County Borough of Croydon. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and SCHOOL MEDICAL SERVICE For the Year 1947 OSCAR M. HOLDEN, G.M., M.D., D P.H. croydon: PRINTED BY THE CROYDON TIMES LTD., 104, HIGH STREET C.T. 2. 4-10-48. 150. i. COUNTY BOROUGH OF CROYDON. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1947. 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 Twentieth Annual Report upon the Health Services carried out by the Council. This report is the 48th of the series of these reports. The population of the town, as estimated by the RegistrarGeneral was 242,770. Since the cessation of the war the population has grown rapidly and has now exceeded the pre-war level. During the year 2,416 marriages were solemnized, an increase of 311 over 1946. The marriage rate was 11.5 per 1,000 of the population. The Birth Rate was 21.0 per 1,000, an increase of 0.4 per 1,000 over that for 1946. There were 5,100 live births, of whom 2,615 were males and 2,485 females. Of these approximately 37.97 per cent, were born in hospital, and 25.74 per cent, in registered maternity homes. There were 283 illegitimate births, a percentage of 5.5 of the total live births, which shows a further reduction of 1.0 per cent, below the 1946 figure. ii. The Still Births registered were 111 as compared with 131 in 1946, the rate was 21.3 per 1,000 total live and still births. This was 26.5 per 1,000 in 1946. The Infantile Mortality was 38 per 1,000 live births, an increase of 7 per 1,000 on 1946, in which year the lowest recorded rate of 31 per 1,000 was attained. The maternal mortality rate was 1.92 per 1,000 total births, an increase of 1.31 over 1946. The infantile mortality among legitimate children was 36 per 1,000 births, and among illegitimate 71 per 1,000 births. Both these figures, especially that for illegitimates, show an increase on 1946. The major causes of death among the population were diseases of the heart and circulatory system (4.17 per 1,000 population), cancer (1.94), diseases of the respiratory system (1.84), diseases of the digestive system (0.65), and violent causes, including suicide (0.48). As compared with 1946, the groups comprised in diseases of the respiratory system and of the digestive system show an increase. Deaths from violence remained much the same. Among the notifiable infectious diseases, measles and whooping cough showed considerable increases; scarlet fever, a small increase; diphtheria, a further decline. In the last quarter of the year, Croydon, as with other districts throughout England, experienced a wave of cases of Poliomyelitis. The incidence was showing a considerable decline as the year drew to a close. During 1947, 58 cases were notified, of whom 31 were males and 27 females. Individuals of all ages between 1 year and 45 years were attacked, and the incidence of cases was general over the town ; only one ward, Bensham Manor, escaped. South Norwood, with 10 cases, and Broad Green (9) had the highest incidence. The resources of the Department were fully capable of dealing with the cases; a special department for remedial exercises, under-water massage, etc., was commenced at Mayday Hospital, cases being automatically referred thereto from the Borough Isolation Hospital at the expiration of the acute stage. All cases were seen and advised upon by a specialist orthopedic surgeon. The Home Helps scheme continued to expand, and at the end of the year there were 37 full-time and 20 part-time Helps employed. Nine hundred and sixty-six applications for Helps were received and 871 of these requests were met, an increase of iii. 233 over 1946. This is proving a valuable service, and we are fortunate in having an excellent body of women doing these duties who take an interest in the work and who understand the peculiar difficulties which might arise if discretion and tact were not shown. The Ambulance Service also showed expansion. The calls for help rose from 15,274 to 18,368, and the mileage covered from 88,255 miles to 146,199 miles. Details of the work are set out on pages 36—42 inclusive. One major catastrophe occurred in October, when a collision between two S.R. electric trains near South Croydon Station resulted in over 120 casualties being dealt with by the service and ambulances from surrounding boroughs. The service was thanked and congratulated by the railway company on the expedition and efficiency with which the emergency was met. All casualties had been evacuated from the area in under an hour and a half. In addition to accident work, the service dealt with over 4,000 private removals from hospitals, etc, and nearly 7,000 departmental calls. The number of accidents to children, unfortunately, rose fromt 324 in 1946 to 379, the reason for the increase being more accidents in the streets. Attendances at the Venereal Diseases Clinic showed a decline from the peak number reached in 1946. New cases, however, increased from 1,143 to 1,654, there being a very marked increase in new female cases, from 411 to 1,076. The demobilisation of large numbers of service personnel is possibly the reason. The apparent discrepancy between the increases in new cases and decrease in total attendance is explained by the greatly curtailed length of treatment brought about by the use of penicillin in gonococcal infections. Regulation 33.B. came to an end at the end of the year. This regulation was intended to give medical officers powers to trace sources of infection and to bring pressure to bear upon contacts found infected to undergo treatment. As the operation of the regulation had to rely upon information given by a patient on the source of his or her infection, it was never very effective. More women were informed upon by men than men by women, and thenumbers brought to notice were fewer in 1947 than in 1946. There were 10 cases in all, of whom 4 were men and 6 women. All the contacts concerned were traced, examined and received treatment. iv. The incidence of deaths from Cancer showed little change, and it fell practically equally on men and women. The most usual sites quoted in men were the Lungs (61 cases), Stomach (45), Bowel (32), Rectum (27), and Prostate (24). In women the sites most usually affected were: Breast (50), Bowel (42), Stomach (28), Uterus (22), Ovary (19) The incidence of Tuberculosis also showed little change, being 1.46 per 1,000 of the population, as compared with 1.49 in 1946. The number of deaths, however, decreased by 8.9 per cent. The majority of the deaths occurred in the age groups between 25 and 55 years of age. In women the deaths occur at an earlier age than in men, the age group 25—35 giving the highest figure. Mass Radiology was continued through the co-operation of Surrey County Council, and the unit visited the town on one occasion. I am indebted to the County Medical Officer for the following particulars of the work done by the unit on its visit to Croydon : — 6,190 persons were examined during the year, of which 3,274 were males and 2,916 were females.' Table I. Age 14 15—24 25—34 35—44 45—59 60 and over. Total all ages. Male 560 1,058 714 526 329 87 3,274 Female 514 1,118 542 400 296 46 2,916 Total 1,074 2,176 1,256 926 625 133 6,190 Number recalled for full-sized X-ray plate 345 (5.57% of total examined) Number recalled for clinical examination.. 135 (2.18% of total examined) Number failing to attend for full-sized X-ray plate 4 (1.15% of those recalled) Number refusing further action after full- sized plate or clinical examination nil Number still under observation or undiagnosed 1 V. Abnormalities Revealed. A. Non-Tuberculous Conditions: 1. Abnormalities of ribs and bony thorax 33 2. Bronchitis and emphysema 27 3. Bronchiectasis 7 4. Pneumokoniosis — 5. Pleural thickening 66 6. Intrathoracic neoplasms — 7. Cardiovascular lesions: (a) Congenital 5 (b) Acquired 30 8. Miscellaneous 35 B. Cases with evidence of Pulmonary Tuberculosis including healed lesions: 1. Previously known cases 15 (Inactive, 7; Active and still attending Clinic, 8) 2. Newly-discovered cases— (a) Inactive lesions requiring no further action : (i) Healed primary lesions 119 (it) Healed post primary lesions 66 185 (b) Active lesions 23 (0.33% of the total examined). vi. < Table II. 23 cases of active Pulmonary Tuberculosis, showing extent of the lesion, presence or absence of symptoms and disposal: Disposal. Extent of lesion and presence of symptoms. Dispensary Observation. Hospital or Sanatorium. Total. Unilateral: With symptoms 3 4 7 Without symptoms 1 — 1 Bilateral: With symptoms 4 6 10 Without symptoms 5 — 5 13 10 23 Table III. 23 cases of active Pulmonary Tuberculosis, sub-divided into sex and age groups: Age 14 15—24 25—34 35—44 45—59 60 and over. Total all ages. Males . — 1 2 2 3 1 9 Females 2 5 5 1 1 — 14 During 1947, out of 5,211 live and still births allocated to Croydon, the Council's Obstetric Service dealt with 3,800, and of these 1,816 were delivered at home by the municipal midwives; 1,280 in Mayday Hospital, and 704 in St. Mary's Hospital. The beds in both hospitals—68 in Mayday and 30 in St. Mary's—were kept fully occupied throughout the year; in fact, on occasion there supervened an undesirable amount of overcrowding, and this in spite of the system of priority which gave preference to the admission of first births, abnormalities, and those living under bad home conditions. The Obstetric Unit, as a unit, has once again proved its,value in providing an unbroken service of doctors and midwives throughout a mother's pregnancy and confinement. Unfortunately, it would appear that this most desirable continuity will be broken when the provisions of the National Health Service Act come into force, and, at any rate, theoretically, there will be three separate and distinct administrative bodies concerned in what is vii. « fundamentally a continuous period in a woman's life and should be treated as such by a continuity of medical and nursing supervision. For the existing continuity to be preserved under the National Health Service Act will mean a close and understanding, co-operation between Local Health Authorities, Regional Hospital Boards and Local Executive Councils. It is to be fervently wished that this is attained, otherwise the efforts in Croydon, during the past 17 years, to weld the service as one comprehensive and consolidated whole, will have been largely wasted. During the year 611 sessions of the Ante-Natal Clinic were held, at which 20,910 attendances were made, of which 3,785 were made by new cases. At the Post-Natal Gynaecological Clinic 101 sessions were held, at which 4,460 individual patients were seen, of whom 2,173 were post-natal cases, and 1,151 gynaecological cases. Among the post-natal cases followed up, in only one case was health seriously impaired as a consequence of labour. In 95.5 per cent, there was no impairment, whilst in the remainder there was some slight impairment. Attendances at Infant Welfare Centres again showed a substantial increase from 78,122 in 1946 to 87,806 in 1947. This increase led to further overcrowding at most of the Centres. The establishment of new housing estates which are inhabited very largely by young couples, will necessitate the establishment in the near future of further Centres in order to relieve congestion at some of the existing Centres, and also to provide Centre facilities within reasonable distance of the mothers' homes. There is no need now to emphasise the value of infant welfare consultation. The practice has become established firmly in the mind of the mothers, and many attend with their baby at their nearest Centre as soon as they are well enough after confinement to do so, and sometimes even before the health visitor has had time to visit the home. The following summary illustrates the magnitude of the work covered by the 19 Centres, of which 2 are Municipal and the rest administered and provided by the Croydon Mothers' and Infants' viii. Welfare Association, and subsidised financially by the Council, who also provide the skilled medical and nursing assistance : — 1947. 1946. New Cases attending a Centre for the first time 5,098 4,558 Total attendances of all cases 87,653 77,941 Consultations with doctor 27,115 23,407 Average attendance per session 71.3 68.7 As the Chief Sanitary Inspector has remarked in his introductory letter, housing work has been largely, through force of post-war circumstances, confined to the dealing with complaints. Owners, as well as tenants, have got into the habit of asking for sanitary inspections so as to facilitate obtaining the necessary licences to permit of essential repairs being carried out. The inspectors inspected 11,372 houses during the year and 9,521 informal notices were served on owners for the execution of repairs. Of these 8,827 were complied with. Those not complied with were referred for Statutory Orders. A total of 3,673 statutory notices were served and of these 3,533 were complied with by the end of the year; 1,648 were still outstanding. The number of defective dwelling houses rendered fit was 7,724 without formal notice. Of those the subject of statutory notices 3,100 were rendered fit by the owners and 433 by the local authority in default of the owners. Food supplies were watched carefully; a total of 3,667 visits were paid to premises in the borough at which food was known to be sold, manufactured or stored. These premises number 2,821, excluding slaughterhouses, dairies and farms, and milkshops. A considerable amount of food of various kinds had to be condemned as unfit for human consumption. This included 88,875 lbs. of beef, 3,371 lbs. of mutton, 105,418 lbs. of offal, 11,699 lbs. of fish, 7,768 lbs. of fruit and vegetables, and 41,223 lbs. of canned goods. The inspection of meat is carried out at the Public Abattoir and at the Government Meat Depot. The Abattoir was taken over by the Ministry of Food in November, 1946. During 1947 the Council's meat inspectors inspected a total of 25,822 animals slaughtered at the abattoir. Of this number 94 carcases of cattle, 6 carcases of calves, 6 of sheep and 5 pigs were condemned. ix. During the year 261 samples of milk were examined and the standard was maintained in a very satisfactory way. Ice-cream has been carefully watched. This trade has increased very greatly since the war and all the participants therein do not maintain a satisfactory standard of cleanliness. On May 1st, the Ministry of Health issued, somewhat tardily, a provisional standard in accord with a grading system. The gradings were arrived at by the methylane blue method. Of a total of 155 samples, 44 per cent. (69) failed to reach a satisfactory standard of bacterial purity. Most unfortunately, there are no chemical standards for ice-cream, and although ice-creams manufactured by the large wholesale makers have a considerable nutritive value, some of those manufactured from made-up powders, or by small dealers, have little nutritive properties. Under the Food and Drugs Act, 1938, the sanitary inspectors took 659 samples, of which 249 were of milk. Of the latter samples 5 were not genuine, but otherwise the average composition of the milk samples was well above the legal minimum. Of the other non-genuine samples, 3 were of vinegar, 2 whisky, 1 gin, 2 sherbet, and various other commodities (see page 140). On the school medical side of the work, there was a small drop in the number of children examined at routine medical inspections. The general average standard of nutrition and growth seems to have been maintained, and on the whole there has been less uncleanliness among school children. Verminous conditions accounted for 13.85 per cent, of the total exclusions, as compared with 22.13 per cent, in 1946. On the other hand, there was a higher incidence of the common infectious diseases, especially mumps, which accounted for 22.15 per cent, of exclusions, and measles, which caused 21.15 per cent, of the exclusions. Attendances at the Minor Ailments Clinics were higher than in 1946; 3,295 cases with 16,049 attendances as compared with 2,846 cases and 13,477 attendances in 1946. In the section dealing with the school dental service, an opportunity has been taken of making a forecast, in the light of educational developments, and of the rapidly increasing population, of the requirements in the way of clinics and dental staff, which should come about within the next 3 years. It has been estimated that at least 3 and possibly 4 additional branch clinics X. will be required, and 5 more dentists and dental attendants. It is impossible to say what effect the dental and other provisions of the National Health Service Act, will have on the School Medical Service. If and when Health Centres are established it would be advantageous for a portion of the Centre to be allocated to School Clinics. This might result in a closer contact being reached between the general medical practitioner and the school medical staff. The general overall picture presented of the health of the borough shows that, although there has been no very obvious deterioration, there has certainly not been any improvement. A delicate indicator of health, namely, the Infantile Mortality rate, shows an increase in this mortality, though even with the increase it is still much below the average before 1938. As has been mentioned in previous reports, although the health and general nutritional standards of young children and of expectant mothers have been well maintained, there is evidence to show that the general population outside these two special categories is suffering from a degree of under-nutrition. This leads to a disinclination for effort, and a readier susceptibility to chance infections. So long as the existing restrictions upon food remain, with the consequent impossibility of obtaining a varied diet, it is to be feared that the maximum effort called for so insistently by politicians, will not be forthcoming In conclusion, I wish to tender my thanks to you, Mr. Chairman, and the members of the Health Committee for your encouragement and support, and to the staff of the department for their co-operation and help and for the consistently worthy manner in which they have carried out their duties. I am, Yours faithfully, OSCAR M. HOLDEN, Medical Officer of Health. 1 PUBLIC HEALTH COMMITTEE. 1946—1947. The Worshipful The Mayor (Alderman H. Regan, J.P.) Councillor J. T Twitchett (Chairman) Councillor W. H. Gough (Vice-Chairman). Alderman Col. C. H. Gibson. Alderman Mrs. M. Squire, J.P. Councillor Miss M. G. Billson. Councillor Mrs. V. L. Child. Councillor Mrs. E. E. Cook. Councillor A. V. Dammarell. Councillor C. E. Ebbutt. Councillor F. Gardner. Councillor A. Goodbun. Councillor R. Hyder. Councillor W. J. Maile (resigned). Councillor Mrs. E. M. Regan. Councillor J. Todd. Councillor G. H. Ward, O.B.E. Miss Dorothy Day, M.R.C.S., L.R.C.P. R. N. Deane, Esq., M.B., B.Ch., B.A.O. G. G. Genge, Esq., M.D. (deceased). 2 SUMMARY OF VITAL STATISTICS FOR 1947. Area, 12,617 acres. Population (Census 1931), 233,115. Population (estimate of Registrar-General), 242,770. Number of Inhabited Houses (1931 Census), 56,429. Overcrowding Census (1936), 65,550. Rateablet Value (1st April, 1947), £2,515,408. Product of a Penny Rate (1946—1947), £9,773. Rate in the £ : 12s. 4d. Gross expenditure on Health and Hospital Services (administered by Medical Officer of Health) £509,874 Income on Health and Hospital Services (excluding transfers) 119,974 Net expenditure on Health and Hospital Services £389,900 Expressed as a Penny Rate, 3/4d. in the pound. M. F. Total. Live Births Legitimate 2,481 2,336 4,817 Illegitimate 134 149 283 5,100 Birth-rate per 1,000 of the estimated resident population, 21.0. Still Births 111. Rate per 1,000 total (live and still) births, 21.3. Birth-rate (live and still births) per 1,000 population, 21.5. Deaths, 2,889 (Registrar-General's figures). Death-rate per 1,000 of the estimated resident population, 11.9. Deaths from diseases and accidents of pregnancy and childbirth, 10; from puerperal and post-abortal sepsis, 1; other causes, 9, 8 Maternal mortality, 1.92 per 1,000 total live and still births. Death-rate of Infants under one year of age (194 deaths, 5,100 births)— All Infants per 1,000 live births 38 Legitimate Infants (174 deaths) per 1,000 live births 36 Illegitimate Infants (20 deaths) per 1,000 live births 71 Deaths from Influenza 21 ,, ,, Whooping Cough (all ages) 4 ,, ,, Diarrhoea (under 2 years of age) 28 ,, ,, Diphtheria (all ages) 1 ,, „ Pneumonia 145 ,, ,, Cancer 472 The following are compiled from local statistics: — Rate per 1,000 Population Deaths from diseases of Cardiac and Circulatory System (including Cerebral Haemorrhage) 4.17 „ „ diseases of the Respiratory System (including Tuberculosis) 1.84 „ „ diseases of Digestive System 0.65 „ „ Suicide and Violent Causes 0.48 „ „ Old Age 0.56 Marriages. The number of marriages solemnised was 2,416, compared with 2,105 in 1946, 2,268 in 1945, 1,578 in 1944, 1,574 in 1943, and 2,042 in 1942. 1,090 were solemnised in Established Churches, 329 in other places of worship, and 996 in the Register Office. One was performed under Jewish ritual. 4 Births. The live births registered were 4,817 legitimate and 283 illegitimate. The birth-rate consequently was 21.0. For England and Wales and in the Great Towns the rates were 20.5 and 23.3. The illegitimate births in Croydon were 5.5 of the total, compared with 6.5 in 1946; 10.6 in 1945; 7.7 in 1944; 7.8 in 1943; 7.5 in 1942; and 6.3 in 1941. The live male births numbered 2,615, the female 2,485, being a proportion of 1,052 males to 1,000 females. The subjoined table gives the vital statistics for the Wards in the Town. It is seen that the Wards with the highest birthrates were Addington (26.8), Whitehorse Manor (23.0) and South Norwood (22.5). Those with the lowest were Norbury (15.9) and West Thornton (17.7). Deaths. The deaths numbered 2,889, compared with 2,691 in 1940; For 1947 the death-rate was 11.9; for 1946 it was 11.5. The death-rate for England and Wales was 12.0, and for the Great Towns 13.0. For London the death-rate was 12.8. There were 167 inquests held by Coroners in respect of Croydon residents during 1947 and 250 findings by Coroners after post-mortem examination without inquest. Wards with the highest death-rate were Central (15.3), Addiscombe (13.6), and Upper Norwood (13.4). Lowest: Broad Green (9.3), Waddon (9.7), and Addington (10.1). 5 WARD STATISTICS 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 Diarrhœa. 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 15917 334 214 21.0 13.4 42 — 0.06 1.32 0.38 0.13 5.21 0.69 2.64 + 120 Norbury 15997 255 170 15.9 10.6 16 — — 1.25 0.56 — 3.31 0.50 2.38 + 85 West Thornton 19522 346 216 17.7 11.1 29 — 0.20 1.02 0.31 — 4.15 0.36 2.00 + 130 Bensham Manor 15914 343 200 21.6 12.6 52 — 0.13 2.20 0.38 — 4.78 0.31 2.07 + 143 Thornton Heath 17956 398 186 21.6 10.4 33 0.06 0.11 1.17 0.45 — 3.95 0.39 1.50 +212 South Norwood 17545 394 213 22.5 12.1 41 — 0.06 1.42 0.34 0.11 4.22 0.40 2.17 + 181 Woodside 15972 352 186 22.0 11.6 34 — 0.13 1.19 0.38 0.13 3.88 0.38 2.38 + 166 East 16022 349 206 21.8 12.9 34 — 0.19 1.25 0.50 0.12 5.43 0.56 2.31 + 143 Addiscombe 16208 358 218 22.1 13.6 45 0.06 0.25 1.48 0.31 0.06 5.12 0.49 2.78 + 140 Whitehorse Manor 16626 383 211 23.0 12.7 42 0.06 0.12 1.92 0.48 0.12 5.05 0.30 1.62 + 172 Broad Green 17071 361 159 21.1 9.3 44 — 0.18 0.70 0.35 — 4.22 0.41 1.58 +202 Central 12095 255 185 21.1 15.3 39 0.08 0 25 2.07 0.25 — 6.45 0.58 2.56 + 70 Waddon 18204 332 177 18.2 9.7 27 0.05 0.06 1.21 0.38 0.05 3.85 0.44 1.37 + 155 South 15005 299 195 19.9 13.0 43 0.07 0.07 1.67 0.20 — 5.73 0.67 1.53 + 104 Addington 12716 341 128 26.8 10.1 38 — 0.24 0.79 0.39 0.16 3.54 0.31 1.73 +213 The Borough 242770 *5100 *2889 21.0 11.9 38 0.02 0.13 1.36 0.38 0.06 4.17 0.45 2.03 +2211 * 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 1417 101 17 13 110 364 812 F 1472 92 5 6 105 249 1015 Diphtheria M 1 — — 1 — — — F - - - - - - - Whooping Cough M 3 2 1 — — — — F 1 1 - - - - - Encephalitis Acute Infectious M - - - - - - - F 3 — — — 1 — 2 Cerebro Spinal Fever M 2 — 1 — — — 1 F - - - - - - - Measles M 1 — 1 — — — — F - - - - - - - Influenza M 8 — — 1 1 3 3 F 13 — — — — 3 10 Poliomyelitis & Polioencephalitis M 2 — — — 2 — — F 3 — — 1 2 — — Tuberculosis (respiratory) M 62 — — 1 26 26 9 F 31 — — — 23 6 2 Tuberculosis (other forms) M 3 1 1 - — 1 — F 9 1 - - 5 1 2 Syphilitic diseases M 13 - - - 1 5 7 F 4 - - - - - 4 Cancer M 236 — — — 16 73 147 F 236 — — — 16 83 137 Diabetes M 4 — — 1 - 2 1 F 12 - — 1 1 2 8 Intra cranial vascular lesions M 116 — — — 2 28 86 F 174 — — — - 29 145 Heart diseases M 417 —. — 12 87 318 F 474 — — — 6 46 422 Other circulatory diseases M 30 — - - 1 5 24 F 54 — — — 1 5 48 Bronchitis M 74 — — — 3 18 53 F 71 1 - — 1 9 60 Pneumonia (all forms) M 69 18 3 — 4 17 27 F 76 17 2 1 4 12 40 Other respiratory diseases M 21 — — - 2 13 6 F 6 — — — - 2 4 Ulcer of stomach or duodenum M 26 — - — 3 14 9 F 6 - - - 3 3 Diarrhoea (under 2 years) M 17 16 1 — — — - F 11 11 — — - — — Appendicitis M 6 — — 1 2 3 — F 3 — — — 2 — 1 Other digestive diseases M 25 4 — 1 1 8 11 F 28 1 — — 2 9 16 Nephritis M 34 1 1 — 3 9 20 F 36 — — 1 3 8 24 Puerperal sepsis F 1 — — — 1 — — Other maternal causes F 9 — — — 9 — - Congenital debility, malformations, premature birth, etc. M 56 49 2 1 3 1 F 60 52 1 — 2 3 2 Suicide M 20 — — - 4 14 2 F 19 — - - 7 6 6 Road traffic accidents M 16 — 3 1 4 5 3 F 6 — — 1 2 - 3 Other violent causes M 41 4 - 3 10 7 17 F 35 2 1 - 4 1 27 All other causes M 114 6 3 2 13 23 67 F 91 6 1 1 13 21 49 Totals 2889 193 22 19 215 613 1827 7 Comparisons with 1946. In the zymotic diseases group there were 4 deaths from Whooping Cough, 1 from Diphtheria, and 1 from Measles. - There were again no deaths in the Typhoid group. The deaths from Pulmonary Tuberculosis decreased by 5; those from Cancer increased by 47; those from Pneumonia by 35; and a decrease of 7 was recorded in those caused by Bronchitis. Deaths from Suicide show an increase of 8, and road traffic accidents a decrease of 2. The total number of deaths was 2,889, as compared with 2,691 in 1946. The percentage of deaths under 1 year of age to the total deaths was 6.7 per cent.; deaths under 15 years, 8.1 per cent.; deaths under 65 years, 36.8 per cent.; and deaths over 65 years, 63.2 per cent. The corresponding figures for 1946 were 5.6 per cent., 6.8 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 2,396,526,000 Metropolitan Water Board in bulk 692,625,000 3,089,151,000 The Water supply has been satisfactory in quality and quantity. The supply is piped throughout the area. 8 (a) Bacteriological Examinations. Regular bacteriological examinations were made of the raw water going into supply after treatment. 228 raw water samples and 889 treated water samples were thus examined bacteriologically during the year by the Chemist and Bacteriologist on the staff of the Water Undertaking. In addition 18 samples of raw water and 50 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 76 of raw waters and 150 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 1947 the total number of samples taken by the Public Health Department was as follows :— For bacteriological examination 75 For chemical examination 75 All these samples were taken direct from consumers' taps. 9 LABORATORY, AMBULANCE, NURSING FACILITIES, HOSPITALS, Etc. There have been no material changes in the Laboratory and Nursing Facilities in the home since my report in 1940. All Clinics have continued throughout the year. A report on the activities of the Ambulance Service will be found on page 36. DEPARTMENTAL CLASSIFICATION OF DEATHS ACCORDING TO DISEASE OVER A PERIOD OF SIX YEARS. Cause of Death. 1942 Total Deaths 1943 Total Deaths 1944 Total Deaths 1945 Total Deaths 1946 Total Deaths 1947 Total Deaths Death Rate Enteric Fever - - - - - - - Acute Infectious Encaphalitis — — — 1 — 3 0.012 Poliomyelitis — — 1 1 — 5 0.021 Measles — 1 1 6 1 1 0.004 Scarlet Fever 1 1 - - - - - Whooping Cough 3 1 10 3 3 4 0.016 Diphtheria and Croup 3 2 — 2 3 1 0.004 Influenza (incl. Influenzal pneumonia) 19 81 19 11 35 22 0.091 Dysentery 2 — — 1 — 1 0.004 Erysipelas 1 — 1 — — — — Cerebro-Spinal Fever 6 1 1 3 2 2 0.008 Pulmonary Tuberculosis 97 107 98 78 101 92 0.379 Tuberculous Meningitis Other Tuberculous Diseases 19 16 11 14 9 14 0.058 Cancer, Malignant Disease 409 454 420 470 451 492 2.027 Rheumatic Fever 3 2 2 1 4 5 0.021 Meningitis 9 7 4 6 1 7 0.029 Organic Heart Disease 741 515 563 542 697 665 2.739 Bronchitis, Acute and Chronic 131 150 126 124 156 148 0.610 Pneumonia 113 182 129 160 156 185 0.762 Other Diseases of the Respiratory Organs 22 17 23 19 19 21 0.087 Diarrhoea & Enteritis 15 21 22 20 27 32 0.132 Appendicitis 6 8 8 8 6 6 0.025 Cirrhosis of Liver 5 4 2 5 1 7 0.029 Alcoholism — — - — 1 - - Nephritis & Bright's Disease 57 44 44 35 48 53 0.218 *Puerperal Sepsis 3 1 — 1 — 1 0.192 *Other diseases and accidents of pregnancy and parturition 9 1 8 8 3 9 1.727 Congenital debility, malformation and Premature Birth 82 73 89 72 58 100 0.412 Violent Deaths (excluding suicide) 61 46 45 64 65 79 0.325 Suicide . 24 21 16 24 32 37 0.152 Other Defined Diseases 568 860 1206 808 814 874 3.601 Diseases Ill-Defined or Unknown — 12 8 4 10 14 0.058 Total 2409 2628 2857 2491 2703 2880 11.589 *Calculated per 1,000 live and still births. 1947 showed a slight increase in both the death and birth rates. 10 MAYDAY HOSPITAL. Medical Superintendent: C. F. Swinton, M.D., E.R.C.S.(Ed.), Ch.M. Nursing Staff. Matron: Miss J. Llewellyn, S.R.N. Trained Nurses 76 Assistant Nurses 7 Student Nurses 91 Male Nurses 10 Steward : Mr. R. Grist. The following Specialist Services are carried:—Orthopædic, Gynaecological and Obstetrical, Dental, X-ray, Deep X-ray Therapy, Massage, Ultra Violet Light, Ophthalmic, Ear, Nose and Throat, School E.N.T. Clinic, Gastroscopy, Psychiatric, Medical and Surgical Out-patients. TABLE I. 1947 1946 1. Total number of admissions (including infants born in hospital) 8250 8471 2. Number of women confined in hospital 1320 1316 3. Number of live births 1281 1224 4. Number of still births 57 75 5. Number of deaths among the newly-born (i.e., under 4 weeks of age) 24 47 6. Number of deaths among children under one year (including those given under 5) 86 89 7. Number of maternal deaths among women admitted to hospital for confinement 1 — 8. Total number of deaths 807 804 9. Total number of discharges "(including infants born in hospital) 7873 7649 10. Duration of stay of patients included in 8 and 9 above :— (a) under four weeks 6464 6980 (b) four weeks and under thirteen weeks 1058 1193 (c) thirteen weeks or more 351 280 11. Number of beds occupied (excluding cots in maternity wards):— (a) Average during the year 453 443 (6) Highest—574 on 9/5/47 — 552 on 4/2/46 (c) Lowest—407 on 26/12/47 — 404 on 25/12/46 12. Number of surgical operations under anaesthetic 1987 2924 13. Number of abdominal sections 559 516 11 TABLE II. Classification of In-Patients who were Discharged from or who Died in the Institution During the Year ended 31st December, 1947. Disease Groups Children (under 16) Men and Women Discharged Died Discharged Died A. Acute infectious disease 28 — 15 2 B. Influenza 3 — 4 1 C. Tuberculosis: Pulmonary 10 1 132 25 Non-Pulmonary 9 — 18 — D. Malignant Disease — — 73 138 E. Rheumatism— (1) Acute rheumatism (rheumatic fever) together with sub-acute rheumatism and chorea 4 - 4 - (2) Non-articular manifestations of so-called "rheumatism" (muscular rheumatism, fibrositis, lumbago and sciatica) - - - - (3) Chronic Arthritis 2 — 29 — F. Venereal Disease — — 1 — G. Puerperal Pyrexia Puerperal Fever — — 2 — H. Other diseases and accidents connected with pregnancy and childbirth — — 636 I. Mental diseases 6 — 269 3 J. Senile decay — — 34 3 K. Accidental injury and violence 80 1 223 22 L. Diseases of the Nervous System and Sense Organs 23 10 77 115 M. Disease of the Respiratory System 125 24 260 62 N. „ „ Circulatory System 16 5 188 208 O. „ „ Digestive System 186 21 619 60 P. „ ,, Genito-Urinary System 158 3 168 44 Q. „ „ Skin 76 — 144 1 R. Other diseases 386 21 388 13 S. Mothers and infants discharged from Maternity Wards and not included in the above figures: Mothers — - 1320 - Infants 1281 24 — — T. Any persons not falling under any of the above headings 40 29 — 2433 110 4633 697 12 RADIOLOGICAL DEPARTMENT. A. RADIODIAGNOSIS. 1947. 1946. 1. Total Number of Patients Examined 8,393 5,072 (a) In-Patients 2,824 1,858 Male Wards 1,306 879 Female Wards 1,186 784 Children's Wards 210 97 Maternity and Gynaecological Wards 122 98 (b) Out-Patients 5,569 3,214 Mayday Hospital 1,907 579 Maternity and Gynaecological Clinics 555 342 T.B. Clinic 2,592 1,848 Men 1,107 759 Women 1,141 880 Children 34 1 209 Dental Clinic 144 138 Staff 285 250 Others 86 57 2. Total Number of Films Taken 14,544 7,825 3. Total Number of Screening Examinations 686 400 4. Special Examinations— Barium Meals, including oesophagus 340 312 Barium Enemas 48 38 Cholecystographies 76 44 Pyelographies 112 39 Chests 4,568 2,816 Bronchographies 21 22 Skeletal System 2,373 1,240 Skull 205 136 Spine and Pelvis 336 192 Extremities 1832 912 Maternity and Gynaecological 596 404 Dental 175 132 Miscellaneous 84 25 B. RADIOTHERAPY. 1. Number of Patients Treated 155 69 Mayday Hospital 62 53 Croydon General Hospital 91 16 Others 2 — 2. Number of Treatments Given 2,279 914 13 3. Conditions Treated— (Number of Patients) (a) Malignant Diseases 102 51 Carcinoma of Breast 62 22 Gynaecological Carcinoma 6 4 Carcinoma of Mouth and Neck 7 3 Carcinoma of Skin 7 3 Other Carcinoma 6 7 Sarcoma of Bone 8 7 Lymphadenoma and Leukaemia 7 5 (b) Non-Malignant Diseases 53 18 Dermatological 30 4 Osteo-arthritis 18 2 Menorrhagia 2 12 Miscellaneous 3 — PHYSIOTHERAPY. Massage 12,657 Radiant Heat 10,940 Exercises 4,528 Electrical 2,104 Diathermy 314 Infra-red 1,233 Ultra Violet Light 1,803 Wax 937 Spray Baths 1,260 Kromayer Lamp 164 Short wave 5,283 41,223 Total number of patients treated 2,268 MENTAL PATIENTS DEALT WITH DURING THE YEAR. Male. Female. Admitted 120 169 Certified and sent to Warlingham Park Hospital 2 13 As Voluntary Patients to Warlingham Park Hospital 75 76 Discharged not certified 43 80 SPECIMENS EXAMINED IN THE PATHOLOGICAL LABORATORY DURING THE YEAR. Positive. Negative. Swabs for Diphtheria _ 1,012 Sputa for T.B. 655 1,163 Pus for T.B 2 8 Pus for Gonococci — 386 Urine for T.B 3 27 Faeces for T.B. 4 8 14 Faeces for Coli Typhoid Group— (1) Cultures — 323 (2) Microscopy or ? amoebae — 306 Blood—Widals 4 18 Hairs for ringworm 7 7 Blood cultures 2 37 Faeces for occult blood 291 468 4,731 Urine for routine examination 1,837 Pus for organisms 386 Blood urea estimations 298 Blood sugar estimations 184 Cerebro-spinal fluids 141 Urea Cone. Tests Urea clearance tests 82 Fractional test meals 181 Pleural fluids 85 Blood counts 1,053 Haemoglobin estimations 1,116 Blood groups 592 Compatability tests 286 Faecal fat examinations 2 Van den Bergh reaction 10 Blood sedimentation rates 1,154 Glucose tolerance tests 14 Blood coagulation and bleeding time 80 Other examinations—unclassified 166 Total number of examinations 12,398 Number of specimens sent to Croydon General Hospital— Blood for W.R. and Kahn 2,761 Blood for W.R. only 206 Blood for G.C.F.T 143 C.S.F. for W.R. and Lange 53 Tissue for Histology 369 Specimens for Guinea Pig inoculations 2 3,534 Specimens sent to Sutton Blood Depot for R.H. factor 3,287 NUMBER OF POST MORTEMS ORDERED BY THE CORONER AND PERFORMED AT MAYDAY HOSPITAL DURING THE YEAR. Outside cases 333 Hospital cases 107 Number of Post-Mortems not ordered by the Coroner 163 15 Table III Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Alimentary Appendicitis — — — — 204 39 1 1 245 Appendicular Colic 2 - - - - - - - 2 Appendicular Abscess 5 3 - - - - - - 8 Gastric Ulcer 4 32 1 8 4 6 — 3 58 Duodenal Ulcer — 20 — 4 2 6 — 6 38 Dyspepsia 1 2 - - - - - - 3 Cholelithiasis — — — — 1 5 — — 6 Colitis 2 8 — 1 — 1 — — 12 Intestinal Obstruction — — — — 3 6 1 7 17 Ischio-rectal Abscess — 1 - - - - - - 1 Constipation 12 20 - - - - - - 32 Hernia — 6 — — 71 44 1 9 131 Haemorrhoids 1 1 — — 4 15 — — 21 Cholecystitis — 11 — — 4 18 — — 33 Gastro-enteritis 14 20 2 23 — — — — 59 Gastritis 2 13 - - - - - - 15 Alveolar Abscess 3 3 - - - - - - 6 Intestinal Colic 6 11 — — 1 - — — 18 Catarrhal Jaundice 1 1 - - - - - - 2 Prolapse of Rectum 1 — — — 1 1 — — 3 Pyloric Stenosis 1 1 — — 2 1 — — 5 Diarrhoea — 2 - - - - - - 2 Peptic Ulcer 5 23 2 2 1 — — — 33 Peritonitis — 1 — — 3 1 — 4 9 Adhesions — 6 — — 7 1 — 1 15 Jaundice 1 4 1 1 — — — — 7 Collapse — — 1 - - - - - 1 Peritonsillar Abscess 6 - - - - - - - 6 16 Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Perianal Abscess - - - - 3 4 — — 7 Acidosis - - - - - - - - 1 Pancreatitis — - — 1 — — — — 1 Ascites — 1 — — — — — 1 Diverticulitis 1 4 - - - - - - 5 Intussusception — — — — 2 — — 2 4 Coeliac Disease — — — 1 — — — — 1 Haematemesis — 13 - — — — — — 13 Actinomycosis - - — — — - — — - Hepatitis 1 2 1 2 — - - — 6 Cirrhosis of Liver — 1 — 1 — - — — 2 Yellow Atrophy of Liver — — 1 3 — — — — 4 Rectal Polypi — 1 — — 1 — — — 2 Fistula in Ano — 2 — — 5 3 — — 10 Swallowed F.B. 20 — 1 — — — — — 21 Tapeworm — 1 — — - — — — 1 Stomatitis 1 - - - - - - - 1 Abdominal Abscess — — — — — 1 - — 1 Gastroptosis - 1 - - - - - - 1 Pyloric Spasm 1 3 - - - - - - 4 Ilitis — — — — — 1 — — 1 Gingivitis — 2 — — — — — — 2 Malaena — — 1 — — — — — 1 Achlorhydria — 1 - - - - - - 1 Perforated Colon - - - - - - - 1 1 Guardia Intestinalis 1 - - - - - - - 1 Intestine Hypotonia — 1 - - - - - - 1 Abdominal Pain 1 - - - - - - - 1 Biliary Gravel — 1 - - - - - - 1 G.I.T. Lesion — 1 - - - - - - 1 Ptosis of Stomach — 1 - - - - - - 1 886 17 Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Bones and Joints Arthritis 1 25 2 — — — — — 28 Fibrositis — 6 - - - - - - 6 Bursitis 2 3 — — — — — — 5 Paget's Disease — 1 1 — — — — — 2 Spina Bifida — — — 5 — — — — 5 Synovitis — 4 — - — — — — 4 Osteomyelitis 1 14 - - - - - - 15 Osteo-arthritis — 10 - - — — — — 10 Acute Rheumatism — 8 — — — — — — 8 Hallux Valgus — — — — 3 1 — — 4 Muscular Rheumatism — 1 - - - - - - 1 Talipes — 1 - - - - - - 1 Exostosis — 1 - - - - - - 1 Sequestra of Fibula — — 1 — — — — - 1 Myelomatosis — — — 1 — — — — 1 Effusion into Joint — 1 — — — — — — 1 Hammer Toe — — — — 1 1 — — 2 Ganglion — — — — — 2 — — 2 Osteoclastoma 1 — — — — — — — 1 Amyotrophic Sclerosis — — — 1 — — — — 1 Congenital Dislocation of Limbs — 1 - - - - - - 1 Coccyalgia — 1 - - - - - - 1 Necrosis — 1 — — — — — — 1 Ankylosis 1 - - - - - - - 1 103 Carcinoma Breast - - - - - 7 10 19 36 Rectum - - - - - 3 4 8 15 Stomach - - - - - 2 6 20 28 18 Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Cervix - - - - - - 2 1 3 Ovary - - - - - - 1 5 6 Uterus - - - - - - - 2 2 Prostate - - - - - 1 3 6 10 Colon - - - - - 3 5 23 31 Tongue and Mouth - - - - - - 2 — 2 Larynx - - - - - 1 — 1 2 Oesophagus - - - - - - - 3 3 Bladder - - - - - - - 3 3 Pancreas - - - - - 1 — 1 2 Lung — — — — — — 2 4 6 Bronchus - - - - - - 7 26 33 Epithelioma - - - - - - - 2 2 Peritonei - - - - - - 2 1 3 Testis — — — — — — — 1 1 Sarcoma - - - - - 2 4 2 8 Liver - - - - - - - 2 2 Thyroid - - - - - - - 1 1 Glands - - - - - - - 1 1 Pharynx - - - - - - - 1 1 Jaw - - - - - - 1 1 2 Neck - - - - - - - 1 1 Ventriculi - - - - - 2 1 1 4 Tonsil - - - - - - 1 — 1 Vulva - - - - - - - 1 1 Caecum - - - - - - - 1 1 211 Circulatory Blood Anaemia 1 2 — 1 — — — — 4 Septicaemia 1 3 - - - - - - 4 19 Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Hyperpiesia - - - - - - - - - Pernicious Anaemia - 2 — 2 — — — — 4 Thrombosis - 3 - - - - - - 3 Phlebitis 2 2 — 1 — — — — 5 Gangrene - - - - - 2 1 2 5 Varicose Veins — — — — 2 7 1 — 10 Leukaemia — — — 3 — — — — 3 Epistaxis — 7 - - - - - - 7 Malaria — 1 - - - - - - 1 Varicose Ulcer 3 7 — 1 — — — — 11 Trendelenburg — 1 - - - - - - 1 Ischaemia — — 1 - - - - - 1 Thrombo-Cytopenia 1 - - - - - - - 1 Naevus — - — — 3 2 — — 5 Toxaemia — — — 6 — — — — 6 Banti's Disease — 1 - - - - - - 1 Oxalaemia — 1 - - - - — - 1 Aneurisia — 1 - - - - - - 1 74 Circulatory Heart Myocardial Degeneration — 7 2 82 — — — — 91 Hypertension — 31 1 1 — — — — 33 Aortic Incompetence — 2 — 4 — — — - 6 Arterio-sclerosis — 6 — 5 — — — - 11 Coronary Thrombosis 2 12 — 25 — — — - 39 Endocarditis — 1 1 - - - - - 2 Auricular Fibrillation — 13 — 8 — — — — 21 Myocarditis — 1 — 2 — — — - 3 Mitral Stenosis — 12 1 3 — — — - 16 Carditis — 1 - - - - - - 1 20 Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Congestive Heart Failure — 24 - 61 — — — — 85 Congenital Heart Disease — — — 2 — — — — 2 Achalasia of Cardia — — 1 — — — — — 1 Angina 1 7 - - - - - - 8 Rheumatic Carditis — 2 - - - - - - 2 Cardiac Disease — — — 2 — — — — 2 Aortitis — — — 1 — — — — 1 Aortic Regurgitation — — 1 — — — — — 1 Heart Block — 1 — 1 — — — — 2 Lymphangitis 1 — 1 - - - - - 2 Rheumatic Fever 5 9 - - - - - - 14 343 Constitutional Diabetes Mellitus — 27 — 4 — — — — 31 Nutritional Disorder 8 6 - - - - - - 14 Marasmus — 1 - - - - - - 1 Malnutrition 1 4 — 1 — — — — 6 Rickets 2 - - - - - - - 2 Cachexia — — — 3 — — — — 3 Diabetic Coma — 1 - - - - - - 1 Debility — 4 - - - - - - 4 Obesity — — 1 — — — — — 1 Dietetic Upset 6 3 - - - - - - 9 Fatigue 1 - - - - - - - 1 73 Ear, Nose and Throat. Enlarged T's and A's 6 4 — — 246 11 1 — 268 Quinsy 2 - - - - - - - 2 Otitis Media 19 32 - - - - - - 51 Mastoiditis — — — — 4 12 — — 16 21 Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Laryngitis 1 1 - - - - - - 2 Sinusitis 1 3 1 - - - - - 5 Bleeding Tonsil Tag 2 - - - - - - - 2 Coryza 6 - - - - - - - 6 Rhinitis — 1 - - - - - - 1 Pharyngitis — 2 - - - - - - 2 Catarrh — 1 - - - - - - 1 356 Genito-Urinary Nephritis 2 8 — 6 — — — — 16 Urethral Stricture 1 8 - - - - - - 9 Vesical Calculus - - - - - 3 1 — 4 Pyelitis 5 35 - - - - - - 40 Enlarged Prostate 1 4 — — 5 20 — 1 31 Uraemia — 1 — 30 — — — — 31 Renal Colic — 5 1 1 — — — — 7 Urinary Calculus - - - - - 3 — — 3 Pyelonephritis — — — 6 — — — — 6 Suprapubic Fistula — 1 - - - - - - 1 Hypernephroma of Kidney — 1 - - - - - - 1 Hydronephrosis - - - - - 2 — — 2 Circumcision — — — — 129 6 — — 135 Haematuria — 5 1 1 — — — — 7 Cystoscopy — — — — 1 — — — 1 Retention — 10 - - - - - - 10 Orchitis 2 4 — — — 2 — — 8 Sacral Sinus — — 1 — — — — — 1 Undescended Testicle — — — — 3 — — — 3 Glycosuria — — 1 — — — — — 1 Incontinence — 1 1 - - - - - 2 22 Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Pilonidal Sinus — — — — 1 — — — 1 Cystitis 1 17 1 1 — — — — 20 Congenital Absence Left Kidney — — 1 — — — — — 1 Papilloma Bladder — — — — — 16 2 — 18 Con. Renal Tumour — — — 1 — — — — 1 Renal Calculus — 2 — — 1 — — — 3 Gall Bladder Calculus — — — — 1 2 — — 3 Balanitis — 1 - - - - - - 1 Urethro-Trigonitis — — 1 — — — — — 1 Urethral Dilatation — 1 - - - - - - 1 Hydrocele — — — — 1 3 — - 4 373 Glands Adenitis 16 11 - - - - - - 27 Hodgkin's Disease — — 2 — — — — — 2 Adenoma - — — — 3 3 — — 6 Goitre — 4 - - - - - - 4 Thyrotoxicosis 2 — — — 1 7 — — 10 Lymphadenoma — — — 1 — — — — 1 Glandular Fever 1 - - - - - - - 1 Cervical Cyst - - - - - 1 - - 1 52 Gynaecological Abortion — — — — 269 — — — 269 Fibrosis Uteri — — — — — 9 — — 9 Ovarian Cyst — — — — 2 22 — — 24 Uterine Haemorrhage — — — — — 19 — — 19 Mastitis — — — — 5 9 — — 14 Amenorrhoea — — — — — — — — - Menorrhagia — — — — — 14 — — 14 23 Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Metrorrhagia — — — — — 2 — — 2 Vaginitis — — — — 1 — — — 1 Dysmenorrhoea - - - - - 1 — — 1 Bartholin's Cyst — — — — 2 — — — 2 Bartholin's Abscess — — - — 6 — — — 6 Erosion of Cervix - - - - - 20 — — 20 Hysterectomy — — — — — 77 — — 77 Deficient Pelvic Floor — — — — 4 19 — — 23 Cervical Polypi — — — — 3 — — — 3 Salpingitis — — — — — 8 — — 8 Retroversion — — — — 1 — — 1 Salpingo-oophoritis - - - - - 8 — — 8 Retained Products - - - - - 17 — — 17 Urethral Caruncle - - - - - 2 — — 2 Cystocele - - - - - 4 — — 4 For Sterilization — — — — 1 3 — — 4 Sterility - - - - - 1 — — 1 Dermoid Cyst — — — — 1 — — — 1 Urethral Tear — — — — — 1 — — 1 Procidentia — — — — — 1 — — 1 Vaginal Discharge - - - - - 1 — — 1 E.U.A. — — — - 2 22 — — 24 Menopausal Syndrome — — — — — 2 — — 2 Imperforate Hymen - - - - - 1 — — 1 Excision of Vulva — — — - - 1 — — 1 Prolapsed Uterus - - - - - 2 — — 2 Investigation - - - - - 2 — - 2 Progestone Implantation — — — — 1 — — — 1 Cervicitis - - - - - 1 — — 1 Cauterisation of Cervix — — — — 3 — — — 3 Dilatation of Cervix - - - - - 1 — — 1 24 Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Excision of Sinus — — — — 1 — — — 1 Laparotomy — — — — — 6 — — 6 Hydatiform Mole — — — — 1 — — — 1 Pruritis - - - - - 1 - — 1 Haemorrhage of Puberty — — — — — 1 — — 1 D. & C. — — — — — 16 — — 16 Rectocele — — — — — 1 — — 1 Recto-Vaginal Fistula - - - - - 1 — — 1 Vulvar Abscess - - - - - 1 — — 1 Myomectomy — — — — 2 — — — 2 Insufflation — — — — — 8 — — 8 Renal Investigation - - - - - 3 — — 3 Ventrofixation - - - - - 1 — — 1 614 Eye Conjunctivitis 4 - - - - - - - 4 Infectious Influenza 3 3 — 1 — — — — 7 Puerperal Pyrexia 3 1 — - - - - - 4 Scarlet Fever — — 2 - - - - - 2 Poliomyelitis — 29 1 1 — — — — 31 Whooping Cough — — 1 - - - - - 1 Measles — — 7 — — — — — 7 Mumps — — 1 — — — — — 1 Streptoccal Haemalytic Carrier — 1 - - - — - - 1 Pneumococcal Meningitis — — — 1 — — — — 1 55 25 Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Maternity Pyelitis of Pregnancy - - - - - 19 — — 19 False Labour Pains - - - - - 56 — — 56 Ectopic Gestation - - - - - 2 — — 2 Albuminuria of Pregnancy — — — — — 1 — — 1 A.P.H. — — — — 7 — — — 7 R.B.P. - - - - - 1 1 — 2 Anaemia of Pregnancy — — — — — 2 — — 2 Vomiting of Pregnancy - - - - - 3 — — 3 A.N. Observation — — — — — 16 — — 16 A.N. Rest — — — — — 46 — — 46 Hyperemesis - - - - - 15 — — 15 Termination of Pregnancy — — — — — 10 — — 10 Toxaemia of Pregnancy — — — — — 23 — — 23 P.P.H. — — — — — 5 — — 5 Blood Transfusion — — — — — 1 — — 1 Intra-uterine Death - - - - - 1 — — 1 Suturing of Perineum — — — — — 3 — — 3 Eclampsia — — — — 1 1 — — 2 Hydramnies — — — — 1 — — — 1 For Version — — — — — 5 — — 5 Mothers — — — — 1320 — — — 1320 Babies — — — — 1281 — — 24 1305 2845 Mental Uncertified — 38 175 1 — — — — 214 Certified — — 11 — — — — — 11 Mental Deficiency — 1 7 - - - - - 8 Epilepsy — 13 2 1 — — — — 16 Senile Dementia — — 2 1 — — — — 3 26 Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Loss of Memory — 5 — — — — — - 5 Hysteria — 6 6 - - - - - 12 Depression 1 3 1 — — — — — 5 Mongolism — 1 — — — — — — 1 Schizophrenia — 3 - - - - - - 3 278 Nervous and Sensory Cerebral Haemorrhage — — 1 31 — — — — 32 Meningitis 7 3 — 5 — — — — 15 Chorea 1 3 - - - - - - 4 Hemiplegia - 16 — 12 — — — — 28 Sciatica 1 4 - - - - - - 5 Neurasthenia — 1 — — — — — — 1 Neurosis 2 9 1 - - - - - 12 Cerebral Thrombosis — 13 1 52 — — — — 66 Neuritis — 1 - - - - - - 1 Cerebral Tumour — 1 4 2 — — — - 7 Glioma — 1 - - - - - - 1 Paraplegia — 2 — - — — — — 2 Encephalitis — 1 — 3 — — — — 4 Cerebral Abscess — — — 3 — — — — 3 Subarachnoid Haemorrhage 1 1 — 6 — — — — 8 Paralysis — 1 — — — — — — 1 Habit Vomiting — 3 — — — — — — 3 Hydrocephalus — 1 — 3 — — — — 4 Headache — 2 - - - - - — 2 Convulsions — 5 — 1 — — — — 6 Vaso-Vagal — 1 - - - - - - 1 Cerebral Arterosclerosis — 1 — 3 — — — - 4 Hemiparesis 1 - - - - - - - 1 27 Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Cerebellar Tumour — — — 1 — — — — 1 Disseminated Sclerosis — 3 3 3 — — — — 9 Enuresis — 2 - - - - - - 2 Aides Syndrome — — 1 — — — — - 1 Anorexia — 1 - - - - - - 1 225 Respiratory Bronchitis 22 102 3 7 — — — — 134 Pneumonia 60 111 1 70 — — — — 242 Pleural Effusion — 12 - - - - - - 12 Lung Abscess - 4 - - - - - - 4 Bronchiectasis — 9 2 - - - - - 11 Atelectasis 1 2 — 2 — — — — 5 Pleurisy 2 7 - - - - - - 9 Emphysema — 2 — 1 — — — — 3 Asthma — 22 2 - - - - - 24 Empyema 1 5 1 - - - - - 7 Pulmonary Congestion — 1 — 1 — — — - 2 Spontaneous Pneumothorax — 1 - - - - - - 1 Haemoptysis — 1 — 1 — — — - 2 Pleural Thickening — - 1 — — — — — 1 Pulmonary Embolism — 1 — 2 — — — — 3 Pyrexia — 3 - - - - - - 3 Collapse of Lung — — — 2 — — — — 2 Pneumonitis 1 1 - - - - - - 2 Pulmonary Infarct 1 — - - - - - - 1 Silicosis — — 1 - — — — — 1 Boecks Sarcoidosis — — 1 - - - - - 1 Investigation — 1 - - - - - - 1 471 28 Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Senility - 4 29 3 — — — 36 Skin Boils, Abscesses Carbuncles, etc — — — — 19 57 1 — 77 Burns and Scalds — — — — 9 13 1 1 24 Eczema — 13 - - - - - - 13 Impetigo 2 4 - - - - - - 6 Scabies 5 - - - - - - - 5 Dermatitis 6 12 - - - - - - 18 Septic Spots 1 2 - - - - - - 3 Cellulitis 1 9 1 - - - - - 11 Ulceration — — — — 5 7 - — 12 Papilloma - - - - - 1 1 — 2 Whitlow - - - - - 1 - — 1 Psoriasis — 1 - - - - - - 1 Herpes 2 - - - - - - - 2 Pemphigus — 1 — - - - - - 1 Ringworm — - 8 — — - - 8 Sycosis Barbae — 1 - - - - - — 1 Erythema Nodosum 5 1 - - - - - - 6 Lipoma — — — — — 1 - — 1 Acne Vulgaris — 1 - - - - - - 1 Infected Wound 3 9 - - - - - - 12 Sebaceous Cyst - — — — — 3 - — 3 Angioma — 1 - - - - - - 1 Breast Abscess — — — — 6 4 - — 10 Furunculosis 1 - - - - - - - 1 Discharging Scars — — 1 — — — — — 1 Epidermophytosis 1 - - - - - - - 1 222 29 Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Tuberculosis Pulmonary T.B 1 132 15 26 — — — — 174 Epididymis — — 1 — — — — — 1 Meninges — — 3 — — — — — 3 Hip — 1 - - - - - - 1 Glands 1 5 2 - - - - - 8 Kidney — — 2 — — — — — 2 Os Pubis — 1 - - - - - - 1 Metatarsal — 2 - - - - - - 2 Spine — 1 1 - - - - - 2 Sacroiliac Joint — — 1 — — — — — 1 195 Venereal Syphilis — 1 - - - - - - 1 Violence Fractured limbs — — — — 18 90 3 11 122 Spine — — — — 1 2 — 4 7 Malleolus — — — — 1 3 — — 4 Skull — — — — 1 6 — 3 10 Ribs — — — — — 9 — — 9 Clavicle — — — — 1 3 — — 4 Pelvis - - - - - 2 — 2 4 Patella — — — — — 2 — — 2 Mandible - - - - - 1 — — 1 Humerus - - - - - 4 — — 4 Radius and Ulna - - - - - 5 — — 5 Minor Injuries — — — — 14 23 1 — 38 Contusions and Abrasions — — — — 2 12 — — 14 Sprain — — — — 1 8 — — 9 Bruises — — — — 1 6 — — 7 Dislocations — — — — 2 10 1 — 13 30 Diagnoses Medical Surgical Total Cured Relieved Unrelieved Died Cured Relieved Unrelieved Died Concussion — — — — 16 23 — - 39 Lacerations, Wounds, etc. — — — — 3 20 — — 23 Amputations - - - - - 7 — — 7 Multiple Injuries - - - - - 1 — 1 2 Cerebral Contusion - - - - - - - 1 1 Shock - - - - - - - 1 1 326 Miscellaneous Poisoning 10 8 — 6 — — — — 24 B.B.A. 4 - - - - - - - 4 N.A.D. 22 - - - - - - - 22 P.U.O. 6 7 - - - - - - 13 With Mother 20 - - - - - - - 20 Hare Lip and Cleft Palate - - - - - 5 1 — 6 Prematurity 2 2 — 11 — — — 15 F.B. — — — — 4 2 — — 6 Extraction of Tooth — — — — 1 5 — — 6 For X-ray — 4 - - - - - - 4 Removal of Nail — — — — 4 - _ — 4 Supernumerary Thumb — — — — 1 — — — 1 Vaccinia — — — 1 — — — - 1 Alcoholism 3 - - - - - - - 3 Dental Caries — — — — 1 — — — 1 130 TOTAL NUMBER OF PATIENTS DISCHARGED FROM MAYDAY HOSPITAL YEAR ENDED 31st DECEMBER, 1947. Cured 4,159 Relieved 2,498 Unrelieved 409 Died 807 7,873 TOTAL NUMBER OF OUT-PATIENTS TREATED AT MAYDAY HOSPITAL DURING THE YEAR 1947 21,671 31 operations performed at mayday hospital during 1947. abdominal. Gastrectomy 4 Resection of Gut 5 Lumbar sympathectomy 1 Repair of intestine 4 Caecostomy 5 Intussusception 5 Gastro-jejunostomy 1 Fistula in Ano 7 Resection of colon 1 Carcinoma of splenic flexure 1 Oesophagoscopy 1 Appendicectomy 220 Intestinal obstruction 4 Appendix abscess drained 3 Sigmoidoscopy 31 Enterectomy 1 Herniotomy 110 Cholecystectomy 12 Laparotomy 19 Gastro-enterostomy 5 Colostomy 16 Perforated gastric ulcer 18 Injection of Haemorrhoids 2 Haemorrhoidectomy 17 Perforated duodenal ulcer . 3 Peptic ulcer 2 Gastroscopy 11 509 bones and joints. For osteo-myelitis 4 Amputation of limbs 16 Wiring of bones 48 Removal of pins and wire 3 Resection of rib 5 Application of plaster 70 Reduction of joints 27 Manipulation of limbs 39 Osteotomy 2 Removal of Sequestrum 1 Division of webbed phalanges 1 Bone graft 2 Excision of coccyx 1 Excision of Fract. Patella 1 Hallux Valgus 5 Arthrodesis 3 Removal of plaster 11 Hammer toe 1 Spinal meningocele 1 Prepatella bursa 1 242 32 ear, nose and throat. Thyroidectomy 9 Mastoidectomy 15 Tonsillectomy 130 Adenoidectomy 2 Laryngoscopy 1 Repair of hare lip 2 Cleft palate 3 Tonsil tags 1 Nasal septum, cauterised 1 Excision uvula 1 165 genito-urinary. Removal rectal polyp. 1 Cystoscopy 67 Circumcision 94 Prostatectomy 22 Supra-pubic cystostomy 30 Urethral dilatation 16 Fulguration of bladder 3 Insertion De-Pezzer catheter 5 Supra-pubic stab 2 Undescended testicle 3 Orchidectomy — For hydrocele 6 Examination 3 Cholecystotomy 10 Supra-pubic Lithotomy 1 Cauterisation Papilloma 1 Nephrectomy 4 Proctoscopy 1 Repair of prolapse of Rectum 1 270 gynaecological. Examination under anaesthetic 27 Total Hysterectomy 52 Sub-total Hysterectomy 36 Salpingo-oophorectomy 8 Dilatation and curetage 41 Salpingectomy 4 Ovariotomy 5 Incision of Bartholin's cyst 2 Incision of Bartholin's abscess 2 Insertion of Pessary 2 Ventro-fixation 1 Colpo-perineorrhapy 17 Cauterisation of Cervix 52 Excision of Vulva 2 Fothergill's operation 6 Implantation 7 Cervical polypus 1 Biopsy of Cervix 16 Suture of Cervix 1 33 Removal of gauze packing from uterus Biopsy of uterus 1 Suture of laceration of vaginal wall 2 Incision of hymen 2 Myomectomy 3 Suturing of perineum 3 Pelvic examination 5 Ruptured membranes 2 Correction of retroversion 1 Insufflation 7 Cautery excision of urethral caruncle 2 Removal of fibroid 3 Removal of ovarian cyst 23 Laparotomy 13 Drainage pelvic abscess 1 351 obstetrical. Caesarian section 83 Evacuation of Uterus 199 Bougie induction 5 Induction of labour 80 Termination of pregnancy 10 A.R.M. 30 407 miscellaneous. Removal of warts 2 Incisions, abscesses, etc. 83 Cleaning of burns, etc 3 Skin graft 5 Amputation of breast 11 Suture of wounds 35 Removal of sutures 1 Excision of wounds 2 Removal cartilage 2 Aspiration of chest 1 Aspiration of ankle 1 Removal of foreign body 10 Paracentesis 1 Extraction of teeth 15 Injection of varicose veins 3 Ligature of varicose veins 14 Removal of glands 6 Aspiration of cold abscess 5 Diathermy 9 Removal of naevus 7 Removal of ganglion 2 Pyelogram 1 Excision of scar tissue 1 Intravenous saline 1 Biopsy 2 Removal of toe nail 6 Phrenic crush 61 Bronchoscopy 1 Thoracotomy 2 34 Lipoma of thigh 1 Lipoma of buttock 1 Lipoma of chest 2 Trendelenburg 2 Divisions of adhesions 8 Trephining 1 Evisceration of Cornea 1 Excision of adenoma 3 Excision of cyst 14 326 Number of patients who had teeth extracted : 243. Coombe Cliff Convalescent Home. The following is a summary of the cases dealt with : — Number of cases admitted during the year 144 Total number of cases discharged 119 Number of patient days—45.7 per patient (1947 cases). Age groups of cases admitted. 0-4 5—8 9—12 Over 12 Total Male 33 35 14 1 83 Female 9 33 18 1 61 Total 42 68 32 2 144 Condition on discharge. 0—4 5—8 9—12 Over 12 Total M. F. M. F. M. F. M. F. M. F. Improved 5 1 7 5 1 6 - - 13 12 Much Improved 10 4 15 15 8 9 1 1 34 29 No change 2 - 1 — 1 - - - 4 - Discharged at parent's request 3 1 2 2 - - - - 5 3 Transferred to Hospital, etc 7 2 2 6 1 1 - - 10 9 Total 27 8 27 28 11 16 1 1 66 53 35 PUBLIC ASSISTANCE. (a) Domiciliary Relief. Number of Croydon cases resident in the Borough and in receipt of outdoor relief on the— 1st January, 1947 1,628 persons 884 cases 1st July, 1947 1,517 ,, 840 „ 1st January, 1948 1,522 ,, 813 ,, Expenditure on Out-relief during the 12 months ended 30th September, 1947, to Croydon cases resident in the Borough :— Half-year ended 31st March, 1947 £32,993 14s. 6d. Half-year ended 30th September, 1947 £32,452 l1s. 6d. (b) Institutional Relief. Number of Croydon persons relieved in the Mayday Hospital on 1st January, 1948, and in the Queen's Road Homes on the same date : — Mayday Hospital 36 Queen's Road Homes and Hostels 507 (excluding 25 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 district. Particulars for Year ended 31-3-48. All Districts. (1) Average number of separate patients attended during each quarter 1,912 (2) Attendances at patients' homes 15,265 (3) Attendances on patients at the surgery 18,809 (4) Total number of prescriptions written 41,341 (5) Estimated cost of drugs, dressings and dispensing £3,310 18s. 0d. (6) Estimated amount of per capita payment to doctors in respect of patients actually attended (calculated quarterly) 5s. 9.83d. (7) Estimated average payment per service point 2.10d. 36 HOME HELPS. The Home Helps scheme during the year 1947 expanded considerably largely owing to the considerable increase that occurred in the birth-rate. (1) Number of Home Helps—January 1st and December 31st, 1947— 1/1/47. 31/12/47. (a) Full-time 35 37 (b) Part time 10 20 (2) Number of applications— (a) Maternity 825 (b) Sickness 141 (3) Number of applications met— (a) Maternity 771 (b) Sickness 100 (4) Average duration of services given— (a) Maternity 14 days (b) Sickness 10—21 days (5) Amount recovered for services £1,770 17s. 5d. (6) Rate of remuneration of "Helps"— (a) Maternity : Jan. 1st—Oct. 28th £4 5s. 2d. weekly Oct. 29th—Dec. 31st £4 14s. Od. weekly (b) Sickness : Jan. 1st—Oct. 28th l/9fd. per hour Oct. 29th—Dec. 31st 2/0d. per hour Reference should also be made to page 97 for further data in regard to this Service. AMBULANCE SERVICE. To the Medical Officer of Health. I beg to submit the Sixth Annual Report and Statistics of this Service, for the year ended 31st December, 1947. During the year the Service dealt with 18,368 calls, which is an increase of 3,094 over the figures for 1946, and this increase is spread over all types of cases. The total mileage covered by ambulances on calls during the year was 146,199 miles, which is almost double the mileage for 1946. 37 The average time for an ambulance to attend a call remained substantially the same at 4½ minutes. Once again during the past year the Croydon Ambulance Service has been requested by adjacent Boroughs to stand by for accident calls, and these requests have always been attended to. During the year the ambulances ABY 229, BOY 555 and CCP 392 have been replaced by two Heavy Albion ambulances and one Light Morris ambulance. In addition one new Humber Pullman has been supplied by Roots, Ltd., and has proved completely satisfactory as regards springing and accessories. On 25th January, 1947, there was an air crash at Croydon Airport, to which one heavy Albion ambulance and four other ambulances were despatched. Twelve bodies were conveyed to the mortuary. Also, on the 14th June, 1947, the Service received a call* to Pampisford Road, where a plane had crashed. As the Airport ambulance was at the scene, no casualties were conveyed, but the personnel of this Service rendered first aid to the three casualties and, as the Airport ambulance had no bell, one of the ambulances of this Service preceded same in order to ensure a clear run to hospital. On 24th October, 1947, the Service received a call to the railway disaster at Sussex Road. Eight ambulances, two ambulance sitting cars and emergency tender were despatched, and dealt with 51 casualties—37 of which were conveyed to hospitals for treatment and 14 bodies to Mayday mortuary. Assistance was also given by ambulances of surrounding Boroughs when requested. The call was received at 8.29 a.m. and all casualties and bodies, totalling 120 in all, had been removed and the incident closed at 10.5 a.m. The two Albion heavy ambulances purchased from the Ministry of Supply have both been painted internally and externally. FRK 900 has been converted to carry 16 sitting patients or 2 stretcher and 10 sitting patients. Both these vehicles have proved to be of great value to the Service for conveying children to and from New Addington Day Nursery daily, transport of ante-natal cases from New Addington to Lodge Road Clinic weekly, cases from Mayday Hospital to Monteagle Nursing Home (daily), and also for the transport of children after tonsil and adenoid operations to their various homes thrice weekly, 38 The system of noting accident calls on a map is still being maintained, but owing to the widespread nature of the calls for 1947 it is not possible to pinpoint any specific areas as " blackspots," as calls seem to have been evenly distributed throughout the Borough. I 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, once again, no complaints have been received. In conclusion, may I express my thanks to the members of the Ambulance Sub-Committee and to the Medical Officer of Health for the help, encouragement and advice I have received, which has been of great assistance to me in the administration of the Service. A. L. HILL, Chief Officer. ANALYSIS OF ACCIDENTS FOR YEAR ENDED 31st DECEMBER, 1947. 1947. 1946. Collision between Vehicles, Cycles, &c. 130 124 PEDESTRIANS KNOCKED DOWN BY— (1) Motor Cycle 29 19 (2) Motor Lorry 32 33 (3) Pedal Cycle 35 25 (4) Public Service Vehicle 16 20 (5) Motor Car 51 80 163 177 INJURIES SUSTAINED BY FALLING— (1) In the Street 160 114 (2) In the Home 59 70 (3) From Vehicles, Cycles, &c 89 63 (4) Down Stairs 34 28 (5) From Trees, Scaffolding, &c 12 12 354 287 WORKS ACCIDENTS— (1) Caught in Machinery 18 16 (2) Crushed by heavy objects 30 16 (3) Miscellaneous accidents at work 54 99 (4) Falling 25 — 127 131 39 ACCIDENTS IN PUBLIC PLACES— 1947. 1946. (1) Theatres 3 2 (2) Cinemas — 1 (3) Public Halls — 3 (4) Railway Stations 12 15 (5) Sports Grounds 34 27 (6) Recreation Grounds 11 19 60 67 Miscellaneous Accidents 149 62 DEATHS— (1) Certified at Hospital . 43 43 (2) Certified at scene of accident or illness 10 11 53 54 SUICIDES— (1) Hanging — — (2) Poison 1 (3) Coal Gas Poisoning 11 13 (4) Gun-shot Wound 1 — 13 15 ATTEMPTED SUICIDE— (1) Poison 8 8 (2) Cut Throat . 4 1 (3) Coal Gas Poisoning 11 12 (4) Cutting Wrists — 2 (5) Hanging 2 — (6) Jumping from Roof 1 — (7) Overdose of Sleeping Tablets 1 — 27 23 BURNS AND SCALDS 16 21 PERSONS FALLING FROM PUBLIC SERVICE VEHICLES 40 27 COMMON ASSAULT 33 20 SUDDEN ILLNESS IN THE STREET 341 322 EPILEPTIC FITS 90 53 OXYGEN USED 50 46 ACCIDENTS TO CHILDREN UNDER 15 YEARS OF AGE— (1) Schools 87 78 (2) In the Home 98 82 (3) In the Streets 194 164 379 324 40 During the year 18,368 calls were dealt with by the Ambulance Service as follows: — 1947. 1946. Accidents in Streets, Places of Employment, and Public Places 948 897 Accidents in Private Houses 339 243 Sudden Illness in Street, Places of Employment, etc. 482 510 Sudden Illness in Private Houses 179 183 Transport of Cases from Hospitals after treatment . 876 871 Private Removals from Hospitals, Nursing Homes, Private Residences, etc. 4,007 3,185 Public Health Department—Transport of Patients 5,911 4,047 Public Assistance Department—Transport of Patients 810 626 Services of Ambulance not required or refused 231 177 Accidents in Schools 86 79 Calls taken by Mayday and Borough Hospital Ambulances 4,499 4,456 Totals 18,368 15,274 INCIDENCE OF CALLS. 2 days 5 calls 2 days 27 calls 10 days 49 calls 1 „ 6 „ 3 „ 28 „ 11 „ 50 „ 1 „ 7 „ 1 „ 29 „ 6 „ 51 „ 3 „ 8 ,, 2 „ 30 ,, 6 „ 52 „ 2 „ 9 „ 2 „ 31 „ 11 ,, 53 „ 4 ,, 10 „ 2 „ 32 „ 11 „ 54 „ 9 ,, 11 ,, 8 ,, 33 ,, 8 ,, 55 ,, 4 „ 12 „ 4 „ 34 „ 6 „ 56 „ 8 ,, 13 ,, 7 ,, 35 ,, 5 ,, 57 ,, 9 „ 14 „ 4 „ 36 „ 2 ,, 58 „ 11 „ 15 „ 12 „ 37 ,, 6 „ 59 „ " 9 ,, 16 „ 6 „ 38 „ 5 „ 60 „ 6 ,, 17 „ 13 „ 39 „ 5 „ 61 „ 2 „ 18 „ 10 „ 40 ,, 4 „ 62 „ 4 „ 19 „ 10 „ 41 „ 3 „ 63 „ 6 „ 20 ,, 7 ,, 42 ,, 2 ,, 64 „ 8 „ 21 „ 18 ,, 43 „ 3 „ 65 „ 3 „ 22 ,, 7 „ 44 „ 2 66 „ 5 „ 23 „ 5 „ 45 „ 1 ,, 68 „ 4 „ 24 ,, 12 ,, 46 „ 2 „ 69 „ 2 „ 25 „ 7 „ 47 ,, 1 „ 74 „ 2 ,, 26 „ 6 „ 48 „ 1 „ 76 „ 1 „ 77 ,, FINANCIAL STATEMENT. Income from Private Use of Ambulances. Accounts totalling £295 10s. 6d. have been rendered during the year for the private use of ambulances for conveying sick persons to Hospitals, Nursing Homes, etc. Transport of Patients for Public Health Department. Accounts totalling £250 5s. Od. have been rendered to the Public Health Department for patients conveyed on their behalf. 41 Transport of Patients for Public Assistance Committee. Patients conveyed for Public Assistance Committee realised the sum of £176 10s. 0d. and accounts for this amount have been rendered. During the year cash to the value of £148 4s. 6d. (representing private removal money collected from patients at time of removal, and credit accounts paid to Headquarters Station) has been paid into the Finance Department. 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 3586 198 5 9 122 7 3 1942 5.56 23418 2690 992 526 4208 418 12 3 148 2 2 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 1947 7.95 146199 7640 4007 6721 18368 295 10 6 324 14 6 AMBULANCE STATISTICS—Year 1947. 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 continues to operate satisfactorily. The authorities concerned are: — Geographical Position in No. of Cases Authority. relation to Croydon. conveyed. Borough of Beckenham East of Borough Boundary 3 Carshalton U.D.C. and West „ „ 2 Borough of Beddington and Wallington. Borough of Mitcham North-West ,, 9 Coulsdon and Purley South ,, ,, 20 U.D.C. London County Council North ,, „ 15 42 On 707 occasions First Aid was rendered to injured persons prior to their removal to Hospital. On 50 occasions oxygen and carbon dioxide were administered to patients by means of the "Novox Resuscitating Apparatus." On 10 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 was called upon to deal with 13 cases of suicide and 27 cases of attempted suicide. Calls during the year were apportioned as follows: — Headquarters Station 9,100 No. 2 Station, Thornton Heath 3,517 No. 3 Station, Crunden Road 1,252 Mayday and Borough Hospitals 4,499 18,368 HOW CALLS WERE RECEIVED. Fire Stations and Ambulance Police Call Boxes All other sources Total 781 413 17174 18368 During the year the Service has again undertaken to convey children daily from Tennison Road to Addington Day Nursery and return, and also to collect children from their homes, convey them to St. Margaret's School and return them to their homes. The apparatus for gas and air analgesia has been in demand 576 times and a total of 3,823 miles were covered on calls for this apparatus. During the year the Service has answered calls to convey the "Flying Squad" from Mayday Hospital to various private addresses and hospitals. 43 INFECTIOUS DISEASES NOTIFIED DURING YEAR 1947. 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. 1947. 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 547 1 107 363 47 23 6 - 23 16 41 47 31 32 48 46 33 14 48 22 57 37 52 464 - 268 279 Diphtheria 25 - 4 13 3 3 2 - 1 1 1 - 3 2 - 1 - 1 6 3 5 1 - 20 1 9 16 Erysipelas 22 - - - 1 10 7 4 1 - 1 2 1 1 2 - 3 4 2 1 2 2 - 7 - 8 13 Cerebro-Spinal Meningitis 4 1 - 2 - - - - - - - - - - - - - - - - - - - 4 2 2 2 Enteric & Paratyphoid - - - - - - - - - - - - - - - - - - - - - - - - - - - Small Pox - - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 39 - - - 10 29 - - - - 20 - - - 1 - - 1 10 2 1 3 1 9 - - 39 Ophthalmia Neonatorum 11 11 - - - - - - - - 6 2 1 - - - - 1 - - - - 1 1 - 4 7 Poliomyelitis and Polio-encephalitis 58 - 15 19 13 11 - - 1 5 6 - 2 10 5 5 3 5 9 1 3 1 2 43 5 31 27 Dysentery 2 - - - - 1 - 1 - - 1 1 - - - - - - - - - - - 1 - - 2 Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Primary and Acute Influenzal Pneumonia 76 4 2 16 4 20 22 8 - - 9 2 - 3 2 7 11 10 11 5 11 3 2 - 12 39 37 Measles 1774 65 770 875 43 17 2 2 43 76 144 130 139 151 43 125 155 139 157 66 129 68 209 58 1 860 914 Whooping Cough 605 101 309 182 .3| 8 1 1 8 22 43 60 41 73 14 23 66 48 53 24 61 44 25 33 4 290 315 Totals 3163 183 1207 1470 124 122 40 17 77 120 272 244 218 273 115 208 271 223 297 124 270 159 292 640 25 1512 1651 41 Comments on the Incidence and Prevalence of Infectious Disease. Scarlet Fever cases showed an increase on 1946. The incidence rate of Diphtheria was 0.10, compared with 0.15 in 1946. No cases of Small Pox occurred during the year. There were 39 cases of Puerperal Pyrexia; 10 occurred in the 15-24 age group, and 29 in the age group 25-44 years. BOROUGH HOSPITAL. Table A gives a summary of all cases treated at the Hospital during 1947. 895 patients were admitted during 1947 which, together with 87 patients in hospital at the commencement of that year, makes a total of 962 patients dealt with. Included in the tables are 32 cases admitted from Penge Urban District. Twenty-two deaths occurred, giving a case mortality of 2.29 per cent. The distribution of fatalities by diseases was as follows: — Gastro-enteritis 9 Whooping Cough 6 Poliomyelitis 5 Diphtheria 1 Laryngeal Stridor 1 All Gastro-enteritis deaths and five of the six whooping cough deaths were in infants under one year of age, who thus contribute 15 of the total of 22 deaths. 45 Complaint for which admitted. Patients remaining in Hospital on 1st January, 1947 Patients admitted and discharged in 1947 Patients admitted during 1947 and remaining in Hospital on 1st January, 1948 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 47 47 - 466 466 - 40 40 - 506 506 - - 27 Poliomyelitis — - - 83 79 4 2 1 1 85 80 5 5.9 16 Polio Encephalitis — - - 1 1 — — — - 1 1 - - 3 Diphtheria 15 15 - 49 47 2 4 4 - 53 51 2 3.8 33 Measles 2 2 - 63 63 — 1 1 - 64 64 — - 13 Whooping Cough 1 1 - 34 28 6 4 4 - 38 32 6 15.8 27 Gastro Enteritis — — - 47 39 8 4 3 1 51 42 9 17.6 18 Mumps — — - 26 26 — 2 2 - 28 28 — - 12 C.S.M — — - 8 8 — — — - 8 8 — - 14 Erysipelas — — - 8 8 — — — - 8 8 — - 10 Dysentery — — - 2 2 — — — - 2 2 — — 8 Rubella — — - 3 3 — — — - 3 3 — — 15 Chicken Pox 1 1 - 3 3 — — — - 3 3 — - 15 Typhoid Fever 1 1 - 1 1 — — — - 1 1 — - 14 Glandular Fever — — - 1 1 — — — - 1 1 — — 22 Vincent's Angina — — - 1 1 — — — - 1 1 — — 3 Tonsilitis — — - 2 2 — — — - 2 2 — — 7 Meningitis — — - 5 5 — 1 1 - 6 6 — — 8 Pemphigus — — - 2 2 — — — - 2 2 — — 13 Ophthalmia Neonatorum — — - 1 1 — — — - 1 1 — — 15 Puerperal Pyrexia — — - 9 9 — 1 1 - 10 10 — — 10 Peurperal Sepsis — — - 1 1 - - - - 1 1 — — 15 Phlegmasia - — - 1 1 — — — - 1 1 — — 65 Venereal Disease - — - 3 3 — — — - 3 3 — — 11 No Disease — — - 13 13 — 2 2 - 15 15 — — 15 Pyrexia of unknown origin — — - 1 1 — — — - 1 1 — — 14 Totals 67 67 - 834 814 20 61 59 2 895 873 22 - - 46 SCARLET FEVER. The total number of Scarlet Fever cases admitted during the year was 506, an increase of 113 cases on 1946. Of the 506 cases 29 were not cases of Scarlet Fever, leaving a total of 477 cases of true Scarlet Fever. The following complications and sequelae occurred amongst the true Scarlet Fever cases : — Serum Cases. Non-Serum Cases. Total. Rhinorrhoea 7 3 10 Otorrhoea 12 13 25 Adenitis 4 6 10 Furunculosis 3 - 3 Paronychia 1 2 3 Impetigo 1 - 1 Conjunctivitis 2 1 3 Secondary Tonsillitis 4 5 9 Rheumatism 3 2 5 Enteritis — 1 1 Scarlet Fever Relapse 2 2 4 Pneumonia - 1 1 The average stay in hospital for serum cases was 28.2 days, and for non-serum cases 26 days. No deaths occurred amongst the Scarlet Fever cases. The total number of complications amongst the serum cases was 39, and a similar number of complications occurred amongst the non-serum cases. 47 Ages and Sexes Admitted. Scarlet Fever. Age. Male. Female. Totals. 0-1 1 1 1—2 9 2 11 2—3 14 7 21 3—4 17 42 29 4—5 15 22 37 5—10 97 102 199 10—15 60 71 131 15—20 14 19 33 20—30 7 11 18 30 or over 6 20 26 Total 1947 239 267 506 Total 1946 177 216 393 DIPHTHERIA. 53 cases were admitted with a diagnosis of diphtheria that is 36 less than in 1946. Of the 53 cases admitted 11 were found to be cases of positive swabs (Diphtheria carriers), and 15 cases were as follows: — Tonsillitis 6 Laryngitis 2 Coryza 2 Vincent's Angina 1 Glandular Fever 1 Diphtheria Contacts 3 Total 15 Thus only 27 cases of the 53 admitted were cases of true Diphtheria, of which only 7 had been immunized. There was 1 death. The child had not been immunized. 25 were cases of Faucial Diphtheria, 1 of Nasal Diptheria and 1 of Laryngeal Diphtheria. The following complications occurred: — Paralysis: Palate 8 Eyes 1 Pharynx 1 Myocarditis 6 Laryngeal obstruction 1 Secondary sore throat 2 Adenitis 1 48 Ages and Sexes Admitted. Diphtheria. Age. Males. Females. Totals. 0—1 2 1 3 1—2 1 2 3 2—3 0 0 0 3—4 1 2 3 4—5 0 2 2 5—10 2 8 10 10—15 6 7 13 15—20 0 3 3 20—30 6 3 9 30 & over 2 5 7 Total 1947 20 33 53 Total 1946 30 59 89 Poliomyelitis 86 cases were admitted as suffering from this disease, including one case admitted as polio-encephalitis. In 51 cases the diagnosis was confirmed. The incidence of admissions, corresponding with the nation-wide epidemic of this disease, was practically confined to the months July-October inclusive. Measles. Of the 64 admissions for this disease the diagnosis was confirmed in 58 cases. Complications occurred as follows: — Lobar Pneumonia. 1 Adenitis 1 Broncho-Pneumonia 3 Encephalitis 2 Otorrhoea 2 No fatal cases occurred. Whooping Cough. 38 cases were admitted as Whooping Cough, the diagnosis being confirmed in 33 cases. The following complications occurred: — Convulsions 3 Broncho-pneumonia 4 Enteritis 5 Anaemia 1 There were 6 fatal cases, in 3 of which convulsions was the fatal complication, and in the other 3 enteritis. Five deaths were in infants under one year, and the sixth in a child of 18 months. Gastro-Enteritis. There was a total of 51 admissions for this condition, of whom 44 were babies under one year. 10 of these cases were 49 found not to be suffering from gastro-enteritis, leaving 41 cases in which the diagnosis of gastro-enteritis was established. Of these 9 cases proved fatal. The age distribution of fatal cases was : under 6 months, 7 cases; 6-12 months, 2 cases. Further complications occurring in gastro-enteritis cases were: Convulsions—1, Jaundice—1, Broncho-pneumonia—1, Intestinal Atrophy—1. Mumps. The diagnosis was confirmed in all 28 cases of mumps admitted. There were no complications and no fatalities. Cerebro-Spinal Meningitis. Of the 8 cases admitted for this disease the diagnosis was confirmed in 4 cases. Complications were as follows : — Facial paralaysis—1 case, Ocular paralysis—1 case. There were no fatal cases. Meningitis other than Cerebro-spinal. 6 patients were admitted as suffering from meningitis of an unspecified nature. In none of these cases was the diagnosis of meningitis confirmed- Erysipelas. The diagnosis was confirmed in 7 of the 8 cases admitted as suffering from this disease, 1 case being re-diagnosed as cellulitis. One case of conjunctivitis was the only complication encountered and there were no fatalities. Dysentery. Only 2 cases were admitted for this disease, and in 1 of those the diagnosis had to be amended to enteritis. Rubella. Of the 3 patients admitted 2 were true rubella cases, the third being scarlet fever. Chicken Pox. Only 3 patients had to be admitted for this infection, 1 of whom was rediagnosed as dermatitis, 50 Typhoid Fever. The only case admitted for this disease was re-diagnosed as glandular fever. Glandular Fever. One case was admitted and the diagnosis confirmed. Vincent's Angina. In the only case admitted for this condition the diagnosis could not be confirmed. Tonsillitis. 2 patients were admitted for this complaint. Pemphigus. The 2 patients admitted were new born babies and the disease was of a mild type. Ophthalmia Neonatorum. Only 1 case required admission and recovered without complication. Puerperal Pyrexia and Sepsis. Of the 11 cases admitted 1 case was diagnosed as pyelitis and 1 as acute appendicitis. The remainder were suffering from infective conditions of the genital tract. Venereal Disease. The 3 patients requiring isolation for this condition were all in the puerperium. 15 healthy babies had to be admitted with the mothers suffering from the foregoing conditions, and are entered in the main table under the heading " no disease." Out of Borough Cases. Disease Males. Females. Total. Deaths. Scarlet Fever 2 11 13 — Diphtheria 2 5 7 — Poliomyelitis 2 6 8 — Gastro-enteritis. 3 — 3 1 Rubella - 1 1 — Total 9 23 32 1 51 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 and over Totals Deaths M F M F M F M F M F M F M F M F Poliomyelitis - - 2 3 7 8 18 11 4 14 8 4 2 3 1 - 85 5 Polioencephalitis — — — — — — 1 — - - - — - - - - 1 - Measles 3 3 8 3 15 8 14 6 - 4 - — - - - - 64 - Whooping Cough 11 6 5 2 5 4 1 4 - - - - - - - - 38 6 Gastro-enteritis 28 16 2 2 2 - - - - - - 1 - - - - 51 9 Mumps — — — 2 8 4 7 5 - 1 - 1 - - - - 28 - Cerebro-spinal Meng. 1 — — — — 1 2 2 - - 1 - - - - 1 8 Erysipelas — — — — — — - 1 - - - - - - 4 3 8 Dysentery 1 - - - - - - - - 1 - - - - - - 2 Rubella — — - — - 1 - 2 - - - - - - - - 3 - Chicken Pox — — - 1 1 - - 1 - - - - - - - - 3 - Typhoid Fever - - - - - - - - 1 - - - - - - - 1 - Glandular Fever - - - - - - - - - - - - - - - - 1 - Vincent's Angina - - - - - - - - - - - - - - - - 1 - Tonsillitis — — — — 1 - - 1 - - - - - - - - 2 - Pemphigus — 2 - - - - - - - - - - - - - - 2 - Ophthalmia Neon — 1 - - - - - - - - - - - - - - 1 - Puerperal Pyrexia — — — - — — - - - 1 — 6 - 3 _- - 10 - Puerperal Sepsis - - - - - - - - - - - 1 - - - - 1 - Phlegmasia — - — - — — - - - - — 1 - - - - 1 - Venereal Disease — — — — — - - - - 1 - 1 - 1 - - 3 - No Disease 8 7 - - - - - - - - - - - - - - 15 - Pyrexia of unkn. orig. - - - - 1 - - - - - - - - - - - 1 - Meningitis (other) 1 1 - 1 1 1 — 1 - - — - - - — - 6 - Totals 53 36 17 15 41 28 43 34 5 22 9 15 2 7 5 4 336 20 52 Report on work done in the Laboratory. NOSE AND THROAT SWABS EXAMINED FOR DIPHTHERIA BACILLI. Positives Total Positives on during Negatives. Examined. Admission. Convalescence. 33 60 1,451 1,544 FÆCES EXAMINED FOR PATHOGENS. Number Examined 56 Number found Negative 56 AGGLUTINATION TESTS (Dreyer's Technique for Typhoid, Paratyphoid and Salmonella Organisms). Number of Specimens Examined 3 Number found Negative 3 MISCELLANEOUS EXAMINATIONS. 4 Specimens of Urine: Routine examination. 4 Specimens of Pus: Staphylococcus Aureus grown. 11 Throat Swabs for Vincent's Organisms: 1 positive. 9 Cerebro-Spinal Fluids : 1 positive for Meningococcus, 8 sterile. 5 Eye Swabs cultured. 5 Vaginal Swabs cultured. 4 Specimens Blood for white cell count. 1 Specimen Blood for Haemoglobin content. 1 Specimen Blood for complete differential count. 1 Specimen of Sputum for Tubercle Bacilli : Negative. CULTURE MEDIA PREPARED. 150 doz. Loffler's Blood Serum Slopes. 6,500cc Nutrient Agar. 6,500cc Nutrient Broth. 500cc MacConkey Agar. l,000cc Peptone Water, 53 BACTERIOLOGICAL EXAMINATIONS. I am indebted to the Borough Pathologist, Dr. H. W. Southgate, for the figures given in the appended tables. At the Laboratory, Croydon General Hospuital. 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 19 883 ... ... ... 83 ... ... 8 914 5 70 3 94 35 2044 Virulence tests for Diphtheria ... ... ... ... 1 ... ... ... ... ... ... ... M.R.U ... ... 1 ... Sputum for Tub. Bac 33 315 ... ... ... ... 1012 1441 ... ... 1 14 21 277 1037 2047 Pus for Tub. Bac ... 11 ... 3 1 8 ... ... ... ... ... 103 ... ... 1 125 Pus for Gonococci ... 8 ... ... ... ... ... ... ... 14 ... 78 ... ... ... 100 Pus for other organisms ... 12 ... 6 ... 9 ... ... ... 14 ... 128 ... ... ... 169 Blood for Typhoid Groups ... 5 ... ... ... ... ... ... ... ... ... 28 ... 8 ... 41 aBlood for Wassermann ... 10 5 294 ... 12 1 ... ... ... 16 2730 ... ... 22 3046 Material for Spirochaetes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Faeces for Typhoid Group, etc. 3 38 ... ... ... 3 ... ... ... 1 3 66 ... 13 6 121 Hair for Ringworm ... ... ... ... ... ... ... ... 4 6 ... 6 ... ... 4 12 Examination of Urine 5 ... ... ... ... 99 ... 104 Examination of Pleural Fluid 1 ... ... ... ... ... ... 1 Examination of C.S. Fluid ... 53 8 ... ... 3 ... 64 Other Examinations 405 610 39 2 478 3360 34 4928 a The increase in the Nos. of W.R. and other examinations for " Other Institutions of the Corporation," is due to all Ante Natal cases having W.R.'s, Kahn's, etc. 54 Examinations for Special Clinic. Pos. Neg. Pus for Gonococci (Smears) 219 1,873 ,, ,, (Cultures) 38 1,176 Blood for Wassermann 191 1,201 Kahn 280 1,020 G.C.F.T 112 653 Material for Spirochaetes 18 10 Cerebro-spinal Fluids 93 Other Examinations 454 Examinations Done Under the National Health Insurance Act. Nature of Examination. Pus for Gonococci 15 (all neg.) Pus for other organisms 20 Pus for Tub. Bac. 19 (1 pos.) Blood for Wassermann 33 (1 pos.) Complete Blood Counts 51 Urine for Chemical Exam. 15 Urine for Microscopal Exam. 15 Urine for Tub. Bac 15 Urine for Cultural Exam. 15 Other Examinations 75 Bacteriological Examination of Milk. Number of Samples submitted for Counts 389 Number under 10,000 per cc 135 Number over 10,000 but under 50,000 per cc 139 Over 50,000 but under 100,000 per cc 46 Over 100,000 but under 500,000 per cc 49 Over 500,000 but under 1,000,000 per cc 5 Over 1,000,000 per cc 15 Tubercle Bacilli— Number of samples of milk submitted 389 Number found positive by inoculation test 0 The number of milk examinations decreased by 20 Number of samples still under investigation for T,B, 0 55 389 milk samples were submitted to the Methylene Blue Test, which 83 failed to satisfy. 90 milk samples ware also submitted to the Bacillus Coli Test and 78 were satisfactory. Milk Samples. 263 samples were submitted to the Phosphatase Test, of which 7 failed to satisfy. IMMUNISATION AGAINST DIPHTHERIA. New cases came from the following sources: — School cases 588 Children under 5 years 3,050 The ensuing tables give some further details: — Total number of sessions held 139 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 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 1947 5174 3638 139 2 — 3237 3135 93 7 3638 Summary of Attendances and Treatment. Under Treatment 1.1.47 Total new Cases, 1947. 1947 Cases Completed Treatment. Received A.P.T. Under Treatment 31.12.47 Defaulted. 236 3638 3516 5174 196 266 56 Origin and Source of New Cases attending. Year. School M.C.W. Total Percent. Total. Percent. 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 1947 588 16.2 3050 83.8 Home Visits by Health Visitors. A total of 834 home visits was paid during the year. 57 VACCINATION ACTS. I am indebted to Mr. Huggins, the Vaccination Officer, for the particulars in the returns in the subjoined Tables. Registration Subdistricts in V.O. District. Births Registered. Vaccinated. Insusceptible. Statutory Declaration. Died Unvaccinated. P.P.O. Transferred to other V.O.s Untraced Removals. In Default. Overage when Registered. South Sub-District 2248 1132 15 583 46 29 103 133 207 — West Sub-District 2235 1145 16 638 76 22 11 113 214 — North Sub-District 1165 596 12 351 39 12 9 34 112 — 5648 2873 43 1572 161 63 123 280 533 — During the year 3,801 Forms Q were sent to parents and 200 Forms K. Form Q is the Form drawing attention to the requirements of the Vaccination Acts and Form K refers to cases in default. 510 cases were transferred to this Borough from other districts. 1,782 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, 1947: — 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 465 21 486 58 No. 2 Area 417 17 434 16 No. 3 Area 159 17 176 8 No. 4 Area 255 9 264 5 No. 5 Area 681 30 711 21 Addington Area 146 20 166 2 Queen's Road Homes - - - - Mayday Hospital — 2 2 2 Children's Homes — - - - Shirley Residential Schools - 7 7 - 2123 123 2246 112 58 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. 1938. 1939. 1940. 1941 1942 1943. 1944. 1945. 1946. 1947. New male patients 416 316 187 448 661 239 232 390 732 578 New female patients 257 191 202 258 300 489 523 604 411 1076 Attendances, male patients 7318 4258 2996 3033 3932 2214 2758 5498 9757 9316 Attendances, female patients 5365 3150 1772 1508 1585 4026 5940 8848 11439 11122 Attendances of Croydon patients at various London Hospitals under General Scheme. There were 97 new patients, who made a total of 1,102 attendances. Pathological Examinations at London Hospitals for Croydon Patients. 496 Examinations were made for* various Clinics and 36 examinations of material submitted by medical practitioners. Bacteriological Examinations carried out at London Hospitals for Croydon Patients. Hospital. Detection of Spirochaetes Detection of Gonococci. Wassermann 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. — — 20 — 16 — 20 — 56 St. Thomas's — — 33 — 81 — 101 — 215 South Lon. Hos. for Women — — 4 1 2 2 2 — 11 Royal Free — — 19 — 7 — 26 — 52 King's College 1 — 22 — 26 - 1 - 50 Whitechapel Clinic, L.C.C — — 1 — 3 — 3 — 7 University College - - - - - - - - - Guy's Hospital — — 43 9 30 12 35 12 141 Seamen's - - - - - - - - - Westminster Hospital - - - - - - - - — Total 1 — 142 10 165 14 188 12 532 59 Croydon Cases attending London Hospitals. Hospital. Cases seen for the first time. Conditions other than venereal. Total number of attendances. Aggregate number of Inpatient Days. Syph. Gon. Endell Street L.C.C — 1 2 88 — St. Thomas's 4 6 30 499 — Guy's 2 6 13 173 - King's College 1 2 11 169 2 Royal Free — — 2 26 — S. Lond. Hosp. for Women — — 10 137 - Whitechapel Clinic, L.C.C. — — 2 4 - Westminster — — — — - Mothers 1 — 4 6 — Seamens — — — — — Total 8 15 74 1102 2 60 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, 1947. Syphilis Soft Chancre Gonorrhoea Nonvenereal or undiagnosed conditions Totals M F M F M F M F M F Ttls. 1. Number of cases on 1st January under treatment or observation 97 75 - - 76 39 5 14 178 128 306 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 2 1 - - - - - - 2 1 3 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 34 5 - - - - - - 34 5 39 „ secondary 18 12 - - - - - - 18 12 30 „ latent in 1st year of infection 3 13 - - - - - - 3 13 16 „ all later stages 1 15 - - - - - - 1 15 16 „ congenital 1 5 - - - - - - 1 5 6 Soft Chancre - - - - - - - - - - - Gonorrhoea, 1st year of infection - - - - 125 53 - - 125 53 178 „ later - - - - 3 2 - - 3 2 5 Non-venereal conditions - - - - - - 393 971 393 971 1364 Conditions remaining undiagnosed at 31st December - - - - - - - - - - - 4. Number of cases dealt with for the first time during the year under report known to have received treatment for the same infection, or to have been under observation, at other Centres or Service Hospitals, or by General Practitioners approved under Ministry of Health Circular 2226 10 3 - - 2 1 11 6 33 10 43 Totals of Items 1, 2, 3 and 4 166 129 - - 216 95 409 991 791 1215 2006 5. Number of cases discharged after completion of treatment and final tests of cure or after diagnosis as non-venereal 83 41 - - 146 60 403 938 632 1039 1671 6 aNumber of cases which ceased to attend before completion of treatment and were, on first attendance, suffering from:— Syphilis, primary - - - - - - - - - - - „ secondary 1 - - - - - - - 1 - 1 , latent in 1st year of infection - - - - - - - - - - - „ all later stages - - - - - - - - - - - „ congenital - - - - - - - - - - - Soft Chancre - - - - - - - - - - - Gonorrhoea, 1st year of infection - _ - - - - - - - _ - „ later - - - - - - - - - _ - 6.6Number of cases under treatment or observation which died. 1 - - - - 1 - - 1 1 2 7. Number of cases which ceased to attend after completion of treatment but before final tests of cure - - - - 4 2 - - 4 2 6 8. Number of cases tranferred to other Centres or to institutions, or to care of private practitioners 11 3 - - 44 1 2 22 57 26 83 9. Number of cases remaining under treatment or observation on 31st December 70 85 — - 22 31 4 31 96 147 243 Totals of Items 5, 6, 7, 8 and 9 166 129 _ 216 95 403 991 791 1215 2006 (These totals should agree with those of Items 1, 2. 3 and 4) 61  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, 4188 4531 — - 2134 2169 2135 2848 8357 9548 17905 (b for intermediate treatment, e.g., irrigation, dressing 527 928 — - 315 188 117 458 959 1574 2533 Total Attendances 4715 5459 — — 2349 2357 2252 3306 9316 11122 20438 II. In-patients:— (a) Total number of persons admitted for treatment during the year 66 30 - - - 1 - - 66 31 97 (b) Aggregate number of "in-patient days " of treatment given 66 40 — — 24 — - 66 64 130 12. Number of cases treated with penicillin 51 53 - - 144 57 - - 195 110 305 13. Number of cases of congenital syphilis in Item 3 above classified according to age periods Under 1 year 1 and under 5 years 5 and under 15 years 15 years and over * Totals M. F. M. F. M. F. M. F. M. F. - - - - - - 1 5 1 5 14. Pathological Work. Microscopical Cultural for G'n'rh. Serum spinal fluid Others for diagnosis of Venereal Disease for Syphilis for 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 42 2572 2009 W.R. 3126 887 95 Kahn Test 3006 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 Number of cases from each area included under the following headings in Item 3:— Syphilis 63 25 15 4 107 Soft Chancre - - - - - Gonorrhoea 113 42 23 5 183 Non-venereal and undiagnosed conditions 1086 173 60 45 1364 Total 1262 240 98 54 1654 B Total number of attendances of all patients residing in each area 13134 4690 1894 720 20438 62 Report on Social Work for the Special Clinic for the year 1947. (1) Visits paid : 205. Letters sent: 1,492. (These visits were made in Surrey, Kent and part of London, as well as Croydon). Results of Visits— 6 cases were transferred to other Clinics and known to be receiving treatment. 6 returned for treatment but did not have final tests of cure. 1 case of secondary syphilis, living at Ashstead, moved away, and, so far, has not been traced. (2) Unmarried mothers with venereal disease, or non-venereal disease, helped either into homes or hostels, or sent to Moral Welfare or Social Workers : 32. (3) Adoptions helped : 6. (4) Fares paid : 4. (5) Patient sent to Public Assistance for help : 1. (6) Contact Tracing results— Syphilis. Gonorrohcea. Non-V.D. Male. Female. Male. Female. Male. Female. 10 12 29 17 53 92 63 CANCER. Deaths from Cancer numbered 492 as compared with 451 in 1946; 470 in 1945; 420 in 1944; 456 in 1943; 405 in 1942; 377 in 1941; 443 in 1940; 414 in 1939; and 380 in 1938. Death-rate per 1,000 of the population for the previous 10 years are as follows: — 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) 1942—2.07 (405) 1947—2.03 (492) 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 - - - 101569 - 25 and under 35 years 3 3 6 36159 0.166 35 and under 45 years 14 14 28 39372 0.711 45 and under 65 years 81 82 163 48213 3.381 65 years and over 152 143 295 17457 16.899 250 242 492 242770 Sites of Fatal Cancer. Site. Male. Female. Total. Percentage of Total. Peritoneum - 1 1 0.203 Naso-pharynx — 1 1 0.203 Skin 0 4 10 2.033 Tongue and Mouth 4 2 6 1.219 Oesophagus 4 3 7 1.423 Stomach 45 28 73 14.837 Liver 3 8 11 2.236 Bowel 32 42 74 15.041 Rectum 27 13 40 8.130 Bladder 8 2 10 2.033 Prostate 24 — 24 4.878 Larynx and Pharynx 7 5 12 2.439 Uterus — 22 22 4.472 Breast 2 50 52 10.569 Ovary — 19 19 3.862 Pancreas 2 9 11 2.236 Gall Bladder and Duct 3 — 3 0.610 Mediastinum 1 1 2 0.407 Bones 5 4 9 1.830 Lungs 61 15 76 15.447 Kidney 2 3 5 1.017 Brain 2 1 3 0.610 Retroperitoneal 2 — 2 0.407 Thyroid Gland 2 3 5 1.017 Lymphatic Glands 3 1 4 0.813 Genital Organs 3 4 7 1.423 Eye 1 — 1 0.203 Tonsil 1 — 1 0.203 Ear — 1 1 0.203 250 242 492 64 Comments on Foregoing Table. The organs most often attacked in descending order of incidence are: In the males—the Lungs (24.4 percent.), the Bowels and Rectum (23.6 per cent.), and the Stomach (18.0 per cent.); in females—the Bowels and Rectum (22.7 per cent.), the Breast (20.7 per cent.), the Stomach (11.6 per cent.), and the Uterus (9.1 per cent.) THE PREVENTION AND CONTROL OF TUBERCULOSIS. I am indebted to Dr. J. C. McMillan, the Assistant Medical Officer of Health for Tuberculosis, for the statistical part of this section of the report. While prevention has so far yielded greater dividends than treatment, treatment has not stood still. A survey of the incidence and mortality figures in recent years shows greater diminution in mortality than in incidence of the pulmonary form of the disease. Although social conditions were different and broadly unfavourable in 1947, a comparison with 1920 is the best we can do. The outstanding facts are these: In 1920, 102 per 100,000 of the population in Croydon died from all forms of tuberculosis; in 1947 the corresponding figure was 44. Notification of Tuberculosis. Two hundred and thirty-four cases of Pulmonary Tuberculosis and 43 cases of Non-pulmonary Tuberculosis were notified on Form A (primary notifications); of these 143 males and 91 females were pulmonary cases; 22 males and 21 females nonpulmonary. In addition, 67 pulmonary cases and 10 nonpulmonary came to our notice as new cases otherwise than by notification. The total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year 1947 by notification or otherwise was 354, as compared with 348 in 1946, 374 in 1945, 315 in 1944, and 383 in 1943. 301 of these were cases of Pulmonary Tuberculosis, 189 in males and 112 in females. There were 2 more cases of Pulmonary Tuberculosis in males and 10 fewer in females than in 1946. 65 There were 20 cases of Non-pulmonary Tuberculosis among children under 15 years as compared with 19 in 1946. The number of cases in adults was 33, compared with 20 in 1946. Of the cases notified in 1947, 7 males and 3 females died from the Pulmonary form of the disease during the year, equal to 4.2 per cent, of those notified. The incidence rate of Tuberculosis of all forms was 1.46 per 1,000 of the population ; for Pulmonary Tuberculosis 1.24, and for Non-Pulmonary 0.22 per 1,000 population. The notification rate was 1.14 per 1,000. In 1946 the corresponding figures were 1.49, 1.32, 0.17, and 1.12 per 1,000. Public Health (Tuberculosis) Regulations, 1930. Summary of notifications during the period from 1st January, 1947, to 31st December, 1947 : — 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 2 2 22 24 27 16 25 18 5 143 158 Females — — 2 3 12 19 31 13 5 2 4 91 95 Non-Pulmonary— Males 2 — 3 4 3 3 4 — 3 — — 22 27 Females 1 2 3 1 2 4 2 5 1 — — 21 27 Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1947, to 31st December, 1947, otherwise than by formal notification:— Age periods. 0—1 1—5 5—10 10—15 15—20 20—25 25—35 35—45 45—55 55—65 65 and upwards Total Cases. Pulmonary Males — — 1 — 3 5 19 8 4 1 5 46 Females — — — — 1 8 6 1 2 — 3 21 Non-pulmonary Males — 1 — 1 — 1 1 1 — — — 5 Females - - - 2 - - 2 - - 1 — 5 66 Notification Register. Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1947:— PULMONARY. NON-PULMONARY. Total Cases. Males. Females. Total. Males. Females. Total. 817 654 1471 121 113 234 1705 CLASSIFICATION OF NEW PATIENTS. Pulmonary Tuberculosis. During 1947, 197 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) 85 or 43.1% T.B. plus 1 (early cases, sputum positive) 17 or 8.6% T.B. plus 2 (intermediate cases, sputum positive) 75 or 38.2% T.B. plus 3 (advanced cases, sputum positive) 20 or 10.1% 197 100.0% Non-Pulmonary Tuberculosis. There were 34 cases examined at the Clinic and found to have Non-pulmonary Tuberculosis in the following forms:— Bones and Joints 16 Abdominal 3 Other Organs 14 Peripheral Glands 1 34 pumomry Tuberculosis Distribution of fatal cases according to age groups for the years 1934-1940 and 1941-1947 for the County Borough of Croydon for both sexes. Showing, especially in males, a lowering of the mortality in the younger age groups and a definite increase in mortality in the older age groups which means an increase in active disease in the more experienced workers, a condition to be expected as the industrial conditions become more stabilised 67 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 1947 — 1 14 34 31 12 92 In 1947 the death-rate from all forms of Tuberculosis was 0.44 per 1,000 population. The rate for Pulmonary Tuberculosis was 0.38 and the rate for Non-Pulmonary Tuberculosis 0.06. Similar figures for 1946 were 0.43 and 0.04. Pulmonary Tuberculosis. In 1947 the total number of deaths decreased by 8.9 per cent. compared with 1946, and was 22.7 per cent. less than in 1938. There was only one death in children up to school leaving age (15 years). The majority of the deaths occurred in age groups 25-55 years. There were 7 fewer deaths in males than in 1946, with almost 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 2 less than in 1946. New cases show a slight increase in males and a decrease of 8.2 per cent. in females, compared with 1946, that is a total slight decrease compared with 1946, but an increase of 10,3 per cent. over 1938. 68 Since the war ended there has been a slight annual increase in new cases in men with an annual decrease in women. The total number of new cases in 1947 was males 189, females 112, that is approximately three new cases in men for every two new cases in women. In consequence there is a greater demand for male beds. Non-Pulmonary Tuberculosis. The diagnoses of the new cases entered in the Notification Register during 1947 were as follows:— Male. Female Glands 8 2 Spine 4 4 Sacro-ilia joint 1 1 Hip 2 2 Knee — 2 Toe 1 — Abdomen 1 4 Genito-urinary tract 7 7 Lupus — J Miliary — 1 Meninges 3 2 Totals 27 26 Deaths from Non-Pulmonary Tuberculosis. During 1947, 14 deaths were certified to be due to NonPulmonary Tuberculosis, compared with 9 in 1946, 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 3 4 Tuberculous Peritonitis — 1 1 Miliary Tuberculosis — 2 2 „ „ and Tb. Hp — 1 1 Spinal Tuberculosis — 2 2 Adrenal Tuberculosis — 1 1 Totals 3 11 14 69 Co-ordination with Medical Practitioners, and Other Branches of the Health Department. During the year 593 cases of suspected Tuberculosis were referred by private medical practitioners; 77 were diagnosed as suffering from Tuberculosis and were subsequently notified. In addition, 88 children were referred by the School Medical Service, and 76 cases from the Maternity and Child Welfare section of the Public Health Department. 83.4 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 95.0 per cent. in 1946. The number of reports sent in by Insurance medical practitioners on their domiciliary cases (Form G.P.36) was 216. Examination of Sputum. The results of examinations made in 1947 are as follows:— For Clinic. For General Practitioners. Totals. Positive (i.e., tubercle bacilli present) 1034 60 1094 Negative (i.e., tubercle bacilli absent) 1517 600 2117 Totals 2551 660 3211 For each 100 new cases and contacts examined at the Clinic, 193 specimens of sputum were examined. X-Ray Work. 2,795 X-Ray examinations were made during the year. This is equivalent to 212 for every 100 new cases and contacts seen, and compares with a rate of 143 in 1946. 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 has been a great handicap in the routine work of the Clinic, and the cause of a lot of inconvenience to patients. Blood Examinations. Blood sedimentation rate was ascertained in 503 cases at Mayday Hospital for the Chest Clinic during the year. 70 Residential Treatment for Pulmonary Tuberculosis. Summary of Patients who received Institutional Treatment during 1947. Institution. In Institutions on 1.1.47. Admitted During 1947. Discharged During 1947. Died During 1947. Remaining in on 31.12.47. Adults. Adults. Adults. Adults. Adults. M F Ch. M F Ch. M F Ch. M F Ch. M F Ch. Croydon Borough Sanatorium 44 34 - 89 80 - 82 82 - 3 3 48 29 — Brompton Hospital and Sanatorium 4 2 — 7 13 1 8 10 — 2 1 1 1 4 - Children's Sanatorium, Harpenden — — 2 — — 1 — — 2 — — — — - 1 Croydon General Hospital 1 — — 2 — 1 3 — 1 — — — — - - Horton Hospital (Chest Unit) — — — 4 1 — 4 1 — — — — - - - Grosvenor Sanatorium 5 2 — 22 4 — 14 2 — — 1 — 13 3 - West Ham Sanatorium — — 1 — — — — — — — — — — — 1 Preston Hall Sanatorium — 1 - 1 - - - - - - - — 1 1 - Royal National Sanatorium 1 - - - - - 1 - - - - - - - — Royal Free Hospital - - - - - 1 — — 1 — — — - —— - Heath End Sanatorium — — 2 — — 1 — — 3 — — — - - - Mayday Hospital 26 12 6 118 76 15 99 54 18 19 9 1 26 25 2 Pinewood Sanatorium — — — — 1 — — — — — — — - 1 - Papworth 1 1 — 1 — — 2 — — — — — — 1 - R.N.H.C., Ventnor 2 1 — 1 — — 3 — — — 1 — — - - London Chest Hospital — — — 7 7 — 4 5 — — — — 3 2 — National Sanatorium - - - 1 - - - - - - - - 1 - - Nayland Sanatorium — 3 - - - - - 3 - - - - - - - St. Michael's Home, Axbridge - - - 1 - - 1 - - - - - - - - King George's Sanatorium for Sailors - - - - - - - - - - - — 2 - - Eversfield Chest Hospital - — — 1 — — 1 - - - - - - - - Children's Sanatorium, Holt - - - - - 1 — — - - - - - - 1 84 56 11 257 182 21 222 157 25 24 15 2 95 66 5 71 Residential Treatment for Non-Pulmonary Tuberculosis. Summary of Patients who have received Institutional Treatment during 1947. Institution. In Institutions on 1.1.47. Admitted During 1947. Discharged During 1947. Died During 1947. Remaining in on 31.12.47. 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 - - - - - 2 Rowley Bristow Orthopaedic Hospital, Pyrford — - - 1 1 3 — — 2 - 1 1 1 Royal Sea Bathing Hospital 3 2 1 2 — — 3 1 1 — — — 2 1 — Lord Mayor Treloar Cripples Hosp. - — 1 1 — 2 - - - - - - 1 — 3 Hammersmith Hospital — - - — — 1 — - 1 — — — — — — Royal National Orthopaedic Hospital — — — 1 — I — — — — — — 1 — 1 Horton Emergency Hospital — - — — — — — — — — — — — — — Croydon General Hospital — - _ 5 0 3 5 6 3 - - - - - - St. George's Hospital 1 — — — — — 1 — — — — — — - — Mayday Hospital - 1 - 6 5 3 3 3 3 - — — 3 3 — Victoria Home for Inv. Children — — 3 — — 1 — — 3 — — — — — 1 St. Peter's Home — — — — 1 — — 1 — — — — — — — St. Vincent's Orthopaedic Hospital — — — — 1 — — — — — — — — 1 — 4 3 8 16 14 14 12 11 14 — — — 8 6 8 72 Extra Nourishment. Provision of special nourishment in the form of milk was granted to 31 selected cases for varying periods during the year, and 17 cases were in receipt of extra nourishment at the end of the year. 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 61 patients had Phrenic Nerve Operations performed at Mayday Hospital, and a number of other cases received surgical treatment at Brompton Hospital, in the Chest Unit at Horton Emergency Hospital and at London Chest Hospital. Residential Treatment. 361 males, 255 females and 54 children were treated in Residential Institutions in connection with the Croydon Tuberculosis Scheme during 1947. At the end of the year there were 77 beds occupied in the Croydon Borough Sanatorium, North Cheam, compared with 78 at the end of 1946 and the normal 94 beds pre-war. The immediate results of treatment of patients discharged from residential institutions during the year are as follow:— Pulmonary Tuberculosis. In Class T.B. Minus, 14 males, 16 females and 4 children were discharged with the disease in a quiescent condition, i.e., 53.9 per cent. of the total cases in this class. Twelve males and 15 females were not in a quiescent condition, 42.8 per cent. Two females died, i.e., 3,3 per cent. 73 In Class T.B. Plus, the corresponding figures were 15 males and 9 females quiescent. 19.5 per cent.; 53 males and 40 females, not quiescent. 75.6 per cent.; 3 males and 3 females died, 4.9 per cent. Taking the groups together, 31.2 per cent. of cases were discharged as quiescent; 64.5 per cent. as not quiescent; and 4.3 per cent. died. Modern methods of treatment have greatly increased the life expectancy of infectious cases, but we appear to be approaching the limits of potential success obtainable by our present methods of treatment. Sputum conversion has become the touchstone of successful treatment in pulmonary tuberculosis, that is, the making of the infectious patient non-infectious. The sputum conversion rate has increased side by side with the application of collapse therapy, suggesting that the introduction of active therapy is responsible for the better results. Patients who entered Sanatorium with a Positive sputum during the years indicated:— 1939 1940 1941 1912 1943 1944 1945 1946 Totals % % % % % % % % % Sputum positive cases discharged sputum Negative 49.1 60.0 44.1 61.9 62.8 62.1 62.0 64.2 58.4 Sputum positive cases discharged sputum Positive 50.9 40.0 55.9 38.1 37.2 37.9 38.0 35.8 41.6 Sputum positive cases discharged Sputum NEGATIVE Of 160 cases that have been traced, who were discharged from sanatorium during the four years 1939—1942, 115, or 71.9 per cent., were still alive at the end of 1947. Sputum positive cases discharged sputum POSITIVE Of 152 cases that have been traced, who were discharged from sanatorium during the four years 1939—1942, only 32, or 21 per cent., were still alive at the end of 1947. Non-Pulmonary Tuberculosis. 18 patients were discharged during the year, and 55.5 per cent. of these were quiescent. 74 The Chest Clinic and Home Visiting. It would appear that we have concentrated too much on the results of sanatorium treatment and too little on the methods of domiciliary and dispensary care, accompanied by adequate environmental hygiene. The tuberculosis scheme has probably come to depend too much upon residential institutions and too little on the building up of personal resistance in the home surroundings. The subjoined table gives a summary of the work done in connection with the Clinic. 967 new cases were examined during the year. This is equal to 912 for each 100 deaths from the disease. 218 or 206 for each 100 deaths were found to be definitely tuberculous. The total number of attendances at the Clinic was 8,865. The Tuberculosis Officer paid 156 home visits and the District Health Visitors 1,864 visits for Clinic purposes. In addition, the Health Visitors made 459 primary visits for the purpose of the Notification Register. The Tuberculosis Officers paid 150 visits to Mayday Hospital in a consultative capacity, and there examined 865 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 508 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 350 contacts were examined, equal to 330 for each 100 deaths, compared with 294 in 1946, 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, 10 were considered to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 28.5 compared with 1.46 per 1,000 of the general population. 474 appointments for examination were offered to new contacts during 1947, but only 350 new contacts attended and were examined. 75 The Clinic Register of Cases. The number of cases of Tuberculosis under the supervision of the Clinic at the end of the year was 1,352. This is equivalent to 5.5 persons per 1,000 of the population. During the year 104 Clinic cases died. Of this number 8 or 7.7 per cent. were seen for the first time in 1947. Dental Treatment for Patients Referred from the Chest Clinic to Lodge Road. Patients referred from the Chest Clinic are treated at Lodge Road Treatment Centre on Wednesday afternoons from 3.30 to 5 p.m. 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. 1947 1946 Referred from Chest Clinic 10 13 23 14 Treatment cases continued from Cheam. 11 3 14 12 Attendances 90 45 135 85 Extractions 57 20 77 73 Fillings 6 17 23 12 Other Operations 3 — 3 — Scalings 3 4 7 3 Denture Dressings 66 11 77 50 Dentures fitted 28 5 33 16 Repairs — — - 3 Number of Treatment Sessions: 22. 76 SUMMARY OF CLINIC STATISTICS FOR 1947. Number of persons on Clinic Register, January 1st, 1947 1,457 ,, notified cases examined for the first time 51 ,, cases sent for an opinion 818 ,, first attendances, including 64 inward transfers 1,381 ,, consultations of T.O. with medical practitioners— (a) Personal 10 (b) Other 1,035 ,, visits paid by T.O. to homes of patients 156 ,, visits paid by T.O. to Mayday Hospital 150 ,, patients examined by T.O. at Mayday Hospital 865 ,, visits paid to homes of patients by Health Visitors 2,323 ,, visits paid to homes of patients by District Nurses for nursing attention 508 Attendances of patients at the Clinic— Men 3,616 Women 3,629 Children 1,620 Total 8,865 Number of Insured Patients under Domiciliary Treatment at the end of the year— Pulmonar 238 Non-Pulmonary... 8 Total 246 Number of reports received from Panel Practitioners (G.P.36) 216 ,, report forms sent to Panel Practitioners (G.P.36) 328 ,, reports received from Panel Practitioners on Forms G.P.17 1 ,, reports received from Panel Practitioners on Forms G.P.35 ,, X-Rays taken 2,795 ,, reports made to Ministry of Pensions by T.O. on general progress of Tuberculous ex-Service men 46 ,, special reports made to the Ministry of Pensions by T.O. re Tuberculous ex-Service men (Form M.P.M.S.D. 122) 36 ,, cases referred for Light Treatment 1 ,, cases referred to Orthopaedic Clinic 4 ,, cases receiving extra nourishment at the end of year 17 ,, cases referred by the Ministry of Labour and National Service Medical Board for examination and report 24 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 1947. 77 (1) No. of patients in receipt of Ministry of Health Allowances as at 31-12-46 51—24 in Institutions. 27 on Domiciliary ment. (2) No. of new patients 96 (3) No. of patients no longer in receipt of Allowances 88 (4) No. of patients in receipt of Ministry of Health Allowances as at 31-12-47 59—33 in Institutions. 26 on Domiciliary treatment. The Council's extension of Maintenance Allowances scheme continued during 1947. 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 31-12-46 31— 6 in Institutions. 25 on Domiciliary treatment. (2) No. of new patients 19 (3) No. of patients no longer in receipt of Allowances 17 (4) No. of patients in receipt of Council Allowances as at 31-12-47 33— 5 in Institutions. 28 on Domiciliary ment. CHEAM SANATORIUM. The Sanatorium is situated at North Cheam, and has accommodation for 93 adult patients of both sexes; men 53 and women 40. All available accommodation is occupied. 78 Immediate Results of Treatment. Group. Total number of cases discharged 1947. 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 22 28 1 — 21 28 - - - - - - 135 112 Class T.B. Plus— Group I 39 27 — — 36 26 3 1 — — — — 130 127 Group II 26 36 1 - 23 32 1 2 — 2 1 — 187 169 Group III 11 3 — — 5 - 3 2 3 1 — — 328 132 Observation Non T.B. — 1 - - - - - - - - - - - - 98 95 2 - 85 86 7 5 3 3 1 - In-patients on 1st Jan., 1947 Admitted during year 1947 Discharged during year including deaths In on 1st Jan. 1948. Died during year 1947 M F M F M F M F M F 44 34 103 90 98 95 49 29 3 3 Number of patients 1st January, 1947 78 ,, ,, admitted, 1947 193 ,, ,, discharged during 1947 187 ,, ,, died during 1947 6 ,, ,, remaining 1st January, 1948 78 Number of X-Ray screenings Out patient 1,880 In-patient 951 ,, X-Ray films taken Out-patient 96 In-patient 679 ,, refills given Out-patient 1,635 In-patient 514 ,, aspirations 6 ,, A.P. cases commenced 11 79 ,, Pneumoperitoneum refills Out-patient 111 In-patient 76 ,, Blood Sedimentation Tests 314 ,, Sputum Tests 892 ,, Chest Explorations 6 ,, Urine Tests 226 ,, A.P. Cases attempted 2 ,, Pneumoperitoneum Cases attempted 1 ,, patients sent to Mayday and London Hospitals for opinion 7 ,, patients admitted to Mayday Hospital for surgical treatment 16 „ admitted to London Hospitals for surgical treatment 13 There was one Observation case (female) sent in during the year under review. This case was found to be non-tubercular, and is not classified in the positive cases tabulated above. The out-patient Artificial Pneumothrax Clinic was transferred to the Chest Clinic at 20, Katharine Street on 1st October, 1947. Plans for the alteration of "C" block to accommodate a new X-Ray plant, waiting room, dental surgery and laboratory have been approved by the Ministry of Health, and the work will shortly be put in hand. The X-Ray plant is expected to arrive in March, and a Radiographer has been appointed to take charge of it. 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. 80 Review of Work Done. Males. Females. Total. 1947 1946 Number Examined 66 63 131 86 Referred Treatment 44 47 91 71 Treated 41 44 85 63 Attendances 146 124 270 287 Extractions 88 57 145 60 Fillings 21 46 67 92 Dressings 4 7 11 13 Scalings 10 20 30 24 Root Treatments — — — 2 Denture Dressings 40 10 50 59 Dentures Fitted 13 1 14 20 Repairs 1 - 1 3 Mandibular Injections 11 12 23 6 Number of Treatment Sessions: 32. MATERNITY AND CHILD WELFARE. Notification of Births. Notifications were received from— Live Still Births. Births. Total. Midwives 3,942 87 4,029 Doctors, Parents and others 1,542 36 1,578 5,484 123 5,607 Maternal Mortality. There were 10 deaths, compared with 3 in 1946. The maternal mortality rate was 1.92 per 1,000 births, compared with 0.61 in 1946. The deaths were caused by— (1) Acute yellow atrophy of liver. (2) ,, ,, ,, ,, (3) ,, ,, ,, ,, 81 (4) General peritonitis following perforation of uterus by introduction of chemical irritant. (5) Toxaemia of pregnancy. (6) Pelvic peritonitis and retained products of tion. (7) Fatty degeneration of liver: hyperemesis gravidarum. (8) Obstetric shock and haemorrhage, abortion. (9) Shock and haemorrhage from post-partum hage of unknown aetiology. (10) Eclampsia. MATERNAL AND INFANT MORTALITY FOR THE YEARS 1931—1947 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 39 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 1947 5,211 10 1.92 38 82 Puerperal Pyrexia. Thirty-nine cases of Puerperal Pyrexia were notified. This is a rate of 7.5 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 2,035 36.29 In Public Institutions 2,129 37.97 In Registered Maternity Homes 1,443 25.74 5,607 Still Births. During 1947, 111 still births were registered in respect of Croydon. Of these 59 were male babies and 52 female; 2 males and 3 females were illegitimate. The proportion of still births to living children was as 1 to 46. The still birth rate was 2.1 per cent. of the total births. The still birth rate, on the same basis as for Infant Mortality, was 21.3 per 1,000 births. An Analysis of Still Births occurring during the Year. Of the 91 still births investigated 47 were males and 44 females. STILL BIRTHS, 1947. Attended by Midwives alone 38 „ Doctors alone 5 ,, Midwives and Doctors 48 Occurred at 9 months 73 ,, 8 months 9 „ 6-7 months 9 Type of Delivery.—In 37 cases the confinement was difficult or prolonged. Normal confinement was noted in 54 cases. Age of Mother.—Under 20 years, 2; between 20 and 29 years, 45; between 30 and 39 years, 37; between 40 and 49 years, 5; while in 2-cases age was not stated. 83 The Health of the Mother during her pregnancy was stated to be good in 61 cases and indifferent or poor in 11 cases; no particulars were obtained in 19 cases. In 1 case, however, the mother had had a shock or fall before the still birth. In 70 instances the mother had attended the Ante-Natal Clinic. 21 cases had never attended the Clinic. Attendance at Confinement.—Fifty-two of the still births investigated occurred in the Mayday Hospital; 19 in St. Mary's Hospital; 8 were attended in their own homes by a private medical practitioner either alone or in conjunction with a midwife; 8 were attended by a midwife alone; 4 occurred in private nursing homes. Forceps were reported to have been utilised in 16 of the cases. In 73 cases the baby was born at full term; in 9 during the 8th month of gestation; in 9 during the 7th month. The baby was apparently a normal child in 72 cases, abnormal in 19. The still birth was the first pregnancy in 45 instances; the 2nd in 24; the 3rd in 5; the 4th in 9; the 5th in 2; the 6th in 2; and the 7th in 4. Previous still births had occurred in 9 cases. Ophthalmia Neonatorum. Eleven cases were notified during 1947. The following table gives the notifications in Croydon during the past ten years:— 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 No of Cases 20 15 14 17 19 10 3 11 6 11 Rate per 1,000 Births 6.0 4.5 4.7 7.0 5.5 2.7 0.8 3.1 1.2 2.2 Results of Treatment. Notified. Cases treated. Vision Unimpaired. Vision impaired Died. Removed Remaining under Treatment At home. In hospital 11 10 1 11 — — — - 84 Infant Mortality. The Infantile Mortality rate was 38 per 1,000 live births registered. For the past 5 years the number of infant deaths has been 1943—137, 1944—156, 1945—145, 1946—151, and 1947—194. Among the 194 deaths, 104 occurred in boy babies and 90 in girls. Of the births, 2,615 were males and 2,485 females. The infantile mortality rate for the two sexes was, therefore, Boys— 40, Girls—36. 154 deaths of infants occurred in Institutions, including Registered Nursing Homes. The following table gives the cause of death during the first month of life: — (1) Complications of Labour— Trauma and Inattention at Birth 3 — 3 (2) Foetal States— Congenital Heart Malformation 7 Other Congenital Deformities 13 Atelectasis, etc 8 Hemorrhagic Disease of Newborn 2 Foetal Endocarditis 1 —31 (3) Prematurity 55 —55 (4) Post-Natal Causes 11 —11 100 Percentage Deaths per Deaths per 1,000 Total Infantile Deaths. Births. 1947 1946 1947 1946 Premature Births 28.4 25.2 10.8 7.9 Respiratory Diseases 20.6 23.8 7.8 7.5 Infectious Diseases (including Tuberculosis) 2.6 2.7 1.0 0.8 Atelectasis, Debility and Marasmus 5.2 7.3 2.0 2.3 †Diseases of Digestion 17.5 16.6 6.7 5.2 Injury at Birth and Congenital 17.0 13.2 6.5 4.2 *These deaths were due to Whooping Cough 3 and Tuberculosis 2. †These deaths were due to Diarrhoea 28, Intussusception 4, Hepatitis 1 and Inguinal Hernia 1. 85 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  136 37 99 18 58 53 7 96 34 6 5100 76 11 10 14 4,255 babies under one year of age attended the Clinics for the first time during 1947. Within the same period 5,100 babies were born and 194 died; 58 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 136 babies tabulated who died, 37 had attended a clinic in Croydon and 99 had not attended, .i.e., 27 per cent. of the deaths were in clinic babies and 73 per cent. in nonclinic babies. Of the 5,100 babies born, approximately 4,243 attended on calculation based on past attendances. The infantile mortality, estimated on this basis, is only 9 per 1,000 births for the clinic babies, and 115 per 1,000 births for non-clinic babies. 86 The rate of infant mortality amongst legitimate children was 36 per 1,000 births. The rate in illegitimate children was 71 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 1 mnth. 1-2 mths. 2-3 mths. 3-4 mths. 4-5 mths. 5-6 mths. 6-7 mths. 7-8 mths. 8-9 mths. 9-10 mths. 10-11 mths. 11-12 mths. total. All Causes 50 5 7 8 1 1 - 13 8 7 100 20 14 7 11 8 11 7 2 5 4 5 194 Chicken Pox - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - 1 2 - - - - - - - - 3 Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - 1 - - - - - - - 1 Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - 1 — 1 Meningitis (not Tuberculous) - - - - - - - - - - - 1 - - - - - - - 1 - - 2 Convulsions - - - - - - - - - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - - 1 - 1 - - - - - 2 Pneumonia (all forms) - - 1 1 - - - 2 1 4 9 6 3 1 2 5 2 3 - 2 2 2 37 Diarrhoea and Enteritis - - - - - - - - - - - 4 4 2 6 1 4 4 1 1 — 1 28 Gastritis - - - - - - - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - - Congenital Malformations 7 - 1 1 - 1 - 7 2 1 20 4 3 - 1 - 2 - - - - - 30 Premature Birth 36 4 3 4 - - - 4 4 - 55 - - - - - - - - - - - 55 Atrophy, Atelectasis, Debility and Marasmus 5 - 1 1 - - - - - 1 8 1 1 - - - - - - - - - 10 Injury at Birth - - - 1 - - - - 1 - 2 - - - - - 1 - - - - - 3 Other Causes 2 1 1 - 1 - - - - 1 6 4 2 2 - 2 1 - 1 1 1 2 22 Totals 50 5 7 8 1 1 - 13 8 7 100 20 14 7 11 8 11 7 2 5 4 5 194 87 MIDWIFERY SERVICE. Midwives Acts, 1902 to 1936. Eighty-two midwives notified the Local Supervising Authority of their intention to practice within the Borough during 1947. Four ceased practising in the Borough; so that seventy-eight remained on the Register at the end of the year including seven 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 days afterwards. The following table gives details of the reasons for sending for medical nid: For Complications during Pregnancy. Abortion 22 Other causes 32 Albuminuria 6 60 For Complications during Labour. Breech 3 Premature Labour 3 Persist. Occipito Posterior 1 Malpresentation 4 Precipitate Labour 1 Foetal Distress 5 17 Delayed Labour. Uterine Inertia 2 Prolonged and obstructed 70 72 Haemorrhage. Ante-partum 6 Post-partum 12 18 Other Causes. Adherent and Retained Torn Perineum 225 Placenta 12 Illness of Mother 2 239 For Complications during Puerperium. Pyrexia 35 Pain in Breasts 3 Pain in Lees 13 Other causes 20 71 For Complications in regard to the Baby. Inflammation of Eyes 44 Still Birth 4 Feebleness 8 Other causes 68 Premature Birth 10 134 611 88 In accordance with Rule 33 of the Central Midwives Board, the following reasons for the discontinuance of breast-feeding were received: — Illness of Mother 25 Insufficient Milk 76 Other Causes 30 Total 131 MUNICIPAL MIDWIVES. Ante Natal Clinic Attendances— Jan. 1367 May 1150 Sept. 987 Feb. 1099 June 1000 Oct. 1028 March 1094 July 1126 Nov. 973 April 1172 August 854 Dec. 878 Midwifery Maternity Month Mileage Deliveries Normal Abnormal Normal Abnormal Bookings Ante-Natal Visits paid Post Natal Visits paid Gas and Air Office Bookings January 2595 185 163 3 19 — 263 394 3140 83 197 February 2042 161 136 2 23 — 157 344 3040 70 109 March 2109 171 155 2 13 1 182 482 3089 70 167 April 2261 174 147 5 21 1 142 405 3038 78 201 May 2629 183 157 6 17 3 205 451 3437 84 160 June 2597 145 119 4 19 3 190 527 3030 74 130 July 2295 171 150 1 20 — 163 564 3469 88 199 August 2245 128 108 3 16 1 161 463 3003 78 130 September 2299 126 98 7 20 1 204 541 2671 87 159 October 2193 118 93 4 21 — 139 470 2735 76 173 November 2162 114 91 4 17 2 151 464 2341 71 134 December . 2467 140 121 5 12 2 107 489 3160 73 95 Total 27894 1816 1538 46 218 14 2064 5594 36153 932 1854 89 Inpection of Midwives. Dr. Jenkin-Lloyd, the Inspector of Midwives, interviewed two midwives at the Town Hall. Sixty-two visits were paid by her to the homes of midwives. Doctors' Accounts under Section 14 (1) of the Midwives Act, 1918. 539 accounts were received from doctors for services rendered under the provisions of this Section. This compares with 401 in 1946, 291 in 1945, 248 in 1944, 329 in 1943, and 373 in 1942. The total amount of the accounts was £787 12s. 6d. £471 5s. 2d. was ultimately recovered from the patients. In 1946 the amount paid to doctors was £626 Is. 6d., and in 1945, £392 9s. 6d. Nursing Homes. Maternity Homes. Other Nursing Homes. Combined Maternity and other Nursing Homes. Total. No. of Homes on Register on 31/12/46 6 20 7 33 No. of Applications for Registration during 1947 - 3 1 4 No. of Homes Registered during 1947 - 3 1 4 No. of Homes on Register on 31/12/47 6 21 8 35 No. of Beds available 76 334 (a) Mat. Beds 55 (b) Other Beds 97 562 90 DAY NURSERIES. Attendances at Day Nurseries, 1947. Coldharbour House. Whitehorse Road. Mayday Road. Morland Road. Bramley Hill. Ritchie Road. New Addington. Euston Road. Bensham Grove. Date opened 23/2/42 1/6/42 1/6/42 8/3/43 27/10/43 23/11/43 28/3/44 15/5/44 21/3/1945 Number on books at end of year 89 49 49 58 53 58 60 54 49 Attendances : under 2 3939 4470 3906 4027 3712 3957 1616 2857 2745 over 2 13679 6702 6579 8275 7356 7342 8778 8003 8184 Total 17618 11172 10485 12302 11068 11299 10394 10860 10929 Number of days opened 303 303 303 303 303 304 303 303 303 Average daily attendance (excluding Saturdays) 58 37 35 41 37 37 34 36 36 91 MATERNITY AND CHILD WELFARE CONSULTATIONS. There are 17 Maternity and Child Welfare Centres, 15 of which are conducted by the Croydon Mothers' and Infants' Welfare Association and 2 by the local authority. A total of 25 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 1947, 4,243 new cases under 1 year of age and 855 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 77,941 in 1946, to 87,653 in 1947. Consultations with doctors increased from 23,407 to 27,115. 27 expectant mothers were seen, a decrease of 10 on 1946, and a total of 153 visits to the Centres was paid by them. The total of all visits to the Centres was 87,806, an increase of 9,684 compared with 1946. The table on page 95 gives detailed figures for the separate Centres. The highest average attendance of mothers and babies at each session was recorded at South Croydon (93.4), Boston Road (89.0), Norbury (87.6), Municipal (85.3), St. Andrew's (83.9). Dental Treatment. Maternity and Child Welfare Patients. Expectant and nursing mothers and children below school age are referred by Medical Officers attending Ante- and Post-Natal Clinics, and from Infant Welfare Centres. A substantial number are also sent by those in charge of Day Nurseries and similar institutions. Increasing applications for treatment have also been received through the Municipal Midwives' Service. 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 he commenced. During 1947 a considerable number of prospective mothers were inspected between the "third" and "fourth" months of pregnancy, and approximately 85.4 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. 92 A welcome increase is again noted in the numbers of preschool children referred for treatment; special reference is made to conditions found among the above at a later stage of this report. Expectant Mothers. Expectant mothers examined during the year numbered 658 compared with 733 last year, and represented 90.6 per cent. of the total number of new cases referred. Of the above, 85 per cent:. presented themselves during the first six months of pregnancy. The remainder, 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. New cases referred were 107 compared with 100 last year. Those seen during the first six months after their confinement constituted 81 per cent. of the total number referred, compared with 74 per cent last year. A minority with infants between seven and twelve months were referred from Post-natal Clinics and Welfare Centres for 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 908, compared with 919 in 1946. 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 264 against 260 last year. One less satisfactory feature of the scheme is that 23 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. 93 The Pre-School Child. The total number of such children referred from Welfare Centres, Day Nurseries and other sources was 529 against 448 last year. This further rise is encouraging, but dental supervision of those between three and live years of age is still very incomplete, and until this can be carried out on more systematic lines, far too large a proportion will remain untreated. The importance of inspection and care of 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 should materially assist in reducing present deficiencies until such time as Nursery Schools become an established fact. The introduction of wider measures for ante-natal care, 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 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 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. 94 Treatment. The following summary shows particulars of the work accomplished: — Expectant Mothers. Nursing Mothers. Total. Young Children. New Cases Examined 658 107 765 410 Re-treated 68 75 143 119 Total 726 182 908 529 Attendances 2383 306 2689 1017 Fillings 715 61 776 507 Extractions 1541 264 1805 382 " Gas " Cases 360 38 398 148 Local Anaesthesia 459 57 516 157 Scaling and Gum Treatment 342 29 371 6 Dressings 592 202 794 778 Denture Dressings 969 153 1122 — Silver Nitrate - - - 30 Treatments Completed 346 44 390 323 Number of Sessions (treatment) 450 Dentures Fitted 264 Dentures repaired 20 The centres, etc., at which patients were examined, or from which they were referred, are given in the following list:— Young Mothers. Children Mothers. Young Children. Ante-Natal 687 - Bensham Manor 6 11 Post-Natal 6 - St. Andrew's 1 10 Municipal Midwives 188 - Waddon 6 16 Municipal 7 28 Shirley 4 6 East Croydon 5 31 Boston Road 13 18 Upper Norwood - 6 Norbury 6 30 West Croydon 1 5 Holy Trinity 1 12 South Norwood 4 14 Addington — 13 South Croydon — 2 Day Nurseries — 88 St. Alban's 10 16 The Retreat 8 - Woodside 3 18 Referred by Dental Officers - . 195 St. Oswald's 3 19 Mothers: 959. Young Children: 538. Total : 1,497. The amount received for attendance fees was £147 9s. 0d., as against £69 8s. Od. in 1946. Attendances at Infant Centres—1947. Municipal. Boston Road. St. Andrew's. South Croydon. Shirley. Woodside. East Croydon. South Norwood. Upper Norwood. St. Alban's. Bensliam Manor. St. Oswald's. West Croydon. Norbury. Waddon. Selhurst. New Addingtmi. Total 1947. Total 1946. New cases under 1 year 441 244 200 237 191 238 412 365 177 297 245 284 96 343 140 133 200 4243 3719 No. of re-attendances 5295 2632 2593 3038 1634 3502 4695 4764 2144 4379 4149 4230 1342 5118 1879 1864 1802 55060 44927 New cases over 1 year 62 46 48 35 60 76 70 65 40 61 57 11 37 44 30 33 60 855 839 No. of re-attendances 2709 1441 1186 1261 1131 1656 2136 1475 971 1760 1857 2649 949 3251 816 1351 896 27495 28456 Attendances of children 0-5 8527 4363 4027 4571 3016 5472 7313 6669 3332 6497 6308 7174 2424 8756 2865 3381 2958 87653 77941 Consultations with Doctor 2520 1394 1203 1178 527 1837 2127 1940 860 2174 2058 2064 1035 2443 1016 1376 1298 27115 23407 No. of Sessions 100 49 48 49 49 98 99 98 48 99 96 98 49 100 50 50 52 1232 1137 Expectant Mothers: No. of new cases - - - 2 - - - - - - 3 1 - 1 9 - 11 27 37 No. of re-attendances - - - 6 - - - 4 - - 1 - 12 1 63 27 12 126 144 Total attendances of Expectant Mothers - — — 8 — — — 4 — — 4 1 12 2 72 27 23 153 181 Total attendances 8527 4363 4027 4579 3016 5472 7313 6673 3332 6497 6312 7175 2436 8758 2937 3408 2981 87806 78122 Average attendance per Session 1947 85.3 89.0 83.9 93.4 61.6 55.8 73.9 68.1 69.4 65.6 65.7 73.2 49.7 87.6 58.7 68.2 57.3 71.3 — 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 — 68.7 95 96 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 1947 who were born— (i) at home 81 (ii) in hospital 234 (2) The number of those born at home— who were nursed entirely at home 71 who died during the first 24 hours 10 who survived at the end of one month 71 (3) The number of those born in hospital— who died during the first 24 hours 45 who survived at the end of one month 189 The Work of the Health Visitors.—Maternity and Child Welfare Visits Only. Visits Re Ashe Comm. 20/1/47 Baker Comm. 18/8/47 Biggs Bird Blest Comm. 6/1/47 Left 24/1/47 Christie Devaney Early Edwards Elliott Ernest Hall Comm. 5/8/47 Hillyard Hinton Hobdey Comm. 27/5/47 Johns Left 22/3/47 Linton Comm. 18/8/47 Munroe Oakley Orridge Comm. 6/1/47 Partridge Comm. 3/2/47 Left 5/7/47 Reed Southgate Comm. 4/9/47 Stack Left 30/4/47 Stokes Thomas Toneri Walker Warman Webb Left 22/11/47 Wilson Wybrew Total Infants under 1 year— First Visits 114 199 32 280 192 14 285 106 305 206 267 264 100 212 220 39 37 49 37 196 177 139 180 48 71 245 283 272 127 202 212 242 5352 Re-visits 325 442 128 505 817 18 685 630 1160 494 524 731 372 1357 1177 45 154 172 46 595 265 273 197 308 50 761 421 605 252 899 546 445 15399 Children 1—2 years— First Visits - 4 - 4 8 - 157 2 12 14 5 9 7 1 13 2 1 4 - 1 27 1 17 3 1 5 4 13 2 5 5 8 335 Re-visits 138 305 67 427 379 9 346 329 894 239 136 484 183 460 666 41 73 101 12 359 187 154 160 180 28 151 388 589 137 515 328 216 8681 Children 2—5 years— First Visits - 2 3 1 13 - 125 1 10 37 - 7 3 - 20 - 5 2 - 1 30 i 1 7 - 3 9 5 14 3 7 15 25 356 Re-visits 279 562 56 492 749 9 385 455 631 407 281 805 296 327 1305 61 178 170 30 505 370 305 311 196 90 319 541 913 305 734 836 347 13250 Expectant Mothers— First Visits 63 53 8 82 65 11 92 60 130 87 101 127 57 78 59 5 12 27 21 60 33 21 96 32 24 87 75 90 59 49 125 85 1974 Re-visits 7 3 1 — 1 — 1 39 1 4 12 11 5 — 32 — 1 1 — 18 — 1 8 — 1 5 1 5 — 2 27 7 194 Still Births 1 3 — — 1 — 1 1 1 1 1 3 1 - - - - - - - - - - 2 3 1 - 2 2 1 28 Deaths under 1 year 2 15 — 8 2 — 4 3 3 11 5 11 1 — - 1 1 1 — 4 3 4 4 — 1 2 7 7 1 3 6 4 114 Miscellaneous Visits — 53 44 6 98 3 56 15 6 7 68 312 11 5 1 - 4 9 21 57 6 11 182 16 — 110 35 77 14 97 100 42 1466 Ineffective Visits 221 548 128 292 531 21 360 138 791 500 473 460 342 373 363 84 117 171 38 726 230 304 406 213 67 370 281 512 433 636 422 458 11009 Totals: 1947 1150 2189 467 2097 2856 85 2497 1779 3944 2007 1880 3224 1378 2813 3856 278 583 707 205 2525 1328 1214 1568 996 336 2066 2044 3098 1333 3151 2624 1880 58158 1946 1048 — - 1663 769 — 2286 1958 2136 695 1579 1049 - 3034 3708 — 1162 — 2077 2052 — - 1389 — 1395 645 1492 2967 1446 2165 2848 2181 *50737 *Including Health Visitors who left during 1946. 97 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 Centres. I am indebted to the Convalescence Secretary for the data given below: — Total number of children under 5 sent to Convalescent Homes 4 Total number of weeks 23 Number of mothers sent for Convalescence 14 Number of children under 5 sent with their mothers to Convalescent Homes and Cottages 16 Total number of weeks 31½ Number of mothers sent for Convalescence to Relatives1 Total Cost of Convalescence for the year £186 6d. 5d. Home Helps. During the year 825 expectant mothers applied for Home Helps, and 771 were supplied. The corresponding figures for 1946 were 622 mothers applied, and 551 were supplied. At the end of the year there were the names of 37 full-time and 20 casual Home Helps on the register. Babies' Help Report. I am indebted to Mrs. Philpott for the following particulars: — " In January, 1947, three mothers and babies were receiving grants. During the year nine mothers were helped and at the end of the year one was receiving help. Payments are made at 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. 98 PUBLIC HEALTH ACT, 1936. PART VII. Child Life Protection. This part of the Act deals with Foster Mothers and Foster Children. The Tables below give figures for 1947. FOSTER CHILDREN No. as at Dec. 31st 1946 Notice of Reception of Children during the year Notice of removal to— Children Adopted Died Children reaching age of 9 No. as al Dec. 31st 1947 Parent Another aiea with Foster Parent Another Foster Mother Public Institution 107 114 57 15 10 19 20 — 8 92 FOSTER MOTHERS. No. as at December 31st 1946 Applications for Authorisati n during the year. Removals during the year Authorisation cancelled for other reasons No. as at December 31st 1947 With Child Without child 85 42 4 — 48 75 The Health Visitors paid 939 visits to foster-mothers for (he purpose of supervision. THE OBSTETRIC SERVICE. The Obstetric Service has been described in my Report lor 1938. The following are the statistics for 1947: — Taking the Registrar-General's figures for maternal mortality (deaths directly due to pregnancy), the rate for England and Wales for 1947 was 1.17 per 1,000 births. In Croydon the rate was 1.92. In "booked" cases treated by the Obstetric Service the rate for 1947 was 0.58 per 1,000 Hospital deliveries; nil per 1,000 home deliveries, and 0.26 per 1,000 over all deliveries. Of the cases treated to a conclusion at the Post-Natal Clinic during 1947, 95.5 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 1946 was 96.2. 99 The number of cases delivered of viable babies in Mayday Hospital, with a nominal 68 beds, was 1,280. The number delivered at St. Mary's Maternity Hospital, with 30 beds, was 704. The number of cases delivered by the Domiciliary Branch of the Service (Municipal Midwives) was 1,816. Including 51 cases admitted after delivery, the total number of deliveries dealt with by the Obstetric Service was 3,851. The total number of infants born was 3,925. 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. 822 mothers and babies were transferred from Mayday Hospital, and 125 mothers and babies from St. Mary's Hospital in 1947 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 1947, as compared with previous years. General Statistics, 1947. No. of live births allocated to the Borough of Croydon 5,100 „ still „ ,, ,, ,, 111 No. of maternal deaths 10 No. of cases of notified Puerperal Pyrexia 39 No. of expectant mothers who attended the Bnrough AnteNatal Clinics 3,735 No. of cases delivered in Mayday Hospital as Booked cases (exclusive of abortions) 1,019 No. of cases delivered in Mayday Hospital as Emergency cases (exclusive of abortions) 261 Total cases delivered in Mayday Hospital 1,280 No. of cases delivered in St. Mary's Maternity Hospital as Booked cases 704 No. of cases delivered in St. Mary's Maternity Hospital as Emergency cases - Total cases delivered in St. Mary's Maternity Hospital 704 No. of cases delivered by Municipal midwives 1,816 Total 3,800 100 No. of cases admitted to the Puerperal Infection Unit, Borough Hospital, including 5 from Mayday Hospital and 2 from St. Mary's Nursing Hospital 15 No. of Maternal deaths in Booked cases from Borough Ante-Natal Clinics 1 No. of Maternal deaths in Emergency cases at Mayday Hospital (including 4 abortion deaths) 5 No. of Maternal deaths in cases admitted as Puerperal Sepsis per se 0 Total Maternal deaths in beds of the Obstetric Service 6 The total number of patients treated by the Obstetric Service was:— (a) In Mayday Hospital 1,665 (b) In St. Mary's Maternity Hospital 797 (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) 1,827 (e) At the Post-Natal Clinics, excluding those included in (a), (b), (c) and (d) 37 (f) At the Ante-Natal Clinics and undelivered on December 31st, 1947 936 (g) At Gynaecological Clinic— (i) New cases referred by Doctors 592 (ii) Obstetric Service cases—seen as new cases 559 6,428 Incidence of Abortion. 1946. 1947. Incomplete abortions 171 168 Threatened abortion with final evacuation 24 26 Inevitable abortion 27 12 Complete abortion 32 16 Missed abortion — 3 Threatened abortion discharged undelivered 44 35 Total 298 260 ANTE-NATAL SUPERVISION. 1946 1947 No. of Sessions at Ante-Natal Clinics held 603 611 No. of individuals who attended 4,484 3,735 No. of previous year's cases continuing attendance 1,177 866 No. of new cases 3,238 2,722 No. of cases undelivered on 31st December 866 936 Total attendances made 21,615 20,916 Average attendances per session 36 34 No. of cases delivered in hospital as Booked cases 1,941 1,780 No. of cases delivered by Municipal Midwives. 1.610 1,816 101 No. of cases delivered at other places under the care of private doctors or midwives 65 130 No. of patients found not to be pregnant 18 55 No. of patients referred to hospital for Ante- Natal treatment 316 480 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 1947 the ObstetriG Service dealt with 3,851 out of the total births allocated to the Borough. Major Ante-Natal Conditions treated at the Ante-Natal Clinic. BREECH PRESENTATION. Breech presentation diagnosed 240 Spontaneous version 81 External version successful 132 External version not successful 49 Allowed to go to term as Breech 17 Not recognised as Breech before labour 27 VENEREAL DISEASE. Gonorrhoea Total cases 1 Transferred to Borough V.D. Clinic 1 Syphilis ... Total cases 6 Transferred to Borough V.D. Clinic 6 Non-Venereal 3 Independent Midwives Cases. These cases may be summarised as follows: — Total number of midwives' cases during 1947 10 Number of cases sent for one consultation only 5 Number of cases supervised entirely 5 Emergency Obstetric Service. Number of calls 13 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 1,070 102 SPECIAL INVESTIGATIONS. Special investigations were carried out on ante-natal patients attending the Clinics and on patients in St. Mary's Maternity Hospital and Mayday Hospital Maternity Wards. Pathological Investigations. Blood for Wassermann and Kahn reactions 2,861 Gonococcal fixation tests 120 Blood for Hb. estimation 620 Blood for grouping 250 Compatability tests 120 Blood counts 326 Blood films 8 Blood sedimentation rate 6 Blood culture 6 Blood urea 120 Bleeding and Clothing time 4 Prothrombin time 1 Van den Bergh reaction 3 Glucose Tolerance test — Blood sugar 4 Rh. Factor 3,287 Catheter Specimen of Urine 720 Urea Clearance tests 82 Urea concentration — Urine for Ascheim-Zondek Test 92 Throat swabs 384 Nasal swabs 46 Vaginal swabs 260 Urethral swabs 15 Conjunctival swabs 41 Ear swabs —« Bacteriology of Breast Milk 4 Sputa 3 Cerebro-Spinal Fluid 2 Pus from Wounds, Spots, Blisters, etc. 22 Faeces culture 4 Specimens of tissue for histology 61 X-Ray Examinations (Mayday Hospital X-Ray Department). 275 cases were referred from Mayday Hospital, St. Mary s Maternity Hospital, and Ante-Natal Clinics. Reasons for reference were:— Breech for Attitude, etc. 29 For Presentation, Attitude, etc 20 Twins 58 Foetal Death 3 Foetal Parts 5 Disproportion 14 Foetal Abnormalities 17 Pelvic Abnormality and Pelvimetry 58 Ches 30 Various 41 108 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 1,016 704 . 1,720 (2) Delivered in hospital before 28th week 3 0 3 (3) Admitted after delivery 21 10 31 (4) Discharged undelivered after ante-natal treatment and not subsequently delivered in hospital - - - (5) Died undelivered - - - (6) Ectopic Pregnancy — — - 1,040 714 . 1,754 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 28th week.. 261 — (c) Delivered in hospital before 28th week — — (d) Died undelivered 1 — (2) After Delivery 29 — (3) Ectopic Pregnancy 3 - 294 - 104 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. Toxaemia 157 24 37 218 Eclampsia 1 2 — 3 Persistent vomiting of pregnancy 10 8 - 18 Acute pyelitis 12 6 — 18 Retroverted gravid uterus — — — — 2. Intercurrent Diseases. Chronic nephritis 2 - - 2 Pulmonary Tuberculosis 5 — — 5 Venereal disease 4 — — 4 Cardiac disease 32 2 7 41 3. Conditions chiefly Natal. Presentations at Delivery :— Anterior positions of the vertex 961 199 641 1801 Posterior positions of the vertex 48 9 50 107 Breech 69 14 24 107 Shoulder 1 1 — 2 Face and brow 2 1 1 4 Complex — — — — Caesarean section 54 10 — 64 Twins and Triplets 22 5 13 40 Accidental haemorrhage 12 9 1 22 Placenta praevia 20 10 3 33 Hydramnios 17 2 5 24 Prolapse of cor 3 1 1 5 Retained placenta 15 10 10 35 Post-Partum haemorrhage 49 15 16 80 B.B.A 22 23 6 51 Lacerated perineum 246 30 141 417 Obstructed labour — - - - Premature labour 98 24 53 175 Abortion 30 230 — 200 Ectopic pregnancy — 3. — 3 Abdominal Hysterotomy 9 6 — 15 Forceps delivery 94 22 47 163 4. Conditions chiefly Post Natal, excluding re-admissions from Post Natal Clinic. Breast abscess - - - - Notified pyrexia or fever 9 8 6 23 In addition 10 cases of Puerperal Pyrexia and 1 of Sepsis per se were admitted to the Puerperal Infection Unit of the Borough Hospital. 105 Blood Transfusion (64 Obstetrical and 44 Gynaecological cases). For every case, stored blood from the Blood Transfusion Depot, Sutton, was used. There were 2 deaths from Serum Hepatitis, but no death due to blood transfusion. Infants. Mayday Hospital Booked. Mayday Hospital Emergency St. Mary's Maternity Hospital Booked. Total No. of infants in Hospital on 1st Jan., 1947 26 5 25 56 Total No. of live births, still births and infants admitted with Mother (B.B.A.) 1126 261 718 2105 No. of infants in Hospital on 31st Dec., 1947 27 3 23 53 Alive on discharge from Hospital 1050 333 690 2073 Stillborn 33 21 20 79 Died (born alive, but died in Hospital) 38 7 8 53 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 1,283 infants discharged from Mayday Hospital, 856 were up to or over birth weight (67 per cent.). Of 690 infants discharged from St. Mary's Maternity Hospital, 486 were up to or over birth weight (70 per cent.). Twins and Triplets. There were 43 cases of Twins and none of Triplets. There was no maternal death. Mayday Hospital. Booked. Mayday Hospital. Emergency. St. Mary's Maternity Hospital. 1. Booked. Total. No. of cases 24 6 13 43 No. of infants discharged alive 41 9 20 70 No. of still-births and infant deaths 7 3 6 16 Foetal and Infant Mortality 14.6% 25.0% 23.1% 18.6% 106 ANTE-NATAL CLINIC Total new patients registered 2,943 Total new patients who did not attend for first appointment because aborted, left district, reason unknown, etc. 82 Total new patients sent to Midwives, Nursing Homes, etc.; who could not be accommodated in Mayday or St. Mary's 775 Total who booked at a Nursing Home 111 Total who booked at a Hostel for Unmarried Mothers 21 POST-NATAL AND GYNAECOLOGICAL CLINIC. Number of Sessions held 101 „ „ Individuals presented 4,460 Average attendance per session 44 Number of Post-Natal cases 2,173 Number of Gynaecological cases 1,151 END RESULTS. 977 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 507 426 933 95.5 Health slightly impaired 25 18 43 4.4 Health seriously impaired — 1 1 0.1 Totals, treated to conclusion 532 445 977 Maternal Mortality (Obstetric Service). Six deaths occurred of mothers dealt with by the Service, one in "Booked" cases, five in "Emergency." The maternal mortality of "Booked" cases, i.e., cases under the continued supervision of the Service, is 0.58 per 1,000 hospital deliveries, and 0.26 per 1,000 total deliveries, including the Municipal Midwives "Booked" cases. Puerperal Infection. Thrty-nine cases were treated in isolation for puerperal infection, 15 of them in the Borough Hospital, 24 in St. Mary's and Mayday Hospitals. There was no death. 107 Sources of the Cases. Cases. Deaths. From Mayday Hospital:— " Booked " Cases 5 - " Emergency " Cases — — From St. Mary's Maternity Hospital 2 — From other Hospitals — — From private doctors, deliveries in Nursing Homes 1 — From private doctors, deliveries at home 7 - The Assistant Medical Officer of Health for Obstetrics was called in by medical practitioners to see 77 obstetrical and 592 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 104 cases in the medical and surgical wards of the Hospital. MENTAL DEFICIENCY. Number of known Mentally Defective Patients in the Borough: — 1946. 1947. (1) Statutory Cases : Aged 0—5 years 60 74 Aged 5—16 years 100 182 Over 16 years 536 395 Total 696 651 (2) Education Cases : Aged 7—16 years 148 160 Combined Total 844 811 Compared with 1946, the Statutory cases show a decrease of 45 and the Educational cases an increase of 12. Seven of the cases under Statutory supervision have died. Three Institution patients have died in hospital. 108 The Statutory cases are distributed as follows:— 1946. 1947. In Certified Institutions 230 238 In Approved Homes 5 6 On leave from Institutions 8 18 Under Statutory supervision at home 361 225 Under Guardianship 64 66 In Mental Hospitals 8 18 Observation cases 20 80 696 651 The Education cases were distributed as follows: — In Certified Residential Schools 1 — In Certified Day Schools 147 160 In Private Schools — — Awaiting vacancies at St. Christopher's - — 148 160 During the year the Certifying Medical Officers made examinations and paid visits to the number of 135 to Statutory cases. The Mental Deficiency Visitors paid 1,458 visits to Statutory cases and 984 to Education cases, 2,442 visits in all, an increase of 438 on 1946 figures. During 1947, 41 Statutory cases were dealt with as follows- 1946. 1947. Sent to Certified Institutions 19 26 Placed under Guardianship 4 1 Sent to Warlingham Park Hospital — — Varying Orders: (a) Change of Guardian 8 5 (6) From one Institution to another. 2 5 (c) From Guardianship to Institution. 3 — (d) Orders closed — 4 Eighty Orders were renewed during the year, 17 of which were Guardianship. Guardianship Cases. There were 66 cases under Statutory Guardianships, 40 of these under the care of relatives, and 26 with Guardians who are not relatives. 10 males and 3 females are at work. 109 248 visits have been paid to Guardianship cases during the year. There are 18 cases on leave from Institutions (10 boys and 8 girls). Clinic for Mentally Defective, Backward and Abnormal Children. 134 children were examined during 1947. The classifications arrived at, together with recommendations made, are summarised under— 1946. 1947. (1) Certified as Mentally Defective : (a) Recommended for Occupation Centre — 13 (2) Found to be educationally subnormal : Recommendations— (a) Recommended for Special Day School 47 46 (b) Recommended for Residential School 2 6 (3) Found to be dull and backward: (a) Referred to a Special Class 17 1 (b) Further trial in Ordinary Class 2 1 (c) Re-test in one year 17 46 (d) To attend St. Giles' because of physical defect 1 2 (e) To attend St. Luke's — 1 (f) Referred for Medical Treatment. — 2 (g) Recommended for Special School for Deaf - 2 (h) Recommended for Epileptic Colony — 2 (4) Referred to Child Guidance Clinic - — (5) Referred for Vocational Guidance — 1 86 123 Mental Tests at St. Christopher's 12 11 98 134 ORTHOPAEDIC DEPARTMENT. The arrangements are the same as in 1946. Summary of Cases Attending the Orthopœdic Clinic. Jan. 1st, 1947. New Cases, 1947. Cases Discharged, 1947. Cases on books, Jan. 1st, 1948. M.C.W. S M.S. Tuberc. M.C.W. S-M.S. Tuberc. M.C.W. S.M.S.. Tuberc. M.C.W. S.M.S. T uberc 223 262 75 135 193 4 36 60 2 322 395 77 560 332 98 794 110 Cases seen by the Orthopaedic Surgeon, 1947. Defects. School. M.C.W. Tuberculosis. Total. Cases. Cases. Cases. Cases. ances. ances. ances. ances. Infantile Paralysis 3 23 3 4 6 27 Curvature or Postural Defects 22 34 1 2 — — 23 36 Pes Cavus 8 17 — — — — 8 17 Pes Planus 11 182 17 18 — - 128 2C0 Genu Valgum 33 36 49 83 — — 82 119 Talipes 7 9 33 95 — — 40 104 Obstetrical Paralysis 2 4 2 2 4 6 Joint Diseases 14 25 1 6 11a 4s 1m 39a 13s 1m 31 84 Injuries 13 27 1 1 — — 14 23 Rickets 3 3 — — - - 3 3 Wry Neck 1 4 6 11 — — 7 15 Spastic Paraplegia 5 11 1 1 - - 6 12 Congenital dislocation of the Hip 11 19 3 3 — — 14 22 Other deformities 47 58 56 74 — — 103 132 280 452 173 300 16 53 469 805 a—Adults; s—School Child; m—Pre-School. Summarised, the table shows 280 school children attended and made 452 attendances. 173 babies made 300 attendances, and 16 tuberculosis cases made 53 attendances A total of 469 cases made 805 attendances. 111 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 XRays No. of Cases Treatments X- Rays Cases No. of Treatments XRays Cases No. of Treatments XRays Infantile Paralysis 1 — 1 - - - - - - 1 — 1 Curvature or postural defect 7 70 3 1 — 2 - - - 8 70 5 Pes cavus - - - - - - - - - - - - Pes planus 9 97 2 — - - - - - 9 97 2 Genu Valgum 1 — 1 - - - - - - 1 — 1 Wipes — — — 2 12 1 — — — 2 12 1 Joint Disease 4 — 5 2 - 4 13 — 16 19 - 25 Injuries .9 - 10 - - - - - - 9 - 10 Rickets - - - - - - - - - - - - Wry Neck 1 - 1 1 16 — - - — 2 16 1 Spastic Paraplegia 1 8 1 - - - - - - 1 8 1 Congenital Dislocation of the Hip. 4 — 6 3 — 3 — — — 7 — 9 Other Deformities - - - 2 - 2 - - - 2 - 2 37 175 30 11 28 12 13 — 16 61 203 58 112 Cases admitted to Residential Institutions. Name of Institution. School Cases. M. & C.W. Cases Tuberculosis Cases. Total. No. in on 1st Jan., 1947 Admitted Discharged. No. in on 1st Jan., 1947 Admitted. Discharged. No. in on 1st Jan.. 1947 Admitted. Discharged. No. in on 1st Jan., 1947 Admitted. Discharged. No. in on 1st Jan.. 1948 Victoria Home - - - - - - 15 - 15 1 - 1 - Pyrford 1 - 1 — — — 15 1m 2a 1m 4s 1m 1s 1a 1m 4s 2 3 4 1 Croydon Gen. Hosp. — 12 12 — 9 7 — 3a 2A — 29 26 3 Heritage Craft Schls. 1 — 1 — — — 3s — 1s 4 — 2 2 Pinner - - - - - - - - - - - - - Ld. Myr. Treloar Hosp. — — — — — — 1s 3s — 1 3 - E. M. S. Hosp. - - - - - - - - - - - - - Shaftesbury Homes... 1 - - - - - - - - - - - 1 Queen Mary's Hosp. 1 - 1 — — — 1s — 1s 2 — 2 - Royal Nat. Orth. Hosp — 1 1 - - - - - - - 1 1 - Mayday Hosp. 2 — 2 1 — 1 5a 2a 5a 8 2 8 2 Redhill Hosp. - - - - - - - - - - - — — Wingfield Morris Hos. - - - - - - - - - - — — 3 R. S. B. H - - - - - - 4a 1s 2a 3a 15 5 2 4 • 6 13 18 1 9 8 8s 9a (2m 7s 9a 2m 9s 11a 24 40 43 16 113 Conditions for which Patients were admitted to Hospitals with the Results of Treatment. Condition. In on 1st Jan. 1947 Admitted or transferred. Discharged. I.S.Q. Died. In on 1st Jan. 1948 Arrested. Quiescent. Improved. Infantile Paralysis 1 — — — — — — 1 Tubercular Joint Disease 13 17 3 14 5 — — 8 Hip Disease 5 — — — 5 — — — Hemiplegia — - — — — — — — Genu Valgum — 1 — — I -• — — Pes Planus — 6 - — 6 — — — Talipes — 3 — — 3 — — — Rickets - — — — — — — — Other Deformities — 10 — — 8 — — 2 Spastic Paraplegia — 2 — — 2 — — — Scoliosis — — — — — — — — Osteomyelitis — — — — — — — — 19 39 3 14 30 — — 11 114 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 466 Number of Blind who benefit from instruction in Braille or Moon type (including those who already read) 185 Number of Blind who benefit from part-time instruction Ill Number in remunerative handicrafts— (a) Home worker 32 (b) In workshops 7 (c) St. Dunstan's 18 (d) Workers not included in scheme 39 Home Teachers 4 The Health Visitors paid 551 visits to blind persons during the year. The following Table shows:— (a) The number of blind persons registered. (b) The ages at which blindness occurred. (c) The method of training. (d) The occupations of employed blind persons. (e) The defective blind. (f) The unemployable blind persons in homes, mental hospitals or institutions. 115 116 M. = Males. F. = Females. T. = Total. WELFARE OF THE BUND—REGISTRATION. As at 31/3/48. TABLE 1. Age period 0—1 Age period 1—5 Age period 5—16 Age period 16—21 Age period 21—40 Age period 40—50 Age period 50—65 Age period 65—70 Age period 70 and over (i) Total of all age groups (ii) Age unknown M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. — - — 1 1 2 5 3 8 2 1 3 28 20 48 30 22 52 50 54 104 26 33 59 60 127 187 (i) 202 (ii) - (i) 261 (ii) 3 463 (ii) 3 AGES AT WHICH BLINDNESS OCCURRED. Age period 0—1 Age period 1—5 Age period 5—10 Age period 10—20 Age period 20—30 Age period 30—40 Age period 40—50 Age period 50—60 Age period 60—70 Age period 70 and over Age period Unknown M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 23 17 40 7 6 13 7 10 17 11 10 21 21 12 33 28 21 49 26 29 55 14 37 51 21 38 59 28 69 97 16 15 31 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 4 — — 1 — — (a) Workshops (b) Home workers Other Schools 1 1 — — — — Not at School M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. — — — 1 — — 5 2 7 23 9 32 31 8 39 59 19 78 4 - 4 - - - - - - - - - 1 - 1 138 245 383 202 264 466 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, Shop. Keepers Firewood Workers Gardeners Hawkers, Newsvendors, &c. Home Teachera 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 — — — — — — — — — — — — — — — — — — — — — — — — — — — — 7 In approved Home Workers Schemes — 4 — — — 2 — 1 — 3 — — — 1 — 1 — — 7 — — 2 — 1 — — — — — — 10 — — 32 Others not parttime workers) — — — — — — — — — — — — — — — — — — — — 2 1 2 2 — — — — — 8 — — 16 39 Total - 5 1 — 1 3 — 1 — 3 4 — 3 1 — 1 2 — 8 - 3 3 2 3 - — — - — 8 10 — 16 78 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 Public Vssistance Institutions M. P. 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 (ii) 2 (i) 5 (ii) 1 11 3 1 - 1 — 2. 2 — — — — — 16 17 33 — 5 5 1 1 2 6 21 27 117 SANITARY CIRCUMSTANCES. To the Medical Officer of Health. 1 beg to submit a report for the year ending the 31st December, 1947, of the work of the Sanitary Inspectors and other officers under my supervision. It has been a year given over largely to dealing with complaints of conditions affecting the housing environment of residents in the Borough. Six years of war, in five of which the Borough was subjected to considerable damage by enemy action has left property in a bad state of repair and since the "peace" labour and materials difficulties have not permitted a rapid restoration. Owners, as well as tenants, of property have had recourse to "calling in the Sanitary Inspector" in order to facilitate the granting of the necessary building licence to permit essential works of repair to be carried out. Today the major portion of building licences issued, is to cover works asked for on Sanitary Notices and the quantities of controlled building materials required to comply with such notices have to be agreed and certified by my staff. During the year under review 13,194 Notices have been served and 12,300 have been complied, a result, under the circumstances, I consider, satisfactory. It was found necessary in 433 cases, for the Local Authority to do the works asked for on Statutory Notices in default of owners. On account of the abnormal number of "housing" complaints it has not been possible to give attention, on a pre-war scale to routine inspection of factories, workplaces, food premises, etc., but the tables in this report will show that these have not been neglected. Rats and Mice Destruction has been given special attention, An intensive attack on the sewer rat has been carried out and the whole of the sewerage system of the Borough has been baited, involving some 4,000 manholes and whilst it is too early yet to finalise the results, indications are that it has been particularly successful. The Food Supply of the Borough has been supervised both by inspection and by sampling. At the Abattoir a total of 25,822 animals have been slaughtered and all of these have been inspected regarding their fitness for food. In addition, all the meat passing through the Government Meat Depot, which serves a population of 350,000, has also been inspected by my staff. Food preparation premises and shops have also received 118 tion. Food and drink is regularly sampled for chemical and bacteriological examination, 1,302 such samples having been taken during the year, the results of which are set out in the body of the report. I should finally like to take this opportunity of thanking all those under my control, who have throughout the year and under difficult working conditions, given such excellent service in maintaining the work of the department. 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) 11,372 Number of houses inspected where zymotic diseases have occurred 421 House drains tested 835 House drains tested on application 11 Number of smoke tests during repair 108 Inspections of drainage work during repair 2,986 Number of water tests during repair 169 Final tests of drains after repair 76 Final tests of drains when completely relaid 25 Length of new drains tested feet 3,290 Inspection of yards, stables and manure pits 90 ,, passages 56 „ public conveniences 58 „ pigstyes 57 ,, tents, vans and similar structures 72 ,, theatres, cinemas, halls, etc. 116 ,, ponds and ditches and static water tanks 202 ,, schools and school sanitary conveniences 21 ,, common lodging-houses 11 ,, verminous premises 92 ,, premises where offensive trades are conducted 22 „ gipsy encampments, camps, fairs, etc 4 ,, cesspools 2 ,, gathering grounds of water supply 57 Number of visits under Rats and Mice (Destruction) Act, 1919 6,953 Inspections of war damaged houses 85 Smoke observations 45 Number of visits re Infectious Diseases 2,208 Inspections of Shops (under Shops Acts) 955 Special Early Closing and Evening Patrols (Shop Hours Acts) 271 Overcrowding inspections 355 Inspections under Fertilisers and Feeding Stuffs Act 2 ,, under Pharmacy and Poisons Act 40 ,, Dairies 58 „ Farms and cowsheds 76 ,, Milkshops 4 ,, Premises where food is prepared or sold 3,729 ,, Bakehouses 79 „ Slaughterhouses 662 119 Inspection Factories without mechanical power 81 ,, Factories with mechanical power 199 ,, Workplaces, Public Health Act 64 „ Outworkers' premises 68 Visits re Young Persons Employment Act 19 Water samples taken 113 Food and Drugs Acts: milk samples taken 249 Food and Drugs Acts : other foods and drugs samples taken 410 Milk Special Designations Orders : samples taken 261 Non-designated Milk: samples taken 114 Ice Cream samples taken 155 Reinspections of work on outstanding notices 29,683 Sundry inspections and visits 2,759 Appointments kept with owners, builders, etc 4,730 Complaints from public investigated (including those in regard to housing defects) 15,100 Informal notices outstanding 31-12-46 2,582 Informal notices served 9,521 Informal notices complied 8,827 Number of Informal Notices referred for Statutory Orders 1,875 Informal notices outstanding 3,276 Statutory notices outstanding 31-12-46 1,508 Statutory notices served 3,673 Statutory notices complied 3,533 Statutory notices outstanding 31-12-47 1,648 Total number of callers and complaints received at the office 13,634 Total number of letters received at the Office 12,383 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1947 and for which action was taken to enforce compliance:— (1) NUISANCES AND HOUSING DEFECTS AT HOUSES, etc. Insufficient means of ventilation: Defective ventilators, windows and sashcords 1,991 Conditions causing dampness: Defective roofs 1,916 Defective window frames 682 Defective walls, etc. 1,4/9 Want of efficient damp-proof course 464 Defective gutters and downspouts 1,488 Other structural defects: Defective plaster 1,724 Cleansing and limewashing required 1,286 Defective floors and stairs 1,363 Insufficient ventilation under floor 164 Defective brickwork, cills, lintels, chimneys, etc 573 Defective stoves and fireplaces and flues 964 Defective drains, sanitary fittings, etc.: Defective sinks and waste pipes 756 Defective w.c.'s 682 Defective drainage 760 Stoppages in drainr 627 Defective water services and tanks 373 Domestic nuisances: Want of cleanliness 38 Dirty w.c. pans 56 Verminous conditions 57 120 Other nuisances and infringements: Offensive accumulations 96 Dirty or defective sanitary conveniences 20 Overcrowding 100 Smoke nuisances 5 Sundry nuisances or defects 106 Particulars not inserted in Rent Book (Housing Act) 4 „ ,, ,, (Rent Restriction Act) 7 (Z) FACTORIES AND WORKPLACES. Want of cleanliness 15 Inadequate ventilation 3 Inadequate lighting 4 Insufficient drainage of floors 3 Abstract not exhibited 6 Means of ablution required 6 Sundry nuisances or defects 47 W.C.'s—Insufficient 35 ,, Unsuitable or defective 58 „ Not separate for sexes 6 (3) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924. Food cupboards defective or required 23 (4) INFRINGEMENTS OF FOOD AND DRUGS ACT, 1938, AND FOOD BYELAWS. Cleansing or repair of walls and ceilings 210 Cleansing or repair of floors, utensils, fixtures, etc. 154 Overalls required 3 Accumulation in yards or stores 35 Defective structures 157 Dirty or defective w.c. accommodation 83 Food storage accommodation required 10 Food improperly stored 11 Refuse bins insufficient 43 Animals kept in food store 2 Dirty or defective vehicles 1 Means of ablution required or defective 26 Provision of cloakroom accommodation 12 Insufficient w.c. accommodation 10 Insufficient or defective sink accommodation and water supply 82 Lighting and ventilation required in food store 15 Household washing in food store 2 Impervious floors required to kitchens, etc. 28 Defective paving 20 (5) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING, Etc. Defective Yard Paving 50 Want of a sanitary dustbin 397 (6) INFRINGEMENTS OF SHOPS ACT. Shops Closing Hours 15 Infringement in hours of employment and welfare provisions 61 Notices to be exhibited or amended 423 Defective ventilation 4 121 Provision of means of heating 12 Insufficient w.c. accommodation 3 Want of washing facilities 5 Defective w.c. accommodation 29 Defective walls, floors, ceilings, etc 13 Defective lighting 41 Seating accommodation 7 (7) INSPECTION OF AMUSEMENT HOUSES. Defective sanitary fittings 9 W.C. defective and dirty 8 (8) KEEPING OF ANIMALS. Nuisances arising from the keeping of animals 6 (9) INSPECTION OF WATERCOURSES, etc. Cleansing of watercourses and ponds 10 (10) INFRINGEMENTS OF OTHER BYELAWS. Noisy animals 9 Noisy radio 4 HOUSING. Individual Unfit Houses. During the year action tinder 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 has 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. 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) ... 11,372 (b) Number of inspections and re-inspections made for the purpose 38,555 (2) (a) Number of dwelling houses included under the head (1) above, which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932— (b) Number of inspections made for the purpose— (3) Number of houses found to be in a state so dangerous and injurious to health as to be unfit for human habitation— (4) Number of dwelling houses (exclusive of those referred to under the previous sub-head) found not to be in all respects reasonably fit for human habitation 10,369 122 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 7,724 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 during the year requiring repairs 1,643 (2) Number of dwelling houses which were rendered fit after service of formal notices— (а) By owners 984 (b) By local authority in default of owners 83 B.—Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served during the year requiring defects to be remedied 2,030 (2) Number of dwelling houses in which defects were remedied after service of formal notices :— (a) By owners 2,116 (b) By local authority in default of owners 350 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 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fi— HOUSES LET IN LODGINGS. There are 12 houses registered and they gave little cause for complaint during the year. 123 West Croydon Men's Hostel. This is situated at Pitlake and is available for use by "nightly lodgers." It has 104 cubicle beds, three of which are reserved for staff. The charge is 1s. 3d. per night or 7s. 6d. per week, and 1s. per night or 6s. per week for Old Age Pensioners. Cooking facilities are provided. Hot baths may be taken any time after 9 a.m. Clothes may be washed and dried in the wash-house provided. The average number of nightly lettings during the year was 100, and the number accommodated during the year 36,434. The receipts and expenditure for the past 5 years has been as follows:— Receipts. Expenditure. £ s. d. £ s. d. 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 1947 1,597 0 0 2,450 0 0 Houses—Sanitary Certificates. House drains and sanitary fittings are tested and examined on request, at a fee. During the year 11 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 199 62 - Without Mechanical Power 81 56 — Outworkers and Employers of outworkers 68 — - Total 348 118 — 124 Defects Found. Particulars. Number of Defects. Referred to H.M. Inspector. Prosecutions. Found. Remedied. Want of Cleanliness 15 14 — — Inadequate Ventilation 3 3 — - Ineffective Drainage of Floors 3 3 — - Sanitary Conveniences. Insufficient 35 33 - Unsuitable or Defective 53 52 - — Not Separate for Sexes 6 6 - — No Lighting — - — — Sundry Nuisan es or Defects 63 58 — — Total 183 169 - — Home Work. Lists of home workers or outworkers as they are termed are sent in twice yearly, and this year contained the names of 184 workers residing in the Borough. 68 visits were paid to outworkers. Nature of Employment of Outworkers on the Register, 31st December, 1947. Nature of Work. Number Employed. Outwork in Infected Premises. Outwork in Unsatisfactory Premises. Remarks. Making Cleaning, Altering and Repairing, Wearing Apparel 132 - - - Upholstery Work 7 — — — Other Classes of Work 45 - - - Total 184 — — — Inspection of Schools. These are inspected with particular reference to sanitary . accommodation including washing facilities. During the year 21 inspections were made and defects found were referred to the Education Officer. 125 SHOPS, Etc., ACTS. The Shops Acts, 1912-l936, contain provisions for dealing with closing hours, the hours of work, and health and comfort of those employed. Closing hours have during the year given little cause for complaint. 25 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. 955 inspections were made under the Shops, etc., Acts, and a number of infringements were found. PUBLIC HEALTH ACTS. Drainage Work. During the year there was no lessening of work in this branch of the department's duties. Some 2,986 visits of inspection were made to underground drains in course of repair. With the stringent licensing of building works and the labour and materials difficulties it became essential to serve Statutory Orders in almost all cases of drainage defects. Of 2,030 Orders served, 350 had to be done in default of the owners. KEEPING OF ANIMALS. There was 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 however arisen. OFFENSIVE TRADES. There are but few registered and during the year there has been no cause for complaint. WATERCOURSES, PONDS AND DITCHES, Etc. 202 inspections were made and pollutions were found in 10 cases. SMOKE OBSERVATIONS. During the year 45 observations were made of factory chimneys for the purpose of detecting offences. In those cases where 126 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. AMUSEMENT HOUSES. 116 inspections were made of Theatres, Music Halls, Cinemas, Dance Halls, and premises where stage plays are given. A report is submitted annually to the Licensing Authorities on the sanitary condition of these premises. Notices are issued to remedy any unsatisfactory conditions. DISINFECTION. The Borough Disinfecting Station is situated at Factory Lane. Two steam disinfectors are in use and are supplied with steam from the Electricity Works. The following articles were disinfected at the Disinfecting Station during the year:— By Steam 56,787 articles ,, Formalin Gas 3,184 ,, „ „ Spray 1,673 „ Total 61,644 „ In addition 642 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 1947, 2,528 articles were disinfected, the receipts amounting to £77 14s. 9d. Disinfection was carried out after infectious or contagious disease at the following premises:— 1,342 rooms at 1,089 houses, hospital wards, clinics, and creches. 3,130 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 127 in adults and children. A woman attendant deals with school children and women. During the year 5 adults and 40 children were cleansed of verminous conditions and 131 adults and 149 children were treated for Scabies. DISINFESTATION OF PREMISES. The Department does little in the way of treatment of premises infested with vermin, the practice being to make owners or occupiers responsible for disinfestation. Advice is given on methods to be employed and at times Hydrogen Cyanide is applied by specialist firms to infested premises. The use of this gas is controlled by stringent regulations and the compliance with these regulations is observed by a Sanitary Inspector. The number of premises disinfested by owners or occupiers during the year was 57. 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 Wool Flock Soluble Chlorine 11 parts per 100,000 No. 2 Linsey Flock ,, ,, 27 ,, ,, 100,000 No. 3 Red Jute ,, ,, 28 ,, ,, 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 36. In addition, 216 applications were made for the retention of names on the list for a further period of twelve months. 4 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. 128 RATS AND MICE DESTRUCTION ACT, 1919. INFESTATION ORDER, 1943. During the year 995 complaints were received of rat or mice infestation. Of these complaints the presence of rodents was confirmed in 578 cases. The two Ratcatchers in dealing with these infestations paid 6,434 visits, and used 1881bs. of poison bait, as well as using traps and gassing. An estimated total of 4,415 rats were destroyed. The types of premises found to be infested were:— Dwelling Houses (Inside) 186 ,, ,, (Sheds, etc.) 90 ,, ,, (Gardens) 42 ,, ,, (Poultry Houses) 74 Premises where Food is prepared or sold 67 Factories, Workshops and Business premises 25 Dumps 2 Allotments 11 Schools 31 Shops 21 Drains 29 Sewers in the Borough were baited with good results, the total number of rats destroyed therein being estimated at 7,144. 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 148 Butchers 194 Confectioners 388 Fishmongers 84 Fish Friers only 33 Greengrocers 284 Grocers 647 Stalls and Rounds 196 Catering Establishments (including Hotels, Canteens, Restaurants, Clubs, Snack Bars, etc.) 734 Miscellaneous (including Chemists, etc.) 113 2,821 129 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 988 Ice Cream Vendors and Manufacturers 227 Bakers 126 Confectioners 91 Greengrocers 159 Fishmongers 168 Grocers 752 Fried Fish Shops 45 Stalls and Rounds 203 Poultry and Game Catering Establishments 729 Dealers 70 Miscellaneous 99 Cooked Meat Preparation Premises 10 Total 3,667 General Summary of Meat and other Articles of food found to be unfit and condemned by the Inspectors during 1947:— Articles. Weight in lbs. Diseased. Unsound. Total. Beef 64644 24231 88875 Veal 147 112 259 Mutton 620 2751 3371 Pork 784 12 796 Offal 105021 397 105418 Fish — 11699 11699 Fruit and Vegetables — 7768 7768 Canned, bottled and packeted goods - 41223 41223 Other goods — 17836 17836 171216 106029 277245 The above includes:— Canned, bottled and packeted goods:— 42,043 cans, 956 Bottles, packets, etc. 130 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 by the Ministry. A fair proportion of the other foods condemned was dealt with by firms who specialise in converting such into manures, animal feeding stuffs, oils, etc. MEAT INSPECTION. This is carried out at the Public Abattoir and 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 1947 the following animals were slaughtered there and inspected by the Corporation's Meat Inspectors:— Cattle. Calves. Sheep. Goats. Pigs. Total. 7,988 2,107 15,070 190 467 25,822 The result of these inspections was as follows:— Carcases Inspected and Condemned. Cattle Calves Sheep Goats Pigs Number killed 7988 2107 15070 190 467 Number inspected 7988 2107 15070 190 467 All Diseases except Tuberculosis. Whole Carcases condemned 5 3 6 — 5 Tuberculosis Only. Whole Carcases condemned 89 3 — - — All Diseases except Tuberculosis. Total weight in lbs. of Carcases and parts of Carcases condemned 57,777 Tuberculosis Only. Total weight in lbs. of Carcases and parts of Carcases condemned 113,439 131 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 1947) 5 Cowsheds on register (end of 1947) 6 Average number of cows in sheds (1947) 82 Number of dairies and purveyors of milk on the register (end of 1947) 128 During the year 138 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" Nil (3) Dealers' Licences to use the designation "Tuberculin Tested"— (а) Bottling establishments Nil (b) Shops 10 (4) Dealers' Licences to use the designation "Accredited"— (a) Bottling establishments Nil (b) Shops Nil (5) Dealers' Licences to use the designation "Pasteurised"— (a) Pasteurising establishments 1 (b) Shops 36 132 (6) Dealers' Supplementary Licences to use the designation— (a) Tuberculin Tested 4 (b) Accredited— (c) Pasteurised 4 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 of milk were examined:— Tuberculin-Tested Milk— From licensed producers supplying milk to licensed local dairymen 22 Accredited Milk— From licensed producer supplying milk to a licensed dairyman Nil Pasteurised Milk— Samples from licensed dealers 179 Heat Treated Milk— Samples from licensed dealers 60 The following tables summarise the result of the bacteriological examinations of Tuberculin Tested, Accredited, Pasteurised and Heat Treated samples during the year:— Tuberculin Tested Milk. Licences granted under 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. Not satisfied. Satisfied. Tubercle bacillus — 22 — — - — — — - — - — Bacillus Coli - — — 22 - — — — — — — — Blood — — — — — 22 - - - - - - Pus — - — — — — — 22 — — — — Detritus — _ — — — — — — — 22 — — Methylene Blue Test — — — — — - — — — - 1 21 Totals — 22 — 22 — 22 — 22 — 22 1 21 133 Accredited Milk. Licences granted under the Milk (special Designations) Order 1936. Present. Absent. Present in 1/100 M.1. Absent. Present. Absent. Present. Absent. Exceeding a trace. 1 Not exceeding a trace. Not satisfied. Satisfied. i Tubercle bacillus — Nil — — — — - — - - - - Bacillus Coli — — — Nil - - - - - - - - Blood — — — — — Nil — — — — — — Pus — — — — — — — Nil — — — — Detritus — — — — — — — — — Nil — — Methylene Blue Test — — — — — — — — — — - Nil Totals — Nil — Nil — Nil — Nil Nil - Nil Pasteurised Milk. Licences granted under the milk (Special Designations) Order, 1936. JPresent. 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 — 179 — — — — — — — — - — — - Total number of bacteria — — 24 155 - - - - - - - - - - Blood — - - - - 179 - - - - — — — — Pus — — — — — — — 179 - - — — — — Detritus — - — — — — — — — 179 — — — - Methylene Blue — _ — - — — — — — — 27 152 — — Phosphatase — - — — — — - - — — — — 3 176 Totals — 179 24 155 — 179 - 179 - 179 27 152 3 176 134 Heat Treated Milk. Present. Absent. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Not satisfied. Satisfied. Not 'satisfied. Satisfied. Tubercle bacillus - 60 — — — — — — - — — - Blood — — — 60 - - - - - - - - Pus — — — — — 60 - - - - - - Detritus — — — — — — — 60 — — — — Methylene Blue Test — — — — — — — — 21 39 — — Phosphatase Test — — — — — — — — - — 2 58 Totals — 60 — 60 — 60 — 60 21 39 2 58 ORDINARY MILK. During the year 114 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 38 Samples taken from local dairymen or milk sellers on their rounds in different parts of the Borough 9 Samples taken at Farms in the Borough 67 114 The following table summarises the results of the bacteriological examination of Ordinary Milk samples, taken from 1st January—31st December, 1947:— Ordinary Milk. Present. Absent. Over 100,000 per M.1. Under 100,000 per M.1. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Not satisfied Satisfied. Tubercle bacillus — 114 - - - - - - - - - - Total number of bacteria — — 25 89 — — — — — — — — Blood - - - - - 114 - - - - - - Pus - - - - - - - 114 - - - - Detritus - - - - - - - - - 114 - - Methylene Blue Test - - - - - - - - - - 22 92 Totals — 114 25 89 — 114 — 114 — 114 22 92 135 BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM. Prior to the 1st May, 1947, there was no bacteriological standard for Ice Cream, but on that date the Ministry of Health instituted a Provisional Standard in accord with a Grading System. Thus Grades 1 and 2 were satisfactory and Grades 3 and 4 unsatisfactory. These gradings were arrived at by a timing of the decolorisation of methylene blue. Before this standard was made we had required a satisfactory ice cream to have less than 100,000 bacteria per ml. and bacillus coli absent in l-10th of a ml. Of the 21 samples taken prior to 1st May, 6 failed to reach this requirement. From the 1st May to the end of the year 134 samples were taken, the results being as under:— No. of Grade. Samples 1 51 2 20 3 30 4 33 Out of a total of 155 samples taken 69 (44 per cent.) failed to reach a satisfactory standard of bacterial purity. In all cases after the results of sampling are known the vendors and/or manufacturers are made aware of the results and where the Gradings are 3 or 4, then a visit is made, methods of service or manufacture are investigated, faults rectified and further samples taken. I am hopeful that with the coming to hand of plant for the efficient heat treatment of ice cream in accord with the Ice Cream (Heat Treatment) Regulations and the understanding of such plant and its objects by the manufacturers and retailers, we may look forward to better results in the future. There is no chemical standard for ice cream. 136 FOOD AND DRUGS ACT, 1938. During the year 249 samples of milk and 410 other samples were taken. Summary of Samples. During 1947 samples were obtained and submitted to the public Analyst as follows : — Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Arrowroot 2 2 - - - Aspirin 3 3 - - - Bacon 2 2 - Baking Powder 7 7 Barley Flakes 1 1 Batter Mixture 2 2 Beans with Tomato Sauce 3 3 Beef, minced 1 1 Beer 8 8 - - - Beer, Ginger 1 1 - - - Bicarbonate of Soda 3 3 - - - Black Pudding 4 4 - - - Boric Ointment 3 3 - - - Bread 6 6 - - - Butter 1 1 - - - Cake Mixture 5 5 - - - Camphorated Oil 3 3 - - - Carrots, Diced 1 1 - - - Castor Oil 3 3 - - - Celery Salt 1 1 - - - Cheese 6 6 - - - Cinnamon, Ground 5 5 - - - Cloves, Ground 1 1 - Cocoa 10 10 Cod Liver Oil 3 3 Coffee 8 8 Coffee and Chicory 7 7 Coffee and Chicory Essence 1 1 - Coffee Essence 1 - 1 1 Confection of Senna 1 1 - - - Cooking Fat 3 3 - - - Cordial, Blackcurrant Flavour 2 2 - - - Cordial, Ginger Flavour 1 1 - - - Cordial, Lime Juice Flavour 2 2 - - - Cordial, Orange Flavour 1 1 - - - Cornflour 1 1 - - - Cream of Tartar 3 3 Crayfish 2 2 - - - Curry Powder 3 3 - - - Dates 1 1 - - Dessert Sauce Powder 1 1 - Dressed Crab, Tinned 1 1 - Fish Cakes 2 2 - Fish, Tinned 1 1 - Flavouring Concentrate 1 1 Flavouring Essence 3 3 - - Flour, Bun 1 1 - - - Flour, Cake 2 2 - - Flour, Self-raising 5 5 - - - Gaffelbiter in Wine Sauce 1 - 1 - - Carried forward 140 138 2 1 — 137 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought Forward 140 138 2 1 — Gin 5 4 1 1 1 Ginger Beer 6 6 — — — Ginger, Ground 4 4 - — — Glycerine 1 1 - — — Golden Raising Powder 2 2 - — — Grapefruit Squash 2 2 - - - Gravy Powder 6 6 - - - Ham and Beef 1 1 - - - Hake, Silver, Tinned 2 2 - - - Hake, with Tomato Puree 1 1 - - - Honey 3 3 - — — Horlicks Tablets 1 1 - — — Horseradish Cream 1 1 - — — Ice Cream 6 6 - — — Iodine, Tincture of 3 3 - — — Jam 9 8 1 — — Jelly Crystals 2 2 — — — Junket Powder 3 3 - — — Lard 2 2 — — — Lemonade 4 4 — — — Lemonade Powder 7 7 - — — Lemon Squash 2 2 — — — Lingfo Fizz 1 1 — — — Liquid Paraffin 2 2 — — — Liquorice Powder Compound 2 2 — - - Macaroni 4 4 — — — M. & V. Ration 3 3 - - — Macedoine (Vegetable in Brile) 1 1 — — — Malted Milk Powder 1 1 — — — Margarine 3 2 1 — — Meat Cubes 1 1 - — — Meat Pie 3 3 — — — Meat, Pressed 1 1 - - — Milk 249 244 5 — — Mustard 3 3 — — — Mustard Mixture 1 1 — — — Oatmeal 2 2 — — — Orangeade 3 3 — — — Orange Squash 5 5 — — — Paste, Meat 3 3 — — — Paste, Fish 19 19 — — — Pate de Foie 2 2 — — — Pearl Barley 3 3 — — — Pepper, Black 2 2 — — Pepper, Medium 1 1 - — — Pepper, White 3 3 — — — Piccalilli 4 4 — — — Pickles 7 7 — — — Pickled Gherkins 1 — 1 — — Pickled Onions 1 — 1 — Picnic Pie 1 1 — — — Pies, Meat 1 1 — — — Pressed Meat 2 2 — — — Processed Peas 1 1 — — - Prunes 2 2 —; — — Pudding Mixture 2 2 — — — Raising Powder 1 1 — — — Carried forward 554 542 12 2 1 138 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought Forward 554 542 12 2 1 Rhubarb Comp. Tinc. of 1 1 - — — Rissoles 1 1 — — — Rum 2 2 — — — Sauce 2 2 — — — Sauce, Worcestershire 1 1 — — — Sausage 3 3 — — — Sausage, Beef 3 2 1 — — Sausage, Breakfast 2 2 — — — Sausage, Liver 4 4 — — — Sausage, Luncheon 4 4 — — — Sausage, Meat, Beef 2 2 — — — Sausage, Savouries, Whalemeat 1 1 — — — Sausage, Tinned 2 2 — — — Scotch Pudding 1 1 — — — Semolina 2 2 — — — Smoked Fillets, Whiting 1 1 — — — Soup, Desiccated 2 2 — — — Soup 2 2 — — — Soup, Kidney Flavour 1 1 - — — Soup, Green Pea 1 1 — - Soup, Meat 2 2 - — - Soup, Mulligatawney 1 1 — - Soup, Powder 1 1 - — - Soup, Onion 1 1 - — - Sherbert 2 — 2 — - Spaghetti 1 1 — — — Spaghetti in Meat Sauce 1 1 — - - Spice, Mixed 3 3 — — Spice, Mixed, Ground 1 1 — — - Spice Pickling 2 2 — — - Sponge Mixture 3 3 — — - Steak Pies 1 — 1 — - Steak, Stewed 1 1 - — — Stout 1 1 — — - Stuffing, Sage and Onion 1 1 — — - Sugar 3 3 — — - Sweets 6 6 — — - Syrup of Figs 2 2 — — - Synth tic Colour, Cochineal 1 1 — — - Tea 5 5 — — - Veal and Beef Loaf 1 1 — — - Vegetables, Mixed 2 2 — — - Vinegar, Alcoholic 1 1 — — - Vinegar, Malt 7 6 1 — - Vinegar, Non-brewed 6 4 2 — - Whiskey 6 4 2 1 1 Wine, Alcoholic Green Ginger 1 1 — — - Wine, Rich Ruby 1 - 1 — - Yeast Tablets, Live 1 1 — — - Yorkshire Pudding Mixture 1 1 — — - Yorkshire Relish 1 1 — — - Totals 659 637 22 3 2 139 Result of Analysis of New Milk Samples. Solids Not Fat (Legal standard is 8.5%)* 8.4 8.5* 8.6 8.7 8.8 8.9 9.0 9.1 4 14 50 83 67 26 2 3 Milk Fat (Legal standard is 3%) 2.68 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 4.1 4.3 5.4 5.7 1 2 2 13 34 41 54 36 26 20 9 5 3 1 1 1 Total samples of new milk: 249 The samples of Milk for analysis were obtained as follows: — Taken on Milk Rounds 146 ,, at Dairies 74 ,, at Institutions 27 ,, at Local Farms 2 249 Average composition of New Milk Samples— Solids not fat 8.72% Milk Fat 3.58% 140 Adulterated Samples. The following is a detailed statement of the adulterated samples and the action taken:— Adulteration or No. Sample of Deficiency. Remarks. 1150 Coffee Essence Deficient in Caffeine. Case dismissed. Manufac- Sample contained turers established that 0.3 p.c. weight in they had used 4 lbs., of volume. roasted coffee to each gallon in the preparation of the product. 801 Gaffelbiter in Sample contained tin Referred to Ministry of Wine Sauce. 2.9 grains per Food: investigation still pound. in progress. 8 Gin Alcoholic strength of Vendor prosecuted and the sample was fined £10, plus 1 guinea 42.0° under proof. costs. 63 Damson Jam Sample contained Manufacturer's explanation particles of glass. accepted. 886 Margarine Sample contained Subsequent formal sample (Informal 16.7 p.c. water. proved genuine. sample). 634 Milk Sample contained Vendor warned. milk fat 2.68 p.c., milk solids other than milk fat 8.56 p.c. 341 Milk Sample contained Vendor warned. milk fat 3.30 p.c.; milk solids other than milk fat 8.41 p.c. 294 Milk Sample contained Vendor warned. milk fat 3.50 p.c.; milk solids other than milk fat 8.44 p.c. 623 Milk Sample contained Vendor warned. milk fat 3.51 p.c.; milk solids other than milk fat 8.41 p.c. 618 Milk Sample contained Vendor warned. milk fat 3.35 p.c.; milk solids other than milk fat 8.45 p.c. 141 No. Sample of Adulteration or Deficiency. Remarks. Informal sample Pickled Onions. Informal sample Pickled Gherkins. These samples were badly fermented, contaminated with yeasts and of low acidity. The remainder of the stock was surrendered and destroyed. 26 Beef Sausage Sample contained 30 p.c. by weight of meat. Referred to Ministry of Food. Vendor warned by Local Food Control Committee. 499 Sherbert (Informal sample). This was a sample of coloured and flavoured health salts and contained no sugar. Vendor warned and instructed to describe article as Health Salts. 660 Sherbert (Informal sample). This proved to be a sample of Lemonade Crystals. A subsequent formal sample was purchased, but the article was then being sold as Lemonade Crystals and proved genuine. 727 Steak Pies Piecrust 83 p.c. Filling, consisting of one - fifth cooked meat and four-fifths cooked potato and flavouring 17 p.c. (The proportion of cooked meat in the sample amounted to 3.5 p.c.) Vendor warned. 1122 Vinegar, Malt Salt (sodium chloride) 0.8 p.c. The Ministry of Food acquiesce in the addition of salt. 890 Vinegar (nonbrewed). Acetic Acid 2.5 p.c. Insoluble organic matter - a small proportion. Vendor warned-subsequent sample proved genuine. 1004 Vinegar (nonbrewed). Acetic Acid 3.75 p.c. 57 Whiskey, Irish . Alcoholic strength of the sample was 10.2 under proof. Excess water 8 p.c. Vendor prosecuted and fined £5, plus 1 guinea costs. 134 Whiskey Alcoholic strength of the sample was 35.7° under proof. Excess water 1 p.c. Vendor warned. 1026 Wine, Rich Ruby. Proof spirit 22.2 p.c. Manufacturer's explanation accepted. 142 CROYDON AIRPORT-AIRCRAFT AND PASSENGER ARRIVALS. Day Hours Far East Persia South Africa Middle East South Atlantic South America West Africa North Atlantic (U.S.A., Canada Newfoundland) Continental Total Remarks AC BP AP AC BP AP AC BP AP AC BP AP AC BP AP AC BP AP AR C Sunday 0.8 - - - - - - - - - - - - 3 13 8 8.12 - 16 5 2 11 - - - 1 - - 2 74 425 236 12.16 - 8 1 2 8 6 - - 3 - 3 9 164 837 822 16.20 - 16 1 5 44 8 - 3 2 - 2 4 191 733 468 20.24 1 22 4 2 19 6 - 4 2 - 4 2 116 517 313 560 2685 1903 28 Monday 0.8 - - - - 5 - - - 2 - - - 15 39 3 8.12 - 2 3 - 28 9 - 20 8 - 2 7 145 480 975 12.16 - 4 3 1 12 3 - 5 2 - 2 3 226 896 1073 16.20 1 11 2 11 67 10 - 2 3 - - 1 213 718 590 20.24 1 12 2 2 60 7 - - - - 1 - 119 591 314 734 2957 3020 45 Tuesday 0.8 - - - 1 9 1 - - - - - - 20 42 74 8.12 - 9 3 - 13 5 - 2 - - 1 5 122 429 730 12.16 - 6 1 8 27 3 - - - 3 189 733 832 16.20 - 24 . 2 7 56 13 - - 1 - 1 5 188 636 549 20.24 - 30 5 2 13 11 - - - - - 1 109 508 311 646 2539 2555 29 Wednesday 0.8 - 3 3 - 3 5 - 1 3 - - 2 22 32 54 a Includes 1 BP who died during the flight from Lausanne. 8.12 - 7 20 - 15 10 - 4 8 - 5 3 128 397 763 12.16 - 5 2 5 12 6 - 1 4 - 5 14 206 853 905 16.20 1 15 2 7 84 13 - - 4 - 6 3 197 595a 669 20.24 - 16 6 5 28 14 - 1 4 - - 1 119 481 291 690 2569 2809 30 Thursday 0.8 - - 1 - 1 2 - - - - - 2 20 20 32 8.12 - 11 3 2 31 8 - 1 - - - 3 123 452 686 12.16 - 5 11 3 20 25 - - - - 3 8 181 810 868 16.20 - 8 - 2 27 12 - - - - - 3 171 672 448 20.24 - 4 2 3 26 18 - - - 1 5 4 89 381 264 595 2477 2400 33 Friday 0.8 - - - - 2 12 - - - - - - 18 37 31 8.12 - 13 1 - 21 8 - 1 3 - - 6 130 571 643 12.16 - 11 1 4 23 10 - 3 - - 5 16 199 875 777 16.20 - 17 1 7 47 10 - 5 8 - 1 5 198 702 472 *20.24 - 37 7 2 35 13 - - 1 - 1 3 116 455 313 674 2862 2341 40 Saturday 0.8 - 2 - - - 2 - - - - - - 20 34 56 8.12 - 17 18 1 21 9 - - - - - 7 143 591 648 12.16 - 7 - 5 27 15 - - - - - 11 177 867 725 16.20 1 7 1 7 69 18 - - - - - 3 176 834 431 20.24 - 7 1 1 26 3 - - 2 - 2 6 100 437 286 631 2948 2242 19 1 Total 4530 19037 17270 224 1 Note.-AC = Aircraft, BP=British AP= Alien Passengers AR=No. of Allens refered to medical by the Immigration Officer C- No. of Certificates issueu.ed 143 County Borough of Croydon ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER For the Year ending December 31st, 1947. Ladies and Gentlemen, I have pleasure in presenting for your consideration my report as School Medical Officer. This is the twentieth annual report I have had the honour to present to you, and the fortyeighth of the yearly series dealing with the School Medical work of the Borough. 144 Cost of the School Health Service. The gross cost of the medical, dental and nursing services was £28,108. The rateable value of the Borough as at 1st April, 1946, was £2,515,408. The Government grant is 49.727 per cent, of the expenditure, hence the actual cost to the rates was £14,131, i.e., a rate of 1.45 pence. Cost of Special Schools. Schools maintained by the Council, £13,149, contributions to schools under other authorities, £3,373; income from parents' contributions and other receipts, £35, giving an actual cost of £16,487, of which £8,289 was payable out of local rates, i.e., a rate of .85 pence. Cost of Milk and Meals. Meals and milk cost £97,780, 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 is shown below:- Schools No of Departments Number on the Registers Average attendance Average attendance per cent. SECONDARY SCHOOLS Council Boys 7 1607 1448 91 Girls 8 1883 1684 89 Mixed 5 1346 1201 89 20 4836 4333 90 Voluntary Girls 1 128 116 91 145 Schools No. of Departments Number on the Registers Average attendance Average attendance per cent. PRIMARY SCHOOLS Council Junior Mixed 2 712 641 90 Senior and Junior Boys 1 327 291 92 Senior and Junior Girls 1 284 255 90 Senior and Junior Mixed 2 885 820 92 Junior Boys 7 2076 1906 92 Junior Girls 5 1377 1255 91 Junior Girls and Infants 3 1206 1080 90 Junior Mixed and Infants 12 4874 4385 90 Infants 14 3314 2910 89 Voluntary Senior and Junior Boys 47 15056 13546 90 1 207 189 91 Senior Mixed and Infants 3 823 732 89 Junior Girls and Infants 2 375 323 86 Junior Mixed and Infants 4 711 635 89 Senior and Junior Mixed 1 310 262 85 Infants 2 164 136 83 13 2590 2277 88 SPECIAL SCHOOLS Council Mixed 3 299 252 84 GRAMMAR AND TECHNICAL SCHOOLS Boys (Technical) 2 401 379 95 Boys (Grammar) 2 920 880 96 Girls (Grammar) 1 563 525 93 Boys (Central) 1 213 203 95 Girls (Central) 1 370 350 95 Mixed (Heath Clark) 1 311 295 95 Girls (Coloma) 1 504 473 94 9 3282 3105 94 Medical Inspection in Schools. A total of 5,758 children were examined as compared with 7,017 in 1946, and 8,986 parents attended the examinations. The percentage attendance of parents in the Entrants' group was for boys 86.5 per cent.; and girls 86.5 per cent.; in the Intermediate group, boys 58.0 per cent., girls 76.6 per cent.; and in the Leavers' group, boys 22.8 per cent., girls 34.1 per cent. The total percentage of parents attending was 69.2 as against 65.4 last year. 783 specials and re-inspections of children were carried out. 146 PARENTS PRESENT, 1947 Entrants Intermediate Leavers Other Ages TOTAL Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. All Saints' ... ... ... ... 6 25 ... 14 ... ... ... ... ... ... ... ... 6 25 A. Tenison' ... ... ... ... ... ... ... ... 55 14 ... 10 ... ... ... ... 55 14 Ashburton 25 25 21 25 19 19 16 18 12 9 3 3 ... ... ... ... 56 53 Benson 17 9 17 9 10 8 7 8 ... ... ... ... ... ... ... ... 27 17 Beulah 64 64 55 58 36 57 8 39 18 31 13 18 ... ... ... ... 118 152 Christ Church 6 8 4 6 20 20 9 15 ... ... ... ... ... ... ... ... 26 28 Croydon British ... ... ... ... ... ... ... ... ... 18 ... 6 ... ... ... ... ... 18 Cypress 52 57 46 49 49 25 41 24 ... ... ... ... ... ... ... ... 101 82 Davidson 48 41 42 30 24 38 6 19 23 9 3 4 ... ... ... ... 95 88 Duppas 31 26 23 22 ... ... ... ... ... ... ... ... ... ... ... ... 31 26 Ecclesbourne 69 56 54 49 ... ... ... ... 24 ... 11 ... ... ... ... ... 93 56 Elmwood 46 34 43 31 48 50 28 40 23 7 12 6 ... ... ... ... 117 91 Gonville 41 55 39 49 26 24 16 18 ... ... ... ... ... ... ... ... 67 79 Heath Clark ... ... ... ... ... ... ... ... 51 47 ... 4 ... ... ... ... 51 47 Howard 50 27 32 26 30 3 14 1 ... 21 ... 14 ... ... ... ... 80 51 Ingram 28 29 26 27 ... ... ... ... 16 15 3 ... ... ... ... ... 44 44 John Ruskin ... ... ... ... ... ... ... ... 21 ... 1 ... ... ... ... ... 21 ... Kensington 45 55 45 52 32 37 23 29 7 8 1 5 ... ... ... ... 84 100 Kingsley 75 70 69 60 55 38 36 22 ... ... ... ... ... ... ... ... 130 108 Lady Edridge ... ... ... ... ... ... ... ... ... 97 ... 33 ... ... ... ... ... 97 Lanfranc ... ... ... ... ... ... ... ... 6 ... 2 ... ... ... ... ... 6 ... Monks Orchard ... ... ... ... 17 24 12 16 ... ... ... ... ... ... ... ... 17 24 New Addington 85 93 76 80 20 28 12 24 7 4 6 4 ... ... ... ... 112 125 Norbury Manor 68 64 66 60 40 47 29 37 45 36 24 18 ... ... ... ... 153 147 Oval 57 37 50 31 12 12 2 11 ... ... ... ... ... ... ... ... 69 49 Parish Church 27 26 25 25 20 28 10 25 10 16 5 5 ... ... ... ... 57 70 Portland 61 60 54 52 ... ... ... ... 14 31 1 16 ... ... ... ... 75 91 Purley Oaks 65 56 46 43 22 50 14 32 58 30 17 12 ... ... ... ... 145 136 Rockmount 48 32 44 24 26 16 16 16 ... ... ... ... ... ... ... ... 74 48 St. Andrew's 31 33 27 29 8 9 4 7 ... ... ... ... ... ... ... ... 39 42 St. Giles ... ... ... ... ... ... ... ... ... ... ... ... 34 ... 17 ... 34 ... St. Joseph's 15 20 13 20 ... ... ... ... ... ... ... ... ... ... ... ... 15 20 St Luke's ... ... ... ... ... ... ... ... ... ... ... 14 ... 5 ... 14 ... St. Mark's 13 11 13 8 ... ... ... ... ... ... ... ... ... ... ... ... 13 11 Addington Village 6 17 6 15 ... ... ... ... 10 2 9 2 ... ... ... ... 16 19 St. Mary's R.C. 18 15 16 10 34 14 20 13 8 30 1 9 ... ... ... ... 60 59 St. Peter's 16 21 16 20 ... ... ... ... ... ... ... ... ... ... ... ... 16 21 St. Saviour's 10 7 7 4 ... ... ... ... ... ... ... ... ... ... ... ... 10 7 School of Art ... ... ... ... ... ... ... ... 7 9 1 1 ... ... 1 ... 8 9 Sch. of Building ... ... ... ... ... ... ... ... 19 ... ... ... ... ... ... ... 19 ... Selhurst Gram. ... ... ... ... ... ... ... ... 43 75 ... 4 ... ... ... ... 43 75 Shirley ... ... ... ... 21 18 14 14 ... ... ... ... ... ... ... ... 21 18 Stanley Technical ... ... ... ... ... ... ... ... 70 ... 3 ... ... ... ... ... 70 ... South Norwood 65 77 42 50 71 ... 32 ... 26 ... 16 ... ... ... ... ... 162 77 Sydenham 40 36 31 31 9 20 2 14 ... ... ... ... ... ... ... ... 49 56 Tavistock 53 41 43 34 ... ... ... ... 22 21 ... 13 ... ... ... ... 75 62 Waddon 39 65 34 52 36 26 14 20 ... ... ... ... ... ... ... ... 75 91 West Thornton 55 54 55 54 20 35 18 34 ... ... ... ... ... ... ... ... 75 89 Whitehorse Manr. 44 47 37 39 ... 25 ... 19 14 ... ... ... ... ... ... ... 58 72 Winterbourne 70 45 61 44 33 32 25 27 ... ... ... ... ... ... ... ... 103 77 Woodside 56 51 52 49 37 34 25 28 ... 24 ... 2 ... ... ... ... 93 109 1539 1454 1331 1267 781 762 453 584 609 554 139 189 49 ... 23 ... 2978 2780 3003 2598 l543 1037 1163 328 49 23 5758 PERCENTAGE OF PARENTS PRESENT AT MEDICAL EXAMINATIONS Entrants Boys 86.5 86.5 69.2 „ Girls 86.5 Intermediate Boys 58.0 67.2 „ Girls 76.6 Leavers Boys 22.8 28.2 „ Girls 34.1 Other Ages Boys 47.0 47.0 „ Girls - 147 Uncleanliness. Number of children inspected for Cleanliness (first inspection) 61,236 Number of children inspected (subsequent inspections) 3,926 Number of children found unclean (first inspection) 1,117 (2,044 occasions of infestation). Number of occasions in which children found unclean (subsequent inspections) 1,544 At the primary inspections vermin were found in 159 and nits alone in 1,885 children. On these inspections, 3.3 per cent. of the children showed evidence of infestation as against 4.1 in 1946. Tuberculosis in Children of School Age. Contacts among school children kept under supervision during 1947- Number of cases under observation at beginning of 1947 391 Number of cases added during year 40 Number of cases discharged from observation during the year 7 Number of cases under observation at the end of 1947 424 Taking the total school population as 32,963, the pulmonary tuberculosis incidence rate was 30.3 per 100,000. There was one death from pulmonary tuberculosis. There were no deaths from non-pulmonary tuberculosis, while the incidence rate was 42.5. CAUSES OF DEATH IN CHILDREN OF SCHOOL AGE. School population 32,963. Number of deaths 19, which is equal to a death-rate of 0.6 per 1,000. The deaths were due to: Tuberculosis (Pulmonary) 1 Diphtheria 1 Acute Poliomyelitis 1 148 Rheumatic Fever 1 Pneumonia 2 Influenza 1 Chronic Nephritis 1 Congenital Pulmonary Stenosis 1 Diabetes Mellitus 2 Intussusception 1 Intestinal Obstruction 1 Cerebellar Abscess 1 Asphyxia 1 Road Traffic. Accidents 2 Murder 1 Open Verdict-Hanging 1 VISION. Extent of Defect. Intermediate. Leavers. Total. Boys. Girls. Boys. Girls. Boys. Girls. No. % No. % No. % No. % % % Normal: R 761 97.4 718 94.2 567 93.1 518 93.5 95.5 93.9 6/6ths or 6/9ths L 751 96.2 721 94.6 562 92.3 518 93.5 94.5 94.1 6/12ths or 6/24ths R 16 2.1 39 5.1 37 6.1 30 5.4 3.8 5.2 L 25 3.2 38 5.0 35 5.8 34 6.1 4.3 5.5 6/36ths or worse R 4 0.5 5 0.7 5 0.8 6 1.1 0.7 0.9 L 5 0.6 3 0.4 12 1.9 2 0.4 1.2 0.4 TEETH. Entrants. Intermediate. Leavers. Boys. Girls. Boys. Girls. Boys. Girls. No. % No. % No. % No. % No. % No. % Perfect set of Teeth 1344 87.3 1253 85.0 713 91.3 708 92.9 563 92.4 524 94.6 One to four Decayed 144 9.4 131 8.9 49 6.3 32 4.2 28 4.6 19 3.4 Four or more Decayed 51 3.3 80 5.5 19 2.4 22 2.9 18 3.0 11 2.0 Totals 1539 1464 781 762 609 554 149 HEIGHTS AND WEIGHTS. 1947 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. 1943 27 41.5 40.3 44.0 45.5 38.2 36.5 28 40.4 37.5 44.0 46.0 30.0 33.0 1942 853 43.3 44.1 46.3 50.0 40.4 37.5 776 43.3 41.6 45.6 48.9 40.2 35.8 1941 546 44.5 45.7 47.1 53.0 42.2 39.2 511 44.2 43.7 46.9 50.9 41.4 37.9 1940 144 47.3 51.6 50.1 58.4 43.8 46.6 102 46.6 49.1 49.5 56.7 44.2 43.1 1939 41 49.2 56.0 51.5 62.7 46.1 46.8 41 49.7 54.0 53.6 59.2 48.1 47.9 1938 65 51.5 61.4 55.0 74.4 48.3 53.4 33 51.1 58.6 55.6 67.2 49.9 56.7 1937 94 53.6 63.7 56.2 74.5 49.8 54.1 81 54 0 70.8 57.3 94.9 51.6 60.4 1936 511 55.4 73.0 59 5 88.6 51.2 60.5 559 55.4 72.9 59.3 91.4 51.4 58.3 1935 248 50.5 76.6 60.4 91.5 53.2 64.0 262 56.5 77.5 60.3 98.0 52.9 63.7 1934 33 57.9 83.9 65.1 112.5 52.2 63.9 41 60.2 88.2 64.0 112.6 56.2 78.8 1933 158 60.5 95.7 65.9 120.6 55.3 71.7 192 61.4 101.3 65.7 127.4 58.0 81.3 1932 84 65.9 117.4 68 9 136.1 61.7 97.1 91 64 0 114.8 66.8 129.3 61.1 98.2 1931 131 66.8 120.2 71.5 163.4 62.7 101.4 158 64.9 122.4 68.5 147.6 61.5 102.6 1930 46 67.6 129.7 70.9 147.4 64.0 114.5 64 65.0 122 0 67.5 145.1 62.9 101 .6 150 RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION. 1947. Defects. Boys. Girls. No. requiring Treatment. No. referred for Observation. Percentage of total Examined. No. requiring Treatment. No. referred for Observation. Percentage of total Examined. Ma lnutrition 189 6 6.55 171 12 6.58 Uncleanliness— Head - - - - - - Body Skin Disease 8 1 0.30 16 2 0.65 Eye Disease— Defective Vision 119 8 4.26 136 12 5.32 Squint 59 8 2.25 49 5 1.94 External Eye Trouble 11 . 0.37 10 2 0.43 Ear Disease— Deafness 3 . 0.10 4 1 0.11 Otitis Media 4 1 0.17 5 1 0.22 Other Disease 4 - 0.13 3 - 0.11 Nose and Throat— Enlarged Tonsils only 28 53 2.72 36 59 3.42 Adenoids only 12 12 0.81 15 13 1.01 Enlarged Tonsils and Adenoids 145 66 7.09 126 62 6.76 Other Conditions 86 28 3.83 75 27 3.67 Enlarged CervicalGlands(notT.B.) 4 5 0.30 4 3 0.25 Dental Defects 51 1 1.75 58 2 2.16 Speech Defects 14 4 0.60 2 - 0.07 Heart and Circulation— Organic 5 8 0.44 7 9 0.58 Functional 5 5 0.34 5 9 0.50 Anaemia 22 7 0.97 15 10 0.90 Bronchitis 10 9 0.64 13 2 0.54 Other Non-T.B 12 8 0.67 4 2 0.22 Pulmonary Tuberculosis 9 3 0.40 8 3 0.40 Other Tuberculosis 1 2 0.10 - - - Nervous System Disorders (including Epilepsy, chorea, etc.) 4 13 0.57 6 18 0.86 Deformities— Rickets 5 1 0.20 1 - 0.01 Spinal Curvature 66 2 2.28 65 9 2.66 Others 172 17 6.35 137 20 5.65 Other Defects and Diseases 29 13 1.41 30 7 1.33 Totals 1077 281 1001 290 Total Children Examined 2978 2780 151 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS, 1947 (Percentages.) Condition. Entrants. Intermediates. Leavers. Other Ages. All Groups. Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Cleanliness: (Percentage Clean) Head 100.0 99.9 100.0 99.9 100.0 100.0 100.0 - 100.0 99.9 Body 100.0 100.0 100.0 100.0 100.0 100.0 100.0 - 100.0 100.0 Clothing (satisfactory) 100.0 100.0 100.0 100.0 99.7 100.0 100.0 - 99.9 100.0 Footgear (satisfactory) 99.7 100.0 100.0 100.0 99.7 100.0 100.0 - 99.8 100.0 Nutrition (Normal) 84.3 83.4 85.9 88.6 92.1 96.4 100.0 - 86.6 87.4 Defects: Circulatory System 5.5 4.9 3.8 7.2 5.9 8.0 2.0 - 5.1 6.2 Pulmonary System 5.4 3.0 2.2 1.6 1.5 0.9 2.0 - 3.7 2.2 Skin Diseases 1.0 1.2 1.2 0.5 0.7 2.7 - - 0.9 1.3 Defects of Nose and Throat 33.5 29.9 16.2 21.8 8.7 12.0 8.2 - 23.5 24.2 Enlarged Cervical Glands 11.2 10.2 3.7 8.3 3.1 5.8 - - 7.4 8.8 External Eye Disease 0.6 1.0 0.5 1.4 1.0 0.7 2.0 - 0.7 1.0 Defective Vision 0.5 0.8 6.9 10.2 . 10.2 10.7 6.1 - 4.3 5.3 Defective Hearing 0.2 0.3 - 0.3 - - - - 0.1 0.3 Speech Defects 1.7 0.6 0.8 0.1 0.3 - - - 1.1 0.4 Dental Disease (more than four decayed) 3.3 5.5 2.4 3.0 2.0 2.0 - 3.0 4.1 Dull and Backward 0.7 0.7 0.4 0.5 0.2 0.2 2.0 - 0.5 0.5 Taking all the groups examined, subnormal nutrition was recorded in 13.0 per cent of the children as contrasted with 10.8 per cent, in 1946. CHIEF CAUSES OF EXCLUSIONS FROM SCHOOL. Condition. Exclusions during 1947. Percentage of total exclusions. Exclusions during 1946. Percentage of total exclusions Ringworm 38 0.95 33 1.20 Verminous Conditions 551 13.85 610 22.13 Impetigo 162 4.07 186 6.71 Scabies 126 3.17 258 9.36 Scarlet Fever 345 8.68 257 9.32 Measles (inc. German) 841 21.15 372 13.49 Diphtheria 11 0.28 20 0.73 Whooping Cough 303 7.62 208 7.54 Chicken Pox 467 11.74 441 16.00 Mumps 881 22.15 227 8.23 External Eye Disease 42 1.06 39 1.41 Sore Throat 26 0.65 18 0.65 Other Causes 184 4.63 88 3.19 Total 3977 - 2757 - The figures for exclusions are not related in any way to the figures obtained in routine medical inspections. These, figures show an increase in Ringworm, Scarlet Fever, Measles, Whooping Cough, Chicken Pox, Mumps, Conjunctivitis, whilst Impetigo and Scabies showed a decrease. The practical elimination of Diphtheria as a cause of exclusion is notable. It is a pleasing commentary upon the effectiveness of the methods of immunisation employed. 152 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-spinal Meningitis. Poliomyelitis. Jaundice. Conjunctivitis. Sore Throat. Indefinite Sickness. In, Not Infectious Percentage incidence of conditions notified in school Ashburton 766 3 1 6 1 9 2 4 ... ... 27 ... ... 2 ... ... 1 5 ... 8.0 Benson 646 38 1 ... 22 2 ... 4 ... ... 22 ... ... ... ... ... 1 4 ... 14.6 Beulah 1018 39 19 22 15 103 10 11 1 ... 12 ... ... ... 16 10 ... 16 2 27.1 Croydon British 190 1 ... ... ... 3 ... ... ... 1 3 ... ... ... ... ... ... 4 ... 6.3 Cypress 422 10 5 1 4 47 1 1 1 1 1 ... ... 1 ... ... 1 2 18.0 Davidson 700 58 4 24 11 22 12 5 ... ... 6 ... ... ... ... 2 ... 6 ... 21.4 Duppas 408 5 1 11 3 34 3 3 ... ... 10 ... ... ... ... 3 3 1 ... 18.9 Ecclesbourne 651 17 2 11 39 16 2 4 1 ... 5 ... ... ... ... ... ... ... ... 14.9 Elmwood 949 42 14 9 30 7 4 2 ... 18 ... ... 1 ... 5 ... 5 1 15.0 Gonville 396 28 23 5 12 3 1 ... 1 ... 4 ... ... 1 ... 1 ... 4 ... 21.0 Heathfield 85 ... ... 2 ... ... 3 6 ... ... ... ... ... ... ... ... ... ... ... 12.9 Howard 389 2 3 3 6 ... 4 5 ... ... 6 ... ... ... ... ... ... 1 ... 7.7 Ingram 509 2 ... 6 6 16 3 2 ... ... 1 ... ... ... ... ... ... 3 1 7.9 Kensington 417 48 2 3 7 14 ... ... ... ... ... ... ... ... ... ... ... 1 ... 18.0 Kingsley 656 30 2 14 4 74 2 5 1 2 11 ... ... ... ... 2 ... 6 ... 23.6 Lanfranc 676 1 ... 1 1 9 6 6 1 1 2 ... ... ... 1 ... ... 1 ... 4.6 Monks Orchard 370 2 1 ... 8 7 1 6 ... 8 ... ... ... ... ... ... ... ... 8.9 New Addington 840 3 9 ... 7 1 ... 4 ... ... 11 ... ... ... 1 1 ... 4 ... 4.9 Norbury Manor 964 33 1 6 3 4 4 5 1 ... 7 ... ... ... ... ... 1 4 1 7.3 Oval 702 63 5 35 8 31 ... ... 2 ... 8 ... ... ... 3 3 2 9 l 24.2 Portland 798 3 1 1 46 25 14 6 4 ... 2 ... ... ... ... ... 1 2 l 13.3 Purley Oaks 700 7 2 11 2 6 1 2 2 ... 5 ... ... ... 5 1 ... 2 ... 6.6 Rockmount 590 2 5 9 83 38 ... 3 1 ... 2 ... ... ... ... ... ... 2 ... 24.6 South Norwood 846 14 ... 20 11 32 4 10 10 ... 9 ... ... 1 1 2 ... 6 ... 14.2 Sydenham 600 3 1 9 1 15 4 7 ... ... 5 ... ... ... ... ... ... 3 ... 8.0 Tavistock 647 24 ... 12 3 50 5 2 ... 1 6 ... ... ... 1 2 2 2 ... 17.0 Waddon 814 37 3 6 1 25 1 1 1 1 15 ... ... 3 l 3 4 5 1 13.3 W. Thornton 639 18 5 2 6 25 13 20 ... ... 14 ... ... ... l ... 1 2 ... 16.7 Whitehorse 776 39 1 19 29 30 1 8 6 ... 9 ... ... 2 ... ... ... 4 2 19.3 Winterbourne 870 45 2 8 7 7 6 ... 2 ... 20 ... ... 1 1 1 ... 1 ... 11.6 Woodside 961 6 5 9 31 44 3 7 ... ... 17 ... ... 1 ... 2 ... 2 ... 13.3 Lady Edridge 369 1 1 ... ... 1 ... ... ... ... 12 ... ... ... ... ... ... 1 ... 4.3 Heath Clark 310 ... ... ... ... 1 ... 1 ... ... 4 ... ... ... ... 1 ... ... ... 23 Arch. Ten.(Bys) 211 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 0.9 Arch. Ten. (Gls) 126 ... ... 2 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 6.3 Addington Village 137 1 1 ... 6 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 7.3 All Saints 187 ... 1 2 17 10 ... 1 ... ... 1 ... ... ... ... 1 ... ... ... 17.6 Christ Church 292 15 2 1 4 91 2 3 ... 1 2 ... ... ... ... ... ... 2 1 42.5 Parish Church 445 23 ... 9 1 13 1 1 ... 1 11 ... ... ... ... ... 1 3 3 15.1 St. Andrews 397 13 2 10 1 3 2 ... ... ... 7 ... ... ... ... ... ... ... 1 9.8 St. Josephs 238 2 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1.3 St. Marks 140 12 ... ... 11 ... 4 3 1 ... 2 ... ... 2 ... ... ... ... ... 25.0 St. Marys (R.C.) 396 5 ... 1 3 7 1 4 ... ... 5 ... ... ... ... 1 4 ... ... 7.8 St. Peters 80 1 3 8 14 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 33.7 St. Saviours 124 2 ... ... 4 4 ... 4 ... ... 1 ... ... ... ... ... ... ... 1 12.9 Shirley 169 18 2 ... 13 13 ... 1 ... ... 3 ... ... ... ... ... ... 1 ... 30.2 St. Christophers 177 ... 1 ... 1 3 2 1 ... 1 ... ... ... ... ... ... 2 ... 2 7.3 St. Giles 101 3 ... ... ... 2 ... ... ... ... 6 ... ... ... ... ... ... ... ... 10.9 St. Lukes 25 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4.0 Coloma 506 ... ... ... ... 1 ... ... ... 1 10 ... ... ... ... ... ... 1 ... 2.8 Selhurst Gram. 1141 1 ... ... 1 4 ... ... ... ... 8 ... ... ... ... ... ... ... ... 1.2 John Ruskin 337 ... ... ... 1 ... ... ... ... ... 2 ... ... ... ... 1 ... 1 1 1.5 School of Bldg. 149 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 1.3 Stanley Tech. 250 ... ... ... 1 ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... 1.6 Totals 721 120 303 467 881 126 162 38 11 345 ... 1 17 32 42 26 116 18 841 1946 357 15 208 441 227 258 182 33 20 257 ... 5 13 39 18 68 2 372 153 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 709 Visits re Scabies 1 Visits re Infectious Disease 107 Visits re Medical Inspections 336 All other reasons 515 Home Visits. Concerning defects found at routine medical inspections 970 Subsequent visits re defects found at routine medical inspections 203 Visits re special cases 405 Visits to dental cases 47 Visits following other inspections 1,513 Visits in connection with infectious cases (including 447 visits concerning uncleanliness) 7,353 TREATMENT. The Work of the School Clinics. SUMMARY OF ATTENDANCES. 1947. 1946. Increase or Decrease. Minor Ailments Clinic 15998 13477 + 2521 Inspection Clinic 3296 2437 + 859 Dental Clinics 19108 20128 - 1022 Ophthalmic Clinic 4422 5855 - 1433 Orthopaedic Clinic 462 486 - 24 Remedial Exercises Clinic 7020 8160 - 1140 Nose and Throat Clinic 434 2361 - 1927 Rheumatism Clinic 102 280 - 178 50840 53184 - 2344 154 The Minor Ailments Clinics. At the Lodge Road Clinic, 1,646 defects involved 8,601 attendances, while at the subsidiary Clinics held at 206, Selhurst Road on five days weekly, 769 defects, ,3,027 attendances, and at the Duppas School 864 defects, 4,370 attendances. Complaint. 194 7 1946. Cases. Attendances. Average No. of Attendances, per case. Cases. Attendances. Average No. of Attendances, per case. Ringworm 69 576 8.3 33 190 5.8 Scabies 110 401 3.6 191 614 3.2 Impetigo 230 1418 6.2 239 1331 5.6 Other Skin Diseases 115 425 3.7 148 325 2.2 Otorrhoea and other Ear defects 305 1734 5.7 245 1594 6.5 External Eye Disease 339 1372 4.0 262 852 3.2 Miscellaneous 2127 10123 4.8 1728 8571 4.7 3295 16049 4.9 2846 13477 4.7 Adenoids and Enlarged Tonsils. During 1947 135 children were operated upon for adenoids and enlarged tonsils, and 434 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 1395 - 1395 921 907 - This Clinic showed a decrease upon 1946 in numbers submitted to refraction. A total of 4,422 attendances was recorded. 155 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 of certain nonmaintained schools, approved by the local Education Authority, are also eligible for treatment. In addition to the above, facilities are provided for those referred under Maternity and Child Welfare, Tuberculosis and Mental Deficiency Schemes. The present staff consists of six full-time dental officers. The appointment of a further officer has been sanctioned and this vacancy will be filled as soon as the necessary surgery accommodation is available. Arrangements for Treatment. At present the major portion of the treatment is carried out at the Lodge Road Health Centre, where three surgeries are designed to work as a centralised unit. A fourth surgery has recently been introduced, but the latter is of a temporary character to serve until the proposed extension of the above premises can be completed. Additional treatment centres are provided at Duppas Hill and South Norwood; in both localities, however, accommodation is extremely limited and improved facilities are badly needed. As a relief measure plans were put into operation some time ago for the opening of a new surgery in the Woodside area. Unfortunately, building restrictions have prevented the necessary alterations being carried out during the current year. It is hoped that it will be possible for this work to be proceeded with as soon as ministerial sanction can be obtained. To meet expanding requirements on the eastern side of the Borough provisional arrangements have been made for a temporary dental clinic on the New Addington housing estate. This project is bejng put in hand as soon as circumstances permit. In addition to the above mentioned provisions, a further long term plan of development has been drawn up to meet future education commitments and is outlined later in this report. Staffing. At present insufficient personnel is available to cope with the demands made upon the Service. The fact that one dentist's time is completely taken up with work in connection with the M. and C.W. Scheme, means that only five officers are available 156 to care for the entire school population of over 26,000 children. At present this is equivalent to some 5,200 per dental officer. Recent increases in the acceptance rate, now approximately 73 per cent., plus the introduction of routine inspections for Grammar and Technical schools, have greatly broadened the scope of treatment and have thus rendered the old establishment inadequate. If, to suit future needs, the more up to date figure of 3,500 per dentist is substituted it will be seen that a considerable increase in staff will be required if the desirable annual inspection and treatment is to be achieved. In addition to present commitments, developments in connection with the Education Act, 1944, such as the raising of the school leaving age and provision for those attending County Colleges, will in time greatly increase the number requiring to be dealt with. Recent estimates have assessed possibilities 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. Unfortunately, the implementation of this programme depends chiefly on the provision of adequate clinic accommodation, and for that reason even the initial stages of the scheme as originally laid down are now appreciably behind schedule. It is hoped that as soon as suitable sites can be secured, some progress in this direction will be possible, otherwise the curtailment of treatment for certain groups of children will have to be made. The following Table of Analysis illustrates the calculated year to year increase in the school population, together witn 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. Plus Housing Estate 5,260 34,690 2 Extension) 1950 Plus County Colleges, 7,000 - and Plus Nursery Schools, 800 42,490 1-2 onwards. - ' Total: 5-6 * Now behindschedule. 157 Inspections. The number of children on the register at Primary and Secondary Schools within the Borough at the close of 1947 was 26,191. Including an additional 552 free-place scholars at nonmaintained schools this represents a sum total of 26,743 children. Of these, 18,489 were inspected and 9,728 (52.6 per cent.) referred for treatment, compared with 22,020 inspected and 12,046 (54.7 per cent.) referred in 1946. This further decline of 2.1 per cent. in the number requiring treatment, added to the figure of 6.9 per cent. obtained last year, 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 clearly the beneficial effect of more frequent inspection and treatment. As mentioned in last year's report there has been a noticeable improvement in the calcification of the teeth of those entering school, and it would seem reasonable to conclude that the increased ante-natal care for mothers, and improved nutrition and hygiene for infants, is beginning to pay a dividend. Unfortunately there is as yet little evidence in support of the supposition that this will lead automatically to any decrease in the incidence of caries in the permanent dentition. Owing to insufficient staff 16 departments (Primary and Secondary) comprising approximately 4,554 children, received no routine inspection during the year. The figures obtained from school inspections were as follows:- Acceptance of Treatment 72.9% Refused Treatment 11.8% Forms not Returned 15.3% Compared with the previous year these results indicate a rise of 2.9 per cent. in the acceptance rate, with a corresponding decrease in the two remaining categories. In view of the fact that the success of any dental scheme bears a definite relationship to the regularity with which treatment is accepted, the present increase may be regarded as worthy of note. 158 The following analysis demonstrates the gradual rise in the acceptance rate during recent years:- RESULTS OF SCHOOL INSPECTIONS. 1947. 1946. 1944. 1943. 1937. No. referred forTreatment 9728 12046 8047 9041 13498 Consents 7093: 72.9% 8433: 70% 5335: 06.3% 564 : 62.4% 7762:57.5% (Total Consents Including Specials)* (9006:77.3%) (13810: 74%) (6320: 70%) (6814: 67%) (10146:63%) Refusals 1107: 11.8% 1542:12.8% 1314:16.3 % 1519: 16.8% 3242: 24% Forms Not Returned 1488: 15.3% 207 :17.2% 1398:17.4 % 1880: 20.8% 2494:18.5% * Specials.-Those referred by Head Teachers with Emergency Forms By way of comment it should be explained that the acceptance rate mentioned above is for the Borough as a whole, and that in practice this figure varies appreciably from school to school. Whilst in certain districts the response may be as high as 85 per cent., in less enlightened areas this may be at a considerably lower level. In spite of many years of continuous effort by the dental staff it has still to be admitted that that section of the community for whom the service was primarily designed is often the last to take advantage of its benefits. Reasons for Refusal of Treatment. A brief survey was recently conducted into the reasons for non-acceptance of treatment. Excluding those receiving bone-fide private treatment, results may be summarised 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. "Overcrowding," "chronic'illness" in the home, or the frequent absence of the father, lead to lack of supervision of the child and may result in dental matters being "overlooked." Pre-occupation with the family business, or the fact that "mother goes to work" is also a predisposing cause of dental neglect. 159 In the case of large families, certain members may be permanently in the care of an elderly relative, whose "restricted outlook" precludes any interest being taken in regular treatment. The above and many other widely differing factors may be said to be responsible for a very large number of nonacceptances of 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 voluntarily and becomes amenable to treatment. Should parental control be entirely lacking very little success can be expected with these cases. The foregoing investigations illustrate some of the difficulties encountered in dealing with "recalcitrant" cases. Treatment. Of 9,006 children consenting to treatment (including specials) 8,666 (96 per cent.) were treated and 7,830 (86.9 per cent.) cured (completely), compared with 10,197 consenting," 9.043 (88.6 per cent.) treated, and 8.297 (81.3 per cent.) cured in 1946. 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. Clinical sessions fell from 1,934 to 1,795 and accordingly output suffered a corresponding decline. Attendances during the year rose from 10.3 to 10.6 patients per session. 160 With the exception of the early part of the year attendance at clincis was remarkably satisfactory, and no special comment need be made. A glance at the year's results shows that treatment was very well sustained. Items of Treatment. The ensuing Table gives particulars of the principal items of treatment compared with those obtained last year:- 1947 1946. Attendances 19,106 20,128 Treated 8,666 9,043 Re-treated 4,324 4,680 Fillings-Permanent 5,915 6,729 Temporary 2,236 2,366 Extractions-Permanent 1,521 1,702 Temporary 9,462 10,507 Gas Administration 3,440 3,695 Local Anesthetics 3,489 3,508 Other Operations-Permanent 7,260 7,533 Temporary 3,619 3,187 Cases Completed 7,830 8,297 Special Treatment. These include- 1947 1946 Root treatment in anterior teeth 28 38 Removal of nerves under local anaesthetic 18 17 Gingivectomy 6 3 Removal of bone sequestra 7 10 Splints for fractured incisors 2 1 Number of M.D.s treated 21 7 Dentures inserted 45 35 Irrigation of sockets 20 45 Removal of impacted and difficult teeth 25 20 Ulcerative stomatitis (Vincent's infection) 13 15 Cleft Palate 1 1 Application of Penicillin "Cones" 42 50 Crowns for Incisor Teeth 2 - 161 Forms from Head Teachers. The number of forms issued by Head Teachers for emergency treatment was 1,913 compared with 1,764 in 1946. 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 110, compared with 158 in 1946. Orthodontic Treatment. Though substantial progress continues to be made, it is still impossible to deal adequately with all those requiring attention, and preference must therefore be given to those where treatment is likely to bestow the maximum individual benefit. In view of the highly specialised nature of the work, such treatment places a heavy demand on the dental officer's time, and must of necessity be carried out along certain radical lines whenever this is indicated. In the case of gross irregularity attention is directed to improving the general harmony of the arches, rather than producing a perfect assthetic result. Certain more complicated deformities, needing expert diagnosis and treatment, are referred to one or other of the major teaching hospitals. In conformity with the provisions of the Education Act, 1944, all such treatment, including any necessary appliances, is supplied free of cost to patients. As this work expands the Committee will have to consider at some future date the appointment of a special Orthodontic Surgeon who, in the first instance, could be employed on a parttime basis. Treatment sessions devoted to this work were 248 against 260 test year. The following is a summary of treatment performed:- 1947. 1946. Cases under Treatment 425 361 New Cases 201 186 Cases Completed 126 98 Attendances 3,381 2,985 Appliances-Fixed 7 6 Removable 317 272 Treatment Sessions 248 260 162 Treatment of " Free-Place " Scholars. As previously stated, all children in the Borough Secondary and Technical Schools have now been included within the routine scheme of treatment. Pupils previously attending Primary Schools who enter certain non-maintained schools as "free-place" scholars are, however, eligible for attendance at the School Dental Clinic. A summary of the treatment performed for the above children is efiven below:- 1947. 1946. Attendances 298 358 New Cases Treated 44 101 Re-treated 63 66 Fillings-Permanent 173 176 Extractions-Permanent 59 51 Temporary 40 56 Other Operations 64 84 "Gas" Cases 36 37 Local Anæsthesia 23 27 Cases Completed 86 92 Root Fillings - 4 Dentures Fitted 3 2 Referred X-Ray 1 5 Summary of Work Done at the Selhurst Road Clinic. 1947. 1946. Attendances 3,706 4,258 Extractions 1,968 1,958 Fillings 1,242 1,425 Other Operations 3,214 3,570 "Gas" Cases 578 642 Local Anaesthesia 470 199 Cases Completed 1,628 1,519 Sessions held : Inspection 34, Treatment 376, Gas 39. The average attendance at this Clinic per session is 9.8. 163 Summary of Work Done at the Waldrons Clinic. 1947. 1946. Attendances 2,389 2,764 Extractions 1,579 1,587 Fillings 1,859 2,025 Other Operations 309 342 "Gas" Cases 359 477 Local Anaesthesia 2,315 2,445 Cases Completed 900 1,107 Sessions held : Inspector 21, Treatment 268, Gas 36. The average attendance at this Clinic per session is 8.9. DENTAL DEFECTS. (1) Number of children who were(a) Inspected by Dental Officer: Year 1947. Year 1946. Aged 5-6 1,016 Total: 18,489 1,200 ,, 6-7 1,683 2,275 „ 7-8 1,794 2,672 „ 8-9 2,001 2,436 „ 9-10 1,944 2,404 „ 10-11 1,916 2,494 „ 11-12 1,851 2,169 ,, 12-13 1,949 2,161 „ 13-14 1,741 1,815 ,, 14-15 1,391 1,452 „ 15-16 890 944 „ 16 up 313 - Specials 1,913 1,764 • 20,402 23,786 (b) Found to require treatment 11,641 13,810 (c) Actually treated 8,666 9,043 (2) Half-days devoted to Inspection 173 184 Treatment 1,795 1,934 1,968 2,118 Number of Gas Sessions- Lodge Road 169 179 (by Dental Officeers) Selhurst and Waldrobns 61 78 230 257 104 Administrative Sessions 125 99 Orthodontic Sessions 248 260 (3) Attendances made by children for treatment 19,106 20,128 (4) Fillings- Permanent teeth 5,915 6,729 Temporary teeth 2,236 2,366 8,151 9,095 (5) Extractions- Permanent teeth 1,521 1,702 Temporary teeth 9,462 10,507 10,983 12,209 (6) Administrations of general anaesthetics for extractions 3,440 3,695 (7) Administrations of local anaesthetics for extractions 3,489 3,508 (8) Other Operations- Permanent teeth 7,260 7,533 Temporary teeth 3,619 3,187 10,879 10,720 Fillings per session 4.5 4.7 Extractions per session nitrous oxide 47.7 47.5 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 574. Every endeavour is being made to immunize children before they enter school. The very small incidence of Diphtheria in children of school age seems to show this policy is a right one. 165 ORTHOPAEDIC WORK. Summary of Cases attending the Orthopaidic Clinic:- Jan. 1st, 1947. New Cases. Cases Discharged. Cases on Books 31st Dec., 1947. 262 197 60 399 283 children were seen by the Orthopaidic Surgeon and 402 attendances were made. SPINAL AND OTHER REMEDIAL CLINICS. Attendances. 1947. Sessions. Av. att. Attend ances. 1946. Sessions. Av. att. Spinal 1,592 333 4.8 1,875 362 5.2 Massage 187 187 1.0 220 220 1.0 Flat Feet 3,237 356 9.1 3,128 336 9.3 Breathing 2,004 230 8.7 2,937 279 10.5 7,020 1,106 8,160 1,197 RHEUMATISM CLINIC. The total number of children whose names were on the "live" register at the end of 1947 was 154 (males.73, females 81). Appointments were made for 122 children, of whom 85 attended. Two cases were referred to Mayday Hospital for admission and six for convalescent home treatment. A further eight cases were referred for special investigation, three by the Ear, Xose and Throat Specialist, one by the Orthopaedic Surgeon and two by the Pediatrician. Cases Examined at Rheumatism Clinic. 1944. 1945. 1946. 1947. Primary 9 32 59 27 Re-exams. 7 10 47 75 16 42 106 102 Primary Cases. Rheumatic 8 24 49 21 (77.7%) Non-Rheumatic 1 8 10 6 (22.2%) 9 32 59 27 166 Classification of Rheumatic Cases. Primary. Re-examinations. Males 14 36 Females 7 38 21 74 Ages 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Primary 7 6 2 2 1 2 3 2 1 1 - - - - Re-exams - 1 2 6 8 12 6 9 13 14 4 - - - Grouping of Cases (Classification of Dr. R. Miller). 1944. 1945. 1946. 1947. Total. Prim. Re's. Prim. Re's. Mild and Potential 10 20 34 23 12 42 54 Definitely Active 4 9 5 4 2 5 7 Quiescent 1 5 10 20 - 14 14 The Mild and Potential cases include those showing the first initial symptoms of "growing pains" in highly strung children. The "Definitely Active" group included cases with physical signs of rheumatic fever or chorea. "Quiescent Cases" are those which at a previous examination had shown signs of mild and potential rheumatism or of active rheumatism, but which had now settled down and were no longer active. Primary Examinations. Amongst the 21 new cases the following Rheumatic manifestations were recorded:- Rheumatic pains 20 Chorea (suspected) - Carditis (definite) 3 Carditis (suspected) 3 Tonsillitis and Infected Tonsils 5 Sore Throat (but Tonsils and Adenoids removed) 1 Family Histories. Of the new cases, 7 gave a history of rheumatism in the family, 2 being histories of rheumatic fever in parents or brothers and sisters. 167 Nervous Conditions. Recorded in 21 cases— Highly strung 6 Headaches 8 Night terrors 3 Enuresis 1 Twitchings 4 Past history of Chorea or other nervous condition - Minor degrees of nervous disorders 6 Often a combination of more than one of the above symptoms was manifested. Re-examinations. 75 children were re-examined : 3 were worse, 19 showed no essential change, 26 were improved, and 28 were quiescent. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Blind Children. 3 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; Court Grange Special School for Blind, 1 boy. Deaf Children. 10 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, 2 boys and 1 girl; Brighton School for the Deaf, 1 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. 4 boys and 1 girl. The institutions which these children attend are:—Lingfield Epileptic Colony, Surrey, 1 boy; Chalfont Colony, Chalfont St. Peter's, Bucks, 3 boys and 1 girl. Mentally Defective Children. In addition to the day accommodation provided at St. Christopher's School, 1 boy and 2 girls are resident in the Monyhull Mental Defectives School—Birmingham. 168 ST. CHRISTOPHER'S (M.D.) SPECIAL SCHOOL. I am indebted to Mr. Ramsden, the head master, for the following observations: — 1947 has been a year of quiet progress and endeavour at St. Christopher's. On December 31st, 1947, there were 173 children on roll— 108 boys and 65 girls. 1 have to record a very gratifying level of attendance—85 per cent. over the year. This, despite the long journeys and very bad weather of the early months of the year. We welcome two newcomers to our staff, Mr. Huxley, T.C.A., from Paddington Technical, and Miss Cooney, who has been loaned to us from the Medical Department. The teaching of craft is very popular, whether it be Cardboard Modelling, Raffia, Needlework, Rug Making, Plastics or Woodwork, and it would surprise many to see what excellent work our children produce. An Open Day for parents and friends was held in July, and about 100 saw the children give a display of folk-dancing, physical training and singing. Tables containing the work of the school were on display, and the table displaying the results of the boys' and girls' cookery lessons—biscuits, cake, jar of preserves and pickles—was especially a centre of interest and admiration. Gardening still proves very popular and this summer we disposed of over 300 lbs. of tomatoes. Physical training branched out in swimming for the first time, and a class of boys was sent to the Croydon Central Baths under the charge of Mr. Huxley, and we are pleased to record 16 boys have gained Swimming Certificates of Proficiency in 20, 50 and 100 yards. Our Christmas entertainment of carols, illustrated by tableaux, was again witnessed by a large audience of parents and friends. On the last day, from a huge Christmas Tree, 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. Speech Defects Clinic. Total number of cases treated 105 ,, ,, discharged 43 ,, ,, still attending 62 Referred for physical treatment 11 ,, Child Guidance Clinic . 5 Number of stammerers treated 34 ,, alalias treated 5 ,, cleft palate treated 5 ,, lisps 10 ,, spastic diplegia 2 „ congenital deafness 3 ,, dyslalia 46 During 1917 the Speech Clinic has continued to treat a large proportion of pre-school children suffering from dyslalia, and enabled many of them to enter school without the initial disadvantage of a speech defect. It could be wished that stammerers were referred equally young since in this defect the prognosis is so very much better for the younger age groups. At present the average age on admittance is 9.7. 169 Number attending 1st January, 1947 147 „ „ „1948 160 ,, referred to Public Elementary Schools - ,, discharged— (i) Fit to work 6 (ii) Unfit to work 1 (iii) Referred to M.D. Committee 13 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 boy and 2 girls; Oak Bank Open-air School, Sevenoaks, 1 girl; Henwick Hall, 3 boys; St. Catherine's Home, 3 boys; Rob Roy, Speldhurst, 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 and 1 girl; St. John's, Woodford Bridge, 1 boy. 170 JUVENILE EMPLOYMENT RETURN. The following numbers of children were examined by the medical officers during 1947 as to their fitness to following the part-time employment indicated:- 1947. 1946. 1945. 1944. 1943. Delivery of Goods for Shopkeepers 112 2 60 81 80 Delivery of Newspapers 151 125 90 167 139 Delivery of Milk 6 9 13 17 7 269 136 163 265 226 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT. During 1947 all milk was supplied free of charge, and approximately 22,000 children per day received l/3rd pint each. This was equal to 92 per cent. of the children attending schools. All the milk supplied is pasteurised milk, and the sources of supply are subject to the approval and constant supervision of the Medical Officer of Health. The number of meals supplied daily rose from 12,200 at the beginning of 1947 to 15,100 at the end of 1947. Malt and Oil is given free on the recommendation of the School Medical Officer, and the following issues were made:- 1947. Issues. 1946. Issues. Free Malt and Oil 549 104,960 424 82,731 171 CHILD GUIDANCE. Analysis of 1947 Cases. Referred By Intelligence Result Total No. M.O.H. Court Police Pro.Off. R. Home A. Sch. Educ. Dpt. & Schools Gen. Pract. Parents Miscll. High Average Low Not Classified Diagnostic only Improved Not Improved Parents uncoopera tive Boarding School Foster Home Others, Various other advice Still Attending Males 135 45 26 1 12 8 33 10 19 43 39 34 38 30 1 11 4 1 18 32 Females 134 24 7 64 12 7 20 - 17 29 65 23 78 14 1 7 - 3 16 15 269 172 NON-MAINTAINED SCHOOLS. The usual arrangements for the medical inspection of nonmaintained school children were continued in 1947; 203 children were examined, 49 boys and 154 girls. Table. II. of Appendix B. gives the detailed findings. Yours faithfully, OSCAR M. HOLDEN, School Medical Officer. 173 APPENDIX A. MEDICAL INSPECTION RETURNS. Year ended 31st December, 1947. Table I. MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. A.—Periodic Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 3,003 Second Age Group 1,543 Third Age Group 1,163 Total 5,709 Number of other Periodic Inspections 49 Grand Total 5,758 B.—Other Inspections. Number of Special Inspections 5,096 Number of Re-Inspections 9,415 Total 14,511 Group For defective vision (excluding squint). For any of the other conditions recorded in Table 1IA Total individual pupils. (1) (2) (3) (4) Entrants 16 997 1011 Second Age Group 119 390 504 Third Age Group 117 174 283 Total (prescribed groups) 252 1561 1798 Other Periodic Inspections 3 7 9 Grand Total 255 1568 1807 174 Table II. A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION. Defect Code No. Defect or Disease Periodic Inspections Special Inspections No. of defects No. of defects Requiring treatment Requiring to be kept under observation, but not requiring treatment. Requiring treatment Requiring to be kept under observation, but not requiring treatment. (1) (2) (3) (4) (5) 4 Skin 24 3 3 - 5 Eyes— (a) Vision 225 20 71 - (b) Squint 108 13 2 1 (c) Other 24 2 2 1 6 Ears— (a) Hearing 7 1 1 - (b) Otitis Media 9 2 - - (c) Other 7 - 2 - 7 Nose or Throat 523 320 52 8 8 Speech 16 4 11 - 9 Cervical Glands 8 8 2 - 10 Heart and Circulation 59 48 2 1 11 Lungs 39 21 4 1 12 Developmental— (a) Hernia Not available (b) Other „ „ 13 Orthopaedic— (a) Posture 131 11 10 - (b) Rickets 6 1 - - (c) Other 309 37 18 1 14 Nervous System— (a) Epilepsy 1 2 2 1 (b) Other 9 29 5 2 15 Psychological— (a) Development Not available (b) Stability „ „ 16 Other 59 20 4 4 B. CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS INSPECTED DURING THE YEAR IN THE AGE GROUPS. Age Groups Number of Pupils Inspected A. (Good) B. (Fair) C. (Poor) No. % of col. 2 No. % of col. 2 No. % of col. 2 (1) (2) (3) (4) (5) (6) (7) (8) Entrants 3003 2518 83.8 479 16.0 6 0.2 Second Age Group 1543 1346 87.2 197 12.8 - - Third Age Group 1163 1095 94.2 68 5.8 - - Other Periodic Inspections 49 49 100.0 - - - - Total 5758 5008 87.0 744 12.9 6 0.1 175 Table III. TREATMENT TABLES. GROUP I.—MINOR AILMENTS (excluding Uncleanliness, for which see Table V.) (a) Number of Defects treated or under treatment during the year. Skin— Ringworm—Scalp— (i) X-Ray treatment 9 (ii) Other treatment 69 Ringworm—Body - Scabies 110 Impertigo 230 Other skin diseases 115 Eye Disease 339 (External and other, but excluding errors of refraction, squint and cases admitted to hospital) Ear Defects 305 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 2127 Total 3300 (b) Total number of attendances at Authority's minor ailments clinics 15998 GROUP II.—DEFECTIVE VISION AND SQUINT (excluding Eye Disease treated as Minor Ailments—Group 1). No. of defects dealt with Errors of Refraction (including squint) 1395 Other defect or disease of the eyes (excluding those recorded in Group 1) Total 1395 No. of Pupils for whom spectacles were (a) Prescribed 921 (b) Obtained 907 GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Total number treated Received operative treatment— (a) for adenoids and chronic tonsillitis 135 (b) for other nose and throat conditions - Received other forms of treatment - Total 135 GROUP IV.—ORTHOPAEDIC AND POSTURAL DEFECTS. (a) No. treated as in-patients in hospitals or hospital schools 20 (b) No. treated otherwise, e.g., in clinics or out-patient departments. 283 GROUP v.—CHILD GUIDANCE TREATMENT AND SPEECH THERAPY. No. of pupils treated (a) under Child Guidance arrangements 269 (b) under Speech Therapy arrangements 100 176 Table IV. DENTAL INSPECTION AND TREATMENT. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups . 18489 (b) Specials 1913 (c) Total (Periodic and Specials) 20402 (2) Number found to require treatment 11641 (3) Number actually treated 8666 (4) Attendances made by pupils for treatment .9106 (5) Half-days devoted to : (a) Inspection 173 (b) Treatment 1795 Total (a) and (b) 1968 (6) Fillings: Permanent Teeth 5915 Temporary Teeth 2236 Total 8151 (7) Extractions: Permanent Teeth 1521 Temporary Teeth 9462 Total 10983 (8) Administration of general anaesthetics for extraction 3440 Other Operations: (a) Permanent Teeth 7260 (b) Temporary Teeth 3619 Total (a) and (b) 10879 Table V. INFESTATION WITH VERMIN. (i) Total number of examinations in the schools by the school nurses or other authorised persons 65162 (ii) Total number of individual pupils found to be infested 1242 (iii) Number of individual pupils in respect of whom cleansing notices were issued 551 (iv) Number of individual pupils voluntarily cleansed at Cleansing Station 81 177 Table VI. SCHOOL MEDICAL AND DENTAL STAFF. Names of Medical Officers. Proportion of whole time (expressed as a percentage) devoted to School Health Service. Public Health S.M.O.—Holden, Oscar M., G.M., M.D., D.P.H. 20% 80% a.S.M.0.8— Fleming, Gerald M., M.A., M.B., B.Ch., D.P.H. 65% 35% Morrison, Rose, M.B., B.Ch., D.P.H 45% 55% Hegarty, Ellen Mackenzie, M.B., B.Ch., D.P.H. 35% 65% Collett, Suzanne, L.R.C.P., L.R.C.S., L.R.F.P.S. 35% 65% Douglas, Mary C., M.B., Ch.B 20% 80% 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. 65% 35% Newling, Edith, B.A., M.B., B.S., M.R.C.S., L.R.C.P. - - 100% McGrath, George Donald, M.B., B.Ch - 100% Wyatt, Mabel A., M.D., M.B., B.S., M.R.C.S., L.R.C.P. 100% - Specialist Part-time Medical Officers— Davies, T. E„ M.B., B.S., D.O.M.S Rota of three local Medical Practitioners of tonsils and adenoids. In addition there is a Consulting Surgeon, a Consulting Laryngologist and Otilogist, 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. 90% 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., R.C.S. Eng. Roston, Sarah, L.D.S., R.C.S Eng. Dental Surgical Degree (Warsaw) Nurses. Number of Officers. Aggregate of time given to S.H.S. work in terms of whole time Officers. School Nurses 27 45% District Nurses - - Nursing Assistants* - - Dental Attendants 6 100% * This term refers to the untrained assistants described in paragraph 3 of Circular 1604. 178 APPENDIX B. NON-MAINTAINED SCHOOLS. Year ended 31st December, 1947. Table I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Year Year 1947. 1946. Age 11 or under 54 86 12 51 87 13 21 8 14 20 24 15 18 64 16 24 18 17 15 15 18 or over - 4 Total 203 306 B.—Other Inspections. Year Year 1947. 1946. Number of Special Inspections - - Number of Re-inspections - 47 Total - 47 Visits to Non-maintained Schools 11 15 179 NON-MAINTAINED TABLE II.—A.—Return of Defects Found by Medical Inspection in tiie Year ended 31st December, 1947. DEFECT OR DISEASE. Routine Inspections. Number of defects. Special Inspections Number of defects. Requiring treatment. Requiring to be kept under observation but not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment (1) (2) (3) (4) (5) Malnutrition ... ... ... ... Uncleanliness. (See Table IV.—Group V.) Skin— Ringworm: Scalp ... ... ... ... Body ... ... ... ... Scabies ... ... ... ... Impetigo ... ... ... ... Other diseases (non-tuberculous) ... ... ... ... Eye— Blepharitis ... ... ... ... Conjunctivitis ... ... ... ... Keratitis ... ... ... ... Corneal opacities ... ... ... ... Defective vision (excluding squint) 7 1 ... ... Squint ... ... ... ... Other conditions ... ... ... ... Ear— Defective hearing ... ... ... ... Otitis media ... ... ... ... Other ear diseases ... ... ... ... Nose and Throat— Enlarged tonsils only ... 1 ... ... Adenoids only ... ... ... ... Enlarged tonsils and adenoids ... 1 ... ... Other conditions 1 ... ... ... Enlarged Cervical Glands (Non-Tuberculous) ... ... ... ... Defective Speech ... ... ... ... Teeth—Dental Disease 2 1 ... ... Heart and Circulation— Heart Disease— Organic ... ... ... ... Functional ...... ... ... ... Anaemia 1 ... ... ... Lungs— Bronchitis ... 1 ... ... Other non-tuberculous diseases ... ... ... ... Tuberculosis— Pulmonary— Definite ... ... ... ... Suspected ... ... ... ... Non-pulmonary— Glands ... ... ... ... Spine ... ... ... ... Hip ... ... ... ... Other bones and joints ... ... ... ... Skin ... ... ... ... Other forms ... ... ... ... Nervous System— Epilepsy ... ... ... ... Chorea ... ... ... ... Other conditions ... ... ... ... Deformities— Rickets ... ... ... ... Spinal curvature 8 5 ... ... Other forms 20 2 ... ... Other Defects and Diseases 2 ... ... ... 180 CONTENTS. A.—PUBLIC HEALTH REPORT. page Abortion 100 Acts, Adoptive 119 Adulteration 140 Airport 142 Ambulance Service 9, 36 Amusement Houses 121, 126 Animals, Keeping of 121, 125 Ante-Natal Clinic 88, 100, 106 Babies Help Committee 97 Births 2, 4, 80 Blind Persons 114 Blood Transfusions 105 Blood Examinations 69 Borough Hospital 44 Byelaws and Regulations 119 Cancer 63 Cerebro-Spinal Meningitis 49 Chest Clinic 64 Chicken Pox 49 Contacts, Tuberculosis 74 Committee 1 Coombe Cliff 34 Cowkeepers 131 Convalesence 97 Dairies, Cowsheds & Milkshops 131 Day Nurseries 90 'Deaths 2.3,4,6,9 Dental Treatment—M. &. C.W. 91 Diphtheria 47, 55 Disinfection 126 Disinfestation 126 Ditches 121, 125 Drainage 125 Dysentery 49 Enteric Group 50 Erysipelas 49 Expectant Mothers 91, 99 Extra Nourishment 72 Factories and Workshops Acts 120, 123 Fertilisers & Feeding Stuffs Act 127 Foods 128, 130, 136 Foster-Mothers 98 Foster-Children 98 Gastro-Enteritis 48 German Measles 49 Glandular Fever 50 Gynaecological Clinic 106 (* See also inset table between pages 96 and 97). page *Health Visitors, Work of 56 Home Helps 36, 97 Home Nursing 74 Homework 121 Hospitals 9 Hospital, St. Mary's (Maternity) 99 Houses.Let in Lodgings 122 Housing 118, 121 Housing Act 118, 121 Ice Cream 135 Illegitimacy 2, 3, 4, 97 Immunisation Clinic 55 Infant Welfare Clinics 91, 95 Infant Mortality 3, 81, 84 Infectious Diseases 43 Inquests 4, 14 Laboratory Work 9, 13, 52, 53, 102, 135 Local Acts 119 Lodging Houses, Common 122 Marriages 3 Massage 13 Maternity Homes 89 Maternity Homes, Registration 89 Mayday Hospital 10, 99 Measles 48 Meat Inspection 129, 130 Medical Help Records 87 Men's Hostel 123 Mental Deficiency 13, 107 Midwives 87 Midwives, Municipal 88 Midwives Act 87 Milk, Provision of 72 Milk, Examination of 54, 131, 139 Milk, Tuberculous 131 Milkshops 131 Mortality in Childbirth 2, 80, 98, 106 Mothers' and Infants' Welfare Association 91, 96 Mumps 49 Neo-Natal Deaths 84 Notification of Birth Acts 80 Nuisances 119 Nursing Arrangements 9 Nursing Homes 89 Nursing Mothers 92 Obstetrical Unit 98 Offensive Trades 125 Ophthalmia Neonatorum 58, 83 181 page Orthopaedic Department 109 Out of Borough Cases 50 Out-patients 30 Outworkers 124 Pathological Investigations 13, 53, 102 Pemphigus 50 Physiotherapy 13, 101 Poisons and Pharmacy Act 127 Poliomyelitis 48 Ponds 121, 125 Population 2 Post-Natal Clinic 106 Post-Mortems 4, 14 Premature Infants 96 Public Assistance 35 Puerperal Sepsis and Pyrexia 50, 82, 106 Queen's Road Homes 35 Radiological 12, 69, 78 Rag Flock Acts 127 Rats & Mice (Destruction) Act 128 Rescue Home 97 Road Traffic Accidents 6 Rubella 49 Sanatorium, Cheam 77. Sanatoria, Treatment in 70 Sanitary Administration 118 Sanitary Certificates 123 Sanitary Inspectors, Work -of 118 Scarlet Fever 46 Schools, Inspection of 124 Shop Hours Acts 125 Slaughterhouses 130 Smoke Observation 125 Sputum, Examination 53, 69 Still-Births 2, 82 B.—SCHOOL MEDICAL REPORT page Accommodation 145 Adenoids 153, 154 Blind Children 167 Child Guidance 171 Cleansing of Children 147 Clinics 153 Clothing and Footgear 150 Cod Liver Oil 170 Cost 144 Crippling Defects 153 Deaf Children 167 Deaths 147 Defective Children 150 Defective Hearing 167 Deformities 153 page St. Mary's Maternity Hospital 99 Suicide 6, 9 Tonsillitis 50 T uberculosis—Cheam Sanatorium 77 ,, Contacts 74 „ Deaths 67 ,, Dental Treatment 75, 79 ,, Notifications 64 „ Thoracic Surgery 72 ,, Home Nursing 74 ,, Home Visits 74 ,, Statistics 76 ,, Pneumothorax 78, 79 ,, Pneumoperitoneum cases 79 ,, Institutional Treatment 70, 77 ,, Allowances 76 Twins and Triplets 105 Unmarried Mothers 2, 3, 4, 97 Vaccination 57 Verminous Persons 126 Venereal Diseases 50, 54, 101 Vincent's Angina 50 Vital Statistics 2 Ward Statistics 5 Watercourses 121, 125 Water Supply 7 Whooping Cough 48 Workplaces 124 Workshops 124 X-Ray Examination 12, 69, 78, 102 Zymotic Diseases 5 page Dental Service 155 Dental Treatment 153 Ear Disease 167 Epileptic Children 167 Exclusions 151 Eye Clinic 153, 154 Eye Disease 148 Following-up 153 Health Visitors, Work of 153 Heights and Weights 149 Immunization, Diphtheria 164 Infectious Diseases 150 Inspection Clinic 153 Inspections 145 182 page Juvenile Employment 170 Lungs, Diseases of 147 Malnutrition 150 Malt 170 Massage Clinic 165 Meals, Provision of 170 Mentally Defective Children 168 Milk, etc., Provision of 144 Minor Ailments 153, 154 Non-maintained Schools 172 Nutrition 150 Orthopaedic Work 153 Orthodontic Service 161 Parents' Attendances 146 Physically Defective Children 169 Population 144 page Remedial Exercises 165 Rheumatism Clinic 153, 165 Schools, Special 145, 168 Secondary Schools 145 Speech 169 Staff 177 Statistical Tables 173 Surveys, Uncleanliness 147 St. Christopher's 168 Throat and Nose 153, 154 Treatment 153 Tuberculosis 147 Uncleanliness 147 Vision, Defective 148 X-Ray 161