Ac 44132 cro 46 Eonnto Borongh of Croydon ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and SCHOOL MEDICAL SERVICE For the Year 1944 OSCAR M. HOLDEN, G.M., M.D., D.P.H. CROYDON: PRINTED BY THE CROYDON TIMES, LTD., 104, HIGH STREET C.T.2. 2-11-45. 150 i. COUNTY BOROUGH OF CROYDON. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and SCHOOL MEDICAL OFFICER For the Year 1944. OSCAR M. HOLDEN, G.M., M.D., D.P.H. To the Chairman and Members of the Public Health Committee. Ladies and Gentlemen, I herewith have the honour to present my Seventeenth Annual Report on the Health activities carried out by the Council, being the 45th of the series. The Report retains the abbreviated form followed last year. The Birth Rate for the year was 19.4 per 1,000, an increase of 1.00 per 1,000 over 1943. The Death Rate was 15.1, an increase of 2.00 per 1,000 of population. The Infantile Mortality rate was 44 per 1,000 live births, an increase of 7 per 1,000 upon 1943. The Maternal mortality was 2.17 per 1,000 total live and still births. These mortality rates all show an increase, possibly accounted for by five years of war conditions, and, although morbidity rates, if available, would be a more accurate index of the general health of the population, there seems to be evidence that the restrictions and rationing of foodstuffs may be having some adverse effect. It would be an exaggeration to say that there is a general state of subnutrition, but it is not unlikely that the restriction of such articles as milk, butter and meat, is not helping to mainfain High nutritional standards among all sections of the population. ii. Notifiable Infectious Diseases remained low, and most gratifying is the infrequency of cases of Diphtheria. Much of the credit of this latter result is due to immunisation. A disease which formerly was prevalent in the town and caused annually deaths among the younger age groups has become of minor significance. There were no deaths during the year from this illness. Full statistics are given of patients treated in Mayday Hospital, which is classified as a general hospital under the Emergency Hospitals Scheme of the Ministry of Health; ^50 beds were held always ready for emergencies, and another 250 were available within 48 hours. The major causes of death among the general population were Diseases of the Cardiac and Circulatory system, which reached a new height of 6.09 per 1,000 of the population. Since 1939 this figure has risen each year. Next were deaths from diseases of the Respiratory system, including Pulmonary Tuberculosis (1.95): and Deaths from War operations, 1.68 per 1,000 of the population. The incidence of skin affections remains high, and it is not particularly associated with dirt or overcrowding. During the year 527 appointments were made for families to attend at the Cleansing Station for Scabies treatment, comprising 1,325 individuals. 470 families attended for the treatment, totalling 1,147 individuals. The method of treatment was by Benzyl Benzoate and was successful in one application in the majority of cases. Very severely infected persons required a second treatment. They numbered 425. It is noticeable that many children admitted to the Borough Hospital, and seen at school have small sores at the corners of the mouth, or behind the ears and at the junction of nose and the upper lip. Also it has been observed that these sores are slow in clearing up. This is, it is suggested, evidence of a degree of subnutrition. The scheme for the diagnosis and treatment of Venereal Disease has functioned on the same lines as formerly. Our experience of the working of Regulation 33B is not such as to lead to any anticipation that it is likely to be of much value as a preventive measure. The particulars obtained are often too vague to give any knowledge of the source of infection. In those instances where accurate information has been given, the person who is the source of alleged infection has, in all but four presented themselves for examination. The following figures iii. give a summary of the work done under the Regulation during 1944:— Contacts notified to the Medical Officer of Health during the period 1st January, 1944—31st December, 1944: M. F. (1) Total number in respect of whom Form 1 was received — 47 (2) No. of cases in (1) in which attempts were made outside the scope of the Regulation to persuade the contact to be examined before the latter had been named on a second Form 1— Contacts found — 16 ,, examined — 12 (3) No. of those in (1) in respect of whom two or more Forms 1 were received — 2 (4) No. of those in (3) who were— (a) found — 1 (b) examined after persuasion — — (c) served with Form 2 — 1 (d) examined after service oForm 2 — 1 (e) prosecuted for failure (i) to attend for, and submit to, medical examination — — (ii) to submit to and continue treatment — — The incidence rate for Pulmonary Tuberculosis was 1.43 per 1,000 of the estimated population, and for non-Pulmonary Tuberculosis 0.23. Both these figures are down upon the 1943 figures. Mass Radiography was not carried out in 1944. Arrangements, however, were completed with the Surrey County Council for the use of their Unit, and premises at 20, Katharine Street were made ready for its reception early in 1945. , The Maternity and Child Welfare Services have continued satisfactorily in spite of the flying bomb attacks, which ol necessity reduced the numbers attending on account of evacuation, and dislocated occasionally the holding of Clinic sessions. Comparison with 1943 shows an increase in attendances at the iv. Infant Welfare Centres, but a decrease in the total number of births notifications. It is interesting also to note—as an illustration of the popular trend—that some 50 per cent, of the total births occurred in Public Maternity Hospitals and another 20 per cent, in Private Maternity Homes. The comprehensive Obstetric Service which has operated in the Borough since 1933, continued to do excellent work. A total of 2,221 patients were dealt with either in Mayday or St. Mary's Hospitals. A total of 21,141 attendances were made by expectant mothers to the Ante-Natal Clinics. The Municipal Midwives delivered 991 mothers in their own homes. It can be claimed with justification that the Council, through its obstetric service, is responsible for the care of at least 75 per cent.—80 per cent, of the births occurring in the Borough. It would therefore seem that arguments which are raised against State or Local Authority intervention in medical affairs are not supported by the public. On the contrary, the demands made are very heavy and cannot always be met with the resources at present available. The Council will have to consider, seriously, a considerable extension of their maternity hospital accommodation and their midwifery service, when times become more settled. Housing conditions in the town have deteriorated and the position is now such as to cause considerable concern. The damage done by the Flying Bomb attacks from the middle of June onwards, was much greater than previous damage incurred in piloted bomber attacks. No new houses have been built, whilst at the same time many hundreds have been totally destroyed. In the nature of events it has not been practicable to take any steps, other than asking for essential repairs to make the premises habitable, with houses which immediately prior to the outbreak of the war were to have been scheduled for inclusion in Clearance or Redevelopment schemes. A total of 1,320 houses were dealt with, of which 1,120 were made fit for habitation. Scarcity of labour and materials have rendered action, even on the reduced scale indicated, a difficult and tedious matter. The Flying Bomb attacks brought new work for the Sanitary Inspectors, inasmuch as wide damage was done to food premises with resultant damage to quantities of food. Twentythree tons of food was condemned as having been rendered unfit for human consumption. In addition, 7 tons of food were removed from shops which had been damaged or rendered unsafe, and placed in the Council's Central Salvage Depot. V. The other work of the Sanitary Inspector's Department continued as during the previous year, but perforce on a restricted scale, as 8 Inspectors had left for H.M. Forces. In conclusion, ladies and gentlemen, I wish to express my indebtedness to the professional, nursing and clerical staffs of my department for the conscientious manner in which they have carried out their duties during the year. Also my thanks are due to the members of the Committee for their help and encouragement throughout a particularly difficult period. I am, Yours faithfully, OSCAR M. HOLDEN, Medical Officer of Health. 1 PUBLIC HEALTH COMMITTEE. NOVEMBER, 1943-1944. The Worshipful The Mayor Councillor Miss L.Gooch. (Alderman A. Lester Boddineton, J P ) Councillor W. H. Gough. CouncillorG. Lewin, J.P. (Chairman) Councillor Mrs. E. M. Regan. Councillor H. Regan (Vice-Chairman). Councillor Mrs. G. L. Rogers. Alderman E. E. L- Arkell, J.P. Councillor D. G. Stewart. Alderman Mrs. B. J. Roberts. Councillor J. T. Twitchett. Alderman Mrs. M. Squire, J.P. Councillor G. H. Ward. Councillor Mrs. V. L. Child. Miss Dorothy Day, M.R.C.S., Councillor E. E. Constable. L.R.C.P., (from 30th September, 1944) Councillor A. V. Dammarell. P. W. Hamond, Esq., M.D. Councillor Miss M. H. Glazier. (to 30th September, 1944) G. G. Genge, Esq., M.D. 2 SUMMARY OF VITAL STATISTICS FOR 1944. Area, 12,617 acres. Population (Census 1931), 233,115. Population (estimated middle of 1944), 190,130. Number of Inhabited Houses (1931 Census), 56,429. Overcrowding Census (1936), 65,550. Rateable Value (1st April, 1944), £2,524,742. Product of a Penny Rate (1943—1944), £9,600. Rate in the £ : 12/4d. Gross expenditure on Health and Hospital Services (administered by Medical Officer of Health £333,946 Income on Health and Hospital Services (excluding transfers) 64,461 Net expenditure on Health and Hospital Services £269,485 Expressed as a Penny Rate, 2/4d. in the pound. M. F. Total. Live Births Legitimate 1,720 1,588 3,308 Illegitimate 129 146 275 3,583 Birth-rate per 1,000 of the estimated resident population, 18.8. Still Births 97. Rate per 1,000 total (live and still) births. 24.5. Birth-rate (live and still births) per 1,000 population, 19.4. Deaths, 2,854 (Registrar-General's figures). Death-rate per 1,000 of the estimated resident population, 15.1. Deaths from diseases and accidents of pregnancy and childbirth, 8; from puerperal and post-abortal sepsis, 3; other causes, 5. 3 Maternal mortality 2.17 per 1,000 total live and still births. Death-rate of Infants under one year of age (157 deaths. 3,583 births)— All Infants per 1,000 live births 44 Legitimate Infants (133 deaths) per 1,000 live births 40 Illegitimate Infants (24 deaths) per 1,000 live births 87 Deaths from Influenza 18 ,, ,, Whooping Cough (all ages) 11 ,, ,, Diarrhoea (under 2 years of age) 15 ,, „ Diphtheria (all ages) — ,, ,, Pneumonia 103 ,, ,, Cancer 410 Rate per 1,000 Population. Deaths from diseases of Cardiac and Circulatory System (including Cerebral Haemorrhage) 6.09 ,, ,, diseases of the Respiratory System (including Tuberculosis) 1.95 ,, ,, diseases of Renal System 0.27 ,, ,, diseases of Digestive System 0.60 ,, ,, Suicide and Violent Causes (excluding War Operations) 0.40 ,, ,, Old Age (local statistics) 0.99 ,, ,, War Operations (local statistics) 1.68 Marriages. The number of marriages solemnised was 1,578, compared with 1,574 in 1943, 2,042 in 1942, 2,187 in 1941, 2,792 in 1940, and 2,674 in 1939. The marriage rate was 8.3 per 1,000 of the population ; 812 were solemnised in Established Churches, 252 in other places of worship, 512 in the Register Office, and 2 performed under Jewish ritual. 4 Births. The births registered were 3,308 legitimate and 275 illegitimate. The birth-rate consequently was 18.8. For England and Wales and in the Great Towns the rates were 17.6 and 20.3. The illegitimate births in Croydon were 7.7 of the total, compared with 7.8 in 1943; 7.5 in 1942; 6.3 in 1941; 5.3 in 1940 and 1939 ; and 4.9 in 1938. The live male births numbered 1,849, the female 1,734, being a proportion of 1,061 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 (26.5) and Waddon (19.9). Those with the lowest were Norbury (10.2) and Upper Norwood (11.5). Deaths. The deaths numbered 2,854, compared with 2,611 in 1943. For 1944 the death-rate was 15.1; for 1943 it was 13.1. The death-rate for England and Wales was 11.6, and for the Great Towns 13.7. For London the death-rate was 15.7. There were 126 inquests held by Coroners in respect of Croydon residents during 1944, and 175 findings by Coroners after post-mortem examination without inquest. 5 Wards with the highest death-rates were Whitehorse Manor (20.2), South (17.9), Upper Norwood (16.1), and Central (16.0). Lowest: Addington (11.5), West Thornton (12.5), and Addiscombe (12.6). 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 12578 145 203 11.5 16.1 62 — — 1.51 0.87 0.08 6.04 0.56 2.15 — 35 Norbury 12620 129 187 10.2 14.8 70 — 0.16 0.78 0.48 — 4.75 0.48 1.98 — 52 West Thornton 15397 191 193 12.4 12.5 52 — 0.19 0.97 0.45 — 3.96 0.39 2.14 + 51 Bensham Manor 12575 197 198 15.7 15.7 71 0.08 0.08 1.43 0.56 — 5.33 0.72 2.30 + 72 Thornton Heath 14172 210 206 14.8 14.5 33 — 0.07 1.34 0.42 0.01 4.66 0.42 1.98 + 77 South Norwood 13851 203 216 14.7 15.6 64 — 0.07 1.37 0.65 0.07 5.13 0.29 1.88 + 74 Woodslde 12623 227 177 18.0 14.0 57 — 0.08 1.11 0.32 0.08 5.31 0.32 1.98 + 38 East 12660 167 172 13.4 13.6 36 — 0.08 0.95 0.47 0.08 5.13 0.47 2.13 + 44 Addlscombe 12806 208 188 16.2 12.6 53 0.08 0.08 1.56 0.70 0.16 4.61 0.31 2.81 + 91 Whitehorse Manor 13134 224 266 17.1 20.2 67 — 0.08 2.13 0.69 — 6.55 0.38 3.65 + 74 Broad Green 13520 236 195 17.5 14.4 21 — 0.15 1.70 0.44 0.07 5.77 0.52 1.92 + 47 Central 9589 133 153 13.9 16.0 75 0.10 — 1.56 0.52 0.10 5.63 0.10 2.19 — 14 Waddon 14366 286 186 19.9 12.9 52 — 0.21 1.32 0.49 — 5.08 0.14 2.02 + 109 South 11856 178 212 15.0 17.9 45 0.08 0.42 1.43 0.25 — 6.16 0.42 2.19 — 13 Addington 8383 222 96 26.5 11.5 49 0.12 — 0.95 0.24 0.12 4.29 0.48 1.55 +211 The Borough 190130 *3583 *2854 18.8 15.1 44 0.03 0.12 1.34 0.51 0.06 5.24 0.40 2.21 +774 * These are the corrected totals. The totals of births in each Ward do not include inward transfers. 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 1444 95 17 31 135 409 757 F 1410 62 19 14 130 292 893 Whooping Cough M 6 4 2 — — — — F 5 1 3 1 — — — Encephalitis Lethargica M — — — — — — — F 1 — — — — — 1 Cerebro Spinal Fever M 2 — 2 — — — — F — — — — — — — Measles M — — 1 — — — — F 1 — — — — — — Influenza M 9 2 — 1 1 1 4 F 9 1 — — — — 8 Poliomyelitis & Polioencephalitis M 1 — — — 1 — — F — — — — — — — Tuberculosis (respiratory) M 65 — — 1 28 27 9 F 27 — 1 — 19 5 2 Tuberculosis (other forms) M 6 1 1 — 2 1 1 F 7 2 2 1 2 — — Syphilitic diseases M 10 — — — — 4 6 F 2 — — — — 1 1 Cancer M 212 — 1 — 11 93 107 F 198 — — — 12 91 95 Diabetes M 1 — — — — — 1 F 11 — — — 3 1 7 Intra cranial vascular lesions M 105 — — — — 29 76 F 169 — — — 2 26 141 Heart diseases M 383 — — — 8 76 299 F 430 — — 1 14 40 375 Other circulatory diseases M 44 — — — — 7 37 F 27 — — — — 2 25 Bronchitis M 85 2 1 1 1 23 57 F 63 1 — — — 6 56 Pneumonia (all forms) M 58 15 4 2 2 14 21 F 45 4 3 — 3 8 27 Other respiratory diseases M 10 — — 1 2 5 2 F 18 — — — 3 5 10 Ulcer of stomach or duodenum M 25 — — — 2 12 11 F 9 — — — — 3 6 Diarrhoea (under 2 years) M 9 9 — — — — — F 6 6 — — — — — Appendicitis M 8 — — 1 1 1 5 F 2 — — — — 1 1 Other digestive diseases M 29 — 1 — 3 10 15 F 27 — — — 5 6 16 Nephritis M 25 — — — 2 7 16 F 26 — — 1 2 4 19 Puerperal sepsis F 3 — — — 3 — — Other maternal causes F 5 — — — 5 — — Congenital debility, malformations, premature birth, etc M 55 51 1 2 1 — F 48 41 1 — 1 2 3 Suicide M 11 — — 1 2 7 1 F 6 — — — 2 2 2 Road traffic accidents M 10 — — I 4 4 1 F 7 — — — 1 2 4 Other violent causes M 182 4 5 19 59 63 32 F 179 2 8 8 47 62 52 All other causes M 93 7 — 2 4 24 56 F 79 4 — 2 6 25 42 Totals 2854 157 36 45 265 701 1650 7 Comparisons with 1943. In the zymotic diseases group there were 11 deaths from Whooping Cough and 1 from Measles. There were again no deaths in the Typhoid group. There were no deaths from Diphtheria, compared with 2 in 1943. The deaths from Pulmonary Tuberculosis decreased by 11: those from Cancer by 44; those from Pneumonia by 14; and 47 in those caused by Bronchitis. Deaths from Suicide show a decrease of 4, and road traffic accidents remained the same. The total number of deaths was 2,854, as compared with 2,611 in 1943. The percentage of deaths under 1 year of age to the total deaths was 5.5 per cent.; deaths under 15 years, 8.3 per cent.: deaths under 65 years, 42.2 per cent.; and deaths over 65 years, 57.8 per cent. The corresponding figures for 1943 were 5.2 per cent., 7.4 per cent., 41.2 per cent., and 58.8 per cent, respectively. The above total differs slightly from the total recorded by the department, as the period covered by the Registrar-General refers to the weekly returns from the Registrars, while the department records are calculated from 1st January to 31st December. WATER. The Water supply is drawn from deep wells in the chalk. These wells are situated in Surrey Street, Stroud Green, Waddon, Selhurst and Addington. A portion of the northern side of the Borough is supplied with water which is purchased in bulk from the Metropolitan Water Board. The amount of water consumed during the year was— Corporation's Wells 1,686,187,783 Metropolitan Water Board in bulk 676,114,000 2,362,301,783 The Water supply has been satisfactory in quality and quantity. During the summer months, owing to the general water shortage, the Metropolitan Water Board prohibited the use of hosepipes for garden watering, etc., within its area of supply, and according to the terms of the Agreement by which a bulk supply of water is purchased by the Corporation from the Board, it was necessary for similar restrictions to be imposed within the Croydon water limits. The supply is piped throughout the area. 8 (a) Bactoriological Examinations. Regular bacteriological examinations were made of the raw water going into supply after treatment. 265 raw water samples and 900 treated water samples were thus examined bacteriologically during the year by the Chemist and Bacteriologist on the staff of the Water Undertaking. In addition 81 samples of treated water were subjected to bacteriological examination by the Consultant Bacteriologist to the Water Undertaking. Further samples were submitted by the Medical Officer of Health for examination by the Public Analyst. The results of the bacteriological examination of the raw waters were typical of waters pumped from the chalk, some of them shewing the normal deterioration in quality which occurs after heavy rain. In all cases the examinations shewed that the raw water was suitable for treatment. The bacteriological examinations of the treated waters shewed that these waters were of uniformly excellent quality. (b) Chemical Analyses. The arrangements for chemical analyses are similar to those for bacteriological examinations. The total numbers of samples analysed in the Water Department's laboratory and by the Consultant were 91 of raw waters and 160 of treated waters going into supply. The results of the chemical analyses were uniformly satisfactory. The waters are not liable to have plumbo -solvent action. No cases of contamination of any of the sources of supply arose during the year. The whole of the population and dwelling-houses within the area of supply are supplied from public water mains direct to the houses. During 1944 the total number of samples taken by the Public Health Department was as follows:— For bacteriological examination 66 For chemical examination 62 All these samples were taken direct from consumers' taps. 9 In two cases the bacteriological results were not entirely satisfactory. Investigation was immediately carried out and check samples taken at adjacent premises. In both cases the contamination proved to be local in character, one being due to the tap from which the sample was taken being contaminated, and the other being due to a defect in the service pipe to a particular house. 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. 1939 Total Deaths 1940 Total Deaths 1941 Total Deaths 1942 Total Deaths 1943 Total Deaths 1944 Total Deaths Death Rate Enteric Fever 2 - 1 - - - - Malaria — — 1 — - — — Poliomyelitis — — — — — 1 0.005 Measles — — 5 — 1 1 0.005 Scarlet Fever — — — 1 1 — — Whooping Cough 3 2 6 3 1 10 0.052 Diphtheria and Croup 16 4 4 3 2 — — Influenza (incl. Influenzal pneumonia) 48 49 36 19 81 19 0.100 Dysentry 1 — 2 2 - — — Erysipelas 2 2 — 1 — 1 0.005 Cerebro-Spinal Fever 2 16 8 6 1 1 0.005 Pulmonary Tuberculosis 89 128 90 97 107 98 0.515 Tuberculous Meningitis Other Tuberculous Diseases 18 21 19 19 16 11 0.058 Cancer, Malignant Disease 419 443 376 409 454 420 2.209 Rheumatic Fever 2 8 2 3 2 2 0.010 Meningitis 3 5 3 9 7 4 0.021 Organic Heart Disease 782 682 672 741 515 563 2.961 Bronchitis, Acute and Chronic 47 130 80 131 150 126 0.663 Pneumonia 151 206 194 113 182 129 0.663 Other Diseases of the Respiratory Organs 13 21 30 22 17 23 0.129 Diarrhoea & Enteritis 23 18 13 15 21 22 0.116 Appendicitis 15 15 10 6 8 8 0.042 Cirrhosis of Liver 12 1 10 5 4 2 0.010 Alcoholism 1 2 1 — — — — Nephritis & Bright's Disease 63 63 60 57 44 44 0.231 *Puerperal Sepsis 2 2 3 3 1 — — *Other diseases and accidents of pregnancy and parturition 2 3 5 9 1 8 2.174 Congenital debility, malformation and Premature Birth 71 53 34 82 73 89 0.461 Violent Deaths (excluding War operations and suicide) 77 61 74 61 46 45 0.236 Suicide 28 20 20 24 21 16 0.084 Other Defined Diseases 662 1152 778 568 860 1206 6.343 Diseases Ill-Defined or Unknown 3 11 2 — 12 8 0.042 Total 2557 3118 2539 2409 2628 2857 — *Calculated per 1,000 live and still births. 1944 showed an increase both in the death and birth rates. The death rate, excluding deaths from War operations, showed a slight increase only (0.4) 10 MAYDAY HOSPITAL. Table I. 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 84 Male Attendants 6 Steward: Mr. R. Grist. Table I. 1.—Total number of admissions (including infants born in hospital) 7,557 2.—Number of women confined in hospital 1,060 3.—Number of live births 1,044 4.—Number of still births 38 5.—Number of deaths among the newly-born (i.e., Under 4 weeks of age) 64 6.—Number of deaths among children under one year (including those given under 5) 97 7.—Number of maternal deaths among women admitted to hospital for confinement 4 8.—Total number of deaths 829 9.—Total number of discharges (including infants born in hospital) 6,130 10.—Duration of stay of patients included in 8 and 9 above— (a) Under four weeks 6,109 (b) Four weeks and under thirteen weeks 1,287 (c) Thirteen weeks or more 230 11.—Number of beds occupied (excluding cost in maternity wards)— (a) Average during the year 413 (b) Highest 545 on 29.2.44 (c) Lowest 252 on 25.8.44 12.—Number of surgical operations under anaesthetic 2,369 13.—Number of abdominal sections •580 The following Specialist Services are carried on:—Orthopædic, Gynecological, Dental, X-Ray, Deep X-Ray Therapy, Massage, Ultra-Violet Light, Ophthalmic, Ear, Nose and Throat, School E.N.T. Clinic, Gastroscopy. 11 Table II. Classification of In-Patients who were discharged from or who died in the Institution during the year ended 31st December, 1944. Disease Groups. Children (under 16) Men and Women. Discharged. Died. Discharged. Died. A.—Acute infectious disease 44 — 10 — B.—Influenza 3 — 8 — C.—Tuberculosis : Pulmonary 3 1 60 36 Non-Pulmonary 3 2 7 3 D.—Malignant Disease — 1 92 101 E.—Rheumatism:— (1) Acute rheumatism (rheumatic fever) together with sub-acute rheumatism and chorea 2 - 5 - (2) Non-articular manifestations of so called "rheumatism" (muscular rheumatism, fibro- sitis, lumbago, and sciatica) - - 5 - (3) Chronic Arthritis — — 10 1 F.—Venereal Disease - - 2 - G.—Puerperal Pyrexia - - 1 - Puerperal Fever — - — - H.—Other diseases and accidents connected with pregnancy and childbirth — — 295 6 I.—Mental diseases 10 — 227 3 J.—Senile decay — — 119 2 K.—Accidental injury and violence 28 2 198 14 In respect of cases not included above. L.—Diseases of the Nervous System and Sense Organs 13 5 92 98 M.—Disease of the Respiratory System 82 16 270 74 N. „ „ Circulatory System 7 4 215 277 0. „ „ Digestive System 120 11 560 61 P. „ „ Genito Urinary System 64 3 95 29 Q- „ „ Skin 65 — 101 1 R.—Other diseases 570 29 490 13 S.—Mothers and infants discharged from Maternity Wards and not included in above figures :— Mothers — — 1150 — Infants 1020 36 — — T.—Any persons not falling under any of the above headings 39 — 45 — Totals 2073 110 4057 719 12 NUMBER OF X-RAY FILMS TAKEN. Spine 291 Bones 1,404 Pelvis 46 Chest 2,531 Barium Meals 506 Barium Enemas 39 Renal 128 Gall-Bladder 96 Teeth 628 Abdominal 32 Maternity Cases 592 Skull 374 6,667 Total number of Cases X-rnyed 3,800 DIAGNOSTIC. 1943. 1944. Oesophagus with Barium 10 3 Barium Meals 124 82 Barium Enemeta 20 27 Gail-Bladder (Plain) 7 9 Cholecystograms 26 20 Renal Tracts (Plain) 23 14 Pyelograms 29 19 Abdomen for F.B.'s, etc. 26 15 Maternity Cases 425 393 Hysterographies 13 7 Lungs (Mayday Hospital) 578 448 (Sick Staff) 3 7 (Staff on Appointment) 100 109 (T.B. Dispensary) 1,506 1,362 (Others) 18 18 Lungs' after Lipiodol 2 1 Heart and Aorta 14 4 Skulls 73 81 Accessory Nasal Sinuses 42 37 Vertebral Column 99 106 Ribs 23 42 Pelvis 31 24 Long Bones 180 209 Short Bones 79 312 Joints 348 391 Teeth and Jaws 151 191 3,950 3,931 Examinations by Portable Set 128 99 13 X-RAY. 1943. 1944 Men's Wards 543 609 Women's Wards 668 574 Children's Wards III 83 Maternity and Gynaecological Wards 128 77 Staff 137 174 Total "In-Patients" 1,587 1,517 T.B. Dispensary (Men) 846 640 (Women) 556 623 (Children under 16) 104 99 Croydon Borough Hospital 2 2 Ante-Natal Clinic 356 316 Queen's Road Homes 29 30 Dental Clinic 112 191 Others 74 373 St. Mary's Hospital 8 9 Total "Out-Patients" 2,087 2,283 Total 3,674 3,800 "Screen Examinations" 945 708 MASSAGE. Massage 9,346 Exercises 14,021 Radiant Heat 6,686 Electrical 544 Infra-red 3,032 Ultra Violet Light 1,251 Wax 56 34,936 Total number of patients treated 1,757 MENTAL PATIENTS DEALT WITH DURING THE YEAR. Male. Female. Admitted 95 135 Certified and sent to Warlingham Park Hospital 9 26 As Voluntary Patients to Warlingham Park Hospital 48 87 Discharged not certified 38 22 14 SPECIMENS EXAMINED IN THE PATHOLOGICAL LABORATORY DURING THE YEAR. Positive. Negative. Swabs for Diphtheria 853 Sputa for T.B 237 398 Pus for T.B 4 1 Pus for Gonococci — — Urine for T.B — 5 Faeces for T.B 6 11 Faeces for Coli Typhoid Group 11 279 Blood—Widals — — 6 Hairs for ringworm 1 1 Blood cultures 8 25 Faeces for occult blood 129 133 2,108 Urine for routine examination 885 Pus for organisms 195 Blood urea estimations 248 Blood sugar estimations 113 Cerebro spinal fluids 53 Urea Cone. Tests 7 Urea clearance tests 129 Fractional test meals 94 Pleural fluids 56 Blood counts 466 Haemoglobin estimations 893 Blood groups 268 Compatibility tests 180 Faecal fat estimations 2 Van den Bergh re-action 14 Vaccines 7 Blood sedimentation rates 433 Glucose tolerance tests 1 Blood coagulation and bleeding time 11 Other examinations—unclassified 302 Total number of Examinations 6,465 Number of Specimens sent to Croydon General Hospital 468 NUMBER OF POST MORTEMS ORDERED BY THE CORONER AND PERFORMED AT MAYDAY HOSPITAL DURING THE YEAR. Outside Cases 225 Hospital Cases 57 NUMBER OF POST MORTEMS NOT ORDERED BY THE CORONER 50 15 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 1 18 - 1 - - - Cervix 2 12 - 1 - - 1 Ovary 2 24 - 2 - - - Oseophagus 1 5 - - 1 - - Breast 22 189 - 13 1 1 7 Lung 2 32 - 1 1 - - Testicle 1 1 - - - - 1 Sarcoma of Hip 2 17 - 1 1 - - Buttock 1 12 - 1 - - - Epithelioma of lip 1 - - - 1 - - vulva 4 72 - 3 - - 1 Menorrhagia 4 42 3 1 - - - Lymphatic Leukaemia 7 84 - 6 1 - - Myeloma 1 12 - 1 - - - Sarcoma of muscles of thigh 1 7 - 1 - - - Pruitus Vulva 1 3 - 1 - - - Boecks Sarcoid 1 12 - 1 - - - Ewings Tumour 1 26 - 1 - - - Carcinoma of Bronchus 2 5 - - - 1 1 57 573 3 35 6 2 11 Corresponding totals for 1943 78 930 4 56 12 1 6 16 Table III Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Alimentary. Appendicitis - - - - 141 35 7 1 184 Gastric ulcer 6 26 4 3 2 6 1 1 49 Duodenal ulcer 3 14 5 2 7 6 2 4 43 Anastomatic ulcer - - - - - 1 - - 1 Dyspepsia - - - - 4 2 - - 6 Cholelithiasis - 3 1 - 2 1 - - 7 Colitis 1 2 5 2 1 1 - - 12 Intestinal obstruction - - - - 5 10 1 19 35 Ischio-rectal abscess 2 8 - - - - - - 10 Constipation 9 27 6 - - - - - 42 Hernia - - - - 54 50 14 3 121 Haemorrhoids - - - - 10 3 - - 13 Cholecystitis - - - - 10 10 4 1 25 Gastro enteritis 9 5 1 8 - - - - 23 Gastritis 6 8 3 - - - - - 17 Intestinal colic - 4 - 1 1 3 - - 9 Catarrhal jaundice 6 4 1 - 1 - - - 12 Prolapse of Rectum 1 - 1 - 1 - - - 3 Pyloric stenosis - 2 1 - 3 3 - 3 12 Intestinal Haemorrhage - - 1 - - - - - 1 Diarrhoea 1 2 - - - - - - 3 Nervous Dysphagia 1 - - - - - - - 1 Peptic Ulcer - 1 2 - - - - - 3 Appendicular Colic 2 1 - - - 1 - - 4 Peritonitis - - - 2 6 9 1 10 28 Stomatitis - 1 - - - - - - 1 Pelvic Abscess 2 - - - 1 - - - 3 Jaundice 3 - - 1 - 1 1 - 6 17 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Collapse - 10 2 1 - - - - 13 Pyioric Ulcer - 1 - - - - - - 1 Peritonsillar Abscess - - - - 1 3 2 - 6 Appendicular Abscess - - - - - 4 1 1 6 Perineal Abscess - - - - - 1 - - 1 Acidosis - - - - 1 - - - 1 Abdominal Abscess - - - - 1 - - - 1 Pancreatitis 4 3 - 2 - - - - 9 Hepatic abscess - - - - - 2 - - 2 Ascitis - - 1 - - - - - 1 Diverticulitis - - - 1 - 1 1 - 3 Gallstone Colic - - - - - 1 1 1 3 Intussusception - 1 - - 1 2 - 1 5 Hepatitis - 1 - - - - - - 1 Coeliac Disease 1 - - - - - - - 1 Haematemesis of unknown origin 1 8 6 4 - - - - 19 Liver Abscess - - - - - 1 - - 1 Visceroptosis - - 2 - - - - - 2 Malaena - 2 - - - - - - 2 Bones, and Joints. 752 Arthritis 1 4 5 1 - - - - 11 Fibrositis 2 9 - - - - - - 11 Bursitis 5 3 1 - - - - - 9 Sacro-iliac strain 2 1 - - - - - - 3 Paget's Disease - 2 1 - - - - - 3 Spina bifida - 1 - 1 - - - - 2 Pleurodynia - 1 2 - - - - - 3 Lumbago 2 1 - - - - - - 3 Synovitls 2 2 1 - - - - - 5 Osteomyelitis 2 9 5 - - - - - 16 18 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Periostitis - - 3 - - - - - 3 Charcots joint - 2 1 - - - - - 3 Genu Valgum - - 4 - - - - - 4 Osteo-arthritis - - 4 - - - - - 4 Coxitis - 1 1 - - - - - 2 Myositis - 3 - - - - - - 3 Acute Rheumatism 1 4 2 - - - - - 7 Muscular Rheumatism - 3 2 - - - - - 5 Hallux Valgus - 4 2 - - - - - 6 Osteitis - 1 2 - - - - - 3 Osteoperosis - - 2 - - - - - 2 Effusion into joint - - 3 - - - - - 3 Coccydynia - 1 2 - - - - - 3 Torticollis - - 2 - - - - - 2 Kyphosis - 1 1 - - - - - 2 Flat feet 1 - - - - - - - 1 Polydactyly - - 1 - - - - - 1 Ganglion - - - - 3 4 1 - 8 Carcinoma 128 Breast - - - - 2 6 6 8 22 Stomach - - - - - - 9 19 28 Rectum - - - - - - 9 4 13 Cervix - - - - - 3 7 2 12 Ovary - - - - - 1 - 4 5 Uterus - - - - 1 2 3 1 7 Prostate - - - - - 1 1 3 5 Tongue and Mouth - - - - - - 2 1 3 Colon - - - - - 1 4 13 18 Oesophagus - - - - - 1 - 1 2 Bladder - - - - - - 2 5 7 19 Dlagnoies in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Lung - - - - - - 3 10 13 Bronchus - - - - - - 2 3 5 Pancreas - - - - - - 1 - 1 Epithelioma - - - - - 3 5 2 10 Nose - - - - - - - 1 1 Peritonei - - - - - - 1 - 1 Cervix uteri - - - - - - 1 5 6 Sarcoma - - - - - 3 2 5 10 Penis - - - - 1 - - - 1 Spine - - - - - - 1 2 3 Liver - - - - - - - 5 5 Rodent ulcer - - - - - - - 1 1 Thyroid - - - - - - 1 1 2 Glands - - - - - - 1 2 3 Vulva - - - - - - 1 1 2 Pylorus - - - - - - - 1 1 Femur - - - - - - 1 - 1 Ileo-caecal junction - - - - - - 1 - 1 Caecum - - - - - 1 2 - 3 Head - - - - - - - 1 1 Anal canal - - - - - - - 1 1 Circulatory (Blood). 194 Anemia - 7 - 3 - - - -- 10 Septicaemia 2 4 2 10 - - - - 18 Hyperpiesia - 3 1 - - - - - 4 Pernicious Anaemia 2 5 2 2 - - - - 11 Thrombosis - 6 1 4 - - - - 11 Phlebitis 5 3 1 - - - - - 9 Varicose veins 9 7 2 - - - - - 18 Gangrene - 3 4 4 - - - - 11 Leukaemia - 1 - 1 - - - - 2 20 Diagnoses In Cases Treated Medical. Surgical. Total. Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Naevus - 2 - - - - - - 2 Epistaxis ... 2 7 - - - - - - 9 Circulatory (Heart) 105 Fatty Degen. of Heart - 1 - - - - - - 1 Myocardial Degen : 2 21 14 116 - - - - 153 Hypertension 2 8 2 1 - - - - 13 Aortic incompetence - - 1 - - - - - 1 Arterio sclerosis - 6 11 16 - - - - 33 Aortic stenosis - 1 - - - - - - 1 Endocarditis - 1 1 1 - - - - 3 Auricular fibrillation - 2 - 3 - - - - 5 Myocarditis - 5 2 24 - - - - 31 Mitral stenosis - 6 - 4 - - - - 10 Carditis - 2 4 3 - - - - 9 Congestive heart failure - 11 - 39 - - - - 50 Heart failure - 4 3 44 - - - - 51 Congenital heart disease - 1 - 1 - - - - 2 Tachycardia - 1 - - - - - - 1 Cardiac disease - 6 7 3 - - - - 16 Angina 3 6 - - - - - - 9 Banti's disease - - 1 - - - - - 1 Rheumatic Carditis - 4 2 2 - - - - 8 Constitutional. 398 Diabetes Mellitus 2 23 6 5 - - - - 36 Debility - 1 - - - - - - 1 Nutritional disorder 5 - - - - - - - 5 Marasmus 1 2 - 4 - - - - 7 Malnutrition 3 2 - - - - - - 5 Diabetic coma - 5 - 4 - - - - 9 Cachexia - - - 3 - - - - 3 66 21 Diagnoses In Cases T reated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Ear, Nose and Throat. Enlarged T. and A. 3 6 - - 439 4 2 - 454 Quinsy - 1 - - 2 - - - 3 Otitis Media 23 18 5 1 - - - - 47 Pharyngitis 2 2 - - - - - - 4 Mastoiditis - - - - 12 7 1 2 22 Laryngitis 1 - - - - - - - 1 Catarrh - 2 - - - - - - 2 Sinusitis - 1 - - - - - - 1 Adenoids - - - - 1 - - - 1 Meniere's disease - 1 1 - - - - - 2 537 Eye. Iritis - 1 1 - - - - - 2 Conjunctivitis 1 2 - - - - - - 3 5 Qenito Urinary. Nephritis 3 5 2 3 - - - - 13 Urethral stricture 1 4 2 - - - - - 7 Pyelitis 10 9 - 2 - - - - 21 Enlarged prostate 6 13 3 4 - - - - 26 Uraemia - 2 1 21 - - - - 24 Renal colic - 1 - - - - - - 1 Urinary calculus - 1 - - - - - - 1 Pyonephrosis - 1 - - - - - - 1 Suprapubic fistula. - 2 1 - - - - - 3 Hypernephroma of kidney 1 1 - - - - - - 2 Hypernephrosis - - - 1 - 1 - - 2 Epididymo-orchitis - 1 1 - - 1 - - 3 22 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Circumcision - - - - 46 8 1 - 55 Haematuria - 1 2 - - - - - 3 Diverticulitis - - 1 - - - - - 1 Retention - 12 3 1 - - - - 16 Undescended testicle 2 - - - - - 1 - 3 Cystitis 2 3 - - 3 1 - - 9 Glands. 191 Adenitis 7 16 1 - - - - - 24 Hodgkin's disease - - - 1 - - - - 1 Gynaecological. 25 Abortion - - - - 233 - 1 3 237 Fibrosis Uteri - - - - 59 4 - - 63 Ovarian cyst - - - - 25 - 1 - 26 Uterine haemorrhage - - - - 17 6 1 - 24 Mastitis - - - - 6 6 - - 12 Amenorrhoea - - - - - - 1 - 1 Menorrhagia - - - - 11 - - - 11 Metorrhagia - - - - 5 - - - 5 Dysmenorrhoea - - - - 8 2 - - 10 Bartholin's cyst - - - - 1 - - - 1 Bartholin's abscess - - - - 7 - - - 7 Erosion of cervix - - - - 23 - - - 23 Deficient pelvic floor - - - - 25 - - - 25 Cervical polypi - - - - 5 - 1 - 6 Salpingitis - - - - 10 - - - 10 Retroversion - - - - 31 2 - - 33 Salpingo-oophoritis - - - - 1 - - - 1 Retained products - - - - 4 - - - 4 For sterilization - - - - - 1 - - 1 23 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Sterility - - - - 24 2 1 - 27 Endometritis - - - - 3 - - - 3 Dermoid cyst - - - - 2 - - - 2 Urethral tear - - - - 1 - - - 1 Peivic infection - - - - 1 2 - - 3 Vaginal discharge - - - - 4 - - - 4 Peritoneal cyst - - - - - - 1 - 1 Imperforate hymen - - - - 1 - - - 1 542 Infectious. Influenza 11 - - - - - - - 11 Puerperal pyrexia 1 - - - - - - - 1 Scarlet Fever - - 8 - - - - - 8 Dysentery - 4 13 - - - - - 17 Whooping Cough 1 3 5 - - - - - 9 Measles 1 - - - - - - - 1 Erysipelas 1 - 2 - - - - - 3 Chicken Pox 1 1 12 - - - - - 14 Mumps - - 1 - - - - - 1 Rubella - - 1 - - - - - 1 66 Maternity. Pyelitis of pregnancy - - - - 10 2 - - 12 false labour pains - - - - - 1 18 - 19 Ectopic gestation -- - - - 3 3 - 1 7 Albuminuria of pregnancy - - - - - 1 1 - 2 a.p.h - - - - - 2 - - 2 R.b.p. - - - - - 7 - - 7 Toxaemia of pregnancy - - - - 3 1 - 2 6 Anaemia of pregnancy - - - - - 1 - - 1 24 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Vomiting of pregnancy - - - - 1 1 - - 2 A.N. Observation - - - - - 1 - - 1 A.N. rest - - - - 1 - - - 1 Termination of pregnancy - - - - 4 - - - 4 Mothers - - - - 1150 - - - 1150 Babies - - - - 1020 - - 36 1056 2270 Mental. Uncertified 2 10 136 1 - - - - 149 Certified - - 35 - - - - - 35 M.D - 2 4 - - - - - 6 Epilepsy - 23 9 2 - - - - 34 Senile Dementia - - 4 - - - - - 4 Loss of memory 1 1 - - - - - - 2 Hysteria - 6 1 - - - - - 7 Depression - 3 - - - - - - 3 240 Nervous and Sensory. Cerebral haemorrhage 2 5 4 46 - - - - 57 Meningitis - - 1 5 - - - - 6 Chorea 1 5 2 - - - - - 8 Hemiplegia 1 7 11 16 - - - - 35 Neurasthenia 1 2 - - - - - - 3 Neurosis - 9 2 - - - - - 11 Cerebral thrombosis - 9 4 26 - - - - 39 Disseminated sclerosis - - - 1 - - - - 1 Paralysis agitans - 1 2 1 - - - - 4 Neuritis - - 3 - - - - - 3 Convulsions - 3 - - - - - - 3 Cerebral tumour - - 3 - - - - - 3 25 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Tabes dorsalis - - - 1 - - - - 1 Glioma - 1 - - - - - - 1 Parkinson's disease - 1 1 2 - - - - 4 Cerebral arterio sclerosis - 2 1 1 - - - - 4 Cerebral tumour - 1 - - - - - - 1 Paraplegia - 1 2 - - - - - 3 Cerebral abscess - - - 1 - - - - 1 Subarachnoid haemorrhage - 2 1 2 - - - - 5 Paralysis - 8 4 1 - - - - 13 Migraine - - 1 - - - - - 1 Cerebral degen - 1 - - - - - - 1 208 Respiratory. Bronchitis 33 67 11 16 - - - - 127 Pneumonia 108 23 7 54 - - - - 192 Pleural effusion - 8 15 - - - - - 23 Bronchial Catarrh 1 - - - - - - - 1 Bronchiectasis 4 5 - - - - - - 9 Pleurisy 11 4 3 - - - - - 18 Asthma 5 28 8 2 - - - - 43 Empyema 3 1 2 3 - - - - 9 Pulmonary congestion - - - 2 - - - - 2 Spontaneous Pneumothorarax 1 - - - - - - - 1 Asphyxia - - - 3 - - - - 3 Fibrosis of lungs - 1 - - - - - - 1 Tumour of lung - - - 1 - - - - 1 Pulmonary embolism 1 - 2 9 - - - - 12 442 26 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Senility - - 119 2 - - - - 121 Skin. 121 Boils, abscess and carbuncles 19 30 3 - - - - - 52 Burns and scalds 2 8 - - - - - - 10 Eczema 9 4 2 - - - - - 15 Impetigo 20 1 - - - - - - 21 Scabies 15 1 - - - - - - 16 Dermatitis 6 1 3 - - - - - 10 Septic spots 2 1 - - - - - - 3 Ringworm - 1 - - - - - - 1 Ingrowing toenail - 2 - - - - - - 2 Cellulitis 6 1 - - - - - - 7 Sinusitis 2 1 - - - - - - 3 Ulceration 9 6 3 - - - - - 18 Urticaria - - 1 - - - - - 1 Papilloma - 2 1 1 - - - - 4 Whitlow 2 1 1 - - - - - 4 167 Pulmonary Tuberculosis - 19 44 37 - - - - 100 Non-Pulmonary Tuberculosis. Spine - - 2 - - - - - 2 Meningitis - - 1 2 - - - - 3 Knee - - 2 - - - - - 2 Glands - - 3 - - - - - 3 Peritonitis - - - 1 - - - - 1 Miliary - - - 2 - - - - 2 Ileo canal - 1 1 - - - - - 2 15 27 Diagnoses in Cases Treated Medical. Surgical. Total Cured Re- Unrelieved lieved Died Cured Relieved Unrelieved Died Venereal. Syphilis - - 2 - - - - - 2 Violence. Fractured limbs - - - - 5 45 23 10 83 Fractured spine - - - - - 1 1 1 3 Fractured malleolus - - - - - 9 3 - 12 Fractured skull - - - - 1 4 1 2 8 Fractured ribs - - - - 3 5 - - 8 Fractured clavicle - - - - 1 2 - - 3 Fractured pelvis - - - - 2 2 - - 4 Fractured sacrum - - - - - 1 - - 1 Fractured nasal bones - - - - - 1 - - 1 Minor injuries - - - - 10 5 2 - 17 Contusions and abrasions - - - - 4 8 - - 12 Sprain - - - - 2 4 2 - 8 Bruises - - - - 1 - 1 - 2 Dislocation - - - - - 7 - - 7 Gun shot wound - - - - - - 7 - 7 Concussion - - - - 10 21 1 - 32 Lacerations, wounds, etc. - - - - 9 18 4 3 34 242 Miscellaneous. Poisoning 2 2 - 1 - - - - 5 Alcoholism 2 - - - - - - - 2 Dental caries 1 - 1 - - - - - 2 b.b.a 9 - - - - - - - 9 nad. 45 - - - - - - - 45 Warts » 1 1 - - - - - - 2 28 Diagnoses in Cases Treated Medical. Surgical. total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died With Mother 30 - - - - - - - 30 Hare lip 1 2 - 1 - - - - 4 Prematurity 8 - - 19 - - - - 27 Foreign body 6 - - - - - - - 6 Extraction of tooth - - - - 1 2 - - 3 Amputations - - - - 1 7 - - 8 143 TOTAL NUMBER OF PATIENTS DISCHARGED FROM MAYDAY HOSPITAL YEAR ENDED 31st DECEMBER, 1944. Cured 4,076 Relieved 1,185 Unrelieved 869 Died 829 6,959 TOTAL NUMBER OF OUT-PATIENTS TREATED AT MAYDAY HOSPITAL DURING THE YEAR 8,124 OPERATIONS PERFORMED AT MAYDAY HOSPITAL DURING 1944 ABDOMINAL. Appendicectomy 158 Appendix abscess drained Sigmoidoscopy Herniotomy 93 Cholecystectomy 21 Laparotomy 45 Gastro-enterostomy 1 Colostomy 14 Perforated gastric ulcer 24 Injection of haemorrhoids 1 Haemorrhoidectomy 11 Perforated duodenal ulcer 5 Gastroscopy 6 Undescended testicle 3 For hydrocele 3 Gastrectomy 2 Rammstedt's operation 8 Resection of gut 4 Splenectomy 1 420 29 BONES AND JOINTS. For osteo-myelitis 1 Amputation of limbs 17 Wiring of bones 23 Removal of pin 5 Resection of rib 3 Application of plaster 34 Reduction of joints 27 Manipulation of limbs 20 Osteotomy 5 Removal of Sequestrum 6 Division of webbed phalanges 3 Bone graft 3 147 EAR, NOSE AND THROAT. Mastoidectomy 20 Tonsillectomy 451 Adenoidectomy 6 Myringotomy 6 Bronchoscopy 1 484 GENITO URINARY. Cystoscopy 34 Circumcision 50 Prostatectomy 11 Supra pubic cystotomy 34 Urethral dilatation 2 Fulguration of bladder 3 Insertion of Depezar catheter 1 135 30 GYNAECOLOGICAL. Examination under Anaesthetic 83 Total hysterectomy 56 Sub-total hysterectomy 20 Salpingo-oophorectomy 10 Dilation and Curetage 104 Removal of ovarian cyst 14 Salpingectomy 12 Induction of abortion 3 Ovariotomy 4 Incision of Bartholin's abscess 9 Incision of Bartholin's cyst 1 Insertion of pessary 4 Colpo-perineorrhapy 19 Cauterization of Cervix 7 Baldy Webster Operation 21 Fothergills Operation 7 Urethral and cervical smears taken 1 Cervical polypus 5 Amputation of Cervix 5 Colpotomy 4 Biopsy of Cervix 9 Removal of Gauze Packing from Uterus 14 Suture of laceration of vaginal wall 9 Intra-uterine Lipiodol 3 Repair of pelvic floor 1 425 OBSTETRICAL. Caesarean Section 49 Evacuation of Uterus and Glycerine Pack 186 For Ectopic Gestation 2 Induction of Labour 13 Rupture of Membranes 105 355 31 MISCELLANEOUS. Blood Transfusions 4 Incisions, abscesses, etc. 109 Cleansing of Burns, etc. 4 Amputation of Breast 12 Suture of Wounds 137 Excision of Wounds 17 Lumbar Puncture 22 Aspiration of Chest 13 ,, ,, Knee 2 „ ,, Abscess 4 Removal of Nail 7 Removal of Foreign Body 21 Paracentesis 11 Suture of Tendon 4 Extraction of Teeth 2 Thyroidectomy 2 Injection of Varicose Veins 1 Ligature of Varicose Veins 4 Thoracotomy 2 Removal of Glands 9 Venesection 2 Tissue for Biopsy 2 Removal of naevus 12 403 Number of patients who had teeth extracted 130 32 PUBLIC ASSISTANCE. (а) Domiciliary Relief. Number of Croydon cases resident in the Borough and in receipt of outdoor relief on the— 1st January, 19441,684 persons 915 cases 1st July, 1944 1,486 ,, 824 ,, 1st January, 19451,287 ,, 767 ,, Expenditure on Out-relief during the 12 months ended 30th September, 1944, to Croydon cases resident in the Borough : — Half-year ended 31st March, 1944 ... £32,094 3s. 0d. Half-year ended 30th September, 1944 £27,151 Is. 0d. (b) Institutional Relief. Number of Croydon persons relieved in the Mayday Hospital on 1st January, 1945, and in the Queen's Road Homes on the same date :— Mayday Hospital 15 Queen's Road Homes 386 (Excluding 130 evacuated.) (c) Medical Relief. In May, 1941, the Public Assistance Committee decided to form one panel for all districts in the Borough operating the scheme instead of separate panels for each such district. Particulars for Year ended 31.3.44. All Districts. (1) Average number of separate patients attended during each quarter 1,146 (2) Attendances at Patients' homes 7,765 (3) Attendances on patients at the surgery 9,513 (4) Total number of prescriptions written 20,224 (5) Estimated cost of drugs, dressings and dispensing £969 9s. 3d. (6) Estimated amount of per capita payment to doctors in respect of patients actually attended (calculated quarterly) 5s. 10.65d. (7) Estimated average payment per service point 2.52d. Table I. INFECTIOUS DISEASES NOTIFIED DURING YEAR 1944. Notifiable Disease. Cases notified in the whole District. Total cases notified in each Ward. Total cases removed to Borough Hospital & diagnosis confirmed. Total Deaths in the Borough. Sex Distribution 1944. 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. At all Ages. Under 1 year. 1-4. 5-14. 15-24. 25-44. 45-64. 65 and up. M F Scarlet Fever 358 - 80 221 36 18 3 - 24 12 70 17 30 ?9 37 29 23 22 26 8 24 7 50 308 - 169 189 Diphtheria 20 1 3 4 7 4 1 - 2 1 4 1 2 1 - 3 3 1 1 - - 1 - 20 - 10 10 Erysipelas 37 - - 2 - 14 18 3 2 4 - 5 3 3 4 2 5 1 4 - 2 2 - 13 1 20 17 Cerebro-Spinal Meningitis 6 1 2 1 1 1 - - - - 1 - 1 - - - 1 1 - 1 1 - - 6 1 3 3 Enteric &Paratyphoid 2 - - - - - 2 - - - - - - - - 1 - - - - - 1 - 2 - 1 1 Small Pox - - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - -. Puerperal Pyrexia 43 - - - 9 39 - - 2 - 37 1 - 1 1 - - 1 1 1 1 2 - 44 - - 48 Ophthalmia Neonatorum 3 3 - - - - - - - - - - 1 - - - - 1 1 - - - 3 - 1 2 Poliomyelitis and Polio-encephalitis 2 - - - 2 - - - - - - 1 1 - - - - - - - - - - 2 1 2 - Dysentery 19 4 9 2 2 1 1 - - - 3 1 4 1 - - 2 2 1 1 2 - 2 18 - 7 12 Malaria 11 - - - 3 7 1 - - - 8 - - - - 2 - - 1 - - - - 10 - 11 - Acute Primary and Acute Influenzal Pneumonia 34 3 1 2 3 8 11 6 - - 1 1 1 6 2 4 3 1 2 3 7 1 2 14 4 ?? 1? Measles 258 5 71 153 20 7 2 - 5 7 11 18 14 1 1 7 27 23 23 7 22 17 20 i 56 23 1 135 123 Whooping Cough 561 59 263 228 1 7 3 - 13 20 24 35 82 23 I24 54 63 61 7 | 20 33 33 69 32 10 255 306 Totals 1359 76 429 613 84 106 42 9 48 44 109 80 139 65 75 122 123 114 51 56 87 67 179 495 18 636 723 * Includes notifications from Mayday and St. Mary's Hospitals. 33 34 Comments on the Incidence and Prevalence of Infectious Disease. Scarlet Fever was less prevalent than in 1943. The incidence rate of Diphtheria was 0.11, compared with 0.29 in 1943. No cases of Small Pox occurred during the year. There were 48 cases of Puerperal Pyrexia; 9 occurred in the age-group 15—24 years and 39 in the age-group 25—44 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 1944. 612 patients, were admitted and discharged which, together with patients in at the commencement of 1944 (73), gives a total of 685 dealt with. Nine died, giving a case mortality for the Hospital of 1 per cent., as against 0.6 per cent, in 1943. Penge Urban District Council have an arrangement with the Corporation to send their cases to the Hospital. During the year 32 cases were admitted and these are included in the tables. Two operations for tonsils and adenoids were performed. On August 16th a flying bomb fell in the hospital grounds, severely damaging Wards J and D and causing much damage by blast to all the other wards. Though both Wards J and D were occupied at the time, the patients and nurses escaped with minor injuries, in spite of some being pinned under debris. Within a short time, the patients from these wards were transferred to others, the work being made easier by the prompt assistance offered by the first aid squads and members of the Hospital staff. The work of repair of the damaged wards is progressing satisfactorily. No nurses entered during the year for the State examination. Complaint for which admitted. Patients remaining in Hospital on 1st January, 1944 Patients admitted and discharged in 1944 Patients admitted during 1944 and remaining in Hospital on 1st January, 1945 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 61 61 - 323 323 - 21 21 - 344 344 - - 28.3 Diphtheria 2 2 - 38 38 - 6 6 - 44 44 - - 26.4 Enteric Fever - - - 1 1 - 1 1 - 2 2 - - 44 C.S.M - - - 12 11 1 - - - 12 11 1 8.3 14.2 Dysentry 3 3 - 13 13 - - - - 13 13 - - 12 Puerperal Pyrexia 1 1 - 7 7 - 1 1 - 8 8 - - 10 Erysipelas - - - 11 11 - - - - 11 11 - - 10.3 Measles - - - 28 28 - 4 4 - 32 32 - - 12.4 Rubella - - - 35 35 - - - - 35 35 - - 9.9 Whooping Cough 2 2 - 27 22 5 2 2 - 29 24 5 17.2 22.2 Chicken Pox 2 2 - 39 39 - - - - 39 39 - - 13.1 Mumps - - - 6 6 - - - - 6 6 - - 12.8 Encephalitis - - - 1 1 - - - - 1 1 - - 9 Tonsilitis - - - 3 3 - - - - 3 3 - - 10 Vincents Angina - - - 3 3 - - - - 3 3 - - 10 Croup - - - 1 - 1 - - - 1 - 1 10.0 6 Dermatitis - - - 1 1 - - - - 1 1 - - 9 Meningitis - - - 1 1 - - - - 1 1 - - 7 Scabies - - - 3 3 - - - - 3 3 - - 5 Oastro Enteritis - - - 2 2 - - - - 2 2 - - 15 Tuberculosis 1 - 1 - - - - - - - - - - - Bronchitis - - - 2 2 - - - - 2 2 - - 8 Venereal Disease - - - 6 6 - - - - 6 6 - - 12.5 No Disease 1 1 - 13 13 - 1 1 - 14 14 - - - Totals 73 72 1 576 569 7 36 36 - 612 605 7 - - 35 36 SCARLET FEVER. The total number of Scarlet Fever cases admitted during the year was 344, a decrease of 426 on 1943. The type of the disease was of moderate severity. Of the 344 cases, 10 were not cases of scarlet fever, leaving a total of 334 cases of true Scarlet Fever. The following complications and sequelae occurred amongst the true Scarlet Fever cases : — Serum Cases. NonSerum Cases. Total. Rhinorrhoca 1 6 7 Otorrhoea 6 15 21 Adenitis 2 7 9 Relapse - 2 2 Mastoid - 1 1 Rheumatism - 4 4 Abscesses - 1 1 Secondary throat - 1 1 Arthritis - 1 1 Erysipelas - 1 1 The average stay in hospital for serum cases was 28.3 days for non-serum cases 29 days. No deaths occurred amongst the scarlet fever cases. The number of complications amongst the non-serum cases was 40 and amongst the serum cases 9. Both M.B. 693 and M.B. 760 proved useful, particularly in clearing up the otorrhoea due to streptococci and staplylococci. respectively. 37 Ages and Sexes Admitted. Scarlet Fever. Age. Male. Female. Totals. 0—1 - 1 1 1—2 15 6 21 2—3 11 12 23 3—4 10 14 24 4—5 20 25 45 5—10 58 62 120 10—15 28 27 55 15—20 10 13 23 20—30 6 12 18 30 or over 5 9 14 Total 1944 163 181 344 Total 1943 372 398 770 DIPHTHERIA. 44 cases were admitted with a diagnosis of diphtheria, a decrease of 46 on 1943. Of these 12 were found not to be cases of diphtheria and 11 were cases of positive swabs without clinical symptoms, leaving 21 cases of true diphtheria. There were no deaths amongst them. The cases were all of the faucial type and there were no cases of laryngeal diphtheria. The following complications and sequelae occurred amongst the diphtheria cases :— Rhinorrhoea 2 Otorrhoea 1 Paralysis: Palatal 2 Eyes 1 Cardiac failure 2 Adenitis 1 Quinsy 1 The 12 cases found not to be diphtheria were as follows :— Tonsillitis 11 Vincent's angina 1 38 Ages and Sexes Admitted. Diphtheria. Age. Males. Females. Totals. 0—1 1 3 4 1—2 2 - 2 2—3 2 1 3 3—4 - 1 1 4—5 - - - 5—10 2 2 4 10—15 2 5 7 15—20 5 2 7 20—30 3 7 10 30 & over 3 3 6 Total 1944 20 24 44 Total 1943 40 50 90 The steady yearly decrease of diphtheria admissions is no doubt the result of active immunization at the various Infant Centres in the town, and it is worthy of note that in the age groups 1—10 who contracted the disease the children had not been previously immunized, or had not received the full course of immunization, thus proving the great value of this method. Typhoid Fever. During the year two cases of typhoid fever were admitted, but in one the diagnosis was not confirmed; it was a case of acute enteritis. Puerperal Fever and Pyrexia. During the year there were 8 cases of puerperal pyrexia, but three were not confirmed, one being a case of influenza, one a case of pneumonia, and the third constipation only. Erysipelas. There were eleven cases of erysipelas, but in two the diagnosis was not confirmed, both being cases of boils of face. There were two deaths. Measles. Thirty-two cases were admitted, a decrease of 35 cases on 1943. In four the diagnosis was not confirmed. 1 was a case of rubella. 1 was a case of scarlet fever. 2 were cases of dermatitis. Whooping Cough. Twenty-nine cases were admitted, but in five the diagnosis was not confirmed. Five cases proved fatal owing to bronchopneumonia. 39 Cerebro-Spinal Meningitis. Twelve cases were admitted, but in 5 cases the diagnosis was not confirmed. 1 was a case of pneumococcal meningitis. 1 was a case of acute rheumatism. 1 was a case of erysipelas. 1 was a case of acute enteritis. 1 was a case of teething. The case of pneumococcal meningitis proved fatal. The combined treatment by lumbar puncture and sulphapyridine in doses of 2 grns. repeated in four hours' time and then 1 grn. given four hourly, continued for a week proved successful, as it had done previously . No ill effects were observed from giving sulphapyridine, but in those who could not tolerate the drug by mouth owing to it causing vomiting, M.B. 693 (soluble) hypodermically was given instead. No deaths occurred amongst the true cerebro-spinal meningitis cases. Dysentery. Thirteen cases were admitted Of these 11 were cases of Sonne dysentery, one a case of Morgan No. 1 bacillus, whilst one was a non-specific infection. Mumps. Six cases were admitted, but in two the diagnosis was not confirmed; they were cases of simple adenitis. There were no cases of anterior poliomyelitis or ophthalmia admitted during the year. Out of Borough Cases. Disease. Males. Females. Total. Deaths. Scarlet Fever 7 14 21 - Diphtheria 2 1 3 - Measles 3 3 6 - Enteric Fever 1 - 1 - No Disease - 1 1 - Total 13 19 32 - 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 - Puerperal Pyrexia - - - - - - - - - 3 - 4 - 1 - - 8 - Puerperal Fever - - - - - - - - - - - - - - - - - Erysipelas - - - - - - 1 - - - - 2 - - 6 2 11 - Measles 2 2 5 - 5 4 4 2 2 - 4 2 - - - - 32 - Rubella 1 - - 2 6 2 2 8 5 3 2 1 - - 3 .- 35 - C.S.M 1 - - 3 - - 2 - 2 1 - 1 - - 1 1 12 1 Whooping Cough 1 4 3 9 4 4 3 1 - - - - - - - - 29 5 Chicken Pox 1 1 4 3 8 3 5 4 3 3 2 1 1 - - - 39 - Mumps - - - 1 - - 1 - 2 1 - 1 - - - - 6 - Encephalitis - - - - - - - - - - 1 - - - - - 1 - Dysentery - 4 3 1 3 - - - - - - 1 - - - - 13 - Tonsilitis - - - - - - - 1 2 - - - - - - - 3 - Vincent's Angina - - - - - 1 1 - - 1 - - - - - - 3 - Croup - 1 - - - - - - - - - - - - - - 1 1 Dermatitis - 1 - - - - - - - - - - - - - - 1 - Meningitis - 1 - - - - - - - - - - - - - - 1 - Scabies - - - - - - 1 1 - 1 - - - - - - 3 - Gastroenteritis 1 - - - - - - - - - - - - - - - 2 - Bronchitis - 1 1 - - - - - - - - - - - - - 2 - Venereal Disease - - - - - - - - - 3 - 1 - 2 - - 6 - No Disease - - - - - - - - - - - - - - - - 14 - Totals 7 15 16 20 26 14 21 18 17 16 9 14 1 3 10 3 224 7 40 41 Croydon Borough Hospital Laboratory Report. DIPHTHERIA. Cases Positive on Admission. Cases Positive during Convalescence. Total Negative. Total. 20 41 1,631 1,692 SPEC. FAECES EXAMINED FOR ENTERIC AND DYSENTERY GROUPS. B. Typhosum B. ParaTyphosum A. B. ParaTyphosum B. Dysentery (Sonne). Total Negative. Total Examined. + + + + 1 — — 8 41 50 CEREBRO-SPINAL FLUIDS EXAMINED FOR ORGANISMS. Fluids containing Meningococcus. Fluids containing Pneumococci. Fluids Sterile. Total Examined. 3 1 5 9 MISCELLANEOUS EXAMINATIONS. Vaginal and Urethal Swabs examined for organisms (12): 1 Vaginal Swab + Gc., 1 Urethral Swab + Gc. Sputums examined for presence of B. Tuberculosis (3): All negative. Specimens of Blood cultured for organisms (2): Both sterile. Specimens of Urine for organisms and routine examination (13). Pus examined for organisms, 3 specimens, Haemolytic Streptococcus Longus grown. Throat Swabs examined for presence of Vincent's Angina (4): all positive. 42 SPECIMENS OF BLOOD FOR DREYER'S AGGLUTINATION TESTS. Positive B. Typhosum. Positive ParaTyphosum A. Positive ParaTyphosum B. Negative. Total Examined. 1 - - 3 4 CULTURE MEDIA PREPARED. 161 doz. Loeffler's Blood Serum. 2,500cc Agar Agar. l,000cc Peptone Water. 8,000cc Broth. 3,500cc Endo's Media. For private practitioners Mayday Hos. For Borough Hospital For Chest Clinic For School Medical Other Instns. ofCorporation Other Institutions Total BACTERIOLOGICAL EXAMINATIONS. I am indebted to the Borough Pathologist, Dr. H. V Southgate, for the figures given in the appended tables. Table At the Laboratory, Croydon General Hospital. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Swabs for Diphtheria 13 661 ... ... ... 1 ... 2 10 303 ... ... 2 248 25 1215 Virulence tests for Diphtheria ... ... ... ... 4 ... ... ... ... ... ... ... 1 ... 5 ... Sputum for Tub. Bac 41 373 ... ... ... ... 573 831 ... ... ... ... 11 115 622 1369 Pus for Tub. Bac ... 3 ... 2 ... 1 ... ... ... ... ... 3 ... ... ... 9 Pus for Gonococci ... ... ... 1 2 ... ... ... 1 3 1 19 ... ... 4 23 Pus for other organisms ... 6 ... 4 ... 1 ... ... ... 2 ... 18 ... ... ... 31 Blood for Typhoid Groups ... 2 ... ... ... ... ... ... ... ... ... 1 ... 2 ... 5 Blood for Wassermann ... 2 13 132 ... ... ... ... ... ... ... 6 ... ... 13 140 Material for Spirochaetes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Faeces for Typhoid Group 6 17 ... ... ... ... ... ... ... 1 1 9 ... ... 7 27 Hair for Ringworm ... ... ... ... ... ... ... ... 4 ... 1 ... ... ... 5 ... Examination of Urine 1 ... ... ... ... 7 ... 8 Examination of Pleural Fluid 1 ... ... ... ... ... ... 1 Examination of C.S. Fluid ... 9 ... ... ... ... ... 9 Other Examinations 269 481 ... ... 85 110 105 1050 43 44 Examinations Done Under the National Health Insurance Act. Nature of Examination. Nature of Examination. Pus for Gonococci 6 (1 pos.) Urine for Chemical Exam 6 Pus for other organisms 13 Urine for Microscopal Exam. 6 Pus for Tub. Bac. 11 Urine for Tub. Bac 6 Blood for Wasserman 11 (1 pos.) Urine for Cultural Exam 6 Complete Blood Counts 12 Other Examinations 15 Bacteriological Examination of Milk. Number of Samples submitted for Counts 228 Number under 10,000 per cc 100 Number over 10,000 but under 50,000 per cc 70 Over 50,000 but under 100,000 per cc 19 Over 100,000 but under 500,000 per cc 28 Over 500,000 but under 1,000,000 per cc 7 Over 1,000,000 per cc 4 Tubercle Bacilli— Number of samples of milk submitted 228 Number found positive by inoculation test 0 The number of milk examinations decreased by 30 Number of samples still under investigation for T.B 0 Milk Samples. 228 milk samples submitted to the Methylene Blue Test, of which 33 failed to satisfy. 78 milk samples were also submitted to the Bacillus Coli Test and 52 were satisfactory. IMMUNISATION AGAINST DIPHTHERIA. New cases came from the following sources : — School cases 531 Children under 5 years 1,320 The ensuing tables give some further details : — Total number of sessions held 81 Average attendance per session 14 45 Summary of Attendances and Treatment, 1944. Year. Total attended for treatment. New cases attended. No. of sessions held. No. Riven 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 99.1 5854 1944 2652 2482 81 - - 244 233 95.5 1851 Summary of Attendances and Treatment, Under Treatment 1.1.44 Total new Cases, 1944. 1944 Cases Completed Treatment. Received A.P.T. Under Treatment 31.12.44 Defaulted. 170 2482 1851 2652 162 639 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 1944 531 28.7 1320 71.3 Immunisation in Residential Schools and Homes. Owing to the evacuation of Residential Schools and Homes, no immunisation was conducted in the Institutions in 1944. Home Visits by Health Visitors. A total of 691 home visits was paid during the year. 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 to other V.O.s Untraced Removals. In Default. Overage when Registered. South Sub-District 1309 624 4 365 43 14 85 141 33 - West Sub-District 1776 786 3 593 80 29 27 222 36 - North Sub-District 544 229 2 185 16 6 8 77 21 - 3629 1639 9 1143 139 49 120 440 90 - During the year 2,785 Forms Q were sent to parents, 413 Forms K and 56 Final Forms K. Form Q is the Form drawing attention to the requirements of the Vaccination Acts and Form K refers to cases in default. 384 cases were transferred to this Borough from other districts. 1,346 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, 1944 : — 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. 5 433 54 487 24 No. 2 Area and part of No. 5 333 34 367 8 No. 3 Area 112 9 121 2 No. 4 Area 103 11 114 2 Addington (New) :— 51 6 57 - Queen's Road Homes - - - - Mayday Hospital 1 - 1 - Children's Homes - - - - Shirley Residential Schools - - - - 1033 114 1147 36 47 VENEREAL DISEASES. No changes have been made in the Scheme as given in my Report for 1930. Attendances at the Croydon Clinic during past 10 years. 1935. 1936. 1937. 1938. 1939. 1940. 1941 1942 1943. 1944. New male patients 287 300 395 416 316 187 448 661 239 232 New female patients 213 188 184 257 191 202 258 300 489 523 Attendances, male patients 5548 7525 8610 7318 4258 2996 3033 3932 2214 2758 Attendances, female patients 5977 5226 5405 5365 3150 1772 1508 1585 4026 5940 Attendances of Croydon patients at various London Hospitals under General Scheme. There were 105 new patients, who made a total of 1,206 attendances. Pathological Examinations at London Hospitals for Croydon Patients. 559 Examinations were made for various Clinics and 2,657 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. - - 4 - 4 - 4 - 12 St. Thomas's - - 57 - 74 - 130 - 261 South Lon. Hos. for Women - - 106 1 19 1 11 7 145 Royal Free - - 4 - 2 - 4 - 10 King's College - - 35 - 13 - - - 48 Whitechapel Clinic, L.C.C. - - 2 - 2 - 2 - 6 University College - - 3 - 3 - 3 - 9 Guy's Hospital - - 26 1837 20 486 25 521 2715 Mothers - - 2 - 1 - 2 - 5 Seamen's - - 1 - - - - - 1 Westminster Hospital - - - - - 2 - 2 4 Total - - 240 1638 138 489 181 530 3216 48 Croydon Cases attending London Hospitals. Hospital. Cases seen for the first time. Conditions other than venereal. Total number of attendances. Aggregate number of Inpatient Days. Syph. Gon. Endell Street L.C.C - - 3 12 - St. Thomas's 2 5 38 338 - Guy's 1 7 8 246 - King's College I 2 13 366 - Royal Free - - 4 45 - S. Lond. Hosp. for Women ... — 3 14 171 — Whitechapel Clinic, L.C.C. - - 1 4 - Westminster - - 1 18 - Mothers - - 1 1 - Seamens - 1 - 5 - Total 4 18 83 1206 - 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, 1944. Syphilis Soft chancre Gonorrhoea Nonvenereal or undiagnosed condition Totals M F M F M F M F M F Ttls. Number of cases on 1st January under treatment or observation 40 69 - - 13 48 3 8 56 125 181 Number of cases removed from the register Muring any previous year which returned during the year under report for treatment or observation of the same infection 2 2 - - 3 4 - - 5 6 11 Number of cases dealt with for the first time during the year under report (exclusive of cases under Item 4) suffering from :— Syphilis primary (1151) 12 4 - - - - - - 12 4 16 „ secondary 9 10 - - - - - - 9 10 19 „ latent in 1st year of infection - 12 - - - - - - - 12 12 „ all later stages 15 10 - - - - - - 15 10 25 „ congenital 2 - - - - - - - 2 8 10 Soft Chancre - - - - - - - - - - - Gonorrhoea, 1st year of infection - - - - (161)50 135 - - 50 135 185 „ later - - - - 5 - (123) - 5 - 5 Non-venereal conditions - - - - - - 139 344 139 344 483 Conditions remaining undiagnosed at 31st December - - - - - - - - - - - 4. Number of cases dealt with for the first time during the year under report known to have received treatment for the same infection, or to have been under observation, at other Centres or Service Hospitals, or by General Practitioners approved under Ministry of Health Circular 2226 8 5 - - 7 7 - 4 15 16 31 Totals of Items 1, 2, 3 and 4 88 120 - - 78 194 142 356 308 670 978 Number of cases discharged after completion of treatment and final tests of cure or after diagnosis as non-venereal 15 40 - - 38 130 134 342 187 512 699 Number of cases which ceased to attend before completion of treatment and were, on first attendance, suffering from :— Syphilis, primary - - - - - - - -- - - - ,secondary - - - - - - - - - - - , latent in 1st year of infection - 2 - - - - - - - 2 2 ,, all later stages - - - - - - - - - - - ,, congenital - - - - - - - - - - - Soft Chancre - - - - - - - - - - - Gonorrhoea, 1st year of infection - - - - 1 - - - 1 - - later - - - - - - - - - - - 7. Number of cases which ceased to attend after completion of treatment but before final tests of cure - 2 - - - 2 - - - 4 4 8. Number of cases tranferred to other Centres or to institutions, or to care of private practitioners 13 5 - - 7 2 - - 20 27 47 9. Number of cases remaining under treatment or observation on 31st December 60 71 - - 32 40 8 14 100 125 225 Totals of Items 5, 6, 7, 8 and 9 ... these totals should agree with those of Items 1 2. 3 and 4) 88 120 - - 78 194 142 356 308 670 978 50 Syphilis Soft Chancre Gonorrhoea Nonvenereal or undiagnosed condition Totals M F M F M F M F M F total 10. Number of attendances :— (a) for individual attention of the medical officer 1389 2126 - - 470 1890 697 1434 2556 5450 81 (b) for intermediate treatment, e.g., irrigtion, dressing 4 - - - 194 398 4 92 202 490 64 Total Attendances 1393 2126 - - 654 2288 701 1526 2758 5940 82 11. In-patients:— (a) Total number of persons admitted for treatment during the year 11 15 - - 1 1 - - 12 16 28 (b) Aggregate number of " in-patient days " of treatment given 33 29 - - 10 14 - - 43 43 88 Under 1 year 1 and under 5 years 5 and under 15 years 15 years and over Totals M. F. M. F. M. F. M. F. M. F. 12. Number of cases of congenital syphilis in Item 3 above classified according to age periods 1 1 - - 1 1 - 6 2 8 Microscopical. Others for diagnosis of Venereal Diseast 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 (1151) 43 24 9 6 82 Soft Chancre - - - - - Gonorrhoea (161) 98 72 11 9 190 Non-venereal and undiagnosed conditions (182) 295 142 30 16 483 Total 436 238 50 31 755 B. Total number of attendances of all patients residing in each area 4664 (1435) 2626 486 230 8006 51 CANCER. Deaths from Cancer numbered 420 as compared with 456 in 1943: 405 in 1942; 377 in 1941 : 443 in 1940; 414 in 1939; 380 in 1938; 421 in 1937; 421 in 1936; and 321 in 1935. Death-rate per 1,000 of the population for the previous 10 years are as follows : — 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) 1939—1.78 (414) 1944—2.21 (420) 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 79546 0.013 25 and under 35 years 1 2 3 28319 0.106 35 and under 45 years 8 10 18 30835 0.584 45 and under 65 years 90 94 184 37759 4.873 65 years and over 114 100 214 13671 15.653 214 206 420 190130 2.209 Sites of Fatal Cancer. Male. Female. Total. Percentage of Total. Site. Skin 5 3 8 1.905 Tongue and Mouth 8 - 8 1.905 Tonsil 1 - 1 0.238 Oesophagus 4 2 6 1.429 Stomach 51 32 83 19.762 Liver 4 5 9 2.143 Bowel 30 36 66 15.714 Rectum 17 14 31 7.381 Bladder 6 4 10 2.383 Prostate 14 - 14 3.333 Larynx 3 - 3 0.714 Uterus - 22 22 5.238 Breast 1 40 41 9.762 Ovary - 13 13 3.095 Pancreas 3 5 8 1.905 Peritoneum 2 - 2 0.476 Gall Bladder and Duct 1 4 5 1.190 Mediastinum 1 2 3 0.714 Bones 4 3 7 1.667 Lungs 43 8 51 12.143 Kidney 2 2 4 0.952 Brain 1 1 2 0.476 Maxillary Antrum 3 - 3 0.714 Pharynx 2 - 2 0.476 Fallopian Tube - 1 1 0.238 Parotid Glands 1 - 1 0.238 Thyroid Gland 1 5 6 1.429 Lymphatic Glands 2 1 3 0.714 Genital Organs 2 2 4 0.952 Not defined 2 1 3 0.714 214 206 420 52 Comments on Foregoing Table. The organs most often attacked in descending order of incidence are: In the males— the Stomach (23.8 per cent.), the Bowels and Rectum (22.0 per cent.), the Lungs 20.1 per cent.), and the Prostate (6.5 per cent.); in females— the Bowels and Rectum (24.3 per cent.), the Breast (19.4 per cent.), the Stomach (15.5 per cent.), and the Uterus (10.7 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. While prevention has so far yielded greater dividends than treatment, treatment has not stood still. A survey of the incidence and mortality figures in recent years shows greater diminution in mortality than in incidence of the pulmonary form of the disease. Although social conditions are different and broadly unfavourable in 1944, a comparison with 1914 is the best we can do. The outstanding facts are these: In 1914, 105 per 100,000 of the population in Croydon died from all forms of tuberculosis; in 1944 the corresponding figure was 57. Owing to fluctuations in population the following statistics cannot be correlated to those of previous war years. Notification of Tuberculosis. Two hundred and twenty-two cases of Pulmonary Tuberculosis and 35 cases of Non-pulmonary Tuberculosis were notified on Form A (primary notifications); of these 126 males and 96 females were pulmonary cases; 19 males and 16 females non-pulmonary. In addition, 49 pulmonary cases and 9 nonpulmonary came to our notice as new cases otherwise than bv notification. The total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year 1944 by notification or otherwise was 315, as compared with 383 in 1943, 323 in 1942, and 286 in 1941. 53 271 of these were cases of Pulmonary Tuberculosis, 151 in males and 120 in females. There were 28 fewer cases of Pulmonary Tuberculosis in males and 9 fewer in females than in 1943. There were 12 cases of Non-pulmonary Tuberculosis among children under 15 years as compared with 24 in 1943. The number of cases in adults was 32, compared with 51 in 1943. Of the cases notified in 1944, 25 males and 8 females died from the Pulmonary form of the disease during the year, equal to 14.8 per cent, of those notified, and 1 male and 3 females from the Non-pulmonary form. The incidence rate of Tuberculosis of all forms was 1.66 per 1.000 of the population; for Pulmonary Tuberculosis 1.43, and for Non-pulmonary 0.23 per 1,000 population. The notification rate was 1.35 per 1,000. In 1943 the corresponding figures were 1.92, 1.54, 0.38 and 1.50 per 1,000. Public Health (Tuberculosis) Regulations, 1930. Summary of notifications during the period from 1st January, 1944, to 31st December, 1944: — 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 1 14 19 18 25 22 21 5 126 139 Females - - 1 4 19 21 25 12 9 2 3 96 114 Non-Pulmonary— Males - - 2 4 1 1 4 2 2 1 2 19 21 Females 1 2 1 - 2 3 5 1 1 - - 16 18 54 Supplemental Return. New cases of Tuberculosis coming to the knowledge of ihe Medical Officer of Health during the period from 1st January, 1944, to 31st December, 1944, otherwise than by formal notification : — Age periods. 0—1 1—5 5—10 10—15 15—20 20—25 25—35 35—45 45—55 55—65 65 and upwards Total Cases. Pulmonary Males 1 1 2 - 1 4 8 1 4 - 3 25 Females - 1 - - 2 6 9 3 1 2 - 24 Non-pulmonary Males - 1 - - 2 - - 1 - 1 1 6 Females - - - 1 - 1 1 - - - - 3 Notification Register. Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1944 : — PULMONARY. NON-PULMONARY. Total Cases. Males. Females. Total. Males. Females. Total. 666 579 1245 116 146 262 1507 CLASSIFICATION OF NEW PATIENTS. Pulmonary Tuberculosis. During 1944, 201 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) 91 or 45.0% T.B. plus 1 (early cases, sputum positive) 12 or 6.0% T.B. plus 2 (intermediate cases, sputum positive) 79 or 40.0% T.B. plus 3 (advanced cases, sputum positive) 19 or 9.0% 201 100.0% 55 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 1944 2 1 15 36 33 11 98 In 1944 the death-rate from all form of Tuberculosis was 0.57 per 1,000 population. The rate for Pulmonary Tuberculosis was 0.51 and the rate for Non-Pulmonary Tuberculosis 0.06. Similar figures for 1943 were 0.62 and 0.08. Pulmonary Tuberculosis. In 1944 the total number of deaths from pulmonary tuberculosis was nine fewer than in 1943. The decrease was confined to women, and may have been due to the evacuation of greater numbers of women. 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. There was a decrease of 12.0 per cent, in the number of new cases in 1944, compared with 1943, which had the highest number for the past 13 years, and in women in the age groups 15-35 years. Most of the new cases in men occurred in the age groups 20-55 years. There is a close similarity in age distribution of deaths and new cases in the two sexes. Non-Pulmonary Tuberculosis. The diagnosis of the new cases entered in the Notification Register during 1944 were as follows: — Male. Female. Spine 2 Rib 1 1 Hip 1 Knee 2 Foot 3 Abdomen 5 1 Genito-urinary tract 3 Meninges 2 2 Axilla 1 Skin 3 Glands 4 4 Totals 19 16 56 Deaths from Non-Pulmonary Tuberculosis. During 1944, 11 deaths were certified to be due to NonPulmonary Tuberculosis, compared with 16 in 1943, 17 in 1942, 19 in 1941, 21 in 1940, 12 in 1939, and 18 in 1938. The deaths were due to: — Males. Females. Total. Tuberculous Meningitis 1 4 5 Tuberculous Kidney — 1 1 Tuberculous Peritonitis — 1 1 Miliary Tuberculosis 1 1 2 Tuberculosis of Adrenals 2 — 2 Totals 4 7 11 Co-ordination with Medical Practitioners, and Other Branches of the Health Department. During the year 412 cases of suspected Tuberculosis were referred by private medical practitioners; 65 were diagnosed as suffering from Tuberculosis and were subsequently notified. In addition, 31 children were referred by the School Medical Service, and 35 cases from the Maternity and Child Welfare section of the Public Health Department. 87.5 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 84.6 per cent, in 1943. The number of reports sent in by Insurance medical practitioners on their domiciliary cases (Form G.P. 36) was 164. Examination of Sputum. The results of examinations made in 1944 are as follows: — For Clinic. For General Practitioners. Totals. Positive (i.e., tubercle bacilli present) 563 49 612 Negative (i.e., tubercle bacilli absent) 888 490 1378 Totals 1451 539 1990 57 For each 100 new cases and contacts examined at the Clinic, 150 specimens of sputum were examined. X-Ray Work. 1,331 X-Ray examinations were made during the year. This is equivalent to 137 for every 100 new cases and contacts seen, and compares with a rate of 108 in 1943. 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 79 cases at May Jay Hospital for the Chest Clinic during the year. Extra Nourishment. Provision of special nourishment in the form of milk was granted to 69 selected cases for varying periods during the year, and 16 cases were in receipt of extra nourishment at the end of the year. Residential Treatment for Pulmonary Tuberculosis. Summary of Patients who received Institutional Treatment during 1944. Institution. In Institutions on 1.1.44. Admitted During 1944. Discharged During 1944. Died During 1944. Remaining in on 31.12.44. 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 — 84 61 — 79 58 — 8 5 — 39 38 — Brompton Hospital and Sanatorium 7 1 — 6 7 — 10 5 — 1 — — 2 3 — Children's Sanatorium, Harpenden — — 2 — — 3 — — 2 — — — — — 3 Croydon Borough Hospital — — 1 — — — — — — — — 1 — — — London Chest Hospital — — — — 1 — — 1 — — — — — — — Horton Hospital (Chest Unit) 2 2 — 2 4 — 4 6 — — — — — — — King George's Sanatorium 2 — — 1 — — — — — — — — 1 — — Grosvenor Sanatorium — 3 — 1 8 — 2 5 — — — — 1 6 — Langdon Hills Sanatorium — — 1 — — — — — — — — — — — 1 Preston Hall and Nayland Sanatorium — — — 1 1 — 1 1 — — — — — — — National Sanatcrium, Benenden 1 — — — — — — — — — — — 1 — — Royal National Sanatorium — — — — 4 — — — — — — — — 4 — White Lodge Hospital 1 — — — — — 1 — — — — — — — — St. Michael's Home — — — — 1 — — — — — — — — 1 — King Edward VII W.N.M.A. Hospital — — — — 1 — — — — — — — — 1 — Holy Cross Sanatorium — — — — 1 — — — — — — — — 1 — Mayday Hospital 7 14 1 65 51 4 34 43 3 26 11 1 12 11 1 Fairlight Sanatorium — — — 1 — — — — — — — — 1 — — Naburn Sanatorium (E.M.S.) — 16 — — 16 — — — — — — — — Papworth 1 — — — 1 — — — — — — — 1 1 — R.N.H.C., Ventnor — — — 1 — — — — — — — — 1 — — Sheffield Sanatorium — — — 1 — — — — — — — — 1 — — Scottish E.M.S. Hospital — — — 2 1 .—. 1 1 — — — — 1 — — Three Counties E.M.S. Hospital — — — — 1 — — 1 — — — — — — — 63 60 5 181 143 7 148 121 5 35 16 2 61 66 5 58 Residential Treatment for Non-Pulmonary 1 uberculosis. Sumrna ry of Patients who Have received Institutional Treatment during 1943. Institution. In Institutions, on 1.1.44. Admitted During 1944. Discharged During 1944. Died During 1944. Remaining in on 31.12.44. Adults. Adults. Adults. Adults. Adults. M. F Ch. M F Ch. M F Ch. M F Ch. M F Ch. Royal Sea Bathing Hospital 1 1 — 1 — — 2 1 — — — — — — — Heritage Craft School — — 3 — — 1 — — 1 — — — — — 3 St. Nicholas' & St. Martins Hosp. Pyrford — — 2 — — 2 — — 1 — — — — — 3 Roy. Nat. Orthopaedic Hosp — 1 — 1 1 — — 2 — — — — 1 — — Lord Mayor Treloar Cripples Hosp. — — — — — 1 — — 1 — — — — — — Nayland Sanatorium — — — — 1 — — — — — — — — 1 — Queen Mary's Hospital — — 1 — — — — — — — — — — — 1 Scottish E.M.S. Hospital — — — — 1 — — — — — — — — — — St. Luke's Home 1 — — — — — 1 — — — — — — — — St. Michael's Hcspital 2 — — — — — 2 — — — — — — — — Croydon General Hospital 1 — — 4 1 — 5 1 — — — — — — — Redhill County Hospital — — — 1 — — — — — — — — 1 — — Mayday Hospital — 1 — 2 2 2 2 2 1 — 1 1 — — — Victoria Home for Inv. Children — — 4 — — 2 — — 4 — — — — — 2 St. Anthony's Hospital — — — 1 — — — — — — — — 1 — — 5 3 10 10 6 8 12 7 8 — 1 1 3 1 9 59 60 Residential Treatment. 259 males, 212 females and 30 children were treated in Residential Institutions in connection with the Croydon Tuberculosis Scheme during 1944. The immediate results of treatment of patients discharged from residential institutions during the year are as follows: — Pulmonary Tuberculosis. In Class T.B. Minus, 21 males, 22 females and 2 children were discharged with the disease in a quiescent condition, i.e., 75 per cent, of the total cases in this class. Four males and 11 females were not in a quiescent condition, 25 per cent. In Class T.B. Plus, the corresponding figures were 20 males and 11 females, quiescent, 31.6 per cent.; 39 males and 15 females, not quiescent, 55.1 per cent.; 8 males and 5 females died, 13.3 per cent. Taking the groups together, 48.1 per cent, of cases were discharged as quiescent; 43.7 per cent, as not quiescent; and 8.2 per cent. died. Non-Pulmonary Tuberculosis. 14 patients were discharged during the year, and 71.4 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. 789 new cases were examined during the year. This is equal to 724 for each 100 deaths from the disease. 219 or 200 for each 100 deaths were found to be definitely tuberculous. The total number of attendances at the Clinic was 5,286. The Tuberculosis Officer paid 75 home visits, and the District Health Visitors 1,930 visits, for Clinic purposes. In addition, the Health Visitors made 279 primary visits for the purpose of the Notification Register. The Tuberculosis Officer paid 61 visits to Mayday Hospital, in a consultative capacity, and there examined 293 patients. 61 Patients requiring home nursing or surgical dressings are attended to by the nurses from the Croydon Nursing Service, by arrangement with that organisation, and 1,018 such visits were made during the year. Their assistance is a valuable adjunct in the care of domiciliary cases. Contact Examination. The contacts of definite cases are urged to attend the Clinic for examination (and subsequent supervision). This is an important preventive measure. During the year 181 contacts were examined, equal to 166 for each 100 deaths, compared with 267 in 1943, 238 in 1942, 227 in 1941, 278 in 1940, 325 in 1929. and 301 in 1938. Of these 4 were considered to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 22.1 compared with 1.66 per 1,000 of the general population. 281 appointments for examination were offered to new contacts during 1944, but only 181 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 1,060. This is equivalent to 5.5 persons per 1,000 of the population. During the year 89 Clinic cases died. Of this number 25 or 28.1 per cent. were seen for the first time in 1944. Dental Treatment for Patients Referred from the Chest Cine 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. 62 Summary of Work Done. Males. Females. Total. 1944 1943 Referred from Chest Clinic 2 14 16 21 Treatment cases continued from Cheam. 11 8 19 19 Attendances 45 63 108 131 Extractions 2 35 37 47 Fillings 9 14 23 25 Dressings — 5 5 5 Scalings — 4 4 14 Denture Dressings 35 34 69 81 Dentures fitted 1 9 22 28 Dentures Repaired — 2 2 2 Number of Treatment Sessions: 21. The amount of 6s. was taken in attendance fees during the year at Lodge Road. SUMMARY OF CLINIC STATISTICS FOR 1944. Number of persons on Clinic Register, January 1st, 1944 1,049 ,, notified cases examined for the first time 29 ,, cases sent for an opinion 584 ,, first attendances, including 80 inward transfers 1,050 ,, consultations of T.O. with medical practitioners— (a) Personal 11 (b) Other 068 ,, visits paid by T.O. to homes of patients 75 ,, visits paid by T.O. to Mayday Hospital 61 ,, patients examined by T.O. at Mayday Hospital 293 ,, visits paid to homes of patients by Health Visitors 2,209 ,, visits paid to homes of patients by District Nurses for nursing attention 1,018 Attendances of patients at the Clinic— Men 2,519 Women 2,307 Children 460 Total 5,286 63 Number of Insured Patients under Domiciliary Treatment at the end of year— Pulmonary 200 Non-Pulmonary 14 Total 214 Number of reports received from Panel Practitioners (G.P.36) 164 ,, report forms sent to Panel Practitioners (G.P.36) 287 ,, reports received from Panel Practitioners on Forms G.P.17 1 „ reports received from Panel Practitioners on Forms G.P.35 1 ,, X-Rays taken 1,331 ,, reports made to Ministry of Pensions by T.O. on general progress of Tuberculous exService men. 85 ,, special reports made to the Ministry of Pensions by T.O. re Tuberculous ex-Service Men (Form M.P.M.S.D. 122) 23 ,, cases referred to Light Treatment 2 ,, cases referred to Orthopaedic Clinic 13 „ cases receiving extra nourishment at the end of year 16 ,, cases referred by the Ministry of Labour and National Service Medical Board for examination and report 94 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, continued to be administered during: 1944. (1) No. of patients in receipt of Ministry of Health Allowances as at 31.12.43 49—26 in Institutions 23 on Domiciliary treatment. (2) No. of new patients 96 (3) No. of patients no longer in receipt of Allowances 108 (4) No. of patients in receipt of Ministry of Health Allowances as at 31.12.44 37—21 in Institutions 16 on Domiciliary treatment. 64 The Council's extension of the Maintenance Allowances scheme continued during 1944. 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 31.12.43 23— 3 in Institutions 20 on Domiciliary treatment. (2) No. of new patients 22 (3) No. of patients no longer in receipt of Allowances 18 (4) No. of patients in receipt of Council Allowances as at 31.12.44 27— 3 in Institutions 24 on Domiciliary treatment. 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 1944. i 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 21 23 20 20 1 1 2 158 Class T.B. Plus- Group I 7 3 3 2 4 — — 1 — ' — — — 138 Group II 42 26 6 7 20 11 4 3 3 2 9 3 177 Group III 15 4 1 — 2 — 6 1 5 3 1 183 Observation Non T.B 2 1 — — — — — — — — — — — 87 57 30 29 27 12 10 5 8 5 10 5 — 65 In-patients on 1st Jan., 1944 Admitted during year 1944 Discharged during year including deaths In on 1st Jan. 1945. Died during year 1944 M F M F M F M F M P 43 39 101 63 104 64 40 38 8 5 Number of Patients January 1st, 1944 82 Admitted, 1944 164 Discharged, 1944 155 Died, 1944 13 Remaining January 1st, 1945 78 No. of X-Ray Screenings 2,229 No. of X-Ray Films taken 457 No. of Refills given 2,041 No. of Gas Replacements 13 No. of A.P. Cases commenced 27 No. of Sputum Tests 838 No. of Pneumoperitoneum 41 Artificial Pneumothorax cases discharged but still under treatment: 17 males, 7 females (see above), making total discharges: Males 104, females 64. These Artificial Pneumothorax cases only refer to cases discharged in 1944. Those discharged in 1943 and still having refills have not been included. There were 5 Observation cases sent in—2 males and 3 females. Of the 2 males 2 were not tubercular, and of the 3 females 1 was not tubercular. Therefore, there were 3 Observation cases in non tuberculars, which are shown above. The 2 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. 66 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 were 27 compared with 33 last year. There was some fall in output through patients absenting themselves from the Sanatorium during the fly-bomb period, but many of these were afterwards referred from the Chest Clinic and thus had the necessary work completed at Lodge Road. Review of Work Done. Males. Females. Total. 1944 1943 Number Examined 37 44 81 111 Referred Treatment 31 42 73 93 Treated 31 42 73 82 Attendances 101 125 226 298 Extractions 60 57 117 146 Fillings 15 55 70 99 Dressings 2 7 9 16 Scalings 10 24 34 33 Root Treatments — — — — Denture Dressings 24 6 30 34 Dentures Fitted 5 2 7 9 Dentures Repaired 2 1 3 1 Mandibular Injections 4 6 10 22 Number of Treatment Sessions: 27. MATERNITY AND CHILD WELFARE. Notification of Births. Notifications were received from— Live Births. Still Births. Total. Midwives 2,872 63 2,935 Doctors, Parents and Others 614 28 642 3,486 91 3,577 67 Maternal Mortality. There were 5 deaths directly due to pregnancy, compared with 2 in 1943. The maternal mortality rate was 1.36 per 1,000 births, compared with 0.53 in 1943. The deaths directly due to pregnancy were caused by— (1) Shock : accidental ante-partum haemorrhage. (2) Retained placenta: incomplete spontaneous abortion. (3) Uramia: toxamia of pregnancy. (4) Eclampsia (post-partum). (5) Circulatory failure: post-partum shock. Puerperal Pyrexia. Forty-eight cases of Puerperal Pyrexia were notified. This is a rate of 13.0 per 1,000 births (live and still births). Accommodation for Confinement. The following table gives information concerning the accommodation utilized for confinements:— Number. Percentage. In Private Houses 1,084 30.30 In Public Institutions 1,756 49.09 Registered Maternity Homes 737 20.60 3,577 Still Births. During 1944, 97 still births were registered in respect of Croydon. Of these 48 were male babies and 49 female; 6 males and 5 females were illegitimate. The proportion of still births to living children was as 1 to 37. The still birth rate was 2.6 per cent, of the total births. The still birth rate, on the same basis as for Infant Mortality, was 26.4 per 1,000 births. Ophthalmia Neonatorum. Three cases were notified during 1944. 68 The following table gives the notifications in Croydon during the past ten years: — 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 No of Cases 13 20 21 20 15 14 17 19 10 3 Rate per 1,000 Births 3.9 6.2 6.4 6.0 4.5 4.7 7.0 5.5 2.7 0.8 Results of Treatment. Notified. Cases treated. Vision Unimpaired. Vision Impaired Died. Removed Remaining under T reatraent At home. In hospital 2 — — 1 - 3 3 — Infant Mortality. The Infantile Mortality rate was 44 per 1,000 live births registered. For the past 5 years the number of infant deaths have been 1940—116, 1941—90, 1942—137, 1943—137, and 1944—156. 125 deaths of infants occurred in Institutions, including Registered Nursing Homes. Among the 156 deaths, 95 occurred in boy babies and 01 in girls. Of the births, 1,849 were males and 1,734 females. The infantile mortality rate for the two sexes was, therefore Boys—51, Girls-35. 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 28 9 2 1 2 2 2 24 19 5 94 15 11 10 4 7 1 5 3 4 2 — 156 Chicken Pox — — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — — — — — — — Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — Whooping Cough — — — — — — — — — — — — — 2 — — — 2 — 1 — — 5 Diphtheria and Croup — — — — — — — — — — — — — — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — — — — — — — — 1 — — — — 1 Abdominal Tuberculosis — — — — — — — — — — — — — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — — — — — — — 1 — — — — — 1 Meningitis (not Tuberculous) — — — — — — — — — — — — — — — — — — — — — — — Convulsions — — — — — — — — — — — — — — — — 1 — — — — — 1 Laryngitis — — — — — — — — — — — — — — — — — — — — — — — Bronchitis — — — — — — — — — 1 1 — 1 1 — — — — — — — — 3 Pneumonia (all forms) — — — — — — — 5 2 — 7 4 2 3 1 2 — 1 — 2 2 — 24 Diarrhoea and Enteritis — — — — — — — 2 3 1 6 1 3 — 2 1 — 1 1 — — — 15 Gastritis — — — — — — — — — — — — — — — — — — — — — — — Syphilis — — — — — — — — — — — — — — — — — — — — — — — Rickets — — — — — — — — — — — — — — — — — — — — — — Congenital Malformations 4 4 — — — 2 — 1 — 1 12 5 1 1 1 — — — — — — — 20 Premature Birth 15 5 2 — 1 — 1 11 11 — 46 3 1 — — — — — — — — — 50 Atrophy, Atelectasis, Debility and Marasmus 8 — — — — 1 3 _ 12 1 1 1 — — — — — — 15 Injury at Birth 1 — — — — — — 2 1 — 4 — — — — — — — — — — — 4 Other Causes — — — 1 1 — — — 2 2 6 2 2 2 — 2 — — 2 1 — — 17 Totals 28 9 2 1 2 2 2 24 19 5 94 15 | 11 10 4 7 1 5 3 4 2 156 69 The rate of infant mortality amongst legitimate children was 40 per 1,000 births. The rate in illegitimate children was 87 per 1,000 births. The following table gives the cause of death during the first month of life: — (1) Complications of Labour— Trauma at Birth 4 (2) Foetal States— 4 Congenital Heart Malformation 5 Other Congenital Deformities 7 Atelectasis, etc. 12 Hemorrhagic Disease of Newborn 3 27 (3) Prematurity 46 46 (4) Post-Natal Causes 17 017 94 70 71 Confinements Attended by Midwives (including Municipal Midwives). Cases attended by Midwives alone 2,897 81% of total Cases attended by Midwives when a doctor was also engaged 383 Cases attended by Midwives when a doctor was also summoned 297 Total 3,577 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 mrdical aid: For Complications during Pregnancy. Abortion 4 Other causes 14 Albuminuria 7 25 For Complications during Labour. Breech 4 Transverse Lie 1 Face 1 Undiagnosed 9 15 Delayed Labour. Uterine Inertia 4 Prolonged 18 Delayed 21 Other 5 48 Haemorrhage. Ante-Partum 2 Post-Partum 2 4 Other Causes. Adherent and Retained Illness of Mother 6 Placenta 4 Torn Perineum 103 113 For Complications during Puerpf.rium. Pyrexia 10 Pain in Breasts 4 Pain in Legs 18 Other causes 1 33 For Complications in regard to the Baby. Inflammation of Eyes 32 Still Birth 1 Feebleness 12 Other causes 10 Premature Birth 4 59 297 72 In accordance with Rule 33 of the Central Midwives Board, the following reasons for the discontinuance of breastfeeding were received: — Illness of Mother 15 Insufficient Milk 54 Other Causes 15 Total 84 Inspection of Midwives. Dr. Jenkin Lloyd, the Inspector of Midwives, iiiteiviewed 11 midwives at the Town Hall. Fourteen visits were paid by her to the homes of midwives. Doctors' Accounts under Section 14 (1) of the Midwives Act, 1918. 248 accounts were received from doctors for services rendered under the provisions of this Section. This compares with 329 in 1943, 373 in 1942, 245 in 1941, 321 in 1940, and 424 in 1939. The total amount of the accounts was £385 10s. Od. £272 5s. 8d. was ultimately recovered from the patients. In 1943 the amount paid to doctors was £671 Is. Od. and in 1942 £461 16s. 6d. Nursing Homes. Maternity Homes. Other Nursing Homes. Combined Maternity and other Nursing Homes. Total. No. of Homes on Register on 31/12/43 6 15 14 35 No. of Applications for Registration during 1944 1 3 — 4 No. of Homes Registered during 1944 1 3 — 4 No. of Homes on Register on 31/12/44 9 23 5 37 No. of Beds available 60 326 (a) Mat. Beds 29 471 (6) Other Beds 56 WARTIME NURSERIES. Attendances at War-time Nurseries, 1944. Coldharbour House. Whitehorse Road. Mayday Road. Tennison Road. Morland Road. Bramley Hill. Ritchie Road. New Addington. Euston Road. Date opened 23/2/42 1/6/42 1/6/42 1/6/42 8/3/43 27/10/43 23/11/43 28/3/44 15/5/44 Number on books at end of year 88 41 49 47 43 53 45 34 43 Attendances : under 2 4351 2979 4023 3167 3532 4091 2987 793 1396 over 2 12225 5355 6238 7926 6513 5662 4283 2369 3116 Total 16576 8334 10261 11093 10045 9753 7270 3162 4512 Number of days opened 304 298 302 304 304 305 266 226 192 Average daily attendance • 55 * 28 34 36 33 32 * 27 14 24 73 * Extensive War Damage. MATERNITY AND CHILD WELFARE CONSULTATIONS. There are 18 Maternity and Child Welfare Centres, 10 of which are conducted by the Croydon Mothers' and Infants' Welfare Association and 2 by the local authority. A total of 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 1944, 2,663 new cases under 1 year of age and 449 over 1 year of age attended for the first time; the total of attaidairces of infants and young children from 0—5 years decreased from 85,809 in 1943 to 50,884 in 1944. Consultations with doctors decreased from 22,935 to 17,034. 45 expectant mothers were seen, a decrease of 12 on 1943, and a total of 209 visits to the Centres was paid by them. The total of all visits to the Centres was 57,093, a decrease of 29,149 compared with 1943. The highest average attendance of mothers and babies at each session was recorded at St. Stephen's (72.5), South Croydon (69.1), St. John's (63.8), Norbury (60.1), Municipal (57.5), Boston Road (57.5). 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 examined during the year numbered 602 compared with 570 last year, and represented 93 per cent, of the total number of mothers seen for the first time. Of the above, 85 per cent, presented themselves during the first six months of gestation; the remaining 15 per cent, seen during the later stages of pregnancy, included some who had either failed earlier appointments or "declined" dental treatment when this was previously advised in the Ante Natal Clinic. 75 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 44 compared with 55 last year. Those seen during the first six months after their confinement constituted 79 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 also completed for those referred before their confinements in the previous year. Treatment. Including those continuing treatment from the previous year, the total of expectant and nursing mothers treated was 778 compared with 733 in 1943. As before, 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, tail 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 ssction of expectant mothers receiving medical attention who, through ignorance or prejudice, fail to avail themselves of existing dental facilities. The Pre-School Child. The total of the above children referred from Welfare Centres and other sources was 299. This figure is slightly 'ess than that of the previous year, which was below that recorded in normal times. One probable cause is that wartime employment undertaken by mothers tends to restrict treatment for this class of patient. Whilst, as might be expected from the number of interruptions experienced, treatment figures were generally slightly lower than in the previous year, the number of fillings inserted shows, curiously enough, a definite increase on 1943. Full details are to be found in the ensuing Table. 76 The following summary shows particulars of the work accomplished: — Expectant Mothers. Nursing Mothers' Total. Young Children. New Cases Examined 602 44 646 247 Re-treated 124 8 132 52 Total 726 52 778 299 Attendances 2446 164 2610 548 Fillings 724 25 749 448 Extractions 1832 67 1889 264 "Gas" Cases 253 11 264 87 Local Anaesthesia 456 7 463 125 Scalings and Gum Treatment 293 7 300 5 Dressings 508 26 534 20 Denture Dressings 1382 145 1527 — Silver Nitrate — — 264 Treatments Completed 275 16 291 147 Number of Sessions (treatment) 445 Dentures Fitted: Full 180 Partial 102 Total 282 Dentures repaired 20 The Centres at which patients were examined, or from which they were referred, are given in the following list: — Ante-Natal 553 The Retreat 4 Waddon 2 Post-Natal 1 South Croydon 4 Shirley 10 Municipal Midwives 146 St Albans 8 Boston Road 18 Municipal 27 Woodside 8 St. Stephen's 6 East Croydon 23 Norbury (St. Paul's) 5 Holy Trinity 11 Upper Norwood 9 Bensham Manor 4 Addington 5 West Croydon 8 St Oswald's 10 War-time Nurseries 26 South Norwood 11 St. Andrew's 7 By Dental Officers 122 Total: 1,028 The amount received for attendance fees was £62 13s. Od., as against £79 14s. Od. in 1943. The Work of the Health Visitors.—Maternity and Child Welfare Only. Visits Re:— Adalian Ashe Bird 1 Buttfield | Lef t 27-9-44 Catlow Cross Devaney Early Ernest Hinton Hobdey Lewis Oakley Overington Ponting Richardson Southgate Toneri Wakefield Walker Warman Webb Wilson Wybrew Total Infants under 1 year. First visits 93 78 185 129 191 80 158 115 181 153 197 103 146 179 150 140 165 278 110 214 177 143 165 179 3724 Re-visits 71 234 828 589 450 167 955 030 296 993 1171 859 455 932 322 504 209 246 198 558 590 487 414 663 12851 Children 1-2 years. First visits 10 1 13 4 2 1 3 — 6 4 11 9 13 2 1 1 4 6 2 10 5 2 3 6 119 Re-visits 52 150 501 354 293 204 475 346 111 616 760 494 337 641 216 308 211 122 213 628 216 341 363 395 8353 Children 2-5 years. First visits 9 2 8 11 — 5 7 — 3 1 — 6 11 3 1 2 7 1 — 15 7 5 14 12 130 Re-visits 137 263 516 705 251 158 419 455 184 554 1201 582 355 552 519 401 341 83 317 892 660 468 716 045 11374 Expectant Mothers. First visits 64 57 90 92 58 56 62 47 75 51 73 50 64 38 55 108 118 121 65 84 116 61 122 81 1808 Re-visits 2 14 7 4 12 22 — 53 6 — 50 1 — 4 2 11 24 1 3 14 - 3 45 8 286 Still Births — — 2 — 1 — — 1 — — — 3 — 1 — 2 4 3 1 1 1 3 2 25 Deaths under I year 1 5 2 5 2 3 2 1 7 — 3 1 1 — 4 — 8 5 1 4 2 1 6 4 68 Miscellaneous visits 35 4 49 5 12 73 33 66 131 3 7 3 4 20 2 19 522 78 16 11 4 41 165 8 1311 Ineffective visits 350 218 289 588 493 447 423 265 473 636 399 547 572 323 517 344 395 278 364 793 381 756 700 541 11095 Totals—1944 824 10232490 248S 1771 1216 2537 2009 14733017 3872 2655 1961 2697 1790 1847 2006 1223 1292 3224 2159 2309 2716 2544 51144 1943 761 837 1073 2336 1913 818 1931 1841 1049 2060 3514 1625 1922 1990 850 1226 1150 1097 900 2319 1130 1056 1985 1771 38771 77 Attendances at Infant Centres—1944. 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 1944. Total 1943. New cases under 1 year 332 133 126 166 140 134 276 195 65 150 114 174 69 116 117 95 118 143 2663 3142 No. of re-attendances 3368 1493 1469 2256 1135 1429 2777 2590 945 2281 1663 2448 882 1463 1403 1369 1436 2222 32629 51588 New cases over 1 year 58 18 22 32 25 17 52 33 18 28 36 17 21 14 24 18 1 15 449 755 No. of re-attendances 1997 1174 1027 931 698 919 1717 1206 916 1364 1227 1452 900 1347 755 1232 961 1320 21143 30384 Attendances of children 0-5 5755 2818 2644 3385 1998 2499 4822 4024 1944 3823 3040 4091 1872 2940 2299 2714 2516 3700 56884 85869 Consultations with Doctor 2052 877 798 956 502 710 1563 1487 523 1289 991 1223 735 668 845 967 774 1074 17034 22935 No. of Sessions 100 49 48 49 37 49 89 82 48 78 48 87 49 49 49 49 72 51 1083 1148 Expectant Mothers: No. of new cases 4 — — — — — — 12 — 2 13 — 1 1 11 1 — — 45 57 No. of re-attendances — — — 1 — — 3 9 — 12 7 — 28 2 70 32 — — 164 316 Total attendances of Expectant Mothers 4 — — 1 — — 3 21 — 14 20 — 29 3 81 33 — — 209 373 Total attendances 5759 2818 2644 3386 1998 2499 4825 4045 1944 3837 3060 4091 1901 2943 2380 2747 2516 3700 57093 86242 Average attendance per Session 1944 57.5 57.5 55.1 69.1 54.0 51.0 54.2 49.3 40.5 49.1 63.8 47.0 38.8 60.1 48.6 56.1 34.9 72.5 ‡52.7 1943 85.2 77.6 85.8 91.5 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 ‡ Total average attenaance ea.cn week at all centres. 78 79 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 14 Total number of weeks 154 Cost £117 7s. 5d. Numbers of mothers sent for convalescence None Number of children under 5 sent with their mothers to cottages One Home Helps. From 1st January to December 21st, 412 mothers applied for Home Helps, and 373 were supplied. The corresponding figures for 1943 were 431 mothers applied, and 381 were supplied. £567 19s. 2d. was collected in payment for their services. At the end of the year there were the names of 14 full-time and 4 casual Home Helps on the register. Babies' Help Report. I am indebted to Mrs. Philpott for the following particulars:— In January, 1944, 3 mothers and babies were receiving help. In December 11 were on the books. 24 have been helped during the year. We are again grateful to the Health Visitors for their help in the 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. 80 The Tables below give figures for 1944. FOSTER CHILDREN No.as at Dec. 31st 1943 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 1944 Parent Another area with Foster Parent Another Foster Mother Public Institution 144 126 76 51 14 13 17 3 9 1 87 FOSTER MOTHERS. No. as at December 31st 1943 Applications for Authorisation during the year. Removals during the year Authorisation cancelled for other reasons No. as at December 31 st 1944 With Child Without child 150 31 11 40 G9 61 The Health Visitors paid 972 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 1944. Taking the Registrar-General's figures for maternal mortality (deaths directly due to pregnancy, but excluding abortion, the rate for England and Wales for 1944 was 1.53 per 1,000 birthsIn Croydon the rate was 1.08. In "booked" cases treated by the Obstetric Service the rate for 1944 was 0.63 per 1,000 Hospital deliveries; nil per 1,000 home deliveries, and 0.39 per 1,000 over all deliveries. The total rate for the Service, 0.39 per 1,000, is the lowest ever recorded. The only death in booked cases was an abortion. Of the cases treated to a conclusion at the Post-Natal Clinic during 1944, 96.7 per cent, were classified as "Health Unimpaired." This signifies that anatomically and functionally their condition was the same as before their pregnancies. The corresponding figure for 1943 was 88.9. 81 The number of cases delivered of viable babies in Mayday Hospital, with a nominal 68 beds, was 1,098. The number delivered at St. Mary's Maternity Hospital, with 30 beds, was 490. The number of cases delivered by the Domiciliary Branch of the Service (Municipal Midwives) was 991. Including 32 cases admitted after delivery, the total number of deliveries dealt with by the Obstretric Service was 2,579. The total number of infants born was 2,604. 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. 368 mothers and babies were transferred from Mayday Hospital, and 27 mothers and babies from St. Mary's Hospital in the first half of 1944 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 1944, as compared with previous years. The Home was closed for the last half of 1944, owing to enemy action. General Statistics, 1944. No. of live births allocated to the Borough of Croydon 3,583 ,, still ,, ,, ,, ,, 97 No. of maternal deaths (directly due to pregnancy) No. of cases of notified Puerperal Pyrexia 48 No. of expectant mothers who attended the Borough Ante- Natal Clinics 3,783 No. of cases delivered in Mayday Hospital as Booked cases (exclusive of abortions) 1,030 No. of cases delivered in Mayday Hospital as Emergency cases (exclusive of abortions) 68 Total cases delivered in Mayday Hospital 1,098 No. of cases delivered in St. Mary's Maternity Hospital as Booked cases 490 No. of cases delivered in St. Mary's Maternity Hospital as Emergency cases — Total cases delivered in St. Mary's Maternity Hospital 490 No. of cases delivered by Municipal midwives 991 Total 2,579 82 No. of cases admitted to the Puerperal Infection Unit, Borough Hospital and Mayday Hospital Isolation Wards, including 22 from Mayday Hospital and 7 from St. Mary's Maternity Hospital 36 No. of Maternal deaths in Booked cases from Borough Ante-Natal Clinics 1 (an abortion) No. of Maternal deaths in Emergency cases at Mayday Hospital 6 (including 3 criminal abortions) No. of Maternal deaths in cases admitted as Puerperal Sepsisperse 0 Total Maternal deaths in beds of the Obstetric Service 7 (including 4 abortions, 3 of which were criminal) The total number of patients treated by the Obstetric Service was:— (a) In Mayday Hospital 1,731 (b) In St. Mary's Maternity Hospital 490 (c) In the Borough Hospital Puerperal Infection Unit and Mayday Hospital Isolation Wards, excluding 15 from (a) and 7 from (b) 7 (d) At the Ante Natal Clinics and delivered outside the above Hospitals (including Municipal Midwives' cases) 1,416 (e) At the Post-Natal Clinics, excluding those included in (a), (6), (c) and (d) 1,370 (/) At the Ante-Natal Clinics and undelivered on December 31st, 1944 939 5,953 ANTE-NATAL SUPERVISION. 1943 1944 No. of Sessions at Ante-Natal Clinics held 565 551 No. of individuals who attended 4,100 3,783 No. of previous year's cases continuing attendance 778 982 No. of new cases 3,322 2,824 No. of cases undelivered on 31st December 982 Total attendances made 22,273 21,141 Average attendances per session 39 No. of cases delivered in hospital as Booked cases 1,737 1-584 No. of cases delivered by Municipal Midwives. 1,072 991 No. of cases delivered at other places under the care of private doctors or midwives 138 83 No. of patients found not to be pregnant 29 25 No. of patients referred to hospital for Ante- Natal treatment 489 267 The conditions for which these were admitted can be ascertained by reference to the "Booked" columns of the Numerical Summary of Cases. 8 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 1944 the Obstetric Service dealt with 2,(504 out of the total births allocated to the Borough. Major Ante-Natal Conditions treated at the Ante-Natal Clinic. BREECH PRESENTATION. Breech presentation diagnosed 211 Spontaneous version 16 External version successful 146 External version not successful 49 Allowed to go to term as Breech 49 Not recognised as Breech before labour 0 DENTAL TREATMENT. No. of cases referred to Borough Dental Surgeons 700 No. of cases referred to Private Dental Surgeons 91 No. of cases refusing dental treatment 42 No. of cases seen too late for necessary dental treatment 46 TUBERCULOSIS. Referred from Tuberculosis Officer because of pregnancy 8 Referred to Tuberculosis Officer for opinion on lung condition 17 VENEREAL DISEASE. Gonorrhoea Total cases 2 Transferred to Borough V.D. Clinic 2 Syphilis Total cases 7 Transferred to Borough V.D. Clinic 7 Non-Venereal 5 Independent Midwives Cases. These cases may be summarised as follows: — Total number of midwives' cases during 1944 425 Number of cases sent for one consultation only 90 Number of cases supervised entirely 335 84 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 117 Blood for Gonococcus Fixation Test 117 Blood for Grouping 181 Blood for Culture 8 Blood for Urea Content 46 Blood for Cell Count, etc. 80 Catheter Urine for Routine Examination 452 Urine for Aschheim-Zondek Test 40 Urine for Urea Concentration Test 124 Lochia for Culture 92 Sputum for Examination 12 Pus for Identification of Organism 38 Urethral Smears for Gonococci, etc. 8 Cervical Smears for Gonococci, etc. 9 Conjunctival Smears 28 Histological Sections 263 Throat Swabs for Organisms 96 Faeces for Occult Blood, etc. 15 Blood for Hb. Estimation 616 Various 16 Blood Compatibility Tests 130 X-Ray Examinations (Mayday Hospital X-Ray Department). 343 cases were referred from Mayday Hospital, St. Mary's Maternity Hospital, and Ante-Natal Clinics. Reasons for reference were: — Breech for Attitude, etc. 67 For Presentation, Attitude, etc. 65 Twins 72 Foetal Death 6 Foetal Parts 6 Disproportion 91 Foetal Abnormalities 25 Pelvic Abnormality 5 Various 6 85 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 998 490 1,488 (2) Delivered in hospital before 28th week.. 67 — 67 (3) Admitted after delivery 25 — 25 (4) Discharged undelivered after ante-natal treatment and not subsequently delivered in hospital 1 2 3 (5) Died undelivered 1 — 1 (6) Ectopic Pregnancy — — — 1,092 492 1,584 B.—"Emergency" patients sent into Hospital with some complications by outside doctors or midwives. No "Emergency" cases were admitted into St. Mary's Maternity Hospital: — Mayday (1) Before Labour : Hospital. (a) Discharged undelivered 14 (b) Delivered in hospital after 28th week 68 (c) Delivered in hospital before 28th week 128 (d) Died undelivered — (2) After Delivery 7 (3) Ectopic Pregnancy 4 221 86 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 90 11 23 124 Eclampsia — 2 — 2 Persistent vomiting of pregnancy 6 1 — 7 Chronic cervitis — — — — Acute pyelitis 13 5 2 20 Malnutrition, debility, simple anaemia,etc. 28 — 10 38 Retroverted gravid uterus 2 — — 2 2. Intercurrent Diseases. Chronic nephritis — — — — Pulmonary Tuberculosis 8 — — 8 Venereal disease 14 — — 14 Cardiac disease 20 1 2 23 3. Conditions chiefly Natal. Presentations at Delivery:— Anterior positions of the vertex 951 50 452 1453 Posterior positions of the vertex 37 7 23 67 Breech 34 5 15 54 Shoulder — 1 1 2 Face and brow — — — — Complex — — 1 1 Caesarean section 45 2 — 47 Twins and Triplets 17 — 8 25 Accidental haemorrhage 10 9 3 22 Placenta praevia 19 2 2 23 Hydramnios 10 — 1 11 Prolapse of cord 3 — — 3 Retained placenta 7 1 5 13 Post-Partum haemorrhage 44 1 10 55 B.B.A 25 7 — 32 Lacerated perineum 351 17 186 554 Obstructed labour — — — — Premature labour 72 5 19 96 Abortion 98 144 — 242 Ectopic pregnancy — 4 — 4 Abdominal Hysterotomy — 2 — 2 Forceps delivery 51 6 32 89 4. Conditions chiefly Post Natal, excluding re-admissions from Post Natal Clinic. Breast abscess 6 1 — 7 Notified pyrexia or fever 20 2 7 29 In addition 7 cases of Puerperal Pyrexia per se were admitted to the Puerperal Infection Unit of the Borough Hospital. 87 Blood Transfusion (93 Obstetrical and 50 Gynecological cases). For every case, stored blood from the Blood Transfusion Depot, Sutton, was used. There were no deaths. Infants. Mayday Hospital Booked. Mayday Hospital Emergency St. Mary's Maternity Hospital Booked. Total Per Cent. No. of infants in Hospital on 1st Ian., 1944 50 2 18 70 — Total No. of live births, still births and infants admitted with Mother (B.B.A.) 1047 68 498 1613 — No. of infants in Hospital on 31 st Dec., 1944 35 — 16 51 — Alive on discharge from Hospital 984 52 477 1513 93.9 Stillborn 27 8 14 49 3.0 Died (born alive, but died in Hospital) 36 8 5 49 3.0 Twins and Triplets. There were 25 cases of Twins and no Triplets. There was no maternal death. Mayday Hospital. Booked. Mayday Hospital. Emergency St. Mary's Maternity Hospital. . Booked. Total. No. of cases 17 — 8 25 No. of infants discharged alive 24 — 13 37 No. of still-births and infant deaths 10 — 3 13 Foetal and Infant Mortality 29.4% . — 18.7% 26% 88 POST NATAL AND GYNAECOLOGICAL CLINIC. Number of Sessions held 130 ,, ,, Individuals presented 1,723 ,, ,, Subsequent attendances 1,086 Total attendances 2,809 Average attendance per session 21 Number of Post-Natal cases 1,439 Number of Gynaecological cases 1,370 END RESULTS. 1,091 cases were treated on their termination (other than death) during the year, and the results were classed as follows:— Mayday St. Mary's M.M. Total. % Health unimpaired 571 275 190 1,036 96.7 Health slightly impaired 21 11 23 55 3.3 Health seriously impaired 0 0 — 0 0. Totals, treated to conclusion 592 286 213 1,091 Maternal Mortality (Obstetric Service). Seven deaths occurred of mothers dealt with by the Service, one f in a "Booked" case and 6 emergencies.* The maternal mortality of "Booked" cases, i.e., cases under the continued supervision of the Service, is 0.65 per 1,000 hospital deliveries, and 0.39 per 1,000 total deliveries, including the Municipal Midwives " Booked " cases. Puerperal Infection, Thirty-sdx cases were treaited in isolation for puerperal infection, 7 of them in the Borough Hospital and 29 in Mayday Hospital. There was no death. Sources of the Cases. Cases. Deaths. From Mayday Hospital:— "Booked" Cases 20 — "Emergency" Cases 2 — From St. Mary's Maternity Hospital 7 — From other Hospitals — — From private doctors, deliveries in Nursing Homes — — From private doctors, deliveries at home * Including 3 criminal abortions. † An abortion. 89 The Assistant Medical Officer of Health for Obstetrics was called in by medical practitioners to see 85 obstetrical and 178 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 45 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 40 Aged 5—16 years 170 Over 16 years 390 Total 600 2.—Education Cases. Aged 7—16 years 128 Combined Total 728 Compared with 1943, the Statutory cases show an increase of 32 and the Educational cases an increase of 14. Three of the cases under Statutory supervision have died-two in hospital and 1 at home. 3 institution patients have died in hospital. The Statutory cases are distributed as follows: — In Certified Institutions 191 In Approved Homes 5 On leave from Institutions 3 Under Statutory supervision at home 279 Under Guardianship 66 In Mental Hospitals 7 Observation Cases 54 605 90 The Education cases were distributed as follows:— In Certified Residential Schools 3 In Certified Day Schools 101 In Private Schools — Awaiting vacancies at St. Christopher's 24 128 During tlie year the Certifying Medical Officers made examinations and paid visits to the number of 120 to Statutory cases. The Mental Deficiency Visitors paid 1,060 visits to Statutory cases and 1,006 to Education cases, 2,066 visits in all, a decrease of 229 on 1943 figures. During 1944, thirty-one Statutory cases were dealt with as follows: — Sent to Certified Institutions 12 Placed under Guardianship 11 Sent to Croydon Mental Hospital Varying Orders: (a) Change of Guardian 2 (b) From one Institution to another 3 (c) From Guardianship to Institution — (d) Orders closed 3 Eighty-seven Orders were renewed during the year, 10 of which were Guardianship. Guardianship Cases. There were 66 cases under Statutory Guardianships, 42 of these under the care of relatives, and 24 with Guardians who are not relatives. 9 males and 3 females are at work. 480 visits have been paid to Guardianship cases during the year. There are 3 cases on leave from Institutions (2 boys and 1 gir1). 91 Clinic for Mentally Defective, Backward and Abnormal Children. 107 children were examined during 1944. The classifications arrived at, together with recommendations made, are summarised under: — (1) Certified as Mentally Defective: Recommendations. (a) Recommended for Special Day School 43 (b) Recommended for Residential School 5 (c) Recommended for Occupational Centre 3 (2) Found to be dull and backward: (a) Referred to a special class 26 (b) Further trial in ordinary class 1 (c) Re-test in one year 25 (d) To attend St. Giles because of physical defect 1 (f) To attend St. Luke's 1 (J) Referred for Medical Treatment — (3) Referred to Child Guidance Clinic 3 107 Mental Tests at St.-Christopher's 19 ORTHOPAEDIC DEPARTMENT. The arrangements are the same as in 1943. Summary of Cases Attending the Orthopedic Cimie. Jan. 1st, 1944. New Cases, 1944. Cases Discharged, 1944. Cases on books, Dec. 31st, 1944. M.C.W. S.M.S. T uberc. M.C.W. S.M.S. T uberc. M.C.W. S.M.S. Tuberc. M.C.W. S.M.S. T uberc 136 196 86 76 127 13 73 142 13 139 181 86 418 216 228 406 92 Cases Seen by the Orthopccdic Surgeon. Defects. School. M.C.W. Tuberculosis. Total. Cases. Attendances. Cases. Attendances. Cases. Attendances. Cases. Attendances. Infantile Paralysis Curvature or Postural 10 22 1 4 — — 11 26 Defects 26 40 — — — — 26 40 Pes Cavus 7 9 — — — — 7 9 Pes Planus 89 167 14 24 — — 103 191 Genu Valgum 46 58 73 134 — — 119 192 Talipes 9 20 10 21 — — 19 41 Obstetrical Paralysis 1 1 1 2 39a 84a 2 3 Joint Diseases 4 6 — — 4s 5s 49 102 2m 7m Injuries 6 13 1 1 — — 7 14 Rickets 1 1 3 5 — — 4 6 Wry Neck 1 4 4 10 — — 5 14 Spastic Paraplegia 8 12 6 9 14 21 Congenital dislocation of the Hip . 10 22 — — — — 10 22 Other deformities 46 59 30 39 — — 76 98 264 434 143 249 45 96 452 779 a—Adults; s—School Child; m—Pre-School. Summarised the Table shows 264 school children attended and made 434 attendances; 143 babies made 249 attendances; and 45 tuberculosis cases made 96 attendances; a total of 452 cases, nakir.g 779 attendances. 93 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 T reatments X- Rays Cases No. of Treatments X- Rays Cases No. of Treatments XRays Cases No. of Treatments XRays Infantile Paralysis 2 27 — — — — — — — 2 27 — Curvature or postural defect 4 16 1 — — — — — — 4 16 1 Pes cavus — — — — — — — — — — — — Pes planus 2 18 — — — — — — — 2 18 — Genn Valgum 1 — 1 — — — — — — 1 — 1 Talipes — — — 2 49 — — — — 2 49 — Joint Disease 1 — 1 — — — 16 1 21 17 1 22 Injuries 3 3 5 1 — 1 — — — 4 3 6 Rickets — — — — — — — — — — — — Wry Neck 1 5 — 3 13 1 — — — 4 18 1 Spastic Paraplegia — — — — — — — — — — — — Congenital Dislocation of the Hip. 5 4 4 — — — — — — 5 4 4 Other Deformities 8 — 8 2 1 1 — — — 10 1 9 27 73 20 8 63 3 16 1 21 51 137 44 94 Cases sent to Residential Institutions. Name of Institution. School Cases. M. & C.W. Cases Tuberculosis Cases. Total. No. in on 1st Jan., 1944 Admitted Discharged. No. in on 1st Jan., 1944 Admitted. Discharged. No. in on 1st Jan.. 1944 Admitted. Discharged. No. in on 1st Jan. 1944 Admitted. Discharged. No. in on 1st Jan. 1945 Horton — — — -.— — — 1A — lA 1 — l — Pyrford — 1 — — — — 2s 2s 1s 2 3 1 4 Croydon Gen. Hosp. — 4 4 — 2 2 1a lA 2a 1 7 8 — Heritage Craft Schls. 1 — — — —- — 1s 1s — 3 1 — 4 lM Pinner — — — 1 — — — — — 1 — — 4 E. M. S. Hosp. — — — — — — — 2a lA — 2 1 — Royal Sea-bathing Hosp. — — — — — — 1A — lA 1 — 1 — Shaftesbury Homes 1 — — — — — — — — 1 — — 1 Queen Mary's Hosp. — — — — — — 1s — — 1 — — — Royal Nat. Orth. Hosp — — — — — — lA lA 2A 1 1 2 — Mayday Hosp. 2 2 4 — 4 2 lA 7A 4A 3 14 11 6 1s 1s Redhill Hosp. — — — — — — — 1A — — 1 — 1 4 7 8 1 6 4 10 16 13 15 29 25 19 95 Conditions for which Patients were admitted to Hospitals with the Results of Treatment. Condition. In on 1st Jan. 1944 Admitted or transferred. Discharged. I.S.Q. Died. In on 1st Jan. 1945 Arrested. Quiescent. Improved. Infantile Paralysis 1 1 — — 1 — — 1 Tubercular Joint Disease 10 16 3 1 5 4 — 13 Hemiplgeia Genu Valgum — 4 — — 2 — — 2 Pes Planus — 2 — — 2 — — — Talipes - - - - - - - - Rickets - - - - - - - - Other Deformities — 4 — — 4 — — — Spastic Paraplegia — 1 — — 1 — — — Scoliosis 2 — — — 2 — — — Osteomyelitis - - - - - - - - Congenital Disease of Hip 2 1 - - - - - 3 15 29 3 1 17 4 — 19 The percentage of arrested cases was 12 per cent.; quiescent cases was 4 per cent.; and 68 per cent. were improved. 96 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) 81 Number of Blind who benefit from part-time instruction 43 Number in remunerative handicrafts— (a) Home worker 35 (b) In workshops 9 (c) St. Dunstan's 13 (d) Workers not included in scheme 31 Home Teacher 1 The Health Visitors paid 489 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. Number of Blind on Register 450 97, 98 M.= Males. F.= Females. T.= Total. TABLE I. WELFARE OF THE BLIND—REGISTRATION. As at 31/3/45. Age period Age period Age period Age period Age period Age period Age period Age period Age period (i) Total of all age groups 0—1 1—5 5—16 16—21 21—40 40—50 50—65 65—70 70 and over (ii) Age unknown M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. — — — 1 — 1 6 3 9 6 3 9 24 21 45 25 23 48 58 63 121 20 18 38 58 119 177 (i) 198 (i) 250 (i) 448 (ii) — (ii) 2 (ii) 2 AGES AT WHICH BLINDNESS OCCURRED. Age period Age period Age period Age period Age period Age period Age period Age period Age period Age period Age period 0—1 1—5 5—10 10—20 20—30 30—40 40—50 50—60 60—70 70 and over 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. 30 19 49 4 6 10 10 9 19 15 10 25 18 11 29 23 19 42 28 26 54 17 41 58 20 42 62 20 49 69 13 20 33 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 (c) (d) (e) (f) (g) All others not included in (a) and (b) Total Employed Industrial Secondary Professional and University In Schools for the Blind 4 — — 1 — — Trained but unemployed No training but trainable Unemployable Total (a) (b) Other Schools 2 1 — — — — Workshops Home workers M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. Sot at School — — — 1 — — 7 2 9 24 11 35 24 7 31 55 20 75 4 2 6 — — — — — — — — — — — — 132 227 359 191 249 440 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 Healers, Tea Agents, Newsagents, Shop. Keepers 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 (Fendoff) Makers Telephone Operators Tuners Weavers Miscellaneous Total Hand Machine Mattress Makers Machinists Upholsterers Within Institution lor the Blind — 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 9 Id approved Home Workers Schemes — 7 — — — 2 — — — 2 — — — 1 — — 1 9 — — 2 — — — — — — — — 11 — — 35 Others not parttime workers) ... — 1 — — 1 — — — — — 3 — 4 — — 1 — — 1 — 1 2 2 1 — 2 — — — 3 1 — — 31 Total — 9 1 — 1 2 — — 2 3 — 4 1 — 1 — 1 11 — 2 4 2 2 — 2 — 3 — 3 12 8 75 PHYSICALLY AND MENTALLY DEFECTIVE. (a) (b) (c) Combinations of (a) and (b) Combinations of (a) and (c) Combinations of (b) and (c) Combinations of (a), (b), (c) Total Homes for the Blind Mental Hospitals Poor Law Institutions Mentally Defective. Physically Defective. (i) Deaf (ii) Deaf-mute M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 2 5 7 3 4 7 (i) 6 (i) 2 8 1 — 1 — 2 2 — — — — — — 14 14 28 — 2 2 1 2 3 7 20 27 (ii) 2 (ii) 1 3 99 SANITARY CIRCUMSTANCES. To the Medical Officer of Health. I beg to submit a report for the year ending the 31st December, 1944, of the work of the Sanitary Inspectors and other officers under my supervision. Reports during the war years have, of necessity, been much curtailed, but I think space can here be found for an appreciation of the efforts of the staff during this most trying year. From the middle of June onwards working conditions in the Borough were abnormal, starting with the 10 weeks of almost incessant day and night attacks from the enemy's "flying bomb," followed by the aftermath of destruction, and the consequent curtailment of building works other than those licensed as most urgent. All this meant extra work in the department and yet the normal essential duties of food inspection and sampling, infectious disease enquiries, disinfection, drainage and other complaints had to receive attention. The text of the report sets out fully the work done. GEO. GRIEVE, Acting 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) Number of houses inspected under the Rent Restriction Acts Number of houses inspected where zymotic diseases have occurred Number of houses inspected under Landlord and Tenant (War Damage) Acts House drains tested with smoke (primary) House drains tested with smoke (on application) Number of smoke tests during repair Inspections of drainage work during repair Number of water tests during repair Final tests of drains after repair Final tests of drains when completely relaid Length of new drains tested yards Inspection of yards, stables and manure pits ,, passages ,, public conveniences „ pigstyes ,, tents, vans and similar structures „ theatres, cinemas, halls, etc. ,, ponds and ditches and static water tanks ,, schools and school sanitary conveniences „ offices „ common lodging-houses ,, verminous premises ,, premises where offensive trades are conducted ,, gipsy encampments, camps, fairs, etc. „ cesspools ,, pail closets, privies „ gathering grounds of water supply 1,320 4 323 140 429 7 105 3,623 183 215 19 1,004 253 104 40 102 25 109 71 14 10 2 106 5 3 1 8 159 100 Number of visits under Rats and Mice (Destruction) Act, 1919— Private Houses 3,723 Shops 1,260 A.R.P.—Inspections concerning measures for protection against gas contamination 68 ,, Miscellaneous inspections and reinspections after air raids 146 ,, Inspections of posts and centres 274 ,, Inspections of war damaged houses 7,040 ,, Inspections of war damager food shops 2,925 Smoke observations 14 Number of visits re Infectious Diseases 1,283 Inspections of Shops (under Shops Acts) 338 Special Early Closing Patrols 1 Sunday Patrols 2 Special Evening Patrols (under Shop Hours Act) 1 Inspections under Fertilisers and Feeding Stuffs Act 2 ,, under Pharmacy and Poisons Act 47 ,, Dairies 78 „ Farms and cowsheds 53 ,, Milkshops 20 ,, Premises where food is prepared or sold 3,801 „ Slaughterhouses 103 ,. Factories without mechanical power 64 ,, Factories with mechanical power 261 ,, Workplaces, Public Health Act 80 ,, Outworkers' premises 258 Visits to Employers of Outworkers 17 Visits re Young Persons Employment Act 1 Water samples taken 128 Food and Drugs Acts: milk samples taken 248 Food and Drugs Acts : other foods and drugs samples taken 353 Milk Special Designations Orders: samples taken 145 Non-designated Milk: samples taken 88 Reinspections of work on outstanding notices 10,462 Sundry inspections and visits 4,261 Appointments kept with owners, builders, etc. 2,212 Complaints from public investigated (for purposes other than inspection of house) 5,281 Informal notices outstanding 31-12-43 1,224 Informal notices served 2,451 Informal notices complied 3,408 Number of Informal Notices referred for Statutory Orders 921 Informal notices outstanding 729 Statutory notices outstanding 31-12-43 111 Statutory notices served 748 Statutory notices complied 762 Statutory notices outstanding 97 Total number of complaints received at the office 4,018 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1944 and for which action was taken to enforce compliance:— (Not including defects found as a result of Air Raid Damage). (1) NUISANCES AND HOUSING DEFECTS AT HOUSES, etc. Insufficient means of ventilation: Defective windows and sashcords 157 Want of windows or ventilators 90 101 Conditions causing dampness: Defective roofs 212 Defective windows 31 Defective walls, etc 107 Want of efficient damp-proof course 61 Defective gutters and downspouts 146 Other structural defects: Detective plaster 162 Cleansing and limewashing required 115 Defective floors and stairs 182 Insufficient ventilation under floor 36 Defective brickwork, cills, lintels, chimneys, etc 46 Defective stoves and fireplaces and flues 148 Defective drains, sanitary fittings, etc.: Defective sinks and waste pipes 158 Defective w.c.'s 130 Defective drainage 145 Stoppages in drains 108 Domestic nuisances: Want of cleanliness 23 Dirty w.c. pans 36 Verminous conditions 106 Other nuisances and infringements: Offensive accumulations 26 Insufficient accommodation for sub-tenants 28 Defective manure receptacles 3 Dirty or defective sanitary conveniences 9 Smoke nuisances 18 Sundry nuisances or defects 50 Particulars not inserted in Rent Book (Housing Act) 10 „ ,, ,, (Rent Restriction Act) 6 (2) FACTORIES AND WORKPLACES. Want of cleanliness 10 Inadequate ventilation 9 Insufficient drainage of floors 1 Abstract not exhibited 5 Thermometers required 1 Unreasonable temperature 2 Sundry nuisances or defects 6 W.C.'s—Insufficient 4 ,, Unsuitable or defective 6 ,, Not separate for sexes 5 ,, Not lighted 1 (3) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924. Food cupboards defective or required 4 (4) INFRINGEMENTS OF FOOD AND DRUGS ACT, 1938, AND FOOD BYELAWS. Cleansing or repair of walls and ceilings 31 Cleansing or repair of floors, utensils, fixtures, etc. 12 Dirty or defective w.c. accommodation 7 Food storage accommodation required 10 Animals kept in food store 2 Refuse bins uncovered 3 Accumulation in food store and yards adjacent 4 Food in uncovered vehicles or baskets 2 Premises not suitable for storage or manufacture of food 5 102 Want of provision of towels 4 Provision of cloakroom accommodation 3 Want of intervening ventilated space to w.c. 5 Insufficient or defective sink accommodation and water supply 14 Ventilation required in food store 9 Household washing in food store 2 Swill bins defective 5 Food stored in intervening ventilated space of w.c. 2 Impervious floors required to kitchens, etc. 14 (5) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING, Etc. Defective Yard Paving 6 Want of a sanitary dustbin 455 (6) INFRINGEMENTS OF SHOPS ACT. Provision of means of heating 1 Seating accommodation required for females 2 Infringement in hours of employment 7 (7) INSPECTION OF AMUSEMENT HOUSES. Defective sanitary fittings 7 W.C. defective and dirty 2 Ventilation of w.c.'s 5 (8) KEEPNG OF ANIMALS. Nuisances arising from the keeping of animals 3 (9) INSPECTION OF WATERCOURSES, etc. Cleansing of watercourses and ponds 7 (10) INFRINGEMENTS OF RAT AND MICE DESTRUCTION ACT. Infestations found as follows:— Private Houses— Inside houses 154 Sheds and outhouses 107 Gardens 108 Defective drainage 19 Fowl houses 82 Air raid shelters 24 Under paving 4 Garages 5 Shops, Business Premises, etc.— Factories, Workshops, Offices, etc 15 Public buildings 16 Food shops 28 Other shops 21 (11) INFRINGEMENTS OF OTHER BYELAWS. Noisy animals 5 Noisy radio 1 (12) INFRINGEMENTS OF MILK AND DAIRIES ORDERS, REGULATIONS, Etc. Defective paving 2 103 HOUSING. Individual Unfit Houses. During the year action under the Housing Acts was confined to the repair of houses. The accepted standard of repair was lower than that of pre-war years owing to shortage of labour and materials. In spite of the concentration of the labour on war damage repair, it was possible to have some made available to comply with our restricted requirements and the result, on the whole, has been satisfactory, as the under-mentioned tables will show. I.—Inspection of dwelling houses during the year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health and Housing Acts) 1,320 (b) Number of inspections made for the purpose 1,320 (2) (a) Number of dwelling houses included under the head (1) above, which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 - (b) Number of inspections made for the purpose - (3) Number of houses found to be in a state so dangerous and injurious to health as to be unfit for human habitation - (4) Number of dwelling houses (exclusive of those referred to under the previous sub-head) found not to be in all respects reasonably fit for human habitation 1,320 II.—Remedy of defects throughout the year without service of Formal Notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 1,120 III.—Action under Statutory Powers during the year:— A.—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 251 (2) Number of dwelling houses which were rendered fit after service of formal notices- (a) By owners 178 (b) By local authority in default of owners 10 B.—Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 497 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 332 (b) By local authority in default of owners 131 104 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 1 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 - Rent Restriction Acts. A number of applications were received for certificates as to the condition of repair of the houses concerned. In 3 instances where the Acts applied certificates were granted. Landlord and Tenant (War Damage) Amendment Act, 1941. This Act gives the owner or occupier of a house which has received damage from enemy action; the right to apply to the local authority for a certificate of fitness following repair. The standard of repair necessary to merit a certificate is to be such as will render the house reasonably suitable for housing purposes. I am the officer appointed to issue such certificates and during the year 140 applications were made and 62 certificates were granted. HOUSES LET IN LODGINGS. There are 12 houses registered and during the year they all suffered seriously from damage by enemy action. Repairs are being executed. Municipal Lodging House. This is situated at Pitlake and is available for use by "nightly lodgers." It has 104 cubicle beds, three of which are reserved for staff. The charge is 1s. per night or 6s. per week. Cooking facilities are provided. Hot baths may be taken any time after 7 a.m. Clothes may be washed and dried in the washhouse provided. The number of nightly lettings during the year was 72 and the number accommodated during the year 26.650. The receipts and expenditure for the past 10 years has been as follows:— 105  Receipts. Expenditure. £ s. d. £ s. d. 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 1944 1,119 0 0 1,785 0 0 War Damaged Houses. The Sanitary Inspectors visited these to ascertain the damage to sanitary arrangements and water supply. Some 7,000 such visits were made and the defects found received early attention by the War Damage Repairs Department. Houses—Sanitary Certificates. House drains and sanitary fittings are tested and examined on request, at a fee. During the year 7 such requests were made. FACTORIES ACT, 1937. During the year the under-mentioned inspections have been made and defects were found as set out:— FACTORIES. Inspection. Premises. Number of Inspections. Written Notices. Prosecutions. Factories:— With Mechanical Power 264 30 — Without Mechanical Power 64 19 — Outworkers and Employers of outworkers 275 — — Total 603 49 — 106 Defects Found. Particulars. Number of Defects. Referred to H.M. Inspector. Prosecutions. Found. Remedied. Want of Cleanliness 10 10 — — Inadequate Ventilation 9 9 — — Ineffective Drainage of Floors 1 1 — — Sanitary Conveniences. Insufficient 4 4 — — Unsuitable or Defective 6 6 — — Not Separate for Sexes 5 5 — — No Lighting 1 1 — —- Total 36 36 — — Home Work. Lists of home workers or outworkers as they are termed are sent in twice yearly, and this year contained the names of 339 workers residing in the Borough. 258 visits were paid to outworkers and 17 visits were paid to premises of employers of outworkers to examine lists. Nature of Employment of Outworkers on the Register, 31st December, 1944. Nature of Work. Number Employed. Outwork in Infected Premises. Outwork in Unsatisfactory Premises. Remarks. Making, Cleaning, Altering and Repairing, Wearing Apparel 361 — — — Upholstery Work 2 — — — Lace Goods 2 — — — Other Classes of Work 2 — — — Total 367 — — — Inspection of Offices—Public Health Act. During 1944, 10 inspections were made and defects found included lack of sanitary accommodation and lack of ventilation. These were remedied by informal action. 107 Inspection of Schools. These are inspected with particular reference to sanitary accommodation including washing facilities. During the year 14 inspections were made and defects found were referred to the Education Officer. SHOPS, Etc., ACTS. The Shops Acts, 1912-1936, contain provisions for dealing with the hours of work, closing hours and health and comfort of those employed. Hours of work and closing hours have during the War years given little cause for complaint. The health and comfort of those employed is safeguarded in the matter of shop ventilation, warming, washing facilities, facilities for taking meals and suitable and sufficient sanitary accommodation, and action has been taken in the cases where these fell short of requirements. The Young Persons Employment Act, 1938, regulates the hours of employment of persons under the age of 18 years, not controlled by the Shops Acts. 339 inspections were made and a number of infringements were found as set out. PUBLIC HEALTH ACTS. Drainage Work. During the year there was no lessening of work in this branch of the department's duties. The "flying bomb," whilst it had a severe surface blast effect, did not pierce, as did the high explosive, and ire consequence underground drainage was not so badly affected as in high explosive incidents. Sanitary fittings above ground level did however suffer considerably over a wide area. Some 3,600 visits of inspection were made to underground drains in course of repair. With the stringent building works licensing and the labour difficulties it has become essential to serve Statutory Orders in all cases of drainage defects. Of these Orders a large proportion have to be done in default of the owners. This has been possible by employing specialist labour set aside for this purpose. 497 Statutory Orders have been served to comply with drainage defects during the year. KEEPING OF ANIMALS. There has been during the war a large increase in the number of pig and poultry keepers. Byelaws were relaxed by Government Order, but this did not relieve the keepers of providing against nuisance. Little complaint of nuisance has arisen but there has been an increase in rat infestations particularly at 108 try keepers' premises. This could be reduced by raising sheds at least 9in. off the ground and the removal of unconsumed food and water in the evening. We have byelaws in force to control the nuisance from dogs fouling footpaths and the nuisance of the noisy animal—both byelaws difficult to apply and yet both unnecessary if only people would carry into "the peace" the neighbourliness they showed during the War. OFFENSIVE TRADES. There are but few registered and during the year there has been no cause for complaint. WATERCOURSES, PONDS AND DITCHES, Etc. 71 inspections were made and pollutions were found in 7 cases. Observation is also kept on static water tanks for evidence of nuisance or mosquito breeding. SMOKE OBSERVATIONS. During the year 14 observations were made of factory chimneys for the purpose of detecting offences. In those cases where nuisance occurred appropriate action was taken to remedy the condition. To-day there is little choice left to the factory owner regarding the fuel he uses and this creates a difficult problem in smoke abatement. AMUSEMENT HOUSES. 109 inspections were made of Theatres, Music Halls, Cinemas, Dance Halls, and premises where stage plays are given. A report is submitted annually to the Licensing Authorities on the sanitary condition of these premises. Notices are issued to remedy any unsatisfactory conditions. DISINFECTION. The Borough Disinfecting Station is situated at Factory Lane. Two steam disinfectors are in use and are supplied with steam from the Electricity Works. The Station was badly damaged during the year by enemy action but the steam disinfectors were usable and work was continued with little break. 109 The following articles were disinfected at the Disinfecting Station during the year:— By steam 65,756 articles ,, Formalin Gas 3,095 ,, ,, ,, Spray 7,106 ,, Total 75,957 „ In addition 128 articles were destroyed on request. Disinfection of bedding and upholstered articles is carried out for traders, who deliver them to and collect them from the Station. For this service a charge is made. During 1944, 2,580 articles were disinfected, the receipts amounting to £67 2s. 6d. Disinfection of the under-mentioned articles from such premises as A.R.P., report centres; casualty services; engineers' services; fire service, etc., have been carried out:— Mattresses 458 Trousers 89 Blankets 4,170 Coats 2 Sheets 10 Caps 35 Bolsters 3 Overalls 20 Pillows 439 Bunks 26 Pillow Slips 5 Cushions 7 Blouses 67 Other articles 15 Disinfection was carried out after infectious or contagious disease at the following premises:— 667 rooms at 547 houses, hospital wards, clinics, and creches. 26 A.R.P. Shelters. 2,865 Library and other books were disinfected. CLEANSING OF VERMINOUS, Etc., PERSONS. A Cleansing Station consisting of a reception room, four bath rooms and a discharge room, is attached to the Disinfecting Station, and is used for dealing with verminous, etc., conditions in adults and children. A woman attendant deals with school children and women. During the year 11 adults and 129 children were cleansed of verminous conditions and 361 adults and 598 children were treated for Scabies. 110 DISINFESTATION OF PREMISES. The Department does little in the way of treatment of premises infested with vermin, the practice being to make owners or occupiers responsible for disinfestation. Advice is given on methods to be employed and at times Hydrogen Cyanide is applied by specialist firms to infested premises. The use of this gas is controlled by stringent regulations and the compliance with these regulations is observed by a Sanitary Inspector. The number of premises disinfested by owners or occupiers during the year was 108. RAG FLOCK ACTS, 1911 and 1928. 3 samples were taken during the year from bedding manufacturers in the Borough. These samples were submitted for analysis and the results were as follows:— No. 1 Dyed Red Jute Soluble Chlorine 10 parts per 100,000 No. 2 Black Linsey ,, ,, 6 ,, ,, 100,000 No. 3 Utility Flock (Red) ,, ,, 11 ,, ,, 100,000 The 3 samples conformed to the standard of cleanliness prescribed under the Rag Flock Regulations, 1912. The legal maximum of chlorine allowed is 30 parts per 100,000. PHARMACY AND POISONS ACT, 1933. The Act consolidates the Poisons and Pharmacy Acts since 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 entry of names on the list of persons entitled to sell poisons under Part II of the Act was 11. In addition, 211 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. Inspections of premises where fertilisers and feeding stuffs were sold were carried out during the year and no infringement of the Act was found. One sample of fertiliser was taken during the year and was reported on as genuine. 111 RATS AND MICE DESTRUCTION ACT, 1919. INFESTATION ORDER, 1943. During the year 997 complaints were received of rat or mice infestation. The Department had the assistance up to June of a number of temporary ratcatchers, but the advent of the "flying bomb" caused the withdrawal of this labour. Of these 997 complaints the presence of rodents was confirmed in 583 cases and action was taken as under:— 194 dealt with by Sanitary Inspectors advising occupiers. 389 dealt with by Ratcatchers, by trapping and poisoning. The above action resulted in the estimated destruction of 7,269 rats and mice and the number of infestations cleared was 344. The number of visits made by the Sanitary Inspectors and Ratcatchers to investigate complaints, advise and follow up was 3,723 to private houses and 1,260 to shops. Sewers in the town were baited with good results, the total number of rats destroyed therein being 2,274. DECONTAMINATION OF CIVILIAN CLOTHING AFFECTED WITH WAR GASES. The Chief Sanitary Inspector is the appointed Officer. Arrangements have been made with six large laundries to deal with affected clothing should the necessity arise. Special plant has been fitted at each of these laundries and the personnel Have received training in methods of decontamination and personal protection, by the staff of the department. FOOD SUPPLY. The supervision and inspection of the food supplies is carried out by the 12 Sanitary Inspectors who are all qualified in food inspection. The following table shows the premises in the Borough at which food is known to be sold, manufactured or stored:— Bakers 101 Butchers 166 Confectioners 329 Fishmongers (including Fish Friers) 50 112 Fish Friers only 18 Greengrocers 209 Grocers 614 Stalls and Rounds 141 Catering Establishments (including Hotels, Restaurants, Clubs, Snack Bars, etc 726 Miscellaneous (including Chemists, etc.) 137 2,491 In addition to the above there are the following premises at which food is prepared for sale:— Slaughterhouses, Dairies (including Farms) and Milkshops. The following table gives a summary of the inspections made during the year, not including visits made to slaughterhouses, dairies or milkshops, nor does it include those foodshops visited following damage by enemy action:— Butchers 970 Greengrocers 159 Bakers 83 Grocers 1,265 Confectioners 86 Stalls and Rounds 253 Fishmongers 116 Catering Establishments 436 Fried Fish Shops 42 Miscellaneous 150 Total 3,560 General Summary of Meat and other Articles of food found to be unfit and condemned by the Inspectors during 1944excluding that damaged by enemy action:— Articles. Weight in lbs. Diseased. Unsound. Total. Beef 23 1974 1997 Veal 8 680 688 Mutton 8 882 890 Pork 16 1536 1552 Offal 178 533 711 Fish — 5781 5781 Fruit and Vegetables — 7435 7435 Canned, bottled and packeted goods — 42341 42341 Other goods — 13196 13196 233 74358 74591 113 The above, apart from the Meat, include:— Fish: Mackerel, Cod, Pilchards, etc. Fruit and Vegetables : Potatoes, Dates, Prunes, etc. Canned, bottled and packeted good: 38,344 cans, 2,987 bottles, packets, etc. Other goods: Rabbits, Flour, Cereals, Sugar, etc. Disposal of Condemned Foodstuffs. The Meat was condemned at the Ministry of Food Depot or at shops supplied therefrom and was disposed of by the Ministry. A fair proportion of the other foods condemned was dealt with by firms who specialise in converting such into manures, animal feeding stuffs, oils, etc. MEAT INSPECTION. This is carried out at the Government Meat Depot from which all meat supplied to Croydon is distributed. One Inspector spends the major portion of his time here. Butcher's shops are visited by the District Sanitary Inspectors to observe the condition of the meat at time of sale. The Public Abattoir has been closed now for some years, but in order to provide facilities for the slaughter of casualties and those animals licensed by the Ministry of Food to be slaughtered locally, a Private Slaughterhouse has been made available. During 1944 the following animals have been slaughtered at this private slaughterhouse and inspected there:— Goats. 56 Pigs. 175 Total. 231 114 The result of these inspections was as follows:— Carcases Inspected and Condemned. Sheep. Goats. Pigs. Number killed 1 56 175 Number inspected 1 56 175 All Diseases Except Tuberculosis. Whole Carcases Condemned — — — Carcases of which some part or organ was condemned — — — Percentage of the number spected affected with disease other than Tuberculosis — — — Tuberculosis Only. Whole Carcases Condemned — — — Carcases of which some part or organ was condemned — — 2 Percentage of the number spected affected with culosis — — — THE "FLYING BOMB" ATTACK AND THE FOOD SUPPLY. During the period from June 15th to September 2nd, your Sanitary Inspectors made 2,624 visits to food premises for the purpose of ascertaining if any damage had accrued to the stocks of food therein. At 461 premises, varying quantities of Food were found to be damaged to such an extent as to render them unfit for human consumption. The aggregate weight of food thus condemned was 23 tons. This was collected and taken to our Central Salvage Depot, which had been established at the Abattoir, Pitlake, for further sorting under the supervision of a Sanitary Inspector. Of these goods, 7½ tons were salvaged for use for processing, animal feeding or technical purposes. In addition to the above, the entire recoverable stocks amounting to some 7 tons, from 9 food shops, which had been demolished or made unsafe, were removed to our Central Salvage Depot. From these stocks 3½ tons were recovered as fit for food and disposed of to local wholesalers, and 2 tons were salvaged for use for processing, animal feeding or technical purposes. All the goods condemned and recovered were listed separately. Copies were sent daily to the local Food Executive Officer and the Ministry of Food's Salvage Officer, thus enabling these officials to adjust ration allotments and deal with disposal respectively. 115 DECONTAMINATION OF FOODS AFFECTED WITH WAR GASES. The Chief Sanitary Inspector is the appointed officer. He is assisted by 12 Inspectors and 3 Assistants, who have been trained in decontamination measures. In addition, there are 47 trained Food Treatment Volunteers who assist the staff in the event of enemy gas attacks. Four depots have been established and equipped for the treatment of gas-contaminated foodstuffs. 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 on the register:— Cowkeepers on register (end of 1944) 5 Cowsheds on register (end of 1944) 5 Average number of cows in sheds (1944) 77 Number of dairies and purveyors of milk on the register (end of 1944) 128 During the year 151 inspections were made of dairies, cowsheds and milkshops. Milk (Special Designations) Order, 1936. The following licences were granted during the year under this Order:— (1) Producers' Licences to use the designation "Tuberculin Tested" 1 (2) Producers' Licences to use the designation "Accredited" 1 (3) Dealers' Licences to use the designation "Tuberculin Tested"— (a) Bottling establishments 1 (b) Shops 12 116 (4) Dealers' Licences to use the designation "Accredited"— (a) Bottling establishments ... — (b) Shops - (5) Dealers' Licences to use the designation "Pasteurised"— (a) Pasteurising establishments 2 (b) Shops 38 (6) Dealers' Supplementary Licences to use the designation— (a) Tuberculin Tested 5 (b) Accredited - (c) Pasteurised 6 Inspection of these licenced premises has been carried out 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 producers supplying milk to licenced local dairymen 24 Accredited Milk— Licenced producer supplying milk to a licenced dairyman 12 Pasteurised Milk— Samples from licenced dealers 109 117 The following tables summarise the result of the bacteriological examinations of Tuberculin Tested, Accredited and Pasteurised samples during the year:— Tuberculin Tested Milk. Licences granted under the Milk (Special Designations) Order, 1036. Present. Absent. Present in 1/100 Ml Absent. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Satisfied. Not satisfied. Tubercle bacillus - 24 — — - — — — — — — - Bacillus Coli — — 7 17 - - - - - - - - Blood Pus — — — — — 24 - - - - - - — — — — — •- — 24 — — — — Detritus — — — — — — — — — 24 — — Methylene Blue Test — — - — — — — — — — 23 1 Totals — 24 7 17 — 24 — 24 — 24 23 1 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 - 12 — - — - - — - - Bacillus Coli — — 2 10 - - - - - - - - Blood — — — — — 12 — — — — — — Pus — — — — — — - 12 — — — — Detritus — — — — — — — — — 12 — — Methylene Blue Test — — — — — — — — — — 11 1 Totals 12 2 10 — 12 — 12 — 12 11 1 118 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 — 109 - - - - - - - - Total number of bacteria — — 13 96 — — — — - - Blood - - - - - 109 - - - - Pus — — — — — — — 109 — - Detritus — — — — — — — — — 109 Totals - 109 13 96 — 109 — 109 — 109 These 109 Pasteurised Milk samples contained bacteria per millilitre as follows:— Under 1,000 1,000—5,000 6 28 5,000—10,000 20 10,000—20,000 26 20,000—30,000 7 30,000—50,000 5 50,000—100,000 4 Over 100,000 13 109 Under the Regulations, Pasteurised Milk must not contain more than 100,000 bacteria per millilitre. ORDINARY MILK. During the year 88 samples of ordinary milk were procured and submitted to examination for tuberculosis and bacterial content. These samples were taken as follows:— Samples taken at cowsheds in the Borough 31 Samples taken at dairymen's premises in the Borough 27 Samples taken in course of delivery by local dairymen or milk sellers on their rounds in different parts of the Borough 30 88 119 The following table summarises the results of the bacteriological examination of Ordinary Milk samples, taken from 1st January—31st December, 1944:— Ordinary Milk. Present. Absent. Over 100,000 per M. I. Under 100,000 per M.I. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Satisfied. Not satisfied. Tubercle bacillus — 88 - - - - - - - - - - Total number of bacteria — — 25 63 - - - - - - - - Blood — — — — — 88 - - - - - - Pus — — — — — — — 88 - - — — Detritus — — — — — — — — — 88 — — Methylene Blue Test - - - - - - - - - - 72 16 Totals — 88 25 63 — 88 — 88 — 88 72 16 BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM. There were no samples taken during 1944 as no ice cream was manufactured for sale. 120 FOOD AND DRUGS ACT, 1938. During the year, 248 samples of milk and 361 other samples were taken. Summary of Sample. During 1944, samples were obtained and submitted to the Public Analyst as follows:— Samples of Total Samples. Genuine. Not Genuine. Prosecutions. Convictions. Cautions. Arrowroot 3 3 - - - - Aspirin Tablets 5 gr. 3 3 - — — — Bacon 7 7 - - — — Baking Powder 6 6 - — — — Batter Producer 1 1 - — — — Beans in Tomato Sauce 5 5 - - - - Beer 8 8 - - - — "Bev," an essence of Coffee and Chicory 1 1 - - - - Bicarbonate of Soda 2 2 - — - — Blaud's Pills 1 1 - - - - Bread 7 7 - - - — Cake Mixture 3 - 3 3 - — Cake Mixture, unsweetened 1 1 — — - — Cake Mixture, sweetened 2 2 — - - — Cane Syrup 1 1 — — — — Castor Oil 2 2 - - - — Cheese 7 7 - - - - Chocolate Cup 1 1 — - - — Chocolate Powder, sweetened 1 1 - - - — Cocoa 7 7 - - - — Cod Liver Oil 1 1 - - - — Coffee 4 4 - - - — Coffee and Chicory Essence 1 1 — — — — Coffee Essence with Chicory 4 4 — — - — Coffee and Chicory Extract with preservative 1 1 - - - - Compound Liquorice Powder 1 1 — — — — Compound Syrup of Figs 1 1 — — — — Confectionery 5 5 — — — — Cooking Fat 1 1 — — — — Cordial, Blackcurrant I 1 — — — — „ Ginger 2 2 — — — — „ Lime Flavour 1 1 — — - — Cornflour 1 1 - - - - Curry Powder 10 9 1 1 - — Custard Powder 4 4 - - - — Custard Substitute 1 1 - - - — Dried Eggs 1 1 — — — — Drinking Chocolate 1 1 — — — — Eucalyptus Oil 1 1 — — — — Fish Paste 4 4 — — - — Fish Roll 1 1 - - - — Flavouring Essence, Lemon 1 1 — — — — ,, ,, Orange 1 1 — — — — ,, „ Vanilla 4 4 — — — — Flour 2 2 - - - — „ Batter 1 1 - - - — „ Bun 2 2 — — — — Carried Forward 127 123 4 4 — — 121 Samples of Total Samples. Genuine. Not Genuine. Prosecutions. Convictions. Cautions. Brought Forward 127 123 4 4 - — Flour,Cake 9 9 - - - - „ Plain 1 1 - - - - „ Self-Raising 6 6 - — - — „ Soya 4 4 - — — — Friar's Balsam 1 1 - - - - Gelatine 2 2 - - - - Gelatine, Powdered 2 2 - - — - Gin 3 3 - - - - Ginger Beer 2 2 - - - - Glauber's Salts 1 - 1 - - - Golden Raising Powder 2 2 — — - — Grapefruit Squash 4 4 — - — — Gravy Maker 1 1 — — — — Gravy Powder 6 6 — — — — Ground Ginger 4 4 — - — - Halibut Liver Oil Capsules 1 1 - - — - Iodine, Tincture of 1 1 - - - - Jain 9 7 2 - - - Junket Powder 2 2 - - - - Lard 1 1 - - - - Lemonade 2 2 - - - - Lemonade Crystals 2 2 — — — — Lemon Essence 2 2 - - - - Lemon Flavouring 1 1 — — — — Lemon Squash 4 4 — . — — - Liquid Paraffin 1 1 - — — - Liver Sausage 4 4 - - - - Luncheon Sausage 1 1 — — — - Malt, Extract of and Halibut Liver Oil 1 1 - - - - Meat Pies 1 1 - - - - Milk 248 248 — - - - Minced Beef 1 1 - - - - Mixed Spice 7 7 - — — - Mustard Mixture 3 3 - - - - Oil of Wintergreen 1 1 — - — - Orangeade 2 2 - - - - Orange Squash 1 1 - - - - Parrish's Food 1 1 - - - - Pearl Barley 5 5 - - - - Pease Pudding 1 1 - - - - Pepper 5 5 - - - - Pickles 3 3 - - - - Pickling Mustard 1 1 - - - - Pudding Mixture 10 10 - - - - Rennett Tablets 1 1 - - - - Rice 3 3 - - - - Rolled Oats 1 1 - - - - Rum 3 3 - - - - Sauce 5 5 - - - - Sausage Meat 4 3 1 1 1 - Sausages 21 21 — - - - Sausage, Luncheon 2 2 - - - - Scone Mixture 3 3 - - - - Semolina 9 9 - - - - Soup 10 10 - - - - Soup, Kidney 2 — 2 - - - „ Meat 4 4 — - - - „ Vegetable 1 1 - - - - Soup Powder 3 3 — — — — Carried forward 569 559 10 5 1 — 122 Samples of Total Samples. Genuine. Not Genuine. Prosecutions. Convictions. Cautions. Brought forward 569 559 10 5 1 — Spicc, Mixed 2 2 — — — — „ Pickling 1 1 — — — — Sponge Pudding Mixture 1 1 — — — — Stewed Steak (Canned) 4 4 — — — — Stuffing 5 5 — — — — Sugar 3 3 — — — — Tea 6 6 — — — — Vegetable Broth 1 1 — — — — Vegetables in Gravy 2 2 — — — — Vinegar, non-brewed 1 1 — — — — Malt 6 6 — — — — Vinegar, Virgin 2 2 — — — — Whisky 2 2 — — — — Yorkshire Pudding Mixture 3 2 1 — — 1 Yorkshire Pudding, Fritter and Pancake Mixture including egg 1 — 1 - - - Totals 309 597 12 5 1 1 123 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 9.1 9.2 - - - - 6 27 92 78 35 8 2 - 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 - - 6 22 31 32 42 47 28 17 7 7 3 4.3 4.4 4.6 4.7 3 2 1 - Total samples of New Milk: 248. The samples of Milk for analysis were obtained as follows:— Country milk in course of +delivery — On milk rounds 152 "Appeal to cow" samples — At Shops 90 Taken at Institutions 6 Taken at Farms — Other samples — 248 AVERAGE COMPOSITION OF NEW MILK SAMPLES. Solids not fat 8.75% Milk fat 3.63% Percentage of New Milk samples below legal standard: Nil. 124 Adulterated Samples. The following is a detailed statement of the adulterated samples and the action taken:— No. Sample. Adulteration or Deficiency. Remarks. 1786. Cake Mixture Contained 110 parts per million by weight of fluorine Court action. Cases dismissed. Expert evidence conflicting. No standards prescribed. 1795. Cake Mixture Contained 140 parts per million by weight of fluorine 2257. Cake Mixture Contained 100 parts per million by weight of fluorine 2054. Curry Powder Contained Lead: 40 . parts per million. Court action. Case dismissed. Warranty pleas successful. 2018. Yorkshire Pudding Mixture. Contained compounds of fluorine expressed as fluorine—40 parts per million. Letter of caution sent to firm on advice of Legal Department. 2089. Yorkshire Pudding, Fritter and Pancake Mixture, including Egg. Contained less than 1 per cent. dried egg. Manufactured in accordance with Ministry of Food recipe. 2380. Glauber's Salts . Contained 47.4 p.c. . water of crystallisation. Less than B.P. standard. Sample had been in stock for some time, and the labelling of the packet disclosed that such action would take place over a long period of storage. In the circumstances, no action was possible. 1409. Jam, Plum (Formal) Deficient in plum fruit. Error in sampling technique. Further sample satisfactory. 2378. do. (Informal) do. do. 1434. Pork Sausage Meat. Deficient in meat content. Vendors pleaded guilty, but case dismissed under Probation of Offenders Act. Costs granted. 108. Soup, Kidney (Formal) Deficient in meat solids, according to the Meat Products Canned Soup and Canned Meat (Control and Maximum Prices) Order, 1944. Referred to Divisional Food Officer, to be taken up with makers. It later transpired that these products had been manufactured before the Order came into force. 2182. do. (Informal)