■ 4S COUNTY BOROUGH 0 F CROYDON V ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH A N D SCHOOL MEDICAL OFFICER FOR THE YEAR 1941 f • OSCAR M. HGLDEN M.D. D.P.II. PUBI1C HEALTH COMMITTEE NOVEMBER, lS-iO - 1941 'THE TfORSrnrFTJL TEE , Councillor A,V. Dcanmarell. (Aidormcn A,H, Harding, J ,P.) Councillor Miss M.Il, Glazier. Councillor G Lyyjin, l.P, (Claai :r*man) Councillor A. Good bun. Councillor H. Regan, (Vj.ce-Chairman) Councillor W,H, Gough. Aldoirxin E.E.J, Arkell. J,P. Councillor Mrs. E,M, Regan. Alderman Mrs, D.J, Roberts Councillor D.G, Stow art. Alderman Mrs. M. Squire, J.P. Councillor J.T. Ti.ltchott. Councillor L.A. Aston. Councillor G.H, Ward. Councillor E,S. Constable. G.G, Genge Esq. M.D.j Councillor Mrs. V.L, Child J«H« Thompson Eaq#. M.B., B.Ch. Sbl Chairman and Members of the Fublio Health Committee. Ladies and Gentlemen, I have the honour to present my fourteenth Annual Report, being the forty-second of the series, dealing with the work of the Public Health and School Medical Departments, Tlie report has been greatly curtailed although the full statistical details have been prepared so that the sequence of figures is not broken and are available for reference if necessary. Statistical Tables have been limited to those of .lost importance and interest, coiamontaries thereon have been omitted except where necessary to clarify the figures given. Air-raids on a fairly heavy scale continued until the end of May but they did not dislocate the work of the department though on occasion they threw heavy extra burdens upon the staff. The Birth-rate for the year was 14,3 per 1,000 of the estimated population, a decrease of .1.1 per 1,000 on 1940. The death rate was 13,75 a decrease of 1,85 per 1,000 of the population. The Infantilo Mortality rate was maintained at a low level being 3? per 1,000 births. This is the lowest figure yet recorded for Croydon and must be con;, i do red as very satisfactory under the conditions prevailing. It is necessary however, to point out that owing to the uncertainty as to the actual population, which towards tho end of the year showed a considerable Ingress, it is not possible to say that the above figures are absolutely, correct. The incidence of notifiable diseases remained low, with the exception of Measles and Whooping Cough, both of which showed fairly considerable increase. This was expected as regards Measles>as the incidence had been exceptionally loxv in 1940. With the exception of those two zymotics, the figures for infectious diseases incidence have remained remarkably low taking into consideration the abnormal conditions brought about by sleeping in Air-raid shelters during the first part of the year. The greatest cause of death was from diseases of the heart and circulatory system, and the figures rose from 4,31 per 1,000 of the population to 5.43. 'This increase is probably little influenced by raid conditions but the general stress and strain of life under wartime restrictions is probably a contributory factor. Deaths from diseases of the digestive system showed a decrease. Deaths due to enemy action numbered 0.68 per 1,000 of tho population. ' There has be n an increase in skin affections, particularly Scnbies, but so far influenza shows no tendency to assume tho pandemic incidence which occured in 1918 - 1919. Considered as a Thole as reflected in the Vital Statistics the health of Croydon has been well maintained in 1941. Immunisation against Diphtheria has been proceeding steadily and the incidence of Diphtheria in Croydon during the year was the lowest yet noted. There is, however, much to bo done before the desired rate of at least Q0% of the population immunised is attained. Full statistics are given of the cases treated in Mayday Hospital because this information may bo of value to other hospitals, The hospital had a busy year though 250 bods were kept empty under the Emergency Hospital Scheme arrangements. Happily they have not yet been needed to go into commission. So.far there has been only a plight rise in the incidence of Tube-rcculesis both Pulmonary and Non-Pulmonary, whilst the death rates for both for.a shows a small declino. As cornered with England end wales as a whole the figures are low. The Comprehensive Maternity and Child Welfare- Services have functioned well throughout the year. The figures are generally lower than in 1940 but this is due to a higher proprottion of that section of the population concerned haying evacuated the town than was the case in 1940. The Maternal Mortality rate was 3.2 per 1,000 total live and still births, a figure higher than for 1940. Too much importance should not bo assigned to this, however, on account of the relatively small number under consideration, The number of cases of Venereal Diseases dealt with at the Clinic shows an increase on 1940. Thin unfortunately was expected as a concomitant of war time conditions. The powers for prevention of these infections is unhappily, very limited and* there is certainly a need to bring in some Method of securing that (a) Persons who know they are infected being compelled to obtain proper treatment and (b) seeing that treatment is carried through until cure or a non-infectious - state is reached. Although there has of necessity, been much diminution of activity in dealing with adverse housing conditions, the Chief Sanitary Inspectors department has had a busy year, more particularly in connection with foods and drugs inspections. I feel it, however, my duty to point out that owing to the lack of r pairs to houses, and the cessation of building of new houses, the problems which will face the Council in the near future, especially if there is - as appeared probable towards th end of the year an influx of families into Croydon, will be both large end difficult. Already there are evidences of an increase in overerowding, and of houses really unfit for,human habitation, having to be occupied because there was nowhere else to go. If this undesirable state of affairs continues and becomes more pronounced it cannot but fail to .have a detrimental influence upon the general health of the town. A report upon the duties under the Mental Deficiency Acts is included as has been done in previous years. This work is under the jurisdiction of the Mental Deficiency Committee. No report has been included respecting the Civil Defence duties undertaken by members of the Health Department as it is felt this is not properly a health service, though it has shown itself a service competent in the art and practice of saving life, not seldom under adverse environmental conditions. In conclusion - wish to express my thanks to you, Ladies and Gentlemen for the help and encouragement you have at all times given me, and at the same time I would like to. bring to your notice the loyal and competant way in which the members of my professional, technical and clerical staffs have carried out their duties. Yours faithfully, OSCAR. M. GOLDEN. Medical Officer of Health. The staff of the Public Health Department on the 31st December, 1941, was as follows:- Medical Staff: - (a) Whole-time Oscar M. Holden, M.D., D.P.H., Medical Officer of Health, School Medical Officer, and Medical officer under the Mental Deficiency Acts, etc. John T.H.Lewis, M.D., D.P.H., Deputy Medical officer of Health, Deputy School Medical officer, and Medical officer under the Mental Deficiency Acts. J.C.McMillan, M.B., C'-.B., B.A.O., B.Sc., D.P.H., 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. J.P.Crichton, L.R.C'..P, L.R.C.S., D.P.He, Temporary Assistant Medical Officer of Health and Assistant School radical officer. Gordon I . Hobbin, M.B., Ch.B., Assistant Medical office of Air Raid Precautions. Iris A.Jenkin -Lloyd M.R.C.S., L.R.C.P., D.P.H., Assistant Medical Officer of Health and Assistant School Medical officer. Rosa Morrison, H.B., D.P.H,, Assistant Medical officer of Health and Assistant School Medical Officer. Ellen Mackenzie Hegartv, M.B., Ch.B., D.P.H., Assistant Medical Officer of Health and Assistant School Medical officer. J. Todesco, M.D., M.R.C.S., L.R.C.P., D.P.H., Resident Medical Superintendent, Borough (Fever) Hospital. R.G.Poyser, M.R.C.S., L.R.G.P., Resident Medical Superintendent, Croydon Borough Sanatorium. (b) Part-time:- H.W.Southgate, M.B., B.S., B.Sc., Pathologist. J.S.Bookless, B.A., M.B., F.R.C.S., Ophthalmic Surgeon (School Medical Service) MAYDAY H0SP1 TAL. Charles Frederick Swinton, M.D., F.R.C.S.,(Ed) Ch.M. Medical Superintendent. John Joseph Walsh M.D,, F.R.C.S.,(Eng.) Deputy Medical Superintendent. John Swart Edson, M.Sc., M.D,, M.R'.C.P,, Senior Assistant Medical Officer, (on active service) Eric Joseph Tamblyn, M.B., B.S., Senior Assistant Medical officer. Winifred Margaret Bond, M.R. C.S., L.R.C.P., Junior Assistant Medical Officer. James Robertson Bryson, M.B., Ch.B., Junior Assistant Medical officer, Michael Chandler Mundle, M.R.C.S., L.R.C.P., Junior Assistant Medical Officer. Catherine F. O'Connor, :M.R.C.S., L.R.G.P., Assistant Bacteriologist and Pathologist (Part-time). Consultants to the Public Health Department. Thomas Warwick Preston, M.D., M.R.C.P., Physician, (on active• service). Ernest Marshall Cowell, D.S.O., M.D., F.R.C.S., Surgeon, (on active service). Alan Herapath Todd, M.S., F.R.C.S., Orthopaedic-Surgeon. John Smeed Bookless, B.A,, M.B., B.S., 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. Visiting Radiologist , Mayday Hospital (a) David Low Greig , M.R.C.S., L.R.C.S., L.R C.P., D.M.R.E., P.w. Hammond,M . D., (1ocum ) Visiting Anaesthetist, Mayday Hospital. Ruth E. Mansfield, M.R.C.S., L.R.C.P., D.A. Public. Vaccinators. Charles Fredk. Swinton, M.D., F.R.C.S., ( for Mayday Hospital) William Vaudrey Braddon, M.B. Ch.B., L.S.A. Dr. H.H.A. Elder, M.B., C .B. , (Deputy to Dr. W.H.M. Smith, M.R.C.S., L.R.C.P., on active service.) Dr. D.F. Kanaar, B.Sc., M.D. (Deputy to Dr. G.D. McGrath, M.B., E.Ch. B.A.O. , on active service.) Thomas Dunlop Miller, M.D., B.Sc., Gilbert charrington .wellish, M.B., Ch.M. , F.R.C.S Valentine hilkinson, M.B. L.R.C.P. Cecil Meredy-th Jones, M.R.C.S., L.R.C.P. ( for Shirley Residential Schools) Dental Staff. Senior Dental Surgeon, P.G. Oliver, L.D.S. Assistant Dental Surgeons:(a)J.K.R. Bryce, L.D.S., W.A. Sowden Hills, L.D.S. Miss S.M,V. Hathorn, L.D.S., C.P. Urbani, L.D.S., S.H.. Barlow, L.D.S. (locum) Dental Surgeon: Mayday Hospital: E.H. Laurence, L.D.S. (part time) Inspectors. R.J. Jackson, M.R.S.I., A.M.I.S.E., M.S.I.A. Chief Sanitary Inspector. G. Grieve, A.M.I .S.E., M.S.I .A., Acting Deputy Chief Inspector. 19 District Sanitary Inspectors. There are 5 disinfectors, and 6 assistants to the Sanitary Inspectors. In addition 1 disinfector and 5 assistants to the Sanitary Inspectors are on active service. Health Visiting Staff. A.M.D. Allford (Superintendent) 24 District Health Visitors; 2 Special Visitors; 1 Tuberculosis Furse; 3 Almoners and 5 Dental Attendants. Also 1 Whole-time Masseuse and Remedial Gymnast. Municipal Midwives. Norah A. Rigby. (Superintendent) 9 District Municipal Midwives. Clerical Staff. 3 B.W. Cummins ( Chihef Clerk) 39 full-time Clerks (12 of whom are on.active service and replaced by 10 temporary clerks.) Analyst (part-time) Edward* Hinks, B.Sc., F.I..C., F.C.S. Vaccination Officer. Gerald F. Hugins Cert. R.S.I. Mayday - .Hospital, Croydon Borough Hospital, Croydon Borough. Sanatorium, and St. Mary's Maternity Hospital. Nursing and Domestic Staffs. Pathological Lsboratory . 4 Laboratory Assistants. (a) on active Service. CONTENTS. A.. -Public HEALTH REPORT. Page Adulterated Samples 106 Ambulance Service 4 Amusement Houses 92 Animals, Keeping of 93 Ante-natal Clinic 61 Babies Help Committee 73 Bactoriogcal Examination 31,33,62 Bakehouses 90 Birth 1 , 54 Blind Pesons 80 Blood Transfusions 65 Borough Hospital 25 Bye-laws and Regulations 85 British Social Hygenne Council 42 Cancer 43 Cerebro-Spinal Meningitis 29 Chest Clinic 44 Children Acts 74 Contacts, Tuberculosis 50 Cowkeepers 90 & 99 Croydon Nursing Service 50 Convalescence 73 Coombe Cliff Convalescent Home 73 Creche 73 Dairies, Cowsheds and Milkshops 90 Deaths 1 - 6,54, 57 Dental Treatment 53, 68 Diphtheria 23, 28, 34 Disinfection 95 Disinformation 94 Dried Milk 72 Dysentery 30 Enteric Fever 29 Erysipelas 29 Extra Nourishment 47 Factories & Workshops Acts 85, 89 Fertilisers & Feeding Stuffs Act 93 Foods, Inspection of 95, 97 Food and Drug Acts 103 Foster Mothers 74 Foster Children 74 Gynaecological Clinic 66 Health Visitors, Work of 71 Home Helps ' 73 Home Nursing 50 Homework 90 Hospitals 4 Hospital, St. Mary's (Maternity) 60 Houses let in Lodgings 92 Housing 87 Ice Cream103 Illegitimacy 73 Immunisation Clinic 34 Infant W 1fare Clinics, (Muni cipa1) 70 Page Infant Welfare Clinics, (Voluntary) 70 Infant Mortality 1, 55 Infantile Paralysis 30 Infectious Diseases 23 Inquests 2 Laboratory Work 31, 33, 62 Loding House 91 Marriages 2 Maternity Homes 59 Mayday Hospital 7 Measles 27 Meat Inspection 98 Medical Help Records 58 Mental Deficiency, Etc 78 Midwives 58 Midwives Acts 58 Milk, Provision of 47, 72 Milk, Examination of 34,100 Milk, Tuberculous 100 Milkshops 90 Mortality in Childbirth 1,54, 66 Mothers' and Infants Welfare Association 73, 68 Mumps 30 Municipal Lodging Houses 91 Municipal Midwives 63 Neo-natal Deaths 57 Notification of Births Acts 54 Nuisance 84, 93 Nursing Arrangements 4 Nursing Homos 59 Obstetrical Unit 60 Offensive Trades 92 Ophthalmia Neonatorum 30, 55 Orthopaedic Department 74 Out of Borough Cases 25,30 Overcrowding 88 Pathological Laboratory 33 Poisons and Pharmacy Act 93 Poliomyelitis 30 Population 1 Post-natal Clinic 66 Public Assistance 22 Puerperal Sepsis Pyrexia 29,54,67 Rag and .Flock Acts 92 Rats and Mice (Destruction) Act 95 Rescue Home 73 Rent Restriction Acts 87 Rivers and Streams 93 Sanatorium, Cheam 52 Sanatoria, Treatment in 48 Sanitary Administration 83 Sanitary Certificates 87 Sanitary Inspectors, Work of 83 Page Scarlet Eever 27 Schick Test 34 Schools 93 Show Hours Acts 86, 91 Slaughtenhouse 90, 06 Smoke Observation 92 Sputum Examination 47 Still --births 1, 54 St. Mary"s Maternity Hospital 60 Tuberculosis, Borough Hospital 30 Tube rculosis , Cheam Sanitarium 52 Tuberculosis, Contacts 50 Tuberculosis, Deaths 45 Tuberculosis, Dental Treatment 53 Tuberculosis, Notifications 44 Tuberculosis, Homo Nursing 50 Tuberculosis, Home Visits 50 Tuberculosis, Institutional Treatment 48 Typhoid Fever 29 Unmrried Mother 1,73 Vaccination 36 Veneraal Liaeases 37 Verminous Parsions 93 Vitcal Statistics 1 Ward Strtisties 6 Waterreourses 93 Water Supply 4 Whooping Cpugh 29 Workplaces 85 Workshops 85 X-ray Examination 9 , 47 B. SCHOOL MEDICAL REPORT. (See separate document). Page Adenoids 12 Blind Children 19 child Guidance Clinic 22 Clinics 11 Cost 2 Crippling Defects 18 Deaf Children 19 Deaths 21 Defects " (Evacuation) 8 Defective Children 7, 20 Deformities 18 Dental Treatment 13 Epileptic Children 19 Evacuation 8 Exclusions 7 Eye Clinic 12 Eye Defects 4, 12 Following up 11 Health Visitors of work 11 Heart Defects 7 Weights and Weights 6 Infectious Diseases 7 Inspection Clinic 11 Inspections,Routine 3,5,7 Inspections, Special 24 Page Juvenile Employment 20 Massage Clinic 11 Meals, Provision of 20 Mentally Deofective children 20 Milk etc .,Provision of 20 Minor Ailments 11 Orthopaedic Work 18 Parents Present 4 Physically Defective children 20 Population,School 2 Remedial Exercise 18 Rheumatism Clinic 18 Re-inspections 24 Secondary Schools 21,26 Speech 20 Statistical Table 24 Surveys, Uncleanliness 5 St. Christopher's 21 Teeth 4, 13 Throat and Nose 12 Treatment 11 Tuberculosis 5 Uncleanliness 5 Vision, Defective 5, 12 SUMMARY OF VITAL STATISTICS FOR 1941 Area, 12,617 acres. Population (Census 1931) 233,115. .population(estimated middle of 1941) 184,500. Number of Inhabited Houses (1931 Census) 56,429. Overcrowding Census (1936) 65,550 Rateable Value (1st April 1941) £2,508,020 Product of a Penny Rate (1940 - 1941) £9,291 Rate in the £ 12/8d, Gross expenditure on Health Services (administered by Medical Officer of Health £232,254. Income on Health Services (excluding transfers) £ 65,757. Net expenditure on Health Services £166,497. Expressed as a Penny Rate, 17.92 pence in the pound. Live Births - M. F. Total Legitimate 1,260 1,216" 2,476 )2 Illegitimate 82 84 166) ' The Registrar General has submitted a separate figure of 2,408 for the purpose of calculating Infant and Maternal Mortality rates. Birth-rate per 1,000 of the estimatad rasident population, 14.3. Still Births 65 Rate per 1,000 total (live and still) births, 24.01 (for the purpose of Infant and Maternal Mortality rates the Registrar General submits a total of 64 still births). Birth rate per 1,000 (live and still births) 14.7. Deaths 2538. Death rate per 1,000 of the estimated resident population 13.75 Deaths from diseases and accidents of pregnancy and childbirth: 8. From sepsis 3; other causes 5. Maternal mortality 3.23 per 1,000 total live and still births. " " 2.01 " " " " " " " (excluding abortions) Death-rate of Infants under one year of age (90 deaths, 2408 births) All Infants per 1,000 live births 37 Legitimate Infants (81 deaths) per 1,000 live births 34 Illegitimate Infants (9 deaths)per 1,000 live births 56 Deaths from Influenza 35 Deaths from Diphtheria (all ages) 4 " " Whooping Cough (all ages) 6 " Pneumonia 168 " " Diarrhoea (under 2 years of age) 6 " " Cancer 370 Rate per 1,000 Deaths from diseases of Cardiac and Circulatory System, (including Population Cerebral Haemorrhage) 5.43 Deaths from diseases of the Respiratory System (including Tuberculosis) 2.39 - 1 - Deaths from diseases of Renal System 0.35 Deaths from diseases of Digestive System 0.58 Deaths from .Suicide and Accidents 0.44 Deaths from Old Age 0.54 Deaths from war Operations 0.68 Marriages The number of marriages solemnised was 2,187 compared with 2792 in 1940; 2,674 in 1939; 2,319 in 1938; 2,210 in 1937; 2,198 in 1936. The marriage rate was 11.9 per 1,000 of the population; 1225 were solemnised in Established Churches, 319 in other places of worship; 643 in the Register Office and nil performed under Jewish ritual. Births, The births registered were 2,476 legitimate and 166 illegitimate. The birth rate consequently was 14.3 For England and Wales and in the Great Towns the rates were 14.2 and. 14.7 The illegitimate births in Croydon were 6.3 of the total, compared with 5.3 in 1940 and 1939; 4.9 in 1938; 4.6 in 1937; 5.5 in 1936 and 4.4 in 1935. The live male births numbered 1,342, the female 1,300, being a proportion of 1,031 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 Aldington 20.7, Whitehorse Manor 17.1 and Addiscombe 13.4. Those with the lowest were Norbury 7.3, Upper Norwood 7.6 and South 8.7. Deaths. The deaths numbered 2,538 compared with 3,118 in 1940. For 1941 the death rate was 13,7. For 1940 it was 15,6. The death rate for England and Wales was 12.9 and for the Great Towns 14.9. For London the death, rate was 16.3. There were 80 inquests held by Coroners in respect of Croydon residents during 194.1 and 213 findings by Coroners after post mortem examination without inquest. ' Wards with the highest death rates were: Whitehorse Manor 16.6, and Central 16.5; lowest in Waddon 10.0 and Addington 10.2. - 2 - Registrar General's Table of DEATHS according to Cause, Age and Sex, Sex All Ages 0 - 1 - 5 - 15- 65- All Causes M 1245 54 26 15 142 344 664 F 1293 36 23 16 124 290 804 Whooping Cough M 3 2 1 - - - - F -3 - 3 - - - - Diphtheria M 3 - 1 2 - - - F 1 - 1 - - - - Cerebro Spinal Fever M 3 - 2 - - 1 - F 6 - 2 1 3 - - Typhoid group M 1 - - - 1 - - F - - - - - - - Measles M 4 1 2 1 - - - F 1 _ 1 - _ - _ Influenza M 11 - - - 1 1 9 F 24 1 2 - - 3 18 Poliomyelitis & Polioencephalitis M 2 - - - 2 - - F _ — — — — - — Acute infantile encephalitis M - - - - - - - F 1 - - - 1 - - Tuberculosis (respiratory) M 52 - - - 20 22 10 F 38 - - 2 22 11 3 Tuberculosis (other forms) M 9 2 - 1 5 1 - F 12 - 3 2 3 2 2 Syphilitic diseases M 16 - - - 1 12 3 F 6 - - - 1 2 3 Cancer M 194 - - - 18 74 102 F 176 - - 1 8 79 88 Diabetes M 7 - - - - 1 6 F 12 - - - - 5 7 Cerebral Haemorrhage etc: M 65 - - - 3 20 42 F 130 - - - 5 30 95 Heart diseases M 364 - — - 12 75 277 F 375 - - — 8 40 327 Other circulatory diseases M 39 - - - 2 11 26 F 36 - — — 3 6 27 Bronchitis M 60 1 1 - 1 13 44 F 72 1 - - 1 11 59 Pneumonia (all forms) M 74 l3 8 - 2 19 32 F 94 13 1 — 6 24 50 Other repiratory diseases M 12 - - - 2 8 2 F 18 — - 1 2 8 7 Ulcer of stomach or duodenum M 27 - - - 7 14 6 F 4 - - - - 2 2 Diarrhoea (under 2 years) 1 5 4 1 - - - - F 1 1 - - — - - Appendicitis M 6 - 1 1 1 2 1 F 3 - 1 1 1 1 - Other digestive' diseases M 29 - — 1 2 12 14 F 32 - - - 6 6 20 Nephritis M 27 - - - 3 11 13 F 37 - - - 6 14 17 Puerperal sepsis F 3 - - - 3 - - Other maternal causes F 5 - - — 5 - - Congenital debility, malformations, M 31 27 1 1 2 - _ premature birth, etc: F 20 16 1 - 1 2 - Suicide M 8 - - - 2 2 4 F 10 - - - 4 5 1 Road traffic accidents M 9 - — - 3 3 3 F 6 - - — 2 4 - Other violent causes M 108 2 4 6 34 30 32 F 88 3 7 6 25 12 35 All other causes M 76 2 4 2 18 12 38 F 79 1 2 2 8 23 43 Totals 2538 90 49 31 266 634 1468 - 3 - t Registrar General's Table of Deaths (see next page). COMPARE SONS with 1940. In the zynotic diseases group there were increases in the number of deaths caused by Whooping Cough and Measles; there was 1 death in the Typhoid group compared with nil in 1940; deaths from Diphtheria remained at 4. The deaths from Pulmonary Tuberculosis decreased by 38, those from Cancer by 60; and those from Heart disease by 16. There was an increase of 13 in the Pneumonia deaths and a decrease of 70 in those caused by Bronchitis. Deaths from Suicide and other violence show a decrease of 214, and road 'traffic accidents caused 8 less deaths than in 1940. The total number of deaths was 2538 as compared with 3132 in 1940. The percentage of deaths under 1 year of age to the total deaths was 3,5%; deaths under 15 years 6,7%; deaths under 65 years 42.2%; and deaths over 65 years 57.8%. The corresponding figures for 1940 were 3.7%; 6.6%; 46.8%; 53,2% respectively. WATER The water supply is drawn from deep wells in the chalk. These wells are situated in Surrey Street, Stroud Green, Waddon, Selhurst and Addington. A portion of the northern side of the Borough, is supplied with water which is purchased in bulk from the Metropolitan Water Board. The amount of water consumed during the year was Corporation's Wells 2,395,302,512 Metropolitan Water Board in bulk 335,798,000 2,731,100,512. Gallons. The same arrangements regarding samples as were commenced in 1938 continued in 1941. . LABORATORY. AMBULANCE, NURSING FACILITIES, HOSPITALS, ETC. There have been no material changes in the Laboratory, Ambulance and Nursing Facilities, in the home since my report, in 1940 All the Clinics have continued throughout the year, and the Tonsils and Adenoids Clinic" at the Croydon General Hospital, which closed in August 1940, was reopened on.18th August 1941. The throat Clinic at Croydon General Hospital was transferred to Mayday Hospital on 3rd November 1941. - 4 - The above total differs by 1 from the total recorded by the department, as the period covered by the Registrar General refers to the weekly returns from the Registry of Deaths, whereas the department records are calculated from 1st January to 31st December. 1 * DEPARTMENTAL CLASSIFICATION OF DEATH'S ACCORDING TO DISEASE OVER A PERIOD OF SIX YEARS. Cause of Death. 1936 1937 1938 1939 1940 1941 Death Rate Total Deaths Total Death: Total Deaths Total Deaths Total Deaths Total Deaths Enteric Fever 4 35 12 2 - 1 0.005 Malaria - - - - - 1 0.005 Small Pox - - - - - - - Measles 21 5 8 - - 5 0.027 Scarlet Fever 2 3 3 - - - - Whooping Cough 15 5 3 3 2 6 0.033 Diphtheria and Croup 8 15 16 16 4 4 0.022 Influenza (including Influenzal pneumonia 39 71 21 48 49 36 0.195 Dysentery _ - 1 1 - 2 0.011 Erysipelas 6 3 3 2 2 - - Cerebro-Spinal Fever - 3 5 2 16 8 0.043 Pulmonary Tuberculosis 132 140 117 89 128 90 0.488 Tuberculous Meningitis) 19 15 20 18 6 19 0.103 Other Tuberculous) Diseases) - - - - 15 - - Cancer, Malignant Disease 428 432 387 419 443 376 2.038 Rheumatic Fever 6 11 6 2 8 2 0.011 Meningitis 4 4 5 3 5 3 0.016 OrganicHeart Disease 749 770 777 782 682 672 3.642 (Bronchitis, Acute and Chronic ) 44 50 49 47 130 80 0.434 Pneumonia 185 179 150 151 206 194 1.051 Other Diseases of the) Respiratory Organs ) 23 12 25 13 21 30 0.163 Diarrhoea & Enteritis 31 45 29 23 18 13 0.075 Appendicitis 18 22 15 15 15 10 0.054 Cirrhosis of liver 8 9 8 12 1 10 0.054 Alcoholism - 1 1 1 2 1 0.005 (Nephritis & Bright's Disease ) 89 84 72 63 63 60 0.325 Puerperal Fever 5 1 1 2 2 3 0.016 Other diseases & Acciddent of pregnancy & partumition 7 11 2 2 3 5 0.027 (Congenital Debility 105 64 71 53 34 0.184 Malformation and ) 63 Premature Birth ) Violent Deaths (excluding suicide ) 85 102 78 77 61 74 0.401 Suicide 29 30 43 28 20 20 0.108 Other Defined Diseases Diseases I11-Defined . 570 634 595 662 1152 778 4.217 or Unknown - 2 - 3 11 2 0.011 TOTAL "590 2800 2496 2557 3118 2539 - 5 - Calculated per 1,000 live and still births. 1941 showed a decrease in the general death rate- and the birth rate. - 9 - WARDS Estimated Population Births Deaths Birth Rate Death Rate Deaths under 1 year per 1,000 births Death Hate from six Zymotic Diseases (excludj.ng Diarrhoea) Death Rate from Diarrhoea. Death Rate from Bronchitis and Pneumoni a Death Rate from Pulmonary Tuberculosis Death Rate from Non-Pulmonary Tuberculosis Be ath Rate from HEART ' Circulation Diseases. Deathh Pate from Nervous Diseases I Death Rate from Cancer. Natural increase or decrease of population. Upper Norwood 12,677 97 178 7.6 14.4 52 0.16 0.16 1.42 0.32 - 4.54 0.32 2.45 - 81 Norbifry 12 237 89 157 7.3 12.8 34 0 .68 - 1.23 0.57 0.03 4 .82 0.25 1.96 - 68 West Thornton 14,948 151 183 10.1 12.2 40 0.13 - 1.40 0.47 0.13 4 .35 0.47 1.74 - 32 Bensham Manor 12,679 167 188 13.2 14.8 47 - 0.03 1.26 0.47 0,16 5,21 0.63 2.76 - 21 Thornton Health 15,758 162 158 11.8 11.5 43 0.15 0.07 1.09 0.29 - 4,22 0.36 2.18 -4 South Norwood 13,447 175 2.16 13.0 16.1 46 - 0.15 2.60 0.45 0.15 6.10 0.52 2.53 - 41 Woodside 12,254 133 160 10.9 13.1 23 -- ¬- 1.31 0.41 0.08 4.41 0.41 2.04 - 27 East 12,290 112 138 9.1 11.2 18 - -- 0.81 0.57 - 3.99 0.24 1.09 - 26 Addiscombe 12,132 16 7 202 13.4 16.2 36 0.08 - 1.45 0.24 0.08 6,76 0.4-8 2.57 -35 Whitehorse Manor 12,748 218 212 17.1 16.6 37 0.31 0.31 1.33 0.78 0.16 7.14 0.47 2.27 + 6 Broad Green 13.124 175 18 5 13.3 14.1 40 - 0.08 2.67 0.69 - 5,03 0.31 1.90 - 10 Central 9.259 100 153 10.8 16.5 50 0.11 - 1.62 0.43 0.22 6.80 0.54 1.95 - 53 Waddon 13.948 186 140 13.3 10.0 54 0.07 - 1.36 0.57 0.07 3.66 0.57 0.86 +46 South 11,508 100 185 !8.7 16.1 60 - 0.09 1.48 0.70 0.18 6.25 0.61 1.91 - 85 Addington 7.191 149 73 20.7 10.2 47 0.28 0.14 0.83 0.28 0.42 3 .06 0. 56 1.11 +76 The Borough 184, 500 2642 2539 14.3 13.8 37 0.09 !- 1.49 0.49 0.10 5,12. 0.44 2.04 - 347 6 Those ere the corrected totals. MAYDAY HOSPITAL, Specialised Service Orthopaedic, Gynaecological, Dental, X-ray, Deep X-ray Therapy, Massage, Ultra -violet Light, Ophthalmic, Ear, Nose and Throat, School E.N.T. Clinic, Gastroscopy. Number of Trained nurses. 37 plus 15 Pupil Midwives. Number of Probationer nurses.79 Number of Assistant nurses. 5 Number of Male Attendants. 7 Acconmdation . Wards. Normal, or Basic Emergency Bed ' Pating. • Rating; 1. 32 8 (.Converted into Casualty Reception Ward. ) 2. 32 40 3. 32 40 4. 32 40 5. 40 6. 28 34 7. 32 8 (Converted into Casualty Reception Ward.) 8. 32 37 9. 32 40 10. „ 32 ' 39 11. 32 40 12. 32 40 13. 23 35 14. 23 35 15. 23 35 16. 23 28 C.W.3 24 cots ) Beds not returned to E.M.S. except under G.W.2. 24 cots ) heading Reserved beds - 17.17. Adult Beds. C.W.3 Emergency Theatrea Maternity Block. 44 ) This is exclusive of 1st stage labour and labour Maternity Isolation 4 ) beds and infants cots. X Maternity isolation ward destroyed by enemy action. GENERAL,STTISTICS. 1. Total number of admissions (including infants born in hospital) 4,853 2. Number of Women confined in hospital 627 3. Number of live births 606 4. Number of still births 28 5. Number of deaths among the new ly-born 19 (i.e. under 4 weeks of age) 6. Number of deaths among children under 1 year 36 (including those given under 5) 7. Number of Maternal deaths among women admitted to Hospital for confinement 5 8. Total number of deaths 630 9. Total number of discharge including infants born Hospital 4,173 10. Duration of stay of patients included in 8 and 9 above:- (a ) Under four weeks 3,397 (b) Pour weeks and under thirteen weeks 863 ( c) Thirteen weeks or more 143 11. Number of beds occupied (excluding cots in Maternity wards) (a) Average during the year 285 (b) Highest 351 on 10.3.41. (c) Lowest 170 on 26.4.41. 12. Number of surgical operations under general anaesthetic 1,487 (excluding dental operations) 13. Number of abdominal section 460 - 7 - Classification of In-Patients who were discharged from or who died in the Institution during the year ended 31st December, 1941. Disease Groups. Children of age. Men and Women Discharged Died Discharged Died. A. Acute infectious disease 28 - 19 2 B. Influenza 1 - 22 1 C. Tuberculosis: - - - - Pulmonary 1 - 51 23 Non-pulmonary 8 5 13 4 D. Malignant Disease - - 73 124 3. Rheumatism: - - - - (1) 2 - 9 - (2) - - 1 - (3) - — 14 2 P. Venereal Disease - - 9 4 G. Puerperal Pyrexia _ - 29 - Puerperal Fever - - - - H. Other diseases and accidents connect with pregnancy and childbirth. - - 417 6 I. Mental diseases 6 176 - J. Senile Decay - - 39 31 K. Accidental injury end violence 32 1 231 28 In respect of cases not included above. L. Diseases of the Nervous System and Sense Organs ;11 6 80 68 M. Disease of the Respiratory System 87 18 164 50 N. " " " Circulatory System 6 1 151 145 0. " " Digestive System 67 3 416 32 P.,Gnito-Uri&ary System 12 - 115 24 Q,. ,, ,, ,, Skin 62 | 1 79 7 R. Other Diseases 222 3 269 19 S. Mothers & Infants discharged from Maternity Wards and not included in above figures. Mothers: Infants: 574 17 600 5 T. Any persons not falling under any of the above headings. 42 - 35 ~ TOTALS 1,161 55 3,012 575 - 8 - Number of X-Ray Films Taken Spine 269 Bones 852 Pelvis 56 Chest 1578 Barium Meals 559 Barium Enemata 101 Renal 191 Gall-bladder 160 Toeeth 421 Abdominal F.B 29 Maternity cases 353 Skull 343 4,912 Total number of cases x-rayed - 2,463 DIAGNOSTIC 1940 1941 Oesophagus with Barium 3 7 Barium meals 140 140 Barium enemeta 16 36 Gall-bladder (plain) 7 20 Cholecystograms 16 31 Renal tracts (plain) 24 29 Pyelograms 28 30 Abdomen for F.B's etc 10 10 Maternity cases 164 155 Hysterographies 5 4 Lungs (Mayday) 383 362 Sick Staff 8 7 Staff on appointment 71 91 T.B. Dispensary 730 763 Others 27 - Lungs after lipiodol 7 8 Heart and aorta 2 5 Skulls 98 81 Accessory nasal sinuses 16 31 Vertebral column 76 90 Ribs 41 22 Pelvis 29 41 Long Bones 250 155 Short Bones 59 124 Joints 472 281 Teeth and jaws 82 141 2,764 Examinations by portable set ... 204 2,664 129 x-RAY 1940 1941 . Men's Wards 731 625 Women's Wards 579 467 Children's Wards 80 57 Maternity & Gynaecological Wards ... 124 77 Staff 10 8 131 Total in-patients 1,622 1,357 T.B. Dispensary (men) 404 395 Women 299 336 Children under 16 27 32 Croydon Borough Hospital 3 1 Ante-Natal Clinic 125 118 St. Mary's Hospital 10 5 Queen's Soad Homes- 32 16 Dental Clinic 77 108 Others 67 56 Total "Out-Patients" 1,044 i,067 Total 2,666 2,424 Screen Examinations 266 397 HASSAGS. Massage 4,094 Exercises 1,101 Radiant Heat 1,538 Electrical. 389 Diathermy Discontinued for duration of war) Ultra Violet light 749 Wax Infra red 1,062 8,933 Total number of patients treated 334 MENTAL PATIENTS DEALT WITH PITTING THE TEAR. Male Female Admitted 79 113 Certified and sent to Warlingham Park Hospital 6 12 As Voluntary Patients to Warlingham Park Hospital 46 56 Discharged not certified 24 34 - 10 - SPECIMENS EXAMINED IN; THE PATHALOGI CAL .LABRTORY DURING. THE-YEAR. Positive. Negative.  Swabs for Diphtheria 8 432 Sputa for T.B. 63 294 Pus for T.B. 3 3 urine for T.B. 2 8 Faeces for Coli- Typhoid Group 7 127 Blood-widels 6 30 Hairs for Ringworm 1 1 Blood cultures 16 27 Faeces for occult blood 84 129 1,241 Urine for routine examination 955 Pus for organisms. 148 BIood urea estimation. 201 Blood Sugar;' estimations. 85 Cerebro spinal, fluids 93 urea conc. testes 68 Urea' clearance tests 68 Fractional test"meals 67 Pleural fluids 47 Blood counts 524 Blood Groups 144 Haemoglobin estimations 640 Faecal fat estimations 1 Van den.Bergh re-action 9 Vaccinas 3 Blood sedimentation rates 54 Glucose tolerance tests 2 Blood coagulation and bleedings time 8 other examinations - unclassified 197 ■ Total number of examinations. 4,555 No. of specimens sent to Croydon General Hospital 414 Number of Post Mortems ordered by the Coroner and performed at Mayday Hospital during the year. Outside cases 188 Hospital cases 73 Number of Post .Mortens not ordered by the Coroner. 69. - 11 - THERAPY DEPARTMENT Condition for which treatment was £iven. No. of patients. No. of applications. Cured. Relieved . Died. Transferred to other Hosps. Still under Treatment, Carcinoma of Anus 1 12 - 1 Cervix 2 20 - 1 - - 1 Uterus 5 28 1 - - 2 Breast 10 128 - ** 1 1 8 Larynx 1 62 • - 1 Rectum 3 33 - 2 • - 1 Ovaries n 66 - - 2 Herd Palate 1 12 — ~ - _ 1 Shoulder 1 8 - — - 1 Taw 1 9 - - 1 - - Fibroid Uterus- 2 16 - - 2 Sterilization 4 16 2 - - - 2 Lympho sarcoma 2 23 - 1 - 1 Epithelioma of lip 1 9 - - - 1 Pruritis 1 6 - - - 1 Secondaries liver 1 6 - — - - 1 Malignant testicle 4 33 - - 1 - 3 warts 1 8 - 1 - - - 41 495 2 " 5 5 1 28 Corresponding.' Totals for 19 40. 26 181 6 2 —- — 2 8 MEDICAL SURGICAL TOTAL Diagnosis Cured Reli eved Unrelieved Died Cured Fiel¬lieved irelieved Died Alimentary, Appendicitis. 1 119 21 2 6 148 Gastric ulcer. 1 1 - 3 11 26 3 7 1 51 Duedenal ulcer. 2 3 - 2 2 19 1 1 i 30 Dyspepsia. 1 1 - - - i 1 2 Cholelithiasis 4 ! 3 - 1 -3 2 - _ 13 Colitis 2 - 2. - — _ 1 4 Intestinal obstruction - - 4 1 4 12 Ischio-rectal abscess - - - — 2 1 _ — ; ,3 Consti pation. 14 16 1 - — - 1 — 31 Hernia. - - - 36 36 ; 1 5 78 Haemorrhoids. - - - — 2 4 1 - - 7 Cholecystitis - - - _ 5 16 - - i 21 Gastro-enteri tis 19 5 1 1 - _ - - 1 26 Gastritis, 9 |10 1 - - — — _ 20 Alveolar abscess - - _ 2 3 - - 5 Cirrhosis of Liver - - - 1 - - —, 1 Intestinal colic 2 4 - - - - - 1 6 Catarrhal jaundice 1 - - — - - ... - - 1 Prolapse of rectum - - - - — 1; l - - 2 Pyloric Stenosis 5 1 _ - - — - - I 6 Fistula in Ano. - - _ - 1 - 1 1: I 2 Swallowed Fb. 2 i - 2 _ - - _ 4 Diarraoea 1 ! - — - - - - 1 Cyclic vomiting - 1 _ - _ _ _ - - 1 Peptic ulcer 2 2 *• - _ - - - - 4 Peritonitis - 1 - - 2 1 - - - 4 - 12 - Continued. MEDICAL SURGICAL Total Diagnosis Cured Relieved Unrelieved Died. Cured Relieved Unreli eved Died. Stomatitis: 1 - - - _ - _ - 1 Adhe si ons. - 1 - - - 1 - - 2 Pelvic Abscess - - - - - 1 - - 1 Collapse. - - 1 - - - - ~ 5 Pyloric ulcer. - 1 - - 1 - - — 2 Apendicular abacess - - - - 3 2 - - 5 Perienal ebsces. - - - - - 1 — - 1 Pancreatitis. - - - - 1 - — 1 Pyloric obstruction. - - 1 - 1 - - — 2 Ileitis. - - 1 - - - - — 1 Peri diverti culi bis. - - - - _ 1 - - 1 Gallstone Colic. - 3 1 - - - - - 4 Intu ssuscept ion. 1 - - - - - - — 1 Gingivitis. ~ - - - 2 1 — — 3 Polyposis Intestine. - 1 - - - - — — 1 V i sceroptosis. - 1 - - - - - — 1 Diverticulitis. _ 1 - - - - - — 1 Proctitis. - 1 - - - - - — 1 Haenetemecis of unknown origin. 1 - - - - - - - 1 518 Bones and Joints. Arthritis. - 6 6 2 - - - -- 14 Sacro iliec strain. 1 - - - - - - - 1 Fibrositi-s 1 2 - - - - - - 3 Bursitis. 1 - - - - - - - 2 Synovitis. - - - - 1 - - - 4 Osteo-myelitis. - - - - - 2 1 4 12 Osteo-arthriti s. - 3 1 - - - - - 4 Coxitis. 1 - - - - - - 1 Rheumatism. 5 6 1 - - - - 12 Hallux Valgus. - - - - - 2 - - 2 Osteoporosis. - - 1 - - - - - 1 Osteitis. — 1 — — - - - " 1 57 Circulatory - Heart. Myocardial degen. _ 10 4 73 87 Aortic Incompetence. - 1 - - 1 Artsrio-Sclerosis. - 5 5 4 14 Endocarditis. - 1 1 4 6 Myocarditis, - 10 11 10 31 Carditis. - 1 1 - 2 Auricullar Fibrillection - 4 - 4 8 Mitral Stenosis. - 18 1 1 20 , " Regurgitation - 1 - - 1 Congestive Heart failure. - 6 1 15 22 Heart failure. - 5 - 17 - 22 Congenital heart disease - - 1 1 2 Tachycardia. 1 3 2 - 6 Coronary Thrombosis, 2 - - 3 5 Angina. - 3 - - 3 Lymphangiti s. - 1 - - 1 Cardiac disease. - - 1 - 1 232 - 13 - Diagnosis. MEDICAL SURGICAL Cured Be¬icved Unrelieved Died Cured Rel¬ieved Unrelieved Died. Total Circulatory - Blood. Anaemia. 1 5 - 1 7 Hyperpiesia. - 10 8 1 19 Septicaemia. - - - 2 2 Pcmicious Anaemia. 1 7 1 2 11 Epistasis. 4 2 2 - 8 Thrombosis. 1 1 - - 2 Phlebitis, 5 4 - - 9 Varicose veins. - 3 - - 3 Gangrene - - - 4 4 Leukaemia. - - - 4 4 69 Carcinoma. Breast. 4 7 5 8 24 Stomach. - 1 3 23 33 Rectum. - 3 5 13 21 Ovary. - 2 - - 2 Cervix. - 2 2 - 4 Uterus - - 2 2 4 Prostate - 5 2 9 16 Tongue and Mouth.. • 2 1 2 5 Colon. - 2 1 18 21 Spine. - 1 - - 1 Larynx. - 1 2 1 4 Oesophagus. - - - 3 3 Gall bladder. - l 1 2 Lung. - 1 - 5 6 Bronchus. - - - 3 3 Pancreas. - — — 6 6 Epithelioma. - 2 3 3 8 Clavicle — 1 - _ 1 Antrum. - - - 1 1 Cheek. - _ - 1 1 Urinary Bladder. - 1 1 3 5 Cervix Uteri. - — 4 2 6 Sarcoma of F.;mur. - — _ 2 2 " Lung. - - - 2 2 " " Jaw. - - 1 - 1 Peni s. — - 2 2 Liver. — — - 1 1 Tonsil. — - - 1 1 Recto-sigmoid.junction. - - - 1 1 "Ventriculi. - 1 - 1 2 Rodent ulcer. - - 1 1 2 Me sentry. _ - 1 1 2 Intestine. — -. 2 2 Pelvic-rectal junction .. - - — 1 Labium. - - 1 - 1 197 Constitutional. Diabetes Mellitus. 8 1 8 17 Debility. - 2 1 - 3 Nutritional disorder 4 1 - - 5 Marasmus. 9 5 - 1 15 Malnutrition. - 2 1 - 3 Obesity. - - 1 - 1 44 - 14 - Diagnosis. MEDICAL SURGICAL, TOTAL Cured Relieved Unrelieved ! Died. Cured Relieved Unrelieved Died. Eyes. Corneal ulcers. - 2 1 - 3 Ophthalmitis. - 1 - 1 4 Ear. Nose and Throat. Enlarged T & A. 11 3 5 - 114 23 2 - 158 Labrynthine dis: - — 1 • - - - - 1 Quinsey. 3. 2 - - - - - - 5 Otitis Media. - - - - 13 7 4 - 24 Pharyngi ti s. - - - - - 1 - - 1 Otorrhoea. - - - - 3 2 2 - 7 Mastoiditis. - - - - 8 - 3 - 11 Sinusitis. - - ■- - - 1 - - 1 Tracheitis. - 1 - - - - - - 1 209 Genito Urinary. Nephritis. 2 2 2 7 — — — - 13 Urethral stricture - 5 1 - - 1 - - 7 Pyelitis. 22 15 - - - - - - 37 Perinephric abscess - - - - - - - 1 1 Enlarged Prostate. 1 1 2 2 9 8 - 4 27 Hydrocele. - - - - - 1 - - 1 Cystitis. 3 6 - 1 - - - - 10 Papilloma of bladder - 1 3 1 - 2 - - 7 Uraemia. - 1 - 8 - - - - 9 Renal Colic. - 3 - - - - - - 3 " Vescial calculus. - 1 - - - 1 - - 3 Hydronephro si s. - - - - 1 - - - 1 Urinary calculus. - 1 - - 2 2 - - 5 Pyonephrosis. - - - - - 2 - - 2 Epididymo Orchitis . 1 - - - - - - - 1 Circumcision. - - - - 6 1 - - 7 Haematuria. - - - - - 1 - - 1 Retention. - 2 - - ~~ - - - 2 Diverticulitis. - 4 1 - - - - - 5 Varicocele. - - - - - 1 — - 1 Haemorrhage per Urethra. - 1 - - - - - - 1 Urethral fistula. - - - - - 1 - - 1 Haematocele. - 1 - - - - - - 1 Enuresis. 1 - - - - - - - 1 Rupture of kidney. - - - - - 1 - - 1 Balanitis. - - - - - 1 - - 1 Fibrosis of Prostate. - - - - - 1 - _ 1 Epididymitis. - 1 - - - - - - 1 Glands. 151. Adenitis. _ — - - 11 3 _ 1 15 Hodgkins Disease. - - - - - - 1 - 1 Adenoma. - - - - 1 - - — 1 Goitre. - - - - - - - 1 1 Glandular Fever. 1 — - - - - - _ 1 Myxoedema. - 3 1 - - - - — 4 Thyrotoxicosis 1 2 - - - - - - 3 Hyperthyrodi sm. - 1 - - - - - - 1 27 -*-*KSE5 - 15 - Diagnosis. MEDICAL SURGICAL TOTAL  Cured Relieved Unrelieved Died. Cured Relieved Unrelieved Died Gyneecological Abortion. 139 35 8 5 187 Ovarian cyst. 17 1 - - 18 Fibrosis Ut.ri. 28 1 1 - 30 Uterine haemorrhage. 2 4 - - 6 Mastitis 13 10 - - 23 Menorrhagia. - 1 - - 1 Metrorrhagia. — - 1 - 1 Vaginitis. - 3 - - 3 Dysmenorrhoea. - - 2 - 2 Bartholin's Ah seess. . 4 - - - 4 Erosion of Cervix. 3 7 1 - 11 Deficient Pelvic Floor 15. _ — — 15 Subinvolution* - 1 - - • 1 Pelvic Peritonitis - 1 - - 1 Salpingitis. " 2 6 3 1 12 Hetroversion. 11 1 - 15 Salpmgo-oophritis 1 2 - — 3 Retained products. 4 - - - 4 Cervicitis. 3 5 * — 8 For Sterilization. - - 2 - 2 Urethral Ceruncle. - 1 - ~ 1 Cystocele. 3 1 - - 4 Cervical Polypus. 4 1 - - 5 Procidentia 2 1 — - 3 Pelvic Infection. 2 4 - - 6 U r o thrul t e a r. 1 - - - 1 Ova ri an ab sce s s. - 1 - - 1 Vaginal discharge. - 2 1 - 3 Byspsreunia. - - 1 — 1 Sterility. _ - 7 -* 7 Menopausal syndroms • - 2 - - 2 Pelvic abscess. - 1 - 1 2 Prulapsed Uterus. 2 2 1 - 5 Endocarditis 1 — — - 1 Prolapsed ovary. - 1 - - 1 Atresia of Vagina. 1 - - - 1 391 Maternj ty. For version _ 3 4 - 7 Pyelitis of Pregnancy. 9 13 2 - 24 Albuminuria of " 1 9 1 - 11 False labour pains. - 6 10 - 16 Ectopic gestation. 4 - - - 4 A.P.H. 2 4 1 - 7 R.B.P. 2 18 1 - 21 Toxaemia of pregnancy 2 17 1 - 20 Vomiting of " 13 6 - — 19 Anaemia of " - 1 - — 1 A.N. Observation. 6 24 23 - 53 A.N. Rest. - 4 1 - 5 Hydramnios. - 1 - -- 1 For termination of pregancy 1 ~ - — 1 P.P.H. 1 - - - 1 Ruptured tubal pregnancy - - - 1 1 192 _ - 16 - Diagnosis MEDICAL SURGICAL TOTAL Cured eved Unrelieved Died. Cured Relieved Unrelieved . Died Infectious. Influenza. 18 4 — - 22 Scarlet Fever. - - 4 - 4 Paratyphoid. - - 1 - 1 Dysentery. - 1 2 1 4 Whooping Cough. 1 - 7 - 8 Cerebro spinal fever 1 1 5 1 8 Influenzal Pneumonia 10 1 - - 11 Measles - - 12 - 12 Diphtheria - - 1 1 2 Chicken pox. - - 1 - 1 73 Mental. Uncertified. 1 20 94 - 115 Certified. - - 18 - 18 M.D. - 1 2 - 3 Epilepsy. 2 14 4 - 20 G.P.I. - - 3 - 3 Imbecile. - - 1 - 1 Senile Dementia. - 4 11 - 15 Loss of Memory. 1 2 1 - 4 Hysteria. - 2 - - 2 Cretin. - 1 - - 1 182 Nervous and Sensory. Cerebral Haemorrhage - 6 2 39 47 Meningitis. 4 - 1 6 11 Chorea. 5 2 - - 7 Hemiplegia. 8 3 - - 11 Sciatica. 2 2 - - - 4 Neurosis. - 6 2 - 8 Cerebral thrombosis. 2 9 5 22 - 38 Cerebral tumour. - - 1 - 1 Disseminated sclerosis. - 3 2 - 5 Paralysis Agitans. - - 1 - 1 Neuralgia. - 1 - - 1 Convulsions. - - - 1 1 Tabes Dorsalis - 1 2 - Parkinson's disease.- - 1 - 1 Cerebral arteriosclerosis - 3 3 - 6 Cerebellar tumour. - - 1 ~ - 1 Paraplegia. - 1 - 1 2 Cerebral abscess. - - 1 - - 1 Subarrachnoid haem: - 1 - 3 - 4 Motor Spasm. 1 2 - - 3 Landry's paralysis. - - - 1 - 1 Von Recklinghausens Dis. - - 1 - - 1 Apnesia - - 1 - 1 Tetanus. 1 - - - 1 Migraine. 1 1 - - 2 Cerebral degeneration-. - - 1 1 Tics. 1 - - - 1 Hydrocephalus. - 1 - 1 165 - 17 - - 18 - Diagniogis. MEDICAL SITRGI OAL TOTAL. Cured Rel- ieved Unrelieved Died, Cured Relieved Unrelieved Died. Respiratorsy. Bronchitis. 47 37 3 8 95 Pneumonia. 87 6 3 54 150 Pleural effusion. - 3 4 - 7 Brcnchiel caterrh. 2 1 - - 3 Bronchiectasis. - 8 3 1 12 Atelectasis. 1 1 - - 2 Pleurisy. 6 7 - - 13 Emphysema. - 2 - - 2 Aschma. 7 11 2 - 20 Empyema. - 3 - 2 5 Pulmonary abscess. - - 2 - 2 Neoplasm. - - 1 - 1 Spontaneous Pneumo thorax. 1 1 - - 2 Asphyxia. - - - 1 1 Fibre si s of lungs. - 2 - - 2 Tumour of lung. - - - 1 1 Pulmonary embolism - - - 1 1 319. Senility. 1 19 19 31 70. Skin Boils, abscess and carburials. - - - - 21 11 - - 32 Burns and Scalds. - - - - 9 4 - 4 17 Eczema 5 4 - - - - - - 9 Impetigo. 11 2 - - - - - - 13 Scabies 22 5 1 - - - - - 29 Dermatitis. 7 2 - - - - - - 9 Pemphigus, - - - 1 - - - - 1 Septic Spots. - - - - 1 3 - - 4 Lymphangitis. 1 - - - - - - - 1 Actinomycosis. - - - 1 - - - - 1 Celloitis. 2 6 _ 1 - - - - 9 Sinusitis. 2 3 1 1 - - - - 7 Ulceration. 4 6 1 - - - - - 11 Herpes. 2 1 - - - - - - 3 Papilloma. - - - - 1 - - - 1 Urticaria. 1 - - - - - - - 1 Erysipelas. - 1 - - - - - - 1 149 Pulmonary Tuberculosis. - 28 24 23 75 Non-Pulmonary Tuberculosis. Rib., - 1 - - 1 Spire. - 3 3 - 6 Moninges. - - - 5 5 Knee. - 2 - - 2 Gland s. - 3 1 - 4 Hip. - 1 - - 1 Shoulder. - - 1 - 1 Pericarditis - - - 1 1 Kidney. - 1 - 1 2 Epididymitis. - 1 - - 1 Elbow. - - 1 - 1 Miliary. - - - 1 1 Abdominal. - - 1 1 2 Cont. 28 19 MEDICAL SUTRGT CAL Died. TOTAL. Diagnosis. Cured Relieved Unre lieved Died Cured Relieved Unrelieved Nonr-Pulmonary Tuberculosis. (continued) 28 Saloingitis. - 1 - - 1 Pubis - 1 — — 1 30 Venereal. Syphilis. 1 3 5 4 13 Violonce. Fractured limbs. 26 72 7 21 126 „ spine. 1 4 - - 5 „ malleolus. - 2 - - 2 „ skull. - 2 1 2 6 „ ribs. 1 g - 2 5 „ clavicle. 1 2 - - 3 Minor injuries. 8 3 1 - 12 Contusions and abrasions. 11 21 1 2 35 Sprains. 2 1 - - 3 Dislocation. 1 4 1 - 6 Amputation - 1 - - 1 Ccncussicn. 9 21 - - 30 Lacerations, wounds etc. 17 23 - - 40 Removal of plaster. 5 7 1 - 13 G.S.V. - - - 1 1 Fractured Pelvis. 1 1 - - 2 Fractured sacrum 1 - - - 1 Fractured nasal bones. - 1 - - 1 292 Miscellaneous. Pelscming. 9 6 - l 16 Alcoholsm „ 1 3 1 2 7 B.B.E. 15 - - - 15 n.a.d 36 - - - 36 With Mother. 25 - - - 25 Hare, Up. - - 1 - 5 - - - 6 J aurcice.. 1 - - - 1 Prematurity. 2 - - - 2 Post-operative haem 1 1 - - - 1 - - 3 Hypoglycaemia coma. 2 - - - 2 Congenital biliary artresia - - - 1 1 P.U.O. 2 - - - 2 Haemoptysis. - - 1 — 1 Tetanus. 1 - - - 1 Cut throat. - - - - - - - 1 1 J 119 Total number of patients discharged from Mayday Hospital, Year ended 31st December, 1941. Cured 2502 Relieved 1174 Unrelieved 497 Died 630 4,803. 20 OPERATIONS PERFORMED AT MAYDAY HOSPITALduring 1941. Abdominal, Appendi cectomy. 146 Intussusception. 1 Appandix abscess drained. 3 Perforated gostric ulcer. 7 Suture of Perforated clu od ena 1 ulcer. 3 Castro jejunostomy 2 For anal fistula. 5 Sigmoidoscopy. 19 Ligature of haemorrhoids. 8 Herniotomy. 75 Injection of 7 Cholecystectomy. 21 For duodenal ulcer. 1 Laparot amy. 36 Tyrrell-Grey op. 1 Gestroentecroetomy. .4 Excision of papiloma Colostomy. 10 abdominal wall 1 For Pyloric stonosis 1 Gastroscopy. 4 Caecostomy. 1 356 Bones and Joints. For osteo-myelitis. 4 Bone graft. 2 Amputation of limbs. 14 Hallux Valgus. 2 Wiring; of bones. 13 Osteotomy 1 Removal of pin. 1 Incision and drainage Resection of rib. 7 of pre-patolla bursa. 1 Application of plaster 51 111 Manipulation of limbs. 13 Reduction of joints. 2 Ear, Nose and Throat. Mastoidectomy. 14 Antrostomy 1 Tonsillectomy. 141 Oesopliago scopy 1 Adenoidect omy. 3 Bronchoscopy. 2 Myringotomy. 7 169 Genito Urinary Cystoscopy. 41 Urethrotomy. 1 Circumcision. 9 Incision of ischio rectal Nephrectomy. 3 abscess. 2 Prostatectomy. 16 Pyelolit otomy. 1 Supra-pubic Cystotomy 27 Pylography. 3 For urethral stricture. 1 Insertion of Pilcher's Urethral dilatation. 6 Bag. 1 111 Gynsecoloi leal. Examination una r Ana -thctic 97 Utheral and cervical smears taken. 5 Total Eysterectomy. 6 Sub-total hysteroctomy. 30 Cervical polyp. 14 Salpingo-oophorectoy;. 10 Amputation of ccrvix. 5 Dilation Curetago. 67 Coipotomy. 8 Removal of ovarian cyst. 9 Twstd fibroid. 1 Salpingectomy . 4 Repair of ectocelo. 3 Induction of abortion 1 Bio'o sy of c o rvix. 2 Ovariotomy. 2 Removal of gauze packing from uterus. Suture of laceration of. 3 Incision of Bartholin's abn cess. 9 Insertion of pessary. 3 vsrinal wall. 1 Removal of pessary. 1 Le Fort's operation. 2 Colpo-perineorrhaphy. 7 Urethrotomy, 1 Cauterization of cervix. ry o Wethin's inter-position operation. 1 Baldy Webster operation. 8 Fothergill's operation. 5 Intra-uterine liniodol. 3 Insertion of Laminaria teats 1 Repair of Recto vaginal fistula. 1 Removal of leioinaria tents. 1 307 21 Obstetriccl. Caesarian Section 24 Evacuetion of uterus and glycerine pack. 139 For Ectopic gestation 5 Induction of Labour. 42 Hysterotomy. 1 211 Miscellaneous. Blood transfusion. 53 Incisions, ob. ceases etc. 98 Cleansing burns, etc. 10 Amputation of breast. 4 Suture of Tjounds. 15 Thiersch skin graft. 2 Excision of - ounds. 6 Lumbar puncture. 63 Aspiration of chest. 63 Aspiration of left tunica venticia. 1 Aspiration of abdominal wall. 1 Aspiration of abdomen 1 Aspiration of hydrocele. 2 Remove1 of nail. 5. Romoval of F.B. 2 Parecontesis. 23 Suture of tendron. 1 For hare lip. 4 A. P. Rifill's. 4 Extraction of teeth. 6 Thyroidectomy. 3 Injection of varicose veins. 1 Ligature of varicose veins. 1 Thoracotomy. 1 368 Number of Patients who have had teeth extracted 147. - 22 - PUBLC ASSISTANCE. (a) Domiciliary Relief. Number of Croydon cases resident in the Borough and in receipt of outdoor relief on the- 1st January, 1941 1900 persons; 1065 cases 1st July, 1941 1730 „ ; 1028 " 1st January, 1942 1832 „ ; 1016 " Expenditure on Outrelief during the 12 months ended 30th September, 1941 to Crovdon cases resident in the Borough. Half-year ended 31st March, 1941 £32,103.13.Od Half-year ended 30th September,1941 £29,611.11.6d (b) Institutional Relief. Number of Croydon poor persons relieved in the Mayday Hospital on 1st January, 1942 end in the Queen's Road Homes on the same date Mayday Hospital 14, Queen's Road Homes 497. (c) Medicel Relief. In May 1941 the Public Assistance Committee decided to form one panel for all districts in the Borough operating the scheme instead of separate panels for each district. Particulars for year ended 31.3.42:- All Districts. 1. Average number of separate patients 1241 attended during each quarter 2.Attendances at patients' homes 9517 3.Attendances on patients at the surgery 10734 4.Total number of prescriptions written 20208 5.Estimated cost of drugs, dressings & £850;15;4d. dispensing 6.Estimated amount of per capita payment to doctors in respect of patients actually attended, (calculated quarterly) 3s:0.24d 7.Estimated average payment per service point l,22d - 23 - CASES OF NOTIFIED INFECTIOUS DISEASES, 1941. Notifiable cisease. Cases notified in the whole district at ager - years Total cgres notified in each Ward Total cases removed to Borough Hospital and Diagnosis confirmed Total Deaths in respect of the Borough. Sex Distribution Upper Norwood Norbury West Thornton Bensham Manor Thornton Heath South Norwood Woodside East Aldiscombe Whi tehorse Mar Broad Green Central VJaddon South Mdington At all ages Under lyr. 1-5 6-15 16 - 25 26 - 45 46 - 65 66 and up M F Small Pox - - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - — - - - — - - — - - - Diphtheria 63 - 20 17 18 8 - - 3 4 5 1 3 2 1 1 8 5 13 1 12 - 4 61 4 30 33 Erysipelas 37 - - 1 2 o O 21 5 4 1 5 6 3 2 - 1 6 2 4 1 1 1 - 15 - 11 26 Scarlet Fever 181 - 47 74 57 20 2 - 7 8 16 8 8 16 12 21 15 18 22 4 9 8 9 155 - 86 95 Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - - Enteric Fever & Paratyphoid 10 . _ 5 1 - - 5 1 - - - - - 2 1 - - - 1 - - 7 1 4 6 Puerperal lyrexia 51 - - - 23 28 - - - - 32 1 2 2 1 1 — 2 3 1 - 4 2 9 - 51 Cerebro Spinal Meningitis 32 - 12 5 5 8 2 - 3 3. 2 1 3 1 1 2 2 6 1 1 - 3 25 9 19 13 Ophthalmia Neonatorum 17 17 - - - - - - - - 5 - - _ - _ _ 6 5 1 1 1 - 7 — 8 9 Poliojmyelitis and Polioencephalitis - - - - - - - - - - - - - - - - - - - - - - 3 3 2 1 2 Encephalitis Lethargica 1 - - - 1 - - - - - - - - - - - 1 - - - - 1— 1 _ 1 1 Dysentery 8 - 3 , 2 2 - 1 - - - 2 - - 1 - - - 3 1 - . - 1 6 - 6 2 Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - _ Ac. Primary Ac. Influenzal Pnaumcnia 55 2 9 3 10 9 14 8 - 2 6 5 8 1 2 4 9 1 7 4 2 3 1 1 35 26 29 Measles 1588 38 346 656 *35 12 1 - 45 59 111 114 221 144 126 92 100 101 101 78 49 64 183 26 5 808 780 whooping Cough 939 103 569 249 3 10 2 30 51 25 64 35 155 49 40 41 73 68 65 103 19 41 112 58 6 478 461 24 Notified Disease. Incidence Rate per 1,000 population 1941 1940 Housing Conditions Case occurring in Institutions in the Borough Total cases notified#/##] 1 - 3 rooms 4-5 rooms Dvor 5 rooms Sniall Pox. - - - - - - - Diphtheria. 0.34 0.34 5 47 8 3 63 Exysepelas. 0.20 0.23 4 22 8 3 37 Scarlet Fever. 0.98 0.79 12 125 22 22 181 Enteric Eever (Inc. Paratyphoid) 0.05 0.10 - 3 2 5 10 Puerperal Pyrexia. 0.28 0.22 - 2 2 47 51 Cerebro-spinal Meningitis 0.17 0.21 - 23 5 3 31 Ophthalmia Neonatorum. 0.09 0.07 2 5 - 10 17 Poliomyelitis and Polioencephalitis 0.02 0.01 - 3 - - 3 Encephali tis Lethargica 0.01 - 1 - - - 1 Acute Primary or Acute Influenzal Pneumonia. 0.30 0.25 3 38 14 - 55 Dysentery. 0.03 0.04 - - 6 6 The 1931 Census shoved that housee 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 rooms 43.9%-. Comments on the Incidence and Prevelence of Infectious Disease. Scarlot Fever was more prevelent than in 1940; the largest incidence has been in East, Broad Green, Whitehorse Manor and Aldington Wards. The incidenco rate of Diphtheria was 0.34, the same as in 1940. No cases of Small Pox occurred during the year. There wore. 51 cases of Puerperal Pyrexia; 23 occurred in the age group 16 - 25 years and 28 in the age group 26-45 years. A majority of the cases Occurred in women having their first confinement. 25 Borough Hospitsl Table A gives a summary of all cases treated at the Hospital during 1941. 473 patients were admitted and discharged which, together with peitj ents in at the commencement of 1941 (25) gives a total of 532 cases death with. Twenty-five died giving a ease mortality for the Hospital of 4,8% as against 406% in 1940. Perge Urban District Council have sn arrangement with the Corporation to send their cases to the Hospital. During 1941 a total of 26 cases were admitted, t'ese are included in the table. The Hospital is a recognised training school for nurses. During the year 2 probationers passed the preliminary examination of the.General Nursing Council, , Owing to the greatly reduced number of cases: admitted, one of the scarlet fever wards and a diphtheria ward were closed during the year. The following operations were performed in 1941:- 1 case ofocuto appendicitis. 1 acute mastoid„ 1 removal of eyeball. 1 tonsils and adenoids. During the severe aif raids which took place in the year a bomb Sell in the hospital grounds on April 16th, completely demolishing the discharge block and severely damaging the diphtheria ward (B) which was occupied at the time. The laundry and mortuary were also damaged by blast. Fortunately there were no casualties through this raid. 26 TABLE A. Complaint for which admitted Patients remaining in Hospital 1.1.41. Patients Admitted & Discharged in 1941. Patients Admitted in 1941 & remaining in hospital 1,1.42. Analysis of cases admitted, whether discharged or not during the year, Total Recovered Died Total Re cove red Died Total Recovered Died Total Recovered Died Case Mortality Average No. of Days in Hospital Scarlet Fever 19 19 - 155 154 1 14 14 - 169 168 1 % 0.6 34.5 Diphtheria 4 4 - 109 106 3 6 6 - 115 112 3 2.6 31.6 Enteric Fever - - - 1 1 - - - - 1 1 - - 70 Para-Typhoid 1 1 - 7 7 - - - - 7 7 - - 32 Fever Puerperal Pyrexia - - - 10 9 1 - - - 10 9 1 10.0 22.6 Puerperal Fever - - - 1 - 1 1 1 - 2 1 1 50.0 23 Erysipelas - - - 15l 15 - 1 - 1 16 16 - - 16.4 Measles 3 3 - 27 24 3 - - - 27 24 3 11.1 14.3 Rubella - - - 15 15 - - - - 15 15 - - 14 C. S. M. 1 1 - 31 21 10 1 1 - 32 22 10 31.2 17.5 Whooping Cough - - - 58 54 4 4 4 - 62 58 4 6.4 30,4 Chicken Pox - - - 7 7 — - - - 7 7 - - 23.1 Mumps - - - 6 6 - - - - 6 6 - - 16.9 Tonsillitis - - - - - - - - - - - - - - Poliomyelitis - - - 3 3 - - - - 3 3 - - 59.1 Dysentery 1 1 - 5 5 - - - - 5 5 - - 10.2 Pemphigus - - - - - - - - - - - - - - Vincents Angina - - - 1 1 - 1 1 - 2 2 - - 13.1 Pleurisy 1 1 - - - - - - - - - - - - Phlebisis - - - - - - - - - - - - - - Tuborculosis - - - 7 5 2 1 1 - 8 6 2 25.0 142 Ophthalmia - - - 5 5 - - - - 5 5 - - 9.2 Dermatitis - - - 2 2 - - - - 2 2 - - 6.1 No Disease 1 1 - 12 12 - - - - 12 12 - - - TOTALS 31 31 - 477 452 25 29 28 1 506 481 25 27 Scarlet Fever, The total number of Scarlot Fever cases admitted during the year was 169, an increase of 22 on 1940. The type of disease admitted during the year was of moderate severity. 4 cases sent in as Scarlet Fever were not suffering from the disease. The following complications and sequelae occurred amongst the true Scarlet Fever cases:- Table B Serum Cases Non- Serum Cases Total Total cases 56 109 165 Adenitis 6 6 12 Otorrhoea 2 5 7 Khinarrhoea - 4 4 Relapse. 2 1 3 Rheumatism 2 - 2 Broncho-pneumonia - 1 1 Acute Appendix 1 "" 1 The average stay in hospital of serum cases was 34,8 days and of non-serum cases 34.5 days. One death oceurred amongst the Scarlet Fever cases, this was due to r.cutc appendicitis with perforation having developed two days after the patient's admission to hospital, and general peritonitis supervening later. The number of complications amongst the 109 non-sarum cases was 17, whereas the complications amongst the serum cases was 13. Prontosil album was again found useful in clearing up of persistent otorrhoea in some cases, as was M.B.693. Ages & Sexes Admitted. Table C. Age Wale Female Totale % 0-1 - 1 1 0.59 1-2 3 5 8 4.73 2-3 4 5 9 5.33 3-4 7 4 11 6.51 4-5 6 11 17 10.05 5-10 28 25 53 31.36 10-15 7 5 12 7.10 15-20 7 16 23 13.61 20-30 7 13 20 11.83 30 or over 4 11 15 8.88 Total 1941 -73 96 169 Total 1940 -79 68 147 28 Diphtheria. 115 cases were admitted with a diagnosis of Diphtheria, an increase of 12 cases on 1940. Of these 16 were found not to be oajos of Dipat eria and 40 nere cases of positive swabs without clinical sjmptoms leaving 59 cases of true clinical diphtneria. There were 2 deaths, a mortality of 5%. Analysis of the 59 cases:- Faucial diphtheria 53 Nasal diphtheria 3 Laryngesl dipb bheria 2 Faucial & nasal diphtheria Faucial & Laryngeal diphtheria 1 Total 59 The following pornplications and sequelae occurred amongst the diphtheria caees:- Rhinorrhoea 3 Secondare sore throat 1 Albuminuria 3 Heart failure 4 Adenitis 4 Farslysis:- Palatal 5 Eyes 2 Diaphragm AGES AND SEXES ADMITTED. Table D. Age Males Females Totals Percentage o-1 - 2 2 1.74 1-2 6 4 10 8.70 2-3 9 3 12 10.43 3-4 3 5 8 6.96 4-5 5 4 9 7.83 5-10 15 8 23 20.00 10-15 5 8 13 11.30 15-20 5 9 14 12.17 30-30 5 11 16 13.91 3o or over 3 5 8 6.96 Total 1941 56 59 115 Total 1940 44 67 111 29 Typhoid and Para-Typhold Cases. During the year 8 cases of typhoid and para-typhoid fever were admitted and in all the diagnosis was confirmed. No deaths occurred amongst them. Of the 8cases admitted one was a case of typhoid fever, whereas the other 7 ware cases of para-typhoid B. Puerperal Fever. During the year there were 2 cases of Puerperal Fevor and 10 of Puerperal Pyrexia. Two deaths occurred amongst the twelve cases. The two cases of puerperal fever wore complicated as follows:- 1 was complicated by general septicemia. 1 was complicated by thrombo-phlebitis. One of Hig puerperal pyrexia cases was complicated by pneumonia and pleurisy. Erysipelas. There were 16 cases of Erysipelas admitted, a decrease of¢ one case on 1940. In one case the diagnosis was not confirmed, the case being one of a septic ulcer of the leg. One death occurred amongst them due to being complicated by Morbus Cordis. MeasLos. There wore 2? oases of measles admitted, and 3 deaths occurred rmongst them dua to being complioatcd by Broncho-pneumonia. In 3 of the twenty-seven cases the diagnosis was not oonfinnad, 2 being cases of Dermatitis and 1 a case of Urticaria, The disgaso was of average severity. Whooping Cough, There were 62 cases of Whooping Cough admitted and 4 deaths occurrod enongst these being complicated by Broncho-pneumonia, There was an increase of 58 cases on 1940, Cerebro-Spinal Meningitis. There were 32 cases of Cerebro-Spinal Meningitis, but of these only in 22 cases was the Diagnosis confirmed. Of the other 10 the diagnosis was as follows:- 3 were cases of Tubercular Meningitis. 3 ware cases of Influenza, 1 was a case of Coryza. 1 was a case of Encephalitis Lethargica. 1 was a case of Trismus. There were lQ daeths amongst ther, but 2 of the daeths occured in the Tuber cular Meningitis group. The disease was of a fairly sever type, but in the cases admitted in the early stages the response treatment was very good. The treatment consisted in lumbar mncture on admission with the administration of 20-30 c.c. meningococcus anti-toxin intra-the cenlly. At the same time sulphapyridine was given in doses of 2 grms. repeated in four hours time, and then 1 grm. was given four-hourly. T is was continued for 4 to 5 days. In the case of children, half the adult dose was similarly given, whilst in those cases who were sick after giving the drug, the soluble form in doses of 2.5 c.c. was administered by intra muscular injection. 30 The response to this treatment was really remarkable in some cases, the temperature falling within 24 hours rapidly to normal and the patient from being delirious and violent, becoming more rational and quieter. No 111 effects were, observed from the admiri strati on cf this drug, beyond some named eyanosis at times and repeated vomicing in those eases who could not tolerase the M.B. 693 given by mouth. The death rate amongst the 22 cases was 31.8% Open thalmic & Noon acocum Five cases Were admitted, but only in one case was the diagnosis confirmed tha other four being cases of simple ophthalmia. Infontle & Paralysis. Three ceaos of this disease, were admitted, two of which were fairly severe. In these only partial recovery took place whilst in hpspital. No deaths occurred. Dyeentery. Five cases were admitted, being all of the Sonne type and mild in character. Mumos. Six casos of the disease were admitted, but in one the diagnosis was not confirmsd, it baing a case of Scarlet Fever with Nephritis. Tuberculosis. During the year. 8 cases of this disease were admitted temporarily, some being tater transferred to Cheam Sanatorium. Two deaths occurred amongst them. Table F. OUT O0F BOROUCH CASES. Disease Males Females Total Deaths. Scarler Fever 2 7 9 - Diphtneria 7 8 15 1 Dysentery, Sonne) 1 - 1 - Para-typhoid B. - 1 1 - 31 Borough hospital. Laboratory Annual Report, 1941. Diphtheria. Swabs positive on Admission Swabs Positive during Convalescence Total Negative Totals.[/##] 67 117 1759 1943 Faeces examined for Enteric and Dysentery Groups. Sonne Dysentery Positive Para.Typhosus B Positive Total Negative. Totals. 8 3 47 58 Sputurns examined for presence of Tubercle Bacillus. Positive Negative. Totals 12 5 17 Cerebro-Spinal Fluids for examination. Pfeiffer Bacillus Positive. Meningococcus Total Negative. Total Examined. 1 14 8 23 Miscellaneous Examinations. Urines. Examination for organisms, sugar estimation and routine 17. Swabs - For presence of Vincents Angina - 2 Positive - 2 Negative - Total 4 Swabs - Examined for Gonococci - 1 Vag Swab 1 Negative - 3 Eye Swabs Negative -Total 5 Swabs - From skin examined for organisms - 3 Staph. Aureas - Total 3 Pus - for organi sms - 1 B.Coli present - Total 1. Culture Media. Leofflers Blood Serum - 180½ doz. Agar Agar - 3,500 c.c. Peptone Water - 2,500 c.c. MacConkey's Media - 1,160 c.c. Litmus Milk - 500 c.c. 32 TABLE E. AGE GROUPS OF CASES ADMI TTED (other than Scarlet Fever and Diphtheria) 0 - 1 1 -2 2 - 5 5 - 15 15 - 25 25 - 35 85 - 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 - Pera-typhoid B. - - - - - - - 1 1 4 - - - 1 - - 7 - Puerperal Fever - - - - - - - - - - - 2 - - - - 2 1 Puerperal P- rexia - - - - - - - - - 7 - 1 - 2 - - 10 1 Erysipelas - - - - - - - - - - - 2 5 - - 9 16 - Measles 4 2 1 1 4 7 2 1 4 - - - - - - 27 3 Rubella - - - - 1 1 2 - 2 - 8 1 - - - - 15 - C. S. M. 1 - - 3 3 8 2 1 3 1 2 - 2 2 2 2 32 10 Whooping Cough 28 6 9 s 2 7 2 - - - - - - - - - 62 4 Chicken Pox 1 - - - 1 - 1 2 - 2 - - - - - 7 - Ophthalmia 2 3 - - - - - - - - - - - - - - 5 - Mumps - - - - - - - - 2 2 2 - - - - 6 - Vincent's Angina - - - - - — - 1 1 - - - - - - - 2 = Ainterior Poliomyelitis - - 1 - - 1 1 - - - - - - - - - 3 - Dermatitis 1 - - - - - 1 - - - - - - - - - 2 — Tuberculosi s - - - - - - - - - - 1 1 2 2 1 1 8 2 Dysentery Sonne - - 1 - 2 - - 1 1 - — — — - - - 5 - - No disease 12 - - - - - - - - - - 1 - - - - 12 - TOTAIS 49 11 12 12 13 24 11 7 14 18 13 7 9 7 3 12 222 21 33 AT THE LABORATORY, CROYDON GENERAL HOSPITAL For private practitnrs. Mayday Hospl. For Borough Hospital For Chest Clinic For School Medical Other Instns of Corpn. Other Institns. Total Pos. Neg. Pos. Neg Pos. Neg. Pos. Neg. Pes Neg. Pos. Neg. Pos. Neg. Pos. Neg. Swabs for diphtheria 44 707 ... ... ... ... ... 6 28 939 4 58 ... 119 76 1829 Virulence tests for diph. ... ... 1 1 ... 1 ... ... ... ... ... ... ... ... 1 2 Sputum for Tb. Bac. 49 454 ... ... ... ... 436 638 ... ... ... 1 11 52 496 1145 Pus for Tb. Ba.c. ... 2 2 1 ... ... ... ... ... ... ... 9 ... ... 2 12 Pus for Gonococci 2 4 ... ... ... ... ... ... ... ... 3 51 ... ... 5 55 Pus for other or goni sms ... 4 ... ... 1 ... ... ... ... ... ... 12 ... ... 17 Blood for typhoid groups, 3 14 ... ... ... 1 ... ... ... ... ... ... ... 4 3 19 Blood for Wasserman ... 2 24 164 ... 1 ... ... ... ... 2 5 ... ... 26 172 Material for Spirochaetes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Faeces for Typhoid Group 1 21 ... ... ... 1 ... ... ... ... ... 2 ... ... ... 24 Hair for Ringworm ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 Examination of Urine 1 2 ... ... ... 8 ... 11 Examn. of Pleural Fluid ... ... ... ... ... ... ... ... Examn. of C. S. Fluid ... 17 ... ... ... ... ... 17 Other Examinations 34 i 280 5 •... 9 91 1 420 I BACTERIOLOGICAL EXAMINATIONS. I an indebted to the Borough Pothologrst, Dr. H. W. Southgate, for the figures given in the appended tables. 34 Examinations done under the National Health Insurance Act. Nature of Examination: Nature of Examination; Pus for Gonococci 8 (1 pos.) Urine for Chemical Examination 2 Pus for other organisms 9 Urine for Microscopical Examn. 2 Pus for Tub. Bac, 3 Urine for Tub, Bac. 2 Blood for I'Jasserman 10 (2 pos,) Urine for Cultural Exam. 2 Complete Blood Counts 10 Other examinations 7 Bacteriological Examination of Milk. Number of Samples submitted for Counts 347 Number under 10,000 per cc 69 Number over 10,000 but under 50,000 per cc 126 Over 50,000 but under 100,000 per cc 49 Over 100,000 but under 500,000 per cc 57 Over 500,000 but under 1,000,000 per cc 5 Over 1,000,000 per cc 41 Tubercle Bacilli- Number of samples of milk submitted 346 llLL-iber found positive by inoculation test 1 The number cf milk examinations decreased by 42 Number of samples still under investigation for Tb.B. 38 Milk Samples. 347 milk samples submitted to the Methylene'Blue Test, of which 68 failed do satisfy. Of these 22 were further investigated and three of them were found satisfactory to the Bacillus Coli test. IMMUNISATION AGAINST DIPHTHERIA During 1941 the routine of the Diphtheria Immunisation Clinics remained unchanged, that is to say, ilium precipitated toxoid was the prophylactic used, and Schick testing both before and after treatment was, except for a few cases, dispensed with. This meant only two visits compared with four or five of former years. New cases came from the following sources- School cases 4477 Infant Welfare eases 12-39 Others under 5 years 923 The ensuing tables give some further details- Total number of Sessions held 206 Highest att ndance at any one session 172 Lowest attendance at any one session 8 Average attendance per session 61 - 55 - Summary of Work of Clinic since its start. Year Total attended for treatment Mewcases attended. No. of Sessions held fiver a ge attend. per Session Number given primary Schick % Pos. on primary Schick No. given posterior Schick No. Neg. on Post Schick % Neg. on Post. Schick No. Completed Treatment 1934 509 509 ... 36 389 ... 185 ... ... 185 1935 1431 1151 97 58 634 76 781 766 98.8 781 1936 2285 1661 145 61 1215 78 1264 1254 99,2 1264 1937 1894 1286 122 58 1017 86 1222 1215 99.5 1222 1938 2049 1541 115 56 1208 69 1152 1140 98.9 1152 1939 1488 1020 61 63 593 76 678 671 98.9 1201 1940 508 42 8 33 28 • • • ... • • • • • • • • • 419 1941 6639 6639 206 61 • • • • • • • • • • • • • • • 5833 Summary of Attendances and Treatment 1941 Under Treatment 1.1.41 Received A.P.T. Defaulted new cases 1941 Nil Nil Nil 6639 1941 cases completed treatment Received A.P.T. Under treatment 31.12.41 Defaulted 5833 6639 490 316 Origin and Source of Cases Attending. Year School Inf. Welfare C. Others under 5 years Total % Total % Total % 1934 339 67 ... ... 1.70 055 1935 944 66.6 265 18.7 208 14.7 1936 1620 74.8 310 14.3 257 10.9 1937 928 72.2 155 12.0 '.205 15.8 1938 1179 76.5 130 8.4 252 15.1 1939 704 69.0 225 22.0 91 9.0 1940 216 50.0 98 23.0 114 27.0 1941 4477 67.4 1239 18.7 925 15.9. Immunisation in Residential Schools and Homes. Owing to the evacuation of Residential Schools and Homes, no immunisation was conducted in the Institutions in 1941. 36 VACCINATION ACTS. I am indebted to Mr Huggins, the Vaccination Officer, for the particulars in the returns in the subjoined Tables. Rogistrati on Sub-districts in. V.O.District Births Registered Vaccinated Insusceptible Statutory Declrn. Died unvaccinated P.PiO. Transfd. to other V.Js. Untraoed Removals In Default Overage when Registered. South Sub District 836 349 3 266 24 9 63 60 62 ... Wort sub District 1242 462 6 512 37 22 15 91 96 1 Nourth Sub District 433 166 2 167 12 8 11 34 32 1 2511 977 11 945 73 39 89 185 190 2 During the year 1,429 Poms Q wore sent to parents, and 100 Forms K. Forn Q is the Forn drawing.attention to the requirements of the Vaccination Acts and Pom K refers to eases in default. 788 names were sent on the H lists to Public Vaccinators to be visited. Return shewing the Numbers of Persons vaccinated and re-vaccinated at the cost of the rates by the Medical Officer of the Publio . Assistance Institution's and the Public Vaccinators during the year ended 30th September, 1941:- Name of Public Assistance . Institution of Vaccination District Numbers of successful primary Vaccinations of Persons. Number of successful revaccinations i.e. successful vaccinations of persons who had been successfully vaccinated at some previous time. Under one yr of age One year & upwards Total Ci'oyuon No. 1 Area 146 7 153 1 No. 2 Area 108 5 113 2 No. 3 Area 68 3 71 1 No. 4 Area 59 2 61 1 No. 5 Area 168 rr O 171 1 Addington 45 3 48 - Queen's Road Homes 1 - 1 - Mayday Hospital 1 1 2 1 Children's Homes - - - -■ Shrirley Residential Schools - - - - 596 24 620 7 37- VENEREAL DISEASES. No changes have been made in the Scheme as given in my Report for 1930. Attendances at the Croydon Clinic duringj past ten years. 1932 1933 » 1934 1935 1936 1937 1938 1939 1940 1941 Now mle patients 235 242 297 207 300 395 416 316 187 448 (a) New female patients 241 214 232 213 188 184 257 191 202 258 (a) Attendances (Maies) 4691 4578 5858 5548 7525 8610 7318 4258 2996 3033 (a) do (Females) 2724 2677 3962 5977 5226 5405 5365 3150 1772 1508 (a) (a) Includes 124 new cases and 1029 total attendances by patients from outside areas. Attendances of Croydon patiants at various London Hospitals under General Schem e There wore 58 new patients, who made a total of 1161 attendances. Pathological Examinations at London Hospitals for Croydon Patients. 418 Examinations were made for various Clinics and 948 Examinations of material submitted by medical practitioners. Bacteriological Examinations carried out at London Hospls for Croydon Patients. Hospital Detection of Spirochaetes Detection of Gonococci Wassoman Re-action Other Exams Total For For For For For For For For Clinic Prac. Clinic Prac. Clin Prao. Clin Prac. St. Thomas 1 ... 65 ... 41 ... 71 ... 168 South Lon. Eos. for Women ... ... 15 5 8 3 3 4 38 Royal Free ... ... 20 ... 1 ... 2 ... 23 King's College ... ... 46 ... 18 ... 10 ... 74 Whitechapel Clinic, L.C.C. ... ... 1 ... 2 ... ... ... 3 Westminster Hospital ... ... 5 ... ... ... ... ... 5 Guy's Hospital 14 ... 20 460 12 150 16 326 998 Mothers . ... ... 48 ... 8 ... 1 ... 57 Total 15 ... 210 465 90 153 103 330 1366 Croydon Cases attending London Hospitals. Hospital Cases seen for the first time Conditions other than venereal Total number of attendances Aggregate number of Inpa tient Days Syph. Go n. . St. Thomas's 3 5 17 361 ... Guy's ... ... 8 148 ... King's College 1 3 8 418 16 Royal Free 1 ... 2 31 ... S. London IIosp for Women ... 3 1 88 ... JThitechapel Clinic, L.C.C ... ... 1 2 ... iVe strains to r 1 1 1 86 ... Mathers ... ... 2 27 50 Total 6 12 40 1161 66 38 Return relating to all persons who were treated at the Treatment Centre at Croydon during the yoar ended 31st December 1941. Syphilis . Soft Chancre Gonorrhoea Non-venereal or undiagnosed conditions Totals M F M F M F M F M F Total Numbcr of cases on 1st January under treatment or observation 54 58 ... ... 16 9 V 5 8 75 75 150 . 2. Tumbor of eases removed from the Registor dur— ing any previous year which returned during the year urder report for treatmont or observation of the same infection ... ..2 ... ... 4 ... ... ... 4 2 6 3. Number of cas os dealt with for the first time during the year' under report (exclusive of cases under Itoh 4) suffering fromSyphilis, prirmary 3 3 ... ... ... ... ... ... 3 3 6 ,, seccnaary 4 4 ... ... ... ... ... ... 4 4 8 ,, latent in 1st yr of infection 2 • • • ... ... ... ' • • • 2 2 ,, all later str ps 6 7 ... ... ... ... ... ... 6 7 13 ,, congenital 2 4 ... ... ... ... ... ... 2 ... 6 Soft Chancre ... ... • • • ... ... ... ... ... ... ... ... Gonorrhoea, 1st yr of infection ... ... ... ... 72 32 ... ... 72 32 104 ,, later ... ... ... ... 7 5 ... ... 7 5 12 Non-venereal conditions ... ... ... • • • ... ... 88 201 88 201 289 Conditions rjmaining undiagnosed at 31st December ... ... ... ... ... ... 1... ... Number of cases dealt with for the first time during the yoar under report known to have received treatment for the s arte infection, or to have been und r observation at other Centres (56) (210) (266) 17 14 ... ... ... 2 ... ... 17 16 299 142 94 ... ... 309 48 93 209 544 351 895 Figures in brackets refer to Service cases. Syphilis Soft Chancre Gonorrhoea Non-venereal or undiagnosed conditions Totals M. F. M. F. M. F. M. F. M. F. Totals. 5. Number of cises discharged after completion, of treatmeit and final tests of cure or after diagnosis as non-venereal 10 12 - - (87) 155 26 80 196 245 234 479 6. Number of cases which ceased to attend before completion of treatment and were, on first attendance, suffering from:- Syphilis, primary - - - - - - - - - - - " , secondary - - - - - - - - - - - , latent in first year of infection — _ - _ - - - - - - - , all later stages 2 2 - - - - - - '- 2 4 , Congenital - - - - - - - - - - - Soft Chancre - - - - - - - - - - - Gonorrhoea 1st Yr. of infection - - - - - — - - - - - „ Later - - - - - - - - - - - 7. Numbei of cases which ceased to attend after completion of treatment but before final test of cure 10 6. - - .12 2 - - 22 8 30 8. Number of cases transferred to ocher Centres or to institutions, or to cars of private pr?ctLticners. 4 2 - - - 12 - - 4 14 18 9. Number of cases remaining under treatment (58) or observation on 31st December. 116 72 - - (130) 142 8 (13) 13 271 93 364 TOTALS OF ITEMS 5, 6, 7, 8 and 9 142 94 - - - 309 48 93 209 544 351 895 40 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 the individual attention of the medical officer(s) (712) 1304 907 - - (564) 960 192 183 364 (1276) 2447 1463 (1276) 3910 (b) for the intermediate treatment e.g. irrigation dressing. - - - - 576 10 20 35 596 45 641 TOTAL ATTENDANCES 1304 907 - - 1536 202 203 399 3043 1503 4551 11. In Patients:- (a) Total number of persons admitted for treatment during the year i 2 4 - - 1 - - - 2 4 6 (b) Aggregate number of in Patient days of treatment given 80 4 - - 20 - - - 80 4 84 Under 1 Yr. 1 & under 5 Yrs. 5 & under 15 Yrs. 15 Yrs. &.c over Tot als. M F M F M F M F M F 12. Number of cases of congenital syphilis in item 3 above classified according to age periods. 1 1 - - - - 1 3 2 4 Mi croscopical for Syphilis for Gonorrhoea Others for diagnosis of Venereal Disease 13. Pathologi cal Work:- Number of specimens examined at, and by the Medical Officer of, the Treatment Centre. - - - The figures in brackets refer to Service Cases. 41 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 Croydon Surrey Kent London Total. (or Country in tho case of persons residing else herj than in England and -ales) to by inserted in these headings. A. dumber of cases from each rea inclr.ded under the following headings in item 3:- Syphili s 20 5 2 2 29 Soft Chancre - - - — - Gonorrhoea 69 36 5 6 116 Non-venereal and undiagnosed conditions 227 58 4 6 295 Total 316 99 11 14 440 B. Total nunbor of rttendcnces of all (1,276) (1,276) patients residing in each area. 2,246 2,072 116 117 4,551 Figaros in brackets refer to St, vice cases. The Croydon Branch of the British Social Hygiene Council which receives a grant of £50 annually fron the Borough Council towards its expenses carried out a programme which had been adopted to war-ticie conditions. I an indebted to the Hon. Secretery, Mrs.?. ?. Allen for the following report. During the year the work of the Branch has boon handicapped by wartime conditiona and also changos in the British Social Hygiene Council itself. Mrs. A. Moat, vho had previously filled, the posts of Chairman and Hon. Secretary, was ro )elected as Chairmen, and Mrs, P Allen, B,Sc., who had been invited on to the coEdttee as elected as Hon. Secretary. Mrs, Hunt continued as Hon. Treasurer. Dr, A, C. West, as representative on the war Emergency Committee, reported on its meetings from time to time. One of tho inain aims of the year's work vas to co-operate with the Youth Croups of the town, and a sub-commi teo of the Croydon Youth Committee and this Branch wa. set up to plan this work, By this moans, some lectures were arranged and literature was sent to several clubs for distribution. Literature was also circulated to msmbers of the Forces through the Y.M.C.A. Cveral youths clubs .'rote to ask for lectures and films, ana often had to be refused because the numbers in the clubs did not warrant the expenses involved. A further attempt as nede to introduce lectures to local factories and Government Training Centres, but was unsucessful Posters were distributed aaongst the chief A,R.P, shelters in the town. Lectures and courseruplenned for the early part of 1942 had to be cancelled owing to the changes which were taking place at head quarters and the consequent uncertainty of the position of the branches. The bulk of the British Social Hygiene Council's work was being taken over by the Central Council for Health Education, working una r the Ministry of Health. This raisee many financial problems as grants wero to be made direct to this body and the British Social Hygieno Council would exist on voluntary funds. Plans wero postponed until, the question of breaches was ir.de quito clear. An invitation received, later from Dr. Holden suggested that this Committee should take up work under the Central Council and, acting with him, continue a progremao of work similar to that followed previously but possibly extended on the linos .of general health education. The Coiaraittoe welcomed and accepted this lnvit. tation, with the intention of re-organisation if necessary to fill the needs of the new system. At the time of writing, however, the exact position of the branches of the British Social Hygiene Council and Central Council for Health Education is still awaiting discussion at Head quarters. It is hoped that this matter will soon be cleared end further work undsrtahen. Buring July four lectures were given by Dr. Mart to girls of the Selfurst Crammer School, both at Guildford (whore some are evacuated) and in Croydon. 50 girls wore present, at the Guildford lectures and 40 at the Croydon Croydon lectures. November and December 1941. A Youth Course was arranged through the Y. W. C. A. in Croydon, It consisted of:- Lecturer. Attendance. Mixed mooting Mr. Hoggard 70 Me ting for boys Mr. Hoggard 20 Meeting for girls Mrs. Hume 50 Meeting for girls Mrs. Hume 50 Mixed meeting Mrs. Davidson 60 At these meetings films wore shown to illustrate the lectures, and each was follwwoc by a keen discussion. CANCER. Depths from Cancer numbered 377 as compared with 443 in 1940; 414 in 1939; 380 in 1930; 421 in 1937; 421 in 1936; 3£1 in 1935; 371 in 1934; 374 in 1933; and 341 in 1932 Death-rate per 1,000 of the population for the previous 10 years are as follows:- 1932 1.44 (341) 1933 1.56 (374) 1934 1,54 (371) 1935 1.33 (321) 1936 1.75 (421) 1937 1.74 (421) 1938 1.56 (380) 1939 1.78 (414) 1940 2.22 (443) 1941 2.04 (377) Deaths from Cancer Occurred at the following ages:- Age period Male Female Total Calculated population at this age period Incidences per 1,000 persons living. Under 25 years 1 1 2 77,192 0.022 25 & under 35 Yrs. 1 - 1 27,481 0.036 35 & under 45 Yrs. 13 6 19 29,922 0.635 45 & under 65 Yrs. 72 78 150 36,641 4.093 65 years & over 108 97 205 13,264 15.455 195 182. 377 184,500 2,043 . Sites of Fatal Cancer. Site Male Female Total Percentage of Total. Brain 1 1 2 0.530 Skin 6 2 8 2.122 Tongue and Mouth 8 1 9 2.387 Tonsi1 1 2 3 0.796 Oesophagus 7 2 9 2.387 Stomach 42 27 69 18.302 Liver 6 4 10 2.653 Bowel 29 23 52 13.793 Rectum 19 13 32 8.499 Bladder 8 5 13 3.448 Prostate 16 - 16 4,344 Larynx 1 3 4 1.061 Uterus - 21 21 5.570 Breast - 40 40 10.610 Ovary - 7 7 1.357 Pancreas 5 10 15 3.979 Gall Bladder and Duct - 3 3 0.796 Bones 9 5 14 3.711 Lungs 25 5 30 7.957 Kidneys 1 3 4 1.061 Antrum 1 - 1 0.265 Lymphatic Glands 1 - 1 0.265 Thyroid Gland 2 2 4 1.061 Pituitary Glands 1 - 1 0.265 Genital Organs 5 2 7 1.357 Not defined 1 1 2 0.530 195 182 377 43 Comments on Foregoing Table. The organs most often attacked in descending order of incidence are, in the males the Bowels and Rectum (24.6%); the Stomach (21,6%); the Lungs (12,8%); and the Prostate (3.2%); in females the Breast (22%) the Bowels and Rectum (19.8%); the Stomach (14.8%) and the Uterus (11.5%). THE PREVENTION AND CONTROL OF TUBERCULOSIS. I am indepted 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 sixty one cases of pulmonary tuberculosis and fifty one cases of Non-pulmonary tuberculosis were notified on Form. A (primary notifications); of these 93 males and 68 females were pulmonary cases, 28 males and 23 females non-pulmonary. In addition, 59 pulmonary cases and 15 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 194.1 by notification or otherwise was 286, as compared with 263 in 1940; 279 in 1939; 332 in 1938; and 338 in 1937. 220 of these were cases of Pulmonary tuberculosis, 124 in males and 96 in females. There are 12 more cases of Pulmonary tuberculosis in males, and 1 less in females, than in 1940. There were 29 cases of non-pulmonary tuberculosis among children under 15 years as compared with 21 in 1940. The number of cases in adults was 37, compared with 33 in 1940. Of the cases notified in 1941, 19 males and 11 females died from the Pulmonary form of the disease during the year, equal to 18.6% of those notified, and 4 males and 5 females from the non-pulmonary form. The incidence rate of Tuberculosis of all forms was 1.55 per 1,000 of the population, for pulmonary tuberculosis 1.19 and for non-pulmonary 0.36 per 1,000 population. This rate is low as compared with other large centres of population. The Notification rate was 1.15 per 1,000. In 1940 the corresponding figures were 1.31, 1.04, 0.27 and 0.94 per 1,000. Public Health (Tuberculosis) Resulations, 1930. Summary of notifications during the period from 1st January, 1941 to 31st December, 1941:- FORMAL NOTIFICATIONS Number of Primary Notifications of Now Ceses of Tuberculosis. Age Periods. 0-1 1-5 5-10 1O-15 15-20 20 - 25 25-35 35-45 45-55 55-65 65 up Total all ages Total Notifications on Form A. Pulmonary males - - 2 - 12 6 22 18 17 8 8 93 101 ,, females - - 2 2 11 16 17 7 5 5 5 68 75 Non-pulmonary males - 1 7 6 7 1 2 3 - - 1 28 29 ,, ,, females - 4 2 2 4 1 6 1 - 2 1 23 23 44 SUPPLEMENTAL RETURN. New capes of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1941 to 91st December 1941, otherwise then by formal notification. Age periods 0-1 1-5 5-10 10-15 15-20 30-25 25-35 35-45 45- 55 55-65 65 and upwards Total cases Pulmonary males. - - - 2 5 6 3 7 4 3 1 31 ,, females - - - - 6 4 5 6 2 4 1 28 Non-pulmonary males 2 - - 2 2 — 1 - - - - 7 ,, females - 1 1 1 1 - - 2 - 2 - 8 Notification Register. Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1941. PULMONARY HON-PULMONARY Males 537 Females 467 Total 1,004 Males 115 Females 114 Total 229 Total cases 1,233 CLASSIFICATION OF NEW PATIENTS. Pulmonary Tuberculosis. During 1941, 140 new patients were examined at the clinic and were found to be in the undermentioned stager of the disease on the first examination:- T.B. minus (sputum negative or absent) 50 or 25.7% T.B, plus 1 (early cases, sputum positive) 6 or 4.3% T.B. plus 2 (intermediate cases, sputum positive) 64 or 45.7% T.B, plus 3 (advanced cases, sputum positive) 20 or 14.3% 140 or 100.0% This is 6 more than in 1940. AGES AT DEATH PULMONARY TUBERCULOSIS. Year 0-5 5-15 15-25 £5-45 45-65 Over 65. Total. 1957 - 2 35 55 40 8 140 1933 - 3 22 46 40 8 119 1939 - - 19 44 30 3 96 1940 - l 18 61 38 10 128 1941 - 2 11 33 32 12 90 In 1941 the death rate from all forms of Tuberculosis was 0.59 per 1,000 population. The rate for Pulmonary Tuberculosis was 0.49 and the rate for Non-Pulmonary Tuberculosis 0.10. Similar figures for 1940 were 0.74, 0.64, and 0.10. 45 PULMONARY TUBERCULOSIS. In 1941 there were fever deaths from pulmonary tuberculosis than in 1940 but the reduction was only in men, the female deaths showing no appreciable change. The greatest reduction occurred in the 25-35 years age group. The highest peak in men was in the 45-55 years age group and in women, the 25-35 years age group. On the other hand, there was a greater number of new cases in 1941 than in 1940, again this increase was confined to men. In women, however, the incidence fell more on the younger omen, 15-25 years, than in the previous year. In men the increase has been in the 45-55 years group. NON-PULMONARY TUBERCULOSIS. The diagnosis of the new cases entered in the Notification Register during 1941 were as follows:- Male Female Wrist - 1 Elbow - 1 Hip 1 1 Humerus - 1 Knee 2 1 Spine 1 1 Pubic Bone 1 - Shoulder 2 1 Foot 1 - Eye - 1 Meaninges 6 5 Meninges and peritoneum - 1 Abdomen 5 2 Kidney 1 2 Kidney and spine - 1 Kidney and epididymis 1 - Pericardium 2 - Skin 1 l Glands 10 11 Miliary 1 -j 35 31 DEATHS FROM NON-PULMONARY TUBERCULOSIS. During 194.1, 19 deaths were certified to be due to Non-Pulmonary Tuberculosis, compared with 21 in 1940; 12 in 1939; 13 in 1938 and 15 in 1937. The deaths were due to:- Males Females Total. Tuberculous Meningitis 5 2 7 ,, ,, and Peritonitis - 1 1 ,, and Tuberculous Pericarditis 1 1 Miliary Tuberculosis 1 2 3 Renal Tuberculosis 2 1 3 ,, ,, and Spinal caries — 1 1 Abdominal Tuberculosis - 1 1 Tuberculous Pericarditis 1 - 1 Tuberculous Elbow - 1 1 9 10 19 46 CO-ORDINATION W1TH MEDICAL PRACTIONERS & OTHER BRANCHES OF THE HEALTH DEPT. During the year 199 casses of suspected Tuberculosis were referred by private medical practioners, 37 were diagnoses as suffering from Tuberculosis and were, subsequently notified. In addition, 48 children were referred by the School Medical Service, and 35 cases from the Maternity and Child Welfare section of the Public Health Department. 75.9% of all notified cases were examined at the Clinic or were seen at the request of the Medical attendant at the patient's home, as compared with 87% in 1939; 83.6% in 1938; and 87% in 1937. The number of reports sent in by Insurance medical practioners on their domiciliary cases (Form G.P. 36) was 212. EXAMINATION OF SPUTUM. The results of examinations made in 1941 are as follows:- For Clinic For General Practitioners Totals. Positive (i.e. tubercle bacilli present) 430 60 490 Negative (i.e. tubercle bacilli absent) 636 489 1,125 Totals 1,066 549 1,615 For each 100 new cases and contacts examined at the Clinic, 137 specimens of sputum were examined. X-Ray Work. 793 X-ray examinations were made during the year, an increase of 99 over 1940. This is equivalent to 101.7 for every 100 new cases and contacts seen, and compares with a rate of 86.8 in 1940; 9.1.1 in 1939; 74.7 in 1938; and 68.4 in 1937. In addition, a certain number of cases who have already been examined at various Hospitals are referred to the Clinic. During the year the X-ray examinations were carried out at Mayday Hospital. EXTRA NOURISHMENT. Provisions of special nourishment in the form of milk was granted to 77 selected cases for varying periods during the year, and 36 cases were in receipt of extra nourishment at the end of the year. 47 48 RESIDENTIAL TREATMENT FOR PULMONARY TUBERCULOSIS-1941. Summary of Patients who received Institutional Treatment. during 1941. Institution. In institutions on 1.1.41. Admitted during 1941. Discharged during 1941. Deaths during 1941. Remaining in on 31.12.41. Adults Adults Adults Adults Adults M F Gh. M F Ch. M F Ch. M F Ch. M F Ch. Respirator Croydon Borough Senitorium. 45 33 - 80 55 - 72 56 - 9 10 - 44 22 - Brampton Hospital and Sanitorium. - 1 - 4 7 - 4 5 - - 1 - - 2 - Children's Senitorium, Harpenden. - - 1 - - 1 - - 1 - - - - - 1 Burrow Hill - - 2 - - 1 - - - - - - - - - Pepworth 2 - - - - - 2 - - - - - - - - Berks. & Bucks. Joint Sanitorium. - - - - 1 1 - - - - - - - 1 1 St. Michael's Home, Axbridge. - - - 1 - - 1 - - - - - - - - Eorton Hospital - - - 7 7 - 2 - - - - - 5 4 - Southlands Hospital - - - 1 - - 1 - - - - - - - - Groydon Borough Isolation Hospital. - - - - 7 - - 6 - - 2 - - - - Maday Hospital 9 1 - 41 21 4 31 23 3 11 8 - 8 1 1 56 56 3 134 108 7 113 93 7 20 21 - 57 30 3 49 Summary of Patients who have received Institutional Treatment during 1941. Institution. In Institution Ion 1.1.41. Adults Admitted during 1941 Adults Discharged during 1941. Adults Deaths during 1941. Adults Remaining in on 31.12.41. Adults M F Ch. M F Ch. M F Ch. M F Ch. M F Ch. Non-Respiratory Tuberculosis. Royal Sea-bathing Hospital 1 1 - 5 - - 2 - - 1 - - 3 1 Heritage Craft School. - - 2 - - 2 - - 3 - - - - - 1 St. Nicholas' & St. Martin's Hospital, - 2 5 1 - 2 — 1 2 — 1 - 1 - 5 Pyrford. Royal National Orthopeadic Hospital. - 1 - 1 - - - 1 - - - - 1 - - Atkinson-Morley Convalescent Hospital (St. George's Hospital 1 - - 1 - - 2 - - - - - - - - Holland Lodge Convalescent Home - - 1 - - - - - 1 - - - - - - Lord Myor Traloar Cripple's Hospital - - 2 - - 1 - - 2 - - - - - 1 King George's Sanatorium - - - 1 - - - - - - - - 1 - - St. Peter's Memorial Home - - - - - - - 1 - - - - - - - South Coast Conv. Home for Boys - - - - - 2 - - 2 - - - - - - Botley's Park Hospital - - - 1 1 - - - - - - - 1 1 - Croydon General Hospital - - - 4 2 2 3 2 2 - - - 1 - - Croydon Borough Isolation Hospital - - - - 1 - - - - - - - - 1 - Mayday Hospital 4 2 1 3 2 4 6 1 5 1 - - - 3 - 6 6 11 17 7 13 13 6 17 2 - 8 6 7 The Immediate Results of Institutiona1 Treatment. The immediate results of treat:sent of patients discharged from residential institutions during the year are as follows:- Among the pulmonary cases 31.9% were classified as early cases, the percentage of early cases receiving treatment in institutions was in women 36.0%; in men 27.0%. 49.0% of the total cases were intermediate cases, the males showing an excess in this group, 58.7 males to 40.0% females, and 19%. were definitely advaned. Of the total Pulmonary cases treated in Institutions 76.0% were potentially infectious. 133 males, 114 females end 7 children suffering from Pulmonary tuberculosis were discharged from, or died in Institutions in connection with the Croydon tuberculosis scheme during 1941. The Tuberculosis Clinic and Home Visiting. The subjoined table gives a summary of the work done in connection with the Clinic. 553 new cases were examined during the year, this is equal to 507 for each 100 deaths from the disease. 149 or 137 for each 100 deaths were found to be definitely tuverculous. The total number of attendances st the Clinic "as 4,515, The Tuberculoisis Officer paid 91 home visits, and the District Health Visitors £,424 visits, for Clinic purposes. In addition, the Health Visitors made 270 primary visits for the purpose of the Notification Register. The Tuberculosis Officer paid 43 visits to Mayday Hospital, in a consultive capacity, and there examined 169 patients. Patients requiring home nursing or surgical dressings are attended to by the nurses from the Croydon Nuring Service, by arrangement with that organisation, and 694 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 (subsequent supervision). This is an important preventative measure. During the year 227 contacts were examined, equal to 208 for each 100 deaths, compared with 278 in 1940; 525 in 1939; or 301 in 1938 par 100. Of these 5 were considered to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 22.0, compared with 1.55 per 1,000 of the general population. 459 appointments for examination were offered to new contacts during 1941 but only 227 new contacts attended and were examined. The Clinic Register of Cases. The number of casses of Tuberculosis under the supervision of the Clinic at the end of the year was 785. This is equivalent to 4.2 persons per 1,000 of the population. During the year 94 Clinic cases died, of this number 19 or 20.2% were seen for the first time in 1941, 50 Summary Of Statistics for 1941. Number of parsons on Clinic Register, January 1st 1941. 785 ,, notified cases examined for the first time. 79 ,, cases sent for an opinion 410 ,, first attendances, including 91 transfers in 871 ,, consultations of T.O. with medical practitioners:(a) Personal 24 (b) Other 487 ,, visits paid by T.O. to homes of patients. 91 ,, visits paid by T.O. to Cheam Sanitorium. 1 ,, visits paid by T.O. to Meyday Hospital. 43 ,, patients examined by T.O. at Mayday Hospital. 169 ,, visits paid to homes of patients by Health Visitors. 2,694 ,, visits paid to homes of patients by District Nurses for nursing attention. 694 Attendances of patient at the Clinic:- Men 1,856 Women 2,071 Children 588 Total 4,515 Number of Insured patients under Domiciliary Treatment at the end of year:- Pulmonary 162 Non-Pulmonary 8 Total 170 Number of reports received Penel Practitioners (G.P.36) 212 ,, reports forms sent to Panel Practitioners (G.P.36) 493 ,, reports received from Panel Practitioners on Forms 1 G.P.17 ,, reports received from Panel Practitioners on Forms - G.P.35 ,, X-rays taken 793 ,, reports made to Ministry of Pensions by T.O. on general progress of Tuberculosis discharged Ex-Service men 24 ,, cases referred to Light Treatment 5 ,, cases referred to Orthopaedic Clinic 16 ,, cases receiving extra nourishment at the end of year 36 ,, cases referred by the Ministry of Labour and National Service medical boards for examination and report 144 51 CHEAM SANATORIUM. The Sanatorium is situated at North Cheam, and normally has accomodation for 93 adult patients of both sexes; Men 53 and Women 40, Oving to the blackout arrangements the number of beds non available is 48 men and 27 women. In-patients on 1st. Jan. 1941 Admitted during the year. Discharged during the year. Died during the year. In on 1st Jan. 1942. M F M F M F M F M F 45 34 85 57 77 59 9 10 44 22 Number of Artificial Pneumothorax eases begun 30 ,, of Refills given 2069 ,, of X-ray Sreenings 2127 ,, of films taken 409 ,, of Sputum tests 879 ,, of Gas replacements 13 Immediate results of treatment Group Total number of cases discharged. Quiescent Improved No Materia1 Improvement Died in the Sanatorium Discharged before completion of treatment Average duration of stay in days m f m f m f m f m f m f Class T.B. Minus 10 16 7 10 1 3 1 - - - 1 3 166 Class T.B. Plus Group 1 6 7 4 3 — 3 1 - - - 1 - 169 Croup 11 36 24 | 1 2 23 10 5 5 1 1 6 6 302 Group 111 16 14 — 1 4 - 3 4 8 9 1 - 225 Observation Non-tuberculcus 7 - - - - - - - - - - - - 75 , 61 12 17 28 16 10 9 9 10 9 9 - At the beginning of 1941 there wore 79 patients in Cheam Sanatorium. During the year 142 were admitted and 136 discharged, whilst 19 died, thus leaving 66 patients in at the end of 1941. There wore 9 observation cases sent in; 8 males and 1 female. Of the 8 males 7 were not tuberculous, and the 1 female was tubercular, therefore there were 7 observation cases in non-tuberculous cases vhich are shown above. The 2 that were tuberculous are in with the tuberculous cases and are not shown as observation. Artificial pneumothorax cases discharged but still under treatment, 11 males, 8 females (see above), making total discharges , males 77, females 59. These artificial Pneumothorax cases only refer to cases discharged in 1941, those discharged in 1940 and still having refills have not been included. 52 DENTAL REPORT-CHEAM SANATORIUM. 1941. Review of work done. Males Females Total Total 1940. Number Examined 70 41 m 100 Referred Treatment 56 36 92 83 Treated 51 36 87 83 Attendances 157 111 268 367 Extractions 75 63 138 140 Fillings 57 60 117 181 Dressings 9 6 15 27 Scalings 23 20 43 55 Root Treatments - 4 4 4 Denture Dressings 20 5 25 26 Dentures Fitted 6 1 7 5 Mendibular Injections 15 8 ! ! 23 30 No. of sessions Treatment; 34. Summary of work done. Males Females Total Total 1940. Referred from Dispensary. 1 15 \ 16 27 Treatment cases continued from Cheam | 3 2 5 4 Attendances 11 55 66 117 Extractions 10 29 39 53 Fillings - 23 23 28 Dressings - 5 5 2 Sealings - 6 6 14 Denture dressings 7 14 21 51 Dentures fitted [ 2 4 6 19 Number of Sessions treatment. 15. The amount of 10s. 0d. was taken in attendance fees during the year at Lodge Road. 53 MATERNITY AND CHILD WELFARE Notification of Births. Notifications were received from:- Live Births Still Births Total Midwives 2032 35 2067 Doctors, Parents & Others 591 28 619 2623 63 2686 Maternal Mortality. There were 8 deaths directly due to pregnancy, compared with 5 in 1910. The maternal mortality rate was 3.23 per 1,000 births, compared with 1.65 in 1940. In other words one? mother died for every 309 live babies born. The deaths directly due to pregnancy were caused by:- 1. Rapture of Uterus. Epileptic form convulsions. 2. Obstetric shock and haemorrhage. 3. Puerperal sepsis and septicaemia. 4. Cardiac failure. haemorrhage. Threatened abortion. 5. Myocardial failure. Fatty degeneration. Parturition. 6. Uraemia (with fits) Chr. Nephritis. months pregnaney. Caesarean section . 7. Haemorrhage. Ruptured tubal pregnancy. 8. Obstetric shock. In addition there were three deaths due to Criminal abortion included by the Registrar General under suicide. Puerperal Fever and Puerperal Pyrexia. Fifty three cases of Puerperal Pyrexia were notified. This is a rate of 19.7 per 1,000 births (live and still births). Accomodation for Confinement. The following Table gives information concerning the accomodation utilized for confinements. Number Percentage In private houses 997 37.12 In public institutions 1299 48.36 Registered Maternity Homes 390 14.52 2686 Still Births During 1940, 65 still births were registered in respect of Croydon. Of these 35 were male babies and 30 female; 2 males and 4 females were illegitimate. The proportion of still births to living children was as 1 to 41. The still birth rate was 2,5% of the total births. The still birth rate, on the same basis as for Infant Mortality, was 24.0 per 1,000 births. 54 Ophthalmia Neonatorum. Seventeen cases were notified during 1941. The following table gives the notifications in Croydon during the past eleven years:- 1932 1933 1931 1935 1936 1937 1938 1939 1940 1941 No. of cases 21 10 13 13 20 21 20 15 14 17 Rate per 1,000 6.3 3.2 4.0 3.9 6.2 6.4 6.0 4.5 4 .7 7.0 Births Results of Treatment. Cases treated Vision Unimpaired Vision Impaired Died Removed Remaining under Trestment etc. Notified At home In hospital 12 - 1 4 - 17 % 4 13 Infant Mortality. The Infantile Mortality rate was 37 per 1,000 live births registered. For the past 5 years the numbers of infant deaths have been 1937, 195; 1938, 135: 1939,130; 1940, 116; 1941, 90; 58 deaths of infants occurred in Institutions, including Registered Nursing Homes. Among the 90 deaths, 54 occurred in boy babies and 36 in girls. Of the births, 1215 were males and 1193 females. The infantile mortality rate for the two sexes was, therefore:- Boys 44; Girls, 31. The rate of infant mortality amongst illegitimate children was 44 per 1,000. The rate in legitimate children was 37 per 1,000. 55 56 Deaths under one Year, arranged in days weeks and months. CAUSES OF DEATH 1st Day 2nd Day 3rd Day 4th Day 5th Day 6th Day 7th Day 1st-2nd week 2nd-3rd week 3rd-4th week Under 1 month 1-2 Mths 2-3 Mths. 3-4 Mths. 4-5 Mtns. 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 27 6 2 1 1 1 - 6 - 3 47 8 10 6 - 5 4 3 2 1 2 1 89 uncertified 1 - - - - - - - - - 1 - - - - - - - - - - - 1 Chicken Pox - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - 1 - 1 Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - hooping Cough - - - - - - - - - - - - - - - - - - 1 — — 1 2 Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - 1 Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - 1 Meningitis (Not tuberculous) - - - - - - - - - - - - - - - - - - - - - - - Convulsions - - - - - - - - - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - - - - - - - - - Bronchitis — - - - — - - - - - - 1 - - - - - - - - - - - Pneumonia (All forms) 1 - - - - - - 1 - 2 4 4 7 4 - 4 2 2 1 - 1 - 29 Diarrhoea & Enteritis - - - - - - - - - - - 1 1 2 - - 1 - - - - - 5 Gastritis - - - - - - - - — — - — _ _ _ - - - - - - - - Syphilis - - - - - - - — - — - - — - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - - Congenital Malformations 2 - 1 - - 1 - 1 - - 5 — 1 - - - 1 - - - - - 7 Premature Birth 18 5 — 1 - — - - - 1 25 - - - - - - - - - - - - Atrophy,Atelectasis, Debility and Merasmus 1 - 1 - - - - 2 - - 4 - - - - - - - - - - - 25 Intury at Birth 9 1 - - - - - 1 - - 4 - - - - - - - - - - - A Other causes 4 - - — 1 - - 1 - - 6 48 2 - - - 1 - 1 - - - - 10 28 6 2 1 1 1 - 6 - 3 8 10 6 - 5 4 3 2 1 2 1 90 The following table gives the cause of death during the first month of life;- 1. Complications of Labour Trauma at Birth 4 4 2. Foetal States Congenital Heart Malformation 3 Other congenital deformities etc. 3 Atelectasis etc. 4 10 3. Prematurity 25 25 4, Post-natal causes 9 9 48 Percentage Deaths per Total. Infantile Deaths Deaths per 1,000 Births 1911 1940 1941 1940 Premature Births fc.7.7 19.8 10.4 7.8 Respiratory Diseases (Pneumonia Bronchitis etc,) 4.4 23.3 12.1 9.2 ^Infectious Diseases (Including Tuberculosisj 5.5 3.4 2.1 1.4 Atelectasis, Debility and Marasmus 4.4 9.5 1. v 3.7 *Diseases of Digestion. 5.5 10.3 2.1 4.1 Injury at Birth and Congenital 12.2 17.2 4.6 6.8 0 Analysed these deaths were due to Measles 1; Whooping Cough 2; and Tuberculosis (Meningitis end Miliary) 2. x These deaths were due to Diarrhoea 5. Midwives Acts, 1902 to 1926. Seventy eight midwives notified the Local Supervising Authority of their intention to practise within the Borough during 1941, Nineteen ceased practising in the Borough; so that fifty nine remained on the Register at the end of the year. All these these 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 advise of a doctor. The sum of £1.10.0d., was paid out during the year. Confinements attended hy Midwives (including Municipal midwives) Cases attended by Midwives alone 1920 vl.5$ of Total. Cases atteided by Midwives ''hen a doctor w:-. s also e age god 450 Cases attended by Midwives when a doctor was also summoned 316 TOTAL 2686 The Rules of the Central Mdwives Board lav down that the Local Supervising Authority must he 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 rives details of the reasons for sending for medical aid: For complications during pregnancy. Abortion 8 Other causes 27 Albuminuria 3 38 For complications during 1 hour, Breech 4 Occipito-Posterior 2 Transverse 1 Undiagnosed 5 12 Delayed Labour Utrine Inertia 2 Prolonged 17 Delayed 21 40 Eaemorrhage Ante Partum 2 Post Partum 8 10 Other Causes. Adherent Placents: 1 Illness of Mother 5 Torn Perinoun 102 108 For complications during puerperium. Pyrexi a 8 Pain in Breasts 3 Pain in legs 14 Other causes 8 Toxaemia 2 35 For complications for regard to the baby. Inflammation of Eyes 42 Still birth 1 Feebleness 4 Premature birth 5 Other cruses 21 73 316 58 In accordance with rule 53, of the Central Midwives Board, the following reasons for the discontinuance of breast feeding were received Illness of Mother 4 Insufficient Milk 21 Other causes 14 Total 39 Inspection of Midwives. Br, Tonkin Lloyd, the Inspector of Midwives, interviewed 10 midwives at the Town. Ball. 7 visits were paid by her to the homes of midwives. Doctor's Accounts under Section 14 (1) of the Midwives Act, 1918. 241 accounts were received from doctors for services rendered under the provisions of this Section. This compares with 33th in 1940; 424 in 1939; 388 in 1935; 234 in 1937, 268 in 1936. The total amount of the accounts was £432*3 3,0.1, £.225.2„0d, was ultimately recovered from the patients. In 1940 the amount paid to doctors was £528.2.0d. and in 1939 £533.4.0d. NURSING HOMES. Maternity Homes Other Nursing Homes Combined Maternity and other Nursing Homes Total No. of Homes on Register on 31,12.40. 5 19 17 41 No. of Applications for Registration during 1941 - - - - No. of Womens Registered during 1941. - - - - No. of Homes on Register on 31,12,41. 5 19 17 41 No. of Beds available 63 283 (a) Mat. Beds 76 (a)139 (b) Other Beds 76 (b)359 59 THE OBSTETRIC SERVICE. The obstetric service has been described in my report for 1938. The following are the statistics for 1941 Talcing the Registrar General's figures for maternal mortality (deaths directly due to pregnancy but excluding abortion) the rate for England and Wales for 1941 was 2.23 per 1,000 births. In Croydon the rate was 3.24. In booked cases treated by the Obstetric Service the rate for 194.1 was 3.3 per 1,000 Hospital deliveries; nil per 1,000 home deliveries and 2.1 per 1,000 over all deliveries. Of the cases treated to a conclusion at the Post Natal Clinic during 1941, 92,7 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 1940 was 94.7. The number of cases delivered of viable babies in Mayday Hospital with a nominal 43 beds, was 629, The number delivered at St. Mary's Maternity Hospital, with 30 beds, was 579, Owing to bomb damage the wards at Mayday Hospital were closed for nearly three months. GENERAL STATISTICS, 1941. No, of live births allocated to the Borough of Croydon. 2642 ,, ,, still ,, ,, ,, ,, ,, ,, ,, 65 No. of maternal deaths (directly due to pregnancy) 8 No. of cases of notified Puerperal Pyrexia. 51 No. of expectant mothers who attended the Borough Ante Natal Clinics. 2828 No. of cases delivered in Mayday Hospital as Booked cases. 600 No. of cases delivered in Mayday Hospital as emergency cases. 168 Total cases delivered in Mayday Hospital. 768 No, of cases delivered in St. Mary's Maternity Hospital as booked cases. 579 No. of cases delivered in St. Mary's Maternity Hospital as Emergency cases. - Total cases delivered in St Mary's Maternity Hospital. 579 No, of cases delivered by Municipal Midwives 730 TOTAL 2077 No, of ceses admitted to the Puerperal Infection Unit Borough Hospital and Mayday Hospital Icclavicn Wards, including 28 from Mayday Hospital and 6 from St, Mary's Maternity Hospital. 38 No. of Maternal deaths in Booked cases from Borough Ante Natal Clinics. 4 No. of Maternal deaths in Emergency cases at Mayday Hospital. 7 No. of Maternal deaths in cases admitted as Puerperal Sepsis per se 1 Total Maternal deaths in beds of the Obstetric Service. 12 (including 3 cases of criminal abortion and 1 "foreign" case) 60 The total number of patients treated by the Obstetric Service was:- (a) In Mayday Hospital 1690 (b) In St. Mary's Maternity Hospital. 657 (c) In the Borough Hospital Puerperal Infection Unit 'arid Mayday Hospital Isolation Wards, excluding 28 from (a) and 6 from (b) 4 (d) At the Ante Natal Clinics and delivered outside the above Hospitals (including Municipal Midwives cases) 901 (e) At the Post Natal Clinics, excluding those included in (a), (b), (c) and (d.). 328 . (f) At the Ante Natal Clinics and undelivered on December 31st 1941. 531 4111 ANTE NATAL SUPERVISION. 1940 1941 Number of sessions at Ante Natal Clinics held 411 471 Number of individuals who attended 3257 3402 Number of previous year's cases continuing attendance, 574 574 Number of new cases 2642 2828 Number of cases undelivered on 31st December 574 620 Total attendances made. 15249 16169 Average attendances per session. 37 34 Number of cases delivered in hospital as Booked cases. 1277 1199 Number of cases delivered by Municipal Midwives 939 730 Number of cases delivered at other places under the care of private doctors or midwives (about) 200 171 Number of patients found not to be pregnant. 19 18 Number of patients referred to hospital for Ante Natal treatment. 509 480 The conditions for which these were admitted can be ascertained by reference to the 'Booked' columns of the Numerical summary of Gases, 6 Ante-natal clinics per week are now held at Lodge Road for cases booked for Hospital delivery and 4 clinics per week for home delivery. A post-natal clinic for cases delivered at home has also been instituted. During 1941 the Obstetric Service dealt with 1965 out of the total births allocated to the Borough. Major Ante-Natal Conditions Treated at the Ante-Natal Clinic. Breech Presentation. Breach presentation diagnosed 202 Spontaneous version 15 External version successful 121 External version not successful 56 Allowed to go to term as Breech 56 Not recognised as Breech before labour 4 Dental Treatment No. of cases inferred to Borough Dental Surgeons. 743 No. of cases referred to Private Dental Surgeons. 96 No. of cases refusing dental treatment. 48 No. of cases seen too late for necessary dental treatment. 42 Tuberculosis Referred from Tuberculosis Officer because of pregnancy. 1 Referred to Tuberculosis Officer for opinion on lung condition. 8 61 Venereal Disease. Gonorrhoea-Total cases 4 Transferred to Borough V.D. Clinic 4 Syphilis-Total cases. 7 Transferred to Borough V.D. Clinic 7 These cases are delivered in Mayday Hospital Isolation Wards, and transferred to the Borough V.D. Clinic on discharge. Midwives Cases. These cases may be summarised as follows:- Total number of midwives cases during 1941 171 Number of cases sent for one consultation only 65 Number of cases supervised entirely 106 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 Wasserman 146 Blood for Kahn Reaction 113 Blood for Gonococcus Fixation Test 113 Blood for Grouping 96 Blood for Culture 10 Blood for Urea Content 42 Blood for Widals etc. 13 Blood for Cell Count, etc. 36 Catheter urine for Routine Examination 382 Urine for Aschheim-Zondek Test 19 Urine for Urea Concentration Test 124 Lochia for Culture 25 Sputum for examination 10 Pus for identification of Organism 17 Urethral smears for Gonococci, etc. 25 Cervical smears for Gonococci, etc. 51 Conjunctival smears 28 Histological sections 159 Van den Burgh 3 Throat swabs for organisms 98 Faeces for Occult Blood etc. 2 Blood for sugar estimation 2 Blood for Hb Estimation 441 Urine for T.B. 2 Various 9 Glucose Tolerance Test 1 X-Ray Examinations (Mayday Hospital X-Ray Department.) 115 cases were referred, from Ante Natal Clinics and 261 films were used. Reasons for reference were:- Breech for attitude etc. 12 For presentation, attitude etc. 37 Twins 36 Foetal death 3 ,, parts 20 Disproportion 7 62 40 cases were referred from the Meternity and Gynaecological Wards at Mayday and St. Bory's Hospitals and 105 films were used. Reasons for reference were:- For presentation. 7 Twins 6 For foetal death 4 For foetal parts 7 Breech? Extended legs 8 Disproportion 6 Hydrocephalus 2 Anencephaly 4 Vesicular mole 2 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. 597 579 1176 2. Delivered in hospital before 23th ,, 3 - 3 3. Admitted after delivery. 19 - 19 4. Discharged undelivered after ante-natal treatment and not subsequently delivered in Hospital. - - - 5. Died undelivered - 1 1 6. Ectopic Pregnancy - — — 619 580 T199 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) Discharge undelivered. 13. (b) Delivered in hospital after 28th week. 32 (c) Delivered in hospital before 28th week. 131 (d) Died undelivered. — 2. After Delivery 8 3. Ectopic Pregnancy 5 189 MUNICIPAL MIDWIVES Cases delivered (including twins 730 Maternal deaths nil Maternity cases. 101 Medical aid sought 117 Live Births 724 Ante-natal visits by Still births (3 macerated) 6 midwives 531-1 ,, ,, clinic attendances. 4165 Post-natal clinic attendances. 387 63 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. Manday Hospital Emergency St. Mary's Maternity Hospital Booked. Total 1. Conditions chiefly Ante-Natal. Albuminuria 112 10 61 183 Eclampsia — — - Persistent vomiting of pregnancy 3 7 — 10 Chronic cervitis 3 — - 3 Acute pyelitis 16 3 14 33 Malnutrition, debility, simple anaemia, etc. 22 - 10 32 Breech presentation for version - - - - Retroverted gravid uterus - 1 - 1 2. Intercurrent Diseases. Chronic nephritis 1 - - 1 Pulmonary Tuberculosis 1 - - 1 Venereal disease - - - - Cardiac disease 15 - - 15 Exophthalmic goitre — — *• 3, Conditions chiefly Na tal. Presentations at Delivery- Anterior positions of the vertex. 550 24 508 1082 Posterior positions of the vertex 15 2 44 61 Breech 34 2 26 62 Shoulder - - 1 1 Pace and brow 3 - 3 6 Complex - - 1 1 Caesarean section. 21 3 1 25 Twins 10 - 10 20 Accidental haemorrhage 7 1 2 10 Placenta praevia 9 3 2 14 Kydramnios 6 - 7 13 Prolapse of cord 3 - 1 4 Retained placenta 7 - 6 13 Post-Partum haemorrhage 29 28 28 85 B.B.A . 20 7 3 30 Lacerated perineum 201 19 245 465 Obstructed labour 2 «- 2 4 Premature labour 56 9 62 127 Abortion 7 143 - 150 Ectopic pregnancy - 5 - 5 Abdominal Hysterotomy 1 1 . 64 Mayday Hospital Bocked. Mayday Hospital Emergency St.Mary's Maternity Hospital Booked. Total 4. Conditions chiefly Post- Natal excluding re-admissions from Post-Natal Clinic. Breast abscess 9 - - 9 Notified pyrexia or fever 24 17 6 47 In addition 4 cases of Puerperal Pyrexia per se were admitted to the Puerperal Infection Unit of the Borough Hospital. x Including 13 cases of septic abortion. Blood Transfusion. (52 obstetrical and 46 gynaecological cases) For every case, stored blood from the Blood Transfusion School, Sutton, was used. One Mayday Hospital "Booked" Obstetrical case, and one Gynaecological case died. Infants. Mayday Hospital Booked. Mayday Hospt. Emergency. St.Mary's Maternity Hospital Booked, Total Per Cent No. of infants in Hospital on 1st January, 1941. 21 - 17 38 Total No. of live births, still births and infants admitted with Mother (B.B.A.) 621 41 582 1244 No. of infants in Hospital on 31st December, 1941. 41 - 27 68 Living-alive on discharge from Hospital. 569 42 579 1190 95.4 Stillborn 24 4 11 39 3.1 Died (born alive, but died in Hospital) 17 - 2 19 1.5 65 INFANT FENDING AND WEIGHT ON DISCHARGE FROM HOSPITAL. In both hospitals normal infante were breast-fed every four hours omitting the early morning feed. Of 611 infants discharged from Mayday Hospital, 377 -'ere up to or over birth weight (62%). Of 532 infants discharged from St. Mary's Maternity Hospital, 532 were up to or over birth weight (57%). Twins and Triplets. There were 20 eases of Twins and none of Triplets. There was no maternal death. Mayday Hospital Booked Hospital Emergency St. Mary's Maternity Hospital Booked. Total. Number of cases 10 - 10 20 Number of infants discharged alive 15 - 19 34 Number of still-births and infant deaths 5 - 1 6 Foetal and infant mortality 25% - 5% 15% POST NATAL AND GYNAECOLOGICAL CLINIC. Number of Sessions hold 154 ,, individuals presented 1676 ,, subsequent attendances 886 Total attendances 2162 Average attendance per session 14 Number of Post-Natal cases 1276 Number of Gynaecological cases 328 END RESULTS. 633 cages 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 250 337 587 92.7% Health slightly impaired 24 20 44 7.0% Health seriously impaired 1 1 2 0.3% Totals, treated to conclusion 275 358 633 MATERNAL MORTALITY. (Obstetric Service ) Twelve deaths occurred of Mothers dealt with by the service, four in Booked cases, and eight in emergency'' cases. The maternal mortality of "Booked" cases, i.e. cases under the continued supervision of the service, is 3.3 per 1,000 hospital deliveries, and 2.1 per 1,000 total deliveries including the Municipal Midwives booked cases. 66 Puerperal Infection. Fifty cases were treated in isolation for puerperal infection, 11 of them in the Borough Hospital and 39 in Mayday Hospital. There was 1 death (en abortion). Sources of the Cases. From Heyday Hospital;- Cases. Deaths "Booked" Cases 24 ) 5 (including "Emergency" Cases 17 ) 4 abortions,) From St. Mary's Maternity Hospital. 5 - From Other Hospitals - - From private doctors, deliveries in Nursing Homes 3 1 From private doctors, deliveries at home - — The assistant Medical Officer of Health for Obstetrics was called in by medic: 1 practitioners to see 57 obstetrical and 3.05 gynaecological patients who could not afford to pay a privato consultant. In addition, he was asked by the Medical Superintendent of Mayday Hospital to give an opinion on the obstetric and gynaecological aspects of 40 cases in the medical and surgical wards of the hospital. 67 MATERNITY AND CHILD WELFARE CONSULTATIONS There ar 18 Maternity and Child Welfare Centres, 16 of which are conducted by the Croydon Mother's 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 1941, 2,430 new: cases under 1 year of age, and 1,008 over 1 year of age at attended for the first time, the total of attendances of infants and young children from 0-5 years decreased from 66,609-in 1940 to 64,'322 in 1941. Consultations with doctors decreased from 21,375 to 21,319. 48 expectant mothers were seen, a decrease of 20 on 1940, end a total of 438 visits to the Centres were paid by them. The total of all visits to the centres was 64,760 a decrease of 2,243 compared with 1940. The highest average attendance of mothers and babies at each session was recorded at South Croydon(86.0), Municipal (77.6), St. Andrews (71.4) and Selhurst (67.7). DENTAL TREATMENT - MATERNITY AMD CHILD WELFARE PATIENTS. Expectant and Nursing Mothers and children below school age are referred by Medical Officers attending Ante-Natal Clinics and Post-Natal Clinics. Since the inauguration of the Municipal Midwives Service applications for dental treatment have also been received in increasing numbers from this source. EXPECTANT MOTHERS. These numbered 562 compared with 378 last year and represent 85% of the total number referred. Of these, 65% presented themselves during the first six months of pregnancy. The remaining 35%, some of whom had but recently returned from evacuation, were first seen during the later stages of gestation. As stated previously conservative measures constituted quite a considerable proportion of the treatment, 839 fillings being inserted against 565 in 1940. NURSING- MOTHERS Due primarily to the increase during the to preceding years in numbers of mothers treated antenatally, the number of those referred during the nursing poriod is again seen to be low. The latter figure was 99 against 84 last year. Those treated during the first six months of the nursing period constituted 68%. For the remainder referred from the 7th to 12th month, emergency treatment only was in most cases carried out. THE PRE-SCHOOL CHILD. Some reduction will be noted in the number of children under school age referred in 1941, these were 253 against 318 last year. Though this reduction may to some extent be due to the enforced curtailment of visits to Welfare Centres, facilities for easily obtaining treatment do in fact exist. Until such time, therefore, as a large scale return takes place of mothers from evacuation, it is doubtful whether more substantial results will be obtained. Fillings inserted for these small patients show an increase on the last report. Extractions performed, on the contary, are to some extent reduced. - 68 - DENTAL TREATMENT - MATERNITY AND CHILD WELFARE PATIENTS. (continued) The following summary shows particulars of the work accomplished: - Expectant Mothers Nursing Mothers Young Children. Total 1941 1940 Number examined 491 75 232 797 780 Referred for treatment 71 25 23 119 712 Attendances 2046 431 565 3042 2855 Fillings ”839 106 304 1249 919 Extractions 2003 427 350 2780 2776 “Gas” Cases 269 61 112 442 529 Local Anaesthesia 416 71 64 551 325 Scalings 218 17 5 240 139 Dressings 295 68 126 489 400 Denture Dressings 767 213 13 993 1021 Gum reatment 39 5 - 44 37 Silver Nitrate 12 11 183 206 127 Treatments Completed 328 60 193 581 510 Number of Sessions (treatment) 432. Appointments kept 78% Dentures fitted - Full 138, partial 59. The Centres at which patients were examined , or from which they were referred, are given in the following list:- Ante-Natal 589 The Betreat 9 Waddon 10 Municipal South Croydon 6 Shirley 14 Midwives 154 St. Albans 20 Boston Ed. 5 Municipal 32 Woodside 20 St.Stephen’s 13 E. Croydon 33 Norbury 9 Holy Trinity 15 Upper Norwood 8 St. Paul's 11 Addington 11 West' Croydon 17 St. Oswald's 8 St.George's South Norwood 24 St. Andrew's 6 Total 1,014 The amount received for attendance fees as £64. 9. Od. as compared with £70.15. Od. in 1940. - 69 - ATTENDANCES AT INFANT CENTRES - l94l. Municipal Boston Rd, St. -Andrew's Sth.Croydon Shirley Woodside. Lr, Addiscombe Rd. South Norwood Westow Street St. Ajbank St.Paul’s St.Oswald’s West Croydon Norbury Waddon Addington Selhurst St.Stephen’s Total 1941. Total 1940. 1. 370 1C3 112 132 127 133 270 169 71 176 98 100 82 87 97 124 94 85 2430 2655 2. 4562 1337 1775 2349 1482 1577 3323 2734 1049 2547 1307 1697 1513 1533 1436 1391 1688 1349 34627 33297 3. 108 28 31 45 28 54 101 66 38 83 37 49 20 34 76 104 48 48 1008 1104 4. 2713 948 1581 1765 1054 1330 2374 1631 1016 2105 1378 1115 815 1322 1045 1577 1651 837 26257 29553 5. 7753 2406 3497 4291 2691 3094 6068 4600 2174 4911 2820 2961 2430 2976 2654 3196 3481 2319 64322 66609 6. 2500 839 1049 1119 801 803 2021 1820 799 1891 1019 1093 954 837 907 761 1239 862 21319 21375 7. 100 51 49 51 48 49 100 102 51 100 49 51 51 52 52 97 52 52 1157 1155 8. - - - 10 9 2 - 10 3 2 - - 1 5 3 — 1 - 46 66 9. 2 - 2 87 13 - 7 28 7 2 - - 35 22 149 — 38 - 392 328 10. 2 — 2 97 22 2 7 38 10 4 - - 36 27 152 — 39 - 438 394 11. 7755 2406 3499 4388 2713 3096 6075 4638 2184 4915 2820 2961 2466 3003 2806 3196 3520 2319 64760 67003 1941) 12.) 77.6 47.2 71.4 86.0 56.5 63.2 60.8 45.5 42.8 49.2 j 57.6 58.1 48.4 57.8 54.0 32.9 67.7 44.6 ø56.0 - 1940) 73.4 68.4 I55.0 83.8 44.5 69.7 57.1 49.6 52.8 59.0 64.5 43.8 53.9 67.0 58.7 58.7 40.5 41.2 ø58.0 ø Total average attendance each week at all centre 1. New cases under 1 year. 2.Number of re-attendances. New cases over 1 year. 4.Number of re-attendances. 5. Attendances of children 0-5 years. 6. Consultations with Doctor. 7. Number of Sessions 8. Expectant Mothers. Number of new cases. 9. Number of re-attendances. 10. Total attendances of E-oectant Mothers. 11. Total attendances. 12. Average attendance per Session. THE WORK OF THE HEALTH VISITORS - MATERNITY AND CHILD WELFARE ONLY. Visits Re:- Wilson Ashe Southgate Walker Hobday Hinton Cracknell Wakefield Overington Wybrew Early Warrman Oakley Devaney Cross Bird I Webb Buttfield Bond Ernest Lewis Williams Catlow Cox Toneri Total Infants under 1 Yr. First visits 126 79 68 230 204 142 7 69 225 63 76 157 108 179 73 146 138 115 185 147 83 55 152 97 31 2955 Re- visits 358 233 174 401 977 669 48 208 789 169 452 486 544 673 206 489 444 530 654 371 479 161 664 278 160 10617 Children 1-2 Yrs. First visit 7 - 4 10 8 3 2 2 13 2 - 4 6 53 3 30 10 13 29 3 11 1 7 2 - 223 Re- Visits 236 165 133 397 514 428 36 162- 905 107 465 289 374 443 169 275 260 364 597 210 279 68 558 246 92 7773 Children 2-5 Yrs. First Visits 14 - 6 16 6 - - 2 1 2 1 2 18 64 4\ 30 7 12 11 - 28 4 4 5 - 237 Re- visits 666 350 339 723 1036 480 42 268 552 290 474 837 426 319 223 359 483 695 566 251 460 191 325 262 49 10660 Expectant Mothors First visits 54 24 13 9 29 24 - 18 16 23 16 27 17 38 24 21 19 30 13 32 17 - 33 26 6 529 Re- visits 11 6 3 1 48 2 - 2 - - 27 1 - 2 21 - - 3 6 15 - - 8 3 - 359 Still Births 2 6 1 1 - 1 - - - 1 1 3 4 - 1 - - - - - 10 - - 1 - - 31 Milk (Mothers and Childrens order) 13 62 9 - - 1 - 2 1 - 30 1 - 4 16 4 - - 115 154 - 16 - 7 12 197 Deaths under 1 Yr. 1 - 1 3 - - - - 2 1 3 3 2 1 2 2 - 1 1 6 4 1 2 - - 36 Miscellsneous visits 12 4 98 11 8 5 _ 14 3 3 9 2 5 21 68 18 25 39 5 117 26 16 9 18 37 573 Ineffective visits 301 202 330 398 671 404 103 270 403 257 274 320 513 466 631 362 418 520 289 428 377 169 265 142 54 8E77 Total 1941 1801 1131 1179 2199 3502 2158 238 1017 2911 928 1880 2133 2013 2264 1140 1737 1804 2322 2471 1744 1764 682 2028 1086 441 42873 Total 1940 1972 1333 1540 2913 5993 2622 - 1215 3145 2244 2843 2435 2329 3311 1631 2469 2303 3339 2144 6564 - - - _ - 51994 Others - 71 - MILK (Mothers and Children). Order. The table below gives the number of families who were in receipt of assistance under the provisions of the above-named order during the year. The Borough Council pay for all dried milks sold below cost price or given free whether ordered at the Voluntary Centres or at the Municipal Centre. All wet milk ordered under coat price is also paid for by the Council. On Dec. 31st 1940. New cases during the year. Cases discontinued On Dec. 31st 1941. Free 8 32 10 30 Half-price - 13 3 10 ' 8 45 13 40 Assisted Fluid Milk Scheme. The amount of milk granted was 756 pints. In 1940 it was 118,000 pints Supplied to Families, Number of pints. Corporation Liability. MLlk at half-price 168 £. s. d, 4. 1. 6. Milk free 588 11. 0. 6. 756 12. 2. 0. Dried Milk (Coupon) Scliora®. The amount of dried milk granted free or at half-price was 1,890 packets. In 1940 it was 11,360 packets. Number of Packets. Corporation Liability. Dried Milk at half-price 384 £. s. a, 42. 10. 6. Dried Milk free 1,506 175. 3. 4. [ 1,890 217. 13. 10. - 72 - 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 felf're Clinics. I am indebted to the Convalesence Secretary for the data given below. Convalescent. Homos. Total number of Children under 5 sent to convalescent homes (with mothers -6) 8 Total number of weeks Coot £13. 2. 6d. Number of mothers sent for convalescence 10 Number of children under 5 sent with their Mothers to cottages 6 A grant of £500 was made by the Council to the Association for this work in 1941. The year is the financial year ending 31st March, 1942. Home Helps. From January to December 31st, 321 mothers applied 'for Home Helps, and 296 were supplied. £328 was collected in payment for,their :services. At the end of the year there were 15 names of Home Helps on the register. Babies' Help Report. I am indebted to Mrs. Philpott for the following particulars. At the beginning of 1941 the Babies Help Committee had eight cases on the books, at the end of the year there were three. During the year 24 Mothers and Babies have been helped. CROYDON ASSOCIATION OF MORAS WELFARE. This Association has a home for Girls at 34, Morland Road. As the Council now makes a yearly financial grant of £100 towards its conduction, it is periodically inspected by the Council's Officers. THE CRECHE, WHITEHORSE ROAD. The Council give an annual grant of £300 towards the cost of this Creche. A total of 6,206 attendances was recorded. (Numbers were low during April, May, and June owing to Measles and '.'hooping Cough ) COOMBS CLIFF COIW-ALDESCENT HOME. The Home closed on the 31st March, 1941 the premises being token over by the Air Training Corps. The following is a summary of tho cases dealt with during the March Quarter. Number of cases admitted 19 Total number of cases discharged 33 Number of patient days. 51.3 per patient. - 73 - CHILD LIFE PROTECTION. PUBLIC HEALTH ACT, 1936, PART VII This part of the Act deals with Foster Mothers and Foster Children. The Tables bolow give figures for 1941. FOSTER CHILDREN. No. as at Dec. 31st 1940. Notice of Reception of Children during th year. Parent Notice of removal to Another Children Adopted Died Children reaching ago of 9. No. as at 3ec. 31st 1941 area with Foster Parent. Another Foster Mother. Public Institution 135 143 32 2' 24 6 17 1 9 137 The number of foster children, showed an increase of 2 during the year. F0STER MOTHERS No, as at Dec. 31st 1940 Applications for Authorisation during the year. Removals during the year. Authorisation cancelled for other reasons No. as at Dec. 31st 1941. With Child Without Child 107 50 7 23 125 The number of foster-mothers increased by 18 during the year. The Health Visitors paid 1,024 visits to foster-mothers for the purpose of supervision. 74 - 0RTH0PAEDIG DEPARTMENT. The arrangements are the same as in 1940. Summary of Cases attending the Orthopaedic Clinic. 1st January, 1941 New Cases, 19 41. Cases discharged 1941. Cases on Books 31st December 1941. 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. 264 259 30 102 101 16 29 37 - 133 164 73 603 219 66 369 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 40 1 4 - - 14 44 Curvature or Postural Defects. 20 68 1 1 - - 21 69 Pes Cavus 4 10 _ - - - . 4 10 Pes Planus 31 85 9 27 - - 40 112 Genu Valgum 28 45 46 159 - - 94 204 Talipes 26 65 34 111 - - 60 176 Obstetrical Paralysis - 1 2 4 - 2 5 (49 a 98a) Joint Diseases 10 29 1 3 ( 7s 11s) 69 144 2m 3m) Injuries 3 8 3 5 - - 6 13 Rickets 2 7 9 19 - - 11 26 Wry Neck 8 15 1 1 - - 9 16 Spasti c Parsplegia 14 21 3 15 - - 17 36 Congenital dislocati on of the Hip. 5 10. 1 3 - - 6 131 Other deformities. 34 74 32 48 1 1 67 123 198 478 163 400 59 113 420 991 Summarised the Ta.ble shows 198 School children attended and made 478 attendances, 163 babies made 400 attendances and 59 Tuberculosis cases made 113 attendances, a total of 420 cses, making 991 attendances. The following Table shows the number of cases refered direct from the Orthopaedic Clinic for Massage, Swedish Remedial and Electrial Treatment, and also X-Ray examinations at'the Croydon General -ospital. School Cases M.C.W. Cases Tuberculosis Cases Total Defects Cases No. of Treatments X—Rays L i Cases I No. of Troatmonts X-Ray Cases No. of Treatments j' X-Rays Cases No. of Treatments X-Rays Infantile Paralysis ' 2 56 _ . - - - - - - 2 56 - Curvature or postural . 14 328 2 — - 1 16 1 15 344 3 Pes cavus - - - - - - - - - - - - Pes planus 2 46 - 1 1 - - - - 3 47 - Genu Valgum 2 33 - 1 - l - - - 3 33 1 Talipes - - - 2 17 - - - - 2 17 - Bone and Joint disease ”8 - 9 - - - 27 - 28 35 - 37 Injuries 2 A. 2. 1 - 1 - - 3 4 3 Rickets - - - 1 - l - -• - 1 - 1 Wry Neck 3 53 - - - - - i - .3 53 - Spastic paraplegia - - - - _ _ - - - — - - Cong. Dis. of the hip 2 — 2 - - - - - - 2 - 2 Other Deformities 6 20 10 3 - 3 - - - 9 20 13 41 540 25 9 18 6 28 16 29 78 574 60 - 76 - Cases sent to Residential Institutions:- Name of Institution. School Cases M.C.W, Cases Tuborcu1osis Cases, Total No, in on 1st Jan,1941 Admitted Discharged No. in on 1st Jan. 1941 Admitted ! Discharged No. in on Ist Jan , 1941. Admitted Discharged No. in on 1st Jan, 1341 Admitted Discharged No. in on 1st Jan.1942. Pyrford 1 - - 1 - 1 5s ls 5 s 6s 8 5 7 6 Croydon General Hospital 1 3 3 - 2 2 la Is (la (Is 1 6 7 - Heritage Craft Schools 1 - - - - - 2s - 2s 3 _ 2 1 Pinner 1 1 2 2 - 1 - - -- 3 1 3 1 Lord Mayor Treloar Hosp, - - - - - - 1m 1m 1m 1 1 1 1 Royal Soabathing Hosp. - - - - - - (2s (1a 4a 2s 2a 3 4 4 3 Eirchington 1 - 1 - - - - - - 1 - 1 - Queon Mery's Hospital - 1 - - - 2s 2s 2s 2 3 2 3 Royal Nat. Orth. Hosp, - - - - - - la - la 1 - 1 - Mayday Hosp, - 1 1 - - - 1s 3a 1m 4a 1m 4a 1s 4 6 7 3 4 6 7 3 2 4c 20 18 24 27 26 35 18 Conditions for which Patients were admitted to Hospitals with the results of Treatment. Condition. In on 1st Jan. 1941 Admitted or transferred Discharged In on 1st Jan. 1942. Arrosted Quiescent. Improved I.S.Q Died Infantile Peralysis. - 1 - - 1 - - - Tubercular Joint Disease. 23 7 7 2 1 1 3 18 Congenital Hip Disease 4 1 - - 4 - - - Hemiplegia - - - - - - - - Genu Valgum - - - - - - - - Pes Caves - - - - - - - - Talipes. 1 3 - - 3 - - 1 Rickets. - 1 - l - - - - Other Deformities - - - - - - - - Spastic Paraplegia - - - - - - - - Scoliosis - - - - - - - - Osteomyelitis 2 1 - " 1 - - 2 30 14 7 3 10 1 3 21 The percentage of arrested casses was 33 1/3% , quiescent cases 14.3%, whilst 47.6% were "improved". - 77 - MENTAL DEFECIENCY. Number of known Mentally Destructive Pormonism in the, Borough:- 1. Statutory Cases. Aged 0-5 Years 10 Aged 5-16 Years 120 Over 16 Years 400 Total 530 2. Education Cases. Aged 7 -16 Years 120 Combined Total 650 Compared with 1940, the Statutory cases show an increase of 3 and the Educational cases 5. 12 of the cases under Statutory supervision have died. 5 died in an institution, 1 under guardianship, 2 were under observation end 4 were under Statutory supervision. The Statutory cases are distributed as follows:- In Certified Institutions 160 In approved Homes 2 On leave from Institutions 7 Under Statutory supervision at Home 240 Under Guardianship 65 In Mental Hospitals 15 Cases under Public Assistance 5 Obeervation Cases 38 530 The Education Cases were distributed as follows:- In Certified Residential Schools 10 In Certified Day Schools 70 In Private Schools Awaiting vacancies at St. Christopher's 40 120 During the; year the Certified Medical Officers made examinations and paid visits to the number of 96 to Statutory cases and 50 to Educ tional Cases, a total of 146, the same as in 1940. The Mental Deficiency Visitors paid 1852 visits to Statutory cases end 846 Education cases, 2,678 visits in all, an increase of 100 on 1940 figures. During the year 49 names have been added to the Statutory list, of whom 16 wore notified from the Local Education Authority, During 1941, thirty Statutory cases were dealt with as follows:- Sent to Certified Institutions 9 Placed under Guardianship 2 Sent to Croydon Mental Hospital 1 Varying Orders. (a) Change of Guardian 4 (b) From one Institution to Another 6 (c) From Guardianship to Institution Orders closed 1 - 78 - 23 Thirty nine orders were, renowed during the year, 13 of which were guardiarieship . The number of cases sent to Certified Institutions show a an increase of 9. GUARDIANSHIP CASES There are 65 cases under Statutory Guardianship, 36 of these under the care of relatives, and l.0with Guardians who are not relatives. 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 DEFECTIVE. backWArd AND ABNORMAL children. 86 Children were examined during 1941. The classifications arrived at, together with recommendations made are summarised as under:- 1. Certified as Mentelly Defective. Recommendations. (a) recommendedfor Special. Day School 30 (b) referred to Occupation Centre 10 or institution.40 2. Found to be dull and backward. (a) referred to a secial class 16 (b) further trial in ordinary class 44 3. Found to bo physically defective. To attend St. Gilos School 1 4. Referred to Child Guidance Clinic 1 1 86 - 79 - - 80 - BLIND PERSON ACT, I930. Close co-operation has been maintained with, the Croydon Voluntry Association for the Blind. The Blind persons residing in Croydon are now visited at regular intervals by the Health Visitors, and any circumstances in their reports justifying further investigation are followed up. I am indebted to the Secretary of the Voluntary Association for the figures below Number of blind on Resister 408 Number of blind who benefit from instruction in Braille or Moon type (including those who already read ) 104 Number of blind who benefit from part-time instruction. 49 Number in remunerative handcrafts (a) Home worker 41 (b) In workshops 5 (c) St. Dunstan's 7 (u) Workors not included in scheme 16 Home Teacher 1 The Health Visitors paid 502 visits to blind persons during the year. The following table shows: (a) Th number of blind persons registered, (b) The ages at which blindness occurred. (c) The method of training. (d.) The occupations of employed blind persons. (c) The defective blind. (f) The unemployable blind persons in homes, mental hospitals or institutions. WELFARE OF THE BLIND - REGISTRATION. Age period 0-1 Age period 1-5 Age period 5-16 Age period 16 - 21 Age period 21 - 40 Age period 40 - 50 Age period 50 - 65 Age period 65 - 70 Age period 70 & Over (l) Total of all age group. M F T M F T M F T M F T M F T M F T M F T M F T M F T (2) Age unknown. - M F T - - - - - - 7 2 9 2 2 4 25 27 52 30 22 52 53 53 106 14 35 49 46 87 133 177 228 405 (1) - . 1 2 3 (2) 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 70 & Over Age period 1 unknown M F T M F T M F T M F 1 T M F T M F T M F T M F T M F T M F T M F T 22 17 39 8 14 22 11 8 19 13 7 20 13 16 29 30 19 49 20 31 51 19 35 54 20 34 54 6 31 37 16 18 34 Normal Mentally Defective Physically Defective By Blind EMPLOYED (d) Total employed (e) Industrial UNDERGOING TRAINING (h) Trained but Unemployed. (c) All others not included in (a) & (b) (f) Secondary (g) Profossional and University M F M~ F M F Organisations (a) (b) In Scliools for the Blind 7 1 - - - - Workshops Some Workers M F T M F T M F T M F T M F T M F T M F T M F T Other Scl ools - - - - - - 8 1 2 10 30 13 43 15 4 17 51 • 19 70 1 1 _ - - 1 1 - 1 1 Not at School .- - - 1 - - (i)He training but trainable - Nil. (j) Unemployable - M.120, F.207, T.327, (k) Total - M.171, F.228, T.399. - 81 - OCCUPATIONS OF EMPLOYED BLIND PERSONS. Agents, Collectors Basket Workers Bedding including divans & Ottomans & Upholstering. Boot Repairers Braille Copyists, & Proof Readers. . Brushnakers Carpenters 80 Woodworkers Chairseaters Clerk. & Typists Coalbag makers Dealers, Tea agents Newsagents, Shop keepers. Firewood workers Gardeners Hawkers Newsvendors etc. Horne Teachers Knitters 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 Labours Within Institution for the Blind. 2 1 - - - - - - 1 - - - - - 1 - 1 -- - - - 1 - - - 3 - - - - 1 11 In approved Home Workers Schemes 7 - - - 2 - - - - 5 - - - 1 - - - - 10 — 1 2 - 1 — - - - - - 14 - - 43 Others (not part time workers) 2 - - - - 1 - - - - - 4 - - 1 - - 1 - 1 2 2 1 - - 1 - - 1 - - - 17 Total 11 1 - - 2 1 - - 5 1 - 4 1 - 1 1 - 12 - 2 4 2 3 - - 1 3 - 1 14 - 1 71 (a) Mentally (b) Physioally (c) Deaf (l) Combinations Combinations Combinations Combi nations Total Homes for Mental the blind Hospitals Poor Law Institutions. Defective Defective Deaf Mute (11) of (a)&(b) Of (c) & (c) of (b) (c )'i of (a) (b )' t;(c ) 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 (1) 3 (11) 1 4 1 - 1 - 1 1 - -- - - - - 5 7 12 - 1 1 - 3 3 5 18 23 - 52 - SANITARYOIROUMSTANCES. To the Medical Officer of Healh. I beg to submit in accordance with the Sanitary Officers' Order, 1922, a report for the 'year ending 31st December, 1941, 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 number of houses inspected for housing defects (under Public Health or Housing Act.) 452 Number of houses inspected under the Housing (Consolidated Regulations) Number of house inspected under, the Rent Restriction Acts 90 Number of houses inspected where zymotic diseases have occured 121 House drains, tested with smoke (primary) 996 House drains tested with smoke (on application) 14 Number of smoke tests during repair 390 Inspection of drainage work during construction 7595 Number of water tests during repair 796 Pinal tests of drains after repair 127 Pinal test of drains when completely relaid 56 Length of new drains tested yards 4755 Inspection of yards, stables and manure pits 598 " passages 305 " public conveniences 735 " pigstyes 426 " tents, vans and similar structures 18 " theatres, cinemas, halls "etc 102 " ponds and ditches 99 Schools and School lavatories 42 common lodging houses 30 houses let in lodgings 101 premises where offensive trades are conducted 25 Gipsy eneampments, camps etc 41 cesspools 22 " pail closets, privies 11 gathering grounds 85 Food Control - Visits concerning price lists and orders 2921 " visits regarding complaints of shortages 115 " " visits regarding complaints of overcharging 302 " " Miscellaneous visits and retail licence applications 3989 A.R.P. Inspections concerning measures for protection against gas contamination 143 " Miscellaneous inspections and reinspections after our return 95 air raids 2678 " Inspections of posts and centres 205 " Inspection of damaged houses 7433 " Inspection of damaged food shops 1652 Smoke Observations 18 Number of visits re Infectious diseases 1041 Inspections of Shops (under Shops Acts) 1494 Special Early Closing Patrols 237 Sunday Patrols 30 Special evening patrols under Shop hours Act 9 Inspections under Fertilisers and Feeding Stuffs Act 1 " " Pharmacy and Poisons Act 48 " Dairies 143 " Farms and Cowsheds 113 83 - Inspections Milkshops 129 " Premises where food is prepared or sold 6342 " Slaughterhouses 39 " Factories with mechanical power 833 " Factories without mechanical power 309 " Workplaces, Public Health Act 427 " Outworkers premises 198 Visits ro Young Persons Employment Act 113 Water samples examined 80 Visits to Employers of Outworkers 24 Rcinspections of work in progress 12741 Sundry inspections and visits 5177 Appointments kept with Ovmers, builders etc 2158 Complaints from public, investigated 4742 (for purposes other than inspection of house) Examination of building plans 30 Informal notices outstanding 31,1240 1025 Informal notices served 3095 Informal notices complied 3497 Number of Informal notices referred for Statutory Orders 139 Informal notices outstanding 444 Statutory notices outstanding 31.12.40 221 Statutory notices served- 368 Statutory notices complied 470 Total number of complaints received 2173 Interviews with callers 1873 Letters received 3133 Letters and other intimations, etc, sent (net including notices) 3732 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1941 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 212 Want of windows or ventilators 2 Conditions causing dampness Defective roofs 361 Defective walls, etc,- 135 Want of proper damp proof course 25 Defective gutters and downspouts 202 Other structural defects Defective plaster 225 Cleansing and limewashing required 168 Defective floors 72 Insufficient ventilation under floor Defective brickwork, cills, lintels, etc 52 Defective stovos and fireplace: 92 Defective drains, sanitary fitting, etc Defective sinks and waste pipes 90 • • Abolition of drinking water cisterns Defective W.C.'s. 498 Defective drainage 468 Stoppage in drains 173 Domestic nuisances Want of cleanliness 14 Dirty w.c. - pans 3 » 84 - 4 Other nuisances and infringements. Offensive accumulations 90 Insufficient accomodation for sub-tenants - Defective manure receptacles 4 Want of manure receptacles 3 Dirty or defective sanitary conveniences 34 Smoke nuisances 2 Sundry nuisances or defects 115 Limewashing of -tables 1 Particulars not inserted in Rent Book (Housing Act) 28 " " " " " (Rent restriction Act) 55 2• Factories and Workplaces. Want of cleanliness 12 Inadequate ventilation 3 Insufficient drainage of floors 1 Overcrowding Abstract not exhibited 17 Thermometers required 9 Unreasonable temperature 4 Notices re maximum number required 2 Outworkers registers required 2 Sundry nuisances or defects 45 W.C.'s. Insufficient 5 Unsuitable or defective 155 Not separate for sexes 5 3• Infringements of Croydon Corporation Act. I924. Food cupboards defective or required 53 Dustbins required 232 Verminous conditions 79 4. Infringements of Public Health Act, 1925. (S 72-75) Infringements of Food Bye-lws, and Food and Drugs Act. 1938. Cleansing or repair of walls and ceilings 52 Cleansing or repairs.of floors, utensils, fixtures, etc 59 Dirty or defective W, C.accommodation 36 Food storage accomodation required 4 Animals kept in food store 3 Refuse bins uncovered 1 Accumulation in food store and yards adjacent 63 Food in uncovered vehicles or baskets 1 Pood improperly kept or manufactured 5 Premises not suitable for storage or manufacture of food 6 Want of provision of towels 6 Provision of cloakroom accommodation 6 Want of intervening ventilation space to W,C 4 Insufficient or defective sink accomodation and water supply 6 Drain inlet in Pood Store 2 Ventilation required in food store 1 Household washing in food store 3 Swill bins defective 1 Food stored in intervening ventilated space of W.C. 3 5. Infringements of Public Health Act. Pavins-, Etc. Defective Yard Paving 68 - 85 - 6. Infringement of Shops Act. Insufficient lighting to.W.C. Insufficient or defective W. C. accommodation 50 Reasonable temperature required 7 Provision of means of heating 10 Unsuitable or insufficient washing facilities 2 Insufficient accommodation for assistants' meals 1 Seating accommodation required for females Infringement in hours of employment 15 7 • Infringements of Common Lodging Byelaws 8. Infringement of Houses let in Lodging Byelaws Defective windows and sashcords 2 Want of artificial lighting to common staircase 1 Cleansing required 3 Provision of Balusters to stairs 1 Defective .W.C.floors 1 Defective W.C. windows 1 9. Infringement of Offensive Trade Byelaws Fishfrying premises - Limewashing required 1 Other premises. Dirty or defective W.C. accommodation 1 Cleansing and whitewashing required Offal bins-required 1 Carrying on rag trade without liconce 1 10. Inspection of amusement houses. Defective. Sanitary fittings 2 W.C. defective and dirty 16 Notices. to be fixed to door of lavoratories 5 Dressing room floors defective 1 11. Keeping of animals. Nuisances in connection with the keeping of pigs 11 Nuisances arising form the keeping of other animals 13 12. Inspection of watercourscs, etc. Cleansing of watercourses and ponds 13. Infringements of Pharmacy and Poisons etc., Act. Article not labelled with accordance with the Act 1 14. Infringements ofFertilisers and Feeding Stuffs Act. .Section 1. (1) (11) 15. Infringement of Rat and Mice Destruction.Act. Infestation of rats on premises where food is prepared or sold 39 Accumulations of refuse, etc., harbouring rats 25 Structural defects allowing ingress of rats into dwelling houses 50 Dilapidated sheds, etc., harbouring rats 24 Rats in business premises 14 Rats in piggeries. 16. Infringementsof Merebandise Marks Act and Agricultural Produce and Marking Act. Apples not marked 1 17. Inspection of School lavatorios. Defective sanitary fittings 1 Dirty W.C. s. 1 18. Infringement of other Byelaws. Noisy animals 12 19. Infringements of Public Health (Meat)Resulations. Meat displeyed outside, shopfront 1 20. Infringements of Food and Drugs (Adulteration Act. 1988) Margarino not marked 2 21. Infringements of Milk and Dairies Resulation,etc. Dirty cowsheds or dairies 1 Defective sanitary fittings 1 Defective paving 1 Sanitary Certificates. During 1941 requests were made in connection with 3 houses. Rent Restriction Acts. A number of applications wore received for certificates as to the condition of repair of the houses concerned. In 12 instances'where the Acts applied certificates wera granted. HOUSING. In the Five Year Plea it was estimated that some 150 individual unfit houses were subject. to be dealt with in the Borough. A revised estimate now brings the total. to 247. Up to the end of 1941, 216 houses have been approved for demolition and demolition orders had been made, 180 houses had been actually demolished, the tenants being ro~housed. when they desire, by the Council, 691 persons were displaced. Twentythree houses' have been demolished through informal action, 26 persons being displaced. In addition 94 closing orders have been made and 90 parts of houses closed for human habitation, 230 persons being displaced. The following tables give particulars as to housing during 1941 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) 452 (b) Number of inspections made for the purpose. 452 (2)(a) Number of dwelling houses included under the sub-head (l) above, which were inspected and recorded under the Housing Consolidated Regulations, 1925 and .1932 - (b) Number of inspections made for the purpose 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 those referred to under the previous sub-head) found not to be in all respects reasonably fit for human'habitation. - 87 - 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. 397 3. Action under Statutory Powers during the year. A. Proceedings under sections 9, 10 and 16 of the Housing Act, 1936. 1. Number of dwelling houses in respect of which notices were served requiring repairs 114 2. Number of dwelling houses which were rendered fit after service of formal notices. (a) by owners 201 (b) by local authority in defaultof owners 12 B. Proceedings under Public Health Acts. 1. Number of dwelling houses in respect of which notices were served requiring defects to be remedied 5 2. Nmber of dwelling houes in which defect were remedied after service of formal notices (a) by owners 4 (b) by local authority in default of owner C. Proeedings under sections 11 and 13 of the Housing- Act, 1936. 1. Numbr of dwelling houses in respect of which Demolition Orders were made 1 2. Number of dwelling houses demolished in persuance of Demolition Orders 7 D.Proceedings under section 12 of the Housing Act, 1935. 1. Number of separate tenements or undergroud 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 rondere fit OVERCROWDING HOUSING Act,1936.Overcrowding (a) 1. Number of dwellings at the end of the year. 2.Number of families dwelling therein, 3. Number of persons dwelling therein. (b) Number of new cases of overcrowding reported during the year. (c) 1. Number of cases of overcrowding relieved during the year. 2. Number of persons concerned in such cases. (d) Particulars of any cases in which dwelling houses have again become overcrcrowded after the local Authority have taken stops for the abatement of crowding. NOTE: Owing to the evacuation of families it has been found impossible to bring this table up to date. 88 - FACTORIES ACT, 1937. The new Factories Act came into force on July 1st, 1933. This caused considerable alterations of an additional character in regard to the work. The word "workshop" has now been left out and all places where persons are employed are now factories. Factories. Inspections Inspections. Number of Prosecutions. Premises. written notices. Factories. (with mechanical power) 833 95 - Factories. (without mechanical power) 309 36 - Other premises under the Act. 427 1.0 - Total 1,569 141 - Defects found. Number of Defects Referred Prosecutions. Particulars. Found Remedied to H.M. Inspector. Want of cleanliness 12 11 - - Overcrowding - - - Unreasonable temperature 4 3 - - Inadequate ventilation 3 3 - - Ineffective drainage of floors. 1 1 Thermometers required 9 9 - Sanitary Conveniences _ . Insufficient 5 5 - Unsuitable or defective 155 134 - Not separate for sexes 3 2 - - Other Offences (not including offences relating to homework or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories'and Workshops Transfer of Bowers Order, 1921) and re-enacted in the Third ' • Schedule to the Factorie a Act' 1937). 66 59 Total. 258 227 Factories Me cchenical 14 23 Non-mechanical 713 Other -premises under the Act. Employers of outworkers. 40 89 Bakehouses. The control of Bakehouses is dealt with under the Factories Act, the Food Drugs Act and Public Health Acts, Croydon Corporation Act, 1924and Cleanliness of Food Bye-laws, For details of Croydon Corporation Act, see under Food Inspection. Number of Bakehouses on Register, 31st December, 1941. 87 Number of Bakehouses (underground) (included in above) 4 Visits made to bakehouses during the year 175 Defects found 21 Notices issued and complied with 18 Homo Work. lists of home workers are sent in twice yearly, and last year contained the names of 153 workers residing within the Borough, 195 visits were paid to outworkers and 24 visits were paid to premises of employers of outworkers to examine lists and for other purposes. Nature of employment of workers on the Register 31st Dodonber, 1941. Nature of work Number Outwork in infected premises Outwork in unsatisfactory premises Remarks employed Making clean, altering and repairing, wearing apparel. 82 - - - Uphelstery work 6 - - - Lace goods 4 - - - Other classes of work 61 - - - Total 153 Registered and licenced premises in the Borough. 31st December, 1941. Slaughterhouses (not including Public) 3 Bakehouses 87 Common Lodging Houses 2 Houses let in lodgings 66 Dairies and Milkshops 234 Cowsheds 6 Offensive Trades 27 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. 141 Promises registered for preparation or sale of ice cream. 316 Inspection of Offices - Public Health Act. During 1941, 79 inspections of offices were carried out. This is a now branch of tho work necessitated by the Public Health Act, A number of defects were found, including lack of sanitary accommodation for the sexes, cleansing of sanitary arrangements, rodecorations required. - 90 - Shop Acts. The Shop Acts, 1934, contains provisions for dealing with health and comfort of persons employed and also regarding ventilation, temperature, sanitary conveniences, washing facilities and the' facilities for taking meals in shops. The Shops (Sunday Trading Restriction) Act, 1936, restricts the sale of certain goods on Sunday, deals with 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, cane 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. 1,770 inspections were made and a number of infringements were 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 situated at Pitjake, 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 promises. The charge per night to lodgers is Is. Od., the cost of a weekly ticket: is 6s. Od., for 7 nights. The number of men aecomodated during the year was 22,175. The number of men lodgers exceeded 60 per night throughout the year. The receipts and expenditure for the last ten years are as follows Receipts. Expenditure. 1932 1932 £1517. 8. 4. £1547. 5. 5. 1933 1437. 2. 6. 1544. 7.10. 1934 1469.16. 1. 1695. 8. 9. 1925 1488.11.5. 1420.14. 9. 1936 1446. 0. 2. 1381.19. 2. 1957 1378.14.8. 1348.7.2. 1938 1253. 2.0. 1530. 6.5. 1939 1284. 3. 4. 1269. 0. 4. 1940 1178,11.10. 1059.10. 0. 1941 1048. 0. 0. 1271. 0. 0. 2. Private Common Logging Houses. There are 2 common lodging houses on the register. During 1941, 30 inspections were made. Notices were served for the conditions and defects found. The following table gives the situation of and the accomodation in the common lodging houses:- Premises. No. of rooms. Accomodation. 11 & 12, Princess Road. 10 38 men and women. - 91 - Houses lot in Lod.gings There are 66 houses registered under the Byelaws. 101 visits were made for inspection purposes. 3 notices were served for various amendments. 3 notices were complied with. The following table gives the situation of these promises. Road Number of houses let in lodgings. Road Number of houses let in lodgings Beulah Grove 1 Derby Road 2 Princess Road 1 Belgrave Road 2 Queens Road, Croydon 2 Pawsons Road 1 Ely Road 5 Windmill Road 4 Forster Read 8 Heathfield Road 1 Wilford Road 16 St.Peter's Road 2 Nursery Road 1 Alexandra Road 1 St.James Road 1 Whitehorse Road 2 Lodge Road 1 Grange Road 1 Tamworth Road 2 Solhurst Road 1 Bert Road 1 Wellesloy Road 1 Bensham Manor Road 1 South Norwood Hill 1 Clyde Road 4 Sydenham Road 1 Canning Road 2 Notices wore served for the conditions and defects found, OFFENSIVE TRADES. Byelaws relating to the Offensive Trades were adopted during the latter part of the year 1925. 25 inspections were made of premises where such trades were carried on and notices issued requiring amendments in accordance with the Byelaws, The following are on the register:- Rag. and Bone Dealers 24 Gut Scrapers 2 Rabbit Skin Drier 1 27 Rag Flock, Acts, 1911 and 1928. Five samples were obtained and subjected to analysis, the results being as follows:- Number 1 contained 1 part of Chlorine per 100,000 „ 2 „ T{ T? 7Y „ 3 „ 4 parts „ „ „ „ 4 „ 2 „ „ „ „ „ 5 „ 5 „ „ „ „ The five samples conformed to the standard of cleanliness prescribed under the Rag Flock regulations, 1912, made under the Rag Flock, Act, 191! The legal maximum of Chlorine allowed is 30 part: per 100,000, Smoke Observation. During the year 18 observations were made of factory chimneys for the purpose of detecting offences under the Act. Two notices were sent and amendments carried out to stop the nuisance. Anousement Houses. 102 visits were made to Theatres, Music Halls, Cinemas and premises where stage plays are given. Attention was given to the ventilation of the hal! sanitary conveniences, structure'and cleanliness of the dressing rooms. - 92 - Amusement Houses (continued). A report is submitted to the Licencing Authorities annually. Notices were issued for the conditions and defects found. Keeping of Animals. 139 inspections wore made in connection with the keeping of animals. There were 47 promises including institutions, where pigs wore known to be kept in the Borough. 11 notices were served to abate nuisances arising from various causes in connection with the keeping of pigs and 13 notices were served to abate nuisances in connection with the keeping of other animals, Dye-law - Nuisances from dogs. In connection with the fouling of footpaths by dogs a number of warnings have been given. Action was taken in 12 instances and the nuisance was abated. Schools. 42 inspections of schools and school lavatories were made during 1941. The water supply in all cases is from the mains. Inspection of Watercourses, Etc. During the year 99 visits were made to ditches, watercourse etc., in order to see whether there were any infringements of the several Acts., etc. Parmacy. and Poisons Act. 1935. Tho 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 11, and application was made and granted for entry into the list of names of 6 deputies. In addition, 243 applications were made for the retention of names on the list for a further period of twelve months. One infringement of the Act was found. 'Fertilisers and Feeding Stuffs Act. 1926. 1 inspection of premises where fertilisers and feeding stuffs wore sold was carried out during the year, and no infringement of the Act was found. Disinfection. The Borough disinfecting station is situated 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. 93 Disinfection (continued.) The following articles were disinfected at the disinfecting station during the year:- By Steam 60,273 articles. By Formalin gas 2,586 " By Formalin Spray 2,365 " 65,224 In addition 218 articles wore destroyed on request. Disinfection after infectious or contagious diseases was carried out in: 942 rooms at 733 houses 49 sir raid shelters 159 hospital wards. 1 rest centre. 850 hospital clinic and 1 [???] post. creche rooms. 3 fire stations. 1C vehicles. 1 police station. 1 hut 1 military building. 2012 library and 465 other books Disinfecting of bedding and other upholstered goods is carried out for trader . who deliver to and collect articles from the station. For this service a charge is made. During 1941, 8373 such articles were disinfected, the receipts for this work amounting to £84. 7.od. Disinfestation. In addition to the [???] has been carried out for various services such as report [???] services, engineers' centres, fire services etc., as follows:- Blankets 5941 Bolsters 14 Pillows 265 Quilts 2 Mattresses 862 Bugs 5 Cushions 94 Kit bags 24 Beds 4 Other articles 13 Bedding is treated by steam disinfection and delivered in a second van to the house. A number of notifications wore received from contractors who have boon employed by the Estates Dept. etc., to carry out cyanide disinfestation of houses. while the process being carried out the premises were kept t 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 moans of sulphur and spraying with various typos of vermicides. Number of private houses disinfected by. owners or tenants 79 Cleansing of Verminous Persons Etc. During the year 19 adults and 90 children were cleansed for verminous conditions and 230 adults and 450 children for scabies. 94 Rats and Mice Destruction. Wherever rate arc found advice is given to the persons concerned and in the event of no action being taken by the occupier notices are served end followed up, The number of visits made during 1941 was 3065. Food Supply. The supervision and inspection of the food supplies is carried out by 18 of the district inspectors who are qualified in food inspection. The Public Slaughterhouse3 arc under the control of the Superintendent who also acts under the supervision of the Chief Sanitary Inspector. During the year there were 13,587 animals slaughtered for human consumption. The following table shows the premises in the Brough at which foodstuffs are known to be sold, manufactured or stored:- General Shops. 228 Grocers and Prevision Shops 636 Greengrocers and Fruiterers 598 Confectioners, Bakers and Pie Makers 648 Ice-cream Shoos 340 Hotel and Restaurant Kitchens and Dining Rooms 359 Butchers 256 Fishmongers (including fried fish shops) 166 Other Food premises 419 Ham end Beef Shops 79 Sweet manufactureres 12 3,791 In addition to the premises in the above table, there are the following food premises, referred to in other paragraphs of this report:Slaughterhouses and dairies, cowsheds and milkshops on the registers, Further, there are a large number of stalls and barrows used for food purpose is in different areas in the Borough and forming street markets. are. also barrows and other vehicles which are used by hawkers, etc,, for the soiling of foodstuffs, but it is difficult to estimate the actual number in use, as this varies daily. All these barrows and vehicles, wherever found, are inspected by the food inspectors, A watch has been at especially for street traders who frequent the public Elementary School: hen the children are going in and coming out, and who trade toys, sweets, etc., for old clothing. Food Control Enforcement. The Ministry of Pood contribute the sum of £600 per annum for work carried out by the Sanitary Inspectors 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 2,921 Visits regarding complaints of shortages 115 Visits regarding complaints of overcharges, etc. 302 Miscellaneous Visits including visits regarding applications for Retail Licences 3,989 7,327 A number of prosecutions were instituted by the Food Enforcement Sub-Committee 95 Public Slaughterhouses, Pitlake and Meat Inspection These slaughterhouses, although the buildings -'-re not originally intended for such, comprise twelve slaughterhouses with lairage attached. In addition, a gut cleaning firm utilises one building on the premises. Of the twelve slaughterhouses, nine with lairage attached 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 19415- Pitlako, Cattle Calves Sheep Pips Total. 3,856 678 6,414 2,639 15,587 The whole of the meat and offal is examined before ir leaves tho premises. The following meat and offal from the Public Slaughterhouses was condemned and disposed of as salvage by tho Ministry of Food during the year 1941. Descriptom Causes. 45 beef carcases and offals General Tuberculosis, 33 beef forequarers localised tuberculosis.,, 4 beef hindquarters ,, ,, 27 beef parts ,, ,, 35 beef offals, complete Tuberculosis. 367 sets beef lungs Localised tuberculosis. 172 beef heads ,, ,, 216 beef various offals ,, ,, 14 beef heads Actinomycosis 1 beef carcase and offal Peritonitis and Metritis, 13 beef various parts Inflamatory etc. 554 beef various offals Inflammatory conditions etc. 4 veal plucks Tubercular, 1 veal liver ,, 2 veal carcases Inflammatory etc. 2 veal livers ,, ,, 4 pig carcases and offals General tuberculosis. 1 pig forequarter Localised tuberculosis. 46 pig heads ,, ,, 20 pig plucks ,, ,, 1 pig offal, complete Tubercular. 9 pig carcases and offals Svd.no fever. 19 pig carcases and offals Inflammatory conditions etc. 14 pig plucks ,, ,, ,, 57 pig various offals and 11 parts ,, ,, ,, 5 pig carcases and offals Moribund. 6 sheep carcases and offals Inflammatory etc. 5 sheep parts ,, ,, 14 sheep plucks Parasitical etc. 137 sheep various offals ,, ,, Total Weight: 59,264½- lbs. Private Slaughterhouses and Meat Inspection. Control by the Ministry of Food and centralised slaughtering came into force early in 1940, with the result that private slaughterhouses were closed down. 96 Summary of whole carcases condemmed with the reasons for such condomation. Class of Animal. Tuberculosis. Emaciated and Dropsical, Inflammatory conditions Peritonitis trltis Swine Fever. Unsound . Total carcases. Cattle 45 –, – 1 – – 46 Calves – 1 1 – – – 2 Sheep – 3 3 – – 3 9 Pigs 4 1 19 – 9 7 40 49 5 23 1 9 10 97 Carcases inspected and condemned. Number killed Cattle Galves Shoot & Lambs Pigs 3,056 678 6,414 2,639 Number inspected 5,856 678 6,414 2,639 All diseases except tuberculosis whole cancase condermned. 1 2 6 33 Carcases of which some part or organ was condemned. 302 2 149 56 Percentage of the number inspected affected with diseese other than tuberculosis 7.8 0.6 2.4 3.3 Tuberculosis only. Whole carcases condemned. 45 – – 4 Carcases of which some part or organ was condemned. 44.3 5 54 Percentage of the number inspected effected with tuberculosis. 12.6 0.7 — 2.2 General Food Inspection, 4 The following table given a summary of the inspections made during the year (not .including vieits made to slaughterhouses or dairies, cowsheds and milkashops):- Butchers 1,304 Bakers' Premises 175 Fishmongers 206 Confectioners Premises 620 Fried Fish Shops 94 Marl-rets 565 Grocers 1,360 Hawkers carts 131 Greengrocers 826 Poultry and Gome Dealers 64 Hotel and other . Kitchens etc 476 Cooked and Prepared Meat Shop's 90 Ice-cream. Manufacturers and Vendors 66 219 146 Total 6,342. 97 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 .1941, 96 beef parts and trimmings Unsound. 27 1bs. beef kidneys ,, 30 1bs. beef livers ,, 985 lbs. beef offals (various) ,, 46 1bs. veal parts ,, 93 1bs. veal offals (various) ,, 345 1bs. mutton parts ,, 3 mutton carcases ,, 1542 1bs. mutton offals (various) ,, 3 pork carcases ,, 245 1bs. pigs offals (various) ,, 87 1bs. pork parts ,, 274 1bs. bacon and ham ,, 456 1bs. haddock, cod etc. ,, 2174 1bs. rabbits ,, 1486 tins etc. peas, alums, pineapple etc. ,, 492 tins sardines, herrings etc. ,, 1657 tins milk ,, 115 packets cereals, flour, etc. ,, 625 lbs. potatoes, apples, etc. ,, 396 1bs. jam ,, 713 lbs. brown, veal loaf, bacon roll, etc ... ,, 4026 eggs ,, 59 1bs. butter ,, Total weight 19,328¾ lbs. General Summary of Meat and other articles disposed of during the year 1941, Articles Beef. Diseased Wei Hit in lbs Unsound I Total. He marks. 27,681 4,421— ! l OP-?- C-j j J Including 46 carcases. Veal. 56 97-jx 153j T? p 11 Mutton. 437£ 350 787+ " 9 " Pork. 2,476 l,055i 3,529-| " 40 " Offal. 29,759ir i 31,213 imported offal. Fish. W I 455® Haddock, cod, etc, Fruit. Tinned Goods. 586 5,752j | 586 5,752f Potatoes, apples, etc. 3,488 tins, 147 jars, etc, Sundries, - 4,012-1- , <„oi4 Rabbits, jam., etc. ' 60,410 7 18,1834 ! ~ I 70,593;-:; Disposal of Condemned Foodstuffs. 1, Government Slaughterhouse, Pit lake'.') Condemned foodstuff is dealt 2, Government Meat D0pot. ) with by the Ministry of Food. 3, General Food inspection. Articles of food which have been damaged through enemy air raids are dealt with through th 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. 98 Enquiries show that approximately 13,398 gallons of milk are sold daily in the borough. Of this amount 95.5% is bottled, 4% is loose, which is sold wholesale, and the remaining small portion is retailed as loose milk. Those 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 and Dairies Amendment Act, 1922. The Milk and Dairies Orders. 1926. and The Food and Drugs Act, 1938 Cowkeepers, Dairymon and Purveyers of Milk. The following statement shews the number of Cowkeepers, Cowsheds, Dairies end Purveyors of Milk premises on the register 8 " added to the register 1941 – " discontinued 2 Net. 6 Cowsheds on register 1940 13 " added to register 1941 – " discontinued 7 Net. 6 Number of cows provided for 143 Average number of cows in sheds 1941 121 Number of dairies and purvoyers of milk on the register 1940 267 Number of dairies end purveyors of milk added to register 1941 2 Number of dairies and purveyors of milk diacentinued 1941 35 Net. 234 Grand total of cowsheds, dairies and purveyors of milk on register 31st December, 1941 240 During the year 385 inspections wore made of dairies, cowsheds and milkshops. Milk (Special Desianations) Order. 1936. The following licences were granted during the year under this order. 1. Producers' Licences to use the desgnation "Accredited" 6 2. Dealers Licences to use the designation "Tuberculin Tested. " (a) Settling Establishments – (b ) Shops. 15 3, Dealers' Licences to use the designation "Accredited" (a) Bottling establishments – (b ) Shops 1 4. Dealers' Licences to use the designation "Pasteurised" (a) Pasteurizing establishment 2 (b) Shops 46 5. Dealers' Supplementary Licences to use the designation:- (a) Tuberculin-Tested 2 (b ) Accredited – (c) Pasteurised 2 99 Inspection of these licenced, premises has been carried out regularly during the year to see the conditions of the licences were observed. Inuring the year the fallowing Samples were examined under the Milk (Special Designations) Order, 1936:- Tuberculin-Tested Milk Licenced country producer Supplying milk to licenced local dairymen Accredited Milk Licenced local producers Supplying milk to a licenced dairyman Pasteurised Milk Samples from licenced dealers 177 The following tables Summarise the result of the bacteriological examinations of Accredited and Pasteurised samples during the year:- Accredited. Licences granted under the Milk (special Designations) Order 1935 Present. Absont. Prcesent in 1/100. M.1 Absent Present Absont. Present Absont. Exceeding a trace. Net ex- ceedubg a trace. Satisfied Not Satisfied. Tubercle bacillus – 9 – – – – – – – – – – Bacillus Coli – – – 9 – – – – – – – – Blood – – – – – 9 – – – – – – Pus – – – – – – – 9 – – – – Detritus – – – – – – – – – 9 – – Methylene Blue Test – – – – – – – – – – 4 5 – 9 – 9 – 9 – 9 – 9 4 5 The following tables summarise the results of the bacteriological examinations of Pasteurised Milk Samples during the year:- Pasteurised Milk. (Licences granted under the milk (Specialised Designations) Order 1956) Present Absent Over 100,000 per M.l. . Under 100,000 per M. 1. Present Absent Present Absent Present Absent Tubercle bacillus. – 177 – – – – – – – – Total number of bacteria – – 45 134 – – – – – – Blood – – – – – 177 – – – – Pus – – – – – – – 177 – – Detritus – – – – – – – – – 177 – 177 43 134 177 177 177 100 These 177 Pasteurised Milk samples contain bacteria per M.1. as follows Under 1,000 6 1,000 - 5,000 18 5,000 - 10.000 24 10,000 - 20,000 26 20, 000 - 30,000 18 30,000 - 50,000 19 50,000 - l00,000 24 Over 100,000 42 177 Under the Regulations, Pasteurised Milk must not contain more than 100,000 bacteria per millilitre. Provision as to Milk Supply, During the year 152 samples of ordinary milk wore procured and submitted to examination for tuberculosis in accordance with the Milk and Dailies (Consolidation) Act , 1915. These samples wore taken as follows:- Samples taken at cowsheds in the Borough 12 Samples in course of delivery from country cowsheds to local dairymen and 11 Samples taken at dairymen's premises 41 Samples taken in course of delivery by local dairymen or milk sellers on their rounds in different parts of the Borough 88 152 One sample proved to be tuberculous, 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 - 3.1st December, 1941, Present Absent Over 100,000 per M.1. Under 100,000 per M.1. Present Absent Present Absent Exceeding a trace .... - Not exceeding a trace Satisfied Net satisfied. Tubercle bacillus 1 151 – – – – – – – – – – Total number of bacteria – – 51 101 – – – – – – – – Blood – – – – – 152 – – – – – – Pus – – – – – – – 152 – – – – Detritus – – – – – – – – – 152 – – Methylene Blue Test – – – – – – – – – – 120 32 1 151 51 101 – 152 – 152 – 152 120 32 101 The 152 samples taken under the Milk and B dries (Consolidation) Act, 1915, were samples of Milk which had been produced in the Following areas:- Number obtained Nuber tuberculosis. Croydon 13 – Kent 5 – Surrey – – Sussex 6 1 X Unclassified 127 – X These samples could not bo classified owing to the fact that it was mixed milk of large dairy fins or wholesale, purveyors of milk, who obtain their milk from practically all the areas mentioned in the above table. 102 Bacteriological Examinations Of Ice Cream. There were no Samples taken during 1941 FOOD AND DRUGS ACT, 1938 During the year 314 samples of Milk and 507 other samples were taken. SUMMARY OF SAMPLES During 1941 samples were obtained and submitted to the Public .Analyst as follows Samples of Total Sample s Genuine Not Genuine Prosecutions Convictions Cautions Milk 314 287 27 1 1 19 Anchovy Paste 1 1 – –– – – Arrowroot 5 5 – – – – Asparagus 1 1 – – – – Aspirin Tablets 10 10 – – – – Baking Powder 14 14 – – – – Baked Beans 3 3 – – – – Beef Sausage 19 19 – – – – Beef Sausage Meat 2 2 – – – – Bitter Beer 3 3 – – – – Black Puddings 4 4 – – – – Bloater Past 8 8 – – – – Boiled Sweets 6 6 – – – – Boracic Ointment 4 4 – – – – Brawn 5 3 – – – – Bread 12 12 – – – – Breakfast Sausage 3 3 – – – – Bun Flour 9 9 – – – – Butter 1 1 – – – – Blancmange 2 2 – – – – caster oil 9 9 – – – – Chicken and Tongue 2 2 – – – – Chicken and Ham Ro11 2 2 – – – – Chicken and Ham Paste 2 2 – – – – Cooked. Haricot Beans 2 2 – – – – Cocoa 16 16 – – – – Cod Liver Oil 3 3 – – – – Coffee and Chicory 17 17 – – – – Cinnamon 1 1 – – – – Coffee 6 6 – – – – Coffee and Chicory Essence 6 6 – – – – Comp. Liquorice Powder 1 1 – – – – Confection of Senna 2 2 – – – – Corn Flour 6 6 – – – – Crab and Lobster Paste 1 1 – – – – Corned Mutton 1 1 – – – – Cake Flour 6 6 – – – – Cream of Tartar 3 3 – – – – Custard Powder 13 13 – – – – Camphorated Oil 1 1 – – – – Cheese 1 1 – – – – Dried Carrots 1 1 – – – – Dripping 1 1 – – – – Dry Ginger Ale 2 2 – – – – Egg Substitute Powder 10 10 – – – – Carried forward 541 512 29 l 1 19 103 Samples of Total Samples Genuine N. t Genuine Prosecutions Convict- ions Cautions Brought forward 541 51.3 29 1 1 19 Faggots 1 1 – – – – Fish Calces 4 4 – – – – Fish Roll 1 1 – – – – Fish Paste 9 9 – – – – Flour 6 6 – – – – Ginger Beer 6 6 – – – – Ginger Wine 5 5 – – – – Glucose Syrup 1 1 – – – – Gin 4 3 1 – – – Glycerine 1 1 – – – – Ground Almonds 2 2 – – – – Ground Cinnamon 6 6 – – – – Ground Ginger 2 2 – – – – Ground Nutmeg 4 4 – – – – Ground Ri ce 8 8 – – – – Honey 1 1 – – – – Jam 1 1 – – – – Lard 1 1 – – – – Luncheen Meat 3 3 – – – – Lemonade 14 14 – – – – Lemon Cheese 1 1 – – – – Lemon Powder 1 1 – – – – Lemon Juice 1 – 1 – – – Lemon Curd 2 2 – – – – Lemon Squash 4 4 – – – – Liver Sausage 2 2 – – – – Luncheon Sausage 9 9 – – – – Luncheon Galantine 2 2 – – – – Meat Paste 6 6 – – – – Meat Pies 2 2 – – – – Meat Roll 5 5 – – – – ML Id Beer 6 6 – – – – Malted Milk, Cocaa & Eggs 2 1 1 – – – Marmalade 1 1 – – – – Mint Sauce 2 2 – – – – Mistard 7 7 – – – – Mixed Spice 7 7 – – – – Oatmeal 5 5 – – – – Olive Oil 1 1 – – – – Orange Squash 1 1 . – – – – Orange Champagne 1 1 – – – – Ox Tail Soup 1 1 – – – – Pearl Barley 8 8 – – – – Prepared Meal 3 3 – – – – Popper 5 5 – – – – Piccalilli 3 3 – – – – Picnic Roll 1 – 1 – – – Pickles 4 4 – – – – Plain Flour 1 1 – – – – Pork Sausages 10 10 – – – – Pork Polonies 1 1 – – – – Pork Pie 1 1 – – – – Pork Roll 1 – 1 1 1 – Roast Pork 1 1 – – – – Raisin Wine 1 1 – – – – Rice 5 5 – – – – Spaghetti 1 1 – – – – Salmon and Shrimp Paste 5 5 – – – – Soup Powder 10 10 – – – – Sago 8 8 – – – – Salad Oil 1 1 – – – – Self Raising Flour 3 3 – – – – Sponge Mixture 9 9 – – – – Carried forward 772 738 34 . 2 2 19 104 Samples of Total Samples Genuine Wot Genuine Prosecutions Ccn- victions Cautions. Brought forward 772 738 34 2 2 19 Sultanas 2 2 - - - - Shredded Beef Suet 1 1 - - - - Steak and Kidney Pie 1 1 - - - - Shredded Beef 1 1 - - - - Steamed Pudding 1 1 - - - - Sweetened Custard Powder 1 1 - - - - Table Jellies 5 3 - - - - Tapioca 5 5 - - - - Tea 1 1 - - - - Tinned Vegetables 6 6 - - - - Tinned Beans 6 6 - - - - Tinned Soup 6 6 - - - - Tinned Peas 5 5 - - - - Tinned Carrots 2 2 - - - - Tincture of Iodine 1 1 - - - - Vegetable Brawn 1 1 - - - - Vinegar (non-brewed) 1 – 1 - - 1 Whiskey 5 5 - - - 821 786 35 2 2 20 | Result of analysis of Now Milk Samples Solids not Fat. (Legal standard is 8.5%) 5.36 5.64 5.97 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 9.0 9.1 9.2 1 1 1 3 4 11 22 70 72 70 42 14 2 1 Milk fat (Legal standard is 3%) 2.32 2.51 2.7 2.80 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 1 1 1 1 1 20 36 59 55 51 31 26 8 11 4.1 4.2 4.3 4.4 4.5 4.6 6 2 1 1 1 1 Total samples of new milk 314. The samples of milk for analysis were obtained as follows:- Country milk in course of delivery 4 On milk rounds 150 "Appeal to cow" samples – At shops 149 Taken at Institutions 7 Taken at Farms 4 Other samples 314 •ft-vcrago oomnosition of new milk samples. Solids not fat 8.78% Milk fat 5.54$ Percentage of new mi 11c samples below losal standard 8.1$. 105 Adulterated samples. The following is a detailed statement of the adulterated samples and the action taken". - Number Sample Adulteration or Deficiency. Remarks. 206 Milk 3% added water Warning given. 229 Milk 1% -do- -do- 256 Malted milk Cocoa with eggs. 24% added sugar This label was used for a considerable number of years by one of the large cocoa manufacturers and I am informed by them that no exception had ever been taken to it. I discussed the matter with their chief chemist who took an opinion and they agreed to alter the label to "Melted Milk Cocoa with Eggs - Sweetened 262 Milk 3% added water Warning given. Further samples taken Droved genuine. 265 Milk 2% added water -do- 266 Milk 1% added water -do- 267 Milk 1% added water -do- 570 Fancy- Containing Meat Fined £8.0.0. Quality Roast Pork. (including fat) 13% Cereal filler, wheat, calculated as bread with 40% moisture, 64$ .Additional viator 22$ Costs £3.3.0 392 Milk 7% deficient in milk fa Further samples taken proved genuine. 413 Lemon Juice Lemon juice diluted with. not less than an equal volume of water and sweetened with sugar. I took this matter up with the vendors, one of the large milk combines, who informed me that this was labelled "lemon juice" inadvertently and should have been "lemon squash". The price asked for the article would confirm that it was not lemon juice. 426 Milk Small percentage added water Warning given. 431 Milk 7% deficient in milk fat -do- 461 . Milk Small percentage added water -do- 506 Milk -do- -do- 527 Picnic. Roll Boric Acid 0,03% Vendors informed me that they admitted a small percentage of boric acid which was accounted for by the fact that they were using as one of the ingredients of the rolls American pork backs bellies and shoulders containing borax, imported by Ministry of Food under "lease and lend" agreement, and that they are authorised to use the material for manufacturing purposes by the Manufactured Meats Section of the Ministry of Food. Although every endeavour is made to keep the borax down to a minimum by washing it is impossible to remove it entirely. No boric acid or borax is added during manufacture. 106 Number Sample Adulteration of Deficiency. Remarks. 686 Milk 1% added water warning given 808 Milk -do- -do- 819 Nonbrewed Deficient by 0.8 guns, acetic acid per 100 c.c. -do- Vinegar 1058 Milk 36% added water These were milks delivered to a 1059 Milk 33% added water dairyman in the borough from a 1060 Milk 29% added water farm in East Sussex. It eventually 1061 Milk 32% added water transpired that a cowman had added water to the milk before it was despatched from the farm. Proceedings were taken by the East Sussex authority and penalties obtained against the cowman amounting to £10.10.0, 1447 Milk 1% added water Warning given. 1448 Milk 1% added water -do- 1450 Milk 2% added water -do- 1477 Brawn Boric Acid 0.08% it was ascertained d that the use of imported pork was the reason for the boric acid being found in the brawn. 1542 Brawn Boric Acid 0.09% -do- 1691 Milk 6% deficient in milk fat Further sample proved genuine. 1696 Milk 1% added water Warning given. 1726 Milk 1% deficient in Milk solids other than milk fat. -do- 1729 Milk 3% added water Warning given. Further sample proved genuine. 1757 Milk 1% deficient in milk solids other than milk fat. This was taken from a large dairy company who informed me that they had discovered themselves a drop in the non-fatty solids when the milk got out on the found. As much of it was withdrawn as was possible but some of it was inadvertently issued. It was due to a crack developing in one of the plates of the pasteurisingmachine "breathing" in hot water during the fall of the pressure on the milk side which occurs at the break between holders. This would appear to be the cause and further samples were taken which proved to bo genuine. 1738 . . . Milk 15% deficient in milk fat This milk came from a farm and I investigated the matter. Samples were taken of all the cows concerned with the result that certain cows were found giving milk 13c which was deficient in milk fat. They were removed from the herd. Further samples taken were genuine. 107 Number Sample Adulteration of Deficiency. Remarks. 1739 Milk 1% added water Warning given. 1798 Gin Excese water 2% This would appear to be a genuine mistake admitted by the licensee that he had some difficulty in reading his instruments in breaking down the spirits. This explanation was accepted. Public Health (Preservatives, etc in Food) Regulations. 1985 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. 103