CRO 52 county Borough of Croydon. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1950 S. L. WRIGHT, M.D., M.R.C.P., D.P.H. CROYDON: PRINTED BY THE CROYDON TIMES, LTD., 104, HIGH STREET, CROYDON 1 HEALTH COMMITTEE. Councillor J. Todd (Chairman). Councillor M. Davis (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 R. H. Davies. Councillor J. W. Dowsett. Councillor A. J. R. Dunn. 1950. Councillor A. Goodbun. Councillor Mrs. E. M. Jenkins. Councillor F. A. Messer. Councillor C. E. Moyce. Councillor S. E. Rumball. 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. Miss M. M. Durrani, S.R.N., l.N. Royal College of Nursing. Mrs. F. R. Mitchell, O.B.E Royal College oj Midwives, Miss A. E. Humphrey, S.R.N., S.C.M., Croydon Nursing Service. Q.I.D.N.S. Mrs, H. Thatcher Croydon Family Planning Association. 2 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1950. S. L. WRIGHT, M.D., M.R.C.P., D.P.H, To the Chairman and Members of Ihe Health Committee. Ladies and Gentlemen, I have the honour to present the 51st Annual Report on tlie health of the people of Croydon and the relevant services of the Corporation for the year ending December 31st, 1950. As shown by statistics this was a year of progress. The standardised death-rate, the infant mortality rate and the tuberculosis death-rate, which together comprise the most sensitive index of the health of a community were the lowest on record. The birth-rate fell to a figure approaching the level prevailing in the years preceding World War II. For the first time the Registrar-General provides a comparability factor for adjusting local birth-rates according to the proportion of women of childbearing age. The factor for Croydon being less than one, shows that in comparison with the country as a whole, Croydon has a larger than average proportion of potential mothers. As regards infectious diseases during 1950, poliomyelitis was prevalent, but not to the extent experienced in 1947. Duties under the National Health Service Act gave rise to no particular difficulties, but demands on all facilities continued to increase. The cordial relationships with the hospital and general practitioner divisions of the service have continued and wherever spheres of influence met co-ordination and the avoidance of overlapping have been fostered. The figures which I am able to present suggest that our combined efforts have met with some 3 success. I thank my colleagues in other departments of the Corporation and other sections of the Health Service for their unfailing courtesy and assistance whenever I have asked for advice, help or information. To you, Mr. Chairman, and to the members of the Committee I am indebted for much encouragement and constructive comments and ideas. The members of the staff of the Department have shown unfailing interest in their work and solved for me many administrative problems. I am, Yours faithfully, S. L. WRIGHT, Medical Officer of Health. 4 STATISTICS SUMMARY OF VITAL STATISTICS FOR 1950. Area, 12,672 acres. Population (Census 1931), 233,115. Total Population (estimate of Registrar-General), 251,600 (Midsummer, 1950). Number of Inhabited Houses: (1931 Census), 56,429; 1950, 67,268. Rateable Value (1st April, 1950): .£2,615,378. Product of a Penny Rate (1949-1950): £10,457. Rate in the £: 15s. 2d. Live Births: M. F. Total. Legitimate 1,752 1,771 3,523 Illegitimate 99 88 187 3,710 Birth-rate per 1,000 of the estimated resident population, 14.7 (England and Wales 15.8: Great Towns 17.6). Birth-rate (as adjusted by comparability factor (0.96): 14.1. Still Births, 77. Rate per 1,000 total (live and still) births, 20.0. Deaths, 2,724. Death-rate per 1,000 of the estimated resident population, 10.8. (England and Wales 11.6: Great Towns 12.3). Death-rate (as adjusted by comparability factor, 0.93), 10.0. Infant mortality rate, 26 per 1,000 live births. (England and Wales 30: Great Towns 34). Legitimate Infants (93 deaths), 26 per 1,000 live births. Illegitimate Infants (3 deaths), 16 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 Haemorrhage) 5.49 ,, ,, Cancer l.$9 ,, ,, diseases of the Respiratory System (excluding Tuberculosis) 1.24 ,, ,, diseases of Digestive .System 0.32 ,, ,, Tuberculosis (all forms) 0.27* ,, ,, Suicide and Violent Causes 0.20 * England and Wales 0.36: Great Towns 0.42. Rate per 1,000 of age group. (2) Ages 15-45 years. Deaths from Tuberculosis (all forms) 0.18 ,, ,, Cancer 0.32 ,, ,, Cardiac and Circulatory System 0.29 Marriages. The number of marriages solemnised was 2,051, compared with 2,066 in 1949, 2,169 in 1948, 2,416 in 1947, 2,105 in 1946, 2,268 in 1945, and 1,578 in 1944. 901 were solemnised in Established Churches, 377 in other places of worship, and 771 in the Register Office Two were performed under Jewish ritual. Births. The live births registered were 3,523 legitimate and 187 illegitimate. The birth-rate consequently was 14.7. For England and Wales and in the Great Towns the rates were 15.8 and 17.6. The illegitimate births in Croydon were 5.0 of the total compared with 4.9 in 1949, 6.0 in 1948, 5.5 in 1947, 6.5 in 1946, 10.6 in 1945, and 7.7 in 1944. The live male births numbered 1,851, the female 1,859, being a proportion of 1,000 males lo 1,004 females. 6 Deaths. The deaths numbered 2,728, compared with 2,734 in 1949. For 1950 the death-rate was 10.8, for 1949 it was 10.9. The deathrate for England and Wales was 11.6, and for the Great Towns 12.3. For London the death-rate was 11.8. There were 81 inquests held by Coroners in respect of Croydon residents during 1950 and 284 findings by Coroners after post-mortem examination without inquest. Wards with the highest death-rate were South (15.0), Addiscombe (12.7), East (12.6), and Bensham Manor (12.5). Lowest: Addington (7.7) and West Thornton (8.5). Still Births. During 1950, 77 still births were registered in respect of Croydon. Of these, 37 were male babies and 40 females; 4 males and 3 females were illegitimate. The proportion of still births to living children was as 1 to 48. The still birth rate was 2.0 per cent. of the total births. The still birth rate, on the same basis as for Infant Mortality, was 20.0 per 1,000 births. Notification of Births. Notifications were received in respect of confinement? conducted by:— Live Births. Still Births. Total. Midwives 3,000 59 3,059 Doctors 1,112 26 1,138 4,112 85 4,197 Accommodation for Confinement. The following table gives information concerning the accom niodation utilised for confinements:— Number. Percentage. In Private Houses 1,242 29.59 In Public Institutions 2,240 53.37 In Registered Maternity Homes 715 17.04 4,197 7 Maternal Mortality. There were 2 deaths, compared with 5 in 1949. The maternal mortality rate was 0.53 per 1,000 births, compared with 1.22 in 1949. The deaths were caused by— (1) Toxic nephritis due to septic incomplete abortion, p.m. (2) Post-partum haemorrhage due to pathologically adherent placenta, p.m. MATERNAL AND INFANT MORTALITY FOR THE YEARS 1932—1950 Year Births (Live and Still) Maternal Deaths Maternal Mortality Rate Infant Mortality Rate 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 1950 3787 2 0.53 26 Infant Mortality. The Infantile Mortality Rate was 26 per 1,000 live births registered and is the lowest yet recorded. 8 For the past 5 years the number of infant deaths has been 1946—151, 1947—194, 1948—120, 1949—13 6, and 1950—96. Among the 96 deaths, 47 occurred in boy babies and 49 in girls. Of the births, 1,851 were males and 1,859 females. The infantile mortality rate for the two sexes was, therefore, Boys— 25, Girls—26. 84 deaths of infants occurred in Institutions, including Registered Nursing Homes. The following table gives the cause of death during ihe first month of life:— (1) Complications of Labour— Placenta Prasvia 1 -1 (2) Foetal States— Congenital Heart Malformation 4 Other Congenital Deformities 1 Atelectasis, etc. 5 Hemorrhage Disease of Newborn 4 — 14 (3) Prematurity 42 — 42 (4) Post-Natal Causes 5 — 5 62 Percentage Deaths per Total Infantile Deaths. Deaths per 1,000 Births 1950 1949 1950 1949 Premature Births 45.8 35.3 11.9 10.2 Respiratory Diseases 18.8 18.1 4.9 5.2 infectious Diseases (Including Tuberculosis) 1.1† 1.7 0.3 0.50 Atelectasis, Debility and Marasmus 6,3 11.2 1.6 3.26 Diseases of Digestion 10.4* 5.2 2.7 1.49 Injury at Birth and Congenital 9.4 18.1 2.4 5.23 †This death was due to Whooping Cough *These deaths were due to Diarrhoea, 8 Oastritis 1, Intussusception 1 9 Deaths under one year, arranged in days, weeks and months. The rate of infant mortality amongst legitimate children was 26 per 1,000 births. The rate in illegitimate children was 16 per 1,000 births. CAUSES OF DEATH. 1st day. 2nd day. 3rd day. 4th day. 5th day. 6th day. 7th day. lst-2nd wk. 2nd-3rd wk. 3rd-4th wk. Under 1 mnth. 1-2 mths. 2-3 mths. 3-4 mths. 4-5 mths. 5-6 mths. 6-7 mths. 7-8 mths. 8-9 mths. 9-10 mths. 10-11 mths. 11-12 mths. TOTAL. All Causes 41 5 4 1 1 3 2 2 1 2 62 8 9 2 5 2 4 4 ~ — — — 96 Polio-Encephalitis - - - - - - - - - - - - - - - - - - - - - - - Chicken Pox - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - -- - - - - - 1 - - - - - - - - - - 1 Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - - - - - - 1 - - - - - - 1 Convulsions - - - - - - - - - - - - - - 1 - - - - - - - 1 Laryngitis - - - - - - - - - - - - - - - - - - - -- - - - Bronchitis - - - - - - - - - - - - - - - - - - - - - - - Pneumonia (all forms) — 1 — - — 1 — — 1 1 4 3 2 1 3 — 4 1 - — — - 18 Diarrhoea and Enteritis — — - - - - - - - - - 1 3 1 — 1 — 2 - - - - 8 Gastritis - - - - - - - - - - 1 - - - - - - - - - - - 1 Syphilis — - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - Congenital Malformations 2 1 1 1 - - - - - - 5 2 - - 1 - - - - - - - 8 Premature Birth 34 2 2 - - 1 2 1 - — 42 — 2 — — — — — - - - 44 Atrophy, Atelectasis, Debility and Marasmus 4 - - - - - - 1 - 1 6 - - - - - - - - - - - 6 Injurv at Birth - - - - - - - - - - - - 1 - - - - - - - - - 1 Haemorrhagic disease of newborn 1 1 1 - 1 - - - - - 4 - - - - - - - - - - - 4 Other Causes - - - - - - - - - - - 1 1 - - - 1 - - - - 3 Totals 41 5 4 1 1 3 2 2 1 2 62 8 9 2 5 2 4 4 - — — — 96 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 Cancer. Natural Increase or Decrease of Population. Upper Norwood 17506 235 212 13.4 12.1 43 0.06 1.49 0.34 0.06 6.00 2.17 + 23 Norbury 16371 151 168 9.2 10.3 7 — — 0.98 0.24 0.12 5.07 2.14 — 17 West Thornton 19545 237 167 12.1 8.5 17 0.05 — 0.97 0.20 0.05 4.40 1.64 + 70 Bensham Manor 16360 246 205 15.0 12.5 24 — — 1.16 0.12 — 6.97 2.38 + 41 Thornton Heath 18399 256 167 13.9 9.1 16 - — 0.49 0.16 0.05 5.00 1.96 + 89 South Norwood 17507 288 187 16.5 10.7 45 — 0.12 1.26 0.29 — 5.26 1.66 + 101 Woodside 16459 234 192 14.2 11.7 21 — — 1.34 0.24 0.06 5.71 2.31 + 42 East 17004 251 214 14.8 12.6 32 — 0.06 1.18 0.24 — 6.53 2.00 + 37 Addiscombe 16362 267 206 16.3 12.7 19 0.06 — 1.04 0.49 — 7.21 2.14 + 61 Whitehorse Manor 16562 257 178 15.5 10.7 23 — — 0.85 0.18 — 5.43 2.42 + 79 Broad Green 17439 267 160 15.3 9.2 30 — 0.06 1.43 0.23 — 3.84 1.80 + 107 Central 12358 211 143 17.1 11.6 28 0.08 — 0.65 0.16 — 6.47 1.29 + 68 Waddon 18155 214 168 11.7 9.3 33 — — 1.43 0.28 — 4.30 1.76 + 46 South 15357 215 230 14.0 15.0 23 — 0.07 1.56 0.26 — 7.29 2.67 — 15 Addington 16196 381 125 23.5 7.7 21 0.06 0.12 0.56 0.12 0.06 3.52 1.54 +256 The Borough 251600 *3710 *2724 14.7 10.8 26 0.02 0.03 1.10 0.24 0.03 5.49 1.99 +988 *These are the corrected totals. 11 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX. Sex 0 - 1 - 5 - 15 - 25 - 45 - 65 - 75 - Total All Causes M 48 13 7 20 70 315 346 463 1282 F 48 10 5 14 60 255 350 704 1446 Tuberculosis (respiratory) M — 2 — 4 4 18 8 3 39 F — — — 3 5 8 — 3 19 Tuberculosis (other forms) M - — — 1 1 2 — - 4 F - 2 - - 1 - - - 3 Syphilitic diseases M - - - - 1 2 1 4 F - - - - - - 2 — 2 Diphtheria M - - - - - - - - F - - - - - - - - Whooping Cough M - - - - - - - - F 1 - - - - - - - 1 Meningococcal Infections M - - - - - - - - F - - - - - - - - Acute Poliomyelitis M - 1 - - 1 - - - 2 F - - 1 1 2 - - - - 3 Measles M - 1 - - - - - 2 F - - - - - - - - Other infective and parasitic diseases M - - - - 2 2 - - 4 F — — 1 — 2 2 — - 5 Malignant neoplasm, stomach M — — — — 3 7 11 10 31 F - - - - 2 5 20 17 44 „ „ lung, bronchus M - - - - - 35 29 2 66 F - - - - - 5 3 1 9 ,, ,, breast F — — — — 10 24 9 9 52 ,, ,, uterus F — - — — 1 10 10 4 25 Other malignant and lymphatic neoplasms M — - — 1 10 38 39 35 124 F — - — 1 10 52 35 39 137 Leukaemia; aleukaemia M - - 1 - - 2 2 1 6 F - - - - - - 2 - 2 Diabetes M - - - - - - 3 1 4 F — - — 1 1 5 9 3 19 Vascular lesions of nervous system M — — — - 4 17 55 58 134 F - - - - 1 32 53 131 217 Coronary disease, angina M — — 1 — 10 56 61 57 185 F - - - - - 17 51 46 114 Hypertension with heart disease M — - - — 1 12 7 7 27 F - - - - - 5 12 18 35 Other heart diseases M — — 1 1 4 28 53 159 246 F — — 1 1 5 30 74 288 399 Other circulatory diseases M - - - - - 9 17 21 47 F — — — — 2 11 20 32 65 Influenza M - - - - - 2 2 6 10 F — — — 1 — 4 1 3 0 Pneumonia M 8 2 — 1 — 5 9 15 40 F 5 3 1 1 1 4 3 24 42 Bronchitis M 1 — - — 1 23 24 26 75 F - - - - 8 7 32 47 Other diseases of respiratory system M — — - — 2 3 1 7 13 F - - - - - 2 1 3 6 Ulcer of stomach and duodenum M — — — 1 3 10 3 5 22 F - - - - - 1 1 2 4 Gastritis, enteritis and diarrhoea ... M 4 - - - - 1 - - 5 F 3 - - - 1 - 1 2 7 Nephritis and nephrosis M — — - — 3 2 2 4 11 F — 1 — — 1 3 7 7 19 Hyperplasia of prostate Pregnancy, childbirth and abortion M - - - - - 3 3 22 28 F - - - - 2 - - - 2 Congenital malformations M 4 - l - 2 2 - - 9 F 7 - - — 2 1 3 — 13 Other defined and ill-defined diseases M 30 3 l 2 12 25 11 19 103 F 32 - l - 10 19 23 32 117 Motor vehicle accidents M - — 1 6 3 1 - - 11 F — 2 — 3 — — - 2 - All Other accidents M 1 3 - 1 3 2 - 3 13 F - 2 - - 1 1 2 5 11 Suicide M - - - 2 1 9 ! 3 1 16 F - - - 1 2 6 1 1 11 Homicide and operations of war M - - - - - 1 - 1 F - - - - - - - - Totals 96 23 12 34 130 570 696 1167 2728 12 Comparisons with 1949 (Registrar-General's Table). There were two deaths from Whooping Cough (1949—2) and one from Measles (1949—1). There were again no deaths in the Typhoid group and none from Diphtheria. The deaths from Pulmonary Tuberculosis decreased by 30; those from Cancer increased by 31; (hose from Pneumonia decreased by 15; and a decrease of 18 was also recorded in those caused by Bronchitis. Deaths from suicide show a decrease of 5, and road traffic accidents a similar figure. The total number of deaths was 2,728 as compared with 2,731 in 1949. The percentage of deaths under I year of age lo the total deaths was 3.5 per cent.; deaths under 15 years, 4.8 per cent.; deaths under 05 years, 31.7 per cent.; and deaths over 65 years, 68.3 per cent. The corresponding figures for 1949 were 4.2 per cent., 5.6 per cent., 33.0 per cent., and 67.0 per cent. respectively. The Registrar-General has continued to supply a comparability factor—0.93—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 tabulated in the Department numbered 501 as compared with 481 in 1949; 510 in 1948; 492 in 1947; 451 in 1946; 470 in 1945; 420 in 1944; 456 in 1943; 405 in 1942; 377 in 1941; and 443 in 1940. Death-rate per 1,000 of the population for the last 11 years are as follows:— 1940—2.22 (443) 1941—2.04 (377) 1942—2.07 (405) 1943—2.28 (456) 1944 2.21 (420) 1945—2.34 (470) 1946—1.93 (451) 1947—2.03 (492) 1948—2.06 (510) 1949—1.93 (481) 1950—1.99 (501) 13 Deaths from Cancer occurred at the following Ages:— Age period. Male. Female. Total. Under 25 years 2 1 3 25 and under 35 years 4 4 8 35 and under 45 years 8 19 27 45 and under 65 years 82 98 180 65 years and over 131 152 283 227 274 501 Sites of Fatal Cancer. Site. Male. Female. Total. Percentage of Total. Skin 2 3 5 0.998 Tongue and Mouth 7 2 9 1.796 Oesophagus 5 7 12 2.394 Stomach 34 46 80 15.968 Liver 3 2 5 0.998 Bowel 21 40 61 12.176 Rectum 23 9 32 6.387 Bladder 10 11 21 4.192 Prostate 18 — 18 7.929 Larynx and Pharynx 7 3 10 1.996 Uterus — 27 27 9.854 Breast — 52 52 18.978 Ovary — 19 19 6.934 Pancreas 6 12 18 3.593 Gall Bladder and Duct 1 3 4 0.798 Circulatory System 7 1 8 1.597 Bones 2 8 10 1.996 Lungs 64 12 76 15.170 Kidney 2 3 5 0.998 Brain 3 1 4 0.798 Retroperitoneal — 1 1 0.200 Thyroid Gland — 1 1 0.200 Lymphatic Glands 4 2 6 1.197 Mediastinum — 1 1 0.200 Parotid Gland 1 - 1 0.200 Suprarenal Gland 1 - 1 0.200 Genital Organs — 3 3 0.599 Tonsil — 1 1 0.200 Undefined 6 4 10 1.996 227 274 501 Comments on Foregoing Table. The organs most often attacked in descending order of incidence are: In The males—the Lungs (28.1 per cent.), the Bowels and Rectum (19.4 per cent.), and the Stomach (15.0 per cent.); in females—the Breast (19.0 per cent.), the Bowels and Rectum (17.9 per cent.), the Stomach (16.8 per cent.), and the Uterus (9.8 per cent.) 14 INFECTIOUS DISEASES NOTIFIED DURING YEAR 1950. Notifiable Disease. Cases notified in the whole District. Total cases notified in each Ward. Sex Distribution of Notified Cases. 1950. 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. At all Ages. Under 1 year. 1—4. 5—14. 15—24. 25—44. 45—64. 65 and up. M F Scarlet Fever 543 - 164 354 21 6 1 - 28 18 37 28 46 73 54 58 33 23 34 17 23 32 42 208 248 Diphtheria 1 - — — 1 — — - — — — — 1 - - - - - - - - - - - 1 Erysipelas 33 - — 1 2 7 16 7 3 4 2 3 2 - 1 3 1 3 5 - 9 1 3 11 22 Cerebro-Spinal Meningitis 1 - 1 — — — — — — — - - - 1 - - - - - - - - - 1 - Enteric & Paratyphoid 3 - - — 1 2 - - - - - - - - - - - - 2 1 - - - - 3 Small Pox - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 35 — — — 14 21 — — 2 — 24 — 3 1 1 - 1 - 1 - 1 - 1 - 35 Ophthalmia Neonatorum Poliomyelitis and 3 3 — — — — — — — — — 1 1 — — — — — - — — 1 2 1 Polio-encephalitis 39 3 12 14 6 4 — — 7 1 1 1 3 6 - 4 - - 2 2 - 2 10 20 19 Dysentery bb 3 18 14 8 II 1 — - 8 5 — 8 I 1 12 5 2 3 2 1 1 - 26 29 Malaria — — — — — — — — - - - - - - - - - - - - - - - - - Acute Primary and Acute Influenzal Pneumonia 52 2 8 14 2 13 0 3 4 - 5 3 3 2 1 - 2 6 8 2 8 4 4 26 26 Food Poisoning 48 — 4 11 3 21 9 — 3 1 1 8 13 - - - 2 3 2 5 - - 10 21 27 Encephalitis Lethargica 2 1 — - — 1 - — - - - - - - - - - - - - 1 - 1 2 - Measles 1367 28 619 704 8 7 1 — 120 60 92 22 105 131 122 126 8Q 56 16 5-1 55 267 703 664 Whooping Cough 1204 97 566 516 4 18 2 1 83 45 94 83 127 96 64 85 87 78 60 30 88 34 147 570 634 Totals 3389 137 1392 1628 70 111 40 11 256 137 281 152 312 311 244 288 220 171 169 75 178 129 486 1680 1709 15 MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1950 Jan. Feb. Mar. April May June July August Sept. Oct. Nov. Dec. Total Scarlet Fever 76 60 65 59 48 24 32 21 22 57 46 36 546 Diphtheria 1 ...... ... ... ... ... ... ... ... ... ... ... 1 Erysipelas 4 6 6 4 2 3 4 2 2 ... ... ... 33 C.S.M. ... 1 ... ... ... ... ... ... ... ... ... 1 Enteric and Paratyphoid ... ... ... ... 2 ... ... ... ... ... 1 ... 3 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 3 4 6 2 4 5 5 4 1 ... ... ... 35 Ophthalmia Neonatorum ... ... ... ... 1 1 i ... ... ... ... ... 3 Poliomyelitis and Polioencephalitis ... ... ... ... ... 1 1 5 9 9 10 4 39 Dysentery 1 1 ... ... 4 9 ... 2 1 ... 5 32 55 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... Ac. Pri. & Ac. Inf. Pneumonia 8 11 . 3 6 5 1 4 2 1 ... ... 11 52 Food Poisoning 4 ... ... 1 4 4 7 6 8 1 8 5 48 Encephalitis Lethargica ... 1 ... ... ... ... ... ... ... ... ... 1 2 Measles 9 47 44 33 78 110 109 133 49 37 158 560 1367 Whooping Cough 20 13 17 35 46 169 239 279 70 57 130 129 1204 TOTAL 3389 16 WADDON (ISOLATION) HOSPITAL. Admission of Infectious Cases to Waddon Hospital in 1950. I am indebted lo Dr. J. Linehan for the following report on infectious cases admitted to the Waddon Hospital during 1950:— Poliomyelitis proved to be the most serious infectious disease encountered during 1950. The diagnosis was confirmed in 29 cases, of whom 28 were admitted from the Croydon Borough. Cases commenced to occur in June and continued till the end of the year. The epidemic was second in severity only to that of 1947. Five of the 28 Croydon cases were non-paralytic. In a further five cases with spinal paralysis and in two encephalitis cases complete recovery occurred whilst in Waddon Hospital. Of the remaining 16 cases, 6 were fatal, 9 were either discharged or transferred with residual paralysis for further treatment, and one remains in hospital with persisting respiratory paralysis. In seven of the surviving cases, residual paralysis could be described as extensive. Ten patients required treatment in a respirator, including five of the fatal cases. In the fatal cases the causes of death were as follows: bulbar paralysis—one case; combined bulbar and respiratory paralysis—four cases; encephalitis and respiratory paralysis—one case. All fatal cases had also extensive paralysis of the trunk and limbs. Thus, though in an appreciable proportion of patients paralysis was absent or transient, in the remainder it tended to be .generalised and frequently fatal. Scarlet Fever wats prevalent in the early part of the year when a number of severer cases with a higher incidence of complications were encountered. Other fever hospitals had a similar experience. Complications included one fatal case of urajmia following scarlet fever nephritis and one case of brain abscess in a late admission. The total number of admissions was 455 (seven cases more than in the previous year). The diagnosis was confirmed in 434 cases, of whom 414 were from the Croydon Borough. IIhooping Cough.— There were 51 patients admitted for this disease, in 41 of whom the diagnosis was confirmed. There was one fatal case—a seven-weeks-old babv. 1 consider that the use of streptomycin in whooping cough broncho-pneumonia helped to achieve a mortality lower than had previously been experienced in a comparable number of admissions. Chloramphenicol was given in a few cases, but was generally unavailable for whooping cough cases during 1950. 17 Measles cases were relatively few, there being only 37 admissions, of whom 34 were from Croydon Borough as compared with 118 cases in the previous year. Most of the cases were admitted towards the end of the year and represent the commencement of the present year's epidemic. There were no fatal cases. Gastro-Enteritis continued to decline both in numbers and severity. Of 38 admissions, the diagnosis could only be confirmed in 22, of whom 21 were from the Croydon Borough. There was only one fatal case—a child aged two months. Food Poisoning.—Six cases of infection by the food poisoning organism, Salmonella Typhi-murium, were admitted. They were of unusual severity and three proved fatal. Two deaths were directly due to the infection, and the third was from heart disease probably aggravated by it. Of the six cases four, including two fatal cases, were from Croydon Borough. Unusual features were hemorrhagic diarrhoea and septicemia. Another new feature noted was the prolonged convalescent carrier state, particularly in young infants and babies. Meningitis.—Although there were 17 admissions for this disease, the diagnosis was confirmed in only two cases, one tuberculous and the other meningococcal. The former was transferred for treatment and the latter made an uncomplicated recovery. Diphtheria.—The admission of only one case of diphtheria in the year constitutes a record for that disease. Dysentery.—Seventeen dysentery patients were admitted, of whom 14 were from the Croydon Borough. They were all mild cases of the Sonne type and represent part of the general increased prevalence of this infection. Other Infections.—One case of typhoid fever was admitted. Fatal infections other than those enumerated under the preceding headings were:— (1) Erysipelas—one fatal case occurring as a complication of herpes zoster in an elderly patient with heart disease; (2) Infective hepatitis—one fatal case occurring in association with pregnancy; (3) Broncho-pneumonia—one fatal case in a seven months' old baby. Cases (1) and (2) were late admissions. 18 Analysis of all cases admitted with corrected diagnoses (the figures for cases admitted from the Croydon Borough are given ill brackets):— Scarlet Fever 434 (414) Puerperal Pyrexia 8 (8) Whooping Cough 41 (38) Non-Patient Babies 9 (9) Measles 37 (34) Infections of the Newborn 3 (3) Poliomyelitis and Pneumonia 13 (12) Encephalitis 29 (27) Tonsillitis 22 (20) Gastro-Enteritis 22 (21) Streptococcal Sore Throat 9 (9) Chicken-Pox 33 (26) Otitis Media 3 (3) Mumps 17 (16) Quinsy 1 (1) Dysentery 17 (14) Impetigo 1 (1) Food Poisoning 6 (4) Gastritis 2 (2) Meningitis 2 (2) Stomatitis 1 (1) Diphtheria 1 (1) Appendicitis 1 (0) Typhoid Fever 1 (1) Melasma 1 (1) Paratyphoid Fever 1 (1) Indigestion 2 (1) Infective Hepatitis 3 (3) Toxic Erythema 4 (4) Erysipelas 10 (8) Urticaria 3 (3) Rubella 4 (3) Herpes Zoster 2 (2) Bronchitis 14 (13) Drug Rash 2 (1) Pharyngitis 16 (16) Infective Dermatitis 1 (1) Influenza 4 (4) Cellulitis 1 (1) Common Cold 2 (2) Breast Abscess 1 (1) Laryngitis 1 (1) Rheumatic Endocarditis 1 (0) Lymphadenitis 2 (1) Uraemia 1 (1) Non-Patient Mothers 4 (4) Haemoptysis 1 (1) Pyrexia of Unknown Origin 1 (1) Diseases shown in the table other than acute specific infections mostly relate to changes in diagnosis. Most cases of fhe milder infectious diseases were admitted from other general hospitals and required to remain in hospital for pre-existing disease. Other infectious cases were admitted for clinical or nublic health reasons. With the opening of the maternity isolation block in Mayday Hospital, admission of puerperal cases was discontinued by the end of May. Tn the latter half of the year fewer beds were available for infectious cases and a certain number of local cases had to be admitted to fever hospitals elsewhere. IMMUNISATION AGAINST DIPHTHERIA. A total of 3,089 new cases came from the following sources:— School Children 587 Children under 5 2,502 Of these, 75 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-vearly intervals. The number of such injections given during the year was 4,512. 19 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 1950 3089 3014 75 4512 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 1950 587 19.0 2502 81.0 IMMUNISATION AGAINST WHOOPING COUGH. A total of 2,234 children were immunised against whooping cough, comprising 2,134 under school age and 100 school children. VACCINATION AGAINST SMALL-POX. A total of 2,391 persons were vaccinated against Small-pox. Under 1 year of age 1-4 5—14 15 or over Total Successful Vaccinations 1272 197 135 185 1789 ,, Re-vaccinions - 28 60 413 501 Insusceptible to Vaccination 64 2 7 28 101 2391 20 THE PREVENTION AND CONTROL OF TUBERCULOSIS. I am indebted to Dr. J. C. McMillan for the following section of the report. There is a possibility that the Chest Clinic may be moved from Katharine Street. This will mean a great inconvenience for many of the patients, especially those who attend the Clinic weekly for treatment for a number of years. As it is impossible to find other premises that are so accessible as the present Clinic, it will probably also mean the further use of the ambulance service in Croydon, as patients who at present can use public transport will probably require the use of ambulances and cars to convey them to any new premises. 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. Although social conditions were different in 1950, a comparison with 1923 shows that in 1923, 98 per 100,000 of the population in Croydon died from all forms of tuberculosis; in 1950 the corresponding figure was 27. The years selected were five 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 1950 by notification or otherwise was 369, as compared with 305 in 1949, 350 in 1948, 354 in 1947, and 348 in 1946. 333 of ihese were cases of Respiratorv Tuberculosis; 194 in males and 139 in females. There were 38 more cases in males and 31 more in females than in 1949. There were 12 cases of Non-Respiratory Tuberculosis among children under 15 years as compared with 13 in 1949. The number of cases in adults was 24, compared with 28 in 1949. Of the cases notified in 1950, 6 males and 3 females died from the Respiratory form of the disease during the year, equal to 3.6 per cent. of those notified. 21 The incidence rate of Tuberculosis of all forms was 1.47 per 1,000 of the population; for Respiratory Tuberculosis 1.32, and for Non-Respiratory 0.14 per 1,000 population. The notification rate was 1.09 per 1,000. In 1949 the corresponding figures were 1.22, 1.06, 0.16 and 0.94 per 1,000. Public Health (Tuberculosis) Regulations, 1930. Summary of notifications during the period from 1st January, 1950, to 31st December, 1950:— 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 - 2 3 — 1 4 14 36 22 32 21 10 1 146 Respiratory, Females — 1 4 2 5 16 19 27 12 7 5 3 1 102 Non-Respiratory, Males — — 1 1 2 — — 3 2 1 1 — — 11 Non-Respiratory, Females — — 2 2 — 3 1 3 2 — 1 2 — 16 22 Source of Information Number of cases in age Groups Total Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1950, to 31st December, 1950, otherwise than by formal notification:— 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— Death Returns from Local Registrars Respiratory M — 1 — — — — _ — 1 2 — — 4 (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 - - - - - - - - - - - - - — (B) Non-Respiratory M - - - - - - - - - - - - - — (C) F - - - - - - - - - - - - - — (D) Posthumous Notifications Respiratory M - - - - - - - - - - 1 — 1 2 (A) F - - - - - - - - - - - - - — (B) Non-Respiratory M - - - - - - - - - - - - - — (C) F - - - - - - - - - - - - - — (D) "Transfers" from Other Areas (excluding transferable deaths) Respiratory M - - - - - 1 8 15 9 2 2 — — 37 (A) F — — 2 1 — 3 9 15 6 1 — — — 37 (B) Non-Respiratory M — — 1 1 — 1 — 1 1 — — — — 5 (C) F — — — - - — 1 — — — — — — 2 (D) Other Sources Respiratory M - - - - - - - 1 2 — — — 3 (A) F - - - - - - - - - - - - - — (B) Non-Respiratory m - - - - - - - - - - - - - — (C) f - - - - - - - - - - - - - — (d) TOTALS (A) 48 (B) 37 (C) 7 (D) 2 23 Notification Register. Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1950:— RESPIRATORY. NON-RESPIRATORY. Total Cases. Males. Females. Total. Males. Females. Total. 927 739 1666 125 Ill 236 1902 CLASSIFICATION OF NEW PATIENTS. Respiratory Tuberculosis. During 1950, 232 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) 128 or 55.2% T.B. plus 1 (early cases, sputum positive) 20 or 8.6% T.B. plus 2 (intermediate cases, sputum positive) 78 or 33.6% T.B. Plus 3 (advanced cases, sputum positive) 6 or 2.6% 232 100.0% Non-Respiratory Tuberculosis. There were 21 cases examined at the Clinic and found to have Non-Respiratory Tuberculosis in the following lorms:— Bones and Joints 7 Abdominal 3 Other Organs 4 Peripheral Glands 7 21 24 Ages at Death from Respiratory Tuberculosis. Year 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 1950 1 — 7 10 28 14 60 Eight cases were not notified during life. Of these, five were certified by the Coroner, after a post-mortem examination; two cases died in a mental hospital, and one in a general hospital. In 1950 the death-rate from all forms of Tuberculosis was 0.27 per 1,000 population. The rate for Respiratory Tuberculosis was 0.24 and the rate for Non-Respiratory Tuberculosis 0.03. Similar figures for 1949 were 0.36 and 0.02. Respiratory Tuberculosis. In 1950 the total number of deaths decreased by 32.6 per cent., compared with 1949, there being a decrease in both sexes of over 30 per cent. There was one death in children up lo schoolleaving age (15 years). 70 per cent. of the total deaths occurred in the age groups 45 and over. New cases show an increase in males of 24.3 per cent, and of 28.7 per cent. in females, compared with 1949; that is a total increase, compared with 1949, of 26.1 per cent., and a rise of 6 per cent. compared with 1948. In contrast, the total deaths in 1950 were 42.3 per cent, less than in 1948. The total numbers of the new cases in 1950 were : Males 194, females 139; that is approximately three new cases in men for every two new cases in women. The increase in the number of new cases found in 1950 may be partly accounted for by the fact that the Mass Radiography Unit visited Croydon during 1950, and the fuller use the General Medical Practitioners have been making of the facilities at the Chest Clinic, in conjunction with a more thorough follow-up of 26 contacts. The increase in new cases is therefore partly due to the better ascertainment, as the notifications of Tuberculosis in 1950 for the rest of the country have fallen. This increase should mean a higher proportion of early cases and, therefore, better prospects of cure; and, in fact, 63.8 per cent. were classified as early cases. The rather remarkable fall in the deaths from Pulmonary Tuberculosis during 1950 is undoubtedly connected with the marked strides that have been made in the treatment of the disease in recent years, the efforts of the Croydon Corporation to re-house the infectious cases and the increase in the number of beds in the Borough made available for the treatment of Tuberculosis. During the year two wards in Waddon Hospital have been opened. Deaths from Non-Respiratory Tuberculosis. During 1950, seven deaths were certified to be due to NonRespiratory Tuberculosis, compared with five in 1949 and eight in .1948. All the patients died in Institutions. Two of them were not notified during life. The deaths were due to:— Males. Females. Total. Tuberculous Meningitis 1 2 3 Renal Tuberculosis 2 1 3 Tuberculous Peritonitis — 1 1 Totals 4 3 7 Co-ordination with Medical Practitioners and the Health Department. During the year 124 children were referred by the School Medical Service, and 42 cases from the Maternity and Child Welfare section of the Public Health Department. 92 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 9fi per cent. in 1949 and 88 per cent. in 1948, 26 Extra Nourishment. Provision of special nourishment in the form of milk was granted to 12 selected cases for varying periods during the year, and 3 cases were in receipt of extra nourishment at the end of ihe year. Residential Treatment. 270 males, 162 females and 33 children were admitted to Residential Institutions during 1950. At the end of the year there were 52 beds occupied in the Cheam Sanatorium, North Cheam, compared with 65 at the end of 1949 and the normal 94 beds pre-war. The Regional Hospital Board has taken over a further number of beds in the Sanatorium for the use of patients from other areas. The Chest Clinic and Home Visiting. 1,492 new cases were examined during the year. 241 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 12,152. There were also 4,932 attendances by patients for collapse therapy. The Clinic doctors paid 384 home visits and the Tuberculosis Visitors 2,734 visits for Clinic purposes. In addition, the Tuberculosis Visitors made 331 primary visits for Ihe purposes of the Notification 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 561 contacts were 27 examined. Of these, 12 were considered to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 21.4 compared with 1.47 per 1,000 of the general population. The Clinic Register of Cases. The number of cases of Tuberculosis under the supervision of the Clinic al the end of the year was 1,590. This is equivalent to 6.3 persons per 1,000 of the population. During the year 63 Clinic cases died. Of this number six or 9.5 per cent. were seen for the first time in 1950. The following table gives a summary of the work done in connection with the Clinic:— No. of persons on Clinic Register, January 1st, 1950 1,998 ,, cases sent for an opinion 1,411 first attendances, including 81 inward transfers 2,053 ,, visits paid by Clinic doctors to homes of patients 384 ,, visits paid by Clinic doctors to local Hospitals 260 ,, patients examined by Clinic doctors in local Hospitals 1.292 ,, visits paid to homes of patients by Tuberculosis Visitors 3,065 Attendances of patients at the Clinic— Men 4,607 Women 4,204 Children 3,341 Total 12,152 No. of X-Ray films taken 6.979 Number of persons on the Clinic Register on the 31st December, 1950:— Cases of Tuberculosis 1,590 Cases under observation and not yet diagnosed 209 28 Re-housing of Tuberculosis patients. Fifteen families were re-housed specifically on the grounds of the presence of infective tuberculosis, so that the patient could have a separate bedroom. B.C.G. Vaccination. In July, 1950, (he .Minister of Health gave his approval (o the Council's proposals under Section 28 of the National Health Service Act regarding the arrangements for B.C.G. (Bacillus Calmette Guerin) vaccination. This form of inoculation is the same in principle as, for instance, smallpox vaccination, viz., to produce in the human body an artificially acquired resistance to the disease by injecting its causal organism in a form which does not cause development of the disease itself. B.C.G. vaccine is prepared from a bovine type of the tubercle bacillus that has been rendered so little virulent as to be harmless, but is still effective in helping the body to resist invasion of the active virulent germ of tuberculosis. It is not yet certain that this vaccination gives complete immunity again ^ the disease, but there is no doubt that it reduces the danger of infection. B.C.G. can only be of benefit to those who have not been naturally infected with the tubercle bacillus, i.e., to persons who do not re-act to the strongest tuberculin skin test. Before B.C.G. vaccination is given, therefore, it is necessary for the person to undergo tuberculin tesls, and the results of these tests must be negative if B.C.G. is to be given. Under the arrangements for introducing the use of li.C.(i. in England and Wales, the vaccine is made available to physicians with special knowledge and experience of tuberculosis. Facilities for vaccination are provided for groups of persons at special risk, such as contacts of persons suffering from tuberculosis, and nurses. In the latter part of 1950 a start was made with these two groups, and 23 Contacts and 18 Nurses were successfully vaccinated. The contacts were mostly vaccinated whilst the known patient was away having institutional treatment or were removed from the home to the care of relatives until vaccination was successful. 29 MASS RADIOGRAPHY. I am also indebted to the Medical Director of the Surrey Area of the South-West Metropolitan Regional Hospital Board Mass Radiography Unit for the following particulars of persons examined and of abnormalities found:— No. of Persons examined. ActivePulmonary Tuberculosis. Inactive Pulmonary Tuberculous Non-Tuberculosis Conditions. Croydon district 11,485 43 316 325 Thornton Heath and 3,601 11 139 125 Waddon Factory Groups. OCCUPATIONAL THERAPY. 1950 was the first full year of the Occupational Therapy Scheme for tuberculosis patients, who are at home, but unfit for work. The classes are still held weekly at the Chest Clinic on a Friday afternoon under the supervision of a trained occupational therapist. Although the class attendances are small, the scheme helps a larger number of patients than the weekly register suggests. Many patients are skilled in handicrafts which they have learned in Sanatorium and need very little instruction, and merely attend for advice on minor difficulties they encounter, and to buy materials. There is a nucleus of regular attenders, mostly patients with long-standing disease, who are otherwise housebound, and to whom the opportunity of meeting others on the basis of a common interest, is the weekly highlight of an otherwise very restricted existence. Basket-making, foot-stools, lampshademaking and weaving still remain the favourite crafts. There is the constant problem of disposing of the goods over and above those which the patient makes for his own or his friends' use. In this direction, the biggest development has been through the Ministry of Pensions Home Industries' Scheme. The Ministry, in conjunction with the W.Y.S., will undertake to collect the work of ex-Service pensioners and exhibit it in workshops for the disabled, exhibitions and W.Y.S. shops who undertake to sell the goods and to obtain orders. This is a great encouragement to the patients, and also brings them in a little pocket-money, which is all ihe more acceptable for having been earned by their own efforts. 30 Financially, the scheme is sound, as the plan of allowing patients to pay regular small sums for their materials and completing payment before the next article is commenced, works very smoothly on the whole. In all, payments of £41 18s. Od. were received during the year. TUBERCULOSIS AFTER-CARE FOR 1950, Report of After-Care Almoner (Miss Bridger). Arrangements were basically the same as in 1949, statutory and voluntary services working in conjunction with each other. Special grants continued to be paid through the National Assistance Board to patients who had lost income in order to undergo treatment for pulmonary tuberculosis. On December 31st, 1949, there were 133 patients in receipt of these grants which are arranged through co-operation between myself and the N.A.B. During 1950, 181 new cases were referred and 128 cases ceased to need assistance, leaving a total of 186 receiving the allowances at December 31st, 1950. Of the cases ceasing to receive these grants, 12 died, 50 returned to work, 42 were no longer in need of assistance on admission to hospital, and 24 were either awarded pensions or left the district. In addition to these regular weekly allowances, special grants to cover unforeseen needs were obtained in 78 cases. These were mainly to enable relatives to visit patients in distant sanatoria, to help patients and their families with clothing or with removal expenses when they were re-housed. In addition, towards the end of the year the new system of referring patients to the N.A.B. for authority to pav fares for their admission to hospital from their homes came into force, and has meant additional contact with the Board. Assistance in kind continued to be given bv the After-Care Committee in the form of the loan of beds and bedding to 23 patients. This is particularly valuable in so far as it enables the patient to begin treatment immediately with a measure of isolation, and minimises the risk of infection on his return from Sanatorium. Free milk has also been supplied through the Council's Scheme to those patients whose incomes fall below a certain level. Voluntary agencies have continued their much valued co-operation in supplementing statutory relief. Over £100 was raised from voluntary sources, such as ex-Service funds, British 31 Red Cross, trade and professional organisations and local charities, by appealing on individual cases. This money covered extra comforts for the patient, wireless licences, holidays for the family or help with furnishing the home after rehousing. The B.R.C.S. continue to help with food parcels for some 30 home-bound patients each month whenever supplies permit, hut I am told that these parcels are now in short supply. The Emergency Help Scheme of the B.R.C.S. also sent parcels of invalid foods to bed-ridden ex-Service pensioners. For the married women patients, their chief worry is the care of their children whilst they undergo a prolonged spell of treatment. In 49 cases home help was arranged to enable the mother of a family to have bed rest at home. Where children could not he cared for by relatives, arrangements have had to be made with the Children's Officer for them to be boarded-out with foster parents or admitted to Residential Nurseries. In all, 23 children have been accommodated. From the male patient's point of view, his biggest problem on his discharge from Sanatorium is often the difficulty of finding suitable employment. With co-operation from a man's employers it is often possible to secure sufficient adjustment in hours or working conditions to enable him to resume his former occupation. Where this is not possible, the Ministry of Labour gives help and advice under the Disabled Persons Act. 68 people were registered as disabled and for 31 of these, training in a different occupation was arranged. There are now three men working at the Bermondsey Remploy Factory for tuberculous patients and five at the Waddon Remploy Factory. These men are severely handicapped and unfit to work under normal industrial conditions. Arising out of these activities, 453 home visits were paid. 32 VENEREAL DISEASES. Return relating to all persons who were treated at the Treatment Centre at Special Clinic, General Hospital, Croydon, during the year ended the 31st December, 1950. Syphilis Gonorrhoea Other Conditions Totals M F M F M F M F Ttls. 1. Number of patients on 1st January under treatment or observation 52 87 5 3 18 34 75 124 199 2. Number of patients removed from the register during any previous year which returned during the year under report for treatment or observation of the same infection 3 4 11 16 14 20 34 3. Number of patients deal twith for the first time during the year under report (exclusive of those under Item 4) suffering from:— (a) Syphilis, primary 4 - - - - - 4 - 4 (b) „ secondary 3 2 — — — — 3 2 5 (c) ,, latent in 1st year of infection 3 12 — — — — 3 12 15 (d) ,, cardio-vascular 3 8 — — — — 3 8 11 (e) ,, of the nervous system 7 1 — — — — 7 1 8 (f) ,, all other late or latent stages 9 7 — — — — 9 7 16 (g) ,, congenital (under 1 year) - - - - - - - - - (h) ,, ,, (over 1 year) 1 10 — — — — 1 10 11 (i) Gonorrhoea — — 53 14 — — 53 14 61 Other conditions (J) Chancroid — — — — — — — - — (k) Lymphogranuloma inguinale - - - - - - - - - (l) Granuloma venereum - - - - - - - - - (m) Any other conditions requiring treatment - - - - 102 54 102 54 156 (n) Conditions not requiring treatment ... — — — — 202 480 202 480 682 (o) Conditions remaining undiagnosed at 31st December - - - - - - - - - 4. Number of patients dealt with for the first time who have been transferred from other Centres (civil or Service) or from practitioners approved under Ministry of Health Circular 2226 2 1 3 2 1 7 2 9 Totals of Items 1, 2, 3 and 4 87 132 61 17 335 585 483 734 1217 5. Number of patients suffering from syphilis and gonorrhoea discharged after completion of treatment and the final tests of cure, or who were diagnosed as "other conditions " 27 41 54 16 312 535 393 592 985 6. Number of patients suffering from:— (a) Syphilis who defaulted after completion of treatment, but before final discharge 1 - - - - - 1 - 1 (b) Gonorrhoea who degaulted before 3 months - - - - - - - - - (c) Gonorrhoea who degaulted after 3 months - - 2 - - - 2 - 2 7. Number of patients who ceased to attend before completion of treatment and were suffering from (a) Acquired syphilis of less than 1 year's duration - - - - - - - - - (b) Acquired syphilis of more than 1 year's duration - - - - - - - (c) Congenital syphilis (under 1 year) - - - - - - - - — (d) ,, ,, (over 1 year) - - - - - - - - — (e) Gonorrhoea — — — — — — — — — 8. Number of patients under treatment or observation known to have died:— (a) From syphilis — — — — — — — — — (ft) From treatment — — — — — — — — — (c) From other causes 3 — — — — — 3 — 3 Totals of Items 5, 6, 7 and 8 31 41 56 16 312 535 399 592 991 33 Syphilis Gonorrhoea Other Conditions Totals M F M F M F M F Ttts. Totals of Items 5, 6, 7 and 8 (brought forward) 31 41 56 16 312 535 399 592 991 9. Number of patients transferred to other Centres or Institutions or to private practitioners 7 7 4 1 5 4 16 12 28 10. Number of patients remaining under treatment or observation on 31st December 49 84 1 — 18 46 68 130 198 Totals of Items 5, 6, 7, 8, 9 and 10 87 132 61 17 335 585 483 734 1217 (These totals should agree with those of Items 1, 2, 3 and 4) 11. Number of patients included in Item 7 who failed to complete one course of treatment of either penicillin or of arsenic and bismuth and were suffering from:— (a) Acquired syphilis of less than 1 year's duration - - - - - - - - - (/>) Acquired syphilis of more than 1 year's duration - - - - - - - - - (c) Congenital syphilis of less than 1 year's duration - - - - - - — - - (d) Congenital syphilis of more than 1 year's duration - - - - - - - - - 12. Number of attendances (a) for individual attention by the medical officers 3754 4504 614 226 2783 2978 7151 7708 14859 (6) for intermediate treatment, e.g., dressings, etc. 846 1219 — 4 162 1565 1008 2788 3796 Total Attendances 4600 5723 614 230 2945 4543 8159 10496 18655 Under 1 year 1 and under 5 years 5 and under 15 years 15 years and over Totals M F M F M F M F 13. Number of patients suffering from congenital syphilis in Item 3 above classified according to age - - - 1 1 1 - 8 1 10 Microscopical Serum Others 14. Pathological Work:— for Syphilis for G'n'rh. Cultural for Syphilis Wr. & G Kahn for G'n'rh. Cerebro. Spinal Fluid (a) Number of specimes xamined at, and by the medical officer of, the Treatment Centre 4 1160 1006 1596 401 58 - (b) Number of specimens from patients at the Treatment Centre sent to a pathological laboratory - - - 8 - - - Syphilis (less than 1 year) Syphilis (more than 1 year) Gonorrhoea Other Conditions M F M F M F M F 15. Contacts attending for examination through the agency of :— (a) Patients 5 5 7 4 8 4 52 41 (b) Health Visitor or Social Service Worker 3 5 11 9 4 6 38 78 Totals 8 10 18 13 12 10 90 119 31 STATEMENT SHOWING THE SERVICES RENDERED AT THE TREATMENT CENTRE DURING THE YEAR, CLASSIFIED ACCORDING TO THE AREAS IN WHICH THE PATIENTS RESIDED. Name of County or County Borough (or Country in the case of persons residing elsewhere than in England and Wales) to be inserted in these headings Croydon Surrey Kent London Total Number of cases from each area included under the following headings in Item 3 :—• Syphilis 50 12 3 5 70 Gonorrhoea 45 17 2 3 67 Other Conditions 662 113 37 26 838 Totals 757 142 42 34 975 35 WATER. I am indebted to the Water Engineer, W. C. Knill, Esq., 13.Sc., M.I.C.E., M.I.MechE., M.I.W.E., for the following data:— "The Water supply is drawn from deep wells in the chalk. These wells are situated at 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. The amount of water consumed during the year was— Corporation's Wells 2,061,221,000 M.W.B. Bulk Supplies 889,306,000 2,950,527,000 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. 199 raw water samples and 828 treated water samples were thus examined bacteriologicallv during the year by the Chemist and Bacteriologist on the staff of the Water Undertaking. In addition 17 samples of raw water and 55 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 die Public Health Laboratory Service. The results of the bacteriological examination of the raw waters were tvpical of waters pumped from the chalk, some of diem showing the normal deterioration in quality which occurs after heavy rain. In all cases the examinations showed that the raw water was suitable for treatment. 36 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 52 of raw waters and 118 of treated waters going into supply. The results of the chemical analyses were uniformly satisfactory. The waters are not liable to have plumbo-solvent action. The whole of the population and dwelling-houses within the area of supply are supplied from public water mains direct to the houses." Testing of Samples by the Health Department. The Corporation resolved that routine testing of consumers' water samples by the Health Department should concentrate more on bacteriological than chemical analysis. Accordingly, from the commencement of the year at least five samples each week have been submitted to the area Public Health Laboratory at Park Hospital, Lewisham, for bacteriological examination. The premises from which the samples are taken are selected to cover each week the different sources of supply of the several areas of the borough. In addition, a monthly chemical analysis is carried out by the Public Analyst, who is furnished with copies of the reports of the bacteriologist. During the year under review the total numbers of examinations thus performed were: Bacteriological 322 Chemical 18 As far as the Croydon derived water was concerned the results were consistently of the highest standard, but during the latter half of the year some anomalous reports were received regarding the water supplied by the Metropolitan Water Board. Although these did not suggest that the M.W.B. water was cither than pure and wholesome, and entirely fit for public and domestic usage, the deviations from normal were considered sufficient to 37 warrant raising the matter with the Water Engineer and the Board's officers. A meeting of all concerned arranged for a standard method of bacteriological technique and simultaneous sampling. From the latest reports of the Public Analyst, it would appear that some variation in the method of treatment of these bulk water supplies was also introduced by the Board after this meeting, subsequent to which, the reports received reverted to the usual "Class I," "Highly Satisfactory" standard. 38 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.AIun.E., M.I.W.E.. for the following information:— Refuse Collection and Disposal. 56,710 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 at Mitcham Common and a further 16 acres of boggy water-logged common have been raised about six feet, covered with soil of which five acres have been grassed down for use as playing fields. Work has commenced on an additional 23 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 four outside authorities, viz., Coulsdon and Purley U.D.C., Caterham and Warlingham U.D.C., Banstead U.D.C., and Carshalton U.D.C. The sewage flow from an estimated population of 333,000 is treated at the Beddington Works, the dry weather flow being about 10J 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. 39 ANTE-NATAL AND POST-NATAL CLINICS. Administrative arrangements under the National Health Servic Act are complex because there is a variety of interests involved. The essential requirements are that an expectant mother shall receive her ante-natal care from those who will be responsible for the confinement and shall have freely available to her all the obstetric facilities she may require. Some of the steps taken in Croydon to achieve this objective, include a Group Maternity Advisory Committee to discuss technicalities of major questions of policy in regard to obstetrics, and the Consultant Obstetrician to Mayday and St. Mary's Hospital acting as the clinical adviser on obstetrics to the Local Health Authority and being a member of the appropriate Corporation Committee. Ante-natal and post-natal clinics for hospital-booked cases are staffed by hospital doctors and midwives and those for domiciliary confinements by the domiciliary midwives. Almoner and clerical staffs are common to both clinics and the same form of case records are kept. These are immediately available for the hospital obstetricians should a mother, not previously known to them, be admitted as an emergency case. Every mother has a blood test for blood group, Rh. factor, W.R. and Kahn tests and is offered instruction in relaxation exercises, mothercraft and ante-natal demonstration of the gas/air apparatus. When mothers booked for home confinement prefer to attend their own doctor, contact is maintained with the midwife by a record card exchanged between her and the doctor or by attendance of the midwife at the doctor's surgery. Nine general practitioner obstetricians held regular ante-natal sessions at their surgeries at which the domiciliary midwives attended. A mother receiving ante-natal care from her own doctor is welcomed at the Ante-Natal Clinics for any of the ancillary services for which her doctor may refer her. A mobile Obstetric Emergency Unit, staffed from the Maternity Hospital, is available at all times and if a midwife cannot readily obtain the services of a doctor, she may summon the Unit direct. General practitioners who applied for admission to the list of general practitioner obstetricians and who have insufficient post-graduate experience are offered training facilities in local ante-natal clinics and hospital maternity units. During the year 4,420 cases were seen at the Ante-Natal Clinics, of which 3,569 were new cases. A total of 28,221 attendances was recorded, and 1,676 cases were seen at the Post-Natal Clinics (1,589 new cases) and 1,785 attendances recorded. 40 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 1950 who were born— (i) at home 64 (ii) in hospital or nursing home 145 (2) The number of those born at home— who were nursed entirely at home 62 who died during the first 24 hours 2 who survived at the end of one month 59 (3) The number of those born in private nursing homes— who died during the first 24 hours who survived at the end of one month 10 41 42 ATTENDANCES AT INFANT CENTRES— 1950 Bensham Manor, Monday, a.m. Bensham Manor, Monday, p.m. Boston Road, Thursday Brighton Road, Wednesday East Croydon Tuesday East Croydon, Friday Monks Hill, Tuesday Municipal Monday Municipal, Thursday, a.m. Municipal, Thursday, jp.m. New Addington, Wednesday Norbury, Wednesday, a m. Norbury, Wednesday, p.m. St. Albans, Wednesday St. Albans, Friday St. Andrews, Monday St. Judes Hall, Tuesday, a.m. St. Judes Hall, Tuesday, p.m. St. Oswald, Thursday, a.m. St. Oswalds, Thursday, p.m. Holy Trinity, Selhurst, Wednesday Shirley, Thursday South Croydon, Thursday South Norwood, Tuesday, South Norwood, Friday Upper Norwood, Monday Waddon, Wednesday West Croydon, j Friday Lecture Hall, West Wickham, Monday Woodside, Friday, a.m. Woodside, Friday, p.m. Total, 1950 Total, 1949 New cases under 1 year 48 110 99 13 128 132 52 130 66 134 168 80 125 111 67 134 44 119 47 101 86 99 148 122 159 178 74 71 62 70 121 3098 3397 No. of Re-attendances 1068 2114 1462 100 2146 1657 596 1864 1379 1825 1791 1449 1958 2071 1551 2085 1185 2291 1177 1254 972 1227 2218 1980 1941 2065 950 1077 702 1238 1599 46992 50328 New cases over 1 year 10 25 34 - 21 19 35 16 10 29 95 11 26 30 21 21 6 2 2 8 16 30 25 26 18 57 25 20 26 19 31 714 870 No. of Re-attendances 982 1336 1260 97 1181 1160 329 888 510 712 1097 1133 1453 1239 983 814 487 1415 718 1483 942 807 1414 1018 812 1582 939 1065 528 717 1020 30121 30996 Attendances of Children 0-5 2108 3585 2855 210 3476 2968 1012 2898 1965 2700 3151 2673 3562 3451 2622 3054 1722 3827 1944 2846 2016 2163 3805 3146 2930 3882 1988 2233 1318 2044 2771 80925 85591 Consultations with Doctor ... 739 1012 925 59 816 681 500 997 532 735 1100 752 879 980 814 907 563 846 599 661 754 625 969 805 838 855 788 882 583 547 815 23558 25602 No. of Sessions 48 48 48 8 48 48 48 48 48 48 47 48 48 48 48 48 40 48 48 48 49 48 48 48 48 48 48 48 48 48 48 1440 1381 Expectant Mothers : No. of new cases - - - - 2 - - - - - - - - - - - 2 1 - - - - - - - 1 11 - - - - 17 29 No. of Re-attendances - - - - - - - - - - - - - - - - - - - - - - - - - - 56 17 - - - 85 143 Total attendances of Expectant Mothers - - - - 2 - - - - - - - - - - - 2 1 - - 12 - - - - 1 67 17 - - - 102 172 Total attendances 2108 3585 2855 210 3478 2968 1012 2898 1965 2700 3151 2673 3562 3451 2622 3054 1724 3828 1944 2846 2028 2163 3805 3146 2930 3883 2055 2250 1318 2044 2771 81027 85763 Average for Session, 1950 43.9 74.7 57.4 26.3 72.5 61.8 21.1 60.4 40.9 56.3 67.0 55.7 74.2 71.9 54.6 63.6 43.1 79.8 40.5 59.3 41.4 45.1 79.3 65.5 61.0 80.9 42.8 46.9 27.5 42.6 57.7 56.3 - Average for Session, 1949 54.3 68.8 72.2 - 78.9 70.7 24.7 65.4 36.6 62.5 59.4 55.5 75.2 76.9 53.2 62.5 - 93.6 51.2 70.0 47.1 50.7 92.3 ' 66.1 67.7 77.9 50.7 57.4 25.3 56.4 74.5 - 62.1 DAY NURSERIES. Attendances at Day Nurseries, 1950. 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 89 46 39 45 16 46 44 45 54 Attendances : under 2 4448 3669 3551 3713 2157 3362 1701 2678 1962 over 2 13913 6376 5714 8155 6601 6598 9267 7918 8449 Total 18361 10045 9265 11868 8758 9960 10968 10596 10411 Number of days opened 282 280 280 268 234 270 282 282 266 Average daily attendance (excluding Saturdays) 71 39 36 47 34 39 43 41 41 * Closed 31st December, 1950. 44 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 99 cases were dealt with by the Social Worker. 31 cases were admitted to hostels. 64 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 those undergoing their confinements in their homes, reference is made through the Municipal Midwives' Service or by the practitioner in charge of the patient. During recent years facilities for the above treatment have 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 attention can be received. 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 further 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 45 themselves and partly owing to the fact that since the inauguration of the National Health Service alternative 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 conditions have steadily improved during the post-war period, and the demand for treatment shows a welcome 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. As previously stated the majority of private dentists are already fully occupied 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 424 compared with 735 in 1949. Of these 84.7 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 firstrate importance. Nursing Mothers. The number of nursing mothers referred during the year declined still more and only 17 new cases were examined, compared with 29 last year. The above returns are in striking contrast with those of pre-war years when treatment carried out for this class of patient assumed considerable proportions. 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. Most nursing mothers attending the dental clinics are now 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, 46 Treatment. Including those continuing treatment from the previous year, 476 mothers were dealt with, compared with 837 in 1949. Except for the fact that the volume of work decreased, attendances were satisfactory, and in the majority of patients there appeared to be 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 alreadv opted to receive attention through the General Practitioner Service and have thus not come the way of the clinic. It is disappointing to note that of the total of 570 mothers referred from medical departments, approximately 37.5 per cent, still failed to attend for their dental inspection after signifying a desire for treatment. This figure is approximately the same as that of the previous year. Attempts at "following up" such patients give little result. The Pre-School Child. The total number of children referred from Welfare Centres, Day Nurseries and other sources was 641, compared with 687 last year. Despite a slight reduction in the number actually referred the interest shown in this branch of the service is verv 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. As stated in last year's Report on this subject access to the "four-year-old" class is by no means easy, as these children are no longer regular attenders at Infant Centres. 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 threeand-a-half years receive at least one yearly dental inspection until such time as they enter on their school careers. Though at this 47 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. 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. Treatment. The following summary shows particulars of the workaccomplished : — Expectant Mothers. Nursing Mothers. Total. Young Children. New Cases Examined 424 17 441 538 Re-treated 32 3 35 103 Total 456 20 476 641 Expectant and Nursing Young Mothers Children Attendances 1127 1012 Fillings 290 264 Extractions 640 628 Gas Cases 90 207 Local Anaesthesia 253 53 Scaling and Gum Treatment 177 5 Dressings 250 564 Denture Dressings 316 Silver Nitrate 26 Treatments Completed 268 436 Number of Sessions (treatment) 213 Dentures Fitted 60 Dentures Repaired 10 48 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 301 - Bensham Manor - 25 Municipal Midwives 259 - St. Andrew's - 20 Welfare Centres: Waddon 1 19 Municipal 2 9 Shirley - 10 East Croydon 2 8 Boston Road - 5 Upper Norwood 1 5 Norbury - 13 West Croydon - 18 Holy Trinity 3 13 South Norwood 1 7 Addington - 13 South Croydon - 19 Sussex Rd., West St. Alban's - 11 Wickham - 7 Woodside - 17 Day Nurseries - 93 St. Oswald's - 17 Referred by Dental St. Jude's - 5 Officers - 305 Monks Hill Estate - 2 Mothers: 570. Young Children : 641. Total: 1,211 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 476 471 471 268 Children under Five 641 634 634 436 (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 640 253 90 290 177 - 250 5 20 40 Children under Five 628 53 207 264 5 590 - - - - 48A The Work of the Health Visitors.—Maternity and Child Welfare Visits Only. Visits Re Ashe Baker Beaumont E. M. Biggs Comm. 10/7/50 H. L. Biggs Bird Blest Devaney Early Eldridge Comm. 2/1/50 Elliott Griggs Hall Hillyard Hinton Johns Lucey Mayo Left 31/1/50 Morgenthal Left 31/1/50 Munroe Partridge Stanton Transferred June, 1950 Teasdale Comm. 23/1/50 Theison Comm. 8/5/50 Thompson Comm. 15/5/50 Thomas Left 28/2/50 Toneri Vince Comm. 15/8/50 Walker Left 31/7/50 Warman Webb Weller Comm. 2/1/50 Western Wilson Wybrew Total, 1950 Total, 1949] Infants under 1 year- First Visits 132 125 118 57 148 120 148 172 59 118 154 103 163 47 176 50 178 12 - 124 136 75 148 114 57 18 193 22 107 137 146 130 142 136 123 3888 4575 Re-visits 434 480 753 324 877 655 497 900 702 657 599 653 833 271 1620 141 863 85 51 602 350 185 606 347 305 98 599 176 302 432 828 372 471 965 574 18607 18582 Children 1—2 years- First Visits 4 6 - 1 6 7 6 115 2 5 2 - - 2 6 - 2 1 - 14 23 1 11 - 2 4 2 2 2 - 2 6 4 7 245 325 Re-visits 237 242 566 215 540 467 362 779 525 370 240 328 694 247 866 78 663 63 26 355 265 117 443 200 308 132 576 141 339 191 646 119 396 592 303 12631 11738 Children 2—5 years— First Visits - 12 - 6 5 4 14 108 1 2 8 - - - - - - - - 25 19 7 6 3 - 10 6 12 33 11 5 3 3 3 8 314 342 Re-visits 498 759 815 339 648 382 852 839 732 1108 426 714 1119 205 648 207 924 56 14 525 442 130 734 373 664 192 1038 433 549 573 1422 530 831 953 919 21593 16750 Expectant Mothers— First Visits 61 63 48 8 75 74 46 42 40 34 99 56 83 29 59 17 63 3 4 76 55 39 49 31 40 9 83 16 46 78 69 80 58 59 27 1719 2527 Re-visits 8 3 8 1 - - - - 30 8 7 8 17 6 - - - 6 - - 8 - - - 23 1 - 1 2 - 2 7 10 2 3 161 145 Still Births 2 - - - - - - - - - - - - - - - - - - 2 1 1 1 - - 1 1 - - - - - - 1 - 13 18 Deaths under 1 year 2 1 - - 3 - 1 - - - - - - - - - - - - - 1 3 2 2 1 1 1 - 1 3 3 4 1 2 - 32 73 Miscellaneous Visits 3 38 1 17 3 2 7 51 4 102 8 47 4 11 3 11 - - 3 - 8 26 1 4 43 11 12 - 13 8 21 72 27 31 26 618 586 Ineffective Visits 250 409 577 441 743 494 423 547 396 486 283 276 582 196 287 120 418 22 21 550 200 172 634 323 863 81 493 161 269 528 861 353 956 402 451 14268 13286 Totals : 1950 1631 2138 2886 1409 3050 2205 2356 3553 2491 2890 1826 2185 3495 1015 3665 624 3111 248 119 2273 1508 756 2635 1397 2304 556 3006 964 1663 1963 4003 1672 2901 3150 2441 74089 _ 1949 1370 2040 980 - 3086 1989 2465 3253 2495 - 1398 1850 3743 2857 3293 626 3283 1917 2405 2236 1425 2326 - - - 1965 2545 - 2921 2267 3664 - 1752 977 1914 - *68947 *Including Health Visitors who left during 1949 49 MIDWIFERY SERVICE. This has continued without any major changes, but efforts to promote co-ordination with the general practitioner obstetricians have continued, as detailed elsewhere. The Superintendent Midwife has performed the supervisory duties formerly carried out by the Medical Supervisor of Midwives, who now visits private midwives only. Midwives Acts, 1902 to 1936. The number of midwives who notified the Local Supervising Authority of their intention to practice within the Borough during 1950 and who were practising at the end of the year, was 76, including those who intended practising as maternity nurses. All these were trained and held the certificate of the Central Midwives Board. The Rules of the Central Midwives Board lay down that the Local Supervising Authority must be informed within 36 hours by a midwife if she has summoned medical help during pregnancy, in a confinement or within 14 days afterwards. The following table gives details of the reasons tor sending for medical aid : For Complications during Pregnancy. Abortion 11 Other causes 10 21 For Complications during labour Breech 2 Premature Labour 3 Foetal Distress 3 Malpresentation 4 12 Delayed Labour Uterine Inertia 4 Prolonged and obstructed 24 28 Hœmorrhage. Ante-partum 11 Post-partum 13 24 Other Causes Adherent and Retained Torn Perineum 83 Placenta 6 89 For Complications during Puerperium. Pyrexia 12 Pain in Breasts 8 Pain in Legs 12 Other causes 13 45 For Complications in regard to the Baby. Inflammation of Eyes 28 Still Birth 1 Feebleness 1 Other causes 21 Premature Birth 4 55 274 60 In accordance with Rule 33 of the Central Midwives Board, the following reasons for the discontinuance of breast-feeding were received : — Illness of Mother 19 Defects of lactation 188 Other Causes 21 Total 228 Addington = 1146 Month Mileage Deliveries Midwifery Maternity Bookings AnteNatal Visits PostNatal Visits Gas and Air Office Booking Home Visits Normal Abnormal Normal Abnormal Midwives Pupils Midwives Pupils Jan 2735 106 64 1 40 1 161 495 171 1478 710 84 139 - Feb 2205 86 52 2 31 1 130 418 152 1152 614 76 117 - March 2801 122 69 2 51 - 142 500 202 1590 892 108 130 - April 2557 117 68 - 48 1 83 455 179 1483 850 100 93 - May 2504 113 64 1 45 3 129 469 188 1540 763 91 93 - June 2571 96 67 1 26 2 125 486 205 1269 726 79 111 - July 2928 107 56 2 48 1 99 514 191 1435 673 84 97 - August 2137 93 48 3 37 5 138 562 169 1394 702 87 141 - Sept 2292 94 52 1 40 1 165 509 255 1230 750 79 118 - Oct 2521 88 48 3 35 2 146 558 227 1288 758 79 134 - Nov 2295 94 50 1 42 1 142 546 201 1238 654 83 150 - Dec 2149 95 47 2 42 4 78 392 144 1146 734 82 64 41 Total 29695 1211 685 19 485 22 1538 8188 25069 1032 1387 41 WORK OF MUNICIPAL MIDWIVES. Number of Stillbirths 9 Number of Premature births 17 Ante-Natal Clinic Attendances (Lodge Road)— January 593 May 516 September 488 February 522 June 493 October 498 March 609 July 367 November 468 April 469 August 494 December 445 5962 50 SUPPLY OF MATERNITY OUTFITS. Cases dealt with by the Midwifery Service were suppled with Maternity Outfits and a few sets were issued to cases under the care of independent midwives, giving a total of 1,266 issued during the year. 52 AMBULANCE SERVICE. To the Medical Officer of Health. I beg to submit the Ninth Annual Report and Statistics of this Service for the year ended 31st December, 1950. During the year the Service dealt with 45,533 calls' (an increase of 10,607 on the previous year) and were responsible for the conveyance of 88,559 patients. Calls were dealt with as follows : — Headquarters Station, Stroud Green, Croydon 34,333 No. 2 Station, Cassland Road, Thornton Heath 5,213 No. 3 Station, Crunden Road, South Croydon... 5,087 Waddon Hospital 900 Total mileage covered by all vehicles 355,021 Classification of Calls. Street Accidents 794 Works Accidents 284 Home Accidents 508 School Accidents 101 Sport Accidents 99 Miscellaneous Accidents 153 Street Illness 484 Home Illness 160 Works Illness 73 Common Assault 25 Suicide 14 Attempted Suicide 28 Health Service Removals 41,706 Services refused or ambulance not required 204 44,633 Calls Conveyed by Waddon Hospital Ambulance 900 45,533 53 Analysis of Accidents, etc., for the year ended 31st December, 1950. 1950. 1949. Collisions between vehicles, cycles, etc.181 130 PEDESTRIANS KNOCKED DOWN BY— (1) Motor Cycles37 29 (2) Lorries 23 21 (3) Motor Cars 84 92 (4) Pedal Cycles 42 36 (5) Public Service Vehicles 15 31 (6) Horse and Cart 3 - (7) Tradesman's Barrow 1 -[ (8) Auto-cycle 1 - 206 209 INJURIES SUSTAINED BY FALLING— (1) In the Street 99 107 (2) In the Home 195 126 (3) From vehicles, cycles, etc.157 180 (4) Down Stairs 49 50 500 463 WORKS ACCIDENTS— (1) Lifting 4 - (2) Caught in Machinery 38 18 (3) Crushed by Heavy Objects 55 21 (4) Falling 73 69 (5) Knocked Down by Vehicles 10 2 (6) Burns and Scalds 10 15 (7) Falling from Height 47 25 (8) Miscellaneous Accidents 47 88 284 238 ACCIDENTS IN PUBLIC PLACES— (1) Theatres, Cinemas and Public Halls 30 23 (2) Swimming Pools 22 - (3) Fairs 3 - (4) Railway Stations 44 16 (5) Sports Grounds -12 (6) Recreation Grounds 50 56 (7) Public Houses 32 4 (8) Shops 88 30 269 141 MISCELLANEOUS ACCIDENTS (Unclassifiable) ... 153 374 DEATHS— (1) Certified at Hospital 40 51 (2) Certified at Scene of Accidents or Illness 19 7 59 58 54 1950. 1949. SUICIDES— (1) Lying in Front of Train 1 - (2) Hanging 1 2 (3) Poison 1- (4) Coal Gas Poisoning 11 11 (5) Suffocation - 1 14 14 ATTEMPTED SUICIDE— (1) Poison 16 10 (2) Cut Throat - 4 (3) Coal Gas Poisoning 11 12 (4) Severed Arteries 1 - 28 26 BURNS AND SCALDS 40 50 PERSONS FALLING FROM PUBLIC SERVICE VEHICLES 48 46 EPILEPTIC FITS 112 91 ACCIDENTS TO CHILDREN UNDER 15 YEARS OF AGE— (1) Down Stairs 4 - (2) In Schools 99 105 (3) In the Home 206 143 (4) In the Street 209 203 (5) Sports 36 - (6) Miscellaneous 79 111 633 562 INCIDENCE OF CALLS. 2 days 31 calls 2 days 71 calls 3 days 116 calls 4 days 142 calls 1 „ 32 „ 1 „ 72 „ 4 „ 117„ 5 „ 143 „ 2 33 „ 1 „ 73 „ 5 ,, 118 „ 7 „ 144„ 1 ,, 38 „ 1 „ 75 „ 3 „ 119 „ 7 „ 145„ 1 ,, 40 „ 1 „ 76 „ 4 „ 120 „ 4 „ 146 „ 1 ,, 42„ 1 „ 77 „ 4 „ 121 „ 5 „ 147 „ 1 „ 44 „ 1 „78 „ 6 „ 122 „ 6 „ 148 „ 1 „ 49 „ 1 „ 85 ,, 9 ,, 123 „ 5 „ 150 „ 1 „ 51 „ 1 „ 94 „ 7 ,, 124 „ 3 ,, 151 „ 1 „ 52 „ 2 ,, 98 ,, 12 „ 125 „ 3 ,, 152 ,, 1 „ 53 „ 1 „ 99 „ 12 „ 126 „ 3 ,, 153 ,, 2 „ 54 „ 1 ,, 100 ,, 6 „ 127 „ 5 „ 154 ,, 1 „ 55 ,, 2 „ 101 „ 10 ,, 128 „ 2 „ 155 „ 1 „ 56 ,, 1 ,, 103 „ 10 „ 129 ,, 6 ,, 156 „ 2 „ 57 ,, 2 „ 104 „ 7 ,, 130 „ 4 ,, 157 „ 2 „ 58 „ 2 „ 105 ,, 12 „ 131 „ 4 „ 158 „ 2 59 „ 2 ,, 106 „ 12 „ 132 „ 3 „ 159 „ 1 60 „ 1 „ 107 „ 5 ,, 133 „ 3 „ 160 ,, 1 61 ,, 3 „ 108 „ 7 „ 134 ,, 5 ,, 161 „ 2 ,, 62 ,, 3 „109 ,, 7 „ 135 ,, 3 „ 162„ 1 „ 63 „ 3 „ 110 „ 6 „ 136 „ 2 „ 163 „ 2 „ 64 ,, 4 „ 111 ,, 4 „ 137 „ 3 „ 164 „ 1 „ 65 „ 1 „ 112 „ 3 „ 138 „ 4 „ 165 „ 1 „ 67 ,, 4 „ 113 „ 8 „ 139 „ 5 „ 166 ,, 2 „ 68 „ 3 ,, 114 „ 11 „ 140 „ 2 „ 70 „ 3 „ 115 „ 3 „ 141 ,, 55 Cases Conveyed by Waddon Hospital Ambulance. Scarlet Fever 462 Measles 44 Poliomyelitis 39 Whooping Cough 55 Mumps 15 Dysentery 17 Enteritis 33 Diphtheria 15 Chicken Pox 24 Typhoid 4 Breast Abscess 1 Rubella 1 Puerperal Pyrexia 28 Erysipelas 10 Cerebro-Spinal Fever 16 Pneumonia 5 Ulcerated Throat 1 Jaundice 5 Encephalitis 1 Bronchitis 1 Impetigo 1 Stomatitis 1 Otitis Media 1 Pyrexia 6 Tonsillitis 1 Septic Throat 1 Quinsy 1 Patients Out of the Borough 53 Service Requirements 97 939 On 61 occasions oxygen and carbon dioxide were administered to patients by means of the "Novox Resuscitating Apparatus." The gas and air sets were used 1,138 times, necessitating 3,882 miles. On 320 occasions calls were received for the Croydon Nursing Service, necessitating 5,106 miles, 56 4,973 miles were travelled, conveying children to and from St. Margaret's School. There were 7,205 calls out of the Borough, necessitating 112,310 miles. A. L. HILL, Chief Officer. 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 259 Air Cushions 295 Bed Rests 140 Bed Cradles 22 Rubber Bed Pans 176 Urinals 111 Mackintosh Sheets 338 Air Beds 16 Water Beds 11 Dunlopillo Mattresses 4 Feeding Cups 16 Kidney Dishes 4 Wheel Chairs 12 Douche Can 1 Sorbo Cushions 4 Sputum Mugs 3 Commodes 5 Bed Tables 7 Crutches pairs 2 Walking Machine 1 Bed with pulley 1 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, 99 cases were dealt with, 70 being adults (male, 26, female, 44) and 29 children. These figures do not include school children for whom arrangements are made by the Education Committee. DOMESTIC HELPS. This service continued in great demand and an analysis of . the work covered shows the following approximate percentages : — Maternity Cases 29.3 Sickness 69.7 Sick Room Helpers 1-0 (1) Number of Home Helps—January 1st and December 31st, 1950: — (a) Full-time 36 (b) Part-time 105 57 (2) Number of applications— (a) Maternity 711 (b) Sickness 1,693 (c) Sick Room Helpers 25 (3) Number of applications met— (a) Maternity 620 (b) Sickness 1,675 (c) Sick Room Helpers 25 (4) Average duration of services given— (a) Maternity 14 days (b) Sickness (acute cases) 10—21 days (5) Amount recovered for services £4,758 0s. Od. (6) Rate of remuneration of "Helps"— (a) Maternity £4 14s. Od. per week (b) Sickness 2s. per hour HEALTH PROPAGANDA. The usual continuous and detailed advice on health matters, which forms part of the daily duty of Doctors, Health Visitors, Midwives, Mental Health Workers and other Officers of the Department and certain general health propaganda features were continued. A well-constructed and attractive display panel continued on loan from 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. These were exhibited together with suitable handbills and pamphlets at selected sites throughout the Borough and was a most effective propaganda medium. 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 Central Office of Information regarding care of children's teeth, care of eyes, etc., at lectures for Parent-Teachers' Associations, 58 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 monthlv meetings. The staff employed on this work comprised :— The Medical Officer of Health—in general administrative control. The Deputy Medical Officer of Health and four Assistant Medical Officers of Health (approved bv 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. The Deputy Medical Officer of Health continues to pay periodic visits to the Mental Hospital accepting the majoritv of Croydon cases. The only duty delegated to a voluntary association was the supervision of 14 mental defectives placed under guardianship in Brighton, bv the Guardianship Society. Work carried out in the Community. Under Section 28, National Health Service Act. Mental Health Education. While the basic causes of mental deficiency remain obscure, no preventive action is possible. The investigations now proceeding on the effects of virus infections during pregnancy may eventually give an indication of one of the factors, but at present this is mere speculation. For mental illnesses which develop later in life, however, there must be preventive measures capable of application in infancy and childhood comparable with those 60 advised for the prevention of physical ailments. Much interest has recently been shown by psychiatrists regarding this aspect of their speciality, but details of practicable measures capable of application bv a local health authority are not easily formulated. It seems reasonable to apply the lesson learned from the problems of general health propaganda, viz., that the family is the biological unit within which the mother is the most potent educative force. It is the clinic medical officers and the health visitors who impart learning to mothers with young children and who have therefore the first opportunity of guiding emotional adjustments between mother and child. Accordingly, the following procedures were carried out during the year under review. A series of lectures for Health Visitors was given bv the Medical Director of the Croydon Child Guidance Council on this subject of the importance of the early years in promoting or preventing normal mental and emotional development, and social adaptation. Special ante- and post-natal efforts were made to encourage breast feeding using the technique suggested by Dr. Waller, and emphasising the psychological as well as physical benefits for the infant. Ante-natal mothercraft lectures also stressed the importance of recognising emotional as well as nutritional needs. Posters and pamphlets at Infant Welfare Centres were made available, dealing with mental development and psychological difficulties of voung children. A second anniversary birthday letter was sent to parents asking them to bring their toddlers to the Infant Welfare Centre specifically to discuss behaviour patterns in the growing child. Whether such measures are likely to be successful is too early to judge, but the response from parents is sufficiently encouraging to warrant continuing on these lines. It is appreciated that such efforts deal with a verv small part of a formidable problem, but it is a facet largely the concern of the local health authority and for which this type of authority is unique in having well-established facilities easily capable of the necessary adaptation. Mental After-Care. On the recommendation of the Medical Staff of Warlingham Park Hospital, the Corporation accept financial responsibility for patients to stay at approved homes conducted by the Mental After-Care Association. 61 Two cases were so dealt with during the year. Under the Lunacy and Mental Treatment Acts. Patients dealt with under the Lunacy and .Mental Treatment Acts during 1950, are as follows:— (a) Certified and admitted to Warlingham Park Hospital 40 (b) Admitted to Warlingham Park Hospital as voluntary patients 49 (c) Removed to Mayday Hospital under Detention Order 260 (d) Admitted to Warlingham Park Hospital as temporary patients 2 (e) Investigated and no action taken 150 (/) Urgency Orders 3 510 Under the Mental Deficiency Act. Number of known Mentally Defective Patients in thr Borough: 1949. 1950. Under 5 years 26 46 Aged 5-16 years 84 94 Over 16 years 549 542 Total 659 682 Compared with 1949 the cases show an increase of 23. Four Institution patients have died in hospital. The cases are distributed as follows:— 1950. In Certified Institutions 299 In Approved Homes 1 On Licence from Institutions 15 Under Statutory supervision at home 210 Under Guardianship 61 In Mental Hospitals 10 Observation cases 80 In "Place of Safety" — 682 62 During the year the Certifying Medical Officers made examinations and paid visits to the number of 130 cases. The Mental Deficiency Visitors paid 3,919 visits. 41 new cases were examined during 1950 and certified as mentally defective. Eight of these cases were recommended for the Occupation Centre. The remainder were placed under statutory supervision. During 1950, 41 cases were dealt with as follows:— 1949. 1950. Sent to Certified Institutions 18 24 Placed under Guardianship 5 2 Sent to Warlingham Park Hospital — — Varying Orders : (a) Change of Guardian 6 2 (b) From one Institution to another — 6 (c) From Guardianship to Institution ... 1 3 (d) Institution to Guardianship — 1 (e) Orders closed 2 3 Twenty-two Orders were renewed during the year, eight of which were Guardianship. Nine children were admitted to the Occupation Centre during 1950. There were 15 cases awaiting vacancies in Institutions on the 31st December, 1950. Guardianship Cases. There were 61 cases under Statutory Guardianships, 38 of these under the care of relatives, and 23 with Guardians who are not relatives. Two males and one female are at work. One of the patients under Guardianship has died. 801 visits have been paid to Guardianship cases during the year. There are 15 cases on licence from Institutions (5 males and 10 females). 63 The following report is made by the Supervisor of the Occupation Centre:— Number on Register, January, 1950 42 ,, ,, December, 1950 40 Sessions open 402 Total attendance for the year 13,208 Average attendance per session 33 In January, 1950, through the courtesy of the Manager of the Grand Theatre, Croydon, 36 children were taken to see the pantomime "Mother Goose." In September an untrained assistant was replaced by a trained Mental Nurse. On November 30th a Sale and Exhibition of Work was held for the benefit of parents and others, the proceeds of the sale amounting to £13. The parents were greatly impressed by the work completed by their children, and numerous orders have been placed by the parents, thus ensuring the full-time occupation of the children for many months. In December the usual Christmas Party was given, and thanks to the generous grant of the Committee, the Christmas Tree laden with presents was again dismantled by Dr. Fleming, who acted as Father Christmas. In spite of the restricted space, the children enjoyed the tea and had a delightful party. Mrs. Cole, the Guide, contributed 18s. towards the party—the money had been given her by neighbours. A wireles set has been installed at the Centre. Instruction at the Centre consists of classes in the following subjects:—Cookery, laundry work, woodwork, stool seating, physical training, handiwork, rug-making, knitting, embroidery, singing, speech training, percussion band, sense and habit training. 64 SANITARY CIRCUMSTANCES. To the Medical Officer of Health. I beg to submit a report for the year ending the 31st December, 1950, of the work of the Sanitary Inspectors and other officers under my supervision. During the year there has been a welcomed reduction in the number of complaints regarding the disrepair of dwelling houses. The controls on building materials have been somewhat relaxed and licensing restrictions have not been so severe, hence there has been a steady increase in the number of houses which have received their final war damage repair. I think it would be true to say that in general the repair condition of dwelling houses in the Borough is reasonably good and it now rests with both landlord and tenant to see that, within their respective spheres, this repair condition is maintained. Prior to the war it was agreed that the areas of the Borough most in need of clearance and redevelopment were those of Leighton Street and Albion Street; and Wilford Road and Forster Road. The Leighton Street redevelopment was commenced before the war and left only partly completed at the outbreak of hostilities'. Work is now rapidly going ahead to complete this scheme and that of Wilford Road and Forster Road will shortly be put in hand. More attention has been given to the inspection of shops, factories, workplaces and offices and it has been possible to have repairs and improvements carried out at these premises on a more ambitious scale than in the other post-war years. The various Government Departments responsible for licensing such works have been ready to co-operate. Food inspection has taken up a considerable amount of the time of the Inspectorate, as a glance at the tables under " Food Supply " will show. The Sanitary Inspectors make routine inspections of premises where food is prepared for sale, stored or sold and during these inspections they examine food regarding its fitness for consumption ; the premises regarding their suitability for such trade and the methods of preparation and handling of the foods to be sold. The proprietor is generally only too ready to call in the Sanitary Inspector to examine food which he considers unfit or " doubtful " and this attitude is encouraged as thereby the chance of unsound food being sold is reduced to a minimum. 65 Sampling of food and drink has been carried out as a routine with a view to detecting adulterations or irregularities. Gradually by the efforts of the food traders themselves and strengthened legislation there has been a definite improvement in the proteciion given to the purchaser. Whilst the existing law has its shortcomings in regard to matters affecting the premises on which food is prepared and handled, its wise use over a number of years has resulted in the establishment of a reasonable standard throughout the Borough. New byelaws will shortly be made which will help in due course to further improve this standard. We can have good premises brought into disrepute and good food made dangerous by bad handling in preparation and service. This bad handling is invariably due to habit or a lack of knowledge on the part of the handler of the dangers that may accrue to those consuming mishandled food. As an experiment, it was arranged for a number of food handlers from the Corporation's communal feeding undertakings to attend a talk and see films all to do with the hygienic handling of food. Following this, a number of the larger food handling firms in the Borough were invited to send members of their staffs to such talks and they responded fairly well. It was evident that this was a useful way of showing the food handler the types of mistake made, how to prevent them and, having regard to the facilities available, the best methods of food production and service. In consequence, all food handling establishments in the Borough were circularised with a view to their staffs attending talks, augmented bv films, with regard to clean food production, and there has been a reasonably good response. Early in the year it was reported by the Inspectors that galvanised containers were being used for the pickling (salting) of meat. In consequence, samples were taken of the brine and the pickled meat from a number of premises, and a rather high absorption of zinc was found in both. It was considered advisable to request that such containers be not used for such purposes. Full co-operation was forthcoming from the trade locally and the findings were given publicity in trade journals. The statistical tables and the comments in the body of the report give some indication of the amount and variety of work which has been done in a loyal and satisfactory manner by those under my control. GEO. GRIEVE, Chief Sanitary Inspector. 66 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) 6,24-2 Number of houses inspected where symotic diseases have occurred 401 House'drains tested 2,500 House drains tested on application 7 Number of smoke tests during repair 255 Inspection of drainage work during repair 4,140 Number i{ water tests during repair 291 Final tests of drains after repair 115 Final tests of drains when completely relaid 64 Inspection of yards, stables and manure pits 168 ,, passages 133 ,, public conveniences 99 ,, pigstyes and foodbins 99 ,, tents, vans and similar structures 73 ,, theatres, cinemas, halls, etc. 124 ,, ponds and ditches 163 ,, schools and school sanitary conveniences 30 ,, verminous premises 158 ,, premises where offensive trades are conducted 42 ,, g'Psy encampments, camps, fairs, etc. 6 ,, cesspools and earth closets 17 ,, gathering grounds of water supply 31 Number of visits under Rats and Mice (Destruction) Act, 1919 10,171 Smoke observations 239 Number of visits re Infectious Diseases 1,729 Inspections of Shops (under Shops Acts) 1,341 Special Early Closing and Evening Patrols (Shop Hours Acts) 518 Overcrowding inspections 305 Inspections under Diseases of Animals Acts 130 Inspections under Fertilisers and Feeding Stuffs Act 4 ,, under Pharmacy and Poisons Act 103 rnder Merchandise Marks Acts 24 Inspection of Dairies 107 ,, Farms 5 ,, Milkshops 12 ,, Premises where food is prepared or sold 7,111 ,, Bakehouses 98 ., School Kitchens and Services 53 ,, Imported Food at Aerodrome 29 ,, Factories without mechanical power 199 ,, Factories with mechanical power 278 ,, Workplaces (Public Health Act) 79 ,, Outworkers' premises 356 ,, Offices 39 Visits re Young Persons' Employment Act 8 Drinking water samples taken 345 Swimming bath waters: samples taken 95 Food and Drugs Acts : milk samples taken 261 Food and Drugs Acts : other foods and drugs samples taken 386 Milk Soecial Designations Orders: samples taken 277 Non-designated Milk : samples taken 12 Ice Cream samples taken 304 Rag Flock samples taken' 4 Reinsoections of work on outstanding notices 29,437 Sundry inspections and visits 2,357 Appointments kept with owners, builders, etc. 5,393 67 Complaints from public investigated (including those in regard to housing defects) 8,907 Informal notices outstanding 1-12-49 1,793 Informal notices served 4,653 Informal notices complied 3,680 Number of Informal Notices referred for Statutory Orders 1,141 Informal notices outstanding 31-12-50 1,620 Statutory notices outstanding'31-12-49 1,047 Statutory notices served 2,103 Statutory notices complied 2,292 Statutory notices outstanding 31-12-50 858 Total number of callers and complaints received at the office 7,020 Total number of letters received at the office 10,445 Nuisances, Infringements of Acts, Byelaws, Regulations or Order*, ascertained by the Sanitary Inspectors during the year 1950 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 1,076 Conditions causing dampness: Defective roofs 1,107 Defective window frames 151 Defective walls, etc. 298 Want of efficient damp-proof course 29 Defective gutters and downspouts 869 'Other structural defects: Defective plaster 1,286 Cleansing and redecoration required 1,293 Defective floors and stairs 772 Insufficient ventilation under floor 56 Defective brickwork, sills, lintels, chimneys 667 Defective stoves and fireplaces and flues 690 Defective drains, sanitary fittings, etc.: Defective sinks and waste pipes 341 Defective w.c.'s 253 Defective drainage 317 Stoppages in drains 213 Defective water services and tanks 52 Domestic nuisances: Want of cleanliness 7 Verminous conditions 151 Other nuisances and infringements: Offensive accumulations 46 Overcrowding 100 Smoke nuisances 11 Sundry nuisances or defects 19 Particulars not inserted in Rent Book (Housing Act) 10 (Rent Restriction Act) — 68 (2) FACTORIES AND WORKPLACES. Want of cleanliness 17 Inadequate ventilation 7 Insufficient drainage of floors 7 Abstract not exhibited 16 Sundry nuisances or defects 20 W.C.'s—Insufficient 31 ,, Unsuitable or defective 132 ,, Not separate for sexes 2 (3) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924. Food cupboards defective or required 12 (4) INFRINGEMENTS OF FOOD AND DRUGS ACT, 1938, AND FOOD BYELAWS. Structural defects in shops and stores 82 Cleansing or repair of walls and ceilings 194 Cleansing or repair of floors, utensils, fixtures, etc. 127 Insufficient or defective sink accommodation and water supply 61 Insufficient lighting or ventilation 21 Defective drainage 43 W.C. accom.—Insufficient 9 ,, ,, Repair or cleansing required 59 ,, ,, Artificial light required 3 ,, ,, Want of intervening ventilated space 5 Cloakroom accommodation required or defective 11 Overalls required or dirty 6 Ablutions—Wash basins required 31 ,, Hot water supplies required 144 ,, Soap and towels required 15 Food improperly stored 45 Food store—Required or defective 18 ,, Animals kept in 1 ,, Household washing in — Accumulation in yards or stores 44 Offal and refuse bins uncovered or defective 53 Footpaths fouled by waste water 3 Yard paving defective 25 Vehicles—dirty or defective 3 (5) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING, Etc. Defective Yard Paving 136 Want of a sanitary dustbin 167 (6) INFRINGEMENTS OF SHOPS ACT. Shops Closing Hours 12 Infringement in hours of employment and welfare provisions 26 Notices to be exhibited or amended 70 Defective ventilation 3 Provision of means of heating 3 Insufficient w.c. accommodation 6 Want of washing facilities 2 Defective w.c. accommodation 16 Defective walls, floors, ceilings, etc. 15 Defective lighting 3 Seating accommodation 1 69 (7) INSPECTION OF AMUSEMENT HOUSES. Defective sanitary fittings 5 W.C. defective and dirty 1 (8) KEEPING OF ANIMALS. Nuisances arising from the keeping of animals 2 (9) INSPECTION OF WATERCOURSES, Etc. Cleansing of watercourses and ponds 11 (10) INFRINGEMENTS OF OTHER BYELAWS. Noisy animals 8 HOUSING. Individual Unfit Houses. During the year action under the Housing Acts was mainly confined to the repair of houses. It was found necessary to apply Demolition Orders to 11 dwellings and Closing Orders to parts of nine dwellings. 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) 0,242 (b) Number of inspections and re-inspections made for the purpose 33,183 (2) (a) Number of dwelling houses included under the subhead (1) above, which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 193 (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 11 (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 4,574 11.—Remedy of defects throughout the year without service of Formal Notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 3,020 III.—Action under Statutory Powers during the year:— A.—Proceedings under Sections 9, 10 and 10 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which notices were served during the year requiring repairs 1,141 70 (2) Number of dwelling houses which were rendered fit after service of formal notices— (a) By owners 1,215 (b) By local authority in default of owners 82 B.—Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served during the year requiring defects to be remedied 835 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 618 (b) By local authority in default of owners 219 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 11 (2) Number of dwelling houses demolished in pursuance of Demolition Orders — 1).—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 9 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — 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 Is. 3d. per night or 7s. 6d. per week, and Is. per night or 6s. per week for Old Age Pensioners. Cooking facilities are provided. Hot baths may be taken any 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. 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 1950 1,844 0 0 3,741 0 0 71 Houses—Sanitary Certificates. House drains and sanitary fittings are tested and examined on request, at a fee. During the year 7 such requests were made. FACTORIES ACT, 1937. During the year the under-mentioned inspections have been made and defects were found as set out:— FACTORIES. Inspection. Premises. Number of Inspections. Written Notices. Prosecutions. Factories:— With Mechanical Power 278 40 — Without Mechanical Power 91 20 — Other Premises 108 11 — Outworkers and Employers of outworkers 351 — — Total 828 71 — Defects Found. Particulars. Number of Defects. Referred to H.M. Inspector. Prosecutions. Found. Remedied. Want of Cleanliness 17 13 2 — Overcrowding 1 1 — — Unreasonable Temperature 1 1 — — Inadequate Ventilation 7 7 — — Ineffective Drainage of Floors 7 6 — — Sanitary Conveniences. (a) Insufficient 31 27 — — (b) Unsuitable or Defective 132 109 — — (c) Not Separate for Sexes 2 2 — — Other offences against the Act (not including offences relating to Outworkers) 34 28 4 — Total 232 194 6 — 72 Home Work. Lists of home workers, or outworkers as they are termed, are sent in twice yearly, and this year contained the names of 457 workers residing in the Borough. 351 visits were paid to outworkers. Nature of Employment of Outworkers on the Register, 31st December, 1950. Nature of Work. Number Employed. Outwork in Infected Premises. Outwork in Unsatisfactory Premises. Remarks. Making, Cleaning, Altering and Repairing Wearing Apparel 284 1 — Upholstery Work 4 — — — Other Classes of Work 169 2 — — Total 457 3 — — Inspection of Schools. These are inspected with particular reference to sanitary accommodation including washing facilities. During the year 30 inspections were made and defects found were referred to the Education Officer. SHOPS, Etc., ACTS. The Shops Acts 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. 26 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. 1,341 inspections were made under the Shops, etc., Acts, and a number of infringements were found. 73 PUBLIC HEALTH ACTS. Drainage Work. During the year there was no lessening of work in this branch of the department's duties. Some 4,146 visits of inspection were made to underground drains in course of repair. The labour and materials situation being somewhat easier it was not necessary to serve so many statutory orders as in previous post-war years. Of 819 Orders served, 219 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 there has been no cause for complaint. WATERCOURSES, PONDS AND DITCHES, Etc. 163 inspections were made and pollutions were found in 11 cases. SMOKE OBSERVATIONS. During the year 239 observations were made of factory chimneys for the purpose of detecting offences. In those cases where nuisance occurred appropriate action was taken with a view to remedying the condition. Today there is little choice left to the factory owner regarding the fuel he uses and this creates a difficult problem in smoke abatement. The difficulty of renewals of plant has also to be overcome. 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 steani disinfectors are in use and are supplied with steam from the Electricity Works. 74 The following articles were disinfected at the Disinfecting Station during the year:— By Steam 18,411 articles „ Formalin Gas 5,881 „ „ „ Spray 125 „ Total 24,417 „ In addition 894 articles were destroyed on request. Disinfection ot 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 1950, 1,130 articles were disinfected, the receipts amounting to £65 13s. 3d. Disinfection was carried out after infectious or contagious disease at the following premises : — 1,430 rooms at 1,060 houses, hospital wards, clinics, and creches. 1,959 library and other books were disinfected. CLEANSING OF VERMINOUS, Etc., PERSONS. A Cleansing Station consisting of a reception room, four bath rooms and a discharge room, is attached to the Disinfecting Station, and is used for dealing with verminous, etc., conditions in adults and children. A woman attendant dealt with children and women. During the year 6 adults and 50 children were cleansed of verminous conditions and 8 adults and 28 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 oi fumigation. PHARMACY AND POISONS ACT, 1933. The object is to regulate the sale of certain poisonous substances and the Act contains important provisions. 75 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 26. In addition, 246 applications were made for the retention of names on the list for a further period of twelve months. 13 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 proviri genuine. PREVENTION OF DAMAGE BY PESTS ACT, 1949. During the year 1,486 complaints were received ot rat or mice infestation. Of these complaints the presence of rodents was confirmed in 888 cases. The three Ratcatchers in dealing with these infestations paid 8,879 visits, and used 110 lbs. of poison bait, as well as using traps and gassing. The types of premises found to be infested were : — Dwelling Houses (Inside) 277 ,, ,, (Outside) 295 ,, ,, (Poultry Houses) 119 Premises where Food is prepared or sold 71 Factories, Workshops and Business Premises 43 Refuse Tips 1 Sewage Farms 1 Allotments 5 Schools, Hospitals, etc. 26 Shops 14 Drains 36 All sewers in the Borough have received two maintenance treatments during the year. 2,059 manholes were examined for ihe presence of rats and poison bait laid in 838 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. 76 The following table shows the premises in the Borough at which food is known to be sold, manufactured or stored:— Bakers 154 Butchers 189 Confectioners 410 Fishmongers 96 Fish Friers only 45 Greengrocers 402 Grocers 628 Stalls and Rounds 143 Catering Establishments (including Hotels, Canteens, Restaurants, Clubs, Snack Bars, etc.) 910 Miscellaneous (including Chemists, etc.) 245 3,222 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. The following table gives a summary of the inspections mad" during the year, not including visits made to slaughterhouses, dairies or milkshops:— Butchers 1,416 Ice Cream Vendors and Manufacturers 667 Bakers and Bakehouses 268 Confectioners 280 Greengrocers 260 Fishmongers 269 Grocers 1,555 Fried Fish Shops 109 Stalls and Rounds other than in Markets 131 Poultry and Game Dealers 195 Catering Establishments 1,154 Cooked Meat Preparation Premises 74 Miscellaneous 418 6,790 77 General Summary of meat and other articles of food found to be unfit and condemned by the Inspectors during 1950:— Articles. Weight in lbs. Diseased. Unsound. Total. Beef 40638 9848 50486 Veal - 39 39 Mutton 1220 5169 6389 Pork 2393 240 2633 Offal 83351 947 84298 Fish — 6719 6719 Fruit and Vegetables — 7292 7292 Canned, bottled and packeted goods — 40865 40865 Other goods — 17409 17409 127602 88528 216130 The above includes— Canned, bottled and packeted goods: 28,654 cans, 6,219 bottles, packets, etc. 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. Butchers' 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 78 the year 1950 the following animals were slaughtered there and inspected by the Corporation's Meat Inspectors:— Cattle excluding Cows. 5,198 Cows. 2,245 Calves. 664 Sheep and Lambs. 13,994 Goats. 442 Pigs. 972 Total. 23,073 The result of these inspections was as follows:— CARCASES INSPECTED AND CONDEMNED Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed 5198 2245 664 13994 972 Number inspected 5198 2245 664 13994 972 Alt Diseases except Tuberculosis. Whole Carcases condemned 2 3 1 3 12 Carcases of which some part or organ was condemned 1672 639 — 1690 64 Percentage of the number inspected affected with disease other than Tuberculosis 32.2 28.6 .15 12.1 7.8 Tuberculosis only. Whole carcases condemned 8 51 - - 2 Carcases of which some part or organ was condemned 415 591 3 - 12 Percentage inspected affected with Tuberculosis 8.1 28.6 .45 — 1.4 MILK SUPPLY. During the year 124 inspections were made of dairies and milkshops. Milk and Dairies Regulations, 1949. The following licences were granted during the year:— Dealers' Licences to use the designation "Tuberculin Tested" 51 Licences to use the designation "Pasteurised"- (a) Dealers' (Pasteurisers') Licences 2 (b) Dealers' Licences 58 79 Licences to use the designation "Sterilised"— Dealers' Licences 67 Dealers' Supplementary Licences to use the designation- (а) Tuberculin Tested 4 (b) Sterilised 3 (c) Pasteurised 4 Inspection of these licensed premises has been carried out during the year to see that the conditions of the licences were observed. Bacteriological Examinations of Milk. During the year the following samples of milk were examined:— Tuberculin-Tested Milk- Samples from licensed dealers 15 Pasteurised Milk- Samples from licensed dealers 251 Heat Treated Milk- Samples from licensed dealers 12 Sterilised Milk- Samples taken 11 The following table summarises the results of the bacteriological examinations of Tuberculin Tested, Pasteurised, Heat Treated and Sterilised milk samples during the year:- Tuberculin-Tested Milk. Methylene Blue Test. No. Samples Taken. Not Satisfied. Satisfied. 15 Nil 12* * Three Methylene Blue Tests were void owing to Laboratory temperature. 80 Pasteurised Milk. No. Samples Taken. Methylene Blue Test. Phosphatase Test. Not Satisfied. Satisfied. Not Satisfied. Satisfied. 251 Nil 177* Nil 251 *74 Methylene Blue Tests Were Void Owing To Laboratory Temperature Heat Treated Milk. No. Samples Taken. Methylene Blue Test. Phosphatase Test. Not Satisfied. Satisfied. Not Satisfied. Satisfied. 12 11 Nil 12 Sterilised Milk. No. Samples Taken. Turbidity Test. Not Satisfied. Satisfied. 11 Nil 11 81 BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM. 304 samples were taken, the results being as under:— Grade. 1 2 3 4 No. of Samples. 177 78 41 8 Out of a total of 304 samples taken, 49 (1G.1 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. Fourteen 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 2½ 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% 5% to 7½% 71% to 10% Over 10% nil 1 8 6 82 FOOD AND DRUGS ACT, 1938. During the year 283 samples of milk and 412 other samples were taken. Summary of Samples. During 1950 samples were obtained and submitted to the Public Analyst as follows:— Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Ale, Ginger 1 1 — — — Almond, Ground 2 2 — — — Arrowroot 2 2 — — — Aspirin Tablets 2 2 — — — Bacon 1 1 — — — Baking Powder 2 1 1 — — Barley Crystals (Beverage) 1 1 - — — Batterflour Mixture 2 2 - — — Beans in Tomato Sauce 2 2 - — — Beef Cubes 1 1 - — — Beef, Minced 2 2 - — — Beef, Pressed 3 3 - — — Beef, Salt Boiled 1 — 1 — — Beer 5 5 - — — Bicarbonate of Soda 2 2 - — — Biscuits 5 5 - — — Black Pudding 4 4 - — — Blanc Mange Powder 4 4 - — — Boracic Ointment 1 1 - — — Brawn 4 4 - — — Bread 8 8 - — — Bread, Brown 1 1 - — — Bread, Wholemeal 1 I - — — Brine 7 2 5 — — Brisling, tinned 1 1 — — — Butter, National 1 1 — — — Butter, Peanut 1 1 — — — Cabbage (Red Pickled) 1 1 — — — Cakes, Fancy 3 3 — — — Cake, Fruit 2 2 — — — Cake Mixture 3 3 — — — Cake Powder, Mixture 1 1 — — — Castor Oil 1 1 — — — Cheese, Gruyere 1 1 — — — Cheese, Processed 2 2 — — — Cherries in light syrup 1 — 1 — — Chocolate Cakes 1 1 — — Chocolate Spread 1 - 1 — — Chocolate Slices 1 1 — — — Cocoa 4 4 - — — Cocoa, flavouring 1 1 — — — Coconut, desiccated 1 1 - — Cod Liver Oil 2 2 — — — Coffee 4 4 — — Coffee, essence 4 4 — — Coffee and Chicory Essence 6 6 — — — Confectionery 1 1 — — Cornflakes 1 1 — — Cornflour 1 1 — — — Cough Mixture 1 1 — — — Cough Sweets 1 1 — — — Cough Syrup 1 1 — — — Cream Powder, artificial 1 — 1 — — Cream of Tartar 1 1 — — — Carried forward 115 105 10 — — 83 Samples of Total Samples Genuine Not Genuine Prosecutions ctions Brought forward 115 105 10 — - Curd, Lemon 1 1 - - - Currants 2 2 - — — Curry Powder 1 1 - — - Custard Powder 6 6 - — - Dessert Powder 6 5 1 — — Doughnuts, 1 1 - — - Dripping, Beef 2 2 - — - Epsom Salts 1 1 - — — Essence, Almond 1 1 - — — Essence, Lemon 1 1 - — - Essence of Rennet 1 1 - — — Fish Cakes 5 5 - — — Flavouring (Creme-de-menthe) 1 1 - — — Flour 2 2 - — — Flour, Self-Raising 2 2 - — — Fruit, Frozen 1 1 - — — Galantine 2 2 - — — Gelatine 3 3 - - — Gin 6 6 - - — Ginger Beer 1 1 - - — Glauber Salt 1 1 - - — Golden Raising Powder 1 1 - - — Gooseberries in Syrup 1 1 - - — Glycerin 2 2 - - — Grapes in Syrup 1 1 - - — Gravy Cubes 1 1 - - — Gravy Powder 3 3 - - - Ham 1 1 - - - Herbs, Mixed 2 2 - - - Herring, Tinned 1 1 - - — Herring in Tomato 1 1 - - — Honey 1 1 - - - Ice Cream 13 13 - - - Ice Lollie 6 6 - - — Icing, Soft 1 1 - - — Iodine, Tincture of 3 1 2 - — Jam, Blackcurrant 2 2 — - — Jam, Damson 1 1 — - — Jam, Raspberry 1 1 — - — Jelly, Bramble 1 — 1 - — Jelly, Table 1 1 — - — Junket Powder 2 2 — - — Lemon Squash 1 1 — - — Lemonade 1 1 — - — Lemonade Crystals 1 1 — - — Lemonade Powder 3 3 — - — Luncheon Meat 4 4 — - - Luncheon Meat, Pork 1 1 — - — Macedoine, Vegetable 1 1 — - — Macaroni 1 1 — - — Malted Milk Tablets 1 1 — - — Margarine 1 1 — — — Marmalade 3 2 1 - — Meat Paste 2 2 — - — Meat from Brine 5 2 3 - — Milk 283 276 7 - — Milk, Condensed 3 3 — - — Carried forward 519 494 25 — - 84 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought forward 519 494 25 - - Milk (Malted) 1 1 — — — Mincemeat 3 3 — — — Mineral Water 1 1 — — — Mustard 1 1 — — — Oatmeal 3 3 — — — Ointment of Boric Acid 2 2 — — — Olive Oil 1 1 — — — Onions, Brown 1 1 — — — Onions, Pickled 1 1 — — — Orange Squash 1 1 — — — Paraffin, Liquid 3 2 1 — — Paste (Fish) 2 2 — — — Paste (Meat) 4 4 — — — Pastiles (Throat) 1 1 — — — Pastries 2 2 — — — Pastry Mix 1 1 — — — Pate Foie 1 1 — — — Peas, Tinned 2 2 — — — Pearl Barley 2 2 — — — Peel, Mixed 3 3 — — — Pepper 4 4 — — — Pepper, Flavoured Compound 1 1 — — — Pickles 8 8 — — — Pilchards 3 3 — — — Pork (Chopped, Tinned) 1 1 — — — Pork (Danish, Tinned) 1 1 — — — Pudding Mixture 3 3 — — — Red Currant Jelly 1 1 — — — Rice 2 2 — — — Rum 5 5 — — — Sago 1 1 — — — Salad Cream 2 2 — — — Salt Beef 3 — 3 — — Salt Beef Brine 1 — 1 — — Salmon, Tinned 1 1 — — — Sandwich Spread 2 2 — — — Sauces 6 6 — — — Sausage, Beef 14 14 — — — Sausage, Liver 4 4 — — — Sausage, Luncheon 4 4 — — — Sausage, Pork 3 3 — — — Sausage, Smoked 1 1 — — — Sausage Meat 5 5 — — — Semolina 2 2 — — — Senna, Confection of 1 1 — — — Sherbert Fountain 1 1 — — — Sherbert, Lemon 1 1 — — — Shortbread 1 1 — — — Shortpaste 1 1 — — — Soft Drinks 3 3 — — — Soup Powder 1 1 — — — Soup 3 3 — — — Snoek in Tomato Sauce 1 1 — — — Spice Mixed 6 6 — — — Sponge Mixture 1 1 — — — Squash, Lemon 1 1 — — — Squash, Orange 1 1 — — — Stuffing 4 4 — — — Suet 1 1 — — — Sultanas 3 3 — — — Carried forward 663 633 30 — — 85 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought Forward 663 633 30 - - Syrup of Figs 2 2 - - - Tablets, Malted Milk 1 1 - - - Tea 1 1 - - - Tapioca 3 - - - Toffee 1 1 - - - Tomatoes 1 1 - - - Tomato Ketchup 2 - - - Tomato Sauce 1 1 1 - - - Tomato Soup 1 - - - Treacle 1 1 - - - T ruffles 1 1 - - - Tunny Fish 1 1 - - - Veal and Ham Loaf (Tinned) 1 1 - - - Vegetable Mixed 2 2 - - - Vinegar, Malt 2 1 1 - - Whiskey 5 5 - - - Wines 5 5 - - - Yeast Tablets 1 1 - — — Totals 695 664 31 — — Result of Analysis of Milk Samples. Solids Not Fat (Legal standard is 8.5%)* 7.68 8.30 8.31 8.35 8.37 8.5* 8.6 8.7 8.8 8.9 9.0 9.1 9.2 14 1 2 1 1 2 38 87 80 52 9 2 2 Milk Fat (Legal standard is 3%) 2.49 2.70 2.75 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 1 1 1 2 2 31 38 62 30 29 25 3.8 3.9 4.0 4.1 4.3 4.6 4.8 5.1 27 16 5 2 1 2 1 2 Total samples of milk: 278. The samples of Milk for analysis were obtained as follows:- Taken on Milk Rounds 170 ,, at Dairies 46 ,, at Institutions 55 ,, at Local Farms 4 ,, at Schools 3 278 86 Average composition of Milk Samples:— Solids not fat 8.76% Milk Fat 3.53% Adulterated Samples. The following is a detailed statement of the adulterated samples and the action taken:— Sample No. 18 589 520 249 402 531 61 348 Sample °f Artificial Cream Powder Baking Powder Bramble Jelly Cherries in Light Syrup Chocolate Spread Dessert Powder Dessert Powder Marmalade Adulteration or Deficiency. Consisted of cream substitute powder containing 48% of edible fat, but no milk fat. Contained only 6.0% of available carbon dioxide instead of not less than 8% Contained 67.8% of soluble solids instead of not less than 68.5% Contaminated with sulphuretted hydrogen and with sulphides of iron, contained 0.1% of compounds of iron calculated as iron. Contained 13% by weight of large hard angular crystals of sugar. Contained 220 parts per million by weight of sulphur dioxide. The article did not contain salt, although this was one of the ingredients specified on the label. The label attached to this article specified the ingredients as Fresh Mangoes packed with refined sugar. Remarks. Undertaking from Manufacturer to re-label article "Synthetic Cream Powder" accepted. This article was withdrawn from sale. Manufacturer's explanation accepted. Matter referred to Ministry of Food—Food Standards Division. Importers agreed to withdraw this article from sale. This article was an imported one: importation had been discontinued for some considerable time, and the remainder of the stock was withdrawn from sale. Manufacturer's explanation accepted. The Producers had used old labels which had originally been printed for use on tins containing Mangoe Jam. The labels had been overprinted "Marmalade,'' but the specification of the ingredients had re mained unaltered. The Importers agreed to have the stock re-called and to alter the labels. 87 Sample No. 244 49 429 509 428 500 508 583 585 587 584 586 588 Sample Malt Vinegar Paraffin, liquid Beef, Salt boiled Beef. Salt boiled Brine ,, ,, ,, ,, ,, Meat from Brine ,, ,, Adulteration or Deficiency. Contained 0.7% of added salt which is not a natural ingredient of malt vinegar. Odour and taste nauseating. Contained zinc 90 parts per million. Contaminated with lead. Contained zinc 25 parts per million. Contained zinc 20 parts per million. Contaminated with lead. Contained zinc 130 parts per million. ,, ,, 50 „ ,, ,, 30 „ ,, „ 195 „ ,, ,, 90 ,, ,, ,, 80 ,, Remarks. The addition of salt is permitted by the Ministry of Food. This sample was submitted by a private consumer. On enquiry it was found that the whole of the stock of which the sample formed a part had been sold. No other complaints were received and a subsequent sample taken from the same source of supply was genuine. See report below. Recently the pre-war practice of "pickling" meat in a solution of brine has re-commenced. It was found that galvanised iron containers were being used by some butchers for this purpose; the above-mentioned results representing part of an investigation which has been carried out. As a result of this investigation a communication was sent to the National Federation of Meat Traders' Associations recommending that this form of container be not used. Local butchers have been visited, and this type of container is now no longer used. 88 Sample No. 472 477 419 420 422 495 497 167 270 Sample of Milk ,, ,, ,, ,, ,, Tincture of Iodine ,, Adulteration or Deficiency. 1.7% of added water. 2% deficient in milk solids other than milk fat. 17% deficient in milk fat and 9% deficient in milk solids other than milk fat. 8% deficient in milk fat. 2% deficient in milk solids other than milk fat. 1.5% deficient in milk solids other than milk fat. 10% deficient in milk fat and 2% deficient in milk solids other than milk fat. No. 167 contained only 1.63% w/v of potassium iodide instead of not less than 2.45% w/v as required by the B.P. No. 270 contained only 1.45% w/v of potassium iodide instead of not less than 2.45% w/v as required by the B.P. Remarks. Samples taken from one producer. Investigation showed that first sample result was due to a defective "cooler." Subsequent samples from bulk supply showed that certain cows were producing milk below standard. Feeding arrangements were altered, and subsequent samples from this supply have proved to be genuine. Article withdrawn from sale. 89 MISCELLANEOUS. Nursing Homes—Public Health Act, 1936. Number of Homes. 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. NURSES AGENCIES REGULATIONS, 1945. During the year one application was refused and one agency removed from register following criminal proceedings. Four agencies remained on the register at the end of the year. 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 Number of at children provided 31-12-50. for Premises 3 65 Daily Minders 19 117 STAFF MEDICAL EXAMINATIONS. Nine hundred and ninety-five examinations were made during the year by the Medical Staff of the Department. 90 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. CREMATION ACT, 1902. During the year 1,619 Certificates were completed in the Department in the capacity 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. In January, the Public Health (Aircraft) Regulations, 1950, were issued. These extended the "excepted area" from which passengers are not subjected to health control when arriving in this country, to all the territories in Europe of the Brussels Treaty Powers (Western Union). The Regulations reduced still further the routine health control duties at Croydon Airport. While it was still necessary to maintain a continuous "on call" rota of medical officers, the medical receptionist work between 22.00 and 9.00 hours was transferred to the Customs Preventive Officers, the night-time Immigration staff being withdrawn. No difficulties were experienced in the year under review. The Chief Immigration and Chief Preventive Officers and their staffs continued to be most helpful in the performance of the work and the compiling of the necessary statistics. 91 CROYDON AIRPORT—AIRCRAFT AND PASSENGER ARRIVALS. * A return of aircraft and passengers from the " Excepted area" has only been made since 2/9/ 50. (i.e., since the new form has been used ). Day Hours (See*) "Excepted area" Europe outside "Excepted area" North Atlantic (U.SA.,Canada Newfoundland) South Atlantic South America West Africa South Africa Middle East Far East Persia Total Note.—AC=Aircraft BP = British Passengers AP=Alien Passengers AR=No. of Aliens referred to Medical Officer by the Immigration Officer C=No. of Certificates issued Sunday AC BP AP AC BP AP AC BP AP AC BP AP AC BP AP AC BP AP AC BP AP AR C 0.8 3 - - - - - - - - - - - - - - - - - 51 112 10 1 - 8.12 9 3 2 3 - - - - - - - - - - - - - - 12.16 8 10 3 3 - - - - - - - - - - - - - - 16.20 8 20 1 7 23 4 — — — — — — 1 12 — — — — 20.24 4 14 - 5 30 - - - - - - - - - - - - - Monday 0.8 9 6 — 4 1 - - - - - - - - - - - - - 76 93 33 - - 8.12 10 4 6 4 5 - - - - - - - - - - - - - 12.16 10 6 7 11 10 5 — — — — — — 1 4 — — — — 16.20 15 28 10 6 11 3 - - - - - - - - - - - 20.24 1 1 — 5 17 2 - - - - - - - - - - - - Tuesday 0.8 12 — — 7 4 1 - - - - - - - - - - - - 64 38 9 - - 8.12 5 1 — 1 - - - - - - - - - - - - - - 12.16 15 17 6 4 - - - — — - - - 1 4 - — — — 16.20 11 5 - 4 3 - - - - - - - - - - - - - 20.24 2 — — 2 4 — — — — — — — — — — — — — Wednesday 0.8 16 - 1 4 - - - - - - - - - - - - - - 79 46 14 - - 8.12 7 3 1 2 — — — — — — — — 1 4 — — — — 12.16 19 7 6 9 11 1 - - - - - - - - - - - - 16.20 8 12 4 10 6 1 - - - - - - - - - - - - 20.24 1 — — 2 3 — — - — — — — — — — — — — Thursday 0.8 21 - - 5 2 - - - - - - - 1 1 - - - - 74 57 18 - - 8.12 5 9 5 1 - - - - - - - - - - - - - - 12.16 10 4 3 5 3 6 — — — — — — 1 3 — — — — 16.20 16 4 2 5 30 1 - - - - - - - - - - - - 20.24 4 1 1 - - - - - - - - - - - - - - - Friday 0.8 18 - — 3 2 — — — — — — - — — — — — — 83 67 17 - - 8.12 8 4 — 4 1 4 - - - - - - - - - - - - 12.16 9 1 1 9 8 5 - - - - - - 1 13 — — — — 16.20 14 11 5 8 15 1 - - - - - - - - - - - - 20.24 4 3 — 5 9 1 - - - - - - - - - - - - Saturday 0.8 16 - - - - - - - - - - - - - - - - - 76 46 7 - - 8.12 9 12 1 5 3 1 - - - - - - - - - - - - 12.16 13 7 1 5 6 - - - - - - - - - - - - 16.20 12 3 1 10 13 2 - - - - - - - - - - - - 20.24 2 - - 1 2 — - — — — — — 1 — — — — — Grand Total. *503 459 108 1 — 93 County Borough of Croydon ANNUAL REPORT of the SCHOOL MEDICAL OFFICER For the Year ending December 31st, 1950. 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, 1950. There are no major changes to which attention need be drawn. Routine medical inspections of the extra age group, first introduced last year, have proceeded smoothly. The delays in obtaining glasses have gradually diminished. Difficulties in the dental service, on which the Senior Dental Officer comments, have not been solved, but some improvement has been effected in the total aggregate of staff employed. The School Dental Service, however, remained unable to fulfil its proper function of systematically establishing a dentally fit school population and the conditions under which the dental officers continued to work were harassing and frustrating. Infectious diseases, mainly mild in character, were somewhat prevalent. The change in the severity of such illnesses as Scarlet Fever renders strict exclusion, and contact control, irksome to 93 parents and patients, and difficult to enforce. If the prevailing type of this infection continues it would seem justifiable to consider its reclassification as a minor communicable disease. Poliomyelitis, as always, occasioned concern in schools where cases occurred. A statement was issued drawing attention, amongst other matters, to the fact that avoidance of fatigue is an important safeguard against paralysis. Thus it is the overindulgence in strenuous swimming and not infection from the swimming bath which may precipitate an attack of this distressing complaint. For physically handicapped children more accommodation at the special day school is awaited as the delays before entry were considerable. Similarly with readier ascertainment and speed of assessment more places were required at the special school for educationally sub-normal children. It is hoped that extensions to the school premises will soon be completed. There was great difficulty in dealing with the few educationally sub-normal children for whom residential schooling was required as no vacancies in existing establishments were forthcoming. The early and precise ascertainment of hearing defects were given prominence during the vear and personal contact established with the Deafness Clinic at the Royal Ear, Nose and Throat Hospital. We would prefer to have such facilities locally, but the relatively small number involved makes this impracticable. Similarly children have had to be sent to the L.C.C. day special schools and nursery schools for the deaf and partially deaf, and this has meant somewhat lengthy car journeys for some of the nupils concerned. Wherever possible, retention in an ordinary school with a hearing aid was first considered. The association between the School Health Service and the hospitals bv the appointment of Medical Officers as Clinical Assistants has continued. Pressure of work has compelled the re-arrangement of the sessions so that they do not conflict with periods available for direct school duties. Once again, I am able to report that the overall picture the health and well being of the children, as judged by average heights and weights shows an improvement on the record figures of the previous year. 94 I thank you, Mr. Chairman, and the members of the Committee for their encouragement, and the medical, dental, nursing, and other officers of the department for their routine performance of duties and special suggestions for the improvement of the service. 95 STAFF OF THE SCHOOL HEALTH SERVICE. *Medical Officers 10 (including 2 part-time) *Dental Officers 8 (including 4 part-time) *Physiotherapists 3 Speech Therapists 2 (part-time) *School Nurses 31 *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 Minor Ailments Dental Diphtheria Immunisation Eye Inspection Remedial Exercises and Massage Rheumatism Speech Defects Verruca clinic Address 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.). Lodge Road, Broad Green, Croydon; 206 Selhurst Road, South Norwood,; Waldrons Hall, 55 Duppas Hill Lane, Croydon. Lodge Road, Broad Green, Croydon; 206 Selhurst Road, South Norwood. (Discontinued in June, 1950.) 47 St. James' Road, Broad Green, Croydon. Lodge Road, Broad Green, Croydon; 206 Selhurst Road, South Norwood; Duppas School, Goodwin Road, Waddon. Waldrons Hall, 55 Duppas Hill Lane, Croydon. Lodge Road, Broad Green, Croydon. 33 St. James' Road, Broad Green, Croydon. Lodge Road, Broad Green, Croydon. 96 RETURN OF ATTENDANCE IN MAINTAINED PRIMARY, MODERN, CENTRAL, TECHNICAL AND GRAMMAR SCHOOLS School. Average No. on Registers. Average attendance. Average attendance per cent. Average 1949 attendance per cent. COUNCIL PRIMARY SCHOOLS Ashburton Junior Mixed 436 404 92.6 191.5 Ashburton Infants 307 268 87.2 Benson Junior Mixed and Infants 466 432 92.7 92 Beulah Junior Boys 344 319 92.7 92.2 Beulah Junior Girls 322 296 91.9 93.1 Beulah Infants 340 268 78.8 87.9 m.E.& W.C. Cypress Junior Mixed and Infants 397 362 91.1 90.9 Davidson Infants 259 236 91.1 87.8 Duppas Junior Mixed and Infants 371 325 87.6 92 W.C. Ecclesbourne Junior Boys 284 261 91.9 91.7 Ecclesbourne Infants 208 186 89.4 92 Elmwood Junior Boys 256 233 91 90 Elmwood Junior Girls 232 210 91.8 90.4 Elmwood Infants 239 200 83.7 86.8 s.p., W. c. & m.e. Gilbert Scott Junior Mixed 368 334 90.7 88.6 Gilbert Scott Infants 254 217 85.4 Gonville Junior Mixed and Infants 401 366 91.3 90.7 Howard Junior Mixed and Infants 360 331 91.9 93.7 Ingram Infants 159 140 88 89.4 Kensington Avenue Junior Mixed and Infants 438 403 92 90.7 Kingsley Junior Mixed 335 301 89.9 91.2 Kingsley Infants 327 281 85.9 88.1 Monks Orchard Junior Mixed and Infants 442 411 92.9 92.4 Overbury Infants 240 199 82.9 91.7 Norbury Manor Junior Mixed 369 339 91.8 94.5 Norbury Manor Infants 239 198 82.8 89.2 G.I. Oval Junior Mixed 424 386 90.1 90.5 Oval Infants 215 186 86.5 80.6 g.i. Portland Infants 299 274 91.6 86.7 Purley Oaks Senior and Junior Mixed 593 541 91.2 92.0 Purley Oaks Infants 166 145 87.3 92.5 Rockmount Junior Mixed 313 289 92.3 93.3 Rockmount Infants 196 168 85.7 91.4 m. & W.C. South Norwood Junior Boys 365 342 93.7 92.6 South Norwood Junior Girls and Infants 524 477 91 88.8 Spring Park Junior Mixed and Infants 435 395 90.8 90.9 Sydenham Junior Boys 254 230 90.5 91 Sydenham Junior Girls and Infants 403 365 90.6 89 Waddon Junior Mixed and Infants 448 408 91.1 91 West Thornton Junior Boys 188 175 93 91 West Thornton Junior Girls 180 164 90 93.3 West Thornton Infants 239 205 85.8 90 Whitehorse Manor Junior Girls 247 228 92.3 92 Whitehorse Manor Infants 254 226 88 88.6 Winterbourne Junior Boys 290 273 94 94 Winterbourne Junior Girls , 343 327 95.3 94.2 Winterbourne Infants 417 375 89.9 88.5 Wolsey Junior Mixed 471 435 92.3 92.4 Wolsey Infants 273 235 86 89.4 Woodside Junior Boys 388 371 95.6 92.7 Woodside Junior Girls 352 331 94 92.6 Woodside Infants 302 268 88.7 89.3 Total 16,972 15,339 90.4 90.8 G.I. = General Illness. C.P. = Chicken Pox. S.F. = Scarlet Fever. M. = Mumps. M.E. = Measles. W.C. = Whooping Cough. 97 School Average No. on Registers Average attendance Average Attendance per cent. Average Attendance 1949 per cent. COUNCIL SECONDARY MODERN SCHOOLS Ashburton Senior Mixed 678 622 91.7 90.1 Croydon British Girls 206 184 89.3 89 Davidson Senior Boys 306 281 91.8 91.5 Davidson Senior Girls 196 175 89.2 88.1 Ecclesbourne Senior Girls 319 285 89.3 86.5 Ingram Senior Boys 319 290 90.9 91.1 Ingram Senior Girls 287 259 90.2 89 Lanfranc Senior Boys 478 425 88.9 87.7 Lanfranc Senior Girls 385 346 89.8 89 Norbury Manor Senior Boys 367 339 92.3 92.3 Norbury Manor Senior Girls 316 293 92.7 92.3 Overbury Senior Mixed 295 260 88.1 92 Portland Senior Boys 203 189 93.1 92 Portland Senior Girls 294 271 92 89.1 Tavistock Senior Boys 397 357 90 87 Tavistock Senior Girls 436 386 88.3 86 Waddon Senior Mixed 481 403 83.8 84 Whitehorse Manor Senior Boys 209 186 89 90 Total 6172 5551 89.9 88.9 Archbishop Tenison's Vol. Sec. Modern 131 120 91.6 91.7 Grand Total 6303 5671 89.9 SPECIAL SCHOOLS St. Christopher's (E.S.N.) 203 172 84.7 85.6 St. Giles' (Ph. and Del.) 147 128 87 83.2 St. Luke's (P.S.) 29 25 86.2 93.1 Total 359 325 85.7 85.2 VOLUNTARY PRIMARY SCHOOLS All Saints Mixed and Infants 277 240 86.6 86.8 G.I. Christ Church Junior Mixed and Infants 233 213 91.4 91 Parish Church Junior Girls and and Infants 368 328 89.1 90 St. Andrew's Mixed and Infants 427 391 91.6 93 St. Joseph's Mixed and Infants 396 346 87.4 89.5 St. Mark's Junior Girls and Infants 124 111 89.5 88.4 St. Mary's R.C. Senior and Junior Mixed 373 333 89.3 89.7 St. Mary's R.C. Infants 81 71 87.6 86 W.C. St. Michael's Infants 158 130 80.2 88 M.E. W.C. St. Peter's Infants 119 101 84.8 91.4 M.E. Shirley Junior Mixed and Infants (St. John's) 181 171 94.4 92.3 Total 2737 2435 89 90.2 98 School Average No. on Registers Average Attendance Average attendance per cent. Average 1949 attendance per cent. selective central schools Archbishop Tenison's Senior Boys 202 191 94.6 95.3 Heath Clark Mixed 312 294 94.2 93.9 Lady Edridge Senior Girls 329 318 96.7 97 Total 843 803 95.3 95.3 grammar schools Selhurst Boys 570 545 95.6 95 Selhurst Girls 553 522 94.4 94.5 John Ruskin Boys 351 331 94.3 95 Coloma Girls 502 466 92.8 93.3 Total 2819 2667 94.6 94.7 technical schools Stanley Technical Boys 234 223 95.3 95.1 School of Building 163 155 95.1 94 Total 397 378 95.2 94.6 summary of school attendance Council Primary 16972 15339 90.4 90.8 Voluntary Primary 2737 2435 89.1 90.2 Secondary Modern 6303 5671 89.9 88.9 Grammar Central 2819 2667 94.6 94.7 Technical 397 378 95.2 94.6 Special 379 325 84.2 85.2 Total 29607 26815 90.5 90.8 99 MEDICAL INSPECTION IN SCHOOLS. The system of routine medical inspection is now as followsA. Primary and Modern Secondary Schools. (1) Entrants i.e., (2) 8-year-old i.e., Group (3) Primary i.e., Leavers (4) Leavers i.e., (Final) (5) Special Cases i.e., (if any) Children admitted for the first time to a Maintained School. 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. Children in their last year of attendance in a Maintained Primary School and who have not been medically examined in that year. Children in their last year of attendance in a Maintained Secondary School who have not been medically examined in that year. 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 11,102 children were examined as compared with 11,747 in 1949, and 7,147 parents attended the examinations. The percentage attendance of parents in the Entrants' group was for boys 90.2 per cent. and girls 86.9 per cent.; in the Intermediate group, boys 53.1 per cent., girls 06.5 per cent.; in the Leavers' group, boys 13.5 per cent., girls 36.4 per cent.; and in the Other Ages group, boys 72.1 per cent., girls 78.0 per cent. The total percentage of parents attending was 64.4 as against 63.5 last year. 72l specials and 534 re-inspections of children were carried out. 100 PARENTS PRESENT Entrants Intermediate Leavers 8 to 9 years TOTAL Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Addington New ... ... ... ... ... ... ... ... 32 14 3 3 ... ... ... ... 32 14 All Saints' 58 41 54 33 36 22 20 12 ... ... ... ... 16 10 13 6 110 73 Arch. Tenison's B. ... ... ... ... ... ... ... ... 56 ... 1 ... ... ... ... ... 56 ... ,, „ Girls ... ... ... ... ... ... ... ... ... 25 ... 10 ... ... ... ... ... 25 Ashburton 16 24 16 23 49 25 36 15 71 88 12 20 48 85 34 59 184 222 Benson 42 24 37 23 46 35 40 33 1 4 1 2 18 17 12 15 107 80 Beulah 80 87 81 59 133 112 68 78 ... ... ... ... 167 65 134 43 389 264 Christ Church 18 19 17 18 17 37 6 17 ... ... ... ... 25 33 18 26 60 89 Croydon British ... ... ... ... ... ... ... ... ... 40 ... 8 ... ... ... ... ... 40 Cypress 33 26 30 25 24 33 18 22 ... ... ... ... 29 29 23 24 86 88 Davidson 28 34 24 31 ... ... ... ... 54 77 11 31 19 15 14 3 101 126 Duppas 22 13 19 11 53 31 21 19 ... ... ... ... 58 44 33 18 133 88 Ecclesbourne 53 54 52 47 49 3 22 3 ... 52 ... 19 70 9 55 8 172 118 Elmwood 42 59 39 52 55 20 33 17 ... ... ... ... 74 67 49 56 171 146 Gilbert Scott 109 51 96 45 54 51 16 35 ... ... ... ... 36 61 27 46 199 163 Gonville 11 9 10 9 19 29 9 19 ... ... ... ... 9 13 5 12 39 51 Heath Clark ... ... ... ... ... ... ... ... 25 23 ... 2 ... ... ... ... 25 23 Howard 19 23 13 19 ... ... ... ... ... ... ... ... 73 32 47 22 92 55 Ingram 47 41 45 37 ... ... ... ... 53 122 3 41 ... ... ... ... 100 163 John Ruskin ... ... ... ... ... ... ... ... 56 ... 1 ... ... ... ... ... 56 ... Kensington av. 20 17 20 17 12 ... 11 ... ... ... ... ... 9 10 8 10 41 27 Kingsley 49 37 40 32 80 13 25 4 ... ... ... ... 11 6 4 6 140 56 Lanfranc ... ... ... ... 16 5 9 1 294 37 67 18 ... ... ... ... 310 42 Monks Orchard 48 71 46 68 31 51 16 43 ... ... ... ... 23 20 21 18 102 142 Norbury Manor 25 28 21 28 1 1 ... 1 57 55 11 23 93 51 80 47 176 138 Oval 96 86 85 70 43 45 19 31 ... ... ... ... ... 18 ... 16 139 149 Parish Church 22 32 20 32 2 ... 1 ... ... ... ... ... 17 23 13 19 41 55 Portland 52 57 49 47 17 26 5 15 97 134 13 78 26 3 20 3 192 220 Purley Oaks ft 51 41 47 50 29 28 18 57 44 11 12 62 40 32 37 213 164 Rockmount 65 47 55 36 51 48 40 43 ... ... ... ... 52 54 49 50 168 149 St. Andrew's 29 16 27 14 42 28 24 21 14 18 ... 7 24 23 22 21 109 85 St. Joseph's 36 47 33 4 ... ... ... ... ... ... ... ... ... 5 ... 2 36 52 St. Mark's 21 14 15 12 ... 14 ... 8 ... ... ... ... ... 15 ... 12 21 43 St. Mary's R.C. 39 17 34 12 55 42 22 19 16 27 ... 3 38 40 18 28 148 126 St. Michael's 22 23 20 22 ... ... ... ... ... ... ... ... ... ... ... ... 22 23 St. Peter's 24 22 19 19 ... ... ... ... ... ... ... ... 6 ... 6 6 30 29 Sch. of Building ... ... ... ... ... ... ... ... 42 ... 3 ... ... ... ... ... 42 ... Selhurst Gram. ... ... ... ... ... 51 ... 35 102 105 3 42 ... ... ... ... 102 156 Shirley 25 32 21 29 32 19 22 15 ... ... ... ... 12 17 12 12 69 68 South Norwood 19 23 17 20 90 60 56 33 ... ... ... ... 44 36 27 29 153 119 Spring Park 123 65 116 64 26 22 16 13 ... ... ... ... 25 27 17 21 174 114 Stanley Technical ... ... ... ... ... ... ... ... 62 ... 2 ... ... ... ... ... 62 ... Sydenham 11 13 11 13 47 54 26 34 ... ... ... ... 92 18 51 13 150 85 Tavistock ... ... ... ... ... 4 ... 4 49 43 9 17 ... ... ... ... 49 47 Waddon 34 23 28 20 33 24 21 16 95 56 12 15 30 56 19 36 192. 159 West Thornton 59 54 54 47 12 62 6 40 ... ... ... ... 89 67 67 63 160 183 Whitehorse Manr. 90 52 78 46 18 97 6 62 122 ... 1 ... ... 105 ... 90 230 254 Winterbourne 57 45 53 42 96 ... 35 ... ... ... ... ... ... 72 ... 60 153 117 Wolsey 93 101 86 88 64 36 29 26 ... ... ... ... 70 73 53 55 227 210 Woodside 59 49 55 46 82 119 56 78 ... ... ... ... 93 97 68 74 234 265 1749 1527 1577 1327 1435 1248 762 830 1355 964 183 351 1458 1366 1051 1066 5997 1105 3276 2904 2683 1592 2319 534 2824 2117 11102 PERCENTAGE OF PARENTS PRESENT AT MEDICAL EXAMINATIONS Entrants Boys 90.2 88.6 64.4 ,, Girls 86.9 Intermediate Boys 53.1 59.3 ,, Girls 66.5 Leavers Boys 13.5 23.0 ,, Girls 35.4 Other Ages Boys 72.1 75.0 8/9 years Girls 78 0 101 heights and weights, 1950. Age. Number Examined 1950 Average Height in inches. Average Weight in lbs. 1950 | 1949 1948 1947 1936 1950 1949 1948 1947 1939 BOYS 5 years 1028 43.4 43.2 43.4 43.3 41.8 43.7 43.4 44.0 44.1 41.5 6 ,, 591 44.2 44.2 44.7 44.5 43.8 45.1 45.5 46.2 45.7 43.4 7 ,, 252 48.2 46.7 46.9 47.3 45.3 53.8 50.5 51.1 51.6 47.9 8 ,, 762 50.0 50.1 48.7 49.2 49.5 58.2 58.0 54.1 56.0 55.5 9 ,, 453 50.9 51.2 50.5 51.5 51.2 61.0 62.1 60.1 61.4 58.8 10 „ 443 54.9 54.2 53.9 53.6 52.7 74.0 71.7 70.1 63.7 62.9 11 ,, 829 55.2 55.6 55.6 55.4 53.7 75.4 75.2 73.7 73.0 68.7 12 „ 339 56.6 56.4 56.5 56.5 55.7 79.2 77.1 78.2 76.6 79.9 13 „ 13 59.3 57.3 60.4 57.9 58.4 91.8 82.9 93.0 83.9 81.6 14 ,, 331 62.7 62.8 61.7 60.5 59.0 106.5 105.8 98.4 95.7 90.8 15 „ 758 63.8 63.6 63.1 65.9 — 113 7 113.1 109.8 117.4 — 16 „ 138 66.9 66.4 67.2 66.8 — 127.7 125.1 120.9 120.2 — 17 „ 52 68.8 68.3 68.7 67.6 — 140.5 132.6 134.3 129.7 — GIRLS 5 years 927 43.1 43.5 42.9 43.3 41.2 42.3 42.9 42.5 41.6 39.7 6 „ 490 43.6 44.2 44.0 44.2 42.7 43.7 44.2 44.3 43.7 41.4 7 ,, 123 47.3 47.1 46.1 46.6 44 1 51.3 49.9 49.5 49.1 436 8 „ 607 49.5 49.8 49.7 49.7 49.9 56.0 57.5 54.8 54.0 54.7 9 „ 525 50.6 51.3 52.4 51.1 50.9 59.5 60.7 62.8 58.6 57.6 10 ,, 298 54.7 53.3 53.8 54.0 52.1 72.5 70.7 69.2 70.8 62.9 11 „ 769 55.6 56.1 55.8 55.4 53.6 76.6 76.6 75.1 72.9 68.3 12 „ 442 56.7 57.5 57.1 56.5 56.6 80.8 81.6 79.3 77.5 77.2 13 „ 30 59.3 59.7 61.0 60.2 58.8 91.5 92.8 98.4 88.2 85.3 14 „ 412 62.2 62.3 62.6 61.4 60.3 109.2 106.4 07.3 101.3 97.9 15 ,, 506 62.6 62.6 62.6 64.0 62.0 113.3 11.2 10.6 114.8 05.5 16 „ 63 4 — — — — 123.4 — — — — 17 ,, 16 — — - — 130.7 — — — — 102 RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 1950. 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 31 6 0.62 34 6 0.78 Uncleanliness- Head — — — — — — Body Skin Disease 14 3 0.28 26 8 0.67 Eye Disease— Defective Vision 323 43 6.10 251 28 5.47 Squint 26 11 0.62 32 13 0.88 External Eye Trouble 11 5 0.27 10 3 0.25 Ear Disease— Deafness 6 7 0.22 12 5 0.31 Otitis Media 7 9 0.27 3 3 0.12 Other Disease 5 1 0.10 2 1 0.06 Nose and Throat— Enlarged Tonsils only 52 71 2.05 64 48 2.19 Adenoids only 21 8 0.48 12 2 0.27 Enlarged Tonsils and Adenoids 175 69 4.07 159 65 4.39 Other Conditions 46 20 1.10 28 10 0.74 Enlarged Cervical Glands (not T.B.) 2 10 0.20 2 8 0.20 Dental Defects 156 3 2.65 122 3 2.45 Spefch Defects 11 17 0.47 7 7 0.27 Heart and Circulation— Organic 8 14 0.37 7 9 0.31 Functional 2 8 0.17 5 5 0.20 Anaemia 4 6 0.17 5 5 0.20 Bronchitis 18 23 0.68 13 21 0.67 Other Non-T.B 19 38 0.95 11 18 0.57 Pulmonary Tuberculosis 15 12 0.45 7 21 0.55 Other Tuberculosis — 3 0.05 — 2 0.04 Nervous System Disorders (including Epilepsy, Chorea, etc.) 2 14 0.27 7 12 0.37 Developmental— (a) Hernia 6 3 0.15 — 1 0.02 (6) Other 4 2 0.10 — 2 0.04 Psychological— (a) Development 1 1 0.03 1 4 0.10 (b) Stability 3 4 0.12 — 5 0.10 Deformities— Flat Feet 174 87 4.35 14 4 0.35 Posture 291 73 6.07 17 3 0.39 Others 130 58 3.13 14 6 0.39 Other Defects and Diseases 89 77 2.77 21 14 0.69 Totals 1652 706 886 342 Total Children Examined 5997 5105 103 VISION. Extent of Defect Intermediate Leavers Other Ages Total Boys Girls Boys Girls Boys Girls Boys Girls No. % No. % No. % No. % No. % No. % % % Normal: R 1392 97.0 1204 96.5 1273 93.9 909 94.3 1415 97.0 1328 97.2 96.0 96.2 6/6ths or 6/9ths L 1388 96.7 1205 96.6 1266 93.4 905 93.9 1402 96.2 1322 96.8 95.5 95.9 6/12ths or 6/24ths R 37 2.6 40 3.2 69 5.1 48 5.0 35 2.5 33 2.4 3.3 3.4 L 38 2.7 37 3.0 68 5.0 44 4.6 47 3.2 39 2.8 3.6 3.4 6/36ths or worse R 6 0.4 4 0.3 13 1.0 7 0.7 8 0.5 5 0.4 0.7 0.4 L 9 0.6 6 0.5 21 1.6 15 1.5 9 0.6 5 0.4 0.9 0.7 Cost of the School Health Service. The gross cost of the medical, dental and nursing services was £30,030. The expenditure is subject to Education grant. Cost of Special Schools. £ Schools maintained by the Council 19,765 Other Schools (not maintained by local authorities) 6,965 Adjustments with other authorities in respect of Special Schools— Full cost £2,200 Rate cost 242 2,442 £29,172 With the exception of £242 calculated at Rate Cost, the above expenditure is subject to Education grant. Cost of Milk and Meals. Meals and Milk cost £161,528. Income from payment for meals was £63,968, making a net cost of £97,560, on which grant is paid of 100 per cent. on approved expenditure. 104 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS, 1950 (Percentages of Children examined) Condition Entrants Intermediates Leavers Other Ages All Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Circulatory System 1.3 1.2 1.7 2.8 1.6 1.6 2.4 1.4 1.8 1.7 Pulmonary System 3.3 3.1 2.6 1.9 1.6 2.0 4.0 2.0 2.9 2.3 Skin Disease 1.1 0.8 2.0 1.8 2.8 2.2 1.5 2.0 1.8 1.6 Defects of Nose and Throat 20.1 19.6 7.1 7.4 3.6 2.2 9.8 8.8 10.8 10.4 Enlarged Cervical Glands 1.7 1.0 1.0 1.0 0.2 — 1.5 1.0 1.2 0.8 Squint 1.9 2.1 0.5 0.6 0.3 1.1 0.8 1.2 0.9 1.3 External Eye Disease 0.5 0.2 0.7 0.4 — 0.3 0.4 0.4 0.4 0.3 Defective Vision 0.5 0.8 7.4 8.0 10.0 8.8 7.9 6.0 6.1 5.5 Defective Hearing and other Ear Defects 1.0 0.9 0.8 1.0 1.0 0.9 0.7 0.6 0.9 0.8 Speech Defects 1.1 0.7 0.2 0.2 0.2 — 0.3 0.1 0.5 0.3 Dental Disease (more than four decayed) 2.3 2.4 1.3 1.3 0.7 0.7 2.2 1.7 1.7 1.6 Dull and Backward 0.3 0.1 — — 0.2 — 0.4 — 0.3 — Malnutrition 3.0 3.7 4.7 4.9 3.8 2.6 4.4 4.7 3.9 4.1 Deformities 12.1 11.7 12.3 15.4 8.4 13.4 12.7 12.9 11.5 13.4 Nervous System 0.1 0.4 0.6 1.0 0.2 0.1 0.3 0.4 0.3 0.5 Developmental— Hernia 0.2 0.1 0.1 — 0.1 — 0.3 0.1 0.2 — Other 0.6 0.1 0.4 — 0.1 — 0.4 — 0.4 — Psychological— Developmental — 0.1 0.1 — — — 0.1 0.2 — 0.1 Stability 0.5 0.3 0.1 0.1 — — 0.1 — 0.2 0.1 Other Defects 2.9 2.4 3.8 2.5 0.6 3.2 2.7 2.2 2.4 2.5 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) 68,255 Number of children inspected (subsequent inspections) 4,202 105 Number of children found unclean (first inspection) 728 (1,180 occasions of infestation). Number of occasions in which children found unclean (subsequent inspections) 1,398 At the primary inspections vermin were found in 51 and nits alone in 1,129 children. On these inspections 1.7 per cent. of the children showed evidence of infestation as against 2.6 in 1949. TUBERCULOSIS IN CHILDREN OF SCHOOL ACE. Contacts among school children kept under supervision during 1950:— Number of cases under observation at beginning of 1950 211 Number of cases added during year 42 Number of cases discharged from observation during the year 11 Number of cases under observation at the end of 1950 242 Number of cases of Notified Tuberculosis— Pulmonary 8 Non-Pulmonary 5 Taking the total child population at 34,080, the pulmonary tuberculosis incidence rate per 100,000 was 23.5, and the nonpulmonary incidence rate 14.6. There were no deaths from pulmonary tuberculosis or from non-pulmonary tuberculosis. CAUSES OF DEATH IN CHILDREN OF SCHOOL AGE. Child population, 34,080. Number of deaths 12, which is equal to a death-rate of 0.35 per 1,000. The deaths were due to: Measles 1 Malignant Tumour of Tibia 1 Pneumonia 2 Leukæmia 1 Acute Lymphatic Leukæmia 1 Appendicitis 1 Meningeal Infection 1 Road Traffic Accidents 1 Mitral Stenosis 1 Congenital Heart Disease 1 Polio-encephalitis 1 Salmonella Infection—open verdict 1 106 TREATMENT. The Work of the School Clinics. SUMMARY OF ATTENDANCES 1950 1949 Increase or Decrease Minor Ailments Clinic 10736 18162 -7426 Inspection Clinic 3573 4625 -1052 Dental Clinics 20434 18620 +1814 Orthopaedic Clinic 512 461 +51 Remedial Exercises Clinic 11154 8606 +2548 Nose and Throat Clinic 1885 2350 -465 Rheumatism Clinic 148 129 +19 Verruca Clinic 2867 - 51309 52953 The Minor Ailments Clinics. At the Lodge Road Clinic 1,634 defects involved 8,015 attendances, while at the subsidiary Clinics held at 206, Selhurst Road on five days weekly, 298 defects, 1,721 attendances; at the Duppas School 646 defects, 3,765 attendances; and at Rockmount School 45 defects, 102 attendances. Complaint 1950 1949 Cases Attendances Average No. of Attendances per case Cases Attendances Average No. of Attendances per case Ringworm 16 80 5.0 33 204 6.2 Scabies 14 37 2.6 28 96 3.4 Impetigo 37 408 11.0 77 559 7.3 Other Skin Diseases 84 298 3.5 80 494 6.2 Otorrhoea and other Ear defects 225 1254 5.6 253 1443 5.7 External Eye Disease 215 776 3.6 264 1164 4.4 Miscellaneous 2032 10750 5.3 2119 14202 6.7 2623 13603 5.2 2854 18162 6.4 Adenoids and Enlarged Tonsils. During 1950, 585 children were operated upon for adenoids and enlarged tonsils, and 1.885 attendances were made at the Throat Clinic. Operations were suspended during the months of high incidence of poliomyelitis. 107 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. Body Ringworm Scalp Diphtheria. Scarlet Fever Dysentery Poliomyelitis. Jaundice. Conjunctivitis. Sore Throat. Indefinite Sickness. In, Not Infectious Meningococcal Infection Percentage incidence of conditions notified in Schools All Saints 277 2 ... 10 8 1 ... 2 ... ... ... 1 ... 1 1 ... 2 ... ... 1 10.5 Arch. Ten.(Bys) 202 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 0.5 Arch. Ten. (Gls) 131 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 0.8 Ashburton 421 10 4 18 5 2 1 2 ... ... ... 26 ... ... ... 3 1 3 ... ... 5.3 Benson 466 3 1 7 37 ... ... 1 2 ... ... 2 ... ... ... ... ... 2 ... ... 11.8 Beulah 1006 34 ... 46 46 ... 1 4 5 5 ... 26 5 1 ... 2 2 4 ... ... 18.1 Christchurch 233 16 ... 5 3 1 ... 5 ... ... ... 3 ... ... ... 6 ... 1 ... ... 17.2 Coloma 502 ... ... ... ... ... ... ... ... ... ... 7 ... ... ... ... ... ... ... ... 1.4 Croydon British 206 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croydon High 902 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 0.2 Cypress 397 22 4 4 6 2 ... ... 1 ... ... 20 ... ... ... ... ... ... ... ... 14.9 Davidson 761 4 ... 18 10 14 ... ... ... ... ... 16 ... ... ... 1 ... 2 ... ... 8.7 Duppas 371 ... ... 5 1 7 ... ... ... ... ... 3 ... 1 ... ... ... 5 ... ... 5.7 6.0 Ecclesbourne 811 l ... 13 10 8 ... 11 ... ... ... 3 ... ... ... 1 ... 1 ... ... Elmwood 727 23 ... 16 32 ... ... 6 1 ... ... 10 ... ... 3 3 3 2 ... ... 13.6 Gilbert Scott 622 1 ... 22 53 ... ... 4 1 ... ... 2 ... 1 3 2 ... ... ... ... 14.3 Gonville 401 ... ... 21 3 26 ... ... ... ... ... 8 ... ... ... ... ... 2 ... ... 15.0 Heath Clark 312 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 0.3 Howard 360 25 ... 8 3 1 1 ... ... ... ... 1 ... ... 1 ... 1 ... ... ... 5.0 Ingram 765 ... 3 39 1 1 ... ... 2 ... ... 7 4 1 ... ... ... 2 ... ... 11.2 John Ruskin 351 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 0.3 Kensington 438 23 14 7 2 ... ... ... ... ... 3 ... ... ... ... ... ... ... ... 11.4 Kingsley 662 2 2 20 18 4 1 ... 1 ... ... 18 ... ... ... 3 ... 2 ... ... 11.3 Lady Edridge 329 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... - Lanfranc 863 ... ... ... 1 2 ... ... 1 ... ... 2 1 1 ... 1 1 ... ... ... 2.1 Monks Orchard 442 2 ... ... 20 2 1 ... ... ... ... 6 ... 1 ... ... ... ... ... ... 7.5 New Addington 535 14 ... 2 1 ... ... ... ... ... ... ... ... 1 13 ... ... ... ... ... 5.8 Norbury Manor 1291 1 2 34 11 65 2 ... ... ... ... 11 ... ... 1 ... ... 2 ... ... 10.2 Old Palace 383 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... - Oval 639 7 4 31 5 ... 4 1 ... ... ... 5 ... ... ... 2 ... 4 ... ... 9.9 Parish Church 368 1 16 4 2 ... ... ... ... ... ... 7 ... ... ... 1 ... 2 ... ... 9.0 Portland 796 2 ... 11 5 ... ... ... ... ... ... 24 ... ... ... 2 4 ... ... 6.0 Purley Oaks 759 8 2 16 28 1 ... ... 1 ... ... 18 ... ... ... ... ... ... ... ... 10.1 Rockmount 509 36 ... 19 22 47 ... ... ... ... ... 7 ... 1 8 1 1 20 ... ... 32.8 St. Andrew's 427 1 ... 2 22 ... ... ... ... ... ... 3 ... 1 ... ... ... ... ... ... 6.4 St. Christophers 203 ... ... 2 1 ... 1 ... ... ... ... ... ... ... ... 2 ... ... ... ... 4.4 St. Giles' 147 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1.4 St. Joseph's 396 ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 0.5 St. Luke's 29 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Mark's 124 7 ... 9 2 8 ... ... ... ... ... 4 ... ... ... ... ... 1 ... ... 25.0 St. Mary's R.C. 454 ... ... ... 10 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2.6 St. Michael's 158 ... ... 11 1 8 ... ... ... ... ... 1 ... ... 3 2 ... 2 ... ... 18.4 St. Peter's 119 2 ... 8 58 30 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 83.2 School of Bldg. 163 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 0.6 Selhurst Gram. 1123 ... 1 ... 2 2 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 0.6 Shirley 181 ... 1 2 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 3.3 South Norwood 889 10 2 4 7 43 ... ... ... 2 ... 43 ... ... ... ... ... 1 ... ... 19 8 Spring Park 435 1 ... 3 2 2 ... ... ... ... ... 9 ... ... ... ... ... ... ... ... 4.1 Stanley Tech 234 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 0.9 Sydenham 657 ... ... 12 1 15 ... ... ... ... ... 9 ... ... ... ... ... 2 ... ... 5.9 Tavistock 833 ... ... 1 1 1 2 ... ... ... ... 1 ... ... ... 1 1 1 ... ... 1.2 Waddon 929 ... ... 10 3 1 ... ... ... ... ... 2 ... ... ... 3 1 ... ... ... 2.7 W. Thornton 602 26 ... 14 ... 23 ... ... 1 ... ... ... ... ... ... ... ... 2 ... ... 11.8 Whitehorse 710 1 ... 32 7 1 3 ... ... ... ... 10 ... ... ... ... ... 1 ... ... 8.2 Whitgift Gram. 800 ... ... ... ... ... ... ... ... ... 3 ... 1 ... ... ... ... ... ... 0.5 Whitgift Middle 539 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 0.2 Winterbourne 1050 2 1 13 11 10 ... 3 ... ... ... 27 ... ... 1 2 ... ... ... ... 6.7 Wolsey 744 33 ... 6 8 2 ... 1 ... ... ... 6 ... ... 4 1 ... ... ... ... 8.2 Woodside 10,2 25 2 30 6 2 ... 6 1 ... ... 19 ... 1 1 1 ... 1 1 ... 9.2 Totals 347 58 553 489 336 17 88 17 7 1 390 10 14 40 41 17 73 1 1 24 108 CHIEF CAUSES 0F EXCLUSIONS FROM SCH00L Condition Condition Percentage of total exclusions Exclusions during 1949 Percentage of total exclusions Ringworm 24 0.91 39 1.83 Verminous Conditions 128 4.87 156 7.33 Impetigo 88 3.35 79 3.12 Scabies 17 0.65 44 2.07 Scarlet Fever 390 14.84 276 12.97 Measles (inc. German) 405 15.41 634 29.79 Diphtheria 1 0.04 4 0.19 Whooping Cough 553 21.04 95 4.46 Chicken Pox 489 18.60 483 22.70 Mumps 336 12.78 102 4.79 External Eye Disease 41 1.56 65 3.05 Sore Throat 17 0.65 43 2.02 Other Causes 140 5.33 108 5.08 Total 2629 2128 — The figures for exclusions are not related in any way to the figures obtained in routine medical inspections. These figures show an increase in Impetigo, Scarlet Fever, Whooping Cough, Mumps and Chicken Pox, whilst Ringworm, Verminous Conditions, Scabies, Measles, External Eye Disease and Sore Throat 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 656 Visits re Scabies 1 Visits re Infectious Disease 80 Visits re Medical Inspections 628 All other reasons 889 Home Visits. Concerning defects found at routine medical inspections 2,265 Subsequent visits re defects found at routine medical inspections 346 Visits re special cases 600 Visits to dental cases 42 Visits other than infectious cases 1,242 Visits in connection with infectious cases (including 514 visits concerning uncleanliness) 4,393 109 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 1671 - 1671 815 — This Clinic showed a decrease upon 1949 in numbers submitted to refraction. A total of 3,127 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, 194S, 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. Staffing. The work of the sub-department continues to be seriously handicapped by lack of professional staff. Since last year's Report the services of two further part-time dentists have been secured, giving an added seven sessions weekly. Though this indicates some measure of improvement, the present total of four full-time and four part-time dental surgeons only represents the equivalent of 5.4 full-time officers, compared with the normal establishment of nine full-time dental surgeons necessary to deal with the school population of approximately 29,500. 110 When deductions are made for Maternity and Child Welfare work present commitments entail a potential "panel" of some 6,700 children to each full-time dentist. With the existing acceptance rate of 74 per cent. this state of affairs involves an unduly long period between successive inspections, or a serious curtailment in the scope of treatment. In practice it is found that, despite the application of every reasonable compromise, the average child is lucky to be offered treatment at under an eighteen months period, compared with the yearly minimum advocated bv the Ministry. In the face of the rising school population the difficulties of maintaining an adequate service over the next few years must inevitably increase. As a result of the unsatisfactory staffing position it has, unfortunately, not been possible to proceed with the plan of clinic development required to serve the more outlying sections of the Borough. This omission involves much additional time spent in travelling for patients residing in such areas and also leads to overcrowding of existing centres. A angements for Treatment. In the absence of alternative clinic accommodation the major portion of treatment continues to be carried out at Lodge Road clinic, where five surgeries are forced to work in close proximity to one another. Though with the recent extension these premises would be capable of dealing with normal requirements, the introduction of additional part-time staff has created a good deal of congestion at "peak" periods and a greater degree of decentralisation is now urgently required. It is hoped that this will be possible as soon as more outside surgery accommodation is available. Other dental centres are provided at Duppas Hill (South Crovdon) and at 206, Selhurst Road. In the case of the latter clinic a major reconstruction is at present being carried out and treatment at these premises is due to recommence at an early date. Additional clinics have been planned for the Woodside area and the New Addington Housing Estate, as part of the post-war programme of expansion formulated in 1946. At Addington suitable premises are available adjoining the existing Welfare Centre, and it is hoped that conversion will be possible during the early months of 1951. 111 The following Table illustrates the suggested "long term" plan of development mentioned above, together with the increase in staff likely to be required:— PRESENT AND FUTURE COMMITMENTS. Year. Estimated Increase in School Population. Total. Probable Increase in Dental Officers Required 1946 Present Population 25,680 1 (Woodside)* 1947 Plus 14-15 age group, 1,855 27,575 1 (Addington)* 1948-9 Plus 15-16 age group, 1,855 — Plus Housing Estate 5,260 34,690 2 (Lodge Rd. extension) 1950 and onwards. Plus County Colleges 7,000 Plus Nursery Schools 800 42,490 1-2 Total: 5-6 *Now behind schedule. Inspections. The number of children on the register at Primary and Secondary Schools within the Borough at the close of 1950 was 29,235. Including an additional 77 free-place scholars at nonmaintained schools, this represents a sum total of 29,312. Of these 23,534 were inspected and 11,716 (50 per cent.) referred for treatment, compared with 20,478 inspected and 9,404 referred in 1949. Though these figures show an increase of some 4 per cent. in the number requiring treatment this does not necessarily indicate a worsening of the dental condition generally. Bearing in mind the fact that fewer children received treatment as "emergency" cases before their school could be inspected, it is probable that the above findings are of only passing significance. Owing to lack of staff, sixteen departments (Primary and Secondary) comprising some 4,140 children, received no routine dental inspection during the year. The results obtained from school inspections were as follows: Acceptance of Treatment 71.9% Refused Treatment 15.0% Forms Not Returned 13.1% 112 Compared with recent years acceptances show a fall of some 2.5 per cent. Whilst at the present time this may be regarded as a not unmixed blessing it undoubtedly represents the public reaction to conditions existing in (he Service. This view is confirmed bv various communications from parents expressing dissatisfaction at the long waiting period for treatment and informing us of their decision to make alternative arrangements in future. The following Table demonstrates the progressive rise in the acceptance rate during recent years:— RESULTS OF SCHOOL INSPECTIONS. 1950. 1949. 1946. 1943. 1937. No. referred for— Treatment 11716 9404 12046 9041 13498 Consents 8420: 71.9% 6996:74.4 % 8433: 70% 5642:62.4% 7762:57.5% (Total Consents Including Specials)* 10817:76.6%) (10098:80 7%) (13810:74%) (6814: 67%) (10146:63%) Refusals 1757:15.% 1213:12.9% 1542:12.8% 1519: 16.8% 3242: 24% Forms Not Returned 1539:13.1 % 1195:12.7% 2071:17.2% 1880: 20.8% 2494:18.5% *Specials.—Those referred by Head Teachers with Emergency Forms Treatment. Of 10,817 children consenting to treatment (including specials) 9,717 (89.8 per cent.) were treated and 8,220 (75.9 per cent.) cured (completely), compared with 10,098 consenting, 9,513 (94.2 per cent.) treated, and 8,302 (82.6 per cent.) cured in 1949. As a result chiefly of increased sessions by part-time staff, operative sessions rose from 1,605 to 1,921. Assistance thus given has materially helped in reducing arrears of treatment, particularly for schools in outlying areas. Because of this, appreciably less time has been spent in dealing with casual cases, and it has been possible for the energies of the staff to be more constructively employed. An index of the improved position will be gained in noting that the ratio of fillings inserted per 100 children treated, which in more normal times stood at approximately 120 and fell in 1949 to 65.3, has now assumed the more substantial level of 98.6 for the current year. 113 Items of Treatment The ensuing Table gives particulars of the principal items of treatment compared with those obtained last year:— 1950. 1949. Attendances 20,434 18,620 Treated 9,717 9,513 Re-treated 5,304 4,632 Fillings—Permanent 8,129 5,182 Temporary 1,449 1,036 Extractions—Permanent 2,069 1,722 Temporary 9,444 10,056 Gas Administration 3,695 3,447 Local Anaesthetics 2,018 2,780 Other Operations—Permanent 5,929 5,533 Temporary 2,712 3,047 Cases Completed 8,220 8,302 Special Treatment. These include— 1950. 1949. Root treatment in anterior teeth 49 36 Removal of nerves under local anaesthetic 20 17 Gingivectomy 3 4 Removal of bone sequestra 4 2 Splints for fractured incisors 17 1 Number of M.D.s treated 41 20 Dentures inserted 54 43 Irrigation of sockets 23 28 Removal of impacted and difficult teeth 28 24 Ulcerated stomatitis (Vincent's infection) 18 20 Cleft Palate or Labial Fraenum — — Application of Penicillin "Cones" 49 43 Crowns for Incisor Teeth 2 2 Referred for X-Ray 165 10.1 Forms from Head Teachers. The number of forms issued by Head Teachers for emergency treatment was 2,397 compared with 3,102 in 1949. X-Ray Examinations. The number of cases referred to Mayday Hospital for the above purpose was 165, compared with 101 in 1949. 114 Orthodontic Treatment. Because of staffing limitations less time has been available for this branch of work. 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 172 compared with 157 last year. The following is a summary of treatment performed:— 1950. 1949. Cases under Treatment 256 277 New Cases 89 128 Cases Completed 93 147 Attendances 1,861 2,040 Appliances—Fixed 47 16 Removable 107 136 Treatment Sessions 172 157 Treatment of "Free-Place" Scholars. As previously stated, all children in the Borough Secondary and Technical Schools have now been included within the routine scheme of treatment. Pupils previously attending Primary Schools who enter certain non-maintained schools as "free-place" scholars are, however, eligible for attendance at the School Dental Clinic. A summary of the treatment performed for the above children is given below:— 1950. 1949. Attendances 271 268 New Cases Treated 38 43 Re-treated 39 66 Fillings—Permanent 156 158 Extractions—Permanent 49 33 Temporary 23 23 Other Operations 69 100 "Gas" Cases 14 22 Local Anaesthesia 40 17 Cases Completed 73 83 Dentures Fitted 3 3 Referred X-Ray 4 5 115 Summary of Work Done at the Selhurst Road Clinic. 1950. 1949. Attendances 3,149 3,181 Extractions 1,478 1,567 Fillings 1,133 993 Other Operations 2,610 2,898 "Gas" Cases 357 319 Local Anæsthesia 508 711 Cases Completed 1,175 1,343 Sessions held: Inspection 31, Treatment 380, Gas 29. The average attendance at this Clinic per session is 8.2. Summary of Work Done at the Waldrons Clinic. 1950. 1949. Attendances 2,808 2,639 Extractions 1,303 1,493 Fillings 1,265 584 Other Operations 793 746 "Gas" Cases 526 578 Local Anæsthesia 120 223 Cases Completed 837 759 Sessions held: Inspection 18, Treatment 270, Gas 41. The average attendance at this Clinic per session is 10.3. DENTAL DEFECTS. (1) Number of children who were— (a) Inspected by Dental Officer: Year Year 1950. 1949. Aged 5-6 1,181 Total: 23,534 1,236 ,, 6-7 2,284 2,239 ,, 7-8 2,227 2,289 ,, 8-9 2,389 1,864 ,, 9-10 2,354 2,062 ,, 10-11 2,227 2,068 ,, 11-12 2,089 1,998 ,, 12-13 2,120 1,705 ,, 13-14 2,332 1,794 ,, 14-15 2,207 1,632 ,, 15-16 1,376 1,052 ,, 16 up 748 539 Specials 2,397 3,102 25,931 23,580 116  Year Year 1950. 1949. (b) Found to require treatment 14,113 12,506 (c) Actually treated 9,717 9,513 (2) Half-days devoted to Inspection 185 156 Treatment 1,921 2,106 1,605 1,761 Number of Gas Sessions 243 228 Administrative Sessions 82 101 Orthodontic Sessions 172 157 (3) Attendances made by children for treatment 20,434 18,620 (4) Fillings— Permanent teeth 8,129 5,182 Temporary teeth 1,449 9,578 1,036 6,218 (5) Extractions— Permanent teeth 2,069 1,722 Temporary teeth 9,444 11,513 10,056 11,778 (6) Administrations of general anaesthetics for extractions 3,695 3,447 (7) Administrations of local anaesthetics for extractions 2,018 2,780 (8) Other Operations— Permanent teeth 5,929 5,533 Temporary teeth 2,712 8,641 3,047 8,580 Attendances per session 10.6 11.6 DIPHTHERIA IMMUNIZATION. Diphtheria Immunization has been carried out at the clinics and in the schools. The assistance of the teachers has been much appreciated. Inoculations were suspended during the period of incidence of poliomyelitis. The number of children between the ages of 5 and 15 years immunized against Diphtheria during the year was 560 together with 3,809 who were given re-inforcing injections. Every 117 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., 1950. Cases. Discharged. 1950. 394 269 212 451 337 children were seen by the Orthopaedic Surgeon and 512 attendances were made. ST. CHRISTOPHER'S SPECIAL EDUCATIONALLY SUB-NORMAL SCHOOL. I am indebted to Mr. Ramsden, the Head Master, for the following observations:— This School is for Educationally Sub-normal Children and at the present time has a roll of 200. During 1951, we hope to extend the facilities to a further 40 children. The year 1950 may be looked upon as one of definite progress. It is very pleasing to be able to report that the teaching of Arithmetic has made great strides during the past year. Many children are now tackling problem Arithmetic in a very efficient manner. We can, also, report with satisfaction that we have many fluent readers, and many are borrowers from the public library. In this sphere, we feel, is an opportunity for any well-wishers to assist in the provision of a good library for each class, and any subscriptions would be gratefully acknowledged by the Headmaster. Great advance has been made by the higher grade boys in the craft of book-binding under the tuition of Mr. Butler, and during The forthcoming year of 1951 we hope to successfully bind a book. The provision of cocoa on arrival, and the excellent hot midday meals continue to be a very important factor in building up the children's physical and mental condition, and many thanks are again due to the Education Committee for their provision, and to our Cook and her staff for the good cooking and excellent service. During the year the School again visited Littlehampton, and a very enjoyable day was spent by the sea. In 1950 the School was re-furnished throughout with locker desks obtained from the John Ruskin Grammar School. The year 1950 was also memorable as we held our first Sports' Meeting. The talent found encourages us to hope that very soon we shall be able to compete in the Croydon School Sports Day with other schools 118 Form la boys, with their teacher, Miss Knight, visited the Evening Standard works and saw the paper printed from start to finish. A very interesting visit which we hope will be renewed at some future date. This excursion has had an incalculable effect on the morale of the School, and will be remembered for a very long time. We hope to extend this visiting to works in Croydon for both boys and girls during 1951. His Majesty's Inspector of Schools, Miss R. C. Goulden, visited the School and inspected the girls physical training, and expressed her pleasure at the results obtained by Miss Thompson. Finally, we once again ended our year with the Christmas Carol and Tableaux Service. A large number of parents and friends joined us. Among our guests we warmly welcomed the Lord Bishop of Croydon and the local inspectors. Number attending January 1st, 1950 183 „ „ December 31st, 1950 200 „ referred to Public Elementary Schools 3 Number discharged : (i) Ineducable and referred to Mental Health Committee 4 (ii) Unfit to work „ „ „ 3 (iii) Fitto work „ „ „ 9 CLINIC FOR EDUCATIONALLY SUB-NORMAL CHILDREN. 300 children were examined during 1950. 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 10 (b) Found to be mentally defective and referred to Local Authority for Statutory Supervision 14 (c) Recommended Institutional Care and referred to Local Authority 8 (2) Found to be educationally sub-normal : (a) Recommended to St. Christopher's Special School 64 (b) Recommended to Residential School 4 119 (c) Referred to Special Class in Ordinary tary School 30 (d) Recommended for re-test 62 (e) Deferred for Medical Treatment 10 (f) Recommended for St. Giles' 6 (g) Recommended Epileptic Colony 2 (h) Referred hack to Ordinary Elementary School 42 (3) Referred to Child Guidance Clinic 12 (4) Examined for other Authorities 6 270 Mental Tests at St. Christopher's 30 300 768 home visits have been paid to Education cases. Speech Defects Clinic. Cases treated 142 Cleft palate and allied Cases discharged 81 disorders 12 Cases still attending 61 Sigmatism 18 Cases referred for phyDeafness 5 sical treatment 10 Dyslalia 56 Cases referred for resiUndeveloped speech 8 dential treatment 3 Dyspituitary 1 Cases referred to Child Aphasia 1 Guidance Clinic 3 Post-Meningitis 1 Stammerers 38 Dysarthria 2 The most noticeable trend in the Speech Clinic in 1950 has probably been the large number of organic cases referred for treatment. Functional cases still predominate, but far more specialist hospitals seem to be asking for local clinical facilities for their patients. The proportion of stammerers to the case treated has been less than for some years. 120 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 — 3 3 7 45 26 62 1 1 148 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Homes - 3 1 4 44 22 - 1 - 75 On or about December 1st:— C. Number of Handicapped Pupils from the area : (i) attending Special Schools as Day Pupils Boarding Pupils - 28 3 8 64 90 200 - - 393 4 — 8 1 13 3 3 3 4 39 (ii) Boarded in Homes - - - - - - - - - - (iii) attending assisted schools (under approved arrangements) ___ 3 1 2 6 12 Total (C) 4 28 14 10 77 95 203 9 4 444 D. Number of Handicapped pupils being educated under arrangements made under Section 56 of the Education (a) in hospitals - - - - - 9 - - - 9 (b) elsewhere - — — 11 6 — — — 17 E. Number of Handicapped pupils from the area requiring places in special schools (including any such unplaced children who are temporarily receiving home tuition) - - 1 1 11 6 27 - - 46 Number of children reported during the Calendar Year : Under Section 57(3) of Education Act, 1944 14 „ „57(4) „ „ „ Nil „ „ 57(5) „ „ „ 7 121 JUVENILE EMPLOYMENT RETURN. The following numbers of children were examined by the medical officers during 1950 as to their fitness to following the part-time employment indicated:— 1950. 1949. 1948. 1947. 1946. Delivery of Goods for Shopkeepers 71 218 190 112 2 Delivery of Newspapers 323 283 375 151 125 Delivery of Milk 29 16 33 6 9 Shop Assistants 104 — — — — 527 517 598 269 136 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT. During 1950 all milk was supplied free of charge, and approximately 24,000 children per day received l/3rd pint each. This was equal to 90 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 1950 was approximately 16,200. CHILD GUIDANCE CLINIC. Return of Cases referred by the School Medical Officer and the Education Department, from 1st January to 31st December, 1950. Boys. Girls. Total number referred 51 23 \nalvsis of the above Cases:— Diagnostic only 15 6 Current Cases under treatment 19 6 Cases Closed—improved 11 5 Cases Closed—not improved 6 6 51 23 132 NON-MAINTAINED SCHOOLS. The usual arrangements for the medical inspection of nonmaintained school children were continued in 1950, 123 children were examined. Table II of Appendix B gives the detailed findings Yours faithfully, S. L. WRIGHT, School Medical Officer. 123 APPENDIX A. MEDICAL INSPECTION RETURNS. Year ended 31st December, 1950. Table I. MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. A.—Periodic Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 3,276 Second Age Group 2,683 Third Age Group 2,319 Total 8,278 Number of other Periodic Inspections (8-9 years). 2,824 Grand Total 11,102 B.—Other Inspections. Number of Special Inspections 4,471 Number of Re-Inspections 6,760 Total 11,231 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 11 A. Total individual pupils. (1) (2) (3) (4) Entrants 18 549 565 Second Age Group 186 355 529 Third Age Group 199 181 377 Total (prescribed groups) 403 1085 1471 Other Periodic Inspections 171 406 562 / Grand Total 574 1491 2033 124 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 40 11 6 1 5 Eyes— (a) Vision 574 71 76 4 (b) Squint 58 24 3 - (c) Other 21 8 3 1 6 Ears— (a) Hearing 18 12 3 - (6) Otitis Media 10 12 1 - (c) Other 7 2 2 3 7 Nose or Throat 557 293 32 6 8 Speech 18 24 6 1 9 Cervical Glands 4 18 - 1 10 Heart and Circulation 31 47 8 3 11 Lungs 83 133 8 7 12 Developmental— (a) Hernia 6 4 - - (b) Other 4 14 - - 13 Orthopaedic— (a) Posture 291 73 17 3 (b) Flat foot 174 87 14 4 (c) Other 130 58 14 6 14 Nervous System— (a) Epilepsy 4 8 1 5 (ft) Other 5 18 2 2 15 Psychological— (a) Development 2 5 — — (b) Stability 3 9 1 2 16 Other 89 77 21 14 * These figures refer to Special Inspection in school only. 125 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 3276 895 27.3 2271 69.3 110 3.4 Second Age Group 2683 766 28.6 1788 66.6 129 4.8 Third Age Group 2319 576 24.8 1667 71.9 76 3.3 Other Periodic Inspections 2824 715 25.3 1981 70.2 128 4.5 Total 11102 2952 26.6 7707 69.4 443 4.0 Table III. INFESTATION WITH VERMIN. (i) Total number of examinations in the schools by the school nurses or other authorized persons 72457 (ii) Total number of individual pupils found to be infested 785 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 30 (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) 4 126 Table IV. GROUP 1.—DISEASES OF THE SKIN (excluding uncleanliness, for which see Table III) Number of cases treated or under treatment during the year. By the Authority. Otherwise. Ringworm—(i) Scalp 4 (ii) Body 12 — Scabies 14 Impetigo 37 — Other Skin Diseases 84 — Total 151 — GROUP 2.—EYE DISEASES, DEFECTIVE VISION AND SQUINT. Number of cases dealt with. By the Authority. Otherwise. External and other, excluding errors of refraction and squint 215 - Errors of Refraction (including squint) — 1671* Total 215 1671 Number of pupils for whom spectacles were (a) Prescribed — 815* (b) Obtained — 1123* Total — 1938 GROUP 3.—DISEASES AND DEFECTS OF EAR, NOSE AND THROAT. Number of cases treated. By the Authority. Otherwise. Received operative treatment (a) for diseases of the ear — — (b) for adenoids and chronic tonsilitis — 585 (c) for other nose and throat conditions — — Received other forms of treatment — — Total 585 * Including cases dealt with under arrangements with the Supplementary Ophthalmic Services. 127 GROUP 4.—ORTHOPAEDIC AND POSTURAL DEFECTS. (a) Number Treated as in-patients 11 By the Authority. Otherwise. (ft) Number treated otherwise, e.g., in clinics or outpatients departments 257 337 GROUP 5.—CHILD GUIDANCE TREATMENT. Number of cases treated. In the Authority's Child Guidance Clinics. Elsewhere Number of pupils treated at Child Guidance Clinics — 74 GROUP 6.—SPEECH THERAPY. Number of pupils treated by Speech Therapists Number of cases treated. By the Authority. Otherwise. 142 GROUP 7.—OTHER TREATMENT GIVEN. Number of cases treated. By the Authority. Otherwise. (a) Miscellaneous minor ailments 1662 — (b Other (specify) 1. Orthoptic — 132 2. Sunlight — 46 3. Verruca 370 — Total 2032 178 128 Table V. DENTAL INSPECTION AND TREATMENT. 1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 23534 (b) Specials 2397 (c) Total (Periodic and Specials) Total 1 25931 (2) Number found to require treatment 14113 (3) Number referred for treatment 14113 (4) Number actually treated 9717 (5) Attendances made by pupils for treatment 20434 (6) Half-days devoted to : (a) Inspection 185 (b) Treatment 1921 Total 6 2106 (7) Fillings: Permanent Teeth 8129 Temporary Teeth 1449 Total 7 9578 (8) Number of Teeth filled: Permanent Teeth Not Recorded Temporary Teeth Not Recorded (9) Extractions: Permanent Teeth 2069 Temporary Teeth 9444 Total 9 11513 (10 Administration of general anaesthetics for extraction 3695 (11 Other Operations: (a) Permanent Teeth 5929 (b) Temporary Teeth 2712 Total 11 8641 129 APPENDIX B. NON-MAINTAINED SCHOOLS. Year ended 31st December, 1950. Table I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Year 1949. Year 1960. Age 11 or under 48 35 12 74 16 13 40 4 14 41 35 15 21 6 16 19 24 17 14 1 18 or over 8 2 Total .. 265 123 B.—Other Inspections. Year 1949. Year 1950. Number of Special Inspections — — Number of Re-inspections 1 3 Total 1 3 Visits to Non-maintained Schools 13 7 130 NON-MAINTAINED TABLE II.—A.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1960. Routine Inspections Number of defects. Special Inspections Number of defects. DEFECT OR DISEASE. Requiring treatment Requiring to be kept under observation but not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment (1) (2) (3) (4) (5) Malnutrition ... ... ... ... Uncleanliness. (See Table IV.—Group V.) Skin— Ringworm: Scalp ... ... ... ... Body ... ... ... ... Scabies ... ... ... ... Impetigo ... ... ... ... Other diseases (non-tuberculous) ... ... ... ... Eye— Blepharitis ... ... ... ... Conjunctivitis 1 ... ... ... ...Keratitis ... ... ... ... Corneal opacities ... ... ... ... Defective vision (excluding squint) 16 ... ... ... Squint 2 ... ... ... Other conditions ... ... ... ... Ear Defective hearing ... ... ... ... Otitis media ... ... ... ... Other ear diseases ... ... ... ... Nose and Throat- Enlarged tonsils only ... ... ... ... Adenoids only ... ... ... ... Enlarged tonsils and adenoids 2 2 ... ... Other conditions 1 ... ... ... Enlarged Cervical Glands (Non-Tuberculous) ... ... ... ... Defective Speech ... 1 ... ... Teeth—Dental Disease ... ... ... ... Heart and Circulation— Heart Disease— Organic ... ... ... ... Functional ... ... ... ... Anaemia ... ... ... ... Lungs— Bronchitis ... ... ... ... Other non-tuberculous diseases ... ... ... ... Tuberculosis— Pulmonary— Definite ... ... ... ... Suspected ... ... ... ... Non-pulmonary— Glands ... ... ... ... Spine ... ... ... ... Hip ... ... ... ... Other bones and joints ... ... ... ... Skin ... ... ... ... Other forms ... ... ... ... Nervous System— Epilepsy ... ... ... ... Chorea ... ... ... ... Other conditions ... ... ... ... Deformities— Flat feet 10 ... ... ... Posture 8 ... ... ... Other forms 9 ... ... ... Other Defects and Diseases 2 ... ... ... 131 CONTENTS. A.—PUBLIC HEALTH REPORT. page Acts, Adoptive 67 Airport 90 Ambulance Service 52 Amusement Houses 73 Animals, Keeping of 73 Ante-Natal Clinic 39 Births 4, 5, 6 Byelaws and Regulations 67 Cancer 12 Chemical Analyses 36 Chest Clinic 20 Child Minders 89 Contacts, Tuberculosis 26 Convalescence 56 Committee 1 Cremation 90 Dairies, Cowsheds and Milkshops 78 Day Nurseries 43 Deaths 4,5,6,11 Dental Treatment—M. & C.W. 44 Diphtheria 17 Disinfection 73 Disinfestation 74 Ditches 73 Domestic Helps 56 Drainage 73 Dysentery 17 Extra Nourishment 26 Factories and Workshops 71 Fertilisers & Feeding Stuffs Act 75 Foods 75, 76, 77, 82 Gastro-Enteritis 17 Health Propaganda 57 Health Visitors, Work of 48a page | Acts, Adoptive 67 Airport 90 Ambulance Service 52 Amusement Houses 73 Animals, Keeping of 73 Ante-Natal Clinic 39 Births 4,5, 6 Byelaws and Regulations 67 Cancer 12 Chemical Analyses 36 Chest Clinic 20 Child Minders 89 Contacts, Tuberculosis 26 Convalescence 56 Committee 1 Cremation 90 Dairies, Cowsheds and Milkshops 78 Day Nurseries 43 Deaths 4,5,6,11 Dental Treatment—M. & C.W. 44 Diphtheria 17 Disinfection 73 Disinfestation 74 Ditches 73 Domestic Helps 56 Drainage 73 Dysentery 17 Extra Nourishment 26 Factories and Workshops 71 Fertilisers & Feeding Stuffs Act 75 Foods 75, 76, 77, 82 Gastro-Enteritis 17 Health Propaganda 57 Health Visitors, Work of 48a pag3 Home Helps 56 Home Nursing 26 Homework 72 Hospital, Isolation 16 Housing 69 Housing Act 69 Ice Cream 81 Illegitimacy 4,5,44 Immunisation 18 Infant Welfare Clinics 41 Infant Mortality 4, 7,8,9 Infectious Diseases 14, 16 Inquests 6 Local Acts 67 Marriages 5 Maternity Homes 89 Maternity Homes, Registration 89 Maternity Outfits 51 Measles 14, 16 Meat Inspection 77 Medical Help Records 49 Men's Hostel 70 Mental Health 59 Midwives 49 Midwives, Municipal 50 Midwives Act 49 Milk, Provision of 26 Milk, Examination of 78 Milk, Tuberculous 79 Milkshops 78 Mortality in Childbirth 7 National Assistance Act 90 Neo-Natal Deaths 8 Notification of Birth Acts 6 Nuisances 66 Nursing Equipment 56 Nursing Homes 89 Nurses' Agencies 89 Offensive Trades 73 Ophthalmic Neonatorum 14 Outworkers 72 132 page Pests 75 Poisons and Pharmacy Act 74 Poliomyelitis 14 Ponds 73 Population 4 Post-Natal Clinic 39 Post-Mortems 6 Premature Infants 40 Puerperal Sepsis and Pyrexia 14 Rats & Mice (Destruction) Act 75 Refuse Collection 38 Road Traffic Accidents 12, 52 Sanatoria, Treatment in 26 Sanitary Administration 66 Sanitary Certificates 71 Sanitary Inspectors, Work of 66 Scarlet Fever 16 Sewage 38 Shop Hours Acts 72 Slaughterhouses 77 Smoke Observation 73 Staff Examinations . 89 Still-Births 4,6 page Tuberculosis—After Care 30 „ Allowances 30 „ Contacts 26 „ Deaths 24 „ Notifications 21 „ Home Nursing 26 „ Home Visits 26 „ Institutional Treatment 26 „ Occupational Therapy 29 „ Vaccination 28 „ Mass Radiography 29 Vaccination 19 Verminous Persons 74 Venereal Diseases 32 Vital Statistics 4 Ward Statistics JO Watercourses 73 Water Supply 35 Whooping Cough 16, 19 Zymotic Diseases 10 B.—SCHOOL MEDICAL REPORT. page Accommodation 96 Adenoids 106 Blind Children 120 Child Guidance 121 Cleansing of Children 104 Clinics 95, 106 Cod Liver Oil 121 Cost 103 Crippling Defects 117 Deaf Children 125 Deaths 104 Defective Children 102 Defective Hearing 124 Deformities 117 Dental Service 109 Ear Disease 124 Epileptic Children 124 Exclusions 108 Eye Clinic 109 Following-up 108 Health Visitors, Work of 108 Heights and Weights101 Immunization, Diphtheria 116 Infectious Diseases 107 Inspection Clinic 106 Inspections 99 Juvenile Employment 121 page Malt 121 Meals, Provisions of 121 Mentally Defective Children 117 Milk, etc., Provision of 103, 121 Minor Ailments 106 Non-maintained Schools 122 Orthopaedic Work 117 Orthodontic Service 114 Parents' Attendances 100 Physically Defective Children 120 Population 96 Remedial Exercises 106 Rheumatism Clinic 95 Schools, Special 103 Speech 119 Staff 95 Statistical Tables 123 Surveys, Uncleanliness 104 St. Christopher's 117 Throat and Nose 106 Treatment 106 Tuberculosis 105 Uncleanliness 104 Vision, Defective 109 X-Ray 113