. 779. Compound Syrup of Figs. Contained salicylic acid 0.15 per cent. Manufacturers' explanation accepted. 861. Milk 3 per cent deficient in milk fat. Vendor warned. Further samples taken proved genuine. 809. Ice Cream Contained fat, 6.8 per cent., of which not more than onesixth was fat dederived from milk. Manufacturers warned. 234 No. Sample. Adulteration or Deficiency. Remarks. 51. Ice Cream (inf.) Fat, 8.9 per cent.— Fat almost entirely consisted of a fat of the coconut oil type the milk fat being not more than one-twentieth of the total fat. Further sample taken proved genuine. 55. Compound Syrup of Figs. Contained salicylic acid 0.02 per cent. Manufacturers warned. 80. Milk 12 per cent. deficient' in milk fat. "Appeal to cow" sample taken showed a deficiency. The matter was taken up with the producer. Further samples proved genuine. 90. Milk 16 per cent. deficient in milk fat. 106. Milk 1 per cent. added water. Vendor warned. Further samples taken proved genuine. 82. Milk 1 per cent. added water. Producer was warned. Further samples taken proved genuine. 137. Blackcurrant Jam (Full Fruit Standard). Not of Full Fruit Standard. Further samples genuine. Manufacturers warned. 202. Blackcurrant Jam (Full Fruit Standard). Not of Full Fruit Standard. 1118. Milk 3 per cent. deficient in milk fat. Vendor warned. 1147. Milk 2 per cent. added water. The producers were communicated with. Further series of samples taken proved genuine. 226. Milk One half of 1 per cent. added water. 228. Milk One half of 1 per cent. added water. 229. Milk 2 per cent. deficient in milk solids. 230. Milk 1 per cent. added water. 231. Milk 1 per cent. deficient in milk fat, and 2 per cent. deficient in milk solids. 233. Milk 4 per cent. added water. 237. Milk 1 per cent. added water. The producer was prosecuted and fines and costs of £13 9s. Od. were incurred. 276. Milk 7 per cent. added water. 277. Milk 2 per cent. added water. 278. Milk 4 per cent. added water, and 1 per cent. deficient in milk fat. 279. Milk 6 per cent. added water. 235 Public Health (Preservatives, etc., In Food) Regulations, 1925 to 1927. During the course of inspections of food shops particular attention is paid to the above Regulations regarding the marking of foodstuffs to which the Regulations apply. Open-Air Swimming Pool—Purley Way. During the year a number of samples for bacteriological investigation have been taken to ensure that the condition of the water was satisfactory. CROYDON AERODROME. A number of visits were made during the year to examine foodstuffs under the Imported Food Regulations. Other visits were made under the Public Health Aircraft Regulations. 236 The following are the details of the samples taken from the Open Air Swimming Pool, Purley Way, Croydon, and submitted for bacteriological examination to the Borough Pathologist : — Date taken. Time taken. P.M. Temp, of water. Degrees FAHR. No. of bather? during the day up to time of sampling Weather Conditions. Remarks. Result. 9/6/38 7.20 67 195 Overcast, cloudy and rain. Ozone on all day. Filters on for past 72 hours. Chlorine put on at 9.15 today due to colour of water. No B. Coli in 0.001 c. c. No strept. or staph. aureus present. Organisms : 30 per 1 c. c. 15/6/38 7.15 68 588 Overcast, slight clouds. Ozone on all day. Filters on for the past 36 hours. No B. Coli in 0.001 c.c. No strept. or staph, aureus present. Organisms : Nil per 1 c. c. 22/6/38 (Inlet) 7.20 70 966 Overcast, slight rain. Ozone on all day. Filters on continuously for the past 36 hours. No B. Coli in 0.001 c.c. No strept. or staph, aureus present. Organisms : 10 per 1 c.c. 22/6/38 (Outlet) 7.20 70 966 Overcast, slight rain. Ozone on all day. Filters on continuou?ly for the past 36 hours. No B. Coli in 0.001 c.c. No strept. or staph, aureus present. Organisms : Nil per 1 c.c. 29/6/38 7.15 66.5 118 Clear and sunny. Ozone on all dav. Filters on continuously for the past 36 hours. No B. Coli in 0.001 c.c. No strept. or staph, aureus present. Organisms : 20 per 1 c.c. 237 The following are the details of the samples taken from the Open Air Swimming Pool, Purley Way, Croydon, and submitted for bacteriological examination to the Borough Pathologist—(continued)— Date taken. Time taken. P.M. Temp, of water. Degrees FAHR. No. of bathers during the day up to time of sampling Weather Conditions. Remarks. Result. 6/7/38 (Inlet) 7.30 68 226 Cloudy. Ozone on all day. Filters on continuously for the past 36 hours. No B. Coli in 0.001 c.c. No strept. or staph, aureus present. Organisms: Nil per 1 c.c. 6/7/38 (Outlet) 7.30 68 226 Cloudy. Ozone on all day. Filters on continuously for the past 36 hours. No B. Coli in 0.001 c.c. No strept. or staph, aureus present. Organisms: 10 per 1 c.c. 13/7/38 7.30 69 847 Blue sky, sunny. Ozone on all day. Filters on continuously for the past 36 hours. No B. Coli in 0.001 c.c. No strept. or staph, aureus present. Organisms: Nil per 1 c.c. 20/7/38 7.30 69 1,141 Blue sky. Ozone on all day. Filters on continuously for the past 36 hours. No B. Coli in 50 c.c. or under. No strept. or staph, aureus present. Organisms: Nil per 1 c.c. 27/7/38 7.15 69 1,451 Overcast, cloudy. Ozone on all day. Filters on continuously for the past 36 hours. No B. Coli in 50 c.c. or under. No staph, aureus or strept. present. Organisms: Nil per 1 c.c. 238 The following are the details of the samples taken from the Open Air Swimming Pool, Purley Way, Croydon, and submitted for bacteriological examination o the Borough Pathologist—(continued)— Date taken. Time taken. P.M. Temp, of water. Degrees FAHR. No. of bathers during the day up to time of sampling Weather Conditions. Remarks. Result. 3/8/38 7.30 75 4,545 Blue sky, sunny. Ozone on all day. Chloramine has been added during heavy bathing loads. Filters on continuously. No B. Coli in 50 c.c. or under. No strept. or staph, aureus present. Organisms : 930 per 1 c.c 10/8/38 7.15 72 219 Overcast. Raining all day. Ozone on all day. Filters on continuously. Chloramine has been added during heavy bathing loads. No B. Coli in 50 c.c. or under. No strept. or staph, aureus present. Organisms : Nil per 1 c.c. 17/8/38 7.15 67.5 1,023 Cloudy. Ozone on all day. Filtering continuously. Cultures sterile. 24/8/38 7.15 68 1,907 Blue sky with clouds. Ozone on all day. Filtering continuously for past 36 hours. Cultures sterile. The following are the details of the samples taken from the Open Air Swimming Pool, Purley Way, Croydon, and submitted for bacteriological examination to the Borough Pathologist—(continued)— Date taken. Time taken. P.M. Temp, of water. Degrees FAHR. No. of bathers during the day up to time of sampling Weather Conditions. Remarks. Result. 31/8/38 7.15 66 365 Cloudy. Ozone on all day. Filtering continuously for past 36 hours. Cultures sterile. 7/9/38 7.15 66 207 Overcast, dull. Ozone on all day. Filtering continuously for past 36 hours. Cultures sterile. 14/9/38 7.10 68.5 639 Overcast, cloudy and rain. Ozone on all day. Filtering continuously for past 36 hours. Cultures sterile. 21/9/38 7.15 68 8 Overcast, rain. Ozone on all day. Filtering continuously for past 36 hours. Cultures sterile. 238 240 MEMBERS OF THE EDUCATION COMMITTEE. NOVEMBER, 1937-38. The Mayor (Councillor E. C. Stuart Baker, C. I.E., 0 B.E.) Alderman H. J. Morland, M. A., J.P. (Chairman). P. Squire, Esq. (Vice-Chairman). Alderman T. Betteridqe, J.P. Councillor S. A. Maycock. Alderman A. Jackson. Councillor Major J. Petrie, O.B.E. Alderman J. Marshall, J.P. Councillor H. Regan. Alderman A. Peters,C.B.E., J.P. Councillor H. Watson. Alderman T. W. Wood Roberts, J.P. Mrs. R. L. Gurner. Alderman W. West. Mrs. M. A. Hinks. Councillor E. E. L. Arkell, J.P. B. Holden, Esq. Councillor A. J. Carpenter, J.P. Miss A. M. Jackson, M.A. Councillor W. F. Chandler. Capt. H. Lethbridoe-Abell, F.Z.S. Councillor A. H. Harding. Mrs. M. M. Wood Roberts. Councillor Eng.-Rear-Adml. J. H. Harrison. G. Robinson, Esq. Councillor W. G. Higgins. Dr. A. Sandison, O.B.E., M.D., B.Sc. Councillor H. L. Kendell. Rev. Canon G. M. Scott, M.A. Councillor G. Lewin. Sir Frederic Williamson, C.B., C.B.E. Ernest Taberner (Solicitor) 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 Medical Officer : D. D. Payne, M.D., B.S., D.P.H. Assistant Medical Officers of Health and Assistant School Medical Officers : J. T. R. Lewis, M.D., B.S., D.P.H. E. H. Harte, M.B., Ch.B., D.P.H. (commenced 1st May, 1938.) 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, a Consulting Orthopaedic Surgeon, and a Consulting Pathologist, 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 : P. G. Oliver, L.D.S. (commenced 1st September, 1938,) Assistant Dental Surgeons : J. K. R. Bryce, L.D.S., W. A. Sowden Hills, L.D.S., C. P. Urbani, L.D.S. Miss S. M. V. Hathorn, L.D.S. (commenced 1st September, 1938). (commenced 23rd May, 1938). Remedial Gymnasts : Miss F. Davey and Miss M. K. Thomas (part-time). Mental Deficiency Visitor : Miss E. McQuade (part-time). Assistant Mental Deficiency Visitor : Miss C. W. Brown (part-time). Orthopaedic Work Almoner : Miss A. Hailey (part-time). Supt. Health Visitor : Miss A. M. Allford (part-time). School Nurses : 24 district nurses (part-time) Clerks: Six full-time and eight part-time. 24 1 SCHOOL CLINICS. Name. Purpose. Where held. Times.[/##] INSPECTION Special examination of cases referred by teachers, school enquiry officers and school nurses and on application of parents. Municipal Clinic, Lodge Road. 47, St. James' Rd. when necessary. 206, Selhurst Rd. when necessary. Duppas School. Wed. and Sat., 9 a. m., and more frequently as necessary, (by appointment). 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. 47, St. James' Rd. Mon., and Tues., 1.30 p.m., Tues., Thurs., and Fri., 9 a.m. (by appointment). DENTAL Dental Treatment. Lodge Road, Selhurst Road, and Waldrons Hall. Daily, 9 a.m. and 2 p.m. EAR Treatment of Chronic Ear Discharge. Lodge Road. Fridays, 2 p.m. (by appointment). DEFECTIVE CHILDREN Examination. Town Hall. As required. X-RAY Treatment of Ringworm. Mayday Hospital. By appointment. ORTHOPAEDIC Treatment of Crippling Defects. General Hospital. Thurs., 10 a. m. THROAT Operative Treatment Enlarged Tonsils and Adenoids. Do. Mon. and Wed., 1.45 p. m. (by appointment). SYNTHETIC SUNLIGHT Treatment of Rickets, etc. Do. Tues., 2 p. m., and Fri., 3.30 p. m. (by appointment). REMEDIAL EXERCISES Treatment of Deformities. Welcome Hall, Scarbrook Road. Daily. (by appointment). CLEANSING STATION Treatment of Scabies and Cleansing of Verminous Cases. Factory Lane. Arranged as required. TUBERCULOSIS DISPENSARY Treatment of Tuberculosis and Examination of Contacts. 13. Katharine Street. Tues., Wed., Thurs. Fri. and Sat., a.m.; Mon. and Fri., p.m. RHEUMATISM Examination. Lodge Road. Mon. and Thurs., 9 a. m. (by appointment). IMMUNIZATION Protection against Diphtheria. Lodge Road. Selhurst Road. Tues., 2 p. m. Thurs., 2 p. m. 242 County Borough of Croydon. ANNUAL REPORT of the SCHOOL MEDICAL OFFICER for the Year ending December 31$t, 1938. Ladies and Gentlemen, I have the honour to present to you my Eleventh Annual Report on the work carried out by the School Medical Service. The work has been continued on the same administrative lines as have been described in previous reports, and there have been no developments or modifications. The time of the Medical Officers has been so fully occupied that it has not been possible to undertake any special investigations, although the sphere of school medicine is one which offers many interesting lines of thought, that, in less strenuous times, would repay following up. At the end of the year the Coloma School was included in the school medical scheme, and a yearly medical inspection of all scholars in that school will henceforth be carried out. As was expected, measles became prevalent during the first quarter of the year, and in certain districts, notably the Beulah and Ecclesbourne schools districts, reached epidemic proportions. This his disease shows a two-yearly cycle of incidence in Croydon, but the cycle for the Northern part of the Borough does not always coincide with the Southern part. 243 Mumps, also, was rather prevalent, and, to a lesser extent, Chicken Pox. Scarlet Fever, Diphtheria, and Whooping Cough were less prevalent than in the previous year. There were a few changes in the professional staff of the Department. Dr. Harte replaced Dr. Payne, who was promoted to be Deputy School Medical Officer. In the dental department Mr. Urbani replaced Mr. Davie, resigned, and Miss Hathorn was appointed an additional dentist for M. and C.W. work. The school and other dentist work, however, is divided among the dental surgeons, so that the equivalent of the whole time of one surgeon is given to M. and C.W. This arrangement makes the work more varied and interesting. As in previous years the work done at the Immunisation Clinic is included in my main report. The total number of children of school age who attended for Immunisation was 1,179. I have once more to acknowledge with grateful thanks the co-operation of the head teachers; without their help the work would be rendered far more difficult and would be much less complete. The Society for the Prevention of Cruelty to Children, through their local inspectors, have, as heretofore, helped in getting recalcitrant parents to recognise their responsibilities, and the Voluntary School Care Committee have wholeheartedly cooperated. The actual detailed spade work shown by the figures in this report has been done by the medical, dental, nursing and clerical staff of the School Medical Service, to whom I wish to express my grateful thanks, and to bring to your notice the thoroughness, zeal and loyalty they have exhibited throughout the year. Yours faithfully, OSCAR M. HOLDEN, School Medical Officer. 244 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 Schools— Duppas. North Park (Stores and Workshop). St. Giles (Addington). Selhurst Grammar (Boys). Selhurst Grammar (Girls). Internal Painting and Distempering at the following Schools— Duppas. Rockmount Infants'. North Park (Stores and Workshop). St. Giles (Addington). St. Mary's (Addington). 245 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. Ashburton Sen. Mixed Boys 169 4 Pedestal Sep. cistn. 20 ft. A.F. *9 4 12 Girls 193 10 Do. do. — *9 4 12 Jun. Mixed Boys 190 4 Do. do. 20 ft. A.F. *6 4 12 Girls 168 10 Do. do. — *6 5 15 Benson Infants — 1 Do. do. - 1 1 2 Junior Mixed B. 138 2 Do. do. 17 ft. A.F. 5 3 6 G. 164 7 Do. do. — Sen. Mixed Boys 67 3 Do. do. 20 ft. A.F. 5 3 6 Girls 85 5 Do. do. — 5 3 6 Beulah Junior Boys 415 6 Do. do. 44 ft. A.F. 13 9 ... Towels changed. Junior Girls 394 20 Do. do. — 13 8 ... Infants B. 193 4 Do. do. 22 ft. A.F. 18 6 ... G. 186 11 Do. do. — John Ruskin Boys 344 21 Do. do. 42 ft. A.F. 3 Wg. Tr'ghs 8 24 Towels changed. Davidson Senior Boys 141 5 Do. do. 36 ft. A.F. 2 tr'ghs 4 12 Senior Girls 113 14§ Do. do. — Do. 3 9 J. G. & I. B. 144 3 Do. do. 20 ft. A.F. Wshg. tr'ghs 2 7 21 G. 257 6 Do. do. Duppas Junior Boys 175 4 Do. do. 15ft. 6in.A.F. 6 4 - Towels changed. Junior Girls 218 8 Do. do. — 6 4 - Infants B. 105 3 Do. do. 15i ft. A.F. 8 4 — G. 88 6 Do. do. — Ecclesbourne Cookery Dept. - — — — 2 See Senr. girls. Laundry „ 2 Junior Boys 280 6 Trough. 42½ ft. stop cock 10 8 24 2 Pedestal. Senior Girls 258 9 Tr'gh A.F. - 6 Not in use. 8 24 7 Ped'l A.F. Infants B. 109 2 Tr'gh A.F. 24 ft. stop cock 2 tr'ghs 4 8 G. 148 6 Tr'gh A.F. — Elmwood Senior S. 240 4 Pedestal 25 ft. A.F. 9 3 6 & J. B. J. 120 3 sep. c'stn. 16 ft. A.F. 6 2 4 S. & S. 160 8 Do. do. - 7 3 9 J. G. J. 159 8 Do. do. — 6 3 9 Infants B. 176 4 Do. do. 26 ft. A.F. 8 2 6 G. 180 10 Do. do. (inft. sze.) 8 2 6 * Plus 1 tink. § 4 W.C.'s reserved for use of Infant Girls. 246 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. Gonville Junior Boys 118 3 Do. do. 18 ft. A.F. 7 3 22 Junior Girls 127 11 Do. do. — 5 4 Infants G. 84 2 Do. do. — 6 3 B. 109 12 ft. A.F. Howard Junior Boys 151 5 Pedestal sep. c'stn. 20 ft. A.F. 7 2 6 Junior Girls 149 6 Do. do. — 6 2 6 Infant B. 34 3 Do. do. 10 ft. A.F. 4 5 27 Infant G. 47 4 Do. do. - Ingram Senior Boys 300 5 Do. do. 28 ft. A.F. 4 1 tr'gh 6 18 Senior Girls 260 13 Do. do. — 4 5 15 Infants B. 300 3 Do. do. 24 ft. A.F. 1 5 15 G. 6 Do. do. — tr'gh 1 do. Kensington Avenue Junior Boys 122 3 Do. do. 12 ft. A.F. 6 3 9 Junior Girls 134 7 Do. do. — 6 3 9 Infants B. 57 2 Do. do. 5 ft. A.F. 6 3 9 G. 49 4 — Kingsley Senior Boys 334 6 Do. do. 30 ft. A.F. 14 6 12 Senior Girls 336 18 Do. do. — 14 7 14 Junior Mixed B. 203 4 Do. do. 17 ft. A.F. 8 4 8 G. 188 10 Do. do. — 8 4 8 Infants B. 179 4 Do. do. 17 ft. A.F. 8 4 8 G. 179 10 Do. do. - 8 4 8 Lanfranc Senior Boys 186 6 Do. do. 41 ft. A.F. 16 5 32 Senior Girls 192 16 Do. do. — 16 5 Norbury Manor Senior Boys 250 5 Do. do. 40 ft. A.F. 2 Tr'ghs 6 ft. 4 12 Towels changed as required. Senior Girls 222 14 Do. do. - 2 ditto 4 12 Junior Girls 6 Do. do. - J. B. & G. 250 13 Do. do. 23 ft. A.F. 21 9 18 Infants 350 17 Do. do. 12 ft. A.F. 247 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. Oval Cooking — — — - — 1 - Changed daily Handycraft — - — — — 1 - Changed 2 a week Senior Boys 160 4 Do. do. 15 ft. A.F. 10 3 Towels changed Senior Girls 138 8 Do. do. — 10 3 J. B. & G. B. 125 4 inc. inf. b 10 inc. inf. g Do. do. 21 ft. A.F. 8 4 G. 117 Do. do. - Infants B. 98 Do. do. — 10 4 G. 82 Portland Senior Boys 231 ‡7 Do. A.F. 29 ft. stop cock 2 tr'ghs 5 ft. 6 6 Senior Girls 184 ‡10 Do. do. - Do. 5 5 Infants B. 183 ‡2 Do. do. 24 ft. stop cock Do. 6 6 G. 146 ‡7 Do. do. — Temporary School, Overbury Crescent, New Addington Boys 45 3 — 5 ft. 5 in. A.F. 1 1 Changed 2 a week Girls I. 61 3 1 for tchrs. — - 1 1 Changed 3 a week Purley Oaks S.B. 101 6 Ped. Sep. Cis 33 ft. A.F. 3 3 9 S.G. 75 9 Do. do — 2 2 6 J.B. & G. B 73 Shared with Senior Boys 4 3 9 G. 77 Shared with Senior Girls Infants B. 98 4 Ped. sep. 14ft. 6in. A.F. 4 3 4 G. 67 4 cistern — Rockmount S. & J.B. 174 4 Do. do. 2 ft. A.F. 7 4 13 S. & J.G. 124 10 Do. do. - 7 3 12 Inft. B. 81 3 Do. A.F. 20 ft. A.F. 8 3 13 Inft. G. 98 7 Do. A.F. — South Norwood Jnr. B. 339 6 Do. sep. cistern 40 ft. A.F 16 5 22 Approx. Jnr. G. ... 21 Do. do. — ... ... ... Infants B. 127 Do. do. 16 ft. A.F. 19 8 24 G. 316 Do. do. — * Towels Changed approx. every other day. †More towels if required. ‡ 1 Auto tank to each range of closets. 248 Sanitary Accommodation. School. Approx. No. of scholars. No. of W.C.s Type of closet. Urinal space. No. of wash basin: No. of towels in use at time of insp. No. of towels used ea. wk. Sydenham Jnr. Boys 370 7 Do. do. 33 ft. A.F. 12 14 24 J.G. 370 19 Do. do. 21 ft. A.F. 17 14 28 Infants Tavistock Snr. Boys 215 7 Do. do. 54 ft. A.F. 2 tr'ghs 4 8-12 Snr. Girls 231 17 Do. do. — Do. 6 12-18 Infants B. 96 2 Do. do. 7 ft. A.F. 7 4 8-12 G. 88 5 Do. do. — Waddon Snr. Boys 258 4 Do. do. 20 ft. A.F. 8 5 ... Changed as necessary Snr. Girls 278 10 Do. do. - 10 6 ... J. B. & G. B. 184 7 Do. do. 22ft. 6 in. AF. 6 5 ... G. 189 10 Do. do. - 6 Infants B. 72 3 Do. do. 13 ft. A.F. 3 2 ... G. 74 7 Do. do. — 6 3 West Thornton J.B. 273 9 Do. do. 30 ft. A.F. 9 6 15 Changed three times per week J.G. 238 13 Do. do. 7 6 15 Infants f B. 148 3 Do. do. 23 ft. A.F. 4 15 G. 144 6 Do. do. — 4 3/ Whitshorse Manor S.B. 170 9 (1 lockd up) Do. do. 32 ft. A.F. 12 6 12 J.G. 236 16 (1 staff) Do. do. — 11 4 20 Infants B. 216 4 Do. do. 26 ft. A.F. 18 & 2 slcp sinks. 3 11 G. 100 8 Do. do. - Rec'pt'n Room — 3 — - Winterbourne J.B. 356 7 Do. do. 39 ft. A.F. 16 8 ... Towels changed as necessary. J.G. 397 17 Do. do. - xl8 8 ... Infants B. 172 3 Do. do. 24 ft. A.F. xl5 (& 5 ... G. 152 11 Do. do. — 1 sink) *Woodside Jnr. Boys 423 9 Pedestal sep. cist. 37 ft. A.F. *7 9 18 Jnr. Girls 296 16 Do. do. — 19 5 25 Infants B. 146 5 Do. do. 9 ft. A.F. 5 4 16 G. 125 7 Do. do. x Plus one sink. * Alterations to buildings and new Infant School in course of construction Junior Girls— New range of W.C.'s. , „ „ „ Lavatories. 249 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. Heath Clark Cent. B. 196 5 Do. do. 22 ft. stop cock 8 4 12 Cent. G. 187 10 Do. do. — 8 4 12 Croydon British Senior Girls 157 12 Do. do. — 10 5 15-17 Lady Edridge Cent. G. 317 8 Do. do. — 4 8 16 St. Christophers B. 74 3 Do. do. 7 ft. A.f. 4 2 6 G. 36 6 Do. do. — 3 1 3 I. 26 7 Do. do. 23 ft. A.F. 3 1 3 St. Giles B. 102 3 Do. do. 9 ft. A.F. 3 102 ... ChChanged fortnightly. G. 80 5 Do. do. — 3 80 New Block B. included above 3 Do. do. 9 ft. A.F. 3 ... ... G. 5 Do. do. — 3 ... ... St. Luke's Myope B. 27 2 Do. do. 4 ft. A.F. 2† 2 ... Towels changed weekly. G. 19 3 Do. do. — 2† 2 St. George's Hall B. 42 1 Do. do. 6ft. & 1 stall with w.w.p. 1 1 ... Towels changed weekly. G. 41 2 Do. do. — 1 1 Suffolk Road Temporary Infants B. 2 Standard pattern and height space for 3 persons 2 ... ... Not Now in Use as a School. G. 4 — 4 All Saints S.B. 39 1 Pedestal sep. cist. 6 ft. hand flushed cist. 2 1 3 S.G. 40 2 Do. do. - 2 1 3 J.B. 99 3 Do. do. 6½ ft. A.F. 2 2 6 J.G. 83 5 (J.G. & I.G.) Do. do. - 2 2 6 Infants B. 40 3 (Inf. boys) Do. do. 8 ft. A.F. 2 2 6 G. 38 † 1 Shower Bath for Boys. † 1 Shower Bath for Girls. 250 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. Christ Church J.M. & I. J.B. 122 4 Do. do. 16 ft. A.F. 4 8 16 J.G. 158 14 Do. do. — Inf. B. 65 7 Do. do. Inf. G. 62 Cypress Jnr. Boys 103 3 Do. do. 17 ft. A.F. 4 7 14 Jnr. Girls 75 11 Do. do. — 10 Inft. Boys 82 2 Do. do. 11 ft. A.F. Shared with J.B. Inft. Girls 71 Use Girls above - Shared with J.G. Kindgtn. — 1 — — 1 Holy Trinity J.G. & 200 11 Pedestal — 6 6 12 Towels changed twice weekly. I.G. 50 sep. cist. Parish Church S. & J.B. 210 4 Do. do. 21 ft. A.F. 6 8 8 J.G. & I. 315 16 Do. do. 11 ft. A.F. 5 6 6 St. Andrew's . S. & J.B. 154 3 Do. do. 25 ft. A.F. *5 3 6 S. & J.G. 153 9 Do. do. — *7 2 4 Infants B. 45 2 Do. do. 7 ft. A.F. *6 2 4 G. 44 4 Do. do. — St. Joseph's Boys 99 3 Do. do. 8 ft. stop tap 2 2 6 Infant Boys 20 ... Girls and 95 6 Do. do. — 3 2 6 Infant Girls 30 — 2 2 6 St. Mark's J.G. & I. B. 30 2 — 5 ft. A.F. 3 3 7 G. 130 5 Do. do. — St Mary's (Addington) J. M. & I. Junior B. 50 3 Do. do. 12 ft. A.F. 3 1 2 Junior G. 52 4 Do. do. — 1 2 Infants ... Shared with Junior Boys 3 1 2 ... Shared with Junior Girls St. Mary's R.C. . Mixed B. 154 4 Do. do. 16 ft. A.F. 4 2 4-6 Infants 81 4 Do. do. 8 ft. A.F. 2 2 4-6 Mixed G. 187 9 Do. do. — 2 2 4-6 * Adjacent St. Andrew's Hall used by scholars and has 4 W.Cs. not included in above figures. 251 sch ool. 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. St. Peter's . Inf. B. 55 3 sis. troughA.F. 4ft.6in. A.F. }< 2 4 Inf. O. 69 Do. Do. do. — St. Saviour's . J. M. \ >250 4 7 Do. do. Do. do. 23 ft. A.F. }' 6 12 Infants s 2 Do. do. 7 ft. 3 4 8 Shirley . J. Mxd. j B. IG. 94 65 3 4 Pedestal sep. cist. Do. do. 10i ft. stop cock 2 2 4 Infants B. G. 60 30 2 3 Do. do. Do. do. 4 ft. A.F. }2 2 4 Archbishop Tenison's . Central B. 193 4 Do. do. 18 ft. A.F. 9 5 16 Senior Q. 117 8 Do. do. 5 3 6 St. Michael's . Central G. 220 9 Do. do. — 3 3 9 Monks Orchard . Junior B 51 3 P.W.D. 13 ft. A.F. *4 1 4 Junior G 70 6 P.W.D. J4 2 8 Infant B. 74 2f P.W.D. 14 ft. I'6 2 8 Infant G. 56 5 P.W.D. f 1 Babies (Boys and Girls). * Plus one sink. Cost of the School Medical Service. The gross cost of the medical, dental, and nursing services was £13,878; from this an income of £845 should be deducted, making a nett cost of £13,033. The rateable value of the Borough in 1938 was £2,328,293. The Government grant is 50 per cent, of the expenditure, hence the actual cost to the rates was £6,517, i.e., a rate of 0.68 pence. The nett cost of these services to the rates for 1938 per child on the school registers was 5s. 0.4d. The figures do not include £300 for Medical Inspection (Higher Education) and for Blind persons £744. Cost of Special Schools. Schools maintained by the Council, £9,220; Contributions to schools under other authorities, £4,432; Loans charges, £579; Other expenses (travelling, etc.), £35; Income from parents' 252 tributions and other receipts, £783, giving an actual cost of £13,483, of which £6,742 was payable out of local rates, giving a rate of 0.69 pence. Cost of Milk and Meals. Milk and meals costs £1,632 4s. 1d.; wages, fuel, printing, etc., £660 12s. 6d.; income from parents' contributions, £8 6s. 0d.; giving an actual cost of £2,284 10s. 7d. There has been a slight increase in the cost of the actual medical services rendered in the Public Elementary Schools from 0.58 in 1937 to 0.68 of a penny rate in 1938. The cost of maintenance in Special Schools has also increased from a rate of 0.60 to 0.69 pence. The cost of milk and meals has increased by £301 9s. l1d. This increase relates to " food, etc.," only, not to the expenditure on Provision of Meals account as a whole. School Population. The average number of children on the School registers continues to decline. This is due to the fall in the birth-rate, which has been evident for some years past in Croydon, as over England as a whole. Table 1. No. of Departments. Average number on the Registers. Average attendance. Average attendance per cent. Senior Boys 10 c. 2559 2406 54 2 n.p. 419 401 96 Senior Girls 11 c. 2660 2468 93 2 n.p. 353 335 94 Senior Mixed 7 c. 2369 2210 93 4 n.p 1240 1120 90 junior Boys 7 c. 2294 2145 94 Junior Girls 8 c. 2787 2525 91 3 n.p. 725 665 92 Junior Mixed 12 c. 4973 4441 89 4 n.p. 1020 877 86 lnfants (323 under 5) 15 c. 3843 3283 85 2 n.p. 194 168 87 Schools— Church of England 13 3951 3566 90 Roman Catholic 2 Council 31 21485 19478 91 Total 46 25436 23044 91 "C."— Council. "N.P."— Non-Provided. 25a Medical Inspection in Schools. The work of medical inspection is spread over all the staff of Assistant Medical Officers, excepting those acting as Resident Medical Officers in Institutions, or as specialist officers. The Deputy Medical Officer, Dr. Payne, devoted 3/llths of his time to school medical duties; Dr. Lewis 9/llths; Dr. Harte 7/llths; Dr. Jenkin-Lloyd 2/llths; Dr. McMahon 3/llths; Dr. Morrison 6/llths. The groups examined have been entrants, usually aged 5-7 years; intermediates 8 years; and leavers 12-14 years. These are the three statutory groups. Examinations of children outside these groups are classified as "others." Children brought forward by head teachers, enquiry officers, school nurses, etc., are classified as "specials." The same arrangements as appertained in 1937 continued. An effort has been made to carry out reinspections more frequently and they are far more complete than formerly. Table II. gives a summary of the number of children examined in the various classes in the different schools, together with the parental attendance at the examinations. A total of 8,111 children were examined as compared with 7,855 in 1937, and 5,943 parents attended the examinations. The percentage attendance of parents in tlie lintrants group was tor boys 84.5 per cent. and girls 87.9 per cent.; in the Intermediate group, boys 72.0 per cent., girls 77.8 per cent.; and in the Leavers' group, boys 42.9 per cent., girls 56.2 per cent. 12,039 re-inspections were made as against 12.399 in 1937, and 12,122 in 1936. The total percentage of parents attending was 73.3, as against 72.9 last year. 254 Table II. Entrants. Intermediate. Leavers. Other Ages. Number Exmnd. Parents Present. Number Exmnd. Parents Present. Number Exmnd. Parents Present. Number Exmnd. Parents Present. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Ashburton 18 14 18 13 15 23 13 23 34 39 28 21 ... ... ... ... Benson 29 39 26 37 16 28 13 28 15 19 6 2 ... ... ... ... Beulah 17 11 17 9 177 105 146 80 ... ... ... ... ... ... ... ... Croy. British ... 49 23 Cypress 60 36 54 32 37 32 33 27 Davidson 52 55 44 46 31 35 20 29 59 43 15 30 Duppas 27 20 20 11 83 90 53 67 St. George's Hall (Temporary) 24 22 21 18 ... ... ... ... ... ... ... ... ... ... ... ... Ecclesbourne 54 54 50 47 88 ... 67 ... ... 65 ... 31 ... ... ... ... Elmwood 73 60 47 47 77 53 48 40 70 48 26 26 ... ... ... ... Gonville 42 34 41 33 32 36 27 34 ... ... ... ... ... ... ... ... Howard 22 33 18 26 65 82 29 51 ... ... ... ... ... ... ... ... Ingram 42 50 35 42 ... ... ... ... 105 36 62 15 ... ... ... ... Kensington Av. 25 23 23 23 32 34 25 29 ... ... ... ... 2 2 2 2 Kingsley 52 59 44 53 93 109 65 87 93 66 42 47 ... ... ... ... Lanfranc ... ... ... ... ... ... ... ... 64 72 27 51 ... ... ... ... Monks Orchard 20 20 18 17 14 23 10 18 ... ... ... ... ... ... ... ... New Addington 38 46 34 42 11 2 11 1 ... ... ... ... ... ... ... ... Norbury Manor 44 73 41 66 52 35 42 31 110 80 69 48 ... ... ... ... Oval 56 39 41 33 69 64 53 52 41 25 24 19 ... ... ... ... Portland 70 65 66 60 ... ... ... ... 96 68 24 51 ... ... ... ... Purley Oaks 22 12 12 8 15 20 7 12 29 30 6 9 ... ... ... ... Rockmount 20 27 27 24 24 12 17 9 25 22 14 18 ... ... ... ... South Norwood 77 54 60 43 113 75 71 50 ... ... ... ... ... ... ... ... Sydenham 35 38 28 31 89 36 66 31 ... ... ... ... ... ... ... ... Tavistock 33 28 26 27 ... ... ... ... 90 80 55 43 ... ... ... ... Waddon 38 47 35 43 57 89 42 56 78 70 45 43 ... ... ... ... West Thornton 62 58 51 53 43 105 31 82 ... ... ... ... ... ... ... ... Whitehorse Mnr. 76 51 61 42 ... 58 ... 47 68 ... 29 ... ... ... ... ... Winterbourne 84 63 77 60 49 109 41 88 ... ... ... ... ... ... ... ... Woodside 48 39 44 37 84 86 62 83 ... ... ... ... 14 1 8 1 All Saints 33 32 24 29 26 16 22 15 16 18 11 15 ... ... ... ... A. Tenison's Gls. ... ... ... ... ... ... ... ... ... 32 ... 12 ... ... ... ... Christ Church 35 30 30 27 29 36 24 30 ... ... ... ... ... ... ... ... Holy Trinity ... ... ... ... ... 35 ... 31 ... ... ... ... ... ... ... ... Parish Church 37 34 32 31 21 46 17 35 25 ... 13 ... ... ... ... ... St. Andrew's 20 11 17 10 26 32 18 18 24 13 5 ... ... ... ... ... St. Joseph's 6 17 6 15 9 25 2 15 9 16 5 6 ... ... ... ... St. Mark's 13 20 11 19 ... 41 ... 36 ... ... ... ... ... ... ... ... St. Mary's, Addington 3 1 1 1 5 13 2 3 ... ... ... ... ... ... ... ... St. Mary's 31 30 22 25 18 23 8 14 25 17 9 ... ... ... ... ... St. Peter's 12 26 11 22 ... ... ... ... ... ... ... ... ... ... ... ... St. Saviour's 25 13 8 16 12 19 6 12 ... ... ... ... ... ... ... ... Shirley 38 16 37 13 33 23 22 19 ... ... ... ... ... ... ... ... 1513 1400 1278 1231 1545 1650 1113 1283 1076 908 515 510 16 3 10 3 2913 2509 3195 2396 1984 1025 19 13 PERCENTAGE OF PARENTS PRESENT AT MEDICAL INSPECTIONS. Entrants Boys 84.5 86.1 73.3 ,, Girls 87.9 Intermediate Boys 72.0 75.0 ,, Girls 77.8 Leavers Boys 47.9 51.7 ,, Girls 56.2 Other Ages Boys 62.5 68.4 ,, Girls 100.0 255 FINDINGS AT ROUTINE MEDICAL INSPECTIONS. Uncleanliness. For uncleanliness surveys the health visitors made 464 visits to schools, a decrease of one. At the primary inspections they found vermin in 149 and nits alone in 1,905 children. On these inspections, 3.5 per cent. of the children showed evidence of infestation as against 3.0 in 1937 and 3.1 in 1936. Clothing and Footgear. At routine medical inspections 99.3 per cent. of the boys and 99.5 per cent. girls were clothed and shod properly. Close scrutiny has been exerted by the medical inspectors and the findings are satisfactory. Nutrition. In the Entrants 16.4 per cent. of the boys and 16.5 per cent. of the girls were below normal nutrition for the area. In the Intermediate group 16.6 per cent. of the boys and 16.8 per cent. of the girls were under average; in the Leavers' group 12.8 per cent. of the boys and 7.9 per cent. girls, giving in the whole school groups examined 15.4 per cent. boys and 14.6 per cent. girls. No standard of nutrition, and no universal method of assessment has yet been evolved. The Board of Education has laid down the following grades, but in the absence of standardised tests, and criteria, actual assessment naturally varies with the varying ideas of the examining medical officers:— A. Excellent. B. Normal. C. Slightly sub-normal. D. Bad. Height 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 during 1938. As this Table has now been compiled over a period of 10 years, i.e., the length of a child's school life, it is possible to ascertain the rate of growth of the same group of children from their entrance to school to the time of their leaving. 256 The following statistics give a summary of the findings: — Table III. HEIGHTS AND WEIGHTS. 1938. 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. 1934 160 41.2 39.9 42.8 43.9 39.5 36.1 150 40.9 38.7 42.3 41.3 39.7 35.7 1933 844 43.1 42.4 45.7 49.3 40.5 37.1 782 42.8 41.4 45.3 48.2 40.1 35.7 1932 330 44.8 44.9 47.3 51.5 42.4 39.4 379 44.4 44.0 46.9 50.3 42.1 38.6 1931 121 47.1 50.9 49.3 55.3 45.4 45.7 73 47.0 49.7 48.5 54.3 45.1 44.9 1930 620 49.4 56.0 52.4 64.9 46.7 48.5 640 48.9 53.4 53.1 64.7 46.8 46.2 1929 782 50.8 59.3 54.4 71.0 47.2 49.8 845 50.5 57.7 53.9 70.1 47.3 47.6 1928 177 52.5 64.4 54.5 72.2 50.2 56.1 145 52.4 63.0 54.6 72.8 50.2 56.0 1927 19 54.2 69.6 56.9 81.3 52.2 61.1 23 55.1 71.3 59.1 103.7 54.1 62.4 1926 46 56.2 75.9 60.2 88.6 52.2 62.2 11 57.1 75.7 — — — — 1925 884 57.6 84.6 63.5 115.6 53.5 66.8 831 58.5 85.8 63.4 118.0 53.4 65.3 1924 123 59.2 88.9 63.7 110.0 55.6 71.6 46 60.2 98.0 63.2 109.3 57.5 85.5 1923 3 64.7 111.2 — — — — 3 61.5 103.2 — — — — 257 Children Born in 1933.— The Boys are 0.3 inches taller and 1.0 lbs. heavier on the average than the girls. The average minimum weights of the boys is 1.4 lbs. more and their average minimum height 0.4 inches more than the corresponding figures for the girls. The average maximum weight of the boys is 1.1 lbs. more and their average maximum height 0.4 inches taller than the girls. Children Born in 1932.— The boys are 0.4 inches taller and 0.9 lbs. heavier on the average than the girls. The average minimum weights of the boys is 0.8 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 1.2 lbs. more than the girls, and their average maximum height 0.4 inches taller than for the girls. Children Born in 1930.— The boys are 0.5 inches taller and 2.6 lbs. heavier on the average than the girls. The average minimum weight of the boys is 2.3 lbs. more and their average minimum height 0.1 inches less than the corresponding figure for the girls. The average maximum weight of the boys is 0.2 lbs. more than the girls, and their average maximum height is 0.7 inches shorter than the girls. Children Born in 1925.— The boys in this group were 0.9 inches shorter and 1.2 lbs. lighter on the average than the girls. The average minimum weight of the boys is 1.5 lbs. more, and their average minimum height 0.1 inches taller than the girls. The average maximum weight of the boys is 2.4 lbs. less and their average maximum height 0.1 inches taller 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: the girls exhibiting greater fluctuations around the mean average. RANGE OF VARIATION. Height. inches. Weight. pounds. Born in 1933: Boys 5.2 12.2 Girls 5.2 12.5 Born in 1932: Boys 4.9 12.1 Girls 4.8 11.7 Born in 1930: Boys 5.7 16.4 Girls 6.3 18.5 Born in 1925: Boys 10.0 48.8 Girls 10.0 52.7 258 Heart and Circulatory System. At routine medical inspections among the Entrant group 10 boys and 14 girls were found to have organic disease. In the Intermediate group, the figures were 17 boys and 34 girls, and in the Leaver group 10 boys and 29 girls. Functional disease was found in 43 boys and 24 girls in the Entrants; 38 boys and 54 girls in the Intermediate; 22 boys and 22 girls in the Leaver group. Anæmia was present in 49 boys and 47 girls in the Entrant group; 59 boys and 62 girls in the Intermediate; and 16 boys and 35 girls in the Leavers. The percentage of all Heart and Circulatory defects among children examined at routine medical inspection was 7.2. Chest Complaints (Other than Tuberculosis). In all the groups combined 2.9 per cent. of the boys and 2.0 per cent. of the girls had some minor affection of the lungs. This was usually a mild Bronchitis. Tuberculosis. Seventeen children were referred to the Tuberculosis Officer for further examination. All contacts of known cases of Tuberculosis are kept under supervision and re-examined at each school medical inspection. 303 children were under such surveillance at the beginning of the year, 59 were added during the year, 40 were discharged, leaving 322 under observation at the end of the year. Ten cases of pulmonary Tuberculosis and 17 cases of nonpulmonary Tuberculosis in children of school age were notified to the Medical Officer of Health during the year. Three children died of pulmonary Tuberculosis and 4 of non-pulmonary Tuberculosis. The ages at death of these cases were:— Pulmonary: 14 years, 7 years, 2 years. Non-pulmonary: 5 years, 7 years, 12 years, 15 years. The non-pulmonary deaths were certified as follows:— One from tuberculous meningitis, one acute miliary tuberculosis, one tuberculosis of both kidneys, and one tuberculosis of right hip. Taking the total school population as 25,436, the mortality rate from pulmonary Tuberculosis in school children was 11.8 per 100,000, and the incidence rate 39.3 per 100,000. For non-pulmonary Tuberculosis the respective figures were 18.7 and 66.8. 259 Nose and Throat. In all the groups 403 boys and 492 girls had enlarged tonsils; 19 boys and 13 girls had adenoids only; 487 boys and 524 girls had adenoids and enlarged tonsils; 70 boys and 54 girls were mouth breathers; 466 boys and 451 girls exhibited enlarged glands in the neck. Of all children examined at Routine Medical Inspection, in the Entrant group 13.6 per cent. had enlarged tonsils; 0.6 per cent. had adenoids alone: 17.9 per cent. enlarged tonsils and adenoids; and 14.8 per cent. had enlargement of the submaxillary or cervical glands. In the Intermediate group the respective percentages were 10.7 per cent., 0.5 per cent., 14.0 per cent., and 13.0 per cent.; and in the Leaver group, 7.8 per cent., nil, 7.2 per cent., and 3.5 per cent. The percentages for the three groups in relation to the total number of children examined, were 11.0 per cent., 0.4 per cent., 12.5 per cent., and 11.1 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 32.9 32.8 16.5 12.9 Intermediates 24.1 28.7 11.7 14.2 Leavers 8.0 14.3 2.9 4.3 Other Ages 25.0 ... 3.3 ... * 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 0.4 per cent. Entrants, 0.6 per cent. Intermediates, and 0.4 per cent. Leavers in the children examined had defective hearing. The report on the work done in the Ear Clinic is given on page 281. 260 Speech Defects. The special class is held twice weekly, and is conducted by two qualified lady teachers. During 1938, 55 children attended. A special report on the results of the class is given on page 291. Routine medical inspection findings showed in the Entrant group 0.5 per cent. children defective, in the Intermediate group 0.5 per cent., and 0.1 in the Leaver group. Skin Diseases. The findings show only the incidence in the groups examined at a specific examination and must not be taken to indicate the total incidence of skin disease in school children. Entrants gave 1.7 per cent. incidence in boys and 1.6 per cent. in girls; Intermediate boys 1.7 per cent. and girls 1.6 per cent.; Leavers 1.6 per cent. boys and 2.3 per cent. girls; a total in all groups of 1.7 per cent. boys and 1.8 per cent. girls. Deformities. Among children examined at Routine Medical Inspection 0.2 per cent. of the boys and 0.2 per cent. of the girls showed evidences of rickets; 2.2 per cent. boys and 2.7 per cent. girls had some abnormal degree of spinal curvature, and 4.0 per cent. boys and 4.8 per cent. girls showed some other physical deformity. External Eye Diseases. Squint was present in 2.0 per cent. of all children examined in the various groups and was most frequently found in the Entrant, group (1.9 per cent. boys and 2.0 per cent. girls). Its incidence declined as age advanced. Blepharitis occurred in 0.9 per cent. of all the children and other external eye defects in 0.3 per cent. The total percentages of eye defects in the various groups was 4.2 for Entrants; 3.1 for Intermediates; and 1.6 for Leavers. For 1937 the corresponding figures were 3.2, 4.0 and 3.1. Vision. The Entrant group is not examined for visual acuity at routine medical inspection. If a child is wearing corrective glasses, the vision is tested with the glasses worn at the time of examination. 261 In the Intermediate group 8.2 per cent. of the boys and 7.9 per cent. of the girls were referred for treatment or observation for defective vision, and in the Leaver group 8.6 per cent. of the boys and 10.5 per cent. of the girls. The Leaver group of girls invariably gives the worst figures for vision. Table V. Extent of Defect. Intermediate. Leavers. Total. Boys. Girls. Boys. Girls. Boys. Girls. No. % No. % No. % No. % % % Normal: R 1470 95.2 1559 94.5 1040 96.7 859 94.6 95.8 94.5 6/6ths or 6/9ths L 1458 94.4 1542 93.5 1033 96.0 851 93.7 95.0 93.5 6/12ths or 6/24ths R 67 4.3 80 4.8 29 2.7 34 3.7 3.6 4.5 L 77 5.0 92 5.6 33 3.1 46 5.1 4.2 5.4 6/36ths or worse R 8 0.5 11 0.7 7 0.6 15 1.7 0.6 1.0 L 10 0.6 16 1.0 10 0.9 11 1.2 0.8 1.1 Table VI. TEETH. Entrants. Intermediate. Leavers. Boys. Girls. Boys. Girls. Boys. Girls. No. % No. % No. % No. % No. % No. % Perfect set of Teeth 929 61.4 831 59.3 1117 72.3 1147 69.5 587 54.6 665 73.2 One to four Decayed 319 21.1 298 21.3 272 17.6 323 19.6 374 34.7 187 20.6 Four or more Decayed 265 17.5 271 19.4 156 10.1 180 10.9 115 10.7 56 6.2 Totals 1513 1400 1545 1650 1076 908 It is interesting to note that 5,293 children of all groups, or 65.2 per cent., were said to have sound teeth at medical inspection. The percentage of sound teeth found by the Dental Inspectors was 28 per cent. The examination made by the dentists is more searching than that made by the medical inspectors, who are instructed to concentrate rather on purely medical signs. 262 Table VII. SUMMARY OF THE FINDINGS AT ROUTINE EXAMINATIONS. (Percentages.) Condition. Entrants. Intermediate. Leavers. Other Ages. All Groups. Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Cleanliness: (Percentage Clean) Head 100.0 99.1 98.8 98.5 100.0 99.2 100.0 100.0 99.9 98.9 Body 100.0 99.7 99.9 99.9 100.0 99.7 100.0 100.0 100.0 99.8 Clothing (satisfactory) 100.0 99.9 99.8 100.0 98.8 98.3 100.0 100.0 99.4 99.6 Footgear (satisfactory) 100.0 99.9 99.7 99.5 98.8 98.3 100.0 100.0 99.3 99.4 Nutrition (normal) 83.6 83.5 83.4 83.2 87.2 92.1 100.0 100.0 84.6 85.4 Defects: Circulatory System 6.8 6.1 7.3 9.1 4.5 9.5 18.7 ... 6.4 8.1 Pulmonary System 5.4 2.8 1.9 1.9 0.8 0.9 6.3 ... 2.9 1.6 Skin Disease 1.7 1.6 1.7 1.6 1.6 2.3 6.3 ... 1.7 1.8 Defects of Nose and Throat 35.9 34.2 25.3 30.5 8.6 15.0 37.5 ... 24.9 28.2 Enlarged Cervical Glands 16.5 12.9 11.7 14.2 2.9 4.3 31.3 ... 11.2 11.5 External Eye Disease 1.3 1.2 1.0 1.5 1.2 1.1 6.3 ... 1.2 1.3 Defective Vision 0.3 1.0 8.2 7.9 8.6 10.5 12.5 33.3 5.4 6.9 Defective Hearing 0.4 0.4 0.4 0.7 0.3 0.6 ... ... 0.4 0.6 Speech Defects 0.7 0.3 0.7 0.3 0.1 0.1 ... ... 0.5 0.3 Dental Disease (more than four decayed) 17.5 19.4 10.1 10.9 10.7 6.2 6.3 ... 12.9 12.8 Dull and Backward 0.2 0.2 0.7 0.7 0.6 0.2 ... ... 0.5 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, followed by enlarged cervical glands. There is a close relationship between enlarged cervical glands and unhealthy conditions of the nose and throat. In themselves simple enlarged neck glands are of no great moment, but they serve as pointers to unhealthy conditions elsewhere, and may become the nidus of Tubercular infection. Taking all the groups examined subnormal nutrition was recorded in 16.1 per cent. of the children as contrasted with 11.6 Per cent. in 1937. The influence of school work on eyesight is again 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. 263 There is no doubt that school work does lead to a breakdown of normal vision in a fairly high proportion of school children. This may be due to inherently weak accommodation, or to the overtaxing of accommodation by incorrect postures when reading and writing. The tendency of children, unless corrected, is to sit with their eyes too close to the paper when writing or reading and the influence of incorrect posture is considerable in the aggravation of mild myopia. The following Table was compiled from the findings at routine medical inspections, so as to try to ascertain the amount of visual defect in the particular children examined in the various schools. It relates only to those children who were referred from routine medical inspections for treatment or observation and who were consequently thought to be in need of spectacles. Table VIII. School. Intermediates. Leavers. School. Intermediates. Leavers. Boys Girls Boys Girls Boys Girls Boys Girls Ashburton 26.7 26.1 11.8 7.7 Rockmount 4.2 8.3 — 9.1 Benson — 10.7 13.3 10.5 South Norwood 16.0 9.3 ... ... Beulah 1.7 4.8 ... ... Sydenham 5.6 11.1 ... ... Croydon British ... ... ... 10.2 Tavistock ... ... 16.7 13.8 Cypress 8.1 21.9 ... ... Waddon 1.8 3.4 6.4 8.6 Davidson 19.4 20.0 13.6 14.0 West Thornton 7.0 2.9 ... ... Duppas 3.6 1.0 ... ... Whitehorse Manor — 1.7 1.5 ... St. George's Hall ... ... ... ... Winterbourne 4.1 11.0 ... ... Ecclesbourne 7.9 ... ... 15.4 Woodside 10.7 10.5 ... ... Elmwood 2.6 1.9 4.3 4.2 All Saints' — 6.3 — — Gonville 9.4 — ... ... Archbishop Tenison's ... ... ... 9.4 Howard 4.6 9.8 ... ... Christ Church 3.4 11.1 ... ... Ingram ... ... 12.4 13.8 Holy Trinity — 8.6 ... ... Kensington Avenue 21.9 5.9 ... ... Parish Church 4.8 13.0 4.0 ... Kingsley 4.3 10.1 7.5 7.6 St. Andrew's 46.2 3.1 4.2 7.7 Lanfranc ... ... 6.3 13.8 St. Joseph's — — — — Monks Orchard 21.4 13.0 ... ... St. Mark's ... 9.8 ... ... New Addington 18.2 — ... ... St. Mary's Addington ... ... ... ... Norbury Manor 5.8 14.3 5.5 3.8 St. Mary's 16.7 4.3 24.0 29.4 Oval 17.4 12.5 12.2 8.0 St. Peter's ... ... ... ... Portland ... ... 9.4 13.2 St. Saviour's 16.6 — ... ... Purley Oaks 6.6 10.0 6.9 16.6 Shirley 9.1 8.7 ... ... Note.— Where a dash is placed, children were examined, but no visual defects were found. The true meaning of this Table will not be apparent until the findings for 10 years are summarised In this time an Entrant group will have passed through the whole school period. 264 Table IX. Return of Defects Found in the Course of Medical Inspection, 1938. 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 252 32 6.84 225 27 6.36 Uncleanliness— Head 1 ... 0.02 6 ... 0.15 Body Skin Disease 18 6 0.58 13 3 0.44 Eye Disease— Defective Vision 169 56 5.42 186 55 6.08 Squint 47 23 1.69 39 26 1.64 External Eye Trouble 12 6 0.43 12 3 0.38 Ear Disease— Deafness 5 6 0.27 12 7 0.48 Otitis Media ... 8 0.19 3 3 0.15 Other Disease 13 4 0.41 6 ... 0.15 Nose and Throat— Enlarged Tonsils only 23 124 3.54 30 110 3.54 Adenoids only 6 8 0.34 4 4 0.20 Enlarged Tonsils and Adenoids 133 171 7.33 129 153 7.12 Other Conditions 27 23 1.21 15 21 0.91 Enlarged Cervical Glands (not T.B.) 6 7 0.31 2 15 0.43 Dental Defects 62 2 1.54 44 3 1.19 Speech Defects 11 6 0.41 6 4 0.25 Heart and Circulation— Organic 6 24 0.72 9 53 1.56 Functional ... 20 0.48 3 20 0.58 Anaemia 27 16 1.04 38 19 1.44 Bronchitis 8 28 0.87 5 12 0.43 Other Non-T.B. 3 12 0.36 4 5 0.23 Pulmonary Tuberculosis 3 7 0.24 2 15 0.43 Other Tuberculosis 1 3 0.10 ... 1 6.03 Nervous System Disorders (including Epilepsy, chorea, etc.) 2 34 0.87 6 44 1.77 Deformities— Rickets 1 — 0.02 2 ... 0.05 Spinal Curvature 29 40 1.66 42 38 2.02 Others 45 53 2.36 63 53 2.93 Other Defects and Diseases 7 17 0.58 6 14 0.50 Totals 917 736 39.83 912 708 40.90 Total Children Examined 4150 3961 265 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 1937. Entrants 2913 565 19.4 20.5 Intermediates 3195 717 22.5 19.4 Leavers 1984 315 15.9 21.3 Other Ages 19 7 36.8 22.0 8111 1604 19.8 21.7 The fact that 19.4 per cent. of children examined shortly after entering school at 5 years of age required treatment of some kind in an adverse commentary upon the lack of any systematic medical and dental supervision of the pre-school child. The Maternity and Child Welfare Committee during the year made provision for the treatment of children under school ages found to be suffering from minor disabilities. Naturally this only reaches children who are attending the Infant Welfare Centres; but nevertheless it is a considerable step forward towards achieving a reduction in the amount of disability previously found at the first routine medical examination after entering school. Similar Clinic facilities are now available for children under school age as are provided for school children. 266 TABLE XI. CHIEF CAUSES OF EXCLUSIONS FROM SCHOOL. Condition. Exclusions during 1938. Percentage of total exclusions. Exclusions during 1937. Percentage of total exclusions. Ringworm— Head 8 0.10 6 0.09 Body 19 0.24 18 0.27 Verminous Conditions 1682 21.06 1511 23.11 Impetigo 408 5.11 291 4.45 Scabies 171 2.14 95 1.45 Scarlet Fever 287 3.59 467 7.14 Measles 1613 20.20 763 11.67 Diphtheria 202 2.50 212 3.24 Whooping Cough 440 5.51 553 8.46 Chicken Pox 661 8.28 931 14.24 Mumps 1083 13.56 593 9.07 Tuberculosis (all forms) 20 0.25 43 0.66 External Eye Disease 43 0.54 20 0.31 Sore Throat 329 4.12 352 5.38 Other Causes 1020 12.77 683 14.47 7986 ... 6538 ... The figures for exclusions are not related in any way to the figures obtained in routine medical inspections. There were 1,448 more children excluded from school on account of various illnesses than in 1937. The chief causes of exclusion were Infectious Diseases, 53.9 per cent., and of these Measles (20.2 per cent.) and Mumps (13.56 per cent.) were the principal offenders. All the other notifiable diseases showed a decline. There were no exclusions on account of Typhoid Fever during the year. Exclusions on account of verminous conditions were higher than in 1937 and constituted 21.1 per cent, of the total exclusions. The health visitors examined 59,758 children in the schools in connection with their primary inspections for the personal cleanliness of the scholars. Impetigo was more prevalent than in 1937. 267 Table XII. CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS. Name of School. School Population. Measles. Whooping Cough. Chicken Pox. Mumps. Scabies. Impetigo. Sore Throats. Ringworm (Body). Ringworm (Scalp). Indefinite Sickness. 111. Not Infectious Conjunctivitis. Scarlet Fever. Diphtheria. Ac. Primary Pneumonia. Percentage incidence of Infectious Diseases in Schools. Ashburton 728 44 4 46 21 ... 10 ... ... ... 13 2 ... 1 ... ... 11.4 Benson 468 52 ... 7 101 ... 3 1 ... ... 1 5 ... 7 ... ... 35.7 Beulah 1140 144 61 14 7 7 27 27 3 ... 17 56 4 29 12 ... 23.4 Croydon British 117 2 ... ... ... 5 ... 2 ... ... 1 5 ... 1 ... ... 2.6 Davidson 661 55 44 2 79 4 8 18 1 ... 13 27 1 13 ... ... 30.1 Duppas 589 45 12 11 20 11 15 28 ... ... 1 8 4 4 5 ... 16.5 Ecclesbourne 815 102 7 1 3 3 10 10 ... ... 8 19 4 6 11 ... 15.8 Elmwood 1051 61 2 17 41 13 26 3 ... 1 11 32 2 13 4 ... 13.3 Gonville 426 88 3 22 15 2 3 2 ... 1 11 14 ... 11 ... ... 32.6 Howard 388 29 5 7 15 ... ... ... ... ... 2 10 ... 5 1 ... 16.0 Ingram 675 58 5 1 7 1 18 8 ... ... 9 18 1 6 4 ... 12.0 Kensington 353 43 25 28 107 1 6 ... ... ... 3 5 ... 11 ... ... 60.6 Kingsley 1464 66 34 26 28 15 36 33 ... ... 14 66 2 19 18 ... 13.0 Lanfranc 414 2 ... 1 2 13 4 5 1 ... 3 4 1 2 ... ... 1.7 Monks Orchard 239 46 1 6 35 1 4 4 ... ... 9 2 ... 7 ... ... 39.7 Norbury Manor 1078 28 1 29 101 ... 12 2 ... ... 4 11 ... 11 8 ... 16.5 Oval 729 38 24 58 49 1 15 7 3 ... 18 50 2 5 4 ... 24.4 Portland 766 11 29 5 18 11 19 6 ... ... 4 10 1 7 2 ... 9.4 Purley Oaks 483 33 16 7 33 ... 9 3 1 ... 9 26 ... 4 1 ... 19.4 Rockmount 467 63 ... 14 6 2 5 2 ... ... 3 18 ... 7 3 ... 20.0 South Norwood 772 5 22 4 38 5 21 19 1 ... 7 13 1 5 15 ... 11.5 Sydenham 605 18 ... 68 22 1 12 6 ... ... 6 27 3 2 20 ... 21.5 Tavistock 656 8 1 37 38 6 4 23 2 ... 3 22 1 4 1 ... 13.6 Waddon 1092 52 15 18 12 14 12 26 1 ... 10 29 ... 23 7 ... 11.6 West Thornton 774 57 21 1 11 14 8 15 ... ... 8 10 4 11 5 ... 13.7 Whitehorse 724 70 4 5 32 6 34 13 1 ... 8 57 4 5 27 1 19.9 Winterbourne 1059 58 2 74 42 ... 4 5 ... ... 3 21 ... 15 8 ... 18.8 Woodside 975 9 28 60 17 4 9 18 1 ... 12 24 ... 6 9 ... 13.2 Heath Clark 405 1 ... 3 6 ... 1 ... ... ... ... ... ... 2 ... ... 3.0 John Ruskin 366 1 ... 2 2 ... ... ... ... ... 1 2 ... ... ... ... 1.4 Lady Edridge 347 ... 1 ... ... ... 2 ... ... ... ... ... ... ... ... ... 0.3 St. Christopher's 134 1 ... 1 2 ... 3 ... ... ... 2 1 ... ... 2 ... 4.5 St. Giles 183 6 ... 3 2 ... 1 1 ... ... ... 5 ... ... 3 ... 7.6 Myopic Class 42 3 ... ... 1 ... ... 1 ... ... 1 4 ... ... 1 ... 11.9 Addington St. Mary's 88 7 ... 7 8 ... 1 6 ... ... 2 6 ... ... ... ... 25.0 All Saints' 331 10 1 11 3 2 4 3 ... ... ... 6 3 5 2 ... 9.7 Arch. Tenison's 338 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 0.6 Christ Church 407 59 11 1 7 6 22 6 2 ... 6 20 1 5 3 ... 21.1 Holy Trinity 245 46 1 21 2 ... 3 2 ... ... 1 15 ... 1 ... ... 29.0 Parish Church 527 11 1 17 22 6 4 16 ... 1 8 34 ... 6 7 1 12.3 St. Andrew's 387 34 1 3 60 5 12 3 ... 1 9 24 ... 1 3 ... 26.3 St. Joseph's 232 ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 0.4 St. Mark's 160 14 8 14 14 ... 1 1 ... ... 2 5 ... ... ... ... 31.2 St. Mary's 363 6 18 2 ... ... 4 2 ... ... 3 14 ... 4 3 ... 9.4 St. Peter's 116 37 12 1 6 ... ... ... ... ... 2 22 ... ... ... ... 48.3 St. Saviour's 246 ... ... 2 2 5 10 ... 1 1 ... 5 ... 2 4 ... 4.0 Shirley 235 35 1 3 38 ... ... ... ... ... ... 3 ... 1 1 ... 33.6 St. Michael's 239 ... ... ... ... 2 1 ... 1 ... ... ... 1 ... 1 ... 0.4 Selhurst Grammar 933 ... ... ... 1 ... ... ... ... ... ... ... ... 2 ... ... 0.2 St. George's 71 36 5 ... 1 5 3 ... ... ... 3 2 2 1 ... ... 60.6 Cypress 331 19 13 1 6 ... 1 ... ... ... 2 8 1 15 ... ... 16.3 Addington Temporary 89 ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... 1.1 Totals 1613 440 661 1083 171 408 329 19 8 253 767 43 287 202 5 263 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 Kensington Avenue (60.6) and Monk's Orchard (39.7), due chiefly to Measles and Mumps; next were Benson (35.7) and Shirley (33.6), also due chiefly to the same diseases. The lowest incidence was in Selhurst Grammar (0.2). Scarlet Fever. Two hundred and eighty-seven cases were notified from the schools, 180 less than in 1937. Beulah (29) and Waddon (23; had the most cases. Diphtheria. Two hundred and two oases were notified from schools. This was 10 less than in 1937. The Whitehorse Manor with 27 cases and Sydenham with 20 cases had the highest individual numbers. Mumps. One thousand and eighty-three cases were notified from schools. Kensington (107) and Benson and Norbury Manor (101) had the highest individual numbers. Chicken Pox. Six hundred and sixty-one cases occurred in schools and were notified therefrom, 270 less than last year. Winterbourne (74), Sydenham (68), Woodside (60), and Oval (58) showed the highest incidence. Whooping Cough. Four hundred and forty notifications were received from schools, 113 less than in 1937. The highest numbers for individual schools were. Beulah (61) and Davidson (44). Measles. Sixteen hundred and thirteen cases occurred in schools. Those showing the highest incidence were Beulah (144), Ecclesbourne (102), and Gonville (88). 269 FOLLOWING UP. There axe 24 Health Visitors, who devote 5/11ths of their time to school work. During the year 2 additional Health Visitors were appointed. 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 five whole-time dental assistants. The nurses assist at routine and special medical inspections in the schools and pay periodical visits to schools for cleanliness surveys and to investigate outbreaks of infectious disease. With the helpful co-operation of the Chief Enquiry Officer and his staff, persistent offenders against cleanliness have been preceded against in Court, others have been brought before the Committee and warned. One case of persistent uncleanliness was taken to Court after all per suasive efforts had failed to bring about improvement. School Visits. The following Table summarises the visits paid, etc., in connection with these duties:— Visits to Schools re Cleanliness 49 Total Visits to School Departments re Cleanliness 464 Number of children inspected for cleanliness (first inspection) 59,758 Number of children inspected (subsequent inspections) 2,477 Number of children found unclean (first inspection) 1,682 (2,054 occasions of infestation) tation) Number of occasions in which children found unclean (subsequent inspections) 1,123 In addition, 1,468 "other visits" to schools were made. Home Visits. Concerning defects found at routine medical inspections 1,180 Subsequent visits re defects found at routine medical inspections 615 Visits re special cases 1,553 Visits to dental cases 93 Visits in connection with infectious cases and other visits (including 116 visits concerning uncleanliness) 14,960 270 These figures show an increase of 62 in the number of children inspected for cleanliness; an increase of 513 in visits paid in connection with infectious cases and other visits for miscellaneous reasons, a decrease of 28 in the following-up visits to dental cases; an increase of 759 in visits to special cases; a decrease of 743 in the visits made regarding defects found at routine medical inspections, and a decrease of 20 in the home visits regarding uncleanliness. TREATMENT. The Work of the School Clinics. Table XIII. Summary of Attendances. 1938. 1937. Increase or Decrease. Minor Ailments Clinics 13864 11042 + 2822 Inspection Clinic 3581 1872 + 1709 Dental Clinics 18833 19225 - 392 Ophthalmic Clinic 4828 3562 + 1266 Orthopaedic Clinic 1307 1465 - 158 Remedial Exercises Clinic 8729 8474 + 255 Nose and Throat Clinic 884 1220 - 336 Ionization Clinic 493 424 + 69 Rheumatism Clinic 552 438 + 114 53071 47722 + 5349 The Minor Ailments Clinics. Clinics are held each morning at Lodge Road and on five mornings at Selhurst Road, and at Duppas School. One nurse is in attendance for the whole session, and a doctor attends when possible to see cases referred. 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 any further action that may be necessary. At the subsidiary Clinics held at 206, Selhurst Road on five days weekly, 904 children made 3,470 attendances, and at the Duppas School 748 children made 5,323 attendances. 271 Table XIV. 1938 1937. Complaint. Cases. Attendances. Average No. of Attendances. per case. Cases. Attendances. Average No. of Attendances. per case. Ringworm of Scalp 12 339 28.2 6 20 3.3 Body 24 130 5.4 13 55 4.3 Scabies 98 356 3.6 72 358 5.0 Impetigo 183 1237 6.8 203 909 4.5 Other Skin Diseases 82 236 2.9 119 394 3.3 Otorrhoea and other Ear defects 328 1868 5.7 243 881 3.6 External Eye Disease 260 1028 4.0 276 1946 7.1 Miscellaneous 1644 8328 5.1 1639 6479 3.9 2631 13522 5.1 2571 11042 4.3 From this Table it is seen that the average number of attendances per child increased from 4.3 to 5.1; the total attendances increased by 2,480, and the number of individual cases by 60. Adenoids and Enlarged Tonsils. During 1938, 60 cases of tonsils only, 12 cases of adenoid? only, and 288 cases of adenoids and enlarged tonsils, a total of 360 cases, were recommended for treatment. There were 61 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 children were examined at the Throat Clinic the week prior to the operation. 306 children were operated upon, a decrease of 102 on 1937. 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. Children admitted to Mayday Hospital are kept for a minimum of 5 days in hospital. All children are conveyed home by ambulance. In all there were 192 non-attendances. 272 Of the 306 children operated on 177 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 58 per cent. compared with 57 per cent. in 1937. 32 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. 118 were operated upon in Mayday Hospital. These were children over the age of 12 years, or for whom the parents had expressly desired the operation done in the hospital. The Inspection Clinic. The object of the Inspection Clinic is (a) to examine children referred by parents or teachers for special examination; (b) children sent by school enquiry officers for an opinion as to their fitness or otherwise to attend school; (c) children referred for examination under the provisions of the Education Act, 1918, Sec. 15; (d) cases in whom a further examination is desired after routine medical inspection; (c) children referred under the Juvenile Employment regulations. 3,581 attendances were made by children during the year, an increase of 1,709. 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 1242 21 1263 771 21 775 21 Secondary Schools 251 14 265 160 14 175 14 1493 35 1528 931 35 950 35 This Clinic showed an increase upon 1937 of 197. 273 Orthopaedic Work. The Orthopaedic Scheme continued 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 Welcome Hall, Scarbrook Hill; (c) The St. Giles' School, Addington. Table XVI. Spinal and Other Remedial Clinics. 1938. 1937. Attendances. S essions. Av. att. Attendances. Sessions. Av. att. Spinal 2,650 527 5.0 2,735 540 5.1 Massage 155 155 1.0 172 172 1.0 Flat Feet 1,991 230 8.7 1,587 206 7.7 Breathing 2,575 261 9.9 2,792 261 10.7 7,371 1,173 7,286 1,179 St. Giles' School, Addington. Total number of female patients 20 38 Total number of male patients 18 Total number of attendances 1,358 Total number of sessions 203 Average attendance per session 7 No. of cases still under treatment 17 Complaints. Male. Female. Total. Spastic Diplegia 4 1 5 Kyphosis 3 — 3 Hemiplegia 1 1 2 Infantile Paralysis 1 1 2 Talipes — 2 2 Post. Op. Tonsils and Adenoids 2 2 4 Scoliosis 4 8 12 Knock-knee and Flat-foot 2 2 4 Muscular Dystrophy — 1 1 Lordosis — 1 1 Tb. Knee — 1 1 Contracture Due to Scar 1 — 1 Total 18 20 38 271 THE SCHOOL DENTAL SERVICE. The Dental Staff now consists of five full-time Dental Officers. There has been one addition to the staff during the latter part of the year, the equivalent of whose whole time is occupied with work for the Mother and Child Welfare Scheme. The Dental Service deals not only with the inspection and treatment of those attending the Elementary, Central and Special Schools, but also with a large number of scholarship holders at Secondary Schools. Treatment is provided in addition for patients referred under the Maternity and Child Welfare, Tuberculosis, and Mental Deficiency Schemes. During the year the reconstructed Dental Clinic in Lodge Road was opened. These premises, which provide three surgeries and ancillary rooms and offices which all work together in one centralised unit, are proving most popular with all who attend. The Branch Clinics at South Norwood and Duppas Hill have thoroughly established themselves and are giving exceedingly good service, though facilities are somewhat limited in many respects. Two outlying districts—Noribury and the Shirley-Addington area—still have no provision made for treatment locally, hence mothers and children are faced with travelling long distances to receive attention. In cases of large families and difficult circumstances this places an unnecessary strain on parents both financially and otherwise. Both these areas are developing very rapidly, and the need for the provision for treatment in them is becoming more and more urgent. As the Central Clinic, Lodge Road, is forced to serve such a large area, the congestion of work in it is very great and in spite of the recent redesign and additions, is quite unable to deal with the demands made upon it. Staffing. There have been the following changes in staff during the year: Mr. Oliver vice Mr. Fletcher; Mr. Urbani vice Mr. Davie; Miss Hathorn appointed. Despite the recent addition to the staff the number of dentists is still inadequate to give the necessary annual attention to all who accept treatment. 275 There are only four dentists available for the whole of the School Population of just under 26,000 children. This figure approximates to over 6,000 children to each Dental Burgeon, and exceeds that advocated as a maximum in Circular 1444 of the Board of Education, viz., 5,000. The latter applies only in the case of a 50% acceptance for treatment, and as recent returns now indicate a rate of 60% locally, the discrepancy is thereby increased. In addition allowance must be made for time spent with work for the Tuberculosis Scheme which continues to increase in volume. At least one additional whole-time dentist and dental attendant is urgently required to make the School Dental Service approximately adequate. Some of the disabilities caused by the inadequate staff are easily deduced from a careful perusal of the work done during the year. It is unfortunately true to say that a considerable portion of the work in only temporarily palliative and by being so is merely patching up and not preventative. Inspections. The present arrangements allow most of the schools to be visited only once in two years, consequently a very large number of defects were disclosed at the inspections. In the older children most mouths showed at least 4 or 5 teeth that required fillings and several needing extraction. In a large percentage this is not due to neglect on the children's part but simply that treatment cannot be offered at frequent enough intervals to keep pace with the ravages of decay. Out of a population of 25,740 attending the Elementary and Central Schools, 14,300 were inspected and 10,255 referred for treatment compared with 17,747 inspected and 13,498 referred in 1937. The reason that fewer children could be inspected was that a large amount of work from the previous year had to be completed before fresh schools could be begun. The percentage of children suffering from dental disease was 71% as compared with 76% in 1937. This figure should not be interpreted as necessarily an improvement in the condition of the mouths, but rather that as many children were forced to seek casual treatment before their re-inspection could be made. The number inspected represents 55% of the total school roll as compared with 68% in 1937. Sessions devoted to inspection totalled 103 as against 108 the previous year. The smaller number 276 of children inspected per session allows for a greater degree of accuracy and gives more opportunity for getting into personal "contact" with each individual child. The total number of children with healthy dentitions was 9,704. This figure represents 4,045 found healthy at dental inspections and 5,659 rendered artificially sound as compared with 4,249 sound and 5,194 cured last year. Treatment. Details of treatment show a steady increase in the amount of work performed, especially on the conservative side. Every effort is made to concentrate on the younger age-groups, so that they may reap the maximum benefit from the scheme. Many of theae have received treatment as pre-school cases and are proving excellent patients. As the facilities are increased every effort is being made to give each child a more complete treatment, instead of the merely " palliative " measures, that do little to improve permanently the condition of the mouth. The above method of treatment is continually stressed by the Board of Education as being one of the chief conditions in the working of a satisfactory scheme. Every precaution is taken to render operations as painless as possible, and in so doing to banish the bogey of the Dentist's Chair. It has been found that purely "wholesale" methods do not obtain the desired effect and in many cases have only proved an obstacle to further treatment. Owing to the bad condition of the mouths found at inspections a very large amount of time had to be devoted to each child, hence the number for which work was done will be seen to be less than the previous year. This was 7,614 as against 10,404 in 1937. The number cured increased from 5,194 to 5,659, the aggregate of Treatment sessions being 1,585 against 1,551 in 1937. The ratio of inspection sessions to treatment sessions was 1:14.4 compared with 1:8 for the country as a whole. Fillings in permanent teeth increased from 8,603 to 8,879; fillings in temporary teeth numbered 949 compared with 923 the previous year. The number of fillings per 100 children treated has risen considerably and stands at 120.9 compared with 91 in 1937. 277 ''Other Operations" for the year, which include a large amount of conservative work, stand at 4,675 compared with 4,061. This figure includes some 18,000 Zinc Oxide Dressings, 520 additional dressings in temporary teeth, 310 applications of Silver Nitrate, Scalings, Gum Treatments, etc. Special Treatments include— Treatment of septic roots in Anterior teeth, 17. Removal of Nerves under local anaesthetic, 8. Gingivectomy, 3. Removal of Bone Sequestra, 1. Porcelain Crowns for Anterior tooth, 1. Splints for fractured incisors, 2. Minor operations on gums, tongue and fraenum, treatment of haemorrhage, etc. 26 vulcanite dentures were inserted to replace teeth lost by caries or traumatic injury. Extraction of Teeth. The number of permanent teeth removed for caries and Orthodontic reasons was 3,003 compared with 2,946 in 1937. The removal of temporary teeth was slightly lower than last year at 11,495 compared with 12,025. Local anaesthesia was used on 3,688 occasions against 3,570 in 1937, for extraction of teeth and preparation of sensitive cavities. Nitrous Oxide was administered on 2,668 occasions as compared with 2,640. At Lodge Road Treatment Centre "gas" is administered by the dental surgeons who devoted 118 sessions to this work. At the Selhurst and Waddon Clinics the administration is performed by medical officers and 85 sessions were set apart for this purpose. Special Cases. The number of Special forms issued by Head Teachers was 2,379 compared with 2,384 in 1937. This figure, however, does not include the large number of written requests for treatment that are received at the Clinics daily. It is regrettable that this form of treatment is of such dimensions that routine appointments are considerably interfered with. Until, however, it is possible to provide each child with a complete annual treatment, no reduction can be expected. 278 Acceptance Rate. The acceptance rate for the year has risen from 57.5% in 1937 to 60% last year. This shows a steady increase in the public appreciation of the scheme which though gratifying in many respects also places a greater burden on those concerned and increases the interval at which all can be re-treated. Every effort is made not to waste time treating cases of persistent "refusals." It is, however, often impractical to exclude them entirely from treatment, especially where private attention cannot be afforded. Attendances and Charges for Treatment. The total number of attendances for the year was 18,833 compared with 19,225 for 1937. The Clinic charges for treatment are now at the "flat rate" of 1s. per annum, with an extra charge of 2s. for each administration of gas. The above arrangement is working extremely well, though in cases of proved inability to pay this charge is temporarily "waived." The sum of £418 l1s. was received in payment for treatment and £5 3s. 1d. from the Voluntary Box contribution. Cases X-Rayed. The number of cases referred to Mayday Hospital for X-Ray examination was 103 as compared with 84 in 1937. This form of examination is a most valuable aid to diagnosis, especially prior to Orthodontic treatment or in cases of traumatic injury and impacted teeth. Special times are reserved on two days a week for dealing with dental cases of this type at the Hospital. Treatment of Scholarship Children. Scholarship children are treated at all the clinics and the following is a summary of the work:— Attendances 411 Gas Cases 25 New Cases Treated 123 Local 51 Fillings—permanent 324 Cases Completed 52 Extractions — permanent 96 Root Fillings 2 Extractions — temporary 20 Crowns 1 Other Operations 118 Dentures fitted 4 Referred X-Ray 4 Appointments not kept 50 279 In common with those attending Central Schools, these children require a considerable amount of attention, but on the whole are very good patients and most appreciative of work done. It is essential that some scheme of inspection and treatment should be carried out for this class of child, but with the present number of dental personnel this is impossible. It should be remembered that after the age of 12 twice as much time is required to give satisfactory treatment. Propaganda. The Dental Surgeons give "talks" to the parents of children having their first school inspection. Parents are also urged to accompany their children when attending the Clinics for treatment. In this way individual points can be explained and many misunderstandings avoided. Orthodontic Treatment. The Orthodontic Scheme for the regulation and "straightening" of teeth continues to give very gratifying results. There were, however, many urgent cases that could not be dealt with as only a limited amount of time can be allotted for this work. A summary of the treatment performed during the year is as follows:— Cases under treatment 129 Completed 91 Appliances Inserted: Removable 283 Fixed 9 Attendances 2,463 No. of Sessions 89 Summary of Work Done at the Selhurst Road Clinic. 1938. 1937. Attendances 4,682 5,100 Extractions 4,174 4,244 Fillings 2,415 2,483 Other Operations 1,290 1,280 "Gas" Cases 518 634 Local Anaesthesia 1,634 1,491 Cases Completed 1,865 1,693 Sessions held: Inspection 33, Treatment 372, Gas 44. The average attendance at this clinic per session is 10.7. 280 Summary of Work Done at the Waldrons Clinic. 1938. 1937. Attendances 3,787 4,161 Extractions 2,522 2,831 Fillings 2,353 3,054 Other Operations 811 756 Scalings 88 101 "Gas" Cases 499 556 Local Anaesthesia 454 640 Cases Completed 1,197 1,379 DENTAL DEFECTS. (1) Number of children who were— Year 1937. (a) Inspected by the Dental Officers.— Aged 5—6 915 Total: 14,300 1,025 „ 6—7 1,460 1,733 a 7—8 1,533 2,070 „ 8—9 1,599 2,046 ,, 9—10 1,454 1,895 „ 10—11 1,587 1,633 ,, 11—12 1,337 1,617 „ 12—13 1,515 1,778 ,, 13—14 1,536 1,951 ,, 14—15 934 1,335 ,, 15 up 430 664 Specials 2,379 2,384 16,679 20,131 (b) Found to require treatment 12,634 15,882 (c) Actually treated 7,614 10,404 (2) Half-days devoted to inspection 103 108 Do., treatment 1,586 1,551 Do., administration 30 12 Do., gas administration— (by dental officers) 118 94 (by medical officers) 85 97 Do., orthodontia 89 47 2,011 1,909 281 (3) Attendances made by children for treatment 18,833 19,225 (4) Fillings—Permanent teeth 8,879 8,603 Temporary teeth 949 923 9,828 9,526 (5) Extractions—Permanent teeth 3,003 3,019 —Temporary teeth 11,495 12,025 14,498 15,044 (6) Administrations of general anaesthetics for extractions 2,668 2,640 (7) Administrations of local anaesthetics for extractions 3,688 3,570 (8) Other operations— Permanent teeth 4,155 3,940 Temporary teeth 520 121 4,675 4,061 EAR CLINIC. This clinic is held at weekly intervals at Lodge Road Treatment Centre, for school children and children under school age. Cases are referred for treatment to the Clinic mainly by the Assistant School Medical Officers and the Medical Officers of the Infant Welfare Centres, and are seen by appointment. The treatment advised and administered at the weekly Ear Clinic is continued where deemed necessary at daily intervals through the agenoy of the Minor Ailments Clinic. The early investigation of children with discharging ears and the subsequent frequent treatment by thorough cleansing of the ears is most important in the prevention of deafness in later years. 1938. 1937. The number of sessions held 47 45 No. of first attendances 76 66 No. of re-attendances 417 372 Total number of children treated or investigated 120 76 Of this total of 120 children, 12 were under school age and 44 were cases continuing treatment commenced in 1937. 282 The following is a brief summary of the action taken in cases classified in these Groups:— Group I.—14 cases. In the majority of these cases the defect found was an accumulation of wax blocking the meatus, symptoms clearing up after the wax had been removed by syringing. In other cases symptoms were due to furunculosis of the meatal wall, these cleared up with either fomentations, swabbing with Argyrol, application of iodex or careful cleansing. Group II.—8 cases. Four of these cases suffered from congenital nerve deafness, one of whom was admitted to St. Giles' School for physical Defectives and utilises a valve hearing aid apparatus, the other three cases were slight; in one of these a recommendation was made to the head teacher that the child should be seated in the front row of the class. Four cases suffered from Eustachian deafness. Two were recommended removal of tonsils and adenoids, one for Eustachian catheterisation at the Croydon General Hospital and one benefited by alkaline nasal lotion and ointment and the use of a benzedrine inhaler. Group III.—98 cases:— Found dry and requiring no treatment 13 Found dry but recommended tonsillectomy 1 Active cases of otorrhoea 84 These 84 cases of actively discharging ears were treated as follows:— Seventy-eight were treated with insufflation of iodized boracic powder, several of these having had preliminary treatment during the first few attendances with glycerine and carbolic drops or swabbing with Argyrol. Fifty-four of these cases were discharged during the year with dry ears; in many cases the perforations in the drum had healed. These 120 cases were classified into three main groups:— 1938. 1937. Group I.—No evidence of otorrhoea past or present, or deafness of more than a trivial or temporary nature 14 12 Group II.–Deafness only 8 7 Group III.—Otorrhoea, active quiescent or cured 98 57 283 Four were referred to the Croydon General Hospital, on two of these mastoidectomy was performed, one case had an aural polypus removed, and in one case continuance of conservative treatment was recommended. Three cases only were treated by ionization, in one there was marked improvement, in one slight improvement, one did not respond to this treatment. The attendance at the Clinic during 1938 has markedly increased. The treatment of chronic ottorhoea with insufflations of 0.75% iodine in boracic powder has been most successful, preliminary thorough and careful cleansing is required otherwise the method is not satisfactory.The foul smelling discharges rapidly lose their offensive character, granulations disappear, the drum becomes much more healthy in appearance and in the majority of cases the discharge completely ceases. RHEUMATISM CLINIC. The Rheumatism Clinic is concerned with the diagnosis, supervision, advice and re-examination of cases of juvenile rheumatism. Though this Clinic is advisory and no medical treatment is undertaken, the following facilities for providing the appropriate treatment are available. In the active and acute stage of the disease, children are referred for Hospital in-patient treatment, or, where home conditions are favourable, for domiciliary treatment by the patients' own doctor. The mild and potential cases benefit greatly by a period of convalescence at Coombe Cliff Convalescent Home. With extra rest, a nourishing and well-balanced diet, and supervision under satisfactory hygienic conditions, the symptoms of rheumatism or debility frequently clear up. For other suitable cases extra nourishment in school, such as milk or cod liver oil and malt, is provided. Cases of fully developed chronic valvular heart disease, who are medically unfit to attend a public Elementary School, are recommended to St. Giles' School for Physical Defectives. Children who have recently been discharged from hospital or convalescent home following a rheumatic attack, or children whose hearts are affected and might be injured further by undue 284 exertion, are excluded for a suitable period from partaking in games, drill or school swimming. It should be emphasised, however, that both from the mental and physical well-being of the child, it is inadvisable to limit normal activities more than is absolutely necessary. Children in whom rheumatic manifestations are quiescent and who have a mild fully compensated cardiac lesion, and others in whom a systolic murmur is purely functional, may be turned into introspective invalids by exclusion from the normal school routine. In all cases the general health is carefully watched and particular attention is paid to the tonsils and teeth, treatment being provided when required. The houses of all new cases attending the Clinic have continued to be inspected by a Sanitary Inspector, and notices are served on the owners for any necessary repairs; or the family recommended for consideration for a Council house. Rheumatism is an insidious disease. Acute rheumatic fever is far less common that the vague joint pains or mild chorea so frequently met with. The mild form, in which there are only vague joint pains or mild muscular twitching, may cause irreparable cardiac damage if neglected or overlooked; it is for this reason, and because relapses are common, that the constant supervision afforded by the Clinic is so necessary. Many children who complain of muscular pains in the limbs are not rheumatic, but are suffering from, minor postural or orthopaedic defects; these are referred either for remedial exercises or to the Orthopaedic Clinic. In others, there may be associated with the pains, such conditions as debility, malnutrition, anaemia and mental and physical tiredness; excellent results are achieved by sending such children to the Open Air School for a period of a year or eighteen months, where the "debility pains" soon disappear. Difficult and severe cases have been referred to the OutPatients' Department at Croydon General Hospital, where Dr. Preston, as in previous years, has very kindly given his assistance and advice. 285 The statistics of the work accomplished have been drawn up on the same lines as those in previous reports, so that a comparison can be readily obtained. The total number of children whose names were on the "live" register at the end of 1938 was 457. Table XVII. Cases Examined at Rheumatism Clinic. 1936. 1937. 1938. Primary 154 187 89 Re-examinations 407 479 438 561 666 527 Rheumatic 145 (94.2%) 158 (84.5%) 76 (85.4%) Non-Rheumatic 9(5.8%) 29 (15.5%) 13 (14.6%) 154 187 89 A satisfactory feature of the year's working was that 163 children (who had been under observation) were considered quite free from rheumatism with normal hearts and were discharged from further attendance at the Clinic. The number of new cases referred to the Rheumatism Clinic showed a marked decrease this year. The number of re-examinations of cases on the "Live Register" showed little change. Classification of Rheumatic Cases- Primary. Re-examination. Sex—Males 33 (43.4%) 231 (52.7%) Females 43 (56.6%) 207 (47.3%) Total 76 438 Age when Examined— Ages 5 6 7 8 9 10 11 12 13 14 15 Primary 7 10 6 9 11 11 8 7 6 1 — Re-examinations 3 16 49 39 53 55 61 76 51 23 12 286 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 9 cases Group II.—Symptoms suggesting the presence of toxaemia, e.g., aching limbs, lassitude, headache 70 cases Group III.—Symptoms suggesting a disturbance of the nervous system, e.g., irritability, disturbed sleep, nocturnal eneuresis, fidgetiness 36 cases Groups II. and III. include the majority of cases. In many cases there is a combination of the symptoms specified in Groups II. and III., varying in severity according to the type of case observed. 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. Grouping of Cases (Classification of Dr. R. Miller). 1937. 1938. Mild and Potential 120 (76.0%) 59 (77.6%) Definite Active 23 (14.5%) 7 (9.2%) Definite Quiescent 15 (9.5%) 10 (13.2%) 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: 76 cases. Rheumatic Pains 65 (85.5%) Rheumatic Fever 8 (10.5%) Chorea 6 (7.9%) Carditis, Definite 10 (13.2%)* *Slight 5 (6.6%) *Marked 5 (6.6%) Carditis, Suspected 4 (5.3%) Tonsillitis 18 (23.7%) 287 Rheumatic Fever Cases. There were 8 children who gave a definite history of Rheumatic Fever. Of these, 4 had sound hearts, and 4 had definite carditis. Chorea Cases. There were 6 cases of Chorea. Of these, 2 had definite carditis, 1 slight or suspected, and 3 sound hearts. Family Histories. In the case of 28 families (36.8%), either the father or the mother had had rheumatic fever, chorea or juvenile rheumatism. In 11 other eases (14.5%) a history of rheumatism was obtained in near relatives of the parents. In the case of 23 children (30.3%) their brothers or sisters gave a similar history of rheumatic manifestations. Skin Conditions. Recorded in 76 cases. Fair 46 (60.5%) Dark 30 (39.5%) Moist skin and a history of liability to sweating was recorded in 9 cases. A history of flushing and rashes in 28 cases. Nervous Conditions. Recorded in 76 cases. Children recorded as highly strung 38 (50.0%) Headaches 32 (42.1%)* *Occasional 28 (36.8%) *Frequent 4 (5.3%) Night terrors, etc. 18 (23.7%) † †Slight 17 (22.4%) † Severe 1 (1.4%) Enuresis 11 (14.5%) Twitchings 12 (15.8%) Often a combination of more than one of the above symptoms was manifested. Catarrhs. A history of various catarrhs, not tonsillitis, was reported in 10 cases (13.2%). Tonsillectomy. Operation reported in 27 cases (35.5%). 288 Re-Examinations. Four hundred and thirty-eight re-inspections were carried out. In 17 (3.9%) of these the conditions had become worse; 16 (3.7%) was considered to be non-rheumatic; 63 (14.4%) stationary; 93 (21.2%) were definitely improved; and 249 (56.8%) quiescent. Environment and Other Conditions in Rheumatism Clinic Cases. Reported in 76 cases. Wards.—Cases were drawn from all Wards in the Borough with the exception of South and Addington. Woodside 5 Thornton Heath 3 Addiscombe 4 Bensham Manor 5 South Norwood 4 West Thornton 10 Upper Norwood 4 Waddon 17 Norbury 3 East 3 Whitehorse Manor 8 Central 4 Broad Green 5 Housing Conditions—Drainage of Subsoil and Condition of Houses. Sixty-one of the houses were sufficiently drained and 9 were well drained; in 6 drainage was problematical. Houses which were perfectly dry and did not show any signs of dampness numbered 42, whilst 24 showed traces of damp: 8 were damp; 2 houses were specified as very damp. Of these two latter houses, in one case a notice was served for remedying the defect, in the other case the family was living in a basement room, which is scheduled for inspection and closure. Aspect. The aspects of the houses were as follows:— 161 cases reported. S.E. 10 S.W. 8 E. 11 N.E. 10 N.W. 9 S. 8 N. 10 W. 10 The majority of houses in which cases occurred were ordinary terrace houses (40), 35 were semi-detached, and 1 was a detached house. Economic Status. The economic status of the families from whom patients were examined was as follows:— Poor in 11; average working class, 39; better working class, 17; clerical work, 7; and superior, 2. The interior home conditions were classified as follows:— Clean, 55; moderately clean, 13; superior, 8. 289 CHILD GUIDANCE. SUMMARY OF CASES REFERRED TO CHILD GUIDANCE CLINICS DURING 1938. No. M. Age. Why referred. By whom referred. Where referred. Action taken and result of treatment. F. 1 F. 13 Lack of confidence, timid, slow progress at school. Headmistress. London Child Guidance. Satisfactory progress made. 2 F. 12 Nightmares, irritable and restless. Do. Do. Satisfactory results. 3 F. 10 Pilfering, difficult to discipline. Do. Do. Great improvement. 4 F. 11 Lack of confidence, stammer. Principal Royal Normal College. Do. Recommended admission to Grange Court School. 5 M. 14 Emotional : sex education. Speech Clinic. Do. Great improvement 6 M. 7 Speech. Do. West End Hospital Nervous Diseases. Great improvement 7 M. 8 Speech. Do. Do. Attended only for consultation. 8 M. 12 Aberrations of conduct, stealing. Town Clerk, Gravesend. Mayday Clinic. Present surroundings unsatisfactory—recommended change of home. 9 M. 8 Sleep walking and speech defect. Speech Clinic. Do. Made steady progress— ready for discharge. 10 M. 8 Instability. School Medical Officer. Do. To be boarded out. 11 M. 5 Uncontrolled behaviour. Highly excitable and destructive. Parent. Do. Started school and settling down well. 12 F. 10 Unruly, lying and stealing. Headmistress. Do. Improved—parents not co-operative and irregular attendance. 13 F. 9 Untruthful, petty theft. Parent. Do. Did not keep appointment after first interview. 14 M. 9 Petty theft. Prob. Officer. Do. Discharged improvedhigh intelligence. 15 M. 8 Stealing. Parent per Headteacher. Do. Still attending—slight improvement— parents difficult— father attending clinic with son each week. 16 F. 14 Apathetic, inert. Headteacher Do. Home conditions difficult—continue attendance. 17 F. 14 Self-consciousness. Do. Do. Some improvement— still attending. 18 F. 5 Instability. Parent. Do. Under observation for a few months. One case was recommended to attend Grange Court School; in 9 cases progress after attendance at the clinic was satisfactory; in 3 cases although there was improvement, home or other circumstances mitigated against an entirely satisfactory result; in 2 cases conditions were such that it was recommended the child be boarded out; in 2 cases attendance was only made for consultation; and in 1 case diagnosis has not been made, the case still remaining under observation. 290 BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Full statistical details are given in Table III. of the Tables required by the Board of Education. Blind Children. Nine 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, 6 boys and 1 girl; Barclay Blind School, Brighton, 2 girls; Court Grange, Devon, 1 boy; Sunshine Homes, East Grinstead, 2 boys. The Committee are also responsible for the maintenance of 1 girl at the Goodrich Road (L.C.C.) School for Partially-Sighted Children. St. Luke's Special School For Partially Sighted Children. At the end of the year there were 44 children in attendance. Of these, 14 were cases of myopia and 3U were non-myopes. The curriculum is that usually laid down for the myope and the partially sighted, respectively, but is under constant review, and changes are introduced according to experience. Both boys and girls have attended domestic science classes, and physical exercises, suitably restricted for certain children, are in regular use, with a noticeable improvement in carriage and posture. Deaf Children. Eleven boys and 6 girls are resident at special schools for the deaf; 3 boys attend special day schools. The institutions which these children attend are:—Royal School for the Deaf, Margate, 10 boys and 6 girls; Balham L.C.C. Day (Deaf) School, 2 boys, at Oldridge Road; Anerley Deaf School, 1 boy; St. John's Institution, Boston Spa, 1. Epileptic Children. One girl is resident at the Lingfield Epileptic Colony. Mentally Defective Children. In addition to the day accommodation provided at St. Christopher's School, 5 girls are resident in the Monyhull M.D. School, Birmingham ; 1 girl is at Knotty Ash M.D. School, Liverpool, and 11 boys at Besford Court, Worcestershire 291 Physically Defective Children. In addition to 83 physically defective children accommodated at the St. Giles' Day Open Air School, the Education Authority have crippled children in the following special schools:—The Heritage Craft School, Chailey, 3 boys and 2 girls; Lord Mayor Treloar Hospital, Alton, 1 boy; St. Vincent's Orthopaedic Hospital, 2 boys; Victoria Home for Crippled Children, Bournemouth, 1 boy; National Children's Home, Chipping Norton, 1 boy; Hawkenbury Convalescent Home, 1 boy; St. Patrick's Open Air School, Hayling Island, 1 girl; St. Nicholas-at-Wade Convalescent Home, 1 girl; Wingfield-Morris Hospital, Oxford, 1 girl. There are also 102 delicate children in attendance at the extension of St. Giles' School, which now has a total accommodation for 190 children. Speech Defects Class. The tri-weekly class conducted by two trained speech therapists has continued throughout the year and has thoroughly proved its usefulness. The number of children that can attend each class at any given time is limited as each child has to be dealt with individually. Cured. Improved. Ceased Attendance non-cooperation. Referred psych. trt. Temporarily discharged. Still Attending. Stammer 7 2 2 2 12 Lalling and Lisping 6 3 4 Undeveloped Speech 1 1 2 Cleft Palate 1 2 Malformed Palate 2 Post Adenoidal 1 Motor Dysarthria 1 Spastic Palate 1 1 Organic Deafness 1 Aphaisia 3 Cases Discharged. Speech now normal 28 Non-co-operation of parents 3 For psychological treatment 3 292 SCHOOL CAMPS AT PILGRIM FORT, CATERHAM. The following schools sent parties, each of which was under the care of two teachers:— No. of Children.  Boys— Ashburton Senior Mixed 42 Elmwood Boys' 21 Ecclesbourne Junior Boys' 40 Oval Senior Mixed 19 South Norwood Junior Boys' 39 Sydenham Junior Boys' 44 Tavistock Senior Boys' 20 Waddon Senior Mixed 40 All Saints' 40 St. Joseph's 19 Girls— Davidson Junior Girls' 31 Kingsley Senior Girls' 40 *Norbury Manor Senior Girls 45 Oval Senior Mixed 43 Portland Senior Girls' 36 Winterbourne Junior Girls' 40 All Saints' 34 593 *This camp was held during the school holidays at Whitsun. The Fort is equipped for school camps of 40 children and when one school is unable to send this number, two combine, each contributing a party of 20. The period during which the weather is deemed to be suitable for school camps lasts about 20 weeks, and school holidays fall during six of these. In addition, nearly 100 children from the Public Assistance Committee Homes and about 160 other campers used Pilgrim Port. All the children in School camps are medically examined before proceeding to the Fort and the blankets in which they sleep are disinfected each week. 293 JUVENILE EMPLOYMENT RETURN The following numbers of children were examined by the medical officers during 1938 as to their fitness to follow the parttime employment indicated. 1938 1937. 1936 1935. 1934.  Delivery of Goods for Shopkeepers 334 172 151 208 96 Delivery of Newspapers 265 245 245 285 190 Delivery of Milk 68 31 43 42 34 667 448 439 535 320 It will be observed that there has been an increase of 162 in the delivery of goods for shopkeepers; of 20 in the delivery of newspapers, and of 37 in the delivery of milk. Forty-five girls 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 for necessitous children have been continued during the past year. Children are provided with free dinners at the Domestic Subjects Centres of the following schools:—Davidson, Ecclesbourne, Elmwood, Howard, Ingram, Kingsley, Sydenham, Tavistock and Waddon. Milk and cod-liver oil and malt are also provided in school for children suffering from malnutrition. Recommendations for extra nourishment are made by the School Medical Officers, Teachers, School Enquiry Officers and Care Committees. Re-examinations are made every three months, if practicable, by the medical officers in cases referred on medical grounds, when renewal or discontinuance is decided on. 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 14,000 bottles of milk, containing one-third of a pint, are 294 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. 1937. 1938. No. of Children who received Free Dinners 524 660 „ Free Dinners provided 67,357 86,743 No. of Children who received, on the recommendation of the School Medical Officer:— 1937. 1938. Pints. Pints. Free Milk 656-56,375 1,340—127,414 Milk (part payment) 32—1,722 12—447 Milk (whole payment) 56—2,705 9—104 Issues. Issues. Free Malt 192—15,011 210—22,198 Malt (whole payment) 74—3,377 12—642 (N.B.—Milk and malt and oil given on the recommendation of the School Medical Officer are supplied free of cost; voluntary payments, however, are accepted from the parents.) The amounts supplied, as will be seen from the figures, shows a very substantial increase on 1937. The Committee continued, during the Easter, Whitsun, Midsummer and Christmas Vacations, to provide facilities at the Free Dinner Centres for children to receive milk under the Milk Marketing Board's scheme at a cost of ½d. per one-third of a pint. In the Midsummer Vacation, 7,997 bottles were sold; 1,179 bottles were supplied during the Easter Vacation, and 1,285 during the Christmas Vacation. All the milk supplied is Pasteurised milk and the sources of supply are subject to the approval of, and constant supervision by, the Medical Officer of Health. ST. CHRISTOPHER'S SPECIAL SCHOOL. This school is for dull and backward children and those who have been certified as educationally mentally defective but educable. I am indebted to Mr. H. J. Edmonds, the Headmaster, for the following report:— "The past year may be looked upon as one of very definite progress. 295 During the year 27 children were admitted, and 21 left. On December 31st, 1938, there were 136 children on the roll—94 boys and 42 girls. I have again to record a very gratifying level of attendance for the year—89%. It is very pleasing to be able to report on the great strides that the teaching of reading has made in the past year. We have many fluent readers in the school, and many are borrowers from the Public Libraries. Each class now has its own little library. The teaching of physical drill is still very popular and it would surprise many to see what our children can do in this subject. We have now reached the stage when children have to be restrained in their activities, where formerly they needed encouragement. Woodwork is now the most popular subject. 36 boys receive instruction weekly in this most useful part of the curriculum. Very useful models for the home have been made. We have now started a small boot-repairing class, and it is hoped soon to extend this, so as to include a greater number of boys. Four happy years have been spent at Mitcham Road and we are shortly moving to new premises at Warwick Road, where we hope to have more scope for our activities, among surroundings which are far more congenial than our present ones. The provision of excellent hot mid-day meals continues to be a very important factor in building up the children's physical condition and many thanks are again due to the Education Committee for their provision. I must once more record my appreciation of the kindly interest shown by the staff and scholars of John Ruskin School." PHYSICAL TRAINING IN SCHOOLS. Detailed reports have been presented by the Assistant Inspector of School and the Organiser of Physical Training to the Education Committee, and the following is only a precis of the reports. Boys. During the past year efficient provision of physical education and recreation has been maintained, and certain important advances 296 can be recorded. Our Schools have taken their part in the forward movement for National Fitness initiated by the Government, and increased opportunities and material facilities have been provided. Purley Oaks Senior, and Lady Edridge Central School, now in an advanced stage of re-building, will both be equipped with changing rooms, showers, and gymnasia, and the Committee has recently approved plans for the erection of a gymnasium at the lavistock School. The pupils of the newly reconditioned Whitenorse Manor Senior School are already in enjoyment of modern shower bath equipment and dressing rooms. The past year has witnessed a general adoption of suitable clothing for the physical training lesson. All children of necessitous parents are now supplied with plimsolls and Senior boys will be equipped with shorts in the near future. During the past year, nine men have attended Intensive Courses of one month's duration at Scarborough or Loughborough, and one man took a whole year's course of training. A more ambitious programme of apparatus and agility work is being attempted in Senior Schools with trained specialist staffs. Provision is made for the teaching of Country Dancing in the Junior Schools, and Sword and Morris Dancing in the Seuior Schools, as part of our physical training programme. The provision of playing fields has been maintained, and additional grounds have been secured. All available facilities for swimming have been used to the full. For the first time, Winter Swimming has been introduced, and has proved a success. The Inter-Schools Gala, held at the Central Baths on July 20th, was a fine testimony to the all-round excellence of Croydon swimming. The Inter-School field events were organised by the Croydon School Sports Association. Ten Boys' Schools, as against seven in the previous year, attended the camps at the Pilgrim Fort, and the new cooking arrangements, and reduced scales of charges indicate that the popularity of the Fort will increase rather than diminish. 297 There has been an increased number of School Journeys during the year. Parties of scholars have visited Switzerland, Scandinavia, France, Germany, and many parts of the Homeland. Teachers' Courses and Demonstrations have again been held, and the Courses arranged by the Central Council for Recreative Physical Training have been well supported. Our Schools and officers of the Committee gave assistance in the organisation of the rally of the National Fitness Council at the North End Hall in April last. The Croydon Schools Athletic Association has continued its good work during the past year. Its officers have given generously of their free time in coaching, arranging, and supervising sports events. Thirty Schools participated in seven League and Cup Competitions, and a Croydon team reached the divisional final of the English Schools Shield Competition. Once again, the Sports were held at the Galpins Road Ground of the Thornton Heath Sports Club. In spite of rain on the first day, which made the ground heavy, two new records were established, and three were equalled. Eighteen Senior and twelve Junior teams took part in the cricket and this year the number of fixtures was increased. Successful group parties were organised during the Autumn Term, and Folk Dancing activities in individual Schools are increasing. The Swimming Section takes over responsibility for the award of Swimming and Life Saving Certificates. More than 4,000 Swimming and 800 Live Saving Certificates were awarded. Croydon pupils distinguished themselves during the year in the London Schools Swimming Association events by winning the National Sunday League Shield, the Working Men's Club Shield, and the Fabian Shield. Two boys won titles in the Southern Division of the London Schools Boxing Championships. The Schools Amateur Boxing Association provided an exhibition bout on the occasion of Lord Aberdare's visit for the Keep Fit Demonstration in May. 298 Girls. The renewed emphasis on the value of Physical Training, due to the public interest created by the Physical Training and Recreation Act, 1937, has had its effect on the work in the Schools where enthusiasm and efficiency have been maintained. The supply of a certain number of plimsolls for use in Physical Training lessons by children who are unable to provide their own, has continued to be a valuable and much appreciated means of maintaining efficiency and ensuring safety in the physical training lessons. It is hoped to equip all Senior girls who are in need of assistance with shorts in the near future. In spite of lack of changing room accommodation in many of the Schools, it is encouraging to note that the majority of Senior scholars (also many in Junior Departments) now make every effort to wear suitable clothing for physical exercises and the standard of training improves accordingly. Swimming continues to be one of the most valuable and popular branches of Physical Education, and all Central, Senior and Junior Departments, with one exception, sent classes of girls to the Baths during the summer season. Only Senior Departments were included in the winter swimming time-table but this privilege may probably be extended to Junior Departments, as it is found that the scholars from these departments are very keen to continue swimming throughout the year. Particular mention must be made of the work of the teachers out of school hours, when—Winter and Summer—scholars and teachers voluntarily attend the Baths in large numbers and full use is made of the Gift Tickets and Winter admission privileges granted by the Baths Committee. Twenty-one girls' departments held Swimming Galas in addition to taking part in the Inter-Schools Gala in July. Continued use was made of the Playing Fields and Recreation Ground accommodation throughout the Borough, both for the regular organised games' lessons and also for Sports afternoons. Thirty-five schools held their own school Sports afternoons and, m addition, twenty-five arranged Physical Training Displays, Polk Dancing Demonstrations and Inter-House Games Tournaments. The various Folk Dance parties, etc., arranged by the Folk Dance section of the Croydon Schools Sports Association and by the East Surrey Branch of the English Folk Dance and Song Society were well supported as usual. These included an Open 299 Air party in the Playing Field of the Gonville School in June with over 450 children dancing, Group parties at seven centres in November, attended by more than 700 children, and two parties at the Adult School in December, organised by the E.F.D.S. with about 600 children in attendance. School Journeys were taken by girls from various schools to the Isle of Wight (9), Seaford (2), Peak District, Boscombe, West Wickham, Paris, Brittany, Belgium, and Switzerland, while seven schools sent girls' camping parties to Pilgrim Fort. Corrective Classes, for girls with faulty posture, were continued in six schools. The following Courses and Demonstrations were arranged for Teachers:— Courses of Physical Training for Infants' Schools. Three Demonstrations on the Class Teaching of Swimming. Demonstration of Modern Methods of Physical Training. Four teachers attended Vacation Courses in Physical Training, in August, and many attended the various courses and demonstrations arranged by the Central Council of Recreative Physical Training and other bodies, in conjunction with the National Fitness Campaign. In connection with the Polytechnic and Evening Institutes, sixteen Gymnastic and Keep Fit Classes have been held for women and girls. The Croydon Schools Sports Association continued to render most valuable help, by its voluntary organisation of all branches of physical training, out of school hours. The work of the various sections is maintained at a high standard by the many hours of voluntary service of the teachers and their help and co-operation is, as always, greatly appreciated. 300 INSTRUCTION IN SPECIAL SUBJECTS. In the time-table for the year commencing 1st August, 1938, the following provision is made for the instruction of Senior 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). Benson (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, or the school premises. Causes of Death in Children of School Age. Taking the school population as 25,436, the death rate per 1,000 in school children was 1.53. 301 There were 39 deaths in children of school age; those caused by Infectious Diseases, 13; Pneumonia, 3; Tuberculosis, 5; Influenza. 2 Diseases of the Respiratory System, 1; other defined causes, 15: Street Accidents 2 Mastoiditis 1 Lymphatic Leukaemia 1 Aplastic Anaemia 1 Osteo-myelitis 1 Pneumococcal Peritonitis 1 Convulsions 1 Meningococcal Meningitis 1 Aneurysm 1 Chronic Nephritis 1 Little's Disease 1 Rheumatic Fever 1 Endocarditis 1 Pericarditis 1 15 In the Infectious Diseases Group the causes were: Diphtheria, 12; and Scarlet Fever, 1. SECONDARY SCHOOLS. The usual arrangements for the medical examination of secondary school children were continued in 1938; 1,662 children were examined, 519 of whom were boys and 1,143 girls. Table II. of Appendix under this heading gives the detailed findings. 56 boys (10.8 per cent.) and 131 girls (11.5 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 height and weights has been included below. 302 Table XVIII. SECONDARY SCHOOLS. HEIGHTS AND WEIGHTS. 1938. 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. 1932 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1931 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1930 ... ... ... ... ... ... ... 7 50.8 60.8 52.2 66.8 50.7 59.3 1929 ... ... ... ... ... ... ... 12 51.1 60.5 52.7 68.8 47.3 51.8 1928 6 56.0 78.2 57.0 94.0 54.0 65.2 47 55.7 75.6 61.7 110.1 51.9 75.2 1927 130 56.7 81.8 60.4 104.7 53.8 67.4 195 56.9 78.5 60.0 100.4 52.9 61.7 1926 120 57.7 82.8 61.2 103.7 54.8 70.6 193 59.6 89.5 64.3 115.5 54.2 67.4 1925 98 59.9 93.3 65.3 120.5 55.7 74.5 226 60.3 95.1 64.0 121.6 56.9 77.7 1924 66 63.1 109.3 67.7 131.6 58.8 89.4 113 62.0 102.6 65.0 122.5 58.4 83.0 1923 45 65.8 123.2 69.1 143.8 61.3 99.2 171 63.2 110.9 66.0 144.7 59.6 89.0 1922 43 66.6 129.7 72.1 151.2 62.5 106.6 100 64.0 117.0 67.6 139.5 63.0 101.2 1921 20 68.4 136.1 71.3 153.7 66.0 119.0 64 64.0 120.1 67.1 133.9 60.4 103.8 1920 ... ... ... ... ... ... ... 13 64.0 120.2 66.1 133 0 61.0 100.0 303 Table I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups: Year Year 1938. 1937. Entrants 2,913 3,115 Second Age Group 3,195 2,405 Third Age Group 1,984 2,090 Total 8,092 7,610 Number of other Routine Inspections 19 245 Grand Total 8,111 7,855 B.—Other Inspections. Number of Special Inspections 6,866 5,383 Number of Re-Inspections 12,039 12,399 Total 18,905 17,782 C.—Children Found to Require Treatment. Number of individual children found at Routine Medical Inspection to require treatment (excluding Nutrition, Uncleanliness and Dental Diseases). Group. For Defective Vision (excluding squint). For all other conditions recorded in Table 11 a. Total. Total 1937. Entrants 8 342 346 494 Second Age Group 200 341 523 408 Third Age Group 144 120 251 413 Total (Prescribed Groups) 352 803 1,120 1,315 Other Routine Inspections 3 5 7 46 Grand Total 355 808 1,127 1,361 Total visits to Elementary Schools: 492. 304 TABLE II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1938. defect or disease. (1) Routine Inspections. No. of Defects. Special Inspections. No. of Defects. Requiring Treatment. (2) Requiring to be kept under observation, but not requiring Treatment. (3) Requiring Treatment. (4) Requiring to be kept under observation, but not requiring Treatment. (5) Skin— (!) Ringworm: Scalp ... 1 ... ... (2) Body 1 ... ... (3) Scabies 8 ... 1 ••• (4) Impetigo 8 ••• ... ... (5) Other Diseases (Non-Tuberculous 14 8 1 ... Total (Heads 1 to 5) 31 9 2 ... Eye— (6) Blepharitis 14 5 2 2 (7) Conjunctivitis 4 ... ••• ... (8) Keratitis ... ... ... ... (9) Corneal Opacities ... ••• ... ... (10) Other Conditions (excluding Defective Vision and Squint) 6 4 1 ... Total (Heads 6 to 10) 24 9 3 2 (11) Defective Vision (excluding Squint) 355 111 63 2 (12) Squint 86 49 7 2 Ear— (13) Defective Hearing 17 13 5 ... (14) Otitis Media 3 11 4 ... (15) Other Ear Diseases 19 4 3 ... Nose and Throat— (16) Chronic Tonsillitis only 53 234 6 5 (17) Adenoids only 10 12 2 1 (18) Chronic Tonsillitis and Adenoids 262 324 24 9 (19) Other Conditions 42 44 11 1 (20) Enlarged Cervical Glands (Non-Tuberculous) 8 22 1 2 (21) Defective Speech 17 10 4 1 Heart and Circulation— Heart Disease: (22) Organic 15 77 7 4 (23) Functional 3 40 1 2 (24) Anaemia 66 35 5 1 305 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 13 40 3 1 (26) Other Non-Tuberculous Diseases 7 17 1 3 Tuberculosis— Pulmonary: (27) Definite ... 1 ... ... (28) Suspected 5 22 ... 1 Non-Pulmonary : (29) Glands ... 2 1 ... (30) Bones and Joints ... ... ... ... (31) Skin ... ... ... ... (32) Other Forms 1 2 ... ... Total (Heads 29 to 32) 1 4 1 ... Nervous System— (33) Epilepsy 1 7 ... 1 (34) Chorea 3 22 2 5 (35) Other Conditions 4 49 1 6 Deformities— (36) Rickets 3 ... ... ... (37) Spinal'Curvature 71 78 7 ... (38) O'her Forms 108 106 15 4 (39) Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 13 31 5 4 Total 1,239 1,381 183 57 B.—Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. Age-groups. Number of Children Inspected. A (Excellent). B (Normal). c (Slightly subnormal). D (Bad). No. % No. % No. % No. % Entrants 2913 164 5.6 2270 77.9 476 16.4 3 0.1 Second Age-group 3195 176 5.5 2485 77.8 515 16.1 19 0.6 Third Age-group 1984 101 5.1 1673 84.3 210 10.6 ... ... Other Routine Inspections 19 ... ... 19 100.0 ... ... ... ... TOTAL 8111 441 5.4 6447 79.5 1201 14.8 22 0.3 306 TABLE III. Return of all Exceptional Children in the Area. Children Suffering from Multiple Defects. Number of children suffering from combination of defects 4 BLIND CHILDREN. A blind child is a child who is too blind to be able to read the ordinary school books used by children. In this Section only children who are so blind that they can only be appropriately taught in a school for blind children are included. At Certified Schools for the Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 12 ... ... 1 13 PARTIALLY BLIND CHILDREN. Only children who, though they cannot read ordinary school books or cannot read them without injury to their eyesight, have such power of vision that they can appropriately be taught in a school for the partially blind are included. Children who are able by means of suitable glasses to read the ordinary school books used by children without fatigue or injury to their vision are not included in this Table. At Certified Schools for the Blind. At Certified Schools for the Partially Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. ... 45 16 ... 1 62 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. 14 ... ... ... 14 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 and Partially Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 6 2 ... ... 8 307 MENTALLY DEFECTIVE CHILDREN. Feeble-Minded Children. Mentally Defective children are children who, not being imbecile and not being merely lull or backward, are incapable by reason of mental defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools but are not incapable by reason of that defect of receiving benefit from instruction in Special Schools for 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 Schools for Mentally Defective Children. At Public Elementary Schools. At Private Schools. At no School or Institution. Total. 154 20 4 6 184 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. . 1 ... ... ... 1 PHYSICALLY DEFECTIVE CHILDREN. Physically Defective children are children who, by reason of physical defect, are incapable of receiving proper benefit from the instruction in the ordinary Public Elementary Schools, but are not incapable by reason of that defect of receiving benefit from instruction in Special Schools for physically defective children. A. Tuberculous Children. In this category are placed only cases diagnosed as tuberculous and requiring treatment for tuberculosis at a sanatorium, a dispensary, or elsewhere. Children suffering from crippling due to tuberculosis which is regarded as being no longer in need of treatment are recorded as crippled children, provided that the degree of crippling is such as to interfere materially with a child's normal mode of life. All other cases of tuberculosis regarded as being no longer in need of treatment are recorded as delicate children. I—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 8 15 1 ... 24 308 II.—Children Suffering from Non-Pulmonary Tuberculosis. (This category includes tuberculosis of all sites other than those shown in (I) above. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 19 13 4 1 37 B. Delicate Children. This Section is confined to children (except those included in other groups) whose general health renders it desirable that they should be specially selected for admission to an Open Air School. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 91 25 2 2 120 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 sufficiencly severe to interfere materially with a child's normal mode of life, i.e., children who generally speaking are unable to take part, in any complete sense, in physical exercises or games or such activities of the School curriculum as gardening or forms of handwork usually engaged in by other children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 52 11 3 7 73 D. Children with Heart Disease. This Section is confined to children whose defect is so severe as to necessitate the provision of educational facilities other than those of the Public Elementary School. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 42 12 3 3 60 Children Suffering from Multiple Defects. Combination of Defect. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At No School or Institution. Total. Blind, M.D. and Epilepsy 1 ... ... ... 1 M.D. and Cripple 1 ... ... 1 M.D. and Blind ... ... ... 1 1 M.D. and Epilepsy 1 ... ... ... 1 309 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 10 ... 10 (ii) Other Treatment 12 ... 12 Ringworm-Body 24 ... 24 Scabies 98 ... 98 Impetigo 183 ... 1?3 Other Skin Disease 82 ... 82 Minor Eye Defects— External and other, but excluding cases falling in Group II 260 ... 260 Minor Ear Defects 328 ... 328 Miscellaneous— Minor Injuries, Bruises, Sores, Chilblains, etc. 1644 ... 1644 Total 2641 ... 2641 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) 1242 21 1263 Other defect or disease of the eyes (excluding those recorded in Group I) ... ... ... Total 1242 21 1263 No. of Children for whom spectacles were (a) Prescribed 771 21 792 (b) Obtained 775 21 796 310 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; part from the Authority's Scheme. (2) Total. (3) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 2 3 301 ... 8 1 23 ... 10 4 324 ... ... 338 (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. GROUP IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme. Total number treated. Residential treatment with education. (i) Residential treatment without education. (ii) Non-residential treatment at an orthopaedic clinic. (iii) Number of children treated 25 21 305 328 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 915 1460 1533 1599 1454 1587 1337 1515 15 6 1364 14300 (b) Specials 2379 (c) Total (Routine and Specials) 16679 (2) Number found to require treatment 12634 (3) Number actually treated 7614 (4) Attendances made by children for treatment 18833 (5) Half-days devoted to: (7) Extractions: Inspection 103 Permanent Teeth 3003 Treatment 1586 Temporary Teeth 11495 Total 1689 Total 14498 (8) Administrations of general anaesthetics for extractions 2668 (6) Fillings: (9) Other Operations: Permanent Teeth 8879 Permanent Teeth 4155 Temporary Teeth 949 Temporary Teeth 520 Total 9828 Total 4675 TABLE VI.—Uncleanliness and Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurses 9.5 (ii) Total number of examinations of children in the Schools by School Nurses 62235 (iii) Number of children found unclean 1502 (iv) Number of children cleansed under arrangements made by the Local Education Authority 153 (v) Number of cases in which legal proceedings were taken: (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws — 311 SECONDARY SCHOOLS. Year ended 31st December, 1938. Table I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Year 1938. 1937. Age 11 or under 394 352 12 326 270 13 262 305 14 177 394 15 245 351 16 141 147 17 93 29 18 or over 24 2 Total 1,662 1,850 B.—Other Inspections. Year 1938. Year 1937. Number of Special Inspections 386 256 Number of Re-inspections 842 860 Total 1,228 1,116 Visits to Secondary Schools 80 104 312 SECONDARY TABLE II.—A.—Return of Defects Found by Medical Inspection in the Year Ended 31st December, 1938 DEFECT OR DISEASE. (1) Routine 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 treatment (5) Malnutrition 11 10 ... ... Uncleanliness. (See Table IV.—Group V.) Skin— Ringworm: Scalp ... ... ... ... Body ... ... ... ... Scabies 1 ... ... ... Impetigo ... ... ... ... Other diseases (non tuberculous) 3 4 ... ... Eye— Blepharitis 3 1 ... ... Conjunctivitis ... ... ... ... Keratitis ... ... ... ... Corneal opacities ... ... ... ... Defective vision (excluding squint) 100 97 3 ... Squint 3 ... ... ... Other conditions ... ... 1 ... Ear— Defective hearing l ... ... ... Otitis media 1 1 ... ... Other ear diseases ... ... ... ... Nose and Throat— Enlarged tonsils only 1 46 ... ... Adenoids only ... ... ... ... Enlarged tonsils and adenoids 2 5 ... ... Other conditions 4 2 1 ... Enlarged Cervical Glands (Non Tuberculous) ... ... ... ... Defective Speech ... 1 ... ... Teeth—Dental Disease 5 1 ... ... Heart and Circulation— Heart Disease— Organic l 28 ... ... Functional ... 10 ... ... Anaemia 6 11 1 ... Lungs— Bronchitis ... 3 ... ... Other non-tuberculous diseases ... 5 ... ... Tuberculosis— Pulmonary— Definite ... ... ... ... Suspected 1 2 ... ... Non-pulmonary— Glands ... ... ... ... Spine ... ... ... ... Hip ... ... ... ... Other bones and joints ... ... ... ... Skin ... ... ... ... Other forms ... ... ... ... Nervous System— Epilepsy ... 1 ... ... Chorea ... 3 1 ... Other conditions ... 2 ... ... Deformities— Rickets ... ... ... ... Spinal curvature 20 42 ... ... Other forms 24 54 ... ... Other Defects and Diseases ... 5 2 ...