CRO53 ronntg Borongh of rrogdon. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1951 S. L. WRIGHT, M.D., M.R.C.P., D.P.H. CROYDON : PRINTED EY THE CROYDON TIMES LTD., 104 HIGH STREET, CROYDON 1 1 HEALTH COMMITTEE. 1951. 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. H. M. Bunning. Councillor Mrs. V. L. Child. Councillor J. J. Cooper. Councillor A. V. Dammarell. Councillor R. H. Davies. Councillor J. W. Dowselt. Councillor A. Goodbun. Councillor Mrs. E. M. Jenkins. Councillor C. E. Mcyce. Councillor S. E. Rumbail. Councillor G. H. Ward, O.B.E. Councillor S. G. Wilkes. Miss Dorothy Day, M.R.C.S., L.R.C.P. R. N. Dcane, Esq., M.B., B.Ch., B.A.O. O. E. Finch, Esq., M.C., M.D. T. P. Rees, Esq., O.B.E., B.Sc. M.D., B.Ch., M.R.C.P., M.R.C.S.,. D.P.H. 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., Croydon Local Medical L.R.C.P. Committee. D. F. Kanaar, Esq., M.D., M.R.C.P. J. S. Lane, Esq., B.A., M.R.C.S., L.R.C.P. A. F. Clift, Esq., F.R.C.S., M.R.C.O.G. Croydon Group Hospital Management Committer.. Miss M. M. Durrani, S.R.N., I.N. Royal College of Nursing. Mrs. F. R. Mitchell, O.B.E Royal College oj Midwiver Miss J. C. Dickinson Croydon Nursing Service. Mrs. H. Thatcher Croydon Family Planning Association. 2 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1951. S. L. WRIGHT, M.D., M.R.C.P., D.P.H To the Chairman and Members of the Health Committee. Ladies and Gentlemen, I have the honour to present the 52nd Annual Report on the health of the people of Croydon and the relevant services of the Corporation for the year ending December 31st, 1951. In the year under review there was carried out the first census io be taken since 1931. From the preliminary report issued by the Registrar-General, Croydon had a "de facto" population (the actual number counted in Croydon as' present at midnight on 8-4-51) of 249,592. In due course when the analysis of all returns shows who normally lived elsewhere, and how many Croydon residents were counted at a place of temporary residence, a second total, the "de jure" population, will be available. This figure will probably be somewhat larger than the preliminary Croydon census figure and closer to the Registrar-General's estimate. During the interval 1921 to 1931, the census population of Croydon increased by 21.7 percent, and between 1931 and 1951, by 7.1 percent. The ratio of females to males remained relatively unchanged at 1,164 females to every .1,000 males. As counted on 8-4-51, there was an actual female excess of 18,958. Owing to the greater longevity of women, there is an overall female excess for the country as a whole, but the ratio is highest in London and Southern England. It is higher in Croydon than London. The Registrar-General suggests that these areas are more attractive to women because of opportunities for employment, and for those who have retired from work. 3 The birth rate in 195.1 showed a further decline. The standardised death rate was higher due to an epidemic of influenza with fatalities amongst elderly persons. There was another sharp decline in the infant mortality rate from the record low figure of last year. The improvement in mortality from tuberculosis was also maintained. As regards infectious diseases, the notifications of measles were exceptionally numerous. Some part of the increase no doubt relates to the readier availability of medical advice since 1948, but the large number of school entrants due to high post-war birth rates was also involved. All infectious diseases were mainly mild in character, and high incidence did not result in any similar increase in the number of fatal cases. Poliomyelitis cases were few compared with previous years. The absence of a single case of diphtheria is noteworthy. The personal health services provided by the Corporation have continued with few changes. Demands on the Ambulance Service have maintained their tendency to increase despite all administrative measures to lessen the burden. Delays arose in taking nonurgent patients to and from hospital out-patient departments. These journeys involve not only local hospitals, but any within the Greater London area The cost of providing an individual vehicle or an immediate response would be prohibitive. The essential need to maintain an irreproachable accident and emergency service means that rising costs' must be met from the purely transport side of the work, if existing expenditure limits are to be observed. The Council's policy of imposing an income limit for parents requesting admission of their children to a Corporation Day Nursery resulted in a marked fall in attendances and two nurseries were closed. The report of the Chief Sanitary Inspector shows how this work of the Department, which relates to the earliest health duties imposed on local authorities, retains its paramount importance. Atmospheric pollution is not usually an outstanding problem in Croydon, but valid complaints were received of nuisances due to grit and water vapour from the electricity stations. The statutory powers of the Corporation are restricted to ensuring the taking of all practicable measures to abate such a nuisance and unquestionably this was being done by the British Electricity Authority. It was admitted that success had not been obtained, but further comprehensive alterations were being carried out, which could not be completed during the year under review. 4 There occurred one large-scale outbreak of mild food poisonat a factory canteen. On investigation this was shown to be due to a disregard of one of the fundamental rules relating to the use of meals cooked and kept over-night. It emphasised the responsibility which rests upon the personnel, however modern the premises and adequate the equipment. Education of food handlers is the most important factor in any campaign to prevent food poisoning. Close co-operation and cordial officer relationships continue between the three authorities responsible under the National Health Service Act for the carrying out in Croydon of the National Health Service. I thank the Committee for their unfailing interest and encouragement in the work of the Department and the members of the staff for their usual high standard of courtesy and efficiency. I am, Yours faithfully, S. L. WRIGHT, Medical Officer of Health. 5 STATISTICS SUMMARY OF VITAL STATISTICS FOR 1951. Area, 12,672 acres. Population (Census 1951), 249,592. Total Population (estimate of Registrar-General), 250,300 (Midsummer, 1951). Number of Inhabited Houses : 67,268. Rateable Value (1st April, 1951): £2,644,428. Product of a Penny Rate (1950-1951): £10,588. Rate in the £ : 15s. 2d. Live Births: M. F. Total. Legitimate 1,765 1,660 3,425 Illegitimate 101 93 194 3,619 Birth-rate per 1,000 of the estimated resident population, 14.5 (England and Wales 15.5: Great Towns 17.3). Birth-rate (as adjusted by comparability factor, 0.96): 13.9. Still Births, 78. Rate per 1,000 total (live and still) births, 21.1. Deaths, 2,975. Death-rate per 1,000 of the estimated population, 11.9. (England and Wales 12.5: Great Towns 13.4). Death-rate (as adjusted by comparability factor, 0.93), 11.1. Infant mortality rate, 19 per 1,000 live births. (England and Wales 30: Great Towns 34). Legitimate Infants (65 deaths), 19 per 1,000 live births. Illegitimate Infants (4 deaths), 21 per 1,000 live births. 6 Principal Causes of Death in order of frequency (Registrar-General's Return). Rate per Population. (1) All Ages. Deaths from diseases of Cardiac and Circulatory System 4.93 „ ,, Cancer 1.96 ,, ,, diseases of the Respiratory System (excluding' Tuberculosis) 1.30 ,, ,, diseases of Digestive System 0.21† ,, ,, Tuberculosis (all forms) 0.26* ,, ,, Suicide and Violent Causes 0.36 * England and Wales 0.31: Great Towns 0.37 t ulcers of stomach, duodenum: gastritis and enteritis. Rate per 1,000 of age group. (2) Ages 15-45 years. Deaths from Tuberculosis (all forms) 0.24 ,, ,, Cancer 0.30 ,, ,, Cardiac and Circulatory System 0.20 Marriages. The number of marriages solemnised was 1,900, compared with 2,051 in 1950, 2,060 in 1949, 2,109 in 1948, 2,410 in 1947, 2,105 in 1946, 2,268 in 1945, and 1,578 in 1944. 956 were solemnised in Established Churches, 334 in other places of worship, and 008 in the Register Office. Apparently two were performed under Jewish ritual. Births. The live births registered were 3,425 legitimate and 194 illegitimate. The birth-rate consequently was 14.5. For England and Wales and in the Great Towns the rates were 15.5 and 17.3. The illegitimate births in Croydon were 5.4 of the total compared with 5.0 in 1950, 4.9 in 1949, 0.0 in 1948, 5.5 in 1947, 0.5 in 1946 and 10.0 in 1945. The live male births numbered 1,866, the female 1,753, being a proportion of 1,005 males to 1,000 females. Deaths. The deaths numbered 2,975, compared with 2,728 in 1950. For 1951 the death-rate was 11.9, for 1950 it was 10.8. The deathrate for England and Wales was 12.5, and for the Great Towns 13.4. For London the death-rate was 12.5. 7 There were 89 inquests held by Coroners in respect of Croydon residents during 1951 and 375 findings by Coroners after post-mortem examination without inquest. Wards with the highest death-rate were East and Shirley (15.3), Central (14.2), and Bensham Manor (14.0). Lowest: Addington (3.0), Waddon (10.0), and West Thornton (10.6). Still Births. During 1951, 78 still births were registered in respect of Croydon Of these, 46 were male babies and 32 females; 2 males and 2 females were illegitimate The proportion of still births to living children was as 1 to 4G The still birth rate was 2.1 per cent, of the total births. The still birth rate, on the same basis as for Infant Mortality, was 21.1 per 1,000 births. Notification of Births. Notifications were received in respect of confinements conducted by:— Live Still Births. Births. Total. Midwives 2,970 66 3,036 Doctors 943 20 963 3,913 86 .. . 3,999 Accommodation for Confinement. The following table gives information concerning the accommodation utilised for confinements:— Number. Percentage. In Private Houses 1,343 33.58 In Public Institutions 2,035 50.89 In Registered Maternity Homes 621 15.53 3,999 8 Maternal Mortality. There were 3 deaths, compared with 2 in 1950. The maternal mortality rate was 0.81 per 1,000 births, compared with 0.53 in 1950. The deaths were caused by— (1) Pulmonary embolism, p.m. (2) Pulmonary embolism. (3) Toxaemia of pregnancy, p.m. MATERNAL AND INFANT M0RTAL1TY FOR THE YEARS 1933—1951 Year Births (Live and Still) Maternal Deaths Maternal Mortality Kate Infant Mortality Rate 1933 3,239 12 3.70 47 1934 3,301 13 3.93 46 1935 3,391 10 2.95 45 1936 3,373 13 3.85 41 1937 3,357 13 3.87 60 1938 3,430 3 0.87 40 1939 3,511 4 1.16 38 1940 3,031 5 1.65 30 1941 2,472 8 3.23 37 1942 3,579 12 3.35 3) 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 1951 3.697 3 0 81 19 Infant Mortality. The Infantile Mortality Rate was 19 per 1,000 live births registered, being a considerable reduction on 1950, which was then the lowest previously recorded. 9 For the past 5 years the number of infant deaths has been 1947—194, 1948—120, 1949—116, 1950—9G, and 1951—68. Among the G8 deaths, 31 occurred in boy babies and 37 in girls. Of the births, 1,866 were males and 1,753 females. The infantile mortality rate for the two sexes was, therefore, Boys— 17, Girls—21. Sixty deaths of infants occurred in Institutions, including Registered Nursing Homes. The following table gives the cause of death during the first month of life: — (1) Complications of Labour— Trauma at Birth 5 5 (2) Foetal States— Congenital Heart Malformation 2 Other Congenital Deformities 2 Atelectasis, etc. 4 Hemorrhagic Disease of Newborn 5 13 (3) Prematurity 25 25 (4) Post-Natal Causes 4 4 47 Percentage Deaths under 1 year per Total Infantile Deaths. Deaths under 1 year per 1,000 Births 1950 1951 1950 1951 Premature Births 45.8 38.2 11.9 7.19 Respiratory Diseases 18.8 14.7 4.9 2.76 Infectious Diseases 1.1 1.5† 0.3 0.28 Atelectasis, Debility and Marasmus 6.3 7.4 1.6 1.38 Diseases of Digestion 10.4 2.9* 2.7 0.55 Injury at Birth and Congenital 9.4 25.0 2.4 4.70 This was a death due to Whooping Cough *These deaths were due to Diarrhoea 1 and Gastritis 1. 10 The rate of infant mortality amongst legitimate children was 2G per 1,000 births. The rate in illegitimate children was l6 per 1,000 births. Deaths under one year, arranged in days, weeks and months. CAUSES OF DEATH. ■ 1st day. 2nd day. 3rd day. 4th day. 5th day. 6th day. 7th day. lst-2nd week. 2nd-3rd week. 3rd-4th week. Under 1 month. 1-2 months. 2-3 months. 3-4 months. 4-5 months. 5-6 months. 6-7 months. 7-8 months. 8-9 months. 9-10 months. 10-11 months. 11-12 months. total. All Causes 29 5 - 3 1 2 1 4 1 1 47 6 5 4 2 - 1 - 3 - - 68 Polio-Encephalitis - - - - - - - - - - - - - - - - - - - - - - - Chicken Pox - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - — — — - - — - - - — - — Scarlet Fever — — - — - — - - - — — — - —- - - - - - - - Whooping Cough — — - — - — - - - — - — - - - : - - - 1 - - 1 Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - - - - - - - - - - - - - - Convulsions - - - - - - - - - - - - - - - - - - - - - Laryngitis — — - — - — - - — — - - - - - - — - - Bronchitis - - - - - - - - - - - - - - - - - - - - - - - Pneumonia (all forms) — 1 — 1 - 1 - 3 1 2 3 - 1 - - - - - -, 10 - - - - - - - - - - - - - - - - - - - - - 1 Gastritis — — - — - — - - - - — 1 — — - - - - — - - 1 Syphilis — - — — — - — — — — - — - — — - - — — — — — — Rickets - — — - — - — — —. — - — . — — - - Congenital Malformations 2 1 - - - - - - 1 - 4 2 2 - - 1 - 1 2 - 12 Premature Birth 20 1 — 1 — 1 — 1 — 1 25 - 1 — — — — — — — — - 26 Atrophy, Atelectasis, Debility and Marasmus 3 1 - - - - - - - - 4 - - 1 - - - - - - - - 5 Injurv at Birth 1 1 2 1 - - - - - - - - - - - - - - - - - 5 Haemorrhagic disease of newborn 3 - - - - - - - - - - - - - - - - - - - - - 5 Other Causes - - - - - - - 1 - - 1 1 - - - - - - - - - - 2 Totals 29 5 _- 3 1 2 1 4 1 1 47 6 5 4 - 2 - 1 -| 3 — - 68 11 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 16862 228 199 13.5 11.8 22 0.06 - 0.77 0.24 0.18 5.75 1.96 + 29 Norbury 15761 161 210 10.2 13.3 31 - 0.06 1.52 0.19 0.12 4.06 2.47 — 49 West Thornton 18840 221 199 11.7 10.6 18 - - 0.85 0.21 0.05 4.62 1.59 + 22 Bensham Manor 15751 208 221 13.2 14.0 15 - — 1.21 0.19 - 6.66 2.98 — 13 Thornton Heath 17728 253 225 14.3 12.7 24 - - 1.47 0.34 0.06 5.06 2.09 + 28 South Norwood 16863 282 211 16.7 12.5 21 - - 0.90 0.18 - 4.90 1.60 + 71 Woodside 15847 222 195 14.0 12.3 23 — 0.06 2.02 0.38 - 6.44 1.96 + 27 East and Shirley 17983 329 275 18.3 15.3 9 — — 1.28 0.28 0.17 5.12 2.11 + 54 Addiscombe 15753 224 210 14.2 13.3 13 - - 1.40 0.06 - 5.46 2.79 + 14 Whitehorse Manor 15946 266 217 16.7 13.6 8 — — 1.63 0.25 0.06 4.64 2.19 + 49 Broad Green 16817 250 191 14.9 11.4 20 0.06 — 0.89 0.30 0.06 4.40 1.84 + 59 Central 11870 182 168 15.3 14.2 22 0.08 — 1.18 — 0.08 7.16 2.36 + 14 Waddon 17491 201 178 11.5 10.2 30 0.06 — 1.14 0.29 0.06 3.95 1.20 + 23 South 14778 213 192 14.4 13.0 14 — — 0.81 0.07 — 5.21 1.97 + 21 Addington 22010 379 67 17.2 3.0 21 0.05 — 0.27 — 0.05 0.86 0.41 + 312 The Borough 250300 3619* 2975* 14.5 11.9 19 0.02 0.01 1.23 0.20 0.05 4.93 1.91 +644 * These are the corrected totals. 12 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX. All Causes Sex 0 - 1 - 5 - 15 - 25 - 45 - 65 - 75 - Total M 31 15 5 12 67 359 445 499 1433 F 38 12 8 9 60 274 394 747 1542 Tuberculosis (respiratory) M - — 1 1 8 18 8 1 37 F — — — 1 7 5 2 — 15 Tuberculosis (other forms) M — 1 1 2 1 1 1 — 7 F — — — 2 2 — 1 - 5 Syphilitic diseases M — — — — 1 2 3 3 9 F - - - - - 2 3 — 5 Diphtheria M - -- - - - - - - F - - - - - - - - - Whooping Cougi M — 1 - - - - - - 1 F 1 1 - - - - - - 2 Meningococcal Infections M — — — — — — - - - F - - - - - - - - - Acute Poliomyelitis M — — — — 1 1 - 2 F - - - - - - - - Measles M — 1 - - - - - - 1 F - 1 - - - - - - 1 Other infective and parasitic diseases M - - - - - 1 - 1 2 F 1 - - _-__ - - 1 - 2 Malignant neoplasm, stomach M - — — — 2 11 16 6 35 F — — — — — 7 15 14 36 ,, ,, lung, bronchus M — — — — 4 39 21 8 72 F — — — — 1 5 2 3 11 ,, ,, breast M — — — — 1 — — — 1 F — — — — 8 20 17 8 53 ,, ,, uterus F — — — — 2 12 8 1 23 Other malignant and lymphatic neoplasms M — — — — 7 30 50 37 124 F — — 1 1 9 40 25 49 125 Leukaemia; aleukaemia M — — — — 1 — — 1 2 F — 1 1 — 2 1 4 - 9 Diabetes M - - - - - - 4 3 7 F - - - - - 1 2 3 6 Vascular lesions of nervous system M — — — 1 3 28 40 57 129 F - - - - - 33 71 112 216 Coronary disease, angina M — — — — 5 63 82 63 213 F - - - - - 32 48 53 133 Hypertension with heart disease M - - - - - 13 20 24 57 F - - - - - 8 14 23 45 Other heart diseases M — — — 2 5 27 70 159 263 F — — — 1 1 26 84 291 403 Other circulatory diseases M — — — — 1 9 19 20 49 F - - - - - 14 14 44 72 Influenza M — 1 — — 2 8 11 11 33 F — 1 — — — 6 9 13 29 Pneumonia M 3 2 — 1 1 11 20 14 52 F 7 1 — — 2 1 13 35 59 Bronchitis M — 1 — — 1 33 39 40 114 F — — 1 — 2 13 23 43 82 Other diseases of respiratory system M - - - - - 4 4 3 11 F — — — — 2 3 — 2 7 Ulcer of stomach and duodenum M — — — — — 14 10 9 33 F — — — — 1 — 2 3 6 Gastritis, enteritis and diarrhoea M 2 — — — — — 1 - 3 F — — — 2 — 1 4 3 10 Nephritis and nephrosis M — — — — 4 5 5 — 14 F - — — 1 4 3 5 3 16 Hyperplasia of prostate Pregnancy, childbirth and abortion M — — — — — — 6 15 21 F — — — 1 2 — — — 3 Congenital malformations M 4 1 1 — 1 3 1 — 11 F 4 1 1 — 3 4 — — 13 Other defined and ill-defined diseases M 22 2 2 3 6 24 9 17 85 F 25 4 3 — 7 27 18 26 110 Motor vehicle accidents M — 1 — 1 4 3 — — 9 F — — 1 — — — 2 1 4 All Other accidents M — 3 — 3 4 2 6 18 F — 2 — — 2 2 5 15 26 Suicide M — — — 1 5 7 3 1 17 F — — — — 3 8 2 2 15 Homicide and operations of war M - 1 - - - - -. 1 F - - - - - - - - — Totals 60 27 13 21 127 633 839 1246 2975 13 Comparisons with 1950 (Registrar-General's Table). There were three deaths from Whooping Cough (1950—2) and two from Measles (1950—2). There were again no deaths in the Typhoid group and none from Diphtheria. The deaths from Pulmonary Tuberculosis decreased by 6; those from Cancer decreased by 5; those from Pneumonia increased by 29; and an increase of 74 was also recorded in those caused by Bronchitis. Deaths from suicide show an increase of 5, and motor vehicle accidents a decrease of 4. The total number of deaths was 2,975 as compared with 2,728 in 1950. The percentage of deaths under 1 year of age to the total deaths was 2.3 per cent.; deaths under 15 years, 3.7 per cent.; deaths under 65 years, 29.9 percent; and deaths over 05 years, 70.1 percent. The corresponding figures for 1950 were 3.5 per cent., 4.8 percent., 31.7 per cent., and 68.3 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 479 as compared with 501 in 1950; 481 in 1949; 510 in 1948; 492 in 1947; 451 in 1940; 470 in 1945; 420 in 1944; 450 in 1943; 405 in 1942 and 377 in 1941. Death-rate per 1,000 of the population for the last 11 years are as follows:— 1941—2.04 (377) 1945—2.34 (470) 1949—1.93 (481) 1942—2.07 (405) 1940—1.93 (451) 1950—1.99 (501) 1943—2.28 (456) 1947—2.03 (492) 1951—1.91 (479) 1944—2.21 (420) 1948—2.06 (510) 14 Deaths from Cancer occurred at the following Ages Age period Male Female Total Under 25 years 4 4 25 and under 35 years 3 4 7 35 and under 45 years 10 15 25 45 and under 65 years 76 83 159 65 years and over 138 146 284 227 252 479 Sites of Fatal Cancer. Site Male Female Total Percentage of Total Eye 1 1 2 0.417 Skin — 2 2 0.417 Tongue and Mouth 7 — 7 1.461 Oesophagus 5 10 15 3.132 Stomach 33 35 68 14.196 Liver 2 3 5 1.044 Bowel 23 32 55 11.482 Rectum 15 14 29 6.054 Bladder 13 5 18 3.758 Prostate 19 — 19 8.370 Larynx and Pharynx 4 — 4 0.835 Uterus — 22 22 8.730 Breast 1 53 54 21.032 Ovary — 10 10 3.968 Pancreas 9 11 20 4.175 Gall Bladder and Duct 4 6 10 2.088 Circulatory System — 1 1 0.209 Bones 2 4 6 1.253 Lungs 68 13 81 16.910 Kidney 3 2 5 1.044 Brain 4 2 6 1.253 Retroperitoneal 1 1 2 0.417 Thyroid Gland — 3 3 0.626 Lymphatic Glands 1 — 1 0.209 Hodgkin's Disease 5 5 10 2.088 Leukaemia 2 9 11 2.295 Parotid Gland 1 — 1 0.209 Genital Organs 1 2 3 10.626 Undefined 3 6 9 1.879 227 252 479 Comments on Foregoing Table. The organs most often attacked in descending order of incidence are: In the males—the Lungs (30.0 per cent.), the Bowels and Rectum (1G.T per cent.), and the Stomach (14.5 per cent.); in females—the Breast (21.0 per cent.), the Bowels and Rectum (18.3 per cent.), the Stomach (13.9 per cent.), and tlie Uterus (8.7 per cent.). 15 INFECTIOUS DISEASES NOTIFIED DURING YEAR 1951. Notifiable Disease. Cases notified in the whole District. Total cases notified in each Ward. Sex Distribution of Notified Cases. 1951. At all Ages. At ages—years. Upper Norwood. Norbury. West Thornton. Bensham Manor. Thornton Heath. South Norwood. Woodside. East. Addiscombe. Whitehorse Manor. Broad Green. Central. Waddon. South. Addington. Shirley Under 1 year. 1—4. 5—14. 15—24. 25—44. 45—64. 65 and up. M F Scarlet Fever 435 - 147 270 13 5 - - 22 14 23 14 28 29 30 45 15 19 18 14 27 42 38 57 235 200 Diphtheria — — — — — - - — — — — — — — — - - - — - - - — - - Erysipelas 19 - — — 1 6 7 5 — 1 1 1 — 1 — 6 1 3 1 1 1 — 1 1 9 10 Meningococcal Infection 1 1 - - - - - - - - - - - - - - - - - - - - - - - 1 Enteric & Paratyphoid 3 2 - - - - - - - - - - - - - - - - - - - 2 — 1 2 Small pox - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 30 - — — 10 20 — — — 1 15 — 1 1 1 — 1 1 5 — 1 3 — — — 30 Ophthalmia Neonatorum 2 2 — - - - - - - - - - - - - - - - - - - - - - 1 1 Acute Poliomyelitis 9 — 2 2 1 4 — — 1 — 1 1 — — — — 1 1 1 1 — 1 — 1 5 4 Dysentery 79 3 19 24 8 18 4 3 4 2 4 5 12 2 — 7 1 — 8 6 16 6 — 6 42 37 Malaria — — — — — —. — — — - — — - - - - - - - - - - - - - - Acute Primary and Acute Influenzal Pneumonia 62 2 3 7 4 14 5 17 1 - 9 4 8 - 2 5 1 4 7 2 6 5 1 7 29 33 Food Poisoning 39 — 4 7 7 13 8 — 4 2 3 6 11 1 5 — 1 1 — — 2 3 - — 16 23 Acute Encephalitis — — — — — — — — — — — — — — — — — — — — - — — - - - Measles 4490 115 2421 189 30 25 2 — 223 241 327 276 249 269 273 390 213 313 219 173 376 205 421 322 22502240 Whooping Cough 699 63 368 257 4 6 - 1 17 27 49 27 25 35 43 79 24 48 41 23 59 30 134 38 344 355 Totals 5868 186 2966 2464 78 112 36 26 272 288 433 335 336 338 354 532 258 390 300 220 488 295 597 432 2932 2936 COMMUNICABLE DISEASES 16 MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1951 Jan. Feb. Mar. April May June July August Sept. Oct. Nov. Dec. Total Scarlet Fever 41 34 45 43 42 36 36 13 11 36 52 46 435 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 1 2 2 5 2 1 1 1 2 2 ... ... 19 Meningococcal Infection ... 1 ... ... ... ... ... ... ... ... ... ... 1 Enteric and Paratyphoid ... ... ... ... 1 ... 1 1 ... ... ... ... 3 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia ... ... ... 1 ... ... ... 4 7 7 ... 9 30 Ophthalmia Neonatorum ... ... ... ... 1 ... 1 ... ... ... ... ... 2 Poliomyelitis and Polioencephalitis Dysentery 1 36 ...19 ...3 1 4 ... 6 ... ... 3 ... 1 5 2 1 ...3 ... ... 1 2 9 79 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... Ac. Pri. & Ac. Inf. Pneumonia 19 12 7 4 7 1 4 ... ... ... 4 4 62 Food Poisoning ... ... 4 1 ... 4 6 3 8 3 7 3 39 Acute Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 555 1236 1412 655 450 110 41 12 6 6 5 2 4490 ;Whooping Cough 145 93 80 79 69 39 45 55 34 23 25 12 699 Total 5868 17 WADDON (ISOLATION) HOSPITAL. Report on Patients Admitted to Waddon Hospital in 1951 I am indebted to Dr. J. Linehan for the following report on infectious, etc., cases admitted to the Waddon Hospital during 1951:— There were a total of 750 admissions of whom 78 patients were admitted as suffering from pulmonary tuberculosis and 672 from other infectious diseases. Where some patients were admitted from outside the Borough of Croydon, the number of patients admitted from Croydon is shown separately in brackets. Admissions to the Tuberculosis Wards—78 patients were admitted of whom 75 (70) were diagnosed as suffering from pulmonary tubehrculosis. There was a total of four deaths during the year, two of whom were admitted in 1951 and two in the previous year. The average number of occupied beds in these wards was 37. The following is a list of patients admitted to the other infectious disease wards, according to diagnosis, corrected where necessary, together with brief details relating to common infectious diseases:— Scarlet Fever 328 (316) Measles 76 (73) Chicken-Pox 57 (47) Whooping Cough 28 Mumps 27 Dysentery 17 Gastro-Enteritis 16 (14) Poliomyelitis 8 (7) Food Poisoning 5 Erysipelas 3 Infective Hepatitis3 Meningitis 2 Typhoid Fever 1 (0) Rubella 6 Malaria 1 (0) Pyrexia of Unknown Origin 1 Puerperal Pyrexia 1 Tonsillitis 14 (13) Pharyngitis 7 Pneumonia 7 Streptococcal Sore Throat 3 Bronchitis 3 Laryngitis 1 Sore Throat 2 Rheumatic Fever 2 Influenza 3 Vincent's Angina .3 Otitis Media 2 Cervical Lymphadenitis 2 Gingivitis 1 Ulcerative Stomatitis 1 Ulcerative Colitis 1 Carcinoma of Cascum 1 Intussusception 1 Indigestion 1 Teething 1 Tuberculous Peritonitis 1 Cystitis 1 Cellulitis 1 Osteomyelitis 1 Arthritis 1 Impetigo 3 Toxic Erythema 3 Papular Urticaria 4 Infectious Erythema 2 Purpura Simplex 1 Dermatitis 1 Teething Rash 1 Neuritis 1 Paralytic Brachial Neuritis 1 Disseminated Sclerosis 2 Subarachnoid Hemorrhage 1 Non-Patient Mothers 3 Non-Patient Babies 1 Sunstroke 1 18 Scarlet Fever—Scarlet Fever remained a mild disease throughout the year. The only severe complications encountered were one case of nephritis and one of endocarditis. The incidence of otitis media was low—about 5 per cent. The total number of admissions was less than in any year since 1941, when the incidence was affected by large scale evacuation of children. The reduced number of admissions was in part due to the fact that a second ward could not be opened for these cases during the prevalent winter period, as had been done in previous years. Measles.—1951 was a measles year. The disease became epidemic during the first five months of the year. Seventy-six cases were admitted but accommodation at the hospital unfortunately fell short of what was required. Interesting and unusual complications encountered were, one case of meningo-encephalitis. one case developing Haemophilis influenza meningitis, a case of hemorrhagic measles in which a hæ morrhagic state was accompanied by severe renal haemorrhage and a case of laryngeal obstruction requiring emergency tracheotomy. No fatal cases occurred. Chicken-pox.—Admissions were mainly from hospitals, institutions, rest centres and residential schools to control spread of infection. A few patients were severely ill. These were an adult with staphylococcal pneumonia, gangrenous chicken-pox in a child resulting in staphylococcal septicaemia and general peritonitis and chicken-pox occurring in a hydrocephalic infant in whom gangrene of the grossly distended scalp accelerated death. There was also one patient with complicating pleurisy. Whooping Cough—All 28 cases admitted were from the Croydon Rorough. Seven patients had broncho-pneumonia and 2 had convulsions. This was the first year in which chloramphenicol was available for regular treatment of whooping cough and the results in this limited number of cases appeared to be good. It is probably significant in this connection that 1951 was the first year since 1940 in which no fatal case was encountered. In 1940, however, only 4 cases were admitted, due doubtless to the large scale evacuation of children from the Rorough. As far as could be ascertained, the drug did not alter the infectivitv of cases, as positive swabs could still be obtained after treatment. Mumps—Twenty-five of the 27 patients admitted were from residential schools, children's homes and hospitals. One patient developed pancreatitis and oophoritis while another developed mumps meningitis. 19 Dysentery—Cases were, as in previous years, all of the mild Sonne type. Gastro-Enteritis-There were only 16 cases admitted, mostly of a mild type. There has been a progressive decline in incidence and severity of this complaint since 1947, when there were 51 admissions and 9 deaths. Poliomyelitis—Only 8 patients were admitted, 4 being paralytic cases and 4 non-paralytic. In two of the paralytic cases, paralysis was transient with complete recovery. Both patients who suffered residual paralysis were adults. Of the four nonparalytic cases, two had benign lymphocytic meningitis. In one of these cases, benign lymphocytic chorio-meningitis, leptospiral infection and mumps were excluded by serological tests. Meningitis—Of the cases shown under this heading, one was pneumococcal and the other was secondary to an intracranial abscess, the organism not having been isolated. There were also two cases of benign lymphocytic meningitis regarded as poliomyelitis, one case of mumps meningitis, one case of measles meningo-encephalitis and one case of hæ mophilis influenza meningitis complicating measles. All cases' recovered. Other Infections—For the first year on record no case of diphtheria was admitted. Food poisoning cases were all due to Salmonella typhi-murium infections. The one case of typhoid fever—a man 48 years old—was admitted from Lambeth Borough. The attack was severe and despite chloramphenicol treatment continued as currently recommended for two weeks after the temperature became normal, a relapse of almost equal severity occurred requiring a second course of treatment. The occurrence of only one fatal case in the fever wards was a record. The previous lowest number of deaths was eight in each of the years 1943 and 1944. To this comprehensive report of Dr. Lineham, I would add that a mild type of dysentery (Sonne dysentery) gave rise to difficulties during the year in all the Day Nurseries, and in one of the Corporation's Rest Centres. This infection may produce no signs, or very minor disturbance only in adults. In babies and young children the upset is usually of a few days duration only, but during that time the child may be quite ill. No serious or fatal cases occurred, and all responded quickly to chemotherapy. In the Day Nurseries spread was rapid, and while strict hygienic discipline might confine the infection to one section of 20 a nursery, it was usually necessary to treat all staff and children with a prophylactic sulpha drug. This raised some administrative difficulties but was effective. Unfortunately, the drug of choice was in short supply and expensive. Follow-up of family contacts was effected as adult symptomless carriers tended to cause re-infection. Food handlers found infected were put off work until clear. The essential co-operation of family doctors was readily forthcoming, so that the whole family could be treated at the same time. It is probable that the infection was prevalent throughout the Borough, but it was only recognised when multiple simultaneous cases led to bacteriological examinations being performed. This is the usual history of present-day Sonne Dysentery, and except when it occurs in closed, or semi-closed communities of young children the extent of the disability does not warrant strict control measures. 21 The following table shows the great improvement in mortality from tuberculosis over the last forty years. Tuberculosis (All Forms) 0-15 years All ages Tuberculosis (All Forms) 0-15 years All ages Year Number of Deaths Death Rate per thousand of population Number of Deaths Death Rate per thousand of population Year Number of Deaths Death Rate per thousand °f population Number of Deaths Death Rate per thousand of population 1912 33 0.66 181 1.04 1932 10 — 166 0.70 1913 48 — 202 1.13 1933 13 — 184 0.77 1914 35 — 192 1.06 1934 10 — 157 0.65 1915 46 — 245 1.38 1935 9 — 176 0.71 1916 43 — 223 1.27 1936 11 — 151 0.60 1917 50 — 256 1.37 1937 10 — 155 0.64 1918 58 — 283 1.68 1938 12 — 137 0.56 1919 38 — 217 1.18 1939 6 — 107 0.46 1920 39 — 195 1.02 1940 8 — 146 0.74 1921 29 0.57 184 0.96 1941 10 — 111 0.59 1922 30 — 209 1.09 1942 8 — 116 0.63 1923 25 — 190 0.98 1943 9 — 120 0.62 1924 18 — 188 0.96 1944 9 — 105 0.57 1925 27 — 181 0.91 1945 9 — 92 0.46 1926 27 — 208 1.01 1946 7 — 105 0.47 1927 15 — 203 0.96 1947 4 0.08 105 0.44 1928 24 — 206 0.96 1948 3 0.06 111 0.45 1929 21 — 178 0.80 1949 6 0.12 94 0.38 1930 15 175 0.79 1950 4 0.08 65 0.27 1931 18 0.36 177 0.75 1951 3 0.03 61 0.25 THE PREVENTION AND CONTROL OF TUBERCULOSIS. I am indebted to Dr. J. F. Heffernan, Acting Chest Physician, for the following section of the Report. Although social conditions were different in 1951, a comparison with 1924 shows that in 1924, 96.9 per 100,000 of the population in Croydon died from all forms of tuberculosis; in 1951 the corresponding figure was 25. The years selected were six years after a major war. The Chest Clinic, so far, has not moved and remains centrally situated in Katharine Street, where the work continues in the fields of prevention and control of tuberculosis, increasing a little each year in proportion with the rising population of the area served. Methods of prevention and treatment move forward together, and, in fact, being interdependent, cannot be regarded separately. B.C.G. vaccination has been carried cut regularly throughout the year for groups of persons at special risk; domiciliary treatment remains an important feature in the work, and chemo-therapy has been begun at home in suitable cases awaiting hospital and sanatorium beds. While at the present time the wait for a bed is considerably longer for men than for women, the position is reversed in the case of beds for major thoracic surgery, women patients having to wait four or five times as long as men. At the time of writing the report arrangements have been nearly completed for the opening of 21 beds at Coombe Wood, for early non-infectious cases of pulmonary tuberculosis, needing observation and supervision, and for suitable cases of pleurisy. * Incidence. 183 cases of Respiratory Tuberculosis and 31 cases of NonRespiratory Tuberculosis were notified on Form A during 1951 (Table I- Formal Notifications). Of these 116 males and 67 females were Respiratory cases and 15 males and 16 females were non-Respiratory. In addition, 89 Respiratory cases and 13 NonRespiratory cases came to our notice as new cases otherwise than by notification (Table II—Supplemental Return). 22 23 The total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year 1951 by notification or otherwise was 316, as compared with 369 in 1950, 305 in 1949, 350 in 1948, and 354 in 1947. 272 of these were cases of Respiratory Tuberculosis; 171 in males and 101 in females. There were 23 fewer cases in males and 38 fewer in females than in 1950. There were 9 cases of Non-Respiratory Tuberculosis among children under 15 years as compared with 12 in 1950. The number of cases in adults was 35, compared with 24 in 1950. Of the cases notified in 1951, 9 males died from the Respiratory form of the disease during the year, equal to 4.9 percent of those notified. The incidence rate of Tuberculosis of all forms was 1.25 per 1,000 of the population; for Respiratory Tuberculosis 1.08, and for Non-Respiratory 0.17 per 1,000 population. The notification rate was 0.89 per 1,000. In 1950 the corresponding figures were 1.47, 1.32, 0.14 and 1.09 per 1,000. Public Health (Tuberculosis) Regulations, 1930. Summary of notifications during the period from 1st January, 3951, to 31st December, 1951:— TABLE I. Formal Notifications. Number of Primary Notifications of new cases of tuberculosis Age Periods 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total (all ages) Respiratory, Males 1 3 1 3 1 8 11 16 18 22 17 14 1 116 Respiratory, Females — - 2 2 2 13 0 10 11 4 4 1 2 67 Non-Respiratory, Males — 2 2 1 3 2 2 2 1 — — — 15 Non-Respiratory, Females — 1 — 2 - 2 1 3 4 2 - — 1 16 24 TABLE II. Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1951, to 31st December, 1951, otherwise than by formal notification - Source of Information Number cf cases in age Groups 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— Total Death Returns from Local Registrars Respiratory M - - - - - - - - - - 1 1 - 2 (A) F - - - - - - - - - - 1 - - 1 (B) Non-Respiratory M - — — 1 — — — 1 — — — - — 2 (C) F - - - - - - 1 - - - - 1 — 2 (D) Death Returns from Registrar-General (Transferable deaths) Respiratory M - - - - - - - - - - - - - - (A) F - - - - - - 1 - - - - - 1 2 (B) Non-Respiratory M - - - - - - 1 - - 1 - - - 2 (C) F - - - - - 1 - - 1 - - - - 2 (D) Posthumous Notifications Respiratory M - - - - - - - - - - - - - — (A) F - - - - - - - - - - - - - — (B) Non-Respiratorv M - - - - - - - - - - - - - — (C) F - - - - - - - - - - - - - — (D) "Transfers" from Other Areas (excluding transferable deaths) Respiratory M — — — 1 — — 10 32 6 i — 2 — 52 (A) F — — — 1 — 2 10 13 4 — — — 30 (B) Non-Respiratory M - - - - - - 1 - - - - - - 1 (C) F - - - - - - 1 1 1 — — 1 — 4 (D) Other Sources Respiratory M - - - - - - - - 1 - - - - 1 (A) F | - - - - - - - 1 - - - - - 1 (B) Nen-Respiratory M - - - - - - - - - - - - - — (C) F - - - - - - - - - - - - - — (D) TOTALS (A) 55 (B) 34 (C) 5 (D) 8 25 Notification Register. Number of cases of Tuberculosis remaining on the Notifiation Register on 31st December, 1951: — RESPIRATORY. NON-RESPIRATORY. Total Cases. Males. Females. Total. Males. Females. Total. 1003 759 1762 134 120 254 2016 CLASSIFICATION OF NEW PATIENTS. Respiratory Tuberculosis. During 1951, 172 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) 68 or 39.5% T.B. plus 1 (early cases, sputum positive) 24 or 14.0% T.B. plus 2 (intermediate cases, sputum positive) 73 or 42.4% T.B. Plus 3 (advanced cases, sputum positive) 7 or 4.1% 172 100.0% Non-Respiratory Tuberculosis. There were 32 cases examined at the Clinic and found to have Non Respiratory Tuberculosis in the following forms: — Bones and Joints 11 Abdominal 1 Other Organs 10 Peripheral Glands 10 32 26 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 1959 1 — 7 10 28 14 60 1951 - — 2 15 21 13 51 Five cases were not notified during life. Of these, three were certified by the Coroner, after a post-mortem examination; one case died in a nursing home, and one in a fever hospital. In 1951 the death-rate from all forms of Tuberulosis was 0.25 per 1,000 population. The rate for Respiratory Tuberculosis was 0.20 and the rate for Non-Respiratory Tuberculosis 0.05. Similar figures for 1950 were 0.24 and 0.03. Respiratory Tuberculosis. In 1951 the total number of deaths decreased by 13.3 per cent., compared with 1950, there being a decrease in males of 15 per cent. and in females of 10 per cent. 65.4 per cent. of the total deaths occurred in the age groups 45 and over, and 32.7 per cent. in the age groups 20—44 years. It is interesting to note that, for the first time since 1948, there was no death amongst children (1—15 years). New cases show a decrease in males of 11.8 per cent, and of 27.3 per cent. in females, compared with 1950, that is a total decrease, compared with 1950, of 18.1 per cent. The total numbers of the new cases in 1950 were : Males 171, females 101; that is, approximately three new cases in men for every two new cases in women. As the Mass Radiography Unit continues to visit Croydon at regular intervals and has a good response from the public, and all the facilities of the Chest Clinic have been used as; much as in 1950 by the General Medical Practitioners, it can be fairly assumed that the decrease in new cases found to be suffering from Respiratory Tuberculosis is a real one. 27 The maintenance of the lower death rate at the low figure of 25 per 100,000 population continues to reflect the general modern advances in treatment, associated with necessary local measures to make available more beds and the rehousing of infectious cases by the Croydon Corporation. Deaths from Non-Respiratory Tuberculosis. During 1951 thirteen deaths were certified to be due to NonRespiratory Tuberculosis, compared with seven in 1950 and five in 1949. Twelve of the patients died in Institutions. Eight of them were not notified during life. The deaths were due to:— Males. Females. Total. Tuberculous Meningitis 3 2 5 Renal Tuberculosis 1 — 1 Tuberculous Peritonitis 2 1 3 Miliary Tuberculosis 2 1 3 Lupus Vulgaris of Mouth and Throat — 1 1 Totals 8 5 13 Co-ordination with Medical Practitioners and the Health Department. During the year 104 children were referred by the School Medical Service, and 37 cases from the Maternity and Child Welfare Section of the Public Health Department. 95 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 92 per cent. in 1950 and 96 per cent. in 1949. Extra Nourishment. Provision of special nourishment in the form of milk was granted to 11 selected cases for varying periods during the year, and 6 cases were in receipt of extra nourishment at the end of the year. 28 Residential Treatment. 235 males, 216 females and 30 children were admitted to Residential Institutions during 1951. At the end of the year there were 27 beds occupied in the Cheam Sanatorium, North Cheam, compared with 52 at the end of 1950 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. 1,549 new cases were examined during the year. 195 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 12,905. There were also 6,802 attendances by patients for collapse therapy. The Clinic doctors paid 267 home visits and the Tuberculosis Visitors 3,851 visits for Clinic purposes. In addition, the Tuberculosis Visitors made 387 primary visits for the 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 562 contacts were examined. Of these, 9 were considered to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 16 compared with 1.25 per 1,000 of the general population. In addition there were 8 found to be tuberculous who had been under observation from previous years. The Clinic Register of Cases. The number of cases of Tuberculosis under the supervision of the Clinic at the end of the year was 1,691. This is equivalent to 6.7 persons per 1,000 of the population. 29 During the year 58 Clinic cases died. Of this number ten or 17.2 per cent. were seen for the first time in 1951. The following table gives a summary of the work done in connection with the Clinic: — No. of persons on Clinic Register, January 1st, 1951 1,799 patients examined for the first time excluding 95 inward transfers, i.e., patients removed from other areas 2,111 ,, visits paid by Clinic doctors to homes of patients 267 visits paid by Clinic doctor to local Hospitals 312 patients examined by Clinic doctors in local Hospitals 1,552 visits paid to homes of patients by Tuberculosis Visitors 4,238 Attendances of patients at the Clinic— Men 4,992 Women 4,450 Children 3,403 Total 12,905 No of X-Ray films taken 7,542 Number of persons on the Clinic Register on the 31st December, 1951: — Cases of Tuberculosis 1,691 Cases under observation and not yet diagnosed 323 Re-Housing of Tuberculosis Patients. Thirty-two 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. During 1951 a number of sessions were held for B.C.G. vaccination. 65 contacts were successfully vaccinated, also 68 nurses and three members of a hospital staff. 30 The response of parents of children who have been in contact with an infectious case, usually a member of the family, has been good. Only a few exceptional cases have turned down the offer of preventive vaccination. Included in 1951 figures for successful B.C.G. vaccination were seven new born babies. Switzerland. So far, only two patients from the Croydon area have been sent to Switzerland under the scheme for the treatment of certain cases of respiratory tuberculosis in Swiss sanatoria. X-Ray Service. In addition to the routine work of the Chest Clinic, the facilities at the Clinic are used for X-ray examination of staff coming in contact with children, such as teachers, the staff at nursery schools, residential schools and homes, and also other staff on appointment, as requested by the Medical Officer of Health. With the increasing work of the Chest Clinic, combined with these additional services, the number of X-ray films used will tend to increase correspondingly, although, in view of the shortage, every effort is made to economise in the use of films. During the period under review, Dr. J. C. McMillan was the Chest Physician, and I record the loss suffered by his sudden and untimely death. 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. Active Pulmonary Tuberculosis. Inactive Pulmonary Tuber¬culosis. Non- Tuberculous Conditions. Croydon district 11,894 14 401 410 31 TUBERCULOSIS AFTER-CARE FOR 1951 Report of After-Care Almoner (Miss Bridger). Arrangements were basically the same as in 1950, 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, 1950, there were 189 patients in receipt of these grants which are arranged through co-operation between myself and the N.A.B. During 1951 161 new cases were referred and 146 cases ceased to need assistance, leaving a total of 204 receiving the allowances at December 31st, 1951. Of the cases ceasing to receive these grants, 19 died, 73 returned to work, 37 were no longer in need of assistance on admission to hospital, and 17 were either awarded pensions or left the district. In addition to these regular weekly allowances, special grants to cover unforeseen needs were obtained in 92 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. Assistance in kind continued to be given by the After-Care Committee in the form of the loan of beds and bedding to 27 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 tne.. much valued co-operation in supplementing statutory relief. .£130 was. raised from voluntary sources, such as ex-Service funds, British 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. For the married women patients, their chief worry is the care of their children whilst they undergo a prolonged spell of treatment. In 42 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 32 the Children's Officer for them to be boarded-out with foster parents or admitted to Residential Nurseries. In all, 17 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. 53 people were registered as disabled and for 29 of these, training in a different occupation was arranged. There are now three men working at the Bermondsev 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, 428 home visits were paid. OCCUPATIONAL THERAPY Arrangements of the Occupational Therapy Scheme, inaugurated in 1949, continued unchanged. Number of attendances increased slightly, and many more people bought materials through the scheme for use at home. Progress can be estimated by comparing the takings of 1950 (£41 18s. 0d.) with a total of £82 13s. 1d. payment received in 1951. 33 VENEREAL DISEASES. Return relating to nil persons who were treated at the Treatment Centre at Special Clinic, General Hospital, Croydon, during the year ended the 31st December, 1951. Syphilis Gonorrhoea Other Conditions Totals M F M F M F M F Ttls. Number of patients on 1st January under treatment or observation 49 84 1 - 18 46 68 130 198 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 - - - - 20 18 20 18 38 3.Number of patients dealt with for the first time during the year under report (exclusive of those under Item 4) suffering from:— (a) Syphilis, primary 7 1 - - - - 7 1 8 (b) „ secondary — 3 - - - - - 3 3 (c) „ latent in 1st year of infection 5 4 — — — - 5 4 9 (d) ,, cardio-vascular 1 - - - - - 1 — 1 (e) ,, of the nervous system 4 4 — — — - 4 4 8 (f) ,, all other late or latent stages 9 6 — — — - 9 6 15 (g) „ congenital (under 1 year) - - - - - - - - — (h) ,, ,, (over 1 year) 1 4 — — — 1 4 5 (i) Gonorrhoea - — 32 6 — - 32 6 38 Other conditions :— (j) Chancroid - - - - - - - - - (k) Lymphogranuloma inguinale - - - - - - - - - (l) Granuloma venereum - - - - - - - - — (m) Non-gonococcal urethritis(males only) — — — — 51 - 51 — 51 (n) Any other conditions requiring treatment - - - - 25 81 25 81 106 (o) Conditions not requiring treatment — — — — 201 505 201 505 706 (p) 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 proved under Ministry of Health Circular 2226 1 3 - - 2 2 3 5 8 Totals op Items I, 2, 3 and 4 77 109 33 6 317 652 427 767 1194 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 " 35 30 26 4 307 621 363 655 1023 Number of patients suffering from :— (a) Syphilis who defaulted after completion of treatment, but before final discharge - - - - - - - - - (b) Gonorrhoea who defaulted before 3 months - - - - - - - - - (c) Gonorrhoea who defaulted after 3 months - - - - - - - - - Number of patients who ceased to attend Wore completion of treatment and were suffering from:— (a) Acquired syphilis of less than 1 year's duration - 1 - - - - - 1 1 (b) Acquired syphilis of more than 1 year's duration - - - - - - - - - (c) Congenital syphilis (under 1 year) - - - - - - - - - (d) ,, ,, (over 1 year) - - - - - - - - - (e) Gonorrhoea _- - - - - - - - - Number of patients under treatment or observation known to have died :— (a) From syphilis . - - - - - - - - - (b) From treatment - - - - - - - — - (c) From other causes 2 - - - - - 2 — 2 Totals of Items 5, 6, 7 and 8 37 31 26 4 307 621 370 656 1026 34  Syphilis Gonorrhoea Other Conditions Totals M F M F M F M F Totals of Items 5,6,7 and 8 (brought forward) 37 31 26 4 307 621 370 656 9. Number of patients transferred to other Centres or Institutions or to private practitioners 7 7 7 2 6 4 20 13 10. Number of patients remaining under treatment or observation on 31st December 33 71 — — 4 27 37 98 Totals of Items 5, 6, 7, 8, 9 and 10 77 109 33 6 317 652 427 767 (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 - - - - - - - - (b) 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 2109 2249 382 87 2891 2616 5382 4952 (b) for intermediate treatment, e.g., dressings, etc. 862 1481 — 21 807 1391 1669 2893 Total Attendances 2971 | 3730 382 108 3698 4007 7051 7845 13. Number of patients suffering from congenital syphilis in Item 3 above classified according to age Under 1 year 1 and under 5 years 5 and under 15 years 15 years and over Totals M F M F M F M F M - - - - - - 1 4 1 14. Pathological Work (a) Number of specimens examined at, and by the medical officer of, the Treatment Centre Microscopical Serum for Syphilis for G'n'rh. Cultura for Syphilis Wr. & Kahn for G'n'rh. Cerebro. Spinal Fluid - - - - - - (b) Number of specimens from patients at the Treatment Centre sent to a pathological laboratory 5 685 730 724 294 59 15. Contacts attending for examination through the agency of Syphilis (less than 1 year) Syphilis (more than 1 year) Gonorrhoea Other Condition M F M F M F M 4 1 1 1 3 51 (b) Health Visitor or Social Service Worker 9 5 4 7 10 3 54 Totals 13 6 5 8 13 1 3 105 36 TATEMENT 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 the case of persons residing elsewhere than in England and 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 35 6 5 3 49 Gonorrhoea 22 8 4 4 38 Other Conditions 655 105 65 38 863 Totals 712 119 74 45 950 36 PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT ANTE-NATAL AND POST-NATAL CLINICS During the year 3,572 cases were seen at the Ante-Natal Clinics, of which 2,853 were new cases. A total of 27,115 attendances was recorded, and 1,510 cases were seen at the Post-Natal Clinics (1.478 new cases) and 1,815 attendances recorded. Every effort has been made to foster close co-operation between all concerned with maternal care as outlined in my report for last year. Mothercraft instruction classes became firmly established, and at times more applications were outstanding than could be included in current lectures. Relaxation exercise sessions were also increased in response to demand. CARE OF PREMATURE INFANTS Premature Babies. Arrangements have been made for premature infants born in Private Nursing Homes 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 1951 who were born— (i) at home 66 (ii) in private nursing homes 7 (iii) in hospital 124 (2) The number of those born at home— who were nursed entirely at home 65 who died during the first 24 hours — who survived at the end of one month 65 (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 6 (4) Number of those born in hospital— who died during the first 24 hours 15 who died before the 28th day 10 who survived at the end of one month 99 (The hospital statistics provide for the inclusion of out of the Borough cases). 37 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 90 cases were dealt with by the Social Worker. 14 cases were admitted to hostels. 21 cases were temporarily accommodated at Glazier House (the Croydon Home of the Moral Welfare Association). INFANT WELFARE CENTRES Their work continued unchanged and attendances were well maintained. It might be thought that with the fall in the infant mortality rate these centres had fulfilled the task they set out to perform. They are still essential to give advice on the upbringing of children, and all that is different is that emphasis can now be laid on promoting healthy minds and bodies, in place of dealing with the prevention of disease and death. Some of the centres are held in buildings which are inconvenient and alternative premises were found for Spring Park. Some 200 Voluntary Workers continue to give invaluable help to the medical and health visitor staffs. It is a pleasing feature to he able to report on this continued combination of voluntary and municipal effort. 38 DAY NURSERIES. Attendances at Day Nurseries, 1951. *Coldharbour House. Whitehorse Road. †Mayday Road. Morland Road. Ritchie Road. New Addington. Euston Road. Bersham Grove. Date opened 23/2/42 1/6/42 1/6/42 8/3/43 23/11/43 28/3/44 15/5/44 21/3/45 Capacity 80 50 50 56 50 56 50 52 Number on books at end of year 47 47 — 32 43 25 30 40 Attendances: under 2 2608 2756 786 2262 1943 1151 1233 1184 over 2 11873 6035 1599 5431 7380 4858 6047 7771 Total 14481 8791 2385 7693 9323 6009 7280 8955 Number of days opened 251 155 127 255 255 254 254 254 Average daily attendance (excluding Saturdays) 57 34 19 30 37 24 29 35 *Closed December, 1951. †Closed June, 1951 ATTENDANCES AT INFANT CENTRES—1951 Bensham Manor, Monday, a.m. Bensham Manor, Monday, p.m. Boston Road, Thursday, p.m. Brighton Road, Wednesday, p.m. East Croydon Tuesday, p.m. East Croydon, Friday, p.m. Monks Hill, Tuesday, p.m. Municipal Monday, p.m. Municipal, Thursday, a.m. Municipal, Thursday, p.m. New Addington, Wednesday a.m. New Addington, Wednesday, p.m. Norbury, Wednesday, a m. Norbury, Wednesday, p.m St. Albans, Wednesday, p.m. St. Albans, Friday, p.m. St. Andrews, Monday, p.m. St. Judes Hall, Tuesday, a.m. St. Judes Hall, Tuesday, p.m. St. Oswald, Thursday, a.m. St. Oswalds, Thursday, p.m. Selhurst, Wednesday, p.m. Shirley, Thursday, p.m. South Croydon, Thursday, p.m. South Norwood, Tuesday, p.m. South Norwood, Friday, p.m Spring Park Monday, p.m. Upper Norwood, Monday, p.m. Waddon, Wednesday, p.m. West Croydon, Friday, p.m. Woodside, Friday a.m. Woodside, Friday, p.m. Total, 1951 Total, 1950 New cases under 1 year 60 113 104 84 34 118 54 145 72 131 78 200 70 110 114 74 112 51 84 57 98 65 81 96 141 150 86 200 84 72 67 119 3124 3098 No. of Re-attendances 1187 1714 1654 1437 1741 1663 609 1613 1069 1928 902 1900 1235 1971 1971 1156 1836 1381 1773 1076 1572 1031 1280 1534 1784 1881 1395 2185 1190 975 1141 1558 47342 46992 New cases over 1 year 11 22 19 12 17 20 41 23 16 19 45 118 15 23 15 16 17 6 4 3 19 20 24 24 20 27 34 38 30 14 8 15 735 714 No. of Re-attendances 1026 1317 1175 634 1156 986 588 869 454 740 698 1376 1071 1608 1027 953 932 921 1284 808 1302 921 759 1040 1057 894 763 1405 849 797 684 997 31091 30121 Attendances of Children 0-5 2284 3166 2952 2167 2948 2787 1292 2650 1611 2818 1723 3594 2391 3712 3127 2199 2897 2359 3145 1944 2991 2037 2144 2694 3002 2952 2278 3828 2153 1858 1900 2689 82292 80925 Consultations with Doctor 849 1093 966 600 706 717 547 932 664 1036 421 1072 794 991 968 762 874 691 747 727 875 720 547 904 919 936 763 915 815 921 555 791 25868 23558 No. of sessions 49 49 48 48 48 48 48 49 48 48 48 48 48 48 48 48 49 48 48 48 48 48 48 48 48 48 49 49 48 48 48 48 1542 1440 Expectant Mothers: No. of new cases - - 1 - - - - - - - - - - - - - - - 1 - - - - - - - - - 13 - - - 16 17 No. of Re-attendances — 1 2 - - - - - - - - - - - - - - - 2 - - - - - - - - - 54 - - - 59 85 Total attendances of Expectant Mothers — 1 3 - - - - - - - - - - 1 - - - - 3 - - - - - - - - - 67 - - - 75 102 Total Attendances 2284 3167 2955 2167 2948 2787 1292 2650 1611 2818 1723 3594 2391 3713 3127 2199 2897 2359 3148 1944 2991 2037 2144 2694 3002 2952 2278 3828 2220 1858 1900 2689 32367 31027 Average per Session, 1951 46.6 64.6 61.6 45.1 61.4 58.1 26.9 54.1 33.6 58.7 35.9 72.9 49.8 77.4 65.1 45.8 59.1 49.1 65.6 40.5 62.3 42.4 44.7 56.1 62.5 61.5 46.5 78.1 46.3 38.7 39.6 56.0 53.4 — 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 50.5 59.3 41.4 45.1 79.3 65.5 61.0 — 80.9 42.8 46.9 42.6 57.7 — 56.3 39 40 41 DENTAL TREATMENT Maternity and Child Welfare Patients. Expectant and nursing mothers requiring dental attention are referred by Medical Officers attending Municipal Ante- and PostNatal Clinics. In the case of children below school age reference comes chiefly from Infant Welfare Centres; an appreciable number of applications continue, however, to be received from Day Nurseries and similar institutions still in operation. Since the commencement 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 attending their own dental practitioner. Though as yet not all those referred avail themselves of this opportunity, it is felt that the practice is a good one and should be adhered to as far as possible. For the third year in succession there has been a reduction in the number of expectant and nursing mothers undergoing attention at the Local Authority's Dental Clinics. This has come about partly as a result of the continued fall in the birth-rate since the post-war peak period, and also on account of the introduction of alternate sources of treatment by the Health Act of 1946. Whilst it is too early to assess whether these effects will be permanent, it seems likely that, provided reasonable priority can be given by private practitioners the major part of this work will continue to be dealt with outside the Municipal schemes. In contrast with the ante-natal work recent legislation has done little to diminish the responsibilities of the local services in respect to the pre-school child, and attendances on this side have continued to show a healthy upward trend. A contributing cause in this respect is the fact that the majority of private practitioners are already fully occupied in dealing with adult requirements, and find difficulty to offer adequate facilities for patients of this type. In, addition to this due credit should be accorded to those officiating at Welfare Centres for their continued efforts in bringing defects to the notice of parents and arranging for subsequent visits to the clinic. Expectant and Nursing Mothers. The total number of expectant and nursing mothers referred from all sources was 393 compared with 570 in 1950. For the first time fewer cases were notified from ante-natal clinics than by the Municipal Midwives Service. With certain limited exceptions 42 fewer cases were also referred from Welfare Centres. Though all those applying for treatment received appointments to attend the Dental Clinic, absenteeism continues to be rather high and some 30 per cent. failed to appear for their oral examination. Expectant mothers examined for the first time numbered 2G8 against 424 last year. Of these, 75.4 per cent. were seen during the first six months of pregnancy, compared with 84.7 per cent. previously recorded. Despite this slight decline the year's figures are still substantially high, and have no doubt to some extent been influenced by failure in keeping "initial" appointments. It is also significant that certain of those attending at later stages of their confinements did so as the result of pain or discomfort, which might have been avoided had treatment been sought at an earlier date. There has been a further decrease in the amount of work carried out for nursing mothers. To a certain extent this is the outcome of the steady emphasis on the importance of treatment being carried out during the ante-natal period; in this respect a limited decline may be regarded as a measure of the success of the scheme. In the case of recent returns, figures are too low to afford any reasonable assessment of present requirements; it would appear, however, that such patients are adequately "served" in other quarters. Only 13 nursing mothers visited the clinic during the current year, compared with 17 in 1950. Treatment. Including those continuing treatment from the previous year, 297 mothers were dealt with, compared with 476 in 1950. Though the volume of work decreased, appointments were well kept, and there would appear to be a greater appreciation of the importance of preserving the natural dentition. As in the previous year there has also been a noticeable decrease in the need for wholesale removal of teeth; though it is unlikely that this represents a universal picture, it seems probable that a great many previously suffering front chronic oral sepsis have already received attention through the General Practitioners Dental Service and thus do not come the way of the Clinic. 43 The Pre-School Child. The total number of children referred from all sources during the year was 862, compared with 641 in 1950. The fact that this increase was achieved despite the closure of certain Day Nurseries which to date have provided a useful "field" of supervision, reflects great credit on all concerned in this work, and it is hoped that the present position can be maintained. Though the "passing" of these Nurseries is to be regretted, it is possible that the inauguration of further Nursery Classes at Primary Schools will to some extent offset these effects until the introduction of permanent Nursery Schools. As stated previously, the major problem in this branch of dentistry is to gain access to these children during the critical three to four-year period when systematic inspection should be commenced. In practice it is found that even "enlightened" parents are too prone to be guided by their own visual observations, with the inevitable result that many cavities are found to be beyond repair when eventually brought to notice. The condition in the mouths of certain children at their first school inspection is a constant reminder of the fact that until a far greater degree of supervision can be exercised during the preschool period, there can be no satisfactory solution to the problem of safeguarding the foundation teeth. 14 Treatment The following summary shows particulars of the work accomplished: — Expectant Mothers. Nursing Mothers. Total. Young Children. New Cases Examined 268 13 281 743 Re-treated 16 — 16 119 Total 284 13 297 862 Expectant and Nursing Young Mothers Children Attendances 633 1103 Fillings 161 327 Extractions 337 570 Gas Cases 67 234 Local Anaesthesia 129 40 Scaling and Gum Treatment 99 10 Dressings 170 368 Denture Dressings 164 — Silver Nitrate — 456 Treatments Completed 174 469 Number of Sessions (treatment) 169 Dentures Fitted 35 Dentures Repaired 11 46 The Centres at which patients were examined, or from which they were referred, are given in the following list: — Young Mothers Children Ante-Natal Clinic 177 — Municipal Midwives 216 — Welfare Centres: Municipal — 35 East Croydon — 6 Upper Norwood — 11 West Croydon — 22 South Norwood — 9 South Croydon — 15 St. Alban's - 19 Woodside — 23 St. Oswald's — 20 St. Jude's — 20 Monks Hill Estate — 5 Young Mothers Children Bensham Manor — 23 St. Andrew's — 14 Waddon — 23 Shirley — 3 Boston Road — 13 Norbury — 7 Holy Trinity — 8 Addington — 38 Sussex Rd., West Wickham — 1 Spring Park — 4 Day Nurseries — 62 Referred by Dental Officers — 481 Mothers : 393. Young Children : 862. Total: 1,255 Special Table for the Ministry of Health (See Circular 42/51). (a) Numbers provided with Dental Care Examined. Needing Treatment. Treated. Made Dentally Fit. Expectant and Nursing Mothers 297 297 292 174 Children under Five 862 795 795 469 (ft) 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 337 129 67 161 99 - 170 6 12 23 Children under Five 570 40 234 327 10 456 368 — — — 46 MIDWIFERY SERVICE The Corporation employ directly 1 Superintendent and 19 Domiciliary Midwives. 10 Midwives are recognised by the Central Midwives' Board to have pupils for the second three months ot their Part II C.M.B. training. The work of the Municipal Midwives was as follows: — I.—The number of maternity deliveries by Municipal Midwives on the district that attended the Lodge Road Ante-Natal Clinic in the year 1951 1,322 2.—The number of spontaneous deliveries 1,303 3.— The number of forceps deliveries 19 4.—The number of live births 1,313 5.—The number of stillbirths 9 (7 + 1 set of twins) 6.—The number of neo-natal deaths 2 7.—and the weight of each baby (1)—6 lbs. 8 ozs. Found dead in bed. (2)—8 lbs. Found dead in bed. 8.—The number of premature live born infants treated in their own homes, and their weights and ultimate result 15 + 3 sets of twins. (1) 30 weeks—4 lbs. 8 ozs. 14th day—4 lbs. 12 ozs. (2) 38 weeks—4 lbs. Transferred Mayday. (3) 36 weeks—5 lbs. 8 ozs. Transferred Mayday, died later. (4) 36 weeks—4 lbs. 12 ozs. 14th day—4 lbs. 4 ozs., Transferred H.V. (5) 38 weeks—4 lbs. 8 ozs. 14th day—5 lbs. 4 ozs. (6) 35 weeks—4 lbs. 6 ozs. 14th day—5 lbs. 8 ozs. (7) 34 weeks—4 lbs. 8 ozs. Transferred Mayday, died. (8) 37 weeks—5 lbs. 8 ozs. 14th day—G lbs. (9) 36 weeks—5 lbs. 14th day—6 lbs. (10) 32 weeks—4 lbs. 4 ozs. Transferred Mayday. (11) 36 weeks—4 lbs. 4 ozs. 14th day—5 lbs. 4 ozs. (2) 27 weeks—not weighed Transferred Mayday. (13) 36 weeks—4 lbs. 14th day—4 lbs. 6 ozs. (14) 36 weeks—3 lbs. 8 ozs. Transferred Mayday. (15) 28 weeks—3 lbs. 8 ozs. Transferred Mayday. Twins:— (1) 34 weeks—4 lbs. 4 ozs. Transferred Mayday, one died. 5 lbs. (2) 38 weeks—6 lbs. 14th day—6 lbs. 4 ozs. 5 lbs. 14th day—5 lbs. 8 ozs. (3) 36 weeks—5 lbs. 14th day—5 lbs. 8 ozs. 5 lbs. 12 ozs. 14th day—6 lbs. 12 ozs. 9.—The number who received Gas and Analgesia 1,235 10.—The number of cases of P.P.H. 14 6 remained at home 8 transferred Mayday II.—The number of cases of manual removal of placenta None. 12.—The number who received blood transfusion 4 13.—The number of cases to which the Emergency Obstetric Service was called 5 14.—The number of patients sent into Mayday 183 transferred during Hospital the A.N. period. 79 sent in during and after delivery. 47 15.—The number of eases of toxaemia of pregnancy treated at home No Midwifery cases. 16.—The number of cases of prolonged labour (over 24 hours) 13 17.—The number of breech deliveries:— In primipara 3 (1 Midwifery, 2 Maternity). In multipara 4 (4 Maternity). 18.—The number of twins delivered in their own homes and the weights of the babies 4 sets. (1) 34 weeks—4 lbs. 4 ozs. and 5 lbs. (2) 38 weeks—6 lbs. and 5 lbs. (3) 36 weeks—5 lbs. and 5 lbs. 12 ozs. (4) 36 weeks—4 lbs. 8 ozs. and 4 lbs. S.B. 19.—The number of cases of Puerperal Pyrexia.— Genital 1 Extra-Genital 5 20.—The number of congenital malformation 6 One Maternal death, 10th day.—Pulmonary Embolism (Maternity case). Number of Stillbirths 9 (7 + 1 set of twins) Number of Premature births 15 + 3 sets of twins Ante-Natal Clinic Attendances (Lodge Road)— January 548 May 529 September 446 February 520 June 644 October 522 March 660 July 489 November 650 April 552 August 545 December 451 6556 Addington 1979 + 124 Post Natal = Total 2103 Midwife Mileage Deliveries Midwifery Maternity Gas and Air AnteNatal Visits PostNatal Visits Bookings Office Booking Home Visits Normal Abnormal Normal Abnormal Midwives Pupils Midwives Pupils 1 1833 3 - 1 2 - 3 15 - 173 - - - 14 2* 3340 83 47 2 33 1 65 607 465 772 1141 160 144 52 3 Bicycle 45 17 — 26 2 44 326 748 — 58 36 42 4* 2290 75 53 7 13 2 73 370 287 962 905 99 88 28 5* 4534 94 61 1 31 1 93 455 326 1277 1001 90 45 36 6 Bicycle 24 13 — 10 1 23 107 — 357 — — 25 — 7* 1671 93 90 — 3 — 88 243 77 1212 1044 150 116 4 8* 5507 122 86 3 29 4 118 1015 67 1567 447 127 121 19 9* 5284 71 44 3 22 2 65 519 267 1126 982 111 105 52 10* 1883 28 18 1 9 — 22 185 234 404 512 43 44 19 11 Bicycle 59 31 3 24 1 57 248 — 1171 — 79 62 62 12 Bicycle 54 26 — 26 2 50 257 — 861 — — 40 39 13* 3895 102 67 1 34 — 92 304 311 1127 1064 124 136 91 14 1183 79 46 2 26 5 74 242 — 825 — 77 78 47 15* Bicycle 84 62 2 19 1 76 493 207 1137 1033 123 100 42 16 Bicycle 47 31 1 13 2 44 239 — 729 — 65 55 65 17* Bicyclc 69 52 1 16 — 69 263 245 990 1084 112 104 37 18 Bicycle 71 48 1 22 — 67 157 — 823 — 60 59 63 19* Bicycle 65 41 1 23 — 60 351 154 1009 893 75 63 66 20 Bicycle 32 24 - 6 2 30 161 - 510 - 48 37 46 21 Bicycle 22 17 — 5 — 22 126 — 345 — 15 14 5 Total 31420 1322 874 30 392 26 1235 6683 2640 18125 10106 1616 1472 829 *Midwives with Pupil Midwives. 1. Asst. Superintendent. 6. Left 5/51 10. On sick leave since 6/51. 21. Commenced 8/51. 48 The following table gives the details of the reasons for Midwives summoning medical aid: — For Complications during Pregnancy. Abortion 12 Other Causes 12 24 For Complications during Labour. Breech 3 Premature Labour 4 Foetal Distress 3 Malpresentation 3 13 Delayed Labour. Prolonged and obstructed 25 Haemorrhage. Ante-partum 4 Post-partum 6 10 Other Causes. Adherent and Retained Torn Perineum 104 Placenta 7 1ll For Complications during Puerperium. Pyrexia 17 Pain in Breasts 4 Pain in Legs 14 Other causes 30 71 For Complications in regard to the Baby. Inflammation of Eyes 37 Still Birth 1 Feebleness 1 Other causes 31 Premature Birth 5 75 329 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 177 Other causes 34 Total 230 Midwives Acts, 1902-51. The number of Midwives who notified their intention to practise as midwives or maternity nurses, within the Borough (including those in hospitals) and who were practising at the end of the year was 80. All these were trained and held the certificate of the Central Midwives' Board. The Medical Supervisor of Midwives visits midwives in private practice and nursing homes. SUPPLY OF MATERNITY OUTPUT Cases dealt with by the Midwifery Service were supplied with Maternity Outfits and a few sets were issued to cases under the care of independent midwives, giving a total of 1,450 issued during the year. 49 50 The Work of the Health Visitors.—Maternity and Child Welfare Visits Only. Visits Re Ashe Left, 31/5/51 Baker Beaumont Left 21/4/51 E. Biggs H. Biggs Left 30/6/51 Bird Blest Devaney Early Eldridge Elliott Emms Comm. 13/8/51 Griggs Hall Hinton Johns Lucey Morton Comm. 1/6/51 Munroe Left 19/5/51 Partridge Rawlings Comm. 7/5/51 Teasdale Left 31/5/51 Theison Thompson Toneri Toripet Comm. 1/6/51 Vince Warman Webb Wcller Weston Wilson Wybrew Total, 1951 Total, 1950 Infants under 1 year— First Visits 54 92 31 114 67 109 147 206 101 134 139 58 120 180 168 35 116 86 45 126 82 77 119 99 139 76 114 156 145 141 152 114 150 3692 3888 Re-visits 172 473 173 532 361 691 440 728 845 788 534 244 524 874 1022 254 699 357 170 322 322 230 565 610 513 895 554 443 835 660 406 836 624 18605 18607 Children 1—2 years— First Visits - 4 - 7 - 15 14 108 3 5 3 4 - 1 1 2 2 8 4 14 10 2 - 3 5 9 3 2 4 4 1 4 6 248 245 Re-visits 104 238 168 303 234 449 288 672 615 452 168 130 313 543 838 156 526 214 93 266 170 158 305 515 385 681 509 309 480 174 366 385 460 11667 12631 Children 2—5 years— First Visits - 5 - 5 - 1 20 134 1 2 - 1 - - - 1 - 6 14 13 9 2 1 1 6 6 6 12 8 3 1 3 14 275 314 Re-visits 229 749 252 437 301 311 764 770 814 1294 398 344 699 1266 549 227 908 402 142 511 348 325 357 997 896 1147 1016 675 1055 504 883 873 1316 21759 21593 Expectant Mothers— First Visits 3 40 5 12 1 1 16 - 20 6 19 7 8 37 7 - 1 1 1 22 15 1 2 25 54 106 30 69 38 31 17 2 7 604 1719 Re-visits - 2 2 5 - - - - 42 - - - 4 11 - - - - - 1 - 1 36 - 143 8 - - 4 1 2 - 262 161 Still Births - - 1 - - - - - - - - - 3 - - - 2 - - - 2 2 - 3 1 2 - - - - - - 16 13 Deaths under 1 year 1 1 - - - - - - 4 1 i; 1 - - - 2 - - 4 - 1 1 - 1 - 1 - - 1 - - 20 32 Miscellaneous Visits - 42 2 59 4 3 8 64 4 113 22 16 S 46 4 13 4 - 30 - 20 27 1 9 64 9 75 - 10 30 59 33 25 15 811 618 Ineffective Visits 90 376 110 821 271 416 234 444 528 321 299 308 296 545 217 236 350 508 169 192 363 158 385 668 420 236 257 649 775 332 900 366 465 2705 14268 Totals : 1951 653 2022 744 2295 1239 1996 1931 3126 2973 3119 1583 1113 2010 3465 3715 915 2602 1616 638 1486 1351 965 1747 3019 2430 3376 2499 2326 3370 1912 2761 2610 3057 70664 1950 1631 2138 2886 1409 3050 2205 2356 3553 2491 2890 1826 - 2185 3495 3665 624 3111 - 2273 1508 - 2635 1397 2304 3006 - 964 1963 4003 1672 2901 3150 2441 '74089 51 THE WORK OF THE HEALTH VISITORS The health of a family largely depends upon the wisdom and care of the mother. When Health Visitors were first employed by local authorities they were concerned with families where ignorance and neglect brought infant and child deaths. That they have been most successful in their efforts is unquestionable. The need today may not be so apparent or pressing as crudities have generally been removed, and it is the more insidious causes of ill-health, or maldevelopment, emotional and physical, which remain. While variations in emphasis and training are required to deal with changing demands, the fundamental basis of the Health Visitor being first a nurse does not seem to need alteration. When, as in Croydon, the work of the Health Visitor is combined with School Nursing, the suggestion of her being only a social worker is obviously untenable. The Health Visitor as at present trained has proved herself a most important and competent health worker, and one sees no valid reason to anticipate that she will be less effective in the future. 52 HOME NURSING This service is carried out by the Croydon District Nursing Association, acting- as agents of the Corporation. 1 am indebted to the Superintendent for the following information : — Staff at 31-12-51 Superintendent. 2 Assistant Superintendents. 30 whole time Nurses (State Registered Enrolled assistants). Summary of work carried out during the year under revaiew.:— Patients remaining on books from 1950 586 New patients 4,203 Total 4,849 New Patients:— Medical 2,012 Surgical 1,500 Gynaecological 97 Obstetric 48 Total 4,203 Specially classified:— Cases Visits Tuberculosis 113 18,190 Pneumonia 257 3,124 Maternity Complications 56 524 Infectious Diseases 17 134 Children under five years 192 1,320 53 Visits:— Termination of Cases:— Convalescent 2,556 Hospital 622 Died 491 Removed for other causes 520 Still on books 660 Total 4,849 January 9,879 February 9,924 March 9,861 April 9,574 May 9,916 June 8,970 July 8,666 August 9,398 September 9,289 October 9,870 November 11,138 December 11,327 Total 117,812 54 IMMUNISATION AGAINST DIPHTHERIA. A total of 3,459 new cases came from the following sources:— Of these, 23 failed to return for completion of the course. School Children 312 Children under 5 3,147 Reinforcing injections are now being recommended, just before the child starts school, and again at 10 years of age, i.e., at about 5-yearly intervals. The number of such injections given during the year was 2,921. The ensuing comparative tables give some further details:— Year New Cases Completed Treatment Failed to attend for completion of Course Reinforcing Injections 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 — — 1940 3935 3934 386 32 1947 3638 3516 266 641 1948 3799 3704 95 1667 1949 4299 4216 83 2898 1950 3089 3014 75 4512 1951 3459 3436 23 2921 Origin and Source of New Cases attending. Year School Pre-school Total Per cent. Total Per cent. 1937 928 72.2 3)8 27.8 1938 1179 76.5 332 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 3K6 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 1951 312 9.0 3147 91.0 55 IMMUNISATION AGAINST WHOOPING COUGH A total of 2,448 children were immunised against whooping cough, comprising 2,381 under school age and 67 school children. VACCINATION AGAINST SMALL POX A total of 4,226 persons were vaccinated against Small-pox. Under 1 year of age 1—4 5—14 15 or over Total Successful Vaccinations 1587 310 307 406 2610 „ Re-vaccinations — 35 160 1336 1531 Insusceptible to Vaccination 40 4 5 36 85 4226 56 AMBULANCE SERVICE. To the Medical Officer of Health. I submit the Tenth Annual Report of the Croydon Ambulance Service, for the year ended 31st December, 1951. During the year the Service was called upon to deal with 46,019 calls, an increase of 486 over the previous year. In this connection it should be noted that the calls for the year 1952 will be appreciably less in number, due to a standardised definition of "journey" as laid down in Ministry of Health circular 25/51, which requires a return to be submitted showing details of journeys, etc., but although the number of calls will be less the same amount of work will be carried out, and in fact, judging by the increase in the first five weeks of this year, the mileage covered will be greater. During the year some difficulty was experienced in conveying all patients at the exact time, but the system was rearranged in order to overcome these difficulties satisfactorily. A new Daimler was delivered to the Service in July and has proved satisfactory. Some of the ambulances are very old and uneconomical to run and in addition spares are difficult to obtain. It is hoped that these vehicles will be replaced in the near future. In conclusion may I express my sincere thanks to the Members of the Ambulance Sub-Committee and to the Medical Officer of Health, for their help and encouragement which has been of great assistance to me in the administration of the duties of Chief Ambulance Officer. A. L. HILL, * Chief Officer. Calls were dealt with as follows:— Headquarters Station, Stroud Green 29,958 No. 2 Station, Thornton Heath 5,106 No. 3 Station, South Croydon 4,854 No. 4 Station, Mayday Hospital 5,455 No. 5 Station, Waddon Hospital 646 57 Gasification of Calls. Previous Year 1950 Home Accidents 531 508 Miscellaneous Accidents (Unclassifiable) 122 153 Recreational Accidents 142 99 School Accidents 134 101 Street Accidents 815 794 Work Accidents 233 284 Home Illness 151 160 Street Illness 477 484 Work Illness 65 73 Common Assault 25 25 Attempted Suicide 40 28 Suicide 20 14 Health Service Removals 42,401 41,706 Services refused or ambulance not required 217 204 45,373 44,633 Calls taken by Waddon Hospital (Infectious Diseases) 646 900 46,019 45,533 The total mileage covered by ambulances and cars during the year was 366,095 miles, which is an increase of 11,074 miles over the previous year. Analysis of Accidents, etc., for the year ended 31st December, 1951 STREET ACCIDENTS PEDESTRIANS KNOCKED DOWN BY:— (1) Pedal Cycles (Adults) 25 ,, ,, (Children) 12 (2) Motor-Cycles (Adults) 22 ,, ,, (Children) 7 (3) Cars (Adults) 60 ,, (Children) 37 (4) Vans (Adults) 8 ,, (Children) 3 (5) Lorries (Adults) 9 ,, (Children) 6 (6) Buses (Adults) 8 ,, ,, (Children) 2 (7) Trams (Adults) — ,, (Children) 2 (8) Trade Vehicles (Adults) — „ ,, (Children) 2 202 58 FALLING— (1) In the Street (Adults) 126 ,, (Children) 56 (2) Inside Buses (Adults) 8 ,, ,, (Children) 3 (3) From Pedal Cycles (Adults) 71 ,, ,, ,, (Children) 68 (4) From Motor-Cycles (Adults) 41 „ „ (Children) — (5) From Cars (Adults) 8 „ ,, (Children) 1 (6) From Lorries (Adults) 1 (7) From Buses (Adults) 33 „ ,, (Children) 1 (8) From Taxis (Adults) 1 (9) From Trams (Adults) 1 (10) From Auto-Cycles (Adults) 2 (11) From Invalid Chairs (Adults) 1 117 COLLISIONS BETWEEN VEHICLES— (1) Cycle Crash (Adults) 9 ,, ,, (Children) 3 (2) Van Crash (Adults) 1 ,, „ (Children) 1 (3) Car Crash (Adults) 27 (4) Motor-Cycle Crash (Adults) 18 (5) Cycle and Motor-Cycle (Adults) 15 ,, „ ,, „ (Children) 2 (6) Cycle and Car (Adults) 30 „ ,, ,, (Children) 14 (7) Cycle and Lorry (Adults) 10 ,, „ (Children) 4 (8) Cycle and Van (Adults) 12 ,, ,, ,, (Children 8 (9) Cycle and Bus (Adults) 1 „ „ „ (Children) 1 (10) Motor-Cycle and Car (Adults) 24 (11) Motor-Cycle and Van (Adults) 4 (12) Motor-Cycle and Bus (Adults) 3 (13) Motor-Cycle and Lorry (Adults) 9 (14) Car and Lorry (Adults) 8 (15) Car and Van (Adults) 2 190 STREET ACCIDENTS TO ADULTS .. CHILDREN 69 HOME ACCIDENTS— (1) Falling in the Home (Adults) 144 „ „ „ (Children) 121 (2) Falling Down the Stairs (Adults) 37 „ „ „ (Children) 3 (3) Burns and Scalds (Adults) 26 „ „ „ (Children) 25 (4) Cuts by Broken Glass, etc. (Adults) 6 „ „ „ (Children) 24 (5) Injuries Sustained by Tools, etc. (Adults) 7 „ „ „ (Children) 11 (6) Falling From Heights (Adults) 11 „ „ „ (Children) 19 (7) Injuries Sustained by Falling Objects (Adults) 6 „ „ „ (Children) 14 (8) Dog Bites (Adults) 9 ,, ,, (Children) 6 (9) Accidental Poisoning (Adults) 8 ,, ,, (Children) 16 (10) Falling from Bed (Adults) 6 (11) Miscellaneous (Children) 35 531 HOME ACCIDENTS TO ADULTS 259 CHILDREN 272 531 WORKS ACCIDENTS— (1) Caused by Machinery or Tools 58 (2) Caused by Falling Objects 45 (3) Falling 35 (4) Falling from a Height 50 (5) Falling down Holes 7 (6) Knocked down by Vehicles 6 (7) Colliding with Objects 14 (8) Burns and Scalds 11 (9) Lifting 7 233 SCHOOL ACCIDENTS— (1) Falling in the Classroom 26 (2) Falling in the Playground 66 (3) Falling from Height 11 (4) During P.T. 23 (5) Colliding with Objects 7 (6) Dog Bites 1 134 60 RECREATIONAL ACCIDENTS— (1) Football (Adults) 34 ,, (Children) 10 (2) Rugby (Adults) 5 ,, (Children) 3 (•3) Cricket (Adults) 0 ,, (Children) 4 (4) Swimming (Adults) 12 ,, (Children) 14 (5) Athletics (Adults) 4 ,, (Children) 1 (6) Squash (Adults) 1 „ (Children) 1 (7) Horse Riding (Adults) 1 (8) Playing in Parks (Children) 39 (9) Boxing (Children) 1 (10) Tennis (Adults) 1 (11) Miscellaneous (Adults) 5 142 ATTEMPTED SUICIDES— (1) Coal Gas Poisoning 13 (2) Cut Throat 6 (3) Poisoning 20 (4) Shooting 1 (5) Threw self under Car 1 40 SUICIDES— (1) Coal Gas Poisoning 15 (2) Cut Throat 2 (3) Shooting 1 (4) Strangulation 2 20 FATAL ACCIDENTS AND ILLNESS— (1) Certified dead at Hospital 63 (2) Certified dead at scene of Accident or Illness 17 80 ACCIDENT AND ILLNESS IN PUBLIC PLACES— (1) Recreational Grounds (Adults) 63 ,, ,, (Children) 37 (2) Shops (Adults) 85 ,, (Children) 8 (3) Public Houses (Adults) 35 (4) Cinemas and Theatres (Adults) 35 „ ,, „ (Children) 2 (5) Swimming Baths (Adults) 15 ,, ,, (Children) 10 (6) Railway Stations (Adults) 47 ,, ,, (Children) 4 331 61 ACCIDENTS AND ILLNESS TO ADULTS— Home Accidents 259 Miscellaneous Accidents 73 Recreational Accidents 69 Street Accidents 589 Work Accidents 233 Home Illness 117 Street Illness 456 Works Illness 65 Common Assault 25 Attempted Suicide 40 Suicide 20 1946 ACCIDENTS AND ILLNESS TO CHILDREN— Home Accidents 272 Miscellaneous Accidents 49 Recreational Accidents 73 School Accidents 134 Street Accidents 226 Home Illness 34 Street Illness 21 809 INFECTIOUS CASES CONVEYED BY WADDON HOSPITAL— Chicken Pox 46 Diphtheria 5 Dysentery 13 Encephalitis 3 Erysipelas 4 Food Poisoning 1 Gastro-Enteritis 21 Jaundice 3 Laryngitis 1 Measles 81 Meningitis 15 Mumps 30 Pneumonia 4 Poliomyelitis 12 Puerperal Pyrexia 2 Rubella 2 Scarlet Fever 355 Septic Rash 2 Septic Throat 4 Stomatitis 1 Tonsilitis 1 Tuberculosis 8 Typhoid 1 Vincents Angina 2 Whooping Cough 29 646 62 HOW EMERGENCY CALLS WERE RECEIVED— Doctor 163 Passer By 619 Police 308 Householder 641 Fire Brigade 227 Staff 797 2,755 The Gas and Air Apparatus was in demand 879 times, which necessitated vehicles travelling 44,885 miles. 316 calls were received to convey members of the Croydon Nursing Service, which entailed travelling 6,192 miles. Conveying children to and from St. Margaret's School accounted for 4,429 miles. CIVIL DEFENCE —Ambulance Section Since its inception on October 5th, 1951, this Section has functioned smoothly and well, an average attendance of 16 Volunteers being maintained at each session. Some difficulty regarding accommodation was experienced at first, but this problem has now been solved by utilising the whole of the basement at Stroud Green, for training purposes. Lectures and practical demonstrations have been given at the weekly sessions, and in addition a number of Volunteers have been given driving tests by the Vehicle Maintenance Officer. At the end of the year the total strength of Volunteers was 38, comprising 20 females and 18 males. 63 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, 92 cases were dealt with, 83 being adults (male, 25, female, 58) and 9 children. These figures do not include school children for whom arrangements are made by the Education Committee. LOAN OF NURSING EQUIPMENT The Corporation loan equipment and make a small weekly charge, with exemption for incomes below a certain figure. During the vear the undermentioned loans were made:— Bed Pans 211 Air Cushions 330 Bed Rests ... 153 Bed Cradles 23 Rubber Bed Pans ... 90 Urinals 109 Mackintosh Sheets 339 Air Beds 20 Feeding Cups 11 Dunlopillo Mattresses 2 Wheel Chairs 12 Kidney Dishes 4 Commodes ... 15 Bed Tables 7 Crutches ... pairs 2 Douche Can 3 DOMESTIC HELPS. This service continued in great demand and an analysis of the work covered shows the following approximate percentages:— Maternity Cases 37.5 Sickness 61.2 Sick Room Helpers 1.2 (1) Number of Home Helps—January 1st and December 31st, 1951:— (a) Full-time 22 (b) Part-time 95 (2) Number of new applications— (a) Maternity 625 (b) Sickness 950 (c) Sick Room Helpers 18 64 (3) Number of applications met— (a) Maternity 564 (b) Sickness 920 (c) Sick Room Helpers 18 (4) Number of cases attended during year 2,020 (5) Average duration of services given- (a) Maternity 12 days (b) Sickness (acute case 10—21 days (6) Amount recovered for services £4,842 (7) Rate of remuneration of "Helps" £4 18s. 5d. per week; subsequently increased1 to£5 4s. 4d. later in the year. HEALTH PROPAGANDA. The usual continuous and detailed advice on health matters, which forms part of the daily duty for 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. 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. 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. 65 MENTAL HEALTH. As requested by the Ministry the following details of the service are set out: — Administration. The staff employed on this work comprised:— The Medical Officer of Health—in general administrative control. The Deputy Medical Officer of Health and one Assistant Medical Officer of Health (approved by the Ministry of Education for purposes of Section 53 of the Handicapped Pupils and School Health Services Regulations), as certifying Medical Officers for Mental Deficiency. 5 Duly Authorised Officers. 1 Occupation Centre Supervisor. 4 Assistant Occupation Centre Supervisors. There is close personal contact with the Medical Officers and Social Workers of the Hospital Psychiatric O.P. Clinic, the Regional Hospital Board's O.P. Mental Deficiency Clinic and the Child Guidance Centre. The Deputy Medical Officer of Health continues to pay periodic visits to the Mental Deficiency Colony accepting the majority of Croydon cases. Two Authorised Officers attended a nine weeks' course on First Aid in Mental Health " arranged by the National Council of Social Services and sponsored by the National Provincial Council for Mental Welfare. The only duty delegated to a voluntary association was the supervision of 15 mental defectives placed under guardianship in Brighton, by the Guardianship Society. Work carried out in the Community. 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 .*'<e Mental After-Care Association. Four 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 1951, are as follows:— (a) Certified and admitted to Warlingham Park Hospital 50 (b) Admitted to Warlingham Park Hospital as voluntary patients 48 61 (c) Removed to Mayday Hospital under Detention Order 250 (d) Admitted to Warlingham Park Hospital as temporary patients 3 (e) Investigated and no action taken 130 (f) Urgency Orders 2 483 Under the Mental Deficiency Act. Number of known Mentally Defective Patients in thf Borough: 1950 1951 Under 5 years 46 56 Aged 5-16 years 94 108 Over 16 years 542 566 Total 682 730 Compared with 1950 the cases show an increase of 48. Three Institution patients have died in hospital. The cases are distributed as follows:— 1951 In Certified Institutions 306 In Approved Homes 12 On Licence from Institutions 16 Under Statutory supervision at home 296 Under Guardianship 62 In Mental Hospitals 8 Observation cases 30 In "Place of Safety" — 730 During the year the Certifying Medical Officers made examinations and paid visits to the number of 120 cases. The Mental Deficiency Visitors paid 4,49G visits. 48 new cases were examined during 1951 and certified as mentally defective. 12 of these cases were recommended for the Occupation Centre and 20 were placed under statutory supervision. Eight were recommended for institutional care and eight for friendly supervision. 67 During 1951, 52 cases were dealt with as follows:— 1950 1951 Sent to Certified Institutions 24 45 Placed under Guardianship 2 — Sent to Warlingham Park Hospital — — Varying Orders: (a) Change of Guardian 2 2 (b) From one Institution to another 6 4 (c) From Guardianship to Institution 3 1 (d) Institution to Guardianship 1 — (e) Orders closed 3 — Tliirty-four Orders were renewed during the year, six of wliicli were Guardianship. Seven children were admitted to the Occupation Centre during 1951. Five left or were excluded. There were seven cases awaiting vacancies in Institutions on the 31st December, 1951. Guardianship Cases. There were 02 cases under Statutory Guardianship, 37 of these under the care of relatives, and 25 with Guardians who are not relatives. Two males and one female are at work. 659 visits have been paid to Guardianship cases during the year- There are 10 cases on licence from Institutions (0 males and 10 females). Report on (he Occupation Centre, January-December, 1951. Number on Register, January 43 ,, ,, December 41 Number of Admissions 7 Number of Fxclusions 5 Average attendance per session 35 Times open, Morning-Afternoon 400 Total attendance for year 14,087 68 :n January, we were again abie to take most ot the children attending the Centre to a Pantomime. An official visit from Miss Crozier, B.O.C. Inspector, was made early in February. In May, we had a tea party to celebrate the Centre's third birthday. In September, Miss Hensher returned to the Centre as Assistant Supervisor, having completed her training with the Mental Health Association. The Norbury Methodist Church sent a box of fruit and vegetables for the children during the Harvest Festival season. In November, we held our Open Day and Sale of Work. Almost every parent attended, and this again proved a great success. The Sale for the year amounted to £40 lis. 8d. In December, we held the Children's Christmas Party, Dr. Fleming very kindly came along to tea and distributed the presents to the children. Several D.P.H. Students visited the Centre during the year. Instruction at the Centre consists of various activities, including cookery, laundry for the girls, stool seating, cane weaving, gardening for the boys, and singing, percussion band, P.T., Sense-Habit training for the younger children. LILIAN B. COONEY, Supervisor. 69 SANITARY CIRCUMSTANCES To the Medical Officer of Health. I beg to submit a report for the year ending 31st December, 1951, of the work of the Sanitary Inspectors and other officers under my supervision. Housing has again occupied much of the time of the inspectorate. Whilst new house building is going on apace within the Borough, the list of those requiring homes of their own is still a long one and it is therefore essential that those houses which are now fit for occupation should be so maintained, as every house allowed to fall into disrepair and decay, so as to be suitable only for demolition, adds at least or.e family to such list. The powers given to Local Authorities under the Housing Act 1936 have been used judiciously to maintain dwelling houses in a reasonable state of repair and this, together, with the repairs done following war damage, has given a new life to many hundreds of houses in the Borough. All the unfit and substandard houses in the Leighton Street and Albion Street area have now been demolished, sites cleared and new homes built for the displaced tenants. Wilford Road and Forster Road is now in course of being re-developed and it is hoped, in the near future, that what is now one of the ugly spots of the Borough will present a new face of good homes and well kept open spaces. More attention has been given to the routine inspection of factories, shops, offices and work places and the accompanying tables will show with what result. Improvements have been effected in many such premises and I have received ready co-operation from the Government departments responsible for thr licensing of such works. The year under review has been an eventful one in the field of food hygiene. The inspectorate in their personal contacts with business proprietors and householders have taken every opportunity to spread knowledge on this subject, and this form of approach will continue. It was, however, felt that a series of talks, augmented bv films, given to those engaged in the food trades, showing the mistakes made by food handlers and the consequences of such errors and omissions and how, by simple precautions, such conditions can be prevented from arising, would stimulate interest and be of value. All proprietors of food businesses were invited, in writing, to co-operate by arranging for themselves and members of their staffs to attend such talks at limes to suit their convenience. The response has been quite 70 good, and the time, mostly after normal hours, and effort given chiefly by my Deputy, has, I am sure, not been wasted- 41 such talks have been given during the year to some 1,700 people. Sampling of food and drink has been carried out as a routine with a view to detecting adulterations and irregularities. The .Ministry of Food have, through their Food Standards Orders, and Labelling of Food Orders, done much to improve the composition of foods. These Orders are welcomed by manufacturers and packers of repute and they are of great value to those who have to "watch over" the public's food supply. Irregularities are from time to time observed which are r.ot of serious import, and these are readilv put right by the packers. Wilful adulteration or acts of carelessness which may have serious consequences, have to be dealt with in a more summary manner. I would here like to thank our Public Analyst, Mr. Moir, for the help he gives me in this complicated side ot food control. The Municipal Slaughterhouse continues to be used to capacity by the Ministry of Food, and during the year, 23,000 animals were slaughtered and their carcases and offals were inspected by the Meat Inspectors. Amongst the diseased conditions met with, tuberculosis is still very prevalent. In the future, with the progress of the tubercle free herd scheme of the Ministry of Agriculture and Fisheries, one can hope for a reduction in the heavy losses from this disease. The "liver fluke" has been responsible for the condemnation of very many livers and it is pleasing to note that the same Ministry are taking steps to see that land heavily infested with the snail in which part of the life cycle of this parasite is spent, is disinfested. A few cases have been observed of "measly" beef—a condition which, if such meat was consumed without sufficient cooking, could give rise to the tapeworm of man. This infection of the beef animals has become much more prevalent in this country during and since the war. The attack on rodents continues and in this connection it is interesting to note that in 1947, when the sewers of the Borough were lirst baited, "takes" of bait, signifying the presence of rats, were observed in 1,323 manholes, and since that time baiting and poisoning has gone an annually with a result that in 1951 the manholes showing the presence of rats had been reduced to 307. The statistical tables and 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 bv those under my control. GEO. GRIEV.E, Chief Sanitary Inspector. 71 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) 5,615 Number of houses inspected where symotic diseases have occurred ... 325 House'drains tested 2,904 House drains tested on application 10 Number of smoke tests during repair 135 Inspection of drainage work during repair 4,270 Number of water tests during repair 277 Final tests of drains after repair 106 Final tests of drains when completely relaid 67 Inspection of yards, stables and manure pits 160 ,, passages 143 ,, public conveniences 238 ,, pigstyes and foodbins 112 „ tents, vans and similar structures 108 ,, theatres, cinemas, halls, etc. 100 ,, ponds, ditches and watercourses 269 ,, schools and school sanitary conveniences 43 ,, verminous premises 126 ,, premises where offensive trades are conducted 16 ,, gipsy encampments, camps, fairs, etc. 38 ,, cesspools and earth closets 31 ,, gathering grounds of water supply 43 Number of visits re Rats and Mice Infestations 11,368 Smoke observations 231 Number of visits re Infectious Diseases 1,570 Inspections of Shops (under Shops Acts) 1,243 Special Early Closing and Evening Patrols (Shop Hours Acts) 744 Overcrowding inspections 287 Inspections under Diseases of Animals Acts 104 Inspections under Fertilisers and Feeding Stuffs Act 45 ,, under Pharmacy and Poisons Act 135 under Merchandise Marks Acts 3 Inspection of Dairies 116 ,, Milkshops 60 ,, Premises where food is prepared or sold 6,934 ,, Bakehouses 147 ,, School Kitchens and Services 68 ,, Imported Food at Aerodrome 142 ,, Factories without mechanical power 201 ,, Factories with mechanical power 612 ,, Workplaces (Public Health Act) 114 ,, Outworkers' premises 311 ,, Offices 48 Visits re Young Persons' Employment Act 7 Drinking water samples taken 326 Swimming bath waters : samples taken 118 Food and Drugs Acts : milk samples taken 283 Food and Drugs Acts : other foods and drugs samples taken 454 Milk (Special Designations) Orders : samples taken 272 Ice Cream samples taken 244 Reinspections of work on outstanding notices 26,181 Sundry inspections and visits 2,530 Appointments kept with owners, builders, etc. 5,441 73 Complaints from public investigated (including those in regard to housing defects) 6 369 Informal notices outstanding 31-12-50 1,620 Informal notices served 5,179 Informal notices complied 4,335 Number of Informal Notices referred for Statutory Orders 860 Informal notices outstanding 31-12-51 1,604 Statutory notices outstanding 31-12-50 858 Statutory notices served 1,523 Statutory notices complied 1,779 Statutory notices outstanding 31-12-51 602 Total number of callers and complaints received at the office 10,671 Total number of letters received at the office 8,971 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1951 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 814 Conditions causing dampness: Defective roofs 1,207 Defective window frames 378 Defective walls, etc. 533 Want of efficient damp-proof course 209 Defective gutters and downspouts 920 'Other structural defects: Defective plaster 1,138 Cleansing and redecoration required 1,146 Defective floors and stairs 543 Insufficient ventilation under floor 60 Defective brickwork, sills, lintels, chimneys 484 Defective stoves and fireplaces and flues 440 Defective drains, sanitary fittings, etc.: Defective sinks and waste pipes 380 Defective w.c.'s 252 Defective drainage 498 Stoppages in drains 408 Defective water services and tanks 71 Domestic nuisances: Want of cleanliness 11 Verminous conditions 56 Other nuisances and infringements: Offensive accumulations 102 Overcrowding 84 Smoke nuisances 30 Sundry nuisances or defects 34 Particulars not inserted in Rent Book (Housing Act) 18 (Rent Restriction Act) - 73 (2) FACTORIES AND WORKPLACES. Want of cleanliness 26 Inadequate ventilation 7 Insufficient drainage of floors 1 Abstract not exhibited 15 Sundry nuisances or defects 63 W.C.'s—Insufficient 13 ,, Unsuitable or defective 131 ,, Not separate for sexes "" (3) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924. Food cupboards defective or required 7 (4) INFRINGEiMENTS OF FOOD AND DRUGS ACT, 1938, AND FOOD BYELAWS. Structural defects in shops and stores 57 Cleansing or repair of walls and ceilings 147 Cleansing or repair of floors, utensils, fixtures, etc. 104 Insufficient or defective sink accommodation and water supply 38 Insufficient lighting or ventilation 23 Defective drainage 32 W.C. accom.—Insufficient 10 ,, ,, Repair or cleansing required 34 ,, ,, Artificial light required 6 ,, ,, Want of intervening ventilated space 1 Cloakroom accommodation required or defective 4 Overalls required or dirty 3 Ablutions—Wash basins required 40 ,, Hot water supplies required 109 ,, Soap and towels required 13 Food improperly stored 12 Food store—Required or defective 9 ,, Animals kept in 3 ,, Household washing in 1 Accumulation in yards or stores 42 Offal and refuse bins uncovered or defective 42 Footpaths fouled by waste water 2 Yard paving defective 18 Vehicles—dirty or defective 3 (5) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING, Etc. Defective Yard Paving 100 Want of a sanitary dustbin 125 (6) INFRINGEMENTS OF SHOPS ACT. Shops Closing Hours 36 Infringement in hours of employment and welfare provisions 11 Notices to be exhibited or amended 222 Provision of means of heating 3 Insufficient w.c. accommodation 8 Want of washing facilities 2 Defective w.c. accommodation 10 Defective walls, floors, ceilings, etc. 10 Defective lighting 7 Seating accommodation 4 74 (7) INSPECTION OF AMUSEMENT HOUSES. Defective sanitary fittings 6 W.C. defective and dirty 8 (8) KEEPING OF ANIMALS. Nuisances arising from the keeping of animals 8 (9) INSPECTION OF WATERCOURSES, Etc. Cleansing of watercourses and ponds 10 (10) INFRINGEMENTS OF OTHER BYELAWS. Noisy animals 6 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 4 dwellings. 1.— Inspection of dwelling houses during the year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health and Housing Acts) 5,615 (b) Number of inspections and re-inspections made for the purpose 28,299 (2) (a) Number of dwelling houses included under the head (1) above, which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 — (b) Number of inspections made for the purpose - (3) Number of houses found to be in a state so dangerous anil injurious to health as to be unfit for human habitation 4 (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 4,012 II.—Remedy of defects throughout the year without service of Formal Notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 4,231 III.—Action under Statutory Powers during the year:— A.- Proceedings under Sections 9, 10 and 16 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which notices were served during the year requiring repairs 828 75 (2) Number of dwelling houses which were rendered fit after service of formal notices— (a) By owners 965 (b) By local authority in default of owners 87 13.—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 604 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 420 (b) By local authority in default of owners 195 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 4 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 12 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 — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 3 West Croydon Men's Hostel. This is situated at Pitlake and is available for use by "nightly lodgers." It has 104 cubicle beds, four of which are reserved for staff. The charge is 1s. 3d. per night or 7s. 6d. per week, and 1s. per night or 6s. per week for Old Age Pensioners. Cooking facilities are provided. Hot baths may be taken any time after 9 a.m. Clothes may be washed and dried in the wash-house provided. The average number of nightly lettings during the vear was 100, and the number accommodated during the vear 36,500. The receipts and expenditure for the past 5 years have been as follows:— Receipts. Expenditure. £ s. d. £ s. d. 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 1951 1,834 0 0 3,062 0 0 76 Houses—Sanitary Certificates. House drains and sanitary fittings are tested and examined on request, at a fee. During the year 10 such requests were made. FACTORIES ACT, 1937 During the year the under-mentioned inspections have been made and defects were found as set out:— FACTORIES Inspection Premises. Number of Inspections. Written Notices. Prosecutions. Factories:— With Mechanical Power 492 69 — Without Mechanical Power 201 20 — Other Premises 130 4 — Outworkers and Employers of outworkers 311 — — Total 1134 93 — Defects Found Particulars. Number of Defects. Referred to H.M. Inspector. Prosecutions. Found. Remedied. Want of Cleanliness 26 23 — — Overcrowding — — — — Unreasonable Temperature — — — — Inadequate Ventilation 7 6 — — Ineffective Drainage of Floors 1 — — — Sanitary Conveniences. (a) Insufficient 13 9 — — (b) Unsuitable or Defective 131 103 — — (c) Nat Separate for Sexes — — — — Other offences against the Act (not including offences relating to Outworkers) 63 49 9 — Total 241 190 9 — 77 Home Work. Lists of home workers, or outworkers as they are termed, are sent in twice yearly, and this year contained the names of 45G workers residing in the Borough. 311 visits were paid to outworkers. Nature of Employment of Outworkers on the Register, 31st December, 1951 Nature of Work. Number Employed. Outwork in Infected Premises. Outwork in Unsatisfactory Premises. Remarks. Making Cleaning, Altering and Repairing Wearing Apparel 273 — — — Upholstery Work 6 — — — Other Classes of Work 177 — — — Total 456 — — — Inspection of Schools. These are inspected with particular reference to sanitary accommodation including washing facilities. During the year 43 inspections were made and defects found were referred to the Education Officer. SHOPS 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. 11 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. 1,243 inspections were made under the Shops Acts, and a number of infringements were found. 78 DRAINAGE During the year there was no lessening of work in this branch of the department's duties. Some 4,270 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 592 Orders served, 195 had to be done in default of the owners. KEEPING OF ANIMALS. There was during the war a large increase in the number of pig and poultry keepers. Byelaws were relaxed by Government Order, but this did not relieve the keepers of providing against nuisance. Little complaint of nuisance has however arisen. OFFENSIVE TRADES. There are but few registered, and during the year there has been no cause for complaint. WATERCOURSES, PONDS AND DITCHES, Etc. 269 inspections were made and pollutions were found in 10 cases. SMOKE OBSERVATIONS. During the year 231 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. 100 inspections were made of Theatres, Music Halls, Cinemas, Dance Halls, and premises where stage plays are given. A report is submitted annually to the Licensing Authorities on the sanitary condition of these premises. Notices are issued to remedy any unsatisfactory conditions. DISINFECTION. The Borough Disinfecting Station is situated at Factory Lane. Two steam disinfectors are in use and are supplied with steam from the Electricity Works. 79 The following articles were disinfected at the Disinfecting Station during the year:— By Steam 17,332 articles „ Formalin Gas 5,025 „ „ „ Spray 101 „ Total 22,458 „ In addition 939 articles were destroyed on request. Disinfection of bedding and upholstered articles is carried out for traders, who deliver them to, and collect them from, the Station. For this service a charge is made. During 1951, 863 articles were disinfected, the receipts amounting to £37 13s. 2d. Disinfection was carried out after infectious or contagious disease at the following premises:— 905 rooms at 756 houses, hospital wards, clinics, and creches. 4,251 library and other books were disinfected. CLEANSING OF VERMINOUS, Etc., PERSONS. A Cleansing Station consisting of a reception room, four bath rooms and a discharge room, is attached to the Disinfecting Station, and is used for dealing with verminous, etc., conditions in adults and children. A woman attendant deals with children and women. During the year 4 adults and 80 children were cleansed of verminous conditions and 6 adults and 10 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 on fumigation. PHARMACY AND POISONS ACT, 1933. The object is to regulate the sale of certain poisonous substances and the Act contains important provisions. 80 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 29. In addition, 262 applications were made for the retention of names on the list for a further period of twelve months. 11 infringements of the Act were found. FERTILISERS AND FEEDING STUFFS ACT, 1926. 45 inspections of premises where fertilisers and feeding stuffs were sold were carried out during the year. Samples taken proved genuine. PREVENTION OF DAMAGE BY PESTS ACT, 1949. This Act is mainly concerned with the destruction of rats and mice and it places a duty on the occupier of any premises to report to the Local Authority any infestation by such rodents. Three ratcatchers, officially designated rodent operatives, are employed to deal with such complaints. During the year, 1664 private dwellings were inspected following complaints and in 867 instances infestation was confirmed. The rodent operatives dealt with 735 of these infestations and the occupiers themselves, after being advised, dealt with 108. In 24 instances defective drainage was permitting the egress of rats from the sewers—appropriate action was taken to have the drains repaired and the adjacent sewers treated. 147 business premises were found to be infested with rats or mice and these were all disinfested during the year. Corporation owned premises including sewage works, refuse tips, depots, etc., are periodically inspected for the presence of rodents and if infested then action is taken by the department to eradicate the pests. 34 such premises were found to be infested during the year. Included in the Corporation's ownership are the sewers of the Borough and for some years now these have been systematically treated for rat infestation and the results have shown a steady decline in the rat population over the years. Originally each manhole on the foul water sewerage system was baited and takes of bait, proving the presence of rats, were observed in 1,323 manholes. During 1951 the manholes showing the presence of rats had been reduced to 367. The Ministry of Agriculture and Fisheries through their pest control branch are constantly experimenting in the war against rodents and other pests, and are ready to pass on to Local Authorities any new findings which will be helpful in this essential public health function. 81 FOOD SUPPLY. The supervision and inspection of the food supplies is carried out by the Sanitary Inspectors who are all qualified in food inspection. The following table shows the distribution of trades among the 2,811 premises in the Borough at which food is known to be sold, manufactured or stored:— Bakehouses 79 Bakers Shops 131 Sugar Confectioners 474 Cafes, Restaurants, Snack Bars and Eating Houses 435 Kitchens of the School Meals Service and at Residential Hotels 71 Works and Club Canteens 313 Public Houses 103 Off Licences 44 Grocers 651 Butchers 202 Chemists 93 Greengrocers 412 Fishmongers 101 Fried Fish Shops 48 Milk Distributors and Dairies 75 Premises from which Roundsmen and Mobile Shops operate 80 Stalls in Markets 91 Food Manufactories 19 Other food premises not enumerated above 21 3,503 The following table gives a summary of the inspections made during the year, not including visits made to slaughterhouses or dairies:— Butchers 1,134 Ice Cream Vendors and Manufacturers 536 Bakers and Bakehouses 354 Confectioners 330 Greengrocers 235 Fishmongers 244 Grocers 1,689 Fried Fish Shops 82 Stalls and Rounds other than in Markets 125 Poultry and Game Dealers 274 Catering Establishments 942 Cooked Meat Miscellaneous 440 ation Premises 248 6,633 82 In addition to the above, Croydon Airport was visited on 80 occasions to inspect foodstuffs arriving by air from the Continent. Such foodstuffs included Salami, Hams, Reindeer Meat, Brawn and Delicacies. Out of the 40 tons imported only 67 lbs. had to be condemned. General Summary of meat and other articles of food found to be unfit and condemned by the Inspectors during 1951:— Articles. Weight in lbs. Diseased. Unsound. Total. Beef 29960 2884 32844 Veal — 13 13 Mutton 485 212 697 Pork 4151 356 4507 Otfal 53478 74 53552 Sundry Foodstuffs — 15608 15608 Canned, bottled and packeted goods — 46964 46964 88074 66111 154185 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 83 the year 1951 the following animals were slaughtered there and inspected by the Corporation's Meat Inspectors:— Cattle excluding Cows. Cows. Calves. Sheep and Lambs. Goats. Pigs. Total. 6,586 1,933 659 8,524 1,838 3,774 23,314 The result of these inspections was as follows:— CARCASES INSPECTED AND CONDEMNED Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Goats Number killed 6586 1933 659 8524 3774 1838 Number inspected 6586 1933 659 8524 3774 1838 All Diseases except Tuberculosis. Whole Carcases condemned 2 5 — 11 34 — Carcases of which some part or organ was condemned 2100 480 — 890 120 7 Percentage of the number inspected affected with disease other than Tuberculosis 31.9 25.1 — 10.6 4.1 .4 Tuberculosis only. Whole carcases condemned 16 20 — — 3 — Carcases of which some part or organ was condemned 465 460 1 — 49 — Percentage inspected affected with Tuberculosis 7.3 24.8 .15 — 1.4 — MILK SUPPLY. During the year 17G 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 " 52 Licences to use the designation "Pasteurised "— (a) Dealers' (Pasteurisers') Licences 2 (b) Dealers' Licences 58 84 Licences to use the designation "Sterilised"— Dealers' Licences 69 Dealers' Supplementary Licences to use the designation— (a) Tuberculin Tested 6 (b) Sterilised 4 (c) Pasteurised 6 Inspection of these licensed premises has been carried out during the year to see that the conditions of the licences were observed. Bacteriological Examinations of Milk. During the year the following samples of milk were examined:— Tuberculin-Tested Milk 21 Pasteurised Milk 243 Sterilised Milk 8 The following table summarises the results of the bacteriological examinations of Tuberculin Tested, Pasteurised and Sterilised milk samples during the year:— Tuberculin-Tested Milk. Methylene Blue Test. No. Samples Taken. Not Satisfied. Satisfied. 21 1 20 85 Pasteurised Milk. No. Samples Taken. Methylene Blue Test. Phosphatase Test. Not Satisfied. Satisfied. Not Satisfied. Satisfied. *243 3 186 3 240 * 54 Methylene Blue Tests were Void Owing To Laboratory Temperature, but of these51 showed a satisfactory result to the Test. Sterilised Milk. No. Samples Taken. Turbidity Test. Not Satisfied. Satisfied. 8 Nil 8 86 BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM. 244 samples were taken, the results being as under:— Grade. No. of Samples. 1 166 2 63 3 10 4 5 Out of a total of 244 samples taken, 15 (6.1 per cent.) failed to reach a satisfactory standard of bacterial purity. This is an improvement on the previous year when 16.1 per cent. failed. 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. During the year the Ministry of Food made a standard for Ice Cream viz: 5% Fat, 10% Sugar and 7½% Milk solids other than fat. Twenty-two samples were taken and five failed to reach this standard. In the five cases it was the milk solids other than fat that was found to be deficient, all being well above the requirement regarding fat and sugar. The Manufactories were outside the Borough and expert advice was recommended and taken by the firms concerned and as a result further samples proved to be satisfactory and have remained so. 87 FOOD AND DRUGS ACT, 1938. During the year 296 samples of milk and 475 other samples were taken. Summary of Samples. During 1951 samples were obtained and submitted to the Public Analyst as follows:— Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Aspirin Tablets 3 3 — — — Barley Crystals 1 1 — — — Batter Mixture 1 1 — — — Beans, Cooked 1 1 — — — Beans in Tomato Sauce 2 2 — — — Beef, Minced 1 1 — — — Beans, Green, Sliced 1 1 — — — Beer 5 5 — — — Bicarbonate of Soda 2 2 — — — Biscuits 8 8 — — — Black Pudding 4 4 — — — Blancmange Powder 4 4 — — — Boracic Ointment 1 — 1 — — Brawn 3 3 — — — Brawn Pork 1 1 — — — Bread 11 11 — — — Bread Rolls 1 1 — — — Buns, Cream 1 1 — — — Butter 5 4 1 — — Cachous, Silver 1 1 — — — Cake 6 6 — — — Cake Flour Mixture 10 10 — — — Cake, Fruit 2 2 — — — Camphorated Oil 2 2 — — — Castor Oil 1 1 — — — Cheese, Dutch 1 1 — — — Cheese, Processed 2 1 1 — — Cheese Spread 3 3 — — — Cherries, Glace 1 1 — — — Cherries, Tinned 1 1 — — — Chocolate Spread 1 1 — — — Cochineal 1 1 — — — Cocoa 5 5 — — — Coconut, Desiccated 4 4 — — — Coconut Ice 1 1 — — — Cod Liver Oil 1 1 — — — Coffee 3 2 1 — — Coffee and Chicory 1 1 — — — Coffee and Chicory Essence 1 1 —. — — Concentrated Orange Peel 1 1 — — — Confectionery 9 9 — — — Cordial, Lime Juice 1 1 — — — Cornflour 2 2 — — — Cough Mixture 1 1 — — — Cough Sweets 1 1 — — — Cornish Pasty 1 — 1 — — Crab Meat 1 1 — — — Cream, Synthetic 7 6 1 — — Cream, Synthetic, Powder 1 1 — — — Currants 1 1 — — — Custard Powder 8 7 1 1 — Dessert Powder 6 6 — — — Curry Powder 1 1 — — — Duck, Savoury 3 3 — — — Carried forward 148 141 7 88 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought forward 148 141 7 Essence, Flavouring 2 2 — — — Faggots 2 2 — — — Fish Balls 1 1 — — — Fish Cakes 5 5 — — — Flour 3 3 — — — Food Colourings 2 2 — — — Galantine 3 3 — — — Gelatine 1 1 — — — Gin 5 5 — — — Ginger 1 1 — — — Ginger Beer 2 2 — — — Gravy Cubes 1 1 — — — Gravy Powder 5 4 1 — — Gravy, Thick 1 1 — — — Ham Loaf 1 1 — — — Herrings in Tomato 2 2 — — — Herbs, Mixed 1 1 — — — Honey 1 1 — — — Ice Cream 22 17 5 — — Indigestion Tablets 2 2 — — — Iodine, Tincture of 1 — 1 — — Jam 9 9 — — — Jelly, Base 1 1 — — — Jelly Crystals 3 3 — — — Jelly, Table 8 5 3 — — Kippers, Tinned 1 1 — — — Lemonade 1 1 — — — Lemonade Powder 2 2 — — — Lemon Curd 2 2 — — — Lollies, Ice 2 2 — — Lolly Juice 1 — 1 — — Lozenges, Cough 1 1 — — — Luncheon Meat 18 18 — — — Marmalade 5 5 — — — Meat Cubes 1 1 — — — Meat Pie 4 3 1 — — Meat Roll 1 1 — — — Meringue Mixture 1 — 1 — — Milk, Condensed 2 1 1 — — Milk 296 287 9 — — Milk Whipping Compound 1 1 — — — Mincemeat 7 7 — — — Mustard Mixture 3 3 — — — Non-Brewed Condiment 1 1 — — — Oatmeal 1 1 — — — Onions, Pickled 1 1 — — — Paraffin, Liquid 1 1 — — — Paste, Cod Liver 1 1 — — — Paste, Fish 6 6 — — — Paste, Meat 3 3 — — — Paste, Tomato 1 1 — — Pearl Barley 3 3 — — — Pea Flour 1 1 — — — Peas, Tinned 11 11 — — — Peppermint Lozenges 1 1 — — — Pepper, White 2 2 — — — Pepper, Black 1 1 — — — Carried forward 616 583 33 — — 89 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought forward 616 583 33 Pepper Flavoured Compound 1 1 — — — Piccalilli 1 — 1 — — Pickles 9 9 — — — Pineapple Juice 1 1 — — — Plums in Syrup 2 2 — — — Powder, Orangeade 1 1 — — — Pudding, Fig 1 1 — — — Pudding Mixture 1 1 — — — Raising Powder 1 1 — — — Rissoles 1 1 — — — Rice 2 2 — — — Roes, Herring 1 1 — — — Rum 5 5 — — — Salad Cream 1 1 — — — Salad Dressing 1 1 — — — Salt 2 2 — — — Sandwich Spread 1 1 — — — Sardines 3 3 — — — Sauce 6 6 — — — Sauce, Fruit 2 2 — — — Sauce, Mint 2 2 — — — Sausage, Beef 7 7 — — — Sausage, Breakfast 3 3 — — — Sausage, Cocktail 1 1 — — — Sausage, Ham 1 1 — — — Sausage, Liver 5 5 — — — Sausage, Luncheon 6 6 — — — Sausage, Pork 10 10 — — — Sausage, Salami 2 2 — — — Sausage Meat, Beef 6 6 — — — Sausage Meat, Pork 2 2 — — — Saveloys 1 1 — — — Semolina 5 5 — — — Senna, Confection of 1 1 — — — Sherry 1 1 — — — Shrimps, Peeled 1 1 — — — Sodium Citrate Tablets 1 — 1 1 1 Soft Drinks 10 10 — — — Soup, Chicken Noodle 1 1 — — — Soup Powder 1 1 — — — Soup, Vegetable 1 1 — — — Spice, Mixed 3 3 — — — Sponge Mixture 1 1 — — — Steak Pie 1 1 — — — Stuffing 1 1 — — — Sugar 6 4 2 — — Sultanas 1 1 — — — Syrup of Figs 1 1 — — — Syrup, Golden 1 1 — — — Tapioca 1 1 — — — Throat Sweets 2 2 — — — Tomato Juice 1 1 — — — Tongue, Ox 1 1 — — — Treacle 1 1 — — — Tunny Fish 2 2 — — — Vegetables, Mixed 3 3 — — — Vinegar with Caramel 1 1 — — — Vinegar, Malt 3 3 — — — Carried forward 757 720 37 1 1 90 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought forward 757 720 Whiskey 6 6 — — — Wine, Port Type 1 1 — — — Wine, Raisin 2 2 — — — Wine, Ruby 1 1 — — — Wine, White 3 3 — — — Yeast Tablets 1 1 — — — Totals 771 734 37 1 1 Result of Analysis of Milk Samples. Solids not Fat (Legal standard is 8.5%)* 8.3 8.4 8.45 8.5* 8.6 8.7 8.8 8.9 9.0 9.1 1 2 1 6 52 111 09 20 3 1 Milk Fat (Legal standard is 3%)* 2.7 3.0* 3.1 3.2 3.3 3.4 3.45 3.5 3.6 3.7 3.8 3-9 4.0 4.2 1 — 11 12 54 53 1 48 35 23 20 5 1 2 Total samples of milk : 266 (Excluding South Devon and Channel Islands milks) South Devon and Channel Islands Milks Solids not Fat (Legal standard is 8.5%)* 8.7 8.8 8.9 9.0 9.1 9.2 3 3 5 3 9 7 Milk Fat (Legal standard is 4%)* 1.89 3.44 3.75 3.95 4.0* 4.1 4.2 4.3 4.4 4.5 4.6 1 1 1 1 3 7 3 6 2 3 2 Average composition of Milk Samples Milk (excluding South Devon and Channel Island Milks) Solids not Fat 8.72% Milk Fat 3.47% South Devon and Channel Island Milk Solids not Fat 9.0% Milk Fat 4.1% 91 The samples of milk for analysis were obtained as follows: Taken on Milk Rounds 196 „ at Dairies 47 „ at Institutions 46 „ at Local Farms 3 „ at Schools 4 296 DETAILS OF NON-GENUINE SAMPLES TAKEN Sample No. Article Nature of Adulteration or Deficiency Action Taken 81 Boracic Ointment Contained 1.55% of boric acid instead of the 1.0% (limits 0.9 to 1.1) of the British Pharmacopoeia. Vendor warned. 118 Cheese, processed Consisted of processed cheese of the Gruyere variety and contained only 40.3% of fat, calculated on the dry matter. Vendor warned. 134 Custard Powder Contained a small piece of string and several hard granular or seed-like lumps. (The small lumps present were not of foreign material, but had apparently been formed by the wetting and subsequent drying of the powder with drops of water.) This article was from a School Feeding Centre—stock was withdrawn. 135 Gravy Powder Contained 6% of rust (iron oxide). Rust present was in the form of small flakes and would appear to have been derived from the rusty surface of a metal container. Manufacturer informed—subsequent sample proved genuine. 112 Milk Contained only 3.95% of butterfat instead of not less than 4%. (Channel Island Milk should show on analysis a butterfat content of not less than 4% (The Milk (Control and Maximum Prices) (Great Britain) Order, 1947.) Dairyman interviewed and warned regarding proper mixing of milk. 161 Milk 1% deficient in milk solids other than milk fat. Freezing test did not indicate added water. Dairyman informed. 92 Sample No. Article Nature of Adulteration or Deficiency Action Taken 83 Milk, condensed Exhibited a brown discolouration throughout due to a fault in manufacture. Article pure and wholesome and fit for human consumption. Manufacturer informed. 70 Synthetic Cream Specification of ingredients on the label not satisfactory. Packer informed and the necessary alteration to the labels was made forthwith. 363 Ice Cream Contained only 4% of milk solids other than fat instead of not less than 7½%. These three samples were from the same manufacturer, the samples were otherwise of good standard, containing an average of: 341 Ice Cream Contained only 5% of milk solids other than fat instead of not less than 7½%. Fat Total Sugars Sucrose 10.4% 18.8% 14.1% 311 Ice Cream Contained only 5% of milk solids other than fat instead of not less than 7½%. Enquiries from the responsible Local Authority revealed that the manufacturer was under a misapprehension regarding the required standard—further samples were taken and proved genuine. 397 Lollies, Ice The ingredients were not specified on the label as is required by the Labelling of Food Order, 1950. The Manufacturer was interviewed and undertook to have the ingredients overprinted on the Lolly Bags. 470 Meringue Mixture Possessed an objectionable odour due to partial decomposition as a result of bacterial growth. The Local Authority for the area in which this article was manufactured was communicated with. Stock was withdrawn from sale. 296 Milk 1% deficient in milk solids other than milk fat. Subsequent samples proved genuine. 304 Milk Slightly deficient in milk solids other than milk fat. Subsequent samples proved genuine. 319 South Devon Milk Contained only 3.75% of butter fat instead of not less than 4%. Circumstance reported to Ministry of Food. 330 Paste, Tomato, concentrated Contained 4.0 grains of tin per pound. Whole of wholesalers stock surrendered and destroyed. 590 Milk 10% deficient in milk fat. Official warning given by letter. 93 Sample No. Article Nature of Adulteration or Deficiency Action Taken 16 Milk 1% deficient in milk solids other than milk fat. Vendor's explanation accepted—subsequent samples proved genuine. 400 Milk 52% deficient in butter fat. This sample was submitted by a private purchaser on account of the "thin" appearance of the milk. The bottle was unopened to all appearances and was supplied by one of the large firms from whom very frequent samples are taken. The purchaser was satisfied that this was an isolated instance for which no explanation could be given and did not wish any further action to be taken. Subsequent samples have all proved genuine. 585 Ice Cream Contained 6% of milk solids other than fat instead of not less than 7½%. This result was due to a fault in the sampling technique. 13 Ice Cream Contained 7¼% of milk solids other than fat instead of not less than 7½%. The Manufacturers were working with a formula which they had been advised would comply with the Regulations, they immediately altered their formula and subsequent samples have proved genuine. 109 Butter (Informal) Consisted of Margarine. Vendor warned—subsequent formal samples proved genuine. 164 Coffee (Informal) Contained 40% of Chicory. This was the residue of a stock of loose coffee. Formal samples could not be taken as remainder of stock had been sold. 88 Cornish Pasty (Formal) Pastry Crust 76%. Filling, comprising mixed vegetables and seasoning 21.4%. Meat 2.6%. The filling of the sample consisted of a mixture of potatoes, beans, carrots, onions and meat, in that order, the proportion of meat being only one eighth of the total filling. In the opinion of the Analyst, the proportion of meat is not of the standard of quality to be expected for Cornish Pasties prepared in the home or on a commercial scale. There is no standard of meat content for Cornish Pasties, but the attention of the Manufacturer was drawn to analyst report. 57 Table Jelly (Informal) Contaminated with mould growth and of low setting quality. Manufacturers warned. 600 Table Jelly (Informal) This jelly was of low setting quality. 97 Table Jelly (Formal) The article failed to comply with the setting test prescribed 108 Lolly Fruit Ice (Informal) Saccahrin was not specified as one of the ingredients on the label printed on the container in which this article was sold. Referred to Ministry. Manufacturers agreed to relabel article. 107 Lolly Juice (Informal) The ingredients of this ice lolly liquor were stated to be sugars, real fruit juice and oil, flavouring and colouring, citric acid and stabiliser, but did not include sacchrin. 71 Meat Pie (Formal) The lean meat of this sample is no more than one-thirtythird of the total weight of pastry plus filling, and the ratio of fat to lean meat is excessive. As a result, the filling of this pie is not recognisable as meat filling, but has the appearance of a semi-liquid light coloured pulp. Whilst there is no standard for this article the manufacturers were interviewed and informed of the result of this sample. 139 Channel Island Milk (Formal) Contained only 3.44% butter fat instead of not less than 4%. Referred to Ministry of Food. 114 Piccalilli ... (Formal) The ingredients of this article were not specified in the correct order in that the malt vinegar is included at the end of the list instead of at the beginning. Referred to Ministry of Food. 58 Sodium Citrate Tablets (Informal) These tablets consisted of ½gr. tablets of ephedrine hydrochloride. Vendor prosecuted: pleaded warranty successfully — Manufacturers fined £10 with 20 guineas costs. 309 Sugar (Informal) Contaminated with 1.0% of carbonate of soda. Unfit for human consumption. Vendors warned. Repeat samples found to be satisfactory. 310 Sugar (Informal) Contaminated with 1.6% of carbonate of soda. Unfit for human consumption. 457 Iodine, Tincture of Contained 14% excess of Iodine and 16% excess of Potassium Iodide. Remainder of stock withdrawn from sale. 94 95 WATER. I am indebted to the Water Engineer, W. C. Knill, Esq., B.Sc., M.IC.E., M.I.Mech.E., 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 2,328,989,000 M.W.B. Bulk Supplies 723,031,000 Sutton District Water Company 7,286,000 East Surrey Water Company 3,079,000 3,062,385,000 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. 38S raw water samples and 821 treated water samples were thus examined bacteriologically during the year by the Chemist and Bacteriologist on the staff of the Water Undertaking. In addition 17 samples of raw water and 54 samples of treated water were subjected to bacteriological examination by the Consultant Bacteriologist to the Water Undertaking. Further samples were submitted by the Medical Officer of Health for examination by the Public Health Laboratory Service. The results of the bacteriological examination of the raw waters were typical of waters pumped from the chalk, some of them showing the normal deterioration in quality which occurs 96 after heavy rain. In all cases the examinations showed that the raw water was suitable for treatment. The bacteriological examinations of the treated waters showed that these waters were of uniformly excellent quality. (b) Chemical Analyses. The arrangements for chemical analyses are similar to those for bacteriological examinations. The total numbers of samples analysed in the Water Department's laboratory and by the Consultant were 112 of raw waters and 117 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. 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 number of examinations thus performed were: Bacteriological 283 Chemical 10 All reports showed the samples to be "Class I," "Highly Satisfactory" in so far as bacteriological tests were concerned, and of excellent quality from the viewpoint of chemical analysis. 97 SEWAGE DISPOSAL AND REFUSE COLLECTION. I am indebted to the Borough Engineer, C. E. Boast, Esq., O.B.E., M.C., M.I.C.E., F.R.I.C.S., M.I.Mun.E., M.I.W.E.. for the following information:— Refuse Collection and Disposal. 58,957 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 15.1 acres of boggy water-logged common have been raised about six feet, covered with soil and partially levelled and a further 4.1 acres have been grassed down. Refuse not only from Croydon, but also from the Boroughs of Mitcham and Beddington and Wallington has been disposed of on this site. 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 10½ million gallons per day. The Works include a very modern sludge digestion plant, from which Methane Gas is evolved as a natural by-product of the process. This gas is used for generating all the electricity required for power and lighting of the Works, for maintaining temperature in the digestors, and, by compressing it, for use on vehicles as a fuel in lieu of petrol. Some 60 vehicles, including the fleet of refuse collectors, have been converted to run on this gas, and by this means over 85,000 gallons of petrol are saved per annum. 98 MISCELLANEOUS Nursing Homes—Public Health Act, 1936. Number of Homes. Number of Beds provided for Maternity. Others. Total. Homes registered during the year — — — — Homes on the Register at the end of the year 33 46 531 577 Premises in which it is proposed to establish new homes are visited as frequently as is necessary so that the appropriate recommendations can be made to the Health Committee. The Chief Officer of the Fire Brigade Department advises on essential fire precautions and these usually entail 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. No applications were received during the year. Three 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 at 31-12-5. Number of children provided for Premises 4 75 Daily Minders 21 120 STAFF MEDICAL EXAMINATIONS. Eight hundred and sixty-four examinations were made during the year by the Medical Staff of the Department. 99 NATIONAL ASSISTANCE ACT, 1948 (Section 47). Action was taken in two cases in accordance with procedure permitted by the National Assistance (Amendment) Act, 1951. In both instances a letter was obtained from a hospital stating that a bed was available. This, and the necessary medical certificates were shown to a Justice of the Peace, who was then taken to see the case. His signature to the order being obtained forthwith, a waiting ambulance was able to remove the patient to hospital. The first case, a man age 68, had for many years lived like a hermit, in a shed which had been condemned as unfit for habitation. There was no furniture and he lay on sacking, covered with an old coat, filthy, verminous and so ill that he was unable to get up. Nevertheless, he resolutely refused assistance or removal to hospital, and the order was essential. He died 48 hours later, the cause of death being broncho-pneumonia. The second case was a woman of 84 living alone, without friends and relatives, who collapsed on various occasions to be found by a neighbour lying on the floor. Her room was filled with furniture, papers and other belongings, none of which the Home Help was allowed to move. Finally, the neighbour refused further attention and when she again collapsed an order was obtained for her removal to hospital. It was, in fact, not required, as she finally raised no objection, when the ambulance crew effected the removal. She died suddenly from heart failure 27 days after admission to hospital. CREMATION ACT, 1902 During the year 1,967 Certificates were completed in the Department in the capacity of Medical Referee under the above Act. In one case of sudden death a post-mortem was carried out. Death was due to natural causes. CROYDON AIRPORT—HEALTH CONTROL With the partial withdrawal of Immigration Officers, the work formerly performed by the Medical Receptionists was placed upon the Customs Officers. The system of continuous "on call" manning by Medical Officers has continued. One medical examination was carried out under the Aliens Order. Other queries arose regarding passengers who were ill or who died whilst travelling. No cases of suspected infectious diseases were encountered. 100 Aircraft and Passenger Arrivals, Croydon Airport. Aircraft British Passengers Alien Passengers "Excepted Area" 2,520 2,633 355 Europe outside Excepted Area 59 179 42 South Africa, Middle East 2 6 1 Far East, Persia 1 1 — 2,582 2,819 398 101 County Borough of Croydon ANNUAL REPORT of the SCHOOL MEDICAL OFFICER For the Year ending December 31st, 1951. 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, 1951. The work of the service has continued without any major change. Routine medical inspections of the three statutory and one additional age groups covered over one-third of the total school population. These examinations are unique in the facility afforded for reviewing a large and representative sample of the child population. The percentage of parents attending with the younger age groups remains consistently high. A defect of routine school medical examinations lies in the unavoidable lack of knowledge by the school doctor of the home background. This is remedied to large extent by the School Nurse being also the district Health Visitor. In addition, every effort is made to have the same Doctor and Health Visitor team serving the Infant Welfare Centre and the schools. A second defect is the division of medical advice between 102 the school and family doctor. This is inescapable if large numbers of children are to be surveyed by the same examiners, and cannot be remedied by any system of employing general practitioners. In so far as health education is concerned, this division is not of great importance since the basic rules of health are generally agreed. If, however, a defect is found in an individual child, which is thought to need treatment, then clearly the family doctor must be consulted. We have, therefore, adopted the scheme suggested by the British Medical Association and the Society of Medical Officers of Health, whereby a note is sent to the family doctor stating the suggestion made to the parent, and giving him the opportunity to deal with the patient himself. The absence of a reply is the indication that he wishes action to be taken by the School Health Service, and a copy of any report is forwarded in due course. These arrangements are working smoothly. The School Dental Service has been augmented by part-time dental officers, but remains far below effective strength. There are now no undue delays in the supply of spectacles, and their provision has become a direct function of the Group Hospital Management Committee. The co-operation between the Hospital and School Health Service remains close and cordial. The incidence of infectious diseases was relatively high, especially Measles, and this must be related to the large intake of susceptible 5-year olds from small families, now reaching a peak figure. General hygienic measures, and the exclusion of cases, suspects and contacts have been applied. The stringency of the measures taken must be related to the severity of the illnesses concerned. There is clearly little advantage in excluding children for long periods for infections producing a few days of minor illhealth only. The reasons for the changes in the nature of the common infectious diseases of childhood are debatable, but it is a fact that at present most are consistently mild. The difficulty of insufficient accommodation, both day and residential, for Educationally Sub-Normal children continued. The former should be relieved by the classrooms which were being built at St. Christopher's School, but no early solution is likely for the problem of residential places. The demand for suitable vacancies for maladjusted and physically handicapped pupils was greater than could be met. My thanks are due to the Members of the Education Committee, whose interest in the health and welfare of the children is, as always, their major concern, and to the Officers of the Department for their constant application to routine and special duties. 103 STAFF OF THE •Medical Officers *Dental Officers *Physiotherapists Speech Therapists *School Nurses *Dental Attendants SCHOOL HEALTH SERVICE 10 (including 2 part-time) 9 (including 5 part-time) 3 2 (part-time) 30 6 *Performing also duties in other sections of Public Health Department. PARTICULARS OF CLINICS HELD The following Clinics are provided by the Education Committee: attendance thereat, with the exception of the Minor Ailments Clinic, is by appointment arranged by the School Medical Officer — Clinic Address Minor Ailments Lodge Road, Broad Green, Croydon (Daily, Monday to Saturday, a.m.); Ashburton School (Mondays and Thursdays only, 9 a.m.); Rockmount School (Mondays and Thursdays only, 9 a.m.); Duppas School, Goodwin Road, Waddon (Daily, Monday to Friday, a.m.). Dental Lodge Road, Broad Green, Croydon; 206 Selhurst Road, South Norwood; Waldrons Hall, 55 Duppas Hill Lane, Croydon. Inspection Lodge Road, Broad Green, Croydon; Duppas School, Goodwin Road, Waddon. Remedial Exercises and Massage Waldrons Hall, 55 Duppas Hill Lane, Croydon. Rheumatism Lodge Road, Broad Green, Croydon. Speech Defects 33 St. James' Road, Broad Green, Croydon. Verruca clinic Lodge Road, Broad Green, Croydon; Cypress School, Cypress Road, South Norwood (Weds, only, 9 a.m.). 104 RETURN OF ATTENDANCE IN MAINTAINED PRIMARY, MODERN, CENTRAL, TECHNICAL AND GRAMMAR SCHOOLS FOR THE AUTUMN TERM, 1951 School Average No. on Registers Average Attendance Average Attendance per cent. Average Attendance 1950 per cent. COUNCIL PRIMARY SCHOOLS Ashburton Junior Mixed 497 465 93.5 92.6 Ashburton Infants 324 291 89.8 87.2 Benson Junior Mixed and Infants 494 462 93.5 92.7 Beulah Junior Boys 379 360 95.0 92.7 Beulah Junior Girls 310 293 94.5 91.9 Beulah Infants 340 300 88.2 78.8 Cypress Junior Mixed and Infants 399 342 85.6c.p. 91.9 Davidson Infants 268 242 90.2 91.1 Duppas Junior Mixed and Infants 362 331 91.4 87.6 Ecclesbourne Junior Boys 272 246 93.0 91.9 Ecclesbourne Infants 227 201 88.5 89.4 Elmwood Junior Boys 276 254 92.0 91.0 Elmwood Junior Girls 259 234 90.7 91.8 Elmwood Infants 267 238 89.1 83.7 Fairchildes Junior Mixed and Infts. 151 133 88.0 Gilbert Scott Junior Mixed 363 340 93.7 90.7 Gilbert Scott Infants 279 249 88.2 85.4 Gonville Junior Mixed and Infants 422 394 93.4 91.3 Howard Junior Mixed and Infants 415 379 91.3 91.9 Ingrain Infants 183 165 90.2 88.0 Kensington Avenue Junior Mixed and Infants 479 437 91.2 92.0 Kingsley Junior Mixed 389 354 91.0 89.9 Kingsley Infants 344 305 88.6 85.9 Monks Orchard Junior Mixed and Infants 432 399 92.4 92.9 Overbury Infants and Junior Mixed 310 279 90.0 82.9 Norbury Manor Junior Mixed 429 394 91.8 91.8 Norbury Manor Infants 236 206 86.9 82.8 Oval Junior Mixed 459 427 93.0 90.1 Oval Infants 207 183 88.4 86.5 Portland Infants 289 267 92.3 91.6 Purlcy Oaks Senior and Junior Mixed 562 521 92.7 91.2 Purley Oaks Infants 178 150 84.3m.& g.i. 87.3 Rockmount Junior Mixed 332 314 94.6 92.3 Rockmount Infants 212 190 89.2 85.7 South Norwood Junior Boys 393 369 93.8 93.7 South Norwood Junior Girls and Infants 571 509 89.1 91.0 St. Peter's Junior Mixed and Infants 231 207 89.6 84.8 Spring Park Junior Mixed and Infants 599 537 89.6 90.8 Sydenham Junior Boys 281 255 90.7 90.5 Sydenham Junior Girls and Infants 383 311 81.2 c.p. 90.6 Waddon Junior Mixed and Infants 445 409 91.9 91.1 West Thornton Junior Boys 205 194 94.6 93.0 West Thornton Junior Girls 188 177 94.1 90.0 West Thornton Infants 237 222 93.3 85.8 Wtiitehorse Manor Junior Girls 227 210 92.5 92.3 Whitehorse Manor Infants 287 249 86.8 8S.0 Winterbourne Junior Boys 322 306 95.0 94.0 Winterbourne Junior Girls 359 341 95.0 95.3 Winterbourne Infants 402 354 88.1 89.9 Wolsey Junior Mixed 493 461 93.5 92.3 Wolsey Infants 367 326 88.8 86.0 Woodside Junior Boys 403 385 95.5 95.6 Woodside Junior Girls 378 357 94.4 94.0 Woodside infants 341 309 90.6 88.7 Total 18,457 16,833 91.2 90.4 C.I. = General Illness. M. = Mumps. c.p. = Chicken Pox. me = Measles. s.f. — Scarlet Fever. w.c. = Whooping Cough. 105 School Average No. on Registers Average Attendance Average Attendance per cent. Average Attendance 1950 per cent. COUNCIL SECONDARY MODERN SCHOOLS Ashburton Senior Mixed 801 736 91.8 91.7 Davidson Senior Boys 287 267 93.0 91.8 Davidson Senior Girls 169 152 90.0 89.2 Ecclesbourne Senior Girls 354 313 88.4 89.3 Fairchildes Senior Mixed 318 284 89.3 — Ingram Senior Boys 346 320 92.5 90.9 Ingram Senior Girls 294 267 90.8 90.2 John Newnham Senior Mixed 173 159 91.9 — Lanfrane Senior Boys 471 423 89.8 88.9 Lanfrane Senior Girls 480 441 91.8 89.8 Norbury Manor Senior Boys 351 325 92.5 92.3 Norbury Manor Senior Girls 294 276 93.9 92.7 Portland Senior Boys 190 180 94.7 93.1 Portland Senior Girls 259 238 91.8 92.0 Tavistock Senior Boys 399 360 90.2 90.0 Tavistock Senior Girls 418 363 86.8 88.3 Waddon Senior Mixed 437 369 84.4 83.8 Whitehorse Manor Senior Boys 217 194 89.4 89.0 Total 6,258 5,667 90.6 89.0 Archbishop Tenison's Vol. Sec. Mod. 137 128 93.4 91.6 St. Andrew's Vol. Sec. Mod. 282 257 91.1 — Our Lady's Vol. Sec. Mod. 135 118 87.4 — Total 554 503 90.8 — SPECIAL SCHOOLS St. Christopher's (E.S.N.) 204 175 85.8 84.7 St. Giles'(P.M. & Delicate) 150 133 88.6 87.0 St. Luke's (Partially Sighted) 30 27 90.0 86.2 Total 384 335 87.2 85.7 VOLUNTARY PRIMARY SCHOOLS All Saints' Mixed and Infants 290 253 87.2 86.6 Christ Church Junior Mixed and Infants 228 211 92.5 91.4 Parish Church Junior Girls and Infants 446 402 90.1 89.1 St. Joseph's Mixed and Infants ... 446 393 88.1 87.4 St. Mark's Junior Girls and Infants 125 113 90.4 89.5 St. Mary's (R.C.) Senior and Junior Mixed 380 347 91.3 89.3 St. Mary's Infants 82 70 85.5 87.6 St. Michael's Infants 163 143 87.7 80.2 Shirley Junior Mixed and Infants (St. John's) 187 175 93.6 94.4 Total 2,347 2,107 90.3 89.0 100 School Average No. on Registers Average Attendance Average Attendance per cent. Average Attendance 1950 per cent. SELECTIVE CENTRAL SCHOOLS Archbishop Tenison's Senior Boys 184 174 94.6 94.6 Heath Clark Mixed 295 279 94.6 94.2 Total carried forward 479 453 94.6 94.3 GRAMMAR SCHOOLS Selhurst Boys 557 533 93.9 93.6 Selhurst Girls 542 515 95.0 94.4 John Ruskin Boys 364 346 95.1 94.3 Coloma Girls 515 476 92.4 92.3 Lady Edridge Girls 333 326 97.0 95.7 Total 2,793 2,649 94.8 94.6 TECHNICAL SCHOOLS Stanley Technical Boys 234 230 98.3 95.3 School of Building 190 180 94.7 95.1 Total 424 410 96.7 95.2 SUMMARY OF SCHOOL ATTENDANCE for the Autumn Term, 1951 Council Primary 18,457 16,833 91.2 90.4 Voluntary Primary 2,347 2,107 90.3 89.1 Council Secondary Modern 6,258 5,667 90.6 89.9 Voluntary Secondary Modern 554 503 90.8 — Grammar, Central 2,793 2,649 94.8 94.6 Technical 424 410 93.7 95.2 Specials 384 335 87.2 84.2 Total 31,217 23,504 91.3 90.5 Crosfield Nursery 43 40 94.0 88.0 107 MEDICAL INSPECTION IN SCHOOLS. The system of routine medical inspection is now as followsA. Primary and Modern Secondary Schools. (1) Entrants i.e., Children admitted for the first time to a Maintained School. (2) 8-year-old Group i.e., Children who had attained their 8th birthday at the opening date of the Term but have not yet reached their 9th birthday and who have not been medically examined at the age 8 years. (3) Primary Leavers i.e., Children in their last year of attendance in a Maintained Primary School and who have not been medically examined in that year. (4) Leavers (Final) i.e., Children in their last year of attendance in a Maintained Secondary School who have not been medically examined in that year. (5) Special Cases (if any) i.e., 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 12,978 children were examined as compared with 11,102 in 1950, and 8,912 parents attended the examinations. The percentage attendance of parents in the Entrants' group was for boys 90.1 per cent. and girls 89.0 per cent.; in the Intermediate group, boys 58.9 per cent., girls G8.2 per cent. in the Leavers' group, boys 10.1 per cent., girls 33.2 per cent.; and in the Other Ages group, boys 74.8 per cent., girls 78.9 per cent. The total percentage of parents attending was 68.7 as against 64.4 last year. 616 specials and 481 re-inspections of children were carried out. 108 PARENTS PRESENT 1951 Entrants Intermediate Leavers Other Ages TOTAL Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. M. F. M. F. M. F. M. F M. F. M. F. M. F. M. F. M. F. All Saints 36 38 25 32 9 19 7 14 ... ... ... ... 16 15 14 11 61 72 Arch.Tenison'sGs ... ... ... ... ... 6 ... 3 ... 41 ... 9 ... ... ... ... ... 47 Ashburton 155 102 121 97 42 26 24 14 46 26 2 4 40 19 28 13 283 173 Benson 40 61 39 59 71 71 60 55 ... ... ... ... 59 59 49 50 170 191 Beulah 85 78 81 75 85 146 43 109 ... ... ... ... 67 104 44 66 237 323 Christ Church 18 20 17 16 2 ... 1 ... ... ... ... ... 10 11 7 10 30 31 Coloma ... ... ... ... ... ... ... ... ... 120 ... 23 ... ... ... ... ... 123 Croydon British ... ... ... ... ... ... ... ... ... 43 ... 11 ... ... ... ... ... 43 Croydon Techncl. ... ... ... ... ... ... ... ... 48 ... 2 ... ... ... ... ... 48 ... Cypress 38 19 34 11 46 17 28 16 ... ... ... ... 21 48 19 42 105 84 Davidson 84 61 72 52 ... ... ... ... 78 41 14 11 ... ... ... ... 162 102 Duppas 30 37 22 28 27 36 12 20 ... ... ... ... 20 22 10 12 77 95 Ecclesbournc 46 46 44 45 63 ... 38 ... ... 70 ... 24 84 ... 56 ... 193 116 Elmwood 75 84 66 71 47 76 34 41 ... ... ... ... 37 75 31 60 159 235 Fairchildes 17 17 16 16 4 2 2 1 14 5 1 1 10 10 7 7 45 34 Gilbert Scott 67 106 61 94 ... 22 ... 13 ... ... ... ... 58 32 43 28 125 160 Gonville 52 49 51 42 37 64 24 53 ... ... ... ... 37 57 31 47 126 170 Heath Clark ... ... ... ... ... ... ... ... ... 24 ... 2 ... ... ... ... ... 24 Howard 18 17 14 17 42 33 18 19 ... ... ... ... 26 48 22 33 86 98 Ingram 54 43 50 42 ... ... ... ... 110 56 16 14 ... ... ... ... 164 99 John Newnham ... ... ... ... ... ... ... ... ... 20 ... 8 ... ... ... ... ... 20 John Ruskin ... ... ... ... ... ... ... 38 ... 1 ... ... ... ... ... 38 ... Kensington Av. 26 12 23 12 76 81 53 56 ... ... ... ... 72 66 65 57 174 159 Kingsley 122 118 111 104 47 78 24 47 ... ... ... ... 84 68 54 57 253 264 Lady Edridgc ... ... ... ... ... ... ... ... ... 119 ... 39 ... ... ... ... ... 119 Lanfranc ... ... ... ... ... 6 ... 5 68 132 9 68 ... ... ... ... 68 138 Monks Orchard 20 12 18 11 5 43 4 35 ... ... ... ... 54 24 48 21 79 79 Norbury Manor 89 79 83 74 58 70 45 54 94 94 12 33 18 61 13 55 259 310 Our Lady ... 21 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Overbury 71 77 62 67 15 5 6 5 10 9 ... 1 46 53 38 40 142 144 Oval 59 44 42 40 43 80 21 62 ... ... ... ... 94 107 60 84 196 231 Parish Church 52 36 47 34 26 32 13 18 ... ... ... ... 9 7 7 5 87 75 Portland 27 38 26 34 13 6 5 5 43 78 4 32 40 63 28 57 123 185 Purley Oaks 4f 52 42 38 36 34 19 23 25 28 2 7 41 21 32 15 148 135 Rockmount 86 65 84 62 38 19 33 15 ... ... ... 44 46 39 39 168 130 St. Andrew's 15 9 15 9 15 11 10 8 10 9 ... ... 7 2 4 ... 47 31 St. Joseph's 44 26 40 16 40 32 14 10 ... ... ... ... 4 22 2 11 88 80 St. Mark's 23 19 22 16 ... 23 ... 21 ... ... ... ... 14 ... 9 23 56 St. Mary's R.C. 10 14 10 10 25 2 5 13 23 21 5 3 14 8 3 4 73 71 St. Michael's 73 61 58 51 ... ... ... ... ... ... ... ... ... ... ... ... 73 61 St. Peter's 22 17 19 14 ... ... ... ... ... ... ... ... 9 27 6 19 31 44 Selhurst Gram. ... ... ... ... ... 101 ... 79 69 27 ... 12 ... ... ... ... 69 128 Shirley 6 10 6 16 6 6 6 3 ... ... ... ... 29 10 25 8 41 26 South Norwood 88 81 78 72 169 118 117 70 ... ... ... ... 108 50 77 38 365 249 Spring Park 74 77 69 76 21 14 14 9 ... ... ... ... 19 28 16 23 114 119 Stanley Tech ... ... ... ... ... ... ... ... 42 ... 2 ... ... ... ... ... 42 ... Sydenham 42 42 40 39 67 97 46 58 ... ... ... ... 37 33 28 23 147 173 Tavistock ... ... ... ... ... ... ... ... 145 182 1 77 ... ... ... ... 145 182 Waddon 42 47 42 42 13 10 11 5 63 61 1 21 22 44 13 36 142 162 West Thornton 62 84 62 77 47 37 24 19 ... ... ... ... 37 71 28 50 147 192 Whitehorse 31 34 32 31 ... 75 ... 50 45 ... 1 ... 29 ... 20 77 138 Winterbourne 92 91 89 80 101 175 37 140 ... ... ... ... 38 106 32 98 234 372 Wolsey 41 61 44 5i 97 67 48 43 ... ... ... ... 45 46 37 35 187 174 Woodside 94 105 87 93 76 129 44 86 ... ... ... ... 116 117 85 97 286 351 2184 2111 1967 1879 1510 1901 891 1297 971 1206 98 400 1472 1623 1101 128 3137 6s41 4295 3846 3411 2187 2177 498 3095 2381 12978 PERCENTAGE OF PARENTS PRESENT AT MEDICAL INSPECTIONS Entrants Boys 90.1 89.5 88.7 „ Girls 89.0 Intermediate Boys 58.9 64.1 „ Girls 68.2 Leavers Boys 10.1 22.9 „ Girls 33.2 Other Ages Boys 74.8 76.9 8 to 9 years Girls 78.9 109 HEIGHTS AND WEIGHTS, 1951. Age. Number Examined 1951 Average Height in inches. Average Weight in lbs. 1951 1950 1949 1948 1939 1951 1950 1949 1948 1939 BOYS 5 years 1325 43.0 43.4 43.2 43.4 41.8 42.8 43.7 43.4 44.0 41.5 6 „ 648 44.3 44.2 44.2 44.7 43.8 45.4 45.1 45.5 46.2 43.4 7 „ 204 47.4 48.2 46.7 46.9 45.3 51.7 53.8 50.5 51.1 47.9 8 „ 723 50.3 50.0 50.1 48.7 49.5 59.4 58.2 58.0 54.1 55.5 9 „ 594 51.3 51.9 51.2 50.5 51.2 61.7 61.0 62.1 60.1 58.8 10 „ 583 54.7 54.9 54.2 53.9 52.7 72.6 74.0 71.7 70.1 62.9 11 „ 778 55.5 55.2 55.6 55.6 53.7 74.7 75.4 75.2 73.7 68.7 12 „ 258 56.6 56.6 56.4 56.5 55.7 78.6 79.2 77.1 78.2 79.9 13 „ — — 59.3 57.3 60.4 58.4 — 91.8 82.9 93.0 81.6 14 „ 372 62.7 62.7 62.8 61.7 59.0 106.2 106.5 105.8 98.4 90.8 15 „ 495 64.4 63.8 63.6 63.1 — 115.5 113 7 113.1 109.8 — 16 „ 73 67.6 66.9 66.4 67.2 — 134.9 127.7 125.1 120.9 — 17 „ 33 69.8 68.8 68.3 68.7 — 146.1 140.5 132.6 134.3 — GIRLS 5 years 1258 42.6 43.1 43.5 42.9 41.2 41.5 42.3 42.9 42.5 39.7 6 ,, 647 44.1 43.6 44.2 44.0 42.7 43.8 43.7 44.2 44.3 41.4 7 „ 173 47.5 47.3 47.1 46.1 44.1 52.7 51.3 49.9 49.5 43.6 8 „ 790 49.9 49.5 49.8 49.7 49.9 56.8 56.0 57.5 54.8 54.7 9 „ 696 50.8 50.6 51.3 52.4 50.9 59.5 59.5 60.7 62.8 57.6 10 „ 574 54.5 54.7 53.3 53.8 52.1 72.7 72.5 70.7 69.2 62.9 11 „ 981 55.8 55.6 56.1 55.8 53.6 76.2 76.6 76.6 75.1 68.3 12 „ 370 56.9 56.7 57.5 57.1 56.6 81.5 80.8 81.6 79.3 77.2 13 „ 31 60.6 59.3 59.7 61.0 58.8 96.6 91.5 92.8 98.4 85.3 14 „ 595 62.4 62.2 62.3 62.6 60.3 110.0 109.2 106.4 107.3 97.9 15 „ 488 62.7 62.6 02.6 62.6 62.0 111.3 113.3 111.2 110.6 105.5 16 „ 114 64.4 64.4 — — 125.0 123.4 — — — 17 „ 61 64.5 65.6 — — — 125.5 130.7 — — — 110 RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION. 1951. 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 17 9 0.42 22 6 0.41 Uncleanliness— Head — — — — Body Skin Disease 10 4 0.23 15 6 0.31 Eye Disease— Defective Vision 277 27 4.96 426 32 6.68 Squint 46 13 0.96 34 17 0.75 External Eye Trouble 9 3 0.20 14 7 0.31 Ear Disease— Deafness 19 5 0.39 12 4 0.23 Otitis Media 4 3 0.11 10 4 0.23 Other Disease 3 3 0.10 3 8 0.16 Nose and Throat— Enlarged Tonsils only 49 58 1.74 54 52 1.55 Adenoids only 17 5 0.36 18 8 0.38 Enlarged Tonsils and Adenoids 170 91 4.25 156 06 3.25 Other Conditions 36 30 1.07 34 9 0.63 Enlarged Cervical Gland 1 20 0.34 4 5 0.13 (not T.B.) Dental Defects 101 2 1.68 128 6 1.96 Speech Defects 17 11 0.46 8 10 0.28 Heart and Circulation— Organic 5 9 0.23 12 12 0.35 Functional 3 6 0.14 7 10 0.25 Anaemia 4 8 0.20 8 4 0.18 Bronchitis 4 18 0.36 11 11 0.32 Other Non-T.B 22 35 0.90 16 37 0.78 Pulmonary Tuberculosis 5 11 0.26 8 17 0.37 Other Tuberculosis 4 7 0.18 2 1 0.04 Nervous System Disorders (including Epilepsy, Chorea, etc.) 8 15 0.37 4 14 0.28 Developmental— (a) Hernia 3 3 0.10 — 1 0.01 (b) Other 2 6 0.13 — 2 0.03 Psychological— (a) Development 2 4 0.10 1 1 0.03 (b) Stability 2 6 0.13 2 5 0.10 Deformities— Flat Feet 117 56 2.82 105 45 2.19 Posture 108 25 2.17 197 26 3.26 Others 79 33 1.83 107 36 2.09 Other Defects and Diseases 39 32 1.16 64 44 1.58 Totals 1183 558 1482 506 Total Children Examined 6137 6841 1ll Extent of Detect Intermediate Leavers Other Ages Total Boys Girls Boys Girls Boys Girls Boys Girls No. % No. % No. % No. % No. % No. % % % Normal : R 1477 97.8 1838 96.7 926 95.4 1146 95.0 1437 97.6 1563 96.3 97.2 96.1 6/6ths or 6,'9ths L 1468 97.2 1856 97.6 928 95.6 1149 95.3 1436 97.6 1563 96.3 96.9 96.6 6/12ths or 6/24ths R 30 2.0 54 2.8 37 3.8 51 4.2 33 2.2 52 3.2 2.5 3.3 L 37 2.5 37 2.0 32 3.3 45 3.7 33 2.2 52 3.2 2.6 2.8 6/36ths or worse R 3 0.2 9 0 5 8 0,8 9 0.8 2 0.2 8 0.5 0.3 0.6 L 5 0.3 8 0.4 11 1.1 12 1.0 3 0.2 8 0.5 0.5 0.6 Cost of the School Health Service. The gross cost of the medical, dental and nursing services was £32,421. The expenditure is subject to Education grant. Cost of Special Schools. £ Schools maintained by the Council 19,120 Other Schools (not maintained by local authorities) 7,824 Adjustments with other authorities in respect of Special Schools— £ Full cost 181 Rate cost 2,309 2,490 £29,434 With the exception of £2,309 calculated at Rate Cost, the above expenditure is subject to Education grant. Cost of Milk and Meals. Meals and Milk cost £147,944. Income from payment for meals M as £68,485, making a net cost of £79,459, on which grant is paid of 100 per cent. on approved expenditure. 112 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS, 1951 (Percentages of Children examined) Condition Entrants Intermediates Leavers Other Ages 8 to 9 years All Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Circulatory System 1.1 1.1 1.3 2.3 0.5 2.5 0.8 1.9 1.0 1.8 Pulmonary System 2.7 1.9 1.4 1.3 1.4 2.6 2.0 2.0 2.0 1.9 Skin Disease 0.5 0.4 1.2 0.9 1.5 1.7 1.0 1.2 1.0 1.0 Defects of Nose and Throat 17.5 14.1 4.7 4.8 1.9 2.4 8.4 7.6 9.6 7.9 Enlarged Cervical Glands 2.0 0.9 0.7 0.7 — — 1.4 0.7 1.2 0.7 Squint 2.1 1.9 0.4 0.8 0.4 0.5 1.2 0.7 1.2 1.1 External Eye Disease 0.2 0.4 0.5 0.7 0.1 0.9 0.2 0.3 0.3 0.6 Defective Vision 0.5 0.7 7.4 8.8 6.7 8.5 5.2 8.5 4.3 6.2 Defective Hearing and other Ear Defects 1.3 1.1 0.8 0.5 1.0 0.3 0.4 0.7 0.7 Speech Defects 0.9 0.7 0.3 0.1 0.1 0.1 0.4 0.1 0.5 0.3 Dental Disease (more than four decayed) 2.4 2.8 1.2 1.2 0.5 0.6 1.1 1.8 1.5 1.7 Dull and Backward 0.4 0.1 0.4 0.1 0.1 0.2 0.3 0.1 0.3 0.1 Malnutrition 3.8 5.1 4.6 4.0 3.7 2.7 5.0 5.2 4.3 4.4 Deformities 10.3 8.2 9.8 12.0 6.6 15.6 9.6 10.2 9.4 11.1 Nervous System 0.3 0.2 0.6 0.5 0.2 0.3 0.5 0.4 0.4 0.4 Developmental— Hernia 0.1 0.1 0.2 — — — 0.1 — 0.1 — Other 0.5 0.1 0.3 — — 0.7 0.4 — Psychological— Developmental 0.2 0.1 0.1 — — — 0.1 0.1 0.1 — Stability 0.4 0.2 0.1 0.2 0.1 0.1 0.3 0.1 0.3 0.2 Other Defects 2.1 2.3 1.4 1.9 0.6 3.7 1.9 1.9 1.6 2.4 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 dor the treatment of scabies and very occasionally deals with other verminous conditions. Number of children inspected for Cleanliness (first inspection) 66,703 Number of children inspected (subsequent inspections) 3,598 113 Number of children found unclean (first inspection) 682 (97G occasions of infestation). Number of occasions in which children found unclean (subsequent inspections) 1,116 At the primary inspections vermin were found in 50 and nits alone in 926 children. On these inspections 1.5 per cent, of the children showed evidence of infestation as against 1.7 in 1950. TUBERCULOSIS IN CHILDREN OF SCHOOL AGE. Contacts among school children kept under supervision during 1951:— Number of cases under observation at beginning of 1951 242 Number of cases added during year 51 Number of cases discharged from observation during the year 14 Number of cases under observation at the end of 1951 279 Number of cases of Notified Tuberculosis— Pulmonary 10 Non-Pulmonary 6 Taking the total child population at 34,954, the pulmonary tuberculosis incident rate per 100,000 was 28.6, and the nonpulmonary incidence rate 17.2. There were no deaths from pulmonary tuberculosis and two from non-pulmonary tuberculosis. CAUSES OF DEATH IN CHILDREN OF SCHOOL AGE. Child population, 34,954. Number of deaths 13, which is equal to a death-rate of 0.37 per 1,000. The deaths were due to: Tuberculosis (non-respiratory) 2 Bronchitis 1 Appendicitis 1 Hydrocephalus 1 Rheumatic Pancarditis 1 Hodgkin's Disease 1 Leukaemia 1 Cerebral Abscess 1 Hirschsprung's Disease 1 Uræmia 2 Road Traffic Accident 1 114 TREATMENT. The Work of the School Clinics. SUMMARY OF ATTENDANCES 1951 1950 Increase or Decrease Minor Ailments Clinic 9238 10736 — 1498 Inspection Clinic 2739 3573 — 834 Dental Clinics 27529 20434 + 7095 Orthopaedic Clinic 434 512 — 78 Remedial Exercises Clinic 12608 11154 + 1454 Nose and Throat Clinic 2721 1885 + 836 Rheumatism Clinic 91 148 — 57 Verruca Clinic 3112 2867 + 245 58472 51309 The Minor Ailments Clinics. At the Lodge Road Clinic 1,460 defects involved 7,326 attendances, while at the subsidiary Clinics held at Ashburton School 149 defects, 740 attendances; at the Duppas School 581 defects, 3,125 attendances and at Rockmount School 166 defects, 985 attendances. Complaint 1951 1950 Cases Attendances Average No. of Attendances per case Cases Attendances Average No. of Attendances per case Ringworm 15 59 3.9 16 80 5.0 Scabies 8 12 1.5 14 37 2.6 Impetigo 29 195 6.7 37 408 11.0 Other Skin Diseases 67 497 7.4 84 298 3.5 Otorrhoea and other Ear defects 131 610 4.7 225 1254 5.6 External Eye Disease 200 845 4.2 215 776 3.6 Miscellaneous 1428 7020 4.9 2032 10750 5.3 1878 9238 4.9 2623 13603 5.2 Adenoids and Enlarged Tonsils. During 1951, 831 children were operated upon for adenoids and enlarged tonsils, and 2,721 attendances were made at the Throat Clinic. 115 CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS. Name of School. School Population. Measles. German Measles. Whooping Cough. Chicken Pox. Mumps. Scabies. Impetigo. Ringworm Diphtheria. Scarlet Fever Dysentery Poliomyelitis. laurdice. Conjunctivitis. Sore Throat. Indefinite Sickness, Paratyphoid Erycipelas Vermin Meningococcal Total Body Scalp All Saints 290 18 1 4 43 15 ... 1 ... ... 5 9 ... ... ... ... 1 ... ... ... ... 97 33.4 Arch. Ten.(Bys) 184 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 0.5 Arch. Ten. (Gls) 137 1 ... ... 2 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 5 3.6 Ashburton 1622 24 2 1 12 25 ... 2 ... ... ... 9 2 ... ... ... ... 2 ... ... ... ... 79 4.9 Benson 494 39 ... 13 13 19 ... ... ... ... 6 3 ... ... ... ... 1 ... ... ... ... 94 19.0 Beulah 1029 42 1 11 44 18 1 2 1 ... ... 13 1 ... ... 2 1 4 ... ... 10 ... 151 14.7 Christchurch 228 6 1 15 7 2 ... 2 1 ... ... 2 ... ... ... ... ... ... ... ... 2 ... 38 16.7 Coloma 515 ... ... ... ... ... ... ... ... ... ... 4 ... .. ... ... ... ... ... ... ... ... 4 0.8 Crossfield Nurs. 43 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 2.3 Croydon High b92 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... — — Croydon Tech. 190 2 ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 5 2.6 Cypress 399 23 1 ... 53 55 ... 3 ... ... ... 4 ... ... 1 ... ... 1 ... ... ... ... 141 35.3 Davidson 724 35 1 ... 84 25 ... ... 2 ... ... 2 ... ... ... ... ... 6 ... ... 9 ... 164 22.7 Duppas 362 6 5 ... 9 4 ... ... ... ... ... 5 3 ... ... 2 ... ... ... ... ... ... 34 9.4 Ecclesboune 853 61 2 ... 6 16 1 1 ... ... ... 8 ... ... ... ... ... 2 ... ... 2 ... 99 11.6 Blmwood 802 27 1 5 47 5 ... 6 ... ... ... 14 1 ... 1 1 ... 2 ... ... 7 ... 117 14.6 Fairchildes 469 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 2 0.4 Gilbert Scott 642 60 ... 6 ... 2 ... ... ... ... ... 11 ... ... 1 ... ... ... ... ... ... ... 80 12.5 Gonville 422 68 1 ... 18 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 88 20.9 Death Clark 295 1 ... ... 2 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 5 1.7 Howard 415 46 3 1 4 13 ... ... ... ... ... 12 1 ... ... ... ... ... ... ... ... ... 80 19.3 Ingram 823 20 1 1 6 40 ... ... ... ... ... 2 1 ... ... 1 ... ... ... ... 10 ... 82 10.0 John Ruskin 364 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 0.3 Kensington 479 3 ... 1 46 9 ... 2 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 63 13.2 Kingsley 733 78 9 16 75 45 ... 1 2 ... ... 11 ... ... ... 5 ... 4 ... ... 17 ... 263 35.9 Lady Edridge 336 ... ... ... 2 1 ... ... ... ... 1 ... ... ... ... ... 4 1.2 Lanfranc 951 1 1 ... 5 4 ... ... 1 ... ... 1 ... ... ... 1 ... ... ... ... 4 ... 18 1.9 Monks Orchard 432 3 1 8 ... 12 ... ... ... ... ... 2 ... ... ... ... ... ...... ... ... ... ... 26 6.0 New Addington 310 ... ... ... ... 1 ... ... ... ... ... 2 ... ... 4 ... ... ... ... ... ... ... 7 2.3 Norbury Manor 1310 80 ... 4 17 4 1 1 1 ... ... 5 ... ... ... ... ... 1 ... ... ... ... 114 8.7 Old Palace 402 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... — Oval 666 32 ... 6 48 37 2 ... ... ... ... 4 ... 1 ... ... ... 2 ... ... ... ... 132 19.8 Parish Church 446 24 5 7 11 3 ... ... ... ... ... 12 ... ... ... ... ... ... ... ... ... ... 62 13.9 Portland 738 48 1 2 35 ... 1 ... ... ... ... 5 ... ... ... ... ... ... ... ... 5 ... 97 13 1 Purley Oaks 740 20 2 20 5 42 ... ... ... ... ... 15 ... 1 ... ... ... 1 ... ... ... ... 106 14.3 Rockmount 544 24 1 2 61 58 1 2 ... ... ... 6 ... ... ... 1 ... ... ... ... ... ... 157 28 8 St. Andrew's 282 49 2 26 22 7 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 108 38.3 St. Christophers 204 ... ... 3 2 2 1 ... 1 ... ... 3 1 ... ... ... ... 1 ... ... ... ... 18 8.8 St. Giles' 150 ... 1 2 11 8 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 15.3 St. Joseph's 446 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 2 0.4 St. Luke's 30 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... — St. Mark's 12b 9 ... 1 6 6 ... 2 ... ... ... 2 ... ... ... ... ... ... ... ... 1 ... 27 21.6 St. Mary's R.C. 462 15 ... ... 3 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 3 ... 22 4.8 St. Michael's 163 18 1 8 19 7 ... ... ... ... ... 2 ... ... ... ... ... 1 ... ... 4 ... 70 42.9 St. Peter's 231 38 ... 1 3 1 ... ... ... ... ...... 1 ... ... ... ... ... ... ... ... 44 19.0 Selhurst Oram. 1099 ... ... ... 2 ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... 5 0.5 Shirley 187 20 ... 3 4 7 ... ... ... ... ... 5 1 ... ... ... ... ... ... ... ... ... 40 21.4 South Norwood 9b4 36 ... 17 23 1.1 ... 1 3 ... ... 15 1 ... 1 ... ... ... ... ... 6 ... 116 12.0 Spring Park 599 7 ... 7 2 33 ... ... ... ... ... 18 1 ... ... ... ... ... ... ... ... ... 68 11.4 Stanley Tech 234 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... — Sydenham 664 9 1 7 106 2 ... 1 ... ... ... 4 ... 1 ... ... ... ... ... ... 4 ... 135 20.3 Tavistock 817 ... ... ... 6 1 ... 1 ... ... ... 1 ... ... ... 2 ... ... ... ... 10 ... 21 2.6 Waddon 882 79 3 13 5 5 ... ... ... ... ... 4 4 ... ... 3 2 5 ... ... ... ... 123 13.8 W. Thornton 630 ... ... ... 8 ... ... ... ... ... ... 8 1 ... 1 ... ... 2 ... ... 4 ... 24 3 8 Whitehcrse 731 29 ... 1 3 5 1 2 ... 6 ... ... ... ... ... 1 ... ... 20 ... 68 9.3 Whitgift Oram. 794 ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 2 03 Whitgift Middle 551 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 0.2 Winterbourne 1083 25 2 5 33 9 ... 1 ... ... ... 5 1 ... ... ... ... 1 ... ... ... ... 82 7.6 Wolsey 860 ... 3 5 13 5 ... ... ... ... ... 13 ... ... ... ... ... ... ... ... ... ... 39 4.5 Woodside 1122 8 3 10 40 68 ... ... ... ... ... 11 ... ... ... ... 1 ... ... ... 2 ... 143 12.7 Totals 1148 56 233 971 635 8 32 13 1 ... 271 34 3 9 20 4 42 ... ... 121 ... 3601 14 116 CHIEF CAUSES OF EXCLUSIONS FROM SCHOOL Condition Exclusions during 1951 Percentage of total exclusions Exclusions during 1950 Percentage of total exclusions Ringworm 14 0.39 24 0.91 Verminous Conditions 121 3.36 128 4.87 Impetigo 32 0.89 88 3.35 Scabies 8 0.22 17 0.65 Scarlet Fever 271 7.53 390 14.84 Measles (inc. German) 1204 33.44 405 15.41 Diphtheria — — 1 0.04 Whooping Cough 233 6.47 553 21.04 Chicken Pox 971 26.97 489 18.60 Mumps 635 17.63 336 12.78 External Eye Disease 20 0.55 41 1.56 Sore Throat 4 0.11 17 0.65 Other Causes 88 2.44 140 5.33 Total 3601 — 2629 — The figures for exclusions are not related in any way to the figures obtained in routine medical inspections. These figures show an increase in Measles, Chicken Pox and Mumps, whilst the remainder all show a decrease. The 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 528 Visits re Scabies — Visits re Infectious Disease 60 Visits re Medical Inspections 74 All other reasons 841 Home Visits. Concerning defects found at routine medical inspections 1,819 Subsequent visits re defects found at routine medical inspections 415 Visits re special cases 741 Visits to dental cases 70 Visits other than infectious cases 1,221 Visits in connection with infectious cases (including 484 visits concerning uncleanliness) 5,730 117 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 — 1433 1433 — 957 This Clinic showed a decrease upon 1950 in numbers submitted to refraction. A total of 3,107 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. Staffing. Though there has been some improvement in the overall position during the past year, the work of the Sub-department continues to be handicapped by lack of professional staff, and in the face of a rapidly rising school population it was still impossible to carry out annual inspection- and treatment for all within the scheme. Because of the dearth of applicants for full-time posts, the policy of supplementing permanent staff by additional sessions from part-time dental surgeons has been continued to good effect; with recent additions this help now represents the equivalent of two full-time dentists. The full complement of regular and part-time staff now amounts to six full-time officers. Though arrangements of this kind raise certain administrative problems, part-timers have worked exceedingly well, and their efforts have assisted in appreciably reducing the time lag 118 between successive treatments. The fact that 78 per cent, of the Primary and Secondary Schools were visited during the year may be considered a very real achievement. On the debit side it should be realised that when allowance is made for M. & C. W. commitments, present staffing still entails a "panel" of approximately 6,000 children per full-time dentist, and except in certain areas where populations are numerically smaller, this ratio precludes an annual inspection and treatment. On an average this period still stands at between sixteen and eighteen months, but in some cases longer periods must elapse. Because of successive delays in carrying out the post-war programme of clinic development, the recent introduction of numerous sessional workers has led to an acute shortage of surgery accommodation, resulting in considerable congestion at Lodge Road Clinic. The existence of this bottleneck precludes the introduction of any further part-time assistance, and is thus hampering certain important developments in the Service. Amongst other difficulties encountered by staff are the very large number of children showing marked irregularities of the teeth and jaws. Certain of these cases would appear to be the direct result of inadequate attention during earlier years, and present exceedingly difficult problems in the realms of diagnosis and treatment. Because of the very limited time available for this work, special measures are needed to deal with these deformities. A fuller assessment of such requirements is given in the appropriate section of the Report. Arrangements for Treatment. In the absence of alternative clinic accommodation in the outlying parts of the Borough, the major portion of treatment continues to be performed at the Central Clinic, Lodge Road. Here five surgeries are called upon to function in premises originally planned for three dentists, and congestion is very severe especially when anaesthetic sessions are in progress. Whilst the opening of the New Addington Clinic will to some extent reduce the demands on the above premises, a far greater degree of decentralisation is called for as soon as present material and economic restrictions are removed. The provision of a further Dental Centre is urgently needed to serve the eastern portion of the Borough including the newly developed Ashburton Building Estate. In addition to giving added surgery accommodation such a project would assist in restoring the balance of the scheme and reducing the time now spent in travelling to and from the Lodge Road Clinic. 119 Dental Centres are already provided at Duppas Hill, South Croydon and at 206, Selhurst Road, South Norwood. In the case of the latter a major conversion has lately been carried out which has greatly improved facilities for treatment. After many unsuccessful efforts to secure a site on the New Addington Building Estate, accommodation has at last been secured at the Overbury Primary School, where the work of adapting certain unused cloakrooms to serve as a Dental Clinic is expected to begin early in 1952. The following Table illustrates the suggested "long term" plan of development drawn up in 1946, 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 School 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 Plus County Colleges 7,000 and Plus Nursery Schools 800 42,490 1-2 onwards 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 1951 was 31,787. Including an additional 85 free-place scholars at nonmaintained schools, this represents a sum total of 31,872. Of these 24,961 were inspected and 12,920 (51.3 per cent.) referred for treatment, compared with 23,534 inspected and 11,716 (50 per cent.) referred in 1950. Because of present limitations on the work which can be carried out on temporary teeth, the above figures should not be regarded as an index of the incidence of decay, which is naturally appreciably higher. For practical purposes mouths are classed as 'healthy" unless the case is actually referred for treatment. 120 Owing to lack of staff eighteen departments (Primary and Secondary) comprising some 4,790 children, received no routine dental inspection during the year. The results obtained from school inspections were as follows:— Acceptance of Treatment 68.0% Refused Treatment 18.5% Forms Not Returned 13.5% As indicated above a further decline of 3.9 per cent, is seen in the number accepting treatment, making a decrease of 0.4 per cent, since the peak of 1949. This reduction is chiefly related to the more understaffed areas where parental anxiety would seem to be reflected by action favouring treatment by private practitioners. The following Table demonstrates the variation in the acceptance rate during recent years:— RESULTS OF SCHOOL INSPECTIONS. 1951. 1950. 1949. 1943. 1937. No. referred for— Treatment 12920 11716 9404 9041 13498 Consents 8790: 68% 8420: 1.9 % 6996: 74.4% 5642:62.4% 7762:57.5°;, (Total Consents Including Specials)* (11358:73.3%) (10817:76 6%) (10098:80.7%) (6814:67%) (10146:63%) Refusals 2390: 18.5% 1757: 15% 1213:12.9% 1519: 16.8% 3242: 24% Forms Not Returned 1740: 13.5% 1539:13.1 % 1195:12.7% 1880 : 20.8% 2494:18.5% * Specials.—Those referred by Head Teachers with Emergency Forms Treatment. Of 11,358 children consenting to treatment (including specials) 10,067 (88.0 per cent.) were treated and 8,353 (73.5 per cent.) cured (completely), compared with 10,817 consenting, 9,717 (89.8 per cent.) treated, and 8,220 (75.9 per cent.) cured in 1950. As a result chiefly of increased sessions by part-time staff, operative sessions rose from 1,921 to 2,200. Assistance thus given has materially helped in reducing arrears of treatment, particularly for schools in outlying areas. 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 G5.3, has now assumed the more substantial level of 107.7 for the current year. 121 Items of Treatment. The ensuing Table gives particulars of the principal items of treatment compared with those obtained last year:— 1951 1950  Attendances 22,234 20,434 Treated 10,067 9,717 Re-treated 5,329 5,304 Fillings—Permanent 8,191 8,129 Temporary 2,658 1,449 Extractions—Permanent 1,661 2,069 Temporary 10,116 9,444 Gas Administration 4,024 3,695 Local Anaesthetics 1,612 .2,018 Other Operations—Permanent 6,827 5,929 Temporary 3,531 2,712 Cases Completed 8,353 8,220 Other Operations These include:— 1951 1950 Root treatment in anterior teeth 55 49 Removal of nerves under local anaesthetic 23 20 Gingivectomy 2 3 Removal of bone sequestra 10 4 Removal of gum flap 2 — Splints for fractured incisors 11 17 Partial pulpotomy 5 — Number of M.D.s treated 58 41 Dentures inserted 61 54 Irrigation of sockets 35 23 Removal of impacted and difficult teeth 29 28 Ulcerated Stomatitis (Vincent's infection) 26 18 Cleft Palate — — Application of Penicillin "Cones" 28 49 Local application of Sulfonamides 15 — Crowns for Incisor Teeth 1 2 Referred for X-Ray 155 165 Forms from Head Teachers. The number of forms issued-by Head Teachers for emergency treatment was 2.568 compared with 2,397 in 1950. X-Ray Examinations. The number of cases referred to Mayday Hospital for the above purpose was 155, compared with 165 in 1950. 122 Orthodontic Treatment. Though in the past there has been a tendency to rate this branch of treatment at a purely æsthetic level, there is now much evidence to show that, far from being of a luxury character, this work has become an inseparable part of Children's Dentistry. In practice it is found that there are many mouths in which restoration of function cannot be achieved without adequate measures being taken to ensure a reasonable balance of articulation. As previously stated the need for such measures has unfortunately become increasingly apparent at a time when owing to staff restrictions less time is available for treatment. Cases causing particular anxiety are those in which diagnosis is complicated by early loss of certain temporary and permanent teeth, and where urgent steps are necessary to correct jaw relationship before the discrepancies become too marked. Whilst every effort is made to deal with the simpler of these defects, many of a more complicated nature have to be left untreated, or if considered practical are referred to one or other of the Teaching Hospitals in the hope that help will be forthcoming. Unfortunately at the present time most of these Institutions have already closed their waiting lists or cannot guarantee treatment for years to come. Because of the lack of outside facilities a considerable extension in the "scope" of this treatment is called for, together with the introduction of a "Special Unit" staffed by a visiting Consultant to undertake certain of the more "advanced" work and generally advise on procedure. Such an arrangement would considerably increase the output of completed cases whilst at the same time conserving the energies of existing staff. The number of sessions devoted to this work was 180 compared with 172 last year. The following is a summary of treatment performed:— 1951 1950 Cases under Treatment 320 256 New Cases 169 89 Cases Completed 99 93 Attendances 2,319 1,861 Appliances—Fixed 16 47 Removable 191 107 Treatment Sessions 180 172 123. 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:— 1951 1950 Attendances 183 271 New Cases Treated 38 38 Re-treated 47 39 Fillings—Permanent 110 156 Extractions—Permanent 19 49 Temporary 16 23 Other Operations 38 69 "Gas" Cases 11 14 Local Anaesthesia 7 40 Cases Completed 68 73 Dentures Fitted — 3 Referred X-Ray 2 4 124 Summary of Work Done at the Selhurst Road Clinic. 1951 1950 Attendances 2,925 3,149 Extractions 1,582 1,478 Fillings 1,084 1,133 Other Operations 2,182 2,610 "Gas" Cases 411 357 Local Anaesthesia 481 508 Cases Completed 1,062 1,175 Sessions held: Inspection 44, Treatment 380, Gas 26. The average attendance at this Clinic per session is 7.7. Summary of Work Done at the Waldrons Clinic. 1951 1950 Attendances 3,532 2,808 Extractions 1,781 1,303 Fillings 1,383 1,265 Other Operations 1,190 793 "Gas" Cases 646 526 Local Anaesthesia 109 120 Cases Completed 898 837 Sessions held : Inspection 12, Treatment 340, Gas 46. The average attendance at this Clinic per session is 10.4. DENTAL DEFECTS. (1) Number of children who were:— (a) Inspected by Dental Officer: Year 1951 Year 1950 Aged 5—6 2,008 Total: 24,961 1,181 „ 6—7 2,633 2,284 „ 7—8 2,817 2,227 ,, 8—9 2,688 2,389 „ 9—10 2,709 2,354 „ 10—11 2,228 2,227 „ 11—12 2,097 2,089 ,, 12—13 2,238 2,120 „ 13—14 1,995 2,332 „ 14—15 1,848 2,207 ,, 15—16 1,255 1,376 „ 16 up 445 748 Specials 2,568 2,397 27,529 25,931 125  Year 1951 Year 1950 (b) Found to require treatment 15,488 14,113 (c) Actually treated 10,067 9,717 (2) Half-days devoted to Inspection 195 185 Treatment 2,260 1,921 – 2,455 – 2,106 Number of Gas Sessions 257 243 Administrative Sessions 96 82 Orthodontic Sessions 180 172 (3) Attendances made by children for treatment 22,234 20,434 (4) Fillings— Permanent teeth 8,191 8,129 Temporary teeth 2,658 1,449 – 10,849 – 9,578 (5) Extractions— Permanent teeth 1,661 2,069 Temporary teeth 10,116 9,444 – 11,777 – 11,513 (6) Administrations of general anæsthetics for extractions 4,024 3,695 (7) Administrations of local anaesthetics for extractions 1,612 2,018 (8) Other Operations— Permanent teeth 6,827 5,929 Temporary teeth 3,531 2,712 – 10,358 – 8,641 Attendances per sessions 9.8 10.6 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 312 together with 3,459 who were given re-inforcing injections. 126 ORTHOPAEDIC WORK. Summary of Cases attending the Orthopaedic Clinic:— Cases on Hooks Jan. 1st, 1951. New Cases. Cases Discharged. 31st Dec., 1951. 451 201 169 483 257 children were seen by the Orthopedic Surgeon and 434 attendances were made. SPINAL AND OTHER REMEDIAL CLINICS. 1951. 1950. Attendances. Sessions. Av. attn. Attendances. Sessions. Av. attn. Spinal 5,527 976 5.7 4,448 793 5.6 Flat Feet 3,684 585 6.3 4,907 752 6.5 Breathing 1,913 369 5.2 1,799 260 6.9 11,124 1,930 11,154 1,805 376 individual cases were treated, and 1,078 attendances were made to see doctor. RHEUMATISM CLINIC. The total number of children whose names were on the "live" register at the end of 1951 was 126 (males 52, females 74). Of this number, 75 attended the Rheumatism Clinic during the course of the year, either as new cases or re-examinations; the remaining 51 failed to keep their appointments. Cases Examined at Rheumatism Clinic. 1947. 1948. 1949. 1950. 1951 Primary 27 31 37 24 22 Re-exams 75 27 76 84 53 Totals 102 58 113 108 75 Primary Cases. Rheumatic 21 22 30 17 19 (86.4%) Non-Rheumatic 6 4 3 7 1 (4.5%) Doubtful Rheumatic — 5 4 — 2 (9.1%) Totals 27 31 37 24 22 Classification of Rheumatic Cases. Primary. Re-examinations. Males 11 24 Females 8 25 (plus 4 non- rheumatic) Totals 19 49 (+4) Ages: 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Ttl. Rheumatic: Primary 1 1 1 4 4 3 4 – – – – – – – 19 Re-exams – 5 1 2 5 5 5 8 8 9 1 – – – 49 Others – 1 – – 1 1 2 1 1 – – – – – 7 The average age of primary cases of rheumatism, on first attendance at the clinic, was 9.2 years for both boys and girls. Grouping of Cases. 1949 1950 1951 Prim. "Re's. Ttl. Prim. Re's. Ttl. Prim. Re's. Ttl. Mild and Potential 24 32 56 5 52 59 15 20 35 Definitely Active 2 – 2 1 4 5 1 2 3 Quiescent 4 31 35 9 18 27 1 25 26 Doutbful or Non-Rheumatic 7 13 20 7 10 17 5 6 11 The Mild and Potential cases include those showing the first initial symptoms of "growing pains" in highly strung children. The "Definitely Active" group included cases with physical signs of rheumatic fever or chorea. Quiescent Cases "are those which at a previous examination had shown signs of mild and potential rheumatism or of active rheumatism, but which had now settled down and were no longer active. 128 Primary Examinations. Amongst the 19 new cases diagnosed as rheumatic the following manifestations were recorded:— Girls Boys Total Rheumatic pains 7 10 17 Chorea (suspected) — — — Carditis (definite) — 3 3 Carditis (suspected) 1 — 1 Tonsillitis and Infected Tonsils — — — Pyrexial attacks — — — Erythema Nodosum — — — Recent Rheumatic Fever 1 — 1 Family Histories. Of the primary cases, 3 gave a history of rheumatism in parents. Nervous Conditions. Girls Boys Total Highly strung 1 4 5 Headaches — — — Night terrors — 1 1 Enuresis — — — Minor degrees of nervous disorders — 9 2 Often a combination of more than one of the above symptoms was manifested. Disposal. The following recommendations were made in respect of the 19 new cases:— Girls Boys Continue attendance at Rheumatic Clinic 8 9 Referred to Pædiatrician 1 — ,, ,, Cardiologist ... — — ,, ,, Psychiatrist — — Restriction as to P.T. and games 4 3 For T. and A. operation — 1 Convalescent Home 1 — Remedial Exercises — — For admission to St. Giles' — — 129 ST. CHRISTOPHER'S SPECIAL EDUCATIONALLY SUB-NORMAL SCHOOL. I am indebted to Mr. Ramsden, the Head Master, for the following observations:— Festival year of 1951 saw the school celebrate with its own project on Croydon. Each class contributed to this project. In the various classes we covered the History. Industries, Health Services, 999 Services, Homes, the Clothes we, Wear, Transport, the Toys we Play With and Nursery Rhymes. Each child made a booklet for itself during the course of this experiment. The whole was a great success and was shown to the parents on Open Day in July. The Mayor and Mayoress of Croydon, the Chief Education Officer. H.M. Inspectors and the local Inspectors, and friends from a fifty-mile radius visited the Exhibition. A film was made of many of the activities, the outstanding of which was the making by Class 1 Boys of a Plaque of the Croydon Coat of Arms, and at the request of the Mayor this was on view in the Mayor's Parlour. In May. we were honoured in being selected by Mrs. Golden. H.M.I., to demonstrate physical training and folk dancing to a week-end course of Surrey teachers. A new venture of 1951 has been the acquisition of a printing machine, which enables the boys to print school notices, etc. Seven children took part in the Croydon Schools Sports for the first time: one boy reaching the sixth place for Putting the Weight, achieving a distance of 25 feet 5 inches. The annual outing to Littlehampton was again, thanks to the weather and the arduous work put in by all the staff, a great success; 142 children with 26 staff taking part. During the year, the Beddington Sewage Works, the South Kensington Museum, the Oliver Typewriter works, the Parish Church, the Old Palace, and Bowatcrs were visited by various classes. The standard of health and cleanliness continues to improve in conjunction with the academic and social training. We look forward to the completion of our new extension early in the new year. Number attending January 1st, 1951 200 ,, ,, December 31st, 1951 202 ,, referred to Public Elementary Schools 2 Number discharged: (i) Ineducable and referred to Mental Health Committee 2 (ii) Unfit to work ,, ,, ,, — (iii) Fit to work ,, ,, ,, 10 130 CLINIC FOR EDUCATIONALLY SUB-NORMAL CHILDREN. 300 children were examined during 1951. 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 12 (b) Found to be mentally defective and referred to Local Authority for Statutory Supervision 20 (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 60 (b) Recommended to Residential School 4 (c) Referred to Special Class in Ordinary tary School 20 (d) Recommended for re-test 50 (e) Deferred for Medical Treatment 26 (f) Recommended for St. Giles' 4 (g) Recommended Epileptic Colony 1 (h) Referred back to Ordinary Elementary School 10 (3) Referred to Child Guidance Clinic 8 (4) Examined for other Authorities 6 229 Mental Tests at St. Christopher's 12 241 760 home visits have been paid to Education cases. 131 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 – 4 2 1 38 27 26 3 – 101 B. Handicapped Pupils newty ascertained as requiring education at Special Schools or boarding in Homes – 7 – 1 53 35 27 4 – 127 On or about December 1st:— C. Number of Handicapped Pupils from the area: (i) attending Special Schools as Day Pupils – 30 4 9 65 89 205 – – 402 Boarding Pupils 3 – 7 1 4 4 4 – 2 25 (ii) Boarded in Homes – – – – – – – – – – (iii) attending assisted schools (under approved arrangements) – – 3 2 – 2 – 7 – 14 Total (C) 3 30 14 12 69 95 209 7 2 441 D. Number of Handicapped pupils being educated under arrangements made under Section 56 of the Education Act, 1944— (a) in hospitals – – – – – 5 – – – 5 (b) elsewhere – – – – 12 6 2 – – 20 E. Number of Handicapped pupils from the area requiring places in special schools (including any such unplaced children who are temporarily receiving home tuition) 3 3 – 35 27 29 1 – – 98 Number of children reported during the Calendar Year: Under Section 57(3) of Education Act, 1944 15 „ „ 57(4} „ „ „ – „ „ 57(5) „ „ „ 6 132 JUVENILE EMPLOYMENT RETURN. The following numbers of children were examined by the medical officers during 1951 as to their fitness to following the part-time employment indicated:— 1951. 1950. 1949. 1948. 1947. Delivery of Goods for Shopkeepers 72 71 218 190 112 Delivery of Newspapers 225 323 283 375 151 Delivery of Milk 30 29 16 33 6 Shop Assistants 133 104 — — — 460 527 517 598 269 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT. During 1951 all milk was supplied free of charge, and approximately 23,400 children per day received l/3rd pint each. This was equal to 88 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 1951 was approximately 13,300. CHILD GUIDANCE CLINIC. Return of Cases referred by the School Medical Officer and the Education Department, from 1st January to 31st December, 1951. Boys. . Total number referred 46 30 Analysis of the above Cases— – – Diagnostic only 8 8 Current Cases under treatment 27 12 Cases Closed—improved 6 7 Cases Closed—not improved 5 3 46 30 133 Speech Defects Clinic. Cases treated 118 Cases discharged 47 Cases still attending 71 Cases referred for physical treatment 7 Cases referred for residential treatment 3 Cases referred to Child Guidance Clinic 2 Stammerers 25 Cleft palate and allied disorders 7 Sigmatism 8 Deafness 3 Dyslalia 45 Undeveloped speech 18 Dyspituitary 1 Aphasia 2 Post-Meningitis 1 Dysarthria 7 Mongolism 1 Attendance by the patients at the Speech Clinic throughout 1951 has been regular and continuous. This is largely accounted for by the number of severe speech cases referred, which makes patients realise the necessity for co-operation. There has been a corresponding decline in the number of less severe articulatory defects. NON-MAINTAINED SCHOOLS. The usual arrangements for the medical inspection of nonmaintained school children were continued in 1951, 122 children were examined. Table II of Appendix B gives the detailed findings. Yours faithfully, S. L. WRIGHT, School Medical Officer. 134 APPENDIX A. MEDICAL INSPECTION RETURNS. Year ended 31st December, 1951. Table I. MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. A.—Periodic Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 4,295 Second Age Group 3,411 Third Age Group 2,177 Total 9,883 Number of other Periodic Inspections 3,095 (8-9 years). – Grand Total 12,978 B.—Other Inspections. Number of Special Inspections 2,929 Number of Re-Inspections 6,363 Total 9,292 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 HA. Total individual pupils. (1) (2) (3) (4) Entrants 29 638 664 Second Age Group 284 383 641 Third Age Group 179 194 254 Total (prescribed groups) 492 1215 1659 Other Periodic Inspections 211 388 576 Grand Total 703 1603 2235 135 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 25 10 3 2 5 Eyes— (a) Vision 703 59 45 2 (b) Squint 80 30 8 — (c) Other 23 10 8 — 6 7 Ears— (a) Hearing 31 9 4 2 (b) Otitis Media 14 7 5 — (c) Other 6 11 1 — Nose or Throat 534 319 26 4 8 Speech 25 21 8 2 9 Cervical Glands 5 25 — — 10 Heart and Circulation 39 49 3 3 11 Lungs 66 129 5 2 12 Developmental— (a) Hernia 3 4 — — (b) Other 2 8 1 1 13 Orthopaedic— (a) Posture 305 51 8 — (b) Flat foot 222 101 7 1 (c) Other 186 69 8 3 14 Nervous System— (a) Epilepsy 4 11 — — (b) Other 8 18 1 2 15 Psychological— (a) Development 3 5 — — (b) Stability 4 11 2 1 16 Other 103 76 18 9 * These figures refer to Special Inspection in school only. 136 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 4295 1227 28.6 2877 67.0 191 4.4 Second Age Group 3411 1130 33.1 2134 62.6 147 4.3 Third Age Group 2177 487 22.4 1621 74.5 69 3.1 Other Periodic Inspections 3095 1018 32.9 1918 62.0 159 5.1 Total 12978 3862 29.9 8550 65.9 566 4.3 Table III. INFESTATION WITH VERMIN. (i) Total number of examinations in the schools by the school nurses or other authorized persons 70301 (ii) Total number of individual children examined (school population) 31217 (iii) Total number of individual pupils found to be infested 618 (iv) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 21 (v) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) 5 137 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—(1) Scalp 4 — (ii) Body 11 — Scabies 8 — Impetigo 29 — Other Skin Diseases 67 — Total 119 — GROUP 2.—EYE DISEASES, DEFECTIVE VISION AND SQUINT. Number of cases dealt with. By the Authority. wise. External and other, excluding errors of refraction and squint 200 – Errors of Refraction (including squint) – 1433 Total 200 1433 Number of pupils for whom spectacles were (a) Prescribed – 957 (b) Obtained – 957 GROUP 3.—DISEASES AND DEFECTS OF EAR, NOSE AND THROAT. Number of cases treated. By the Authority. wise. Received operative treatment (a) for diseases of the ear — — (b) for adenoids and chronic tonsilitis — 831 (c) for other nose and throat conditions — — Received other forms of treatment (Ear Minor Ailments Clinic) 131 — Total 131 831 138 GROUP 4—ORTHOPAEDIC AND POSTURAL DEFECTS. (a) Number Treated as in-patients 13 By the Authority. Otherwise. (b) Number treated otherwise, e.g., in clinics or outpatients departments 195 257 GROUP 5.—CHILD GUIDANCE TREATMENT. Number of cases treated. In the Authority's Child Guidance Clinics. here Number of pupils treated at Child Guidance Clinics — 76 GROUP 6.—SPEECH THERAPY. Number of cases treated. By the Authority. Otherwise. Number of pupils treated by Speech Therapists 118 – GROUP 7.—OTHER TREATMENT GIVEN. Number of cases treated. By the Authority. Otherwise. (a) Miscellaneous minor ailments 1428 — (b) Other (specify) 1. Orthoptic – 98 2. Sunlight — 62 3. Verruca 501 — Total 1929 160 139 Table V. DENTAL INSPECTION AND TREATMENT. ( 1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 24961 (b) Specials 2568 (c) Total (Periodic and Specials) Total 27529 (2) Number found to require treatment 15488 (3) Number referred for treatment 15488 (4) Number actually treated 10067 (5) Attendances made by pupils for treatment 22234 (6) Half-days devoted to: (a) Inspection 195 (b) Treatment 2260 Total 6 2455 (7) Fillings: Permanent Teeth 8191 Temporary Teeth 2658 Total 7 10849 (8) Number of Teeth filled: Permanent Teeth 10350 and Temporary Teeth (9) Extractions: Permanent Teeth 1661 Temporary Teeth 10116 Total 9 11777 (10) Administration of general anaesthetics for extraction 4024 . 11) Other Operations: (a) Permanent Teeth 6827 (b) Temporary Teeth 3531 Total 11 10358 140 APPENDIX B. NON-MAINTAINED SCHOOLS. Year ended 31st December, 1951. Table I. RETURN OF MEDICAL INSPECTIONS. A. —Routine Medical Inspections. Year 1950. 1951. Age 11 or under 35 — 12 16 25 13 4 9 14 35 35 15 6 17 16 24 32 17 1 4 18 or over 2 — Total 123 122 B.—Other Inspections. Year 1950. Year 1951. Number of Special Inspections — 8 Number of Re-inspections 3 7 Total 3 15 Visits to Non-maintained Schools 7 5 141 NON-MAINTAINED TABLE II.—A.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1951. DEFECT OR DISEASE. Routine Inspections. Number of defects. Special Inspections Number of defects. Requiring treatment. Requiring to be kept under observation but not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment (1) (2) (3) (4) (5) Malnutrition ... ... ... ... Undeanliness. (See Table IV.—Group V.) Skin— Ringworm : Scalp ... ... ... ... Body ... ... ... ... Scabies ... ... ... ... Impetigo ... ... ... ... Other diseases (non tuberculous) 1 ... ... ... Eye— Blepharitis 1 ... ... ... Conjunctivitis 1 ... ... ... Keratitis ... ... ... ... Corneal opacities ... ... ... ... Defective vision (excluding squint) 5 ... ... ... Squint ... ... ... ... Other conditions ... ... ... ... Ear— Defective hearing ... 1 ... ... Otitis media ... ... ... ... Other ear diseases ... ... ... ... Nose and Throat— Enlarged tonsils only 1 1 ... ... Adenoids only ... ... ... ... Enlarged tonsils and adenoids ... ... ... ... Other conditions ... ... ... ... Enl.arged Cervical Glands (Non-Tuberculous) ... ... ... ... Defective Speech ... ... ... ... Teeth—Dental Disease 1 ... ... ... 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 1 ... ... ... Posture 2 ... ... ... Other forms 2 ... ... ... Other Defects and Diseases 2 ... ... ... 142 CONTENTS. A.—PUBLIC HEALTH REPORT. PAGE Acts, Adoptive 72 Airport ... ... 99 Ambulance Service 56 Amusement Houses 74,78 Animals, Keeping of 78 Ante-Natal Clinic 36 Births 5,6, 7 Byelaws and Regulations 72 Cancer 12,13 Chemical Analyses 95 Chest Clinic 22 Child Minders 98 Contacts, Tuberculosis 28 Convalescence 63 Committee 1 Cremation 99 Dairies, Cowsheds and Milkshops 83 Day Nurseries 40 Deaths 5,6, 12 Dental Treatment—M. & C.W. 41 Diphtheria 54 Disinfection 78 Disinfestation 79 Ditches 78 Domestic Helps 63 Drainage 78 Dysentery 15, 19 Extra Nourishment 27, 31 Factories and Workshops 73, 76 Fertilisers & Feeding Stuffs Act 80 Foods 73, 81, 87 Gastro-Enteritis 19 Health Propaganda) 64 Health Visitors, Work of 49 pace Home Helps 63 Home Nursing 52 Homework 77 Hospital, Isolation 17 Housing 29,72,74 Housing Act 74 Ice Cream 86 Illegitimacy 5,36 Immunisation 54 Infant Welfare Clinics 37 Infant Mortality 5,8 Infectious Diseases 15 Inquests 7 Local Acts 72 Marriages 6 Maternity Homes 98 Maternity Homes, Registration 98 Maternity Outfits 48 Measles 18 Meat Inspection 82 Medical Help Records 48 Men's Hostel 75 Mental Health 65 Midwives 46 Midwives, Municipal 46 Midwives Act 48 Milk, Provision of 27,31 Milk, Examination of 84,90 Milk, Tuberculous 84 Milkshops S3 Mortality in Childbirth 8 National Assistance Act 99 Neo-Natal Deaths 9 Notification of Birth Acts 7 Nuisances 72 Nursing Equipment 63 Nursing Homes 98 Nurses' Agencies 98 Offensive Trades 78 Ophthalmic Neonatorum 15 Outworkers 77 143 PAGE Pests 80 Poisons and Pharmacy Act 79 Poliomyelitis 19 Ponds 78 Population 5 Post-Natal Clinic 36 Post-Mortems 7 Premature Infants 36 Puerperal Sepsis and Pyrexia 15 Rats & Mice (Destruction) Act 80 Refuse Collection 97 Road Traffic Accidents 12, 57 Sanatoria, Treatment in 28 Sanitary Administration 69 Sanitary Certificates 76 Sanitary Inspectors, Work of 71 Scarlet Fever 15,18 Sewage 97 Shop Hours Acts 73,77 Slaughterhouses 82 Smoke Observation 78 Staff Examinations 98 Still-Births 57 B.—SCHOOL MEDICAL REPORT PAGE Accommodation 104 Adenoids 114 Blind Children 131 Child Guidance 132 Cleansing of Children 112 Clinics 103, 114 Cod Liver Oil 132 Cost 111 Crippling Defects 126 Deaf Children 131 Deaths 113 Defective Children 110 Defective Hearing 131 Deformities 126 Dental Service 117 Ear Disease 131 Epileptic Children 131 Exclusions 116 Eye Clinic 117 Following-up 116 Health Visitors, Work of 116 Heights and Weights 109 Immunization, Diphtheria 125 Infectious Diseases 115 Inspection Clinic 114 Inspections 107 Juvenile Employment 132 PAGE Tuberculosis—After Care 31 „ Allowances 31 ,, Contacts 28 „ Deaths 21 26 „ Notifications 23 „ Home Nursing 28 „ Home Visits 28 „ Institutional Treatment 28 „ Occupational Therapy 32 „ Vaccination 29 „ Mass Radiography 30 „ Re-Housing 29 Vaccination 55 Verminous Persons 79 Venereal Diseases 33 Vital Statistics 5 Ward Statistics 11 Watercourses 78 Water Supply 95 Whooping Cough 55 X-Ray 30 Zymotic Diseases 11 PAGE Malt 132 Meals, Provisions of 132 Mentally Defective Children 129 Milk, etc., Provision of 111, 132 Minor Ailments 114 Non-maintained Schools 133 Orthopaedic Work 126 Orthodontic Service 122 Parents' Attendances 108 Physically Defective Children 130 Population 104,113 Remedial Exercises 126 Rheumatism Clinic 126 Schools, Special 111 Speech 133 Staff 103 Statistical Tables 134 Surveys, Uncleanliness 112 St. Christopher's 129 Throat and Nose 114 Treatment 103,114 Tuberculosis 113 Uncleanliness 112 Vision, Defective 111 X-Ray 121 144