Apane copy CRO 41 LIBRARY COUNTY BOROUGH OF CROYDON OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER FOR THE YEAR 1939 OSCAR M. HOLDEN M.D. D.P.H. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER FOR THE YEAR 1939 OSCAR M. HOLDEN M.D. , D.P.H. t • ' " . •• PUBLIC HEALTH COMMITTEE NOVEMBER, 1938-1939 THE WORSHIPFUL THE MAYOR (Alderman A.H. Hurding J.P) Councillor G. Lewin (Chairmen) Councillor E.E.L. Arkell (Vice Chairman) Alderman Mrs. B.J. Roberts. Councillor L.A. Aston. Councillor E.E. Constable. Councillor A.V. Dammarell. Councillor Miss M.E. Glazier. Councillor W.W. Gough. Councillor A. Goodburn. Councillor Mrs. E.M. Regan. Councillor H. Regan. Councillor Mrs. M. Squire J.P. Councillor D.Stewart. Councillor J.T. Twitchett Councillor C.H. Ward. To the Chairman and Members of the public Health Cormittee. Ladies and Gentlemen, I have the honour to present herewith my Twelfth Annual Report, being the fortieth of the series, dealing with work of the Public Health Department. There is also incorporated my report) as School Medical Officer. to the Education Committee. The report has been much curtailed because of the necessity to economise in paper. It was felt that some of the usual statistical data, although of interest, were not indispensable. For any who are particularly interested, the usual full statistical details, on the lines of my previous reports, are available, and will be filed so that continuity in recording will not be broken. The issue of the report has been delayed, firstly, because relevent data wore not received from tho Registrar-General until a much later date than usual, and, secondly, on account of the pressure of Air Raid Precaution matters, The year 1939 was once again a healthy year, and although the statistics may not be absolutely accurate owing- to the fluctuations of population from September to december, they are sufficiently so to show that 1939 was no less satisfactory than 1933. The out ward trend of population tends to raise the calculated death rates and to lower the birth rates. The population was estimated at 245,900 . The Birth rate was 14.0 per 1000 of the estimated population - an increase on 1938; the Death rate was 11.0 per 1,000 estimated population - an increase of 0.7 per 1,000; the maternal mortality was 1.16 por 1,000 total births - a low figure - and the infantile mortality was 38 per 1,000 live births, the lowest rate yet recorded. In spite of tho additional heavy burdens placed on tho department by the demands of Civil Defence, the appropriate public health activities have continued with practically no vital curtailment The good record of health for the year bears evidence that vigilance has not boon allowed to relax because of abnormal circumstances. In order to maintain continuity in the form of the report it has been divided into the usual sections, but commentations upon the statistical tables have been omitted. It is felt that the tables are sufficiently explicit to put the facts before readers. This results in substantial reduction in the bulk of the report without impairing its use as a record of the health of the town and work done by the responsible department. No details have been given regarding the Casualty Services of the Civil Defence organisation as I feel this is not a public health service but an entirely separate division. The organisation of these services has,however, consumed much time and energy, covering as they do the building up of Stretcher Party and Ambulance Services; th establishment of First Aid Posts and the modification of Hospital arrangement under the Emergency Hospital Scheme. This could not have been done without the loyal and whole-hearted co-operation and help of the professional and all other members of the department and I wish to record my sincere thanks to them. To you, ladies and gentlemen, I also express ny thanks for the support and encouragement I have experienced throughout the year in all matters which I have brought before you, and for the active interest you have taken in the welfare of the department. I am, Yours faithfully, Oscar M. Holden. Medical Officer of Health. STAFF OF THE HEALTH DEPARTMENT. The staff of tho Public Health Department on tho 31st December, 1939, was as follows:- Medical Staff.- (a) Whole-time;- Oscar M. Holden, M.D., D.P.H., Medical Officer of Health, School Medical Officer, and Medical Officer under the Mental Deficiency Acts, etc. John T.R. Lewis, M.D., D.P.H., Deputy Medical Officer of Health form I.I IS.O and Deputy School Medical Officer.(as from 1.1.1940) D.D. Payne, M.D., B.S., D.P.H., Doputy Medical Officer of Health, Deputy School Medical Officer and Medical Officer under the Mental Deficiency Acts (to 31.13.19:59). J.C.Mc.Millan, M.E., Ch.B., B.A.O., B.Sc., D.P.H., Assistant Medical Officer of Health for Tuborculosis. Rufus C. Thomas, M.R.C.S., L.R.O.P., F.R.C.S. (Ed.), M.C.O.G., Assistant Medical Officer of Health for Obstetrics. E.H. Harte, M.B., Ch.B., D.P., Assistant Medical Officer of Health and Assistant School Medical Officer. Gordon M. Hobbin, M.B., Ch.B., Assistant Medical Officer of Health Air Raid Precautions (as from 27.8.1939) Trie A. jenklu-lioyd, M.R.O.S, L.R.C.R. 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. Todesco, M.D., M.R.C.S., L.R.C.P., D.P.H., Resident Medical Superintendent, Borough (Fever) Hospital. R.C. Poyser, M.R.C.S., L.R.C.P., Resident Medical Superintendent, Croydon Borough Sanatorium. (b) Part-time:- H.W. Southgate, M.B., B.S., B.Sc., Pathologist. 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 Cilray, 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. Arthur B. Higginson, M.B., Ch.B., Assistant Medical Officer of Health for Obstotics. Ralph Spencer M.B., Ch.B., B.Sc., Junior Resident Assistant Medical Officer. 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.3.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.T. Southgate, M.B., B.S., B.Sc., Pathologist. Visiting Radiologist, Mayday Hospital.- David Low Greig, M.R.C.S., L.R.C.P., D.M.R.E. 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.2.C.S.I. & L.M. Panel of Medical Practitioners appointed for Addiseobe, Central, East, South Norwood, Woodside, Thornton Heath, Waddon and South Wards. Public Vaccinators. William Vaudrey Braddon, M.B., Ch.B., L.S.A. Walter Hugh Montgomery Smith, M.R.C.S., L.R.C.P. George Donaj. McGrath, M.B., B.Ch., B.A.O. Thomas Dunlop Miller., M.D., B.S. Gilbert Charrington Wellish, M.B., Ch.M., F.R.C.S. Dental Staff.- Senior Dental Surgeon: P.G. Oliver, L.D.S. 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., C.P. urbani. L.D.S- Dental Surgeon: Mayday Hospital: E.H. Laurence, L.D.S (part-time). Inspectors. R.J. Jackson, M.R.S.I., A.M.I.S.3., M.S.I.A., Chief Sanitary Inspector G Grieve, A.M.I.S.E., M.S.I.A., Acting Deputy Chief Inspector. 19 District Sanitary Inspectors. In addition, there are 7 disinfectors, and 6 assistants to the Sanitary Inspectors. Health Visiting Staff.- A.M.D. Allford (Superintendent). 22 District Health Visitors; 2 Special Visitors; 1 Tuberculosis Nurse; 3 Almoners and 5 Dental Attendants. Also 2 whole-tine Masseuses and Remedial Gymnasts. Municipal Midwives.- Norah A. Rigby (Superintendent) 10 District Municipal Midwives Clerical Staff. - B.W. Cummins (Chief Clerk). 35 full-time Clerks (including members on active service). (Part-time).- Peter R.A. Thrale, O.B.E., M.R.C.V.S. Analyst (Part-time).- Edward Hinks, B.Sc., F.I.C., F.C.S. 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. CONTENTS. A. - PUBLIC HEALTH REPORT. Page Airport 118 Ambulance Service 6 Amusement Houses 67,75 Animals, Keeping of67,75 Ante-natal Clinic 38 Babies Help Committee 61 Bacteriological Examination 8,20,35,39 Bakehouses Births 1,50 Blind Persons 115 Blood Transfusions 42 Borough Hospital 31 Bye-laws and Regulations 66 British Social Hygiene Council. 16 Cancer 114 Cerebro-Spinal Meningitis 34 Chicken Pox 34 Children Acts 63 Contacts, Tuberculosis 99 Cowkeepers 82 Croydon Nursing Service 99 Convalescence 61 Coombe Cliff Convalescent Hosp. 62 Creche 62 Dairies, Cowsheds and Milkshops 82 Deaths 1,3, 6 Dental Treatment 103 Diphtheria 32,90,106 Disinfection 76 Disinfestation 76 Dispensary, Tuberculosis 93 Dried Milk 60 Dysentery 34 Enteric Fever 33 Erysipelas 33 Extra Nourishment 96 Factories & Workshops Acts 66,71 Fertilisers & Feeding Stuffs Act 67,76 Foods, Inspection of 78,81,86 Food & Drugs Acts 85 Foster-Mothers Foster-Children 63 Gynaecological Clinic 43 Health Visitors, Work of 59 Home Helps 61 Home Nursing 99 Homework 72 Hospitals 6 Hospital, St. Mary's (Maternity) 37,40 Houses Let in Lodgings 74 Housing 65,69,92 Ice Cream 85 Illegitimacy 2, 62 Immunization Clinic 96 Infant Welfare Clinics, Municipal 57 Infant Welfare,Clinics, Voluntary 57 Infant Mortality 1, 51 Page Infantile Paralysis 34 Infectious Diseases 90 Inquests 2 Laboratory Work 39,8,20,35 Lodging Houses, Common 73 Marriages 2 Maternity Homes 56 Mayday Hospital 17,37 Measles 34 Meat Inspection 78 Medical Help Records 54 Mental Deficiency, etc 47 Midwives 54 Midwives Acts. 54 Milk, Provision of 60 Milk, Examination of 82,88 Milk, Tuberculous 83,85 Milkshops 82 Mortality in Child-birth 1,37,50 Mothers' and Infants' Welfare Association 57 Mumps 34 Municipal Lodging House 73 Municipal Midwives 40 Neo-natal Deaths 53 Notification of Births Acts. 50 Nuisances 65,75 Nursing Arrangements 6 Nursing Homes 56 Obstetrical Unit 37 Occupation Centre 49 Offensive Trades 74 Ophthalmia Neonatorum 34,51 Orthopaedic Department 1ll Out of Borough Cases 35 Overcrowding 70 Pemphigus 34 Poisons Pharmacy Act 67,75 Poliomyelitis 34 Poor Law Relief 45 Population 1 Post-natal Clinic 43 Public Laboratory 35,8,20,39 Puerperal Sepsis and Pyrexia 33,50 Rag Flock Acts 74 Rats & Mice(Destruction) Act 68,77 Rescue Home 62 Rent Restriction Acts 68 Rivers and Streams Sanatorium, Cheam 105 Sanatoria, Treatment in 97 Sanitary Administration 64 Sanitary Certificates 68 Sanitary.Inspectors, Work of 64 Scarlet Fever 32, 90 Schick,Test 96 Schools 75 Page St. Christopher's Special School 49 Shop Hours Acts 67,73 Slaughterhouses 78 Small Pox 90 Smoke Observations 75 Sputum, Examination 96 Still-births 1,50 St. Mary's Maternity Hospital 37,40 Swimming Pool 89 Tuberculosis - Care Committee 104 Cheam Sanatorium 105 " Contacts 99 " Deaths 95 " Dental Treatment 103 ' Notifications 93 :' Home Nursing 99 Home Visits 99 " Housing 101 " Institutional, Treatment 34,97 Typhoid Fever 33 Page Unmarried Mothers 2, 63 Vaccination 110 Venereal Diseases 100 Verminous Persons 77 Vital Statistics 1 Ward Statistics 7 Watercourses 67,75 Water Supply 6 Whooping Cough 33 Workplaces 66 Workshops 66 X-ray Examination 96 B.- SCHOOL MEDICAL REPORT. (See separate document). Page Page Accommodation 5 Adenoids 15 Blind Children 25 Child, Guidance Clinic 25 Clinics 14 Committee 2 Cost 4 Crippling Defects 17 Deaf Children 25,32,37 Deaths 29 Defective Children 11,32,37 Deformities 17,33,37 Dental, Defects 9 Dental Treatment. 18 Ear clinic 23 Epileptic. Children 25 Exclusions. 12 Eye Clinic 16 Eye Defects 9,32,37 Following up 14 Health Visitors, Work of 14 Health Defects 32,37 Health and Weights 8,30 Iufectious Diseases 13 Inspection Clinic 16 Inspections, Routine 5,31 Inspections, Special 31 Juvenile Employment 38 Massage Clinic 17 Meals, Provision of 4,28 Mentally Defective Children 26 Milk, etc., Provision of 4,28 Minor Ailments 15 Orthopaedic Work 17 Orthodontic Service 21 Physically Defective Children 26 Population 4 Remedial Exercises 17 Rheumatism Clinic 23 Re-inspections 31 School Camps 27 Schools, Epecial. 17,26,29 Secondary Schools 29 Skin Affections 32,37 Speech 27 Statistical Tables 31 Surveys, Uncleanliness 14,35 St. Christopher's 29 St• Giles 17 St. Luke's 26 Throat and Nose 15,32,37 Treatment 14 Tuberculosis 7 Uncleanliness 7,14 Vision, Defective 9,16 SUMMARY of VITAL STATISTICS FOR 1939. Area, 12,617 acres. Population (Census 1931) 233,115. Population (estimated middle of 1939) (a) for Birth Rate 243,900 (b) For Death Rate 232,800 Number of Inhabited Houses (1931 Census) 56,429. Overcrowding Census (1936), 65,550. Rateable Value (1st April 1938) £2413,024. Product of a Penny Rate (1938-1939) £9,601. Rate in the £. 11/4d. Gross expenditure on Health Services (administered by Medical Officer of Health) 213,069 0 11 Income on Health Services (excluding transfers) 23,864 4 9 Net expenditure on Health Services £189,204 16 2 Expressed as a Penny Rate, 19.71d. pence in the pound. Live Births- M. F. Total. Legitimate 1,676 1,548 3,224 Illegitimate 90 90 180 Birth-rate per 1,000 of the estimated resident population, 14.0 Still Births 107. Rate per 1,000 total (live and still) births. 30.5 Birth rate per 1,000 (live and still births) 14.4 Deaths 2557 rate per 1,000 of the estimated resident population 11.0 Deaths from diseases and accidents of pregnancy and childbirth: From sepsis 1; other causes 3. Maternal mortality: Q.18 per 1,000 total live and still births. Death-rate of Infants under one year of age- (130 deaths,3340 births) All Infants per 1,900 live births 38 Legitimate Infants (119 deaths) per 1,000 live births 36 Illegitimate Infants (11 deaths)per 1,000 live births 62 Deaths from Influenza 48 Deaths from Diphtheria (all 16 " " Measles (all ages) - ages) " " Whooping Cough Typhoid or Paratyphoid Fever 2 (all ages) 3 pneumonia 151 Diarrhœa(under 2 10 Cancer 414 years of ago) 19 Deaths from diseases of Cardiac and Circulatory System (including Cerebral Haemorrhage) 4.22 Deaths from diseases of the Respiratory System (including Tuberculosis) 1.29 Deaths from diseases of Renal System 0.27 Deaths from diseases of Digestive System 0.55 Deaths from Suicide and Accidents 0.45 Deaths from Old Age 0.40 1 Marriages The number of marriages solemnised was 2,674 compared with 2,319 in 1938; 2,210 in 1937; 2,198 in 1936; 2,132 in 1935: 2,125 in 1934 and 2,244 in 1933. The marriage rate was 11,0 per 1,000 of the population; 1253 were solemnised in Established Churches, 407 in other places of worship; 1,008 in the Register Office and 6 performed under Jewish ritual. Births The births registered wore 3,224 legitimate and 180 illegitimate. The birth rate consequently was 14.0. For England and Wales and in tho Great Towns the rate was 15.0 and 14.8. The illegitimate births in Croydon were 5.3 of the total compared with 4.9 in 1938, 4.6 in 1937, 5.5 in 1936, 4.4 in 1935 and 4.7 in 1934. The live male births numbered 1,676, the female 1,548, being a proportion of 1,083 males to 1,000 females. The subjoined table gives the vital statistics for the Wards in the Town. It is seen that tho Wards-with the highest birth rates were Addington(27.3) Thornton Heath (17.6) and Whitehorse Manor (17.0) Those with tho lowest were: Norbury(7.5) Upper Norwood (10,3) and East (11.0). Deaths The deaths numbered 2,557, compared with 2,486 in 1978. For 1939 the death rate was 11.0. For 1938 it was 10.3."The death rate for England and Wales was 12.1 and for the Great Towns 12.0. For London the death rate was 11.9. The male death rate was 11.4, the female 10.1 for the Borough. There were 145 inquests held by Coroners in respect of Croydon residents during 1939 and 134 findings by Coroners after post mortem examination with out inquest. Wards with the highest death rates were: Central 14.7 and Bensham Manor (12.8); lowest in Addington (7.1) West Thornton (8.4) and Norbury (9.1). Natural Increase-. The excess of births over deaths was 861 or 3.5 per 1000 of the population. 2 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE AGE AND SEX Sox All Ages 00 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- All Causes M 1228 75 7 12 17 30 47 55 132 214 324 317 F 1329 58 4 6 22 27 36 63 88 197 301 527 Enteric Group M 1 — _ - - - 1 _ — — - _ F 1 - mm - — — 1 - mm — — Whooping Cough M 2 _ 1 1 - — - - — - F 1 1 - - - - - - - - - - Diphtheria M 6 - - 4 2 - - - - - - - F 10 - _ 2 7 1 - - - - - _ Influenza M 22 - — — — 1 - 3 6 2 3 7 F 26 1 - - - - 4 2 4 4 4 7 Cerebro Spinal Fever M 2 1 - - 1 - - - - - - - F — _ _ - _ - - - - - - _ Tuberculosis . (Respiratory) M 57 - - — — 9 10 14 15 7 2 - F 32 - - - - 8 10 8 5 1 - - Other Tuberculous diseases M 11 - l 1 2 3 1 1 — 1 1 - F 7 - - - 2 - 2 1 1 - - 1 Syphilis M 4 - — - - - - - _ 3 1 - F 2 2 - - - — — — _ — — - G.P.I, etc. M 8 - - - - - - 1 3 3 1 - F - - - - - - - - - - - - Cancer M 184 _ mm - 2 1 2 8 28 37 70 36 F 235 - - - - - 3 11 38 60 56 67 Diabetes M 16 - - - 1 - 1 — 6 5 3 F 18 - — 1 — - — — _ 5 7 5 Cerebral Haemorrhage etc M 33 - - - - - - 2 3 5 8 15 F 65 - - - — - - — 2 11 19 33 Heart Disease M 370 - - - 1 1 6 5 32 88 114 123 F 412 - - - 2 2 2 9 12 38 114 233 Aneurysm M 7 - - - - - 2 - - 2 1 2 F 7 - — - - 1 - — 1 1 4 — Other circulatory diseases M 95 - - - - _ - - 3 13 34 45 F 91 - — — — — 1 4 13 22 51 Bronchitis M 24 2 1 — - 1 — 1 2 3 6 8 F 23 - 1 _ - - - 1 - 2 3 17 Pneumonia (all forms)- M 75 12 2 3 — 3 2 1 10 9 20 13 F 76 8 2 2 2 4 2 4 4 14 13 21 other respiratory diseases M 5 — — - — _ 1 — 1 1 1 1 F 8 - - - 1 1 - _ 2 1 3 Peptic ulcer M 21 - - - - - - 2 5 6 4 4 F 8 - - - - - - 2 - 1 2 3 Diarrhoea, etc M 10 8 1 - - - - - - - - 1 F 12 9 1 — - _ 1 _ 1 - - - Appendicitis M 4 _ - _ _ 2 1 - - 1 _ F 11 — - — l 2 - 3 — 2 3 - Cirrhosis of liver M 6 — — - - - — — — 4 2 — F 6 - - - - - - 1 1 2 1 1 Other diseases of liver etc. M 2 - - - - - - - - 1 1 — F 7 - — - - _ _ - - 1 3 3 Other digestive diseases M 18 1 — - 1 1 2 1 4 2 5 2 F 24 1 - - 3 - 1 — - 4 7 8 Nephritis M 32 1 1 l — 3 1 6 4 8 7 F 31 _ - l 1 1 5 1 8 8 6 Puerperal sepsis Other puerperal causes F 2 - - - - - 2 - - - - F 3 - - - - - 1 2 - - - - Cong. Debility, prem. birth etc. M 40 40 - - - - - - - - - - F 32 31 - - l - - - - - - - 3 Registrar General's Table of Deaths according to Cause, Age and Sex (Cont) Sex All Aces 0- 1-. 2- 5- 15- 25- 35- 45- 55- 65- 75- Senility M 19 4 15 F 23 2 21 Suicide M 13 1 4 1 3 2 1 1 F 15 1 1 2 3 7 - 1 Other violence 35 1 1 2 3 7 4 5 4 2 6 F 42 2 1 1 2 1 - — 1 4 8 22 Other defined diseases M 105 7 1 1 5 5 4 8 6 11 29 28 F 97 3 1 5 5 10 10 17 24 22 Causes ill-defined or unknown M M 1 1 F 2 2 Comparisons with 1938. There was a fall in the deaths from the Zymotic diseases excluding; Typhoid Fever and Diphtheria. In 1939 there wore no deaths from Measles or Scarlet Fever, Whooping Cough caused 3 deaths and Diphtheria 16 deaths. The deaths from Pulmonary Tuberculosis decreased by 28 in 1939. The number of deaths attributed to Cancer totalled 419, compared with 387 in 1938. Deaths from Heart Disease increased by 5. Pneumonia deaths showed an increase of 21 and those due to Bronchitis a decrease of 2. Deaths from Digestive Diseases, including Appendicitis increased by 26. Deaths from Suicide and Violence decreased from 121 to 105. The percentage of deaths under 1 year of ago to the total deaths was 5,1%. Deaths under 15 years 10.0%; deaths under 65 years, 42.6% deaths ovdr 65 years 57.4. The corresponding figures for 1938 were 5.4% 8.5%, 45.0% and 55.0%. 4 Classification of Deaths according to disease over a poriod of six years. Cause of Death 1934 Total Deaths 1935 Total Deaths 1936 Total Deaths 1937 Total Deaths 1938 Total Deaths 1939 Total Deaths Death Rate Enteric Fever 1 - 4 35 12 2 0.009 malaria - - - - — - "" Small Pox - - - — — — - Measles 14 - 21 5 8 — - Scarlet Fever 3 — 2 3 3 — Whooping Cough 18 2 15 5 3 3 0.013 Diphtheria and Croup 24 12 8 15 16 16 0.067 Influenza (including Influenzal pneumonia) 28 25 39 71 21 48 0.206 Dysentery 1 1 0.004 Erysipelas 5 2 6 3 3 2 0.009 Cerebro -Spinal Fever 3 3 3 5 2 0.009 Pulmonary Tuberculosis 144 148 132 140 117 89 0.382 Tuberculous Meningitis 6 9 19 15 20 18 0.077 Other Tuberculous Disease 7 14 Cancer.Malignant Disease 371 321 428 432 38? 419 1.800 Rheumatic Fever 6 9 6 11 6 2 0.009 Meningitis 9 14 4 4 5 3 0.013 Organic Heart Disease 591 780 749 770 777 782 3.359 Bronchitis,Acute and Chro nic 93 45 44 50 49 47 0.202 Pneumonia 199 120 185 179 150 151 0.649 Other Diseases of the Respiratory Organs 24 29 23 12 25 13 O.056 Diarrhoea and Enteritis 18 29 31 45 29 23 0.099 Appendicitis 23 48 18 23 15 15 0.063 Cirrhosis of Liver 5 2 8 9 8 12 0.052 Alcoholism 5 2 - 1 1 1 0.004 Nephritis & Bright's Disease 75 66 89 84 72 63 0.276 Puerperal Fever 5 7 5 1 1 2 0.009 Other diseases & accidents of pregnancy & parturition 8 1 7 11 2 2 0.009 Congenital Debility and Malformation 33 87 63 105 64 71 0.305 Premature Birth 34 Violent deaths (excluding suicide) g 91 85 85 102 78 77 0.331 Suicide 37 26 29 30 43 28 0.120 Other Defined Diseases 688 567 570 634 595 062 2.844 Diseases Ill-defined or Unknown 3 - - 2 - 3 0.013 TOTAL 2,571 2,453 2,590 2,800 2,496 2,257 1939 showed a slight increase both in the general death rate and in the birth rate, and a fall in the infant mortality rate to the lowest figure yet recorded. - 5 - Water. The water supply is drawn from deep wells in the chalk. These wells are situated in 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. The amount of water consumed during the year was Corporation's Wells 2,033,600,744 Metropolitan Water Board in bulk 675,273,000 2,708'3,873,744 The same arrangements regarding samples as were commenced in 1938 continued in 1939. Laboratory, Ambulance, Nursing Facilities, Hospitals etc. There have been no changes in the Laboratory, Ambulance and Nursing Facilities in the homo since my 1938 report. Nor are there any changes to record in the Hospital beds available other than that at the outbreak of War, 500 beds were taken over at Mayday Hospital by the Emergency Hospital Service. This necessitated a considerable transference of patients elsewhere. Some 40 beds were also taken over at Cheam Sanatorium, tho patients having to be discharged home; and 200 beds at the Croydon General Hospital. All the Clinics have continued throughout the year, with the exception of thr Tonsils and Adenoids Clinic previously held at the Croydon General Hospital. This ceased on the outbreak of War. The cases arc now dealt with by admission to Mayday Hospital. - 6 - TABLE 1. 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 16,794 173 165 10.3 10.3 35 0.06 0.87 0.31 0.06 3.18 0.37 1.93 20 8 Norbury 16,173 122 140 7.5 9.1 25 - 0.65 0.58 - 2.79 0.84 1.23 29 18 West Thornton 19,612 232 158 11,8 8.4 52 0.05 0.10 0.74 0.37 0.05 2.70 0.53 1.27 42 74 Bensham Manor 16,797 233 205 13.9 12.8 39 0.17 0.29 1.06 0.50 - - 3i86 0.56 1.68 50 38 Thornton Heath 18,058 318 197 17.6 11.4 38 0.17 0.06 1.21 0.40 0.06 3.23 0.40 1.73 51 121 South Norwood 17,565 243 207 13.8 12.3 37 0.06 2.26 0.30 0.06 3.39 0.30 2.20 29 36 Woodside 16,190 219 176 13.5 11.4 37 0.13 0.19 0.84 0.45 0.06 3.75 0.65 2.01 37 43 East 16,226 178 151 11.0 9.8 34 0.06 0.19 0.78 0.45 - 3.16 0.12 1.61 10 27 Addiscambe 16,368 242 180 14.8 11.5 33 0.13 1.28 0.32 0.06 3.46 0.45 2.30 49 62 Whitehorse Manor 16,866 286 200 17.0 12.4 63 0.19 0.25 1.55 0.80 0.06 3.16 0.43 1.55 63 86 Broad Green 17,242 241 182 14.0 11.0 25 0.06 0.06 1.21 0.67 3.21 0.73 1.94 69 59 Central 12,467 170 172 13.6 14.7 29 1.36 0.08 O.08 4.09 0.68 2.81 33 2 Waddon 18,248 184 164 15.6 9.4 39 0.11 0.06 1.14 0.34 0.18 2.63 0.46 i;i4 22 120 South 15,261 189 180 12.4 12.4 27 0.07 0.07 1.24 0.14 " - 4.34 0.34 2.20 13 9 Addington 10,033 274 66 27.3 7.1 36 0.22 0.43 0.32 0.11 1.94 0.22 1.18 1 208 The Borough 243,900 3,404 2,557 14.0 11.0 38 0.09 0.10 1.13 0.41 (5.05 3.27 0.48 1.78 19 861 These are the corrected totals. For private practitioners Mayday Hospital For Borough Hospital For Tab. Dispensary For School Medical. Other Instnss of Corporation Other Instns. Total BACTERIOLOGICAL EXAMINATIONS. I am indebted to the Borough Pathologist, Dr. H.w. Soughgate, At the Laboratory, Croydon Gerneral Hospital. Pos Neg Pos. Neg. Pos Neg. Pos. Neg. Pos • Neg. Pos. Neg. Pos Neg Pos. Neg Swabs for Diphtheria 160 1,334 2 13 5 6 82 3,645 1 47 477 305 5467 "Virulence tests for Diphtheria 4 15 1 2 2 21 3 Sputum for Tub. Bac. 81 580 591 907 13 7? — 685 1559 Pus for Tub. Bac 1 6 1 4 1 1 1 36 2 3 50 Pus for Gonococci 10 63 1 73 Pus for other organisms 20 4 1 1 12 48 153 12 227 Blood for Typhoid Groups 1 18 25 1 2 2 45 Blood for Wassermann 3 147 5 29 155 Material for Spiroehaetes Faeces for Typhoid Group 7 ' 3 22 Hair for Ringworm 9 3 1 10 3 Examination of Urine 6 2 1 1 34 2 45 Examination of Pleural Fluid 1 | 1 Examination of C.S. Fluid 20 1 1 21 Other Examinations 13 168 6 - ' 140 76 5 4 35 Examinations done under National Health Insurance Act. Nature of examination Nature of examination Pas for Gonococci 21 (5 pos.) Urine far Chemical Exam. 12 Pus for other organisms 19 Urine for Microseopal Exam 12 Pus for Tubercle B 14 Urine for Tubercle B 12 Blood for Wassermann 16 (1 pos.). Urine for Cultural Exam. 12 Complete Blood Counts 11 Other Examinations 16 Bacteriological Examination of Milk. Number of samples submitted for. counts 467 Number under 10,000 per cc 215 Number over 10,000 but under 50,000 per cc. 156 Over 50,000 but under 100,000 per cc 36 Over 100,000 but under 500,000 per cc. 24 Over 500,000 but under 1,000,000 per cc 7 Over 1,000,000 per cc 29 Tubercle Bacilli- Number of samples of milk submitted 465 Number found positive by inoculation test 14 The number of milk examinations decreased 13 for Bac. Count. 33 for T.B. There are 39 samples still under investigation for Tubercle Bacilli, Milk Samples. 467 mill: samples were submitted to the Methylene Blue. Test, of which 69 failed to satisfy. Of these 4 were further investigated and found satisfactory to the Bacillus Coli test. 9 VSNERAL DISEASES No changes have been made in the Scheme as given in my Report. for 1930. Attendances at the Croydon Clinic during past 10 years. 1930 1931 1932 1933 1934 1935 1936 1937 1938 1935 New male patients 196 263 235 242 297 287 300 395 416 31E a New female patients 171 205 241 214 232 • 213 188 184 257 191 a Attendances, male patients 5050 4923 4691 4578 ■ 5858 5548 7525 8610 7318 4258 a Attendances, female Patients 3029 3271 2724 2677 3962 5977 5226 5405 5365 315C a a Includes 157 new cases and 2417 total attendances by patients from outside areas. Attendances of Croydon patients at various London Hospitals under the General Scheme. There were 97 new patients, who made a total of 1959. attendances. Pathological Examinations at London Hospitals for Croydon Patients. 886 Examinations were made for various Clinics and 3086 examinations of material submitted by medical practitioners. Bacteriological Examinations carried out at London Hospitals for Croydon Patients. Hospital Detection of Spirochetes Detection of Gonococci Wassermann Other Pe-action Exams Total For clinic For Prac. For Clinic For Prac. For Clinic For Prac. For Clinic For Prac. St. Thomas's 1 206 106 175 488 Great Ormond Street 5 4 9 South London Hospital for Women 69 8 10 2 7 96 Royal Free 2 2 King's College 7 30 6 43 Whitechapel Clinic,L.C.C. 27 13 19 59 Westminster Hospital 20 12 12 16 12 72 Guy's Hospital 3 48 1046 35 776 42 1227 3177 Seamen's 4 2 6 Salvation Army Mother's 16 3 1 20 TOTAL 1 3 399 1054 214 790 272 1239 3972 -10- 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 Goncrrhoea St. Thomas's 1 5 45 811 21 Guy's 1 8 14 428 King's College 2 2 5 286 Great Ormond Street 14 Royal Free 33 South London Hospital for Women 1 7 158 Whitechapel Clinic (L.C.C.) 2 42 Seamen's 1 9 Westminster 1 161 Salvation Army Mothers' 2 17 TOTAL 5 17 75 1959 21 11 Return relating to all persons who were treated at the Treatment Centre at Croydon during the Year ended the 31st December, 1939. Syphilis Soft Chancre Gonorrhoea Non-venereal or undiagnosed conditions. Totals M F M F M F M F M F Totals I. Number of cases on 1st January under treatment or observation 76 79 57 35 18 21 151 135 286 2. Number of cases removed from the register during any previous year which returned during the year under report for treatment or observation of the same infection. 2 6 4 2 10 12 3. Number of cases dealt with for the first time during 1939 (exclusive of cases under item 4) suffering from:- Syphilis, primary 3 3 3 " , secondary 1 2 1 2 3 " , latent in 1st year of infection 4 1 4 1 5 " , all later stages 23 11 23 11 34 " , Congenital 5 7 5 7 12 Soft Chancre Gonorrhoea, 1st year of infection 103 18 103 18 121 " , later 6 3 6 3 9 Non venereal conditions Conditions remaining undiagnosed at 31st December. 171 149 171 149 320 4. Number of cases dealt with for the first time during the year under report known to have received treatment for the same infection, or to have been under observation at other Centres 12 9 15 5 27 14 41 Total of items 1, 2, 3 and 4. 126 115 181 65 189 170 , 350 846 12 Syphilis Soft Chancre Gonnorhoea Non venereal or undiagnosed conditions Totals M F M F M F M F M F Total 5. Number of cases disohargod after completion of treatment and fisal tests of cure or after diagnosis as nan-venereal. 11 11 105 40 180 163 296 214 510 6. Number of cases which ceased to attend before completion of treatment and were, on first attendance, saffering from:- Syphil is, primary " , secendary 2 4 2 4 6 " , lateht in first year of infection 3 3 3 " all later stages 13 9 13 9 22 Congenital 3 8 3 8 11 Soft Chancre Gonorrhoea 1st year of infection 18 4 18 4 22 later 4 4 4 7. Number of cases which ceased to attend after completion of treatment but before final tests of cure. 6 4 22 10 28 14 42 8. Number of cases transferred to other Centres or to institutions, or to care of private practitioners. 16 9 8 4 1 24 14 38 9. Number of cases remaining under treatment or observation on 31st December 75 67 28 3 9 6 112 76 188 Totals of Items 5, 6, 7, 8 and 9 126 115 181 65 189 170 496 350 846 13 Syphilis Soft Chancre Gonorrhoea Non venereal or undiagnosed conditiors Totals M F M F M F M F M F Total 10. Number of attendances (a) for individual attention of the medical officer(s) 1592 1312 768 227 534 434 2894 1973 4867 (b) for intermediate treatment, e.g. irrigation dressing 3 1093 474 271 700 1364 1177 2541 TOTAL ATTENDANCES 1592 1315 1861 701 805 1134 4258 3150 7408 11 In Patients:- (a) Total number of persons admitted for treatment during the year 2 1 1 2 2 4 (b) Aggregate number of in-patient" day of treatment given. 5 15 13 5 28 33 Under 1 year 1 and under 5 years 5 and under 15 years 15 years end over TOTALS M F M F M F M F M F 12 Number of cases of congenital syphilis in item 3 above classified according to age periods. 1 2 2 7 5 7 13 Pathological Work:- Microscopical For Syphilis For Gonorrhoea Number of specimens examined at, and by the Medical Officer of, the treatment Centre 3 8 Statement showing the services rendered at the Treatment Centre during the year, classified according to the areas in which the patients resided. Nome of County or County Borough (or Country in the case of persons residing elsewhere than in England and/ales) to be inserted in these headings. Croydon Surrey Kent London Total A. Number of cases from each area included under the following" headings in item 3:- Syphilis 34 4 4 1 57 Soft Chancre Gonorrhoea 82 33 10 5 130 Npn-venereal and undiagnosed conditions 234 62 15 9 320 Total 350 113 29 15 507 B. Total number of attendances of all patients residing in each area. 4991 1874 336 207 7408 15 The Croydon Branch of the British Social Hygiene Council which receives a grant of £5C annually from the Borough Council towards its expenses carried out the following programme which had hoon adapted to war-time conditions:- "A meeting was held in conjunction with the Women's Citizen's Association at the Methodist Hall, Norbury. The speaker was Mrs. M.C. Hume on the subject of "Sex Education". A lecture was given to the Golden Circle of the Y.W.C.A. by Mrs. Basil Hood on October 9th, the subject being "Happy Marriage". A further I lecture will be given in March. Three lectures for young men, with a special invitation to recruits, wero given at the Y.M.C.A, Hornimon Hall, by Sir Drummond Shiels on "Sex and Happiness". These wore illustrated by films. A talk was given to tho St. John's Ambulance Class at Eldon House on November 28th by Dr.Doris Mart. The subject was "Women in War Time". Six lectures are being arranged early in 1940 for Stretcher Party Depots in the District. Special free literature for War-time was distributed and selected publications sold" I am indebted to the Hon. Secretary, Mrs. M.L.Massey for the above report. 16 MAYDAY HOSPITAL 1. Total number of admissions (including infants born in hospital) 6119 2. Number of women confined in hospital 871 3. Number of live births 837 4. Number of still births 44 5. Number of deaths among the newly born (i.e. under four weeks of age) 36 6. Total number of deaths among children under -one year (including those given under 5). 60 7. Number of Maternal deaths among women admitted to hospital for confinement. 4 8. Total number of deaths. 768 9. Total number of discharges (including infants bom in hospital) 5,534 10. Juration of stay of patients included in 8 and 9 above.- (a) Under four weeks 4,727 (b) Four weeks and under thirteen weeks. 1,231 (c) Thirteen weeks or more. 344 11. Number of beds occupied (excluding cots in maternity wards). (a) Average during the year. 442 (b) Highest 553 on 4r.4.39. (c) Lowest 174 on 16.9,39. 12. Number of surgical operations under general anaesthetic (excluding dental operations) 1,110 13. Number of abdominal sections. 429 Number of X-Ray Films Taken. Spine. 169 Bones. 1,349 Pelvis. 45 Chest. 1,648 Barium Meals 283 Barium Enemata. 48 Renal. 204 Gall-Bladder. 105 Teeth 400 Abdominal. 36 Maternity cases. 647 Skull. 381 5,315 Total number of cases X-Rayed 2.728. DIAGNOSTIC 1938 1939 Oesophagus with Barium 7 4 Barium Meals 115 78 Barium Enemata 25 16 Gall-Bladders (Plain) 19 9 Cholecystograms 17 23 Renal Tracts (Plain) 35 26 Pyelograms 32 27 Abdomen for F.B's etc. 20 21 Maternity cases 305 274 Hystorographies. 1 - Lungs (Mayday Hospital) 429 420 (Sick Staff) 16 18 (Staff on appointment) 100 86 (T.B. Dispensary) 622 729 (Others) 16 2 Lungs after Lipiodol. 4 9 - 17 - [$$$ 1938 1939 Heart and Aorta 1 4 Skulls 113 107 Accessory Nasal Sinuses 22 20 Vertebral Column 94 65 Ribs 25 32 Pelvis 42 26 long Bones 362 229 Short Box.es 50 55 Joints 150 232 Tooth and Jaws 172 153 2,794 2,566 Examinations by portable sot. 171 130 THERAPY DEPARTMENT. X-Pay. Condition for which treatment was given. No. of patients. No. of applications. Re- - Cured. lieved. Died. Transferred to other hosps. Still under treatment. Carcinoma of Breast 2 30 1 1 " " Parotid 1 12 1 " " Larynx 1 12 i " " Lung 1 10 1 " " Uterus 3 39 1 2 " " Oesophagus 1 24 1 Sterilisation for:- Menorrhagia 3 32 1 1 2 Heart Diseaso 4 33 1 2 1 Renal Disease 1 16 1 Eclampsia — Numerous Pregnancies 2 24 2 Partial Sterilisatioii 2 0 2 Uterine Fibroids 3 46 1 1 1 Sarcoma of Kidney 11 " Hip - " " Acetabulum 1 8 1 Kraurosis Vulvae 1 12 1 Arthritis of Knee 1 18 1 Warts 2 34 2 Epithelioma of Jaw 1 6 1 Rodent Ulcer 1 38 1 31. 405 4 9 7 1 10 Corresponding Totals for 1938 30 478 6 4 8 2 l§ Number of Post Mortems Ordered by the Corcner and performed at Mayday Hospital during the Year: cutside Cases: 220. Hospital Cases: 146. Number of Post Mortems not ordered by the Coroner: 121. - 18 - Classification of In-patients who were discharged From or who died in the Institution during the year ended 31st December, 1939. Di Children 16 years_Discharged under of age Died Men and Women. Discharged Died A. Acute infectious disease 42 - 6 - B. Influenza 1 - 26 2 C. Tuberculosis: Pulmonary 2 1 87 39 Non-Pulmonary 5 5 18 4 D. Malignant Disease 1 88 130 E. Rheumatism (1) Acute rheumatism (rheumatic fever) together with sub-acute rheumatism and chorea 19 1 20 - (2) Non-articular manifestations of so-called rheumatism (muscular rheumatism, fibrositis, lumbago and sciatica). _ - 1 - (3) Chronic arthritis 4 38 3 F. Venereal Disease - 2 11 1 G. Puerperal pyrexia (including cases classified) - _ 2 - Puerperal fever (a) Women confined in hospital - - _ - (b) Other cases - - - - H. Other diseases and accidents connected with pregnancy and childbirth. - - 479 6 I. Mental diseases (a) Seni-le Dementia - - 14 1 (b) Other 18 - 208 - J. Senile decay • - - 77 31 K. . Accidental injury and violence - - 307 17 In respect of cases not included above. L. Diseases of the Nervous System and Sense Organs. 17 4 174 78 M. Disease of the Respiratory System. 120 13 251 100 N. " " " Circulatory System. 9 6 151 193 0. " " " Digestive System 150 15 519 43 P. " " " Genito-Urinary System 18 - 226 30 Q. " " " Skin 69 - 84 6 R. Other diseases 288 5 162 1 3. Mothers and infants discharged from Maternity Wards and not included in the above figures Mothers - - 862 - Infants 808 - - - T, Any person not falling under any of the i above headings 31 30 29 - TOTALS L694 83 3840 685 - 19 - Specimens examined in the Pathological laboratory during the Year. Positive. Negative. Swabs for Diphtheria 27 832 Sputa for Tuberculosis 365 500 Urine for Tuberculosis 10 7 Urine for Typhoid 9 49 Faeces for Typhoid - 46 Faeces for Tuberculosis 1 8 Pus for Tuberculosis 6 5 Faeces for Enteric and Dysentery Infections 20 51 Blood for Widals 6 7 Blood Cultures 2 13 Pus for Gonococci 5 129 Hairs for Ringworm 25 31 Faeces for Occult Blood 113 125 Urine for Routine Examination 947 Pus for Organisms 59 Blood Urea Estimations 170 Blood Sugar Estimations 75 Urea Clearance Tests 95 Urea Concentration Tests 257 Cerebro Spinal Fluids 83 Fractional Test Meals 25 Faecal Fat Estimations 4 Pleural Fluids 49 Glucose Tolerance Tests 2 Serum Calcium Estimations 3 Vaccines 1 Van Den Bergh Re-actions 13 Blood Counts. 304 Haemoglobin Estimations 294 Blood Groupings 128 Blood Compatibility Tests 22 Blood Sedimentation Rates 22 Blood Coagulation and Bleeding Time 2 Blood Fragility Tests 3 Other examinations - unclassified 21 2,579 Number of Specimens sent to Croydon General Hospital. 322 - 20 - Medical Surgical Diagnoses. Relieved Unrelieved Died Cured Relieved unrelieved Died. Total Cured Alimentary. Appendicitis. 195 19 1 4 219 Gastric Ulcer 8 32 2 4 8 2 2 58 Duodenal Ulcer 6 20 2 4 5 1 38 Dyspepsia 12 2 14 Cholelithiasis 2 2 Intestinal Obstruction 1 3 1 8 13 Colitis 1 3 1 2 2 2 9 Hernia 2 1 1 60 10 1 75 Ischio-rectal Abcess 4 4 Constipation 27 10 37 Haemorrhoids 6 1 7 Cholecystitis 6 14 2 7 6 35 Gastro enteritis 34 3 11 48 Gastritis 5 7 12 Alveolar abscess 8 3 11 Cirrhosis of live 1 1 Intestinal Colic 2 3 5 Intussusception 1 1 1 3 Prolapse Rectum 1 1 Fistula in Ano 1 1 Swallowed F.B. 3 3 Diarrhoea 3 1 4 Peptic Ulcer 4 4 Appendicular colic 1 1 Peritonitis 6 6 Adhesions 3 3 Stomatitis 12 12 Peritonsillar abscess 2 2 4 Appendicular abscess 1 3 5 9 j?ori-anal abscess 1 1 2 Gastroptosis 1 1 Pancreatitis 1 1 Hirschsprung's disease 1 1 Pyloric Stenosis 2 1 3 Pelvic Abscess 1 1 1 3 Anorexia 1 1 Abdominal Tumour 1 1 Anal Fissure 1 1 Abdominal Allergy 1 1 Spastic sphincter 1 1 Abdominal Abscess 1 1 Prolapsed Anus 1 1 Intestinal stasis 1 3 1 5 Post Operative Haem 1 1 Malaena 1 1 Cholangitis 1 1 2 Diverticulitis 1 3 2 5 671. -81 -  Medical Surgical Bones. Joints and Muscles Relieved Unrelieved Died Cured Relieved Unrelieved Died Total Cured Arthritis 4 15 7 1 1 28 Fibrositis 1 1 Rheumatism 10 20 1 31 Bursitis 2 6 2 10 Sacro-iliac strain 1 1 1 3 Pleurodynia 1 1 Lambago 2 2 4 Synovitis 1 1 2 Osteo-myelitis 3 8 2 13 Periostitis 1 1 Osteo-arthritis 8 2 10 Coxitis 1 1 Myositis 1 1 Schmorl's disease 1 1 Fragolitas Ossium 1 1 Perthes' Disease 1 1 109 Carcinoma Breast 4 7 11 22 Stomach 5 4 28 37 Rectum 1 4 5 12 22 Corvix Uteri 7 12 10 29 Ovary 2 1 4 7 Prostate 3 4 3 1C Tongue and Mouth 4 3 7 Glands 2 2 Anus 1 1 2 Larynx 1 1 4 6 Oesophagus 1 4 5 Cheek 1 1 Colon 2 1 1 14 18 Gall bladder 1 1 2 Lang 1 1 7 2 Bronchus 1 7 3 Liver 1 4 5 Pancreas 2 2 Caecum 1 1 1 3 Pinna 1 Maxillary Antrum 2 2 Epithelioma of nose etc 1 1 3 Rodent ulcer 1 2 3 Scrotum 1 1 Intestine 1 1 3 Care inomatosis 1 1 1 3 Kidney 1 1 Jaw 1 1 Penis 1 1 Vulva 1 1 Sarcoma of Skull 1 1 " " " Humerus 1 1 " " " Fibroid uterus 1 1 " " " Brain 1 1 Blood and Blood Vessels Anaemia 2 4 2 2 10 pernicious Anaemia 2 4 1 7 Epistaxis 5 1 6 Phlebitis 4 4 1 9 Varicose Veins 11 3 14 Leukemia 1 1 Aneurysm 1 1 Gangrene 1 3 1 2 7 - 22 - 55.  Medical. Surgical Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Total Circulatory (Heart) Myocardial Degeneration. 24 10 141 175 Amenio Sclerosis 8 8 13 29 Extrasyotoles 1 1 Endocarditis. 1 3 4 Thrombosis 2 2 4 Myocarditis 2 2 Auricular Fibrillation 5 2 7 Mitral Stenosis 10 1 1 12 Valvular disease 1 1 Congenital Heart dis. 1 2 3 Mitral Regurgitation 1 1 Coronary atheroma 1 2 3 Congestive heart failure 10 1 6 17 Angina Pectoris 1 1 Aortic Regurgitation 4 1 5 Tachycardia 1 1 Pericarditis 1 1 Heart Failure 3 3 Carditis 1 2 3 Coliapse 6 1 7 Hyperpiasia 2 17 3 22 Coronary Thrombosis 3 3 305. Constitutional. Diabetes Mellitus 1 11 2 14 Debility 3 7 1 11 Nutritional Disorder 3 2 5 Marasmus 18 3 1 3 25 Malnutrition 6 3 9 Riekets 2 2 4 Obesity 2 1 3 Acidosis 1 1 72 Eye Conjurctivitis 4 2 6 Keratitis 1 1 Phlyetens 1 1 Daeryocystitis 1 1 9 Ear Nose and Throat. Enlarged Tonsils & Adenoids 22 3 3 195 1 224 Quinsy 2 1 3 Otiti Media 50 12 1 63 Otorrhoea 3 1 4 Rhinoiahoea 1 1 Mastoiditis 1 2 1 4 Catarrh. 2 2 4 Pharyngitis 1 1 Nasal Obstruction 1 2 1 4 Laryngitis 2 2 4 Rhinitis 1 1 2 Sinusitis 1 1 1 3 317 - 23 —  Medical Surgical Diagnoses. Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Total Glands. Adenitis 13 2 15 Hodgkin's Disease 2 2 Parotitis 1 1 Myxoedema 1 1 Gland in Groin 1 1 20. Genito urinary Nephritis 9 6 3 5 23 Pyelitis 20 4 24 Urethral Stricture 3 5 8 Enlarged Prostate 1 4 1 1 8 13 3 31 Pyelo-nephritis 4 1 3 8 Perinephric abscess 1 1 Hydrocele of Cord 1 1 Cystitis 2 4 3 2 11 Uraemia 9 1 10 Renal Colic 1 3 1 5 Urinary Calculus 1 1 Pyo-nephrosis 1 1 Varicocele 2 2 Epididymo-orchitis 2 2 Circumcision 2 7 9 Haematuria 1 3 2 6 Congenital Polycystic Kidneys 1 1 Mobile Kidney 1 1 Dysuria 1 1 Perinephritis 1 1 147 Gynaecological. Abortion 145 34 2 2 183 Ovarian Cyst 8 1 9 Fibrosis Uteri 26 2 2 30 Uterine Haemorrhage 1 1 Mastitis 9 5 14 Menorrhagia 1 6 3 10 Metrorrhagia 3 1 4 Bartholin's Abscess 1 1 2 Bartholin's Cyst 2 1 3 Dysmenorrhoea 1 3 4 Erosion of Cervix 3 10 13 Deficient Polvic Floor 16 2 18 Subinvolution 6 3 9 Salpingitis 7 6 13 Retroversion 10 3 1 14 Uteric Prolapse 2 3 5 For Sterilization 5 6 2 14 Retained Products 33 1 1 5 Investigation of Sterility 1 1 Hyportension - 1 1 Cervical Polypi 6 6 Cervicitis 3 12 1 10 Urethral Caruncle 2 2 Cystocele 1 11 Recto-vaginal Fistula 1 1 Prolapse of Vaginal Wall 1 1 2 For Paracentesis 4 2 6 Contracted Pelvis 2 2 Cyst of Labia - 24 - 1 1 Medical Surgical Diagnoses. Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Total Gynaecological (Continued) Temination of Pregnancy r 2 2 Cyst on external os. 1 1 Haematocolpos 1 1 Infantile Uterus 2 2 Ruptured R. Tubal Pregnancy. 1 1 397 Infectious. Influenza 26 1 1 2 30 Puerperal Pyrexia 2 2 Sonne Dysentery 4 4 Diphtheria 2 2 Cerebro Spinal Fever 2 2 Chicken-Pox 1 4 5 Erysipelas 1 1 2 Whooping Cough 7 7 Scarlet Fever 3 3 Typhoid Fever 2 2 Paratyphoid Fever 1 1 Polio-Myelitis 3 1 4 Flexner Dysentery 1 1 Septicaemia 1 2 3 Undulant Fever 1 1 Cellulitis 1 2 11 14 83 Maternity Deliveries 862 4 866 Live Births 806 30 836 Delivered before admission 2 2 For Version 5 4 5 14 Pyelitis of Pregnancy 1 6 7 Albuminuria of Pregnancy 4 12 1 17 False Labour Pains 3 3 Ante Parturm Haemorrhage 4 4 Ectopic Gestation 5 5 H.B.P. of Pregnancy 2 21 1 24 Vomiting of Pregnancy 11 8 1 20 Toxaemia of Pregnancy 4 18 2 24 Ante Natal Observation 5 31 21 57 Ante Natal Rest 8 3 11 Anaemia of Pregnancy 10 10 Hydramnios 1 1 1901. Mental — Uncertified 8 47 41 96 Certified 53 53 Loss of Memory 1 1 2 Epilepsy 3 23 9 35 M.D. 2 13 15 Mongolism 1 1 G.P.I 3 3 6 Hysteria 4 15 19 Senile dementia 4 10 1 15 Imbecile 1 1 243 - 25 - Herpes 2 - 36 - 2  Diagnoses Medical Surgical Cured Rel- i3ved Unrelieved Died Cured Relieved Unrelieved Died Total Nervous and Sensory - Cerebral Haemorrhage 10 4 51 65 Meningitis 3 1 2 6 Chorea 5 1 6 Spina Bifida 1 1 2 Habit Vomiting 1 1 2 Neuraesthenia 5 2 7 Cerebral thrombosis 2 20 5 20 47 Sciatica 1 4 5 Neurosis 15 3 18 Disseminated Sclerosis 2 3 3 8 Cerebral Tumour 1 1 2 Hemiplegia 9 4 2 15 Neuritis 1 5 6 Tabes Dorsalis 3 3 Convulsions 6 3 2 11 Parkinson's Disease 3 7 1 11 Cerebral arterio Sclerosis 25 17 4 46 Cerebellar tumour 1 1 Migraine 1 1 Paraplegia 1 1 Congenital Athetosis 1 1 Cyclix Vomiting 1 1 Headache after Cerebral operation 1 1 Cephalgia 1 1 2 Muscular Atrophy 1 1 Cerebral Diplegia 1 1 Subarachnoid haemorrhage 1 2 272. Respiratory. Bronchitis 99 46 6 151 Pneumonia 139 14 1 112 266 Pleural Effusion 1 1 Bronchial Catarrh 1 1 Bronchiectasis 2 1 1 4 Atelectasis 2 2 Asthma 5 17 4 26 Pleurisy 14 8 22 Empyema 4 1 2 7 Pulmonary Embolism 5 5 Influenzal Pneumonia 12 1 5 18 Silicosis 1 1 Pulmonary Fibrosis 1 1 Pulmonary Abscess 1 1 2 Tumour of Pleura 1 1 Tracheitis 1 1 509 Senility 36 30 31 97 Skin Boils, Abscesses, etc. » 35 11 1 47 Burns and scalds 12 3 1 16 Eczema 4 7 11 Impetigo 15 15 Scabies 7 7 Dermatitis 10 8 18 Septic spots 1 2 3 Ringworm 18 18 Erythema Nodosum 1 2 3 Lipoma 1 1 Ulceration Pruritis 3 1 1 1 9 5 1 20 Medical Surgical Diagnoses Cured Relieved Unrelieved Died Cured Relieved Unrelieved Die d Total Skin (Cont) Haematoma 1 1 Pemphigus 1 1 2 Urticaria 1 2 166. Pulmonary Tuberculosis 38 51 40 129 Non-Pulmonary Tuberculosis Spine 3 2 5 Meninges 4 4 Pericardium 1 1 Hip 5 1 6 Kidney 1 2 3 Fallopian tubes 1 1 Miliary 2 2 Knee 1 1 2 Colon 1 1 Epididymo-Orchitis 1 1 Vesiculitis 1 1 Keratitis 1 1 Wrist 2 2 Larynx 1 1 Lupus Vulgaris 1 1 32 Violence. Fractured Limbs 44 92 4 3 143 Fractured Spine 3 2 1 6 Fractured Malleolus 2 7 9 Fractured Skull 7 5 2 14 Fractured Ribs 9 7 16 Fractured Clavicle 4 1 5 Minor Injuries 26 10 1 37 Sprains 2 1 3 Contusions and Abrasions 27 9 1 37 Abdominal Injury 1 1 Concussion 59 21 80 Dislocation 2 2 4 Laceration, wounds etc., 17 6 1 24 For removal of plaster 15 7 2 24 Fractured Jaw 1 1 Gun Shot Wound 1 1 405. Venereal Gonorrhoea 3 3 1 7 Syphilis 4 3 7 Misce1laneous. 1 Poisoning 23 3 1 27 Alcoholism 6 4 1 11 Dental Caries 4 2 6 N.A.D. (With Mother etc.) 27 41 68 Pyrexia of Unknown Origin 2 1 3 Hare lip and cleft Palate 1 1 Heat Stroke 1 1 Teething 2 — 2 Prematurity 3 6 9 Insulin Hypoglycaemia 1 1 Ulcerated Perineum. 1 1 130 - 27 - Operations performed at Mayday Hospital during 1939 Abdominal. Appendicectomy 182 Suture of Perforated Duodenal Ulcer 8 Paul's Operation for Carcinoma Coli 1 Sigmoidoscopy 11 Herniotomy 63 Cholecystectomy 7 Laparotomy 29 Drainage of Common Bile duct. 1 Gastrectomy 5 Colostomy 2 For Intestinal Obstruction 5 For Perforated Gastric Ulcer 10 For Anal Fistula 2 Ligature of Haemorrhoids 6 Resection of Colon 2 Volvulus of small intestine 1 Ovariotomy 5 Hysterectomy 1 Adhesions 1 Anastomosis of Bowel 1 For ruptured Tubal Pregnancy. 1 344 Bones and Joints. For Osteo-myelitis 2 Amputation of limbs 6 Wiring of bones 23 Resection of Rib 15 Application of Plaster 68 Removal of Sequestra 1 Reduction of Joints 2 Manipulation of Limbs 12 Excision of Patella 1 Elevation of fractured nasal bones 1 Reduction of fracture 19 For walking iron 7 Aspiration of knee 4 Exploration of hip 2 Suppurative Arthritis Knee Joint 1 164 v Ear, Nose and Throat. Mastoidectomy 5 Tonsillectomy 200 For Nasal Polypi 4 Adenoidectomy 4 Tracheotomy 1 214 Genito-Urinary. Cystoscopy 25 Circumcision 6 For Hydrocele 1 Prostatectomy 16 Cystostomy 23 For Extravasion of Urine 1 Epididymectomy 1 Reduction of Prolapsed Rectum 1 Varicocele 3 Supra Pubic puncture 2 79 - 28 - Gynaecological. Examination under Anaesthetic 54 Total Hysterectomy 10 Sub-total Hysterectomy 20 Salpingo-cophorectomy 1 Dilation and Curetage 92 Salpingectomy 4 Incision of Breast Abscess 3 Excision of Bartholin's Cyst 1 Insertion of Ring Pessary 2 Colpo-perineorrhaphy 16 Cauterization of Cervix 22 Amputation of Cervix 4 Baldy Webster Operation 8 Myomectomy 1 Removal of Cervical Polypi 5 For Imperforate Anus 1 Ant. Colporrhaphy 2 Modified Gilliams Operation 1 Biopsy 1 Fothergill's Operation 1 Colpotomy 2 For Sterilization 1 Insertion of Laminaria Tents 3 For Uterine Lavage 1 Trachelorrhaphy 2 Repair of Recto-vaginal Fistula 1 Removal of Urethral Caruncle 1 Hymenectomy 1 261 Obstetrical. Hysterotomy 16 Caesarean Section 41 Evacuation of Uterus and Glycerin Pack 125 Induction of Labour 2 For retained products 1 Cevical Swab and Smear 5 Rupture of Membranes 4 Repair of torn perineum 1 Repair of 3rd degree tear 1 Miscellaneous. 196 Exploration of swelling under chin 1 Aspiration of right breast 1 Removal Sebaceous Cyst of R. pinna 1 Excision of glands 4 Blood transfusion 29 Incisions (Abscessos etc) 119 Cleansing of Scalds and Burns 2 Amputation of breast 3 Suture of wounds 20 Thiersch Skin Graft 5 Excision of Wounds 3 Removal of foreign body 3 Iridectomy 1 Lumbar Puncture 71 Aspiration of chest 117 Paracentesis 42 Pyelogran 6 Exploration of chest 1 Venesection 28 Suture of Tætdon Excision of Varicose Veins 3 Empyema 1 Aspiration of abscess 9 Injections to leg 21 Extraction of tooth 2 Excision Epithelioma Face 1 Air Refill of right chest 2 498 Number of patients who had teeth extracted - 256. Total number of patients discharged from Mayday Hospital Year ended 31st December, 1939. Cured 3,656 Relieved 1,330 Unrelieved 548 Died 768 6,302. - 30 - 31 BOROUGH HOSPITAL. Table A gives a Summary of the cases treated at the Hospital daring 1939. 797 patients were ;admittad and discharged which, together with the patients in at the commencement of 1939 (26) gives a total of 813 cases dealt with. 57 died giving a case mortality for the Hospital of 3.3% as against 24.5% in 1933. During 1939 a total of 65 cases was admitted from Penge and 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 3 the final examination. One of the wards (F.Ward) was equipped as a First Aid Post. Two air raid shelters were built in the grounds, and other precautions included the sand-bagging of the wards and administrative blocks, the provision of tanks filled with water at various points in the Hospital grounds and fire fighting appliances. During the year 9 cases were operated for tonsils and adenoids and 5 for acute mastoiditis. 3 cases had uterine drainage performed and 1 case had blood transfusion performed. TABLE A. Patients remaining in hospital 1.1.1940. Patients admitted arid discharged in 1939. Patients admitted in 1939 and remaining in Hospital l.l.40. Analyses of cases whether admitted or discharged'in the year. Total Recovered Died . Total Rocovered Died Total ' Recovered Died Total Recovered Died Case mortality Average No. days in. Scarlet Fever 50 50 270 270 9 9 279 279 36.7 Diphtheria 53 53 315 298 177 11 11 326 309 17 8.9 38.2 Enteric Fever 2 1 1 2 1 1 50.0 37.1 Para typhoid fever 1 1 2 1 1 2 1 1 50.0 33.0 Puerperal Fever 11 9 2 11 9 2 18.2 25.2 Puerperal pyrexia 10 10 10 10 15.6 Erysipelas 2 2 15 13 2 1 1 16 14 2 12.5 11. 7 Measles 1 1 1 1 18. Rubella 22 22 22 22 14.4 C.S.M. 3 2 1 3 2 1 3.3 7.3 Whooping Cough 29 27 2 29 27 2 6.9 36.0 Chicken pox 4 4 47 46 1 4 4 51 50 1 1.9 20 Ophthalmia 2 2 2 2 2 2 8.1 Mumps 1 1 7 7 7 7 14.5 Tonsillitis 1 1 8 8 8 8 30.8 Anterior poliomyelitis 1 1 4 4 4 4 56.5 Dysentery 5 5 1 1 6 6 23.2 Pemphigus 1 1 1 1 51. Otorrhoea 1 1 10 1 9. Cellulitis of leg 1 1 1 1 9 Tuberculosis 9 9 9 9 36. Vincent's angina 1 1 1 1 1.4 Diarrhoea 1 1 1 1 3. No disease 20 20 20 20 TOTALS 115 115 787 760 27 26 26 813 786 27 The average number of days of each patient in Hospital for all classes of patients was 24.5 days compared with 22,6 days in 1938. Scarlet Fever. The total number of Scarlet Fever cases admitted during the year was 270 a decrease of 354 on 1938. 230 cases were admitted from the Borough and 40 from Penge. 6 cases sent in as Scarlet Fever were not suffering from the disease, leaving a total of 264 true cases. Serum Cases NonSerum cages. Total Total cases 42 222 264 Adenitis 5 26 31 Otorrhoea 3 25 28 Phirorrhoea 3 12 15 Albuminuria. — 1 1 Nephritis - 2 2 Rheumatism - 4 4 Relapses 1 3 4 Secondary Sore Throat - 3 3 Abscesses and Boils - 3 3 Mastoid - 3 3 Pneumonia - 1 1 No deaths occurred amongst the scarlet fever cases. Diphtheria. 315 cases wore admitted with a diagnosis of Diphtheria, a decrease of 91 cases an 1938. Of these 15 were found not to be cases of Diphtheria and 110 were cases of positive swabs without clinical symptons, leaving 190 cases of true clinical diphtheria. There were 17 deaths a mortality of 8.9%. The 15 cases not true diphtheria were made up as follows Simple laryngitis 2 Quinsy 1 Vincent's angina 2 Tonsillitis 10 Total 15 Analyses of 190 cases Faucial diphtheria 169 Nasal diphtheria 16 Laryngeal diphtheria 1 Faucial laryngeal diphtheria 2 Faucial nasal diphtheria 2 Total 190 The following complications and sequelae occurred amongst the diphtheria cases Rhinorrhoea 6 Otorrhoea 5 Adenitis 6 Heart failure 15 Albuminuric. 3 Secondary sore throat 3 Acute mastoid 2 Paralyses: Palatal 15 Eyes 4 Facial 2 Diaphragm 1 The type" of diphtheria Cases admitted during the first four months of the year was very severs and marked - with, greats foxemia and this accounts for the hight death rate of 889% Compared with 6% for 1938, as also the fact that there wore only 190 cases admitted in 1939 as opposed to 267 in 1938. Most of the fatal cases were admitted lat , usually on the day of disease and only 5 of these cases had recoived serum proviouse to admission, the dose given not exceeding 8000 units. The number of admissions after September was very small - only 32 cases for the period September to January 1940, these including cases of positive swabs. The iron lung was used in one of the fatal cases, with great success, but unfortunately the child died subseouently through suddon heart failure. TYPHOID AND PARA. TYPHOID FEVER. During the year 4cases of typhoid fever or para typhoid fever were admitted and in all cases the diagnosis was confirmed. Two deaths occurred amongst the four cases, one being a case of toxic typhoid fever; the other a case of para typhoid fever complicated by pneumonia. PUERPERAL FEVER During the year 11 cases of puerperal fever and 10 cases of puerperal pyrexia were admitted. Two deaths oeeurred amongst the puerperal fever cases both duo to septicaemia. Of the cases of Puerperal Fever 5 were complicated by other diseases, as follows 2 wore complicated by thrombo phlebitis of leg. 1 was " " Polvic thrombo phlebitis and bilateral salpingitis 1 " " " infective endocarditis 1 " " " influenza. ERYSIPELAS There were 15 cases if Erysipeas admitted, 16 less than in 1938. In 4 cases the diagnoses wore not confirmed, they were as follows 1 ease of cellulitis of face. 1 case of cellulitis of axilla. 1 case of cellulitis of leg. Excluding these cases were 11 cases of true Erysirelas. The disease was of average severity. Two deaths occurred amongst them, one being complicated by cerebral haemorrhage, the other by chronic myocarditis. WHOOPPING COUGH There were 29 cases of whooping cough, a fall of 18 cases on 1938. The disease was of average severity. There were two deaths both complicated by broncho pneumonia. 33 ORDER SPINAL MENINGITIS Three cases of this disease were admitted, but only one had the diagnosis confirmed, this proved fatal. In one other case left under observation the diagnosis was not confirmed, the other being a case of cerebral abscess. OPHTHAMIA NEONATORUM Two cases were admitted, but they were both cases of simple Ophthalmia INFANTILE PARALYSIS (POLIOMYELITIS) Four cases were admitted. In two cases the diagnosis was confirmed, the others were(l) a case of abscess of right hip joint (2) a case of acute rheumatism. DYSENTERY Five cases were admitted,four of the Sonne type and one of Flexner type, they were all mild cases. PEMPHIGUS One case admitted as Pemphigus Was really a case of chronic eczema. MUMPS Seven cases were admitted as mumps, one of them was a case of alveolar abscess. MEASLES One case only was admitted: this proved to be one of positive nasal swab. CHICKEN POX Forty seven cases were admitted and one death occurred amongst them, the child suffering from severe convulsions. TUBERCULOSIS. After the outbreak of war 9 cases of Pulmonary Tuberculosis were admitted temporarily and subsequently transferred to other institutions, 6 males and three females. 34 Miscellaneous examinations. Urines for Organisms 13 1 Haemelytic Streptococci 3 B. Coli Blood for Culture 9 Specs 8 Sterile. 1 Haemolytic Streptococci Spec. Pus for organisms 4 IB. Typhosus .2 B. Coli 1 Haemolytic Streptococci Spec. Hair for Ringworm (negative). Lochia swabs far culture 5. 2 Haemolytic Streptococci 1 Staphylococci 2 Sterile Cerebro Spinal Fluids 4 1 Meningococci present 3 Sterile. 1 Swab for Vincents Angina (Positive) 1 Eye Swab for Organisms (Sterile) 5 Vaginal Swabs for presence Gonococci (Negative) 35 Out of Borough Cases. Disease Males Females Totals Deaths Scarlet Fever 21 19 40 Diphtheria 4 16 20 3 Puerperal Pyrexia - 2 2 1 No disease 2 1 3 4 Croydon Boro Hospital Laboratory. Diphtheria. Cases swabbed »n admission. Patients Swabbed during convalescence Negatives. Total, Positive. Positive 209 580 4716 5505 Faeces. Enteric and Dysentery Groups. B.Typhosus B.Para Typhosus. B. Dysentery. Negatives Total Examined. positive Positive Positive Flexner Total 2 2 1 17 22 Widals, Dreyers, Agglutination Tests. B. Typhosus B Para Typhosus B Total Total Exemined. Positive Positive Negative 1 2 3 6 Sputum examined for Tuberculosis Bacilli. Positive Negative Total 9 4 13 Swabs examined for Haemolytie Streptococci Positive Negative Total 10 3 13 36 AGE CROUK; OF CASES ADMITTED 0-1 1-2 2-5 5-15 15 - 30 30 and Totals Deaths. M F M F M F M F M F over M F Scarlet fever 1 — 5 6 42 38 52 84 6 25 5 6 270 Diphtheria 2 l 4 1 42 26 81 99 16 22- 5 16 315 17 Enteric Fever 2 2 1 Para typhoid 1 1 2 1 Puerperal Fever 9 2 11 2 Puerperal Pyrexia 10 10 Erysipelas 1 8 6 15 2 Measles 1 - 1 Rubella 1 4 3 4 6 4 22 C.S.M. 2 1 3 1 Whooping Cough 4 1 2 6 6 6 3 1 29 2 Chichen pox 4 1 7 1 13 9 6 6 47 1 Ophthalmia 1 1 2 Mumps 4 1 2 7 Tonsillitis 3 1 2 2 8 Anterior Poliomyelitis 1 2 1 4 Dysentery Sonne 2 3 5 Pemphigus 1 1 Otorrhea 1 1 Colliulitis of leg 1 1 Tubed culosis 2 3 4 9 Vincents Angina 1 1 Dparrthoes 1 No disease 20 15 4 19 14 112 91 153 196 26 80 26 30 787 27 THE OBSTETRIC SERVICE ThE Obstetric Service has.been described in my Report for 1938. The following ate the statistics for 1939. Since, August, 19.39 there has been a whole time resident for the Obstetric and Gynaecological Departments in Mayday Hospital. There is also a whole time resident in St. Mary's Hospital. Taking the Registrar General's figures for maternal mortality (deaths directly due to pregnancy) the rate for England and Wales for 1939 is 2.93 per 1,000 births. In Croydon the rate was 1,16. In Booked cases treated by the Obstetric Service the rate for 1939 was 0.7 per 1,000 Hospital deliveries; nil per 1,000 home deliveries and 0,4 per 1,000 over all deliveries. Of the cases treated to a conclusion at the Post Natal Clinic during 1939, 97.4 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 1938 was 87,5%. The number of cases delivered of viable babies in Mayday Hospital with a nominal 48 beds, was 871. The number delivered at St. Mary's Maternity Hospital, with 30 beds, was 451. GENERAL STATISTICS, 1939. No, of live births allocated to the Borough of Croydon 3404 " " still 407 No of maternal deaths (directly due to pregnancy) 4 No. of cases notified as Puerperal Pyrexia 39 No of Expectant Mothers who attended the Borough Ante Natal Clinics 3334 No, of cases delivered in Mayday Hospital as Booked cases 822 No. of cases delivered in Mayday Hospital as emergency cases 214 Total cases delivered in Mayday Hosp. 1036 No. of cases delivered in St. Mary's Maternity Hospital as booked cases 451 No. of cases delivered in St. Mary's Maternity Hospital as Emergency cases Total cases delivered in St. Mary's Maternity Hospital 451. No. of cases delivered by Municipal Midwives 994 TOTAL 2481 No. of cases admitted to the Puerperal Infection Unit, Borough Hospital and Mayday Hospital Isolation Wards, including 13 from Mayday Hosp. and 8 from St. Mary's Maternity Hospital. 41 No. of Maternal deaths in Booked cases from Borough Ante Natal Clinics 1 No, of Maternal deaths in Emergency cases at Mayday Hospital 2 No, of maternal deaths in cases admitted as Puerperal Sepsis per se 2 Total Maternal deaths in bods of the Obstetric Service 5 37 The conditions for which these were admitted can be ascertained by reference to the Booked columns of tho Numerical summary of Cases . 6 ante-nat 1 clinics per week are now held at Lodge Road for cases booked for Hospital delivery and 2 clinics per week for home delivery. A postnatal clinic for cases- delivered at home has also been instituted. During 1939 ,the. .Obstetric, Service dealt with 2272 out of the total births allocated to the Borough. Major Ante-Natal Conditions Treated at the Ante-Natal Clinic. Breech Presentation. Breech presentation diagnosed 267 Spontaneous version 24 External version successful 197 External version not successful 23 Allowed to go to term as Breech 15 Not recognised as Breech before Labour. 9 Dental Treatment. No, of cases referred to Borough Dental Surgeons 536 No. of cases referred to Private Dentral Surgeons 85 No. of cases refusing dental treatment 52 No. of cases seen too late for necessary dental treatment . 43 Tuberculosis Referred from Tuberculosis Officer because of pregnancy. 9 Referred to Tuberculosis Officer for opinion on lung condition 5 38 ANTE NATAL SUPERVISION. 1938 1939 Number of sessions at Ante Natal Clinics held 283 460 Number of individuals who attended 2,667 3334 Number of previous year's cases continuing attendance 686 583 Number of new cases 1,981 2719 Number of cases undelivered on 31st December 583 528 Total attendances made 12,992 16850 Average attendances per session 46 Number of cases delivered in hospital as Booked cases 1,319 1265 Number of cases delivered by Municipal Midwives 886 994 Number of cases delivered at other places under the care of private doctors or midwives (about) 100 200 Number of patients found not to be pregnant 20 24 Number of patients referred to hospital for Ante Natal treatment 682 602 The total number of patients treated by the Obstetric service was:- (a) in Mayday Hospital 1487 (b) In St. Mary's Maternity Hospital 451 (c) In the Borough Hospital Puerperal Infection Unit and Mayday Hospital Isolation Wards, excluding 13 from (a) and 8 from (b) 20 (d) At the Ante Natal Clinics and delivered outside the above Hospitals (about) (including Municipal Midwives cases) 1221 (e) At the Post Natal Clinics, excluding those included in (a), (b), (c), and (d). 406 (f) At the Ante Natal Clinics and undelivered on December 31st, 1939. 528 TOTAL 4113 Venereal Disease. Gonorrhoea - Total cases 2 Transferred to Borough V.D. Clinic 2 Syphilis - Total cases 3 Transferred to Borough V.D. Clinic 3 These cases are delivered in Mayday Hospital in Isolation Wards, and transferred to the Borough V.D. Clinic on discharge. Midwives Cases. These cases may be summarised as follows Total number of midwives cases during 1939 (about) 227 Number of cases sent for one consultation only 99 Number of oases supervised entirely 137 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 92 Blood for Kahn Reaction 72 Blood for Gonococcus Fixation Test 36 Blood for Grouping 95 Blood for Culture 3 Blood for Urea Content 87 Blood for Widals 1 Blood for Cell Count etc. 75 Catheter urine for Routine Examination 582 Urine for Aschheim-Zondek Test 54 Urine for Urea Concentration Test 330 Lochia for Culture 13 Sputum for examination 10 Pus for identification of Organism 25 Urethral smears for Gonococci, etc. 24 Cervical smears for Gonococci, etc. 28 Conjunctival smears 45 Histological sections 46 Van den Burgh 9 Throat Swabs for Organisms 56 Faeces for Occult Blood etc. 6 Blood for sugar estimation 2 Blood for Hb Estimation 186 Compatibility tests 2 Others 10 X-Ray Examinations (Mayday Hospital X-Ray Department) 215 cases were referred from Ante-natal Clinics and 472 films wore used. Reasons for reference were:- Breech far attitude etc. 23 For presentation, attitude etc. 78 Twins 54 Foetal death 3 " parts 17 Disproportion 41 Others 2 39 Further details will be included in the Annual Report of the Obstetrical Service which is prepared as a separate report. 40 59 cases were referred from the Maternity and Gynaecological Wards at Mayday and St. Mary's Hospitals and 148 films were used. Reasons for reference were:- For presentation 20 Twins 11 For foetal parts 4 Foetal death 2 Hydramnios 3 Breech? Extended legs 10 Disproportion 7 Hydrocephalus 1 Ancncephaly 3 IN - PATIENT TREATMENT. A.- Patients "Booked" in the Ante-Natal Department:- Mayday Hospital. St. Mary's Maternity Hospital. Total (1) Delivered in hospital after 28th week. 811 447 1258 (2) Delivered in hospital before 28th week 7 0 7 (3) Admitted after delivery 4 4 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 0 823 451 1,273 B. - "Emergency'' patients sent into Hospital with some complications by outside doctors or midwives. No "Emergency" cases were admitted into St. Mary's Maternity Hospital. Mayday Hospital (1) Before Labour. (a) Discharged undelivered - (b) Delivered in hospital after 28th week. 60 (c) Delivered in hospital before 28th week. 139 (d) Died undelivered 1 (2) After Delivery 9 (3) Ectopic Pregnancy 5 Total. 214 MUNICIPAL MIDWIVES Cases Booked 1158 Attended (including 7 twins) 993 Maternity Cases 116 Live Births 989 Still births (7 macerated) 16 Maternal deaths nil Medical aid sought 278 Ante-natal visits by midwives 5660 " clinic attendances 3614 Post-natal 347 41 A Numerical Summary of eases admitted for troatment, 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 125 17 54 196 Eclampsia - 4 1 5 Persistent vomiting of pregnaney 13 - - 13 Chronic cervitis 3 - - 3 Acute pyelitis 8 2 4 14 Malnutrition, debility, simple anaemia, etc. 34 6 40 Breech presentation for version 32 - 10 42 Disproportion 61 5 19 85 Retroverted gravid uterus — 2 "" 2 2. Intercurrent Diseases Chronic nephritis 2 1 2 5 Pulmonary Tuberculosis 11 - - 11 Venereal disease 5 - - 5 Cardiac disease 13 5 1 19 Exophthalmic goitre 1 - - 1 3. Conditions chiefly Natal. Presentations at Delivery- Anterior positions of the vertex 723 46 397 1166 Posterior positions of the vertex 36 1 39 76 Breech 43 8 17 68 Shoulder 3 2 1 6 Face and Brow 1 1 1 3 Caesarean section 33 7 7 47 Twins 14 - 6 20 Accidental haemorrhage 8 4 1 13 Placenta praevia 16 7 1 24 Hydramnios 18 - 2 20 Prolapse of cord 5 1 1 7 Retained placenta 7 - 4 11 Post-Partum haemorrhage 15 - 10 25 B.B.A. 4 9 4 17 Lacerated perineum 182 25 150 357 Obstructed labour 3 2 1 6 Premature labour 82 3 35 120 Abortion 31 139 - 170 Ectopic pregnancy - 5 - 5 Abdominal Hysterotomy - 16 - 16 42 Mayday Hospital Booked. Mayday Hospital Emergency St. Mary's Maternity Hospital Booked. Total . 4. Conditions chiefly Post- Natal excluding re-admissions from Post-Hatal Clinic. Retroversion 48 6 40 94 Delayed involution 8 1 5 14 Breast abscess 1 - 3 4 Notified pyrexia or fever 11 2 8 21 In addition 20 cases of Puerperal Fever per so were admissed to the Puerperal Infection Unit of the Borough Hospital. Blood Transfusion. (11 obstetrical and 14 gynaecological cases) The citrate method was employed and all except one donor were supplied by the blood transfusion service of the British Red Cross Society. One Borough Hospital Obstetrical case and one gynaecological case died. Infants Mayday Hospital Booked. Mayday Hospital Emergency St. Mary's Maternity . Hospital Booked. Total Per cent. No. of infants in Hospital on 1st January 1939. 21 - 20 49 Total No. of live births, still births and infants admitted with mother (B.B.A.) 829 69 457 1355 No. of infants in Hospital on 31st December 1939 39 _ 22 61 Living-alive on discharge from Hospital 774 50 435 1259 93.9 Stillborn 35 ' 11 13 59 4.4 Died (born alive, but died in Hospital). 20 8 9 37 2.7 POST NATAL AND GYNAECOLOGICAL CLINIC. In 1939 31% of the "Booked" cases delivered in the Hospitals attended the Post-Natal Clinic six weeks after their confinements. This is 4% more than in 1938. Number of Sessions held 101 j No. of individuals presented 1507 No. of subsequent attendances. 1153 Total attendances 2609 Average attendance per session 26 No. of Post-Natal cases 1015 No. of Gynaecological cases 492 END RESULTS. 915 cases were treated to their termination (other than death) during the year, and the results were classed as Follows:- % Mayday St.Mary's where TOTAL Health Unimpaired 506 371 15 892 97.4 Health slightly impaired. 8 4 4 16 1.7 Health seriously impaired 4 1 2 7 0,9 Totals, treated to conclusion 518 376 21 915 Maternal Mortality (Obstetric Service) Five deaths occurred of Mothers dealt with by the service. Of these, however, only two were Croydon cases, one a Booked case, the other an emergency case. The maternal mortality of "Booked" cases, i.e. cases under the continued supervision of the service, is 0.7 per 1,000 Hospital deliveries, and 0.4 per 1,000 total deliveries including the Municipal Midwives booked cases. This is the same as for 1938, which was the lowest rate on record, 43 Infant Feeding and weight on Discharge from Hospital. In both hospitals normal infants wore breast-fed every four hours mitting the early morning feed. Of 8.34 infants discharged from Mayday Hospital, 654 were up to or over birth weight (79 pur cent) Of 435 infants discharged from St. Mary's Maternity Hospital, 260 were up to or over birth weight (SO per cent). Twins and Triplets. There were 20 cases of Twins and none of Triplets. There was no maternal death. Mayday Hospital Booked Mayday Hospital Emergency St.Mary's Maternity Hospital Booked. Total. No. of cases 14 — 6 20 No of Infants discharged alive 25 - 11 36 No of stillbirths and infant deaths 3 - 1 4 Foetal and infant mortality. 10.7% 8.3% 10% One Emergency case from another Borough died in Mayday Hospital, a case of Eclampsia. Two cases of Puerperal Sepsis per so, which died in the Borough Hospital, were also admitted from other Boroughs, and only came under the Service after the onset of sepsis. SOURCES OF THE GASES From Mayday Hospital- . Cases Deaths "Booked' Cases 11 "Emergency" Cases 2 From St.Mary's Maternity Hospital 8 From other Hospitals From private doctors, deliveries ) in Nursing Homes) 20 2 From private doctors, deliveries ) at home.) 37 cases followed Labour with 2 deaths 4 cases followed abortion,with no deaths Both these deaths were cases admitted from outside Boroughs, and therefore do not enter into the Croydon Borough mortality rate. The 41 cases treated may be classified as follows:- (1) Patients with infection of the genital tract 29 2 6,9% (a) Infection limited to uterus,vagina and perineum 16 (b) Infection involving pelvic cellular tissues, ovaries, Fallopian tubes, pelvic peritoneum or veins. 8 - - (c) Infection of the birth canal spread beyond the pelvis (general peritonitis septicaemia, etc) 5 2 40$ (2) Patients with infective conditions not originating in the genital tract 12 The Assistant Medical Officer of Health for Obstetrics was called in by medical practitioners to see 66 obstetrical and 86 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 tho obstetric and gynaecological aspects of 25 casee in the medical and surgical wards of the hospital. 44 POOR-LAW RELIEF (a) Domiciliary Relief. Number of Croydon cases resident in the Borough and in rcccipt of outdoor relief, on the- 1st January,1939 4695 persons; 2360 cases. 1st July,1939 4502 2325 1st January,1940 4194 2421 Expenditure on Outrelief during the 12 months ended 30th Suptember, 1939 to Croydon cases resident in the Borough. Half-year ended 31st March,1939 £50914.5.5d. Half-year ended 30th September,19 39 £47903.9.6d. ( b) Institutional Relief. Number of Croydon poor persons relieved in the Mayday Hospital on 1st January,1940 and in the Queen's Road Homes on the same date - Mayday Hospital 39 Queen's Road Homes 505 (c) Medical Relief. During the year the Panel Medical Service Scheme was extended to two other medical relief districts of the Eorough and medical relief is now administered by this method in 6 out of 8 medic1 relief districts of the Eorough. 45 Particulars. No.2 Dist. Yearto 31/3/1940 No.3 Dist. Year to 31/3/l940 No.4 Dist. 8 months to 31/3/1940 No.5 Dist. Year to 31/3/1940 No.6Dist. Year to 31/3/1940 No.7 Dist. 9 months to 31/3/1940 1. Average number of separate patients attended during each quarter. 218 214 225 197 356 44 2. Attendances at patients' hones. 966 893 662 593 1346 161 3- Attendances on patients at the surgery. 1012 810 578 592 1109 168 4. Total number of proscriptions written. 3644 3913 2270 2599 4163 532 5. Estimated cost of drugs, dressings and dispensing. £93.6.0d. £100.4.Od £53.7.00. £66.14.0d £105.10.0. £12.6.0d. 6. Estimated amount of per capita payment to doctors in respect of patients act ually attended. 2/9.7d. 3/2.5d. 2/9.2d. 2/6.4d. 2/6.3d. 2/3.4d. 7. Estimated average payment per service point. 1.15d. 1.46d. 1.59d. 1.63d. 1.51d. .85d. MENTAL DEFICIENCY Number of known Meroully Defective Persons in the Borough- 1. Statutory Cases- Aged 0-5 years 5 Aged 5-16 years 120 Over 16 years 574 Total 699 2. Eduaution Cases- Aged 7-16 years 186 Combined total 885 Compared with 1938, the Statutory cases show a decrease of 8 and the Education cases an increase of 2. Five of the cases under Statutory supervision have died. Four died in an Institution and one under guardianship. . The Statutory cases are distributed as follows:- In Certified Institutions 169 In Places of Safety and Approved Homes 4 On leave from Institutions 2 Under Statutory Supervision at Home 400 Under Guardianship 65 In Mental Hospitals 10 Cases under Public Assistance 14 Observation Cases 35 The Education cases were distributed as follows:- In Certified Residential Schools 15 In Certified Day Schools 132 At Private Schools 3 At Council Schools (awaiting vacancies at St. Christopher's) 30 Released for work 6 During the year the. Certifying Medical Officers made examinations and paid visits to the number of 88 to Statutory cases and 95 to Education cases - a total of 183, a decrease of 228 compared with 1938. The Mental Deficiency Visitors paid 2,200 visit's to Statutory cases and 1,800 Education cases, 4,000 visits in all, a decrease of 96 on 1938 figuresi. During the year 23 names have been added to the Statutory List - all of these being notified from the Local Education Authority. 20 names have been removed from the list. 6 cases chargeable to other Local Authorities are under supervision in the Borough. NOTIFIED CASES. Of the 23 cases notified by the Local Education Authority - 18 are at work; 5 are at home. 47 During 1939, twenty-four statutory cases were dealt with as follows, viz Sent to Certified Institutions 11 Placed under Guardianship 5 Varying Orders - (a) Change of Guardian 2 (b) From one Institution to another 6 8 30 Orders were renewed during the year - 10 of which were guardianships. The number of cases sent to Certified Institutions shows an incree.se of 4. GUARDIANSHIP CASES. There are' 65 cases under Statutory guardianship - 35 of these under the care of relatives, and 30 with guardians who are not relations. 7 males and 6 females are at work. 400 visits have been paid to guardianship cases during the year. There are 2 cases on leave from institutions, both these cases are girls. TOWN HALL CLINIC FOR MENTALLY DEFECTIVE. BACRWARD AND ABNORMAL CHILDREN. 86 children were examined during 1939 The classifications arrived at, together With the recommendations made are summarised as under :- 1. (a)Certified as Mentally Defective 24 (b)Confirried us Mentally Defective 20 44 Recommendations - (a)Recommended for Special Day School 34 (b) Recommended for Residential School (c) deferred to Occupation Centre or Institution 6 (d) Observation at home 4 2. Found to be dull and backward 44 (a) Referred to a Special Class 36 (b) Further trial in Ordinary Class 2 (c) For trial in Ordinary Elementary School 6 3. Referred to Child Guidance Clinic .4 4. Mental examinations at St. Christopher's School, 16 48 The Occupation Centre. Owing to the outbreak of the war the Occupation Centre did not reopen as usual for the Autumn term. It was reopened on the 13th October 1939 with one teacher in charge for si:c children. On the 1st April 1940 it reopened after the vacation for 20 children with three teachers. The St. Christopher's Special School The Children were evacuated to the Constitutional Camp at Hopton near Gt. Yarnouth in September. The numbers have gradually decreased from fifty to twenty eight at the present time. 49 MATERNITY AND CHILD WELFARE Notificstion of sirthe Act. 1915 Notifications were received from:- Live Births. Still Births Total Midwives 2452 68 2520 Doctors, Parents and others 1059 41 1100 Total 3511 109 3620 Maternal Mortality There were 4 deaths directly due to pregnancy, compared with 3 in 1938. The maternal mortality rote was 1.16 per 1,00G births, coup: red with 0.87 in 1938. In other words one mother died for every 835 live babies born. The deaths directly due to pregnancy were caused by:- (a) Detachment of the placenta: haemorrhage from uterus (b) Pulmonary embolism consequent upon operation of Caesarean section performed for placenta praevia. (c) Fatty degeneration of the heart, accelerated by difficult labour (brow presention.). (a) Acute peritonitis consequent upon septic abortion (natural) . Puerperal Fever and Puerperal Pyrexia. Thirty-nine cases of Puerperal Pyrexia were notified. This is a rate of 11.3 per 1,000 births (live and still births). Accommodation for Confinement. The following Table gives information concerning the accommodation utilized for confinements. Number. Percentage. In Private Houses 1563 42.53 In Public Institutions 1402 38.15 Registered Maternity Homes 710 19.32 Still Births. During 1939, 107 still births were registered in respect of Croydon. Of these 64 were male babies and 43 female; 2 males were illegitimate. The proportion of still births to living children was as 1 to 32. The still birth rate was 3.1 per cent of the total births. The still birth rate, on the same basis as for Infant Mortality, was 30.4 per 1,000 births. Ophthalmia Neonatorum. Fifteen. cases were notified during 1939. The following table gives the notification's in Croydon during the past eleven, years:- 1929 1930 1931 1932 1933 1934 1950 1936 1937 1938 1939 No. of cases 5 19 14 21 10 13 13 20 21 20 15 Rate per 1000 births. 1.5 5.4 5.6 6.3 3.2 4.0 3.9 6.2 6.4 6.0 4.5 . _ Results of Treatment Cases treated Vision Unimpaired vision Impaired Died Removed Remaining under Treatment.etc. Notified At home In hospital 15 12 3 11 - - 2 2 Infant Mortality The Infantile Mortality rate was 38 per. 1,000 live births registered. This, is 2 per 1,000 births less than in 1938 and is the lowest yet recorded. For the past 5 years the numbers. If infant deaths have been: 1935, 147; 1936, 134, 1937, 195; 1938, 155; 1939, 130; 98 deaths of infants occurred in institutions, including Registered Nursing Homes. Among the 130 deaths, 71 occurred in boy babies and 59 girls. Ox the births, 1,732 were nales and 1,$08 females. The infantile mortality rate for the two sexes was, therefore Boys, 41; girls,37. The rate of infant mortality amongst illegitimate children was 62 per 1,000. The rate in legitimate children was 36 per 1,000. -52- Deaths under one Year, arranged in days, weeks and months. CAUSES OF DEATH 1st day. 2nd day. 3rd day. 1th dev. 5th day. 6th day. 7th day. lst-2nd wk. 2nd-3rd wk. 3rd-4th wk. Under 1 month. 1-2 mths. 2-3 mths. 3-4 mths. 4-5 mths. 5-6 mths. 6-7 mths. 7-8 mths. 8-9 mths. 9-10 mths. LO-11 mths. 11-12 mths. TOTAL. All Causes Certified 29 5 11 6 3 3 1 8 3 7 76 11 6 8 8 2 7 3 3 3 1 1 129 Uncertified ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 1 ... ... ... 3 Convulsions ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 2 Pneumonia (all forms) ... ... 1 1 ... ... ... 2 ... 1 5 2 — 1 2 2 ... 2 ... 1 1 1 1 18 Diarrhoea and Enteritis ... ... ... ... ... ... ... 1 ... 1 2 1 ... 4 4 1 4 3 1 ... ... ... 20 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Congenitai Malformations 3 1 3 1 1 ... ... 1 1 2 13 2 ... ... ... ... ... ... ... ... ... ... 16 Premature Birth 12 4 4 1 2 ... ... 2 2 1 28 1 ... 1 ... ... ... ... ... ... ... ... 30 Atroply, Atelectasis, Debility, and Marasmus 12 ... 2 1 ... 1 ... 1 ... 2 19 1 ... 1 l ... ... ... ... ... ... ... 22 Injury at birth 2 ... ... 1 ... ... ... ... ... 4 ... 1 ... ... ... ... ... ... ... ... ... 5 Other causes 1 ... ... ... ... 2 1 1 ... ... 5 1 1 ... 1 ... 1 ... ... 1 ... ... 10 The Rate of infantile mortality for England and Wales was 50, and for the 126 large towns, 53. For Croydon the rate was 38. An analysis of the above table shows that 23.1 per cent occurred on the first day of life, and 59.2 per cent before the completion of the first month. The following table gives the causes of death during the first month of life:- 1. COMPLICATIONS OF LABOUR. Trauma at Birth 4 4 II. FOETAL STATES. Congenital Heart Malformation 10 Other Congenital Deformities 3 atelectasis etc., 19 32 III. PREMATURITY 28 28 IV. POST-NATAL CAUSES 13 13 77 percentage Deaths per total Infantile Deaths. Deaths per 1,000 Births. 1038. 1939 1938 1939 Premature Births 17.8 23.1 7.2 9.0 Respiratory Diseases (Pneumonia and Bronchitis) 13.15 15.4 5.4 6.0 Infectious Diseases (inc. Tuberculosis) Atelectasis, Debility 10.4 1.5 4.2 0.6 and Marasmus 13.3 16.2 5.4 6.6 Diseases of Digestion 10.3 17.7 7.8 6.9 Accidental and Congenital 15.6 1 16.2 6.3 6.3 ж Analysed these deaths were due to Whooping Cough 1; Cerebro-Spinal Fever 1; ł .Analysed these deaths were due to Diarrhoea 20; Intussusception 1; Pharyngeal abscess 1; and Toxic Jaundice 1. 53 MIDWIFERY SERVICE. Midwives Acts. 1902 and 1918. 111 midwives notified the Local Supervising Authority of their intention to practise within the Borough during 1939. 40 ceased practising in the Borough; so that 61 remained on the Register at the end of the year. All these 61 wero trained and held the certificate of the Central Midwives Board. Midwives. are compensated if they losena case through admission to a hospital or maternity home on the advice of a doctor. The sum of £12.12.0. was paid out during the year. Confinements attended by Midwives,(Including Municipal Mftdwives}, Cases attended by midwives alone 2782 75.4$ of total. Cases attended by midwives when a doctor was also engaged 439 Cases attended by midwives when a doctor was also summoned 471 TOTAL 3,692 The Rules of the Central Midwives Board lay down that the Local Supervising Authority must be informed within 56 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 7 Other causes 6 Albuminuria 10 — 23 FOR COMPLICATIONS DURING LABOUR Breech 3 Occipito-Posterior 2 Extended Breech 1 Transverse 3 Hand 2 1 Undiagnosed 5 — 16 Obstructed Labour 2 — 2 Delayed Labour - Uterine Inertia 8 Prolonged 37 Delayed 25 — 70 Heamorrhage Ante partum 22 "Haemorrhage" or 5 Post Partum 8 "bleeding" - 35 Other Causes- Adherent Placenta 3 Illness of Mother 30 Retained Placenta 6 Eclampsia 2 Torn Perineum 139 — 180 FOR COMPLICATIONS DURING PUERFERIUM: Pyrexia 26 Pain in Breasts 6 Pain in legs 15 Other causes 11 Toxaemia 6 — 64 FOR COMPLICATIONS IN REGARD TO THE BABY Inflammation of Eyes 51 Convulsions 2 Still birth 4 Deformities 9 Feebleness 14 Other causes 29 Premature Birth 8 - 117 54 In accordance with Rule 12a of the Central Midwives Board, the following reasons for the discontinuance of breast feeding were received Illness of Mother 4 Other causes 3 Insufficient Milk 25 Inverted Nipples 6 Total. 38 Inspection of Midwives. Dr. Jenkin-Lloyd, the Inspector of Midwives interviewed 3 midwives at the Town Hall. 31 visits were paid by her to the home of midwives. Doctors' Accounts under Section 14 (1) of the Midwives Act, 1918. 424 accounts wore received from Doctors for services rendered under the provisions of this section. This compares with 388 in 1938, 284 in 1937, 268 in 1936, 243 in 1935 and 172 in 1934, The total amount of the accounts was £533. 4. 0. £207. 2. 6 was ultimately recovered from the patients. In 1938 the amount paid to doctors was £501.9.6 and in 1937 £372.13.0. -55- NURSING HOMES (REGISTRATION) ACT, 1927. Maternity Homes. Other Nursing Homes Combined Maternity and other Nursing Homes Total. No. of Homes on Register, on 31/12/38 13 26 9 48 No. of Applications for Registration during 1950 - 2 - 2 No. of Hones registered during 1939 - 2 2 No. of Homes on Register on 31/12/39 13 25 8 46 No. of Beds available 68 548 (a) Mat. (a) beds:39 107 (b) Other(b) beds:57 405 -56- MATERNITY AND CHILD WELFARE CONSULTATIONS. There are 18 Maternity and Child Welfare Centres, 16 of which are conducted by the Croydon Mothers' and Infants' Welfare Association, and 2 by the Local Authority, a total of 22 sessions per week are held and at all of these a doctor and nurse on the staff of the Health Department attend. During 1939, 2,703 new cases under 1 year of age, and 1,047 over a year of age attended for the first tine; The total attendances of infants and young children from 0-5 years decreased from 88,168 in 1938 to 79,714 in 1939. Consultations with doctors decreased from 24.548 to 21,511. 51 expectant mothers were seen, a decrease of 60 on 1938, and a total of 505 visits to the Centres were paid, by them. The total of all visits to the Centres was 80,219 a decrease of 8,564 compared with 1938. The highest average attendance of mothers and babies at each session was recorded at St. Judes (102.0), Woodside (99.5), South Croydon (97.3) and St. Andrews (91.3). For a week after the outbreak of war all the Welfare Centres were closed. Happily, events showed this was unnecessary and they were reopened. The evacuation of mothers accounts for the small decrease in numbers attending. -57- -58- ATTENDANCES AT INFANT CETTRES - 1939 Muncipal Boston Rd. St .Andrews Sth. Croydon. Shirley Woodside. Lr. Addiscombe Rd. Sth. Norwood . Weston St. st. Alban's. St. Paul's St. Oswald's. Vest Croydon. Norbury. Waddon. St. Jude's. Selhurst ton Monks Orchard Total 1938 Total 1939 l 431 113 74 132 124 123 219 177 97 183 244 78 69 125 101 124 62 174 53 2692 2703 2 5568 1613 1365 1832 1494 1892 3446 2925 1114 2782 2405 1498 809 1816 1666 1700 1057 1992 641 40942 37615 3 108 47 19 43 39 37 89 72 40 53 102 20 28 39 27 29 34 176 45 1097 1047 4 3585 2100 1356 2345 1138 2320 3338 3065 1650 3278 2538 1289 1612 1396 1985 1408 1430 2015 501 43437 38349 5 9692 3873 2814 4352 2795 4372 7092 6239 2901 6296 5289 2885 2518 3376 3779 3261 2583 4357 1240 88168 79714 6 2525 1062 697 903 709 1042 1932 2044 991 1698 1391 803 801 777 1119 795 738 1062 402 24548 21511 7 113 46 31 45 39 44 93 95 60 73 62 33 39 39 61 32 32 77 24 1050 1038 8 7 - 1 3 9 3 2 3 _ 2 - - - 1 15 - - 3 2 111 51 9 29 28 14 22 17 5 55 64 10 4 - 3 36 5 110 - 48 10 - 504 454 10 36 28 15 25 26 8 57 67 10 6 - 3 36 6 125 - 42 13 2 615 505 11 9728 3901 2829 4377 2821 4380 7149 6306 ' 2911 6302 5289 2888 2554 3382 3904 3261 2625 4370 1242 88783 80219 12 1939 86.1 ; 84.8 91.3 97.3 72.3 99.5 76.9 66.4 48.5 86.3 85.3 87.5 65.5 86.7 64.0 102.0 82.0 56.8 51.7 ж77.3 1936 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 ж84.6 жTotal average attendance each week at all the Centres. łCommenced in March. (1) New cases under 1 year. (2) No. of re-attendances. (3) New cases over 1 year. (4) No. of re-attendances. (5) Attendances of children 0-5. (6)Consultations with Doctor. (7) No. of Sessions. EXPECTANT MOTHERS-(8) No. of New cases; (9) No. of re-attendances; and(10) Total attendances of Expectant Mothers. 11. Total attendances; (12) Average attendance per Session. -59- The Work of the Health Visitors - Maternity and Child Welfare Only. C.W R.A A.W W M.S A.P A.W J.C E.H A.K K.T V.C C Wa. D.S A.O L.W I.E M.W L.O W.W B.D E.C L.B E.W G.B D.B Others Total 1. 13 1 30 5 1 1 2 14 3 6 5 1 - 1 3 1 4 6 - 1 - - - - - - 100 2. 16 3 6 10 - - 7 11 - 2 - - - - 1 1 10 - 1 - - - - - 1 69 3. 109 125 108 40 187 132 239 199 115 94 69 71 166 174 70 98 138 115 98 399 80 101 198 121 378 227 3851 4. 420 184 150 129 307 250 328 720 481 169 225 284 459 403 224 376 434 432 385 638 107 211 332 247 483 354 8732 5. 5 - - 1 2 8 16 9 2 5 2 - 3 8 2 2 2 3 10 64 2 16 1 2 37 3 205 6. 222 114 1 72 104 160 298 289 570 399 134 282 223 246 454 207 387 325 289 338 497 63 109 246 205 371 159 6863 7. 4 - - 1 2 6 6 15 - 3 - 2 - - 2 - 4 8 2 66 5 13 7 1 16 4 165 8. 529 360 287 237 154 578 209 935 498 | 412 366 311 289 342 448 484 598 402 553 554 79 180 559 358 303 307 10332 9. 1 - _ 1 3 - - - 2 - 1 - - - 5 2 1! - - - 1 - - 2 3 22 10. 2 - - 1 - - - - - - - - - - - 2 1 - - - - 1 - - 4 - 11 11. - 6 3 1 5 4 4 2 1 3 2 2 5 3 4 3 3 5 2 17 1 5 13 2 5 10 111 12 2 36 - - - - 2 7 4 l 2 13 27 - - 46 13 16 24 68 2 16 14 4 9 11 297 13 4 8 9 1 3 10 1 2 2 4 2 2 2 6 1 3 8 1 5 9 2 3 - 2 2 13 105 14. 9 - 2 45 12 2 1 - 13 63 5 18 1 7 17 3 1 5 4 81 14 69 33 1 18 30 454 15. 266 138 164 283 293 394 311 336 368 131 412 296 398 232 296 437 722 619 311 592 160 294 481 330 181 369 8814 1602 955 931 859 1129 1683 1415 2820 1888 1027 1372 1224 1596 1630 1274 1848 2256 1912 1732 2989 513 1019 1884 1273 1809 1191 40131 2471 1314 2259 1283 951 1944 1838 3553 1912 2332 12512 1446 2904 1441 2622 1406 2541 2841 1934 1378 1205 1265 578 193 845 44938 Visits to expectant Mothers Children 1-2 years Ophthalmia Neonatorum-13. Houses where deaths 1. First visits 5. First visits 9 First visits of infants occurred. 2 He-visits 6. Re.visits. 10 Re-visits 14. Miscellaneous visits. Infants under 1 year Children 2-5 years 3. First visits 7. First Visits 11 Still births 15. Ineffective visits. 4. Re-visits 8. Re-visits. 12 Milk (Mothers and Children's order). Milk (Mothers and Children) Order. Dried Milk Supplied at On Dee. 31st 1938 New cases during the year. Cases discontinued. On Dec.31st, 1939 Free 668 1,060 1,196 532 Half-price 83 199 197 85 Total 751 1,259 1,393 617 In cases where there has been a change from free milk to milk at half-price it has been counted as a new case. The year showed a decrease of 134 in assisted milk cases. ASSISTED FLUID MILK SCHEME. The amount of milk granted was 228,500 pints. In 1938 it was 261,000 pints. Supplied to Families. No. of Pints Corporation Liability. £ s. d. Milk at 1½d. pint 25,500 212 15 4 Milk Free 203,000 2,960 9 2 £228,500 £ 3,173 4 6 DRIED MILK (COUPON) SCHEME. The amount of dried milk granted free or at halfprice was 14,553 packets. In 1938 it was 14,108 packets. Mo. of Packets. Corporation Liability. £ s. d. Dried Milk at Half-price 1,532 63 10 11 Dried Milk Free 13,021 1,080 6 5 £14,553 £1,143 17 4 DRUGS SUPPLIED UNDER COUPON SCHEME. During the year £303-2-7d was spent on drugs. In 1S38 it was £239-4-lld. -60- CONVALESCENCE COMMITTEE OF THE CROYDON MOTHERS' AND INFANTS' WELFARE ASSOCIATION This Committee undertakes the arrangements for convalescence in cases of mothers and children referred for that purpose by the medical officers at the various Infant Welfare Clinics. I am indebted to the Convalescence Secretary for the data given. CONVALESCENT HOMES Total number of children under 5 sent to Convalescent homes (all with mothers) 8 Total number of weeks 17 Cost, £27-ll-6d. Number of mothers sent for convalescence 70 Number of children under 5 sent with their mothers to cottages (this includes 11 who went to relations) 72 A grant of £300 was made by the Council to the Association for this work in 1939. The year is the financial year. HOME HELPS From January 1st to December 31st, 560 mothers applied for Home Helps, and 536 applications were supplied. £308-0-6d. was collected in payment for their services. At the end of the year there were 28 names of Home Helps on the register. This service has shown a continued growth during the year. BABIES' HELP REPORT I am indebted to Mrs. Philpott for the following particulars:- "At the beginning of 1939 the Babies' Help Committee had four cases on the books; at the end of the year there were seven cases. During the year 16 Mothers and Babies were helped. The Committee would thank the Health Visitors for their co-operation in this work." -61- CROYDON ASSOCIATION OF MORAL WELFARE This Association has a Hoes for Girls at 54 norland Road. As the Council now makes a yearly financial grant of £loo towards its conduction, it is periodically inspected by the Council's officers. THE CRECHE. WHITEHORSE ROAD. The Council give an annual grant of £500 towards the cost of this Creche. A total of 5,885 attendances was recorded. COOMBE CLIFF CONVALESCENT HOME. The following is a summary of the cases dealt with;- Number of, cases admitted during the year- 144. Total number of cases discharged- 147. Number of patient days- 51.112 per patient (1939 cases). Age groups of cases admitted. 0-4 5-8 9-12 Over 12 Total Male 29 33 18 2 82 Female 15 28 12 7 62 Total 44 61 30 9 144 Condition on discharge. 0-4 5-8 9-12 Over 12 Total M. F. M. F. M. F. M. F. M. F. Improved 12 5 20 15 4 9 1 l 37 30 Much Improved 7 4 12 13 16 8 1 5 36 30 No change 1 1 1 1 2 - - - 4 2 Discharged at parent's request. 1 2 1 3 1 - - 5 3 Total 21 12 34 29 25 18 2 6 82 65 -62- PUBLIC HEATH ACT, 1936. PART VII. This part of the Act deals with Foster Mothers and Foster Children. The Tables below give figures for 1939:- FOSTER CHILDREN No.as at Dec, 31st 1938 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 1939. , Parent Another area with Foster Parent another Foster other public Institution 303 215 155 64 38 30 18 .. 2 13 198 The number of foster-children showed a decrease of 105 during the year. FOSTER MOTHERS Ho. as at December 31st, 1938 Applications for Authorisation during the year Removals during the year Authorisation cancelled for other reasons. No. as at December 31st,1939. With Child Without Child 150 39 22 - 48 119 The number of foster-mothers decreased by 31 during the year. The Health visitors paid 2132 visits to fostermothers for the purpose of supervision. -63— 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, 1939 of the work carried out by the Sanitary Inspectors and other officers under my supervision. ROBERT J. JACKSON, Chief Sanitary Inspector. SUMMARY OF INSPECTIONS MADE BY THE SANITARY INSPECTORS, AND OTHER DEPARTMETAL WORK. Total No. of Houses inspected for housing defects (under Public Health or Housing Acts) 3060 No. of houses inspected under the Housing (Consolidated Regulations) 1925 1932 No. of Houses inspected under the Rent Restriction Acts... 9 No. of Houses inspected where zymotic diseases have occurred 356 House drains tested with smoke (primary) 794 House drains tested with smoke (on application) 13 Mo. of smoke tests during repair 227 Inspection of drainage work during construction 3504 No. of water tests during repair 397 Final tests of drains after repair 68 Final tests of drains when completely relaid 58 Length of new drains tested yards... ... 2645 Inspection of yards, stables and manure pits 391 " Passages 159 " Public Conveniences 4018 " Pigstyes 128 " Tents, Vans, and similar structures 126 " Theatres, Cinemas, Halls, ets. 95 " Ponds and Ditches 77 " Schools and School Lavatories 132 " Common Lodging Houses (including night visits) 46 " Houses let in lodgings 78 " Premises where offensive trades are conducted. 54 " G-psy Encampments, camps, etc. 32 " Cesspools 82 " Pail closets, privies. 252 " Gathering grounds 563 Siting Shelters, Reinspections, etc 30161 Smoke Observations 109 No. of Visits re Infectious Diseases 1123 Inspections of Shops (under Shops Acts) 1733 Special Early Closing Patrols 49 Sunday Patrols 51 Special Evening Patrols under Shop Hours Act 123 Inspections under Fertilisers and Feeding Stuffs Act 6 " under Pharmacy and poisons Act 26 " Dairies 72 " Farms and Cowsheds 185 " Milkshops 340 " Premises where food is prepared or sold 5463 " Slaughterhouses 668 " Factories with mechanical power 1197 " Factories without mechanical power 167 " Workplaces, Public Health Act 431 " outworkers Premise 218 Visits re Young Persons Employment Act. 56 -64- Baths Inspections 20 Open Air Swimming Pool, samples 14 Water Sanples examined 127 Visits to Enployers of Outworkers 26 Reinspections of Work in Progress 22415 Sundry Inspections and Visits 5281 Appointments kept v;ith' Owners , builders, etc. 2208 Complaints fron public investigated (for purposes other than inspection of House) 3882 Examination of Building Plaxis56 Informal Notices outstanding 31/12/38 2935 w " served 6795 " " complied 7250 No. of Informal Notices referred for Statutory Orators 589 Informal Notices outstanding 1891 Statutory Notices outstanding 31/12/38 156 " " served 673 ' " complied 659 Total number of complaints received 2975 Interviews with callers 3845 Letters received 5120 Letters and other intimations, etc., sent (not including notices) 6663 Nuisances, Infringements- of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1939 and for which action was taken to enforce compliance:- 11) NUISANCES AND HOUSING DEFEATS AT HOUSES, Etc. Insufficient means ot Ventilation Defective windows and sashcord 1285 Want of windows or ventilators 32 Conditions causing dampness- Defective roofs 1241 „ gutters- and downspouts 689 „ walls, etc. 375 Deposits of refuse causing dampness 5 Want of proper damp proof course 411 Other structural defects- Defective plastert 916 Cleansing and limewashing required 1247 Defective floors 318 Insufficient ventilation under floor 28 Defective brickwork, cills, lintels, etc 426 Defective stoves and fireplaces 434 No concrete site under floors 2 Defective drains, sanitary fitting, etc.- Defective sinks and waste pipes 358 Abolition of drinking water cisterns 7 Defective w.c.'s 635 '' drainage 568 Stoppage in drains 137 Abolition of pail closets, privies, etc 5 Domestic nuisances - Want of cleanliness 6 Dirty w.c. pans 10 -65- Other nuisances and infringements- Removal of caravans 1 Offensive accumulations 108 Insufficient accommodation for sub-tenants 5 Defective manure receptacles 3 Want of manure receptacles 1 Defective sanitary conveniences 25 Dirty sanitary conveniences 8 Smoke nuisances 5 Sundry nuisances or defects 417 Limewashing of stables 6 Defective stables 2 Particulars not inserted in Rent Book (Housing Act) 697 " " " " (Rent Restriction Act) 149 (2) FACTORIES & ORKPLACES- Want of cleanness 57 Inadequate ventilation 2 Insufficient drainage of floors 1 Overcrowding 1 Abstract not exhibited 5 Thermometers required 74 Unreasonable temperature 5 Defective roofs 6 " or dirty-yards 12 " gutters and downspouts 3 Provision of water supply off main 7 Damp conditions 4 Defective drains 16 Unsuitable Rooms 1 Notices re maximum no. required 8 Outworkers registers required 6 Limewashing registers required 1 W.c.'s- Insufficient 8 Unsuitable or. Def-ectiye 258 (3) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924 - Food cupboards defective or required 220 Dustbins required 505 Verminous conditions 133 (4) INFRINGEMENTS OF PUBLIC HEALTH ACT , 1925 (S.72-75) INFRINGEMENTS OF FOOD BYE-LAWS, AND FOOD AND DRUGS ACT,1938. Cleansing or repair of walls and ceilings 74 " " repairs of floors, . utensils, fixtures, Dirty or defective w.c. accommodation 28 Food storage accomodation acquired 3 Animals kept in food store 7 Refuse bins uncovered 4 Ac-cumulation in food store and yards adjacent 29 Food in uncovered vehicles or basket3 5 Food improperly kept or mamifactured 15 Premises not suitable for storage or manufacture of food. 8 Want of provision of towels 8 Provision of cloak room accommodation 17 Illegal wrapping of food 1 Household washing in food store 3 Want of ventilation in food store 4 " intervening ventilated space to w.c. 3 " additional w.c . accommodation 1 -66- Drain inlets in food stores 1 Offal bin required Insufficient or defective sink accommodation and water supply 12 Defective sanitary fittings 1 Overalls required 1 (5) INFRINGEMENTS OF PUBLIC HEALTH ACT: PAVING, Etc. Defective yard paving 255 Rainwater pipe used as ventilation pipe 1 (6) INFRINGEMENTS OF SHOPS ACTS- Insufficient lighting to w.c. 44 Insufficient or defective w.c, accommodation 25 Reasonable temperature required 16 Provision of means of heating 13 Unsuitable or insufficient washing facilities 12 Insufficient accommodation for assistants meals 3 Seating accommodation required for females 3 Assistants Weekly Half-Holiday Notices required, etc. 69 Mixed Shop Notices required 55 Young persons hours of employment infringed 8 Hours of employment forms not exhibited or incorrect256 (7) INFRINGEMENTS OF COMMON LODGING HOUSE BYELAWS- (8) INFRINGEMENTS OF HOUSES LET IN LODGINGS BYELAWS- Additional cooking and sink accommodation 1 Want of food storage accommodation 2 Artificial lighting to common staircase 5 Cleansing required 2 Provision of dustbins 2 Defective flooring 1 (9) INFRINGEMENTS OF OFFENSIVE TRADE- Fishfrying premises- Limewashing required 1 Artificial lighting for fish cleaning shed 1 Other premises- Dirty or defective w.c. accommodation 1 Cleansing and whitewashing required 7 Dirty or defective yard paving 1 Offal bins required 1 (10) INSPECTION OF AMUSEMENT HOUSES- Defective sanitary fittings 1 W.c. defective 10 W.c. required cleansing 2 Notices to be fixed to door of lavatories 1 Defective drains 2 (11) KEEPING OF ANIMALS- Pigstyes within 100 feet of dwellings 1 Nuisances in connection with the keeping of pigs 1 Nuisances arising i rom the keeping of other animals 10 (12) INSPECTION OF WATERCOURSES, etc. - Cleansing of watercourses and ponds 2 Spraying of ponds required 1 (13) INFRINGEMENTS OF PHARMACY & POISONS, &c. , ACTArticle not labelled in accordance with the Act (14) INFRINGEMENTS OF FERTILISERS & FEEDING STUFFS ACT, Sec.1 (1) (11) -67- (15) INFRINGEMENTS OF RATE & MICE DESTRUCTION ACTInfestation of rats on premises where food is prepared or sold 2 Accumulations of refuse, etc., harbouring rats 26 Defective drainage 4 Structural defects al]owing ingress of rats into dwelling houses 23 Dilapidated sheds, etc., harbouring rats 27 Rats in business premises 4 Ani.xal and bird food attracting rats 1 Rats under yard paving 4 (16) INFRINGEMENTS OF MERCHANDISE MARKS ACT & AGRICULTURAL PRODUCE & MARKING ACT- Apples not narked 15 Tomatoes " 10 Eggs " 2 Butter " 1 Currant " 2 Sultanas " 2 Meat " 7 Salmon " 3 (17) INSPECTION OF SCHOOL LAVATORIES- Defective sanitary fittings 2 (18) INFRINGEMENTS OF OTHER BYELAWS- Noisy animals 7 Noisy instruments Milk bottles on public highway 2 Foul water flowing over footpath 2 Fouling of footpaths by dogs 1 (19) INFRINGEMENTS OF PUBLIC HEALTH (MEAT )REGULATIONSCarrying meat by neat porter without head covering. 3 Transport of uncovered meat 1 (20) INFRINGEMENTS OF FOOD AND DRUGS (ALOITERATION ACT, 1928 Margarine not marked 3 (21) INFRINGEMENTS OF MILK AND DAIRIES REGULATIONS, etc.- Dirty cowsheds or dairies Cleansing of cows flanks required 1 Defective sanitary, fittings 1 Offensive accumulations 1 Pasteurised -Milk sold unlabelled 1 Disinfection of cowsheds under T. Order 1 Sale of Tuberculin. Tested Milk without licence 5 Sale of loose milk from bottles 1 SANITARY CERTIFICATES During 1939-requests were made in connection with 13 houses. The following defects were ascertained in consequence of these inspections:- Defective gully 1 " Downspout 1 n drains 3 " sanitary fittings 10 " w.c.'s 1 RENT RESTRICTION ACTS a number of application were received for certificates as to the condition of repair of the houses concerned. In 7 instances where the Acts applied certificates were granted. In 3 instances certificates were given to owners stating that the work had been carried out. -68- 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 the total to 247. Up to the end of 1939 196 houses had been approved for demolition and demolition orders had been made; 162 houses had been actually demolished, the tenants being re-housed, when they desired, by the Council; 731 persons were displaced. In addition 90 closing orders have been made and 89 parts of houses closed for human habitation; 232 persons being displaced. The following tables give particulars as to housing during 1939 under the headings prescribed by the Ministry of Health:- 1. Inspection of Dwelling Houses during the year:- (1) (a) Total number dwelling houses inspected for housing defects (under Public Health and Housing Acts) 3060 (b) Number of inspections made for the purpose. 3060 (2) (a) Number of dwelling houses included under the sub-head (1) above) which ©ere inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932. 1932 (b) Number of inspections made for the purpose 1932 (3) Number of houses found to be in a state so dangerous and injurious to health as to be unfit for human habitation 17 (4) Number of dwelling houses (exclusive of those referred to under the previous sub-head) found not to be in all respects reasonably fit for human habitation 1811 2. Remedy of Defects throughout 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 1734 3.-Action under Statutory Powers daring the year. A. Proceedings under sections 9, 10 and 16 of the Housing Act 193.6 1. Number of dwelling houses in respect of which notices were served requiring repairs 233 2. Number of dwelling houses which were rendered fit after service of formal notices (a) by owners 256 (b) By local authority in default of owners. 2 B. Proceedings under Public Health Acts 1. Number of dwelling houses in respect of which notices were served requiring defects to be remedied. 4 2. Number of dwelling houses in which defects were remedied after service of formal notices (a) by mors 4 (b) by Local authority in default of owners C. Proceedings under section 11 and 13 of the Housing Act. 1936 1. Number of dwelling houses in respect of which Demolition Orders were made 17 (2) Number of dwelling houses demolished in pursuance of Demolition Orders. 21 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 9 (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit 1 Not including 122 houses concerning which notices were served prior to 1939. OVERCROWDING. Housing Act, 1936. Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year (ii) No. of families dwelling therein (iii) No. of persons dwelling therein 1 (b) No. of new cases of overcrowding reported during the year 1 (c) (i) No. of cases of overcrowding relieved during the year j / (ii) No. of persons concerned in such cases (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 NOTE Owing to the evacuation of families it has been found impossible to bring this table up to date. -70- 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. FACTORIES. Inspections Premises. Inspections Number of Written Notices. Prosecutions. factories (with mechanical power) 1197 78 - FACTORIES (without mechanical power) 167 103 Other premises under the Act 431 72 - TOTAL 1795 253 - Defects Found. No. of Defects Referred to H.M. Inspector Prosecutions. Particulars. Found Remedied Want of Cleanliness 57 51 _ _ Overcrowding 1 1 _ _ Unreasonable temperature. 5 5 _ _ Inadequate ventilation 2 1 _ _ Ineffective drainage of floo r 1 1 _ _ Thermometers required 74 64 _ _ Sanitary Conveniences- Insuff icientr 8 7 _ _ Unsuitable or Defective 258 229 — _ Not separate for sexes - - _ _ 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). • TOTAL. 475 417 Factories Mechanical 715 Non-Mechanical . 304 Temporary Factories Mechanical 12 Non-Mechanical 12 Other premises under the Act. Employers of outworkers 29 - 71 - Bakehouses. The control of Bakehouses is dealt with under the Factorios Act, the Food Drugs Act and the Public Health Acts, Croydon Corporation Act, 1924 and Cleanliness of Food Bye-laws. For details of Croydon Corporation Act, see under Food Inspection. No. of Bakehouses on Register, 31st December 1939. No. of underground bakehouses (included in above) Visits made to bakehouses during the year Defects found Notices issued and complied with 81 5 161 27 16 Home Work. Lists of home workers are sent in twice yearly, and last year contained the names of 137 workers.residing within the Borough 218 visits were paid to outworkers and 26 visits were paid to premises of employers of outworkers to examine lists and for other purposes. Nature of employment of workers on the Register, 31st December 1938. Nature of work. No. employed Outwork in infected premi ses Outwork in unsatisfactory premises Remarks. Making,cleaning altering and repairing wearing apparel. 91 2 Upholstery work. 7 Lace goods. 3 Other classes of work 36 TOTAL 137 2 REGISTERED AND LICENCED PREMISES IN THE BOROUGH, 31st DECEMBER 1939. Slaughterhouses (not including Public) 3 Bakehouses 86 Common Lodging Houses 2 Houses let in lidgings 60 Dairies and Milkshops 273 Cowsheds 15 Offensive Trades 106 Wholesale dealers in Margarine etc. 37 Premises registered under Artificial Cream Act, 1929 Premises registered for prepartion or Manufacture of potted, pressed, pickled or preserved meat, fish or other food intended for the purpose of sale for human food 140 Premises registered for preparation or sale of ice cream 274 INSPECTION OF OFFICES - PUBLIC HEALTH ACT Dur ng 1939 188 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 accomodation for the sexes, cleansing of sanitary arrangements, redecorations required. -72- SHOP ACTS The Shop Acts, 1934, contains provisions for dealing with the health and coiafort of persons employed and also regarding ventilation, temperature sanitary conveniences, washing facilities and the facilitios for taking meals in shops. The Shops (Sunday Trading Restriction) Act, 1936, restricts the sale of certain goods on Sunday, deals with the hours which the assistants have to work and introduces now requirements. The Retail Meat Dealers' Shops (Sunday Closing) Act, 1936, prohibits the sale of meat en Sundays, with certain exceptions. The Young Persons Employment Act, 1938 came into force during the year. 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 wore carried out. 1956 inspections were made and a number of infringements were found as sot out. COMMON LODGING HOUSES 1. Municipal Lodging House. The Municipal Lodging House (built by the Corporation owing to displacement of private common lodging houses due to the 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., tho cost of a weekly ticket is 6s., for seven nights. The number of men accomodated during the year was 25,889. The number of men lodgers exceeded 70 per night throughout tho year. The recoipts and expenditure for the last ten years arc as follows:- Receipts Expenditure. 1930 £1344 10 9d. £.1477 3.3 6d. 1931 1366 6 4 1711 19 6 1932 1517 8 4 1347 5 5 1933 1437 2 6 lb 44 7 10 1934 1439 16 1 1695 8 9 1935 1468 11 5 1430 14 9 1936 1446 0 2 1381 19 2 1937 1378 14 8 1348 7 2 1938 1253 2 0 1580 6 5 1939 1284 3 4 1269 0 4 2. Private Common Lodging Houses, There are 2 common lodging houses on tho register. During 1939 43 day and 3 night inspections were made. Notices were served for the conditions and defects found. The following table gives tho situation of and the accommodation in the common lodging hcur.es:- Premises. No.of rooms. Accommodation. 11 and 12, Princess Road 10 38 men and women. -73- There are 66 houses registered under the Byelaws. 73 visits were made for inspection purposes. 7 notices were served for various amendments. 7 notices were complied with. The following table gives the situation of these promises - Road. No. of houses. let in lodgings. Beulah Grave 1 Prineese Road 1 Queens, Croydon 2 Ely Road 5 Forster Road 8 Wilford Road 16 Nursery Road 1 St. James' Road 1 Lodge Road 1 Tamworth Road 2 Bert Road 1 Bensham Manor Road 1 Clyde Road 4 Canning Road 2 Derby Road 2 Bolgrave Road 2 Fawsons Road 1 Windmill Road 4 Heath field Road 1 St. Peter's Road 2 Alexandra Road 1 Whitehorse Road 2 Grange Road 1 Solduret Road 1 Welles ley Road 1 South Norwood Hill 1 Sydenham Road 1 Notices were served for the conditions and defects found. OFFENSIVE TSAWES. By laws relating to the Offensive Trades were adapted during the latter part of the year 1925. 54 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 71 Rabbit Skin Drier 1 Fellmonger 1 106 RAG FLOCK ACTS, 1911 and 1928. Six samples were obtained and subjected to analyses, the results being as follows No, 1 cantained 10 parts of Chlorine per 100,000 " 2 "3 " 4 "3 " 6 8 " 11 " 7" 10 " 14 " " " " " " -74- 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 109 observations were made of factory chimneys for the purpose of detecting offences under the Act. Five notices were sent and amendments carried out to stop the nuisance. amusement house. 95 visits were made to theatres, music balls, cinemas and premises where stage ploys 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 tho Licencing Authorities annually. Notices were issued for the condi tions and defects found, KEEPING OF ANIMALS. 124 inspections were made in connection with the keeping of animals. There were 17 premises including institutions, where pigs v/ero knovm to be kept in the Borough. 2 notices were served to abate nuisances arising from various causes in connection with tho keeping of pigs and 10 notices were served to abate nuisances in connection with the keeping of other animals. BYELW - NUISANCES FROM DOGS. In connection with the fouling of footpaths by dog3 a number of warnings have been given. NOISY ANTMAIS BYE-LAW. Action was taken in 7 instances and the nuisance was abated. SCHOOLS. 132 inspections of schools and school lavatories Were made during 1939. The water supply in all cases is from the mains. INSPECTION OF WATERCOURSES, ETC. During the year 77 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, 1955. 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 11 of this Act was 13, and application was made and granted for entry into tho list of the names of 22 deputies. In addition, 263 applications were made for the retention of names on the list.for a further period of twelve months. No infringements of the Act were found. -75- FERTILISERS AND FEEDING STUFFS ACT, 1936. 6 inspections of premises where fertilisers and feeding stuffs were sold and 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 aro 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 women attendant deals with school children and women. Tho following articles wcro disinfected at tho Disinfocting Station during the year:- By Stoam 49,918 articles. By Formalin gas 2,753 w By Formalin Spray 1,593 " 54,264 In addition 1,006 articles were destroyed on request. Disinfection after infectious or contagious disease was carried out in 1,343 rooms at 973 houses 15 class rooms 86 hospital wards 693 hospital clinic and' creche rooms 20 vehicles 3 school departments 5 huts 4 offices 3 tonts 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 1939 899 such articles were disinfected, the receipts for this work amounting to £35. 14. 0. DISINFSS TATION 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 loft in the articles. The furniture and effects are re-packod into the wans 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 thirty cases were dealt with during the course of 1939 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. A number of notifications were received from contractors who have been employed by private persons to carry out cyanide disinfestation of houses. While the process was being carri ed out the premises were kept under observation by the inspector. At the conclusion a certificate was issued by the firm stating that the premises were free from cyanide gas. DISINFESTATION OF HOUSES (OTHER THAN OF CONTENTS) FOR BED BUGS ETC. , Houses are disinfected by means of sulphur and spraying with various * types of vermicides. Cyanide is not used in houses, but is used for furnishings. The latter process is carried out in the special vans. Number of Council houses- (1) Infestod 51 (2) Disinfested 51 Number of houses other than Council Houses- Disinfested Number of houses,other than disinfested by owners or CLEANSING Council Houses tenants 133 OF VERMINOUS PERSONS ETC. During the year 5 adults and 131 children were cleansed for verminous conditions: 46 adults and 148 children for scabios: 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 1939 under the ate and Mice (Destruction) Act, 1919. Premises No. of visits made No. of poison and other baits laid. No. of Killed. Private Rouses 1288 2014 226 Butchers. 2 Other premises where food is prepared or sold 38 Other premises 188 Total 1516 2014 226 -77- FOOD SUPPLY. The supervision and inspection of the food supplies is carried out by eighteen of the district inspectors who aro qualified in food inspection. The Public Slaughterhouses aro under the control of the Superintendent who also acts under the supervision of the Chief Sanitary inspector. During the year there wore 33-287 animals slaughtered for human consumption. The following table shows tho premises in the Borough at wjrich foodstuffs are known to be sold, manufactured or stored;- General Shops 209 Grocers and Provision Shops 761 Greengrocers and Fruiterers 553 Confectioners, Bakers and Pie Makers. 592 Ice-Cream Shops 274 Hotel and Restaurant Kitchens and Dining Rooms 371 Butchers 282 Fishmongers (including fried fish shops) 204 Ham and Boef shops 110 Sweet Manufacturers 11 Other food premises 40 ■ 3407 In addition to the promises in the above table, there are the following food premises, referred to in other paragraphs of this report: - Slaughterhouses and dairies, cowsheds and milkshops on tho 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 food stuffs, but it is difficult to estimate tho actual number in use, as this varios daily. All these barrows and vehicles, wherever found, are inspected by the food inspectors. A watch has beon kept especially for street traders who frequent the public Elementary Schools when'the children are going in and coming out, and who trade toys, sweets, etc., for old clothing. Proceedings were taken in one instance and a fine with costs incurred of £4. 0. 0. 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 tho premises. Of tho twelve slaughterhouses, nine with lairage attached were let on agreement to tenant butchers, and tho remainder were used for public slaughtering, for which head rate tolls are charged. Tho following animals were slaughtered at the Public Slaughterhouses during 1939:- Pitlake. Public Slaughterhouses Cattle Calves Shoep Pigs Total Public section 277 523 846 1801 3447 Private Section 1031 1722 8400 11175 22234 TOTALS 1308 2245 9252 12976 25781 The whole of the meat and offal is examined before it leaves the premises. 78. The following meat and offal from tho Public Slaughterhouses was surrendered and destroyed during the year 1939. Description Cause. 11 beef carcases and offals General tuberculosis 2 " fore quarters Localised tuberculosis. 19 " parts " " 33 " Offals, complete Tuberculosis 105 sets beef lungs Localised tuberculosis 33 beef heads " " 22 " various offals " " 4 " heads Actinomycosis 2 " carcases and offals Septicaemia 2 " various parts Inflammatory etc. 56 " various offals Inflammatory conditions etc. 3 veal carcases and offals General tuberculosis 2 " heads Tubercular 8 " offals, complete " " 10 " plucks " " 6 " carcases Immaturity etc. 7 " various offals, etc Inflammatory etc. 1 " part " " 14 pig carcases and offals General tuberculosis 4 " various parts Localised tuberculosis 140 " heads " " 10 " plucks " " 7 " various offals " " 119 " offals, complete Tubercular 7 " carcases and offals Swine fever 9 " carcases and offals Acute swine Erysipilas 16 " carcases and offals Inflammatory conditions etc. 88 plucks " " 564 " various offals and 10 parts " " 15 " carcases and offals Oedema and emaciation 4 " sheep carcases and offals " " 4 " parts Inflammatory etc. 5 " plucks Parasitical etc. 9 " various offals " " Total weight destroyed: 22,542 PRIVATE SLAUGHTERHOUSES AND MEAT INSPECTION At the end of 1939 there were three registered slaughterhouses in the Borough. Registered Private Slaughterhouses have in recent years been gradually 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 1939 was 668. The number of animals slaughtered in the Private Slaughterhouses during the year was:- Cattle. Calves. Sheep Pigs Total 107 1333 2525 3547 7506. The following meat and offal from Private Slaughterhouses was surrendered and destroyed during 1939 Description. Cause. 1 beef part Localised tuberculosis 1 beef head " " 5 " sundry offals " " 7 " sundry offals Parasitical etc. 2 veal plucks Localised tuberculosis 2 " plucks Inflammatory 2 pig carcases and offals General tuberculosis 40 " heads Localised tuberculosis -79- Description. 12 pig plucks Localised tuberculosis 17 " sundry offals " " 8 " plucks Inflammatory etc. 30 " offals (various) 5 sheep sundry offals Parasitical etc. Total weight destroyed: 1,31-1.lbs. Total number of animals slaughtered for human consumption in the-' Borough during 1939:- Cattle Calves Sheep Pigs Total 1415 3578 11,771 16,523 33, 287 Summary of whole carcases destroyed with the reasons for such destruction. Class of Animal. Tuber culosis Emaciated and Dropsical Inflammatory conditions Immaturity Swine Fever Acute swine Erysipelas Jaundice Septicaemia Putrefaction Unsound Total carcases Cattle 11 — — — — — — 3 — — 13 Calves 3 1 3 2 — — — — — — 9 Sheep — 29 — — — — — — 2 72 103 Pigs 16 15 14 — 7 9 1 — 1 — 63 TOTALS 30 45 17 2 7 9 1 2 3 72 188 Carcases inspected and condemned. Cattle Calves Sheep & Lambs Pigs Number killed 1415 3578 11,771 16,523 Number inspected 1415 3578 11,771 16,523 All diseases except tuberculosis: Whole carcases condemned 2 6 4 47 Carcases of which some part or organ was condemned 66 10 25 696 Percentage of the number inspected affected with disease other than tuberculosis 4.8 0.44 0.24 4.5 Tuberculosis only Whole carcases condemned 11 3 — 16 Carcases of which dome part or organ was condemned 161 20 — 235 % of the number inspected affected with tuberculosis 12.1 0.64 — 1.5 -80- 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 1723 Fishmongers 153 Fried Fish Shops 137 Grocers 520 Greengrocers 258 Poultry and Game Dealers 92 Cooked and Prepared Meat Shops 889 Bakers' Premises 161 Confectioners Premises 390 Markets 494 Hawkers carts and barrows 111 Hotel and other Kitchens otc. 352 Ice Cream Manufacturers and Vendors. 550 General Shops 198 Other premises 35 5463 The following articles of food were surrendered and destroyed during 1939:- 97 beef parts and trimmings (Imported) Unsound 29 lbs. beef kidneys " 44 lbs. beef livers " 20 lbs calf livers " 1259 lbs mutton parts " 99 mutton carcases " 2028 lbs lambs liver etc. " 187 lbs tinned ham " 41 lbs pig kidneys etc. " 439 lbs rabbits . " 208 lbs herrings, haddock etc. " 69 lbs butter " 116 tins salmon etc " 1022 tins etc. pineapple, plums, beans etc. " 190 tins milk and cream " 98 bottles soup, sauce etc. " 37 tins beef etc. " 220 lbs bacon. " 883 lbs. sweets etc. " Total weight destroyed 13,794. lbs. General Summary of Meat and other articles destroyed during the Articles year 1939. Weight in lbs. Total Remarks. Diseased Unsound Eeef 8237 3818½ 12.055½ Including 13 carcases Veal 241 42 283 " 9 " Mutton 1655 2258 3,913 " 103 " Pork 6788 142 6,930 " 63 " Offal 8555 ½ 1741½ 10,297 " imported offal Fish - 208 ½ 208 Herrings etc. Tinned Goods - 1917¼ l,917¼ 1366 tins,80 jars etc. Sundries — 2046¼ 2,046¼ Ham,Rabbit,Sweets 25,476½ 12,173½ 37,650 -81- MILK Enquiries show that approximately 21,806 gallons of mil's are sold daily in the Borough. Of this amount 96% is bottled, just under 4$ is loose, which is sold wholesale, and the remaining small portion, namely 3 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 rounds, is discouraged. MI IK AND DAIRIES (CONSOLIDATION) ACT' 1915; THE MIIK AND DAIRIES AMENDMENT ACT 1922, THE MIIK AND DAIRIES ORDERS, 1926, AND THE FOOD AND DRUGS ACT, 1938. 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 (1938) 9 " added to tho register (1939) " discontinued 1939 Net. 9 Cowsheds on register (1938) 15 " added to register (1939) – " discontinued (1939) – Net. 15 Number of cows provided for 204 Average no.of cows in sheds (1939) 158 No. of dairies and purveyors of milk on register 1938. 383 No. of dairies and purveyors of milk added to register,1939. 20 No. of dairies and purveyors of milk discontinued 1939. 130 Net. 273 Grand total of cowsheds, dairies and purveyors of milk on register 31st December, 1939. ' 288 During the year 597 inspections were made of dairies, cowsheds and milkshops. Mr. P.Thrale, the part-time vetinerary surgeon, makes quarterly reports on his visits to farms and his examination of cattle thereon. Milk (Special Designations) Order, 1936. B The following licences were granted during the year under this order. 1. Producers' Licences to use the designation "Accredited" 2 2. Dealers' Licences to use the designation "Tuberculin Tested" (a) Bottling establishments 1 (b) Shops 12 3. Dealers' Licences to use the designation "Accredited". (a) Bottling Establishments (b) Shops 4. Dealers' Licences to use the designation "Pasteurised". (a) Pasteurizing establishments. 2 (h) Shops. 51 -82- 5. Dealers' Supplementary Licences to use tho designation:- (a) Tuberculin-Tested (b) Accredited (c) Pafctourised. 4 1 3 Inspection of these licenced 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 wore examined under the Milk (Special Designations) Order, 1936:- Tuberculin Tested Milk- Licenced country producers supplying milk to licenced local dairymen. 4 Accredited Milk- Liconcod local producers supplying milk to a licenced dairyman 20 Pasteurised Milk- Samples from licenced dealers 162 The following tables summarise tho result of the bacteriological examinations of Tuberculin Tested, Accredited and Pasteurised samples during the year:- TUBERCULIN TESTED (Licences granted under the Milk (Special Designations)Order 1936 Pre sent Absent Present in 1/100 m.l. Absent Present Absent Present- Absent Exceeding trace Not exceeding a trace Satisfied test Tubercle bacillus 4 Bacillus Coli 4 Blood 4 Pus 4 Detritus 4 Methylene Blue Test Total. 4 4 4 4 4 4 The above 4 Tuberculin Tested milk samples contained total bacteria per m.l. as follows:- Under 5,000 3 Over " 1 Under the Regulations Tuberculin Tested Milk shall satisfy a methylene blue redaction test and contain ho coliform bacillus in one hundredth of a millimetre 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 Satisfied Not satisfied Tubercle bacillus 15 15 Bacillus Coli 2 18 Blood 20 Pus 20 Detritus 2 18 Methylene Blue Test 15 5 5 15 2 18 20 20 2 18 15 5 -83- -5 Samples from a local Accredited Producer's farm proved to be tuberculous After systematic sampling of the herd two cows were found to be giving tuberculous milk and were slaughtered under the Tuberculosis order. The following tables summarise the results of the bacteriological examinations of Pasteurised Milk Samples during the £ear:- PASTEURISED MILK (Licences granted under, the milk (Special Designations) Order Present Absent Over 100,000 per m.l. Under 100,00C per m.l. Present Absent Present Absent Present Absent Tubercle bacillus 162 1 Total number of bacteria 6 156 Blood 162 Pus 162 Detritus 162 162 6 156 162 162 162 The above 162 Pasteurised Milk samples contained bacteria per m.l. as follows:- Under 1,000 6 1,000 - 5,000 36 5,000 - 10,000 30 10,000 - 20,000 41 20,000 - 30,000 18 30,000 - 50,000 13 50,000 - .100,000 12 Over 100,000 6 162 Under the Regulations Pasteurised Milk must not contain more than 100,000 bacteria per millilitre. PROVISION AS TO MILK SUPPLY. During the year 259 samples of ordinary milk were procured and submitted to -examination far tuberculosis in accordance with the Milk and Dairies (Consolidation Act, 1915. Those samples were taken as follows Samples taken at cowsheds in the Borough 14 Samples in course of delivery from country cowsheds to local dairymen and purveyors of milk in the Borough 20 Samples taken at dairymen's premises in the Borough 146 Samples taken in course of delivery by local dairymen or milk sellers on their rounds in different parts of the Borough. 79 -84- 259 Nine samples proved to be tuberculous. Six samples were from supplies coming from Sussex and three from local farms. A considerable number of cows were examined by the Authorities' Veterinary Officers, suspected animals isolated and samples taken. As a result of their investigations seven 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, 1939. 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 9 250 Total no.of bacteria 40 219 Blood 2 257 Pus 259 Detritus 259 Methylene Blue Test 319 40 9 250 40 219 2 257 259 259 ; 319 40 The 259 samples taken under the Milk and Dairies (Consolidation) Act, 1915, were samples of milk which had been produced in the following areas:- No.obtained. No. tuberculous. Croydon 14 3 Kent Surrey Sussex 23 6 Unclassified 222 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 analyses as shown under the Food and Drugs Act section, bacteriological examination of ice cream was carried out in 44 instances, mainly at producers premises. Suggestions were made to 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) 1928 ACT AND FOOD AND DRUGS ACT, 1938. During the year 386 samples of milk (384 new 2 condensed) and 821 other samples were taken. lu 1 instance the vendor was warned. 14 samples of ice cream were taken during the year. The Public Analyst reports that 4 of these samples contained fat in amounts varying from 2.1 % to 9.8 10 contained fat in amounts varying from 10.2 % to 14 % –85- SPTflARY OF SABLES. During 1939 samples were obtained and submitted to the Public Analyst as fallows:- Samples of Total Samples Genuine Not Genuine Prosecutions convictions Cautions Milk 384 370 14 1 – 1 Condensed Milk 2 2 Arrowroot 11 11 Aspirin Tablets 9 9 Bacon 12 12 Baking Powder 7 7 Beer 6 6 Bicarbonate of Soda 1 1 Black Pudding 3 3 Black Treacle 2 2 Boracic Ointment 6 6 Bramble Jelly 1 1 Brandy 2 2 Brawn 15 15 Bread 17 17 Brisket of Beef 1 1 Bun flour 6 6 Butter 23 23 Camphorated Oil 6 6 Candied Peel 4 4 Cane Syrup 1 1 Castor Oil 8 8 Castor Sugar 1 1 Cheese 7 7 Cocoa 13 13 Cod Liver Oil 7 7 Coffee 12 12 Coffee & Chicory 10 10 Compound Liquorice Powder 1 1 Compound Syrup of Figs 6 5 Comp.Tincture of Rhubarb 2 2 Confection of Senna 4 4 Cooking Fat 7 7 Corn Flour 9 9 Corned Beef 5 5 Cream Soda 1 1 Cube Sugar 1 1 Cream of Tartar 8 8 Currants 4 4 Custard Powder 8 8 Demerera Sugar 18 18 Dried Apricots 3 3 Dripping 17 17 Egg Substitute 4 4 Faggots 1 1 Fish Cakes 2 2 Fish Paste 13 13 Flour 11 11 Gin 2 2 Ginger Ale 4 4 Ginger Beer 8 7 1 Ginger Wine 3 3 Ginger Wine Essence 1 1 Glycerine 6 6 Golden Syrup 4 4 Granulated Sugar 5 5 Ground Almonds 11 11 Ground Cinnamon 1 1 -86- Total Samples. Genuine Not Genuine Prosecutions Convictions Cautions Ground Ginger 10 10 Ground Nutmeg 2 (incl.1 inf) 2 Ground Rice 12 12 Ham 3 3 Honey 11 11 Ice Cream 14 14 Icing Sugar 1 1 Jam 18 18 Jellied Veal 2 2 Lard 10 10 Lemonade 8 8 Lemonade Powder 9 9 Lemon Curd 8 8 Lemon Squash 4 4 Liquorice Powder 1 1 Liver Sausage 7 7 Malt Vinegar 13 13 Margarine 15 15 Meat Paste 13 13 Meat Pie' 2 2 Minced Beef 20 19 1 1 1 Mincemeat 6 6 Mint Sauce 1 1 Mixed pickles 7 7 Mixed Spice 5 5 Mustard Mixture 8 8 Oatmeal 4 4 Olive Oil 10 10 Pearl Barley 10 10 Pepper 11 11 Pickled Onions 10 10 Pressed Beef 2 2 Raisin Wine 3 3 Rissoles 2 2 Rum 1 1 Sausage " Beef 24 24 "Beef Preserved 3 3 " Luncheon 18 18 " Pork 12 12 " Pork Preserved 8 8 Smoked 2 2 Saveloys 5 5 Sherbet powder 1 1 Shredded Suet 6 6 1 Shredded Suet with 6 Rice Flour 5 1 Spirit Vinegar 1 1 Sponge Mixture 5 5 Sweets 16 16 Syrup of Figs 2 2 Table Jelly 8 8 Tapioca 10 10 Tea 16 16 Tinned Asparagus 5 5 Tinned Beans 10 10 Tinned Cream 5 5 Tinned Herrings l 1 Tinned Peas 14 14 Tinned Soup 8 8 Treacle 1 1 Tincture of Iodine 1 — 1 Vinegar 6 6 Whiskey 3 3 1207 1185 22 2 1 1 -87- Result of Analysis of New Milk Samples. SOLIDS NOT FAT (Legal standard is 8.5%) 8.0 8.4 8.5 8.6 8.7 8.8 8.9 9.0 9.1 9.2 9.4 1 4 7 27 127 116 65 29 6 1 1 MILK FAT (Legal standard is 3%) 2.5 2.6 2.7 2.8 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 1 3 6 8 24 50 80 73 40 36 31 11 6 4.1 4.2 4.3 4.4 4.6 4.8 4 2 2 1 1 2 Total samples of new milk 384. The samples of milk for analyses 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 54 On Milk Rounds 169 "Appeal to Cow1' samples. 3 At Shops 140 Taken at Institutions 13 Taken at farms 4 Other samples 1 384 AVERAGE COMPOSITION OF NEW MILK SAMPLES. Solids not fat 8.78% Milk Fat 3.5% Percentage of new milk samples below legal standard 3.65% Adulteratod samples. The following is a detailed statement of the adulterated samples and the action taken:- No. Sample Adulteration or Deficiency Remarks. 347 Milk Contained l/3rdof 1 per cent added water ) Further samples taken 414 Milk Deficient in milk fat 3 per cent proved genuine. u.55 Milk One half of one per cent deficient in ) These samples were taken milk solids ) in connection with 361 Milk Deficient in milk solids, 1½% ) samples 237, 276, 277, 278 and 279 reported on last year, aid in which fines and costs were incurred. 622 Milk Deficient in milk fat 5% ) Producer of this milk 681 Milk 5% of added water ) was prosecuted. Case 683 Milk Deficient in milk fat 14% ) dismissed. 684 Milk Deficient in milk fat 10% ) 631 Milk Deficient in milk fat, 8% ) From a local producer 639 Milk Deficient in milk fat 18% ) A cow in the herd was 640 Milk Deficient in milk fat 4% ) found to be giving milk 722 Milk Deficient in milk fat 6% ) deficient in fat.Further samples proved genuine. 738 Milk Deficient in milk fat, 2% ) Producers explanation 812 Milk Deficient in milk fat 1% j accepted. 1163 Tincture Contained Iodine 2.40%, w/v Manufacturers explanation of Iodine accepted. -88- 1161. Ginger Beer Contained 160 parts per million of benzoic acid 1218. Compound Contained salicylic acid,0.065% Syrup of figs. This matter was taken, up with the manufacturers. Further samples proved genuine. This matter was taken up with tho vendor. The remainder of his stock was withdrawn from sale. 1276 Ground Nutmeg Contained 8% vegetable bark ) 10. " " (inf) " 6% vegetable bark ) 1018 Chopped suet and flour; Excesive proportion of flour. 197 Beef Suet Contained 16.9% of flour 193. Minced Beof Contained minced lung 25% Manufacturers communicated with and explanation accepted. Further samples proved genuine. Vendor communicated with and explanation accepted. Manufacturers communicated with and explanation accepted. Vendors prosecuted and fines and costs of £8. 2. 0. incurred. Public Health (Preservatives, etc., In Food) Regulations, 1935 to 1927. During the course of inspections of food shops particular attention is paid to the above Regulations regarding tho marking of foodstuffs to which the Regulations apply. Open Air Swimming Pool, Purley Nay. 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 tho year to examine foodstuffs under the Imported Food Regulations. Other visits were made under the Public Health Aircraft Regulations. UNKNOWN Scarlet Fever was less prevalent than in 1938; the largest incidence has been in Wood side, Vest Thornton, South Norwood, and Addis combe . The incidence rate of Diphtheria was 0.81 compared with 1.19- in 1938; lost cases occurred in Whitehorse Manor, Beusham Manor, Thornton Heath and South Norwood Wards. No cases of Small Pox occurred during the year. There were 39 cases of Puerperal Pyrexia; 24 occurred in the age group 16-25 year and 15 in the age group 26-45 years. A majority of the cases occurred in women having their first confinement. For particulars regarding the Borough Hospital for infectious Diseases see page 31. -90- -91- - CASES OF NOTIFIED INFECTIOUS DISEASE, 1939 Notifiable disease. Cases notified in the whole District. Total cases notified in each Ward. Total cases ved to Borough Hospital diagnosis confirmed Total Deaths in the Borough 1939 At all Ages at ages - years Upper Norwood Norbury West ton Bensham Manor Thornton Neath 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. branous Group) 198 1 52 99 22 21 3 - 4 2 14 25 21 21 13 10 5 25 17 3 20 15 3 170 16 82 109 Frysioslas 48 - - 1 3 10 27 7 3 1 5 5 7 6 1 2 2 4 3 3 2 2 2 15 2 26 22 Scarlet Fever 250 .. 92 118 22 15 3 - 16 13 26 13 20 24 29 15 24 12 13 7 18 9 11 230 - 102 148 Typhus Fever ... .. .. ... .. .. .. .. .. .. .. .. ... ... • • .. .. .. .. .. .. .. .. ... .. ... ... Enteric Fever (including Paratyphoid) 5 .. 1 1 1 2 1 .. .. 1 3 .. .. .. .. .. .. 1 .. .. .. .. 4 2 2 3 Puerperal Pyrexia 39 .. .. ... 24 15 .. .. .. .. 17 .. 2 1 2 .. .. 1 6 2 .. 6 2 19 .. ... 39 Cerebro-Spina1 Meningitis 2 1 1 ... . .. .. .. ... .. 2 .. .. .. .. .. .. .. .. .. .. .. .. 1 2 2 - Ophalmia Neonatorum 13 15 .. .. .. .. .. .. ... .. .. 1 2 1 .. .. 1 7 1 .. .. 1 1 2 .. 9 6 Polionyelitis 3 .. 2 1 .. .. .. .. .. .. 1 1 .. .. .. .. .. .. 1 .. .. .. .. 4 1 1 2 Encephalitis Lethargica ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... .. ... ... Dysentery 4 .. 3 1 .. .. 2 .. .. .. 3 1 .. .. .. .. .. .. .. .. .. .. .. 5 • • 2 2 Malaria ... ... .. ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... ... ... ... Ac. Primary and Ac. INf. Pheumonia 60 4 6 5 6 22 9 8 3 1 4 3 4 7 4 3 5 4 3 4 7 6 2 ... 24 34 26 Ac. Polio Encephalitis 1 .. .. ... .. .1 .. .. ... .. .1 .. .. .. .. .. .. .. .. .. .. .. .. ... ... 1 ... a Influenzal Pneuraonia only. % Not accomodated at Borough Hospital. 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. 1939 1938 Small Pox .. .. .. .. .. .. .. Diphtheria 0.81 1.19 10 126 32 30 198 Erysipelas 0.20 0.24 1 31 10 6 48 Scarlet Fever 1.03 2.15 3 183 36 23 250 Enteric Fever (inc. Paratyphoid.) 0.02 0.02 .. 2 .. 3 5 Puerperal Pyrexia 0.16 0.8 .. 6 3 30 39 Cerebro-Spinal Meningitis 0.01 0.029 .. .. .. 2 2 Ophthalmia Neonatorum 0.06 0.082 .. 14 1 .. 15 Poliomyelitis 0.01 0.012 .. 2 .. 1 3 Encephalitis Lethargica .. .. .. .. .. .. .. Acute Primary or Acute Influenzal Pneumonia. 0.25 0.168 3 40 12 5 60 Dysentery 0.02 0.025 .. 1 .. 3 4 Polio-encephalitis 0.01 .. .. .. .. 1 2 The 1931 Census showed that houses of 1-3 rooms formed 4.7% of the total number of houses in Creyton: those of 4-5 rooms 51.4% and those with over 5 rooms 43.9%. 92 PREVENTION AND CONTROL OF TUBERCULOSIS. 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. One hundred and eighty six cases of Pulmonary Tuberculosis and 45 of Non-Pulmonary Tuberculosis were notified on Form A (primary notifications), of these 121 males and 65 females were Pulmonary cases, 22 males and 25 females Non-Pulmonary. In addition, 55 Pulmonary cases and 15 lion-Pulmonary came to our notice as new cases otherwise than by notification. Tile total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during 1959 by notification or otherwise, was 279, as compared with 552 in 1958, 358 in 1957, 511 in 1956, 555 in 1955, 525 in 1934, 546 in 1955, and 569 in 1952. 221 of these were cases of Pulmonary Tuberculosis; 140 males and 81 females. There were 11 fewer cases of Pulmonary Tuberculosis in males, and 58 fewer in females than in 1938. There were 51 cases of Non-Pulmonary Tuberculosis among children under 15 years as compared with 25 in 1958. The number of cases in adults was 27 compared with 37 in 1958. Of the cases notified in 1959, 21 males and 8 females died from the Pulmonary form of the disease during the year, equal to 15.6% of those notified, and 5 males and 2 females from the NonPulmonary form. The incidence rate of Tuberculosis of all forms was 1.14 per 1,000 of the population; for Pulmonary Tuberculosis 0.91 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 0.94 per 1,000. In 1958 the corresponding figures were 1.56, 1.11, 0.25 and 1.05 per 1,000. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications during the period from the 1st January, 1959 to the 31st December- 1939:- formal notifications . Age periods Ho. of Primary Notifications of New cases of tuberculosis. Total Notifications on Form a. 0 to 1 1 to. 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 55 to 45 45 to 55 55 to 65 65 and up Total (all ages) Pulmonary Males - - 1 1 15 15 30 24 11 16 8 121 154 " Females - - - 1 15 8 17 14 7 2 1 65 81 • Non-pulmonary Males - 4 3 5 4 1 3 1 1 - - 22 22 " " Females - 3 4 7 1 2 1 1 2 1 1 23 24 93 SUPPLEMENTAL RETURN. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from the 1st January, 1939, to the 31st December, 1939, otherwise than by formal notification. Age Periods. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Cases Pulmonary Males - 1 - - 1 1 8 5 - 2 1 19 " Females - - - - 3 4 7 1 - .- 1 16 Non -Pulmonary Males - 1 2 1 2 - - - - 1 - 7 " " Females - 1 - - 1 2 1 1 - - - 6 NOTIFICATION REGISTER. Number of cases of Tuberculosis remaining on the Notification register on the 31st December, 1930:- PULMONARY NON-PULMONARY Total Cases Males Females Total Males Females Total 597 484 1081 119 121 240 1321 PULMONARY TUBERCULOSIS. During 1939, 172 new patients were examined at the Clinic and were found to be in the undermentioned stages of the disease on the first examination:- T.B. minus (sputum negative or absent . 61 or 35.5 T.B. plus 1 (early cases, sputum positive) 13 or 7.5 T.B. plus 2 (intermediate cases, sputum positive) 64 or 37.2 T.B. plus 3 (advanced cases, sputum positive) 34 or 19.8 172 or 100.0% This is 17 fewer than in 1938. AGES AT DEATH FROM PULMONARY TUBERCULOSIS. Year 0-5 5-15 15-25 25-45 45-65 Over 65 Total 1937 ... 2 35 55 40 8 140 1938 ... 3 22 46 40 8 119 1939 ... ... 19 44 30 3 96 94 In 1939 the death-rate from all forms of Tuberculosis was 0.46 per 1,000 population. The rate for Pulmonary Tuberculosis was 0.41 and the rate for Non-Pulmonary Tuberculosis 0.05. Similar figures for 1938 wore 0.56, 0.49 and 0.07. PULMONARY TUBERCULOSIS. In 1939 there were fewer deaths from Pulmonary Tuberculosis than in 1938, the greatest number occurring in the age group 35-45 years, whereas in 1938 the greatest number occurred in the 25-35 years age group. Apart from the 35-45 age group, there were fewer deaths in all the other age groups than in 1938. NON-PULMONARY TUBERCULOSIS. This year the greater proportion of new cases of NonPulmonary Tuberculosis occurred in children up to 15 years, 53.4%, and 46.5% in adults. Of the cases occurring in children, 51.6% were in boys; in adults the greater proportion of the cases were in women, 51.8%. 33.3% of the deaths occurred under the age of 10 years compared with 44.4 in 1938. The diagnoses of the new cases entered in the Notification Register during 1939 were as follows:- Male. Female. Arm. 3 - Hip, Ankle & Bladder 1 — Hip 2 3 Knee 2 1 Dactylitis - 1 Spine 4 3 Wrist — 1 Ankle — 1 Abdomen 5 2 Glands 3 10 Epididymis 3 - Fallopian Tubes — 2 Kidney 1 2 Meninges 4 2 Brain & Intestines 1 — Irido-Cyclitis — 1 29 29 DEATHS FROM NON-PULMONARY TUBERCULOSIS. During 1939, 12 deaths were certified to be due to NonPulmonary Tuberculosis, compared with 18 in 1938. The deaths were due to:- Males. Females. Total. Tuberculous Meningitis 4 1 5 Tb. Meningitis and Miliary Tb. 1 - 1 Tb. Kidneys - 1 1 Tb. Kidneys, Prostate, and Testis 1 - 1 Tb. Spine 2 — 2 Tb. Intestines — 1 1 Tb. Peritonitis 1 - 1 9 3 12 95 CO-ORDINATION WITH MEDICAL PRACTITIONERS, AND OTHER BRANCHES OF THE HEALTH DEPARTMENT. During the year 205 cases of suspected. Tuberculosis were referred by private medical practitioners; 50 were diagnosed as suffering from Tuberculosis and were subsequently notified. In addition, 14 children were referred by the School Medical Service, and 28 cases from the Maternity and Child Welfare section of the Public Health Department. 8% 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 83.6% in 1938, 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 medicial practitioners on their domiciliary cases (Form G.P.36) was 416. EXAMINATION OF SPUTUM. The results of examinations made in 1939 are as follows:- For For General ClinicPractitioners. Totals. Negative (i.e., tubercle bacilli absent) 907 653 1,560 Positive (i.e., tubercle bacilli present) 592 96 688 Totals 1,499 749 2,248 For each 100 new cases and contacts examined at the Clinic 187 specimens of sputum were examined. X-RAY WORK. 729 X-ray examinations were made during the year, an increase of 109 over 1938. This is equivalent to 91.1 for every 100 new cases and contacts seen, and compares with a rate of 74.7 in 1938, 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. During the year the X-ray examinations were carried out at Mayday Hospital. Twelve cases were examined by Tomograph methods. EXTRA NOURISHMENT. Provision of special nourishment in the form of milk was granted to 115 selected cases for varying periods during the year, and 61 cases were in receipt of extra nourishment at the end of the year. 96 97 INSTITUTIONAL TREATMENT Pulmonary Cases Treated in Institutions, 1939 In at beginning of 1939 Admitted during 1939 Discharged during 1939 Died during 1939 In at end of 1939 Adults Adults Adults Adults Adults M F C M F C M F C M F C M F C Croydon Boro' Sanatorium, Cheam 54 39 1 82 61 - 91 66 1 5 5 - 40 29 - Mayday Hospital 22 11 - 67 41 6 45 37 5 29 9 1 15 6 - Grosvenor 4 2 - 2 3 - 5 5 - - - - 1 - - Burrow Kill Colony - - 1 2 - - 1 - - - - - 1 - 1 Brompton 5 1 - 8 7 - 13 6 - - - - - 2 — Papworth 1 - - 1 - - - - - - - - 2 - - King Edward VII Sanatorium - - - 2 - - 2 - - - - - - — — R.N.H.C., Ventnor 1 - - - - - 1 - - - - - - - - Royal Chest Hospital 2 4 1 8 8 - 10 11 1 - 1 - - - - King George's Sanatorium 1 - - - - - - - - - - - 1 - - Royal National Sanatorium - - - - - - - 1 - - - - - - - Eversfield Chest Hospital - - - 2 - - - - - - - - 2 — — Preston Hall Colony 1 - - 1 - - 2 - - — - — — - - National Children's San.Harpenden - - 2 - - - - - 2 - — - — — - Winsley Sanatorium - - - 1 - - 1 - - - — - — — — Hill End hospital - - - - 1 - - - - - — — — 1 - University College Hospital - - - - 1 - - 1 - — - - - - - Ipswich Borough Sanatorium - - - - - 2 - - - - — - — - 2 Croydon Borough Hospital, Waddon - _ — 5 3 - 5 3 - - - - - - - 91 57 5 181 126 8 176 130 9 34 15 1 62 38 3 Non-Pulmonary Cases Treated in Institutions, 1939 In on 1st Jan.1939 Admitted during 1939 Discharged Died During 1939 In on 31st Dec. 1939 Adults Adults Mults Adults Adults M F C M F C M F C M F C M F C Mayday Hospital 2 1 1 3 2 6 2 3 5 1 - - 2 - 2 Royal Sea Bathing Hospital 4 3 3 3 1 3 5 - 1 - - - 2 4 5 St. Thomas's Hospital - - - 1 - - 1 - - - - - - - - St. Nicholas Hospital - - 2 - - 5 - - 5 - - - - - 2 Tait Convalescent Home - - - - 2 - - 1 - - - — — 1 — Treloar Cripples' Hospital - - - - - - - - - - - - — - — Croydon General Hospital - - - 2 2 8 2 1 8 - 1 - - - - Pyrford - - 3 2 - 5 - - 5 - - - 2 - 3 Heritage Craft School - - 1 - - 1 - - - - - - - - 2 King George's Sanatorium 1 - - - - - 1 - - - - - - - - Royal National Orthopaedic Hospital - - - - 1 - - - - - - - - 1 - St. Vincent's Orthopaedic Hospital - - - - 1 1 - - 1 - - - - 1 - Atkinson Morley Convalescent Hospital - - - 1 - - - - - - - - 1 - - Holland Lodge Convalescent Home — — - — — 1 — — - - — - - - 1 7 4 10 12 9 30 11 5 25 1 1 - 7 7 15 The Immediate Results of Institutional Treatment The immediate results of treatment of patients discharged from institutions during the year are as follows. Among the Pulmonary cases 27,7% were classified as early cases; the percentage of early cases receiving treatment in institutions was in women, 9.9%; in men, 16.6%; 51.6% of the total cases were intermediate cases, the males showing an excess in this group - 29.0% males to 22.2% females - and 20.6% were definitely advanced. Of the total Pulmonary cases treated in Institutions 77.7% were potentially infectious. 151 males, 97 females and 4 children, suffering from Pulmonary Tuberculosis, were discharged from or died in Institutions in connection with the Croydon Scheme during 1939. During the year 86 Clinic cases died; of this number, 25 or 29.1% were seen for the first time in 1939. The Tuberculosis Clinic and Home Visiting. The subjoined table gives a summary of the work done in connection with the Clinic. 475 new cases were examined during the year; this is equal to 439 for each 100 deaths from the disease. 191, or 177 for each 100 deaths, were found to be definitely Tuberculous. The total number of attendances at the Clinic was 5,000. The Tuberculosis Officer paid 171 home visits, and the District Health Visitors 3,055 visits for Clinic purposes. In addition, the Health Visitors made 363 primary visits for the purpose of the Notification Register. The Tuberculosis Officer paid 70 visits to Mayday Hospital, in a consultative capacity, and there examined 253 patients. The Croydon Nursing Service, by arrangement with that organisation paid 1,445 visits 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 preventative measure. During the year 325 contacts were examined, equal to 301 for each 100 deaths, compared with 341 in 1938, or 249 per 100 deaths. Of these, 10 were considered to be Tuberculous. This is equal to a Tuberculous rate per 1,000 contacts of 30.7, compared with 1.14 per 1,000 of the general population. Included in the 10 contacts found to be Tuberculous are 5 who had been under observation from previous years. 569 appointments for examination were offered to new contacts during 1939, but only 325 new contacts attended and were examined. The Clinic Register of Cases. The number of cases of Tuberculosis under the supervision of the Clinic at the end of the year was 829. This is equivalent to 3.6 persons per 1,000 of the population. 99 SUMMARY OF CLINIC STATISTICS FOR 1939 No. of persons on Clinic Register, January 1st, 1939 899 " Notified Cases examined for the first time 64 " Cases sent for an opinion 318 " First attendances, including 29 transfers in 829 " Consultations of T.O. with medical practitioners- (a) Personal 29 (b) Other 577 " Visits paid by T.O. to homes of patients 171 " Visits paid by T.O. to Cheam Sanatorium 10 " Visis paid by T.O. to Mayday Hospital 70 " Patients examined by T.O. at Mayday Hospital 253 " Visits paid to homes of patients of Health Visitors 3055 " Visits paid to homes of patients by District Nurses 1445 " Attendances of patients at the Clinic- Men 1982 Women 2299 Children 719 Total. 5000 No. of reports received from Panel Practitioners(G.P.36) 416 " Report forms sent to Panel Practitioners( G.P.36) 808 " Reports received from Panel Practitioners on Forms G.P.17 - " Reports received from Panel Practitioners on Forms G.P.35. 5 " X-rays taken 729 " Reports made to Ministry of Pensions by the T.O. on general progress of Tuberculosis Discharged Ex-Service men 2 " Cases referred for "Light" treatment 8 " Cases referred to Orthopaedic Clinic 23 " Cases receiving extra nourishment at end of year. 61 No.of Insured patients under Domiciliary Treatment at end of year- Pulmonary 207 Non-Pulmonary 10 Total. 217 100 Housing Statistics of Patients. 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 17 5 - 22 15 years and over 525 96 297 918 542 101 297 940 Number of Non-Pulmonary Cases- Under 15 years 35 23 6 64 15 years and over 61 13 40 114 96 36 46 178 Totals 638 137 343 1118 The above table gives a summary of the housing conditions found in notified oases. It is seen that 57.6% of the Pulmonary cases and 53.9% of the Non-Pulmonary cases were occupying a separate bedroom. In 31.5% of the Pulmonary and 25.8% of the Non-Pulmonary the sleeping arrangements were not satisfactory. Forty-two families had been rehoused in Council houses under the scheme begun in 1935 by the end of 1939. 101 102 PULMONARY TUBERCULOSIS The Condition at the end of 1939 of cases discharged from Sanatoria during the yearn indicated. 1935 1936 1937 1938 1939 Totals T.B. - T.B. + T.B. - T.B. + T.B. - T.B. + T.B. - T.B. + T.B. - T.B. + T.B. - T.B. + Dead 5 46=54.7% 5 26=43.3% 1 30=33.0% 1 11=14.5% - 5=4.5% 12 118=27.9% 45.5% 37.0% 24.2% 11. 2% 3.1% 22.0% Working or Fit for Work 19 31=37.0% 18 20=33.% 34 38=41.7% 30 44=57.9% 41 53=47.3% 142 136=44.0% 44.7% 45. 2% 56.2% 69.2% 58. 4% 56. 4% Not able to work 4 7=8.3% 1 14=23.3% 2 23=25.3% - 21=27.6% 8 54=48.2% 15 119=28.1% 9.8% 17.8% 19.5% 19.6% 38.5% 22.6% Left District 9 27 17 17 7 27 14 15 2 7 49 93 37 111 41 77 44 118 45 91 51 119 218 516 SUMMARY OF DENTAL TREATMENT AFFORDED TO TUBERCULOSIS PATIENTS DISPENSARY Males Females Total Referred from Dispensary 13 19 32 Treatment cases continued from Cheam. 8 1 9 Attendances 87 72 159 Extractions 51 66 117 Fillings 4 26 30 Dressings 8 4 12 Scalings 8 7 15 Denture Dressings 33 21 54 Dentures Fitted 10 6 16 "Gas" cases (on the recommendation of Tuberculosis Officer) - 4 4 No. of Sessions Treatment: 22. CHEAM SANATORIUM Number examined 52 51 103 Referred Treatment 43 48 91 Treated 41 44 85 Attendances 187 137 324 Extractions 62 40 102 Fillings 72 74 146 Dressings 7 1 8 Scalings 28 20 48 Denture Dressings 21 15 36 Dentures Fitted 6 5 11 Mandibular Injections 8 16 24 Repairs to Dentures 3 2 5 No. of Sessions Treatment: 33. 103 T.B. AFTER CARE COMMITTEE During 1939 £440 were spent from the After Care Funds for the benefit of the tuberculosis patients and their families. 157 patients received financial aid, bed and bedding were supplied in 18 cases, clothing in 57 cases, extra nourishment in 47 cases and surgical instruments in 29 cases. Fares were allowed to enable relations to visit certain patients receiving treatment in institutions away from Croydon. In two cases grants were made towards the cost of removal to a Council House when the previous accommodation was unsuitable. Assistance was given with insurances where these were in danger of lapsing owing to the patients inability to keep up the payments. The number of patients assisted shows an increase on previous years; particularly marked is the increasing number of grants made for extra nourishment both for the patients and the contact members of the family. The resources of the fund were severely taxed at the time of the evacuation from Mayday and Cheam and certain London Hospital on the outbreak of war. Within a few hours 77 patients were discharged to their homes. In some cases bed and bedding had to be supplied at short notice as the sleeping accomodation was unsuitable and a large number of grants had to be made for extra nourishment. Fares ware provided to enable patients to return to their homos in certain instances of patients who hadpreviously been living in lodgings or working in domestic service in Croydon. Three such patients wore sent home to Ireland on medical advice. The help which the Committee was able to render at that time of stress did much to alleviate the very natural anxiety of those patients whose treatment was necessarily interrupted. Fortunately many of these patients have since then been able to resume their treatment. Once again thanks are due to the many outside Societies for help given to the tuberculous patients and to the Public Assistance Committee and Unemployment Assistance Board for their co-operation in allowing special grants for extra nourishment. 104 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: Ken, 53 Women, 40. In-patients on Jan. 1st 1939 Admitted during year 1939 Discharged during year 1939 including deaths In on Jan.1st, 1940 Died during year 1939 M F M F M F M F M F 54 40 89 66 103 77 40 29 5 5 No. of Artificial Pneumothorax cases began 30 No. of Refills given 1770 No. of X-ray Screenings 1916 No. of Films taken 519 No. of Sputum tests 903 No. of Gas Replacements 13 Immediate Results of Treatment Group Total number of cases discharged 1939 Quiescent Improved No Material Improve ment Died in Institution Average duration of stay in days Discharged before completion of treatment M F M F M F M F M F M F Class T.B. Minus 21 20 16 10 2 2 2 1 1 - 146 - 7 Class T.B. Plus- Group I 8 6 2 2 5 2 - 2 - - 159 1 - Group II 37 37 6 4 21 20 7 6 1 1 248 2 6 Group III 18 7 - - 6 2 6 1 3 4 290 3 - Observation NonT.B. 8 1 - - - - - - - - - - - 92 71 24 16 34 26 15 10 5 5 843 6 13 At the beginning of 1939 there were 94 patients in Cheam. During the year 155 were admitted and 170 discharged, whilst 10 died, thus leaving 69 patients in at the beginning of 1940. There were 14 observation cases sent in: 11 males and 3 females. Of the 11 males 8 were not tubercular, and of the 3 females 1 was not tubercular; therefore •there were 9 observation cases in non-tuberculars which are shown above. The 5 that were tubercular are in with the tubercular cases and are not shown as observation. A.P. cases discharged but still under treatment, 11 males, 6 females (see above) making total discharges: males 103, females 77. These 17 Artificial Pneumothorax cases only refer to cases discharged in 1939; those discharged in 1938 and still having refills have not been included. 105 IMMUNISATION against diphthEria. During the year 1939 the routine employed in this branch of preventive medicine has been considerably modified. Up to September of this year all children over 5 years, and a proportion of these under 5 years, were submitted to a Primary Schick Test, those negative were discharged, and those positive inoculated with one or other of the preparations, a final Schick Test being performed two or three months later. This entailed four or five visits to the Clinic. An analysis of the data, provided by nearly six years of this work in Croydon, showed that in Schools or areas where the incidence of diphtheria had been low, in children over 10 year, less than 75 per cent would be Schick positive; where the diphtheria incidence had been high, in children over 8 years less than 75 per cent would be positive; while in places where there had been a localized outbreak, in children over 5 years, less than 50 per cent would be positive. Alum precipitated toxoid was used in 1938 and continued during 1939. Of the 43 reactions 35 were mild and occurred after the first injection; 8 were severe,- 7 after the first injection. Of the 8 severe reactions, one occurred in a child of 5 years, 3 in children of 8 years, 3 in children of 9 years and 1 in a child of 14 years. TABLE I Following results obtained by Schick Testing two to three months after two injections of A.P.T. Age Group Originally Schick Positive Cases not given Primary Schick Total cases treated Number treated Number still Schick Positive Schick Conversion rate per cent Number treated Number Schick Positive Schick Negative rate per cent Number ed Number still Schick positive Schick Negative rate per cent 1-5 128 0 100 270 3 98.8 398 3 99.2 5-8 315 4 98.7 8 0 100 323 4 98.8 8-10 145 0 100 0 0 0 145 0 100 10-14 172 2 98.8 1 0 100 173 2 98.8 1-14 760 6 99.2 279 3 99.9 1,039 9 99.1 TABLE II Reactions obtained after A.P.T. Age Group. Total Cases Total Reactions Reactions Per cent. 1-5 402 4 0.99 5-8 334 11 3.3 8-10 154 9 5.8 10-14 192 19 | 9.9 1-14 1,082 .. . .. 43 3.9 106 The Work of the Year. On January 1st, 1939, 497 oases were awaiting completion of treatment. Of these, 1 completed a course of T.A.M., 13 of T.A.F., and 454 of a.P.T; 29 defaulted. In 1939, 1020 new cases attended, a decrease of over 500 on the previous year. The cause of this is to be found in the outbreak of war and the evacuation of the child population. Small outbreaks of the disease at Whitehorse; Ecclesbourne and Elmwood Schools were followed, as is always the case by a rush of applications for treatment. 593 of the new 1939 cases were given a Primary Schick test, of which 452 were positive, a percentage of 76; 141 were negative, a percentage of 24; a more detained Table giving the results of Schick tests at ages is appended - Table III. 427 cases commenced treatment without a Primary Schick test. The new cases were derived from the following sources:- School Cases 704 Infant Welfare Centre Cases 225 Other cases under 5 years 91. As will be seen from Table VI the proportion of cases from Infant Welfare Centres has increased this year, a change probably due to the evacuation scheme. No case in 1939 received T.A.M.; 9 cases received T.A.F.; and 724 A.P.T. This makes a total of 733 completed cases. 87 cases were awaiting completion of treatment on Dec.31st, 1939; 59 cases defaulted. The 468 cases carried over from 1938 and completed in 1939, together with the 733 cases make a total of 1201 cases completed in 1939. The total number of cases that attended in 1939 was 1488. 7 of the. 1938 A.P.T. cases were found to be Schick positive two or three months after their second injection. The reaction noted was. very faint. 5 cases were given a further injection and were then found to be Schick negative. One of the 1939 A.P.T. cases was faintly Schick positive; a further injection . was given. 272 of the 1939 oases were given a final Schick test; 271 were found to be Schick negative. The following figures give some further details Total number of sessions held 61 Highest attendance at any one session 118. Lowest " " " " " 11 Average attendance per session 63. TABLE III Summary of Results of 593 Primary Schick Tests. Age Group Positive %Positive. Negative %Negative Total Under 5 years. 85 95.5 4 4.5 89 Over 5 under 6 44 90 5 10 49 "6 "7 40 95 2 5 42 " 7 " 8 31 86 5 14 36 " 8 " 9 40 83 8 17 48 " 9 " 10 34 77 10 23 44 " 10 " 15 178 62 107 38 285 TOTAL 452 76 141 24 593 107 TABLE IV SUMMARY OF WORK OF CLINIC SINCE ITS START. Year Total attended for treatment. New cases attended No. of sessions held Av. attend. per session No. given ary Schick %Pos. on Primary Schick No. given posterior Schick No. Neg. on post. Schick %Neg. on Post. Schick. No. completed treatment. 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 1939 1488 1020 61 63 593 76 678 671 93.9 1201 TABLE V. SUMMARY OF ATTENDANCES AND TREATMENT 1939. Under Treatment 1.1.39. Received T.A.M. Received T.A.F. Received A.P.T. Defaulted Given Primary Schick test. No. Positive % tive. No. not given Primary Schick. Total new cases 1939. 497 1 13 454 29 593 452 76 427 1020 1939 cases completed treatment. Received T.A.M. Received, T.A.F. Received A.P.T. No. given Post. Schick. No. Neg. on Post. Schick. % neg. on Post. Schick. Total cases attended 1939. Under ment 31.12.39 Default ed. 733 - 9 724 272 271 99 1488 87 59 TABLE VI ORIGIN AND SOURCE OF CASES ATTENDING. Year School Inf. Welfare C. Others under 5 years. Total % Total % Total % 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 1939 704 69 225 22.0 91 9.0 108 IMMUNIZATION AT RESIDENTIAL SCHOOLS AND HOMES. The table below gives a detailed analysis of immunization done at the various schools and hones. The large numbers of uncompleted cases is due to the evacuation of the schools and homes. Name of Institution. No. not completed, 1938. No. primary Schick. No. Positive % Positive No. given A.P.T. No. retested. No. Negative. % Negative. Uncompleted Removed from District. Fidelis Convent, central Hill 11 8 8 l00% 7 11 11 100% 8 Infirmary Convent, Central Hill 8 l5 6 40% 5 8 5 62.5% 9 Russell School 9 28 16 57.2% 16 8 8 100% 16 St. Jude's Home, Dagnall Park 3 2 1 50% 1 3 3 100% 1 P.A.C., 386 London Road 10 33 20 60.6% 16 7 7 100% 20 6 Queen' Road Homes 13 13 41 86 51 58 37 34 67 6 109 vaccination acts I am indebted to Mr. Huggins, the Vaccination Officer, for the particulars in the returns in subjoined Tables. Registration Sub-Districts in V.O. District. Births Registered. Vaccinated. Insusceptible. Statutory Declarations Died Unvaccina ted. P.P.O. ferred to other VOS Not traced Removals. In Default. Overage when istered. South Sub-District 1521 575 9 636 55 14 46 163 23 - West " 1547 488 4 724 55 16 19 223 18 - North " 687 254 2 330 18 6 - 66 9 2 3755 1317 15 1690 128 36 65 452 50 2 During the year 23,487 Forms Q were sent to parents, and 275 Forms K and 129 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. 1,108 names were went on the H lists to Public Vaccinators to te visited. During, the past year 38 summonses were taken against parents who had failed to comply with the Vaccination Act . 8 were fined 5s. each; 13 fined 7/6d " 4 fined 10s. 1 " 20s. 11 adjourned, afterwards withdrawn children vaccinated 1 not served (moved and could not be traced). 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,1939. 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 unwards. Total. Croydon No.1 Area 156 32 188 10 No.2 Area 133 15 148 5 No.3 Area 81 4 85 3 No.4 Area 124 22 146 4 No.5 Area 32 267 2 Addington 85 3 88 - Queen's Road Homes 3 1 4 — Mayday Road Hospital. - - - - Children's Homes - - - - Shirley Schools — 103 103 — 817 212 1029 24 110 111 ORTHOPAEDIC DEPARTMENT The arrangements are the same as in 1938 Summary of Cases Attending the Orthopaedic Clinic Jan. 1st 1939 New Cases, 1939 Cases Discharged 1939 Cases oh books Dec.31st, 1939 M.C.W. S.M.S. Tuberc. M.C.W. S.M.S. Tuberc. M.C.W. S.M.S. Tuberc. M.C.W. S.M.S. Tuberc. 154 162 50 96 94 23 73 104 15 164 224 68 366 213 193 456 Cases Seen by the Orthopaedic Surgeon Defects School Visits M.C.W. Visits Tuberculosis Visits Total Visits Cases paid Cases paid Cases paid Cases paid Infantile Paralysis 21 51 4 12 - — 25 63 Curvature or postural defects 27 68 1 2 — — 28 70 Pes Cavus 3 7 2 2 — — 5 9 Pes Planus 71 139 18 41 - — 89 180 Genu Valgum 25 42 71 147 - - 96 189 Talipes 7 20 9 27 - - 16 47 Obstetrical Paralysis - - 1 2 - - 1 2 Joint Disease 14 28 2 2 41A 25S 1M 108A 56S 1M 83 195 Injuries 7 17 3 11 - - 10 28 Rickets 2 2 19 37 - - 21 39 Wry Neck 8 13 3 7 - - 11 20 Spastic Paraplegia 11 22 7 16 - - 18 38 Congential dislocation of the Hip 4 13 3 7 - - 7 20 Other Deformities 33 51 21 33 — — 54 84 233 473 164 346 67 165 464 984 Summarised, the Table shows 233 school children attended and made 473 attendances; 164 babies made 346 attendances; and 67 tuberculosis cases made 165 attendances; a total of 466 cases, making 984 attendances. Cases referred from Orthopaedic Clinic for Remedial Treatment and X-Ray at Croydon General Hospital Defects School Cases M.C.W. Cases Tuberculosis Ca ses Total Cases No. of ments XRays Cases No. of Treatments XRays Cases No. of Treatments XRays Cases No. of ments XRays Infantile Paralysis 3 34 1 2 36 — — — — 5 70 1 Curvature or postural defects 13 209 4 - - - - - - 13 209 4 Pes Planus 6 16 2 - - - — — — 6 16 2 Talipes - - - 3 114 - - - - 3 114 - Genu Valgum 7 1 1 6 70 1 - - - 13 71 2 Joint Disease 5 9 4 1 - 1 43 12 47 49 21 52 Injuries 3 14 2 1 - 2 - — - 4 14 4 Rickets - - - 2 1 1 - - - 2 1 1 Torticollis 3 22 - 3 5 - - - - 6 27 — Spastic Paraplegia 2 32 - 1 11 - - - - 3 43 - Congenital dislocation of the Hip 3 22 2 2 4 — - - - 5 26 2 Other Deformities 3 2 2 5 4 1 — — — 8 6 3 48 361 18 26 245 6 43 12 47 117 618 71 Cases Sent to Residential Institutions Name of Institution School Cases M.C.W. Cases Tuberculosis CEses Total No. in on Jan 1st 39 Admitted Discharged No. in on Jan 1st 39 Admitted Discharged No. in on Jan 1st 39 Admitted Discharged NO. in on Jan lst 39 Admitted Disscharged n on Jan 1st 40 Pyrford 1 - 1 - 3 3 3 6 5 4 9 9 4 Croydon General Hospital 1 4 5 — 3 3 — 8 8 1 15 16 - Heritage Craft Schools 4 1 1 1 - 1 1 1 — 6 2 2 6 Pinner 2 5 2 — 2 — — 2 1 2 9 3 8 Lord Mayor Treloar's Hospital 1 1 2 - - - — - - 1 1 2 — Nat.Children's Home, Chipping Norton 1 — — — — — — — — 1 — — 1 Wingfield Morris Hosp. 1 — 1 — — — — — — 1 — 1 — 5S 4S Mayday 2 2 3 — 2 2 1A 5A 5A 3 14 14 3 2S 3S Royal Sea Bathing Hosp. 6A 2A 6A - - - - - - 8 5 6 7 Dirchington - 1 - - - - 1S 1S - 1 2 - 3 Royal National Orthopaedic - 1 1 — - - - 1A - - 2 1 1 Victoria Home 1 1 1 — — — — — — 1 1 1 1 Burrow Hill Colony - - - - - - — 1A 1A — 1 1 - 22 21 23 1 10 9 6 30 24 29 61 56 34 112 Conditions for which Patients were admitted to Hospitals and the results of treatments. Condition In on Jan 1st 1939 Discharged In on Jan 1st 1940 Admitted Cared. Much Improved Improved I.S.Q. Died Infantile Paralysis 2 4 - 3 1 1 - 1 Tubercular Joint Disease 14 34 1 10 12 5 2 18 Other Joint Disease 8 4 1 4 2 — — 5 Hemiplegia 1 1 — — — — — 2 Genu Valgum — 1 1 — — — — — Congenital dislocation of Hip - 4 - 1 1 - - 2 Talipes - 2 - - 1 - — 1 Rickets - 3 2 1 - - - - Other Deformities - 3 2 - - - - 1 Spastic Paraplegia - 2 - — - 1 - 1 Scoliosis 1 - - 1 - - - - Injury — 1 1 — — — — - 26 59 8 20 17 7 2 31 The percentage of cures in cases discharged was 15 per cent., whilst 38 per cent. were much improved. 113 CANCER. Deaths from Cancer numbered 414 as compared with 380 in 1938; 421 in 1937; 421 in 1936; 321 in 1935; 371 in 1934; 374 in 1933; 341 in 1932; 342 in 1931; 339 in 1930; 330 in 1929; and 327 in 1928. Death-rate per 1,000 of the population for the previous 11 years are as follows:- 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) 1933 - 1.56 (374) 1939 - 1.78 (414) Table I. Deaths from Cancer occurred at the following ages:- Age period Male Female Total Under 25 years 3 - 3 25 and under 35 years 2 3 5 35 and under 45 years 7 12 19 45 and under 65 years 64 99 163 65 years and over 102 122 224 178 236 414 Table II. Sites of fatal Cancer. Site Male Female Total Percentage of Total Skin 5 2 7 1.691 Tongue and Mouth 4 2 6 1.449 Tonsil 2 1 3 0.725 Oesophagus 4 5 9 2.174 Stomach 42 28 70 16.908 Liver 4 10 14 3.382 Bowel 16 41 57 13.768 Rectum 16 17 33 7.971 Bladder 5 3 8 1.932 Prostate 11 - 11 2.657 Larynx 7 2 9 2.174 Uterus - 28 28 6.763 Breast - 45 45 10.869 Ovary - 10 10 2.415 Pancreas 10 8 18 4.348 Gall Bladder and Duct 3 3 6 1.449 Bones 4 2 6 1.449 Lungs 32 12 44 10.628 Kidneys 2 4 6 1.449 Antrum - 2 2 0.483 Lymphatic Glands 2 - 2 0.483 Pharynx - 1 1 0.242 Genital Organs 1 3 4 0.966 Thyroid 1 2 3 0.725 Spine 2 - 2 0.483 Parotid Gland - 1 1 0.242 Brain 1 - 1 0.242 Muscle - 1 1 0.242 Abdomen - 1 1 0.242 Blood vessels 2 - 2 0.483 Indefinite - 1 1 0.242 Mediastinum 2 1 3 0.725 178 236 414 Comments on Foregoing Table. The organs most often attacked in descending order of incidence are, in males the Stomach (23.6); the Lungs (18.0); the Rectum and Bowels (18.0); in females, the Bowels and Rectum (24.6); the Breast (19.0); the Stomach (11.9) and the Uterus (11.9). (Figures quoted are percentages) 114 BLIND PERSONS ACT, 1920. Close co-operation has boon 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 405 Number of blind who benefit from instruction in Braille or Moon type (including those who already read) 91 Number of blind who benefit from pastime instruction 51 Number in remunerative handicrafts (a) Home workers 37 (b) In workshops 4 (c) St. Dunstan's 8 (d) Workers not included in scheme 17 Home Teacher 1 The Health Visitors paid 777 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 homos, mental hospitals or institutions. 115 116 M. - Males. WELFARE OF THE BLIND - REGISTRATION. As at 31/3/4-0. F. - Females. T. - Total. Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period (i) Total of all are Groups 0-1 1-5 5-16 16-21 21-40 40-50 50-65 65-70 70 & over (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 (i) 181 222 403 - - - - 1 1 8 3 11 2 1 3 25 25 50 30 19 49 48 57 105 19 27 46 49 89 138 (ii) - 2 2 Ages at which Blindness Occurred. Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period unknown 0-1 1-5 5-10 10-20 20-30 30-40 40-50 50-60 60-70 70 and over M F T M F T M F T M F T M F T M F T M F T M F T M F T M F T M F T 23 15 38 6 9 15 10 8 18 12 6 18 14 16 30 27 22 49 23 34 57 20 32 52 21 32 53 10 33 43 15 17 32 Normal Mentally Defective Physically Defective Employed Undergoing Training (h) By Blind Organisations (c) (d) (e) (f) (g) M F M F M F All others not included in Total Employed Trained But Unemployed In Schools for the Blind 3 (a) (b) Professional and University Other Schools Workshops Home Workers (a) and (b) Industrial Secondary M F T M F T M F T M F T M F T M F T M F T M F T Not at school 1 5 2 7 25 12 37 20 3 23 50 17 67 1 1 (i) (j) (k) No training but trainable Unemployable Total M F T M F T M F T 1 1 122 202 324 173 220 393 117 Occupations of Employed Blind Persons. Agents,Collectors etc. Basket Workers cluding divans and Ottomans & Upholstering Boot Repairers Braille Copyists and Proof readers Brushmakers Carpenters and Woodworkers Chairseaters Clerks and Typists Coal bag makers Dealers,Tea agents Newsagents,Shopkeepers. Firewood workers. Gardeners Hawkers, News vendors etc. Home Teachers Knitters Massage ' Mat makers Ministers of Religion. Musicians & Music teachers Netting makers. Porters,packers cleaners. Poultry Farmers. School teachers Ships Fender (Fender) makers Telephone Operators Tuners Weavers Miscellaneous. TOTAL Mattress Makers Machinists i Upholsterers Hand Machine Labourers Within Institution for the Blind 3 1 1 1 1 3 1 12 In approved Home Workers Schemes 4 1 5 1 10 1 2 1 12 37 Others (not pastime workers 1 1 4 1 1 1 2 2 1 1 1 2 18 Total 7 1 2 5 1 4 1 1 1 12 2 4 2 3 2 1 3 2 12 1 67 (a) Mentally Defective (b) Physically Defective (c) Deaf(i) Deaf muto (ii) Combinations of (a) & (b) Combinations of (a) & (b) Combinations of (b) & (c) Combinations of (a) (b) & (c). Total Homes for the Blind Mental Hospitals Poor Law Institutions M F T M F T M 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 2 3 4 4 (i) 3 3 (ii) 1 1 1 1 1 1 - - - - - - 4 9 13 3 3 1 2 3 7 15 22 LONDON TERMINAL AERODROME. Aliems Act, 1930. IMedical Officer's Return for January to August, 1939. Number of planes. Arrived from Arr. Seen. Paris Amsterdam Brussels Elsewhere Total 6,107 2,46.5 2,895 1,324 623 1,365 Passengers. British. Others Inspected Exd. 32,284 36,131 28,121 2,153 The Airport was closed on the outbreak of the War. 118 GROUP III (con.) (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and adenoids. (iv) Other defects of the nose and threat. GROUP IV - Orthopaedic and Postural Defects. Under the Authority's Scheme Total r treated >-/ • Residential treatment with education Residential treatment without education (ii) NonResidential treatment at an orthopaedic clinic. (iii ) Number of children treated 24 12 140 162 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 547 896 821 934 1053 1059 1229 1034 890 448 8910 (b) Special 1118 (c) TOTAL (Routine and Specials) 10028 (2) Number found to require treatment 7294 (3) Number actually treated 4864 (4) Attendances made by children for treatment 12391 (5) Half-days devoted to: (7) Extractions: Inspections 98 Permanent Teeth 2182 Treatment 1480 Temporary Teeth 8979 Total 1573 11161 (6) Fillings: (8) Administration of general anaesthetics for extraction 2701 Permanent Teeth 6240 Temporary Teeth 656 (9) Other Operations: 6896 Permanent Teeth. 3295 Temporary Teeth 570 3865 TABLE VI - UNCLEANLINESS AND VERMINOUS CONDITIONS (i) Average number of visits per school made during the year by the School Nurses 7.0 (ii)Total number of examinations of children in the Schools by School Nurses 33189 (iii)Number of children found unclean 928 (iv)Number of children cleansed under arrangements made by the Local cation Authority 120 (v) Number of cases in which legal proceedings were taken: (a) Under the Education Act, 1921 Nil (b) Under School Attendance Eyelaws Nil 25 APPENDIX B. SECONDARY SCHOOLS. Year ended 31st December, 1940. TABLE I. RETURN OF MEDICAL INSPECTIONS. A.- Routine Medical Inspections. Year 1940 Year 1939 Age 11 or under 119 30 12 128 48 13 138 251 14 79 407 15 41 435 16 32 261 17 12 42 18 or over 3 9 Total 552 1483 B.- Other Inspections. Year 1940 Year 1939 Number of Special Inspections 53 120 Number of Re-inspections 357 704 410 824 Visits to Secondary Schools 29 70 26