9/11/53 CRO 54 County Borough of Croydon. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1952 S. L. WRIGHT, M.D., M.R.C.P., D.P.H. 0CROYDON: PRINTED BY THE CROYDON TIMES LTD., 104 HIGH STREET, CROYDON c.t.2. 150. 31-7-53. 1 HEALTH COMMITTEE. 1952. 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 W. A. H. Gerlack. Councillor A. Goodbun. Councillor G. W. Hills. Councillor Mrs. E. M. Jenkins. Councillor C. E. Moyce. Councillor G. H. Ward, O.B.E. Councillor S. G. Wilkes. Miss Dorothy Day, M.R.C.S., L.R.C.P. R. N. Deane, Esq., M.B., B.Ch., B.A.O. O. E. Finch, Esq., M.C., M.D. 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., L.R.C.P. D. F. Kanaar, Esq., M.D., M.R.C.P. J. S. Lane, Esq., B.A., M.R.C.S., L.R.C.P. Miss K. C. Vost, M.B., B.S., D.P.H, Croydon Local Medical Committee. A. F. Clift, Esq., F.R.C.S., M.R.C.O.G. Croydon Group Hospital Management Committee. Miss M. M. Durrant, S.R.N., I.N. Royal College of Nursing. Mrs. F. R. Mitchell, O.B.E. - Royal College of Mid-wives. Miss J. C. DickinsonCroydon District Nursing Association Mrs. H. Thatcher Croydon Family Planning Association. 2 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1952. 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 Annual Report on the health of the people of Croydon and the relevant services of the Corporation for the year ending December 31st, 1952. It will be noted that the birth rate continued to decline, but the estimated population still remained just over a quarter of a million. The standardised death rate was unaltered, in contrast to the much reduced figure for the whole country. The infant mortality rate showed a small rise over the record low figure of last year, and a further impovement in mortality from tuberculosis was achieved. The Chest Physician, however, draws attention to the rise in deaths from pulmonary tuberculosis amongst males over the age of 45 years. Infectious diseases continued prevalent but generally mild in character. In the statistical section are included extracts from tables issued by the Registrar-General of the 1 per cent. samples of the 1951 Census. It is of interest that an improvement is shown in the housing ratios, in comparison with those of the 1931 Census. The present housing shortage represents the failure to meet the demand due to the general rise in the standard of living. This problem continued to be aggravated by the difficulty of retaining privately owned properties as fit dwellings owing to the disparity between restricted rents and costs of essential repairs. 8 Atmospheric pollution, particularly in the western area of the borough, was constantly under review. Abnormal weather conditions in December emphasised by a marked increase in deaths the persistent threat to health from this theoretically preventable cause. Remembering that 50 per cent. of smoke pollution comes from domestic fires, it is a fair analogy to regard our present problem of smoke pollution as comparable with that of polluted water which confronted authorities 100 years ago. The complete solution probably implies a change of national habits and a capital investment programme equalling the sums expended in the past on drainage systems and sewage disposal schemes. Meanwhile the efforts of the department have necessarily to be limited to the strict application of existing powers and to advocating wherever possible the domestic employment of smokeless fuels. The example of other areas regarding smokeless zones has not been overlooked, nor the importance of urging the Corporation and other public bodies to replace smoke producing appliances used in their own buildings. The Minister of Health requested local health authorities to obtain and forward early in the year as part of the annual report of their medical officer of health a review of their services under the National Health Service Act. The information so provided is now presented in the form suggested by the Minister. SURVEY OF SERVICES PROVIDED BY THE CORPORATION UNDER PART III OF THE NATIONAL HEALTH SERVICE ACT, 1946. Administration 1.—(a) Executive. The Health Committee with 18 Council and 4 Co-opted Members has retained 3 sub-committees. One dealing mainly with duties under the Public Health Act, 1936, and allied matters, one with personal health services under the National Health Service Act, and the third with the Ambulance Service. The Mental Welfare Sub-Committee business proved relatively small, and since 1951, such items have been considered by the main Committee. (6) Administrative. Removal to new premises permitted a considerable degree of centralisation of all sections, including School Health, in a single building. This greatly increased the ease of co-operation between individual officers dealing with related problems. 4 Staff of the Department. Medical Officer of Health and Deputy Medical Officer of Health (also School Medical Officer and Deputy School Medical Officer). General Administration Chief Clerk, 13 Clerks, 4 Typists. Sanitary and Food Inspection Chief Sanitary Inspector, Deputy, 18 Inspectors, 6 Assistants, 4 Disinfectors, 3 Rodent Operators, 9 Clerks, 2 Typists. Maternity and Child Welfare 6 Clinic Medical Officers whole-time (but also School Health duties), 4 Part-time. Supt. Health Visitor, Deputy, and 28 Health Visitors (also School Nurses), Almoner (part-time), Assistant Almoner. Superintendent Midwife, Deputy, 17 Midwives, 2 Physiotherapists, 5 Clerks. (Dental Service as for School Health). Unmarried Mothers (Agency arrangements), 1 Moral Welfare Worker. District Nursing (Agency arrangements) Supervisor, 3 Assistants, 36 Nurses and 1 Clerk. Domestic Help Supervisor, Assistant, 2 Clerks, 17 Fulltime, 117 Part-time Home Helps. Day Nurseries 5 Nurseries with Matron, Deputy Matron, Wardens, Nurses', Students and Domestic staff. Vaccination and Immunisation 1 Clerical Officer. Ambulance Service Ambulance Officer, Deputy, Second Officer, Maintenance Officer, 4 Leading Drivers, 57 Driver-Attendants, 3 Clerks, 1 Telephone Operator. Prevention, Care and Aftercare 4 Tuberculosis Visitors, 2 Almoners, 1 Clerk, 1 Occupational Therapist (part-time). Mental Health 5 Duly Authorised Officers, 1 Clerk, 1 Occupation Centre Supervisor, 3 Assistants. 6 Co-Ordination with Other Parts of the National Health Service 2.—The Health Committee has arranged for co-opted members from other organisations to serve on the main Committee and its Sub-Committees. At the time of writing there is no formal co-ordinating machinery at member level, although individuals serve on more than one of the 3 sections of the service. Such machinery is now under consideration. With the boundaries of the County Borough approximating to those of the Executive Council and Hospital Management Committee, it seems unlikely that any elaborate administrative arrangements will be made. A technical co-ordinating committee to deal with Maternity services convened by the Hospital Management Committee as required was set up in 1949 and has met on four occasions. The Medical Officer of Health is ex-officio a member of the Local Medical Committee, the Group Hospital Medical Advisory Committee, the Isolation and Maternity (Part II C.M.B. training) Hospitals House Committees. Close co-operation at all levels between the personnel of all branches of the service has been maintained since the appointed day. A joint pamphlet was produced in 1948 giving information of services available under the National Health Service Act. Joint Use of Staff 3.—General practitioners assist on a sessional basis at 3 Infant Welfare Centres, but this covers a minority of the clinics. At one outlying Ante-Natal Clinic a general practitioner acts as the local health authority clinic Medical Officer. To meet the criticism that this meant his dealing with mothers on the lists of other general practitioners, the clinic was made available for any doctor to attend to examine his own cases. The method works fairly well. In my view the fusion of local authority infant welfare and maternity services with general practice must, in large urban areas, await the development of a group practice system. Assistant Medical Officers of Health act as clinical assistants in Hospital out-patients departments, but as observers rather than active members of the hospital staff. In all arrangements for specialist services the principle of using hospital facilities and not creating separate local authority schemes has been observed. 6 Voluntary Organisations 4.—The Corporation have where possible utilised the services of efficient voluntary organisations and retained agency arrangements, e.g., Home Nursing, Care of the Unmarried Mother, Family Planning Clinics. Particular Services Expectant and Nursing Mothers 5.—Before 1948 a system of central combined ante and postnatal clinics for hospital and domiciliary cases had been developed in Croydon. This has been retained by agreement between the Hospital and Local Health Authority. The Senior Consultant Obstetrician is in clinical charge, and hospital staff attend for mothers booked for hospital confinement. Whole-time Assistant Medical Officers of Health function at the domiciliary midwives' sessions, except as previously mentioned in an outlying clinic in a new housing estate. Almoner and clerical staff are shared. Relaxation exercises and mothercraft classes are available for expectant mothers and blood groups, Rh. factor, W.R. and Khan reactions are ascertained for all who attend, or are referred by general pactitioners for the purpose. Dental treatment is available through arrangements with the School Dental Service. Maternity outfits are supplied for domiciliary confinements from the antenatal clinic. Unmarried mothers are dealt with by the Croydon Association for Moral Welfare acting as agents of the Corporation. A capitation fee is paid for the case work of their Social Welfare Officer, and reimbursement on a case basis, of the cost of Mother and Baby Homes. The usual period of stay is 3 months. There was a considerable increase in the numbers referred during 1952, which, as far as can be judged in the absence of the Registrar-General's figures, arose from a greater use of the service, and not an increase in the illegitimate birth rate. Child Welfare There were 19 premises providing 32 Infant Welfare sessions per week during the year under review. The figures are almost identical with previous years. No new buildings were provided, but minor exchanges of premises were effected where more suitable accommodation became available. Medical staffing is mainly by Assistant Medical Officers of Health and except for the Health Visitor in charge, the remaining staff is made up entirely of voluntary workers. This represents a continuation of the system operating before the appointed day when the Infant Welfare Centres in Croydon were conducted by a voluntary organisation. Their loyal and experienced assistance is of the 7 greatest value. There is no scheme for assisting with local authority staff any general practitioners holding clinics at their own surgeries. Premature Infants Outfits are available on loan at any time and delivered by the Ambulance Service (cots', blankets, hot-water bottles, Belcroy feeders, etc.), The co-ordination of the institutional and domiciliary obstetric service enables most expectant mothers who are likely to give birth to grossly premature babies being admitted for ante-natal care and hospital confinement. As a result it is unusual for infants below 4 lbs. in weight to be born on the district. There was no difficulty in obtaining the admission of a premature baby to hospital when this was necessary. Supply of Dried Foods, etc Ministry of Food Welfare Foods are available at all centres, but other supplies of dried milk and a limited number of simple medicaments are issued by arrangements with local pharmacists. No charge is made for medicaments or in the case of necessitous mothers for proprietary brands of dried milk. Dental Care This continued to be arranged through the School Dental Service under the direction of the Senior School Dental Officer and his detailed report will be included in the printed copy. 20 per cent. of the available dental resources were given to the Maternity and Child Welfare Service. The dental staff was strengthened during the year by the employment of part-time dental officers. A new surgery was also opened on an outlying housing estate. The Corporation resolved to anticipate their ability to recruit further staff, in excess of present surgery accommodation bv asking authority to build a new twin dental surgery to serve the eastern portion of the Borough. Other Provision The physiotherapists continued remedial treatment for minor posture defects in the pre-school children. Owing to the falling birth rate this work has considerably diminshed in amount, which allowed more of their time to be given to ante-natal relaxation classes. Arrangements for Recuperative Holidays for mothers with voung babies continued. Authority for suitable cases to be sent for re-education at homes' for neglectful or incompetent mothers was sought in connection with families referred through the Corporation's co-ordinating Committee for Children Neglected or Ill-treated in their own Homes. 8 Day Nurseries The policy of the Corporation has been to restrict the use of nurseries to mothers who are obliged to work because their earnings are the sole support of the family, or there are other exceptional home conditions. The numbers qualifying for admission have steadily diminished and nursery capacity has been reduced in step with the demand. 5 nurseries remained at the close of 1952. Midwifery 6.—The Corporation administers directly the domiciliary midwives service. A Superintendent Midwife acts as non-medical supervisor for this staff. Midwives employed in Maternity homes are supervised by one of the whole-time Assistant Medical Officers of Health who combines these visits with inspections of the Homes under the Public Health Act, 1936. Approximately twothirds of the Midwives own their own motor-cars or autocycles and are paid travelling allowances. The remainder use bicycles, but a car is maintained by the Ambulance Service and is available for these Midwives when required. Accommodation has been provided for one Midwife who lives on an isolated housing estate. All Midwives are competent to administer and have available gas/air analgesia and pethidine. For those without motor-cars gas/air equipment is transported by the Ambulance Service. Midwives attend the Ante-natal sessions with the mothers for whom they are booked. If this care is being given by the family doctor, Midwives are required to visit independently. A form for interchange of information was drawn up by the Local Medical Committee and issued by the Executive Council. (It is now very little used, being replaced by direct contact between Midwife and Doctor). Midwives attend the surgeries of 10 family doctors who hold regular ante-natal sessions. Home visiting of mothers not qualifying for priority admission to hospital on medical grounds is carried out by the domiciliary midwives, who advise whether a home confinement is practicable. 3 or 4 Midwives each year are required to attend a two weeks' refresher course in London arranged by one of the professional organisations, so that each Midwife attends at intervals of 5 years. 10 Midwives have Part II C.M.B. pupils for three months' district training, the course being held in conjuction with St. Mary's Maternity Hospital Part II training school. Part I Pupil Midwives attend the Antenatal clinic from Mayday Hospital. Post-natal clinics are held in the same premises as the Ante-natal clinics. Midwives followup their mothers who fail to attend. The Midwifery Service has recovered from the initial disturbance following the introduction of the National Health Service Act and is working smoothly with the general practitioner obstetricians and the hospital service. 9 Health Visiting 7.—As with Midwifery and Home Nursing this is in Croydon a specialised service, except that all Health Visitors are also School Nurses, with the same areas for the two functions. Health Visitors are expected to meet the District Midwife at the home of a lying-in mother between the 10th-14th day, so that there is no sudden break in the advice being given. Visiting of old people, foster children, cases of minor notifiable infectious diseases and housing cases also come within her duties as do Mothercraft lectures to expectant mothers, to Parent-Teacher Associations and Women's organisations. There is close personal connection with the Almoners of local hospitals, and many reports are furnished for London Teaching Hospitals. Practical training of Health Visitor students is performed for the Royal College of Nursing. All Croydon Health Visitors have the necessary certificate on appointment and special training facilities for appointed staff has not been required. Vacancies have always, so far, been satisfactorily filled. Refresher courses are arranged as for Midwives, but special local lecture courses on "Mental Health" and "Health Education" have been held. The general problem of integration with the general practitioner service has not been solved, but recognition of its importance has not been overlooked. Home Nursing 8.—The Corporation have maintained their agency arrangement with the Croydon District Nursing Association subject "to the Medical Officer of Health supervising the services so provided." The service operates from a central hostel, although the majority of the staff are non-resident. The direct availability of the Supervisor and her Assistants makes co-operation with general practitioners simple and effective. The hospital requests for services discharge form used throughout the London area is employed in Croydon and works well. The details of actual cases nursed are given in later tables, but the chronic sick and aged constitute the major type of patient. The Corporation have supplied approximately 25 per cent. of the nurses with small vans and motor-cycles, these being allocated to the male nurses and those with scattered or hilly districts. A rota for night duty gives each nurse about one night on call per month. An Ambulance Service car takes nurses without their own transport for these emergency night visits. The Association is recognised for practical District Nurse training, lectures being taken through the Headquarters of the Queen's Institute. Refresher courses are arranged for trained staff as for other nursing officers. 10 Vaccination and Immunisation 9.—It is the duty of the Health Visitor to visit the parents of every child aged 2—3 months to urge vaccination. A special form is supplied by the Clerical Officer which serves as a reminder to the Health Visitor and as a record of the result. Similarly she is required to visit again at 6—9 months specifically to urge immunisation against Diphtheria. Immunisation against Whooping Cough is given if requested but not advocated in the same manner as vaccination and diphtheria immunisation. It is normally given as a mixed Diphtheria/Whooping Cough reagent. A reminder is sent to parents of school entrants which also advises " booster " doses at 5 years and 10 years of age. These forms are distributed through the schools, and injections given in the schools. Ambulance Service 10.—The three divisions of a modern Ambulance Service which have developed since the appointed day are evident in Croydon:— (a) The emergency and accident calls. (b) The less urgent but priority hospital admissions. (c) The out-patient clinic appointments. The first group comprises the oldest ambulance duty and has produced no special difficulty. The second group has been complicated by the new availability of hospitals irrespective of borough boundaries. It is usually when the pressure of work is heaviest that vacant beds cannot be obtained in local hospitals, and ambulances are required to transport patients anywhere in the Greater London area. It is, however, the demands of the third group which seem insatiable, despite the application of the measures suggested by Ministry of Health Circular 30/51. Patients are quite properly discharged home from hospitals at the earliest opportunity both for their own benefit and to achieve a high usage rate for expensive in-patient hospital beds. Frequently this can be done only if they are brought to and from the hospital by ambulance transport for a period for routine clinic treatment. Family doctors have been asked to limit requests for domiciliary consultations, e.g., by referring appropriate patients to an out-patient department. Again, this is often possible only if ambulance transport is provided. These treatment and consultation journeys involve in Croydon not only local institutions, but also all the London Teaching Hospitals, as the 11 Corporation have not thought it reasonable to apply the suggestion of Circular 30/51 regarding the use of local hospitals only, to imply the exclusion of Croydon practitioners sending cases by ambulance transport to the Out-patient departments of London Teaching Hospitals. It is not thought that radio control will be of material assistance in the better deployment of the services especially vehicles operating outside the borough. No particular design of stretcher case ambulance has been found necessary, but special 10-seater "clinic" ambulances have proved of great value. Transport Officers at busy hospitals are essential if patients are not to be overlooked and vehicle space wasted. Long distance journeys by ambulances are now uncommon, as almost all patients can be dealt with satisfactorily by ambulance and rail transport. Abuse of the service insofar as a breach of statutory provisions is concerned is rare but in division (c) the position is perhaps comparable with the demands which arose for other facilities under the National Health Service Act, and for which a suitable form of financial discouragement was ultimately imposed. Prevention, Care and Aftcr-Care Tuberculosis l1-The Corporation reimburse to the Regional Hospital Board part of the salary of the Chest Physician and his deputy. Apart from this formal recognition of their dual capacity of preventing and treating tuberculosis, there is the important factor that they are concerned with the same population as the local health authority and that the latter is the housing, education and sanitary authority. In such circumstances, it is fair to observe that to produce an artificial division of the Croydon Tuberculosis service would be more difficult than the preservation of the unity which existed for over 30 years. In fact, no difficulties have been revealed and the integration of the treatment of tuberculosis within the general hospital system has undoubtedly been to its advantage. I believe the service has greater scope and facilities than before the appointed day. On the fundamental issue of housing, the Chest Physician advises the Department on every case, and the Corporation Housing Committee affords first priority to these applicants. The 4 Tuberculosis Visitors and the Almoners and Clerk who are employed by the Corporation work at the Chest Clinic under the day to day supervision of the Chest Physician. The Health Committee administers after-care functions through a section of one of its Sub-Committees, there being no voluntary after-care organisation. The usual loan of 12 beds, bedding and garden shelters, extra nourishment, advice and care of relatives, and home occupational therapy is available. The Corporation also pay for patients in the rehabilitation units of Village settlements. Liaison is maintained with the Ministry of Labour and advantage taken of nearby Remploy factories. The Health Committee deals with the arrangements for ensuring that all Corporation employees whose duties involve contact with children are free from infectious Tuberculosis. There has been no extenison of these services for other illnesses except that financial responsibility is accepted for recuperative holidays at approved voluntary homes, for suitable patients, subject to recovery of cost according to income. This service has had to be limited by the availability of the funds provided in the yearly estimates. The loan of nursing requisites for domiciliary cases, on payment of a small charge has grown steadily since the inception of the service, but no special difficulties have arisen. A sick room helpers scheme is also operated under this section of the Act, but is administered as part of the Home Help service. Domestic Help Service 12.—Since the appointed day the pattern of work has changed to the extent that full-time help for maternity cases has been overshadowed by the part-time assistance required for long term patients, and especially old persons. Again, demand has been heavy and limitations of financial estimates have to be considered when deciding how much help can be allocated for the old age pensioners to whom no charge is normally made. No special facilities have been provided for the training of the Home Helps. Night attendants are supplied in appropriate cases, to assist in the care of patients being nursed at home during periods when no relative or other person is available to be with an invalid who cannot be left alone. This service is limited to covering cases awaiting hospital admission or relieving relatives exhausted by continuous attention. Health Education 13.—Experience has shown that intensive but brief composite functions while spectacular achieve little permanent result. The best medium is the personal advice and persuasion of doctors, health visitors, sanitary inspectors and other members of the department engaged in their daily tasks. The Health Committee makes an annual payment to the Central Council for Health 13 Education and use had been made of their posters, exhibition material, film strips, leaflets, etc. Every month 1,750 copies of "Better Health" are distributed through Maternity and Child Welfare Clinics. The Health Committee also contributes to the Royal Society for the Prevention of Accidents and their posters and leaflets are exhibited at Infant Welfare and School Clinics. Constant emphasis is made by Health Visitors during their district visiting on this question of safety in the home. The Sanitary Inspectors have conducted lecture courses for all personnel throughout the Borough concerned with food handling for commercial or canteen purposes. MENTAL HEALTH SERVICES. (I) Administration 14.— (a) The Health Committee is directly responsible. The Medical Superintendent of the Mental Hospital serving Croydon is a co-opted member of the Committee. (b) Staff employed comprise the Medical Officer of Health in general administrative control. The Deputy Medical Officer of Health and one Assistant Medical Officer of Health are approved as certifying Officers for Mental deficiency. Five Duly Authorised Officers deal with duties under The Lunacy and Mental Treatment, and The Mental Deficiency Acts. The Occupation Centre has a Supervisor, one qualified and 3 other assistants. (c) There is close personal contact with Medical Officers and Social Workers of the Mental and Mental deficiency hospital service. The Mental Hospital had an established follow-up system which has been extended since the appointed day and duplication by the local health authority is clearly unnecessary. At the request of the institution concerned, supervision of patients on licence from mental defective colonies is carried out by the Authorised Officers, who supply the necessary reports. (d) The Guardianship Society supervise a small number of Croydon patients placed in the Brighton area. Convalescent Homes of the Mental After-care Association are used for patients recommended for recuperative holidays. (e) Since the appointed day, Authorised Officers have attended courses arranged by appropriate organisations in in the London area. No local training scheme has been 14 necessary. One Occupation Centre assistant was given paid leave to attend the whole-time course of the National Association for Mental Health. (II) Work undertaken in the community (a) Under Section 28.—No special measures have been taken under this section. The Health Committee were advised that psycho-therapeutic group treatment facilities for out-patients were provided by the Hospital Board and no action was necessary by the local health authority. Measures for the direct prevention of mental ill-health are difficult to define. Emphasis by Doctors and Health Visitors on the emotional needs of babies and young children has continued at Infant Welfare Centres, as outlined in past reports. The services of the Child Guidance Clinic provided by the Hospital Board are freely invoked for later age groups. Medical certificates for rehousing on the grounds of mental ill-health due to home conditions are commonplace, but very infrequently is a psychiatrist able to certify that housing is the basic cause and alternative accommodation the only necessary treatment. Direct advice by Mental Health workers to prevent serious mental ill-health is therefore usually limited to that given for physical ailments, viz. to obtain treatment in the early stages when arrest and cure are possible. The Corporation have arrangements for recuperative holidays in selected voluntary homes for mentally ill patients for periods up to 3 months, subject to psychiatric recommendations. (b) Under The Lunacy and Mental Treatment Act, the 5 Duly Authorised Officers' are each responsible for an area of the borough. After office hours one is "on call," on a rota basis for any urgent cases. For such urgent cases requiring institutional care, admission is usually arranged to Maydav Hospital which is designated to receive 3-day observation cases. The psychiatric staff of the Mental Hospital visit the Observation Ward, and the only difficulty on the local health authority side has been on, occasions, the question of depleted hospital staffs providing escorts. Since 1948, there have been only two formal complaints from relatives regarding measures taken by an Authorised Officer. In neither case was any breach of statutory powers disclosed, nor did serious consequences result. It is the policy 15 of the Authorised Officers to obtain whenever possible, written medical advice in support of the action they propose taking. (c) Under the Mental Deficiency Act, 1913-1938. i. Ascertainment of mental defectives. Children are referred from Infant Welfare Centres, from the hospitals and by general practitioners. The certifying Medical Officers are also School Medical Officers approved by the Minister of Education for the ascertainment of Educationally Sub-normal Children, so that there is prior knowledge of any defectives notified by the Education Department as ineducable or leaving special schools. Supervision is carried out by each Authorised Officer in his own area. ii. Guardianship. Defectives under guardianship in Croydon are visited by the Authorised Officer of the area concerned and by the Deputy Medical Officer of Health. Those supervised by the Guardianship Society are visited by their visitors and their medical consultant. A small number in the areas of other local authorities have been visited by the Mental Deficiency visitors of the local health authority concerned, on a reciprocity basis. The Corporation maintains an Occupation Centre with a total capacity of 90 places, but which is at present being restricted to 60 defectives. This Centre is held in a large building especially adapted for the purpose, with excellent playgrounds. A midday meal is provided (from the School Meals Service) and all children are brought to and from the Centre by coaches. Regular visits for health inspection are paid by the School Nurse/Health Visitor of the area, and by the Deputy Medical Officer of Health. No home teaching facilities are considered necessary inview of this provision. In conclusion, I have already mentioned the high mortality experienced in December and this reflected the heavy burden of work which fell upon the domiciliary health services, at a time when staffs were themselves depleted by sickness. These conditions continued with greater emphasis into 1953 and will be dealt with in 16 another report. It does, however, increase my debt to the Committee for their constant encouragement and support and to the members of the staff for the manner in which they meet such abnormal demands. I am, Yours faithfully, S. L. WRIGHT, Medical Officer of Health. 17 STATISTICS SUMMARY OF VITAL STATISTICS FOR 1952. Area, 12,672 acres. Population (Census 1951), 249,592. Total Population (estimate of Registrar-General), 250,500 (Midsummer, 1952). Number of Inhabited Houses: 07,852. Rateable Value (1st April, 1952): £2,701,370. Product of a Penny Rate (1951-1952): £10,865. Rate in the £ : 15s. l0d. Live Births: M. F. Total. Legitimate 1,695 1,588 3,283 Illegitimate 106 79 185 3,468 Birth-rate per 1,000 of the estimated resident population, 13.8 (England and Wales 15.3 : Great Towns 16.9). Birth-rate as adjusted by comparability factor, 0.96): 13.2. Still Births, 80. Rate per 1,000 total (live and still) births, 22.5. Deaths, 2,986. Death-rate per 1,000 of the estimated population, 11.9. (England and Wales 11.3 : Great Towns 12.1). Death-rate (as adjusted by comparability factor, 0.93), 11.1. Infant mortality rate, 20 per 1,000 live births. (England and Wales 28 : Great Towns 31). Legitimate Infants (68 deaths), 21 per 1,000 live births'. Illegitimate Infants (1 death), 5 per 1,000 live births. 18 Principal Causes of Death in order of frequency (Registrar-General's Return). (1) All Ages. Rate per Population. Deaths from diseases of Cardiac and Circulatory System 4.67 ,, ,, Cancer 2.26 ,, ,, diseases of the Respiratory System (excluding Tuberculosis) 1.39 ,, ,, Suicide and Violent Causes 0.27 ,, ,, Tuberculosis (all forms) 0.24* ,, ,, diseases of Digestive System 0.17† * England and Wales 0.24: Great Towns 0.28 † ulcers of stomach, duodenum : gastritis and enteritis. (2) Ages 15-45 years. Rate per 1,000 of age group. Deaths from Tuberculosis (all forms) 0.12 ,, ,, Cardiac and Circulatory System 0.22 ,, ,, Cancer 0.25 Marriages. The number of marriages solemnised was 1,993, compared with 1,960 in 1951, 2,051 in 1950, 2,066 in 1949, 2,169 in 1948, 2,416 in 1947, 2,105 in 1946, 2,268 in 1945, and 1,578 in 1944. 979 were solemnised in Established Churches, 336 in other places of worship, and 678 in the Register Office. Births. The live births registered were 3,283 legitimate and 185 illegitimate. The birth-rate consequently was 13.8. For England and Wales and in the Great Towns the rates were 15.3 and 16.9. The illegitimate births in Croydon were 5.3 of the total compared with 5.4 in 1951, 5.0 in 1950, 4.9 in 1949, 6.0 in 1948, 5.5 in 1947 and 6.5 in 1946. The live male births numbered 1,801, the female 1,667, being a proportion of 1,080 males to 1,000 females. Deaths. The deaths numbered 2,986, compared with 2,975 in 1951. For 1952 the death-rate was 11.9 as in 1951. The death-rate for England and Wales was 11.3, and for the Great Towns 12.1. For London the death-rate was 12.6. 19 There were 95 inquests held by Coroners in respect of Croydon residents during 1952 and 373 findings by Coroners after post-mortem without inquest. Wards with the highest death-rate were Whitehorse Manor (15.1) and South (14.1). Lowest: Addington (4.0) and Shirley (7.7). Still Births. During 1952, 80 still births were registered in respect of Croydon. Of these, 42 were male babies and 38 females; 2 males were illegitimate. The proportion of still births to living children was as 1 to 43. The still birth rate was 2.3 per cent. of the total births. The still birth rate, on the same basis as for Infant Mortality, was 22.5 per 1,000 births. Notification of Births. Notifications were received in respect of confinements conducted by:— Live Births. Still Births. Total. Midwives 2,973 66 3,039 Doctors 770 25 795 3,743 91 3,834 Accommodation for Confinement. The following table gives information concerning the accommodation utilised for confinements:— Number. Percentage. In Private Houses 1,230 32.08 In Public Institutions 2,060 53.73 In Registered Maternity Homes 544 14.19 3,834 20 Maternal Mortality. There were 2 deaths, compared with 3 in 1951. The maternal mortality rate was 0.56 per 1,000 births, compared with 0.81 in 1951. MATERNAL AND INFANT MORTALITY FOR THE YEARS 1933—1952 Year Births (Live and Still) Maternal Deaths Maternal Mortality Rate Infant Mortality Rate 1933 3,239 12 3.70 47 1934 3,304 13 3.93 46 1935 3,391 10 2.95 45 1936 3,373 13 3.85 41 1937 3,357 13 3.87 60 1938 3,430 3 0.87 40 1939 3,511 4 1.10 38 1940 3,031 5 1.65 39 1941 2,472 8 3.23 37 1942 3,579 12 3.35 39 1943 3,785 2 0.53 37 1944 3,680 8 2.17 44 1945 3,675 9 2.45 41 1946 4,937 3 0.61 31 1947 5,211 10 1.92 38 1948 4,597 2 0.44 27 1949 4102 5 1.22 29 1950 3787 2 0.53 26 1951 3,697 3 0.81 19 1952 3,548 2 0.56 20 Infant Mortality. The Infantile Mortality Rate was 20 per 1,000 live births. 21 For the past 5 years the number of infant deaths has been 1948—120, 1949—116, 1950—96, 1951—68, and 1952—69. Among the 69 deaths, 41 occurred in boy babies and 28 in girls. Of the births, 1,801 were males and 1,667 females. The infantile mortality rate for the two sexes was, therefore, Boys— 23, Girls—17. Sixty-four 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 2 — 2 (2) Foetal States— Congenital Deformities 9 Atelectasis, etc. 3 I hemorrhagic Disease of Newborn 4 — 16 (3) Prematurity 27 — 27 (4) Post-Natal Causes 3 — 3 — 48 — Percentage Deaths under 1 year per Total Infantile Deaths. Deaths under 1 year per 1,000 Births 1952 1951 1952 1951 Premature Births 39.1 38.2 7.80 7.19 Respiratory Diseases 15.9 14.7 3.17 2.76 Infectious Diseases — 1.5 — 0.28 Atelectasis, Debility and Marasmus 4.3 7.4 0.87 1.38 Diseases of Digestion 2.9* 2.9 0.58 0.55 Injury at Birth and Congenital 15.9 25.0 4.90 4.70 *These deaths were due to Diarrhoea 22 The rate of infant mortality amongst legitimate children was 21 per 1,000 births. The rate in illegitimate children was 5 per 1,000 births. Deaths under one year, arranged in days, weeks and months. causes of death. 1st day. 2nd day. 3rd day. 4th day. 5th day. 6th day. 7th day. lst-2nd wk. 2nd-3rd wk. 3rd-4th wk. Under 1 mnth. 1-2 mths. 2-3 mths. 3-4 mths. 4-5 mths. 5-6 mths. 6-7 mths. 7-8 mths. 8-9 mths. 9-10 mths. 10-11 mths. 11-12 mths. total. All Causes 22 7 6 5 2 — 1 3 1 1 48 5 4 2 2 4 1 2 1 — — — 69 Polio-Encephalitis — — — — — — — — — — — — — — — — — — — — — — — Chicken Pox — — — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — — — — — — — Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — Diphtheria and Croup — — — — — — — — — — — — — — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — — — — — — — — — — — — — — Abdominal Tuberculosis — — — — — — — — — — — — — — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — — — — — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — — — — — — — — — — — — — — — — — — Convulsions — — — — — — — — — — — — — — — — — — — — — — — Laryngitis — — — — — — — — — — — — — — — — — — — — — — — Bronchitis — — — — — — — — — — — — — — — — — — — — — — — Pneumonia (all forms) — 1 — — — — — — — 1 2 1 1 1 2 2 1 1 — — — — 11 Diarrhoea and Enteritis — — — — — — — — — — — — 2 — — — — — — — — — 2 Gastritis — — — — — — — — — — — — — — — — — — — — — — — Syphilis — — — — — — — — — — — — — — — — — — — — — — — Rickets — — — — — — — — — — — — — — — — — — — — — — — Congenital Malformations 2 2 1 — 1 — 1 1 1 — 9 3 1 — — — — — — — — — 13 Premature Birth 16 3 3 3 1 — — 1 — — 27 — — — — — — — — — — — 27 Atrophy, Atelectasis, Debility and Marasmus 1 1 1 — — — — — — — 3 — — — — — — — — — — — 3 Injury at Birth 1 — — 1 — — — — — — 2 — — — — — — — — — — — 2 Haemorrhagic disease of newborn 1 — 1 1 — — — 1 — — 4 — — — — — — — — — — — 4 Other Causes 1 — — — — — — — — — 1 1 — 1 — 2 — 1 1 — — — 7 Totals 22 7 6 5 2 — 1 3 1 1 48 5 4 2 2 4 1 2 1 — — — 69 23 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 17,968 197 199 11.0 11.1 30 — — 1.22 0.11 — 4.40 2.23 — 2 Norbury 16,777 167 200 10.0 11.9 12 — — 1.55 0.30 — 4.11 2.98 — 33 West Thornton 16,325 214 201 13.1 12.3 23 — 0.12 1.22 0.37 — 4.66 1.84 + 13 Bensham Manor 17,743 221 230 12.5 13.0 — — 1.58 0.28 — 5.47 2.03 — 9 Thornton Heath 16,548 198 195 12.0 11.8 10 — — 1.81 0.18 — 4.47 2.41 + 3 South Norwood 16,740 250 230 14.9 13.7 20 — 0.06 1.25 0.18 — 4.36 2.51 + 20 Woodside 15,173 225 168 14.8 11.1 13 — — 1.65 — — 5.80 1.98 + 57 East 16,703 189 182 11.3 10.9 26 — — 0.60 0.12 — 4.37 2.22 + 7 Shirley 12,431 135 96 10.9 7.7 7 — — 0.48 0.24 — 4.18 1.69 + 39 Addiscombe 16,355 232 218 14.2 13.3 17 — — 1.53 0.43 — 4.46 2.69 + 14 Whitehorse Manor 14,002 263 211 18.8 15.1 23 — — 2.14 0.28 — 3.99 2.57 + 52 Broad Green 14,126 208 193 14.7 13.7 29 — — 1.70 0.35 — 3.76 2.27 + 15 Central 12,030 198 165 16.5 13.7 15 — — 0.91 0.25 — 6.82 2.91 + 33 Waddon 15,955 190 181 11.9 11.3 37 — — 1.38 0.06 — 4.01 2.82 + 9 South 17,221 212 242 12.3 14.1 9 — — 1.51 0.06 0.12 4.30 2.26 — 30 Addington 14,403 369 58 25.6 4.0 33 — — 0.49 0.14 — 1.31 0.69 +311 The Borough 250,500 3,468* 2,986* 13.8 11.9 20 — 0.01 1.33 0.21 0.01 4.67 2.26 + 499 *These are the corrected totals. 24 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX Sex 0- 1- 5- 15- 25- 45- 65- 75- All Causes M 40 8 10 14 63 386 446 499 F 28 7 7 9 54 258 366 791 Tuberculosis (respiratory M — — — — 5 18 13 5 F — — — — 7 5 1 2 Tuberculosis (other forms) M — — — — — 2 1 — F — — — — 1 — _— — Syphilitic diseases M — — — — 1 4 1 F — — — — — 1 1 1 Diphtheria M — — — — — — — F — — — — — — — — Whooping Cough M — — — — — — — F — — — — — — — — Meningococcal Infections M — 1 — — — — — F — 1 — — — — — Acute Poliomyelitis M — — — — 1 — — — F — — 1 — — — — Measles M — — — — — — — — F — — — — — — — — Other infective and parasitic diseases M — — — — 1 3 1 F 1 — 1 1 1 — Malignant neoplasm, stomach M — — — — 1 9 12 9 F — — — — — 8 19 20 „ ,, lung, bronchus M — — — — 2 34 28 8 F — — — — — 9 3 1 ,, ,, breast M — — — — — — — 1 F — — — — 6 18 17 10 ,, ,, uterus F — — — — 1 16 7 2 Other malignant and lymphatic neoplasms M — — 1 — 11 56 47 49 F — — 1 — 5 46 42 49 Leukaemia; aleukaemia M — — — — 1 3 5 1 F — — — — — 6 2 1 Diabetes M — — — — 1 1 3 2 F — — — — — — 4 3 Vascular lesions of nervous system M — — — — 2 33 48 68 F — — — — 3 49 71 124 Coronary disease, angina M — — — — 9 68 86 58 F — — — 1 1 18 43 78 Hypertension with heart disease M — — — — 1 12 13 21 F — — — — — 3 9 44 Other heart diseases M — — — — 3 19 51 126 F — — — 1 5 21 61 275 Other circulatory diseases M — — — — — 18 27 23 F — — — 1 1 10 22 41 Influenza M — — — — 1 1 2 2 F — — — — — 1 2 — Pneumonia M 4 2 — 1 1 9 10 23 F 4 1 — — 4 4 12 40 Bronchitis M — 1 — — — 51 45 44 F — 1 — 1 — 8 19 46 Other diseases of respiratory system M — 1 — — 2 2 3 4 F 1 — 1 — 1 3 Ulcer of stomach and duodenum M — — — — 1 11 9 6 F — — — 1 3 1 Gastritis, enteritis and diarrhoea M 2 — — — — — 1 — F 1 — — 1 4 1 — Nephritis and nephrosis M 1 — 1 2 2 2 4 F — — 1 — 3 1 5 3 Hyperplasia of prostate M — — — — — 1 14 17 Pregnancy, childbirth and abortion F — — — 1 1 — — Congenital malformations M 9 — — 3 3 1 — Other defined and ill-defined diseases F 5 — — — 1 — M 23 2 5 4 5 21 13 21 F 17 3 2 3 9 21 19 37 Motor vehicle accidents M — — 3 1 2 3 3 1 F — — — — — — — — All Other accidents M 2 — 1 2 8 3 F — — — — 1 1 1 9 Suicide M — — — 1 7 6 1 F — — — — 1 4 5 1 Homicide and operations of war M — — — 1 — — — — F — — — 1 — — — — Totals 68 15 17 23 117 644 812 1,290 25 Comparisons with 1951 (Registrar-General's Table). There were again three deaths from Whooping Cough and none from Measles (1951—2). There were again no deaths in the Typhoid group and none from Diphtheria. The deaths from Pulmonary Tuberculosis increased by 4; those from Cancer increased by 88; those from Pneumonia increased by 4; and an increase of 20 was also recorded in those caused by Bronchitis. Deaths from suicide show a decrease of 6, and motor vehicle accidents remain at 13. The total number of deaths was 2,986 as compared with 2,975 in 1951. The percentage of deaths under 1 year of age to the total deaths was 2.3 per cent.; deaths under 15 years, 3.4 per cent.; deaths under 65 years, 29.6 per cent.; and deaths over 65 years, 70.4 per cent. The corresponding figures for 1951 were 2.3 per cent., 3.7 per cent., 29.9 per cent., and 70.1 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 567 as compared with 479 in 1951; 501 in 1950; 481 in 1949; 510 in 1948; 492 in 1947; 451 in 1946; 470 in 1945; 420 in 1944; 456 in 1943 and 405 in 1942. Death-rate per 1,000 of the population for the last 11 years are as follows:— 1942—2.07 (405) 1946—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) 1952—2.26 (567) 1945—2.34 (470) 1949—1.93 (481) 26 Deaths from Cancer occurred at the following Ages:— Age period Male Female Total Under 25 years 25 and under 35 years 1 3 4 35 and under 45 years 13 8 21 45 and under 65 years 103 104 207 65 years and over 161 174 335 278 289 567 Sites of Fatal Cancer. Site Male Female Total Percentage of Total Skin 4 4 8 1.411 Oesophagus 12 7 19 3.351 Stomach 32 47 79 13.933 Liver 1 1 2 0.353 Bowel 24 34 58 10.229 Rectum 27 18 45 7.936 Bladder 7 10 17 2.998 Prostate 26 — 26 9.353 Larynx and Pharynx 6 2 8 1.411 Uterus — 26 26 8.997 Breast — 50 50 17.301 Ovary — 26 26 8.997 Pancreas 14 15 29 5.115 Gall Bladder and Duct 2 2 4 0.705 Tonsil — 1 1 0.176 Bones 5 2 7 1.235 Lungs 71 14 85 14.991 Kidney 6 — 6 1.058 Brain 12 6 18 3.175 Thyroid Gland 2 2 4 0.705 Lymphatic Glands 2 4 6 1.058 Hodgkin's Disease 8 3 11 1.940 Leukaemia 11 9 20 3.527 Genital Organs — 3 3 0.529 Undefined 6 3 9 1.587 278 289 567 Comments on Foregoing Table. The organs most often attacked in descending order of incidence are: In the males—the Lungs (25.5 per cent.), the Bowels and Rectum (18.3 per cent.), and the Stomach (11.5 per cent.); in females—the Bowels and Rectum (18.0 per cent.), the Breast (17.3 per cent.), the Stomach (16.3 per cent.), the Uterus (9.0 per cent.), and the Ovary (9.0 per cent.). 27 Census, 1951 Preparing detailed tables for individual areas of the country is a lengthy process. The Registrar General has therefore analysed a 1% sample of the total returns obtained from the 1951 census survey and issued these as an indication of the probable findings to be available in due course (Census 1951, One per cent. Sample Tables, Part I). Those relating to Croydon show for example that the total excess of females over males is due to a preponderance of women over 34 years of age. Up to 35 there is an excess of males. That of the total males aged 15 years and over, both occupied and retired, the occupational group distribution is:— Occupational Group Distribution of Males Total Males Occupational Group I II III IV V England and Wales 15,467,700 3.3% 15.0% 52.7% 16.2% 12.8% Greater London 2,906,000 4.9% 16.6% 54.7% 10.7% 13.2% Croydon 88,600 4.5% 18.4% 55.2% 9.1% 12.8% The occupational groups of the Registrar General are Group I—Professional, etc. occupations. Group II—Intermediate occupations. Group III—Skilled occupations. Group IV—Partly skilled occupations. Group V—Unskilled occupations. Summary of Private Households, Rooms Occupied, Densities of Occupation and Household Arrangements Actual figures converted to percentages for purposes of comparison. Area Households Households of successive densities of occupation (persons per room) Households without exclusive use of: In Shared Dwellings over 3 3 and over 2 2 and over 1½ l½ and over 1 1 or less Water Closet Fixed Bath Both Stove and Sink (a) (c) (d) (e) (/) (g) (h) (j) (k) (i) Croydon 25% Nil 1.02% 2.04% 8.56% 88.38% 18.3% 40.4% 11.6% England and Wales 15% 0.18% 0.96% 3.89% 10.81% 84.15% 21.4% 44.6% 13.7% Greater London 36% 0.13% 0.83% 4.58% 11.51% 82.95% 24.5% 45.6% 12.8% Persons per Household Persons per Room % of Persons living more than Two per Room Croydon 2.98 0.67 1.72 England and Wales 3.19 0.73 2.16 Greater London 3.01 0.77 1.71 at 1931 Census: Croydon 3.62 0.75 3.35 28 COMMUNICABLE DISEASES COMMUNICABLE DISEASES NOTIFIED DURING YEAR 1952. Notifiable Disease. Cases notified in the whole District. Total cases notified in each Ward. Sex Distribution of Notified Cases. 1952. At all Ages. At ages—years. 65 and up. 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. M F Scarlet Fever 401 — 88 299 10 3 1 — 25 23 28 48 46 51 20 17 13 15 9 12 18 10 22 44 204 197 Diphtheria 1 — — — 1 — — — — — — 1 — — — — — — — — — — — — — 1 Erysipelas 27 — — — — 2 19 6 2 1 1 3 7 1 3 — 3 — 1 2 1 — — 2 10 17 Meningococcal Infection 5 3 1 — 1 — — — — — — — — — — — — — — — — — — 2 2 3 *Enteric & Paratyphoid 2 — 1 1 — — — — — — — — — — — — — — — — — — — — 1 1 Small pox — — — — — — — — — — — — — — — — — — — — — — — — — — Cholera — — — — — — — — — — — — — — — — — — — — — — — — — — Typhus — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Pyrexia 75 — — — 27 48 — — 1 — 62 — 1 3 — 1 — 1 4 — — 1 1 — — 75 Ophthalmia Neonatorum 3 3 — — — — — — — — — — — — — — — — — — — — — — 1 2 Acute Poliomyelitis 27 1 6 10 1 8 1 — — 2 1 1 2 3 — 1 3 1 4 1 3 — 5 — 16 11 Dysentery 48 3 15 24 3 2 — 1 21 — 1 — 2 2 1 — 1 3 — 2 — 1 4 10 26 22 Malaria — — — — — — — — — — — — — — — — — — — — — — — — — Acute Primary and Acute Influenzal Pneumonia 56 4 6 7 1 14 12 12 5 — 7 1 10 1 — 4 1 — 4 7 9 2 1 4 25 31 Food Poisoning 41 1 7 6 9 13 4 1 1 1 1 2 15 — 3 2 — 5 1 1 — 5 — 4 21 20 Acute Encephalitis — — — — — — — — — — — — — — — — — — — — — — — — — — Measles 1235 27 501 688 13 6 — — 119 94 55 55 112 50 45 74 59 124 43 97 117 31 44 116 633 602 Whooping Cough 466 27 244 192 1 2 — — 27 8 36 42 34 28 7 17 22 15 17 30 20 43 102 18 213 253 Totals 2387 69 869 1227 67 98 37 20 202 129 193 153 230 139 79 118 102 165 85 152 168 93 179 200 1152 1235 *Both cases, not connected, were Paratyphoid, one patient contracted infection abroad, but the source in the second case could not bo found. 29 MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1952 Jan. Feb. Mar. April May June July August Sept. Oct. Nov. Dec. Total Scarlet Fever 37 50 61 26 31 19 16 6 17 45 53 40 401 Diphtheria ... ... 1 ... ... ... ... ... ... ... ... ... 1 Erysipelas ... 4 2 2 4 2 2 3 ... 2 5 1 27 Meningococcal Infection 1 1 2 1 ... ... ... ... ... ... ... ... 5 Enteric and Paratyphoid ... ... 1 ... ... ... ... ... ... 1 ... ... 2 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 10 3 8 7 6 9 8 2 5 7 9 1 75 Ophthalmia Neonatorum ... ... 2 ... ... ... 1 ... ... ... ... ... 3 Poliomyelitis and Polioencephalitis ... ... 1 ... ... ... 4 8 5 3 5 1 27 Dysentery 2 1 ... 1 5 19 6 1 1 1 2 9 48 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... Ac. Pri. & Ac. Inf. Pneumonia 9 6 8 10 3 1 2 2 4 4 3 4 56 Food Poisoning 5 2 1 4 ... 2 10 6 5 6 ... ... 41 Acute Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 7 3 30 22 23 207 352 178 42 11 136 224 1235 Whooping Cough 33 29 50 74 71 46 76 57 14 1 4 11 466 Total 2387 30 WADDON (ISOLATION) HOSPITAL. Report on Patients Admitted to Waddon Hospital in 1952 I am indebted to Dr. J. Linehan for the following report on infectious, etc., cases admitted to the Waddon Hospital during 1952:— There was a total of 828 admissions, comprised of 646 acute infectious cases, 153 cases of pulmonary tuberculosis and 29 chronic sick. In the latter two categories are included patients admitted to wards temporarily opened in September, 1952 in substitution for wards under repair at Mayday Hospital. Where patients were admitted from outside the Borough of Croydon, the number of patients admitted from Croydon is shown separately in brackets. The average number of occupied beds was 98, the bed occupancy varying from 54 to 151. Admissions to Tuberculosis Wards.—153 (145) patients were admitted and there were 7 deaths. All fatal cases were in the older age groups (youngest 49 years). The average stay in hospital of all tuberculosis patients discharged during the year was 140 days. The corresponding figure for fatal cases was 40 days. The following are the diagnoses, corrected where necessary, of patients admitted to the acute infectious diseases wards, together with brief details relating to the common infectious diseases. The average stay in hospital of these cases was 23 days. 31 Scarlet Fever 262 (246) Measles 43 (39) Chicken-pox 42 Rubella 36 Gastroenteritis 34 (31) Whooping Cough 33 (32) Poliomyelitis and Encephalitis 24 Dysentery 14 (13) Food Poisoning 7 (5) Mumps 6 (5) Erysipelas 3 Meningitis 3 Influenza 6 (5) Infective Hepatitis 3 Malaria 1 Tonsillitis 20 (19) Vincent's Angina 1 Quinsy 1 Streptococcal Sore Throat 12 Pharyngitis 12 Coryza 1 Otitis Media 3 Sinusitis 1 Laryngitis 3 Bronchitis 13 Pneumonia 16 Pleurisy 1 Gastritis 1 Indigestion 1 Appendicitis 1 Colitis 1 Congenital Pyloric Stenosis 1 Carcinoma of Rectum 1 Toxic Erythema 2 Purpura Simplex 1 Pityriasis Rosea 2 Papular Urticaria 5 Herpes Zoster 1 Erythema Multiforme 2 Dermatitis 1 Vaccinia 1 Peripheral Neuritis 1 Tuberose Sclerosis 1 Narcotic Poisoning 1 Transverse Myelitis 1 Nervous Debility 2 Heat Stroke 1 Acidosis 3 Anaemia 1 Acute Rheumatism 1 Nephritis 1 Thrombo-Phlebitiis 1 Pyrexia of Unknown Origin 4 Fractured Sacrum 1 Nil Abnormal 3 Non-Patient Babies 2 Scarlet Fever.—The number of admissions continued to decline and was the lowest since 1941. This was to some extent due to admissions refused during the peak periods but also to an exceptionally low demand for admissions during the late summer and autumn. There was nothing unusual to note. Four cases of nephritis were encountered but there was no ascertainable case of cardiac involvement. The incidence of otitis media was 5.7 per cent. Measles.—As the disease was not epidemic, admissions were comparatively few. They occurred mainly in June, July and August and again in December as a prelude to the present epidemic. Chicken-Pox.—Of the patients admitted, 15 were undergoing treatment in general hospitals and 19 were from Children's Homes, Rest Centres and residential schools. Three were admitted for complicating pneumonia, one for concurrent whooping cough and four for domestic reasons. Rubella.—The disease was exceptionally prevalent in the early part of the year. Half the admissions shown were due to confusion with scarlet fever. The majority of the remaining cases were 32 admitted in circumstances similar to the chicken-pox admissions. A few were admitted to avoid contact with pregnancy. Gastro-Enteritis.—The 34 cases shown in the table were comprised of 2 adults and 32 infants. Only four cases could be classified as severe and there were no deaths. Whooping Cough.—Experience supported the impression of the previous vear that chloramphenicol treatment was beneficial. Grave complications were rare e.g. only one case of convulsions was encountered. Poliomyelitis and Encephalitis.—The disease showed its usual seasonal incidence and 21 of the 24 patients were admitted in the months July-November inclusive. Of the total admissions, 19 were paralytic, 2 were cases of meningo-encephalitis and 3 were purely meningitif. There was one death among the paralytic cases—a man aged 40 years who developed bulbar and resniratorv paralysis. One of the meningoencephalitis cases—a boy aged 4 years—died after transfer to Atkinson Morley Hospital. 13 patients had residual limb paralysis on discharge or transfer. The age incidence of all cases was as follows:— Under 5 years—6; 5-10 years—8; 10-15 years—1; 15-25 years —3; 25-35 years—4; 35-45 years—2. The incidence and severity, though greater than in the previous year, was not exceptional. It was the only notifiable infectious disease, tuberculosis excepted, in which a fatal case occurred. Other Infections.—Dysentery remained a mild disease. Bacteriologically, ten were cases of Sonne dysentery, two Flexner and two unascertained. Of the food poisoning cases, 5 were Salmonella typhi-murium infections, one Salmonella enteritidis and one unascertained. Persistent Salmonella carriers continued to give rise to difficulty. Meningitis cases consisted of one meningococcal and one pneumococcal case, both of whom recovered and one pyogenic meningitis of unascertained type in which the patient, a child suffering from congenital heart disease, died a few hours after admission. Other deaths not already referred to, were one from bronchpneumonia and myocardiac degeneration and one from narcotic poisoning. 33 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 Deaths Death Rate per thousand of population Year Number of Deaths Death Rate per thousand of population Number of Deaths Death Rate per thousand of population 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 0.06 64 0.25 1932 10 — 166 0.70 1952 — — 54 0.22 34 THE PREVENTION AND CONTROL OF TUBERCULOSIS. I am indebted to Dr. R. H. J. Fanthorpe, Chest Physician, for the following section of the Report. Although social conditions were different in 1952, a comparison with 1925 shows that in 1925, 92 per 100,000 of the population in Croydon died from all forms of tuberculosis; in 1952 the corresponding figure was 21.6. The years selected were seven years after a major war. It is now certain that the Chest Clinic will be moved from its existing centrally situated premises in Katharine Street. The new Clinic will be housed on the ground floor of the Mayday Road Offices, and although this accommodation may offer some advantage in terms of working facilities, the site is far less accessible to patients. This is likely to throw a further burden on the ambulance and car service. In March, 1952, Coombe Wood Hospital was opened, and its use for the treatment of early non-infectious cases of minimal tuberculosis and pleural effusions has helped markedly to reduce the waiting period for patients for admission to hospital. In addition, it has been used for the convalescence of post-operative surgical patients. In 1952 there was a general reduction in the waiting period for patients for admission to hospital. Patients recommended for major thoracic surgery still have to wait either in hospital locally or at home, but the position was considerably better in 1952, when compared with the previous year. As more surgical beds become available it is hoped that the situation will improve still further. Early in 1952 Isoniazide became available for use in this country and, together will Streptomycin and Para-amino-salicylic acid, it is proving a most valuable chemotherapeutic agent. Incidence. 224 cases of Respiratory Tuberculosis and 19 cases of NonRespiratory Tuberculosis were notified on Form A during 1952 (Table I—Formal Notifications). Of these 135 males and 89 females were Respiratory cases and 7 males and 12 females were Non-Respiratory. In addition, 82 Respiratory cases and 6 NonRespiratory cases came to our notice as new cases otherwise than by notification (Table II—Supplemental Return). Of the 135 new cases of male Respiratory Tuberculosis notified on Form A during the year, 59 were over the age of 45. This represents 43.7 per cent. of male formal notifications. A 36 comparison with the year 1947 shows 143 new cases of male Respiratory Tuberculosis notified on Form A, with 48 occurring in patients over 45 years of age. During that year this represented 33.5 per cent. of male formal notifications. The increased male incidence in the over 45 age groups in the past few years presents a problem both from the point of view of spread of infection and of treatment. The total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year 1952 by notification or otherwise was 331, as compared with 316 in 1951, 369 in 1950, 305 in 1949, and 350 in 1948. 306 of these were cases of Respiratory Tuberculosis; 190 in males and 116 in females. There were 34 more cases in males and 15 more in females than in 1951. There were 5 cases of Non-Respiratory Tuberculosis among children under 15 years as compared with 9 in 1951. The number of cases in adults was 20, compared with 35 in 1951. Of the cases notified in 1952, 8 males and 1 female died from the Respiratory form of the disease during the year, equal to 3.6 per cent. of those notified. The incidence rate of Tuberculosis of all forms was 1.32 per 1,000 of the population; for Respiratory Tuberculosis 1.22, and for Non-Respiratory 0.10 per 1,000 population. The notification rate was 0.97 per 1,000. In 1951 the corresponding figures were 1.25, 1.08, 0.17 and 0.89 per 1,000. Public Health (Tuberculosis) Regulations, 1952. Summary of notifications during the period from 1st January, 1952, to 31st December, 1952:— TABLE I. Formal Notifications. Age Periods Number of Primary Notifications of new cases of tuberculosis 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total (all ages) Respiratory, Males — — — 6 — 8 13 22 27 24 21 12 2 135 Respiratory, Females — — 1 5 4 13 13 27 9 5 6 5 1 89 Non-Respiratory, Males — 1 — 2 — — — — — 3 1 — — 7 Non-Respiratory, Females — — 2 — — 1 3 1 1 2 1 1 — 12 86 Source of information Number of cases in age Groups TABLE II. Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1952, to 31st December, 1952, otherwise than by formal notification:— 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— Total Death Returns from Local Registrars Respiratory M — — — — — — — — — 1 — 3 1 5 (A) F — — — — — — — 1 — — — — 1 2 (B) Non-Respiratory M — — — — — — — — — 1 — — — 1 (C) F — — — — — — — — — — — — — — (D) Death Returns from Registrar-General (Transferable deaths) Respiratory M — — — — — — — — 1 1 1 — — 3 (A) F — — — — — — — — — — — — — — (B) Non-Respiratory M — — — — — — — — — — — — — — (C) F — — — — — — — — — — — — — — (D) Posthumous Notifications Respiratory M — — — — — — — — — — 1 — — 1 (A) F — — — — — — — — — — — — — — (B) Non-Respiratory M — — — — — — — — — — 1 — — 1 (C) F — — — — — — — — — — — — — — (D) "Transfers" from Other Areas (excluding transferable deaths) Respiratory M — — — — 2 1 8 19 9 5 — — — 44 (A) F — — — — — — 8 8 5 1 1 — — 23 (B) Non-Respiratory M — — — — — — 2 — — — — — — 2 (C) F — — — — — — — I 1 — — — — 2 (D) Other Sources Respiratory M — — — — — — 1 — 1 — — — — 2 (A) F — — — — — — 1 — 1 — — — — 2 (B) Non-Respiratory M — — — — — — — — — — — — — — (C) F — — — — — — — — — — — — — — (D) TOTALS (A) 55 (B) 27 (C) A (D) 2 37 Notification Register. Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1952:— RESPIRATORY. NON-RESPIRATORY. Total Cases. Males. Females. Total. Males. Females. Total. 1058 793 1851 126 126 252 2103 CLASSIFICATION OF NEW PATIENTS. Respiratory Tuberculosis. During 1952, 193 of the new patients examined at the Clinic were found to be in the undermentioned stages of the disease on the first examination:— A, or T.B. minus (sputum negative or absent) 96 or 49.8% B, or T.B. plus 1 (early cases sputum positive) 19 or 9.8% B, or T.B. plus 2 (intermediate cases, sputum positive) 70 or 36.2% B, or T.B. plus 3 (advanced cases, sputum positive) 8 or 4.2% 193 100.0% Non-Respiratory Tuberculosis. There were 18 cases examined at the Clinic and found to have Non-Respiratory Tuberculosis in the following forms:— Bones and Joints 7 Abdominal — Other Organs 6 Peripheral Glands 5 18 38 Ages at Death from Respiratory Tuberculosis. Year 0-5 5-15 15-25 25-45 45-65 over 65 TOTAL 1945 1 17 28 23 6 75 1946 — 2 17 38 36 8 101 1947 — 1 14 34 31 12 92 1948 — — 12 43 39 10 104 1949 — 2 11 38 23 15 89 1950 1 — 7 10 28 14 . 60 1951 — — 2 15 21 13 51 1952 — — — 10 22 20 52 Nine cases were not notified during life. Of these, six were certified by the Coroner, after a post-mortem examination; three cases died in hospital. In 1952 the death-rate from all forms of Tuberculosis was 0.216 per 1,000 population. The rate for Respiratory Tuberculosis was 0.208 and the rate for Non-Respiratory Tuberculosis 0.008. Similar figures for 1951 were 0.20 and 0.05. Respiratory Tuberculosis. In 1952 the total number of deaths increased by approximately 2.0 per cent., compared with 1951, there being an increase in males of 11.7 per cent. and a decrease in females of 17.6 per cent. 80 per cent. of the total deaths occurred in the age groups 45 and over, and the remainder in the age groups 20—44 years. There was again no death amongst children (1—15 years). New cases show an increase in males of 11.1 per cent. and of 14.9 per cent. in females, compared with 1951, that is a total increase, compared with 1951, of 12.5 percent. The total numbers of the new cases in 1952 were: Males 190, females 116; that is, approximately three new cases in men for every two new cases in women. The maintenance of the death rate at the low figure of 21.5 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. 39 Deaths from Non-Respiratory Tuberculosis. During 1952 two deaths were certified to be due to NonRespiratory Tuberculosis, compared with thirteen in 1951 and seven in 1950. Both of the patients died in general hospitals. One of them was not notified during life. The deaths were due to:— Males. Females. Total. Miliary Tuberculosis & Tuberculous Meningitis ... 1 — 1 Tuberculosis of Both Suprarenal Glands Addison's Disease — 1 1 Totals 1 1 2 Co-ordination with the Health Department. During the year 133 children were referred by the School Medical Service, and 16 cases from the Maternity and Child Welfare Section of the Public Health Department. Extra Nourishment. Provision of special nourishment in the form of milk was granted to 15 selected cases for varying periods during the year, and 11 cases were in receipt of extra nourishment at the end of the year. Residential Treatment. 267 males, 221 females and 37 children were admitted to Residential Institutions during 1952. The Chest Clinic and Home Visiting. 1,565 new cases were examined during the year. 201 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 13,266. There were also 8,949 attendances by patients for collapse therapy. 40 The Clinic doctors paid 252 home visits and the Tuberculosis Visitors 4,053 visits for Clinic purposes. In addition, the Tuberculosis Visitors made 429 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 661 contacts were examined. Of these, 10 were considered to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 15 compared with 1.32 per 1,000 of the general population. In addition there were 4 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 1,766. This is equivalent to 7 persons per 1,000 of the population. During the year 51 Clinic cases died. Of this number six or 11.8 per cent. were seen for the first time in 1952. The following table gives a summary of the work done in connection with the Clinic:— No. of definite cases of Tuberculosis on Clinic Register, January 1st, 1952 1,691 ,, patients examined for the first time excluding 79 inward transfers, i.e., patients removed from other areas 2,226 ,, visits paid by Clinic doctors to homes of patients 252 ,, visits paid to homes of patients by Tuberculosis Visitors 4,482 41 Attendances of patients at the Clinic— Men 5,306 Women 4,601 Children 3,359 Total 13,266 No. of X-Ray films taken 10,642 No. of definite cases of Tuberculosis on the Clinic Register on the 31st December, 1952 1,766 Re-Housing of Tuberculosis Patients. Thirty-one 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 1952 a number of sessions were held for B.C.G. vaccination. 89 contacts were successfully vaccinated, also 22 nurses and members of a hospital staff. 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. Switzerland. During 1952 one more patient from the Croydon area was sent to Switzerland under the scheme for the treatment of certain cases of respiratory tuberculosis in Swiss sanatoria. X-Ray Service. It is now necessary under the Ministry of Education scheme for all newly appointed school teachers to have an X-ray examination of the chest on their appointment and thereafter annually. In this connection 177 examinations were carried out in 1952 of staff coming into contact with children, such as teachers, the staff of nursery schools, residential schools and homes. The work of the Chest Clinic has shown an overall increase when compared with previous years. As diagnostic facilities improve it is likely that the work will increase still further, particularly in the field of case finding. 42 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 Tuberculosis. Nonruberculous Conditions. Croydon district 15,859 33 680 519 43 TUBERCULOSIS AFTER-CARE I am indebted to Miss Bridger, Almoner of the Chest Clinic, for the following reports:— " During the year 1952, arrangements remained unchanged in principle; statutory and voluntary help being used to complement each other. " There was a slight decrease in the number of patients who received the special grants through the National Assistance Board payable to those who have lost income in order to undergo treatment for tuberculosis of the respiratory system. On December 31st, 1951, there were 204 patients in receipt of these grants which are arranged through co-operation between myself and the N.A.B. During 1952, 134 new cases were referred and 157 cases ceased to need assistance, leaving a total of 183 receiving the allowances at December 31st, 1952. Of the patients ceasing to receive these grants, 11 died, 99 returned to work, 21 were no longer in need of assistance upon admission to hospital, and 10 were either awarded pensions or left the district. In addition to these regular weekly allowances, special grants to cover particular needs were obtained in 89 cases. These were mainly to enable relatives to visit patients in hospitals a long way off, to replace worn-out clothing for patients and their families; or to cover removal expenses attendant upon rehousing. " Assistance in kind continued to be given by the Local Health Authority in the form of the loan of beds and bedding to 20 patients. This enabled them to start treatment at home whilst awaiting hospital admission or to continue to occupy a separate room, where advisable, after their discharge from Sanatorium. Free milk has also been provided in the few instances where a patient's income falls below a certain level. It has also been possible to obtain from the British Red Cross Society parcels of invalid foods for ex-Service pensioners who need them, and these have been much appreciated. Voluntary societies have been extremely generous in making cash grants for individual patients whose needs have not been entirely met by statutory provisions. Just on £300 in cash was raised from such sources as ex-Service funds, British Red Cross, trade and professional organisations, Friends of the Poor, and local charities. This money has made all the difference to the patients' comfort and has filled such needs as wireless licences and repairs, an occasional outing, or such major items as help with private school fees or essential furniture after a patient has been rehoused. 14 " From the housewife's point of view, her chief worry is the care of the home, if she is being nursed at home, and the problem of seeing that the children are properly cared for while she is in hospital. Where relatives were unable to help, Home Help was arranged, and the children either placed in residential nurseries or boarded out, by arrangement with the Children's Department. These plans worked very well on the whole, with co-operation from all parties. " The most difficult problem from a man's point of view is to find suitable employment, adapted to his disability. Some are fortunate enough to be able to return to their former work, perhaps with some slight adjustment in hours or working conditions. Others, however, are less fortunate, and we rely very much on the closest co-operation with the Disabled Resettlement Officer in trying to find suitable openings or a period of retraining for those who are sufficiently adaptable. The D.R.O. attends the Clinic for conferences with the Chest Physician and myself, and individual problems are discussed from all points of view, in an attempt to rehabilitate as many as possible. " 88 visits in all were paid to Coombe Wood Hospital, Mayday, Waddon and Cheam Sanatorium, and these visits are invaluable in keeping in touch with the patient and his home worries throughout his treatment. In some instances, correspondence courses have been arranged through the British Council for Rehabilitation, with the joint aim of keeping the patient profitably occupied and of preparing the ground work for a better chance of employment on his discharge. " Arising out of these activities, 443 home visits were paid." OCCUPATIONAL THERAPY "A class continued to be held at the Chest Clinic on Friday afternoons for the benefit of those patients who are at home and able to get about, but who are not yet fit for work. Arrangements were the same as in previous years, and takings for the year for materials supplied to patients amounted to £71 10s. 11d." 45 VENEREAL DISEASES. Return relating to all persons who were treated at the Treatment Centre at Special Clinic, General Hospital, Croydon, during the year ended the 31st December, 1952. Syphilis Gonorrhoea Other Conditions Totals M F M F M F M F Ttls. 1 Number of patients on 1st January under treatment or observation 33 71 — — 4 27 37 98 135 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 condition 2 2 — — 32 7 34 9 43 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 3 — — — — — 3 — 3 (b) „ secondary — — — — — — — — — (c) „ latent in 1st year of infection 2 — — — — — 2 — 2 (d) ,, cardio-vascular 1 — — — — — 1 — 1 (e) „ of the nervous system 2 — — — — — 2 — 2 (f) ,, all other late or latent stages 12 6 — — — — 12 6 18 (g) ,, congenital (under 1 year) — 1 — — — — — 1 1 (h) ,, ,, (over 1 year) 4 3 — — — — 4 3 7 (i) Gonorrhoea — — 46 3 — — 46 3 49 Other conditions :— (j) Chancroid — — — — — — — — — (k) Lymphogranuloma inguinale — — — — — — — — — (/) Granuloma venereum — — — — — — — — — (m) Non-gonococcal urethritis(males only) — — — — 60 — 60 — 60 (n) Any other conditions requiring treatment — — — — 56 27 56 27 83 (o) Conditions not requiring treatment — — — — 268 185 268 185 453 (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 approved under Ministry of Health Circular 2226 1 7 1 1 2 5 4 13 17 Totals of Items 1, 2, 3 and 4 60 90 47 4 422 251 529 345 874 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 " 20 21 19 2 409 218 448 241 689 Number of patients suffering from:— (a) Syphilis who defaulted after completion of treatment, but before final discharge — 10 — — — — — 10 10 (b) Gonorrhoea who defaulted before 3 months — — — — — — — — — (c) Gonorrhoea who defaulted after 3 months — — 1 — — — 1 — 1 7. Number of patients who ceased to attend before completion of treatment and were suffering from:- (a) Acquired syphilis of less than 1 year's duration — 1 — — — — — 1 1 (b) Acquired syphilis of more than 1 year's duration — 4 — — — — — 4 4 (c) Congenital syphilis (under 1 year) — — — — — — — — — (d) „ ,, (over 1 year) — — — — — — — — — (e) Gonorrhoea — — 1 — — — 1 — 1 3. Number of patients under treatment or observation known to have died:— (a) From syphilis 1 — — — — — 1 — 1 (b) From treatment — — — — — — — — — (c) From other causes 1 — — — — — 1 — 1 Totals of Items 5, 6, 7 and 8 22 36 21 2 409 218 452 256 708 46  Syphilis Gonorrhoea Other Conditions Totals M F M F M F M F Totals of Items 5, 6, 7 and 8 (brought forward) 22 36 21 2 409 218 452 256 9. Number of patients transferred to other Centres or Institutions or to private practitioners 3 4 2 1 3 2 8 7 10. Number of patients remaining under treatment or observation on 31 st December 35 50 24 1 10 31 69 82 Totals of Items 5, 6, 7, 8, 9 and 10 60 90 47 4 422 251 529 345 (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 887 408 313 12 1521 434 2721 854 (b) for intermediate treatment, e.g., dressings, etc. 490 728 17 3 142 486 649 1217 Total Attendances 1377 1136 330 15 1663 920 3370 2071  Under 1 year 1 and under 5 years 5 and under 15 years 15 years and over Tom M F M F M F M F M 13. Number of patients suffering from congenital syphilis in Item 3 above classified according to age — 1 — — — — 4 3 4  Microscopical Cultural Serum Cerebro. Spinal Fluid 14. Pathological Work :— (a) Number of specimens examined at, and by the medical officer of, the Treatment Centre for Syphilis for G'n'rh. for Syphilis Wr. & Kahn for G'n'rh. — — — — — — (b) Number of specimens from patients at the Treatment Centre sent to a pathological laboratory 6 718 331 857 376 42  Syphilis (less than 1 year) Syphilis (more than 1 year) Gonorrhoea Other Condition M F M F M F M 15. Contacts attending for examination through the agency of :— (a) Patients — — 6 1 1 — 28 (b) Health Visitor or Social Service Worker 1 — 5 3 4 — 72 Totals 1 — 11 4 5 — 100 47 STATEMENT SHOWING THE SERVICES RENDERED AT THE TREATMENT CENTRE DURING THE YEAR, CLASSIFIED ACCORDING TO THE AREAS IN WHICH THE PATIENTS RESIDED. Name of County or County Borough (or Country in the case of persons residing elsewhere than in England and 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 20 10 3 1 34 Gonorrhoea 29 16 2 2 49 Other Conditions 391 117 54 34 596 Totals 440 143 59 37 679 48 PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT ANTE NATAL AND POST-NATAL CLINICS During the year 3,774 cases were seen at the Ante-Natal Clinics, of which 2,959 were new cases. A total of 27,490 attendances was recorded, and 1,663 cases were seen at the Post-Natal Clinics (1,635 new cases) and 1,910 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 1952 whc were born— (i) at home 41 (ii) in private nursing homes 1 (iii) in hospital 129 (2) The number of those born at home— who were nursed entirely at home 40 who died during the first 24 hours — who survived at the end of one month 40 (3) 1 I he number of those born in private nursing homes— who died during the first 24 hours — who survived at the end of one month 1 (4) Number of those born in hospital— who died during the first 24 hours 13 who died before the 28th day 15 who survived at the end of one month 129 ATTENDANCES AT INFANT CENTRES—1952 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. Munipl, Mon. a.m. Closed Oct., 1952 Municipal, Monday, p.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, Tuesday, a.m. St. Judes, Tuesday, p.m. St. Oswalds, 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, 1952 Total, 1951 New cases under I year 53 119 99 79 131 98 57 52 123 127 162 184 68 121 111 66 100 40 83 72 94 73 80 124 128 74 61 151 72 67 65 110 3044 3124 No of Re-attendances 1092 1892 1581 1697 1909 1657 868 655 1425 1641 2217 1606 1491 2066 1709 1234 1880 1064 1697 1195 1668 974 1032 1679 1675 2079 1199 1842 1030 1102 1280 1505 47641 47342 New cases over 1 year 11 16 14 9 14 14 36 9 21 23 105 81 15 13 13 10 16 7 12 4 20 17 31 39 17 19 14 38 23 15 9 22 712 735 No. of Re-attendances 926 1182 972 686 964 961 746 312 735 601 1483 1015 882 1628 978 701 747 868 1289 817 1274 1170 761 1200 915 823 888 1138 769 748 654 996 29829 31091 Attendances of Children 0-5 2082 3209 2666 2471 3018 2730 1707 1028 2394 2392 3967 2886 2456 3828 2811 2011 2743 1979 3081 2088 3056 2234 1904 3042 2735 2995 2162 3169 1899 1932 2008 2633 81226 82292 Consultations with Doctor 797 960 846 758 731 797 613 479 890 852 1028 854 766 1000 803 595 804 550 689 614 730 822 476 851 854 932 584 828 596 897 543 717 24255 25868 No. of Sessions 48 48 48 49 49 48 49 41 48 48 49 49 49 49 49 48 48 49 49 48 48 47 48 48 49 48 48 48 49 45 48 48 1537 1542 Expectant Mothers: No. of new cases 2 — — — — — 5 1 4 — — — — — 1 1 — — — — — — — — — — — — 16 — — — 30 16 No. of Re-attendances — — — — — — 7 — — — — — — — — — — — — — — — — — — — — — 62 — — — 69 59 Total attendances of Expectant Mothers 2 — — — — — 12 1 4 — — — — — 1 1 — — — — — — — — — — — — 78 — — — 99 75 Total Attendances 2084 3209 2666 2471 3018 2730 1719 1029 2308 2392 3967 2886 2456 3828 2812 2012 2743 1979 3081 2088 3056 2234 1904 3042 2735 2995 2162 3169 1977 1932 2008 2633 81325 82367 Average per Session 1952 43.4 66.9 55.5 50.4 61.6 56.9 35.1 25.1 48.1 49.8 81.0 58.9 50.1 78.1 57.4 41.9 57.1 40.4 62.9 43.5 63.7 47.5 39.7 63.4 55.8 62.4 45.0 66.0 40.3 42.8 41.8 54.9 52.9 — Average per Session 1951 46.6 64.6 61.5 45.1 61.4 58.1 26.9 33.6 54.1 58.7 35.9 72.0 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 61 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— 137 cases were dealt with by the Social Worker; 33 cases were admitted to Hostels; 15 cases were temporarily accommodated at Glazier House (the Croydon Home of the Moral Welfare Association). INFANT WELFARE CENTRES These have continued basically unchanged. The provision of toddlers' rooms has been arranged wherever the premises afforded the necessary accommodation and in smaller halls play tables supplied. Such arrangements are nothing new, but have been emphasised because of the efforts now being made to encourage the attendance of the " toddler " group. The critics of infant welfare centres have been prominent during recent years. The record low infant mortality rates are the latest reason put forward as indicating a need to transfer this work from local authorities, but no unanimity exists amongst those anxious for such a change. Some suggest transfer to the hospital service and others to the general practitioners. As regards the former, their bias is necessarily towards the treatment of established illness, this being their primary statutory duty. It is essential to have infant welfare centres wihin easy " pram pushing " distance of the homes of mothers concerned so that clinics outside hospital premises as at present would still be needed. I have always wished that hospital medical officers should give reciprocal sessions at infant welfare clinics and am still hopeful that such arrangements may be made in Croydon. This is surely the rational form that developments should take, insofar as full correlation of hospital and local authority services 62 are concerned. As regards general practitioners, while some do already assist in Croydon, there is the real difficulty that the mothers and children attending a typical urban centre are on the medical lists of a number of doctors practising in the area. However friendly their professional relationship to each other it is more difficult for them to reconcile the advising of their patients by another practitioner giving general medical services, than by a local authority medical officer. One thus fails to achieve the ideal of a single doctor dealing with both prevention and cure, and risks the creation of unnecessary discord. This is not a theoretical objection, the difficulty having already been met at an ante-natal clinic to which the Corporation appointed a general practitioner obstetrician. The solution there applied, of giving access to all general practitioner obstetricians in the area, is not feasible for infant welfare centres. For integration with the family doctor service, the development of group practice seems essential. Should this prove to be the future trend, the staffing of infant welfare centres would necessarily change. On balance however there seems no reason for radical changes at present. While ruling out therefore any drastic re-organisation in the source or quality of medical advice at infant welfare centres, possibly the quantity might be reduced without any loss of efficiency. At centres with relatively small attendances, frequent medical reviews of obviously healthy infants do occur. Reducing the attendance of the doctor at such centres to fortnightly intervals has resulted in a 50 per cent. saving without any apparent true weakening of the service. HOME NURSING This service is carried out by the Croydon District Nursing Association, acting as agents of the Corporation. I am indebted to the Superintendent for the following information:— Staff at 31-12-52 Superintendent. Deputy Superintendent. 2 Assistant Superintendents. 35 whole time Nurses (State Registered Enrolled assistants). Summary of work carried out during the year under review:— Patients remaining on books from 1951 660 New patients 4,952 Total 5,612 53 New Patients:— Medical 2,868 Surgical 1,966 Gynaecological 87 Obstetric 31 Total 4,952 Specially classified:— Cases Visits Tuberculosis 152 4,222 Pneumonia 222 2,587 Maternity Complications 51 474 Infectious Diseases 40 336 Children under five years 224 1,376 Visits:— Termination of Cases:— Convalescent 3,133 Hospital 729 Died 475 Removed for other causes 569 Still on books 706 Total 5,612 January 12,617 February 12,205 March 11,849 April 10,869 May 11,387 June 9,610 July 10,983 August 9,502 September 9,741 October 11,351 November 11,343 December 13,281 Total 134,738 64 DAY NURSERIES. Attendances at Day Nurseries, 1952. Whitehorse Road. Bramley Hill Morland Road. *Ritchie Road. New Addington. †Euston Road. Bensham Grove. Date opened 1/6/42 Re-opened 1/1/52 8/3/43 23/11/43 28/3/44 15/5/44 21/3/45 Capacity 50 50 56 — 56 — 52 Number on books at end of year 37 31 29 — 10 — 23 Attendances : under 2 2331 1416 2735 280 607 553 1294 over 2 6052 5820 6769 1078 3041 2477 5697 Total 8383 7236 9504 1358 3648 3030 6991 Number of days opened 256 256 256 59 256 170 256 Average daily attendance (excluding Saturdays) 33 28 37 23 14 18 25 * Closed March, 1952. † Closed August, 1952 56 M. and C.W. PHYSIO THERAPY CLINIC The following figures relate to the work carried out at the above clinic during the year. Complaint No. of Cases Total M. F. Bow Legs 26 15 41 Knock-knees and Flat Feet 42 44 86 Chest Conditions: Post T.A. and Asthma 11 6 17 Cerebral palsy 4 1 5 Torti-collis 1 — 1 Posture 2 — 2 Valgus ankles 25 19 44 A.P.M. 2 — 2 Spina bifida 1 — 1 114 85 199 Total Attendances: 2,434 Ante-Natal Relaxation Attendances for 1952: Total number of Patients: 232 Total number of attendances: 1,093 56 DENTAL TREATMENT Health, Maternity and Welfare Service I am indebted to the Senior Dental Surgeon, Mr. P. G. Oliver, for the following report:— Expectant and nursing mothers requiring dental treatment are referred by Medical Officers attending Municipal Ante- and Post-Natal Clinics. In the case of children below school age reference comes chiefly from Infant Welfare Centres; a reduced number of applications continue 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. After a decline of three successive years a rise is again shown in the total of expectant and nursing mothers referred for treatment. Whilst this increase is encouraging, an appreciable proportion of those referred via Ante Natal Clinics still fail to appear for their dental examination, and thus the volume of work handled by the dental section remains considerably less than in the period prior to the Health Act of 1946. Though following the introduction of certain changes under the General Practitioners' Service there has been a lessening in the demand for dental appliances in private practices, no corresponding increase has been noticeable in Local Authority returns, and requirements in this respect remain if anything, below the average. If, as seems possible, many potential "denture" patients have been already rendered dentally fit during the previous "free treatment" period, this would account for the present hiatus, and little harm can result from the dearth of such cases. The closure of certain Day Nurseries during the year has unfortunately had a prejudicial effect on the number of pre-school children sent for treatment, and has to some extent halted the progress made previously. Whilst regretting the further curtailment, full credit should be given to Matrons and staff at these insitutions for their able help in the dental field. 57 The development of alternative means of access to children of this age group is presenting a current administrative problem, discussed later in this Report. Expectant and Nursing Mothers. The total number of expectant and nursing mothers referred from all sources was 426 compared with 393 in 1951. In contrast with the previous year the greater proportion of these were sent from the Ante-Natal Clinic, whilst those from the Municipal Midwives' Service were somewhat reduced in number. With certain exceptions fewer cases were again 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 329 against 268 last year. Of these, 75.6 per cent were seen during the first six months of pregnancy, compared with 75.4 per cent. previously recorded. Though a slight decline has been noticeable during recent years this figure continues to be reasonably high, and has 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 resiult of pain or discomfort, which might have been avoided had treatment been sought at an earlier date. There has been some increase in the amount of work carried out for nursing mothers. This has been caused by later dates of reference from the Ante-natal Department which did not permit of treatment until after the confinement; in other cases names were first received during the post natal period. 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. 21 nursing mothers were referred during the current year, compared with 13 in 1951. Treatment. Including those continuing treatment from the previous year, 352 mothers were dealt with, compared with 297 in 1951. This increase is in no way sensational, but it may indicate a turning point in the future of the Service from which more results may 58 follow. 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 and though it is unlikely that this represents a universal picture, it seems probable that a great many previously suffering from chronic oral sepsis have already received attention through the General Practitioners' Service and thus do not come the way of the Clinic. The Pre-School Child. The number of children referred from all sources during the year was 671, compared with 862 in 1951. Though this decrease is to a certain extent the result of the falling birth rate, an additional factor has been the progressive reduction in the number of Day Nurseries previously operating in the Borough. The presence of these institutions has provided a most useful field of supervision for children no longer attending Welfare Centres. In this respect it is hoped that the inauguration of further nursery classes at certain Primary Schools will help to make some redress until the programme for Nursery Schools can be put into effect. Though contacts obtained through the Welfare Centres themselves have in the past been disappointing, it is felt that increased publicity on the part of Health Visitors and voluntary workers would pay a worth while dividend by encouraging parents to seek earlier advice and treatment. 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 of many mouths at the first school inspection is a constant reminder of the fact that until a far greater degree of supervision can be exercised during the pre-school period, there can be no satisfactory solution to the problem of safeguarding the foundation teeth. 59 Treatment The following summary shows particulars of the work accomplished : — Expectant Mothers. Nursing Mothers. Total. Young Children. New Cases Examined 319 21 340 530 Re-treated 10 2 12 141 Total 329 23 352 671 Expectant and Nursing Mothers Young Children Attendances 755 1189 Fillings 215 390 Extractions 322 642 Gas Cases 58 257 Local Anaesthesia 134 32 Scaling and Gum Treatment 136 36 Dressings 231 119 Denture Dressings 154 — Silver Nitrate — 678 Treatments Completed 173 463 Number of Sessions (treatment) 281 Dentures Fitted 32 Dentures Repaired 6 60 MIDWIFERY SERVICE The Corporation employ directly a Superintendent and 18 domiciliary midwives. Ten midwives are recognised by the Central Midwives' Board to have pupils for the second three months of their Part II C.M.B. training. The work of the municipal midwives was as follows : — 1.—The number of maternity deliveries by Municipal Midwives on the district that attended the Lodge Road Ante-Natal Clinic in the year 1952 1,221 2.—The number of spontaneous deliveries 1,198 3.—The number of forceps deliveries 23 4.—The number of live births 1,207 5.—The number of stillbirths 14 6.—The number of neo-natal deaths None 7.—The number of premature live born infants treated in their own homes, and their weights and ultimate result 17 (1) 38 weeks—4 lbs. 12 ozs. 14th day—6 lbs. (2) 37 weeks—4 lbs 14th day—6 lbs. 4 ozs. (3) 38 weeks—5 lbs. 8 ozs. 14th day—5 lbs. 8 ozs. (4) 39 weeks—4 lbs. 14th day—4 lbs. 14 ozs. (5) 36 weeks—4 lbs. 6 ozs. 14th day—4 lbs. 8 ozs. (6) 37 weeks—5 lbs. 8 ozs. 14th day—6 lbs. (7) 38 weeks—4 lbs. 12 ozs. 14th day—5 lbs. (8) 38 weeks—5 lbs. 8 ozs. 14th day—6 lbs. (9) 36 weeks—5 lbs. 8 ozs. 14th day—5 lbs. 8 ozs. (10) 34 weeks—4 lbs. 8 ozs. 14th day—4 lbs. 12 ozs. (11) 37 weeks—5 lbs. 4 ozs. 14th day—6 lbs. (12) 37 weeks—4 lbs. 8 ozs. Transferred Mayday (13) 38 weeks—4 lbs. 8 ozs. Transferred Mayday (14) 36 weeks—4 lbs. Transferred Mayday (15) 35 weeks—4 lbs. Transferred Mayday (16) 28 weeks—3 lbs. 8 ozs. Transferred Mayday (17) 36 weeks—4 lbs. 12 ozs. Transferred Mayday 8. The number who received Gas and Air Analgesia 1,147 9. The number of cases of P.P.H. 25 (13 remained at home, 11 transferred Mayday) 10. The number of cases of manual removal of the placenta None 11. The number who received blood transfusion 7 12. The number of cases to which the Emergency Obstetric Service was called 7 13. The number of patients sent into Mayday Hospital: During the A.N. period 225 During and after delivery 79 Sent home for nursing 80 14. The number of cases of toxaemia of pregnancy treated at home 1 (Maternity) 15. The number of cases of prolonged labour (over 24 hours) 30 16. The number of breech deliveries: In primipara 1 (Maternity) In multipara 8 (Maternity); 1 (Midwifery); Total 10 61 17. The number of twins delivered in their own homes and the weights of the babies One set (Maternity) 6 lbs. 2 ozs.; 7 lbs. 2 ozs. 18. The number of cases of Puerperal Pyrexia: Genital 3 Extra-Genital 13 Total: 16 19. The number of congenital malformations 6 ante-natal clinic attendances— Number of Stillbirths: 14. Number of Premature Births: 18. January 559 May 564 September 477 February 585 June 442 October 503 March 534 July 444 November 434 April 533 August 467 December 340 5882 Addington: 2052+149 Post Natal. Midwife Mileage Deliveries Midwifery Maternity Gas and Air AnteNatal Visits PostNatal Visits Bookings Office Bookings Home Visits Normal Abnormal Normal Abnormal Midwives Pupils Midwives Pupils 1 2504 7 4 3 — 6 46 — 209 — 2 Bicycle 67 51 2 12 2 65 306 — 902 — 60 — 46 3 Bicycle 49 23 — 19 7 46 227 — 825 — 72 — 45 4 2153 70 46 1 21 2 66 164 — 689 — 40 — 44 5 Bicycle 59 32 1 24 2 55 334 126 980 760 37 — 19 6 Bicycle 47 40 — 7 — 47 180 205 668 1058 74 — 24 7 4245 53 36 2 13 2 51 331 — 925 — 34 — 30 8 Bicycle 112 86 3 19 4 106 577 238 1128 1088 117 — 54 9 Bicycle 66 31 — 29 6 62 145 — 714 — 62 — 45 10 3860 96 47 1 47 I 82 370 308 1024 1051 130 — 71 11 5670 116 110 2 3 1 111 996 160 1504 1182 158 — 13 12 1599 97 97 — — 96 317 112 1060 1290 135 — 3 13 2891 76 49 1 23 3 74 388 206 825 817 86 — 23 14 Bicycle 61 55 — 6 — 59 263 — 978 — 75 — 60 15 4744 81 56 2 19 4 68 567 346 1237 1054 117 — 40 16 Bicycle 32 18 — 13 I 31 212 — 494 — 39 — 19 17 2413 56 42 1 8 5 53 413 412 680 1096 102 — 36 18 4070 76 52 2 21 1 69 492' 317 1074 1069 111 — 30 Total 34149 1221 875 18 287 41 1147 6328 2430 15916 10465 1449 — 602 1. Deputy Superintendent. 6. 3½ months sick leave. 17. 2½ months sick leave. 10. 1 month sick leave. 16. Left service August. 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 1,283 issued during the year. 02 Gas and Air Analgesia. of the 1,221 births Gas and Air was given to 1,147 Balance 74 Reasons for Non-use of Gas and Air. Midwife summoned too late : baby born before arrival 45 Mother unfit 10 Other anesthetics (Chloroform 2) and Trilene (7) ) 9 Refusals (One husband refused) 8 Apparatus not obtainable (Fog) 2 74 63 The following table gives the details of the reasons for Midwives summoning medical aid: — For Complications during Pregnancy. Abortion 8 Other Causes 8 16 For Complications during Labour. Malpresentation Breech 2 3 Premature Labour 4 Delayed Labour. 9 Prolonged and Obstructed 22 Hcemorrhage. Ante-partum 14 Post-partum 8 22 Other Causes. Adherent and Retained Torn Perineum 97 Placenta 1 98 For Complications during Puerperium. Pyrexia 18 Pain in Breasts 5 Pain in Legs 15 Other causes 18 56 For Complications in regard to the Baby. Inflammation of Eyes 21 Still Birth 2 Feebleness 4 Other causes 21 Premature Birth 4 52 275 In accordance with Rule 33 of The Central Midwives' Board the following reasons for the discontinuance of breast feeding were received :— Illness of Mother 24 Defects of lactation 216 Other causes 27 Total 267 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 79. 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, and the Superintendent Municipal Midwife carries out these duties for the domiciliary midwives. 64 THE WORK OF THE HEALTH VISITORS The recorded visits include 940 made for special purposes in connection with re-housing, day nurseries, follow up of hospital cases and aged persons. The practice of visiting foster children on behalf of the Children's Officer continued and numbered 812 during 1952. Health Visitors have also dealt with special survey visits for certain national investigations into child health. They have continued to demonstrate their complete ability to meet such varying health and social problems. Co-ordination with hospital staff was improved by arrangements to further personal contact between Health Visitors and Hospital Almoners and the extension of their work to assist directly general practitioners was under review. The Mothercraft classes commenced in 1951 proved in such demand that extra afternoon and evening sessions were required. The strength of the staff is equivalent to 18 whole time health visitors. The average for the country of 9 per 100,000 of the population would give a staffing figure of 23 for Croydon. With the four whole time Tuberculosis Visitors, the establishment is in fact sufficient, but difficulties arise when absences through sickness coincide with interim periods between resignations and new appointments. Happily I am able to report that so far qualified applicants have always been forthcoming to meet vacancies and the need for special training schemes has not arisen. 66 6§ The Work of the Health Visitors.—Maternity and Child Welfare Visits Only. Visits Re Baker E. Biggs Left 30/4/52 Bird Blackmore Blest Devaney Early Eldridge Elliott Emms Left 31/12/52 Griggs Hall Hinton W. Johns Trans. 21/1/51 Lucey Morton Partridge Pickering Comm. 28/1/52 Rawlings Theison Thompson Toneri Tripet Vince Warman Webb Weller Weston Wilson Wybrevv Total, 1952 Total, 1951 Infants under 1 year— j j First Visits 148 49 85 112 119 175 97 128 135 146 138 120 68 7 75 164 145 126 96 108 127 140 139 167 154 155 141 137 115 128 3644 3692 Re-visits 446 184 591 332 592 636 937 652 526 649 741 480 602 62 630 607 353 748 352 533 759 701 1197 854 544 915 640 562 837 514 18176 18650 Children 1—2 years— First Visits 7 1 16 6 6 76 2 7 4 — 1 1 3 — — 4 12 2 15 — — 5 8 4 5 4 4 — 5 8 206 248 Re-visits 267 120 519 256 341 634 735 434 205 327 417 294 418 29 457 431 240 388 244 357 685 449 886 893 258 678 193 468 408 387 12418 11667 Children 2—5 years— First Visits 12 2 4 19 13 97 3 5 6 1 - 2 4 — — 9 12 — 29 — 4 1 12 1 22 12 2 — 8 19 299 275 Re-visits 773 171 514 412 843 732 946 1071 339 607 889 770 704 50 952 705 555 837 558 305 1081 1017 1811 1572 626 1265 541 1209 839 1027 23721 21759 Expectant Mothers— First Visits 70 2 — 35 8 — 18 18 30 6 43 38 1 — 18 38 19 3 20 4 25 43 82 58 51 28 16 7 42 26 749 604 Re-visits 6 1 — 5 3 — 44 2 7 — 11 14 — — — 6 1 — 2 1 25 — 89 26 — 2 3 1 1 — 250 262 Still Births — — — 2 — — — — — 2 — 2 — — — —— — 1 — - 1 — 2 3 — 1 1 — — 1 16 16 Deaths under 1 year 1 — — — 2 — 1 — — — 1 2 — — — 2 2 — 1 — 1 — 1 — — 2 1 2 — — 19 20 Miscellaneous Visits 67 9 8 125 15 45 9 100 22 4 115 6 11 1 5 12 50 11 28 15 59 16 36 1 37 43 74 46 53 35 1058 811 Ineffective Visits 373 355 575 380 311 613 551 201 465 450 509 352 113 23 337 920 169 534 445 355 592 506 306 396 631 740 324 822 405 396 13149 12705 Totals : 1952 2170 894 2312 1684 2253 3008 3343 2618 1739 2192 2865 2081 1924 172 2474 2898 1558 2650 1790 1678 3359 2878 4569 3975 2328 3845 1940 3254 2713 2541 73705 — 1951 2022 2295 1996 — 1931 3126 2973 3119 1583 1113 2010 3465 3715 915 2602 1616 1486 — 1351 1747 3019 2430 3376 2499 2326 3370 1912 2761 2610 3057 — *70664 * Including Health Visitors who left in 1951 67 IMMUNISATION AGAINST DIPHTHERIA. A total of 2,884 new cases came from the following sources:—1 Of these, 51 failed to return for completion of the course. School Children 385 Children under 5 2,499 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 3,144. 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 — — 1946 3935 3934 386 32 1947 3638 3516 266 641 1948 3799 3704 95 1667 1949 4299 4216 83 2898 1950 3089 3014 75 4512 1951 3459 3436 23 2921 1952 2884 2833 51 3144 Origin and Source of New Cases attending. Year School Pre-school Total Per cent. Total Per cent. 1937 928 72.2 358 27.8 1938 1179 76.5 362 23.5 1939 704 69.0 316 31.0 1940 216 50.0 212 50.0 1941 4477 67.4 2162 32.6 1942 2660 48.3 2851 51.7 1943 2818 48.1 3036 51.9 1944 531 28.7 1320 71.3 1945 281 9.4 2698 90.6 1946 789 20.0 3146 80.0 1947 588 16.2 3050 83.8 1948 334 8.8 3465 91.2 1949 548 12.7 3751 87.3 1950 587 19.0 2502 81.0 1951 312 9.0 3147 91.0 1952 385 13.4 2499 86.6 68 IMMUNISATION AGAINST WHOOPING COUGH A total of 2,200 children were immunised against whooping cough, comprising 2,160 under school age and 40 school children. 179 children were given reinforcing injections. VACCINATION AGAINST SMALL-POX A total of 2,526 persons were vaccinated against Small-pox. Under 1 year of age 1 2—4 5—14 15 or over Total Successful Vaccinations 1420 82 83 84 163 1832 „ Re-vaccinations — — 17 47 476 540 Insusceptible to Vaccination 103 3 5 7 36 154 2526 09 AMBULANCE SERVICE. To the Medical Officer of Health. I submit the Eleventh Annual Report of the Croydon Ambulance Service, for the year ended 31st December, 1952. While the work carried out was greater than in any previous year this cannot be shown by the comparison of the number of calls. It will be remembered that commencing in 1952, the Ministry of Health requested all Ambulance Authorities to adopt a r.ationl unit for defining "calls", and this differed materially from the method previously used in Croydon. As judged by the number of miles travelled by vehicles—390,535 as against 360,095 in 1951—the increase in work was 6.7 per cent. On a similar basis of comparison the increase between 1950-1951 was 3.1 per cent. Three Ex W.D. Albion Ambulances (FVB 570, GBY 515 and FOY 807) and one Armstrong Ambulance (BVB 1) were disposed of and in place of these two Bedford Sitting Case Ambulances (KBY 700 and KRK 563), one Bedford 32 Seater Coach (KRK 252—Mental Deficiency) and or.e Daimler Ambulance (KOY 800) were delivered. These new vehicles have proved very satisfactory. The weather during 1952 has been exceptionally bad and as a result of this many extra emergency calls have been received to convey patients suffering from influenza and various chest complaints. 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 24,011 No. 2 Station, Thornton Heath 4,307 No. 3 Station, South Croydon 4,378 No. 4 Station, Mayday Hospital 2,232 No. 5 Station, Waddon Hospital 678 70 Classification of Calls. Home Accidents 587 Miscellaneous Accidents (Unclassifiable) 168 Recreational Accidents 138 School Accidents 138 Street Accidents 792 Work Accidents 244 Home Illness 183 Street Illness 551 Work Illness 55 Common Assault 38 Attempted Suicide 31 Suicide 11 Attempted Murder 1 Murder 1 Health Service Removals 31,647 Services refused or Ambulance not required 343 34,928 Calls taken by Waddon Hospital (Infectious Diseases) 678 35,606 The total mileage covered by ambulances and cars during the year was 390,535 miles, which is an increase of 24,440 miles over the previous year. Analysis of Accidents, etc. STREET ACCIDENTS PEDESTRIANS KNOCKED DOWN BY:— (1) Pedal Cycles (Adults) 35 „ „ (Children) 20 (2) Motorised Cycles (Adults) 1 (3) Auto Cycles (Adults) 1 (4) Motor-Cycles (Adults) 29 ,, ,, (Children) 8 (5) Cars (Adults) 67 „ (Children) 23 (6) Taxi (Adults) 1 ,, (Children) 1 (7) Vans (Adults) 7 ,, (Children) 1 (8) Lorries (Adults) 12 „ „ (Children) 5 (9) Buses (Adults) 7 (Children) 3 (10) Coach (Adults) 2 (11) Trade Vehicles (Adults) 2 223 71 FALLING— (1) In the Street (Adults) 112 „ „ „ (Children) , 30 (2) Inside Buses (Adults) 12 „ ,, (Children) 1 (3) From Pedal Cycles (Adults) 81 „ „ (Children) 69 (4) From Motorised Cycles (Adults) 2 (5) From Auto-Cycles (Adults) 1 (6) From Motor-Cycles (Adults) 16 (7) From Invalid Chair (Adults) 1 (8) From Cars (Adults) 2 ,, ,, (Children) 1 (9) From Lorries (Adults) 5 (10) From Trolley Buses (Adults) 1 (11) From Buses (Adults) 35 „ „ (Children) 4 (12) From Coach (Adults) 1 374 COLLISIONS BETWEEN VEHICLES— (1) Cycle Crash (Adults) 5 „ „ (Children) 11 (2) Cycle and Motor-Cycle (Adults) 8 „ „ (Children) 2 (3) Cycle and Car (Adults) 27 „ ,, „, (Children) 16 (4) Cycle and Van (Adults) 5 .„ „ ,, (Children) 1 (5) Cycle and Lorry (Adults) 10 „ „ ,, (Children) 5 (6) Cycle and Bus (Adults) 3 ,, ,, ,, (Children) 3 (7) Cycle and Coach (Adults) 1 .„ „ ,, (Children) 1 (8) Motor-Cycle Crash (Adults) 14 ,, ,, ,, (Children) 1 (9) Motor-Cycle and Car (Adults) 26 ,, ,, „ ,, (Children) 2 (10) Motor-Cycle and Van (Adults) 3 (11) Motor-Cycle and Bus (Adults) 4 (12) Motor-Cycle and Lorry (Adults) 9 (13) Motor-Cycle and Coach (Adults) 1 (14) Car Crash (Adults) 13 „ ,, (Children) 7 (15) Car and Van (Adults) 5 (16) Car and Lorry (Adults) 8 (17) Van Crash (Adults) 1 (18) Car and Invalid Chair (Adults) 1 (19) Bus Crash (Adults) 1 (20) Coach Crash (Adults) 1 195 STREET ACCIDENTS TO ADULTS 585 „ „ ,, „ CHILDREN 207 792 72 HOME ACCIDENTS— (1) Falling in the Home (Adults) 136 ,, ,, „ (Children) 119 (2) Falling Down the Stairs (Adults) 29 „ ,, ,, (Children) 7 (3) Burns and Scalds (Adults) 26 ,, ,, (Children) 25 (4) Cuts by Broken Glass, Tools etc. (Adults) 35 ,, ,, ,, ,, (Children) 59 (5) Falling from Heights (Adults) 15 „ ,, „ (Children) 27 (6) Injuries sustained by Falling Objects (Adults) 9 „ „ Children) 12 (7) Dog Bites (Adults) 1 ,, „ (Children) 5 (8) Accidental Poisoning (Adults) 22 ,, ,, (Children) 13 (9) Falling from Bed (Adults) ,, ,, (Children) 5 (10) Miscellaneous (Adults) 23 (Children) 12 587 HOME ACCIDENTS TO ADULTS 303 CHILDREN 284 WORKS ACCIDENTS— (1) Caused by Machinery or Tools 51 (2) Caused by Falling Objects 39 (3) Falling 50 (4) Falling from a Height 49 (5) Falling down Holes 5 (7) Colliding with Objects 8 (8) Burns and Scalds 22 (9) Lifting 8 (10) Miscellaneous 5 244 SCHOOL ACCIDENTS— (1) In the Classroom 40 (2) In the Playground 56 (3) During P.T 27 (4) Miscellaneous 15 138 73 RECREATIONAL ACCIDENTS— (1) Football (Adults) 28 „ (Children) 14 (2) Rugby (Adults) 9 ,, (Children) 1 (3) Cricket (Adults) 2 „ (Children) 3 (4) Swimming (Adults) 5 „ (Children) 5 (5) Hockey (Adults) 1 ,, (Children) 1 (6) Table-Tennis (Adults) 1 (7) Boxing (Adults) 1 (8) Tennis (Adults) 2 (9) Golf (Adults) 1 (10) Dancing (Adults) 5 (11) Weight Lifting (Adults) 1 (12) Judo (Adults) 1 (13) Miscellaneous in Parks (Adults) 6 „ „ „ (Children) 51 138 RECREATIONAL ACCIDENTS TO ADULTS 63 RECREATIONAL ACCIDENTS TO CHILDREN 75 ATTEMPTED SUICIDES— (1) Coal Gas Poisoning 12 (2) Cut Wrists 1 (3) Poisoning 16 (4) Jumped from Upstair Window 1 (5) Jumped from Top of Building 1 31 SUICIDES— (1) Coal Gas Poisoning 7 (2) Cut Throat 1 (3) Poisoning 1 (4) Strangulation 2 11 FATAL ACCIDENTS AND ILLNESS— (1) Certified dead at Hospital 50 (2) Certified dead at scene of Accident or Illness 18 68 74 ACCIDENT AND ILLNESS IN PUBLIC PLACES— (1) Recreational Grounds (Adults) 33 ,, ,, (Children) 51 (2) Shops (Adults) 92 „ (Children) 8 (3) Public Houses (Adults) 52 (4) Cinemas and Theatres (Adults) 13 „ „ „ (Children) (5) Swimming Baths (Adults) 5 „ ,, (Children) 14 (6) Railway Stations (Adults) 40 „ ,, (Children) 6 321 ACCIDENTS AND ILLNESS TO ADULTS— Home Accidents 303 Miscellaneous Accidents 97 Recreational Accidents 63 Street Accidents 585 Work Accidents 244 Home Illness 148 Street Illness 538 Work Illness 55 Common Assault 38 Attempted Suicide 31 Suicide 11 Attempted Murder 1 Murder 1 2,115 ACCIDENTS AND ILLNESS TO CHILDREN— Home Accidents 284 Miscellaneous Accidents 71 Recreational Accidents 75 School Accidents 138 Street Accidents 207 Home Illness 35 Street Illness 13 823 HOW EMERGENCY CALLS WERE RECEIVED— Doctor 181 Passer By 687 Police 291 Householder 920 Fire Brigade 254 Staff 60S 2,938 75 INFECTIOUS CASES CONVEYED BY WADDON HOSPITAL— Anthrax 1 Bronchitis 2 Chicken Pox 51 Diphtheria 8 Dysentery 16 Encephalitis 3 Erysipelas 2 Gastro-Enteritis 42 Gastric-Influenza 1 Jaundice 4 Laryngitis 1 Measles 36 Meningitis 15 Mumps 4 Nephritis 1 Pneumonia 9 Poliomyelitis 33 Puerperal Pyrexia 13 Quinsy 1 Ringworm 1 Rubella 18 Scarlet Fever 341 Septic Throat 2 Tonsilitis 4 Tuberculosis 21 Typhoid 2 Whooping Cough 46 678 The Gas and Air Apparatus was in demand 796 times, which necessitated vehicles travelling 5,972 miles. 314 calls were received to convey members of the Croydon Nursing Service, which entailed travelling 7,280 miles. Conveying children to and from St. Margaret's School accounted for 3,504 miles. 7,178 cases were conveyed to Hospitals, etc., outside the Borough boundary, and on these journeys 114,546 miles were travelled. CIVIL DEFENCE—Ambulance Section 1 his Section continues to function smoothly. The number of personnel has increased to 128 and training classes are held on four nights every week. Section Training is now being carried out by means of Lectures, Demonstrations and Practical Exercises. A Full First Aid Course has just been completed, and examinations will be held in January, 1953. 76 Driving Instruction is being given to a number of Volunteers, but owing to the fact that most of the lessons have to be given on a Sunday, these courses take a considerable time to complete. During the year the Section has taken part in two combined Exercises at Beckenham, and in February is due to join in a large-scale Exercise arranged by the Wandsworth Civil Defence Corps. 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, 68 cases were dealt with, 61 being adults (male, 11, female, 50) and 7 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 week! charge, with exemption for incomes below a certain figure. Durinj the vear the undermentioned loans were made:— Bed Pans 223 Bed Rests 146 Rubber Bed Pans 107 Mackintosh Sheets 284 Feeding Cups 14 Wheel Chairs 17 Commodes 11 Crutches pairs 2 Steam Kettles 2 Walking Machines 3 Sputum Mugs 4 Air Cushions 308 Bed Cradles 13 Urinals 103 Air Beds 22 Dunlopillo Mattresses 6 Water Bed 1 Bed Tables 2 Douche Can 1 Hot Water Bottles 2 Draw Sheets 4 DOMESTIC HELPS. This service continued in great demand and an analysis of the work covered shows the following approximate percentages: — Maternity Cases 31.22 Sickness 67.75 Sick Room Helpers 1.03 (1) Number of Home Helps—January 1st and December 31st, 1952:— (a) Full-time 17 (b) Part-time 113 77 (2) Number of new applications— (a) Maternity 528 (b) Sickness 872 (c) Sick Room Helpers 13 (3) Number of applications met:— (a) Maternity 394 (b) Sickness 855 (c) Sick Room Helpers 13 (4) Number of cases attended during year 1,862 (5) Average duration of services given— (a) Maternity 12 days (b) Sickness (acute cases) 10—21 days (6) Amount recovered for services £4,441 (7) Rate of remuneration of "Helps" 2s. 6Jd. per hour HEALTH PROPAGANDA. This has continued to be regarded as part of the routine duty of all members of the department who come into contact with the general public. Food hygiene remained a subject of particular interest to the Sanitary Inspectors. Poster sites have been retained, display panels continued at appropriate clinics, and the distribution of "Better Health" and literature of the Royal Society for the Prevention of Accidents maintained at Infant Welfare Centres. Booklets and pamphlets on ante-natal care and parentcraft are supplied at Ante-Natal clinics. Lectures have been given by members of the staff to various organisations in the Borough, including talks on "Cancer" to women's associations. 78 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. The only duty delegated to a voluntary association was the supervision of 14 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 the Mental After-Care Association. Two cases were so dealt with during the year. Under the Lunacy and Mental Treatment Acts. Patients dealt with under the Lunacy and Mental Treatment Acts during 1952, are as follows:— (a) Certified and admitted to Warlingham Park Hospital 52 (b) Admitted to Warlingham Park Hospital as voluntary patients 46 79 (c) Removed to Mayday Hospital under Detention Order 248 (d) Admitted to Warlingham Park Hospital as temporary patients 10 (e) Investigated and no action taken 126 (/) Urgency Orders 6 488 Under the Mental Deficiency Act. Number of known Mentally Defective Patients in the Borough : 1951 1952 Under 5 years 56 64 Aged 5-16 years 108 112 Over 16 years 566 569 Total 730 745 Compared with 1951 the cases show an increase of 15. Six Institution patients have died in hospital. The cases are distributed as follows:— In Certified Institutions 326 In Approved Homes 15 On Licence from Institutions 20 Under Statutory supervision at home 282 Under Guardianship 63 In Mental Hospitals 8 Observation cases 31 In "Place of Safety" — 745 During the year the Certifying Medical Officers made examinations and paid visits to the number of 98 cases. The Mental Deficiency Visitors paid 4,492 visits. 46 new cases were examined during 1952 and certified as mentally defective. 10 of these cases were recommended for the Occupation Centre and 20 were placed under statutory supervision. 10 were recommended for institutional care and six for friendly supervision. 80 During 1952, 27 cases were dealt with as follows:— 1951 1952 Sent to Certified Institutions 45 16 Placed under Guardianship — 2 Sent to Warlingham Park Hospital — — Varying Orders: (a) Change of Guardian 2 1 (b) From one Institution to another 4 5 (c) From Guardianship to Institution 1 2 (d) Institution to Guardianship — — (e) Orders closed — 1 Thirty-eight Orders were renewed during the year, eight of which were Guardianship. Seven children were admitted to the Occupation Centre during 1952. Three left or were excluded. There were 10 cases awaiting vacancies in Institutions on the 31st December, 1952. Guardianship Cases. There were 57 cases under Statutory Guardianship, 36 of these under the care of relatives, and 21 with Guardians who are not relatives. Two males and two females are at work. 640 visits have been paid to Guardianship cases during the year. There are 20 cases on licence from Institutions (10 males and 10 females). Report on the Occupation Centre, January-December, 1952. Number on Register, January 41 ,, ,, December 49 Number of Admissions 7 Number of Exclusions 3 Average attendance per session 37 Times open, Morning-Afternoon 384 Total attendance for year 14,472 31 I am indebted to Miss Cooney, Supervisor of the Occupation Centre, for the following report:— " The Occupation Centre is divided into Classes, according to age and ability. Handwork, P.T., Music and Movement, Hygiene and Household Training form the most important part of the daily routine. In March, the Centre moved to larger premises and it was unfortunate that Miss Hensher was obliged to go into hospital for a long rest. In June, the Parents' Association gave the children a day's outing to Sudbury Court. In July, Mrs. Warner, untrained assistant, attended a week's refresher course for staffs of Centres. Dr. Lilly, Commissioner, Board of Control, paid a routine visit in October. Twenty-nine students from various areas visited the Centre. The Sale of Work was held in November. In December, the children had their Christmas Party. Dr. Wright kindly distributed the presents from the tree. As we now have a large hall it was possible to extend the time limit and the children stayed on till 5 p.m., finishing up with games and a sing-song." 82 SANITARY CIRCUMSTANCES To the Medical Officer of Health. I beg to submit a report for the year ending 31st December, 1952 of the work of the Sanitary Inspectors and other officers under my supervision. During the year every opportunity has been taken to emphasise the importance of cleanliness in the handling of food. Talks, augmented by films, have been given to some hundreds of food workers, housewives and schoolchildren on the subject of food hygiene. One large employer of labour arranges for all new entrants into the food trades section, to attend such talks etc. Bye-laws were made during the year in connection with the hygienic handling, wrapping and delivery of food and a copy, together with a letter explaining the purpose of the bye-laws, was sent to the proprietors of all food handling businesses. Already these bye-laws have proved of value and improvements are becoming more apparent in the display and handling of foods. Housing, as usual, has occupied much of the time of the inspectorate, largely in following up complaints. The Wilford Road and Forster Road redevelopment scheme is progressing, new houses having been built on part of the site to house some of the occupants of the demolished houses. Sampling of food and drink, including drinking water; drugs; fertilisers and feeding stuffs; rag flock and other upholstery fillings and swimming bath waters is constantly taking place. Some 1,600 such samples were taken during the year, all with a view to protecting consumer or user from health hazards, adulteration or misdescription. A considerable amount of time of the inspectorate is spent in following up notifications of infectious disease with a view to preventing the spread of such diseases. The new Rivers (Prevention of Pollution) Act has to be administered by the department and this has given additional work in the way of observing and sampling streams in the Borough for evidence of pollution. Any pollution found has to be traced to its source and stopped and this is not an easy task with intermittent discharges. 83 The administration of the Diseases of Animal Acts, whereby the spread of animal diseases is controlled, has' been more onerous this year. In view of the country wide outbreaks of foot and mouth disease much attention has had to be given to licensing of animal movement into and out of the Borough. Fortunately no case of foot and mouth disease occurred locally although there were cases in the near vicinity. A case of Anthrax and three cases of swine fever notified to me proved to be positive. The Statistical tables and comments in the body of the report give some indication of the amount and variety of work done in a loyal and conscientious manner by those under my control. GEO. GRIEVE, Chief Sanitary Inspector. 84 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) 4,074 Number of houses inspected where Zymotic diseases have occurred. 379 Inspection of underground rooms 39 Investigations into complaints other than Housing matters 2,963 House drains tested 2,529 House drains tested on application 18 Number of smoke tests during repair 105 Inspections of drainage work during repair 3,461 Number of water tests during repair 228 Final tests of drains after repair 61 Final tests of drains when completely relaid 52 Inspections of yards, stables and manure pits 235 ,, passages 167 ,, public conveniences 270 ,, pigstyes 155 ,, tents, vans and similar structures 86 ,, theatres, cinemas, halls, etc 135 ,, ponds, ditches and watercourses 256 ,, schools and school sanitary conveniences 73 ,, verminous premises 151 ,, premises where offensive trades are conducted 16 ,, gipsy encampments, camps, fairs, etc 33 ,, cesspools and earth closets 33 ,, gathering grounds of water supply 69 Inspections of Swimming Baths 25 ,, „ Wells 57 Number of visits re Rats and Mice Infestations 3,481 ,, „ ,, ,, Smoke Abatement 370 ,, ,, „ ,, Infectious Diseases 1,704 Inspections of Shops (under Shops Acts) 2,121 Special Early Closing and Evening Patrols (Shop Hours Acts) 484 Overcrowding inspections 272 Inspections under Diseases of Animals Acts 118 Inspections under Fertilisers and Feeding Stuffs Act 14 ,, under Pharmacy and Poisons Act 329 under Merchandise Marks Acts 254 Inspections under Pets Act 106 ,, ,, Rag Flock and other fillings materials Act 48 ,, ,, Rivers (Prevention of Pollution) Act 123 Inspection of Dairies 77 ,, Milkshops 120 ,, Premises where food is prepared or sold 8,877 ,, Bakehouses 150 ,, School Kitchens and Services 155 „ Imported Food at Aerodrome 52 ,, Factories without mechanical power 104 ,, Factories with mechanical power 1,109 ,, Workplaces (Public Health Act) 112 ,, Outworkers' premises 284 ,, Offices 79 Drinking water samples taken 326 Swimming bath waters: samples taken 83 Food and Drugs Acts: milk samples taken 288 Food and Drugs Act : other foods and drugs samples taken 406 Milk (Special Designations) Orders: samples taken 286 85 Ice Cream samples taken 222 Samples taken of Rag Flock and other filling materials 14 ,, „ ,, Fertilisers and Feeding Stuffs 9 Reinspections of work on outstanding notices 21,961 Sundry inspections and visits 2,522 Appointments kept with owners, builders, etc. 4,657 Complaints from public investigated (including those in regard to housing defects) 7,215 Informal notices outstanding 31-12-51 1,604 Informal notices served 4,765 Informal notices complied 4,315 Number of Informal Notices reterred for Statutory Orders 498 Informal notices outstanding 31-12-52 1,556 Statutory notices outstanding 31-12-51 602 Statutory notices served 892 Statutory notices complied 1,100 Statutory notices outstanding 31-12-52 394 Total number of callers and complaints received at the office 8,095 Total number of letters received at the office 7,405 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1952 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 610 Conditions causing dampness: Defective roofs 762 Defective window frames 242 Defective walls, etc. 385 Want of efficient damp-proof course 187 Defective gutters and downspouts 611 'Other structural defects: Defective plaster 847 Cleansing and redecoration required 851 Defective floors and stairs 427 Insufficient ventilation under floor 96 Defective brickwork, sills, lintels, chimneys 279 Defective stoves and fireplaces and flues 388 Defective drains, sanitary fittings, etc.: Defective sinks and waste pipes 229 Defective w.c.'s 209 Defective drainage 398 Stoppages in drains 290 Defective water services and tanks 81 Domestic nuisances: Want of cleanliness 18 Verminous conditions 72 Dirty W.C. pans 5 Other nuisances and infringements: Offensive accumulations 88 Overcrowding 70 Smoke nuisances 3 Sundry nuisances or defects 58 Particulars not inserted in Rent Book (Housing Act) 16 86 (2) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924. Food cupboards defective or required 9 (3) INFRINGEMENTS OF FOOD AND DRUGS ACT, 1938, AND FOOD BYELAWS. Structural defects in shops and stores 67 Cleansing or repair of walls and ceilings 186 Cleansing or repair of floors, utensils, fixtures, etc. 134 Insufficient or defective sink accommodation and water supply 47 Insufficient lighting or ventilation 24 Defective drainage 26 W.C. accom.—Insufficient 5 ,, ,, Repair or cleansing required 73 ,, ,, Artificial light required 15 ,, ,, Want of intervening ventilated space 1 Cloakroom accommodation required or defective 12 Overalls required or dirty 8 Ablutions—Wash basins required 23 ,, Hot water supplies required 88 ,, Soap and towels required 17 Food improperly stored 46 Food store—Required or defective 17 ,, Animals kept in 5 ,, Household washing in 5 Accumulation in yards or stores 41 Offal and refuse bins uncovered or defective 36 Yard paving defective 24 Vehicles—dirty or defective 10 (4) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING, Etc. Defective Yard Paving 84 Want of a sanitary dustbin 91 (5) INSPECTION OF AMUSEMENT HOUSES. Defective sanitary fittings 7 W.C. defective and dirty 23 (6) KEEPING OF ANIMALS. Nuisances arising from the keeping of animals 12 (7) SMOKE ABATEMENT. Nuisances observed 3 87 HOUSING. Individual Unfit Houses. During the year action under the Housing Acts was mainly confined to the repair of houses. I.—Inspection of dwelling houses during the year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health and Housing Acts) 4,074 (b) Number of inspections and re-inspections made for the purpose 23,501 (2) (a) Number of dwelling houses included under the subhead (1) above, which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 — (b) Number of inspections made for the purpose — (3) Number of houses found to be in a state so dangerous and injurious to health as to be unfit for human habitation 1 (4) Number of dwelling houses (exclusive of those referred to under the previous sub-head) found not to be in all respects reasonably fit for human habitation 3,331 11.—Remedy of defects throughout the year without service of Formal Notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 2,650 HI.—Action under Statutory Powers during the year:— A.— Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936 (1) Number of dwelling houses in respect of which notices were served during the year requiring repairs 440 (2) Number of dwelling houses which were rendered fit after service of formal notices— (a) By owners 653 (b) By local authority in default of owners 64 B.—Proceedings under Public Health Acts :— (1) Number of dwelling houses in respect of which notices were served during the year requiring defects to be remedied 380 (2) Number of dwelling houses in which defects were remedied after service of formal notices :— (a) By owners 224 (b) By local authority in default of owners 147 88 C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which Demolition Orders were made 1 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 6 D.—Proceedings under Section 12 of the Housing Act, 1936 :— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 3 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit West Croydon Men's Hostel. This is situated at Pitlake and is available for use by "nightly lodgers." It has 104 cubicle beds, four of which are reserved for staff. The charge is 1s. 9d. per night of 11s. 6d. per week, and 1s. 9d. per night or 8s. per week for Old Age Pensioners. Cooking facilities are provided. Hot baths may be taken any time after 9 a.m. Clothes may be washed and dried in the wash-house provided. The average number of nightly lettings during the year was 98, and the number accommodated during the year 35,770. The receipts and expenditure for the past 5 years have been as follows:— Receipts. Expenditure. £ s. d. £ s. d. 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 1952 1,832 0 0 ...... 3,289 0 0 89 Houses—Sanitary Certificates. House drains and sanitary fitting's are tested and examined on request, at a fee. During the year 14 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 1109 60 — Without Mechanical Power 104 19 — Other Premises 112 13 — Outworkers and Employers of outworkers 284 — — Total 1609 92 — Defects Found Particulars. Number of Defects. Referred to H.M. Inspector. Prosecutions. Found. Remedied. Want of Cleanliness 19 17 — — Overcrowding — — — — Unreasonable Temperature 1 1 — — Inadequate Ventilation 2 2 — — Ineffective Drainage of Floors — — — — Sanitary Conveniences. (a) Insufficient 38 35 — — (b) Unsuitable or Defective 155 143 — — (c) Not Separate for Sexes 10 8 — — Other offences against the Act (not including offences relating to Outworkers) 56 51 15 Total 281 257 15 — 90 Home Work. Lists of home workers, or outworkers as they are termed, are sent in twice yearly, and this year contained the names of 387 workers residing in the Borough. 282 visits were paid to outworkers. Nature of Employment of Outworkers on the Register, 31st December, 1952 Nature of Work. Number Employed. Outwork in Infected Premises. Outwork in Unsatisfactory Premises. Remarks. Making, Cleaning, Altering and Repairing Wearing Apparel 203 — — — Upholstery Work 4 — — — Other Classes of Work 180 — — — Total 387 — — — Inspection of Schools. These are inspected with particular reference to sanitary accommodation including washing facilities. During the year 73 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. 8 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. 2,121 inspections were made under the Shops Acts, and the infringements found were as follows:— Hours of closing 15 Hours of employment of staff 8 Provision of means of heating 22 Insufficient W.C. accommodation 5 Want of washing facilities 2 91 Defective W.C. accommodation 41 Depective walls, floors, ceilings, etc. 28 Defective and insufficient lighting 27 Want of seating accommodation 3 Notices to be exhibited or amended 433 Two shopkeepers were fined during the year for contraventions of the provisions of the Shops Acts regarding closing hours. DRAINAGE During the year there was no lessening of work in this branch of the department's duties. Some 3,461 visits of inspection were made to underground drains in course of repair. It was not necessary to serve so many statutory orders as in previous postwar years. Of 380 Orders served, 147 had to be done in default of the owners. KEEPING OF ANIMALS. In spite of the large increase in the number of pig and poultry keepers during and since the war, there have been few complaints lodged regarding nuisance. Bye-law powers, relaxed by government order, during the war, have now been reinstated, and this will help to further control those who have given trouble in the past. OFFENSIVE TRADES. There are but few registered, and during the year there has been no cause for complaint. POLLUTION OF RIVERS AND STREAMS During the year 379 inspections were made to ascertain if any evidence of pollution or obstruction was apparent in the watercourses within the Borough and in addition samples of the waters were taken for analysis. Oil was found to be the most frequent polluting material, and in those cases which were traced the offenders had little idea that in disposing of waste oil down the nearest drain, they had polluted a stream. Waste oil should not be disposed of by way of surface water drainage. Another cause of pollution is the connection of sink, bath and lavatory basin waste pipes to the surface water drains. It should be remembered that all surface water drainage in the Borough is discharged into streams, and it is' an offence to permit a polluting material to enter surface water drainage systems. 92 SMOKE ABATEMENT. The District Sanitary Inspectors observe the various factory chimneys in their respective areas with a view to detecting the discharge of smoke or grit such as to be a nuisance. Bye-laws are in force regarding the emission of "black" smoke, whereby it is an offence if such smoke is discharged for more than two minutes, in total, over a period of half an hour's observation. Thirty such observations were carried out and in two instances black smoke was emitted for more than the statutory limit. The Managements were immediately interviewed and informed of the offence and advised. Further observations on the offending chimneys showed no contravention. During the year complaint was received from the western part of the Borough of a particularly heavy grit deposit. This complaint was investgated and proved to be justified and the offending installation was amended thereby abating the nuisance. It is not always possible for the factory owner to obtain the fuel best suited to his plant and in consequence this adds to the problem of smoke abatement. AMUSEMENT HOUSES. 135 inspections were made of Theatres, Music Halls, Cinemas, Dance Halls, and premises where stage plays are given. A report is submitted annually to the Licensing Authorities on the sanitary condition of these premises. Notices are issued to remedy any unsatisfactory conditions. DISINFECTION. The Borough Disinfecting Station is situated at Factory Lane. Two steam disinfectors are in use and are supplied with steam from the Electricity Works. The following articles were disinfected at the Disinfecting Station during the year:— By Steam 16,344 articles ,, Formalin Gas 6,130 „ „ ,, Spray 1,199 ,, Total 23,673 In addition 426 articles were destroyed on request. 93 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 1952, 1,570 articles were disinfected, the receipts amounting to £78 9s. 6d. Disinfection was carried out after infectious or contagious disease at the following premises:— 900 rooms at 750 houses, hospital wards, clinics and creches. 2,943 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 1 adult and 64 children were cleansed of verminous conditions and 7 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 or fumigation. PHARMACY AND POISONS ACT, 1933. The object is to regulate the sale of certain poisonous substances and the Act contains important Drovisions. 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 30. In addition, 289 applications were made for the retention of names on the list for a further period of twelve months. 19 infringements of the Act were found. FERTILISERS AND FEEDING STUFFS ACT, 1926. 14 inspections of premises where fertilisers and feeding stuffs were sold, were carried out during 1952. During the year the undermentioned samples were taken:— Fertilisers 7 Feeding Stuffs 2 94 The undermentioned were found not to be in accordance with the requirements of the Act:— 1 Excess of Phosphoric Acid in Super Phosphate. 1 Excess of Phosphoric Acid in Bonemeal. 1 Deficiency of Fibre in Fine Millers Offals (Middlings). In each case the manufacturer was informed of the result of the analysis and requested to take steps to comply with the requirements of the Act. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951. This Act regulates the manufacture and sale of materials used as fillings for upholstery, bedding, toys, etc., with the object of compelling the use of clean fillings. During 1952, 14 samples of various fillings, as listed below were taken. All of these samples conformed with the requirements of the Regulations made under the Act : — Article No. of Samples Rag Flock 4 Washed Flock 5 White Cotton Felt 1 Cotton Felt 1 Coir Fibre 1 Woollen Mixture Felt 1 Cotton Millpuff 1 PET ANIMALS ACT, 1951. 18 premises were licensed for the purpose of keeping Pet Shops. During the year there were no infringements of the conditions, specified in the licences. DISEASES OF ANIMALS ACTS. During the year I had notified to me as Inspector under the above Acts three cases of suspected Anthrax and four cases of suspected Swine Fever. Two of the Anthrax suspects proved to be negative and the positive case was in a pig at a local farm. The carcase and organs of the pig were destroyed on the site by burning and the infected premises were disinfected by my staff. No further case occurred in the contact pigs. 95 A notification was received from the Ministry of Agriculture and Fisheries that a hide from an animal infected with Anthrax had been brought into Croydon. This hide was traced and destroyed by burning. All contact hides and the premises were disinfected, and those employees who handled the hide were given prophylactic treatment. No employees were infected. Of the four notifications of suspected Swine Fever, three proved to be positive, two being found by the Meat Inspector at the slaughterhouses and the other being in pigs at a smallholding. The Ministry of Agriculture and Fisheries dealt with the contact pigs. 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, 1,660 private dwellings were inspected following complaints and in 924 instances infestation was confirmed. The rodent operatives dealt with 715 of these infestations and the occupiers themselves, after being advised, dealt with 147. In 41 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. 180 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. 11 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. 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. 96 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 3,385 premises in the Borough at which Food is known to be sold, manufactured or stored: — Bakehouses 72 Bakers Shops 130 Sugar Confectioners 516 Cafes, Restaurants, Snack Bars and Eating Houses and Kitchens 446 Works and Club Canteens 277 Public Houses 162 Off Licences 51 Grocers 631 Butchers 212 Chemists 92 Greengrocers 364 Fishmongers 92 Fried Fish Shops 52 Milk Distributors and Dairies 76 Premises from which Roundsmen and Mobile Shops operate 46 Stalls in Markets 91 Food Manufactories 34 Other food premises not enumerated above 41 3,385 The following table gives a summary of the inspections made during the year, not including visits made to slaughterhouses or dairies: — Butchers 1,041 Ice Cream Vendors and Bakers and Bakehouses 406 Manufacturers 776 Confectioners 543 Greengrocers 484 Fishmongers 294 Grocers 2,127 Fried Fish Shops ... 100 Stalls and Rounds other than in Markets 126 Poultry and Game Dealers 277 Catering Establishments 1,098 Cooked Meat Miscellaneous 234 ation Premises 286 7,792 97 In addition to the above, Croydon Airport was visited on 52 occasions to inspect foodstuffs arriving by air from the Continent. Such foodstuffs included Salami, Brawn and Delicacies. Out of the 10 tons imported it was not found necessary to condemn any article. General Summary of meat and other articles of food found to be unfit and condemned by the Inspectors during 1952: Articles. Weight in lbs. Diseased. Unsound. Total. Beef 29582 7113 36695 Veal 182 38 220 Mutton 714 2360 3074 Pork 7285 704 7989 Offal 60264 572 60836 Sundry Foodstuffs — 20064 20064 Canned, bottled and packeted goods — 40272 40272 98027 71123 169150 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 98 the year 1952 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. 5,918 1,589 953 13,298 663 4,474 26,895 The result of these inspections was as follows :— CARCASES INSPECTED AND CONDEMNED Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Goats Number killed 5918 1589 953 13298 4474 663 Number inspected 5918 1589 953 13298 4474 663 All Diseases except Tuberculosis. Whole Carcases condemned 11 1 13 46 Carcases of which some part or organ was condemned 2316 447 2 1310 253 4 Percentage of the number inspected affected with disease other than Tuberculosis 39.13 28.82 .31 10.09 6.86 .6 Tuberculosis only. Whole carcases condemned 9 21 1 — 4 Carcases of which some part or organ was condemned 337 320 1 — 74 — Percentage inspected affected with Tuberculosis 5.84 21.46 .21 — 1.74 — MILK SUPPLY. During the year 197 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" 43 Licences to use the designation " Pasteurised "— (a) Dealers' (Pasteurisers') Licences 2 (b) Dealers' Licences 57 99 Licences to use the designation " Sterilised "— Dealers' Licences 86 Dealers' Supplementary Licences to use the designation— (a) Tuberculin Tested 9 (b) Sterilised 6 (c) Pasteurised 9 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 13 Pasteurised Milk 246 Sterilised Milk 7 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. 13 Nil 13 100 Pasteurised Milk. No. Samples Taken. Methylene Blue Test. Phosphatase Test. Not Satisfied. Satisfied. Not Satisfied. Satisfied. 246 6 240 Nil 246 Sterilised Milk. No. Samples Taken. Turbidity Test. Not Satisfied. Satisfied. 7 Nil 7 101 BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM. 230 samples were taken, the results being as under:— Grade. No. of Samples. 1 136 2 71 3 23 4 - Out of a total of 230 samples taken, 23 (10 per cent.) failed to reach a satisfactory standard of bacterial purity. In all cases after the results of sampling are known, the vendors and/or manufacturers are made aware of the results, and where the Gradings are 3 or 4, then a visit is made, methods of service or manufacture are investigated, faults rectified and further samples taken. CHEMICAL EXAMINATIONS OF ICE CREAM. 8 samples taken from local manufacturers were found to comply with the standard made last year by the Ministry of Food. 102 FOOD AND DRUGS ACT, 1938. During the year 322 samples of milk and 389 other samples were taken. Summary of Samples. During 1952 samples were obtained and submitted to the Public Analyst as follows:— Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Almonds, Ground 1 1 — — Apricots, Crushed 1 — 1 — — Aspirin Tablets 2 2 — — — Beans, Tinned 6 6 — — — Beef, Pressed 2 2 — — — Beef Loaf, Minced 1 1 — — — Beer 10 10 — — — Bicarbonate of Soda 1 1 — — — Biscuits 3 3 — — — Biscuits, Charcoal 1 1 — — — Black Pudding 2 2 — — — Blancmange Powder 1 1 — — — Boracic Acid Ointment 1 1 — — — Brawn 1 1 — — — Brawn, Pork 1 1 — — — Brawn, Veal 1 — 1 — — Bread 7 7 — — — Butter 1 1 — — — Butter, Peanut 1 1 — — — Cakes 8 8 — — — Cake and Pudding Mixtures 9 9 — — — Cake Decorations 1 1 — — — Camphorated Oil 3 3 — — — Carrots, Tinned 2 2 — — — Castor Oil 1 1 — — — Cheese, Processed 2 2 — — — Cheese, Spread 3 2 1 — — Cherries in Syrup 1 1 — — — Chicken in Jelly 1 1 — — — Chocolates 1 1 — — — Christmas Pudding 3 3 — — — Chutney 1 1 — — — Cider 2 2 — — — Cocoa 3 3 — — — Cocoanut 1 1 — — — Cod Roe 1 1 — — — Coffee 6 6 — — — Coffee Essence 1 1 — — — Coffee and Chicory — — — — — Coffee and Chicory Essence 5 5 — — — Confectionery 1 1 — — — Cordials 8 8 — — — Corn Flakes 1 1 — — — Cream, Synthetic 2 2 — — — Curry Powder 1 1 — — — Custard Powder 9 9 — — - Custard Tart 1 1 — — — Dates 1 1 — — — Dessert, Maple 1 1 — — — Dessert Powder 1 1 — — — Dessert Table Cream 1 — 1 — — Essences, Flavouring 2 2 — — — Fish Cakes 3 3 — — — Fish, Tinned 1 1 — — — Carried forward 132 128 4 — — 103 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought forward 132 128 4 — — Flour 1 1 — — — Fruit Pulp (Metz Fruit) 1 1 — — — Gelatine 1 1 — — — Gin 4 4 — — — Ginger Beer 1 1 — — — Ginger, Preserved 1 1 — — — Golden Syrup 2 2 — — — Gooseberries in Syrup 2 2 — — — Gravy Powder 2 2 — — — Greengages 1 1 — — — Haggis 1 1 — — — Halibut Liver Oil Capsules 1 1 — — — Herrings in Sauce 2 2 — — — Honey 1 1 — — — Ice Cream 8 8 — — — Ice Cream Lollie 2 2 — — — Ice Lollies 9 9 — — — Indigestion Tablets 1 1 — — — Iodine 2 2 — — — Iodine, Tincture of 2 1 1 — — Jam 3 3 — — — Kidneys, Braised 1 1 — — — Lemon Cheese 1 1 — — — Lemon Curd 1 1 — — — Liquid Paraffin 1 1 — — — Liver Sausage 1 1 — — — Lozenges, Throat 2 2 — — — Luncheon Meat 13 13 — — — Luncheon Sausage 2 2 — — — Macaroni 1 1 — — — Mackerel in Tomato 1 1 — — — Malted Milk Tablets 1 1 — — — Margarine 1 1 — — — Marmalade 3 3 — — — Meat Cube 1 1 — — — Meat Roll 1 1 — — — Meat Rissoles 1 1 — — — Meat, Tinned 1 1 — — — Milk 301 299 2 — — Milk, Channel Island 17 16 1 — — Milk, South Devon 4 4 — — — Mincemeat 3 3 — — — Mineral Water 1 1 — —. - Mint Sauce 1 1 — — - Mustard 1 1 — — - Oatmeal 1 1 — — - Onions, Pickled 1 1 — — - Paste 3 3 — — - Paste, Fish 2 2 — — - Paste, Chicken and Ham 1 1 — — - Paste, Meat 6 6 — — - Pastilles, Throat 1 1 — — - Pearl Barley 2 2 — — - Pears in Syrup 1 1 — — - Peas, Tinned 7 6 1 — - Peel, Mixed 1 1 — — - Pepper 3 3 — — - Pickles 6 6 — — - Carried forward 576 567 9 — — 104 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought forward 576 567 9 — _ Pineapple 2 2 - - Plums, Dried 1 1 — - - Plums, Tinned 5 5 — — - Popcorn 1 1 — — Porridge Oats 1 1 — — _ Pork Brawn 2 2 — Pork, Pressed 1 1 _ - Port 1 1 - - Prunes 1 1 _ - Pudding, Fig 1 1 — - Raisins 1 1 — Raspberries in Syrup 1 1 — — _ Rice 1 1 — Roes, Herring 2 2 - - Rum 1 1 - Rusk Crumbs 1 1 - Saccharin Tablets 1 1 - Salad Cream 1 1 _ - Salt 1 1 - Sandwich Spread 1 1 - - Sardines 1 1 — - Sauce 3 2 1 - Sausage, Beef 19 18 1 - Sausage Chipolata 1 1 — - Sausage, Ham 1 1 - Sausage, Liver 1 1 - Sausage, Pork 28 25 3 1 1 Sausagemeat 5 5 - Semolina 1 1 - 1 1 __ - 4 4 __ - Spice, Mixed 1 1 . - Spread, Tomato 1 1 - Squash 2 2 - Steak Pudding 1 1 _ - Steak, Stewed 2 2 _ - Stuffing 3 3 - Suet, Beef, Shredded 3 2 1 - Syrup 1 1 - - - Syrup of Figs 1 1 - - Tapioca 1 1 - - Tea 4 4 - - Tomatoes, Peeled 3 3 - - - Veal, Jellied 2 2 - - Veal Loaf 1 1 - - Vegetables, Mixed 1 1 - - - Vegetables, Cooked 1 1 - - - Vegetable Salad 1 1 - - - Vinegar, Malt 2 2 - - Vitamin Pellets (Multivite) 1 - 1 - - Welsh Rarebit 1 1 - - - Whisky 5 5 - - - Wine, Cocktail 1 11 - - Wine, Port Style 2 2 __ - - Wine, Raisin 1 1 - - Yeast Tablets 1 1 — — —- Totus 711 695 16 1 1 105 Result of Analysis of Milk Samples. Solids not Fat (Legal standard is 8.5%)* 8.4 8.5* 8.6 8.7 8.8 8.9 9.0 9.1 9.2 2 22 51 73 104 41 7 3 2 Milk Fat (Legal standard is 3%)* 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.1 4.2 4.3 4.4 4.4 3 5 30 46 71 68 42 15 9 8 2 2 2 1 1 (Excluding South Devon and Channel Islands milks) South Devon and Channel Islands Milks Solids not Fat (Legal standard is 8.5%)* 726* 8.8 9.0 9.2 1475 Milk Fat (Legal standard is 4%)* 3.9 4.0 4.1 4.3 4.4 4.5 5.4 1 2 4 6 2 1 1 Average composition of Milk Samples Milk (excluding South Devon and Channel Island Milks) Solids not Fat 8.69% Milk Fat 8.47%' South Devon and Channel Island Milk Solid not Fat 8.9% Milk Fat 4.3% Total number Milk Samples 322. 106 The samples of milk for analysis were obtained as follows : Taken on Milk Rounds 198 ,, at Dairies 60 ,, at Institutions 58 ,, at Local Farms 3 ,, at Schools 3 322 DETAILS OF NON-GENUINE SAMPLES TAKEN Sample No. Article Nature of Adulteration or Deficiency Action Taken 247 Cheese— Spread... Contained numerous large and small crystals of Sodium Phosphate rendering the article unfit for human consumption. This was a sample of old stock, it was not possible to obtain a formal sample, the remainder of the stock having been sold. 365 Milk Contained 16% added water. Vendor warned. 472 Processed Canned Peas The peas were infested with the pea weevil. Unfit for human consumption. Stock surrendered and used for animal feeding. 287 Multivite Pellets Deficient in Vitamin A. Contained not more than 1,250 International units of Vitamin A per pellet instead of the 2,500 specified on the label. The manufacturer agreed to withdraw outstanding stocks from sale and to amend the labelling of the products with a recommendation regarding suitable storage and also giving a date up to which the Vitamin A activity may be expected to be retained. 540 Veal Brawn Sample consisted of Jellied Veal. Not correctly described as veal brawn. Manufacturer requested to describe article in future as Jellied Veal. 580 Pork Sausages Meac, including fat, 35% instead of a minimum of 65%. Vendor prosecuted. Fines:— Vendor £5 0 0 Manager £2 0 0 Costs ... £3 17 0 132 Apricots— Crushed This article was in a highly fermented condition. The Kilner jar had not been sealed correctly. Unfit for consumption. Stock withdrawn from sale. 107 Sample No. Article Nature of Adulteration or Deficiency Action Taken 195 Dessert Table Cream This article contained sugar, cornflour, cocoa, gelatine and salt, but the cocoa was not specified as an ingredient on the label. Manufacturer has given instructions for labels to be altered. 198 Iodine— Tincture of Contained only 1.80% of potassium iodide instead of 2.5% (limits 2.45 to 2.55%) as required by the British pharmacopoeia. Stock withdrawn and packer warned. 47 Milk 1% deficient in milk solids other than milk fat. Further samples proved genuine. 85 Sausage— Pork Contained 3.5% of hard cartilaginous tissue. Manufacturers warned. 222 Sausage— Pork Contained only 52% of meat, including fat, instead of a minimum of 65%. Referred to Ministry of Food. 446 Milk Contained 8% of added water. Milk fat 3.52%. Milk solids other than milk fat, 7.96%. The freezing point (Hortvet) confirmed the presence of added water. Pasteuriser-distributor warned and recommended to more regularly sample his incoming milk. 250 Sauce— Tomato The ingredients of this tomato sauce were not specified on the label as is required by the Labelling of Food Order and the declaration as to the presence of preservative was not in its normal form. The sample contained 250 p.p.m. by weight of sulphur dioxide. This was an imported product and the Vendor withdrew stock from sale. 314 Sausages— Beef Contained 650 p.p.m. by weight of sulphur dioxide instead of a maximum of 450 parts, the limit of the Public Health (Preservatives, etc. in Food) Regulations. Vendor warned. Further samples proved satisfactory. 392 Suet— Beef, Shredded Contained 79.5% by weight of fat instead of a minimum of 83%. Manufacturer warned and will increase his fat ratio. Further samples to be taken. 108 WATER. I am indebted to the Water Engineer, W. C. Knill, Esq., B.Sc., M.I-C.E., M.I.Mech.E., M.I.W.E., for 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 Wells 2,379,270,000 M.W.B. Bulk Supplies 800,350,000 Sutton District Water Co 328,000 East Surrey Water Company 297,000 Total: 3,180,245,000 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. 430 raw water samples and 952 treated water samples were thus examined bacteriologically during the year by the Chemist and Bacteriologist on the staff of the Water Undertaking. In addition 16 samples of raw water and 47 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 109 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 63 of raw waters and 109 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 Chemical 274 12 110 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. 58,888 tons of house refuse are collected annually in Croydon and disposed of by controlled tipping. This latter is being carried out at present at the East Surrey Gravel Pits to restore the level for eventual use as school playing fields. 3,950 tons of refuse are swept and collected from the streets annually in addition to 1,034 tons of market refuse which are disposed in a similar manner. 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 Iv.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 45 vehicles, including part of the fleet of Refuse Collecting Vehicles, have been converted to run on this gas, and by this means about 60,000 gallons of petrol are saved per annum. 111 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 32 41 545 586 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. There are three Nurseries which take 2½ to 5-year-olds daily excepting Saturdays. One Nursery receives toddlers at two separate morning and afternoon sessions, the remainder being of the " part time " class receiving toddlers for mornings only. The Registered Minders receive children for the day. They are not encouraged to take children under 2 years. Number registered at 31-12-52. Number of children provided for Premises 6 125 Daily Minders 28 196 112 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 oontinued. One medical examination was carried out under the Aliens Order. Other queries arose regarding passengers who were ill whilst travelling. One case of suspected infectious disease was encountered and arrangements for subsequent admission to Waddon Hospital were made. Aircraft and Passenger Arrivals, Croydon Airport. Aircraft British Passengers Alien Passengers "Excepted Area" 1,544 1,004 295 Europe outside Excepted Area 232 80 17 South Africa, Middle East — — — Far East, Persia — — — 1,776 1,084 312 NATIONAL ASSISTANCE ACT, 1948 (Section 47). No cases dealt with during 1952. CREMATION ACT, 1902 During the year 2,156 certificates were completed by the Medical Officer of Health in the capacity of Medical Referee under the above Act. STAFF MEDICAL EXAMINATIONS. Eight hundred and sixty-seven examinations were made during the year by the Medical Staff of the Department. 113 County Borough of Croydon ANNUAL REPORT of the SCHOOL MEDICAL OFFICER For the Year ending December 31st, 1952. 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, 1952. The work of the Department has continued without major changes. Owing to resignations of Medical Officers and the inevitable intervals before new members of staff commence duty, there was a fall, in comparison with last year, of the numbers of children seen at routine school medical inspections. It will be remembered, however, that in addition to the three statutory examinations, in Croydon a fourth medical inspection covers, roughly, the period of change from infant to junior departments. Despite the general availability of the general practitioner medical service since 1948, I am still satisfied that properly conducted routine inspection sessions give opportunities for the early detection of defects and for health education which are otherwise still unobtainable. Infectious diseases, prevalent mainly in primary schools were usually mild in character. In two schools numerous cases of Sonne Dysentery occurred and required extensive follow-up of family contacts and the co-operation, most readily given, of family doctors. 114 The policy of providing subsiduary minor ailment clinics in conveniently situated schools continued, and arrangements were made for one to open in New Addington. The ascertainment of handicapped pupils and their proper educational placement were assisted by extensions to local day special schools. The position regarding residential special school places was also easier. Recommendations for recuperative holidays increased, and since this is a permissive service, they were finally limited by financial consideration. The Senior Dental Surgeon deals with the difficulties of the school dental service where merely to maintain the existing staff with an increasing school population has necessarily meant a relative weakening of the service. Speech therapy is a duty which the present staff, giving part-time service only, cannot adequately cope. However, the difficulties of the Education Committee in trying to meet greater demands from all sections with a limited budget are understood, and I must express my appreciation of their sympathetic endeavours to maintain and augment the School Health Service. I thank also the members of the Education Department for their unfailing co-operation and the School Health staff for meeting the challenge of the increasing school population with resource and zeal. 115 STAFF OF THE SCHOOL HEALTH SERVICE *Medical Officers 9 (including 1 part-time) *Dental Officers 8 (including 1 part-time) *Physiotherapists 3 Speech Therapists 2 (part-time) *School Nurses 31 (including S.H.V. and Deputy) *Dental Attendants 7 *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 Minoi 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.); Wolsey Grove, New Addington (Monday and Thursday, a.m.. Dental Lodge Road, Broad Green, Croydon; 206 Selhurst Road, South Norwood; Waldrons Hall, 55 Duppas Hill Lane, Croydon, Overbury School, New Addington. 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 (Monday and Friday, p.m.). 116 RETURN OF ATTENDANCE IN MAINTAINED PRIMARY, MODERN, CENTRAL, TECHNICAL AND GRAMMAR SCHOOLS FOR THE AUTUMN TERM, 1952 School Average No. on Roll Average Attendance Average Attendance per cent. Average 1951 Attendance per cent. COUNCIL PRIMARY SCHOOLS Ashburton Junior Mixed 534 500 93.6 93.5 Ashburton Infants 349 314 90.0 89.8 Benson Junior Mixed and Infants 542 503 92.8 93.5 Beulah Junior Boys 395 368 93.2 95.0 Beulah Junior Girls 346 321 92.8 94.5 Beulah Infants 321 290 90.0 88.2 Cypress Junior Mixed and Infants 410 372 90.7 85.6 Davidson Infants 294 264 89.7 90.2 Duppas Junior Mixed and Infants 341 303 88.0 91.4 Ecclesbourne Junior Boys 290 257 89.0 93.0 Ecclesbourne Infants 249 216 87.0 88.5 Elmwood Junior Boys 267 244 91.0 92.0 Elmwood Junior Girls 296 263 89.0 90.7 Elmwood Infants 323 282 87.0 89.1 Fairchildes Junior Mixed and Infts. 353 305 86.2 88.0 Gilbert Scott Junior Mixed 406 375 92.3 93.7 Gilbert Scott Infants 324 287 88.5 88.2 Gonville Junior Mixed and Infants 465 417 89.6 93.4 Howard Junior Mixed and Infants 451 412 91.4 91.3 Ingram Infants 242 212 87.6 90.2 Kensington Avenue Junior Mixed and Infants 341 484 89.4 91.2 Kingsley Junior Mixed 419 373 89.0 91.0 Kingsley Infants 373 318 85.2 G.I. 88.6 Monks Orchard Junior Mixed and Infants 434 399 91.9 92.4 Overbury Infants and Junior Mixed 543 461 84.8 G.I. 90.0 Norbury Manor Junior Mixed 449 421 93.7 91.8 Norbury Manor Infants 295 254 86.1 c.p. 86.9 Oval Junior Mixed 469 434 92.5 93.0 Oval Infants 227 195 85.9 G.I. 88.4 Portland Infants 292 264 90.4 92.3 Purley Oaks Senior and Junior Mixed 560 518 92.5 92.7 Purley Oaks Infants 198 173 89.9 84.3 Rockmount Junior Mixed 337 319 94.7 94.6 Rockmount Infants 269 219 81.4c.p.&G.I. 89.2 South Norwood Junior Boys 385 352 91.4 93.8 South Norwood Junior Girls and Infants 632 567 89.7 89.1 St. Peter's Junior Mixed and Infants 355 320 90.2 89.6 Spring Park Junior Mixed and Infts. 703 622 88.5 89.6 Sydenham Junior Boys 286 263 91.9 90.7 Sydenham Junior Girls and Infants 385 337 87.5 81.2 Waddon Junior Mixed and Infants 430 391 90.9 91.9 West Thornton Junior Boys 219 206 94.0 94.6 West Thornton Junior Girls 190 177 93.1 94.1 West Thornton Infants 271 234 86.3 93.3 Whitehorse Manor Junior Girls 251 226 90.3 92.5 Whitehorse Manor Infants 315 249 79.0 G.I.&M. 86.8 Winterbourne Junior Boys 353 333 94.0 95.0 Winterbourne Junior Girls 407 381 94.0 95.0 Winterbourne Infants 436 379 87.0 88.1 Wolsey Junior Mixed 507 459 90.5 93.5 Wolsey Infants 398 353 88.4 88.8 Woodside Junior Boys 445 418 93.9 95.5 Woodside Junior Girls 391 368 94.1 94.4 Woot»side Infants 367 325 88.5 90.6 Total 20,330 18,297 90.0 91.2 G.I. = General Illness M. = Mumps C.P.. — Chicken Pox M.E. = Measles S.F.. = Scarlet Fever W.C. = Whooping Cough 117 School Average No on Register Average Attendance Average Attendance per cent. Average 1951 Attendance per cent. COUNCIL SECONDARY MODERN SCHOOLS Ashburton Senior Boys 429 397 92.5 91.8 Ashburton Senior Girls 430 393 91.4 91.8 Davidson Senior Boys 261 242 92.7 93.0 Davidson Senior Girls 145 131 90.3 90.0 Ecclesbourne Senior Girls 304 261 85.9 G.I. 88.4 Fairchildes Senior Mixed 336 296 88.0 89.3 Ingram Senior Boys 345 312 90.4 92.5 Ingram Senior Girls 282 253 89.7 90.8 John Newnham Senior Mixed 241 223 92.5 91.9 Lanfranc Senior Boys 426 379 88.9 89.8 Lanfranc Senior Girls 490 441 90.0 91.8 Norbury Manor Senior Boys 336 307 91.3 92.5 Norbury Manor Senior Girls 264 244 92.4 93.9 Portland Senior Boys 171 161 94.2 94.7 Portland Senior Girls 216 197 91.2 91.8 Tavistock Senior Boys 403 359 89.1 90.2 Tavistock Senior Girls 387 345 89.1 . 86.8 Waddon Senior Mixed 391 331 84.7 G.I. 84.4 Whitehorse Manor Senior Boys 207 188 90.8 89.4 Total 6,064 5,460 90.0 90.6 St. Andrew's Vol. Sec. Mod. (Mxd.) 256 228 89.0 91.1 Our Lady's Vol Sec. Mod. (Girls) 171 150 87.7 87.4 Total 427. 378 88.5 89.3 SPECIAL SCHOOLS St. Christopher's E.S.N.) 208 181 87.0 85.8 St. Giles' (Delicate and Physically Handicapped) 196 167 85.2 88.6 St. Luke's (Partially Sighted) 30 27 90.0 90.0 Total 434 375 86.4 87.2 VOLUNTARY PRIMARY SCHOOLS All Saints'Mixed and Infants 312 265 84.9 87.2 Christ Church Junior Mixed and Infants 246 224 91.0 92.5 Parish Church Junior Girls and Infants 486 426 87.6 90.1 St. Joseph's Mixed and Infants 476 414 87.0 88.1 St. Mark's Junior Girls and Infants 157 138 87.9 90.4 St. Mary's (R.C.) Senior and Junior Mixed 360 319 88.6 91.3 St. Michael's Infants 203 169 83.2 G.I. 87.7 Shirley Junior Mixed and Infants (St. John's) 192 178 92.7 93.6 St. Mary's (R.C.) Infants 83 65 78.3M.&c.p. 85.5 2,515 2,198 87.3 90.3 118 School Average No. on Registers Average Attendance Average Attendance per cent. Average 1951 Attendance per cent. SELECTIVE CENTRAL SCHOOLS Archbishop Tenison's Senr. Mixed 291 275 94.5 94.6 Heath Clark Mixed 298 282 94.4 94.6 Total carried fwd. 589 557 94.5 94.6 GRAMMAR SCHOOLS Selhurst Boys 571 542 94.9 93.9 Selhurst Girls 520 489 94.0 95.0 John Ruskin Boys 360 338 93.8 95.1 Coloma Girls 526 487 92.5 92.4 Lady Edridge Girls 336 317 94.3 97.0 Total 2,902 2,730 94.1 94.8 TECHNICAL SCHOOLS Stanley Technical Boys 253 239 94.4 98.3 School of Building 208 195 93.7 94.7 Total 461 434 94.1 96.7 SUMMARY OF SCHOOL ATTENDANCE for the Autumn Term, 1952 Council Primary 20,330 18,297 90.0 91.2 Voluntary Primary 2,515 2,198 87.3 90.3 Council Secondary Modern 6,064 5,460 90.0 90.6 Voluntary Secondary Modern 427 378 88.5 90.8 Grammar, Central 2,902 2,730 94.1 94.8 Technical 461 434 94.1 96.7 Specials 434 375 86.4 87.2 Totals 33,133 29,872 90.1 91.3 Crosfield Nursery 43 37 86.0 94.0 119 MEDICAL INSPECTION IN SCHOOLS. The system of routine medical inspection is now as follows—■ A. Primary and Modern Secondary Schools. (1) Entrants i.e., Children admitted for the first time to a Maintained School. (2) S-year-old i.e., Children who had attained their 8th Group 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 of 8 years. (3) Primary i.e., Children in their last year of attendance Leavers in a Maintained Primary School and who have not been medically examined in that year. (4) Leavers i.e., Children in their last year of attendance (Final) in a Maintained Secondary School who have not been medically examined in that year. (5) Special Cases i.e., Children of other ages who are appar- (if any) ently defective and whom the Head Teacher and parents wish the Medic?! Officer to see at his next visit. A total of 11,573 children were examined as compared with 12,978 in 1951, and 7,921 parents attended the examinations. The percentage attendance of parents in the Entrants' group was for boys 91.1 per cent, and girls 91.2 per cent.; in the Intermediate group, boys 57.8 per cent., girls 67.0 per cent.; in the Leavers' group, boys 9.4 per cent, girls 32.5 per cent.; and in the Other Ages group, boys 74.7 per cent., girls 78.0 per cent. The total percentage of parents attending was 68.5 as againsft 68.7 last year. 842 specials and 344 re-inspections of children were carried out. 120 PARENTS PRESENT 1952 Entrants Intermediate Leavers Other Aqes and 8 to 9 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 19 13 12 12 10 15 5 8 ... ... ... ... 28 18 21 13 57 46 Arch. Tenison's ... ... ... ... ... ... ... ... 47 20 1 16 ... ... ... ... 47 20 Ashburton 24 18 20 16 24 20 102 81 25 42 25 26 23 16 151 149 Benson 33 33 31 20 ... ... ... ... ... ... ... ... ... ... ... ... 33 33 Beulah 94 71 84 62 44 22 28 18 ... ... ... ... 63 140 55 116 201 233 Christ Church . 30 21 23 17 28 31 18 25 ... ... ... ... 22 23 15 22 80 75 Coloma ... ... ... ... ... ... ... ... ... 103 ... 6 ... ... ... ... ... 103 Croydon Tech ... ... ... ... ... ... ... ... 43 ... 1 ... ... ... ... ... 43 ... Cypress 28 30 28 29 2 1 2 ... ... ... ... ... 22 6 17 5 52 37 Davidson 31 26 27, 25 38 17 6 7 ... ... ... ... 69 43 Duppas 24 32 22 31 33 19 16 ... ... ... ... ... 30 28 21 16 87 79 Ecclesbourne 77 59 73 58 58 37 ... ... 51 ... 14 128 82 263 110 Elmwood 67 53 63 48 72 63 34 41 ... ... ... ... 110 77 81 55 249 193 Fairchildes 79 67 76 61 10 2 5 1 44 24 6 4 5 12 2 10 138 105 Gilbert Scott 98 73 85 64 36 22 24 15 ... ... ... ... 50 66 41 53 184 161 Gonville 56 52 50 51 17 34 13 19 ... ... ... ... 27 34 14 25 100 120 Heath Clark ... ... ... ... ... ... ... ... 37 35 ... 1 ... ... ... ... 37 35 Howard 70 84 63 82 45 38 21 21 ... ... ... ... 44 37 33 29 159 159 Ingram 58 68 56 61 ... ... ... ... 43 70 7 28 ... ... ... ... 101 138 John Newnham ... ... ... ... ... ... ... ... 19 7 ... 3 ... ... ... ... 19 7 John Ruskin ... ... ... ... ... ... ... ... 116 ... 2 ... ... ... ... ... 116 ... Kensington Av. 41 44 41 40 6 6 ... ... ... ... ... ... ... ... ... 47 44 Kingsley 57 66 52 61 58 27 30 22 ... ... ... ... 90 53 63 44 205 146 Lady Edridge ... ... ... ... ... ... ... ... ... 65 ... 19 ... ... ... ... 65 Lanfranc ... ... ... ... ... ... ... ... 135 46 20 25 ... ... ... ... 135 46 Monks Orchard 74 54 64 48 60 24 37 19 ... ... ... ... 52 58 45 48 186 136 Norbury Manor 65 48 59 44 ... 15 ... 7 105 78 6 37 114 110 102 99 284 251 Our Lady ... ... ... ... ... ... ... ... ... 23 ... 5 ... ... ... ... 23 Oval 55 52 52 51 92 50 56 32 ... ... ... ... 30 48 19 32 177 150 Overbury 52 81 49 78 ... ... ... ... ... ... ... ... 13 16 10 14 65 97 Parish Church 58 67 48 56 41 46 18 29 ... ... ... ... 59 47 43 36 158 160 Portland 85 72 80 68 1 7 1 4 36 65 5 14 55 62 43 50 177 206 Purley Oaks 66 38 59 37 65 42 39 26 35 22 5 7 35 38 26 26 201 140 Rockmount 27 26 27 26 39 ... 33 ... ... ... ... ... ... ... ... ... 66 26 St. Andrew's ... ... ... ... 6 3 4 2 40 48 3 9 7 6 5 4 53 57 St. Joseph's 37 40 29 28 32 34 18 8 ... ... ... ... 20 29 12 17 89 103 St. Mark's 20 18 15 16 ... 13 ... 11 ... ... ... ... ... 14 ... 9 20 45 St. Mary's ... ... ... ... 10 16 7 11 14 16 4 27 26 20 14 51 58 St. Michael's 53 52 48 48 ... ... ... ... ... ... ... ... ... ... ... ... 53 52 St. Peter's 68 62 63 57 12 24 3 10 ... ... ... ... 44 24 22 21 124 110 Selhurst Gram. ... ... ... ... ... 47 ... 40 73 179 1 56 ... ... ... ... 73 226 Shirley 26 18 24 17 ... ... ... ... ... ... ... ... 8 12 7 11 34 30 South Norwood 43 33 38 32 23 ... 19 ... ... ... ... ... 43 23 32 19 109 56 Spring Park 88 88 81 81 27 46 16 38 ... ... ... ... 34 19 27 17 149 153 Stanley Tech. ... ... ... ... ... ... ... ... 94 ... ... ... ... ... ... ... 94 ... Sydenham 81 71 75 65 62 44 46 31 ... ... ... ... 81 64 67 55 224 179 Tavistock ... ... ... ... ... ... ... ... 99 85 17 45 ... ... ... ... 99 85 Waddon 31 41 28 36 38 29 19 20 22 40 3 11 30 49 19 32 121 159 West Thornton 65 51 58 44 2 34 1 25 ... ... ... ... 58 11 47 10 125 9b Whitehorse 90 114 84 98 3 44 ... 31 33 23 2 4 ... 24 21 126 205 Winterbourne 172 146 170 136 54 74 10 52 ... ... ... ... 69 66 45 47 295 286 Wolsey 54 52 48 50 ... 18 ... 13 ... ... ... ... ... ... ... ... 54 70 Woodside 64 75 54 70 123 ... 75 ... ... ... ... ... 126 99 98 79 313 174 22602 >109 2059 924 1109 908 641 608 1175 1098 110 357 1549 1365 1157 1065 o093 5480 4369 3983 2017 1249 2273 467 2914 2222 11573 PERCENTAGE OF PARENTS PRESENT AT MEDICAL INSPECTIONS Entrants Boys 91.1 91.2 68.5 ,, Girls 91.2 Intermediate Boys 57.8 61.9 ,, Girls 67.0 Leavers Boys 9.4 20.5 ,, Girls 32.5 Other Ages Boys 74.7 76.3 8 to 9 years Girls 78.0 121 HEIGHTS AND WEIGHTS, 1952. Age. Number Examined 1952 Average Height in inches. Average Weight in lbs. 1952 1951 1950 1949 1939 1952 1951 1950 1949 1939 BOYS 5 years 1364 43.0 43.0 43.4 43.2 41.8 43.0 42.8 43.7 43.4 41.5 6 „ 780 43.8 44.3 44.2 44.2 43.8 44.4 45.4 45.1 45.5 43.4 7 „ 193 48.1 47.4 48.2 46.7 45.3 54.4 51.7 53.8 50.5 47.9 8 ,, 931 50.0 50.3 50.0 50.1 49.5 58.3 59.4 58.2 58.0 55.5 9 „ 584 51.2 51.3 51.9 51.2 51.2 61.8 61.7 61.0 62.1 58.8 10 ,, 487 54.9 54.7 54.9 54.2 52.7 72.9 72.6 74.0 71.7 62.9 11 „ 499 55.3 55.5 55.2 55.6 53.7 75.3 74.7 75.4 ?5.2 68.7 12 „ 89 56.8 56.6 56.6 56.4 55.7 78.7 78.6 79.2 77.1 79.9 13 „ 6 56.7 — 59.3 57.3 58.4 91.0 91.8 82.9 81.6 14 „ 453 61.8 62.7 62.7 62.8 59.0 104.7 106.2 106.5 105.8 90.8 15 „ 443 64.4 64.4 63.8 63.6 — 114.6 115.5 113.7 113.1 — 16 „ 249 67.0 67.6 66.9 66.4 — 128.2 134.9 127.7 125.1 — 17 „ 47 67.8 69.8 68.8 68.3 — 137.4 146.1 140.5 132.6 — GIRLS 5 years 1356 42.6 42.6 43.1 43.5 41.2 41.5 41.5 .42.3 42.9 39.7 6 „ 668 43.2 44.1 43.6 44.2 42.7 42.8 43.8 43.7 44.2 41.4 7 ,, 157 47.6 47.5 47.3 47.1 44.1 52.0 52.7 51.3 49.9 43.6 8 „ 780 49.7 49.9 49.5 49.8 49.9 56.9 56.8 56.0 57.5 54.7 9 „ 522 51.0 50.8 50.6 51.3 50.9 59.6 59.5 59.5 60.7 57.6 10 „ 432 55.4 54.5 54.7 53.3 52.1 72.5 72.7 72.5 70.7 62.9 11 „ 410 55.9 55.8 55.6 56.1 53.6 77.6 76.2 76.6 76.6 68.3 12 „ 139 58.0 56.9 56.7 57.5 56.6 86.0 81.5 80.8 81.6 77.2 13 „ 25, 59.3 60.6 59.3 59.7 58.8 91.8 96.6 91.5 92.8 85.3 14 „ 353 62.0 62.4 62.2 62.3 60.3 107.7 110.0 109.2 106.4 97.9 15 „ 478 63.0 62.7 62.6 62.6 62.0 112.2 111.3 113.3 111.2 105.5 16 „ 182 64.2 64.4 64.4 — - 23.2 125.0 123.4 — — 17,, 70 64.2 64.5 65.6 — — 21.4 125.5 130.7 - 122 RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 1952 Defccts 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 22 2 0.39 17 1 0.33 Uncleanliness— Head — — — — — — Body Skin Disease 17 9 0.43 14 4 0.33 Eye Disease— Defective Vision 280 5 4.68 265 14 5.09 Squint 30 8 0.62 38 7 0.82 External Eye Trouble 14 4 0.30 15 5 0.40 Ear Disease— Deafness 15 11 0.43 9 4 0.24 Otitis Media 7 - 0.11 3 3 0.11 Other Disease 3 3 0.10 3 2 0.09 Nose and Throat— Enlarged Tonsils only 47 21 1.12 45 25 1.28 Adenoids only 33 5 0.62 22 10 0.60 finlarged Tonsils and Adenoids 141 90 3.79 119 62 3.30 Other Conditions 74 10 1.38 37 6 0.80 Enlarged Cervical Glands (not T.B.) 1 2, 0.05 1 5 0.11 Dental Defects 133 4 2.25 107 2 2.00 Speech Defects 10 10 0.33 5 6 0.20 Heart and Circulation— Organic 19 14 0.54 6 16 0.40 Functional 7 7 0.23 9 3 0.22 Anaemia 2 3 0.08 13 3 0.30 Bronchitis 15 30 0.74 2 0.04 Other Non-T.B. 40 56 1.58 2 1 0.06 Pulmonary Tuberculosis 19 9 0.48 5 3 0.15 Other Tuberculosis 6 5 0.18 1 _ 0.02 Nervous System Disorders (including Epilepsy, Chorea, etc.) 4 14 0.30 3 1 0.07 Developmental— * (a) Hernia 7 - 0.11 1 1 0.04 (6) Other 20 5 0.41 1 3 0.07 Psychological— (a) Development 10 1 0.18 3 1 0.07 (b Stability' 6 6 0.20 2 4 0.11 Deformities— Flat Feet 166 55 3.63 20 3 0.42 Posture 298 32 5.42 13 3 0.30 others 137 48 3.03 11 6 0.31 Other Defects and Diseases 92 72 2.70 20 7 0.50 Totals 1,675 541 812 211 Total Children Examined 6093 5480 123 VISION Extent of Defect Intermediate Leavers 8 to 9 years and Other Ages Total Boys Girls Boys Girls Boys Girls Boys Girls No. % No. % No. % No. 0/ /o No. % No. °/ /o % % Normal: R 1062 95.8 853 94.0 1122 95.5 1027 93.5 1489 96.1 1313 96.2 95.8 94.7 6/6ths or 6/0ths L 1077 97.1 863 95.0 1119 95.3 1039 94.6 1490 96.2 1327 97.2 96.2 95.8 6/12ths or 6/24ths R 43 3.8 43 4.7 43 3.6 65 6.0 55 3.6 47 3.4 3.7 4.6 L 29 2.6 39 4.3 49 4.1 47 4.3 54 3.5 38 2.8 3.4 3.7 6/36tlis or worse R 4 0.4 12 1.3 10 0.9 6 0.5 5 0.4 5 0.4 0.5 0.7 L 3 0.3 6 0.7 7 0.6 12 1.1 5 0.4 - - 0.4 0.5 Cost of the School Health Service. The gross cost of the medical, dental and nursing services, was £35,437. The expenditure is subject to Education grant. Cost of Special Schools. £ Schools maintained by the Council 26,384 Other Schools (not maintained by local Education authorities) 8,450 Adjustments with other authorities in respect of Specials Schools, at rate cost 1,281 £36,115 With the exception of the <£1,281 calculated at Rate Cost, the above expenditure is subject to Education grant. Cost of Milk and Meals. Meals and Milk cost £183,560. Income from pavment for meals was £90,807, making a net cost of £92,753, on which grant is paid of 100 per cent, on approved expenditure. 124 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS, 1952 (Percentages of Children examined) Condition Entrants Intermediates Leavers Other Ages and 8 to 9 yrs. All Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Circulatory System 1.1 1.0 1.6 1.3 0.9 3.3 1.5 1.2 1.0 1.6 Pulmonary System 3.0 2.2 1.7 0.8 0.9 2.7 2:4 1.5 2.2 1.9 Skin Disease 1.0 0.4 0.9 0.7 0.3 1.0 1.2 1.1 0.9 0.8 Defects of Nose and Throat 15.0 11.8 3.3 4.3 0.9 1.4 7.4 5.9 8.5 7.5 Enlarged Cervical Glands 0.8 0.1 0.5 0.6 0.3 — 1.0 0.4 0.7 0.6 Squint 1.7 1.6 0.6 0.2 0.2 0.5 0.5 1.1 0.9 1.0 External Eye Disease 0.1 0.2 0.1 0.3 0.3 0.3 0.3 0.5 0.2 0.3 Defective Vision 1.2 1.0 5.4 7.9 8.1 9.0 6.7 6.4 4.7 5.1 Defective Hearing and other Ear Defects 1.1 0.6 0.2 0.1 0.5 0.7 1.3 0.7 0.9 0.6 Speech Defects 0.7 0.4 0.1 — — — 0.6 0.2 0.4 0.2 Dental Disease (more than four decayed) 0.8 1.0 0.6 0.6 - 0.3 0.9 1.2 0.6 0.8 Dull and Backward 0.2 0.1 0.2 0.1 — 0.1 0.6 0.2 0.3 0.1 Malnutrition 5.9 7.0 4.2 4.2 3.9 2.7 6.3 4.4 5.3 5.0 Deformities 8.6 7.2 8.8 9.6 4.3 10.7 8.3 9.5 7.7 8.9 Nervous System 0.4 0.2 0.1 0.2 0.2 — 0.3 0.1 0.3 0.2 Developmental— Hernia — 0.1 0.3 — - — 0.1 — 0.1 0.1 Other 0.5 — 0.3 0.2 - 0.1 1.0 — 0.5 0.1 Psychological— Developmental 0.3 0.1 — — — — 0.2 0.2 0.2 0.1 Stability 0.2 0.2 0.1 0.2 0.1 0.1 0.1 0.2 0.1 0.2 Other Defects 2.1 1.9 2.1 2.5 1.6 3.3 3.5 2.3 2.4 2.3 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 tor the treatment of scabies and very occasionally deals with other verminous conditions. Number of children inspected for Cleanliness (first inspection) 71,475 Number of children inspected (subsequent inspections) 3,447 126 Number of children found unclean (first inspection 529 (802 occasions of infestation). Number of occasions in which children found unclean (subsequent inspections) 754 At the primary inspections vermin were found in 53 and nits alone in 749 children. On these inspections 1.1 per cent, of the children showed evidence of infestation as against 1.5 in 1951. TUBERCULOSIS IN CHILDREN OF SCHOOL AGE. Contacts among school children kept under supervision during 1952: — Number of cases under observation at beginning of 1952 168 Number of cases added during year 31 Number of cases discharged from observation during the year 4 Number of cases under observation at the end of 1952 195 Number of cases of Notified Tuberculosis— Pulmonary 15 Non-Pulmonary 2 Taking the total child population at 35,144, the pulmonary tuberculosis incident rate per 100,000 was 42.9, and the nonpulmonary incidence rate 5.7. There were no deaths from tuberculosis. CAUSES OF DEATH IN CHILDREN OF SCHOOL AGE. Child population, 35,144. Number of deaths 17, which is equal to a death-rate of 0.4(5 per 1,000. The deaths were due to Influenzal Meningitis 1 Poliomyelitis 1 Meningitis 1 Appendicitis 3 Encephalomyelitis 1 Chronic Nephritis 1 Malignant Disease 2 Cerebral Diplegia 1 Adenoidectomy 1 Intestinal Obstruction 1 Traffic Accidents 4 126 TREATMENT. The Work of the School Clinics. SUMMARY OF ATTENDANCES 1952 1951 Increase or Decrease Minor Ailments and Vcrruca Clinics 13545 12350 + 1195 Inspection Clinic 2837 2739 + 98 Dental Clinics 24096 27529 —3433 Remedial Exercises Clinic 11980 12608 — 628 Rheumatism Clinic 102 91 + 11 52560 55317 —2757 The Minor Ailments Clinics. At the Lodge Road Clinic 1,524 defects involved 6,542 attendances, while at the subsidiary Clinics held at Ashburton School 338 defects, 1,849 attendances; at Duppas School 547 defects 3,591 attendances; at Rockmount School 225 defects, 1,370 attendances ; and at Wolsey School 34 defects, 193 attendances. Complaint 1952 1951 Cases Attendances Average No. of Attendances per case Cases Attendances Average No. of Attendances per case Ringworm 7 30 4.3 15 59 3.9 Scabies 4 10 2.5 8 12 1.5 Impetigo 24 111 4.6 29 195 6.7 Other Skin Diseases 46 168 3.7 67 497 7.4 Otorrhoea and other Ear defects 175 828 4.7 131 610 4.7 External Eye Disease 259 891 3.4 200 845 4.2 Miscellaneous 1716 8203 4.8 1428 7020 4.9 2231 10241 4.6 1878 9238 4.9 1 CV7 CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS. 1952 Name of School School Population. Measles. Oerman Measles Whooping Cough Chicken Pox Mumps Scabies Impetigo Ringworm Diphtheria Scarlet Fever Dysentry Poliomyelitis Jaundice Conjunctivitis Sore Throat Indefinite Sickness Paratyphoid hrycipelas Vermin Meningococcal Total % Body Scalp All Saints 312 2 1 2 17 ... ... ... ... ... ... 3 63 ... 1 ... ... ... ... ... ... ... 80 28.5 Archbp. Tenison 291 ... 5 ... 2 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 9 3 1 Ashburton 1742 1 5 ... 15 5 ... 1 ... ... ... 3 ... ... ... ... ... ... ... ... 1 ... 31 1.8 Benson 542 7 9 7 5 23 ... ... ... ... ... 10 ... ... ... ... ... ... ... ... ... 61 11 3 Beulah 1062 38 16 8 38 18 ... 3 ... 1 ... 16 2 ... ... 2 ... 4 ... ... 25 ... 171 16.1 Christchurch 246 ... 7 ... 7 8 ... 1 ... ... ... 1 ...... ... ... ... ... ... ... ... 3 ... 27 11.0 Coloma 526 ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... 3 0.6 Crossfield Nursery 43 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croydon High 895 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 0.1 Croydon Tech. 208 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 0.5 Cypress 410 1 20 4 1 1 ... ... ... ... ... 15 ... ... ... ... ... 1 ... ... ... ... 43 10.5 Davidson 700 2 15 26 14 2 ... 3 ... ... ... 8 ... 2 ... 1 ... 1 ... ... 11 ... 85 12.1 Duppas 341 ... 6 2 4 5 ... ... ... ... ... 2 ... ... ... ... ... 1 ... ... ... ... 20 5.9 Ecclesbourne 843 17 3 10 31 7 ... ... ... ... ... 25 ... ... ... ... ... 1 ... ... 4 1 99 11.7 Elmwood 888 16 15 2 8 9 ... 1 ... ... ... 9 1 ... ... 2 ... ... ... ... 9 ... 72 8 1 Fairchildes 689 ... ... ... ... ... ... ... ... ... ... 9 1 ... ... ... 1 ... ... ... ... ... 4 0.6 Gilbert Scott 730 ... 2 ... 6 69 ... ... ... ... ... 3 ... 2 ... ... ... 2 ... ... ... ... 84 11 5 Gonville 465 ... 3 31 1 ... ... ... ... ... ... 14 ... ... ... ... ... ... ... ... ... ... 49 10.5 Heath Clark 298 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 0.3 Howard 451 13 14 2 15 6 ... ... ... ... ... 7 ... ... ... ... ... ... ...... ... ... 57 12.6 Ingram 869 3 1? 5 9 8 ... ... 1 1 ... 10 ... ... ... ... ... 6 ... ... 7 ... 61 7.0 John Ruskin 360 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 0.3 Kensington Av 341 ... 1 1 10 2 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 16 4.7 Kingsley 792 9 16 18 5 14 ... ... ... ... ... ... ... 1 ... ... ... 6 ... ... ... ... 72 9.1 Lady Edridge 336 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 3 0.9 Lanfranc 916 2 1 ... 7 3 ... ... ... ...... ... ... ... ... 1 ... ... 2 ... ... 1 ... 17 1.9 Monks Orchard 434 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... New Addington 543 ... ... 4 1 ... ... 1 ... ... ... 4 ... ... ... ... ... ... ... ... ... ... 10 1.8 Norbury Manor 1334 29 16 4 ?8 15 ... 1 3 1 10 ... ... ... ... ... ... ... ... 2 ... 109 8.2 Old Palace 415 ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 2 0.5 Our Lady's 171 ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 2 1.2 Oval 696 1 16 16 44 9 ... 1 ... ... ... ... 1 ... 1 ... ... 2 ... ... ... ... 91 13.1 Parish Church 486 19 5 ... 11 4 ... ... ... ... ... 4 ... 1 ... ... ... ... ... ... ... ... 45 9.3 Portland 679 ... 6 ... 2 ... ... 1 ... ... ... 6 ... 1 ... ... ... 4 ... ... ... ... 19 2.8 Purley Oaks 758 1 2 11 20 6 ... ... ... ... ... 2 ... ... 1 ... ... ... ... ... 2 ... 45 5.9 Rockmount St. Andrew's 606 256 74 1 22 6 19 1 1 3 18 ... ... ... 1 ... 2 ... ... ... ... ... 7 ... ... ... ... ... ... ... 1 ... ... ... 6 ... ... ... ... ... 1 ... ... ... 152 12 25.1 4.7 St. Christopher's 208 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 4 1.9 St. Giles' 196 1 2 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 7 3.6 St. Joseph's 476 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 0.2 St. Luke's 30 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3.3 St. Mark's 157 ... 8 ... ... ... ... ... ... ... ... 8 ... ... ... ... ... ... ... ... 10 ... 26 16.6 St. Mary's R.C. 83 ... ... 1 13 ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... 17 20 5 St. Michael's ?03 14 4 9 3 4 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 36 17.7 St. Peter's 355 ... 3 15 15 34 ... 1 ... ... ... 6 ... ... ... 1 2 ... ... ... ... 77 21.7 Selhurst Gramm. 1091 ... ... ... 1 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 4 0.4 Shirley . 192 ... ... ... 2 ... ... ... ... ... ... ... 5 ... ... ... ... ... ... ... ... ... 7 3.6 South Norwood 1017 4 25 1 3 7 ... 3 2 ... ... 12 ... 2 ... ... ... 1 ... ... 6 ... 67 6.6 Spring Park 703 67 ... ... 2 1 ... 2 ... ... ... 17 ... ... ... ... ... ... ... ... 1 95 13.5 Stanley Tech 253 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sydenham 671 ... 1 ... 1 ... ... ... ... ... ... ... 2 ... ... ... ... 3 ... ... 9 ... 20 3.0 Tavistock 790 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 ... 12 1.5 Waddon 821 28 41 ... 57 20 ... ... ... ... ... ... 4 ... ... 1 ... 2 ... ... ... ... 151 18.6 West Thornton 681 3 6 1 6 3 ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ?4 3.5 Whitehorse Manr 773 2 4 2 7 6 ... ... ... ... ... ... 24 ... ... ... ... 3 ... ... 6 ... 54 7.0 Whitgift Gram. 777 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whitgift Middle 516 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Winterbourne 1196 1 19 2 38 ... ... ... ... ... 19 ... ... ... ... ... ... ... ... ... ... 81 6.8 Wolsey 905 ... 2 4 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 1.0 Woodside 1203 20 ? 1 78 10 ... ... ... ... ... ... ... ... ... ... 115 9.6 Totals 378 345 211 534 314 .. 23 9 3 ... 290 38 84 -9 4 10 46 ... ... 110 2 2374 12 128 CHIEF CAUSES OF EXCLUSIONS FROM SCHOOL Condition Exclusions during 1952 Percentage of total exclusions Exclusions during 1951 Percentage 'of total exclusions Ringworm 12 0.51 14 0.39 Verminous Conditions 110 4.63 121 3.36 Impetigo 23 0.97 32 0.89 Scabies — — 8 0.22 Scarlet Fever 290 12.22 271 7.53 Measles (inc. German) 723 30.45 1204 33.44 Diphtheria — — — Whooping Cough 211 8.88 233 6.47 Chicken Pox 534 22.49 971 26.97 Mumps 314 13.23 635 17.63 External Eye Disease 10 0.42 20 0.55 Sore Throat 2 0.08 4 0.11 Other Causes 145 6.11 88 2.44 Total 2374 — 3601 — The figures for exclusions are not related in any way to figures obtained in routine medical inspections. These figures show a slight increase in Scarlet Fever a Other Causes, whilst the remainder all show a decrease. School Visits. Visits to School Departments re Cleanliness 720 Visits re Scabies 1 Visits re Infectious Disease 81 Visits re Medical Inspections 750 All other reasons 884 Home Visits. Concerning defects found at routine medical inspections 1,8(54 Subsequent visits re defects found at routine medical inspections 576 Visits re special cases 824 Visits to dental cases 22 Visits other than infectious cases 1,139 Visits in connection with infectious cases (including 405 visits concerning uncleanliness) 4,504 129 SCHOOL DENTAL SERVICE. Report of the Senior Dental Surgeon, Mr. P. G. Oliver. 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 more children than ever before visited the local clinics there has been an appreciable loss of ground by the Service during the year, and a consequent slowing down of "routine" treatment. This recession has been caused by the increased time required for dealing with "emergency" and other "priority" cases, together with the overall rise in the school population. As a result fewer schools were visited and the time lag between inspections has increased; in extreme cases this has now extended beyond the two year period, whilst the average interval is in the region of 18 months. Because of their cumulative effect recent delays must further prejudice the position of those at present awaiting attention, and generally reduce the effectiveness of treatment. Though full time staff is still in short supply there has been a noticeable increase in offers of part-time assistance from outS|de practitioners. Unfortunately, such help has been somewhat 'imited in scope and duration, and because of a continued lack of surgery accommodation no major increase of personnel has been possible. Apart from the promotion of one part-time dentist to whole time status the total staff, equivalent to that of six full-time officers, remained approximately the same as in the previous year. 130 Allowing for Maternity and Child Welfare requirements the above Establishment still entails a panel of upwards of 6,000 children per dental officer, or twice that considered reasonable to permit the carrying out of an annual inspection and treatment. The most pressing need is for an increase in surgery accommodation to permit the requisite expansion necessary for removing existing anomolies (in staffing) and bringing the service into line with present day requirements. Though acquisition of suitable personnel is likely to remain a long term problem, improvements in premises and working conditions would do much to attract applicants with the necessary qualifications and experience. On the credit side the new full-time clinic opened at the Overburv School in September last is fulfilling a long felt need and has proved an unqualified success. These premises should cater adequately for those attending schools on the New Addington Building Estate whilst at the same time reducing the pressure on remaining clinics. Eollowing developments at New Yddington a reorganisation of sessions worked by part-time officers has been possible at Lodge Road Clinic, which will in turn provide accommodation for a further full-time dentist and additional part-time sessions. Proposals for a hew Dental Centre to serve the eastern side of the Borough have received general approval and it is hoped that more detailed plans can be submitted in the near future. The above project represents a further stage in the 1946 Plan of Development for meeting the requirements of the Woodside, Shirley and Monks Hill districts, reasons for which were fully explained in last year's Report. Difficulties continue to be experienced in providing adequate attention for those children presenting very marked deformities of the teeth and jaws; owing to lack of suitable accommodation little progress has been possible as regards specialist treatment for these cases. A fuller assessment of such requirements will be found in a later section of the Report. 131 A programme for improving surgery amenities and equipment has been commenced during the year and will be progressively extended to include all existing clinics. Shadowless operating lights have been installed in two surgeries which will materially reduce eye strain to both dentist and patient. An experiment to test certain new forms of surgery illumination is being carried out at the New Addington Clinic and should also assist in this respect. Visits paid by Representatives of the Ministries of Health and Education have, as usual, been most helpful in formulating future policy and clarifying certain aspects of administration. Inspections. The number of children on the register at Primary and Secondary Schools withi'n the Borough at the close of 1952 was 33,133. Including an additional 109 free-place scholars at r.onmaintained schools, this represents a sum total of 33,242. During the year 63.4 per cent, of the school population were examined, compared with 78.5 per cent, in 1951, showing a reduction of 15.1 per cent. As stated previously this was in fact due to the larger number requiring to be seen and also the inability of existing staff to keep abreast of treatment. Because of these handicaps some 8,900 children received no examination and schools can now only be revisited on an average every 18 to 20 months, compared with 15 to 18 months previously. At those schools visited 20,996 were inspected and 10,723 (51 per cent.) referred for treatment, compared with 24,961 inspected and 12,960 (51.3 per cent.) referred in 1951. In view of present limitations relating to 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. 132 The results obtained from school inspections were as follows : — Acceptance of Treatment 64.0% Refused Treatment 24.6% Forms Not Returned 11.4% As indicated there has been a further fall of 4 per cent, in the acceptance rate, making a total decrease of some 10 per cent, since the peak of 1949. The fact that the above decline is chiefly discernable in the more understaffed areas is a clear reflection of parental anxiety at the slow progress of treatment. An additional reason is that with less frequent visits to schools there is a corresponding loss of interest in the value of conservative treatment. The following Table demonstrates the variation in the acceptance rate during recent years : — RESULTS OF SCHOOL INSPECTIONS. 1952. 1951. 1949. 1943. 1937. No. referred for— Treatment 10723 12920 9404 9041 13498 Consents 6867 : 64% 8790 :68% 6996 : 74.4% 5642 :62.4% 7762 : 57.5% (Total Consents Including Specials)* 9727 :71.6%) (11358:73 3%) (10098:80.7%) (6814 : 67%) (10146:63%) Refusals 2639 :24.6% 2390 :18.5% 1213:12.9% 1519 : 16.8% 3242 : 24% Forms Not Returned 1217 :11.4 % 1740 :13.5% 1195:12.7% 1880 : 20.8% 2494:18.5% * Specials.—Those referred by Head Teachers with Emergency Forms Arrangements for Treatment. Of 13,583 children referred for treatment (including specials) 10,493 (77.2 per cent.) were treated and 8,318 (61.3 per cent.) cured completely, compared with 15,488 referred, 10,067 (65 per cent.) treated and 8,353 (54 per cent.) cured in 1951. As a result of one part time dentist changing to full time status overall treatment sessions rose from 2,260 to 2,452. Part time assistance declined somewhat from 814 to 753 sessions. Whilst most treatment figures show a corresponding increase, the index of fillings inserted suffered a slight set-back, by falling from 107.7 to 106.9 per 100 children treated. 133 In addition to time spent on "emergency" measures, a contributing cause of the slowness of "routine" treatment has been the very large number of requests from parents for advice concerning their "offsprings" immediate dental conditions. Until these cases have been actually examined it is often impossible to assess the degree of urgency involved, and for this reason it would be imprudent for these requests to be ignored. Despite prevailing conditions it is highly desirable that reasonable provision should be made for the requisite information to be obtainable at the time it is needed, rather than that the matter should wait upon administrative convenience. It is also felt that contact with such parents is of inestimable value, even though a complete solution of their problems may not always be possible at the time. Items of Treatment The ensuing Table gives particulars of the principal items of treatment compared with those obtained last year: — 1952 1951 Attendances 24,096 22,234 T reated 10,493 10,067 Re-treated 5,486 5,329 Fillings—Permanent 8,234 8,191 Temporary 2,989 2,658 No. of Teeth Filled—Permanent 7,676 Temporary 2,878 Extractions—Permanent 1,947 1,661 Temporary 10,609 10,116 Gas Administration 4,440 4,024 Local Anaesthetics 1,716 1,612 Other Operations—Permanent 8,161 6,827 Temporary 2,874 3,531 Cases Completed 8,318 8,353 134 Miscellaneous Operations These include: — 1952 1951 Root treatment in anterior teeth 26 55 Removal of nerves under local anaesthetic 15 23 Gingivectomy 1 2 Removal of bone sequestra 6 10 Splints for fractured incisors 6 11 Partial pulpotomy 3 5 Number of M.D.s treated 44 58 Dentures inserted 56 61 Denture repairs 9 — Irrigation of sockets 34 35 Removal of impacted and difficult teeth 43 29 Ulcerated Stomatitis (Vincent's infection) 26 26 Cleft Palate 1 — Application of Penicillin "Cones" 35 28 Crowns for Incisor Teeth 14 1 Forms from Head Teachers. The number of forms issued by Head Teachers for emergency treatment was 2,860 compared with 2,568 in 1951. X-Ray Examinations. The number of cases referred to Mayday Hospital for the above purpose was 140, compared with 155 in 1951. Orthodontic Service The demand for the above treatment has now reached very substantial proportions and constitutes a major problem in children's dentistry. Whilst in the past there has been a general tendency to rate this work at a purely aesthetic level, recent research in jaw development has shown conclusively that this viewpoint represents but a "half truth." In addition to the psychological benefit to the patient of improving more obvious defects, there are in practice many mouths in which function cannot be adequately restored, without measures to achieve a reasonable balance of articulation. 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 135 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. 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 anc generally advise on procedure. Such an arrangement woulc 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 228 compared with 180 last year. The following is a summary of treatment performed: — 1952 1951 Cases under Treatment 390 320 New Cases 174 169 Cases Completed 126 99 Attendances 2,752 2,319 Appliances—Fixed 30 16 Removable 228 191 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 :— 1952 1951 Attendances 269 183 New Cases Treated 28 38 Re-treated 81 47 Fillings—Permanent 178 110 Extractions—Permanent 47 19 Temporary 14 16 Other Operations 52 38 "Gas" Cases 19 11 Local Anaesthesia 19 7 Cases Completed 69 68 Dentures Fitted 3 — Referred X-Ray 7 2 136 Summary of Work Done at the Selhurst Road Clinic. 1952 1951 Attendances 2,887 2,925 Extractions 1,661 1,582 Fillings: 1,232 1,084 Other Operations 2,044 2,182 "Gas" Cases 371 411 Local Anaesthesia 555 481 Cases Completed 1,089 1,062 Sessions held : Inspection 38, Treatment408, Gas 28. The average attendance at this Clinic per session is 7. Summary of Work Done at the Waldrons Clinic. 1952 1951 Attendances 3,737 3,532 Extractions 1,950 1,781 Fillings 1,702 1,383 Other Operations 1,297 1,190 "Gas" Cases 699 646 Local Anaesthesia 143 109 Cases Completed 1,054 898 Sessions held : Inspection 11, Treatment 364, Gas 49. The average attendance at this Clinic per session is 10.3 DENTAL DEFECTS. (1) Number of children who were:— (a) Inspected by Dental Officer: Year 1952 Year 1951 Aged 5—6 1,541 Total: 20,996 2,008 „ 6—7 2,353 ... 2,633 „ 7—8 2,038 2,817 „ 8—9 2,252 2,688 „ 9—10 2,204 2,709 „ 10—11 1,949 2,228 „ 11—12 1,885 2,097 „ 12—13 1,722 2,238 „ 13—14 1,636 1,995 „ 14—15 1,523 1,848 „ 15—16 1,140 1,255 ,, 16 up 753 445 Specials ... 2,860 2,568 23,856 27,529 137 Year 1952 Year 1951 (b) Found to require treatment 13,583 15,488 (c) Actually treated 10,493 10,067 (2) Half-days devoted to Inspection 154 195 Treatment 2,452 2,260 2,606 2,455 Number of Gas Sessions 296 257 Administrative Sessions 104 96 Orthodontic Sessions 228 180 (3) Attendances made by children for treatment 24,096 22,234 (4) Fillings— Permanent teeth 8,234 8,191 Temporary teeth 2,989 2,658 (5) Extractions— 11,223 10,849 Permanent teeth 1,947 1,661 Temporary teeth 10,601 10,116 12,548 11,777 (6) Administrations of general anaesthetics for extractions 4,440 4,024 (7) Administrations of local anaesthetics for extractions 1,716 1,612 (8) Other Operations— Permanent teeth 8,161 6,827 Temporary teeth 2,874 3,531 11,035 10,358 Attendances per sessions 9.8 9.8 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 385 together with 3,144 who were given re-inforcing injections. 138 SPINAL AND OTHER REMEDIAL CLINICS. 1952 Av. att. 1951. Attendances. Sessions. Attendances. Sessions. Av. att. Spinal 5,910 1,166 5.1 5,527 976 5.7 Flat Feet 3,345 600 5.6 3,684 585 6.3 Breathing 2,307 444 5.2 1,913 369 5.2 11,562 2,210 11,124 1,930 418 individual cases were treated and 1,117 attendances were made to see doctor. RHEUMATISM CLINIC. The total number of children whose names were on th< "live" register at the end of 1952 was 53 (males 22, females 31), Of this number, 50 attended the Rheumatism Clinic during the course of the year, either as new cases or re-examinations; th< remaining: 3 failed to keep their appointments. Cases Examined at Rheumatism Clinic. 1948. 1949. 1950. 1951. 1952 Primary 31 37 24 22 4 Re-exams. 27 76 84 53 46 Totals 58 113 108 75 50 Primary Cases. Rheumatic 22 30 17 19 4 Non-Rheumatic 4 3 7 1 — Doubtful Rheumatic 5 4 — 2 — Totals 31 37 24 22 4 139 Classification of Rheumatic Cases. Males Primary. Re-examinations. 1 20 (plus 1 non- rheumatic) Females 3 19 (plus 6 non- rheumatic) Totals . 4 39 ( + 7) Ages: 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Ttl. Rheumatic : Primary 1 2 1 4 Re-exams — 1 3 2 2 5 7 10 7 7 1 45 Others 1 1 1 14 The average age of primary cases of rheumatism, on first attendance at the clinic, was 7.5 years for both boys and girls. Grouping of Cases. 1950 1951 1952 Mild and Prim. Re's. Ttl. Prim. Re's. Ttl. Prim. Re's. Ttl. Potential 5 52 59 15 20 35 3 25 28 Definitely Active 1 4 5 1 2 3 — 2 2 Quiescent . 9 18 27 1 25 26 1 12 13 Doubtful or Non-Rheumatic 7 10 17 5 6 11 7 7 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. 140 Primary Examinations. Amongst the 4 new cases diagnosed as rheumatic the following manifestations were recorded: — Girls Boys Total Rheumatic pains 3 1 4 Chorea (definite) 1 — 1 Carditis (definite) — — — Carditis (suspected) — — — Tonsillitis and Infected Tonsils — — — Pyrexial attacks — — — Erythema Nodosum — — — Recent Rheumatic Fever — — — Family Histories. Of the primary cases, none gave a history of rheumatism in parents. Nervous Conditions. Girls Boys Total Highly strung 1 — 1 Headaches 1 — 1 Night terrors 2 — 2 Enuresis — — — Minor degrees of nervous disorders 1 — 1 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 3 1 Referred to Paediatrician — — ,, ,, Cardiologist — — „ ,, Psychiatrist — — Restriction as to P.T. and games 1 — For T. and A. operation — — Convalescent Home — — Remedial Exercises — — For admisison to St. Giles' — — 141 ST. GILES' SCHOOL FOR PHYSICALLY HANDICAPPED AND DELICATE CHILDREN I am indebted to the Head Teacher, Miss Lambert for the following report:— The outstanding feature in the life of the school this year has been the opening of the new block of buildings to provide accommodation for fifty additional children. The block consists of two classrooms, a General Purposes room and cloakrooms. One classroom is also equipped for General Science; and the General Purposes Room has equipment for Domestic Science. Needlework and Tailoring. These rooms are specially suitable for Senior Pupils and their design, decoration and equipment are very pleasant and greatly appreciated. The new buildings were opened in June when fifty children were admitted mostly in the 5-8 years age range, so that the more Junior classes had to be formed and considerable regrading done throughout the lower school. For parties of Seniors the Youth Education Officer has arranged visits to Engineering Works, to the Central Telephone Exchange, to a hospital and to a department store. A group of Seniors also, by kind permission of the Chief Education Officer, saw the Sadlers Wells Ballet. The younger children have been generously entertained by the girls of Croydon High School and these have been very welcome visitors to St. Giles' School. A choir group has taken part in the Schools' Carol Service and in the Schools' Musical Festival at the Civic Hall. Throughout the year visits have been paid in holiday times, by pupils with the Staff to concerts, art galleries, theatres, museums and other places and events of interest. Physical Education in addition to the usual and special exercises has included Football, Cricket. Netball. Rounders and Tennis. The boys had. again, the previlege of three periods of training from the F.A. coach. An outdoor Agility Apparatus was installed for the younger children. An average of 20 children and 5 Staff attended the Central Baths for the weekly Swimming Instruction. In June the School was happy to welcome 200 visitors to the Annual Sports Meeting Old Scholars keep well in touch with the School and it is gratifying to know that the great majority are happy in self-supporting employment. The Staff very much appreciates the continued co-operation and friendship of the parents with whom several very enjoyable and helpful Parent-Teacher gatherings have taken place during the year. DISABILITIES AND TREATMENT. In the School there have been 70 children disabled by cerebral palsy, poliomyelitis, tubercular bone disease and by other causes. Twenty-six children suffered from cardiac disability and 67 from respiratory disorders. The remainder were delicate from various causes. Physiotherapy has been given on 4 days per week. Other treatments, as prescribed, have been given by the Nursing Sister who also treats Minor Ailments daily, supervises physical welfare, keeping all necessary records of individual progress. The appointment of a Male Attendant has now made it possible for a number of severely disabled boys to have the benefits of school life from which their disability had previously excluded them. The system of medical inspection provides that each child is examined at least once every 6 months and more often if desirable. There have been 22 inspections during the year at which 371 children were examined, an average of 17 on each occasion. An average of 9 parents attended each examination. Parents, children and the Staff of the School desire to record their very grateful appreciation of the devoted work of Dr. Hegarty at these examinations and in the follow-up entailed by them. The Head Teacher wishes to record her thanks to the Chief Medical Officer and his Staff, the Chief Education Officer and his Staff and to the Staff of St. Giles' School for guidance, help and co-operation during the year. Average number on roll 185 Admission during year 75 Left for : — Employment 13 Grammar School 1 Technical School 1 Other vocational training 2 Ordinary School 8 25 142 ST. CHRISTOPHER'S SPECIAL EDUCATIONALLY SUB-NORMAL SCHOOL. I am indebted to Mr. Ramsden, the Head Master, for the following observations: — This past year of 1952 has been rather a quiet year of steady progress in the 3 R's, after the thrill and excitement of our Croydon Project. We have had two new ventures this past year—first, the commencement of the House System in the School. Boys and Girls have been divided into four Houses—St Andrew and St. George for boys and St. David and St. Patrick for girls, with Blue, Yellow, Red and Green for colours. The first year's working has proved an unqualified success, and St. George House became the first holders of the House Trophy. Our second venture was the holding of the School's First Sports on the Barclay Bank Sports Ground, Norbury. There was great enthusiasm and keen competition for the Sports Shield, presented by Alderman Aston, Mayor of Croydon, and the Fisher Cup, presented by the School Attendance Officer, Mr. Fisher; George House again being winners by a narrow margin. Six children from the School took part in the Croydon School Sports and we gained a Second place in the girls' 100 yards race. On June 10th, we welcomed Dr. Birchall, Deputy Medical Officer, to the School, and hope that we may long have the pleasure of his company. We again made our Annual Trip to Littlehampton, and the excellent discipline on these occasions reflects great credit on the general work of the staff throughout the year. On March 11th we opened our new extension, long looked forward to and now in full working order. During the year we held a Folk Dancing Display, a Garden Fete for School Funds, an Open Day, when we were visited by the Chairman of the Education Committee, Alderman and Mrs. Cole, and our Sixth Annual Carol Service and Tableaux. Our Christmas Party was attended by the Mayor, Alderman Arkell, and by the Chief Education Officer, Mr. Herbert Roberts. The Youth Employment Officer visited us at the end of each term, and all children leaving school were found places of employment. Our two outstanding boys were, respectively, found work with the Post Office as Telegraph Boy and with the Y.M.C.A. farming course. We hear that both are making a success of their new work. We intend to make 1953, Coronation Year, a memorable year in our 44 years' history. Number attending January 1st, 1952 202 ,, ,, December 31st, 1952 210 ,, referred to Public Elementary Schools ... 3 Number discharged : (i) Ineducable and referred to Mental Health Committee 6 (ii) Unfit to work ,, ,, ,, — (iii) Fit to work ,, ,, ,, 8 143 CLINIC FOR EDUCATIONALLY SUB-NORMAL CHILDREN. 286 children were examined during 1952. 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 17 (b) Found to be mentally defective and referred to Local Authority for Statutory Supervision 3 (c) Recommended Institutional Care and referred to Local Authority 6 (2) Found to be educationally sub-normal: (a) Recommended to St. Christopher's Special School 37 (b) Recommended to Residential School 4 (c) Referred to Slow Stream in Ordinary Elementary School 18 (d) Recommended for re-test 47 (e) Deferred for Medical Treatment 3 (f) Recommended for St. Giles' 3 (g) Recommended Epileptic Colony 1 (h) Referred back to Ordinary Elementary School 85 (3) Referred to Child Guidance Clinic 18 (4) Examined for other Authorities 3 245 Mental Tests at St. Christopher's 41 286 144 HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS OR BOARDING IN BOARDING SCHOOLS. 1952 Blind Partially Sighted Deaf Partially Deaf Delicate Physically Handicapped Educationally Sub-normal Maladjusted Epiletic Total In the Calendar year:— (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) A. Handicapped Pupils newly placed in Special Schools or Homes 1 6 5 3 49 53 45 2 2 166 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Homes 1 3 3 1 33 23 48 2 2 116 On or about December 1st:— C. Number of Handicapped Pupils from the area: (i) attending Special Schools as Day Pupils 27 6 8 85 109 202 437 Boarding Pupils 1 — 6 2 6 3 5 3 3 29 (ii) Boarded in Homes — — — — — — — — — — (iii) attending assisted schools (under approved arrangements) — — 3 2 — 2 — 4 — 11 Total (C) 1 27 15 12 91 114 207 7 3 477 D. Number of Handicapped pupils being educated under arrangements made under Section 56 of the Education Act, 1944— (a) in hospitals — — — — — 7 — — — 7 (b) elsewhere — — — 1 10 5 2 — — 18 E. Number of Handicapped pupils from the area requiring places in special schools (including any such unplaced children who are temporarily receiving home tuition) — — 4 2 8 11 24 — — 49 Number of children reported during the Calendar Year: Under Section 57(3) of Education Act, 1944 22 „ „ 57(4) „ „ ,, — „ „ 57(5) ,, „ „ 5 145 JUVENILE EMPLOYMENT RETURN. The following numbers of children were examined by the medical officers during 1952 as to their fitness to following the part-time employment indicated: — Delivery of Goods for Shopkeepers 1952 1951. 1950. 1949. 1948. 74 72 71 218 190 Delivery of Newspapers 338 225 323 283 375 Delivery of Milk 32 30 29 16 33 Shop Assistants 118 133 104 — — 562 460 527 517 598 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT. During 1952 all milk was supplied free of charge, and approximately 25,000 children per day received l/3rd pint each. This was equal to 87 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 1952 was approximately 14,100. CHILD GUIDANCE CLINIC. Return of Cases referred by the School Medical Officer and the Education Department, from 1st January to 31st December, 1952. Total number referred Boys. Girls. 59 37 Analysis of the above Cases :— Diagnostic only 5 6 Current Cases under treatment 29 18 Cases Closed—improved 11 4 Cases Closed—not improved 14 9 59 37 146 Speech Defects Clinic. Cases treated 128 Cases discharged 54 Cases still attending 74 Cases referred for physical treatment 10 Cases referred for residential treatment 3 Cases referred to Child Guidance Clinic 3 Stammerers 11 Cleft palate and allied disorders 5 Sigmatism 12 Deafness 3 Dyslalia 51 Undeveloped speech 31 Dyspituitary 1 Aphasia 2 Post-Meningitis 1 Dysarthria 10 Mongolism 1 Speech Therapy is limited to 6 sessions per week for the whole school population and undoubtedly an additional full-time Assistant Speech Therapist is required. With an additional member of staff, more visits to schools could be carried out and continuous treatment sessions held at a whole-time Speech Therapy Clinic. The two part-time Therapists now employed are both of high professional ability and have extensive experience, but clearly cannot cope within their session with all that is needed. It is hoped that this essential expansion of the service will be accomplished in the near future. NON-MAINTAINED SCHOOLS. The usual arrangements for the medical inspection of nonmaintained school children were continued in 1952, 121 children were examined. Table II of Appendix B gives the detailed findings. Yours faithfully, S. L. WRIGHT, School Medical Officer. 147 APPENDIX A. MEDICAL INSPECTION RETURNS. Year ended 31st December, 1952 Table I. MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. A.—Periodic Medical Inspections. Number of Inspections in the prescribed Groups: Entrants 4,369 Second Age Group 2,017 Third Age Group 2,273 Total 8,659 Number of other Periodic Inspections 2,914 (8-9 years). Grand Total 11,573 B.—Other Inspections. Number of Special Inspections 3,709 Number of Re-Inspections 4,488 Total 8,197 C.—Pupils found to require Treatment. (Excluding Dental Disease and Infestation with Vermin). Group (1) For defective vision (excluding squint) (2) For any of the other conditions recorded in Table IIA. (3) Total individual pupils. (4) Entrants 47 682 723 Second Age Group 132 246 366 Third Age Group 192 219 392 Total (prescribed groups) 371 1147 1481 Other Periodic Inspections including 8 to 9 years 174 202 371 Grand Total 545 1349 1852 148 Table II. A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION. Defect Code No. Defect or Disease Periodic Inspections Special Inspections* No. of defects No. of defects Requiring treatment Requiring to be kept under observation, but not requiring treatment Requiring treatment Requiring to be kept under observation, but not requiring treatment (1) (2) (3) (4) (5) 4 Skin 31 13 5 2 5 Eyes— (a) Vision 545 19 53 — (b) Squint 68 15 1 3 (c) Other 9 3 — — 6 Ears— (a) Hearing 24 15 6 2 (6) Otitis Media 10 3 1 — (c) Other 6 5 2 3 7 Nose or Throat 518 329 59 19 8 Speech 15 16 6 5 9 Cervical Glands 2 7 1 — 10 Heart and Circulation 56 46 9 5 11 Lungs 55 86 4 1 12 Developmental— (a) Hernia 7 — 1 1 (b) Other 20 5 1 3 13 Orthopaedic— (a) Posture 298 32 13 3 (b) Flat foot 166 55 20 3 (c) Other 137 48 11 6 14 Nervous System— (a) Epilepsy 1 3 3 1 (b) Other 3 11 — — 15 Psychological— (a) Development 10 1 3 1 (ft) Stability 6 6 2 4 16 Other 92 72 20 7 * These figures refer to Special Inspection in school only. 149 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 4369 1176 26.9 2913 66.7 280 6.4 Second Age Group 2017 844 41.8 1089 54.0 84 4.2 Third Age Group 2273 300 13.2 1897 83.5 76 3.3 Other Periodic Inspections including 8 to 9 years 2914 908 31.2 1848 63.4 158 5.4 Total 11573 3228 27.9 7747 66.9 598 5.2 Table III. INFESTATION WITH VERMIN. (i) Total number of examinations in the schools by the school nurses or other authorized persons 74922 (ii) Total number of individual pupils found to be infested 582 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 12 (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) 150 Table IV. GROUP 1.—DISEASES OF THE SKIN (excluding uncleanliness, for which see Table III) Number of cases treated or under treatment during the year. By the Authority. Otherwise. Ringworm—(i) Scalp 1 — (ii) Body 6 — Scabies 4 — Impetigo 24 — Other Skin Diseases 46 — Total 81 — GROUP 2.—EYE DISEASES, DEFECTIVE VISION AND SQUINT. Number of cases dealt with. By the Authority. Otherwise. External and other, excluding errors of refraction and squint Errors of Refraction (including squint) 259 — — 1411 Total 259 1411 Number of pupils for whom spectacles were (a) Prescribed — 1100 (ft) Obtained — 1100 GROUP 3—DISEASES AND DEFECTS OF EAR, NOSE AND THROAT. Number of cases treated. By the Authority. Otherwise. Received operative treatment (a) for diseases of the ear — — (b) for adenoids and chronic tonsilitis — 584 (c) for other nose and throat conditions — — Received other forms of treatment (Ear Minor Ailments Clinic) 175 — Total 175 584 151 GROUP 4.—ORTHOPAEDIC AND POSTURAL DEFECTS. (a) Number Treated as in-patients Not available By the Authority. Otherwise. (ft) Number treated otherwise, e.g., in clinics or outpatients departments 646 Not available GROUP 5.—CHILD GUIDANCE TREATMENT. Number of cases treated. In the Authority's Child Guidance Clinics. Elsewhere Number of pupils treated at Child Guidance Clinics — 96 GROUP 6.—SPEECH THERAPY. Number of pupils treated by Speech Therapists Number of cases treated. By the Authority. Otherwise. 128 — GROUP 7.—OTHER TREATMENT GIVEN. Number of cases treated. By the Authority. Otherwise. (a) Miscellaneous minor ailments 1716 — (6) Other (specify) 1. Orthoptic — 107 2. Sunlight — 22 3. Verruca 437 — Total 2153 129 152 Table V. DENTAL INSPECTION AND TREATMENT. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 20996 (b) Specials 2860 (c) Total (Periodic and Specials) ... Total 23856 (2) Number found to require treatment * (3) Number referred for treatment 13583 (4) Number actually treated 10493 (5) Attendances made by pupils for treatment 24096 (6) Half-days devoted to : (a) Inspection 154 (b) Treatment 2452 Total 6 2606 (7) Fillings: Permanent Teeth 8234 Temporary Teeth 2989 Total 7 11223 (8) Number of Teeth filled: Permanent Teeth 7676 and Temporary Teeth 2878 Total 8 10554 (9) Extractions: Permanent Teeth 1947 Temporary Teeth 10601 Total 9 12548 (10) Administration of general anaesthetics for extraction 4440 (11) Other Operations: (a) Permanent Teeth 8161 (b) Temporary Teeth 2874 Total 11 11035 * A difference of approximately 20% in Infant Departments and 10% in Junior Departments between those referred treatment and those found defective not referred, was found in a sample analysis of 1,604 children. 153 APPENDIX B. NON-MAINTAINED SCHOOLS. Year ended 31st December, 1952. Table I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Year 1952 Year 1961. Age 11 or under — — 12 26 25 13 10 9 14 30 35 15 5 17 16 40 32 17 5 4 18 or over 5 — Total 121 122 B.—Other Inspections. Year 1952 Year 1961. Number of Special Inspections — 8 Number of Re-inspections 12 7 Total 12 15 Visits to Non-maintained Schools 6 5 154 NON-MAINTAINED TABLE II.—A.—Return of Defects Found by Medical Inspection in the Year ended 31st December, 1952. DEFECT OR DISEASE. Routine Inspections Number of defects. Special Inspections Number of defects. Requiring treatment. Requiring to be kept under observation but not requiring treatment. Requiring treatment. Requiring to be kept under observation but not requiring treatment (1) (2) (3) (4) (5) Malnutrition ... ... ... ... Uncleanliness. (See Table IV.—Group V.) Skin— Ringworm : Scalp ... ... ... ... Body ... ... ... ... Scabies ... ... ... ... Impetigo ... ... ... ... Other diseases (non-tuberculous) 1 ... ... ... Eye— Blepharitis ... ... ... ... Conjunctivitis ... ... ... ... Keratitis ... ... ... ... Corneal opacities ... ... ... ... Defective vision (excluding squint) 9 ... ... ... Squint 1 ... ... ... Other conditions 1 ... ... ... Ear— Defective hearing ... ... ... ... Otitis media ... ... ... ... Other ear diseases ... ... ... ... Nose and Throat— Enlarged tonsils only ... 1 ... ... Adenoids only ... ... ... ... Enlarged tonsils and adenoids ... 2 ... ... Other conditions 1 ... ... ... Enlarged Cervical Glands (Non-Tuberculous) ... ... ... ... Defective Speech ... ... ... Teeth—Dental Disease 1 ... ... ... Heart and Circulation— Heart Disease— Organic ... ... ... ... Functional ... ... ... ... Anaemia ... 1 ... ... 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 2 ... ... ... Posture 2 ... ... ... Other forms 4 ... ... ... Other Defects and Diseases 5 ... ... ... 155 CONTENTS. A.-PUBLIC HEALTH REPORT. PAGE Airport 112 Ambulance Service 69 Amusement Houses 86,92 Animals, Keeping of 91 Ante-Natal Clinics 48 Births 17, 18, 19 Byelaws and Regulations 85 Cancer 24,25 Census 27 Chemical Analyses 109 Chest Clinic 34 Child Minders 111 Contacts, Tuberculosis 40 Convalescence 76 Committee 1 Cremation 112 Dairies, Cowsheds and Milkshops 98 Day Nurseries 54 Deaths 17, 18, 24 Dental Treatment—M. & C.W. 56 Diphtheria 67 Disinfection 92 Disinfestation 93 Domestic Helps 76 Drainage 91 Dysentery 28, 32 Extra Nourishment 39,43 Factories and Workshops 89 Fertilisers & Feeding Stuffs Act 93 Foods 86,96, 102 Gastro-Enteritis 32 Health Propaganda 77 Health Visitors, Work of 64 Home Helps 76 PAGE Home Nursing 52 Homework 90 Hospital, Isolation 30 Housing 41,85, 87 Housing Act 87 Ice Cream 101 Illegitimacy 51 Immunisation 67 Infant Welfare Clinics 51 Infant Mortality 17,20 Infectious Diseases 28 Inquests 19 Local Acts 85 Marriages 18 Maternity Homes 111 Maternity Homes, Registration 111 Measles 31 Meat Inspection 97 Medical Help Records 63 Men's Hostel 88 Mental Health 78, 79 Midwives 60 Midwives, Municipal 60 Midwives Acts 63 Milk, Provision of 39,43 Milk, Examination of 98 Milk, Tuberculous 98 Milkshops 98 Mortality in Childbirth 20 National Assistance Act 112 Neo-Natal Deaths 21 Notification of Birth Acts 19 Nuisances 85 Nursing Equipment 76 Nursing Homes 111 Nurses'Agencies 111 Offensive Trades 91 Outworkers 90 156 PAGE Pests 95 Physiotherapy 55 Poisons and Pharmacy Act 93 Poliomyelitis 32 Population 17 Post-Natal Clinics 48 Post-Mortems 19 Premature Infants 48 Puerperal Sepsis and Pyrexia 28 Rats & Mice (Destruction) Act 95 Refuse Collection 110 Road Traffic Accidents 70 Sanatoria, Treatment in 39 Sanitary Administration 82 Sanitary Certificates 89 Sanitary Inspectors, Work of 89 Scarlet Fever 31 Sewage 110 Shop Hours Acts 90 Slaughterhouses 97 Smoke Observation 92 Staff Examinations 112 Still-Births 19 PAGE Tuberculosis—After Care ... 43 „ Allowances ... .... 43 „ Contacts 40 „ Deaths 38,39 „ Notifications 35 „ Home Nursing ... 40 „ Home Visits 39 „ Institutional Treatment 39 „ Occupational Therapy 44 „ Vaccination 41 „ Mass Radiography ... 42 „ Re-Housing ... . 41 Vaccination 68 Verminous Persons ... ... 93 Venereal Diseases ... 45,46,47 Vital Statistics IV Ward Statistics 23 Watercourses 91 Water Supply ... 108 Whooping Cough ... ... 32 X-Ray 41 Zymotic Diseases ... ... 23 B.—SCHOOL MEDICAL REPORT PAGE Accommodation 116 Blind Children 144 Child Guidance 145 Cleansing of Children 124 Clinics 126 Cod Liver Oil 145 Cost 123 Crippling Defects 138 Deaf Children 144 Deaths 125 Defective Children 122 Defective Hearing 144 Deformities 138 Dental Service 129 Ear Disease 144 Epileptic Children 144 Exclusions 128 Following-up 128 Health Visitors, Work of 128 Heights and Weights 121 Immunization, Diphtheria 137 Infectious Diseases 127 Inspection Clinic 126 Inspections 119 Juvenile Employment 145 PAGE Malt 145 Meals, Provision of 145 Mentally Defective Children 144 Milk, etc., Provision of 123 ,145 Minor Ailments 126 Non-maintained Schools 146 Orthodontic Service 134 Parents' Attendances 120 Physically Defective Children 143 Population 116 Remedial Exercises 138 Rheumatism Clinic 138 Schools, Special 123 Speech 146 Staff 115 Statistical Tables 147 Surveys, Uncleanliness 124 St. Christopher's 142 Throat and Nose 126 Treatment 126 Tuberculosis 125 Uncleanliness 24 Vision, Defective 123 X-Ray 134