~uHr.»r-iu '_i_]jggg 1 AC 44132 CRO 50 Vol. LXVII.Part 2. No. 2, 19 County Borough of Croydon. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1948 S. L. WRIGHT, M.D., M.R.C.P., D.P.H. CROYDON: PRINTED BY THE CROYDON TIMES LTD., 104, HIGH STREET C.T. 2. 16-8-49. 300 21 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1948. S. L. WRIGHT, M.D., M.R.C.P., D.P.H. To the Chairman and Members of the Health Committee. Ladies and Gentlemen, I have the honour to present the 49th Annual Report on the health of the people of Croydon and the relevant services of the Corporation for the year ending December 31st, 1948. During the greater part of this period, Dr. Holden was your Medical Officer of Health and, consequently, I can add little contemporary personal observation to the facts set out in this statistical review. It has been said that the Annual Report of a Medical Officer of Health should be seen but not read. It is true that such reports are composed mainly of comparative tables of deaths, diseases, epidemics and similar data, essential for reference but most tedious for sustained reading. Yet the report which I am able to present shows no mean achievements. It is noteworthy that in 1848 was passed the first Public Health Act, so that 1948, a year memorable in its own right in the history of social legislation, marks also the centenary of this first Act. In 1848, the parish of Croydon had an estimated population of 19,380 persons. Its crude death-rate was 28.2 per thousand of the population. Of the 546 deaths recorded, 42 were ascribed to "Fever" (probably typhoid and typhus), 31 to Smallpox, 26 to "Hooping Cough," 22 26 to Measles and 18 to Scarlet Fever. 122 deaths occurred in children under two years of age. The birth-rate cannot be computed, for, as the recorder observes for a later year "it is to be regretted that so many of the poor neglect to register the birth of their children." With this background in mind, 1 emphasise the following items from the year under review: — VITAL STATISTICS. Population. The Registrar-General's estimate of 247,000 shows an increase of over 4,000 in the figure for last year and over 3,000 on that for 1938. Births. The birth-rate fell to 18.2 per 1,000 of the population. The peak of the post-war years appears over. Deaths. A crude death-rate of 10.7 per 1,000 of the population is commendably low. It cannot be compared fairly with former years or other localities since the "crude " death-rate depends not only upon the state of health of the population concerned, but also on its composition as regards sex and age groups. Since 1938, the Registrar - General has been unable to supply local "comparability "factors. It is probable that if such data were available Croydon's death-rate for 1948 would be the lowest in its records. Of the causes of death, diseases of the heart and blood vessels continued to rank first, with cancer second. Infant Mortality. The death-rate per 1,000 live births, of infants under one year of age was 27. This is the lowest figure ever recorded in Croydon. Maternal Mortality. With a figure of 0.44 per 1,000 total births, a new low record has been achieved. The small numbers involved in calculating this figure, allow considerable fluctuation from year to year. The overall tendency for the last few years is a steady diminution in the risk of maternal death in child-birth. ii 23 There is no doubt that the Maternity and Child Welfare services can claim much credit for these two record figures, which must be considered as an encouragement to further efforts. The importance, however, of differential food rationing for mothers and babies should not be forgotten, since adequate nutrition is the basic necessity for such achievements. Tuberculosis Death-Rate. Against The general background of improved or recordbreaking figures, the increased number of deaths from pulmonary tuberculosis is disappointing. It would not be right to make deductions from such an annual fluctuation, which, in any case, shows a more favourable figure than 1938. Nevertheless, for the overall trend to be one of sustained improvement, 1949 must record a substantial reduction. Infectious Diseases. Of all the notifiable conditions, excluding tuberculosis, whooping cough provided the most fatalities. While five deaths is not a large number, the question which immediately arises is : —Were they preventable? Unfortunately, the results of the largescale trials now proceeding of whooping cough vaccine will not be available for some time. Inoculation against whooping cough is performed in Croydon at the specific request of the parents, but with a warning that no guarantee of resulting immunity can be given, as is possible in the case of diphtheria. In any event, it will be observed that all five deaths were in infants under six months of age, and four of them were under three months of age. The present method of inoculation could not have prevented these deaths. Measles was prevalent, but mild in character. Diphtheria is no longer a killing disease and the number of cases notified continues to decline. Scarlet fever cases were fewer but still plentiful. The illness was in general of short duration and mild in character. In many instances in scarlet fever the rash is now so fleeting that diagnosis is doubtful and strict isolation difficult to enforce. Polio-myelitis was much diminished in incidence in comparison with 1947. No case of typhoid fever was notified. Venereal Diseases. The tables included in the reports show the number of cases reporting for treatment for the first time during the last ten years. iii 24 These demonstrate the rise coinciding with the war, and the great increase in those attending for diagnosis and classed as nonvenereal. Penicillin appears to have established itself as a most potent and effective substance for the rapid cure of gonorrhoea and probably also of syphilis. Food Poisoning. No large-scale outbreaks were reported. During the Autumn attention was drawn to cases of sickness and diarrhœa in some of the Corporation's schools. These were carefully investigated but were found to be the type classified by the Ministry of Health as epidemic nausea and vomiting. ENVIRONMENTAL HYGIENE. The work carried out by the Sanitary Inspectors is fully covered by the report of the Chief Sanitary Inspector, but I would mention three aspects of the housing problem. Firstly, appeals for re-housing on the grounds of danger to health. In modern communities with pure water supplies and water carriage sewage disposal systems, it is most difficult, except for tuberculosis, to produce factual evidence of specific diseases directly due to bad housing. Where overcrowding affecting young children is concerned, there are grounds for asserting that the increased incidence of certain illnesses is directly due to such housing conditions. Fven here, the evidence is derived mainly from conditions in tenement buildings and not from areas with the smaller properties of the type found in Croydon. In any case, if it is contended that housing conditions today are particularly bad, it will be remembered that the infant mortality figures are the best ever recorded. The potent force in the demand for more houses is the wish of most married couples to have and develop their own family unit in their own home. This is commendable and understandable, but it is usually impossible to estimate in terms of illnesses the effect of frustration and delay in re-housing on the physical and mental well-being of a family unit. The daily appeals therefore for my support for housing applications are all investigated sympathetically, but it is seldom that any can receive effective support when assessed strictly according to the established facts of environmental hygiene. The second difficulty relates to sub-standard houses, of borderline character, for rendering fit at reasonable cost. To advise closure or demolition is to lose a housing unit. To temporise and patch up is to consolidate slum property and make iv 25 future trouble. With no easement of the pressure for re-housing and increasing dilapidation this problem grows steadily larger. Thirdly, the effect of housing costs on family budgets is again being noted on housing estates. Families moved from inadequate but cheap lodgings to a spacious modern council house may find costs for rent, furniture and fares more than their incomes can sustain, unless drastic cuts are made in other expenditure. It is probable that in such circumstances "bad housing" as we know it today, is on balance less harmful than continuous underfeeding, especially in houses where poverty also prevents adequate heating during the winter. It requires, therefore, very careful judgment to advise some families whether it is belter for them to move or to remain. PERSONAL HEALTH SERVICES. The coming into operation on July 5th, 1948, of the National Health Service Act, 1940, made considerable changes in the facilities controlled by the Corporation for medical care of the individual. Thus the provision of hospitals, both general, and special, and maternity homes passed to the new Regional Hospital Boards, as did the V.D. service and part of the Tuberculosis service. On the other hand, existing powers were enlarged, new duties imposed and new permissive functions outlined. It may be helpful to reprint here the relevant portions of an explanatory summary dealing with the Corporation's duties under the National Health Service which was issued by the Corporation. SERVICES PROVIDED BY THE CORPORATION. Ante=Natal, Midwifery and Post=NataI Services. The Corporation provide the following Clinics at their Centre in Lodge Road, West Croydon: — (a) Ante=Natal Clinics. Eight sessions per week (four sessions being for municipal midwives' cases) every week-day morning at 9 a.m. and Monday and Wednesday afternoons at 2 p.m. (b) Post=Natal Clinics. Two sessions per week, i.e., Tuesday and Friday afternoons at 2.15 p.m. An expectant mother wishing to make use of this service should apply to attend the Ante-Natal Clinic either to the Health Department, 20, Katharine Street, Croydon, V 26 or by attending direct at the Clinic with a letter from her doctor. On attending the Clinic, the expectant mother will be told whether she can have her baby in hospital or whether she will have it at home, and be attended by a municipal midwife (and a doctor if necessary); in the latter case, a home help can also be supplied if necessary during the period of the confinement and lying-in. It is not possible to offer hospital accommodation to all expectant mothers who would like it, as hospital beds are usually reserved for cases which have medical priority or whose home conditions make it impossible for them to have the baby at home. Gas and Air Analgesia is available for every case (whether a hospital or home case) if the patient wishes it, and is medically fit. Infant Welfare Centres. These Centres have t\venty-eight sessions per week, and any mother can attend for advice and help in connection with her baby. A list of the Centres, with the times of their sessions, is obtainable from the Health Department, and all the mother need do is to attend at a Centre. Health Visiting. The Corporation employ a staff of Health Visitors—all State Registered Nurses and State Certified Midwives, who call and advise any householder where there is an expectant or nursing mother, young children, or any sick person. No charge is made by the Corporation for this service. Home Nursing and Home Helps. Arrangements have been made through the Croydon Nursing Service for any person who needs a nurse at home to have one provided. The Corporation also employ a number of "Home Helps" who can be sent if available to give domestic help in households where it is needed because of ill-health, maternity, age, or the welfare of children. The Corporation make a charge for the services of the home help, but the amount of the charge depends upon the family income. Applications for a Home Nurse or Help should be made to the Health Department, 20, Katharine Street, Croydon. Day Nurseries. As part of their Child Welfare Scheme, the Corporation have a number of Day Nurseries open from Monday to Saturday inclusive, from 8 a.m. to 6 p.m. (Saturdays, 8 a.m. to 12 noon), where children up to five years of age can be cared for. The demand, however, for accommodation at these nurseries is far greater than the accommodation available, and therefore the Corporation have had to restrict admissions to priority cases. The Day Nurseries are at— Coldharbour House, Purley Way. Mayday Road. vi 27 Whitehorse Road. Robin House, Morland Road. Bramley Hill. Ritchie Road. Addington Nursery, Salcot Crescent. Euston Road. Bensham Grove. The Corporation charge 1/- per child per day for the meals supplied at the Day Nursery. Care and After=Care of the Sick. The Corporation have power to provide many of the extras (but not cash grants) necessary for the proper care or after-care of sick persons. These include such things as nursing equipment (which can sometimes be supplied on loan), special foods and extra comforts. In tuberculosis cases, particularly, the Corporation have a comprehensive after-care scheme. The Corporation may make a charge for the articles and equipment they supply; detailed information regarding this service can be obtained from the Health Department, 20, Katharine Street, Croydon. Ambulance Service. The Corporation provide an ambulance service which covers not only accidents, but which will also provide, on the request of a doctor or a State registered nurse or State certified midwife, transport for persons who are ill, mentally defective, or who are expectant or nursing mothers. While the person needing the transport should live within the borough, the destination to which he is going may be inside or outside the borough. The service operates from three stations at Stroud Green, Crunden Road, and Cassland Road, and any of the following three telephone numbers may be called:—ADD. 4373, CRO. 4373, or THO. 4373. No charge is made for the ambulance service. Enquiries regarding the service should be made direct to the depots or to the Health Department, 20, Katharine Street, Croydon. Vaccination and Immunisation. Vaccination against Smallpox is no longer compulsory, but the Corporation offer wide facilities for the vaccination and immunisation of persons (particularly children) against Smallpox and Diphtheria. The vaccination and immunisation can be carried out at Infant Welfare Centres, the School Clinics, or by private medical practitioners. Vaccine and anti-Diphtheria prophylactic will be supplied by the Corporation, and any doctor may carry out vaccinations and inoculations under the Corporation's scheme, and claim his fees from the Corporation. Whooping Cough inoculations can be carried out at the request of a parent. vii 28 Mental Health Services. The Mental Health Service covers both mental defectiveness and mental treatment. Treatment in an institution or hospital is, of course, provided by the State, but the Corporation have arrangements to help persons suffering mentally, or their relatives, in their own homes, and to follow them up after discharge from a hospital or institution. (a) Mental Deficiency. The Corporation have qualified visitors who are prepared to visit and advise the relatives of mental defectives, and, if necessary, the defective can be placed under statutory guardianship or sent to an institution where he or she can be trained according to his or her capacity. Defectives under guardianship can be helped financially. The Corporation conduct an Occupation Centre for 30 suitable children at 589, London Road. Enquiries regarding these services should be made to the Health Department, 20, Katharine Street, Croydon. (b) Mental Treatment. It is probably common knowledge that a person who feels that he or she needs a period of treatment in a mental hospital can voluntarily enter the hospital for treatment and be able to leave at any time on short notice. Cases arise, however, where a person needing treatment in a mental hospital is too ill to make this decision, and under the old system a Relieving Officer could be consulted, who could send the patient for observation to a hospital. With the repeal of the Poor Law, the new Health Service provides for "authorised officers" who have no connection with the Poor Law or any other service, who will be properly trained in mental deficiency and mental treatment work, and who will be able to take initial proceedings in providing for the care and treatment of persons suffering from mental illness. Enquiries can be made from the Health Department, 20, Katharine Street, Croydon. No difficulty was experienced in the year under review in meeting demands upon the various sections set out above, but these were heavy and increases in personnel and equipment, in accordance with the Corporation's approved schemes were necessary. Reviewing the whole range of new services operating from July 5th, 1948, hospital, general practitioners and supplementary, it is clear that the Local Health Authorities, having the long established machinery of local government through which to functions, were able rapidly to resolve the problems which arose, and to give some needed help to the newly-established hospital system. The problems which were (and remain) difficult to solve, arose from the fact that the hospitals were quite unable to accept all those for whom hospital treatment or nursing care were deemed viii 29 essential. While home nursing and domestic helps can deal with many of these cases, for patients requiring continuous care, such domiciliary attention can only he a costlv and inefficient substitute for hospital treatment. Health Centres. No formal schemes have been submitted, as the Minister of Health did not request that these were to be prepared by any certain date. On the contrary, it was made clear that building difficulties were such that only schemes where special circumstances could be advanced were likely to receive formal approval. Long discussions were held on the possibility of Health Centres on certain new housing estates and these were being considered at the close of the year now under review. Finally, what of the future? It may be felt that the loss of its hospital services seriously diminishes the ability of the Corporation to improve the health of the residents of the Borough. It is true that illness and its treatment are of intense personal interest to most people. For who knows when he or she may be in need of hospital care? Further, there is the feeling of innate nobility of purpose to tend the sick and relieve pain and suffering. Yet the triumphs of curative medicine may be counted in single numbers and for those who deal with costs, at ever mounting expense. Prevention is still better than cure, from every point of view, though, as always, without glamour and proved only by statistical data. While the record of no single death from diphtheria is undoubtedly of greater merit than the possession of the finest hospital for the treatment of this disease, the drawbacks of such an achievement are obvious. A numerical observation affords little opportunity for civic functions, no laying of. foundation stones or opening ceremonies, and even worse, no tangible example of corporate enterprise available for inspection. Nevertheless, when the initial phase of the changeover has passed, Health Committees and Health Departments will find that they been have relieved of a burden which since the operation of the Focal Government Act of 1929, has diverted them from their position as the pioneers of the practice of preventive medicine. It will also be remembered that, as the authorities responsible for the provision of Health Centres, Health Committees will have the opportunitv to promote the unity of the preventive and curative ix 30 personal health services. It has been said that the Health Act of 1946 is in effect a "National Treatment of Illness Act." This is largely true, but it is significant and appropriate that the local government component of the service is accurately named the "Local Health Authority" A new era in the practice of personal and environmental hygiene now opens for them. I take this opportunity to thank the Chairman and members of the Health Committee for their invariable encouragement and support during my introductory period. To the staff of the Department, my thanks are due for their zeal and loyalty, and for the enthusiasm and skill with which they have met and solved the new difficulties and problems of the period under review. S. L. WRIGHT, Medical Officer of Health. 31 HEALTH COMMITTEE. 1947— Councillor W. H. Gough (Chairman). Councillor J. Todd (Vice-Chairman from 13.7.1948). Alderman Col. C. H. Gibson. Alderman H. Regan, J.P. (Vice-Chairman until 24.6.1948). Alderman Mrs. M. Squire, J.P. Councillor J. D. Bell. Councillor Miss M. G. Billson. Councillor Mrs. V. L. Child. Councillor Mrs. E. E. Cook. Councillor A. V. Dammarell. Councillor M. Davis. 1948. Councillor J. W. Dowsett. Councillor C. E. Ebbutt. Councillor A. Goodbun. Councillor L. N. Loder, M.C. Councillor Mrs. E. M. Regan. Councillor G. H. Ward, O.B.E. Councillor S. G. Wilkes. Miss Dorothy Day, M.R.C.S., L.R.C.P. R. N. Deane, Esq., M.B., B.Ch., B.A.O. J. R. MacNeill, Esq., F.R.C.S. (resigned). O. E. Finch, Esq., M.C., M.D. 5 32 SUMMARY OF VITAL STATISTICS FOR 1948. Area, 12,617 acres. Population (Census 1931), 233,115. Population (estimate of Registrar-General), 247,000. Number of Inhabited Houses (1931 Census), 56,429. Overcrowding Census (1936), 65,550. Rateable Value (1st April, 1948), £2,579,649. Product of a Penny Rate (1947—1948), ,£10,401. Rate in the £: 15s. 0d. Live Births M. F. Total. Legitimate 2,145 2,090 4,235 Illegitimate 141 131 272 4,507 Birth-rate per 1,000 of the estimated resident population, 18.2. Still Births 90. Rate per 1,000 total (live and still) births, 19.6. Birth-rate (live and still births) per 1,000 population, 18.6. Deaths, 2,648 (Registrar-General's figures). Death-rate per 1,000 of the estimated resident population, 10.7. Deaths from diseases and accidents of pregnancy and childbirth, 2; from puerperal and post-abortal sepsis, 1; other causes, 1. Maternal mortality, 0.44 per 1,000 total live and still births. 2 33 Death-rate of Infants under one year of age (120 deaths, 4,507 births)— All Infants per 1,000 live births 27 Legitimate Infants (111 deaths) per 1,000 live births 26 Illegitimate Infants (9 deaths) per 1,000 live births 33 Deaths from Influenza 4 ,, ,, Whooping Cough (all ages) 5 ,, ,, Diarrhoea (under 2 years of age) 7 ,, ,, Pneumonia 142 ,, ,, Cancer 510 Rate per 1,000 Population Deaths from diseases of Cardiac and Circulatory System (including Cerebral Hæmorrhage) 4.99 ,, ,, Cancer 2.06 ,, diseases of the Respiratory System (including Tuberculosis) 1.51 ,, ,, diseases of Digestive System 0.32 ,, ,, Suicide and Violent Causes 0.31 ,, ,, Old age 0.32 « Marriages. The number of marriages solemnised was 2,169, compared with 2,416 in 1947, 2,105 in 1946, 2,268 in 1945, 1,578 in 1944 and 1,574 in 1943. 947 were solemnised in Established Churches, 322 in other places of worship, and 898 in the Register Office. Two were performed under Jewish ritual. 3 34 Births. The live births registered were 4,235 legitimate and 272 illegitimate. The birth-rate consequently was 18.2. For England and Wales and in the Great Towns the rates were 17.9 and 20.0. The illegitimate births in Croydon were 6.0 of the total compared with 5.5 in 1947; 0.5 in 1946; 10.6 in 1945; 7.7 in 1944; 7.8 in 1943 and 7.5 in 1942. The live male births numbered 2,286, the female 2,221, being a proportion of 1,029 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 (24.1), Addiscombe (21.7) and South (20.1). Those with the lowest were Norbury (11.2) and West Thornton (15.6). Deaths. The deaths numbered 2,648, compared with 2,889 in 1947; For 1948 the death-rate was 10.7; for 1947 it was 11.9. The death-rate for England and Wales was 10.8, and for the Great Towns 11.6. For London the death-rate was 11.6. There were 93 inquests held by Coroners in respect of Croydon residents during 1948 and 248 findings by Coroners after post-mortem examination without inquest. Wards with the highest death-rate were Central (13.9), South (12.3) and East (12.0). Lowest: Addington (8.2), Broad Green and Waddon (9.3). * 4 i 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 Diarrhoea. Death Rate from Bronchitis and Pneumonia. Death Rate from Pulmonary Tuberculosis. Death Rate from Non-Pulmonary Tuberculosis. Death Rate from Heart and Circulation Diseases. Death Rate from Nervous Diseases. Death Rate from Cancer. Natural Increase or Decrease of Population. Upper Norwood 17200 318 183 18.5 10.6 31 — . — 0.81 0.17 0.06 5.23 0.23 2.27 + 135 Norbury 16050 179 153 11.2 9.5 34 0.06 — 1.00 0.44 — 4.11 0.25 1.93 + 26 West Thornton 19250 300 192 15.6 10.0 17 — 0.05 0.73 0.36 0.05 4.73 0.10 2.13 + 103 Bensham Manor 16050 291 177 18.1 11.0 17 — 0.12 1.31 0.25 — 5.92 — 1.74 + 114 Thornton Heath 18100 324 176 17.9 9.7 19 - '— 0.72 0.55 0.06 4.14 — 2.43 + 148 South Norwood 17200 342 202 19.9 11.7 41 0.06 0.12 0.87 0.70 0.06 5.47 0.12 1.98 + 140 Woodside 16150 284 182 17.6 11.3 21 - 0.12 0.87 0.37 — 6.07 0.06 1.86 + 102 East 16700 307 200 18.4 12.0 33 — 0.12 1.03 0.48 0.06 5.27 0.12 2.22 + 107 Addiscombe 16050 348 189 21.7 11.8 34 0.06 0.03 0.93 0.56 0.06 4.67 0.12 2.63 + 159 Whitehbrse Manor 1620 321 180 19.8 11.1 28 - — 1.29 0.37 0.03 5.85 0.24 1.60 + 141 Broad Green 17150 293 159 17.1 9.3 34 0.17 0.06 0.99 0.58 — 3.85 0.06 1.81 + 134 Central 12053 209 167 17.3 13.9 14 — 0.08 1.58 0.33 - 6.47 0.08 2.81 + 42 Waddon 17850 305 166 17.1 9.3 20 — — 0.62 0.39 0.06 4.31 — 2.02 + 139 South 15050 303 185 20.1 12.3 26 , 0.07 — 0.93 0.33 — 5.91 0.20 2.13 + 118 Addington 15900 383 130 24.1 8.2 23 — 0.06 1.00 0.31 — 3.46 0.19 1.51 +253 The Borough 247000 *4507 2648 18.2 10.7 27 0.03 0.05 0.96 0.42 0.03 4.99 0.13 2.06 +1866 35 *These are the corrected totals. 36 DEPARTMENTAL CLASSIFICATION OF DEATHS ACCORDING TO DISEASE OVER A PERIOD OF SIX YEARS. Cause of Death. 1943 Total Deaths 1944 Total Deaths 1945 Total Deaths 1946 Total Deaths 1947 Total Deaths 1948 Total Deaths Death Rate Enteric Fever - - - - - - - Acute Infectious Encephalitis — — 1 — 3 2 0.008 Poliomyelitis — 1 1 — 5 4 0.016 Measles 1 1 6 1 1 1 0.004 Scarlet Fever 1 — — — — — — Whooping Cough 1 10 3 3 4 5 0.020 Diphtheria and Croup 2 — 2 3 1 — — Influenza (incl. Influenzal pneumonia) 81 19 11 35 22 4 0.016 Dysentery — — 1 - 1 — - Erysipelas — 1 — — — 1 0.004 Cerebro-Spinal Fever 1 1 3 2 2 1 0.004 Pulmonary Tuberculosis 107 98 78 101 92 103 0.417 Tuberculous Meningitis 16 11 14 9 14 8 0.032 Other Tuberculous Diseases Cancer, Malignant Disease 454 420 470 451 492 510 2.065 Rheumatic Fever 2 2 1 4 5 3 0.012 Meningitis 7 4 6 1 7 2 0.008 Organic Heart Disease 515 563 542 697 665 791 3.202 Bronchitis, Acute and Chronic 150 126 124 156 148 96 0.389 Pneumonia 182 129 160 156 185 142 0.575 Other Diseases of the Respiratory Organs 17 23 19 19 21 32 0.130 Diarrhoea & Enteritis 21 22 20 27 32 13 0.053 Appendicitis 8 8 8 6 6 6 0.024 Cirrhosis of Liver 4 2 5 1 7 6 0.024 Alcoholism — — — 1 — — 3.202 Nephritis & Bright's Disease 44 44 35 48 53 60 0.243 *Puerperal Sepsis 1 — 1 — 1 1 0.207 *Other diseases and accidents of pregnancy and parturition 1 8 8 3 9 1 0.207 Congenital debility, malformation and Premature Birth 73 89 72 58 100 63 0.267 Violent Deaths (excluding suicide) 46 45 64 65 79 45 0.182 Suicide 21 16 24 32 37 32 0.130 Other Defined Diseases 860 1206 808 814 874 701 2.838 Diseases Ill-Defined or Unknown 12 8 4 10 14 7 0.028 Total 2628 2857 2491 2703 2880 2644 10.704 *Calculated per 1,000 live and still births. 1948 showed a decrease in the death rate from 11.9 in 1947 to 10.7. 6 37 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE, AGE A ND SEX Sex All Ages 0— 1— 5— 15— 45— 65— All Causes M 1301 65 8 14 105 343 766 F 1347 58 7 10 93 264 915 Diphtheria M - - - - - - - F - - - - - - - Whooping Cough M 1 1 - - - - - F 5 4 - 1 — — — Encephalitis Acute Infectious M 1 — - — — 1 — F 1 - - - - - 1 Cerebro Spinal Fever M 1 — — — — 1 - F - - - - - - - Measles M 1 — 1 — — — — F - - - - - - - Influenza M 2 - - — — — 2 F 2 - - - - - 2 Poliomyelitis & Polioencephalitis M 1 — - — 1 — — F 2 — 1 — 1 — — Tuberculosis (respiratory) M 63 — - — 27 29 7 F 37 — - 1 26 7 3 Tuberculosis (other forms) M 6 — - 1 3 1 1 F 5 — - 1 2 2 — Syphilitic diseases M 8 - - — 1 6 1 F 4 — - — — 1 3 Cancer M 236 1 - 2 16 85 132 F 257 1 - — 22 86 148 Diabetes M 1 — - — — — 1 F 8 - - — — 2 6 Intra cranial vascular lesions M 119 — - 1 4 26 88 F 162 — - — 1 39 122 Heart diseases M 418 — - 2 13 97 306 F 456 — - 1 5 46 404 Other circulatory diseases M 49 — - — — 7 42 F 56 — - — 1 7 48 Bronchitis M 81 1 1 — 4 24 51 F 41 4 - 1 1 5 30 Pneumonia (all forms) M 62 16 2 1 1 10 32 F 44 3 3 — 1 8 29 Other respiratory diseases M 12 — — — 2 6 4 F 22 — — — 4 8 10 Ulcer of stomach or duodenum M 22 — — — 1 12 9 F 10 — — — 1 2 7 Diarrhoea (under 2 years) M 5 5 - - - - - F 2 2 - - - - - Appendicitis M 5 — — 1 2 1 1 F 5 — — — 1 3 1 other digestive diseases M 17 1 1 — 3 6 6 F 19 — — — 3 4 12 Nephritis M 29 — — — 5 7 17 F 34 — — — 4 11 19 Puerperal sepsis F 1 — — — 1 — - Other maternal causes F 1 — — - 1 — — Congenital debility, malformations, premature birth, etc. M 36 34 — 1 1 — — F 45 41 1 — 1 1 1 Suicide M 18 — — — 5 7 6 F 11 — — 4 5 2 Road traffic accidents M 8 — — 1 3 3 1 F 8 — — - — 1 7 Other violent causes M 20 3 1 1 5 4 6 F 12 — . — 1 — 1 10 All other causes M 79 3 2 3 8 10 53 F 97 3 2 4 13 25 50 Totals 2648 123 15 24 198 607 1681 7 38 Comparisons with 1947. In the zymotic diseases group there were 6 deaths from Whooping Cough and 1 from Measles. There were again no deaths in the Typhoid group. The deaths from Pulmonary Tuberculosis increased by 7; those from Cancer by 21; those from Pneumonia decreased by 39 and a decrease of 23 was also recorded in those caused by Bronchitis. Deaths from Suicide shows a decrease of 10, and road traffic accidents a decrease of 6. The total number of deaths was 2,648 as compared with 2,889 in 1947. The percentage of deaths under 1 year of age to the total deaths was 4.6 per cent.; deaths under 15 years, 6.1 per cent.; deaths under 65 years, 36.5 per cent.; and deaths over 65 years, 63.5 per cent. The corresponding figures for 1947 were 6.7 per cent., 8.1 per cent., 36.8 per cent., and 63.2 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. During 1948, additional supplies were purchased in bulk from the East Surrey and Sutton District Water Companies. The amount of water consumed during the year was— Corporation's Wells 1,821,266,000 M.W.B. Bulk Supplies 1,138,660,000 Other Water Undertakings Bulk 5,675,000 2,965,601,000 The Water supply has been satisfactory in quality and quantity. The supply is piped throughout the area. 8 39 (a) Bacteriological Examinations. Regular bacteriological examinations were made of the raw water going into supply aft.gr treatment. 225 raw water samples and 854 treated water samples were thus examined bacteriologically during the year by the Chemist and Bacteriologist on the staff of the Water Undertaking. In addition 19 samples of raw water and 79 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 showing the normal deterioration in quality which occurs after heavy rain. In all cases the examinations showed that the raw water was suitable for treatment. The bacteriological examinations of the treated waters showed 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 70 of raw waters and 142 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. The whole of the population and dwelling-houses within the area of supply are supplied from public water mains direct to the houses. During 1948 the total number of samples taken bv the Public Health Department was as follows:— For bacteriological examination 66 For chemical examination 66 All these sampler were taken direct from consumers' taps'. 9 40 MAYDAY HOSPITAL. I am indebted to Mr. C. F. Swinton, the Surgeon Superintendent. for the following statistics. Although the Hospital was transferred to the authority of the South-West Metropolitan Regional Hospital Roard on the 5th July, 194S, the figures are given for the whole year. The following Specialist services are carried:—Orthopaedic, Gynaecological and Obstetrical, Dental, X-ray, Massage, Ultraviolet Light, Ophthalmic, Ear, Nose and Throat, School E.N.T. Clinic, Gastroscopy, Psychiatric, Medical and Surgical Out-Patients. TABLE I. 1. Total number of admissions (including infants born in hospital) 8901 2. Number of women confined in hospital 1302 3. Number of live births 1264 4. Number of still births 47 5. Number of deaths among the newly-born (i.e., under 4 weeks of age) 26 6. Number of deaths among children under one year including those given under 5 56 7. Number of maternal deaths among women admitted to hospital for confinement 1 8. Total number of deaths 595 9. Total number of discharges (including infants born in hospital) 8892 in. Duration of stay of patients included in 8 and 9 above:— (a) Under 4 weeks 7486 (b) 4 weeks and under 13 weeks 1093 (c) 13 weeks or more 312 11. Number of beds occupied (excluding cots in maternity wards)— (a) Average during the year 482 (b) Highest 517 (c) Lowest 409 12. Number of surgical operations under anaesthetic 2169 10 41 TABLE II. Classification of IN-PATIENTS WHO WERE discharged from OR WHO died IN THE institution DURING THE YEAR ENDED 31st december, 1948. Disease Groups Children (under 16) Men and Women Discharged Died Discharged Died A. Acute Infectious Disease 31 — 5 — B. Influenza — — 1 — C. Tuberculosis: Pulmonary 5 1 167 21 Non-Pulmonary 7 — 18 5 D. Malignant Disease 1 — 80 73 K. Rheumatism— (1) Acute rheumatism (rheumatic fever) together with sub-acute rheumatism and chorea 1 - - - (2) Non-articular manifestation of so-called "rheum" (Muscular rheumatism, fibrositis, lumbago and sciatipa) 1 - 9 - F. Venereal Disease — — — — G. Puerperal Pyrexia - - - - Puerperal Fever - - 1 - H. Other diseases and accidents connected with pregnancy and childbirth 2 — 876 — I. Mental diseases 14 — 227 1 J. Senile decay — — 24 2 K. Accidental injury and violence 70 — 206 4 L. Nervous and Sensory 16 9 72 64 M. Respiratory 124 15 208 86 N. Circulatory 16 4 195 176 0. Digestive 180 5 705 51 P. Genito-Urinary 373 — 167 33 Q. Skin 45 — 100 — R. Other diseases 1537 9 196 9 S. Mothers and infants discharged from Maternity Wards and not included in the above figures: Mothers — — 1301 1 Infants 1264 26 — — T. Any person not falling under any of the above headings 23 — 29 - 3710 69 4587 526 11 42 Table III. Patients Discharged from Mayday Hospital during Year ended 31st December, 1948. Diagnoses Cured Relieved UnRelieved Died Total Alimentary 506 300 19 24 849 Bones and Joints 29 55 7 - 91 Carcinoma 10 29 42 73 154 Circulatory, Blood 36 41 4 15 96 Circulatory, Heart 16 102 12 165 295 Eye 2 2 1 — 5 Constitutional 18 40 2 32 92 Ear, Nose and Throat 1461 37 2 1 1501 Genito-Urinary 436 100 4 33 573 Glands 12 19 1 — 32 Gynaecological 659 6 — — 665 Infectious 2 6 30 — 38 Maternity 212 1 — — 213 Mental 7 32 202 1 242 Nervous and Sensory 13 51 24 73 161 Respiratory 174 137 21 101 433 Senility — 2 22 2 26 Skin 72 69 4 — 145 Tuberculosis 5 152 40 27 224 V.D. — — — — — Violence 93 175 8 4 280 Miscellaneous 154 11 3 17 185 Mothers 1301 — — 1 1302 Babies 1264 — — 26 1290 Totals 6482 1367 448 595 8892 12 40 RADIOLOGICAL DEPARTMENT. A. RADIODIAGNOSIS. 1948 1947 J. Total Number of Patients Examined 9,486 8,393 (a) In-Patients 3,350 2,824 Male Wards 1,402 1,306 Female Wards 1,514 1,186 Children's Wards 300 210 Maternity and Gynaecological Wards 134 122 (b) Out-Patients 6,136 5,569 Mayday Hospital 3,331 1,907 Maternity and Gynaecological Clinics 876 555 T.B. Clinic 1,328 2,592 Dental Clinic 190 144 Staff 315 285 Others 96 86 2. Total Number of Films Taken 19,392 14,544 3. Total Number of Screening Examinations 1,543 686 4. Special Examinations— Barium Meals, including oesophagus 608 340 Barium Enemas 99 48 Cholecystographies 129 76 Pyelographies 180 112 Chests 3,776 4,568 Bronchographies 26 21 Tomographies 22 — Skeletal System 3,211 2,373 Skull 358 205 Spine and Pelvis 470 336 Extremities 2,385 1,832 Maternity and Gynaecological 911 596 Pelvimetries 311 111 Dental 239 175 Miscellaneous 285 84 B. RADIOTHERAPY. (Temporarily discontinued on 1.7.48) 1. Number of Patients Treated 125 155 Mayday Hospital 56 62 Croydon General Hospital 55 91 Others 14 2 2. Number of Treatments Given 1,318 2,279 13 44 3. Conditions Treated— (Number of Patients) (a) Malignant Diseases 57 102 Carcinoma of Breast 31 62 Gynaecological Carcinoma 5 5 Carcinoma of Mouth and Neck 2 7 Carcinoma of Skin 6 7 Other Carcinomas 3 6 Sarcoma of Bone 5 8 Lymphadenoma and Leukaemia 5 7 (b) Non-Malignant Diseases 68 53 Haemangioma and Keloids 10 — Dermatological 19 30 Osteoarthritis 23 18 Menorrhagia 13 2 Miscellaneous 3 3 4. Radiotherapy Clinic- Number of Patients seen 630 (a) New Patients 122 (b) Old Patients 508 PHYSIOTHERAPY. Massage 15,602 Radiant Heat 14,018 Exercises 4,015 Electrical 2,412 Diathermy 114 Infra-red 864 Ultra Violet Light 1,266 Wax 1,143 Spray Baths 3,415 Kromayer Lamp 217 Short-Wave 6,587 49,653 Total number of patients treated 31,306 Total number of new patients 2,365 MENTAL PATIENTS DEALT WITH DURING THE YEAR. Male Female Admitted 99 148 Certified and sent to Warlingham Park Hospital 11 19 As Voluntary Patients to Warlingham Park Hospital 53 67 Discharged not certified 36 62 14 45 NUMBER OF POST-MORTEWS ORDERED BY THE CORONER AND PERFORMED AT MAYDAY HOSPITAL DURING THE YEAR. Outside Cases 235 Hospital Cases 89 Number of Post Mortems not ordered by the Coroner 124 SPECIMENS EXAMINED IN THE PATHOLOGICAL LABORATORY DURING THE YEAR. Positive Negative Swabs for Diphtheria — 2,411 Sputa for T.B. 939 1,419 Pus for T.B 7. 48 Pus for Gonococci (included under Pus for organisms) — — Urine for T.B. 11 22 Faeces for T.B. 1 8 Faeces for Coli Typhoid Group . — 51 Blood—Widals — 10 Hairs for Ringworm — 2 Blood Cultures 2 21 Faeces for occult blood 290 396 Urine for routine examination 1,631 Pus for organisms 209 Blood urea estimations ' 324 Blood sugar estimations 201 Cerebro-spinal fluids 123 Urea conc. Tests 19 Urea Clearance Tests 75 Fractional Test Meals 183 Pleural Fluids 147 Blood Counts 1,559 Haemoglobin estimations 882 Blood groups 469 Compatability Tests 227 Van den Bergh reaction 14 Blood sedimentation rates 1,502 Glucose tolerance tests 5 Blood coagulation and bleeding time 371 Other examinations—unclassified 24^ Total number of examinations 13,819 NUMBER OF SPECIMENS SENT TO CROYDO GENERAL HOSPITAL Blood for W.R. and Kahn 2,884 Blood for W.R. only 121 Blood for G.C.F.T 98 C.S.F. for W.R. and Lange 37 Tissue for Histology 354 Specimens for Guinea Pig Inoculations 3 15 46 NUMBER OF SPECIMENS SENT TO SUTTON BLOOD DEPOT For Rh. factor 3,946 NUMBER OF OPERATIONS CARRIED OUT IN THE GENERAL AND GYNAECOLOGICAL THEATRES Abdominal 550 Bones and Joints 202 Ear, Nose and Throat 172 Genito-Urinary 220 Miscellaneous 390 Gynaecological 408 Obstetrical 230 TOTAL NUMBER OF PATIENTS DISCHARGED FROM MAYDAY HOSPITAL DURING YEAR ENDED 31st DECEMBER, 1948. Cured 0,482 Relieved 1,307 Unrelieved 448 Died 595 8,892 TOTAL NUMBER OF OUT-PATIENTS TREATED AT MAYDAY HOSPITAL DURING YEAR ENDED 31st DECEMBER, 1948. 20,330 16 47 HOME HELPS. The Home Helps Service during the year 1948 expanded considerably in accordance with the Corporation's scheme under the National Health Service Act, 1948. (1) Number of Home Helps—January 1st and December 31st, 1948— 31/12/47. 31/12/48. (a) Full-time 37 42 (b) Part-time 20 32 (2) Number of applications— (a) Maternity 843 (b) Sickness 1,134 (3) Number of applications met— (a) Maternity 801 (b) Sickness 1,129 (4) Average duration of services given— (a) Maternity 14 days (b) Sickness 10—21 days (5) Amount recovered for services £2,136 4s. 4d. (6) Rate of remuneration of "Helps"— (a) Maternity £4 14s. 0d. per week (b) Sickness 2s. per hour Reference should also be made to page 70 for further data in regard to this Service. AMBULANCE SERVICE. I beg to submit the Seventh Annual Report and Statistics ol this Service for the year ended 31st December, 1948. During the year the Service dealt with 25,227 calls, which is .hi increase of 6,859, or approximately 37 per cent, over the figures for 1947, and this increase is mainlv accounted for by the expansion due to the National Health Service Act. The total mileage covered by ambulances on calls during the year was 185,611 miles, which is an increase of 39,172 over the previous year's figures. 17 48 The average time for an ambulance, to attend emergency calls was four minutes, which, in view of their scattered nature, is quite reasonable. During the year sitting case cars JK 3705 (Hudson Terraplane) and CMK 891 (Ford V.8) were taken out of commission and at the same time two new Humber Hawk sitting cars were delivered and taken into service. Also, a second-hand Wolseley saloon car was taken over from the Borough Engineer's Department," and this also is now used as a sitting case car, making a total of four such cars. In addition, two further cars have been acquired for the Croydon Midwife Service, the maintenance and garaging of which are at present the responsibility of the vmbulance Service, together with the provision of a driver as and when necessary. Once again numerous letters of appreciation and thanks have been received from residents who have had occasion to use the Ambulance Service during the year. A. L. HILL, Chief Officer. ANALYSIS OF ACCIDENTS FOR YEAR ENDED 31st DECEMBER, 1918. 1948. 1947. Collision between Vehicles, Cycles, &c. 128 130 PEDESTRIANS KNOCKED DOWN BY— (1) Motor Cycle 32 29 (2) Motor Lorry 58 32 (3) Pedal Cycle 52 35 (4) Public Service Vehicle 12 16 (5) Motor Cars 136 51 290 163 INJURIES SUSTAINED BY FALLING— (1) In the Street 166 160 (2) In the Home 51 59 (3) From Vehicles, Cycles, &c 125 89* (4) Down Stairs 31 34 (5) From Trees, Scaffolding, &c. 4 12 377 354 WORKS ACCIDENTS— (1) Caught in Machinery 17 18 (2) Crushed by heavy objects 17 30 (3) Miscellaneous accidents at work 109 54 (4) Falling 43 25 186 127 18 49 ACCIDENTS IN PUBLIC PLACES— 1948, 1947 (1) Theatres 2 2 (2) Cinemas. — 1 (3) Public Halls 1 3 (4) Railway Stations 10 15 (5) Sports Grounds 46 34 (6) Recreation Grounds 25 11 84 66 Miscellaneous Accidents 195 149 DEATHS— (1) Certified at Hospital 39 43 (2) Certified at scene of accident or illness 9 10 48 53 SUICIDES— (1) Hanging 1 — (2) Poison — 1 (3) Coal Gas Poisoning 10 11 (4) Gun-shot Wound — 1 11 13 ATTEMPTED SUICIDE— (1) Poison 6 8 (2) Cut Throat 2 4 (3) Coal Gas Poisoning 10 11 (4) Jumping from vehicles 2 — 20 23 BURNS AND SCALDS 10 16 PERSONS FALLING FROM PUBLIC SERVICE VEHICLES 28 40 COMMON ASSAULT 18 33 SUDDEN ILLNESS IN THE STREET 396 341 EPILEPTIC FITS 100 90 OXYGEN USED 29 50 ACCIDENTS TO CHILDREN UNDER 15 YEARS OF AGE— (1) In Schools 81 87 (2) In the Home 161 98 (3) In the Streets 175 194 417 379 19 50 During the year 25,227 calls were dealt with by the Ambulance Service, as follows— Miscellaneous Accidents 59 Accidents in Streets, Pluces of Employment and Public Places 850 Accidents in Private Houses 355 Sudden Illness in Street, Places of Employment, etc. '472 Sudden Illness in Private Houses 126 Transport of Cases from Hospitals, after treatment 920 Private Removals, from Nursing Homes, etc. 2,265 Public Health Department—Transport of Patients 4,075 Public Assistance Department—Transport of Patients 395 Accidents in Schools 81 General Removals under National Health Service 11,227 Services of Ambulance not required, or refused 216 Calls taken by Borough Hospital and Mayday Ambulance 4,186 25,227 INCIDENCE OF CALLS. 1 day 7 calls 1 day 33 calls 12 days 59 calls 6 days 83 calls 2 8 „ 3 „ 34 „ 11 ,. 60 „ 2 ,, 84 „ 2 ,, 9 3 ,, 35 ,, 4 „ 61 „ 5 ,, 85 ,, 1 „ 10 „ 3 „ 38 „ 8 „ 62 „ 4 „ 86 „ 1 ,, 11 ,, 1 ,, 39 „ 8 ,, 63 ,, 1 ,, 88 „ 4 ,, 12 „ 1 ,, 40 ,, 3 ,, 64 „ 4 „ 89 ,, 3 ,, 13 ,, 1 ,, 41 ,, 6 ,, 65 „ 5 ,, 90 „ 2 „ 14 ,, 2 ,, 42 ,, 7 „ 66 ,, 2 „ 91 „ 2 „ 15 „ 1 ,, 43 ,, 10 „ 67 „ 3 „ 92 „ 1 ,, 16 „ 5 ,, 44 ,, 4 ,, 68 ,, 1 „ 93 „ 7 „ 17 ,, 1 „ 45 „ 6 ,, 69 ,, 4 „ 94 ,, 4 ,, 18 „ 6 ,, 46 ,, 1 ,, 70 „ 7 „ 96 „ 4 ,, 19 ,, 4 ,, 47 3 „ 71 „ 1 „ 97 „ 2 „ 20 „ 4 ,, 48 „ 8 ,, 72 ,, 6 „ 98 „ 5 ,, 21 „ 6 ,, 49 ,, 2 ,, 73 „ 7 „ 99 „ 6 „ 22 ,, 6 „ 50 ,, 4 ,, 74 ,, 4 ,, 100 ,, 7 „ 23 ,, 3 ,, 51 ,, 2 ,, 75 „ 3 ,, 101 ,, 4 „ 24 „ 6 ,, 52 3 76 ,, 1 „ 103 ,. 2 25 8 „ 53 „ 5 ,, 77 ,, 1 ,, 105 ,, 3 ,, 26 „ 10 ,, 54 „ 2 „ 78 2 „ 107 „ 2 ,, 27 „ 2 ,, 55 1 ,, 79 ,, 1 „ 108 ,, 3 ,, 28 ,, 8 ,, 56 ,, 4 „ 80 ,, 1 ,, 109 ,, 2 ,, 29 „ 7 ,, 57 ,, 3 „ 81 ,, 1 „ 111 ,. 3 ,, 31 5 „ 58 „ 4 ,, 82 „ AMBULANCE STATISTICS—Year 1948. Financial Statement. Income from Private Use of Ambulances. Accounts totalling £158 1s. 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. 0d. have been rendered to the Public Health Department for patients conveyed on their behalf. 20 51 Transport of Patients for Public Assistance Committee. Patients conveyed for Public Assistance Committee realised (he sum of £98 7s. 0d., and accounts for this amount have been rendered. 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 were:— London County Council 12 cases Borough of Mitcham 8 ,, Coulsdon and Purley U.D.C. 22 ,, Borough of Beckenham 7 ,, On 649 occasions First Aid was rendered to injured persons prior to their removal to Hospital. On 29 occasions oxygen and carbon dioxide was administered to patients by means of the "Novox Resuscitating Apparatus." On 9 occasions persons were certified dead at scene ot accident or illness. On 39 occasions injured persons were conveyed to. hospital, hut were certified dead on arrival. During the year the Service was called upon to deal with 11 cases of suicide and 20 cases of attempted suicide. Calls during the year were apportioned as follows:— Headquarters Station 13,040 No. 2 Station, Thornton Heath 4,060 No. 3 Station, Crunden Road 3,941 Mayday and Borough Hospitals 4,186 25,227 How Calls were Received. Police 821 Fire Brigade 379 Other Ambulance Services 85 Public 1,963 Doctors and Hospitals 22,473 25,227 21 52 INFECTIOUS DISEASES NOTIFIED DURING YEAR 1948. Notifiable Disease. Cases notified in the whole District. Total cases notified in each Ward. Total Deaths in the Borough. Sex Distribution of Notified Cases. 1948. 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 377 2 91 255 15 11 3 - 23 32 11 22 21 28 33 35 30 8 21 15 38 31 29 - 194 183 Diphtheria 7 — 1 4 1 1 — - - - — 1 2. - - 1 - 1 2 - - - 4 3 Erysipelas 35 — - 1 1 7 18 8 1 1 4 3 — - 5 6 1 2 2 3 4 - 3 1 23 12 Cerebro-Spinal Meningitis 2 1 1 - - - - - - - 1 - - - 1 - - - - - - - - 1 1 1 Enteric & Paratyphoid 1 - - 1 - - - - - - - - - - - - - - - - - 1 - - - 1 Small Pox - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus — — — — — — — — — - - - - - - - - - - - - - - - - - Puerperal Pyrexia 31 — — — 10 21 — — 1 — 18 — 1 2 - 1 - 1 1 1 2 3 - - - 31 Ophthalmia Neonatorum 13 13 — — — — — — 1 — 6 1 — — —. - 1 - 1 - - - 3 - 9 4 Poliomyelitis and Polio-encephalitis 13 - 4 5 - 4 - - 2 2 - 1 2 - - - - - - - - 1 5 2 9 4 Dysentery 7 1 5 — 1 - - - - - - - - - - 1 — 2 1 — 1 2 - - 4 3 Malaria — — — — — — — — — — — — — — — — — — — - - - - - - - Acute Primary and Acute Influenzal Pneumonia 53 3 9 11 1 12 11 6 3 2 1 3 1 2 4 2 1 7 16 3 3 5 1 32 21 Measles 2356 81 1170 1063 22 16 3 1 75 91 149 168 91 206 237 156 161 253 139 81 142 184 223 1 1212 1144 Whoping Cough 956 107 533 299 2 11 4 - 30 33 81 53 52 72 97 91 74 48 41 24 55 93 112 5 452 504 Totals 3851 208 1814 1639 53 83 39 15 136 161 271 252 168 310 379 292 268 322 222 128 247 315 380 11 1940 1911 23 53 Comments on the Incidence and Prevalence of Infectious Disease. Scarlet Fever cases showed a large decrease on 1947. The incidence rate of Diphtheria was 0.03, compared with 0.10 in 1947. No cases of Small Pox occurred during the year. There were 31 cases of Puerperal Pyrexia; 10 occurred in the 15-24 age group, and 21 in the age group 25-44 years. ISOLATION HOSPITAL. 1 am indebted to Dr. J. Linehan, the Medical Superintendent pf the Croydon Isolation Hospital, for the following particulars. Although the Hospital was transferred to the Hospital Board as from the 5th July, 1948, the statistics have been submitted for the whole year and will be considered in relation to the table of Infectious Diseases on page 22:— 23 54 Complaint for which admitted. Patients remaining in Hospital on 1st January, 1948 Patients admitted and discharged in 1948 Patients admitted during 1948 and remaining in Hospital on 1st January, 1949 Analysis of Cases admitted whether discharged or not during the year. Total. Recovered etc. Died. Total. Recovered etc. Died. Total. Recovered, etc. Died. Total. Recovered etc. Died. Case Mortality.% Average No. of days in Hospital. Scarlet Fever 40 40 - 341 340 1 25 25 - 366 365 1 0.3 31 Measles 1 1 - 115 114 1 1 1 - 116 115 1 0.9 16 Measles Contacts — — - 2 2 — — — - 2 2 — 2 Whooping Cough 4 4 - 64 60 4 1 1 — 65 61 4 6.2 30 Gastro Enteritis 4 3 1 38 32 6 5 5 - 43 37 6 14.0 25 Diphtheria 4 4 - 31 30 1 — — — 31 30 1 3.2 21 Mumps 2 2 - 26 26 — 1 1 - 27 27 — — 17 Poliomyelitis 2 1 1 14 13 1 2 2 - 16 15 1 6.2 25 Tuberculous Meningitis — — - 1 — 1 — — - 1 — 1 100.0 10 Erysipelas — — - 14 14 — — — — 14 14 — — 14 Chicken Pox — — - 11 11 — 2 2 - 13 13 — — 25 Cerebro-Spinal Meningitis — — - 8 8 — 1 1 - 9 9 — — 12 Ophthalmia Neonatorum — — - 6 6 — — — - 6 6 — — 9 Rubella — — - 3 3 — — — - 3 3 — — 9 Paratyphoid — — - 2 2 — — — - 2 2 — — 37 Encephalitis Lethargica — — - 2 2 — — — - 2 2 — — 29 Dysentery — — - 2 2 — — — - 2 2 — — 8 Tonsilitis — — - 3 3 — — — - 3 3 — — 18 Vincent's Angina — — - 1 1 — — — - 1 1 — — 15 Ophthalmia — — - 1 1 — — — - 1 1 — — 20 Convulsions — — - 1 1 — — — - 1 1 — — 8 Observation — — - 1 1 — — — - 1 1 — — 27 Puerperal Infection — — - 24 23 1 — — - 24 23 1 4.2 10 Non-Patient Babies 2 2 - 24 24 — — - 24 24 — — 10 Non-Patient Mothers - - - 4 4 - - - - 4 4 - - 8 Totals 59 57 2 739 723 16 38 38 — 777 761 16 — — 24 55 AGE GROUPS UNDER DIAGNOSIS (Unconfirmed) FOR WHICH ADMITTED. 0—1 1—2 2—5 5—15 15—25 25—35 35—45 45 and over Totals M F M F M F M F M F M F M F M F Scarlet Fever 1 2 10 2 52 38 116 113 3 12 - 8 - 5 2 2 366 Measles 4 5 14 15 25 24 18 10 — 1 - - - - - - 116 Measles Contacts — — — 1 — — - 1 — — - — — — — — 2 Whooping Cough 7 9 7 10 13 8 5 5 - - - - - - - 1 65 Gastro-enteritis 15 10 5 4 3 1 1 - - - - - 1 — 1 2 43 Diphtheria 2 — — 2 2 2 7 7 4 1 1 2 — 1 — - 31 Mumps — — — 1 4 4 8 — — 3 5 2 — — — — 27 Poliomyelitis — — 1 — 3 — 5 1 1 1 — 2 1 1 - - 16 Tuberculous Meningitis — — — — — 1 — — — - — — — — - 1 Erysipelas — — — — — 1 — 1 - — 2 1 1 — 6 2 14 Chicken Pox — 1 2 — 3 1 2 1 — 1 — 1 — — 1 - 13 Cerebro-spinal Meningitis — 1 — 1 5 1 1 - - - - - - - - - 9 Ophthalmia Neonatorum 3 3 - - - - - - - - - - - - - - 6 Rubella — 1 — — — — 1 1 - - - - - - - - 3 Paratyphoid - - - - - - - 1 — 1 - - - - - - 2 Encephalitis Lethargica - 1 — - 1 — - — — — — - - - - - 2 Dysentery — — — — — — - — — — 1 - - 1 - - 2 Tonsilitis - - - - - - - - - 1 - - - - - - 3 Vincent's Angina - - - - - - 1 - - - - - - - - - 1 Ophthalmia 1 - - - - - - - - - - - - - - - 1 Convulsions — — 1 - - - - - - - - - - - - - 1 Observation - - - 1 - - - - - - - - - - - - 1 Puerperal Infection — - - - - - - - - 7 — 12 — 5 — — 24 Non-Patient Babies 12 12 - - - - - - - - - - - - - - 24 Non-Patient Mothers - - - - - - - - - 2 - 2 - - - - 4 Totals 45 45 40 37 111 80 166 141 8 30 9 30 4 13 10 8 777 25 56 Whooping Cough. 65 cases were admitted for this disease. In 5 cases the diagnosis was amended to bronchitis and in two other cases to broncho-pneumonia and endocarditis respectively. Whooping Cough was present as a concomitent infection in one case of scarlet fever and one measles patient. Thus the number of confirmed cases was GO as compared with 33 in the previous year. The following complications occurred:— Broncho- Cardiac Convulsions 1 Malnutrition 1 pneumonic 10 Failure 4 Otitis Media 1 Enteritis 5 Bronchiectasis 2 The ages of the four fatal cases were 4 months, 9 weeks, 4 weeks, and 3 weeks respectively. Complications present in the fatal cases were broncho-pneumonia, enteritis, acute heart failure and convulsions. The two older babies were moribund on admission and died within 24 hours. Gastro-Enteritis. 43 cases were admitted for this complaint, in 33 of whom the diagnosis was confirmed, as well as in one other case admitted as dysentery. This is 7 cases fewer than in the previous year. The following complications occurred:— Relapse of Enteritis 3 Bronchopneumonia 2 Anaemia 1 Paralytic Ileus 2 Jaundice 1 Stomatitis 1 In the 10 admissions where the diagnosis had to be amended the following diagnoses were established:— Dysentery 3 Bronchitis 1 Aortic Stenosis 1 Malnutrition 1 Bronchopneumonia 2 Coryza 1 Indigestion 1 One of the fatal cases in this group of admissions was due to aortic stenosis as shown in the list of amended diagnoses. Of the remaining five fatalities, 4 belonged to the infantile and one to the senile type of gastro-enteritis. All four infants were bottlefed, and their ages were 4 months, 3 months, 3 months, and 7 weeks respectively. Diphtheria. The diagnosis of diphtheria was confirmed in only 8 of the 31 patients admitted for this disease. This constitutes a marked reduction when compared with 27 confirmed cases in the previous year. The remaining 23 cases were diagnosed as follows : Tonsillitis 9 Streptococcal Sore Vincents Angina 2 Laryngitis 4 Throat 2 Bronchopneumonia 2 Diphtheria Carrier 1 Peritonsillar Abscess 2 Diphtheroid Carrier 1 26 57 None of the confirmed cases were of the very severe type, and the only complications which occurred were:— Heart Block 2 Secondary Sore Throat 1 There were no fatal cases. Five of the 8 cases had not previously been immunised against diphtheria. Mumps. Of the 27 patients admitted all but one were considered to be suffering from this disease. This was two admissions fewer lhan in the previous year. One case of orchitis was the onlv complication which developed. Poliomyelitis Among the l(i patients admitted as suffering from poliomyelitis the following revised diagnoses were established:— Hysteria 2 Hemiplegia 1 Lobar Influenza 1 Pneumonia 1 The diagnosis of poliomyelitis was established in the remaining 11 cases, and there was one case of polio-encephalitis admitted as encephalitis lethargica. Though much below the epidemic figure of 51 cases in t-he previous year, this is a higher incidence of the disease than is normally experienced. As usual, this higher incidence was in the last five months of the year, when there were 8 cases as compared with 3 cases in the first seven months. The one fatal case was due to respiratory paralysis affecting a woman at full term pregnancy. Two other cases required respirator treatment. Scarlet Fever. The total number of cases admitted during the year as suffering from scarlet fever was 366. The diagnosis of scarlet fever was confirmed in 342 of these cases while one case admitted as tonsilitis subsequently developed scarlet fever. This total of 343 cases is 134 fewer than in the previous year. The highest prevalence was during the first three months of the year when (wo scarlet fever wards were in use. For the remainder of the year one ward sufficed. The following complications and sequelae occurred:— Otitis Media 29 Adenitis 10 Vaginitis 1 Rhinorrhoea 27 Glandular Abscess 3 Endocarditis 3 Secondary Scarlet Fever 9 Paronychia 10 Rheumatism 4 Secondary Sore Throat 8 Streptococcal Fissure 9 Erythema Nodosum 2 Peritonsillar Abscess 1 Impetigo 4 Chorea 1 Sinusitis 4 Furunculosis 2 Nephritis 2 Bronchitis 6 Conjunctivitis 1 Jaundice 1 Lobar Pneumonia 1 27 58 There were two cases of surgical scarlet fever, one due to burns, and the other following tonsillectomy. Scarlet Fever was complicated by a second infection in the following cases:— Scarlet Fever and Chicken-pox 11 Scarlet Fever and Measles 2 Scarlet Fever and Whooping Cough 5 Scarlet Fever, Measles and Chicken- pox 1 Of the 24 cases admitted as scarlet fever in which the diagnosis proved incorrect the revised diagnoses were as follows:— Tonsillitis 9 Rubella 2 Scabies 1 Measles 3 Toxic Erythema 2 Septic Rash 1 Pharyngitis 3 Chicken-pox 1 Bronchitis 1 Otitis Media 1 The fatal case of scarlet fever was due to the complication of rheumatic endocarditis aggravated by chorea gravis. Death from congestive heart failure occurred 4J months after admission. Measles. 116 patients were admitted as suffering from measles and the diagnosis was confirmed in all but one case which was diagnosed as bronchitis. In addition, 3 cases admitted as scarlet fever patients and 1 observation case were diagnosed as measles. Measles developed after admission in 2 scarlet fever patients and 1 patient suffering from cerebro-spinal meningitis, making a total of 122 measles cases treated as compared with 58 in the previous year. The great majority of cases were admitted during the months of March, April and May, when the disease was epidemic in the locality and a ward was opened for their accommodation. The following complications Occurred:— Broncho- Enteritis 4 Sinusitis 1 Hepatitis 1 pneumonia 13 Pleurisy 1 Meningitis 1 Phlyctenular Otitis Media 5 Conjunctivitis 1 Impetigo 1 In the one fatal case which occurred death was due to acute atrophy of the liver following hepatitis—an unusual complication. Cerebro-Spinal Meningitis. Nine patients were admitted for this disease, but the diagnosis was confirmed in only 2 of these cases. One patient admitted as suffering from encephalitis lethargica was diagnosed as cerebro-spinal meningitis, making a total of 3 cases treated as compared with 4 in the previous year. They all had 28 59 plicated recoveries. The. 7 cases in whom the diagnosis was altered were suffering from the following complaints:— Lobar Pneumonia 2 Broncho-pneumonia 1 Pharyngitis 1 Influenza 2 Tonsillitis 1 Tuberculous Meningitis. The patient who died from this disease had been admitted in (he previous year, when he was immediately transferred to St. Bartholomew's Hospital for streptomycin treatment. This treatment was unsuccessful, and he was readmitted to the Isolation Hospital in the terminal stage of the disease. Erysipelas. The diagnosis was confirmed in 12 of theJ4 cases admitted; the remaining 2 cases being re-diagnosed as dermatitis and sunburn respectively. This compares with 7 cases in the previous rear. Conjunctivitis was present in 2 cases and 1 patient suffered a relapse. Otherwise recoveries were uneventful. Chicken Pox. The diagnosis of chicken-pox was confirmed in 10 of (lie 13 admissions shown in the main table. One case admitted as scarlet fever was re-diagnosed as chicken-pox, while chicken-pox was present as a second infection in 11 .scarlet fever and 1 measles patients. There were no complications. Three cases admitted as chicken-pox were diagnosed respectively as impetigo, papular urticaria and otitis media wiili a septic rash. Ophthalmia Neonatorum. The diagnosis was confirmed in all (i cases as compared with only one case treated in the previous year. All made complete recoveries. Paratyphoid. Of the two cases admitted one was re-diagnosed as suffering from sinusitis. The other case was confirmed as paratyphoid B. The disease ran a typical typhoid course. Dysentery. The two cases admitted as dysentery were re-diagnosed as gastro-enteritis and ulcerative colitis respectively, while two other patients admitted as suffering from gastro-enteritis were found to have Sonne dysentery. 29 60 Rubella. The diagnosis of rubella was confirmed in two of the three cases shown in the main table and in two other cases admitted as scarlet fever. The case shown as admitted for observation was diagnosed as dermatitis herpetiformis, while in the case of the child admitted with convulsions (he cause of the convulsions remained uncertain. DETAILS OF CASES ADMITTED. The main tables give a sumarv of all cases treated in the Isolation Hospital during 1948. Of the total, 723 admissions were from the Borough of Croydon and 54 from the following local authority areas:—Penge 30 cases; Wandsworth 6 cases; Carshalton 6 cases; Coulsdon and Purley 4 cases; Sutton and Cheam 2 cases; one case each from Camberwell, Lewisham, Southwark, Harrow and Banstead. The distribution by diseases of cases admitted from outside boroughs was as follows:— . Scarlet Fever 22 Whooping Poliomyelitis 3 Puerperal Gastro-Enteritis 8 Cough 4 Erysipelas 2 Infection 1 Measles 5 Mumps 4 Cerebrospinal Non-Patient Diphtheria 3 Fever 1 Baby 1 Fatal Cases. The main statistical tables show all cases, including fatalities, under the disease for which they were admitted. The following is a corrected list of the causes of death:— No. of Deaths Diseases. No. of in the previous Deaths year. Diphtheria 0 1 Laryngeal Stridor 0 I Gastro-enteritis 5 9 Whooping Cough 4 6 Scarlet Fever 1 0 Measles 1 0 Poliomyelitis 1 5 Tuberculous Meningitis 1 0 Broncho-pneumonia 1 0 Atheromatous Valvular Disease of the Heart 1 0 Pulmonary Embolism due to Puerperal Fermoral Thrombosis 1 0 No deaths occurred in the group of cases admitted from outside the Croydon Borough. 30 61 BACTERIOLOGICAL EXAMINATIONS. 1 am indebted to the Pathologist, Dr. A. I. Ross, for the figures given in the appended tables, which, following the transfer to the Hospital Board, are for the period to 4th July. At the Laboratory, Croydon General Hospital. For private practitioners Mayday Hos. For Borough Hospital For Chest Clinic For School Medical Other Instns. ofCorporation Other Institutions Total Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Swabs for Diphtheria 4 428 ... ... ... ... ... ... 1 265 ... 37 ... 64 5 794 Virulence tests for Diphtheria ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 ... Sputum for Tub. Bac A. 45 217 ... ... ... ... 525 1066 ... ... 2 M.R.L 11 11 142 583 1436 Pus for Tub. Bac ... 1 ... 1 ... 5 ... ... ... 1 1 41 ... ... 1 49 Pus for Gonococci ... 4 ... 1 ... ... ... ... ... 1 ... 8 ... 2 ... 16 Pus for other organisms ... 5 ... 1 ... 5 ... ... ... 3 ... 46 ... 2 ... 62 Blood for Typhoid Groups ... 2 ... ... ... ... ... ... ... ... ... 6 ... 3 ... 11 aBlood for Wassermann 2 5 6 90 ... 3 ... ... ... ... 5 1546 ... 3 13 1657 Material for Spirochaetes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Faeces for Typhoid Group, etc. ... 11 ... ... ... ... ... ... ... ... ... 32 ... ... ... 43 Hair for Ringworm ... ... ... ... ... ... ... ... 2 7 ... 1 ... ... 2 8 Examination of Urine 1 ... 1 ... ... 36 ... 38 Examination of Pleural Fluid ... ... ... ... ... ... ... ... Examination of C.S. Fluid ... 16 2 ... ... ... ... 18 Other Examinations 166 215 12 ... 96 1843 24 2356 a The increase in the Nos. ot W.K. and other examinations for Other Institutions of the Corporation, is due to ail Ante Natal cases having W.R.'s, Kahn's, etc. These figures only represent work 1st January-4th July, 1948. 31 62 Examinations for Special Clinic. Pos. Neg. Pus for Gonococci (Smears) 47 G76 ,, ,, (Cultures) 4 458 Blood for Wassermann 116 567 Kahn 145 478 G.C.F.T 44 306 Material for Spirochaetes 9 9 Cerebro-spinal Fluids 58 Other Examinations 301 Examinations Done Under the National Health Insurance Act. Nature of Examination. Pus for Gonococci 5 (all neg.) Pus for other organisms 13 Pus for Tub. Bac. 12 (all neg.) Blood for Wassermann 10 (1 pos.) Complete Blood Counts 17 Urine for Chemical Exam. 10 Urine for Microscopical Exam. 10 Urine for Tub. Bac. 10 1'rine for Cultural Exam. 10 Other Examinations 17 Bacteriological Examination of Milk. Number of Samples submitted for Counts 191 Number under 10,000 per cc 65 Number over 10,000 but under 50,000 per cc 78 Over 50,000 but under 100,000 per cc 21 Over 100,000 but under 500,000 per cc 24 Over 500,000 but under 1,000,000 per cc 1 Over 1,000,000 per cc 2 Tubercle Bacilli— Number of samples of milk submitted 191 Number found positive bv inoculation test 0 The number of milk examinations decreased by 198 Number of samples still under investigation for T.B. 0 These figures only represent work 1st January-4th July, 1948. 191 milk samples were submitted to the Methylene Blue Test, which 26 failed to satisfy. 64 milk samples were also submitted lo the Bacillus Coli Test and 45 were satisfactory. 32 63 Milk Samples. 146 samples were submitted to the Phosphatase Test, of which 1 failed to satisfy. IMMUNISATION AGAINST DIPHTHERIA. A total of 3,799 new cases came from the following sources:— School Children 334 Children under 5 3,465 Of these, 95 received one injection, but failed to return for completion of the course. Routine Posterior Schick Testing was discontinued in November, the efficiency of the antigens in use being so well established. During the preceding part of the year 2,699 children had been tested. Reinforcing injections are now being recommended, just before the child starts school, and again at 10 years of age, i.e., at about 5-yearly intervals. The number of such injections given during the year was 1,667. The ensuing comparative tables give some further details:— Year New Cases Completed Treatment One injection only Re-inforcing Injections 1936 1661 1264 — - 1937 1286 1222 — — 1938 1541 1152 — — 1939 1020 1201 — — 1940 428 419 — — 1941 6639 5833 — — 1942 6133 5511 — — 1943 5200 4854 — — 1944 2482 1851 — — 1945 3174 2707 — — 1946 3935 3934 386 32 1947 3638 3516 266 641 1948 3799 3704 95 1667 33 64 Origin and Source of New Cases attending. Year. School M.C.W. Total Per cent. 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 1948 334 8.8 3465 91.2 IMMUNISATION AGAINST WHOOPING COUGH. A total of 1,190 children were immunised against whooping cough, comprising 1,149 under school age and 41 school children. VACCINATION AGAINST SMALL-POX. From the 5th July a total of 988 persons were vaccinated against Small-pox. Under 1 year of age 1-4 5—15 15 or over Total Successful Vaccinations 759 38 16 24 837 „ Re-vaccinations — — 11 102 113 Insusceptible to Vaccination 29 1 — 8 38 988 Home Visits by Health Visitors. A total of 995 visits was made in respect of immunisation and vaccination. 34 65 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.Os. Untraced Removals. ( In Default. Over age when | Registered. South Sub-District 952 157 3 115 9 4 26 6 632 — West Sub-District 1117 205 4 191 29 4 2 16 666 — North Sub-District 527 146 9 82 9 2 2 3 274 — 2596 508 16 388 47 10 30 25 1572 — During the period from 1st January, 1948, to 5th July, 1948, 1,509 Forms Q were sent to parents. Form Q is the Form drawing attention to the requirements of the Vaccination Acts. 15G cases were transferred to this Borough from other districts. 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 1st October, 1947, to bth July, 1948:— Name of Public Assistance Institution or Vaccination District. Numbers of successful Primary Vaccinations of persons. No. of successful re- vaccinations, 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 276 17 293 28 No. 2 Area 260 23 283 21 No. 3 Area 95 4 99 2 No. 4 Area 164 10 174 4 No. 5 Area 503 13 516 22 Addington Area 131 7 138 5 1429 74 1503 82 35 66 VENEREAL DISEASES. Sew Cases seen at Croydon and London Hospitals under the General Scheme. 1939. 1940. 1941. 1942. 1943. 1944. 1945. 1946. 1947. 1948. Syphilis 62 55 41 49 73 86 112 97 115 88 Gonorrhoea 147 116 128 147 183 208 232 330 198 85 Non-vqnereal 395 314 329 333 586 566 771 822 1438 1131 604 485 498 529 842 860 1115 1249 1751 1304 Croydon Cases attending London Hospitals, year 1948. 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 — — 4 25 — St. Thomas's 1 2 26 318 — Guy's — 3 8 137 - King's College 3 3 16 255 — Royal Free — — 2 12 — S. Lond. Hosp. for Women — — 9 102 - Whitechapel Clinic, L.C.C. — — 1 2 — Westminster — — 3 17 — Mothers — — — — — Seamens — — — — — Total 4 8 69 868 — 36 67 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, 1948. 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 70 85 - - 22 31 4 31 96 147 243 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 6 2 - - 2 2 - - 8 4 12 3. Number of cases dealt with for the first time during the year under report (exclusive of cases under Item 4) suffering from:- Syphillis, primary 10 5 - — — - - - 10 5 15 „ secondary 11 14 - - - - - - 11 14 25 „ latent in 1st year of infection 6 10 - - - - - - 6 10 16 „ all later stages 10 9 - - - - - - 10 9 19 „ congenital 4 5 - - - - - - 4 5 9 Soft Chancre — — - — — — — — — — - Gonorrhoea, 1st year of infection — — — — 52 16 - — 52 16 68 „ later - — — — 5 4 - - 5 4 9 Non-venereal conditions - - - - - - 397 667 397 667 1064 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 5 6 - - 2 - 11 9 18 15 33 Totals of Items 1, 2, 3 and 4 122 136 - - 83 53 412 707 617 896 1513 5. Number of cases discharged after completion of treatment and final tests of cure or after diagnosis as non-venereal 43 19 - - 75 48 398 604 516 671 1187 6.a Number of cases which ceased to attend before completion of treatment and were, on first attendance, suffering from:— Syphilis, primary - - - - - - - - - - „ secondary - - - - - - - - - - - „ latent in 1st year of infection - - - - - - - - - - - „ all later stages - - - - - - - - - - - „ congenital - - - - - - - - - - - Soft Chancre - - - - - - - - - - - Gonorrhoea, 1st year of infection - - - - - - - - - - - „ later - - - - - - - - - - - 6b Number of cases under treatment or tion which died. 1 - - - — - - - 1 - 1 7. Number of cases which ceased to attend after completion of treatment but before final tests of cure 1 - - - 4 - - - 5 - 5 8. Number of cases tranferred to other Centres or to institutions, or to care of private prac- itioners 10 3 - - 2 - 3 1 15 4 19 9. Number of cases remaining under treatment or observation on 31st December 67 114 - — 2 5 11 102 80 221 301 Totals of Items 5, 6, 7, 8 and 9 (These totals should agree with those of Items 1, 2,3 and 4) 122 136 — — 83 53 412 707 617 896 1513 37 68  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 3956 5479 - — 1099 920 2175 2699 7230 9098 (b) for intermediate treatment, e.g., irrigation, dressing 559 1068 - - - 29 179 823 738 1920 Total Attendances 4515 6547 - — 1099 949 2354 3522 7968 11018 11. In-patients:— (a) Total number of persons admitted for treatment during the year 69 32 - - - - - - 69 32 (b) Aggregate number of "in-patient days" of treatment given 69 32 - - - - - - 69 32 12. Number of cases treated with penicillin 52 67 — — 60 21 — — 112 8 Under 1 year 1 and under 5 years 5 and under 15 years 15 years and over Totals M. F. M. F. M . F. M. F M. F. 13. Number of cases of congenital syphilis in Item 3 above classified according to age periods — — - — 1 3 3 2 4 5 1 Microscopical Cultural for G'n'rh. Serum Cerebrospinal fluid Others for diagnosis Venereal Diseases for Syphilis for G'n'rh. for Syphilis for G'n'rh. 14. Pathological Work:— (a) Number of specimens examined at, and by the Medical Officer of, the Treatment Centre - - - KAHN 1402 WR GCFT - - (b) Number of specimens from patients attending at the Tre atment Centre sent for examination to an approved laboratory 20 1546 1094 1402 745 101 — STATEMENT SHOWING THE SERVICES RENDERED AT THE TREATMENT CENTRE DURING THE YEAR, CLASSIFIED ACCORDING TO THE AREAS IN WHICH THE PATIENTS RESIDED. Name of County or County Borough (or Country in the case of persons residing elsewhere than in England and Wales) to be inserted in these headings. Croydon Surrey Kent London Total A. Number of cases from each area included under the following headings in Item3:— Syphilis 47 25 8 4 84 Soft Chancre — — — — — Gonorrhoea 45 22 7 3 77 Non-venereal and undiagnosed conditions 808 170 53 33 1064 Total 900 217 68 40 1225 B. Total number of attendances of all patients residing in each area 12715 3929 1789 553 18986 38 69 CANCER. Deaths from Cancer numbered 510 as compared with 492 in 1947; 451 in 1940; 470 in 1945; 420 in 1944; 45G in 1943; 405 in ]942; 377 in 1941; 443 in 1940; 414 in 1939; and 380 in 1938. Death-rate per 1,000, of the population for the previous 11 years are as follows:— 1938—1.56 (380) 1942—2.07 (405) 1946—1.93 (451) 1939—1.78 (414) 1943—2.28 (456) 1947—2.03 (492) 1940—2.22 (443) 1944—2.21 (420) 1948—2.06 (510) 1941—2.04 (377) 1945—2.34 (470) Deaths from Cancer occurred at the following Ages:— Age period. Male. Female. Total. Under 25 years 5 2 7 25 and under 35 years 2 1 3 35 and under 45 years 12 15 27 45 and under 65 years 87 83 170 65 years and over 142 161 303 248 262 510 Sites of Fatal Cancer. Site. Male. Female. Total. Percentage of Total. Naso-pharynx 3 1 4 0.784 Skin 4 1 5 0.980 Tongue and Mouth 8 3 11 2.157 Oesophagus 8 7 15 2.941 Stomach 36 42 78 15.294 Liver 3 8 11 2.157 Bowel 23 38 66 12.941 Rectum 26 12 33 7.451 Bladder 11 10 21 4.118 Prostate 22 — 22 4.314 Larynx and Pharynx 3 1 4 0.784 Uterus — 31 31 6.078 Breast — 49 49 9.608 Ovary — 17 17 3.333 Pancreas 11 7 18 3.529 Gall Bladder and Duct 1 2 3 0.588 Mediastinum 1 — 1 0.196 Bones 4 8 12 2.353 Lungs 55 13 68 13.333 Kidney 4 3 7 1.372 Brain 5 4 9 1.765 Retroperitoneal ,3 — 3 0.588 Thyroid Gland 1 1 2 0.392 Lymphatic Glands 1 1 2 0.392 Suprarenal Glands 1 — 1 0.196 Mesenteric Glands 1 — 1 0.196 Parotid Gland 1 — ] 0.196 Genital Organs 1 1 2 0.392 Eye 2 — 2 0.392 Tonsil 1 — 1 0.196 Undefined 3 2 5 0.980 248 262 510 39 70 Comments on Foregoing Table. The organs most often attacked in descending order of incidence are : In the males—the Lungs (22.2 per cent.), the Bowels and Rectum (21.8 per cent.), and the Stomach (14.5 per cent.); in females—the Bowels and Rectum (19.1 per cent.), the Breast (18.7 per cent.), the Stomach (16.0 per cent.), and the Uterus (11.8 per cent.) THE PREVENTION AND CONTROL OF TUBERCULOSIS. 1 am indebted to Dr. J. C. McMillan for the following 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 in 1948, a comparison with 1921 shows that in 1921, 96 per 100,001) of the population in Croydon died from all forms of tuberculosis; in 1948 the corresponding figure was 45. The total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year 1948 by notification or otherwise was 350, as compared with 354 in 1947, 348 in 1946, 374-in 1945, and 315 in 1944. 312 of these were cases of Pulmonary Tuberculosis, 181 in males and 131 in females. There were 8 fewer cases of Pulmonary Tuberculosis in males and 19 more in females than in 1947. There were 18 cases of Non-pulmonary Tuberculosis among children under 15 years as compared with 20 in 1947. The number.of cases in adults was 20, compared with 33 in 1947. Of the cases notified in 1948, 18 males and 6 females died from the Pulmonary form of the disease during the year, equal to 9.4 per cent, of those notified. The incidence rale of Tuberculosis of all forms was 1.42 per 1,000 of the population; for Pulmonary Tuberculosis 1.26, and for Non-Pulmonary 0.16 per 1,000 population. The notification rate was 1.15 per 1,000. In 1947 the corresponding figures were 1.46, 1.24, 0.32 and 1.14 pr 1,000. 40 71 Public Health (Tuberculosis) Regulations, 1930. Summary of notifications during the period from 1st January, 1948, to 31st December, 1948:— FORMAL NOTIFICATIONS. Age Periods Number of Primary Notifications of new cases of tuberculosis 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total (all ages) Respiratory, Males - 1 2 1 3 17 26 28 18 20 17 8 3 144 Respiratory, Females — — 1 3 3 18 25 27 17 9 3 3 1 110 Non-Respiratory, Males — 1 1 3 1 2 1 — 1 — — — — 10 Non-Respiratory, Females — — 1 6 1 2 2 2 4 1 — 1 — 20 Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1948, to 31st December, 1948, otherwise than by formal notification:— 72 Supplemental Return. Source of Information Number of cases in age Groups 0— 1— 2— 5— 10— 15- 20— 25— 35— 45— 55— 65— 75— Total Death Returns from Local Registrars Respiratory M — - - - - - - - - 1 2 — 1 4 (A) F — — — 1 — 1 — — — — — 1 — 3 (B) Non-Respiratory M - - - - - - - - - - - - - — (C) F - - - - - - - - - - - - - — (D) Death Returns from Registrar-General (Transferable deaths) Respiratory M — — — — — — — 1 — 1 — 1 3 (A) F - - - - - - - - 1 - - - - 1 (B) Non-Respiratory M — 1 - - - - - - - - - - - 1 (C) F - - - - - - - - - - - 1 - 1 (D) Posthumous Notifications Respiratory M - - - - - - - - - - - - - — (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - — (C) F - - - - - - - - - - - - - — (D) 'Transfers" from Other Areas (excluding transferable deaths) Respiratory M — — 1 1 — 1 5 12 4 2 1 — 1 28 (A) F - - - - - - 5 10 1 1 — - — 17 (B) Non-Respiratory M — — 1 1 — — 1 1 — — — - — 4 (C) F - - 1 - — - - 1 - - - - - 2 (D) Other Sources Respiratory M - - - - - - - - - 1 1 - — 2 (A) F - - - - — - - - - - - - - — (B) Non-Respiratory M - - - - - - - - - - - - - — (C) F - - - - — - - - - - - - - — (D) Totals (A)37 (B)21 (C)5 (D)3 42 78 Notification Register. Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1948:— PULMONARY. NON-PULMONARY. Total Cases. Males. Females. Total. Males. Females. Total. 847 653 1500 117 102 219 1719 CLASSIFICATION OF NEW PATIENTS. Pulmonary Tuberculosis. During 1948, 1228 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) 101 or 44.3% T.B. plus 1 (early cases, sputum positive) 22 or 9.0 T.B. Plus 2 (intermediate cases, sputum positive) 92 or 40.4% T.B. Plus 3 (advanced cases, sputum positive) 13 or 5.7% 228 100.0% Non-Pulmonary Tuberculosis. There were 25 crises examined at the Clinic and found to have \Ton-pulmonary Tuberculosis in the following forms:— Bones and Joints 8 Abdominal 5 Other Organs 7 Peripheral Glands 5 25 43 74 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 1948 — — 12 43 39 10 104 In 1948 the death-rate from all forms of Tuberculosis was 0.45 per 1,000 population. The rate for Pulmonary Tuberculosis was 0.42 and the rate for Non-Pulmonary Tuberculosis 0.03. Similar figures for 1947 were 0.38 and 0.06. Pulmonary Tuberculosis. In 1948 the total numbers of deaths increased by 13 per cent, compared with 1947, there being an increase in both sexes. There were no deaths in children up to school leaving age (15 years). There were 5 more deaths in males than in 1947, with more than 70% more deaths in males than in females. In men the deaths are mostly in the age groups 35-05 years, showing a steady increase with age up to age 65, whereas in women they are mostly at an earlier age. New cases show a slight decrease in males and an increase of 11.6 per cent, in females, compared with 1947, that is a total slight increase compared with 1947, but an increase of 15.5 per cent, over 1938. In contrast the total deaths in 1948 were 14.4 per cent, less than in 1938. 44 75 The total number of new cases in 1948 was males 18.1, females 1-31, thai 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 1948 were as follows:— Male. Female. Glands 3 5 Rib — 1 Spine 4 2 Hip 1 — Knee 1 — L. Tibia 1 — Abdomen 3 5 Genito-urinary tract 1 2 Lupus — 4 Miliary — 1 Meninges 1 3 Totals 15 23 Deaths from Non-Pulmonary Tuberculosis. During 1948, '8 -deaths were certified to be due to NonPulmonary Tuberculosis, compared with 14 in 1947, 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 1 . 2 3 Tuberculous Peritonitis — 1 1 Miliary Tuberculosis 1 — 1 ,, „ and Tb. Meningitis 1 1 2 Spinal Tuberculosis 1 - 1 Totals 4 4 8 45 76 Co-ordination with Medical Practitioners, and Other Branches of the Health Department. During the year 845 cases of suspected Tuberculosis were referred by private medical practitioners; 103 were diagnosed as suffering from Tuberculosis and were subsequently notified. In addition, 104 children were referred by (lie School Medical Service, and 78 cases from the Maternity and Child Welfare section of the Public Health Department. 88 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 83.4 per cent, in 1947. Examination of Sputum. The results of examinations made in 1948 are as follows:— For Clinic. For General Practitioners. Totals. Positive (i.e., tubercle bacilli present) 940 38 978 Negative (i.e., tubercle bacilli absent) 1777 434 2211 Totals 2717 472 3189 For each 100 new cases and contacts examined at the Clinic, 160 specimens of sputum were examined. X-Ray Work. 4,265 X-Ray examinations were made during the year. This is equivalent to 261 for every 100 new cases and-contacts seen, and compares with a rate of 212 in 1947. 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 until the end of April. On the 1st May an X-Ray plant installed at the Chest Clinic was brought into use. Blood Examinations. Blood sedimentation rate was ascertained in 474 cases at Mayday Hospital for the Chest Clinic during the year. 46 77 Residential Treatment for Pulmonary Tuberculosis. Summary of Patients who received Institutional Treatment during 1948. Institution. In Institutions at beginning of Year ADMISSIONS DISCHARGES DEATHS During the Year Remaining in at end of the Year Up to 4th July During Whole Year Up to 4th July During Whole Year Adults. Ch. Adults. Ch. Adults. Ch. Adults. Ch. Adults. Ch. Adults. Ch. Adults. Ch. M F M F M F M F M F M F M F Cheam Sanatorium 48 29 - 35 37 - 74 69 - 46 34 - 76 68 - 6 4 - 40 26 - Mayday Hospital 26 25 2 62 51 5 125 98 10 46 36 2 97 80 6 21 14 — 33 29 6 Brompton Hospital and Sanatorium 1 4 — 5 4 — 8 9 — 4 2 — 8 9 — — — — 1 4 — British Legion Sanatorium 1 1 - - - - - - - - 1 - - 1 - - - - 1 - - Children's Sanatorium, Holt - - 1 - - - - - - - - - - - - - - - - - 1 Coombe Clitf — — — — — — — — 2 — — — — — — — — — — — 2 Croydon General Hospital — — — — 5 — 2 5 — — 4 - 2 4 — — — — - 1 — Eversfield Chest Hospital - - - 1 - - 1 - - - - - - - - - - - 1 - - Orosvenor Sanatorium 13 3 — 15 5 — 17 10 — 11 1 — 24 9 - 1 — — 5 4 — Guy's Hospital — - — — — 1 — — 1 — — — — — 1 — — — — — — Higwood Hospital - - - - - - - - 1 - - - - - 1 - - - - - - Horton Chest Unit — - - 1 — — 1 — - 1 — - 1 - - - - - - - - King George's Sanatorium 2 - - - - - - - - 1 - - 2 - - - - - - - - King's College Hospital - - - - 1 - - 2 - - - - - 1 - - - - - 1 - London Chest Hospital 3 2 - 5 8 - 7 11 — 7 8 - 9 10 - — — - 1 3 — Milford Sanatorium — — - 1 — - 2 - - - - - 1 - - - - - 1 - - National Children's Sanatorium - — 1 - - 1 - — 2 - - 1 - - 1 - - - - - 2 National Sanatorium, Benenden 1 - - - - - - 1 - 1 - - 1 - - - - - - 1 — Papworth Village Settlement — 1 - - - - - - - - 1 - - 1 - - - - - - - Pinewood Sanatorium — 1 - — — — — — — — — — — 1 - — — — — — — Quantock Sanatorium - - - 1 - - 1 - - - - - 1 - - - - - - - - Royal National San., Bournemouth - - - 1 1 - 1 1 - 1 - - 1 1 - - - - - - - St. Helier Hospital — - - - — — 1 4 — - — - 1 4 - — — — — — — St. Mary's Hospital (London) - - - - - - - 1 - - - - - 1 - - - - - - - West Ham Sanatorium — 1 — — — - — — — — — — — 1 — — — — — — Totals 95 66 5 127 112 7 240 211 16 118 87 3 224 190 10 28 18 — 83 69 11 47 78 Immediate Results of Treatment of Patients Discharged from Cheam Sanatorium in 1948. Classification on Admission. Quiescent. Improved. No material Improvement. Died in the Sanatorium. Transferred to other Institutions. Totals. M. F. M. F. M. F. M. F. M. F. M. F. T.B. Minus 13 9 3 8 2 - 1 - - 2 19 19 T.B. Plus: Group 1 5 6 3 2 1 — — - — — 9 8 Group 2 5 3 23 26 9 7 3 3 4 2 44 41 Group 3 - - 5 1 3 — 2 1 — 1 10 3 23 18 34 37 15 7 6 4 4 5 82 71 Sputum Conversion. Of 99 patients who were discharged to their homes during 1948 and who entered the Sanatorium with a positive sputum, 67.7% were discharged with a negative sputum and 32,3% were di scharged with a positive sputum. 48 79 Extra Nourishment. Provision of special nourishment in the form of milk was granted to 32 selected cases for varying periods duing the year, and 12 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 unforutnate 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, at London Chest Hospital and St. Helier Hospital. Residential Treatment. 356 males, 301 females and 42 children were treated in Residential Institutions in connection with the Croydon Tuberculosis Scheme during 1948. At the end of the year there were 6(3 beds occupied in the Croydon Borough Sanatorium, North Cheam, compared with 77 at the end of 1947 and the normal 94 beds pre-war. 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 following table gives a summary of the work done in connection with the Clinic. 49 80 SUMMARY OF CLINIC STATISTICS FOR 1948. Number of persons on Clinic Register, January 1st, 1948 1,546 ,, notified cases examined for the first time 57 ,, cases sent for an opinion 1,116 ,, first attendances, including 62 inward transfers 1,760 ,, consultations of T.O. with medical practitioners— (a) Personal 12 (b) Other 1,276 ,, visits paid by T.O. to homes of patients 189 ,, visits paid by T.O. to Mayday Hospital 159 ,, patients examined by T.O. at Mayday Hospital 1,102 ,, visits paid to homes of patients by Health Visitors 2,4413 „ visits paid to homes of patients by District Nurses for nursing attention 520 Attendances of patients at the Clinic- Men 4,127 Women 4,050 Children 2,224 Total 10,401 Number of X-Rays taken 4,265 ,, reports made to Ministry of Pensions by T.O. on general progress of Tuberculous ex-Service men 69 „ special reports made to the Ministry of Pensions by T.O. re Tuberculous ex-Service men (Form M.P.M.S.D. 122) 66 ,, cases referred for Light Treatment 1 „ cases referred to Orthopaedic Clinic 11 „ cases receiving extra nourishment at the end of year 12 ,, cases referred by the Ministr) of Labour and National Service Medical Board for examination and report 32 cases on the Clinic Register (including those under observation) on the 31st December, 1948 1,938 ,, families rehoused because of recommendations made by Chest Physical! on the grounds of risk of infection to others through a tuberculous patient being in the home 11 MASS RADIOGRAPHY WORK. Number of persons X-rayed by Miniature Mass Radiography unit of the Surrey County Council during visits to factories in Croydon 10,392 Fn addition there were about 200 persons who were Xrayed by the unit at the Chest Clinic during the last four weeks of the year. 50 81 1,247 new cases were examined during the year. This is equal to 1,113 for each 100 deaths from the disease. 238 or 212 for each 100 deaths were found to, be definitely tuberculous. The total number of attendances at the Clinic was 10,401. The Tuberculosis Officer paid 189 home visits and the District I lealth Visitors 1,906 visits for Clinic purposes. In addition, the Health Visitors made 537 primary visits for the purpose of ' i he Xotification Register. The Tuberculosis Officers paid 159 visits to Mayday Hospital in a consultative capacity, and there examined 1,102 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 520 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 451 contacts were examined, equal to 403 for each 100 deaths, compared with 330 per 100 deaths in 1947, 294 in 1946, 153 in 1945, 181 in 1944, 267 in 1943, 238 in 1942, 227 in 1941, 27'8 in 1940 , 325 in 1939, and 301 in 1938. Of these, 12 were considered to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 26.6 compared with 1.42 per 1,000 of the general population. 595 appointments for examination were offered to.new contacts during 1948, but only 451 new contacts attended and were examined. The Clinic Register of Cases. The number of cases of Tuberculosis under the supervision of the Clinic at the end of the year was 1,404. This is equivalent to 5.6 persons per 1,000 of the population. During the year 106 Clinic cases died. Of this number 18 or 17 per cent, were seen for the first time in 1948. 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 until July 4th, 1948. After this date financial distress was dealt with under the National Assistance Act. 51 82 Ministry of Health Tuberculosis Maintenance Allowances. (1) No. of patients in receipt of Ministry of 1 Health Allowances as at 31-12-47 59—-33 in Institutions. 36 on Domiciliary treatment. (2) No. of new patients 74 (3) No. of patients no longer in receipt of Allowances 51 (4) No. of patients in receipt of Ministry of Health Allowances as at 4-7-48 79—44 in Institutions. 35 on Domiciliary treatment. Council's Tuberculosis Scheme. (1) No. of patients in receipt of Council Allowances as at 31-12-47 33— 5 in Institutions. 28 on Domiciliary treatment. (2) No. of new patients 10 (3) No. of patients no longer in receipt of Allowances 14 (4) No. of patients in receipt of Council Allowances as at 4-7-48 29— 7 in Institutions. 22 on Domiciliary treatment. 52 83 DENTAL REPORT—CHEAM SANATORIUM. 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 lit received appointments to attend Lodge Road Clinic at a later date for the necessary work to be completed. Since the inauguration of the National Health Service responsibility for this work has passed to Regional Boards and treatment will, therefore, cease in the near future. Review of Work Done. Males. Females. Total. 1948 1947 Number Examined 69 54 123 131 Referred Treatment 50 46 96 91 Treated 45 43 88 85 Attendances 169 127 296 270 Extractions 21 46 67 145 Fillings 22 32 54 67 Dressings 8 9 17 11 Scalings 15 31 46 30 Denture Dressings 51 9 60 50 Dentures Fitted 12 3 15 14 Repairs 3 . — 3 1 Mandibular Injections 5 3 8 23 Number of Treatment Sessions: 33. 53 84 Dental Treatment for Patients Referred from the Chest Clinic to Lodge Road. Patients referred from the Chest Clinic are ireated 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 Cfficer, the remainder being patients discharged from the Borough Sanatorium at Cheam before dental treatment could be completed. Since the inauguration of the National Health Service responsibility for this work has passed to Regional Hoards and treatment will therefore cease in the near future. Summary of Work Done. Males. Females. Total. 1948 1947 Referred from Chest Clinic 9 13 22 23 Treatment cases continued from Cheam. 7 5 12 14 Attendances 43 67 110 135 Extractions 12 16 28 77 Fillings 9 16 25 23 Other Operations 10 8 18 3 Scalings 1 6 7 7 Denture Dressings 17 30 47 77 Dentures fitted 9 10 19 33 Repairs — 1 1 — Number of Treatment Sessions: 19. 54 85 MASS RADIOGRAPHY. I am indebted to Dr. F. J. H. Walters, the Medical Director of the South-West Metropolitan Regional Mass Radiography Unit, for the following information:— TOTAL NUMBER X-RAYED IN CROYDON DURING JANUARY—DECEMBER, 1948. Male 0,045 Female 4,347 10,392 ABNORMALITIES. Abnormalities of bony thorax 82 Chronic bronchitis and emphysema 90 Bronchopneumonia 3 Bronchiectasis 12 Pulmonary fibrosis, non-tuberculous 7 Pneumokoniosis, etc. 1 Basal pleural fibrosis, etc. 138 Spontaneous pneumothorax, non-tuberculous I Intrathoracic new growth 2 Congenital heart lesions 0 Acquired heart lesions 43 Miscellaneous 21 Tuberculous inactive primary lesions 248 Tuberculous active post-primary unilateral (with symptoms) 11 (without symptoms) 10 Tuberculous active post-primary bilateral (with symptoms) 1 (without symptoms) 7 Tuberculous—inactive post-primary 129 Abscess of lung 2 MATERNITY AND CHILD WELFARE. Notification of Births. Notifications were received from— Live Births. Still Births. Total. Midwives 3,667 72 3,739 Doctors, Parents and others 1,272 26 1,298 4,939 98 5,037 55 86 Maternal Mortality. There were 2 deaths, compared with 10 in 1947. The maternal mortality rate was 0.44 per 1,000 births, compared with 1.92 in 1947:— The deaths were caused by— (1) Acute bilateral pyelo-nephritis of pregnancy. (2) Pulmonary embolism following Cesarean section operation. P.M. MATERNAL AND INFANT MORTALITY FOR THE YEARS 1931—1948 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 3,301 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 1948 4.597 2 0.44 27 56 87 Puerperal Pyrexia. Thirty-one cases of Puerperal Pyrexia were notified. This is a rate of 6.7 per 1,000 births (live and still births). Accommodation for Confinement. The following table gives information concerning the accommodation utilised for confinements:— Number. Percentage. In Private Houses 1,726 34.27 In Public Institutions 2,219 44.05 In Registered Maternity Homes 1,092 21.68 5,037 Still Births. During 1948, 90 still births were registered in respect of Croydon. Of these 52 were male babies and 38 female; 5 males and 1 female were illegitimate. The proportion of still births to living children was as 1 to 50. The still birth rate was 2.0 per cent, of the total births. The still birth rate, on the same basis as for Infant Mortality, was 19.6 per 1,000 births. An Analysis of Still Births occurring during the Year. Of the 69 still births investigated 38 were males and 31 females. STILT. BIRTHS. 1948. Attended by Midwives alone 40 ,, Doctors alone 17 ,, Midwives and Doctors 11 ,, Relative only 1 Occurred at 9 months 49 ,, 8 months 14 ,, 6-7 months 6 Age of Mother.—Under 20 years, 2; between 20 and 29 years, 35; between 30 and 39 years, 25; between 40 and 49 years, 7. The Health of the Mother during her pregnancy was stated lo be good in 51 cases and indifferent or poor in 9 cases; no particulars were obtained in 9 cases. In 1 case, however, (lie mother had had a fall before the still birth. In 55 instances the mother had attended the Ante-Natal Clinic. Fourteen cases had never attended the Clinic. 57 88 Attendance at Confinement.— Forty-four of the still births investigated occurred in the Mayday Hospital; 8 in St. Mary's Hospital; 3 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; 6 occurred in private nursing homes. Forceps were reported to have been utilised in 10 of the cases. In 49 cases the baby was born at full term; in 14 during the 8th month of gestation; in 6 during the 7th month. The baby was apparentlv a normal child in 58 cases, abnormal in 11. The still birth was the first pregnancv in 33 instances; the 2nd in 16; the 3rd in 8; the 4th in 5; the 5th in 2; the 6th in 3; and the 7th in 2. Previous still birth had occurred in one case. Ophthalmia Neonatorum. Thirteen cases were notified during 1948. The following table gives the notifications in Croydon during the past ten years: — 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 No of Cases 15 14 17 19 10 3 11 6 11 13 Rate per 1,000 Births 4.5 4.7 7.0 5.5 2.7 0.8 3.1 1.2 2.2 2.8 Results of Treatment. Notified. Cases treated. Vision Unimpaired. Vision Impaired Died. Removed Remaining under Treatment At home. In hospital 13 8 5 12 — — 1 — Infant Mortality. The Infantile Mortality rate was 27 per 1,000 live births registered and is the lowest vet recorded. 58 89 For the past 5 years the number of infant deaths has been 1944—156, 1945—145, 194G—151, 1947—194, and 1948—120. Among the 120 deaths, 63 occurred in boy babies and 57 in girls. Of the births, 2,286 were males and 2,221 females. The infantile mortality rate for the two sexes was, therefore, Bovs— 28, Girls—26. 93 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 6 (2) Foetal States— —6 Congenital Heart Malformation 4 Other Congenital Deformities 6 Atelectasis, etc. 9 Hæmorrhagic Disease of Newborn 4 —23 (3) Prematurity 35 —35 (4) Post-Natal Causes 4 —4 68 Percentage Deaths per Deaths per 1,000 Total Infantile Deaths. Births. 1948 1947 1948 1947 Premature Births 28.3 28.4 7.8 10.8 Respiratory Diseases 29.2 20.6 5.8 7.7 *Infectious Diseases (including Tuberculosis) 4.2 2.6 1.1 1.0 Atelectasis, Debility and Marasmus 9.2 5.2 2.4 2.0 †Diseases of Digestion 8.3 17.5 2.2 6.7 Injury at Birth and Congenital 16.7 17.0 4.4 6.5 *These deaths were due to Whooping Cough 5. †These deaths were due to Diarrhoea 7, Intussusception I, Oesophageal fistula 1 and Fibrocystic Disease of Pancreas 1. 59 90 The rate of infant mortality amongst legitimate children was 2G per 1,000 births. The rate in illegitimate children was 33 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 26 8 11 4 1 2 1 9 — 6 68 14 5 6 5 5 1 1 3 4 2 6 120 Chicken Pox - - - - - - - - - - - - - - - - - - - - - - - Measles — — - - - - - - - — — — — — — - - - — — — — — Scarlet Fever - - - - - - - - - - - - - - - - - - - - — —. — Whooping Cough - - - - - - - - - - - 3 1 - 1 - - - - - - - 5 Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - - - - - - - - 1 - - - - 1 Convulsions — — - — - — - — - — — — — — — - - — — — — — — Laryngitis — — - — - — - — - — — — — —- — - - — — — — — Bronchitis — - - — - - — - — —. 2 - - - - - - 1 — 1 — 4 Pneumonia (all forms) - - - - - - - - - 2 3 4 2 2 1 2 1 - 1 3 - 3 22 Diarrhoea and Enteritis - - - - - - - - - - - 2 2 1 2 — — - - - - - 7 Gastritis — — - — - — - — - — — — — — — — - — — - — — Syphilis — —. - — - — - — - — — —. — — —. — - — — — —• .— Rickets - - - — - - - - - - - - - - - - - - - - - - - Congenital Malformations 5 1 1 — - — - 2 - 1 10 — — 2 — 1 - - — 1 — — 14 Premature Birth 15 3 6 2 1 1 — 4 - 3 35 — — — — — — - — — — — 35 Atrophy, Atelectasis, Debility and Marasmus 5 2 1 - - - - 1 - - 9 2 - - - - - - - - - - 11 Injury at Birth 1 2 1 1 - — 1 — - — 6 — — - — — - - — — — — 6 Other Causes - - 2 1 - 1 - 1 - - 5 1 - 1 1 2 - - 1 - 1 3 15 Totals 26 8 11 4 1 2 1 9 — 6 68 14 5 6 5 5 1 1 3 4 2 6 120 09 91 MIDWIFERY SERVICE. Midwives Acts, 1902 to 1936. One hundred and three midwives notified the Local Supervising Authority of their intention to practice within the Borough during 1948. Eleven ceased practising in the borough; so that ninety-two 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 aid: For Complications during Pregnancy Abortion 23 Albuminuria 3 For Complications during Labour. Breech ... ... ... 11 Persist. Occipito Posterior 1 Precipitate Labour 3 Delayed Labour. Uterine Inertia 10 Haemorrhage. Ante-partum 7 Other Causes. Adherent and Retained Placenta 11 For Complications during Puerperium. Pyrexia 25 Pain in Legs 8 For Complications in regard to the Baby Inflammation of Eyes 35 Feebleness 3 Premature Birth 6 Other causes 22 48 Premature Labour 2 Malpresentation 2 Foetal Distress 2 21 Prolonged and obstructed 53 — 63 Post-partum10 17 Torn Perineum 200 Illness of Mother1 212. Pain in Breasts 4 Other causes12 49 Baby. Still Birth 4 Other causes 56 104 514 61 -92 In accordance with Rule 33 of the Central Midwives Board, the following reasons for the discontinuance of breast-feeding were received: — Illness of Mother 22 Defects of lactation 277 Other Causes 39 Total 338 MUNICIPAL MIDWIVES. Ante Natal Clinic Attendances— Jan. 1143 May 933 Sept. 815 Feb. 896 June 1032 Oct. 764 March 1047 July 1009 Nov. 549 April 1048 August . 908 Dec. 734 Total attendances 10378 (1500 women attended). Month Mileage Deliveries Midwifery Maternity Midwives Bookings Ante-Natal Visits paid Post Natal Visits paid Gas and Air Office Bookings Normal Abnormal Normal Abnormal January 2589 129 106 3 17 3 225 389 2743 79 182 February 2937 138 110 9 18 1 165 478 2781 78 150 March 3072 126 109 1 14 2 158 546 2825 81 201 April 3159 136 119 — 12 5 156 376 2784 89 143 May 2996 129 114 2 11 2 164 502 2706 65 184 June 2767 122 103 1 18 — 149 484 2610 87 164 July 2815 139 117 4 17 1 136 369 2898 101 127 August 3026 125 108 1 16 — 137 371 2615 83 170 September 2607 121 100 4 17 — 137 339 2552 84 152 October 2365 114 92 4 16 2 141 385 2229 72 139 November 2500 115 98 — 16 1 133 418 2340 84 188 December 2678 116 92 3 20 1 113 423 2323 90 102 Total 33511 1510 1268 32 192 18 1814 5030 31406 993 1902 62 93 Inspection of Midwives. Dr. Hegarty, the Inspector of Midwives, interviewed two midwives at the Town Hall. Seventy-two visits were paid by her to the homes of midwives. Nursing Homes. Number of Homes. Number of Beds provided for:— Maternity. Others. Total. Humes registered during the year 6 2 47 49 Homes on the Register at the end of the year 33 96 46 563 63 94 DAY NURSERIES. Attendances at Day Nurseries, 1948. 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 21/3/45 Number on books at end of year 90 53 52 60 53 56 53 52 51 Attendances : under 2 4619 4212 4125 4264 3918 3699 1772 3065 3213 over 2 14191 6473 6575 8912 7463 6915 8850 8903 8665 Total 18810 10685 10700 13176 11381 10614 10622 11973 11878 Number of days opened 306 305 306 307 305 303 306 306 305 Average daily attendance (excluding Saturdays) 71 40 39 51 43 41 41 45 46 64 95 MATERNITY AND INFANT WELFARE CONSULTATIONS. There are 20 Maternity and Infant Welfare Centres. A total of 28 sessions per week are held and at these a doctor and one, or, if necessary, two health visitors, attend. During 1948, 3,831 new cases under 1 year of age and 987 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 87,653 in 1947 to 94,312 in 1948. Consultations with doctors increased from 27,115 to 28,810. 56 expectant mothers were seen, an increase of 29 on 1947, and a total of 216 visits to the Centres was paid by them. The total of all visits to the.Centres was 94,528, an increase of 6,722 compared with 1947. The table on page 69 gives detailed figures for the separate Centres. The highest average attendance of mothers and babies at each session was recorded at South Croydon (93.2), Boston Road (81.6), Norbury (79.8),. St. |ude's Hall (79.1), and St. Andrew's • 79.0. Dental Treatment. Maternity and Child Welfare Patients. Expectant and nursing mothers and children below school age requiring dental attention are referred by Medical Officers attending Ante- and Post-Natal Clinics, and from Infant Welfare Centres. A substantial number of applications for treatment of "toddlers" are also received from those in charge of Day Nurseries and similar institutions. In the case of confinement taking placee at home reference is made through the Municipal Midwives Service or by the practitioner in charge of the patient. During recent years this side of the dental service has been considerably expanded and now one dental officer's time is wholly devoted to Maternity and Child Welfare work. The above arrangement has done much to reduce the waiting period before treatment can be commenced. Since the inauguration of the National Health Service all those attending ante-natal clinics are automatically referred for a routine dental examination, unless they are in the habit of visiting an outside practitioner. Though as yet not all those referred avail themselves of this opportunity it is felt that this practice is a good one, and that results should improve as time proceeds. 65 96 During 1948 an appreciable number of prospective mothers received their inspection during the “fourth” month of pregnancy, and approximately 82 per cent. commenced treatment 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. Expectant Mothers. Expectant mothers examined during the year numbered 87-3 compared with 658 last year, and represented 92.6 per cent. of the total number of new cases examined. Of the above, 82 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 Ante-Natal Clinic. Nursing Mothers. New cases referred were 69 compared with 107 last year. Those seen during the first six months after their confinement constituted 72 per cent. of the total number referred, compared with 8] per cent. last year. Mothers with infants between seven and twelve months were referred from Post-Natal Clinics and Welfare Centres for emergency treatment. Treatment. Including those continuing treatment from the previous year, the total of mothers treated was 1,063, compared with 908 in 1947. With minor exceptions, once treatment had been begun clinics were well attended, and most patients appeared 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 was, unfortunately, the only remedy. Dentures inserted numbered 228 against 264 last year. One disappointing feature of the present scheme is that during the current year approximately 36 per cent. of those referred failed to keep their appointments for the initial dental inspection to be carried out. Though "follow-up" enquiries have established that treatment has in a great many cases been received privately, the time lost by such "lapses" is considerable, and it would be helpful if some indication as to their desire to attend the dental clinic could be elicited when such patients are referred from the various medical departments. 66 97 The Pre-School Child. The total number of children referred from Welfare Centres, Hay Nurseries and other sources was 558 against 529 last year. In spite of this increase dental supervision of those between three and five 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. Increased contact between dental officers and parents would undoubtedly be helpful, but at present there is little available time for personal visits to such Centres. The importance of inspection and care for these children cannot be overstressed, as it is only when repairs are carried out during the very early stages of the disease that undue loss of deciduous teeth can be avoided. The introduction of nursery classes at certain Primary Schools should materially assist in reducing present deficiencies until more Nursery Schools can be established. Routine ante-natal care and increased attention to the diet and nutrition of infants is undoubtedly producing 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 1948 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 percent. 1943 22.4 „ 1945 26.5 „ Such statistics indicate a rise of 17.7 per cent. in those showing "little decay" during the initial 14-year period, plus an additional improvement of 4.1 per cent. in the subsequent 18 months. 67 98 Treatment. The following summary shows particulars of the work accomplished: — Expectant Mothers. Nursing Mothers. Total. Young Children. New Cases Examined 873 69 942 440 Re-treated 103 18 121 118 Total 976 87 1063 558 Attendances 2412 270 2682 1010 Fillings 589 37 626 499 Extractions 1425 63 1488 489 "Gas" Cases 222 12 234 157 Local Anaesthesia 375 24 399 99 Scaling and Gum Treatment 328 21 349 13 Dressings 604 218 922 568 Denture Dressings 856 79 935 -- Silver Nitrate - — - 236 Treatments Completed 490 42 532 413 Number of Sessions (treatment) 420 Dentures Fitted 228 Dentures repaired 39 The Centres at which patients were examined, or from which they were referred, are given in the following list — Mothers Young Children Mothers Young Children Ante-Natal 981 — Bensham Manor 1 27 Post-Natal 2 — St. Andrew's — 7 Municipal Midwives 450 — Waddon 4 14 Municipal 12 29 Shirley — 17 East Croydon 4 20 Boston Road 6 10 Upper Norwood — 1 Norbury 4 18 West Croydon — 17 Holy Trinity — 2 ' South Norwood 3 2 Addington — 8 South Croydon — 5 Day Nurseries — 65 St. Alban's 1 8 West Wickham — 10 Woodside 2 17 The Retreat 2 - St. Oswald's 2 15 Referred by St. Jude's 1 6 Dental Officers: 202 Monks Hill Estate — 2 Mothers: 1,475. Young Children: 502. Total 1,977. 68 99 • Attendances at Infant Centres—1948. Municipal. Boston Road. St. Andrew's. South Croydon. Shirley. Woodside. East Croydon. South Norwood Upper Norwood. St. Alban's. Benshatn Manor. St. Oswald's. West Croydon. Norbury. Waddon. Selhurst. New Addington. St. Jude's Hall Heathfield. Lecture Hall, West Wickliam Total 1948. Total 1947. New cases under 1 year 386 158 158 228 161 220 362 341 153 229 184 241 102 221 116 109 151 139 100 72 3831 4243 No. of re-attendances 4703 2366 2654 3152 1556 3314 4866 4537 2073 4095 3503 4591 1274 4393 1626 1524 1992 1940 575 730 55464 55060 New cases over 1 year 64 25 19 32 68 84 96 62 55 40 55 21 35 43 22 34 68 22 68 74 987 855 No. of re-attendances 2383 1615 962 1342 1397 2286 2447 2433 1284 2274 2700 3153 1420 3322 943 970 1053 904 451 681 34030 27495 Attendances of children 0-5 7536 4164 3793 4754 3182 5904 7771 7373 3565 6638 6442 8006 2831 7979 2707 2637 3264 3005 1194 1567 94312 87653 Consultations with Doctor 2107 1490 892 1167 775 1986 1871 2430 948 2234 2370 2352 1181 2292 742 1012 1105 780 461 615 28810 27115 No. of Sessions 101 51 48 51 51 102 101 101 48 101 96 102 51 100 50 50 51 38 40 39 1372 1232 Expectant Mothers : No. of new cases — — — — — — — — — 4 8 12 — — 17 — 10 — 5 — 56 27 No. of re-attendances 2 — — — — — 3 — - - 6 6 19 21 — 72 26 4 - 1 - 160 126 Total attendances of Expectant Mothers 2 — — — — — 3 — — 10 14 31 21 - 89 26 14 — 6 — 216 153 Total attendances 7538 4164 3793 4754 3182 5904 7774 7373 3565 6648 6456 8037 2852 7979 2796 2663 3278 3005 1200 1567 94528 87806 Average attendance per Session 1948 74.6 81.6 79.0 93.2 62.4 57.8 76.9 73.0 74.3 65.8 65.9 78.8 55.5 79.8 55.9 53.3 64.3 79.1 30.0 40.2 68.9 - 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 69 100 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 1948 who were born— (i) at home 91 (ii) in hospital 168 (2) The number of those born at home— who were nursed entirely at home 80 who died during the first 24 hours 3 who survived at the end of one month 80 (3) The number of those born in hospital— who died during the first 24 hours 14 who survived at the end of one month 134 Home Helps. During the year 843 expectant mothers applied for Home Helps, and 801 were supplied. The corresponding figures for 1947 were 825 mothers applied, and 771 were supplied. At the end of the year there were the names of 42 full-time and 32 casual Home Helps on the register. 70 101 102 The Work of the Health Visitors.—Maternity and Child Welfare Visits Only. Visits Re Ashe Baker Biggs Bird Blest Devaney Early Left 30//3/48 Edwards Elliott Ernest Hall Comm. 14/1/43 Hayward Hillyard Hinton Left 25/2/48 Hobdey Johns Comm. 16/4/48 Lucey Comm. 18/2/48 Morganthal Munroe Oakley Orridge Partridge Left 31/5/48 Southgate Stack Comm. 5/1/48 Stanton Thomas Tonerie Walker Warman Webb Wybtew TOTAl Infants under 1 year- First Visits 111 164 79 174 171 222 113 61 196 218 202 172 190 168 41 79 82 124 133 46 133 157 3 172 231 215 255 243 103 135 213 4609 Re-visits 229 453 263 579 672 944 681 152 267 339 1027 555 704 1268 233 139 393 502 656 94 673 324 4 748 838 480 519 554 233 626 890 16039 Children 1—2 years— First Visits 3 4 - 1 13 91 2 - 1 2 2 6 4 1 4 2 1 5 16 1 3 29 1 3 9 2 8 19 1 13 42 289 Re-visits 159 237 154 371 502 518 380 136 142 140 764 371 481 492 151 112 305 252 374 57 560 246 9 362 379 166 449 581 143 648 641 10325 Children 2—5 years— First Visits 2 6 - - 10 72 1 - 22 3 3 7 16 — 3 1 2 4 18 4 1 25 - 3 4 2 9 12 4 17 12 263 Re-visits 232 495 149 311 596 593 627 89 199 208 905 451 565 282 243 128 542 441 645 70 668 317 6 293 398 300 679 917 263 813 1004 13429 Expectant Mothers— First Visits 86 94 36 117 112 103 63 16 141 99 156 97 112 84 19 60 23 74 75 26 94 63 - 68 94 109 142 111 85 71 85 2515 Re-visits 9 6 — - 3 — 34 - 1 2 17 10 19 — 6 — 4 - 2 - 10 5 - 2 1 5 2 29 - 2 - 169 Still Births — — — 2 1 — 3 — — — — 1 — — — — — — — 1 - — 1 - 1 3 1 - 1 - 15 Deaths under I year 4 3 1 1 2 - 1 — — 5 2 — 1 - 1 — 2 1 3 — 2 5 — 6 3 — 2 4 3 2 3 57 Miscellaneous Visits 1 55 2 7 13 28 - - 8 56 6 1 13 4 1 11 - 14 11 44 18 13 - 102 46 55 25 61 22 57 27 701 Ineffective Visits 161 349 368 404 437 389 216 138 232 318 584 509 609 217 91 141 282 788 456 112 693 224 13 445 569 374 331 464 412 673 709 11711 Totals : 1948 937 1896 1052 1967 2532 2960 2121 592 1209 1390 3668 2179 2715 2516 793 673 1636 2215 2389 454 2859 1403 33 2305 2572 1709 2427 2999 1239 3058 3626 60122 1947 1150 218 467 2097 2856 2497 1779 3944 2007 1880 3224 - 1378 2813 3856 278 - - 707 205 2525 1328 1568 996 - 2066 2044 3098 1333 3151 1880 58158 *Including Health Visitors who left during 1947 71 72 103 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 1948. FOSTER CHILDREN No.as at Dec. 31st 1947 Notice of Reception of Children during the year Notice of removal to— • Parent Another area with Foster Parent Another Foster Mother Public Institution Children Adopted Died Children reaching age of 9 No. as at Dec. 31st 1948 92 147 58 17 11 14 21 — 3 115 FOSTER MOTHERS. No. as at December 31st 1947 Applications for Authorisation during the year. Removals during the year Authorisation cancelled for other reasons No. as at December 31st 1948 With Child Without child 75 59 5 1 33 95 The Health Visitors paid 970 visits to foster-mothers for the purpose of supervision. THE OBSTETRIC SERVICE. The National Health Service Act, which came into operation on July 5th, divided responsibility for Maternity Services between Regional Hospital Boards, Executive Councils and Local Health Authorities. Undoubtedly, one of the most important features of the Croydon Obstetric Service was its co-ordination under one clinical adviser and consequent continuity of supervision of the mothers throughout their- Ante-Natal, lying-in, and Post-Natal periods. Endeavour has been made to preserve this characteristic and I am pleased to be able to thank Mr. Clift, Senior Obstetric Consultant to Mayday Hospital for the following report, which despite changes in administration is still able to cover the whole of the year now under review: — 73 104 Taking the Registrar-General's figures for maternal mortality (deaths directly due to pregnancy), the rate for England and Wales for 1948 was 1.02 per 1,000 births. In Croydon the rate was 0.44. In "booked" cases treated by the Obstetric Service the rate for 1948 was 1.18 per 1,000 Hospital deliveries. The number of cases delivered of viable babies in Mayday Hospital, with a nominal 68 beds, was 1,269. The number delivered at St. Mary's Maternity Hospital, with 30 beds, was 707. The number of cases delivered by the Domiciliary Branch of the Service (Municipal Midwives) was 1,511. Including 36 cases admitted after delivery, the total number of deliveries dealt with by the Obstetric Service was 3,523. The total number of infants born was 3,551. General Statistics, 1948. No. of live births allocated to the Borough of Croydon 4,507 ,, still ,, ,, ,, 90 No. of maternal deaths 2 No. of cases of notified Puerperal Pyrexia 31 No. of expectant mothers who attended the Borough Ante- Natal Clinics 4,912 No. of cases delivered in Mayday Hospital as Booked cases (exclusive of abortions) 957 No. of cases delivered in Mayday Hospital as Emergency cases (exclusive of abortions) 312 Total cases delivered in Mayday Hospital ——1,209 No. of cases delivered in St. Mary's Maternity Hospital as Booked cases 700 No. of cases delivered in St. Mary's Maternity Hospital as Emergency cases 7 Total cases delivered in St. Mary's Maternity Hospital 707 No. of cases delivered by Municipal midwives 1,511 Total 3,487 No. of cases admitted to the Puerperal Infection Unit, Borough Hospital 24 No. of Maternal deaths in Booked cases from Borough Ante-Natal Clinics 2 No. of Maternal deaths in Emergency cases at Mayday Hospital No. of Maternal deaths in cases admitted as Puerperal Sepsis per se 1 Total Maternal deaths in beds of the Obstetric Service 3 74 105 The total number of patients treated by the Obstetric Service was: — (a) In Mayday Hospita 1,818 (b) In St. Mary's Maternity Hospital 707 (c) In the Borough Hospital Puerperal Infection Unit 24 (d) At the Ante-Natal Clinics and delivered outside the above Hospitals (including Municipal Midwives' cases) 1,511 (e) At the Ante-Natal Clinics and undelivered on December 31st, 1948 1,268 (f) At Gynaecological Clinic— (») New cases referred by Doctors 1,453 (ii) Obstetric Service cases—seen as new cases 6,781 Incidence of Abortion. 1947. 1948. Total cases 260 208 ANTE-NATAL SUPERVISION. 1947 1948 No. of Sessions at Ante-Natal Clinics held 611 613 No. of individuals who attended 3,735 4,912 No. of previous year's cases continuing attendance 866 1,553 No. of new cases 2,722 3,858 No. of cases undelivered on 31st December 936 1,268 Total attendances made 20,916 31,370 Average attendances per session 34 51 No. of cases delivered in hospital as Booked cases 1,780 1,657 No. of cases delivered by Municipal Midwives 1,816 1,511 No. of cases delivered at other places under the care of private doctors or midwives 130 110 No. of patients found not to be pregnant 55 47 No. of patients referred to hospital for Ante- Natal treatment 480 321 During 1948 the Obstetric Service dealt with 3,523 out of the total births allocated to the Borough. Venereal Disease Conditions treated at Ante-Natal Clinic. Gonorrhoea Total cases 3 Transferred to Borough V.D. Clinic 3 Syphilis Total cases 5 Transferred to Borough V.D. Clinic 5 Non-Venereal 2 Emergency Obstetric Service. Number of calls 9 75 106 SPECIAL INVESTIGATIONS. Special investigations to the number of 10,179 were carried out on ante-natal patients attending the Clinics and on patients in St. Mary's Maternity Hospital and Mayday Hospital Maternity Wards. This total included Rh. 3,508 and W.R. 2,987. X-Ray Examinations (Mayday Hospital X-Ray Department). 1,090 cases were referred from Mayday Hospital, St. Mary's Maternity Hospital, and Ante-Natal Clinics. IN-PATIENT TREATMENT. A.—Patients "Booked" in the Ante-Natal Department: — Mayday Hospital 993 St. Mary's Maternity Hospital 700 Total 1,693 B.—"Emergency" patients sent into Hospital with some complications by outside doctors or midwives: — Mayday Hospital 317 POST-NATAL AND GYNAECOLOGICAL CLINIC. Number of Sessions held 104 „ „ Individuals presented 4,591 Average attendance per session 44 Number of Post-Natal cases 2,028 Number of Gynæcological cases 1,453 The Consultant Obstetrician was called in by medical practitioners to see 26G obstetrical and 1,453 gynecological patients. MENTAL HEALTH. As requested by the Ministry the following details of the service are set out:— Administration. The Mental Health Sub-Committee was composed of 8 members of the Health Committee (plus the Chairman and ViceChairman as ex-officio members), together with two representatives of the Croydon Medical profession nominated by the Local Medical Committee. The Sub-Committee held monthly meetings. 76 107 The staff employed on this work comprised:— The Medical Officer of Health—in general administrative control. The Deputy Medical Officer of Health and one Assistant Medical Officer of Health (both approved by the Ministry of Education for purposes of Section 53 of the Handicapped Pupils and School Health Services Regulations), as certifying Medical Officers for Mental Deficiency. 5 Duly Authorised Officers. 1 Occupation Centre Supervisor. 4 Assistant Occupation Centre Supervisors. There is close personal contact with the Medical Officers and Social Workers of the Hospital Psychiatric O.P. Clinic, the Regional Hospital Board's O.P. Mental Deficiency Clinic and the Child Guidance Centre. Steps for formal integration of the work of Authorised Officers and Psychiatric Social Workers were being taken. The only duty delegated to a voluntary association was the supervision of approximately 20 mental defectives placed under guardianship in Brighton, by the Guardianship Society. Arrangements were made for three Authorised Officers to attend a special course arranged by the National Council for Mental Health early in 1949. Work carried out in the Community. Under Section 28, National Health Service Act. Nil. Under the Lunacy and Mental Treatment Acts. Patients dealt with under the Lunacy and Mental Treatment Acts since 5th July, 1948, are as follows: — (a) Certified and admitted to Warlingham Park Hospital 20 (b) Admitted to Warlingham Park Hospital as voluntary patients 61 (c) Removed to Mayday Hospital under Detention Order 143 (d) Admitted to Warlingham Park Hospital as temporary patients 2 (e) Investigated and no action taken 48 274 77 108 Under the Mental Deficiency Act. Number of known Mentally Defective Patients in the Borough: 1947. 1948. Under 5 years 74 14 Aged 5-16 years ;182 108 Over 16 years 395 509 Total 651 631 Compared with 1947 the cases show a decrease of 20. Three Institution patients have died in hospital. The cases are distributed as follows:— 1947. 1948, In Certified Institutions 238 235 In Approved Homes 6 5 On Licence from Institutions 18 18 Under Statutory supervision at home 225 208 Under Guardianship 66 71 In Mental Hospitals 18 14 Observation cases 80 77 In "Place of Safety" 3 651 631 During the year the Certifying Medical Officers made examinations and paid visits to the number of 124 cases. The Mental Deficiency Visitors paid 1,716 visits. 48 new cases were examined during 1948 and certified as mentally defective. 31 of these cases were recommended for the Occupation Centre. During 1948, 47 cases were dealt with as follows:— 1947. 1948. Sent to Certified Institutions 26 13 Placed under Guardianship 1 12 Sent to Warlingham Park Hospital— 1 Varying Orders: (a) Change of Guardian 5 7 (b) From one Institution to another 5 8 (c) From Guardianship to Institution 2 (d) Institution to Guardianship— 2 (e) Orders closed 4 2 78 109 Sixty-One Orders Were renewed during the year, 9 of which were Guardianship. 18 children were admitted to the Occupation Centre during 1948. There were 39 cases awaiting vacancies in Institutions on the 31st December, 1948. Guardianship Cases. There were 71 cases under Statutory Guardianships, 44 of these under the care of relatives, and 27 with Guardians who are not relatives. 5 males and 1 female are at work. Four of the patients under Guardianship have died. 524 visits have been paid to Guardianship cases during the year There are 18 cases on licence from Institutions (5 males and 13 females). Training. The following report is made by the Supervisor of the Occupation Centre: — The Occupation Centre was opened on 25th May, 1948, and was to accommodate 40 patients. One Untrained Assistant, One Cook appointed. The number of patients on the register at the time of opening was 10. Eight of these were children who had to be excluded from St. Christopher's Special School, and had been in an occupation class there for 18 months—pending the opening of the Centre. Dinner was provided the meal being cooked on the premises, the charge for this being the same as for school children, i.e., 5d. first child, 4d. second child. At the end of December the number on the register was 21, and two more untrained assistants were appointed. It was then decided to discontinue the cooking of dinners on the premises, and it was arranged that school meals be sent in in the New Year. The hours during which the Centre is open are those adopted by the National Association for Mental Health Workers, i.e., 9.30 a.m.—3.30 -Monday—Friday. 79 110 Patients receive instruction in the following items:-Singing, Percussion Band, Physical Training, Educational Games, Sense Training, Speech Training, Stool Weaving, Rug Work, and various form of Handwork. Some of the children have half-hour's rest on beds and mats after dinner; the rest have the time out in the garden, if fine: in the music room if wet. Almost all take their turn in laying dinner tables, handing dinners round, washing and wiping-up. The cutlery is cleaned on Friday afternoons by the older girls and boys. Free milk is given to all on the register. A Christmas party was held on December 21st, 1948, to which 21 parents were invited—all but one attended. The efforts of the work done by the patients were put on exhibition, and the parents were greatly interested. Number on register May, 1948 10 Number on register December, 1948 21 Sessions open whole day 90 Total attendance 1,528 Average attendance per session 16.9 Number of children left Nil Number of children admitted 11 Ambulance Service. No difficulty was experienced in arranging the necessary transport for Mental Health patients by the Corporation ambulances. A panel of names of female and male assistants upon whom the Authorised Officers could call was available. These were all experienced personnel from the observation wards of Mayday Hospital. ORTHOPAEDIC DEPARTMENT. Summary of Cases Attending the Orthopcedic Clinic. Jan. 1st, 194S. New Cases, 1948. Cases Discharged, 1948. Cases on books, 31-12-1948.. M.C.W. S.M.S. T uberc. M.C.W. S.M.S. Tuberc. M.C.W. S.M.S. Tuberc. M.C.W. S.M.S. Tuberc 322 395 77 155 248 11 183 204 5 294 439 83 794 414 392 816 80 111 Cases seen by the Orthopaedic Surgeon, 1948. Defects. School. M.C.W. Tuberculosis. Total. Cases. Attendances. Cases. Attendances. Cases. Attendances. Cases, Attendances. Infantile Paralysis 5 10 1 1 — — 6 11 Postural Defect 24 31 1 3 — — 25 34 Pes Cavus 8 12 1 1 — — 9 13 Pes Planus 152 228 27 35 — — 179 263 Genu Valgum 20 42 73 111 — — 93 153 Talipes 7 10 25 72 — — 32 82 Obstetrical Paralysis 2 2 1 4 - - 3 6 19a 76a Joint Diseases 8 11 1 4 4s 20s 34 118 2m 7m Injuries 8 23 2 2 — 10 25 Rickets - - - - - - - - Wry Neck 5 9 14 21 — — 19 30 Spasticity 11 21 2 3 — — 13 24 Cong. Disloc. Hip 6 12 — — — — 6 12 Other deformities 97 124 54 78 — — 151 202 353 535 202 335 25 103 580 973 A—Adults; s—School Child; m—Pre-School. Summarised, the table shows 353 school children made 535 attendances; 202 babies made 335 attendances; and 25 T.B. cases made 103 attendances. A total of 580 cases made 973 attendances. 61 112 The following table shows the number of cases referred direct from the Orthopaedic Clinic for Massage, Swedish Remedial and Electrical" Treatment, and also X-Ray examinations at Croydon General Hospital: — Defects. School Cases. M. & C.W. Cases. Tuberculosis Cases. Total. Cases No. of Treatments X- Rays Cases No. of Treatments X- Rays Cases No. of Treatments XRays Cases No. of Treatments Infantile Paralysis - - - - - - - - - - - Postural defect 6 58 8 2 — 2 — — — 8 58 Pes cavus - - - - - - - - - - - Pes planus 28 335 - - - - - - - 28 335 Genu Valgum - - - - - - - - - - - Talipes 1 15 . — 3 22 1 — - — 4 37 Joint Diseases 1 — 2 — — - 22 — 27 23 — Injuries 7 12 9 - - - - - - 7 12 Rickets - - - — — — — — — — — Wry Neck 1 21 1 1 5 — — — — 2 26 Spastic Paraplegia - - - - - - - - - - - Congenita! Dislocation of the Hip. 5 — 6 1 — 3 - - — 6 — Other deformities 9 - 9 3 - 3 - - - 12 - 58 441 35 10 27 9 22 — 27 90 468 82 113 Cases admitted to Residential Institutions. Name of Institution. School Cases. i i M. & C.W. Cases Tuberculosis Cases. Total. No. in on 1st Jan., 1948 Admitted Discharged. | No. in on j 1st Jan., 1948 Admitted. Discharged. No. in on 1st Jan.. 1948 Admitted. Discharged. No. in on 1st Jan., 1948 Admitted. Discharged. No. in on 1st Jan., 1949 ???ctria Home — — — — — — — 1s — — 1 — 1 ???yrford — — — — — — 1A 1A — 1 3 2 2 1s 1s 1M 1M ???oy Ion Gen. Hosp. — 23 19 2 6 5 lA 1A 2A 3 31 27 7 1M 1M ???eri age Craft Schls. — — — — — — 2s — 1s 2 — 1 1 ???Vincent's — 1 1 — — — — — — — 1 1 — ???Myr.Treloar Hosp. — 1 1 — — — 4s 18 2s 4 4 3 5 2M ???haf;esbury Homes 1 — — — — — — — — 1 — — 1 ???ue n Mary's Hosp. — 1 - l — 1 ???yal Nat. Orth. Hosp — 1 1 — — — — — — — l 1 — ???lay jy Hosp. — 3 3 — — — 2a lA 3a 2 4 6 — ???S. B. H. — — — — — — 3A lA — 3 1 4 1 30 25 2 6 5 13 11 11 16 47 41 22 114 Conditions for which Patients were admitted to Hospitals with the Results of Treatment. Condition. In on 1st Jan. 1948 Admitted or transferred. Discharged. In on 1st Jan. 1949 Arrested. Quiescent. Improved. I.S.Q. Died. Infantile Paralysis 1 4 — — 4 — — 1 Tubercular Joints 13 11 — 7 3 — 1 13 Hip Disease — — — — — — — — Hemiplegia — 2 — — 2 — — — Genu Valgum — 1 — — — — — 1 Pes Planus — 5 — — 5 — — — Talipes — 3 — — 2 — — 1 Rickets — — — — — — — — Other Deformities 2 18 — — 14 — — 6 Spastic Paraplegia — 3 — — 3 — — — Scoliosis — — — — — — — — Osteomyelitis — — — — — — — — 16 47 — 7 33 — 1 22 84 115 BLIND PERSONS ACT, 1920. Up to the 5th July, 1948, when the functions of the Association were transferred to the Welfare Department, close co-operation was maintained by this Department and the. cases were 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 ... ... ... ... 4S4 Number of Blind who benefit from instruction in Braille or Moon type (including those who already read) ... 178 Number of Blind who benefit from part-time instruction ... ... ... ... ... ... 109 Number in remunerative handicrafts— (a) Home worker ... ... ... ... ... 28 (b) In workshops ... ... ... ... 4 , (c) St. Dunstan's ... ... ... ... ... 19 (d) Workers not included in scheme ... ... 43 Home Teachers ... ... ... ... ••• ••• 4 The Health Visitors paid 192 visits to blind persons during the period. 85 116 SANITARY CIRCUMSTANCES. To the Medical Officer of Health. I beg to submit a report for the year ending the 31st December, 1948, of the work of the Sanitary Inspectors and other officers under my supervision. It has again been a year given over largely to dealing with complaints of conditions affecting the housing environment of residents in the Borough. During the year some 12,000 houses have been rendered reasonably fit as a result of informal and formal action by this department, ll was necesssary in 442 cases for- the Local Authorilv to do the works asked for on formal notices, in default of owners. It has not been possible to give as much, attention to the routine inspection of factories, workplaces and food shops as I would like, but these have not been neglected, as the tables in the report will show. Meat Inspection occupies the time of two Inspectors between the Abattoir, where 23,833 animals were inspected after slaughter, and the Meat Depot which serves a population of some 350,000. In those Food preparation premises and shops which have been inspected, a steady improvement has become apparent in their condition. Repairs at the instigation of the department have been carried out to many such premises. 1,320 samples of food and drink for both chemical and bacteriological examination have been taken during the year. Rats and Mice Destruction has gone on throughout the year, both in the sewers of the Borough and on the surface. The results of the sewer treatments have been particularly successful, the manholes now requiring poison baiting having been reduced very considerably and this reduction should be progressive. GEO. GRIEVE, Chief Sanitary Inspector. 86 117 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) 12 746 Number of houses inspected where zymotic diseases have occurred 270 House drains tested 1 363 House drains tested on application 7 Number of smoke tests during repair 201 Inspections of drainage work during repair 3,220 Number of water tests during repair 220 Final tests of drains after repair 87 Kinal tests of drains when completely relaid 32 Length of new drains tested feet) 4,6i9 Inspection of yards, stables and manure pits 141 ,, passages 46 ,, public conveniences 60 ,, pigstyes 65 ,, tents, vans and similar structures 74 theatres, cinemas, halls, etc. 87 ,, ponds and ditches 115 ,, schools and school sanitary conveniences 15 ,, common lodging-houses 26 ,, verminous premises 97 ,, premises where offensive trades are conducted 21 ,, S?'psv encampments, camps, fairs, etc. 3 ,, cesspools 3 ,, gathering grounds of water supply 49 Number of visits under Rats and Mice (Destruction) Act, 1919 8,054 Inspections of war-damaged houses 21 Smoke observations 34 Number of visits re Infectious Diseases 1,044 Inspections of Shops (under Shops Acts) 1.168 Special Early Closing and Evening Patrols (Shop Hours Acts) 384 Overcrowding inspections 399 Inspections under Fertilisers and Feeding Stuffs Act 5 ,, under Pharmacy and Poisons Act 85 ,, Dairies 110 ,, Farms and cowsheds 48 ,, Milkshops 13 ,, Premises where food is prepared or sold 4,.330 ,, Bakehouses 107 Slaughterhouses 257 School Kitchens and Serveries 42 Inspection Factories without mechanical power 68 ,, Factories with mechanical power 254 ,, Workplaces, Public Health Act 28 Outworkers' premises 128 Visits re Young Persons Employment Act 9 Drinking water samples taken 89 Swimming bath waters: samples taken 48 Food and Drugs Acts: milk samples taken 314 Food and Drugs Acts: other foods and drugs samples taken 399 Milk Special Designations Orders: samples taken 273 Non-designated Milk: samples taken 48 Ice Cream samples taken 197 Reinspections of work on outstanding notices 36,275 Sundry inspections and visits 2,124 Appointments kept with owners, builders, etc, 6,233 87 118 Complaints from public investigated (including those in regard to housing defects) 13,862 Informal notices outstanding 31-12-47 3,276 Informal notices served 11,116 Informal notices complied 9,489 Number of Informal Notices referred for Statutory Orders 1,873 Informal notices outstanding 31-12-48 3,030 Statutory notices outstanding 31-12-47 1,648 Statutory notices served 3,()28 Statutory notices complied 3,508 Statutory notices outstanding 31-12-48 1,168 Total number of callers and complaints received at the office 9,301 Total number of letters received at the Office 14,277 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1948 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 2,372 Conditions causing dampness: Defective roofs 999 Defective window frames 1,565 Defective walls, etc 1,755 Want of efficient damp-proof course 486 Defective gutters and downspouts 2,160 Other structural defects: Defective plaster 4,476 Cleansing and limewashing required 4,299 Defective floors and stairs 1,680 Insufficient ventilation under floor 183 Defective brickwork, cills, lintels, chimneys, etc 2,152 Defective stoves and fireplaces and flues 1,494 Defective drains, sanitary fittings, etc.: Defective sinks and waste pipes 1,034 Defective w.c.'s 714 Defective drainage 1,091 Stoppages in drains 276 Defective water services and tanks 198 Domestic nuisances: Want of cleanliness 19 Dirty w.c. pans 14 Verminous conditions 85 Other nuisances and infringements: Offensive accumulations 109 Dirty or defective sanitary conveniences 14 Overcrowding 88 Smoke nuisances 2 Sundry nuisances or defects 72 Particulars not inserted in Rent Book (Housing Act) 7 „ „ „ (Rent Restriction Act) 5 88 119 (???) FACTORIES AND WORKPLACES. Want of cleanliness 9 Inadequate ventilation 1 Inadequate lighting 2 Insufficient drainage of floors 4 Abstract not exhibited 3 Means of ablution required 3 Sundry nuisances or defects 33 W.'C.'s- Insufficient 19 „ Unsuitable or defective 67 „ Not separate for sexes 6 (3) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924. Food cupboards defective or required 13 (4) INFRINGEMENTS OF POOD AND DRUGS ACT, 1988, AND FOOD BYELAWS. Structural defects in shops and stores 162 Cleansing or repair of walls and ceilings 310 Cleansing or repair of floors, utensils, fixtures, etc. 136 Insufficient or defective sink accommodation and water supply 109 Insufficient lighting or ventilation 26 Defective drainage 33 W.C. Accom. Insufficient 35 „ Repair or cleansing required 95 ,, Artificial light required 6 ,, Want of intervening ventilated space 6 Cloakroom accommodation required or defective 11 Overalls required or dirty 3 Ablutions : Wash basins required 86 „ Hot water supplies required 179 ,, Soap and towels required 16 Food improperly stored 11 Food store: Required or defective 3 „ Animals kept in 3 ,, Household washing in 2 Fish frying apparatus defective 1 Accumulation in yards or stores 33 Offal and refuse bins uncovered or defective 31 Footpaths fouled by waste water 1 Yard paving defective 12 (51) INFRINGEMENTS OF PUBLIC HEALTH ACT. PAVING, Etc. Defective Yard Paving 304 Want of a sanitary dustbin 319 (61) INFRINGEMENTS OF, SHOPS ACT. Shops Closing Hours 12 Infringment in hours of employment and welfare provisions 42 89 120 Notices to be exhibited or amended 531 Defective ventilation 1 Provision of means of heating l6 Insufficient w.c. accommodation 2 Want of washing facilities 10 Defective w.c. accommodation 4 Defective walls, floors, ceilings, etc. 15 Defective lighting 120 Seating accommodation 7 (7) INSPECTION OF AMUSEMENT HOUSES. Defective sanitary fittings 10 W.C. defective and dirty 7 (8) KEEPING OF ANIMALS. Nuisances arising from the keeping of animals 2 (9) INSPECTION OF WATERCOURSES, etc. Cleansing of watercourses and ponds 7 (10) INFRINGEMENTS OF OTHER BYELAWS. Noisy animals 7 Noisy radio 2 HOUSING. Individual Unfit Houses. During the year action under the Housing Acts was confined to the repair of houses. The accepted standard of repair whilst lower than that of pre-war years is higher than in previous postwar years due to an improvement in the availability of labour and materials. Action under the Public Health Acts in regard to drainage and sanitary fittings lias 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) 12,746 (b) Number of inspections and re-inspections made for the purpose 46,021 (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 1 (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 ... 11,778 90 121 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 8,496 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 1,680 (2) Number of dwelling houses which were rendered fit after service of formal notices— (a) By owners 1,964 (b) By local authority in default of owners 196 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 1,348 (2) Number of dwelling houses in which defects were remedied after service of formal notices: — (a) By owners 1,102 (b) By local authority in default of owners 246 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 1 (2) Number of dwelling houses demolished in pursuance of Demolition Orders — D—Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 2 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — HOUSES LET IN LODGINGS. There are 12 houses registered and they gave little cause for complaint during the year. 91 122 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 Is. 3d. per night or 7s. 6d. per week, and Is. per night or 6s. per week for Old Age Pensioners. Cooking facilities are provided. Hot baths may be taken any tim'e 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 36,631. The receipts and expenditure for the past 5 years have 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 1948 1,907 0 0 2,377 0 0 Houses—Sanitary Certificates. House drains and sanitary fittings are tested and examined on request, at a fee. During the year 7 such requests were made. FACTORIES ACT, 1937. During the year the under-mentioned inspections have bean made and defects were found as set out:— FACTORIES. Inspection. Premises. Number of Inspections. Written Notices. Prosecutions. Factories:— With Mechanical Power 254 52 — Without Mechanical Power 68 14 — Other Premises 31 3 — Outworkers and Employers of outworkers 131 1 — Total 484 70 — 92 123 Defects Found. Particulars. Number of Defects. Referred to H.M. Inspector. Prosecutions Found. Remedied. Want of Cleanliness 9 9 — — Overcrowding — — — — Unreasonable Temperature — — — — Inadequate Ventilation 1 1 — — Ineffective Drainage of Floors 4 4 — — Sanitary Conveniences. (a) Insufficient 19 19 — — (b) Unsuitable or Defective 67 67 — — (c) Not Separate for Sexes 6 6 — — Other offences against the Act (not including offences relating to Outworkers) 41 41 — — Total 147 147 — — Home Work. Lists of home workers or outworkers as they are termed are sent in twice yearly, and this year contained the names of 229 workers residing in the Borough. 128 vjsifs were paid to outworkers. Nature of Employment of Outworkers on the Register, 31st December, 1948. Nature of Work. Number Employed. Outwork in Infected Premises. Outwork in Unsatisfactory Premises. Remarks. Making, Cleaning, Altering and Repairing Wearing Apparel 162 — — — Upholstery Work 7 — — — Other Classes of Work 60 — — — Total 229 — — — Inspection of Schools. These are inspected with particular reference to sanitary accommodation including washing facilities. During the year 15 inspections were made and defects found were referred to the Education Officer. 93 124 SHOPS, Etc., ACTS. The Shops Acts, 1912-1938, contain provisions for dealing with closing hours, the hours of work, and health and comfort of those employed. Closing hours have duri'ng the year given little cause for complaint. 37 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 gases 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. 1,168 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 3,220 visits of inspection were made to underground drains in course of repair. The labour and materials situation being somewhat easier it was not necessary to serve so many statutory orders as in previous post-war years. Of 1,029 Orders served, 116 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. 115 inspections were made and pollutions were found in 7 cases. SMOKE OBSERVATIONS. During the year 34 observations were made of.factory chimneys for the purpose of detecting offences. In those cases where 94 125 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 plani has also to be overcome. Some factories have changed over from solid fuel firing to oil firing. AMUSEMENT HOUSES. 87 inspections were made of Theatres, Music 11 al 1ft, Cinemas, Dance Halls, and premises where stage plays are given. V 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 39,502 articles „ Formalin Gas 723 „ „ „ Spray 2,120 Total 42,345 „ In addition 621 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 1948, 1,047 articles were disinfected, the receipts amounting to £34 lis. 9d. Disinfection was carried out after infectious or contagious disease at the following premises:— 1,231 rooms at S67 houses, hospital wards, clinics, and creches. 2,523 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 95 126 in adults and children. A woman attendant deals with children and women. During the year 8 adults and 65 children were cleansed of verminous conditions and 22 adults and 87 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 fir occupiers during the year was 68. 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 41. In addition, 238 applications were made for the retention of names on the list for a further period of twelve months. 7 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. Samples taken proved genuine. RATS AND MICE DESTRUCTION ACT, 1919. INFESTATION ORDER, 1943. During the year 960 complaints were received of rat or mice infestation. Of these complaints the presence of rodents was confirmed in 483 cases. The two Ratcatchers in dealing with these infestations paid 7,282 visits, and used 1511bs. of poison bait, 96 127 as well as using traps and gassing. The types of premises found to be infested were:— Dwelling Houses (Inside) 155 „ „ (Outside) 132 ,, ,, (Poultry Houses) 66 Premises where Food is prepared or sold 52 Factories, Workshops and Business Premises 23 Agricultural Land 2 Allotments 3 Schools 26 Shops 3 Drains 21 All sewers in the Borough have received two maintenance treatments during the year. 3,955 manholes were examined for the presence of rats and poison bait laid in 870 instances. 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 153 Butchers 191 Confectioners 390 Fishmongers 86 Fish friers only 30 Greengrocers 279 Grocers 652 Stalls and Rounds 203 Catering Establishments (including Hotels, Canteens, Restaurants, Clubs, Snack Bars, etc.) 743 Miscellaneous (including Chemists, etc.) 211 2,938 In addition to the above there are the following premises at which food is prepared for sale-or sold:— Slaughterhouses, Dairies (including Farms) and Milkshops 97 128 The following table gives a summary of the inspections made during the year, not including visits made to slaughterhouses, dairies or milkshops- Butchers 904 Ice Cream Vendors and Manufacturers 399 Bakers 107 Confectioners 187 Greengrocers 155 Fishmongers 279 Grocers 913 Fried Fish Shops 90 Stalls and Rounds 147 Poultry and Game Dealers 82 Catering Establishments 790 Miscellaneous 109 Cooked Meat Preparation Premises 11 Total 4,173 General Summary of Meat and other Articles of food found to be unlit and condemned by the Inspectors during 1948:— Articles. Weight in lbs. Diseased. Unsound. Total. Beef 59597 9500 69097 Veal 312 28 340 Mutton 843 199 1042 Pork 1110 301 1411 Offal 105497 72 105569 Fish — 10030 10030 Fruit and Vegetables — 794 794 Canned, bottled and packeted goods — 26636 26636 Other goods — 22034 22034 167359 69594 236953 The above includes:— Canned, bottled and packeted goods:— 17,701 cans, 1,089 bottles, packets, etc. 98 129 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. Phis 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 1948 the following animals were slaughtered there and inspected by the Corporation's Meat Inspectors:— Cattle. Calves. Sheep. Goats. Pigs. Total. 8,769 1,060 13,198 418 388 23,833 The result of these inspections was as follows:— Carcases Inspected and Condemned. Cattle Calves Sheep Goats Pigs Number killed 8769 1060 13198 418 388 Number inspected 8769 1000 13198 418 388 All Diseases except Tuberculosis. Whole Carcases condemned 2 1 8 — 7 Tuberculosis Only. Whole Carcases condemned 75 4 — — — All Diseases except Tuberculosis. Total weight in lbs. of Carcases and parts of Carcases condemned 56,805 Tuberculosis Only. Total weight in lbs. of Carcases and parts of Carcases condemned 110,553 99 130 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 1948) 5 Cowsheds on register (end of 1948) 5 Average number of cows in sheds (1918) 80 Number of dairies and purveyors of milk on the register (end of 1948) 119 During the year 171 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”— (a) Bottling establishments 1 (b) Shops 21 (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 44 100 131 (6) Dealers' Supplementary Licences to use the designation— (a) Tuberculin Tested 7 (b) Accredited — (c) Pasteurised 7 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 18 Accredited Milk- From licensed producer supplying milk to a licensed dairyman Nil Pasteurised Milk— Samples from licensed dealers 198 Heat Treated Milk- Samples from licensed dealers 57 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 — 18 — — — — — — — — — — Bacillus Coli — — 1 17 — — — — — — — — Blood — — — — — 18 — — — — — — Pus — — — — — — — 18 — — — — Detritus — — — — — — — — — 13 — — Methylene Blue Test. — — — — — — — — — — — 18 Totals — 18 1 17 — 18 — 18 — 18 — 18 101 132 Accredited Milk. Licences granted under the Milk (special Designations) Order, 1936. Present. ' Absent. Present in 1/100 M.l. Absent. Present. Absent. Present. Absent. Exceeding a trace. I Not exceeding a trace. Not satisfied. Satisfied. 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. Present. Absent. Over 100,000 per M.l. Under 100,000 per M.l. Present. Absent. Present. Absent. Present. Absent. Not satisfied. Satisfied. Not satisfied. Tubercle bacillus — 198 — — — — — — — — — — Total number of bacteria — — 18 180 — — — — — — — — — Blood — — — — — 198 — — — — — — — Pus — — — — — — — 198 — — — — — Detritus — — — — — — — — — 198 — — — Methylene Blue — — — — — — — — — — — — — Phosphatase — — — — — — — — — — — — — Totals — 198 18 180 — 198 — 198 — 198 6 192 — 102 133 Heat Treated Milk. Present. Absent. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Not satisfied. Satisfied. Not satisfied. Satisfied. Tubercle bacillus — 57 — — . __ Blood — — — 57 Pus — — — — — 57 Detritus — — — — — — — 57 — — — — Methylene Blue Test — — — — — — — — 7 50 — — Phosphatase Test 3 54 Totals — 57 — 57 — 57 — 57 7 50 3 54 ORDINARY MILK. The following table summarises the results of the bacteriological examination of Ordinary Milk samples, taken from 1st January—31st December, 1948 : — Ordinary Milk. Present. Absent. Over 100,000 per M.I. Under 100,000 per M.I. Present. Absent. Present. Absent. Exceeding a trace. Not exceeding a trace. Not satisfied Satisfied, Tubercle bacillus — 48 — — — — — — — — — — Total number of bacteria — — 5 43 — — — — — — — — Blood — — — — — 48 — — — — — — Pus — — — -- — — — 48 — — — — Detritus — — — — — — — — — 43 — — Methylene Blue Test — — — — — — — — — — 3 45 Totals — 48 5 43 — 48 — 48 — 48 3 45 103 134 BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM. 197 Samples were taken, the results being as under:— Grade. No. of Samples, 1 112 2 52 3 29 4 4 Out of a total of 107 samples taken 33 (16.75 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. The coming to hand of plant for the efficient treatment of ice cream in accord with the Ice Cream (Heat Treatment) Regulations and the better understanding of such plant by manufacturers and retailers is giving us an improvement in the bacterial purity. The failures of all samples taken this year are 16.75 per cent, as against 44 per cent, for 1947. There should be a further reduction in the number of failures next year when most manufacturers will have plant in full conformity with the Heat Treatment Regulations. There is no chemical standard for ice cream. 104 135 FOOD AND DRUGS ACT, 1938. During the year 314 samples of milk and 399 other samples were taken. Summary of Samples. During 1948 samples were obtained and submitted to the Public Analyst as follows:— Samples of Total Samples Genuine Not Genuint Prosecutions Convictions Apple Juice 1 1 — — — Apple, Tinned 1 — 1 — — Arrowroot 3 3 — — — Aspirin Tablets 5 5 — — — Bacon 2 2 — — — Baking Powder 5 5 — — — Batter Mixture 2 2 — — — Beans, Tinned 4 4 — — — Beef, Minced 1 1 — — — Beef and Ham, Pressed 1 1 — — — Beef Broth 1 1 — — — Beer 5 5 — — — Bicarbonate of Soda 3 3 — — — Black Pudding 7 7 — — — Blanc-Mange Powder 1 1 — — Boracic Acid Ointment 4 3 1 — — Brawn 2 2 — — — Bread 7 7 — — — Bun Mixture 1 1 — — — Butter 1 1 — — — Cake Flour Powder 1 1 — — — Cake Icing 1 1 — — — Cake Mixture 3 3 — — — Cake and Pudding Mixture 2 2 — — — Cake, Sponge and Steamed Pudding Mixture 1 1 ' — — — Camphorated Oil 2 2 — — — Candied Peel 1 1 — — — Carrots, Tinned 2 2 — — — Castor Oil 4 4 — — — Cereoca 1 — 1 — — Cheese 4 4 — — — Chewing Plugs 1 1 — — — Chocolate Laxative . 1 1 — — — Chutney 1 1 — — — Cinnamon, Ground 4 4 — — — Cockles 1 1 — — — Cocoa 10 10 — — — Cocoa Powder, Sweetened 1 1 — — — Cod Liver Oil 1 1 — — — Coffee 7 7 — — — Coffee and Chicory 2 2 — — — Coffee and Chicory Essence 2 2 — — — Coffee Extract 1 1 — — — Confection of Senna 1 1 — — — Cooking Fat 4 4 — — — Cornflour I 1 — — — Cordial, Lime Juice 1 1 — — — Cough Syrup 1 1 — — — Crab Paste 1 1 — — — Cream of Tartar 1 1 — — — Carried forward 121 118 3 — — 105 136 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought Forward 121 118 3 — — Currants 1 1 — — — Curry Powder 2 2 — — — Custard Powder 2 2 — — — Faggots 1 1 — — — Fish Cakes 5 5 — — — Fish Paste 5 5 — — — Fish Spread 1 1 — — — Flavouring 4 4 — — — Flavouring Essence 3 3 — —x — Flour, Batter 1 1 — — — Flour, Bun 2 2 — — — Flour, Cake 2 2 — — — Flour, Self—raising 6 6 — — — Frying Oil 1 — 1 — — Gelatine 2 2 — — — Gherkins 2 2 — — — Gin 3 3 — — — Ginger Beer 6 6 — — — Ginger, Ground 4 4 — — — Ginger Wine 2 2 — — — Glycerine 1 1 — — — Grape Fruit 2 2 — — — Grapefruit Crush 1 1 — — — Gravy Powder 6 6 — — — Haggis 1 1 — — — Hake, Flaked 1 1 — — — Honey 1 1 — — — Horseradish 1 1 — — — Ice Cream 3 3 — — — Iodine, Tincture of 2 2 — — — Jam 6 6 — — — Jelly, Table 3 3 — — — Junket Powder 3 3 — — — Lemonade 5 5 — — — Lemonade Crystals 1 1 — — — Lemonade Powder 8 8 — — — Liqueur 1 1 — — — Liquorice Powder Comp 3 3 — — — Macaroni 3 3 — — — Malted Milk Tablets 2 2 — — — Margarine 1 1 — — — Marmalade 3 3 — — — Meat Paste 3 3 — — Meat Pies 5 4 1 — — Meat Soup 1 1 — — — Milk 314 313 1 — — Milk, Dried 2 2 — — — Mineral Water 1 1 — — — Mushroom Ketchup 1 1 — — — Mustard 4 4 — — — Mint Sauce 1 1 — — — Mustard Sauce 1 1 — — — Oatmeal 2 2 — — Olive Oil 3 3 — — — Orangeade 2 2 — — — Orange Squash 3 3 — — — Ovaltine Tablets 1 1 — — — Carried forward 578 572 6 — — 106 137 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought Forward 578 572 6 — — Paste. Fish 2 2 — — — Pearl Barley 3 3 — — — Paraffin, Liquid, Medical 1 1 — — — Peas, Processed 2 2 — — — Peel, Cut 1 1 — — — Pepper 6 6 — — — Piccalilli 1 1 — — — Pickles 8 8 — — — Pickled Walnuts 1 1 — — — Pork, Danish 1 1 — — — Potato Powder 1 1 — — — Pressed Beef and Ham 1 1 — — — Pudding Mixture 1 1 — — — Pudding Powder 1 1 — — — Raising Powder 1 1 — — — Raspberries Frozen in Light Syrup 1 1 — — — Rhubarb, Comp. Tine, of 2 2 — — — Rum 5 5 — — — Salad Oil 1 1 — — — Salmon 2 2 — — — Sauce 2 2 — — — Sauce, Worcester 2 2 — — — Sausage, Breakfast 5 5 — — — Sausage, Liver 3 2 1 — — Sausage, Luncheon 4 4 — — — Sausage, Beef 3 1 2 — — Sausage Meat, Beef 3 3 — — — Sausage Meat 3 3 — — — Sausage, Salami 3 3 — — — Sausage, Whale 2 2 — — — Sausage, White 1 1 — — — Semolina 1 1 — — — Snoek in Tomato 1 1 — — — Soup, Meat 1 1 — — — Soup, Mock Turtle 2 2 — — — Soup, Powder 1 1 — — — Soup, Tinned 1 1 — — — Soup, Tomato 1 1 — — — Soup, Vegetable 5 5 — — — Spaghetti in Meat Sauce 1 1 — — — Spice 1 1 — — — Spice, Ground Mixed 5 5 — — — Spinach Purée 1 1 — — — Sponge Mixture 2 2 — — — Stout 1 1 — — — Stuffing, Sage and Onion 1 1 — — — Suet 1 1 — — — Sugar 2 2 — — — Summer Drink, or Sucker 1 1 — — — Sweephat 1 1 — — — Sweets 4 4 — — — Syrup of Figs 2 2 — — — Tea 4 4 — — — Thirst Quenchers 1 1 — — — Tomato Ketchup I — 1 — — Vegetables, Mixed 1 1 — — — Vegetables, Tinned 1 1 — — — Veal and Ham Loaf 1 1 — — — Venison, Pressed 1 1 — — — Vinegar, Malt 5 4 1 — — Vinegar, Non-Brewed 2 2 — — — Whalemeat Steak Casserole 1 1 — — — Whisky 6 6 — — — Yeast Tablets 1 1 — — — Zinc Ointment 1 1 — — — Totals 713 702 11 — — 107 138 Result of Analysis of Milk Samples. Solids Not Fat (Legal standards is 8.5%)* 8.4 8.5* 8.6 8.7 8.8 8.9 9.0 9.1 9.3 1 2 33 116 97 47 13 4 1 Milk Fat (Legal standard is 3%) 2.92 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 1 1 7 29 46 57 38 37 25 32 15 12 4.1 4.2 4.3 4.6 5.0 5.1 713111 Total samples of milk: 314. The samples of Milk for analysis were obtained as follows:— Taken on Milk Rounds 219 ,, at Dairies 59 ,, at Institutions 35 ,, at Local Farms 1 314 Average composition of Milk Samles— Solids not fat 8.76% Milk Fat 3.55% 108 139 Adulterated Samples. The following is a detailed statement of the adulterated samples and the action taken:— Sample No. Sample of Adulteration or Deficiency. Remarks. 1031 (Informal) Apple, Tinned. The sample contained 1.3% of added salt, which imparted an objectionable salty taste.. This sample was from the the stock held by a canteen. The stock was destroyed by the proprietor. 227 (Formal) Boracic Acid Ointment. Contained 9.9% of boric acid instead of not more than ' 1.1% Sample was old stock and accorded approximately with the previous B.P. standard of 10% of boric acid. 1 (Formal) Cereoca Slightly infested with beetles. A small quantity only remained of this stock. This was surrendered and used for animal feeding. 1096 (Informal) Frying Oil. This oil specified on the label as Tea Seed Oil, Liq. Par. consisted of 100% coloured liquid paraffin. The whole consignment of this frying oil was withdrawn from sale by the Manufacturer on account of a pending action by another Local Authority. 317 (Formal) Meal Pie. The sample contained only 6.9% of filling of which about one-half consisted of meat. No action taken as the division of the sample was in question. 34 (Formal) Milk 2% deficient in milk fat. Vendor warned. 1090 (Formal) Sausage, Liver The sample contained 36% of meat instead of 45% Matter referred to Ministry of Food, who issued a warning to Vendor. 838 (Formal) Sausages, Beef. Contained 36% of meat instead of a minimum of 50%. Referred to Local Food Control Committee for appropriate action to be taken. 321 (Formal) Sausage, Beef. Contained 33% of meat instead of a minimum of 50%. Vendor's explanation accepted. 109 140 Sample No. Sample of Adulteration or Deficiency. Remarks. 320 (Formal) Tomato Ketchup. Unfit for human consumption owing to decomposition by yeast fermentation. This sample was taken at the request of the Vendor. The remainder of the stock was withdrawn from sale by the Manufacturer, whose explanation was accepted. 68 (Formal) Vinegar (Malt). Contained 0.75% of salt, which is not a natural ingredient of malt vinegar. No action taken as salt is allowed as an added ingredient to vinegar by the Ministry of Food. CROYDON AIRPORT—HEALTH CONTROL. On the 1st April, 1948, the Public Health (Aircraft) Regulations, 194S, came into operation. The Corporation continued to act as agents for the Ministry of Health, but owing to considerable lessening in the number of aircraft arriving from abroad, the staff of medical receptionists was reduced and the post of Assistant Medical Officer Aircraft and Aliens was abolished, Medical supervision is now given by an "on call" rota of medical officers. 110 CROYDON AIRPORT—AIRCRAFT AND PASSENGER ARRIVALS. AC BP AP AC BP AP AC BP AP AC bp AP AC BP AP AC BP AP AR c Sunday 0.8 - - - - - - - - - - - - 6 1 1 1 B.P. stretcher case 8.12 - - - - - - - - - - - - 42 31 4 (No diagnosis given) 12.16 — - — 1 2 — — — — — — 1 57 105 31 16.20 — — — 1 6 — — 2 1 — 1 3 109 293 36 20.24 - - - - - - - - - - - 2 42 109 3 258 550 82 — — Monday 0.8 - - - - - - - - - - - 1 22 12 5 1 A.P. Str. case (Colitis) 8.12 - - - - - - - - - - 4 1 75 162 94 12.16 — — — 3 7 — — — — — — — 94 136 112 1 Crash landing (Party of M.P.s) 16.20 — — 1 1 10 5 — —- 2 — — 3 121 277 44 20.24 — — — 1 6 1 - - - - - 4 58 106 34 375 720 307 — — Tuesday 0.8 - - - - - - - - - - - - 32 24 3 1 Medical examination 8.12 - - - - 7 - - - - - - - 62 102 93 (B.P. child covered in spots) 12.16 — 1 - - - - - - - - - - 99 157 79 16.20 — 1 — 3 27 1 — — 3 — — 3 111 173 66 20.24 — — — 1 9 — — — — — — — 38 68 8 346 569 256 — — Wednesday 0.8 - - - - - - - - - - - - 39 14 4 1 B.P. str. case (Heart disease) 8.12 — — — — 5 — — — — — — 2 44 48 40 1 B.P. str. case (Disseminated Sclerosis) 12.16 — — — 2 13 — — — — — 2 4 84 127 64 1 B.P. str. case (Colostomy) 16.20 — 1 - - - - - - - - - 2 111 174 32 1 B.P. str. case (No diagnosis given) 20.24 — — — — 2 1 — — — — — — 38 47 9 318 433 158 — — Thursday 0.8 - - - - 1 - - - - - - - 32 21 3 1 A.P. str. case (Colitis) 8.12 - - - - - - - - - - - - 58 67 103 1 B.P. str. case (No diagnosis given) 12.16 — — — 2 8 4 67 58 54 16.20 — — — 2 6 — — — 1 - - 1 99 170 44 20.24 - - - - 1 - - - - - 1 — 42 40 2 302 373 212 — — Friday 0.8 - - - - - - - - - - - - 38 12 1 1 B.P. str. case (Fibromata) 8.12 — — — — 3 — — — — — — — 51 55 65 1 B.P. str. case (Leukaemia) 12.16 — — — 1 12 — — — — — — 1 82 105 60 1 B.P. str. case (Faecal Fistula) 16.20 — — — — 19 2 — — — - — 1 126 146 35 20.24 - 1 - - - - - - - - - - 72 42 5 370 395 170 — — Saturday 0.8 - - - - - - - - - - - - 43 12 10 1 B.P. str. case (Nervous disorder) 8.12 — — — 1 3 1 — — — — 1 7 72 93 86 2 B.P. str. cases (No diagnosis given) 12.16 — — — 5 11 3 — — — — 1 3 91 135 39 1 B.P. sent to Croy. Gen. Hosp. 16.20 — 3 — 1 3 1 — — — — — 4 100 182 38 1 Emergency landing 20.24 — 5 — — 7 1 — — — — — 2 46 60 3 359 516 198 — — Grand Total 2328 3556 1383 — — Note.—AC=Aircraft BP=British AP=Alien Passengers AR=No. of Aliens referred to Medical Officer by the Immigration Officer C= No. of Certificates issued Ill 141 142 County Borough of Croydon ANNUAL REPORT of the SCHOOL MEDICAL OFFICER For the Year ending December 31st, 1948. To the Chairman and Members of the Education Committee. Ladies and Gentlemen, I have the honour to present for your consideration the 49th Annual Report of the School Medical Officer. During the greater part of the year under review, Dr. O. M. Holden was your School Medical Offiecr and the work recorded was therefore carried out mainly under his supervision. There are no special points to which attention should be drawn, except to comment on the effect of the coming into operation of the National Health Service Act, 1946. The Education Act, 1944, makes it a duty of Education Authorities to "make such arrangements for securing the provision of free medical treatment for pupils as are necessary for securing that comprehensive facilities for free medical treatment are available to them either under this Act or otherwise."The other means were and are intended to be the services available through the National Health Service Act. Unfortunately, the immediate effects of this Act on important parts of the School Health Service have been entirely adverse. Thus the Dental Service has been disrupted and long waiting periods introduced into the ophthalmic and orthopaedic schemes. The children have lost their former 112 143 priority places and are now compelled to wait their turn with the general population. I am sure this was never the wish or intention of any concerned with the new Health Service, and I hope the difficulties will be solved before the next annual report is due. I take this opportunity to thank the members of the Education Committee for their kind consideration during this period of my initiation into their service. The Chief Education Officer and his staff have always been ready to assist and the Head Teachers invariably co-operative. The Medical, Dental and other officers of the department have been painstaking to overcome the many new administrative difficulties which 1948 has brought and anxious always to promote the health of the children entrusted to their care. 113 144 Cost of the School Health Service. The gross cost of the medical, dental and nursing services was £41,365. Approximately one-third of this was for hospital treatment of school children. The rateable value of the Borough as at 1st April, 1948, was £2,498,635. The Government grant is 49.727 per cent. of the expenditure, hence the actual cost to the rates was £20,796, i.e., a rate of 2.00 pence. Cost of Special Schools. Schools maintained by the Council, £14,906, contributions to schools under other authorities, £5,093, sundry receipts, £19, giving an actual cost of £19,950, of which £10,030 was payable out of local rates, i.e., a rate of .97 pence. Cost of Milk and Meals. Meals and milk cost £105,671, including wages, fuel, printing, etc. On this expenditure the Government now make a grant of 100 per cent. 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 2254 2002 89 Girls 8 2546 2234 88 Mixed 2 944 817 87 17 5744 5053 88 Voluntary Girls 1 165 151 90 114 145 Schools No. of Departments Number on the Registers Average attendance Average attendance per cent. PRIMARY SCHOOLS Council Junior Mixed 2 659 600 91 Senior and Junior Boys 1 348 305 88 Senior and Junior Girls 1 313 235 91 Senior and Junior Mixed 2 781 713 92 Junior Boys 7 2043 1862 91 Junior Girls 5 1414 1292 92 Junior Girls and Infants 2 858 766 89 Junior Mixed and Infants 12 5127 4584 89 Infants 16 3681 3153 85 Senior Mixed 2 368 336 91 50 15592 13397 89 Voluntary Senior and Junior Boys 1 175 158 90 Senior Mixed and Infants 3 947 839 83 Junior Girls and Infants 2 357 320 85 Junior Mixed and Infants 4 646 571 88 Senior and Junior Mixed 1 337 325 89 Infants 3 231 199 87 14 2753 2421 88 SPECIAL SCHOOLS Council Mixed 3 354 287 82 GRAMMAR AND TECHNICAL SCHOOLS Boys (Technical) 2 418 398 95 Boys (Grammar) 2 954 908 95 Girls (Grammar) 1 553 505 91 Boys (Central) 1 210 199 95 Girls (Central) 1 359 342 95 Mixed (Heath Clark) 1 203 273 93 Girls (Coloma) 1 503 474 94 9 3290 3099 94 115 146 MEDICAL INSPECTION IN SCHOOLS. A total of 8,511 children were examined as compared with 5,758 in 1947, and 5,720 parents attended the examinations. The percentage attendance of parents in the Entrants' group was for boys 86.3 per cent.; and girls 88.6 per cent.; in the Intermediate group, boys 53.0 per cent.; girls 66.5 per cent.; and in the Leavers' group, boys 22.1 per cent.; girls 44.0 per cent. The total percentage of parents attending was 67.2 as against 69.2 last year. 637 specials and 470 re-inspections of children were carried out. VISION. Extent of Defect. Intermediate. Leavers. Total. Boys. Girls. Boys. Girls. Boys. Girls. No. % No. % No. % No. % % % Normal: R 876 95.5 933 96.3 868 96.3 1287 91.9 95.9 93.7 6/6ths or 6/9ths L 875 95.4 925 95.5 860 95.4 1289 92.1 95.4 93.4 6/12ths or 6/24ths R 35 3.8 26 2.7 29 3.2 93 6.6 3.5 5.0 L 38 4.1 29 3.0 35 3.9 93 6.6 4.0 5.2 6/36ths or worse R 6 0.7 10 1.0 4 0.5 20 1.5 0.6 1.3 4 0.5 15 1.5 6 0.7 18 1.3 0.6 1.4 116 147 parents present, 1948 Entrants Intermediate Leavers Other Ages TOTA l 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. 43 62 29 59 12 6 9 4 ... ... ... ... ... ... ... ... 55 68 ... ... ... ... ... ... ... ... 78 24 2 4 ... ... ... ... 78 24 61 4 46 4 22 29 15 18 ... 17 ... 4 19 ... 17 ... 102 50 77 92 59 82 20 29 7 4 ... ... ... ... ... ... ... ... 97 121 66 79 60 74 102 108 51 60 ... ... ... ... ... ... ... ... 168 187 47 59 37 55 25 24 12 19 ... ... ... ... ... ... ... ... 72 83 ... 20 ... 5 ... ... ... ... ... 51 ... 8 ... ... ... ... ... 71 ... ... ... ... ... ... ... ... ... 44 ... 25 ... ... ... ... ... 44 52 68 49 61 52 43 28 28 ... ... ... ... ... ... ... ... 104 111 51 45 42 42 12 ... 9 ... ... ... ... ... ... ... ... ... 63 45 79 78 67 72 ... 45 ... 33 25 23 4 13 ... ... ... ... 104 146 25 21 22 20 26 15 12 12 22 37 11 21 ... ... ... ... 73 73 59 78 56 72 45 24 19 19 ... 44 ... 21 ... ... ... ... 104 146 85 59 70 56 25 44 20 36 37 22 6 7 ... ... ... ... 147 125 29 37 20 33 20 11 14 3 ... 25 ... 19 ... ... ... ... 49 73 ... ... ... ... ... ... ... ... ... 44 ... 1 ... ... ... ... ... 44 19 33 18 28 ... ... ... ... ... ... ... ... ... ... ... ... 19 33 26 33 22 28 26 34 11 20 ... ... ... ... ... ... ... ... 52 67 52 67 51 57 ... 5 ... 1 42 62 9 20 ... ... ... ... 94 134 ... ... ... ... ... ... ... ... 85 ... 2 ... ... ... ... ... 85 ... 23 28 23 23 20 32 9 27 ... ... ... ... ... ... ... ... 43 60 69 68 62 62 33 57 19 36 24 ... 14 ... ... ... ... ... 126 125 ... ... ... ... ... ... ... ... ... 198 ... 55 ... ... ... ... ... 202 ... ... ... ... ... ... ... ... 69 82 20 40 ... ... ... ... 69 82 41 25 40 22 17 17 13 9 ... ... ... ... ... ... ... ... 58 42 44 68 43 51 9 16 4 14 21 4 6 ... ... ... ... ... 74 88 60 77 55 74 34 35 30 29 31 24 10 11 ... ... ... ... 125 136 72 78 64 70 24 26 14 14 30 17 6 11 ... ... ... ... 126 121 41 33 39 26 11 5 10 4 50 24 19 19 ... ... ... ... 102 62 80 85 75 81 25 ... 3 ... 62 57 3 30 ... ... ... ... 167 142 59 55 57 51 53 47 33 27 32 1 1 ... ... ... ... ... 144 103 89 69 69 62 20 24 16 20 36 17 18 10 ... ... ... ... 145 110 23 24 20 19 ... ... ... ... 13 9 3 1 ... ... ... ... 36 33 ... ... ... ... ... ... ... ... ... ... ... ... 15 ... 12 14 15 15 ... ... ... ... ... ... ... ... ... ... ... ... 35 ... 26 ... 35 ... 50 62 22 41 18 10 5 10 ... ... ... ... ... ... ... ... 68 72 12 9 11 8 ... ... ... ... ... ... ... ... ... ... ... ... 12 9 68 52 47 46 40 37 17 14 2 2 2 ... ... ... ... ... 110 91 10 13 7 11 ... ... ... ... ... ... ... ... ... ... ... ... 10 13 16 13 16 13 12 12 3 5 ... ... ... ... ... ... ... ... 28 25 ... ... ... ... ... ... ... ... 18 18 1 9 ... ... ... ... 18 18 ... ... ... ... ... ... ... ... 21 ... 1 ... ... ... ... ... 21 ... ... ... ... ... ... ... ... ... ... 328 ... 175 ... ... ... ... ... 328 48 65 41 51 97 23 39 20 ... ... ... ... ... ... ... ... 145 88 ... ... ... ... ... ... ... ... 53 ... 3 ... ... ... ... ... 53 ... 36 41 35 36 28 55 15 46 36 ... 24 ... ... ... ... ... 100 96 28 32 28 27 14 ... ... ... 16 93 2 43 ... ... ... ... 58 125 56 69 42 56 ... ... ... ... 51 65 15 35 ... ... ... ... 107 134 78 88 60 76 18 43 11 35 ... 20 ... 12 21 ... 17 ... 117 151 102 110 101 97 ... 24 ... ... 22 48 3 22 ... ... ... ... 124 182 68 89 66 83 13 52 9 45 ... ... ... ... ... ... ... ... 81 141 85 98 81 93 44 37 29 32 25 ... 14 ... ... ... ... ... 154 135 2029 2186 1752 1937 917 969 486 644 901 1400 199 616 90 19 72 14 3937 4574 4215 3689 1886 1130 2301 815 109 86 PERCENTAGE OF PARENTS PRESENT AT MEDICAL EXAMINATIONS Entrants Boys 86.3 87.5 67.2 ” Girls 88.6 Intermediate Boys 53.0 59.9 ” Girls 66.5 Leavers Boys 22.1 35.4 ” Girls 44.0 Other Ages Boys 80.0 78.9 ” Girls 74.0 117 118 HEIGHTS AND WEIGHTS. 1948. 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 minimum Height in inches. Average maximum Weight in lbs. Average minimum Weight in lbs. Number Examined. Average Height in inches. Average Weight in lbs. Average maximum Height in inches. Average minimum Height in inches. Average maximum Weight in lbs. Average minimum Weight in lbs. 1944 44 41.6 41.5 43.8 39.5 47.9 36.3 26 41.3 40.8 43.7 38.8 45.4 35.3 1943 1045 43.4 44.0 46.2 42.7 50.8 38.3 934 42.9 42.5 45.8 41.0 49.6 36.2 1942 671 44.7 46.2 47.7 40.6 52.6 39.8 628 44.0 44.3 47.0 41.6 51.3 38.3 1941 145 46.9 51.1 54.0 49.0 61.4 48.5 155 46.1 49.5 49.3 43.1 59.3 43.1 1940 38 48.7 54.1 52.4 49.3 73.8 46.3 33 49.7 54.8 52.0 47.0 61.0 55.0 1939 40 50.5 60.1 54.8 48.6 70.4 49.4 25 52.4 62.8 54.5 51.0 73.0 56.6 1938 55 53.9 70.1 56.5 61.0 85.6 55.3 52 53.8 69.2 57.1 52.8 82.3 60.4 1937 735 55.6 73.7 59.4 51.4 90.0 59.9 871 55.8 75.1 60.0 51.4 90.5 59.8 1936 359 56.5 78.2 60.3 52.8 94.1 64.9 487 57.1 79.3 62.3 53.1 102.4 63.8 1935 33 60.4 93.0 66.0 55.6 126.6 79.5 117 61.0 98.4 63.7 56.2 120.7 78.1 1934 72 61.7 98.4 68.7 53.3 129.5 83.8 184 62.6 107.3 66.9 58.2 133.4 81.4 1933 457 63.1 109.8 68.7 57.5 138.8 83.8 577 62.6 110.6 69.2 58.6 138.9 86.7 1932 131 67.2 120.9 71.3 63.1 157.2 97.8 170 64.6 120.3 67.7 61.5 142.1 99.8 1931 45 68.7 134.3 71.8 64.0 152.5 106.6 80 64.7 123.5 68.9 62.1 147.5 102.3 148 149 RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 1948. 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. Malnutrition 305 2 7.80 270 5 6.01 Uncleanliness— Head 2 — 0.05 — — — Body Skin Disease 16 2 0.46 41 5 1.01 Eye Disease— Defective Vision 151 10 4.09 238 3 5.27 Squint 62 25 2.21 54 27 1.77 External Eye Trouble 23 5 0.71 22 2 0.52 Ear Disease— Deafness 21 10 0.79 17 3 0.44 Otitis Media 2 7 0.23 11 2 0.8 Other Disease 5 7 0.31 8 4 0.26 Nose and Throat— Enlarged Tonsils only 40 67 2.72 35 67 2.23 Adenoids only 21 16 0.94 17 17 0.74 Enlarged Tonsils and Adenoids 306 123 11.00 261 112 8.15 Other Conditions 92 32 3.12 81 17 2.14 Enlarged CervicalGlands(notT.B.) 9 46 1.37 8 20 0.61 Dental Defects 79 3 2.08 76 2 1.71 Speech Defects 27 6 0.84 11 5 0.35 Heart and Circulation— Organic 8 9 0.43 4 22 0.57 Functional 2 15 0.43 14 17 0.68 Anaemia 14 1 0.38 58 1 1.29 Bronchitis 13 23 0.91 22 5 0.59 Other Non-T.B 9 23 0.81 12 16 0.61 Pulmonary Tuberculosis 15 11 0.66 10 9 0.42 Other Tuberculosis 4 6 0.25 3 4 0.15 Nervous System Disorders (including Epilepsy, chorea, etc.) 16 26 1.07 12 33 0.98 Deformities— Rickets 2 1 0.08 1 - 0.02 Spinal Curvature 83 4 2.21 150 9 3.48 Others 273 53 8.28 322 33 7.87 Other Defects and Diseases 68 42 2.79 98 35 2.91 Totals 1668 575 1856 480 Total Children Examined 3937 4574 119 150 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS, 1948 (Percentages of Children examined.) Condition. Entrants. Intermediates. Leavers. Other Ages. All Groups. Defects: Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Circulatory System 2.1 3.0 3.1 4.0 3.9 6.8 5.6 15.8 2.8 4.4 Pulmonary System 5.3 2.7 1.7 2.0 2.6 1.2 3.3 5.3 3.8 2.1 Skin Diseases 0.7 1.3 1.4 1.3 4.0 2.8 2.2 5.3 1.7 1.8 Defects of Nose and Throat 29.4 18.2 16.1 18.3 10.8 9.4 15.6 10.5 21.7 15.5 Enlarged Cervical Glands 7.7 5.6 4.3 5.0 4.5 1.9 3.3 — 6.1 4.3 Squint 3.4 2.7 2.0 1.8 1.1 1.3 2.2 5.3 2.5 2.1 External Eye Disease 0.7 0.6 1.3 0.4 1.3 0.9 4.4 — 1.1 0.7 Defective Vision 0.8 0.7 8.7 6.7 7.0 11.4 6.7 10.5 4.1 6.4 Defective Hearing 1.2 0.6 0.7 0.4 0.1 0.4 3.3 — 0.9 0.5 Speech Defects 1.7 0.6 0.4 0.5 0.9 0.2 1.1 5.3 1.2 0.5 Dental Disease (more than four decayed) 2.6 2.1 1.6 1.9 2.3 1.6 - - 2.2 1.9 Dull and Backward 0.7 0.2 0.9 0.4 0.4 0.4 - - 0.7 0.3 UNCLEANLINESS. Number of children inspected for Cleanliness (first inspection) 66,346 Number of children inspected (subsequent inspections) 2,853 Number of children found unclean (first inspection) 901 (1,946 occasions of infestation). Number of occasions in which children found unclean (subsequent inspections) 1,117 At the primary inspections vermin were found in 101 and nits alone in 1,846 children. On these inspections, 2.9 per cent. of the children showed evidence of infestation as against 3.3 in 1947. TUBERCULOSIS IN CHILDREN OF SCHOOL AGE. Contacts among school children kept under supervision during 1948— Number of cases under observation at beginning of 1948 424 Number of cases added during year 39 Number of cases discharged from observation during the year 288 Number of cases under observation at the end of 1948 175 Number of cases of Notified Tuberculosis— Non-Pulmonary 12 Pulmonary 12 120 151 Taking the total child population as 33,767, the pulmonary tuberculosis incidence rate was 35.5 per 100,000. There were no deaths from pulmonary tuberculosis and there were three deaths from non-pulmonary tuberculosis, while the incidence rate was 35.5. CAUSES OF DEATH IN CHILDREN OF SCHOOL AGE. Child population, 33,767. Number of deaths 24, which is equal to a death-rate of 0.71 per 1,000. The deaths were due to: Tuberculous Meningitis 2 Miliary Tuberculosis 1 Poliomyelitis 1 Malignant Disease of Stomach 1 Malignant Disease of Suprarenal Glands 1 Rheumatic Heart conditions 4 Heart Disease 1 Pneumonia 1 Aplastic Anaemia 1 Acute Leukaemia 1 Congenital Heart Disease 1 Hydrocephalus 1 Otitis Media 1 Volvulus 1 Subarachnoid Haemorrhage 1 Encephalitis 2 Road Traffic Accidents 1 Electrocution on Railway 1 Fracture of Skull—Struck by falling branch of tree 1 121 152 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 Poliomyelitis. Jaundice. Conjunctivitis. Sore Throat. Indefinite Sickness. In, Not Intectious Paratyphoid Erycipelas Ashburton 808 4 1 4 5 ... ... 4 ... ... 20 ... ... 1 ... 4 ... ... ... Benson 709 4 7 19 3 122 2 ... ... ... 9 ... ... 1 ... 1 ... ... ... Beulah 998 51 3 17 150 39 16 2 2 ... 4 ... ... 1 9 16 4 ... ... Croydon British 237 ... ... ... 2 ... ... ... ... 1 3 ... ... ... ... ... 1 ... ... Cypress 421 5 2 14 7 3 ... 3 1 ... 14 ... 1 ... 2 10 ... ... ... Davidson 813 45 6 13 56 20 2 5 1 ... 12 ... ... 2 ... 2 ... ... ... Duppas 387 3 1 1 54 17 4 ... ... ... 2 ... 1 ... 3 5 ... ... ... Ecclesbourne 730 30 5 7 54 8 4 1 ... 1 4 ... ... 1 ... ... ... ... ... Elmwood 736 46 1 9 13 4 1 5 ... 1 2 ... 1 2 ... 1 ... ... ... Gonville 408 28 3 24 4 30 2 ... 1 ... ... ... ... ... ... 1 ... ... ... Heathfield 106 14 ... 1 1 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... Howard 358 9 ... 24 4 8 ... ... ... ... 5 ... ... ... ... 1 ... ... ... Ingram 755 21 5 22 59 25 11 5 ... ... 6 ... ... ... ... 5 ... ... ... Kensington 438 16 1 6 77 55 ... ... ... ... 10 ... ... 1 1 1 1 ... ... Kingsley 642 48 1 5 35 ... 5 9 3 ... 5 ... 2 ... ... 2 ... ... ... Lanfranc 889 ... ... ... 9 2 4 2 ... ... 3 ... ... ... ... 1 ... ... ... Monks Orchard 427 22 1 23 29 1 ... 4 ... ... 2 ... ... ... ... 1 ... ... ... New Addington 191 4 1 15 3 14 ... 2 1 ... 4 ... ... 1 ... 1 ... ... ... Norbury Manor 1145 48 2 3 30 74 1 5 2 ... 17 ... 1 3 4 3 1 ... ... Oval 652 14 19 22 44 66 ... 5 ... ... 3 ... 2 2 1 4 3 ... ... Portland 934 65 9 30 31 13 1 2 1 ... 11 ... 3 4 1 1 1 ... ... Purley Oaks 739 44 ... 21 2 16 ... 6 ... ... 9 ... ... 1 3 6 ... ... ... Rockmount 446 39 11 21 7 2 1 ... ... ... ... ... 1 1 ... 9 ... ... ... South Norwood 858 32 14 4 24 7 1 6 1 ... 14 ... 1 ... ... 3 2 ... ... Sydenham 638 29 3 ... 26 3 ... 2 1 ... 4 ... ... ... ... ... ... ... ... Tavistock 787 33 2 9 21 3 8 8 ... 1 ... ... ... 1 2 6 ... ... ... Waddon 968 8 2 7 78 6 5 2 ... 2 11 ... ... 3 2 1 ... ... ... W. Thornton 748 47 1 4 11 7 ... 4 2 ... 4 ... 5 ... ... 2 ... ... ... Whitehorse 725 32 10 5 55 8 ... 3 ... ... 4 ... ... 1 ... 3 ... ... ... Winterbourne 915 50 1 6 6 8 7 I 1 ... 9 ... ... 1 ... ... ... ... ... Woodside 1117 36 20 27 35 5 2 2 1 ... 23 ... 1 1 1 5 ... ... ... Lady Edridge 348 ... ... ... ... 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... Heath Clark 281 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... Arch.Ten.(Bys) 184 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Arch. Ten. (Gls) 155 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... Addington Village 137 25 1 2 3 24 ... ... ... ... 2 ... ... 1 ... ... ... ... ... All Saints 220 20 4 1 13 5 ... 2 ... 1 ... ... ... ... ... ... ... ... ... Christ Church 271 36 2 12 13 14 4 4 ... ... 2 ... ... ... 1 1 ... ... ... Parish Church 419 22 3 7 16 16 6 2 ... ... 13 ... ... ... 2 3 1 ... ... St. Andrews 423 5 ... 5 11 29 ... ... ... ... 1 ... ... ... ... 2 ... ... ... St. Josephs 333 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Marks 152 23 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Marys (R.C.) 453 3 ... 11 11 ... 9 3 1 1 3 ... 1 ... ... 2 1 ... ... St. Peters 104 5 ... 3 6 31 ... 1 ... ... 5 ... ... ... ... 1 ... ... ... St. Michaels 137 1 2 2 ... ... ... 1 ... ... 1 ... ... 1 ... ... ... ... ... Shirley 194 8 1 20 19 ... ... 2 ... ... ... ... ... 1 ... ... ... ... ... St. Christophers 188 1 ... 1 3 ... 1 1 ... 4 l ... ... ... ... 2 ... ... ... St. Giles 150 ... 1 ... ... ... 3 1 ... ... ... ... ... ... ... ... ... ... St. Lukes 28 ... ... ... 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... Coloma 503 ... ... 1 ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... Selhurst Gram. 1153 ... ... ... 3 ... ... 2 2 ... 2 ... ... ... ... 1 ... ... ... John Ruskin 354 ... l ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... School of Bldg. 159 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stanley Tech. 259 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Shirley Meth. Temp. 88 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 976 149 432 1034 697 102 110 21 12 249 3 21 32 36 107 16 1 1 1125 122 153 CHIEF CAUSES OF EXCLUSIONS FROM SCHOOL. Condition. Exclusions during 1948. Percentage of total exclusions Exclusions during 1947. Percentage of total exclusions. Ringworm 21 0.49 38 0.95 Verminous Conditions 295 6.87 551 13.85 Impetigo 110 2.53 162 4.07 Scabies 102 2.38 126 3.17 Scarlet Fever 249 5.80 345 8.68 Measles (inc. German) 1125 26.20 841 21.15 Diphtheria 12 0.28 11 0.28 Whooping Cough 432 10.06 303 7.62 Chicken Pox 1034 24.08 467 11.74 Mumps 697 16.23 881 22.15 External Eye Disease 32 0.75 42 1.06 Sore Throat 36 0.81 26 0.65 Other Causes 149 3.47 184 4.63 Total 4294 — 3977 — The figures for exclusions are not related in any way to the figures obtained in routine medical inspections. These figures show an increase in Measles, Whooping Cough and Chicken Pox, whilst Impetigo, Scabies, Scarlet Fever, Mumps, Conjunctivitis and Verminous Condition, 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. 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 722 Visits re Scabies 3 Visits re Infectious Disease 191 Visits re Medical Inspections 450 All other reasons 656 Home Visits. Concerning defects found at routine medical inspections 2,157 Subsequent visits re defects found at routine medical inspections 272 Visits re special cases 722 Visits to dental cases 25 Visits other than infectious cases 1,629 Visits in connection with infectious cases (including 414 visits concerning uncleanliness) 8,150 123 154 TREATMENT. The Work of the School Clinics. SUMMARY OF ATTENDANCES. 1948. 1947. Increase or Decrease. Minor Ailments Clinic 20331 15998 + 4333 Inspection Clinic 4033 3296 + 737 Dental Clinics 20035 19106 + 929 Ophthalmic Clinic 4632 4422 + 210 Orthopaedic Clinic 542 462 + 80 Remedial Exercises Clinic 9270 7020 + 2250 Nose and Throat Clinic 4002 434 + 3568 Rheumatism Clinic 58 102 — 44 62903 50840 + 12063 The Minor Ailments Clinics. At the Lodge Road Clinic, 1,662 defects involved 11,184 attendances, while at the subsidiary Clinics held at 206, Selhurst Road on five days weekly, 802 defects, 3,695 attendances, and at the Duppas School 855 defects, 5,452 attendances. Complaint. 1948. 194 7 Cases. Attendances. Average No. of Attendances. per case. Cases. Attendances. Average No. of Attendances. per case. Ringworm 33 258 7.8 69 576 8.3 Scabies 53 206 3.9 110 401 3.6 Impetigo 151 1164 7.7 230 1418 6.2 Other Skin Diseases 92 580 6.3 115 425 3.7 Otorrhoea and other Ear defects 318 2076 6.5 305 1734 5.7 External Eye Disease 371 1438 3.9 339 1372 4.0 Miscellaneous 2314 9807 4.2 2127 10123 4.8 3332 15529 4.7 3295 16049 4.9 Adenoids and Enlarged Tonsils. During 1948, 1,161 children were operated upon for adenoids and enlarged tonsils, and 4,002 attendances were made at the Throat Clinic. 124 155 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 1934 1934 1.20 - 571 up to July 5 — This Clinic showed an increase upon 1947 in numbers submitted to refraction. A total of 4,632 attendances was recorded. SCHOOL DENTAL SERVICE. The following Report is given by Mr. P. G. Oliver, Senior Cental Officer. The above service deals chiefly with the routine inspection and treatment of those attending Borough Primary, Secondary, Technical and Special Schools. "Free-place" scholars at certain non-maintained schools approved by the local Education Committee are also eligible for treatment. In addition to the above, facilities are also provided for those referred under Maternity and Child, Welfare and Mental Deficiency Schemes. Since the inception of the National Health Service on 5th July, 1948, the dental care of those suffering from Tuberculosis is no longer the responsibility of Local Authorities, and treatment of the above patients will cease as soon as alternative arrangements can be provided through the Regional Board. Arrangements for Treatment. The major portion of treatment is at present carried out at Lodge Road Health Centre where three surgeries are designed to work as a centralised unit. An additional surgery has recently been introduced to serve until the proposed extension to these premises is complete. Other dental centres are provided at Duppas Hill and South Norwood, but in both these localities accommodation is limited and improved facilities are needed. 125 156 Additional dental clinics have been planned to serve the Woodside area and the New Addington Housing Estate, but to date building restrictions have impeded development. In the last-named district the only possible accommodation is at present used for Education purposes, and it is unlikely that these premises will be vacated until the end of 1949. Should these quarters not become available it is hoped that permanent accommodation will ultimately be included in the proposed District Health Centre. To meet future Education commitments an additional long term expansion of the service was formulated in 1946, but with one exception these undertakings have not yet advanced beyond the blue print stage. The following Table illustrates the probable yearly increase in the school population, together with the requisite in staff likely to be 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 and onwards Plus County Colleges, 7,000 — Plus Nursery Schools, 800 42,490 1-2 Total: 5-6 * Now behind schedule. Staffing. Difficulty in obtaining "professional" personnel is creating a major problem and is seriously hampering urgently needed expansion of the local scheme. Until lately the staff consisted of six full-time dental officers. One dental surgeon has, unfortunately, resigned and as no suitable candidate was forthcoming, has been replaced by a part-time officer. At the time of writing the general "drift" of public dental officers into more remunerative* fields is having its local repercussions, and further losses are feared to be eminent.* * On going to press, the resignation of a second dentist is reported. 126 157 Existing staff is quite inadequate to deal with the school population of over 27,000 and other Maternity and Child Welfare commitments. In terms of establishment this represents over 5,000 children to one dental officer, and makes it impossible to carry out the annual inspection recommended by the Ministry. Recent statistics show that the time lapse between successive treatments is now in the neighbourhood of 16-18 months, and unless additional assistance is forthcoming, this period is likely to become progressively longer. As mentioned later in this Report delay in revisiting schools has produced a substantial increase in the number of those applying for emergency treatment. Whilst such applications are unfortunately unavoidable, the time required to deal with these cases is considerable, and thus the carrying out of routine treatment is further retarded. As a result of the above position, over 9,000 children on the school register received no inspection during the current year. Hearing in mind the fact that local services are now serving the needs of approximately 80% of the juvenile population of the Borough, further diminution in staff may well be productive of disastrous results. The suggestion that in the event of a breakdown of the School Dental Scheme, alternative treatment could be obtained through the General Practitioner Service has little foundation in fact, and it is probable that in practice such an arrangement would mean attention for only a small minority. Private dentists are in the main fully occupied in coping with the demands of the adult section of the community, and have neither the time nor the facilities to deal with children in any appreciable numbers. In view of the fact that the present entry into the dental profession is only one third of the number actually required for the nation as a whole, the position is unlikely to alter for a considerable number of years. An aspect of the problem not fully appreciated is that "Children's Dentistry," involving as it does the care of the very young, has today become a highly specialised occupation, calling for the employment of specially selected staff. When applied to the masses the carrying out of such work involves many technical and social problems which can be most satisfactorily handled at a national level. From a "preventative" standpoint the existing arrangements for linking treatment with Local Authority Education Schemes represents the most practical method of bringing dentistry to the individual child. 127 158 Inspections. The number of children on the register at Primary and Secondary Schools within the Borough at the close of 1948 was. 27,724. Including an additional 104 free-place scholars at nonmaintained schools this represents a sum total of 27,828 children. Of these, 18,706 were inspected and 9,432 (50.4%) referred for treatment, compared with 18,489 inspected and 9,728 (52.6%) referred in 1947. The above results indicate a further reduction of 2.2% in the number requiring treatment. This figure, compared with that obtained in 1945, shows a total decrease of approximately 11% in the three successive years and represents a substantial achievement in dealing with wartime arrears. It is significant that present gains have only been rendered possible by more frequent inspection and treatment, and unless this practice can be continued some deterioration is to be expected. 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 is generally accepted that this has come about as a result of increased ante-natal care for mothers, and improved nutrition in infancy. Though the effect of these structural changes does to some extent tend to postpone the onset of decay in the milk teeth, such children still require a considerable amount of attention to keep their dentitions intact, and there appears to be little evidence that anything has occurred to lessen the incidence of caries in the permanent teeth. Owing to insufficient staff eighteen Departments (Primary and Secondary) comprising some 9,235 children, received no routine dental inspection during the year. The results obtained from school inspections were as follows: Acceptance of Treatment 74.4% Refused Treatment 12.3% Forms Not Returned 13.3% Compared with 1947 acceptances indicate a further increase of 1.5%, thus maintaining the upward trend noticeable in recent years. 128 159 Although since the passing of the National Health Act free treatment is now available through the General Practitioner Service, there is so far little indication that parents wish to avail themselves of such facilities for their children. In practice it has been found that during recent months practitioners have had little time to devote to juvenile patients, and have in many cases recommended that attention should be obtained at the school clinic instead. The following analysis demonstrates the progressive rise in the acceptance rate during recent vears:— RESULTS OF SCHOOL INSPECTIONS. 1948. 1947. 1946. 1943. 1937. No. referred for— Treatment 9432 9728 12046 9041 13498 Consents 7019:74.4% 7093:72.9% 8433:70% 5642:62.4% 7762:57.5% (Total Consents Including Specials)* (9316:79.1%) (9006:77.3%) (13810:74%) (6814:67%) (10146:63%) Refusals 1153:12.3 % 1107: 11.8% 1542:12.8% 1519: 16.8% 3242: 24% Forms Not Returned 1255:13.3 % 1488: 15.3% 2071:17.2% 1880: 20.8% 2494:18.5% * Specials.—Those referred by Head Teachers with Emergency Forms Treatment. Of 9,516 children consenting to treatment (including specials) 9,344 (98.2 per cent.) were treated and 8,614 (90.5 per cent.) cured (completely), compared with 9,006 consenting, 8,666 (96 per cent.) treated, and 7,830 (86.9 per cent.) cured in 1947. Clinical sessions rose from 1,795 in 1947, to 1,832. Attendances during the year rose from 10.6 to 10.9 patients per session. Though these figures indicate a slight advance on the previous year, the overall position cannot be considered satisfactory whilst so many children are precluded from receiving an annual inspection and treatment. Another undesirable feature noted during the year has been the very appreciable increase in requests for emergency treatment, caused by delay in revisiting certain schools. Whilst every effort has been made to meet these demands, such work can only be carried out at the expense of those already awaiting treatment, and thus routine measures are further retarded. 129 160 Items of Treatment * The ensuing Table gives particulars of the principal items treatment compared with those obtained last year:— 1948. 1947. Attendances 20,035 19,106 Treated 9,344 8,666 Re-treated 4,651 4,324 Fillings—Permanent 5,981 5,915 Temporary 2,047 2,236 Extractions—Permanent 1,832 1,521 Temporary 11,062 9,462 Gas Administration 3,747 3,440 Local Anaesthetics 3,585 3,489 Other Operations—Permanent 6,974 7,260 Temporary 3,154 3,619 Cases Completed 8,614 7,830 Special Treatment. These include:— 1948. 1947 Root treatment in anterior teeth 24 28 Removal of nerves under local anasthetic 6 18 Gingivectomy 4 6 Removal of bone sequestra 9 7 Splints for fractured incisors — 2 Number of M.D.s treated 27 21 Dentures inserted 38 45 Irrigation of sockets 19 20 Removal of impacted and difficult teeth 27 25 Ulcerative stomatitis (Vincent's infection) 16 13 Cleft Palate or Labial Fraenum 1 1 Application of Pencillin "Cones" 36 42 Crowns for Incisor Teeth 1 2 Referred for X-Ray 102 110 Treatment for haemorrhage 2 — Forms from Head Teachers. The number of forms issued by Head Teachers for emergency treatment was 2,497 compared with 1,913 in 1947. X-Ray Examinations. The number of cases referred to Mayday Hospital for the above purpose was 102, compared with 110 in 1947. 130 161 Orthodontic Treatment. Despite much good work carried out by the dental staff the treatment of oral deformities continues to present many technical difficulties, and with existing facilities it is not as yet possible to cope with all conditions requiring attention. Those necessitating the fitting of more complicated appliances are now referred to one or other of the major teaching Hospitals, but unfortunately this involves considerable delay before actual treatment can be commenced. The establishment of a specialised department to handle such cases is now urgently required, and it is hoped that some such project can receive active consideration as soon as increased accommodation becomes available. The number of sessions devoted to this work were 239 compared with 248 last year. The following is a summary of treatment performed:— 1948. 1947. Cases under Treatment 370 425 New Cases 141 201 Cases Completed 170 126 Attendances 2,843 3 381 Appliances—Fixed 13 7 Removable 238 317 Treatment Sessions 239 248 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 "freeplace" scholars are, if desired, eligible for attendance at the School Dental Clinic. A summary of the treatment performed for the above children given below:— 1948. 1947. Attendances 209 298 New Cases Treated 39 44 Re-treated 49 63 Fillings—Permanent 128 173 Extractions—Permanent 29 59 Temporary 44 40 Other Operations 47 64 "Gas" Cases 24 36 Local Anaesthesia 20 23 Cases Completed 50 86 Dentures Fitted 1 3 Referred X-Ray 2 1 131 162 Summary of Work Done at the Selhurst Road Clinic. 1948. 1947. Attendances 3,431 3,706 Extractions 2,076 1,968 Fillings 1,202 1,242 Other Operations 2,807 3,214 "Gas" Cases 594 578 Local Anaesthesia 519 470 Cases Completed 1,569 1,628 Sessions held: Inspection 31, Treatment 378, Gas 45. The average attendance at this Clinic per session is 9. Summary of Work Done at the Waldrons Clinic. 1948. 1947. Attendances 2,628 2,389 Extractions 1,826 1,579 Fillings 1,625 1,859 Other Operations 383 309 "Gas" Cases 495 359 Local Anaesthesia 1,816 2,315 Cases Completed 931 900 Sessions held: Inspection 12, Treatment 269, Gas 37. The average attendance at this Clinic per session is 9.8. DENTAL DEFECTS. (1) Number of children who were— (a) Inspected by Dental Officer: Year 1948. Year 1947. Aged 5—6 1,174 Total: 18,706 1,016 ,, 6—7 2,229 1,683 ,, 7—8 1,839 1,794 ,, 8—9 1,913 2,001 ,, 9—10 2,152 1,944 ,, 10—11 2,124 1,916 ,, 11—12 1,635 1,851 ,, 12—13 1,393 1,949 ,, 13—14 1,352 1,741 ,, 14—15 1,345 1,391 ,, 15—16 1,010 890 ,, 16 up 540 313 Specials 2,497 1,913 21,203 20,402 132 163 Year Year 1948 1947 (b) Found to require treatment 11,929 11,641 (c) Actually treated 9,344 8,666 (2) Half-days devoted to Inspection 157 173 Treatment 1,832 1,795 1,989 1,968 Number of Gas Sessions— Lodge Road 173 169 (by Dental Officers). Selhurst and Waldrons 82 61 255 230 Administrative Sessions 119 125 Orthodontic Sessions 239 248 (3) Attendances made by children for treatment 20,035 19,106 (4) Fillings— Permanent teeth 5,981 5,915 Temporary teeth 2,047 2,236 8,028 8,151 (5) Extractions- Permanent teeth 1,832 1,521 Temporary teeth 11,062 9,462 12,894 10,983 (6) Administrations of general anaesthetics for extractions 3,747 3,440 (7) Administrations of local anaesthetics for extractions 3,585 3,489 (8) Other Operations— Permanent teeth 6,974 7,260 Temporary teeth 3,154 3,619 10,128 10,879 Fillings per session 4.3 4.5 Extractions per session nitrous oxide 50.5 47.7 133 164 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 314 together with 1,421 who were given re-inforcing injections. 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. ORTHOPAEDIC WORK. Summary of Cases attending the Orthopaedic Clinic : — Jan. 1st, 1948. New Cases. Cases Discharged. Cases on Books 31st Dec., 1948. 399 248 204 443 355 children were seen by the Orthopaedic Surgeon and 536 attendances were made. .SPINAL AND OTHER REMEDIAL CLINICS. 1947. 1948. Attendances. Sessions. Av. att. Attend ances. Sessions. Av. att. Spinal 1,592 333 4.8 1,657 333 5.0 Massage 187 187 1.0 30 30 1.0 Flat Feet 3,237 356 9.1 2,800 337 8.3 Breathing 2,004 230 8.7 4,783 395 12.1 7,020 1,106 9,270 1,095 RHEUMATISM CLINIC. The total number of children whose names were on the " live " register at the end of 1948 was 122 (males 53, females 69). Four names were removed from the register as completely recovered or non-rheumatic. Four cases were referred for convalescent home treatment. One case was referred to the Child Guidance Clinic, one case to its own doctor, and two cases were put on the list for tonsillectomy. 134 165 Cases Examined at Rheumatism Clinic. 1945. 1946. 1947. 1948. Primary 32 59 27 31 Re-exams. 10 47 75 27 42 106 102 58 Primary Cases. Rheumatic 24 49 21 22 (71.0%) Non-Rheumatic 8 10 6 4 (12.9%) Doubtful Rheumatic — — — 5 (16.1%) 32 59 27 31 Classification of Rheumatic Cases. Primary. Re-examinations. Males 6 15 Females 16 12 22 27 Ages . 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Primary Re-exams. 1 3 2 4 2 1 2 6 1 5 4 1 5 8 2 1 6 1 1 o — — Grouping of Cases. 1945. Mild and Prim. 1946. Re's. Prim. 1947. Re's. Total. Prim. 1948. Re's. Total. Potential 20 34 23 12 42 54 17 9 26 Definitely Active 9 5 4 2 5 7 0 6 6 Quiescent 5 Doubtful or 10 20 — 14 14 5 10 15 Xon-Rheumatic ... ... ... ... 9 2 11 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 ho longer active. 135 166 Primary Examinations. Amongst the 22 new cases the following Rheumatic man testations were recorded :— Rheumatic pains 21 Chorea (suspected) 2 Carditis (definite) 2 Carditis (suspected) 6 Tonsillitis and Infested Tonsils 6 Pyrexial attacks 2 Erythema Nodosum 1 Family Histories. Of the primary cases, 10 gave a history of rheumatism in th family, 8 being histories of rheumatic fever in parents and 2 ii brothers and sisters. Nervous Conditions. Recorded in 21 cases— Highly strung 4 Headaches 11 Night terrors 5 Enuresis 1 Twitchings — Past history of Chorea or other nervous condition — Minor degrees of nervous disorders 6 Often a combination of more than one of the above symptom! was manifested. Re-examinations. Of the 27 cases re-examined, none were worse, 2 showed iw essential change, 20 were improved, and 5 were quiescent. BLIND, DEAF, EDUCATIONALLY SUB-NORMAL AND EPILEPTIC CHILDREN. Blind Children. 4 boys are resident in specials schools for the blind. The institutions which these children attend are as follows The Worcester School for the Blind, 2 boys; Linden Lodge, 2 boys.j Deaf Children. 17 boys and 8 girls are resident at special schools for the deaf. The institutions which these children attend are:—Royal School for Deaf, Margate, 7 boys and 4 girls; Rayners School 136 167 for the Deaf, Penn, 1 boy; 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; Anerley Residential, 2 boys; East Anglia School, 1 boy; Townsend Street L.C.C., 1 boy; Old Kent Road, 2 boys. Epileptic Children. 5 boys. The institutions which these children attend are : — Lingfield Epileptic Colony, Surrey, 2 boys; Chalfont Colony, Chalfont St. Peter's, Bucks, 3 boys. Educationally Sub-Normal Children. In addition to the day acommodation provided at St. Christopher's School, 2 boys and 2 girls are resident in the Monvhull Residential School, Birmingham; Gosden House, Brnmley, 1 boy, 1 girl; St. foseph's, Dunmow, 1 boy; Caldicott Community, 1 boy; Modern School, Surbiton, 2 boys; Michael Hall School, 1 boy; Davington School, Usk, 1 boy. ST. CHRISTOPHER'S SPECIAL EDUCATIONALLY SUB-NORMAL SCHOOL. I am indebted to Mr. Ramsden, the Head Master, for the following observations : — During 1948 the steady progress made in the previous year has been maintained in spite of the upheavals caused by changes of staff and repairs to the school and playground. We welcomed to our Staff Mr. Powell, Miss Gelderd, L.C.P., Mrs Maddock and Miss Pelton. Our swimming class continued to prosper, anil on Friday, July 23rd, • Dr. Holden visited the school and presented George Knowles and Roy Anstiss with their Intermediate Life Saving Certificates. He also presented 25 yards', 50 yards' and 100 yards' Certificates to several other boys. The School was granted a day's holiday on September 13th in honour of this event. On the last day of the school year George Knowles and Roy Anstiss passed the examination for the Royal Life Saving Institution's Bronze Medallion. The annual Open Day was again a great success and a large crowd of parents and friends saw the year's work of the children and were duly impressed. Unfortunately, owing to the lack of a music tutor we were not able to give our customary Carol and Tableaux Service at Christmas. We regret that during holiday periods two of our children, Margaret Dye and John Holman suffered fatal accidents, and our sincere sympathy is felt for the parents in their sad loss. The last term of the year was notable for the immunisation of about 120 scholars following several cases of Diphtheria amongst the children. We are pleased to record that this is now satisfactorily over and all are recovered and back at School. 137 168 His Majesty's Inspector visited the School during the year andl expressed his pleasure at the work being done and the happy, willingl attitude of the children to their work. We look forward to 1949 with our misfortunes of 1948 left behind! and with the hope that prosperity and success will reward our earnestl endeavours. Number attending 1st January, 1948 173 do do. 31st December, 1948 186 do. referred to Public Elementary Schools 2 Number discharged : (i) Ineducable and referred to Mental Health Committee 10 (ii) Unfit to work do. do. do. 1 (iii) Fit to work do. do. do. 1 (iv) Fit to work and not referred to Mental Health mittee 2 CLINIC FOR EDUCATIONALLY SUB-NORMAL CHILDREN. 171 children were examined during 1948r The classifications! arrived at, together with recommendations made, are summarised! under— (1) Found to be educationally subnormal : 1947. 1948.1 (a) Recommended for Special Day School 40 64 I (b) Recommended for Residential School 6 (2) Found to be dull and backward : (a) Referred to a Special Class 1 14 I (b) Re-test in one year 46 25 I (c) To attend St. Giles' because of physical defect 2 31 (d) Referred for Medical Treatment 2 2 (e) Recommended for Special School for Deaf 2 2 (/) Recommended for Epileptic Colony .2 1 (g) Recommended for Home Teaching 1 (3) -Referred to Child Guidance Clinic 4 (4) Referred back to ordinary school 17 (5) No recommendation made. For further examination 9 (6) Examined for other Authorities 2 110 144 Mental Tests at St. Christopher's 11 27 121 171 841 home visits have been paid to Education cases. 138 169 Physically Handicapped Children. In addition to 151 physically handicapped children accommodated at St. Giles' Open-air School, the Education Authority have crippled children in the following special schools :—The Heritage Craft School, Chailey, 1 girl; Henwick Hall, 3 boys; St. Catharine's Home, 1 boy; Rob Roy, Speldhurst, 1 girl; Cony Hill Residential, Margate, 1 boy; Campbell Rudolf Steiner, 1 boy; Fairfield House, Broadstairs, 1 girl; St. Margaret's (Spastic), 3 boys and 2 girls; Alexander Hospital, I girl; llollins Hall Home, 1 boy; Hillaway School, 1 boy; Downs Residential School, 1 boy; Children's Seaside Home, Exmouth, I girl; Lillesden School, 1 girl; West Wickham Heart Hospital, 1 boy, 1 girl; St. Vincent's, 1 boy. Speech Defects Clinic. Total number of cases treated 120 ,, ,, discharged 55 ,, ,, still attending 65 Referred for physical treatment 5 ,, Child Guidance Clinic 3 Number of stammerers treated 48 ,, alalias treated 7 ,, cleft palate treated "4 „ lisps 6 ,, congenital deafness 1 ,, dyslalia 54 JUVENILE EMPLOYMENT RETURN. The following numbers of children were examined by the medical officers during 1948 as to their fitness to following the part-time employment indicated : — 1948. 1947. 1946. 1945. 1944. Delivery of Goods for Shopkeepers 190 112 2 60 81 Delivery of Newpapers 375 151 125 90 167 Delivery of Milk 33 6 9 13 17 598 269 136 163 265 139 170 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT. During 1948- all milk was supplied free of charge, anil approximaptely 23,000 children per day received l/3rd pint each. This was equal to 93 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 over 16,000 at the beginning of 1948 to 17,000 at the end of 1948. Malt and Oil is given free on the recommendation of the School Medical Officer, and the following issues were made 1947. Issues. 1948. Issues. Free Malt and Oil 549 104,960 1,872 372,528 140 CHILD GUIDANCE CLINIC. Return of Cases for the year 1948. Girls. Boys. Total No. 315 158 157 Source of Referral, Medical Officer of Health 34 64 Court and Police 2 17 Remand Home and Approved School 61 1 Education Department and Schools 5 12 General Practitioners and Hospitals 14 19 Parents and Relatives 32 37 Miscellaneous 10 7 . 158 157 Intelligence Quotient. High—(ab. 110) 18 19 Average—(90/110) 35 32 Low—(below 90) 57 38 Not classified 48 68 158 157 171 Girls. Boys Results. Diagnostic/advice given 81 42 Improved 15 20 Slight limprovement 7 6 Not improved 2 5 Parents unco-operative 9 11 Boarding School — — Foster Homes — 3 Others 8 13 Transfer of School 2 2 Current cases 34 55 158 157 - —— Total 315 Examinations by the Educational Psychologist 336 Xumber of cases attending for psychiatriac treatment 1,321 NON-MAINTAINED SCHOOLS. The usual arrangements for the medical inspection of nonmaintained school children were continued in 1948; 138 children were examined, all girls. Table II. of Appendix 13. gives the detailed findings. Yours faithfully, S. L. WRIGHT, School Medical Officer. 172 APPENDIX A. MEDICAL INSPECTION RETURNS. Year ended -31st December, 1948. Table I. MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. A. Periodic Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 4,215 Second Age Group 1,886 Third Age Group 2,301 Total 8,402 Number of other Periodic Inspections 109 Grand Total 8,511 B.—Other Inspections. Number of Special Inspections 7,394 Number of Re-Inspections 13,874 Total 21,269 C.—Pupils found to require Treatment. (Excluding Dental Disease and Infestation with Vermin). Group (1) For defective vision (excluding squint). (2) For any of the other conditions recorded in Table 11A (3) Total individual pupils. (4) Entrants 27 1302 1320 Second Age Group 139 439 531 Third Age Group 214 540 692 Total (prescribed group?) 380 2281 2543 Other Periodic Inspections 8 37 42 Grand Total 388 2318 2585 142 173 Table II. A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION. Periodic Inspections Special Inspections Defect Code No. No. of defects No. of Refects Defect or Disease 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 57 7 8 1 5 Eyes— (a) Vision 388 13 71 1 (b) Squint 116 52 10 — (c) Other 32 6 5 —, 6 Ears— (a) Hearing 38 13 1 (b) Otitis Media 13 9 1 — (c) Other 13 11 2 1 7 Nose or Throat 853 451 41 26 8 Speech 38 11 5 1 9 Cervical Glands 17 66 1 2 10 Heart and Circulation 100 65 8 5 11 Lungs 56 67 2 3 12 Developmental— (a) Hernia Not available (b) Other 13 Orthopaedic— (a) Posture 233 13 12 (b) Rickets 3 1 — — (c) Other 595 91 28 10 14 Nervous System— (a) Epilepsy 4 1 5 (b) Other 28 55 3 6 15 Psychological— (a) Development Not available (b) Stability „ „ 16 Other 166 77 17 14 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 4215 708 16.8 3092 73.4 415 9.8 Second Age Group 1886 242 12.8 1457 77.3 187 9.9 Third Age Group 2301 243 10.5 1845 80.2 213 9.3 Other Periodic Inspections 109 3 2.7 90 82.6 16 14.7 Total 8511 1196 14.0 6484 76.2 831 9.8 143 174 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 (ii) Other treatment 258 Ringworm—Body — Scabies 55 Impetigo 151 Other skin diseases 92 Eye Disease 371 (External and other, but excluding errors of refraction, squint and cases admitted to hospital) Ear Defects 318 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 2314 Total 3559 (b) Total number of attendances at Authority's minor ailments clinics 20331 GROUP II.—DEFECTIVE VISION AND SQUINT (excluding Eye Disease treated as Minor Ailments—Group I). No. of defects dealt with Errors of Refraction (including squint) 1934 Other defect or disease of the eyes (excluding those recorded in Group I) — Total 1934 No. of Pupils for whom spectacles were (a) Prescribed 1020 (b) Obtained to 5th July, 1948 571 GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Total number treated Received operative treatment— (a) for adenoids and chronic tonsillitis 1161 (b) for other nose and throat conditions — Received other forms of treatment — Total 1161 GROUP IV.—ORTHOPAEDIC AND POSTURAL DEFECTS. (a) No. treated as in-patients in hospitals or hospital schools 19 (f>) No. treated otherwise, e.g., in clinics or out-patient departments 362 GROUP v.—CHILD GUIDANCE TREATMENT AND SPEECH THERAPY. No. of pupils treated (a) under Child Guidance arrangements 315 (b) under Speech Therapy arrangements 120 144 175 Table IV. DENTAL INSPECTION AND TREATMENT. (1) Number of pupils inspected by the Authority's Dental Officersfa) Periodic age groups 18706 (ft) Specials 2497 (c) Total (Periodic and Specials) 21203 (2) Number found to require treatment 11923 (3) Number actually treated 9344 (4) Attendances made by pupils for treatment 20035 (5) Half-days devoted to : (a) Inspection 157 (b) Treatment 1832 Total (a) and (ft) 1989 (6) Fillings: Permanent Teeth 5931 Temporary Teeth 2047 Total 8028 (7) Extractions: Permanent Teeth 1832 Temporary Teeth 11062 Total 12894 (8) Administration of general anaesthetics for extraction 3747 (9) Other Operations : (a) Permanent Teeth 6974 (b) Temporary Teeth 3154 Total (a) and (b) 10128 Table V. INFESTATION WITH VERMIN. (i) Total number of examinations in the schools by the school nurses or other authorised persons 69199 (ii) Total number of individual pupils found to be infested 954 (iii) Number of individual pupils in respect of whom cleansing notices were issued 295 (iv) Number of individual pupils voluntarily cleansed at Cleansing Station 75 176 Table VI. SCHOOL MEDICAL AND DENTAL STAFF. as at 31st December, 1948. Names of Medical Officers. Proportion of whole time (expressed as a percentage) devoted to School Health Service. Public Health S.M.O.—Wright, S. L., M.D., M.R.C.P., D.P.H 20% 80% A.S.M.O.s— Fleming, Gerald M., M.A., M.B., B.Ch., D.P.H. 60% 40% Morrison, Rosa, M.B., B.Ch., D.P.H 25% 75% Hegarty, Ellen Mackenzie, M.B., B.Ch., D.P.H. . 25% 75% Harding, Kathleen, M., M.B., B.S 20% 80% Douglas, Mary C., M.B., Ch.B 25% 75% Burns, J. P., M B., B.S., B.A.O., D.P.H 65% 35% Senior Dental Officer—Oliver, Percy Gerrard, L.D.S. 90% 10% Assistant Dental Officers— Bryce, J. K. R., L.D.S. • Urbani, C. P., L.D.S., R.C.S. Eng. 100% - 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 28 45% District Nurses — — Nursing Assistants — — Dental Attendants 4 100% * This term refers to the untrained assistants described in paragraph 3 of Circular 1604. 146 177 NON-MAINTAINED TABLE II—A.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1948. Routine Inspections. Number of defects. Special Inspections Number of defects. DEFECT OR DISEASE. 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 2 ... ... ... Uncleanliness. (See Table IV.—Group V.) Skin— Ringworm: Scalp ... ... ... ... Body ... ... .... ... Scabies ... ... ... ... Impetigo ... ... ... ... Other diseases (non-tuberculous) 2 ... ... ... Eye— Blepharitis 1 ... ... ... Conjunctivitis 1 ... ... ... Keratitis ... ... ... ... Corneal opacities ... ... ... ... Defective vision (excluding squint) 14 ... ... ... Squint ... ... ... ... Other conditions 1 ... ... ... Ear— Defective hearing 1 1 ... ... Otitis media ... ... ... ... Other ear diseases ... ... ... ... Nose and Throat— Enlarged tonsils only ... ... ... ... Adenoids only 1 ... ... ... Enlarged tonsils and adenoids 2 3 ... ... Other conditions 1 ... ... ... Enlarged Cervical Glands (Non-Tuberculous) 1 ... ... ... Defective Speech ... ... ... ... Teeth—Dental Disease 1 ... ... ... Heart and Circulation— Heart Disease— Organic ... 1 ... ... Functional 2 ... ... ... Anaemia 5 ... ... ... Lungs— Bronchitis ... ... ... ... Other non-tuberculous diseases 1 ... ... • •• Tuberculosis— Pulmonary— Definite ... ... ... ... Suspected ... ... ... ... Non-pulmonary— Glands ... ... ... ... Spine ... ... ... ... Hip ... ... ... ... Other bones and joints ... ... ... ... Skin ... ... ... ... Other forms ... ... ... ... Nervous System— Epilepsy ... ... ... ... Chorea l ... ... ... Other conditions 2 ... ... ... Deformities- Rickets ... ... ... ... Spinal curvature 11 ... ... ... Other forms 14 ... ... ... Other Defects and Diseases 7 1 ... ... 147 178 APPENDIX B. NON-MAINTAINED SCHOOLS. Year ended 31si December, 1948. Table I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Year 1948. Year 1947. Age 11 or under 43 54 12 19 51 13 18 ^1 14 18 20 15 6 18 16 10 24 17 14 15 18 or over 10 .— Total 138 203 B.—Other Inspections. Year 1948. Year 1947. Number of Special Inspections — — Number of Re-inspections 7 — Total 7 - Visits to Non-maintained Schools 6 11 148 179 CONTENTS. A PUBLIC HEALTH REPORT. PAGli Abortion 75 Acts, Adoptive 87 Adulteration 109 Airport 110 Ambulance Service 17,80 Amusement Houses 90,95 Animals, Keeping of 90,94 Ante-Natal Clinic 62, 75 Births 2, 4, 55 Blind Persons 85 Blood Examinations 46 Borough Hospital 23 Byelaws and Regulations 90 Cancer 39 Cprebro-Spinal Meningitis 28 Chest Clinic 40 Chicken Pox 29 Contacts, Tuberculosis 51 Committee 1 Cowkeepers 100 Dairies, Cowsheds & Milkshops 100 Day Nurseries 64 Deaths 2,3,4,6,7,30 Dental Treatment—M. & C.W. 65 Diphtheria 26, 33 Disinfection 95 Hisinfrstation 95 Ditches 90, 94 Drainage 94 Dysentery 29 Enteric Group 29 Erysipelas 29 Kxoectant Mothers 65, 66, 74 Extra Nourishment 49 F i tories and Workshops Acts 89, 92 Fertilisers & Feeding Stuffs Act 96 Foods 89. 97. 105 Foster-Mothers 73 Foster-Children 73 Onstro-Entefitis 26 German Measles 30 Gynaecological Clinic 76 Health Visitors, Works of 34, 71 Home Helps 17, 70 'tome Nursing 49 Homework 93 PAGE Hospital, St. Mary's (Maternity) 73 Houses Let in Lodgings 91 Housing 90 Housing Act 90 Ice Cream 104 Illegitamacy 2, 3, 4 Immunisation Clinic 33 Infant Welfare Clinics . 65, 69 Infant Mortality 3, 56, 58, 60 Infectious Diseases 22 Inquests 4 Laboratory Work 9, 15, 31, 46, 76, 104 Local Acts 87 Lodging Houses, Common 91 Mass Radiography 50, 55 Marriages 3 Massage 14 Maternity Homes 63 Maternity Homes, Registration 63 Mayday Hospital 10,74 Measles 28 Meat Inspection 99 Medical Help Records 61 Men's Hostel 92 Mental Health 76 Mid wives 61 Mid wives, Municipal 62 Midwives Act 61 Milk, Provision of 49 Milk, Examination of 32, 108 Milk, Tuberculosis 100 Milkshops 100 Mortality in Childbirth 2, 56, 74 Mothers' and Tnfants' Welfare Association 65 Mumps 27 Neo-Natal Deaths 59 Notification of Birth Acts 55 Nuisances 88 Nursing Homes 63 Obstetrical Unit 73 Offensive Trades 94 Ophthalmia Neonatorum 29, 58 Orthopaedic Department 80 Out of Borough Cases 30 Out-patients 16 Outworkers 93 149 180 PAGE Physiotherapy 14 Poisons and Pharmacy Act 96 Poliomyelitis 27 Ponds 90, 94 Population 2 Post-Natal Clinic 76 Post-Mortems 4 Premature Infants 70 Puerperal Sepsis and Pyrexia 22, 57 Rats & Mice (Destruction) Act 96 Road Traffic Accidents 18 Rubella 30 Sanatorium, Cheam 47, 49 Sanatoria, Treatment in 47^49 Sanitary Administration 87 Sanitary Certificates 92 Sanitary Inspectors, Work of 87 Scarlet Fever 27 Schools, Inspection of 93 Shop Hours Acts 89, 94 Slaughterhouses 99 Smoke Observation 94 Sputum, Examination 15,31,46 Still-Births 2, .57 St. Mary's Maternity Hospital 74 Suicide 6. 7. 19 13 —SCHOOL MEDICAL REPORT PAGE Accommodation 114 Adenoids 124 Blind Children 136 Child Guidance 140 Cleansing of Children 120 Clinics 124 Cod Liver Oil 140 Cost 114 Crippling Defects 124, 134 Deaf Children 136 Deaths 121 Defective Children' 119, 139 Defective Hearing 136 Deformities 124,134 Dental Service 125 Dental Treatment 124 Ear Disease 136 Epileptic Children 137 Exclusions 123 Eye Clinic 124 Eye Disease 124 Following-up 123 PAGE Tuberculosis—Cheam Sanatorium 47, 49 ,, Allowances 51 ,, Contacts 51 ,, Deaths 44 ,, Dental Treatment 53, 54 ,, Notifications 41 ,, Thoracic Surgery 49 ,, Home Nursing 49 ,, Home Visits 49 ,, Statistics 50 ,, Institutional Treatment 47, 49 Vaccination 34 Verminous Persons 95 Venereal Diseases 36, 75 Vital Statistics 2 Ward Statistics 5 Watercourses 90, 94 Water Supply 8 Whooping Cough 26,34 Workplaces 89. 91? Workshops 89, 92 X-Ray Examination 46, 50 76 Zymotic Diseases 5 PAGE Health Visitors, Work of 123 Heights and Weights 118 Immunization, Diphtheria 134 Infectious Diseases 122 Inspection Clinic 124 Inspections 116 Juvenile Employment 139 Lungs, Diseases of 120 Malnutrition 119 Malt 140 Massage Clinic 134 Meals, Provisions of 114, 140 Mentally Defective Children 137 Milk, etc., Provision of 114, 140 Minor Ailments 124 Non-maintained Schools 141 Nutrition 119 Orthopaedic Work 124. 134 Orthodontic Service 131 150