CRO 51 County Borough Croydon. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1949 S. L. WRIGHT, M.D., M.R.C.R, D.P.H. CROYDON: printed by the croydon times ltd., 104, high street C.T.2. 12-10-50. 150. 1 HEALTH COMMITTEE. 1949. Concillor J. Todd (Chairman). Councillor Mrs. E. M. Regan (Vice-Chairman). Alderman H. Regan, J.P. Councillor F. T. Adams. Councillor H. A. Banks. Councillor J. D. Bell. Councillor Mrs. V. L. Child. Councillor A. V. Dammarell. Councillor M. Davis. Councillor J. W. Dowsett. Councillor A. J. R. Dunn. Councillor C. E. Ebbutt. Councillor A. Goodbun. Councillor F. A. Messer. Councillor C. E. Moyce. Councillor R. E. Prentice. 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. O. E. Finch, Esq., M.C., M.D. Members appointed to Sub-Committees on nomination of Outside Bodies as shown: — S. A. Forbes, Esq., M.R.C.S., L.R.C.P. J. Newton Hudson, Esq., M.B., M.R.C.S., L.R.C.P. D. F. Kanaar, Esq., M.D., M.R.C.P. Miss D. M. Kapp, B.Sc., M.B., B.S. J. S. Lane, Esq., B.A., M.R.C.S., L.R.C.P. G. McComas, Esq., M.D., M.R.C.P., M.R.C.S Croydon Local Medical Committee. A. F. Clift, Esq., F.R.C.S., M.R.C.O.G. Croydon Group Hospital Management Committee. T. P. Rees, Esq., O.B.E., B.Sc., M.D., Warlingham Park Hospital B.Ch., M.R.C.P., M.R.C.S., D.P.H. Management Committee. Mrs. O. Caradoc Evans, S.R.N., S.C.M. Royal College of Nursing. Mrs. F. R. Mitchell, O.B.E. - Royal College of Midwives. Miss A. E. Humphrey, S.R.N., S.C.M., Q.I.D.N.S Croydon Nursing Service. . Mrs. H. Thatcher Croydon Family Planning Association. 2 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1949. 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 50th Annual Report on the health of the people of Croydon and the relevant services of the Corporation for the year ending December 31st, 1949. This was a year during which the available statistics show no marked changes. For the first time the Registrar-General's estimate of the total population of the Borough just exceeds a quarter of a million persons. The decline in the birth-rate continued, the general and infant mortality rates were both a fraction higher than in 1948, but the death rate from pulmonary tuberculosis was considerably reduced. 1949 was the first complete year of working of the National Health Service Act, 1946, and no great difficulties arose in so far as the Corporation's duties were concerned. Three factors were helpful. Firstly, these duties are continuations or extensions of services previously performed by County Borough Councils. Secondly, there was no excess of illness during the winter months. Thirdly, for some facilities which it provides, the Local Health Authority has the power to recover charges assessed according to the income of the recipients. 3 I am pleased to record that there has been close co-operation between medical and administrative personnel concerned with the hospital and general practitioner services, and the Health Department. Any request which I have made has been received svmpathetically. We are fully conscious of each other's difficulties and the need for mutual assistance if the best possible service is to be given to the public. Croydon is fortunate in that the Group Hospital Management Committee and the Croydon Executive Council serve, in the main, the residents of the County Borough area. This important basic advantage towards coordination of the three divisions of the Health Service would be valueless without the spirit of goodwill which we fortunately enjoy. My thanks are due to the Committee for their help and encouragement and to the members of my staff for their continued application to routine duties and many helpful suggestions for improvements in the working of the Department. I am, Yours faithfully, S. L. WRIGHT, Medical Officer of Health. 4 STATISTICS SUMMARY OF VITAL STATISTICS FOR 1949. Area, 12,672 acres. Population (Census 1931), 233,115. Total Population (estimate of Registrar-General), 250,040 (Civilian, 249,740). Number of Inhabited Houses: (1931 Census), 56,429; 1949, 66,780. Rateable Value (1st April, 1949), £2,562,426. Product of a Penny Rate (1948-1949), £10,450. Rate in the £ : 15s. 6d. Live Births M. F. Total. Legitimate 1,965 1,856 3,821 Illegitimate 106 89 195 4,016 Birth-rate per 1,000 of the estimated resident population, 16.1. Still Births, 86. Rate per 1,000 total (live and still) births, 21.0. Deaths, 2,734 (Registrar-General's figures). Death-rate per 1,000 of the estimated resident population, 10.9. Death-rate (as adjusted by comparability factor, 0.94), 10.3. Infant mortalitv rate, 29 per 1,000 live births. Legitimate Infants (110 deaths), 29 per 1,000 live births. Illegimate Infants (6 deaths), 31 per 1,000 live births. 5 Principal Causes of Death in order of frequency. Rate per 1,000 Population (1) All Ages. Deaths from diseases of Cardiac and Circulatory System (including Cerebral Hasmorrhage) 5.34 „ ,, Cancer 1.93 ,, ,, diseases of the Respiratory System (excluding Tuberculosis) 1.19 ,, ,, Tuberculosis (all forms) 0.38 ,, ,, diseases of Digestive System 0.37 Old age 0.28 ,, ,, Suicide and Violent Causes 0.12 Rate per 1,000 of age group. (2) Ages 15-4-5 years. Deaths from Tuberculosis (all forms) 0.47 ,, „ Cancer 0.27 „ ,, Cardiac and Circulatory System 0.26 Marriages. The number of marriages solemnised was 2,066, compared with 2,169 in 1948, 2,416 in 1947, 2,105 in 1946, 2,268 in 1945, and 1,578 in 1944. 923 were solemnised in Established Churches, 333 in other places of worship, and 806 in the Register Office. Four were performed under Jewish ritual. Births. The live births registered were 3,821 legitimate and 195 illegitimate. The birth-rate consequently was 16.1. For England and Wales and in the Great Towns the rates were 16.7 and 18.7. The illegitimate births in Croydon were 4.9 of the total compared with 6.0 in 1948; 5.5 in 1947; 6.5 in 1946; 10.6 in 1945; 7.7 in 1944; and 7.8 in 1943. The live male births numbered 2,071, the female 1,945, being a proportion of 1,065 males to 1,000 females. 6 Deaths. The deaths numbered 2,734, compared with 2,648 in 1948. For 1949 the death-rate was 10.9; for 1948 it was 10.7. The deathrate for England and Wales was 11.7, and for the Great Towns, 12.5. For London the death-rate was 12.2. There were 92 inquests held by Coroners in respect of Croydon residents during 1949 and 269 findings by Coroners after post-mortem examination without inquest. Wards with the highest death-rate were Central (15.6) and South (15.3). Lowest: Addington (7.0) and Waddon (8.5). Still Births. During 1949, 86 still births were registered in respect of Croydon. Of these, 50 were male babies and 36 female; 6 males and 4 females were illegitimate. The proportion of still births to living children was as 1 to 47. The still birth rate was 2.1 per cent, of the total births. The still birth rate, on the same basis as for Infant Mortality, was 21.0 per 1,000 births. Notification of Births. Notifications were received in respect of confinements conducted by: — Live Births. Still Births. Total. Midwives 3,072 61 3,133 Doctors, Parents and others 1,252 25 1,277 4,324 86 4,410 Accommodation for Confinement. The following table gives information concerning the accommodation utilised for confinements: — Number. Percentage. In Private Houses 1,487 33.72 In Public Institutions 2,119 48.05 In Registered Maternity Homes 804 18.23 4,410 7 Maternal Mortality. There were 5 deaths, compared with 2 in 1948. The maternal mortality rate was 1.22 per 1,000 births, compared with 0.44 in 1948: — The deaths were caused by— (1) Acute yellow atrophy of liver. (2) Air embolism following intra uterine injection of potassium permanganate self administered. (3) Cardiac failure during chloroform anaesthesia for reversion of breech presentation. (4) Pulmonary embolism due to chorionic embolism during normal labour, p.m. (5) Heart failure: intra-partum eclampsia. MATERNAL AND INFANT MORTALITY FOR THE YEARS 1931—1949 Year Births (Live and Still) Maternal Deaths Maternal Mortality Rate Infant Mortality Rate 1931 3,501 23 6.57 57 1932 3,429 7 2.04 49 1933 3,239 12 3.70 47 1934 3,304 13 3.93 46 1935 3,391 10 2.95 45 1936 3,373 13 3.85 41 1937 3,357 13 3.87 60 1938 3,430 3 0.87 40 1939 3,511 4 1.16 38 1940 3,031 5 1.65 39 1941 2,472 8 3.23 37 1942 3,579 12 3.35 39 1943 3,785 2 0.53 37 1944 3,680 8 2.17 44 1945 3,675 9 2.45 41 1946 4,937 3 0.61 31 1947 5,211 10 1.92 38 1948 4,597 2 0.44 27 1949 4102 5 1.22 29 Infant Mortality. The Infantile Mortality Rate was 29 per 1,000 live births registered. 8 For the past 5 years the number of infant deaths has been 1945—145, 1946—151, 1947—194, 1948—120, and 1949—116. Among the 116 deaths, 68 occurred in boy babies and 48 in girls. Of the births, 2,071 were males and 1,945 females. The infantile mortality rate for the two sexes was, therefore, Boys—33 Girls—25. 95 deaths of infants occurred in Institutions, including Registered Nursing Homes. The following table gives the cause of death during the first month of life: — (1) Complications of Labour- Trauma and Inattention at Birth 3 3 (2) Foetal States— Congenital Heart Malformation 5 Other Congenital Deformities 5 Atelectasis, etc. 12 Hemorrhagic Disease of Newborn 9 —31 (3) Prematurity 40 —40 (4) Post-Natal Causes 6 — 6 80 Percentage Deaths per Total Infantile Deaths. Deaths per 1,000 Births. 1948 1949 1948 1949 Premature Births 29.2 35.3 7.8 10.2 Respiratory Diseases 21.7 18.1 5.8 5.2 Infectious Diseases (including Tuberculosis) 4.2 1.7* 1.1 0.50 Atelectasis, Debility and Marasmus 9.2 11.2 2.4 3.26 Diseases of Digestion 8.3 5.2† 2.2 1.49 Injury at Birth and Congenital 16.7 18.1 4.4 5.23 *These deaths were due to Whooping Cough 1, and Polio-encephalitis 1. These deaths were due to Diarrhoea 6. 9 The rate of infant mortality amongst legitimate children was 29 per 1,000 births. The rate in illegitimate children was 31 per 1,000 births. Deaths under one year, arranged in days, weeks and months. CAUSES OF DEATH. 1st day. 2nd day. 3rd day. 4th day. 5th day. 6th day. 7th day. 1 st-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 42 10 9 7 1 1 4 2 4 80 11 8 2 5 - 2 2 1 — 1 4 116 Polio-Encephalitis - - - - - - - - - - - - - - - - - - - - - 1 1 Chicken Pox - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - 1 - - - - - - - - - - 1 Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) - - - —- - - - - - - - - - - 1 - - - - - - 1 2 Convulsions - - - - - - - - - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - - 1 - - - - - - - 1 Pneumonia (all forms) — — 1 — 2 - 3 6 5 3 2 1 1 — 1 — - 1 20 Diarrhoea and Enteritis - - - - - - - - - - - - 2 — 2 - - 1 - - - 1 6 Gastritis —. — — — — — — — — : - - — - - — — - Syphilis — - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - - Congenital Malformations 4 3 — 2 - 1 — 10 3 3 — — - 1 1 — - 18 Premature Birth 28 4 3 3 1 - 1 - —. — 40 1 — — - — — — - 41 Atrophy, Atelectasis, Debility and Marasmus 6 1 2 1 - - - 1 1 - 12 1 - - - - - - - - - - 13 Injury at Birth 2 1 - - - - - - - - 3 - - - - - - - - - - - 3 Haemorrhagic disease of newborn 2 1 3 1 1 — 1 9 — — — — — — - — — 9 Other Causes - - - - - - - - - - - - - - - - - - - - 1 ~ 1 Totals 42 10 9 7 1 — 1 4 2 4 80 11 8 2 5 — 2 2 1 — 1 4 116 10 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 17382 261 196 15.0 11.3 23 0.06 — 0.75 0.35 0.06 5.64 0.23 2.01 + 65 Norbury 16247 171 180 10.5 11.1 35 — — 0.98 0.43 — 5.29 0.12 2.15 — 9 West Thornton 19421 264 177 13.6 9.1 19 — — 1.08 0.26 — 4.79 0.05 1.39 + 87 Bensham Manor 16236 255 194 15.1 11.9 12 — — 1.66 0.49 — 5.60 0.18 2.28 + 61 Thornton Heath 18275 276 187 15.1 10.2 36 — — 1.04 0.33 0.05 5.09 0.16 1.70 + 89 South Norwood 17383 293 186 16.9 10.7 31 0.06 0.12 1.21 0.52 — 4.66 0.06 1.78 + 107 Woodside 16335 249 161 15.2 9.9 32 — — 1.04 0.24 — 4.59 0.12 1.71 + 88 East 16880 278 203 16.5 12.0 25 — 0.12 1.07 0.24 0.06 5.69 0.12 2.37 + 75 Addiscombe 16238 238 203 17.7 12.5 35 0.06 — 1.23 0.43 0.06 6.77 0.06 2.09 + 85 Whitehorse Manor 16438 316 183 19.2 11.1 16 — 0.06 1.03 0.49 — 6.39 — 1.46 + 133 Broad Green 17335 300 171 17.3 9.9 40 — — 1.15 0.46 — 3.89 0.06 2.19 + 129 Central 12234 209 191 17.1 15.6 24 — 0.16 1.72 0.49 — 7.36 0.25 2.94 + 18 Waddon 18031 227 153 12.6 8.5 57 — 0.06 0.67 0.17 — 4.33 0.06 1.28 + 74 South 15233 248 233 16.3 15.3 44 0.07 — 0.92 0.26 — 8.40 0.13 2.17 + 15 Addington 16072 381 112 23.7 7.0 16 — — 0.37 0.25 0.06 2.99 0.03 1.74 +269 The Borough 249740 *4016 *2735 16.1 10.9 29 0.02 0.03 1.05 0.36 0.02 5.38 0.11 1.93 + 1281 11 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX. Sex All Ages 0— 1— 5— 15— 45— 65— All Causes M 1319 68 10 14 92 348 787 F 1415 48 9 5 93 215 1045 Diphtheria M 1 — - — 1 - — F - - - - - - - Whooping Cough M - - - - - - - F 2 1 - 1 - - — Encephalitis, Acute Infectious M 1 - - — 1 — — F - - - - - - - Cerebro Spinal Fever M - - - - - - - F - - - - - - - Measles M - - - - - - - F 1 — 1 — — — — Influenza M 15 — — — 2 4 9 F 18 — 1 — 2 2 13 Poliomyelitis & Polioencephalitis M - - - - - - - F 2 1 — — 1 — — Tuberculosis (respiratory) M 57 — — 1 26 18 12 F 31 — — 1 22 4 4 Tuberculosis (other forms) M 4 — 2 1 1 — — F 2 — — 1 1 — — Syphilitic diseases M 9 — — 1 4 4 F 2 - - — 1 1 Cancer M 215 — — 1 10 102 102 F 250 — — 1 19 76 154 Diabetes M 3 — — — — 2 1 F 9 — — — — 4 5 Intra cranial vascular lesions M 104 — — — 2 18 84 F 188 — — — 2 24 162 Heart diseases M 465 — — — 5 92 368 F 529 — — — 12 50 467 Other circulatory diseases M 31 — — — 4 11 16 F 53 — — — 3 3 47 Bronchitis M 76 1 — — 4 22 49 F 64 — — — — 8 56 Pneumonia (all forms) M 46 8 1 — 1 12 24 F 51 7 1 — — 5 38 Other respiratory diseases M 20 — — — 1 5 14 F 13 — — — — 4 9 Ulcer of stomach or duodenum M 20 — — — 1 11 8 F 6 — — — — 2 4 Diarrhoea (under 2 years) M 6 5 1 — — — — F 1 1 - - - - - Appendicitis M 5 — 1 2 1 1 — F 2 — — — 1 — 1 Other digestive diseases M 19 1 — — 2 5 11 F 22 — — — 2 4 16 Nephritis M 30 — - — 4 4 22 F 31 — — 1 3 5 22 Puerperal sepsis F 1 — — — 1 — — Other maternal causes F 4 — — — 4 — — Premature birth M 25 25 - - - - — F 14 14 - - - - - Congenital debility, malformations, etc. M 35 27 2 — 2 4 — F 25 19 4 - — 1 1 Suicide M 19 — — — 5 10 4 F 13 — - - 5 3 5 Road traffic accidents M 19 — - 5 9 1 4 F 4 - - 1 — 3 Other violent causes M 11 — 1 - 3 4 3 F 9 — - - 3 1 5 All other causes M 83 1 2 4 6 18 52 F 68 5 2 — 11 18 32 Totals 2734 116 19 19 185 563 1832 12 Comparisons with 1948. In the zymotic diseases group there were two deaths from hooping Cough (1948—6), one from Measles (1948—1), and one from Diphtheria (1948—nil). There were again no deaths in the Typhoid group. The deaths from Pulmonary Tuberculosis decreased bv 12; those from Cancer by 28; those from Pneumonia by 9; and an increase of 18 was recorded in those caused by Bronchitis. Deaths, from suicide show an increase of 3, and road traffic accidents of 7. The total number of deaths was 2,734 as compared with 2,648 in 1948- The percentage of deaths under 1 year of age to the total deaths was 4.2 per cent.; deaths under 15 years, 5.6 per cent.; deaths under 65 years, 33.0 per cent.; and deaths over 65 years, 67.0 per cent. The corresponding figures for 1948 were 4.6 per cent., 6.1 per cent., 36.5 per cent., and 63.5 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. The Registrar-General for the first time since 1939 has supplied a comparability factor by which the crude death-rate must be adjusted for comparison with other areas of the country as a whole. It will be observed that this factor is less than unity, so that the standardised, or corrected death-rate, is less than the crude death-rate. In other words, Croydon has a greater "weighting" of elderly persons than the average for the country. CANCER. Deaths from Cancer numbered 481 as compared with 510 in 1948; 492 in 1947; 451 in 1946; 470 in 1945; 420 in 1944; 456 in 1943; 405 in 1942; 377 in 1941; 443 in 1940; and 414 in 1939. Death-rate per 1,000 of the population for the last 11 years are as follows:— 1939—1.78 (414) 1943-2.28 (456) 1947—2.03 (492) 1940—2.22 (443) 1944—2.21 (420) 1948—2.0(3 (510) 1941—2.04 (377) 1945—2.34 (470) 1949—1.93 (481) 1942—2.07 (405) 1946—1.93 (451) 13 Deaths from Cancer occurred at the following Ages :— Age period. Male. Female. Total. Under 25 years 1 1 2 25 and under 36 years — 2 2 35 and under 45 years 11 16 27 45 and under 65 years 102 77 179 65 years and over 108 163 271 222 259 481 Sites of Fatal Cancer. Site. Male. Female. Total. Percentage of Total. Skin 3 1 4 0.832 Tongue and Mouth 3 - 3 0.624 Oesophagus 6 6 12 2.495 Stomach 45 39 84 17.464 Liver 7 4 11 2.287 Bowel 22 39 61 12.682 Rectum 14 19 33 6.861 Bladder 5 1 6 1.247 Prostate 18 — 18 8.108 Larynx and Pharynx 7 1 8 1.663 Uterus — 24 24 9.266 Breast — 52 52 10.811 Ovary — 12 12 4.633 Pancreas 11 13 24 4.990 Gall Bladder and Duct 1 6 7 1.455 Nervous System — 1 1 0.208 Bones 5 1 6 1.247 Lungs 53 18 71 14.761 Kidney 3 2 5 1.040 Brain 5 3 8 1.663 Retroperitoneal 1 — 1 0.208 Thyroid Gland 1 — 1 0.208 Lymphatic Glands 6 2 8 1.663 Mesenteric Glands — 1 1 0.208 Parotid Gland — 1 1 0.208 Genital Organs 2 7 9 1.871 Tonsil 1 — 1 0.208 Undefined 3 6 9 1.871 222 259 481 Comments on Foregoing Table. The organs most often attacked in descending order of incidents are: In the males—the Lungs (23.9 per cent.), the Stomach (20.3 per cent.), and the Bowels and Rectum (16.2 per cent.); in females—the Bowels and Rectum (22.4 per cent.), the Breast (20.1 per cent.), the Stomach (15.1 per cent.), and the Uterus (9.3 per cent.). 14 INFECTIOUS DISEASES NOTIFIED DURING YEAR 1949. Notifiable Disease. Cases notified in the whole District. Total cases notified in each Ward. Sex Distribution of Notified Cases. 1949. 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 476 2 125 325 10 13 1 - 26 37 35 27 21 34 52 45 43 23 30 21 31 17 34 249 227 Diphtheria 2 — — — 1 1 - - 1 — - — — 1 — — — — — — - — — 1 1 Erysipelas 37 — — 1 — 14 18 4 — 3 1 — 2 1 3 7 7 5 1 - 4 2 1 13 24 Cerebro-Spinal Meningitis 2 — 2 - - - - - - - 1 - - 1 - - - - - - - - - 1 1 Enteric & Paratyphoid - - - - - - - - - - - - - - - - - - - - - - - - - Small Pox - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 29 — — — 17 12 — — 1 — 12 1 2 — — 3 1 5 1 1 2 - - 29 Ophthalmia Neonatorum 8 8 — — — — — — 2 — 3 — 1 1 — — — — — 1 — — 2 6 Poliomyelitis and Polio-encephalitis 11 1 4 2 1 3 2 1 2 - 2 1 1 2 - - - - 6 5 Dysentery 4 — 2 1 — 1 — — — — 1 — — — — — — 1 — 2 — — — 3 1 Malaria 1 — — — — 1 — — — — — — — — — — — — — — 1 — — 1 — Acute Primary and Acute Influenzal Pneumonia 44 - 5 2 5 10 14 8 1 - 4 3 1 3 1 4 6 3 6 1 5 5 1 26 18 Food Poisoning 79 — 3 14 16 28 20 8 — 4 8 9 6 2 3 4 9 3 3 4 13 8 3 37 42 Encephalitis Lethargica — — — — — — — — — — — — — - — — — — — — — — — — — Measles 2136 84 1067 947 17 18 2 1 140 85 147 86 116 126 93 206 184 110 127 88 97 141 390 1138 998 Whooping Cough 309 33 170 99 — 6 1 — 7 9 13 16 9 38 25 30 19 33 15 8 19 17 51 149 160 Totals 3138 128 1378 1381 68 106 56 21 180 138 226 144 158 207 177 298 272 180 189 125 172 192 480 1626 1512 MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1949 15 MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1949 Jan. Feb. Mar. April May June July August Sept. Oct. Nov. Dec. Total Scarlet Fever 47 44 33 20 24 36 32 18 27 40 74 81 476 Diphtheria ... ... ... ... 1 ... 1 ... ... ... ... ... 2 Erysipelas 6 1 3 4 2 8 1 2 2 ... 5 3 37 C.S.M. ... ... ... 1 ... ... ... ... 1 ... ... ... 2 Enteric and Paratyphoid ... ... ... ... ... ... ... ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 2 3 4 ... 3 1 2 7 4 2 1 ... 29 Ophthalmia Neonatorum ... ... 1 2 ... ... 1 ... ... 3 ... 1 8 Poliomyelitis and Polioencephalitis ... ... ... ... 2 1 2 ... 3 1 ... 2 11 Dysentery ... ... ... ... ... ... ... ... ... 2 1 1 4 Malaria ... ... ... ... ... ... 1 ... ... ... ... ... 1 Ac. Pri. & Ac. Inf. Pneumonia 8 11 8 2 1 2 3 ... 1 2 4 2 44 Food Poisoning ... ... ... ... 8 ... 5 20 18 14 5 9 79 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 60 122 298 562 241 397 259 91 31 46 19 10 2136 Whooping Cough 9 26 36 42 38 43 39 37 20 4 4 11 309 Total 3138 16 Comments on Infectious Diseases. There was a measles epidemic in the year under review, but it was mild in type and, fortunately, came after the winter months, so that serious complications were less prevalent. It will be observed that while there were only two notified cases of diphtheria, in the cause of deaths table there is recorded a death from diphtheria. The patient was an adult male age 39, and his death was attributed to " hypertoxic diphtheria." No other case was found associated with him, and no explanation of how the infection was acquired or the reason for its fulminating nature. Assuming the accuracy of the diagnosis, it is an isolated phenomenon incapable of explanation against the present general background of the epidemology of diphtheria. Anterio poliomyelitis cases occurred, but were not numerous. During the months when this condition was increasing in frequency in surrounding areas all operations for removal of tonsils and adenoids were suspended in Croydon. The value of this precautionary measure is perhaps doubtful, but weighing possible benefits and risks, the decision seems fully justifiable. Food poisoning cases showed an increase, but this is probably due to a reminder to all practitioners that the condition is notifiable under the provisions of the Food and Drugs Act. There was no large scale outbreak. Scarlet fever maintained its prevalence and its mild character. CROYDON ISOLATION HOSPITAL. Infectious cases admitted from Croydon Borough in 1949:— Scarlet Fever. Scarlet Fever became unusually prevalent during the last three months of the year, but the total number of admissions was 74 less than in 1948. Measles. Measles was prevalent in the early part of the year, but the total number admitted was 15 fewer than in the previous year. Rare complications encountered were interstitial emphysema (2 cases) and keratitis with corneal opacity, now rare (1 case). There was one fatal case, gastro-enteritis being the fatal complication. 17 A similar fatality due to the same complication occurred in a child admitted from outside the borough. Both children were admitted from Rest Centres where communal living accommodation obtained. Gastro-Enteritis. The mortality continued to decline—two deaths among 33 cases. Whooping Cough. Both admission rates and mortality (one death) were exceptionally low. Fifteen cases only were admitted from Croydon Borough in the year. Poliomyelitis. Only six poliomyelitis and one encephalitis cases were admitted from Croydon Borough. This was contrary to experience elsewhere as throughout the country an epidemic second only to that of 1947 was encountered. Meningitis. Seven cases were admitted—two cases each of pneumococcal, meningococcal and tuberculous, and one of streptococcal meningitis. This accords with the experience elsewhere that the meningococcal form no longer predominates among meningitis cases admitted to Isolation Hospitals. There were no fatal cases. Diphtheria. Only two cases were admitted which is the lowest annual admission rate recorded for this disease. 18 COMMUNICABLE DISEASES THE PREVENTION AND CONTROL OF TUBERCULOSIS. I 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. Chemo-therapy shows greater promise than at any time in the past. Surgical technique also has made good progress in recent years. Unfortunately, these advances in treatment lead to a longer stay of patients in Hospitals and Sanatoria, and in consequence the waiting lists for admission to these institutions are growing rapidly, and as there are not nearly enough beds provided patients have to wait in their homes for long periods, often in unsatisfactory conditions- Many beds are available, but are not in use because of a lack of nurses. There appears to be some difficulty in getting nurses to nurse tuberculous patients. This would seem to be due partly to an unfounded and exaggerated fear of the danger of infection. Yet the late Medical Superintendent of Cheam Sanatorium, during his service there for a period of over 20 years, did not have a single nurse develop the disease. Apparently it is only the very few who are susceptible that develop tuberculosis, and this can happen just as easily in other employments. Doctors treating patients with tuberculosis, and constantly being infected, do not appear to be more liable to develop tuberculosis. The community should be informed that, for people who are properly fed and leading a healthy life, the danger of developing tuberculosis after exposure to infection is very slight. Although social conditions were different in 1949, a comparison with 1922 shows that in 1922, 109 per 100,000 of the population in Croydon died from all forms of tuberculosis; in 1949 the corresponding figure was 38. The years selected were four years after a major war. The total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year 1949 by notification or otherwise was 305, as compared with 350 in 1948, 354 in 1947, 348 in 1946, and 374 in 1945. 264 of these were cases of Respiratory Tuberculosis; 156 in males and 108 in females. There were 25 fewer cases in males and 23 fewer in females than in 1948 19 There were 13 cases of Non-Respiratory Tuberculosis among children under 15 years as compared with 18 in 1948. The number of cases in adults was 28, compared with 20 in 1948 Of the cases notified in 1949, 10 males and 5 females died from the Respiratory form of the disease during the year, equal to 7.2 per cent. of those notified. The incidence, rate of Tuberculosis of all forms was 1.22 per 1,000 of the population; for Respiratory Tuberculosis 1.06, and for Non-Respiratory 0.16 per 1,000 population. The notification rate was 0.94 per 1,000. In 1948 the corresponding figures were 1.42, 1.26, 0.16 and 1.15 per 1,000. Public Health (Tuberculosis) Regulations, 1930. Summary of notifications during the period from 1st January, 1949, to 31st December, 1949:— 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 — 1 3 3 14 18 25 26 15 11 5 1 123 Respiratory, Females 1 — 3 4 3 12 17 20 11 7 2 2 2 84 Ncn-Respiratory, Males - 1 — 2 2 1 2 4 2 — 2 — — 16 Non-Respiratory, Females - — 2 1 1 1 1 2 1 3 — - — 12 20 Supplemental Return. New cases of Tuberculosis coming to the know ledge of the Medical officer of Health during the period from 1st January, 1949, to 31st December, 1949, otherwise than by formal notificaion:- 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 1 1 3 (A) F - - - - - - - - - - - - - — (B) Non-Respiratory M — — 1 1 - - - - - - - - - 2 (C) F - - - - - - - - - - - - - — (D) Death Returns from Registrar-General (Transferable deaths) Respiratory M — — — — — — — — — 1 — 1 — 2 (A) F - - - - - - - 1 - - - - - 1 (B) Non-Respiratory M - - - - - - - 1 - - - - - 1 (C) F - - - - - - - - - - - - - — (D) Posthumous Notifications Respiratory M - - - - - - - - - - - - - — (A) F - - - - - - - - - - - - - — (B) Non-Respiratorv M — 1 - - - - - - - - - - - 1 (C) F - - - - - - - - - - - - - — (D) "Transfers " from Other Areas (excluding transferable deaths) Respiratory M - - - - - 1 11 10 5 1 — — — 28 (A) F - - - - - 1 6 7 4 3 — — — 21 (B) Non-Respiratory M — — — — 1 1 1 1 - - - - - 4 (C) F - - - - - 1 1 2 1 — — — — 5 (D) Other Sources Respiratory M - - - - - - - - - - - - - — (A) F - - - - - 1 1 - - - - - - 2 (B) Non-Respiratory M - - - - - - - - - - - - - — (C) F - - - - - - - - - - - - - - (D) 21 Notification Register. Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1949:— RESPIRATORY. NON-RESPIRATORY. Total Cases. Males. Females. Total. Males. Females. Total. 865 680 1545 121 104 225 1770 CLASSIFICATION OF NEW PATIENTS. Respiratory Tuberculosis. During 1949, 209 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) 107 or 51.2% T.B. plus 1 (early cases, sputum positive) 23 or 11.0% T.B. plus 2 (intermediate cases, sputum positive) 68 or 32.5% T.B. Plus 3 (advanced cases, sputum positive) 11 or 5.3% 209 100.0% Non-Respiratory Tuberculosis. There were 21 cases examined at the Clinic and found to have Non-Respiratory Tuberculosis in the following forms:— Bones and Joints 7 Abdominal 2 Other Organs 5 Peripheral Glands 7 21 22 Ages at Death from Respiratory Tuberculosis. 0-5 5-15 15-25 25-45 45-65 over 65 TOTAL 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 1949 — 2 11 38 23 15 89 Six cases were not notified during life. Of these, two were certified by the Coroner, after a post-mortem examination ; three cases died in a mental hospital, and one in a private nursing home. In 1949 the death-rate from all forms of Tuberculosis was 0.38 per 1,000 population. The rate for Respiratory Tuberculosis was 0.36 and the rate for Non-Respiratory Tuberculosis 0.02. Similar figures for 1948 were 0.42 and 0.03. Respiratory Tuberculosis. In 1949 the total number of deaths decreased by 14.5 per cent. compared with 1948, there being a decrease in both sexes. There were two deaths in children up to school leaving age (15 years). There were approximately two male deaths for each female death. In men the deaths are fairly evenly distributed through the age groups from 25 years upwards, whereas in women they are mostly at an earlier age, being mainly in the age groups 20-45 years. New cases show a drop in males of 15.9 per cent. and of 21.3 per cent. in females, compared with 1948; that is a total decrease compared with 1948 of 16.4 per cent., and a fall of 2.3 per cent. compared with 1938. In contrast the total deaths in 1949 were 25.3 per cent. less than in 1938. The total number of new cases in 1949 was males 151, females 108; that is, approximately three new cases in men for every two new cases in women. The fall in the number of new cases found in 1949 may be partly accounted for by the fact that the Mass Radiography Unit did not visit Croydon during 1949; also that the visit of the Unit to Croydon in 1948 probably brought to light a number of cases that would not otherwise have been discovered until 1949, 23 Deaths from Non-Respiratory Tuberculosis. During 1949, five deaths were certified to be due to NonRespiratory Tuberculosis, compared with eight in 1948. All five patients died in Hospital. Four of them were not notified during life. The deaths were due to:— Males. Females. Total. Tuberculous Meningitis 3 — 3 Tuberculous Enteritis 1 — 1 Broncho Pneumonia and Tb. Meningitis — 1 1 Totals 4 1 5 Co-ordination with Medical Practitioners and the Health Department. During the year 157 children were referred by the School Medical Service, and 53 cases from the Maternity and Child Welfare section of the Public Health Department. 96 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 88 per cent. in 1948. Extra Nourishment. Provision of special nourishment in the form of milk was granted to 21 selected cases for varying periods during the year, and 8 cases were in receipt of extra nourishment at the end of the year. Residential Treatment. 217 males, 138 females and 24 children were admitted to Residential Institutions during 1949. At the end of the year there were 65 beds occupied in the Cheam Sanatorium, North Cheam, compared with 66 at the end of 1948 and the normal 94 beds pre-war 24 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. Owing to lack of beds and the large number of patients in their homes, home visiting is steadily increasing, both for the doctors and the tuberculosis visitors. 1,425 new cases were examined during the year. This is equal to 1,516 for each 100 deaths from the disease. 214 or 227 for each 100 deaths were found to be definitely tuberculous. The total number of attendances at the Clinic was 10,302. The Clinic doctors paid 220 home visits and the Tuberculosis Visitors 2,530 visits for Clinic purposes. In addition, the Tuberculosis Visitors made 575 primary visits for the purposes of the Notfication Register. Patients requiring home nursing or surgical dressings are attended to by the nurses from the Croydon Nursing Service, by arrangement with that organisation. 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 415 contacts were examined, equal to 441 for each 100 deaths. Of these, 13 were considered to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 31.3 compared with 1.22 per 1,000 of the general population. The Clinic Register of Cases. The number of cases of Tuberculosis under the supervision of the Clinic at the end of the year was 1,490. This is equivalent to 6.0 persons per 1,000 of the population. During the year 88 Clinic cases died. Of this number 15 or 16.8 per cent. were seen for the first time in 1949, 25 The following table gives a summary of the work done in connection with the Clinic:— No. of persons on Clinic Register, January 1st, 1949 1,938 ,, notified cases examined for the first time 42 ,, cases sent for an opinion 1,295 ,, first attendances, including 72 inward transfers. 1,912 ,, visits paid by Clinic doctors to homes of patients 220 ,, visits paid by Clinic doctors to Mayday Hospital 158 ,, patients examined by Clinic doctors at Mayday Hospital 957 ,, visits paid to homes of patients by Tuberculosis Visitors 3,105 Attendances of patients at the Clinic— Men 4,141 Women 3,655 Children 2,506 Total . 10,302 No. of X-Rays taken 5,517 ,, cases on the Clinic Register (including those under observation) on the 31st December, 1949 1,998 OCCUPATIONAL THERAPY. On July 1st, 1949, an Occupational Therapy Scheme for tuberculous patients who were at home but unfit for work, was put into operation. Subject to the Chest Physician's approval, patients attend the weekly class held at the clinic between 2.30 and 4.30 p.m. every Friday, under the guidance of a trained occupational therapist. Work undertaken includes soft toy making, leather work, basket work, slipper making, rug making, lampshade making and weaving. Patients either take the article home and work on it during the week, or return to continue it at the following week's class. Materials are sold at cost price, plus 10 per cent. handling charge. Up to December 31st, 1949, £25 lis. 6d. had been taken for materials sold. Patients are allowed to pay weekly instalments, but no patient is allowed to start a second article until the first has been paid for. Under this scheme no bad debts are incurred. There were 28 patients on the register at December 31st, 1949. Mostly, patients attend for advice to buy materials, and continue their work at home, so that the actual classes are small, numbering on an average, six. All goods are disinfected with formalin vapour by the Sanitary Department on completion, 26 VENEREAL DISEASES. New Cases seen at Croydon and London Hospitals under the General Scheme. 1940. 1941. 1942. 1943. 1944. 1945. 1946. 1947. 1948. 1949. Syphilis 55 41 49 73 86 112 97 115 88 70 Gonorrhoea 116 128 147 183 208 232 330 198 85 88 Non-venereal 314 329 333 586 566 771 822 1438 1131 943 485 498 529 842 860 1115 1249 1751 1304 1101 The cases seen at the Croydon Clinic include patients from other areas. Croydon Cases attending London Hospitals, year 1949 Hospital. Cases seen for the first time. Conditions other than venereal. Syph. Gon. Endell Street L.C.C — — 1 St. Thomas's 1 2 13 King's College 1 1 10 S. Lond. Hosp. for Women — 1 12 Whitechapel Clinic, L.C.C. .. — 1 Westminster — ! 1 Total 2 5 38 27 Return relating to all persons who were treated at the Treatment Centre at Croydon General Hospital during the year ended the 31st December, 1949. 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 67 114 - - 2 5 11 102 80 221 301 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 4 1 - - - - 18 9 22 10 32 3. Number of cases dealt with for the first time during the year under report (exclusive of cases under Item 4) suffering from:— Syphilis, primary 6 4 6 4 10 „ secondary 7 4 — — 7 4 11 „ latent in 1 st year of infection 2 5 — - — — - 2 5 7 „ Nervous or Cardio-vascular 4 5 — - — — - 4 5 9 „ all later stages 10 6 - - - - - - 10 6 16 „ congenital 5 10 — — — — — 5 10 15 Soft Chancre — — — — — — — — Gonorrhoea, 1st year of infection — — — 60 23 — 60 23 83 Any other conditions — — — 348 556 345 556 904 Conditions remaining undiagnosed at 31st December - - - - - - 1 1 1 4. Number of cases dealt with for the first time during the year under report known to have received treatment for the same infection, or to have been under observation, at other Centres or Service Hospitals, or by General Practitioners approved under Ministry of Health Circular 2226 5 5 - - 2 4 1 11 6 17 Totals of Items 1, 2, 3 and 4 110 154 — — 64 28 382! 668 556 850 1405 5. Number of cases discharged after completion of treatment and final tests of cure or after diagnosis as non-venereal 47 55 - - 52 21 360 632 459 703 1167 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 — — — __ - 6.b Number of cases under treatment or observation which died - 2 - - - - - - 2 2 . Number of cases which ceased to attend after Completion °' treatment but before final tests of cure 1 1 - - 2 - - - 3 1 4 8. Number of cases tranferred to other Centres or to institutions, or to care of private practitioners 10 9 - - 5 4 4 2 19 15 34 9. Number of cases remaining under treatment or observation on 31st December 52 87 — — 5 3 18 34 75 124 199 Totals of Items 5, 6, 7, 8 and 9 110 154 64 28 382 668 556 850 1406 These totals should agree with those of Items 1,2. 3 and 4) 28 Syphilis Soft Chancre Gonorrhoea Nonvenereal or undiagnosed condition Total M F M F M F M F M F 10. Number of attendances:— (a) for individual attention of the medical officer 2606 4907 - - 352 122 2212 2744 5470 7773 (b) for intermediate treatment, e.g., irrigation, dressing 756 980 — — - 57 287 598 1043 1635 Total Attendances 3652 58s7 — — 352 176 2496 3342 6513 9408 11. Number of cases of congenital syphilis in Item 3 above classified according to age periods Under 1 year 1 and under 5 years 5 and under 15 years 15 years and over Total M. F. M. F. M. F. M. F. M. — - 1 1 3 1 1 8 5 12. Pathological Work:— (a) Number of specimens examined at, and by the Medical Officer of, the Treatment Centre Microscopical Cultural for G'n'rh. Serum Cerebro spinal fluid Other diaga Ve Di for Syphilis for G'n'rh. for Syphilis for G'n'rh. - - - WR& KAHN GCFT - - (b) Number of specimens from patients attending at the Treatment Centre sent for examination to an approved laboratory 14 1611 1711 2028 617 70 - 13. Contacts attending for examination through the agency of:— (a) Patients Syphi is (less than 1 year) Syphilis (more than 1 year) Gonorrhoea other Condision M. F. M. F. M. F M. - - 2 1 1 2 20 (b) Health Visitor or Social Service Worker, Sister-in-Charge 1 2 1 1 1 2 16 Totals 1 2 3 2 2 4 36 STATEMENT SHOWING THE SERVICES RENDERED AT THE TREATMENT CENTRE DURING Till 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 Til A. Number of cases from each area included under the following headings in Item 3 :— Syphilis 34 17 12 0 Soft Chancre — — — — Gonorrhoea 51 21 6 5 Non-venereal and undiagnosed conditions ... 707 121 43 34 a Total 792 159 61 44 i« 29 PUBLIC HEALTH BACTERIOLOGY. During the year the following examinations were made at the Laboratory of the Clinical Research Association:— Ante-natal (determination of pregnancy) 12 Swabs and feces examinations 154 Milk examinations 298 IceCream ,, 264 Water ,, 98 Blood ,, 26 Food ,, 19 871 30 WATER. I am indebted to the Water Engineer, W. C. Knill, Esq., B.Sc., M.I.C.E., M.I.Mech.E., M.I.W.E., for most of the following data:— The Water supply is drawn from deep wells in the chalk. These wells are situated in Surrey Street, Stroud Green, Waddon, Selhurst and Addington. The water from all of the wells is treated by the addition of chlorine, and in the case of the water from Surrey Street and Waddon, ammonia is added after chlorination. Owing to the occasional occurrence of turbidity in the raw water from the Addington Well, this water is filtered before chlorination. A portion of the northern side of the Borough is supplied with water which is purchased in bulk from the Metropolitan Water Board. During 1949 additional supplies were purchased in bulk from the Sutton District Water Company. The amount of water consumed during the year was— Corporation's Wells 1,882,761,000 M.W.B. Bulk Supplies 1,060,522,000 Other Bulk Supplies 20,013,000 2,963,296,000 The water supply has been satisfactory in quality and quantity. The supply is piped throughout the area. (a) Bacteriological Examinations. Regular bacteriological examinations were made of the raw water going into supply after treatment. 194 raw water samples and 861 treated water samples were thus examined bacteriologically during the year by the Chemist and Bacteriologist on the staff of the -Water Undertaking. In addition 18 samples of raw water and 66 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 31 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 76 of raw waters and 130 of treated waters going into supply. The results of the chemical analyses were uniformly satisfafctory. 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 1949 the total number of samples taken by the Public Health Department was as follows:— For bacteriological examination 60 For chemical examination 60 All these samples were taken direct from consumers' taps. 32 SEWAGE DISPOSAL AND REFUSE COLLECTION. I am indebted to the Borough Engineer, C. E. Boast, Esq., O.B.E., M.C., M.I.C.E., F.R.I.C.S., M.I.Mun.E., M.I.W.E., for the following information:— Refuse Collection and Disposal. 56,500 tons of house refuse are collected annually in Croydon and disposed of by controlled tipping. This latter is being carried out at the present time on Mitcham Common and already 15 acres of boggy water-logged common have been raised about six feet, covered with soil and grassed down for use as playing fields. Work has commenced on a further 34 acres, using the refuse not only from Croydon, but also from the Boroughs of Mitcham, and Beddington and Wallington. Sewage Disposal. The sewage of the Borough is dealt with at Beddington and South Norwood. The Addington area drains into the West Kent Drainage Board Works and a small part of Upper Norwood into the L.C.C. system. The main works at Beddington deals not only with the sewage from the major part of the Borough, but takes the sewage under agreement from five outside authorities, viz., Coulsdon and Purley U.D.C., Caterham and Warlingham U.D.C., Banstead U.D.C., Beddington and Wallington Borough, and Carshalton U.D.C. The sewage flow from an estimated population of 330,000 is treated at the Beddington Works, the dry weather flow being about 10½ million gallons per day. The Works include a very modern sludge digestion plant, from which Methane Gas is evolved as a natural by-product of the process. This gas is used for generating all the electricity required for power and lighting of the Works, for maintaining temperature in the digestors, and, by compressing it, for use on vehicles as a fuel in lieu of petrol. Some 60 vehicles, including the fleet of refuse collectors, have been converted to run on this gas, and by this means over 85,000 gallons of petrol are saved per annum. Attendances at Midwives' Ante-Natal Clinics were less than in 1948, due partly to the fall in the birth-rate and partly to Some mothers being attended by their doctors, under the Maternity Scheme of the General Practitioner Service. Lodge Road (Hospital Cases) Municipal Midwives Total. Lodge Road Addington Ante-Natal Clinic: No. of cases seen 3069 857 131 4057 „ ,, new cases 2190 557 131 2878 ,, ,, attendances 18978 7846 633 27457 Post-Natal Clinic: No. of cases seen 1588 24 1612 „ „ new cases 2424 24 2448 „ ,, attendances 3020 34 3054 33 SERVICES PROVIDED UNDER NATIONAL HEALTH SERVICE ACT, 1946. Health Centres. Considerable attention was given to the theoretical planning and distribution of Health Centres in Croydon, but no schemes were submitted to the Ministry of Health during the year under review, CARE OF MOTHERS AND CHILDREN. Ante- and Post-Natal Clinics. At Lodge Road the new extensions were completed and have made a great difference to the comfort and convenience of mothers and staff. The work of these Clinics was modified in certain details. Mothers booked for hospital confinement are now seen by the doctors and midwives who will attend them while in hospital, separate sessions being held for domiciliary booked cases, and the district midwives deal with such clinics, assisting medical officers of the Health Department. The Senior Obstetrician of Mayday Hospital is in Clinical Charge of the entire Clinic. Almoners work both in the wards and in the Anteand Post-Natal Clinics. These arrangements are administratively exceedingly complex, and they work smoothly because of the willing co-operation of all concerned. A new Clinic was opened at New Addington to serve this relatively remote portion of the Borough. The general practitioner of the area, who performs approximately 85 per cent. of the midwifery, was appointed as the Clinic Medical Officer, but the general practitioner obstetricians practising in the area were invited to see their cases at this clinic. These arrangements are working well and there is complete co-operation between general practitioner obstetricians and the district midwives. Including Gynaecological cases 34 CARE OF PREMATURE INFANTS. 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 1949 who were born— (i) at home 62 (ii) in hospital or nursing home 108 (2) The number of those born at home— who were nursed entirely at home 57 who died during the first 24 hours — who survived at the end of one month 54 (3) The number of those born in private nursing homes— who died during the first 24 hours 1 who survived at the end of one month 11 MATERNITY AND INFANT WELFARE CONSULTATIONS There are 20 Maternity and Infant Welfare Centres. A total of 29 sessions per week are held and at these a doctor and one, or, if necessary, two health visitors, attend. During 1949, 3,397 new cases under 1 year of age and 870 over 1 year of age attended for the first time; the total of attendances of infants and young children from 0—5 years decreased from 94,312 in 1948, to 85,591 in 1949. Consultations with doctors decreased from 28,810 to 25,602. 29 expectant mothers were seen, a decrease of 27 on 1948, and a total of 172 visits to the Centres was paid by them. The total of all visits to the Centres was 85,763, a decrease of 8,765 compared with 1948. The table on page 35 gives detailed figures for the separate Centres and sessions. ATTENDANCES AT INFANT CENTRES—1949. Municipal Monday Municipal Thursday, a.m. Municipal Thursday, p.m. Boston Road St. Andrew's South Croydon Shirley Woodside, a.m. Woodside, p.m. East Croydon Tuesday East Croydon Friday South Norwood Tuesday South Norwood Friday Upper Norwood St. Alban's Wednesday St. Alban's Friday Bensham Manor, a.m. Bensham Manor, p.m. St. Oswald's, a.m. St. Oswald's, p.m. West Croydon Norbury, a.m. Norbury, p.m. Waddon Selhurst New Addington St. Jude's Hall Heathfield Lecture Hall, W. Wickham Total, 1949 Total, 1948 New cases under 1 year 137 81 154 131 132 183 104 100 135 149 152 136 149 170 147 78 60 132 76 89 100 90 109 92 85 163 137 66 60 3397 3831 Nq. of Re-attendances 2002 1096 2011 2150 1983 2636 1296 1642 1999 2423 1934 2038 2299 1876 2119 1455 1562 1905 1315 1709 1494 1589 1901 1265 1202 1583 2734 636 474 50328 55464 Nev cases over 1 year 21 17 21 44 19 38 36 33 64 25 39 24 29 61 49 15 14 29 - 5 47 12 19 31 30 76 2 31 39 870 987 No. of Re-attendances 981 308 814 1142 866 1574 998 931 1379 1105 1198 977 772 1554 1364 951 367 1217 1068 1556 1085 974 1581 976 920 1031 1615 452 640 30996 34030 Attendances of Children 0-5 3141 1502 3000 3467 3000 4431 2434 2706 3577 3702 3323 3175 3249 3661 3679 2499 2603 3283 2459 3359 2726 2665 3610 2364 2237 2853 4488 1185 1213 85591 94312 Consultations with Doctor 1207 487 741 1103 900 895 766 866 1114 812 666 943 962 1072 1206 847 930 1063 818 842 1041 760 848 845 809 936 1107 468 548 25602 28810 No. of Sessions 48 41 48 48 48 48 48 48 48 47 47 48 48 47 48 47 48 48 48 48 48 48 48 48 48 48 48 48 48 1381 1372 Expectant Mothers: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - No. of new cases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 29 56 No. of Re-attendances — — — — — — - - - 8 - - - - 8 - 3 12 - - 30 - - 54 24 - 4 - - 143 160 Total attendances of Expectant Mothers - - - - - - - - - - - - - - 13 — 3 18 — 2 30 — — 70 24 — 4 - - 172 216 Total attendances 3141 1502 3000 3467 3000 4431 2434 2706 3577 3710 3323 3175 3249 3661 3692 2499 2606 3301 2459 3361 2756 2665 3610 2434 2261 2853 4492 1185 1213 85763 94528 average for Session, 1949 65.4 36.6 62.5 72.2 62.5 92.3 50.7 56.4 74.5 78.9 70.7 66.1 67.7 77.9 76.9 53.2 54.3 68.8 51.2 70.0 57.4 55.5 75.2 50.7 47.1 59.4 93.6 24.7 25.3 62.1 - Average for Session, 1948 68.6 - 80.1 81.6 79.0 93.2 62.4 53.0 62.7 83.8 70.3 72.2 73.7 74.3 73.8 57.8 54.7 79.3 68.9 88.1 55.5 61.7 99.8 55.9 53.3 64.3 79.1 30.0 40.2 — 68.9 DAY NURSERIES. Attendances at Day Nurseries, 1949. 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 49 48 55 50 54 52 47 52 Attendances: under 2 5157 4301 3730 4370 3709 3292 1992 2538 2564 over 2 16146 6713 6861 8526 7905 7474 9367 8916 9641 Total 21303 11014 10591 12896 11614 10766 11359 11454 12205 Number of days opened 303 302 305 304 303 304 303 303 303 Average daily attendance (excluding Saturdays) 81 42 39 51 44 42 44 44 48 37 38 CARE OF THE UNMARRIED MOTHER. The Croydon Association for Moral Welfare continued to act for the Corporation and received payment on a capitation basis for cases dealt with by their Social Worker. The Corporation also paid hostel fees in respect of approved cases for whom such accommodation was required. During the year under review 123 cases were dealt with by the Social Worker. 30 cases were admitted to hostels. 10 cases were temporarily accommodated at Glazier House (the Croydon Home of the Moral Welfare Association). 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 "home" confinements reference is made through the Municipal Midwives' Service or by the practitioner in charge of the patient. During recent years the adult side of the local dental service has been considerably expanded and now one dental officer's time is wholly devoted to Maternity and Child Welfare Work. This increased provision 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. There has been a noticeable decline in the number of expectant and nursing mothers receiving treatment at the Authority's Dental Clinic during the past year. This has occurred partly as the result of the reduction in the activities of Ante-Natal Clinics themselves and partly owing to the fact that since the initiation of the National Health Service alternative 39 facilities are available through the General Dental Service. Whilst it is yet too early to assess what permanent effect these changes will have, it seems likely that provided an adequate degree of priority can be given to such patients a certain proportion of these " outside " contracts will become a regular feature of the Scheme. In the case of the pre-school child, matters tend to be reversed and the number of these children requiring to be dealt with continues to increase. This rise is in no small degree due to the continued efforts of those officiating at Welfare Centres and Day Nurseries in bringing defects to the notice of parents and arranging for subsequent treatment. Added to this is the fact that the majority of private dentists are already strained to breaking point in catering for the requirements of the adult population and therefore find it difficult to offer facilities, often at short notice, for cases of this type. Under the circumstances parents are often advised to seek attention at the local clinic. Expectant Mothers. Expectant mothers examined during the year numbered 735, compared with 873 in 1948. Of these, 86.4 per cent. were seen during the first six months of their pregnancy. As the benefit derived from such treatment is greatly enhanced by early removal of sepsis, the results obtained above may be considered of first-rate importance. Nursing Mothers. The number of nursing mothers referred during the year declined still more and only 29 new cases were examined, compared with 69 last year. The reason for this progressive reduction is largely due to greater emphasis on ante-natal treatment; a more recent factor, however, has been the provision of free attention outside the Local Authority's scheme. The major proportion of mothers attending the dental clinics were dealt with either during, or closely following the nursing period; in the latter category were included certain patients for whom, on medical grounds, work was delayed until after the confinement. Including those continuing treatment from the previous year, 837 mothers were dealt with, compared with 1,063 in 1948. Except for the fact that the volume of work decreased, attendances were satisfactory, and in the majority of patients there appeared to be 40 a healthy interest in treatment of a conservative nature. There was also a noticeable decline in the number of mouths requiring wholesale removal of teeth. Whilst it is unlikely that such patients no longer exist, it seems probable that many sufferers from " chronic " oral sepsis may have already opted to receive attention through the General Practitioner Service and have thus not come the way of the clinic. On the debit side it was noted that of the total of 1,012 mothers referred from medical departments, approximately .34 per cent. failed to attend for their dental inspection after signifying a desire for treatment. This figure is but a slight improvement on the results of the previous year. Attempts at "following up" such patients have in most cases been singularly unsuccessful. The Pre-School Child. The total number of children referred from Welfare Centres, Day Nurseries and other sources was 687, compared with 558 last year. As mentioned previously in this Report, the expansion that has taken place during the post-war years in this branch of the service is very gratifying, and reflects much credit on all concerned. The importance of regular inspection and treatment for these children cannot be overstressed, as it is only when repairs can be carried out in the initial stages that undue loss of teeth can be avoided. Despite recent advances, a certain hiatus still exists among "four-year-olds," as these children are no longer regular "habituees" at Infant Centres, and therefore come in for little oral supervision. It is also apparent that many parents are still too prone to neglect the simple precaution of introducing their "offspring" to the dentist until actual discomfort is felt, with the result that irreparable damage is done to the foundation teeth. In the above connection it is hoped that as soon as "staffing" permits, a "progressive campaign" of publicity can be undertaken to ensure that as many children as possible over the age of three-and-a-half years receive at least one yearly dental inspection until such time as they enter on their school careers. Though at this early age the normal "comprehensive" treatment may not always be possible, certain protective measures can be initiated from which much benefit can be obtained. Such activities would, it is felt, pay a substantial dividend, and also assist by stimulating interest in the more " preventive " aspect of the scheme Treatment. The following summary shows particulars of the work accomplished:— Expectant Mothers. Nursing Mothers. Total. Young Children. New Cases Examined 735 29 764 574 Re-treated 65 8 73 113 Total 800 37 837 687 Attendances 1757 67 1824 1167 Fillings 286 10 296 247 Extractions 792 20 812 694 Gas Cases 124 7 131 226 Local Anaesthesia 371 6 377 101 Scaling and Gum Treatment 274 1 275 12 Dressings 436 44 480 767 Denture Dressings 582 28 610 — Silver Nitrate — — — 67 Treatments Completed 539 20 559 546 41 As mentioned in last year's Report, the introduction of Nursery Classes at certain Primary Schools should materially assist the dental supervision of the above-mentioned age-group until more Nursery Schools can be established. On the nutritional side, the steady improvement noted in the calcification of the deciduous teeth, brought about by improved infant diet and more adequate ante-natal care for mothers will, it is hoped, also contribute by further postponing the onset of dental decay, thus reducing the necessity for active intervention at such an early age. Number of Sessions (treatment) 301 Dentures Fitted 116 Dentures Repaired 19 42 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 Clinic 605 — Bensham Manor — 24 Municipal Midwives 402 — St. Andrew's — 6 Welfare Centres: Wpddon — 12 Municipal 2 26 Shirley — 6 East Croydon — 10 Boston Road — 12 Upper Norwood — 4 Norbury — 19 West Croydon — 15 Holy Trinity — 9 South Norwood 2 14 Addington — 13 South Croydon — 7 Sussex Rd., West Wickham - 15 St. Alban's — 9 Woodside — 28 Day Nurseries —. 79 St. Oswald's — 17 The Retreat 1 — St. Jude's — 6 Referred by Dental Officers 239 Monks Hill Estate — 4 Mothers: 1,012. Young Children : 574. Total: 1,586 Tables required by Ministry of Health ,Circular 2/50). (a) Numbers provided with Dental Care Examined. Needing Treatment. Treated. Made Dentally Fit. Expectant and Nursing Mothers 837 830 830 559 Children under Five 687 677 677 546 (b) Forms of Dental Treatment provided : Extrac tions. Anaesthetics. Fillings. Scalings or Scaling and gum treatment. Silver Nitrate treatment. Dressings. Radio graphs Dentures provided. Local General. Complete. Partial. Expectant and Nursing Mothers 812 377 131 296 275 - 480 9 57 59 Children under Five 694 101 226 247 12 767 — — — — 43 44 The Work of the Health Visitors.—Maternity and Child Welfare Visits Only. Visits Re Ashe Baker Beaumont Comm. 1/10/49 Biggs Bird Blest Devaney Early Elliott Ernest Left 31/8/49 Griggs Comm. 7/2/49 Hall Left 22/10/49 Hayward Hillyard Hinton Johns Lucey Mayo Comm. 23/5/49 Morgenthal Munroe Oakley Orridge Left 15/4/49 Partridge Stack Stanton Thomas Toneri Walker Warman Webb Weston Comm. 13/6/49 Wilson Comm. 1/9/49 Wybrew Total Infants under 1 year- First Visits 109 144 23 195 139 152 204 92 174 41 102 191 82 189 180 43 190 158 131 126 15 22 147 211 199 287 194 234 153 248 62 39 99 4575 Re-visits 322 532 256 841 688 451 832 787 403 106 340 1099 576 703 1512 130 1179 605 646 635 80 89 367 998 648 460 607 627 410 752 284 231 381 18582 Children I—2 years— First Visits 55 5 - 1 - 10 106 6 8 - 1 1 3 8 1 1 - 9 - 6 2 - 42 2 5 10 3 20 3 3 6 2 6 325 Re-visits 150 238 279 506 378 441 592 491 139 23 205 790 512 670 703 89 695 372 322 265 28 91 238 369 362 206 482 527 243 613 213 193 313 11738 Children 2—5 years— First Visits — 13 - 1 1 16 145 - 4 - 4 - 5 6 - - 2 6 3 24 - - 28 I 7 17 1 14 10 9 6 3 15 342 Re-visits 426 565 299 562 258 811 678 6 9 281 35 531 937 809 580 533 138 795 387 452 500 29 99 347 277 4:3 373 679 905 651 1241 523 261 686 16750 Expectant Mothers- First Visits 80 94 17 92 115 84 86 88 110 30 73 118 78 88 103 27 103 44 67 103 - 21 67 149 109 124 108 108 74 64 48 29 26 2527 Re-visits 18 I 1 - - 5 - 21 1 4 4 14 6 12 - - - 23 - 2 3 - 4 - - 4 5 13 - 1 2 1 - 145 Still Births 5 1 - - 2 - - - - - - -- 2 - 2 - 2 1 2 - - - - - - - - - - - 1 - 18 Deaths under 1 year 3 14 - 2 1 4 1 2 4 - - 4 - 1 - 1 2 1 1 8 - 1 1 1 5 5 1 3 - 5 - - 2 73 Miscellaneous Visits 5 26 1 2 2 5 47 1 14 33 37 5 9 15 16 87 - 3 8 5 40 1 4 17 40 65 21 24 18 20 8 2 5 586 Ineffective Visits 197 407 104 881 405 486 562 338 260 89 553 584 396 578 245 108 317 307 774 560 65 71 180 385 518 414 444 446 705 708 600 215 381 13286 Totals: 1949 1370 2040 980 3086 1989 2465 3253 2495 1398 362 1850 3743 2476 2857 3293 626 3283 1917 2405 2236 262 395 1425 2410 2326 1965 2545 2921 2267 3664 1752 977 1914 68947 1948 997 1896 - 1052 1967 2532 2960 2121 1209 1390 - 3668 2179 2715 2516 673 1636 - 2215 2389 454 2859 1408 2205 2572 1709 2427 2999 1269 3058 — - 3626 *60122 *Including Health Visitors who left during 1948 45 MIDWIFERY SERVICE. The advent of a general practitioner maternity service under the National Health Service Act gave rise to certain difficulties. Firstly, the status of the midwife booked to attend a case for whom a doctor had also been booked as a general practitioner obstetrician. It soon became apparent, and was confirmed by official guidance, that in most cases the midwife would have to consider herself as acting in that capacity, as in very few cases did the doctor wish her to act as a maternity nurse only. Co-operation between doctors and midwives in Croydon was, generally speaking, very good and every effort has been made by the Local Medical Committee and the Local Health Authority to foster and assist this relationship. A record document for communication between doctor and midwife regarding ante-natal examinations was issued by the Executive Council to all general practitioner obstetricians and, whenever possible, midwives were urged to consult directly the doctor booked for the confinement. The feeling that both were essential partners to assist the expectant and lying-in mother was becoming firmly established by the close of the year. It must be recognised, however, that there is great pressure from the expectant mothers themselves to have their confinements in hospitals. At present, it is greatly to their financial advantage to do so. In the past, pressure of work has curtailed the available time which the domiciliary midwife could give to each case, but in the year under review the case-load in Crovdon reached that recommended by the Working Party on 'the Midwifery Service. If the full establishment of midwives can be maintained it is hoped that in future they will be able to give individual attention surpassing that afforded in hospitals. Midwives Acts, 1902 to 1936. The number of midwives who notified the Local Supervising Authority of their intention to practice within the Borough during 1949 and who were practising at the end of the year, was 73, including those who intended practising as maternity nurses. All these were trained and held the certificate of the Central Midwives Board. Dr. Hegarty, the Medical Supervisor of Midwives, during the year paid 82 visits to the homes of midwives. 46 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 11 Other causes 11 Albuminuria 1 23 For Complications during Labour. Breech 1 Premature Labour 2 Foetal Distress 2 Malpresentation 4 (\ Delayed Labour. Uterine Inertia 7 Prolonged and obstructed 25 32 Haemorrhage. Ante-partum 3 Post-partum 14 17 Other Causes. Adherent and Retained Torn Perineum 144 Placenta 2 146 For Complications during Puerperium. Pyrexia 27 Pain in Breasts 3 Pain in Legs 9 Other causes 25 64 For Complications in regard to the Baby. Inflammation of Eyes 27 Still Birth 3 Feebleness 4 Other causes 42 Premature Birth 7 83 374 47 WORK OF MUNICIPAL MIDWIVES. Number of Stillbirths 17 Number of Premature births 17 Midwifery Maternity Month Mileage Deliveries Normal Abnormal Normal Abnormal Bookings Ante-Natal Visits Post-Natal Visits Gas and Air Office Bookings January 2439 114 78 1 35 — 197 509 2317 74 189 February 2305 114 79 2 31 2 117 468 2197 78 152 March 2710 126 89 1 33 3 206 691 2535 98 174 April 2031 126 82 1 42 1 158 652 2425 97 140 May 2402 124 72 — 50 2 132 605 2626 110 151 June 2553 122 84 1 35 2 120 622 2413 109 108 July 2216 117 70 1 44 2 109 528 2347 100 119 August 2197 121 67 1 52 1 150 635 2419 98 148 September 2615 134 89 2 41 2 126 641 2639 121 116 October 2112 110 68 4 36 2 107 650 2231 80 114 November 2374 97 63 1 33 — 117 620 2087 79 108 December 2020 101 55 2 42 2 104 615 2070 84 71 Total 27974 1406 896 17 474 19 1643 7236 28306 1128 1590 SUPPLY OF MATERNITY OUTFITS. Cases dealt with by the Midwifery Service were supplied with Maternity Outfits and a few sets were issued to cases under the care of independent midwives, giving a total of 1,450 issued during the year. HOME NURSING. This service was carried out by the Croydon Nursing Service (Queen's Nurses) as agents of the Corporation. It was a year of considerable difficulty for them owing to a prolonged illness of the Superintendent, who was eventually forced to retire through ill-health. 48 Nevertheless, the work was continued and increased greatly during the year under review. An analysis of the cases receiving attention showed that 80 per cent. of the cases receiving attention showed that 80 per cent. were in the category" chronic sick and aged persons." The Corporation agreed to supply four small vans for the transport of the staff, and three were received and put into commission during the year. They have been extremely useful and much appreciated. Thirty whole-time and five part-time nurses made 99,980 attendances in respect of 4,079 cases during the year. At the end of the year the staff consisted of— 2 Acting Superintendents (joint). 17 Queen's Nursing Sisters. 1 Male Queen's Nurse. 1 Queen's Nursing Sister (part-time). 9 State Registered Nurses. 3 ,, ,, ,, (part-time). 2 ,, Enrolled Assistant Nurses. 1 ,, ,, Male Assistant Nurse. 1 ,, ,, Nurse (part-time). IMMUNISATION AGAINST DIPHTHERIA. A total of 4,299 new cases came from the following sources : — School Children 548 Children under 5 3,751 Of these, 83 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. 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 2,898. 49 The ensuing comparative tables give some further details:— Year New Cases Completed Treatment Failed to attend for completion of Course 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 1949 4299 4216 83 2898 Origin and Source of New Cases attending Year. School M.C.W. Total Per cent. Total. Per cent. 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 1949 548 12.7 3751 87.3 IMMUNISATION AGAINST WHOOPING COUGH. A total of 3,148 children were immunised against whooping cough, comprising 2,950 under school age and 192 school children. VACCINATION AGAINST SMALL-POX. A total of 2,176 persons were vaccinated against Small-pox. Under 1 year of age 1—4 5—14 15 or over Total Successful Vaccinations 1493 77 71 86 1727 „ Re-vaccinations — 5 45 366 416 Insusceptible to Vaccination 24 — 3 6 33 2176 50 Home Visits by Health Visitors. A total of 9,806 visits was made in respect of immunisation and vaccination. AMBULANCE SERVICE. To the Medical Officer of Health. I beg to submit the Eighth Annual Report and Statistics of this Service, for the year ended 31st December, 1949. During the year the Service dealt with 34,926 calls, which is an increase of 9,699 or approximately 38 per cent. over the figures for 1948, and this increase is obviously accounted for by the expansion due to the National Health Service Act. The mileage covered by ambulances on calls during the year was 295,565 miles, which is an increase of 109,954 over the previous year's figures. The average time taken by an ambulance to attend emergency calls was four minutes, and as the accident calls were scattered throughout the Borough this time would appear to be quite reasonable. During the year, ambulance ABY 11 was taken out of commission and was replaced by a new Humber-Pullman ambulance. In addition, one new Hillman Minx sitting case car was taken into service. Also during this year a 44-hour week was introduced for the personnel of this Service, which necessitated the employment of a further 5 driver-attendants in order to maintain the efficiency of the Service. I have to report that numerous letters of appreciation have been received from persons who have had occasion to avail themselves of the ambulances. A. L. HILL, Chief Officer. 51 ANALYSIS OF ACCIDENTS FOR YEAR ENDED 31st DECEMBER, 1949. 1949. 1948. Collisions between Vehicles, Cycles, etc 130 128 PEDESTRIANS KNOCKED DOWN BY— (1) Motor Cycle 29 32 (2) Motor Lorry 21 58 (3) Pedal Cycle 36 52 (4) Public Service Vehicle 31 12 (5) Motor Cars 92 136 209 290 INJURIES SUSTAINED BY FALLING— (1) In the Street 107 166 (2) In the Home 126 51 (3) From Vehicles, Cycles, &c 180 125 (4) Down Stairs 50 31 (5) From Trees, Scaffolding, &c 25 4 488 377 WORKS ACCIDENTS— (1) Caught in Machinery 18 17 (2) Crushed by heavy objects 21 17 (3) Miscellaneous accidents at work 88 109 (4) Falling 69 43 (5) Knocked down by train 2 — (6) Burns and scalds 15 — 213 186 OCCIDENTS IN PUBLIC PLACES— (1) Theatres 2 2 (2) Cinemas 4 — (3) Public Halls 17 1 (4) Railway Stations 16 10 (5) Sports Grounds 12 46 (6) Recreation Grounds 56 25 (7) Public Houses 4 — (8) Shops 30 — 141 84 Miscellaneous Accidents 374 195 DEATHS— (1) Certified at Hospital 51 39 (2) Certified at scene of accident or illness 7 9 58 48 52 SUICIDES— 1949. 1948. (1) Hanging 2 1 (2) Poison — — (3) Coal Gas Poisoning 11 10 (4) Suffocation 1 — 14 11 ATTEMPTED SUICIDE— (1) Poison 10 6 (2) Cut Throat 4 2 (3) Coal Gas Poisoning 12 10 (4) Jumping from vehicles — 2 26 20 BURNS AND SCALDS 50 10 PERSONS FALLING FROM PUBLIC SERVICE VEHICLES 46 28 COMMON ASSAULT 23 18 SUDDEN ILLNESS IN THE STREET 474 396 EPILEPTIC FITS 91 100 OXYGEN USED 41 29 ACCIDENTS TO CHILDREN UNDER 15 YEARS OF AGE— (1) In Schools 105 81 (2) In the Home 143 161 (3) In the Streets 203 175 (4) Miscellaneous Accidents 1ll 562 417 During the year 34,926 calls were dealt with by the Ambulance Service as follows:— 1949. 1948. Miscellaneous 374 59 Accidents in streets, places of employment and public places 927 850 Accidents in Private Houses 343 355 Sudden illness in street, places of employment 519 472 Sudden illness in Private Houses 166 126 Accidents in Schools 105 81 General Removals under National Health Service 32,309 18,882 Services of ambulance not required or refused 134 216 Suicides, attempted suicides and assault 49 — 34,926 21,041 Calls taken by Borough (and Mayday) Hospitals 826 4,186 35,752 25,227 53 INCIDENCE OF CALLS. 1 day 24 calls 2 days 53 calls 2 days 95 calls 7 days 122 calls 1 ,, 25 „ 5 .. 54 „ 2 „ 96 „ 7 „ 123 ,, 1 ,, 26 „ 3 „ 55 „ 3 „ 97 „ 9 „ 124 „ 2 „ 27 „ 2 ,, 56 „ 5 „ 99 „ 9 „ 125 „ 2 „ 28 „ 6 „ 57 „ 3 „ 100 ,, 4 „ 126 „ 2 „ 29 „ 1 „ 58 „ 1 „ 101 „ 5 „ 127 „ 2 „ 30 „ 4 ,, 59 ,, 1 „ 102 „ 5 ,, 128 „ 2 „ 31 „ 5 ,, 60 ,, 4 „ 103 „ 3 ,, 129 2 „ 32 „ 4 „ 62 ,, 7 ,, 104 „ 4 „ 130 „ 7 „ 33 „ 4 „ 63 „ 5 ,, 105 „ 4 „ 131 „ 5 „ 34 „ 1 ,, 65 „ 8 „ 106 „ 10 „ 132 „ 1 „ 35 „ 2 „ 66 „ 7 ,, 107 ,, 5 „ 133 „ 3 „ 36 „ 2 „ 67 ,, 3 ,, 108 „ 4 „ 134 6 „ 37 „ 3 „ 68 „ 6 „ 109 „ 4 „ 135 „ 1 „ 38 „ 1 70 ,, 4 „ 110 „ 2 „ 136 „ 3 „ 39 „ 2 ,, 72 „ 7 „ 111,, 3 „ 137 „ 4 „ 40 „ 2 ,, 73 „ 8 ,, 112 „ 4 „ 138 „ 2 „ 41 ,, 4 ,, 75 „ 5 113 „ 3 ,, 139 „ 5 „ 42 „ 1 ,, 77 „ 6 ,, 114 „ 3 „ 140 „ 1 „ 43 „ 1 „ 79 „ 5 „ 115 „ 2 „ 141 ,, 1 „ 47 „ 1 „ 81 „ 6 „ 116 „ 1 „ 143 „ 1 „ 48 „ 1 „ 82 „ 5 „ 117 ,, 4 „ 144 ,, 1 „ 49 „ 2 „ 85 ,, 7 ,, 118 „ 1 „ 145 ,, 3 „ 50 „ 1 ,, 88 ,, 4 „ 119 „ 1 ,, 146 „ 2 „ 51 ,, 1 „ 90 ,. 5 ,, 120 „ 1 ,, 147 ,, 6 „ 52 „ 1 „ 93 „ 8 ,, 121 „ 4 ,, 148 ,, AMBULANCE STATISTICS—Year 1949. Calls during the year were apportioned as follows:— Headquarters Station 24,467 No. 2 Station, Thornton Heath 5,403 No. 3 Station, Crunden Road 5,056 Borough Hospital 826 35,752 The arrangements for mutual assistance with surrounding authorities for the use of ambulances to convey persons injured in accidents, etc., to home addresses after treatment at Hospitals continue to operate satisfactorily. On 715 occasions First Aid was rendered to injured persons prior to their removal to Hospital. On 41 occasions oxygen and carbon dioxide was administered to patients by means of the " Novox " apparatus. 54 On 7 occasions persons were certified dead at scene of accident or illness, and on 51 occasions persons were certified dead on arrival at hospital. During the year the Service was called upon to deal with 14 cases of suicide and 22 cases of attempted suicide. Cases conveyed by Croydon Isolation Hospital Ambulance: Scarlet fever 429 Measles 1ll Poliomyelitis 23 Whooping Cough 21 Mumps 7 Dysentery 6 Enteritis 47 Diphtheria 16 Chicken-pox 5 Typhoid 2 Food poisoning 3 Cerebro-spinal fever 13 Puerperal fever and W.R. 31 Erysipelas 16 Impetigo 1 Journeys out of Borough 39 Service requirements 56 826 On 820 occasions Gas and Air Analgesia sets were conveyed to addresses on behalf of Municipal Midwives, entailing mileage of 4,822. 852 calls were received to convey members of Croydon Nursing Service which necessitated travelling 3,412 miles. Conveying children to and from St. Margaret's School accounted for 5,600 miles. 14,042 miles were covered on behalf of the Mental Deficiency Committee conveying children to and from School, 5 PREVENTION OF ILLNESS AND AFTER-CARE. TUBERCULOSIS AFTER-CARE. The following report on the work of the Almoner's Department has been submitted by Miss Bridger, the After-Care Almoner. Arrangements for the year were the same as the latter half of 1948. Special grants continued to be paid through the National Assistance Board to patients who had lost income to undergo treatment for tuberculosis of the respiratory system. On 31st December, 1948, there were 134 patients in receipt of these grants, which are arranged through co-operation between myself and the N.A.B. During 1949, 119 new cases were referred and grants made, and .120 cases ceased to need assistance, leaving a total of 133 at 31st December, 1949. Of the 120 cases taken off assistance, 30 died, 43 returned to work, 24 were no longer in need on admission to hospital, and 23 were either awarded pensions, or left the district. In addition to regular weekly allowances, grants for special needs arising out of exceptional circumstances were obtained through the N.A.B. in 53 cases. These cases included fares to visit relatives in hospital, clothing grants, help with moving expenses where families were rehoused, and a cot and pram for a new baby. Considerable sums of money have been obtained from voluntary funds, such as ex-Service sources and the B.R.C.S. Emergency Help Scheme. Over £120 was raised by appealing on individual cases, enabling patients and their families to enjoy a number of comforts not provided by statutory funds. This money covered such items as holidays for the patient's family, heavy insurance or hire purchase commitments, wireless licences, and clothing, where no help could be obtained from the N.A.B. Assistance in kind has been given by the After-Care Committee. Beds and bedding were loaned in 21 cases to enable patients to sleep alone, and thus help to prevent the spread of infection. This has proved of great value in view of the length of the waiting list for institutional treatment. Garden shelters have been lent to two patients where suitable garden space was available. Free milk has been provided in certain cases, and overseas food parcels obtained through the B.R.C.S. at the rate of 30 a month, in addition to the invalid food parcels for home-bound ex-Service men. 56 During the year, seven couples were referred to Probation Officers and the Marriage Guidance Council for advice on matrimonial problems arising out of the strain of prolonged illness, Arrangements were also made through the Children's Officer and in co-operation with the Day Nurseries for ten children whose mothers were unable to care for them because of tuberculosis, and where no family arrangements could be made. In 37 cases, Home Help was arranged when the mother of a family was recommended bed rest at home. In the field of rehabilitation, close liaison was maintained with the Ministry of Labour. Under the Disabled Persons Scheme, three men were placed at the Bermondsey Re-employ factory, and two at the new Waddon Re-employ factory. 53 persons were registered as disabled, and of those who were unfit to return to their former employment, training courses were arranged in subjects which include shorthand and typing, book-keeping, watch and clock repairing, chiropody, tailoring and typewriter mechanics. Arising out of these activities, 351 visits were paid to patients' homes. CONVALESCENCE. The Corporation accept financial responsibility for convalescent treatment for approved cases, subject to recovery of cost according to the income of the patient. The conditions imposed are that convalescence must follow some definite illness or accident, must be recommended by a doctor, and taken at a recognised convalescent home. During the year, 51 cases were dealt with, 36 being adults (male, 13; female, 23) and 15 children. These figures do not include school children for whom arrangements are made by the Education Committee. LOAN OF NURSING EQUIPMENT. The Corporation loan equipment and make a small weekly charge, with exemption for incomes below a certain figure. During the year the undermentioned loans were made:— Bed Pans 190 Air Beds 34 Air Cushions 268 Feeding Cup 16 Bed Rests 107 Sputum Mug 3 Bed Cradles 20 Wheel Chair 2 Rubber Bed Pan 46 Thermometer 1 Urinals 59 Dunlopillo Mattress 3 Kidney Dish 5 Bed Table 7 Douche Can 5 Crutches 1 Mackintosh Sheets 257 Commode 1 1,025 57 DOMESTIC HELPS. This service continued in great demand and it was necessary to ask for an additional expenditure of £6,000 above that estimated for the financial year concerned. An analysis of the work covered shows the following approximate percentages:— Maternity Cases 32.7 Sickness, acute 26.5 ,, chronic 38.9 Sick Room Helpers 2.0 Number of Home Helps—January 1st and December 31st, 1949:— 31/12/48. 31/12/49. (a) Full-time 42 46 (b) Part-time 32 82 (2) Number of applications— (a) Maternity 775 (b) Sickness 1,504 (c) Sick Room Helpers . 45 (3) Number of applications met— (a) Maternity 746 (b) Sickness 1,492 (c) Sick Room Helpers . 45 (4) Average duration of services given— (a) Maternity 14 days (b) Sickness (acute cases) 10—21 days (5) Amount recovered for services £3,115 0s. Od. (6) Rate of remuneration of " Helps "— (a) Maternity £4 14s. Od. per week (b) Sickness 2s. per hour HEALTH PROPAGANDA. In addition to the continuous and detailed advice on health matters, which form part of the daily duty of Doctors, Health Visitors, Midwives, Mental Health Workers and other Officers of the Department, certain general health propaganda features were instituted. A well-constructed and attractive display panel was loaned by the Central Council for Health Education, together with a series of topics dealing with such subjects as " Food Hygiene," " Diphtheria Immunisation," "Dental Hygiene," '' Work of the Health Visitor," etc. 58 These were exhibited together with suitable handbills and pamphlets at selected sites throughout the Borough. The exhibit attracted much attention and favourable comment, and undoubtedly this is a most effective propaganda medium. Display sets regarding the causation, prevention and treatment of the Common Cold, were received from the Central Office of Information, one series being displayed at the Health Departand other sets distributed to large industrial undertakings. The Chief Sanitary Inspector and his staff have devoted much time to education on clean food handling to those concerned in canteens and the food trade, using material also prepared by the Central Council for Health Education. Two poster sites are retained in the Borough on which the Central Council's posters are also displayed. On the School Health side, use has been made of films provided by the Centra Office of Information regarding care of children's teeth, care of eyes, etc., at lectures for Parent-Teachers' Associations. Posters and pamphlets supplied by the Royal Society for the Prevention of Accidents, have been displayed in Infant Welfare Centres, emphasising the dangers from which babies and small children should be protected in the home. The monthly journal, "Better Health," continued to be distributed and in great demand at Welfare Centres. Booklets and pamphlets on ante-natal care and parentcraft are supplied at the Ante-Natal Clinics. 59 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. 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 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. One Authorised Officer attended the seven weeks' course arranged by the National Provincial Council for Mental Health for Duly Authorised Officers. Work carried out in the Community. Under Section 28, National Health Service Act. Nil. 60 Under the Lunacy and Mental Treatment Acts. Patients dealt with under the Lunacy and Mental Treatment Acts during 1949, are as follows:— (a) Certified and admitted to Warlingham Park Hospital 66 (b) Admitted to Warlingham Park Hospital as voluntary patients 116 (c) Removed to Mayday Hospital under Detention Order 300 (d) Admitted to Warlingham Park Hospital as temporary patients 3 (e) Investigated and no action taken 125 (f) Urgency Orders 8 618 Under the Mental Deficiency Act. Number of known Mentally Defective Patients in the Borough : 1948. 1949. Under 5 years 14 26 Aged 5-16 years 108 84 Over 16 years 509. 549 Total 631 659 Compared with 1948 the cases show an increase of 28. Four Institution patients have died in hospital. The cases are distributed as follows:— 1948. 1949. In Certified Institutions 235 267 In Approved Homes 5 2 On Licence from Institutions 18 20 Under Statutory supervision at home 208 210 Under Guardianship 71 70 In Mental Hospitals 14 12 Observation cases 77 76 In " Place of Safety " 3 2 631 659 61 During the year the Certifying Medical Officers made examinations and paid visits to the number of 132 cases. The Mental Deficiency Visitors paid 2,413 visits. 36 new cases were examined during 1949 and certified as mentally defective. 10 of these cases were recommended for the Occupation Centre. The remainder were placed under statutory supervision. During 1949, 32 cases were dealt with as follows:— 1948. 1949. Sent to Certified Institutions 13 18 Placed under Guardianship 12 5 Sent to Warlingham Park Hospital 1 — Varying Orders: (a) Change of Guardian 7 6 (b) From one Institution to another 8 — (c) From Guardianship to Institution 2 1 (d) Institution to Guardianship 2 — (e) Orders closed 2 2 Forty Orders were renewed during the year, 16 of which were Guardianship. 23 children were admitted to the Occupation Centre during 1949. There were 23 cases awaiting vacancies in Institutions on the 31st December, 1949. Guardianship Cases. There were 70 cases under Statutory Guardianships, 40 of these under the care of relatives, and 30 with Guardians who are not relatives. 5 males and 1 female are at work. Five of the patients under Guardianship have died. 614 visits have been paid to Guardianships cases during the year. There are 20 cases on licence from Institutions (6 males and 14 females). The following report is made by the Supervisor of the Occupation Centre: — Number on Register, January, 1949 21 ,, ,, December, 1949 43 Sessions open (whole day) 204 Total attendance for the year 11,046 Average attendance per session 27.42 62 The Occupation Centre, which was opened on May 26th, 1948, has 43 children on the roll. Seven children have been excluded or left, and 22 admitted during the year. The staff consists of a Supervisor, 1 Trainee, 3 Assistant Teachers, 2 Guides, 1 Domestic Help and 2 Cleaners. Dinners are provided through the School Meals Service and free milk is given to all children attending the Centre. The patients attending the Centre are divided into 4 classes according to age and ability. 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. to 3.30 p.m., Monday to Friday. The syllabus consists of instruction in the following subjects:—Singing, physical training, educational games to wireless and music, percussion bands, sense and memory training, speech training, stool weaving, rug work and various other forms of hand work. Cooking and laundry instruction is given to the senior girls and instruction in wood work and gardening to the senior boys. Young children have a 30-minute rest after dinner. The rest spend half-an-hour in the garden if fine or in the music room if wet. Almost all the patients take turns in laying dinners, handing round meals and of washing and wiping up. The cutlery is cleaned once a week by the older boys and girls. In January, 1949, through the courtesy of the Grand Theatre, Croydon, the children were taken to a matinee performance of " Robinson Crusoe." An Open Day and Exhibition of work was held in November for parents, who were agreeably surprised at the standard of work on exhibition. The children gave a short concert consisting of percussion band and singing. Sales of the articles made by the children realised £8 6s. 9d. The usual Christmas Party was held on December 19th, when presents were distributed from the Christmas Tree by the Chairman of the Mental Health Sub-Committee. A number of visitors attended, including the Medical Officer of Health, Chairman of the Committee, and others interested in the work of the Centre. 63 SANITARY CIRCUMSTANCES. To the Medical Officer of Health. I beg to submit a report for the year ending the 31st December, 1949, of the work of the Sanitary Inspectors and other officers made under my supervision. During the year under review there has been a reduction in the number of complaints of conditions affecting the housing environment compared with the past few years and in consequence it has been possible to give more attention to the inspection of food premises, factories and work places, as the tables in the report will show. Some 9,000 houses have been rendered fit as a result of action by the Department. It was necessary in 369 cases for the local authority to do the works asked for on formal notices, in default of owners. The improvement in the structural condition of food premises has been maintained. It is possible by statute to require the necessary fitments to provide the facilities for general and personal cleanliness in the food trades, but it is another matter ensuring that full advantage is taken of such facilities when provided. The Inspectorate emphasise this angle at every opportunity. 1,500 samples of food and drink for both chemical and bacteriological examination have been taken during the year. Meat inspection occupies the time of two Inspectors between the Abattoir, where 24,769 animals were inspected after slaughter, and the Meat Depot which serves a population of some 350,000. Rats and mice destruction has gone on throughout the year and the results have been very encouraging. GEO. GRIEVE, Chief Sanitary Inspector. 64 Summary of Inspections made by the Sanitary Inspectors, and other Departmental Work. Total number of houses inspected for housing defects (under Public Health or Housing Acts) 9,121 Number of houses inspected where zymotic diseases have occurred 248 House drains tested 2,001 House drains tested on application 13 Number of smoke tests during repair 674 Inspections of drainage work during repair 3,883 Number of water tests during repair 231 Final tests of drains after repair 78 Final tests of drains when completely relaid 42 Inspection of yards, stables and manure pits 182 ,, passages 68 ,, public conveniences 86 ,, pigstyes 98 ,, tents, vans and similar structures 46 ,, theatres, cinemas, halls, etc. 124 ,, ponds and ditches 106 ,, schools and school sanitary conveniences 16 ,, common lodging-houses 16 ,, verminous premises 191 ,, premises where offensive trades are conducted 28 ,, gipsy encampments, camps, fairs, etc. 4 ,, cesspools 30 ,, gathering grounds of water supply 42 Number of visits under Rats and Mice (Destruction) Act, 1919 11,108 Smoke observations 117 Number of visits re Infectious Diseases 1,582 Inspections of Shops (under Shops Acts) 1,035 Special Early Closing and Evening Patrols (Shop Hours Acts) 261 Overcrowding inspections 404 Inspections under Fertilisers and Feeding Stuffs Act 4 ,, under Pharmacy and Poisons Act. 94 ,, of Dairies 193 ,, Farms and cowsheds 59 ,, Milkshops 127 ,, Premises where food is prepared or sold 6,442 ,, Bakehouses 113 ,, School Kitchens and Services 43 Inspection of Factories without mechanical power 93 ,, Factories with mechanical power 401 ,, Workplaces, Public Health Act 45 ,, Outworkers' premises 250 Visits re Young Persons Employment Act 12 Drinking water samples taken 69 Swimming bath waters : samples taken 57 Food and Drugs Acts : milk samples taken 337 Food and Drugs Acts : other foods and drugs samples taken 446 Milk Special Designations Orders : samples taken 314 Non-designated Milk: samples taken 58 Ice Cream samples taken 278 Reinspections of work on outstanding notices 30.477 Sundry inspections and visits 2,353 Appointments kept with owners, builders, etc. 5,293 Complaints from public investigated (including those in regard to housing defects) 10,410 65 Informal notices outstanding 31-12-48 3,030 Informal notices served 8,204 Informal notices complied 7,929 Number of Informal Notices referred for Statutory Orders 1,512 Informal notices outstanding 31-12-49 1,793 Statutory notices outstanding 31-12-48 1,168 Statutory notices served 2,380 Statutory notices complied 2,501 Statutory notices outstanding 31-12-49 1,047 Total number of callers and complaints received at the office 8,983 Total number of letters received at the Office 10,335 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 1,223 Conditions causing dampness: Defective roofs 1,484 Defective window frames 513 Defective walls, etc. 559 Want of efficient damp-proof course 321 Defective gutters and downspouts 1,105 Other structural defects: Detective plaster 2,236 Cleansing and redecoration required 2,181 Defective floors and stairs 1,121 Insufficient ventilation under floor 101 Defective brickwork, cills, lintels, chimneys, etc. 1,144 Defective stoves and fireplaces and flues 861 Defective drains, sanitary fittings, etc.: Defective sinks and waste pipes 647 Defective w.c.'s 410 Defective drainage 730 Stoppages in drains 235 Defective water services and tanks 92 Domestic nuisances: Want of cleanliness 10 Dirty w.c. pans 8 Verminous conditions 81 Other nuisances and infringements: Offensive accumulations 91 Dirty or defective sanitary conveniences 4 Overcrowding 83 Smoke nuisances 2 Sundry nuisances or defects 32 Particulars not inserted in Rent Book (Housing Act) 6 „ ,, ,, (Rent Restriction Act) 1 66 (2) FACTORIES AND WORKPLACES. Want of cleanliness 12 Inadequate ventilation 1 Insufficient drainage of floors 1 Abstract not exhibited 4 Sundry nuisances or defects 24 W.C.'s—Insufficient 14 ,, Unsuitable or defective 58 ,, Not separate for sexes 3 (3) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924. Food cupboards defective or required 9 (4) INFRINGEMENTS OF FOOD AND DRUGS ACT, 1936, AND FOOD BYELAWS. Structural defects in shops and stores 79 Cleansing or repair of walls and ceilings 245 Cleansing or repair of floors, utensils, fixtures, etc. 149 Insufficient or defective sink accommodation and water supply 56 Insufficient lighting or ventilation 23 Defective drainage 40 W.C. Accom. Insufficient 25 ,, Repair or cleansing required 59 ,, Artificial light required 6 ,, Want of intervening ventilated space 6 Cloakroom accommodation required or defective 18 Overalls required or dirty 3 Ablutions : Wash basins required 57 ,, Hot water supplies required 225 ,, Soap and towels required 28 Food improperly stored 16 Food store: Required or defective 22 ,, Animals kept in 6 ,, Household washing in — Fish frying apparatus defective 4 Accumulation in yards or stores 61 Offal and refuse bins uncovered or defective 54 Footpaths fouled by waste water 1 Yard paving defective 29 Vehicles—dirty or defective 3 ,, Name and address not on 1 (5) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING, Etc. Defective Yard Paving 173 Want of a sanitary dustbin 308 (6) INFRINGEMENTS OF SHOPS ACT. Shops Closing Hours Infringment in hours of employment and welfare provisions 60 67 Notices to be exhibited or amended 246 Defective ventilation 3 Provision of means of heating 5 Insufficient w.c. accommodation 10 Want of washing facilities 12 Defective w.c. accommodation 14 Defective walls, floors, ceilings, etc. 7 Defective lighting 9 Seating accommodation 20 (7) INSPECTION OF AMUSEMENT HOUSES. Defective sanitary fittings 7 W.C. defective and dirty 6 (8) KEEPING OF ANIMALS. Nuisances arising from the keeping of animals 6 (9) INSPECTION OF WATERCOURSES, etc. Cleansing of watercourses and ponds 12 (10) INFRINGEMENTS OF OTHER BYELAWS. Noisy animals 15 HOUSING. Individual Unfit Houses. During the year action under the Housing Acts was mainly confined to the repair of houses. The accepted standard of repair whilst lower than that of pre-war years is higher than in previous post-war 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 has been maintained at a level corresponding with that of pre-war. I.—Inspection of dwelling houses during the year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health and Housing Acts) 9,121 (b) Number of inspections and re-inspections made for the purpose 33,456 (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 8 (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 7,825 68 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 6,523 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 1,162 (2) Number of dwelling houses which were rendered fit after service of formal notices— (a) By owners 1,203 (b) By local authority in default of owners 122 —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 1,133 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 880 (b) By local authority in default of owners 247 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 8 (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 — 69 West Croydon Men's Hostel. This is situated at Pitlake and is available for use by "'nightly lodgers." It has 104 cubicle beds, four of which are reserved for staff. The charge is 1s. 3d. per night or 7s. 6d. per week, and 1s. per night or 6s. per week for Old Age Pensioners. Cooking facilities are provided. Hot baths may be taken any time after 9 a.m. Clothes may be washed and dried in the wash-house provided. The average number of nightly lettings during the year was 100, and the number accommodated during the year 36,500. The receipts and expenditure for the past 5 years have been as follows:— Receipts. Expenditure. £ s. d. £ s. d. 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 1949 1,854 0 0 3,169 0 0 Houses—Sanitary Certificates. House drains and sanitary fittings are tested and examined on request, at a fee. During the year 8 such requests were made. FACTORIES ACT, 1937. During the year the under-mentioned inspections have been made and defects were found as set out: — FACTORIES. Inspection. Premises. Number of Inspections. Written Notices. Prosecutions. Factories:— With Mechanical Power 401 34 — Without Mechanical Power 93 23 — Other Premises 45 3 — Outworkers and Employers of outworkers 250 — — Total 789 60 — 70 Defects Found. Particulars. Number of Defects. Referred to H.M. Inspector. Prosecutions. Found. Remedied. Want of Cleanliness 12 12 — — Overcrowding 1 1 — — Unreasonable Temperature — — — — Inadequate Ventilation 1 1 — — Ineffective Drainage of Floors 1 1 — — Sanitary Conveniences. (a) Insufficient 14 14 — — (b) Unsuitable or Defective 58 58 — — (c) Not Separate for Sexes 3 3 — — Other offences against the Act (not including offences relating to Outworkers) 28 28 - - Total 118 118 - — Home Work. Lists of home workers, or outworkers as they are termed, are sent In twice yearly, and this year contained the names of 399 workers residing in the Borough. 250 visits were paid to outworkers. Nature of Employment of Outworkers on the Register, 31st December, 1949. Nature of Work. Number Employed. Outwork in Infected Premises. Outwork in Unsatisfactory Premises. Remarks. Making. Cleaning, Altering and Repairing Wearing Apparel 256 - - - Upholstery Work 6 - - - Other Classes of Work 137 - - - Total 399 — — — Inspection of Schools. These are inspected with particular reference to sanitary accommodation including washing facilities. During the year 16 inspections were made and defects found were referred to the Education Officer. 71 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 during the year given little cause for complaint. 20 infringements were found in regard to hours of work of assistants but these were amended forthwith. The health and comfort of those employed is safeguarded in the matter of shop ventilation, lighting, warming, washing facilities, facilities for taking meals and suitable and sufficient sanitary accommodation, and action has been taken in the cases where these fell short of requirements. The Young Persons Employment Act, 1938, regulates the hours of employment of persons under the age of 18 years, not controlled by the Shops Acts. 1,035 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 3,883 visits of inspection wen' 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 vears. Of 934 Orders served, 131 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 are relaxed by Government Order, but this does not relieve the keepers of providing against nuisance. Little complaint of nuisance has however arisen. OFFENSIVE TRADES. There were but few registered, and during the year the're has been no cause for complaint. WATERCOURSES, PONDS AND DITCHES, Etc. 106 inspections were made and pollutions were found in 12 cases. SMOKE OBSERVATIONS. During the year 117 observations were made of factory ch.m. tieys for the purpose of detecting offences. In those cases where 72 nuisance occurred appropriate action was taken with a view to remedying the condition. Today there is little choice left to the factory owner regarding the fuel he uses and this creates a difficult problem in smoke abatement. The difficulty of renewals of plant has also to be overcome. Some factories have changed over from solid fuel firing to oil firing. AMUSEMENT HOUSES. 124 inspections were made of Theatres, Music Halls, Cinemas, Dance Halls, and premises where stage plays are given. A report is submitted annually to the Licensing Authorities on the sanitary condition of these premises. Notices are issued to remedy any unsatisfactory conditions. DISINFECTION. The Borough Disinfecting Station is situated at Factory Lane. Two steam disinfectors are in use and are supplied with steam from the Electricity Works. The following articles were disinfected at the Disinfecting Station during the year:— By Steam 29,886 articles ,, Formalin Gas 804 ,, ,, ,, Spray 603 ,, Total 31,293 In addition 680 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 1949, 620 articles were disinfected, the receipts amounting to £27 3s. 3d. Disinfection was carried out after infectious or contagious disease at the following premises:— 1,377 rooms at 940 houses, hospital wards, clinics, and creches. 2,169 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 73 in adults and children. A woman attendant dealt with children and women. During the year 12 adults and 93 children were cleansed of verminous conditions and 28 adults and 47 children were treated for scabies. DISINFESTATION OF PREMISES. The new insecticides have provided a ready and easily applied remedy for vermin and pest infestation of premises, and occupiers are advised and instructed in their use by the Inspectors. The department assists in the more difficult cases either by spraying or fumigation. 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 37. In addition, 236 applications were made for the retention of names on the list for a further period of twelve months. 11 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 1,537 complaints were received of rat or mice infestation. Of these complaints the presence of rodents was confirmed in 782 cases. The three Ratcatchers in dealing with these infestations paid 9,872 visits, and used 338½lbs. of poison 74 bait, as well as using traps and gassing. The types of premises found to be infested were:— Dwelling Houses (Inside) 245 ,, ,, (Outside) 253 ,, ,, (Poultry Houses) 129 Premises wheer Food is prepared or sold 42 Factories, Workshops and Business Premises 44 Refuse Tips 2 Sewage Farms 3 Allotments 9 Schools, Hospitals, etc. 20 Shops 20 Drains 15 All sewers in the Borough have received two maintenance treatments during the year. 2,468 manholes were examined for the presence of rats and poison bait laid in 849 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 166 Butchers 216 Confectioners 430 Fishmongers 110 Fish friers only 49 Greengrocers 440 Grocers 703 Stalls and Rounds 196 Catering Establishments (including Hotels, Canteens, Restaurants, Clubs, Snack Bars, etc.) 897 Miscellaneous (including Chemists, etc.) 232 3,439 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. 75 The following table gives a summary of the inspections made during the year, not including visits made to slaughterhouses, dairies or milkshops:— Butchers 1,058 Ice Cream Vendors and Manufacturers 669 Bakers 113 Confectioners 348 Greengrocers 309 Fishmongers 446 Grocers 1,492 Fried Fish Shops 136 Stalls and Rounds 94 Poultry and Game Dealers 120 Catering Establishments 1,179 Miscellaneous 328 Cooked Meat Preparation Premises 35 Total 6,327 General Summary of meat and other articles of food found to be unfit and condemned by the Inspectors during 1949 : — Articles. Weight in lbs. Diseased. Unsound. Total. Beef 63276 4368 67644 Veal 169 100 269 Mutton 1654 1738 3392 Pork 2030 12 2042 Offal 92022 123 92145 Fish — 12178 12178 Fruit and Vegetables — 5142 5142 Canned, bottled and packeted goods — 29277 29277 Other goods — 19678 19678 159151 72616 231767 The above includes— Canned, bottled and packeted goods: 22,560 cans, 7,425 bottles, packets, etc. 76 Disposal of Condemned Foodstuffs. The Meat was condemned at either the Public Abattoir, the Ministry of Food Depot or at shops supplied therefrom and was disposed of by the Ministry. A fair proportion of the other foods condemned was dealt with by firms who specialise in converting such into manures, animal feeding stuffs, oils, etc. MEAT INSPECTION. This is carried out at the Public Abattoir, and the Government Meat Depot from which all meat supplied to Croydon is distributed. Butcher's shops are visited by the Sanitary Inspectors to observe the condition of meat at time of sale. The Public Abattoir was taken over by the Ministry of Food in November, 1946, for the slaughtering of livestock, and during the year 1949 the following animals were slaughtered there md inspected by the Corporation's Meat Inspectors:— Cattle Calves Sheep Goats Pigs Total 7,709 875 14,857 323 1,005 24,769 The result of these inspections was as follows:— Carcases Inspected and Condemned. Cattle Calves Sheep Goats Pigs Number killed 7709 875 14857 323 1005 Number inspected 7709 875 14857 323 1005 All Diseases except Tuberculosis. Whole Carcases condemned 6 Nil 23 Nil 17 Tuberculosis Only. Whole Carcases condemned 87 3 Nil Nil 4 All Diseases except Tuberculosis. Total weight in lbs. of Carcases and parts of Carcases condemned 54,247 Tuberculosis Only. Total weight in lbs. of Carcases and parts of Carcases condemned 98,824 77 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 1949) 5 Cowsheds on register (end of 1949) 5 Average number of cows in sheds (1949) 86 Number of dairies and purveyors of milk on the register (end of 1949) 96 During the year 379 inspections were made of dairies, cowsheds and milkshops. Milk (Special Designations) Order, 1936. The following licences were granted during the year under this Order:— (1) Producers' Licences to use the designation "Tuberculin Tested" 1 (2) Producers' Licences to use the designation "Accredited" 1 (8) Dealers' Licences to use the designation "Tuberculin Tested"— (a) Bottling establishments 2 (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 78 (6) Dealers' Supplementary Licences to use the designation— (a) Tuberculin Tested 6 (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. Bacteriological Examinations of Milk. During the year the following samples of milk were examined: — Tuberculin-Tested Milk— From licensed producers supplying milk to licensed Jocal dairymen 16 Accredited Milk— From licensed producer supplying milk to a licensed dairyman 5 Pasteurised Milk— Samples from licensed dealers 190 Heat Treated Milk- Samples from licensed dealers 39 Non-designated Milk— Samples taken 53 The following tables summarise the results of the bacteriological examinations of Tuberculin Tested, Accredited, Pasteurised, Heat Treated and non-designated milk samples during the year:— Tuberculin Tested Milk. No. Samples Taken. Methylene Blue Test. Bacillus Coli. Not Satisfied. Satisfied. Present in 1/100 ml. Absent in 1/100 ml. 16 Nil 16 Nil 16 Accredited Milk. No. Samples Taken. Methylene Blue Test. Bacillus Coli. Not Satisfied. Satisfied. Present in 1/100 ml. Absent in 1/100 ml. 5 Nil 5 Nil 5 79 Pasteurised Milk. No. Samples Taken. Methylene Blue Test. Phosphatase Test. Not Satisfied. Satisfied. Not Satisfied. Satisfied. 190 1 189 2 188 Heat Treated Milk. No. Samples Taken. Methylene Blue Test. Phosphatase Test. Not Satisfied. Satisfied. Not Satisfied. Satisfied. 39 Nil 39 1 38 Non-designated Milk. No. Samples Taken. Methylene Blue Test . Not Satisfied. Satisfied. 53 Nil 53 80 BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM. 264 Samples were taken, the results being as under:— Grade. No. of Samples 1 117 2 99 3 45 4 3 Out of a total of 264 samples taken, 48 (18.2 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. CHEMICAL EXAMINATIONS OF ICE CREAM. Fifty samples were taken during the year. Whilst there is no standard for the chemical composition of ice cream, the Ministry of Food allot a little more sugar and fat to those manufacturers who undertake not to allow the fat content of their ice cream to fall below 21 per cent. It was emphasised by the Ministry of Food that this did not mean the introduction of a 2½ per cent, fat content standard for ice cream. In none of the samples did the fat content fall below this figure, the range being as follows:— 2½ to 5% 11 5% to 7½ 16 7½ to 10% 17 Over 10% 6 81 FOOD AND DRUGS ACT, 1938. During the year 343 samples of milk and 417 other samples were taken. Summary of Samples. During 1949 samples were obtained and submitted to the Public Analyst as follows:— Samples of Total Samples Genuine Not Genuine Prisecutions Convictions Aislet 1 1 — — — Ale, Ginger 2 2 — — — Almond Substitute 1 1 — — — Anchovies in Olive oil 1 1 — — — Arrowroot 1 1 — — — Aspirin Tablets 1 1 — — — Baking Powder 2 2 — — — Barley Crystals 1 1 — — — Beans in Tomato Sauce 3 3 — — — Beef Cubes 2 2 — — — Beef Suet 1 1 — — — Beer 4 4 — — — Beer, Ginger 4 4 — — — Bicarbonate of Soda 2 2 — — — Black Pudding 5 5 — — . — Blanc Mange Powder 2 2 — — — Boric Acid Ointment 2 2 — — — Brawn 7 6 1 (infml.) Bread 6 6 — — — Broth (Scotch) 1 1 — — — Bun Flour 1 1 — — — Burton 1 1 — — — Butter 2 2 — — — Cakes, Fancy 4 4 — — — Cake Mixture 4 3 1 — — Cake Powder 1 1 — — — Cake, Sponge and Steamed Pudding 3 3 — — — Camphorated Oil 3 2 1 — — Caramel Dessert Powder 1 1 — — — Castor Oil 3 3 — — — Cheese 1 1 — — — Cherryade 1 1 — — — Chicken Broth 1 1 — — — Cinnamon, Ground 2 2 — — — Cocoa 4 3 1 — — Cod Fish, Tinned 1 1 — — — Cod Liver Oil 3 3 — — — Coffee 4 4 — — — Coffee and Chicory 3 3 — — — Coffee and Chicory Essence 3 2 1 — — Confection of Senna 1 1 — — — Cooking Fat 4 4 — — — Cornflour 1 1 — — — Cough Mixture 1 1 — — — Crab Paste 1 1 — — — Cream of Tartar 1 1 — — — Cream Shortbreads 1 1 — — — Curry Powder 3 3 — — — Custard Powder 6 6 — — — Dessert Powder 3 3 — — — Dessicated Soup 1 1 — — — Doughnuts, Cream Filled 1 1 — — — Drinking Chocolate 1 1 — — — Carried forward 120 115 5 — — 82 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought forward 120 115 5 — — Elderberry Wine 1 1 — — — Epsom Salts 1 1 — — — Essence of Lemon 1 I — —. — Faggotts 1 I — — — Fancy Pastry 1 1 — — — Figs 2 2 — — — Fig Pudding 1 1 — — — Fish Cake 6 6 — — — Fish Fillets 1 1 — — — Fish Paste 6 6 — — — Flavouring Essence, Almond 1 1 — — — Flour, Bun 1 1 — — — Flour Mixture, Batter 2 2 — — — Flour, Self Raising 2 2 — — — Flour, Soya 1 1 — — — Fruit Sauce 1 1 — — — Gelatine 2 2 — — — Gin 4 4 — — — Ginger, Ground 1 1 — — — Ginger Wine 1 1 — — — Ginger Wine—non Alcoholic 1 1 — — — Glyceryl Monsterate 1 1 — — — Glycerine 1 1 — — — Golden Raising Powder 1 1 — — — Grapefruit Squash 1 1 — — — ' Gravy Powder 5 5 — — — Guava Jelly 1 1 — — — Herring Roes 1 1 — — — Herrings in Tomato I 1 — — — Honey 3 3 — — — Ice Cream 50 50 — — — Iodine 2 2 — — — Jam 7 7 — — — Jam Tarts 1 1 — — — Jelly Crystals 1 1 — — — Lemon, Essence of 1 1 — — — Lemonade 1 1 — — — Lemonade Powder 6 6 — — — Lemon Curd 1 1 — — — Lemonade Crystals 1 1 — — — Lime Juice Cordial 3 3 — — — Lemon Squash 1 1 — — — Lingfo Fizz 1 1 — — — Liquid Paraffin 3 3 — — — Liquorice Powder Comp 1 1 — — — Luncheon Meat 1 1 — — — Macaroni 2 2 — — — Malted Milk Powder 1 1 — — — Malt Tablets 1 1 — — — Mace, Ground 1 1 — — — Macedoine 1 1 — — — Marmalade 5 5 — — — Margarine 1 1 — — — Meat Galantine 1 1 — — — Meat Paste 3 3 — — — Meat Rissoles 1 1 — — — Milk 343 340 3 — — Carried forward 613 605 8 — — 83 Samples of Total Samples Genuine Not Genuine Prosecutions Cinvictions Brought forward 613 605 8 — — Mint Sauce 1 1 — — — Mixed Peel 1 1 — — — Mixed Vegetables 1 1 — — — Mustard 3 3 — — — Mustard, French 1 1 — — — National Flour 3 3 — — — Oatmeal 3 3 — — — Olive Oil 2 2 — — — Onions, Pickled 1 1 — — — Orangeade 1 1 — — — Orange Juice 1 1 — — — Pancake Mixture 1 1 — — — Pearl Barley 1 1 — — — Peas 4 4 — — — Pepper 4 4 — — — Pickled Onions 3 3 — — — Pickled Red Cabbage 1 1 — — — Pickles, Sweet 2 2 — — — Polony 1 1 — — — Pork Maw Press 1 1 — — — Pork Pie 1 1 — — — Pudding Mixture 1 1 — — — Raising Powder 1 1 — — — Rhubarb, Compound Tincture of 1 1 — — — Rice 1 1 — — — Rum 4 4 — — — Rum Flavouring 1 1 — — — Saccharin Tablets 1 1 — — — Sage and Onion Stuffing 1 1 — — — Sago 4 4 — — — Salad Cream 2 2 — — — Salami 1 1 — — Sandwich Spread 1 1 — — — Sausage, Beef 3 3 — — — Sausage, Liver 3 3 — — — Sausage, Luncheon 7 7 — — — Sausage, Meat 5 5 — — — Sausage, Smoked Danish 1 1 — — — Sausages, Montadella 2 2 — — — Sausages, Vegetable and Cereal 1 1 — — — Savoury Duck 1 1 — — — Savoury Rissoles 1 1 — — — Semolina 3 3 — — — Smoked Fish Fillet 1 1 — — — Snoek, Natural I 1 — — — Soft Drink Powder 1 1 — — — Soup, Oxtail Flavour 1 1 — — — Soup Powder 2 2 — — — Soup, Vegetable 1 1 — — — Spaghetti in Meat Sauce 1 1 — — — Sparkling Clarade 1 1 — — — Spice 3 3 — — — Sponge Mixture 2 1 1 — — Stuffing 2 2 — — — Suet 4 4 — — — Sugar 1 1 — — — Sugar, Demarara 1 1 — — — Sweets 3 3 — — — Syrup of Figs 2 2 — — — Table Jellies 1 1 — — — Carried forward 724 711 9 — — 84 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought Forward 724 711 9 — — Tapioca 3 3 — — — Tea 2 2 — — — Teaseed Oil 2 2 — — — Tinned Meat 1 1 — — — Toffee, Caramel 1 1 — — — Throat Sweets 1 1 — — — Tomato Puree 1 1 — — — Tomato Soup 1 1 — — — Tomato Ketchup 1 1 — — — Treacle Minto 1 1 — — — Veal Loaf 1 1 — — — Vegetables, Mixed 4 4 — — — Vegetable, Salad 1 1 — — — Vinegar, Non-Brewed 1 1 — — — Vinegar, Malt 1 — 1 — — Whalemeat Steak Casserole 1 1 — — — Worcester Sauce 2 2 — — — Whiskey 8 8 — — — Yeast Extract Concentrated 1 1 — — — Yeast Tablets 2 2 — — — Totals 760 750 10 — — Result of Analysis of Milk Samples. Solids Not Fat (Legal standard is 8.5%)* 8.28 8.38 8.4 8.5* 8.6 8.7 8.8 8.9 9.0 1 1 1 6 67 130 81 44 9 Milk Fat (Legal standard is 3%) 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 12 32 70 72 75 38 21 10 1 4.1 4.2 4.3 4.4 4.5 4-8 4.9 2 1 2 1 1 1 1 Total samples of milk: 340 The samples of Milk for analysis were obtained as follows:— Taken on Milk Rounds 260 ,, at Dairies 55 ,, at Institutions 13 ,, at Local Farms 10 ,, at Schools 2 340 Average composition of Milk Samples:— Solids not fat 8.73% Milk Fat 3.55% 85 Adulterated Samples. The following is a detailed statement of the adulterated samples and the action taken:— Sample No. Sample °f Adulteration or Deficiency. Remarks. 531 Brawn (Informal Contained numerous pieces of cartilage, the size and number of which were considered to be excessive. Vendor warned. 118 Cake Mixture (Formal) Madeira. Yielded 0.33 per cent, of carbon dioxide instead of not less than 0.40 per cen t. Vendors admitted deterioration owing to stock being kept for undue length of time. Stock withdrawn and vendors' explanation accepted. 724 Camphorated (Formal) Oil. Contained 23.0 per cent, of camphor. (Camphorated Oil of the B/P should contain 20.0 per cent. W/W of Camphor (limits, 19.0 to 21.0).) Manufacturer's explanation accepted. 510 Cocoa (Formal) The statement on the label did not specify the ingredients strictly in accordance with the requirements of the Labelling of Food Order, 1946. Matter referred to Ministry of Food. 528 Coffee and (Formal) Chicory Essence. Contained 0.21 per cent, weight in volume of caffeine instead of not less than 0.25 per cent. Vendor's explanation that 2¾ lbs. of coffee were used to each gallon of liquid prepared was accepted. 351 (Formal) Milk 1200 548 No. 351 1 per cent, deficient in milk solids other than milk fat. No. 1200. Deficiency of milk solids other than milk fat equivalent to 2 per cent, of added water. No. 548 1 per cent, deficient in milk solids other than milk fat. t +As a result of these samples the Dairyman had his plant overhauled and had samples taken. These latter samples showed that a "producer supplier" was sellng milk to him with solids other than milk fat below the statutory requirements. The Public Analyst's report on a sample of milk from the farm of the "producer supplier" showed that this deficiency was " natural," and the farmer agreed to amend his feeding methods. Further sampling has proved the supply to be satisfactory. 86 Sample No. Sample of Adulteration or Deficiency. Remarks. 233 Sponge (Formal) Mixture. Yielded only 0.18 per cent, of available carbon dioxide. Manufacturer's explanation accepted. (In the Public Analyst's opinion sponge mixture containing baking powder should yield not less that 0.40 per cent, of available carbon dioxide). 392 Malt Vine(Formal) gar. Added salt 0.9 per cent. The addition of salt is allowed by the Ministry of Food. 87 MISCELLANEOUS. Nursing Homes—Public Health Act, 1936. Number of Homos. Number of Beds provided for:— Maternity. Others. Total. Homes registered during the year 3 20 57 77 Homes on the Register at the end of the year 35 83 523 606 Premises in which it was proposed to establish new homes were visited as frequently as was necessary so that the appropriate recommendations could be made to the Health Committee. The Chief Officer of the Fire Brigade Department advised on essential fire precautions and these usually entailed building alterations. Established nursing homes were visited by a Medical Officer of the Department once every quarter and, except for some minor matters, were all satisfactory. NURSERIES AND CHILD-MINDERS REGULATION ACT, 1948. The necessary preliminary inspections and routine re-inspections of Registered Minders and private Day Nurseries have been carried out in accordance with the above Act. There are no day nurseries which take children of all ages for the whole day. The accommodation provided is of the type classed as "part-time" nurseries during the war years, and toddlers only are received, for mornings only, or at two separate morning and afternoon sessions. In the latter case, a stipulation was made that the same children must not attend both sessions. Number registered at 31-12-49 Number of children provided for Premises 3 65 Daily Minders 18 112 88 STAFF MEDICAL EXAMINATIONS. Nine hundred and fifty-eight examinations were made during the year by the Medical Staff of the Department. These examinations varied from assessment of fitness for sick pay, for employment as drivers of mechanical vehicles, for employment in the Water Undertaking, for employment in food handling, for entry into the Superannuation Scheme, and for recommendations as to retirement on pension, for permanent ill-health or transfer to other duties. NATIONAL ASSISTANCE ACT, 1948 (Section 47). No action was taken under this legislation. Cases which arose were dealt with by appropriate combination of general practitioner, nursing, Home Help and Sick Room Attendant Service, and when requested, prompt and helpful assistance by the Local Hospital Bed Bureau. The main burden falls upon the Home Helps, and special volunteers, who may have to work under most trying conditions, are essential. Given such facilities, however, and acceptance of the fact that it is not an offence for individuals who wish to die in the somewhat squalid surroundings in which they may have elected to live, Section 47 appears redundant. CREMATION ACT, 1902. During the year 1,517 certificates were completed in the Department in the capaciy of Medical Referee under the above Act. CROYDON AIRPORT. There was a considerable diminution of passenger arrivals from abroad to an extent which made the employment of special receptionists appear to the Ministry of Health to be unnecessary. These duties were accordingly transferred to the permanent staff of the Home Office who deal with immigration. These officers now act also on behalf of the Health Department and no difficulties arose as a result of such new arrangements. I acknowledge the very helpful co-operation given by H.M. Chief Immigration Officer in effecting the change-over and in the carrying out of the work. 89 CROYDON AIRPORT—AIRCRAFT AND PASSENGER ARRIVALS. 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. C — — — — — — — — ar — — — — —• — — — ap 67 135 108- 90 106 91 94 691 Total bp 642 793 362 280 335 392 362 3166 ac 268 315 254 232 262 319 306 1956 Continental | ap 3 — 15 43 5 6 23 33 59 12 1 29 42 27 7 10 25 20 22 12 7 31 27 36 4 7 16 17 32 18 1 14 32 39 6 ... bp 17 24 59 344 184 27 121 142 355 127 14 27 79 178 57 17 18 57 133 45 11 25 83 143 47 10 38 78 218 43 7 10 53 227 57 Total ac 14 3b 39 125 50 50 46 63 113 35 55 31 60 78 28 53 27 47 75 29 50 24 61 91 33 51 22 64 111 70 47 24 77 107 48 Grand (U.bA.,Canada, Newfoundlands ap — — — — — — — — 2 — — — — — — — — — — — — — — — — — — 1 — — — — — — — bp — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ac — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — |South America West Africa ap — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — bp — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ac — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 South Africa Ali ddle bast ap — — — — 1 — — — — — — — — — 2 — — — 1 — — — 1 — — — — — — — — — 2 — — bp 9 — 2 2 — — — 8 2 5 — — — 6 1 — — 7 3 — 4 8 5 5 4 — — 5 — — — — 1 6 — AC 1 — — 1 1 — — 1 — — — — — 1 — — — 1 — — 1 1 — 1 — — — — 1 — — — 1 1 — Far East Persia ap — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — bp — — — 1 — — 6 — — — — — — — — — — — — — — — — — — — — — — — — — — — — ac — — — 1 — — 1 1 — — — — 1 — — — — — — — — — — — — — — — — — — — 1 — — Hours 0.8 8.12 12.16 16.20 20.24 or 8.12 12.16 16.20 20.24 i0.8 8.12 12.16 16.20 20.24 0.8 8.12 12.16 16.20 20.24 0.8 8.12 12.16 16.20 20.24 0.8 8.12 12.16 16.20 20.24 or 8.12 12.16 16.20 20.24 Day Sunday Monday Tuesday Wednesday Thursday Friday Saturday 90 County Borough of Croydon ANNUAL REPORT of the SCHOOL MEDICAL OFFICER For the Year ending December 31st, 1949. To the Chairman and Members of the Education Committee. Ladies and Gentlemen, I have the honour to present for your consideration the Annual Report of the School Medical Officer for the year ending December 31st, 1949. During the year under review it was possible to commence the scheme approved by the Committee and the Ministry of Education of providing four routine medical examinations during the period of normal school attendance at Corporation maintained schools. It is interesting to recall that in the immediate pre-war years the system of routine medical examinations was subjected to much criticism by School Medical Officers. It was suggested that medical scrutiny of the whole school population in order to detect a minority of defective children was outdated and an uneconomic employment of medical personnel. If routine school medical inspections are regarded solely as a method of detecting gross physical defects these criticisms are justified, and it was perhaps for this reason that the school medical services during the war were allowed to offset the effects of staff reductions by curtailing routine examinations. In my experience, it was the parents who in pre-war years asked for the continuation of such examinations, and now request their re-introduotion and 91 extension. They do so because when properly conducted they give an opportunity for parents to ask questions which concern them personally, regarding the healthy upbringing of their children. Such advice is sought from the family doctor only when definite illness is thought to be present, but no such qualification is required where school medical examinations are concerned. General lectures on health education cannot equal in effect information given to parents in response to enquiries about their'own children. I am, therefore, pleased to be able to report that the extension of routine examinations, initiated by my predecessor, is now operating. It is appropriate in this connection to recollect that under the 1944 Education Act, the title "School Medical" was changed to " School Health Service." The customary ascertainment of children requiring special educational treatment has continued, and close co-operation maintained with all hospitals dealing with Croydon School children, so that education appropriate for the children concerned was arranged with a minimum of delay. There were waiting lists for the Day Schools dealing with physically handicapped and educationally sub-normal pupils, but steps are being taken to remedy this by the building of additional classrooms. The South-West Metropolitan Regional Hospital Board accepted responsibility for the provision of Ophthalmic Surgeons for the School Eye Clinics, but arrangements for the supply of glasses remained under the Supplementary Ophthalmic Service with an average waiting period between prescription and supply of several months. A scheme of giving whatever priority was possible to cases certified by the Surgeon as urgent, was introduced and worked quite well. The Senior Dental Officer deals with the difficulties which confront the School Dental Service. There has been a marked improvement in the general dental health of children during the last decade, no doubt associated with better nutrition. It is all the more unfortunate that the opportunity to intensify the preventive aspects of school dentistry and thus consolidate and expedite this improvement has been set back by the equivalent of 20 years by the advent of the National Health Service Act, 1948. For it was in 1930 that the Education Committee appointed a third Dental Officer and lowered the number of children served by each officer from 10,000 to 7,000—the figure at which it now stands. At that time it was noted that the Ministry of Education recommended one dentist to 5,000 children as an immediate ratio and 92 one to 2,300 as an ideal. It appears to me that the only possible solution of the problem of adequate preventive dentistry for children is the introduction of the dental hygienist on the New Zealand pattern to assist the School Dental Officer. As a somewhat happier record, I would draw attention to the charts of height and weights on page 12. These should be read as showing trends only since the numbers in some groups are too small to give an accurate sample. It is clear, however, that the children are taller and heavier than the same age groups of ten years ago. I have no comparable data on assessment of intelligence, but in so far as physical state is concerned, there is no doubt that the average child of 1949, for whose education the Committee was responsible, was taller, heavier, cleaner and healthier than ever before. The difficulties which beset the Committee, the Education Department, and the teachers in relation to the provision of adequate accommodation and education for the continually growing numbers of children is understood, and the consideration which nevertheless was afforded to the School Health Service is all the more appreciated. My thanks are also due to the members of my department who have continued to give of their best in the interests of the school children of Croydon. 93 STAFF OF THE SCHOOL HEALTH SERVICE. *Medical Officers 10 (including 2 part-time) *Dental Officers 6 (including 2 part-time) *Physiotherapists 3 School Therapists 2 (part-time) *School Nurses 34 *Dental Attendants 6 *Performing also duties in other sections of Public Health Department. PARTICULARS OF CLINICS HELD. The following Clinics are provided by the Education Committee: attendance thereat, with the exception of the Minor Ailments Clinic, is by appointment arranged by the School Medical Officer:— Clinic Address Minor Ailments Lodge Road, Broad Green, Croydon (Daily, Monday to Saturday, a.m.); 206 Selhurst Road, South Norwood (near South Norwood Clock) (Daily, Monday to Friday, a.m.); Duppas School, Goodwin Road, Waddon (Daily, Monday to Friday, a.m.). Dental Lodge Road, Broad Green, Croydon ; 206 Selhurst Road, South Norwood,; Waldrons Hail, 55 Duppas Hill Lane, Croydon. Diphtheria Immunisation Lodge Road, Broad Green, Croydon; 206 Selhurst Road, South Norwood. Eye 47 St. James' Road, Broad Green, Croydon. Inspection Lodge Road, Broad Green, Croydon; 206 Selhurst Road, South Norwood; Duppas School, Goodwin Road, Waddon. Remedial Exercises and Massage Waldrons Hall, 55 Duppas Hill Lane, Coydon. Rheumatism Lodge Road, Broad Green, Croydon. Speech Defects 33 St. James' Road, Broad Green, Croydon. 94 RETURN OF ATTENDANCE IN MAINTAINED PRIMARY, MODERN, CENTRAL, TECHNICAL AND GRAMMAR SCHOOLS for the Term ended 20th December, 1949 School. Average No. on Registers. Average attendance. Average attendance per cent. Average 1948 attendance per cent. COUNCIL PRIMARY SCHOOLS Ashburton Junior Mixed and Infants 367 336 91.5 91 Benson Senior Mixed 166 153 92.1 93 Benson Junior Mixed and Infants. 504 464 92 90 Beulah Junior Boys 346 319 92.2 91 Beulah Junior Girls 323 301 93.1 90 Beulah Infants 341 300 87.9 86 Cypress Junior Mixed and Infants 408 371 90.9 87 Davidson Infants 296 260 87.8 88 Duppas Junior Mixed and Infants 431 395 92 90 Ecclesbourne Junior Boys 252 231 91.7 89 Ecclesbourne Infants 201 185 92 88 Elmwood Junior Boys 237 214 90 88 Elmwood Junior Girls 221 200 90.4 91 Elmwood Infants 265 230 86.8 83 Farmhouse Cafe Junior Mixed and Infants 106 93 87.7 81 Gilbert Scott Junior Mixed and Infants 299 265 88.6 — Gonville Junior Mixed and Infants 409 371 90.7 89 Howard Junior Mixed and Infants 338 317 93.7 90 Ingram Infants 160 143 89.4 85 Kensington Avenue Junior Mixed and Infants 434 394 90.7 89 Kingsley Junior Mixed 354 325 91.2 91 Kingsley Infants 304 268 88.1 82 Monks Orchard Junior Mixed and Infants 452 418 92.4 91 Overbury Junior Mixed and Infants 73 67 91.7 91 New Addington Senior Mixed 250 230 92 90 Norbury Manor Junior Mixed 331 313 94.5 92 Norbury Manor Infants 251 224 89.2 83 Oval Junior Mixed 425 385 90.5 89 Oval Infants 274 221 80.6 G.I. Portland Infants 314 273 86.7 88 Purley Oaks Senior and Junior Mixed 593 546 92 90 Purley Oaks Infants 148 137 92.5 85 Rockmount Junior Mixed 270 252 93.3 94 Rockmount Infants 187 171 91.4 89 Shirley Methodist Temporary Infants 90 80 88.8 81 South Norwood Junior Boys 356 330 92.6 93 South Norwood Junior Girls and Infants 528 469 88.8 91 Spring Park Junior Mixed and Infants 297 270 90.9 — Sydenham Junior Boys 246 223 91 89 Sydenham Junior Girls and Infants 400 356 89 88 Waddon Junior Mixed and Infants 492 450 91 88 West Thornton Junior Boys 231 210 91 91 West Thornton Junior Girls 180 168 93.3 93 West Thornton Infants 292 263 90 87 Whitehorse Manor Junior Girls 262 240 92 90 Whitehorse Manor Infants 254 225 88.6 85 Winterbourne Junior Boys 271 255 . 94 92 Winterbourne Junior Girls 329 310 94.2 92 Winterbourne Infants 376 333 88.5 85 Wolsey Junior Mixed 489 452 92.4 — Wolsey Infants 246 220 89.4 — Woodside Junior Boys 401 372 92.7 92 Woodside Junior Girls 380 352 92.6 93 Woodside Infants 301 269 89.3 87 Total 16751 15219 90.8 89 G. I.=General Illness. 95 School Average No. on Registers Average attendance Average Attendance per cent. Average Attendance 1948 per cent. COUNCIL SECONDARY MODERN SCHOOLS Ashburton Senior Mixed 435 392 90.1 89 Croydon British Girls 227 202 89 88 Davidson Senior Boys 306 280 91.5 91 Davidson Senior Girls 203 179 88.1 87 Ecclesbourne Senior Girls 281 243 86.5 87 Ingram Senior Boys 281 256 91.1 89 Ingram Senior Girls 291 259 89 87 Lanfranc Senior Boys 507 450 87.7 88 Lanfranc Senior Girls 368 327 89 87 Norbury Manor Senior Boys 403 372 92.3 93 Norbury Manor Senior Girls 340 314 92.3 92 Portland Senior Boys 209 193 92 89 Portland Senior Girls 324 289 89.1 89 Tavistock Senior Boys 385 336 87 85 Tavistock Senior Girls 444 384 86 86 Waddon Senior Mixed 466 391 84 85 Whitehorse Manor Senior Boys 201 180 90 88 Total 5671 5047 88.9 88 SPECIAL SCHOOLS St. Christopher's (E.S.N.) 181 155 85.6 80 St. Giles' (Ph. and Del.) 149 124 83.2 82 St. Luke's (P.S.) 29 27 93.1 86 Total 359 306 85.2 82 VOLUNTARY PRIMARY SCHOOLS All Saints Mixed and Infants 259 225 86.8 87 Archbishop Tenison's Girls' (Modern) 146 134 91.7 90 Christ Church Junior Mixed and Infants 256 233 91 89 Parish Church Junior Girls and and Infants 363 327 90 90 St. Andrew's Mixed and Infants 429 399 93 89 St. Joseph's Mixed and Infants 343 307 89.5 89 St. Mark's Junior Girls and Infants 129 114 88.4 87 St. Mary's, Addington Junior Mixed and Infants 116 107 92.2 89 St. Mary's R.C. Senior and Junior Mixed 379 340 89.7 89 St. Mary's R.C. Infants 86 74 86 87 St. Michael's Infants 150 132 88 88 St. Peter's Infants 107 98 91.4 86 Shirley Junior Mixed and Infants (St. John's) 182 168 92.3 89 Total 2945 2658 90.2 88 96 School Average No. on Registers Average Attendance Average attendance per cent. Average 1948 attendance per cent. SELECTIVE CENTRAL SCHOOLS Archbishop Tenison's Senior Boys 194 185 95.3 95 Heath Clark Mixed 311 292 93.9 93 Lady Edridge Senior Girls 329 318 97 95 Total 834 795 95.3 94.4 GRAMMAR SCHOOLS Selhurst Boys 616 585 95 96 Selhurst Girls 549 519 94.5 91 John Ruskin Boys 347 331 95 94 Coloma Girls 481 449 93.3 94 Total 2827 2679 94.7 94 TECHNICAL SCHOOLS Stanley Technical Boys 267 254 95.1 96 School of Building 182 171 94 94 Total 449 425 94.6 95 SUMMARY OF SCHOOL ATTENDANCE Council Primary 16751 15219 90.8 89 Voluntary Primary 2945 2658 90.2 88 Secondary Modern 5671 5047 88.9 88 Grammar Central 2827 2679 94.7 94 Technical 449 425 94.6 95 Special 359 306 85.2 82 Total 29002 26444 90.8 89.2 97 MEDICAL INSPECTION IN SCHOOLS. The system of routine medical inspection is now as follows— A. Primary and Modern Secondary Schools. (1) Entrants i.e., Children admitted for the first time to a Maintained School. (2) 8-year-old i.e., Group Children who had attained their 8th birthday at the opening date of the Term but have not yet reached their 9th birthday and who have not been medically examined at the age 8 years. (3) Primary i.e., Leavers Children in their last year of attendance in a Maintained Primary School and who have not been medically examined in that year. (4) Leavers i.e., (Final) Children in their last year of attendance in a Maintained Secondary School who have not been medically examined in that year. (5) Special Cases i.e., (if any) Children of other ages who are apparently defective and whom the Head Teacher and parents wish the Medical Officer to see at his next visit. A total of 11,747 children were examined as compared with 8,511 in 1948, and 7,457 parents attended the examinations. The percentage attendance of parents in the Entrants' group was for boys 86.6 per cent., and girls 84.6 per cent.; in the Intermediate group, boys 59.1 per cent., girls 74.5 per cent.; in the Leavers' group, boys 12.8 per cent., girls 42.6 per cent.; and in the Other Ages group, boys 69.7 per cent., girls 71.9 per cent. The total percentage of parents attending was 6-3.5 as against 67.2 last year. 683 specials and 1,284 re-inspections of children were carried out. 98 PARENTS PRESENT, 1949 Entrants Intermediate Leavers Other Ages tOTAL Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. Parents Present namber Exmnd. M. F. M. F. m. f. M. f. M. F. M. F. M. F. M. f. M. F. Addington Village 21 25 21 19 10 15 6 14 20 ... 3 ... 4 12 2 10 55 ??? All Saints' 15 13 13 12 17 19 15 15 ... ... ... ... 19 16 12 11 51 ??? Arch. Tenison's ... ... ... ... ... ... ... ... 28 57 1 31 ... 7 ... 5 28 ??? Ashburton 36 67 32 57 40 30 27 22 25 47 2 17 13 18 11 5 114 ??? Benson 73 43 68 38 49 41 32 32 31 10 3 4 20 42 17 35 173 ??? Beulah 157 135 142 117 68 34 43 22 ... ... ... ... 78 39 53 31 303 ??? Christ Church 19 26 16 25 20 28 13 22 ... ... ... ... ... ... ... ... 39 ??? Coloma ... ... ... ... ... ... ... ... ... 131 ... 42 ... ... ... ... ... ??? Croydon British ... ... ... ... ... ... ... ... ... 109 ... 48 ... ... ... ... ... ??? Croydon Polytnc. ... ... ... ... ... ... ... ... 17 23 1 2 ... ... ... ... 17 ??? Cypress 31 29 31 28 44 18 37 11 ... ... ... ... 55 35 43 28 130 ??? Davidson 33 57 28 27 ... ... ... ... 66 49 21 13 14 11 14 10 113 ??? Duppas 35 69 26 47 17 36 3 16 ... ... ... ... 23 9 18 7 75 ??? Ecclesbourne 33 40 27 37 106 ... 45 ... ... 111 ... 47 44 ... 27 ... 183 ??? Elmwood 90 92 87 85 97 108 68 78 ... ... ... ... 41 40 26 24 228 ??? Gonville 41 49 37 43 ... ... ... ... ... ... ... ... 3 22 2 19 44 ??? Heath Clark ... ... ... ... ... ... ... ... 46 ... 4 ... ... ... ... ... 46 ??? Heathfield 11 8 11 8 4 3 3 3 ... ... ... ... 6 14 6 10 21 ??? Howard 33 39 27 29 26 18 19 17 ... ... ... ... 17 23 10 15 76 ??? Ingram 46 35 36 28 35 ... 23 37 73 3 42 11 11 9 10 94 ??? John Ruskin ... ... ... ... ... ... ... ... 116 ... 3 ... ... ... ... ... 116 ??? Kensington 51 33 49 33 53 48 41 43 ... ... ... ... 56 51 49 40 160 ??? Kingsley 82 58 54 44 40 61 21 38 ... ... ... ... 34 35 20 25 156 ??? Lady Edridge ... ... ... ... ... ... ... ... ... 76 ... 19 ... ... ... ... ... ??? Lanfranc ... ... ... ... ... 17 ... 11 139 183 18 70 ... 4 ... 2 139 ??? Monks Orchard .85 58 70 56 38 61 19 44 25 22 ... 12 10 12 5 160 ??? New Addington ... ... ... ... 37 12 20 9 6 35 1 8 ... ... ... ... 43 ??? Norbury Manor 72 27 65 62 88 49 55 39 89 149 21 91 49 63 35 48 298 ??? Oval 19 29 15 25 34 35 16 28 ... ... ... ... 35 13 28 12 88 ??? Parish Church 43 73 33 68 36 60 21 48 18 ... 7 ... 24 9 17 8 121 142 Portland 59 78 54 64 ... ... ... ... 94 151 12 82 ... 10 ... 4 153 ??? Purley Oaks 40 27 36 24 24 39 10 29 44 8 11 3 34 31 16 27 142 105 Rockmount 37 45 28 37 40 22 26 16 ... ... ... ... 112 37 93 32 189 104 St. Andrew's 19 15 18 15 22 27 16 21 51 33 12 11 9 11 8 10 101 86 St. Christopher's ... ... ... ... ... ... ... ... ... ... ... ... 21 12 8 7 21 12 St. Joseph's 40 84 27 33 17 6 5 1 ... ... ... ... 16 25 5 11 73 15 St. Mark's 20 30 16 29 ... 1 ... ... ... ... ... ... 9 9 20 40 St. Mary's R.C. 13 5 6 4 ... ... ... ... 19 7 2 l 14 36 5 16 46 48 St. Michael's 43 61 37 50 ... ... ... ... ... ... ... ... ... ... ... ... 43 61 St. Peter's 32 41 28 34 ... ... ... ... ... ... ... ... ... ... ... ... 32 41 Sch. of Building ... ... ... ... ... ... ... ... 45 ... 5 ... ... ... ... ... 45 ... Selhurst Gram. ... ... ... ... 24 ... 20 ... 192 233 1 80 ... 24 ... 14 216 257 Shirley 47 23 41 18 ... ... ... ... ... ... ... ... ... ... ... ... 47 23 Shirley Methodist 44 41 34 35 ... ... ... ... ... ... ... ... ... ... ... ... 44 41 South Norwood 75 76 70 70 82 25 39 22 ... ... ... ... 98 ...... 65 ... 255 101 Spring Park 25 49 25 46 ... ... ... ... ... ... ... ... ... ... ... ... 25 49 Stanley Technical ... ... ... ... ... ... ... ... 127 ... 10 ... ... ... ... ... 127 ... Sydenham 99 49 81 47 107 38 69 23 ... ... ... ... 49 46 34 29 255 133 Tavistock ... ... ... ... ... ... ... ... 97 146 14 57 ... ... ... ... 97 146 Waddon 39 71 35 56 31 11 15 10 86 62 8 38 44 58 25 37 200 202 West Thornton 72 44 66 43 50 107 24 81 ... ... ... ... 53 15 30 13 175 166 Whitehorse Manr. 24 59 23 51 9 30 3 20 52 20 3 14 12 13 7 9 97 122 Winterbourne 112 97 100 90 33 75 21 64 ... 24 20 ... 93 ... 72 145 289 Wolsey 33 30 26 30 ... ... ... ... ... ... ... ... ... ... ... ... 33 30 Woodside 98 82 90 77 90 74 47 59 ... ... ... ... 25 1 21 1 213 157 1997 2057 1729 1741 1353 1183 799 881 1470 1737 188 740 1045 905 728 651 5865 5882 4054 3470 2536 1683 3207 928 1950 1379 11747 PERCENTAGE OF PARENTS PRESENT AT MEDICAL EXAMINATIONS Entrants Boys 86.6 85.6 „ Girls 84.6 Intermediate Boys 59.1 66.2 „ Girls 74.5 Leavers Boys 12.8 63.5 28.9 „ Girls 42.6 Other Ages Boys 69.7 70.7 „ Girls 71.9 99 HEIGHTS AND WEIGHTS. 1949. Age. Number Examined 1949 Average Height in inches. Average Weight in lbs. 1949 1948 1947 1939 1949 1948 1947 1939 BOYS 5 years 1143 43.2 43.4 43.3 41.8 43.4 44.0 44.1 41.5 6 „ 541 44.2 44.7 44.5 43.8 45.5 46.2 45.7 43.4 7 „ 202 46.7 46.9 47.3 45.3 50.5 51.1 51.6 47.9 8 „ 642 50.1 48.7 49.2 49.5 58.0 54.1 56.0 55.5 9 „ 389 51.2 50.5 51.5 51.2 62.1 60.1 61.4 58.8 10 „ 342 54.2 53.9 53.6 52.7 71.7 70.1 63.7 62.9 11 „ 795 55.6 55.6 55.4 53.7 75.2 73.7 73.0 68.7 12 „ 262 56.4 56.5 56.5 55.7 77.1 78.2 76.6 79.9 13 „ 52 57.3 60.4 57.9 58.4 82.9 93.0 83.9 81.6 14 „ 138 62.8 61.7 60.5 59.0 105.8 98.4 95.7 90.8 15 „ 840 63.6 63.1 65.9 — 113.1 109.8 117.4 — 16 „ 220 66.4 67.2 66.8 — 125.1 120.9 120.2 — 17 „ 86 68.3 68.7 67.6 — 132.6 134.3 129.7 — GIRLS 5 years 1102 43.5 42.9 43.3 41.2 42.9 42.5 41.6 39.7 6 „ 522 44.2 44.0 44.2 42.7 44.2 44.3 43.7 41.4 7 „ 168 47.1 46.1 46.6 44.1 49.9 49.5 49.1 43.6 8 „ 553 49.8 49.7 49.7 49.9 57.5 54.8 54.0 54.7 9 „ 441 51.3 52.4 51.1 50.9 60.7 62.8 58.6 57.6 10 „ 275 53.3 53.8 54.0 52.1 70.7 69.2 70.8 62.9 11 „ 875 56.1 55.8 55.4 53.6 76.6 75.1 72.9 68.3 12 „ 413 57.5 57.1 56.5 56.6 81.6 79.3 77.5 77.2 13 „ 121 59.7 61.0 60.2 58.8 92.8 98.4 88.2 85.3 14 „ 449 62.3 62.6 61.4 60.3 106.4 107.3 101.3 97.9 15 „ 859 62.6 62.6 64.0 62.0 111.2 110.6 114.8 105.5 100 RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 1949. 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 186 5 3.26 207 6 2.62 Uncleanliness— Head — — — 3 — 0.05 Body Skin Disease 11 8 0.32 20 2 0.37 Eye Disease— Defective Vision 302 39 5.81 332 37 6.73 Squint 54 31 1.45 46 28 1.26 External Eye Trouble 8 5 0.22 17 9 0.44 Ear Disease— Deafness 11 2 0.22 11 7 0.31 Otitis Media 11 3 0.24 8 6 0.24 Other Disease 5 7 0.20 6 6 0.21 Nose and Throat— Enlarged Tonsils only 56 81 2.34 49 66 1.96 Adenoids only 20 12 0.55 16 9 0.43 Enlarged Tonsils and Adenoids 166 90 4.36 176 89 4.51 Other Conditions 53 18 1.21 38 13 0.87 Enlarged Cervical Glands (not T.B.) 4 18 0.38 1 12 0.22 Dental Defects 265 6 4.62 208 10 3.71 Speech Defects 20 27 0.80 15 12 0.46 Heart and Circulation— Organic 9 19 0.48 8 18 0.44 Functional 5 15 0.34 2 12 0.24 Anaemia 2 8 0.17 23 12 0.46 Bronchitis 6 19 0.43 13 19 0.54 Other Non-T.B 22 30 0.89 12 19 0.53 Pulmonary Tuberculosis 4 17 0.36 11 10 0.36 Other Tuberculosis 3 4 0.12 2 3 0.09 Nervous System Disorders (including Epilepsy, Chorea, etc.) 9 25 0.58 11 14 0.43 Developmental— (a) Hernia 1 1 0.03 1 3 0.07 (b) Other 3 4 0.12 2 2 0.07 Psychological— (a) Development 3 1 0.07 2 1 0.05 (6) Stability 3 4 0.12 5 4 0.15 Deformities— Flat Feet 84 27 1.89 89 22 1.89 Posture 109 18 2.17 152 20 2.93 Others 161 91 4.30 220 75 5.02 Other Defects and Diseases 60 51 1.89 82 61 2.43 Totals 1656 686 1788 607 Total Children Examined 5865 5882 101 VISION. Extent of Defect Intermediate Leavers Other Ages Total Boys Girls Boys Girls Boys Girls Boys Girls No. % No. % No. % No. % No. % No. % % % Normal : 6/6ths or 6/9ths R 1313 97.0 1131 95.6 1394 94.8 1617 93.1 1015 97.1 866 95.7 96.2 94.4 L 1297 95.9 1129 95.4 1386 94.3 1624 93.5 1019 97.5 863 95.3 95.7 94.5 6/12ths or 6/24ths R 36 2.7 47 4.0 54 3.7 104 6.0 23 2.2 31 3.4 2.9 4.8 L 46 3.4 48 4.1 59 4.0 95 5.5 22 2.1 36 4.0 3.3 4.7 6/36ths or worse R 4 0.3 5 0.4 22 1.5 16 0.9 7 0.7 8 0.9 0.9 0.8 L 10 0.7 6 0.5 25 1.7 18 1.0 4 0.4 6 0.7 1.0 0.8 Cost of the School Health Service. The gross cost of the medical, dental and nursing services was £34,120, of which £4,918 was for hospital treatment of school children. The expenditure is subject to Education grant. Cost of Special Schools. £ Schools maintained by the Council 17,565 Other Schools (not maintained by local authorities) 5,664 Adjustments with other authorities in respect of Special Schools 286 £23,515 The expenditure is subject to Education grant. Cost of Milk and Meals. Meals and Milk cost £164,840. Income from payment for meals was £61,471, making net cost of £103,369, on which grant is paid of 100 per cent. on approved expenditure. 102 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS, 1949 (Percentages of Children examined) Condition Entrants Intermediates Leavers Other Ages All Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Circulatory System 1.4 1.4 2.6 2.3 1.7 3.6 1.5 2.6 1.8 2.4 Pulmonary System 3.5 1.9 2.6 2.0 1.2 1.9 1.7 1.4 2.2 1.9 Skin Disease 2.4 1.5 1.8 3.0 3.9 1.7 1.9 2.4 2.5 2.0 Defects of Nose and Throat 25.5 21.6 9.5 12.9 5.5 5.1 11.3 10.4 14.3 13.3 Enlarged Cervical Glands 3.3 2.6 1.6 0.7 1.2 0.5 1.4 1.5 2.5 1.4 Squint 3.3 3.0 1.1 1.8 1.0 0.9 1.6 1.5 1.9 1.9 External Eye Disease 0.5 0.7 0.7 0.2 0.6 1.3 0.8 0.9 0.6 0.8 Defective Vision 1.3 1.4 8.2 8.3 9.4 9.3 6.4 8.8 5.8 6.3 Defective Hearing and other Ear Defects 2.9 2.6 0.9 2.4 1.3 0.9 1.2 1.4 1.7 1.9 Speech Defects 2.1 1.4 0.6 0.3 0.4 0.1 0.4 0.2 1.0 0.6 Dental Disease (more than four decayed) 2.0 1.8 1.3 0.6 1.0 1.2 2.8 2.3 1.7 1.5 Dull and Backward 0.6 0.4 0.4 0.3 0.3 0.2 0.5 0.4 0.5 0.4 Malnutrition 6.8 8.1 7.0 4.8 3.8 5.5 6.8 5.6 6.1 6.3 Deformities 18.1 14.4 16.6 19.4 9.8 12.7 17.9 14.7 15.6 15.0 Nervous System 1.1 0.8 0.5 0.4 0.3 0.5 1.3 0.7 0.8 0.6 Developmental— Hernia 0.3 0.5 0.5 0.2 0.1 — 0.2 0.6 0.3 0.3 Other 1.8 0.1 0.8 0.2 0.9 0.1 1.4 — 1.3 0.1 Psychological— Developmental 0.9 0.1 — 0.1 0.1 0.1 0.2 — 0.4 0.1 Stability 0.3 0.2 0.1 0.5 0.2 0.1 0.7 0.2 0.3 0.2 Other Defects 5.0 3.4 3.3 3.8 2.7 5.4 4.0 3.9 3.8 4.1 UNCLEANLINESS. Cleanliness inspections are carried out by the School Nurses each term in every school, so that all pupils are brought under review. The finding of slight infestation in unexpected offenders leads to the issue of an informal letter to the parents, setting out a method of treatment and offering a supply of suitable emulsion. The appropriate formal notices are sent to the parents of children previously found verminous. Steel combs are sold or loaned where necessary. Endeavour is made to serve notices on the parents by the School Nurse personally, so that she has opportunity to emphasise that infestation may be a family complaint and not limited to the school child, and the need for constant cleanliness to prevent relapses. A cleansing station is provided for the treatment of scabies and very occasionally deals with other verminous conditions. Number of children inspected for Cleanliness (first inspection 65,848 Number of children inspected (subsequent inspections) 3,479 103 Number of children found unclean (first inspection) 805 (1,707 occasions of infestation). Number of occasions in which children found unclean (subsequent inspections) 1,239 At the primary inspections vermin were found in 90 and nits alone in 1,627 children. On these inspections 2.6 per cent. of the children showed evidence of infestation as against 2.9 in 1948. TUBERCULOSIS IN CHILDREN OF SCHOOL AGE. Contacts among school children kept under supervision during 1949:— Number of cases under observation at beginning of 1949 175 Number of cases added during year 43 Number of cases discharged from observation during the year 7 Number of cases under observation at the end of 1949 211 Number of cases of Notified Tuberculosis— Pulmonary 13 Non-Pulmonary 8 Taking the total child population as 35,416, the pulmonary tuberculosis incidence rate per 100,000 was 36.7, and the non-pulmonary incidence rate 22.6. There were two deaths from pulmonary tuberculosis and two deaths from non-pulmonary tuberculosis. CAUSES OF DEATH IN CHILDREN OF SCHOOL AGE. Child population, 35,416. Number of deaths 19, which is equal to a death-rate of 0.54 per 1,000. The deaths were due to : Tuberculous Meningitis 2 Pulmonary Tuberculosis 2 Whooping Cough 1 Malignant Disease of Brain 1 Malignant Disease of Lymphatic Glands 1 Pneumonia 1 Leukaemia 2 Chronic Nephritis 1 Appendicitis 2 Meningeal Infection 1 Road Traffic Accidents 3 Shocks and Burns (open verdict) 2 104 TREATMENT. The Work of the School Clinics. SUMMARY OF ATTENDANCES 1949 1948 Increase or Decrease Minor Ailments Clinic 18162 20331 — 2169 Inspection Clinic 4625 4033 + 592 Dental Clinics 23580 20035 + 3545 Orthopaedic Clinic 461 542 — 81 Remedial Exercises Clinic 8606 9270 — 664 Nose and Throat Clinic 2350 4002 — 1652 Rheumatism Clinic 129 58 + 71 57913 58271 — 358 The Minor Ailments Clinics. At the Lodge Road Clinic 1,754 defects involved 11,228 attendances, while at the subsidiary Clinics held at 206, Selhurst Road on five days weekly, 424 defects, 2,744 attendances, and at the Duppas School 676 defects, 4,190 attendances. Complaint 1949 1948 Cases Attendances Average No. of Attendances per case Cases Attendances Average No. of Attendances per case Ringworm 33 204 6.2 33 258 7.8 Scabies 28 96 3.4 53 206 3.9 Impetigo 77 559 7.3 151 1164 7.7 Other Skin Diseases 80 494 6.2 92 580 6.3 Otorrhoea and other Ear defects 253 1443 5.7 318 2076 6.5 External Eye Disease 264 1164 4.4 371 1438 3.9 Miscellaneous 2119 14202 6.7 2314 9807 4.2 2854 18162 6.4 3332 15529 4.7 Adenoids and Enlarged Tonsils. During 1949, 683 children were operated upon for adenoids and enlarged tonsils, and 2,350 attendances were made at the Throat Clinic. 105 CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS. Name of School School Population. Measles. German Measles. Whooping Cough. Chicken Pox. Mumps. Scabies. Impetigo. Ringworm. Diphtheria. Scarlet Fever. Dysentery Cero. Spinal Men. Poliomyelitis. Jaundice. conjunctivitis. Sore Throat. Indefinite Sickness. III, Not Infectious Paratyphoid Erysipelas Percentage incidence of conditions notified in Schools Ashburton 802 ... 1 ... 3 1 3 2 1 ... 5 ... ... ... ... 1 1 ... ... ... ... 2.2 Benson 670 56 3 3 2 1 ... 4 ... ... 3 ... ... ... 1 21 ... 19 1 ... ... 17.0 Beulah 1010 18 ... 1 53 3 6 5 8 ... 7 ... ... ... ... 1 ... 6 ... ... ... 10.7 Croydon British 227 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0.9 Cypress 408 2 2 ... 2 1 ... ... 1 ... 10 ... ... ... ... ... ... ... ... ... ... 4.4 Davidson 805 24 1 2 4 2 3 4 1 1 12 ... ... ... ... 1 ... ... 2 ... ... 7.1 Duppas 431 8 ... 3 5 ... 2 ... 1 ... 5 ... ... ... ... 1 1 ... ... ... 6.0 Ecclesbourne 734 28 ... ... 1 6 2 1 ... ... 2... ... ... ... ... ... ... ... ... ... ... 5.4 Elmwood 723 10 ... 1 7 8 ... 7 3 ... 16 ... ... ... 2 ... 1 1 1 ... ... 7.9 Gonville 409 8 1 1 65 ... ... 1 1 ... 6 ... ... ... ... 2 ... ... 1 21.0 Heathfield 106 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... 5.7 Howard 338 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1.2 Ingram 732 28 1 ... 4 ... 3 3 1 ... ... ... ... ... 2 1 1 2 ... ... ... 6.3 Kensington 434 3 4 ... ... ... ... 1 ... ... 13 ... ... ... ... 2 1 1 ... ... ... 5.8 Kingsley 658 40 ... 2 2 12 ... 4 2 ... 11 ... ... ... ... 1 ... 1 ... ... ... 11.4 Lanfranc 875 ... ... ... 3 ... ... 2 2 ... ... ... ... 1 ... 3 ... 1 ... ... ... 1.4 Monks Orchard 452 ... 1 ... 1 ... ... 4 ... ... 2 ... ... ... ... ... 1 1 1 ... ... 2.4 New Addington 250 ... ... ... 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1.2 Norbury Manor 1325 30 1 3 27 1 ... 2 1 ... 15 ... ... ... ... 3 ... ... 1 ... ... 6.3 Oval 699 70 6 20 52 13 3 6 1 ... 20 ... ... ... ... 3 9 7 3 ... ... 30.5 Portland 847 1 ... 7 6 ... 3 2 1 ... 16 ... ... ... ... ... 9 1 1 ... ... 5.5 Purley Oaks ... 741 24 ... 2 3 10 3 1 ... ... 1 ... ... ... 1 ... 3 ... ... ... ... 6.5 Rockmount 457 22 3 5 90 ... ... 1 1 ... 3 ... ... ... ... 1 ... 1 4 ... ... 28.7 South Norwood 884 45 ... 10 50 ... 1 2 ... ... 12 ... ... ... 1 1 2 1 1 ... ... 14.2 Sydenham 646 6 3 3 ... 1 3 ... 4 1 8 ... ... ... 1 2 ... ... ... ... ... 5.0 Tavistock 829 ... ... ... 1 2 ... 1 1 1 ... ... ... 1 ... 2 2 1 ... ... ... 1.4 Waddon 958 4 ... 6 1 ... ... 4 ... ... 8 ... ... ... 1 5 5 3 ... ... ... 3.9 W. Thornton 703 17 ... 2 10 3 ... 2 2 ... 10 ... ... ... ... 2 ... 2 ... ... ... 7.1 Whitehorse 717 ... ... ... ... 1 3 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... 1.0 Winterbourne 976 12 ... ... 2 ... 1 ... 1 ... 15 ... ... ... ... 1 ... ... ... ... ... 3.1 Woodside 1082 5 1 1 3 1 3 8 ... ... 22 ... ... ... 1 1 3 7 1 ... ... 5.3 lady Edridge 329 ... ... ... ... ... ... ... ...... ... ... ... ... ... ... 1 ... ... ... ... ... 0.3 Heath Clark 311 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 0.3 Arch. Ten.(Bys) 194 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... — Arch. Ten. (GIs) 146 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... — Addington Vil. 116 ... ... 2 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 2 ... ... 4.3 All Saints 259 18 2 ... ... 2 ... ... 2 ... 3 ... ... ... ... 1 ... ... ... ... ... 10.8 Christchurch ... 256 15 4 ... 38 11 ... 1 ... ... 4 ... ... ... ... 2 ... ... ... ... ... 29.3 Parish Church 363 13 ... ... 10 1 ... 1 2 ... 8 ... ... ... ... 2 3 3 1 ... ... 12.1 St. Andrew's ... 429 6 ... 1 4 1 ... 2 ... ... 7 ... ... ... ... 1 ... 1 ... ... ... 5.4 St. Joseph's 343 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 0.6 St. Mark's 129 ... ... ... 5 1 ... 2 ... ... 5 ... ... ... ... ... ... 4 ... ... ... 13.2 St. Mary's R.C. 465 6 ... 2 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 2.6 St. Peter's 107 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 6.5 Shirley 182 15 1 4 7 4 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 19.8 St. Christophers 181 ... ... ... 2 3 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 4.4 St. Giles' 149 11 ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 10.8 St. Luke's 29 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Coloma 481 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0.4 Selhurst Oram. 1165 1 ... ... 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1.0 John Ruskin 347 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... School of Bldg. 182 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... - Stanley Tech 267 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 0.7 Shirley Meth. Hall 90 5 ... ... ... ... ... 2 ... ... 3 ... ... ... ... ... ... 1 ... ... ... 13.3 St.Michael's 150 17 1 10 ... 11 ... ... ... 1 4 ... ... ... 1 2 ... 1 ... ... ... 32.0 Crossfield Nury. 43 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 2.3 Old Palace ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Occuptn. Centre 43 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2.3 Wolsey 735 20 ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3.3 Croydon High ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Spring Park 297 ... 1... 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 3.0 Totals 595 39 95 483 102 44 79 39 4 276 1 ... 3 11 65 43 70 22 ... 1 634 106 CHIEF CAUSES OF EXCLUSIONS FROM SCHOOL Condition Exclusions during 1949 Percentage of total exclusions Exclusions during 1948 Percentage of total exclusions Ringworm 39 1.83 21 0.49 Verminous Conditions 156 7.33 295 6.87 Impetigo 79 3.12 110 2.56 Scabies 44 2.07 102 2.38 Scarlet Fever 276 12.97 249 5.80 Measles (inc. German) 634 29.79 1125 26.20 Diphtheria 4 0.19 12 0.28 Whooping Cough 95 4.46 432 10.06 Chicken Pox 483 22.70 1034 24.08 Mumps 102 4.79 697 16.23 External Eye Disease 65 3.05 32 0.75 Sore Throat 43 2.02 36 0.81 Other Causes 108 5.08 149 3.47 Total 2128 — 4294 — The figures for exclusions are not related in any way to the figures obtained in routine medical inspections. These figures show an increase in Scarlet Fever and Conjunctivitis, whilst Impetigo, Scabies, Measles, Whooping Cough, Chicken Pox, Mumps, and Verminous Conditions 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. Visits to School Departments re Cleanliness 669 Visits re Scabies — Visits re Infectious Disease 74 Visits re Medical Inspections 656 All other reasons 877 Home Visits. Concerning defects found at routine medical inspections 1,915 Subsequent visits re defects found at routine medical inspections 324 Visits re special cases 681 Visits to dental cases 32 Visits other than infectious cases 1,361 Visits in connection with infectious cases (including 525 visits concerning uncleanliness) 5,113 107 Treatment of Visual Defects. Number of defects dealt with. Spectacles prescribed 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. Errors of Refraction 2183 — 2183 1013 — This Clinic showed a decrease upon 1948 in numbers submitted to refraction. A total of 3,664 attendances was recorded. SCHOOL DENTAL SERVICE. 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. Particulars of work carried out in connection with the former will be found in the appropriate Report. Since the inception of the National Health Service Act 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 ceased in the early months of 1949 when alternative arrangements, provided through the Regional Board, began to operate. Arrangements for Treatment. The major portion of the treatment is at present carried out at Lodge Road Health Centre, where four surgeries are designed to work as a centralised unit. The recently completed extension to these premises providing, in addition to medical accommodation, for an extra dental surgery, recovery room and improved waiting room accommodation, has greatly assisted in reducing the former congestion during "peak" periods. 108 Other dental centres are provided at Duppas Hill (South Croydon) and at South Norwood. In the case of the latter surgery space is very limited, and it is hoped that an extension to these premises will be possible in the very near future. Additional clinics have also been planned to serve the Woodside area and the New Addington Housing Estate; suitable premises are at present available, but at the time of writing shortage of dentists is holding up developments. To meet future Education commitments a further long-term expansion 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 staff likely to be required:— PRESENT AND FUTURE COMMITMENTS. Probable Increase Estimated Increase in in Dental Year. School Population. Total. Officers Required. 1946 Present Population 25,680 1 (Woodside)* 1947 Plus 14-15 age group, 1,855 27,575 1 (Addington)* 1948-9 Plus 15-16 age group, 1,855 — (Lodge Rd. Plus Housing Estate 5,260 34,690 2 Extension) 1950 Plus County Colleges, 7,000 — and Plus Nursery Schools, 800 42,490 1-2 onward Total: 5-6 * Now behind schedule. Staffing. Shortage of dental man-power continues to present a formidable problem and seriously complicates the day-to-day administration of the service. The more far-reaching result, however, has been to hamper the plan of post-war expansion so vitally necessary to keep pace with increased commitments under the Education Act. Early in 1948 the establishment of the local services was increased to provide for two additional dental officers: unfortunately, owing to lack of clinic accommodation at that period, it was not possible to fill these posts. Since then the service has sustained the loss of two full-time members of the staff, and to 109 date no satisfactory replacements have been forthcoming. More recently two dentists have been engaged on a part-time basis to help with arrears of work, but this has only slightly eased the situation. At the moment additional staff is urgently required to assist in the treatment of children at New Addington and other outlying districts of the Borough. At present the only available facilities for such patients are those at Lodge Road Clinic, and this involves considerable loss of time travelling by parents. The numerical strength of the staff is now four full-time and two part-time dental officers. This is considerably below the establishment required to deal with the school population of approximately 29,000 children. The fact that one dental surgeon's time is devoted entirely to work for the Maternity and Child Welfare Scheme further reduces the personnel available for Education purposes, and necessitates a potential "panel" of 7,000 children per dental officer. This is more than twice the number that any officer can be expected to handle during the twelve months period. The time lapse between successive school inspections is now approximately 18 months, and in certain cases this period has recently extended to over two years. The infrequency of these visits compares most unfavourably with the annual minimum recommended by the Ministry. Inspections. The number of children on the register at Primary and Secondary Schools within the Borough at (he close of 1949 was 29,106. Including an additional 109 free-place scholars at nonmaintained schools this represents a sum total of 29,215. Of these, 20,478 were inspected and 9,404 (46 per cent.) referred for treatment, compared with 18,706 inspected and 9,432 referred in 1948. The above results indicate a further reduction of 4.4 per cent. in the number requiring treatment. This figure cannot, however, be said to represent a true record, as many children are now forced to receive emergency treatment before their respective schools are visited and, therefore, do not "register" any defects; in the light of prevailing conditions it is doubtful whether this figure exceeds the 2 per cent. recorded last year. 110 In viewing such statistics it should also be realised that these figures give no indication of the extent of the damage to the individual mouth. Though many teeth may become unsaveable as the result of inadequate attention, the true picture does not become apparent until they have finally to be removed. Owing to lack of staff, twenty departments (Primary and Secondary) comprising some 8,628 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 12.9% Forms Not Returned 12.7% The above figures are almost identical with those obtained in 1948 and do not indicate any lessening in the responsibilities of the service as the result of recent bureaucratic changes. The following analysis demonstrates the progressive rise in the acceptance rate during recent years:— RESULTS OF SCHOOL INSPECTIONS. 1949. 1948. 1946. 1943. 1937. No. referred for— Treatment 9404 9432 12046 9041 13498 Consents 6996:74.4% 7019 :74.4% 8433 :70% 5642:62.4% 7762 :57.5% (Total Consents Including Specials)* (10098:80.7%) (9516:79.1%) (13810:74%) (6814:67%) (10146:63%) Refusals 1213:12.9% 1158:12.3% 1542 :12.8% 1519 : 16.8% 3242 : 24% Forms Not Returned 1195:12.7% 1255 :13.3 % 2071 :17.2% 1880 : 20.8% 2494 :18.5% * Specials.—Those referred by Head Teachers with Emergency Forms Treatment. Of 10,098 children consenting to treatment (including specials) 9,513 (94.2 per cent.) were treated and 8,302 (82.6 per cent.) cured (completely), compared with 9,516 consenting, 9,344 (98.2 per cent.) treated, and 8,614 (90.5 per cent.) cured in 1948. Clinical sessions fell from 1,832 in 1948 to 1,605. As a direct result of the slowing down of routine dental treatment there continues to be a progressive increase in the number of requests for emergency attention submitted through Head Teachers; on occasions the volume of such cases has reached serious proportions. Recent statistics have established that during the year one child in every three attended because of toothache or other "acute" conditions. 111 The arrival of an unspecified number of such "casuals" not only seriously disorganises the work of the clinics, but also greatly reduces the output of restorative and preventive work which should be the prime object of the service. Items of Treatment The ensuing Table gives particulars of the principal items of treatment compared with those obtained last year:— 1949. 1948. Attendances 18,620 20,035 Treated 9,513 9,344 Re-treated 4,632 4,651 Fillings— Permanent 5,182 5,981 Temporary 1,036 2,047 Extractions Permanent 1,722 1,832 Temporary 10,056 11,062 Gas Administration 3,447 3,747 Local anæsthetics 2,780 3,585 Other Operations— Permanent 5,533 6,974 Temporary 3,047 3,154 Cases Completed 8,302 8,614 Special Treatment. These include— 1949. 1948. Root treatment in anterior teeth 36 24 Removal of nerves under local anæsthetic 17 6 Gingivectomy 4 4 Removal of bone sequestra 2 9 Splints for fractured incisors 1 2 Number of M.D.s treated 20 27 Dentures inserted 43 38 Irrigation of sockets 28 19 Removal of impacted and difficult teeth 24 27 Ulcerated stomatitis (Vincent's infection) 20 16 Cleft Palate or Labial Frænum — 1 Application of Penicillin "Cones" 43 36 Crowns for Incisor Teeth 3 1 Referred for X-Ray 101 102 Forms from Head Teachers. The number of forms issued by Head Teachers for emergency treatment was 3,102 compared with 2,497 in 1948. 112 X-Ray Examinations. The number of cases referred to Mayday Hospital for the above purpose was 101, compared with 102 in 1948. Orthodontic Treatment. Because of the general reduction of working sessions less time has been available for this branch of work than hitherto. In the existing emergency energies are chiefly directed to the correction of the simpler irregularities; those of a more complicated nature have often to remain untreated, or in certain suitable cases have been referred to one or other of the "teaching" Hospitals. The establishment of a "special" department to deal with such deformities is now urgently required and it is hoped that when conditions improve some such project can receive active consideration. The number of sessions devoted to this work was 157 compared with 239 last year. The following is a summary of treatment performed:— 1949. 1948. Cases under Treatment 277 370 New Cases 128 141 Cases Completed 147 170 Attendances 2,040 2,843 Appliances—Fixed 16 13 Removable 136 238 Treatment Sessions 157 239 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, however, eligible for attendance at the School Dental Clinic. 113 A summary of the treatment performed for the above children is given below:— 1949. 1948. Attendances 268 209 New Cases Treated 43 39 Re-treated 66 49 Fillings—Permanent 158 128 Extractions—Permanent 33 29 Temporary 23 44 Other Operations 100 47 "Gas" Cases 22 24 Local Anæsthesia 17 20 Cases Completed 83 50 Dentures Fitted 3 1 Referred X-Ray 5 2 Summary of Work Done at the Selhurst Road Clinic. 1949. 1948. Attendances 3,181 3,431 Extractions 1,567 2,076 Fillings 993 1,202 Other Operations 2,898 2,807 "Gas" Cases 319 594 Local Anæsthesia 711 519 Cases Completed 1,343 1,569 Sessions held : Inspection 35, Treatment 362, Gas 26. The average attendance at this Clinic per session is 8.8. Summary of Work Done at the Waldrons Clinic. 1949. 1948. Attendances 2,639 2,628 Extractions 1,493 1,826 Fillings 584 1,625 Other Operations 746 383 "Gas" Cases 578 495 Local Anæsthesia 223 1,816 Cases Completed 759 931 Sessions held: Inspection 6, Treatment 210, Gas 44. The average attendance at this Clinic per session is 9.8. 114 DENTAL DEFECTS. (1) Number of children who were— (a) Inspected by Dental Officer : Year 1939. Year 1938. Aged 5—6 1,236 Total : 20,478 1,174 „ 6—7 2,239 2,229 „ 7-8 2,289 1,839 „ 8—9 1,864 1,913 „ 9—10 2,062 2,152 „ 10—11 2,068 2,124 „ 11—12 1,998 1,635 „ 12—13 1,705 1,393 „ 13—14 1,794 1,352 „ 14—15 1,632 1,345 „ 15—16 1,052 1,010 16 up 539 540 Specials 3,102 2,497 23,580 21,203 Year Year 1949 1948 (b) Found to require treatment 12,500 11,929 (c) Actually treated 9,513 9,344 (2) Half-days devoted to Inspection 156 157 Treatment 1,005 1,832 1,761 1,989 Number of Gas Sessions— Lodge Road (by Dental Officers) 11 173 Selhurst and Waldrons 217 82 228 255 Administrative Sessions 101 119 Orthodontic Sessions 157 239 (3) Attendances made by children for treatment 18,620 20,035 115 Year Year 1949. 1948. (4) Fillings— Permanent teeth 5,182 5,981 Temporary teeth 1,036 2,047 6,218 8,028 (5) Extractions— Permanent teeth 1,722 1,832 Temporary teeth 10,056 11,062 11,778 12,894 (6) Administrations of general anaesthetics for extractions 3,447 3,747 (7) Administrations of local anaesthetics for extractions 2,780 3,585 (8) Other Operations— Permanent teeth 5,533 6,974 Temporary teeth 3,047 3,154 8,580 10,128 Attendances per session ... 11.6 10.9 DIPHTHERIA IMMUNIZATION. Diphtheria Immunization has been carried out at the clinics and during the year under review the system of providing diphtheria immunization in the schools themselves was introduced and proved most successful, 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 538 together with 2,046 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:— Cases on Books Jan. 1st, New Cases 31st Dec., 1949. Cases. Discharged. 1949. 443 245 294 394 340 children were seen by the Orthopædic Surgeon and 461 attendances were made. 116 SPINAL AND OTHER REMEDIAL CLINICS. Attendances. 1949. Sessions. Av. att. Attendances. 1948. Sessions. Av. att. Spinal 1,960 407 4.8 1,657 333 5.0 Massage 50 50 1.0 30 30 1.0 Flat Feet 4,639 493 9.4 2,800 337 8.3 Breathing 1,957 200 9.8 4,783 395 12.1 8,606 1,150 9,270 1,095 RHEUMATISM CLINIC. The total number of children whose names were on the "live" register at the end of 1949 was 154 (males 66, females 88). Of this number, 113 attended the Rheumatism Clinic during the course of the year, either as new cases or re-examinations; the remaining 41 failed to keep their appointments. Cases Examined at Rheumatism Clinic. 1945. 1946. 1947. 1948. 1949. Primary 32 59 27 31 37 Re-exams 10 47 75 27 76 Totals 42 106 102 58 113 Primary Cases. Rheumatic 24 49 21 22 30(81.1%) Non-Rheumatic 8 10 6 4 3(8.1%) Doubtful Rheumatic — — — 5 4(10.8%) Totals 32 59 27 31 37 Classification of Rheumatic Cases. Primary. Re-examinations. Males 13 31 (plus 1 doubtful and 1 non-rheumatic) Females 17 32 (plus 4 doubtful and 7 non-rheumatic) Totals 30 63 ( + 13) 117 Ages: 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Ttl. Rheumatic : Primary — 252425252 1— — — 30 Re-exams — — 3 2 5 5 4 12 7 10 11 4 — — 63 Others 1 1 1 4—4 4 3 — — 2 — — — 20 The average age of primary cases of rheumatism, on first attendance at the clinic, was 10.2 years for both boys and girls. Grouping of Cases. 1947. 1948. 1949. Prim. Re's. Ttl. Prim. Re's. Ttl. Prim. Re's. Ttl. Mild and Potential 12 42 54 17 9 26 24 32 56 Definitely Active 2 5 7 — 6 6 2 — 2 Quiescent — 14 14 5 10 15 4 31 35 Doubtful or Non-Rheumatic — 9 2 11 7 13 20 The Mild and Potential cases include those showing the first initial symptoms of " growing pains " in highly strung children. The "Definitely Active" group included cases with physical signs of rheumatic fever or chorea. " Quiescent Cases " are those which at a previous examination had shown signs of mild and potential rheumatism or of active rheumatism, but which had now settled down and were no longer active. Primary Examinations. Amongst the 30 new cases diagnosed as rheumatic the following manifestations were recorded : — Girls Boys Total Rheumatic pains 14 10 24 Chorea (suspected) 1 1 2 Carditis (definite) 4 4 8 Carditis (suspected) 1 2 3 Tonsilitis and Infested Tonsils 4 1 5 Pyrexial attacks — 1 1 Erythema Nodosum — — — 118 Family Histories. Of the primary cases, 17 gave a history of rheumatism in the family, 7 being histories of rheumatic conditions in parents and 4 in grand-parents, 4 in brothers and sisters, and 2 in both parents and grand-parents. Nervous Conditions. Girls Boys Total Highly strung 9 5 14 Headaches 8 7 15 Night terrors 3 3 6 Enuresis 2 1 3 Minor degrees of nervous disorders 1 3 4 Often a combination of more than one of the above symptoms was manifested. Disposal. The following recommendations were made in respect of the 37 new cases:— Girls Boys Continue attendance at Rheumatic Clinic 22 15 Referred to Paediatrician 5 — „ „ Cardiologist 1 — „ „ Psychiatrist 1 — Restriction as to P.T. and games 4 2 For T. and A. operation 2 — Convalescent Home 3 — Remedial Exercises 1 — For admission to St. Giles' — 1 BLIND, DEAF, EDUCATIONALLY SUB-NORMAL AND EPILEPTIC CHILDREN. Blind Children. Four boys are resident in special schools for the blind. The institutions which these children attend are as follows:—The Worcester School for the Blind, 2 boys; Royal Normal College for Blind, Shropshire, 1 boy; Brighton School for Partiallysighted, 1 boy. Deaf Children. 10 boys and 10 girls are resident at special schools for the deaf. The institutions which these children attend are:—Royal 119 School for Deaf, Margate, 5 boys and 4 girls; Mill Hall School for Deaf, 1 girl; L.C.C., Warwick, 1 girl; Peckham Park, 1 boy and 1 girl; Brighton School for the Deaf, 1 boy and 1 girl; Oak Lodge, Nightingale Lane, Clapham, 1 girl; Anerley Residential, 1 boy; East Anglia School, 1 boy; Old Kent Road, 1 boy and 1 girl. Epileptic Children. 4 boys and 1 girl. The institutions which these children attend are:—Lingfield Epileptic Colony, Surrey, 2 boys; Chalfont Colony, Chalfont St. Peter's, Bucks, 2 boys and 1 girl. Educationally Sub-Normal Children. In addition to the day accommodation provided at St. Christopher's School, 2 girls are resident in the Monyhull Residential School, Birmingham; Gosden House, Bramley, 1 boy, 1 girl; St. Joseph's, Dunmow, 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. An interesting report has been received from Mr. Ramsden, the Head Master, showing that the work has been carried out as in the past. During the year nearly 100 visitors from all parts of Great Britain and many other countries throughout the world have visited the school. Mr. Ramsden served on a London University Institute of Education Committee regarding the training of teachers of educationally sub-normal children. Number attending January 1st, 1949 188 „ „ December 31st, 1949 183 „ referred to Public Elementary Schools 4 Number discharged : (i) Ineducable and referred to Mental Health Committee 1 (ii) Unfit to work „ „ „ 2 (iii) Fit to work „ „ „ 8 (iv) Fit to work not „ „ „ 3 120 CLINIC FOR EDUCATIONALLY SUB-NORMAL CHILDREN. 325 children were examined during 1949. The classifications arrived at, together with recommendations made, are as follows— (1) Found to be mentally defective : (a) Found to be mentally defective and referred to Local Authority and Occupation Centre 4 (b) Found to be mentally defective and referred to Local Authority for Statutory Supervision 14 (c) Recommended Institutional Care and referred to Local Authority 6 (2) Found to be educationally sub-normal : (a) Recommended to St. Christopher's Special School 78 (b) Recommended to Residential School 1 (c) Referred to Special Class in Ordinary tary School 32 (d) Recommended for re-test 86 (e) Deferred for Medical Treatment 8 (f) Recommended for St. Giles' 4 (g) Recommended Epileptic Colony 1 (h) Referred back to Ordinary Elementary School 50 (3) Referred to Child Guidance Clinic 10 (4) Examined for other Authorities 4 298 Mental Tests at St. Christopher's 27 325 745 home visits have been paid to Education cases. 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, 2 boys; St. Catharine's Home, 3 boys; Rob Roy, Speldhurst, 1 girl; Cony Hill Residential, Margate. 1 boy; St. Margaret's (Spastic), 3 boys and 3 girls; Alexander Hospital, 1 girl; Hollins Hall Home, 1 boy; Chidren's Seaside Home, Exmouth, 1 girl; Lillesden School, 1 girl; West Wickham Heart Hospital, 1 boy, 1 girl; St. Vincent's, 1 boy; St. John's, Kemp Town, 1 girl; Castlehain, 2 girls; Moor House, 1 girl; The Hall School, 1 boy; Hawkenburv, 1 boy; Ledston Hall, 1 boy; Hamilton House, 1 boy; Sunnydene, 1 boy; Port Regis, 1 girl; St. Dominic's, 1 boy; Brabazon House, 1 girl; Charlton, 1 boy. 121 Speech Defects Clinic. Total number of cases treated 149 „ „ discharged 87 „ „ still attending 62 Referred for physical treatment 9 „ Child Guidance Clinic 4 Number of stammerers treated 50 „ cleft palate treated 10 „ sigmatism 17 „ deafness 8 „ dyslalia 64 HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS OR BOARDING IN BOARDING SCHOOLS. Blind Partially Sighted Deaf Partially Deaf Delicate Physically Handicapped Educationally Sub-normal Maladjusted Epiletic Total In the Calendar year :— (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) A. Handicapped Pupils newly placed in Special Schools or Homes 1 – 2 2 26 12 31 3 2 79 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Homes – – – 1 31 23 63 1 2 121 On or about December 1st:— C. Number of Handicapped Pupils from the area : (i) attending Special Schools as Day Pupils 1 30 3 3 70 86 183 — — 376 Boarding Pupils 2 — 10 3 7 2 5 1 4 34 (ii) Boarded in Homes – – – – – – – 5 — 5 (iii) attending assisted schools (under approved arrangements) – 1 – – 3 – 5 – 9 Total (C) 3 30 14 6 77 91 188 11 4 424 D. Number of Handicapped pupils from the area requiring places in Special Schools or Homes, but remaining unplaced – – 1 1 11 12 32 1 1 59 E. Number of Handicapped pupils receiving home tuition (including those also returned in D) — — — — 5 3 — – — 8 Number of children reported during the Calendar Year : Under Section 57(3) of Education Act, 1944 ... 18 „ 57(4) „ „ „ Nil 122 JUVENILE EMPLOYMENT RETURN. The following numbers of children were examined by the medical officers during 1949 as to their fitness to following the part-time employment indicated : — 1949. 1948. 1947. 1946. 1945. Delivery of Goods for Shopkeepers 218 190 112 2 60 Delivery of Newpapers 283 375 151 125 90 Delivery of Milk 16 33 6 9 13 517 598 269 136 163 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT. During 1949 all milk was supplied free of charge, and approximately 23,000 children per day received 1/3rd 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 during 1949 was approximately 17,000. CHILD GUIDANCE CLINIC. Return of Cases referred by the School Medical Officer and the Education Department, from 1st January to 31st December, 1949. Boys. Girls. Total number referred 50 30 Analysis of the above Cases: — Diagnostic only 8 9 Diagnostic—awaiting treatment 5 2 Current Cases under treatment 22 11 Cases Closed—improved 8 5 Cases Closed—not improved 7 3 50 30 123 NON-MAINTAINED SCHOOLS. The usual arrangements for the medical inspection of nonmaintained school children were continued in 1949, 265 children were examined, all girls. Table II of Appendix B gives the detailed findings. Yours faithfully, S. L. WRIGHT, School Medical Officer. 124 APPENDIX A. MEDICAL INSPECTION RETURNS. Year ended 31st December, 1949. Table I. MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. A.—Periodic Medical Inspections. Number of Inspections in the prescribed Groups : Entrants 4,054 Second Age Group 2,536 Third Age Group 3,207 Total 9,797 Number of other Periodic Inspections 1,950 Grand Total 11,747 B.—Other Inspections. Number of Special Inspections 5,261 Number of Re-Inspections 8,214 Total 13,475 C.—Pupils found to require Treatment. (Excluding Dental Disease and Infestation with Vermin). Group For defective vision (excluding squint) For any of the other conditions recorded in Table IIA. Total individual pupils. (1) (2) (3) (4) Entrants 42 903 940 Second Age Group 187 419 569 Third Age Group 283 477 702 Total (prescribed groups) 512 1799 2211 Other Periodic Inspections 122 310 409 Grand Total 634 2109 2620 125 Table II. A RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION. Defect Code No. Defect or Disease Periodic Inspections Special Inspections* No. of defects No. of defects Requiring treatment Requiring to be kept under observation, but not requiring treatment Requiring treatment Requiring to be kept under observation, but not requiring treatment (1) (2) (3) (4) (5) 4 Skin 31 11 1 1 5 Eyes— (a) Vision 634 76 63 8 (b) Squint 100 59 7 — (c) Other 25 14 2 — 6 Ears— (a) Hearing 22 9 1 2 (b) Otitis Media 19 9 3 — (c) Other 11 13 1 2 7 Nose or Throat 574 378 30 12 8 Speech 35 39 4 3 9 Cervical Glands 5 30 2 1 10 Heart and Circulation 49 84 4 4 11 Lungs 53 87 11 2 12 Developmental— (a) Hernia 2 4 — — (b) Other 5 6 1 1 13 Orthopaedic— (a) Posture 261 38 6 1 (b) Flatfoot 173 49 8 1 (c) Other 381 166 16 8 14 Nervous System— (a) Epilepsy 5 6 — 1 (6) Other 15 33 1 8 15 Psychological— (a) Development 5 2 1 — (6) Stability 8 8 1 3 16 Other 142 112 13 7 * These figures refer to Special Inspection in school only. 126 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 4054 962 23.7 2789 68.8 303 7.5 Second Age Group 2536 566 22.3 1818 71.7 152 6.0 Third Age Group 3207 714 22.3 2341 73.0 152 4.7 Other Periodic Inspections 1950 478 24.5 1349 69.2 123 6.3 Total 11747 2720 23.2 8297 70.6 730 6.2 Table III. INFESTATION WITH VERMIN. (i) Total number of examinations in the schools by the school nurses or other authorized persons 69327 (ii) Total number of individual pupils found to be infested 909 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 86 (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) 7 127 Table IV. 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 4 Ringworm—Body 29 Scabies 28 Impetigo 77 Other skin diseases 80 Eye Disease (External and other, but excluding errors of refraction, squint and cases admitted to hospital.) 264 Ear Defects 253 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 2119 Total 2854 (b) Total number of attendances at Authority's minor ailments clinics 18162 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) 2183 Other defect or disease of the eyes (excluding those recorded in Group I) — Total 2183 No. of Pupils for whom spectacles were (a) Prescribed 1013 (b) Obtained — GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Total number treated Received operative treatment— (a) for adenoids and chronic tonsillitis 683 (b) for other nose and throat conditions — Received other forms of treatment — Total 683 GROUP IV.—ORTHOPAEDIC AND POSTURAL DEFECTS. (a) No. treated as in-pat,ents in hospitals or hospital schools 10 (b) No. treated otherwise e.g., in clinics or out-patient departments 340 GROUP V.—CHILD GUIDANCE TREATMENT AND SPEECH THERAPY. No. of pupils treated (a) under Child Guidance arrangements 287 (b) under Speech Therapy arrangements 147 128 Table V. DENTAL INSPECTION AND TREATMENT. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 20478 (b) Specials 3102 (c) Total (Periodic and Specials) 23580 (2) Number found to require treatment 12506 (3) Number actually treated 9513 (4) Attendances made by pupils for treatment 18620 (5) Half-days devoted to : (a) Inspection 156 (b) Treatment 1605 Total (a) and (b) 1761 (6) Fillings: Permanent Teeth 5182 Temporary Teeth 1036 Total 6218 (7) Extractions : Permanent Teeth 1722 Temporary Teeth 10056 Total 11778 (8) Administration of genefal anaesthetics for extraction 3447 (9) Other Operations: (a) Permanent Teeth 5533 (b) Temporary Teeth 3047 Total (a) and (b) 8580 129 APPENDIX B. NON-MAINTAINED SCHOOLS. Year ended 31st December, 1949. Table I. RETURN OF MEDICAL INSPECTIONS. A. —Routine Medical Inspections. Year 1948. Year 1949. Age 11 or under 43 48 12 19 74 13 18 40 14 18 41 15 6 21 16 10 19 17 14 14 18 or over 10 8 Total 138 265 b.—Other Inspections. Year 1948. Year 1949. Number of Special Inspections — — Number of Re-inspections 7 1 Total 7 1 Visits to Non-maintained Schools 6 1 130 NON-MAINTAINED TABLE II.—A.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1949. DEFECT OR DISEASE. Routine Inspections Number of defects. Special Inspections Number of defects. Requiring treatment Requiring to be kept under observation but not requiring treatment. Requiring treatment Requiring to be kept under observation but not requiring treatment (1) (2) (3) (4) (5) Malnutrition 9 ... ... ... Uncleanliness. (See Table IV.—Group V.) Skin— Ringworm: Scalp ... ... ... ... Body ... ... ... ... Scabies ... ... ... ... Impetigo ... ... ... ... Other diseases (non-tuberculous) 4 ... ... ... Eye— Blepharitis 2 ... ... ... Conjunctivitis 1 ... ... ... Keratitis ... ... ... ... Corneal opacities ... ... ... ... Defective vision (excluding squint) 27 ... ... ... Squint 4 ... ... ... Other conditions 1 ... ... ... Ear— Defective hearing 3 ... ... ... Otitis media ... ... ... ... Other ear diseases 1 ... ... ... Nose and Throat— Enlarged tonsils only ... ... ... ... Adenoids only ... ... ... ... Enlarged tonsils and adenoids 2 1 ... ... Other conditions 3 ... ... ... Enlarged Cervical Glands (Non-Tuberculous) ... ... ... ... Defective Speech ... ... ... ... Teeth—Dental Disease 2 ... ... ... Heart and Circulation— Heart Disease— Organic ... ... ... ... Functional 3 ... ... ... Anaemia 5 ... ... ... Lungs— Bronchitis 1 ... ... ... Other non-tuberculous diseases ... ... ... ... Tuberculosis— Pulmonary— Definite ... ... ... ... Suspected ... ... ... ... Non-pulmonary— Glands 1 ... ... ... Spine ... ... ... ... Hip ... ... ... ... Other bones and joints ... ... ... ... Skin ... ... ... ... Other forms 1 ... ... ... Nervous System— Epilepsy 1 ... ... ... Chorea ... ... ... ... Other conditions ... ... ... ... Deformities— Flat feet 8 ... ... ... Spinal curvature 16 ... ... ... Other forms 17 ... ... ... Other Defects and Diseases 5 1 ... ... 131 CONTENTS a.—PUBLIC HEALTH REPORT. PAGE PAGE Acts, Adoptive 65 Home Helps 57, 88 Adulteration 81 Home Nursing 47 Airport 88 Homework 70 Ambulance Service 50 Amusement Houses 67,72 Hospital, Isolation 16 Animals, Keeping of 67, 71 Housing 65, 67 Ante-Natal Clinic 33 Housing Act 67 Bacteriology 29, 30, 78, 80 Ice Cream 29, 80 Births 4, 5, 6 Illegitimacy 4, 5, 38 Blood Examinations 29 Immunisation 48 Byelaws and Regulations 65 Infant Welfare Clinics 34 Infant Mortality 4, 7, 8, 9 Cancer 12 Infectious Diseases 14, 16 Chemical Analyses 31 Inquests 6 Chest Clinic 18 Child Minders 87 Laboratory Work 29 Contacts, Tuberculosis 24 Local Acts 66 Convalescence 56 Committee 1 Marriage 5 Cowkeepers 77 Marriage Homes 63 Cremation 88 Maternity Homes, Registration 63 Maternity Outfits 47 Dairies, Cowsheds & Milkshops 77 Measles 14, 16 Day Nurseries 37, 87 Meat inspection 76 Deaths 4, 5, 6, 11 Medical Help Records 46 Dental Treatment—M. & C.W. 38 Men's Hostel 69 Diphtheria 17, 48 Mental Health 59 Disinfection 72 Midwives 45 Disinfestation 72 Midwives, Municipal 47 Ditches 67, 71 Midwives Act 45 Domestic Helps 57, 88 Milk, Provision of 23 Drainage 71 Milk, Examination of 78, 84 Dysentery 14 Milk Tuberculous 77 Milkshops 77 Expectant Mothers 33, 39 Mortality in Childbirth 7 Extra Nourishment 23 National Assistance Act 88 Factories and Workshops Neo-Natal Deaths 8 Fertilisers & Feeding Stuffs Act 73 Notification of Birth Acts 6 Acts 66, 69 Nuisances 65 Food 29, 66, 74 , 77, 81, 85 Nursing Equipment 56 Nursing Homes 87 Gastro-Enteritis 17 Offensive Trades 71 Health Centers Ophthalmic Neonatorum 14 Health Propaganda 57 Outworkers 70 Health Visitors, Work of 35, 43, 50 132 PAGE Poisons and Pharmacy Act 73 Poliomyelitis 14 Ponds 67, 71 Population 4 Post-Natal Clinic 33 Post-Mortems 6 Premature Infants 34 Puerperal Sepsis and Pyrexia 14 Rats & Mice (Destruction) Act 73 Refuse Collection 32 Road Traffic Accidents 11, 51 Sanatoria, Treatment in 23 Sanitary Administration 64 Sanitary Certificates 69 Sanitary Inspectors, Work of 64 Scarlet Fever 16 Schools, Inspection of 70 Sewage 32 Shop Hours Acts 66, 71 Slaughterhouses 74 Smoke Observation 71 Staff Examinations 88 Still-Births 4, 6 Suicide 11 B.—SCHOOL MEDICAL REPORT. PAGE Accommodation 94 Adenoids 104 Blind Children 118 Child Guidance 122 Cleansing of Children 102 Clinics 93, 104 Cod Liver Oil 122 Cost 101 Crippling Defects 115 Deaf Children 118 Deaths 103 Defective Children 100, 120 Defective Hearing 118 Deformities 115 Dental Service 107 Ear Disease 118 Epileptic Children 118 Exclusions 105 Eye Clinic 107 Following-up 107 Health Visitors, Work of 106 Heights and Weights 99 Immunization, Diphtheria 115 Infectious Diseases 105 Inspection Clinic 104 Inspections 97 Juvenile Employment 122 PAGE Tuberculosis—After Case 55 „ Allowances 55 „ Contacts 24 „ Deaths 22 „ Notifications 19 „ Home Nursing 24 „ Home Visit 24 „ Institutional Treatment 23 „ Occupational Therapy 25 Vaccination 49 Verminous Persons 72 Venereal Diseases 26 Vital Statistics 4 Ward Statistics 10 Watercourses 67, 71 Water Supply 30 Whooping Cough 14, 17, 49 Workplaces 66, 69 Workshops 66, 69 Zymotic Diseases 12 PAGE Malnutrition 100 Malt 122 Massage Clinic 116 Meals, Provisions of 101 Mentally Defective Children 119 Milk, etc., Provision of 401-122 Minor Ailments 104 Non-maintained Schools 123 Nutrition 100 Orthopaedic Work 115 Orthodontic Service 112 Parents' Attendances 98 Physically Defective Children 120 Population 94 Remedial Exercises 116 Rheumatism Clinic 116 Schools Special 95, 101 Speech 121 Staff 93 Statistical Tables 124 Surveys, Uncleanliness 102 St. Christopher's 119 Throat and Nose 104 Treatment 104 Tuberculosis 103 Uncleanliness 102 Vision, Defective 107 X-Ray 112