CRO 48 County Borough of Croydon ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL SERVICE For the Year 1946 OSCAR M. HOLDEN, G.M., M.D., D.P.H. croydon: PRINTED BY THE CROYDON TIMES LTD. 104, HIGH STREET C.T. 2 1-1-48. 150. i. COUNTY BOROUGH OF CROYDON. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1946. 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 my nineteenth Annual Report upon the Health Services carried out by the Council. This report is the 47th of the series of such reports. The population of the town as estimated by the Registrar- General was 233,230. During the year 2,105 marriages were solemnized, a marriage rate of 9.0 per 1,000 of the population. The Birth Rate was 20.6 per 1,000, an increase of 2.8 per 1,000 over that for 1945. There were 4,800 live births of whom 2,444 were males and 2,362 females. Of these approximately 42.08 per cent. were born in hospital, and 24.07 in Registered Maternity Homes. There were 314 illegitimate births, a percentage of 6.5 of the total live births. This is 4.3 below the 1945 figure. ii. The still-births registered were 131 as compared with 100 in 1945, the rate, however, was 26.5 per 1,000 total live and stillbirths, which was 0.7 per 1,000 less than in 1945. The Infantile mortality was 31 per 1,000 live births, a decrease of 10 per 1,000 upon 1945, and the lowest ever recorded. The maternal mortality rate was 0.61 per 1,000 total births. The infant mortality of legitimate children was 31.4, of illegitimate 35 per 1,000 live births. Full statistics are included of the work done at Mayday Hopital. These show that the hospital has definitely assumed the status of a large general hospital. The major causes of death among the population were: Cardiac and Circulatory System Diseases and conditions (5.40 per 1,000 of the population), Cancer (1.93), diseases of the Respiratory System, including Tuberculosis (1.69), Diseases of the Digestive System (0.48), and deaths due to suicide and violence (0.49). Notifiable Infectious Diseases remained low in incidence. There were nine deaths from this group of conditions, namely three from Whooping Cough, three from Diphtheria, two from Cerebro-Spinal Fever and one from Measles. The Home Helps Scheme under which help is afforded in the home in instances of acute illness and maternity, had a busy year, and on several occasions there were insufficient helps to meet the demand. The service expanded from 21 full-time and nine part-time helps, to 35 whole-time and 10 part-time. A total of 638 cases were helped. The Ambulance Service also was fully extended, as was expected on the Service being made free within the Borough. An increase of 8,875 calls over 1945 was recorded, and the mileage travelled was doubled. The detailed analysis of accidents is worthy of close study, and the fall in the number of street accidents to children seems to show the effect of Safety First training in schools. The most dangerous times of the 24 hours were from 10 a.m. to 11 a.m. and 2 p.m. to 3 p.m. Immunisation against Diphtheria was pursued with especial attention to children under school age. The low incidence of Diphtheria was maintained and it is significant that of the 43 true iii. cases only 15 were stated to have been immunised and in none of these had a posterior-schick test been done. This test indicates whether the immunisation injections have been effective. In some children the usual course proves insufficient to create immunity. Attendances at the Venereal Diseases Clinic showed a further increase from 14,346 in 1945 to 21,196, and new cases from 994 to 1,143. The increase was greater for male than for female patients, in fact there was a fall of 193 in the number of new women patients. This increase in attendances may be accounted for by the national propaganda which has been undertaken; it does not mean an actual increase in the amount of V.D. in the population, but a welcome recognition by those who may have run the risk of infection of the value of early examination. Contacts notified to the Medical Officer of Health during the period 1st January, 1946, to 31st December, 1946: — M. F. (1) (a) Total number in respect of whom Form 1 was received 2 15 (b) Number in (a) transferred from other areas — 1 (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 2 10 Contacts examined 2 9 (3) (a) Number of those in (1) in respect of whom two or more Forms 1 were received - - (b) Number in 3 (a) in respect of whom first Form 1 was previously reported under (1) — — (c) Number in 3 (a) transferred from other areas - - (4) Number of those in 3 (a) who were (a) found — — (b) examined after persuasion — — (c) served with Form 2 — — iv. (d) examined after service of Form 2 — — (e) prosecuted for failure (i) to attend for and submit to medical examination - - (ii) to submit to and continue treatment - — Cancer deaths showed a decrease, the incidence per 1,000 of the population (1.93) was the lowest recorded since 1939. It is difficult to say if this has any significance. The most usual sites attacked were in men: the lungs, bowel, stomach, rectum and prostate; in women: the breast, bowel, stomach and uterus. Deaths from Cancer of the lung showed a further increase, and this site is now one of the commonest. The incidence rate of Tuberculosis fell from 1.86 per 1,000 of the population to 1.49, but the number of deaths increased by 26 per cent. There were twice as many deaths in males as in females. The Mass Radiological Unit of the Surrey County Council visited the town on two occasions, and I append herewith the work done and the results achieved, for which 1 am indebted to the members of the Unit. Numbers Examined: Age 14 15—24 25—34 35—44 45—59 CO and over Total all ages Male 385 1,142 1,186 911 636 127 4,387 Female 265 1,131 442 350 262 30 2,480 Total 650 2,273 1,628 1,261 898 157 6,867 Number recalled for full-sized X-ray plate 508 (7.4% of the total examined). Number recalled for clinical examination 259 (3.77% of the total examined). Number failing to attend for full-sized X-ray plate 3 (0.6% of those recalled). V. Number refusing further action after fullsized X-ray plate or clinical examination 1 Number still under observation and not yet diagnosed 2 Abnormalities Revealed- A: Non-Tuberculous Conditions : 1. Abnormalities of the ribs and bony thorax 39 2. Bronchitis and emphysema 55 3. Bronchiectasis 7 4. Pneumokoniosis 9 5. Pleural thickening 75 6. Intrathoracic neoplasms 2 7. Cardiovascular lesions (a) Congenital 5 (b) Acquired 29 8. Miscellaneous 42 B. Cases with evidence of Pulmonary Tuberculosis including healed lesions. 1. Previously known cases 15 (Inactive, 5; Active and still attending Clinic, 10). 2. Newly discovered cases— (a) Inactive lesions requiring no further action— (i) Healed primary lesions 146 (ii) Healed post primary primary lesions 70 (b) Active lesions 35 (0.51% of the total examined). 35 active cases of pulmonary tuberculosis, showing extent of the lesion, presence or absence of symptoms and disposal, vi. Extent of lesion and presence of symptoms. Disposal. Dispensary Observation. Hospital or Sanitorium. Total. Unilateral with symptoms 5 3 8 without symptoms . 5 1 6 Bilateral with symptoms 7 3 10 without symptoms 6 5 11 23 12 35 (0.34%) (0.17%) (0.51%) (The figures in brackets refer to the precentage of the total number examined.) 35 active cases of pulmonary tuberculosis sub-divided into sex and age groups. 60 and Total Age 14 1.5—24 25—34 35—44 45—59 over all ages Males — 3 7 2 10 1 23 Females 1 6 2 2 8 — 12 Preventative measures of this kind are unfortunately handicapped by a lack of Sanatorium beds. This does not apply to Croydon alone, but is general throughout the country. Some of the accommodation available cannot be used because of lack of nursing and domestic staffs. Another serious handicap in the treatment of Pulmonary Tuberculosis is the difficulty of obtaining provision for Thoracic Surgery. There is an insufficiency of skilled surgeons in this special branch of surgery which has the unfortunate result of patients having to wait up to two years for an operation, and owing to this delay some are found to have deteriorated so much that they are no longer fit. In consequence patients who may have had a reasonable prospect of relief of their condition, are doomed to succumb to the diseases. This branch of surgery requires specially trained teams working together under exceptional conditions not normally associated with routine general operative procedure. A multiplication of such teams working in selected centres capable of dealing promptly with any demands is urgently needed. vii. Throughout 1946 a very heavy load was placed upon the maternity scheme. The number of cases delivered in Mayday Hospital increased from 1,075 in 1945 to 1,321 in 1946, and at St. Mary's Hospital the increase was from 609 to 669. The municipal midwives delivered 1,610 cases as compared with 1,015 in 1945. A table has been included in the relevant section of the report to show, in detail, the work done by the municipal midwives, who throughout the year shouldered so successfully a burden much greater than they had ever been called upon to do previously. The Obstetric Service of the Council delivered 3,600 mothers out of a total of 4,806 births allocated to Croydon. In spite of this heavy presssure there were only three maternal deaths, and the Infant deaths before the end of the first week of life fell from 15/1,000 live births to 12/1,000. Once again attention must be directed to the inadequacy of the Lodge Road premises. With the substantial increase in the birth rate and the greater readiness of expectant mothers to go to Ante-natal Clinics; the sessions have been uncomfortably crowded and mothers have been forced to wait longer than would have been required if more doctors could have been accommodated. Also the number of maternity beds, even with the reopening of the Monteagle annexe (20 beds) proved insufficient to provide institutional care for all those who asked for it. In consequence admissions had to be restricted to medically abnormal cases or those whose housing conditions were quite impossible for a confinement. The Infantile mortality rate was 10 per 1,000 births lower than for 1945 and reached a new low record. Still-births also showed a small decrease from 27.2 per 1,000 births to 26.5. Attendances at the Infant Welfare Centres showed a substantial increase and several Centres had to duplicate their sessions in order to cope with the numbers. As a whole the Centres are overcrowded, and if the present tendency of attendances continues more Centres will have to be established. The following summary of the relevant figures shows clearly the heavy use made of these Centres: — 1946 1945 New cases attending for the first time 4,558 3,930 Total attendances 77,941 66,446 Doctors' Consultations 33,407 21,724 Average attendance per session 68.7 62.2 viii. A special section of the report is devoted to the work of the Obstetric Service, which covers the Ante-natal, natal and postnatal periods. 3,491 new patients registered at the Ante-natal Clinics and of these it was impossible to accommodate 1,347 in hospital beds and so they were referred to Midwives or Nursing Homes. At the post-natal Clinic 1,633 patients attended, and at the Gynæcological Clinic, 2,099. A follow-up of cases confined under the care of the Service showed that 96.2 per cent. had no impairment of health, whilst 3.6 per cent. had some slight impairment. Only 0.2 per cent. had any serious damage to their health. It can be said with reason that the risks attending confinement have been brought down to a very low figure, and it would probably be brought lower if all mothers appreciated fully the value of early Antenatal care. Owing to the large number of houses totally destroyed or seriously damaged by enemy activity, and the considerable influx of population since the end of the war, housing conditions leave much to be desired. There are a large number of properties, some of which had already been scheduled or catalogued for representation before the war, which under normal conditions would have to be condemned as unfit for human habitationOwing to the shortage of alternative accommodation, no steps can be taken other than to endeavour to have repairs done and the most serious defects remedied or ameliorated. Landlords are reluctant to spend money upon property which has seriously deteriorated during the war years, apart from actual war damage. Also the difficulties of supply and labour do not ease the situation. Such conditions call for close watching. The Sanitary Inspectors inspected 9,321 houses under the Public Health or Housing Acts, and 19,266 reinspections. 8,430 houses were deemed to be not in all respects fit for human habitation, of these 4,242 were made more or less fit during the year. Food supplies have been watched carefully. The number of premises in the Borough at which food is known to be sold, manufactured or stored, increased from 2,491 in 1945 to 2,884 in 1946. To these premises 2,166 visits were made as compared with 1,623 the previous year. It is interesting to note that the number of catering establishments increased by 61. ix. The quantity of meat and other articles of food found unfit and condemned during the year rose from 53,029 lbs. in 1945 to 97,489 in 1946. The chief causes of this increase were in supplies of Beef—an increase of 27,307 lbs., offal 18,904 lbs., canned and packeted goods, 5,761 !bs., fish and fruit and vegetables showed a considerable decrease in the amounts condemned. The reasons for the increases were probably in the case of beef and offal, that the Ministry of Food began slaughtering at the Corporation Slaughterhouse, previously slaughtering had been done elsewhere. In the instance of canned goods this is probably due to the letting on to the market of accumulated stocks. Ice Cream was a source of anxiety as there are no standards governing either cleanliness or food value. What should be a clean and wholesome food is not seldom found to be quite the reverse. Although there are no bacteriological standards for ice cream the inspectors have worked to a local standard. Where the bacteriological count exceeded 100,000 organisms per C.C. or when B.Coli was found in 1/10th of a C.C. the suppliers were visited and advised upon cleanliness measures and were later revisited to note improvements or otherwise. Milk supplies both as to quality and to a rather less degree as to cleanliness were on the whole satisfactory. No sample fell below the legal limit of 8.5 per cent. non fatty solids and 3.0 per cent. fats. The picture drawn by statistics of births and deaths shows that the health of Croydon has been maintained and the health of babies and young children has improved. Unfortunately the statistics available can only give a part of the general scene. Figures of morbidity of mild illnesses and of catarrhal conditions especially are not available. There is undoubtedly an impression among medical men in general practice and others who come into close contact with the adult population, that there is a definite lowering of vitality. Upsets in health are more frequent and mild infections are not thrown off as readily as they should be. Especially among women with several children and a house to run, and among the elderly, there is a lassitude which is a new phenomenon. Calories are not the beginning and end of nutrition. Variety in supplies and in cooking are equally important. The limitation of certain essential food stuffs, especially fats and milk is a restriction which should be lifted as soon as circumstances permit, otherwise the general standard of health of the population as a whole, will decline further. X. In conclusion, Ladies and Gentlemen, I wish to express my thanks to the staff of the Department for their co-operation and help, and for the manner in which they have carried out their various and varied duties. To you, Mr. Chairman, and the members of the Health Committee, the Education Committee and of the various Sub-Committees I desire to tender my thanks for the encouragement and support which has been given to me throughout the year- I am, Yours faithfully, OSCAR M. HOLDEN, Medical Officer of Health. 1 PUBLIC HEALTH COMMITTEE. 1945—1946. The Worshipful The Mayor Councillor Mrs. E. E. Cook. (Alderman J. Marshall, J.P.) Councillor A. V. Dammarell. Alderman H. Regan (Chairman). Councillor A. Goodbun. Councillor J. T. Twitchett (Vice-Chairman). Councillor W. H. Gough. Alderman E. E. L. Arkell, J.P. Councillor R. Hyder. Alderman Col. C. H. Gibson. Councillor Mrs. E. M. Regan. Alderman R. F. Russell. Councillor Mrs. G. L. Rogers. Alderman Mrs. M. Squire, J.P. Councillor G. H. Ward, O.B.E. Councillor Miss M. G. Billson. Miss Dorothy Day, M.R.C.S., L.R.C.P. Councillor Mrs. V. L. Child. G. G. Genge, Esq., M.D. Councillor E. E. Constable (resigned). 2 SUMMARY OF VITAL STATISTICS FOR 1946. Area, 12,617 acres. Population (Census 1931), 233,115. Population (estimated middle of 1946), 233,230. Number of Inhabited Houses (1931 Census), 56,429. Overcrowding Census (1936), 65,550. Rateable Value (1st April, 1946), £2,503,826. Product of a Penny Rate (1945—1946), £9,521. Rate in the £ : 12s. 4d. Gross expenditure on Health and Hospital Services (administered by Medical Officer of Health) £367,542 Income on Health and Hospital Services (excluding transfers) 91,717 Net expenditure on Health and Hospital Services £275,825 Expressed as a Penny Rate, 2/5d. in the pound. M. F. Total. Live Births Legitimate 2,281 2,211 4,492 Illegitimate 163 151 314 4,806 Birth-rate per 1,000 of the estimated resident population, 20.6. Still Births 131. Rate per 1,000 total (live and still) births, 26.5. Birth-rate (live and still births) per 1,000 population, 21.2. Deaths, 2,691 (Registrar-General's figures). Death-rate per 1,000 of the estimated resident population, 11.5. Deaths from diseases and accidents of pregnancy and childbirth, 3; from puerperal and post-abortal sepsis, nil; other causes, 3. 3 Maternal mortality 0.61 per 1,000 total live and still births. Death-rate of Infants under one year of age (151 deaths, 4,806 births)— All Infants per 1,000 live births 31 Legitimate Infants (140 deaths) per 1,000 live births 31 Illegitimate Infants (11 deaths) per 1,000 live births, 35 Deaths from Influenza 35 ,, ,, Whooping Cough (all ages) 3 ,, ,, Diarrhoea (under 2 years of age). 22 ,, ,, Diphtheria (all ages) 3 ,, ,, Pneumonia 110 „ ,, Cancer 425 Rate per 1,000 Population. Deaths from diseases of Cardiac and Circulatory System (including Cerebral Hæmorrhage) 5.40 ,, ,, diseases of the Respiratory System (including Tuberculosis) 1.69 ,, ,, diseases of Renal System 0.21 ,, ,, diseases of Digestive System 0.48 ,, ,, Suicide and Violent Causes 0.49 ,, „ Old Age (local statistics) 0.33 Marriages. The number of marriages solemnised was 2,105, compared with 2,268 in 1945, 1,578 in 1944, 1,574 in 1943, 2,042 in 1942, and 2,187 in 1941. The marriage rate was 9.0 per 1,000 of the population; 1,086 were solemnised in Established Churches, 295 in other places of worship, and 721 in the Register Office. Three were performed under Jewish ritual. 4 Births. The live births registered were 4,492 legitimate and 314 illegitimate. The birth-rate consequently was 20.6. For England and Wales and in the Great Towns the rates were 19.1 and 22.2. The illegitimate births in Croydon were 6.5 of the total, compared with 10.6 in 1945; 7.7 in 1944; 7.8 in 1943; 7.5 in 1942; 6.3 in 1941; and 5.3 in 1940. The live male births numbered 2,444, the female 2,362, being a proportion of 1,035 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 (29.9), Waddon (24.2) and South Norwood (23.2). Those with the lowest were Norbury (15.4) and Upper Norwood (16.3). Deaths. The deaths numbered 2,691, compared with 2,513 in 1945. For 1946 the death-rate was 11.5; for 1945 it was 12.5. The death-rate for England and Wales was 11.5, and for the Great Towns 12.7. For London the death-rate was 12.7. There were 199 inquests held by Coroners in respect of Croydon residents during 1946 and 217 findings by Coroners after post-mortem examination without inquest. Wards with the highest death-rates were Central (15.1), Addiscombe (14.3), South (13.9) and Bcnsham Manor (13.2). Lowest: Waddon (8.7), Broad Green (9.6) and South Norwood (9.9). Wards with the highest death-rates were Central (15.1), Addiscombe (14 3), South (13.9) and Bensham Manor (13.2). Lowest: Waddon (8.7), Broad Green (9.6) and South Norwood (9.9). 5 WARDS. Estimated Population. Births. Deaths. Birth Rate. Death Rate. Deaths under 1 year per 1,000 Births. Death Rate from Six Zymotic Diseases (excluding Diarrhoea) Death Rate from Diarrhoea. Death Rate from Bronchitis and Pneumonia. Death Rate from Pulmonary Tuberculosis. Death Rate from Non-Pulmonary Tuberculosis. Death Rate from Heart and Circulation Diseases. Death Rate from Nervous Diseases. Death Rate from Cancer. Natural Increase or Decrease of Population. Upper Norwood 15429 252 186 16.3 12.1 32 — 0.06 1.62 0.32 — 4.21 0.58 2.66 + 66 Norbury 15530 239 170 15.4 10.9 38 — 0.06 1.16 0.26 — 4.96 0.58 1.74 + 69 West Thornton 18886 316 199 16.7 10.5 32 0.05 0.11 1.43 0.64 0.05 3.92 0.53 2.07 + 117 Bensham Manor 15426 288 203 18.7 13.2 21 — 0.13 1.23 0.71 0.13 5.45 0.32 2.53 + 85 Thornton Heath 17384 382 190 22.0 10.9 45 0.17 0.23 1.84 0.23 0.06 4.03 0.17 1.61 + 192 South Norwood 16990 395 169 23.2 9.9 18 — 0.18 1.24 0.41 0.06 4.71 0.35 1.41 +226 Woodside 15482 312 178 20.2 11.5 29 — 0.13 1.42 0.71 — 4.72 0.39 2.07 + 134 East 15529 353 180 22.7 11.6 11 — 0.06 0.58 0.52 — 5.09 0.52 2.64 + 173 Addiscombe 15708 335 225 21.4 14.3 36 0.06 0.06 1.21 0.64 — 6.88 0.51 1.85 + 111 Whitehorse Manor 16111 336 193 20.9 12.0 27 — 0.19 1.80 0.25 0.06 4.47 0.50 2.05 + 143 Broad Green 16534 332 159 20.1 9.6 60 0.06 0.10 1.27 0.36 0.06 3.81 0.30 1.33 + 173 Central 11763 219 178 18.6 15.1 32 — 0.09 1.70 0.51 0.09 6.12 0.51 2.47 + 41 Waddon 17621 427 154 24.2 8.7 37 0.06 0.11 0.85 0.45 — 3.18 0.40 1.31 +273 South 14553 289 203 19.9 13.9 17 — — 1.79 0.21 — 6.67 0.82 1.65 + 86 Addington 10284 307 112 29.9 10.9 33 — 0.19 0.88 0.29 — 4.28 0.48 1.94 + 195 The Borough 233230 *4806 *2691 20.6 11.5 31 0.03 0.12 1.34 0.44 0.04 4.79 0.46 1.93 +2115 *These are the corrected totals. 6 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX. Sex All Ages 0— 1— 5— 15— 45— 65- All Causes M 1302 87 9 8 94 376 728 F 1389 63 9 8 89 286 934 Diphtheria M - - - - - - - F - - - 1 2 — - Whooping Cough M 3 3 - — — - - F - - - - - - — Encephalitis Acute Infectious M — — - — — — — F 1 — - — — 1 — Cerebro Spinal Fever M - - - - - - - F 2 - 1 - - 1 - Measles M - - - - - - - F 1 1 - - - - - Influenza M 14 1 - — - 6 7 F 20 2 - — 2 4 12 Poliomyelitis & Polioencephalitis M 1 — — — 1 — — F — — - — — — — Tuberculosis (respiratory) M 64 — - 1 28 29 6 F 34 — 1 1 25 7 — Tuberculosis (other forms) M 5 — 3 — 1 — 1 F 2 — 1 — 1 — — Syphilitic diseases M 13 1 — — — 5 7 F 8 1 — — 1 4 2 Cancer M 201 - — 2 11 85 103 F 224 - —. - 13 87 124 Diabetes M 5 — — — — — 5 F 12 - — - - 4 8 Intra cranial vascular lesions M 121 — — - 2 32 87 F 169 - — 1 5 37 126 Heart diseases M 392 - — - 12 87 293 F 48 — — — 14 59 413 Other circulatory diseases M 44 — — — 1 11 32 F 47 —. — — — 4 43 Bronchitis M 69 1 — — 2 18 48 F 83 2 2 1 1 9 68 Pneumonia (all forms) M 60 18 1 — — 12 29 F 50 11 1 — 1 10 27 Other respiratory diseases M 12 — — — 1 7 4 F 13 — 1 1 — 5 6 Ulcer of stomach or duodenum M 28 — —. — 2 18 8 F 13 — — —. - 5 8 Diarrhoea (under 2 years) M 14 14 — - — — — F 8 8 - - - - - Appendicitis M 4 — 1 - 1 2 — F 2 — — — — 1 1 Other digestive diseases M 14 1 — 1 1 5 6 F 28 — — - 6 5 17 Nephritis M 30 — — - 2 15 13 F 20 - — — 2 4 14 Puerperal sepsis F — — — — — — - Other maternal causes F 3 — — — 3 - - Congenital debility, malformations, premature birth, etc. M 48 45 - - 1 2 - F 33 30 1 — 1 1 — Suicide M 16 - — - 7 6 3 F 15 — — - 5 8 2 Road traffic accidents M 18 — 1 1 7 5 4 F 6 - .— 1 — 2 3 Other violent causes M 26 1 2 1 7 5 10 F 33 3 - - 1 2 27 All other causes M 100 2 1 2 7 26 62 F 73 5 1 2 6 26 33 Totals 2691 150 18 16 183 662 1662 7 Comparisons with 1945. In the zymotic diseases group there were 3 deaths from Whooping Cough, 3 from Diphtheria, and 1 from Meales. There were again no deaths in the Typhoid group. The deaths from Pulmonary Tuberculosis increased by 24: those from Cancer decreased by 39; those from Pneumonia by 7; and an increase of 11 was recorded in those caused by Bronchitis. Deaths from Suicide show an increase of 8, and road traffic accidents of 3. The total number of deaths was 2,691, as compared with 2,513 in 1945. The percentage of deaths under 1 year of age to .the total deaths was 5.6 per cent.; deaths under 15 years, 6.8 per cent.; deaths under 65 years, 38.2 per cent.; and deaths over 65 years, 61.8 per cent. The corresponding figures for 1945 were 5.9 per cent., 7.9 per cent., 38.2 per cent., and 61.8 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 2,229,823,000 Metropolitan Water Board in bulk 710,575,000 2,940,398,000 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. 250 raw water samples and 902 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 78 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 82 of raw waters and 137 of treated waters going into supply. The results of the chemical analyses were uniformly satisfactory. The waters are not liable to have plumbo-solvent action. No cases of contamination of any of the sources of supply arose during the year. The whole of the population and dwelling-houses within the area of supply are supplied from public water mains direct to the houses. During 1946 the total number of samples taken by the Public Health Department was as follows: — For bacteriological examination 61 For chemical examination 61 All these sample-; 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 35. DEPARTMENTAL CLASSIFICATION OF DEATHS ACCORDING TO DISEASE OVER A PERIOD OF SIX YEARS. Cause of Death. 1941 Total Deaths 1942 Total Deaths 1943 Total Deaths 1944 Total Deaths 1945 Total Deaths 1943 Total Deaths Death Rate Enteric Fever 1 - - - - - - Malaria 1 — — — 1 — — Poliomyelitis — — — 1 1 — — Measles 5 — 1 1 6 1 0.004 Scarlet Fever —. 1 1 — — — - Whooping Cough 6 3 1 10 3 3 0.013 Diphtheria and Croup 4 3 2 — 2 3 0.013 Influenza (incl. Influenzal pneumonia) 36 19 81 19 11 35 0.150 Dysentery 2 2 — — 1 — — Erysipelas — 1 — 1 - — — Cerebro-Spinal Fever 8 6 1 1 3 2 0.009 Pulmonary Tuberculosis 90 97 107 98 78 101 0.433 Tuberculous Meningitis 19 19 16 11 14 9 0.039 Other Tuberculous Diseases Cancer, Malignant Disease 376 409 454 420 470 451 1.934 Rheumatic Fever 2 3 2 2 1 4 0.017 Meningitis 3 9 7 4 6 1 0.004 Organic Heart Disease 672 741 515 563 542 697 2.988 Bronchitis, Acute and Chronic 80 131 150 126 124 156 0.669 Pneumonia 194 113 182 129 160 156 0.669 Other Diseases of the Respiratory Organs 30 22 17 23 19 19 0.081 Diarrhoea & Enteritis 13 15 21 22 20 27 0.116 Appendicitis 10 6 8 8 8 6 0.026 Cirrhosis of Liver 10 5 4 2 5 1 0.004 Alcoholism 1 — — — — 1 0.004 Nephritis & Bright's Disease 60 57 44 44 35 48 0.206 *Puerperal Sepsis 3 3 1 — 1 - — Other diseases and accidents of pregnancy and parturition 5 .9 1 8 8 3 0.013 Congenital debility, malformation and Premature Birth 34 82 73 89 72 58 0.249 Violent Deaths (excluding War operations and suicide) 74 61 46 45 64 65 0.279 Suicide 20 24 21 16 24 32 0.137 Other Defined Diseases 778 568 860 1206 808 814 3.490 Diseases Ill-Defined or Unknown 2 - 12 8 4 10 0.043 Total 2539 2409 2628 2857 2491 2703 11.589 *Calculated per 1,000 live and still births. 1946 showed a decrease in the death and an increase in the 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 J. Llewellyn, S.R.N. Trained Nurses 69 Assistant Nurses 7 Student Nurses 90 Male Nurses 11 Steward: Mr. R. Grist. The following Specialist Services are carried:—Orthopædic, Gynæcological and Obstetrical, Dental, X-Ray, Deep X-Ray Therapy, Massage, Ultra-Violet Light, Ophthalmic, Ear, Nose and Throat, School E.N.T. Clinic, Gastroscopy, Psychiatric, Medical and Surgical Out-patients. Table I. 1.- Total number of admissions (including infants born in hospital) 8,471 2.- Number of women confined in hospital 1,316 3.- Number of live births 1,224 4.- Number of still births 75 5.- Number of deaths among the newly-born (i.e., under 4 weeks of age) 47 6.- Number of deaths among children under one year (including those given under 5) 89 7.- Number of maternal deaths among women admitted to hospital for confinement - 8.- Total number of deaths 804 9.- Total number of discharges (including infants born in hospital) 7,649 10.- Duration of stay of patients included in 8 and 9 above: — (a) Under four weeks 6,980 (b) Four weeks and under thirteen weeks 1,193 (c) Thirteen weeks or more 280 11.- —Number of beds occupied (excluding cots in maternity wards): — (a) Average during the year 443 (b) Highest 552 on 4-2-46 (c) Lowest 404 on 25-12-46 12.- Number of surgical operations under anæsthetic 2,924 13.- Number of abdominal sections 516 11 Table II. Classification of In-Patients who were discharged from or who died in the Institution during the year ended 31st December, 1946. Disease Groups. Children (under 16) Men and Women. Discharged. Died. Discharged. Died. A—Acute infectious disease 21 1 15 2 B—Influenza 2 - 8 - C.—Tuberculosis: Pulmonary 3 2 113 44 Non-Pulmonary 7 1 11 — D.—Malignant Disease — — 93 151 E.—Rheumatism:— (1) Acute rheumatism (rheumatic fever) together with sub-acute rheumatism and chorea 8 - 11 - (2) Non-articular manifestations of so called "rheumatism" (muscular rheumatism, fibrositis, lumbago, and sciatica) 2 - 1 - (3) Chronic Arthritis 3 — 14 — F.—Venereal Disease 1 — 4 1 G.—Puerperal Pyrexia - - 1 — Puerperal Fever — . — — — H.—Other diseases and accidents connected with pregnancy and childbirth — — 576 1 1.—Mental diseases 9 — 256 2 J.—-Senile decay — — 13 7 K.—Accidental injury and violence 62 — 210 27 In respect of cases not included above. L..—Diseases of the Nervous System and Sense Organs 9 3 101 103 M.—Disease of the Respiratory System 118 27 273 45 N. „ „ Circulatory System 8 — 233 215 O. „ „ Digestive System 160 15 622 54 P. „ „ Genito Urinary System 163 1 121 39 Q. ,, Skin 58 - 148 4 R-—Other diseases 1154 5 425 10 S.—Mothers and infants discharged from Maternity Wards and not included in above figures:— Mothers — — 1316 — Infants 1224 44 — — T.—Any persons not falling under any of the above headings 25 - 47 — Totals. 3037 93 4612 705 12 NUMBER OF X-RAY FILMS TAKEN. Spine 354 Bones 2,000 Pelvis 40 Chest 2,814 Barium Meals 606 Barium Enemas 76 Renal 241 Gall-Bladder 200 Teeth 500 Abdominal 25 Maternity Cases 824 Skull 145 7,825 Total number of Cases X-rayed 5,072 DIAGNOSTIC. 1945. 1946. Oesophagus with Barium ... 3 9 Barium Meals 344 303 Barium Enemata 31 38 Gall-Bladder (Plain) 29 21 Cholecystograms ... 36 23 Renal Tracts (Plain) 39 30 Pyelograms ... 60 9 Abdomen for F. B.'s, etc. 20 25 Maternity Cases 384 404 Hvsterographies ... 7 — Lungs (Mayday) ... ... ... 825 671 (Sick Staff) 7 13 (Staff on Appointment) 169 104 (T.B. Dispensary) ... 1,370 ... 1,848 (Others) 125 140 Lungs' after Lipiodol ... ... 9 22 Heart and Aorta 9 6 Skulls 89 90 Accessory Nasal Sinuses ... 48 46 Vertebral Column ... 394 152 Ribs 24 34 Pelvis 21 40 Long Bones 550 281 Short Bones ... 520 163 Joints ... , 300 468 Teeth and Jaws ... 294 142 5,707 ... 5,082 Examinations by Portable Set 60 102 13 x-ray. 1945. 1946. Men's Wards 967 879 Women's Wards 868 784 Children's Wards 257 97 Maternity and Gynaecological Wards 212 98 Staff 165 2150 Total "In-Patients" ... 2,469 2,108 T. B. Dispensary (Men) 762 759 (Women) 699 880 (Children under 16) 209 209 Croydon Borough Hospital 20 4 Ante-Natal Clinic 484 342 Queen's Road Homes 14 21 Dental Clinic 265 138 Others 15 10 St. Mary's Hospital 10 22 Total "Out-Patients" ... 2,478 ... 2,385 Total 4,947 ... 4,493 "Screen Examinations" 827 400 physiotherapy. Massage 14,720 Radiant Heat 13,645 Exercises 9,802 Electrical 1,999 Diathermy 996 Infra-red 1,398 Ultra Violet Light 1,722 Wax 1,615 Spray Baths 68 45,965 Total number of patients treated 1,962 mental patients dealt with during the year. Male. Female. Admitted 108 110 Certified and sent to Warlingham Park Hospital 8 13 As Voluntary Patients to Warlingham Park Hospital 90 90 Discharged not certified 10 7 14 SPECIMENS EXAMINED IN THE PATHOLOGICAL LABORATORY DURING THE YEAR. Positive. Negative. Swabs for Diphtheria — 1,577 Sputa for T.B. 395 792 Pus for T.B. 4 10 Pus for Gonococci — 279 Urine for T.B. 1 24 Faeces for T.B. 2 9 Faeces for Coli Typhoid Group 11 724 Blood—Widals 5 20 Hairs for ringworm 23 18 Blood cultures 5 25 Faeces for occult blood 164 282 4,370 Urine for routine examination 1,423 Pus for organisms 226 Blood urea estimations 225 Blood sugar estimations 200 Cerebro spinal fluids 119 Urea Conc. Tests 9 Urea clearance tests 175 Fractional test meals 130 Pleural fluids 103 Blood counts 888 Haemoglobin estimations 1,138 Blood groups 412 Compatibility tests 399 Faecal fat estimations 5 Van den Bergh re-action 21 Blood sedimentation rates 1,094 Glucose tolerance tests 16 Blood coagulation and bleeding time 74 Other examinations—unclassified 218 Total number of Examinations 11,251 Number of Specimens sent to Croydon General Hospital 603 NUMBER OF POST MORTEMS ORDERED BY THE CORONER AND PERFORMED AT MAYDAY HOSPITAL DURING THE YEAR. Outside Cases 306 Hospital Cases 116 NUMBER OF POST MORTEMS NOT ORDERED BY THE CORONER 77 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 rectum ... 1 12 — — — — 1 Uterus 1 12 — — — 1 Cervix 1 20 — — 1 — — Ovary 1 20 — — — — 1 Larynx 1 12 — — — — 1 Breast 22 332 1 2 — 19 Lung 3 60 — - 2 — 1 Testicle 2 48 — - — — 2 Spine 1 12 — - — — 1 Glands in neck 1 18 - - - - 1 Sarcoma of Hip 1 18 — - 1 — — Abdomen ... 2 20 — - 2 — — Other bones 6 120 — — 1 — 5 Epithelioma of lip 1 16 — - — 1 — Vulva 1 20 — — 1 — — Face 3 24 2 — — — 1 Menorrhagia 12 56 12 — — — — Spondylitis 1 12 — — — — 1 Lymphatic Leukaemia 3 40 — 3 — — — Arthritis 1 24 — — — — 1 Warts 3 10 3 — - . — — Keloid scar 1 8 1 — - — — 69 914 19 3 10 1 36 Corresponding totals for 1945 59 660 8 19 18 — 14 Cases referred from Croydon General Hospital for treatment 16 16 Table III Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Alimentary. Appendicitis — — - — 189 17 — 4 210 Appendicular Colic — 6 — — — — — — 6 Appendicular Abscess — 4 - - - - - - 4 Gastric ulcer — 56 — 8 — 12 — 5 81 Duodenal ulcer — 36 — 1 2 23 — 2 64 Anastomatic ulcer 2 1 — — — — — — 3 Dyspepsia — 2 - - - - - - 2 Cholelithiasis — 5 — 1 — 10 — — 16 Colitis — 12 — 2 — — — — 14 Intestinal obstruction — 15 — 3 — 5 — 3 26 Ischio-rectal abscess - 13 — — — — — — 13 Constipation 3 72 - - - - - - 75 Hernia - — — — 81 39 — 11 131 Haemorrhoids — 1 — — 21 — — — 22 Cholecystitis 1 5 — — 3 9 — 2 20 Gastro enteritis — 15 — 14 — — — — 29 Gastritis 1 11 - - - - - - 12 Alveolar abscess 1 1 - - - - - - 2 Cirrhosis of liver — 2 — 2 — — — — 4 Intestinal colic 2 3 — — — 1 — — 6 Catarrhal jaundice — 2 - - - - - - 2 Prolapse Rectum — 2 - - - - - - 2 Pyloric stenosis 1 1 — — — 7 — — 9 Fistula in ano 1 — 1 — 5 — — — 7 Diarrhoea 4 10 - - - - - - 14 Peptic Ulcer — 18 2 2 — 1 — — 23 Tapeworm — 1 - - - - - - 1 Thread worms — 1 — — — — — - 1 17 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Peritonitis — 2 — 1 — 1 — 3 7 Stomatitis — 4 — — — — — — 4 Adhesions 1 — — — 1 5 — — 7 Jaundice — 2 - - - - - - 2 Pyioric Ulcer — — — — — 1 — — 1 Peritonsillar Abscess 1 — — — — — — — 1 Perineal Abscess — — — — — 2 — — 2 Pancreatitis — 1 — 1 — — — — 2 Hirschsprungs Disease — 1 — 1 — — — — 2 Abdominal actinomycosis ... — — - 1 - — - - 1 Diverticulitis — 3 — — — 1 - 1 5 Hepatitis 1 8 — 1 — — — — 10 Intussusception — — — — — 2 — — 2 Gingivitis 2 - - - - - - - 2 Haematemesis of unknown origin — 1 - - - - - - 1 Ileitis — 1 - - - - - - 1 Swallowed F. B. 1 — — — — — — - 1 Collapse — 1 - - - - - - 1 851 Bones, and Joints. Arthritis 1 20 4 - - - - - 25 Fibrositis 1 3 - - - - - - 4 Scheuerman's Disease — 1 - - - - - - 1 Bursitis — 5 - - - - - - 5 Osteomyelitis — — — — — 18 2 1 21 Osteo-arthritis — 9 — — — — — — 9 Acute Rheumatism 3 17 - - - - - - 20 Bow legs — — — — — 2 — — 2 Effusion into joint — 2 - - - - - - 2 Coccydynia - — — — — 2 — — 2 Diagnoses In Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Osteitis deformans — 1 - - - - - - 1 Ganglion — — — — — 2 — — 2 Coxitis — 1 — — — — — — 1 Synovitis — 1 — — — — — — 1 96 Carcinoma. Breast — — — — — 7 5 11 23 Rectum — — — — — 4 6 13 23 Stomach — — — - — — 7 19 26 Cervix — — — — — — 5 4 9 Ovary - - - - - - 3 2 5 Uterus - - — — — — 4 3 7 Prostate — — — — — — 5 4 9 Tongue and Mouth - - - - - 1 1 1 3 Colon — - — — — 3 5 28 36 Oesophagus - - - - - - 1 4 5 Pharynx — — — — — — 1 1 Bladder — — — — — - 4 2 6 Pancreas — — — — — — 1 4 5 Lung — — — — - — 3 10 13 Bronchus — — — — — 1 11 17 29 Epithelioma — — — — — — 1 2 3 Jaw — — — — — — 1 — 1 Cervix uteri — — — — — — 1 — 1 Sarcoma — — — — — 3 3 7 13 Spine — — — — — - 1 — 1 Liver — — — — — - — 8 8 Rodent ulcer — — — — — — 1 3 4 Ventriculi — — — — — 1 — 2 3 Glands — — — — — — 1 — 1 18 19 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Pelvic rectal junction - - - - - 1 - 2 3 Spleen — — — — — — 1 — 1 Lip — - — — — — — 1 1 Thyroid — — — — — — — 1 1 Ileo-caecal junction - - - - - - 1 — 1 Caecum — — — — — — — 1 1 Glioma of brain — - — — — — — 1 1 244 Circulatory (Blood). Anaemia — 8 1 1 — - — — 10 Septicaemia — 1 — 2 — - — — 3 Hyperpiesia — 1 — 1 — — — — 2 Pernicious Anaemia — 6 — 1 — — — — 7 Pyaemia — — — 3 — — — — 3 Thrombosis — 14 — 11 — — — — 25 Phlebitis — 7 — — — - — — 7 Gangrene — — — — — 4 — 1 5 Varicose veins — — — — — 11 — — 11 Leukaemia — 1 — 4 — — — — 5 Naevus — — — — — 1 — — 1 Epistaxis — 13 — — — — - - 13 Beri-beri — 1 — — - — - - 1 Malaria 1 19 — — — — — — 20 Purpura rheumatica — — — 1 — — — — 1 Blood transfusion — 1 — — — — — — 1 Haematoma — 1 — — — — — — 1 116 Circulatory (Heart) Myocardial Degen: — 19 2 101 — — — — 122 Hypertension — 29 3 3 — — — — 35 Arterio sclerosis — 21 2 25 — — - — 48 Endocarditis — 2 — 2 — — — — 4 20 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Auricular fibrillation — 6 — 1 — — — — 7 Myocarditis — 4 — 2 — — — — 6 Mitral stenosis — 7 1 4 — — — - 12 Carditis — 4 - - - - - - 4 Congestive heart failure — 24 2 50 — — — — 76 Tachycardia — 1 — — — — — — 1 Aortic regurgitation — — 1 2 — — — — 3 Angina — 9 — - - - - - 9 Rheumatic Carditis — 8 - - - - - - 8 Effort syndrome — 1 — — — — — — 1 Congenital heart disease — - 1 — — — — — 1 Vaso vagal syndrome — 1 — — — — — — 1 Heart block — 2 — — — — — — 2 340 Constitutional. Diabetes Mellitus — 24 — 1 - — — — 25 Debility — 3 — — — — — — 3 Nutritional disorder 3 18 — — — — — — 21 Marasmus — 2 — — — — — — 2 Malnutrition — 5 - - - - - - 5 Muscular atrophy — — 1 — — — — — 1 Rickets — 2 - - - - - - 2 . Cachexia — — — 2 — — — — 2 Diabetic coma — 1 — 2 — — — — 3 Obesity — — 1 — — — — — 1 65 Eye. Conjunctivitis — 2 — — — — — 2 Ear, Nose and Throat. Enlarged T's. and A's. 13 7 — — 978 — — — 998 Quinsy 2 - - - - - - - 2 21 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Otitis Media 11 40 - - - - - - 51 Pharyngitis — 5 - — — — — - 5 Laryngitis 3 - — — — — - - 3 Mastoiditis — — — — — 11 — - 11 Polypus - - - - - 7 — — 7 Sinusitis 1 14 - - - - - - 15 Coryza 2 - - - - - - - 2 Vestibular vertigo — 1 - - - - - - 1 Otorrhoea 1 - - - - — - - 1:: Vincents angina 1 - — - — — - - 1 - - 1097 Genito Urinary. Nephritis — 14 2 7 — — — — 23 Urethral stricture — 2 1 - — - - - 3 Vesical calculus — 1 — - — — - - 1 Pyelitis 3 28 1 - - - - - 32 Enlarged prostate - 14 1 3 — 9 - 2 29 Uraemia - 2 — 20 — — - - 22 Renal colic - 7 — 1 — — — — 8 Urinary calculus — 5 - - - - - - 5 Pyelonephritis — 4 — 6 — — — - 10 Perinephric abscess 1 — — - 1 — — - 2 Hydronephrosis — 1 — - - - - - 1 Papilloma of bladder - - - — - 6 - 1 7 Haematuria 1 - - - - - - - 1 Circumcision — — — — 143 2 — - 145 Retention - 10 - - - - - - 10 Penile Hypospadias — 1 - - - - - - 1 Undescended testicle — 1 — — — 4 — — 5 Dysuria — — 1 — — — — - 1 Incontinence — 2 - - - - - - 2 22 Diagnoses in Cases Treated Medical Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Cystitis — 8 - - - - - - 8 Hydrocele - — — — — 5 — — 5 Cystic kidney — — — — 1 — — - 1 Orchitis — 1 - - - - - - 1 Enuresls — 1 - - - - - - 1 324 Glands. Adenitis 2 22 - - - - - - 24 Hodgkin's disease — 1 1 — — - — — 2 Lymphadenoma — 2 — 1 — - — — 3 Thyroglossal cyst — i - - - - - - 1 Myxoedema — 1 - - - - - - 1 Thyrotoxicosis — 1 — — — 4 — — 3 Hyperthyroidism — 1 - - - - - - 1 Addisons disease — — 1 - - - - - 1 Parotitis 2 - - - - - - - 2 Thyroid adenoma 1 — - — — — — — 1 Glandular Fever 1 - - - - - - - 1 42 Gynaecological. Abortion — — — — 335 — — — 335 Fibrosis Uteri — — — — — 36 — — 36 Ovarian cyst — — — — — 44 — - 44 Uterine haemorrhage — — — — — 12 — — 12 Mastitis — — — — — 16 — — 16 Menorrhagia — — — — — 30 — - 30 Metrorrhagia - — — — — 9 — — 9 Vaginitis — — — — - 2 — — 2 Prolapsed uterus — — — — 2 — — 2 Dysmenorrhoea — — — — — 1 — — 1 Bartholin's cyst — - — — - 6 - — 6 23 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Bartholin's abscess — — — — — 1 - - 1 Erosion of cervix — — — — — 12 — — 12 Hysterectomy — — — — — 21 — — 21 Deficient pelvic floor — — - — — 23 — — 23 Cervical polypi — — — — 10 — — — 10 E.U.A. — — — — — 8 3 — 11 Salpingitis — — — — — 16 — — 16 Retroversion — — — — — 13 — — 13 Salpingo—oophoritis — — — — 3 6 — — 9 Retained products — — — — — 7 — — 7 Cervicitis - — - — — 2 — — 2 Cystocele — — - — — 2 - — 2 For sterilization — — - — — 1 - — 1 Sterility — — - — — 12 - — 12 Endometritis — — - — — 1 - — 1 Procidentia - — — — — 1 — — 1 Menopausal syndrome — — — — — 6 — — 6 Labial cyst — — — — 2 — — — 2 Urethral tear — — - — — 2 - — 2 Vaginal discharge - — - — — 1 — — 1 Parametritis — — — — — 2 - — 2 Colpo-perineorrhaphy — — — — — 1 - — 1 649 Infectious. Influenza 8 2 — — — — - — 10 Puerperal pyrexia — — 1 - - - - - 1 Scarlet Fever — — 5 - - - - - 5 Poliomyelitis — 6 — — — — - — 6 Dysentery — 3 - - - - - - 3 Whooping Cough — — 4 — — — — — 4 Cerebro spinal meningitis — 2 4 2 — — - - 8 Influenzal pneumonia — — - 1 — — - — 1 24 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Measles — — 1 - - - - - 1 Chicken pox — — 3 — — ~~ - — 3 Erysipelas — 2 — — — — — — 2 Infective enteritis — — 1 — — — — - 1 Tetanus 1 - - - - - - - 1 Rubella — 1 - - - - - - 1 Paratyphoid — — 2 — — — — — 2 49 Maternity. Pyelitis of pregnancy — — — — — 24 — — 24 False labour pains - - - - - 39 — - 39 Ectopic gestation - - - - - 10 — — 10 P.P.H. — — — — — 1 — — 1 A.P.H. - - - - - 11 — — 11 R.B.P. - - - - - 8 — — 8 Toxaemia of pregnancy - - - - - 23 — — 23 Vomiting of pregnancy — — — — — 13 — — 13 A.N. Observation - - - - - 38 — — 38 A.N. rest — — — — — 19 — — 19 Hyperemesis — — — — — 6 — — 6 Termination of pregnancy - - - - - 6 — 1 7 Ruptured tubal pregnancy - - - - - 3 — — 3 Icterus neonatorum — — — — — — — 1 1 Mothers — — — — 1316 — — — 1316 Babies — — — — 1224 — — 44 1268 2787 Mental. Uncertified — 14 183 — — — — — 197 Certified — — 21 — — — — — 21 Mental Deficiency — — 4 — — — — — 4 Epilepsy — 14 3 — - — — — 17 Hysteria - 10 — — - — — - 10 25 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Imbecile — — 1 — — — - - 1 Depression — 11 - - - - - - 11 Petit mal — 2 - - - - - - 2 Grand mal — 1 - - - - - - 1 Senile Dementia — 1 - 2 — — — — 3 267 Nervous and Sensory. Cerebral haemorrhage — 2 — 34 — — — — 36 Meningitis 1 2 — 3 — — — - 6 Chorea — 2 1 — — — — — 3 Hemiplegia — 7 — 5 — — — — 12 Sciatica — 10 - - - - - - 10 Neurasthenia — 1 — — — — — — 1 Neurosis — 16 1 - - - - - 17 Paralysis agitans — 1 1 - - - - - 2 Cerebral thrombosis — 21 3 47 — — — — 71 Neuritis — 8 - - - - - - 8 Convulsions — 4 — — — — — — 4 Parkinsons disease — 1 1 1 — — — — 3 Cerebral arterio-clerosis — - — 5 — — — — 5 Paraplegia — 3 1 - - - - - 4 Encephalitis — — 1 2 - — — — 3 Cerebral abscess — 1 2 1 — — — — 4 Subarachnoid haemorrhage — 3 — 5 — - — — 8 Migraine — 3 - - - - - - 3 Headache — 1 - - - - - - 1 Bell's Palsy — 2 - - - - - - 2 Disseminated sclerosis — 2 — 1 — — — — 3 Pseudo tumour — — 1 - - - - - 1 Cerebral tumour — — 3 — — — — — 3 Paralysis — — 1 - - - - - 1 26 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Hydrocephalus — — — 2 — — — — 2 Pinks disease — 1 - - - - - - 1 Intracranial tumour — — 1 — — — — — 1 Spinal tumour — 1 - - - - - 1 216 Respiratory. Bronchitis 9 76 1 6 — — — — 92 Pneumonia 32 183 1 58 — — — — 274 Pleural effusion — 20 - - - - - - 20 Bronchial Catarrh — 2 - - - - - - 2 Bronchiectasis — 10 1 — — — — — 11 Atelectasis — — — I — — — — 1 Pleurisy - 13 1 — — — — — 14 Emphysema - 4 — 1 — — — — 5 Asthma — 22 - - - - - — 22 Empyema 2 3 — 3 — — — - 8 Pulmonary congestion - 1 — — — — — — 1 Spontaneous Pneumothorax — 2 - - - - - - 2 Fibrosis of lungs — 1 2 — — — — — 3 Tumour of lung — — 2 — - — — — 2 Pulmonary embolism — 1 — 3 — — — — 4 Pyrexia - 1 — — — — — — 1 Asphyxia 1 — — — — — — — 1 463 Senility — 8 5 7 — — — — 20 Skin. Boils, abscess and carbuncles, etc. — — — — 13 57 1 — 71 Burns and scalds - - - - - 9 — 3 12 Eczema — 8 . — — — — — — 8 Impetigo — 11 — — — — — — 11 Scabies — 12 — — — — — — 12 27 Diagnoses in Cases Treeated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured lieved Unrelieved Died Dermatitis — 17 — — — — — — 17 Septic spots — 9 - - - - - - 9 Ringworm — 2 - - - - - - 2 Sycosis Barbae — 2 - - - - - - 2 Erythema nodosum — 1 - - - - - - 1 Ingrowing toenail — — — — — 1 — — 1 Lipoma — — — — — 1 — - 1 Cellulitis - - - - - 25 — 1 26 Ulceration — — — — — 24 — — 24 Urticaria — 2 - - - - - - 2 Excision of scar — — — — — 2 ' — — 2 Infected corn - — — — — 1 — — 1 Herpes 1 3 - - - - - - 4 Papilloma — — — — — 2 — — 2 Lupus vulgaris — — 1 — — — — — 1 Whitlow — — — — — 1 — — 1 210 Pulmonary Tuberculosis — 71 45 46 — — — — 162 Non-Pulmonary Tuberculosis. Spine — 3 1 - - - - - 4 Hip — — 2 — — — — — 2 Glands — 6 - - - - - - 6 Wrist — 1 - - - - - - 1 Arthritis — 2 - - - - - - 2 Sacro iliac joint — 1 — — — — — — 1 Meninges — — — 1 — — — — 1 Peritoneum — 2 - - - - - - 2 Venereal. 19 Syphilis — 2 2 1 — — — — 5 Gonorrhoea — 1 - - - - - - 1 6 28 Diagnoses In Cases Treated Medical. surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Violence. Fractured limbs - - - - - 86 2 22 110 Fractured spine — — — — — 3 — — 3 Fractured malleolus — — — — — 5 — - 5 Fractured skull - - - - - 6 - 3 9 Fractured ribs — — — — — 11 — — 11 Fractured clavicle — — — — — 5 — — 5 Fractured scapula — — — — — 2 — — 2 Fractured humerus — — — — — 12 — — 12 Fractured pelvis — — — — — 1 — — 1 Fractured nasal bones — — — — — 3 - — 3 Fractured patella - — — — — 4 — — 4 Fractured lumber transverse process — — — — 1 — — — 1 Minor injuries — — — — 1 15 — — 16 Contusions and abrasions — — — — 3 23 — — 26 Sprain — — — — — 8 — — 8 Concussion — — — — 1 40 — — 41 Bruises — — — — — 6 — — 6 Gun shot wound — — — — — 4 — — 4 Lacerations, wounds, etc. — — — — 2 16 , — 2 20 Shock — — — — — 2 — — 2 Amputations — — — — — 7 — — 7 Dislocation — - — - — 3 — — 3 299 Miscellaneous. Poisoning — 15 — 4 — - — - 19 Alcoholism 1 2 — — — - — - 3 B.B.A. ... 2 - - - — — - — 2 N.A.D. 47 — — - — - — - 47 With Mother 21 - - - - - - - 21 29 Diagnoses in Cases Treated Medical. Surgical. Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Hare lip and cleft palate — - — — — 14 — — 14 Dentition — 2 - - - - - - 2 Prematurity — 2 — 1 — — — — 3 Post op.; haemorrhage — - — 1 — — — — 1 Extraction of tooth — - — — — 2 — — 2 F.B. — - - — 2 2 — — 4 Malingering — — 2 — — — — — 2 Removal of nail — — — — — 5 — — 5 Supernumerary thumb — — ' — — — 1 - — 1 Tetanus — — - 1 ,— — — — 1 For X-ray — 1 - - - - - - 1 Paracentesis — 1 - - - - - - 1 129 TOTAL NUMBER OF PATIENTS DISCHARGED FROM MAYDAY HOSPITAL YEAR ENDED 31st DECEMBER, 1946. Cured 4,540 Relieved 2,682 Unrelieved 427 Died 804 8,453 TOTAL NUMBER OF OUT-PATIENTS TREATED AT MAYDAY HOSPITAL DURING THE YEAR 1946 16,198 30 OPERATIONS PERFORMED AT MAYDAY HOSPITAL DURING 194G ABDOMINAL. Appendicectomy 179 Appendix abscess drained 5 Sigmoidoscopy 24 Herniotomy 103 Cholecystectomy 15 Laparotomy 77 Gastro-enterostomy 8 Colostomy 17 Perforated gastric ulcer 21 Injection of haemorrhoids 2 Haemorrhoidectomy 18 Perforated duodenal ulcer 10 Gastroscopy 29 Undescended testicle 2 Orchidectomy 3 For hydrocele 8 Gastrectomy 1 Resection of gut 2 Intussusception 1 Gastro jejunostomy 4 Fistula-in-ano 4 Resection of colon 2 Inguinal fistula 1 Ca. of splenic flexure 1 537 BONES AND JOINTS. For osteo-myelitis 2 Amputation of limbs 8 Wiring of bones 17 Resection of rib 7 Application of plaster 44 Reduction of joints 13 Manipulation of limbs 19 Removal of Sequestrum 2 Division of webbed phalanges 1 Bone graft 2 Genu-varum 1 Prepatellar bursa 2 Excision of coccyx 2 120 EAR, NOSE AND THROAT. Tonsillectomy 972 Adenoidectomy 2 Thyroidectomy 5 Mastoidectomy 14 Pinna for section 1 Repair of hare lip 10 Tonsil tags 4 Nasal septum cauterised 4 Removal of aural polyp. 5 1,017 31 GENITO URINARY. Cystoscopy 45 Circumcision 144 Prostatectomy 12 Supra pubic cystotomy 22 Urethral dilatation 9 Fulguration of bladder 1 Insertion of Depezar catheter 3 Nephrectomy 3 Prostoscopy 3 242 GYNAECOLOGICAL. Examination under Anaesthetic 105 Total hysterectomy 39 Sub-total hysterectomy 14 Salpingo-oophorectomy 19 Dilation and Curetage 98 Resection of ovaries 6 Salpingectomy 2 Ovariotomy 5 Incision of Bartholin's cyst 3 Insertion of pessary 5 Colpo-perineorrhapy 15 Cauterization of Cervix 42 Baldy Webster Operation 15 Fothergill's Operation 4 Urethral and cervical smears taken 1 Cervical polypus 8 Amputation of Cervix 2 Biopsy of Cervix 17 Removal of Gauze Packing from Uterus 6 Suture of laceration of vaginal wall 3 Intra-uterine Lipiodol 2 Dudley's Operation 2 Myomectomy 7 Hymenectomy 7 Painting vagina 20 Pelvic examination 5 Removal of broad ligament cyst 2 Cautery excision of urethral caruncle 3 Removal of fibroid 2 Evacuation of hæmatoma of labia 2 Drainage of ovarian cyst 1 Removal of ovarian cyst 2 464 OBSTETRICAL. Caesarean Section 59 Evacuation of uterus 244 Removal of placenta 2 Termination of pregnancy 2 Artificial rupture of membranes 113 Bougie induction 18 438 32 MISCELLANEOUS. Blood Transfusions 28 Incisions, abscesses, etc. 110 Cleansing of Burns, etc. 3 Skin graft 4 Amputation of Breast 9 Suture of Wounds 25 Excision of Wounds 6 Lumbar Puncture 48 Aspiration of chest 56 Aspiration of breast 2 Aspiration of neck 1 Aspiration of shoulder 1 Aspiration of thigh 2 Aspiration of kidney 1 Removal of foreign body 11 Paracentesis 17 Extraction of teeth 10 Injection of Varicose Veins 3 Ligature of Varicose Veins 10 Removal of Glands 4 Aspiration of cold abscess 2 Venesection 17 Removal of Naevus 1 Removal of Ganglion 5 Pyelogram 3 Excision of Scar Tissue 1 Injection of Sciatic Nerve 3 A.P. refill 27 Intravenous saline 4 Splanic block 1 Removal of toe nail 9 Phrenic crush 17 Bronchoscopy 1 Thoracotomy 1 Lipoma of thigh 1 444 Number of patients who had teeth extracted: 163 33 Coombe Cliff Convalescent Home. The following is a summary of the cases dealt with: — Number of cases admitted during the year 133 Total number of cases discharged 118 Number of patient days—53.5 per patient (1946 cases). Age groups of cases admitted. 0—4 5—8 9—12 Over 12 Total Male 23 21 22 3 69 Female 20 29 13 2 64 Total 43 50 35 5 133 Condition on discharge. 0—4 5—8 9—12 Over 12 Total M. F. M. F. M. F. M. F. M. F. Improved 7 7 8 15 8 3 - - 23 25 Much Improved 12 7 6 10 8 6 1 1 27 24 No change 1 3 2 — — 1 — 1 3 5 Discharged at parent's request 1 - 3 3 2 - 2 - 8 3 Total 21 17 19 28 18 10 3 2 61 57 34 PUBLIC ASSISTANCE. (a) Domiciliary Relief. Number of Croydon cases resident in the Borough and in receipt of outdoor relief on the— 1st January, 1946 1,586 persons 871 cases 1st July, 1946 1,541 ,, 862 „ 1st January, 1947 1,628 ,, 884 ,, Expenditure on Out-relief during the 12 months ended 30th September, 1946, to Croydon cases resident in the Borough:— Half-year ended 31st March, 1946 £33,063 17s. 0d. Half-year ended 30th September, 1946 £32,413 14s. 6d. (b) Institutional Relief. Number of Croydon persons relieved in the Mayday Hospital on 1st January, 1947, and in the Queen's Road Homes on the same date: — Mayday Hospital 30 Queen's Road Homes 473 (excluding 50 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 31-3-47. All Districts. (1) Average number of separate patients attended during each quarter 1,860 (2) Attendances at patients' homes 13,499 (3) Attendances on patients at the surgery 17,112 (4) Total number of prescriptions written 35,376 (5) Estimated cost of drugs, dressings and dispensing £2,207 7s. 11d. (6) Estimated amount of per capita payment to doctors in respect of patients actually attended (calculated quarterly) 5s. 11.78d. (7) Estimated average payment per service point 2.37d. 35 HOME HELPS. The Home Helps scheme during the year 1946 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, 1946— 1/1/46. 31/12/46. (a) Full-time 21 35 (b) Part time 9 10 (2) Number of applications— (a) Maternity 622 (b) Sickness 100 (3) Number of applications met— (a) Maternity 551 (b) Sickness 87 (4) Average duration of services given— (a) Maternity 14 days (b) Sickness 10—21 days (5) Amount recovered for services £981 lis. 3d. ((>) Rate of remuneration of "Helps"— (a) Maternity: Jan. 1st—July 29th £3 12s. 6d. weekly July 30th—Dec. 31st £4 5s. 2d. weekly (b) Sickness: Jan. 1st—July 29th l/6d. per hour July 30th—Dec. 31st 1 /9¾d per hour Reference should also be made to page 94 for further data in regard to this Service. AMBULANCE SERVICE. To The Medical Officer of Health. 1 beg to submit the Fifth Annual Report and Statistics for this Service, for the year ended 31st December, 1946. During the year the Service dealt with 15,274 calls, which is an increase of 8,875 over the figures for 1945. This increase is accounted for by the substantially higher figures for Private Removals (3,605 against 1,608), Public Health Department (4,047 against 1,407), and Public Assistance Committee (626 against 194), and shows the full effect of the free ambulance service within the Borough. 36 The total mileage covered by ambulances on calls during the year was 88,255 miles, which is more than double the mileage for 1945. The average time for an ambulance to attend a call has risen slightly to minutes, which is accounted for by the congestion of traffic on the roads in the centre of the Borough, which is where the majority of the accidents occur, and which have to be most widely used. Once again during the past year the Croydon Ambulance Service has been requestd by adjacent boroughs to stand by for accident calls, and those requests have always been fulfilled. With effect from the 26th October, 1946, the Ambulance Service was removed to, and situated at the following points Headquarters Station—Stroud Green, Shirley Road. No. 2 Station—Cassland Road, Thornton Heath. No. 3 Station—Crunden Road, South Croydon. I would like to mention that the situation of these ambulance stations has given every cause for satisfaction as all calls in the Borough have consequently been attended to with the minimum amount of delay. Our system of noting accident calls on a map is still being maintained, and from this I am able to derive the following figures showing the comparison between 1945 and 1946 at the various " Black-spots" in the Borough: — 1946. 1945. District 1. (Mayday Road to Bensham Lane) 37 30 District 2. (George Street to "Davis Theatre" and Crown Hill) 142 98 District 3. 4 ("Swan and Sugar Loaf" to "Red Deer") 33 27 District 4. (High Street, South Norwood and Portland Road) 29 11 District 5. (North End, Croydon, from Tamworth Road to Kennards) 75 48 The weekly toll of accidents is still being recorded by means of graphs at the Headquarters Station, and this has proved of value to the Safety First Committee. 37 1 am again able to record that we have received numerous letters of appreciation and thanks from residents who have had occasion to use the ambulance service, and I am pleased to state that no single complaint has been received. The mechanical condition of the ambulances has been the subject of a special report, and it is to be hoped that the existing ambulances will be replaced by newer vehicles at the earliest possible moment in order that the efficiency of the Service can be maintained. Repairs and maintenance work are being carried out by 2nd Officer Innes and his staff, and thanks are due to them for the efficient way in which they have carried out their work and also to the officers and men for their ready co-operation, which has combined to make the Service run smoothly. In conclusion, may I express my sincere thanks to the Members of the Ambulance Sub-Committee and to the Medical Officer of Health, for their help, encouragement and advice, which has been of great assistance to me in the administration of the duties of Chief Ambulance Officer. A. L. HILL, Chief Officer. FINANCIAL STATEMENT. Income from Private Use of Ambulances. Accounts totalling £252 13s 0d. 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 £195 7s. 0d. have been rendered to the Public Health Department for patients conveyed on their behalf. Transport of Patients for Public Assistance Committee. Patients conveyed for Public Assistance Committee realised the sum of £240 1s. 6d., and accounts for this amount have been rendered. 38 During the year cash to the value of £160 17s. 0d. (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. The decrease in the above amounts compared with the previous year is an obvious outcome of the free ambulance service ANALYSIS OF ACCIDENTS FOR YEAR ENDED 31st DECEMBER. 1946. 1946. 1945. Collision between Vehicles, Cycles, &c. 124 56 PEDESTRIANS KNOCKED DOWN BY— (1) Motor Cycle 19 12 (2) Motor Lorry 33 55 (3) Pedal Cycle 25 29 (4) Public Service Vehicle 20 27 (5) Motor Car 80 78 (6) Horse drawn vehicles — 4 177 205 INJURIES SUSTAINED BY FALLING— (1) In the Street 114 165 (2) In the Home 70 84 (3) From Vehicles, Cycles, &c. 63 95 (4) Down Stairs 28 38 (5) From Trees, Scaffolding, &c. 12 18 (6) From Horses — 1 287 401 WORKS ACCIDENTS— (1) Caught in Machinery 16 13 (2) Crushed by heavy objects 16 23 (3) Miscellaneous accidents at work 99 110 131 146 ACCIDENTS IN PUBLIC PLACES— (1) Theatres 2 5 (2) Cinemas 1 3 (3) Public Halls 3 5 (4) Railway Stations 15 31 (5) Sports Grounds 27 45 (6) Recreation Grounds 19 - (7) Miscellaneous — 5 67 94 39 1946. 1945. ACCIDENTS— (1)Dog Bites 3 4 (2)Miscellaneous 59 121 62 125 DEATHS— (1)Certified at Hospital 43 41 (2)Certified at scene of accident or illness 11 5 54 46 SUICIDES— (1)Hanging — 1 (2)Poison 2 — (3)Coal Gas Poisoning 13 4 (4)Drowned in Bath — 1 15 6 ATTEMPTED SUICIDE— (1)Poison 8 10 (2)Cut Throat 1 2 (3)Coal Gas Poisoning 12 5 (4)Cutting Wrists 2 2 23 19 BURNS AND SCALDS 21 50 PERSONS FALLING FROM PUBLIC SERVICE VEHICLES 27 41 COMMON ASSAULT 20 32 SUDDEN ILLNESS IN THE STREET 322 No record EPILEPTIC FITS 53 do. OXYGEN USED 46 do. ACCIDENTS TO CHILDREN UNDER 15 YEARS OF AGE— (1)Schools 78 59 (2)In the Home 82 88 (3)In the Streets 164 289 324 436 40 STATISTICS. During' the year 15,274 calls were dealt with by the Ambulance Service as follows :— 1946. 1945. Accidents in Street, Places of Employment, Public Places 897 1,135 Accidents in Private Houses 243 266 Sudden Illness in Street, Places of Employment, etc. 510 552 Sudden Illness in Private Houses 183 138 Transport of Cases from Hospitals after treatment 871 965 Private Removals from Hospitals, Nursing Homes, Private Residences, etc. 3,185 1,608 Public Health Department—Transport of Patients 4,047 1.407 Public Assistance Committee—Transport of Patients 626 194 Service of Ambulance not required, or refused 177 134 Accidents in Schools 79 — Calls taken by Mayday and Borough Hospital Ambulances 4,456 Totals 15,274 6,399 INCIDENCE OF CALLS. 2 days 3 calls 5 days 24 calls 3 days 45 calls 1 „ 4 „ 5 ,, 25 ,, 3 „ 46 „ 1 ,, 5 ,, 3 „ 26 ,, 7 ,, 47 „ 1 ,, 6 „ 6 „ 27 ,, 5 ,, 48 „ 8 ,, 7 ,, 4 ,, 28 ,, 1 ,, 49 „ 8 ,, 8 ,, 9 „ 29 „ 10 ,, 50 „ 10 ,, 9 ,, 13 ,, 30 ,, 6 ,, 51 ,, 7 „ 10 „ 9 „ 31 ,, 3 „ 53 „ 5 „ 11 „ 7 ,, 32 „ 3 ,, 54 „ 4 ,, 12 ,, 15 ,, 33 ,, 1 ,, 55 „ 8 „ 13 „ 9 ,, 34 „ 3 ,, 56 „ 7 ,, 14 ,, 5 ,, 35 ,, 3 ,, 57 „ 10 ,, 15 ,, 10 ,, 36 ,, 2 „ 58 „ 9 „ 16 „ 9 „ 37 „ 2 ,, 59 „ 4 17 „ 10 ,, 38 ,, 1 ,, 60 3 ,, 18 „ 7 „ 39 „ 3 ,, 61 „ 19 „ 19 „ 15 ,, 40 ,, 1 ,, 62 „ 16 „ 20 ,, 5 ,, 41 ,, 1 ,, 64 „ 8 ,, 21 ,, 10 ,, 42 ,, 1 ,, 65 „ 5 „ 22 „ 5 „ 43 „ 1 „ 76 „ 4 „ 23 ,, 4 ,, 44 ,, 41 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 13 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 1946 5.65 88255 7416 3185 4673 15274 252 13 0 274 13 6 HOW CALLS WERE RECEIVED. Police Fire Stations and Ambulance Call Boxes All other sources Total 452 235 14587 15274 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. Borough of Beckenham East of Borough Boundary 3 Borough of Carshalton, Borough of Beddington and Wallington. West „ ,, 2 Borough of Mitcham North-West 4 Coulsdon and Purley U.D.C. South ,, ,, 12 London County Council North 7 42 SERVICES RENDERED BY STAFF AT ACCIDENTS. On 987 occasions First Aid was rendered to injured persons prior to their removal to Hospital. On 46 occasions Oxygen and Carbon Dioxide were administered to patients by means of the "Nevex Resuscitating Apparatus." On 11 occasions persons were certified dead at scene of accident or illness- On 43 occasions injured persons were conveyed to hospital, but were certified dead on arrival. During the year the Service were called upon to deal with 15 cases of Suicide and 23 cases of attempted Suicide. The calls during the year were dealt with as follows :— Headquarters Station 8,765 No.2 Station, Thornton Heath 1,894 No.3 Station, Crunden Road 159 Mayday and Borough Hospitals 4,456 15,274 During the year the Service has undertaken to convey children daily from Tennison Road to Addington Day Nursery and return, and, since 25th November, 1946, have daily collected children from their homes, conveyed them to St. Margaret's School and returned them to their homes. Since the inception of the service for Gas and Air Analgesia on 3rd October, 1946, Gas and Air sets have been in demand 84 times, and a total of 444 miles was covered on these calls. I wish to report that since the Ambulance at Mayday Hospital was incorporated in the Croydon Ambulance Service on 30th April, 1946, there is now one combined Service for the whole of the Borough. HOURS AT WHICH CALLS WERE RECEIVED. 12 midnight to 1 a.m. 244 12 noon to 1 p.m. 989 1 a.m. to 2 a.m. 235 1 p.m. to 2 p.m. 953 2 a.m. to 3 a.m. 96 2 p.m. to 3 p.m. 1,145 3 a.m. to 4 a.m. 92 3 p.m. to 4 p.m. 983 4 a.m. to 5 a.m. 197 4 p.m. to 5 p.m. 597 5 a.m. to 6 a.m. 160 5 p.m. to 6 p.m. 381 6 a.m. to 7 a.m. 178 6 p.m. to 7 p.m. 264 7 a.m. to 8 a.m. 188 7 p.m. to 8 p.m. 220 8 a.m. to 9 a.m. 349 8 p.m. to 9 p.m. 157 9 a.m. to 10 a.m. 785 9 p.m. to 10 p.m. 156 10 a.m. to 11 a.m. 1,138 10 p.m. to 11 p.m. 173 11 a.m. to 12 noon 960 11 p.m. to 12 midnight 178 4,622 6,196 Total Calls 10,818 Mayday and Borough Hospitals 4,456 15,274 INFECTIOUS DISEASES NOTIFIED DURING YEAR 1946. 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 of Notified Cases. 1946. 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 440 1 90 302 25 18 4 - 15 20 29 20 32 41 47 45 30 22 30 24 38 18 29 374 - 206 234 Diphtheria 36 - 5 15 6 6 3 1 6 - - 1 5 1 2 2 4 2 4 2 6 1 - 34 3 11 25 Erysipelas 35 - 1 — 2 11 16 5 - 2 2 6 6 2 3 2 - 4 - 3 3 2 - 11 - 13 22 Cerebro-Spinal Meningitis 8 - 3 3 1 - — 1 2 — 2 - - — 1 - - — 2 — — 1 - 4 2 4 4 Enteric & Paratyphoid 3 - 1 - - 1 1 - - - 3 - - - - - - - - - - - - 3 - - 3 Small Pox - - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 57 - - - 14 43 — — 4 1 30 1 1 — 1 •—1 1 2 5 2 1 8 15 — - 57 Ophthalmia Neonatorum 7 7 - - - - - - - - 1 2 2 - - - - 1 - 1 - - - 1 - 3 4 Poliomyelitis and Polio-encephalitis 4 - 1 1 2 - - - - - 2 - - 1 - - - - - - - 1 — 2 1 2 2 Dysentery 2 - - 1 1 - - - - - - - - - - - - 1 - 1 - - - - - 1 1 Malaria 2 - - - - 2 - - - - - - - - - - - 1 - - - - - - - 2 - Acute Primary and Acute Influenzal Pneumonia 64 4 6 7 3 21 16 7 1 5 10 5 — 5 1 4 2 4 7 8 7 4 1 — — 37 27 Measles 869 24 397 423 13 11 1 — 57 39 97 114 69 51 43 107 51 25 30 25 73 84 4 26 1 425 444 Whooping Cough 368 29 207 128 — 2 2 —• 22 26 30 32 39 24 21 65 10 9 8 4 21 17 40 11 3 191 177 Totals 1895 65 711 880 67 115 43 14 107 93 207 181 154 125 119 225 98 71 86 70 149 136 74 481 — 895 1000 48 44 Comments on the Incidence and Prevalence of Infectious Disease. Scarlet Fever cases showed a decrease on 1945. The incidence rate of Diphtheria was 0.15, compared with 0.15 in 1945. No cases of Small Pox occurred during the year. There were 57 cases of Puerperal Pyrexia; 15 occurred in the 15-24 age group, and 43 in the age group 25-44 years. BOROUGH HOSPITAL. 682 patients were admitted and discharged which, together with patients in at the commencement of 1946 (67) gives a total of 749 dealt with. Ten deaths occurred, giving a case mortality of 1.47. Penge Urban District Council have an arrangement with the Corporation to send their cases to the Hospital. During the year 22 cases were admitted and these are included in the tables. Three operations for tonsils and adenoids were performed Three nurses passed the Final General Nursing Council Fxamination during the year. Table A gives a summary of all cases treated at the Hospital during 1946. Complaint for which admitted. Patients remaining in Hospital on 1st January, 1946 Patients admitted and discharged in 1946 Patients admitted during 1946 and remaining in Hospital on 1st January, 1947 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 38 38 - 346 346 - 47 47 - 393 393 - - 25 Diphtheria 10 10 - 74 72 2 15 15 - 89 87 2 2.2 32 Enteric Fever — — - 3 3 — 1 1 — 4 4 — — 20 C.S.M. 1 1 - 12 11 1 — — - 12 11 1 8.3 30 Dysentery — - - 6 6 - - - - 6 6 - - 8 Puerperal Pyrexia — — — 15 15 — — — - 15 15 - - 18 Erysipelas 1 1 - 12 12 — — — - 12 12 - - 18 Measles - - - 25 24 1 2 2 - 27 26 1 3.7 12 Rubella — — - 1 1 — — — - 1 1 — — 15 Whooping Cough — — - 12 11 1 1 1 — 13 12 1 7.7 29 Chicken Pox 2 2 - 42 42 — 1 1 - 43 43 — — 18 Mumps — —• - 3 3 — — — - 3 3 — — 12 Encephalitis — — — 1 — 1 — — — 1 — 1 100.0 15 Tonsilitis — — - 4 4 —• — — - 4 4 — — 10 Meningitis 1 1 - 5 4 1 — — - 5 4 1 20.0 12 Gastro Enteritis 1 1 - 13 10 3 — — - 13 10 3 23.0 11 Poliomyelitis 1 1 - 3 3 — — — - 3 3 — — 29 Ophthalmia — — - 5 5 — — — - 5 5 — — 19 Venereal Disease — — - 5 5 — — — - 5 5 — — 13 Pemphigus — — - 1 1 — — — — 1 1 — — 14 Dermatitis 1 1 - - - - - - - - - - - - No Disease - - - 27 27 - - - - 27 27 - - - Totals 56 56 — 615 605 10 67 67 — 682 672 10 — — 45 46 SCARLET FEVER. The total number of Scarlet Fever cases admitted during the year was 393, an increase of 4 cases on 1945. The type of disease was of average severity. Of the 393 cases 7 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 2 5 7 Otorrhoea 1 6 7 Adenitis 1 9 10 Relapse — — — Abscesses — 1 1 Quinsy — 1 1 Secondary sore throat — 2 2 Rheumatism 1 1 2 Albuminuria 1 — 1 The average stay in hospital for serum cases was 24.8 days, for non-serum cases 24.9 days. No deaths occurred amongst the Scarlet Fever cases. The total number of complications amongst the serum cases was 6, and amongst the non-serum cases 25. Both M B. 693 and M.B. 760 proved useful, particularly in clearing up the otorrhoea due to streptococci and staphylococci respectively. 47 Ages and Sexes Admitted. Scarlet Fever. Age. Male. Female. Totals. 0—1 - 1 1 1—2 11 8 19 2—3 15 7 22 3—4 13 13 26 4—5 27 18 45 5—10 70 100 170 10—15 25 42 67 15—20 6 12 18 20—30 4 6 10 30 or over 6 9 15 Total 1946 177 216 393 Total 1945 178 211 389 DIPHTHERIA. 89 cases were admitted with a diagnosis of diphtheria, that is three less than 1945. Of the 89 cases 29 were found to be cases of positive swabs, and 17 cases were as follows :— Tonsillitis 13 Vincent's angina 2 Simple croup 1 Scarlet fever 1 Total 17 Thus only 43 cases of the 89 admitted were cases of true Diphtheria, of which only 15 had been immunised. There were 2 deaths amongst them, due to heart failure, an adult female and a girl aged 14 years. Neither of them had been immunised. 41 cases were cases of Faucial Diphtheria and 2 cases of Nasal Diphtheria. The following complications occurred amongst them :— Rhinorrhœa 2 Adenitis 2 Heart failure 3 Paralysis: Eyes 1 Palate 2 48 Ages and Sexes Admitted. Diphtheria. Age. Males. Females. Totals. 0—1 - - - 1—2 4 1 5 2—3 4 3 7 3—4 2 2 4 4—5 2 1 3 5—10 6 16 22 10—15 3 10 13 15—20 2 7 9 20—30 4 8 12 30 & over 3 11 14 Total 1946 30 59 89 Total 1945 40 52 92 Typhoid Fever. Four cases were admitted as cases of typhoid, but in one the diagnosis was not confirmed. Two were cases of paratyphoid B fever, and the third was a case of typhoid fever. Puerperal Fever and Pyrexia. Fifteen cases were admitted, of these twelve were cases of puerperal fever, the other three were as follows:— One case of wound sepsis, one case of streptococcal throat infection, one case of influenza. Erysipelas. Twelve cases were admitted, but one of them was a case of leg ulcer. Measles. Twenty-seven cases were admitted as measles, but in one the diagnosis were not confirmed. The disease was of average severity, and one death due to ensuing broncho-pneumonia occurred. One of the cases was complicated by encephalitis. Cerebro-Spinal Meningitis. Twelve cases were admitted as cerebro-spinal meningitis. Of these, five were true cases, and in one the diagnosis was not confirmed. The other six cases were as follows:— Three cases of influenza, one case of cerebral tumour, one case of T.B.meningitis, one case of encephalitisNo deaths occurred amongst these cases. Whooping Cough. Thirteen cases were admitted as whooping cough, but in two the diagnosis was not confirmed. One was a case of bronchitis and one a case of teething. One death occurred amongst the nine true cases, due to broncho-pneumonia. 49 Encephalitis. One case admitted which died, was a case of sub-arachnoid cerebral hæmorrhage. Dysentery. Six cases were admitted, but four proved negative, one was a case of colitis, and one of gastro-enterilis. Gastro-Enteritis. Thirteen cases were admitted, but in four of these the diagnosis was not confirmed. Three were cases of diarrhoea and vomiting, and one of Sonne dysentery. Three deaths occurred amongst the cases of gastro-enteritis. Poliomyelitis. Three cases were admitted as poliomyelitis, but one proved to be a case of hysteria. Meningitis. Five cases were admitted as such, but three were cases as follows:— One a case of T.B.meningitis, one a case of influenza, one a case of broncho-pneumonia. The T.B.meningitis case died. Pemphigus. One case was admitted, but it proved to be a case of dermatitis. Ophthalmia. Five cases were admitted, of these four were cases of simple ophthalmia, whilst one was a true case of ophthalmia- Out of Borough Cases. Disease. Males. Females. Total. Deaths. Scarlet Fever 3 9 12 — Diphtheria 3 6 9 — C.S.M 1 — 1 — Total 7 15 22 — AGE GROUPS OF CASES ADMITTED (other than Scarlet Fever or Diphtheria). 0—1 1—2 2—5 5—15 15—25 25—35 35—45 45 & over Totals Deaths M F M F M F M F M F M F M F M F Enteric Fever - - - - - - - - 1 - - 1 - - - 1 4 - Puerperal Pyrexia — - - — — — - - 5 — — 7 — 3 — — 15 — Erysipelas - — - — — 1 — — — 1 1 2 — 1 1 5 12 — Measles — 1 1 1 5 5 6 3 2 1 — — — 1 — 1 27 1 Rubella - — — — 1 — — — - — — — — — — — 1 — C.S.M — — — — 4 1 3 — 1 1 1 — — — — 1 12 1 Whooping Cough 1 1 4 — 3 — 3 1 — — — — — — — — 13 1 Chicken Pox 4 3 3 4 — 7 14 2 2 1 2 1 — — — — 43 — Mumps — — — — 1 — 1 — — — — 1 — — — — 3 — Encephalitis — — — — — — — — — — — — — — 1 - 1 1 Dysentery — — — 3 — —. — — — — — 1 — 1 - 1 6 — Gastro-enteritis 3 3 — 2 - — 1 1 — 2 — 1 — — — — 13 3 Poliomyelitis — — — — — — 2 — — 1 — — — — — — 3 — Meningitis 2 — — — 2 — — — 1 — — — — — — - 5 1 Tonsilitis — — — — — — 3 1 - - - - - - - - 4 — Pemphigus 1 - - - - - - - - - - - - - - - 1 — Ophthalmia 2 3 - - - - - - - - - - - - - - 5 — Venereal Disease - - - - - - - - - - - - - - - - 5 — No Disease - - - - - - - - - - - - - - - - 27 - Totals 13 11 8 10 17 14 33 8 12 12 4 14 — 6 2 9 200 8 50 51 Croydon Borough Hospital Laboratory Report. DIPHTHERIA (Nose and Throat Swabs). Positive Swabs on admission. Positive Swabs during convalescence. Total Negatives. Total Examined. 54 145 1,968 2,167 FÆCES(Examined for Salmonella, Shigali Groups). Positive Salmonella Typhi. Positive Salmonella Para. B. Positive B. Aertryche. Positive Dysentery Sonnè. Total Negatives. Total Examined. 1 1 1 1 32 36 AGGLUTINATION TESTS (Dreyer Technique). Positive Salmonella Typhi. Positive Salmonella Para. B. Positive B. Aertryche. Total Negatives. Total Examined. 1 1 1 3 6 MISCELLANEOUS EXAMINATIONS. 12 Specimens Urines: Routine examination. 3 Pus Swabs for organisms: Staphylococci grown. 2 Throat Swabs: Vincent's Angina present. 9 Cerebro-Spinal Fluids: 4 Meningococcus present, 5 sterile. 1 Sputum for T.B.: Negative. 2 Specimens Pus cultured for organisms: 1 Hæmolytic Strept. Longus, 1 Staphylococcus Aureas. 1 Swab Ear for organisms: Staphylococcus Aureas. 1 Eye Swab for organisms: Sterile. 1 Swab from Skin: Staphylococcus Aureas cultured. 2 Specimens Feces : Occult blood test positive 3 Specimens Blood for white cell count. 1 Specimen Blood for Hæmoglobulin content. CULTURE MEDIA. 200 doz. Leoffler's Blood Serum Slopes. 6,000cc Nutrient Agar. 8,000cc Nutrient Broth. 4,000cc Peptone Water. At the Laboratory, Croydon General Hospital. For private practitioners Mayday Hos. For Borough Hospital For Chest Clinic For School Medical Other Instns. of Corporation Other Institutions Total Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Swabs for Diphtheria 35 890 ... ... ... ... ... 1 35 937 4 243 5 198 79 2269 Virulence tests for Diphtheria ... ... ... 1 9 ... ... ... ... ... 1 ... ... ... 10 1 Sputum for Tub. Bac. 42 435 ... ... ... ... 836 1276 ... ... ... ... 24 186 902 1897 Pus for Tub. Bac. ... 8 ... 1 2 1 ... ... ... ... 1 35 ... ... 3 45 Pus for Gonococci. ... 12 ... ... ... ... ... ... ... 4 ... 71 ... ... ... 87 Pus for other organisms. ... 16 ... 1 ... 3 ... ... ... 3 ... 50 ... ... ... 73 Blood for Typhoid Groups ... 2 ... ... ... ... ... ... ... ... ... 18 ... ... ... 20 Blood for Wassermann. ... 13 26 209 ... 3 ... 1 ... 1 ... 15 ... ... 26 242 Material for Spirochaetes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Faeces for Typhoid Group 2 34 1 ... ... ... ... ... ... 1 8 6 Sonne 24 ... ... 11 6Sonne 59 Hair for Ringworm ... ... ... ... ... ... ... ... 3 4 1 1 ... ... 4 5 Examination of Urine 3 ... 1 ... ... 33 ... 37 Examination of Pleural Fluid 3 ... ... ... ... 2 ... 5 Examination of C.S.Fluid ... 45 ... ... ... ... ... 45 Other Examinations 488 472 ... ... 278 327 2 1567 BACTERIOLOGICAL EXAMINATIONS. I am indebted to the Borough Pathologist, Dr.H.W. Southgate, for the figures given in the appended tables. 52 53 Examinations for Special Clinic. Pos. Neg. Pus for Gonococci (Smears) 554 2,310 ,, ,, ,, (Cultures) 99 1,680 Blood for Wassermann 229 1,433 ,, ,, Kahn 228 1,081 ,, ,, G.C.F.T. 67 949 Material for Spirochaetes 15 5 Cerebro-spinal Fluids 72 Other Examinations 374 Examinations Done Under the National Health Insurance Act. Nature of Examination. Pus for Gonococci 11 (2 pos.) Pus for other organisms 27 Pus for Tub. Bac. 23 Blood for Wasserman 39 (2 pos.) Complete Blood Counts 39 Urine for Chemical Exam. 16 Urine for Microscopal Exam. 16 Urine for Tub. Bac. 16 Urine for Cultural Exam. 16 Other Examinations 35 Bacteriological Examination of Milk. Number of Samples submitted for Counts 409 Number under 10,000 per cc 167 Number over 10,000 but under 50,000 per cc 147 Over 50,000 but under 100,000 per cc 35 Over 100,000 but under 500,000 per cc 43 Over 500,000 but under 1,000,000 per cc 8 Over 1,000,000 per cc 9 Tubercle Bacilli— Number of samples of milk submitted 409 Number found positive by inoculation test 0 The number of milk examinations increased by 60 Number of samples still under investigation for T.B. 0 409 milk samples were submitted to the Methylene Blue Test, which 78 failed to satisfy. 118 milk samples were also submitted to the Bacillus Coli Test and 84 were satisfactory. 54 Milk Samples. 248 samples were submitted to the Phosphatase Test, of which 5 failed to satisfy. IMMUNISATION AGAINST DIPHTHERIA. New cases came from the following sources:— School cases 789 Children under 5 years 3,146 The ensuing tables give some further details:— Total number of sessions held 130 Summary of Attendances and Treatment. 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 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 1946 5346 3935 130 — — 2899 2710 93.5 3934 Summary of Attendances and Treatment. Under Treatment 1.1.46 Total new Cases, 1946. 1946 Cases Completed Treatment. Received A.P.T. Under Treatment 31.12.46 Defaulted. 272 3935 3934 5346 236 385 55 Origin and Source of New Cases attending Year. School M.C.W. Total Per cent. Total. Per cent. 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 281 9.4 2698 90.6 1946 789 20.0 3146 80.0 Home Visits by Health Visitors. A total of 1,094 home visits was paid during the year. 56 VACCINATION ACTS. I am indebted to Mr. Huggins, the Vaccination Officer, for the particulars in the returns in the subjoined Tables. Registration Subdistricts in V.O. District. Births Registered. Vaccinated. Insusceptible. StatutoryDeclaration. Died Unvaccinated. P.P.O. Transferred to other V.O.s Untraced Removals. In Default. Overage when Registered. South Sub-District 2106 1084 12 559 52 32 129 145 93 — West Sub-District 2090 1111 13 580 66 44 41 133 102 - North Sub-District 939 484 10 298 21 14 12 57 43 - 5135 2079 35 1437 139 90 182 335 238 - During the year 3,240 Forms Q were sent to parents, 308 Forms K and 115 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. 413 cases were transferred to this Borough from other districts. 1,504 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, 1946:— Name of Public Assistance Institution or Vaccination District. Numbers of successful Primary Vaccinations of persons. No. of successful revaccinations, i.e., successful vaccinations of persons who had been successfully vaccinated at some previous time. Under 1 year of age. 1 year and upwards. Total. Croydon No.1 Area 439 40 479 32 No.2 Area 339 14 353 16 No.3 Area 215 12 227 11 No.4 Area 203 5 208 1 No.5 Area 354 31 385 3 Addington Area 83 9 92 1 Queen's Road Homes - - - - Mayday Hospital 2 2 4 - Children's Homes — — — — Shirley Residential Schools - - - - 1635 113 1748 64 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. 1937. 1938. 1939. 1940. 1941 1942 1943. 1944. 1945. 1946. New male patients 395 416 316 187 448 661 239 232 390 732 New female patients 184 257 191 202 258 300 489 523 604 411 Attendances, male patients 8610 7318 4258 2996 3033 3932 2214 2758 5498 9757 Attendances, female patients 5405 5365 3150 1772 1508 1585 4026 5940 8848 11439 Attendances of Croydon patients at various London Hospitals under General Scheme. There were 106 new patients, who made a total of 1,218 attendances. Pathological Examinations at London Hospitals for Croydon Patients. 571 Examinations were made for various Clinics and 353 examinations of material submitted by medical practitioners. Bacteriological Examinations carried out at London Hospitals for Croydon Patients. Hospital. Detection of Spirochaetes Detection of Gonococci. Wasserman Re-action. Other Exams. Total. For Clinic For Prac. For Clinic For Prac. For Clinic For Prac. For Clinic For Prac. Endell Street, L.C.C. — — 5 — 4 — 8 — 17 St. Thomas's — — 38 — 56 — 88 — 182 South Lon. Hos. for Women — — 38 2 16 3 16 — 75 Royal Free — — 25 — 5 — 29 — 59 King's College 2 — 32 — 24 — — — 58 Whitechapel Clinic, L.C.C. — - 4 — 1 — 10 - 15 University College - - - - - - - - - Guy's Hospital — — 83 91 40 129 43 126 512 Seamen's — — 2 — 1 — 1 — 4 Westminster Hospital - - - - - 1 - 1 2 Total 2 — 227 93 147 133 195 127 924 58 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. — — 2 12 — St. Thomas's 3 8 35 387 - Guy's — 6 16 293 - King's College 3 5 8 254 - Royal Free — — 2 38 14 S.Lond.Hosp. for Women 1 — 10 196 - Whitechapel Clinic, L.C.C. — — 2 6 - Westminster — 1 2 23 - Mothers — — — — 12 Seamens — 1 1 9 - Total 7 21 78 1218 26 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, 1946. Syphilis Soft Chancre Gonorrhoea Nonvenereal or undiagnosed condition Totals M F M F M F M F M F Ttls. 1.Number of cases on 1st January under treat- ment or observation 85 103 - - 63 46 10 34 158 183 341 2.Number of cases removed from the register during any previous year which returned during the year under report for treatment or observation of the same infection 3 2 - - 2 1 - - 5 3 8 3.Number of cases dealt with for the first time during the year under report (exclusive of cases under Item 4) suffering from:— Syphilis, primary (1)22 9 - - - - - - 22 9 31 „ secondary (1)17 10 - - - - - - 17 10 27 „ latent in 1st year of infection 2 — - - - - - - 2 - 2 „ all later stages 11 8 - - - - - - 11 8 19 „ congenital 5 6 - - - - - - 5 6 11 Soft Chancre - - 1 - - - - - 1 - 1 Gonorrhoea, 1st year of infection - — - — (12)213 88 - - 213 88 301 „ later - — - — 3 5 - - 3 5 8 Non-venereal conditions - - - — — (43)457 (1) 285 457 285 742 Conditions remaining undiagnosed at 31st December - - - - 1 — 1 - 1 4.Number of cases dealt with for the first time during the year under report known to have received treatment for the same infection, or to have been under observation, at other Centres or Service Hospitals, or by General Practitioners approved under Ministry of Health Circular 2226 (4)40 10 - (8)52 7 (10)10 2 102 19 121 Totals of Items 1,2,3 and 4 185 148 1 - 333 147 478 321 997 616 1613 5.Number of cases discharged after completion of treatment and final tests of cure or after diagnosis as non-venereal 64 42 - 207 91 467 307 738 440 1178 6.a Number of cases which ceased to attend before completion of treatment and were, on first attendance, suffering from Syphilis, primary - - - - - - - - - - - ,, secondary - - - - - - - - - - - ,, latent in 1st year of infection - - - - - - - - - - - ,, all later stages - - - - - - - - - - - ,, congenital - - - - - - - - - - - Soft Chancre - - - - - - - - - - - Gonorrhoea, 1st year of infection - - - - - - - - - - 1 „ later - - - - - - - - - - - 6.b Number of cases under treatment or observation which died. 2 1 - - - - - - 2 1 3 7.Number of cases which ceased to attend after completion of treatment but before final tests of cure - - - - 8 '1 - - 8 1 9 8. Number of cases tranferred to other Centres or to institutions, or to care of private practitioners 22 30 1 - 41 16 6 - 70 46 116 9.Number of cases remaining under treatment or observation on 31st December 97 75 - - 76 39 5 14 178 128 306 Totals of Items 5,6,7,8 and 9 (These totals should agree with those of Items 1, 2,3 and 4) 185 148 1 - 333 147 478 321 997 616 1613 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 and Penicillin, 4863 5968 1 — 2425 2262 2251 1962 9540 10192 19732 (b)for intermediate treatment, e.g., irrigation, dressing — — — — 88 713 129 534 217 1247 1464 Total Attendances 4863 5968 1 — 2513 2975 2380 2496 9757 11439 21l96 11.In-patients:— (a)Total number of persons admitted for treatment during the year 43 39 - - 1 1 - - 44 40 84 (b)Aggregate number of "in-patient days " of treatment given 244 235 - - 18 5 — — 262 240 502 12.Number of cases treated with penicillin 51 65 — - 176 7s — - 227 143 370 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. 13. Number of cases of congenital syphilis in Item 3 above classified according to age periods — — — — 1 1 4 5 5 6 Microscopical Cultural for G'n'rh. Serum - Cerebrospinal fluid Others for diagnosis Venereal Disease for Syphilis for s G'n'rh. for Syphilis for G'n'rh Number of specimens from patients attending at the Treatment Centre sent for examination to an approved laboratory 31 2035 943 1692 1034 76 1406 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 40 30 16 4 90 Soft Chancre 1 — - - 1 Gonorrhoea 160 69 50 30 309 Non-venereal and undiagnosed conditions 435 171 79 58 743 Total 636 270 145 92 1143 B.Total number of attendances of all patients residing in each area 12566 6127 1907 596 21196 61 CANCER. Deaths from Cancer numbered 451 as compared with 470 in 1945; 420 in 1944; 456 in 1943; 405 in 1942; 377 in 1941; 443 in 1940; 414 in 1939; 380 in 1938; and 421 in 1937. Death-rate per 1,000 of the population for the previous 10 years are as follows : — 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) 1941—2.04(377) 1946—1.93(451) Deaths from Cancer Occurred at the following Ages :— Age period. Male. Female. Total. Calculated population at this age period Incidence per 1,000 persons living. Under 25 years 1 1 2 97578 0.021 25 and under 35 years 4 2 6 34738 0.173 35 and under 45 years 6 9 15 37825 0.397 45 and under 65 years 90 87 177 46318 3.821 65 years and over 118 133 251 16771 14.966 219 232 451 233230 Sites of Fatal Cancer. Site. Male. Female. Total. Percentage of Total. Skin 6 2 8 1.774 Tongue and Mouth 2 2 4 0.887 Oesophagus 7 4 11 2.439 Stomach 28 41 69 15.299 Liver 6 6 12 2.660 Bowel 34 46 80 17.738 Rectum 25 11 36 7.982 Bladder 4 4 8 1.774 Prostate 19 - 19 4.213 Larynx and Pharynx 6 1 7 1.552 Uterus - 26 26 5.765 Breast - 56 56 12.417 Ovary - 9 9 1.996 Pancreas 13 5 18 3.991 Gall Bladder and Duct 2 3 5 1.109 Mediastinum 1 - 1 0.222 Bones 4 5 9 1.996 Lungs 51 4 55 12.195 Kidney 2 - 2 0.443 Brain 1 1 2 0.443 Retroperitoneal 1 1 2 0.443 Thyroid Gland - 1 1 0.222 Lymphatic Glands 3 1 4 0.887 Genital Organs 2 - 2 0.443 Not defined 2 3 5 1.109 219 232 451 62 Comments on Foregoing Table. The organs most often attacked in descending order of incidence are: In the males—the Bowels and Rectum (26.9 per cent.), the Lungs (23.3 per cent.), and the Stomach (12.8 per cent.); in females—the Bowels and Rectum (24.6 per cent.), the Breast (24.1 per cent.), the Stomach (17.7 per cent.), and the Uterus (11.2 per cent.) THE PREVENTION AND CONTROL OF TUBERCULOSIS. I am indebted to Dr. J. C. McMillan, the Assistant Medical Officer of Health for Tuberculosis, for the statistical part of this section of the report. An Assistant Medical Officer was appointed to the Chest Clinic during the year and she commenced her work on October 1st. She will undertake artificial pneumothorax, both at Cheam and Mayday, and later, when arrangements have been made, at the Chest Clinic. Her appointment will also permit of more extensive examination of contacts—a most important branch of prevention. 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 1946, a comparison with 1916 is the best we can do. The outstanding facts are these: In 1916, 127 per 100,000 of the population in Croydon died from all forms of tuberculosis; in 1946 the corresponding figure was 47. Owing to fluctuations in population the following statistics cannot be correlated to those of previous war years. Notification of Tuberculosis. Two hundred and thirty-seven cases of Pulmonary Tuberculosis and 24 cases of Non-pulmonary Tuberculosis were notified on Form A (primary notifications); of these 143 males and 94 females were pulmonary cases; 13 males and 11 females nonpulmonary. In addition, 72 pulmonary cases and 15 nonpulmonary came to our notice as new cases otherwise than by notification. 63 The total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year 1946 by notification or otherwise was 348, as compared with 374 in 1945, 315 in 1944, 383 in 1943, and 323 in 1942. 309 of these were case of Pulmonary Tuberculosis, 187 in males and 122 in females. There were 8 more cases of Pulmonary Tuberculosis in males and 13 fewer in females than in 1945. There were 19 cases of Non-pulmonary Tuberculosis among children under 15 years as compared with 27 in 1945. The number of cases in adults was 20, compared with 33 in 1945. Of the cases notified in 1946, 21 males and 4 females died from the Pulmonary, form of the disease during the year, equal to 10.5 per cent, of those notified. The incidence rate of Tuberculosis of all forms was 1.49 per 1,000 of the population; for Pulmonary Tuberculosis 1.32, and for Non-pulmonary 0.17 per 1,000 population. The notification rate was 1.12 per 1,000. In 1945 the corresponding figures were 1.86, 1.56, 0.30, and 1.53 per 1,000. Public Health (Tuberculosis) Regulations, 1930. Summary of notifications during the period from 1st January, 1946, to 31st December, 1946 :— 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 65 up. Total (all ages) Pulmonary— Males - 2 1 5 15 20 35 25 22 13 5 143 153 Females - - 2 1 14 21 24 18 7 4 3 94 104 Non-Pulmonary— Males - 4 2 3 1 2 1 - - - - 13 15 Females — — 2 1 3 1 — 2 — — 2 11 13 64 Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1946, to 31st December, 1946, otherwise than bv 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 — 3 7 13 8 4 6 2 44 Females — — 1 — 2 6 13 6 — — — 28 Non-pulmonary Males — 2 — 2 — 1 1 — — 1 1 8 Females 1 1 1 — — 2 1 1 — — — 7 Notification Register. Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1946:— PULMONARY. NON-PULMONARY. Total Cases. Males. Females. Total. Males. Females. Total. 789 661 1450 130 153 283 1733 CLASSIFICATION OF NEW PATIENTS. Pulmonary Tuberculosis. During 1946, 229 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) 115 or 50.2% T.B. plus 1 (early cases, sputum positive) 19 or 8.3% T.B. plus 2 (intermediate cases, sputum positive) 80 or 34.9% T.B. plus 3 (advanced cases, sputum positive) 15 or 6.6% 229 100.0% 65 Non-Pulmonary Tuberculosis. There were 24 cases examined at the Clinic and found to have Non-pulmonary Tuberculosis in the following forms:— Bones and Joints 6 Abdominal 5 Other Organs 4 Peripheral Glands 9 24 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 1946 — 2 17 38 36 8 101 In 1946 the death-rate from all forms of Tuberculosis was 0.47 per 1,000 population. The rate for Pulmonary Tuberculosis was 0.43 and the rale for Non-Pulmonary Tuberculosis 0.04. Similar figures for 1945 were 037 and 0.09. Pulmonary Tuberculosis. In 1946 the total number of deaths increased by 26 per cent. compared with 1945, but still was 17.8 per cent. less than in 1938. There were only two deaths in children up to school leaving age (15 years). The majority of the deaths occurred in age groups 25-55 years. There were 23 more deaths in males than in 1945, with more than twice as many deaths in males as in females. In men the deaths are mostly in the age groups 35-55 years, whereas in women they are mostly at an earlier age. The number of female deaths was 3 more than in 1945. 66 New cases show an increase of 4.4 per cent. in males and a decrease of 9.6 per cent. in females, compared with 1945, that is a total slight decrease compared with 1945, but an increase of 14.4 per cent. over 1938. Non-Pulmonary Tuberculosis. The diagnoses of the new cases entered in the Notification Register during 1946 were as follows:— Male. Female. Glands 4 9 Right Elbow 1 — Wrist — 1 Spine 3 — Sacro-iliac joint 1 — Hip 1 — Knee 1 — Abdomen 2 1 Genito-urinary tract 3 4 Lupus 1 — Miliary 2 — Meninges 2 3 Totals 21 18 Deaths from Non-Pulmonary Tuberculosis. During 1946, 9 deaths were certified to be due to Non- Pulmonary Tuberculosis, compared with 18 in 1945, 11 in 1944, 16 in 1943, 17 in 1942, 19 in 1941, 21 in 1940, and 12 in 1939. The deaths were due to:— Males. Females. Total. Tuberculous Meningitis 2 1 3 Tuberculous Kidney — 1 1 Tuberculous Enteritis — 1 1 Miliary Tuberculosis 1 1 2 Genito-urinary and Spinal Tuberculosis 1 — 1 Tuberculosis of Skin 1 — 1 Totals 5 4 9 67 Co-ordination with Medical Practitioners, and Other Branches of the Health Department. During the year 583 cases of suspected Tuberculosis were referred by private medical practitioners; 73 were diagnosed as suffering from Tuberculosis and were subsequently notified. In addition, 67 children were referred by the School Medical Service, and 42 cases from the Maternity and Child Welfare section of the Public Health Department. 950 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 80.0 per cent, in 1945. The number of reports sent in by Insurance medical practitioners on their domiciliary cases (Form G.P.36) was 270. Examination of Sputum. The results of examinations made in 1946 are as follows:— For Clinic. For General Practitioners. Totals. Positive (i.e., tubercle bacilli present) 826 48 874 Negative (i.e., tubercle bacilli absent) 1250 440 1690 Totals 2076 488 2564 For each 100 new cases and contacts examined at the Clinic, 149 specimens of sputum were examined. X-Ray Work. 2,029 X-Ray examinations were made during the year. This is equivalent to 143 for every 100 new cases and contacts seen, and compares with a rate of 128 in 1945. In addition, a certain number of cases who have already been examined at various hospitals are referred to the Clinic. The X-Ray examinations were carried out at Mayday Hospital. The absence of an X-Ray plant at the Chest Clinic is a great handicap in the routine work of the Clinic, and is the cause of a lot of inconvenience to patients. Blood Examinations. Blood sedimentation rate was ascertained in 299 cases at Mayday Hospital for the Chest Clinic during the year. 68 Residential Treatment for Pulmonary Tuberculosis. Summary of Patients who received Institutional Treatment during 1946. Institution. In Institutions on 1.1.46. Admitted During 1946. Discharged During 1946. Died During 1946. Remaining in on 31.12.46. Adults. Adults. Adults. Adults. Adults. M F Ch. M F Ch. M F Ch. M F Ch. M F Ch. Croydon Borough Sanatorium 39 25 — 68 77 — 60 65 — 3 3 44 34 — Brompton Hospital and Sanatorium 2 4 — 7 7 — 4 9 — 1 — — 4 2 — Children's Sanatorium, Harpenden — — 3 — — 3 — — 4 — — — — — 2 Croydon General Hospital — — — 2 1 — 1 1 — — — — 1 — — Horton Hospital (Chest Unit) — — — 2 6 — 2 6 — — — — — — — Grosvenor Sanatorium 1 1 — 7 4 — 3 3 — — — — 5 2 — Langdon Hills Sanatorium — — 1 — — — — — — — — — — — 1 Preston Hall Sanatorium 1 — — — 2 — — 1 — 1 — — — 1 — Royal National Sanatorium — 5 — 2 2 — — 7 — 1 — — 1 — — Hempstead E.M.S. Hospital — — — — — 1 — — 1 — — — — — — Heath End Sanatorium — — — — — 2 — — — — — — — — 2 Mayday Hospital 16 17 1 100 77 15 64 71 8 26 11 2 26 12 6 Fairlight Sanatorium — — — 1 — — 1 — — — — — — — — Papworth 1 1 — — — — — — — — — — 1 1 — R.N.H.C., Ventnor 1 — — 3 2 — 2 1 — — — — 2 1 — Leatherhead E.M.S. Hospital — — — 1 — — 1 — — — — — — — — King's College Hospital — — — 2 — — 2 — — — — — — — — Nayland Sanatorium — 2 — — 4 — — 3 — — — — — 3 — 61 55 5 195 182 21 140 167 13 32 14 2 84 56 11 69 Residential Treatment for Non-Pulmonary Tuberculosis. Summary of Patients who have received Institutional Treatment during 1946. Institution. In Institutions on 1.1.46. Admitted During 1946. Discharged During 1940. Died During 1946. Remaining in on 31.12.46. 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 — — 1 — — 2 — — — — — — Royal Sea Bathing Hospital — — — 4 2 1 1 — — — — — 3 2 1 Lord Mayor Treloar Cripples Hosp. — — 1 — — — — — — — — — — — 1 Queen Mary's Hospital — — 1 — — — — — 1 — — — — — — Leatherhead Emergency Hospital — — 1 2 — 1 2 — — — — — — — Horton Emergency Hospital — — — — 1 — — 1 — — — — — — — Croydon General Hospital 1 — 1 1 1 1 2 1 2 — — — — — — St. George's Hospital — — — 1 — — — — — — — — 1 — — Mayday Hospital 1 — — 4 6 3 5 5 3 — — — — 1 — Victoria Home for Inv. Children — — 3 — — 2 — — 2 — — — — — 3 2 — 10 11 12 9 9 9 11 — — — 4 3 8 70 Extra Nourishment. Provision of special nourishment in the form of milk was granted to 38 selected cases for varying periods during the year, and 16 cases were in receipt of extra nourishment at the end of the year. Residential Treatment. 269 males, 249 females and 45 children were treated in Residential Institutions in connection with the Croydon Tuberculosis Scheme during 1946. Owing to the difficulty of obtaining nursing and domestic staff and other factors, the number of patients treated in the Croydon Borough Sanatorium during the year was considerably reduced. At the end of the year there were 78 beds occupied, compared with 64 at the end of 1945 and the normal 94 beds pre-war. Thoracic Surgery. There is great need for better provision for Thoracic Surgery both minor and major, in the treatment of Pulmonary Tuberculosis, and also for Non-Tuberculous diseases of the chest. This unfortunate position is not peculiar to Croydon- There is, at present, an insufficiency of surgeons especially skilled in this branch of surgery, and also of hospital beds for the .patients. The few patients, who have been able to have major operations, have had to wait for a considerable period, sometimes up to two years. Owing to this delay some patients either are not so fit or are no longer fit for the operation, due to deterioration in their condition. During the year 17 patients had Phrenic Nerve Operations performed at Mayday Hospital, and a number of other cases received surgical treatment at Brompton Hospital and in the Chest Unit at Horton Kmergency Hospital. The immediate results of treatment of patients discharged from residential institutions during the year are as follows: — Pulmonary Tuberculosis. In Class T.B. Minus, 15 males, 19 females and 3 children were discharged with the disease in a quiescent condition, i.e., 68.5 per cent, of the total cases in this class. Three males, 11 females and 3 children were not in a quiescent condition, 31.5 per cent. 71 In Class T.B. Plus, the corresponding figures were 16 males and 14 females quiescent; 30.6 per cent.; 30 males and 29 females, not quiescent, 60.2 per cent.; 5 males and 4 females died, 9.2 per cent. Taking the groups together, 44.1 per cent, of cases were discharged as quiescent; 50.0 per cent, as not quiescent; and 5.9 per cent. died. Non-Pulmonary Tuberculosis. 17 patients were discharged during the year, and 58.8 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. 1,088 new cases were examined during the year. This is equal to 989 for each 100 deaths from the disease. 242 or 220 for each 100 deaths were found to be definitely tuberculous. The total number of attendances at the Clinic was 6,143. The Tuberculosis Officer paid 124 home visits and the District Health Visitors 2,243 visits for Clinic purposes. In addition, the Health Visitors made 382 primary visits for the purpose of the Notification Register. The Tuberculosis Officer paid 100 visits to Mayday Hospital, in a consultative capacity, and there examined 480 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 441 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 323 contacts were examined, equal to 294 for each 100 deaths, compared with 153 in 1945, 181 in 1944, 267 in 1943, 238 in 1942, 227 in 1941, 278 in 1940, 325 in 1939, and 301 in 1938. Of these, 7 were considered to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 21.6 compared with 1.49 per 1,000 of the general population. 72 411 appointments for examination were offered to new contacts during 1946, but only 323 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 1,325. This i.s equivalent to 5.9 persons per 1,000 of the population. During the year 91 Clinic cases died. Of this number 13 or 14.3 per cent, were seen for the first time in 1946. Dental Treatment for Patients Referred from the Chest Cl'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. 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. 1946 1945 Referred frotn Chest Clinic 8 6 14 12 Treatment cases continued from Cheam. 6 6 12 14 Attendances 43 42 85 96 Extractions 30 43 73 53 Fillings 6 6 12 18 Other Oprations — — — 3 Scalings 1 2 3 8 Denture Dressings 27 23 50 45 Dentures fitted 7 9 16 13 Repairs 3 — 3 1 Number of Treatment Sessions: 21. 73 SUMMARY OF CLINIC STATISTICS FOR 1946. Number of persons on Clinic Register, January 1st, 1946 1,271 ,, notified cases examined for the first time 49 ,, cases sent for an opinion 791 ,, first attendances, including 87 inward transfers 1,498 ,, consultations of T.O. with medical practitioners— (a) Personal 14 (b) Other 933 ,, visits paid by T.O. to homes of patients 124 ,, visits paid by T.O. to Mayday Hospital 100 ,, patients examined by T.O. at Mayday Hospital 480 ,, visits paid to homes of patients by Health Visitors 2.625 ,, visits paid to homes of patients by District Nurses for nursing attention 441 Attendances of patients at the Clinic— Men 2,763 Women 2,631 Children 749 Total 6,143 Number of Insured Patients under Domiciliary Treatment at the end of year— Pulmonary 273 Non-Pulmonary 7 Total 280 Number of reports received from Panel Practitioners (G.P.36) 270 ,, report forms sent to Panel Practitioners (G.P.36) 378 ,, reports received from Panel Practitioners on Forms G.P.17 — „ reports received from Panel Practitioners on Forms G.P.35 1 ,, X-Rays taken 2,029 ,, reports made to Ministry of Pensions by T.O. on general progress of Tuberculous ex-Service men 56 „ special reports made to the Ministry of Pensions by T.O. re Tuberculous ex-Service men (Form M.P.M.S.D. 122) 16 ,, cases referred to Light Treatment 6 ,, cases referred to Orthopsedic Clinic 6 ,, cases receiving extra nourishment at the end of year 16 ,, cases referred by the Ministry of Labour and National Service Medical Board for examination and report 30 Tuberculosis Maintenance and Other Allowances. The Ministry of Health Tuberculosis Maintenance Allowances (as in Memorandum 266/T) to alleviate patients' financial distress caused by loss of income when undertaking treatment for Pulmonary Tuberculosis, continued to be administered during 1946. I 74 (1) No. of patients in receipt of Ministry of Health Allowances as at 31-12-45 56—18 in Institutions 38 on Domiciliary treatment. (2) No. of new patients 82 (3) No. of patients no longer in receipt of Allowances 87 (4) No. of patients in receipt of Ministry of Health Allowances as at 31-12-46 51—24 in Institutions 27 on Domiciliary treatment. The Council's extension of Maintenance Allowances scheme continued during 1946. These allowances are granted to patients suffering from Pulmonary Tuberculosis who are not entitled to allowances under the Government scheme, but who carry out treatment recommended under the Council's Tuberculosis scheme:— (1) No. of patients in receipt of Council Allowances as at 31-12-45 26— 2 in Institutions 24 on Domiciliary ment. (2) No. of new patients 27 (3) No. of patients no longer in receipt of Allowances 22 (4) No. of patients in receipt of Council Allowances as at 31-12-46 31— 6 in Institutions 25 on Domiciliary ment. CHEAM SANATORIUM. The Sanatorium is situated at North Cheam and normally has accommodation for 93 adult patients of both sexes : men 53 and women 40. 75 Immediate Results of Treatment. Group. Total number of cases discharged 1946. 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 M F Class T.B. Minus 12 23 6 4 6 16 — — — — — 3 208 128 Class T.B. Plus— Group 1 4 11 1 4 3 6 — — — 1 — — 290 108 Group 11 26 26 1 2 19 16 3 5 1 2 2 1 225 215 Group III 9 2 — — 3 1 3 1 2 — 1 — 389 758 Observation Non T.B. - 51 62 8 10 31 39 6 6 3 3 3 4 In-patients on 1st Jan., 1943 Admitted during year 1946 Discharged during year including deaths 1 In on 1st Jan. 1947. Died during year 1946 M p M F M F M F M _i — F 39 26 71 77 66 69 41 34 3 3 Number of Pateints January 1st, 1946 65 ,, ,, admitted, 1946 148 ,, ,, discharged, 1946 129 ,, ,, died, 1946 6 ,, ,, remaining January 1st, 1947 78 Number of X-Ray screenings 2,945 ,, ,, X-Ray films taken 647 Number of refills given 2,520 ,, aspirations 26 ,, A.P. cases commenced 27 „ pneumoperitoneum refills 161 ,, blood sedimentation tests 101 ,, sputum tests 786 ,, chest explorations 4 ,, tuberculin tests 1 ,, urine tests 51 76 Artificial Pneumothorax cases discharged but still under treatment, 15 males, 7 females (see above), making total discharges males 66, females 69. These Artificial Pneumothorax cases only refer to cases discharged in 1946. Those discharged in 1945 and still having refills have not been included. There were two Observation cases sent in during the year under review. These cases were found to be Tubercular and are classified in the Positive cases tabulated above. The two Observation cases above are one male and one female patient. One male patient and four female patients were sent to Brompton Hospital for opinion regarding surgical treatment, but were not admitted direct. Three male patients and one female patient were admitted to Brompton Hospital for surgical treatment. Three male patients and three female patients were admitted to Horton E.M.S. Hospital for surgical treatment. Three male cases have had phrenic interruption at Mayday Hospital by arrangement with the Medical Superintendent. 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. Patients 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. 77 Review of Work Done. Males. Females. Total. 1946 1945 Number Examined 46 40 86 48 Referred Treatment 37 34 71 45 Treated 33 30 63 43 Attendances 144 143 287 182 Extractions 41 19 60 107 Fillings 50 42 92 57 Dressings 6 7 13 8 Scalings 10 14 24 17 Root Treatments — 2 2 1 Denture Dressings 28 31 59 41 Dentures Fitted 7 13 20 9 Repairs 2 1 3 6 Mandibular Injections 2 4 6 6 Number of Treatment Sessions: 28. MATERNITY AND CHILD WELFARE. Notification of Births. Notifications were received from— Live Births. Still Births. Total. Midwives 3,762 103 3,865 Doctors, Parents and others 1,306 33 1,339 5,068 136 5,204 Maternal Mortality. There were 3 deaths, compared with 9 in 1945. The maternal mortality rate was 0.61 per 1,000 births, compared with 1.36 in 1945. The deaths were caused by— (1) Puerperal septicaemia. (2) Eclampsia. (3) Acute intestinal obstruction : toxaemia. 78 MATERNAL AND INFANT MORTALITY FOR THE YEARS 1931—1946 Year Births (Live and Still) Maternal Deaths Maternal Mortality Rate Infant Mortality Rate 1931 3,501 23 6.57 57 1932 3,429 7 2.04 49 1933 3.239 12 3.70 47 1934 3,304 13 3.93 46 1935 3,391 10 2.95 45 1936 3,373 13 3.85 41 1937 3,357 13 3.87 60 1938 3,430 3 0.87 40 1939 3,511 4 1.16 38 1940 3,031 5 1.65 39 1941 2,472 8 3.23 37 1942 3,579 12 3.35 3 9 1943 3,785 2 0.53 37 1944 3,680 8 2.17 44 1945 3,675 9 2.45 41 1946 4,937 3 0.61 31 79 Puerperal Pyrexia. Fifty-seven cases of Puerperal Pyrexia were notified. This is a rate of 11.5 per 1,000 births (live and still births). Accommodation for Confinement. The following table gives information concerning the accommodation utilised for confinements:— Number. Percentage. In Private Houses 1,801 33.85 In Public Institutions 2,239 42.08 In Registered Maternity Homes 1,281 24.07 5,321 Still Births. During 1946, 131 still births were registered in respect of Croydon. Of these 76 were male babies and 55 female; 5 males and 3 females were illegitimate. The proportion of still births to living children was as 1 to 37. 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 26.5 per 1,000 births. An Analysis of 100 Still Births occurring during the Year. Of the 100 still births investigated 55 were males and 45 females. STILL BIRTHS, 1946. Attended by Midwives alone 52 ,, Doctors alone f ,, Midwives and Doctors 41 Occurred at 9 months 80 ,, 8 months 15 ,, 6-7 months 5 Type of Delivery.—In 55 cases the confinement was difficult or prolonged. Normal confinement was noted in 45 cases. Age of Mother.—Under 20 years, 2; between 20 and 29 years, 40; between 30 and 39 years, 53; between 40 and 49 years, 5. 80 The Health of the Mother during her pregnancy was stated to be good in 60 cases and indifferent or poor in 24 cases; no particulars were obtained in 16 cases. In 5 cases, however, the mother had had a shock or fall before the still birth. In 81 instances the mother had attended the Ante-Natal Clinic. 19 cases had never attended the Clinic. Attendance at Confinement.—Sixty-one of the still births investigated occurred in the Mayday Hospital; 14 in St. Mary's Hospital; 10 were attended in their own homes by a private medical practitioner either alone or in conjunction with a midwife; 6 were attended by a midwife alone; 3 occurred in private nursing homes, etc. Forceps were reported to have been utilised in 16 of the cases. In 80 cases the baby was born at full term; in 15 during the 8th month of gestation: in 5 during the 7th month. The baby was apparently a normal child in 63 cases, abnormal in 37. The still birth was the first pregnancy in 37 instances; the 2nd in 22; the 3rd in 19; the 4th in 10; the 5th in 2; the 6th in 6; the 7th in 1, the 9th in 1 ; the 10th in 1; and the 13th in 1. Previous still births had occurred in 10 cases. Ophthalmia Neonatorum. Six cases were notified during 1946. The following table gives the notifications in Croydon during the past ten years:— 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 No of Cases 21 20 15 14 17 19 10 3 11 6 Rate per 1,000 Births 6.4 6.0 4.5 4.7 7.0 5.5 2.7 0.8 3.1 1.2 Results of Treatment. Notified. Cases treated. Vision Unimpaired. Vision Impaired Died. Removed Remaining under Treatment At home. In hospital 6 — — — — 6 2 4 81 Infant Mortality. The Infantile Mortality rate was 31 per 1,000 live births registered. For the past 5 years the number of infant deaths have been 1942—187, 1943-1-37, 1944—156, 1945—145, and 1946—151. Among the 151 deaths, 87 occurred in boy babies and 64 in girls. Of the births, 2,444 were males and 2,362 females. The infantile mortality rate for the two sexes was, therefore, Boys— 36, Girls—27. 120 deaths of infants occurred in Institutions, including Registered Nursing Homes. The following table is intended to show the deaths of babies who at one time or another during their first year attended a Clinic, as compared with deaths among those who never attended. If a baby only attended once it is included in the Clinic returns:— Deaths Attended M. & C. W. centre Attended at Birth by Full Time Baby Births during the same period Deaths in Institutions Yes No Doctor Midwife Doctor & Midwife Not known, etc. Yes No Not known, etc. Mayday Hospital Regd. Maternity Homes St. Mary's Hospital Other Institutions 118 29 89 11 68 30 9 85 30 3 4806 79 3 7 7 3,719 babies under one year of age attended the Clinics for the first time during 1946. Within the same period 4,806 babies were born and 151 died; 33 of these latter are not included in the above table, as information concerning them was not obtainable. Although the clinic attendance figures and the births and deaths figures do not cover precisely the same periods, the attendances of new cases at the clinics do not fluctuate so greatly as to cause serious error. Of the 118 babies tabulated who died, 29 had attended a clinic in Croydon and 89 had not attended, i.e., 25 per cent, of the deaths were in clinic babies and 75 per cent, in nor- clinic babies. Of the 4,806 babies born, approximately 3,810 attended on calculation based on past attendances. The infantile mortaliay, estimated on this basis, is only 8 per 1,000 births for the clinic babies, and 89 per 1,000 births for non-clinic babies. 82 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 3 Other Congenital Deformities 9 Atelectasis, etc. 10 Hœmorrhagic Disease of Newborn 1 Uraemia 1 Hypernephroma of Kidney 1 —25 (3) Prematurity 38 —38 (4) Post-Natal Causes 9 — 9 77 Percentage Deaths per Total Infantile Deaths. Deaths per 1,000 Births. 1946 1945 1946 1945 Premature Births 25.2 29.0 7.9 11.7 Respiratory Diseases 23.8 20.0 7.5 8.1 *Infectious Diseases (including Tuberculosis) 2.7 4.1 0.8 1.7 Atelectasis, Debility and Marasmus 7.3 6.2 2.3 2.5 †Diseases of Digestion 16.6 15.2 5.2 6.1 Injury at Birth and Congenital 13.2 15.9 4.2 6.4 *These deaths were due to Whooping Cough 3 and Measles 1. †These deaths were due to Diarrhoea 23, Intussusception 1 and Catarrhal Jaundice 1. 83 The rate of infant mortality amongst legitimate children was 31 per 1,000 births. The rate in illegitimate children was 35 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. lst-2nd wk. 2nd-3rd wk. 3rd-4th wk. Under I mnth. 1-2 mths. 2-3 mths. 3-4 mths. 4-5 mths. 5-6 mths. 6-7 mths. 7-8 mths. 8-9 mths. 9-10 mths. 10-11 mths. 11-12 mths. TOTAL. All Causes 19 13 11 7 4 1 4 10 4 4 77 12 21 9 9 7 4 3 5 2 1 1 151 Chicken Pox — — — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — 1 — — — — 1 Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — Whooping Cough — — — — — — — — — — — — — — 1 — — — 1 — — — 3 Diphtheria and Croup — — — — — — — — — — — — — — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — — — — — — — — — — — — — — Abdominal Tuberculosis — — — — — — — — — — — — — — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — — — — — — — — — — — — — — Meningitis (not Tuberculous) — 1 — — — — — — — — 1 — — — — — — — — — — — 1 Convulsions — — — — — — — 1 — — 1 — — — — — — — — — — — 1 Laryngitis — — — — — — — — — — — — — — — — — — — — — — — Bronchitis — — — — — — — — — — — — — — — — — — — — — — 4 Pneumonia (all forms) — — 1 — 1 — — 1 2 2 7 3 8 2 4 1 1 1 2 1 — 1 31 Diarrhoea and Enteritis — — — — — — — — — — — 3 5 5 1 4 2 1 — 1 1 — 23 Gastritis — — — — — — — — — — — — — — — — — — — — — — — Syphilis — — — — — — — — — — — — — — — — — — — — — — — Rickets — — — — — — — — — — — — — — — — — — — — — — — Congenital Malformations 1 2 1 1 1 1 — 1 1 1 10 3 1 1 — 1 1 — — — — — 17 Premature Birth 12 7 5 4 2 — 3 4 — 1 38 — — — — — — — — — — — 38 Atrophy, Atelectasis, Debility and Marasmus 2 2 2 — — — 1 2 1 — 10 1 — — — — — — — — — — 11 Injury at Birth 2 1 — — — — — — — — — — — — — — — — — — — — 3 Other Causes 2 — 2 2 — — — 1 — — 7 1 5 1 3 — — — 1 — — — 18 Totals 19 13 11 7 4 1 4 10 4 4 77 12 21 9 9 7 4 3 5 2 1 1 151 84 MIDWIFERY SERVICE. Midwives Acts, 1902 to 1936. Eighty-three midwives notified the Local Supervising Authority of their intention to practice within the Borough during 1946. Five ceased practising in the Borough; so that seventy-eight remained on the Register at the end of the year including six independent domiciliary. All these were trained and held the certificate of the Central Midwives Board. The Rules of the Central Midwives Board lay down that the Local Supervising Authority must be informed within 36 hours by a midwife if she has summoned medical help during pregnancy, in a confinement or within 14 davs afterwards. The following table gives details of the reasons for sending for medical aid: For Complications during Pregnancy. Abortion 19 Other causes 29 Albuminuria 2 50 For Complications during Labour. Breech 3 Malpresentation 3 Persist. Occipito Posterior 6 Twins 1 Precipitate Labour 3 Foetal Distress 3 Premature Labour 2 Undiagnosed 4 25 Delayed Labour. Uterine Inertia 13 Prolonged 20 Delayed 32 65 Haemorrhage. Ante-partum 8 Post-Partum 6 14 Other Causes. Adherent and Retained Placenta 2 Torn Perineum . 205 Illness of Mqther 1 208 For Complications during Puerperium. Pyrexia 29 Pain in Breasts 7 Pain in Legs 9 Other causes 24 69 For Complications in regard to the Baby. Inflammation of Eyes 47 Still Birth 2 Feebleness ... 4 Other causes 47 Premature Birth 4 104 535 85 In accordance with Rule 33 of the Central Midwives Board, the following reasons for the discontinuance of breast-feeding were received:— Illness of Mother 14 Insufficient Milk 83 Other Causes 24 Total 121 MUNICIPAL MIDWIVES Ante-Natal Clinic Attendances: January 694 May 1,047 September 1,090 February 701 June 934 October 1,389 March 789 July 1,090 November 1,208 April 898 August 1,025 December 934 Mileage Deliveries Midwifery Maternity Bookings Ante Natal Visits paid Post Natal Visits paid G.&A. Cases Normal Abnormal Normal Abnormal January 2452 106 89 3 11 3 202 450 2443 2 February 2780 106 85 2 14 5 186 458 2232 6 March 2933 132 103 5 23 1 192 439 2679 17 April 2593 128 106 7 12 3 158 478 2691 11 May 2485 113 92 4 16 1 193 468 2520 7 June 2403 120 109 2 9 — 123 331 2435 11 July 2310 153 120 4 26 3 151 395 2807 33 August 2484 144 126 3 15 — 191 455 2706 32 September 3085 153 128 7 15 3 191 509 2608 57 October 3608 143 122 3 15 3 205 413 2880 61 November 2724 141 116 2 19 4 191 548 2723 77 December 2990 171 142 6 21 2 118 420 3094 88 Total 32847 1610 1338 . 48 196 28 2101 5364 31818 402 1386 224 37182 80 Inpection of Midwives. Dr. Jenkin Lloyd, the Inspector of Midwives, interviewed twelve midwives at the Town Hall. Seventy visits were paid by her to the homes of midwives. Doctors' Accounts under Section 14 (1) of the Midwives Act, 1918. 401 accounts were received from doctors for services rendered under the provisions of this Section. This compares with 291 in 1915, 248 in 1944, 329 in 1943, 373 in 1942, and 245. in 1941. The total amount of the accounts was £626 1s. 6d. £214 18s. Od. was ultimately recovered from the patients. In 1945 the amount paid to doctors was £392 9s; 6d., and in 1944, £385 10s. Od. Nursing Homes. Maternity Homes. Other Nursing Homes. Combined Maternity and other Nursing Homes. Total. No. of Homes on Register on 31/12/45 9 23 6 38 No. of Applications for Registration during 1946 — 3 — 3 No. of Homes Registered during 1946 — 3 — 3 No. of Homes on Register on 31/12/46 6 20 7 33 No. of Beds available 73 296 (a) Mat. Beds 47 (b) Other Beds 94 510 87 DAY NURSERIES. Attendances at Day Nurseries, 1946. Coldharbour House. Whitehorse Road. Mayday Road, Morland Road. Bramley Hill. Ritchie Road. New Euston Addington Road. Bensham Grove. Date opened 23/2/42 1/6/42 1 '6 48 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 74 49 50 54 52 58 48 48 48 Attendances: under 2 4376 4051 5150 4438 4227 3818 1835 2714 2768 over 2 14022 7451 7375 7973 8407 8257 8412 8274 7884 Total 18398 11502 12525 12411 12634 12075 10247 10988 10652 Number of days opened 303 304 304 305 303 302 301 302 ' 304 Average daily attendance (excluding Saturdays) 67 43 46 46 46 46 40 41 40 88 MATERNITY AND CHILD WELFARE CONSULTATIONS. There are 18 Maternity and Child Welfare Centres, 16 of which are conducted by the Croydon Mothers' and Infants' Welfare Association and 2 by the local authority. A total of 24 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 1946, 3,719 new cases under 1 year of age and 839 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 65,767 in 1945 to 77,941 in 1946. Consultations with doctors increased from 21,613 to 23,407. 37 expectant mothers were seen, a decrease of 12 on 1945, and a total of 181 visits to the Centres was paid by them. The total of all visits to the Centres was 78,122, an increase of 12,016 compared with 1945. The highest average attendance of mothers and babies at each session was recorded at Municipal (97.0), Norbury (91.1), South Croydon (85.5), Woodside (77.0), Bensliam Manor (76.7), Boston Road (75.5). Dental Treatment. Maternity and Child Welfare Patients. Expectant and nursing mothers and children below school are referred by Medical Officers attending Ante- and Post-Natal Clinics, and from Infant Welfare Centres. Reference is also made from those in charge of Day Nurseries and similar institutions. An increasing number of applications for mothers have been received from the Municipal Midwives. When this side of the dental service was expanded some years ago, a dental surgeon was specially appointed for the care of mothers and young children, and now eleven sessions weekly are devoted to this work. The above arrangement has done much to reduce the waiting period before treatment can be commenced. 89 During 1946 a substantial proportion of expectant mothers were inspected between the "third" and "fourth" months of pregnancy, and approximately 80 per cent. received attention before the expiration of the "sixth" month. Excluding those who failed to keep appointments, very few of those referred remained uninspected at the close of the year. A welcome increase is again noted in the numbers of preschool children referred for treatment and special reference is made to conditions found among the above later in this report. Expectant Mothers. Expectant mothers examined during the year numbered 733 compared with 657 last year, and represented '88 per cent. of the total number of new cases referred. Of the above, 80 per cent, presented themselves during the first six months of pregnancy. The remaining 20 per cent. seen during a later stage, included some who failed to keep earlier appointments or had "declined" dental treatment when this was previously advised in the AnteNatal Clinic. Nursing Mothers. Owing to the greater number receiving their treatment antenatally, the proportion of mothers dealt with during the nursing period has declined considerably during recent years. New cases referred were 100 compared with 56 last year. Those seen during the first six months after their confinement constituted 74 per cent. of the total number referred, compared with 70 per cent. last year. The remainder with infants between seven and twelve months, referred in the majority of cases from Welfare Centres, received mostly emergency treatment. In addition to mothers attending for the first time, a substantial amount of treatment was completed for those referred before their confinements in the previous year. Treatment. Including those continuing treatment from the previous year, the total of mothers treated was 919, compared with 812 in 1945. Once treatment has been begun clinics are well attended, and most patients appear to take a keen interest in the service. As in previous years a substantial amount of conservative work was performed. In many mouths wholesale removal of teeth is, unfortunately, the only remedy. Dentures inserted numbered 260 against 225 last year. 90 One less satisfactory feature of the scheme is that 25 per cent. of those referred failed to keep appointments for their dental inspection to be carried out. Attempts at following up such cases have in the main been singularly unsuccessful, but it is hoped that continued propaganda by Medical Officers and Midwives will in time assist in bringing home to prospective mothers the importance of such measures and in reducing absenteeism to more reasonable dimensions. The Pre-School Child. The total number of such children referred from Welfare Centres, Day Nurseries and other sources was 443, against 390 last year. This further rise is encouraging, but dental supervision of those between three and five years of age is still verv incomplete, and until this can be carried out on more systematic lines, far loo large a proportion will remain untreated. The importance of early inspection and care for these children cannot be overstressed, as it is only when repairs are carried out during the very early stages of the disease that undue loss of deciduous teeth can be avoided. The introduction of nursery classes at certain Primary Schools will, it is hoped, materially assist in reducing present deficiencies until more far reaching plans for Nursery Schools become an established fact. The institution of wide spread measures for ante-natal care of mothers, and increased attention to the diet and nutrition of infants, is undoubtedly producing beneficial results, and for several years past a steady improvement has been noted by dental officers in the calcification of the enamel of those entering school. Confirmation of the above has recently appeared in a report of Lady Mellanby's findings, following her examination last year of certain groups of "five-year-old" L.C.C. children. The following quotation from the summary of her report is interesting: "The general dental health of the children examined in 1943 was much better than that of the 1929 group, and in 1945 there was a further appreciable improvement." The actual figures for children found to be "almost" caries free are represented as follows:— 1929 4.7 per cent. 1943 22.4 1945 26.5 91 Such statistics indicate a rise of 17.7 per cent. in those showing "little decay" during the initial fourteen-year period, plus an additional improvement of 4.1 per cent. in the subsequent eighteen months. Treatment. The following summary shows particulars of the work accomplished:— Expectant Mothers. Nursing Mothers. Total. Young Children. New Cases Examined 733 100 833 376 Re-treated 55 31 86 67 Total 788 131 919 443 Attendances 2911 227 3138 926 Fillings 773 29 802 456 Extractions 2013 160 2173 362 "Gas" Cases 337 21 358 131 Local Anaesthesia 461 14 475 117 Scalings and Gum Treatment 408 22 430 19 Dressings 758 140 898 73 Denture Dressings 1319 113 1432 — Silver Nitrate - — — 739 Treatments Completed 372 19 391 306 Number of Sessions (treatment) 473 Dentures Fitted 260 Dentures repaired 27 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 666 — Bensham Manor 3 7 Post-Natal 4 — St. Andrew's 1 10 Municipal Midwives 225 — Waddon 4 3 Municipal 32 51 Shirley 2 9 East Croydon 6 33 Boston Road 27 21 Upper Norwood — 3 St. Stephen's 2 20 West Croydon — 5 Holy Trinity 2 12 South Norwood 8 3 Addington 2 9 South Croydon 1 3 Day Nurseries — 75 St. Alban's 3 13 The Retreat 18 — Woodside 4 6 Referred by Dental St. Oswald's 1 17 Officers — 93 Mothers: 1,011. Young Children: 393. Total: 1,404. 92 The amount received for attendance fees was £69 8s. 0d., as against £69 13s. 0d. in 1945. PREMATURE 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 1946 who were born— (i) at home 59 (ii) in hospital 186 (2) The number of those born at home— who were nursed entirely at home 53 who died during the first 24 hours 2 who survived at the end of one month 57 (3) The number of those born in hospital— who died during the first 24 hours 38 who survived at the end of one month 148 The Work of the Health Visitors.—Maternity and Child Welfare Only. Visits Re Allford Left 6/8/46 Andrews Ashe Bird Comm. 19/8/46 Blest Left 1/12/46 Catlow Left 16/2/46 Cross Devaney Early Comm. 26/4/46 Edwards Ernest Comm. 2/9/46 Elliott Comm. 4/3/46 Giffard Left 31/12/46 Comm. 22/7/46 Left 19/10/46 Gladstone Comm. 16/9/46 Hall Hinton Hobdey Left 16/5/46 Re-com. 25/11/46 Linton Left 25/5/46 Mace Comm. 4/2/46 Newcombe Oakley Comm. 4/2/46 Orridge Left 23/2/46 Overington Comm. 11/2/46 Left 9/9/46 Perry Southgate Stokes Re-comm. 1/3/46 Comm. 2/9/46 j Thomas Toneri Left 11/4/46 Wakeifeld [ Walker Warman Webb Wilson Wybrew Total. Infants under 1 year— First Visits - 136 112 196 77 158 27 176 92 159 260 81 167 73 96 190 241 93 54 166 158 243 56 139 165 143 38 311 26 254 143 206 253 268 4947 Re-visits - 269 269 533 187 363 7 833 636 550 322 111 273 82 229 1254 1154 285 260 426 570 414 192 157 169 248 108 381 71 575 242 536 500 528 12744 Children 1—2 years— First Visits - 34 5 8 4 4 1 13 - 10 3 1 13 3 3 3 15 7 - 11 17 - 2 15 5 10 1 4 - 17 8 10 12 11 250 Re-visits - 289 102 385 84 223 18 459 364 469 103 61 184 87 179 407 603 188 176 303 353 286 138 106 150 230 80 268 64 580 114 380 382 278 8093 Children 2—5 years— First Visits - 41 - 1 - 3 1 16 - 4 6 11 12 1 2 1 32 16 2 6 13 7 - 7 6 8 2 2 - 16 13 6 19 10 264 Re-visits - 380 257 325 180 169 27 422 524 509 249 125 273 95 287 556 1202 299 203 302 392 432 70 130 362 331 210 205 78 837 310 500 964 471 11676 Expectant Mothers— First Visits — 157 93 147 48 82 20 131 67 100 142 54 71 42 38 75 116 85 38 56 84 170 20 91 136 106 30 101 27 112 117 106 248 152 3062 Re-visits — 1 14 — - 3 4 1 57 - 12 - 7 — - — 65 - - 13 - 14 - 11 8 - — 3 28 — 3 42 — 286 Still Births - - 2 1 1 - 1 — — 1 — — — — — — — — - 2 1 3 — 3 3 1 - 3 -| - - 3 1 - 26 Deaths under 1 year - - 10 2 1 - 1 1 1 1 12 — 4 — 2 — 4 4 4 — — 5 — 7 3 1 - 3 - 2 3 - 9 - 80 Miscellaneous Visits - 8 14 17 7 - 2 28 9 5 84 5 99 1 2 5 7 20 11 8 21 42 — 31 105 7 1 11 3 37 20 29 45 23 707 Ineffective Visits — 157 170 48 180 162 46 206 208 328 386 246 329 68 211 543 269 165 157 401 468 436 68 129 277 310 175 200 75 509 476 386 373 440 8602 Totals: 1946 — 1472 1048 1663 769 1167 155 2286 1958 2136 1579 695 1432 452 1049 3034 3708 1162 905 1694 2077 2052 546 826 1389 1395 645 1492 344 2967 1446 2165 2848 2181 50737 1945 — 1916 922 1699 - 1715 1112 2065 1915 - 1329 - - - - 2569 3254 1745 2292 - 2081 - 2808 - 1691 - - 1209 1044 3025 1408 2093 2436 1827 46180 *Including Health Visitors who left during 1945. Attendances at Infant Centres—1946. Municipal. Boston Road. St. Andrew's. South Croydon. Shirley. Woodside. East C.oydon. South Norwood Upper Norwood. St. Alban's. Bensham Manor. St. Oswald's. West Croydon. Norbury. Waddon. Selhurst. New Addington. St. Stephen's Total 1946. Total 1945. New cases under 1 year 449 163 179 207 180 220 410 304 141 249 146 248 83 180 115 116 103 226 3719 3096 No. of re-attendances 5347 2009 1575 2719 1548 2226 4180 3362 1632 3077 2123 4085 1262 2379 1530 1604 1187 3082 44927 37129 New cases over 1 year 83 43 45 39 41 78 77 74 42 49 36 38 44 41 17 40 16 36 839 834 No. of re-attendances 3725 1410 884 1137 945 1171 2365 1608 918 1760 1685 2523 1063 2058 1056 1768 597 1783 28456 25387 Attendances of children 0-5 9604 3625 2683 4102 2714 3695 7032 5348 2733 5135 3990 6894 2452 4658 2718 3528 1903 5127 77941 66446 Consultations with Doctor 2684 1117 1133 1049 514 1198 2158 2078 994 1945 1167 1907 1083 913 706 828 743 1190 23407 21724 No. of Sessions 99 48 48 48 48 48 97 97 48 95 52 96 48 51 48 48 49 69 1137 1073 Expectant Mothers: No. of new cases — — - — 4 — .— 14 — — — — — — 7 — 12 — 37 49 No. of re-attendances — — — 4 11 — - 1 — — 2 - - 10 82 23 11 — 144 269 Total attendances of Expectant Mothers — — — 4 15 — — 15 — — 2 — — 10 89 23 23 — 181 318 Total attendances 9604 3625 2683 4106 2729 3695 7032 5363 2733 5135 3992 6894 2452 4668 2807 3551 1926 5127 78122 66764 Average attendance per Session 1946 97.0 75.5 55.9 85.5 56.8 77.0 72.5 55.3 56.9 54.5 76.7 71.8 51.1 91.1 58.5 74.0 39.3 74.3 ‡68.7 — 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 ‡Total average attendance each week at all Centres. 93 94 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 13 Total number of weeks 99½ Cost £104 1s. 5d. Numbers of mothers sent for convalescence 4 Number of children under 5 sent with their mothers to Convalescent Homes and cottages 3 Home Helps. During the year 622 expectant mothers applied for Home Helps, and 551 were supplied. The corresponding figures for 1945 were 484 mothers applied, and 433 were supplied. At the end of the year there were the names of 35 full-time and 10 casual Home Helps on the register. Babies' Help Report. I am indebted to Mrs. Philpott for the following particulars:— "In January, 1946, three mothers and babies were receiving grants. During the year eight mothers were helped, and at the end of the year three were receiving grants. Payments 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 34, Morland Road, and a Hostel at 24, Morland Road. As the Council now makes a yearly financial grant of £100 towards its conduction it is periodically inspected by the Council's officers. PUBLIC HEALTH ACT, 1936. PART VII. Child Life Protection. This part of the Act deals with Foster Mothers and Foster Children. 95 The Tables below give figures for 1946. FOSTER CHILDREN No.as at Dec. 31 st 1945 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 1946 Parent Another area with Foster Parent Another Foster Mother Public Institution 112 132 64 25 12 10 23 - 3 107 FOSTER MOTHERS. No. as at December 31st 1945 Applications for Authorisation during the year. Removals during the year Authorisation cancelled for other reasons No. as at December 31st 1946 With Child Without child 105 40 — 5 55 85 The Health Visitors paid 1,097 visits to foster-mothers for the purpose of supervision. THE OBSTETRIC SERVICE. The Obstetric Service has been described in my Report for 1938. The following are the statistics for 1946:— Taking the Registrar-General's figures for maternal mortality (deaths directly due to pregnancy), the rate for England and Wales for 1946 was 1.43 per 1,000 births. In Croydon the rate was 0.61. In "booked" cases treated by the Obstetric Service the rate for 1946 was 1.03 per 1,000 Hospital deliveries; nil per 1,000 home deliveries, and 0.56 per 1,000 over all deliveries. Of the cases treated to a conclusion at the Post-Natal Clinic during 1946, 96.2 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 1945 was 96.8. The number of cases delivered of viable babies in Mayday Hospital, with a nominal 68 beds, was 1,321. The number delivered at St. Mary's Maternity Hospital, with 30 beds, was 669. The number of cases delivered by the Domiciliary Branch of the Service (Municipal Midwives) was 1,610. Including 54 cases admitted after delivery, the total number of deliveries dealt with by the Obstetric Service was 3,605. The total number of infants born was 3,654. 96 In April, 1943, Monteagle Nursing Home was equipped and opened as an annexe to Mayday and St. Mary's Hospitals, providing 20 additional lying-in beds and 2 nurseries. These beds are included in the Mayday Hospital beds named above. 696 mothers and babies were transferred from Mayday Hospital, and 95 mothers and babies from St. Mary's Hospital in 1946 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 1946, as compared with previous years. General Statistics, 1945. No. of live births allocated to the Borough of Croydon 4,806 „ still „ „ „ „ 131 No. of maternal deaths 3 No. of cases of notified Puerperal Pyrexia 57 No. of expectant mothers who attended the Borough Ante- Natal Clinics 3,238 No. of cases delivered in Mayday Hospital as Booked cases (exclusive of abortions) 1,272 No. of cases delivered in Mayday Hospital as Emergency cases (exclusive of abortions) 49 Total cases delivered in Mayday Hospital 1,321 No. of cases delivered in St. Mary's Maternity Hospital as Booked cases 669 No. of cases delivered in St. Mary's Maternity Hospital as Emergency cases — Total cases delivered in St. Mary's Maternity Hospital 669 No. of cases delivered by Municipal midwives 1,610 Total 3,600 No. of cases admitted to the Puerperal Infection Unit, Borough Hospital, including 8 from Mayday Hospital and 7 from St. Mary's Nursing Hospital 15 No. of Maternal deaths in Booked cases from Borough Ante-Natal Clinics 2 No. of Maternal deaths in Emergency cases at Mayday Hospital 1 No. of Maternal deaths in cases admitted as Puerperal Sepsis per se 0 Total Maternal deaths in beds of the Obstetric Service 3 97 The total number of patients treated by the Obstetric Service was:— (a) In Mayday Hospital 1,682 (b) In St. Mary's Maternity Hospital 669 (c) In the Borough Hospital Puerperal Infection Unit 15 (d) At the Ante Natal Clinics and delivered outside the above Hospitals (including Municipal Midwives' cases) 1,774 (e) At the Post-Natal Clinics, excluding those included in (a), (b), (c) and (d) 1,633 (f) At the Ante-Natal Clinics and undelivered on December 31st, 1946 866 6,639 Incidence of Abortion. 1946. 1945. Incomplete abortions 171 167 Threatened abortion with final evacuation 24 33 Inevitable abortion 27 15 Complete abortion 32 16 Missed abortion — 10 Threatened abortion discharged undelivered 44 62 Total 298 303 ANTE-NATAL SUPERVISION. 1945 1946 No. of Sessions at Ante-Natal Clinics held 601 603 No. of individuals who attended 4,092 4,484 No. of previous year's cases continuing attendance 939 1,177 No. of new cases 3,153 3,238 No. of cases undelivered on 31st December 1,177 866 Total attendances made 22,663 21,615 Average attendances per session 38 36 No. of cases delivered in hospital as Booked cases 1,684 1,941 No. of cases delivered by Municipal Midwives. 1,015 1,610 No. of cases delivered at other places under the care of private doctors or midwives 150 65 No. of patients found not to be pregnant 28 18 No. of patients referred to hospital for Ante- Natal treatment 359 316 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 1946 the Obstetric Service dealt with 3,605 out of the total births allocated to the Borough. 98 Major Ante-Natal Conditions treated at the Ante-Natal Clinic. BREECH PRESENTATION. Breech presentation diagnosed 131 Spontaneous version 36 External version successful 49 External version not successful 78 Allowed to go to term as Breech 46 Not recognised as Breech before labour 4 VENEREAL DISEASE. Gonorrhoea Total cases 4 Transferred to Borough V.D. Clinic 4 Syphilis Total cases 5 Transferred to Borough V.D. Clinic 5 Non-Venereal 22 Independent Midwives Cases. These cases may be summarised as follows:— Total number of midwives' cases during 1946 154 Number of cases sent for one consultation only 63 Number of cases supervised entirely 101 Physiotherapy. The following statistics have been furnished by the Physiotherapist in respect of cases seen at Mayday and St. Mary's Maternity Hospitals— Number of patients dealt with 669 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. 90 Pathological Investigations. Blood for Wasserman and Kahn reactions 97 Gonococcal fixation tests 11 Blood for Hb. estimation 740 Blood for grouping 244 Compatability tests 131 Blood counts 88 Blood films 12 Blood sedimentation rate 5 Blood culture 4 Blood urea 40 Bleeding and Clothing time 9 Prothrombin time 1 Van den Bergh reaction 2 Glucose Tolerance test 2 Blood sugar 3 Rh. Factor 52 Catheter Specimen of Urine 686 Urea Clearance tests 172 Twenty-four hour specimen of urine 3 Urea concentration 8 Right and Left Uteric Urine 1 Urine for Ascheim-Zondek Test 32 Throat swabs 196 Nasal swabs 7 Vaginal swabs 212 Urethral swabs 9 Conjunctival swabs 51 Ear swabs 2 Bacteriology of Breast Milk 5 Sputa 10 Vomiting 1 Fractional Test meal 1 Cerebro-Spinal Fluid 1 Pus from Wounds, Spots, Blisters, etc. 35 Faeces culture Specimens of tissue for histology 23 X-Ray Examinations (Mayday Hospital X-Ray Department). 278 cases were referred from Mayday Hospital, St. Mary's Maternity Hospital, and Ante-Natal Clinics. Reasons for reference were:— Breech for Attitude, etc. 56 For Presentation, Attitude, etc. 64 Twins 74 Foetal Death 12 Foetal Parts 17 Disproportion 75 Foetal Abnormalities 47 Pelvic Abnormality 34 Chest 22 Various 5 100 IN-PATIENT TREATMENT. A.—Patients "Booked" in the Ante-Natal Department: — Mayday Hospital. St. Mary's Maternity Hospital. Total. (1) Delivered in hospital after 28th week 1,086 668 1,754 (2) Delivered in hospital before 28th week 5 1 6 (3) Admitted after delivery 9 5 14 (4) Discharged undelivered after ante-natal treatment and not subsequently delivered in hospital - - - (5) Died undelivered — - - (6) Ectopic Pregnancy - - - 1,100 674 1,774 B.—"Emergency" patients sent into Hospital with some complications by outside doctors or midwives:— (1) Before Labour: Mayday Hospital. St. Mary's Hospital. (a) Discharged undelivered — — (b) Delivered in hospital after 28(h week 175 2 (c) Delivered in hospital before 28th week 6 — (d) Died undelivered — — (2) After Delivery 40 — (3) Ectopic Pregnancy 13 — 234 2 101 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 100 21 31 152 Eclampsia 6 1 2 9 Persistent vomiting of pregnancy — — 1 1 Chronic cervitis — — — — Acute pyelitis 2 — 3 5 Malnutrition, debility, simple anaemia,etc. 30 — 8 38 Retroverted gravid uterus 3 — — 3 2. Intercurrent Diseases. Chronic nephritis 3 — — 3 Pulmonary Tuberculosis 6 — — 6 Venereal disease 3 — — 3 Cardiac disease 18 2 6 26 3. Conditions chiefly Natal. Presentations at Delivery:— Anterior positions of the vertex 921 126 615 1662 Posterior positions of the vertex 130 18 33 181 Breech 70 26 30 126 Shoulder 2 2 2 6 Face and brow 3 — — 3 Complex 2 — — 2 Caesarean section 55 — 4 59 Twins and Triplets 20 1 11 32 Accidental haemorrhage 22 10 4 36 Placenta praevia 15 8 1 24 Hydramnios 10 1 2 13 Prolapse of cord 3 1 1 5 Retained placenta 19 4 9 32 Post-Partuin haemorrhage 18 1 49 68 B.B.A 41 8 5 54 Lacerated perineum 332 28 154 514 Obstructed labour — — — — Premature labour 93 14 39 146 Abortion 90 206 — 296 Ectopic pregnancy — 13 — 13 Abdominal Hysterotomy — 3 — 3 Forceps delivery 98 20 47 . 165 4. Conditions chiefly Post Natal, excluding re-admissions from Post Natal Clinic. Breast abscess — — 1 1 Notified pyrexia or fever 24 — 3 27 In addition 15 cases of Puerperal Pyrexia per se were admitted to the Puerperal Infection Unit of the Borough Hospital. 102 Blood Transfusion (84 Obstetrical and 51 Gymaecological cases). For every case, stored blood from the Blood Transfusion Depot, Sutton, was used. There were no deaths. Tnfants. Mayday Hospital Booked. Mayday Hospital Emergency St. Mary' Maternity Hospital Booked. Total No. of infants in Hospital on 1st Jan., 1946 31 5 24 60 Total No. of live births, still births and infants admitted with Mother (B.B.A.) 1849 220 680 2749 No. of infants in Hospital on 31st Dec., 1946 31 4 25 60 Alive on discharge from Hospital 1114 140 . 658 1912 Stillborn 85 27 15 127 Died (born alive, but died in Hospital) 50 15 7 72 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 1,114 infants discharged from Mayday Hospital, 717 were up to or over birth weight (64 per cent.). Of 667 infants discharged from St. Mary's Maternity Hospital, 423 were up to or over birth weight (63 per cent.) Twins and Triplets. There were 33 cases of Twins and 1 of Triplets. There was no maternal death. Mayday Hospital. Booked. Mayday Hospital. Emergency St. Mary's Maternity Hospital. Booked. Total. No. of cases 20 2 11 33 No. of infants discharged alive 36 4 20 60 No. of still-births and infant deaths 6 - 2 8 Foetal and Infant Mortality 14.3% — 9.1% 11.8% 108 ANTE-NATAL CLINIC Total new patients registered 3,491 Total new patients who did not attend for first appointment because aborted, left district, reason unknown, etc. 199 Total new patients sent to Midwives, Nursing Homes, etc.; who could not be accommodated in Mayday or St. Mary's 1,347 Total who booked at a Nursing Home 124 Total who booked at a Hostel for Unmarried Mothers 29 POST NATAL AND GYNAECOLOGICAL CLINIC. Number of Sessions held 102 „ „ Individuals presented 3,732 Average attendance per session 33 Number of Post-Natal cases 1,633 Number of Gynaecological cases 2,099 END RESULTS. 981 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 498 446 944 96.2 Health slightly impaired 21 14 35 3.6 Health seriously impaired 2 — 2 0.2 Totals, treated to conclusion 521 460 981 Maternal Mortality (Obstetric Service). Five deaths occurred of mothers dealt with by the Service, three in "Booked" cases, one in "Emergency," and one therapeutic termination of pregnancy for advanced renal tuberculosis. The maternal mortality of "Booked" cases, i.e., cases under the continued supervision of the Service, is 1.55 per 1,000 hospital deliveries, and 0.83 per 1,000 tota deliveries, including the Municipal Midwives "Booked" cases. Puerperal Infection. Forty-nine cases were treated in isolation for puerperal infection. 20 of them in the Borough Hospital, 2!) in St. Mary's and Mayday Hospitals. There was no death. 104 Sources of the Cases. Cases. Deaths. From Mayday Hospital:— "Booked" Cases 8 - "Emergency" Cases — - From St. Mary's Maternity Hospital — — From other Hospitals — — From private doctors, deliveries in Nursing Homes 1 - From private doctors, deliveries at home 11 - The Assistant Medical Officer of Health for Obstetrics was called in by medical practitioners to see 22 obstetrical and 127 gynaecological patients who could not afford to pay a private consultant. In addition, he was asked by the Medical Superintendent of Mayday Hospital to give an opinion on the obstetric and gynaecological aspects of 51 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 60 Aged 5—16 years 100 Over 16 years 536 Total 696 2.—Education Cases. Aged 7—16 years 148 Combined Total 844 Compared with 1945, the Statutory cases show a decrease of 42 and the Educational cases a decrease of 8. None of the cases under Statutory supervision have died. Two Institution patients have died in hospital. 105 The Statutory cases are distributed as follows:— In Certified Institutions 230 In Approved Homes 5 On leave from Institutions 8 Under Statutory supervision at home 361 Under Guardianship 64 In Mental Hospitals 8 Observation cases 20 696 The Education cases were distributed as follows:— In Certified Residential Schools 1 In Certified Day Schools 147 In Private Schools — Awaiting vacancies at St. Christopher's — 148 During the year the Certifying Medical Officers made examinations and paid visits to the number of 206 to Statutory cases. The Mental Deficiency Visitors paid 1,000 visits to Statutory cases and 1,004 to Education cases, 2,004 visits in all, a decrease of 610 on 1945 figures. During 1946, 36 Statutory cases were dealt with as follows:— Sent to Certified Institutions 19 Placed under Guardianship 4 Sent to Warlingham Park Hospital — Varying Orders: (a) Change of Guardian 8 (b) From one Institution to another. 2 (c) From Guardianship to Institution 3 (d) Orders closed - Seventy-two Orders were renewed during the year, 19 of which were Guardianship. Guardianship Cases. There were 64 cases under Statutory Guardianships, 40 of these under the care of relatives, and 24 with Guardians who are not relatives. 10 males and 3 females are at work. 106 360 visits have been paid to Guardianship cases during the year. There are 4 cases on leave from Institutions (2 boys and 2 girls). Clinic for Mentally Defective, Backward and Abnormal Children. 104 children were examined during 1946. The classifications arrived at, together with recommendations made, are summarised under— (1) Certified as Mentally Defective: Recommendations: (a) Recommended for Special Day School 47 (b) Recommended for Residential School 2 (c) Recommended for Occupational Centre 6 (2) Found to be dull and backward: (a) Referred to a Special Class 17 (b) Further trial in Ordinary Class 2 (c) Re-test in one year 17 (d) To attend St. Giles' because of physical defect 1 (e) To attend St. Luke's — (f) Referred for Medical Treatment — (3) Referred to Child Guidance Clinic — 92 Mental Tests at St. Christopher's 12 104 ORTHOPAEDIC DEPARTMENT. The arrangements are the same as in 1945. Summary of Cases Attending the Orthopaedic Clinic. Jan. 1st, 1946. New Cases, 1946. Cases Discharged, 1946. Cases on books, Dec. 31st, 1946. M.C.W. S.M.S. T uberc. M.C.W. S.M.S. T uberc. M.C.W. S.M.S. T uberc. M.C.W. S.M.S. Tuberc 155 182 87 141 209 6 73 129 18 223 262 75 424 356 220 560 107 Cases seen by the Orthopaedic Surgeon, 1946. Defects. School. M.C.W. Tuberculosis. Total. Cases. Attendances. Cases. Attendances. Cases. Attendances. Cases. Attendances. Infantile Paralysis 12 33 1 2 — — 13 35 Curvature or Postural Defects 24 39 2 2 — — 26 41 Pes Cavus 10 15 1 1 — — 11 16 Pes Planus 166 230 32 47 — — 198 277 Genu Valgum 76 20 54 94 — — 130 114 Talipes 7 14 15 28 — — 22 42 Obstetrical Paralysis 1 3 - - — — 1 3 Joint Diseases 9 27 2 4 40a 61a 58 114 5s 17s 2m 5m Injuries 12 20 — — — — 12 20 Rickets 3 3 10 21 — — 13 24 Wry Neck 4 5 11 14 — — 15 19 Spastic Paraplegia 10 16 4 8 — — 14 24 Congenital dislocation of the Hip 7 11 1 — — — 8 11 Other deformities 37 50 72 93 — — 109 143 378 486 205 314 47 83 630 883 a—Adults; s—School Child; m—Pre-School. Summarised, the table shows 378 schoolchildren attended and made 486 attendances. 205 babies made 314 attendances and 47 tuberculosis cases made 83 attendances. A total of 630 cases made 883 attendances. 108 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 Croydon General Hospital:— Defects. School Cases. M.C.W. Cases. Tuberculosis Cases. Total. Cases No. of Treatments X- Rays Cases No. of Treatments X- Rays Cases No. of Treatments XRays Cases No. of Treatments X- Rays Infantile Paralysis 1 1 — - — — — — — 1 1 - Curvature or postural defect 12 189 6 1 1 1 — — — 13 190 7 Pes cavus — — — — — — — — — — - - Pes planus 1 15 - - - - - - - 1 15 - Genu Valgum — — — — — — - - - - - - Talipes 1 10 - 3 16 — — — — 4 26 - Joint Disease 6 26 1 1 2 1 19 35 18 26 63 23 Injuries 4 6 5 - - - - - - 4 6 5 Rickets — — - — - — — — — — - - Wry Neck 1 1 I 1 6 — — — — 2 7 1 Spastic Paraplegia — — — — — — — — - - - - Congenita! Dislocation of the Hip. 4 20 3 — — — — — — 4 20 3 Other Deformities 2 10 1 4 11 2 — — — 6 21 3 32 278 20 10 36 4 19 35 18 61 349 42 109 Cases admitted to Residential Institutions. Name of Institution. School Cases. M. & C.W. Cases Tuberculosis Cases. Total. No. in on 1st Jan., 1946 Admitted Discharged. ' No. in on 1st Jan., 1946 Admitted. Discharged. No. in on 1st Jan., 1946 Admitted. Discharged. No. in on 1st Jan., 1946 Admitted. Discharged. No. in on 1st Jan., 1947 Victoria Home 1s 1s 1s 1 1 1 1 Pyrford 1 — — — l 1 Is — — 2 1 1 2 Croydon Gen. Hosp. — 26 26 — 13 13 — 1A 1A — 40 40 — Heritage Craft Schls. 1 1 1 — — — 3s 1s 1s 4 2 2 4 Pinner — — - 1 — 1 — — — 1 — 1 — Myr. Treloar Hosp. - - - - - - 1s - - 1 — 1 1 M.S. Hosp. - - - - - - - - - - - - - haftesbury Homes 1 1 1 - - - - - - 1 1 1 1 Queen Mary's Hosp. 1 — — — — — 1s — — 2 — — 2 Royal Nat. Orth. Hosp - 1 1 - - - - - - - 1 1 - Mayday Hosp. 2 2 2 1 6 6 4a lA — 7 9 8 8 Redhill Hosp. — — — — — — — — — - — — — Wingfield Morris Hos. - - - - - - - - - - - - - R. S. B. H. — — — — — — — 4a — — 5 — 5 1s 6 31 31 2 20 21 4A 6a lA 19 60 55 24 7s 3s 2s 110 Conditions for which Patients were admitted to Hospitals with the Results of Treatment. Condition. In on 1st Jan. 1946 Admitted or transferred. Discharged. I.S.Q. Died. In on 1st Jan. 1947 Arrested. Quiescent. Improved. Infantile Paralysis 1 3 — — 3 — — 1 Tubercular Joint Disease 12 8 3 2 2 — — 13 Hip Disease 4 2 — — 1 — — 5 Hemiplegia — — — — — — — — Genu Valgum — 1 — — 1 — — — Pes Planus — 9 — — 9 — — — Talipes — 1 — — 1 — — — Rickets — 4 — — 4 — — — Other Deformities — 13 — — 13 — — — Spastic Paraplegia — — — — — — — — Scoliosis 1 — — — 1 — — — Osteomyelitis — 1 — — 1 — — — 18 42 3 2 36 - — 19 111 112 M. = Males F. = Females. T. = Total. TABLE I. WELFARE OF THE BLIND—REGISTRATION. As at 31/3/47. 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. - - - - - - 7 3 10 5 2 7 19 19 38 32 28 60 49 54 103 27 32 59 60 125 185 (i) (ii) 99 - (i) (ii) 263 3 (ii) 462 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 21 12 33 23 23 46 22 32 56 16 40 56 21 37 58 29 62 91 10 17 27 Children of School Age. • Training and Employment. Normal Mentally Defective Physically Defective Employed Undergoing Training. (h) Trained but unemployed (i) No training but trainable (j) Unemployable (k) Total M. F. M. F. M. F. By Blind Organisations (c) All others not included in (a) and (b] (d) Total Employed (e) Industrial (f) Secondary (g) Professional and University In Schools for the Blind 5 - - 1 - - (a) Workshops (b) Home workers Other Schools 2 1 - - - - M. F. T. M. P. T. M. F. T. M. P. 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 - - 5 2 7 26 9 35 32 7 39 63 18 81 1 - 1 - - - - - 1 — 1 1 - 1 126 245 371 192 263 455 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 Teacher# 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 Upholsterers Hand Machine Within Institution for the Blind - 1 1 - 1 - -' - - - 1 - - - - - 1 - i - 1 - - - - - - - - - - - - 7 In approved Home Workers Schemes - 6 - - - 2 - 1 - 3 - - - 1 - 1 - - 7 - - 2 - 1 - - - - - - 11 - 17 35 Others not parttea workers) - - - - - 1 - - - - 3 - 3 - - - - - - - 2 1 2 2 - - - - - 8 - - 39 Total - 7 1 - 1 3 - 1 - 3 4 - 3 1 - 1 1 - 8 - 3 3 2 3 - - - - - 8 11 - 17 81 PHYSICALLY AND MENTALLY DEFECTIVE. (a) Mentally Defective. (b) Physically Defective. (c) (i) Deaf (ii) Deaf-mute Combinations of (a) and (b) Combinations of (a) and (c) Combinations of (b) and (c) Combinations of (a), (b), (c) Total Homes for the Blind Mental Hospitals Poor Law Institutions 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 1 6 7 - 1 1 7 19 25 (ii) 2 (ii) 1 3 118 BLIND PERSONS ACT. 1920. Close co-operation has been maintained with the Croydon Voluntary Association for the Blind. The blind persons residing in Croydon are visited at regular intervals by the Health Visitors. I am indebted to the Secretary of the Voluntary Association for the figures below : — Number of Blind on Register 465 Number of Blind who benefit from instruction in Braille or Moon type (including those who already read) .187 Number of Blind who benefit from part-time instruction 111 Number in remunerative handicrafts— (a) Home worker35 (b) In workshops 7 (c) St. Dunstan's 17 (d) Workers not included in scheme 39 Home Teachers 2 The Health Visitors paid 360 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 unernployable blind persons in homes, mental hospitals or institutions. 114 SANITARY CIRCUMSTANCES. To the Medical Officer of Health. I beg to submit a report for the year ending the -31st December, 1946, 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) 9,321 Number of houses inspected where zymotic diseases have occurred 269 Number of houses inspected under Landlord and Tenant (War Damage) Acts 37 House drains tested 1,438 House drains tested on application 10 Number of smoke tests during repair 108 Inspections of drainage work during repair 2,643 Number of water tests during repair 127 Final tests of drains after repair 68 Final tests of drains when completely relaid 21 Length of new drains tested feet 2,460 Inspection of vards, stables and manure pits 88 ,, passages 52 ,, public conveniences 141 ,, pigstyes 46 ,, tents, vans and similar structures29 ,, theatres, cinemas, halls, etc. 76 ponds and ditches and static water tanks 56 ,, schools and school sanitary conveniences 13 ,, common lodging-houses 10 ,, verminous premises 59 ,, premises where offensive trades are conducted 14 ,, gipsy encampments, camps, fairs, etc. 2 ,, cesspools ,, gathering grounds of water supply 87 Number of visits under Rats and Mice (Destruction) Act, 1919 7,171 Inspections of war damaged houses 793 Inspections of war damaged food shops 35 Smoke observations 50 Number of visits re Infectious Diseases 2,454 Inspections of Shops (under Shops Acts) 841 Special Early Closing and Evening Patrols (Shop Hours Acts) 43 Overcrowding inspections 315 Inspections under Fertilisers and Feeding Stuffs Act ,, under Pharmacy and Poisons Act . 42 ,, Dairies 38 „ Farms and cowsheds 95 ,, Milkshops 4 ,, Premises where food is prepared or sold. 2,166 ,, Bakehouses 28 ,, Slaughterhouses. 37 115 Inspection Factories without mechanical power 104 ,, Factories with mechanical power 26 „ Workplaces, Public Health Act 29. ,, Outworkers' premises 65 Visits re Young Persons Employment Act 21 Water samples taken 65 Food and Drugs Acts : milk samples taken 295 Food and Drugs Acts: other foods and drugs samples taken . 357 Milk Special Designations Orders : samples taken 280 Non-designated Milk : samples taken 113 Reinspections of work on outstanding notices 19,266 Sundry inspections and visits 1,276 Appointments kept with owners, builders, etc. 3,532 Complaints from public investigated (including those in regard to housing defects) . 8,764 Informal notices outstanding 31-12-45 . 1,061 Informal notices served . 5,763 Informal notices complied . 4,242 Number of Informal Notices referred for Statutory Orders 1,382 Informal notices outstanding 2,582 Statutory notices outstanding 31-12-45 1,602 Statutory notices served 3.964 Statutory notices complied 4,058 Statutory notices outstanding 31-12-46 . 1,508 ' Total number of callers and complaints received at the office 11,611 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 481 Want of windows or ventilators 96 Conditions causing dampness : Defective roofs . 1,317 Defective, window frames 439 Defective walls, etc. 361 Want of efficient damp-proof course 3-38 Defective gutters and downspouts 943 Other structural defects : Defective plaster .. 957 Cleansing and limewashing required 98 Defective floors and stairs 729 Insufficient ventilation under floor 93 Defective brickwork, cills, lintels, chimneys, etc 4-36 Defective stoves and fireplaces and flues . 665 Defective drains, sanitary fittings, etc Defective sinks and waste pipes 895 Defective w.c.'s 495 Defective drainage 578 Stoppages in drains 556 Defective water services and tanks 254 Domestic nuisances : Want of cleanliness 24 Dirty w.c. pans 16 Verminous conditions 60 116 Other nuisances and infringements : Offensive accumulations 107 Defective manure receptacles . 5 Dirty or defective sanitary conveniences 5 Overcrowding 133 Smoke nuisances . 11 Sundry nuisances or defects 3-5 Particulars not inserted in Rent Book (Housing Act) 2 ,, ,, ,, (Rent Restriction Act) 2 (2) FACTORIES AND WORKPLACES. Want of cleanliness 9 Inadequate ventilation 5 Insufficient drainage of floors 1 Abstract not exhibited 13 Thermometers required 2 Sundry nuisances or defects 22 W.C.'s—Insufficient . 7 ,, Unsuitable or defective 12 ,, Not separate for sexes 2 ,, Not lighted 4 (3) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924. Food cupboards defective or required . 27 (4) INFRINGEMENTS OF FOOD AND DRUGS ACT, 1938, AND FOOD BYELAWS. Cleansing or repair of walls and ceilings . 81 Cleansing or repair of floors, utensils, fixtures, etc 53 Dirty or defective w.c. accommodation . 52 Food storage accommodation required . 16 Refuse bins insufficient 42 Food in uncovered vehicles or baskets . 1 Premises not suitable for storage or manufacture of food 8 Want of provision of towels 17 Provision of cloakroom accommodation . 12 Want of intervening ventilated space to w.c. 5 Insufficient or defective sink accommodation and water supply 10 Ventilation required in food store 8 Household washing in food store 4 Impervious floors required to kitchens, etc. ' 52 Defective floors and pavings 18 (5) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING, Etc. Defective Yard Paving 55 Want of a sanitary dustbin 720 (6) INFRINGEMENTS OF SHOPS ACT. Defective ventilation Provision of means of heating 13 Infringement in hours of employment 20 Notices to be exhibited or amended 427 Insufficient w.c. accommodation 13 Want of washing facilities 9 Defective w.c. accommodation Defective walls, floors, ceilings, etc. 34 Defective lighting ... 30 Accommodation for meals 1 Seating accommodation 1 117 (7) INSPECTION OF AMUSEMENT HOUSES. Defective sanitary fittings 12 W.C. defective and dirty . 4 (8) KEEPING OF ANIMALS. Nuisances arising from the keeping of animals 15 (9) INSPECTION OF WATERCOURSES, etc. Cleansing of watercourses and ponds 3 (10) INFRINGEMENTS OF OTHER RYELAWS. Noisy animals 6 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 and materials on new house construction, it was possible to have some made available to comply with our requirements. An effort lias been made, in spite of the aforementioned difficulties, to have some repair effected at 'those properties which were found to be not in all respects fit, and action under the Public Health Acts in regard to drainage and sanitary fittings has been maintained at a level corresponding with that of pre-war. Notices for housing defects, in the remedying of which there was more difficulty in regard to both labour and materials,, have been slower in their compliance. 1. —Inspection of dwelling houses during the year : — (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health and Housing Acts) ... 9,321 (b) Number of inspections made for the purpose 9,321 (2) (a) Number of dwelling houses included under the sub- h'ead (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 ... 8,430 118 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 4,242 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 1,297 (2) Number of dwelling houses which were rendered fit after service of formal notices— (a) By owners 285 (b) By local authority in default of owners 65 B.—Proceedings under Public Health Acts :— (!) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 2,667 (2) Number of dwelling houses in which defects were remedied after service of formal notices : — (a) By owners 2,203 (b) By local authority in default of owners 1,505 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 — 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 — HOUSES LET IN LODGINGS. There are 12 houses registered and they gave little cause for complaint during the year. 119 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 Is. per night or (is. 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 99 and the number accommodated during the year -36,41-5. The receipts and expenditure for the past 5 years has been as follows : — Receipts. Expenditure. £ s. d. £ s. d. 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 1946 1,426 0 0 2,348 0 0 War Damaged Houses. The Sanitary Inspectors visited these on complaint and those items which appeared to be defects resulting from enemy action we referred to 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 10 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 26 9 — Without Mechanical Power 104 21 — Outworkers and Employers of outworkers 66 — — Total 195 30 120 Defects Found. Particulars. Number of Defects. Referred to H.M. Inspector. Prosecutions. Found. Remedied. Want of Cleanliness 9 9 — - Inadequate Ventilation 5 4 — - Ineffective Drainage of Floors 1 1 — - Sanitary Conveniences. Insufficient 7 6 — - Unsuitable or Defective 12 12 — - Not Separate for Sexes 2 2 — — No Lighting 4 4 - — Sundry Nuisan;es or Defects... 22 20 — — Total 62 58 - — Home Work. Lists of home workers or outworkers as they are termed are sent in twice yearly, and this year contained the names of 103 workers residing in the Borough. 65 visits were paid to outworkers and 1 visit was paid to premises of employers of outworkers to examine lists. Nature of Employment of Outworkers on the Register, 31st December, 1946. Nature of Work. Number Employed. Outwork in Infected Premises. Outwork in Unsatisfactory Premises. Remarks. Making, Cleaning, Altering and Repairing, Wearing Apparel 66 - Upholstery Work 3 — — - Other Classes of Work 34 — — - Total 103 — — — Inspection of Schools. These are inspected with particular reference to sanitary accommodation including washing facilities. During the roar 13 inspections were made and defects found were referred to the Education Officer. 121 SHOPS, Etc., ACTS. The Shops Acts, 1912-193(J, contain provisions for dealing with dosing hours, the hours of work, and health and comfort of those employed. Closing hours have during the year given little cause for complaint. 20 infringements were found in regard to hours of work of assistants but these were amended forthwith. 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. 841 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 2,043 visits of inspection were made to underground drains in course of repair. With the stringent licensing of building works and the labour and material? difficulties it became essential to serve Statutory Orders in all cases of drainage defects. Of 1,788 Orders served, 331 had to be done in default of the owners. 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 inrat infestations. OFFENSIVE TRADES. There are but few registered and during the year there has been no cause for complaint. WATERCOURSES, PONDS AND DITCHES, Etc. 56 inspections were made and pollutions were found in 3 cases. Observation was also kept on static water tanks for evidence of nuisance or mosquito "breeding. SMOKE OBSERVATIONS. During the year 50 observations were made of factory chimneys for the purpose of detecting offences. In those cases where nuisance occurred appropriate action was taken with a view to remedying the condition. Today there is little choice left to the factory owner regarding the fuel he uses and this creates a difficult problem in smoke abatement. The difficulty of renewals of plant has also to be overcome. 122 AMUSEMENT HOUSES. 76 inspections were made of Theatres, Music Halls, Cinemas, Dance Halls, and premises where stage play's 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 53,90S articles ,, Formalin Gas 3,268 ,, ,, ,, Spray 3,779 ,, Total 61,045 ,, In addition 363 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 1946, 1,065 articles were disinfected, the receipts amounting to £21 0s. 8d. Disinfection was carried out after infectious or contagious disease at the following premises: — 939 rooms at 771 houses, hospital wards, clinics, and creches. 3,040 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 26 adults and 109 children were cleansed of verminous conditions and 256 adults and 423 children were treated for Scabies. 123 DISINFESTATION OF PREMISES. The Department does little in the way of treatment of premises infested with vermin, the practice being to make owners or occupiers responsible for disinfestation. Advice is given on methods to be employed and at times Hydrogen Cyanide is applied by specialist firms to infested premises. The use of this gas is controlled by stringent regulations and the compliance with these regulations is observed by a Sanitary Inspector. The number of premises disinfested by owners or occupiers during (he year was 53. 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 9 parts per 100,000 No. 2 Linsey ,, ,, 22 ,, ,, 100,000 No. 3 Black Linsey ,, ,, 5 ,, ,, 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 2 of the Act was 42. In addition, 199 applications were made for the retention of names on the list for a further period of twelve months. No infringements of the Act were found. FERTILISERS AND FEEDING STUFFS ACT, 1926. Inspections of premises where fertilisers and feeding stuffs were sold were carried out during the year. 124 RATS AND MICE DESTRUCTION ACT, 1919. INFESTATION ORDER, 1943. During the year 1,281 complaints were received of rat or mice infestation. Of these complaints the presence of rodents was confirmed in 744 cases. The two Ratcatchers in dealing with these infestations paid 6,539 visits, laid 2,129 prebaits and used 3571bs. of poison bait, as well as using traps and gassing. An estimated total of 9,647 rats were destroyed. The types of premises found to be infested were :— Dwelling Houses (Inside) 197 (Sheds, etc.) 321 (Gardens) 106 (Poultry Houses) 140 Premises where Food is prepared or sold 40 Factories, Workshops and Business premises 25 Dumps 1 Allotments 3 Schools 13 Shops 30 Theatres 1 Drains 62 Sewers in the town were baited with good results, the total number of rats destroyed therein being estimated at 1,025. 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 premises in the Borough at which food is known to be sold, manufactured or stored : — Bakers 146 Butchers 193 Confectioners 388 Fishmongers (including Fish Friers) 89 Fish Friers only 33 Greengrocers 284 Grocers 642 Stalls and Rounds 179 Catering Fstablishments (including Hotels Restaurants, Clubs, Snack Bars, etc. 718 Miscellaneous (including Chemists, etc.) 212 2,884 125 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- Butchers 880 Greengrocers 108 Bakers 28 Grocers 428 Confectioners 18 Stalls and Rounds 115 Fishmongers 85 Catering Establishments 400 Fried Fish Shops 28 Miscellaneous 78 Total 2,166 General Summary of Meat and other Articles of food found to be unfit and condemned by the Inspectors during 1946:— Articles. Weight in lbs. Diseased. Unsound. Total. Beef 24296 5290 29586 Veal 143 131 274 Mutton 35 325 3G0 Pork 151 15 166 Offal 19848 47 19895 Fish — 3081 3081 Fruit and Vegetables — 1160 1160 Canned, bottled and packeted goods — 34587 34587 Other goods — 8380 8380 44473 53016 97489 The above includes : — Canned, bottled and packeted goods : — 15,235 cans, 4,377 Bottles, packets, etc. 126 Disposal of Condemned Foodstuffs. The Meat was condemned at either the Public Abattoir, the Ministry of Food Depot or at shops supplied therefrom and was disposed of bv 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. Butcher's shops are visited by the Sanitary Inspectors to observe the condition of meat at time of sale. The Public Abattoir was taken over by the Ministry of Food in November, 1946, for the slaughtering of livestock and during the year the following animals were slaughtered there and inspected by the Corporation's Meat Inspectors : — Cattle. Calves. Sheep. Goats. Pigs. Total. 1,258 838 1,996 2 173 4,267 The result of these inspections was as follows:— Carcases Inspected and Condemned. Cattle Calves Sheep Goats Pigs Number killed 1258 838 1996 2 173 Number inspected 1258 838 1996 2 173 All Diseases e£cept Tuberculosis. Whole Carcases condemned 3 — — — — Tuberculosis Only. Whole Carcases condemned 47 - - - - All Diseases e£cept Tuberculosis. Total weight in lbs. of Carcases and parts of Carcases condemned 7916 Tuberculosis Only. Total weight in lbs. of Carcases and parts of Carcases condemned 41244 127 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 1946) 5 Cowsheds on register (end of 1946) 5 Average number of cows in sheds (1946) 82 Number of dairies and purveyors of milk on the register (end of 1946) 133 During the year 137 inspections were made of dairies, cowsheds and milkshops. Milk (Special Designations) Order, 1936. The following licences were granted during the year under this Order : — (1) Producers' Licences to use the designation "Tuberculin Tested" 1 (2) Producers' Licences to use the designation "Accredited " 1 (3) Dealers' Licences to use the designation "Tuberculin Tested"— (a) Bottling establishments Nil (b) Shops 10 (4) Dealers' Licences to use the designation "Accredited"— (a) Bottling establishmentsNil (b) Shops .. Nil (5) Dealers' Licences to use the designation "Pasteurised"— (a) Pasteurising establishments 1 (b) Shops 36 128 (6) Dealers' Supplementary Licences to use the designation— (a) Tuberculin Tested 6 (b) Accredited — (c) Pasteurised 6 Inspection of these licensed 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— From licensed producers supplying milk to licensed local dairymen 24 Accredited Milk— . From licensed producer supplying milk to a licensed dairyman23 Pasteurised Milk— Samples from licensed dealers 178 The following tables summarise the result of the bacteriological examinations of Tuberculin Tested, Accredited, and Pasteurised and Heat Treated samples during the year: — Tuberculin Tested Milk. Licences granted tinder the Milk (Special Designations) Order, 1936. Present. Absent. Present in 1/100 Ml Absent. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Satisfied. Not satisfied. Tubercle bacillus - 26 - - - - - - - - - - Bacillus Coli - - - 26 - - - - - - - - Blood - - - - - 26 - - - - - - Pus - - - - - - - 26 - - - - Detritus - - - - - - - - - 26 - - Methylene Blue Test - - - - - - - - - - 24 2 Totals 26 — 26 - 26 — 26 — 26 24 2 129 Accredited Milk. Licences granted under the Milk (special Designations) Order 1936. Present. Absent. Present in 1/100 M.l. Absent. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Satisfied. Not satisfied. Tubercle bacillus — 24 - - - - - - - - - - Bacillus Coli — - 6 18 — — — — - — — — Blood - - - - - - - - - - - - Pus . - - - - - - - 24 - - - - Detritus - - - - - - - - - 24 - - Methylene Blue Test - - - - - - - - - - 19 5 Totals — 24 6 18 — 24 — 24 — 24 19 5 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. Not satisfied. Satisfied. Not satisfied. Satisfied. Tubercle bacillus - 178 - - - - - - - - - - - - Total number of bacteria.. - — 16 162 — - - - - - - - - - Blood - - - - - 178 - - - - - - - - Pus - — - — — — — 178 — — — — — — Detritus — — - — — — — — — 178 — — — — Methylene Blue — — — — — — — — — — 22 156 — — Phosphatase — — — — — _ - — — — — 3 175 Totals — 178 16 162 — 178 — 178 — 178 22 156 ' 3 175 These 178 Pasteurised Milk samples contained bacteria per millilitre as follows: — Under 1,000 4 1,000—5,000 28 5,000—10,000 43 10,000—20,000 43 20,000—30,000 24 30,000—50,000 13 50,000—100,000 7 Over 100,000 16 178 130 Heat Treated Milk. Present. Absent. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. ! Not satisfied. Satisfied. Not satisfied. Satisfied. Tubercle bacillus — 52 - - - - - - - - - - Blood — — — 52 — — — — — — — - Pus — — — — — 52 — — — — — - Detritus — — — — — — — 52 — — — - Methylene Blue Test — — — — — — — — 16 36 — - Phosphatase Test - - - - - - - - - - 3 49 Totals - 52 — 52 — 52 - 52 16 36 3 49 ORDINARY MILK. During the year 113 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 37 Samples taken from local dairymen or milk sellers on their rounds in different parts of the Borough . 40 Samples taken at Farms in the Borough36 113 The following table summarises the results of the bacteriological examination of Ordinary Milk samples, taken from 1st January—31st December, 1946 : — 131 Ordinary Milk. Present. Absent. Over 100,000 per M.l. Under 100,000 per M.l. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Satisfied. Not satisfied. Tubercle bacillus — 113 — - — — — — — — — — Total number of bacteria. — — 18 95 — — — — — — — — Blood — — — — — 113 — — — — — — Pus — — — — — — - 113 — — — — Detritus — — — — — — — — — 113 — — Methylene Blue Test - - - - - - - - - - 86 27 Totals - 113 18 95 — 113 - 113 — 113 80 27 BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM. 104 samples of ice cream were obtained for bacteriological examination, with results as follows : — Bacterial Count. Organisms per ml. No. of Samples. Under 1,000 21 Over 1,000 and under 10,000 29 Over 10,000 and under 50,000 22 Over 50,000 and under 100,000 5 Over 100,000 and under 200,000 2 Over 200,000 and under 500,000 3 Over 500,000 and under 1,000,000 3 Over 1,000,000 19 Total 104 Bacillus Coli. No. of Samples. Absent in 1/ 10th cc. 69 Present in 1 / 10th but absent in 1/100th cc. 7 Present in 1 / 100th but absent in 1/1,000 cc 11 Present in 1/1,000 cc. 17 Total 104 There is no bacteriological standard for ice cream. In those cases, however, where the bacterial count exceeded 100,000 or coli was present in 1/10th of a cc., the suppliers were visited and communicated with and later re-sampled. 132 FOOD AND DRUGS ACT, 1938. During the year 295 samples of milk and 357 other samples were taken. Summary of Samples. During 1946 samples were obtained and submitted to the public Analyst as follows : — Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Apples 1 1 - - - Almond Essence 1 1 - - - Arrowroot 2 2 - - - Aspirin Tablets 5 gr. 4 4 - - - Bacon 4 4 - - - Baked Beans 2 2 - - - Baking Powder 5 5 - - - Batter Flour Mixture 2 1 1 - - Beef and Vegetable Extract 2 1 1 - - Beef Extract 1 1 - - - Beef Galantine 1 1 - - - Beer, Bitter 4 4 - - - Beer, Mild 4 4 - - - Beetroot and Horseradish 1 1 - - - Bicarbonate of Soda 4 4 - - - Bismuth Tablets 1 1 - - - Boiled Sweets 2 2 - - - Boracic Ointment 1 1 - - - Boracic Acid Powder 1 1 - - - Bread 7 7 - - - Brown Ale 1 1 - - - Butter 1 1 - - - Cake Mixture 7 7 - - - Cake Flour 3 3 - - - Cake, Sponge, and Steamed Pudding Powder 2 2 - - - Carrots, Tinned 1 1 - - - Camphorated Oil 1 1 - - - Castor Oil 1 1 - - - Cascara Sagrada Extract 1 1 - - - Celery Salt 1 - 1 - - Cheese 6 6 - - - Cinnamon, Ground 3 3 - - - Cocoa 7 7 - - - Compound Glycerin, Lemon & Ipecacuanha 1 1 - - - Cod Liver Oil 1 1 - - - Coffee 2 2 - - - Coffee and Chicory Essence. 2 2 - - - Coffee and Chicory 2 2 - - - Coffee and Chicory Mixture 2 2 - - - Coffee Extract with Preservative 1 1 - - - Conf. Senna 1 1 - - - Cordial, Blackcurrant 2 2 - - - Cordial, Ginger 2 2 - - - Cordial, Lime Flavour t 1 - - - Corned Beef 2 2 - - - Corned Mutton 1 1 - - - Cornflour 1 1 - - - Cream of Tartar 2 2 - - - Curry Powder 3 3 - - - Custard Powder 3 2 1 - - Dates 2 2 - - - Dessert Mould 1 1 - - - Carried Forward 117 113 4 - - 133 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought Forward 117 113 4 — — Eucalyptus Oil 1 1 — - - Fish Cakes 2 2 — — - Fish Paste 8 8 - - Flavouring Essence 1 1 — — - Flavouring, Banana 1 1 — — - „ Orange 1 1 — — - „ Vanilla 1 1 - — - Flour, Plain 1 1 - — - „ Self-raising 7 5 2 — - Forcemeat 1 1 - — - Friar's Balsam 1 1 - — - Gelatine 7 4 3 — - Gin 3 3 — — - Ginger Ale 1 1 — — - Ginger Beer 2 2 — — - Ginger, Ground 4 4 - — - Glycerin - 1 1 - — - Golden Raising Powder 1 1 - — - Golden Syrup. 1 1 — — - Gravy Powder 6 6 __ — - Jam 5 5 - — - Jelly Crystals 1 1 — — - Junket Powder 2 2 — — - Jelly, Table' 1 1 — — - Lard 1 1 - — - Lemonade 7 7 - - - Lemonade Powder 1 1 - - - Lemon Drops 1 1 — - - Lemon Squash 3 3 - - - Limeade 2 2 - — - Liquid Paraffin 2 2 - — - Live Yeast Tablets 2 2 - — - Macaroni 4 4 - - - Malted Milk 2 2 - - - Margarine, Kosher Vegetarian 1 1 - - - Marmalade 1 1 - - - Meat Galantine 1 1 - - - Meat Paste 4 4 - - - Meat Pies 4 4 - - - Meat and Vegetable Ration 4 4 - — - Medicinal Paraffin 1 1 - — - Milk 295 295 - — - Mustard, Continental 2 2 - — - Mustard, Mixture 2 2 - - - Oatmeal 2 2 - - - Pearl Barley 4 4 - - - Peas, Tinned 2 2 - - - Pepper, Black 3 3 - — - White 1 1 - - - Piccalilli 4 4 - - - Pickles' 2 2 - - - Pickled Cabbage 1 1 - - - Prunes 1 1 - - - Pudding Mixture 1 1 - - - Raising Powder 2 2 - - - Rennet Powder 1 1 - - - Rum 4 4 - - - Sauce 2 2 - - - Sauce, Mint 1 1 - - - „ Worcester 2 2 - - - Carried Forward 550 541 9 - — 134 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought Forward 550 541 9 _ — Sausage, Beef 9 8 1 1 1 „ Breakfast 1 1 — - — „ Liver 3 3 — - — „ Luncheon 4 4 — - — „ Meat 7 6 1 - — „ Pork 1 — 1 1 1 ,, Vegetable 1 1 — - — Saveloys 1 1 — - — Semolina 7 7 — - — Soup, Desiccated 1 1 — - — „ Minestrone 1 1 — - — „ Meat 1 1 — - — „ Mock Turtle 1 1 — - — „ Oxtail 2 2 — - — „ Powder 5 5 — - — „ Vegetable 4 4 — - — Spaghetti 1 1 — - — Spice, Mixed 7 7 — - — ,, Pudding 1 1 — - — Spinach Puree 1 1 — - — Sponge Mixture 1 1 — - — Squash, Lemon 1 1 — - — ,, Orange 3 3 — - — Stewed Beef and Vegetable 1 1 — - — Stewed Steak 4 4 — - — Stuffing 4 3 1 - — Suet, Beef 3 2 1 - — Sugar, Demerara 1 1 — - — Sulphur Tablets 1 1 — - — Sultanas 1 1 — - — Sweets 3 3 — - — Tea 5 5 — - — Toffee 3 2 1 - — Tomato Chutney 1 1 — - — Vegetable Extract 1 1 — - — Vegetable, Mixed 1 1 — - — Veal and Ham Paste 1 1 — - — Vinegar 5 4 1 - — Whisky 3 3 - - - Totals 652 636 16 2 2 135 Result of Analysis of New Milk Samples. Solids Not Fat (Legal standard is 8.5%)* 8.5* 8.6 8.7 8.8 8.9 9.0 9.1 9.3 12.2 4 44 52 102 78 35 8 1 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 5.3 5.4 5.7 7.1 8.7 10.7 2 6 9 32 45 51 54 43 23 16 3 5 1 1 1 1 1 1 Total samples of new milk: 295 The samples of Milk for analysis were obtained as follows:— Taken on Milk Rounds182 " at Dairies 82 " at Institutions 29 " at Schools1 " at Local Farms 1 295 Average composition of New Milk Samples— Solids not fat ... ... ... 8.83% Milk Fat 3.62% It will be seen from the above that there were no samples of milk falling below the legal standard. 136 Adulterated Samples. The following is a detailed statement of the adulterated samples and the action taken : — No. Sample. Adulteration or Deficiency. Remarks. 108. Batter Flour Mixture. Partly decomposed batter mixture containing a large number of dead mites. Only four packets of this article were found to be existing; these were withdrawn from sale and destroyed. 240. Beef and Vegetable Extract. Did not include the . protein of beef, as claimed on the label. Reported to Ministry of Food. On enquiry it was found that the article had been in stock prior to commencement of Order coming into force. 546. Celery Salt Did not comply with the Labelling of Food (No. 2) Order, 1944. Only one other jar found to be existing. This was withdrawn from sale. 351. Custard Powder made from cornflour, wheaten flour, rye flour, colouring and flavouring. Contained salt 0.8 per cent. Not declared in accordance with Labelling of Food (No. 2) Order, 1944. Reported to Ministry of Food. 373. Flour—selfraising. Deficient in .15 per cent. available carbon dioxide. Sampling technique incorrect. 541. Flour—-selfraising. Deficient in .03 per cent, available carbon dioxide. Method of manufacture investigated. F urthcr samples taken proved satisfactory. 432 Gelatine A solution prepared by dissolving 2.5 grams of the sample in 50 ml. of water did not set to a jelly when kept at 60 deg. F. for 16 hours. There being no legal standard, the Ministry of Food were acquainted of these results. 51! Gelatine Failed to set to jelly when prepared as above and kept at 60 deg. F. for 16 hours. Sample contained sulphur dioxide 820 parts per million. 137 No. Sample. Adulteration or Defilienry. Remarks. 521. Powdered Gelatine. Failed to set to a jelly when prepared as above and kept at 60 deg. F. for 16 hours. Sample contained sulphur dioxide 500 parts per million. There being no legal standard, the Ministry of Food were acquainted of these results. 386. Sausage, Beef Deficiency of 10 per cent. meat. Vendor prosecuted and fined £5, plus costs £4 18s. 6d. 507. Sausage, Meat Deficiency of 5 per cent. meat. Vendor communicated with. Subsequent re-sampling showed a genuine result. 371. Sausage, Pork Deficiency of 17 per cent. meat. Vendor prosecuted and fined £5, plus costs £4 18s. 6d. 116. Stuffing Label did not bear a statement specifying ingredients. Vendor communicated with. Article withdrawn from sale and re-issued in properly labelled containers. 451. Suet, Beef Deficiency of 3 per cent. fat. Vendor communicated with. Subsequent samples proved genuine. 398. Toffee (Informal Sample) Contained sulphur dioxide 1400 p.p.m. Unable to obtain formal sample as article was withdrawn from sale. Manufacturers communicated with. Subsequent samples proved genuine. 544. Malt Vinegar Added salt 0.9 per cent. Apparently the Ministry of Food acquiesce in the addition of salt. 138 County Borough of Croydon ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER For the Year ending December 31st, 1946. Ladies and Gentlemen, I have pleasure in presenting for your consideration my report as School Medical Officer. This is the nineteenth annual report I have had the honour to present to you, and the fortyseventh of the yearly series dealing with the School Medical work of the Borough. 139 Cost of the School Health Service. The gross cost of the medical, dental and nursing services was £21,363. The rateable value of the Borough as at 1st April, 1946, was £2,503,826. The Government grant is 49.727 per cent. of the expenditure, hence the actual cost to the rates was £10,740, i.e., a rate of 1.13 pence. Cost of Special Schools. Schools maintained by the Council, £9,032; contributions to schools under other authorities, £3,111; income from parents' contributions and other receipts, £136, giving an actual cost of £12,007, of which £6,036 was payable out of local rates, i.e., a rate of .63 pence. Cost of Milk and Meals. Meals and milk cost £58,491, 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 1393 1269 91 Girls 8 1619 1451 90 Mixed 6 1213 1079 89 21 4225 3799 90 Voluntary Girls 1 119 108 90 140 Schools No. of Departments Number on the' Registers Average attendance Average attendance per cent PRIMARY SCHOOLS Council Senior and Junior Boys 1 321 299 93 Senior and Junior Girls 1 300 261 87 Senior and Junior Mixed 2 808 750 93 Junior Boys 7 2027 1858 91 Junior Girls 5 1333 1218 91 Junior Girls and Infants 3 1291 1127 87 Junior Mixed and Infants 11 4529 4028 88 Infants 14 3128 2647 84 44 13737 12188 89 Voluntary Senior and Junior Boys 1 191 172 90 Senior Mixed and Infants 3 808 745 92 Junior Girls and Infants 3 548 474 86 Junior Mixed and Infants 3 607 537 88 Senior and Junior Mixed 1 316 269 85 Infants 2 161 135 84 SPECIAL SCHOOLS Council 13 2631 2332 87 Mixed 3 270 230 85 GRAMMAR AND TECHNICAL SCHOOLS Boys (Technical) 2 395 371 93 Boys (Grammar) 2 924 880 95 Girls (Grammar) 1 576 533 92 Boys (Central) 1 220 217 99 Girls (Central) 1 360 342 95 Mixed (Heath Clark) 1 336 326 97 Girls (Coloma) 1 522 487 93 9 3333 3156 95 Medical Inspection in Schools. A total of 7,077 children were examined as compared with 7,814 in 1945, and 4,628 parents attended the examinations. The percentage attendance of parents in the Entrants' group was for boys 83.4 per cent.; and girls 83.6 per cent.; in the Intermediate group, boys 60.7 per cent., girls 70.6 per cent.; and in the Leavers' group, boys 28.1 per cent., girls 43.7 per cent. The total percentage of parents attending was 65.4 as against 64.8 last year. 1,256 specials and re-inspections were made. 141 parents present, 1946 Entrants Intermediate Leavers Other Ages TOTAL Number Exmnd. Parents Present Number Exrnnd. 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. All Saints' 26 25 19 22 ... ... ... ... 2 8 1 1 ... ... ... ... 28 33 A.Tenison' ... ... ... ... ... ... ... ... 25 7 ... 7 ...... ... ... ... 25 7 Ashburton 12 20 10 20 4 7 4 7 53 26 26 6 ...... ... ...... ... 69 53 Benson 67 66 55 59 20 17 13 15 10 11 6 5 ... ... ... ... 97 94 Beulah 31 53 26 45 ... ... ... ... 6 ... 5 ... ... ... ... ... 37 53 Christ Church 32 18 25 18 ... ... ... ... ... ... ... ... ... ... ... ... 32 18 Coloma ... ... ... ... ... ... ... ... ... 63 ... 14 ... ... ... ... ... 63 Croydon British ... ... ... ... ... ... ... ... ... 26 ... 16 ... ... ... ... ... 26 Cypress 48 34 40 31 101 60 74 45 ... ... ... ... ... ... ... ... 149 94 Davidson 65 64 43 45 ... ... ... ... 25 32 6 11 ... ... ... ... 90 96 Duppas 101 73 72 47 15 3 11 1 17 ... 12 ... ... ... ... ... 133 76 Ecclesbourne 46 43 38 33 ... ... ... ... ... 50 ... 24 ... ... ... ... 46 93 Elmwood 86 87 77 77 ... 48 ... 33 54 70 20 45 ... ... ... ... 140 205 Gonville 30 35 27 33 ... 6 ... 4 ... ... ... ... ... ... ... ... 30 41 Heath Clark ... ... ... ... ... ... ... ... 22 18 3 11 ... ... ... ... 22 18 Howard 38 29 30 20 22 33 6 11 ... ... ... ... ... ... ... ... 60 62 Ingrain 44 56 40 46 ... ... ... ... 26 14 5 12 ... ... ... ... 70 70 John Ruskin ... ... ... ... ... ... ... ... 22 ... 1 ... ... ... ... ... 22 ... Kensington 63 41 59 39 6 4 8 4 ... ... ... ... ... ... ... ... 69 45 Kingsley 49 45 40 43 46 35 24 24 ... ... ... ... ... ... ... ... 95 80 Lady Edridge ... ... ... ... ... ... ... ... ... 220 ... 79 ... ... ... ... ... 220 Lanfranc ... ... ... ... ... ... ... ... 145 131 35 76 ... ... ... ... 145 131 Monks Orchard 38 34 23 34 43 26 36 19 ... ... ... ... ... ... ... ... 71 60 New Addington 76 84 72 78 28 15 17 13 24 4 14 4 ... ... ... ... 128 103 Norbury Manor 28 31 26 29 11 11 10 9 70 81 5 40 ... ... ... ... 109 123 Oval 101 113 84 99 ... ... ... ... 44 28 21 16 ... ... ... ... 145 141 Parish Church 50 70 44 60 ... ... ... ... 25 ... 15 ... ... ... ... ... 75 70 Polytechnic ... ... ... ... ... ... ... ... 42 18 ... ... ... ... ... ... 42 18 Portland 46 50 44 47 ... ... ... ... 47 66 17 34 ... ... ... ... 93 116 Purley Oaks 29 24 20 17 10 9 ... ... 23 10 3 9 ... ... ... ... 62 43 Rockmount 77 59 73 55 40 28 19 20 26 23 8 12 ... ... ... ... 143 110 St.Andrew's 52 44 44 37 ... ... ... ... 20 27 11 13 ... ... ... ... 72 71 St. Joseph's 48 34 22 8 12 6 6 2 2 ... ... ... 8 20 1 13 70 60 St Luke's ... ... ... ... ... ... ... ... ... ... ... ... 21 19 6 9 21 19 St. Mark's 36 47 34 49 ... 9 ... ... ... ... ... ... ... ... ... ... 36 56 St. Mary's R.C. 33 39 25 31 1 ... 1 ... ... 6 ... 1 ... ... ... ... 34 45 St. Peter's 10 11 9 9 ... 10 ... ... ... ... ... ... ... ... ... ... 10 11 St. Saviour's 16 21 11 8 7 6 6 ... ... ... ... ... ... ... ... 23 31 School of Art ... ... ... ... ... ... ... ... 17 38 1 5 ... ... ... ... 17 38 Sch. of Building ... ... ... ... ... ... ... ... 110 ... 16 ... ... ... ... ... 110 ... Selhurst Gram. ... ... ... ... ... ... ... ... 45 174 15 64 ... 66 ... 45 45 240 Shirley 18 5 17 5 ... ... ... ... ... ... ... ... ... ... ... ... 18 5 South Norwood 94 107 82 83 20 51 6 36 ... ... ... ... ... ... ... ... 114 158 Sydenham 32 37 21 27 48 75 22 62 ... ... ... ... ... ... ... ... 80 112 Tavistock 29 31 27 30 ... ... ... ... 72 13 22 6 ... ... ... ... 111 44 Waddon 38 42 33 40 ... ... ... ... 64 59 19 24 ... ... ... ... 102 101 West Thornton 54 58 45 45 9 10 13 10 ... ... ... ... ... ... ... ... 73 68 Whitehorse Manr. 74 66 61 47 ... ... ... ... 35 ... 15 ... ... ... ... ... 109 66 Winterbourne 71 93 64 80 ... 11 ... 11 ... ... ... ... ... ... ... ... 71 104 Woodside 61 55 60 51 2 25 ... 20 ... ... ... ... ... ... ... ... 63 80 1849 1844 1542 1547 455 499 276 352 1073 1223 302 535 29 105 7 67 3406 3671 3693 3089 954 628 2296 837 134 74 7077 PERCENTAGE OF PARENTS PRESENT AT MEDICAL EXAMINATIONS Entrants Boys 83.4 83.6 65.4 „ Girls 83.6 Intermediate Boys 60.7 65.8 „ Girls 70.6 Leavers Boys 28.1 36.5 „ Girls 43.7 Other Ages Boys 24.1 55.2 „ Girls 63.8 142 Uncleanliness. Number of children inspected for Cleanliness (first inspection) 55,174 Number of children inspected (subsequent inspections) 3,606 Number of children found unclean (first inspection) 1,294 (2,256 occasions of infestation). Number of occasions in which children found unclean (subsequent inspections) 1,260 At the primary inspections vermin were found in 176 and nits alone in 2,079 children. On these inspections, 4.1 per cent. of the children showed evidence of infestation as against 4.4 in 1945. Tuberculosis in Children of School Age. Contacts among school children kept under supervision during 1946— Number of cases under observation at beginning of 1946 390 Number of cases added during year 6 Number of cases discharged from observation during the year 5 Number of cases under observation at the end of 1946 391 Taking the total school population as 29,360, the pulmonary tuberculosis incidence rate was 37.5 per 100,000. There were two deaths from pulmonary tuberculosis. There were no deaths from non-pulmonary tuberculosis, while the incidence rate was 37.5. CAUSES OF DEATH IN CHILDREN OF SCHOOL AGE. School population 29,360. Number of deaths 16, which is equal to a death-rate of 0.5 per 1,000. The deaths were due to: Tuberculosis 2 Diphtheria 1 Acute Encephalitis 1 143 Rheumatic Fever 1 Intra-thoracic Sarcoma 1 Bronchiectasis 1 Cerebral Tumour 1 Tumour of Kidney 1 Yellow Atrophy of Liver 1 Subarachnoid Haemorrhage 1 Acute Dilatation of Heart 1 Post-Operative Haemorrhage (Tonsils and Adenoids) 1 Fall from Tree 1 Road Traffic Accidents 2 VISION. Extent of Defect. Intermediate. Leavers. Total. Boys. Girls. Boys. Girls. Boys. Girls. No. % No. % No. % No. % % % Normal: 6/6ths or 6/9 ths R 431 94.7 402 92.6 1027 95.7 1150 94.0 95.4 93.6 L 429 94.3 460 92.2 1019 95.0 1150 94.0 94.8 93.5 6/12ths or 6/24ths R 23 5.1 32 6.4 39 3.6 62 5.1 4.1 5.5 L 21 4.6 33 6.6 45 4.2 57 4.7 4.3 5.2 6/36ths or worse R 1 0.2 5 1.0 7 0.7 11 0.9 0.5 0.9 L 5 1.1 6 1.2 9 0.8 16 1.3 0.9 1.3 TEETH. Entrants. Intermediate. Leavers. Boys. Girls. Boys. Girls. Boys. Girls. No. % No. % No. % No. % No. % No. % Perfect set of Teeth 1663 90.0 1632 88.5 413 90.8 458 91.8 1002 93.4 1157 94.6 One to four Decayed 130 7.0 136 7.4 29 6.4 34 6.8 59 5.5 48 3.9 Four or more Decayed 56 3.0 76 4.1 13 2.8 7 1.4 12 1.1 18 1.5 Totals 1849 1844 455 499 1073 1223 111 HEIGHTS AND WEIGHTS. 194 6. 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. 1941 720 43.2 43.4 45.9 49.9 40.8 37.3 650 42.8 42.0 45.5 49.0 40.4 36.4 1940 638 44.3 45.5 47.1 52.8 41.4 39.1 669 44.1 44.2 46.9 51.4 41.2 38.3 1939 301 46.2 50.2 48.9 57.5 42.7 42.5 341 46.4 48.9 48.8 57.2 43.4 42.4 1938 115 48.7 54.4 51.2 63.3 45.7 47.5 141 48.5 51.8 51.3 58.1 46.0 47.1 1937 110 51.3 61.6 54.4 72.6 48.8 54.2 161 50.8 58.4 54 5 69.2 46.7 48.6 1936 86 53.1 65.6 55.8 85.4 49.3 56.0 142 53.2 65.9 57.0 80.9 49.9 55.5 1935 213 55.4 74.7 59.2 89.3 52.0 61.6 303 56.2 75.6 59.4 96.1 52.4 60.3 1934 138 56.5 78.6 59.6 94.9 53.0 64.4 315 57.6 81.4 62.8 104.6 53.1 65.6 1933 471 58.2 86.1 64.1 116.0 53.0 65.9 377 59.2 88.8 63.6 118.1 54.8 68.0 1932 285 60.8 95.3 67.2 125.5 55.2 75.5 332 60.9 98.4 65.2 122.2 56.7 76.3 1931 68 65.0 116.0 70.0 151.2 60.0 83.3 180 63.8 114.3 67.2 138.8 59.9 90.2 1930 107 67.1 125.7 72 6 147.9 62.3 95.0 145 64.2 118.9 67.7 152.5 60.1 96.0 1929 39 67.5 126.7 71.3 153.1 64.7 111.1 61 64.0 121.7 67.5 144.1 61.1 101.1 1928 7 68.9 139.8 74.0 169.0 66.5 121.0 19 64.2 121 .3 67.8 150.0 61 .7 104.5 115 RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 1946. Defects. Boys. Girls. No. requiring Treatment. No. referred for Observation. Percentage of total Examined. No. requiring Treatment. No. referred foi Observation. Percentage of total Examined. Ma lnutrition 364 11 11.01 403 4 11.09 Uncleanliness— Head 1 — 0.03 5 — 0.14 Body Skin Disease 18 — 0.53 16 3 0.52 Eye Disease— Defective Vision 130 10 4.11 186 7 5.26 Squint 70 9 2.32 90 18 2 94 External Eye Trouble 7 1 0.23 20 0.55 Ear Disease— Deafness 9 3 0.35 6 0.17 Otitis Media 2 2 0.12 1 0.03 Other Disease 3 2 0.15 2 0.05 Nose and Throat— Enlarged Tonsils only 72 79 4.43 65 102 4.55 Adenoids only 11 18 0.85 14 18 0.87 Enlarged Tonsils and Adenoids 240 89 9.46 213 110 8.80 Other Conditions 110 32 4.17 99 17 3.16 Enlarged CervicalGlands(notT.B.) 3 12 0.44 5 7 0.33 Dental Defects 57 2 1.73 59 3 1.69 Speech Defects 22 3 0.73 18 2 0.55 Heart and Circulation— Organic 6 7 0.38 8 21 0.79 Functional 4 19 0.68 10 21 0.84 Anaemia 9 0.73 42 18 1.63 Bronchitis 18 3 0.62 19 2 0.57 Other Non-T.B 13 10 0.68 5 9 0.38 Pulmonary Tuberculosis 9 3 0.35 9 9 0.49 Other Tuberculosis 1 2 0.09 — 3 0.08 Nervous System Disorders (including Epilepsy, chorea, etc.) 5 28 0.68 12 47 1.61 Deformities— Rickets 2 1 0.09 2 0.05 Spinal Curvature 45 3 1.41 82 4 2.34 Others 119 23 4.17 173 16 5.15 Other Defects and Diseases 25 26 1.50 39 11 1.36 Totals 1382 407 1603 452 Total Children Examined 3406 3671 146 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS, 1946 (Percentages.) Condition. Entrants. Intermediates. Leavers. Other Ages. All Groups. Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Cleanliness : (Percentage Clean) Head 99.9 99.4 100.0 98.2 99.8 99.7 100.0 100.0 99.9 99.3 Body 100.0 99.9 100.0 100.0 99.8 100.0 100.0 100.0 99.9 100.0 Clothing (satisfactory) 99.8 99.9 100.0 100.0 97.8 99.1 100.0 100.0 99.2 99.6 Footgear (satisfactory) 99.8 99.9 100.0 100.0 97.9 98.9 100.0 100.0 99.2 99.6 Nutrition (Normal) 89.7, 88.9 86.6 86.2 89.3 90.5 86.2 86.7 89.3 89.0 Detects : Circulatory System 5.3 7.6 4.0 6.2 5.5 9.5 — 7.6 5.1 8.0 Pulmonary System 3.8 2.8 1.8 2.0 2.0 1.4 — 1.9 2.7 2.2 Skin Diseases 1.4 1.7 1.5 1.0 1.6 3.8 — 1.0 1.4 2.3 Defects of Nose and Throat 35.0 32.9 21.8 19.0 14.0 13.3 17.2 8.6 26.5 23.8 Enlarged Cervical Glands 10.1 11.3 9.2 7.0 6.7 3.4 — 1.0 8.8 7.8 External Eye Disease 4.0 5.7 2.0 2.0 2.2 2.3 — 6.7 3.1 4.1 Defective Vision 1.1 1.3 9.2 10.4 7.3 9.2 •— 3.8 4.1 5.3 Defective Hearing 0.5 0.2 0.2 0.6 0.4 0.2 — — 0.4 0.2 Speech Defects 1.6 0.9 0.9 0.8 0.3 0.6 — — 1.1 0.8 Dental Disease (more than four decayed) 3.0 4.1 2.9 1.4 1.1 1.5 3.4 1.9 2.4 2.8 Dull and Backward 0.4 0.4 - 0.4 0.1 - 3.4 1.0 0.3 0.3 Taking all the groups examined, subnormal nutrition was recorded in 10.8 per cent of the children as contrasted with 11.5 per cent. in 1945. CHIEF CAUSES OF EXCLUSIONS FROM SCHOOL. Condition. Exclusions during 1946. Percentage of total exclusions. Exclusions during 1945. Percentage of total exclusions. Ringworm 33 1.20 24 0.90 Verminous Conditions 610 22.13 605 22.75 Impetigo 186 6.71 106 3.99 Scabies 258 9.36 263 9.89 Scarlet Fever 257 9.32 209 7.86 Measles (inc. German) 372 13.49 697 26.21 Diphtheria 20 0.73 19 0.71 Whooping Cough 208 7.54 155 5.83 Chicken Pox 441 16.00 196 7.37 Mumps 227 8.23 237 8.91 External Eye Disease 39 1.41 24 0.90 Sore Throat 18 0.65 12 0.45 Other Causes 88 3.19 112 4.21 Total 2757 — 2659 - The figures for exclusions are not related in any way to the figures obtained in routine medical inspections. These figures show an increase in Whooping Cough. Chicken Pox, Impetigo, Ringworm, Scarlet Fever and Conjunctivitis, whilst Measles, Mumps and Scabies showed a decrease. 147 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. Cerebro-spin Meni itis. Poliomyelitis. Jaundice. Conjunctivitis. Sore Throat. Indefinite Sickness. III, Not ntectious Percentage incidence of conditions notified in Schools Ashburton 762 28 15 2 10 6 5 3 9 1 1 3 10.9 Benson 594 12 7 2 1 2 4 2 5.1 Beulah 1022 23 20 6 2 13 24 3 2 13 3 3 10.9 Croydon British 151 1 1 3 3 5.3 Cypress 378 15 1 2 3 4 5 2 8.5 Davidson 674 7 1 1 49 7 10 3 1 2 1 1 1 1 12.6 Duppas 442 1 3 4 2 19 3 6 1 1 3 9.7 Ecclesbourne 660 27 1 3 14 2 1 3 1 1 8.0 Elnwood 974 1 13 2 3 5 6 11 3 7 5.2 Conville 394 1 5 36 10 1 10 2 2 17.0 Howard 335 3 5 2 1 2 4 5.1 gram 447 18 4 33 1 6 4 1 1 4 2 16.6 Kensington 387 10 4 7 3 3 7.0 Kingsley 665 3 1 45 1 8 7 1 1 3 3 2 11.3 Lanfranc 627 2 1 1 8 5 2 2 2 2 1 4.8 Monks Orchard 350 31 2 7 3 1 2 13.2 New Addington 746 1 2 1 2 3 1.2 Narbury Manor 974 16 30 2 2 15 6 1 6 3 2 8.5 Oval 707 2 4 75 3 9 6 3 2 13 1 1 2 1 17.3 Portland 643 4 3 6 10 5 2 6 1 1 1 6.1 Purley Oaks 639 22 8 76 70 5 4 2 1 2 29.7 Rockmount 496 40 5 10 2 3 3 9 1 2 2 15.7 South Norwood 872 2 1 9 19 6 16 8 19 9.2 Sydenham 612 4 1 1 3 9 3 4 1 1 4.4 Tavistock 527 2 1 2 8 2 2 1 2 1 1 4.2 addon 739 12 8 2 19 11 2 3 1 15 5 9 11.8 W. Thornton 674 27 1 16 3 12 12 2 7 1 2 12.3 Whitehorse 708 4 9 10 8 3 1 6 1 1 6.1 Winterbourne 836 45 12 32 1 1 10 5 1 12.7 Woodside 789 5 5 13 4 6 2 2 10 2 2 6.4 Lady Edridge 359 1 1 2 1.2 Heath Clark 332 1 1 1 1 1.2 Arch. Ten.(Bys) 220 1 1 1 1.4 Adn. St, Mary's 136 9 2 4 2 6 1 17.6 All Saints 156 5 2 2 1 2 1 8.3 Arch. Ten. (Gls) 119 1 1 1 3 5.0 Christ Church 293 2 4 3 5 3 1 7 1 1 3 10.2 Parish Church 453 2 25 1 12 2 7 1 3 2 12.1 St.Andrews 409 1 1 9 3 1 4 1 4.9 St. Josephs 241 1 0.4 St. Marks 148 1 2 4 1 5.4 St. Marys (R.C.) 406 5 1 3 2 1 1 7 1 1 5.4 St. Peters 74 2 1 1 6 9 1 4 1 33.9 St. Saviours 131 1 1 1 1 3.1 Shirley 181 1 4 4 10.6 St. Christophers 142 1 7 2 2 2 1 10.6 St. Giles 100 1 1 2 2 1 4 11.0 St. Lukes 26 1 2 11.5 Coloma 522 15 2.9 Selhurst Gram. 1169 1 3 0.4 John Ruskin 329 1 6 1 2.7 School of Bldg 155 1 1 1.3 Totals 357 15 208 441 227 258 182 33 20 257 5 13 39 18 68 2 372 1945 683 14 155 196 237 263 106 84 19 209 9 2 1 9 24 12 81 6 697 148 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 619 Visits re Scabies 6 Visits re Infectious Disease 109 Visits re Medical Inspections 389 All other reasons 488 Home Visits. Concerning defects found at routine medical inspections 1,086 Subsequent visits re defects found at routine medical inspections 318 Visits re special cases 917 Visits to dental cases 25 Visits following other inspections 2,074 Visits in connection with infectious cases (including 343 visits concerning uncleanliness) 5,204 TREATMENT. The Work of the School Clinics. SUMMARY OF ATTENDANCES. 1946. 1945. Increase or Decrease. Minor Ailments Clinic 13477 12444 + 1033 Inspection Clinic 2437 1939 + 498 Dental Clinics 20128 16017 + 4111 Ophthalmic Clinic 5855 3364 + 2491 Orthopaedic Clinic 486 599 — 113 Remedial Exercises Clinic 8160 7995 + 165 Nose and Throat Clinic 2361 2239 + 122 Rheumatism Clinic 280 62 + 218 53184 44659 + 8525 149 The Minor Ailments Clinics. At the Lodge Road Clinic, 1,244 defects involved 4,378 attendances, while at the subsidiary Clinics held at 206, Selhurst Road on five days weekly, 1,053 defects, 4,025 attendances, and at the Duppas School 549 defects, 5,074 attendances. 1946. 1945 Complaint. Cases. Attendances. Average No. of Attendances, per case. Cases. Attendances. Average No. of Attendances, per case. Ringworm 33 190 5.8 127 1225 9.7 Scabies 191 614 3.2 301 841 2.8 Impetigo 239 1331 5.6 231 1280 5.5 Other Skin Diseases 148 325 2.2 201 665 3.3 Otorrhoea and other Ear defects 245 1594 6.5 158 833 5.3 External Eye Disease 262 852 3.2 324 1435 4.4 Miscellaneous 1728 8571 4.7 1263 6165 4.9 2846 13477 4.7 2605 12444 4.8 Adenoids and Enlarged Tonsils. During 1946 711 children were operated upon for adenoids and enlarged tonsils, and 2,361 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 1583 - 1583 1245 — 1334 — This Clinic showed an increase upon 1945 in numbers submitted to refraction. A total of 5,855 attendances was recorded. 150 SCHOOL DENTAL SERVICE. This Service deals chiefly with the inspection and treatment of children attending Borough Primary, Secondary, Technical, and Special Schools. "Free-place" scholars at certain non-maintained schools, approved by the local Education Authority are also eligible for treatment. In addition to the above, facilities are provided for patients referred under Maternity and Child Welfare, Tuberculosis, and Mental Deficiency Schemes. Present staff-consists of six full-time Dental Officers. The appointment of a further officer has recently been sanctioned, and this vacancy will be filled as soon as dental surgery accommodation permits. Arrangements for Treatment. Treatment is carried out at six surgeries. Three of these are at the Lodge Road Health Centre and work as a centralised unit. A fourth surgery has recently been introduced, but this is of a temporary nature until the proposed extension to the above premises is completed. The two remaining clinics at Duppas Hill and South Norwood have now seen many years of servcie, but facilities are extremely limited and more adequate accommodation is urgently needed to bring them into line with present day requirements. Plans are now in hand for the establishment of a clinic in the Woodside area, and it is hoped that the latter should be in operation early in 1947. A clinic has also been planned for the Addington Estate as soon as circumstances permit. In addition to the above activities, a further programme of development made necessary by future Education commitments, has been put forward and will be discussed later in this report. Staffing. In view of the fact that one dental officer's time is devoted exclusively to the Maternity and Child Welfare Scheme, only five dentists are. available for the care of the school population. With the inclusion of Grammar and Secondary Schools, the total of the above has now been raised to 25,600 children, i.e., 5,120 per dental officer. Progressive increases in the acceptance rate (now approximately 70 per cent.), plus the introduction of specialised treatment such as orthodontic work, has now rendered obsolete the previous establishment figure of 5,000 children per clinic. On the basis 151 of 3,500 per clinic now advocated, a substantial increase in staff is necessary to carry out the requisite annual inspection and treatment. Moreover, impending developments in connection with the Education Act, such as the raising of the school leaving age and the provision for those attending County Colleges, will in time very greatly increase the number of those requiring to be dealt with, and recent estimates have assessed possible liabilities as being in the region of 40,000 children. To meet this situation, comprehensive plans have been submitted for a further expansion of the service extending over a number of years. These measures have now received the general approval of the Council. The ensuing Table of Analysis illustrates the calculated year to year increase in the school population, together with the requisite increase of staff required. PRESENT AND FUTURE COMMITMENTS. Year. Estimated Increase in School Population. Total. Probable Increase in Dental Officers Required. 1946 Present Population 25,680 1 (Woodside) 1947 Plus 14-15 age group, 1,855 27,575 1 (Addington) 1948-9 Plus 15-16 age group, 1,855 — (Lodge (Rd. 2 District Centre) Plus Housing Estate 5,260 34,690 1950 and onwards Plus County Colleges, 7,000 — Plus Nursery Schools, 800 42,490 1-2 Total 5-6 Inspections. The number of children on the register at Primary and Secondary Schools within the Borough at the close of 1946 was 25,128. Including an additional 552 free-place scholars at nonmaintained schools this represents a sum total of 25,680 children. Of these, 22,022 were inspected and 12,046 (54.7 per cent.) referred for treatment, compared with 15,735 inspected and 9,695 (61.6 per cent.) referred in 1945. The above decline of 6.9 per cent. in the number requiring treatment represents a substantial achievement in dealing with war-time arrears, and when compared with the figure of 76 per cent. requiring treatment in 1937, illustrates only too clearly the beneficial effect of more frequent inspection and treatment. 152 Added to the above, ante-natal care for mothers and improved nutrition and hygiene for infants, are already beginning to play their part in lessening the incidence of caries so prevalent in former years. As mentioned in the Maternity and Child Welfare Report, recent investigations have disclosed a noticeable improvement in calcification in the mouths of those entering school. Should, as it is hoped, this become manifest in the older age groups, even more far reaching results may accrue. Owing to lack of time seven departments, comprising approximately 1,400 children, received no routine inspection during the year. The figures obtained from school inspections were as follows:— Acceptance of Treatment 70.% Refused Treatment 12.8% Forms Not Returned 17.2% Allowing for minor variations in the last two categories, these results will be seen to be almost identical with those of 1945. The following analysis demonstrates the gradual rise in the acceptance rate during recent years:— RESULTS OF SCHOOL INSPECTIONS. 1946. 1945. 1944. 1943. 1937. No. referred for— Treatment 12046 9695 8047 9041 13498 Consents 8433:70% 6789:70.0% 5335:66.3% 5642:62.4% 7762:57.5:, (Total Consents Including Specials)* (13810:74%) (8363: 74.%) (6320:70%) (6814:67%) (10146:63%) Refusals 1542:12.8% 1301:13.4% 1314:16.3 % 1519:16.8% 3242 : 24% Forms Not Returned 2071:17.2% 1605:16.6% 1398:17.4 % 1880:20.8% 2494:18.5% * Specials.—Those referred by Head Teachers with Emergency Forms Whilst no apparent increase is shown in the acceptance rate for the current year, it should be remembered that results have been obscured by the introduction for the first time of a substantial proportion of children at secondary schools. As was expected, the response from these schools was not as great as in the case of those Departments which had been within the scheme for a longer duration. Another factor is that many ot the above children have in the past been in receipt of regular treatment from private practitioners, and these will in all probability for the present continue to attend the dentist of their choice. 153 Reasons for Refusal of Treatment. Apart from those receiving bone-fide private treatment, the main reasons for non-acceptance of treatment would appear to be as follows:— (i) Indifference of Parent. These represent a comparatively small minority. Any efforts to assist are as a rule resisted—even medical examination is disliked. Except in the case of relief of pain, very little can be accomplished. (ii) Difficult Home Circumstances. The above represent quite a substantial proportion of the total. The child is often found to be living with an elderly relative, owing to the fact that the parents are either "separated" or both at work. These children are sometimes brought to the Clinic by a friend or elder child for relief of pain. Such patients are usually quite amenable, though it is difficult to enforce regular treatment. (iii) Lack of appreciation on the part of Parents as to the value of early treatment. The latter is more commonly manifest with reference to the temporary dentition. After "refusing" at the time of the school inspection, the child is later brought to the Clinic when in pain, requesting "extractions" but "no fillings." After a suitable explanation many parents show a favourable reaction and accept the requisite treatment. (iv) Fear of the Dentist's Chair. Patients in this category are by far the most difficult to deal with, as their condition is largely psychological and they will often endure prolonged agony rather than present themselves for treatment. In such cases contact can sometimes be made through successful treatment for a friend, or a chance meeting with the parent. Once confidence has been established the sufferer may attend of his own volition and becomes amenable to treatment. Should parental control be entirely lacking very little success can be expected with these cases. The foregoing remarks are intended to illustrate some of the difficulties encountered in dealing with "recalcitrant" cases. In View of the social issues involved progress in winning over such children is bound to be slow, and therefore no large scale improvement can be hoped for in the immediate future. 164 Treatment. Of 10,197 children consenting to treatment (including specials) 9,043 (88.6 per cent.) were treated and 8,297 (81.3 per cent.) cured (completely), compared with 8,363 consenting-, 6,706 (83.4 per cent.) treated, and 5,885 (70.3 per cent.) cured in 1945. The above results not only indicate an appreciable rise in the percentage treated, but also that a larger proportion than usual had all necessary work carried out. The release from the Forces of a member of the staff, plus a decline in the lime lost through sickness, has contributed very materially to wiping off wartime arrears of work. For the first time almost all primary schools were inspected within the year, in addition to the introduction into the scheme of three Grammar Schools. The remaining Secondary and Technical Schools did not, however, receive any attention. Clinical sessions rose from 1,616 to 1,934, whilst output shows a corresponding increase. To provide ' for the large number of irregularities requiring to be dealt with, it was found necessary to devote additional sessions to this work. Attendances during the year rose from 9.9 to 10.3 patients per session. The introduction of Penicillin in the form of "cones" has been found most efficacious in dealing with chronic infection in tooth sockets, and in relief of pain following upon extraction of difficult or "impacted" teeth. This preparation is reasonably stable and can thus be kept at hand ready for use. items of Treatment. The ensuing Table gives particulars of the principal items of treatment compared with those obtained last year:— 1946. 1945. Attendances 20,128 16,017 Treated 9,043 6,706 Re-treated 4,680 3,161 Fillings—Permanent 6,729 5,674 Temporary 2,366 2,838 Extractions—Permanent 1,702 1,491 Temporary 10,507 8,473 Gas Administration 3,695 3,133 Local Anassthetics 3,508 3,275 Other Operations—Permanent 7.533 6,117 ,, ,, Temporary 3,187 2,444 Cases Completed 8,297 5,885 155 Special Treatment. These include:— 1946. 1945. Root treatment in anterior teeth 38 35 Removal of nerves under local anaesthetic 17 13 Gingivectomy 3 1 Removal of bone sequestra 10 — Splints for fractured incisors 1 1 Number of M.D.s treated 7 14 Dentures inserted 35 23 Irrigation of sockets 45 81 Treatment of hæmorrhage — 7 Removal of impacted and difficult teeth 20 4 Operation to labial frænum — — Ulcerative stomatitis (Vincents infection) 15 13 Cleft Palate 1 — Application of Penicillin "Cones" 50 — Forms from Head Teachers. The number of forms issued by Head Teachers for emergency treatment was 1,764, compared with 1,574 in 1945. Black lists of those not accepting treatment at inspections continue to be supplied to Teachers in Charge, together with instructions that unless adequate reason be given, such children shall be precluded from obtaining "special" forms, should toothache subsequently intervene. X-Ray Examinations. The number of cases referred to Mayday Hospital for the above purpose was 158, compared with 162 in 1945. Orthodontic Treatment. In spite of the large amount of corrective work undertaken during recent years the incidence of irregularities continues to be high, and it is clear that more substantial measures will be necessary if future commitments are to be met. Despite present limitations a wide range of defects are being successfully dealt with. Certain more complicated deformities, needing expert opinion, are referred to one or other of the major teaching hospitals. In conformity with the provisions of the Education Act, all such treatment, including any necessary appliances, is supplied free of cost to patients. 156 As this work expands the Committee will have to consider at some future date the appointment of a Specialist Orthodontic Surgeon who, in the first instance, could be employed on a parttime basis. Treatment sessions devoted to the work were 260 against 215 last year. The following is a summary of treatment performed:— 1946. 1945. Cases under Treatment 361 254 New Cases 186 160 Cases Completed 98 58 Attendances 2,985 2,369 Appliances—Fixed 6 4 Removable 272 240 Treatment Sessions 260 215 Treatment of " Free-Place " Scholars. As previously stated, all children at Borough Secondary and Technical Schools have now been included within the routine scheme of treatment. However, those previously attending Primary Schools who enter certain non-maintained schools as "free-place" scholars continue to be eligible for attendance at the School Dental Clinic. A summary of the treatment performed for the above children is given below:— Attendances 358 New Cases Treated 101 Re-treated 66 Fillings—Permanent 176 Extractions—Permanent 51 Temporary 56 Other Operations 84 "Gas" Cases 37 Local Anaesthesia 27 Cases Completed 92 Root Fillings 4 Dentures Fitted 2 Referred X-Ray 5 157 Summary of Work Done at the Selhurst Road Clinic. 1946.  Attendances 4,258 3,846 Extractions 1,958 2,022 Fillings 1,425 1,612 Other Operations 3,570 2,819 "Gas" Cases 642 648 Local Anaesthesia 199 237 Cases Completed 1,519 1,156 Sessions held : Inspection 28, Treatment 382, Gas 42. The average attendance at this Clinic per session is 11. Summary of Work Done at the Waldrons Clinic. 1946. 1945. Attendances 2,764 2,583 Extractions 1,587 1,381 Fillings 2,025 2,335 Other Operations 342 442 "Gas" Cases 477 420 Local Anaesthesia 2,445 2,464 Cases Completed 1,107 1,019 Sessions held : Inspection 32, Treatment 326, Gas 36. The average attendance at this Clinic per session is 8.4. DENTAL DEFECTS. (1) Number of children who were— (a) Inspected by Dental Officer: Year 1946. Year 1945. Aged 5—6 1,200 Total: 22,022 779 „ 6-7 2,275 1,875 „ 7-8 2,672 1,803 „ 8-9 2,436 1,805 ,, 9-10 2,404 1,762 „ 10—11 2,494 1,738 11-12 2,169 1,510 ,, 12—13 2,161 1,519 „ 13-14 1,815 1,532 „ 14—15 1,452 1,053 15 up 944 359 Specials 1,764 1,574 23,786 17,309 153 (b) Found to require treatment 13,810 11,269 (c) Actually treated 9,043 6,706 (2) Half-days devoted to Inspection 184 138 Treatment 1,934 1,616 2,118 1,754 Number of Gas Sessions— Lodge Road 179 133 (by Dental Officers). Selhurst and Waldrons 78 83 257 216 Administrative Sessions 99 76 Orthodontic Sessions 260 215 (3) Attendances made by children for treatment 20,128 16,017 (4) Fillings— Permanent teeth 6,729 5,674 Temporary teeth 2,366 2,838 9,095 8,512 (5) Extractions— Permanent teeth 1,702 1,491 Temporary teeth 10,507 8,473 12,209 9,964 (6) Administrations of general anaesthetics for extractions 3,695 3,133 (7) Administrations of local anaesthetics for extractions 3,508 3,275 (8) Other Operations— Permanent teeth 7,533 6,117 Temporary teeth 3,187 2,444 10,720 8,561 Fillings per session 4.7 5.3 Extractions per session nitrous oxide 47.5 46.0 159 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 1,205. ORTHOPAEDIC WORK. Summary of Cases attending the Orthopaedic Clinic:— Jan. 1st, 1946. New Cases. Cases Discharged. Cases on Books 31st Dec., 1946. 182 209 129 262 RHEUMATISM CLINIC. The total number of children whose names were on the "live" register at the end of 1945 was 142 (males 66, females 76). Appointments were made for 131 children, of whom 117 attended. Three cases were referred for further treatment. 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. 517 children were seen by the Orthopaedic Surgeon and 479 attendances were made. SPINAL AND OTHER REMEDIAL CLINICS. 1946 1945 Attendances. Sessions. Av. att. Attend ances. Sessions. Av. att. Spinal 1,875 362 5.2 1,940 382 5.1 Massage 220 220 1.0 229 229 1.0 Flat Feet 3,128 336 9.3 2,476 264 9.4 Breathing 2,937 279 10.5 3,350 288 11.6 8,160 1,197 7,995 1,163 160 Cases Examined at Rheumatism Clinic. 1943. 1944. 1945. 1946. Primary 38 9 32 59 Re-exams. 37 7 10 47 75 16 42 106 Primary Cases. Rheumatic 30 8 24 49 (83%) Non-Rheumatic 8 1 8 10 (17%) 38 9 32 59 Classification of Rheumatic Cases. Primary. Re-examinations. Males 22 21 Females 27 26 49 47 Ages 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Primary 125493 8—483—11 Re-exams — 1 3244 6 12 7 7 1 — — — Grouping of Cases (Classification of Dr. R. Miller). 1943. 1944. 1945. 1946. Prim. Re's. Prim. Re's. Total. Mild and Potential 37 10 18 2 34 23 57 Definitely Active 4 4 5 4 5 4 9 Quiescent 18 1 1 4 10 20 30 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. 161 Primary Examinations. Amongst the 49 new cases the following Rheumatic manifestations were recorded:— Rheumatic pains 37 Chorea (suspected) 3 Carditis (definite) 7 Carditis (suspected) 10 Tonsillitis and Infected Tonsils 1 Sore Throat (but Tonsils and Adenoids removed) — Family Histories. Of the new cases, 11 gave a history of rheumatism in the family, 3 being histories of rheumatic fever in parents or brothers and sisters. Nervous Conditions. Recorded in 27 out of the 49 cases— Highly strung 8 Headaches 3 Night terrors 1 Enuresis 2 Twitchings 4 Past history of Chorea or other nervous condition 6 Minor degrees of nervous disorders 3 Often a combination of more than one of the above symptoms was manifested. Re-examinations. 47 children were re-examined:1 was worse, 12 showed no essential change, 14 were improved, and 20 were quiescent. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Blind Children. 2 boys are resident in special schools for the blind. The institutions which these children attend are as follows:—The Worcester School for the Blind, 1 boy; Royal Institute for the Blind, Birmingham, 1 boy. Deaf Children. 9 boys and 7 girls are resident at special schools for the deaf. The institutions which these children attend are : Royal School for the Deaf, Margate, 5 boys and 1 girl; Rayners School for the Deaf, Penn, 1 boy and 1 girl; Brighton School for the Deaf, 162 I boy and 3 girls; St. John's School, Boston Spa, 2 boys; Oak Lodge, Nightingale Lane, Clapham, 1 girl; Walpole House, Brighton, 1 girl. Epileptic Children. 3 boys: 1 at Lingfield Epileptic Colony, Surrey: 2 at Chalfont Colony, Chalfont St. Peter's, Bucks. Mentally Defective Children. In addition to 147 children accommodated at St. Christopher's School, 1 girl is resident at the Monyhull Mental Defectives School, Birmingham. ST. CHRISTOPHER'S (M.D.) SPECIAL SCHOOL. The year 1946 has been a year of steady growth and progress and many children have shown an improvement in I.Q. We have had numerous changes in the personnel of the staff. Our heartiest good wishes accompany Miss Appleton on her retirement, whilst we welcome Mr. Towse, Miss Woolverton, Mrs. Jones, Mrs. Corden, Mrs. Corbett, Mrs. Shields and Miss Cooney to our staff. Notable improvements of the year have been first the opening of our own kitchen under the excellent supervision of Miss Dickenson. Secondly, the introduction of the Senior Boys to the Cookery Classes. It is an inspiring experience to enter the Domestic Science Centre at the end of a session and see the boys and girls packing the evening meal, cooked by themselves. The menus varying from sausage, eggs or rolls to stews and puddings. Thirdly, our Christmas entertainment which consisted of six tableaux from carols, accompanied by a mixed choir of boys and girls, was witnessed by about sixty parents and friends. The whole school has been examined by both Doctor and Dentist during the year, and many visits have been taken to the clinics for further remedial treatment. We have had many visitors from all parts of the country to view our work and we have benefited bv their interest and suggestions. At Christmas each child was given a present from the Education Committee, and the infants were each given a pair of woollen gloves knitted by the kitchen staff and their friends. We thank them all for their kind thoughts. 163 We look forward to 1947 and still further steady progress. Number attending, 1st January, 1946 101 1947 147 ,, referred to Public Elementary Schools ,, discharged— (i) Fit to do work 8 (ii) Unfit to do work — (iii) Referred to M.D. Committee 7 Physically Defective Children. In addition to 100 physically defective children accommodated at St. Giles Open-air School, the Education Authority have crippled children in the following special schools : The Heritage Craft School, Chailey, 1 girl; Oak Bank Open-air School, Sevenoaks, 1 girl; Henwick Mall, 3 boys; St. Catherine's Home, 1 boy; Rob Roy, Speidhurst, 1 girl; Cony Hill Residential, Margate, 1 boy; Campbell Rudolf Steiner, 1 boy; Fairfield House, Broadstairs, 2 girls; White Oak Hospital, 1 girl; St. Margaret's (Plastic), 1 boy, 1 girl; St. John's, Woodford Bridge, 1 boy. Speech Defects Clinic. Total number of cases treated 118 ,, ,, ,, discharged 45 ,, ,, ,, still attending 73 Referred for physical treatment 8 Referred for Child Guidance Clinic 5 Number of Stammerers treated 41 ,, Alalias (lack of speech development) 5 ,, Cleft Palates 7 Lisps 10 Spastic Diplegia 5 Congenital Deafness 4 Dyslalia 46 During 1946 the work of the Speech Clinic has settled down to normal conditions, ft is gratifying to note that the age of admittance is considerably lower than in former years, thus showing an increased awareness by parents and teachers of the desirability of obtaining treatment as soon as possible. The Speech Therapists, would, however, welcome still more requests from the M. and C.W. clinics for patients admittance. If normal speech can be established before the child commences school life, it is then enabled to face its new environment with confidence and assurance. 164 JUVENILE EMPLOYMENT RETURN. The following numbers of children were examined by the medical officers during 1946 as to their fitness to following the part-time employment indicated: — Delivery of Goods for 1946. 1945. 1944. 1943. 1942. keepers 2 60 81 80 139 Delivery of Newspapers 125 90 167 139 179 Delivery of Milk 9 13 17 7 26 136 163 265 226 344 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: — 1946 (to 3rd August) Bottles. 1945. Bottles. Free Milk 883 179,676 951 229,325 (As from the 6th August all milk in schools was provided free and was limited at that time to l/3rd pint per child per day. The total number taking milk increased from 69 per cent, in June, 1946, to 96 per cent, in October, 1946.) 1946. Issues. 1945. Issues. Free Malt and Oil 424 82,731 284 38,384 (N.B.—Milk above l-3rd pint 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 and Oil ordered. It is due to anxiety on the part of the medical officers to safeguard the children's health under existing dietary restrictions. 165 CHILD GUIDANCE. ANALYSIS OF 1946 CASES. Total No. of Cases: 215 Referred by Intelligence Result S.M.O. Court Police R.H. Education Dept. Others High Average Low Diag. only Improved No Improvement Parents uncooperative Others : Various action or advice Still Attending Male 101 30 . 14 7 50 15 Not classi 37 fied—17 32 55 16 2 3 4 21 Female 114 28 48 10 28 12 Not classi 24 fied—26 52 71 ! 26 1 3 3 10 166 NON-MAINTAINED SCHOOLS. The usual arrangements for the medical inspection of nonmaintained school children were continued in 1946; 306 children were examined, 60' boys and 246 girls. Table II. of Appendix B. gives the detailed findings. Yours faithfully, OSCAR M. HOLDEN, School Medical Officer. 167 APPENDIX A. MEDICAL INSPECTION AND TREATMENT RETURNS. Year Ended 31st December, 1946. TABLE I. MEDICAL INSPECTION OF CHILDREN ATTENDING MAINTAINED SCHOOLS. A.- Routine Medical Inspections. (1) Number of Inspections: Entrants 3,693 Second Age Group 954 Third Age Group 2,296 Total 6,943 (2) Number of other Routine Inspections 134 Grand Total 7,077 B,—Other Inspections. Number of Special Inspections and Re-Inspections 18,166 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. % 7077 741 10.5 5554 78.5 767 10.8 15 0.2 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 2846 Group II.—Treatment of Defective Vision and Squint. Under the Authority's Scheme ERRORS OF REFRACTION (including squint) 1583 Other defect or disease of the eyes (excluding those recorded in Group I) — Total 1583 No. of Children for whom spectacles were (a) Prescribed 1245 (b) Obtained 1334 168 Group III.—Treatment of Defects of Nose and Throat. Under the Authority's Scheme Received Operative Treatment 711 Received other forms of Treatment Total number treated 711 TABLE IV.—Dentae Inspection and Treatment. (1) Number of children inspected by the Dentist— (a) Routine age-groups 22022 (b) Specials 1764 (c) TOTAL (Routine and Specials) 23786 (2) Number found to require treatment 13810 (3) Number actually treated 9043 (4) Attendances made by children for treatment 20128 5) Half-days devoted to: (7) Extractions : Permanent Teeth Inspection 184 1702 Treatment 1934 Temporary Teeth 10507 Total 2118 Total 12209 (8) Administrations of general anaesthetics for extractions 3695 (6) Fillings: (9) Other Operations : Permanent Teeth 6729 Permanent Teeth 7533 Temporary Teeth 2366 Temporary Teeth 3187 Total 9095 Total 10720 TABLE V.—Verminous Conditions. (i) Total num ber of examinations of children in the Schools by School Nurses or other authorised persons 58780 (ii) Number of individual children found unclean 1389 169 TABIyE VI.—School Medical and Dental Staff. Name of Officer. Proportion of whole time devoted to School Health Service. Public Health S.m.o.—Holden, Oscar M., G.M., M.D., D.P.H 20% 80% d.S.m.o. (Temp.) Fleming, Gerald M., M.A., M.B., B.Ch., D.P.H. 65% (On active 35% service). a.s.M.O.s— Hobbin, Gordon Marnoch, M.B., Ch.B., D.P.H. 65% 35% Jenkin-Lloyd, Iris A., M.R.C.S., L.R.C.P., D.P.H. 20% 80% Morrison, Rose, M.B., Ch.B., D.P.H 45% 55% Hegarty, Ellen Mackenzie, M.B., Ch.B., D.P.H. 35% 65% Collett, Suzanne, l.R.C.P., l.R.C.S., l.R.F.P.S. (Temp.) 35% 65% Temporary Part-time Assistant A.S.M.O.'s— Vost, Kathleen, M.B., B.S., D.P.H., M.R.C.S., L.R.C.P. 10% 20% Specialist Part-time Medical Officers. Davies, t. E., M.B., B.S., D.O.M.S. Rota of three 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. 00% 10% Assistant Dental Officers— Bryce, j. K. R., L.D.S. 100% — Hills, W. A. S., L.D.S. Urbani, C. P., l.D.S. Rosenblum, Sahah, L.D.S. R.C.S. (Eng.), Dental Surgical Degree (Warsaw) (Temporary) School Nursing Staff (excluding Specialist Nurses such as Orthopaedic Nurses). Nurses. Number of Officers. Aggregate of time given to s.m.s. work in terms of whole time Officers. School Nurses 25 45% District Nurses — - Nursing Assistants — - Dental Attendants 5 100%, 170 APPENDIX B. NON-MAINTAINED SCHOOLS. Year ended, 31st December, 1946. TABLE I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Age 11 or under Year 1946. Year 1945. 86 113 12 87 99 13 8 69 14 24 91 15 64 119 16 18 42 17 15 — 18 or over 4 1 Total 306 534 B.—Other Inspections. Year 1946. Year 1945. Number of Special Inspections — 2 Number of Re-inspections 47 193 Total 47 195 Visits to Non-maintained Schools 15 28 171 NON-MAINTAINED TABLE II.—A.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1940. DEFECT OR DISEASE. (1) Routine Inspections. Number of defects. Special Inspections Number of defects. Requiring treatment. (2) Requiring to be kept under observation but not requiring treatment. (3) Requiring treatment. (4) Requiring to be kept under observation but not requiring treatment (5) Malnutrition 3 ... ... ... Uncleanliness. (Sec Table IV.—Group V.) Skin— Ringworm: Scalp ... ... ... ... Body ... ... ... ... Scabies ... ... ... ... Impetigo ... ... ... ... Other diseases (non-tuberculous) 1 ... ... ... Eye— Blepharitis ... ... ... ... Conjunctivitis ... ... ... ... Keratitis ... ... ... ... Corneal opacities ... ... ... ... Defective vision (excluding squint) ... 1 ... ... Squint ... 1 ... ... Other conditions ... ... ... ... Ear— Detective hearing ... ... ... ... Otitis media ... ... ... ... Other ear diseases ... ... ... ... Nose and Throat— Enlarged tonsils only ... 2 ... ... Adenoids only ... ... ... ... Enlarged tonsils and adenoids 1 ... ... ... Other conditions 1 ... ... ... Enlarged Cervical Glands (Non-Tuberculous) ... ... ... ... Defective Speech 2 ... ... ... Teeth—Dental Disease 8 ... ... ... Heart and Circulation— Heart Disease— ... ... ... ... Organic ... ... ... ... Functional ... ... ... ... Anaemia ... 2 ... ... Lungs— Bronchitis ... 1 ... ... Other non-tuberculous diseases 1 4 ... ... Tuberculosis— Pulmonary— Definite ... ... ... ... Suspected ... ... ... ... Non-pulmonary— Glands ... ... ... ... Spine ... ... ... ... Hip ... ... ... ... Other bones and joints ... ... ... ... Skin ... ... ... ... Other forms ... 1 ... ... Nervous System— Epilepsy ... ... ... ... Chorea ... ... ... ... Other conditions ... ... ... ... Deformities— Rickets ... ... ... ... Spinal curvature 1 2 ... ... Other forms 5 1 ... ... Other Defects and Diseases I 1 ... ... 172 CONTENTS. A.- PUBLIC HEALTH REPORT. page Abortion 97 Acts, Adoptive 115 Adulteration 136 Ambulance Service 9, 35 Amusement Houses 117, 122 Animals, Keeping of 117, 121 Ante-Natal Clinic 97, 103 Babies Help Committee 94 Births 2, 4, 79, 96 Blind Persons 111 Blood Transfusions 102 Blood Examinations 67 Borough' Hospital 44 Byelaws and Regulations 114 Cancer 61 Cerebro-Spinal Meningitis 48, 49 Chest Clinic 62 Contacts, Tuberculosis 71 Committee 1 Coombe Cliff 33 Cowkeepers 127 Convalescence 94 Dairies, Cowsheds & Milkshops 127 Day Nurseries 87 Deaths 2, 3, 4, 6, 9 Dental Treatment—M. & C.W. 83 Diphtheria 47, 54 Disinfection 122 Disinfestation 123 Ditches 121 Drainage 121 Dysentery 49 Encephalitis 49 Enteric Group 48 Erysipelas 48 Expectant Mothers 88, 96, 97 Extra Nourishment 70 Factories and Workshops Acts 116, 119 Fertilisers and Feeding Stuffs Act 123 Foods 124, 132 Foods and Drugs Acts 127, 132 Foster-Mothers 94 Foster-Children 94 Gastro-Enteritis 49 Gynaecological Clinic 103 Health Visitors, Work of 55, 92 Home Helps 35, 94 Home Nursing 71 page Homework 120 Hospitals 96 Hospital, St. Mary's (Maternity) 96 Houses Let in Lodgings 118 Housing 114, 117 Housing Act 117 Ice Cream 131 Illegitimacy 2,3,4,94 Immunisation Clinic 54 Infant Welfare Clinics 88,93 Infant Mortality 3,78,82 Infectious Diseases 43 Inquests 4,14 Laboratory Work 9, 14, 51, 52, 98, 131 Local Acts 115 Lodging Houses, Common 119 Marriages 3 Massage 13 Maternity Homes 86 Maternity Homes, Registration 86 Mayday Hospital 10,96 Measles 48 Meat Inspection 125 Medical Help Records 84 Mental Deficiency 13,104 Midwives 84 Midwives, Municipal 85 Midwives Act 84 Milk, Provision of 70, 127 Milk, Examination of 53, 128, 135 Milk, Tuberculosis 53, 128 Milkshops 127 Mortality in Childbirth 2, 3, 77, 78, 95, 103 Mothers' and Infants' Welfare Association 88 Municipal Lodging House 119 Neo-Natal Deaths 83 Notification of Birth Acts 77 Nuisances 115 Nursing Arrangements 9 Nursing Homes 86 Obstetrical Unit 95 Offensive Trades 121 Ophthalmia Neontaoruni 49, 80 Orthopaedic Department 106 Out of Borough Cases 49 Outworkers 120 Pathological Investigations 99 Pemphigus 49 173 page Physiotherapy 98 Poisons and Pharmacy Act 123 Poliomyelitis 49 Ponds 121 Poor Law Relief 34 Population 2 Post-natal Clinic 103 Post-mortems 4, 14 Premature Infants 92 Puerperal Sepsis and Pyrexia 48, 79, 103 Queen's Road Homes 34 Radiotherapy 13 Rag Flock Acts 123 Rats & Mice (Destruction) Act 124 Rescue Home 94 Sanatorium, Cheam 74 Sanatoria, Treatment in 68-70 Sanitary Administration 114 Sanitary Certificates 119 Sanitary Inspectors, Work of 114 Scarlet Fever 46, 50 Schools, Inspection of 120 Shop Hours Acts 121 Slaughterhouses 126 Smoke Observation 121 Sputum, Examination 52, 67 Still-Births 2, 79 St. Mary's Maternity Hospital 96 Suicide 6, 9 page Tuberculosis—Cheam Sanatorium 74 ,, Contacts 71 „ Deaths 65 ,, Dental Treatment 72, 76 ,, Notifications 62 ,, Thoracic Surgery 70 ,, Home Nursing 71 ,, Home Visits 71 ,, Statistics 73 „ Pneumothorax 76 ,, Institutional Treatment 68,70 ,, Allowances 73 Twins and Triplets 102 Unmarried Mothers 2, 3, 4, 94 Vaccination 56 Verminous Persons 122 Venereal Diseases 57, 98 Vital Statistics 2 War Damage 119 Ward Statistics 5 Watercourses 117,121 Water Supply 7 Whooping Cough 48 Workplaces 116 Workshops 116 X-Ray Examination 12, 13, 67, 99 | Zymotic Diseases 5 B —SCHOOL MEDICAL REPORT. page Accommodation 139 Adenoids 149 Blind Children 161 Child Guidance 165 Cleansing of Children 142 Clinics 148 Clothing and Footgear 146 Cod Liver Oil 164 Cost 139 Crippling Defects 159 Deaf Children 161 Deaths 142 Defective Children 145, 161 Defective Hearing 145 Deformities 159 Dental Disease 143 Dental Treatment 150 page Ear Disease 161 Epileptic Children 161 Exclusions 146 Eye Clinic 149 Eye Disease 143 Following-up 148 Health Visitors, Work of 148 Heights and Weights 144 Immunization, Diphtheria 159 Infectious Diseases 147 Inspection Clinic 148 Inspections, Routine 140 Juvenile Employment 164 Lung's, Diseases of 142 174 page Malnutrition 145 Malt 164 Massage Clinic 159 Meals, Provision of 164 Mentally Defective Children 162 Milk, etc., Provision of 139, 164 Minor Ailments 149 Nutrition 145 Orthopaedic Work 159 Orthodontic Service 155 Parents' Attendances 141 Physically Defective Children 163 Population 139 Remedial Exercises 159 PAGE Rheumatism Clinic 159 Schools, Special 139, 162 Secondary Schools 166 Speech 163 Staff 169 Statistical Tables 167 Surveys, Uncleanliness 142 St. Christopher's 162 Throat and Nose 149 Treatment 148 Tuberculosis 142 Uncleanliness 142 Vision, Defective 144 X-Ray 155