CRO42 CROYDON To the Chairman and Members of the Public Health Committee. Ladies and Gentlemen, I have the honour to present my thirteenth Annual Report being the forty-first of the series, dealing with work of the Public Health Department, My report as School Medical Officer to the Education Committee is incorporated. As last year, my report has been much curtailed because of the necessity to economise. The usual full statistical details have been compiled and they will be filed in order to secure continuity of the records. From August until the end of the year Croydon experienced a series of air-raids which caused considerable material damage and loss of life; they did not however, dislocate the work of the department except for a short period when the maternity wards at Mayday Hospital were badly damaged and had to be evacuated for a tine for repairs. Arrangements were made for the patients and also for expectant mothers who had booked bads to be accomodated in two large private Nursing Homes which very efficiently came to our help. In all Mayday Hospital has received damage on three separate occasions, and one block additional to the Maternity Block has been out of action from October until the end of the year, reducing its capacity by 96 beds. The vital statistics for the year 1940 showed a birth rate of 15,4 per 1000 of the estimated population, an increase of 1,4 per 1000 over 1939; and a death rate of 15,6 per 1000 also an increase of 4,6 per 1000 over 1939; owing to the outward flow of population from Croydon after the air-raids commenced, the vital statistics have been based upon a population of 199,800 as against the peace time computation of 233,115, this figure is only approximate, Maternal mortality remained low at 1,65 per 1000 total live and still births, and the Infantile Mortality of 39 was only 1 per 1000 live births higher than that in 1939, which in its turn was the lowest rate yet recorded for the Borough, The incidence of notifiable infectious diseases remained low, and the Borough Hospital had another slack year. There was, however, an increase in deaths from diseases of the Respiratory System, including Tuberculosis, and a considerable increase in deaths specifically ascribed to Pneumonia, There was a slight increase in Cancer deaths. On the whole, therefore, the year has not shown, so far as statistics go, any noticeable decline in the health of the Croydon population, but it should be recollected that the vital statistics of an annual report such as this deal only with deaths, or the incidence of recognisable disease. The incidence of ill health cannot, with the materials available, be gauged with any accuracy; deductions can be made to a limited extent from death rates. The causes of death during 1940 reflect the severity of the winter, and possibly the practise of sleeping in air-raid shelters under artificial and not always healthy conditions, in the increase of deaths from respiratory diseases. The increase in skin diseases, notably Scabies is also due in all probability to shelter life. The effects of chronic undernutrition do not show themselves rapidly but rather by a slow undermining of the constitutional resistance to disease. This was very clearly illustrated by the pandemic of influenza in 1919, Consequently it would be premature and unwise to make any dogmatic statement that tho health, of the Community shows no deterioration due to war conditions. Whatever the bald figures of statistics reveal it must be conceded that the artificial and unsettled conditions inseparable from a war time economy must have some detrimental effect. It is the duty of the Public Health Department to endeavour to keep the unfavourable results as low as possible, and by action and advice, to help the people to overcome the environmental and nutritional difficulties by which they are beset. Some slight rearrangement has been made in the section of the report as contrasted with 1939, but otherwise the sections remain the same. Comments upon statistics have been cut down drastically and for tables which are self-explanatory, have been omitted altogether. As in 1939, the Civil Defence Casualty Services have not been included in my report as, although the Medical Officer of Health is responsible for their organisation and administration, they can hardly be described as Public Health Services, The onset of air-raids' showed however that the Casualty Services were ready and efficient, and the members thereof responded, whole' heartedly and without thought of self, to the calls for assistance which occurred almost nightly from September until the end of the year. In conclusion I express my thanks to the Chairman end Members of the Public Health, Education and Mental Deficiency Committees for their help and encouragement during a somewhat hazardous year. To my staff, professional and lay, for their continued loyalty and adherence to duty I also wish to convey my sincere thanks additionally, I desire to bring this to the notice of the Members of the Committees concerned. I am, Yours faithfully, OSCAR M.HOILEN. Medical Officer of Health. CONTENTS. A. - PUBLIC HEALTH REPORT. Page Ambulance Service 6 Amusement Houses 96 Animals,Keeping of 96 Ante-natal Clinic 63 Babies Help Committee 74 Bacteriological Examination 30,32,64 Bakehouses 93 Births 1,50 Blind Persons 82 Blood Transfusions 67 Borough Hospital 27 Bye-laws and Regulations 87 87 British Social Hygiene Council 43 Cancer 44 Cerebro-Spinal Meningitis 29 Chickon Pox , 27 Children Acts 76 Contacts, Tuberculosis 5-1. Cowkeepers 93 Croydon Nursing Service 5.1. Convalescence 74 Coombe Cliff Convalescent Hosp 75 Creche 75 Dairies,Cowsheds & Milkshops 93 Deaths 1,3,27,56,57 Dental Treatment 55,70 Diphtheria 28,34 Disinfection 97 Disinfestation 98 Dispensary,Tuberculosis 45 Dried Milk 73 Drugs 73 Dysentery 29 Enteric Fever 29 Erysipelas 29 Extra-Nourishment 48 Factories & Workshops Acts 87,92 Fertilisers &, Feeding Stuffs Act 97 Foods,Inspection of 99 ,103,109 Food & Drugs Acts 109 Foster-Mothers 76 Foster-Cliildren 76 Gynaecological Clinic 68 Health Visitors,Work of Home Helps 74 Home Nursing 51 Homework 93 Hospitals 6 Hospital,StJvfcry' s(Maternity) 62 Houses let in Lodgings 93,95 Housing 8589 Ice Cream 109 Illegitimacy 1,75 Immunisation Clinic 34 Infant Welfare Clinics,Municipal 71 Infant Welfare Clinics,Voluntary 71 Infant Mortality 1,57 Page Infantile Paralysis 29 Infectious Diseases 25 Inquests 2 Laboratory work 30,32,64 Lodging Houses 94 Marriages 2 Maternity Homes 61 Mayday Hospital 8,23 Measles 30 Meat Inspection 101 Medical Help Records 60 Mental Deficiency, etc. 80 midwives 60 Midwives Acts 60 Milk,Provision of 48,73,107 Milk,Examination of 33,105 Mi'lk, Tuberculous 105 Milkshops 93 Mortality in Child-birth 1,56 Mothers' and Infants' Welfare Association 71 Mumps 30 Municipal Lodging House 94 Municipal Midwives 85 Neo-natal Deaths 59 Notification of Births Acts 56 Nuisances 86,96 Nursing Arrangements 6 Nursing Homes 61 Obstetrical Unit 62 Occupation Centre 80 Offensive Trades 95 Ophthalmia Neonatorum 29,57 Orthopaedic Department 77 Out of Borough Cases 27 Overcrowding 91 Pemphigus 29 Poisons & Pharmacy Act 97 Poliomyelitis 29 Poor Law Relief 24 Population 1 Post-natal Clinic 68 Public Laboratory 32,64 Puerperal Sepsis & Pyrexia 29,56,69 Rag Flock Acts 96 Rats & Mice(Destruction)Act 98 Rescue Home 75 Rent Restriction Acts 89 Rivers and Streams 96 Sanatorium,Chean 54 Sanatoria,Treatment in 49 Sanitary Administration 85 Sanitary Certificates 89 Sanitary Inspectors,Work of 85 Scarlet Fever 28 Schick Test 34 Schools 96 Shop Hours Acts 88,94 Page Slaughterhouses 93,100 Smoke Observations 96 Sputum, Examination 48 Still-births 1,56 St.Mary's Maternity-Hospital 62 Tuberculosis,Borough-Hospital 30 " Cheem Sanatorium 54 " Contacts 51 " Deaths 47 " Dental Treatment 55 " Notifications 45 " Home Nursing 51 " Home Visits 51 " Institutional Treatment 49 Page Typhoid Fever 29 Unmarried Mothers 1,75 Vaccination 36 Venereal Diseases 37 Verminous Persons Vital Statistics 1 Ward Statistics 7 Watercoursds 96 Water Supply 6 Whooping' Cough 87 Workplaces. 87 Workshops 87 X-ray Examination 8,48 B. - SCHOOL MEDICAL REPORT. (See separate document). Page Adenoids 11 Blind Children 17 Child Guidance Clinic 20 Clinics 10 Cost 2 Crippling Defects 16 Deaf Children 17 Deaths 19 Defects 7 Defective Children 7,18 Deformities 15 Dental Treatment 12 Epileptic Children 17 Evacuation 7 Exclusions 6 Eye Clinic 11 Eye Defects 4,11 Following up 10 Health Visitors,Work of 10 Heart Defects 7 Heights and Weights 5 Infectious Diseases 6 Inspection Clinic 10 Inspections,Routine 2,4,6 Inspections,Special- 21 Page Juvenile Employment 18 Massage Clinic 10 Meals,Provision of 13 Mentally Defective Children 18 Milk etc.,provision of 18 Minor Ailments 10 Orthopaedic Work 16 Physically Defective Children 7,18 Remedial Exercises 16 Rheumatism Clinic 16 Re-inspections 21 Secondary Schools 19 Speech 18 Statistical Tables 21 Surveys ,Uncleanliness 4 St,Christopher's 19 Throat and Nose 11 Treatment 10 Tuberculosis 4 Uncleariliness 4 Vision,Defective 4,11 Visiting Radiologist, Mayday Hospital. David Low Greig, M.R.C.S., L.R.C.S., L.R.C.P., D.M.R.E., (on active P.W.Kamond, M.D., (locum) service) Visiting Anaesthetist, Mayday Hospital. Ruth e.Mansfield,m.R.cTs.V L.R.C.P., D.A. District Public Assistance_Medical Officers.- Henry Fleming Kami It on, M.R., C.B., F.R.C.S. Alan Pride, M.D. , Penel of Medical Practitioners appointed for Addiscorn.be, Central, East, South Norwood, Woodside, Thornton Heath, Waddon and South Wards. Public Vaccinators. William Veudrev Braddon, M.B., C.B. L.S.A. Walter High Montgomery Smith, M.R.C.S., L.R.C.P. George Donal McGrath, M.T?., B.C;., B.A.O., Thomas Dunlop Miller, M.D., B.Sc. , Gilbert Charrington Weillsb, M.3., Ch .M., F.R.C.S. Valentine Wilkinson, M.B., L.R.C.P. Dental Staff. - Senior Dental Surgeon, P.G.Oliver, L.D.S. Assistant Dental Surgeons: J.IC.R.Bryce, *L.D.S., W.A.Sowden Fills, L.D.S. Miss S.M.V.Hathorn,L.D.S., C.P.Urbani, L.D.S., S.W.Barlow, L.D.S. (Locum) Dental Surgeon: Mayday Hospital: E.F.Laurence, L.D.S. (part-time) *on active service Inspectors. R.J.jeckson,M.R.S.I..A.M.I,S.E., 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 4 disinfectors, and 5 assistants to the Sanitary Inspectors. Health Visiting Staff. - A.M.D. Allford (Superintendent) 24 District Health Visitors; 2 Special Visitors; 1 Tuberculosis Nurse; 3 Almoners and 5 Dental Attendants. Also 2 whole-time Masseuses and Remedial Gymnasts. Muni cipa1Midwives. Norah A. Rigby. (Superintendent) 10 District Municipal Midwives. Clerical Staff. B.W.Cummins (Chief Clerk) 35 full-time Clerks (including members on active service ) Veterinary Inspector (Part-time.) Peter R.A.Thrale, O.B.E.,M.R.C.V,S. (to 1,6.1940) Analyst (Part-time) Edward Finks, B.Sc. F.I.C., F.C.S. Vaccination Officer. - Gerald H. Hu&gins. Cert R.S.I. Mayday Hospital,Croydon Borough Hospital, Croydon Borough Sanatorium, Coombe Cliff Convalescent Home and St. Mary's Matofnity_Hospital. Nursing and Domestic Staffs. Pathological Lab oratory. 4 Laboratory Assistants. '*s STAFF OF THE PUBLIC HEALTH DEPARTMENT The staff of the Public Health Department on the 21st December, 1940, was as follows:- Medical Staff:- (a) Whole - time; - Oscar M. Holden, M.D., D.F.H., Medical Officer of Health, School Medical Officer, and Medical Officer under the Mantal Deficiency Acts, etc. John T.R.Lewis, I.D., D.P.., Deputy Medical Officer of Health, Deputy School Medical Officer, and Medical Officer under the Mental Deficiency Acts. B.Sc J.C.McMillan, M.B., Ch.B., 3.A.O.,/B.P.F., Assistant Medical Officer of Health for Tuberculosis. Rufus C.Thomas, M.R.C.S., L.R.C.P., F.R.C.S. (Ed.), M.C.O.G., Assistant Medical Officer of Health for Obstetrics. E.E.Karte, M.3., Ch.B., D.P.H., 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. Iris A.Jenkin-Lloyd, M.R.C.S., L.R.C.P., D.P.M., Assistant Medical Officer of Health and Assistant School Medical Officer. Rosa Morrison, M.B., D.P., Assistant Medical Officer of Health and Assistant School Medical Officer. Ellen Mackenzie Hegarty, M.B., Ch.B. , D.P.H., Assistant Mcdical 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) Horpital. R.C.Foyser, M.R.C.S., L.R.C.P, Resicent Medical Superintendent, Crovdon Borough Sanatorium, (b) Part - time:- E.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. Charles Frederick Swinton, M.D,, F.R.C.S., (Ed ) Ch.M. John Joseph Walsh, M.D., F.R.C.S., (Eng.) Deputy Medical Superintendent. John Ewart Edson, M.D., M.R.C.P., Assistant Medical Officer, (on active service) Arthur B. Higginson, M.B., C.:,B., Assistant Medical Officer for Obstetrics, (left 16.7.1940.) Ralph Spencer M.B'., Ch.B., B. Sc., Junior Resident Assistant Medical Officer, (left 15.6.1940.) Eric Joseph Tamblyn M.3., B.S., F.R.C.S., Assistant Medical Officer. (commenced 17.6.1940.) Elizabeth Bryce Hill, M.L., C: ,B., Assistant Medical Officer. Hugh Francis, M.R.C.S., L.R.C.P., D.M.R., (Lond.) (commenced 10.12.1940) Catherine F. O'Connor, M.R.C.S., L.R.C.P., Assistant Bacteriologist and Pathologist (Part-time) Consultants to the Public Health Department, Thomas Warwick Preston, M.D., M.R.C.P., Physician. Ernest Marshall Cowell, D.S.O., M.D., F.R.C.S., Surgeon. Alan Herapath Todd, M.S., F.R.C.S., Orthopaedic Surgeon. John Sr.ee a Bookless, B.A., M.B., F.R.C.S., Ophthalmic Surgeon. Archer Ryland, F.R.C.S., Ear, Hose and Throat Surgeon. H.W.Southgate, M.B., B.S., B.Sc., Pathologist. Thomas Percy Rees, B.Sc., M.D., M.R.C.P., D. P. M. , Psychiatrist. SUMMARY OF VITAL STATISTICS FOR 1940 Area, 12,617 acres. Population (Census 1931) 233,115. Population (estimated middle of 1940) 199,800. Number of Inhabited Houses (1931 Census) 56,l429. Overcrowding Census (1936), 65,550. Rateable Value (1st April 1939) £2,513,606. Product of a Penny Rate (1939 - 1940) £9,556 Rate in the £. 11/4d. Gross expenditure on Health Services (administered by Medical Officer of' Health ) 249,600 Income on Health Services (excluding transfers) 53,248 Net expenditure on Health Services £196,352 Expressed as a Penny Rate, 20.55d. pence in the pound. Live Births - M. P. Total Legitimate l457 l,450 2,907)3,070 Illegitimate 72 163) The Registrar General has submitted a separate figure of 2949 for the purpose of calculating Infant and Maternal Mortality rates. Birth-rate par 1,000 of the estimated resident population, 15,14. Still Births 85. Rate per 1,000 total (live and still) births, 30.5° (for the purpose of Infant and Maternal Mortality rates tho Registrar General submits a total of 82 still births). Birth rate per l,000(live and still births) I5.4. Deaths 3118. Death rate per 1,000 of the estimated resident population 15.6. Deaths, from diseases and accidents of pregnancy and childbirth: From sepsis 2; other causes 3. Maternal mortality; 1.65 per 1,000 total live and still births abortions) (excluding Death-rate of Infants under one year of ago (ll6 deaths, 2949 births) All Infants per 1,000 live births 39 Legitimate Infants (107 deaths) per 1,000 live births 36 Illegitimate Infants (9 deaths) per 1,000 live births 57 Deaths from Influenza 49 Deaths from Diphtheria (all 4 " " whooping Cough ages) (all ages) 2 Pneumonia 206 " " Diarrhoea (under Cancer 443 2 years of age) 11 Rate per 1,0 00 Deaths from diseases of Cardiac and Circulatory System -papulation (including Cerebral Haemorrhage) 4.31 Deaths from diseases of the Respiratory System(including Tuberculosis) 2.45 1 Deaths from diseases of Ronal System 0.32 Deaths from diseases of Digestive System 0.74 Deaths from Suicide and Accidents 0.41 Deaths from Old Age 1.00 Marriages The number of marriages solemnised was 2,792 compared with 2,674 in 1939; 2,319 in 1938; 2,210 in 1937; 2,198 in I936; 2:132 in 1935; and 2,125 in 1934. The marriage rate was 14.0 per 1,000 of the population; 15l4 were solemnised in Established Churches, 366 in other places of worship; 911 in the Register Office and 1 performed under Jowish ritual. Births. The births registered were 2,907 legitimate and 163 illegitimate. The birthrate consequently was 15.4 For England and Wales and in the Great Towns the rate was 14.6 and l6.0. The illegitimate births in Croydon were 5.3 the total as in 1939, compared with I4.9 in 1938 4.6 in 1937, 5.5 in 1936 and in 1935. The live male births numbered 1,5148, the female 1,522, being a proportion of 1,017 males to 1,000 females. The subjoined table gives the vital statistics for the Wards in the Town. It is seen that the Wards with the highest birth rates were Addington(27.0) Waddon (19.1) and Whitohorse Manor (17.1) Those with the lowest were: Norbury (5.7) Central(8.6) and Upper Norwood (10.1) Deaths The deaths numbered 3,118 compared with 2.557 in 1939 For 1940 the death rate was 15.6. For 1939 it was 11.0. The death rate for England and Wales was 1I4..3 and for the Great Towns 15.8. For London the death rate was 17.8. There wore 91 inquests held by Coroners in respect of Croydon residents during 1940 and 2I4.9 findings by Coroners after post mortem examination without inquest. Wards with the highest death rates were: Central (18.5), and Woodside (l8.2); lowest in Addington (11.6), Waddon (12.6), Norbury (12.7), west Thornton (12,8) 2 - REGISTRAR GENERAL'S TABLE OP DEATHS ACCORDING TO CAUSE AGE AND SEX Sex All Ages 0- 1- 5- 15- 45- 65 All Causes M 1550 70 25 21 227 470 737 F 1582 46 16 28 179 384 929 Whooping Cough M - - - - - - - F 2 l 1 - - - - Diphtheria M 1 - - 1 - - - F 3 -. - 3 - - - Influenza M 24 1 - 4 12 7 F 18 - - - 3 6 9 Cerebro Spinal Fever M 9 1 5 1 1 1 - F 7 1 2 1 2 1 - Poliomyelitis and ) Polioencephalitis) M 1 - - - - 1 - F - - - - - - - Acute Infective ) Encephalitis. ) M 1 - - - - 1 - F 1 - - - 1 - - Tuberculosis ) (Respiratory) ) M 89 - - - 54 28 7 F 39 - - 2 26 8 3 Other Tuberculous) diseases ) M 10 l 3 - 3 2 1 F 8 - 1 1 4 1 1 Syphilis M 9 - - - - 6 3 F 6 - - - 2 3 1 Cancer M 207 - - 1 15 73 118 F 229 - - 1 15 98 115 Diabetes M 15 - - - 3 7 5 F 13 - - - 2 4 7 Cerebral ) Haemorrhage etc.) M 94 - - - - 27 67 F 161 - - - - 38 123 Heart Disease M 343 - - - 20 76 247 F 412 - - 1 7 57 347 Other circulatory) disease's ) M 47 - - - 1 10 36 F 74 - - - - 8 66 Bronchitis M 129 3 - - 5 54 67 F 73 1 - - 4 10 58 Pneumonia (all forms) M 75 17 6 - 4 24 24 F 80 9 3 - 2 15 51 Other respiratory ) diseases ) M 15 - - - 4 6 5 F 23 - - - 1 10 12 Ulcer of Stomach ) or duodenum ) M 33 - - - 2 20 11 F 10 - - - 1 3 6 Diarrhoea (under 2 yrs M 6 5 1 - - - - F 4 4 - - - - - Appendicitis M 10 1 - 1 3 3.; 2 F 6 - - 1 2 3 - Other digestive ) diseases ) M 25 2 - - l 8 14 F 29 - - - 7 6 16 Nephritis M 28 - - - 2 10 16 F 41 - - - 2 22 17 Puerperal sepsis Other puerperal causes F 1 - - - 1 - - F 4 - - - 4 - - Cong. Debility, Malfor mations, prem.birth.etc. M 42 36 - 3 2 - 1 F 25 22 - 1 2 - - - 3 - REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE AGE AND SEX(CONT) Sex All ages 0- 1- 5- 15- 45- 65- Suicide M 9 - - - 3 4 2 F 12 - - - 5 7 - Road Traffic Accidents M 19 - - 1 4 6 8 F 4 - - 1 - 1 2 Other violence M 203 2 8 12 82 68 31 F 204 5 8 11 65 56 59 Other defined ) diseases ) M 106 1 2 1 14 23 65 F 93 3 1 5 21 27 36 Comparisons with 1939 There was a fall in the deaths from the Zymotic diseases excluding Typhoid Fever and Diphtheria. In I940 there were no deaths from Measles or Scarlet Fever. Whooping Cough caused 2 deaths and Diphtheria 4 deaths. The deaths from Pulmonary Tuberculosis increased by 39 in 1940. The number of deaths attributed to Cancer totalled 436, compared with 419 in 1939. Deaths from Heart Disease decreased by 27. Pneumonia deaths showed an increase of 4 and those due to Bronchitis an increase of 155. Deaths from Suicide and Violence increased from I05 to 451. The percentage of deaths under 1 year of age to the total deaths was 3.7%. Deaths under 15, years 6.6%; deaths under 65 years 46.8%, deaths over 65 years 53.2%. The corresponding figures for 1939 were 5.1%, 10.0%, 42.6% and 57. 4% The above total differs slightly - by 14 - from the total recorded by this department, as the period covered by the Registrar General refers to the weekly returns from the Registry of Deaths. The Department records are calculated from the 1st January to 31st December. 4 DEPARTMENTAL CLASSIFICATION OF DEATHS ACCORDING TO DISEASE OVER A PERIOD OF SIX YEARS. Cause of Death ! 1935 1936 1937 1938 1939 1940 Total Deaths Total Deaths Total Deaths Total Deaths Total Deaths Total Deaths Death Rate Enteric Fever - 4 35 12 2 - - Malaria - - - - - - - Small Pox - - - - - - - Measles - 21 5 8 - - - Scarlet Fever - 2 3 3 - - - Whooping Cough 2 15 5 3 3 2 0.010 Diphtheria and Croup 12 8 15 16 16 4 0.020 Influenza (Including Influenzal pheumonia) 25 39 71 21 1 48 49 0.245 Dysentery - - . - 1 1 - - Erysipelas 2 6 3 3 2 2 0.010 Cerebro-Spinal Fever 3 - 3 5 2 16 0.080 Pulmonary Tuberculosis 148 132 l4o 117 89 128 0.641 Tuberculous Meningitis 9 19 15 20 18 6) -1 r- \ 0.105 Other Tuberculous Disease 14) - . 15) / Cancer, Malignant Disease 321 428 432 387 419 443 2.217 Rheunatic Fever 9 6 11 6 2 8 0.040 Meningitis 14 4 4 5 3 .5 0.025 organic Heart Disease 780 749 770 777 782 682 3.413 Bronchitis, Acute and) Chronic ) 45 44 50 49 47 130 0.650 Pnoumenia 120 185 179 150 151 206 1.031 Other Diseases of the) Respiratory Organs ) 29 23 12 25 13 21 0.105 Diarrhoea & Enteritis 29 31 45 29 23 18 0,090 Appendicitis 48 18 23 15 15 35 0.075 Cirrhosis of Liver 2 8 9 8 12 l 0.005 Alcoholism 2 - 1 1 1 2 0.010 Nephritis & Bright' s) Disease ) 66 89 84 72 63 63 0.315 *Puerperal Fever 7 5 1 l 2 2 0.660 *Other diseases & accidents of pregnancy & parturition 1 7 11 2 2 3 0.99c Congenital Debility, Mal formation & Premature Birth 87 63 105 64 71 53 0.265 Violent deaths (excluding suicide) 85 85 102 78 77 61 0.305 Suicide 26 29 30 43 28 2.0 0.100 Other Defined Diseases Diseases Ill-defined or) Unknown ) 567 570 634 2 595 - 662 3 2152 11 5.766 0.055 TOTAL 2,453 2,590 2,800 2,496 2,557 3,118 Calculated per 1,000 Live and still births 1940 showed, a large Increase in the general death rate and an increase in the birth rate. - 5 - WATER The water supply is drawn from deep wells in the chalk. Those 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,l87,844,000 Metropolitan Water Board in bulk 506,508,000 2,694,352,000 The same arrangements regarding samples as were commenced in 1938 continued in 1940. LABORATORY, AMBULANCE, NURSING FACILITIES, HOSPITALS,ETC . There have boon no changes in the Laboratory, Ambulance and Nursing Facilities in the home since my report, in 1939- Nor are there any changes to record in the Hospital beds available other than that the lt.0 bods at Che am Sanatorium taken over by the Emergency Hospital Service in 1939 were released for their original use. All the Clinics have continued throughout the year, and the Tonsils and Adenoids Clinic at the Croydon General Hospital, which wan discontinued on the outbreak of war, reopened in November 1939: It Was closed again in August 1940. - 6 - - 7 - WARDS Estimated Population Births Deaths Birth Rate Deaths under 1 year per 1,000 births. Death Rate from six Zymotic Diseases (excluding Diarrhoea) Death Rate from Diarrhoea i Death Rate from Bronchitis and Pneumonia Death Rate from Pulmonary Tuberclosis Death Rave- from j N on-Pulmonary Tuberculosis Death Rate from Heart and Circulation Diseases Death Rate from Nervous Diseases Death Rate from Cancer Natural increase or decrease of population. ' Upper Norwood 1-3,697 139 231 10.1 16.9 50 - 0.15 1.46 0.73 0.22 4.89 0.22 1.75 -92 Norbury I3,257 76 l68 5.7 12.7 53 - - 1.28 0.45 - 3.02 0.53 2.11 92 West Thornton 15,968 194 204 12.2 12.8 46 - - l.44 0.38 0.13 3.69 0.69 2.57 -10 Bensham Manor 13,659 187 238 13.7 17.4 48 - 0.29 2.43 0.44 - 6.57 0.51 2.34 - 5l Thornton Heath 4,778 216 22C l4.6 14.9 42 0.07 0.07 1.69 0.95 0.20 4.47 0.61 1.76 -4 South Norwood 14,467 211 223 14.6 15-4 38 - 0.07 1.66 0.28 0.l4 4.49 0.62 2.63 - 12 Woodside 13,274 174 24l 13.1 18.2 40 0.08 0.08 2.18 0.83 0.08 5.35 0.60 1.81 - 67 East 13,310 158 207 11.9 15.6 13 - 0.08 1.20 0.53 0.08 4.88 0.68 3.08 - 49 Addiseombe 13,452 201 220 14.9 l6.4 45 - - 1.78 0.74 - 5.20 o.74 2.08 - 19 Whitehorse Manor 13,768 235 251 17.1 18.2 43 - 0.29 2.11 0.65 0.07 6.32 0.87 2.47 - l6 Broad Green l4, l44 198 218 14.0 15.4 45 0.07 0.21 l.9l 0.85 0.07 3.96 0.99 2.l9 - 20 Central 10,279 88 190 8.6 18.5 57 0.10 - 1.65 0.78 0.29 7.00 0.78 2.43 -102 Waddon 14,966 286 188 19.1 12.6 27 - - 0.87 1.00 0.07 4.21 0.53 1.47 + 98 South 12,528 148 216 11.8 17.2 74 0.16 - 2.24 0.56 0.24 5.35 0.72 2,55 - 68 Addington 8,211 222 95 27.0 11.6 54 - 0.12 1.10 0.37 - 2.80 0.24 2.07 -l27 The Borough 199,800 3070 3118 15.4 15.6 39 0.03 0.09 1.69 0.75 0.11 4.31 0.63 2.22 -377 * these are the corrected totals. MAYDAY HOSPITAL 1. Total number of admissions (including infants born in hospital) 5114 2. Number of women confined in hospital 8l8 3. Number, of live births 737 Ij.. Number of still births 42 5. Number of deaths among the newly-born (i.e. under 4 weeks of age) 21 6. Number of deaths among children under one year (including these given under 5) 44 7. Number of Maternal deaths among women admitted to Hospital for confinement) 2 8. Total number of deaths 675 9. Total number of discharges including infants born in hospital. 48l4 10. Duration of stay of patients included in 8 and 9 above :- (a) Under four weeks 4244 (b) Pour weeks and under thirteen weeks 1062 (c) Thirteen weeks or more 183 11. Number of beds occupied (excluding cots in maternity wards) (a) Average during the year - 551 (b) Highest 495 on 13.3.40 (c) Lowest 244 on l6.12.4o. 12. Number of surgical operations under general anaesthetic (excluding dental operations) 873 13. Number of abdominal sections. 433 Number of X-Ray Films Taken Spine. 260 Bones, 1129 Pelvis. 44 Chest. 1572 Barium Meals; 554 Barium Enemeta; 30 Renal. 208 Gall-bladder. 92 Teeth. 229 AMomina1 F.B. 46 Maternity cases. 513 Skull. 382 5,059 Total Number of Cases X-rayed - 2,666 DIAGNOSTIC ... 1940. Oesophagus with Barium. 4 3 Barium Meals. 78 l40 Barium Enemeta. l6 16 Gall-Bladders (Plain). 9 7 Cholecystograms. 23 16 Renal Tracts (Plain). 26 2, Pyelograms. 27 2 - 8- Abdomen for F.B.' s etc. etc Maternity cases. Hysteroraphios . Lungs Mayday Hospital. Sick Staff. Staff on appointment, T.E.Dispensary. Others Lungs after Lipiodol. Heart and Aorta. Skulls. Accessory Nasal Sinuses. Vertebral column. Ribs. Ielvis. Long Bones. Short Bones. Joints. Teeth and jaws. 1252 21 274 420 18 36 729 2 9 4 107 20 65 32 26 229 56 232 153 1240 10 164 383 8 71 730 27 7 2 98 16 76 41 29 250 59 472 Examinations by portable set 2666 130 2764 204 1939. 124.0 Men's Wards. 581 731 Women's Wards. 588 579 Children's Wards. 165 80 Maternity & Gynaecological Wards. 60 124 Staff. l46 108 Total "In-Pattents". 1,540 1,622 T.B. Dispensary (Men) 325 404 (Women) 344 299 (Children) 165 27 Under l6) Croydon Borough Hospital. 4 3 Ante-Natal Clinic. 225 125 St. Mary's Hospital. 17 10 Queen's Road Homes. 17 32 Dental Clinic 130 77 Others. 4 67 Total "Out-Patients" 1,126 1,044 Total 2,666 2,666 Screen Examinations. 890 266 - 9- MASSAGE Exercises. Radiant Heat. Electrical. Diathermy. Ultra Violet Light Was. Infra Red. Total number of patients treatedMental Patients death with during, the Year Male Admitted. Certified and sent to Warlingham Park Hospital. As Voluntary patients to Warlingham Park Hospital. Discha rged not certified. 128 20 39 49 191+0 6,715 2,316 554 255 531 36 553 12,38377 Female 200 27 37 76 THERAPY DEPARTMENT - Condition for which treatment wo.3 given No. of Patients No. of Applications. Cured. Reliev ed . JDied Transferred to other Hosps. Still under treat ment. Carcinoma of Cervix. 3 17 1 2 " Uterus. 3 22 1 1 1 " " Breast. 1 12 ! 1 " Larynx. 1 11 1 2 Sarcoma of Hip. 1 12 1 " Lympho. 1 12 1 Fibroid Uterus 2 12 2 Sterilization. 13 5 1 1 Mitral Stnnosis 1 8 ! 26 181 6 2 2 8 Corresponding Totals for 1939. 31 405 4 9 7 1 10 _- 10 - Classification of In-patients who were discharged from or who died in the Institution during the year ended 31st December,1940 Disease Groups. Children Under 16 yrs. of age. Men and Women. Discharged Died Discharged Died A. Acute infections disease 13 1 10 1 B. Influenza- - - 51 - C. Tuberculosis: Pulmonary 3 - 66 49 Non-Pulmonary . 7 5 9 9 D. Malignant Disease. - - 81 112 E. Rheumatis m. (1) 2 - 7 - (2) - 2 - (3) " - 25 - F. Venereal Disease. _ - 5 - G. Puerperal pyrexia (including cases classified) - - 3 - Puerperal fever. - - - - H. Other diseases and accidents connected with pregnancy and childbirth. - - 414 1 I. Mental diseases. 8 - 238 2 J. Senile Decay. - - 52 34 K. Accidental injury and violence. 43 1 287 24 In respect of cases not included above L. Diseases of the Nervous System and Sense Organs. 21 6 105 73 M. Disease of the Respiratory System. 74 13 179 54 N. " " Circulatory" 3 1 132 155 O. " "Digestive" 98 5 445 46 P. " "Genito-Urinary" 20 - 92 35 Q. " " " Skin, 41 - 90 4 R, Other diseases 204 8 242 14 S. Mothers and infants discharged from Maternity Wards and not included in above figures. Mothers: - - 853 2 Infants: 806 18 - - T. Any persons not falling under any of the above headings. 33 - 50 - TOTALS. 1376 58 3438 617 - 11- Specimens Examined in the Pathological Laboratory during. the Year. Positive. Negative . Swabs for Diphtheria. - 225 Sputa for T.B. 271 492 Pus for T.B. 6 7 Pus for Gonococci. 1 6 Urine for T.B. 7 28 Faeces for T.B. 1 1 Urine for Goli-Typhoid Group. - 3 Pieces for Coli-Typhoid Group. 14 139 Blood - Widals, 18 35 Fairs for ringworm. 1 2 Blood cultures . 12 31 Facees for occult blood. 127 143 1,570 Urine for routine examination. 952 Pus for organisms. 135 Blood urea estimations. 141 Bipod sugar estimations. 45 Cerebro spinal fluids. 135 Urea Cone. tests. 234 Urea Clearance Tests. 211 Fractional tost meals. 53 Pleural fluids. 42 Blood counts. 498 Blood Groups. 90 Eaemoglobin estimations. 257 Compatibility tests. 2 Faecal fat estimations. 6 Van den Bergh re-action. 16 Vaccines. .2 Blood sedimentation rates. 63 glucose tolerance tests. 4 Blood coagulation and bleeding time. 7 Other examinations - unclassified. 219 total number of examinations. 4,680 To. of specimens sent to Croydon General Hospital. 330 Number of Post Mortems Ordered by the Coroner and Performed at Mayday Hospital during the Year: Outside Cases: 235 Hospital Cases: 56. Number of Post Mortems not ordered by the Coroner: 117. -12- Diagnoses ALIMENTARY Medical Surgical, Total cured Relieve Unrelieved Died Cured Relieved Unrelieved Died Appendicitis 126 10 1 2 139 Gastric Ulcer. 11 20 4 5 6 3 - 5 60 Duodenal ulcer., 9 18 3 6 4 4 - 5 49 Anastomatic uIcer - 1 - - - 1 - - 2 Dyspepsia. 5 2 - - - - - - 7 Cholelithiasis 4 4 Colitis. 2 1 - 2 5 Intestinal obstr; 1 2 3 6 Constipation. 17 22 4 43 Hernia 46 21 5 6 78 Ischio Rectal Abscess 2 3 5 Haeraorrhoids 3 1 3 l l 9 Cholecystitis 7 12 2 6 1 2 30 Gastro enteritid 33 4 1 4 42 Gastritis 18 12 1 31 Alveolar Abscess, 1 1 3 5 Intestinal colic 3 3 6 Catarrhal jaundice 2 2 4 Pyloric Stenosis 3 1 1 1 6 Fistula in Ano. 2 2 4 Swallowed P, 1 1 2 Peptic ulcer 2 5 7 Appendicular colic- . 1 3 4 Peritonitis. 1 1 5 7 Stomatitis. 4 1 5 Adhesions. l i Jaundice. 1 l Collapse. 3 3 1 7 Appendicular abscess 1 3 5 9 Abdominal abscess. l l 0esaphageal Varex. - l l Imperforated anus, 1 l Duodenal Ileus 2 2 Pyorrhoea 1 1 2 Pelvic abscess 1 1 Perinal abscess. l i 2 Pancreatitis. 1 1 Pyloric ulcer. 1 l 2 Pyloric obstruction 1 l 2 Subphrenic abscess 1 1 594 BONES AND JOINTS Arthritis. 1 20 1 22 Pagets Disease. 1 1 Pibrositis 1 3 . 4 Rheumatism. 6 4 1 11 Bursitis. l 2 l 4 Synovitis. 1 l 1 1 3 Osteo Myelitis. 1 5 2 8 Osteo Arthritis 4 1 5 Hallux Valgus. l l 2 Coxa Vara 1 1 Diaphysitis. 1 l 2 63 - 13- Diagnosis Medical Surgical Total cured. Relieved Unrelieved Died, Cured. Relieved Unrelieved Died, CARSINOMA. Breast. 3 2 6 11 Stomach. 2 5 20 27 Raoturn. 3 6 4 13 Cervix Uteri. 2 8 3 18 Sareeme. - skull l 1 Brain 1 1 rt .pubic bone 1 1 Ovary. 1 2 4 7 Prostate. 5 1 2 11 Tongue & Mouth. 4 1 5 Anus 2 1 3 Larynx, 1 5 6 Cheek. l 1 Colon. 3 2 10 20 35 Call bladder. 1 1 4 4 10 Lung. 2 8 10 Bronchus. 1 3 4 Liver. 3 3 Pancreas. 2 4 6 Caleum. 1 1 Pylorus . l 1 Parotid. 1 1 Maxillafcy Antrum. 2 2 Rodent ulcer. 1 1 Vulva. 1 l 2 Kidney. 4 4 Pharynx - 1 1 Oesophagus. 1 2 3 Epithelioma. 1 1 2 None. 1 1 Salivary Gland. 1 1 193 CIRCULATERY - BLOOD Annemia 5 8 2 2 17 Hyperpiesia. 9 2 11 Sept icaeraia. l 1 8 Pernicious Anaemia 5 1 3 8 Epistaxis. 4 3 1 Thrombosis . l l 1 5 Phlebitis. 4 1 1 6 Leukaemia. 1 2 3 Gangrene l 1 1 2 5 Purpura. 1 l Varicose Veins 1 l . 65 CIRCULATORY - HEART Myocardial degen: l 13 4 84 102 Arterio Sclerosis 7 4 4 15 Aortic Incornpetenc 3 1 2 6 Aortic Stenosis. l 1 Endocarditis. 3 3 6 Myocarditis. 5 2 8 15 Carditis. 2 1 3 Aur water Fib: 10 7 17 Mitral stenosis. 2 3 4 9 Congenital heart dis 1 l Congestive heart failure. 1 2 15 18 193 -14- Diagnoses, Medical. Surgical. Total Cured Relieved Unrelieved Died. Cured Relieved Unrelieved, Died Cireulatory-Heart. Coutinued 193. Atrtie Regurgitation 2. 2. Heart failure 5 3 11 19 Pneumatic heart 1 1 Entty degeneration of heart 2 2 Aneurysm 1 1 Mitral gurgitation 1 1 Pericarditis 1 1 1 Corenary thrombosis 1 2 3 6 226, Cons1tutional. Diabetes Mellitus 6 3 8 17 Debility 1 5 2 8 Nutritional disorder 6 1 7 Marasmus 7 2 2 11 Malnutrition 1 2 3 Rickets 1 1 Diabetic Coma 1 1 Diabetes Insipidus 1 1 49 Eyes. Conjuretivis 1 1 Glaucoma 1 1 Enucleation of eye 1 1 Daereerystitis 1 1 4. Ear Nose & Throat. EEnlarged T's & A's. 11 2 1 135 13 1 163 Labryneuthitis 2 2 4 Otitis Media 22 2 24 Mastoiditis 3 3 6 Pharyngitis 2 1 1 4 Catarrh 5 5 Laryngitis 1 1 Laryngeal obst. 1 1 Rhinitis 1 1 Aural Polypus 1 1 Cavernous sinus Throrabosis. 1 1 211. Gonito-Urinary. Nephritis 5 4 1 1 2 13 Pyelitis. 15 10 25 Urethral Stricture 2 2 Enlarged prostate 6 1 7 5 7 3 29 rt Pyelonephritis 6 1 7 Hydrocele 2 1 1 4 Cystitis 4 3 1 1 2 11 Papilloma of bladder 1 1 1 3 Uraemia 9 1 10 Urinary Calculus 1 1 2 Hyponephroma of Kidney 1 1 2 Circumcision 15 2 17 Extrdvasion of urine 1 1 2 1 127. 15  Medical Surgical Diagnoses Cured. Rel- ieved. Unrelieved. Died. Cured ieved Unrelieved. Died. Total Genito Urinary - (jontinued. 127 Haematuria 1 1 2 Diverticulitis. 1 1 Urethritis. 1 1 Glycosuria. 2 2 Albuminuria 1 1 Hydronephrosis 1 1 Renal colic. 2 2 Vescial calculus. 1 1 Epididymo-orchitis 1 1 Papiloma of glans penis 1 1 B.Coli infection, 1 1 Orchitis. 2 2 Girrhosis of liver 1 1 Divert, ictiltis . 2 2 Hepatic (Jirrhosis. 1 1 147 Glands. Adenitis. 14 1 15 G1andular fever. 1 1 Abdominal glands. 1 2 1 4 Myxoedema 3 1 4 Adenoma of thyroid 1 1 2 Hodgkins disease 1 1 0erviea1 ahscess 1 1 Parotitis 1 1 Goitre 1 1 P11ui taryen1argement 1 1 Abscesa of 1ivor 1 1 32 Gvnaecologica1 Abortion 135 19 6 1 l6l Ovarian cyst. 9 l 10 Fibrosis Uteri 16 3 1 20 Mastitis 11 l 12 Menorrhagia 2 6 2 10 Vaginitis 2 5 7 Metrorrhagia 3 3 Bartho1in' sabsees 2 2 Dysmenorrhoea 6 1 7 Erosion of Cervix 5 21 1 27 Deficient Pelvic floor 25 23 Salpingitis 2 6 1 9 Retroversion 11 3 3 17 Uterine prolapse 2 2 For StorillzatIon 1 2 l 4 Retained products 8 8 Cervieitis 1 10 11 Urethral Cruncle l 1 Cervieal Polypus 6 1 17 , i Uterine haemorrhage 3 1 4 Bartho1ins cyst. 2 1 2 Sub involutIon 1 1 Cystocele 1 1 Sterility 1 1 Broad ligament cyst 1 1 2 Dermoid cyst 1 1 Menopausal haem: 1 1 354  Medical Surgical. Total Diagnoses. Cured Relieved Unrelieved Died. Cured Relieved Unrelieved Died Gynaecological - continued. 354 Vaginal polypus 1 1 Vulva 1 abscess 1 1 Procidentia 2 1 3 Vaginal discharge 1 1 Menopausal syndrone 1 1 Vesicular mole 1 1 Plastic op: for vagina 1 1 Trachlorrhaphy 1 1 364. infectious. Influenza 21 1 22 Puerperal pyrexia 3 3 Dysentery 2 3 5 Polio-Myelitis 1 1 2 Scarlet Fever 1 1 1 Whooping Cough 2 2 Pa ratyphoid 7 7 Typhoid fever 1 1 Ccrebro spinal fever 1 . 1 2 45. Maternity. Deliveries. 853 2 855 Live Births. 806 18 824 Delivered before admission 3 3 For Version 8 2 4 14 Pyelitis of Pregency 3 4 7 Albuminuria of 1 5 6 False Labour pains 1 7 8 A. P • H. 1 4 5 R.B.P. 26 1 27 Vomiting of pregnancy 9 4 13 Toxaemia of 29 1 30 A.N. observation 12 27 10 49 A. N. rest 20 20 Anaemia of pregnaney 2 2 General Contracted Pelvis 1 1 Termination of pregnancy 4 1 5 1,869 Mental : Uncertified 2 96 45 143 Certified 47 \ 47 Epilepsy 2 23 3 28 M.D. 4 4 Mongolism 1 1 G.P.I. 1 2 3 Hysteria 1 3 1 5 Senile Dementia 11 1 2 2 15 Loss of memory 1 1 2_ 248 -17- Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died. RelCured ieved Unrelieved Died. Nervous & Sensory. Cerebral Haem: 1 7 1 46 56 Meningitis 2 19 8 29 Chorea 3 3 6 Sciatica 1 1 2 Hemiplegia 8 2 2 12 Neurasthenia 8 3 11 Neurosis 4 6 2 12 Cerebral throiribosis 2 13 3 14 32 Cerebral tumour 1 1 Neuralgia 1 1 Neuritis 1 1 1 3 Convulsions 2 4 6 Cerebral arterio- scleroais 6 4 10 Cerebral Hemiparosis 1 l Cerebra1 Oedema 1 l Paraplegia 1 1 Cerebrella tumour 1 l Athetosis 1 1 Cerebral abscess 3 3 Subarrachnoid haem 3 3 Hydroce phalus 1 1 Pleurodynia 1 1 Cerebral embolus 1 1 Paralysis 3 1 4 Effort Syndrome 1 1 Von Rechiuhausen'sDis. 1 1 Porticollis 1 1 Spina Bifida 1 1 Disseminated Sclerosis 1 3 4 Parkinsons disease 1 1 207. Respiratory . Bronchitis 55 58 7 4 124 Pneumonia 85 9 2 60 156 Pleural Effusion 1 l 1 3 Bronchiectasis 1 1 Ateleclasis l 1 Pleurisy 9 3 2 14 Asthema 2 11 1 14 Empyema 1 1 Asphyxia l 1 Pulmonary abscess 1 1 2 Influenzal Pneumonia 1 1 Emhysorna 1 1 Embolus 1 1 320. Senility. 38 14 34 86. - 18 - Diagnoses, Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Skin Boils, abscesses & Carbuncles, 30 8 38 Burns & scalds 11 10 1 22 Eczema 2 9 11 Impetigo 6 2 8 Scabies 12 1 1 13 Dermatitis 1 4 2 7 Erythema Nodosum 2 2 Cheiropompholyx 1 1 Cellulitis 9 5 2 16 Ulceration. 2 4 l 7 Sinusitis 1 1 Adenoma l 1 Polydacty1i sm Herpes 2 1 l 2 2 Pemphigus 1 1 Septic spots 1 1 Purpura 1 1 Erysipelas 1 1 135 Pulmonary T.B. 34 35 49 118 Non-pulmonary T.B. Spine 2 3 5 Meninges 1 5 6 Glands. 3 1 1 5 Hip. 2 2 4 Kidney 2 2 Miliary 2 2 Abdomen 1 1 Panereatitis 1 1 Generalised 1 1 T.BcPeritonitis 1 1 Peritonitis 1 1 Perirectal abscess 1 1 30 Venereal Gonorrhoea 1 1 2 Syphillis 2 1 3 5 Violence Fractured limbs. 34 96 9 19 158 spine. 2 1 3 malleolus 1 1 1 2 skull 3 2 3 8 ribs. 4 5 1 10 Minor injuries. 10 5 15 Contusions & abrasios 11 17 28 Sprains. 3 3 6 Abdominal injury l 1 1 231 -9- Diagnoses Cured Medic al Died Cured Surgical Died Total Relieved ieved Relieved ieved Violence - continued 231 Dislocation. 2 5 7 Concussion 30 15 45 Lacerations, wounds etc. 21 15 1 37 Removal of plaster 13 10 23 Infected wound. 1 1 Oedema of brain. ! 1 1 Pract. pelvis. 2 1 3 " nasal bone 1 1 Shock 3 2 5 Muscular strain, 1 4 355 Miscellaneous. Poisoning 10 3 1 14 Alcoholism. 2 2 4 N.A.D. 51 51 With mother 31 31 P.U.O. 1 1 1 3 Hare lip & cleft palate. 1 1 1 3 Teething. 2 2 4 Post op: haem: 3 3 Prematurity 1 1 2 Congenital organic pain. 1 1 Congenital Artesia Anal canal 1 1 Vaccination reaction 1 1 Hereditary Dyschondroplasia 1 1 Icterus Neonaton 1 1 Haemagroma 1 1 Malingering. 1 1 Kydrocephalus 1 1 123 Total number of Patients Discharged from Mayday Hospital, Year Ended 31st December, 1940. Cured. 3,096 Relieved. 1,260 Unrelieved. 458 Died. 675 5,489 20 Operations performed at Mayday Hospital during 1940. Abdominal. Appendicectomy. 137 Appendix abscess drained. 5 Suture of Perforated duodenal ulcer. 8 For perforated duodenal ulcer. 2 Sigmoidoscopy. 3 Herniotomy. 70 Cholecystectomy. 21 Laparotomy. 36 Gastrcenterostomy. 2 Cho1ecyst-gastrostomy. 1 Colostomy. 7 For Pyloric Stenosis . 3 Caecostomy. 2 Intus susception. 1 For intestinal obstruction. 8 For gastric ulcer. 12 Resection of colon. 5 Castro jejunostomy. 2 For anal fistula. 5 Ligature of haemorrhoids. 8 Removal of anal tag. 3 For duodenal ulcer. l Drainage of abdo.wall abscess. 1 Torsion of omentum. 1 Spelectomy. 1 Repair of peptic ulcer. 1 345 Bones and Joints. For Osteo-myelitis. 3 Amputation of limbs. 9 Wiring of bones. 25 Removal of pin. 3 Resection of rib. 2 Application of plaster. 37 Reduction of joints. 7 Manipulation of limbs. 6 Removal of fibroma of left leg. 1 Removal of internal cartilage. 3 Bone graft. 3 Por Bilateral Hallux Valgus. 1 Osteotomy. 2 Internal Moniscotomy. 1 103. Ear, Nose and Throat. Mastoidectomy. 12 Tensi11ectomy. 117 For nasal polypi. 1 Myringotomy 5 135 21 Genito-Urinary. Cystoscopy. 38 Circumcision, 18 For Hydrocele. 3 Nephrectomy. 4 Prostatectomy. 18 Cystostomy. 23 For Extravasion of urine. 1 For urethral Stricture. 3 For urethral fistula. 1 Orchidectomy. 1 Drainage of pyo-nephrosis. 1 Excision of papilloma of bladder. 2 Drainage of subphrenic abscess. 1 Catheberisation. 1 Removal of gauze plugging from gall bladder site 1 116 Gynaecological. Examination under Anaesthetic. 70 Total Hysterectomy, 3 Subtotal Hysterectomy. 16 Salpingo-oophorectomy. 2 Dilation and Curetage. 72 Removal of ovarian cyst. 8 Salpingectomy, 6 Incision of breast abscess. 10 Incision of vulval abscess. 3 Ovariotomy, 2 Incision of Bartholin's abscess. 2 Incision of Bartholin's cyst. 2 Incision of Peri-renal abscess. 1 Insertion of pessary. 4 Colpo-perineorrhaphy. 18 Dilatation of cervix. 2 Cauterization of cervix. l6 Repair of cervix. 2 Baldy-Webster operation. 8 Modified Fothergill's operation. 4 Insertion of Laminaria tents. 6 Removal of uterine pack. 1 Cervical smears taken. 3 Intra-uterine injection. 2 Cauterisation of urethral caruncle. 1 For sterilization. 1 Cervical polypi. 1 Incision & repair vaginal band of tissue. 1 Insufflation of fallopian tubes. 3 270 22 Obstetrical Caesarean Section. 35 Evacuation of Uterus & Glycerine pack. 131 . For Ectopic Gestation. 2 Induction of labour. 11 For retained products. 3 Hysterotomy. 2 Repair of 3rd decree tear. 3 Ruptured perineum. 1 188 Miscellaneous. Excision of glands. 2 Hemithyroidectomy 2 Blood transfusion. 9 Incisions, abscesses, etc. 71 Cleansing burns etc. 5 Amputation of breast. 1 Suture of wounds. 13 Thiersch skin graft. 4 Excision of wounds. 5 Lumbar puncture. 73 Aspiration. 36 Removal of nail, (toe) 6 Parecentesis. 14 Exploration of left lobe cerebellum. 1. Exploration of chest. 1 Venesection. 2 Suture of tendon. 2 Suture of conjunctiva of 1. eye. 1 Excision of subcutaneous haemangioma of arm 1 Enucleation of eye. 1 Needling of hip. 2 Needling of chest. 6 For hare lip, 3 A.P, refill. 44 305 Number of patients who had teeth extracted. 151. 23 POOR LAW RELIEF (a) Domiciliary Relief Number of Croydon cases resident in the Borough and in receipt of outdoor relief on the - 1st January, 1940 4194 persons; 2421 cases 1st July, 1940 4095 " ; 2448 " 1st January, 1941 1900 " ; 1065 " Expenditure on Outrelief during the 12 months ended 30th September,1940 to Croydon cases resident in the Borough. Half-year ended 31st March, 1940 £55,952. Half-year ended 30th September,1940.., £43,634. (b) Institutional Relief. Number of Croydon poor persons relieved in the Mayday Hospital on 30th December, 1940 and in the Queen's Road Homes on the same date - Mayday Hospital 28 Queen's Road Homes 575 (c) Medical Relief During the year the Panel Medical Service Scheme continued in operation. Particulars for year ended 31.3.41. No.2- Dist No. 3 Dist No,4 Dist No.5 Dist. No.6 Dist. No.7 Dist. 1 Average number of separate patients at bended during each quarter. 176 178 190 138 273 29 2 Attendances at patients' homes 2465 1503 1143 1035 1993 267 3 Attendances on patients at the surgery 619 786 885 452 681 222 4 Total number of prescriptions written 2765 3807 3393 1972 3644 551 5 .Estimated cost of drugs, dressings & dispensing £119 £164 £146 £85 £157 £23 6 .Estimated amount of per capita payment to doctors in respect of patients actually attended 3/7.6d 3/10.1d 3/3.3d 4/1.09d 3/8.9d 3/4.3d 7 .Estimated average payment per service point 1.18d 1.44d 1.36d 2.15d 2.21d 1.46d 24 CASES OF NOTIFIED INFECTIOUS DISEASE, 1940 Notifiable disease. Cases notified in the whole district Total cases notified in each Ward Total cases removed to Borough Hospital and diagnosis confirmed. Total Deaths in respect of the Soroush. Sex Distribution 1940 At all ages at ages - years Upper Norwood Norbury West Thornton Bensham Manor Thornton Heath South Norwood Woodside Fast Addiscombe White horse Mnr Broad Green Central Waddon South Addington Under 1 yr. 1 - 5 6 - 13 16 - 25 26-45 46-85 86 and up M. F. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (the Membranous Group) 68 1 20 23 14 8 2 - 3 7 5 1 2 1 3 4 7 4 8 3 8 6 6 62 4 26 42 Erysipelas 45 - - 2 6 13 16 8 9 3 5 1 3 1 1 2 5 4 2 3 1 2 3 17 2 18 27 Scarlet Fever 157 .. 48 76 17 16 - - 15 13 2 9 10 19 22 6 13 17 9 1 8 4 9 143 - 83 74 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever ing Paratyphoid) 19 - 1 4 9 2 2 1 1 - 3 1 1 2 5 - - - 3 2 1 - - 18 - 6 13 (Puerperal Pyrexia 44 • • .. 1 18 25 .. .. 1 - 31 - 1 - 1 - — 4 — — 1 4 1 5 - .. 44 Cerebro Spinal Meningitis 41 3 11 7 7 8 5 - 3 2 2 4 1 5 3 3 5 3 2 1 5 1 1 42 16 21 20 (Ophthalmia Neonatorum 14 14 .. .. .. .. .. .. 1 - 3 — 1 - 1 - 1 3 - 3 - 1 - - - 6 8 Poliomyelitis &. PolioEncephalitis 2 - 2 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 2 1 - 2 Incephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 ... .... Dysentery 8 - 5 1 - 1 1 - 1 - - 2 - - - - - - 2 - 1 - 2 7 - 4 4 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ac. Primary and Ac. Inf. Pneumonia 50 1 4 2 3 12 21 7 3 5 8 2 2 2 2 9 5 1 2 - 5 4 - - 22 28 22 Measles 239 3 64 64 87 19 2 - 15 8 4 9 21 21 59 35 19 50 5 5 12 12 4 9 - 103 136 Whooping Cough . 42 8 26 - 6 - - - 6 — — 3 7 2 6 2 4 - 1 3 2 4 2 2 2 20 22 a Influenzal Pneumonia only. / 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 0ver 5 rooms 1940 1939 Small pox - - - - - - - Diphtheria 0.34 0.81 8 36 11 13 68 Zysipelas 0.23 0.20 5 27 9 4 45 Cearlet Fever 0.79 1.03 10 124 18 5 157 Enteric Fever (inc.Paratyphoid) 0.10 0.02 - 10 7 2 19 Puerperal Pyrexia. 0.22 0.16 - 5 .. 39 44 Cerebro-Spinal Meningitis 0.21 0.01 - 15 5 20 41 Ophthalmia Neonatorum 0.07 0.06 - 8 2 4 14 Poliomyelitis and Polioancephalitis 0.01 0.01 - 2 - - 2 ancephalitis Dethargica. - - - - - - - Primary or Acute Pneumonia 0.25 0.25 3 30 15 2 50 .. Dysentary 0.04 0.02 - - 3 5 8 The 1939 showed that houses of 1-3 rooms formed 4.7% of the total number of houses in Croydon; those of 4 - 5 rooms 51.4% and those with over 5 Cements on the Incidence and Prevalence of Inectious Disease Scarlet Fever was less prevalent than in 1939: the largest incidence has been Norwood, whitehorse Manor and Upper Norwood Wards. The incidence rate of Diphtheria was 0.34 compared with 0,81 in 1939, No cases or smallpox occurred during the year. There were 44 cases of Puerperal Pyrexia; 18 occurred in the age group 16-25 years and 18 in the age group 26-45 years. A majority of the cases occurred in women having their first confinement. 26 BOROUGH HOSPITAL. Table A gives a Summary of the cases treated at the Hospital during 1940. 505 patients were admitted and discharged, which, together with the patients in at the cannoncoment of 1940 (26) gives a total of 531 cases dealt with. 26 died giving a case mortality for the Hospital of 4.6% as against 3.3% in 1939. During 1910 a total of 18 cases were admitted from Penge and those are included in the Table, The Hospital is recognised training school for nurses. During the year 2 probationers passed the preliminary examination and 3 the final examination. During the year 3 cases wore operated upon for tonsils and adenoids. TABLE A. Complaint for which admitted, Patients remaining in Hospital 1.1.40. Patients admitted & discharged in 1940. Patients admitted in 1940 & remaining in hospital 1.1.40. Analysis of cases admitted whether discharged or not during the year. Total Recovered Died Total Recovered Died Total Recovered Died Total Recovered Died Case Mortality Ave rage No. of days in Hospital. Scarlet Fever 9 9 — 128 128 - 19 19 - 147 147 - 33 Diphtheria 11 11 - 107 100 7 4 4 - 111 104 7 6.3 33 Entoria Fever - - - 4 4 - - - - 4 4 - 39 Para-Typhoid i Fever - - - 13 13 - 1 1 - 14 14 - 32 Pneumonia Pyrexia - - - 6 6 - - - - 6 6 - 14 Fever - - - - - - - - - - - - - Eryapelas 1 l - 17 14 3 - - - 17 14 3 1.8 11.4 Measles - - - 9 8 1 3 3 - 12 11 1 1.3 12 Rubella - - - 82 82 - - - - 82 82 - 10.6 C.S.M. - - - 63 51 12 1 1 - 64 52 12 18.7 19.4 Whooping Cough - - - 4 4 - - - - 4 4 - 26 Chicken Pox 4 4 - 5 4 1 - - - 5 4 1 20 17.2 Ophthalmia - - - 3 3 - - - - 3 3 - 9 Mumps - - - 2 2 - - - - 2 2 - 15 Tonsillitis - - - 1 1 - - - - 1 1 - 9 Anterior Poliomyelitis - - - 1 1 - - - - 1 1 - 41 Dysentery 1 1 - 6 5 1 1 1 - 7 6 1 14.2 18 Pemphigus - - - 2 1 1 - - - 2 1 1 50 7 Otorrhoea - - - - - - - - - - - - - Cellulitis of leg. - - - - - - - - - - - - - Tuberculosis - - - 9 9 - - - - 9 9 36 Vincents Angina - - - 1 1 _ - - - 1 1 - 13 Pleurisy - - - - - - 1 1 - 1 1 - 103 Diarrhoea - - - - - - - - - - - - - No Disease - - - 11 11 - 1 1 - 12 12 - - TOTALS 26 26 - 474 448 26 31 31 - 505 479 26 The average number of days of each patient in Hospital for all classes of patients was 33.4 days compared with 24.5 days in 193S. 27 SCARLET FEVER. The total number of Scarlet Fever cases admitted during the year was 147 a decrease of 123 on 1959. 138 cases ore admitted. from the Borough and 9 from Penge. 4 cases sent in as Scarlet Fever were hot suffering from the disease, leaving a total of 143 Serum Cases Non- Serum Cases Total Total cases 48 95 143 Adenitis 3 8 11 Otorrhoea 1 5 6 Rhinorrhoea 3 2 5 Rheumatism - 1 1 Relapses 1 1 2 Secondary Sure Throat - 2 2 No deaths occurred amongst the scarlet fever cases. AGES & SEXES AMITTED. M F Total. 1-2 6 - 6 2-3 4 3 7 3-4 8 3 11 4-5 10 8 18 5-10 23 28 51 10-15 3 9 17 15-20 7 5 12 20-30 6 8 14 30 & over 7 4 11 79 68 147 DIPHTHERIA. 1ll cases wore admitted with a diagnosis of Diphtheria., a decrease of 204 cases on 1939. Of these 14 were found not to be casos of Diphtheria and 35 wore cases of positive swabs without clinical symptoms, leaving 62 cases of true clinical diphtheria. There wore 7 deaths, a mortality of 11.3%. Analyses of 62 case's:- Faucial diphtheria 54 Nasal diphtheria 6 Laryngeal diphtheria 1 Faucial and nasal diphtheria 1 Total 62 The following complications and sequelae occurred-amongst the diphtheria cases- Rhinorrhoea 6 Otorrhoea 2 Adenitis 5 Heart failure 8 Albuminuria 1 Secondary sore throat 2 Pericarditis 1 Paralysis - Palatal 5 Eyes 5 28 AGES & SEXES ADMITTED. M F Total 0-1 1 - 1 1-2 4 7 11 2-3 3 3 6 3-4 6 3 9 4-5 3 4 7 5-10 15 8 23 10 - 15 2 8 10 15-20 - 17 17 20-30 4 11 15 30 & over 6 6 12 44 67 111 The type of Diphtheria cases admitted during tho first four months of the year was severe and narked by texemia. Most of the fatal cases wore admitted late, usually on the fourth day or later of disease. The number of admissions after September was again very small - only 16 casos for the period September to end of December 1940, these including cases of positive swabs.. TYPHOID AND PARA TYPHOID FEVER. During the year 18 cases of typhoid fever or para typhoid fever were admitted and in all cases the diagnosis was confirmed. No deaths occurred amongst the cases. PUERPERAL PYREXIA. During the year 6 cases of puerperal pyrexia were admitted. No cases of puerperal fever were admitted. ERYSIPELAS There wore 17 cases of Erysipelas admitted, 2 more than in 1939. Three deaths occurred amongst them, one being complicated by heart disease, the others by senility'and general septicaemia. WHOOPING COUGH. There wore 4. cases of whooping cough, a fall of 25 cases on 1939. No deaths occurred. CEREBRO SPINAL MS MENINGITIS . Sixty-three cases of this disease were admitted but in 21 cases the diagnosis was not confirmed. OPHTHALMIC NEONATORUM. Three cases were admitted but they wore all cases of simple Ophthalmia. INFANTILE PARALYSIS (POLIOMYELITIS) . There was only one case admitted. DYSENTERY , Seven cases wore admitted of the Sonne type. One case of acute gastroenteritis died. PEMPHIGUS. Two cases admitted as Pemphigus were really casos of septic dermatitis and of icterus5 the latter case proved fatal. 29 MUMPS. Seven cases were admitted as mumps, one of them was a case of alveolar abscess. MEASLES. Twelve cases were admitted, the diagnosis being confirmed in nine cases. TUBERCULOSIS. Nine cases of pulmonary tuberculosis were admitted temporarily and subsequently transferred to the Borough Sanatorium. Out of Borough Cases. Disease Males Females Total Deaths Scarlet Fever 4 5 9 _ Diphtheria 2 3 5 1 Cerebro Spinal Men. 1 2 3 1 Rubella — 1 1 - Borough Hospital Laboratory. Diphtheria. Cases swabbed Case3 swabbed during Negatives Total on admission convalescence Positive Positive 70 170 1684 1924 Faeces, Enteric and Dysentery Croups. B. Typhosus B. Para Typhosus Dysentery Negatives Total B. Positive Examined Positive Positive Sonne Total 2 10 1 53 60 Widals; Dreyers Agglutination Tests. B. Typhosus B. Para Typhosus B. Total Total Positive Positive Negative Examine. 4 7 2 13 Cerebro Spinal Fluids (for presence of meningococci) Positive Negative Total 30 14 44 Miscellaneous Examinations. 3 Blood specimens for culture (sterile) 3 3wabs for skin vesicles (Staphylococcus aureous cultivate 2 specimen pus for organisms (1 specimen meningococcus growing sterile) 2 specimen sputums (1 B.Typhosus cultivated: 1 for TB negative) 2 specimen urines (examined for organisms: 50th sterile) 7 eye swabs (cultivated for organisms; 2-Staphylococcus aureous present; 5 sterile) 2 Vaginal swabs (examined for organisms: 1 Haemolytic streptococcus Longus present). 30 31 AGE (SOUPS OF CASES ADMITTED (other than Scarlet Fever and Diphtheria) 0-1 1-2 2-5 5-15 15-25 25-35 35-45 45 & over Totals Deaths M. F M F M F M F M F M F M F M F Enteric Fever 1 1 1 1 4 Para-typhoid 1 2 1 2 5 1 2 14 Puerperal Pyrexia 3 3 6 Erysipelas 1 2 1 2 3 3 5 17 3 Measles - 3 - 5 - 2 1 1 12 1 Rubella 1 5 2 24 23 10 9 8 82 C.S.M. 4 2 1 2 7 5 2 9 11 1 7 5 2 - 2 4 64 13 Whooping Cough 1 1 1 1 4 Chicken pox 1 1 2 1 5 1 Ophthalmia 2 1 3 Mumps 1 1 2 Tonsillitis 1 1 Anterior Poliomyelitis 1 1 Dysentery Sonne 1 1 3 1 1 7 1 Pemphigus 1 1 2 1 Cellulitis of leg Tuberculosis 4 3 1 1 9 Vincents Angina 1 1 Pleurisy 1 1 No Disease 1 12 8 6 2 6 10 16 11 15 42 41 18 25 4 25 5 13 247 19 32 BACTERIOLOGICAL EXEKEHATIONS  For private practitioners Mayday Hosp. For Borough Hospital For Tub. Dispensary. For School Medical Other Instns. of Corporation. Other Institutions Total I am indebted to the Borough Pathologist, Dr. H.W.Southgate, for the figures given in the appended tables : At the Laboratory, Croydon General Hospital. Pos. Neg. Pos Neg Pos. Neg. Pos N eg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Swabs for Diphtheria 39 673 - - - 6 - 8 40 1273 3 209 22 925 104 3094 Virulence tests for Diphtheria 1 - - - 7 - - - 3 - - - - - 11 - Sputum for Tub. Bac. 54 436 - - - - 381 772 - - - - 7 40 442 1198 Pus for Tub.Bac. - 7 2 5 - - - - - - - 12 - - 2 24 Pus for Gonococci - 4 - - - - - - - - 3 49 - - 3 53 Pus for other organisms - 16 - - - 1 - - - - - 76 - 12 - 105 Blood for Typhoid Groups 9 8 - - - - - - - - 4 9 - 1 13 18 Blood for Wassermann - 3 9 117 - 1 - - - - - 1 - - 9 122 Material for Spirochaetes - - - - - - - - - - - - - - - - Faeces for Typhoid Group 3 15 - - - - - - - - 1 18 - - 4 33 Hair for Ringworm - - - - - - - - 1 7 - - - - 1 7 Examination of Urine 4 3 - - - 12 - 19 Examination of Pleural Fluid 1 k — - - 1 - 6 Examination of c.s. Fluid 1 7 - - - - - 8 Other Examinations 25 236 3 - 16 153 9 442 Examinations Done Under National Health Insurance Act. Nature of Examination Nature of anamination Pus for Gonococci 15(4 pos.) Urine for Chemical Exam 2 Pus for other organisms 6 Urine for Microscopal Exam. 2 Pus for Tubercle B 14.(1 pos.) Urine for Tubercle B. 2 Blood for Wassermann 8(1 pos.) Urine for Cultural Exam 2 Complete Blood Counts 10 Other Examinations 8 Bacteriological Examination of Milk. Number of Samples submitted for Counts 389 Number under 10,000 per cc 136 Number over 10,000 but under 50,000 per cc 141 Over 50,000 but under 100,000 per cc 43 Over 100,000 but under 500,000 per cc 32 Over 500,000 but under 1,000,000 per cc 6 Over 1,000,000 per cc 31 Tubercle Bacilli Number of samples of milk submitted 388 Number found positive by inoculation test 1 The number of milk examinations decreased by (78 for Bact. 77 for T.B. Milk Samples 389 milk samples submitted to the Methylene Blue Test.. whic1h 55 failed to satisfy. Of these 114. were further investigated and found satisfactory to the Bacillus Coli test. 33 IMMUNISATION AGAINST DIPHTHERIA During 1940 the routine of the Diphtheria immunisation clinics remained unchanged, that is to say Alum precipitated toxoid was the prophylactic used and Schick testing both befrre and after treatment was, except for a few cases, diapensed with. This meant only two visits compared with four or five of former years. The abnormal conditions existing through the year meant a drop in the number of attendances . Thus, the evacuation and temporary closure of the schools. and in the latter half of the year, the air attacks, resulted in the inability or disinclination of parents to venture far from their homes. The consequence was that during a part of the time it became necessary to cut down the sessions to one per month. New cases came from the following source School cases 216 Infant Welfare cases 98 Others under 5 years 114 The ensuing tables give some further details. Total number of sessions hold 33 Highest attendance at any one session 65 Lowest " " " " 7 Average attendance per session 28 Table 1. SUMMARY OP WORK OF CLINIC SINCE. ITS START Year Total attended for treatment Now cases attended Ho. of sessions held Aver. attend, per session. No. given ary schick % pos on prim Nr. givon posterior Schick No. Neg, on Fost. Schick. & Neg on post schick No leted mony 1854 509 509 - 36 389 - 185 - - 185 1945 1431 1151 97 58 634 76 781 766 98.8 761 1986 2885 1661 145 61 1215 78 1264 1254 99.2 1234 1937 1894 1286 122 58 1017 86 1222 1215 99.5 1222 1939 2049 1541 115 56 1208 69 1152 1140 98.9 1152 1939 1438 1020 61 63 593 76 678 671 98.9 1201 1940 508 428 33 28 - - - - - 419 Table 11 SUMMARY OF ATTENDENCE AND TREATMENT 1940. Under Treatment 1.1.40. Received A.P.T. Defaulted. Total new cases 1940. 87 80 7 428 1940 cases completed treatment. Received A.P.T. Under treatment 31.12.40. Defaulted 339 339 89 19 34 TABLE 111 ORIGIN AND - SOURCE OF CASES ATTENDING. Year School Inf .Welfare C. Others under 5 years. Total % " Total % Total % 170 33 1934 339 67 208 14.7 1935 944 66.6 265 18.7 237 10.9 1936 1620 74.8 310 14.3 203 15.8 1937 923 72.2 155 12. C 232 15.1 1938 1179 76.5 130 8.4 91 9.0 1939 704 69 225 22.0 114 27. 1940 216 50 98 23. Immunisation in Residential-Schools and Homes. Owing to the evacuation of Residential Schools and Hones, no immunisation was conducted in the Institutions in 1940. 35 VACCINATION ACTS I am indebted to Mr. Huggins the Vaccination Officer, for the particulars in the returns in subjoined Tables. Registration Sub-District in V.O. District. Births Registered. Vaccinated. Insusceptible. [Statutory Declarations. Died Tinvaccina ted. P.P.0. Transferred to other V.Os Not traced Removals 12 Default. Overage wen Registered. South Sub District 1292 452 11 469 45 12 71 209 21 2 West" 1469 396 10 683 40 19 6 293 22 - North" 610 209 3 266 15 6 5 85 21 — 3371 1057 24 1418 100 37 82 587 64 2 During the year 2,114 Forms Q, were delivered personally to parents, and 175 Forms K and 125 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. 657 names were sent on the H lists to Public Vaccinators to be visited. Return showing the Numbers of Persons vaccinated and re-vaccinated at the cost of the Rates by the Medical Officer of the public Assistance Institutions and the Publio Vaccinators during the year ended 30th September 1940 Numbers of successful primary No"successful reVaccinations of persons. vaccinations,i.e., Name of Public Assist- successful vaccin- ance Institution or Under I I year and Total, ations of persons Vaccination District, year of age upwards who had been successfully vaccinated at some previous time. Croydon No. I Area 148 5 153 4 No. 2 Area 148 18 166 1 No. 3 Area 66 5 71 2 No. 4 Area 94 10 104 1 No. 5 Area 243 9 252 3 Addington 75 20 95 1 Queen's Road Homes 1 - 1 - Mayday Road Hospital - - - - Children's Homes - - - - Shirley Schools - - - - 775 67 842 12 36 VENERAL 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. 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 New male patients 263 235 242 297 287 300 395 416 316 187 (a) New female patients 205 241 214 232 213 188 184. 257 191 202 (a) attendances, Male patients 4923 4691 4578 5858 5548 7525 8610 7318 4258 2996 (a) Attendances, Female Patients 3271 2724 2677 3962 5977 5226 5405 5365 3150 1772 (a) (a) Includes 121 new cases and 1784 total attendances by patients from outside areas. Attendances of Croydon patients at various London Hospitals under the General Scheme. There were 96 new patients, who made a total of 1032 attendances. Pathological Examinations at London Hospitals for Croydon Patients 482 Examinations were made for various Clinics and 2136 examinations of material submitted by medical practitioners. Bacteriological Examinations carried out at London Hospitals for Croydon Patients. Hospital Detection of Spirochetes Detection of Gonococci Wasserman Re-action Other Exams Total For Clinic For Prac. For Clinic For Prac . For Clinic For Prac . For Clinic For Prac St, Thomas's - - 78 4 54 2 86 4 228 South London Hospital for Women 5 - 32 3 20 1 12 - 73 Royal Free - - 40 - 2 - 6 - 48 King's College 1 - 25 - 11 - 8 - 45 Whitechapel Clinic,L.C.C - - 5 - 5 - 5 15 Guy's Hospital 6 - 17 744 27 531 37 847 2209 TOTAL 12 - 197 751 119 534 154 851 2618 37 Croydon Cases attending London Hospitals. Hospital Cases seen for the first time Conditions other than venereal Total No. of Attendances. Aggregate No. of Inpatient Days Syphilis Gonorrhoea St.Thomas's - 2 27 246 - Guy's 3 3 9 225 - Royal Free 1 1 1 50 - South London Hospital for Women 2 3 10 145 - Whitechapel Clinic (L.C.C) - — 1 15 - Seamen's - - 1 1 - King's College 1 2 29 350 25 Total 7 11 78 1032 25 - 39 - Return relating to all persons who were treated at the Treatment Centre at Croydon during the Year ended the 31st December.1940 Syphilis Soft Chancre Gonorrhoea Non-venereal or undiagnosed conditions. Totals M F M F M F M F M F Totals l. Number of cases on 1st January under treatment or observation 75 67 - - 28 3 9 6 112 76 188 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. 4 4 - - 9 - - - 13 4 17 13. Number of cases dealt with for the first time during the ye are under report (exclusive of cases under Item 4) suffering from:- Syphilis, primary 7 4 - - - - - - 7 4 11 " , secondary 1 5 - - - - - - 1 5 6 “ , latent in 1st yr. of tion — 3 — - — - - - - 3 3 " , all later stages 10 11 - - - - - - 10 11 21 " , Congenital 2 5 - - - - - - 2 5 7 Soft Chancre - - — - - - - - - - — Gonorrhoea a, 1st year of infection - - - - 80 12 - - 80 12 92 , Later - - - - 7 6 - — 7 6 13 Non venereal conditions - - - — - - 80 156 80 156 236 Conditions remaining undiagnosed at 31st December - - - - - - - - - - - 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. 10 11 - - 12 1 — - 22 12 34 Totals Of Items 1,2,3and 4- 109 110 - - 136 22 89 162 334 294 628 40  Syphilis Soft Chancre Gonnorhoea Non-venereal or undiagnosed conditions Totals M F M F M F M F M F Totals 5. Number of coses discharged after completion of treatment and final tests of cure or after diagnosis as non-venereal 15 18 - - 71 9 84 154 170 181 351 6. Number of cases which ceased to attend before completion of treatment and were, on first attendance, suffering from:- Syphilis, primar y 2 4 — - — — - - 2 4 6 " , secondary - 2 - - - - — — - 2 2 " , latent in first year of infection 2 3 - - - - - - 2 3 5 all later stages 5 6 - - - - - - 5 6 11 " , Congenital 3 3 - - - - - - 3 3 6 Soft Chancre - - - - - - - - - - - Gonorrhoea 1st year of infection - - - - 27 2 - - 27 2 29 later - - - - 4 - - - 4 - 4 7. Number of cases which ceased to attend after completion of treatment but before final tests of cure. 11 8 - - 13 2 - - 24 10 34 8. Number of cafes transferred to other Centres or to institutions, or to care of private practitioners. 17 8 - - 5 - - - 22 8 30 9.Number of cases remaining under treatment or observation on 31st December. 54 58 - - 16 9 5 8 75 75 150 TOTALS OF ITEMS 5,6,7,8 and 9 109 110 - - 136 22 89 162 334 294 628 41  Syphilis Soft Chancre Gonorrhoea Non venereal or undiagnosed conditions Totals M F M F M F M F M F Totals 10. Number of attendances (a) for individual attention of the medical officer(s) 1256 1056 - - 442 77 407 354 2105 1487 3592 (b) for intermediate treatment, e.g. irrigation dressing - - - - 6l6 45 275 240 891 285 1176 TOTAL ATTENDANCES 1256 1056 - - 1058 122 682 594 2996 1772 4768 11. In Patients:- (a) Total number of persons admitted for treatment during the year 5 2 - - - - - - 5 2 7 (b) Aggregate number of patient days of treatment given 79 17 - - - - - - 79 17 96 12. Number of cases of congenital syphilis in item 3 above classified according to age periods. Under 1 Yr. 1 & under 5 yrs. 5 & under 15 yrs 15 vrs & over. Totals M F M F M F M F M F - - 1 - - 1 2 6 3 7 13. Pathological Work:- Number of specimens examined at, and by the Medical Officer of, the Treatment Centre. Microscopical Others for diagnosis of Venereal Disease - for Syphilis - for Gonorrhoea - 42 Statement showing the services rendered, at the Treatment Centre during the year, classified according to the areas in which the patients resided. Name of County or County Borough (or Country in the Case of persons residing elsewhere than in England and Wales) to "be inserted in these headings Croydon Surrey Kent London Total • ' 1 A. Number of cases from each area included under the following headings in item 3:- Syphilis 53 17 3 3 76 Soft Chancre - - - - - Gonorrhcea 77 30 3 5 115 Non-venereal and undiagnosed conditions 182 48 8 4 242 TOTAL 312 95 14 12 . 433 B. Total number of attendances of all patients residing in each area. 2435 86o 112 812 4219 The Croydon Branch of the British Social Hygiene Council which receives a grant of £50 annually from the Borough Council towards its expenses carried out a programme which had been adapted to war-time conditions. I am indebted to the Hon.Secretary, Mrs. A.Moat for the following report, namely:- The year under review has presented many obstacles to the work of the Branch, mainly owing to the inability to draw audiences owing to the black-out and to the mobile nature of the troops in and around Croydon, These obstacles are now disappearing, and we confidently hope that the larger attendances at the lectures now held will continue and thus enable us to reach a more encouraging proportion of the community. During the year we have lost from the Committee (through evacuation) several valuable members, including the Chairman, Miss Alice M.Jackson, M.A., whose interest in all branches of oxir work was most keen, and our Hon. Secretary, Mrs. Massey. These posts have been filled, pro tem, by Mrs. A.Moat. The Committee has been strengthened by the addition of Mr.H.S.Clayton, M.A., Dr.A.C.West, and Councillor Miss Glazier. Croydon was selected as one of fifteen boroughs to bo represented on the National War Emergency Committee, and Dr.Wost serves as our elected representative. Dr.Olive Falk and Mrs. A.Moat attended the Annual Meeting in London and reported the proceedings to the Branch, Suitable literature has been provided at all lectures, and a distribution of war leaflets for men and women has been made by the Croydon Y.M.c.A. and Y.W.C.A, and at every branch of our public library. An attempt has been made to introduce our lectures to the trainees at the Croydon Government Centre, and although this was not successful at the time we hope with the help of the authorities to succeed in tho near future. Appended is the list of meetings already hold, and at the time of writing we are also arranging four lectures (two in Guildford and two in Croydon) for adolescent pupils under the care of Miss Lister, M.A. During April and May 194O nine lectures were given to Auxiliary Fire Service personnel in Croydon by Captain Buckler (2), Dr.Feldman (2), Mr. Fellowes -Farrow (2), Mr.Dawson (2) and Mr.Hawkins (1). 600 copies of each of "Venereal Diseases and their Effects" and "Facts of Sex for Men" were distributed free at the Depots. Aggregate attendance 595 • May 1940. Fo\ir lectures fixed for troops in Horniman Hall had to bo cancelled owing to the rapid changes in their movements. December 19th,1940. Lecture to troops in Horniman Hall on sex problems for men. 150 present. February l4th,194l Lecture to troops in Horniman Hall by Mr.Dawson. I50 present. 43 Deaths from Cancer numbered 443 as compered with 414 in 1939, 380 in 1938; 421 in 1937; 421 in 1936; 321 in 1935; 371 in 1934; 374 in 1933; 341 in 1932; 339 in 1930; and 330 in 1929: Death rate per 1,000 of the population for the previous 11 years are as follows:- 192:9 - 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 - 1.73(414) 1934 - 1.34 (371) 1940 - 2.22(443) Table 1. Deaths fro n Cancer occurred at t; e. following ages:- Age period Male Female Total tinder 25 years 2 1 3 25 and under 35 years 2 6 8 55 and under 45 years 12 8 20 45 and under 65 years 73 99 172 65 years end over 121 119 240 210 233 443 Sites of fatal Cancer Table 11 Site Male Female Total Percentage of Total. Skin 6 2 8 1.806 Tongue and Mouth 5 - 5 1.129 Oesophagus 5 1 6 1.354 Stomach 46 31 77 17.381 Liver 7 5 12 2.709 Bowel 17 45 62 13.995 Rectum 26 10 36 8.126 Urinary Bladder 7 4 11 2.483 Prostate 22 - 22 4.966 Larynx 6 - 6 1.354 Uterus - 33 33 7.449 Breast - 41 41 9.255 Ovary - 14 14 3.160 Pancreas 5 8 13 2.935 Gall Bladder and Duct - 10 10 12.257 Bones 2 2 4 0.903 Lungs 33 14 47 10.605 Kidneys 7 2 9 2.032 Antrum 2 2 4 0.903 Lymphatic Glands 3 - 3 0.677 Pharynx and Fauces 4 - 4 0.903 Genital Organs 2 2 4 0.903 Sub maxillary salivary gland. 1 - 1 0.226 Spine 1 1 2 0.451 Reticulo endothelial sarcometosis. - 1 1 0.226 Brain 1 2 3 0.677 Muscle 1 - 1 0.226 Mediastinum 1 2 3 0.677 Generalised sarcomatosis - 1 1 0.226 210 233 443 Comments on Foregoing Table. The organs most often attacked in descending order of inidence are, in males the Stomach 21,9 ; the Rectum and Bowels 18.6; the Lungs 15.7; in females, the Bowels and Rectum 23.6; the Breast 17.6; the Uterus 14.2; and the Stomach 13.3. (Figures quoted are per-centages). 44 The 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 forty-eight cases of pulmonary tuberculosis and forty cases of Non-pulmonary tuberculosis were notified on form A (primary notifications) of these 87 males and 61 females were pulmonary cases, 21 males and 19 females non-pulmonary. In addition, 61 pulmonary cases and 14 non-pulmonary came to our notice as new cases otherwise than by notification. The total number of new cases of Tuberculosis coming to the knowledge of the Medical officer of Health during the year 194P by notification or otherwise was 263, as compared with 279 in 1939, 332 in 1938, 338 in 1937 and 311 in 1936. 209 of these were cases of Pulmonary tuberculosis: 112 in males and 97 in females. There were 28 fewer cases of Pulmonary tuberculosis in males, and 16 more in females, than in 1939. There were 21 cases of non-pulmonary tuberculosis among children under 15 years as compared with 31 in 1939. The number of cases in adults was 33, compared with 27 in 1939. of the cases notified in 1940, 21 males and 10 females died from the Pulmonary form of the disease during the year, equal to 20.9% of those notified, and 7 males and 1 female from the Non-pulmonary form. \ The incidence rate of Tuberculosis of all forms was 1.31 per 1,000 of. the population: for Pulmonary tuberculosis 1.04 and for Non-pulmonary 0.27 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 1939 the corresponding figures were 1.14, 0.91 0.23 and 0.94 per 1,000 Public Health (Tuberculosis) Regulations. 1930. Summary of Notifications during the period from the 1st January 1940 to 31st December 1940:- FORMAL NOTIFICATIONS Number of Primary Notifications of New cases of Tuberculosis Age periods 0 to 1 1 to 5 5 to IP 10 to 15 15 to 2P 2P to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 up Total (all ages) Total Notifications on Form A. Pulmonary males - - - - 14 12 18 17 10 11 5 97 96 " females - l 1 1 8 13 14 11 5 3 4 61 79 Non-pulmonary males 1 2 l 2 3 3 3 2 l 1 2 21 22 " females - 2 2 3 4 3 3 _ 1 - 1 19 19 - 45 - SUPPLEMENTAL RETURN, New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during parrow from the 1st. January, 1940 to the 31st. December 1940, otherwise than by formal notification. Age periods 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45 -55 55 - 65 65 and . upwards, Total Cases. Pulmonary males. - - - - 2 2 8 7 3 _ 25 ,, Females. - 1 _ - - 6 19 4 - 3 3 36 Non-Pulmonary Males. - 2 1 - 1 - 1 1 - 1 - 7 ,, Females. - - 2 3 1 1 - ~ - - - 7 Notification Register. Number of cases of Tuberculosis remaining on the Notification Register on the 31st. December 1940. PUIMONARY. NON-PULMONARY. Total Cases. Males. Females. Total. Males. Females. Total. 527 463 990 104 115 219 1209 CLASSIFICATION OF NEW PATIENTS. PULMONARY TUBERCULOSIS. During 1940,134 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) 53 or 39.5% T.B. plus 1 (early cases, sputum positive) 7 or 5.2% T.B. plus 2 (intermediate cases, sputum positive) 43 or 32.1% T.B. plus 3 (advanced cases, Sputum positive) 31 or 23.1% 134 or 100.0% This is 38 fewer than in 1939. 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 14.0 1938 — 3 22 46 40 8 119 1939 — — 19 44 30 3 96 1940 — 1 18 61 38 10 123 In 1940 the deaf rate from all forms of Tuberculosis was 0.74 per 1,000 population. The rate for Pulmonary Tuberculosis was 0.64 and the rate for Non-Pulmonary Tuberculosis 0.1. Similar figures for 1939 were 0.46, 0.41 and 0.05. - 46 - PULMONARY TUBERCULSIS. In 1940 there were more deaths from Pulmonary Tuberculosis than in 1939, the greatest number occurring in the age group 25-35 years, whereas in 1939 the greatest number occurred in the 35-45 years age group. Apart from the 20-25 and 45-55 age group, there were more deaths in all other age groups than in 1939. In females the highest peak was reached in the 25-35 age group. In males the highest peak was also in the 25-35age group. The number of new cases of Pulmonary Tuberculosis in 1940 in the age groups, 15 to 35 years, was smaller than in 1939s and, as in 1939, the greatest number occurred in the 25-35 group. NON-PULMONARY TUBERCULSIS. The diagnosis of the new cases entered in the notification Register during 1940 were as follows Male Female. Wrist. - 1 Spine. 4 2 Pubic Bone. l - Hip. 1 3 Foot. - 1 Peritoneum. 6 3 Glands. 6 9 Kidney. 4 3 Kidney, Bladder and Epididymis. 1 - Epididymis. 1 - Fallopian Tubes. - 1 Meninges. 4 2 Skin of Tight Buttock. - 1 20 26 DEATHS FROM NON-PULMONARY TUBERCULSIS. During 1940s 21 deaths were certified to be due to nonPulmonary Tuberculosis, compared with 12 in 19395 18 in 1938: 15 in 1937; 16 in 1936. The deaths were due to :- Males. Females. Total Tuberculous Meningitis 4 2 6 Tb. Meningitis.and Miliary Tb. - 1 1 Miliary and Generalised Tb. 1 1 2 Tb. Kidneys. 2 - 2 Tb. Adenitis. 2 1 3 Tb. Spine. 2 - 2 Tb. Spine and Kidneys. - 2 2 lb. Pancreatitis 1 - 1 Tb. Peritonitis. - 1 1 Tb. Enteritis. 1 - 1 13 8 21 - 47 - CO-ORDINATION WITH MEDICAL PRACTITIONERS. AND OTHER BRANCHES OF THE HEAD DEPT. During the year 206 cases of suspected Tuberculosis were referred by private medical practitioners; 41 were diagnosed as suffering from Tuberculosis and were subsequently notified. In addition, 16 children were referred by the School Medical Service, and 25 cases from the Maternity and Child Welfare section of the Public Health Department. 87% of all notified cases were examined at the Clinic or were seen at the request of the medical attendant it the patient's home, as compared with 87% in 1939 83.6% in 1938 87% in 1937, and 78.3% in 1936. The number of reports sent in by Insurance medical practitioners on their domiciliary cases (From G.P.36) was 346. EXAMINATION OF SPUTUM The results of examinations made in 1940 are as follows:- For Clinic For General Practitioners . Totals. positive (i.e., tubercle bacilli present) 378 65 443 Negative (i.e., Tubercle bacilli absent) 710 484 1,194 Totals 1,088 549 1,637 For each 100 new cases and contacts examined at the Clinic, 136 specimens of sputum were examined. 1940 shows a decrease in the number of examinations of sputa made for General Practitioners. It is difficult to under stand why this simple test is not always made in any doubtful chest condition. X-RAY WORK. 694 X-ray examinations were made during the year, a decrease of 35 under 1939. This is equivalent to 86.8 for every 100 new cases and contacts seen, and compares with a rate of 91.1 in 1939. 74.7 1938, 68.4 in 1937 and 56.3 in 1936. 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 May day Hospital EXTRA NOURISHMENT. Provision of special nourishment in the form of milk was granted to.. 95 selected cases for varying periods during the year, and 42 cases were in receipt of extra nourishment at the end of the year . - 48 - -49- INSTITUTIONAL TREATMENT. Pulmonary Cases treated in Institutions 1940. In at 1st January 1940. Admitted during 1940 Discharged during I94O Died during 1940. In at 31st DecemBer 1940. Adults. Adults. Adults. ■ Adults Adults. M. F. C. M. • P. c. M. F. c. M. F. C. M. F. c. Croydon Borough Sanatorium, Cheam. 40 29 - 71 66 - 59 57 - 7 5 - 45 33 - Mayday Hospital. 16 6 - 57 49 3 29 41 3 34 12 - , 2 - Grosvenor. 1 - - - - - l - - - - - - - - Burrow Hill Colony. 1 - 1 - - 2 1 - l - - - - - 2 Brompton - 2 - 8 6 - 8 7 - - - - - 1 - Papworth. 2 - - - - - - - - - - - 2 - - Ipswich Borough Sanantcrium - - 2 - - - - - 2 - - - - - - Croydon Borough Hospital. - - - - 10 - - 9 - - - - - 1 - Royal Chest Hospital. - - - 2 - - 2 - - - - - - - - King George's Sanatorium. 1 - - - - - 1 - - - - - - - - Hill End Hospital. - 1 - - - - - 1 - - - - - - - Evers field Chest Hospital. 2 - - - - - 2 - - - - - - - - National Children's Sanatorium. - - -. - - 1 - - - - - - - - 1 62 58 3 131 131 6 103 115 6 41 17 - 56 37 3 I o m i Non-pulmonary cases treated in Institutions-1940 In on 1st.i Jan.1040. 1 Admitted urine 1940 Disc arged .! during 1940 Died . . During 1940.j In on 31st. Dec.1940 Adults Adults Adults Adults. Adults M. F. c. M. F. c. M. F. c. M. F. c. M F. c Mayday Hospital 2 - 2 5 5 3 2 1 4 4 1 - - 4 1 1 Royal Sea Bathing Hospital 2 4 5 — 1 1 3 6 - 1 - - - - St. Peter's Hospital - - - 1 - - 1 - ~ - _ - - - St.Nicholas Hospital - - 2 - - 1 - - 3 - - - - - Tait Convalescent Home. - 1 - _ - - - 1 - - - - - - - St. Reter's Memorial Home - - - - 1 - 1 - - - - - - - Treloar Cripples' Hosp. - - - - - 2 - - - - - - - - 2 Croydon General Hospital - - - 1 5 2 1 5 2 - - - - - - Pyrford 2 - 3 1 2 4 2 - 2 1 - - - 2 5 Heritage Craft Schools - - 9 - - ~ - - - - - - - 2 Royal National Orthopaedic Hosp. - 1 - - l - - 1 - - - - - 1 - St .Vincent's Ortopaedic Hosp. 1 1 - - - - - 1 - - - - - 1 - Atkinson-M^rle Conv. Hosp. 1 1 - - 1 - 1 - — - - - 1 ~ - Holland Ledge Conv. Home - 1 - 1 - - - - - - - - - - 1 7 7 15 9 15 13 8 16 7 2 1 - 6 5 11 The Immediate Result suits of Institutional Treatment. The immediate results of treatment of patients discharged from residential institutions during the year are as follows- Among the pulmonary cases 30.4% were classified as early cases; the percentage of early cases receiving treatment in institutions was in women 15.7% in men, I4.7% 44.5% of the total cases were intermediate cases, the males showing an excessin this group-24.4% males to 19.5% females- and 25% were definitely advanced. Of the total Pulmonary cases treated in Institutions 73.9% were potentially infectious 98 Males, 85 females and 1 child suffering from Pulmonary tuberculosis were discharged from, or died in, Institutions in connection with the Croydon tuberculosis scheme during 1940. The Tuberculosis Clinic and Home Visiting. The subjoined table gives a summary of the work done in nonnection with the Clinic. 521 new-cases were examined during the year; this is equal to 349 for each 100 deaths from the disease. 159, or 107 for each 100 deaths were found to be definitely tuberculous. The total number of attendances at the Clinic was 4,637. Tuberculosis Officer paid 111 home-visits, and the District Health Visitors 2,470 visits for Clinic purposes. In addition, the Health Visitors made 273 primary visits for the purpose of the Notification Register. The Tuberculosis Officer paid 50 visits to Mayday Hospital, in a consultative capacity, and there examined 221 patients. Patients requiring home nursing or surgical dressings are attended to by nurses from the Croydon Nursing Service, by arrangement with that organisation, and 1,012 such visits were made during the year. Their assistance is a valuable adjunct in the care of domiciliary cases. Contact examination. The contacts of definite cases are urged to attend the Clinic for examination (and subsequent supervision). This is an important preventive measure. During the year 278 contacts were examined, equal to 186 for each 100 deaths, compared with 325 in 1939, or 301 per 100 deaths. Of these 5 were considered to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 18.0 compared with 1.31 Per 1,000 of the general population. Included in the 5 contacts found to be tuberculous are 2 who had been under observation from previous years. 516 appointments for examination were offered to new contacts during 1940 but only 278 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 759. This is equivalent to 3.8 persons per 1,000 of the population. During the year 119 Clinic cases died; of this number 29 or 24.3% were seen for the first time in 1940. - 51 - SUMMARY OF CUBIC STATISTICS FOR 1940. So. of persons on Clinic Register, January 1st 1940 840 "Notified cases examined for the 1st time 61 "Cases sent for an opinion 388 "First attendances, including 51 transfers in 850 "Consultations of T. O, with medical practitioners % (a) Personal. 24 (b) Other. 471 "Visits' paid "by T.O. to homos 'of patients 111 "Visits paid "by T.O. to Cheam Sanatorium ' 1 "Visits paid by T.O. to Mayday Hospital. 50 "Patients examined by T.O. at Mayday Hospital 221 "Visits paid to homes of patients by Health Visitors. 2,743 "Visits paid to homes of patients by District Nurses. 1,012 Attendances of patients at the Clinic- Men 2,011 Women 2,154 Children 472 Total. 4,637' No. of Insured patients under Domiciliary Treatment at end of years Pulmonary 190 Non-pulmonary 12 Total. 202 No. of reports received from Panel Practitioners (G.P.36) 34 6 "Reports forms sent to Panel Practitioners (G.P.36) 701 "Reports received from Panel Practitioners on forms G.P.17 2 "Reports received from panel Practitioners on Forms G.P.35 1 "Reports made to Ministry of Pensions by T.O. on general progress of Tuberculosis Discharged Ex-Service men 22 "cases referred to Light Treatment 3 "Cases referred to Orthopaedic Clinic 15 "Cases receiving extra nourishment at end of year 42 "Social examinations for National Service Medical Boards 162 - 52 - PULMONARY TUBERCULOSIS. Showing the Condition at the end of 1940 of cases discharged from Sanatoria during the years indicated 1936 . 1937 1938 1939 1940 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 32 55.15 1 35 1 =39.37 1 19 25-3% 2 20 = 20.6% _ 6 = 10% 9 112 29.6% 46.2% 29% 20.2% ' 16.2% 6.4% 22.7% Working or Fit for Work 17 18 =31% 29 38 =42.7% . 20 44 % 58.6% 36 44 = 45-3% 1 30 26 = 43-3% 13 170 = 44.0% 43.7% 54% 64.6% 58.8% 59.5% 56.6% Not able to Work - 8 =13.7% 5 16 =17.9% 3 12 1 6% 1 33 = 34% 4 28 = 46.6% 13 97 =25.5% 10% 16.9% 15.1% 25% 34-2 20.6% Left District 19 19 3 30 19 18 11 23 2 15 59 105 Totals. 41 77 43 119 43 93 50 120 36 75 213 181 CHEAM SANATORIUM The Sanatorium is situated at North Che .in, and normally has accommodatior for 93 ndult patients of both sexes.0 Men 53 and Women 40. Owing to the blackout arrangements the number of beds now available is; 48 Men and 37 Women. In-patients on 1st Jan. 1940 Admitted during the year Discharged during the year Died during the year In on 1st Jan. 1941 M F M TP * M M F M F 41 29 71 79 59 69 7 5 46 34 Number of Artificial Pneumothorax cases begun 25 of Refills given 1,736 " of X-ray Screenings1,805 of Films taken 344 " of Sputum tests 807 " of Gas Replacements 5 IMMEDIATE RESULTS OF TREATMENT Group Total number of ca.ses discharged 1940 Quiescent Improved No Material Improvement 1 Died in the Sanatorium Aver age 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 15 18 12 17 1 - - - - - 131 2 1 Class T.B. Plus; Group I 6 4 4 2 2 - - - - - 213 - 2 Group II 29 20 11 5 10 9 2 2 3 - 190 3 4 Group III 9 13 - - 2 2 3 5 4 5 171 - 1 Observation - Non-tuberculous l 2 - - - - - - - - - -- - ' 60 57 27 24 15 11 5 7 7 5 _ 5 8 At the beginning of 1940 there were 70 patients in Cheam Sanatorium. During the year 150 were admitted and 128 discharged, whilst 12 died, thus Living 80 patients in at the end of 1940. There were 8 observation cases sunt in 4 males and 4 females. Of the 4 males 1 was not tuberculous, and of the 4 females 2 were not tuberculosis therefore there wore three observation cases in non-tuberculous cases which are shown above. The 5 that were tuberculous are in with the tuberculous cases and are not shown as observation. Artificial pneumothorax cases discharged but still under treatment, 6 males, 17 females (see above), making total discharges Male3 66, females 74. These Artificial pneumothorax cases only refer to oases discharged in 1940. those discharged in 1939 and still having refills have not been included. - 54 - . A DENTAL TREATMENT FOR TUBERCULOSIS CASES REFERRED TO DENTAL CLINIC SUMMARY OF WORK DONE. Males.-- Females Total Total 1939 Referred from Dispensary. 9 18 27 32 Treatment cases continued from Cheam 2 2 4 9 Attendances. 58 59 117 159 extractions. 31 22 53 117 Fillings. 3 25 28 30 Dressings. - 2 2 | 12 Scalings. - 14 14 15 Hoot Treatments. - - - -- Denture Dressings. 32 19 51 54 Dentures Fitted. 12 7 19 16 "Gas Cases (on the recommendation of Tuberculosis Officer). - 1 1 4 No. of Sessions Treatment: 21 The amount of 16s. was taken in attendance fees during the -year at Lodge Ed. DENTAL TREATMENT CARRIED OUT AT CHEAM' SANATORIUM REVIEW OF WORK DONE Hales. Females. Total. Total 1939 Number examined. 59 41 100 103 Referred Treatment. 44 39 83 91 Treated. 44 39 83 55 Attendances. 226 141 367 324 Extractions 74 66 140 102 Fillings. 102 79 181 ' 146 Dressings. 10 17 27 8 dealings. 31 24 55 48 Boot Treatments. - 4 4 - Denture Dressings. 26 - 26 36 Dentures Fitted. 5 - 5 11 Mandibular Injections. 14 16 30 24 No. of Sessions Treatment 41. - 55 - MATERNITY AND CHILD WELFARE. Notification of Births. Notifications were received from:- Live Births Still Births. Total. Midwives 2345 44 2289 Doctors, Parents & others 755 37 792 3000 81 3081 Maternal Mortality. There were 5 deaths directly due to pregnancy, compared with 4 in 1939. The maternal mortality rate was 1.65 per 1,000 births, compared with 1.16 in 1939. In other words one mother died for every 737 live babies born. The deaths directly due to pregnancy were caused by:- (a) Eclampsia. (b) Operation of removal of placenta for incomplete abortion, performed under gas, oxygen and ether. Septicaemia welchii due to natural abortion. (c) Ante-partum haemorrhage: toxaemia of pregnancy. (d) Cardiac failur: ileus: Caesarean section for malpresentation, persistent transverse lie. (e) Criminal abortion. Puerperal Fever and Puerperal Pyrexia. Forty four cases of Puerperal Pyrexia were notified. This is a rate of 14.5 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. 1214 39.40 In Public Institutions 1439 46.71 Registered Maternity Homes 428 13.89 Still Births. During 1940, 85 still births were registered in respect of Croydon. Of these 40 were male babies and 45 female; 6 males and 2 females were illegitimate. The proportion of still births to living children was as 1 to 36. The still birth rate was 2.8 per cent of the total births. - 56 - The still birth rate, on the same basis as for Infant Mortality, was 27.1 per 1,000 births. OphthaImia Neonatorum. Fourteen cases were notified during 1940. The following, table give's the notifications in Croydon, during the past eleven years No. of cases . 1930 1931 1902 1933 1934 1935 1936 1937 1938 1939 1940 19 14 21 10 13 13 20 21 20 15 14 Rate per'. 1000 births. 5.4 5.6 6.3' 3.2 4.0 3.9 6.2 6.4 6.0 4.5 4.7 Results of Treatment Notifiled Cases treated Vision Unimpaired Vision Impaired Died Removed Remaining , under Treatment etc. At home In Hospital . 11 - .- 1 - 14 7 7 Infant Mortality. The Infantile Mortality rate was 39 per 1,000 live births registered. For the past 5 years the numbers of infant deaths have been 1936, 134) 1937, 195; 1938, 135; 1939, 130; 1940, 116; 77 deaths of infants occurred In Institutions, including Registered Nursing Homes. Among the 116 deaths, 70 occurred in boy babies and 46 girls. Of the births, 1481 were males and 1468 females. The infantile mortality rate for the two sexes was, therefore:- Boys., 47; girls, 31 The rate of infant' mortality amongst illegitimate children. was 57 per 1,000. The .rate; in legitimate children was 3.6 per 1000'. -57- Deaths under one Year, arranged in days, weeks and months. CAUSES OP DEATH 1st day 2nd day 3rd day 4th day 5th day 6th day 7th day lst-2nd wk. : 2nd-3rd wk. 3rd-4th wk. Under 1 month. 1-2 mths. 2-3 mths. 3-4 mths. 4-5 mths. 5-6 mths. 6-7 mths. 7-8 mths. 8-9 mths. 9-10 mths. 10-11 mths. 11-12 mths. TOTAL All Causes (certified 19 7 6 2 2 3 3 6 3 5 56 4 9 7 11 12 4 5 4 1 3 - 116 (uncertified - - - - - - - – – - - - - - - - - - - - - - -- Chicken Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 Diphtheria & Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..1.. .. .. .. 1 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 Convulsion .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. 2 Pneumonia (all forms) .. 1 .. 1 .. .. .. .. .. 2 4 1 3 4 .. 4 2 2 1 .. .. .. 25 Diarrohœa and Enteritis .. .. .. .. .. .. .. .. .. .. .. .. 1 1 3 2 1 .. 1 1 .. .. 9 Gastritis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Syphilis ..| .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Congenital Malformations 2 .. 2 1 .. .. .. 1 1 1 8 1 .. .. 2 .. 1 1 .. .. .. .. 13 Premature Birth 1 4 2 .. .. .. 2 2 1 1 22 .. ] .. .. .. .. .. .. .. .. .. 23 11 Atrophy, Atelectasis, Debility and Rasmus 3 2 .. .. .. .. 1 .. .. .. 6 .. 2 .. 3 .. .. .. .. .. .. .. Injury at Birth 3 .. 1 • • 1 .. • • 1 1 .. 7 .. .. .. .. .. .. .. .. .. .. 7 Other cause s 1 !.. 1 • • 1 3 2 . . 1 9 1 2 1 j 1 .. 5 .. 2 1 .. 2 .. 23 The rate of infantile mortality for England and Wales was 55, and for the 126 large towns,61. For Croydon the rate was 39. An analysis of the above table shows that 16.4 per cent occurred on the first day of life and 18.3 per cent before the completion of the first month. ' x Analysed these deaths were due to hooping Cough 1; Cerebro-Spinal Fever 2; and Tuberculosis(Meningitis) 1. 1 Analysed these deaths were due to Diarrhoea 9; Pyloric Stenosis 1; Intestinal obstruction 1 and Peritonitis 1. - 59 - The following, table gives the causes of death during the first month of life:- 1. COMPLICATIONS OF LAB0TTR Trauma at birth 7 -7 II. FOETAL STATES. Congenital Heart Malformation Other Congenital Deformities Atelectasis etc. 4 4 6 -14 III. PREMATURITY 22 —22 IV. POST-NATAL CAUSES 13 —13 56 Percentage Deaths per Total Infantile Deaths Deaths per 1,000 Births 1940 1939 1940 1939 Premature Births 19.8 23.1 7.8 9.0 Respiratory Diseases (Pneumonia and Bronchitis) 23.3 15.4 9.2 6.0 Infectious Diseases (inc .Tuberculosis.) 3.4 1.5 1.4 0.6 Atelectasis, Debility and Marasmus, 9.5 16.2 3.7 6.6 Diseases of Digestion. Injury at Birth and 10.3 17.7 4.1 6.9 Congenital. 17.2 16.2 6.8 6 .3 MIDWIFERY SERVICE Midwives Acts, 1903 to 1956. Seventy six midwives notified the Local Supervising Authority of their intention to practise within the Borough during 1940. Fourteen ceased practising in the Borough; so that sixty two remained on the Register at the end of the year. All these were trained and held the certificate of the Central Midwives Board. Midwives are compensated if they lose a case through admission to a hospital or maternity home on the advice of a doctor. The sum of £l2.12.0d, was paid out during the year. Confinements attended by Midwives (including Municipal Midwives) Cases attended by midwives alone 1908 61.9% of total. Cases attended by midwives when a doctor was also engaged 792 Cases attended by midwives when a doctor was also summoned 381 TOTAL 3081 The Rules of the Central Midwives board lay down that the Local Supervising Authority must be informed within 36 hours, by a midwife if she has summoned medical help during pregnancy; in a confinement or within 14 days afterwards. The following table gives details of the reasons for sending for medical aid; FOR COMPLICAT IONS DURING PREGNANCY Abortion 10 Other causes 7 Albuminuria 11 28 FOR COMPLICATIONS DURING LABOUR Breech 8 Occipito-Posterior 2 Hand 2 Transverse 1 Undiagnosed 2 15 Delayed Labour Uterine Inertia 4 Prolonged 19 Delayed 8 31 Haemorrhage Aute Par turn 18 ''Haemorrhage" or Post Partum 6 "bleeding" 3 27 Other Causes - Adherent Placenta 1 Illness of Mother 23 Retained Placenta 3 164 Torn perineum 137 FOR COMPLICATIONS DURING PUERPERIUM Pyrexia 7 Pain in, Breasts 3 Pain in legs 8 Other causes 7 Toxaemia 1 26 FOR COMPLICATIONS IN REGARD TO THE BABY Inflammation of Eyes 39 Convulsions 1 Still birth 2 Deformities 8 Feebleness 7 Other causes 38 Premature Birth 4 99 In accordance with Rule 33. of the Central Midwives Board, the following reasons for the discontinuance of breast feeding were received:- -60- Illness of Mother 3 Other causes 5 Insufficient Milk 8 Total16 delete 666 656 Inspection of Midwives. Dr. Jenkin Lloyd, the Inspector of. Midwives, interviewed 14 midwives at the To:-;n Hall. 36 visits were paid by her to the hones of midwives. Doctors' Accounts, under section 14 (3.) of the Midwives Act, 1918. 321 accounts we're receiver, from doctors for services rendered under the provisions of this Section. This compares with 424 in 1939, 388 in 1938, 284 in 1937, 268 in 1936, and 243 in 1935. The total amount of the accounts was £528 2s. 0d. £170 7s. 5d. was ultimately recovered from the patients. In 1939 the amount paid to doctors was £533 4s. 0d. and in 1938 £501 0s. 6d. NURSING HOMES. Maternity . Homes . Other Nursing Homes Combined Maternity and other Nursing Homes Total No. of Homes on Register on 31.12.39. 13 25 8 46 No. of Applications for Registration during 1940 - 2 1 3 No. of Homes Registered during 1940 - 2 1 3 No. of Homes on Register on 31.12.40 9 28 7 44 No. of Beds available 69 338 (a) Mat. beds; 49; (b) Other beds: 48. (a) 118 (b) 386 -61- r THE OBSTETRIC SERVICE m The Obstetric Service has been described in my report for 1938. The following are the statistics for 1940. Since August, 1939 there has been a whole time resident for the Obstetric and Gynaecological Departments in Mayday Hospital. Thore 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 but excluding abortion) the rate for England and Wales for 1940 is 2.16 per 1,000 births. In Croydon the rate was 0.99. In Booked cases treated by the Obstetric Service tho rate for 1940 was 0.78 per 1,000 Hospital deliveries; nil per 1,000 home deliveries and 0.45 per 1,000 over all deliveries. Of the cases treated to a conclusion at the Post Natal Clinic during 1940, 94.7 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 1939 was 97.4. The number of cases delivered of viable babies in Mayday Hospital with a nominal 48 beds, was 816. The number delivered at St. Mary's Maternity Hospital, with 30 beds, was 489. GENERAL STATISTICS, 1940 No. of live births allocated to the Borough of Croydon 2949 " " still " " " " " " " 82 No. of maternal deaths (directly due to pregnancy) 3(exclusive of abor- No. of cases notified as Puerperal Pyrexia 44 tion) No.of Expectant Mothers who attended the Borough Ante Natal Clinics 3257 No. of cases delivered in Mayday Hospital as Booked cases 781 No. of cases delivered in Mayday Hospital as emergency casos 176 Total cases delivered in Mayday Hosp: 957 No. of cases delivered in St. Mary's Maternity Hospital as booked cases 489 No. of cases delivered in St. Mary's Maternity Hospital as Emergency casos - Total cases delivered in St. Mary's Maternity Hospital 489 No. of casos delivered by Municipal Midwives 939 TOTAL 2385 No. of cases admitted to the Puerperal Infection Unit, Borough Hospital and Mayday Hospital Isolation Wards, including 26 from Mayday Hosp. and 2 from St. Mary's Maternity Hospital. 35 No. of Maternal deaths in Booked cases from Borough Ante Natal Clinics No. »f Maternal deaths in Emergency cases at Mayday Hospital 1 (exclusive of abortion) No. of maternal deaths in cases admitted as Puerperal Sepsis per se Total Maternal deaths in beds of the Obstetric Service. 2 (exclusive of abortion) - 62 - The total number of patients treated by the Obstetric Service was: - (a) In Mayday Hospital 1131 (b) In St. Mary's Maternity Hospital 591 (c) In the Borough Hospital Puerperal Infectiop. Unit and Mayday Hospital Isolation Wards, excluding 24 from (a) and 6 from (b) 3 (d) At the Ante Natal Clinics and delivered outside the above Hospitals (including Municipal Midlives cases) 1180 (e) At the Post Natal Clinics, excluding those included in (a), (b), (c) and.(d). 463 (f) At the Ante Natal Clinics and undelivered on December 31st, 1940. 574 TOTAL 3942 ANTE NATAL SUPERVISION 1939 1940 Number of sessions at Ante Natal Clinics held 460 411 Number of individuals who attended 3334 3257 Number of previous year's cases continuing attendance 583 574 Number of new cases 2719 264-2 Number of cases undelivered on 31st December 528 574 Total attendances made 16850 15249 Average attendances per session Number of cases delivered in hospital as Booked 30 37 Cases 1265 1277 Number of cases delivered by Municipal Midwives 394 939 Number of cases delivered at other places under the care of private doctors er midwives (about) 200 200 Number »f patients found not to be pregnant 24 19 Number of patients referred to hospital for Ante Natal treatment. 602 509 The conditions for which these were admitted can be ascertained by reference to the 'Booked' columns of the Numerical summary of Cases. 6 Ante-natal clinics par 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 institutod. During 1940 the Obstetric Scrvice dealt with 2273 out of the total births allocated to the. Borough. Major Ante-Natal Conditions Treated at the Ante-Natal Clinic. Breech Presentation. Breech presentation diagnosed 192 Spontaneous version 15 External version successful 146 External version not successful 28 Allowed to go to term as Breech 12 Not recognised as Breech before Labour 6 Dental Treatment No. of cases referred to Borough Dental Surgeons 556 No. of cases referred to Private Dental Surgeons 89 No. of cases refusing dental treatment 45 No. of cases seen too late for necessary dental treatment 36 Tuberculosis Referred from Tuberculosis Officer because of pregnancy. 6 Referi-ed to Tuborculosis Officer for opinion on lung condition 6 -63 - Venereal Disease Gonorrhoea - Total cases 4 Transferred to Borough V.D.Clinic 4 Syphilis - Total cases 4 Transferred to Borough V.D.Clinic 4 These cases are delivered in Mayday Hospital in Isolation Wards, and transferred to the Borough V.D. Clinic on discharge. Midvwives Casos. These cases may bo summarised as follows Total number of .midwives cases during 1940 241 Number of cases sent for one consultation only 72 Number of cases supervised entiroly 169 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 97 Blood for Kahn Reaction 48 Blood for Gonococcus Fixation Test 40 Blood for Grouping 64 Blood for Culture 13 Blood for Urea Content 52 Blood for Widals 2 Blood for Coll Count, etc. 81 Catheter urine for Routino Examination 533 Urine for Aschheim-Zondek Test 60 Urine for Urea Concentration Tost 432 Lochia for Culture 24 Sputum fox" examination 10 Pus for identification of Organism 17 Urethral smears for Gonococci, etc. 20 Corvical smears for Gonococci, etc. 41 Conjunctival smears 43 Histological sections 101 Van den Burgh 5 Throat Swabs for Organisms 83 Faece3 for Occult Blood etc. 5 Blood for other estimation 8 Blood for Hb Estimation 201 Pleural Fluid 2 Urine for T.B. 1 Cerebro Spinal Fluid 2 Breast Milk 2 Urine for Methaomoglobin 1 - 64 - X-Ray Examinations (Mayday Hospital X-Ray Department) 184 cases were referred from Ante-natal Clinics and 391 films were used. Reasons for reference were:- Breech for attitude etc. 26 For presentation, attitude etc. 52 Twins 50 Foetal death 2 " parts 19 Disproportion 21 Others 14 60 cases were referred from the Maternity and Gynaecological Wards at Mayday and St. Mary's Hospitals and 129 films were used. Reasons for reference were:- For presentation 20 Twin& 1 For foetal parts 6 Foetal death 6 Hydramnios 1 Brecch? Extendod legs 6 Disproportion 6 Hydrocephalus 3 Anenc ephaly 5 Placonta Praevia 6 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 779 489 1268 (2) Delivered in hospital before 28th week 2 - 2 (3) Admitted after delivery 7 - 7 (4) Discharged undelivered after ante-natal treatment and not subsequently delivered in hospital - - - (5) Died undelivered 1 - 1 (6) Ectopic Pregnancy - - — 789 -489 1278 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 11 (b) Delivered in hospital after 28th week. 37 (o) Delivered in hospital before 28th week 137 (d) Died undelivered (2) After Delivery 8 (3) Ectopic Pregnancy 3 Total 196 MUNICIPAL MIDWIVES Cases Attended (including twins) . 827 Maternal deaths nil Maternity Cases112 Medical aid sought 234 Live Birth 940 Ante-natal visits by Still births (3 macerated) 6 midwives 6385 " " clinic attendances 3890 Post-natal " " 552 Further details will be included in the Annual Report of the Obstetrical Service which is prepared as a separate report. - 65 - A Numerical Summary of cases admitted for treatment, delivered in Hospital, or admitted after delivery. Some cases appear in more than one category in the Summary Mayday Hospital Booked Mayday Hospital Emergency St. Mary's Maternity Hospital Booked. Total. 1. Conditions chiefly Ante-Natal. Albuminuria 105 12 75 192 Eclampsia 1 2 - 3 Persistent vomiting of pregnancy 10 - - 10 Chronic cervices 6 - - 6 Acute pyelitis 10 2 9 21 Malnutrition, debility, simple' anaemia, etc. 30 - 6 36 Breech presentation for version 24 - 9 33 Disproportion 68 2 23 93 Retraverted gravid uterus — • 1 — 1 2. Intercurrent Diseases Chronic nephritis 3 - - 5 Pulmonary Tuberculosis 6 - 6 Venereal disease 5 - — 5 Cardiac disease 10 - 2 12 Exophthalmic goitre — — - - 3. Conditions chiefly Natal.- Presentations at Delivery - Anterior positions of the vertex 712 30 438 1180 Posterior positions of the vertex 28 1 1 4 70 Breech 39 7 16 62 Shoulder • 2 1 - 3 Pace and Brow 2 - 1 3 Complex 1 - - 1 Caesaroan section 35 3 . 3 41 Twins 15 - 5 20 Accidental haemorrhage 10 3 3 16 Placenta praevia 13 4 •• 17 Hydramnios 9 1 9 19 Prolapse of cord 3 2 2 7 Retained placejita 4 2 1 36 Post-Partum haemorrhage 23 2 11 36 B.B.A. 7 - 8 15 Lacerated perineum '170 11 187 368 Obstructed labour 4 1 — 5 Prematuro labour 103 14 32 149 Abortion, 8 146 — 154 Ectopic pregnancy 3 3 Abdominal Hysterotomy 2 2 66 A  Mayday Hospital looked Mayday Hospital Emergency St. Mary's Maternity Hospital Booked. Total 4. Conditions Natal excluding re-admissions from Post-natal Clinic. Retroversion 19 2 17 38 Delayod involution 36 4 23 63 Breast abscess 5 - - 5 Notified pyrexia or fever 11 14 x 6 31 In addition 3 cases of Puerperal Pyrexia per se were adultted to the Puerperal Infection Unit of the Borough Hospital. including 13 cases of septic abortion Blood Transfusion, (63 obstetrical and 8 gynaecological cases) For every case, stored blood from the Blood Transfusion School, Sutton, was used. One Mayday Hospital "Booked" obstetrical 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, 1940 21 - 20 41 Total No. of live births, still births and infants admitted with mother (B.B.A) 801 37 494 1332 No. of infants in Hospital on 31st December, 1940. 21 - 17 38 Living-alive on discharge from Hospital. 758 24 484 1266 94.83 Stillborn 31 10 9 50 3.74 Diod (born alive, but died in Hospital). 12 3 4 19 1.42 6V - Infant Feeding ami weight en Discharge from Hospital. In both hospitals normal infants were breast-fed every four hours omitting the early morning food. Of 782 infants discharged from Mayday Hospital, 533 were up to or over birth weight (68 per cent). Of 484 infants discharged from St. Mary's Maternity Hospital, 329 were up to or over birth weight (68 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 j Emergency ; St. Mary's Maternity Hospital Booked. Total. No. of cases 15 - 5 20 No. of Infants discharged alive 27 - 8 35 No. of stillbirths and Infant deaths 3 - 2 5 Foetal and infant mortality 10% 20% 12.555 POST NATAL AND GYNAECOLOGICAL CLINIC. In 1940 68/o of the "Booked" cases delivered in the Hospitals attended the Post-Natal Clinic six weeks after their confinements. This is 13$ less than in 1939. Numbers of Sessions held 101 No. of individuals presented 1303 No. of subsequent attendances 632 Total attendances 1935 Average attendance per session 19 . No. of Post-natal cases 1102 No. of Gynaecological cases 201 END RESULTS. 833 cases were treated to their termination (other than death) during the year, and the results were classed as follows Mayday St. Mary's Total % Health Unimpaired 462 327 789 94.7 Health slightly impaired 20 17 37 4.4 Health seriously impaired 4 3 7 0.8 Totals, treated to conclusion 486 347 833 Maternal Mortality (Obstetric Service) Two deaths occurred of Mothers dealt with by the service; one a Booked case, the other an emergency case. The maternal mortality if "Booked" cases, i.e. cases under the continued supervision of the service, is 0.78 per 1,000 Hospital deliveries, and 0.45 per 1,000 total deliveries including the Municipal Midwives booked cases. - 68 Puerperal Infection Thirty-five cases were treated in isolation for puerperal infection; 6 of them in the Borough Hospital and 29 in Mayday Hospital. There wa3 one death (an abortion). Scurcos of the Cases From Mayday Hospital - Cases Deaths "Booked" Cases 11) "Emergency" Cases 14) 1 From St. Mary's Maternity Hospital 6 From other Hospitals From private doctors, deliveries ) in Nursing Homes 4 From private doctors, deliveries ) at home 21 cases followed labour with no deaths 14 cases followed abortion, with ono death. The 35 cases treated may bo classified as follows (1) Patients with infection of the genital tract 29 (a) Infection limited to uterus, vagina and porinoum 22 (b) Infection involving pelvic cellular tissues, ovaries, Fallopian tubes, pelvic peritoneum or veins. 3 (c) Infection of the birth canal spread beyond the pelvis (general peritonitis septicaemia, etc) 4 (2) Patients with infective conditions not originating in the genital tract 6 The Assistant Medical Officer of Health for Obstetrics was called in by medical practitioners to see 51 obstetrical and 69 gynaecological patients who could not afford to pay a private consultant. In addition, ho was asked by the Medical Superintendent of Mayday Hospital to give an opinion on the obstetric and gynaecological aspects of 24 cases in the medical and surgical wards of the hospital. MATERNITY AND CHILD WELFARE CONSULTATIONS. There are 10 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 23 sessions per week are held, and at these a doctor and nurse on the staff of the Health Department attend. During 1940, 2655 new cases under 1 year of age, and 1104 over a year nf age attended for the first time; the total of attendances of infants and young children from 0-5 years decreased from 79,714 in 1959 to 66,609 in 1940. Consultations with doctors decreased from 21,511 to 21,375; 66 expectant mothers were seen, an Increase of 15 on 1939, and a total of 394 visits to the Centres were paid by them. The total of all visits to the Centres was 67,003ba decrease of 13,216 compared with 1939. The highest average attendance of mothers and babies at each session was recorded at South Croydon (83.8), Municipal (73.4), Woodside (69.7) and Boston Road (68.4). DENTAL TREATMENT - MATERNITY AND CHILD WELFARE PATIENTS. Expectant Nursing Young Children Total 1940 1939 Number examined 378 84 318 780 835 Referred for Treatment 355 71 285 712 736 Attendances 1588 552 715 2855 3323 Fillings 565 92 262 919 853 Extractions 1600 410 766 2776 3913 "Gas'' Cases 249 70 210 529 634 Local Anaesthesia 233 72 30 325 383 Scalings 123 15 1 139 218 Dressings 245 80 75 400 419 Denture Dressings 723 298 1021 1209 Gum Treatment 33 3 1 37 37 Silver Titrate 6 - 121 137 347 Treatments Completed 188 75 247 510 528 Number of Sessions (Treatment) 386½ Inspections at Centres 9 Dentures Fitted: Full 166, "Partial 40 Appointments kept 75% The Centres at which patients were examined, or from which they were referred, are given in the following list:- Ante Natal 367 S. Norwood 66 St. Pauls 15 St. Judes 9 Mun. Midlives 189 The Retreat 6 S. Oswalds 8 Holy Trinity 26 Municipal 49 S. Croydon 18 S. Andrews 30 Addington 15 E. Croydon 38 St. Albans 18 Waddon 34 S. Georges 2 U. Norwood 29 Woodside 26 Shirley 8 W. Croydon 18 Norbury 6 Boston Rd 19 Total 996 The amount received for attendance fees was £70 15s. 0d. as compared with £75 8s. 6d. in 1939. 70 - 71 - ATTENDANCES AT INFANT CENTRES -1940 Municipal Boston Rd. St. Andrews Sth. Croydon Shirley Woodside Lr. Add iscorabe Rd. Sth.Nor- wood We stow St. St.Albans St. Pauls St.Oswald's West Croydon Norbury Waddon Selhurst Addington St.Stophons Total 1939 Total 1940 1 446 135 127 155 135 111 283 203 98 177 98 106 78 122 79 91 134 79 2703 2655 2 5417 1567 1233 2305 1183 1502 2840 2911 1071 2661 1658 1117 1277 1681 1303 1193 1727 651 37615 33297 3 139 72 48 46 34 54 119 78 69 104 46 29 20 66 16 39 80 45 1047 1104 4 2863 1713 1397 1762 907 1818 2499 1826 1412 2430 2005 981 1339 1478 1290 1 1349 2065 419 38349 29553 5. 8865 3487 2805 4268 2257 3485 5741 5018 2650 5372 3807 2233 2714 3347 2688 2672 4006 1194 79714 66609 6 6 2598 1007 935 909 724 1020 1999 2005 1191 1820 1186 864 987 877 863 922 1026 442 21511 21375 7 121 51 51 51 51 150 101 102 51 91 59 51 51 50 48 46 101 29 1038 1155 8 5 — — 1 4 1 2 10 11 1 _ — — — 6 — 25 — 51 66 9 14 2 — 6 6 _ 29 29 33 — — — 37 4 79 30 60 — 454 328 10 19 2 — 7 10 1 31 38 44 1 — — 37 4 85 30 85 —■ 505 394 11 8884 3489 2805 4275 2267 3486 5772 5056 2694 5373 3807 2233 2751 3351 2773 2702 4091 1194 80219 67003 12 1940 73.4 88.4 55.0 83.8 44•5 69.7 57.1 49.6 52.8 59.0 64.5 43.8 53.9 67.0 57.8 58.7 40.5 41.2 58.0 1959 36.1 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 82 .0 56.8 51.7 3*77.3 x Total average attendance each, week at all Centres. ~ Commenced in May 1. New cases under 1 year. 2. No. of re-attendances. 3. Hew oases over 1 year. 4. Ho. of re-attendances. 5. Attendances of children 0-5. 6. Consultations with Doctor. 7. No. of Sessions. 8. Expectant Mothers. No. of new cases. 9. No. of re-attendances. and 10. Total attendances of Expectant Mothers. 11. Total attendances; 12. Average attendance per Session. - 72 - THF WORK OF THE HEALTH VISITORS - MATERNITY AND CHILD WELFARE ONLY C.W R. A M.S A.P A.W E.H A. H C Wa. A. O L.W I.E M.W L.O B.D E.C L.B E.W G.B D.B Others Total 1. 20 9 17 4 5 14 _ 3 3 5 3 10 4 10 9 _ 4 4 2 8 130 2. 8 8 14 2 — 29 — 1 _ 1 9 _ _ 4 13 _ _ 5 __ 3 97 3. 133 79 59 214 219 203 139 94 260 148 71 182 115 229 132 208 1 118 155 218 408 3382 4. 374 268 160 264 458 1042 752 265 880 521 689 623 530 909 358 491 575 873 629 1651 12312 5. 10 _ 1 5 5 14 3 2 21 4 — 4 13 30 11 28 5 4 29 27 216 6. 344 185 204 174 508 773 542 211 887 309 712 377 506 596 227 352 361 537 505 1165 9475 7. 9 _ 4 1 9 2 1 _ 1 3 3 16 33 13 47 4 9 23 25 203 8. 639 459 364 455 1002 1457 691 284 612 710 738 594 520 606 256 705 613 959 413 1458 13515 9. _ _ _ _ 3 _ _ 1 _ 1 _ _ _ 1 _ 1 _ _ _ 1 8 10. _ _ _ _ _ _ _ _ — 2 _ _ 1 _ _ _ _ _ 3 1 10 11. 7 1 _ 4 3 _ _ 1 1 1 2 1 1 6 5 1 2 3 _ 8 47 12. 14 104 3 8 2 6 — 9 1 — 133 — 5 74 1 18 12 29 78 211 711 13.. 2 5 3 3 3 5 _ — 4 5 1 5 2 9 2 4 7 3 1 6 70 14. 16 1 58 9. 7 2 5 5 29 9 19 1 6 15 _ 27 4 4 8 202 448 15. 396 234 653 497 689 452 489 339 446 525 466 635 610 789 586 587 802 754 ???235 1386 11370 1940 1972 1333 1540 1640 2913 3999 2622 1215 3145 2244 2843 2435 2329 3311 1634 2469 2303 3339 2144 6564 51994 1939 1602 955 859 1129 1683 2820 1888 1224 1630 1274 1848 2256 1912 2989 513 1019 1884 1273 1809 1491 40131 "Visits tc expectant Mothers Children 1-2 years Ophthalmia "Neonatorum 13.. House's where deaths 1. First visits 5. First visits 9. First visits of infants occurred. 2. Re-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. R«-visits 12. Milk (Mothers and Children's order) ASSISTED MILK SCHEME Dried Milk Supplied at On Dec.31st 1939 Now cases during the year Cases discontinued On Dcc .31st 1940 Free 532 491 1015 8 Half price 85 79 164 Total 617 570 1179 8 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 great decrease in assisted milk cases following the inception of the National Mil.. Scheme. ASSISTED FLUID MILK SCHEME The amount of milk granted was 118,000 pints. In 1939 it was 228,500. Supplied to Families. No. of Pints, Corporation Liability £. s. d. Milk at half price 6,000 43. 15. 0. Milk Free 112,000 1655. 6. 8. . 118,000 £1699. 1. 8. DRIED MILK (COUPON) SCHEME The amount of dried milk granted free or at half-price was 11,360 packets. In 1939 it was 14,553 packets. No. of Packets. Corporation Liability £. S. D. Dried Milk at Half-price 1,860 201. 10. 0. Dried Milk Free 9,500 990. 0. 0. 11,300 £1,191. 10. 0. DRUGS SUPPLIED UNDER COUPON SCHEME During the year £315. 0. 0d. was spent on drugs. In 1939 it was £303. 2. 7d. - 73 - 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 below. CONVALESCENT HOMES. Total number of children under 5 sent to convalescent homes (all with mothers) 1 Total number of weeks 4 Cnst, £5. 16. 6d. Number of mothers sent for convalescence. 9 uNumber of children under 5 sent with their mothers to cottages. 9 A grant of £500 was made by the Council to the Association for this work In 1940. The year is the financial year ending 31st March, 1940. HOME HELPS From January to December 31st, 415 mothers applied for Home Helps, and 367 were supplied. £360 was collected ' in payment for their services. At the-end of the year there were 30 names of Home Helps on the register. BABIES' HELP REPORT I am indebted to Mrs. Philpott for the following particulars. "At the beginning of 1940 the Babies' Help Committee had seven cases on the books; at the end of the year there were eight cases. During the year 21 Mothers and Babies were helped. The Committee would thank the Health Visitors for their co-operation in this work. - 74 - CROYDON ASSOCIATION OF MORAL WELFARE. This Association has a home for Girls at 54 Morland Road. As the Council now makes a yearly Financial grant of £100 towards its conduction, it is periodically inspected by the Council's Officers. THE CRECHE, WHITEHORSE ROAD. The Council give an annual grant of £300 towards the cost of this Creche. . -A total of 6,623 attendances was recorded. COOMBE CLIFF CONVALESCENT HOME. The following is a summary of the cases dealt with:- Number of cases admitted during the year - 77 Total number of cases discharged - 73 Number of patient days. - 83.6 per patient. AGE GROUPS OF CASES ADMITTED. 0-4 5-8 9-12 Over 12 Total Male 23 6 4 2 35 Female 29 5 8 - 42 Total 52 11 12 2 77 CONDITION ON DISCHARGE. 0-4 5-3 9-12 Over 12 Total. M. F. M. F. M. . F. M. F- M. F. Improved. 17 13 2 5 5 2 — — 24 20 Much improved 8 5 4 3 1 3 — — 13 11 No change. 1 — — — — — — — 1 — Discharged at parent's request etc. — 2 2 — — — — — 2 2 Total 26 20 8 8 6 5 — — 40 33 - 75 - / CHILD LIFE PROTECTION. PUBLIC HEALTH ACT, 1936, PART VII This part of the Act deals with Foster Mothers and Foster Children. The Tables below give figures for 1940. FOSTER CHILDREN No. as at De c. 31st 1939. 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 1940 Parent Another area with Foster Parent Another Foster Mother Public Institution 198 148 100 29 32 12 29 — 9 135 The number of foster-children showed a decrease of 63 during the year. FOSTER MOTHERS No.as at December 31st.1939 Applicat ions for Authorisation during the year. Removals during the year Authorisation cancelled for other reasons No. as at December 31st.1940 With child Without Child 119 45 11 19 107 The number of foster-mothers decreased by 12 during the year. The Health Visitors paid 1,342 visits to foster-mothers for the purpose of supervision. - 76 - - 77 ~ ORTHOPAEDIC DEPAKTMENT. The arrangements are the same as in 1939• Summary of Cases Attending the Orthopaedic Clinic. Jal .1st 1940. New cases, 1940. Cases discharged 1940. Cases on Books Dec, 31st 1940. 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. 164 224 68 108 43 15 8 8 3 264 259 80 456 166 19 603 Cases seen by Orthopaedic Surgeon. DEFECTS. School M.C.W. Tuberculosis. Total. Cases Visits paid cases Visits paid cases Visits paid cases Visits paid. Infantile Paralysis. 13 30 1 2 _ _ 14 32 Curvature or postural defects. 10 28 1 2 — — 11 30 Pes Cavus. 5 11 11 16 — _ 16 27 Pes Planus. 20 39 5 12 — — 25 51 Genu Valgum. 13 23 50 100 — — 63 123 Talipes. 7 20 15 59 — — 22 79 Obstetrical Paralysis. 1 3 1 1 — — 2 4 36A 78A Joint Diseases. 2 10 1 2 17S 31S 56 121 Injuries 2 11 1 4 — — 3 15 Rickets. 1 2 6 16 — — 7 18 Wry Neck. 3 3 3 5 _ — 6 8 Spastic Paraplegia. 9 21 4 5 — — 13 26 Congenital dislocation of the Hip. 6 1 11 3 8 — — 9 19 Other deformities. 19 43 43 75 — — 62 118 111 255 145 307 53 109 309 671 Summarised the Table shows 111 school children attended and made 255 attendances; 145 babies made 3o7 attendances; and 53 tuberculosis cases made 109 attendances; a total of 309 cases, making 671 attendances. The following Table shows the number of cases referred direct from the Orthopaedic Clinic for massage, Swedish Remedial and electrical treatment, and also Xray Examinations at theCroydon General Hospital;- School Cases M. C .W. Cases Tuberculosis Cases Total Defects Cases No. of Treat ment XRays Cases No. of Treat ment xrAYS Cases No. of Treat ment XRays Cases No. of Treat ment XRays Infantile Paralysis 2 58 _ _ — _ _ _ _ 2 56 _ Curvature or postural defect 7 195 1 1 54 1 _ _ _ 8 229 _ Pes cavus l 12 _ _ _ _ _ _ _ 1 12 _ Pes planus 7 76 _ 1 7 _ _ _ _ 8 83 2 Genu Valgum 3 28 _ 2 _ 2 _ _ _ 5 28 2 Talipes _ _ _ 4 175 _ _ _ _ 4 175 _ Joint Disease _ _ _ _ _ _ 20 _ 23 20 _ 23 Injuries 1 _ 1 _ _ _ _ _ 1 _ 1 Rickets _ _ _ _ _ _ _ _ _ _ _ _ Wry Neck 2 1 1 2 13 _ _ _ — 4 14 1 Spastic paraplegia 1 _ 1 _ _ _ _ _ _ 1 _ 1 Cong.Dis. of the Hip 2 _ 2 1 _ 2 _ _ _ 3 _ 4 Other Deformities 5 14 5 8 l 9 _ _ _ 13 15 14 31 384 12 19 230 13 20 _ 123 70 614 48 - 78 - Cases sent. to REsidential Institutions. School Cases. M.C.W. Cases. Tuberculosis cases. Total. ??? OF Institution. No. in on Jan lst 1940 Admitted. Dischared No. in on Jan lst 1940. Admitted Discharged. No. in on Jan 1st 1940. Admitted. Discharged. No. in on Jan 1st 1940._ Almitxed Discharged. No. in. on Jan 1st 1941 Pyrford. - 1 - - 1 - 2A 3S 2A 5S 3A 2S 5 9 5 9 Croydon General Hospital. - 3 3 — 2 2 - 3A 1S 3A 5S - 9 9 - Heritage Craft Schools 1 _ - - - - 2S - - 3 - - 3 Pinner. 3 1 3 2 — - 1A - 1A 6 l 4 3 Lord Mayor Treloar Hosp??? - - - - - - - 1M - - 1 - 1 Royal Sea-Bathing Hospital. - - - — - - 5S 1A 1S 4A 4S 10 2 8 4 Cheyne Hosp. 1 - - - - - 2S - 2S 3 - 2 1 Queen Mary's Hosp - - - - - — - 1S - - 1 - 1 Royal Nat. Orth. Hosp. - 1 l - - - 1A 1A 1A 1 2 2 1 Mayday Hosp. - l 1 _ - - 2A 2S 4A 23 4A 3S 4 7 8 3 5 7 8 2 3 2 25 22 28 32 32 38 26 Conditions for which Patients were admitted to Hospitals with the results of Treatment CONDITION In on Jan 1st 1940. Admitted Or trans ferred Discharged. I.S.Q. Died. In on Jan 1 1941. Arrested uics cent. In proved. Infantile Paralysis. - 1 — — 1 - — — Tubercular Joint Disease. 25 22 7 - 2 1 2 19 Other Joint disease. 1 2 1 - — - - 1 Hemiplegia. 1 - - - - - - — Genu Valgum. - - - - - - - — Pes Cavus. - - - - — - — — Talipes. 1 2 - - — — 1 1 Rickets. - - — — — - - _ Other Deformities. 1 1 — - 1 - — 1 Spastic Paraplegia. 1 - - - 1 - — - Scoliosis. - - _ — - - — _ Injuries. 1 1 1 — _ - - 1 Congenital disease of hip. 1 3 - - - 1 - 3 32 32 9 3 6. 2 3 26 The percentage of arrested ahd.quiescent cases was 60% whilst 30% were "improved". - 79 - MEHTAL DEFICIENCY Number of known Mentally Defective Persons in the DorouMi - 1. Statutory Cases - Aged 0-5 years 3 Aged 5-16 years 117 Over 16 years 407 Total 527 2. Education Cases - Aged 7-16 years 115 Combined total 642 Compared with 1939, the Statutory cases show a decrease of 172 and the Education cases 71. Twelve of the cases under Statutory supervision have died. Five died in an Institution, one under guardianship, two were under observation and four were under statutory supervision. The Statutory cases are distributed as follows: - In Certified Institutions 153 In Approved Hones 2 On leave from Institutions 8 Under Statutory Supervision at Home 242 Under Guardianship 65 In Mental Hospitals 13 Gases under Public distance 6 Observation Cases 38 The Education cases we're distributed as fallows In Certified Residential Schools 10 Iii Certified Duy Schools 74 At Private Schools 3 Awaiting vacancies at St. Christopher's. 28 During, the year the Certifying Medical Officers nade examinations and paid visits to the number of 100 to Statutory cases and 46 tn Education cases - a total of 146, a decrease of 37 compared with 1^39. The Mental Deficiency Visitors paid 1,832 visits to Statutory cases and 746 Education cases, 2,578 visits in all, a decrease of 1,422 on 1938 figures. During the year 48 names have been added to the Statutory List - of whom 16 were notified from the Local Education Authority, During 1340, thirty Statutory cases were dealt with as follows, viz: - Sent to Certified Institutions 7 Placed under Guardianship 4 Sunt to Croydon Mental Hospital 1 Varying Orders - (a) Change of C-uardian 5 (b) From one Institution to another 5 (c) From Guardianship to Institution 5 15 Orders closed 3 30 - 80 - Forty nine Orders were renewed during the year - 13 of which were guardianships. The number of cases sent to Certified Institutions shows a decrease of 4. GUARDIANSHIP CASES There are 65 cases under Statutory guardianship - 36 of these under the care of relatives, and 10 with guardians who are not relations. 9 males and 3 females are at work. 400 visits have been paid to guardianship cases during the year. There are 8 cases on leave from institutions (2 boys and 6 girls) TOWN HALL CLINIC FOR MENTALLY DEFFCTP/T , BACKWARD AND ABNORMAL CHILDREN. 56 children were examined during 1940. The classifications arrived at, together with the recommendations made are summarised as under 1. Certified as Mentally Defective 10 Recommendations- (a) Recommended for Special Day School 6 (b) Referred to Occupation Centre or Institution 4 2. Found to be dull and backward 13 (a) Referred to a Special Class 3 (b) Further trial in Ordinary Class 10 3. Found to be physically defective and to attend St. Giles Sohool 1 4. Physical examinations at St. Christopher's School 10 5. Referred to Child Guidance Clinic 1 - 81 - BLIND PERSONS ACT,1920 . Close co-operation has been maintained with the Croydon Voluntary Association for the Blind. The Blind persons residing in Croydon are now visited at regular end frequent intervals by the Health Visitors and any circumstances in their reports justifying further investigation are followed up. I am indebted to the Secretory of the Voluntary Association for the figures below:- Number of blind on Register 396 Number of blind who benefit from instruction in Braille or Moon t,ype (including those who already read) 89 Number of blind who benefit from past-time instruction 56 Number in remunerative handicrafts (a) Home worker 40 (b) In workshops 4 (c) St. Dunstah's 8 (d) Workers not included in scheme. 17 Home Teacher 1 The Health Visitors paid 577 visits to blind persons during the year. The following table shows : (a) the number of blind persons registered, (b) the ages at which blindness occurred: (c) the method of training: (d) the occupations of employed blind persons: (e) the defective blind: and (f) the unemployable blind persons in homes, mental hospitals of Institutions. - 82 - - 83 - M. - Males. F. - Females. T. - Total. WELFARE OF THE BLIND - REGISTRATION. As at 31/3/41 Age Period 0-1 Age Period 1 - 5 Age Period 5 -16 Age Period 16-21 Age Period 21-40 Age Period 40-50 Age Period 50-55 Age Period 65-70 Age period 70 & over (i)Total of all age Groups (ii)Age unknown. M F T M F T M F T M F T M F T M F T M F T M F T M F T M F T - - - - - - 8 4 12 2 2 4 24 24 48 28 19 47 56 56 112 13 28 41 45 84 129 (i) 176 217 393 (ii) 1 2 3 Ages at which Blindness Occurred. Age Period 0-1 Age Period 1-5 Age Period 5-10 Age Period 10-20 Age Period 20 - 30 Age Period 30 - 40 Age Period 40 - 50 Age Period 50 - 60 Age Period 60 - 70 Age Period 70and over Age Period unknown M. F. T. M. F. T. M. F. T. F. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 23 17 0 6 11 17 11 7 18 13 7 20 14 13 27 28 10 47 21 31 52 20 33 53 19 28 47 6 33 39 16 20 36 Mentally Physically Normal Defective Defective Employed Undergoing Training M. F. M. F. M. F. By Blind Organisations (c) (d) (a) (f) (c) (h) In. Scholls for the Blind 8 3 All others not (a) (b) Professional and Trained But Workshops Home Workers included in (a) and (b) Other Schools M. F. T. M. F. T. Total University Unemployed 11 2 13 27 13 40 M. F. T. Employed Industrial Secondary Not at School 1 14 3 17 M. F. T. M. F . T. M. F. T. M. F. T. M. F. T. 52 18 70 1 1 1 1 (i) No training but trainable - Nil. (j) Unemployable.- M.117 F.196 T.313 (k) Total M.169 F.215 T.384. - 84 - Occupations of Employed Blind Persons Agents,Collectors etc. Basket Workers Bedding (inc luding divans and Ottomans & Upholstering. Boot Repairers Braille Copyists and Proof readers Brushmakers Carpenters and Woodworkers Chairsea.ters Clerks & Typists Coal bag makers Dealers,Tea agents Newsagents, Shopkeepers Firewood workers Gardeners Hawkers, News vendors etc. Home Teachers Slitter: Labourers Massage Mat Makers Ministers of Religion Musicians & Music teachers Netting makers Porters, packers, cleaners Poultry Farmers School teachers Ships Fender (Fendoff) makers Telephone Operators Tuners Weavers Miscellaneous TOTAL Mattress Makers Machinists Upholsterers Hand Machine Within Institution for the Blind 3 1 1 1 1 1 1 3 1 13 In approved Home Workers Schemes 6 1 5 1 11 1 2 1 12 40 Others (not pastime workers) 2 4 1 1 1 2 2 1 1 2 17 TOTAL 1 1 1 1 5 1 4 1 1 1 13 2 4 2 5 1 3 2 12 1 70 (a) Mentally Defective (b) Physically Defective (c) Deaf (i) Deaf Mute(ii) Combinations of (a) & (b) Combinations of (a) & (c) 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 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 3 3 1 2 3 i) 3 (ii) 1 4 1 - 1 - 1 1 - - - - - - 5 7 12 - 1 - - 3 3 6 16 22 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, 1940 of the work carried out by the Sanitary Inspectors and other officers under my supervision. robt. J. JACKSON, Chief Sanitary Inspector. SUMMARY OF INSPECTIONS MADE BY THE SANITARY INSPECTORS, AND OTHER DEPARTMENTAL WORK. Total Ho. of Houses inspected for housing defects (under Public Health or Housing Acts) 3086 No. of houses inspected under the Housing (Consolidated Regulations) 1925 2341 No. of Houses inspected under the Rent Restriction Acts 26 No. of Houses inspected where zymotic diseases have occurred 234 House drains tested with smoke (primary) 824 House drains tested with smoke (on application) 17 No. of smoke tests during repair 193 Inspection of drainage work during construction 3182 No. of water tests during repair197. Final tests of drains after repair 70 Final tests of drains when completely relaid 42 Length of new drains tested yards 1101 Inspection of yards, stables and manure pits 473 " Passages 191 " Public Convenience 3301 " Pigstyes 79 " Tents, Vans, and similar structures " Theatres, Cinemas, Halls, etc. 100 " Ponds and Ditches. 13 " Schools and School Lavatories. 37 " Common Lodging Houses. 17 '' Houses let in lodgings 70 " Premises where offensive trades are conducted. 22 " Gipsj' Encampments, camps, etc. 30 " Cesspools. 23 " Pail closets, privies 13 " Gathering Grounds. 119 Food Control - Visits concerning price lists and orders 4430 " Visits regarding complaints of shortages 271 " " Visits concerning complaints of overcharging 156 " Miscellaneous visits and retail licence applications 2046 A.R.P. Inspections concerning measures for protection against gas contamination. 109 " Miscellaneous inspections and reinspections after air raids 4406 " Inspections of posts and centres 244 " Inspection of damaged houses. 7775 " Inspection of damaged food shops 2016 Smoke Observations 61 'No. of Visits re Infectious Diseases 1164 Inspections of Shops (under Shops Acts) 3974 Special Early Clasing Patrols 400 Sunday Patrols Special Evening Patrols under Shop Hours Act 33 Inspections under Fertilisers and Feeding Stuffs Act 8 " under Pharmacy and Poisons Act 92 " Dairies 126 " Farms and Cowsheds 123 - 85 - Inspections Milkshops 504 " Premises where food is prepared or sold. 5251 " Slaughterhouses. 106 " Factories with mechanical power. 733 " Factories without mechanical power 291 " Workplaces, Public Health Act 307 " Outworkers Premises. 221 Visits re Young Persons Employment Act 65 Baths inspections 9 Water Samples examined 92 Visits to Employers of Outworkers 86 Reinspections of Work in Progress 24269 Sundry Inspections and Visits. 5690 Appointments kept with Owners, builders, etc. 2124 Complaints from public investigated (for purposes other than inspection of House) 4180 Examination of Building Plans. 20 Informal Notices outstanding 31/12/39 1891 " " served. 6454 " "complied 6745 No. of Informal Notices referred for Statutory Orders 575 Informal Notices outstanding, 1025 Statutory Notices outstanding 31/12/39 170 " " served 763 " " complied 712 Total number of complaints received 2200 Interviews with callers 3702 Letters received 4091 Letters end other intimations, etc., sent (not including notices) 2032 Nuisances,'Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1940 and for which action,was taken to enforce compliance (1) NUISANCES AND HOUSING DEFECTS AT HOUSES, Etc. Insufficient means of Ventilation - Defective windows and sashcords 1275 Want of windows or ventilators 12 Conditions causing dampness - Defective roofs 938 " gutters and downspouts 535 " walls, etc 203 Deposits of refuse causing dampness. 4 Want of proper damp proof course 337 Other structural defects - Defective plaster 903 Cleansing.and limewashing required 1213 Defective floors 237 Insufficient ventilation under floor 10 Defective brickwork, cills, lintels, etc. 337 Defective stoves and fireplaces 385 No concrete site under floors Defective drains, sanitary fitting, etc. - Defective sinks and waste pipes 307 Abolition of drinking water cisterns 10 Defective W.C.S. 891 " drainage 358 Stoppage in drains 119 Abolition .of pail closets, privies, etc 1 Soil pipe connected to surface water sower 1 - 86 - Domestic nuisances - Want of Cleanliness 8 Dirty W.C. pans 3 Other nuisances and infringements - Offensive accumulations 56 Insufficient accommodation for sub-tenants. 8 Defective manure receptacles 6 Want of manure receptacles. 3 Defective sanitary conveniences 18 Dirty sanitary conveniences. 6 Smoke nuisances 2 Sundray nuisances or defocts 427 Limewashing of stables 3 Particulars not inserted in Rent Bool: (Housing Act) 704 ” ” ” ” ” (Rent tion Act) 197 (2) factories & WORKPLACES - Want of cleanliness 46 Inadequate ventilation 1 Insufficient drainage of floors Overcrowding Abstract not exhibited 1 Thermometers required 20 Unreasonsable temperature 1 Damp, conditions 1 Defective drains 3 Notices re maximum no required 5 Outworkers registers required 3 W.C.S. Insufficient 6 Unsuitable or Defective 192 Not separate for sexes 3 (3) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924.- Food cupboards defective or required 170 Dustbins required 384 Verminous conditions 82 (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 34 " " repairs of flrs,utensils,fixtures,etc 14 Dirty or defective w.c. accommodation 12 Fd storage accommodation required 2 Animals kept in food store 3 Refuse bins uncovered 4 Accumulation in food store and yards adjacent 23 Food in uncovered vehicles or baskets Food improperly kept or manufactured 6 Promises not suitable for storage or manufacture of food. 6 Want of provision of towels 6 Provision of cloak room accommodation 13 Want of intervening ventilated space to w.c. 3 Fd premises used for sleeping purposes 1 Offal bin required 3 Insufficient or defective sink accommodation and water supply 9 - 87 - {5) INFRINGEMENTS OF PUBLIC HEALTH AT: PAVING, Etc, Defective yard paving 213 (6) INFRINGEMENTS OF SHOPS ACT - Insufficient lighting to w.c. 14 Insufficient or defective w.c, accommodation ??? ??? ??? required ??? Provision of means of heating ??? Unsuitable or insufficient washing facilities 9 Insufficient accommodation for assistants' meals 3 Seating accommodation required for females 1 Assistants Weekly Half-Holiday Notices required,etc 159 Mixed Shop Notices required 43 Hours of employment forms not exhibited or incorrect. 617 Infringements in hours of employment 15 (7) INFRINGEMENTS OF COMMON LODGING HOUSE BYELAWS (8) INFRINGEMENTS OF HOUSES LET IN LODGINGS BYELAWS Defective windows and sashcords 4 Want of food storage accomodation 2 ” ” Artificial lighting to common staircase 1 Cleansing required 7 Provision of balusters to stairs 2 Defective w.c. accommodation. 1 (9) INFRINGEMENTS OF OFFENSIVE TRADE BYELAWSFishfrying premises- Limewashing required 1 Other premises - Dirty or defective w.c. accommodation 1 Cleansing and whitewashing required 3 Dirty or defective yard paving 2 Offal bins required 1 (10) INSPECTION OF AMUSEMENT HOUSES - Defective sanitary fittings 1 W.c. defective 5 W.c. required cleansing 1 Notices to be fixed to door of lavatories 1 (11) KEEPING OF ANIMALS- Nuisances in connection with the keeping of pigs 4 Nuisances arising from the keeping of other animals 6 (12) INSPECTION OF WATERCOURSES,, etc.- Cleansing of watercourses and ponds 2 (13) INFRINGEMENTS OF PHARMACY & POISONS, etc., ACT- Article not labelled in accordance with the Act 4 Nicotine sheds not properly kept 1 (14) INFRINGEMENTS OF FERTILISERS 8: FEEDING STUFFS ACT, Sec.l (1) (11) (15) INFRINGEMENTS OF RAT & MICE DESTRUCTION ACT Infestation of rats on premises where food is prepared or sold - 1 Accumulations of refuse, etc., harbouring rats 13 Structural defects allowing ingress of rats into dwelling houses 6 Dilapidated sheds, etc., harbouring rats 9 Rats in business premises 2 - 88 - (16) INFRINGEMENTS OF MERCHANDISE MARKS ACT & AGRICULTUREL PRODUCE & MARKING ACT - Apples not marked 14 Tomatoes ” ” 9 Eggs ” ” 3 Butter ” ” 1 Currants ” ” 1 Sultanas ” ” 1 Meat ” ” 3 (17) INSPECTION OF SCHOOL LAVATORIES- Defective sanitary fittings 1 (18) INFRINGEMENTS OF OTHER BYELAWS- Noisy animals 9 Noisy instruments 1 Milk bottles on public highway 4 (19) INFRINGEMENTS OP PUBLIC HEALTH (MEAT) REGULATIONS- Carrying meat by meet portor without herd covering 1 (20) INFRINGEMENTS OF FOOD AND DRUGS (ADULTERATION ACT, 1928) Margarine not narked 9 (21) INFRINGEMENTS OF MILK AND DAIRIES REGULATIONS,etc.- Dirty cowsheds or dairies 2 Defective sanitcry fittings 1 Offensive accumulations 2 Pasteurised Milk sold unlabelled 2 SANITARY CERTIFICATES During 1940 requests were made in connection vith 5 houses. The following defects were ascertrined in consequence of these inspections:- Defective gully 1 " downSpout 1 " drains 2 " sanitary fittings 1 " W.C.S. 2 " brickwork 1 " Dampness 1 RENT RESTRICTION ACTS. A number of applications were received for certificates as to the condition of repair of the houses concerned. In 5 instances where the Acts applied certificates were granted. In 2 instances certificates, were given to owners stating that the work had been carried out. HOUSING. Individual Unfit Houses. In the Five Year Plan it was estimated that some 150 individual unfit houses were subject to be dealt with in the Borough. A revised estimate now brings the toal to 247. Up to the end of 1940 205 houses had been approved for demolition and demolition ordershad been made; 173 houses had been actually demolished, the tenants being re-housed, when they desired, by the Council; 691 persons were displaced. Twenty-three houses have been demolished through informal action, 26 persons being displaced. In addition 93 closing orders have been made and 90 parts of houses closed for human habitation; 230 persons being displaced. -89- The following tables give particulars as to housing during 1940 under the headings prescribed by the Ministry of Health:- 1. Inspection of Dwelling Houses during the year:- (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health and Housing Acts) 3086 (b) Number of inspections made for the purpose. 3086 (2) (a) Number of dwelling houses included under the head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932. 2341 (b) Number of inspections made for the purpose 2341 (3) Number of houses found to be in a state so dangerous and injurious to health as to be unfit for human habitation. (4) Number of dwelling houses (exclusive of thosereferred to under the previous sub-head) found not to be in all respects reasonably fit for human habitation 1973 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 1657 3. Action under Statutory Powers during the year. A. Proceedings under sections 9, 10 and 16 of the Housing Act 1936. 1. Number of dwelling houses i.n respect of which notices were served requiring repairs. 370 2. Number of dwelling houses which were rendered fit after service' of formal notices (a) by owners 283 (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. 6 2. Number of dwelling houses in which defects were remedied after service of formal notices (a) by owners 5 (b) by local authority in default of owners C. Proceedings under sections 11 and 13 of the Housing Act.1936 1. Number of dwelling houses in respect of which Demolition Orders were made 2. Number of dwelling houses demolished in pursuance of Demolition Orders. 5 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 2. Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit - 90 - 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. (b)No. of new cases of overcrowding reported during the year. (c) (i) No. of cases of overcrowding relieved during the year, (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. 91 - factories act, 1957. 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 ore nov factories. factories. Inspections Premises. Inspections. Number of Written Notices Prosecutions. factories (with mechanical power) 733 63- - factories (without mechanical power) 291 98 - Other premises under the Act 387 49 - total 1411 210 - Defects Found. No. of Defects Referred to H.M. Inspector. Prosecutions . Particulars. Found Remedied Want of Cleanliness 46 41 _ _ Overcrowding — _ _ _ Unreasonable temperature 1 1 _ _ Inadequate ventilation 1 1 _ _ Ineffective drainage of floors - _ _ _ Thermometers required 20 18 _ _ Sanitary Conveniences- Insufficient 6 4 _ _ Unsuitable or Defective 192 177 _ _ Not separate for sexes 3 _ _ _ Other Offences - (not including offences 13 13 lating 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 let,1937). TOTAL 282 255 Factories Mechanical 716 Non-Mechanical 335 Temporary Factories Mechanical 15 Non-Mechanical 26 Other premises under the Act. Employers of outworkers 30 - 92 - Bakehouses. The control of Bakehouses is dealt with under the Factories Act, the Food Drugs Act and the Public Health Acts,Croydon Corporation Act, 1924 and Cleanliness of Food Bye-lews. For details of Croydon Corporation Act, see under Food Inspection. No. of Bakehouses on Register, 31st December 1940 81 No. of underground bakehouses (included in above) 5 Visits made to bakehouse's during the year 168 Defects found 27 Notices issued and complied with 20 Home Work. Lists of homo workers are sent in twice yearly, and last year contained the names of 149 workers residing within the Borough, 221, visits were paid to outworkers and 86 visits were paid to premises of employers of outworkers to examine lists and for other purposes. Nature of employment of workers on the P.egister,31st December, 1940 Nature of work. No. Outwork in Outwork employed . infected in un- marks premises. satisfactory premises. Making,cleaning altering and repairing wearing apparel. 91 Upholstery work. 14 Lace goods. 5 Other classes of work. 51 TOTAL 161 REGISTERED AND LICENCED PREMISES IN THE BOROUGH, 31st DECEMBER. 1940. Slaughterhouses (not including Public) 3 Bakehouses 81 Common Lodging Houses 2 Houses let in lodgings 60 Dairies and Milkshops 267 Cowsheds 13 Offensive Trades 34 Wholesale, dealers in Margarine etc. 37 Premises registered under Artificial Cream Act, 1929 Premises registered for preparation or Manufacture of potted, pressed, pickled or preserved meat, fish or other food intended for the purpose of sale for human food 142 Premises registered for preparation or sale of ice cream. 279 - 93 - INSPECTION OF OFFICES - PUBLIC HEALTH ACT. During 1940, 146 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. SHOP ACTS. The Shop Acts, 1934, contains provisions for dealing with the health, end comfort of persons employed and also regarding ventilation, temperature sanitary conveniences, washing facilities and the facilities for taking meals in shops. The Shops (Sunday Trading Restriction) Act, 1936, restricts : the sale of certain goods on Sunday, deals with the hours which the assistants have to work and introduces new requirements. The Retail Meat Dealers' Shops (Sunday Closing) Act,1936,prohibits the sale of meat on 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 were carried out. 4414 inspections were made and a number-of infringements wore found as set 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 1s., the cost of a weekly ticket is 6s., for seven nights. The number of men accomodated during the year was 22,630 The number of men lodgers exceeded 62 per night throughout the year. The number of men lodgers exceeded 62 per night throughout the year. The receipts and expenditure for the last ton years are as follows:- Receipts. Expenditure. 1931 £1385 6 4 £1711 19 6 1932 1517 8 4 1547 5 5 1933 1437 2 6 1544 7 10 1934 1469 16 1 1695 8 9 1935 1488 11 5 1420 . 14 9 1936 1446 0 2 1381 19 2 1937 1378 14 8 1348 7 2 1938 1253 2 0 1580 6 5 1939 1284 3 4 1269 0 4 1940 1178 11 10 1059 10 0 2. Private Common Lodging Houses. There are 2 common lodging houses on the register. During 1940 17 inspections were made. Notices were served for the conditions and defects found. - 94 - The following table gives the situation of and the accommodation in the common lodging houses:- Premises. No. of rooms. Accomodation. 11 & 12, Princess Road 10 38 men and women. HOUSES LIP IN LODGINGS,, There ere 66 houses registered under the Byelaws. 70 visits were made for inspection purposes. 16 notices were served for various amendments. 13 notices were complied with. The following table gives the situation of these premises- Road No. of houses let in lodgings. Beulah Grove. 1 Princess.Road. 1 Queens Road, Croydon 2 Ely Road 5 Forster Ropd 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 Belgrave Road 2 Pawsons Road , 1 Windmill Road 4 Heathfield Road 1 St. Peter's Road 2 Alexandra Road 1 Whitehorse Road 2 Grange Road 1 Selhurst Road 1 Wellesley Road 1 South Norwood Hill 1 Sydenham Road 1 notices were served for the conditions and defects found. OFFENSIVE TRADES. Byelaws relating to the Offensive Trades were adopted during the latter prrt of the year 1925. 22 inspections were made of promises 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 30 Gut Scrapers 2 Rabbit Skin Drier 2 Fellnonger 34 - 95 - RAG FLOCK: ACTS, 1911 and 1928, Six samples were obtained and subjected to analysis, the results being as follows:- No. 1 contained 8 parts of Chlorine per 100,000 ,, 2 ,, 9 ,, ,, ,, ,, 3 ,, 14 ,, ,, ,, ,, 3 ,, 7 ,, ,, ,, ,, 5 ,, 15 ,, ,, ,, ,, 6 ,, 12 ,, ,, ,, 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 61 observations were made of factory chimneys for the purpose of detecting offences under the Act. Two notices were sent and amendments carried out to stop the huisance. AMUSEMENT HOUSES. 100 visits were made to theatres, music hells, cinemas and premises where stage plays arc given. Attention was given to the ventilation of the halls, sanitary conveniences, structure and cleanliness of the dressing rooms. A report is submitted to the Licencing Authorities annually. notices wore issued for the conditions and defects found. KEEPING OF ANIMALS. 85 inspections were made in connection with the keeping of animals. There were 4-2 premises including institutions, where pigs were known to be kept in the Borough. 4 notices were served to abate nuisances arising from various causes in connection with the keeping of pigs and 6 notices were served to abate nuisances in connection with the keeping of other animals. BYELAW - NUISANCES FROM DOGS. In connection with the fouling of footpaths by dogs a number of warnings have been given. NOISY ANIMALS BYE-LAW. Action was taken in 9 instances and the nuisance was abated. SCHOOLS. 37 inspections of schools and school lavatories were made during 1940. The water supply in all cases is from the mains. INSPECTION OF WATERCOURSES, ETC. During the year 13 visits were made to ditches, watercourse etc., in order to see whether there were any infringements of the several Acts., etc. - 96 - PHARMACY AND POISONS ACT, 1935. 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 9, and application was node and granted for entry into the list of the names of l0 deputies. In addition, 248 applications were made for the retention of names on the list for a further period of twelve months. Five infringements of the Act were found. FERTILISES AND FEEDING- STUFFS ACT,1936. 8 inspections of premises where fertilisers and feeding stuffs were sold end carried out during the .year, and no infringements of the Act was found. DISINFECTION. The Borough Disinfecting station is situate at Factory Lane. Two steam disinfectors are in use and are supplied with steam from the refuse destructor. A Cleansing Station, consisting of reception rooms, four baths and discharge room, is attached to the Disinfecting Station and is used for dealing with verminous conditions in children and adults. A women attendant deals with school children and women. The following articles were disinfected at the Disinfecting Station during the year:- By Steam 51337 articles. By Formalin gas. 2242 ,, By Formalin spray. 2341 ,, 55920 In addition 474 articles we re destro3red on request. Disinfection after infectious or contagious disease was carried out in 954 rooms at 719 houses 87 hospital. ;Werds. 651 hospital clinic and creche rooms 7 vehicles 3 huts • 1 tent 1743 library and 395 other books 21 rooms Fire Station. 1 factory 1 hall. Disinfecting of bedding and other upholstered goods is carried out for traders who deliver to and collect articles from the station. For this service a charge is made. During 1940, 1304 such articles were disinfected, the receipts for this work amounting to £54. 19. 0. - 97 - DISINFESTATION. In addition to the above services disinfection has been carried out for various services such as report centres,casualty services,engineers' centres,fire services etc., as follows:- Blankets 4951 Pillows 193 Mattresses 491 Cushions 104 Overall sets 10 Disinfestation of furniture etc.,by Hydrogen Cyanide is carried out in certain cases before tenants occupy Corporation houses. Bedding is treated by steam disinfection and delivered in a second van to the house. Forty-four cases were dealt with during the course of 1940 without any ill effects to any person,either householder or operator. A number of notifications we re received from contractors who have been employed by private persons to carry out cyanide disinfestation of houses. Villile the process was being carried 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) Infested 31 (2) Disinfested 21 Number of houses other than Council houses Disinfested Number of houses,other than Council houses disinfested by owners or tenants 82 CLEANSING- OF VERMINOUS PERSONS ETC., During the year 19 adults and 132 children were cleansed for verminous conditions and 97 adults and 201 children for scabies. 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. - 98 - The following is a summary of the visits paid during 1939 under the Rats and Mice (Destruction) Act, 1919. Premises. No. of visits made. No. of poison and other baits laid. No. of Filled. Private houses 763 Butchers 3 Other premises where food is prepared or sold. 1187 87 17 Other premises 76 Total 859 1187 87 FOOD SUPPLY. The supervision and inspection of the food supplies is carried out by eighteen of the district inspectors who are qualified in food inspection. The Public Slaughterhouses are under the control of the Superintendent who also acts under the supervision of the Chief Sanitary Inspector. During the year there were 32,255 animals slaughtered for human consumption. The following table shows the premises in the Borough at which foodstuffs are known to be sold, manufactured or stored:- General Shops 232 Grocers and Provision Shops 762 Greengrocers and Fruiterers 526 Confectioners, Bakers and Pie Makers. 683 Ice-Cream Shops 320 Hotel and Restaurant Kitchens and Dining Rooms 320 Butchers 245 Fishmongers (including fried fish shops) 161 Other food premises. 62 Ham and Beef Shops 93 Sweet Manufacturers 12 3416 In addition to the promises in the above table,there are the following food premises,referred to in other paragraphs of this report:Salughterhouses and dairies,cowsheds and milkshops on the registers. Further,there are a large number of stalls end barrows used for food purposes in different areas in the Borough and forming street markets. There are also barrows and other vehicles which pre used by hawkers,etc., for the selling of foodstuffs,but it is difficult to estimate the actual number in use, as this varies daily. All these barrows and vehicles, wherever found,are inspected by the food inspectors. A watch has boon 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. - 99 - FOOD CONTROL - ENFORCEMENT. The Ministry of Food contribute the sura of £600 per annum for work carried out by the Sanitary-Inspec tors on their behalf, the Chief Sanitary Inspector being the.Chief Food Control Enforcement Officer. During the year the Sanitary Inspectors have carried out the undermentioned visits:- Visits regarding the exhibition of price lists and to advise re Price Control Orders 4430 Visits regarding complaints of shortages 271 Visits regarding complaints of overcharges etc., 156 Miscellaneous Visits including visits regarding applications for Retail Licences 2046 6903 A number of prosecutions were instituted by the Food Enforcement Sub-Committee. 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 finn utilises one building on the premises. Of the twelve slaughterhouses, nine with lairage attached were let on agreement to tenant butchers and the remainder were used for public slaughtering,for which head rate tolls are charged. The above slaughterhouses were taken over by the Ministry of Food early in 1940. The following animals were slaughtered at the Public Slaughterhouses during 1940:- Pitlake. Cattle Calves Sheep Pigs Total 5153 2567 14213 9867 31800 The whole of the meat and offal is examined before it leaves the premises. - 100 - The following meat and offal from the Public Slaughterhouses was condemned and disposed of as salvage by the Ministry of Food during the year 1940. Description. Causes. 63 beef carcases and offals General tuberculosis. 37 beef forequarters Localised tuberculosis. 44 beef parts ,, ,, 38 beef offals, complete Tuberculosis. 658 sets beef lungs Localised tuberculosis. 260 beef heads ,, ,, 211 beef various offals ,, ,, 30 beef heads Actinomycosis. 6 beef carcases and offals Oedema amd Emaciation. 29 beef various parts Inflammatory etc. 847 beef various offals Inflammatory conditions etc. 7 veal carcases and offals General tuberculosis. 12 veal plucks Tubercular 6 veal various offals Tubercular. 6 veal carcases Inflammatory etc. 12 veal various offals,etc. Inflammatory etc. 17 pig carcases and offals General tuberculosis. 2 pig forequarters Localised tuberculosis. 112 pig heads ,, ,, 34 pig plucks ,, ,, 3 pig various offals ,, ,, pig offals, complete Tubercular. 17 pig carcases and offals Swine fever. 11 pig carcases and offals Acute swine Erysipilas. 45 pig carcases and offals Inflammatory conditions etc. 115 pig plucks ,, ,, 506 pig various offals and 34 parts ,, ,, 30 pig carcases and offals Oedema and emaciation 9 sheep carcases and offals ,, ,, 9 sheep parts Inflammatory etc. 154 sheep plucks Parasitical etc. 572 sheep various offals ,, ,, Total weight: 94426½ lbs. PRIVATE SLAUGHTCPJIOIIST]S AI'TD MEAT HTSPT.CTIOIT. Control by the Ministry of Food and centralised slaughtering came into force early in 1940, with the result that private slaughterhouses were closed down and the animals slaughtered etc. consequently reduced in number, The number of animals slaughtered in the Private Slaughterhouses during the part of the year before control was: Cattle Calves. Sheep. Pigs. Total. 5 53 161 236. 455 The following meat and offal from Private Slaughterhouses was condemned and disposed of during 1940. Description Cause. 1 beef liver Parasitical 1 pig carcase and offal General tuberculosis. 2 pig heads Localised tuberculosis. 2 pig plucks Localised tuberculosis 2 pig plucks Inflammatory etc. 3 sheep sundry offals Parasitical etc. Total weight - 136 lbs. - 101 - Total number of animals slaughtered for human consumption in the Borough during 1940:- Cattle Calves Sheep Pigs Total. 5158 3620 14374 10103 32255 Summary of whale carcases condemned with the reasons for such condemnation. Class of Animal. Tuber culosis. Emaciated and Dropsical. atory conditions. Umbilical Pyaemia. Swine Fever. Acute Swine Erysipelas. Swine Enteritis. Jaundice & Emaciation. Septicae ???ia. Putrefaction. Unsound etc. Total carcases. Cattle 63 4 1 - - - - 1 - - - 69 Calves 7 2 2 1 - - - - - 1 - 13 Sheep - 12 2 - - - - - - 1 1 16 Pigs 19 30 41 - 17 11 1 - 2 2 2 125 TOTALS 89 48 46 1 17 11 1 1 2 4 3 223 Carcases inspected and condemned. Cattle Calves Sheep & Lambs Pigs. Number Killed 5158 2620 14374 10103 Number inspected 5158 2620 14374 10103 All diseases except tuberculosis: Whole carcases condemned- • : : 6 6 9 103 Carcases of which some part or organ was condemned. 811 12 734 655 Percentage of the number inspected affected with disease other than tuberculosis. 15.8 0.7 5.2 7.5 Tuberculosis only Whole carcases, condemned 63 7 - 18 Carcases of which some part or organ was condemned 737 18 - 149 % of the number inspected affected with tuberculosis 15.5 0.9 - 1.6 - 102 - 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 nd milkshops):- Butchers 781 Fishmongers 187 Fried Fish Shops 123 Grocers 1170 Greengrocers 611 Poultry and Came Dealers 36 Cooked and Prepared Moat Shops 203 Bakers' Premises 168 Confectioners Premises 622 Markets 219 Hawkers carts and barrows 157 Hotel and other Kitchens etc 359 Ice Cream Manufacturers and Vendors 258 General Shops 295 Other premises 57 5251 GOVERNMENT MEAT DEPOT. All meat supplied to the traders in Croydon passes through the above Depot. Examination is carried out by an Inspector, who is practically engaged full time on this part of the work. The following articles of food were condemned and disposed of during 1940. 81 beef parts and trimmings Unsound. 126 lbs. beef kidneys ,, 195 lbs. beef livers ,, 2974 lbs. beef offals (various) ,, 275 lbs. veal offals (various) ,, 3380 lbs. mutton parts ,, 7 mutton carcases ,, 10319 lbs. mutton offals (various) ,, 4 pork carcases ,, 875 lbs. pig offals (various) ,, 1542 lbs. pork parts. ,, 3572 lbs. bacon and ham. ,, 861 lbs. haddock, cod etc. ,, 92 lbs. butter. ,, 197 tins etc. peas, plums,pineapple etc. ,, 105 tins sardines, salmon etc. ,, 40 tins milk and cream. ,, 355 packets cheese etc. ,, 230 lbs. sweets. ,, 270 lbs. chestnuts. ,, 200 lbs. blackcurrants. ,, 102 lbs. chickens, pies etc. ,, Total Weight 22,523¼ lbs. - 103 - General Summary of Meat and other articles disposed of during the year 1940. Articles Weight in lbs. Remarks. Diseased Unsound Total Beef. 49840 2972 52812 Including 69 carcases Veal. 552 111 663 ,, 13 ,, Mutton. 795 5854 6649 ,, 16 ,, Pork. 9948 4593 14541 ,, 125 ,, Offal 39020 8157 47177 ,, imported offal Fish. - 861 861 Haddock, cod, etc. Fruit. - 200. 200 Blackcurrants. Tinned Goods. - 317½ 317½ 316 tins, 24 jars etc Sundries, - 865½ 865¼ Sweets, Chestnuts, etc. 100155 23930¾ 124085¾ DISPOSAL OF CONDEMNED FOODSTUFFS. (1) Government Slaughterhouse, Pitlake. (2) Government Meat Depot. Condemned foodstuff is dealt with by the Ministry of Food. (3) General Food inspection. Articles of food which have been damaged through enejuy air raids are dealt with through the Salvage Officer, Ministry of Food. Any other condemned foodstuffs which can be safely converted to any other purpose are dealt with by firms specialising in this work. MIIIC Enquiries show that approximately 12,818 gallons of milk are sold daily in the Borough. Of this amount 98y& is bottled, just under 2,'to is loose, which is sold wholesale, and the remaining small portion, namely 4^ 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. MILK AND DAIRIES (CONSOLIDATION) ACT 1915; THE MILK AMD DAIRIES AMENDMENT ACT 1922, THE MILK AND DAIRIES ORDERS, 1926, AND IKE'FOOD AND DRUGS ACT, 1938. Cowlceepers, 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 (1939) 9 ,, added to the register 1940. - ,, discontinued 1940. 1 Net. 8 Cowsheds on register 1939. 15 ,, added to register 1940. - ,, discontinued 1940. 2 Net. 13 - 104 - Number of cows provided for 184 Average No. of cows in sheds 1940. 138 No. of dairies and purveyors of milk on register 1939. 273 No. of dairies and purveyors of milk added to register 1940. 60 No. of dairies and purveyors of milk discontinued 1940. 66 Net. 267 Grand total of cowsheds, dairies and purveyors of milk on register 31st December, 1940. 280 During the year 753 inspections were made of dairies, cowsheds and milkshops. Milk (Special Designations) Order, 1936. The following licences were granted during the year under this order. 1. Producers' Licences to use the designation "Accredited" 3 2. Dealers' Licences to use the designation "Tuberculin Tested" (A) Bottling establishments - (B) Shops. 11 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 (b) Shops. 47 5. Dealers' Supplementary Licences to use the designation:- (a) Tuberculin-Tested 3 (b) Accredited 1 (c) Pasteurised. 2 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 were examined under the Milk (Special Designations) Order, 1936:- Tuberculin Tested Milk Licenced country producers supplying milk to licenced local dairyman. 3 Accredited Milk- Licenced local producers supplying milk to a licenced dairyman - Pasteurised Milk- Samples from licenced dealers. 164 - 105 - The following tables summarise the 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. Present. Absent Present in 1/100 m.l. Absent. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Satisfied test. Tubercle bacillus 3 Bacillus Colli 3 Blood 3 Pus 3 Detritus 3 Methylene Blue Test 3 Total. 3 3 3 3 3 3 The above 3 Tuberculin Posted milk samples contained total bacteria par m.l. as follows Under 5,000 1 Over ,, 2 Under the Regulations Tuberculin Tested Milk shall satisfy a methylene blue reduction test and contain no coliform bacillus in one hundredth of a millilitre. The following tables summarise the results of the bacteriological examinations of Pasteurised Milk Samples during the year:- PASTEURISED MILK (Licences granted under the milk (Special Designations) Order 193 Present. Absent. Over 100,000 per m.l. Under 100,000 per m.l. Present. Absent. Present. Absent. Present. Absent. Tubercle bacillus. 164 Total number of bacteria 3 161 Blood. 164 Pup. 164 Detritus. 164 164 3 161 164 164 164 106 These 164 Pasteurised Milk samples contained bacteria per m.l. as follows:- Under 1,000 3 1,000 - 5,000 17 5,000 - 10,000 29 10,000 - 20,000 37 20,000 - 30,000 20 50,000 - 50,000 16 50,000 -100,000 21 Over 100,000 21 164 Under the Regulations, Pasteurised Milk must not contain more than 100,000 bacteria per iniililitre. PROVISION AS TO MILK SUPPLY. During the year 209 samples of ordinary milk were procured and submitted to examination for tuberculosis in accordance with the Milk and Dairies (Consolidation Act, 1915. These samples were taken as follows:- Samples taken at cowsheds in the Borough 3 Samples in course of delivery from country cowsheds to local dairymen and purveyors of milk in the Borough. 10 Samples taken at dairymen's premises in the Borough. 22 Samples taken in course of delivery by local dairymen or milk sellers on their rounds in different parts of the Borough. 174 209. One sample proved to be tuberculous. - 107 - 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, 1940. 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 1 208 Total no. of bacteria 50 159 Blood. - 209 Pus 209 Detritus 209 Methylene Blue Test. 175 34 1 208 50 159 - 209 209 209 175 34 The 209 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 6 - Kent. - - Surrey - - Sussex 3 1 x Unclassified 200 — X 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. - 108 - BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM There were no samples taken during 1940. FOOD AND DRUGS ACT, 1938 During the year 250 samples of milk and 770 other samples were t a lien. Tnree samples of ice cream were taken during the year. The Public Analyst reports that one sample contained 8% milk fat, two samples contained 11.8% and 8.3% fat other than milk fat respectively. SUMMARY OF SAMPLES During 1940 samples were obtained and submitted to the Public Analyst as follows:- Samples of Total samples Genuine Not Genuine Prosecutions Convictions Cautions Milk 260 235 25 Anchovy Paste 1 1 Arrowroot 8 8 Asparagus 6 6 Aspirin Tablets 10 10 Bacon 7 7 Baking Powder 17 17 Baked Beans 2 2 Beef Sausage 14 14 Beans in Tomato Sauce 1 1 Bitter Beer 3 3 Black Puddings 6 6 Black Treacle 1 1 Bloater Paste 2 2 Bo iled Mutton 1 1 Boiled Sweets 7 7 Boracic Ointment 2 2 Brawn 22 22 Bread 13 13 Breakfast Sausage 6 6 Brisket 2 2 Bun Flour 9 9 Butter 15 15 Candied Peel 5 5 Castor Oil 4 4 Chicken & Ham Roll 3 3 Chicken & Ham Paste 6 6 Chicken Soup 1 1 Cocoa 16 16 Cod Liver Oil 4 4 Coffee & Chicory 20 20 Coffee 7 7 Cooking Fat 17 17 ,, Sugar 1 1 Cookeen 2 2 Cooked Ham 1 1 Collared Head 1 1 Condensed Milk 1 1 Comp. Liquorice Pdr. 1 1 Confection of Senna 1 1 Corned Beef 4 4 Corn Flour 10 10 Crab & Lobster Paste 2 2 - 109 - Total samples Genuine Not Genuine Prosecutions Convictions Cautions. Cream Chicken Soup 3 3 Cream Tomato Soup 1 1 Cream of Tarter 12 12 Currants 8 8 Custard Powder 19 19 Camphorated Oil a 2 Cheese 12 12 Chopped Suet 5 2 3 2 1 1 Demarara Sugar 2 2 Dessicated Coconut l l Dried Apricots 3 3 Dried Fruit 1 l Dried Prunes 1 1 Dripping 13 13 Dry Ginger Ale 3 3 Egg Substitute Pdr 2 12 Elderberry Wine 1 1 Faggots 1 l Fish Cakes 8 8 ,, Fillets 1 1 ,, Paste 8 8 Flaked Rice 1 1 ,, Tapioca 1 1 Flour 8 8 Galantine Beef 1 1 Ginger Ale 1 1 ,, Beer 13 13 ,, Wine 8 8 Gin 3 3 Glycerine 1 1 Golden Syrup 3 3 Granulated Sugar 7 7 Grape Fruit Squash 1 1 Ground Almonds 9 9 ,, Cinnamon 7 7 ,, Coffee 2 2 " Ginger 10 9 1 1 Ground Rica 14 14 Ham-Tinned 1 - 1 1 Ham 5 5 Ham & Tongue Paste 1 1 Honey 11 11 Ice Cream 3 1 2 Jam 17 17 Jellied Veal 1 - 1 1 Lard Substitute 5 5 Lemonade 14 14 Lemon Cheese 3 3 Lemon Crystals 1 1 Lemon Curd 11 11 Lemon Squash 4 4 Liver Sausage 6 5 1 1 Luncheon Sausage 14 14 Lunch Tongue 1 1 Margarine 7 6 1 Meat Paste 2 2 Meat Pies 2 2 Meat Roll 1 1 Mild Beer 3 1 2 2 Minced Beef 3 3 - 110 - Total samples Genuine No t Genuine Prosecutions Convictions Cautions Mincemeat 5 5 Mint Sauce 6 6 Mixed Fruit Drops 3 3 Mullagatawny Soup 1 1 Mushroom Soup 1 1 Mustard 8 8 Oatmeal 6 6 Olive Oil 6 6 Orange Crush 1 1 Ox Tail Soup 3 3 Pearl Barley 7 7 Pepper 6 6 Piccalilli 1 1 Pickled Onions 5 5 P i c kl e d Walnuts 1 1 Pickles 1 1 Plain Flour 4 4 Pork & Beans 2 2 Pork Brawn 2 2 PorK Sausages 6 6 Pork & Veal Sausages 3 3 Grade "3" Preserved Beef Sausages 1 1 Pressed Beef 3 3 Prunes 1 1 Raisin Wine 3 3 Rice 3 3 Rissols 4 Rice Flour 1 1 Rum 2 2 Salmon & Shrimp Paste 3 3 Salmon & Tomato Cutlet 1 1 Sausage, Beef Grade 3"2 2 ,, ,, ,, B 3 3 ,, Breakfast 1 1 ,, Smoked 4 4 Saveloys 3 3 Seed Tapioca 1 1 Self Raising Flour 2 2 Smoked Bacon 2 2 Special Margarine 1 - 1 Sponge Mixture 7 7 Still Lemonade 1 1 Sugar 5 5 Sultanas 2 2 Steak & Kidney Pie 1 1 Sherbert 1 1 Shredded Beef 1 1 Syrup of Figs 1 1 Table Jellies 6 6 Tapioca 8 8 Tea 7 7 Tinned Beans 1 1 Tinned Soup 1 1 Tinned Peas 7 7 Tincture of Iodine 1 1 - Ill - Total samples Genuine NOt Genuine Prosecutions Convictions Caution Turkey & Tongue Paste 1 1 Vanilla Bun Flour 2 2 Veal & Ham Sausage 2 2 Veal & Hem Pie 1 1 Vinegar 1 1 Wafer Oats 1 1 White Pepper 3 3 White Bread 1 1 Whiskey 4 3 1 1 1030 991 39 2 1 10 Result of Analysis of New Mil- Samples SOLIDS NOT FAT (Legal standard is 8.5%) 8.1 8.3 8.4 8.5 8.6 8.7 8.8 8.9 9.0 9.1 0.2 1 6 18 31 57 87 45 6 5 3 1 MILK FAT (Legal standard is 3%) 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 4.2 4.7 2 6 25 47 42 35 40 27 22 8 3 1 2 Total samples of new milk 260 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 dairy- (men 6 On milk rounds 130 "Appeal to cow" samples - At shops 112 Taken at Institutions 9 Taken at farms 3 Other samples 260 AVERAGE C OMPOSITION OF NEW MILK SAMPLES Solids not fst 8.65% Milk fat 3.49% Pare ant age of new milk samples below legal standard 9.61 - 112 - Adulterated samples. The following is a detailed statement of the adulterated samples and the action taken:- No. Sample Adult.eraticv; of Remarks 537 Milk 1% deficient in milk solids ) other than milk fat ) Further samples taken proved genuine 598 Milk do. ) 741 Milk do. ) 851 Milk do. ) 864 Milk do. ) 872 Milk do. ) 857 Milk 3% added water These samples were from the wholesale section of a large combine. Subsequent samples proved genuine 1174 Milk 1% do. 1183 Milk 1% do. 800 Milk l% do. 45 Milk 2% do. 113 Milk 1% .do. 119 Milk 2% do. 1081 Milk ½ of 1% do. 1085 Milk l% do. 640 Milk l°/o deficient in milk solids other than milk fat Further samples taken proved genuine. 78 Milk 4% do. These samples were from a local producer. A cow in the herd was found to be giving milk deficient in fat. Further samples taken from this source proved to be genuine 79 Milk l% do. 626 Liver sausage Sample contained sulphur dioxide 210 parts per million Vendor's explanation accepted. 780 Chopped suet Contained: Beef fat 82.9% Fine & Costs £3. 16. 0. Rice flour 14.7% Moisture 2.4% 761 Chopped suet Contained: Beef fat 86.9% Case dismissed with costs against the Corporation Rice flour 11.2% Moisture 1.9% 1189 Chopped suet Contained: Beef fat 86.3% Vendor warned. Rice flour 11.5% Moisture 2.2% 76 Jellied veal Contained Sodium Nitrate 700 parts per million Manufacturer's explanation accepted. 130 Tinned ham 35% ham, 45% breed, 20% excess water. do. 164 Special Margarine Contained Borax Borax subsequently found to have been added under Licence. 598 Margarine As above 169 Ground Contained Sulph. Diox. Manufacturer's explanation accepted. Ginger 170 parts per million 598 Whiskey 35.5 Under proof. Vendor warned. - 113 - 586. Mild Beer Lead was found to be present in these two samples The two licensed houses concerned had new beer pipes fitted. Further samples were taken when the installations were completed and these samples were found to be genuine. 588. Mild Beer Public Health (Preservatives, etc in Food) Regulations, 1925 to 1927. During the course of inspections of food shops particular attention is paid to the above Regulations regarding the marking of foodstuffs to which the Regulations apply. - 114 - COUNTY BOROUGH OF CROYDON. A NNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE YEAR ENDING DECEMBER 31ST, 1940. Ladies and Gontlomon, I have the honour to present to you my thirteenth Annual Report on the work carried out by the School Medieal Service. The report has been drastically ourtailed, though the work has been continued upon "the same basis as has been shown in pre-war reports. In order that continuity should not be broken full statistics are being kept, but only the more important Tables are now included in tho report, whilst letterpress has been reduced to the minimum consistent with retaining readability. Owing to the requirements of H.M. Forces changes have oc«ured in staff and at times, owing to pressure of other duties, the department has been hard pressed. I rnsh to renew my thanks to them for the manner in whi«h they have overcome difficulties. To the members of the Education Committee and to the Eduoation Officer and his staff I am grateful for the ready advice and co-operation I have at all times reoeived. Yours faithfully, OSCAR M. HOLDEN. School Medical Officer. 3 Cost of the School Medical Sorvico. The gross cost of tho nodical, dental and nursing services was £11,842; fron this an incor.io of £5-17 should be deducted, making a nett cost of £14,295. The rateable Ttrilue of the Borough in 1940 was £2,483,476. The Government grant is 44.15 per cent, of the expenditure, hence the actual cost to the rates was £7984, i.e. a rate of 0.84 pence. The figures do not include £300. for Medical Inspection (Higher Education) and for Blind Persons £317 nett. Cost of Special Schools Schools maintained by the Council, £8060; Contributions to schools under other authorities, £5028, Loans charges, £1565, Other expenses (travelling ctc.) £26. Income from parents' contributions and otter receipts £532, giving an actual cost of £14,147 of vihicli £7,902 was payablo out of local rates, giving a rate of 0.83 ponce. Cost of Milk and Meals Milk and meals cost £1276. 13. 4; wages, fuel, printing etc., £619. 0. 6$ income from parents' contributions, £32. 16. 2j giving an actual cost of £1,862. 17. 8. There has been a slight increase in the cost of the actual medical services rendered in the Public Elementary Schools from 0.67 in 1939 to 0.84 of a penny rate in 1940. The cost of maintenance in special schools has decreased from a rate of 0.87 to 0.83 pence. The cost of milk and meals has decreased by £1,370. 9. 3. School Population. No. of Departments. Average No. on the Registers. Average attendance. Average attendance % Senior Boys. 6 C. 1221 1088 90 1 N.P. 228 209 91 Senior Girls. 7 C. 1153 1028 89 1 N. P. 37 36 97 Senior Mixed 9 C. 1699 1496 88 4 N.P. 628 524 83 Junior Boys 5 C. 913 828 97 - N.P. Junior Girls 7 C. 1429 1270 89 1 N.P. 50 44 88 Junior Mixed 14 C. 2826 2424 86 4 N.P. 437 378 86 Infants 14 C 1776 1478 63 3 N.P. 152 109 72 Schools— Church of England 10 1532 1300 85 Roman Catholic 2 Council 32 11017 9612 87 TOTAL 44 12549 10912 86 Medical Inspection in Schools. total of 3969 children were examined as compared with 4908 in 1939, and 2840 parents attended the examinations. The percentage attendance of parents in the Entrants' group was for boys 82.7 per cent and girls 83,5 per cent; in the Intermediate Group, boys 77.5 per cent, girls 76.8 per cent; and in the Leavers' group boys 36.3 per cent, girls 61.6 per cent. 4740 re-inspections were made as against 17,109 in 1939 and 12,039 in 1938. The total percentage of parents attending was 71.6, as against 73,3 last year. 2 PARENTS PRESENT 1940. ENTRANTS INTERMEDIATE LEAVERS OTHER AGES No. Exmnd. Parents Present No Exmnd. Parents Pres. No. Exmnd. Parents Pres. No. Exmnd. Parents Pres. M F M F M F M F M F M F M F M F Addington - - - - - — - — — - — — — — — — Ashburton - - - - 14 10 11 9 7 19 1 16 — — — — Benson 21 32 20 32 11 8 12 8 - — — — — - - — Beulah 87 71 58 62 - 66 - 49 - — — — - — — — Croy. British - - - - - 17 - 9 18 25 8 16 — - — — Cypress 26 24 23 20 - 9 - 9 - — - - — - — — Davi dson 37 32 33 27 - 41 - 28 44 45 13 26 — - - — Duppas 9 16 3 13 38 14 31 13 20 25 13 19 - - - — Ecclesbourne 23 20 19 16 12 4 7 3 - 20 — 3 - - — — Elnwood 45 32 37 28 25 25 20 12 51 34 17 27 6 5 4 - Gonville 24 13 23 12 - - - - 19 9 16 9 — — — — Howard 6 6 1 6 33 42 22 23 — — — - - — — — Ingram 15 - 11 - - 1 - 1 40 26 15 19 - — — — Kensington 15 15 15 15 25 27 22 25 - — 1 - - — — — Kingsley 23 13 22 16 18 32 19 29 12 25 11 11 - — — — Lanfranc - - - - - - — — 41 64 12 41 — — — — Monks Orchard 17 18 16 18 15 9 15 8 - — - - — — — — New Addington 26 15 21 14 28 37 23 31 18 6 5 3 - — — — Norbury Manor 45 32 45 19 21 7 12 6 30 24 9 9 — 18 — 16 Oval 24 23 15 15 10 14 9 10 - - — - - — — — Portland 11 13 10 12 - — — - 48 21 13 9 - — — — purley Oaks 50 28 33 18 6 16 5 13 12 8 6 3 2 1 — 1 Rockmount 3 15 7 12 25 29 19 23 20 15 12 8 — - — — S. Norwood 37 58 28 48 37 — 25 - — - — — — — — — Sydenham 44 35 42 34 21 27 19 20 - - - — — — — — St- George's Hall 10 12 9 - - — - - — - — — — — — Tavistock 25 15 22 15 - — — - 41 46 5 25 — — — — Waddon 8 6 8 6 4 5 4 5 63 42 23 33 — — — — W. Thornton 49 37 38 33 23 25 13 20 - — - — — — — — Whitehorse 34 31 28 29 - 50 - 40 49 25 20 22 — — — — Winterbourne 30 59 30 35 40 - 33 - - 1 — — — — — — Wood side 8 9 7 8 - 36 - 25 - — — — — — — — All Saints 10 7 8 7 6 3 6 3 11 12 6 8 — — — — Arch.Tenisons - - - - - - - - - 43 — 31 — — — — Christ church 19 18 19 17 11 9 8 9 - — - - — — — — Holy Trinity - - - - - - - - — - — — — — — — Parish Church 26 25 21 17 31 — 19 - — 12 - 4 — — — — St .Andrews 7 11 6 8 17 6 9 3 11 10 2 4 6 7 4 5 St.Josephs - - - - - — - - — — — — — — — — St. Marks 14 18 10 14 - - - - - — — — — — — — St .Mary' s 15 6 10 5 11 16 8 12 12 8 — 2 — — — — St, Peters 19 19 13 14 - — — — — — — — — — — — St. Saviours - 13 - 7 - - - - - — - — — — — — Shirley 15 15 14 15 15 14 14 14 — — — — — — — — 886 810 733 676 497 599 385 460 567 566 207 348 14 31 8 23 1,696 1,409 1,096 845 1,132 555 45 31 Entrants Boys 82.7 Girls 83.5 83.1 Intermediate Boys 77.5 Girls 76.8 77.1 71.6 Leavers Boys 36.3 Girls 61.6 49.0 Other Ages Boys 57.1 Girls 74.2 68.8 3 FINDINGS AT ROUT 1MB MEDICAL INSPECTIONS. Uncleanliness. At the primary inspections vermin were found in 47 and nits alone in 1,154 children. On these inspections, 3.7 per cent of the children showed evidence of infestation as against 2.9 per cenb in 1939 and 3.4 in 1930. Tuberculosis in Children of School Ago. Contacts among school children kept under supervision during 1940:- No. of cases under observation at beginning of 1940 331 No of cases added during year 18 " " " discharged from observation during the year 11 No of cases under observation at the end of 1940. 338 Talcing the total school population as 12,549, the Tuberculosis Mortality rate was 8.0 and the incidence rate 15.9 per 100,000. For non-pulmonary Tuberculosis the mortality rate was 15.9 and the incidence rate 63.7. Intermediate Leavers Total Extent of Defect Boys Girls Boys Girls Boys Girls No. % No. % No. % No % % % Normal R 1 477 96.0 580 96.8 5 37 94.7 530 93.8 95.3 95.4 6/6ths or 6/9ths L 478 96.2 577 96.3 544 95.9 529 93.6 96.0 95.0 6/l2th or 6/24ths R 15 3.0 18 3.0 27 4.8 27 4.8 3.9 3.8 L 16 3.2 21 3.5 21 3.7 29 5.1 3.5 4.3 5/36ths or worse R 5 1.0 1 0.2 3 0.5 8 1.4 0.8 0.8 L 3 0.6 1 0.2 2 0.4 7 1.3 0.5 0.7 TEETH. Entrants Intermediate Leavers Boys Boys. Girls Boys Girls No• % No. % No. % No. % No. % No. % Perfect set of teeth. 605 68.3 557 68.8 376 75.7 419 69.9 459 80.9 474 83.9 One to four decayed 161 18.2 129 15.9 79 15.9 101 16.9 80 14.1 66 11.7 Four or more decayed 120 13.5 124 15.3 42 8.4 79 13.2 28 5.0 25 4.4 Totals 886 810 497 599 567 565 4 5 HEIGHTS AND WEIGHTS. 1940 BOYS GIRLS Year of Birth No. examined Average height in inches. Average weight in lbs. Average max. height in inches. Average min. height in inches. Average max. woight in lbs. Average min. | Weight in lbs. No. Examined. Average height in inches. Ave rage Weight in lbs. Average max. height in inches. Average. min height in inches. Average max. weight in lbs. Average in. Weight in ibs. The falling statistics give a summary of the findings:- 1535 325 43.4 43.5 45.7 41.2 49.0 3.81 274 2.3 42.5 45.4 40.5 48.5 39.1 1934 414 45.2 46.7 48.0 42.5 53.8 39.7 363 44.9 45.4 47.4 42.7 51.6 39.0 1933 149 46.3 49.9 49.5 44.3 56.2 42.7 157 47.2 49.1 49.1 44.4 56.7 41.9 1932 233 49.8 56.9 52.3 43.9 65.2 48.6 262 49.2 53.6 52.2 46.7 62 .6 45.5 1931 226 50.1 5 9.9 54.8 48.5 71.8 51.3 284 50.9 58.4 54.2 48.3 72.9 50.6 1930 62 50.1 65.2 56.3 50.6 75.1 54.9 79 52.8 63.0 55.6 50.3 75.0 52 .3 1929 44 54.6 73.7 57.5 52.2 89.0 62.9 75 54.8 73.1 59.7 50.9 93.8 59.2 1928 103 56.8 81.4 60.3 54.2 101.8 66.2 56 57.1 78.3 62.5 53.2 99.4 61.3 1927 411 58.7 86.3 63.9 54.1 112.0 68.7 307 60.1 92.1 63.4 55.2 123.3 69.1 1926 72 60.4 96.3 64.6 55.6 115.5 75.6 71 60.7 96.1 62.9 57.6 114.6 81.6 1925 1 60.0 97.0 — — — — 3 60 • 4 105.5 — — — — SUMMARY OF FINDINGS AT ROUTINE EXAMINATIONS (percentages) Condition Entrants Intermediates Leavers Other Ages All GrOUpS Boys Gls. Boys Gls. Boys Gls. Boys Gls. Bays Gls. Cleanliness; (percentage clean) Head 99.9 99.4 99.6 98.3 99.6 98.6 100.0 100.0 99.7 98.9 Body 99.0 99.7 100.0 99.7 99.8 99.6 100.0 100.0 99.8 99.7 Clothing (satisfactory) 99.9 99.4 100.0 99.8 97.7 99.6 100.0 100.0 99.3 99.6 Footgear (satisfactory) 100.0 99.3 99.6 99.8 97.7 99.8 100.0 100.0 99.2 99.6 Nutrition (Normal) 83.7 87.9 88.1 89.0 92.9 91.9 92.9 77.4 87.6 89.2 Defects. Circulatory System 7.9 7.5 7.2 6.0 6.3 8.0 7.1 9.4 7.3 7.2 Pulmonary Sj^stem 5.9 2.6 1.8 1.0 0.9 0.7 - - 3.4 1.5 Skin Disease 3.0 2.8 2.0 2.2 2.8 1.9 - - 2.7 2.3 Defects of Nose & Throat 29.1 24.8 16.1 16.9 13.8 9.0 7.1 9.4 21.2 17.8 Enlarged Cervical Glands 16.1 12,1 12.9 8.2 8.6 5.0 - - 13.0 8.7 External Eye Disease 1.5 2.2 3.6 1.7 2.1 1.6 - - 2.2 1.8 Defective Vision 1.0 1.4 6.6 5.3 7.9 7.6 7.1 3.2 4.5 4.3 Defective Hearing 0.1 0.1 0.8 0.5 1.2 1.2 - - 0.6 0.5 Speech Defects 1.4 0.7 0.4 0.2 0.4 0.2 - - 0.8 0.4 Dental Disease (more than fear decayed) 13.5 15.3 8.4 13.2 4.9 4.4 – – 9.7 11.4 Null and Backward 0.2 - 2.0 1.0 1.8 0.4 - - 1.1 0.4 Taking ail the groups examined subnormal nutrition was recorded in 11.5 per cent of the children as contrasted with 11.2 per cent in 1939. CHIEF CAUSES OF EXCLUSIONS FROM SCHOOL. Condition Exclusions during 1940 Percentage of total exclusions Exclusions during 1939 Percentage of total exclusions. Ringworm - Head 4 0.14 1 0.0-2 " Body 2 0.07 23 0.36 Verminous Conditions 1672 58.40 997 15.51 Impetigo 83 2.90 317 4.93 Scabies 127 4.44 141 2.19 Scarlet Fever 82 2.87 128 19.9 Measles (inc. German) 461 16.10 621 9.66 Diphtheria 39 1.36 141 2.19 Whooping Cough 25 0.87 634 9.86 Chicken Pox 91 3.18 1298 20.12 Mumps 42 1.47 434 6.75 Tuberculosis (all forms) 6 0.21 16 0.25 External Eye Disease 40 1.40 831 12.93 Sore Threat 37 1.29 235 4.84 Other Causes 141 4.93 618 9.60 Cerebro Spinal Meningitis 11 0.38 2855 ... 6435 ... The figures for exclusions are not related in any way to the figures obtained in routine medical inspections. 6 CIULDRM EXAMINED UNDER EVACUATION PLAN IV & V Total number of children examined 4,874 ,, ,, ,, ,, conditionally Fit 669 ,, ,, ,, ,, Unfit 30 ,, ,, ,, ,, Fit 4,175 MALNUTRITION 6 UNCLEANLINESS- Head 206 Body SKIN DISEASE 42 EYE DISEASE- Defective Vision 33 Squint – External Eye Trouble 8 EAR DISEASE- Deafness 1 Otitis Media - Other Disease 3 NOSE AND THROAT- Enlarged Tonsils only 6 Adenoids, only. - Enlarged Tonsils and Adenoids 15 Other Conditions 8 Enlarged Cervical Glands(not T.B) 2 DENTAL DEFECTS 236 SPEECH DEFECTS 1 HEART and CIRCULATION- Organic 5 Functional - Anaemia 4 BRONCHITIS 5 OTHER NON—T.B. 7 PULMONARY TUBERCULOSIS 1 OTHER TUBERCULOSIS 7 NERVOUS SYSTEM DISORDERS (including Epilepsy, chorea,etc.) 9 DEFORMITIES- Rickets - Spinal Curvature 2 Others 10 OTHER DEFECTS and DISEASES. 105 7 8 CONDITIONS NOTIFIED BY TEACHERS fflD SCHOOL INQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS Name of School School Population0 Measles Whooping Cough Chicken Pox Mumps Scabies Impetigo Sere Throats Ringworm (Body) Ringworm (Scalp) Indefinite Sickness. 111. Not Infectious Conjunctivitis Scarlet Fever Diphtheria Ac. Primary Pneumonia German Measles Cerebro Spinal Meningitis Percentage incidence of In- fectious Diseasea In Schools. Ashburton 371 1 - 4 - 1 - - - - - - 1 5 - - 2 1 2.9 Benson 177 - 1 1 - 2 - - - - - - - 1 - - 2 - 1.7 Beulah 462 - - 2 - 4 2 - - - 4 9 2 2 2 - 20 - 1.3 Croydon British 75 - — - - - - - - - - - - - - - 2 - - Cypress 123 - 6 2 - - - 3 - - - 1 - 10 1 - 1 - 14.8 Davidson 366 1 6 - 2 10 6 - - - - 5 - 5 - - 34 1 4.1 Duppas 185 - 1 1 - 5 1 - - 1 3 - 1 - 7 - 17 - 4.9 Ecclesbourne 266 1 - - - 5 2 1 - - - 1 - 2 2 - 16 - 1.9 Elmwood 632 1 - 14 - 6 4 5 1 - 10 5 - - 1 - 20 - 2.5 Gonville 165 _ - - - 1 3 - - - - - - 2 2 - 14 - 2.4 Howard 131 - - - - 1 1 - - - - - - 1 - - - - 0.8 Ingram 311 2 - - - 4 - 2 - - 1 2 1 - - - 13 - 0.6 Kensington 129 1 - - - - 1 1 - - 1 - - - - - 2 - 0.8 Kingsley 317 - - - - 10 2 - - - 2 - 2 4 2 - 14 - 1.7 Lanfrane 380 - - - - 2 1 4 - - - 1 2 1 1 - 8 - 0.5 Monks Orchard 135 26 - 14 - 2 1 - - 1 1 - 1 1 - - 7 - 30.4 New Aldington. 230 - - - - - - - - - - - - 2 - - - - 0.9 Norbury I.Ian or 471 - 1 2 - 3 4 - - - 1 1 - 3 - - 16 1 2.1 Oval 333 1 - 3 12 2 4 - - 1 9 5 2 - 3 - 21 2 6.2 Portland 311 1 - - 1 - 7 1 - - 2 - 3 2 2 - 4 - 1.6 Pulley Osks 259 - - 16 - 6 8 4. - - 2 1 - 1 1 - 16 - 8.9 Rockmount 1 - - - - 2 2 - - 2 3 - 2 3 - 13 - 1.6 South Norwood 427 1 7 11 3 10 6 - - - 9 3 1 3 - - 3 1 5.7 Sydenham 352 18 - 5 1 7 7 - - - 6 2 - 6 1 - 13 - 8.4 Tavistock 1 _ - - 5 1 - - - 4 1 2 2 - - 9 - 1.1 Waddon 281 - - - 1 10 1 - - - - - 1 1 1 - 7 - 1.1 -9- West Toraton 382 - - 2 - 6 3 4 - - 3 3 4 - 2 - 12 - 1.0 Whitehorse Manor 445 1 - - - 7 3 2 - - 3 1 4 4 - - 5 1 1.3 Winterbourne 370 2 - 1 - 2 1 - - - 2 - 2 1 1 - 28 - 1.4 Woodside 253 29 - 9 - 5 2 3 - - 2 1 3 8 2 - 4 - 18.6 John Huskin 239 - - - - - - - - - - - 1 1 - - 3 - 0.4 Lady Edridge 307 - - - - - - - - - 1 1 - 3 - - - - 1.0 Aldington - St. Mary's 38 - - 1 - - - - - - - - - 4 - - - - 13.2 All Saints' 84 - - 1 - - 2 - - - - 1 - - - - 5 - 1.2 Abp.Tenison' 40 - - - - - - - - - - - - - - - 4 - - Christ Church 166 - - 1 11 - 1 - - - 2 3 1 - - - 9 - 7.2 Farish Church 302 - 1 1 11 3 3 4 - - 3 3 - 1 - - 2 1 5.0 St. Andrew's 236 - - - - 4 - - - - 2 - 3 2 - - 2 1 1.3 St.. Joseph's 126 - - - - - 1 - - - - - - 1 - - - - 0.8 St. Mark's 38 - 2 - - - 1 - - - 2 - 1 - - - 2 - 5.0 St. Mary's R.C. 150 - - - - - - - 1 1 6 - - - - - 6 1 0.7 St. Peter's. 42 - - - - - - - - - - - - - - - - - - St. Saviour's. 85 - - - - 1 1 1 - - 4 - 1 1 - - 2 - 1.2 Shirley 92 - - - - - - - - - - - - - - - 2 - - Selhurst Grammar 277 - - - - - - - - - - - - 1 - - 2 - 0.4 TOTALS 88 25 91 42 125 83 37 2 4 87 53 40 83 37 - 373 10 N.B:- St. Michaels Closed. Holy Trinity Closed. St. Chiristophers Evacuated. St. Giles Evacuated. Heath. Clark Closed. Abp.Tenison's.Boys. Closed. FOLLOWING UP School Visits. The following Table summarises the visits paid by the Health Visitors, etc., in connection with these duties: Visits to Schools re Cleanliness 43 Total Visits to School Departments re Cleanliness 301 Number of children inspected for Cleanliness (first inspection) 32,094 Number of children inspected (subsequent inspections) 1,095 ITunber of children found unclean (first inspection) (1,201 occasions of infestation) 928 Number of occasions in which children found unclean (subsequent inspections) 471 In addition, 933 "otter visits" to schools were ma de. Home Visits. Concerning defects found at routine medical inspections 821 Subsequent visits re defects found at routine medical inspections 266 Visits re special cases 750 Visits to dental cases 440 Visits in connection with infectious cases and other visits (including 370 visits concerning uncleanliness 9,241 TREATMENT The work of the School Clinics Summary of Attendances. 1940 1939 Decrease Minor Ailments Clinics 5,220 14,544 9,324 Inspection Clinic 1,202 2,779 1,577 Dental Clinics 12,591 15,022 2,431 Ophthalmic Clinic 1,920 3,207 1,287 Orthopaedic Clinic 651 852 201 Remedial Exercises Clinic 1,269 5,483 4,214 Hose and Throat Clinic 151 774 623 Rheumatism Clinic 173 315 142 TOTALS 23,177 42,976 19,799 The Mirer Ailments Clinic. At the Lodge Road Clinic, 696 children made 2526 attendances,while at the subsidiary Clinics ha Id. at 206, Se]hurst Road on five days weekly,324 children nade 1,921 attendances, and at the Duppas School 194 children nade 773 attendances. 10 Complaint. Cases 1941 Attendances . Aver.No. of Attendances per case. Cases. 1939 Attendances. Aver.No. of Attendanccs per case. Ringworm of Scalp 5 6 2.0 10 142 7.4.2 ,, ,, Body 7 43 6.1 18 74 4.1 Scabies 121 455 3. 8 71 321 4.5 Impetigo 121 5C3 4.8 95 831 8.7 Other Skin Diseases 59 170 2.9 61 240 3.9 Otorrhoea and other Ear defects 137 631 4.6 101 1,460 0.1 External Eye Disease 184 775 4.2 480 5,604 11.8 Miscellaneous 5182 2,557 4.4 1,577 5,792 3.7 1 ,214 5,220 4.3 2,493 14,544 5.8 Adenoids and Enlarged Tonsils During 1340, 19 cases of tonsils only, 5 vases of adenoids only and 01 cases of adenoids and enlarged tonsils, a total of 105 cases, were recommended for treatment end 70 children were operated upon. This Clinic ceasod functioning early in the year and has not yet recommenood 44 wore operated upon in Meyday Hospital. These were children over the age of 12 years, or for whom the parents had expressly desired the operation done in the hospital. Treatment of Visual Defects Number of defects dea1th with Spectacles prescribed I Spectacles Obtained. ' Under the Authority's Scheme Submitted to refraction by private practitioner or Hospital apart from the Authority's Scheme. Other rise Total Under the Authority's Scheme Otherwise Under the Authority's j Scheme. Otherwise : Errors of Refraction 614 – 614 308 – 366 - This Clinic showed a decrease upon 1939 in numbers submitted to refraction. A total of 1920 attendances was recorded. 11 THE SCHOOL DENTAL SERVICE The Dental Service deals not only with those attending the Elementary, Central and Special schools but also a large number of scholarship holders at Secondary schools. Treatment is, in addition, provided for patients referred under Maternity and Child Welfare, Tuberculosis and Mental Deficiency Schemes. The Dental Staff consists of five full-time Dental Officers, the equivalent cf one dental officer's time being occupied with work for the Maternity and Child Welfare Scheme. INSPECTIONS. During the early part of 1940 routine dental inspections were considerably handicapped by closure of the school premises. Alternative arrangements for these inspections to take place at the clinics themselves did not, unfortunately, meet with the response anticipated. Out of a normal school population of over 25,000 children, 8,910 were inspected and 6,176 referred for treatment compared with 7,928 inspected and 5,477 referred in 1959. The percentage of children found in need of dental attention at school inspections was 69%, that is, the same as that reported for the year before. The total number of children with healthy dentitions at the close of 1910 was 7,162 compared with 7,251 in 1959. This figure represents 2,734 found healthy at inspections and 4,428 rendered artificially so, compared with 2,451 found sound and 4,800 cured lr.st year. Sessions devoted to inspections numbered 98 for the year compared with 59 in 1939. ATTENDANCES and TREATMENT Though not up to pre-war standards attendances throughout the year have for the most part been highly creditable. These stand at 12,591 compared with 15,022 in 1939. The number of children actually treated was 4,864 compared with 5,696 in 1939. Those cured are shown as 4,428 against 4,800 last year. The aggregate of treatment sessions was 1,480 against 1,610 in 1939; the ratio of inspection to treatment sessions was 1: 15.1 compared with 1: 28.6 last year. FILLINGS INSERTED PER 100 CHILDREN. This figure now stands at 141 against 129 recorded for the previous year and indicates a further increase in the AMOUNT cf conservative treatment accomplished for each child. The following Table illustrates the steady increase that has been achieved during recent years. Year of Treatment. 1930. 1935. 1936. 1937. 1938. 1939. 1940 Pi-lings inserted per 100 children: 32 78 90 91 120 129 141 12 The actual number of fillings inserted in permanent teeth fell from 6,719 in 1939 to 6,24-0 last year; those inserted for the temporary dentition, on the other hand, show a slight rise from 638 to 656 in 1940. EXTRACTION 0? TEETH. The number of permanent teeth relieved for caries and orthodontic reasons was 2,182, compared with 2,900 in 1939. Extractions of temporary teeth remained practically constant at 8,979 against 8,972 the previous year. Local anaesthesia was used on 1,259 occasions. Nitrous oxide was administered on 2,701 occasions. At Lodge Road Treatment Centre "gas" is administered by the dental surgeons who devoted 139 sessions to this work. At the Selhurst and Waddon Clinics the administration is performed by medical officers and 78 sessions were set apart for this purpose. OTHER OPERATIONS. A definite decline is shown in the number of "incidental" treatments performed during the year. These were 3,2S5 permanent teeth and 913 temporary toeth arid include many items of a valuable prophylactic nature, such as 343 applications of silver nitrate, also scalingc, gum treatments, etc. Special treatments include: Treatment of septic roots in anterior teeth, 32 Removal of norvos under local anaesthetic, 13 Gingivectomy, 4-. Removal of bone sequestra, 6. Splints for fractured incisors, 2. Visits to Mayday Hospital, 3. Treatment for M.D'3, 7 21 vulcanite dentures were inserted to replace teeth lost by caries or traumatic injury. EMERGENCY FORMS. The number of "special" forms issued by Head Teachers was appreciably less than in 1939, namely 1,118 compared with 1,785 last year. ACCEPTANCE R.ATE. The acceptance rate from school inspections in 1940 was 60 per cent, compared with 62 per cent, the previous year. CHARGES for TREATMENT. The Clinic charges for treatment are at the ''flat rate" of Is. per annum, with an extra charge of 2s. for each administration of gas. The above arrangement is working well, though in case3 of proved inability to pay, this charge is temporarily "waived". The sura of £249.0.9 was received in payment for treatment and £1„14.7 from the Voluntary Box contribution. CASES X-RAYED. The number of cases referred to Mayday Hospital for X-Ray examination was 78 compared with 130 in 1939. 13 TREATMENT OF SCHOLARSHIP CHILDREN. The following is a summary of the work performed: Attendances ... 259 Gas Case3 24 Now Cases Treated 43 Local 27 Re-treated 35 Cases completed 77 Fillings - permanent... 244 Root Fillings 1 Extractions - permanent 71 Dentures Fitted 3 temporary 22 Referred X-Ray 2 Other Operations 42 TREATMENT FOR E7ACTJEES. A special problem presented during the year has been the treatment of cases prior to evacuation. Every effort has been made to carry out "essential measures" before the patient left the district, or where not possible, to arrange for this to bo undertaken later by receiving authorities. In addition, periodical visits were made by members of the staff to Brighton to deal with urgent ca3es in that district until satisfactory services could be organised to permit treatment locally. SUMMARY of TREATMENT CARRIED OUT at BRIGHTON. (Thanks are due in this connection to the Medical Officer of Health, County Borough of Brighton, for the use of premises to facilitate these visits). Number of day visits 8 Children in Attendance: Orthodontic Cases 102 Ordinary Cases 36 M & C.W. Cases 3 141 Fillings Inserted 23 Extractions 25 Local Anaesthetics 22 X-Rays 2 Orthodontic Appliances Fitted 3 Denture Dressings 8 SUMMARY of WORK DONE at the SEIHURST ROAD CLINIC. 1940 1939 Attendances 3,320 3,462 Extractions 2,899 2,488 Fillings 2,281 1,424 Other Operations 1,041 1,142 "Gas" Cases 784 529 Local Anaesthesia 301 953 Cases Completed 1,538 1,344 Sessions held: Inspection 29, Treatment 374, Gas 44. The average attendance at this Clinic per session is 6.8 SUMMARY of WORK DONE at the WALDRONS CLINIC. 1940 1939 Attendances 2,848 3,065 Extractions 2,087 2,314 Fillings 1,170 1,398 Other Operations 1,829 1,232 "Gas" Cases 554 496 Local Anaesthesia. 129 278 Cases Completed 1,024 1,055 Sessions held: Inspection 26, Treatment 379, Gas 43. The average attendance at this Clinic per session is 7.4. 14 DENTAL DEFECTS (1) Number of children who were- Year 1939 (a) Inspected by the Dental Officers- Aged 5-5 547) 378 6-7 895) 818 7-3 821) 889 8-9 954) 827 9-10 1055) 863 10-11 1059) Total: 8,910 836 11-12 1229) 882 12-13 1054) 645 15-14 890) 707 14-15 595) 645 15 up 53) 438 Specials 1.118 1,705 10,028 (b) Found to require treatment 7,294 7,262 (c) Actually treated 4,864 5 j 696 (2) Half days devoted to - inspection 98 59 treatment 1480 1610 administration 45 40 gas admin: - (by dental officers) 139 122 (by medical officers) 78 96 orthodontia 95 111 1,935 2,038 (3) Attendances made by children for treatment 12,591 15,022 (4) Fillings - Permanent teeth 6240 6719 Temporary teeth 656 – 658 6,896 7,357 (5) Extractions - Permanent teeth 2182 2900 Temporary teeth 8979 8972 11,161 11,872 (6) Administrations of general anaesthetics for extractions 2,701 2,570 (7) Administrations of local anaesthetics for extractions 1,259 2,203 (8) Other operations - Permanent teeth 570 647 Temporary teeth 3295 4059 3,865 4,706 «• 15 ~ ORTHOPAEDIC WORK The Orthopaedic Scheme continues on the sane lines as described in ray report for 1031. SPINAL AID OTHER REMEDIAL CLINICS. 1940. 1939 Attend. Attend. ances. Sessions Av. att. ancos, . Sessions Av.att. Spinal 432 174 2.5 2104 370 5.7 Massage - - - 51 51 1.0 Flat Feet 234 78 3.6 1162 119 9.8 Breathing 553 90 5.6 1524 168 9.1 1,269 350 4841 708 RHEUMATISM CLI1TIC The total number of children whose names were on the "live" register at the end of 1940 was 161. C uses examined at Rheumatism Clinic Primary 1938 89 1939 82 1940 28 Re-examinations 438 233 117 527 315 145 Rheumatic 76 (85.4%) 54 (65.9$ 16(57%) Non-Rheumatic 15 (14.6%) 28 (34.1$ 12 (42.9) 89 82 28 Classification of Rheumatic Cases Primary Re-Examination Sex - Males 9 57 (48.7) Females 7 60 (51.3$ Total 16 117 Age when examined 5 6 7 8 9 10 11 12 13 14 15 Primary 3 3 1 – — 2 2 4 1 - - Re-exams 2 3 7 17 12 12 20 19 23 2 - rcuping of Cases (Classification of Dr. R. Miller). 1938 1939 1940 Mild and Potential 59 (77.6%) 35 (64.8%) 13 (81.25%2) Definite Active 7 ( 9.2%) 6 (11.1%) 1 (6.25%) Definite Quiescent 10 (13.2%) 13 (24.1$) 2 (12.50%) The Mild and Potential" included those cases showing the first initial symptoms of "growing pains" in highly-strung children, with or without slight cardiac involvement. 16 The "Definite and Active Group" included besides cases of frank rheumatic carditis, those with narked physical signs of Rheumatic Fever or Chorea. Rheumatic manifestations. Total 16 cases. Rheumatic pains 12 (75.0%) Chorea 1 ( 6.257%) Carditis, (lb finite) 2 (12.50%) Carditis (Suspected) 1 (6. 25%) Tonsi llitis - Two children gave a definite history of Rheumatic Fever. Fgiily Histories. In the case of 3 families (18,8%) cither the father or the mother had had rheumatic fever,, chorea or juvenile rheumatism. In 3 other cases, (18.8%) a history of rheumatism was obtained in near relatives of the parents. In the case of 2 children (12.5%) the in brothers or sisters gave a similar history of rheumatic manifestations. Nervous Conditions. Recorded in 16 cases. Children recorded as highly strung 2 (12. 5%) Headaches (Occasional). 7 (43.757%) Night Terrors etc. 2 (12. 5%) Enuresis 2 (12. 5%) Twitehings 2 (12. 5%) Often a combination of more than one of -the above symptoms was manifested. Tonsillectony Operation reported in 4 cases (25.0??) Re-examinations One hundred and seventeen re-inspections were carried out. In no case had the conditions become worse; 15 (12.3%) was considered to be non-rheumatic; 12 (10.3%) stationary; 23 (19,7%) were definitely improved; and 67 (57.3%) quiescent. PL HID, DEAF, DEFECTIVE MP EPILEPTIC CHILDREN Blind Children. Ten boys end 3 girls are resident at special schools for the blind. The institutions which these children attend arc as follows: Royal Normal College fat- the Blind, 5 boys j Barclay Blind School, Brighton, 2 girls; Suns line Homes, East Grinstead, 1 boy. Chorley Wood College, 1 boy; White Oak, Swanloy, 1 boy; Court Grange, 1 boy; Brighton School for the Blind, 1 boy. The Committee are also responsible for the maintenance of two girls at the Goodrich Road (L.C.C.) School for Partially- Sighted Children. St. Lukes Special School for Partially Sighted Children. This school, which ms evacuated to Eastbourne, was disbanded during the early part of the year, when there were 11 children in attendance. - 17 - Deaf Children. Twelve boys and five girls are resident at special schools for the deaf; one boy and one girl attend a special day school. The institutions which these children attend are: Royal School for the Deaf, Margate, 11 boys and 5 girls; Anerley Deaf School, 1 boy. Epileptic Children. One girl is resident at the Lingfield Epileptic Colony, Surrey. Mentally Defective Children. In addition to the day accommodation provided at St. Christopher's School (evacuated to Banstead) two girls are resident in the Monyhull M.D. School, Birmingham; arid eight boys at Besford Court, Worcestershire. physicall.7 Defective Children. In Audition to physically defective children accommodated at St. Giles' Day Open Air School (evacuated to Bognor Regis) the Education Authority have crippled children in the following special schools: The Hermitage Craft School, Chailey, two boys and one girl; Victoria Homo for Crippled Children Bournemouth, one girl; Rational Children's Home, Chipping Norton, one boy; St. Patrick's Open Air School, Hayling Island, two girls; and St. Catherine's Ventnor, one boy. Speech Defects Class. The class conducted by two trained speech therapists has continued throughout the year and has thoroughlv nroved its usefulness. The number of children that can attend each class at any given time is limited as each child has to be dealt with individually. Total number of cases treated 94 Stammerers treated 2? Referred for Physical Treatment 4 Developmental Dysarthrias 15 do, Psychological do 2 Cleft Palates 4 Discharged as cured: Croydon 26 Alexias 1 Britgton 9 Hysterical Mutism 1 Discharged for reasons of Rvaeaation and non-attendance 18 Palatal Paresis 1 Lisps 10 St ill attanding 33 Undeveloped Speech Cases 7 Dismissal v. hen Brighton Clinic closed 8 Lalling cases 27 Deaf cases 1 JLTENILE EMPLOYMENT RETURN. The following "lumbers of children were examined by the medical officers during 1940 as to their fitness to follow the part-time employment indicated. 1940 1939 1938 1937 1936 Delivery of Goods for Shopkeepers 167 157 334 172 151 Delivery of Newspapers 249 183 255 245 245 Delivery of Milk 19 30 68 31 43 435 370 667 448 439 THE PROVISION OF MEALS AND MILK AMD COD LIVER OIL AND MALT. 1940 1939 Nc. of Children who received free dinners 432 529 No. of Free Dinners provided 35,508 86,717 18 No. of Children who received, on the recommendation of the School Medical Officer:- 1940 Bottles 1939 Bottles Free Milk 1,078 221,105 1,221 376,7756 Milk (Part Payment) - - 9 851 Milk (Whole Payment) - - 10 743 Issues Issues Free Malt • }30 7,922 139 23,090 Malt (Whole Payment) 3 129 10 504 (N.B. Milk and Malt and Oil given on the recommendation of the School Medical Officer are supplied free of cost; voluntary payments, however, are accepted from the Parents.) The Committee continued during the Easter and Mid-summer Vacations to provide facilities at the Free Dinner Centres for children to receive milk under the Milk Marketing Board's Scheme at a cost of ½d. per one third of a pint. All the milk supplied is pasteurised milk and the sources of supply are subject to the approval of, and constant supervision by, the Medical Officer of Health. ST. CHRISTOPHER'S SPECIAL SCHOOL. I am indebted to Mr. H. J. Edmonds for the following information: 1340 finds St. Christopher's hardly existing as a separate school. Our number of evacuated children has now dropped to sixteen only, and wo aro now merged with many other schools, and incorporated as tho Boys' M.D. School, and situated at Banstead Residential School. Following the Government's decision to evacuate children from tho East Coast, wo loft Hopten on 29th May, 1940, forty-five strong, and eventually reached Banstead, where teachers and children wore given a very cordial reception, and wore very soon made comfortable. This Institution is planned on the Cottage Home system - 20 children to a Cottage. Fortunately, we have been able to place all Croydcn children together in one Cottage, where they arc very happy indeed; aid well cared for by a capable House Mother. As for the work of the school this has suffered naturally, and craft work such as tailoring, carpentry, and boot-repairing is impossible. We aro, however, concentrating on the academic side, and hero, I em euro, that most definite progress has boon made. The children are happy and contented and extraordinarily healthy. Visits may bo arranged at any time by arrangement with the Head Master, and here may I say that visitors are very welcome. Boing in an Institution the children miss the greater frc-edom obtaining in the holiday camp st Hopton. CAUSES OF DEATH IN CHILDREN OF SCHOOL AGE. Taking the school population as 12,549, the death rate per 1,000 in school children vies 4.0 There were 49 deaths in children of school ago by: Infectious Diseases 4: Pneumonia 1: Tuberculosis 3; other defined causer, 41, namely: Malignant Disease 2; Epilepsy 1; Appendicitis 3; Pulmonary Stenosis 1: Congenital Malformation 4; Rheumatic .Fever and Carditis Street Accidents 2; Encephalitis 1; Osteomyelitis & due to War Operations 25. In the Infectious Diseases group wore: Diphtheria !5; and Cerebro Spinal Meningitis 1. SECONDARY SCHOOLS. The usuallarrangements for the medical inspection of secondary school children wore continued in 1940: 552 children wore examined, 321 boys and 231 girls. Table II of Appendix gives the detailed findings. - 19 - CHILD GUIDANCE CLINIC, MAYDAY HOSPITAL. Summary of cases referred to Child Guidance Clinics during 1940 No. m. f Age Why Referred By whom Referred Action taken and result of Treatment 3 m. CO Stealing School Medical Officer Treatment for 5 mths. Change of school - case followed up regularly since - no further trouble. 2 m. j 1 rzl i x°2 Stealing and chorea Juvenile Court Irregular attendance. No further stealing improvement in chorea. m. 11 i i Fnonresic and thieving School Medical Officer Treatment 3 mths - some improvement - poor home. 4 M. 9 Untruthful - stealing School Medical Officer Evacuated. 5 M. 13 Stealing Juvenile Court Diagnostic report for Magistrates. 5 M• 15½ Stealing Juvenile Court Diagnostic report for Magistrates. 7 M. 7 Untruthful and immoral School Medical Officer Irregular attendance boarding out recommended. s F. 9 Masturbation - chorea Parent. Treatment for 5 mths - improvement. Referred to schoo. clinic for tonsils and alvirci,-^ 9 M. 14 Out of control of parents Juvenile Court Diagnostic report. 10 M. 10 Eneuresis. School Medical Officer Recommended boarding out. 11 M. 11 Out of control of parents School Medical Officer Parents unco-operative. 12 M. 6 Out of control of parents Croydon Guild Social Service 6 mths. treatment - boarded out for 2 mths. - slight improvement - mother very unstable. 13 M. 8 Backward - fearful School Medical Officer Evacuated. 14 M. 12 Enureses. Probation Officer Diagnostic. 15 M. 15 Stealing Juvenile Court Diagnostic. 16 m. 14 Assault age small boy Juvenile Court Diagnostic. 17 M. 7 lying Probation Officer Irregular attendance unstable mother. 18 M. 15 Early schisophrenic Probation Officer! Admitted to Wariirgham Park Hospital. Intelligence Tests were arranged on 12 of these oases. 4 were below average - 5 average - and 3 of high intelligence, 20 APPENDIX A. Table 1. MEDICAL INSPECTIONS OF C®LDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A. - Routine Medical Inspections. Number of Inspections in the prescribed Groups: Year Year 1940 1939 Entrants 1696 355 Second Age Group 1096 2543 Third Age Group 1132 1984 Total 3924 4882 Number of other Routine Inspections 45 28 Grand Total 3969 4908 B. - Other Inspections Number of Special Inspections 7070 4244 Number of Re-Inspections 4740 17109 Total 11810 21353 C. - Children Found to Require Treatment. Number of individual children found at Routine Medical Inspection to require treatment (excluding Nutrition, Uncleanliness and Dental Diseases.) Group For Defective Vision (excluding 3quint) For all other conditions recorded in Table IIA. Total Total 1339 Entrants 17 201 54 Second age Group 58 116 166 440 Third Age Group 76 82 135 289 Towel (Prescribed Group 151 399 542 783 Other Routine Inspections 1 3 4 4 Grand Total 152 402 546 787 Total visits to Elementary Schools: 199 - 21 - TABLE II. A. - Return of Defects Found by Medical Inspection in the Year ended 31st December 1940. DEFECT OR DISEASE Routine Inspections Special Inspections. No. of Defects No. of Defects Requiring treatment Requiring to be kept under observation, but not requiring Treatment Requiring treatment Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) ? (1) Ringworm Scalp ... • • • • • • • • • (2) Body • • • • • • • • • • • • (3) Scabies 3 • • • • • • ... (4) Impetigo 6 • • • .. (5) Other Diseases (Nontuberculous) 11 2 1 2 Total (Heads 1 to 5) 20 2 1 2 EYE - 16 ) Blepharitis 29 1 2 • • • (7) Conjunctivitis 8 • • • .. ... (S) Keratitis • • • • • • 1 ... (9) Corneal Opacities • • • • • • ... • • • (10) Other Conditions (excluding Defective Vision and Squint 3 1 • * • ... Total (Heads 6 to 10) 40 2 3 ... (11) Defective Vision (excluding Squint) 152 23 25 6 (12) Squint 33 21 3 ... EAR- (13) Defective Hearing 8 4 5 1 (14) 0 citis Media 6 4 ... ... (15) Other Ear Diseases 11 3 1 ... NOSE, AND THROAT - (16) Chronic Tensilities only 18 51 1 7 (17) Andenoids only 5 9 • • • • • • (18) Chronic Tensilities and Adenoids 77 108 4 5 (19) Other Conditions 21 30 1 • • • (20) ENLARGED CERVICAL GLANDS (Non-Tuberculous) 16 11 2 • • • (21) DEFECTIVE SPEECH 13 2 2 ... HEART AND CIRCULATION Heart Disease: (22) Organic 4 22 • • • 1 (So) Functional 10 22 2 • • • (24) Anaemia 56 4 5 • • • - 22 - TABLE IV , TREATMENT TABLES. GROUP 1. - MINOR AILM3NTS (excluding Uncleanliness, for which see Table VI). Disease or Defect Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) SKIN - Ringworm-Scalp: 3 - 3 Ringworm-Body 7 – 7 Scabies 121 - 121 Impetigo 121 - 121 Other Skin Disease 59 – 59 MINOR EYE DEFECTS - External and other, but excluding cases falling in Group II 184 – 184 ME NOR EAR DEFECTS 137 - 137 MISCELLANEOUS - Minor Injuries, Bruises, Sores, Chilblains, etc. 582 - 582 TOTAL 1214 - 1214 GROUP II. - DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defects treated as Minn- Ailments - Group I) Number of -Defects dealt with Under the Authority's Scheme. Otherwise. Total ERRORS OF REFRACTION (including squint) 614 - 614 0 her defect or disease of the "eyes (excluding those recorded in Group l) – – - TOTAL 614 - 614 We. of children for whom spectacles were (a) Prescribed 308 - 308 (b) Obtained 366 - 366 GROUP III - TREATMENT OF DEFECTS OF NOSE AND THROAT. NUMBER OF DEFECTS Received Operative Treatment Received other forms of Treatment Total number treated Under the Authority's Scheme, in Clinic or Kosnital, By Private Practitioner or Hospital, apart from the Authority's Scheme. Total (1) (2) (3) (4) (5) (i) (ii) (iii ) (iv) 2 58 - (i ) (ii ) (iii ) (iv) 2 2 6 - 23 - 1 ) (ii )(iii 2 4 64 (iv) - 70 TABLE II - continued DEFECT OR DISEASE Routine Inspections Special Inspections Wo. of Defects Noc of Defects Requiring treatment Requiring to be kept under observation, but not requiring Treatment Requiring treatment Requesting to be kept under observation, but not re— quiring Treatment (1) (2) (3) (4) (3) LUNGS - (25) Bronchitis 15 7 1 • • • (26) Other Non-Tuberculou3 Diseases 5 9 1 1 TUBERCULOSIS Pulmonary: (27) Definite • • • • • • • • • • • • (28) Suspected 5 12 • • • 1 Non-Pulmonary: (29) Glands • • • • • • • • • • • • (30) Bonos and Joints • • • • • • • • • 1 (31) Skin • • • • • • • • • • • • (32) Other Forms • • • 1 • • • • • • Total (Heads 29 to 32) • • • 1 • • • 1 NERVOUS SYSTEM - (33) Epilepsy • • • 3 • • • • • • (35) Chorea 2 5 • • • 2 (36) Other Conditions 6 21 1 2 ?ORMITIES - (36) Rickets 1 • • • • • • • • • (37) Spinal Curvature 41 5 6 5 (38 ) Other Forms 34 12 3 2 i 39 ) OTHER DEFECTS AND DISEASES (excluding Uncleanliness and Dental Diseases.) 15 2 • • • 1 Total 614 395 67 36 B - CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Age-.gr: up Number of Children Inspected A (Excellent) B (Normal) C (Slightly ' subnormal) D (Bad) No. % No. % No. % No. % Eat rents 1695 154 9.1 1300 75.6 24 2 14.3 – – Second Age Group 1096 118 10.3 853 77.8 125 11,4 – – Third Age Group 1132 123 10.9 923 81.5 86 7,6 - - Other Routine Inspections 45 4 8.9 33 73.3 8 .17,.8 – - TOTAL 3969 39S 10.1 3109 78.3 461 11.5 - – - 24 -