63931 AC44132 CRO45 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL SERVICE For the Year 1943 OSCAR M. HOLDEN, G.M., M.D., D.P.H. CROYDON: PRINTED BY THE CROYDON TIMES, LTD., 104, HIGH STREET C.T. 2. 29-9-44. 100. i. COUNTY BOROUGH OF CROYDON. ANNUAL REPORT THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1943. 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 Sixteenth Annual Report, being the forty-fourth 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 18.4 per 1,000, an increase of 0.1 per 1,000 over 1942. The Death-rate was 13.1, an increase of 0.8 per 1,000 of the population. The Infantile Mortality rate was 37 per 1,000 live births; this was 2 per 1,000 lower than 1942. These rates can be stated to be very satisfactory, especially when the fact that this country had been at war for 4 years is remembered. The restrictions and rationing of foodstuffs does not appear to have had any detrimental effect upon the rate of death. ii. The incidence of notifiable Infectious Diseases remained low with the exception of Measles, which was much the same as 1942, and Scarlet Fever, which showed a considerable increase. Immunization against Diphtheria has proceeded steadily, and the number of children now immunised is estimated at approximately 70 per cent, of the total child population. Diphtheria incidence has remained remarkably low, and only 2 deaths 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 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 5.25 per l,000 of the population to 5.34. Since 1939 this figure has risen steadily each year. Deaths from diseases of the Digestive System remained at practically the same level as in 1942. There has been a continued incidence of skin affections, particularly noticeable in the case of Scabies and Impetigo. Influenza deaths increased from 19 to 75. Considered as a whole, the vital statistics show that Croydon's health has been maintained during 1943. Some increase in the number of cases of Pulmonary Tuberculosis notified is manifest. An increase of 13.6 per cent, in the number of new cases occurred over 1942. This increase was confined to men and was in the 25—35 year group. The Maternity and Child Welfare Services have functioned very fully throughout the year. 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 returned to their pre-war dimensions. iii. 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 evidence that overcrowding is increasing. In conclusion, I express my thanks to you, ladies and gentlemen, for the help and encouragement you have given my staff and myself, and I wish to bring to your notice the competent manner 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. HOLDEN, Medical Officer of Health. 1 PUBLIC HEALTH COMMITTEE. NOVEMBER, 1942-1943. The Worshipful The Mayor (Alderman S. Roden, 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. Chill. Councillor A. V. Dammarell. Councillor Miss M. H. Glazier. Councillor A. Goodbun. (to August, 1943) Councillor W. H. Gough. Councillor Mrs. E. M. Regan. Councillor Mrs. G. L- Rogers. (from September, 1943) Councillor D. G. Stewart. Councillor J. T: Twitchett. Councillor G. H. Ward. G. G. Genge, Esq., M.D. J. H. Thompson, Esq., M.B.,BCh.. (to September, 1943) P. W. Hamond, Esq., M.D. (from October, 1943) 2 SUMMARY OF VITAL STATISTICS FOR 1943. Area, 12,617 acres. Population (Census 1931), 233,115. Population (estima'.ed middle of 1943), 199,500. Number of Inhabited Houses (1931 Census), 56,429. Overcrowding Census (1936), 65,550. Rateable Value (1st April, 1943), £2,524,879. Product of a Penny Rate (1942—1943), £9,408. Rate in the £ : 12/8d. Gross expenditure on Health and Hospital Services, (administered by Medical Officer of Health £282,506 Income on Health and Hospital Services (excluding transfers) 64,351 Net expenditure on Health and Hospital Services £218,155 Expressed, as a Penny Rate, 23.2 pence in the pound. ' ive Births M. F. Total Legitimate 1,777 1,612 3,389 Illegitimate 160 127 287 3,676 Birth-rate per 1,000 of the estimated resident population. 18.4. Still Births 109. Rate per 1,000 total (live and still) births, 28.8. Birth-rate per 1,000 (live and still births), 19.0. Deaths, 2,611 (Registrar-General's figures). Death-rate per 1,000 of the estimated resident population, 13.1. Deaths from diseases and accidents of Pregnancy and childbirth, 2; from sepsis, 1; other causes, 1, 3 Maternal mortality 0.53 per 1,000 total live and still births. Death-rate of Infants under one year of age (137 deaths, 3,676 births)— All Infants per 1,000 live births 37 Legitimate Infants (125 deaths) per 1,000 live births 34 Illegitimate Infants (12 deaths) per 1,000 live births 42 Deaths from Influenza 75 ,, ,, Whooping Cough (all ages) — ,, ,, Diarrhoea (under 2 years of age) 17 ,, ,, Diphtheria (all ages) 2 ,, ,, Pneumonia 117 ,, ,, Cancer 454 Rate per 1,000 Population. Deaths from diseases of Cardiac and Circulatory System (including Cerebral Hemorrhage) 5.34 ,, ,, diseases of the Respiratory System (including Tuberculosis) 2.20 ,, ,, diseases of Renal System 0.26 ,, ,, diseases of Digestive System 0.57 ,, ,, Suicide and Violent Causes 0.56 ,, ,, Old Age (local statistics) 0.93 ,, ,, War Operations (local statistics) 0.17 Marriages. The number of marriages solemnised was 1,574, compared with 2,042 in 1942, 2,187 in 1941, 2,792 in 1940, 2,674 in 1939, and 2,319 in 1938. The marriage rate was 7.9 per 1,000 of the population ; 854 were solemnised in Established Churches, 230 in other places of worship, 486 in the Register Office, and 4 performed under Jewish ritual, 4 Births. The births registered were 3,389 legitimate and 287 illegitimate. The birth-rate consequently was 18.4. For England and Wales and in the Great Towns the rates were 16.5 and 18.6. The illegitimate births in Croydon were 7.8 of the total, compared with 7.5 in 1942; 6.3 in 1941; 5.3 in 1940 and 1939; 4.9 in 1938; and 4.6 in 1937. The live male births numbered 1,937, the female 1,739, being a proportion of 1,114 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 (32.3) and Addiscombe (21.1). Those with the lowest were Norbury (9.1) and Upper Norwood (10.6). Deaths. The deaths numbered 2,611, compared with 2,409 in 1942. For 1943 the death-rate was 13.1; for 1942 it was 12.3. The death-rate for England and Wales was 12.1, and for the Great Towns 14.2. For London the death-rate was 15.0. There were 144 inquests held by Coroners in respect of Croydon residents during 1943, and 176 findings by Coroners after post-mortem examination without inquest. Wards with the highest death-rates were Central and South (16.5), and Addiscombe (14.4). Lowest : Addington (9.0) and West Thornton and Waddon (11.6). 5 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 13193 140 175 10.6 13.3 79 — 0.08 1.67 0.30 — 2.96 0.76 2.27 -35 Norbury 13243 120 172 9.1 13.0 42 — — 1.36 0.30 0.23 3.25 0.45 2.42 -52 West Thornton 16157 239 188 14.8 11.6 54 — — 1.67 0.43 0.12 1.92 0.43 1.73 +51 Bensham Manor 13195 244 172 18.5 13.0 25 0.06 0.08 1.97 0.53 0.08 2.96 0.53 1.74 +72 Thornton Heath 14872 266 189 17.9 12.7 41 — — 1.35 0.40 0.07 3.09 0.27 2.35 +77 South Norwood 14535 249 175 17.1 12.0 40 — 0.14 2.00 0.55 — 2.75 0.14 2.82 +74 Woodside 13245 217 179 16.4 13.5 37 — 0.15 1.96 0.68 0.08 3.10 0.23 2.27 +38 East 13284 215 171 16.2 12.9 19 — — 1.05 0.30 — 3.01 0.60 2.56 +44 Addiscombe 13438 284 193 21.1 14.4 25 — 0.07 1.56 0.74 0.07 3.35 0.22 2.46 +91 Whitehorse Manor 13779 261 187 18.9 13.6 46 0.07 0.07 1.89 0.73 0.15 3.05 0.51 1.45 +74 Broad Green 14187 241 194 17.0 13.7 33 — 0.21 1.83 0.43 0.14 2.19 0.70 2.82 +47 Central 10031 152 166 15.1 16.5 66 — 0.20 2.09 0.60 — 3.48 0.49 2.98 —14 Waddon 15075 284 175 18.8 11.6 49 0.07 0.20 1.85 0.93 0.13 1.79 0.40 1.92 +109 South 12140 192 205 15.4 16.5 42 0 08 0.24 1.61 0.48 0.08 3.38 0.72 3.14 —13 Addington 8796 290 79 32.3 9.0 34 0.11 0.23 0.68 0.57 — 1.93 0.11 1.25 +211 The Borough 199500 *3676 *2611 18.4 13.1 37 0.03 0.11 1.65 0.54 0.08 2.80 0.44 2.28 +774 *These are the corrected totals. 6 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX. Sex All Ages 0— 1— 5— 15— 45— 65— All Causes M 1285 77 11 26 101 365 705 F 1326 60 6 14 128 289 829 Encephalitis Lethargica M - - - - - - - F 2 - - - 1 - 1 Diphtheria M 1 - - 1 - - - F 1 - 1 - - - - Cerebro Spinal Fever M 1 - - - - - 1 F - - - - - - - Measles M 1 - - 1 - - - F - - - - - - - Influenza M 32 2 — — — 15 15 F 43 1 — 1 6 13 22 Poliomyelitis & Polioencephalitis M — — — — — — — F 1 — — — 1 — — Tuberculosis (respiratory) M 64 1 1 — 32 24 6 F 39 — — — 24 12 3 Tuberculosis (other forms) M 7 — 1 2 2 1 1 F 10 — 1 3 3 — 3 Syphilitic diseases M 10 — — — 1 6 3 F 11 1 — — — 7 3 Cancer M 224 — — 1 8 88 127 F 230 — — — 23 81 126 Diabetes M 10 - — — 1 4 5 F 4 — — - 1 — 3 Intra cranial vascular lesions M 96 — — — 2 22 72 F 149 — — — 5 27 117 Heart diseases M 342 — — — 9 71 262 F 406 — — — 14 55 337 Other circulatory diseases M 34 - — — — 12 22 F 39 — — — 3 7 29 Bronchitis M 112 2 2. — 1 28 79 F 83 1 1 1 5 8 67 Pneumonia (all forms) M 52 14 — 3 2 13 20 F 65 8 2 2 7 13 33 Other respiratory diseases M 17 — — 1 3 8 5 F 7 — — — 2 3 2 Ulcer of stomach or duodenum M 28 — — — 4 15 9 F 6 — — — — 1 5 Diarrhoea (under 2 years) M 12 11 1 - — - — F 5 5 - - - - - Appendicitis M 5 — — 1 2 1 1 F 4 — — 1 1 2 — Other digestive diseases M 27 3 — 2 3 8 11 F 26 2 — 1 6 6 11 Nephritis M 24 — 1 — 4 5 14 F 27 1 — — — 14 12 Puerperal sepsis F I — — — 1 — — Other maternal causes F 1 — — — 1 — — Congenital debility, malformations, premature birth, etc. M 43 37 — 4 1 1 — F 45 37 1 1 5 — 1 Suicide M 16 — — — 2 8 6 F 5 — — — 2 2 1 Road traffic accidents M 17 — — 3 5 4 5 F - - — .—. — — — Other violent causes M 34 2 1 2 9 15 5 F 40 4 — 1 7 10 18 All other causes M 76 5 4 5 10 16 36 F 76 — — 3 10 28 35 Totals 2611 137 17 40 229 654 1534 7 Comparisons with 1942. In the zymotic diseases group there were decreases in the number of deaths caused by Whooping Cough and Measles, no deaths occurring in the former disease. There were again no deaths in the Typhoid group. Deaths from Diphtheria numbered 2, compared with 3 in 1942. The deaths from Pulmonary Tuberculosis increased by 6; those frorp Cancer by 45; and those from Heart Trouble by 7. There was an increase of 4 in the Pneumonia deaths and of 64 in those caused by Bronchitis. Deaths from Suicide and other violence show an increase of 25, and road traffic accidents of 2. I The total number of deaths was 2,611, as compared with 2,409 in 1942. The percentage of deaths under 1 year of age to the total deaths was 5.2 per cent.; deaths under 15 years, 7.4 per cent.; deaths under 65 years, 41.25 per cent.; and deaths over 65 years, 58.75 per cent. The corresponding figures for 1942 were 5.6 per cent., 7.8 per cent., 40.9 per cent., and 59.1 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 2,194,444,608 Metropolitan Water Board in bulk 417,277,000 2,611,721,608 galls. The same arrangements regarding samples as were commenced in 1938 continued in 1943. 8 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 Clinics have continued throughout the year. DEPARTMENTAL CLASSIFICATION OF DEATHS ACCORDING TO DISEASE OVER A PERIOD OF SIX YEARS. Cause of Death. 1938 Total Deaths 1939 Total Deaths 1940 Total Deaths 1941 Total Deaths 1942 Total Deaths 1943 Total Deaths Death Rate Enteric Fever 12 2 - 1 - - - Malaria — — - 1 - — - Small Pox — — — — — — — Measles 8 — — 5 - 1 0.005 Scarlet Fever 3 — — - 1 1 0.005 Whooping Cough 3 3 2 6 3 1 0.005 Diphtheria and Croup 16 16 4 4 3 2 0.010 Influenza (incl. Influenzal pneumonia) 21 48 49 36 19 81 0.406 Dysentry 1 1 — 2 2 — — Erysipelas 3 2 2 — 1 — — Cerebro-Spinal Fever 5 2 16 8 6 1 0.005 Pulmonary Tuberculosis 117 89 128 90 97 107 0.536 Tuberculous Meningitis 20 18 1 19 19 16 0.080 Other Tuberculous Diseases Cancer, Malignant Disease 387 419 443 376 409 454 2.276 Rheumatic Fever 6 2 8 2 3 2 0.010 Meningitis 5 3 5 3 9 7 0.036 Organic Heart Disease 777 782 682 672 741 515 2.581 Bronchitis, Acute and Chronic 49 47 130 80 131 150 0.752 Pneumonia 180 151 206 194 113 182 0.912 Other Diseases of the Respiratory Organs 25 13 21 30 22 17 0.085 Diarrhoea & Enteritis 29 23 18 13 15 21 0.105 Appendicitis 15 15 15 10 6 8 0.040 Cirrhosis of Liver 8 12 1 10 5 4 0.020 Alcoholism 1 1 2 1 — — — Nephritis & Bright's Disease 72 63 63 60 57 44 0.221 *Puerperal Sepsis 1 2 2 3 3 1 0.005 *Other diseases and accidents of pregnancy and parturition 2 2 3 5 9 1 0.005 Congenital debility, malformation and Premature Birth 64 71 53 34 82 73 0.366 Violent Deaths (excluding War operations and suicide) 78 77 61 74 61 46 0.231 Suicide 43 28 20 20 24 21 0.105 Other Defined Diseases 595 662 1152 778 568 816 4.311 Diseases Ill-Defined or Unknown — 3 11 2 — 12 0.0"0 Total 2496 2557 3118 2539 2409 2628 — *Calculated per 1,000 live and still births. 1943 showed an increase both in the death and birth rates. 9 MAYDAY HOSPITAL. Table 1. Medical Superintendent: C. F. Swinton, M.D., F.R.C.S.(Ed.), Ch.M. Nursing Staff. Matron: Miss F. Roberts, S.R.N. Trained Nurses 83 Assistant Nurses 7 Student Nurses 103 Male Attendants 6 Steward: Mr. R. Grist. The following Specialist Services are carried on:—Orthopaedic, Gynecological, Dental, X-Ray, Deep X-Ray Therapy, Massage, Ultra-Yiolet Light, Ophthalmic, Ear, Nose and Throat, School E.N.T. Clinic, Gastroscopy. Table I. 1.- Total number of admissions (including infants born in hospital) 7,714 2.- Number of women confined in hospital 1,138 3.- Number of live births 1,101 4.- Number of still births 47 5.- Number of deaths among the newly-born (i.e., under 4 weeks of age) 41 6.- Number of deaths among children under one year (including those given under 5) 78 7.- Number of maternal deaths among women admitted to hospital for confinement 2 8.- Total number of deaths 835 9.- Total number of discharges (including infants born in hospital) 6,730 10.- Duration of stay of patients included in 8 and 9 above— (a) Under four weeks 6,130 (b) Four weeks and under thirteen weeks 1,278 (c) Thirteen weeks or more 215 11.- Number of beds occupied (excluding cost in maternity wards— (a) Average during the year 440 (b) Highest 501, on 13-12-43 (c) Lowest 364, on 3-1-43 12.- Number of surgical operations under anaesthetic 2,579 13.- Number of abdominal sections 721 10 Table II. Classification of In-Patients who were discharged from or who died in the Institution during the year ended 31st December, 1943. Disease Groups. Children (under 16) Men and Women. Discharged. Died. Discharged. Died. A.—Acute infectious disease 58 — 13 6 B.—Influenza 13 — 13 6 C.—Tuberculosis : Pulmonary 8 2 87 36 Non-Pulmonary 9 7 16 7 D.—Malignant Disease - — 118 153 E.—Rheumatism (1) Acute rheumatism (rheumatic fever) together with sub-acute rheumatism and chorea 4 1 5 (2) Non-articular manifestations of so called " rheumatism " (muscular rheumatism, fibrositis, lumbago, and sciatica) 2 1 (3) Chronic Arthritis 2 — 23 — F.—Venereal Disease - — 6 2 G.—Puerperal Pyrexia - - 3 - Puerperal Fever — — — — H.—Other diseases and accidents connected with pregnancy and childbirth — — 473 — I.—Mental diseases 7 — 198 — J.—Senile decay — — 29 9 K.—Accidental injury and violence 51 1 181 17 In respect of cases not included above. l.—Diseases of the Nervous System and Sense Organs 8 7 108 88 M.—Disease of the Respiratory System 108 30 246 75 N. „ „ Circulatory System 7 4 182 250 0. „ „ Digestive System 110 12 498 43 P. „ „ Genito Urinary System 52 2 109 20 Q. „ „ Skin 76 — 95 1 R.—Other diseases 1017 10 427 10 S.—Mothers and infants discharged from Maternity Wards and not included in above figures Mothers — — 1173 2 Infants 1200 33 — — T.—Any persons not falling under any of the above headings 37 — 58 — Totals 2767 109 4063 726 11 NUMBER OF X-RAY FILMS TAKEN. Spine 281 Bones 1,050 Pelvis 34 Chest 2,541 Barium Meals 541 Barium Enemata 37 Renal 176 Gall-Bladder 94 Teeth 492 Abdominal 77 Maternity Cases 797 Skull 336 6,456 Total number of Cases X-rayed 3,674 DIAGNOSTIC. 1942. 1943. Oesophagus with Barium 9 10 Barium Meals 166 124 Barium Enemeta 33 20 Gall-Bladder (Plain) 17 7 Cholecystograms 25 26 Renal Tracts (Plain) 31 23 Pyelograms 43 29 Abdomen for F.B.'s, etc. 13 26 Maternity Cases 295 425 Hysterographies 6 13 Lungs (Mayday Hospital) 463 578 (Sick Staff) 10 3 (Staff on Appointment) 102 100 (T.B. Dispensary) 1,038 1,506 (Others) 11 18 Lungs after Lipiodol 9 2 Heart and Aorta 14 14 Skulls 74 73 Accessory Nasal Sinuses 25 42 Vertebral Column 96 99 Ribs 31 23 Pelvis 30 31 Long Bones 168 180 Short Bones 92 79 Joints 440 348 Teeth and Jaws 147 151 3,388 3,950 Examinations by Portable Set 126 128 12 x-ray. 1942. 1943. Men's Wards 677 543 Women's Wards 688 668 Children's Wards 92 111 Maternity and Gynaecological Wards 92 128 Staff 151 137 Total "In-Patients" 1,700 1,587 T.B. Dispensary (Men) 501 846 (Women) 492 556 (Children under 16) 45 104 Croydon Borough Hospital 3 2 Ante-Natal Clinic 240 356 St. Mary's Hospital 3 8 Queen's Road Homes 20 29 Dental Clinic 121 112 Others 255 74 Total "Out-Patients" 1,680 2,087 Total 3,380 3,674 "Screen Examinations" 729 945 mental patients dealt with during the year. Male. Female. Admitted 82 123 Certified and sent to Warlingham Park Hospital 9 19 As Volntary Patients to Warlingham Park Hospital 40 58 Discharged not certified 38 43 massage. Massage 9,148 Exercises 5,331 Radiant Heat 3,516 Electrical 516 Infra-red 1,392 Ultra Violet Light 1,396 Wax 36 21,335 Total number of patients treated 972 13 specimens examined in the pathological laboratory during the year. Positive. Negative. Swabs for Diphtheria — 1,273 Sputa for T.B. 197 468 Pus for T.B. 2 4 Pus for Gonococci — 1 Urine for T.B 7 14 Faeces for T.B. 5 18 Faeces for Coli Typhoid Group 85 361 Blood—Widals — 4 Hairs for ringworm 3 3 Blood cultures 14 24 Faeces for occult blood 87 120 2,690 Urine for routine examination 1,090 Pus for organisms 199 Blood urea estimations 238 Blood sugar estimations 91 Cerebro spinal fluids 102 Urea Cone. Tests 8 Urea clearance tests 196 Fractional test meals 82 Pleural fluids 39 Blood counts 432 Blood groups 298 Haemoglobin estimations 1,275 Compatibility tests 185 Faecal fat estimations 2 Van den Bergh re-action 8 Vaccines 4 Blood sedimentation rates 162 Glucose tolerance tests 2 Blood coagulation and bleeding time 13 Other examinations—unclassified 106 Total number of Examinations 7,221 Number of Specimens sent to Croydon General Hospital 604 number of post mortems ordered by the coroner and performed at mayday hospital during the year. Outside Cases 251 Hospital Cases 74 number of post mortems not ordered by the coroner 90 14 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 Uterus 4 41 — 3 — — 1 Cervix 7 59 1 5 — 1 — Ovary 2 21 — 2 — — — Oseophagus 2 18 — — 1 — 1 Breast 26 335 — 21 4 — 1 Lung 3 36 — — 3 — — Bladder 1 12 — — 1 — — Testicle 3 36 — 3 — — — Descending Colon 1 12 — 1 — — — Sarcoma of Uterus 1 12 — 1 — — — Shoulder 2 18 — 1 1 — — Hip 2 54 — 1 — — 1 Caecum 1 8 — 1 — — — Epithelioma of finger 1 12 — 1 — — — lip 3 32 - 2 1 — — vulva 2 24 - 1 — — 1 Fibro Sarcoma of rib 1 12 - 1 — — — Fibroma of leg 1 12 — 1 — — — Menorrhagia 3 26 2 1 — — — Lymphatic Leukaemia 4 36 - 4 — — — Hodgkins D'sease 1 12 - 1 - — — Myeloma 1 12 - 1 — — — Osteo arthritis knee 1 24 — 1 — — — hip 1 12 — 1 — — — Rodent ulcer 1 18 — 1 — — — Warts 1 16 1 — — — — Glioma Parietal lobe 1 12 — 1 — — — Parotid tumour I 8 — — 1 — — Total 78 930 4 56 12 1 5 Corresponding totals for 1942 86 1033 4 59 18 1 4 15 Table III Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Alimentary. Appendicitis — — — — 116 20 2 5 143 Oastric ulcer 5 20 3 8 2 4 — 3 45 Duodenal ulcer 9 29 4 4 4 1 — 2 53 Anastomatic uloer 1 2 - - - - - - 3 Dyspepsia 4 1 - - - - - - 5 Cholelithiasis — 2 — — 2 — — — 4 Colitis 2 2 2 1 2 1 — 1 11 Intestinal obstruction — — — — 3 4 3 5 15 Ischio rectal abscess — — — — 4 3 - — 7 Constipation 14 36 2 - - - - - 52 Hernia — — - — 44 57 6 5 112 Haemorrhoids — — — — 7 10 — — 17 Cholecystitis — — — — 6 19 1 2 28 Oastro enteritis 6 15 1 9 — — — — 31 Gastritis 2 16 - - - - - - 18 Alveolar Abscess 1 2 - - - - - - 3 Cirrhosis of liver — — — 1 — — — — 1 Intestinal colic 1 7 — — — — — — 8 Catarrhal jaundice 11 11 1 - - - - - 23 Prolapse of Rectum — 1 — — — — — — 1 Pyloric stenosis — 2 — 3 1 — — — 6 Fistula in Ano — 1 - - - - - - 1 Swallowed F.B 1 - - - - - - - 1 Diarrhoea 4 1 - - - - - - 5 Peptic Ulcer — 1 1 - - - - - 2 Appendicular Colic 1 3 - - - - - - 4 Tapeworm 1 — 1 - - - - - 2 Thread worm 1 - - - - - - - 1 16 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Peritonitis — 1 — 1 — — 1 3 6 Stomatitis 2 - - - - - - - 2 Adhesions 1 — 1 - - - - - 2 Pelvic Abscess — — - - 1 - - - 1 Collapse 3 1 - - - - - - 4 Pyioric Ulcer — 1 — — — 1 — — 2 Peritonsillar Abscess — 1 - - - - - - 1 Appendicular Abscess — — — — — 7 — — 7 Perineal Abscess 4 1 — — 1 — — — 6 Abdominal Abscess 1 1 - - - - - - 2 Abdominal tumour — — 1 - - - - - 1 Pancreatitis — — — 1 — — — — 1 Subphrenic abscess — — — 1 — — — — 1 Ascitis — 2 1 - - - - - 3 Diverticulitis — 3 - - - - - - 3 Hepatitis 1 — - - - - - - 1 Visceroptosis — 2 - - - - - - 2 Haematemesis of unknown origin 1 - - - - - - - 2 Vincent's Angina 6 5 1 - - - - - 12 Malaena - 1 - - - - - - 1 Urticaria 1 - - - - - - - 1 663 Bones, and Joints. Arthritis — 16 9 - - - - — 25 Paget's Disease — 1 — — — — — — 1 Fibrositis 1 4 1 — — — — — 6 Bursitis 3 6 — — — — — — 9 Lumbago — 1 - - - - - — 1 Synovitis — 4 - - - - - — 4 Osteo- myelitis 3 13 — — — — — — 16 Genu Valgum — 1 — - - — — — 1 Osteo- arthritis — 6 2 - - - - - 8 17 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Rheumatism 2 9 - - - - - - 11 Hallux Valgus — 1 - - - - - - 1 Flat feet — 1 - - - - - - 1 Osteitis Deformations — 1 - - - - - - 1 Spina bifida — — — 1 — — — — 1 Ccccy dinia 1 - - - - - - - 1 Pes cavus — 2 - - - - - - 2 Torticollis — 1 - - - - - - 1 90 Carcinoma. Breast — — — — 1 12 13 18 44 Ovary - - - - - 2 — 6 8 Stomach - - - - - 2 5 27 34 Rectum - - - - - 5 2 12 19 Cervix - - - - - 8 9 2 19 Uterus - - - - - 1 2 3 6 Prostate - - - - - 1 1 7 9 Tongue and Mouth - - - - - 1 1 7 9 Colon — — — — 2 6 7 22 37 Larynx - - - - - - 1 1 2 Oesophagus - - - - - 2 1 4 7 Gall-Bladder - - - - - 1 — 2 3 Lung - - - - - - 2 8 10 Bronchus - - - - - - - 2 2 Pancreas - - - - - - - 9 9 Epithelioma - - - - - 1 2 3 6 Nose - - - - - - - 2 2 Cervix uteri - - - - - - 7 1 8 Kidney - - - - - - - 1 1 Sarcoma — — — — 1 1 1 6 9 Liver - - - - - - - 2 2 18 Dlagnoies In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieied Unrelieved Died Cheek - - - - - - 1 — 1 Rodent ulcer — — — — — — 2 — 2 Ventricule — — — — — — — 1 1 Scapula — — — — — 1 — — 1 Testis — — — — — — 2 — 2 Glands - - - - - 1 2 2 5 Tonsil — — — — — — — 2 2 Pelvi rectal junction — — — — — 1 — — 1 Ileo-caecal junction — — — — — — 1 — 1 Femur — — — — — 1 — — 1 Lip — — — — — 1 2 — 3 Caecum — - — — — — — 1 1 Head — — — — — 1 — — 1 Trachea — — — — — — — 1 1 Anal canal — — — — — — — 1 1 Vulva — — — — — — 1 — 1 271 Circulatory (Blood). Anemia — 6 2 3 — — — — 11 Hyperpiesia — 7 1 - - - - - 8 Septicaemia — 1 — 3 — — — - 4 Pernicious Anaemia 2 6 — 3 — — — — 11 Pyaemia — — — 2 — — — — 2 Thrombosis — 3 — 9 — — — — 12 Phlebitis 1 6 1 — — — — — 8 Varicose veins 2 3 1 — — — — — 6 Gangrene — 3 — 2 — — — — 5 Leukaemia 1 9 17 3 — — — — 30 Thrombo Cytopaenic — 1 — — — — — — 1 Naevus — 2 — — — — - — 2 Malaria — 1 — — — — — — 1 101 19 Diagnoses In Caaes Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Circulatory (Heart) Myocardial Degen : — 21 1 157 — — — — 179 Aortic incompetence — 3 - - - - - - 3 Arterio sclerosis — 13 3 9 — — . — — 25 Aortic stenosis — 1 - - - - - - 1 Endocarditis — — - 6 — — — — 6 Myocarditis — 2 1 22 — — — — 25 Carditis — — 1 1 — — — — 2 Auricular fibrillation — 9 1 2 — — — — 12 Mitral stenosis — 4 2 2 — — — — 8 Congestive heart failure 1 14 1 11 — — — — 27 Heart failure — 16 2 16 — — — — 34 Aortic regurgitation — — — 1 — — — — 1 Congenital heart disease — — — 1 - — — — 1 Tachycardia 2 - - - - - - - 2 Cardiac disease — 1 — 1 — — — — 2 Angina — 4 - - - - - - 4 Rheumatic Carditis — 7 1 - - - - - 8 Syncopal attack — 2 — — — —- — — 2 342 Constitutional. Diabetes Mellitus 2 17 — 6 — - — — 25 Debility — 1 1 - - - - - 2 Nutritional disorder 23 15 — - - - - - 38 Marasmus 2 3 — 3 — — — — 8 Rickets — 2 - - - - - - 2 Diabetic coma - 1 — 1 — — — — 2 Malnutrition 1 3 — — — — — — 4 Muscular Dystrophy — — 1 — — — — — 1 82 20 Diagnoses in Cases Treated Medical. Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Ear, Nose and Throat. Enlarged T. and A. — 3 6 — 850 8 — — 867 Quinsy 4 2 - - - - - - 6 Otitis Media 22 23 14 - - - - - 59 Pharyngitis 1 — — — — — — — 1 Otorrhoea — 1 - - - - - - 1 Mastoiditis — — — — 9 8 1 1 19 Catarrh 7 6 1 1 — — — — 15 Sinusitis — — — — 2 2 — — 4 Tracheitis — 1 - - - - - - 1 Adenoids — — — — 1 — — — 1 Bleeding tonsil tag 1 - - - - - - - 1 Epistaxis 1 1 - - - - - - 2 Neoplasm of antrum — — 1 — — — — — 4 978 Eye. Conjunctivitis 4 2 1 - - - - - 7 Ophthalmitis 1 - - - - - - - 1 Blepharitis — 1 1 - - - - - 2 10 Glands. Adenitis 13 16 - - - - - - 29 Hodgkin's disease 1 2 — 1 — — — — 4 Adenoma 1 1 - - - - - - 2 Goitre — 2 - - - - - - 2 Glandular fever 1 - - - - - - - 1 38 21 Diagnoses in Cases T rested Medical. Surgical.  Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Genito Urinary. Nephritis 3 5 4 5 — — — — 17 Urethral stricture — 1 - - - - - - 1 Pyelitis 5 15 2 1 — - — — 23 Enlarged prostate - 13 2 3 9 14 1 3 45 Hydrocele 2 - - - - - - - 2 Perinephric abscess — 3 - - - - - - 2 Cystitis 5 8 2 - - - - - 15 Papilloma of bladder — 2 — — — — 1 — 3 Uraemia — 1 — 10 — — — — 11 Renal colic 1 2 — — — — — — 3 Renal calculus — 2 — — — — — — 2 Hypernephrosis — 1 — — — — — — 1 Epididymo- orchitis 1 2 — — — — — — 3 Circumcision — — — — 37 5 — — 42 Haematuria — 1 — — — — — — 1 Diverticulitis — 1 - - - - - - 1 Suprapubic fistula. — 1 — — — — — — 1 Retention 1 1 - - - - - - 2 Incontinence — 2 — — — — — — 2 Undescended testicle — — — — 1 2 — — 3 Dysuria 1 1 - - - - - - 2 183 Gynaecological. Abortion — — — — 161 68 6 — 235 Fibrosis Uteri — — — — 38 20 7 — 65 Ovarian cyst — — — — 9 9 — 1 19 Uterine haemorrhage — — — — 6 20 — — 26 Mastitis — - - — 4 3 — — 7 Menorrhagia — — — — — 6 4 - 10 22 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Metrorrhagia — — — — — 1 1 - 2 Vaginitis — — — — 1 2 — — 3 Dysmenorrhoea — — — — 2 4 — — 6 Bartholin's cyst — — — — 1 3 — - 4 Bartholin's abscess — — — — — 1 — — 1 Erosion of cervix — — — — 6 6 1 — 13 Deficient pelvic floor — — — — 25 9 2 — 36 Salpingitis — — — — 6 8 1 — 15 Retroversion — — — — 18 8 1 — 27 Salpingo - oophoritis — — — — — 1 — — 1 Retained products — — — — 8 2 — — 10 Cervicitis — — — — 3 — — — 3 Urethral caruncle — — — — — 1 — — 1 Cystocele — — — — 2 2 — — 4 Cervical polypus — — — — 5 4 — — 9 For sterilization — — — — 1 — 1 Sterility — — - — 6 14 11 — 31 Endometritis — — — — 7 — — — 7 Procidentia — — - — — 1 1 — 2 Pelvic infection — — — — 4 8 — — 12 Vaginal discharge — — — — 1 2 — — 3 Menopausal syndrome — — — — — 4 — — 4 Rectocele — — — — 2 — — — 2 Imperforate hymen — — — - 1 — — — 1 Corpus lutum — — — — — 1 — — 1 Spastic colon - - - - - 1 — — 1 562 Infectious. Influenza 19 5 — 6 — — — — 30 Puerperal pyrexia — — 1 — — — — — 1 Scarlet Fever 1 — 17 - - - - - 18 23 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Dysentery — — 17 - - - - - 17 Whooping Cough — — 2 — — — — — 2 Cerebro spinal fever — 1 2 - - - - - 3 Influenzal Pneumonia 1 1 — - — — — — 9 Measles — — 13 - - — — — 13 Chicken Pox — — 12 — — — — — 12 Mumps — — 2 — — — — — 2 Rubella — — 3 — — — — — 3 110 Maternity. Pyelitis of pregnancy — — — — 3 16 1 — 20 False labour pains - - - - - 9 15 — 24 Ectopic gestation — — — — 6 1 — — 7 Albuminuria of pregnancy - - - - - 1 2 — 3 A.P.H — — — — — 4 — — 4 R.B.P — — — — 1 22 1 — 24 P.P.H — — — — — 4 — — 4 Toxaemia of pregnancy — — — — 3 26 1 — 30 Anaemia of pregnancy - - - - - 2 1 — 3 Vomiting of pregnancy — — — — 2 3 — — 5 A.N. Observation — — — — 7 21 14 — 42 A.N. rest — — — — — 6 — — 6 Termination of pregnancy — — — — 2 3 1 — 6 Deliveries — — — — 1173 — — 2 1175 Births — — — — 1100 - — 33 1133 2486 Mental. Uncertified 1 20 115 — — — — — 136 Certified — — 28 - - - - - 28 M.D — — 8 — — — — — 8 24 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Epilepsy — 10 12 - - - - - 22 Senile Dementia — 1 2 - - - - - 3 Hysteria — 3 4 - - - - - 7 Depression — — 1 - - - - - 1 205 Nervous and Sensory. Cerebral haemorrhage — 4 1 49 — — — — 45 Meningitis 2 2 1 5 — — — — 10 Chorea — 2 - - - - - - 2 Spina bifida — 1 — 1 — — — — 2 Hemiplegia — 5 3 14 — — — — 22 Sciatica 1 4 - - - - - - 5 Neurasthenia — 5 2 - - - - - 7 Neurosis — 14 6 - - - - - 20 Cerebral thrombosis 2 18 4 22 — — — — 46 Disseminated sclerosis — 6 3 1 — — — — 10 Paralysis agitans — 3 1 - - - - - 4 Neuralgia — 1 - - - - - - 1 Neuritis — 2 1 - - - - - 3 Convulsions — 3 — 1 — — — — 4 Cerebral tumour — — 2 - — — — — 2 Parkinson's disease — 1 - - - - - - 1 Cerebral arterio sclerosis — 4 — 1 — — — — 5 Encephalitis — 1 — 2 — — — — 3 Cerebral abscess — — 1 1 — — — — 2 Subarrachnoid haemorrhage — 3 — 5 — — — — 8 Paralysis — 1 - - - - - — 1 Tics - 1 - - - - - - 1 Hydrocephalus — — 1 2 — — — — 3 Migraine — 1 - — — — — — 1 25 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Headache — 2 - - - - - - 2 Ganglion — 1 - - - - - - 1 211 Respiratory. Bronchitis 36 65 5 18 — — — — 124 Pneumonia 104 59 2 80 — — — — 245 Pleural effusion 3 11 2 — — — — — 16 Bronchiectasis — 2 2 — — — — — 4 Atelectasis — — — 2 — — — — 2 Pleurisy 2 10 — 1 — — — — 13 Emphysema — 1 - - - - - - 1 Asthma 1 29 4 1 — — — — 35 Empyema — 5 3 — — — — — 8 Pulmonary abscess — 5 1 - - - - - 6 Pulmonary congestion — 1 — 1 — — — — 2 Fibrosis of lungs — 1 — — — — — — 1 Pulmonary embolism — — — 1 — — — — 1 Pulmonary infarct — — — 1 — — — — 1 459 Senility — 12 16 10 — — — — 38 Skin. Boils, abscess and carbuncles — — — - 23 25 5 — 53 Burns and scalds — — — — 7 5 4 — 16 Eczema 5 6 — — — — — — 11 Impetigo 17 5 2 — — — — — 24 Scabies 18 2 — — — — — — 20 Dermatitis 3 5 1 — — — — — 9 Septic spots 2 1 — — — — — — 3 Ringworm — — 1 — — — — — 1 Erythema nodosum — 1 — - — — — — 1 26 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Ingrowing toe nail - - - - 1 - - - 1 Lipoma 1 - - - - - - - 1 Cellulitis 3 5 — 1 — — — — 9 Ulceration 6 8 1 - - - - - 15 Herpes 1 1 - - - - - - 2 Urticaria 2 - - - - - - - 2 Erysipelas — — 1 — — — — — 1 Papilloma — 1 - - - - - - 1 Whitlow — — — — 1 1 — — 2 172 Pulmonary Tuberculosis 2 40 54 37 - - - - 133 Non-Pulmonary Tuberculosis. Spine — 4 1 - - - - - 5 Meningitis — — — 9 — — — — 9 Hip — 2 2 — — — — — 4 Glands — 6 3 1 — — — — 10 Kidney 1 3 1 1 — — — — 6 Foot — 1 - - - - - - 1 Ileo caecal — — — 1 — — — — 1 Peritonitis — — 1 — — — — — 1 Miliary — — — 2 — — — — 2 39 Venereal. Gonorrhoea — 1 1 1 — — — — 3 Syphilis — 4 — 1 — — — — 5 8 27 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Violence. Fractured limbs — — — — 15 73 12 14 114 Fractured spine — — — — 1 — 1 2 4 Fractured malleolus — — — — 1 1 — — 2 Fractured skull - - - - - 2 — 1 3 Fractured ribs — — — — 1 1 — — 2 Fractured clavicle — — — — 1 — 1 — 2 Fractured pelvis — — — — 1 — — — 1 Fractured nasal bones — - — — 1 — 1 — 2 Fractured lumbar transverse process — — - — — 4 — — 2 Minor injuries — — — — 6 2 2 — 10 Contusions and abrasions — — — — 8 19 — — 27 Sprain — — — — 2 4 1 — 7 Abdominal injury - - - - - - 1 — 1 Bruises — — — — 1 1 — 1 3 Dislocation — — — — 3 5 2 — 10 G.S.W — — — — — 2 3 — 5 Concussion — — — - 11 20 1 — 32 Lacerations, wounds, etc. — — — - 4 14 1 — 19 Removal of plaster — — — — — 2 — — 2 Shock - - - - - - - - - 250 Miscellaneous. Poisoning 5 8 2 1 — — — — 16 Alcoholism 1 - - - - - - - 1 B.B.A 10 - - - - - - - 10 N.A.D 58 - - - - - - - 58 With Mother 26 - - - - - - - 26 Tight heel tendons - - - - - 2 — — 2 28 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Haae lip and cleft palate - - - - - 4 - - 4 Prematurity — — — 5 — — — — 5 Stings — 1 - - - - - - 1 F.B 5 3 — — — — — — 8 Extraction of tooth — — - — — 1 — — 1 Malingering — — 1 — — — — — 1 Serum reaction — 1 - - - - - — 1 134 TOTAL NUMBER OF PATIENTS DISCHARGED FROM MAYDAY HOSPITAL YEAR ENDED 31st DECEMBER, 1943. Cured 4,354 Relieved 1,715 Unrelieved 661 Died 835 7,565 OPERATIONS PERFORMED AT MAYDAY HOSPITAL DURING 1943 ABDOMINAL. Appendicectomy 133 Appendix abscess drained 15 Sigmoidoscopy 24 Herniotomy 98 Cholecystectomy 15 Laparotomy 54 Gastro- enterostomy 5 Colostomy 8 Caecostomy 5 Perforated gastric ulcer 14 For anal fistula 3 Gastro jejunostomy 2 Injection of haemorrhoids 5 Haemorrhoidectomy-14 Perforated duodenal ulcer 5 Gastroscopy 13 Undescended testicle 1 Rectal examination 4 For hydrocele 4 Gastrectomy 1 Rammstedt's operation 8 Resection of gut 8 439 29 BONES AND JOINTS. For osteo -myelitis 4 Amputation of limbs 11 Wiring of bones 20 Removal of pin 4 Resection of rib 4 Application of plaster 26 Removal of plaster 1 Reduction of joints 12 Manipulation of limbs 31 Osteotomy 6 Removal of Sequestrum 8 Division of webbed phalanges 1 Coccygectomy 1 Bone graft 2 131 EAR, NOSE AND THROAT. Mastoidectomy 26 Tonsillectomy 844 Adenoidectomy 12 Myringotomy 6 Bronchoscopy 3 Acral Polyp 1 Empyema tube change 1 893 GENITO URINARY. Cystoscopy 32 Circumcision 27 Nephrectomy 2 Prostatectomy 18 Supra pubic cystotomy 28 Urethral dilatation 3 Fulguration of bladder 1 Insertion of Depezar catheter 1 Nephro-lithotomy 3 Proctoscopy 3 118 30 GYNAECOLOGICAL. Examination under Anaesthetic 89 Total hysterectomy 25 Sub-total hysterectomy 57 Salpingo-oophorectomy 10 Dilation and Curetage 135 Removal of ovarian cyst 7 Salpingectomy 9 Ovariotomy 4 Incision of Bartholins abscess 1 Incision of Bartholins cyst 4 Insertion of pessary 3 Colpo-perineorrhaphy 23 Cauterization of Cervix 19 Baldy Webster Operation 18 Fothergills Operation 19 Insertion of Laminaria Tents 1 Uretheral and cervical smears taken 3 Cervical Polyp 3 Amputation of Cervix 5 Colpotomy 1 Twisted fibroid 2 Biopsy of Cervix 10 Removal of Gauze Packing from Uterus 10 Intra Uterine Lipiodol Suture of Perineum ... ... ... 1 Excision of hymen 1 Colporrhaphy 3 474 OBSTETRICAL. Caesarean Section 45 Evacuation of Uterus and Glycerine Pack 161 For Ectopic Gestation 1 Induction of Labour 36 Rupture of Membranes 57 300 31 MISCELLANEOUS. 26 Blood Transfusions Incisions (Abscesses, etc.) 126 Cleansing of Burns, etc. 4 Amputation of Breast 6 Suture of Wounds 28 Skin Graft 1 Excision of Wounds 5 Lumbar Puncture 44 Aspiration of Chest 38 ,, ,, Knee 3 ,, ,, Abscess 7 Removal of Nail 4 Removal of Foreign Body 12 Paracentesis 37 Suture of Tendon 1 For Cleft Palate 4 Extraction of Teeth 10 Thyroidectomy 2 Injection of Varicose Veins 14 Ligature of Varicose Veins 2 Thoracotomy 5 Removal of Glands 4 Venesection 7 Tissue for Biopsy 7 Removal of naevus 2 399 Number of patients who had teeth extracted 158 32 PUBLIC ASSISTANCE. (a) Domiciliary Relief. Number of Croydon cases resident in the Borough and in receipt of outdoor relief on the— 1st January, 1943 1,794 persons 958 cases 1st July, 1943 1,706 934 ,, 1st January, 1944 1,684 915 ,, Expenditure on Out-relief during the 12 months ended 30th September, 1943, to Croydon cases resident in the Borough:— Half-year ended 31st March, 1943 £31,890 7s. 6d. Half-year ended 30th September, 1943 £29,959 16s. 6d. (b) Institutional Relief. Number of Croydon persons relieved in the Mayday Hospital on 1st January, 1944, and in the Queen's Road Homes on the same date:— Mayday Hospital 26 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 schee instead of separate panels for each such district. Particulars for Year ended 31.3.44. All Districts. (1) Average number of separate patients attended during each quarter 1,367 (2) Attendances at patients' homes 10,205 (3) Attendances on patients at the surgery 11,980 (4) Total number of prescriptions written 21,164 (5) Estimated cost of drugs, dressings and dispensing £985 5s. 3d. (6) Estimated amount of per capita payment to doctors in respect of patients actually attended (calculated quarterly) 4s. 7.42d. (7) Estimated average payment per service point 1.91d. 33 Table 1. INFECTIOUS DISEASES NOTIFIED DURING YEAR 1943. Notifiable Disease. Cases notified in the whole District. Total cases notified in each Ward. Total cases removed to Borough Hospital <S diagnosis confirmed. Total Deaths in the Borough. , Sex Distribution 1943. 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 Scarlet Fever 830 4 322 443 33 23 4 1 56 50 61 74 78 52 59 36 64 72 60 20 59 38 51 720 - 408 422 Diphtheria 57 — 7 33 9 7 1 — 4 — 2 1 2 2 2 2 15 11 7 — 9 — — 55 2 24 33 Erysipelas 41 — 1 3 4 16 17 6 2 — 5 6 4 3 5 3 4 4 2 2 3 3 1 — — 20 27 Cerebro-Spinal Meningitis 7 1 3 1 — 1 1 — — — — — — — 2 2 — — — — 2 — 1 7 I 5 2 Enteric & Paratyphoid 2 - - - 1 1 - - - - 1 - 1 - - - - - - - - - - 2 - - 2 Small Pox - - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 90 — — — 30 60 — — 9 — 56 1 1 — — 1 - 6 1 1 4 10 — 13 — — 90 Ophthalmia Neonatorum 10 10 — — — — — — — — 2 - 1 — — — 1 1 3 1 — 1 — 3 — 5 5 Poliomyelitis and Polio-encephalitis 2 2 - - - - - - 1 - - - - - - - - - - - - - 1 - 2 - Encephalitis Lethargies 1 — — — 1 — — — — — — — — 1 — — — — — — — — — — — — 1 Dysentery 32 2 17 5 1 2 1 4 2 1 9 2 3 - 2 — 2 1 1 5 2 2 — 9 — 20 12 Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Primary and Acute Influenzal Pneumonia 50 1 6 9 8 8 9 9 3 2 4 2 2 5 5 5 8 - 1 2 4 3 4 2 2 30 20 Measles 1895 71 1147 619 46 16 1 1 126 91 102 147 136 109 160 92 113 269 134 53 137 96 130 59 — 965 930 Whooping Cough 325 32 227 60 2 3 1 — 11 — 5 22 36 27 57 35 25 11 12 9 13 20 42 13 2 167 158 34 Comments on the Incidence and Prevalence of Infectious Disease. Scarlet Fever was more prevalent than in 1942. The incidence rate of Diphtheria was U.29, compared with 0.25 in 1942. No cases of Small Pox occurred during the year. There were 90 cases of Puerperal Pyrexia; 30 occurred in the age-group 16—25 years and 60 in the age-group 26—45 years. A majority of the cases occurred in women having their first confinement. BOROUGH HOSPITAL. Table A gives a summary of all cases treated at the Hospital during 1943. 1,123 patients were admitted and discharged which, together with patients in at the commencement of 1943 (142), gives a total of 1,265 dealt with. Seven died, giving a case mortality for the Hospital of 0.6 per cent., as against 1.6 per cent. in 1942. Penge Urban District Counril and the Royal Air Force (Biggin Hill Station) have an arrangement with the Corporation to send their cases to the Hospital. During the year 36 cases were 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 State Inter-Examination. One operation for tonsils and adenoids was performed. During the year a static water tank was erected in the hospital between Wards j and K for emergency use, and a trailer pump acquired, 35 Complaint for which admitted. Patients remaining in Hospital on 1st January, 1943 Patients admitted and discharged in 1943 patients admitted during 1943 and remaining in Hospital on 1st January, 1944 Analysis of Cases admitted whether discharged or not during the year. Total. Recovered. Died. Total. Recovered. Died. Total. Recovered. Died. Total. Recovered. Died. Case Mortality. Average No. of days in Hospital. Scarlet Fever 120 120 - 709 708 1 61 61 - 770 769 1 .1 29.5 Diphtheria 18 18 - 83 86 2 2 2 - 90 83 2 .2 32.3 Enteric Fever 1 1 - 2 2 - — — - 2 2 — — 34 Para-Typhoid Fever — — - 1 1 - — — - 1 1 — — 29 Puerperal Pyrexia - — - 11 11 - 1 1 - 12 12 — — 17.3 Puerperal Fever — — - 1 1 - — — - 1 1 — — 35 Erysipelas — — - 17 17 - — — - 17 17 — — 12.4 Measles — — - 67 66 1 — — - 67 66 1 1.5 12.3 Rubella — — - 7 7 - — — - 7 7 - - 9 C.S.M 1 1 - 14 14 - 2 2 - 16 16 — — 19.3 Whooping Cough — — - 20 18 2 2 2 - 22 20 2 9.1 35 Chicken Pox — — - 29 29 - — — - 23 29 — — 15 Mumps — — - 6 6 - — — . - 6 6 — — 16.1 Tonsilitis — — - 2 2 - — — - 2 2 — — 8 Poliomyelitis — — - 2 2 — — — - 2 2 — — 34 Dysentry 1 1 - 22 22 — 3 3 - 25 25 — — 26 Ophthalmia — — - 5 5 - — — - 5 5 — — 9 Tuberculosis — — - — — — 1 — 1 1 1 — — 16.2 Croup — — - 2 2 — — — - 2 2 — —. 6 Jaundice — — - 1 1 — — — - 1 1 — — 16 Encephalitis — - - 1 1 — — — - 1 1 — — 24 Venereal Disease 1 1 - 9 9 — — — - 9 9 — - 14 Bronco-Pneumonia — — - 1 1 - — — - 1 1 - - 9 Pyloric Stenosis — — - 1 1 — — — - 1 1 — — 18 Meningitis — - - 2 1 1 — — - 2 1 1 50 18 No Disease — — - 39 30 — 1 1 - 31 31 — — — Totals 142 142 - 1050 1043 7 73 72 1 1123 1116 7 — — 36 SCARLET FEVER. The total number of Scarlet Fever cases admitted during the year was 770, an increase of 321 on 1942. The type of disease admitted during the year was of moderate severity. Of the 770 cases, 20 were not cases of Scarlet Fever, leaving a total of 750 cases of true Scarlet Fever. The following complications and sequelae occurred amongst the true Scarlet Fever cases:— Serum Cases. NonSerum Cases. Total. Total Cases 165 585 750 Albuminuria 1 1 2 Adenitis 5 20 25 Otorrhoea 1 14 15 Rhinorrhoea 3 7 10 Relapse 1 1 2 Rheumatism — 3 3 Jaundioe — 1 1 Nephritis — 3 3 The average stay in hospital for serum cases was 29 days and for non-serum cases 29.5 days. One death occurred amongst the Scarlet Fever cases due to general septicemia. The number of complications amongst the 585 non-serum cases was 50, whereas amongst the 165 serum cases it was 11. The disease was prevalent throughout the year with a marked rise during the last quarter of the year. Both M.B. 693 and M.B. 760 proved useful, particularly in clearing up otorrhoea due to streptococcal and staphylococcal infection respectvely. 37 Ages and Sexes Admitted. Scarlet Fever. Age. Male. Female. Totals. 0—1 2 3 5 1—2 21 22 43 2—3 18 23 41 3—4 32 35 67 4—5 60 66 126 5—10 175 165 340 10-15 34 50 84 15—20 16 7 23 20—30 4 13 17 30 or over 10 14 24 Total 1943 372 398 770 Total 1942 265 234 499 DIPHTHERIA. 90 cases were admitted with a diagnosis of Diphtheria, a decrease of 11 cases on 1942. Of these, 18 were found not to be cases of Diphtheria and 26 were cases of positive swabs without clinical symptoms, leaving 46 cases of true clinical Diphtheria. There were two deaths, a mortality of 1.1 per cent : this is a marked decrease on the death-rate for 1942, which was 3.6 per cent. Analysis of 46 cases : Faucial diphtheria 43 Nasal diphtheria 2 Laryngeal diphtheria 1 46 The laryngeal case was operated for tracheotomy successfully. The following complications and sequelae occurred amongst the diphtheria cases : — Rhinorrhoea 2 Otorrhoea 1 Adenitis 7 Paralysis—Palatal 6 Eyes 3 The 18 cases found not to be diphtheria were as follows:— Tonsillitis 12 Vincent's angina 3 Simple croup 2 Teething 1 38 Ages and Sexes Admitted. Diphtheria. Age. Males. Females. Totals. 0—1 — — — 1—2 3 2 5 2—3 1 1 2 3—4 1 — 1 4—5 2 2 4 5—10 14 17 31 10—15 12 9 21 15—20 4 7 11 20—30 — 7 7 30 & over 3 5 8 Total 1943 40 50 90 Total 1942 47 53 100 Typhoid and Para-Typhoid Cases. During the year 3 cases of Typhoid and Para-typhoid Fever were admitted, but in one of these the diagnosis was not confirmed, the patient having an acute abdominal condition. Puerperal Fever. During the year there was one case of Puerperal Fever and 12 of Puerperal Pyrexia. Erysipelas. There were 17 cases of Erysipelas, an increase of G cases over 1942. No deaths occurred amongst them. Measles. There were 67 cases of Measles admitted and 1 death occurred amongst them from broncho-pneumonia. Whooping Cough. There were 22 cases of Whooping Cough, a decrease of 12 cases over 1942. Two deaths occurred amongst them due to broncho-pneumonia. Cerebro-Spinal Meningitis. There were 16 cases of Cerebro-Spinal Meningitis, and of these only in 6 cases was the diagnosis confirmed. In 3 observation for cerebro-spinal meningitis was negative. 1 was a case of acute rheumatism. 1 ,, ,, appendicitis. 1 ,, ,, chronic tetanus. 1 ,, ,, jaundice. 1 ,, ,, meningism. 1 ,, ,, bronchitis. 1 ,, ,, influenza. There were no deaths amongst them. 39 The disease was of average severity, but in cases admitted early the response to treatment was good. 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 about a week. Some cases also received injections of 10—20 cc's of meningococcus anti-toxin intra-thecally. The response to treatment was good, the temperature falling to normal within 24 hours, the patients becoming quieter and more rational. 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. G93 given by the mouth. Ophthalmia Neonatorum. Five cases of Ophthalmia were admitted, but only 2 were cases of real ophthalmia, the other 3 were simple ophthalmia. M.B. 693 given in half tablet doses three or four times a day for three days readily cleared up the discharge in the true ophthalmia cases. Anterior Poliomyelitis. Two cases of this disease were admitted, but one was a case of ricketts. Dysentery. Twenty-five cases were admitted, all due to the Sonne type. Mumps. Six cases were admitted, one being complicated by orchitis. Encephalitis Lethargica. One case was admitted as Encephalitis Lethargica, and this diagnosis was confirmed. Out of Borough Cases. Disease. Males. Females. Total. Deaths. Scarlet Fever 20 15 35 - Diphtheria - 1 1 — Total 20 16 36 — 40 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 2 - Para-typhoid B. — — — — — — — — — 1 — — — — — — 1 - Puerperal Pyrexia — — — — — — — — — 4 — 2 — 6 — — 12 — Puerperal Fever - - - - - - - - - - - - - - - - 1 — Erysipelas — — — — — — 2 — 4 1 — 2 2 2 2 2 17 — Measles 8 1 6 7 16 9 4 5 3 1 2 3 — 1 — 1 67 1 Rubella — — — — — 2 2 1 — — 1 1 — — — — 7 — C.S.M — — 1 1 5 2 2 1 2 — — 1 1 — — — 16 - Whooping Cough 1 3 4 2 1 7 2 2 - - - - - - - - 22 2 Chicken Pox 2 — 2 — 14 — 1 5 — 3 2 — — — — — 29 — Ophthalmia 4 1 - - - - - - - - - - - - - - 5 — Mumps — — — — — — — — 4 —. 2 — — — — — 6 — Anterior Poliomyelitis 1 - - - - - - - - - - - - - - - 2 — Encephalitis - - - - - - - - - - - - - - 1 — 1 1 Dysentery 3 — 1 5 7 3 2 — 1 1 — — 1 — 1 — 25 — Tonsilitis — — — — — — — — — 1 — 1 — — - — 2 — Jaundice - - - - - - - - 1 - - - - - - - - - Croup — — 1 1 - - - - - - - - - - - - - - Meningitis — — — — — — 2 — — — — — — — — — 2 - Pvloric Stenosis — 1 - - - - - - - - - - - - - - 1 — Bronchi Pneumonia — 1 — — — — — — — — — — — — — — 1 - Venereal Disease — — — — — — — 1 - 3 — 4 — 1 — - 9 - Phthisis — — — 1 — — — —. — — — — — — - - 1 - No Disease — — — — — — — — — — — — — — - - 31 — Totals 19 7 15 17 44 23 17 15 15 15 7 15 4 11 4 4 263 4 41 Croydon Borough Hospital Laboratory Report. DIPHTHERIA (Swabs examined). Positive on Admission. Positives during Convalescence Negatives Total Examined 50 63 3,720 3,833 FÆCES EXAMINED FOR ENTERIC AND DYSENTERY GROUPS. Positive B. Morgan No. 1 Dysentery (Sonne) B. Typhosus B. ParaTyphosus B. Negatives Total Examined 2 10 2 1 54 69 SPUTUMS EXAMINED FOR PRESENCE OF T.B. Positives. Negatives Total 0 7 7 CEREBRO-SPINAL FLUIDS EXAMINED FOR ORGANISMS. Meningococccs Haemolytic Streptococcus Longus Negatives Total Examined 3 1 6 10 Miscellaneous Examinations. Urines : routine examinations and cultured for organisms, 35. Eye Swabs: 7 examined, 1 Gonococci present, 3 Staphylococcus Aureas grown, 3 sterile. 42 Blood Cultures 2: 1 Hemolytic Streptococcus Longus cultured, 1 specimen sterile. Swabs from Skin 2: Staphylococcus Aureas grown from both swabs. Swabs from Throat for presence of Vincents Angina: 6 examined and found positive. Vaginal Swabs : 11 examined for presence of Gonococcus— all negative. Blood Specimens for Dreyer's Agglutinating tests (3): 1 positive B. Para-Typhosus B., 2 negative. Urethral Swabs: 6 cultured for organisms: 1 B. Coli present, 5 sterile. Plueral Effusion examined for presence of organisms. Haemolytic and Streptococcus Longus seen and cultured. Culture Medea Prepared. LÖeffler's Blood Serum: 350 doz. tubes. Agar Agar 3,500 cc. Meat Broth 13,000 cc. Peptone Water 2,000 cc. 43 For private practitioners Mayday Hos. For Borough Hospital For Chest Clinic For School Medical Other Instns. ofCorporation Other Institutions Total Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. N eg- Pos. Neg. Swabs for Diphtheria 43 039 ... ... ... ... ... ... 30 983 ... ... 2 230 75 2252 Virulence tests for Diphtheria 1 ... ... ... 2 1 ... ... ... ... ... ... ... 3 1 Sputum for Tub. Bac. 39 435 ... ... ... ... 502 882 ... ... ... ... 8 127 549 1444 Pus for Tub. Bac ... 3 ... ... ... ... ... ... ... ... 2 7 ... ... 2 10 Pus for Gonococci ... 6 ... ... ... ... ... ... ... 3 4 40 ... ... 4 49 Pus for other organisms ... 12 ... ... ... ... ... ... ... ... ... 22 ... ... ... 34 Blood for Typhoid Groups 1 8 ... ... ... 1 ... ... ... ... ... 2 ... 2 1 13 Blood for Wassermann 1 1 9 187 ... 3 ... ... ... ... ... 3 ... ... 10 194 Material for Spirochaetes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Faeces for Typhoid Group 7 11 ... ... ... 1 ... ... (s onne's 1 Dysen tery) 2 17 14 ... ... 25 28 Hair for Ringworm ... ... ... ... ... ... ... ... 6 2 ... ... ... ... 6 2 Examination of Urine 3 ... ... ... ... 12 ... 15 Examination of Pleural Fluid ... ... ... ... ... ... ... ... Examination of C.S. Fluid ... 29 ... ... ... ... ... 29 Other Examinations 338 603 9 1 214 71 72 1308 BACTERIOLOGICAL EXAMINATIONS. I am indebted to the Borough Pathologist, Dr. H. W. Southgate, for the figures given in the appended tables. Table At the Laboratory, Croydon General Hospital. 44 Bacteriological Examination of Milk. Number of Samples submitted for Counts 258 Number under 10,000 per cc 75 Number over 10,000 but under 50,000 per cc 88 Over 50,000 but under 100,000 per cc 31 Over 100,000 but under 500,000 per cc 49 Over 500,000 but under 1,000,000 per cc 13 Over 1,000,000 per cc 2 Tubercle Bacilli— Number of samples of milk submitted 258 Number found positive by inoculation test 0 The number of milk examinations decreased by 220 Number of samples still under investigation for T.B 0 Milk Samples. 258 milk samples submitted to the Methylene Blue Test, of which 23 failed to satisfy. 55 milk samples were also submitted to the Bacillus Coli Test and 34 were satisfactory. Examinations Done Under the National Health Insurance Act. Nature of Examination. Nature of Examination. Pus for Gonococci 12 (2 pos.) Urine for Chemical Exam. 7 Pus for other organisms 7 Urine for Microscopal Exam. 7 Pus for Tub. Bac. 2 Urine for Tub. Bac 7 Blood for Wasserman 38 (2 pos.) Urine for Cultural Exam. 7 Complete Blood Counts 36 Other Examinations 2 IMMUNISATION AGAINST DIPHTHERIA. New cases came from the following sources:— School cases 2,144 Infant Welfare cases 1,233 Others under 5 years 1,823 The ensuing tables give some further details: — Total number of sessions held 179 Highest attendance at any one session 121 Lowest attendance at any one session 17 Average attendance per session 48 45 Summary of Attendances and Treatment, 1943. Year. Total attended for treatment. New cases attended. No. of sessions held. 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 — 389 185 185 1935 1431 1151 97 634 76 781 766 98.8 781 1936 2285 1661 145 1215 78 1264 1254 99.2 1264 1937 1894 1286 122 1017 86 1222 1215 99.5 1222 1938 2049 1541 115 1208 69 1152 1140 98.9 1152 1939 1488 1020 61 593 76 678 671 98.9 1201 1940 508 428 33 — — — — 419 1941 6639 6639 206 — — — —. — 5833 1942 6581 6133 144 — — — — — 5511 1943 6497 5200 179 756 749 99.07 5854 Summary of Attendances and Treatment, Under Treatment 1.1.43 Total new Cases, 1943. 1943 Cases Completed Treatment. Received A.P.T. Under Treatment 31.12.43 Defaulted. 1297 5200 5354 6497 170 473 Origin and Source of Cases attending. Year. School M.C.W. Total Per cent. Total. Per cent. 1934 339 67 170 33.0 1935 944 66.6 473 33.4 1936 1620 74.8 547 25.2 1937 928 72.2 358 27.8 1938 1179 76.5 362 23.5 1939 704 69.0 316 31.0 1940 216 50.0 212 50.0 1941 4477 67.4 2162 32.6 1942 2660 48.3 2851 51.7 1943 2818 48.1 3036 51.9 Immunisation in Residential Schools and Homes. Owing to the evacuation of Residential Schools and Homes, no immunisation was conducted in the Institutions in 1943. Home Visits by Health Visitors. A total of 35,354 home visits was paid during the year. This was a part of a drive to increase the number of children immunised. 46 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. Transferred toother V.O.s Untraced Removals. In Default. Overage when Registered. South Sub-District 1594 784 4 471 44 26 82 123 60 — West Sub-District 1837 892 7 640 66 15 10 150 T6 1 North Sub-District 661 309 14 225 17 10 12 44 o0 — 4092 1985 25 1336 127 51 104 317 146 1 During the year 2,377 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. 1,112 names were sent on the H Lists to Public Vaccinators to be visited. Return shewing 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, 1943:— 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 and part of No. 5 529 60 589 7 No. 2 Area and part of No. 5 447 27 474 4 No. 3 Area 122 9 131 2 No. 4 Area 154 10 164 — Addington (New) :— 20 1 21 — Queen's Road Homes — Mayday Hospital — — — - Children's Homes — — — - Shirley Residential Schools - - - - 1272 107 1379 13 47 VENEREAL DISEASES. No changes have been made in the Scheme as given in my ReDort for 1930. Attendances at the Croydon Clinic during past 10 years. 1934. 1935. 1936. 1937. 1938. 1939. 1940. 1941 1942 1943. New male patients 297 287 300 395 416 316 187 448 661 239 New female patients 232 213 188 184 257 191 202 258 300 489 Attendances, male patients 5858 5548 7525 8610 7318 4258 2996 3033 3932 2214 Attendances, female patients 3962 5977 5226 5405 5365 3150 1772 1508 1585 4026 Attendances of Croydon patients at various London Hospitals under General Scheme. There were 114 new patients, who made a total of 1,386 attendances. Pathological Examinations at London Hospitals for Croydon Patients. 638 Examinations were made for various Clinics and 3,821 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. — — 7 — 8 — 8 23 St. Thomas's — — 38 — 54 — 79 — 171 South Lon. Hos. for Women — — 67 7 26 1 32 3 136 Royal Free 2 — 32 — 5 — 32 — 71 King's College — — 37 — 17 — — — 54 Whitechapel Clinic, L.C.C. — — — — 2 — 2 — 4 Westminster Hospital — — — — — — — — — Guy's Hospital — — 80 2524 38 620 49 666 3977 Mothers — — 8 — 7 — 8 — 23 Seamen's — — — — — — — — — Total 2 — 269 2531 157 621 210 669 4459 48 Croydon Cases attending London Hospitals. Hospital. Cases seen for the first time. Conditions other than venereal. Total number of 1 attend| ances. Aggregate number of Inpatient Days. Syph. Gon. Endell Street L.C.C - — 5 19 — St. Thomas's — 6 21 301 — Guy's 1 6 26 392 9 King's College 3 1 14 345 8 Royal Free 2 1 2 50 — S. Lond. Hosp. for Women 1 4 16 222 — Whitechapel Clinic, L.C.C. — - — — — Westminster — 1 2 7 — Mothers — — 2 36 96 Seamens — — — 14 — Total 7 19 88 1386 113 I 49 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, 1943. 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 treatment or observation 59 76 - — 11 27 3 1 73 104 177 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 1 7 - - 1 5 - - 2 12 14 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 (2201) 2 5 - - - - - - 2 2 5 11 7 13 „ secondary 2 11 — — - - - - - 1 i 2 2 „ latent in 1st year of infection — 2 - - - - - - 24 8 32 „ all later stages 24 8 - - - - - - - 12 12 „ congenital — 12 - - - - - - - - Soft Chancre - - - - - - - - - - - Gonorrhoea, 1st year of infection — — - - (360)44 114 - - 44 114 158 „ later — — - — 2 4 (130) - 2 6 Non-venereal conditions - - - - - - 165 332 165 332 497 Conditions remaining undiagnosed at 31st December - - - — — — 1 - 1 1 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 3 6 4 - 6 2 - 4 9 12 21 Totals of items 1,2,3 and 4 91 127 64 152 168 338 323 617 940 Number of cases discharged after completion of treatment and final tests of cure or after diagnosis as non-venereal 43 50 - - 45 76 165 332 253 458 711 Number of cases which ceased to attend before completion of treatment and were, on first attendance, suffering from:— Syp'iilis, primary - - - - - - - - - - - ,, secondary 2 2 - - - - - - 2 2 4 „ latent in 1st year of infection - - - - - - - - - - 1 ,, all later stages 2 3 - - - - - - 2 3 5 „ congenital - - - - - - - - - - - Soft Chancre - — - - - 8 - - - - Gonorrhoea, 1 st year of infection - - - - - - - - 8 8 ,, later - - - - - - - - - - 7. Number of cases which ceased to attend after completion of treatment but before final tests of cure 1 - - - 3 - - - 4 -- 4 8. Number of cases tranferred to other Centres or to institutions, or to care of private practitioners 3 3 - - 3 20 - - 6 23 29 9. Number of cases remaining under treatment or observation on 31st December 40 69 - - 13 48 3 6 5 3 12 3 179 Totals of Items 5, 6, 7, 8 and 9 (these totals should agree with those of Items 1 2. 3 and 4) 91 127 - - 64 152 168 338 323 617 940 50  Syphilis Soft Chancre Gonorrhoea Nonvenereal or undiagnosed condition Totals M F M , F M F M F M F 10. Number of attendances (a) for individual attention of the medical officer(s) 836 1641 - - 424 969 483 996 1743 3606 (2 (b) for intermediate treatment, e.g., irrigtion, dressing — — — — 233 10 238 410 471 420 Total Attendances 836 1641 — - 657 979 721 1406 2214 4026 11. In patients:- (a) Total number of persons admitted for treatment during the year 16 5 - - 2 1 - - 18 6 (b) Aggregate number of " in-patient.days " of treatment given 38 5 — - 26 16 — — 64 21 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. 12. Number of cases of congenital syphilis in Item 3 above classified according to age periods — — — — — — — 11 — Microscopical. Others for diagno of Venereal Disea 13. Pathological Work :— for Syphilis for Gonorrhoea Number of specimens examined at, and by the medical officer of, the Treatment Centre — — - Figures in brackets refer to Service Cases. STATEMENT SHOWING THE SERVICES RENDERED AT THE TREATMENT CENTRE DURING THE YEAR, CLASSIFIED ACCORDING TO THE AREAS IN WHICH THE PATIENTS RESIDED. Name of County or County Borough (or Country in the case of persons residing elsewhere than in England and Wales) to be inserted in these headings. Croydon Surrey Kent London Total A. Number of cases from each area included under the following headings in Item 3 Syphilis 46 19 7 3 75 Soft Chancre — — — — Gonorrhoea 98 62 13 4 177 Non-venereal and undiagnosed conditions 299 152 18 7 476 Total 443 233 38 14 728 B. Total number of attendances of all patients residing in each area 3770 1878 377 215 6243 51 CANCER. Deaths from Cancer numbered 456 as compared with 405 in 1942; 377 in 1941; 443 in 1940; 414 in 1939; 380 in 1938; 421 in 1937; 421 in 1936; 321 in 1935; and 371 in 1934. Death-rate per 1,000 of the population for the previous 10 years are as follows:— 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) 1938—1.56 (380) 1943—2.28 (456) 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 1 2 83467 0.024 25 and under 35 years 1 6 7 29715 0.236 35 and under 45 years 5 15 20 32355 0.618 45 and under 65 years 91 81 172 39619 4.341 65 years and over 128 127 255 14344 17.777 226 230 456 199500 2.286 Sites of Fatal Cancer. Site. Male. Female. Total. Percentage of Total. Nostril 1 1 0.219 Skin 2 2 4 0.877 Tongue and Mouth 16 2 18 3.947 Tonsil 5 — 5 1.096 Oesophagus 5 4 9 1.974 Stomach 46 30 76 16.667 Liver 7 9 16 3.509 Bowel 34 34 68 14.912 Rectum 28 10 38 8.333 Bladder 5 4 9 1.973 Prostate 17 — 17 3.728 Larynx 8 1 9 1.973 Uterus — 30 30 6.579 Breast — 43 43 9.430 Ovary — 10 10 2.193 Pancreas 9 17 26 5.701 Peritoneum — 2 2 0.439 Gall Bladder and Duct — 2 2 0.439 Mediastinum 1 — 1 0.219 Bones 7 5 12 2.632 Lungs 22 9 31 6.798 Kidneys 2 2 4 0.877 Eye 1 — 1 0.219 Tr;chae 1 — 1 0.219 Pharynx 2 1 3 0.658 Soleen — I 1 0.219 Paratoid Glands 1 — 1 0.219 Thyroid Gland — 2 2 0.439 Lymphatic Glands 3 2 5 1.096 Genital Organs 2 4 6 1.316 Not defined 1 4 5 1.096 225 231 456 52 Comments on Foregoing Table. The organs most often attacked in descending order of incidence are : In the males—the Bowels and Rectum (27.6 per cent.), the Stomach (20.4 per cent.), the Lungs (9.8 per cent.), the Prostate (7.6 per cent.), and the Tongue and Mouth (7.1 per cent.); in females—the Bowels and Rectum (19.0 per cent.), the Breast (18.6 per cent.), the Stomach and the Uterus (both 13.0 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. Two hundred and forty-one cases of Pulmonary Tuberculosis and 59 cases of Xon-pulmonary Tuberculosis were notified on Form A (primary notifications); of these 135 males and 106 females were pulmonary cases; 26 males and 33 females non-pulmonary. In addition, 67 pulmonary cases and 16 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 1943 by notification or otherwise was 383, as compared with 323 in 1942, and 286 in 1941. 308 of these were cases of Pulmonary Tuberculosis, 179 in males and 129 in females. There were 39 more cases of Pulmonary Tuberculosis in males and 2 fewer in females than in 1942. There were 24 cases of Non-pulmonary Tuberculosis among children under 15 years as compared with 21 in 1942. The number of cases in adults was 51, compared with 31 in 1942. Of the cases notified in 1943, 19 males and 11 females died from the Pulmonary form of the disease during the year, equal to 12.4 per cent, of those notified, and 3 males and 5 females from the Non-pulmonary form. The incidence rate of Tuberculosis of all forms was 1.92 per 1,000 of the population; for Pulmonary Tuberculosis 1.54, and for Xon-pulmonary 0.38 per 1,000 population. The notification rate was 1.50 per 1,000. In 1942 the corresponding figures were 1.65, 1.39, 0.27 and 1.21 per 1,000. 53 Public Health (Tuberculosis) Regulations, 1930. Summary of notifications during the period from 1st January, 1943, to 31st December, 1943 : — FORMAL NOTIFICATIONS. No. of Primary Notifications of New Cases of Tuberculosis Total Notifications on Form A. Age Periods. 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 3 5 14 21 24 27 18 16 6 135 145 Females — 1 1 1 14 20 32 20 5 9 3 106 113 Non-Pulmonary— Males - 3 2 5 8 2 2 4 - - - 26 28 Females - 2 7 4 4 5 8 1 1 1 - 33 36 Supplemental Return. New cases of Tuberculosis coming to the knowledge of ihe Medical Officer of Health during the period from 1st January, 1943, to 31st December, 1943, otherwise than by formal notification:— Age periods. 0—l 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 1 — — 1 7 13 4 9 5 3 44 Females — — 1 — — 4 10 5 1 1 1 23 Non-pulmonary Males 1 — — — 1 3 1 — 1 — - 7 Females — — — — 2 2 3 1 — — 1 9 Notification Register. Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1943:— PULMONARY. NON-PULMONARY. Total Cases. Males. Females. Total. Males. Females. Total. 632 571 1203 122 148 270 1473 54 CLASSIFICATION OF NEW PATIENTS. Pulmonary Tuberculosis. During 1943, 215 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) 101 or 47.0% T.B. plus 1 (early cases, sputum positive) 17 or 7.9% T.B. plus 2 (intermediate cases, sputum positive) 74 or 34.4% T.B. plus 3 (advanced cases, sputum positive) 23 or 10.7% 215 100.0% This is 56 more than in 1942, an increase of 35.2 per cent. 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 1943 1 — 18 38 39 11 107 In 1943 the death-rate from all forms of Tuberculosis was 0.62 per 1,000 population. The rate for Pulmonary Tuberculosis was 0.54 and the rate for Non-Pulmonary Tuberculosis 0.08. Similar figures for 1942 were 0.63, 0.54 and 0.09. Pulmonary Tuberculosis. In 1943 the total number of deaths from pulmonary tuberculosis was approximately the same as in 1942. Most of the deaths in men occurred after the 25th year, whereas in women the greater proportion of deaths occurred in the earlier age groups. 55 There was an increase of 13.6 per cent, in the number of new cases in 1943, compared with 1942, the increase being confined to men. There was no increase in women. The highest incidence was in the age group 25—35 years in both sexes. Non-Pulmonary Tuberculosis. The diagnoses of the new cases entered in the Notification Register during 1943 were as follows:— Male. Female. Spine 2 1 Chest Wall 1 Rib 1 Hip 1 2 Foot 1 Abdomen 3 4 Genito-urinary tract 8 1 Meninges 1 7 Miliary — 2 Glands 8 16 Totals 26 33 Deaths from Non-Pulmonary Tuberculosis. During 1943, 16 deaths were certified to be due to NonPulmonary Tuberculosis, compared with IT in 1942, 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 4 3 7 Tuberculous Polyserositis 1 — 1 •Tuberculous Kidney 2 — 2 Tuberculous disease of the Spine — 2 2 Tuberculous disease of the Spine ond Tuberculous Meningitis — 1 1 Miliary tuberculosis — 3 3 Totals 7 9 16 56 Co-ordination with Medical Practitioners, and Other Branches of the Health Department. During the year 487 cases of suspected Tuberculosis were referred by private medical practitioners; 71 were diagnosed as suffering from Tuberculosis and were subsequently notified. In addition, 50 children were referred bv the School Medical Service, and -31 cases from the Maternity and Child Welfare section of the Public Health Department. 84.6 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 71.3 per cent, in 1942. The number of reports sent in by Insurance medical practitioners on their domiciliary cases (Form G.P. 36) was 150. Examination of Sputum. The results of examinations made in 1943 are as follows : — For Clinic. For General Practitioners. Totals. Positive (i.e., tubercle bacilli present) 509 53 562 Negative (i.e., tubercle bacilli absent) 786 550 1336 Totals 1295 603 1898 For each 100 new cases and contacts examined at the Clinic, 103 specimens of sputum were examined. X-Ray Work. 1,367 X-Ray examinations were made during the year, an increase of 303 over 1942. This is equivalent to 108 for every 100 new cases and contacts seen, and compares with a rate of 114 in 1942. In addition, a certain number of cases who have already been examined at various hospitals are referred to the Clinic. The X-Ray examinations were carried out at Mayday Hospital. Blood Examinations. Blood sedimentation rate was ascertained in 7 cases at Mayday Hospital for the Chest Clinic during the year. Extra Nourishment. Provision of special nourishment in the form of milk was granted to 89 selected cases for varying periods during the year, and 34 cases were in receipt of extra nourishment at the end of the year. 57 Residential Treatment for Pulmonary Tuberculosis. Summary of Patients who received Institutional Treatment during 1943. Institutions. In Institutions on 1.1.43 Admitted During 1943 Discharged During 1943 Died During 1943. Remaining in on 31.12.43. Adults. Adults. Adults. Adults. Adults. M F Ch. M F Ch. M F Ch. M F Ch. M F Ch. Croydon Borough Sanatorium 42 40 85 72 77 70 8 2 42 40 Brompton Hospital and Sanatorium 2 2 — 11 7 — 6 8 — — — — 7 1 Childrens' Sanatorium, Harpenden — — — — — 2 — — — — — — ■ 2 Croydon Borough Hospital — — — — — 1 — — — — — — 1 Burrow Hill Sanatorium 1 — — — — — 1 — — — — — Croydon General Hospital — — — 1 1 — 1 1 — — — — - — Berks and Bucks Joint Sanatorium - - - - - - - - - - - - - - - Creaton Sanatorium — — — — 1 — — 1 — — Horton Hospital (Chest Unit) — — —* 11 8 — 9 5 — — 1 — 2 2 — King George's Sanatorium — — — 2 — — — — — — — — 2 Grosvenor Sanatorium — — — 1 3 — 1 — — — — 3 Langdon Hills Sanatorium — — — — — 1 — — — — 1 Preston Hall — — — 1 — — — — — 1 National Sanatorium, Benenden — — — 1 — — — — — — . 1 East Sussex County Sanatorium 1 — — — — — 1 — — — — __ White Lodge Hospital — — — 1 — — — — — — — — 1 St. Barnabas Home 1 — — 1 — — 1 — — 1 — — St. Margaret's Hospital — — — — 1 — — 1 — — — — — Groundslow Sanatorium — 1 — — — — — 1 — — — King Edward VII Sanatorium — — — 1 — — 1 — — — — ___ — Mayday Hospital 11 8 — 68 64 10 49 45 9 23 13 — 7 14 1 58 51 1 184 157 14 147 132 10 33 16 62 60 5 58 Residential Treatment for Non-Pulmonary Tuberculosis. Summary of Patients who have received Institutional Treatment during 1943. Institution. In Institutions, on 1.1.43. Admitted During 1943. Discharged During 1943. Died During 1943. Remaining in on 31.12.43 Adults. Adults. Adults. Adults. Adults. | M. F Ch. M F Ch. M F Ch. M F Ch. M F Ch. Royal Sea Bathing Hospital 2 — — — 2 — 1 1 — — — — 1 1 — Heritage Craft School — — 2 — — 1 — — — — — — — — 3 St. Nicholas' & St. Martins Hosp..Pyrford 2 — 2 — — 1 2 — 1 — — — — — 2 Roy. Nat. Orthopaedic Hosp — 1 — 3 — — 3 — - — — — — 1 — Lord Mayor Treloar Cripples Hosp. - - 1 - - - - 1 - - - King George's Sanatorium - - - 1 - - 1 - - - - Queen Mary's Hospital - - 1 - - - - - - - - - - - 1 St. Peter's Memorial Home — 1 — — 2 — — 3 — — — — — — — St. Luke's Home — - - 1 - - - - - - - - 1 - - St. Michael's Hcspital — — — 2 — — — — — — — — 2 — — Croydon General Hospital — — — 2 3 4 1 3 4 — — — I — — Shottery Hall Auxiliary Hospital - - - 1 - - 1 - - - - - - - - Mayday Hospital — 1 1 3 7 3 2 6 2 1 1 2 — 1 — Victoria Home for Inv. Children - — — — — 4 — — — — — — — — 4 Papworth 1 - - - - - - - - - - - 1 - - 5 3 7 13 14 13 11 13 8 1 1 2 6 3 10 59 The Immediate Results of Institutional Treatment. The immediate results of treatment of patients discharged from residential institutions during the year are as follows: — Pulmonary Tuberculosis. In Class T.B. Minus, 15 males and 25 females were discharged with the disease in a quiescent condition, i.e., 83.3 per cent, of the total cases in this class : 4 males and 4 females were not in a quiescent condition, 16.6 per cent. In Class T.B. Plus, Group I., the corresponding figures were 7 males and 7 females, quiescent, 82.4 per cent. : 3 males not quiescent, 17.6 per cent. In Class T.B. Plus, Group II., 13 males and 18 females were quiescent, 34.4 per cent. : 31 males and 18 females not quiescent, 54.4 per cent. : 7 males and 3 females died, 11.1 per cent. In Class T.B. Plus, Group III., or advanced group, no case was discharged as quiescent: 6 males and 1 female, not quiescent, 70.0 per cent, and 3 males died, 30.0 per cent. Taking all groups together, 51.5 per cent, of cases were discharged as quiescent; 40.6 per cent as not quiescent: and 7.9 per cent. died. 165 males, 144 females and 2 children suffering from Pulmonary Tuberculosis were discharged from, or died in, Institutions in connection with the Croydon tuberculosis scheme during 1943. Non-Pulmonary Tuberculosis. 25 patients were discharged during the year, and 36 per cent, of these were quiescent. The Chest Clinic and Home Visiting. The subjoined table gives a summary of the work done in connection with the Clinic. 932 new cases were examined during the year. This is equal to 757 for each 100 deaths from the disease. 247 or 200 for each 100 deaths were found to be definitely tuberculous. The total number of attendances at the Clinic was 5,843. The Tuberculosis Officer paid 60 home visits, and the District Health Visitors 1,950 visits, for Clinic purposes. In addition, the Health Visitors made 355 primary visits for the purpose of the Notification Register. 60 The Tuberculosis Officer paid 68 visits to Mayday Hospital, in a consultative capacity, and there examined 309 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 371 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 329 contacts were examined, equal to 267 for each 100 deaths, compared with 238 in 1942, 227 in 1941, 278 in 1940, 325 in 1939, and 301 in 1938. Of these 12 were considered to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 36.4, compared with 1.92 per 1,000 of the general population. 515 appointments for examination were offered to new contacts during 1943, but only 329 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 1,016. This is equivalent to 5.1 persons per 1,000 of the population. During the year 94 Clinic cases died. Of this number 26 or 27.6 per cent, were seen for the first time in 1943. SUMMARY OF CLINIC STATISTICS FOR 1943. Number of persons on Clinic Register, J&nuary 1st, 1943 894 ,, notified cases examined for the first time 55 ,, cases sent for an opiniin 701 ,, first attendances, including 71 inward transfers 1,332 ,, consultations of T.O. with medical practitioners— (a) Personal 13 (b) Other 532 ,, visits paid by T.O. to homes of patients 60 ,, visits paid by T.T3. to Cheam Sanatorium 1 ,, visits paid by T.O. to Mayday Hospital 68 ,, patients examined by T.O. at Mayday Hospital 309 ,, visits paid to homes of patients by Health Visitors 2,305 ,, visits paid to homes of patients by District Nurses for nursing attention 371 « 61 Attendances of patients at the Clinic— Men 2,492 Women 2,636 Children 715 Total 5,843 Number of insured Patients under Domiciliary Treatment at the end of year— Pulmonary 251 Non-Pulmonary 14 Total 265 Number of reports received from Panel Practitioners (G.P.36) 150 ,, report forms sent to Panel Practitioners (G.P.36) 535 ,, reports received from Panel Practitioners on Forms G.P.17 — ,, reports received from Panel Practitioners on Forms G.P.35 4 ,, X-Rays taken 1,367 ,, reports made to Ministry of Pensions by T.O. on general progress of Tuberculous ex-Service Men 74 ,, special reports mad to the Ministry of Pensions by T.O. re lube ulous ex-Service Men (Form M.I'.M.S.D. 122) 10 ,, cases referred to Li"1it Treatment 9 ,, cases referred to Orihopaedic Clinic 17 ,, cases receiving extra nourishment at the end of year 34 ,, cases referred by the Ministry of Labour and National Service Medical Boards for examinaation and report 189 Tuberculosis Maintenance and Other Allowances. The Ministry of Health Tuberculosis Maintenance Allowances (as in Memorandum 266/T) to alleviate patients' financial distress caused by loss of income when undertaking treatment for Pulmonary Tuberculosis, commenced in Croydon on 1st September, 1943: — (1) No. of patients in receipt of Ministry of Health Allowances as at 1.9.43 33—24 in Institutions 9 on Domiciliary trtmt. (2) No. of new patients 37 (3) No. of patients no longer in receipt of Allowances 21 (4) No. of patients in receipt of Ministry of Health Allowances as at 31.12.43 49—26 in Institutions. 23 on Domiciliary trtmt. 62 The Council's extension of the Maintenance Allowances scheme came into force on 3rd November, 1943. These allowances are granted to patients suffering from Pulmonary Tuberculosis who are not entitled to allowances under the Government scheme but who carry out treatment recommended under the Council's Tuberculosis scheme : — (1) No. of patients in receipt of Council Allowances as at 3.11.43 23— 3 in Institutions 26 on Domiciliary trtmt. (2) No. of new patients 2 (3) No. of patients no longer in receipt of Allowances 2 (4) No. of patients in receipt of Council Allowances as at 31.12.43 23— 3 in Institutions 20 on Domiciliary trtmt. 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. 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 15 22 14 18 1 1 — 1 — — — 2 148 Class T.B. Plus— Group 1 15 12 9 8 6 4 - - - - - - 125 Group II 3! 13 4 4 15 7 6 5 4 — 2 2 251 Group III 16 8 — — 2 1 8 5 5 2 1 — 238 Observation Non T.B. 5 3 - - - - - - - - - - - 82 63 27 30 24 13 14 11 9 2 3 4 - 63 Number of Patients January 1st, 1943 84 Admitted, 1943 165 ,, Discharged, 1943 155 Died, 1943 11 ,, Remaining January 1st, 1944 83 ,, X-Ray Screenings 2,268 ,, Refills given 2,118 ,, X-Ray Films taken 495 ,, Gas Replacements 21 ,, A.P. Cases commenced 32 ,, Sputum Tests 910 ,, Pneumoperitoneum 6 Artificial Pneumothorax cases discharged but stfill under treatment 7 males, 14 females (see above), making total discharges males 89, females 77. These Artificial Pneumothorax cases only refer to cases discharged in 1943. Those discharged in 1942 and still having refills have not been included. There were 11 Observation cases sent in—5 males and 6 females. Of the 5 males none was tubercular, and of the 6 females 3 were not tubercular. Therefore, there were 8 Observation cases in non-tuberculars, which are shown above. The 3 that were tubercular are in with the Tubercular cases and are not shown as Observation. Dental Report. Routine dental inspection and treatment for patients in the above institution is carried out as early as their general condition permits attendance at the surgery. In the acute stage attention is confined to those whose dental condition causes discomfort, or when treatment has been specially recommended by the Resident Medical Superintendent, In-patients on 1st Jan., 1943 Admitted during year 1943 Oi.charged Luring year 1943 including deaths In on 1st Jan. 1944. Died during year 1943 M F M F M F M F M F 43 41 89 76 83 77 43 40 9 2 64 Those returning to their homes in Croydon before being rendered dentally fit can, if desired, attend Lodge Road Clinic at a later date for the necessary work to be completed. Treatment sessions devoted to this class of work were 33. Treatment figures given below follow very closely on those obtained during the previous year. Review of Work Done. Males. Females. Total. 1943 1942 Number Examined 60 51 111 113 Referred Treatment 47 46 93 77 Treated 42 40 82 71 Attendances 140 158 298 284 Extractions 41 105 146 154 Fillings 36 63 99 118 Dressings 4 12 16 15 Scalings 19 14 33 30 Root Treatments — — — 4 Denture Dressings 17 17 34 12 Dentures Fitted 3 6 9 3 Dentures Repaired 1 — 1 — Mandibular Injections 9 13 22 13 Chromic. Acid Treatment 3 — 3 — Number of Treatment Sessions : 33. Dental Treatment for Patients Referred from the Chest Clinic to Lodge Road. Patients referred from the Chest Clinic 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 remainder being patients discharged from the Borough Sanatorium at Cheam before treatment could be completed. 65 Summary of Work Done. Males. Females. Total. 1943 1942 Referred from Chest Clinic 6 ]5 21 15 Treatment cases continued from Cheam. 12 7 19 13 Attendances 58 73 131 80 Extractions 21 26 47 28 Fillings 8 17 25 16 Dressings 1 4 5 — Scalings 5 9 14 9 Denture Dressings 38 43 81 49 Dentures fitted 13 15 28 17 Number of Treatment Sessions: 21. The amount of £ I 4s. Od. was taken in attendance fees during the year at Lodge Road. Maternal Mortality. There were 2 deaths directly due to pregnancy, compared with 9 in 1942. The maternal mortality rate was 0.53 per 1,000 births, compared with 2.51 in 1942. The deaths directly due to pregnancy were caused by— (1) Puerperal sepsis : toxaemia of pregnancy. (2) Obstetric shock. Puerperal Pyrexia. Ninety cases of Puerperal Pyrexia were notified. This is a rate of 23.8 per 1,000 births (live and still births). MATERNITY AND CHILD WELFARE. Notification of Births. Notifications were received from— Live Births. Still Births. Total. Midwives 3,594 ... 137 ... 3,731 Doctors, Parents and Others 387 ... — ... 387 3,981 ... 137 ... 4,1.18 66 Accommodation for Confinement. The following table gives information concerning the accommodation utilized for confinements:— Number. Percentage. In Private Houses 1,310 31.81 In Public Institutions 1,883 45.73 Registered Maternity Homes 925 22.46 4,118 Still Births. During 1943, 109 still births were registered in respect of Croydon. Of these 53 were male babies and 56 female; 5 males and 7 females were illegitimate. The proportion of still births to living children was as 1 to 34. The still birth rate was 2.9 per cent, of the total births. The still birth rate, on the same basis as for Infant Mortalty, was 28.8 per 1,000 births. Ophthalmia Neonatorum. Ten cases were notified during 1943. The following table gives the notifications in Croydon durmg the past ten years :— 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 No of Cases 13 13 20 21 20 15 14 17 19 10 Rate per 1,000 Births 4.0 3.9 6.2 6.4 6.0 4.5 4.7 7.0 5.5 2.7 Results of Treatment. Notified. Cases treated. Vision Unimpaired. Vision Impaired Died. Removed Remaining under Treatment At home. In hospital 8 — 1 1 — 10 6 4 Infant Morality. The Infantile Mortality rate was 37 per 1,000 live births registered. For the past 5 years the number of infant deaths have been 1939—130, 1940—116, 1941—90, 1942—137, and 1943—137. 110 deaths of infants occurred in Institutions, including Registered Nursing Homes. Among the 137 deaths, 77 occurred in boy babies and 60 in girls. Of the births, 1,937 were males and 1,739 females. The infantile mortality rate for the two sexes was, therefore, Boys— 40, Girls—35. 67 The rate of infant mortality amongst illegitimate children was 42 per 1,000. The rate in legitimate children was 37 per 1,000. Deaths under one year, arranged in days, weeks and months. CAUSES OF DEATH. 1st day. 2nd day. 3rd day. 4th day. 5th day. 6th day. 7th day lst-2nd wk. 2nd-3rd wk. 3rd-4th wk. Under 1 mnth. 1-2 mths. 2-3 mths. 3-4 mths. 4-5 mths. 5-6 mths. 6-7 mths. 7-8 mths. 8-9 mths. 9-10 mths. 10-11 mths. 11-12 mths. TOTAL. All Causes Certified 26 11 6 3 1 — 3 11 10 10 81 10 10 9 10 7 1 1 1 3 3 1 137 Chicken Pox - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - 1 - - - - 1 Meningitis (not Tuberculous) - - - - - - - - - - - - - - - - - - - - 1 - 2 Convulsions - - - - - - - - - - - - - - - - - - - - - - 1 Laryngitis - - - - - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - - - - - - - - - - 3 Pneumonia (all forms) - - - - - - - 3 2 3 8 4 3 2 4 2 - 1 1 — - 25 Diarrhoea and Enteritis - - - - - - - - 1 2 3 — 4 2 2 3 - - — — 14 Gastritis - - - - - - - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - 1 - - - - - - - - - - - - - 1 Rickets - - - - - - - - - - - - - - - - - - - - - - - Congenital Malformations — — — 2 — 1 2 — 1 6 1 2 — 1 1 - - - — 1 - 12 Premature Birth 17 6 4 1 1 - 1 4 1 3 38 1 - - - - - - - - - - 39 Atrophy, Atelectasis, Debility and Marasmus 3 2 - - - - - 1 4 - 10 - - 2 1 - - - - - - - 13 Injury at Birth 1 2 - - - - - - - 1 4 1 - - - - - - - - - - 5 Other Causes 5 1 2 - - - 1 1 1 - 11 - 1 3 1 1 1 - - 1 1 1 21 Totals 26 11 6 3 1 - 3 11 10 10 81 10 10 9 10 7 1 1 1 3 3 1 137 68 The following table gives the cause of death during the first month of life:— (1) Complications of Labour- Trauma at Birth 4 4 (2) Foetal States— Congenital Heart Malformation 2 Other Congenital Deformities 5 Other Congenital Systemic Diseases (excluding Syphilis) 5 Atelectasis, etc. 10 Syphilis 1 23 (3) Prematurity 38 38 (4) Post-Natal Causes 16 16 81 Percentage Deaths per Total Infantile Deaths. Deaths per 1,000 Births. 1942 1943 1942 1943 Premature Births 22.6 28.5 8.9 10.6 Respiratory Diseases (Pneumonia and Bronchitis.) 20.4 20.4 8.1 7.6 *Infectious Diseases (including Tuberculosis) 5.1 0.7 2.3 0.3 Atelectasis, Debility and Marasmus 15.3 9.5 6.0 3.5 Diseases of Digestion 11.7 12.4 4.6 4.7 Injury at Birth and Congenital 15.3 12.4 6.0 4.7 *Analysed, this was a death due to Tuberculosis. †These deaths were due to Diarrhoea 14; Peritonitis 1; Inguinal hernia 1; Retro pharyngeal abscess 1. MIDWIFERY SERVICE. Midwives Acts, 1902 to 1936. Ninety midwives notified the Local Supervising Authority of their intention to practice within the Borough during 1943. Nineteen ceased practising in the Borough; so that seventy-one remained on the Register at the end of the year. All these were trained and held the certificate of the Central Midwives Board. 69 Confinements Attended by Midwives (including Municipal Midwives). Cases attended by Midwives alone 3,282 79.7% of total Cases attended by Midwives when a doctor was also engaged 417 Cases attended by Midwives when a doctor was also summoned 419 Total 4,118 The Rules of the Central Midwives Board lay down that the Local Supervising Authority must be informed within 36 hours by a midwife if she has summoned medical help during pregnancy; in a confinement or within 14 days afterwards. The following table gives details of the reasons for sending for medical aid:— For Complications during Pregnancy. Abortion 9 Other causes 26 Albuminuria 4 39 For Complications during Labour. Breech 5 Transverse Lie 1 Face 2 Undiagnosed 1 Delayed Labour. 9 Uterine Inertia 8 Prolonged 21 Delayed 22 Other 5 56 Haemorrhage. Ante-Partum 2 Post-Partum 10 12 Other Causes. Adherent and Retained Illness of Mother 7 Placenta 6 Torn Perineum 148 161 For Complications during Puerperium. Pyrexia 18 Pain in Breasts 4 Pain in Legs 13 Other causes 12 47 For Complications in regard to the Baby. Inflammation of Eyes 47 Still Birth 5 Feebleness 16 Other causes 25 Premature Birth 2 95 419 In accordance with Rule 33 of the Central Midwives Board, the following reasons for the discontinuance of breast-feeding were received:— Illness of Mother 10 Insufficient Milk 34 Other Causes 8 Total 52 70 Inspection of Midwives. Dr. Jenkin Lloyd, the Inspector of Midwives, interviewed 22 midwives at the Town Hall. Five visits were paid by her to the homes of midwives. Doctors' Accounts under Section 14 (1) of the Midwives Act, 1918. 329 accounts were received from doctors for services rendered under the provisions of this Section. This compares with 373 in 1942, 215 in 1941, 321 in 1940, 424 in 1939, and 388 in 1938. The total amount of the accounts was £671 1s. 0d. £412 5s. 11d. was ultimately recovered from the patients. In 1942 the amount paid to doctors was £461 16s. 6d. and in 1941 £432 19s. 0d. Nursing Homes. Maternity Homes. Other Nursing Homes. Combined Maternity and other Nursing Homes. Total. No. of Homes on Register on 31/12/42 6 15 17 38 No. of Applications for Registration during 1943 3 __ 3 No. of Homes Registered during 1943 3 _ - 3 No. of Homes on Register on 31/12/43 6 15 14 35 No. of Beds available 56 269 (a) Mat. Beds 62 (a) 118 (b) Other Beds 56 (b) 315 WARTIME NURSERIES. Attendances at War-time Nurseries, 1943. Coldharbour House Whitehorse Road Mayday Road Tennison Road Morland Road Bramley Hill Ritchie Road Date opened 23/2/42 1/6/42 1/6/42 1/6/42 8/3/43 27/10/43 23/11/43 Number on books at end of year 88 53 57 65 64 32 20 Attendances: under 2 5006 4244 5151 3988 3345 466 157 over 2 11241 6859 7321 9252 6385 556 288 Total 16247 11103 12472 13240 9730 1022 445 Number of days opened 305 305 306 306 250 55 32 Average daily attendance 53 36 41 43 39 19 14 71 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 one, or, if necessary, two health visitors, on the staff of the Health Department attend. During 1943, 3,142 new cases under 1 year of age and 755 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 82,453 in 1942 to 85,869 in 1943. Consultations with doctors decreased from 23,208 to 22,935. 57 expectant mothers were seen, an increase of 8 on 1942, and a total of 373 visits to the Centres was paid by them. The total of all visits to the Centres was 86,242, an increase of 3,455 compared with 1942. The highest average attendance of mothers and babies at each session was recorded at St. Stephen's (115.8), Woodside (92.3), South Croydon (91.5), St. John's (85.9), St. Andrew's (85.8), and Municipal (85.2). 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 570 compared with 532 last year, and represent 91 per cent. of the total number of mothers referred. Of the above, 82.5 per cent. presented themselves during the first six months of pregnancy, while the remaining 17.5 per cent. were first seen during the later period of gestation. One of the most welcome signs during recent years has been the very considerable rise in the number of mothers referred during the ante-natal period. 72 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 55 compared with 66 last year. Those seen during the first six months after their confinement constituted 77 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. As in previous years a substantial amount of treatment has been of a conservative nature; there has also been a rise in the number of dentures inserted. One less satisfactory feature noted is that of those referred from the medical side approximately 20 per cent. fail to present themselves for dental examination when required to do so. Attempts at following up such cases have been singularly unsuccessful, and though a small minority attend at a later date when toothache intervenes, there is, apparently, still a substantial section of nursing mothers who, through ignorance or prejudice, fail to avail themselves of existing facilities. The Pre-School Child. The total of the above children referred from Welfare Centres and other sources was 305. This figure, whilst an improvement on the previous year, is still below that recorded during normal times, and it would seem, therefore, that war-time employment undertaken by mothers still tends to restrict treatment for this class of patient. With the exception that fillings inserted were fewer, treatment results compare quite favourably with those mentioned in the last report. Full details are to be found in the ensuing Table. 73 The following summary shows particulars of the work accomplished:— Expectant Mothers. Nursing Mothers' Total. Young Children. New Cases Examined 570 55 625 305 Re-treated 57 51 108 21 Total 627 106 733 326 Attendances 2545 543 3088 508 Fillings 777 75 852 257 Extractions 2192 348 2540 432 " Gas " Cases 326 45 371 122 Local Anaesthesia 453 55 508 73 Scalings and Gum Treatment 348 44 392 5 Dressings 488 63 551 50 Denture Dressings 1081 417 1498 — Silver Nitrate — — - 252 Treatments Completed 364 48 412 270 Number of Sessions (treatment) 422 Appointments kept 81.2% Dentures Fitted: Full 161 Partial 109 Total 270 The Centres at which patients were examined, or from which they were referred, are given in the following list:— Ante-Natal 655 The Retreat 13 Shirley 15 Post-Natal 2 South Croydon 1 Boston Road 6 Municipal St. Alban's 24 St. Stephen's 18 Midwives 224 Woodside 12 Holy Trinity 12 Municipal 31 Norbury 12 Addington 1 East Croydon 32 St. Paul's 6 War-time Upper Norwood 3 St. Oswald's 27 Nurseries 25 West Croydon 10 St. Andrew's 4 By Dental South Norwood 14 Waddon 6 Officers 159 Total: 1,312 The amount received for attendance fees was £79 14s. 0d., as against £75 10s. 0d. in 1942. 74 The Work of the Health Visitors.-Maternity and Child Welfare Only. Visits Re:- Adalian Com. 18-3-43 Ashe Bird Bond Left 19-6-43 Buttfield Catlow Cox Left 13-3-43 Cross Devaney Early Ernest Hinton Hobdey Lewis Oakley Overington Ponting Richardson Com. 15-3-43 | Southgate Toneri Wakefield Walker Warman Webb Wilson Wybrew Total Infants under 1 year. First visits 101 99 177 59 217 205 31 94 160 97 211 251 255 157 102 182 68 152 169 262 114 224 161 144 155 218 4066 Re-visits 111 225 242 90 477 615 41 170 639 591 296 685 1103 809 458 646 161 335 199 155 166 459 188 574 432 395 10262 Children 1-2 years. First visits 2 1 2 — 21 4 4 5 19 — 1 2 7 11 6 5 10 3 8 6 1 6 7 6 9 9 155 Re-visits 79 108 186 92 419 404 44 70 360 384 105 333 364 250 343 538 126 181 164 141 146 471 121 336 324 263 6357 Children 2-5 years. First visits 7 2 2 36 2 2 1 12 1 1 1 25 4 5 6 — 2 18 — — 9 5 — 7 23 171 Re-visits 127 206 181 75 747 330 72 82 360 290 117 405 1095 161 413 417 181 213 297 118 246 738 428 486 655 530 8970 Expectant Mothers. First visits 20 19 44 15 43 25 7 43 30 32 53 24 71 20 31 24 19 40 68 48 28 29 45 33 90 51 952 Re-visits 1 4 — — — 3 30 2 44 33 — 51 — 5 1 - 14 3 5 4 — 2 27 1 230 Still Births 3 — 5 — 5 1 — 2 2 3 — — 2 — — 3 - 1 — 10 — — 1 3 6 5 52 Milk (Mothers and Children's Order) - 3 4 - - - - 13 - - 1 - 1 _ _ _ _ - 1 - - _ _ - _ - 23 Deaths under 1 year - 4 2 — 6 2 — 2 4 6 4 — 1 1 3 1 1 4 4 8 2 2 1 2 3 8 71 Miscellaneous visits 1 - 3 — 1 5 2 — — 3 — — 2 1 2 - 2 5 — 2 2 — 2 — 33 ineffective visits 309 168 225 100 364 316 21 306 403 390 227 359 539 210 560 161 283 295 206 341 192 375 171 370 275 263 7429 Totals—1943 761 831 1073 438 2336 1913 224 818 1991 1841 1049 2060 3514 1625 1922 1990 850 1226 1150 1097 900 2319 1130 1956 1985 1771 38771 1942 — 1181 2155 1567 3735 2795 2045 1070 3334 1893 1962 2114 3731 2110 2176 3464 — — 1604 1818 841 3536 2124 2622 2391 2391 52659 75 Attendances at Infant Centres—1943. Municipal. Boston Road. St. Andrew's. South Croydon. Shirley. Woodside. Lr. Addiscombe Road. South Norwood Westow Street. St. Alban's. St. John's St. Oswald's. West Croydon. Norbury. Waddon. Selhurst. Addington. St. Stephen's Total 1943. Total 1942. Infants: New cases under 1 year 406 128 138 182 190 189 331 245 116 206 171 147 79 113 110 90 115 186 3142 3091 No. of re-attendances 5084 2438 1994 2922 2090 2891 4539 4120 1795 4514 2270 3720 1501 2363 1549 1971 2230 3597 51588 46904 New cases over 1 year 78 26 34 43 40 42 101 39 42 45 73 36 32 36 16 27 15 30 755 1003 No. of re-attendances 2954 1209 1952 1336 979 1495 2559 1749 1484 2556 1607 1851 954 1538 1007 1831 1463 1860 30384 31455 Attendances of children 0-5 8522 3801 4118 4483 3299 4617 7530 6153 3437 7321 4121 5754 2566 4050 2682 3919 3823 5673 85869 82453 Consultations with Doctor 2352 874 1024 1250 654 1002 2087 2223 746 2302 1275 1429 930 761 910 1220 840 1056 22935 23208 No. of Sessions 100 49 48 49 49 50 99 99 48 99 48 69 49 49 49 49 96 49 1148 1139 Expectant Mothers: No. of new cases 15 — — 2 15 — — 9 — 1 — — — 4 11 — — — 57 49 No. of re-attendances 15 14 28 - - 36 _ - 4 - 34 28 124 33 - 316 289 Total attendances of Expectant Mothers 30 — — 16 43 — — 45 — 1 4 — 34 32 135 33 — — 373 338 Total attendances 8552 3801 4118 4499 3342 4617 7530 6198 3437 7322 4125 5754 2600 4082 2817 3952 3823 5673 86242 82787 Average attendance per Session 1943 85.2 77.6 85.8 61.5 67.3 92.3 76.1 62.2 71.6 74.0 85.9 83.4 52.4 82.7 54.7 80.0 39.8 115.8 ‡74.8 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 ‡Total average attendance each week at all Centres. 76 Convalescence Committee of the Croydon Mothers' and Infants' Welfare Association. This Committee undertakes the arrangements for convalescence in cases of mothers and children referred for that purpose by the medical officers at the various Infant Welfare Clinics. I am indebted to the Convalescence Secretary for the data given below:— Convalescent Homes. Total number of children under 5 sent to Convalescent homes (with mothers—2) 10 Total number of weeks 87 Cost £112 3s. 1ld. Number of mothers sent for convalescence — Number of children under 5 sent with their mothers to cottages — Home Helps. From 1st January to December 31st, 431 mothers applied for Home Helps, and 381 were supplied. The corresponding figures for 1942 were 348 mothers applied, and 299 were supplied. £575 7s. 8d. was collected in payment for their services. At the end of the year there were 18 names of Home Helps on the register. Babies' Help Report. I am indebted to Mrs. Philpott for the following particulars:— " In January, 1943, five mothers and babies were receiving help. In December three were on the books. During the year 16 have been helped. We are grateful to the Health Visitors for co-operation in distribution of grants." 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. 77 The Tables below give figures for 1943. FOSTER CHILDREN No. as at Dec. 31st 1942 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 1943 Parent Another area with Foster Parent Another Foster Mother Public Institution 139 109 65 18 37 10 5 2 4 144 FOSTER MOTHERS. No. as at December 31st 1942 Applications for Authorisation during the year. Removals during the year Authorisation cancelled for other reasons No. as at December 31st 1943 With Child Without child 152 48 4 8 38 150 The Health Visitors paid 1,164 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 1943. Taking the Registrar-General's figures for maternal mortality (deaths directly due;o pregnancy, but excluding abortion) the rate for England and Wales for 1943 was 2.29 per 1,000 births. In Croydon the rate was 0.53. In "booked" cases treated by the Obstetric Service the rate for 1943 was 1.13 per 1,000 Hospital deliveries; nil per 1,000 home deliveries, and 0.70 per 1,000 over all deliveries. The rate for the Borough, 0.53 per 1,000, is the lowest ever recorded. Of the cases treated to a conclusion at the Post-Natal Clinic during 1943, 88.9 per cent. were classified as " Health Unimpaired." This signifies that anatomically and functionally their condition was the same as before their pregnancies. The corresponding figure for 1942 was 86.1. 78 The number of cases delivered of viable babies in Mayday Hospital, with a nominal 68 beds, was 1,138. The number delivered at St. Mary's Maternity Hospital, with 30 beds, was 617. The number of cases delivered by the Domiciliary Branch of the Service (Municipal Midwives) was 1,072. Including 23 cases admitted after delivery, the total number of deliveries dealt with by the Obstetric Service was 2,850. The total number of infants born was 2,878. In April, 1943 Monteagle Nursing Home was equipped and opened as an annexe to Mayday and St. Mary's Hospitals, providing 20 additional lying-in beds and 2 nurseries. These beds are included in the Mayday Hospital beds named above. Over 650 mothers and babies were transferred from Mayday Hospital, and over 50 mothers and babies from St. Mary's Hospital in 1943 to finish their nursing after about the 7th day. This has made possible the considerable increase in the number of deliveries in Mayday Hospital, and, to a lesser extent, in St. Mary's Hospital, in 1943, as compared with previous years. General Statistics, 1943. No. of live births allocated to the Borough of Croydon 3,676 still ,, ,, ,, „ 109 No. of maternal deaths (directly due to pregnancy) 2 No. of cases of notified Puerperal Pyrexia 73 No. of expectant mothers who attended the Borough Ante- Natal Clinics 4,101 No. of cases delivered in Mayday Hospital as Booked cases (exclusive of abortions) 1.120 No. of cases delivered in Mayday Hospital as Emergency cases (exclusive of abortions) 41 Total cases delivered in Mayday Hospital 1,161 No. of cases delivered in St. Mary's Maternity Hospital as Booked cases 617 No. of cases delivered in St. Mary's Maternity Hospital as Emergency cases Total cases delivered in St. Mary's Maternity Hospital 617 No. of cases delivered by Municipal midwives 1,072 Total 2,850 79 No. of cases admitted to the Puerperal Infection Unit, Borough Hospital and Mayday. Hospital Isolation Wards, including 67 from Mayday Hospital and 6 from St. Mary's Maternity Hospital 83 No. of Maternal deaths in Booked cases from Borough Ante-Natal Clinics 2 No. of Maternal deaths in Emergency cases at Mayday Hospital 0 No. of Maternal deaths in cases admitted as Puerperal Sepsis per se 0 Total Maternal deaths in beds of the Obstetric Service 2* (*Exclusive of Abortion) The total number of patients treated by the Obstetric Service was:— (a) In Mayday Hospital 1,877 (b) In St. Mary's Maternity Hospital 617 (c) In the Borough Hospital Puerperal Infection Unit and Mayday Hospital Isolation Wards, excluding 67 from (a) and 6 from (6) 10 (d) At the Ante Natal Clinics and delivered outside the above Hospitals (including Municipal Midwives' cases) 1,210 (e) At the Post-Natal Clinics, excluding those included in (a), (b), (c) and (d) 1,395 (/) At the Ante-Natal Clincs and undelivered on December 31st, 1943 982 6,091 ANTE-NATAL SUPERVISION. 1942. 1943. No. of Sessions at Ante-Natal Clinics held 572 565 No. of individuals who attended 4,305 4,100 No. of previous year's cases continuing attendance 620 778 No. of new cases 3,685 3,322 No. of cases undelivered on 31st December 1,260 982 Total attendances made 21,540 22,273 Average attendances per session 38 39 No. of cases delivered in hospital as Booked cases 1,509 1,737 No. of cases delivered by Municipal Midwives. 1,153 1,072 No. of cases delivered at other places under the care of private doctors or midwives 183 138 80 No. of patients found not to be pregnant 240 29 No. of patients referred to hospital for Ante- Natal treatment 462 489 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 1943 the Obstetric Service dealt with 2,876 out of the total births allocated to the Borough. Major Ante-Natal Conditions treated at the Ante-Natal Clinic. BREECH PRESENTATION. Breech presentation diagnosed 247 Spontaneous version 18 External version successful 146 External version not successful 83 Allowed to go to term as Breech 83 Not recognised as Breech before labour 3 DENTAL TREATMENT. No. of cases referred to Borough Dental Surgeons 881 No. of cases referred to Private Dental Surgeons 92 No. of cases refusing dental treatment 47 No. of cases seen too late for necessary dental treatment 51 TUBERCULOSIS. Referred from Tuberculosis Officer because of pregnancy 9 Referred to Tuberculosis Officer for opinion on lung condition 12 VENEREAL DISEASE. Gonorrhoea Total cases 12 Transferred to Borough V.D. Clinic 12 Syphilis Total cases 4 Transferred to Borough V.D. Clinic 4 Non-Venereal 23 Independent Midwives Cases. These cases may be summarised as follows:— Total number of midwives' cases during 1943 138 Number of cases sent for one consultation only 94 Number of cases supervised entirely 44 31 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 142 Blood for Kahn Reaction 102 Blood for Gonocorcus Fixation Test 102 Blood for Grouping 202 Blood for Culture 5 Blood for Urea Content 39 Blood for Cell Count, etc. 81 Catheter Urine for Routine Examination 635 Urine for Aschheim-Zondek Test 63 Urine for Urea Concentration Test 192 Lcchia for Culture 77 Sputum for Examination 7 Pus for Identification of Organism 32 Urethral Smears for Gonococci, etc. 12 Cervical Smears for Gonococci, etc. 21 Conjunctival Smears 57 Histological Sections 308 Throat Swabs for Organisms 109 Faeces for Occult Blood, etc. 8 Blood for Hp. Estimation 876 Various 20 Blood Compatibility Tests 105 X-Ray Examinations (Mayday Hospital X-Ray Department). 346 cases were referred from Ante-Natal Clinics. Reasons for reference were: — Breech for Attitude, etc. 86 For Presentation, Attitude, etc. 98 Twins 63 Foetal Death 2 Foetal Parts 2 Disproportion 54 Foetal Abnormalities 19 Abnormal Presentations 12 Pelvic Abnormality 8 Various 2 82 60 cases were referred from the Maternity and Gynaecological Wards at Mayday and St. Mary's Hospitals. Reasons for reference were:— For Presentation 23 Twins and Triplets 6 For Foetal Death 1 For Foetal Parts 2 Breech— Extended Legs 16 Disproportion 8 Hydrocephalus 3 Anencephaly 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 1,097 611 1,708 (2) Delivered in hospital before 28th week 29 — 29 (3) Admitted after delivery 26 - 26 (4) Discharged undelivered after ante-natal treatment and not subsequently delivered in hospital - - - (5) Died undelivered — — — (6) Ectopic Pregnancy - - - 1,152 611, 1,763 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:— (1) Before Labour: Mayday Hospital. (a) Discharged undelivered 21 (b) Delivered in hospital after 28th week 41 (c) Delivered in hospital before 28th week 147 (d) Died undelivered — (2) After Delivery 8 (3) Ectopic Pregnancy 4 221 83 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 141 8 63 212 Eclampsia 4 — — 4 Persistent vomiting of pregnancy 2 — — 2 Chronic cervitis 3 — — 3 Acute pyelitis 16 — 4 20 Malnutrition, debility, simple anaemia,etc. 30 — 14 44 Reroverted gravid uterus 4 — — 4 2. Intercurrent Diseases. Chronic nephritis 2 — — 2 Pulmonary Tuberculosis 7 — — 7 Venereal disease 16 — — 16 Cardiac disease 25 — 4 29 3. Conditions chiefly Natal. Presentations at Delivery:— Anterior positions of the vertex 933 33 574 1540 Posterior positions of the vertex 38 1 22 61 Breech 69 6 17 92 Shoulder 3 2 1 6 Face and brow 1 — — 1 Complex — — 1 1 45 Caesarean section 45 — — Twins and Triplets 19 2 6 27 Accidental haemorrhage 12 5 — 17 Placenta praevia 21 6 — 27 Hydramnios 11 2 1 14 Prolapse of cord 6 — 1 7 Retained placenta 12 1 4 17 Post-Partum haemorrhage 35 — 27 62 B.B.A. 23 11 — 34 Lacerated perineum 390 6 128 524 Obstructed labour — — — — Premature labour 87 14 25 126 Abortion 47 176 — 223 Ectopic pregnancy — 4 — 4 Abdominal Hysterotomy — 7 — 7 Forceps delivery 83 4 41 128 4. Conditions chiefly Post Natal, excluding re-admissions from Post Natal Clinic. Breast abscess 7 — — 7 Notified pyrexia or fever 47 20 6 73 In addition 10 cases of Puerperal Pyrexia per se were admitted to the Puerperal Infection Unit of the Borough Hospital. 84 Blood Transfusion (45 Obstetrical and 44 Gynaecological cases). For every case, stored blood from the Blood Transfusion Depot, Sutton, was used. One Mayday 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., 1943 44 5 17 66 - Total No. of live births, still births and infants admitted with Mother (B.B.A.) 1138 48 617 1803 - No. of infants in Hospital on 31st Dec., 1943 50 2 18 70 -— Alive on discharge from Hospital 1104 39 618 1761 97.6 Stillborn 41 7 11 59 3.33 Died (born alive, but died in Hospital) 33 4 6 43 2.5 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 1,101 infants discharged from Mayday Hospital, 790 were up to or over birth weight (71 per cent.) Of 606 infants discharged from St. Mary's Maternity Hospital, 441 were up to or over birth weight (72 per cent.) Twins and Triplets. There were 26 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 19 2 6 27 No. of infants discharged alive 30 3 9 42 No. Of still-birds and infant deaths 8 2 3 13 Foetal and Infant Mortality' 21.0% 40% 25% 23% 85 POST NATAL AND GYNAECOLOGICAL CLINIC. Number of Sessions held 156 „ „ Individuals presented 1,904 „ „ Subsequent attendances 1,328 Total attendances 3,232 Average attendance per session 20 Number of Post-Natal cases 1,837 Number of Gynaecological cases 1,395 END RESULTS. 1,205 cases were treated to their termination (other than death) during the year, and the results were classed as follows:— Mayday St. Mary's M.M. Total. % Health unimpaired 656 326 90 1,072 88.9 Health slightly impaired 83 35 13 131 10.8 Health seriously impaired 1 1 - 2 0.3 Totals, treated to conclusion 740 362 103 1,205 Maternal Mortality (Obstetric Service). Two deaths occurred of mothers dealt with by the Service, both in "Booked" cases. The maternal mortality of "Booked" cases, i.e., cases under the continued supervision of the Service, is 1.13 per 1.000 hospital deliveries, and 0.70 per 1,000 total deliveries, including the Municipal Midwives "Booked" cases. Puerperal Infection, Eighty-three cases were treated in isolation for puerperal infection, 10 of them in the Borough Hospital and 73 in Mayday Hospital. There was one death. Sources of the Cases. Cases. Deaths. From Mayday Hospital:— " Booked " Cases 47 1 " Emergency " Cases 20 — From St. Mary's Maternity Hospital 6 — From other Hospitals 1 — From private doctors, deliveries in Nursing Homes 2 — From private doctors, deliveries at home 7 86 The Assistant Medical Officer of Health for Obstetrics was called in by medical practitioners to see 72 obstetrical and 157 gynaecological patients who could not afford to pay a private consultant. In addition, he was asked by the Medical Superintendent of Mayday Hospital to give an opinion on the obstetric and gynaecological aspects of 52 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 29 Aged 5—16 years 149 Over 16 years 390 Total 568 2.—Education Cases. Aged 7—16 years 114 Combined Total 682 Compared with 1942, the Statutory cases show an increase of 19 and the Educational cases an increase of 39. Six of the cases under Statutory supervision have died. Three died in an institution, 3 under supervision. The Statutory cases are distributed as follows:— In Certified Institutions 191 In Approved Homes 4 On leave from Institutions 7 Under Statutory supervision at home 277 Under Guardianship 59 In Mental Hospitals 8 Observation Cases 22 568 87 The Education cases were distributed as follows:— In Certified Residential Schools 3 In Certified Day Schools 100 In Private Schools — Awaiting vacancies at St. Christopher's. 11 114 During the year the Certifying Medical Officers made examinations and paid visits to the number of 147 to Statutory cases. The Mental Deficiency Visitors paid 1,438 visits to Statutory cases and 857 to Education cases, 2,295 visits in all, a decrease of 483 on 1942 figures. During 1943, twenty-six Statutory cases were dealt with as follows:— Sent to Certified Institutions 18 Placed under Guardianship 3 Sent to Croydon Mental Hospital — Varying Orders: (a) Change of Guardian — (b) From one Institution to another 4 (c) From Guardianship to Institution. 1 (d) Orders closed — Eighty Orders were renewed during the year, .9 of which were Guardianship. Guardianship Cases. There were 59 cases under Statutory Guardianships, 40 of these under the care of relatives, and 19 with Guardians who are not relatives. 9 males and 3 females are at work. 497 visits have been paid to Guardianship cases during the year. There are 7 cases on leave from Institutions (2 boys and 5 girls). 88 Clinic for Mentally Defective, Backward and Abnormal Children. 150 children were examined during 1943. The classifications arrived at, together with recommendations made, are summarised under:— (1) Certified as Mentally Defective: Recommendations. (a) Recommended for Special Day School 51 (b) Recommended for Residential School 2 —53 (2) Found to be dull and backward: (a) Referred to a special class 28 (b) Further trial in ordinary class 3 (c) Re-test in one year 13 (d) To attend St. Giles' because of physical defect — (e) To attend St. Luke's 1 (f) Referred for Medical Treatment 3 —48 (3) Referred to.Child Guidance Clinic 8 — 8 109 Physical and Mental Tests at St. Christopher's 41 ORTHOPAEDIC DEPARTMENT. The arrangements are the same as in 1942. Summary of Cases Attending the Orthopoedic Clinic. Jan. 1st, 1943. New Cases, 1943. Cases Discharged, 1943. Cases on books, Dec. 31st, 1943. M.C.W. S.M.S. Tuberc. M.C.W. S.M.S. Tuberc. M.C.W. S.M.S. T uberc. M.C.W. S.M.S. Tuberc 157 164 81 97 131 17 118 99 12 136 196 86 402 245 229 418 89 Cases Seen by the Orthopaedic Surgeon. Defects. School. M.C.W. Tuberculosis. Total. Cases. Attendances. Cases. Attendances. Cases. Attendances. Cases. Attendances. Infantile Paralysis 14 33 1 5 15 38 Curvature or Postural Defects 31 55 — — — - 31 55 Pes Cavus 5 17 — — — — 5 17 Pes Planus 123 261 40 67 — — 163 328 Genu Valgum 30 69 84 220 — — 114 289 Talipes 9 24 8 17 — — 17 41 Obstetrical Paralysis 2 4 1 7 3 11 Joint Diseases 10 25 1 1 | 56a 9s 1M 135 a 18s 2m 77 181 Injuries 5 11 4 4 — — 9 15 Rickets 1 1 4 8 — — 5 9 Wry Neck 3 5 1 1 — — 4 6 Spastic Paraplegia 15 24 7 13 _ 22 37 Congenital dislocation of the Hip 4 14 1 3 — — 5 17 Other deformities 44 70 57 104 — — 101 174 296 613 209 450 66 155 571 1218 Summarised the Table shows 296 school children attended and made 613 attendances; 209 babies made 450 attendances; and 66 tuberculosis cases made 155 attendances; a total of 571 cases, making 1,218 attendances. 90 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 XRays Cases No. Of Treatments Infantile Paralysis 5 48 2 1 13 — — _ — 6 61 Curvature or postural defect 11 115 4 - - - - - - 11 115 Pes cavus - — — — — — — — — — - Pes planus 5 76 — — — — — — — 5 76 Genu Valgum 1 — 1 1 6 — — 2 6 Talipes 1 1 - - - - - - - 1 1 Joint Disease 5 8 4 — — — 33 42 33 38 50 Injuries 3 73 3 1 — 1 — — — 4 73 Rickets — — — — — — — — — — — Wry Neck 1 23 - 1 3 — — — — 2 26 Spastic Paraplegia — — — — — — — — — - Congenital Dislocation of the Hip. 4 10 5 2 — 2 — — — 6 10 Other Deformities 7 1 6 5 5 2 — — — 12 6 43 355 25 11 27 5 33 42 33 87 424 91 Cases sent to Residential Institutions. Name of Institution. School Cases. M. & C.W. Capes Tuberculosis Cases. Total. No. in on 1st Jan., 1943 Admitted Discharged. No. in on 1st Jan., 1943 Admitted. Discharged. No. in on 1st Jan.. 1943 Admitted. Discharged. No. in on 1st Jan. 1943 Admitted. Discharged. No. in on 1st Jan., 1944 Horton — — — — — — — — — — 1 — 1 Pyrford — — — — — — 2a 1s 2a 3 2 3 2 1s lM 1m croydon Gen. Hosp. — 6 6 1 4 5 — 2a 1a 1 12 12 1 Heritage Craft Schls. 1 1 1 — — — 1s 1s 1s 3 2 2 3 lm Pinner — — — — — — — — — — 1 — 1 Lord Mayor Treloar Hosp. — 1 1 — — — 1m — 1m 1 1 2 — Royal Sea-bathing Hosp. — — — — — — 2a — la 2 — 1 1 shaftesbury Homes — — — — — — — — — — 1 — 1 Queen Mary's Hosp. — — — — — — — — — 1 — — 1 royal Nat. Orth. Hosp — — — — — — la la la 1 1 1 1 mayday Hosp. — 5 3 — 2 2 la 3a 3a 1 12 10 3 2s 2s Tadworth Court — — — — 2 2 — — — — 2 2 — 1 13 11 1 10 9 11 12 13 13 35 33 15 92 Conditions for which Patients were admitted to Hospitals with the Results of Treatment. Condition. In on 1st Jan. 1943 Admitted or transferred. Discharged. I.S.Q. Died. In on 1st Jan. 1944 Arrested. Quiescent. Improved. Infantile Paralysis — 1 — — — — — 1 Tubercular Joint Disease 11 12 2 5 4 2 — 10 Hemiplgeia — — — — — — — — Genu Valgum — 8 — —— 8 — — —— Pes Planus — — — — — — — —— Talipes 1 3 — —— 4 — — — Rickets — — — — — — — — Other Deformities — 5 — — 4 1 — — Spastic Paraplegia — — — — — — — — Scoliosis — 3 — — — 1 — 2 Osteomyelitis 1 —— —— — 1 — — — Congenital Disease of Hip — 3 — —— 1 — —— 2 13 35 2 5 22 4 — 15 The percentage of arrested cases was 4.1 per cent.; quiescent cases was 10.4 per cent.; and 46 per cent, were improved. = Males. =Females. = Total. WELFARE OF THE BLIND—REGISTRATION. As at 31/3/44. TABLE I. 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. — — — 1 — 1 6 1 7 3 3 6 24 23 47 28 21 49 65 63 128 20 23 43 52 114 166 (i) 199 (i) 248 (i) 447 (ii) — (ii) 3 (ii) 3 AGES AT WHICH BLINDNESS OCCURRED. Age period 0—1 Age period 1—6 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 3 6 9 9 9 18 16 9 25 18 11 29 24 19 43 28 25 53 21 41 1 62 20 41 61 18 47 65 14 22 36 Children of School Age. Training and Employment. Normal Mentally Defective Physically Defective Employed Undergoing Training. (h) (i) (j) (k) M. F. M. F. M. F. By Blind Organisations (e) (d) (e) (f) (g) Schools for the Blind 5 (a) Workshops (b) Home workers All others not included in a) and (b Total Employed Industrial Secondary Professional and University Trained but unemployed No training but trainable Unemployable Total other Schools 1 — — — — — 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. Lot at School — — — 1 — — 8 2 10 24 11 35 19 7 26 51 20 71 2 1 3 — — — — — — — — — — — — 146 230 376 199 251 450 OCCUPATIONS OF EMPLOYED BLIND PERSONS. Agents, Collectors, &c. Basket Workers Bedding (including Divans & Ottomans) and Upholstering Boot Repairers Braille Copyists and Proof Readers Brush Makers Carpenters and Woodworkers Chairseaters Clerks and Typists Coal Bag Makers Dealers, Tea Agents, Newsagents, ShopKeepers Firewood Workers Gardeners Hawkers, Newsvendors, &c. Home Teachers Knitters Labourers Massage Mat Makers Ministers of Religion Musicians and Music Teachers Netting Makers Porters, Packers, Cleaners Poultry Farmers School Teachers Ships Fender (Fender) Makers Telephone Operators Tuners Weavers Miscellaneous Total Mattress Makers Machinists Upholsterers Hand Machine Within Institution for the Blind — 2 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 10 In approved Home Workers Schemes — 6 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 35 Others not part— Time workers) — 1 — — — — — — — — — — — — — — — — 1 — 2 2 2 2 — 2 — — 2 — — 4 26 Total — 9 1 — — 2 — — — 2 3 — 4 1 — 1 1 — 12 — 2 4 2 3 — 2 1 3 — 2 12 — 4 71 PHYSICALLY AND MENTALLY DEFECTIVE. (a) Mentally Defective. (b) Physically Defective. (c) (i) Deaf 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 (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. 2 5 7 3 4 7 (i) 6 (ii) 1 (i) 1 (ii) 1 7 2 1 — 1 — 1 1 — — — — — — 13 12 25 1 1 2 2 3 5 3 15 18 . - 93 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. I am indebted to the Secretary of the Voluntary Association for the figures below:— Number of Blind on Register 450 Number of Blind who benefit from instruction in Braille or Moon type (including those who already read) 97 Number of Blind who benefit from part-time instruction 52 Number in remunerative handicrafts— (a) Home worker 35 (b) In workshops 10 (c) St. Dunstan's 14 (d) Workers not included in scheme 26 Home Teacher 1 The Health Visitors paid 309 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, 1943, 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) 2,079 Number of houses inspected under the Housing (Consolidated Regulations), 1925 Number of houses inspected under the Rent Restriction Acts Number of houses inspected where zymotic diseases have occurred House drains tested with smoke (primary) 706 House drains tested with smoke (on application) Number of smoke tests during repair 138 Inspection of drainage work during construction 3,277 Number of water tests during repair 205 Final tests of drains after repair 29 Final tests of drains when completely relaid Length of new drains tested yards 818 Inspection of yards, stables and manure pits 581 ,, passages 231 ,, public conveniences 354 ,, pigstyes 235 ,, tents, vans and similar structures 7 ,, theatres, cinemas, halls, etc. 104 ,, ponds and ditches and static water tanks 135 ,, schools and school lavatories 37 ,, offices 40 ,, common lodging-houses 28 ,, houses let in lodgings ,, premises where offensive trades are conducted 19 ,, gipsy encampments, camps, fairs, etc. 87 ,, cesspools 2 ,, pail closets, privies gathering grounds 207 Number of visits under Rats and Mice (Destruction) Act, 1919— Private Houses 4,225 Shops 2,632 A.R.P.—Inspections concerning measures for protection against gas contamination 122 ,, Miscellaneous inspections and reinspections after air raids 813 ,, Inspections of posts and centres 384 ,, Inspections of damaged houses ,, Inspections of damaged food shops Smoke observations Number of visits re Infectious Diseases 1,479 Inspections of Shops (under Shops Acts) 1,837 Special Early Closing Patrols 135 97 Sunday Patrols 2 Special Evening Patrols (under Shop Hours Act) 5 Inspections under Fertilisers and Feeding Stuffs Act - „ under Pharmacy and Poisons Act 177 „ Dairies 140 „ Farms and cowsheds 172 „ Milkshops 64 „ Premises where food is prepared or sold 7,318 „ Slaughterhouses 97 Factories without mechanical power 183 „ Factories with mechanical power 758 „ Workplaces, Public Health Act 403 „ Outworkers' premises 197 Visits re Young Persons Employment Act 5 Water samples examined 66 Visits to Employers of Outworkers 20 Reinspections of work in progress16,959 Sundry inspections and visits 4,984 Appointments kept with owners, builders, etc. 2,268 Complaints from public investigated (for purposes other than inspection of house) 5,272 Examination of building plans 40 Informal notices outstanding 31-12-42 393 Informal notices served5,195 Informal notices complied 4,449 Number of Informal Notices referred for Statutory Orders 792 Informal notices outstanding 1.194 Statutory notices outstanding 31-12-42 125 Statutory notices served 1,008 Statutory notices complied 861 Total number of complaints received 4,217 Interviews with callers 2,615 Letters received 6,031 Letters and other intimations, etc., sent (not including notices) 3,044 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1943 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 555 Want of windows or ventilators 260 Conditions causing dampness: Defective roofs 695 Defective walls, etc. 504 Want of proper damp-proof course 184 Defective gutters and downspouts 500 Other structural defects: Defective plaster 479 Cleansing and limewashing required 240 Defective floors 194 Insufficient ventilation under floor 64 Defective brickwork, cills, lintels, etc. 105 Defective stoves and fireplaces 227 98 Defective drains, sanitary fittings, etc.: Defective sinks and waste pipes 165 Abolition of drinking water cisterns 34 Defective w.c.'s 243 Defective drainage 180 Stoppage in drains 260 Domestic nuisances: Want of cleanliness 23 Dirty w.c. pans 104 Other nuisances and infringements: Offensive accumulations 105 Insufficient accommodation for sub-tenants 3 Defective manure receptacles 12 Want of manure receptacles 3 Dirty or defective sanitary conveniences 27 Smoke nuisances 16 Sundry nuisances or defects 130 Limewashing of stables 8 Particulars not inserted in Rent Book (Housing Act) 6 ,, ,, ,, (Rent Restriction Act) 23 (2) FACTORIES AND WORKPLACES. Want of cleanliness 13 Inadequate ventilation 1 Insufficient drainage of floors 5 Abstract not exhibited 2 Thermometers required 3 Unreasonable temperature 2 Sundry nuisances or defects 36 W.C.'s—Insufficient 8 ,, Unsuitable or defective 25 ,, Not separate for sexes 15 (3) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924. Food cupboards defective or required 1 Dustbins required 410 Verminous conditions 90 (4) INFRINGEMENTS OF FOOD AND DRUGS ACT, 1938, AND FOOD BYELAWS. Cleansing or repair of walls and ceilings 44 Cleansing or repair of floors, utensils, fixtures, etc. 17 Dirty or defective w.c. accommodation 17 Food storage accommodation required 1 Animals kept in food store — Refese bins uncovered 15 Accumulation in food store and yards adjacent Food in uncovered vehicles or baskets 5 Premises not suitable for storage or manufacture of food — Want of provision of towels 3 Provision of cloakroom accommodation 1 Want of intervening ventilated space to w.c.5 Insufficient or defective sink accommodation and water supply — Drain inlet in food store — Ventilation required in food store 2 Household washing in food store 7 Swill bins defective 13 Food stored in intervening ventilated space of w.c, — 99 (5) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING, ETC. Defective Yard Paving 72 (6) INFRINGEMENTS OF SHOPS ACT. Insufficient or defective w.c. accommodation 16 Reasonable temperature required — Provision of means of heating 6 Unsuitable or insufficient washing facilities 5 Insufficient accommodation for assistants' meals 5 Seating accommodation required for females 5 Infringement in hours of employment — (7) INFRINGEMENTS OF COMMON LODGING BYELAWS — (8) INFRINGEMENTS OF HOUSES LET IN LODGINGS BYELAWS. Defective windows and sashcords 1 Want of artificial lighting to common staircase — Cleansing required 3 Defective w.c. floors — Defective w.c. windows (9) INSPECTION OF AMUSEMENT HOUSES. Defective sanitary fittings — W.C. defective and dirty — Ventilation of w.c.'s 6 (10) KEEPING OF ANIMALS. Nuisances in connection with the keeping of pigs 19 Nuisances arising from the keeping of other animals.. — (11) INSPECTION OF WATERCOURSES, etc. Cleansing of watercourses and ponds — (12) INFRINGEMENTS OF PHARMACY AND POISONS, Etc., ACT. Article not labelled in accordance with the Act ... ... 7 (13) INFRINGMENTS OF RAT AND MICE DESTRUCTION ACT. Infestation of rats on premises where food is prepared or sold 50 Accumulations of refuse, etc., harbouring rats 74 Structural defects allowing ingress of rats into dwelling houses 72 Dilapidated sheds, etc., harbouring rats 15 Rats in business premises 50 Rats in piggeries 15 (14) INFRINGEMENTS OF OTHER BYELAWS. Noisy animals 7 Noisy radio 1 (15) INFRINGEMENTS OF MILK AND DAIRIES REGULATIONS, ETC. Defective paving — 100 Sanitary Certificates. During 1943 requests were made in connection with 16 houses. Rent Restriction Acts. A number of applications were received for certificates as to the condition of repair of the houses concerned. In 13 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 1943, 216 houses have been approved for demolition and Demolition Orders had been made; 202 houses had been actually demolished, the tenants being re-housed when they desired, by the Council. 723 persons were displaced. Twenty-seven 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 1943 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) 2,079 (b) Number of inspections made for the purpose 2,079 (2) (a) Number of dwelling houses included under the head (1) above, which were inspected and recorded under the Housing Consolidated Regulations, 1923 and 1932 — (b) 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 — (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 2,079 II.—Remedy of defects throughout the year without service of Formal Notices:— Number of defective dwelling houses rendered fit in conseauence of informal action by the Local Authority or their officers 652 101 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 repair 455 (2) Number of dwelling houses which were rendered fit after service of formal notices— (a) By owners 249 (b) By local authority in default of owners 90 B.—Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 553 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 480 (b) By local authority in default of owners 40 C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which Demolition Orders were made — (2) Number of dwelling houses demolished in pursuance of Demolition Orders 17 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 730 64 — Without Mechanical Power 183 29 — Other Premises under the Act 604 9 — Total 1517 102 — 102 Defects Found. Particulars. Number of Defects. Referred to H.M. Inspector. Prosecutions. Found. Remedied. Want of Cleanliness 5 5 — — Ineffective Drainage of Floors 5 5 — — Sanitary Conveniences. Insufficient 8 8 Unsuitable or Defective 25 25 — — Not Separate for Sexes 15 15 — — Total 58 58 — Factories. Mechanical 890 Non-Mechanical 400 Public Health Workplaces 735 Other Premises under the Act. Employers of Outworkers 30 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. No. of Bakehouses on Register, 31st December, 1943 92 No. of Basement Bakehouses (included in above) 4 Visits made to Bakehouses during the year 149 Defects found 1 Notices issued and complied with 1 Home Work. Lists of home workers are sent in twice yearly, and last year contained the names of 220 workers residing within the Borough. 197 visits were paid to outworkers and 20 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, 1943. Nature of Work. Number Employed. Outwork in Infected Premises. Outwork in Unsatisfactory Premises. Remarks. Making, Cleaning, Altering and Repairing, Wearing Apparel 125 _ Upholstery Work 1 — — — Lace Goods — — — — Other Classes of Work 30 — — — Total 156 — — — Registered and Licensed Premises in the Borough, 31st December, 1943. Slaughterhouses (not including Public) 1 Bakehouses 92 Houses Let in Lodgings 12 Dairies and Milkshops 136 Cowsheds 8 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 Inspection of Offices—Public Health Act. During 1943, 37 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. SHOPS ACTS. The Shops Act, 1934, contains provisions for dealing with health and comfort of persons employed and also regarding ventilation, temperature, sanitary conveniences, washing facilities and the facilities for taking meals in shops. The Shops (Sunday Trading Restriction) Act, 1936, restricts the sale of certain goods on Sunday, deals with hours which the assistants have to work and introduces new requirements. 104 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. 1,837 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 24,149. The number of men lodgers exceeded 66 per night throughout the year. The receipts and expenditure for the last ten years are as follows:— Receipts. Expenditure. £ s. d. £ s. d. 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 1943 1,039 0 0 1,480 0 0 HOUSES LET IN LODGINGS. There are 12 houses registered under the Byelaws. 3 visits were made for inspection purposes. 105 \ The following table gives the situation of these premises:— Road. Number of Houses Let in Lodgings. Forster Road 8 Clyde Road 4 Notices were served for the conditions and defects found. OFFENSIVE TRADES. Byelaws relating to Offensive Trades were adopted during the latter part of the year 1925. 19 inspections were made of premises where such trades were carried on and notices issued requiring amendments in accordance with the Byelaws. The following are on the Register: — Rag and Bone Dealers 24 Gut Scrapers 2 Rabbit Skin Drier 1 27 RAG FLOCK ACTS, 1911 and 1928. Four samples were obtained and subjected to analysis, the results being as follows:— Number 1 contained 12 parts of Soluble Chlorine per 100,000 . 2 „ 21 „ „ „3 6 „ „ „ „4 5 „ „ „ The 4 samples conformed to the standard of cleanliness prescribed under the Rag Flock Regulations, 1912, made under the Rag Flock Act, 1911. The legal maximum of chlorine allowed is 30 parts per 100,000. SMOKE OBSERVATIONS. During the year 43 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. 104 visits were made to Theatres, Music Halls, Cinemas and premises where stage plays are given. Attention was given to the 106 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. 250 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. 19 notices were served to abate nuisances arising from various causes in connection with the keeping of pigs, and 3 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 7 instances and the nuisance was abated. SCHOOLS. 37 inspections of schools and school lavatories were made during 1943. The water supply in all cases is from the mains. INSPECTION OF WATERCOURSES, Etc. During the year 135 visits were made to ditches, watercourses, static tanks, etc., in order to see whether there were any infringements of the several Acts, etc. PHARMACY AND POISONS ACT, 1933. The Act consolidates the Poisons and Pharmacy Acts from the year 1852. The object is to regulate the sale of certain poisonous substances and the Act contains important provisions. During the year the number of applications granted for the entry of names on the List of Persons entitled to sell Poisons under Part II. of this Act was 5, and application was made and 107 granted for entry into the list of names of 7 deputies. In addition, 208 applications were made for the retention of names on the list for a further period of twelve months. No infringements of the Act were found. FERTILISERS AND FEEDING STUFFS ACT, 1926. Inspection of premises where fertilisers and feeding stuffs were sold were carried out during the year, and no infringement of the Act was found. DISINFECTION. The Borough Disinfecting Station is 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 86,493 articles By Formalin Gas 5,103 „ By Formalin Spray 8,229 ,, 99,825 ,, In addition, 353 articles were destroyed on request. Disinfection after infectious or contagious disease was carried out in: 1,674 rooms at 1,392 houses. 138 hospital wards, clinics, and creche rooms. 1 vehicle. 2,912 library and 952 other books. 3 police stations. 29 gas masks. 1 ambulance. 108 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 1943, 4,338 such articles were disinfected, the receipts for this work amounting to £84 10s. 6d. DISINFESTATION. In addition to the above services disinfection has been carried out for various services, such as report centres, casualty services, engineers' centres, fire services, etc., as follows:— Blankets 1,035 Bolsters 2 Pillows 156 Overalls 101 Mattresses 213 Other articles 3 Cushions 3 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 80. CLEANSING OF VERMINOUS PERSONS, Etc. During the year 11 adults and 165 children were cleansed for verminous conditions, and 446 adults and 925 children for scabies. 109 RATS AND MICE DESTRUCTION ACT, 1919. INFESTATION ORDER, 1943. During the year 801 complaints were received in the Borough. In 7G cases advice was given by the Inspectors. In 129 cases it was found necessary for further investigation, and work was carried out by the Corporation's rat catchers in the remaining 596 cases. The work was carried out by the rat catchers in 104 cases was by trapping and in 492 cases poison was used. 633½ lbs. of pre-bait was laid. 301¾ lbs. of poison bait laid. 59½ lbs. of poison bait was taken. The estimated number of rats destroyed was 2,704. The number of infestations cleared were 208. The District Sanitary Inspectors made 4,255 visits to private houses and 2,662 visits to shops. 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. 110 The following table shows the premises in the Borough at which foodstuffs are known to be sold, manufactured or stored:— General Shops 220 Grocers and Provision Shops 656 Greengrocers and Fruiterers 477 Confectioners, Bakers and Pie Makers 707 Hotel and Restaurant Kitchens and Dining Rooms 213 Butchers 277 Fishmongers (including Fried Fish Shops) 119 Other Food Premises 85 Ham and Beef Shops 92 Sweet Manufacturers 12 2,858 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. 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. PRIVATE SLAUGHTERHOUSES AND MEAT INSPECTION. Control by the Ministry of Food and centralised slaughtering came into force early in 1940, with the result that private 111 slaughterhouses were closed down. After the Public Slaughterhouses 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 1943 the following animals were slaughtered at this Private Slaughterhouse:— Sheep. Goats. Pigs. Total. 1 ... 72 ... 208 ... 281 Summary of Whole Carcases Condemned with the Reasons for such Condemnation. Class of Animal. Tuberculosis Mould. Unsound. Total Carcases. Cattle — — — — Calves — — — — Sheep — 1 — 1 Pigs — — — — Totals — 1 — 1 Carcases Inspected and Condemned. Cattle. Calves. Sheep and Goats. Pigs. Number killed — — 73 208 Number inspected — — 73 208 All Diseases Except Tuberculosis. Whole Carcases Condemned _ 1 Carcases of which some part or organ was condemned e Percentage of the number inspected affected with disease other than Tuberculosis — — 1.37 .96 Tuberculosis Only. Whole Carcases Condemned ... Carcases of which some part or organ was condemned - - - - Percentage of the number inspected affected with Tuberculosis 112 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 2,244 Bakers' Premises 142 Fishmongers 179 Confectioners' Premises 267 Fried Fish Shops 94 Markets 315 Grocers 1,781 Hawkers' Carts & Barrows 135 Greengrocers 430 Hotel and other Kitchens, Poultry & Game Dealers. 26 etc. 411 Cooked & Prepared Meat General Shops 166 Shops 234 Other premises 68 Total: 6,492. 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 1943:— 14 beef parts and trimmings Unsound 328 lbs. beef offals (various) „ 12 lbs. mutton parts „ 1 mutton carcase „ 13 lbs. pigs' offals (various) „ 14 lbs. pork parts „ 9,610 lbs. haddock, cod, whiting, herrings, etc. „ 2,511 lbs. rabbits „ 1,330 lbs. dates, prunes, peas, sultanas, etc. „ 12,208 lbs. potatoes „ 2,977 lbs. flour, cereals, etc. „ 63½ lbs. poultry „ 138 lbs. tea „ 792 lbs. sausage, bacon, pies, etc. „ 984 eggs „ 362 lbs. cheese „ 144 lbs. biscuits and cake „ 2,479 lbs. sugar „ 126 lbs. milk powder „ 140 lbs. dried egg „ 4,395 tins peas, beans, etc. „ 2,288 tins fruit „ 3,717 tins fish „ 6,110 tins milk „ 4,274 tins meat, etc. „ 1,262 jars, bottles, packets jam, sauce, pickles, cocoa, etc. „ Total weight : 63,530½ lbs. „ 113 General Summary of Meat and Other Articles Disposed of during the Year, 1943. Articles. Weight in lbs. Remarks.[/##] Diseased. Unsound. Total. Beef — 1477½ 1477½ — Veal — 8 8 — Mutton — 52 52 Including 1 carcase. Pork — 130 130 — Offal 111 337½ 448½ — Fish — 96101 9610½ Mackerel, Cod, Pilchards, etc. Fruit and Vegetables — 13538 13538 Potatoes, Dates, Prunes, etc. Tinned Goods — 28222 28222 20,784 tins, 1,262 jars, packets, etc. Sundries — 10043½ 10043½ Rabbits, Flour, Cereals, Sugar, etc. 111 63419½ 63530½ Disposal of Condemned Foodstuffs. (1) Government Slaughterhouse, Condemned foodstuff is Pitlake. dealt with by the (2) Government Meat Depot Ministry of Food. (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 14,670 gallons of milk are sold daily in the Borough. Of this amount 97.7 per cent, is bottled, 2.3 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. 114 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 (1942) 6 „ added to the register (1943) — „ discontinued 3 Net 3 Cowsheds on register (1942) 6 „ added to register (1943) 2 „ discontinued Net 8 Number of cows provided for 67 Average number of cows in sheds (1942) 67 Number of dairies and purveyors of milk on the register (1942) 217 Number of dairies and purveyors of milk added to register (1943) — Number of dairies and purveyors of milk discontinued (1943) 81 Net 136 Grand total of Cowsheds, Dairies and Purveyors of Milk on register 31st December, 1943 144 During the year 202 inspections were made of dairies, cowsheds and milkshops. 115 Milk (Special Designations) Order, 1936. The following licences were granted during the year under this Order:— (1) Producers' Licences to use the designation "Accredited" 2 (2) Dealers' Licences to use the designation "Tuberculin Tested"— (a) Bottling establishments 1 (b) Shops 13 (3) Dealers' Licences to use the designation "Accredited"— (a) Bottling establishments ... — (b) Shops — (4) Dealers' Licences to use the designation "Pasteurised"— (a) Pasteurising establishments 2 (b) Shops 45 (5) Dealers' Supplementary Licences to use the designation— (a) Tuberculin-Tested 1 (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 8 Accredited Milk— Licenced local producers supplying milk to a licenced dairyman 32 Pasteurised Milk— Samples from licenced dealers 156 116 The following tables summarise the result of the bacteriological examinations of Accredited and Pasteurised samples during the year:— Accredited Milk. Licences granted under the Milk (special Designations) Order 1936. Present. Absent. Present in 1/100 M.l. Absent. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Satisfied. Not satisfied. Tubercle bacillus - 32 - - - - - - - - - - Bacillus Coli - - 12 20 - - - - - - - - Blood - - - - - 32 - - - - - - Pus - - - - - - - 32 - - - - Detritus - - - - - - - - - 32 - - Methylene Blue Test — — — — — - - - - - 28 4 Totals — 32 12 20 — 32 - 32 - 32 28 4 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 — 156 - - - - - - - - Total number of bacteria — — 17 139 - - - - - - Blood — — - - - 156 - - - — Pus - - - - - - - 156 — — Detritus — — — — — — — — — 156 Totals — 156 17 139 — 156 — 156 - 156 117 These 156 Pasteurised Milk samples contain bacteria per M.l as follows:— Under 1,000 3 1,000—5,000 25 5,000—10,000 26 10,000—20,000 30 20,000—30,000 18 30,000—50,000 21 50,000—100,000 16 Over 100,000 17 156 Under the Regulations, Pasteurised Milk must not contain more than 100,000 bacteria per millilitre. PROVISION AS TO MILK SUPPLY. During the year 72 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 11 Samples in course of delivery from country cowsheds to local dairymen and purveyors of milk in the Borough — Samples taken at dairymen's premises in the Borough 24 Samples taken in course of delivery by local dairymen or milk sellers on their rounds in different parts of the Borough 37 72 The following table summarises the results of the bacteriological examination of Ordinary Milk samples, taken under the 118 Milk and Dairies (Consolidation) Act, 1915, from 1st January— 31st December, 1943 :— 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 - 72 - - - - - - - - - - Total number of bacteria - - 33 39 - - - - - - - - Blood - - - - - 72 - - - - - - Pus — — — — — — — 72 — — — — Detritus — — — — — — — — — 72 — — Methylene Blue Test - - - - - - - - - - 65 7 Totals — 72 33 39 - 72 — 72 — 72 65 7 The 72 samples taken under the Milk and Dairies (Consolidation) Act, 1915, were samples of milk which had been produced in the following areas:— Areas. No. obtained. No. Tuberculosis. Croydon 6 — Kent 3 — Surrey — — Sussex — — *Unclassified 63 — Totals 72 — *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 1943 as no ice cream was manufactured for sale. 119 FOOD AND DRUGS ACT, 1938. During the year 293 samples of Milk and 442 other samples were taken. Summary of Samples. During 1943 samples were obtained and submitted to the Public Analyst as follows:— Smples of Total Samples. Genuine. Not Genuine. Prosecutions. Conviction; Cautions. Apple Juice 1 1 - - - - Arrowroot 3 2 1 — — - Aspirin Tablets 6 6 — — — — Bacon 1 1 — — — — Baked Beans 1 1 — — — — Baked Beans in Tomato Sauce 4 4 — — — — Baking Powder 9 9 — — — — Batter Flour 1 1 — — — — Batter Mix 1 — 1 — — — Beans in Brine 3 3 — — — — Beans with Gravy 1 1 — — — — Beans in Tomato Sauce 1 1 — — — — Beer 6 6 — — — — "Bev" Extract 1 1 — — — — Bicarbonate of Soda 1 1 — — — — Biscuit Mixture,Chocolate flavour 1 1 — — — — Blancmange powder 1 1 — — — — Boiled Beef and Carrots 1 1 — — — — Boric Acid Ointment 1 1 — — — — Braised Beef and Vegetables 1 1 — — — — Bread 8 8 — — — — Bun Mixture, sweetened and flavoured 1 1 - - - - Butter 1 1 — — — — Cake Mixture 1 1 — — — — Cake Mixture, sweetened 7 7 — — — — Carrots, tinned 1 1 — — — — Castor Oil 1 1 — — — — Cheese 9 9 — — — — Chocolate Cup 1 1 — — — — Chocolate Powder, sweetened 2 2 — — — — Cochineal 1 1 — — — — Cocoa 7 7 — — — — Cod Liver Oil 2 2 — — — — Cod Liver Oil Compound 1 1 — — — — Coffee 1 1 — — — — Coffee and Chicory 1 1 — — — — Coffee Essence with Chicory 3 2 1 — — 1 Coffee and Chicory, Essence of 1 1 — — — — Coffee and Chicory Extract 2 2 — — — — Coffee Essence 1 1 — — — — Coffee and Chicory Mixture 1 1 — — — — Compound Syrup of Figs 1 1 — — — — Confectionery 5 5 — — — — Confection of Senna 1 1 — — — — Cooking Fat 3 3 — — — — Carried forward 108 105 3 — — 1 120 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Cautions Brought forward 108 105 3 — — 1 Cordial, Fruit 1 1 „ Blackcurrant 1 1 — — — — „ Lime Flavour 2 1 1 — — — „ Lime Juice 3 3 — — — — „ Peppermint 1 1 — — — — Corned Beef 2 2 — — — — Cornflour 3 3 — — — — Culinary Herbs 1 1 — — — — Curry Powder 2 2 — — — — Custard Powder 5 5 — — — — Custard Powder Substitute 1 — 1 — — — Dried Eggs 3 3 — — — — Drinking Chocolate, sweetened 1 1 — — — — Essence of Almonds 1 1 — — — — Essence of Lemon 2 2 — — — — Egg Substitute Powder 3 3 — — — — Fish Cakes 8 8 — — — — Fish Cake Roll 2 2 — — — — Fish Paste 6 6 — — — — Fish Roll 3 3 — — — — Flavouring Essence, Orange 1 1 — — — — Flour, Batter 2 — 2 — — — Flour, Bun and Cake 4 3 1 — — — Flour, Cake 3 3 — — — — „ ,, Chocolate Flavour 1 — 1 — — 1 „ Pea 1 1 — — — — „ Cake, sweetened 3 2 1 — — 1 „ „ unsweetened 7 6 1 — — 1 „ self-raising 6 5 1 — — 1 „ „ with dried egg powder 1 1 - - - - Flour, plain 1 1 - — — — "Friquix" 1 — 1 — — — Galantine (Liver) 1 1 - — — — Gelatine, powdered 2 2 - — — — Gin 3 2 1 1 1 — Grape-fruit Squash 3 3 - — — — Ginger Beer 3 3 - — — — Ginger Pudding Mixture 1 1 - — — — Gravy Powder 1 1 - — — — Ground Ginger 6 6 - — — — Irish Stew, tinned 1 1 - — — — Jam 5 5 — — — — Jelly Crystals 1 — 1 — — — Junket Powder, sweetened with Dulsac 1 1 - - - - Lancashire Hot-pot 1 1 - — — — Lemonade 4 4 - — — — Lemon Barley 1 1 - — — — Lemonade Powder 1 1 - — — — Lemon Flavouring 3 3 - — — — Lemon Squash 1 1 - — — — Liqueur Brandy 1 1 - — — — Luncheon Meat 4 4 - — — — Luncheon Sausage 1 1 - — — — Maplemeat 1 1 - — — — Margarine 1 1 - — — — Marmalade 3 3 - — — — Meat Paste 4 4 - — — — Meat Roll 1 1 — — — — Meat and Vegetables 1 1 — — — — Carried forward 246 231 15 1 1 5 121 Samples of Total Samples. Genuine Not Genuine Prosecutions Convictions Cautions Brought forward 246 231 15 1 1 5 Milk 293 286 7 — — — Milk Powder, dried 2 2 — — — — Milk Pudding Powder 1 1 — — — — Minced Beef 1 1 — — — — Mineral Water 1 1 — — — — Mineral Water, Orange 1 1 — — — — Mixed Spice 3 3 — — — — Mixed Vegetables 3 3 — — — — Mixed Vegetables in Gravy 2 2 — — — — Mustard Mixture 2 2 — — — — Mustard, French 1 1 — — — — Oatmeal 1 1 — — — — Orangeade 1 1 — — — — Orange Squash 3 3 — — — — Orange Wine Essence 1 1 — — — — Pearl Barley 3 3 — — — — Pease Pudding 1 1 — — — — Pepper 8 8 — — — — Pickles 11 11 — — — — Pickling Spice 1 1 — — — — Prepared Meal 4 4 — — — — Pudding Mixture 2 2 — — — — Pudding Mixture, sweetened 1 1 — — — — Pudding Powder 9 9 — — — — Pudding Powder, sweetened 1 1 — — — — Pudding Sponge, & Cake Mixture 1 — 1 — — 1 Raising Powder, Golden 1 — 1 — — 1 Raising Powder 2 2 — — — — Rice 2 2 — — — — Rice Custard Pudding 1 1 — — — — Sauce 4 4 — — - — Sausages 11 11 — — — — Sausage, Liver 6 6 — — — — Sausage, Luncheon 2 2 — — - — Sausage Meat 6 6 — — — — Sausage, Preserved 4 4 — — - — Savoury roll 1 1 — — — — Scone Mixture 3 3 - - - - Semolina 2 2 - - - - Semolina Pudding Powder 3 3 — — — — Semolina Pudding Mixture 2 2 — — — — Soup 28 28 — — - — Soup, Desiccated 1 1 — — - — Soup Powder 5 5 — — - - Soya Nut Meat 1 1 — — - - Spaghetti 1 1 — — — — Sponge Mixture 2 2 — — — — Sponge Pudding Mixture 2 2 — — - — Stuffing 4 4 — — - — Sugar 3 3 — - - - Syrup of Figs 1 1 — — - — Syrup of Figs, compound 1 1 — — — — Tea 7 7 — - - - Vanilla Flavouring 1 1 — — - - Vanilla Flavouring Essence 2 2 — — — — Veal and Ham Pie 1 1 - - - - Vegetables in Gravy 2 2 — — - — Vinegar 3 2 1 — - 1 Vinegar, Wood 1 1 — — - - Whisky 3 3 — — - — Yorkshire Pudding Mixture 1 1 — — — — Your Pudding and Pancake Mixture 3 3 - - - - Vinegar, Malt 8 7 1 — — 1 Totals 735 709 26 1 1 9 122 Result of Analysis of New Milk Samples. SOLIDS NOT FAT (Legal standard is 8.5%)* 8.1 8.2 8.3 8.4 8.5* 8.6 8.7 8.8 8.9 9.0 9.9 - 1 — 4 21 61 105 73 22 6 - MILK FAT (Legal standard is 3%) 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 4.1 4.2 - 3 9 19 40 62 56 45 31 11 9 3 2 4.3 4.4 4.6 4.7 - 2 1 - Total samples of New Milk : 293. The samples of Milk for analysis were obtained as follows:— Country milk in course of delivery 6 On milk rounds 195 "Appeal to cow" samples — At Shops 89 Taken at Institutions 3 Taken at Farms — Other samples — 293 AVERAGE COMPOSITION OF NEW MILK SAMPLES. Solids not fat 8.64% Milk fat 3.59% Percentage of New Milk samples below legal standard 1.7. Adulterated Samples. The following is a detailed statement of the adulterated samples and the action taken:— No. Sample. Adulteration or Deficiency. Remarks. 1772. Arrowroot Contained 5 per cent. maize starch. Vendor warned. 123 No. Sample. Adulteration or Deficiency. Remarks. 1497. Battermix Contained excessive flourine. 951. Flour, cake, sweetened. do 952. Flour, self raising do 395. Raising powder, golden. do In all these cases the Vendors have been communicated with and steps were taken to ensure that the percentage of flourine is kept down to the minimum. 185. Flour, batter do 1195. Pudding, sponge and cake mixture. do 613. Flour, cake, unsweetened. do 1837. Flour, cake, chocolate flavour. do 1939. Flour, bun and cake. do 382. Custard powder substitute. Sample of wheat flour preparation containing living flour mites. Article and balance of stock at once withdrawn from sale. 363. Vinegar, malt Sample did not contain sufficient malt vinegar, and did contain acetic acid. Vendor communicated with and further samples taken proved genuine. 310. Cordial, lime flavour. In analyst's opinion, cordial sweetening agent should be almost entirely sugar and in this case it was almost entirely saccharin, which is devoid of food value. The Vendors were communicated with and this article proved to have been in stock for over twelve months. It is no longer on sale, as all cordials are now made according to Ministry of Food recipe. 445. "Friquix" Wheat flour mixture containing large numbers of living mites. Article and balance of stock of wholesalers at once withdrawn from sale. 419. Milk Slightly deficient in milk solids. Samples were taken in course of delivery from wholesalers as a result of unsatisfactory results. These also proved unsatisfactory, and the matter was ported to the Authorities in whose areas the farms from which the milk was obtained were situated, asking them to take further samples. Owing to petrol and other restrictions, we were unable to do this ourselves. 428. Milk 4 per cent. added water. 429. Milk 3 per cent. added water. 430. Milk 2 per cent. added water. 431. Milk 1 per cent. added water. 433. Milk 2 per cent. added water. 124 No. Sample. Adulteration or Deficiency. Remarks. 1914. Milk Although the milk solids other than milk fat of the sample were not below the minimum of the Regulations, the freezing point indicates the presence of a small proportion of added water. - 1328. Coffee essence with chicory. This contained 900 parts per million benzoic acid where only 450 parts per million are permitted. Makers communicated with, and they stated that additional benzoic acid was now being used as a preservative than heretofore, owing to shortage of sugar. In this case the limit had been exceeded by an inexperienced employee and steps were being taken to prevent a recurrence. Further samples proved genuine. 1218. Flour, batter Contained large number of living mites, and was unfit for human consumption. Article and balance of stock at once withdrawn from sale. 1207. Jelly crystals Contained 5 parts per million arsenious oxide. Under the regulations, there should not be more than 1.4 parts per million. An attempt was made to purchase further samples, but it was found that the original stock was exhausted and a sample procured proved genuine. 1947. Gin The alcholic strength of the sample was 41.9 degrees under proof. Court case. Fine and costs £12 17s. Od. 603. Vinegar Deficient in acetic acid. Further samples proved genuine. 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. 125 CONTENTS. PUBLIC HEALTH REPORT. PAGE Acts, Adoptive 106 Ambulance Service 8 Amusement Houses 105 Animals, Keeping of 99, 106 Ante-Natal Clinic 79 Babies Help Committee 76 Bakehouses 102 Births 2, 4 Blind Persons 93, 94 Blood Transfusion 84 Borough Hospital 34 Byelaws and Regulations 106 Cancer 51 Cerebro-Spinal Meningitis 38 Chest Clinic 52 Chicken Pox 40 Closet Accommodation 96 Contacts, Tuberculosis 60 Committee 1 Cowkeepers 114 Convalescence 76 Dairies, Cowsheds & Milkshops 115 Deaths 2, 4, 6 Dental Treatment—M. & C.W. 71 Diphtheria 37 Disinfection 107 Disinfestation 108 Dysentery 39 Encephalitis Lethargica 39 Enteric Group 38 Erysipelas 38 Expectant Mothers 71 Factories & Workshops Acts 98, 101 Fertilisers & Feeding Stuffs Act 107 Foods 109, 123 Foods and Drugs Acts 98, 121 Foster-Mothers 77 Foster-Children 77 Gynaecological Clinic 85 Health Visitors, Work of 74 Home Helps 76 Home Nursing 59 Homework 102 Hospitals 77 Hospital ,St. Mary's (Maternity) 78 Houses Let in Lodgings 104 Housing 100 Housing Act 100 PAGE Illegitimacy 2, 3, 4 Immunisation Clinic 44 Infant Welfare Clinics 75, 71 Infant Mortality 3, 66 Infectious Diseases 33 Laboratory Work 13, 41, 43, 81 Local Acts 106 Lodging Houses, Common 104 Marriages 3 Massage Clinic 12 Maternity Homes 70 Maternity Homes, Registration 70 Mayday Hospital 9, 78 Measles 38 Meat Inspection 112 Medical Help Records 69 Mental Deficiency 12, 86 Midwives 68 Midwives, Municipal 69 Midwives Act 69, 70 Milk, Provision of 56, 117 Milk, Examination of 44, 116, 124 Milk, Tuberculous 11.6 Milkshops 115 Mortality in Childbirth 3, 66 Mothers' and Infants' Welfare Association 71 Mumps 39 Municipal Lodging House 104 Neo-natal Deaths 68 Notilication of Birth Acts 65 Nuisances 97 Nursing Arrangements 8 Nursing Homes 70 Obstetrical Unit 77 Offensive Trades 105 Ophthalmia Neonatorum 39, 66 Orthopaedic Department 88 Out of Borough cases 39 Poisons and Pharmacy Act 106 Poliomyelitis 39 Poor Law Relief 32 Population 2 Post-natal Clinic 85 Post-mortems 4, 13 Puerperal Sepsis and Pyrexia 38, 65, 85 Queen's Road Homes 32 126 PAGE Rag Flock Acts 105 Rats and Mice (Destruction) Act 99, 109 Rescue Home 76 Rent Restriction Acts 100 Sanatorium, Cheam 62 Sanatoria, Treatment in 57 Sanitary Administration 96 Sanitary Certificates 100 Sanitary Inspectors, Work of 96 Scarlet Fever 36 Schools 106 Shop Hours Acts 99, 103 Slaughterhouses 110 Smoke Observations 105 Sputum, Examination 56 Still-births 66 St. Mary's Maternity Hospital 78 Suicide 7 Tuberculosis—Cheam Sanatorium 62 ,, Contacts 60 ,, Deaths 55, 57 ,, Dental Treatment 63 ,, Notifications 52 PAGE Tuberculosis—Home Nursing 59 ,, Home Visits 59 ,, Statistics 60 ,, Pregnancy 79 ,, Pneumothorax 63 ,, Institutional Treatment 57 Unmarried Mothers 76 Vaccination 46 Verminous Persons 108 Venereal Diseases 47,81 Vital Statistics 2 Wartime Nurseries 70 Ward Statistics 5 Watercourses 106 Water Supply 7 Whooping Cough 38 Workplaces 98 Workshops 98 X-Rav Examination 11, 12, 56,81 Zymotic Diseases 5 SCHOOL MEDICAL REPORT (See separate Report). PAGE Accommodation 4 Adenoids 12 Blind Children 21 Child Guidance 25 Cleansing of Children 11 Clinics 11 Clothing and Footgear 9 Cost 4 Crippling Defects 19 Deaf Children 22 Deaths 24 Defective Children 22 Defective Hearing 22 Deformities 19 Dental Disease 7 Dental Treatment 13 Ear Disease 22 Epileptic Children 22 Exclusions 9, 10 Eye Clinic 12 Eye Disease 12 Evacuation 9 Following up 11 Health Visitors, Work of 11 Heart Defects 20, 22 Heights and Weights 8, 32 Infectious Diseases 10 Inspection Clinic 11 Inspections, Routine 7 Inspections, Special 27 PAGE Juvenile Employment 23 Lungs, Diseases of 7 Malnutrition 9 Massage Clinic 19 Meals, Provision of 23 Mentally Defective Children 22 Milk, etc., Provision of 4, 23 Minor Ailments 12 Nutrition 9 Orthopaedic Work 19 Orthodontic Service 17 Parents' Attendances 6 Physically Defective Children 22 Remedial Exercises Rheumatism Clinic 20 Sanitary Accommodation — Schools, Special 4. 23 Secondary Schools 24 Speech 22 Staff 29 Statistical Tables 27 Surveys, Uncleanliness 11 St. Christopher's 23 Throat and Nose 12 Treatment 11 Tuberculosis 7 Uncleanliness 7 Vision, Defective 7