CRO 44 Vol LXII. Part 2. No 1. Countg Borough of Croydon. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH and SCHOOL MEDICAL OFFICER For the Year 1942 OSCAR M. HOLDEN, G.M., M.D., D.P.H. CROYDON: PRINTED BY THE CROYDON TIMES, LTD., 104, HIGH STREET c.t. 2. 6-12-13. 100. i. COUNTY BOROUGH OF CROYDON. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and SCHOOL MEDICAL OFFICER For the Year 1942. OSCAR M. HOLDEN, G.M., M.D., D.P.H. To the Chairman and Members of the Public Health Committee. Ladies and Gentlemen, I have the honour to present my Fifteenth Annual Report, being the forty-third of the series dealing with the work of the Public Health Department and School Medical Services and including the report on Mayday Hospital. The report retains the abbreviated form followed last year necessitated by the circumstances of war. The Birth-rate for the year was 18.3 per 1,000, an increase of 4.0 per 1,000 over 1941. The Death-rate was 12.32, a further decrease of 1.43 per 1,000 of the population. The Infantile Mortality rate was 39 per 1,000 live births; this was 2 per 1,000 higher than 1941. These rates can be stated to be very satisfactory, especially when the fact that this country had been at war for 3 years is remembered. The restrictions and rationing of foodstuffs does not appear to have had any detrimental effect upon the rate of death. The incidence of notifiable Infectious Diseases remained low with the exception of Measles, which was much the same as 1941, and Scarlet Fever, which showed a considerable increase. ii. Immunization against Diphtheria has proceeded steadily, and the number of children now immunised is estimated at approximately TO per cent. of the total child population. Diphtheria incidence has remained remarkably low, and only 3 deaths from this formerly dreaded disease occurred in the Borough throughout the year. Full statistics are given of patients treated in Mayday Hospital because this information is of value to other similar hospitals. The year, as shown by the statistics, has been a busy one, with a welcome expansion in all directions in its functions as a general hospital. The hospital is classified under the Emergency Hospitals Scheme as a Number One General Hospital, and arrangements have been made to have 250 beds always ready for emergency and another 250 to be available within 48 hours. The major cause of death remained the same as in recent years, namely, diseases of the Heart and Circulatory system; the figure rose from 5.1 per 1,000 of the population to 5.25. Since 1939 this figure has risen steadily each year. Deaths from diseases of the Digestive System remained at practically the same level as in 1941. There has been a continued incidence of skin affections, particularly noticeable in the case of Scabies and Impetigo. Influenza incidence has remained at a low level. Considered as a whole, the vital statistics show that Croydon's health has been well maintained during 1942. Some increase in the number of cases of Pulmonary Tuberculosis notified is manifest, and this increase has been greatest among women. This is not a surprising finding, though it naturally calls for constant vigilance. The increased employment of women in factories, the black-out, and the restricted consumption of fats probably all play a part in rendering susceptible persons less able to overcome chance infection. The Maternity and Child Welfare Services have functioned very fully throughout the year, and the commencement of Wartime Nurseries has opened up a new branch of activity which is proving of value in the care and training of the pre-school child. Attendances at Infant Welfare Centres have returned to their pre-war dimensions, though it is possible that some of the increases noted are due to the issue of vitamins through the Centres by the Ministry of Food. iii. Venereal Diseases show an increase, an unfortunate concomitant of war conditions. Some small addition towards combating these conditions has been brought about by Regulation 33B, but only a few cases have come to light by this means. All who have been brought forward have submitted themselves to treatment. The Housing position remains much as was stated in the introductory letter to my report for 1941. Lack of materials and labour and the war-time restrictions upon building are contributing towards a steady deterioration, more especially in "border line" properties. There is also some evidence that overcrowding is increasing. Considerable leeway will have to be made up when the time comes when building is again permitted. The Sanitary Inspectors' staff has been depleted owing to call-ups for service in H.M. Forces, but the work has continued on the same lines as were followed in 1941. During the year the Public Health Offices moved from the Town Hall into the old offices of the Croydon Gas Company, and the Chest Clinic, formerly at 13, Katharine Street, was also accommodated in the new premises. This arrangement is a great advantage, simplifying and making more effective the administration of the Department. In conclusion, I express my thanks to you, ladies and gentlemen, for the help and encouragment you have given my staff and myself, and I wish to bring to your notice the competent way in which the members of the professional, technical and clerical staff of the Department in all its branches have carried out their duties. I am, Yours faithfully, OSCAR M. HOLD EN, Medical Officer of Health. 1 PUBLIC HEALTH COMMITTEE. NOVEMBER, 1941-1942. The Worshipful The Mayor (Alderman A. H. Harding, J.P.) Councillor G. Lewin, J.P. (Chairman) Councillor H. Regan (Vice-Chairman) Alderman E. E. L- Arkell, J.P. Alderman Mrs. B. J. Roberts. Alderman Mrs. M. Squire, J.P. Councillor L. A. Aston. Councillor E. E. Constable. Councillor Mrs. V. L. Child. Councillor A. V. Dammarell. Councillor Miss M. H. Glazier. Councillor A. Goodbun. Councillor W. H. Gough. Councillor Mrs. E. M. Regan. Councillor D. G. Stewart. Councillor J. T. Twitchett. Councillor G. H. Ward. G. G. Genge, Esq., M.D. J. H. Thompson, Esq.,M.B.,B.Ch. 2 SUMMARY OF VITAL STATISTICS FOR 1942. Area, 12,617 acres. Population (Census 1931), 233,115. Population (estimated middle of 1942), 195,600. Number of Inhabited Houses (1931 Census), 56,429. Overcrowding Census (1936), 65,550. Rateable Value (1st April, 1942), £2,519,314. Product of a Penny Rate (1941—1942), £9,387. Rate in the £: 12/8d. Gross expenditure on Health Services (administered bv Medical Officer of Health) £254,085 Income on Health Services (excluding transfers) 61,238 Net expenditure on Health Services £192,847 Expressed as a Penny Rate, 17.92 pence in the pound. l ive Births M. F. Total Legitimate 1,680 1,529 3,209 Illegitimate 147 115 262 3,471 Birth-rate per 1,000 of the estimated resident population, 17.7. Still Births 108. Rate per 1,000 total (live and still) births, 30.18. Birth-rate per 1,000 (live and still births), 18.3. Deaths, 2409 (Registrar-General's figures). Death-rate per 1,000 of the estimated resident population, 12.32. Deaths from diseases and accidents of pregnancy and childbirth, 12; from sepsis, 3; other causes, 9. 3 Maternal mortalitv 3.35 per 1,000 total live and still births. Death-rate of Infants under one year of age (136 deaths, 3,471 births)— All Infants per 1,000 live births 39 Legitimate Infants (124 deaths) per 1,000 live births 39 Illegitimate Infants (12 deaths) per 1,000 live births 46 Deaths from Influenza 19 ,, ,, Whooping Cough (all ages) 3 ,, ,, Diarrhœa (under 2 years of age) 15 ,, ,, Diphtheria (all ages) 3 ,, ,, Pneumonia 113 ,, ,, Cancer 409 Rate per 1,000 Population. Deaths from diseases of Cardiac and Circulatory System (including Cerebral Hæmorrhage) 5.25 ,, ,, diseases of the Respiratory System (including Tuberculosis) 1.86 ,, ,, diseases of Renal System 0.29 ,, ,, diseases of Digestive System 0.57 ., ,, Suicide and Accidents 0.43 ,, ,, Old Age (local statistics) 0.97 ,, ,, War Operations (local statistics) 0.03 Marriages. The number of marriages solemnised was 2,042, compared with 2,187 in 1941, 2,792 in 1940, 2,674 in 1939, 2,319 in 1938, and 2,210 in 1937. The marriage rate was 10.4 per 1,000 of the population; 1,120 were solemnised in Established Churches, 308 in other places of worship, 612 in the Register Office, and 2 performed under Jewish ritual. 4 Births. The births registered were 3,209 legitimate and 262 illegitimate. The birth-rate consequently was 17.7. For England and Wales and in the Great Towns the rates were 15.8 and 17.3. The illegitimate births in Croydon were 7.5 of the total, compared with 6.3 in 1941; 5.3 in 1940 and 1939; 4.9 in 1938; 4.6 in 1937; and 5.5 in 1936. The live male births numbered 1,827, the female 1,644, being a proportion of 1,111 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 birthrates were Addington 27.7, Waddon 22.5, and South Norwood 20.2. Those with the lowest were Central 9.6 and Norbury 9.8. Deaths. The deaths numbered 2,409 compared with 2,538 in 1941. For 1942 the death-rate was 12.3; for 1941 it was 13.7. The deathrate for England and Wales was 11.6, and for the Great Towns 13.3. For London the death-rate was 13.9. There were 156 inquests held by Coroners in respect of Croydon residents during 1942 and 138 findings by Coroners after post-mortem examination without inquest. Wards with the highest death-rates were Central 15.3 and Bensham Manor 14.6. Lowest: Addington 8.9 and Waddon 9.0. 5 REGISTRAR GENERAL STABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX. Sex All Ages 0— 1 — 5— 15— 45— 65— All Causes M 1191 77 18 13 90 333 660 F 1218 59 13 9 125 247 765 Whooping Cough M - - - - - - - F 3 2 1 — — — — Diphtheria M 3 - 1 2 — — — F - - - - - - - Cerebro Spinal Fever M 2 1 1 — — — — F 4 — 4 — — — — Scarlet Fever M 1 - — — — — 1 F - - - - - - - Influenza M 12 — — — 2 3 7 F 7 — — — — 1 6 Poliomyelitis & Polioencephalitis M - - - - - - - F 1 - - 1 - - - Tuberculosis (respiratory) M 59 - — — 31 24 4 F 38 - — — 31 7 — Tuberculosis (other forms) M 9 3 1 1 2 — 2 F 10 1 — 2 6 1 — Syphilitic diseases M 10 — — — — 5 5 F 3 — — — — 1 2 Cancer M 208 — 1 — 9 80 118 F 201 — — — 13 94 94 Diabetes M 7 — — 1 1 1 4 F 14 — — - 2 3 9 Intra cranial vascular lesions M 84 — — — 20 64 F 134 — — — 2 29 103 Heart diseases M 348 — — — 6 74 268 F 393 — — 10 46 337 Other circulatory diseases M 31 — — — — 7 24 F 36 2 — — 3 6 25 Bronchitis M 66 1 — — 4 19 42 F 65 1 - — 4 3 57 Pneumonia (all forms) M 59 14 5 — 6 13 21 F 54 11 3 2 2 13 23 Other respiratory diseases M 12 — 1 - 1 6 4 F 10 1 1 — — 3 5 Ulcer of stomach or duodenum M 30 — — — 2 18 10 F 3 — - — 1 1 1 Diarrhoea (under 2 years) M 8 7 1 — — — — F 7 7- - - - - - Appendicitis M 5 — — 1 4 — — F 1 - - - 1 — — Other digestive diseases M 26 1 — 2 1 12 10 F 32 2 — 8 3 19 Nephritis M 27 1 — — 1 13 12 F 30 — — — 4 12 14 Puerperal sepsis F 3 — — — 3 — — Other maternal causes F 9 — — — 9 — — Congenital debility, malformations, premature birth, etc. M 48 47 1 — - — — F 34 31 — 1 2 — Suicide M 15 — — 5 8 2 F 9 — - — 1 3 5 Road traffic accidents M 9 — 1 — 2 3 3 F 6 — 1 1 2 1 1 Other violent causes M 25 1 3 I 3 6 11 F 21 — — — 7 2 12 All other causes M 87 1 2 5 10 21 48 F 90 1 3 2 16 16 52 Totals 2409 136 31 22 215 580 1425 6 Comparisons with 1941. In the zymotic diseases group there were decreases in the number of deaths caused by Whooping Cough and Measles. There were no deaths in the Typhoid group, compared with one in 1941. Deaths from Diphtheria numbered 3, compared with 4 in 1941. The deaths from Pulmonary Tuberculosis increased by 7; those from Cancer by 39; and those from Heart by 2. There was a decrease of 55 in the Pneumonia deaths and of 1 in those caused by Bronchitis. Deaths from Suicide and other violence show a decrease of 141, and road traffic accidents remained the same as 1941. The total number of deaths was 2,409, as compared with 2,538 in 1941. The percentage of deaths under 1 year of age to the total deaths was 5.6 per cent.; deaths under 15 years, 7.8 per cent.: deaths under 65 vears, 40.85 per cent.; and deaths over 65 years. 59.15 per cent. The corresponding figures for 1941 were 3.5 per cent., 6.7 per cent., 42.2 per cent., and 57.8 per cent. respectively. The above total differs slightly from the total recorded by the department, as the period covered by the Registrar-General refers to the weekly returns from the Registrars, while the department records are calculated from 1st January to 31st December. 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 2,330,267,208 Metropolitan Water Board in bulk 336,693,000 2,666,960,208 galls. The same arrangements regarding samples as were commenced in 1938 continued in 1941. 7 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 re-opened on 18th August, 1941. The Throat Clinic at Croydon General Hospital was transferred to Mayday Hospital on 3rd November, 1941. DEPARTMENTAL CLASSIFICATION OF DEATHS ACCORDING TO DISEASE OVER A PERIOD OF SIX YEARS. Cause of Death. 1937 Total Deaths 1938 Total Deaths 1939 Total Deaths 1940 Total Deaths 1941 Total Deaths 1942 Total Deaths Death Rate Enteric Fever 35 12 2 - 1 - - Malaria — — - - 1 - - Small Pox - — - - - - - Measles 5 8 — - 5 - - Scarlet Fever 3 3 — — — 1 0.005 Whooping Cough 5 3 3 2 6 3 0.015 Diphtheria and Croup 15 16 16 4 4 3 0.015 Influenza (including Influenzal pneumonia) 71 21 48 49 36 19 0.097 Dysentry — 1 1 — 2 2 0.010 Erysipelas 3 3 2 2 — 1 0.005 Cerebro-Spinal Fever 3 5 2 16 8 6 0.031 Pulmonary Tuberculosis 140 117 89 128 90 97 0.496 Tuberculous Meningitis 15 20 18 21 19 19 0.097 Other Tuberculous Diseases Cancer, Malignant Disease 432 387 419 443 376 409 2.091 Rheumatic Fever 11 6 2 8 2 3 0.015 Meningitis 4 5 3 5 3 9 0.046 Organic Heart Disease 770 777 782 682 672 741 3.788 Bronchitis, Acute and Chronic 50 49 47 130 80 131 0.670 Pneumonia 179 130 151 206 194 113 0.578 Other Diseases of the Respiratory Organs 12 25 13 21 30 22 0.112 Diarrhoea & Enteritis 45 29 23 18 13 15 0.077 Appendicitis 23 15 15 15 10 6 0.031 Cirrhosis of Liver 9 8 12 1 10 5 0.026 Alcoholism 1 1 1 2 1 - - Nephritis & Bright's Disease 84 72 63 63 60 57 0.291 *Puerperal Fever 1 1 2 2 3 3 0.838 *Other diseases and accidents of pregnancy and parturition 11 2 2 3 5 9 2.515 Congenital debility, malformation and Premature Birth 105 64 71 53 34 82 0.419 Violent Deaths (excluding suicide) 102 78 77 61 74 61 0.312 Suicide 30 43 28 20 2(1 24 0.123 Other Defined Diseases 634 595 662 1152 778 568 2.904 Diseases Ill-Defined or Unknown 2 — 3 11 2 - — Total 2800 2496 2557 3118 2539 2409 — *Calculated per 1,000 live and still births. 8 1942 showed a decrease in the general death rate and an increase in the birth rate. WARDS. Estimated Population. Births. Deaths. Birth Rate. Death Rate. Deaths under 1 year per 1,000 Births. Death Rate from Six Zymotic Diseases (excluding Diarrhoea) Death Rate from Diarrhoea. Death Rate from Bronchitis and Pneumonia. Death Rate from Pulmonary Tuberculosis. Death Rate from Non-Pulmonary Tuberculosis. Death Rate from Heart and Circulation Diseases. Death Rate from Nervous Diseases. Death Rate from Cancer. Natural Increase or Decrease of Population. Upper Norwood 12939 142 174 11.0 13.4 63 — 0.15 1.85 0.62 0.08 4.48 0.62 2.16 — 32 Norbury 12988 127 168 9.8 12.9 47 — 0.15 1.15 0.31 — 5.16 0.54 2.39 — 41 West Thornton 15845 201 164 12.7 10.4 45 — 0.06 1.14 0.69 0.13 3.22 0.25 1.89 + 37 Bensham Manor 12941 203 189 15.7 14.6 44 — 0.08 1.31 0.15 0.08 5.41 0.77 2.78 + 14 Thornton Heath 14585 245 180 16.8 12.3 33 - 0.07 2.19 0.41 0.14 4.80 0.55 1.78 + 65 South Norwood 14255 297 174 20.8 12.2 27 - 0.28 1.26 0.42 0.07 3.79 0.49 1.33 + 123 Woodside 12990 194 145 14.9 11.2 41 — 0.08 1.08 0.31 — 3.46 0.62 2.31 + 49 East 13028 241 153 18.5 11.7 32 — 0.08 1.07 0.46 0.08 3.99 0.69 1.77 + 88 Addiscombe 13179 242 188 18.4 14.3 33 0.08 — 1.90 0.61 0.08 5.16 0.30 1.59 + 54 Whitehorse Manor 13513 201 165 14.9 12.2 75 — 1.04 0.81 0.30 4.22 0.67 1.85 + 36 Broad Green 13914 219 165 15.7 11.9 69 0.07 0.07 1.94 0.50 0.07 3.38 0.58 2.37 + 54 Central 9815 94 150 9.6 15.3 85 — 0.10 1.12 0.61 0.10 4.99 0.41 4.08 -56 Waddon 14784 333 133 22.5 9.0 42 — — 1.08 0.61 0.07 3.18 0.47 1.35 +200 South 12200 182 170 14.9 13.9 33 — 0.08 2.46 0.90 0.08 4.84 0.25 2.46 + 12 Addington 8624 239 77 27.7 8.9 21 — — 0.70 0.81 — 3.25 0.23 1.51 + 162 The Borough 195600 *3471 *2398 17.7 12.3 39 - 0.08 1.44 0.54 0.09 4.18 0.50 2.07 +765 *These are the corrected totals. 9 MAYDAY HOSPITAL. Accommodation. Wards. Normal or Basic Rating. Emergency Bed Rating. 1 32 8 (Converted into Casualty Reception Ward). 2 32 40 3 32 40 4 32 40 5 32 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.1 24 cots Beds not returned to E.M.S. except under heading served beds-17.17. Adult beds. C.W.2 24 cots C.W.3 Emergency Theatre. Maternity Block 44 This is exclusive of 1st stage Maternity Isolation 4 labour and labour beds and infants' cots. 10 Table I. 1.—Total number of admissions (including infants liorn in hospital) 6,828 2.—Number of women confined in hospital 1,008 3.—Number of live births 976 4.—Number of still births 47 5.—Number of deaths among the newly-born (i.e.. under 4 weeks of age) 43 6.—Number of deaths among children under one year (including those given under 5) 72 7. Number of maternal deaths among women admitted to hospital for confinement 2 8.—Total number of deaths 708 9.—Total number of discharges (including infants born in hospital) 6,061 10.—Duration of stay of patients included in 8 and 9 above: — (a) Under four weeks 5,434 (b) Four weeks and under thirteen weeks 1,192 (c) Thirteen weeks or more 164 11.—Number of beds occupied (excluding cots in maternity wards):— (a) Average during the year 389 (b) Highest 438, on 13-4-42. (c) Lowest 321, on 24-12-42. 12. Number of surgical operations under general anæsthetic (excluding dental operations) 2,361 13.—Number of abdominal sections 463 11 Table II. Classification of In-Patients who were discharged from or who died in the Institution during the year ended 31st December, 1942. Disease Groups. Children (under 16) Men and Women. Discharged. Died. Discharged. Died. A.—Acute infectious disease 21 1 4 - B.— Influenza 1 — 3 1 C.—Tuberculosis: Pulmonary 1 - 70 31 Non-Pulmonary 4 5 27 4 D.—Malignant Disease — 2 129 133 E.—Rheumatism:— (1) Acute rheumatism (rheumatic fever) together with sub-acute rheumatism and chorea 3 - 6 - (2) Non-articular manifestations of so called "rheumatism" (muscular rheumatism, fibrositis, lumbago, and sciatica) - - - - (3) Chronic Arthritis 1 - 26 — F.—Venereal Disease 1 — 8 2 Q.—Puerperal Pyrexia - - 5 - Puerperal Fever — — — — H.—Other diseases and accidents connected with pregnancy and childbirth — — 410 2 I.—Mental diseases 8 1 217 1 J.—Senile decay — — 45 19 K.—Accidental injury and violence 44 — 239 24 Inrespect of cases not included above. l.—Diseases of the Nervous System and Sense Organs 12 1 97 74 M.—Disease of the Respiratory System 84 16 197 47 N. „ „ Circulatory System 7 3 176 199 0. „ „ Digestive System 125 13 519 29 P. „ „ Genito Urinary System 23 1 125 35 Q. ,, ,, Skin 66 1 99 2 R.—Other diseases 806 5 391 20 S.—Mothers and infants discharged from Maternity Wards and net included in above figures:— Mothers - - 1015 2 Infants 939 34 — — T.—Any persons not falling under any of the above headings 45 — 62 — Totats 2191 83 3870 625 12 NUMBER OF X-RAY FILMS TAKEN. Spine 268 Bones 1,198 Pelvis 44 Chest 1,985 Barium Meals 647 Barium Enemata 69 Renal 250 Gall-Bladder 123 Teeth 406 Abdominal ? FB 27 Maternity Cases 568 Skull 324 5,909 Total number of Cases X-rayed 3,380 DIAGNOSTIC. 1941. 1942. Oesophagus with Barium 7 9 Barium Meals 140 166 Barium Enemeta 36 33 Gall-Bladder (Plain) 20 17 Cholecystograms 31 25 Renal Tracts (Plain) 29 31 Pyelograms 30 43 Abdomen for F.B.'s, etc. 10 13 Maternity Cases 155 295 Hysterographies 4 6 Lungs (Mayday Hospital) 362 463 (Sick Staff) 7 10 (Staff on Appointment) 91 102 (T.B. Dispensary) 763 1,038 (Others) — 11 Lungs after Lipiodol 8 9 Heart and Aorta 5 14 Skulls 81 74 Accessory Nasal Sinuses 31 25 Vertebral Column 90 96 Ribs 22 31 Pelvis 41 30 Long Bones 155 168 Short Bones 124 92 Joints 281 440 Teeth and Jaws 141 147 2,664 3,388 Examinations by Portable Set 129 126 13 X-RAY. 1941. 1942. Men's Wards 625 677 Women's Wards 467 688 Children's Wards 57 92 Maternity and Gynaecological Wards 77 92 Staff 131 151 Total "In-Patients" 1,357 1,700 T.B. Dispensary (Men) 395 501 (Women) 336 492 (Children under 16) 32 45 Croydon Borough Hospital 1 3 Ante-Natal Clinic 118 240 St. Mary's Hospital 5 3 Queen's Road Homes 16 20 Dental Clinic 108 121 Others 56 255 Total "Out-Patients" 1,067 1,680 Total 2,424 3,380 "Screen Examinations" 397 729 MASSAGE. Massage 7,583 Exercises 2,109 Radiant Heat 3,233 Electrical 791 Infra-red 1,041 Ultra Violet Light 1,119 15,876 Total number of patients treated 471 MENTAL PATIENTS DEALT WITH DURING THE YEAR. Male. Female. Admitted 101 126 Certified and sent to Warlingham Park Hospital 5 26 As Voluntary Patients to Warlingham Park Hospital 54 53 Discharged not certified 46 36 14 SPECIMENS EXAMINED IN THE PATHOLOGICAL LABORATORY DURING THE YEAR. Positive. Negative. Swabs for Diphtheria — 1.200 Sputa for T.B. 171 387 Pus for T.B. — 3 Pus for Gonococci — — Urine for T.B 1 17 Faeces for T.B. 2 1 Urine for Coli Typhoid Group 1 — Faeces ,, ,, ,, 7 162 Blood—Widals — 11 Hairs for ringworm 1 3 Blood cultures 7 27 Faeces for occult blood 57 127 2,185 Urine for routine examination 1,073 Pus for organisms 113 Blood urea estimations 217 Blood sugar estimations 90 Cerebro spinal fluids 80 Urea Conc. Tests 8 Urea clearance tests 141 Fractional test meals 78 Pleural fluids 50 Blood counts 455 Blood groups 215 Haemoglobin estimations 952 Compatibility tests 1 Faecal fat estimations 2 Van den Bergh re-action 5 Vaccines 2 Blood sedimentation rates 109 Glucose tolerance tests 6 Blood coagulation and bleeding time 3 Other examinations—unclassified 343 Total number of Examinations 6,128 Number of Specimens sent to Croydon General Hospital 477 NUMBER OF POST M0RTEMS ORDERED BY THE CORONER AND PERFORMED AT MAYDAY HOSPITAL DURING THE YEAR. Outside Cases 199 Hospital Cases 74 NUMBER OF POST MORTEMS NOT ORDERED BY THE CORONER 101 16 THERAPY DEPARTMENT. Condition for which Treatment was given. No. of Patients. No. of Applications. Cured. Relieved. Died. Transferred to other Hosps. Still under Treatment. Carcinoma of Breast 27 404 — 19 7 1 - Cervix 10 110 — 9 1 — — Uterus 2 18 — 2 — — — Ovaries 7 96 — 7 — — — Menorrhagia 1 12 1 — — — — Fibroid Uterus 1 — — — 1 — — Ovarian Cyst 2 24 — 2 — — — Sterilization 9 82 3 5 — — 1 Carcinoma of Prostate 1 12 — 1 — — — Bladder 1 12 — — — — 1 Larynx 1 12 — 1 — — — Clavicle 1 8 — — 1 — — Liver 1 6 — 1 — — — Testicle 6 54 — 5 1 — — Scrotum 1 12 — — 1 — — neck 1 12 — — 1 — — sub. max. gland 1 12 — — 1 — — Parotid tumour 1 6 - — 1 — — Lymphatic Leukaemia 1 12 - 1 — — — Hodgkins Disease 1 16 1 — — — Sarcoma foot 2 29 — 1 1 — — Epithelioma lip 2 36 — 2 — — — Fibroma of leg 1 12 — 1 — — — Rodent ulcer 1 2 — 1 — — — Leucoplakia labia 1 6 - — — — 1 Osteo arthritis 2 26 - — 1 — 1 Swelling rt. shoulder 1 2 — — 1 — — Total 86 1033 4 59 18 1 4 Corresponding totals for 1941 41 495 2 5 5 1 28 16 Table 111 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Alimentary. Appendicitis — - - — 145 24 — 3 172 Gastric ulcer 13 15 1 5 5 4 — 3 46 Duodenal ulcer 8 12 5 1 5 4 — 5 40 Dyspepsia 5 1 - - - - - - 6 Cholelithiasis — — — — 2 — 1 3 Colitis — 8 2 - - - - - 10 Intestinal obstruction — — — — 3 13 1 6 2i Constipation 26 31. 1 — — — — — 58 Hernia — — — — 51 36 6 2 95 Haemorrhoids — 3 - - 4 3 — — 10 Cholecystitis 4 10 — — 9 4 - — 27 Gastro enteritis 29 5 1 8 - - — — 43 Gastritis 8 10 - - - - - - 18 Alveolar Abscess 1 2 — - - - - - 3 Intestinal colic 4 7 - - - - - - 11 Catarrhal jaundice 8 2 - - - - - - 10 Prolapse of Rectum — 3 1 - - - - - 4 Pyloric stenosis 3 1 - 1 — - — — 6 Fistula in Ano — — 1 - 1 — — — 2 Swallowed F.B 2 — 1 - - - - - 3 Diarrhoea 4 2 2 - - - - - 8 Peptic Ulcer 1 2 - - - - - - 3 Appendicular Colic — 4 1 — 1 1 — — 7 Tapeworm 2 - - - - - - - 2 Peritonitis — — — 2 3 — — 1 6 Stomatitis 1 - - - - - - - 1 Adhesions — 2 1 — 1 i — — 5 Pelvic Abscess — — — — 1 1 - - 2 17 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cared Relieved Unrelieved Died Parenchymatosus Glossitis 1 - - - - - - - 1 Collapse 4 2 1 - - - - - 7 Pyloric Ulcer — 4 - - - - - - 4 Peritonsillar Abscess — — — — 1 1 1 — 3 Appendicular Abscess — — — — 1 6 — — 7 Perianal Abscess — — — — 1 — — — 1 Abdominal Abscess — — — — 1 1 — — 2 Gastroptosis — 1 - - - - - - 1 Pancreatitis — — — 3 — — — — 3 Hepatic Abscess — — 1 — — 1 — — 2 Ascites — 3 - - - - - - 3 Pyloric Spasm 2 1 - - - - - - 3 Ileitis 1 1 - - - - - - 2 Diverticulitis — 5 2 — 1 1 — — 9 Gallstone Colic — 1 - - - - - - 1 Hepatitis 1 - - - - - - - 1 Polyposis Intestine — — — — 1 — — — 1 Haematemesis of unknown origin 1 1 - - - - - - 2 Duodenal ileus — — 1 - - - - - 1 Vincent's Angina 6 - - - - - - - 6 Coeliac disease — 1 - - - - — - 1 Volvulus small intestine — — — 1 — — — — 1 Bones, and Joints. 686 Arthritis 2 19 2 - - - - - 23 Paget's Disease — — — 1 — — - — 1 Fibrositis 4 3 1 - - - - - 8 Coccydynia — 1 - - - - - - 1 Bursitis 1 2 - - - - - - 3 Sacro iliac strain — 2 1 — — — — — 3 Lumbago 1 1 — - - - - - 2 Synovitis 3 2 - - - - - - 5 18 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Osteo-myelitis 2 5 1 2 — — — — 10 Osteo-arthritis — 8 2 - - - - - 10 Coxitis 1 - - - - - - - 1 Functional Disability — 1 — — — — — — 1 Rheumatism 3 5 1 - - - - - 9 Splastic Diplegia — 1 - - - - - - 1 Osteitis — 1 - - - - - - 1 Effusion into Joint 1 2 — — — — - — 3 Bow Legs — — 1 - - - - - 1 Talipes Equino varus — 3 — — — — — — 3 Charcot's Joint — 1 — — — — — — 1 Carcinoma. - - - - - - - - 87 Breast — — — — 1 15 7 16 39 Ovary — - — — 2 1 — 4 7 Stomach — - — — — 3 5 22 30 Rectum — - — — — 2 4 12 18 Cervix — - — — — 8 — 4 12 Uterus — - — — — 3 2 2 7 Prostate ' — — — — — 1 3 3 7 Tongue and Mouth - - - - - 1 3 2 6 Colon — — — — — 4 3 17 24 Larynx — — — — — — 3 4 7 Oesophagus — — — — — — — 5 5 Gall-Bladder — — — — — 2 1 — 3 Lung — — — — — 1 1 3 5 Bronchus — — — — — — 2 7 9 Pancreas — — — — — 1 2 3 6 Epithelioma - - - - - 2 3 4 9 Peritonic — — — — — - 1 — 1 Urinary bladder — — — — — 1 1 3 5 Cervix uteri — — — — — 3 6 4 13 19 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Kidney — — — — — - - 1 1 Sarcoma — — — — — 3 4 5 12 Penis — — — — — — 1 2 3 Lip — — — — — 1 1 - 2 Liver — — — — — — 1 1 2 Malignant Tumour , frontal lobe. - - - - - - - 1 1 Vagina - - - - - - 1 - 1 Intestine — — — — — — — 1 1 Ventriculi — — — — — — 2 — 2 Testis — — — — — 2 — 1 3 Thyroid — — — — — 1 — 1 2 Glands — — — — — 3 2 2 7 Tonsil — — — — — — 1 — 1 Pelvi rectal junction — — — — — 1 1 1 3 Pylorus — — — — — 2 — — 2 Femur — — — — — — 1 - 1 Neck — — — — 1 — — 1 Scrotum — — — — _ — — 1 1 Vulva — — — — — — — 2 2 Ileo-caecal junction — — — — — 1 1 — 2 Caecum — — — — — — — 1 1 264 Circulatory (Blood). Anaemia 1 3 - - - - - - 4 Hyperpiesia 2 28 2 2 — — — — 34 Septicaemia — — — 2 — — — — 2 Pernicious anaemia 3 9 — 4 — — — — 16 Epistaxis 4 1 - - - - - - 5 Thrombosis 1 3 — 8 — — — — 12 Phlebitis — 1 - - - - - - 1 20 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Varicose veins — 3 1 - - - - - 4 Gangrene — 3 1 3 — - — — 7 Leukaemia — 3 1 2 — — — — 6 Malaria — 1 - - - - - - 1 Haemolytic anaemia — — - 1 — - - — 1 - - 1 - - - - - 1 94 Circulatory (Heart) Myocardial Degen: - 23. 2 122 — — — — 147 Arterio sclerosis — 11 3 5 - — — — 19 Endocarditis — 1 — 2 — — — — 3 Myocarditis — 2 — 2 — — — — 4 Carditis 2 5 — — — - — — 7 Auricular fibrillation — 13 — 8 — - — — 21 Mitral stenosis 1 9 1 3 — — — — 14 Mitral Regurgitation — 1 — — — — — — 1 Congestive heart failure 1 13 2 16 — — — — 32 Heart failure — 6 3 17 — — — — 26 Congenital heart disease — 2 — 2 — — — — 4 Tachycardia 1 2 1 - - - - - 4 Angina 2 2 — 1 — - — — 5 Banti's disease — — — 1 — - — — 1 Heart block — — 1 1 — - — — 2 Bradycardia — 1 - - - - - 1 291 Constitutional. Diabetes Mellitus 2 17 — 9 — — — — 28 Debility 2 6 - - - - - - 8 Nutritional disorder 7 2 — — — — — — 9 Marasmus 3 2 — 2 — — — — 7 21 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Malnutrition 1 1 — — — — — 2 Rickets 1 3 - — — — — — 4 Diabetic coma 2 2 - — — — — — 4 62 Ear, Nose and Throat. Enlarged T. and A. 3 — 1 — 677 50 — — 731 Quinsy 1 1 — — 2 1 — — 5 Otitis Media 23 6 — — — — — — 29 Mastoiditis — — — — 15 5 — 2 22 Catarrh 4 2 - - - - - - 6 Nasal Obstruction — — 1 — — — — — 1 Sinusitis — 1 — — — — — — 1 Tracheitis 1 - - - - - - - 1 Adenoids — — — — 11 — — — 11 Stricture of oesophagus — — 2 — — — — — 2 Meniere's disease — 1 1 - - - - - 2 Reflex earache 1 — — — — — — — 1 Sprue — 1 — — — — — — 1 Eye. 813 Conjunctivitis 1 1 - - - - - - 2 Corneal ulcers 2 — — — — — — — 2 Foreign body — — — — 1 — — — 1 Blepharitis 1 - - - - - - - 1 6 Glands. Adenitis 6 7 2 - - - - - 15 Hodgkin's disease - — — 3 — — — — 3 Adenoma 1 2 — — — — — — 3 Goitre 1 - - - - - - - 1 Thyroglossal Cyst 1 — — — — — — — 1 23 22 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Genito Urinary. Nephritis 9 3 — 9 — — — — 21 Urethral stricture — 7 - - - - - - 7 Pyelitis 6 17 - - - - - - 23 Enlarged prostate - 1 1 2 11 20 1 5 41 Pyelonephritis - - - - - - - 4 4 Perineal Hypospadias — 1 1 - - - - - 2 Perinephric abscess — — — — 1 — — — 1 Cystitis 7 6 2 1 — — — — 16 Papilloma of bladder — 4 2 — — 1 — 1 8 Uraemia — — — 12 — — — — 12 Renal colic 2 4 - - - - - - 6 Oxalaria 1 - - - - - - - 1 Visical calculus — — 1 — — 2 — — 3 Pyonephrosis — — — — — 2 — — 2 Hypernephroma of kidney - - - - - - - 2 2 Hypernephrosis — — — — 2 2 - — 4 Epididymo-orchitis — — — — - 1 — — 1 Seminoma rt. testis. - - - - - 1 — — 1 Circumcision — — — — 7 1 — — 8 Undexended testis. — — 1 — — 1 — — 2 Haematuria 2 - - - - - - - 2 Urethral fistula — 1 — — - 1 1 — 3 Retention 1 7 1 — — 4 - — 13 Suprapubic fistula. — - — — - 1 - — 1 Incontinence. — 1 - - - - - - 1 185 Gynaecological. Abortion — — — — 178 39 5 2 224 Fibrosis Uteri — — — — 47 6 6 — 59 23 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Ovarian cyst — — — — 8 2 1 1 12 Uterine haemorrhage — — — — 3 7 2 — 12 Mastitis — — — — 16 6 — — 22 Menorrhagia — — — — 1 5 2 — 8 Vaginitis — — — — — 3 — — 3 Dysmenorrhoea — — — — 1 4 1 — 6 Bartholin's cyst — — — — 4 — — — 4 Bartholin's abscess — — — — 5 — — — 5 Erosion of cervix — — — — 5 5 — — 10 Deficient pelvic floor — — — — 12 — 2 — 14 Salpingitis — — — — 5 3 — — 8 Retroversion — — — — 10 — 1 — 11 Salpingo-oophoritis — — — — 1 — — 1 2 Retained products — — — — 9 — — — 9 Cervicitis — — — — 3 2 — — 5 Urethral caruncle — — — — 1 2 — — 3 Cystocele — — — — 1 1 - — 2 Cervical polypi — — — — 8 1 - — 9 For sterilization - - - - - 2 1 — 3 Sterility - - - - - - 6 — 6 Endometritis — — — — 5 — 1 — 6 Broad ligament cyst — — — — 1 — — — 1 Dermoid cyst — — — ' — 1 — — — 1 Procidentia — — — — 1 — 2 — 3 Pelvic infection — — — — 2 9 — — 11 Vaginal discharge — — — — 3 5 — — 8 Menopausal syndrome — — — — 1 — — — 1 Peritoneal cyst — — — — 1 — — — 1 Rectocele — — — — 1 — 1 — 2 Imperforate hymen — — — — 4 — — - 4 Ruptured ectopic — — — — 2 1 — — 3 478 24 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Infectious. Influenza 2 1 — 1 — — — — 4 Scarlet Fever — — 1 - - - - - 1 Poliomyelitis - 1 - - - - - - 1 Dysentery — — 5 - - - - - 5 Whooping Cough — — 6 - - - - - 6 Cerebro spinal fever 1 — 5 1 — — — — 7 Influenzal Pneumonia 1 - - - - - - - 1 Measles - — 3 - - - - - 3 Chicken Pox — — 1 - - - - - 1 Mumps — 1 1 - - - - - 2 31 Maternity. For version — — — — 1 1 1 — 3 Pyelitis of pregnancy — — — — 9 11 — — 20 False labour pains — — — — — 8 1 — 9 Ectopic gestation - - - - - 1 — — 1 Albuminuria of pregnancy — — — — 1 5 — — 6 A.P.H. — — — — 1 3 — — 4 R.B.P. — — — — 1 11 1 — 13 P.P.H. - - - - - 1 — — 1 Toxaemia of pregnancy — — — — 2 6 1 — 9 Anaemia of pregnancy - - - - - 1 — — 1 Vomiting of pregnancy — — — — 8 5 — — 13 A.N. Observation — — — — 4 27 12 — 43 A.N. rest - - - - - 4 — — 4 Termination of pregnancy — - — — 1 2 — — 3 Ruptured tubal pregnancy — - — — 1 — — — 1 131 25 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Mental. Uncertified 2 31 109 - - - - - 142 Certified — — 31 - - - - - 31 M.D. — 5 11 - - - - - 16 Epilepsy 2 12 8 1 — — — — 23 Mongolism — — — 1 — — — — 1 Senile Dementia - 3 1 — — — — 4 Loss of memory 1 2 - - - - - - 3 Hysteria 1 2 2 - - - - - 5 Imbecile — — 1 - - - - - 1 Congenital idiot — — 1 - - - - - 1 227 Nervous and Sensory. Cerebral haemorrhage — 4 — 31 — — — — 35 Meningitis 7 — — 3 — — — — 10 Chorea 3 1 - - - - - - 4 Habit vomiting — 1 - - - - - - 1 Hemiplegia 2 5 4 3 — — — — 14 Sciatica — 3 1 - - - - - 4 Neurasthenia — 4 1 - - - - - 5 Neurosis 1 8 3 - - - - - 12 Cerebral thrombosis 1 22 1 29 — - — — 53 Disseminated sclerosis — 3 3 1 — — — — 7 Neuralgia 2 - - - - - - - 2 Neuritis 1 — 2 - - - - - 3 Convulsions 1 - - - - - - - 1 Cerebral tumour — — 1 2 — — — — 3 Tabes dorsalis — 2 - - - - - - 2 Parkinsons disease — — — 2 — — — — 2 Cerebral arterio sclerosis — 3 — 1 — — — — 4 26 Diagnoses in Cases Treated Medical. Surgical. _ Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Paraplegia — 1 1 - - - - - 2 Subarachnoid haemorrhage 2 — — 3 — — — — 5 Paralysis — 2 — — — — — — 2 Hydrocephalus 1 - 1 - - - - - 2 Migraine — 3 1 - - - - - 4 Muscular dvstropy - — 1 - - - - - 1 Poliomyelitis - 2 - - - - - - 2 Encephalitis 1 - - - - - - - 1 Headache 1 2 - - - - - - 3 184 Respiratory. Bronchitis 39 45 9 4 — — — — 97 Pneumonia 91 24 1 48 — — — — 164 Pleural effusion — 3 - - - - - - 3 Bronchiectasis 2 7 — 2 — — — — 11 Atelectasis — — — 2 - - — — 2 Pleurisy 6 3 - - - - - - 9 Emphysema - 2 1 - - - - - 3 Asthma 7 22 1 - — - - - 30 Empyema 3 3 - - - - - - 6 Pulmonary abscess 2 2 3 1 — — - — 8 Pulmonary congestion — 1 — 3 — — - — 4 Asphyxia — — — 1 — — - — 1 Fibrosis of lungs — 2 - - - - - - 2 Tumour of lung — — 1 — — — - — 1 Pulmonary embolism — — — 2 — — — — 2 Pulmonary infarct 1 - - - - - - - 1 344 Senility 1 27 17 19 — — - — 64 27 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Skin. Boils, abscess and carbuncles — — — — 26 12 — — 38 Burns and scalds — — — — 6 6 1 1 14 Eczema 9 3 1 — — — — — 13 Impetigo 17 7 — — — — — — 24 Scabies 27 2 — — — — — — 29 Dermatitis 3 4 — — — — — — 7 Scurvy 1 - - - - - - - 1 Septic spots 2 2 - - - - - - 4 Plantar Verrucae — 1 - - - - - - 1 Erythema nodosum 1 — — — — — — — 1 Fibroma — — — — — 1 — — 1 Cellulitis — — — — 8 1 — — 9 Papilloma — — — — — 1 — ' — 1 Sinusitis — 1 — — — — — — 1 Ulceration — — — — 8 6 — — 14 Herpes 4 — — — — — — — 4 Urticaria 2 — — — — — — — 2 Erysipelas 1 — — — — — — - 1 Purpura 1 — — 2 — — — — 3 Infected corn — 1 — — — — — — 1 169 Pulmonary Tuberculosis — 42 29 31 — — — — 102 Non-Pulmonary Tuberculosis. Spine 1 1 2 1 — — — - 5 Meninges — — 5 — — — — 5 Elbow — — 1 — — — — — 1 Knee — — 1 — — — — — 1 Hip 1 — — — — — — — 1 28 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Glands — 6 - - - - - - 6 Shoulder — — 1 — - — — — 1 Kidney — 4 3 - - — - - 7 Peritonitis — 1 — 2 - — — — 3 Foot 2 2 2 - - - - - 6 Bowel — 1 1 - - - - - 2 Abdominal — — 1 — - — — — 1 Miliary — — — 1 - — — — 1 40 Venereal. Gonorrhoea - 1 1 - - - - - 2 Syphilis — 4 3 2 — — — — 9 11 Violence. Fractured limbs — — — — 11 79 9 19 118 Fractured spine — — — — — 4 — — 4 Fractured malleolus — - — — 1 3 — — 4 Fractured skull — - — — 1 3 — 1 5 Fractured ribs — - — — 7 5 — 1 13 Fractured clavicle — — — — — 1 — — 1 Fractured pelvis — — — — 4 2 — — 6 Fractured sacrum - - - - - - 1 — 1 Fractured nasal bones — — — — 1 — — — 1 Minor injuries — — — — 11 7 1 — 19 Contusions and abrasions — - — — 18 19 — — 37 Sprain — - — — 5 2 — — 7 Abdominal injury — — — — 1 1 — 1 3 Dislocation — - — — 2 8 2 — 12 Concussion — — — — 12 17 — — 29 Lacerations, wounds, etc. — — — — 9 16 1 1 27 29 Diagnoses In Casts Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Removal of plaster — — - — 10 7 — — 17 Shock — — - — — 1 — 1 2 Bruises — — - — — 1 - — 1 307 Miscellaneous. Poisoning 25 3 — 2 — — — — 30 Alcoholism 3 2 - - - - - - 5 Dental caries 3 1 - - - - - - 4 B.B.A 20 - - - - - - - 20 N.A.D 63 - - - - - - - 63 With Mother 26 — — — — — — — 26 Hare lip 1 1 3 - - - - - 5 Teething 1 1 — — — — — — 2 Prematurity — — — 1 — — — — 1 Post operative haem. 4 2 - - - - - - 6 Diabetic coma 1 — — 1 — — — - 2 Long vulva 1 — — — — — — — 1 Tight heel tendons — — — — — 1 — — 1 Stings 1 - - - - - - - 1 Webbed fingers — — — — — 1 — — 1 P.U.O 3 2 3 - - - - - 8 Foreign body — — 1 — — — — — 1 177 TOTAL NUMBER OF PATIENTS DISCHARGED FROM MAYDAY HOSPITAL YEAR ENDED 31st DECEMBER, 1942. Cured 4,106 (including mothers and children) Relieved 1,462 Unrelieved 493 Died 708 (including 2 mothers and 34 children) 6,769 30 OPERATIONS PERFORMED AT MAYDAY HOSPITAL DURING 1942 ABDOMINAL. Appendicectomy 166 Appendix abscess drained 10 Sigmoidoscopy 20 Herniotomy 88 Cholecystectomy 13 Laparotomy 46 Gastro-enterostomy 4 Cholecyst-gastrostomy 1 Colostomy 16 For Pyloric Stenosis 3 Caecostomy 2 Perforated gastric ulcer 14 Gastro jejunostomy 4 Ligature of haemorrhoids 1 Haemorrhoidectomv 5 Perforated duodenal ulcer 1 For duodenal ulcer 1 Tyrrell-Grey op 1 Excision of papilloma abdo. wall 1 Gastroscopy 37 Splenectomy 1 Rectal examination 2 437 BONES AND JOINTS. For osteo-myelitis 3 Amputation of limbs 14 Wiring of bones 18 Removal of pin 5 Resection of rib 6 Application of plaste 47 Reduction of joints 11 Manipulation of limbs 22 Osteotomy 3 Removal of Sequestrum 4 Division of webbed phalanges Coccygectomv 1 135 EAR, NOSE AND THROAT. Mastoidectomy 19 Tonsillectomy 734 Adenoidectomy 7 Myringotomy 4 Oesophagoscopy 2 Bronchoscopy 2 Orchidectomv 2 770 31 GENITO URINARY. Cystoscopy 56 Circumcision 11 Nephrectomy 8 Prostatectomy 20 Supra pubic cystotomy 36 For extravasation of urine 1 Urethral dilatation 15 Urethral caruncle 3 Excision of papilloma of bladder 1 Insertion of Pilcher's bag 1 Insertion of Catheter 2 Fulguration of bladder 5 Insertion of Depezar catheter 5 164 GYNAECOLOGICAL. Examination under Anaesthetic 80 Total hysterectomy 10 Sub-total hysterectomy 45 Salpino oophorectomy 6 Dilatation and Curetage 102 Removal of ovarian cyst 5 Salpingectomy 6 Induction of abortion 1 Ovariotomy 3 Incision of Bartholins abscess 3 Incision of Bartholins cyst 4 Insertion of pessary 5 Removal of pessary 1 Colpo-perineorrhaphy 13 Cauterization of Cervix 3 Baldy Webster Operation 12 Fothergills Operation 4 Insertion of Laminaria Tents 1 Removal of Laminaria Tents 2 Urethral and Cervical Smears Taken 5 Cervical Polypi 7 Amputation of Cervix 3 Colpotomy 3 Biopsy of Cervix 4 Removal of Gauze Packing from Uterus 6 Removal of Broad Ligament Cyst 1 Suture of Laceration of Vaginal Wall 1 Urethrotomy 1 Intra Uterine Lipiodol 6 Repair of Pelvic Floor 1 Suture of Perineum 3 347 32 OBSTETRICAL. Caesarean Section 42 Evacuation of Uterus and Glycerine Pack 149 For Ectopic Gestation 2 Induction of Labour 46 Rupture of Membranes 53 Removal of Falopian Tube 1 293 MISCELLANEOUS. Blood Transfusion 20 Incisions (Abscess, etc.) 90 Cleansing of Burns, etc. 10 Amputation of Breast 4 Suture of Wounds 17 Skin Graft 1 Excision of Wounds 1 Lumbar Puncture 55 Aspiration of Chest 37 ,, ,, Abdomen Wall 2 ,, ,, Gall Bladder 1 ,, ,, Knee 3 ,, ,, Abscess 5 Removal of Nail 6 Removal of Foreign Body 16 Paracentesis 25 Suture of Tendon 4 For Hare Lip 1 For Cleft Palate 3 Extraction of Teeth 20 Thyroidectomy 1 Injection of Varicose Veins 3 Ligature of Varicose Veins Thoracotomy 5 Removal of Glands 7 Diathermy to Anal Lupoid Tissue 1 Venesection 7 Tissue for Biopsy 2 356 Number of patients who had teeth extracted 160 33 PUBLIC ASSISTANCE. (a) Domiciliary Relief. Number of Croydon cases resident in the Borough and in receipt of outdoor relief on the— 1st January, 1942 1,832 persons 1,016 cases 1st July, 1942 1,771 „ 984 „ 1st January, 1943 1,794 ,, 958 ,, Expenditure on Out-relief during the 12 months ended 30th September, 1942, to Croydon cases resident in the Borough: — Half-year ended 31st March, 1942 £30,679 19s. l0d. Half-year ended 30th September, 1942 £30,125 5s. 6d. (b) Institutional Relief. Number of Croydon persons relieved in the Mayday Hospital on 1st January, 1943, and in the Queen's Road Homes on the same date: — Mayday Hospital 15 Queen's Road Homes 542 (c) Medical 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 31.3.43. All Districts. (1) Average number of separate patients attended during each quarter 1,388 (2) Attendances at patients' homes 10,085 (3) Attendances on patients at the surgery 12,555 (4) Total number of prescriptions written 22,900 (5) Estimated cost of drugs, dressings and dispensing £1,036 17s. l1d. (6) Estimated amount of per capita payment to doctors in respect of patients actually attended (calculated quarterly) 4s. 3.87d. (7) Estimated average payment per service point 1.77d. 34 Table I. CASES OF NOTIFIED INFECTIOUS DISEASE, 1942. Notifiable Disease. Cases notified in the whole District. Total cases notified in each Ward. Total cases removed to Borough Hospital & diagnosis confirmed. Total Deaths in the Borough. Sex Distribution 1942. At all Ages. At ages—years. Upper Norwood. Norbury. West Thornton. Bensham Manor. Thornton Heath. South Norwood. Woodside. East. Addiscombe. Whitehorse Manor. Broad Green. Central. Waddon. South. Addington. Under 1 year. 1—5. 6—15. 16—25. 26—45. 46—65. 66 and up. M F Small Pox - - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera — - — - — — - — — — - - - - - - — - - - - - - - - - - Diphtheria 48 1 11 12 15 8 — 1 4 — - 1 2 3 2 9 7 7 3 - 3 3 3 46 3 18 30 Typhus — - - — — — - - — — - - — — - - — - — - - - - - - - - Erysipelas 28 - — — 2 6 14 6 1 3 3 7 3 2 - 2 1 — 2 2 — 2 — 10 - 10 18 Scarlet Fever 496 - 208 243 29 14 1 1 21 12 75 36 38 39 38 23 32 22 41 12 32 56 19 457 2 258 238 Enteric & Paratyphoid 3 - — - 2 1 — — — — 1 — — — 1 — — 1 — — — — — 2 — 1 2 Puerperal Pyrexia 78 — — - 29 49 — — 1 1 43 — 2 3 4 — 6 8 1 2 4 4 — 23 - - 78 Cerebro-Spinal Meningitis 15 1 7 4 — 2 1 — 1 2 2 1 — — 1 — — 3 - 1 2 - 2 14 5 6 9 Ophthalmia Neonatorum 19 19 - - - - — - 1 — 4 1 2 — — — 1 5 2 - 1 1 1 5 - 14 5 Poliomyelitis and Poliseneophalitis 3 1 1 1 —. — — 1 — — — — — — — 1 — 1 — — 2 1 — 3 Encephalitis Lethargies 1 - - - - - - - - - - - - - - - - - - - - - - - - - 1 Dysentery 10 1 3 4 — 2 - - - - - - - - 1 2 — 1 1 - 4 1 8 - 5 5 Malaria —. — — — — — — — — — - - — — — - — — — — — — — - - - - Acute Primary and Acute Influenzal Pneumonia 67 1 4 5 6 22 20 9 2 2 3 2 8 1 4 12 7 3 5 2 4 7 5 3 5 35 32 Measles 1596 52 843 665 17 17 — 2 43 60 99 67 113 100 117 48 159 102 183 40 174 106 185 24 — 775 821 Whooping Cough 474 52 310 98 5 8 1 — 18 48 41 43 57 31 19 40 38 22 36 15 18 12 36 34 5 231 243 35 Notified Disease. Incidence Rate per 1,000 population. Housing Conditions. Case occurring in Institutions in the Borough. Total cases notified (1942). 1-3 rooms 4-5 rooms Over 5 rooms 1941 1942 Small Pox - - - - - - - Diphtheria 0.34 0.25 7 24 8 9 48 Erysipelas 0.20 0.14 1 19 6 2 28 Scarlet Fever 0.98 2.54 57 371 59 9 496 Enteric Fever (Inc. Paratyphoid) 0.05 0.05 — 2 — 1 3 Puerperal Pyrexia 0.28 0.40 * * * 63 78 Cerebro-spinal Meningitis 0.17 0.08 _ 8 6 1 15 Ophthalmia Neonatorum 0.09 0.10 * * * 7 19 Poliomyelitis and Polioencephalitis 0.02 0.02 — 2 1 - 3 Encephalitis Lethargica 0.01 — 1 — — - 1 Acute Primary or Acute Influenzal Pneumonia 0.30 0.34 5 43 19 - 67 Dysentry 0.03 0.01 - 7 1 2 10 * Not obtained. The 1931 Census showed that houses of 1—3 rooms formed 4.7 per cent. of the total number of houses in Croydon; those of 4—5 rooms 51.4 per cent., and those with over 5 rooms 43.9 per cent. Comments on the Incidence and Prevelence of Infectious Disease. Scarlet Fever was more prevalent than in 1941. The incidence rate of Diphtheria was 0.25, compared with 0.34 in 1941. No cases of Small Pox occurred during the year. There were 78 cases of Puerperal Pyrexia; 28 occurred in the age-group 16—25 years and 49 in the age-group 26—45 years. A majority of the cases occurred in women having their first confinement. 36 BOROUGH HOSPITAL. Table A gives a summary of all cases treated at the Hospital during 1942. 835 patients were admitted and discharged which, together with patients in at the commencement of 1942 (29), gives a total of 864 dealt with. Fourteen died, giving a case mortality for the Hospital of 1.6 per cent. as against 4.8 per cent. in 1941. Penge Urban District Council and the Royal Air Force Biggin Hill Station) have an arrangement with the Corporation to send their cases to the Hospital. During the vear 32 cases were so admitted and these cases are included in the table. The Hospital is a recognised training school for nurses. During the year one probationer passed the final examination of the General Nursing Council. Owing to the greatly increased number of Scarlet Fever cases admitted in the second six months of the vear, two additional wards were opened for them. Three operations for the removal of tonsils and adenoids were performed. The repairs to Ward B, which was badly damaged during the air raids of 1941, are almost completed. 97 Table V. Complaint for which admitted. Patients remaining in Hospital on 1st January, 1942 Patients admitted and discharged in 1942 Patients admitted during 1942 and remaining in Hospital on 1st January, 1943 Analysis of Cases admitted whether discharged or not during the year. Total. Recovered. Died. Total. Recovered. Died. Total. Recovered. Died. Total. Recovered. Died. Case Mortality. Average No. of days j in Hospital. | Scarlet Fever 14 14 - 379 376 3 120 120 - 499 496 3 0.6 29.5 Diphtheria 6 6 - 82 80 2 18 18 - 100 98 2 0.2 28.6 Enteric Fever — — - 2 2 - 1 1 - 3 3 - - 51 Para-Typhoid Fever - - - 2 2 - - - - 2 2 - - 7 Puerperal Pyrexia — — - 22 22 - - - - 22 22 - - 13 Puerperal Fever 1 1 — 5 5 - - - - 5 5 - - 30 Erysipelas 1 — 1 11 10 1 — - - 11 10 1 9.0 11 Measles — — 26 26 - - - - 26 26 - - 13.2 Rubella - - - 1 1 - - - - 1 1 - - 8 C.S.M. 1 1 - 20 16 4 1 1 - 21 17 4 19 16 Whooping Cough 4 4 - 34 30 4 - - - 34 30 4 11.7 39 Chicken Pox — — 7 7 - - - - 7 7 - - 15.3 Mumps — — - 13 13 - - - - 13 13 - - 16.6 Tonsilitis — — - 1 1 - - - - 1 1 - - 7 Poliomyelitis — — - 2 2 - - - - 2 2 - - 33 Dysentry — — - 7 7 - 1 1 - 8 8 - - 12.4 Pemphigus — — - - - - - - - - - - - - Vincents Angina 1 1 — 2 2 — — - - 2 2 - - 14 Ophthalmia - - - 5 5 - - - - 5 5 - - 5 Tuberculosis 1 1 - - - - - - - - - - - - Dermatitis - - - 5 5 - - - - 5 5 - - 16 Simple Laryngitis - - - 1 1 - - - - I 1 - - 5 Gastro Enteritis - - - 2 2 - - - - 2 2 - - 10 Jaundice - - - 1 1 - - - - 1 1 - - 18 Encephalitis — — - 1 1 - - - - 1 1 - - 19 Venereal Disease — — - 17 17 - 1 1 - 18 18 - - 15 No Disease — — — 45 45 — - - — 45 45 - — - Totals 29 28 1 693 679 14 142 142 - 835 821 14 — — 33 SCARLET FEVER. The total number of Scarlet Fever cases admitted during the year was 499, an increase of 330 on 1941. The type of disease admitted during the year was of moderate severity. The following complications and sequelæ occurred amongst the true Scarlet Fever cases:— TABLE B. Serum Cases. NonSerum Cases. Total. Total Cases 106 393 499 Albuminuria — 1 1 Adenitis 2 13 15 Otorrhoea 5 16 21 Rhinorrhoea 7 15 22 Relapse — 2 2 Rheumatism 1 — 1 Oedema of Lung 1 — 1 Quinsy — 1 1 Nephritis — 3 3 The average stay in hospital of serum cases was 29 days and of non-serum cases 29.5 days. Three deaths occurred amongst the Scarlet Fever cases, two being complicated by broncho-pneumonia and one by oedema of the lungs. The number of complications amongst the 393 non-serum cases was 51, whereas the complications amongst the serum cases was 16. There was a marked increase of the disease from September to January, after which the disease declined. M.B.693 was again found useful in clearing up persistent otorrhoea, and M. 13.760 when the otorrhœa was due to a staphyloccocal infection. 99 Ages and Sexes Admitted. Scarlet Fever. TABLE C. Age. Male. Female. Totals. 0—1 - - — 1—2 14 9 23 2—3 22 17 39 3—4 24 17 41 4—5 38 32 70 5—10 129 115 244 10—15 13 22 35 15—20 8 6 14 20—30 12 13 25 30 or over 5 3 8 Total 1942 265 234 499 Total 1941 73 96 169 DIPHTHERIA. 100 cases were admitted with a diagnosis of Diphtheria, a decrease of 15 cases on 1941. Of these 22 were found not to be cases of Diphtheria and 23 were cases of positive swabs without clinical symptoms, leaving 55 cases of true clinical Diphtheria. There were 2 deaths, a mortality of 3.6 per cent. Analysis of the 55 cases— Faucial diphtheria 45 Nasal diphtheria 5 Laryngeal diphtheria 1 Faucial and nasal diphtheria 4 Total 55 The following complications and sequelæ occurred amongst the diphtheria cases:— Rhinorrhœa 4 Albuminuria 2 Heart failure 4 Adenitis 4 Paralysis— Palatal 3 Eyes 2 Diaphragm 1 The case with diaphragmatic paralysis following on heart failure and palatal paralysis was nursed in a Booth Respirator for three days and recovered completely. 40 Ages and Sexes Admitted. Diphtheria. TABLE D. Age. Males. Females. Totals. 0—1 1 - 1 1—2 3 1 4 2—3 6 1 7 3—4 5 1 6 4—5 4 8 12 5—10 15 5 20 10—15 4 4 8 15—20 3 14 17 20—30 2 15 17 30 & over 4 4 8 Total 1942 47 53 100 Total 1941 56 59 115 Typhoid and Para-Typhoid Cases. During the year 5 cases of Typhoid and Para-typhoid Fever were admitted, hut in only 3 cases was the diagnosis confirmed. No. deaths occurred. Of the three cases admitted as Typhoid one was really a case of Uterine Cancer, and one of the 2 cases admitted as Paratyphoid B. was really a case of Influenza. Puerperal Fever. During the year there were 5 cases of Puerperal Fever and 22 of Puerperal Pyrexia. No deaths occurred amongst the cases. Under the Puerperal Pyrexia heading are included 18 cases suffering from Venereal Disease and sent here for isolation. Of the Puerperal Fever cases 1 was complicated by bilateral salpingitis. 1 was complicated by thrombo-phlebitis of both legs. Erysipelas. There were 11 cases of Erysipelas admitted, a decrease of four cases on 1941. One death occurred amongst them, due to heart disease. Measles. There were 26 cases of Measles admitted, and no deaths occurred amongst them. In 2 of the cases the diagnosis was not confirmed, 1 being a case of Dermatitis and the other a case of Chicken Pox. 41 Whooping Cough. There were 34 cases of Whooping Cough admitted and 1 death occurred amongst these, being complicated by BronchoPneumonia. There was a decrease of 28 cases on 1941. Cerebro-Spinal Meningitis. There were 21 cases of Cerebro-Spinal Meningitis, and of these only in 12 cases was the diagnosis confirmed. 4 were cases of influenza, 1 was a case of sunstroke, 1 was a case of tonsillitis, 1 was a cellulitis of eye, 1 was a case of constipation. There were 4 deaths amongst them. The disease was of average severity, but in the cases admitted early the response to treatment was good. Of the four fatal cases, one drifted on to the chronic stage with a marked general wasting; two were admitted late in the disease; and one had a severe patubrial rash on admission. The treatment consisted in lumbar puncture on admission and giving of sulphapyridine in doses of 2 grms. repeated in four hours' time, then 1 grm. was given four-hourly. This was continued for 4 to 5 days. In the case of children half the adult dose was given, whilst in those cases that were sick after giving the drug, the soluble form in doses of 2.5 cc. was given by intra-muscular injection. In addition, three cases were given meningococcus anti-toxin in 20-30 cc. doses. The response to this treament was very good, the temperature falling within 24 hours to normal and the patients becoming more rational and quieter. No ill-effects were observed from giving sulphapyridine except for some cyanosis and repeated vomiting in those cases who could not tolerate the M.B.693 given by mouth. Ophthalmia Neonatorum. Five cases were admitted, but they proved to be cases of simple ophthalmia. 42 Anterior Poliomyelitis. Two cases of this disease were admitted, but in only one case was the diagnosis confirmed. The other was a case of transient hemiplegia in a child with severe whooping cough. Dysentery. Eight cases were admitted, and of these three were of the Sonne type and one was due to Morgan I. infection. Mumps. Thirteen cases of the disease were admitted, but in three cases the diagnosis was not confirmed. Encephalitis Lethargica. The one case admitted as Encephalitis Lethargica proved to be Neurasthenia. Out of Borough Cases. Table E. Disease. Males. Females. Total. Deaths. Scarlet Fever 11 13 24 — Diphtheria 1 4 5 — Measles 1 — 1 — C.S.M. 1 — 1 — No Disease 1 — 1 — Total 15 17 32 — Croydon Borough Hospital Laboratory Report. DIPHTHERIA. New Cases Swabbed on Admission. Swabs taken during Convalesence. Total. Total. + + Negatives. Swabs Examined. 67 67 2,467 2,601 43 ENTERIC (Dreyer's Agglutination Test). B. Typhosum. B. ParaTyphosum A. B. ParaTvphosum B. Total. + - Examined. 2 4 6 SPECIMENS OF FAECES EXAMINED FOR ENTERIC AND DYSENTERY GROUPS. B. Typhosum. Sonne Dysentry. Total. Total. + + Negative. Examined. 3 2 18 23 CEREBRO-SPINAL FLUIDS EXAMINED FOR ORGANISMS. Fluids found to contain Meningococci. Total Examined and found Sterile. Examined. Total 7 13 20 Miscellaneous Examinations. 12 Swabs from throats: Vincents Angina present. 7 Specimens of Sputum examined for presence of T.B.: all negative. 8 Eye Swabs examined for Gonococci: 2 positive, 6 negative. 30 Specimens of Urines for routine examinations. 12 Lochia Swabs examined for organisms. 3 Specimens of Blood for culture: 2 sterile, 1 hæmolytic streptococcus longus grown. 1 Fluid from Chest found to be sterile. 10 Vaginal Swabs examined for presence of Gonococci: 1 positive, 9 negative. 2 Swabs from Skin: staphylococcus aureas grown. Culture Media Prepared. Loeffler's Blood Serum: 230 doz. tubes. Agar Agar 4,500 cc. Peptone Water 2,500 cc. Litmus Milk 1,000 cc. Endo's Media 2,500 cc. McConkey's Media 750 cc. il Table AGE GROUPS OF CASES ADMITTED (other than Scarlet Fever and Diphtheria). 0—1 1—2 2—5 5—15 15—25 25—35 35—45 45 & over Totals Deaths M F M F M F M F M F M F M F M F Enteric Fever - - - - - - - - 1 - 1 - - - - 1 3 - Para-typhoid B. - - - - - - - - - 2 - - - - - - 2 Puerperal Fever - — — — — — — — — 3 — 1 — — 1 — 5 — Puerperal Pyrexia - — — — — — — — — 8 — 3 — 1 — — 12 Erysipelas - - - - - - - - 1 - - 2 2 1 2 3 11 1 Measles 1 1 1 2 7 3 4 2 2 — 2 — — 1 — — 26 Rubella - — — — — — — — — 1 — — — — — — 1 C.S.M. — — 3 2 4 4 1 2 — 3 1 — — 1 — 21 4 Whooping Cough 3 5 3 7 8 5 2 1 - - - - - - - - 34 4 Chicken Pox — — — — 1 — 4 — 1 — — 1 — — — — 7 — Ophthalmia 4 1 - - - - - - - - - - - - - - 5 — Mumps — — — — 2 1 — 1 4 2 2 1 — — — — 13 — Anterior Poliomyelitis - - - - - 1 - - - 1 - - - - - - 2 — Encephalitis - - - - - - - - - - - - - - - 1 1 — Laryngitis - - - - - - 1 - - - - - - - - - 1 — Dysentery 1 — — — — 2 2 1 1 — — — 1 — — — 8 — Vincent's angina - - - - - - - - 1 1 - - - - - - 2 — Tonsilitis - - - - - - - 1 - - - - - - - - 1 — Dermatitis 3 — 1 - - - - - 1 - - - - - - - 5 — Jaundice - - - - - - - - - - - - - - - - 1 — Venereal Disease — — — — — — — — — — 8 7 — 3 — — 18 — Gastric Enteritis 1 1 - - - - - - - - -- - - - - - 2 — No Disease - - - - - - - - - - - - - - - - 45 - Totals 13 8 5 12 20 16 17 7 14 18 16 16 4 6 4 5 226 9 46 BACTERIOLOGICAL EXAMINATIONS. I am indebted to the Borough Pathologist, Dr. H. W. Southgate, for the figures given in the appended tables. For private practitioners Mayday Hos. For Borough Hospital For Chest Clinic For School Medical Other Instns. of Corporation Other Institutions Total Table At the Laboratory, Croydon General Hospital. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Swabs for Diphtheria 47 991 ... ... ... ... ... ... 10 1204 7 221 3 102 67 2518 Virulence tests for Diphtheria ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 ... Sputum for Tub. Bac. 53 478 ... ... ... ... 558 702 ... ... ... ... 18 69 629 1249 Pus for Tub. Bac. ... 5 1 6 ... 1 ... ... ... ... ... 10 ... ... 1 22 Pus for Gonococci ... 3 2 ... 2 4 ... ... ... ... 3 32 ... ... 7 39 Pus for other organisms ... 6 ... 6 ... 1 ... ... ... ... ... 13 ... ... ... 26 Blood for Typhoid Groups 1 7 ... ... ... ... ... ... ... ... ... 1 1 ... 2 8 Blood for Wassermann 1 9 9 153 ... 3 ... ... ... ... ... 2 ... ... 10 167 Material for Spirochaetes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Faeces for Typhoid Group ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Hair for Ringworm ... ... ... ... ... ... ... ... 4 2 3 ... ... ... 7 2 Examination of Urine 3 ... ... ... ... 9 ... 12 Examination of Pleural Fluid ... ... ... ... ... ... ... ... Examination of C.S. Fluid ... 28 1 ... ... ... ... 29 Other Examinations 215 475 6 ... 360 69 33 1158 46 Examinations Done Under the National Health Insurance Act. Nature of Examination. Nature of Examination. Pus for Gonococci 8 (2 pos.) Urine for Chemical Exam 11 Pus for other organisms 12 Urine for Microscopal Exam 11 Pus for Tub. Bac. 9 Urine for Tub. Bac. 11 Blood for Wasserman 10 (3 pos.) Urine for Cultural Exam. 11 Complete Blood Counts 24 Other Examinations 14 Bacteriological Examination of Milk. Number of Samples submitted for Counts 484 Number under 10,000 per cc 100 Number over 10,000 but under 50,000 per cc 131 Over 50,000 but under 100,000 per cc 66 Over 100,000 but under 500,000 per cc 97 Over 500,000 but under 1,000,000 per cc 17 Over 1,000,000 per cc 73 Tubercle Bacilli— Number of samples of milk submitted 484 Number found positive by inoculation test 0 The number of milk examinations increased by 137 Number of samples still under investigation for T.B. 0 Milk Samples. 484 milk samples submitted to the Methylene Blue Test, of which 116 failed to satisfy. Of these 95 were further investigated and 32 of them were found satisfactory to the Bacillus Coli test. IMMUNISATION AGAINST DIPHTHERIA. During 1942 the routine of the Diphtheria Immunisation Clinics remained unchanged; that is to say, alum 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 2,660 Infant Welfare cases 2,176 Others under 5 years 675 47 The ensuing tables give some further details:— Total number of sessions held 144 Highest attendance at any one session 176 Lowest attendance at any one session 16 Average attendance per session 71 Summary of Attendances and Treatment, 1942. Year. Total attended for treatment. New cases attended. No. of sessions held. Av. attend per session. No. given Primary Schick. % Pos. on Primary Schick. No. given Posterior Schick. No. Neg. on Posterior Schick. % Neg. on Posterior Schick. No.completed treatm't 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 508 428 33 28 — — — — — 419 1941 6639 6639 206 61 — — — — — 5833 1942 6581 6133 144 81 - - - 5511 Summary of Attendances and Treatment, Under Treatment 1.1.42 Total new Cases, 1942. 1942 Cases Completed Treatment. Received A.P.T. Under Treatment 31.12.42 Defaulted. 490 6133 5511 6581 1297 180 Origin and Source of Cases attending. Year. School Inf. Welfare C. Others under 5 yrs. Total Per cent. Total. Per cent. Total. Per cent. 1934 339 67 - - 170 33 1935 944 66.6 265 18.7 208 14.7 1936 1620 74.8 310 14.3 237 10.9 1937 928 72.2 155 12.0 203 15.8 1938 1179 76.5 130 8.4 232 15.1 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 18.7 923 13.9 1942 2660 48.3 2176 39.5 675 12.2 Immunisation in Residential Schools and Homes. Owing to the evacuation of Residential Schools and Homes, no immunisation was conducted in the Institutions in 1942. 48 VACCINATION ACTS. I am indebted to Mr. Huggins, the Vaccination Officer, for the particulars in the returns in the subjoined Tables. Registration Subdistricts in V.O. District. Births Registered. Vaccinated. Insusceptible. Statutory Declaration. Died Unvaccinated. P.P.O. j Transferred j to other V.O.s Untraced Removals. In Default. Overage when Registered. South Sub-District 1379 710 5 385 37 18 95 65 64 — West Sub-District 1725 818 10 605 57 19 12 103 101 — North Sub-District 687 306 9 241 23 8 12 34 54 — 3791 1834 24 1231 117 45 119 202 219 - During the year 2,070 Forms Q were personally delivered to parents, and 75 Forms K. Form Q is the Form drawing attention to the requirements of the Vaccination Acts and Form K refers to cases in default. 857 names were sent on the II Lists to Public Vaccinators to be visited. Return showing the Number of Persons vaccinated and re-vaccinated at the cost of the rates by the Medical Officer of the Public Assistance Institutions and the Public Vaccinators during the year ended 30th September, 1942:— Name of Public Assistance Institution or Vaccination District. Numbers of successful Primary Vaccinations of persons. No. of successful revaccinations, i.e., successful vaccinations of persons who had been successfully vaccinated at some previous time. Under 1 year of age. 1 year and upwards. Total. Croydon No. 1 Area 253 26 279 7 No. 2 Area 222 23 245 5 No. 3 Area 114 12 126 6 No. 4 Area 89 11 100 4 No. 5 Area 233 10 243 4 Addington (New):— Dr. Spurring 31 11 42 — Now joined H.M. Forces. Dr. Kanaar 50 7 57 — Now joined H.M. Forces. Queen's Road Homes — — — — Mayday Hospital — — — — Children's Homes — — — — Shirley Residential Schools - — — — 992 100 1092 26 40 VENEREAL DISEASES. No changes have been made in the Scheme as given in my Report for 1930. Attendances at the Croydon Clinic during past 10 years. 1933. 1934. 1935. 1936. 1937. 1938. 1939. 1940. 1941 1942. New male patients 242 297 287 300 395 416 316 187 448 *661a New female patients 214 232 213 188 184 257 191 202 258 300a Attendances, male patients 4578 5858 5548 7525 8610 7318 4258 2996 3033 3932a Attendances, female patients 2677 3962 5977 5226 5405 5365 3150 1772 1508 1585a a Includes 270 new cases and 1437 total attendances by patients from outside areas. * Including Service Cases. Attendances of Croydon patients at various London Hospitals under General Scheme. There were 79 new patients, who made a total of 1,088 attendances. Pathological Examinations at London Hospitals for Croydon Patients. 516 Examinations were made for various Clinics and 723 Examinations of material submitted by medical practitioners. Bacteriological Examinations carried out at London Hospitals for Croydon Patients. Hospital. Detection of Spirochaetes Detection of Gonococci. Wasserman Re-action. Other Exams. Total. For Clinic For Prac. For Clinic For Prac. For Clinic For Prac. For Clinic For Prac. Endell Street, L.C.C. — - 9 - 2 — 8 — 19 St. Thomas's — — 51 - 56 — 81 — 188 South Lon. Hos. for Women 1 — 23 13 9 2 17 14 79 Royal Free — — 10 — 2 — 10 — 22 King's College — — 46 — 18 — 4 — 68 Whitechapel Clinic, L.C.C. — — 2 — 2 — 2 — 6 Westminster Hospital - - - - - - - - - Guy's Hospital — — 72 363 20 165 22 165 807 Mothers — — 16 — 14 — 19 — 49 Seamen's — — — — - 1 — 1 Total 1 — 229 376 123 168 163 179 1239 30 Croydon Cases attending London Hospitals. Hospital. Cases seen for the first time. Conditions other than venereal. Total number of attendances. Aggregate number of Inpatient Days. Syph. Gon. Endell Street L.C.C. - 1 - 10 — St. Thomas's - 4 22 342 — Guy's - 4 9 153 — King's College 2 2 11 347 2 Royal Free 1 1 4 27 37 S. Lond. Hosp. for Women — 2 9 104 — Whitcchapel Clinic, L.C.C. — — — 4 — Westminster — — 1 4 — Mothers 3 1 1 96 103 Seamens - — — 1 - Total 6 15 58 1088 142 51 Table V. Return relating to all persons who were treated at the Treatment Centre at Croydon General Hospital during the year ended the 31st December, 1942. Syphilis Soft Chancre Gonorrhoea Nonvenereal or undiagnosed condition Totals M F M F M F M F M F Ttls. 1. Number of cases on 1st January under ment or observation (58) 72 - - (130) 8 (13) 13 271 93 364 58 12 - 2. Number of cases removed from the register during any previous year which returned during the year under report for treatment or observation of the same infection - 4 - - 4 2 - - 4 6 10 3. Number of cases dealt with for the first time during the year under report (exclusive of cases under Item 4) suffering from:— Syphilis, primary 4 1 — — — — — — 4 1 5 „ secondary 4 7 — — — - — — 4 7 11 „ latent in 1st year of infection — 7 — — — - — — - 7 7 „ all later stages 7 5 — — — - — — 7 5 12 „ congenital 1 7 — - — - - - 1 7 8 Soft Chancre - — — - — - - - - - Gonorrhoea, 1st year of infection — — — — 55 75 — — 55 75 130 „ later — — — — 2 - - - 2 - 2 Non-venereal conditions — — — — — — 77 198 77 198 275 Conditions remaining undiagnosed at 31st December - - - - - - - - - - - 4. Number of cases dealt with for the first time during the year under report known to have received treatment for the same infection, or to have been under observation, at other Centres or Service Hospitals, or by General Practitioners approved under Ministry of Health Circular 2226 (109) 14 - - (402) 2 (74) 4 (511) 20 (511) 8 — - 82 102 Totals of Items 1, 2, 3 and 4 249 117 - - 605 87 164 215 1018 419 1437 5. Number of cases discharged after completion of treatment and final tests of cure or after diagnosis as non-venereal 6 12 - - (55) 50 (74) 214 (129) 276 (129) 44 87 137 413 6. Number of cases which ceased to attend before completion of treatment and were, on first attendance, suffering from:— Syphilis, primary — — — — - - — — — — - „ secondary — — — — - - - — — — - „ latent in 1st year of infection - - - - - - - - - - - „ all later stages 2 4 — — — - — 2 4 6 „ congenital — — — — — — — - - - Soft Chancre - - - — - - - - - - Gonorrhoea, 1 st year of infection ,, later - - - - - - - - - - - 7. Number of cases which ceased to attend after completion of treatment but before final tests of cure 6 8 - - 18 2 - - 24 10 34 8. Number of cases transferred to other Centres or to institutions, or to care of private practitioners (127) 17 - - (422) 8 - - (549) 25 (549) 12 - 12 37 9. Number of cases remaining under treatment or observation on 31st December (37) 76 — — (55) 27 3 1 (92) 104 (92) 59 11 73 177 Totals of Items 5, 6, 7, 8 and 9 (These totals should agree with those of Items 1, 2, 3 and 4) 249 117 — — 605 87 164 215 1018 419 1437 52 STATEMENT SHOWING THE SERVICES RENDERED AT THE TREATMENT CENTRE DURING THE YEAR, CLASSIFIED ACCORDING TO THE AREAS IN WHICH THE PATIENTS RESIDED. Name of County or County Borough (or Country in the case of persons residing elsewhere than in England and Wales) to be inserted in these headings. Croydon Surrey Kent London Forces Total A. Number of cases from each area included under the following headings in Item 3:— Syphilis 20 20 2 1 — 43 Soft Chancre — — — — — — Gonorrhoea 40 82 5 5 — 132 Non-venereal and undiagnosed conditions 120 145 4 6 — 275 Total 180 247 11 12 — 450 B. Total number of attendances of all patients residing in each area 1353 1268 94 75 2727 5517  Syphilis Soft Chancre Gonorrhoea Nonvenereal or undiagnosed condition Totals M F M F M F M F M F Ttls. 10. Number of attendances:- (a) for individual attention of the medical officer(s) (1489) 939 — — (1164) 289 (74) 349 (2727) 1577 (2727) 635 332 166 1133 2710 (b) for intermediate treatment, e.g., irrigtion, dressing — - — — 72 6 — 2 72 8 80 Total Attendances 2124 939 — — 1568 295 240 351 3932 1585 5517 11. In-patients:— (a) Total number of persons admitted for treatment during the year 1 - - - - - - - 1 - 1 (b) Aggregate number of "in-patient days" of treatment given 32 - - - - - - - 32 - 32 Under 1 year 1 and under 5 years 5 and under 15 years 15 years and over Totals M. F. M. F. M. F. M. F. M. F. 12. Number of cases of congenital syphilis in Item 3 above classified according to age periods 1 1 - - - - - 6 1 7 Microscopical. Others for diagnosis of Venereal Disease for Syphilis for Gonorrhoea 13. Pathological Word:- Number of specimens examined at, and by the medical officer of, the Treatment Centre — — - Figures in brackets refer to Service Cases. 58 CANCER. Deaths from Cancer numbered 405 as compared with 377 in 1941; 443 in 1940; 414 in 1939; 380 in 1938; 421 in 1937; 421 in 1936; 321 in 1935; 371 in 1934; and 374 in 1933. Death-rate per 1,000 of the population for the previous 10 years are as follows:— 1933—1.56 (374) 1938—1.56 (380) 1934—1.54 (371) 1939—1.78 (414) 1935—1.33 (321) 1940—2.22 (443) 1936—1.75 (421) 1941—2.04 (377) 1937—1.74 (421) 1942—2,07 (405) Deaths from Cancer Occurred at the following Ages:— Age period. Male. Female. Total. Calculated population at this age period Incidence per 1,000 persons living. Under 25 years 1 3 4 81836 0.049 25 and under 35 years 1 2 3 29134 0.103 35 and under 45 years 8 8 16 31722 0.504 45 and under 65 years 74 94 168 38845 4.325 65 years and over 115 99 214 14063 15.217 199 206 405 195600 2.071 Sites of Fatal Cancer. Site. Male. Female. Total. Percentage of Total. Brain 1 1 2 0.494 Skin 4 2 6 1.481 Tongue and Mouth 6 - 6 1.481 Tonsil 2 — 2 0.494 Oesophagus 9 4 13 3.209 Stomach 40 24 64 15.802 Liver 7 3 10 2.469 Bowel 28 34 62 15.308 Rectum 16 16 32 7.901 Bladder 8 4 12 2.963 Prostate 16 — 16 3.950 Larynx 4 4 8 1.975 Uterus - 24 24 5.926 Breast — 44 44 10.864 Ovary — 13 13 3.210 Pancreas 15 3 18 4.444 Peritoneum 2 — 2 0.494 Gall Bladder and Duct. 1 3 4 0.988 Mediastinum 1 1 2 0.494 Bones 5 7 12 2.963 Lungs 21 11 32 7.901 Kidneys 3 1 4 0.988 Eye — 1 1 0.247 Paratoid Glands 2 — 2 0.494 Thyroid Gland 2 1 3 0.741 Lymphatic Glands 2 — 2 0.494 Genital Organs 4 4 8 1.976 Not defined - 1 1 0.247 199 206 405 54 Comments on Foregoing Table. The organs most often attacked in descending order of incidence are: In the males— the Bowels and Rectum (22.1 per cent.), the Stomach (20.1 per cent.), the Lungs (10.6 per cent.), and the Prostate (8.0 per cent.); in females— the Bowels and Rectum (24.3 per cent.), the Breast (21.4 per cent.), the Stomach and the Uterus (both 11.6 per cent.) THE PREVENTION AND CONTROL OF TUBERCULOSIS. I am indebted to Dr. J. C. McMillan, the Assistant Medical Officer of Health for Tuberculosis, for the statistical part of this section of the report. Notification of Tuberculosis. One hundred and ninety-eight cases of Pulmonary Tuberculosis and 39 cases of Non-pulmonary Tuberculosis were notified on Form A (primary notifications); of these 102 males and 96 females were pulmonary cases; 16 males and 23 females nonpulmonary. In addition, 73 pulmonary cases and 13 nonpulmonary 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 1942 by notification or otherwise was 323, as compared with 286 in 1941. 271 of these were cases of Pulmonary Tuberculosis, 140 in males and 131 in females. There were 16 more cases of Pulmonary Tuberculosis in males and 35 more in females than in 1941. There were 21 cases of Non-pulmonary Tuberculosis among children under 15 years as compared with 29 in 1941. The number of cases in adults was 31, compared with 37 in 1941. Of the cases notified in 1942, 14 males and 13 females died from the Pulmonary form of the disease during the year, equal to 13.6 per cent. of those notified, and 4 males and 4 females from the Non-pulmonary form. The incidence rate of Tuberculosis of all forms was 1.65 per 1,000 of the population; for Pulmonary Tuberculosis 1.39, and for Non-pulmonary 0.27 per 1,000 population. The notification rate was 1.21 per 1,000. In 1941 the corresponding figures were 1.55, 1.19, 0.36 and 1.15 per 1,000. 55 Public Health (Tuberculosis) Regulations, 1930. Summary of notifications during the period from 1st January, 1942, to 31st December, 1942:— FORMAL NOTIFICATIONS. Age Periods. No. of Primary Notifications of New Cases of Tuberculosis 1 Total | Notifications | on Form A. 0-1 1— 5 5—10 10—15 15—20 20—25 25—35 35—45 45—55 55—65 66 up. Total (all ages) Pulmonary— Males - 1 1 1 12 13 24 18 10 18 4 102 111 Females — — — - 20 24 24 12 10 3 3 96 101 Non-Pulmonary— Males 2 2 1 — 2 - 5 3 — 1 - 16 18 Females - 3 3 2 4 5 1 3 — 2 — 23 24 Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1942, to 31st December, 1942, otherwise than by formal notification:— Age periods. 0—1 1—5 5—10 10—15 15—20 20—25 25—35 35—45 45—55 55—65 65 and upwards Total Cases. Pulmonary Males — — - 1 2 5 10 9 6 2 3 38 Females — — — — 2 13 9 7 1 3 — 35 Non-pulmonary Males 1 1 2 — 1 1 — — 1 — — 7 Females - 2 2 — 1 — 1 — — — 6 Notification Register. Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1942:— PULMONARY. NON-PULMONARY. Total Cases. Males. Females. Total. Males. Females. Total. 571 514 1085 113 129 242 1327 50 classification of new patients. Pulmonary Tuberculosis. During 1942, 159 new patients were examined at the Clinic and were found to be in the undermentioned stages of the disease on the first examination:— T.B. minus (sputum negative or absent) 54 or 33.9% T.B. plus 1 (early cases, sputum positive) 16 or 10.1% T.B. plus 2 (intermediate cases, sputum positive) 63 or 39.6% T.B. plus 3 (advanced cases, sputum positive) 26 or 16.4% 159 100.0% This is 19 more than in 1941. Ages at Death from Pulmonary Tuberculosis. Year. 0—5 5—15 15—25 25—45 45—65 Over 65. Total. 1937 — 2 35 55 40 8 140 1938 — 3 22 46 40 8 119 1939 — — 19 44 30 3 96 1940 — 1 18 61 38 10 128 1941 — 2 11 33 32 12 90 1942 — — 15 50 33 8 106 In 1942 the death-rate from all forms of Tuberculosis was 0.63 per 1,000 population. The rate for Pulmonary Tuberculosis was 0.54 and the rate for Non-Pulmonary Tuberculosis 0.09. Similar figures for 1941 were 0.59, 0.49 and 0.10. Pulmonary Tuberculosis. In 1942 there were more deaths from Pulmonary Tuberculosis than in 1941, but the increase was only in men, the female deaths showing no appreciable change. The greatest increase occurred in the 25—45 years age groups. Most deaths in men occurred after the 25th year, whereas in women most deaths occurred in the earlier age groups, i.e., up to the 45th year. 57 There was an increase of 20 per cent. in the number of new cases in 1942, compared with 1941, the increase being about three times greater in women than in men. In women the highest incidence was in the age groups 20—25 years. In men the highest incidence was in the 25—35 years groups. Non-Pulmonary Tuberculosis. The diagnosis of the new cases entered in the Notification Register during 1942 were as follows:— Male. Female. Meninges 5 3 Spine 1 2 Spine and hip 1 — Hip 2 — Shoulder 2 — Knee 1 — Elbow 1 — Foot 2 3 Sterno-clavicle — 1 Peritoneum 1 2 Abdomen — 2 Kidney 1 3 Skin — 1 Ileo-caecal — 1 Sacro-iliac — 1 Genito-urinary 1 — Miliary 1 1 Glands 4 9 Totals 23 29 Deaths from Non-Pulmonary Tuberculosis. During 1942, 17 deaths were certified to be due to NonPulmonary Tuberculosis, compared with 19 in 1941, 21 in 1940, 12 in 1939, 18 in 1938, and 15 in 1937. The deaths were due to:— Males. Females. Total. Tuberculous Meningitis 3 6 9 „ ,, and Right Apical Pneumonia 1 — 1 Tuberculous Hip disease 1 1 2 Tuberculous Peritonitis 1 1 2 Tuberculous Kidney — 1 1 Tuberculous disease of the Spine 1 — 1 Miliary tuberculosis 1 - 1 Totals 8 9 17 58 Co-ordination with Medical Practitioners, and Other Branches of the Health Department. During the year 317 cases of suspected Tuberculosis were referred by private medical practitioners; 51 were diagnosed as suffering from Tuberculosis and were subsequently notified. In addition, 49 children were referred by the School Medical Service, and 25 cases from the Maternity and Child Welfare section of the Public Health Department. 71.3 per cent. 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 75.9 per cent. in 1941. The number of reports sent in bv Insurance medical practitioners on their domiciliarv cases (Form G.P.36) was 137. Examination of Sputum. The results of examinations made in 1942 are as follows:— For Clinic. For General Practitioners. Totals. Positive (i.e., tubercle bacilli present) 572 76 648 Negative (i.e., tubercle bacilli absent) 713 530 1243 Totals 1285 606 1891 For each 100 new cases and contacts examined at the Clinic, 138 specimens of sputum were examined. X-Ray Work. 1,064 X-Ray examinations were made during the year, an increase of 271 over 1941. This is equivalent to 114 for every 100 new cases and contacts seen, and compares with a rate of 101.7 in 1941. 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. Provision of special nourishment in the form of milk was granted to 91 selected cases for varying periods during the year, and 44 cases were in receipt of extra nourishment at the end of the year. 59 Residential Treatment for Pulmonary Tuberculosis. Summary of Patients who received Institutional Treatment during 1942. Institutions. In Institutions on 1.1.42 Admitted During 1942 Discharged During 1942 Died During 1942. Remaining in on 31.12.42. Adults. Adults. Adults. Adults. Adults. M F Ch. M F Ch. M F Ch. M F Ch. M F Ch. Respiratory. Croydon Borough Sanatorium 44 22 — 79 78 — 78 54 - 3 6 — 42 40 — Brompton Hospital and Sanatorium - 2 — 5 8 — 2 8 — 1 — — 2 2 — Childrens' Sanatorium, Harpenden - - 1 - - 2 - - 3 - - - - - - Burrow Hill Sanatorium — — — 2 — — 1 — — — — — 1 — — Berks and Bucks Joint Sanatorium - 1 1 - - - - 1 - - - - - - 1 Horton Hospital 5 4 — 5 9 — 6 9 — 4 4 — — — — Grosvenor Sanatorium — - - - 1 - - 1 - - - — - - - Preston Hall - - - 1 - - 1 - - - - - - - - East Sussex County Sanatorium - - - 1 - - - - - - - - 1 - - St. Barnabas Home - - - 1 - - - - - - - - 1 - - Groundslow Sanatorium - - - - 1 - - - - - - - - 1 — R. Nat. Hosp. for Consumption, Ventnor - - - 1 - - 1 - - - - - - - - Mayday Hospital 8 1 1 47 51 — 28 32 — 16 12 1 11 8 — 57 30 3 142 148 2 117 105 3 24 22 1 58 51 1 00 Residential Treatment for Non-Pulmonary Tuberculosis. Summary of Patients who have received Institutional Treatment during 1942. Institution. In Institutions. on 1.1.42. Admitted During 1942. Discharged During 1942. Died During 1942. Remaining in on 31.12.42 Adults. Adults. Adults. Adults. Adults. M. F Ch. M F Ch. M F Ch. M F Ch. M F Ch. Non Respiratory Tuberculosis. Royal Sea Bathing Hospital 3 1 — — — — — 1 — I ___ — 2 — — Heritage Craft School - - 1 - - 1 - - - - - - - - 2 St. Nicholas' & St. Martins Hosp. Pyrford 1 — 5 1 I 2 — 1 5 — — — 2 — 2 Roy. Nat. Orthopaedic Hosp. 1 — — 1 1 — 2 — — — — — — 1 — Lord Mayor Treloar Cripples Hosp. - - 1 - - - - - - - - - - - 1 King George's Sanatorium 1 - - - - - 1 - - - - - - - - St. Peter's Memorial Home — — — — 2 — — 1 — — — — — 1 — Botley's Park Hospital 1 1 — — — — 1 1 - - - - - - - Croydon General Hospital 1 - — 1 1 — 2 1 - - - - - - - Croydon Boro. Isolation Hospital — 1 - - - - - 1 - - - - - - - Mayday Hospital — 3 — 6 8 2 4 9 1 2 1 — — 1 1 St. Raphael's Home - - - - 1 - - 1 - - - - - - - Addenbrooke's Hospital - - - 1 - - 1 - - - - - - - - Papworth - - - 1 - - - - - - - - 1 - - 8 6 7 11 14 5 11 10 6 3 1 — 5 3 6 61 The Immediate Results of Institutional Treatment. The immediate results of treatment of patients discharged from residential institutions during the year are as follows:— Among the Pulmonary cases 33.2 per cent. were classified as early cases, the percentage of early cases receiving treatment in institutions was in women 38.7 per cent., in men 26.3 per cent. 51.1 per cent. of the total cases were intermediate cases, the males showing an excess in this group, 47.5 per cent. females to 55.8 per cent. males, and 15.7 per cent. were definitely advanced. Of the total Pulmonary cases treated in Institutions, 76.4 per cent. were potentially infectious. 135 males, 126 females and 4 children suffering from Pulmonary Tuberculosis were discharged from, or died in, Institutions in connection with the Croydon tuberculosis scheme during 1942. The Tuberculosis Clinic and Home Visiting. The subjoined table gives a summary of the work done in connection with the Clinic. 693 new cases were examined during the year. This is equal to 563 for each 100 deaths from the disease. 173 or 141 for each 100 deaths were found to be definitely tuberculous. The total number of attendances at the Clinic was 5,128. The Tuberculosis Officer paid 73 home visits, and the District Health Visitors 2,513 visits, for Clinic purposes. In addition, the Health Visitors made 317 primary visits for the purpose of the Notification Register. The Tuberculosis Officer paid 53 visits to Mayday Hospital, in a consultative capacity, and there examined 222 patients. Patients requiring home nursing or surgical dressings are attended to by the nurses from the Croydon Nursing Service, by arrangement with that organisation, and 636 such visits were made during the year. Their assistance is a valuable adjunct in the care of domiciliary cases. Contact Examination. The contacts of definite cases are urged to attend the Clinic for examination (and subsequent supervision). This is an important preventative measure. During the year 238 contacts were examined, equal to 193 for each 100 deaths, compared with 62 227 in 1941, 278 in 1940, 325 in 1939, and 301 in 1938. Of these 11 were considered to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 46.0, compared with 1.65 per 1,000 of the general population. 407 appointments for examination were offered to new contacts during 1941, but only 238 new contacts attended and were examined. The Clinic Register of Cases. The number of cases of Tuberculosis under the supervision of the Clinic at the end of the year was 870. This is equivalent to 4.4 persons per 1,000 of the population. During the year 85 Clinic cases died. Of this number 21 or 24.7 per cent. were seen for the first time in 1942. SUMMARY OF CLINIC STATISTICS FOR 1942. Slumber of persons on Clinic Register, January 1st, 1942 808 ,, notified cases examined for the first time 44 ,, cases sent for an opinion 498 ,, first attendances, including 78 transfers in 1,009 ,, consultations of T.O. with medical practitioners— (a) Personal 28 (b) Other 518 ,, visits paid by T.O. to homes of patients 73 ,, visits paid by T.O. to Cheam Sanatorium — ,, visits paid by T.O. to Mayday Hospital 53 ,, patients examined by T.O. at Mayday Hospital 222 ,, visits paid to homes of patients by Health Visitors 2,830 ,, visits paid to homes of patients by District Nurses for nursing attention 636 Attendances of patients at the Clinic— Men 2,123 Women 2,375 Children 630 Total 5,128 Number of Insured Patients under Domiciliary Treatment at the end of year- Pulmonary 206 Non Pulmonary 10 Total 216 63 Number of reports received from Panel Practitioners (G.P.36) 137 ,, report forms sent to Panel Practitioners (G.P.36) 399 ,, reports received from Panel Practitioners on Forms G.P.17 2 ,, reports received from Panel Practitioners on Forms G.P.35 2 „ X-Rays taken 1,064 „ reports made to Ministry of Pensions by T.O. on general progress of Tuberculous ex-Service Men 71 ,, cases referred to Light Treatment 2 ,, cases referred to Orthopaedic Clinic 18 ,, cases receiving extra nourishment at the end of year 44 „ cases referred by the Ministry of Labour and National Service Medical Boards for examination and report 165 CHEAM SANATORIUM. The Sanatorium is situated at North Cheam, and normally has accommodation for 93 adult patients of both sexes: men 53 and women 40. Owing to the black-out arrangements the number of beds now available is 48 men and 37 women. In-patients on 1st Jan., 1942 Admitted during the year Discharged during the year. Died during the year. In on 1st Jan. 1943. M F M F M F M F M F 44 22 83 85 81 60 3 6 43 41 Number of Artificial Pneumothorax cases begun 30 ,, Refills given 1,918 ,, X-ray Screenings 2,046 ,, Films taken 455 ,, Sputum tests 879 „ Gas replacements 10 04 Immediate Results of Treatment. Group. Total number of cases discharged Quiescent. Improved. No Material Improve ment. 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 13 20 11 16 — 1 1 1 - 1 1 1 143 Class T.B. Plus— Group 1 11 9 2 6 5 — 1 1 - - 3 2 186 Group II 40 23 5 2 25 12 6 5 - 1 4 3 225 Group III 12 7 — 1 2 — 5 2 3 4 2 — 109 Observation Non T.B. 2 1 - - - - - - - - - - - 78 60 18 25 32 13 13 9 3 6 10 6 — At the beginning of 1942 there were 66 patients in Cheam Sanatorium. During the year 168 were admitted and 141 discharged, whilst 9 died, thus leaving 84 patients in at the end of 1942. There were 4 observation cases sent in: 3 males and 1 female. Of the 3 males, 2 were not tuberculous, and the 1 female was not tubercular. Therefore, there were 3 observation cases in nontuberculous cases, which are shown above. The case that was tuberculous is in with the tuberculous cases and is not shown as observation. Artificial pneumothorax cases discharged but still under treatment: 6 males, 6 females (see above), making total discharges: males 84, females 66. These artificial Pneumothorax cases only refer to cases discharged in 1942, those discharged in 1941 and still having refills have not been included. Dental Report. Dental inspection and treatment for patients in the above institution is carried out as early as their general condition permits attendance at the surgery. For those in the acute stage, 65 however, attention is for the most part confined to those whose dental condition causes discomfort or when treatment has been specially rcommended by the Resident Medical Superintendent. Dental treatment for tuberculosis patients differs from that prescribed for ordinarv individuals in that as the former are already definitely ill, any operations performed must be of short duration, so as not to risk any aggravation of the underlying condition. It is worthy of note that while, in cases where the mouth is unusually neglected, the patient is often loath to have anything done, the reaction once treatment is commenced is usually good and little further trouble is experienced. Those returning to their homes in Croydon before being rendered dentally fit can, if desired, attend at Lodge Road Clinic at a later date for the necessary work to be completed. Treatment sessions devoted to this class of work were 33 against 34 in 1941. Treatment figures given below follow very closely on those obtained during the previous year. Review of Work Done. Males. Females. Total. 1942 1941 Number Examined 59 54 113 111 Referred Treatment 40 37 77 92 Treated 36 35 71 87 Attendances 154 130 284 268 Extractions 109 45 154 138 Fillings 43 75 118 117 Dressings 10 5 15 15 Scalings 13 17 30 43 Root Treatments — 4 4 4 Denture Dressings 7 5 12 25 Dentures Fitted 1 1 2 7 Dentures Repaired 3 2 5 — Mandibular Injections 7 6 13 23 No. of Treatment Sessions: 33 66 Dental Treatment for Patients Referred from the Tuberculosis Dispensary to Lodge Road. Patients referred from the Tuberculosis Dispensary are treated at Lodge Road Treatment Centre on Wednesday afternoons from 3.30 to 5 p.m., and after the treatments are carried out the Clinics are thoroughly disinfected. The majority of cases treated are referred by the Tuberculosis Officer, the remaining being patients discharged from the Borough Sanatorium at Cheam before treatment could be completed. Summary of Work Done. Males. Females. Total. 1942 1941 Referred from Dispensary 2 13 15 16 Treatment cases continued from Cheam. 8 5 13 5 Attendances 26 54 80 66 Extractions 6 22 28 39 Fillings 4 12 16 23 Dressings — — — 5 Scalings 1 8 9 6 Denture Dressings 21 28 49 21 Dentures fitted 8 9 17 6 Number of Treatment Sessions: 20 The amount of 9s. 0d. was taken in attendance fees during the year at Lodge Road. MATERNITY AND CHILD WELFARE. Notification of Births. Notifications were received from— Live Births. Still Births. Total. Midwives 3,183 90 3,273 Doctors, Parents and Others 455 22 477 3,638 112 3,750 67 Maternal Mortality. There were 9 deaths directly due to pregnancy, compared with 8 in 1941. The maternal mortality rate was 2.51 per 1,000 births, compared with 3.23 in 1941. In other words, one mother died for every 400 babies born. The deaths directly due to pregnancy were caused by— (1) Ruptured ectopic gestation. (2) Pulmonary embolism consequent upon child-birth. (3) Coronary embolism: Cesarean section. (4) Post-partum hæmorrhage. (5) Coronary air embolism: gas gangrene of uterus: pregnancy full term. (6) Toxæmia of pregnancy. (7) Puerperal sepsis. (8) Intra-cranial hæmorrhage: eclampsia: pregnancy. P.M. (9) Obstetric shock: dystocia and retained placenta. In addition there were three deaths due to criminal abortion included by the Registrar-General under suicide, etc. Puerperal Fever and Puerperal Pyrexia. Seventy-eight cases of Puerperal Pyrexia were notified. This is a rate of 21.8 per 1,000 births (live and still births). Accommodation for Confinement. The following table gives information concerning the accommodation utilized for confinements:— Number. Percentage. In Private Houses 1,344 35.31 In Public Institutions 1,715 45.06 Registered Maternity Homes 747 19.63 3,806 Still Births. During 1942, 108 still births were registered in respect of Croydon. Of these 59 were male babies and 49 female; 6 males and 4 females were illegitimate. The proportion of still births 68 to living children was as 1 to 32. The still birth rate was 3.0 per cent. of the total births. The still birth rate, on the same basis as for Infant Mortality, was 30.2 per 1,000 births. Ophthalmia Neonatorum. Nineteen cases were notified during 1942. The following table gives the notifications in Croydon during the past ten years:— 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 No of Cases 10 13 13 20 21 20 15 14 17 19 Rate per 1,000 Births 3.2 4.0 3.9 6.2 6.4 6.0 4.5 4.7 7.0 5.5 Results of Treatment. Notified. Cases treated. Vision Unimpaired. Vision Impaired Died. Removed Remaining under Treatment At home. In hospital 19 12 7 17 — — — 2 Infant Morality. The Infantile Mortality rate was 39 per 1,000 live births registered. For the past 5 years the numbers of infant deaths have been 1938—135, 1939—130, 1940—116, 1941—90, 1942—137. 106 deaths of infants occurred in Institutions, including Registered Nursing Homes. Among the 137 deaths, 72 occurred in boy babies and 65 in girls. Of the births, 1,827 were males and 1,644 females. The infantile mortality rate for the two sexes was, therefore— Boys—39. Girls—39. The rate of infant mortality amongst illegitimate children was 46 per 1,000. The rate in legitimate children was 39 per 1,000. 09 Deaths under one year, arranged in days, weeks and months. causes of death. 1st day. 2nd day. 3rd day. 4th day. 5th day. 6th day. 7th day. 1st-2nd wk. 2nd-3rd wk. j 3rd-4th wk. Under 1 mnth. 1-2 mths. 2-3 mths. 3-4 mths. 4-5 mths. 5-6 mths. 6-7 mths. 7-8 mths. 8-9 mths. 9-10 mths. 10-11 mths. 11-12 mths. total. All Causes Certified 41 6 5 2 2 1 11 — 7 3 78 8 8 11 14 8 3 2 2 1 1 1 137 Chicken Pox - - - - - - - - - - - - - - - - - - - - - - - Measles - -'- - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - 1 - - - - - - - - 1 2 Diphtheria and Croup - - - — - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - 2 - 1 - - - - - 3 Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - 1 - - - 1 1 - - 2 Meningitis (not Tuberculous) - - - - - - - - - - - - - - - - - - - - 1 2 Convulsions - - - - - - - - - -- - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - - - - - - - - - - 1 Pneumonia (all forms) — — 1 — 1 1 1 — — 3 1 5 8 3 5 1 1 — 27 Diarrhoea and Enteritis - - - - - - - - - - 1 1 2 6 - 1 1 — 12 Gastritis - - - - - - - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - - Congenital Malformations 6 1 — — 1 1 3 — — — 12 3 — — — — — 1 — 16 Premature Birth 21 1 3 1 — 2 — 3 — 31 — — — — — - - — 31 Atrophy, Atelectasis, Debility and Marasmus 10 2 - - - - - - 4 2 18 - 1 - 2 - - - - - - - 21 Injury at Birth 1 1 — - — — 3 — — — 5 — — — — — - — - — — - 5 Other Causes 3 1 1 1 - - 1 - - 1 8 3 - 1 - 2 — 1 - - - - 15 Totals 41 6 5 2 2 1 11 — 7 3 78 8 8 11 14 8 3 2 2 1 1 1 137 ro The following table gives the cause of death during the first month of life:— (1) Complications of Labour— Trauma at Birth 5 — 5 (2) Foetal States— Congenital Heart Malformation 4 Other Congenital Deformities, etc. 8 Atelectasis, etc. -18 —30 (3) Prematurity 31 —31 (4) Post-Natal Causes 12 —12 78 Percentage Deaths per Total Infantile Deaths. Deaths per 1,000 Births. 1942 1941 1942 1941 Premature Births 22.6 27.7 8.9 10.4 Respiratory Diseases (Pneumonia, Bronchitis, etc.) 20.4 34.4 8.1 12.1 *Infectious Diseases (including Tuberculosis 5.1 5.5 2.3 2.1 Atelectasis, Debility and Marasmus 15.3 4.4 6.0 1.7 †Diseases of Digestion 11.7 5.5 4.6 2.1 Injury at Birth and Congenital 15.3 12.2 6.0 4.6 *Analysed these deaths were due to Cerebro-Spinal Meningitis 1; Whooping Cough 2; and Tuberculosis 5. †These deaths were due to Diarrhoea 12; Peritonitis 1; Pharyngitis 1; Intestinal Obstruction 1; Perforation of Intestine 1. MIDWIFERY SERVICE. Midwives Acts, 1902 to 1936. Seventy-seven midwives notified the Local Supervising Authority of their intention to practice within the Borough during 1942. Fifteen ceased practising in the Borough; so that sixty-two remained on the Register at the end of the year. All these were trained and held the certificate of the Central Midwives Board. Midwives are compensated if they lose a case through admission to a hospital or maternity home on the advice of a doctor. The sum of £3 was paid out during the year. 71 Confinements Attended by Midwives (including Municipal Midwives). Cases attended by Midwives alone 2,904 71.5% of total Cases attended by Midwives when a doctor was also engaged 394 Cases attended by Midwives when a doctor was alss summoned 452 Total 3,750 The Rules of the Central Midwives Hoard lay down that the Local Supervising Authority must be informed within 36 hours by a midwife if she has summoned medical help during pregnancy; in a confinement or within 14 days afterwards. The following table gives details of the reasons for sending for medical aid:— For Complications during Pregnancy. Abortion 11 Other causes 58 Albuminuria 10 -79 For Complications during Labour Breech 9 Undiagnosed 5 -14 Delayed Labour. Uterine Inertia 5 Prolonged 37 Delayed 33 -75 Haemorrhage. Ante-Partum 7 Post-Partum 11 -18 Other Causes. Adherent Placenta 9 Illness of Mother 2 Torn Perineum 131 -142 For Complications during Puerperium. Pyrexia 16 Pain in Breasts 3 Pain in Legs 9 Other causes 13 -41 For Complications in regard to the Baby. Inflammation of Eyes 40 Still Birth 4 Feebleness 13 Other causes 31 Premature Birth 2 -90 459 In accordance with Rule 33 of the Central Midwives Board, the following reasons for the discontinuance of breast-feeding were received:— Illness of Mother 11 Insufficient Milk 30 Other Causes 6 Total 47 78 Inspection of Midwives. Dr. Jenkin Lloyd, the Inspector of Midwives, interviewed 2 midwives at the Town Hall. 17 visits were paid by her to the homes of midwives. Doctor's Accounts under Section 14 (1) of the Midwives Act, 1918. 373 accounts were received from doctors for services rendered under the provisions of this Section. This compares with 245 in 1941, 321 in 1940, 424 in 1939, 388 in 1938, and 284 in 1937. The total amount of the accounts was £461 16s. Od. £241 17s. 2d. was ultimately recovered from the patients. In 1941 the amount paid to doctors was £461 16s. 0d., and in 1940 £528 2s. 0d. Nursing Homes. Maternity Homes. Other Nursing Homes. Combined Maternity and other Nursing Homes. Total. No. of Homes on Register on 31/12/41 5 19 17 41 No. of Applications for Registration during 1942 1 - — 1 No. of Homes Registered during 1942 1 - - 1 No. of Homes on Register on 31/12/42 6 15 17 38 No. of Beds available 55 267 (a) Mat. Beds 40 (a) 95 (b) Other Beds 58 (b) 325 WARTIME NURSERIES. Attendances at War-time Nurseries, 1942. Coldharbour House Whitehorse Road Mayday Road Tennlson Road Date opened 23/2/1942 1/6/1942 1/6/1942 1/6/1942 Number on books at end of year 57 43 56 62 Attendances: under 2 2881 466 2256 2948 over 2 5967 3039 3054 2363 Total 8848 3505 5310 5311 Number of days opened 264 181 181 181 Average daily attendance 33 19 29 29 78 MATERNITY AND CHILD WELFARE CONSULTATIONS. There are 18 Maternity and Child Welfare Centres, 16 of which are conducted by the Croydon Mothers' and Infants' Welfare Association and 2 by the local authority. A total of 23 sessions per week are held and at these a doctor and nurse on the staff of the Health Department attend. During 1942, 3,091 new cases under 1 year of age and 1,003 over 1 year of age attended for the first time; the total of attendances of infants and young children from 0—5 years increased from 64,322 in 1941 to 82,453 in 1942. Consultations with doctors increased from 21,319 to 23,208. 49 expectant mothers were seen, an increase of 3 on 1941, and a total of 334 visits to the Centres were paid by them. The total of all visits to the Centres was 82,787, an increase of 18,027 compared with 1941. The highest average attendance of mothers and babies at each session was recorded at St. Oswald's (100.0), South Croydon (95.7), Woodside (88.8), St. Andrews (84.5), St. Stephen's (84.1), Selhurst (83.5), and Municipal (81.7). Dental Treatment. Maternity and Child Welfare Patients. Expectant and nursing mothers and children below school age are referred by Medical Officers attending Ante-Natal Clinics and Infant Welfare Centres. Since the inauguration of the Municipal Midwives Service applications for dental treatment have also been received in increasing numbers from this source. Expectant Mothers. New cases inspected during the year numbered 532 compared with 491 last year, and represent 89 per cent. of the total number of mothers referred. Of the above, 77 per cent. presented themselves during the first six months of pregnancy, while the remaining 23 per cent. were first seen during the later period of gestation. The demand for treatment in this branch of the dental service continues to increase as more and more cases are referred from Ante-Natal Clinics or by Midwives. Every effort was made to 74 enable patients to receive their first inspection as soon as possible after their names were submitted, but in spite of extra sessions being allotted for this work, delay was sometimes unavoidable. Nursing Mothers. Owing to the greater number receiving their treatment antenatally, the proportion of mothers first inspected during the nursing period continues to decline. New cases referred were 66 compared with 75 last year. Those seen during the first six months after their confinement constituted 57 per cent. of the total number referred; the remainder with infants between seven and twelve months received mostly emergency treatment. In addition to the above a large amount of treatment was performed for those referred during the previous year. Treatment. With the exception that the fillings inserted were slightly fewer than last year, all principal items of treatment show an appropriate increase on 1941. The number of dentures inserted show a considerable rise, and additional time has been allotted to enable this work to be carried out at the Selhurst Road Clinic. During the year 36 extra sessions were devoted to treatment. Full details will be found in the combined Table. The Pre-School Child. Though a considerable amount of treatment was performed for the above, the actual number of new cases inspected was only 212 compared with 253 in 1941. While this further decline is somewhat disappointing, it is possible that owing to the increased number of mothers now on active war work, visits to Welfare Centres paid by children of the 3—5 age groups are far less frequent than in normal times. Figures for fillings and extractions performed on these small patients show a substantial increase on those recorded in the last report. Full details are to be found in the ensuing Table. 75 The following summary shows particulars of the work accomplished:— Expectant Mothers. Nursing Mothers' Total. Young Children. New Cases Examined 532 66 598 212 Re-treated 45 9 54 31 Total 577 75 652 243 Attendances 2397 444 2841 644 Fillings 816 55 871 367 Extractions 2158 415 2573 462 "Gas" Cases 309 59 368 142 Local Anaesthesia 536 40 576 128 Scalings and Gum Treatment 246 20 266 5 Dressings 425 47 472 204 Denture Dressings 1145 259 1404 — Treatments Completed 276 40 316 166 Number of Sessions (treatment) 469 Appointments kept 80% Dentures Fitted: Full 183 Partial 66 Total -249 The Centres at which patients were examined, or from which they were referred, are given in the following list:— Ante-Natal 640 The Retreat 14 Waddon 11 Municipal Midwives 232 South Croydon 10 Shirley 11 St. Alban's 15 Boston Road 8 Municipal 36 Woodside 7 St. Stephen's 6 East Croydon 53 Norbury 6 Holy Trinity 7 Upper Norwood 11 St. Paul's 8 Addington 6 West Croydon 5 St. Oswald's 15 Wartime Nursery 7 South Norwood 15 St. Andrew's 5 Total: 1,128 The amount received for attendance fees was £75 10s. 0d., as compared with £64 9s. 0d. in 1941. 70 The Work of the Health Visitors.— Maternity and Child Welfare Only. Visits Re:— Wilson Ashe Southgate Walker Hobday Hinton Wakefield Overington Wybrew Early Warman Oakley Devaney Cross Bird Webb Buttfieid Bond Ernest Lewis Catlow Cox Toneri Total Infants under 1 year. First visits 131 63 104 221 240 202 63 205 183 121 201 104 215 96 222 128 224 174 176 154 204 182 295 3974 Re-visits 331 233 130 407 817 488 127 681 416 511 340 495 959 205 622 508 694 348 460 623 789 484 253 10981 Children 1-2 years. First visits 4 - 8 8 28 1 1 11 12 6 17 25 7 22 8 29 2 4 13 3 12 10 231 Re-visits 209 100 76 481 3611 273 96 763 173 340 203 276 517 82 340 300 410 280 151 232 574 334 211 6788 Children 2-5 years. First visits 7 — 16 20 40 1 — 4 10 — 12 30 53 4 21 6 53 1 1 15 6 9 3 312 Re-visits 548 205 266 851 864 359 142 570 589 264 590 355 433 113 239 498 781 231 221 412 456 495 221 9703 Expectant Mothers. First visits 110 50 84 77 45 50 41 83 84 69 124 76 73 57 112 67 104 44 97 68 42 72 144 1773 Re-visits 15 6 7 7 36 - 3 2 1 27 - - - 31 - 1 10 - 9 2 20 4 5 186 Still Births 2 2 3 2 5 — — 6 6 2 — - — 5 5 — 1 3 3 3 — 5 — 53 Milk (Mothers and Children's Order) — 21 2 — 1 4 - — — 16 — — — 7 — 9 — - 68 — — — — 128 Deaths under 1 year 2 5 15 6 1 — 2 8 13 5 7 — 3 1 — — 4 1 9 2 6 3 4 97 Miscellaneous visits 813 359 686 972 745 486 256 850 540 369 416 383 542 123 216 711 877 248 330 274 473 268 240 11177 Ineffective visits 219 131 207 424 542 250 110 281 364 169 225 380 514 339 350 386 548 235 _ 433 312 222 177 432 7250 Totals—1942 2391 1181 1004 3536 3731 2114 841 3464 2391 1893 2124 2170 3334 1070 2155 2022 3735 1567 1902 2110 2795 2045 1818 52659 1941 1801 1131 1179 2199 3502 2158 1017 2911 928 1880 2133 2013 2204 1440 1737 1804 2322 2471 1744 1764 2028 1080 441 42873 77 Attendances at Infant Centres—1942. Municipal. Boston Road. St. Andrew's. South Croydon. Shirley. Woodside. Lr. Addiscombe Road. South Norwood Westow Street. St. Alban's. St. Paul's. St. Oswald's. West Croydon. Norbury. Waddon. Selhurst. Addington. St. Stephen's Total 1942. Total 1941. Infants: New cases under 1 year 391 162 129 184 173 190 329 217 103 235 116 175 67 120 108 100 142 150 3091 2430 No. of re-attendances 4760 2233 1878 3044 1734 2480 4390 3569 1601 4259 2178 2871 1388 1953 1807 1874 2294 2591 46904 34627 New cases over 1 year 102 48 23 50 45 55 81 74 58 66 53 64 18 32 74 46 60 54 1003 1008 No. of re-attendances 2920 913 2025 1501 1114 1628 2551 1795 1654 2776 1306 1997 931 1496 1338 2109 1991 1410 31455 26257 Attendances of children 0-5 8173 3356 4055 4779 3066 4353 7351 5655 3416 7336 3653 5107 2404 3601 3327 4129 4487 4205 82453 64322 Consultations with Doctor 2411 803 1081 1259 516 1035 2161 2250 1098 2223 1080 1260 968 712 1101 1205 1007 1038 23208 21319 No. of Sessions 102 51 48 50 48 49 98 99 50 98 48 51 49 50 50 50 98 50 1139 1157 Expectant Mothers: No. of new cases 3 — — — 12 — — 19 — 1 3 — 1 5 — 4 1 49 46 No. of re-attendances 1 — - 6 21 - - 50 - - 5 - 38 13 105 46 4 - 289 392 Total attendances of Expectant Mothers 4 - — 6 33 — — 69 — 1 8 — 38 14 110 46 8 1 338 438 Total attendances 8177 3356 4055 4785 3099 4353 7351 5724 3416 7337 3661 5107 2442 3615 3437 4175 4491 4206 82787 64760 Average attendance per Session 1942 81.7 65.8 84.5 95.7 64.6 88.8 75.0 57.8 68.3 74.9 76.3 100.0 49.8 72.3 68.7 83.5 45.9 84.1 ‡71.6 1941 77.6 47.2 71.4 86.0 56.5 63.2 60.8 45.5 42.8 49.2 57.6 58.1 48.4 57.8 54.0 67.7 32.9 44.6 ‡56.0 Total average attendance each week at all Centres. 78 Convalescence Committee of the Croydon Mothers' and Infants' Welfare Association. This Committee undertakes the arrangements for convalescence in cases of mothers and children referred for that purpose by the medical officers at the various Infant Welfare Clinics. 1 am indebted to the Convalescence Secretary for the data given below:— Convalescent Homes. Total number of children under 5 sent to Convalescent homes (with mothers—2) 4 Total number of weeks 34 Cost £34 19s. 5d. Number of mothers sent for convalescence 6 Number of children under 5 sent with their mothers to cottages 2 Home Helps. From 1st January to December 31st, 348 mothers applied for Home Helps, and 279 were supplied. £402 was collected in payment for their services. At the end of the year there were 12 names of Home Helps on the register. Babies' Help Report. I am indebted to Mrs. Philpott for the following particulars:— "In January, 1942, three mothers and babies were receiving help. In December five were on the books. During the year 13 have been helped. One baby died of pneumonia; all others made good progress." Croydon Association of Moral Welfare. This Association has a Home for Girls at 34, Morland Road, and a Hostel at 24, 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. PUBLIC HEALTH ACT, 1936. PART VII. Child Life Protection. This part of the Act deals with Foster Mothers and Foster Children. The Tables below give figures for 1942. 79 FOSTER CHILDREN No. as at Dec. 31st 1941 Notice of Reception of Children during the year Notice of removal to— Children Adopted Died Children reaching age of 9 No. as at Dec. 31st 1942 Parent Another area with Foster Parent Another Foster Mother Public Institution 137 162 103 11 13 14 11 1 4 142 The number of foster-children showed an increase of 5 during the year. FOSTER MOTHERS. No. as at December 31st 1941 Applications for Authorisation during the year. Removals during the year Authorisation cancelled for other reasons No. as at December 31st 1942 With Child Without child 125 73 3 5 39 151 The number of foster-mothers increased by 26 during the year. The Health Visitors paid 1,223 visits to foster-mothers for the purpose of supervision. THE OBSTETRIC SERVICE. The Obstetric Service has been described in my Report for 1938. The following are the statistics for 1942. Taking the Registrar-General's figures for maternal mortality (deaths directly due to pregnancy, but excluding abortion) the rate for England and Wales for 1942 was 2.01 per 1,000 births. In Croydon the rate was 3.35. In "booked" cases treated by the Obstetric Service the rate for 1942 was 1.32 per l,000 Hospital deliveries; 1.73 per 1,000 home deliveries, and 1.47 per 1,000 over all deliveries. Of the cases treated to a conclusion at the Post-Natal Clinic during 1942, 80.8 per cent. were classified at "Health Unimpaired." This signifies that anatomically and functionally their condition was the same as before their pregnancies. The corresponding figure for 1941 was 92.7. The number of cases delivered of viable babies in Mayday Hospital, with a nominal 48 beds, was 999. The number delivered at St. Mary's Maternity Hospital, with 30 beds, was 561. 80 General Statistics, 1942. No. of live births allocated to the Borough of Croydon 3,471 ,, still „ ,, ,, „ 108 No. of maternal deaths (directly due to pregnancy) 8 No. of cases of notified Puerperal Pyrexia 54 No. of expectant mothers who attended the Borough Ante- Natal Clinics 3,722 No. of cases delivered in Mayday Hospital as Booked cases 948 No. of cases delivered in Mayday Hospital as Emergency cases 232 Total cases delivered in Mayday Hospital 1,180 No. of cases delivered in St. Mary's Maternity Hospital as Booked cases 501 No. of cases delivered in St. Mary's Maternity Hospital as Emergency cases — Total cases delivered in St. Mary's Maternity Hospital 501 No. of cases delivered by Municipal midwives 1,153 Total 2,894 No. of cases admitted to the Puerperal Infection Unit, Borough Hospital and Mayday Hospital Isolation Wards, including 48 from Mayday Hospital and 0 from St. Mary's Maternity Hospital 72 No. of Maternal deaths in Booked cases from Borough Ante-Natal Clinics 4 No. of Maternal deaths in Emergency cases at Mayday Hospital 1* No. of Maternal deaths in cases admitted as Puerperal Sepsis per se 0 Total Maternal deaths in beds of the Obstetric Service 5* (*Exclusive of Abortion) The total number of patients treated by the Obstetric Service was:— (a) In Mayday Hospital 1,718 (b) In St. Mary's Maternity Hospital 561 (c) In the Borough Hospital Puerperal Infection Unit and Mayday Hospital Isolation Wards, excluding 28 from (a) and 6 from (b) 18 (d) At the Ante Natal Clinics and delivered outside the above Hospitals (including Municipal Midwives' cases) 1,336 (e) At the Post-Natal Clinics, excluding those included in (a), (6), (c) and (d) 507 (/) At ti*e Ante-Natal Clinics and undelivered on December 31st, 1942 778 4,918 81 ANTE-NATAL SUPERVISION. l940. 1941. 1942. No. of Sessions at Ante-Natal Clinics held 411 471 572 No. of individuals who attended 3,257 3,402 4,305 No. of previous year's cases continuing attendance 574 574 620 No. of new cases 2,642 2,828 3,685 No. of cases undelivered on 31st December 574 620 1,260 Total attendances made 15,249 16,169 21,540 Average attendances per session 37 34 38 No. of cases delivered in hospital as Booked cases 1,277 1,199 1,509 No. of cases delivered by Municipal Midwives. 939 730 1,153 No. of cases delivered at other places under the care of private doctors or midwives 200 171 183 No. of patients found not to be pregnant 19 18 24 No. of patients referred to hospital for Ante- Natal treatment 509 480 462 The conditions for which these were admitted can be ascertained by reference to the "Booked" columns of the Numerical Summary of Cases. 7 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 1942 the Obstetric Service dealt with 2,744 out of the total births allocated to the Borough. Major Ante-Natal Conditions treated at the Ante-Natal Clinic. BREECH PRESENTATION. Breech presentation diagnosed 209 Spontaneous version 10 External version successful 131 External version not successful 68 Allowed to go to term as Breech 68 Not recognised as Breech before labour 4 DENTAL TREATMENT. No. of cases referred to Borough Dental Surgeons 872 No. of cases referred to Private Dental Surgeons 83 No. of cases refusing dental treatment 52 No. of cases seen too late for necessary dental treatment 48 TUBERCULOSIS. Referred from Tuberculosis Officer because of pregnancy 7 Referred to Tuberculosis Officer for opinion on lung condition 8 VENEREAL DISEASE. Gonorrhoea Total cases 5 Transferred to Borough V.D. Clinic 5 Syphilis Total cases 9 Transferred to Borough V.D. Clinic 9 82 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 1942 183 Number of cases sent for one consultation only 79 Number of cases supervised entirely 104 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 128 Blood for Kahn Reaction 102 Blood for Gonococcus Fixation Test 102 Blood for Grouping 138 Blood for Culture 9 Blood for Urea Content 28 Blood for Widals, etc. 2 Blood for Cell Count, etc. 94 Catheter Urine for Routine Examination 485 Urine for Aschheim-Zondek Test 57 Urine for Urea Concentration Test 135 Lochia for Culture 53 Sputum for Examination 7 Pus for Identification of Organism 15 Urethral Smears for Gonococci, etc. 25 Cervical Smears for Gonococci, etc. 52 Conjunctival Smears 47 Histological Sections 323 Van den Burgh 3 Throat Swabs for Organisms 169 Faeces for Occult Blood, etc. 1 Blood for Icterus Index 2 Blood for Hb Estimation 673 Various 6 X-Ray Examinations (Mayday Hospital X-Ray Department). 238 cases were referred from Ante-Natal Clinics. Reasons for reference were:— Breech for Attitude, etc. 52 For Presentation, Attitude, etc. 70 T wins 57 Foetal Death 8 Foetal Parts 16 Disproportion 12 Foetal Abnormalities 12 Abnormal Presentations 11 83 51 cases were referred from the Maternity and Gynecological Wards at Mayday and St. Mary's Hospitals. Reasons for reference were:— For Presentation 15 Twins and Triplets 8 For Foetal Death 7 For Foetal Parts 6 Breech— Extended Legs 3 Disproportion 9 Hydrocephalus 1 Anencephaly 1 Dermoid Cyst 1 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 937 561 1,498 (2) Delivered in hospital before 28th week 9 — 9 (3) Admitted after delivery 23 — 23 (4) Discharged undelivered after ante-natal treatment and not subsequently delivered in hospital - - - (5) Died undelivered — — — (6) Ectopic Pregnancy — — — 969 561 1,530 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 (1) Before Labour : Hospital. (a) Discharged undelivered 42 (b) Delivered in hospital after 28th week 62 (c) Delivered in hospital before 28th week 43 (d) Died undelivered — (2) After Delivery 13 (3) Ectopic Pregnancy 5 165 84 A Numerical Summary of cases admitted for treatment, delivered in Hospital, or admitted after delivery. Some cases appear in more than one category in the summary. Mayday Hospital Booked. Mayday Hospital Emergency St. Mary's Maternity Hospital Booked. Total. 1. Conditions chiefly Ante Natal. Albuminuria 121 14 61 196 Eclampsia 3 — 1 4 Persistent vomiting of pregnancy 4 7 — 11 Chronic cervitis 3 — 3 Acute pyelitis 16 11 8 35 Malnutrition, debility, simple anaemia,etc. 25 — 12 37 Breech presentation for version — — — — Retroverted gravid uterus 1 - — 1 2. Intercurrent Diseases. Chronic nephritis 2 — — 2 Pulmonary Tuberculosis 7 — — 7 Venereal disease 14 — — 14 Cardiac disease 26 — 3 29 Exophthalmic goitre 1 — — 1 3. Conditions chiefly Natal. Presentations at Delivery:- Anterior positions of the vertex 857 53 503 1413 Posterior positions of the vertex 18 2 34 54 Breech 53 7 19 79 Shoulder — — 2 2 Face and brow 6 1 1 8 Complex 1 — 1 2 Caesarean section 36 6 1 43 Twins and Triplets 18 1 5 24 Accidental haemorrhage 8 3 4 15 Placenta praevia 14 7 — 21 Hydramnios 10 — 8 18 Prolapse of cord 4 — — 4 Retained placenta 10 4 9 23 Post-Partum haemorrhage 39 24 25 88 B.B.A. 23 13 — 36 Lacerated perineum 428 30 254 712 Obstructed labour 2 — 2 4 Premature labour 121 24 36 181 Abortion 9 138 — 147 Ectopic pregnancy — 5 — 5 Abdominal Hysterotomy 3 — — 3 Forceps delivery 57 3 47 107 4. Conditions chiefly Post Natal, excluding re-admissions from Post Natal Clinic. Breast abscess 12 — — 12 Notified pyrexia or fever 35 13 6 54 In addition 18 cases of Puerperal Pyrexia per se were admitted to the Puerperal Infection Unit of the Borough Hospital. 35 Blood Transfusion (55 Obstetrical and 21 Gynaecological cases). For ever)' case, stored blood from the Blood Transfusion School, Sutton, was used. One Domiciliary Obstetrical case died. Infants. Mayday Hospital Booked. Mayday Hospital Emergency' St. Mary's Maternity Hospital Booked. Total Per Cent. No. of infants in Hospital on 1st Jan., 1942 41 - 27 68 - Total No. of live births, still births and infants admitted with Mother (B.B.A.) 975 76 566 1617 - No. of infants in Hospital on 31st Dec., 1942 44 5 17 66 — Alive on discharge from Hospital 912 54 541 1507 93.0 Stillborn 35 12 17 67 4.2 Died (born alive, but died in Hospital) 28 10 8 46 2.8 Infant Feeding and Weight on Discharge from Hospital. In both hospitals normal infants were breast-fed every four hours omitting the early morning feed. Of 954 infants discharged from Mayday Hospital, 624 were up to or over birth weight (65 per cent.) Of 541 infants discharged from St. Mary's Maternity Hospital, 427 were up to or over birth weight (79 per cent.) Twins and Triplets. There were 23 cases of Twins and one of Triplets. There was no maternal death. Mayday Hospital. Booked. Mayday Hospital. Emergency St. Mary's Maternity Hospital. Booked. Total. No. of cases 17 2 5 24 No. of infants discharged alive 28 3 10 41 No. of still-births and infant deaths 6 2 0 8 Foetal and Infant Mortality 17.6% 40% 0 16% 96 POST NATAL AND GYNAECOLOGICAL CLINIC. Number of Sessions held 156 ,, Individuals presented 1,854 ,, Subsequent attendances 1,044 Total attendances 2,568 Average attendance per session 16 Number of Post-Natal cases 1,292 Number of Gynecological cases 562 END RESULTS. 909 cases were treated to their termination (other than death) during the year, and the results were classed as follows:— Mayday. St. Mary's Total. % Health unimpaired 470 313 783 86.1 Health slightly impaired 80 42 122 13.4 Health seriously impaired 2 2 4 0.5 Totals, treated to conclusion 552 357 909 Maternal Mortality (Obstetric Service). Five deaths occurred of mothers dealt with by the Service, four in "Booked" cases, and one in "Emergency" cases. The maternal mortality of "Booked" cases, i.e., cases under the continued supervision of the Service, is 1.32 per 1,000 hospital deliveries, and 1.47 per 1,000 total deliveries, including the Municipal Midwives "Booked" cases. Puerperal Infection, Seventy-two cases were treated in isolation for puerperal infection, 30 of them in the Borough Hospital and 42 in Mayday Hospital. There were no deaths. Sources of the Cases. Cases. Deaths. From Mayday Hospital:— "Booked" Cases 35 - "Emergency" Cases 13 - From St. Mary's Maternity Hospital 6 - From other Hospitals - - From private doctors, deliveries in Nursing Homes 6 - From private doctors, deliveries at home 12 - 87 The Assistant Medical Officer of Health for Obstetrics was called in by medical practitioners to see 59 obstetrical and 120 gynaecological patients who could not afford to pay a private consultant. In addition, he was asked by the Medical Superintendent of Mavday Hospital to give an opinion on the obstetric and gynæcological aspects of 50 cases in the medical and surgical wards of the Hospital. MENTAL DEFICIENCY. Number of known Mentally Defective Patients in the Borough :— 1.—Statutory Cases. Aged 0—5 years 19 Aged 5—16 years 140 Over 16 years 390 Total 549 2.—Education Cases. Aged 7—16 years 75 Combined Total 624 Compared with 1941, the Statutory cases show an increase of 19 and the Educational cases a decrea.se of 45. Three of the cases under Statutory supervision have died. Two died in an institution, 1 under supervision. The Statutory cases are distributed as follows:— In Certified Institutions 219 In Approved Homes 3 On leave from Institutions 7 Under Statutory supervision at home 217 Under Guardianship 66 In Mental Hospitals 10 Observation Cases 27 549 88 The Education cases were distributed as follows:— In Certified Residential Schools 6 In Certified Day Schools 69 In Private Schools — Awaiting vacancies at St. Christopher's — 75 During the year the Certifying Medical Officers made examinations and paid visits to the number of 102 to Statutory cases. The Mental Deficiency Visitors paid 1,832 visits to Statutory cases and 946 to Education cases, 2,778 visits in all, an increase of 100 on 1941 figures. During 1942, twenty-eight Statutory cases were dealt with as follows:— Sent to Certified Institutions 7 Placed under Guardianship 2 Sent to Croydon Mental Hospital — Varying Orders: (a) Change of Guardian 6 (b) From one Institution to another 7 (c) From Guardianship to Institution.. 3 (d) Orders closed 3 Fifty-four Orders were renewed during the year, 14 of which were Guardianship. Guardianship Cases. There are 66 cases under Statutory Guardianship, 44 of these under the care of relatives, and 10 with Guardians who are not relatives. 9 males and 3 females are at work. 420 visits have been paid to Guardianship cases during the year. There are 7 cases on leave from Institutions (2 boys and 5 girls). 89 Clinic for Mentally Defective, Backward and Abnormal Children. 57 children were examined during 1942. The classifications arrived at, together with recommendations made, are summarised under:— (1) Certified as Mentally Defective: Recommendations. (a) Recommended for Special Day School 14 (b) Referred to Occupation Centre or Institution 13 —27 (2) Found to be dull and backward: (a) Referred to a special class 16 (b) Further trial in ordinary class 10 (c) To attend St. Giles because of physical defect 2 —28 (3) Referred to Child Guidance Clinic 2 - 2 57 ORTHOPAEDIC DEPARTMENT. The arrangements are the same as in 1941. Summary of Cases Attending the Orthopædic Clinic. Jan. 1st, 1942. New Cases, 1942. Cases Discharged, 1942. Cases on books, Dec. 31st, 1942. M.C.W. S.M.S. T uberc. M.C.W. S.M.S. T uberc. M.C.W. S.M.S. T uberc. M.C.W. S.M.S. T uberc 132 164 73 119 158 22 94 158 14 157 164 81 369† 299 266 402 † 106 Evacuated. 90 Cases Seen by the Orthopædic Surgeon. Defects. School. M.C.W. Tuberculosis. Total. Cases. Attendances. Cases. Attendances. Cases. Attendances. Cases. Attendances. Infantile Paralysis 18 47 3 9 — - 21 56 Curvature or Postural Defects 34 78 — — — — 34 78 Pes Cavus 5 8 — — — — 5 8 Pes Planus 102 286 27 74 — — 129 360 Genu Valgum 28 48 79 219 — — 107 267 Talipes 23 47 18 47 — — 41 94 Obstetrical Paralysis 3 4 3 10 — — 6 14 Joint Diseases 14 34 2 3 48A 124 A 75 183 10s 21s 1M 1M Injuries 3 7 4 10 — — 7 17 Rickets 1 1 7 13 — — 8 14 Wry Neck 6 7 1 1 — — 7 8 Spastic Paraplegia 17 24 7 14 — — 24 38 Congenital dislocation of the Hip 4 9 6 20 — — 10 29 Other deformities 54 83 46 71 — — 100 154 312 683 203 491 59 146 574 1320 Summarised, the Table shows 312 school children attended and made 683 attendances. 203 babies made 491 attendances, and 59 Tuberculosis cases made 146 attendances; a total of 574 cases, making 1,320 attendances. 91 The following Table shows the number of cases referred direct from the Orthopaedic Clinic for Massage, Swedish Remedial and Electrical Treatment, and also X-Ray examinations at the Croydon General Hospital:— Defects. School Cases. M.C.W. Cases. Tuberculosis Cases. Total. Cases No. of Treatments X- Rays Cases No. of Treatments X- Rays Cases No. of Treatments X- Rays Cases No. of Treatments X- Rays Infantile Paralysis 4 21 2 - - - - - - 4 21 2 Curvature or postural 18 236 2 - - - - - - 18 236 2 Pes cavus 1 7 - - - - - - - 1 7 — Pes planus 5 46 - - - - - - - 5 46 — Genu Valgum 1 — 1 - - - - - - 1 — 1 Talipes 2 32 — 3 37 — — — — 5 69 — Bone and Joint Disease 9 7 8 2 — 2 38 66 47 49 73 57 Injuries 1 — 1 1 — 1 — — - 2 — 2 Rickets - - - - - - - - - - - - Wry Neck - - - - - - - - - - - - Spastic Paraplegia 1 8 - - - - - - - 1 8 — Congenital Dislocation of the Hip. 3 — 3 4 7 9 — — — 7 7 12 Other Deformities 7 — 7 5 1 4 — - - 12 1 11 52 357 24 15 45 16 38 66 47 105 468 87 92 Cases sent to Residential Institutions. Name of Institution. School Cases. M.&C.W. Cases Tuberculosis Cases. Total. No. in on 1st Jan., 1942 Admitted Discharged. No. in on 1st Jan., 1942 Admitted. Discharged. No. in on 1st Jan.. 1942 Admitted. Discharged. No. in on 1st Jan. 1942 Admitted. 1 Discharged. No. in on 1st Jan., 1943 Pyrford 1 — 1 — — — 5s 1s 5s 9 1 7 3 3a - 1a Croydon Gen. Hosp. — 6 6 — 3 2 — - — — 9 8 1 Heritage Craft Schls. 1 - — — — — 1s — — 2 1 — 3 lm — Pinner — — — 1 — 1 - — — 1 — 1 — Lord Mayor Treloar Hosp. - - - - - - lm - - 1 - - 1 Royal Sea-bathing Hosp. - - - - - - 3a - la 3 - 1 2 Birchington - - - - - - - - - - - - - Queen Mary's Hosp. 1 — 1 — — — 2s — 1s 3 — 2 1 Royal Nat. Orth. Hosp - - - - - - - 3a 2a — 3 2 1 Mayday Hosp. - 3 3 - 4 4 — 1m 1m 3 18 20 1 3a 10a 12a 3 9 11 1 7 7 18 16 23 22 32 41 13 Conditions for which Patients were admitted to Hospitals with the Results of Treatment. Condition. In on 1st Jan. 1942 Admitted or transferred. Discharged. I.S.Q. Died. In on 1st Jan. 1943 Arrested. Quiescent. Improved. Infantile Paralysis - - - - - - - - Tubercular Joint Disease 18 16 5 4 5 6 3 11 Congenital Hip Disease 1 2 — — 3 — — — Hemiplgftia — 1 - — 1 — — — Genu Valgum — 1 — — 1 — — — Pes Planus — 2 — — 2 — — — Talipes 1 6 — — 6 — — 1 Rickets - 1 — — 1 — — — Other Deformities — 2 — — 1 1 — — Spastic Paraplegia - — — — - — — — Scoliosis — — — — — — — — Osteomyelitis 2 1 — 2 — — — 1 22 32 5 6 20 7 3 13 The percentage of arrested cases was 12 per cent.; quiescent cases 14.6 per cent.; and 48.8 per cent, were " improved." 93 94 M. = Males. F. Females. T. = Total. WELFARE OF THE BLINDS-REGISTRATION. As at 31/3/43. TADLIE 1. Age period 0-1 Age period 1—5 Age period 5—16 Age period 16—21 Age period 21—40 Age period 40—50 Age period 50—65 Age period 65—70 Age period 70 and over (i) Total of all age groups (ii) Age unknown M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M F. T. M. F. T. - - — — — — 6 2 8 2 2 4 30 29 59 23 15 38 62 62 124 23 24 57 47 91 138 (1)193 (i)235 (i)428 (ii)- (ii)1 (ii)1 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 and over Age period Unknown M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 28 21 49 2 6 8 9 9 18 15 9 24 15 11 26 25 18 43 29 25 54 21 41 62 19 36 55 16 39 55 14 21 35 Children of School Age. Training and Employment. Normal Mentally Defective Physically Defective Employed Undergoing Training. M. F. M. F. M. F. By Blind Organisations (c) (d) (e) (f) (g) (h) (i) (j) (k) In Schools for the Blind 6 1 — — — — All others not included in (a) and (b) Total Employed Industrial Secondary Professional and University Trained but unemployed No training but trainable Unemployable Total (a) (b) Other Schools - — — — — - Workshops Home 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. M. F. T. M. F. T. M. F. T. Not at School - — — 1 — — 8 2 10 27 11 38 19 7 26 54 20 74 2 1 3 - - - - - - - - - - - - 131 213 344 187 234 421 OCCUPATIONS OF EMPLOYED BLIND PERSONS. Agen te, Collectors, &c. Basket Workers Bedding (including Divans & Ottomans) and Upholstering Boot Repairers Braille Copyists and. Proof Readers Brush Makers Carpenters and Woodworkers Chairseaters Clerks and Typiste Coal Bag Makers Dealers, Tea Agents, Newsagents, Shopkeepers Firewood Workers Gardeners Hawkers. Newsvendors, &c. Home Teachers Knitters Labourers Massage Mat Makers Ministers of Religion Musicians and Mueic Teachers Netting Makers Porters, Packers, Cleaners Poultry Farmers School Teachers Ships Fender (Fendoff) Makers Telephone Operators Timers Weavers Miscellaneous Total Mattress Makers Machinists Upholsterers Hand Machine Within Institution for the Blind - 2 1 - - - - - - - l - - - - - 1 - 1 - - - - 1 - - - 3 - - - - - 10 In approved Home Workers Schemes - 6 - - - 2 - - - 3 - - - 1 - - - - 10 - - 2 - - - - - - - - 14 - - 38 Others not parttime workers) - 1 - - - - - - - 1 2 — 4 — — 1 — — 1 — 2 2 2 2 -— 2 1 — — 2 — — 3 26 Total - 9 1 — — 2 - — — 4 3 — 4 1 — 1 1 — 12 — 2 4 2 3 - 2 1 3 - 2 14 3 74 (a) (b) (c) Combinations of (a) and (b) Combinations of (a) and (c) Combinations of (b) and (c) Combinations of (a), (b), (c) Total Homes for the Blind Mental Hospitals Poor Law Institutions Mentally Defective. Physically Defective. (i) Deaf (ii) Deaf-mute 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. 1 4 5 3 4 7 (i) 6 (i) 2 8 - 1 — 1 1 — — — — - — 11 11 22 — 1 1 1 3 4 4 13 17 (ii) 1 (ii)1 2 95 BLIND PERSONS ACT. 1920. Close co-operation has been maintained with the Croydon Voluntary Association for the Blind. The blind persons residing in Croydon are visited at regular intervals by the Health Visitors, and any circumstances in their reports justifying further investigation are followed up. I am indebted in the Secretary of the Voluntary Association for the figures below:— Number of Blind on Register 429 Number of Blind who benefit from instruction in Braille or .Moon type (including those who already read) 90 Number of HIincl who benefit from part-time instruction 48 Number in remunerative handicrafts— (a) Home worker 38 (b) In workshops 10 (c) St. Dunstan's 6 (d) Workers not included in scheme 20 Home Teacher 1 The Health Visitors paid 467 visits to blind persons during the year. The following Table shows:— (a) The number of blind persons registered. (b) The ages at which blindness occurred. (c) The method of training. (d) The occupations of employed blind persons. (e) The defective blind. (f) The unemployable blind persons in homes, mental hospitals or institutions. 96 SANITARY CIRCUMSTANCES. To the Medical Officer of Health. I beg to submit in accordance with the Sanitary Officers' Order, 1922, a report for the year ending 31st December, 1942, of the work carried out by the Sanitary Inspectors and other officers under my supervision. ROBERT J. JACKSON, Chief Sanitary Inspector. Summary of Inspections made by the Sanitary Inspectors and other Departmental Work. Total number of houses inspected for housing defects (under Public Health or Housing Acts) 2,043 Number of houses inspected under the Housing (Consolidated Regulations), 1925 — Number of houses inspected under the Rent Restriction Acts 35 Number of houses inspected where zymotic diseases have occurred 384 House drains tested with smoke (primary) 870 House drains tested with smoke (on application) 35 Number of smoke tests during repair 160 Inspection of drainage work during construction 5,435 Number of water tests during repair 350 Final tests of drains after repair 70 Final tests of drains when completely relaid 20 Length of new drains tested yards 1,510 Inspection of yards, stables and manure pits 1,301 , ,, passages 699 ,, public conveniences 720 ,, pigstyes 502 ,, tents, vans and similar structures 4 ,, theatres, cinemas, halls, etc. 120 ,, ponds and ditches and static water tanks 235 ,, schools and school lavatories 78 ,, common lodging-houses 31 ,, houses let in lodgings 3 ,, premises where offensive trades are conducted 24 ,, gipsy encampments, camps, fairs, etc. 55 ,, cesspools 4 ,, pail closets, privies 0 ,. gathering grounds 103 Food Control—Visits concerning price lists and orders 1.556 ,, Visits regarding complaints of shortages 111 ,, Visits regarding complaints of overcharging 108 ,, Miscellaneous visits and retail licence applications 3,081 A.R.P.—Inspections concerning measures for protection against gas contamination 1,157 ,, Miscellaneous inspections and reinspections after air raids 2,695 ,, Inspections of posts and centres 1,528 ,, . Inspections of damaged houses 759 ,, Inspections of damaged food shops 85 Smoke observations 119 Number of visits re Infectious Diseases 850 Inspections of Shops (under Shops Acts) 3,640 Special Early Closing Patrols 200 97 Sunday Patrols 2 Special Evening Patrols (under Shop Hours Act) 8 Inspections under Fertilisers and Feeding Stuffs Act ,, under Pharmacy and Poisons Act 672 ,, Dairies 207 ,, Farms and cowsheds 189 ,, Milkshops 150 „ Premises where food is prepared or sold 8,563 „ Slaughterhouses 110 „ Factories without mechanical power 470 ,, Factories with mechanical power 1,410 ,, Workplaces, Public Health Act 1,090 ,, Outworkers' premises 210 Visits re Young Persons Employment Act Water samples examined 58 Visits to Employers of Outworkers35 Reinspections of work in progress 21,722 Sundry inspections and visits 5,002 Appointments kept with owners, builders, etc 3>100 Complaints from public investigated (for purposes other than inspection of house) 7,560 Examination of building plans 70 Informal notices outstanding 31-12-41 446 Informal notices served 4,996 Informal notices complied 3,911 Number of Informal Notices referred for Statutory Orders 326 Informal notices outstanding 1,203 Statutory notices outstanding 31-12-41 119 Statutory notices served 650 Statutory notices complied 501 Total number of complaints received 2,920 Interviews with callers 3,014 Letters received 4,222 Letters and other intimations, etc., sent (not including notices) 2.031 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1942 and for which action was taken to enforce compliance:- (1) NUISANCES AND HOUSING DEFECTS AT HOUSES, etc. ACT. Insufficient means of ventilation: Defective windows and sashcords 140 Want of windows or ventilators 25 Conditions causing dampness: Defective roofs 292 Defective walls, etc. 122 Want of proper damp-proof course 12 Defective gutters and downspouts 161 Other structural defects: Defectiue plaster 246 Cleansing and limewashing required 146 Defective floors 105 Insufficient ventilation under floor 9 Defective brickwork, cills, lintels, etc. 53 Defective stoves and fireplaces 126 99 Defective drains, sanitary fittings, etc.: Defective sinks and waste pipes 90 Abolition of drinking water cisterns 5 Defective w.c.'s 350 Defective drainage 344 Stoppage in drains 130 Domestic nuisances: Want of cleanliness 16 Dirty w.c. pans 18 Other nuisances and infringements: Offensive accumulations 65 Insufficient accommodation for sub-tenants 5 Defective manure receptacles 2 Want of manure receptacles 1 Dirty or defective sanitary conveniences 12 Smoke nuisances 2 Sundry nuisances or defects 196 Limewashing of stables 6 Particulars not inserted in Rent Rook (Housing Act) 22 ,, ,, ,, (Rent Restriction Act) 14 (2) FACTORIES AND WORKPLACES. Want of cleanliness 23 Inadequate ventilation 6 Insufficient drainage of floors 1 Abstract not exhibited 7 Thermometers required 11 Unreasonable temperature 4 Sundry nuisances or defects 26 W.C.'s—Insufficient 10 ,, Unsuitable or defective 68 ,, Not separate for sexes 5 (3) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924. Food cupboards defective or required 5 Dustbins required 334 Verminous conditions 75 (4) INFRINGEMENTS OF FOOD AND DRUGS ACT, 1938, AND FOOD BYELAWS. Cleansing or repair of walls and ceilings 55 Cleansing or repair of floors, utensils, fixtures, etc. 21 Dirty or defective w.c. accommodation 28 Food storage accommodation required 5 Animals kept in food store 5 Refuse bins uncovered 4 Accumulation in food store and yards adjacent 51 Food in uncovered vehicles or baskets 1 Premises not suitable for storage or manufacture of food 5 Want of provision of towels 5 Provision of cloakroom accommodation 4 Want of intervening ventilated space to w.c. 1 Insufficient or defective sink accommodation and water supply 2 Drain inlet in food store 1 Ventilation required in food store 1 Household washing in food store 1 Swill bins defective 1 Food stored in intervening ventilated space of w.c. 1 99 (5) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING, ETC. Defective Yard Paving 48 (6) INFRINGEMENTS OF SHOPS ACT. Insufficient or defective w.c. accommodation 16 Reasonable temperature required 3 Provision of means of heating 4 Unsuitable or insufficient washing facilities 1 Insufficient accommodation for assistants' meals 5 Seating accommodation required for females 4 Infringement in hours of employment 1 (7) INFRINGEMENTS OF COMMON LODGING BYELAWS — (8) INFRINGEMENTS OF HOUSES LET IN LODGINGS BYELAWS. Defective windows and sashcords 3 Want of artificial lighting to common staircase 1 Cleansing required 5 Defective w.c. floors 2 Defective w.c. windows 3 (9) INSPECTION OF AMUSEMENT HOUSES. Defective sanitary fittings 7 W.C. defective and dirty 6 (10) KEEPING OF ANIMALS. Nuisances in connection with the keeping of pigs 22 Nuisances arising from the keeping of other animals 6 (11) INSPECTION OF WATERCOURSES, etc. Cleansing of watercourses and ponds 2 (12) INFRINGEMENTS OF PHARMACY AND POISONS, ETC., ACT. Article not labelled in accordance with the Act 10 (13) INFRINGMENTS OF RAT AND MICE DESTRUCTION ACT. Infestation of rats on premises where food is prepared or sold 24 Accumulations of refuse, etc., harbouring rats 23 Structural defects allowing ingress of rats into dwelling houses 88 Dilapidated sheds, etc., harbouring rats 34 Rats in business premises 14 Rats in piggeries 2 (14) INFRINGEMENTS OF OTHER BYELAWS. Noisv animals 3 (15) INFRINGEMENTS OF MILK AND DAIRIES REGULATIONS, Etc. Defective paving 1 100 Sanitary Certificates. During 1942 requests were made in connection with 3 houses. Rent Restriction Acts. A number of applications were received for certificates as to the condition of repair of the houses concerned. In 15 instances where the Acts applied certificates were granted. HOUSING. Individual Unfit Houses. In the Five-Year Plan it was estimated that some 150 individual unfit houses were subject to be dealt with in the Borough. A revised estimate now brings the total to 247. Up to the end of 1942, 216 houses have been approved for demolition and Demolition Orders had been made; 18") houses had been actually demolished, the tenants being re-housed when they desired, by the Council. 719 persons were displaced. Twenty-three houses have been demolished through informal action, 26 persons being displaced. In addition, 94 Closing Orders have been made and 91 parts of houses closed for human habitation, 236 persons being displaced. The following tables give particulars as to housing during 1942 under the headings prescribed by the Ministry of Health:— I.— Inspection of dwelling houses during the year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health and Housing Acts) 1,093 (h) Number of inspections made for the purpose 1,093 (2) (a) Number of dwelling houses included under the head (1) above, which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 — (f) Number of inspections made for the purpose — (4) Number of houses found to be in a state so dangerous and injurious to health as to be unfit for human habitation 2 (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 1,093 II. Remedy of defects throughout the vear without service of Formal Notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 473 101 III.—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 252 (2) Number of dwelling houses which were rendered fit after service of formal notices— (a) By owners 114 (b) By local authority in default of owners 16 B.—Proceedings under Public Health Acts:— (1) Number of dwelling houses. in respect of which notices were served requiring defects to be remedied 13 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 10 (b) By local authority in default of owners — C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which Demolition Orders were made 2 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 5 D.—Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — FACTORIES ACT, 1937. The new Factories Act came into force on July 1st, 1938. This caused considerable alterations of an additional character in regard to the work. The word "workshop" has now been left out, and all places where persons are employed are now factories. FACTORIES. Inspection. Premises. Number of Inspections. Written Notices. Prosecutions. Factories:— With Mechanical Power 1410 55 — Without Mechanical Power 470 30 — Other Premises under the Act 1090 13 — Total 2970 98 — 102 Defects Found. Particulars. Number of Defects. Referred to H.M. Inspector. Prosecutions. Found. Remedied. Want of Cleanliness 5 5 — — Ineffective Drainage of Floors 1 1 — — Sanitary Conveniences. Insufficient 8 8 — — Unsuitable or Defective 17 16 — — Not Separate for Sexes 10 10 — — Total 41 40 - — Factories. Mechanical 990 Non-Mechanical 497 Public Health Workplaces T97 Other Premises under the Act. Employers of Outworkers 40 Bakehouses. The control of Bakehouses is dealt with under the Factories Act, the Food and Drugs Act and Public Health Acts, Croydon Corporation Act, 1924, and Cleanliness of Food Byelaws. For details of Croydon Corporation Act, see under Food Inspection. Xo. of Bakehouses on Register, 31st December, 1942 83 Xo. of Bakehouses (underground) (included in above) 3 Visits made to Bakehouses during the year 202 Defects found 17 Notices issued and complied with 15 Home Work. Lists of home workers are sent in twice yearly, and last year contained the names of 154 workers residing within the Borough. 210 visits were paid to outworkers and 35 visits were paid to premises of employers of outworkers to examine lists and for other purposes. 103 Nature of Employment of Workers on the Register, 31st December, 1941 Nature of Work. Number Employed. Outwork in Infected Premises. Outwork in Unsatisfactory Premises. Remarks. Making, Cleaning, Altering and Repairing, Wearing Apparel 134 - - - Upholstery Work 6 — — — Lace Goods — — — — Other Classes of Work 4 — — — Total 144 — — — Registered and Licensed Premises in the Borough, 31st December, 1942. Slaughterhouses (not including Public) 1 Bakehouses 83 Houses Let in Lodgings 28 Dairies and Milkshops 207 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 Premises registered for Preparation or Sale of Ice Cream 316* (*Discontinued Sept., 1942) Inspection of Offices—Public Health Act. During 1942, 136 inspections of offices were carried out. This is a new branch of the work necessitated by the Public Health Act. A number of defects were found, including lack of sanitary accommodation for the sexes, cleansing of sanitary arrangements, redecorations required. 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. 104 The Shops (Sunday Trading Restriction) Act, 1930, 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, regulates the hours of employment of persons under the age of eighteen employed in certain occupations. 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. 1,070 inspections were made and a number of infringements were found as set out. COMMON LODGING HOUSES. 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 Pitlake, and contains 101 cubicle beds for nightly letting to lodgers. In addition, there are three cubicles allotted to members of the Municipal Lodging House staff, making a total of 104 cubicles on the premises. The charge per night to lodgers is 1s., the cost of a weekly ticket is 6s. for the seven nights. The number of men accommodated during the year was 22,877. The number of men lodgers exceeded 62 per night throughout the year. The receipts and expenditure for the last ten years are as follows: — Receipts. Expenditure. £ s. d. £ s. d. 1933 1,437 2 6 1,544 7 10 1934 1,469 16 1 1,695 8 9 1935 1,488 11 5 1,420 14 9 1936 1,446 0 2 1,381 19 2 1937 1,378 14 8 1,348 7 2 1938 1,253 2 0 1,580 6 5 1939 1,284 3 4 1,269 0 4 1940 1,178 11 10 1,059 10 0 1941 1,048 0 0 1,271 0 0 1942 1,033 0 0 1,321 0 0 105 HOUSES LET IN LODGINGS. There are 28 houses registered under the Byelaws. 3 visits were made for inspection purposes. 2 notices were served for various amendments. 2 notices were complied with. The following table gives the situation of these premises:— Road. Number of Houses Let in Lodgings. Forster Road 8 Wilford Road 16 Clyde Road 4 Notices were served for the conditions and ciefects found. OFFENSIVE TRADES. Byelaws relating to Offensive Trades were adopted during the latter part of the year 1925. 24 inspections were made of premises where such trades were carried on and notices issued requiring amendments in accordance with the Bvelaws. 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. Four samples were obtained and subjected to analysis, the results being as follows:— Number 1 contained 6 parts of Chlorine per 100,000 „ 9 „ 19 „ „ „ „ „ 3 „ 18 „ „ „ „ „ 4 „ 99 „ „ „ „ The 4 samples conformed to the standard of cleanliness scribed under the Rag Flock Regulations, 1912, made under the Rag Flock Act, 1911. The legal maximum of chlorine allowed is 30 parts per 100,000. 106 SMOKE OBSERVATIONS. During the year 119 observations were made of factory chimneys for the purpose of detecting offences under the Act. Notices were sent and amendments carried out to stop the nuisance. AMUSEMENT HOUSES. 120 visits were made to Theatres, Music Halls, Cinemas and premises where stage plays are given. Attention was given to the ventilation of the halls, sanitary conveniences, structure and cleanliness of the dressing rooms. A report is submitted to the Licencing Authorities annually. Notices were issued for the conditions and defects found. KEEPING OF ANIMALS. 512 inspections were made in connection with the keeping of animals. There were 64 premises, including institutions, where pigs were known to be kept in the Borough. 74 notices were served to abate nuisances arising from various causes in connection with the keeping of pigs, and 10 notices were served to abate nuisances in connection with the keeping of other animals. BYE-LAW NUISANCES FROM DOGS. In connection with the fouling of footpaths by dogs a number of warnings have been given. NOISY ANIMALS BYE-LAW. Action was taken in 3 instances and the nuisance was abated. SCHOOLS. 7'8 inspections of schools and school lavatories were made during 1942. The water supply in all cases is from the mains. INSPECTION OF WATERCOURSES, Etc. During the year 235 visits were made to ditches, watercourses, static tanks, etc., in order to see whether there were anv infringements of the several Acts, etc. 107 PHARMACY AND POISONS ACT, 1933. The Act consolidates the Poisons and Pharmacy Acts from the year 1852. The object is to regulate the sale of certain poisonous substances and the Act contains important provisions. During the year the number of applications granted for the entry of names on the List of Persons entitled to sell Poisons under Part II. of this Act was 14, and application was made and granted for entry into the list of names of 21 deputies. In addition, 216 applications were made for the retention of names on the list for a further period of twelve months. Ill infringements of the Act were found. FERTILISERS AND FEEDING STUFFS ACT, 1926. Inspection of premises where fertilisers and feeding stufi's were sold were 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 woman attendant deals with school children and women. The following articles were disinfected at the Disinfecting Station during the year:— By Steam 84,353 articles By Formalin Gas 2,474 ,, By Formalin Spray 5,978 ,, 92,805 „ In addition, 143 articles were destroyed on request. 108 Disinfection after infectious or contagious disease was carried out in : 1,713 rooms at 1,322 houses 59 hospital wards 79 hospital clinic and creche rooms 9 vehicles 1 hut 2,572 library artel 538 other books 9 police stations 9 gas masks. Disinfecting of bedding and other upholstered goods is carried out for traders, who deliver to and collect articles from the station. For this service a charge is made. During 1942, 9,767 such articles were disinfected, the receipts for this work amounting to £147 16s. 6d. DISINFESTATION. In addition to the above services disinfection has been carried out for various services, such as report centres, casualty services, engineers' centres, lire services, etc., as follows:— Blankets 4,944 Bolsters 3 Pillows 195 Quilts 4 Mattresses 556 Rugs 1 Cushions 13 Other articles 27 Beds 8 Bedding is treated by steam disinfection and delivered in a second van to the premises. A number of notifications were received from contractors who have been employed by the Estates Department, etc., to carry out cyanide disinfestation of houses. While the process was being carried out the premises were kept under observation by the Inspector. At the conclusion a certificate is issued by the firm stating that the premises were free from cyanide gas. DISINFESTATION OF HOUSES (OTHER THAN OF CONTENTS) FOR BED BUGS, Etc. Houses are disinfected by means of sulphur and spraying with various types of vermicides. Number of private houses disinfected by owner or tenants 86 109 CLEANSING OF VERMINOUS PERSONS, Etc. During the year 28 adults and 138 children were cleansed for verminous conditions, and 686 adults and 1,114 children for scabies. RATS AND MICE DESTRUCTION. Wherever rats are found advice is given to the persons concerned, and in the event of no action being taken by the occupier notices are served and followed up. The number of visits made during 1942 was 5,376. DECONTAMINATION OF CIVILIAN CLOTHING AFFECTED WITH WAR GASES. The Chief Sanitary Inspector is the appointed officer. Arrangements have been made with six large laundries. 47 laundry workers have been trained in decontamination measures. DECONTAMINATION OF FOODS AFFECTED WITH WAR GASES. The Chief Sanitary Inspector is the appointed officer. He is assisted by 13 Inspectors and 3 Assistants, who have been trained in decontamination measures. In addition, there are 49 trained Food Treatment Volunteers who assist the staff in the event of enemy gas attacks. Six depots have been established and equipped for the treatment of gas contaminated foodstuffs. FOOD SUPPLY. The supervision and inspection of the food supplies is carried out by 12 of the District Inspectors, who are qualified in food inspection. The Public Slaughterhouses are under the control of the Superintendent, who also acts under the supervision of the Chief Sanitary Inspector. During the year there were 266 animals slaughtered for human consumption. The following table shows the premises in the Borough at which foodstuffs are known to be sold, manufactured or stored:— General Shops 204 Grocers and Provision Shops 691 Greengrocers and Fruiterers 607 Confectioners, Bakers and Pie Makers 714 110 Ice-cream Shops 356* Hotel and Restaurant Kitchens and Dining Rooms 429 Butchers 255 Fishmongers (including Fried Fish Shops) 154 Other Food Premises * 131 Ham and Beef Shops 65 Sweet Manufacturers 9 3,615 (*Discontinued Sept., 1942) In addition to the premises in the above table, there are the following food premises, referred to in other paragraphs of this report—Slaughterhouses and Dairies, Cowsheds and Milkshops, on the registers. Further, there are a large number of stalls and barrows used for food purposes in different areas in the Borough and forming street markets. There are also barrows and other vehicles which are used by hawkers, etc., for the selling of foodstuffs, but it is difficult to estimate the actual number in use, as this varies daily. All these barrows and vehicles, wherever found, are inspected by the Food Inspectors. FOOD CONTROL ENFORCEMENT. The Ministry of Food 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 Fnforcement Officer. The above was discontinued owing to the shortage of Inspectorial Staff from the 31st March, 1942. During (he three months the Sanitary Inspectors have carried out the undermentioned visits:— Visits regarding the exhibition of price lists and to advise re Price Control Orders 1,520 Visits regarding complaints of shortages 111 Visits regarding complaints of overcharges, etc. 108 Miscellaneous Visits, including visits regarding applications for Retail Licences 3,081 4,820 A number of prosecutions were instituted by the Food Enforcement Sub-Committee. 111 PUBLIC SLAUGHTERHOUSES, PITLAKE, AND MEAT INSPECTION. These Slaughterhouses, although the buildings were not originally intended for such, comprise twelve slaughterhouses with lairage attached. In addition, a gut cleaning firm utilises one building on the premises. Of the twelve slaughterhouses, nine with lairage attached 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, and were closed down at the end of March, 1942, owing to centralisation of slaughtering. The following animals were slaughtered at the Public Slaughterhouses during 1942:— Pitlake. Cattle. Calves Sheep. Pigs. Total. 107 13 3 143 266 The whole of the meat and offal is examined before it leaves the premises. The following meat and offal from the Public Slaughterhouses was condemned and disposed of as salvage by the Ministry of Food during the year 1942:— Description. Causes. 2 beef forequarters Localised tuberculosis. 1 .. parts „ „ 1 ,, offal, complete Tuberculosis. 23 sets beef lungs Localised tuberculosis. 8 beef heads „ ,, 14 ,, beef various offals ,, „ 1 ,, head Actinomycosis. 1 ,, carcase and offal Putrefaction. 2 „ various parts Inflammatory, etc. 16 ,, various offals Inflammatory conditions, etc. 1 pig carcase and offal General tuberculosis. 2 ,, heads Localised tuberculosis. 1 ,, liver Cirrhosis. 1 ,, carcase and offal Moribund. Total weight: 1,977 lbs. PRIVATE SLAUGHTERHOUSES AND MEAT INSPECTION. Control bv the Ministry of Food and centralised slaughtering came into force early in 1940, with the result that private slaughterhouses were closed down. After the Public 112 houses were closed arrangements were made for one of the Private Slaughterhouses to deal with casualties and pigs which were allowed to be slaughtered by the Ministry of Food. These arose from cottagers' pigs, Pig Clubs, etc. During 1942 the following animals were slaughtered at this Private Slaughterhouse:— Goats. Pigs. Total. 68 181 249 Summary of Whole Carcases Condemned with the Reasons for such Condemnation. Class of Animal. Tuberculosis Mould. Unsound. Total Carcases. Cattle — — 1 1 Calves — — — — Sheep — 3 — 3 Pigs 1 — 1 2 Totals 1 3 2 6 Carcases Inspected and Condemned. Cattle. Calves. Sheep and Goats. Pigs. Number killed 107 13 71 324 Number inspected 107 13 71 324 AM Diseases Except Tuberculosis. Whole Carcases Condemned 1 — — 1 Carcases of which some part or organ was condemned 13 - - 5 Percentage of the number inspected affected with disease other than Tuberculosis 13.1 - - 1.8 Tuberculosis Only. Whole Carcases Condemned - - - 1 Carcases of which some part or organ was condemned 23 - - 3 Percentage of the number inspected affected with Tuberculosis 21.5 - — 1.2 113 General Food Inspection. The following table gives a summary of the inspections made during the year (not including visits made to slaughterhouses or dairies, cowsheds and milkshops):— Butchers 2,629 Confectioners' Premises 774 Fishmongers 242 Markets 1,150 Fried Fish Shops 241 Hawkers' Carts & Barrows 275 Grocers 2,479 Hotel and other Kitchens, etc. 781 Greengrocers 982 Poultry & Game Dealers. 102 Ice Cream Manufacturers and Vendors 165 Cooked & Prepared Meat Shops 295 General Shops 318 Bakers' Premises 396 Other premises 162 Total: 10,991. GOVERNMENT MEAT DEPOT. All meat supplied to the traders in Croydon passes through the above Depot. Examination is carried out by an Inspector, who is practically engaged full time on this part of the work. The following articles of food derived from all sources were found to be unfit for human consumption and disposed of during 1942:— 48 beef parts and trimmings Unsound 153 lbs. beef offals (various) ,, 7 lbs. veal parts „ 44 lbs. mutton parts ,, 3 mutton carcases „ 64 lbs. mutton offals (various) ,, 25 lbs. pigs' offals (various) ,, 12 lbs. pork parts ,, 5,703 lbs. haddock, cod, etc. ,, 1,882 lbs. rabbits ,, 6,299 tins, etc., peas, plums, pineapple, etc. ,, 1,324 tins sardines, herrings, etc. ,, 10,860 tins milk ,, 2,320 tins luncheon and sausage meat, etc. ,, 19,505 lbs. oats, potatoes, onions, etc. ,, 833 lbs. flour, cereals, etc. ,, 778 lbs. sausage, bacon, pics, etc. ,, 1,450 eggs 241 lbs. cheese ,, 494 lbs. biscuits ,, Total weight: 57,390¾ lbs. 114 General Summary of Meat and Other Articles Disposed of during the Year, 1942. Articles. Weight in lbs. Remarks. Diseased. Unsound. Total. Beef 530 1810½ 2340½ Including 1 carcase. Veal - 11 11 — Mutton 8 180 194 „ 3 carcases. Pork 149 148½ 297½ „ 2 „ Offal 1188½ 227½ 1416 ,, imported offal. Fish — 5703 5703 Mackerel, Cod, etc. Fruit and Vegetables — 19505¾ 19505¾ Oats, Onions, etc. Tinned Goods — 25451 25451 20,400 tins, 397 jars, etc. Sundries — 4443 4443 Rabbits, Biscuits, etc. 1881½ 5748¼ 59367¾ Disposal of Condemned Foodstuffs. (1) Government Slaughterhouse, Pitlake. Condemned foodstuff is dealt with by the Ministry of Food. 2) Government Meat Depot (3) General Food Inspection.—Articles of food which have been damaged through enemy air raids are dealt with through the Salvage Officer, Ministry of Food. Any other condemned foodstuffs which can be safely converted to any other purpose are dealt with by firms specialising in this work. MILK. Enquiries show that approximately 18,525 gallons of milk are sold daily in the Borough. Of this amount 96.2 per cent. is bottled, 3.8 per cent. is loose, which is sold wholesale. These figures are interesting in view of the fact that at one time the whole of the milk sold was distributed loose. 115 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, Dairymen and Purveyors of Milk. The following statement shows the number of Cowkeepers, Cowsheds, Dairies and Purveyors of Milk premises on the register:— Cowkeepers on register (1941) 6 ,, added to the register (1942) — ,, discontinued — Net 6 Cowsheds on register (1941) 6 ,, added to register (1942) — ,, discontinued — Net 6 Number of cows provided for 143 Average number of cows in sheds (1941) 130 Number of dairies and purveyors of milk on the register (1941) 234 Number of dairies and purveyors of milk added to register (1942) Number of dairies and purveyors of milk discontinued (1942) 17 Net 207 Grand total of Cowsheds, Dairies and Purveyors of Milk on register 31st December, 1942 213 During the year 552 inspections were made of dairies, cowsheds and milkshops. Milk (Special Designations) Order, 1936. The following licences were granted during the year under this Order:— (1) Producers' Licences to use the designation "Accredited" 3 116 (2) Dealers' Licences to use the designation "Tuberculin Tested"— (a) Bottling establishments — (b) Shops 11 (3) Dealers' Licences to use the designation "Accredited"— (a) Bottling establishments — (b) vShops — (4) Dealers' Licences to use the designation "Pasteurised"— (a) Pasteurising establishments 2 (b) Shops 30 (5) Dealers' Supplementary Licences to use the designation— (a) Tuberculin-Tested 2 (b) Accredited — (c) Pasteurised 2 Inspection of these licenced premises has been carried out regularly during the year to see that the conditions of the licences were observed. During the year the following samples were examined under the Milk (Special Designations) Order, 1936:— Tuberculin-Tested Milk— Licenced country producers supplying milk to licenced local dairymen 1 Accredited Milk— Licenced local producers supplying milk to a licenced dairyman 62 Pasteurised Milk— Samples from licenced dealers 186 The following tables summarise the result of the bacteriological examinations of Accredited and Pasteurised samples during the year:— 117 Accredited Milk. Licences granted under the Milk (special Designations) Order 1936. Present. Absent. Present in 1/100 M.l. Absent. Present. Absent. Present. Absent. Exceeding a trace. 1 Not exceeding a trace. Satisfied. Not satisfied. Tubercle bacillus — 62 — 47 — — — — — — — — Bacillus Coli — — 15 — — — — — — — — — Blood — — — — — 62 — — — — — — Pus — — — — — — — 62 — — — — Detritus — — — — — — — — — 62 — — Methylene Blue Test — — — — — — — — — — 32 30 Totals — 62 15 47 — 62 — 62 — 62 32 30 The following tables summarise the result of the bacteriological examinations of Pasteurised Milk Samples during the year:— Pasteurised Milk. Licences granted under the milk (Specialised Designations) Order, 1936. Present. Absent. Over 100,000 per M.l. Under 100,000 per M.l. Present. Absent. Present. Absent. Present. Absent. Tubercle bacillus — 186 — — — — — — — — Total number of bacteria. — — 57 129 — — — — — — Blood — — — — — 186 — — — — Pus — — — — — — — 186 — — Detritus — — — — — — — — — 186 Totals — 186 57 129 — 186 — 186 — 186 118 These 1'86 Pasteurised .Milk samples contain bacteria per M.l as follows:— Under 1,000 5 1,000—5,000 13 5,000—10,000 21 10,000—20,000 23 20,000—30,000 18 30,000—50,000 19 50,000—100,000 22 Over 100,000 65 186 Under the Regulations, Pasteurised Milk must not contain more than 100,000 bacteria per millilitre. PROVISION AS TO MILK SUPPLY. During the year 103 samples of ordinary milk were procured and submitted to examination for tuberculosis in accordance with the Milk and Dairies (Consolidation) Act, 1915. These samples were taken as follows:— Samples taken at cowsheds in the Borough 16 Samples in course of delivery from country cowsheds to local dairymen and purveyors of milk in the Borough 8 Samples taken at dairymen's premises in the Borough 16 Samples taken in course of delivery by local dairymen or milk sellers on their rounds in different parts of the Borough 63 103 119 The following table summarises the results of the bacteriological examination of Ordinary Milk samples, taken under the Milk and Dairies (Consolidation) Act, 1015, from 1st January— 31st December, 1942: — Ordinary Milk. Present. Absent. Over 100,000 per M.l. Under 100,000 per M.l. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Satisfied. Not satisfied. Tubercle bacillus — 103 — — — — — — — — — — Total number of bacteria. — — 43 60 — — — — — — — — Blood — — — — — 103 — — — — — — Pus — — — — — — — 103 — — — — Detritus — — — — — — — — — 103 — — Methylene Blue Test — — — — — — — — — — 81 22 Totals — 103 43 60 — 103 — 103 — 103 81 22 The 103 samples taken under the Milk and Dairies (Consolidation) Act, 1915, were samples of milk which had been produced in (he following areas: — Areas. No. obtained. No. Tuberculosis. Croydon 13 — Kent 2 — Surrey — — Sussex 5 — * Unclassified 83 — Totals 103 — * These samples could not be classified owing to the fact that it was mixed milk of large dairy firms or wholesale purveyors of milk, who obtain their milk from practically all the areas mentioned in the above table. BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM. There were no samples taken during 1942. 120 FOOD AND DRUGS ACT, 1938. During the year 253 samples of Milk and 520 other samples were taken, Summary of Samples. During 1942 samples were obtained and submitted to the Public Analyst as follows:— Samples of Total Samples. Genuine. Not Genuine. Prosecutions. Conviction ; Cautions. Milk 253 240 13 — — 10 Ale 2 2 — — — — Arrowroot 2 2 — — — — Aspirin Tablets 6 6 — — — — Bacon 1 1 — — — — Baking Powder 9 8 1 — — 1 Beans in Tomato Sauce 2 2 — — — — Beer 3 3 — — — — Bicarbonate of Soda 4 3 1 — — — Black Pudding 3 3 — — — — Blancmange Powder 2 2 — — — — Blancmange Pudding 1 1 — — — — Boric Acid Ointment 2 2 — — — — Brawn 8 4 4 — — — Bread 5 5 — — — — Breakfast Sausage 2 2 — — — — Bun Flour 3 3 — — — — Bun and Cake Flour 1 1 — — — — Butter 2 2 — — — — Cake Flour 2 2 — — — — Cake Flour, sweetened 1 1 — — — — Cake Mixture 3 3 — — — — Cake Mixture, sweetened 3 3 — — — - Carrot Soup 1 1 — — — — Cheese 6 6 — — — — Chopped Carrots 1 1 — — — — Cocoa 13 13 — — — — Cod Liver Oil 2 2 — — — — Cod Liver Oil Emulsion, with hypophosphites of lime, potash and soda 1 1 — — — — Coffee 7 7 — — — — Coffee and Chicory 6 6 — — — — Coffee Essence 2 2 — — — — Coffee Essence with Chicory 1 1 — — — — Coffee with Chicory, sweetened 1 1 — — — — Coffee and Chicory Extract 1 1 — — — — Corn Flour 5 5 — — — — Compound Liquorice Powder 1 1 — — — — Compound Syrup of Figs 2 2 — — — — Compound Tincture Rhubarb 2 2 — — — — Confectionery 11 11 — — — — Confection of Senna 1 1 — — — — Cooking Fat 1 1 — — — — Cream Soda 1 1 — — — — Cream of Tartar 1 1 — — — — Custard Powder 15 14 1 — — 1 Carried forward 402 382 20 — — 12 121 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions ons Brought forward 402 382 20 — — 12 Custard Pudding Powder 1 — 1 — — — Curry Powder 1 1 — — — — Dessert Powder 1 1 — — — — Dry Ginger Ale 1 1 — — — — Egg Substitute 5 5 — — — — Egg Substitute Powder 4 4 — — — — Eggs, Dried 3 3 — — — — Essence of Almonds 2 2 — — — — Essence of Lemon 1 1 — — — — Essence of Vanilla 2 2 — — — — Faggot 1 1 — — — — Fish Cakes 2 2 — — — — Fish Cake Roll 2 2 — — — — Fish Paste 14 14 — — — — Fish Roe, prepared 1 1 — — — — Fish Roll 2 2 — — — — Fish Roll, spiced 1 1 — — — — Flour, Self Raising 10 10 — — — — Flour 2 2 — — — — Gin 4 4 — — — — Ginger Beer 3 3 — — — — Ginger Pudding Mixture 1 1 — — — — " Glusac " 1 — 1 1 1 — Golden Syrup 1 1 — — — — Grape Fruit 1 1 — — — — Grape Fruit Squash 1 1 — — — — Gravy Powder 1 1 — — — — Ground Cinnamon 3 3 — — — — Ground Ginger 8 8 — — — — Ground Nutmeg 2 2 — — — — Ground Rice 7 7 — — — — Ground Rice Pudding 1 1 — — — — Honey 3 3 — — — — Jam 8 7 1 — — — Junket, Powder, sweetened 1 1 — —— — — Lard 3 3 — — — — Lemexa 1 — 1 — — 1 Lemonade 9 9 — — — — Lemonade Powder 1 1 — — — — Lemon Cordial Flavour 2 2 — — — — Lemon Essence 1 1 — — — — Lemon Flavouring 2 2 — — — — Lemon Squash 2 2 — — — — Lemon Substitute Powder 1 1 — — — — Liver Sausage 1 1 — — — — Luncheon Meat 2 2 — — — — Luncheon Meat, Pork 2 2 — — — . — Luncheon Sausage 10 10 — — — — Margarine 3 — 3 — — — Malt Milk, Egg and Cocoa Mixture 1 1 — — — — Meat Paste 14 14 — — — — „ Pie 3 1 2 — — 2 „ Roll 3 3 — — — — Milk, Dried Machine Skimmed 2 2 — — — — Minced Beef 1 1 — — — — Mixed Pickles 2 2 — — — — Mixed Spice 8 7 1 — — 1 Mustard 4 1 3 — — — Mustard Mixture 6 6 — — — — Carried forward 588 555 33 1 1 16 122 Samples of Total Samples. Genuine Not Genuine Prosecutions Convictions Cautions Brought forward 588 555 33 1 1 16 Mustard Sauce 1 1 — — — — Oatmeal 2 2 — — — — Onion Juice 1 — 1 — — 1 Orange Barley Water 1 1 — — — — Orange Cordial 1 — 1 — — — Pearl Barley 4 4 — — — — Pepper, White 1 1 — — — —- Pepper 5 5 — — — — Pickles 9 9 — — — — Pies 1 1 — — — — Prepared Meal 2 2 — — — — Pork Pie 1 — 1 — — 1 Prunes 1 1 — — — — Rice 1 1 — — — — Rice Custard Pudding Powder 1 1 — — — — Rice Flakes 1 1 — — — — Rice Pudding Powder 3 2 1 — — 1 Ruby Fancy Tawny (non-alcoholic) wine 1 1 — — — — Rolled Oats 1 1 — — — — Rum-Ex 1 1 — — — — Sago 1 1 — — — — Sausages 29 27 2 — — 2 Sausage, Liver 2 2 — — — — Sausages, Preserved 6 5 1 — — — Sausage Meat 11 11 — — — — Sausage Meat Pie I 1 — — — — Sausage Meat Preserved 1 1 — — — — Semolina 2 2 — — — — Slippery Elm Food, Unmalted 1 1 — — — — Soup 14 14 — — — — Soup Powder 7 7 — — — — Spice, Mixed 1 1 — — — — Spice, Pickling 1 1 — — — — Sponge Mixture 7 7 — — — — Stewed Beef and Vegetables 1 1 — — — — Sugar 4 4 — — — — Sweet Ginger Wine Essence 1 1 — — — — Table Jelly 1 1 — — — — Tapioca 1 1 — — — —X Tea 4 4 — — — — Tincture of Iodine 2 2 — — — — Tinned Carrots 6 6 — — — — Tinned Beans 1 1 — — — — Tinned Beans in Gravy 1 1 — — — — Tinned Beans in Rich Tomato Sauce 2 2 — — — — Tinned Crayfish 1 1 — — — — Tinned Peas 6 6 — — — — Tinned Prepared Meal 2 2 — — — — Tinned Vegetables 1 1 — — — — Veal and Ham Pie 2 — 2 — — 2 Vinegar, Artificial 2 1 1 — — — Vinegar, Malt 11 11 — — — — Vinegar, Spirit 1 1 — — — — Vinegar, Wood 1 — 1 — — 1 Vinegar, Non-brewed 1 1 — — — — Whisky 4 4 — — — — Yorkshire Pudding, Pancake and Fritter Mixture 5 5 — — — — Yorkshire Pudding, etc., Mixture, — — — — — — including Egg 1 — 1 — — — Totals 773 728 45 1 1 25 123 Result of Analysis of New Milk Samples. SOLIDS NOT FAT (Legal standard is 8.5%)* 8.15 8.18 8.2 8.3 8.4 8.5* 8.6 8.7 8.8 8.9 9.0 9.9 1 1 1 3 5 9 35 84 72 40 4 1 MILK FAT (Legal standard is 3%) 3.02 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 4.1 4.2 1 2 8 21 34 35 45 36 28 21 11 6 2 4.3 4.4 4.55 4.6 5.6 2 1 1 1 1 Total samples of New Milk : 256. The samples of Milk for analysis were obtained as follows:— Country milk in course of delivery 8 On milk rounds 169 "Appeal to cow" samples - At Shops 67 Taken at Institutions 12 Taken at Farms — Other samples — 256 AVERAGE COMPOSITION OF NEW MILK SAMPLES. Solids not fat 8.74% Milk fat 3.63% Percentage of New Milk samples below legal standard 4.3. Adulterated Samples. The following is a detailed statement of the adulterated samples and the action taken:— Adulteration or No. Sample. Deficiency. Remarks. 923. Pork Brawn This contained boricacid. It was ascertained that the boric was introduced by means of bacon, in which preservative is now allowed. 124 No. Somple. Adulteration or Deficiency. Remarks. 1153. Glusac According to the analysis, 1 oz. of Glusac was equal in sweetening power to 2¾lbs. of sugar. The advertisement stated that loz was equal in sweetening power to 41bs. sugar. Proceedings were instituted in this case and a fine ol £5 was imposed on the Makers, with £6 costs and £2 costs awarded to the Vendors. 1033. Meat Pie Deficient in meat content, therefore misdescribed. Manufacturer warned. 1310. Meat Deficient in meat content, therefore misdescribed. The Manufacturers have agreed to describe their products as a sausage meat pie in future. 914. Milk Slightly deficient in milk solids. Vendor warned. Further samples taken found genuine. 1066. Milk Slightly deficient in milk solids. Vendor warned. Further samples taken found genuine. 1063. Milk Deficient in milk solids. Vendor warned. Further samples taken found genuine. 1268. Milk Deficient in milk solids. Vendor warned. Further samples taken found genuine. 1269. Milk Deficient in milk solids. Vendor warned. Further samples taken found genuine. 1322. Milk Deficient in milk solids. Vendor warned. Further samples taken found genuine. 1080. Orange Cordial Misdescribed as a fruit cordial. This matter was referred to the Legal Department and new labels were substituted. 1081. Pork Sausage Contained sulphur dioxide. Vendor warned. 1176. Pork Sausage Contained boric acid. Vendor warned to display proper preservative notice. 932. Pork Sausage (preserved). Contained boric acid. Vendor warned regarding declaration of preservative. 1278. Milk Slightlv deficient in milk solids. Vendors have been warned and further samples taken found genuine. 1335. "Lemexa"— the exact equivalent in taste flavour and food value of natural . lemon juice. Not the exact equivalent of natural lemon juice. This article appeared to be misdescribed and further samples were sought but no purchase was made. 125 No Sample. Adulteraltoii or Deficiency. Remarks. 1285. Bicarbonate of Soda. Phis article had disappearance of egg substitute powder. This was obviously wrongly labelled. Further samples taken were found to be genuine. 1392. Onion Juice Contained only a small percentage of onion juice. Further samples of this article were sought but not obtained. 1397. Brawn Contained boric acid. Boric acid was found to be permitted in one of the ingredients. 752. Pork Pie Misdescribed. This article should have been described as a pork sausage meat pie, and the makers have been asked to do so in future. 972 Brawn Contained boric acid or borates expressed as boric acid. This was introduced through American pork, which was an ingredient and in which boric acid is permitted. Vendor warned and further samples taken. 970. Custard Powder. Prepared from wheat flour and contained large numbers of living mites. Vendor warned and article at once withdrawn from sale. 775. Margarine Contained boric acid or borates expressed as boric acid. I would point out that the introduction of boric acid into margarine, although under licence from the Ministry of Food, appears to be an infringement of the Preservatives in Food Order, Part 2, Section (4), in which a chemical preservative is prohibited in butter, margarine, and the like. 780. Margarine 790. Margarine 796. Milk ¾ p.c. added water. 797. Milk 2 p.c. added water. Further samples taken in course of delivery found 1144. Milk 1 p.c. deficient in milk solids other than milk fat. 1111. Mixed Spice Contained 30 per cent, wheat flour. Manufacturers state that recipe is approved by the Ministry of Food and it is made under licence. Sugar was formerly used for binding purposes. 165. Mustard Deficient in volatile essential oil, only a trace being present. Vendors state that this is due to lack of brown mustard seed, owing to lack of importations, but that article consists of ground white mustard seed. So. Sample. Adulteration or Deficiency. Remarks. 265, Baking Powder. Deficient in available carbon dioxide. Vendor warned. 189. Brawn Contained boric acid. Introduced through an in gredient in which boric acid is permitted. 124. Custard Pudding Powder. Prepared from wheat flour and contained numbers of living mites. Article at once withdrawn from sale. 134. Jam Sample contained excessive sulphur dioxide. Introduced through fruit pulp to which it is added with the approval of the Ministry of Food. 148. Milk Presence of 2 p.c.—4 p.c. added water confilmed by freezing point determinations. Further samples taken, also taken in course of delivery from wholesaler and found to be genuine. 202. Milk 405. Milk 174. Mustard Deficient in volatile essential oil, only a trace being present. Vendors state that this is due to shortage of brown mustard, owing to lack of importations, but that article consists of ground white mustard seed. 175. Rice Pudding Powder. Sample contained 30 p.c. wheat flour. Made under licence and in accordance with a formula approved by the Ministry of Food. 79. Veal and Ham Pie. Misdescribed. Vendor warned and agreed to amend description. 178. Veal and Ham Pie Misdescribed. Vendor warned and agreed to amend description. 137. Vinegar. Artificial. Deficient in acetic acid. Vendor warned and subsequent samples proved genuine. 179. Vinegar, Wood. Deficient in acetic acid. Vendor warned and subsequent samples proved genuine. Yorkshire Pudding, etc. Mixture, including egg. Proportion of egg less than one-half that normally used. Article manufactured in accordance with a formula approved by Ministry of Food. Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. During the course of inspections of food shops particular attention is paid to the above Regulations regarding the marking of foodstuffs to which the Regulations apply. 126 CONTENTS. PUBLIC HEALTH REPORT. PAGE PAGE Acts, Adoptive 106 Illegitimacy 2, 3, 4 Ambulance Service 7 Immunisation Clinic 46 .Vmusement Houses 106 Infant Wellare Clinics 73, 77 Animals, Keeping of 99, 106 Infant Mortality 3, 68 Ante-natal Clinic 81 Infectious Diseases 34 Babies Help Committee 78 Laboratory Work 7, 14, 42, 45, 82 Bakehouses 102 Local Acts 106 Births 2, 4 Lodging Houses, Common 104 Blind Persons 95 Blood Transfusion 85 Marriages 3 Borough Hospital 36 Massage Clinic 13 Byelaws and Regulations 106 Maternity Homes 72 Maternity Homes, Registration 7'2 Cancer 53 Mayday Hospital 9, 79 Cerebro-Spinal Meningitis 41 Measles 40 Chicken Pox 37 Meat Inspection 111 Closet Accommodation 96 Medical Help Records 71 Contacts, Tuberculosis 61 Mental Deficiency 13,87 Committee 1 Midwives 72 Cowkeepers 115 Midwives, Municipal 71 Convalescence 78 Midwives Act 70, 72 Milk, Provision of 58, 118 Dairies. Cowsheds & Milkshops 115 Milk, Examination of 46, 116, 123 Deaths 2, 4, 5, 7 Milk, Tuberculous 116 Dental Treatment—M. & C.W. 73 Milkshops 115 Diphtheria 39 Mortality in Child-birth 2, 67, 79, 86 Disinfection 107 Mothers' and Infants' Welfare Disinfestation 108 Association 73 Dispensary, Tuberculosis 54 Mumps 42 Dvsentery 42 Municipal Lodging House 104 Encephalitis Lethargica . 42 Neo-natal Deaths 70 Enteric Group 40 Notification of Births Acts 66 Erysipelas 40 Nuisances 97 Expectant Mothers 81 Nursing Arrangements 7 Nursing Homes 72 Factories & Workshops Acts 98, 101 Fertilisers & Feeding Stuffs Act 107 Obstetrical Unit 79 Foods 109,123 Offensive Trades 105 Food and Drugs Acts 98, 120 Ophthalmia Neonatorum 41, 63 Foster-Mothers 78 Orthopaedic Department 89 Foster-Children 78 Out of Borough cases 42 Gynaecological Clinic 86 Poisons and Pharmacy Act 107 Poliomyelitis 42 Health Visitors, Work of 76 Poor Law Relief 33 Home Helps 78 Population 2 Home Nursing 61 Post-natal Clinic 86 Homework 102 Post mortems 14 Hospitals 78 Puerperal Sepsis and Pyrexia Hospital. St. Mary's (Maternity) 79 40,67, 86 Houses Let in Lodgings 105 Housing 100 Queen's Road Homes 33 Housing Act, 1930 100 PAGE PAGE Rag Flock Acts 105 Tuberculosis—Notifications 54 Rats and Mice (Destruction) ,, Home Nyrsing 61 Act 99, 109 ,, Home Visits 61 Rescue Home 78 ,, Statistics 62 Rent Restriction Acts 100 ,, Pregnancy 81 ,, Pneumothorax 63 Sanatorium, Cheam 63 . ,, Institutional Snatona, Ireatment in 59 Sanitary Administration 96 men 59 Sanitary Certificates 100 Unmarried Mothers 78 Sanitary Inspectors, Work of 96 Scarlet Fever 38 Vaccination 48 Schools 106 Venereal Diseases 49, 81 Shop Hours Acts 99, 103 Verminous Persons 109 Slaughterhouses 111 Vltal Statistics 2 Smoke Observations 106 Wartime Nurseries 72 Sputum, Examination 58 Ward Statistics 8 Still-births 267 Watercourses 106 St. Mary's Maternity Hospital 79 Water Supply 6 Suicide 6 Whooping Cough 41 Tuberculosis-Therapy 15 Workplaces 98 „ Cheam Sanatorium 63 Workshops 98 „ Contacts 61 X-Ray Examination 12, 58, 82 ,, Deaths 56, 57 ,, Dental Treatment 64 Zymotic Diseases 6 SCHOOL MEDICAL REPORT (See separate Report). PAGE PAGE Accommodation 4 Juvenile Employment 23 Adenoids " 12 Lungs, Diseases of 7 Blind Children 21 Malnutrition 9 Child Guidance 25 Massage Clinic 19 Cleansing of Children 11 Meals, Provision of 23 Clinics 11 Mentally Defective Children 23 Clothing and Footgear 9 Milk, etc., Provision of 4, 23 Cost 4 Minor Ailments 12 Crippling Defects 19 Nutrition 9 Deaf Children 21 Deaths 24 Orthopaedic Work 19 Defective Children 22 Orthodontic Service 17 Defective Hearing 22 Parents' Attendances 6 Deformities 19 Physically Defective Children 21 Dental Disease 7 Dental Treatment 13 Remedial Exercises 19 Rheumatism Clinic 20 Ear Disease 21 Epileptic Children 22 Sanitary Accommodation — Exclusions 9, 10 Schools, Special 4, 23 Eye Clinic 12 Secondary Schools 24 Eye Disease 12 Speech 22 Evacuation 9 Staff 29 Statistical Tables 27 Following up 11 Surveys, Uncleanliness 11 Health Visitors, Work of 11 St Christopher's 23 Heart Defects 20, 22 Throat and Nose . 12 Heights and Weights 8 Treatment 11 Infectious Diseases 10 Tuberculosis 7 Inspection Clinic 11 Uncleanliness 7 Inspections, Routine 7 Inspections, Special 27 Vision, Defective 7