CRO47 Country Borough of London. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL SERVICE For the Year 1945 OSCAR M. HOLDEN, G.M., M.D., D.P.H. CROYDON: PRINTED BY THE CROYDON TIMES, LTD., 104, HIGH STREET C.T. 2. 1-1-47. 2.00. I. COUNTY BOROUGH OF CROYDON. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1945. OSCAR M. HOLDEN, G.M., M.D., D.P.H. To the Chairman and Members of the Public Health Committee. Ladies and Gentlemen, I have the honour herewith to present ray Eighteenth Annual Report upon the Health Services carried out by the Council. This report is the 46th of the series of such reports. The population of the town, as estimated by the RegistrarGeneral, is 200,780. During the year 4,536 persons were married, a marriage rate of 11.3 per 1,000 of the population. The Birth-rate for the year was 17.8 per 1,000, a decrease of 1.0 per 1,000 over 1944. There were 3,575 live births, of whom 1,849 were males and 1,726 females. Of these approximately 4.6 per cent. were born in hospital. There were 387 illegitimate births, a percentage of 10.8 total live births. The still-births registered during the year were 100 as compared with 97 in 1944. The Infantile mortality was 41 per 1,000 live births, a decrease of 3 per 1,000 upon 1944. There were 9 maternal deaths, giving a maternal mortality of 2.4 per 1,000 total live and still births. The number of deaths under 1 year of illegitimate children was 18. Full statistics are given of the work done at Mayday Hospital which show that its activities have continued to expand and that it had assumed the definite status of a large general hospital. II The major causes of death among the population were: Organic Heart Disease (2.61 per 1,000 of the population), Cancer (2.34), Diseases of the Respiratory System (including Tuberculosis) (1.T7), Diseases of the Digestive System (0.59), and deaths due to violence of various kinds, including suicide (0.51). There was a small decrease in the number of deaths from Tuberculosis, but a considerable increase in those attributed to Cancer. Notifiable Infectious Diseases remained low in incidence, and there were only 11 deaths from this group of conditions. Of these, 6 were due to Measles, 2 to Diphtheria, both of whom were nonimmunised patients, and 3 from Whooping Cough. A feature, noticed in 1944, namely, the increased incidence of skin affections, which was not necessarily associated with dirt or overcrowding, was again observed in 1945. During the year 405 appointments were made for families to attend the Cleansing Station for Scabies treatment, comprising 1,108 individuals. Of these, 350 families, comprising 979 individuals, actually attended and were treated. The occurrence of small sores at the corners of the mouth, particularly among children of middle school age, noticed in 1944, was again present during the year. These sores were seen in children who exhibited, also, other signs of nutritional deficiency. There were 29 cases of Clinical Diphtheria and 17 of positive of nose or throat swabs without clinical symptoms, during the year, and of these 12 were stated to have been immunised. In a number of these it was found that the Post Schick Test, had been omitted, with the consequence that there had been no check upon the effectiveness of the immunising injections. It is only right to say that many of the children had received immunisation injections during their evacuation from Croydon. The number of children under 15 years who completed the full course of diphtheria immunisation during the year was 2,707 and 272 received their first injection. 403 notifications of Scarlet Fever, 2,245 notifications of Measles, and 368 notifications of Whooping Cough were received. These figures showed a small increase in notifications of Scarlet Fever, a decrease in notifications of Whooping Cough, and a very substantial increase in notifications of Measles. This latter condition exhibited its characteristic 2-year phase, 1944 was a low year, 1945 a high year. III The scheme for the diagnosis and treatment of Venereal Diseases has functioned on the same lines, and particulars are herewith given of the working of Regulation 33 B. It has not proved to be of much value as a preventive measure, as the particulars obtained are often too vague to enable the alleged source of infection to be followed up. Where accurate information has been given, the person named has, upon receipt of the confidential letter from the Medical Officer of Health, usually obtained treatment. It is curious that in the vast majority of cases men inform upon women. The following figures give a summary of the results under the Regulation during 1945:— Contacts notified to the Medical Officer of Health during the period 1st January, 1945 — 31st December, 1945: M. F. (1) (a) Total number in respect of whom Form 1 was received — 43 (b) Number in (a) transferred from other areas — 2 (2) Number 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 — 19 ,, examined — IS (3) (a) Number of those in (1) in respect of whom two or more Forms 1 were received — 3 (b) Number in 3 (a) in respect of whom first Form 1 was previously reported under (1) — 2 (c) Number in 3 (a) transferred from other areas — 1 (4) Number of those in 3 (a) who were— (a) found — 2 (b) examined after persuasion — — (c) served with Form 2 — 2 (d) examined after service of Form 2 — 2 IV (e) prosecuted for failure (i) to attend for, and submit to, medical examination — — (ii) to submit to and continue treatment — — With the demobilisation of large numbers of persons from the Forces, the new attendances at the Clinic have shown a marked increase for both men and women, the number of the latter being the highest recorded. The apparent great increase in venereal disease which these figures might suggest is, however, not an actual increase, as the figures are swollen by patients (671) who were found on examination not to be suffering from venereal disease. This is an encouraging sign of the value of the National Press propaganda which the Ministry of Health has been carrying out. Cancer shows another increase in incidence, the most usual sites of the body attacked being: For males—the bowels (30 per cent.), the lungs (19.6 per cent.), and the stomach (17.7 per cent.), and for women—the bowels (24.0 per cent.), the breast (18.0 per cent.), and the uterus (15.6 per cent.). Among these figures the high rate of attack upon the lungs is significant and cannot be dissociated from certain manufacturing processes which worked at high pressure during the war vears. Tuberculosis showed a small incidence rate increase from 1.66 to 1.86 per 1,000 of the population, including pulmonary and non-pulmonary forms, but the death-rate declined, namely, from all forms of Tuberculosis 0.46 per 1,000 population as compared with 0.57 in 1944, and for Pulmonary Tuberculosis from 0.51 in 944 to 0.37 in 1945. Mass Radiography was carried out during the year. The Unit conducted by the Surrey County Council paid 2 visits and 7,551 personssubmitted to examination of these 654 were referred for further and more detailed investigation, and 255 were ultimately found to have Tuberculosis, of which number 187 had healed primary or post-primary lesions. It should, however, be remembered that Mass Radiography is not only of value in detecting Tuberculosis of the lungs; through its medium other pathological lung conditions can be diagnosed, and it is also of value in the detection of certain forms of heart abnormalities or disease. Details are given (pp. 72 and 73) of the administration of the Ministry of Health's Tuberculosis Maintenance Allowances (Memo 266/7) and of the local extension of this scheme, the cost of which falls entirely upon the Council. V. The Maternity and Child Welfare Scheme which, in its present form was evolved in 1933 and included in which are the ante-natal clinics, maternity provision in hospitals and by municipal midwives in the patients' own homes, post-natal and gynæcological clinics, Infant Welfare Centres, Home Helps and other ancillary activities, may without fear of contradiction be said to be one of the most complete in the country. Unfortunately, the National Health Services Act will, so far as can be judged, cause a serious disruption of the existing continuity of these services, in as much as part of these will remain with the Council, part will come under the Regional Hospital Boards, and part under the committee administering the general practitioner services. Representations were made by the Public Health Committee to the Minister of Health, but no observable change was made in the provisions originallv laid down in the Bill. Great strain has been laid upon this section of the work owing to much increased demands due to the return of young mothers to the town, and a pronounced increase in the birth-rate. In consequence, the premises used for the ante-natal clinics at Lodge Road are quite inadequate in size and amenities; also, the number of maternity beds is insufficient to obviate undesirable overcrowding, and applicants for admission to hospital for their confinements have to be rigidly restricted to certain classes of cases in whom complications might arise during labour, or who have no facilities whatever for a home confinement. A further complicating factor is the difficult housing position in the town, which naturally impels women to seek to have their confinement away from their homes. A total of 1,684 mothers had their confinements in Mayday Hospital or St. Mary's Hospital; 22,663 attendances were made by expectant mothers to the ante-natal clinics, and 1,015 mothers were delivered at home by the municipal midwives. In 1945 the Council's Obstetric Service dealt with 2,840 out of the 3,575 births which were recorded in Croydon, i.e., nearly 80 per cent. The Ambulance Service, now in its fourth year under the Public Health Committee administration, had a busy year. There were 6,399 calls as compared with 4,736 in 1944. This was due principally to an increase in the number of accident calls, private removals, and public health department needs. A detailed analysis of the kinds of accidents is given and comparison made with 1944 (pp. 36 and 37). A disquieting feature is the increase in the number of accidents to children, from 231 in 1944 to 436 in 1945. Accidents to children in the streets were more than double those in 1944, VI. Housing conditions in the town still remain unsatisfactory. There is a great dearth of accommodation, and it has not been practicable to take any action under the Public Health or Housing Acts other than the enforcement of urgent work to make premises habitable and to remedy serious nuisances. This does not mean that a close watch has not been kept upon housing conditions. The fact that 8,566 houses were inspected for housing defects, as compared with 1,320 in 1944, is evidence of this. Of these 8,141 were found to be not in all respects fit for human habitation. 3,904 unfit houses were rendered fit in consequence of informal action by the Local Authority. Close attention has been paid by the Sanitary Inspectors to the quality of Food Supplies, and to the premises from which food for human consumption is sold, including catering establishments. Especial watch has been kept upon the chemical and especially the bacteriological purity of milk supplies. There has been a decline in the bacteriological standard of pasteurised milk, which has been disappointing, but which is probably due to deterioration of pasteurising plants during the war years and the impossibility of obtaining renewals or new apparatus. Ice cream has also come under close review since its manufacture again was permitted. Possibly owing to circumstances arising out of six years of war, neither the quality nor the cleanliness of this article of food is up to pre-war levels. Three hundred and seventy samples of milk were submitted for bacteriological examination, and 250 for chemical analysis. 549 samples of various other kinds of food under the Food and Drugs Act, 1938, were submitted to the Public Analyst, and of these 15 were found to be not genuine. In conclusion, Ladies and Gentlemen, I wish to express my thanks to the staff of the Department for the co-operative and conscientious way in which they have performed the many and varied duties laid upon them during a difficult and exacting year. From the Chairman and Members of the Committee I have received every help, encouragement and support, and to them I am sincerely grateful. I am, Yours faithfully, OSCAR M. HOLDEN, Medical Officer of Health. 1 PUBLIC HEALTH COMMITTEE. NOVEMBER, 1944-1945. The Worshipful The Mayor Councillor Miss L. Gooch. (Councillor G. Lewin, LP,) Councillor W. H. Gough. Councillor H. Regan (Chairman). Councillor Mrs. E. M. Regan. Councillor Miss M. H. Glazier (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. Todd. (resigned). 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. G. G. Genge, Esq., M.D. Councillor A. V. Dammarell. 2 SUMMARY OF VITAL STATISTICS FOR 1945. Area, 12,617 acres. Population (Census 1931), 233,115. Population (estimated middle of 1945), 200,780. Number of Inhabited Houses (1931 Census), 56,429. Overcrowding; Census (1936), 65,550. Rateable Value (1st April, 1945), £2,505,211. Product of a Penny Rate (1944—1945), £9,517. Rate in the £: 11/8d. Gross expenditure on Health and Hospital Services (administered by Medical Officer of Health) £302,017 Income on Health and Hospital Services (excluding transfers) 59,976 Net expenditure on Health and Hospital Services £242,041 Expressed as a Penny Rate, 2/l½d. in the pound. M. F. Total. Live Births Legitimate 1,652 1,536 3,188 Illegitimate 197 190 387 3,575 Birth-rate per 1,000 of the estimated resident population, 17.8. Still Births 100. Rate per 1,000 total (live and still) births, 27.2. Birth-rate (live and still births) per 1,000 population, 18.3. Deaths, 2,513 (Registrar-General's figures). Death-rate per 1,000 of the estimated resident populaion, 12.5. Deaths from diseases and accidents of pregnancy and childbirth, 9; from puerperal and post-abortal sepsis, 1; other causes, 8. 3 Maternal mortality 2.4 per 1,000 total live and still births. Death-rate of Infants under one year of age (148 deaths, 3,575 births)— All Infants per 1,000 live births 41 Legitimate Infants (130 deaths) per 1,000 live births 41 Illegitimate Infants (18 deaths) per 1,000 live births 47 Deaths from Influenza 6 ,, ,, Whooping Cough (all ages) 3 ,, ,, Diarrhoea (under 2 years of age) 21 ,, ,, Diphtheria (all ages) 2 ,, ,, Pneumonia 117 ,, ,, Cancer 464 Rate per 1,000 Population. Deaths from diseases of Cardiac and Circulatory System (including Cerebral Hemorrhage) 5.39 ,, ,, diseases of the Respiratory System (including Tuberculosis) 1.77 ,, ,, diseases of Renal System 0.24 ,, ,, diseases of Digestive System 0.59 ,, ,, Suicide and Violent Causes (excluding War Operations) 0.51 ,, ,, Old Age (local statistics) 0.45 Marriages. The number of marriages solemnised was 2,268, compared with 1,578 in 1944, 1,574 in 1943, 2,042 in 1942, 2,187 in 1941, and 2,792 in 1940. The marriage rate was 11.3 per 1,000 of the population 1,295 were solemnised in Established Churches, 321 in other places of worship, and 652 in the Register Office. None was performed under Jewish ritual. 4 Births. The births registered were 3,188 legitimate and 387 illegitimate. The birth-rate consequently was 17.8. For England and Wales and in the Great Towns the rates were 16.1 and 19.1. The illegitimate births in Croydon were 10.6 of the total, compared with 7.7 in 1944; 7.8 in 1943; 7.5 in 1942; 6.3 in 1941; and 5.3 in 1940 and 1939. The live male births numbered 1,849, the female 1,726, being a proportion of 1,071 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 (26.0) and South Norwood (20.4). Those with the lowest were Norbury (9.6) and Upper Norwood (10.1). Deaths. The deaths numbered 2,513, compared with 2,854 in 1944. For 1945 the death-rate was 12.5; for 1944 it was 15.1. The death-rate for England and Wales was 11.4, and for the Great Towns 13.5. For London the death-rate was 13.8. There were 165 inquests held by Coroners in respect of Croydon residents during 1945 and 185 findings by Coroners after post-mortem examination without inquest. Wards with the highest death-rates were Central (16.3), South (15.0), Whitehorse Manor (14.5), and Bensham Manor (14.1). Lowest: West Thornton (9.0), Addington (9.5), and Waddon (9.6). 5 WARDS. Estimated Population. Births. Deaths. Birth Rate. Death Rate. Deaths under 1 year per 1.000 Births. Death Rate from Six Zymotic Diseases (excluding Diarrhoea) Death Rate from Diarrhoea. Death Rate from Bronchitis and Pneumonia. Death Rate from Pulmonary Tuberculosis. Death Rate from Non-Pulmonary Tuberculosis. Death Rate from Heart and Circulation Diseases. Death Rate from Nervous Disease. Death Rate from Cancer. Natural Increase or Decrease of Population. Upper Norwood 13262 134 174 10.1 13.1 75 — — 1.58 0.53 0.08 3.84 0.45 3.16 — 40 Norbury 13327 128 166 9.6 12.5 39 — — 1.28 0.53 0.08 4.50 0.68 2.78 — 38 West Thornton 16259 201 146 12.4 9.0 55 0.12 0.06 0.98 0.37 0.06 3.69 0.18 1.23 + 55 Bensham Manor 13280 186 187 14.0 14.1 16 - — 1.96 0.33 0.15 6.25 0.53 2.41 — 1 Thornton Heath 14966 284 164 19.0 11.0 46 0.07 0.07 1.60 0.27 0.13 4.28 0.40 1.74 + 120 South Norwood 14627 298 183 20.4 12.5 17 0.07 0.14 1.37 0.27 — 4.38 0.62 2.32 + 115 Woodside 13330 162 148 12.2 11.1 68 0.23 — 0.68 0.38 0.08 4.80 0.38 2.03 + 14 East 13369 190 165 14.2 12.3 32 0.15 0.07 0.90 0.08 0.15 5.16 0.37 2.92 + 25 Addiscombe 13523 219 185 16.2 13.7 55 — 0.07 1.48 0.22 — 5.47 0.59 2.51 + 34 Whitehorse Manor 13870 224 201 16.2 14.5 45 — — 1.59 0.36 0.14 5.91 0.22 3.53 + 23 Broad Green 14277 202 184 14.1 12.9 84 — 0.14 1.75 0.56 — 4.90 0.42 2.10 + 18 Central 10126 137 165 13.5 16.3 95 — 2.57 0.40 — 6.81 0.40 3.16 — 28 Waddon 15170 295 146 19.4 9.6 34 0.07 — 1.19 0.66 0.07 3.49 0.40 1.19 + 149 South 12520 199 188 15.9 15.0 55 0.08 0.08 1.68 0.32 — 6.71 0.48 2.24 + 11 Addington 8854 230 84 26.0 9.5 30 — — 0.79 0.34 0.11 3.39 0.34 2.48 + 146 The Borough 200780 *3575 *2513 17.8 12.5 41 0.05 0.04 1.42 0.37 0.07 4.90 0.43 2.34 +603 * 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 1221 81 14 12 81 347 686 F 1292 07 14 11 87 247 866 Diphtheria M 1 - - 1 - - - F 1 - 1 - - - - Whooping Cough M 2 2 - - - - - F 1 - 1 - - - - Encephalitis Acute Infectious M 1 - - - - - - F 1 - - - 1 - - Cerebro Spinal Fever M 1 - 1 - - - - F 2 1 - 1 - - - Measles M 4 3 1 — — — F 2 - 2 — — — — Influenza M 2 - - - - - 2 F 4 - - - - - 4 Poliomyelitis & Polioencephalitis M - - - - - - - F 1 — 1 — — — — Tuberculosis (respiratory) M 45 — — — 21 18 6 F 29 - — — 24 5 — Tuberculosis (other forms) M 8 - 2 1 3 2 — F 10 1 2 3 4 — — Syphilitic diseases M 7 — — — — 5 2 F 8 1 — — — 3 4 Cancer M 221 — 2 1 12 96 110 F 243 - — — 9 108 126 Diabetes M 7 - — 1 — 2 4 F 9 - — — - 1 8 Intra cranial vascular lesions M 104 - — — 1 25 78 F 148 —- — — — 17 131 Heart diseases M 352 — — — 8 65 279 F 429 — — 2 8 37 382 Other circulatory diseases M 22 — — — — 10 12 F 28 - - — — 6 22 Bronchitis M 93 2 1 — 5 29 56 F 48 1 1 — 1 9 36 Pneumonia (all forms) M 59 17 3 1 1 16 21 F 58 8 3 — 4 9 34 Other respiratory diseases M 14 — — — 3 7 4 F 10 2 — — 1 2 5 Ulcer of stomach or duodenum M 27 — — — 1 14 12 F 9 — — — — 2 7 Diarrhoea (under 2 years) M 17 16 1 — — — — F 4 3 1 — — — — Appendicitis M 5 — - 1 1 — 3 F 4 — - — 2 — 2 Other digestive diseases M 23 — — 1 2 9 11 F 29 — 1 1 3 12 12 Nephritis M 20 — — — 3 6 11 F 21 — — — 3 7 11 Puerperal sepsis F 1 - - - 1 - - Other maternal causes F 6 — — — 6 — - Congenital debility, malformations, premature birth, etc. M 39 35 1 — 2 1 - F 50 46 — — — 2 2 Suicide M 12 — — — 1' 6 5 F 11 — — — 3 4 4 Road traffic accidents M 13 — — 2 2 7 2 F 8 — — 3 — 2 3 Other violent causes M 22 2 1 1 4 5 9 F 37 2 — - 2 4 29 All other causes M 101 4 1 2 11 24 59 F 80 2 1 1 15 17 44 Totals 2513 148 28 23 168 594 1552 7 Comparisons with 1944. In the zymotic diseases group there were 3 deaths from Whooping Cough, 2 from Diphtheria, and 6 from Measles. There were again no deaths in the Typhoid group. The deaths from Pulmonary Tuberculosis decreased by 18: those from Cancer increased by 54; those from Pneumonia by 14; and a decrease of 7 recorded in those caused by Bronchitis. Deaths from Suicide show an increase of G, and road traffic accidents of 4. The total number of deaths was 2,513, as compared with 2,854 in 1944. The percentage of deaths under 1 year of age to the total deaths was 5.9 per cent.; deaths under 15 years, 7.9 per cent.; deaths under 65 years, 38.2 per cent.; and deaths over 65 years, 61.8 per cent. The corresponding figures for 1944 were 5.5 per cent., 8.3 per cent., 42.2 per cent., and 57.8 per cent. respectively. The above total differs slightly from the total recorded by the department, as the period covered by the Registrar-General refers to the weekly returns from the Registrars, while the department records are calculated from 1st January to 31st December. WATER. The Water supply is drawn from deep wells in the chalk. These wells are situated in Surrey Street, Stroud Green, Waddon, Selhurst and Addington. A portion of the northern side of the Borough is supplied with water which is purchased in bulk from the Metropolitan Water Board. The amount of water consumed during the year was— Corporation's Wells 2,169,733,000 Metropolitan Water Board in bulk 613,972,000 2,783,705,000 The Water supply has been satisfactory in quality and quantity. 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. 240 raw water samples and 850 treated water samples were thus examined bacteriologically during the year by the Chemist and Bacteriologist on the staff of the Water Undertaking. In addition 20 samples of raw water and 84 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 80 of raw waters and 152 of treated waters going into supply. The results of the chemical analyses were uniformly satisfactory. The waters are nut 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 1945 the total number of samples taken by the Public Health Department was as follows:— For bacteriological examination 82 For chemical examination 67 All these samples were taken direct from consumers' taps. 9 LABORATORY, AMBULANCE, NURSING FACILITIES, HOSPITALS, Etc. There have been no material changes in the Laboratory and Nursing Facilities in the home since my report in 1940. All Clinics have continued throughout the year. A report on the activities of the Ambulance Service will be found on page 33. DEPARTMENTAL CLASSIFICATION OF DEATHS ACCORDING TO DISEASE OVER A PERIOD OF SIX YEARS. Cause of Death. 1940 Total Deaths 1941 Total Deaths 1942 Total Deaths 1943 Total Deaths 1944 Total Deaths 1945 Total Deaths Death Rate Enteric Fever - 1 - - - - - Malaria — 1 - - — 1 0.005 Poliomyelitis — — — — 1 1 0.005 Measles — 5 — 1 1 6 0.030 Scarlet Fever — — 1 1 — — Whooping Cough 2 6 3 1 10 3 0.015 Diphtheria and Croup 4 4 3 2 — 2 0.010 Influenza (incl. Influenzal pneumonia) 49 36 19 81 19 11 — Dysentry — 2 2 — — 1 0.005 Erysipelas 2 — 1 — 1 — — Cerebro-Spinal Fever 16 8 6 1 1 3 0.015 Pulmonary Tuberculosis 128 90 97 107 98 78 0.388 Tuberculous Meningitis 21 19 19 16 11 14 0.070 Other Tuberculous Diseases Cancer, Malignant Disease 443 376 409 454 420 470 2.341 Rheumatic Fever 8 2 3 2 2 1 0.005 Meningitis 5 3 9 7 4 6 0.030 Organic Heart Disease 682 672 741 515 563 542 2.610 Bronchitis, Acute and Chronic 130 80 131 150 126 124 0.618 Pneumonia 206 194 113 182 129 160 0.797 Other Diseases of the Respiratory Organs 21 30 22 17 23 19 0.095 Diarrhoea & Enteritis 18 13 15 21 22 20 0.100 Appendicitis 15 10 6 8 8 8 0.040 Cirrhosis of Liver 1 10 5 4 2 5 0.025 Alcoholism 2 1 — - - — - Nephritis & Bright's Disease 63 60 57 44 44 35 0.175 *Puerperal Sepsis 2 3 3 1 - 1 0.272 *Other diseases and accidents of pregnancy and parturition 3 5 9 1 8 8 2.177 Congenital debility, malformation and Premature Birth 53 34 82 73 89 72 0.358 Violent Deaths (excluding War operations and suicide) 61 74 61 46 45 64 0.319 suicide 20 20 24 21 16 24 0.120 Other Defined Diseases 1152 778 568 860 1206 808 4.024 Diseases Ill-Defined or Unknown 11 2 - 12 8 4 0.020 Total 3118 2539 2409 2628 2857 2491 12.407 'Calculated per 1,000 live and still births. t 1945 showed a decrease both in the death and birth rates. 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 66 Assistant Nurses 6 Student Nurses 93 Male Nurses 11 Steward: Mr. R. Grist. The following Specialist Services are carried:—Orthopaedic, Gynaecological and Obstetrical, Dental, X-Ray, Deep X-Ray Therapy, Massage, Ultra-Violet Light, Ophthalmic, Ear, Nose and Throat, School E.N.T. Clinic, Gastroscopy. Table I. 1.—Total number of admissions (including infants born in hospital) 8,288 2.—Number of women confined in hospital 1,027 3.—Number of live births 999 4.—Number of still births 55 5.—Number of deaths among the newly-born (i.e., under 4 weeks of age) 55 6.—Number of deaths among children under one year (including those given under 5) 86 7.—Number of maternal deaths among women admitted to hospital for confinement 1 8.—Total number of deaths 758 9.—Total number of discharges (including infants born in hospital) 7,417 10.—Duration of stay of patients included in 8 and 9 above:— (a) Under four weeks 6,684 (b) Four weeks and under thirteen weeks 1,362 (c) Thirteen weeks or more 196 11.—Number of beds occupied (excluding cots in maternity wards):— (a) Average during the year 421 (b) Highest 472 on 14-2-45 (c) Lowest 373 on 1-1-45 12.—Number of surgical operations under anæsthetic 3,149 13.—Number of abdominal sections 580 11 Table II. Classification of In-Patients who were discharged from or who died in the Institution during the year ended 31st December, 1945. Disease Groups. Children (under 16) Men and Women. Discharged. Died. Discharged. Died. A—Acute infectious disease 81 — 17 — B.—Influenza — — 8 — C.—Tuberculosis: Pulmonary 3 — 83 21 Non-Pulmonary 12 4 4 6 D—Malignant Disease — — 102 134 E.—Rheumatism:- (1) Acute rheumatism .(rheumatic fever) together with sub-acute rheumatism and chorea 4 - 9 (2) Non-articular manifestations of so called "rheumatism " (muscular rheumatism, fibrositis, lumbago, and sciatica) 4 - 5 - (3) Chronic Arthritis 1 — 29 1 F.—Venereal Disease 1 — 6 — G—Puerperal Pyrexia - - 2 — Puerperal Fever — — - — H.—Other diseases and accidents connected with pregnancy and childbirth — — 416 4 I.—Mental diseases 12 — 249 1 J.—Senile decay — — 35 6 K.—Accidental injury and violence 63 — 257 24 In respect of cases not included above. L—Diseases of the Nervous System and Sense Organs 7 6 103 88 M.—Disease of the Respiratory System 113 21 293 68 N. „ „ Circulatory System 6 3 223 215 0. „ „ Digestive System 152 13 690 42 P. „ „ Genito Urinary System 84 — 124 36 Q „ ,, Skin 64 — 144 4 R.—Other diseases. 1243 6 529 7 s.—-Mothers and infants discharged from Maternity Wards and not icluded in above figures:- Mothers — — 1143 1 Infants 1021 47 — — T.—Any persons not falling under any of the above headings 24 — 51 — Totals 2895 100 4522 658 12 NUMBER OF X-RAY FILMS TAKEN. Spine 341 Bones 1,842 Pelvis 31 Chest 2,805 Barium Meals 518 Barium Enemas 56 Renal 204 Gail-Bladder 109 Teeth 581 Abdominal 44 Maternity Cases 693 Skull 310 7,534 Total number of Cases X-rayed 5,707 DIAGNOSTIC. 1944. 1945. Oesophagus with Barium 3 3 Barium Meals 82 344 Barium Enemeta 27 31 Gall-Bladder (Plain) 9 29 Cholecystograms 20 36 Renal Tracts (Plain) 14 39 Pyelograms 19 60 Abdomen for F.B.'s, etc. 15 20 Maternity Cases 393 384 Hysterographies 7 7 Lungs (Mayday Hospital) 448 825 (Sick Staff) 7 7 (Staff on Appointment) 109 169 (T.B. Dispensary) 1,362 1,370 (Others) 18 125 Lungs after Lipiodol 1 9 Heart and Aorta 4 9 Skulls 81 89 Accessory Nasal Sinuses 37 48 Vertebral Column 106 394 Ribs 42 24 Pelvis 24 21 Long Bones 209 550 Short Bones 312 520 Joints 391 300 Teeth and Jaws 191 294 3,931 5,707 Examinations by Portable Set 99 60 13 X-RAY.  1944. 1945. Men's Wards 609 967 Women's Wards 574 868 Children's Wards 83 257 Maternity and Gynaecological Wards 77 212 Staff 174 165 Total "In-Patients" 1,517 2,469 T.B. Dispensary (Men) 640 762 (Women) 623 699 (Children under 16) 99 209 Croydon Borough Hospital 2 20 Ante-Natal Clinic 316 484 Queen's Road Homes 30 14 Dental Clinic 191 265 Others 373 15 St. Mary's Hospital 9 10 Total "Out-Patients" 2,283 2,478 Total 3,800 4,947 "Screen Examinations" 945 827 MASSAGE. Massage 11,512 Exercises 12,341 Radiant Heat 10,489 Electrical 1,274 Infra-red 912 Ultra Violet Light 1,344 Wax 908 Diathermy 1,164 39,944 Total number of patients treated 1,698 MENTAL PATIENTS DEALT WITH DURING THE YEAR. Male. Female. Admitted 121 141 Certified and sent to Warlingham Park Hospital 10 16 As Voluntary Patients to Warlingham Park Hospital 63 79 Discharged not certified 38 43 14 SPECIMENS EXAMINED IN THE PATHOLOGICAL LABORATORY DURING THE YEAR. Positive. Negative. Swabs for Diphtheria — 1,488 Sputa for T.B 267 533 Pus for T.B 5 7 Pus for Gonococci 1 — Urine for T.B. 4 18 Faeces for T.B. 2 6 Faeces for Coli Typhoid Group 43 401 Blood—Widals 1 17 Hairs for ringworm 2 — Blood cultures 6 31 Faeces for occult blood 126 223 3,181 Urine for routine examination 1,196 Pus for organisms 231 Blood urea estimations 306 Blood sugar estimations 173 Cerebro spinal fluids 82 Urea Conc. Tests 7 Urea clearance tests 98 Fractional test meals 130 Pleural fluids 44 Blood counts 686 Haemoglobin estimations 972 Blood groups 259 Compatibility tests 251 Faecal fat estimations 2 Van den Bergh re-action 20 Blood sedimentation rates 864 Glucose tolerance tests 10 Blood coagulation and bleeding time 63 Other examinations—unclassified 404 Total number of Examinations 8,979 Number of Specimens sent to Croydon General Hospital 519 NUMBER OF POST MORTEMS ORDERED BY THE CORONER AND PERFORMED AT MAYDAY HOSPITAL DURING THE YEAR. Outside Cases 255 Hospital Cases 115 NUMBER OF POST MORTEMS NOT ORDERED BY THE CORONER 69 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 3 38 1 2 — — — Cervix 1 12 — 1 — — — Ovary 2 17 1 — 1 — — Larynx 7 86 — 2 4 — 1 Breast 12 175 1 2 6 — 3 Lung 6 93 — 2 3 — 1 Testicle 1 15 — — — — 1 Spine 3 28 — — 1 — 2 Sarcoma of Hip 1 2 — — — — 1 abdomen 1 5 — — - — 1 Epithelioma of lip 1 5 1 — — — — penis 1 8 — 1 — — — Menorrhagia 7 44 3 4 — — — Spondylitis 2 38 — 1 — — 1 Lymphatic Leukaemia 3 16 — 1 1 — 1 Myeloid leukaemia 3 37 1 1 1 — — Cerebral tumour 1 11 — — 1 — — Pruritus Vulva 1 4 — 1 — — — Ewings Tumour 1 5 — — — — 1 Pagets disease 1 14 — 1 — — — Keloid scar 1 7 — — — — 1 59 660 8 19 18 — 14 Corresponding totals for 1944 57 573 3 35 6 2 11 16 Table III Diagnoses In Case Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Alimentary. Appendicitis — - — — 180 35 2 2 219 Appendicular Colic — 8 — — — 2 — — 10 Appendicular Abscess — — — — 4 5 — — 9 Gastric ulcer 8 28 6 6 1 2 — 4 55 Duodenal ulcer 6 38 — 3 11 12 — 2 72 Anastomatic ulcer 2 - - - - - - - 2 Dyspepsia — 9 2 - - - - - 11 Cholelithiasis — 2 2 — 7 2 — — 13 Colitis 1 3 _ 1 — 1 — — 6 Intestinal obstruction 7 14 8 — — — - 29 Ischio-rectal abscess 4 4 - - - - - - 8 Constipation 36 27 - - - - - - 63 Hernia — — - - 84 57 3 6 150 Haemorrhoids — — - - 18 3 1 — 22 Cholecystitis — — - — 9 14 — — 23 Gastro enteritis 14 12 - 6 — — — — 32 Gastritis 14 14 — 2 — — — — 30 Alveolar abscess 1 — — — — — — — 1 Intestinal colic 4 13 - — 1 3 — — 21 Catarrhal jaundice 2 1 - - - - - - 3 Prolapse Rectum — 4 1 — — — — — 5 Pyloric stenosis — 4 1 2 2 2 1 1 13 Diarrhoea 3 1 — — - — — — 4 Nervous Dysphagia — 2 — — — — — — 2 Cyclic vomiting 1 1 - - - - - — 2 Peptic Ulcer — 7 - — 1 — — — 8 Peritonitis — — - 1 1 5 — 6 13 Adhesions — 3 1 - — — — - 4 17 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Jaundice — 7 — 2 — — — — 9 Collapse 1 2 1 - - - - - 4 Peritonsillar Abscess 3 1 - - - - - - 4 Perineal Abscess 5 1 - - - - - - 6 Acidosis — 1 - - - - - - 1 Pancreatitis 4 2 — 1 — - — — 7 Subphrenic abscess — 1 1 - - - - - 2 Vincents angina — 4 — — — - — — 4 Ascitis — 2 - - - - - - 2 Diverticulitis — 2 — — — 2 — — 4 Gallstone Colic 2 — — — — — — — 2 Intussusception — — — — — — — 1 1 Coeliac Disease — 4 - - - - - - 4 Haeimatemesis — 6 1 — _ — — — 7 Actinomycosis — — — 1 — — — — 1 Pyioric Ulcer — — - — 1 — - — 1 Hepatitis 7 - - - - - - - 7 Splenectomy — — - - 1 — — — 1 897 Bones, and Joints. Arthritis — 32 2 — — — - — 34 Fibrositis — 9 1 — — — - — 10 Bursitis 2 10 - - - - - - 12 Paget's Disease — 1 — — — — — — 1 Spina bifida — 2 — 1 — — — — 3 Lumbago — 2 - - - - - - 2 Synovitis 3 7 1 - - - - - 11 Osteomyelitis — — — — 4 9 3 — 16 Genu Valgum — - — — 2 4 - — 6 Osteo-arthritis — 13 3 - - - - - 16 18 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Myositis 1 - - - - - - - 1 Acute Rheumatism 6 6 2 - - - - - 14 Hallux Valgus - - - - - 5 2 — 7 Muscular Rheumatism 2 5 1 - - - - - 8 Osteitis 1 2 - — - - - - 3 Talipes — — — — 1 3 1 — 5 Torticollis — — — — 1 1 2 — 4 Flat foot — 1 - - - - - - 1 Tenotomy — — — - 5 — — — 5 Coccydynia — — — — — 1 — — 1 Osteitis deformans — — 1 — — — — — 1 Muscular dystrophy — — 1 — — — — — 1 Exostosis - - - - - 1 — — 1 Carcinoma. 163 Breast — — — — 2 4 3 10 19 Rectum - - - - - 6 6 11 23 Stomach - - - - - - 13 19 32 Cervix - - - - - 2 4 6 12 Ovary - - - - - - 1 3 4 Uterus - - - - - 2 2 7 11 Prostate - - - - - - 1 1 2 Colon - - - - - - 7 16 23 Tongue and Mouth - - - - - 1 1 3 5 Larynx — — — — 1 2 5 8 Oesophagus - - - - - - 2 2 4 Bladder - - - - - 1 2 6 9 Pancreas - - - - - 1 — 4 5 Lung - - - - - - 7 12 19 Bronchus - - - - - 2 3 8 13 Epithelioma — - — — — 4 1 2 7 19 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Peritonei — — — — — 3 1 2 6 Cervix uteri — — — — — — 1 4 5 Testis — — — — — — — 2 2 Sarcoma — — — — — 1 4 2 7 Spine — — — — — 1 3 1 5 Liver — — — — — — — 6 6 Thyroid — — — — — — — 1 1 Glands — — — — — — 1 — 1 Pelvi rectal junction — — — — — — 2 — 2 Ileo-caecal junction — — — — — — 2 1 3 Rodent ulcer — — — — — 1 — — 1 Common bile duct — — — — — 1 — 1 — 236 Circulatory (Blood). — Anemia 1 6 1 3 — — — 11 Septicaemia 1 5 — 5 — — — — 11 Hyperpiesia — 3 — — — — — — 3 Pernicious Anaemia 1 7 1 1 — — — — 10 Thrombosis 1 3 — — — — — — 4 Phlebitis 5 1 — — — — — — 6 Gangrene — — — — 2 2 1 — 5 Varicose veins — — — — — 12 — — 12 Leukaemia — 1 — 1 —" — — — 2 Epistaxis 1 4 — — — — — — 5 Malaria 16 — — — — — — — 16 85 Circulatory (Heart) Myocardial Degen: — 9 8 85 — — — — 102 Hypertension — 31 6 5 — — — — 42 Aortic incompetence — 3 — — — — — — 3 Arterio sclerosis — 9 4 8 — — — — 21 Aortic stenosis — — — 2 — — — — 2 20 Diagnoses In Cases Treated Medical. Surgical. Total. Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Endocarditis — 1 1 — — — — — 2 Auricular fibrillation — 6 — 2 — — — — 8 Myocarditis — 6 3 1 — — — — 10 Mitral stenosis — 7 4 — — — — — 11 Carditis 1 — 1 1 — — — — 3 Congestive heart failure — 19 2 49 — — — — 70 Congenital heart disease — 1 — — — — — — 1 Tachycardia 1 4 — 1 — — — — 6 Angina 7 6 — 1 — — — — 14 Rheumatic Carditis — — 1 3 — — — — 4 Heart failure — 10 3 50 — — — — 63 362 Constitutional. Diabetes Mellitus — 33 4 3 — — — — 40 Nutritional disorder 18 2 — — — — — — 20 Marasmus — 3 — 1 — — — — 4 Malnutrition 4 5 4 — — — — — 13 Rickets — 1 — — — — — — 1 Cachexia — — — 2 — — — — 2 Diabetic coma — 3 1 — — — — — 4 84 Eye. Conjunctivitis 3 3 — — — — — — 6 Cataract — — 1 — — — — — 1 7 Ear, Nose and Throat. Enlarged T's. and A's. 23 2 — — 1080 — — — 1105 Quinsy — 2 — — — — — — 2 Otitis Media 43 12 2 — — — — — 57 Mastoiditis — — — — 5 4 — — 9 21 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Laryngitis 1 — — — — — — — 1 Nasal obstruction 1 — — — — — — — 1 Sinusitis — 1 — — — — — — 1 Adenoids — — — — 4 — — — 4 Bleeding tonsil tag 1 — — — — — — — 1 Coryza 2 — — — — — — — 2 1183 Genito Urinary. Nephritis — 8 2 3 — — — — 13 Urethral stricture 1 2 — — — — — — 3 Vesical calculus 1 — — — — — — — 1 Pyelitis 21 11 1 — — — — — 33 Enlarged prostate 4 21 1 5 — — — — 31 Uraemia — 1 2 26 — — — — 29 Renal colic 1 2 — — — — — — 3 Urinary calculus 6 3 — — — — — — 9 Pyelonephritis — — — 1 — — — — 1 Suprapubic fistula. — — 2 — — — — — 2 Hydronephroma of kidney — — 1 — — — — — 1 Hypernephrosis — 1 — — — — — — 1 Circumcision — — — — 68 1 — — 69 Haematuria — 2 1 — — — — — 3 Retention 6 8 2 — — — — — 16 Oliguria — 1 — — — — — — 1 Undescended testicle — — — — — 2 — — 2 Incontinence — — 1 — — — — — 1 Cystitis 3 18 — 1 — — — — 22 Papilloma of bladder — — — — — 2 — — 2 Epididymo-orchitis — 1 — — — — — — 1 244 22 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Glands. Adenitis 17 24 3 — — — — — 44 Cervical abscess 1 — — — — — — — 1 Hodgkin's disease — 1 — 2 — — — — 3 Adenoma — 4 — — — — — — 4 Goitre — — 1 — — — — — 1 Thyrotoxicosis — 2 — — — — — — 2 55 Gynaecological. Abortipn — — — — 299 — — 3 302 Fibrosis Uteri — — — — 50 — — 1 51 Ovarian cyst — — — — 23 1 — — 24 Uterine haemorrhage — — — — — 22 — — 22 Mastitis — — — — 15 — — — 15 Amenorrhoea — — — — 4 — — — 4 Menorrhagia — — — — — 17 — — 17 Metrorrhagia — — — — — 7 — — 7 Vaginitis — — — — 1 — — — 1 Dysmenorrhoea — — — — 11 — — — 11 Bartholin's cyst — — — — 2 — — — 2 Bartholin's abscess — — — — 2 1 — — 3 Erosion of cervix — — — — 8 — — — 8 Hysterectomy — — — — 31 — — — 31 Deficient pelvic floor — — — — 29 — — — 29 Cervical polypi — — — — 15 — — — 15 Salpingitis — — — — 18 — — — 18 Retroversion — — — — 13 — — — 13 Salpingo-oophoritis — — — — 4 — — — 4 Retained products — — — — 12 — — — 12 Urethral caruncle — — — — 5 — — — 5 23 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Cystocele — — — — 1 — — — 1 For sterilization — — — — — 2 — — 2 Sterility — — — — 26 — — — 26 Endometritis — — — — 5 — — — 5 Dermoid cyst — — — — 1 — — — 1 Urethral tear — — — — 3 — — — 3 Procidentia — — — — 3 — — — 3 Pelvic abscess — — — — 1 — — — 1 Vaginal discharge — — — — 2 — — — 2 E.U.A — — — — — — 4 — 4 Menopausal syndrome — — — — — 1 — — 1 Imperforate hymen — — — — — 1 — — 1 644 Infectious. Influenza 7 1 — — — — — — 8 Puerperal pyrexia 1 1 — — — — — — 2 Scarlet Fever — — 3 — — — — — 3 Poliomyelitis 1 — — — — — — — 1 Dysentery 2 1 35 — — — — — 38 Whooping Cough — 1 2 — — — — — 3 Measles — — 39 — — — — -- 39 Diphtheria — — 1 — — — — — 1 Typhoid — — 1 — — — — — 1 Mumps 1 — 1 — — — — — 2 Erysipelas 2 — 2 — — — — — 4 Rubella — — 1 — — — — — 1 Cerebro spinal fever — — 3 — — — — — 3 Actinomycosis — 1 — — — — — — 1 107 24 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Maternity. Pyelitis of pregnancy — — — — 19 — 1 — 20 False labour pains — — — — — 24 — — 24 Ectopic gestation — — — — — 8 — — 8 Albuminuria of pregnancy — — — — 2 — — — 2 A.P.H — — — — — 6 — — 6 R.B.P — — — — — 5 — — 5 Anaemia of pregnancy — — — — — 4 — — 4 Vomiting of pregnancy — — — — — 1 — — 1 A.N. Observation — — — — — 12 — — 12 A.N. rest — — — — — 3 — — 3 Hyperemesis — — . — — 3 — — — 3 Termination of pregnancy — — — ' — 1 — — — 1 Toxaemia of pregnancy — — — — — 3 — — 3 Ruptured tubal pregnancy — — — — — — — 1 1 93 Mental. Uncertified — 14 149 — — — — — 163 Certified — — 26 — — — — — 26 Mental Deficiency — — 13 — — — — — 13 Epilepsy — 22 — — — — — — 22 Senile Dementia — 2 5 — — — — — 7 Loss of memory 1 6 2 — — — — — 9 Hysteria — 15 1 — — — — — 16 Depression 3 1 — — — — — — 4 Idiopathic epilepsy — 1 — 1 — — — — 2 262 Nervous and Sensory. Cerebral haemorrhage — 9 5 54 — — — — 68 Meningitis 2 2 — 5 — — — — 9 Chorea — 3 — — — — — — 3 25 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Hemiplegia — 8 5 4 — — — — 17 Sciatica — 7 — — — — — — 7 Neurasthenia — 3 1 — — — — — 4 Neurosis — 15 3 — — — — — 18 Paralysis agitans — 1 1 — — — — — 2 Cerebral thrombosis 2 15 5 26 — — — — 48 Neuralgia — 1 — — — — — — 1 Neuritis 1 2 — — — — — — 3 Cerebral tumour 1 — 3 — — — — — 4 Glioma — — — 1 — — — — 1 Paraplegia — 2 — — — — — — 2 Encephalitis — — 1 1 — — — — 2 Cerebral abscess — — — 1 — — ~ — 1 Subarachnoid haemorrhage 2 2 — 1 — — — — — Paralysis — 4 1 — — — — — 5 Migraine — 1 — — — — — — 1 Habit vomiting — 1 — — — — — — 1 Hydrocephalus — — — 1 — — — — 1 Headache — 1 — — — — — — 1 204 Respiratory. Bronchitis 35 90 20 8 — — — — 153 Pneumonia 115 44 5 65 — — — — 229 Pleural effusion 2 4 8 — — — — — 14 Bronchial Catarrh — 2 — — — — — — 2 Bronchiectasis 3 9 — 2 — — — — 14 Atelectasis 1 — — — — — — — 1 Pleurisy 11 10 — — — — — — 21 Emphysema 1 1 — — — — — — 2 Asthma — 34 1 2 — — — — 37 26 Diagnoses In Cases Treated Medical. Surgical. Total. Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Empyema — 2 — 3 — — — — 5 Pulmonary congestion — 1 — 3 — — — — 4 Spontaneous Pneumothorax — 1 — — — — — — 1 Neoplasm of lung — 1 — — — — — — 1 Fibrosis of lungs 1 2 — — — — — — 3 Pulmonary embolism — 1 — 6 — — — — 7 Pyrexia 1 — — — — — — — 1 495 Senility — — 35 6 — — — — 41 Skin. Boils, abscess and carbuncles, etc. 45 34 — — — — — — 79 Burns and scalds — — — — 6 9 2 3 20 Eczema 8 7 3 — — — — — 18 Impetigo 10 7 — — — — — — 17 Scabies 9 3 1 — — — — — 13 Dermatitis 7 8 2 — — — — — 17 Septic spots 2 4 — — — — — — 6 Ingrowing toenail — — — — — 1 — — 1 Cellulitis — — — — 8 11 — 1 20 Ulceration 11 1 — — — — — — 12 Urticaria 2 1 — — — — — — 3 Papilloma — 2 — — — — — — 2 Whitlow — — — — — 2 — — 2 Psoriasis 1 — — — — — — — 1 Herpes — 1 — — — — — — 1 212 Pulmonary Tuberculosis — 51 35 21 — — — — 107 Non-Pulmonary Tuberculosis. Meninges — 2 — 6 — — — — 8 Hip — — 1 — — — — — 1 27 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Glands — 3 2 1 — — — — 6 Kidney — 1 — — — — — — 1 Peritoneum — 2 — 1 — — — — 3 Miliary — — 1 2 — — — — 3 Abdominal — — 1 — — — — — 1 Spine — — 1 — — — — — 1 Sacro iliac joint — — 1 — — — — — 1 Knee — — 1 — — — — — 1 26 Venereal. Gonorrhoea 1 — 1 — — — — — 2 Syphilis — 2 3 — — — — — 5 7 Violence. Fractured limbs — — — — 5 103 15 21 144 Fractured spine — — — — 1 — — — 1 Fractured malleolus — — — — 1 5 2 1 9 Fractured skull — — — — — 2 — 1 3 Fractured ribs — — — — 4 5 — — 9 Fractured clavicle — — — — — 5 — — 5 Fractured pelvis — — — — — 1 — — 1 Fractured sacrum — — — — 1 — — — 1 Fractured nasal bones — — — — — 1 — — 1 Fractured lumber transverse process — — — — 1 — — — 1 Minor injuries — — — — 3 4 — — 7 Contusions and abrasions — — — — 10 16 1 — 27 Sprain — — — — 7 1 — — 8 Bruises — — — — 2 3 — — 5 Dislocation — — — — 3 9 2 — 14 Gun shot wound — — — — 2 18 10 1 31 28 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Concussion — — — — 13 29 1 — 43 Lacerations, wounds, etc. — — — — 17 12 2 — 31 Amputations — — — — — 3 — — 3 344 Miscellaneous. Poisoning 5 — — 2 — — — — 7 B.B.A 1 — — — — — — — 1 N.A.D 51 — — — — — — — 51 P.U.O. — 1 — — — — — — 1 With Mother 23 — — — — — — — 23 Hare lip and cleft palate — — — — 2 — — — 2 Dentition — 2 — — — — — — 2 Prematurity — 1 — 2 — — — — 3 Post op.; haemorrhage 2 — — — — — — — 2 Stings 1 — — — — — — — 1 F.B. — — — — 5 — — — 5 Extraction of tooth — — — — 2 2 — — 4 Malingering 1 — — — — — — — 1 l or X-ray — — 2 — — — — — 2 105 TOTAL NUMBER OF PATIENTS DISCHARGED FROM MAYDAY HOSPITAL YEAR ENDED 31ST DECEMBER, 1945. Cured 5,069 Relieved 1,697 Unrelieved 651 Died 758 8,175 TOTAL NUMBER OF OUT-PATIENTS TREATED AT MAYDAY HOSPITAL DURING THE YEAR 1945 12,622 20 OPERATIONS PERFORMED AT MAYDAY HOSPITAL during 1945 ABDOMINAL. Appendicectomy 189 Sigmoidoscopy 16 Herniotomy 126 Cholecystectomy 20 Laparotomy 81 Gastroenterostomy 2 Colostomy 14 Perforated gastric ulcer 15 Injection of haemorrhoids 6 Haemorrhoidectomy 24 Perforated duodenal ulcer 15 Gastroscopy 14 Undescended testicle 3 Orchidectomy 1 For hydrocele 3 Gastrectomy 1 Rammstedt's operation 4 Splenectomy 1 Intussusception 1 Gastro jejunostomy 4 Repair of liver 1 541 BONES AND JOINTS. For osteo-myelitis 2 Amputation of limbs 13 Wiring of bones 9 Removal of pin 2 Resection of rib 11 Application of plaster 39 Reduction of joints 8 Manipulation of limbs 49 Osteotomy 2 Removal of Sequestrum 7 Division of webbed phalanges 1 Excision of coccyx 3 Hallux valgus 2 Arthrodesis left hip 1 149 EAR, NOSE AND THROAT. Tonsillectomy 1,023 Adenoidectomy 14 Osophagoscopy 1 Mastoidectomy 10 Bronchoscopy 1 Repair of hare lip 3 Nasal septum cauterised 1 Tonsil tags 8 1,061 30 GENITO URINARY. Cystoscopy 62 Circumcision 77 Prostatectomy 17 Supra pubic cystotomy 40 Urethral dilatation 8 Fulguration of bladder 9 Nephrectomy 2 Proctoscopy 2 217 GYNAECOLOGICAL. Examination under Anaesthetic 107 Total hysterectomy 52 Sub-total hysterectomy 14 Salpingo-oophorectomy 11 Dilation and Curetage 124 Resection of ovaries 6 Removal of ovarian cyst 10 Salpingectomy 12 Ovariotomy 3 Incision of Bartholin's abscess 1 Incision of Bartholin's cyst 1 Insertion of pessary 6 Colpo-perineorrhapy 20 Cauterization of Cervix 13 Baldy Webster Operation 15 Le Fort's operation 4 Fothergills Operation 5 Urethral and cervical smears taken 2 Cervical polypus 4 Amputation of Cervix 2 Biopsy of Cervix 9 Removal of Gauze Packing from Uterus 3 Suture of laceration of vaginal wall 2 Intra-uterine Lipiodol 4 Repair of pelvic floor 3 Incision of hymen for haematocolpos 1 Dudley's Operation 3 Myomectomy 10 Hymenectomy 1 Painting vagina 34 Removal of needle from perineum 1 489 OBSTETRICAL. Caesarean Section 42 Evacuation of Uterus 228 Induction of Labour 14 Rupture of Membranes 118 Removal of Placenta 1 Evacuation of Blood Clot from Ruptured Rectus 1 Termination of Pregnancy 1 405 31 MISCELLANEOUS. Blood Transfusions 18 Incisions, abscesses, etc. 147 Cleansing of Burns, etc. 4 Amputation of Breast 9 Suture of Wounds 23 Excision of Wounds 13 Lumbar Puncture 35 Aspiration of Hip 1 Aspiration of Chest 17 Aspiration of Gland 1 Removal of Nail 4 Removal of Foreign Body 18 Paracentesis 22 Injection of Varicose Veins 2 Ligature of Varicose Veins 8 Removal of Glands 6 Removal of Naevus 3 Removal of Ganglion 9 Pyelogram 9 Excision of Scar Tissue 1 Injection of Sciatic Nerve 1 351 Number of patients who had teeth extracted 153 32 PUBLIC ASSISTANCE. (a) Domiciliary Relief. Number of Croydon cases resident in the Borough and in receipt of outdoor relief on the— 1st January, 1945 1,287 persons 767 cases 1st July, 1945 1,292 „ 779 „ 1st January, 1946 1,586 „ 871 „ The heavy increase at 1st January, 1946, is accounted for largely by return of persons (largely children) from evacuation. Expenditure on Out-relief during the 12 months ended 30th September, 1945, to Croydon cases resident in the Borough:— Half-year ended 31st March, 1945 £28,791 14s. 6d. Half-year ended 30th September, 1945 £27,703 15s. 6d. (b) Institutional Relief. Number of Croydon persons relieved in the Mayday Hospital on 1st January, ]946, and in the Queen's Road Homes on the same date :— Mayday Hospital 33 Queen's Road Homes 453 (excluding 82 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 31-3-46. All Districts. (1) Average number of separate patients attended during each quarter 1,552 (2) Attendances at Patients' homes 10,568 (3) Attendances on patients at the surgery 13,575 (4) Total number of prescriptions written 27,630 (5) Estimated cost of drugs, dressings and dispensing £1,463 4s. 2d. (6) Estimated amount of per capita payment to doctors in respect of patients actually attended (calculated quarterly) 4s. 9.50d. (7) Estimated average payment per service point 2.03d. 83 HOME HELPS. The Home Helps scheme during the year 1945 expanded considerably with the return of persons from evacuation and with the considerable increase that occurred in the birth-rate. (1) Number of Home Helps—January 1st and December 31st, 1945— 1/1/45. 31/12/45. (a) Full-time 16 21 (b) Part time 7 9 (2) Number of applications— (a) Maternity 484 (b) Sickness 55 (3) Number of applications met— (a) Maternity 433 (b) Sickness 35 (4) Average duration of services given— (a) Maternity 14 days (b) Sickness 10—21 days (5) Amount recovered for services—£752 12s. 7d. (6) Rate of remuneration of "Helps"— (a) Maternity: Jan. 1st—April 23rd £2 12s. 6d. weekly April 30th—Dec. 31st £3 12s. 6d. weekly (b) Sickness 1/6 per hour Reference should also be made to page 89 for further data in regard to this Service. AMBULANCE SERVICE. To The Medical Officer of Health. I beg to submit the Fourth Annual Report and Statistics for this Service, for the year ended 31st December, 1945. During the year the Service dealt with 6,399 calls, which is an increase of 1,663 over the figures for 1944. This increase is accounted for in the main by higher figures for Accidents (1,401 against 1,254), Private Removals (1,608 against 1,126), Transport from Hospital after Treatment (965 against 661), and Public Health Department cases (1,407 against 697). The total mileage covered for the year by the Ambulances was 44,014 miles. 34 The average time for an ambulance to attend a call has remained substantially the same at 4 minutes 25 seconds, in spite of the fact that new drivers have had to be trained who are not so familiar with the roads in the district as the older members. On numerous occasions during the past year the Croydon Ambulance Service has been requested by neighbouring Boroughs to stand by for accident calls. Three private cars and one breakdown van have been commissioned for the Service, and have proved of great value. In addition, one Buick ambulance obtained from the Civil Defence on their disbandment is being used for the conveyance of anteand post-rratal cases to and from Mayday Hospital and St. Mary's. The ambulance at the Borough Isolation Hospital has now come under the control of this Service. The ambulance is still, however, maintained at the Borough Hospital, although the drivers are interchangeable with the other personnel. One other innovation is the introduction of the 8-hour shift system for officers and men at the Stations, and this is working satisfactorily. Our system of "flagging" accident calls on a special map has been maintained, and from this I am able to derive the following figures showing the comparison between 1944 and 1945 at the various "Black-spots" in the Borough: 1944. 1945. District 1. (Mayday Road to Bensham Lane) 73 30 District 2. (George Street to "Davis Theatre." and Crown Hill) 143 98 District 3. ("Swan and Sugar Loaf" to "Red Deer") 86 27 District 4. (High Street, South Norwood and Portland Road) 82 41 District 5. (North End, Croydon, from Tamworth Road to Kennards, North End) (no record 48 in 1944) and districts adjacent to these spots. 35 From these figures it will be noticed that there is an all-round improvement in these black-spots. Two other black-spots, however, seem to be developing, that shown as District 5 above, and a new area which is being watched in the current year, i.e., around Thornton Heath Pond. In addition, the weekly toll of accidents is now being recorded by means of a graph at the Headquarters Station, and this should prove very useful in providing information for the Safety First Committee. I am again able to record that we have received numerous letters of appreciation and thanks from those who have had occasion to use the ambulance service, and have had not a single complaint from the public. I would like once more to express my thanks to the officers and staff for their ready co-operation, which has enabled an efficient ambulance service to be maintained in the Borough. Repairs and maintenance work are now carried out by the Senior Mechanic, Mr. Innes, and his staff, and thanks are due to them for the efficient way in which they have carried out their work. Before concluding, may I express my sincere thanks to the Members of the Ambulance Committee and to the Medical Officer of Health, for their help, encouragement and advice, which has been of great assistance to me in the performance of the duties of Chief Ambulance Officer. A. L. HILL, Chief Officer. FINANCIAL STATEMENT. Income from Private Use of Ambulances. Accounts totalling £480 5s. Gd. have been rendered during the year for the private use of ambulances for conveying sick persons to Hospitals, Nursing Homes, etc. Transport of Patients, etc. Accounts totalling £339 9s. 9d. have been rendered to the Public Health Department for patients conveyed on their behalf. 36 Transport of Patients for Public Assistance Committee. Patients conveyed for Public Assistance Committee totalled £80 16s. 0d., and accounts to this amount have been rendered. During the year cash to the value of £404 14s. 9d. (representing private removal money collected from patients at time of removal, and credit accounts paid to Headquarters Station) have been paid into the Borough Treasurer's Department at Barclay Road. ANALYSIS OF ACCIDENTS FOR YEAR ENDED 31st DECEMBER, 1945. 1944 1945 Collision between Vehicles, Cycles, &c. 65 56 PEDESTRIANS KNOCKED DOWN BY— (1) Motor Cycle 11 12 (2) Motor Lorry 46 55 (3) Pedal Cycle 32 29 (4) Public Service Vehicle 16 27 (5) Motor Car 30 78 (6) Horse drawn vehicles 5 4 140 205 INJURIES SUSTAINED BY FALLING— (1) In the Street 118 165 (2) In the Home 84 84 (3) From Vehicles, Cycles, &c. 96 95 (4) Down Stairs 29 38 (5) From Trees, Scaffolding, &c. 12 18 (6) From Horses 1 1 340 401 WORKS ACCIDENTS— (1) Caught in Machinery 32 13 (2) Crushed by heavy objects 32 23 (3) Miscellaneous accidents at work 141 110 205 146 ACCIDENTS IN PUBLIC PLACES— (1) Theatres 4 5 (2) Cinemas 6 3 (3) Public Halls 3 5 (4) Railway Stations 27 31 (5) Sports Grounds 23 45 (6) Public Conveniences 3 3 (7) Immersion in Water 2 2 67 94 37  1944 1945 ACCIDENTS— (1) Dog Bites 1 4 (2) Miscellaneous 46 121 47 125 DEATHS— (1) Certified at Hospital 51 41 (2) Certified at scene of accident or illness 14 5 66 46 SUICIDES— (1) Hanging 4 1 (2) Poison — — (3) Cut Throat — — (4) Coal Gas Poisoning 2 4 (5) Drowned in Bath — 1 6 6 ATTEMPTED SUICIDE— (1) Hanging — — (2) Poison 7 10 (3) Cut Throat 3 2 (4) Coal Gas Poisoning 6 5 (5) Injury by Chopper 1 — (6) Cutting Wrists — 2 16 19 MURDER — 1 BURNS AND SCALDS 36 50 PERSONS FALLING FROM PUBLIC SERVICE VEHICLES 48 41 COMMON ASSAULT 29 32 ACCIDENTS TO CHILDREN UNDER 16 YEARS OF AGE— (1) Schools 88 59 (2) In the Home 73 88 (3) In the Streets 130 289 ' 231 436 38 STATISTICS. During the year 6,399 calls were dealt with by the Ambulance Service as follows:— 1944. 1945. Accidents in Street, Places of Employment, Public Places 1027 1135 Accidents in Private Houses 227 266 Sudden Illness in Street, Places of Employment, Public Places 569 552 Sudden Illness in Private Houses 98 138 Calls to incidents due to enemy action 76 — Transport of Cases from Hospital after treatment 661 965 Private Removals from Hospitals, Nursing Homes, Private Residences, etc. 1126 1608 Public Health Department—Transport of Patients 697 1407 Public Assistance Committee—Transport of Patients 166 194 Service of Ambulance not required or refused 90 134 Totals 4736 6399 INCIDENCE OF CALLS. 3 days 5 calls 25 days 16 calls 7 days 27 calls 3 „ 6 „ 26 „ 17 „ 7 „ 28 „ 4 „ 7 „ 15 „ 18 „ 4 „ 29 „ 10 „ 8 „ 31 „ 19 „ 1 „ 30 „ 14 „ 9 „ 15 „ 20 „ 4 „ 31 „ 12 „ 10 „ 15 „ 21 „ 7 „ 32 „ 19 „ 11 „ 10 „ 22 „ 2 „ 33 „ 20 „ 12 „ 18 „ 23 „ 2 „ 34 „ 26 „ 13 „ 10 „ 24 „ 1 „ 35 „ 18 „ 14 „ 6 „ 25 „ 1 „ 36 „ 22 „ 15 „ 5 „ 26 „ 1 „ 43 „ 1 „ 46 „ HOURS AT WHICH CALLS WERE RECEIVED. 12 midnight to 1 a.m. 153 12 noon to 1 p.m. 468 1 a.m. to 2 a.m. 100 1 p.m. to 2 p.m. 345 2 a.m. to 3 a.m. 113 2 p.m. to 3 p.m. 489 3 a.m. to 4 a.m. 83 3 p.m. to 4 p.m. 490 4 a.m. to 5 a.m. 95 4 p.m. to 5 p.m. 431 5 a.m. to 6 a.m. 84 5 p.m. to 6 p.m. 363 6 a.m. to 7 a.m. 80 6 p.m. to 7 p.m. 315 7 a.m. to 8 a.m. 86 7 p.m. to 8 p.m. 242 8 a.m. to 9 a.m. 197 8 p.m. to 9 p.m. 242 9 a.m. to 10 a.m. 322 9 p.m. to 10 p.m. 219 10 a.m. to 11 a.m. 496 10 p.m. to 11 p.m. 259 11 a.m. to 12 noon 524 11 p.m. to 12 midnight 203 2,333 4,066 Total: 6,399. 30 COMPARATIVE TABLE OF AMBULANCE CALLS, MILEAGE AND INCOME. Mileages Ambulance Calls Income Year Average per call Total Public Private Deptl. Total Private Deptl. £ s d. £ s d. 1940 4.8 17039 2660 532 394 3586 189 17 6 114 3 9 1941 5.03 17507 2448 573 459 3480 198 5 9 122 7 3 1942 5.56 23418 2690 992 526 4208 418 12 3 148 2 3 1943 5.95 28643 2926 1162 718 4806 505 9 6 258 3 9 1944 6.00 28481 2748 1126 862 4736 535 13 9 283 11 6 1945 6.88 44014 3190 1608 1601 6399 480 5 6 339 9 9 HOW CALLS WERE RECEIVED. Police Fire Station Ambulance Call Boxes Public Total 471 125 133 5670 6399 The arrangements for mutual assistance with the following authorities for the use of ambulances to convey persons injured in accidents, etc., to home addresses after treatment at hospitals, continue to operate satisfactorily. The authorities concerned are as follows:— Authority. Geographical Position in relation to Croydon. No. of Cases conveyed from area concerned to Croydon. Borough of Beckenham East of Borough Boundary 4 Borough of Carshalton, Beddington and Wallington. West „ „ 1 Borough of Mitcham North-West 4 Coulsdon and Purley South „ „ 13 U.D.C. London County Council North „ „ 11 Sutton and Cheam Borough West 1 40 In addition, accident and other urgent calls were accepted from other boroughs as follows:— Mitcham Ambulance Service 1 Penge and Beckenham Service 2 Beddington and Wallington Service 3 6 SERVICES RENDERED BY STAFF AT ACCIDENTS. On 1,168 occasions First Aid was rendered to injured persons prior to their removal to hospital. On 52 occasions Oxygen and Carbon Dioxide were administered to patients by means of the "Novox Resuscitating Apparatus." On 6 occasions persons were certified dead at scene of accident or illness. On 38 occasions injured persons were conveyed to hospital, but were certified dead on arrival. During the year the Service were called upon to deal with 6 cases of suicide and 19 cases of attempted suicide. The calls during the year were dealt with as follows:— Headquarters Station 4,765 No. 2 Station, Thornton Heath 1,634 6,399 41 STREET ACCIDENTS TO CHILDREN UNDER 16 YEARS OF AGE. From 1st January to 31st December, 1945. Hours Sun. Mon. Tues. Wed. Thurs. Fri. Sat. Total a.m. 12- 1 — — — — — — — — 1- 2 — — — — — — — — 2- 3 — — — — — — — — 3- 4 — — — — — — — — 4- 5 — — — — — — — — 5- 6 — — — — — — , — — 6-7 — — — — — — — — 7- 8 — — — — — 1 1 8- 9 — 1 1 3 — 2 2 9 9-10 — 2 1 2 1 — — 6 47 10-11 2 1 1 — 5 2 3 14 11-12 1 2 5 1 2 5 11 27 p.m. 12- 1 4 4 3 3 4 3 6 27 1- 2 1 1 3 1 5 3 3 17 2- 3 — 3 2 1 4 — 2 121 72 3- 4 4 3 4 6 2 6 3 28 4- 5 2 8 4 1 4 6 7 32 5- 6 8 3 5 4 2 11 2 35 87 6- 7 2 6 8 3 4 7 30 7- 8 1 6 4 3 4 3 1 22 8- 9 3 4 2 2 3 2 2 18 9-10 1 1 1 1 — 3 1 8 10-11 — — — 1 — 1 — 2 11—12 — — — — — — 1 1 Total 29 45 44 32 40 54 45 289 42 Table I. INFECTIOUS DISEASES NOTIFIED DURING YEAR 1945. 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 1945. At all Ages. At ages—years. Upper Norwood. Norbury. West Thornton. Bensham Manor. Thornton Heath. South Norwood. Woodside. East. Addiscombe. Whitehorse Manor. Broad Green. Central. Waddon. South. Addington. Under 1 year. 1—4. 5—14. 15—24. 25—44. 45—64. 65 and up. M F Scarlet Fever 403 4 107 236 30 22 4 — 11 19 26 6 28 21 29 32 50 20 27 17 40 11 66 — — 187 216 Diphtheria 29 — 8 13 2 5 1 — 5 — 1 1 1 3 3 2 2 3 4 — 1 — 3 — 2 14 15 Erysipelas 34 — — 4 1 9 16 4 1 — 2 3 — 4 3 1 4 6 5 — 2 3 — — — 16 18 Cerebro-Spinal Meningitis 8 2 2 3 — 1 — — — — 1 1 — — 1 — — 1 1 1 2 — — — 3 3 5 Enteric & Paratyphoid 1 — — — — — — — — — — — 1 — — — — — — — — — — — — 1 — Small Pox — — — — — — — — — — — — — — — — — — — — — — — — — — — Cholera — — — — — — — — — — — — — — — — — — — — — — — — — — — Typhus — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Pyrexia 57 — — — 26 31 — — 1 2 33 — 1 — 3 — — 3 5 3 1 5 — — — — 57 Ophthalmia Neonatorum 11 11 — — — — — — — 1 2 1 1 — — — — 2 3 — 1 — — — — 4 7 Poliomyelitis and Polio-encephalitis 6 1 2 1 1 1 — — — 1 — — 1 — — — 2 — — — 1 1 — — 1 2 4 Dysentery 50 5 18 14 5 6 2 — 1 7 17 1 2 2 — 4 2 — 1 1 3 4 5 — 1 26 24 Malaria 2 — — — — 2 — — — — 1 — — — — 1 — — — — — — — — 1 2 — Acute Primary and Acute Influenzal Pneumonia 48 2 2 4 — 17 18 5 2 — 2 3 — 1 5 5 5 7 5 7 4 1 1 — 4 27 21 Measles 2245 99 996 1062 51 32 5 — 109 77 181 158 165 180 255 169 222 155 140 65 151 121 97 — 6 1135 1110 Whooping Cough 368 50 215 98 1 3 1 — 18 7 17 29 46 24 50 23 26 27 32 10 33 20 1 — 3 188 180 Totals 3262 174 1350 1435 117 129 48 9 148 114 283 203 246 235 349 237 313 124 223 104 244 166 173 — 21 1605 1657 43 Comments on the Incidence and Prevalence of Infectious Disease. Scarlet Fever cases showed an increase on 1944. The incidence rate of Diphtheria was 0.14, compared with 0.11 in 1944. No cases of Small Pox occurred during the year. There were 57 cases of Puerperal Pyrexia; 26 occurred in the age-group 15—24 years and 31 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 1945. 798 patients were admitted and discharged which, together with patients in at the commencement of 1945 (56), gives a total of 854 dealt with. Twenty-one died, giving a case mortality for the hospital of 2.5 per cent, as against 1.3 per cent, in 1944. Penge Urban District Council have an arrangement with the Corporation to send their cases to the Hospital. During the year 38 cases were admitted and these are included in the tables. One operation for tonsils and adenoids was performed. The work of repair of the wards damaged by the flying bomb which fell in August, 1944, has been completed. During the year two probationers passed the Preliminary State Examination and one nurse passed the Final State Examination. 44 Complaint for which admitted. Patients remaining in Hospital on 1st January, 1945 Patients admitted and discharged in 1945 Patients admitted during 1945 and remaining in Hospital on 1st January, 1946 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 21 21 — 351 351 — 38 38 — 389 389 — — 28 Diphtheria 6 6 — 82 78 4 10 10 — 92 88 4 4.4 29 Enteric Fever 1 1 — 2 2 — — — — 2 2 — — 45 C.S.M. — — — 14 11 3 1 1 — 15 12 3 20.0 14.5 Dysentry — — — 44 41 3 — — — 44 41 3 6.8 10 Puerperal Pyrexia 1 1 — 9 9 — — — — 9 9 — — 10 Erysipelas — — — 15 15 — 1 1 — 16 16 — — 10 Measles 4 4 — 107 102 5 — — — 107 102 5 4.7 14 Rubella — — — 8 8 — — — — 8 8 — — 8.5 Whooping Cough 2 2 — 22 20 2 — — — 22 20 2 9.1 27 Chicken Pox — — — 8 8 — 2 2 — 10 10 — — 20 Mumps — — — 11 11 — — — — 11 11 — — 11 Encephalitis — — — 1 1 — — — — 1 1 — — 5 Tonsilitis — — — 2 2 — — — — 2 2 — — 10 Vincents Angina — — — 1 1 — — — — 1 1 — — 10 Croup — — — 3 3 — — — — 3 3 — — 18 Dermatitis — — — 1 — 1 1 1 — 2 1 — 50.0 10 Meningitis — — — 2 2 — 1 1 — 3 3 — — 18 Gastro Enteritis — — — 23 20 3 1 1 — 24 21 3 12.5 16 Broncho-Pneumonia — — — 5 5 — — — — 5 5 — — 16 Venereal Disease — — —— 6 6 — — — — 6 6 — — 12 Poliomyelitis , — — — 4 4 — 1 1 — 5 5 — — 29 Ophthalmia — — — 2 2 — — — — 2 2 — — 7 No Disease 1 1 — 19 19 — — — — 19 19 — — — Totals 36 36 — 742 721 21 56 56 — 798 777 21 — — 45 SCARLET FEVER. The total number of Scarlet Fever cases admitted aunrig me year was 389, an increase of 45 on 1944. The type of disease was of moderate severity. Of the 389 cases 3 were not cases of scarlet fever, leaving a total of 386 cases of true Scarlet Fever. The following complications and sequelae occurred amongst the true Scarlet Fever cases:— Serum Cases. NonSerum Cases. Total. Rhinorrhoea 1 6 7 Otorrhoea 4 6 10 Adenitis 5 5 10 Relapse — 5 5 Rheumatism 1 2 3 Abscesses 1 1 2 Secondary sore throat — 1 1 Albuminuria — 1 1 The average stay in hospital for serum cases was 28 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 25 and amongst the serum 12. Both M.B. 693 and M.B. 760 proved useful, particularly in clearing up the otorrhoea due to streptococci and staphylococci, respectivel v. 46 Ages and Sexes Admitted. Scarlet Fever. Age. Male. Female. Totals. 0—1 1 3 4 1—2 7 7 14 2—3 18 15 33 3—4 13 22 35 4—5 21 22 43 5—10 83 91 174 10—15 16 19 35 15—20 9 7 16 20—30 5 13 18 30 or over 5 12 17 Total 1945 178 211 389 Total 1944 63 181 344 DIPHTHERIA. 92 cases were treated with a diagnosis of diphtheria, an increase of 48 on 1944. Of these 14 were found not to be cases of diphtheria and 17 were cases of positive swabs without clinical symptoms, leaving 61 cases of true diphtheria. There were 4 deaths amongst them, one occurring in a ease which had not been immunized. There were two laryngeal cases and one nasal diphtheria, the rest being cases of the faucial type. The following complications and sequelae occurred amongst the diphtheria cases:— Rhinorrhoea 1 Paralysis: Palatal 3 Eyes 1 Cardiac failure 3 Adenitis 3 Secondary sore throat 2 Albuminuria 2 The 14 cases found not to be diphtheria were as follows:— Tonsillitis 10 Vincent's angina 3 Scarlet fever 1 Diphtheria. Age. Males. Females. Totals. 0—1 2 1 3 1—2 4 _ 4 2—3 1 2 3 3—4 1 4 5 4—-5 2 2 4 5—10 13 18 31 10—15 8 4 12 15—20 2 4 6 20—30 6 10 16 30 <£ over 1 7 8 Total 1945 40 52 92 Total 1944 20 24 44 47 Ages and Sexes Admitted. Typhoid Fever. Only two cases were admitted during the year as cases of typhoid fever and in only one was the diagnosis confirmed, the other being a case of gastric influenza. Puerperal Fever and Pyrexia. There were 9 cases of puerperal pyrexia admitted and of these the diagnosis was in 2 cases influenza. Erysipelas. There were 16 cases of erysipelas, but in three the diagnosis was not confirmed, one being a case of carbuncle of neck, one a case of eczema, and one a case of influenza. Measles. There were 107 cases admitted as measles, an increase of 75 on 1944. The disease was of average severity and 4 deaths occurred, two deaths being due to broncho-pneumonia, one to being complicated by encephalitis, and one complicated by laryngeal diphtheria. In 5 cases the diagnosis was not confirmed, including 2 cases in which the diagnosis was acute gastro-enteritis and bronchitis respectively. Whooping Cough. Twenty-two cases were admitted, a decrease of 9 cases on 1944. Two deaths occurred amongst them, both being complicated by broncho-pneumonia. In one case the diagnosis was not confirmed. 48 Cerebro-Spinal Meningitis. Fifteen cases were admitted, but in 5 the diagnosis was not confirmed, and in 3 others the diagnosis was One was a case of meningism, One was a case of acute poliomyelitis, One was a case of enteritis. The combined treatment by lumbar puncture, meningococcus anti-toxin 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. Two deaths occurred amongst the cerebro-sginal fever cases. Rubella. Eight cases were admitted, a decrease of 27 on 1944. One case admitted as rubella was really a case of scarlet fever. Dysentery. There were 44 cases admitted as dysentery, but in one the diagnosis was not confirmed. This showed an increase of 31 cases on 1944. Three deaths occurred amongst them. The type of dysentery was due to Sonne bacillus. Acute Gastro-Enteritis. Twenty-four cases of gastro-enteritis were admitted, an increase of 20 cases on 1944. There were four deaths amongst them. Croup. There were three cases admitted, two of them being cases of laryngeal diphtheria and one of simple croup. Mumps. Eleven cases were admitted, but in two the diagnosis was not confirmed. One was a case of simple adenitis. Out of Borough Cases. Disease. Males. Females. Total. Deaths. Scarlet Fever 7 7 14 — Diphtheria 14 9 23 2 C.S.M. (?) 2 — 2 1 Total 23 16 39 3 49 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 - Poliomyelitis — — — — — — 1 1 1 1 — 1 — — — — 5 1 Puerperal Pyrexia — — — — — — — — — 5 — 4 — — — — 9 — Erysipelas — — — — — — 1 — — 1 2 1 1 3 2 5 16 — Measles 10 11 13 11 15 12 6 6 5 8 2 6 — — 1 1 107 4 Rubella — — — — — — 2 1 — 3 1 — — 1 — — 8 — C.S.M 1 2 — — 2 2 — 2 — 1 2 1 2 — - — 15 2 Whooping Cough 2 2 3 7 3 2 1 2 - - - - - - - - 22 2 Chicken Pox — — — 2 3 2 — — 2 — — 1 — — — — 10 — Mumps — — — — — — — — 3 3 2 2 1 — — — 11 — Dysentery 4 4 3 2 9 2 4 5 3 4 — 3 — — — 1 44 — Gastro-enteritis 8 7 2 2 2 3 - - - - - - - - - - 24 7 Tonsilitis — — — — 1 - - — 1 — — — — — — — 2 — Croup — — 1 — 1 1 — — — — — — — — — — 3 — Vincent's Angina — — — — — — — — — — — — — — — — 1 — Dermatitis (Pemphigus) 1 1 — — — — — — — — — — — — — — 2 1 Meningitis 1 — — — — — 2 — — — — — — — — — 3 — Broncho-pneumonia 1 1 — 1 1 — 1 — — — — — — — — — 5 — Venereal Disease — — — 1 — — — — — 3 — 2 — — — — 6 — Encephalitis — — — — — — — — — 1 — — — — — — 1 — Ophthalmia 1 1 — — — — — — — — — — — — — — 2 — No Disease — — — — — — — — — — — — — — — — 19 — Totals 29 29 22 26 .37 24 19 18 15 30 9 22 4 4 3 7 317 17 50 Croydon Borough Hospital Laboratory Report. SWABS EXAMINED FOR PRESENCE OF DIPHTHERIA BACILLI. Swabs taken during Convalescence. Swabs taken on Admission. Swabs. Examined. + + 95 59 2,085 2,239 F.ECES EXAMINED FOR ENTERIC AND DYSENTE GROUPS. Dysentery Groups. Enteric Group. Negatives. Total Examined. + + 12 Nil 103 115 11 Specimens Dysentery Sonne. 1 Specimen Dysentery Flexner isolated. DREYER'S AGGLUTINATION TEST FOR ENTERIC GROUP. — + Total examined. 2 — 2 MISCELLANEOUS EXAMINATIONS. 5 Swabs from Fingers : Staphylococcus Aureas grown. 6 Swabs from Skin : Staphylococcus Aureas grown. 13 Specimens Pus for examination : 3 contained Hemolytic Streptococcus Longus. 10 contained Staphylococcus Aureas. Culture from Toe Swab : Staphylococcus Aureas grown. 51 2 Swabs examined for Vincent's Angina, positive. 3 Eye Swabs cultured for organisms : Staphylococcus Aureas grown. 2 Ear Swabs cultured for organisms : Staphylococcus Aureas grown. 8 Vaginal Swabs cultured for organisms: 6 grew Staphylococcus Aureas, 2 Hsemolytic Streptococcus Longus. 6 Urethral Swabs cultured for organisms: 4 grew Staphylococcus Aureas, 1 Hasmolytic Streptococcus Longus, 1 Sterile. 1 Vaginal Swab : Gonococcus present. 1 Urehtral Swab : Gonococcus present. 8 Cerebro-Spinal Fluids examined for organisms : 5 Meningococcus present. 3 no organisms found. 2 Specimen Sputums examined for presence of T.B. bacilli : Both negative. 1 Anal Swab cultured for organisms: 13. Coli and Staphylococcus Aureas grown. CULTURE MEDIA. 200J doz. tubes Loeffler's Blood Serum. 4,000cc Agar Agar base. 3,000cc Peptone Water. l.OOOcc Litmus Milk. 52 BACTERIOLOGICAL EXAMINATIONS. I am indebted to the Borough Pathologist, Dr. H. \Y Southgate, for the figures given in the appended tables. At the Laboratory, Croydon General Hospital. For private practitioners Mayday Hos. For Borough Hospital For Chest Clinic For School Medical Other Instns. ofCorporation Other Institutions Total Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Swabs for Diphtheria 27 787 ... ... ... ... ... ... 36 526 ... ... 6 201 69 1514 Virulence tests for Diphtheria ... ... ... ... 5 ... ... ... ... ... ... ... ... 1 5 1 Sputum for Tub. Bac 41 347 ... ... ... ... 581 1108 ... ... ... ... 12 124 634 1579 Pus for Tub. Bac ... 2 ... 7 ... 1 ... ... ... ... 2 29 ... 13 2 52 Pus for Gonococci 1 7 ... ... ... 2 ... ... 1 2 7 66 ... ... 9 77 Pus for other organisms ... 12 ... 7 ... 1 ... ... ... 2 ... 38 ... 12 ... 72 Blood for Typhoid Groups ... 2 ... ... ... ... ... ... ... ... 1 9 1 6 2 17 Blood for Wassermann 1 11 14 154 ... ... ... 1 ... ... 1 8 ... ... 16 174 Material for Spirochaetes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Faeces for Typhoid Group 3 Sonne 17 ... 2 ... 15 ... ... ... ... 2 1Sonne 38 ... 3 5 4 .Sonne 75 Hair for Ringworm ... ... ... ... ... ... ... ... 18 9 ... ... ... ... 18 9 Examination of Urine 2 5 1 ... ... 28 14 50 Examination of Pleural Fluid ... ... ... ... ... 3 ... 3 Examination of C.S. Fluid ... 20 ... ... ... ... ... 20 Other Examinations 320 464 20 ... 60 220 68 1152 53 Examinations for Special Clinic. Pos. Neg. Pus for Gonococci (Smears) GIG 2,477 (Cultures) 202 2,180 Blood for Wassermann 224 1,129 ,, ,, Kahn 26 67 „ ,, G.C.F.T 141 845 Material for Spirochaetes 8 14 Cerebro-spinal Fluids 45 Other Examinations 307 Examinations Done Under the National Health Insurance Act. Nature of Examination. Pus for Gonococci 7 (3 pos.) Pus for other organisms 8 Pus for Tub. Bac. 11 Blood for Wasserman 40 (2 pos.) Complete Blood Counts 20 Urine for Chemical Exam. 7 Urine for Microscopal Exam. 7 Urine for Tub. Bac. 7 Urine for Cultural Exam. 7 Other Examinations 8 Bacteriological Examination of Milk. Number of Samples submitted for Counts 349 Number under 10,000 per cc 136 Number over 10,000 but under 50,000 per cc 108 Over 50,000 but under 100,000 per cc 43 Over 100,000 but under 500,000 per cc 48 Over 500,000 but under 1,000,000 per cc 4 Over 1,000,000 per cc 10 Tubercle Bacilli— Number of samples of milk submitted 349 Number found positive by inoculation test 0 The number of milk examinations increased by 121 Number of samples still under investigation for T.B 0 349 milk samples submitted to the Methylene Blue Test, of which 46 failed to satisfy. 121 milk samples were also submitted to the Bacillus Coli Test and 84 were satisfactory. 54 Milk Samples. From 27th July, 1945, to December 31st, 1945, 119 samples were submitted to the Phosphatase Test, of which 4 failed to satisfy. IMMUNISATION AGAINST DIPHTHERIA. New cases came from the following sources:— School cases 281 Children under 5 years 2,096 The ensuing tables give some further details:— Total number of sessions held 81 Average attendance per session 32.8 Summary of Attendances and Treatment, Under Treatment 1.1.45 Total new Cases, 1945. 1945 Cases Completed Treatment. Received A.P.T. Under Treatment 31.12.45 Defaulted. 162 3174 2707 3336 272 357 Summary of Attendances and Treatment, 1945. Year. Total attended for treatment. New cases attended. No. of sessions held. No. given Primary Schick. % Pos. on Primary Schick. No. given Posterior Schick. No. Neg. on Posterior Schick. % Neg- on Posterior Schick. No.completed treatm't 1934 509 509 - 389 - 185 - - 185 1935 1431 1151 97 634 76 781 766 98.8 781 1936 2285 1661 145 1215 78 1264 1254 99.2 1264 1937 1894 1286 122 1017 86 1222 1215 99.5 1222 1938 2049 1541 115 1208 69 1152 1140 98.9 1152 1939 1488 1020 61 593 76 678 671 98.9 1201 1940 508 428 33 — — — — — 419 1941 6639 6639 206 — — — — — 5833 1942 6581 6133 144 — — — — — 5511 1943 6497 5200 179 — — 756 749 99.1 5854 1944 2652 2482 81 — — 244 233 95.5 1851 1945 3336 3174 81 — — 2007 1905 94.9 2707 55 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 1945 2S1 9.4 2698 90.6 Immunisation in Residential Schools and Homes. Owing to the evacuation of Residential Schools and Homes, no immunisation was conducted in the Institutions in 1945. Home Visits by Health Visitors. A total of 461 home visits was paid during the year. 56 VACCINATION ACTS. 1 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 1356 725 5 396 36 19 60 90 25 - West Sub-District. 1733 899 4 558 85 20 13 101 53 - North Sub-District 543 258 3 186 12 9 6 42 27 - 3632 1882 12 1140 133 48 79 233 105 - During the year 2,317 Forms Q were sent to parents, 368 Forms K and 125 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. 534 cases were transferred to this Borough from other districts. 1,094 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, 1945:— Name nf 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 sonic previous time. Under 1 year of age. 1 year and upwards. Total. Croydon No. 1 Area and part of No. 5 463 32 495 9 No. 2 Area and part of No. 5 409 33 442 2 No. 3 Area 136 4 140 2 No. 4 Area 123 3 126 2 Addington (New):— 56 2 58 — Queen's Road Homes — — — — Mayday Hospital 4 2 6 2 Children's Homes — — — — Shirley Residential Schools — — — — 1191 76 1267 17 57 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. 1936. 1937. 1938. 1939. 1940. 1941 1942 1943. 1944.  New male patients 300 395 416 316 187 448 661 239 232 390 New female patients 188 184 257 191 202 258 300 489 523 604 Attendances, male patients 7525 8610 7318 4258 2996 3033 3932 2214 2758 5498 Attendances, female patients 5226 5405 5365 3150 1772 1508 1585 4026 5940 8848 Attendances of Croydon patients at various London Hospitals under General Scheme. There were 121 new patients, who made a total of 1,030 attendances. Pathological Examinations at London Hospitals for Croydon Patients. 543 Examinations were made for various Clinics and 470 examinations of material submitted bv 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. — — 5 — 5 — 5 — 15 St. Thomas's — — 45 — 6S — 102 — 215 South Lon Hos. for Women — — 84 1 21 2 22 2 132 Royal Free — — 7 — 2 — 8 — 17 King's College 1 — 46 — 13 — — — 60 Whitechapel Clinic, L.C.C — — 2 — 3 — 8 — 13 University College — — — — — — — — — Guy's Hospital — — 27 134 28 165 28 164 546 Mothers — — 2 — 1 — 2 — 5 Seamen's - - - - - - - - - Westminster Hospital 1 — 2 — 2 1 3 1 10 Total 2 — 220 135 143 168 178 167 1013 38 Croydon Cases attending London Hospitals. Hospital. Cases seen for the first time. Conditions other than venereal. Total number of attendances. Aggregate number of Inpatient Days. Syph. Gon. Endell Street L.C.C - 1 4 22 - St. Thomas's 3 10 46 281 - -Guy's — 3 17 184 - King's College 1 3 13 353 1 Royal Free - 2 3 70 6 S. Lond. Hosp. for Women 1 1 5 93 - Wliitechapel Clinic, L.C.C. — 1 4 6 — Westminster — 1 1 19 — Mothers — — 1 2 — Scamens — — — — — Total 5 22 94 1030 7 59 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, 1945. 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 60 71 - - 32 40 8 14 100 125 225 Number of cases removed from the register daring any previous year which returned during the year under report for treatment or observation of the same infection 2 4 - - 1 2 - - 3 6 9 Number of cases dealt with for the first time daring the year under report (exclusive of ws under Item 4) suffering from :— Syphilis, primary (3)13 (2)7 - - - - - - 13 7 20 „ secondary (1)5 10 - - - - - - 5 10 15 „ latent in 1st year of infection (1)7 14 - - - - - - 7 14 21 „ all later stages 18 16 - - - - - - 18 16 34 „ congenital 9 8 - - - - - - 9 8 17 Soft Chancre — — - — — - — — — — — Gonorrhoea, 1st year of infection — — - — (14)121 (2)86 — — 121 86 207 „ later — — - - 3 — — 3 — 3 Non-venereal conditions - - - - - - (30) 214 (10) 457 214 457 671 Conditions remaining undiagnosed at 31st December - - - - - - - 6 - 6 6 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 (4)9 10 - - (9)17 (3)9 (6)10 (4)6 36 25 61 Totals of Items 1, 2, 3 and 4 123 140 - - 174 137 232 483 529 760 1289 Number of cases discharged after completion •[treatment and final tests of cure or after diagnosis as non-venereal 'Number of cases which ceased to attend before completion of treatment and were, on first attendance, suffering from:— 12 20 — - 83 78 218 447 305 515 820 Syphilis primary — 1 - - - - - - - 1 1 ” secondary 1 1 - - - - - - 1 1 2 ii latent in 1st year of infection . - - - - - - - - - - - ” all later stages - - - - - - - - - - - ” congenital - 1 - - - - - - - 1 1 Sift chancre — — — — — — — — — — Gonorrhoea, 1st year of infection — — — — — — — — — — — later — — — — — — — — — — — Number of cases under treatment or observation which died from other causes 2 — — — — — — — 2 — 2 Number of cases which ceased to attend after Completion of treatment but before final tests of cure — — — — 2 — — — 2 — 2 Number of cases tranferred to other Centres or to institutions of to care of private titioners 23 14 — — 26 13 4 2 53 29 82 Number of cases remaining under treatment or observation on 31st December 85 103 — — 63 46 10 34 166 213 379 Totals of Items 5, 6, 7, 8 and 9 These totals should agree with those of Items 1, 2, 3 and 4) 123 140 — — 174 137 232 483 529 760 1289 60  Syphilis Soft Chancre Gonorrhoea Nonvenereal or undiagnosed condition Totals M F M F M F M F M F Ttls 10. Number of attendances :— (a) for individual attention of the medical officer 2161 2906 - - 1440 2264 1143 2382 4744 7552 12296 (b) for intermediate treatment, e.g., irrigation, dressing 6 13 — — 480 586 268 697 754 1296 2050 Total Attendances 2167 2919 — — 1920 2850 1411 3079 5498 8848 14346 11. In-patients:— (a) Total number of persons admitted for treatment during the year 27 26 - - 28 29 - - 55 55 110 (b) Aggregate number of " in-patient days " of treatment given 104 145 — - 114 141 — - 218 286 504 12. Number of cases treated with penicillin 2 6 - - 59 73 — - 61 79 140 13. Number of cases of congenital syphilis in Item 3 above classified according to age periods 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 1 1 — — 2 2 6 7 9 10 14. Pathological Work :— Number of specimens from patients attending at the Treatment Centre sent for examination to an approved laboratory Microscopical Cultural for G'n'rh. Serum Cerebrospinal fluid Others It diagnosis Veners Diseas for Syphih for s G'n'rh. for Syphilis for G'n'rh. 26 1848 1209 1148 891 38 - 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 64 31 9 3 107 Soft Chancre — — — — - Gonorrhoea 121 61 19 9 210 Non-venereal and undiagnosed conditions 414 197 45 21 677 Total 599 289 73 33 994 B. Total number of attendances of all patients residing in each area 8792 4253 1032 269 143461 / 61 CANCER. Deaths from Cancer numbered 470 as compared with 420 in 1944; 456 in 1943; 405 in 1942; 377 in 1941; 443 in 1940; 414 in 1939; 380 in 1938; 421 in 1937; and 421 in 1936. Death-rate per 1,000 of the population for the previous 10 years are as folows:— 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) 1940—2.22 (443) 1945—2.34 (470) 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 3 — 3 84002 0.036 25 and under 35 years 1 1 29905 0.034 35 and under 45 years 10 9 19 32562 0.583 45 and under 65 years 92 109 201 39874 5.042 65 years and over 114 132 24!i 14437 17.039 220 250 470 200780 2.341 Sites of Fatal Cancer. Site. Male. Female. Total. Percentage of Total. Skin 2 1 3 0.638 Tongue and Mouth 9 1 10 2.127 Oesophagus 6 2 8 1.702 Stomach 39 37 76 16.170 Liver 1 5 6 1.277 Bowel 41 41 82 17.447 Rectum 25 19 44 9.362 Bladder 10 6 16 3.404 Prostate 10 — 10 2.127 Larynx 8 — 8 1.702 Uterus — 39 39 8.298 Breast - 46 46 9.787 Ovary — 14 14 2.979 Pancreas 9 11 20 4.255 Peritoneum 2 — 2 0.426 Oall Bladder and Duct 2 3 5 1.064 Mediastinum 1 — 1 0.213 Bones 3 — 3 0.638 Lungs 43 10 53 11.277 Kidney 1 3 4 0.850 Brain — 2 2 0.426 Maxillary Antruni 2 — 2 0.426 Spleen — 1 1 0.213 Retroperitoneal 1 — 1 0.213 Suprarenal 1 — 1 0.213 Thyroid Gland 2 4 6 1.277 Lymphatic Glands 1 2 3 0.638 Genital Organs — 2 2 0.426 Not defined 1 1 2 0.426 220 250 470 62 Comments on Foregoing Table. The organs most often attacked in descending order of incidence are : In the males—the Rowels and Rectum (30.0 per cent.), the Lungs (19.6 per cent), and the Stomach (17.7 per cent.); in females—the Bowels and Rectum (24.0 per cent.), the Breast (18.0 per cent.), the Uterus (15.6 per cent.), and the Stomach (14.8 per cent.) THE PREVENTION AND CONTROL OF TUBERCULOSIS. 1 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 1945, a comparison with 1915 is the best we can do. The outstanding facts are these : In 1915, 138 per 100,000 of the population in Croydon died from all forms of tuberculosis; in 1945 the corresponding figure was 46. Owing to fluctuations in population the following statistics cannot be correlated to those of previous war years. Notification of Tuberculosis. Two hundred and sixty-five cases of Pulmonary Tuberculosis and 43 cases of Non-pulmonary Tuberculosis were notified on Form A (primary notifications); of these 154 males and 111 females were pulmonary cases; 27 males and 16 females nonpulmonary. In addition, 49 pulmonary cases and 17 non-pulmonary came to our notice as new cases otherwise than by notification. The total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year 194o by notification or otherwise was 374, as compared with 315 in 1944, 383 in 1943, 323 in 1942, and 286 in 1941. 314 of these were cases of Pulmonary Tuberculosis, 179 in males and 135 in females. There were 28 more cases of Pulmonary Tuberculosis in males and 15 more in females than in 1944. There were 27 cases of Non-pulmonary Tuberculosis among children under 15 years as compared with 12 in 1944. The number of cases in adults was 33, compared with 32 in 1944. 68 Of the cases notified in 1945, 8 males and 5 females died from the Pulmonary form of the disease during the year, equal to 4.9 per cent, of those notified, and 4 males and 2 females from the Non-pulmonary form. The incidence rate of Tuberculosis of all forms was 1.86 per 1,000 of the population; for Pulmonary Tuberculosis 1.56, and for Non-pulmonary 0.30 per 1,000 population. The notification rate was 1.53 per 1,000. In 1944 the corresponding figures were 1.66, 1.43, 0.23, and 1.35 per 1,000. Public Health (Tuberculosis) Regulations, 1930. Summary of notifications during the period from 1st January, 1945, to 31st December, 1945:— FORMAL NOTIFICATIONS. Age Periods. No. of Primary Notifications of New Cases of Tuberculosis Total Notifications on Form A. 0—1 1—5 5—10 10—15 15—20 20—25 25—35 35—45 45—55 55—65 66 up. Total (all ages) Pulmonary- Males - 1 1 4 19 34 28 17 26 18 6 154 173 Females - 2 1 2 16 23 33 19 7 8 111 112 Non-Pulmonary— Males - 4 6 4 4 — 2 2 4 I — 27 27 Females - 1 4 2 3 — 4 — — 1 1 16 19 Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1945, to 31st December, 1945, 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 6 7 — 7 2 2 25 Females — — — 1 5 9 5 2 1 1 — 24 Non-pulmonary Males — — 1 — — 2 1 1 — — 1 6 Females 1 1 1 2 2 — 2 1 — 1 — 11 64 Notification Register. Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1945:— PULMONARY. NON-PULMONARY. Total Cases. Males. Females. Total. Males. Females. Total. 762 641 1403 134 158 292 1695 CLASSIFICATION OF NEW PATIENTS. Pulmonary Tuberculosis. During 1945, 223 of the new patients examined at the Clinic were found to be in the undermentioned stages of the disease on the first examination:— T.B. minus (sputum negative or absent) 116 or 52.0% T.B. plus 1 (early cases, sputum positive) 14 or 6.3% T.B. plus 2 (intermediate cases, sputum positive) 71 or 31.8% T.B. plus 3 (advanced cases, sputum positive) 22 or 9.9% 223 100.0% Ages at Death from Pulmonary Tuberculosis. Year. 0—5 5—15 15-25 25—45 45—65 Over 65. Total. 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 1945 — 1 17 28 23 6 75 In 1945 the death-rate from all forms of Tuberculosis was 0.46 per 1,000 population. The rate for Pulmonary Tuberculosis was 0.37 and the rate for Non-Pulmonary Tuberculosis 0.09. Similar figures for 1944 were 0.51 and 0.06. 65 Pulmonary Tuberculosis. In 1945 the total number of deaths decreased by 23.5 per cent. compared with 1944, and by 58.6 per cent, compared with 1938. There was only one death in children up to school leaving age (15 years). The majority of the deaths occurred in the age group 25—45 years. In spite of the fact that there were 23 fewer deaths in males than in 1944, there were still 50 per cent, more deaths in males than in females. In males the deaths are fairly evenly distributed over the age groups from 20 to 65 years. The number of female deaths was the same as in 1944. New cases show an increase of 18.5 per cent, in males and 12.5 per cent, in females, compared with 1944, that is a total increase of 15.8 per cent, over 1944, and of 16.3 per cent, over 1938. Non-Pulmonary Tuberculosis. The diagnoses of the new cases entered in the Notification Register during 1945 were as follows:— Male. Female. Mastoid 1 - Elbows 1 — Spine 2 — Sacro-iliac joint 1 — Hip 2 2 Knee — 1 Abdomen 2 3 Genito urinary tract 4 3 Meninges 3 1 Glands 11 6 Totals 27 16 Deaths from Non-Pulmonary Tuberculosis. During 1945, 18 deaths were certified to be due to Pulmonary Tuberculosis, compared with 11 in 1944, 16 in 1943, IT in 1942, 19 in 1941, 21 in 1940, and 12 in 1939. The deaths were due to:— Males. Females. Total. Tuberculous Meningitis 4 5 9 Tuberculous Kidney 1 1 2 Tuberculous Peritonitis 1 — 1 Miliary Tuberculosis 2 2 4 Tuberculosis of Hip 1 — 1 „ „ Spine 1 — 1 Totals 10 8 18 > 66 Co-ordination with Medical Practitioners, and Other Branches of the Health Department. During the year 496 cases of suspected Tuberculosis were referred by private medical practitioners; 65 were diagnosed as suffering from Tuberculosis and were subsequently notified. In addition, 59 children were referred by the School Medical Service, and 50 cases from the Maternity and Child Welfare section of the Public Health Department. 80.0 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 87.5 per cent, in 1944. 20 per cent, of the notified cases were referred from the Fighting Services through the Ministry of Health. The number of reports sent in by Insurance medical practitioners on their domiciliary cases (Form G.P.36) was 216. Examination of Sputum. The results of examinations made in 1945 are as follows:— For Clinic. For General Practitioners. Totals. Positive (i.e., tubercle bacilli present) 372 45 417 Negative (i.e., tubercle bacilli absent) 928 380 1308 Totals 1300 425 1725 For each 100 new cases and contacts examined at the Clinic, 116 specimens of sputum were examined. X-Ray Work. 1,434 X-Ray examinations were made during the year. This is equivalent to 128 for every 100 new cases and contacts seen, and compares with a rate of 137 in 1944. In addition, a certain number of cases who have already been examined at various hospitals are referred to the Clinic. The X-Rav examinations were carried out at Mayday Hospital. Blood Examinations. Blood sedimentation rate was ascertained in 272 cases at Mayday Hospital for the Chest Clinic during the year. Extra Nourishment. Provision of special nourishment in the form of milk was granted to 37 selected cases for varying periods during the year, and 14 cases were in receipt of extra nourishment at the end of the year. 67 Residential Treatment for Pulmonary Tuberculosis. Summary of Patients who received Institutional Treatment during 1945. Institution. In Institutions on 1.1.45. Admitted During 1945. Discharged During 1945. Died During 1945. Remaining in on 31.12.45. Adults. Adults. Adults. Adults. Adults. M F Ch. M F Ch. M F Ch. M F Ch. M F Ch. Croydon Borough Sanatorium 39 38 - 71 45 - 69 53 - 2 5 - 39 25 - Broinpton Hospital and Sanatorium 2 3 - 1 10 — 1 8 - — 1 — 2 4 — Children's Sanatorium, Harpenden — — 3 — — 1 — — 1 — — — — — 3 Croydon General Hospital — - - 1 1 — 1 1 - - — — — — — London Chest Hospital - - — 1 - - 1 - - - - - - - - Horton Hospital (Chest Unit) — — — 5 5 — 5 5 - - — — — — — King George's Sanatorium 1 — - - - - 1 - - - - - - - - Grosvenor Sanatorium 1 6 - 1 9 — 1 14 - - — — 1 1 — Langdon Hills Sanatorium - - 1 - - - - - - - - - - - 1 Preston Hall Sanatorium - - - 1 - - - - - - - - 1 - - National Sanatorium, Benenden 1 - - - - - 1 - - - - - - - - Royal National Sanatorium — 4 — 2 5 — 2 4 - - — — — 5 — Pe.nbury Hospital - - - 1 - - 1 - - - - - - - - St. Michael's Home — 1 - - - - - 1 - - - - - - - King Edward VII W.N.M.A. Hospital - 1 - - - - - 1 - - - - - - - Holy Cross Sanatorium — 1 - - - - - 1 - - - - - - - Maydav Hospital 12 11 1 59 61 8 38 44 7 17 11 1 16 17 1 Fairlight Sanatorium 1 - - - - - 1 - - - - - - - - Radcliffe infirmary - - - - 1 - - 1 - - - - - - - Papworth 1 1 - - - - - - - - - - 1 1 — R.N.H.C., Ventnor 1 — — 2 — — 2 — -— — — — 1 — -— Sheffield Sanatorium 1 - - - - - - - - 1 - - - - - Scottish K.M.S. Hospital 1 - - - - - - - - 1 - - - - - King's College Hospital - - - 1 - - 1 - - - - - - - - Nayland Sanatorium - - - - 2 - - - - - - - - 2 - 61 66 5 146 139 9 125 133 8 21 17 1 61 55 5 68 Residential Treatment for Non-Pulmonary Tuberculosis. Summary of Patients who have received Institutional Treatment during 1945. Institution. In Institutions, on 1.1.45. Admitted During 1945. Discharged During 1945. Died During 1945. Remaining in on 31.12.45. Adults. Adults. Adults. Adults. Adults. M. F Ch. M F Ch. M F Ch. M F Ch. M F Ch. Heritage Craft School — — 3 — — 1 — — 1 — — — — 3 St. Nicholas' & St. Martins Hosp. Pyrford — — — — — — — — — — — — — — 1 Roy. Nat. Orthopaedic Hosp 1 — — 1 — — 1 — — 1 — — — — — Lord Mayor Treloar Cripples Hosp. — — — — — — — — — — — — — — 1 Nayland Sanatorium — 1 — — — — — 1 — — — — — — — Queen Mary's Hospital — — 1 — — — — — — — — — — — 1 London Hospital — — — — — 1 — — 1 — — — — — — St. Peter's Memorial Home — — — — 1 — — 1 — — — — — — — Croydon General Hospital — — — 3 3 1 2 3 — — — — 1 — 1 Redhill County Hospital 1 — — — — — 1 — — — — — — — — Mayday Hospital — — — 3 1 3 2 1 3 — — — 1 — — Victoria Home for Inv. Children — — 3 — — 4 — — 4 — — — — — 3 St. Anthony's Hospital — — — — — 1 — — — — — — — — 3 l 10 7 5 11 7 6 11 l — — 2 — 10 69 Residential Treatment. 217 males, 211 females and 35 children were treated in Residential Institutions in connection with the Croydon Tuberculosis Scheme during 1945. Owing to the difficulty of obtaining nursing and domestic staff and other factors connected with the War, the number of patients treated in the Croydon Borough. Sanatorium during the year was considerably reduced. At the end of the year there were only 64 beds occupied, compared with 77 at the end of 1944 and the normal 94 beds in peace time. The immediate results of treatment of patients discharged from residential institutions during the year are as follows:— Pulmonary Tuberculosis. In Class T.B. Minus, 18 males, 18 females and 2 children were discharged with the disease in a quiescent condition, i.e., 70.4 per cent, of the total cases in this class. Five males and 9 females were nut in a quiescent condition, 26.0 per cent.; 1 male and 1 female died, 3.0 per cent. In Class T.B. Plus, the correspondng figures were 21 males, 14 females, and 1 child quiescent; 35.3 per cent.; 31 males and 28 females, not quiescent, 57.8 per cent.; 2 males and 5 females died, 6.9 per cent. Taking the groups together, 47.4 per cent, of cases were discharged as quiescent; 46.8 per cent, as not quiescent; and 5.8 per cent. died. Non-Pulmonary Tuberculosis. 14 patients were discharged during the year, and 64.2 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. 962 new cases were examined during the year. This is equal to 1,034 for each 100 deaths from the disease. 243 or 261 for each 100 deaths were found to be definitely tuberculous. 70 The total number of attendances at the Clinic was 5,868. The Tuberculosis Officer paid 80 home visits and the District Health Visitors 1,853 visits for Clinic purposes. In addition, the Health Visitors made 329 primary visits for the purpose of the Notification Register. The Tuberculosis Officer paid 72 vists to Mayday Hospital, in a consultative capacity, and there examined 336 patients. Patients requiring home nursing or surgical dressings are attended to by the nurses from the Croydon Nursing Service, by arrangement with that organisation, and 620 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 153 contacts were examined, equal to 164 for each 100 deaths, compared with 1S1 in 1944, 267 in 1943, 238 in 1942, 227 in 1941, 278 in 1940, 325 in 1939, and 301 in 1938. Of these, 3 were considered to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 19.6 compared with 1.86 per 1,000 of the general population. 229 apointments for examination were offered to new contacts during 1945, but only 153 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 1,216. This is equivalent to 6.1 persons per 1,000 of the population. During the year 71 Clinic cases died. Of this number 12 or 16.9 per cent, were seen for the first time in 1945. Dental Treatment for Patients Referred from the Chest CI nic 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. After the treatment has been carried out the Clinic is thoroughly disinfected. 71 The majority of cases are referred by the Tuberculosis Officer, the remainder being patients discharged from the Borough Sanatorium at Cheam before treatment could be completed. Summary of Work Done. Males. Females. Total. 1945 1944 Referred from Chest Clinic 4 8 12 16 Treatment cases continued from Cheam. 0 8 14 19 Attendances 35 61 96 108 Extractions 15 38 53 37 Fillings 5 13 18 23 Dressings 1 2 3 5 Scaling 7 1 8 4 Denture Dressings 16 29 45 69 Dentures fitted 6 7 13 22 Repairs - 1 • 1 2 Number of Treatment Sessions: 19. SUMMARY OF CLINIC STATISTICS FOR 1945. Number of persons on Clinic Register, January 1st, 1945 1,082 ,, notified cases examined for the first time 33 ,, cases sent for an opinion 757 ,, first attendances, including 80 inward transfers 1,218 ,, consultations of T.O. with medical practitioners (a) Personal 4 (b) Other JJ04 ,, visits paid by T.O. to homes of patients 86 ,, visits paid by T.O. to Mayday Hospital 72 ,, patients examined by T.O. at Mayday Hospital 336 ,, visits paid to homes of patients by Health Visitors 2,182 „ visits paid to homes of patients by District Nurses for nursing attention 620 Attendances of patients at the Clinic— Men 2,626 Women 2,621 Children 621 Total 5,868 72 Number of Insured Patients under Domiciliary Treatment at the end of year— Pulmonary 328 Non-Pulmonary 12 Total 340 Number of reports received from Panel Practitioners (G.P.36) 216 ,, report forms sent to Panel Practitioners (G.P.36) 352 ,, reports received from Panel Practitioners on Forms G.P.17 „ reports received from Panel Practitioners on Forms G.P.35 ,, X-Rays taken 1,434 ,, reports made to Ministry of Pensions by T.O. on general progress of t uberculous ex-Service 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) 24 ,, cases referred to Light Treatment 6 ,, cases referred to Orthopaedic Clinic 15 „ cases receiving extra nourishment at the end of year 14 „ cases referred by the Ministry of Labour and National Service Medical Board for examination and report 46 Tuberculosis Maintenance and Other Allowances. The Ministry of Health Tuberculosis Maintenance Allowances (as in Memorandum 266/1") to alleviate patients' financial distress caused by loss of income when undertaking treatment for Pulmonary Tuberculosis, continued to be administered during: 1945. (1) No. of patients in receipt of Ministry of Health Allowances as at 31-12-44 37—21 in Institutions 16 on Domiciliary treatment. (2) No. of new patients 98 (3) No. of patients no longer in receipt of Allowances 79 (4) No. of patients in receipt of Ministry of Health Allowances as at 31-12-45 56—18 in Institutions 38 on Domiciliary treatment. 73 The Council's extension of Maintenance Allowances scheme continued during 194u. These allowances are granted be 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 31-12-44 27— 3 in Institutions 24 on Domiciliary treatment. (2) No. of new patients 16 (3) No. of patients no longer in receipt of Allowances 17 (4) No. of patients in receipt of Council Allowances as at 31-12-45 26— 2 in Institutions 24 on Domiciliary treatment. CHEAM SANATORIUM. The Sanatorium is situated at North Cheam and normally lias accommodation for 93 adult patients of both sexes : men 53 Immediate Results of Treatment. Group. Total number of cases discharged 1945. 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 22 12 20 9 1 3 — — — 1 — 118 Class T.B. Plus- Group 1 5 5 4 3 1 1 — — — — — 1 159 Group 11 31 20 8 2 14 7 6 9 1 2 2 — 191 Group 111 6 5 — — 2 — 3 2 1 3 — — 281 Observation Non T.B. — 4 — — — — — — — — — — — 64 46 32 !4 18 11 9 11 2 5 3 1 — 74 ]In-patients on ist Jan., 1945 i Admitted during year 1945 Discharged during year including deaths In on 1st Jan. 1946. Died during year 1955 M F M F M F M F M F 39 38 74 45 75 58 38 25 2 5 Number of Patients January 1st, 1945 77 Admitted, 1945 119 Discharged, 1945 126 Died, 1945 7 Remaining January 1st, 1946 63 No. of X-Ray Screenings 2,602 No. of X-Ray Films taken 488 No. of Refills given 2,375 No. of Gas Replacements 19 No. of A.P. Cases commenced 28 No. of Sputum Tests 753 No. of Pneumoperitoneum Refills 99 Artificial Pneumothorax cases discharged but still under treatment: 11 males, 12 females (see above), making total discharges: males 75, females 58. These Artificial Pneumothorax cases only refer to cases discharged in 1945. Those discharged in 1944 and still having refills have not been included. There were 5 Observation cases sent in—1 male and 4 females. Of these 1 male was tubercular and of the females 4 were not tubercular. Therefore, there were 4 Observation cases in nontuberculars, which are shown above. The 1 that was tubercular is in with the Tubercular cases and is 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. 75 All available patients were inspected, but owing to a reduction in the overall accommodation at the Sanatorium fewer cases were actually dealt with than in 1944. Those returning to their homes in Croydon before being rendered dentally fit received appointments to attend Lodge Road Clinic at a later date for the necessary work to be completed. Review of Work Done. Males. Females. Total. 1945 1944 Number Examined 24 24 48 81 Referred Treatment 23 22 45 73 Treated 21 22 43 73 Attendances 82 100 182 226 Extractions 28 79 107 117 Fillings 22 35 57 70 Dressings 4 4 8 9 Scalings 6 11 17 34 Root Treatments ' 1 — Denture Dressings 24 17 41 30 Dentures Fitted 6 3 9 7 Repairs 4 2 6 3 Mandibular Injections 1 5 6 10 Number of Treatment Sessions: 23. MATERNITY AND CHILD WELFARE. Notification of Births. Live Births. Still Births. Total. Notifications were received from—- Midwives 3,235 69 3,304 Doctors, Parents and others 544 41 585 3,779 110 3,889 76 Maternal Mortality. There were 9 deaths, compared with 5 in 1944. The maternal mortality rate was 1.36 per 1,000 births, compared with 1.36 in 1944. The deaths were caused by— (1) Ruptured ectopic gestation. (2) Septicaemia : pyelitis of pregnancy. (3) Ponto-cerebellar hemorrhage due to chronic stitial nephritis accelerated by a normal pregnancy. (4) Spontaneous rupture of right tubal pregnancy. (5) Ruptured ectopic gestation. (6) Abortion : placenta praevia. (7) Incomplete abortion (spontaneous). (8) Abortion (induced). (9) Abortion—septicasma. 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 1,203 30.94 In Public Institutions 1,797 46.20 Registered Maternity Homes 889 22.86 3,889 Still Births. During 1945, 100 still births were registered in respect of Croydon. Of these'53 were male babies and 47 female; 7 males and 4 females were illegitimate. The proportion of still births to living children was as 1 to 36. The still birth rate was 2.7 per cent, of the total births. The still birth rate, on the same basis as for Infant Mortality, was 27.2 per 1,000 births. 77 Ophthalmia Neonatorum. Eleven cases were notified during 1945. The following table gives the notifications in Croydon during the past ten years :— 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 No of Cases 20 21 20 15 14 17 19 10 3 11 Rate per 1.000 Births 6.2 6.4 6.0 4.5 4.7 7.0 5.5 2.7 0.8 3.1 Results of Treatment. Notified. Cases treated. Vision Unimpaired. Vision Impaired Died. Removed Remaining under Treatment At home. In hospital 11 9 2 11 — — — Infant Mortality. The Infantile Mortality rate was 41 per 1,000 live births registered. For the past 5 years the number of infant deaths have been 1941—90, 1942—137, 1943—137, 1944—156, and 1945—145. 120 deaths of infants occurred in Institutions, including Registered Xu rsing Homes. Among the 145 deaths, 83 occurred in boy babies and 62 in girls. Of the births, 1,849 were males and 1,726 females. The " fantile mortalitv rate for the two sexes was, therefore, Boys— 45, Girls—36. 78 The rate of infant mortality amongst legitimate children was 41 per 1,000 births. The rate in illegitimate children was 47 per 1,000 births. 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. 1 Ist-2nd wk. 2nd-3rd wk. 3rd-4th wk. Under 1 ninth. i 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 38 5 5 2 1 2 — 8 11 3. 75 18 15 6 0 4 8 3 3 4 1 2 145 Chicken Pox — — — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — 1 — — — — 1 3 Scarlet Fever — — — —- — — — — — — — — — — — — — — — — — — — Whooping Cough — — — — — — — — — — — — — — — — — — — — 1 — 2 Diphtheria and Croup — — — — — — — — — — — — — — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — — — — — — — — — — — — — 1 Abdominal Tuberculosis — — — — — — — — — — — — — — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — — — — — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — — — — — 1 — — — — — — — — — — — 4 Convulsions — — — — — — — — — — — — — — — — — — — — — — — Laryngitis — — — — — — — — — — — — — — — — — — — — Bronchitis — — — — — — — — 1 — 1 1 — — — — — — — — — 1 3 Pneumonia (all forms) — — — — — — — 1 1 1 3 3 4 2 3 2 4 2 1 2 — — 20 Diarrhoea and Enteritis — — — — — — — — 2 — 2 2 7 3 1 1 2 — — — — — 10 Gastritis —. — — — — — 1 — — 1 — — — — — — — — — — — 1 Syphilis — — — — — — — — — — — 1 — — — — — — — — — 1 Rickets — — — — — — — — — — — — — —. — — — — — — — — — Congenital Malformations 6 2 — — — — 4 — — 12 3 1 1 1 — — — — 1 — 19 Premature Birth 21 2 3 2 1 1 — 1 5 2 38 4 — — — — — — — — — — 42 Atrophy, Atelectasis, Debility and Marasmus 7 1 — — — — — — — — 8 1 — — — — — — — — — — 9 Injury at Birth 2 — — — — — 1 — — 3 1 — — — — — — — — — — 4 Other Causes 2 — 1 — 1 — 2 — 6 1 2 — — 1 — — — 1 — — — Totals 38 5 5 2 1 l 2 8 11 3 75 |!8 15 6 6 4 8 3 3 4 1 2 145 79 The following table gives the cause of death during the first month of life :— (1) Complications of Labour— Trauma and Inattention at Birth 5 — 5 (2) Foetal States— Congenital Heart Malformation 4 Other Congenital Deformities 8 Atelectasis, etc. 8 Hemorrhagic Disease of Newborn 3 Acute oesophagitis 1 —24 (3) Prematurity 38 —38 (4) Post-Natal Causes 8 — 8 — 75 — Percentage Deaths per Total Infantile Deaths. Deaths per 1,000 Births. 1944 1945 1944 1945 Premature Births 32.1 29.0 14.0 11.7 Respiratory Diseases (Pneumonia and Bronchitis.) 17.3 20.0 7.5 8.1 Infectious Diseases (including Tuberculosis) 4.5 4.1 2.0 1.7 Atelectasis, Debility and Marasmus 9.6 6.2 4.2 2.5 (Diseases of Digestion 10.3 15.2 4.5 6.1 Injury at Birth and Congenital 15.4 15.9 6.7 6.4 *These deaths were due to Tuberculosis 1, Whooping Cough 2 and Measles 3. IThese deaths were due to Diarrhoea 19, Gastritis 1, Strangulated Inguinal Hernia 1 and Acute Oesophagitis 1. MIDWIFERY SERVICE. Midwives Acts, 1902 to 1936. Eighty-three midwives notified the Local Supervising Authority of their intention to practice within the Borough during 1945. Twenty-four ceased practising in the Borough; so that fifty-n ine remained on the Register at the end of the year. All these were trained and held the certificate of the Ontral Midlives Board, 80 The Rules of the Central Midwives Board lay down that the Local Supervising Authority must be informed within 3G hours by a midwife if she has summoned medical help during pregnancy; in n confinement or within 14 days afterwards. The following table gives details of the reasons for sending for medical aid : For Complications during Pregnancy. Abortion 3 Other causes 24 Albuminuria 3 —30 For Complications during Labour. Breech 6 Undiagnosed 3 -9 Delayed Labour Uterine Inertia 2 Prolonged 4 Delayed 17 Other 2 -25 Haemorrhage. Ante-Partum 1 Post-Partum 4 -5 Other Causes. Adherent and Retained Placenta 2 Torn Perineum 134 Illness of Mother 1 -137 For Complications during Puerperium. Pyrexia 22 Pain in Breasts ... 2 Pain in Legs 10 Other causes ... 4 38 For Complications in regard to the Baby. Inflammation of Eyes ... 39 Still Birth ... ... 1 Feebleness 3 Other causes ... 35 Premature Birth ... 6 84 328 Tn accordance with Rule 33 of the Central Midwives Board, the following reasons for the discontinuance of breast-feeding were received : — Illness of Mother 11 Insufficient Milk 117 Other Causes 37 Total 165 81 Inspection of Midwives. Dr. Jenkin Lloyd, the Inspector of Midwives, interviewed seven 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. 291 accounts were received from doctors for services rendered under the provisions of this Section. This compares with 248 in 1944, 329 in 1943, 373 in 1942, 245 in 1941, and 321 in 1941). The total amount of the accounts was £'392 9s. Gd. £306 19s. 5d. was ultimately recovered from the patients. In 1944 the amount paid to doctors was £385 10s. 0d., and in 1943 £671 Is. Od. Nursing Homes. Maternity Homes. Other Nursing Homes. Combined Maternity and other Nursing Homes. Total. No. of Homes on Register on 31/12/44 9 23 5 37 No. of Applications for Registration during 1945 1 2 O No. of Homes Registered during 1945 1 2 3 No. of Homes on Register on 31/12/45 9 23 6 38 No. of Beds available 90 296 (a) Mat. Beds 41 (b) Other Beds 70 497 WARTIME NURSERIES. Attendances at War-time Nurseries, 1945. Coldharbour House. Whitehorse Road. Mayday Road. Tennison Road. Morland Road. Bramley Hill. ' Ritchie Road. New Addington. Euston Road. Bensham Grove. 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 21/3/1945 Number on books at end of year 79 50 53 Closed 31/8/1945 58 54 52 58 48 48 Attendances: under 2 4676 4067 4839 2461 3761 4,80 3164 1420 2940 1774 over 2 13840 6889 6925 4403 7878 8354 6925 5363 7683 5681 Total 18516 10956 11704 6864 11639 13034 10039 6783 10623 7455 Number of days opened 300 300 302 198 302 300 299 299 299 232 Average daily attendance 62 37 39 35 39 43 34 23 36 32 82 83 MATERNITY AND CHILD WELFARE CONSULTATIONS. There are 18 Maternity and Child Welfare Centres, l6 of which are *conducted by the Croydon Mothers' and Infants' Welfare Association and 2 by the local authority. A total of 23 sessions per week are held and at these a doctor and one, or, if necessary, two health visitors, on the staff of the Health Department attend. During 1945, 3,056 new cases under 1 year of age and 823 over 1 year of age attended for the first time; the total of attendances of infants and young children from 0—5 years increased from 50,884 in 1944 to 65,707 in 1945. Consultations with doctors increased from 17,034 to 21,613. 49 expectant mothers were seen, an increase of 4 on 1944, and a total of 339 visits to the Centres was paid by them. The total of all visits to the Centres was 66,106, an increase of 9,013 compared with 1944. The highest average attendance of mothers and babies at each session was recorded at St. Stephen's (93.4), Norbury (81.5), Bensham Manor (78.9), Selhurst (75.6), South Croydon (75.5), Municipal (73.9). 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. Treatment for the above has progressed very satisfactorily. In spite of more patients than ever before being referred, extra sessions now available permit cases to be dealt with more rapidly than hitherto, and thus only a very small minority remained uninspected at the termination of the year. One verv concrete result of this "speeding up" of examination has been that elimination of sepsis can be carried out much earlier in the confinement than was the case a few vears ago, thus greatly enhancing the value of treatment. A very substantial proportion now begin their treatment between the third and fourth month, and, as recorded below, over 80 per cent, were seen during the first six months of pregnancy. 84 A welcome increase is again noted in the number of preschool children attending; reference to which will he found later in this report. Expectant Mothers. New cases examined during the year numbered 6.57 compared with 602 last year, and represented 92 per cent, of the total number of mothers seen for the first time. Of the above, 82 per cent, presented themselves during the first six months of pregnancy. The remaining 18 per cent, seen during a later stage included some who had either failed earlier appointments or "declined" dental treatment when this was previously advised in the Ante-Natal Clinic. Nursing Mothers. Owing to the greater number receiving their treatment antenataly, the proportion of mothers first inspected during the nursing period has declined considerably during recent years. New cases referred were 56 compared with 44 last year. Those seen during the first six months after their confinement constituted 70 per cent, of the total number referred, compared with 79 per cent, last year. The remainder with infants between seven and twelve months, referred in the majoritv of cases from Welfare Centres, received mostlv emergencv treatment. In addition to mothers attending for the first time, a large amount of treatment was also completed for those referred before their confinements in the previous vear. Treatment. Including those continuing treatment from the previous year, the total of expectant and nursing mothers treated was 812, compared with 776 in 1944. As before, a substantial amount of treatment has been of a conservative nature. 225 dentures were inserted, compared with 282 last year. Absenteeism among mothers in receipt of appointments for examination dropped from approximately 20 per cent, to 14.fi per cent, during the current year. While this result is encouraging, attempts to follow up such cases have been singularly unsuccessful. Though a small minority attend at a later date 85 when toothache 'intervenes, there is, apparently, still a substantial section who, while willing to avail themselves of medical attention, through ignorance or prejudice neglect to take advantage of existing dental facilities. The Pre-School Child. The total of children referred from Welfare Centres and other sources was .390, compared with 299 in 1944. The further rise indicated is heartening as the figure thus obtained now surpasses that of 1938. Treatment for the above children has, from one cause or another, suffered considerably during the war "years. It is hoped, however, that, given more normal conditions, substantial progress will now be possible. The following summary shows particulars of the work accomplished : — Expectant Mothers. Nursing Mothers. Total. Young Children. New Cases Examined 657 56 713 347 Re-treated 52 47 99 43 Total 709 103 812 300 Attendances 2634 104 2738 7 12 Fillings 781 12 793 418 Extractions 1896 35 1931 333 "Gas" Cases 324 7 331 125 Local Anaesthesia 460 11 471 144 Scalings and Gum Treatment 342 3 345 13 Dressings 570 19 589 33 Denture Dressings 1169 43 1212 — Silver Nitrate — — — 624 Treatments Completed 326 8 334 195 Number of Sessions (treatment) 485 Dentures Fitted Full 134 Partial 91 Total 225 Dentures repaired 10 86 The Centres at which patients were examined, or from which they were referred, are given in the following list: — Mothers. Young Children. Mothers. Young Children. Ante-Natal 637 — Bensham Manor 1 6 Post-Natal 1 — St. Andrew's 3 9 Municipal Midwives 274 — Waddon 1 11 Municipal 8 30 Shirley 1 9 East Croydon 9 18 Boston Road 2 13 l~pper Norwood 3 3 St. Stephen's 3 13 West Croydon 6 10 Holy Trinity 6 8 South Norwood 11 10 Addington 11 South Croydon 1 8 Wartime Nurseries — 07 St. Alban's 4 13 The Retreat 10 — Woodside 2 8 Referred by Dental St. Oswald's 4 17 Officers — 126 Mothers, 990. Young Children 390. Total: 1,380. The amount received for attendance fees was £69 13s. 0d., as against £62 13s. 0d. in 1944. PREMAOTRE BABIES. Arrangements have been made for premature infants born in hospitals or at home to be notified to the Medical Officer of Health each week to enable the Health Visitors to follow them up when they return home. (1) Number of premature babies notified during 1945 who were born— (i) at home 46 (ii) in hospital 130 (2) The number of those born at home— who were nursed entirely at home 40 who died during the first 24 hours 1 who survived at the end of one month 45 (3) The number of those born in hospital— who died during the first 24 hours 17 who survived at the end of one month 113 87 The Work of the Health Visitors.— Maternity and Child Welfare Only. Visits Rr:- Adalian IyCft 28-3-45 Andrews Com. 23-5-4f Ashe Bird Catlow Cross Devaney Early Ernest Hinton Hobdey Lewis left 30-11-4 Linton Com. 3-4-4") Mace Com, 3-4-45 Oakley Overington Richardson Left 30-11-4;- Southgate Toneri Wakefield Walker Wannan Webb Wilson Wybrew | Total Infants under 1 year. First visits 26 193 92 186 108 118 209 98 192 132 254 121 173 142 144 199 135 195 313 80 275 129 132 202 199 4047 Re-visits 33 362 231 500 575 153 706 582 285 1024 1042 595 345 656 623 940 537 216 277 153 573 205 460 427 456 11956 Children 1-2 years. First visits 1 65 1 8 3 6 4 1 14 4 24 3 27 17 15 5 16 1 — 15 14 5 18 274 Re-visits 10 430 133 359 398 157 350 384 102 451 514 397 242 397 384 670 267 216 125 197 589 117 397 422 307 8016 Children 2-5 years. First visits 1 81 — 3 2 9 6 — 9 — 27 10 33 4 11 1 3 27 1 2 15 14 21 25 10 315 Re-visits 27 395 226 377 348 197 346 517 260 389 940 666 416 458 372 633 384 406 116 274 925 295 585 85(i 400 10808 Expectant Mothers. First visits 12 100 78 99 44 67 122 66 147 78 116 64 87 79 75 92 89 129 151 64 102 91 77 142 106 2247 Re-visits 2 8 9 — 1 16 — 38 10 — 78 — 1 — — 10 3 6 4 10 9 — — 28 2 236 Still Births 1 — — 1 2 — l — — — — — 1 — — 1 3 4 — — — 1 2 1 13 Deaths under 1 year — — 3 1 — 2 - — 10 — 4 1 7 1 1 2 2 1 0 — 2 2 2 3 5 54 Miscellaneous visits 9 28 2 5 10 17 35 4 31 17 29 5 15 7 10 14 6 219 21 5 10 14 IS 32 20 592 Ineffective visits 58 254 147 161 225 368 287 223 299 474 226 228 399 544 444 232 323 257 110 259 501 527 395 279 317 7617 Totals—1945 180 1916 922 1699 1715 I1121 2065 1915 1329 2369 3254 2090 1745 2292 2081 2808 1755 1691 ,209 1044 3025 1408 2093 2436 1827 46180 1944 824 - 1026 24901 1771 1216 2537 2009 1473 3017 3872 2655 — — 1961 2697 1847 2006 1223 1292 3224 2159 2300 2716 2544 *51111 * Including Health Visitors who left during 1944. SB Attendances at Infant Centres—1945. Municipal. Boston Road. | St. Andrew's. South Croydon. Shirley. Woodside. East C.oydon. South Norwood Upper Nonvood. St. Alban's. Bensham Manor. St. Oswald's. West Croydon. Norbury. Waddon. Selhurst. New Addington. j St. Stephen's Total 1945. Total 1944. New cases under 1 year 391 110 139 191 166 141 297 245 104 184 148 198 110 137 117 112 125 181 3036 2663 No. of re-attendances 4496 1779 1884 2116 1162 1613 3179 2568 1085 2345 2019 2999 1283 1981 1315 1845 1085 2375 37 i 29 32629 New cases over 1 year 72 34 39 50 41 61 70 62 35 47 52 28 30 28 39 71 16 59 834 449 No. of re-attendances 2434 1297 1043 1253 1070 962 2182 1455 994 1321 1643 1857 958 1674 1090 1484 801 1869 25387 21143 Attendances of children 0-5 7393 3220 3105 3610 2439 2777 5728 4330 2218 3897 3862 5082 2381 3820 2561 3512 2027 4484 66446 56884 Consultations with Doctor 2464 1068 1091 1046 538 1034 1928 1919 692 1240 1161 1476 986 849 898 1230 813 1291 21724 17034 No. of Sessions 100 48 49 48 48 49 97 97 49 55 49 96 49 47 47 47 49 48 1073 1083 Expectant Mothers No. of new cases — — — 2 7 — 7 — 3 — — — — 6 2 22 49 45 No. of re-attendances 11 17 24 6 , 24 2 24 10 84 39 28 269 164 Total attendances of pectant Mothers — — 13 24 24 13 — 27 2 — 24 10 90 41 50 318 209 Total attendances 7393 3220 3105 3623 2463 2777 5752 4343 2218 3924 3864 5082 2405 3830 2651 3553 2077 4484 66764 57093 Average attendance per Session 1945 73.9 67.1 63.4 75.5 51.3 56.7 59.1 44.8 45.3 71.4 78 9 52.9 49.1 81.5 56.3 75.6 42.4 93.4 *62.2 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 £ Total average attendance each week at all Centres. 89 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 : — Total number of children under 5 sent to Convalescent homes 15 Total number of weeks 132 Cost £106 19s. 7d. Numbers of mothers sent for convalescence 1 Number of children under 5 sent with their mothers to cottages 2 Home Helps. During the year 484 expectant mothers applied for Home Helps, and 433 were supplied. The corresponding figures for 1944 were 412 mothers applied, and 373 were supplied. At the end of the year there were the names of 21 full-time and 9 casual Home Helps on the register. Babies' Help Report. 1 am indebted to Mrs. Philpott for the following particulars :— In January, 1945, eleven mothers and babies were receiving grants. During the year 27 mothers were helped, and at the end of the year 3 were left on the books. Grants are paid through the Welfare Centres, and the Committee wish to record thanks to the Health Visitors for their co-operation." Croydon Association of Moral Welfare. This Association has a Home for Girls at 31, 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. 90 The Tables below give figures for 1945. FOSTER CHILDREN. No.as at Dec.31st 1044 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 1945 Parent Another irea with Foster Parent Another Foster Motfier Public Institution 87 142 53 22 21 6 6 7 2 112 FOSTER MOTHERS. No. as at December 31st 1944 Applications for Authorisation during the year. Removals during the year Authorisation cancelled for other reasons No. as at December 31st 1945 With Child Without child 61 65 6 3 12 105 The Health Visitors paid 997 visits to foster-mothers for the purpose of supervision. THE OBSTETRIC SERVICE. The Obstetric Service has been described in my Report lor 1938. The following are the statistics for 1945. Taking the Registrar-General's figures for maternal mortality (deaths directly due to pregnancy), the rate for England and Wales for 1945 was 1.79 per 1,000 births. In Croydon the rate was 2.45. In "booked" cases treated by the Obstetric Service the rate for 1945 was 0.02 per 1,000 Hospital deliveries; nil Per 1,000 home deliveries, and 0.38 per 1,000 over all deliveries. The total rate for the Service, 0.38 per 1,000, is the lowest ever recorded- Of the cases treated to a conclusion at the Post-Natal Clinic during 1945, 96.8 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 1944 was 96.7. • 91 The number of cases delivered of viable babies in Mayday Hospital, with a nominal 68 beds, was 1,027. The number delivered at St. Mary's Maternity Hospital, with 80 beds, was 609. The number of cases delivered by the Domiciliary Branch of the Service (Municipal Midwives) was 1,015. Including 48 cases admitted after delivery, the total number of deliveries dealt with by Lhe Obstetric Service was 2,799. The total number of infants born was 2,840. ln 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. 327 mothers and babies were transferred from Mayday Hospital, and 81 mothers and babies from St- Mary's Hospital in 1945 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 1945, as compared with previous years. The Home was closed owing to enemy action up to July, 1945. These figures are, therefore, for the latter half of the year. General Statistics, 1945. No. of live births allocated to the Borough of Croydon 3,575 still ,, ,, „ „ 100 No. of maternal deaths 9 No. of cases of notified Puerperal Pyrexia 57 No. of expectant mothers who attended the Borough AnteNatal Clinics 3,153 No. of cases delivered in Mayday Hospital as Booked cases (exclusive of abortions) 997 No. of cases delivered in Mayday Hospital as Emergency cases (exclusive of abortions) 78 1,075 Total cases delivered in Mayday Hospital - No. of cases delivered in St. Mary's Maternity Hospital as Booked cases 609 No. of cases delivered in St. Mary's Maternity Hospital as Emergency cases 609 Total cases delivered in St. Mary's Maternity Hospital - No. of cases delivered by Municipal midwives 1,015 Total 2,799 92 No. of cases admitted to the Puerperal Infection Unit, Borough Hospital and Mayday Hospital Isolation Wards, including 28 from Mayday Hospital and 7 from St. Mary's Maternity Hospital 43 No. of Maternal deaths in Booked cases from Borough Ante-Natal Clinics 1 No. of Maternal deaths in Emergency eases at Mayday Hospital 6 (including 2 criminal abortions) No. of Maternal deaths in cases admitted as Puerperal Sepsis per se 0 Total Maternal deaths in beds of the Obstetric Service 7 (including 3 abortions, 2 of which were criminal) The total number of patients treated by the Obstetric Service was : — (a) In Mayday Hospital 1,849 (/') In St. Mary's Maternity Hospital 009 (c) In the Borough Hospital Puerperal Infection Unit and Mayday Hospital Isolation Wards, excluding 28 from (a) and 7 from (b) 8 (<f) At the Ante Natal Clinics and delivered outside the above Hospitals (including Municipal Mid wives' cases) 1,165 (e) At the Post-Natal Clinics, excluding those included in (a), (b), (c) and (d) 1,602 (/) At the Ante-Natal Clinics and undelivered on December aist, 1945 1,177 6,380 Incidcncc of Abortion. 1945. 1944. Incomplete abortions 1(37 132 Threatened abortion with final evacuation 33 17 Inevitable abortion 15 14 Complete abortion 16 31 Missed abortion 10 6 Threatened abortion discharged undelivered 62 41 Total 303 241 93 ANTE-NATAL SUPERVISION. 1944 1945 No. of Sessions at Ante-Natal Clinics held 551 601 No. of individuals who attended 3,783 4,092 No. of previous year's cases continuing attendance 982 939 No. of new cases 2,824 3,153 No. of cases undelivered on 31st December 939 1,177 Total attendances made 21,141 22,663 Average attendances per session 39 38 No. of cases delivered in hospital as Booked cases 1,584 1,684 No. of cases delivered by Municipal Midwives. 991 1,015 No. of cases delivered at other places under the care of private doctors or midwives 425 150 No. of patients found not to be pregnant 25 28 No. of patients referred to hospital for Ante- Natal treatment 267 359 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 1945 the Obstetric Service dealt with 2,840 out of the total births allocated to the Borough. Major Ante-Natal Conditions treated at the Ante-Natal Clinic. BREECH PRESENTATION Breech presentation diagnosed 215 Spontaneous version 19 External version successful 138 External version not successful 37 Allowed to go to term as Breech 18 Not recognised as Breech before labour 3 DENTAL TREATMENT. No. of cases referred to Borough Dental Surgeons 912 No. of cases referred to Private Dental Surgeons 63 No. of cases refusing dental treatment 37 No. of cases seen too late for necessary dental treatment 45 TUBERCULOSIS. Referred from Tuberculosis Officer because of pregnancy 15 Referred to Tuberculosis Officer for opinion on lung condition 18 VENEREAL DISEASE. . Gonorrhoea. Total cases 7 Transferred to Borough V.D. Clinic 7 Syphilis Total cases 10 Transferred to Borough V.D. Clinic 10 Non-Venereal 14 94 Independent Midwives Cases. These cases may be summarised as follows :— Total number of midwives' cases during 1945 150 Number of cases sent for one consultation only 96 Number of cases supervised entirely 54 Physiotherapy. The following statistics have been furnished by the Physiotherapist in respect of cases seen at St. Mary's Maternity Hospital:— Number of patients dealt with 613 ,, exercise tables given 3,195 ,, massage treatments given 8 ,, electrical treatments given 38 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 169 Blood for Kahn Reaction 132 Blood for Gonococcal Fixation Test 132 Blood for Grouping 180 Blood for Culture 10 Blood for Urea Content 31 Blood for Cell Count, etc. 74 Catheter Urine for Routine Examination . 504 Urine for Aschheim-Zondek Test 47 Urine for Urea Concentration Test 92 Lochia for Culture 183 Sputum for Examination 1 Pus for Identification of Organism 36 Urethral Smears for Gonococcai, etc. Conjunctival Smears 40 Histological Sections 179 ' Throat Swabs for Organisms 112 Faeces for Occult Blood, etc 7 Blood for Hb. Estimation 034 Various 46 Blood Compatibility Tests 80 95 X-ray Examinations (Mayday Hospital x-ray Department). 366 cases were referred from Mayday Hospital, St. Mary's Maternity Hospital, and Ante-Natal Clinics. Reasons for reference were : — Breech for Attitude, etc. 68 For Presentation, Attitude, etc. 105 Twins 89 Foetal Death • 2 Foetal Parts Disproportion 66 Foetal Abnormalities 15 Pelvic Abnormality 13 Various 3 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 997 609 1,606 (2) Delivered in hospital before 28th week 79 — 79 (3) Admitted after delivery 34 — 34 (4) Discharged undelivered after ante-natal treatment and not subsequently delivered in hospital — — — (5) Died undelivered — — — (6) Ectopic Pregnancy — — — 1,110 609 1,719 B.—"Emergency" patients sent into Hospital with some complications by outside doctors or midwives. No "Emergency" cases were admitted into St. Mary's Maternity Hospital:— (1) Before Labour : Mayday Hospital. (a) Discharged undelivered 24 (b) Delivered in hospital after 28th week 64 (c) Delivered in hospital before 28th week 176 (d) Died undelivered — (2) After Delivery 14 (3) Ectopic Pregnancy 8 286 96 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 147 15 26 188 Eclampsia 3 2 1 6 Persistent vomiting of pregnancy 4 2 — 6 Chronic cervitis — — — — Acute pyelitis 16 4 1 21 Malnutrition, debility, simple anaemia. etc. 32 —• 9 41 Retro verted gravid uterus 7 — — 7 2. Intercurrent Diseases. Chronic nephritis — — — — Pulmonary Tuberculosis i9 — — 19 Venereal disease 17 — — 17 Cardiac disease 18 — 3 21 3. Conditions chiefly Natal. Presentations at Delivery:— Anterior positions of the vertex 788 54 494 1336 Posterior positions of the vertex 123 10 78 211 Breech 60 8 27 95 Shoulder 1 — — 1 Face and brow 2 3 — 5 Complex — — 1 1 Caesarian section 39 3 — 42 Twins and Triplets 24 3 11 38 Accidental haemorrhage 7 2 2 11 Placenta praeyia 9 6 1 16 Hydramnios 10 2 6 18 Prolapse of cord 3 2 1 6 Retained placenta 14 6 5 25 Post-Partum haemorrhage 22 6 12 40 B.B.A 34 14 — 48 Lacerated perineum 333 25 186 544 Obstructed labour — — — — Premature labour 72 19 34 125 Abortion 121 194 — 315 Ectopic pregnancy — 8 — 8 Abdominal Hysterotomy — 3 — 3 Forceps delivery 66 9 33 108 4. Conditions chiefly Post Natal, excluding re-admissions from Post Natal Clinic. Breast abscess 7 _ — 7 Notified pyrexia or fever 24 4 7 35 In addition 8 cases of Puerperal Pyrexia per se were admitted to the Puerperal Infection Unit of the Borough Hospital. 97 Blood Transfusion (71 Obstetrical and 78 Gynæcological cases). For every case, stored blood from the Blood Transfusion Depot, Sutton, was used. There were 3 deaths. Infants. Mayday Hospital Booked. Mayday Hospital Emergency St. Mary's Maternity Hospital Booked. Total Per Cent. No. of infants in Hospital on 1st Jan., 1945 35 - 10 51 - Total No. of live births, still births and infants admitted with Mother (B.B.A.) 1050 81 620 1757 - No. of infants in Hospital on 31st Dec., 1945 32 1 23 50 - Alive on discharge from Hospital 985 59 598 1642 93.4 Stillborn 40 14 11 65 3.1 Died (born alive, but died in Hospital) 31 8 11 50 2.9 Infant Feeding and Weight on Discharge from Hospital. In both hospitals normal infants were breast-fed every four hours omitting the early morning feed. Of 1,044 infants discharged from Mayday Hospital, 529 were up to or over birth weight (51 per cent.). Of 598 infants discharged from St. Marys' Maternity Hospital, 322 were up to or over birth weight (55 per cent.). Twins and Triplets. There were 37 cases of Twins and 1 of Triplets. There was no maternal death. Mayday Hospital. Rooked. Mayday Hospital. Emergency St. Mary's Maternity Hospital. Booked. Total. No. of cases 24 3 11 38 No. of infants discharged alive 34 4 18 56 No. of still-births and infant deaths 15 2 4 21 Foetal and Infant Mortality 30.6% 33.3% 18.1% 27.2% 98 POST NATAL AND GYNAECOLOGICAL CLINIC. Number of Sessions held 94 ,, ,, Individuals presented 1,618 ,, ,, Subsequent attendances 1,253 Total attendances 2,871 Average attendance per session 30 Number of Post-Natal cases 1,269 Number of Gynæcological cases 1,602 END RESULTS. 1,025 cases were treated to their termination (other than death) during the year, and the results were classed as follows :— Mayday St. Mary's Total. % Health unimpaired 554 459 1,013 98.8 Health slightly impaired 6 2 8 0.8 Health seriously impaired 3 1 4 0.4 Totals, treated to conclusion 563 462 1,025 Maternal Mortality (Obstetric Service). Seven deaths occurred of mothers dealt with by the Service, one in a "Booked" case and 6 emergencies.* The maternal mortality of "Booked" cases, i.e., cases under the continued supervision of the Service, is 0.62 per 1,000 hospital deliveries, and 0.38 per 1,000 total deliveries, including the Municipal Midwives "Booked" cases. Puerperal Infection. Thirty-six cases were treated in isolation for puerperal infection, 9 of them in the Borough Hospital and 35 in St. Mary's and Mayday Hospitals. There was no death. Sources of the Cases. Cases. Deaths. From Mayday Hospital "Booked" Cases 24 - "Emergency" Cases 4 - From St. Mary's Maternity Hospital 7 - From other Hospitals - - From private doctors, deliveries in Nursing Homes 1 - From private doctors, deliveries at home 7 - Including 2 criminal abortions. 99 The Assistant Medical Officer of Health for Obstetrics was called in by medical practitioners to see 78 obstetrical and 207 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 obsetric and gym-ecological aspects of 54 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 30 Aged 5—16 years 160 Over 16 years 548 Total 738 2.—Education Cases. Aged 7—16 years 114 Combined Total 852 Compared with 1944, the Statutory cases show an increase of 138 and the Educational cases a decrease of 14. Two of the cases under Statutory supervision have died—one in hospital and one at home. Three institution patients have died in hospital. The Statutory cases are distributed as follows: — In Certified Institutions 260 In Approved Homes 3 On leave from Institutions 17 Under Statutory supervision at home 355 Under Guardianship 65 In Mental Hospitals 8 Observation cases 30 738 100 The Education cases were distributed as follows:— In Certified Residential Schools 1 In Certified Day Schools 101 In Private Schools - Awaiting vacancies at St. Christopher's 10 112 During the year the Certifying Medical Officers made examinations and paid visits to the number of 124 to Statutory cases. The Mental Deficiency Visitors paid 1,060 visits to Statutory cases and 1,554 to Education cases, 2,614 visits in all, an increase of 548 on 1944 figures. During 1945 twenty-five Statutory cases were dealt with as follows:— Sent to Certified Institutions 10 Placed under Guardianship 8 Sent to Croydon Mental Hospital 1 Varying Orders: (a) Change of Guardian 4 (b) From one Institution to another 2 (c) From Guardianship to Institution - (d) Orders closed - Thirty-seven Orders were renewed during the year, 15 of which were Guardianship. Guardianship Cases. There were 65 cases under Statutory Guardianships, 41 of these under the care of relatives, and 24 with Guardians who are not relatives. 10 males and 3 females are at work. 420 visits have been paid to Guardianship cases during the year. There are 11 cases on leave front Institutions (7 boys and 4 girls). 101 Clinic for Mentally Defective, Backward and Abnormal Children. 87 children were examined during 1945. The classifications arrived at, together with recommendaions made, are summarised under:— (1) Certified as Mentally Defective : Recommendations: (a) Recommended for Special Day School 43 (b) Recommended for Residential School 4 (c) Recommended for Occupational Centre 5 (2) Found to be dull and backward: (a) Referred to a special class 12 (b) Further trial in ordinary class 4 (c) Re-test in one year 6 (d To attend St. Giles because of physical defect 1 (e) To attend St. Luke's 1 (f) Referred for Medical Treatment 2 (3) Referred to Child Guidance Clinic 4 82 Mental Tests at St. Christopher's 5 ORTHOPAEDIC DEPARTMENT. The arrangements are the same as in 1944. Summary of Cases Attending the Orthopædic Clinic. Jan. 1st, 1945. New Cases, 1945. Cases Discharged, 1945. Cases on books, Dec. 31st, 1945. M.C.W. S.M.S. Tuberc. M.C.W. S.M.S. Tuberc. M.C.W. S.M.S. Tuberc M.C.W. S.M.S. Tubere 139 181 86 93 190 15 77 189 14 155 182 87 400 298 280 424 102 Cases Seen by the Orthopedic Surgeon. Defects. School. M.C.W. Tuberculosis. Total. Cases. Attendances. Cases. Attendances. Cases. Attendances. Cases. Attendances. Infantile Paralysis 17 39 3 7 - - 20 46 Curvature or Postural Defects 33 52 - - - - 33 52 Pes Cavus 10 17 - - - - 10 17 Pes Planus 127 224 29 54 - - 156 278 Genu Valgum 38 60 64 121 - - 102 181 Talipes 9 19 12 26 - - 21 45 Obstetrical Paralysis 3 4 1 1 - - 4 5 Joint Diseases 11 33 1 4 40a 91a 58 148 5s 11s 1m 9m Injuries 4 9 1 2 - - 5 11 Rickets - - 4 6 - - 4 6 Wry Neck 7 9 3 8 - - 10 17 Spastic Paraplegia 7 16 5 9 - - 12 25 Congenital dislocation of the Hip 9 27 1 1 - - 10 28 Other deformities 63 90 42 66 - - 105 156 338 599 166 305 46 111 550 1015 A—Adults; s—School Child ; M—Pre-School. Summarised, the Table shows 338 school children attended and made 599 attendances. 166 babies made 305 attendances, and 46 Tuberculosis cases made 111 attendances; a total of 550 cases, making 1,015 attendances. 103 The following Table shows the number of cases referred direct from the Orthopaedic Clinic for Massage, Swedish Remedial and Electrical Treatment, and also X-Ray examinations at the Croydon General Hospital : — Defects. School Cases. M.C.W. Cases. Tuberculosis Cases. Total. Cases No. Of Treatments XRays Cases No. of Treatments X- Rays Cases No. of Treatments X- Rays Cases No. of Treatments X- Rays Infantile Paralysis 1 2 - - - - - - - 1 2 - Curvature or postural defect 9 46 6 - - - - - - 9 46 6 Pes cavus - - - - - - - - - - - - Pes planus 1 18 - - - - - - - 1 18 - Genu Valgum - - - - - - - - - - - - Talipes - - - 3 50 - - - - 3 50 - Joint Disease 8 - 13 - - - 23 - 27 31 - 40 Injuries 3 - 3 - - - - - - 3 - 3 Rickets - - - - - - - - - - - - Wry Neck - - - 1 8 - - - - 1 8 - Spastic Paraplegia - - - 1 - 1 - - - 1 - 1 Congenital Dislocation of the Hip. 5 - 5 - - - - - - 5 - 5 Other Deformities 6 - 6 3 - 3 - - - 9 - 9 33 66 33 8 58 4 23 - 27 64 124 64 104 Cases sent to Residential Institutions. Name of Institution. School Cases. M. & C.W. Cases Tuberculosis Cases. Total. No. in on 1st Jan., 1945 Admitted Discharged. No. in on 1st Jan., 1945 Admitted. Discharged. No. in on 1st Jan.. 1945 Admitted. Discharged. No. in on 1st Jan.. 1945 Admitted. Discharged. No. in on 1st Jan. 1946 Victoria Home - - - - - - - 1s - - 1 - 1 Pyrford 1 1 1 - - - 3s - 2s 4 1 3 2 Croydon Gen. Hosp. - 1 1 - - - - - - - 1 1 - Heritage Craft Schls. 1 - - - - - 2s 1s - 4 1 1 4 1 M - 1M Pinner - - - 1 - - - - - 1 - - 1 Ld. Myr. Treloar Hosp. - - - - - - - - - - 1 - 1 E. M. S. Hosp. - - - - - - 1A - 1A 1 - 1 - Shaftesbury Homes 1 - - - - - - - - 1 - - 1 Queen Mary's Hosp. - - - - - - 1s - - 1 - - 1 Royal Nat. Orth. Hosp - - - - - - - lA lA - 1 1 - Mayday Hosp. - 12 10 2 7 9 4a 3a 2a 6 24 .23 7 - 2s 2s Redhill Hosp. - - - - - - 1A - 1 A 1 - 1 - Wingfield Morris Hos. - 1 1 - - - - - - - 1 1 - 3 15 13 3 7 9 13 9 10 19 31 32 18 105 Conditions for which Patients were admitted to Hospitals with the Results of Treatment. Condition. In on 1st Jan. 1945 Admitted or transferred. Discharged. I.S.Q. Died. 1st Jan. 1946 Arrested. Quiescent. Improved. Infantile Paralysis 1 1 - - 1 - - 1 Tubercular joint Disease 13 9 3 2 1 4 - 12 Hip Disease 3 3 - - 1 1 - 4 Hemiplgeia - - - - - - - - Genu Valgum 2 2 - - 3 1 - - Pes Planus - 6 - - 6 - - - Talipes - 2 - - 1 1 - - Rickets - 1 - - 1 - - - Other Deformities - 4 - - 4 - - - Spastic Paraplegia - 1 - - 1 - - - Scoliosis - 1 - - - - - 1 Osteomyelitis - 1 - - 1 - - - 19 31 3 2 20 7 - 18 The percentage of arrested cases was 9.37 per cent.; quiescent rases 6.25 per cent.; and 62.5 per cent. were "improved." 106 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 J * for the figures below:— Number of Blind on Register 462 Number of Blind who benefit from instruction in Braille or Moon type (including those who already read) 116 Number of Blind who benefit from part-time instruction 51 Number in remunerative handicrafts— (a) Home worker 35 (b) In workshops 7 (c) St. Dunstan's 11 (d) Workers not included in scheme 29 Home Teacher 1 The Health Visitors paid 282 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 462 1O7,108 M = Meals F. = Females T, = Total. TABLE I. WELFARE OF THE BLIND—REGISTRATION. As at 31/3/46. Age period 0-1 Age period 1—5 Age period 5—16 Age period 16—21 Age period 21—40 Age period 40—50 Age period 50—65 Age period 65—70 Age period 70 and over (i) Total of all age groups (ii) Age unknown M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. - - - - - - 8 3 11 6 3 9 23 25 48 24 19 43 52 61 113 21 24 45 64 126 190 (i) 198 (i) 261 (i) 459 (ii) - (ii) 3 (ii) 3 AGES AT WHICH BLINDNESS OCCURRED. Age period 0-1 Age period 1—5 Age period 5—10 Age period 10—20 Age period 20—30 Age period 30—40 Age period 40—50 Age period 50—60 Age period 60—70 Age period 70 and over Age period Unknown M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 29 18 47 4 6 10 9 10 19 15 9 24 16 12 28 25 22 47 24 29 53 17 42 59 21 35 56 25 62 87 13 19 32 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) In Schools for the Blind 4 - - 1 - - All others not included in (a) and (b) Total Employed Industrial Secondary Professional and University Trained but unemployed No training but 3 trainable Unemployable Total (a) Workshops (b) Home workers Other School 3 1 - - - - M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F T. M. F. T. M. F. T. M . F. T. M. F. T. M. F. T. Not at School 1 - - 1 - - 5 2 7 25 10 35 24 5 29 54 17 71 2 2 4 - - - - - - - - - 3 2 5 131 240 371 190 261 451 OCCUPATIONS OF EMPLOYED BLIND PERSONS. Agents, Collectors, &c. Basket Workers Bedding (including Divans & Ottomans) and Upholstering Boot Repairers Braille Copyists and Proof Readers Brush Makers Carpenters and Woodworkers Chairseaters 'Clerks and Typists Coal Bag Makers Dealers, Tea Agents, Newsagents, ShopKeepers Firewood Workers Gardeners Hawkers, Newsvendors, &c. Home Teachers Knitters Labourers Massage Mat Makers Ministers of Religion Musicians and Music Teachers Netting Makers Porters, Packers, Cleaners Poultry Farmers School Teachers Ships Fender (Fendoff) Makers Telephone Operators Tuners Weavers Miscellaneous Total Mattress Makers Machinists Upholeterers Hand Machine Within Institution for the Blind - 1 1 - 1 - - - - - 1 - - - - - - - 1 - 1 - - - - - - - - - - - - 7 In approved Home Workers Schemes - 6 - - - 2 - 1 - 2 - - - 1 - 1 - 1 7 - - 2 - 1 - - - - - - 11 - - 35 Others not parttime workers) - - - - - 1 - - - - - - - - - - - - - - 2 1 - 1 - - - - - 5 - - 12 29 Total - 7 1 - 1 3 - 1 - 2 4 - 2 1 - 1 1 1 8 - 3 3 2 2 - - - - - 5 11 - 12 71 PHYSICALLY AND MENTALLY DEFECTIVE. (a) Mentally Defective. (b) Physically (C) (i) Deaf (ii) Deaf-mute Combinations of (a) and (b) Combinations of (a) and (c) Combinations of (b) and (c) Combination# of (a), (b). (c) Total Homes for the Blind Mental Hospitals Poor Law Institutions M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 2 5 7 5 4 9 (i) 6 (i) 5 11 1 - 1 - 2 2 - - - - - - 16 17 33 - 3 3 - 1 1 8 25 33 (ii) 2 (ii)1 3 109 SANITARY CIRCUMSTANCES. To the Medical Officer of Health. I beg to submit a report for the year ending the 31st December, 1945, of the work of the Sanitary Inspectors and other officers under my supervision. GEO. GRIEVE, 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) 8,566 Number of houses inspected where zymotic diseases have occurred 301 Number of houses inspected under Landlord and Tenant (War Damage) Acts 179 House drains tested 1,530 House drains tested on application 37 Number of smoke tests during repair 109 Inspections of drainage work during repair 3,371 Number of water tests during repair 390 Final tests of drains after repair 109 Final tests of drains when completely relaid 75 Length of new drains tested yards 3,071 Inspection of yards, stables and manure pits 75 ,, passages 51 ,, public conveniences 30 „ pigstyes 90 ,, tents, vans and similar structures 20 ,, theatres, cinemas, halls, etc. 97 ,, ponds and ditches and static water tanks 97 ,, schools and school sanitary conveniences 11 ,, common lodging-houses 12 ,, verminous premises 160 ,, premises where offensive trades are conducted 5 ,, gipsy encampments, camps, fairs, etc. 2 ,, cesspools 4 ,, gathering grounds of water supply 110 Number of visits under Rats and Mice (Destruction) Act, 1919— Private Houses 2,326 Shops 667 A.R.P. Miscellaneous inspections and reinspections after air raids 339 ,, Inspections of posts and centres 93 ,, Inspections of war damaged houses 2,840 ,, Inspections of war damaged food shops 36 Smoke observations 33 Number of visits re Infectious Diseases 1,988 Inspections of Shops (under Shops Acts) 125 Special Evening Patrols (under Shop Hours Acts) 2 110 Overcrowding inspections 26 Inspections under Fertilisers and Feeding Stuffs Act 3 „ under Pharmacy and Poisons Act 6 ,, Dairies 33 ,, Farms and cowsheds 50 ,, Milkshops 5 Premises where food is prepared or sold 1,623 ,, Bakehouses 14 ,, Slaughterhouses 41 ,. Factories without mechanical power 32 ,, Factories with mechanical power 77 Workplaces, Public Health Act 22 Outworkers' premises 57 Visits to Employers of Outworkers 3 Visits re Young Persons Employment Act 3 Water samples taken 104 Food and Drugs Acts : milk samples taken 343 Food and Drugs Acts : other foods and drugs samples taken 314 Milk Special Designations Orders: samples taken 302 Non-designated Milk : samples taken 79 Reinspections of work on outstanding notices 11,020 Sundry inspections and visits 972 Appointments kept with owners, builders, etc. 4,190 Complaints from public investigated (for purposes other than inspection for housing defects) 1,879 Informal notices outstanding 31-12-44 729 Informal notices served 5,030 Informal notices complied 3,919 Number of Informal Notices referred for Statutory Orders 779 Informal notices outstanding 1.061 Statutory notices outstanding 31-12-44 97 Statutory notices served 3,455 Statutory notices complied 1,950 Statutory notices outstanding 31-12-45 1,602 Total number of complaints received at the office 9,164. Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1945 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 169 Want of windows or ventilators 87 Conditions causing dampness : Defective roofs 515 Defective window frames 111 Defective walls, etc. 345 Want of efficient damp-proof course 85 Defective gutters and downspouts 491 Other structural defects : Defective plaster 293 Cleansing and limewashing required 80 Defective floors and stairs 685 Insufficient ventilation under floor 187 Defective brickwork, cills, lintels, chimneys, etc. 195 Defective stoves and fireplaces and flues 461 111 Defective drains, sanitary fittings, etc. : Defective sinks and waste pipes 440 Defective w.c.'s 313 Defective drainage 310 Stoppages in drains 526 Defective water services and tanks 161 Domestic nuisances : Want of cleanliness 15 Dirty w.c. pans 20 Verminous conditions 117 Other nuisances and infringements : Offensive accumulations 65 Insufficient accommodation for sub-tenants 17 Defective manure receptacles 1 Dirty or defective sanitary conveniences 7 Overcrowding 17 Smoke nuisances 11 Sundry nuisances or defects 26 Particulars not inserted in Rent Book (Housing Act) 4 ,, ,, ,, (Rent Restriction Act) 2 (2) FACTORIES AND WORKPLACES. Want of cleanliness 6 Inadequate ventilation 7 Insufficient drainage of floors 6 Abstract not exhibited 1 Sundry nuisances or defects 10 W.C.'s— Insufficient 3 ,, Unsuitable or defective 2 ,, Not separate for sexes 5 ,, Not lighted 2 (3) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924. Food cupboards defective or required 10 (4) INFRINGEMENTS OF FOOD AND DRUGS ACT, 1938, AND FOOD BYELAWS. Cleansing or repair of walls and ceilings 84 Cleansing or repair of floors, utensils, fixtures, etc. 24 Dirty or defective w.c. accommodation 12 Food storage accommodation required 32 Refuse bins uncovered 3 Accumulation in food store and yards adjacent 6 Food in uncovered vehicles or baskets 1 Premises not suitable for storage or manufacture of food 2 Want of provision of towels 2 Provision of cloakroom accommodation 2 Want of intervening ventilated space to w.c. 8 Insufficient or defective sink accommodation and water supply 65 Ventilation required in food store 40 Household washing in food store 4 Swill bins defective 30 Impervious floors required to kitchens, etc. 28 Defective floors and pavings 17 (5) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING, Etc. Defective Yard Paving 8 Want of a sanitary dustbin 1,427 112 (6) INFRINGEMENTS OF SHOPS ACT. Provision of means of heating 3 Infringement in hours of employment 2 (7) INSPECTION OF AMUSEMENT HOUSES. Defective sanitary fittings 15 W.C. defective and dirty 7 (8) KEEPING OF ANIMALS. Nuisances arising from the keeping of animals 7 (9) INSPECTION OF WATERCOURSES, etc. Cleansing of watercourses and ponds 2 (10) INFRINGEMENTS OF OTHER BYELAWS. Noisy animals 3 Noisy radio 1 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 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) 8,566 (b) Number of inspections made for the purpose 8,566 (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 8,141 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 3,904 118 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 798 (2) Number of dwelling houses which were rendered fit after service Of formal notices— (a) By owners 270 (b) By local authority in default of owners 12 B.— Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 2,657 (2) Number of dwelling houses in which defects were remedied after service of formal notices : — (a) By owners 533 (b) By local authority in default of owners 1,060 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 2 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 - 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 179 applications were made and 156 certificates were granted. HOUSES LET IN LODGINGS. There are 12 houses registered and they all suffered seriously from damage by enemy action, Repairs were completed during the year. 114 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 Us. per week. Cooking facilities are provided. Hot baths may be taken any time after 9 a.m. Clothes may be washed and dried in the washhouse provided. The average number of nightly lettings during the year was 86 and the number accommodated during the year 31,594. The receipts and expenditure for the past 5 years has been as follows:— Receipts. Expenditure. £ s. d. £ s. d. 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 1945 1,285 0 0 1,965 0 0 War Damaged Houses. The Sanitary Inspectors visited these to ascertain the damage to sanitary arrangements and water supply. Some 2,900 such visits were made and the defects found received 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 14 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 77 22 - Without Mechanical Power 32 20 - Outworkers and Employers of outworkers 60 - - Total 169 42 - 115 Defects Found. Particulars. Number of Defects. Referred to H.M. Inspector. Prosecutions. Found. Remedied. Want of Cleanliness 6 6 - - Inadequate Ventilation 7 7 - - Ineffective Drainage of Floors 6 6 - - Sanitary Conveniences. Insufficient 3 3 - - Unsuitable or Defective 2 2 - - Not Separate for Sexes 5 5 - - No Lighting 2 2 - - Sundry Nuisances or Defects 10 10 - - Total 41 41 - - Home Work. Lists of home workers or outworkers as they are termed are sent in twice yearly, and this year contained the names of 165 workers residing in the Borough. 57 visits were paid to outworkers and 3 visits were paid to premises of employers of outworkers to examine lists. Nature of Employment of Outworkers on the Register, 31st December, 1945. Nature of Work. Number Employed. Outwork in Infected Premises. Outwork in Unsatisfactory Premises. Remarks. Making, Cleaning, Altering and Repairing, Wearing Apparel 470 - - - Upholstery Work 12 - - - Lace Goods 1 - - - Other Classes of Work 70 - - - Total 553 - - - Inspection of Schools. These are inspected with particular reference to sanitary accommodation including washing facilities. During the year 11 inspections were made and defects found were referred to the Education Officer, 116 SHOPS, Etc., ACTS. The Shops Acts, 1912-1936, contain provisions for dealing with closing hours, the hours of work, 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. 128 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. Some 3,371 visits of inspection were made to underground drains in course of repair. With the stringent licensing of building works and the labour difficulties a became essential to serve Statutory Orders in all cases of drainage defects. Of these Orders a large proportion had to be done in default of the owners. This has been possible by employing specialist labour set aside for this purpose. 1,230 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. OFFENSIVE TRADES. There are but few registered and during the year there has been no cause for complaint. WATERCOURSES, PONDS AND DITCHES, Etc. 97 inspections were made and pollutions were found in 2 cases. Observation is also kept on static water tanks for evidence of nuisance or mosquito breeding. 117 SMOKE OBSERVATIONS. During the year 31 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. 97 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 following articles were disinfected at the Disinfecting Station during the year:— By steam 57,819 articles ,, Formalin Gas 2,228 ,, ,, ,, Spray 5,294 ,, Total 65,341 ,, In addition 465 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 1945, 2,969 articles were disinfected, the receipts amounting to £55 7s. 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 169 Trousers 626 Blankets 4,741 Coats 63 Sheets 2 Caps 157 Pillows 92 Overalls 299 Blouses 481 Other articles 46 118 Disinfection was carried out after infectious or contagious disease at the following premises:— 878 rooms at 777 houses, hospital wards, clinics, and creches. 2 A.R.P. Shelters. 2,199 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 12 adults and 93 children were cleansed of verminous conditions and 378 adults and 606 children were treated for Scabies. 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 Sanitarv Inspector. The number of premises disinfested by owners or occupiers during the vear was 111. 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 Red Jute Soluble Chlorine 7 parts per 100,000 No. 2 Black Linsev ,, ,, 3 ,, ,, 100,000 No. 3 Linsey ,, ,, 9 ,, ,, 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 11 of the Act was 8. In addition, 205 applications were made for 119 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. 4 samples of feeding stuffs were taken during the year, 2 were reported as genuine, and contained an ingredient deleterious to poultry. RATS AND MICE DESTRUCTION ACT, 1919. INFESTATION ORDER, 1943. During the year '855 complaints were received of rat or mice infestation. Of these 855 complaints the presence of rodents was confirmed in 687 cases and action was taken as under:— 341 dealt with by Sanitary Inspectors and Ratcatcher advising occupiers. 346 dealt with by the Ratcatcher by trapping and poisoning. The above action resulted in the estimated destruction of 2,124 rats and mice. The number of visits made by the Sanitary Inspectors and Ratcatchers to investigate complaints, advise and follow up was 2,326 to private houses and 667 to shops. Sewers in the town were baited with good results, the total number of rats destroyed therein being 709. FOOD SUPPLY. The supervision and inspection of the food supplies is carried out by the Sanitary Inspectors who are all qualified in food inspection. The following table shows the premised 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 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 2,491 120 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 250 Greengrocers 84 Bakers 43 Grocers 553 Confectioners 31 Stalls and Rounds 109 Fishmongers 99 Catering Establishments 339 Fried Fish Shops 31 Miscellaneous 84 Total 1,623 General Summary of Meat and other Articles of food found to be unfit and condemned by the Inspectors during 1945excluding that damaged by enemy action:— Articles. Weight in lbs. Diseased. Unsound. Total. Beef 66 2213 2279 Veal - - - Mutton 66 414 480 Pork 200 471 671 Offal 223 768 991 Fish - 7151 7151 Fruit and Vegetables - 7013 7013 Canned, bottled and packeted goods - 28826 28826 Other goods - 5618 5618 555 52474 53029 The above, apart from the Meat, include:— Fish: Mackerel, Cod, Pilchards, etc. Fruit and Vegetables: Potatoes, Dates, Prunes, Oranges, etc. Canned, bottled and packeted goods: 21,997 cans, 2,369 bottles, packets, etc. Other goods: Rabbits, Flour, Cereals, Sugar, etc. 121 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 Sanitary Inspectors to observe the condition of meat at time of sale. The Public Abattoir has been made available for the slaughter of casualties and those animals licensed by the Ministry of Food to be slaughtered locally. During 1945 the following animals have been slaughtered at the Abattoir and inspected there:— Goats. Pigs. Total. 15 153 168 The result of these inspections was as follows:— Carcases Inspected and Condemned. Sheep. Goats. Pigs. Number killed - 15 153 Number inspected - 15 153 All Diseases Except Tuberculosis. Whole Carcases Condemned - - - Carcases of which some part or organ was condemned - - 1 Percentage of the number inspected affected with disease other than Tuberculosis - - 65 Tuberculosis Only. Whole Carcases Condemned - - - Carcases of which some part or organ was condemned - - - Percentage of the number inspected affected with Tuberculosis - - - 122 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 1945) 5 Cowsheds on register (end of 1945) 5 Average number of cows in sheds (1945) 77 Number of dairies and purveyors of milk on the register (end of 1915) 136 During the year 88 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' Licenced to use the designation "Tuberculin Tested" 1 (2) Producers' Licences to use the designation "Accredited" 2 (3) Dealers' Licences to use the designation "Tuberculin Tested"— (a) Bottling establishments - (b) Shops 12 (4) Dealers' Licences to use the designation "Accredited"— (a) Bottling establishments - (b) Shops - (5) Dealers' Licences to use the designation "Pasteurised "— (a) Pasteurising establishments 1 (b) Shops 39 123 (6) Dealers' Supplementary Licences to use the designation— (a) Tuberculin Tested 6 (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 31 Accredited Milk— Licenced producer supplying milk to a licenced dairymen 53 Pasteurised Milk— Samples from licenced dealers 155 The following tables summarise the result of the bacferiological examinations of Tuberculin Tested, Accredited, and Pasteurised and Heat Treated samples during the year:— Tuberculin Tested Milk. Licences granted under the Milk (Special Designations) Order, 1(130. Present. Absent. Present in 1/100 Ml Absent. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Satisfied. Not satisfied. Tubercle bacillus - 31 - - - - - - - - - - Bacillus Coli - - 8 23 - - - - - - - - Blood - - - - - 31 - - - - - - Pus - - - - - - - 31 - - - - Detritus - - - - - - - - - 31 - - Methylene Blue Test - - - - - - - - - - 25 6 Totals - 31 8 23 - 31 - 31 - 31 25 6 124 Accredited Milk. Licences granted under the Milk (special Designations) Order 1930. 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 - 53 - - - - - - - - - - Bacillus Coli - - 10 43 - - - - - - - - Blood - - - - - 53 - - - - - - Pus - - - - - - - 53 - - - - Detritus - - - - - - - - - 53 - -- Methylene Blue Test - - - - - - - - - - 47 6 Totals - 53 10 43 - 53 - 53 - 53 47 6 Pasteurised Milk. Licences granted under the milk (Special 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 - 155 - - - - - - - - Total number of bacteria - - 19 136 - - - - - - Blood - - - - - 155 - - - - Pus - - - - - - - - - - Detritus - - - - - - - - - 155 Totals - 155 19 136 - 155 - 155 - 155 These 155 Pasteurised Milk samples contained bacteria per millilitre as follows:— Under 1,000 1 1,000—5,000 33 5,000—10,000 31 10,000—20,000 26 20,000—30,000 11 30,000—50,000 13 50,000—100,000 21 Over 100,000 19 155 125 Under the Regulations, Pasteurised Milk must not contain more than 100,000 bacteria per millilitre. . Heat Treated Milk. Present. Absent. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Not satisfied. Satisfied. Not satisfied. Satisfied. Tubercle bacillus - 61 - - - - - - - - - - Blood - - - 61 - - - - - - - - Pus - - - - - 61 - - - - - - Detritus - - - - - - - 61 - - - - Methylene Blue Test - - - - - - - - 6 55 - - Phosphatase Test - - - - - - - - - - 2 59 Totals - 61 - 61 - 61 - 61 6 55 2 59 ORDINARY MILK. During the year 70 samples of ordinary milk were procured and submitted to examination for tuberculosis and bacterial content. These samples were taken as follows:— Samples taken at dairymen's premises in the Borough 11 Samples taken from local dairymen or milk sellers on their rounds in different parts of the Borough 20 Samples taken in course of delivery to local Institutions 4 70 The following table summarises the results of the bacteriological examination of Ordinary Milk samples, taken from 1st January—31st December, 1945 :— 126 Ordinary Milk. Present. Absent. Over 100,000 per M.l. Under 100,000 per M.I. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Satisfied. Not satisfied Tubercle bacillus - 70 - - - - - - - - - - Total number of bacteria - - 15 55 - - - - - - - - Blood - - - - - 70 - - - - - - Pus - - - - - - - 70 - - - - Detritus - - - - - - - - - 70 - - Methylene Blue Test - - - - - - - - - - 52 18 Totals - 70 15 55 - 70 - 70 - 70 52 18 BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM. The manufacture of ice cream was recommenced during the year, and 24 samples were obtained for bacteriological examination, with results as follows :— Bacterial Count. No. of Organisms per ml. Samples. Under 1,000 7 Over 1,000 and under 10,000 6 Over 10,000 and under 50,000 2 Over 50,000 and under 100,000 - Over 100,000 and under 200,000 3 Over 200,000 and under 500,(MX) - Over 500,000 and under 1,000,000 - Over 1,000,000 6 Total 24 No. of Bacillus Coli. Samples. Absent in l/10th cc. 16 Present in 1/10th but absent in 1/100th cc. 4 Present in 1/100th but absent in 1/1,000 cc. Present in 1/1,000 cc. 1 Total 24 There is no bacteriological standard for Ice Cream. 127 FOOD AND DRUGS ACT, 1938. During the year 200 samples of milk and 299 other samples were taken. Summary of Samples. During 1945 samples were obtained and submitted to the Public Analyst as follows :— Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Apple Juice 1 1 - - - Arrowroot 4 4 - - - Aspirin Tablets 5 gr. 2 2 - - - Bacon 2 2 - - - Baking Powder 5 5 - - - Batter Flour Mixture 1 1 - - - Beer, Bitter 5 5 - - - „ Mild 4 4 - - - Bicarbonate of Soda 4 4 - - - Black Pudding 2 2 - - - Blancmange Powder 1 1 - - - Boiled Sweets 1 1 - - - Brawn 1 1 - - - Bread 3 3 - - - Broth 1 1 - - - Burton 1 1 - - - Butter 2 2 - - - Cake Mixture 2 2 - - - Cake Flour 1 1 - - - Cake Sponge and Steamed Pudding Mixture 1 1 - - - Castor Oil 2 2 - - - Cheese 5 5 - - - Chocolate Creams 1 1 - - - Chocolate Cup 1 1 - - - Chocolate Powder, Sweetened 1 1 - - - Cinnamon, Ground 2 2 - - - Cocoa 6 6 - - - ,, Compound 1 1 - - - Cod Liver Oil 1 1 - - - Coffee 4 4 - - - Coffee and Chicory Essence 1 1 - - - Coffee and Chicory 2 2 - - - Coffee and Chicory Mixture 2 2 - - - Coffee Extract with Preservative 1 1 - - - Colour Mauve, Synthetic 1 1 - - - Compound Bismuth Lozenges 1 1 - - - Confectionery 2 2 - - - Cordial, Ginger 4 4 - - - ,, Lime Flavour 1 1 - - - ,, Peppermint 1 1 - - - Corned Beef 2 2 - - - ,, Mutton 2 2 - - - Cornflour 1 1 - - - Cream of Tartar 1 1 - - - Currants 1 1 - - - Curry Powder 5 5 - - - Custard Powder 2 2 - - - Custard Powder Substitute 1 1 - - - Dates 1 1 - - - Dessert Mould 1 1 - - - Dried Eggs 2 2 - - - Drinking Chocolate 1 1 - - - Carried Forward 104 104 - - - 128 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought Forward 104 104 - - - Fish Cakes 4 4 - - - Fish Paste 2 2 - - - Flavouring Essence, Pineapple 1 1 - - - „ Vanilla 1 1 - - - Flavour, Orange, Emulsified 1 1 - - - Flavouring, Raspberry 1 1 - - - Flour Batter 1 1 - - - Flour, Bun 2 2 - - - „ Plain 1 1 - - - „ Self-raising 2 2 - - - Soya 1 1 - - - Gelatine 1 1 - - - Gelatine, Powdered 1 1 - - - Gin 4 3 1 1 - Ginger Ale 1 1 - - - Ginger Beer 2 2 - - - Ginger, Ground 1 1 - - - Glycerin 1 1 - - - Glycerin, Pure redistilled 1 1 - - - Golden Raising Powder 2 2 - - - Golden Syrup 2 2 - - - Grapefruit Squash 1 1 - - - Gravy Powder 3 3 - - - Gravy Thick 1 1 - - - Ground Ginger 3 3 - - - Ground Mixed Spice 1 1 - - - Jam 5 5 - - - Junket Powder 2 2 - - - Kaolin 1 1 - - - Lard 1 1 - - - Lemonade 3 3 - - - Lemonade Powder 2 2 - - - Lemon Flavouring 1 1 - - - Lemon Squash 2 2 - - - Liver Sausage 2 2 - - - Live Yeast Tablet 5 gr 1 1 - - - Luncheon Meat 1 1 - - - Macaroni 4 4 - - - Margarine 3 3 - - - Marmalade 1 1 - - - Meat Mixed 1 1 - - - Meat Paste 3 3 - - - Meat Pies 1 1 - - - Meat and Vegetable Ration 1 1 - - - Medicinal Paraffin 2 1 1 1 1 Milk 250 245 5 - - Minced Beef 1 1 - - - Mixture, Barley Pudding 1 1 - - - „ Cake and Pudding 1 - 1 - - Mustard Mixture 2 2 - - - Mustard Sauce 1 1 - - - Oatmeal 2 2 - - - Paste, Fish 1 1 - - - „ Meat 1 1 - - - Pearl Barley 4 4 - - - Peas 1 1 - - - Pepper 4 4 - - - Piccallilli 2 2 - - - Pickles 2 2 - - - Pineapple Conserve 1 1 - - - Carried Forward 457 449 8 2 1 129 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought Forward 457 449 8 2 1 Prepared Meal 1 1 - - - Pudding Powder 1 1 - - - Rice 1 1 - - - Rolled Oats 1 1 - - - Rum 5 5 - - - Saccharine Tablets 0.2 gr 1 1 - - - Sandwich Spread 1 1 - - - Salad Cream 1 1 - - - Sauce 1 1 - - - Sauce, Worcester 1 1 - - - Sausage, Breakfast 1 1 - - - „ Meat 2 2 - - - „ Vegetable 1 1 - - - „ Luncheon 3 3 - - - Sausages 8 7 1 1 1 „ Beef 2 2 - - - Semolina 5 5 - - - Semolina Pudding, Chocolate Flavour 1 1 - - - Soup 1 1 - - - „ Mock Turtle 3 - 3 - - „ Desiccated 1 1 - - - „ Mixed Vegetable 1 1 - - - „ Tomato 1 1 - - - „ Meat 1 - 1 - - „ Vegetable 1 1 - - - „ Powder 2 2 - - - Spice, Mixed 5 5 - - - Sponge Mixture 1 1 - - - „ „ Ginger 1 1 - - - Squash, Grapefruit 1 1 - - - „ Lemon 1 1 - - - „ Orange 1 1 - - - Stewed Steak 1 1 - - - „ „ Canned 1 - - - - Stuffing 2 2 - - - Suet, Beef Shredded 1 1 - - - Sugar 5 5 - - - „ Demerara 1 1 - - - „ Icing 1 1 - - - Sulphur, Milk of 1 1 - - - Sultanas 2 2 - - - Syrup of Figs, Compound 1 1 - - - Tea 4 4 - - - Vegetables in Gravy 1 1 - - - „ Mixed 1 1 - - - Vinegar, Distilled Malt 1 1 - - - „ Malt 3 1 2 - - Yeast and Beef Extract 1 1 - - - Whisky 4 4 - - - Yorkshire Pudding Mixture 1 1 - - - Yorkshire Pudding and Batter Mixture 1 1 - - - Yorkshire Relish 1 1 - - - Totals 549 534 15 3 2 130 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 8.1 9.2 9.4 1 1 - 3 13 26 74 64 45 18 4 - 1 MILK FAT (Legal standard is 3%) 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 4.1 4.2 2 - 18 19 37 49 42 40 23 10 4 4 - 4.3 4.4 4.5 4.6 4.7 - 1 1 - - Total samples of New Milk : 350. The samples of Milk for analysis were obtained as follows:- Country milk in course of delivery 4 On milk rounds 90 "Appeal to cow" samples 2 At Dairies 128 Taken at Institutions 23 Taken at Schools. 3 250 AVERAGE COMPOSITION OF NEW MILK SAMPLES. Solids not fat 8.72% Milk fat 3.49% Percentage of New Milk samples below legal standard : 2% 131 Adulterated Samples. The following is a detailed statement of the adulterated samples and the action taken : — No. Sample. Adulteration or Deficiency. Remarks. 1002. Milk 15 per cent. deficient in milk fat. Sampling Officer who took "Appeal to Cow" samples following these unsatisfactory results, was of the opinion that the fat deficiency was due to lack of efficient mixing prior to decanting. Producer warned. 1016. Milk 4 per cent. deficient in milk solids other than milk fat. 1010. Milk 1 per cent. added water. Vendor communicated with and unable to account for result. Repeat sample satisfactory. 1725. Milk 2 per cent. added water. Vendor communicated with and repeat sample was satisfactory. 2136 Sausages Deficient in meat content. Prosecution — Firm fined 20s. and £3 3s. costs. 1739. Meat Soup Deficient in meat content and protein. Stock appeared to have been manufactured before the Meat Products (Canned Soup and Canned Meat) — Control and Maximum Prices— Order, 1944, came into force. 1741. Vinegar, malt Contained added salt. Apparently, the Ministry of Food acquiesle in the addition of this salt. 806. do. do. do. 515. Milk 1 per cent. deficient in milk solids other than milk fat— Hortvet test consistent with but does not necessarily indicate a small percentage of added water. Vendors lommunicated with and further samples taken, which proved satisfactory. 1800. Mixture, Cake and Pudding . Partly decomposed, contained large numbers of dead flour mites. Informal sample taken at request of vendor — balance of stock at once withdrawn from sale. 132 No. Sample. Adulteration or Defilienry. Remarks. 1664. Mock turtle Soup (tinned) Deficient in Meat Solids according to the standard defined by the Meat Products, Canned Soup and Meat (Control and Maximum Prices) Order, 1944. This article is, in the opinion of the Analyst, a meat soup. This matter was reported to the Ministry of Food Divisional Office, and, after investigation, they decided to treat this as an isolated case, and no further action was taken. 1669. do. (Informal) 1263. do. 36. Gin Contained 4.8 per cent. excess water. Prosecution — Case dismissed on a point of law. 15 Medicinal Liquid Paraffin Conformed to the tests for light Liquid Paraffin, but not the liquid paraffin of the British Pharmacopoeia. Prosecution — Firm fined £10 and costs. 133 County Borough of Croydon ANNUAL REPORT of the SCHOOL MEDICAL OFFICER For the Year ending December 31st, 1945. Ladies and Gentlemen, I have pleasure in presenting for your consideration my report as School Medical Officer. This is the eighteenth annual report I have had the honour to present to you, and the fortysixth of the yearly series dealing with the School Medical work of the Borough. 134 Cost of the School Health Service. The gross cost of the medical, denial and nursing services was £15,775. The rateable value of the Borough as at 1st April, 1945, was £2,505,211. The Government grant is 44.15 per cent. of the expenditure, hence the actual cost to the rates was £8,810, i.e., a rate of 0.84 pence. The figures to not include £300 for Medical Inspection (Higher Education). Cost of Special Schools. Schools maintained by the Council, £7,068; contributions to schools under other authorities, £4,247. Income from parents' contributions and other receipts, £704, giving an actual cost of £10,611, of which £5,926 was payable out of local rates, i.e., a rate of 0.57 pence. Cost of Milk and Meals. Meals and milk cost £33,150, including wages, fuel, printing, etc. On this expenditure the Government now make a grant of 100 per cent. for expenditure on milk, and 74.15 per cent. of the expenditure upon meals. School Population. The average number of children on the School Registers. excluding any evacuated children, is shown below:— Schools No of Departments Number on the Registers Average attendance Average attendance per cent SECONDARY SCHOOLS Council Boys 7 1322 1125 85 Girls 9 1920 1666 87 Mixed 6 1404 1270 90 22 4646 4061 87 Voluntary Boys 1 215 198 92 Girls 1 74 69 93 5 .289 267 92 135 Schools No. of Departments Number on the Registers Average attendance Average attendance per cent PRIMARY SCHOOLS Council Senior and Junior Boys 1 313 274 88 Senior and Junior Girls 1 296 250 84 Senior and Junior Mixed 2 722 642 90 Junior Boys 7 1932 1487 77 Junior Girls 5 1304 1175 90 Junior Girls and Infants 3 1289 1098 85 Junior Mixed and Infants 11 4400 3709 84 Infants 14 3212 2540 79 44 13468 11175 83 Voluntary Senior and Junior Boys 1 189 165 87 Senior Mixed and Infants 4 1058 856 81 Junior Girls and Infants 2 410 338 82 Junior Mixed and Infants 4 745 608 82 Infants 2 159 121 76 13 2561 2068 81 SPECIAL SCHOOLS Council Mixed 3 201 175 87 GRAMMAR AND TECHNICAL SCHOOLS Boys 1 570 513 90 Girls 1 560 504 90 Boys 1 307 290 94 Girls 1 538 500 93 Boys 1 124 111 89 5 2099 1918 91 Medical Inspection in Schools. A total of 7,814 children were examined as compared with 4,303 in 1944, and 5,064 parents attended the examinations. The percentage attendance of parents in the Entrants' group was for boys 85.3 per cent.; and girls 85.6 per cent.; in the Intermediate group, boys 63.8 per cent., girls 75.5 per cent.; and in the Leavers' group, boys 35.3 per cent., girls 46.1 per cent. The total percentage of parents attending was 64.8 as against 65.7 last year. 920 specials and re-inspections were made. 136 PARENTS PRESENT, 1945 Entrants Intermediate Leavers Other Ages TOTAL Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M F. M. F. Ashburton 28 8 26 3 7 8 6 ... 19 23 16 17 ... ... ... ... 54 39 Aldington Village 17 27 14 24 33 20 28 7 ... ... ... ... ... ... ... ... 50 47 Benson 99 76 88 73 58 43 38 42 5 5 5 4 ... ... ... ... 162 124 Beulah 102 98 92 87 119 1 80 ... ... ... ... ... 24 ... 20 ... 245 99 Croydon British ... ... ... ... ... ... ... ... ... 50 ... 26 ... ... ... ... ... 50 Cypress 9 8 9 7 1 23 1 19 ... ... ... ... ... ... ... ... 10 31 Davidson 21 29 16 19 ... ... ... ... 22 23 7 10 ... ... ... ... 43 52 Duppas ... 9 ... 9 65 67 22 42 ... ... ... ... ... ... ... ... 65 76 Ecclesbourne 28 39 24 36 17 ... 4 ... ... 59 ... 24 ... ... ... ... 45 98 Elmwood 51 45 41 39 99 3 58 3 49 ... 24 ... ... ... ... ... 199 48 Gonville 36 33 30 31 33 41 24 34 ... ... ... ... ... ... ... ... 69 74 Howard 44 26 34 17 36 32 20 23 ... ... ... ... ... ... ... ... 80 58 Ingram 19 5 18 4 ... ... ... ... 21 61 8 30 ... ... ... ... 40 66 Kensington 41 45 36 43 10 13 9 8 ... ... ... ... ... ... ... ... 51 58 Kingsley 94 69 77 59 127 86 87 63 ... ... ... ... ... ... ... ... 221 155 Lanfranc ... ... ... ... ... ... ... ... 122 97 32 56 ... ... ... ... 122 97 Monks Orchard 43 55 39 50 50 35 41 35 ... ... ... ... ... ... ... ... 93 90 New Addington 65 39 55 33 55 39 39 33 32 35 15 19 ... ... ... ... 152 113 Norbury Manor 69 80 64 72 25 ... 11 ... 45 ... 14 ... ... ... ... ... 139 80 Oval ... ... ... ... 71 25 42 20 35 26 13 11 ... ... ... ... 106 51 Portland 60 53 59 47 13 ... 7 ... 72 60 22 41 ... ... ... ... 145 113 Purley Oaks 47 69 38 56 25 26 17 15 22 26 10 11 ... ... ... ... 94 121 Rockmount 14 7 14 7 ... ... ... ... 15 5 7 ... ... ... ... ... 29 12 South Norwood 29 20 23 17 110 20 65 14 ... ... ... ... ... ... ... ... 139 40 Sydenham 45 66 36 54 79 52 54 38 ... ... ... ... ... ... ... ... 124 118 Tavistock 30 42 24 34 ... ... ... ... 46 75 20 28 ... ... ... ... 76 117 Waddon 16 9 7 7 17 19 9 4 72 58 18 24 11 8 7 6 116 94 West Thornton 90 61 74 50 64 62 44 43 ... ... ... ... ... ... ... ... 154 123 Whitehorse Manr. 65 28 56 25 ... 45 ... 40 44 ... 7 ... ... ... ... ... 109 73 Winterbourne 86 98 77 90 63 42 46 32 ... ... ... ... ... ... ... ... 149 140 Woodside 58 80 51 65 101 62 55 50 ... ... ... ... ... ... ... ... 159 142 Heath Clark ... ... ... ... ... ... ... ... 24 140 4 43 ... ... ... ... 24 140 St. Luke's ... ... ... ... ... ... ... ... ... ... ... ... 11 8 5 3 11 8 All Saints' 13 13 10 11 9 4 9 3 ... ... ... ... ... ... ... ... 22 17 A. Tenison's Gls. ... ... ... ... ... ... ... ... ... 18 ... 14 ... ... ... ... ... 18 Christ Church 9 15 9 13 37 32 23 27 ... ... ... ... ... ... ... ... 46 47 Parish Church 16 12 12 10 ... 17 ... 15 45 ... 16 ... ... ... ... ... 61 29 St. Andrew's ... ... ... ... 27 17 23 13 ... ... ... ... ... ... ... ... 27 17 St. Joseph's 10 15 2 8 13 10 7 5 6 7 1 2 ... ... ... ... 29 32 St. Mark's ... ... ... ... ... 17 ... 8 ... ... ... ... ... ... ... ... ... 17 St. Mary's 13 12 9 8 13 10 8 7 6 13 3 4 ... ... ... ... 32 35 St. Peter's 13 12 11 7 ... ... ... ... ... ... ... ... ... ... ... ... 13 12 St. Saviour's ... ... ... ... 13 13 7 11 ... ... ... ... ... ... ... ... 13 13 Shirley 26 19 24 17 34 38 25 32 ... ... ... ... ... ... ... ... 60 57 A. Tenison's Bys. ... ... ... ... ... ... ... ... 113 ... 32 ... ... ... ... ... 113 ... Selhurst Gram. ... ... ... ... ... ... ... ... 315 240 128 110 ... ... ... ... 315 240 Sch. of Building ... ... ... ... ... ... ... ... 93 ... 28 ... ... ... ... ... 93 ... John Ruskin ... ... ... ... ... ... ... ... 144 ... 53 ... ... ... ... ... 144 ... Lady Edridge ... ... ... ... ... ... ... ... ... 290 ... 130 ... ... ... ... ... 290 1406 1322 1199 1132 1424 922 909 696 1367 1311 483 604 46 16 32 9 4243 3571 2728 2331 2346 1605 2678 1087 62 41 7814 PERCENTAGE OF PARENTS PRESENT AT MEDICAL EXAMINATIONS Entrants Boys 85.3 85.5 Girls 85.6 Intermediate Boys 63.8 68.4 64 8 ,, Girls 75.5 Leavers Boys 35.3 ,, Girls 46.1 40.6 Other Ages Boys 69.6 66.1 ,, Girls 56.3 187 Uncleanliness. Number of children inspected for Cleanliness (first inspection) 7,529 Number of children inspected (subsequent inspections) 2,669 Number of children found unclean (first inspection) 1,223 (2,089 occasions of infestation). Number of occasions in which children found unclean (subsequent inspections) 903 At the primary inspections vermin were found in 211 and nils alone in 1,878 children. On these inspections, 4.4 per cent. of the children showed evidence of infestation as against 3.8 in 1944. Tuberculosis in Children of School Age. Contacts among school children kept under supervision during 1945— Number of cases under observation at beginning of 1945 371 Number of cases added during year 24 Number of cases discharged from observation during the year 5 Number of cases under observation at the end of 1945 390 Taking the total Local Authority school population as 23,984, the pulmonary tuberculosis incidence rate was 37.5 per 100,000. There were no deaths from pulmonary tuberculosis. For nonpulmonary tuberculosis the mortality rate was 10.7 and the incidence rate 83.4. CAUSES OF DEATH IN CHILDREN OF SCHOOL AGE. School population 31,000. Number of deaths 22, which is equal to a death-rate of 0.7 per 1,000. The deaths were due to: Tuberculosis 4 Cerebro Spinal Meningitis 1 Diphtheria 1 Dysentery 1 138 Pneumonia 1 Cancer 1 Appendicitis 1 Diabetes 1 Peritonitis 1 Diseases of the Heart 2 Leukaemia 2 Interssusception 1 Accidental Blow on Head 1 Road Traffic Accidents 4 VISION. Extent of Defect. Intermediate. Leavers. Total. Boys. Girls. Boys. Girls. Boys. Girls. No. % No. % No. % No. % % % Norma! : R 1372 90.3 878 95.2 1298 94.9 1220 93.1 95.7 94.0 6/6ths or 6/9ths L 1373 93.4 880 95.4 1290 94.4 1221 93.1 95.4 94.1 6/12ths or 6/24ths R 47 3.3 35 3.8 50 3.7 84 6.4 3.5 5.3 L 45 3.2 38 4.1 66 4.8 74 5.6 4.0 5.0 6/36ths or worse R 5 0.4 9 1.0 19 1.4 7 0.5 0.8 0.7 L 6 0.4 4 0.5 11 0.8 16 1.3 0.6 0.9 TEETH. Entrants. Intermediate. Leavers. Boys. Girls. Boys. Girls. Boys. Girls. No. % No. % No. % No. % No. % No. % Perfect set of Teeth 1172 83.4 1055 79.8 1231 86.4 793 86.0 1256 91.9 1221 93.1 One to four Decayed 166 11.8 168 12.7 132 9.3 90 9.8 98 7.2 59 4.5 Four or more Decayed 68 4.8 99 7.5 61 4.3 39 4.2 13 0.9 31 2.4 Totals 1406 1322 1424 922 1367 1311 139 HEIGHTS AND WEIGHTS. 1945. The following Statistics give a Summary of the findings. BOYS. GIRLS. Year of Birth. Number Examined. Average Height in inches. Average Weight in lbs. Average maximum Height in inches. Average maximum Weight in lbs. Average minimum Height in inches. Average minimum Weight in lbs. Number Examined. Average Height in inches. Average Weight in lbs. Average maximum Height in inches. Average maximum Weight in lbs. Average minimum Height in inches. Average minimum Weight in lbs. 1940 531 43.3 44.0 46.1 50.2 40.7 38.0 540 43.3 43.1 46.0 50.6 40.5 36.9 1939 670 45.1 47.1 48.0 54.4 41.7 40.3 643 44.7 45.5 48.6 53.3 42.1 39.0 1938 157 46.8 50.5 48.6 56.0 44.3 44.0 180 47.3 50.4 48.4 54.0 44.3 42.7 1937 321 49.2 56.5 53.0 66.1 47.2 50.0 273 49.1 54.4 52.2 64.3 46.5 47.2 1936 642 51.3 60.5 55.2 71.7 47.8 50.7 466 50.7 58.8 54.0 71.3 47.2 48.7 1935 388 53.2 66.3 57.4 81.3 50.0 55.3 188 52.6 64.7 55.4 76.1 49.1 54.3 1934 249 55.9 74.8 60.5 91.6 52.2 61.0 118 56.1 78.0 58.5 96.4 53.7 67.6 1933 169 57.2 79.3 60.8 96.1 54.2 69.8 174 58.5 85.5 62.1 105.6 55.0 69.5 1932 601 58.5 87.0 63.3 115.3 54.2 69.5 618 59.0 90.7 64.0 117.8 54.2 68.3 1931 255 61.3 100.0 66.6 132.6 56.8 78.4 255 61.9 104.6 65.0 125.3 57.6 80.2 1930 80 65.4 120.5 70.0 153.2 58.6 89.3 111 62.8 118.4 66.0 127.9 60.0 95.8 1929 56 67.6 127.2 71.7 150.6 64.4 109.0 131 64.4 121.2 67.3 148.7 60.4 100.3 1923 11 67.3 131.2 71.0 153.0 65.5 119.5 39 64.5 125.6 67.0 143.7 60.9 106.8 140 RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 1945. Defects. Boys. Girls. No. requiring Treatment. No. referred for Observation. Percentage of total Examined. No. requiring Treatment. No. referred for Observation Percentage of total Examined. Ma lnutrition 307 5 7.35 243 5 6.94 Uncleanliness- Head 4 - 0.09 10 2 0.34 Body Skin Disease 30 - 0.71 24 1 0.70 Eyn Disease— Defective Vision 198 42 5.65 218 17 6.58 Squint 105 28 3.13 94 18 3.14 External Eye Trouble 26 4 0.71 20 2 0.62 Ear Disease— Deafness 7 5 0.28 7 2 0.25 Otitis Media 1 2 0.07 3 1 0.11 Other Disease 2 4 0.14 5 1 0.17 Nose and Throat— Enlarged Tonsils only 86 190 6.50 46 112 4.42 Adenoids only 17 9 0.61 12 8 0.56 Enlarged Tonsils and Adenoids 218 102 7.54 213 96 8.65 Other Conditions 130 53 4.31 147 35 5.10 Enlarged CervicalGlands(notT.B.) 4 18 0.52 2 5 0.20 Dental Defects 142 2 3.39 90 4 2.63 Speech Defects 18 5 0.54 8 1 0.25 Heart and Circulation— Organic 10 27 0.87 2 16 0.50 Functional 6 57 1.48 4 8 0.34 Anaemia 62 6 1.60 37 2 1.09 Bronchitis 14 13 0.64 8 4 0.34 Other Non- T.B. 16 20 0.85 4 9 0.36 Pulmonary Tuberculosis 16 8 0.57 8 2 0.28 Other Tuberculosis 3 9 0.28 1 3 0.11 Nervous System Disorders (including Epilepsy, chorea, etc.) 8 35 1.01 6 44 1.40 Deformities— Rickets 5 - 0.12 - - - Spinal Curvature 76 8 1.98 99 5 2.91 Others 130 29 3.75 154 27 5.07 Other Defects and Diseases 32 27 1.39 53 9 1.74 Totals 1673 708 1518 439 Total Children Examined 4243 3571 141 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS, 1945. (Percentages.) Condition. Entrants. Intermediate. Leavers. Other Ages. All Groups. Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Cleanliness: (Percentage Clean) Head 99.9 99.6 99.4 98.1 100.0 9.89 100.0 100.0 99.8 99.0 Body 99.8 99.8 99.9 99.5 99.9 100.0 100:0 100.0 99.9 99.8 Clothing (satisfactory) 99.7 99.7 99.9 99.7 98.7 98.5 100.0 100.0 99.4 99.2 Footgear (satisfactory) 99.9 99.8 99.5 99.7 98.7 98.5 100.0 100.0 99.4 99.3 Nutrition (normal) 84.5 84.8 88.5 88.2 91.4 93.4 89.1 87.5 88.1 88.9 Delects: Circulatory System 8.7 8.5 4.5 5.4 7.2 8.8 10.9 6.2 6.8 7.8 Pulmonary System 4.0 2.7 2.4 1.6 3.6 1.0 - - 3.3 1.8 Skin Diseases 2.6 1.4 1.4 1.6 2.1 4.0 2.2 - 2.1 2.4 Defects of Nose and Throat 38.6 35.2 18.2 25.1 17.6 15.0 26.1 31.2 24.9 25.1 Enlarged Cervical Glands 12.9 15.3 8.4 10.8 3.3 4.0 6.5 - 8.2 9.9 External Eye Disease 0.9 0.5 1.1 1.4 1.3 1.4 4.4 - 1.2 1.9 Defective Vision 7.3 5.4 8.9 12.0 11.2 12.9 6.5 - 9.1 10.0 Defective Hearing 0.5 0.3 0.1 0.4 0.6 0.4 2.2 - 0.4 0.4 Speech Defects 1.6 1.3 1.4 0.7 0.3 0.2 - - 1.1 0.7 Dental Disease (more than four decayed) 4.8 7.5 4.3 4.2 1.0 2.4 - - 3.3 4.7 Dull and Backward 0.3 0.6 0.6 0.5 0.2 0.2 17.4 6.2 0.5 0.5 Taking all the groups examined, subnormal nutrition was recorded in 11.5 per cent of the children as contrasted with 11.8 per cent, in 1944. CHIEF CAUSES OF EXCLUSIONS FROM SCHOOL. Condition. Exclusions during 1945. Percentage of total exclusions. Exclusions during 1944. Percentage of total exclusions. Ringworm 24 0.90 27 0.89 Verminous Conditions 605 22.75 665 22.04 Impetigo 106 3.99 90 2.98 Scabies 263 9.89 185 6.13 Scarlet Fever 209 7.80 146 4.84 Measles (inc. German) 697 20.21 601 19.92 Diphtheria 19 0.71 6 0.20 Whooping Cough 155 5.83 320 10.66 Chicken Pox 196 7.37 529 17.87 Mumps 237 8.91 115 3.81 External Eye Disease 24 0.90 93 3.08 Sore Throat 12 0.45 22 0.73 Other Causes 112 4.21 208 6.89 Total 2659 - 3017 - The figures for exclusions are not related in any way to the figures obtained in routine medical inspections. These figures show an increase in Impetigo, Scabies, both skin conditions, which are often associated with overcrowding and unclean surroundings. Also an increase in Measles, Scarlet Fever and Mumps, and a very slight increase in Diphtheria. Whooping Cough, and External Eye Disease showed a decrease. 142 CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS. Name of School. School Population. Measles. German Measles. Whooping Cough. Chicken Pox. Mumps. Scabies. Impetigo. Ringworm. Diphtheria. Scarlet Fever. Dysentery. Cerebra-spinal Meningitis. Poliomyelitis. Jaundice. Conjunctivitis. Sore Throat. Indefinite Sickness. | | III. Not Infectious Percentage incidence of conditions notified in school Ashburton 670 29 ... 2 3 19 ... 2 1 1 4 ... ... ... ... 1 ... 1 ... 9.4 Benson 542 4 ... ... 28 ... ... 1 ... ... 4 ... ... ... ... ... ... ... ... 6.8 Beulah 1023 59 ... 13 2 51 11 10 2 1 8 ... ... ... ... ... 1 11 16.5 Croydon British 152 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 0.7 Cypress 349 13 ... ... ... 1 3 2 ... ... 6 ... ... ... ... ... ... 1 ... 8.3 Davidson 622 14 ... 5 19 2 7 ... 2 1 9 ... 1 ... 2 ... 1 2 ... 10.5 Duppas 465 15 ... ... ... 1 15 ... 1 ... 8 ... ... ... ... 4 1 5 ... 10.8 Ecclesbourne 650 47 1 9 27 7 17 2 ... ... ... 1 ... ... ... ... ... ... ... 17.1 Elmwood 951 2 ... 4 ... 7 6 2 2 2 4 ... ... ... 2 3 ... 7 ... 4.3 Gonville 385 43 ... 11 5 2 ... ... ... 1 5 ... ... ... ... ... ... ... ... 17.4 Howard 302 10 ... ... ... ... 2 ... ... ... 2 ... ... ... ... ... ... 1 ... 4.9 Ingram 463 21 ... 7 4 7 8 2 ... 3 2 ... ... ... ... ... 2 1 ... 12.3 Kensington 382 12 ... 14 6 ... 1 4 ... ... ... ... ... ... ... ... ... ... ... 9.7 Kingsley 637 41 ... 15 5 3 5 3 3 l 6 ... ... ... ... ... ... ... ... 12.9 Lanfranc 641 2 ... ... 1 1 10 2 3 ... ... ... ... ... ... 2 ... 4 1 4.1 Monks Orchard 313 1 ... 1 4 ... 1 ... ... ... 14 ... ... ... ... ... ... ... ... 6.7 New Addington 728 ... ... ... 2 ... ... 1 ... 1 20 ... ... ... ... ... ... ... ... 3.3 Norbury Manor 912 3 ... 1 3 3 3 2 ... ... 10 6 ... ... ... ... ... 4 ... 3.8 Oval 677 22 ... 1 ... 4 9 1 ... 1 13 1 ... ... 3 ... 2 4 ... 9.0 Portland 594 23 ... 11 2 3 6 7 ... 1 9 ... ... ... ... 1 ... 1 ... 10.8 Purley Oaks ... 618 4 ... ... ... 2 8 1 ... ... 2 ... ... 1 ... 3 ... 2 ... 3.7 Rockmount 435 3 1 ... ... 18 3 2 ... ... 3 ... ... ... ... ... ... ... ... 6.9 South Norwood 878 24 7 5 ... 12 10 3 1 3 5 1 ... ... ... ... ... ... 1 8.2 Sydenham 602 26 1 1 6 4 16 8 ... ... 4 ... ... ... ... 1 ... 8 ... 12.5 Tavistock 497 16 ... 3 7 5 14 3 ... ... 3 ... ... ... ... ... ... 7 1 11.9 Waddon 705 5 ... ... ... 1 14 4 ... ... 6 ... ... ... ... 6 3 4 1 6.2 W. Thornton 709 58 ... 13 ... 15 23 7 7 ... 7 ... ... ... ... ... ... 1 ... 18.5 Whitehorse 703 26 ... 4 5 ... 19 13 ... ... 1 ... ... ... ... ... ... 1 ... 9.8 Winterbourne 790 19 ... ... 2 2 4 3 2 ... 2 ... 1 ... ... ... ... ... ... 4.4 Woodside 777 68 1 4 ... 48 7 6 ... ... 6 ... ... ... ... 1 ... ... ... 18.1 Lady Edridge 380 ... ... ... ... ... 5 ... ... ... ... ... ... ... ... ... ... 2 ... 1.8 Heath Clark 356 ... ... ... 1 ... ... 2 ... ... 1 ... ... ... ... ... ... ... ... 1.1 Arch. Ten. (Bys) 215 ... ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1.4 Adn. St. Mary's 133 2 1 2 10 5 4 1 ... 1 4 ... ... ... ... 1 ... 1 ... 24.0 All Saints 141 8 1 1 ... 1 2 2 ... ... 2 ... ... ... ... ... ... ... 1 12.8 Arch. Ten. (Gls) 74 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1.4 Christ Church 303 21 ... 8 1 2 1 2 ... 2 2 ... ... ... 1 ... 1 2 1 14.6 Parish Church 452 16 ... ... ... ... ... 2 ... ... 4 ... ... ... ... 1 ... 4 ... 6,0 St. Andrew's 386 ... ... 2 25 1 8 3 ... ... 7 ... ... ... ... ... 1 1 ... 12.5 St. Joseph's 240 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 0.8 St. Mark's 147 7 ... 5 ... 7 ... ... ... ... 3 ... ... ... ... ... ... 1 ... 15.7 St. Mary's(R.C.) 368 ... ... 10 22 ... 1 ... ... ... ... ... ... ... ... ... ... 2 ... 9.5 St. Peter's 82 11 ... 2 ... 1 ... ... ... ... 2 ... ... ... 1 ... ... ... ... 20.8 St. Saviour's 124 ... ... ... ... ... 11 2 ... ... 1 ... ... ... ... ... ... 1 ... 12.1 Shirley 185 5 1 1 1 ... ... ... ... ... 3 ... ... ... ... ... ... ... ... 5.9 St. Christophers 114 2 ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 4.4 St. Giles' 65 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 3.1 St. Luke's 22 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 4.5 Coloma 528 ... ... ... ... ... ... ... ... ... 9 ... ... ... ... ... ... 1 ... 1.9 Selhurst Gram. 1123 ... ... ... 1 ... ... ... ... ... 4 ... ... ... ... ... ... ... ... 0.4 John Ruskin 304 ... ... ... 1 ... ... ... ... ... 3 ... ... ... ... ... ... ... ... 1.3 School of Bldg. 136 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1.5 Totals 683 14 155 196 237 263 106 24 19 209 9 2 1 9 24 12 81 6 697 1944 124 477 320 539 115 185 90 27 6 146 ... 4 ... 52 93 22 145 1 601 As compared with 1944 there were increases in cases notified by teachers with regard to Measles, Mumps, Scarlet Fever, Scabies, Impetigo. Decreases in Whooping Cough, Chicken Pox and Conjunctivitis. 140 School Visits. The following Table summarises the visits paid to schools by the Health Visitors, etc., in connection with these duties: — Visits to School Departments re Cleanliness 539 Visits re Scabies 2 Visits re Infectious Disease 62 Visits re Medical Inspections 392 All other reasons 581 Home Visits. Concerning defects found at routine medical inspections 959 Subsequent visits re defects found at routine medical inspections 265 Visits re special cases 831 Visits to dental cases 48 Visits following other inspections 1,835 Visits in connection with infectious cases (including 302 visits concerning uncleanliness) 6,975 TREATMENT. The Work of the School Clinics. SUMMARY OF ATTENDANCES. 1945. 1944. Increase or Decrease. Minor Ailments Clinic 12444 10927 + 1517 Inspection Clinic 1939 1694 + 245 Dental Clinics 16017 12887 + 3130 Ophthalmic Clinic 3364 3170 + 194 Orthopaedic Clinic 599 434 + 165 Remedial Exercises Clinic 7995 5000 + 2995 Nose and Throat Clinic 2239 836 + 1403 Rheumatism Clinic 62 33 + 29 44659 34981 + 9678 The general increase in the number of attendances was not due to an increase in the percentage incidence but to the much greater number of children who were dealt with subsequent to return from evacuation. 144 The Minor Ailments Clinics. At the Lodge Road Clinic, 1,183 defects involved 4,323 attendances, while at the subsidiary Clinics held at 206, Selhurst Road on five days weekly, 693 defects 3,046 attendances, and at the Duppas School 729 defects 5,075 attendances. Complaint. 1945 1944. Cases. Attendances. Average No. of Attendances. per case. Cases. Attendances. Average No. of Attendances. per case. Ringworm of Scalp 17 243 14.3 6 75 12.5 „ „ Body 110 982 8.9 95 785 8.3 Scabies 301 841 2.8 571 1527 2.7 Impetigo 231 1280 5.5 291 1156 3.9 Other Skin Diseases 201 665 3.3 268 782 2.9 Otorrhœa and other Ear defects 158 833 5.3 195 774 4.0 External Eye Disease 324 1435 4.4 201 1036 5.1 Miscellaneous 1263 6165 4.9 1102 4792 4.3 2605 12444 4.8 2729 10927 4.0 Adenoids and Enlarged Tonsils. During 1945 783 children were operated upon for adenoids and enlarged tonsils, and 2,239 attendances were made at the Throat Clinic. Treatment of Visual Defects. Number of defects dealt with. Spectacles prescribed Spectacles obtained. Under the Authority's Scheme. Submitted to refraction by private practitioner or Hospital apart from the Authority's scheme. Otherwise. Total. Under the Authority's Scheme. Otherwise. Under the Authority's Scheme. Otherwise. Errors of Refraction 1153 - 1153 743 - 779 - This Clinic showed an increase upon 1944 in numbers submitted in refraction. A total of 3,364 attendances was recorded. 145 SCHOOL DENTAL SERVICE. This Service deals not only with those attending Borough Primary, Central and Special Schools, but provision is also made for treatment to be obtained for a substantial number of scholarship and free-place pupils at Secondary and Grammar Schools. The present staff consists of six full-time Dental Officers. One member who has been with H.M. Forces has but recently been released, and did not re-commence his duties until 1st September, 1945. In addition to duties carried out for the Education Committee, the equivalent of one dental officer's time is devoted to work under the Maternity and Child Welfare Scheme. Arrangements for Treatment. Treatment is carried out at six Clinics. Four of these are situated in the Health Centre at Lodge Road, and work as a centralised unit: one of the above is, however, of a temporary character, and is intended to serve only until more appropriately placed premises can be established elsewhere. The remaining surgeries at South Norwood and Duppat Hill continue to render good service, but facilities at both are extremely limited, and it is hoped that, as soon as building permits, specially constructed premises will be available in these districts. Provision has lately been made for the establishment of two more branch clinics, first for the Woodside and later for the Addington areas. In the case of the former district prospective accommodation has been secured, but, at the time of writing, difficulties with reconstruction are hindering further developments. Staffing. Owing to the fact that the time of one dental officer is taken up exclusively with work in connection with the Maternity and Child Welfare Scheme, only five dental surgeons are in fact available for the care of the whole of the normal school population of about 25,000. Taking into account the inclusion of treatment for Secondary and Grammar Schools, provision for which has been made in the new Education Act (1945), present liabilities may be assessed as covering some 27,000 children, 146 Successive increases in the acceptance rate (now approximately 70 per cent.), plus the inclusion of large scale treatment for secondary schools, have now rendered obsolete the former Ministry of Education establishment of 5,000 children per clinic. On the basis of 3,000 per head now widely advocated, it is clear that considerable increase in professional staff will be required to achieve the badly needed annual inspection and treatment. Again impending developments on the part of Education Authorities, such as the raising of the school leaving age, the inclusion of treatment for adolescents, etc., will in time greatly increase the numbers now requiring to be dealt with. It is imperative, therefore, that in addition to the extra clinic now urgently required for the treatment of secondary schools, a progressive scheme of expansion extending over some years, should be considered by the Committee if these ever-increasing liabilities are to be met. Suggested Programme of Expansion. Excluding the present arrangements approved for the Woodside area, the plan of expansion explained in the preceding paragraph would work as follows :— 1946—Acquisition of 1 additional Dental Officer, plus Clinic and Staff. 1947 „ 1 ,, ,, ,, ,, 1948 ,, l or 2 ,, ,, ,, ,, Total : 3 or 4 Dental Officers, plus Clinics and Staff. Inspections. The number of children actually on the register at Borough Primary and Central Schools at the end of 1945 was 22,349, compared with approximately 16,000 the previous year. Unfortunately, many children returning from evacuation after their departments had been visited, received no inspection during the current year; but a certain number were dealt with after application had been received through Head Teachers, under the category of "specials." Of those on the register 15,735 were inspected and 9,695 (61.6 per cent.) referred for treatment, compared with 12,875 inspected and 8,047 (62.5 per cent.) referred in 1944. 147 The decrease of 0.9 in the percentage of those referred is interesting, hut this figure has varied considerably during recent years, and is influenced by the regularity with which inspections have been received. Some improvement has been suggested from time to time in the calcification of the enamel of the younger age groups, but in the main the incidence of caries continues to be high, and it is doubtful whether the implication suggested by the above figure can be regarded as permanent. In addition to those returning from evacuation, nine Departments, comprising some 2,400 children, owing to lack of time and staff received no inspection during 1945. The results obtained from school inspections were as follows:—Acceptance of Treatment, 70 per cent.; Refused Treatment, 13.4 per cent.; Forms Not Returned, 16.6 per cent. Such figures show an all round improvement and are, so far, the best results obtained. The following analysis shows the variations that have taken place in the acceptance rate during recent years :— RESULTS OF SCHOOL INSPECTIONS. 1945. 1944. 1943. 1939. 1937. No. referred for— Treatment 9695 8047 9041 5477 13498 Consents 6789 : 70% 5335:66.3% 5642 :62.4% 3430 : 63% 7762:57.5% (Total Consents *Including Specials) (8363 : 74%) (6320 : 70%) (6814 : 67%) (5215 :72%) (10146:63%) Refusals 1301 :13.4 % 1314 : 16.3% 1519 : 16.8% 996 : 18% 3242: 24% Forms Not Returned 1605 :16.6% 1398:17.4% 1880 : 20.8% 1051 : 19% 2494 :18.5% * Specials.— Those referred by Head Teachers with Emergency Forms Acceptance Rate. A rise of 3.7 per cent. is noted in the acceptance rate, the total now standing at 70 per cent., compared with 66.3 per cent. last year. Other figures (given above) obtained from inspections, are correspondingly good and in keeping with the general improvement noted in recent years. This upward trend in the acceptance rate places an increased strain on all personnel concerned, and calls for progressive expansion within the scheme. 148 Treatment. Of 8,368 children consenting to treatment (including specials) 6,706 (80.2 per cent.) were treated and 5,885 (70.3 per cent.) cured (completely), compared with 6,320 consenting, 5,275 (83.4 per cent.) treated, and 4,390 (69.4 per cent.) cured in 1944. The above results may be considered very creditable. The slight reduction in the percentage of those treated was due to the fact that though more children were examined than in the previous year, insufficient time was available for many to receive an appointment for treatment. Though sessions worked are only slightly more than those of 1944, treatment figures (tabulated below) show a consistent rise on those obtained during recent years. Appointments on the whole were well kept, but absenteeism in certain districts is still higher than could be wished, and thus continues to render administration difficult. Attendances rose from 8 to 9.9. per session : fillings from 4.2 to 5.3 per session. terns of Treatment. The ensuing Table gives particulars of the principal items of treatment compared with those obtained last year :— 1945. 1944. Attendances 16,017 12,887 Treated 6,706 5,275 Re-treated 3,161 2,719 Fillings—Permanent 5,674 5,257 Temporary 2,838 2,613 Extractions—Permanent 1,491 1,210 Temporary 8,473 6,099 Gas Administrations 3,133 2,120 Local Anesthetics 3,275 3,431 Other Operations—Permanent 6,117 4,529 Temporary 2,444 1,792 Cases Completed 5,885 4,390 149 Special Treatment. These include:— 1945. 1944 Root treatment in anterior teeth 35 16 Removal of nerves under local anæ sthetic. 13 10 Gingivectomy 1 4 Removal of bone sequestra — 3 Splints for fractured incisors 1 1 Number of M.D.'s treated 14 6 Dentures inserted 23 22 Irrigation of sockets 81. 25 Treatment of hæ morrhage 7 6 Removal of impacted and difficult teeth 4 10 Operation to labial fra?num — l Ulcerative stomatitis (Vincent's infection) 13 3 Cleft Palate — — Form from Head Teachers. The number of forms issued by Head Teachers for emergency treatment was 1,574 compared with 985 in 1944. The foregoing increase was due to urgent work required by children who returned from evacuation after their schools had received their dental inspection. Black lists of those not accepting treatment at inspections continue to be supplied to Teachers in Charge, together with instructions that unless an adequate reason be given, such children shall be precluded from obtaining "special" forms, should toothache subsequently intervene. Charges for Treatment. The sum of £119 13s. Od. was received in treatment fees during the earlier months of the year. In accordance with the provisions of the new Education Act all such charges have now been discontinued. X-Ray Examinations. The number of cases referred to Maydav Hospital for the above purpose was 162, compared with 169 in 1944. 150 Orthodontic Treatment. In spile of additional sessions being allocated to this highly specialised branch of treatment, more children continue to be referred than can possibly be dealt with in the time available. It is clear that cases of this type constitute a major problem in school dentistry: Should the prognosis appear reasonably good, every effort is made to deal with the deformity, and given early diagnosis and co-operation from the patient, exceedingly gratifying results have been obtained. In more difficult cases some amelioration of the condition is attempted, but here a balance has to be struck between the time available and the benefits likely to accrue. Treatment must of necessity be prolonged, as much depends on the ability to institute remedial measures during the period best calculated to produce the maximum physiological growth. As this works expands the Committee will have to consider at some future date the addition of a Specialist Orthodontic Surgeon, who, in the first instance, could be employed on a parttime basis. Treatment sessions devoted to the work were 215 against 190 last year. The following is a summary of treatment performed:— 1945. 1944. Cases under treatment 254 253 New Cases 160 85 Cases Completed 58 46 Attendances 2,369 1,826 Appliances—fixed 4 3 ,, removable 240 149 Treatment Sessions 215 190 Treatment of Scholarship Children. Figures for the year show a further increase in the amount of treatment performed for scholarship holders at Borough Secondary Schools. Such children attend with the greatest regularity and are extremely appreciative of services rendered. It is hoped, however, under the extended dental arrangements which will be required to implement the dental provisions of the Education Act, 1944, that inspection and treatment for all Secondary School children will be available. 151 A summary of the treatment performed is given below:— 1945. 1944. Attendances 821 375 New Cases Treated 189 81 Re-treated 100 38 Fillings—Permanent 597 207 Extractions—Permanent 230 52 ,,Temporary 123 30 Other Operations 193 62 "Gas" Cases 94 26 Local Anæ sthesia 77 31 Cases Completed 269 80 Root Fillings 7 3 Dentures Fitted 11 1 Referred X-Ray 11 16 Summary of Work Done at the Selhurst Road Clinic. 1945. 1944. Attendances 3,846 3,288 Extractions 2,022 1,801 Fillings 1,612 1,717 Other Operations 2,819 1,989 "Gas" Cases 648 479 Local Anaesthesia 237 335 Cases Completed 1,156 728 Sessions held: Inspection 23, Treatment 367, Gas 41. The average attendance at this Clinic per session is 10.5. Summary of Work Done at the Waldrons Clinic. 1945. 1944. Attendances 2,583 2,447 Extractions 1,381 1,054 Fillings 2,335 2,230 Other Operations 442 430 "Gas" Cases 420 335 Local Anæ sthesia 2,464 2,590 Cases Completed 1,019 816 Sessions held: Inspection 31, Treatment 336, Gas 42. The average attendance at this Clinic per session is 7.7. 152 DENTAL DEFECTS. (1) Number of children who were— (a) Inspected by Dental Officer: Year 1945. Year 1944. Aged 5—6 779 622 ,,6—7 1,875 1,486 „7—8 1,8031 1,495 „8—9 1,805 1,540 ,,9—10 1,762 1,496 „10—11 1,738 Total : 15,735 1,365 ,,11—12 1,510 1,193 ,,12—13 1,519 1,196 „13—14 1,532 1,265 „14—15 1,053 938 „15 up 359 277 Specials 1,574 985 17,309 13,858 (b) Found to require treatment 11,269 9,032 (c) Actually treated 6,706 5,275 (2) Half-days devoted to Inspection 138 134 Treatment 1,616 1,611 1,754 1,745 Number of Gas Sessions— Lodge Road 133 109 (by Dental Officers). Selhurst and Waldrons 83 60 216 169 Administrative Sessions 76 67 Orthodontic Sessions 215 190 (3) Attendances made by children for treatment 16,017 12,887 (4) Fillings— Permanent teeth 5,674 5,257 Temporary teeth 2,838 2,613 8,512 7,870 (5) Extractions— Permanent teeth 1,491 1,210 Temporary teeth 8,473 6,099 9,964 7,309 153 (6) Administrations of general anaesthetics for extractions 3,133 2,120 (7) Administrations of local anaesthetics for extractions 3,275 3,431 (8) Other Operations- Permanent teeth 6,117 4,529 Temporary teeth 2,444 1,792 8,561 6,321 Fillings per session 5.3 4.8 Extractions per session nitrous oxide 46 43 DIPHTHERIA IMMUNIZATION. Diphtheria Immunization has been carried out at the clinics and the assistance of the teachers and their co-operation has been much appreciated. The number of children between the ages of 5 and 15 years immunized against Diphtheria during the year was 281. This is, unfortunately, a decrease. Concentration is, however, being directed towards pre-school children. ORTHOPAEDIC WORK. Summary of Cases attending the Orthopaedic Clinic:— Cases on Books Jan. 1st, New Cases 31st Dec., 1945. Cases. Discharged. 1945. 181 190 189 182 338 children were seen by the Orthopaedic Surgeon and 599 attendances were made. SPINAL AND OTHER REMEDIAL CLINICS. 1946 1944 Attendances Sessions. Avatt. antes. Sessions. Avatt. Spinal 1,940 382 5.1 1,627 328 5.0 Massage 229 229 1.0 165 165 1.0 Flat Feet 2,476 264 9.4 1,951 207 9.4 Breathing 3,350 288 11.6 1,257 167 7.5 7,995 1,163 5,000 867 A substantial increase in these treatments has taken place during the year, especially in breathing exercises after operation for removal of enlarged tonsils and adenoids. This is a satisfactory feature showing an appreciation by parents of the value °f this post-operation training. 154 RHEUMATISM CLINIC. The total number of children whose names were on the " live " register at the end of 1945 was 179 (males 81, females 98). The working of this Clinic has been greatly interfered with by evacuation, and difficulties arose in renewing contact with returning evacuees. Appointments were made for 47 children, of whom 46 attended. Facilities for special investigations of patients attending the Rheumatism Clinic are available at the Mayday Hospital, and during the year two cases have been referred for further examination where this has been found desirable. Cases Examined at Rheumatism Clinic. 1942. 1943. 1944. 1945. Primary 9 38 9 32 Re-exams. 25 37 7 10 34 75 16 42 Primary Cases. Rheumatic 5 30 8 24 (75%) Non-Rheumatic 4 8 1 8 (25%) 9 38 9 32 Classification of Rheumatic Cases. Primary. Re-examinations. Males 16 2 Females 8 8 Total 24 10 Age when examined— Ages 5 6 7 8 9 10 11 12 13 14 15 16 Primary 2 1 - - 2 3 4 6 4 1 - 1 Re-exams. - 2 3 - 1 — 2 1 — 1 - — Grouping of Cases (C lassification of Dr. R. Miller). 1942. 1943. 1944 1945. Prim. Re's. Total. Mild and Potential 4 37 10 18 2 20 Definitely Active — 4 4 5 4 9 Quiescent 5 18 1 1 4 5 155 The Mild and Potential cases include those showing the first initial symptoms of "growing pains" in highly strung children. The "Definitely Active" group included cases with physical signs of rheumatic fever or chorea. "Quiescent Cases" are those which at a previous examination had shown signs of mild and potential rheumatism or of active rheumatism but which had now settled down and were no longer active. Primary Examinations. Amongst the 24 new cases the following Rheumatic manifestations were recorded:— Rheumatic pains 20 Chorea (suspected) 2 Carditis( definite) 4 Carditis (suspected) 3 Tonsillitis and Infected Tonsils 5 Sore Throat (but Tonsils and Adenoids removed) 1 Family Histories. Of the new cases, 13 gave a history of rheumatism in the family, G being histories of rheumatic fever in parents or brothers and sisters. Nervous Conditions. Recorded in 22 out of the 24 cases Highly strung 6 Headaches 3 Night terrors 1 Enuresis 3 Twitchings 2 Past history of Chorea or other nervous condition 3 Minor degrees of nervous disorders 4 Often a combination of more than one of the above symptoms was manifested. Re-examinations. Ten children were re-examined: 3 were worse, 2 showed no essential change, 2 were improved, and 3 were quiescent. 156 BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Blind Children. 3 boys are resident at special schools for the blind. The institutions which these children attend are as follows:—Birmingham Royal Institution, 1 boy; Worcester College, 1 boy; Court Grange, Abbotskerswell, Devon, 1 boy. Deaf Children. 6 boys and 6 girls are resident at special schools for the deaf. The institutions which these children attend are: Royal School for the Deaf, Margate, 3 boys and 2 girls; Brighton School for Deaf, 1 boy and 3 girls; St. John's Deaf Institution, Yorkshire, 1 boy; Rayner's School, Penn, 1 boy and 1 girl. Epileptic Children. One boy is at the Lingfield Epileptic Colony, Surrey.' Mentally Defective Children. . In addition to the day accommodation provided at St. Christopher's School, one girl is resident in the Monyhull Mental Defectives School, Birmingham; one girl at Allerton Priory, Liverpool. ST. CHRISTOPHER'S (M.D.) SPECIAL SCHOOL. I am indebted to the Head Teacher, Mr. L. Ramsden, for the following report:— The year 1945 has seen the end of the world conflagration and we, together with the. rest of the educational world, are now viewing our experiences of evacuation and schooling in air-raid shelters as reminiscences. The year commenced with 83 children on roll and ended with 114; a total increase of 31 children. The Intelligence Quotients of the scholars range from 42 to 86. Most of the children are unable to read, and in many cases do not know the sound of the letters when thev first arrive, but, j ' due to (he particularly individual attention, no educable child, who stays until the school leaving age, leaves without acquiring this most necessary knowledge. Several children have left us during the year and returned to the ordinary" elementary school. During the latter months Folk Dancing has been introduced and it is proving very popular under the able tuition of Miss Knight. 157 The provision of hot mid-day meals gives an opportunity for training in table manners and though, at present, we receive them from another school, we hope to have our own kitchen early in the new year. There have been several changes in the members of the staff during the year. Mr. Leonard Ramsden, of the Portland Senior Boys' School, took charge in September. Mr. Maynard has retired, and Mr. Care has been transferred to the Portland Handicraft Centre. Miss Knight has taken charge of Class III. Boys, and Mr. Thomas has filled the vacancy in the Handicraft Room. We look forward to 1946 and hope to record a steady improvement and many successes. The opening of an Occupational Centre for those of I.Q. 50 will relieve all of an arduous burden cheerfuly borne, and a corresponding acceleration in progress of those remaining. Physically Defective Children. In addition to physically defective children accommodated at St. Giles' Day Open-air School, the Education Authority have crippled children in the following special schools: The Heritage Craft School, Chailey, 1 girl; Henwick Hall, 2 boys; St. Martin's Orthopa?dic, 1 boy; Alexandra Hospital, Luton, 1 girl. Speech Defects Clinic. Total number of cases treated 115 ,, ,, ,, discharged 47 Number of cases still attending 68 Referred for physical treatment 12 Refered to Child Guidance Clinic 7 Number of stammerers treated— Dyslalia 44 Agenesis 13 Congenital Aphasia 5 Lisps 11 158 JUVENILE EMPLOYMENT RETURN. The following numbers of children were examined by the medical officers during 1945 as to their fitness to follow the parttime employment indicated:— 1945. 1944. 1943. 1942. 1941. Delivery of Goods for keepers 60 81 80 139 118 Delivery of Newspapers 90 167 139 179 200 Delivery of Milk 13 17 7 26 8 163 265 226 344 326 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT. Number of children who received, on the recommendation of the School Medical Officer— 1945. Bottles. 1944. Bottles. Free Milk 951 229,325 894 190,807 Issues. Issues. Free Malt and Oil 284 38,384 59 5,032 (N.B.—Milk and Malt and Oil are given on the recommendation of the School Medical Officer and are supplied free of cost.) All the milk supplied is pasteurised milk and the sources of supply are subject to the approval of, and constant supervision of the Medical Officer of Health. There has been a large increase in the amount of Malt find Oil ordered. This again is partly accounted for by the return of evacuated children. It is also due to anxiety on the part of the medical officers to safeguard the children's health under existing dietary restrictions. 159 CHILD GUIDANCE. ANALYSIS OF 1945 CASES Total No. of Cases: 107 Referred by Intelligence Result S.M.O. Juvenile Court and Police Education Dept. Others High Average Low 1mImproved No Improvement Parents uncooperative Others : Various action or advice Male 67 28 12 6 21 18 7 Boys not 28 classified 14 21 4 3 39 Female 40 24 1 1 14 10 4 Girls not 16 classified 10 19 2 2 17 160 NON-MAINTAINED SCHOOLS. The usual arrangements for the medical inspection of nonmaintained school children were continued in 1945; 534 children were examined, 242 boys and 292 girls. Table II. of Appendix B. gives the detailed findings. Yours faithfully, OSCAR M. HOLDEN, School Medical Officer. 101 APPENDIX A. MEDICAL INSPECTION AND TREATMENT RETURNS. Year Ended 31st December, 1945. TABLE I. MEDICAL INSPECTION OF CHILDREN ATTENDING MAINTAINED SCHOOLS. A—Routine Medical Inspections. (1) Number of Inspections: Entrants 2,728 Second Age Group 2,346 Third Age Group 2,678 Total 7,752 (2) Number of other Routine Inspections 62 Grand Total 7,814 B.—Other Inspections. Number of Special Inspections and Re-Inspections 13,348 TABLE II. Classification of the Nutrition of Children Inspected During the Year in the Routine Age Group. Number of [Children Inspected a. (Excellent) B. (Normal) c. (Slightly subnormal) D. (Bad) No. % No. % No. % No. % 7814 702 9.0 6210 79.4 897 11.5 5 0.1 TABLE III. Group I.- -Treatment of Minor Ailments (excluding Uncleanliness). Total Number of Defects treated or under treatment during the year under the Authority's Scheme 2605 Group ii.—Treatment of Defective Vision and Squint. Under the Authority's Scheme errors of refraction (including squint) 1153 Other defect or disease of the eyes (excluding those recorded in Group I) - Total 1153 No. of Children for whom spectacles were (a) Prescribed 743 (b) Obtained 779 162 Group III.—Treatment of Defects of Nose and Throat. Under the Authority's Scheme Received Operative Treatment 783 Received other forms of Treatment Total number treated 783 TABLE IV—Dental Inspection and Treatment. (1) Number of children inspected by the Dentist- (a) Routine age-groups 15735 (b) Specials 1574 (c) TOTAL (Routine and Specials) 17309 (2) Number found to require treatment 11269 (3) Number actually treated 6706 (4) Attendances made by children for treatment 16017 (5) Half-days devoted to: (7) Extractions: Inspection 138 Permanent Teeth 1491 Treatment 1616 Temporary Teeth 8474 Total 1754 Total 9965 (8) Administrations of general anaesthetics for extractions 3133 (6) Fillings: (9) Other Operations: Permanent Teeth 5674 Permanent Teeth 6117 Temporary Teeth 2838 Temporary Teeth 2444 Total 8512 Total 8561 TABLE V—Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurses or other authorised persons 9 (ii) Total number of examinations of children in the Schools by School Nurses or other authorised persons 50198 (iii) Number of individual children found unclean 1223 TABLE VI—Blind and Deaf Children. Number of totally or almost totally blind and deaf children who are not at the present time receiving education suitable for their special needs. The return should relate to all such children including evacuees resident in the Authority's area. 1. At a Public Elementary School 2. At an institution other than a Special School 3. At no School or Institution Blind Children Nil Nil Nil Deaf Children Nil Nil Nil 168 TABLE VII.—School Medical and Dental Staff. Proportion of whole time Name of Officer. devoted to School Health Public Health Service. S.M.O.—Holden, Oscar M., O.M., M.D., D.P.H 20% 80% D.S.M.O.'s (Te mp.) Fleming, Oerald Morris, M.A., M.B. B.Ch., D.P.H.7/11 4/11 (On active service). Nicol, Chas. G., M.B., B.S.(Lond.), M.R.C.S., L.R.C.P., D.P.H. 7/11 4/11 A.S.M.O.'s— Hobbin, Gordon Marnoch, M.B., Ch.B., D.P.H 7/11 4/11 (On active service.) Jenkin-Lloyd, Iris A., M.R.C.S., L.R.C.P., D.P.H. 2/11 9/11 Morrison, Rosa, M.B., Ch.B., D.P.H 5/11 6/11 Hegarty, Ellen Mackenzie, M.B., Ch.B., D.P.H 4/11 7/11 Collett, Suzanne, L.R.C.P., L.R.C.S., L.R.F.P.S. 4/11 7/11 Temporary Part-time Assistant A.s.M.O.'s— Vost, Katnleen, M.B., B.S., D.P.H., M.R.C.S., L.R.C.P. 1 /11 2/11 Archer, Marjorie G., M.R.C.S., L.R.C.P, 2/11 3/11 Specialist Part-time Medical Officers. Bookless, J. S., F.R.C.S. (Ophthalmic Surgeon) Rota of Two Local Medical Practitioners for surgical treatment of tonsils and adenoids. In addition there is a Consulting Physician, a Consulting Surgeon, a Consulting Laryngologist and Otologist, a Consulting Orthopaedic Surgeon, and a Consulting Pathologist, who are classified as Consultants to the Public Health Department and whose services are available for school medical cases if the need arises. Senior Dental Officer—Oliver, Percy Gerrard, L.D.S. 10/11 1/11 Oilier Dental Officers— Bryce, J. K. R., L.D.S Hills, W. A. S., L.D.S 11/11 Urbani, C. P., L.D.S Rosenblum, Sarah, L.D.S.,R.C.S. (Eng.), Dental Surgical Degree (Warsaw). (Temporary) School Nursing Staff (excluding Specialist Nurses such as Orthopaedic Nurses). Number of Officers. Aggregate of time given to S.M.S. work in terms of whole j time Officers. School Nurses 25 5/11 District Nurses — — Nursing Assistants — —- Dental Attendants 5 11/11 164 APPENDIX B. NON-MAI NT AIN ED SC HOOLS. Year ended 31s/. December, 1945. TABLE I. . RETURN OF MEDICAL INSPECTIONS. A.- Routine Medical Inspections. Year 1945. Year 1944. Age 11 or under 113 244 12 99 195 13 69 263 14 91 284 15 119 222 16 42 175 17 — 46 18 or over 1 3 Total 534 1,432 B.—Other Inspections. Year 1945. Year 1944. Number of Special Inspections 2 11 Number of Re-inspections 193 170 Total 195 181 Visits to Non-maintained Schools 28 67 165 NON-MAINTAINED TABLE II.—A.-Return of Defects Found by Medical Inspection in the Year ended 31st December, 1945. DEFECT OR DISEASE. Routine Inspections. Number of defects. Special Inspections Number of defects. Requiring treatment. Requiring to be kept under observation but not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment (I) (2) (3) (4) (5) Malnutrition 3 ... ... ... Uncleanliness. (See Table IV.—Group V.) Skin— Ringworm : Scalp ... ... ... ... Body ... ... ... ... Scabies 1 ... ... ... Impetigo ... ... ... • •• Other diseases (non tuberculous) 3 ... ... ... Eye- Blepharitis 2 ... ... ... Conjunctivitis ... ... ... Keratitis ... ... ... ... Corneal opacities ... ... ... ... Defective vision (excluding squint) 30 10 ... ... Squint 1 2 ... ... Other conditions ... ... ... ... Ear— Defective hearing 1 1 ... ... Otitis media ... ... ... ... Other ear diseases ... l ... ... Nose and Throat— Enlarged tonsils only 5 16 ... ... Adenoids only ... ... ... ... Enlarged tonsils and adenoids 1 3 ... ... Other conditions 3 1 ... ... Enlarged Cervical Glands (Non-Tuberculous) ... ... ... * ... Defective Speech ... ... ... ... Teeth—Dental Disease 24 ... ... ... Heart and Circulation— Heart Disease- Organic ... 4 ... ... Functional 2 6 ... ... Anaemia 1 ... ... ... Lungs— Bronchitis 3 1 ... Other non-tuberculous diseases 1 5 ... Tuberculosis— Pulmonary— Definite ... ... ... ... Suspected ... ... ... ... Non-pulmonary— Glands ... ... ... ... Spine ... ... ... ... Hip ... ... ... ... Other bones and joints ... ... ... ... Skin ... ... ... Other forms ... ... ... Nervous System— Epilepsy ... ... ... ... Chorea ... ... ... ••• Other conditions ... ... ... ... Deformities— Rickets ... ... ... ... Spinal curvature 4 1 ... ... Other forms 4 2 ... ... Other Defects and Diseases 1 2 ... 106 CONTENTS. A. PUBLIC HEALTH REPORT. page Abortion 92 Acts, Adoptive 110 Adulteration 131 Ambulance Servics 9, 33 Amusement Houses 112, 117 Animals, Keeping of 112, 116 Ante-Natal Clinic 91, 93 Babies Help Committee 89 Births 2, 4, 91 Blind Persons 106 Blood Transfusions 97 Blood Examinations 66 Borough Hospital 43 Byelaws and Regulations 110 Cancer 61 Cerebro-Spinal Meningitis 48 Chest Clinic 62 Closet Accommodation 109 Contacts, Tuberculosis 70 Committee 1 Cowkeepers 122 Convalescence 89 Croup 48 Dairies, Cowsheds & Milkshops 122 Deaths 2, 4, 6, 9 Dental Treatment—M. & C.W. 83 Diphtheria 46, 54 Disinfection 117 Disinfestation 118 Ditches 116 Drainage 116 Dysentery 48 Enteric Group 47 Erysipelas 47 Expectant Mothers 83, 91, 93 Extra Nourishment 66 Factories and Workshops Acts l1l, 114 Fertilisers and Feeding Stuffs Act 119 Foods 119, 127 Foods and Drugs Acts 111, 127 Foster-Mothers 89 Foster-Children 89 Gastro-Enteritis 48 Gynaecological Clinic 98 Health Visitors, Work of 87 Home Helps 33,89 Home Nursing 70 Homework 115 Hospitals 91 Hospital, St. Mary's (Maternity) 91 Houses Let in Lodgings 113 page Housing 109, 112 Housing Act 112 Ice Cream 126 Illegitimacy 2, 3, 4, 89 Immunisation Clinic 54 Infant Welfare Clinics 83, 88 Infant Mortality 3,77 Infectious Diseases 42 Inquests 4 Laboratory Work 9, 14, 50, 52, 94, 126 Local Acts 110 Lodging Houses, Common 113 Marriages 3 Massage 13 Maternity Homes 81 Maternity Homes, Registration 81 Mayday Hospital 10,91 Measles 47,48 Meat Inspection 120 Medical Help Record 80 Mental Deficiency13,99 Midwives 79 Midwives, Municipal 93 Midwives Act 79 Milk, Provision of 57, 122 Milk, Examination of 53, 122. 130 Milk, Tuberculous 123 Milkshops 122 Mortality in Childbirth 3, 76, 90, 98 Mothers' and Infants' Welfare Association 83 Mumps 48 Municipal Lodging House 114 Neo-Natal Deaths 79 Notification of Birth Acts 75 Nuisances 110 Nursing Arrangements 9 Nursing Homes 81 Obstetrical Unit90 Offensive Trades 116 _ Ophthalmia Neonatorum 77 Orthopaedic Department 101 Out of Borough Cases 48 Outworkers 115 Physiotherapy 94 Poisons and Pharmacy Act 118 Ponds 116 Poor Law Relief 32 Population 2 Post-natal Clinic 98 Post-mortems 14 Premature Infants 86 Puerperal Sepsis & Pyrexia 47, 76, 98 167 page Oueen's Road Homes 32 Rag Flock Acts 118 Rats and Mice (Destruction) Act 119 Rescue Home 89 Sanatorium, Cheam 73 Sanatoria, Treatment in 67 Sanitary Administration 109 Sanitary Certificates 114 Sanitary Inspectors, Work of 109 Scarlet Fever 45 Schools, Inspection of 115 Shop Hours Acts 112, 116 Slaughterhouses 120 Smoke Observation 117 Sputum, Examination 66 Still-Births 76 St. Mary's Maternity Hospital 91 Suicide 6, 9 Tuberculosis—Cheam Sanatorium 73 ,, Contacts 70 ,, Deaths 64 ,, Dental Treatment 70, 74 ,, Notifications 62 page Tuberculosis—Home Nursing 70 ,, Home Visits 70 „ Statistics 71 „ Pregnancy 93 ,, Pneumothorax 74 ,, Institutional Treatment 67 ,, Allowances 72 Unmarried Mothers 2, 3, 4, 89 Vaccination 56 Verminous Persons 118 Venereal Diseases 57, 94 Vital Statistics 2 War Damage 113, 114 Wartime Nurseries 82 Ward Statistics 5 Watercourses 112, 116 Water Supply 7 Whooping Cough 47 Workplaces 111 Workshops 1ll X-Ray Examination 12, 13, 66, 95 Zymotic Diseases 5 B.-SCHOOL MEDICAL REPORT. page Accommodation 134 Adenoids 144 Blind Children ... ... ... 156 Chjld Guidance ... ... 159 Cleansing of Children ... 137 Clinics 143 Clothing and Footgear ... 141 Cod Liver Oil ... ... 158 Cost 134 Crippling Defects ... ... 153 Deaf Children 156 Deaths 137 Defective Children ... 140, 156 Defective Hearing ... ... 156 Deformities 153 page Dental Disease ... ... ... 138 Dental Treatment ... 143, 145 Ear Disease ... ... ... 156 Epileptic Children ... ... 150 Exclusions ... ... 141, 142 Eye Clinic ... ... ... 143 Eye Disease ... ... ... 138 Following-up ... ... ... 143 Health Visitors, Work of ... 143 Heights and Weights .... ... 139 Immunization, Diphtheria ... 153 Infectious Diseases ... ... 142 Inspection Clinic ... ... 143 Inspections, Routine ... ... 135 168 page Juvenile Employment 168 Lungs, Diseases of 137 Malnutrition 140 Malt 158 Massage Clinic 153 Meals, Provision of 158 Mentally Defective Children 156 Milk, etc., Provision of 134,158 Minor Ailments 143 Nutrition 140 Orthopaedjc Work 153 Orthodontic Service 150 • Parents' Attendances 136 Physically Defective Children 157 Population 134 tage Remedial Exercises 143, 153 Rheumatism Clinic 143, 154 Schools, Special 134, 157 Secondary Schools 160 Speech 157 Staff 163 Statistical Tables 160 Surveys, Uncleanliness 137 St. Christopher's 156 Throat and Nose 143 Treatment 143 Tuberculosis 137 Uncleanliness 137 Vision, Defective 138 X-Ray 149