CRO 55 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER For the Year 1953 S. L. WRIGHT, M.D., M.R.C.P., D.P.H. CROYDON: PRINTED BY THE CROYDON TIMES LTD., 104 high STREET. CROYDON 1 HEALTH COMMITTEE. 1953. *Councillor J. Todd (Chairman). Councillor M. Davis (Chairman). Alderman H. Regan, J.P. (Vice-Chairman). Alderman W. Berners Price, J.P. Councillor F. T. Adams. Councillor H. A. Banks. Councillor J. D. Bell. Councillor J. T. Bell Councillor Mrs. H. M. Bunning. Councillor Mrs. V. L. Child. Councillor J. J. Cooper. Councillor R. H. Davies. Councillor K. A. Edwards Councillor E. J. Fowler Councillor A. Goodbun. Councillor G. W. Hills. Councillor Mrs.E.M.Jenkins. Councillor MissL.N.Overton 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 G M. Turner Royal College of Nursing. Mrs. F. R. Mitchell, O.B.E. Royal College of Midwives. Miss J. C. Dickinson Croydon District Nursing Asslciation Mrs. H. Thatcher Croydon Family Planning Association. *(Councillor Todd served as Chairman of the Committee until his death on 29th June, 1953. Councillor Davis, the Vice-Chairman, was later appointed to this position). 2 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1953. 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, 1953. The total number of births fell, but a reduction in the estimated mid-year population and an increase in the area comparability factor resulted in no change in the crude birth rate, and a fractional rise in the corrected rate, as compared with 1952. Despite an influenza outbreak in the early part of the year the death rate was below the figure for last year, and low in comparison with previous years. The stillbirth and infant mortality rates showed small increases. There was a remarkable fall in deaths from tuberculosis and mortality from this disease, formerly the most frequent cause of eath in the age group 15 to 45 years, was, relatively of little significance. In the year under review, motor vehicle accidents killed more persons in this age group than tuberculosis. Total cancer deaths were fewer than in 1952, but lung cancer, in men, showed a percentage increase and remained the site of commonest occurrence. The fundamental importance of the work of the Sanitary Inspectors remains unchanged. It is easy to forget that our system of personal health and curative medical services cannot be established in communities which have not a high level of general 3 hygiene. I do not believe we have yet exhausted the benefits to be gained from improvements in this field. Thus, considerable reductions in the need for treatment facilities will undoubtedly follow the solution of the problem of air pollution in urban areas. The scheme operated by the Corporation under the Natinal Health Service Act continued with minor modifications required to meet special needs or changed conditions. Co-operation at officer level with other branches of the service remained close and cordial. Finally, I express my appreciation to the Committee of their constant interest and encouragement in the work of the departments, to the members of which my thanks are due for application to routine duties and suggestions for future improvements. I am, Yours faithfully, S. L. WRIGHT, Medical Officer of Health. 4 STAFF OF THE HEALTH DEPARTMENT S.L. Wright. M.D.. M.R.C.P., D.P.H., Medical Officer of Health and Principal School Medical Officer. J.C. Birchall, M.B., Ch.B., D.P.H., Deputy Medical Officer of Health and Deputy School Medical Officer. C.M. Bissett. B.A.. B.M.. B.Ch., Assistant Medical Officer of Health and Assistant School Medical Officer. (Left 31.12.53.) A.J. Essex-Cater. L.R.C.P., M.R.C.S., Assistant Medical Officer of Health and Assistant School Medical Officer. (Left 31.12.53.) M.G. Fish. M.B., B.Ch.. B.A.O., Assistant Medical Officer of Health and Assistant School Medical Officer. E.M. Hegarty, M.B., Ch.B.. D.P.H., Assistant Medical Officer of Health and Assistant School Medical Officer. F.L. Mitchell. M.B.. Ch.B., D.C.H., Assistant Medical Officer of Health and Assistant School Medical Officer. M.S. White, M.B., Ch.B., D.Ost., R.C.O.G., Assistant Medical Officer of Health and Assistant School Medical Officer. P.G. Oliver, L.D.S., Principal Dental Officer. L.E. Oakley, S.R.N., C.M.B., H.V.Cert., Superintendent Health Visitor. M.D. E. Warman, S.R.N., C.M.B., H.V.Cert., Deputy Superintendent Health Visitor. K.M. Widdison, S.R.N., S.C.M., Superintendent Municipal Midwife. L.M. Smith, S.C.M., Deputy Superintendent Municipal Midwife. J.C. Dickinson, S.R.F.N., S.R.N.. S.C.M., Q.I.D.N.S., Superintendent Croydon District Nursing Association. A.E. Humphrey, S.R.N., S.C.M., Q.I.D.N.S., Deputy Superintendent Croydon District Nursing Association. C.M. Westley, S.R.N.. S.C.M., H.V.Cert., Q.I.D.N.S., Assistant Superintendent Croydon District Nursing Association. K.Addison. S.R.N., S.C.M., Q.I.D.N.S., Assistant Superintendent Croydon District Nursing Association. K.P. C. Austin, Authorised Officer, Mental Health. G.J. Catmull, Authorised Officer, Mental Health. S.J. Gosden, Authorised Officer, Mental Health. I.M. Stein, Authorised Officer, Mental Health. E.McQuade, Authorised Officer and Co-ordinating Officer. L.B. Cooney, Supervisor Occupation Centre for Mental Defectives. G.Grieve, R.S.I., Meat and Foods Cert., Chief Sanitary Inspector. N.Smith, R.S.I., Meat and Foods Cert., Deputy Chief Sanitary Inspector. A.L. Hill, Chief Officer Ambulance Service. C.J. Harris, Deputy Chief Ambulance Officer. J.E. Heath, Supervisor Home Helps. F.E. Rudd, Assistant Supervisor Home Helps. A.G. Hadler, Chief Clerk. A.E. Butler, Deputy Chief Clerk. R.H. J. Fanthorpe, M.D., M.R.C.P., Chest Physician (Part-time). J.F. Heffernan, M.B., B.S., D.P.H., Assistant Chest Physician (Part-time). Daniel D. Moir, M.Sc., F.R.I.C., Public Analyst (Part-time). 5 STATISTICS SUMMARY OF VITAL STATISTICS FOR 1953 Area, 12,672 acres. Population (Census 1951),249,592. Total Population (estimate of Registrar-General),249,800 (Midsummer,1953). Number of Inhabited Houses:69,197. Rateable Value (1st April, 1953):£2,750,838. Product of a Penny Rate (1952-1953):£11,025. Rate in the £:15s.l0d. Live Births: M. F. Total. Legitimate 1,698 1,557 3,255 Illegitimate 95 94 189 3,444 Birth-rate per 1,000 of the estimated resident population, 13.8 (England and Wales 15.5:Great Towns 17.0). Birth-rate as adjusted by comparability factor, 0.99; 13.7. Still Births, 82. Rate per 1,000 total (live and still) births, 23.8. Deaths, 2,905. Death-rate per 1,000 of the estimated population, 11.6. (England and Wales 11.4:Great Towns 12.2). Death-rate (as adjusted by comparability factor, 0.90), 10.5. Infant mortality rate, 21 per 1,000 live brths. (England and Wales 27:Great Towns 31). Legitimate Infants (65 deaths), 20 per 1,000 live births. Illegitimate Infants (7 deaths), 37 per 1,000 live births. 6 Principal Causes of Death in order of frequency (Registrar-General's Return). Rate per Population. (1) All Ages. Deaths from diseases of Cardiac and Circulatory System 4.28 ,, ,, Cancer 2.16 ,, ,, diseases of the Respiratory System ,, ,, (excluding Tuberculosis) 1.50 ,, ,, Suicide and Violent Causes 0.30 ,, ,, Tuberculosis (all forms) 0.14* ,, ,, diseases of Digestive System 0.14† * England and Wales 0.20:Great Towns 0.24 † ulcers of stomach, duodenum:gastritis and enteritis. Rate per 1,000 of age group. (2) Ages 15-45 years. Deaths from Tuberculosis (all forms) 0.05 ,, ,, Cardiac and Circulatory System 0.14 ,, ,, Cancer 0.19 Marringes. The number of marriages solemnised was 1,987, compared with 1,993 in 1952, 1,960 in 1951, 2,051 in 1950, 2,066 in 1949, 2,169 in 1948, 2,416 in 1947, 2,105 in 1946, and 2,268 in 1945. 95l were solemnised in Established Churches, 329 in other places of worship ,and 707 in the Register Office. Births. The live births registered were 3,255 legitimate and 189 illegitimate. The birth-rate consequently was 13.8. For England and Wales and in the Great Towns the rates were 15.5 and 17.0. The illegitimate births in Croydon were 5.5 of the total compared with 5.3 in 1952, 5.4 in 1951, 5.0 in 1950, 4.9 in 1949, 6.0 in 1948 and 5.5 in 1947. The live male births numbered 1,793, the female 1,651, being a proportion of 1,086 males to 1,000 females. Deaths. The deaths numbered 2,905, compared with 2,986 in 1952. For 1953 the death-rate was 11.6 compared with 11.9 in 1952. The death-rate for England and Wales was 11.4, and for the Great Towns 12.2. For London the death-rate was 12.5. 7 There were 89 inquests held by Coroners in respect of Croydon residents during 1953, and 342 findings by Coroners after post-mortem without inquest. Wards with the highest death-rate were South (12.9) and Central (12.8). Lowest : Addington (4.5) and Shirley (8.4). Still Births. During 1953, 82 still births were registered in respect of Croydon. Of these, 40 were male babies and 42 females; 4 males and 3 females were illegitimate. The proportion of still births to living children was 1 in 42. 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 23.3 per 1,000 births. Notification of Births. Notifications were received in respect of confinement? conducted by:— Live Births. Still Births. Total. Midwives 3,014 71 3,085 Doctors 735 12 747 3,749 83 3,832 Accommodation for Confinement. The following table gives information concerning the accommodation utilised for confinements:— Number. Percentage. In Private Houses 1,176 30.69 In Public Institutions 2,212 57.72 In Registered Maternity Homes 444 11.58 3,832 8 Maternal Mortality. There were 3 deaths, compared with 2 in 1952. The maternal mortality rate was 0.85 per 1,000 births, compared with 0.56 in 1952. MATERNAL AND INFANT MORTALITY FOR THE YEARS 1933—1953 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 1.16 38 1940 3,031 5 1.65 39 1941 2,472 8 3.23 37 1942 3,579 12 3.35 39 1943 3,785 2 0.53 37 1944 3,680 8 2.17 44 1945 3,675 9 2.45 41 1946 4,937 3 0.61 31 1947 5,211 10 1.92 38 1948 4,597 2 0.44 27 1949 4102 5 1.22 29 1950 3787 2 0.53 26 1951 3,697 3 0.81 19 1952 3,548 2 0.56 20 1953 3,526 3 0.85 21 Infant Mortality. The Infantile Mortality Rate was 21 per 1,000 live births. 9 For the past 5 years the number of infant deaths has been 1949—116, 1950—96, 1951—68, 1952—69, and 1953—72. Among the 72 deaths, 40 occurred in boy babies and 32 in girls. Of the births, 1,793 were males and 1,651 females. The infantile mortality rate for the two sexes was, therefore, Boys— 22, Girls—19. Fifty-eight 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 6 Atelectasis, etc. 6 Hæmorrhagic Disease of Newborn 4 — 16 (3) Prematurity 26 — 25 (4) Post-Natal Causes 5 — 5 48 Percentage Deaths under 1 year per Total Infantile Deaths. Deaths under 1 year per 1,000 Births 1953 1952 1953 1952 Premature Births 34.7 39.1 7.26 7.80 Respiratory Diseases 22.2 15.9 4.65 3.17 Infectious Diseases 1.4* — 0.29 — Atelectasis, Debility and Marasmus 8.3 4.3 1.74 0.87 Diseases of Digestion 4.2** 2.9x 0.87 0.58 Injury at Birth and Congenital 19.4 21.7 4.07 4.90 **These deaths were due to Diarrhoea *This death was due to Tuberculosis 10 The rate of infant mortality amongst legitimate children was 20 per 1,000 births. The rate in illegitimate children was 37 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. 8th-14th day 15th-21st day 22nd-28thday Under 1 mnth. 1-2 mths. 2-3 mths. 3-4 mths. 4-5 mths. 5-6 mths. 6-7 mths. 7-8 mths. 8-9 mths. 9-10 mths. 10-11 mths. 11-12 mths. TOTAL. All Causes 26 6 5 1 1 2 5 1 1 — 48 6 2 4 1 3 4 2 1 — — 1 72 Polio-Encephalitis — — — — — — — — — — — — — — — — — — — — — — — Chicken Pox — — — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — — — — — — — Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — Diphtheria and Croup — — — — — — — — — — — — — — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — — — — — — — — — — — — — — Abdominal Tuberculosis — — — — — — — — — — — — — — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — — 1 — — — — — — — — — — 1 Meningitis (not Tuberculous) — — — — — — — — — — — — — — — 1 — — — — — — 1 Convulsions — — — — — — — — — — — — — — — — — — — — — — — Laryngitis — — — — — — — — — — — — — — — — — — — — — — — Bronchitis — — — — — — — — — — — — — — — — — — — — — — — Pneumonia (all forms) — — 1 — — — 3 — — — 4 2 2 2 1 1 3 — 1 — — — 16 Diarrhoea and Enteritis — — — — — — — — — — — — — 1 — 1 — 1 — — — — 3 Gastritis — — — — — — — — — — — — — — — — — — — — — — — Syphilis — — — — — — — — — — — — — — — — — — — — — — — Rickets — — — — — — — — — — — — — — — — — — — — — — — Congenital Malformations 1 1 — — 1 — 1 1 1 — 6 3 — 1 — — 1 1 — — — — 12 Premature Birth 19 4 1 — — 1 — — — — 25 — — — — — — — — — — — 25 Atrophy, Atelectasis, Debility and Marasmus 3 — 1 — — 1 1 — — — 6 — — — — — — — — — — — 6 Injury at Birth 1 — 1 — — — — — — — 2 — — — — — — — — — — — 2 Haemorrhagic disease of newborn 2 — 1 1 — — — — — — 4 — — — — — — — — — — — 4 Other Causes — 1 — — — — — — — — 1 — — — — — — — — — — 1 2 Totals 26 6 5 1 1 2 5 1 1 — 48 6 2 4 1 3 4 2 1 — — 1 72 11 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 (under two years) 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 17,886 188 172 10.5 9.6 27 — — 1.12 0.17 — 4.59 1.56 +16 Norbury 16,697 139 171 8.3 10.2 43 — — 1.91 0.06 — 3.59 2.81 —32 West Thornton 16,243 188 154 11.6 9.5 5 — — 1.35 0.25 — 3.94 1.78 +34 Bensham Manor 17,662 201 150 11.4 8.5 30 — 0.06 1.30 0.11 — 2.77 1.13 +51 Thornton Heath 16,467 215 152 13.1 9.2 14 — 1.46 0.12 0.06 3.16 1.58 +63 South Norwood 16,659 241 179 14.5 10.7 17 0.06 1.56 0.18 — 3.42 1.92 +62 Woodside 15,091 214 168 14.2 11.1 9 — 0.07 1.92 0.07 — 3.51 2.72 +46 East 16,621 174 163 10.5 9.8 23 — — 0.78 0.06 0.12 3.97 2.23 +11 Shirley 12,350 141 104 11.4 8.4 28 — 0.08 1.46 0.08 — 2.43 1.78 +37 Addiscombe 16,273 256 186 15.7 11.4 12 — — 1.84 — — 3.44 2.40 +70 Whitehorse Manor 13,920 256 163 18.4 11.7 51 — 0.07 1.37 0.43 — 4.02 1.65 +93 Broad Green 14,044 222 131 15.1 9.3 9 — — 1.28 0.14 0.07 2.92 2.21 +91 Central 11,951 165 153 13.8 12.8 24 — — 1.76 0.17 — 4.60 2.01 +12 Waddon 15,873 190 152 12.0 9.6 — — — 1.20 0.13 0.06 3.78 1.88 +38 South 17,140 192 221 11.2 12.9 21 0.06 — 1.34 0.06 — 4.49 2.63 —29 Addington 14,923 462 67 31.0 4.5 24 — — 0.13 — 0.07 1.27 1.27 +395 The Borough 249,800 3,444* 2,905* 13.8 11.6 21 0.01 0.02 1.45 0.12 0.02 3.83 2.16 +539 * These are the corrected totals. As deaths occurring in Queen's Hospital are no longer allocated to the home address ward mortality rates involved show a decrease on previous years. 12 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE, AGE AND SEX Sex 0 - 1 - 5 - 15 - 25 - 45 - 65 - 75 - Total All Causes M 40 8 8 9 49 391 406 466 1,377 F 31 7 6 8 33 258 368 817 1,52! Tuberculosis (respiratory) M — — — — 4 9 6 4 23 F 1 — — — 1 1 2 2 1 Tuberculosis (other forms) M — — — — 1 3 — I F 1 __ __ 1 2 Syphilitic Diseases M 2 4 S F 1 I Diphtheria M F _ Whooping Cough M — — — — — — _ F _ Meningococcal Infections M — — — .— — 1 1 F _ Acute Poliomyelitis M 1 — 2 — — _ 3 F Measles M 2 2 F Other infective and parasitic diseases M — 1 — — — 2 — _ 3 F 2 — 2 4 Malignant neoplasm, stomach M — — — — 2 16 16 11 45 F 8 14 19 41 ,, ,, lung, bronchus M 51 16 5 12 F 6 10 4 20 „ „ breast M — — — — — — _ - F — — — 3 21 20 12 56 ,, ,, uterus F — — — 1 14 6 6 27 Other malignant and lymphatic neoplasms M — — — 7 42 51 33 133 F — 2 — 4 54 32 34 126 Leukaemia; aleukaemia M 1 2 — 3 4 1 — 11 F 1 — — — 4 2 2 9 Diabetes M — — — — — 1 — 1 F — — — 2 3 6 1 12 Vascular lesions of nervous system ... M — — — 3 25 45 70 143 F — — 1 2 30 72 146 251 Coronary disease, angina M — — — 2 68 67 51 188 F 18 53 64 135 Hypertension with heart disease M — — — — 5 5 16 26 F 3 10 39 52 Other heart diseases M — 1 — 2 29 57 115 204 F — — 1 6 32 50 252 341 Other circulatory diseases ... M — — — 2 9 22 29 62 F — — — 1 6 12 43 62 Influenza M — — — 2 9 9 15 33 F — — — 1 5 8 30 44 Pneumonia M 11 1 — — 1 16 18 22 69 F 7 1 1 — — 3 22 34 68 Bronchitis M — — — — 3 38 49 47 13? F 6 16 61 83 Other diseases of respiratory system M — — — 1 — 8 4 1 14 F 1 1 2 4 Ulcer of stomach and duodenum ... M 3 8 3 14 F — 1 — — — 1 2 6 1U Gastritis, enteritis and diarrhoea ... M 2 — — — — — 1 1 4 F 1 1 — 1 — — 2 3 8 Nephritis and nephrosis M — — — — 1 5 1 3 10 ill F — — — — 2 1 4 3 iv Hyperplasia of prostate M — — — — — 2 5 13 20 i Pregnancy, childbirth and abortion... F — — — 1 1 — — — i Congenital malformations M 6 1 1 — — 1 — —- F 5 — 1 — . - 3 _ 9 Other defined and ill-defined diseases M 20 1 1 1 9 28 15 21 96 F 16 — 2 — 6 20 22 43 iuy Motor vehicle accidents M — — — 3 1 3 2 — 9 n F 1 1 — 3 — 1 1 2 y All Other accidents M '— 1 1 3 3 3 2 5 10 F — 1 — — — 3 6 10 Suicide M — — — — 2 10 1 — 13 F — — — 1 3 10 I — w 1 Homicide and operations of war M — — — 1 1 — — — t | F 1 — — Totals 71 15 14 17 82 649 774 1,283 2,9ft! 13 Comparisons with 1952 (Registrar-General's Table). There were no deaths from Whooping Cough (1952-3) and two from Measles (1952—nil). There were again no deaths in the Typhoid group and none from Diphtheria. The deaths from Pulmonary Tuberculosis numbered 30 (1952—56); those from Cancer decreased by 27; those from Pneumonia increased by 22; and an increase of 4 was also recorded in those caused by Bronchitis. There were 79 deaths from Influenza (1952—9). Deaths from suicide show an increase of 2, and motor vehicle accidents of 5. The total number of deaths was 2,905 as compared with 2,986 in 1952. The percentage of deaths under 1 year of age to the total deaths was 2.4 per cent.; deaths under 15 years, 3.4 per cent.; deaths under 65 years, 29.2 per cent.; and deaths over 65 years, 70.8 per cent. Th corresponding figures for 1952 were 2.3 per cent., 3.4 per cent., 29.6 per cent., and 70.4 per cent. respectively. The Registrar-General has continued to supply a comparability factor—0.90—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 540 as compared with 567 in 1952; 479 in 1951; 501 in 1950; 481 in 1949; 510 in 1948; 492 in 1947; 451 in 1946; 470 in 1945; 420 in 1944 and 456 in 1943. Death-rate per 1,000 of the population for the last 11 years are as follows:— 1943—2.28 (456) 1944—2.21 (420) 1945—2.34 (470) 1946—1.93 (451) 1947—2.03 (492) 1948—2.06 (510) 1949—1.93 (481) 1950—1.99 (501) 1951—1.91 (479) 1952—2.26 (567) 1953—2.16 (540) 14 Deaths from Cancer occurred at the following Ages: — Age period Male Female Total Under 25 years 3 3 6 25 and under 35 years 3 3 6 35 and under 45 years 10 6 16 45 and under 65 years 112 108 220 65 years and over 133 159 292 261 279 540 Sites of Fatal Cancer. Site Male Female Total Percentage of Total Shoulder 1 — 1 0.185 Endrocrine Glands 2 — 2 0.370 Skin 3 1 4 0.741 Oesophagus 10 5 15 2.778 Stomach 44 39 83 15.370 Liver 2 4 6 1.111 Bowel 19 27 46 8.519 Rectum 11 12 23 4.259 Bladder 11 3 14 2.593 Prostate 17 — 17 6.513 Larynx and Pharynx 10 3 13 2.408 Uterus — 28 28 10.036 Breast — 53 53 18.996 Ovary — 20 20 6.168 Pancreas 14 12 26 4.815 Gall Bladder and Duct — 4 4 0.741 Tongue & Mouth 4 — 4 0.741 Bones 4 3 7 1.206 Lungs 73 23 96 17.778 Kidney 4 5 9 1.667 Brain & Nervous System 3 11 14 2.593 Thyroid Gland 1 — 1 0.185 Lymphatic Glands & Connective Tissue 9 2 11 2.037 Hodgkin's Disease 3 3 6 1.111 Leukaemia 11 9 20 3.704 Genital Organs 1 3 4 0.741 Undefined 4 9 13 2.408 261 279 540 Comments on Foregoing Table. 1 he organs most often attacked in descending order of incidence are: In the males—the Lungs (28.0 per cent.), the Stomach (16.9 per cent.) and the Bowels and Rectum (11.1 per cent.); in females—the Breast (19.0 per cent.), the Stomach and the Bowels and Rectum (14.0 per cent.) and the Uterus (10.0 per cent.). 15 COMMUNICABLE DISEASES COMMUNICABLE DISEASES NOTIFIED DURING YEAR 1953. Notifiable Disease. Cases notified in the whole District. Total cases notified in each Ward. Sex Distribution of Notified Cases. 1953. At all Ages. At ages—years. Upper Norwood. Norbury. West Thornton. Bensham Manor. Thornton Heath. South Norwood. Woodside. East. Addiscombe. Whitehorse Manor. Broad Green. Central. Waddon. South. Addington. Shirley Under 1 year. 1—4. 5—14. 15—24. 25—44. 45—64. 65 and up. M F Scarlet Fever 414 1 69 323 16 3 1 1 29 32 48 51 28 34 13 33 9 24 28 7 13 14 32 19 222 192 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — — — Erysipelas 19 — — — 1 4 7 7 — — 1 2 — — 3 7 — — 2 — 2 1 1 — 14 5 Meningococcal Infection — — — — — — — — — — — — — — — — — — — — — — — — — — Enteric & Paratyphoid 2 — — 1 — 1 — — — — 2 — — — — — — — — — — — — — 1 1 Small Pox — — — — — — — — — — — — — — — — — — — — — — — — — — Cholera — — — — — — — — — — — — — — — — — — — — — — — — — — Typhus — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Pyrexia 67 — — — 34 33 — — 1 — 38 — 3 1 1 1 — 19 — — — 2 1 — — 67 Ophthalmia Neonatorum 3 3 — — — — — — — — 1 — 1 — — 1 — — — — — — — — 2 1 Acute Poliomyelitis 26 3 8 8 4 3 — — 2 4 4 3 — 1 — 2 1 — 2 — — 1 4 2 16 10 Dysentery 78 3 30 32 5 3 4 1 8 1 12 6 6 1 — 2 — 1 2 — 1 11 6 21 37 41 Malaria 2 — — — 1 1 — — — 1 — — — — — — — — — — — 1 — — 1 1 Acute Primary and Acute Influenzal Pneumonia 45 — 4 4 4 5 17 11 7 2 2 — 3 1 1 4 2 1 6 3 5 6 — 2 23 22 Food Poisoning 65 1 10 11 14 10 12 7 3 1 11 6 7 5 3 1 1 — 4 5 4 6 4 4 21 44 Acute Encephalitis — — — — — — — — — — — — — — — — — — — — — — — — — — Measles 4512 118 2088 2258 31 10 5 2 191 167 230 262 223 393 232 270 261 259 222 89 154 362 1054 143 2269 2243 Whooping Cough 679 54 276 338 — 8 3 — 48 19 12 18 20 64 41 97 42 31 20 12 45 35 114 61 307 372 Totals 5912 183 2485 2975 110 81 49 29 289 227 361 348 291 500 294 418 316 335 286 116 224 439 1216 252 2913 2999 16 MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1953 Jan. Feb. Mar. April May June July August Sept. Oct. Nov. Dec. Total Scarlet Fever 45 23 41 21 58 44 28 13 18 20 49 54 414 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 1 2 2 4 1 ... 3 ... 2 2 1 1 19 Meningococcal Infection ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric and Paratyphoid ... ... ... ... ... ... ... ... 2 ... ... ... 2 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 6 ... 3 2 2 3 17 11 8 6 ... 9 67 Ophthalmia Neonatorum ... 1 ... ... ... 1 1 ... ... ... ... ... 3 Poliomyelitis and Polioencephalitis 3 ... 3 2 4 3 4 5 1 1 ... ... 26 Dysentery 5 10 5 4 10 12 11 8 6 2 5 ... 78 Malaria ... ... ... ... ... ... ... 2 ... ... ... ... 2 Ac. Pri. & Ac. Inf. Pneumonia 5 22 3 ... 3 1 ... 3 1 2 2 3 45 Food Poisoning ... 1 2 1 4 9 18 1 18 7 2 2 65 Acute Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 702 1,752 1,482 444 60 53 5 6 6 1 1 ... 4,512 Whooping Cough 31 27 96 74 52 33 106 93 61 35 37 34 679 Total 5,912 17 ANNUAL RETURN OF FOOD POISONING NOTIFICATIONS (CORRECTED) Food Poisoning Notifications (Corrected). 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 3 14 37 11 65 Outbreaks due to identified agents. Total Outbreaks Total Cases 7 22 Outbreaks due to:— (a) Chemical Poisons Nil (d) C1. Botulinum Ni: (b) Salmonella Organ- (e) Other Bacteria Ni' isms 6 (c) Staphylococci cluding toxin) 1 Outbreaks of undiscovered cause. Total Outbreaks Total Cases 5 13 Single Cases. Agent identified Unknown Cause Total 18 12 30 18 WADDON (ISOLATION) HOSPITAL. I am indebted to Dr. J.J.Linehan for the following report on infectious, etc., cases admitted to the Hospital during 1953:— There was a total of 808 admissions, comprised of 603 acute infectious cases, 196 cases of pulmonary tuberculosis and 9 chronic sick. In the figures for tuberculosis and chronic sick patients are included patients in the wards temporarily evacuated from 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 127. Admissions to the Tuberculosis Wards.—196 (163) patients were admitted and there were 16 deaths. The majority of fatal cases were in the older age groups, 13 being over 50 years of whom 8 were over 60. The average stay in hospital of all tuberculosis patients, who were discharged or died during the year was 104.6 days. Fatal cases were generally admitted in the terminal stage of the disease and the average stay in hospital of all fatal cases was 15 days. The average bed occupancy was 68.5. Admissions to the Acute Infectious Diseases Wards.—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 21 days and the average bed occupancy 36.2. 19 Scarlet Fever 214 (212) Measles 88 (87) Gastroenteritis 47 (40) Dysentery 43 Whooping Cough 33 (31) Poliomyelitis and Encephalitis 22 (17) Chicken-pox 17 (16) Food Poisoning 9 (8) Typhoid Fever 2 Erysipelas 2 Mumps 2 Infective Hepatitis 2 Rubella 6 Vincent's Angina 3 Glandular Fever 1 Diphtheria Carrier 1 Malaria 1 Influenza 5 Influenzal Pneumonia 1 Infectious Erythema 1 Staphylococcal Septicaemia 1 Miliary Tuberculosis 1 Meningitis — tuberculous 1 Tonsillitis 13 (12) Streptococcal Sore Throat 8 (7) Pharyngitis 7 Otitis Media 5 Acute Bronchitis 7 Pneumonia 10 Pleurisy 1 Laryngitis 1 Adenitis 3 Rhinitis 1 Thrush 1 Teething 1 Bleeding Tooth Sockets 1 Dental Abscess 1 Volvulus 1 Hirschsprung's Disease 1 Strangulated Hernia 1 Ulcerative Colitis 2 Perforated Duodenal Ulcer 1 Marasmus 1 Subarachnoid Haemorrhage 2 Hysteria 2 Disseminated Sclerosis 1 Cerebellar Tumour 1 Epilepsy 1 Impetigo2 Pemphigus 1 Dermatitis 1 Cellulitis 1 Acute Rheumatism 4 Pyrexia of Unknown Origin 2 Lymphosarcoma 1 Nil abnormal detected 4 Non-Patient Mother 1 Non-Patient Baby 1 Scarlet Fever.—The decline in admission of scarlet fever cases continued and was again the lowest since 1941. To some extent this was due to restrictions caused by staff shortage in the early part of the year hut mainly to low demand for admissions in the second half of the year. The disease remained generally mild. Only one case of nephritis was encountered. The incidence of otitis media was 5.1 per cent. Measles.—Measles was epidemic during the early part of the year and all admissions were in the first six months. 38.6 per cent, of admissions were suffering from pneumonia and 5.7 per cent from otitis media. Two had concurrent whooping cough. 55 of the 88 cases admitted were under 5 years and 13 under one year. Gastro-enteritis.—The age groups of cases treated were as follows:—Under 1 year—20; 1-5 years—21; School age—3: Adults—3. Classified according to severity 22 were mild, 17 moderately severe and 8 very severe. There were two deaths. 7 of the 8 very severe cases, including the two fatal cases, were under one year. 20 Dysentery.—42 of the 43 cases of dysentery admitted were of the Sonne type. The majority occurred in small groups of associated cases. The disease generally remained mild though a few adults were moderately ill. More difficulty was experienced in eliminating the infection from convalescent carriers than in previous years. Whooping Cough.—Of the 33 admissions, 10 were admitted from institutions and 23 from their own homes. Complications were present as follows:—Pneumonia—5 cases; bronchitis—4 cases; convulsions—2 cases; and one case each of bronchiectasis and gastro-enteritis. Admissions occurred in the following age groups:—Under 1 year—6 (of whom 3 were under 3 months); 1-2 years—5; 2-5 years—17; and over 5 years—5. Poliomyelitis and Encephalitis.—There was no undue prevalence of" the disease. The seasonal incidence differed somewhat from the usual pattern in that only one of the 22 cases occurred in the last four months of the year. July and August were the peak months. Classification of patients admitted, in accordance with the part of the nervous system predominantly affected : — Non-Paralytic: Meningitic—3; Encephalitic—1. Paralytic: Limb and Trunk Palsies—13; Bulbar only—2; Bulbar and Respiratory—1 ; Bulbar and Encephalitic—1; Other cranial nerves—1. 11 of the 13 patients with limb paralysis had varying degrees of residual paralysis on discharge from isolation. Two of these were women in advanced pregnancy. Other Infections.—5 of the patients suffering from food poisoning had Salmonella typhi-murium infection and the remaining 4 patients were infected by Salmonella enteritidis, orianberg, muenchen and morbificans bovis respectively. Difficulty continued to be experienced in eliminating the carrier state in Salmonella typhi-murium infections. The influenza and influenzal pneumonia cases were admitted in the first four months of the vear when the disease was epidemic. The patients suffering from typhoid fever, which has now become a rare disease, contracted their infection outside the Croydon area. Chronic Sick Ward.—The 9 admissions were classified as follows:—Senility—4; Chronic Bronchitis—1; Paralysis—1; Senile Dementia—1; Colostomy—1; Influenza Pneumonia—1. Fatal Cases.—There were 25 deaths from the following causes:—Pulmonary Tuberculosis—16; Gastro-enteritis—2; Influenzal Pneumonia—2; and one death each from Volvulus, Lympho-Sarcoma, Acute Bronchitis and Senility, Pulmonary Fibrosis and Senility, Senile Pemphigus. 21 The following table shows the great improvement in mortality from tuberculosis over the last forty years. Tuberculosis (All Forms) 0-15 years All ages Tuberculosis (All Forms) 0-15 years All ages Year Number of Deaths Death Rate per thousand. of population Number °f Deaths Death Rate per thousand of population Year N umber of Deaths Death Rate per thousand of population Number of Deaths Death Rate per thousand °f popuationl 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 1933 13 184 0.77 1953 2 0.04 37 0.15 22 THE PREVENTION AND CONTROL OF TUBERCULOSIS. I am indebted to Dr.R.H.J.Fanthorpe, Chest Physician, for the following section of the Report. The Tuberculosis service is centred on the Chest Clinic, and is fully integrated as between the Regional Hospital Board and the local authority, working as a single unit. Work has now begun on the Mayday Road Offices, and the ground floor of these premises will become the new Chest Clinic. It is anticipated that by the beginning of 1955 the Clinic will be housed in its new accommodation. Although social conditions were different in 1953, a comparison with 1926 shows that in 1926, 101 per 100,000 of the population in Croydon died from all forms of tuberculosis; in 1953 the corresponding figure was 14.8. The years selected were eight years after a major war. Measures for the prevention of the disease have been extended, and during 1953 the number of contacts examined and the number of contacts who have received protection by B.C.G. vaccination have both increased. During the latter part of the year a contact survey of a school was carried out subsequent to the finding of a case of pulmonary tuberculosis among the staff. The children in the school were tuberculin tested and the positive reactors, together with the adult staff, were X-rayed by the Mass Radiography Unit. No case of tuberculosis was found in either the children or the staff. The employment of the tuberculous after completion of treatment, constitutes a problem, but the finding of suitable work for these patients has been made easier by the holding of periodic conferences between the Chest Physician, the Welfare Officer and the Disablement Resettlement Officer from the local office of the Ministry of Labour. Incidence. 190 cases of Respiratory Tuberculosis and 21 cases of NonRespiratory Tuberculosis were notified on Form A during 1953 (Table I—Formal Notifications). Of these 106 males and 84 females were Respiratory cases and 8 males and 13 females were Non-Respiratory. In addition, 86 Respiratory cases and 7 NonRespiratory cases came to our notice as new cases otherwise than by notification (Table II—Supplemental Return). 23 The total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year 1953 by notification or otherwise was 304, as compared with 331 in 1952, 316 in 1951, 369 in 1950, and 305 in 1949. 276 of these were cases of Respiratory Tuberculosis; 152 in males and 124 in females. There were 38 fewer males and 8 more females than in 1952. The reduction in the number of males notified as suffering from Respiratory Tuberculosis is encouraging but there is no reason for complacency. This reduction should only serve as a stimulus to improve and extend methods of case-finding, and it is anticipated that additional facilities in this sphere will be provided at the new clinic. There were 6 cases of Non-Respiratory Tuberculosis among children under 15 years as compared with 5 in 1952. The number of cases in adults was 22, compared with 20 in 1952. Of the cases notified in 1953, 2 males and 2 females died from the Respiratory form of the disease during the year, equal to 2.1 per cent. of those notified. The incidence rate of Tuberculosis of all forms was 1.21 per 1,000 of the population; for Respiratory Tuberculosis 1.10, and for Non-Respiratory 0.11 per 1,000 population. The notification rate was 0.84 per 1,000. In 1952 the corresponding figures were 1.32, 1.22, 0.10 and 0.97 per 1,000. Public Health (Tuberculosis) Regulations, 1952. Summary of notifications during the period from 1st January, 1953, to 31st December, 1953:— 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 — — 3 1 2 9 14 17 22 15 18 3 2 106 Respiratory, Females — 1 4 3 4 14 10 14 14 6 5 3 — 84 Non-Respiratory, Males... — — — — — 1 2 2 2 — 1 — — 8 Non-Respiratory, Females — — 2 2 1 2 2 2 — — 1 — 1 13 24 TABLE II. Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1953, to 31st December, 1953, otherwise than by formal notification : — Source of Information Number of cases in age Groups 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— Total Death Returns from Local Registrars Respiratory M — — — — — — — 1 1 — 3 — — 5 (A) F — — — — — — — — — — 1 — 2 3 (B) Non-Respiratory M — — — — — — — — — 1 — — — 1 (C) F — — — — — — — — — 1 — — — 1 (D) Death Returns from Registrar-General (Transferable deaths) Respiratory M — — — — — — — — — 1 — — — 1 (A) F — — — — — — — — — — — — — — (B) Non-Respiratory M — — — — — — — — — — — — — — (C) F — — — — — — — — — — — — — — (D) Posthumous Notifications Respiratory M — — — — — — — — — — — — 1 1 (A) F 1 — — — — — — — — — — — — 1 (B) Non-Respiratory M — — — — — — — — — — — — — —— (C) F — — 1 — — — — — — — — — — 1 (D) "Transfers" from Other Areas ing transferable deaths) Respiratory M — — — — — 2 9 14 5 5 2 — 1 38 (A) F — —— — 2 — 5 11 9 4 — 2 — — 33 (B) Non-Respiratory M — — — — — — 1 — — — — — — 1 (C) F —— —— 1 — — — 1 — — — — 1 — 3 (D) Other Sources Respiratory M — — — — — — 1 — — — — — — 1 (A) F — — — — — — — 2 1 — — — — 3 (B) Non-Respiratory m — — — — — — — — — — — — — — (C) F — — — — — — — — — — — — — — (D) Total A(46) (B) 40 (C) 2 (D) 5 25 Notification Register. Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1953:— RESPIRATORY. NON-RESPIRATORY. Total Cases. Males. Females. Total. Males. Females. Total. 1068 813 1881 108 112 220 2101 CLASSIFICATION OF NEW PATIENTS. Respiratory Tuberculosis. During 1953, 188 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) 93 or 49.5% B, or T.B. plus, 1 (early cases, sputum positive) 27 or 14.4% B, or T.B. plus, 2 (intermediate cases, sputum positive) 60 or 31.9% B, or T.B. plus, 3 (advanced cases, sputum positive) 8 or 4.2% 188 100.0% Non-Respiratory Tuberculosis. There were 19 cases examined at the Clinic and found to have Non-Respiratory Tuberculosis in the following forms:— Bones and Joints 8 Abdominal 3 Other Organs 5 Peripheral Glands 3 19 26 Ages at Death from Respiratory Tuberculosis. Year 0-5 5-15 15-25 25-45 45-65 over 65 TOTAL 1945 — 1 17 28 23 6 75 1946 — 2 17 38 36 8 101 1947 — 1 14 34 31 12 92 1948 — — 12 43 39 10 104 1949 — 2 11 38 23 15 89 1950 1 — 7 10 28 14 60 1951 — — 2 15 21 13 51 1952 — — — 10 22 20 52 1953 1 — — 5 11 14 31 Ten cases were not notified during life. Of these, six were certified by the Coroner, after a post-mortem examination; seven cases died in hospital and one in a nursing home. Where patients have not been notified during their lifetime a visit is paid by the Tuberculosis Health Visitor to the home of the deceased, to obtain particulars of the contacts and to endeavour to persuade them to attend the Clinic for examination. In 1953 the death-rate from all forms of Tuberculosis was 0.15 per 1,000 population. The rate for Respiratory Tuberculosis was 0.12 and the rate for Non-Respiratory Tuberculosis 0.02. Similar figures for 1952 were 0.208 and 0.008. Respiratory Tuberculosis. In 1953 the total number of deaths decreased by approximately 40 per cent., compared with 1952, there being a decrease in males of 36.8 per cent. and a decrease in females of 50 per cent. 80 per cent. of the total deaths occurred in the age groups 45 and over, and 16 per cent. in the age groups 20—44 years. There was again no death amongst children of school age. The one death which occurred under the age of 5 years was in a baby of four weeks old. The mother was suffering from Miliary Tuberculosis and the child was infected in utero, and constituted one of the extremely rare cases of true congenital tuberculosis. 27 New cases show a decrease in males of 20 per cent. and an increase of 6.9 per cent. in females, compared with 1952, that is a total decrease, compared with 1952, of 9.8 per cent. The total numbers of the new cases in 1953 were: Males 152, females 124; that is, approximately six new cases in men for every five new cases in women. The reduction of the death rate to the low figure of 14.8 per 100,000 population continues to reflect the general modern advances in treatment, associated with necessary local measures to make available more beds and the rehousing of infectious cases by the Croydon Corporation. Deaths from Non-Respiratory Tuberculosis. During 1953 six deaths were certified to be due to NonRespiratory Tuberculosis, compared with two in 1952, thirteen in 1951 and seven in 1950. I wo of the patients died in general hospitals and two in a nursing home. Three of them were not notified during life. The deaths were due to:— Males. Females. Total. Tuberculous cystitis 1 1 Tuberculous Meningitis — 1 1 Renal Tuberculosis 2 2 Tuberculous Peritonitis 1 1 Tuberculosis of Both Suprarenal Glands: — 1 1 Addison's Disease Totals 4 2 6 Co-ordination with the Health Department. During the year 138 children were referred by the School Medical Service, and 9 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 9 cases were in receipt of extra nourishment at the end of the year. Residential Treatment. 241 men, 213 women and 30 children were admitted to Residential Institutions during 1953. 28 The Chest Clinic and Home Visiting. 1,577 new cases were examined during the year. 190 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 13,613. There were also 8,212 attendances by patients for collapse therapy. The Clinic doctors paid 104 home visits and the Tuberculosis Visitors 4,008 visits for Clinic purposes. In addition the Tuberculosis Visitors made 437 primary visits for the purposes of the Notification Register. There were also 1,348 unsuccessful visits made. Patients requiring home nursing or surgical dressings are attended to by the nurses from the Croydon Nursing Association, by arrangement with that organisation. Their assistance is a valuable adjunct in the care of domiciliary cases. Contact Examination. The examination and subsequent supervision of persons coming into contact with patients suffering from tuberculosis plays an important part in the prevention of the spread of infection. During 1953, 668 persons were examined for the first time as contacts of notified cases of tuberculosis, giving a contact-case ratio of over 3 for each notified case during the year. Of these contacts, 17 were found to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 25, compared with 1.21 per 1,000 of the general population. In addition, there were 8 found to be tuberculous who had been under observation from previous years. The numbers of new contacts examined, together with the numbers of New cases of Tuberculosis notified in previous years are as follows:— 1952—'New contacts examined 661. New cases of tuberculosis 243. 1951—New contacts examined 562. New cases of tuberculosis 214. 1950—New contacts examined 561. New cases of tuberculosis 275. B.C.G. Vaccination The use of B.C.G. vaccination for contacts has been extended during 1953 and regular sessions are held at the Clinic for this purpose. 167 contacts were successfully vaccinated during the year, compared with 89 in 1952. In addition, 14 nurses were successfully vaccinated. 29 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 declined the offer of preventive vaccination. The Clinic Register of Cases. The number of cases of Tuberculosis under the supervision of the Clinic at the end of the year was 1,817. This is equivalent to 7.2 persons per 1,000 of the population. During the year 37 Clinic cases died. Of this number five or 13.5 per cent. were seen for the first time in 1953. 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, 1953 1,766 ,, patients examined for the first time, excluding 68 inward transfers, i.e., patients removed from other areas 2,245 visits paid by Clinic doctors to homes of patients 194 visits paid to homes of patients by Tuberculosis Visitors 4,445 Attendances of patients at the Clinic— Men 5,182 Women 4,600 Children 3,831 Total 13,613 No. of X-Ray films taken 13,326 No. of definite cases of Tuberculosis on the Clinic Register on the 31st December, 1953 1,817 Re-Housing of Tuberculosis Patients. Twenty-six families were re-housed specifically on the grounds of the presence of infective tuberculosis, so that the patient could have a separate bedroom. 30 Switzerland. During 1953 four more patients from the Croydon area were 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 346 examinations were carried out in 1953 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. 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. NonTuberculous Conditions. Croydon district 16,477 35 577 501 31 TUBERCULOSIS AFTER-CARE I am indebted to Miss G. Bridger, Almoner of the Chest Clinic, for the following reports:— During 1953 the After Care Scheme continued on the same lines as in previous years, major requirements being met by calling upon statutory provisions, and extra comforts being met where possible from voluntary sources. Financial help continues to be given by the National Assistance Board to supplement Assistance at the special tuberculosis treatment rate, 52 of whom were in hospital and 131 at home. By 31.12.53, 191 were receiving such benefits, of whom 49 were in hospital and 142 at home. We have worked in close touch with the local officers of the N.A.B.. and special grants have been given by them in individual cases to meet such needs as extra clothing and removal expenses where the patient had to be rehoused. Voluntary societies have been very generous in answering appeals for additional help. Over £350 was raised from the various organisations, such as regimental funds, trade benevolent funds, private trusts and specialised agencies. With this help we were able to meet some unexpected bills, pay off debts, provide extra comforts, and help with occasional holiday in particularly hard cases. The grant made by the Sunday Cinemas Fund, for the first time, was particularly valuable in placing a small sum of ready mono at our disposal to cover any urgent need which might arise. This was particularly useful for fares for relatives to visit patients in distant hospitals, and for fares to enable a person to stay with friends in the country for a change. Voluntary sources were also very helpful in providing help in kind, such as grocery vouchers and clothing. The Local Authority continued to make provision in kind for free milk, where more than one patient in the household was ill, for the loan of beds and bedding to prevent the spread of infection, the colonisation of patients at village settlements where suitable, and the provision of garden shelters. Home Helps were supplied where necessary, and arrangements made in conjunction with the Children's Department for the care of the family where the mother was the patient. In the field of rehabilitation. regular case conferences were held between the Chest Physician, Disabled Resettlement Officer and myself, to consolidate the day-to-day contact on patients and the problems which arise when they are fit for work. Wherever possible, suitable alternative work has been found, sometimes after a period of training or at an industrial rehabilitation unit. Arising out of these activities, 308 visits have been paid to patients, either in hospital or in their own homes, in addition to attendance at every clinic session. Report on Home Industry Scheme. In April. 1953, Miss J. Higinbotham took over as part-time occupational therapist, and some alterations were made in the scheme. In addition to regular weekly classes for those fit enough to attend, a session once a fortnight was devoted to visiting patients in their own homes. This has proved a very popular development, as it enabled the homebound to take up a worthwhile hobby, and to pass the time agreeably. By the end of the year, there were twelve home-bound patients on the register and the number is growing, limited only by the fact that it is not possible to visit and instruct more than four patienits in one afternoon. These patients arc able to join the classes at the clinic as soon as they are well enough to travel alone. At the end of the year there were thirty patients on the register for the clinic classes, and the average attendance per class was about six on any one afternoon. These stay for instruction in crafts which are unfamiliar to them, but many more call to obtain materials or advice. During the year, over £35 was paid in for materials by patients. 32 VENEREAL DISEASES. Return relating to all persons who were treated at the Treatment Centre at Special Clinic, General Hospital, Croydon, during the year ended the 31st December, 1953. 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 35 50 24 . 10 31 69 82 151 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 12 4 14 6 20 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 4 1 — — — — 4 1 S (ft) ,, secondary I 1 — — — — 1 1 2 (c) „ latent in 1st year of infection 1 4 — — -L — 1 4 5 (d) ,, cardio-vascular — — — — — - (e) „ of the nervous system 3 1 — — — 3 1 4 (/) „ all other late or latent stages 13 6 — — — — 13 6 19 (g) ,, congenital (under 1 year) ... - (ft) ,, „ (over 1 year) 5 1 — — — — 5 1 6 (i) Gonorrhoea — 90 7 — — 90 7 ?! Other conditions:— (J) Chancroid — — — — — - (ft) Lymphogranuloma inguinale — — — — 1 — 1 — 1 (/) Granuloma venereum — — — — — — — — - (m) Non-gonococcal urethritis (males only) — — — — 80 — 80 — 80 (n) Any other conditions requiring treatment 64 46 64 46 110 (o) Conditions not requiring treatment — — — - 319 66 319 66 385 (p) Conditions remaining undiagnosed at 31st December 4. Number of patients dealt with for thefirst time who have been transferred from other Centres (civil or Service) or from practitioners approved under Ministry of Health Circular 2226 2 4 3 15 6 20 10 30 Totals of Items 1, 2, 3 and 4 66 70 117 8 501 153 684 231 915 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 18 22 76 5 446 122 540 149 689 6. Number of patients suffering from :— (a) Syphilis who defaulted after completion of treatment, but before final discharge — — — — — — — — — (b) Gonorrhoea who defaulted before 3 months — — — — — — — — — (c) Gonorrhoea who defaulted after 3 months — — 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 — — — — — — — — — (ft) Acquired syphilis of more than 1 year's duration — 2 — — — — — 2 2 (c) Congenital syphilis (under 1 year) — — — — — — — — — (d) ,, ,, (over 1 year) — — — — — — — — — (e) ,,Gonorrhoea — — — — — — — — — 8. Number of patients under treatment or observation known to have died :— (a) From syphilis — 1 — — — — — 1 1 (b) From treatment 1 — — — — — 1 — 1 (c) From other causes — — — — — — — — — Totals of Items 5, 6, 7 and 8 19 25 77 5 446 122 542 152 694 33  Syphilis Gonorrhoea Other Conditions Totals M F M F M F M F Ttls. Totals of Items 5,6,7 and 8 (brought forward) 19 25 77 5 446 122 542 152 694 9. Number of patients transferred to other Centres or Institutions or to private practitioners 1 5 9 1 8 7 18 13 31 10. Number of patients remaining under treatment or observation on 31st December 46 40 31 2 47 24 124 66 190 Totals of Items 5, 6, 7, 8, 9 and 10 66 70 117 8 501 153 684 231 915 (These totals should agree with those of Items 1, 2, 3 and 4) 11. Number of patients included in Item 7 who (ailed to complete one course of treatment of either penicillin or of arsenic and bismuth and were suffering from:— (o) 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' duration — — — — — — — — — (d) Congenital syphilis of more than 1 year's duration — — — — — — — — — 12. Number of attendances:— (a) for individual attention by the medical officers 707 230 423 23 1887 264 3017 517 3534 (6) for intermediate treatment, e.g., dressings, etc. 618 1018 130 49 498 603 1246 1670 2916 Total Attendances 1325 1248 553 72 2385 867 4263 2187 6450 Under 1 year 1 and under 5 years 5 and under 15 years 15 years and over Totals M F M F M F M F M F 13. Number of patients suffering from congenital syphilis in Item 3 above classified according to age . — — — 1 — — 5 — 5 1 14. Pathological Work (a) Number of specimens examined at, and by the medical officer of, the Treatment Centre Microscopical Cultural Serum Cerebro. Spinal Fluid Others for Syphilis for O'n'rh. for Syphilis Wr. & Kahn for G'n'rh. 5 742 385 941 488 51 57 (b) Number of specimens from patients at the Treatment Centre sent to a pathological laboratory — — — 36 — — — Syphilis (less than 1 year) Syphilis (more than 1 year) Gonorrhoea Other Conditions M F M F M F M P 15. Contacts attending for examination through the agency of (15) Patients 1 — 1 — — 1 20 i— CO Health Visitor or Social Service Worker 1 1 6 1 15 1 88 34 Totais 2 1 7 1 15 2 108 145 34 STATEMENT SHOWING THE SERVICES RENDERED AT THE TREATMENT CENTRE DURING THE YEAR, CLASSIFIED ACCORDING TO THE AREAS IN WHICH THE PATIENTS RESIDED. Name of County or County Borough (or Country in the case of persons residing elsewhere than in England and Wales) to be inserted in these headings Croydon Surrey Kent London Total Number of cases from each area included under the following headings in Item 3:— Syphilis 21 10 37 41 Gonorrhoea 62 9 1214 97 Other Conditions 303 149 5767 576 totals 386 168 72 1 88 714 35 PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT ANTE-NATAL AND POST-NATAL CLINICS During the year 3,853 cases were seen at the Ante-Natal Clinics, of which 2,751 were new cases. A total of 25,735 attendances was recorded, and 1,596 cases were seen at the Post-Natal Clinics (1,569 new cases) and 1,784 attendances recorded. Mothercraft instruction classes were 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 and 310 patients recorded 1,573 attendances. 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 live premature babies notified during 1953 who were born— (i) at home 60 (ii) in private nursing homes 3 (iii) in hospital 114 (2) The number of those born at home— who were nursed entirely at home 59 who died during the first 24 hours 1 who survived at the end of one month 58 (One case transferred to hospital did not survive). (3) The number of those born in private nursing homes— who died during the first 24 hours — Who survived at the end of one month 3 (4) Number of those born in hospital— who died during the first 24 hours 13 who survived at the end of one month 101 (5) Number of premature still births who were born— (i) at home 1 (ii) in private nursing homes — (iii) in hospital 36 36 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— 159 cases were dealt with by the Social Worker; 20 cases were admitted to Hostels; 8 cases were temporarily accommodated at Glazier House (the Croydon Home of the Moral Welfare Association). The Committee agreed to meet financial responsibility for a stay of an unmarried mother in a Mother and Baby Home for a period of three months except for girls up to 18 years of age, for whom the period would be extended to cover a total of six months. These younger mothers would normally go to Homes specialising in their care. Of the seven infant deaths of illegitimate babies in 1953, only one child was born under such arrangements, the cause of death being severe congenital malformation. INFANT WELFARE CENTRES Their work continued without any major changes. At New \ddington, the former day nursery premises were adapted for use as an Infant Welfare and Ante-Natal Clinic, to give much needed extra accommodation on this growing estate. Welfare Clinics offered facilities for immunisation against diphtheria and vaccination against smallpox at all sessions. Ministry of Food Welfare Foods were also available at all Clinics. 37 38 ATTENDANCES AT INFANT CENTRES—1953 Bensham Manor, Monday, a.m. Bensham Manor, Monday, p.m. Boston Road, Thursday, p.m. Brighton Road, Wednesday, p.m. East Croydon, Tuesday, a.m. East Croydon Friday, p.m. Fairchildes, opened 30.1.53, Friday, p.m. Monks Hill, Tuesday, p.m. 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, Wednesday, p.m. Waddon, Wednesday, p.m. West Croydon Friday, p.m. Woodside, Friday, a.m. Woodside, Friday, p.m. Total, 1953 Total, 1952| New cases under I year 59 101 94 91 91 196 103 51 147 166 131 184 65 116 86 73 118 34 105 41 137 75 87 112 107 128 79 174 92 62 58 84 3247 3044 No. of Re-attendances 1242 1929 1301 1526 1745 2186 1099 794 1826 2045 1861 1488 1440 1851 1192 1162 1781 984 1692 1296 1427 1090 1043 1617 1494 1793 1280 2180 1214 1150 1074 1256 47058 47641 New cases over 1 year 5 19 13 18 2 21 63 13 13 30 63 73 11 20 10 7 14 8 7 9 13 11 15 15 10 18 18 31 14 5 4 9 582 712 No. of Re-attendances 785 1178 900 764 598 987 888 791 481 535 1181 801 989 1287 704 704 609 715 1102 783 989 853 696 1160 577 691 885 926 608 647 655 959 26428 29829 Attendances of Children 0-5 2091 3227 2308 2399 2436 3390 2153 1649 2467 2776 3236 2546 2505 3274 1992 1946 2522 1741 2906 2129 2566 2029 1841 2904 2188 2630 2262 3311 1928 1864 1791 2308 77315 81226 Consultations with Doctor 665 1016 675 734 729 940 510 329 810 900 885 850 782 911 521 431 684 399 680 705 787 668 366 693 634 740 437 857 682 518 575 686 21799 24256 No. of Sessions 47 48 49 48 48 48 44 48 47 49 48 48 48 46 48 48 48 48 48 49 49 48 49 49 48 48 48 48 48 48 48 48 1534 1537 Expectant Mothers: No. of new cases — 1 3 — — — — 3 3 1 — — — — — — — 2 1 — — — — — — — — — 6 — 1 — 21 30 No. of Re-attendances — — — — — — — 1 — 1 — — — — — — — — — — — — — — — — — — 25 — — — 27 69 Total attendances of Expectant Mothers — 1 3 — — — — 4 3 2 — — — — — — — 2 1 — — — — — — — — — 31 — — — 48 99 Total Attendances 2091 3228 2311 2399 2436 3390 2153 1653 2470 2778 3236 2546 2505 3274 1992 1946 2522 1743 2907 2129 2566 2029 1841 2904 2188 2630 2262 3311 1959 1864 1792 2308 77363 81325 Average per Session, 1953 44.5 67.3 47.2 50.0 50.8 70.6 49.0 34.4 52.6 56.7 67.4 53.0 52.2 71.2 41.5 40.5 52.5 36.3 60.5 43.4 52.4 42.3 37.6 59.3 45.6 54.8 47.1 69.0 40.8 38.8 37.4 48.0 50.4 — Average per Session, 1952 43.4 66.9 55.5 50.4 61.6 56.9 ... 35.1 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 39 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 31-12-53 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 1952 706 New patients 5,234 Total 5,940 40 New Patients:— Medical 2,536 Surgical 2,589 Gynaecological 82 Obstetric 8 Maternity 19 Total 5,234 Specially classified: — Cases Visits Tuberculosis 135 3,952 Pneumonia 333 3,286 Maternity Complications 115 801 Infectious Diseases 39 313 Children under five years 273 1,583 Visits:— Termination of Cases:— Convalescent 3,421 Hospital 727 Died 510 Removed for other causes 553 Stili on books 729 Total 5,940 January 13,512 February 13,002 March 11,360 April 10,700 May 10,464 June 10,294 July 10,646 August 10,521 September 9,970 October 10,348 November 10,862 December 11,158 Total 132,837 41 DAY NURSERIES. Attendances at Day Nurseries, 1953. Whitehorse Road. *Bramley Hill Morland Road *New Addington ham Grove Date opened 1/6/42 Re-opened 1/1/52 8/3/43 28/3/44 21/3/45 Capacity 50 50 56 56 52 Number of books at end of year 35 Nil 26 Nil Ni. Attendances: under 2 1,600 377 1,237 126 247 over 2 3,913 923 4,966 566 970 Total 5,513 1,300 6,203 692 1,217 Number of days opened 255 118 255 123 123 Average daily attendance (excluding Saturdays) 22 11 24 6 10 * Closed June, 1953 42 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 17 17 34 Knock Knees and Flat Feet 27 24 51 Valgus Ankles 11 13 24 Chest Conditions: Post T.A. and Asthma 7 6 13 Cerebral Palsy 1 1 Torti-collis 1 1 2 63 62 125 Total Attendances: 2,200 43 DENTAL TREATMENT I am indebted to the Principal Dental Officer, 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. Few major changes have taken place in this Service and generally speaking inspection and treatment have continued along the lines previously detailed. The slight upward trend in the number of expectant mothers referred, reported last year has, unfortunately, not been maintained, and the totals for application forms were rather below the 1951 level. In addition to the smaller number now attending Ante-Natal Clinics, more patients appear to be "opting" to attend their private practitioners and are thus not referred for any routine inspection at clinics. Some increase is reported in the number of emergency cases dealt with, the greater part of such work being for nursing mothers. In. this respect there would appear to be indications that the present system of offering an unrestricted choice of dentist may on occasion lead to a certain amount of abuse. As was expected closure of the greater part of the Day Nurseries has sadly reduced the number of pre-school children previously referred from these institutions, though this loss has to a certain extent been made good by increased numbers referred by the Dental Officers themselves. The number of these children referred through Welfare Centres continues to be disappointing; problems involved in obtaining improved facilities in connection with the above are discussed later in this report. 44 Expectant and Nursing Mothers The total number of expectant and nursing mothers referred from all sources was 329 compared with 426 in 1952. As was the case in the previous year the greater proportion of these were sent from the Ante-Natal Clinic, whilst those from the Municipal Midwives' Service were again 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 268 against 319 last year. Of these, 69.8 per cent. were seen during the first six months of pregnancy, compared with 75.6 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 result of pain or discomfort, which might have been avoided had treatment been sought at an earlier date. There has been some further increase in the amount of work carried out for nursing mothers. In some cases this was caused by late reference from the Ante-Natal Department which did not permit of treatment until after the confinement; in others names were actually received during the post-natal period. 53 nursing mothers were referred during the current year, compared with 21 in 1952. Treatment Including those continuing treatment from the previous year, 371 mothers were dealt with, compared with 352 in 1952. Whenever time permits full conservation of teeth is advised; however, in this respect much depends on the condition of patients, and their willingness to accept the above treatment. In the case of those approaching confinements, removal of possible oral sepsis must remain the first consideration; and completion of any other necessary work is urged at an early date. As has been the case in recent years there has been a continued reduction in patients requiring wholesale removal of teeth and provision of complete dentures. Whilst a similar dearth of 45 such cases in the General Practitioner Service has been attributed to the introduction of certain charges for appliances, this factor can not be said to have led to any abnormal demand in Local Authority Services. A possible explanation would appear to be that a point of saturation was reached during the free treatment period, and time will therefore have to be allowed to achieve a further build up in public requirements. The Pre-School Child The number of children referred from all sources during the year was 557, compared with 671 in 1952. 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 Welfare Centres themselves have in the past been disappointing, it is felt that increased publicity or. the part of the 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 call be excercised during the pre-school period, there can be no satisfactory solution to the problem of safeguarding the foundation teeth. 46 Treatment The following summary shows particulars of the work accomplished:— Expectant Mothers. Nursing Mothers. Total. Young Children. New Cases Examined 268 53 321 410 Re-treated 45 5 50 147 Total 313 58 371 557 47 Expectant and Nursing Mothers Young Children Attendances 765 1217 Fillings 297 421 Extractions 446 493 Gas Cases 92 224 Local Anaesthesia 132 26 Scaling and Gum Treatment 105 22 Dressings 269 200 Denture Dressings 143 — Silver Nitrate — 758 Treatments Completed 170 421 Number of Sessions (treatment) 359 Dentures Fitted 60 Dentures Repaired 12 The Centres at which patients were examined, or from which they were referred, are given in the following list:— Mothers Young Children Mothers Young Children Ante Natal 227 — South Croydon — 2 Municipal Midwives 93 St. Alban's — 2 Post Natal 8 — Woodside — 9 Welfare Centres: Norbury — 11 Addington — 34 Municipal — 12 St. Andrew's — 10 East Croydon 2 Waddon 6 Upper Norwood 6 Boston Road 3 Holy Trinity — 1 St. Jude's — 7 St. Oswald's — 5 Spring Park 1 Bensham Manor 1 12 West Croydon 9 South Norwood — 5 Referred by Dental Officers 420 Mothers: 329 Young Children: 557 Total: 886 48 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 in the year 1953 1,159 2.—The number of spontaneous deliveries 1,146 3.—The number of forceps deliveries 13 4.—The number of live births 1,151 5.—The number of stillbirths 8 6.—The number of neo-natal deaths 1 7.—The number of premature live bom infants treated in their own homes, and their weights and ultimate result 12 (1) 36 weeks—5 lbs 14th day—5 lbs. 4 ozs. (2) 32 weeks—3 lbs. 4 ozs Transferred May day (3) 37 weeks—5 lbs.14th day—5 lbs. 12 ozs. and 6 lbs. 37 weeks-—6 lbs. (4) 37 weeks—4 bs. 12 ozs 14th day—5 lbs. 8 ozs. (5) 38 weeks—5 lbs.14th day—5 lbs. 4 ozs. and 5 lbs. 12 ozs. 38 weeks—6 lbs. (6) 36 weeks—5lbs 14th day—6 lbs. (7) 37 weeks—5 lbs. 14th day—5 lbs. 8 ozs. and 4 lbs. 12 ozs. 37 weeks—4 lbs. 8 ozs (8) 38 weeks—4 lbs. 8 ozs 14th day—5 lbs. 4 ozs. (9) ?Full time—3 bs. 14 ozs 14th day—4 lbs. (10) 38 weeks—5 lbs 14th day—5 lbs. 8 ozs. and 5 lbs. 12 ozs. 38 weeks—5 lbs. 8 ozs. (11) 38 weeks—5 lbs 14th day—5 lbs. 8 ozs. (12) 32 weeks—4 lbs. 2 ozs Died 2nd day 8. The number who received Gas and Air Analgesia 1,095 9.—The number of cases of P.P.H. 20 (13 remained at home, 7 transferred Mayday) 10.—The number of cases of manual removal of the placenta None 11.—The number who received blood transfusion 2 12.—The number of cases to which the Emergency Obstetric Servic was called 5 13.—The number of patients sent into Mayday Hospital: During the A.N. period 142 During and after delivery 84 14.—The number of cases of toxaemia of pregnancy treated at home 15.—The number of cases of prolonged labour (over 24 hours) 14 16.—The number of breech deliveries: In primipara — In multipara 8 17.—The number of twins delivered in their own homes and the weights of the babies 7 sets 5 lbs. 8 ozs. and 5 lbs. 6 ozs. 5lbs. and 6 lbs. 5 lbs. and 6 lbs. 5 lbs. and 6 lbs. 8 ozs. 4 lbs. 8 ozs. and 6 lbs. 6 lbs. and 6 lbs. 12 ozs. 6 lbs. and 6 lbs. 12 ozs. 18.—The number of cases of Puerperal Pyrexia: Oenital — Extra-Genital 14 Total: 14 19.—The number of congenital malformations 8 49 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 Bicycle — — — — — — 18 — 48 — — — — 2 Bicycle 9 5 — 3 1 7 37 — 149 2 — 6 3 2425 Cycle- 1 1 — — — — 17 — 109 — — — — 4 master Cycle- 58 41 1 14 2 53 348 — 855 — 46 — 42 5 master 30 14 1 15 — 28 152 — 498 — 36 — 27 6 1031 67 59 1 7 — 66 171 117 816 1257 64 — 13 7 Bicycle 54 24 1 28 1 52 416 173 900 807 58 — 23 8 4104 37 33 — 3 1 35 278 — 762 — 35 — 8 9 Bicycle Cycle- 77 65 1 9 2 75 564 303 971 1077 105 — 37 10 master 60 42 1 12 5 58 244 267 565 985 59 — 30 11 4179 101 56 1 40 4 98 334 234 1082 982 105 — 72 12 4530 126 120 6 — — 124 893 — 1683 — 106 — 3 13 Bicycle 22 9 2 9 2 20 203 — 370 32 — 9 14 1961 102 97 5 — — 95 370 121 1195 1195 129 — 1 15 3256 96 63 1 29 3 90 471 209 868 809 83 — 32 16 5378 73 50 1 21 1 64 495 219 1098 806 92 — 67 17 Bicycle 39 29 — 10 — 36 365 — 672 — 37 — 23 18 3859 69 44 — 24 1 66 515 369 910 865 102 — 14 19 3140 64 48 1 13 2 58 487 389 644 1033 129 — 43 20 cycle 3 2 — 1 — 3 14 — 33 — 2 — 2 21 Bicycle 32 25 2 5 — 30 155 — 524 — 36 — 15 22 Bicycle 39 30 — 8 1 37 133 — 512 — 27 — 5 Total 33863 1159 857 25 251 26 1095 6680 2401 15264 9816 1285 — 472 3. Deputy Superintendent. 1. Relief nurse—1 month. 2. Three months service. 5. Six months maternity leave. 8. Nine months service. 13. Commenced May. 20. Commenced December. 21. Seven months service. 22. Seven months service. Equivalent to 3½ full time midwives: total complement = 13½+3½=17 full time midwives. 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 1,209 issued during the year. 50 Gas and Air Analgesia. of the 1,159 births Gas and Air was given to 1,095 Balance 64 Reasons for Non-use of Gas and Air. Midwife summoned too late: baby born before arrival 42 Mother unfit 2 Other anesthetics 8 Refusale 12 64 51 The following table gives the details of the reasons for -Midwives summoning medical aid: — For Complications during Pregnancy. Abortion 16 Other Causes 9 24 For Complications during Labour. Breech 7 Malpresentation 3 Premature Labour 7 17 Delayed Labour. 25 Hæmorrhage. Ante-partum 9 Post-partum 15 24 Other Causes. Adherent and Retained Torn Perineum 100 Placenta 2 102 For Complications during Puerperium. Pyrexia 23 Pain in Breasts 2 Pain in Legs 11 Other causes 13 49 For Complications in regard to the Baby. Inflammation of Eyes 25 Still Birth 1 Feebleness 2 Other causes 28 Premature Birth 1 57 298 In accordance with Rule 33 of The Central Midwives' Board the following reasons for the discontinuance of breast feeding were received:— Illness of Mother 45 Defects of lactation 228 Other causes 28 Total 301 Midwives Acts, 1902-51 The number of Midwives who notified their intention to practise as midwives or maternity nurses, within the Borough (including those in hospitals) and who were practising at the end of the year was 80. All 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. 52 THE WORK OF THE HEALTH VISITORS The recorded visits include 1,363 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 816 during 1953. Health Visitors have also dealt with special survey visits for certain national investigations into child health. Records have been re-arranged to show clearly the function of the Health Visitor as an advisor to the family unit and figures are now included giving visits to households which brings out this point. 53 The Work of the Health Visitors—Maternity and Child Welfare Visits Only. 1953 Visits Re Baker Bird Blackmore Blest Chapman Comm. 1/5/53 Devaney Early Eldridge Elliott Griggs Hall Hinton Llewlly Comm. 2/3/53 Lucey Morton Partridge Pickering Rawlings Theison Thompson Toneri Tripet Vince Warman Deputy from Webb Weller Weston Wilson Wybrew Total, 1953 Total, 1952 Infants under 1 year— First Visits 130 70 162 150 103 160 100 145 164 145 129 52 127 128 141 63 125 147 120 130 169 187 144 19 155 127 140 133 134 3699 3644 Re-visits 260 712 650 531 424 468 977 632 471 757 745 732 657 569 450 231 873 295 551 594 760 1070 683 61 830 454 598 832 546 17413 18176 Children 1-2 years- First Visits 10 2 4 11 3 69 - 4 5 2 - - 5 10 10 3 - 1 0 2 1 5 6 1 7 4 - 1 9 184 206 Re-visits 143 602 467 314 297 429 673 373 147 460 392 579 434 422 346 165 358 233 323 471 452 608 911 30 544 170 382 375 346 11446 12418 Children 2-5 years— First Visits 8 5 5 16 15 105 1 4 5 1 11 9 1 – 10 – 3 – 6 – 2 6 2 – 7 24 246 299 Re-visits 477 724 615 757 628 507 814 885 305 961 965 463 645 743 564 386 761 405 336 724 964 1255 1412 72 982 427 976 756 997 20506 23721 Expectant Mothers— First Visits 30 4 64 11 9 1 24 17 42 83 43 – 58 36 56 14 11 36 7 21 25 72 33 2 28 20 15 61 46 869 749 Re-visits 4 - 10 1 3 2 48 6 11 8 5 - 22 — 3 – 26 4 — . 18 2 59 6 — 3 — — 4 — 245 250 Still Births - - 3 1 – – – – – 1 – – 1 – – – – – – – – – 1 1 — 1 1 — — 10 16 Deaths under 1 year - 1 5 3 - - 1 - 3 - — - - 1 — 1 1 — — 1 — 1 2 1 1 – — – — 22 19 Miscellaneous Visits 23 327 277 229 11 258 185 99 318 569 223 92 11 190 233 32 4 51 14 228 190 16 17 18 816 27 42 231 199 4930 1058 Ineffective Visits 217 555 537 306 655 321 374 164 245 510 498 116 503 287 734 96 348 374 330 337 517 194 225 47 623 233 771 267 448 10832 13149 Totals 1953 1302 3002 2799 2330 2148 2320 3197 2329 1716 3497 3000 2034 2474 2386 2546 992 2507 1565 1681 2529 3080 3473 3440 254 3995 1465 2925 2667 2749 70402 — 1952 2170 2312 1684 2253 — 3008 3343 2618 1739 2865 2081 1924 — 2474 2898 1558 2650 1790 1678 3359 2878 4569 3975 2328 3845 1940 3254 2713 2541 73705 55 IMMUNISATION AGAINST DIPHTHERIA. A total of 2,646 new cases came from the following sources: — Of these, 12 failed to return for completion of the course. School Children 138 Children under 5 2,508 Reinforcing injections are now being recommended, just before the child starts school, and again at 10 years of age, i.e., at about 5-yearly intervals. The number of such injections given during the year was 1,775. The ensuing comparative tables give some further details:— Year New Cases Completed Treatment Failed to attend for completion of Course Reinforcing Injections 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 1953 2646 2634 12 1775 Origin and Source of New Cases attending. Year School Pre-school Total Per cent. Total Per cent. 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 1953 138 5.2 2508 94.8 56 IMMUNISATION AGAINST WHOOPING COUGH A total of 2,332 children were immunised against whooping cough, comprising 2,254 under school age and 78 school children. 309 children were given reinforcing injections. VACCINATION AGAINST SMALL-POX A total of 2,302 persons were vaccinated against Small-pox. Under 1 year of age 1 2-4 5—14 15 or over Total Successful Vaccinations 1450 124 86 63 107 1830 „ Re-vaccinations — 1 12 55 243 311 Insusceptible to Vaccination 120 15 9 3 14 161 2302 57 AMBULANCE SERVICE. To the Medical Officer of Health. I submit the Twelfth Annual Report of the Croydon Ambulance Service, for the year ended 31st December, 1953. During the year the Service was called upon to deal with 35,183 journeys and conveyed 87,790 patients to and from Hospitals, etc. As judged by the number of miles travelled bv all vehicles—412,178 against 390,535 in 1952—the increase in work was 5.5 per cent. On a similar basis of comparison the increase between 1951-52 was 6.7 per cent. A new method of classifying journeys has been used since the end of 1951 in accordance with a Ministry of Health Circular 25/51 which stated in item 12: — A journey means a vehicle's round trip from the place where it normally awaits orders, back to that place. This place will usually be its home ambulance station, but where an ambulance is stationed at a hospital during working hours it will be the hospital. The journey should not be regarded as being broken by diversions made to carry out fresh instructions received during its course." Compared with 1952 the journeys show a decrease of 423 and the mileage shows an increase of 21,643. This is accounted for by reason of the following : — (1) A more rigid interpretation of the above-mew oned Circular. (2) Longer out of the borough journeys. (3) An increase of 3,794 miles travelled by the Occur- :ional Vehicles conveying Mentally Defective children (4) Numerous patients moving from Central Croydon o the Addington area, thus entailing more mileage per call. The Ambulance Sub-Committee ruled that Ambulance Personnel must attend refresher courses for First-Aid every three years. This has been carried out and 37 men attended and were all successful. Four extra men were engaged during the year and have all obtained their first-aid certificates. 58 One Humber Snipe Ambulance (DLT 748), one Armstrong Ambulance (COY 999), one Ex-W.D. Hillman Sitting Case Car (GBY 517) and one Ex-W.D. Austin Sitting Case (FUU 724) were disposed of, and in place of these three Diamler Ambulances (LRK 3, LRK 289 and LRK 555) and three Bedford Utilecon Vehicles (LBY 403, LVB 444 and LVB 901) were delivered. Ex-W.D. Albion Ambulance FRK 900 was replaced by one of the above-mentioned Daimlers, and was converted for conveying Mentally Defective Children, in place of Albion GRK 887 which is to be disposed of. All the new vehicles have given every satisfaction. List of Serviceable Vehicles at 31st December, 1953. One Armstrong Ambulance (to be replaced by a Daimler). Six Humber Pullman Ambulances. One Austin Ambulance. Five Daimler Ambulances. Two Bedford Sitting Case Vehicles (11 Seaters). Three Bedford Utilecon Sitting Case Vehicles. One Morris Ex-W.D. (C Licence). Two Hillman Minx Sitting Case Cars. Two Humber Hawk Sitting Case Cars. One Ex-W.D. Albion (for Mentally Defective Children). One Bedford Coach ( ditto ). A Bedford Utilecon Sitting Case Vehicle is to be delivered early in January. Calls were dealt with as follows:— Headquarters Station, Stroud Green 22,734 No. 2 Station, Thornton Heath 4,507 No. 3 Station, South Croydon 4,910 No. 4 Station, Mayday Hospital 2,492 No. 5 Station, Waddon Hospital 540 59 Classification of Calls Home Accidents 662 Miscellaneous Accidents (Unclassifiable) 193 Recreational Accidents 134 School Accidents 159 Street Accidents 838 Work Accidents 254 Home Illness 197 Street Illness 522 Work Illness 65 Common Assault 31 Attempted Suicide 34 Suicide 12 Health Service Removals 31,275 Services refused or Ambulance not required 267 34,643 Calls taken by Waddon Hospital (Infectious Diseases) 540 35,183 The total mileage covered by Ambulances and Cars during the year was 412,178 miles, which is an increase of 21,643 miles over the previous year. Analysis of Accidents, etc. STREET ACCIDENTS PEDESTRIANS KNOCKED DOWN BY:— (1) Pedal Cycles (Adults) 20 ,, ,, (Children) 9 (2) Motor-Cycles (Adults) 35 ,, ,, (Children) 11 (3) Cars (Adults) 64 ,, (Children) 26 (4) Vans (Adults) 1 ,, (Children) 2 (6) Lorry (Adults 12 ,, (Children) 12 (6) Buses (Adults) 10 ,, (Children) 2 (7) Coach (Adults) 1 205 60 COLLISIONS BETWEEN VEHICLES— (1) Cycle Crash (Adults) 4 „ ,, (Children) 3 (2) Cycle and Motor-Cycle (Adults) 20 „ ,, (Children) 1 (3) Cycle and Car (Adults) 34 „ „ (Children) 15 (4) Cycle and Lorry (Adults) 6 „ „ ,, (Children) e (5) Cycle and Bus (Adults) 1 „ (Children) 3 (6) Cycle and Coach (Children) 1 (7) Motor-Cycle Crash (Adults) 30 (8) Motor-Cycle and Car (Adults) 45 (9) Motor-Cycle and Van (Adults) 3 (10) Motor-Cycle and Lorry (Adults) 7 (11) Motor-Cycle and Bus (Adults) 3 (12) Car Crash (Adults) 26 „ ,, (Children) 1 (13) Car and Auto-Cycle (Adults) 1 (14) Car and Lorry (Adults) „ „ ,, (Children) 1 (16) Car and Bus (Adults) 4 (16) Lorry Crash (Adults) 1 221 FALLING— (1) In the Street (Adults) 148 „ „ „ (Children) 32 (2) From Pedal Cycles (Adults) 79 „ „ (Children) 56 (3) From Auto-Cycles (Adults) 8 (4) From Motor-Cycles (Adults) 39 (5) From Buses (Adults) 26 „ ,, (Children) 4 (6) Cars (Adults) 1 (7) Lorries (Adults) 1 (8) Inside Buses (Adults) 17 ,, ,, (Children) 1 412 STREET ACCIDENTS TO ADULTS 652 „ CHILDREN 186 838 61 HOME ACCIDENTS— (1) Falling in the Home (Adults) 171 „ „ (Children) 128 (2) Falling down the Stairs (Adults) 45 „ „ (Children) 6 (3) Falling out of Bed (Adults) 4 „ „ (Children) 5 (4) Burns and Scalds (Adults) 20 ,, ,, (Children) 20 (5) By Tools, Glass, etc. (Adults) 42 ,, ,, (Children) 40 (6) By Falling Objects (Adults) 12 ,, „ (Children) 5 (7) Falling from Heights (Adults) 30 (Children) 40 (8) Accidental Poisoning (Adults) 23 „ „ (Children) 6 (9) Dog-bites (Adults) 5 ,, ,, (Children) 2 (10) Colliding with Objects (Adults) 2 (Children) 3 (11) Miscellaneous (Adults) 15 ,, (Children) 20 682 HOME ACCIDENTS TO ADULTS 375 CHILDREN 287 WORKS ACCIDENTS— (1) Caused by Machinery or Tools 51 (2) Caused by Falling Objects 50 (3) Falling 49 (4) Falling from a Height 43 (5) Falling down Holes 5 (6) Knocked down by Works Vehicles 12 (7) Colliding with Objects 11 (8) Burns and Scalds 10 (9) Lifting 9 (10) Miscellaneous 14 254 62 RECREATIONAL ACCIDENTS— (1) Football (Adults) 36 „ (Children) 16 (2) Rugby (Adults) 13 ,, (Children) 1 (3) Cricket (Adults) 9 ,, (Children) 6 (4) Table Tennis (Children) 1 (5) Swimming ((Adults) 7 „ (Children) ... 17 (6) Dancing (Adults) 2 (7) Golf (Adults) 1 (8) Judo (Adults) 1 (9) Kiddies' Amusements in Parks (Children) 21 (10 Miscellaneous (Adults) 3 134 RECREATIONAL ACCIDENTS TO ADULTS 72 RECREATIONAL ACCIDENTS TO CHILDREN ... 62 ATTEMPTED SUICIDES— (1) Coal Gas Poisoning 15 (2) Poisoning 18 (3) Cut Arteries 1 34 SUICIDES— (1) Coal Gas Poisoning ... 12 12 FATAL ACCIDENTS AND ILLNESS— (1) Certified dead at Hospital 41 (2) Certified dead at scene of Accident or Illness 22 63 ACCIDENTS AND ILLNESS IN PUBLIC PLACES— (1) Recreational Grounds (Adults) 42 „ „ (Children) 30 (2) Shops (Adults) 122 „ (Children) 16 (3) Public Houses (Adults) 21 (4) Cinemas and Theatres (Adults) 39 (Children) 2 (5) Swimming Baths (Adults) 13 „ „ (Children) 18 (6) Railway Stations (Adults) 53 366 63 ACCIDENTS AND ILLNESS TO ADULTS— Home Accidents 375 Miscellaneous Accidents 119 Recreational Accidents 72 Street Accidents 652 Work Accidents 254 Home Illness 160 Street Illness 511 Work Illness 65 Common Assault 31 Attempted Suicide 34 Suicide 12 2,285 ACCIDENTS AND ILLNESS TO CHILDREN— Home Accidents 287 Miscellaneous Accidents 74 School Accidents 159 Street Accidents 186 Recreational Accidents 62 Home Illness 37 Street Illness 11 816 HOW EMERGENCY CALLS WERE RECEIVED— Doctors 176 Paser By 860 Police 269 Householder 708 Fire Brigade 209 Staff 879 3,101 64 INFECTIOUS CASES CONVEYED BY WADDON HOSPITAL- Bronchitis 1 Cerebral Condition 1 Chicken Pox 19 Diphtheria 4 Dysentery 42 Encephalitis 1 Enteritis 9 Erysipelas 4 Food Poisoning 2 Gastro-Enteritis 36 Gastro-Influenza 2 Impetigo 3 Infective Hepatitis 1 Jaundice 1 Measles 64 Meningitis 12 Mumps 3 Otitis Media 2 Pemphigus 1 Pneumonia 1 Poliomyelitis 45 Puerperal Pyrexia 8 Rubella 3 Scarlet Fever 261 Septic Throat 2 Tonsilitis 1 Typhoid 3 Vincent's Angina 3 Whooping Cough 35 560 The Gas and Air Apparatus was in demand 714 times, which necessitated vehicles travelling 5,228 miles. 283 calls were received to convey members of the Croydon Nursing Association, which entailed travelling 6,116 miles. Conveying children to and from St. Margaret's School accounted for 2,739 miles. Conveying Mentally Defective Children to and from the Occupational Centre accounted for 22,585 miles. 7,801 cases were conveyed to Hospitals, etc., outside the Borough boundary, and on these journeys 119,027 miles were travelled. 65 CIVIL DEFENCE—Ambulance Section The number of Volunteers available for training at 31/12/'53 was 210, composed of 70 males and 140 females. This number shows an addition of 82 since the last Annual Report. These Volunteers are sub-divided as follows : — Volunteers attending for full training 143 Volunteers attending for some training 38 Volunteers not yet reported for training 16 Volunteers absent through sickness 4 Instructors (C.D. Volunteers) 9 210 Five Volunteers have resigned and 2 more have moved from the district. The record of possible attendance of 143 Volunteers was as follows: — 75 per cent, to 100 per cent 108 Volunteers. 50 „ „ 75 „ 20 „ 25 ,, ,, 50 „ 12 „ 0 „ „25 „ 3 „ The number of full First-Aiders is 72. The number of qualified Drivers is 21. The number of Volunteers receiving driving instruction is 4. Further First-Aid classes are due to commence on 12th January, 1954. Several small exercises have been carried out successfully and on the 15th December a large-scale exercise was held at the Albert Road Rescue Ground, South Norwood, combining the Experimental Mobile Column with the Ambulance Section. During the year the Civil Defence Austin Ambulance has been disposed of and in place of this an Austin has been purchased from the Fire Service. This vehicle has been converted for Civil Defence Training and Driving Instruction and is fully equipped with four stretchers. A. L. HILL, Chief Officer. 66 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, 59 cases were dealt with, 34 women, 17 men, 7 women with babies and 1 child. These figures do not include school children for whom arrangements are made by the Education Committee. LOAN OF NURSING EQUIPMENT The Corporation loan equipment and make a small weekly charge, with exemption for incomes below a certain figure. During the vear the undermentioned loans were made : — Bed Pans 177 Sputum Mugs 1 Bed Rests 145 Air Cushions 280 Rubber Bed Pans 37 Bed Cradles 16 Mackintosh Sheets 239 Urinals 81 Feeding Cups 14 Air Beds 7 Wheel Chairs 25 Dunlopillo Mattresses 3 Commodes 17 Bed Pulley 1 Crutches pairs 3 Bed Tables 6 Walking Machines 1 Draw Sheets 20 DOMESTIC HELPS. This service continued in great demand and an analysis of applications during the year shows the following percentages:— Maternity Cases 27.09 Sickness 72.14 Sick Room Helpers 0.77 (1) Number of Home Helps—January 1st and December 31st, 1953 : — (a) Full-time 17 (b) Part-time 115 (2) Number of new applications : — (a) Maternity 438 (b) Sickness 950 (c) Sick Room Helpers 10 67 (3) Number of applications met— (a) Maternity 351 (b) Sickness 935 (c) Sick Room Helpers 10 (4) Number of cases attended during year 2,068 (5) Average duration of services given— (a) Maternity 12 days (b) Sickness (acute cases) 10—21 days (6) Amount recovered for services £4,475 (7) Rate of remuneration of "Helps" at 31.12.53 was 2s. 71/8d. per hour. Owing to the added complication of abnormal staff sickness, heavy demands during the early part of the year could be met only by the abrupt cessation of services to elderly persons not acutely ill. These difficulties also stressed a basic insufficiency of supervisory staff, which is now being corrected; and a repetition of this breakdown should not recur. HEALTH PROPAGANDA No new measures were introduced during the year under review. It is still considered that the most effective general advice is that given to the mothers of families, and it is the doctors, health visitors and home nurses who have the best and constant opportunities for such instruction. The essential need to co-ordinate the education of the local health authority with the medical care given during illness was assisted by initial steps to bring together the family doctor and the health visitor. It is hoped that these preliminary moves may have successful results in the near future. Poster sites continued to show the Central Council for Health Education posters. The prevention of home accidents was stressed at all Infant Welfare Clinics and some 1,750 copies of "Better Health" were distributed each montih. Mothercraft lectures, talks to various local organisations and offers of special talks on cancer continued throughout the year. 68 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. Wo 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 Asssciation but no 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 1953, are as follows : — (a) Certified and admitted to Warlingham Park Hospital 19 (h) Admitted to Warlingham Park Hospital as voluntary patients 112 69 (c) Removed to Mayday Hospital under Detention Order 303 (d) Admitted to Warlingham Park Hospital as temporary patients - (e) Investigated and no action taken 104 (f) Urgency Orders — 538 Under the Mental Deficiency Act. Number of known Mentally Defective Patients in the Borough : 1952 1953 Under 5 years 64 45 Aged 5-16 years 112 108 Over 16 years 569 567 Total 745 720 Compared with 1952 the cases show a decrease of 25. Three Institution patients have died in hospital. The cases are distributed as follows : — In Certified Institutions 315 In Approved Homes 4 On Licence from Institutions 25 Under Statutory supervision at home 284 Under Guardianship 64 In Mental Hospitals 7 Observation cases 21 In "Place of Safety" — 720 During the year the Certifying Medical Officers made examinations and paid visits to the number of 98 cases. The Mental Deficiency Visitors paid 4,744 visits. 28 new cases were examined during 1953 and certified as mentally defective. 12 of these cases were recommended for the Occupation Centre and 6 were placed under statutory supervision. 8 were recommended for institutional care and 2 for friendly supervision. 70 During 1953, 33 cases were dealt with as follows : — 1952 1953 Sent to Certified Institutions 16 18 Placed under Guardianship 2 1 Sent to Warlingham Park Hospital — 1 Varying Orders : (a) Change of Guardian 1 2 (b) From one Institution to another 5 4 (c) From Guardianship to Institution 2 2 (d) Institution to Guardianship — 1 (e) Orders closed 1 4 Twenty-six Orders were renewed during the year, nine of which were Guardianship. Ten children were admitted to the Occupation Centre during 1953. Ten left or were excluded. There were 14 cases awaiting vacancies in Institutions on the 31st December, 1953. Guardianship Cases. There were 57 cases under Statutory Guardianship, 34 of these under the care of relatives, and 23 with Guardians who are not relatives. Four males and one female are at work. 704 visits have been paid to Guardianship cases during the year. There are 25 cases on licence from Institutions (10 males and 15 females). Report on the Occupation Centre, January-December, 1953. Number on Register, January 47 ,, ,, December 57 Number of Admissions 20 Number of Exclusions 10 Average attendance per session 43 Times open, Morning-Afternoon 402 Total attendance for year 17,388 71 I am indebted to Miss Cooney, Supervisor of the Occupation Centre, for the following report:— "The patients attending the Occupation Centre are divided into groups according to age and ability, i.e., Nursery—Intermediates—Adult Male, The Nursery group are trained in Sense and Habit forming methods, Hygiene, General Activity, Singing, Games and Speech Training. The Intermediate group receive instruction in Physical Training, Percussion Band, Music and Movement, the Wireless, Team Games, and Handiwork—simple knitting, sewing, weaving on loom, painting. The Adult Female group receive instruction in Cookery, Laundry, Silver Cleaning, Table Setting, Washing-up, Embroidery, Sewing, Singing and Dancing. The Adult Male section are instructed in Gardening, Rug-making, Stool Weaving, Basketry, Physical Training and Singing. The Nursery group rest after dinner for 5 hour. The Intermediate group rest for 20 minutes. The remainder have free play in garden or hall according to weather, for 5 hour. January 1953 opened quietly with 47 patients on roll. In April Miss M. Redhill, Board of Control Inspector, visited the Centre for routine inspection. In June a Coronation Party was held in the Hall; this was a great success. In September Miss Hensher returned from prolonged sick leave to resume class duties. The Annual Sale of Work was held in November. Proceeds of Sale amounted to £21 0s. Od. The sales for the year realised £31 9s. lld. In December the Christmas Party took place. The children were delighted with the Christmas Tree, Lights, Tea, Ice Cream and Film Show, the latter being thoroughly appreciated by all attending the Centre. Twenty-eight students visited the Occupation Centre during the year 72 SANITARY CIRCUMSTANCES To the Medical Officer of Health. I beg to submit a report for the year ending 31st December, 1953, of the work of the Sanitary Inspectors and other officers under my supervision. During the past two or three years much time and thought has been given to the mass "education" of food handlers in matters of food hygiene. Talks and visual aids have been employed and when the opportunity arises these methods are still used. There is, however, apparent a growing appreciation by all concerned, namely trader, handler and the public of the need for cleanliness in the preparation and service of food and the inspectorate are finding that personal contact with the handler at his or her place of business is the better atmosphere in which to "educate". Inspection of food premises at regular intervals and action against any serious defaulters is still the best form of control. The pending new Food and Drugs Act and the regulations to be made thereunder, will give further help to those officers who have the duty of safeguarding the food supply. From that part of the report to do with the repair of houses it will be seen that there is little diminution in the work in this field. The pending new Housing Act with its slum clearance provisions and its repairs and rents sections will increase the burden on this section over the next few years, but on the system of "first things first" I feel we will be able to cope with the additional work involved. Atmospheric pollution has been given more attention during the year, and pollution has been observed on routine inspections and following complaints. Success has attended our efforts in most cases, and in those cases which appear slow to improve progress is being made. 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 Insfector 73 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) 4,408 Number of nouses inspected where Zymotic diseases have occurred 300 Inspection of underground rooms 32 Investigations into complaints other than Housing matters 2,572 House drains tested 2,454 House drains tested on application 17 Number of smoke tests during repair 118 Inspections of drainage work during repair 3,437 Number of water tests during repair 180 Final tests of drains after repair 88 Final tests of drains when completely relaid 77 Inspections of yards, stables and manure pits 190 „ passages 142 „ public conveniences 274 „ pigstyes 117 ,, tents, vans and similar structures 90 ,, theatres, cinemas, halls, etc. 146 ,, ponds, ditches and watercourses 150 ,, schools and school sanitary conveniences 71 ,, verminous premises 88 ,, premises where offensive trades are conducted 30 ,, gipsy encampments, camps, fairs, etc 21 ,, cesspools and earth closets 17 ,, gathering grounds of water supply 54 Inspections of Swimming Baths 17 „ „ Wells 12 Number of visits re Rats and Mice Infestations 3,212 „ „ ,, ,, Smoke Abatement 1,234 „ ,, ,, ,, Infectious Diseases 1,440 Inspections of Shops (under Shops Acts) 2,105 Special Early Closing and Evening Patrols (Shop Hours Acts) 725 Overcrowding inspections 195 Inspections under Diseases of Animals Acts 63 Inspections under Fertilisers and Feeding Stuffs Act 11 ,, under Pharmacy and Poisons Act 153 ,, under Merchandise Marks Acts 539 Inspections under Pets Act 83 ,, ,, Rag Flock and other fillings materials Act 25 ,, ,, Rivers (Prevention of Pollution) Act 384 Inspection of Dairies 62 Milkshops 113 ,, Premises where food is prepared or sold 8,633 ,, Bakehouses 147 ,, School Kitchens and Services 141 ,, Imported Food at Aerodrome 28 ,, Factories without mechanical power 68 ,, Factories with mechanical power 693 ,, Workplaces (Public Health Act) 120 ,, Outworkers' premises 401 ,, Offices 27 Drinking water samples taken 259 Swimming bath waters : samples taken 63 Food and Drugs Acts : milk samples taken 324 Food and Drugs Acts : other foods and drugs samples taken 371 Milk (Special Designations) Orders : samples taken 351 74 Ice Cream samples taken 257 Samples taken of Rag Flock and other filling materials 25 „ „ „ Fertilisers and Feeding Stuffs 11 Reinspections of work on outstanding notices 19,274 Sundry inspections and visits 3,546 Appointments kept with owners, builders, etc. 3,936 Complaints from public investigated (including those in regard to housing defects) 6,043 Informal notices outstanding 31-12-52 1,556 Informal notices served 4,021 Informal notices complied 3,716 Number of Informal Notices referred for Statutory Orders 506 Informal notices outstanding 31-12-53 1,355 Statutory notices outstanding 31-12-52 394 Statutory notices served 870 Statutory notices complied 934 Statutory notices outstanding 31-12-53 330 Total number of callers and complaints received at the office 5,614 Total number of letters received at the office 6,345 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1953 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 419 Conditions causing dampness: Defective roofs 623 Defective window frames 226 Defective walls, etc. 338 Want of efficient damp¬proof course 45 Defective gutters and downspouts 462 'Other structural defects : Defective plaster 317 Cleansing and redecoration required 106 Defective floors and stairs 278 Insufficient ventilation under floor 26 Defective brickwork, sills, lintels, chimneys 165 Defective stoves and fireplaces and flues 266 Defective drains, sanitary fittings, etc. : Defective sinks and waste pipes 128 Defective w.c.'s 281 Defective drainage 378 Stoppages in drains 262 Defective water services and tanks 39 Domestic nuisances : Want of cleanliness 27 Verminous conditions 88 Other nuisances and infringements: Offensive accumulations 81 Overcrowding 65 Smoke nuisances 3 Sundry nuisances or defects 177 Particulars not inserted in Rent Book (Housing Act) 11 75 (2) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924. Food cupboards defective or required 4 (3) INFRINGEMENTS OF FOOD AND DRUGS ACT, 1938, AND FOOD BYELAWS. Structural defects in shops and stores 60 Cleansing or repair of walls and ceilings 172 Cleansing or repair of floors, utensils, fixtures, etc. 129 Insufficient or defective sink accommodation and water supply 47 Insufficient lighting or ventilation 23 Defective drainage 38 W.C. accom—Insufficient 11 „ „ Repair or cleansing required 32 „ „ Artificial light required 11 „ „ Want of intervening ventilated space 10 Cloakroom accommodation required or defective 9 Overalls required or dirty 5 Ablutions—Wash basins required 20 „ Hot water supplies required 65 „ Soap and towels required 21 Food improperly stored 32 Food store—Required or defective 12 „ Animals kept in 5 „ Household washing in 1 Accumulation in yards or stores 37 Offal and refuse bins uncovered or defective 42 Yard paving defective 18 Vehicles—dirty or defective 1 (4) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING, Etc. Defective Yard Paving 59 Want of a sanitary dustbin 117 Public Urinals—defective or dirty 15 (6) INSPECTION OF AMUSEMENT HOUSES. Defective sanitary fittings 6 W.C. defective and dirty 3 (6) KEEPING OF ANIMALS. Nuisances arising from the keeping of animals 6 (7) SMOKE ABATEMENT. Nuisances observed 3 76 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) 4,289 (b) Number of inspections and re-inspections made for the purpose 19,011 (2) (a) Number of dwelling houses included under the head (1) above, which were inspected and recorded under the Housing Consolidated Regulations, 1926 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 — (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 2,99o II.—Remedy of defects throughout the year without service of Formal Notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 2,360 III.—Action under Statutory Powers during the year:— A.- Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which notices were served during the year requiring repairs 434 (2) Number of dwelling houses which were rendered fit after service of formal notices— (a) By owners 418 (b) By local authority in default of owners 46 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 365 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 146 (b) By local authority in default of owners 159 77 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 — (2) Number of dwelling houses demolished in pursuance of Demolition Orders 6 1).—Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 4 (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 or l1s. 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 96, and the number accommodated during the year 34,966. The receipts and expenditure for the past 5 years have been as follows:— Receipts. Expenditure. £ s. d. £ s. d. 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 1953 2,674 0 0 3,711 0 0 78 Houses—Sanitary Certificates. House drains and sanitary fittings are tested and examined on request, at a fee. During the year 17 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 693 118 — Without Mechanical Power 68 19 — Other Premises 120 10 - Outworkers and Employers of outworkers 401 2 — Total 1282 149 — Defects Found Particulars. Number of Defects. Referred to H.M. Inspector. Prosecutions. Found. Remedied. Want of Cleanliness 13 10 — - Overcrowding — — - - Unreasonable Temperature — — — - Inadequate Ventilation 2 2 — - Ineffective Drainage of Floors 1 — — - Sanitary Conveniences. (a) Insufficient 11 6 — - (6) Unsuitable or Defective 112 102 — - (c) Not Separate for Sexes 5 4 — — Other offences against the Act (not including offences relating to Outworkers) 42 39 17 Total 186 163 17 - 79 Home Work. Lists of home workers, or outworkers as they are termed, are sent in twice yearly, and this year contained the names of 216 workers resident in the Borough. 401 visits were paid to outworkers. Nature of Employment of Outworkers on the Register, 31st December, 1953 Ntur Work. Number Employed. Outwork in Infected Premises. Outwork in Unsatisfactory Premises. Remarks. Making, Cleaning, Altering and Repairing Wearing Apparel 96 Upholstery Work 3 — — — Other Classes of Work 117 - - - Total 216 — — — Inspection of Schools. These are inspected with particular reference to sanitary accommodation including washing facilities. During the year 71 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. 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. 2,105 inspections were made under the Shops Acts, and the infringements found were as follows:— Hours of Closing 15 Hours of employment of staff nil Provision of means of heating 11 Insufficient W.C. accommodation 3 Want of washing facilities 1 80 Defective W.C. accommodation 16 Defective walls, floors, ceilings, etc. 13 Defective and insufficient lighting 3 Want of seating accommodation 3 Notices to be exhibited or amended 294 DRAINAGE During the year there was no lessening of work in this branch of the department's duties. Some 3,437 visits of inspecton 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 365 Orders served, 159 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 534 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. Appropriate action was taken where pollution was observed. 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. 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 81 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. 43 such observations were carried out and in 3 instances black smoke was emitted for more than the statutory limit. The Managements were immediately interviewed and informed of the offence and advised. AMUSEMENT HOUSES. 146 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 15,313 articles „ Formalin Gas 7,226 „ „ „ Spray 1,033 „ Total 23,571 „ In addition, 594 articles were destroyed on request. Disinfection of bedding and upholstered articles is carried out 'or traders, who deliver them to, and collect them from, the Station. For this service a charge is made. During 1953, 584 articles were disinfected, the receipts amounting to £35 12s. 4d. Disinfection was carried out after infectious or contagious disease at the following premises:— 82 1,155 rooms at 799 houses, hospital wards, clinics and creches. 4,037 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 60 children were cleansed of verminous conditions and 1 child was 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 spraving: fumigation. PHARMACY AND POISONS ACT, 1933. The object is to regulate the sale of certain poisonous substances and the Act contains important provisions. During the year the number of applications granted for entn of names on the list of persons entitled to sell poisons under Pan 2 of the Act was 22. In addition, 291 applications were made for the retention of names on the list for a further period of twelve months. 8 infringements of the Act were found. FERTILISERS AND FEEDING STUFFS ACT, 1926. 11 inspections of premises where fertilisers and feedings stuffs were sold, were carried out during 1953. During the year the undermentioned samples were taken : — Fertilisers 5 Feeding Stuffs 5 The undermentioned were found not to be in accordance with the requirements of the Act:— 83 1 Deficiency of Fibre in Fine Millers' Offals. 1 Excess of Oil and Fibre in Poultry Pellets. 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 1953, 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 1 Black Flock 1 Washed Flock 8 White Art Wool 1 Cotton Felt 1 Woollen Mixture Felt 1 Brown White 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 three cases of suspected Anthrax were notified but on investigation the animals proved negative to Anthrax. Swine Fever was found in pigs sent into slaughterhouses on five occasions during the year. Appropriate action was taken in these cases. 84 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, 1,397 private dwellings were inspected following complaints and in 858 instances infestation was confirmed. The rodent operatives dealt with 771 of these infestations and the occupiers themselves, after being advised, dealt with 58. In 32 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. 139 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. 45 infestations at such premises were dealt with 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. 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 3,317 premises in the Borough at which food is known to be sold, manufactured or stored:— The following table gives a summary of the inspections made during the year, not including visits made to slaughterhouses or dairies:— Butchers 1,312 Greengrocers 393 Bakers and Bakehouses 436 Grocers 1,946 Confectioners 598 Stalls and Rounds other than in Markets 136 Fishmongers 292 Fried Fish Shops 92 Catering Establishments 1,395 Poultry and Game Dealers 317 Miscellaneous 216 Cooked Meat Preparation Premises 275 Ice¬Cream Vendors and Manufacturers 811 8.219 85 Bakehouses 71 Bakers Shops 123 Sugar Confectioners 541 Cafes, Restaurants, Snack Bars and Eating Houses and Kitchens 489 Works and Club Canteens 220 Public Houses 154 Off Licences 66 Grocers 616 Butchers 196 Chemists 98 Greengrocers 346 Fishmongers 94 Fried Fish Shops 48 Milk Distributors and Dairies 72 Premises from which Roundsmen and Mobile Shops operate 47 Stalls in Markets 66 Food Manufactories 31 Other food premises not enumerated above 39 3,317 Of the above premises 827 are registered under Section 14 of the Food and Drugs Act, as follows:— Retail sale of ice-cream 627 Manufacturers of ic¬cream 7 Preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 193 86 In addition to the above, Croydon Airport was visited on 28 occasions to inspect foodstuffs arriving by air from the Continent. Such foodstuffs included Salami, Brawn and Delicacies. It was not found necessary to condemn any article. General Summary of meat and other articles of food found to be unlit and condemned by the Inspectors during 1953:— Articles. Weight in lbs. Diseased. Unsound. Total. Beef 25986 7158 33144 Veal 144 — 144 Mutton 1115 207 1322 Pork 8527 326 8853 Offal 51522 125 51647 Sundry Foodstuffs — 6048 6048 Canned, bottled and packeted goods — 32781 32781 87294 46645 133939 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. Some of the other condemned foods are converted to animal feeding stuffs and the remainder are destroyed. 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 the year 1953 the following animals were slaughtered there and inspected by the Corporation's Meat Inspectors:— 87 Cattle excluding Cows. Sheep and Cows. Calves. Lambs. Goats. Pigs. Total. 4,623 1,087 396 11,720 259 8,293 26,378 The result of these inspections was as follows:— CARCASES INSPECTED AND CONDEMNED Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Goats Number killed 4623 1087 396 11720 8293 259 Number inspected 4623 1087 396 11720 8293 259 All Diseases except Tuberculosis. Whole Carcases condemned 4 6 4 12 109 Carcases of which some part or organ was condemned 1423 412 — 948 437 2 Percentage of the number inspected affected with disease other than Tuberculosis 30 86 38.45 1.01 8.19 6.58 .77 Tuberculosis only. Whole carcases condemned 9 12 _ 3 Carcases of which some part or organ was condemned 340 230 — — 92 — Percentage inspected affected with Tuberculosis 7.54 22.26 — — 1.14 — MILK SUPPLY. During the year 175 inspections were mnde 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" 53 Licences to use the designation "Pasteurised"— (a) Dealers' (Pasteurisers') Licences 3 (b) Dealers' Licences 62 88 Licences to use the designation "Sterilised"— Dealers' Licences 96 Dealers' Supplementary Licences to use the designation— (a) Tuberculin Tested 8 (b) Sterilised 7 (c) Pasteurised 8 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 334 Sterilised Milk 4 The following table summarises the results of the bacteriological examinations of Tuberculin Tested, Pasteurised and Sterilised milk samples during the year:— TubErculin-Testf.d Milk. Methylene Test. No. Samples Taken. Not Satisfied. Satisfied. 13 1 12 89 Pasteurised Milk. No. Samples Taken. Methylene Blue Test. Phosphatase Test. Not Satisfied. Satisfied. Not Satisfied. fied. 334 2 332 1 333 Sterilised Milk. No. Samples Taken. Turbidity Test. Not Satisfied. Satisfied. 4 Nil 4 90 BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM. 257 samples were taken, the results being as under:— No. of Grade. Samples. 1 154 2 70 3 22 4 11 Out of a total of 257 samples taken, 33 (13 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. Of the 8 samples taken from local manufacturers 7 were found to comply with the standard. The remaining sample contained 3.4 per cent. of fat instead of not less than 5 per cent. The manufacturer was advised and a subsequent sample proved satisfactory. 91 FOOD AND DRUGS ACT, 1938. During the year 324 samples of milk and 373 other samples were taken. Summary of Samples. During 1953 samples were obtained and submitted to the Public Analyst as follows : — Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Albumen—egg white 1 1 __ - - Anchovy 1 1 — __ Apples 1 1 - Apricots in Syrup 1 1 — — __ Arrowroot 1 1 __ Baby Food 2 2 — ___ Beans, Butter 2 2 Beans in Tomato Sauce 3 3 Beef, Minced 2 2 - - Beef, Loaf 2 2 , - Beer 7 7 - Biscuits 5 5 - Blackcurrants in Syrup 1 1 Blanc Mange 4 4 Black Pudding 4 4 - Boric Acid Ointment 2 2 _ - Bloater Spread 1 - 1 Bread 9 9 __ Bread, Wnolemeal 1 - 1 Brawn 3 3 - - - Bun Flour 3 3 - Butter 1 1 - - - Cakes 10 10 - Cake Mixture 5 5 _ Cake Decorations 1 1 _ - Cake and Pudding Mixture 4 4 - Camphorated Oil 1 1 - - Carrots 1 1 - - - Cheese 2 2 - - - Cherries 4 4 - - - Chocolate Drink—Vitacup 1 1 Chutney 2 2 Cocoa 5 5 - - - Cod Liver Oil 2 2 - - - Coffee 3 3 - - - Coffee and Chicory 2 2 _ ___ Coffee and Chicory Essence 1 1 Condiment, Non¬brewed 1 1 - _ Conserve, Ginger 1 1 1 - - - Conserve, Peach 1 Cooking Fat 1 1 - - - Cordial 8 8 - - - Cough Mixture 4 4 - - - Cream 1 1 - - - Cream, Sterilised 1 3 1 3 - - - Curry Powder 2 2 - - - Custard Powder 7 7 - - - Dessert, Caramel 1 1 - - - Dessert, Powder 1 1 - - - Fish Cakes 3 3 - - - Fish, Tunny 1 1 - - - Flavouring Essence 2 2 - - - Fuiit, Dried 3 3 Gelatine 1 1 — — — Carried forward 142 140 2 — — 92 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought forward 142 140 2 — _ Ginger Beer 1 1 — — - Glauber Salts 3 3 — — — Gooseberries in Syrup 1 1 _ — — Glycerine 1 1 — — - Gin 4 4 — — - Ham and Veal Loaf 2 2 — — - Herrings in Tomato 2 2 — — - Honey 2 2 — — — Ice Cream 8 7 1 — — Ice Lollies 13 11 2 — — Iodine, Tincture of 2 1 1 —. — Indigestion Tablets 2 2 — — — Jam 6 6 — — — Jelly, Strawberry 1 1 — — -— Kidney and Backache Pills 1 1 — — — Lemonade 1 1 — — -— Lemonade Powder 1 1 — — - Lemon Curd 2 2 — — - Luncheon Meat 7 7 — — — Luncheon Roll 1 1 — — — Magnesia, Milk of 1 1 — — - Malt with Cod Liver Oil 1 1 - — Margarine 1 1 — - - Marmalade 5 5 — — — Milk 314 303 11 — -— Milk, Channel Island 10 10 — — — Mincemeat 1 1 — — — Mint Sauce 1 1 — — — Mineral Water 1 1 — — — Mussels 1 1 — — — Mustard 2 2 — — — Oranges in Syrup 1 1 — — — Paste 7 7 — — — Paraffin, Liquid 1 1 — — — Pastilles, Throat 1 1 — — — Peel 3 3 — — — Pepper 1 1 - — —- Pepper Flavoured Condiment 1 1 — — — Peas 1 1 — — - Pickle 4 4 — — — Pickling Spice 1 1 — — - Pie, Veal and Ham I 1 — - - Pilchards 1 1 — — — Pineapple, Crushed 1 1 — — — Plums, Canned 2 2 — — — Potato, Cooked 1 1 — — — Prunes in Syrup 1 1 — — -— Puree Apple 2 2 — — Raspberries, Bottled 1 1 — — - Rennet, Essence of 1 1 — — - Roes 1 1 — — - Rolls—Bread 1 1 — —. Rice 7 7 — — —- Rum 5 5 — — - Sago 2 2 — — - Salad Cream 1 1 — — - Salt 1 1 — — -— Sauce 1 1 — — - Carried forward 592 574 18 — - 93 Samples of Total Samples Genuine Not Genuine Prosecutions Convictions Brought forward 592 574 18 — — Sardines 3 3 Sausages, Beef 11 11 — — — Sausages, Pork 14 12 2 — — Sausage, Breakfast 2 2 — — — Sausage, Liver 4 4 — — — Sausagemeat, Beef 2 2 — — — Savoury Ducks 1 1 — - — Semolina 3 3 — — — Sherbet 1 1 — — — Soup 4 3 1 — — Soup, Powder 1 1 — — — Sponge Mixture 1 1 — — — Spread, Celery and Cheese 1 1 — — — Spread, Cheese 1 1 — — — Spread, Veal and Ham 1 1 — — — Spread, Sandwich 2 2 — — — Steak, Stewed 2 2 — — — Strawberries 1 1 — — — Stuffing, Parsley and Thyme 2 2 — — — Suet 1 1 — — — Sugar 7 7 — — — Sweets 19 19 — — — Tapioca 1 1 — — — Tea 3 3 — — — Tongue 1 1 — — — Tomato, Condensed 1 1 — — — Veal, Jellied 1 1 — — — Veal and Ham Loaf 1 1 — — — Vegetables, Mixed 3 3 — — — Vegetarian Food (Rissol Nut) 1 1 — — — Vinegar, Malt 1 1 — — — Wine, White 2 2 — — — Wine, Ruby 1 1 — — — Whisky 4 4 — — — Yeast Tablets 1 1 — — — Totals 697 676 21 - — 94 Result of Analysis of Milk Samples. Solids not Fat (Legal standard is 8.5%)* 8.2 8.3 8.36 8.46 8.5 8.55 8.6 8.7 8.8 8.9 9.0 3 2 1 2 15 1 76 10 88 16 9 Milk Fat (Legal standard is 3%)* 2.48 2.9 2.97 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0 4.1 1 2 1 3 3 16 53 67 56 55 26 16 11 3 1 (Excluding South Devon and Channel Islands milks) South Devon and Channel Islands Milks Solids not Fat (Legal standard is 8.5%)* 9.1 9.2 9.3 6 1 3 Milk Fat (Legal standard is 4%)* 4.1 4.2 4.4 4.5 4.7 5.1 5.3 1 3 1 1 1 1 2 Average composition of Milk Samples Milk (excluding South Devon and Channel Island Milks) Solids not Fat 8.7% Milk Fat 3.48% South Devon and Channel Island Milk Solid not Fat 9.17% Milk Fat 4.6% Total number Milk Samples 324. 95 The samples of milk for analysis were obtained as follows: Taken on Milk Rounds 216 at Dairies 55 „ at Institutions 38 „ at Local Farms 13 „ at Schools 2 324 DETAILS OF NON-GENUINE SAMPLES TAKEN Article Nature of Adulteration or Deficiency Remarks Bloater spread Contained 8 ¾ grains of tin per pound instead of a maximum of 2 grains per pound. Stock Withdrawn. Bread-wholemeal Sample was contaiminated and discoloured by iron in form of particles of rust Investigations showed a small piece of iron rust in the stock of wholemeal flour. It has not been possible to trace the source of this rust either in the Miller's or the Baker's premises. Ice Cream Contained only 3.4% of fat instead of not less than 5% Manufacturer advised and subsequent sample proved genuine. Ice Lolly The sample contained m6 parts per million of lead. Referred to Food and drug Authority in Area Ice Lollies already distributed were recovered and destroyed. Further manufacture ceased pending local investigation and until such time as all moulds are either replated or renewed. Ice Lolly Contained 10 parts per million of lead. All lollies from this batch were withdrawn from sale. The manufacturers have ceased production pending an investigation into the cause of contamination. Iodine-Tincture of Slightly deficient in potassium iodide. Contained 2.37% w/v of KI instead of a maximum of 2.45% w/v. Stock withdrawn. Malt with Cod Liver Oil Contained only 1,900 units per ounce of Vitamin A instead of the 2,800 units per ounce claimed on the label. The article was deficient in vitamin A to the extent of 32%. Stock withdrawn-new stock re¬labelled. 96 Article Nature of Adulteration or Deficiency Remarks Milk slightly deficient in milk solids other than milk fat. Freezing point did not con¬firm the presence of added water. Subsequent samples proved genuine. Milk 3% deficient in milk solids other than milk fat. Freezing point was consistent with the presence of a small proportion of added water. „ „ Milk 3% deficient in milk solids other than milk fat. Contained 5% of added water. Vendor warned. Further samples taken have proved satisfactory. Milk 17% deficient in milk fat, 0.7% deficient in milk solids other than milk fat. These samples were part of a consignment the average of of which was within the Legal Limit. Subsequent samples were found satisfactory. Milk 1 % deficient in milk fat. Milk 1% deficient in milk solids other than milk fat. These samples were taken as part of an investigation following a complaint from an outside authority. A fault in the Dairy Plant was discovered and rectified. Milk Added water 5 percent. Milk Added water 5 percent. Milk Added water 5 percent. Milk 3% deficient in milk fat. 4% deficient in milk fat. These samples were part of a consignment the average of which was within Legal Limit. Subsequent samples were found satisfactory. Sausage-Preserved pork The declaration on the label was not in the form pre¬scribed by the Public Health (Preservatives, etc., in food regulations. At the time of purchase a Notice in the prescribed form was exhibited. the use of the incorrect label has been discontinuued. Sausage-Pork Sample contained Sulphur dioxide:- 160 ppm. by weight. The sample which was imported from Ireland bore a label on which was printed "These sausages contain preservatives." The label, however, did not conform with the Public Health (Preservatives, etc., in food) Regulations 1925-1953. The attention of the Importer had previously been drawn to this matter and new labels have now been printed which conform with the Regulations. Soup--Meat The ingredients of the article included Bone Stock, meat and vegetable extracts, salts, spices and flavourings, but except for the bone stock, these ingredients were not specified on the label On investigation it was found that the article was of very old stock; the manufacturers have for some time past had all labels approved by Ministry of Food i abelli Division. 97 WATER. I am indebted to the Water Engineer, W.C. Knill, Esq., B.Sc., M.IC.E., M.I.Mech.E., M.I.W.E., for the following data:- "The Water supply is drawn from deep wells in the chalk. These wells are situated at Surrey Street, Stroud Green, Waddon, Selhurst and Addington. The water from all of the wells is treated by the addition of chlorine and in the case of the water from Surrey Street and Waddon, ammonia is added after chlorination. Owing to the occasional occurrence of turbidity in the raw water from the Addington Well, this water is filtered before chlorination. A portion of the northern side of the Borough is supplied with water which is purchased in bulk from the Metropolitan Water Board. The amount of water consumed during the year was— Gallons Corporation Wells 2,348,316,000 M.W.B. Bulk Supplies 779,569,000 Total: 3,122,885,000 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. 404 raw water samples and 966 treated water samples were thus examined bacteriologically during the year by the Chemist and Bacteriologist on the staff of the Water Undertaking. In addition 19 samples of raw water and 55 samples of treated water were subjected to bacteriological examination by the Consultant Bacteriologist to the Water Undertaking. Further samples were submitted by the Medical Officer of Health for examination by 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 98 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 74 of raw waters and 125 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 beer submitted to the area Public Health Laboratory, 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 260 Chemical 13 99 SEWAGE DISPOSAL AND REFUSE COLLECTION I am indebted to the Borough Engineer, A. F. Holt, Esq., A.M.I.C.E., for the following information: — Refuse Collection and Disposal. In 1953 the following tonnage were dealt with : — House Refuse 57,066 tons Street Sweepings 3,837 ,, Street Markets refuse 1,200 „ 62,103 „ This was disposed of by Controlled Tipping and three sites were in use during the year, viz. The East Surrey Gravel Pits, Albert Road and West wood Avenue. The last named, at present in use, is being levelled for eventual use as school playing fields Sewage Disposal. The sewage of the Borough is dealt with at Beddington and South Norwood. The Addington area drains into the West Kent Drainage Board Works and a small part of Upper Norwood into the L.C.C. system. The main works at Beddington deals not only with the sewage from the major part of the Borough, but takes the sewage under agreement from four outside authorities, viz., Coulsdon and Purley U.D.C., Caterham and Warlingham U.D.C., Banstead U.D.C., and Carshalton U.D.C. The sewage flow from an estimated population of 333,000 is treated at the Beddington Works, the dry weather flow being about 12 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 35 vehicles, including part of the fleet of Refuse Collecting Vehicles, have been running on this gas during 1953, and by this means about 46,000 gallons of petrol were saved. 100 MISCELLANEOUS Nursing Homes—Public Health Act, 1936. Number of Homes. Number of Beds provided for Maternity. Others. Total. Homes registered during the year 1 — 29 29 Homes on the Register at the end of the year 30 38 544 582 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 31-12-53. Number of children provided for Premises 5 110 Daily Minders 23 196 CROYDON AIRPORT—HEALTH CONTROL With the partial withdrawal of Immigration Officers, the work formerly performed by the Medical Receptionists was placed upon the Customs Officers. The system of continuous "on call" manning by Medical Officers has continued. Aircraft and Passenger Arrivals, Croydon Airport. Aircraft Passengers "Excepted Area" 1,498 3,425 Europe outside Excepted Area 193 2,982 Africa, Middle East 13 89 Asia 2 3 1,706 6,499 Included in the above figures were 1,379 Aliens carried in 356 Aircraft. CREMATIONS ACT, 1902 During the year 2,197 certificates were completed by the Medical Officer of Health in the capacity of Medical Referee under the above Act. INTERNATIONAL CERTIFICATES FOR VACCINATION During the year 848 certificates were dealt with at the office (742 Smallpox, 57 Cholera, 45 T.A.B., 1 Typhus and 3 in respect of general condition of health). NATIONAL ASSISTANCE ACT, 1948 (Section 47) Three cases (females) were dealt with under the National Assistance (Amendment) Act, 1951. Two patients were taken to Queen's Hospital, one age 89 being infirm and one age 65, physically incapacitated. The third case, although over 90 years of age, was sufficiently active for admission to a Corporation hostel for old people. STAFF MEDICAL EXAMINATIONS 932 examinations were made during the year by the Medical Staff of the Department. 101 102 SPASTICS AND EPILEPTICS Ministry of Health Circular 1/54 asks for a report on the incidence of spastics and epileptics in the area, and a review of facilities available to them. The definition of spastic proposed in Ministry of Health Circular 26/53 is—"those who have a permanent and substantial handicap resulting from brain damage or defect occurring before or at birth, or during childhood'. The figures for Croydon, which are not put forward as complete, but represent a joint effort of statutory and voluntary organisations, are as follows : — Total spastics of all ages—83. Pre-school—9. 3 probably ineducable. 1 probably educable. 1 in an institution. 4 not assessed. School age—48. 24 in special schools. (20 in Physically Handicapped Day School.) ( 3 in special school for Spastics.) ( 1 in Physically Handicapped Residential School.) 5 in ordinary schools. 8 ineducable. 4 not yet at school. Final decision regarding schooling 3 ? ineducable. not yet made. 4 at Special Educationally Sub-Normal School. Over School age—22. 9 mentally defective. 2 awaiting training. 1 at work. 10 no details known. Age not known—4. Diagnostic facilities. In addition to the London teaching hospitals, there are available the special unit at Queen Mary's, Carshalton, and the screening facilities of St. Margaret's School. The Croydon Branch of the National Spastics Society have also established their own diagnostic clinic. 103 Treatment. Facilities exist at Carshalton and some parents go to private clinics in London offering special treatment for Spastics. The Croydon Branch of the National Spastics Society is also conducting a day nursery and treatment centre. Education. Spastics with marked disability but normal intelligence are accepted as day pupils at St. Margaret's School for Spastics. Those with similar disabilities, but an I.Q. of less than 80 are admitted to the special day school for physically handicapped children, where special treatment is available. When the physical defect is slight and intelligence average a normal day school has proved satisfactory. Similarly with minor physical disability and educational subnormality a day school for educationally sub-normal children has been recommended. Whenever possible, ineducable Spastics are admitted to the Corporation's Occupation Centre. Recommendations for special training after school age are made to the Welfare Department. Total epileptics of all ages—36. Pre-school—2. 1 educable. 1 probably ineducable. School age—19. 5 at Physically Handicapped Day School. 9 at ordinary schools. 2 at Educationally Sub-Normal School. 2 at Epileptic Residential School. 1 probably ineducable. Adults—15. 104 BLINDNESS Ministry of Health Circular 1/54 requires certain information regarding persons registered as blind or partially blind during 1953. I am indebted to The Chief Welfare Officer for access to his records. 87 forms B.D.8 were received from ophthalmic surgeons of which 30 gave "Primary Cataract" and 16 Glaucoma" as the main cause of blindness. In 5 other cases "Primary cataract" was listed under "other cause." Seven of these patients were recommended for surgical treatment. Subsequent enquiry showed that 3 had had successful operations, 2 were still attending hospital and 2 had refused operations. 105 County Borough of Croydon ANNUAL REPORT of the PRINCIPAL SCHOOL MEDICAL OFFICER For the Year ending December 31st, 1953. 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 Principal School Medical Officer for the year ending December 31st, 1953. The anticipated increase in the school population was met by a special effort to supply the facilities available only through the School Health Service. Thus record numbers of routine school medical inspections were carried out and it was possible to include the permissive examinations of the 4th age group for almost the whole of the year. The fact that schools contained an unusually large number of five-year-old entrants raised the possibility of an increased incidence of infectious diseases. These fears were partly realised, but serious illnesses, e.g., poliomyelitis, were not prevalent. At one school, scarlet fever necessitated special control measures. I have previously noted that the mildness of present day scarlet fever leads to its being overlooked, so that adequate exclusion is sometimes omitted. Sonne dysentery was also encountered but not to an extent which raised special difficulties. The detection of a teacher suffering from infectious pulmonary tuberculosis required skin testing and X-raying of all the children in one school. None was found suffering from active tuberculosis. 106 The central and subsidiary minor ailment clinics continued to provide useful services. Attendances diminished because whenever possible sessions were reduced for the staff to be released for inspection duties. These economies did not reduce efficiency, as treatment facilities available through the National Health Service were used as required. In the ascertainment of handicapped pupils, particular attention was given to the detection and treatment of deafness at the earliest possible age. This necessitated the transport of young children to and from the London area, because the numbers concerned are too small for adequate local facilities. For educationally sub-normal children the additional classrooms recently built have made accommodation at the special day school reasonably sufficient. Improved facilities for physiotherapy treatment at the Day School for Physically Handicapped Children were approved and the building adaptations have commenced. The Principal School Dental Officer deals with the details of the School Dental Service, and the position that a new Surgery could be recommended marks a welcomed change from reports of former years. My thanks are due to the staff of the department for the manner in which the challenge of record numbers was met and to the members of the Education Committee, who despite the heavy burden of meeting the general educational needs, continued to encourage the development of the School Health Service. 107 STAFF OF THE SCHOOL HEALTH SERVICE *Medical Officers 9 (including 1 part-time) *Dental Officers 9 (including 4 part-time) *Physiotherapists 2 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 Minor Ailments Clinic, is by appointment arranged by the School Medical Officer: — Clinic Address Minor Ailments Lodge Road, Broad Green, Croydon (Daily, Monday to Saturday, a.m.); Ashburton School (Mondays and Thursdays only, 9 a.m.); Rockmount School (Mondays and Thursdays only, 9 a.m.); Duppas School, Goodwin Road, Waddon (Daily, Monday to Friday, a.m.); Wolsey Crescent, 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. Speech Defects 33 St. lames' Road, Broad Green, Croydon. verruca Clinic Lodge Road, Broad Green, Croydon (Monday and Friday, p.m.). 108 RETURN OF ATTENDANCE IN MAINTAINED PRIMARY, MODERN, CENTRAL, TECHNICAL AND GRAMMAR SCHOOLS FOR THE AUTUMN TERM, 1953 School Average No. on Register Average Attendance Average Attendance per cent. Average 1952 Attendance per cent. COUNCIL PRIMARY SCHOOLS Ashburton Junior Mixed 556 522 93.8 93.6 Ashburton Infants 345 314 91.0 90.0 Benson Junior Mixed and Infants 558 517 92.7 92.8 Beulah Junior Boys 417 388 93.0 93.2 Beulah Junior Girls 346 327 94.5 92.8 Beulah Infants 286 258 90.0 90.0 Cypress Junior Mixed and Infants 419 373 89.0 90.7 Davidson Infants 310 274 88.3 89.7 Duppas Junior Mixed and Infants 477 432 90.6 88.0 Ecclesbourne Junior Boys 300 276 92.0 89.0 Ecclesbourne Infants 249 231 92.8 87.0 Elmwood Junior Boys 285 263 92.3 91.0 Elmwood Junior Girls 322 290 90.0 89.0 Elmwood Infants 323 286 88.5 87.0 Fairchildes Junior Mixed and Infts. 714 608 85.2w.c.&g.I. 86.2 Gilbert Scott Junior Mixed 432 407 94.2 92.3 Gilbert Scott Infants 337 310 91.9 88.5 Gonville Junior Mixed and Infants 495 448 90.5 89.6 Howard Junior Mixed and Infants 507 465 91.7 91.4 Ingram Infants 254 223 87.8 87.6 Kensington Avenue Junior Mixed and Infants 589 544 92.3 89.4 Kingsley Junior Mixed 451 409 90.7 89.0 Kingsley Infants 365 313 85.7 85.2 Monks Orchard Junior Mixed and Infants 438 401 91.6 91.9 Overbury Junior Mixed and Infts. 631 564 89.4 84.8 Norbury Manor Junior Mixed 455 426 93.6 93.7 Norbury Manor Infants 309 278 89.9 86.1 Oval Junior Mixed 455 430 94.5 92.5 Oval Infants 213 183 85.9c.p.&g.i. 83.9 Portland Infants 277 253 91.3 90.4 Purley Oaks Senior and Junior Mixed 572 537 93.9 92.5 Purley Oaks Infants 189 170 89.9 89.9 Rockmount Junior Mixed 347 325 93.7 94.7 Rockmount Infants 262 211 80.5c.p.&m. 81.4 South Norwood Junior Boys 347 326 93.9 91.4 South Norwood Junior Girls 289 268 92.7 89.7 South Norwood Infants 369 330 89.4 St. Peter's Junior Mixed and Infts 371 347 93.5 90.2 Spring Park Junior Mixed and Infts. 703 631 89.8 88.5 Sydenham Junior Boys 308 286 92.8 91.9 Sydenham Junior Girls and Infants 371 329 88.6 87.5 Waddon Junior Mixed and Infants 271 233 86.0g.i. 90.9 West Thornton Junior Boys 225 213 94.6 94.0 West Thornton Junior Girls 202 186 90.1 93.1 West Thornton Infants 271 232 85.6C.p. 86.3 Whitehorse Manor Junior Girls 274 252 92.0 90.3 Whitehorse Infants 305 259 84.9c. p. 79.0 Winterbourne Junior Boys 383 364 95.0 94.0 Winterbourne Junior Girls 408 390 95.6 94.0 Winterbourne Infants 424 374 88.2 87.0 Wolsey Junior Mixed 538 505 93.9 90.5 Wolsey Infants 326 299 91.7 88.4 Woodside Junior Boys 423 403 95.2 93.9 Woodside Junior Girls 398 371 93.2 94.1 Woodside Infants 362 324 89.5 88.5 Total 21,053 19,178 91.0 90.0 g.i. = General Illness w.c.= Whooping Cough me. = Measles c.p. — Chicken Pox Infl. = Influenza s.f. = Scarlet Fever m. = Mumps 109 School Average No. on Register Average Attendance Average Attendance per cent. Average 1952 Attendance per cent. COUNCIL SECONDARY MODERN SCHOOLS Ashburton Senior Boys 507 484 95.5 92.5 Ashburton Senior Girls 473 434 91.8 91.4 Davidson Senior Boys 267 250 93.6 92.7 Davidson Senior Girls 138 126 91.3 90.3 Ecclesbourne Senior Girls 279 248 88.8 85.9 Fairchildes Senior Mixed 448 404 90.1 88.0 Ingram Senior Boys 386 353 91.5 90.4 Ingram Senior Girls 274 249 90.9 89.7 John Newnham Senior Mixed 329 308 93.6 92.5 Lanfranc Senior Boys 434 387 89.1 88.9 Lanfranc Senior Girls 554 502 90.1 90.0 Norbury Manor Senior Boys 287 270 94.4 91.3 Norbury Manor Senior Girls 269 255 94.7 92.4 Portland Senior Boys 179 167 93.2 94.2 Portland Senior Girls 216 197 91.2 91.2 Tavistock Senior Boys 415 374 90.1 89.1 Tavistock Senior Girls 406 359 88.4 89.1 Waddon Senior Mixed 351 296 84.3G.I. 84.7 Whitehorse Manor Senior Boys 176 159 90.3 90.8 Totals 6,388 5,822 91.1 90.0 St. Andrew's Vol. Sec. Mod. 223 195 87.4 89.0 Our Lady's Vol. Sec. Mod. 173 153 88.4 87.7 Total 396 348 87.8 88.5 SPECIAL SCHOOLS St. Christopher's (E.S.N.) 216 186 86.1 87.0 St. Giles' (Del. & P.H.) 197 162 82.2 85.2 St. Luke's (Partially Sighted) 31 27 87.0 90.0 Total 444 375 84.4 86.4 VOLUNTARY PRIMARY SCHOOLS All Saints' Mixed and Infants 319 292 91.5 84.9 Christ Church Junior Mixed and Infants 237 218 91.9 91.0 Parish Church Junior Girls and Infants 482 427 88.6 87.6 St. Joseph's Mixed and Infants 478 422 88.3 87.0 St. Mark's Junior Girls and Infants 184 166 90.2 87.9 St. Mary's (R.C.) Mixed and Infants 431 380 88.2 88.6 St. Michael's Infants 207 178 86.0 83.2 Shirley Junior Mixed and Infants (St. John's) 210 183 87.1 92.7 Total 2,548 2,266 88.9 87.3 110 School Average No. on Register Average Attendance Average Attendance per cent. Average 1952 Attendance per cent. SELECTIVE CENTRAL SCHOOLS Archbishop Tenison's Snr. Mixed 290 273 94.1 94.5 Heath Clark Mixed 310 294 94.8 94.4 600 567 94.5 94.5 GRAMMAR SCHOOLS Selhurst Boys 579 553 95.5 94.9 Selhurst Girls 526 490 93.1 94.0 John Ruskin Boys 365 346 94.7 93.8 Coloma Girls 524 489 93.3 92.5 Lady Edridge Girls 346 332 95.9 94.3 Total 2,940 2,777 94.4 94.1 TECHNICAL SCHOOLS Stanley Technical Trade 267 252 94.3 94.4 Croydon Secondary Technical 251 239 95.2 93.7 Total 518 491 94.7 94.1 SUMMARY OF SCHOOL ATTENDANCE FOR THE AUTUMN TERM, 1954 Council Primary 21,053 19,178 91.0 90.0 Voluntary Primary 2,548 2,266 88.9 87.3 Council Secondary Modern 6,388 5,822 91.1 90.0 Voluntary Secondary Modern 396 348 87.8 88.5 Grammar, Central 2,940 2,777 94.4 94.1 Technical 518 491 94.7 94.1 Specials 444 375 84.4 86.4 Total 34,287 31,257 91.1 90.1 Crosfield Nursery 42 37 88.0 86.0 111 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., Group Children who had attained their 8th birthday at the opening date of the Term but have not yet reached their 9th birthday and who have not been medically examined at the age of 8 years. (3) Primary i.e., Leavers Children in their last year of attendance in a Maintained Primary School and who have not been medically examined in that year. (4) Leavers i.e., (Final) Children in their last year of attendance in a Maintained Secondary School who have not been medically examined in that year. (5) Special Cases i.e., (if any) Children of other ages who are apparently defective and whom the Head Teacher and parents wish the Medio>! Officer to see at his next visit. A total of 13,257 children were examined as compared with 11,573 in 1952, and 9,144 parents attended the examinations. The percentage attendance of parents in the Entrants' group was for hoys 89.4 per cent. and girls 89.0 per cent.; in the Intermediate group, boys 61.8 per cent. girls 69.1 per cent.; in the Leavers' group, boys 12.6 per cent., girls 35.7 per cent.; and in the Other Ages group, boys 74.0 per cent., girls 82.3 per cent. The total percentage of parents attending was 69.0 as against 68.5 last year. 757 specials and 669 re-inspections of children were carried out. 112 PARENTS PRESENT 1953 Entrants Intermediate Leavers 8 to 9 Years TOTAL Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. Parents Present Number Exmnd. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F All Saints 50 62 38 44 6 15 2 9 ... ... ... ... 35 17 23 14 9 ??? Arch. Tenison's ... ... ... ... ... ... ... ... 22 24 1 6 ... ... ... ... 22 ??? Ashburton 156 121 140 114 85 91 53 69 100 117 16 38 23 21 19 20 364 ??? Benson 72 59 62 52 46 71 34 40 ... ... ... ... 12 50 11 41 130 ??? Beulah 51 52 51 51 37 68 25 47 ... ... ... ... 36 72 33 61 124 ??? Christ Church 21 16 19 14 21 21 13 18 ... ... ... ... 16 20 10 10 58 ??? Coloma ... ... ... ... ... ... ... ... ... 55 ... 2 ... ... ... ... ... 56 Croydon Tech ... ... ... ... ... ... ... ... 68 3 ... ... ... ... ... 68 ... Cypress 25 36 24 33 57 67 38 50 ... ... ... ... 24 27 20 24 106 130 Davidson 47 44 43 40 ... ... ... ... 83 51 17 10 ... ... ... ... 130 96 Duppas 11 11 7 8 68 56 27 33 ... ... ... ... 25 7 14 6 104 74 Ecclesbourne 53 53 48 49 ... ... ... ... ... 109 ... 40 104 ... 86 ... 157 162 Elmwood 82 100 70 93 86 70 55 49 ... ... ... ... ... 92 ... 76 168 262 Fairchildes 125 94 103 87 1 8 6 35 46 5 8 ... ... ... ... 161 148 Gilbert Scott 70 75 62 44 61 57 35 41 ... ... ... ... 39 37 27 26 170 169 Gonville 44 41 42 42 33 35 20 25 ... ... ... ... 36 24 27 18 113 100 Heath Clark ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Howard 43 45 41 45 21 39 9 30 ... ... ... ... 26 19 14 18 90 108 Ingram 55 61 52 56 ... ... ... ... 64 84 8 37 ... ... ... ... 119 145 John Newnham ... ... ... ... ... ... ... ... 26 27 3 14 ... ... ... ... 26 21 John Ruskin ... ... ... ... ... ... ... ... 52 ... 2 ... ... ... ... ... 52 ... Kensington 34 29 28 28 72 56 46 ... ... ... ... 46 45 37 36 152 130 Kingsley 91 78 77 62 24 50 14 34 ... ... ... ... 35 18 24 13 150 146 Lady Edridge ... ... ... ... ... ... ... ... ... 48 ... 32 ... ... ... ... ... 43 Lanfranc ... ... ... ... 21 25 4 15 91 244 15 114 ... ... ... ... 112 269 Monks Orchard 38 27 34 24 43 25 36 15 ... ... ... ... 33 38 25 32 114 90 Norbury Manor 81 81 75 70 92 103 66 77 102 82 8 51 8 1 8 1 283 267 Our Lady ... ... ... ... ... 32 ... 9 ... 28 ... 3 ... ... ... ... ... 60 Oval 54 56 48 50 68 60 46 47 ... ... ... ... 81 83 57 72 203 199 Overbury 72 77 67 74 15 32 7 15 ... ... ... ... 18 5 13 5 105 114 Parish Church 45 25 44 22 43 31 24 22 ... ... ... ... 38 28 33 25 126 84 Portland 38 30 29 27 10 16 3 7 48 46 16 10 28 22 22 16 124 114 Purley Oaks 39 50 38 49 40 33 28 22 40 33 10 18 25 30 20 26 144 146 Rockmount 63 61 58 61 50 74 41 54 ... 88 75 76 73 201 210 St. Andrew's ... ... ... ... ... ... ... ... 22 35 7 9 ... ... ... ... 22 35 St. Joseph's 80 80 61 54 21 28 9 15 ... ... ... ... 7 18 4 10 108 126 St. Mark's 29 24 23 22 ... 25 ... 17 ... ... ... ... ... 3 ... 2 29 52 St. Mary's 40 43 35 35 35 26 17 18 37 31 4 9 15 15 8 10 127 115 St. Michael's 64 44 55 36 ... ... ... ... ... ... ... ... ... ... ... ... 64 44 St. Peter's 47 45 28 36 31 27 25 15 ... ... ... ... 17 38 12 23 95 110 Selhurst Gram. ... ... ... ... ... 11 ... 11 110 128 ... 31 16 ... 3 110 155 Shirley 23 22 22 19 7 13 3 10 ... ... ... ... 13 15 11 14 42 50 South Norwood 143 140 138 116 164 73 97 42 ... ... ... ... 56 ... 40 ... 362 213 Spring Park 80 49 75 46 35 35 27 28 ... ... ... ... 36 57 32 49 151 141 Stanled Tech. ... ... ... ... ... ... ... ... 66 ... 7 66 ... Sydenham 34 43 34 39 64 41 40 32 ... ... 73 43 59 35 171 127 Tavistock ... ... ... ... ... ... ... ... 93 107 17 39 ... ... ... ... 93 107 Waddon 41 39 36 37 27 27 15 16 71 66 5 16 8 20 6 18 147 125 West Thornton 67 83 63 79 28 67 19 51 ... ... ... ... 90 55 55 44 185 205 Whitehorse 100 64 90 58 76 ... 59 27 ... 2 ... ... 76 63 127 216 Winterbourne 85 61 75 58 49 2 17 2 ... ... ... ... 62 115 30 105 196 178 Wolsey 140 140 136 133 65 69 40 46 ... ... ... ... 54 40 ... 259 209 Woodside 114 104 106 99 74 116 52 81 ... ... ... ... 47 ... 32 ... 235 220 2547 2365 2277 2106 1600 1771 988 1223 1157 1361 146 487 1254 1202 928 989 6558 6699 4912 4383 3371 2211 2518 633 2456 1917 13257 PERCENTAGE OF PARENTS PRESENT AT MEDICAL INSPECTIONS Entrants Boys 89.4 89.2 69.0 ,, Girls 89.0 Intermediate Boys 61.8 65.6 ,, Girls 69.1 Leavers Boys 12.6 25.1 ,, Girls 35.7 Other Ages Boys 74.0 78.1 8 to 9 years Girls 82.3 113 HEIGHTS AND WEIGHTS, 1953 Age Number Examined 1953 Average Height in inches Average Weight in lbs. 1953 1952 1951 1950 1939 1953 1952 1951 1950 1939 BOYS 5 years 1,493 42.9 43.0 43.0 43.4 41.8 42.5 43.0 42.8 43.7 41.5 6 „ 863 44.3 43.8 44.3 44.2 43.8 44.8 44.4 45.4 45.1 43.4 7 ,, 273 47.4 48.1 47.4 48.2 45.3 52.0 54.4 51.7 53.8 47.9 8 „ 551 49.9 50.0 50.3 50.0 49.5 58.1 58.3 59.4 58.2 55.5 9 ,, 551 50.9 51.2 51.3 51.9 51.2 61.6 61.8 61.7 61.0 58.8 10 „ 662 55.1 54.9 54.7 54.9 52.7 73.0 72.9 72.6 74.0 62.9 11 „ 801 55.5 55.3 55.5 55.2 53.7 75.6 75.3 74.7 75.4 68.7 12 „ 208 56.3 56.8 56.6 56.6 55.7 77.1 78.7 78.6 79.2 79.9 13 „ 20 60.0 56.7 — 59.3 58.4 90.0 91.0 — 91.8 81.6 14 „ 483 63.1 61.8 62.7 62.7 59.0 105.6 104.7 106.2 106.5 90.8 15 „ 497 64.1 64.4 64.4 63.8 — 115.6 114.6 115.5 113.7 — 16 „ 168 67.7 67.0 67.6 66.9 — 129.8 128.2 134.9 127.7 — 17 „ 10 67.2 67.8 69.8 68.8 — 127.2 137.4 146.1 140.5 — GIRLS 5 years 1,380 42.6 42.6 42.6 43.1 41.2 41.4 41.5 41.5 42.3 39.7 6 „ 850 43.8 43.2 44.1 43.6 42.7 43.4 42.8 43.8 43.7 41.4 7 ,, 190 46.8 47.6 47.5 47.3 44.1 50.0 52.0 52.7 51.3 43.6 8 „ 489 49.7 49.7 49.9 49.5 49.9 56.5 56.9 56.8 56.0 54.7 9 „ 558 50.5 51.0 50.8 50.6 50.9 60.4 59.6 59.5 59.5 57.6 10 „ 670 54.6 55.4 54.5 54.7 52.1 73.8 72.5 72.7 72.5 62.9 11 „ 834 55.8 55.9 55.8 55.6 53.6 76.5 77.6 76.2 76.6 68.3 12 „ 350 57.1 58.0 56.9 56.7 56.6 82.6 86.0 81.5 80.8 77.2 13 „ 61 59.8 59.3 60.6 59.3 58.8 96.0 91.8 96.6 91.5 85.3 14 „ 550 61.8 62.0 62.4 62.2 60.3 109.0 107.7 110.0 109.2 97.9 15 „ 603 62.9 63.0 62.7 62.6 62.0 116.0 112.2 111.3 113.3 105.5 16 „ 136 64.7 64.2 64.4 64.4 — 121.9 123.2 125.0 123.4 — 17 „ 56 64.9 64.2 64.5 65.6 — 127.4 121.4 125.5 130.7 — 114 RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 1953 Defects Boys Girls No. requiring Treatment No. referred for Observation Percentage of total Examined No. requiring Treatment No. referred for Observation Percentage of total Examined Malnutrition 5 1 0.09 3 1 0.06 Uncleanliness— Head Body — — — — — — Skin Disease 11 6 0.27 19 9 0.42 Eye Disease— Defective Vision 230 11 3.68 260 24 4.24 Squint 27 16 0.66 19 10 0.43 External Eye Trouble 11 4 0.33 12 2 0.21 Ear Nisease— Deafness 14 29 0.66 11 14 0.37 Otitis Media 4 7 0.17 7 9 0.24 Other Disease 2 3 0.08 7 6 0.19 Nose and Throat— Enlarged Tonsils only 43 75 1.80 50 62 1.67 Adenoids only 29 16 0.69 31 7 0.57 Enlarged Tonsils and Adenoids 113 98 3.22 99 85 2.75 Other Conditions 54 10 0.98 45 25 1.04 Enlarged Cervical Glands (not T.B.) 2 13 0.23 — 6 0.09 Dental Defects 91 4 1.45 82 9 1.31 Speech Defects 21 12 0.50 12 5 0.25 Heart and Circulation— Organic 17 24 0.62 21 23 0.66 Functional 11 15 0.40 17 12 0.43 Anaemia 4 — 0.06 10 1 0.16 Bronchitis 11 29 0.61 12 21 0.49 Other Non-T.B 15 48 0.96 15 38 0.79 Pulmonary Tuberculosis 8 3 0.17 6 4 0.15 Other Tuberculosis — 2 0.03 5 4 0.13 Nervous System Disorders (including Epilepsy, Chorea, etc.) 10 17 0.41 5 20 0.37 Developmental— (a) Hernia 3 2 0.08 1 3 0.06 (b) Other 17 11 0.43 3 3 0.09 Psychological— (a) Development 8 3 0.17 3 2 0.07 (b) Stability 8 5 0.20 3 5 0.12 Deformities— Flat Feet 76 82 2.41 66 50 1.73 Posture 106 44 2.29 170 47 3.24 Others 46 36 1.25 64 28 1.37 Other Defects and Diseases 39 36 1.14 46 24 - 1.04 Totals 1,036 662 1,104 559 Total Children Examined 6,558 6,699 115 VISION Extent of Defec Intermediate Leavers 8 to 9 years and Other Ages Total Boys Girls Boys Girls Boys Girls Boys Girls No. % No. % No. % No. % No. % No. % No. % No. % Normal: R 1536 96.0 1695 95.7 1102 95.2 1273 93.5 1218 97.1 1154 96.0 3856 96.1 4122 95.1 6/6ths or 6/9ths L 1528 95.5 1710 95.6 1108 95.8 1307 96.0 1230 98.1 1158 96.4 3866 96.4 4175 96.3 6/12ths or 6/24ths R 55 3.4 67 3.8 45 3.9 80 5.9 36 2.9 43 3.6 136 3.4 190 4.4 L 61 3.8 54 3.0 35 3.0 44 3.2 23 1.8 39 3.2 119 3.1 137 3.2 6/36ths or worse R 9 0.6 9 0.5 10 0.9 8 0.6 — — 5 0.4 19 0.5 22 0.5 L 11 0.7 7 0.4 14 1.2 10 0.8 1 0.1 5 0.4 26 0.6 22 O.5 Cost of the School Health Service The gross cost of the medical, dental and nursing services was £34,645. The expenditure is subject to Education grant. Cost of Special Schools Schools maintained by the Council £ 26,914 Other Schools (not maintained by local Education authorities) 7,055 Adjustments with other authorities in respect of Special Schools, at rate cost 1,658 £35,627 With the exception of the £1,658 calculated at Rate Cost, the above expenditure is subject to Education grant. Cost of Milk and Meals Meals and Milk cost £203,749. Income from payment for meals was £92,376, making a net cost of £111,373, on which grant is paid of 100 per cent. on approved expenditure. 116 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS, 1953 (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 1.5 1.7 1.6 1.3 0.6 3.1 1.7 1.7 1.4 1.9 Pulmonary System 2.6 2.6 1.5 1.5 1.5 1.4 2.1 1.4 2.0 1.9 Skin Disease 0.7 0.8 0.8 1.0 1.0 1.4 1.0 1.2 0.8 1.(3 Defects of Nose and Throat 16.1 14.6 8.1 5.8 1.5 2.7 8.1 9.6 9.3 9.2 Enlarged Cervical Glands 2.0 1.5 2.0 1.8 — 0.7 1.1 1.6 1.5 1.2 Squint 1.7 1.3 0.7 0.6 0.2 0.4 0.9 1.7 1.4 0.7 External Eye Disease 0.6 0.3 0.3 0.4 0.1 0.2 1.0 0.5 0.5 0.2 Defective Vision 0.8 0.1 5.4 5.5 6.6 8.5 4.8 5.7 3.7 4.2 Defective Hearing and other Ear Defects 1.5 1.2 0.8 0.7 0.5 0.8 1.2 1.2 1.1 1.0 Speech Defects 0.8 0.5 0.4 0.1 0.1 0.2 0.6 0.3 0.5 0.3 Dental Disease (more than four decayed) 2.5 2.9 1.8 1.6 1.5 1.0 3.0 4.9 2.2 2.5 Dull and Backward 0.3 0.3 0.3 0.3 0.4 0.3 0.2 0.4 0.3 0.3 Malnutrition 6.2 4.8 3.4 3.3 1.9 1.8 3.7 1.6 4.3 3.2 Deformities 8.8 8.2 10.6 10.1 2.7 7.4 8.7 11.4 8.1 9.1 Nervous System 0.5 0.6 0.4 0.5 0.3 0.2 0.4 0.5 0.4 0.5 Developmental— Hernia 0.2 0.2 0.1 0.1 0.1 Other 0.4 0.1 0.5 0.1 0.3 0.7 0.7 0.1 0.5 0.1 Psychological— Developmental 0.3 0.1 0.3 0.1 0.2 0.2 0.1 0.2 0.1 Stability 0.2 0.2 0.4 0.1 0.2 — 0.2 0.2 0.2 0.1 Other Defects 1.7 1.1 1.9 1.6 1.0 2.0 1.4 1.2 1.6 1.4 UNCLEANLINESS. Cleanliness inspections are carried out by the School Nurses each term in every school, so that all pupils are brought under review. The finding of slight infestation in unexpected offenders leads to the issue of an informal letter to the parents, setting out a method of treatment and offering a supply of suitable emulsion. The appropriate formal notices are sent to the parents of children previously found verminous. Steel combs are sold or loaned where necessary. Endeavour is made to serve notices on the parents by the School Nurse personally, so that she has opportunity to emphasise that infestation may be a family complaint and not limited to the school child, and the need for constant cleanliness to prevent relapses. A cleansing station is provided tor the treatment of scabies and very occasionally deals with other verminous conditions. Number of children inspected for Cleanliness (first inspection) 68,681 Number of children inspected (subsequent inspections) 827 117 Number of children found unclean (first inspection) 387 (749 occasions of infestation). Number of occasions in which children found unclean (subsequent inspections) 246 At the primary inspections vermin were found in 41 and nits alone in 708 children. On these inspections 1.8 per cent. of the children showed evidence of infestation as against 1.1 in 1952. 57 children attended the Cleansing Station for treatment. TUBERCULOSIS IN CHILDREN OF SCHOOL AGE. Contacts among school children kept under supervision during 1953 : — Number of cases under observation at beginning of 1953 195 Number of cases added during year none Number of cases discharged from observation during the year 43 Number of cases under observation at the end of 1953 152 Number of cases of Notified Tuberculosis— Pulmonary 10 Non-Pulmonary 3 Taking the total child population at 35,700, the pulmonary tuberculosis incident rate per 100,000 was 28.0, and the nonpulmonary incidence rate 8.4. There were no deaths from tuberculosis. CAUSES OF DEATH IN CHILDREN AGED 5-14 YEARS Child population, 35,700. Number of deaths 14, which is equal to a death-rate of 0.39 per 1,000. The deaths were due to : Polioencephalitis 2 Chronic Myocarditis 1 Appendicitis 1 Pneumonia 1 Hirschsprung's Disease 1 Malignant Disease 4 Acute Rheumatism 1 Status Epilepticus 1 Intestinal Obstruction 1 Asphyxia (Misadventure) 1 118 TREATMENT. The Work of the School Clinics. SUMMARY OF ATTENDANCES 1953 1952 Increase or Decrease Minor Ailments and Verruca Clinics 11151 13545 —2394 Inspection Clinic 2391 2837 — 446 Dental Clinics 26633 24096 + 2537 Remedial Exercises Clinic 7388 11980 —4592 Rheumatism Clinic 102 Closed 47563 52560 —4997 The Minor Ailments Clinics. At the Lodge Road Clinic 1,147 defects involved 4,498 attendances, while at the subsidiary Clinics held at Ashburton School 257 defects, 1,827 attendances; at Duppas School 383 defects, 2,643 attendances; at Rockmount School 169 defects, 1,473 attendances; and at Wolsey School 115 defects, 710 attendances. Complaint 1953 1952 Cases Attendances Average No. of Attendances per case Cases Attendances Average No. of Attendances per case Ringworm 12 24 2.0 7 30 4.3 Scabies — — — 4 10 2.5 Impetigo 26 148 5.7 24 111 4.6 Other Skin Diseases 40 131 3.3 46 168 3.7 Otorrhoea and other Ear defects 116 428 3.7 175 828 4.7 External Eye Disease 211 653 3.1 259 891 3.4 Miscellaneous 1669 9767 5.9 1716 8203 4.8 2074 11151 5.4 2231 10241 4.6 119 CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS. 1953 Name of School School Population. Measles. German Measles Whooping Cough Chicken Pox Mumps Scabies Impetigo Ringworm Diphtheria Scarlet Fever Dysentry Poliomyelitis Jaundice Conjunctivitis Sore Throat Indefinite Sickness Typhoid Erysipelas Vermin Meningococcal Total Body Scalp All Saints 319 10 ... 4 13 ... ... ... ... ... ... 4 2 ... ... ... ... ... ... ... 1 ... 34 Archbp. Tenison 290 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Ashburton 1881 26 1 9 ... ... ... 1 ... ... ... 16 1 ... ... ... ... ... ... ... ... ... 54 Benson 558 27 ... 3 13 1 ... ... ... ... ... 2 2 ... ... 1 ... ... ... ... ... ... 49 Beulah 1049 39 1 9 2 11 ... 3 ... ... ... 11 4 ... ... ... ... 1 ... ... 23 ... 104 Christ Church 237 26 2 ... 2 8 ... ... ... ... ... 9 ... ... ... ... ... ... ... ... 7 ... 54 Coloma 524 ... ... ... ... ... ... ... ... ... ... 4 1 ... ... ... ... ... 1 ... ... ... 6 Crossfield Nursery 42 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croydon High 884 ... ... ... 1 ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... ... 5 Croydon Tech 251 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cypress 41M 25 ... 1 1 ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 29 Davidson 715 70 1 8 14 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 6 ... 101 Duppas 477 1 1 2 ... 6 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 12 Ecclesbourne 828 37 ... ... 43 9 ... 1 1 ... ... 5 ... ... ... 1 ... ... ... ... 2 ... 99 Elmwood 930 16 ... 3 11 8 ... 1 ... ... ... 13 ... ... ... ... ... 2 ... ... 2 ... 56 Fairchildes 1162 2 ... 10 2 2 ... ... ... ... ... 9 ... ... ... ... ... ... ... ... ... ... 26 Gilbert Scott 769 68 1 6 2 3 ... ... ... ... ... 2 ... 1 ... ... ... 1 ... ... 2 ... 86 Gonville 495 ... ... ... 18 2 ... ... ... ... ... 7 ... ... ... ... ... ... ... ... ... ... 27 Heath Clark 310 ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Howard 507 13 2 ... 3 1 ... ... ... ... ... 3 ... ... ... ... ... ... ... ... 1 ... 23 Ingram 914 48 1 10 5 1 ... 1 ... ... ... 8 1 ... ... 2 ... ... ... ... 2 ... 79 John Newnham 329 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 John Ruskin 365 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Kensington Av. 589 25 1 4 6 11 ... ... ... ... ... 4 2 ... ... ... ... ... ... ... ... ... 53 Kingsley 816 60 4 14 22 18 2 ... ... ... 11 2 ... ... ... ... 2 ... ... 2 ... 137 Lady Edridge 346 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lanfranc 988 2 ... 2 2 3 ... 4 ... ... ... 2 1 ... ... ... ... ... ... ... ... ... 16 Monks Orchard 438 ... ... 1 ... ... ... ... ... 1 ... 3 ... ... ... ... ... ... ... ... ... ... 5 Norbury Manor 1320 13 7 ... 8 15 ... ... ... ... ... 11 ... 1 ... 1 ... ... ... ... ... ... 56 Overbury 631 ... ... ... 2 1 ... ... ... 1 ... 5 1 2 ... 2 ... 1 ... ... ... ... 15 Old Palace 407 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Our Lady's 173 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Oval 668 70 3 3 ... 4 ... ... ... ... ... 6 1 ... ... ... ... ... ... ... ... ... 87 Parish Church 482 1 ... ... 4 5 ... ... ... ... ... 2 ... ... ... 1 ... ... ... ... ... ... 13 Portland 67? 10 ... ... 1 ... ... 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 23 Purley Oaks 761 54 ... ... 5 3 ... ... ... ... ... 2 ... ... 1 ... ... 2 ... ... 1 ... 70 Rockmount 609 ... ... 11 120 18 ... ... ... ... ... ... 2 ... ... 2 ... 1 ... ... ... ... 158 St. Andrew's 223 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Christopher's 216 2 ... 1 1 ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 7 St. Giles' 197 17 ... 2 5 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 27 St. Joseph's 478 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 ... 3 St. Luke's 31 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Mark's 184 19 9 7 50 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 9 ... 89 St. Mary's R.C. 431 ... ... ... ... 2 ... ... ... ... ... 2 1 ... ... ... ... ... ... ... 2 ... 7 St. Michael's . 207 22 ... 4 18 97 ... 9 ... ... ... 6 ... ... ... ... ... ... ... ... ... ... 79 St. Peter's 371 65 13 17 98 3 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 ... 199 Selhurst Gramm. 1105 ... ... ... ... ... ... ... ... ... ... 2 1 2 ... ... ... ... ... ... ... ... 5 Shirley (St. John's) 210 14 ... 8 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 23 South Norwood 1005 50 ... 14 31 9 ... 1 1 ... ... 8 ... ... ... ... ... ... ... ... ... ... 107 Spring Park . 703 ... ... 3 ... 4 ... ... ... ... ... 7 5 ... ... ... ... ... ... ... ... ... 19 Stanley Tech. 267 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sydenham 679 23 ... ... 7 2 ... 1 ... ... ... 8 2 ... ... ... ... ... ... ... 12 ...... 56 Tavistock 821 ... ... ... 2 ... ... ... ... ... ... 5 1 1 ... ... ... ... ... ... 3 ... 12 Waddon 622 ... ... 8 ... 13 ... ... ... ... ... 3 ... ... ... 9 ... ... ... ... ... ... 31 West Thornton 698 10 ... 1 57 20 ... ... ... ... ... 6 5 ... ... ... ... 1 ... ... 1 ... 102 Whitehorse Mnr. 755 32 ... ... 1 1 ... ... ... ... ... 10 ... ... ... 1 ... ... ... ... 13 ... 58 Whitgift Gramm. 789 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whitgift Middle 553 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Winterbourne 1215 4 ... ... 5 9 ... ... ... ... ... 70 9 2 ... ... ... ... ... ... 2 ... 95 Wolsey 864 ... ... ... 1 ... ... ... ... ... ... 10 ... ... ... ... ... ... ... ... ... ... 11 Woodside 1183 21 ... 20 7 26 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 75 Totals 922 47 191 588 238 1 21 24 ... 295 46 9 2 15 11 1 ... 95 ... 2488 6 120 CHIEF CAUSES OF EXCLUSIONS FROM SCHOOL Condition Exclusions during 1953 Percentage of total exclusions Exclusions during 1952 Percentage of total exclusions Ringworm 6 0.24 12 0.51 Verminous Conditions 95 3.81 110 4.63 Impetigo 21 0.84 23 0.97 Scabies 1 0.04 — — Scarlet Fever 295 11.86 290 12.22 Measles (inc. German) 969 38.95 723 30.45 Diphtheria — — — — Whooping Cough 191 7.68 211 8.88 Chicken Pox 588 23.63 534 22.49 Mumps 238 9.57 314 13.23 External Eye Disease 15 0.60 10 0.42 Poliomyelitis 9 0.38 — — Dysentery 46 1.85 — — Sore Throat — — 2 0.08 Other Causes 14 0.56 145 6.11 Total 2488 — 2374 — The figures for exclusions are not related in any way to the figures obtained in routine medical inspections. These figures show an increase in Scarlet Fever, Measles, Chicken Pox, and External Eye Diseases, whilst the remainder all show a decrease. School Visits. Visits to School Departments re Cleanliness 505 Visits re Scabies 9 Visits re Infectious Disease 100 Visits re Medical Inspections 603 Visits re Medical Preparations 605 All other reasons 598 Home Visits. Concerning defects found at routine medical inspections 1,776 Subsequent visits re defects found at routine medical inspections 456 Visits re special cases 423 Visits re dental cases 18 Visits other than infectious cases 684 Visits in connection with infectious cases (including 330 visits concerning uncleanliness) 3,528 121 SCHOOL DENTAL SERVICE. Report of the Principal School Dental Officer, Mr. P. G. Oliver. The principal function of this Service is the carrying out of routine inspection and treatment for 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. Under the above aegis 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. Introduction For the first time for many years an appreciable improvement can be discerned in the position of the local Service both as regards inspection and treatment; there would also appear to be some encouraging signs of an easing in the staffing position. Though applicants for full-time posts remain a scarcity, offers of part-time assistance have increased in number and but for limitations in surgery accommodation bolder measures could have been entertained in 1953. Whilst numerically staff has remained at last year's equivalent of approximately six full-time officers, the gradual build-up in part-time personnel has had a cumulative effect, and the scheme has therefore been in a much stronger position to deal with the increased school population. Because of this many more schools were visited than previously, and the general turn round of cases was substantially accelerated. J hough the treatment of casuals continued to represent a serious problem it is hoped that with more frequent offers of treatment this can be reduced to reasonable proportions. I here would appear to be a further slight increase in the number of children obtaining treatment through the General Pactitioner Service, though how much of this is of a regular nature is at present difficult to ascertain; an apprisal of the 122 present position will be found in the appropriate section of this report. Running concurrently with the general programme of expansion, the scheme for the re-organisation and refitting of existing surgeries has continued, with the object of rendering older clinics more up-to-date and improving working conditions for those already in the Service. Besides normal replacements, sundry new items of equipment have been added, including several operating lights of a modern type which should benefit both patient and operator. Clinic Accommodation Shortage in surgery accommodation continues to be the largest single factor affecting the day to day function of the Scheme, and because of time lags inherent in any building programme no new premises have become available during the past year. The newly-adopted surgery at the Overbury School continues to function smoothly and facilities are obviously well appreciated by local residents; unfortunately more recent building developments on the New Addington Estate have largely surpassed the ability of this surgery to deal with the increased demand for treatment. To ease this situation work for certain schools in the Monks Hill district has temporarily been withdrawn to the Lodge Road Centre, until alternative accommodation can be provided at the projected premises at Stroud Green. Plans for this new Centre, which will contain a Twin Surgery Unit and Ancillary accommodation, are now well advanced and it is hoped that a commencement of building will be possible during the early summer of 1954. In addition to relieving the New Addington Clinic the Stroud Green Dental Centre will also cater for all existing and proposed schools in the Woodside, Glade and Shirley areas. Inspections. The number of children on the register at maintained schools within the Borough at the close of 1953 was 34,287. Including an additional 83 free-place scholars at grant assisted schools, this represents a sum total of 34,370. 123 During the year 88.4 per cent. of the school population were examined, compared with 63.4 per cent. in 1952, showing an advance of 25 per cent. Provided this figure can be sustained and progressively improved upon, the position where every child can secure at least one inspection annually may, in the not too distant future, become an actual reality. According to recent analysis some 1,421 children received no examination during 1953. Schools were, however, visited on an average every 14 months, compared with 18 to 20 months previously. At those schools visited 30,319 were inspected and 14,998 (49.4 per cent.) referred for treatment, compared with 20,996 inspected and 10,723 (51 per cent.) referred in 1952. 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 a mouth is classed as "healthy" unless the case is actually referred for treatment. The results obtained from school inspections were as follows: — Acceptance of Treatment 59% Refused Treatment 30% Forms Not Returned 11% As indicated there has been a further fall of 5 per cent. in the acceptance rate, making a total decrease of some 15 per cent. since the peak of 1949. Whilst it has always been assumed that the introduction of free treatment for children under the General Practitioner Service would lead to some reduction in demand in the School Service, repercussions to date have been less than was anticipated, and the present level of acceptance still compares favourably with that of the immediate pre-war period. To match these changes, post-war advances in the technique of children's dentistry has led to a considerable increase in specialised work, such as the correction of irregularities and restoration of fractured incisors. 124 Though it would appear that practitioners are now in a position to set aside more time for conservative work, particularly for the older children, little extension of facilities is perceptible in the case of the younger age groups. 'Whilst it would at present be premature to attempt to assess the final balance between the two services, a substantial volume of parental opinion would still appear to favour treatment of an institutional kind, provided this can be secured at regular intervals. With regard to less well informed areas it is clearly apparent that unless dental supervision can be introduced as an active force which is closely linked with the education side, most of the preventative work now accomplished would go by default. The following Table demonstrates the variation in the acceptance rate during recent years:— RESULTS OF SCHOOL INSPECTIONS. 1953. 1952. 1951. 1949. 1937. No. referred for— Treatment 14998 10723 12920 9404 13498 Consents 8854 : 59% 6867 : 64% 8790:68% 6996 : 74.4% 7762:57.5% (Total Consents Including Specials)* (12496 :66.1 %) (9727 : 71.6%) (11358:73.3%) (10098:80.7%) (10146:63% Refusals 4496 : 30% 2639 : 24.6% 2390 :18.5 % 1213 :12.9% 3242 : 24% Forms Not Returned 1648 : 11% 1217 : 11.4% 1740 :13.5% 1195 :12.7% 2494 : 18.5? * Specials.—Those referred by Head Teachers with Emergency Forms Arrangements for Treatment. Of 18,640 children referred for treatment (including specials) 11,482 (61.6 per cent.) were treated and 8,794 (47.1 per cent.) cured completely, compared with 13,583 referred, 10,493 (77.2 percent.) treated and 8,318 (61.3 per cent.) cured in 1952. As a result of increased assistance from full and part time staff, total treatment sessions rose from 2,452 to 2,487. Because of the conversion of one part-timer to a full-time capacity, however, numerical part-time sessions declined from 753 to 705 sessions. Treatment figures show a corresponding increase, especially in the case of those devoted to restoration of function of fractured 125 incisor teeth. The index of fillings inserted per 100 children rose slightly from 106.9 to 107.3 but still leaves much to he desired from the point of view of an adequate Service. Time spent on "casual" work continues to be high and in spite of recent advances still seriously handicaps the carrying out of routine treatment. An associated problem is that of coping with numerous enquiries from parents for advice on their offsprings' current dental problems. As previously reported it is felt that these routine contacts with parents are in the main beneficial, and that to ignore such requests would be to deny an essential function of the Service. Items of Treatment The ensuing Table gives particulars of the principal items of reatment compared with those obtained last year:— 1953 1662 Attendances 26,633 24,096 Treated 11,482 10,493 Re-treated 5,534 5,486 Fillings—Permanent 9,829 8,234 Temporary 2,498 2,989 No of Teeth Filled—Permanent 9,403 7,676 Temporary 2,429 2,878 Extractions—Permanent 2,230 1,947 Temporary 10,640 10,609 Gas Administration 4,998 4,440 Local Anaesthetics 1,184 1,716 Other Operations—Permanent 9,021 8,161 Temporary 2,850 2,874 Cases Completed 8,794 8,318 126 Miscellaneous Operations 1953 1952 These include:— Root treatment in anterior teeth 13 26 Removal of nerves under local anaesthetic 8 15 Gingivectomy 8 1 Removal of bone sequestra 1 6 Splints for fractured incisors 2 6 Partial pulpotomy 3 3 Number of M.D.s treated 24 44 Dentures inserted 47 56 Denture repairs 18 9 After treatment of sockets, etc 19 34 Removal of impacted and difficult teeth 38 43 Ulcerated Stomatitis (Vincent's infection) 10 26 Cleft Palate 1 1 Application of Penicillin "Cones" 13 35 Acrylic caps for Incisor Teeth 18 14 Forms from Head Teachers. The number of forms issued by Head Teachers for emergency treatment was 3,642 compared with 2,860 in 1952. X-Ray Examinations. The number of cases referred to Mayday Hospital for the above purpose was 240, compared with 140 in 1952. Orthodontic Service The demand for the above treatment has now reached very substantial proportions and constitutes a major problem in children's dentistry. 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 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. 127 Because of the lack of outside facilities a considerable extension in the "scope" of this treatment is called for, together with the introduction of a "Special Unit" staffed by a visiting Consultant to undertake certain of the more "advanced" work and generally advise on procedure. Such an arrangement would considerably increase the output of completed cases whilst at the same time conserving the energies of existing staff. The number of sessions devoted to this work was 231 compared with 228 last year. The following is a summary of treatment performed: — 1063 1962 Cases under Treatment 333 390 New Cases 171 174 Cases Completed 131 126 Attendances 2,925 2,752 Appliances—Fixed 38 30 Removable 225 228 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:— 1953 1952 Attendances 312 269 New Cases Treated 27 28 Re-treated 56 81 Fillings—Permanent 209 178 Extractions—Permanent 43 47 Temporary 6 14 Other Operations 45 52 "Gas" Cases 25 19 Local Anaesthesia 9 19 Cases Completed 51 69 Dentures Fitted 2 3 Referred X-Ray 5 7 128 Summary of Work Done at the Selhurst Road Clinic. 1953 1952 Attendances 2,961 2,887 Extractions 1,273 1,661 Fillings 1,207 1,232 Other Operations 2,194 2,044 "Gas" Cases 364 371 Local Anaesthesia 330 555 Cases Completed 919 1,089 Sessions held : Inspection 44, Treatment 391, Gas 29. The average attendance at this Clinic per session is 7.5. Summary of Work Done at the Waldrons Clinic. 1953 1952 Attendances 3,933 3,737 Extractions 1,847 1,950 Fillings 1,931 1,702 Other Operations 1,519 1,297 "Gas" Cases 780 699 Local Anaesthesia 96 143 Cases Completed 1,127 1,054 Sessions held : Inspection 22, Treatment 365, Gas 51. The average attendance at this Clinic per session is 10.3. Summary of Work Done at the New Addington Clinic 1953 Attendances 3,951 — Extractions 1,834 — Fillings 1,937 — Other Operations 2,054 — "Gas" Cases 639 — Local Anaesthesia 68 — Cases Completed 1,048 — Sessions held : Inspection 12, Treatment 416, Gas 41. The average attendance at this Clinic per session is 9.5. 129 DENTAL DEFECTS. (1) Number of children who were:— (a) Inspected by Dental Officers: Year 1953 Year 1952 Aged 5-6 1,894 1,541 6-7 3,879 2,353 „ 7-8 3,742 2,038 8-9 2,866 2,252 9-10 3,060 2,204 10-11 2,838 Total : 30,319 1,949 ,, 11-12 2,645 1,885 „ 12-13 2,221 1,722 ,, 13-14 2,284 1,636 „ 14-15 2,393 1,523 ,, 15-16 1,767 1,140 ,, 16 up 730 753 (b) Specials 3,642 2,860 33,961 23,856 Year Year 1953 1952 (2) Number found to require treatment 19,556 13,583 (3) Number referred for ment 18,640 13,583 (4) Number actually treated 11,482 10,493 (5) Attendances made by children for treatment 26,633 24,096 (6) Half-days devoted to: Inspection 221 154 Treatment 2,487 2,452 2,708 2,606 Number of Gas Sessions 317 196 Administrative Sessions 86 104 Orthodontic Sessions 231 228 (7) Fillings— Permanent teeth 9,829 8,234 Temporary teeth2,498 2,989 12,327 11,223 130 (8) Teeth Filled— Permanent teeth 9,403 7,676 Temporary teeth 2,429 2,878 11,832 10,554 (9) Extractions— Permanent teeth 2,230 1,947 Temporary teeth 10,640 10,601 12,870 12,548 (10) Administrations of general anaesthetics for extractions 4,998 4,440 Administrations of local anaesthetics for extractions 1,184 1,716 (11) Other Operations— Permanent teeth 9,021 8,161 Temporary teeth 2,850 2,874 11,871 11,035 Attendances per session 10.6 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 138 together with 1,775 who were given re-inforcing injections. 131 SPINAL AND OTHER REMEDIAL CLINICS. 1953. 1952 Attendances. Sessions. Av. att. Attendances. Sessions. Av. att Spinal 2,187 354 6.2 5,910 1,166 5.1 Flat Feet 3,427 556 6.2 3,345 600 5.6 Breathing 1,592 313 5.1 2,307 444 5.2 7,206 1,223 11,562 2,210 740 individual cases were treated and 1,150 examinations were made by doctor. RHEUMATISM CLINIC. The need for this special clinic has ceased with the increase of facilities under the National Health Service Act and the close co-operation with the local hospital cardiology centres. If continuous supervision by the School Health Service is deemed necessary, children are seen in school special inspection sessions. 132 ST. GILES' SCHOOL FOR PHYSICALLY HANDICAPPED AND DELICATE CHILDREN 1 am indebted to the Head Teacher, Miss Lambert, for the following report:— The year has been one of consolidation in all departments following the addition of two classes last year. The most notable social event was the Coronation Tea Party and Entertainment for which a grant was voted by the Croydon Council. We were honoured on this occasion by the visit of Mrs. G. J. Cole who planted a Commemoration tree in the garden and who presented the school with a Coronation Cup to be competed for at the Sports Meeting. Throughout the working year, in curriculum and standards of education, we have endeavoured to approximate closely to those of other schools, and our boys and girls have been encouraged to play their part in all combined school activities. A choir group has again taken part in the Schools' Festival Choir and the Schools' Carol Service: and for the first time it has been possible for the school to enter competitors for the Schools' Sports Meeting. Physical Education has included, in addition to the usual and special exercises, Football, Cricket. Rounders, Netball and Tennis, and again the boys have enjoyed training from the F.A. Coach. An average of 32 children in charge of five staff have attended the Central baths weekly for Swimming lessons, and 11 certificates were won during the year. We are much indebted to the Youth Employment Officer and his staff who have devoted so much time and thought to the placing in employment of boys and girls whose severe disabilities presented most difficult problems. 250 parents and friends attended the June Sports meeting when Alderman Cole, Chairman of the Education Committee, presented the trophies, Mrs. Cole's Coronation Cup being awarded to the compeitior winning the greatest number of individual points. The Christmas Prize Giving and Party was a joyful occasion when we were very happy to welcome Alderman and Mrs. Cole, Councillor and Mrs. Marriott and Councillor and Mrs. Cooper. A very enjoyable renewal of previous school activities was the fortnight at the seaside during the first part of the school summer vacation. Very good accommodation was found at Heme Hay for 22 boys and girls in charge of three members of the staff. Beach games, bathing, boating and numerous excursions made a happy holiday from which all returned in excellent health and spirits. During the year there have been several helpful and enjoyable Parent-Teacher meetings. Old Scholars, several of them now living in distant parts of the world, and many of these in National Service, keep well in touch with the school and reports of their progress are gratifying. DISABILITIES AND TREATMENT In the school there are 74 children disabled by cerebral palsy, polio-myelitis, tubercular bOne disease, spina bifida and other causes. 27 children suffer from cardiac disability and 68 from respiratory disorders. The remainder are 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 and supervises physical welfare, keeping all necessary records of individual progress. In this and particularly in the case of the severely disabled boys the work of the Male Attendant has enabled considerable progress to be made. There have been 23 medical inspections during the year at which 381 have been examined, an average of 17 on each occasion, and an average of 9 parents attended each examination. It is with continued gratitude that parents, children and staff express their appreciation cf the devoted work of Dr. Hegarty for the welfare of the children. The Head Teacher again wishes to record her thanks to the Chief Medical Officer and his staff for guidance, help and co-operation during the year. Average number on roll 19S Admissions during year 6£ Left for:— Employment 18 Technical School 1 Other vocational training 3 Ordinary Schools 46 133 ST. CHRISTOPHER'S SPECIAL EDUCATIONALLY SUB-NORMAL SCHOOL. I am indebted to Mr. Ramsden, the Head Master, for the following observations:— The year of 1953 was devoted to a project depicting aspects of life and architecture in the days of Queens Elizabeth I, Anne and Victoria. Houses of these periods were erected in the School Hall, with peeps into interiors of rooms, e.g. bedroom, kitchen, schoolroom, and dancing on the green round the Maypole. Another scene showed the famous bowls game on Plymouth Hoe at the coming of the Armada. Several hundred parents and friends viisited the Exhibition and were very impressed with the scope of the work involved, done by the children under the supervision of class teachers. We held our second Sports Day on the Barclays Bank Sports field. The children competed with great enthusiasm in the various events, every child capable of doing so taking some part. George House gained the Fisher Cup; David House won the Thorne Cup. Andrew and Patrick Houses shared the points for the Shield. During 1953 we continued to make steady but solid progress, patiently and persistently encouraging the children to master the fundamentals of education and then apply the knowledge to the ever-widening possibilities of achievement. This progress is seen in the variety of occupations taken up by children who have left the school. The Coronation of our Queen was a great opportunity for the children to learn a great deal of the Empire and its variation of races, colours, products and climates, and these aspects of education were simply but graphically set forth in films, maps, pictures and models. We held an Open Day on 8th June during the afternoon and evening. Many parents attended and saw their children at work and discussed with the teachers the difficulties and the progress. These talks were very helpful and instructive to parents and teachers alike, all parents expressing appreciation of the work done at St. Christopher's. We held our Seventh Annual Carol Service and Tableaux in December when we had the pleasure of the company of the Archdeacon of Croydon and Mr. Parnham, Her Majesty's Inspector of Special Schools. Our Christmas tea party was a great success and was attended by the Mayoress and Deputy Mayoress. Number attending January 1st, 1953 210 ,, ,, December 31st, 1953 215 ,, referred to Public Elementary Schools 8 Number discharged: (i) Ineducable and referred to Mental Health Committee 2 (ii) Unfit to work ,, ,, ,, — (iii) Fit to work ,, „ „ 12 134 CLINIC FOR EDUCATIONALLY SUB-NORMAL CHILDREN. 331 children were examined during 1953. 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 14 (b) Found to be mentally defective and referred to Local Authority for Statutory Supervision 8 (c) Recommended Institutional Care and referred to Local Authority 7 (2) Found to be educationally sub-normal: (a) Recommended to St. Christopher's Special School 45 (b) Recommended to Residential School 5 (c) Referred to Slow Stream in Ordinary tary School 47 (d) Recommended for re-test 50 (e) Deferred for Medical Treatment 26 (f) Recommended for St. Giles' 3 (g) Recommended Epileptic Colony 1 (h) Referred back to Ordinary Elementary School 75 (3) Referred to Child Guidance Clinic 10 (4) Examined for other Authorities — 291 Mental Tests at St. Christopher's 40 331 30 home visits have been paid to Education cases. 135 HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS OR BOARDING IN BOARDING SCHOOLS. 1953 Blind Partially Sighted Deaf Partially Deaf Delicate Physically Handicapped Educationally Sub-normal Maladjusted Epileptic Total In the Calendar year:— (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) A. Handicapped Pupils newly placed in Special Schools or Homes 4 7 4 40 25 52 — — 132 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Homes — 4 4 2 36 23 52 1 — 122 On or about December 1st:— C. Number of Handicapped Pupils from the area: (i) attending Special Schools as Day Pupils 28 14 3 99 93 210 — — 447 Boarding Pupils 1 — 9 3 3 4 6 1 1 28 (ii) Boarded in Homes — — — — — — — — — — (iii) attending assisted schools (under approved arrangements) — — 5 2 — 2 — 3 — 12 Total (C) I 28 28 8 102 99 216 4 1 487 D. Number of Handicapped pupils being educated under arrangements made under Section 56 of the Education Act, 1944— (a) in hospitals — — — — — 4 — — — 4 (b) elsewhere — — — — 11 1 — — — 12 E. Number of Handicapped pupils from the area requiring places in special schools— (i) including any such unplaced children who are temporarily receiving home tuition) — — — — 1 — — — — 1 (ii) whose parents have not yet consented to their attending a special school — — 1 — 4 8 24 1 — 38 Number of children reported during the Calendar Year: Under Section 57(3) of Education Act, 1944 17 ,, ,, 57(4) ,, ,, ,, - ,, „ 57(5) „ „ „ 20 136 JUVENILE EMPLOYMENT RETURN. The following numbers of children were examined by the medical officers during 1953 as to their fitness to following the part-time employment indicated:— 1953 1952 1951. 1960. 1949. Delivery of Goods for Shopkeepers 53 74 72 71 218 Delivery of Newspapers 328 338 225 323 283 Delivery of Milk 15 32 30 29 16 Shop Assistants 77 118 133 104 — 473 562 460 527 517 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT. During 1953 all milk was supplied free of charge, and approximately 28,000 children per day received l/3rd pint each. This was equal to 89 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 1953 was approximately 13,500. CHILD GUIDANCE CLINIC. Return of Cases referred by the School Medical Officer and the Education Department, from 1st January to 31st December, 1953. Boys. Girls Total number referred 49 35 Analysis of the above Cases:— Diagnostic only 3 3 Current Cases under treatment 29 17 Cases Closed—improved 7 9 Cases Closed—not improved 9 5 Transferred to another area 1 1 49 36 137 Speech Defects Clinic. Cases treated 132 Stammerers 14 Cases discharged 56 Cleft Palate 10 Cases still attending 76 Sigmatism 13 Cases referred for Deafness 1 physical treatment 13 Dyslalia 68 Cases referred for residential treatment 1 Undeveloped speech 19 Dysarthria 6 Cases referred to Child Guidance Clinic 3 Aphasia 1 The work of the Speech Clinic has progressed steadily throughout 1953, and it has been possible to reduce the waiting list considerably. It is gratifying to know that a Junior full-time Assistant Speech Therapist will be appointed, as soon as suitable premises have been acquired. The Speech Therapists express their warm appreciation to the many Heads of Schools, who have invariably co-operated most willingly in trying to solve the manifold problems which beset the speech-handicapped child. NON-MAINTAINED SCHOOLS. The usual arrangements for the medical inspection of nonmaintained school children were continued in 1953, 277 children were examined at routine examination and also 11 re-examinations. Appendix B gives the detailed findings. Yours faithfully, S. L. WRIGHT, School Medical Officer. 138 APPENDIX A. MEDICAL INSPECTION RETURNS. Year ended 31st December, 1953. Table I. MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS. A.—Periodic Medical Inspections. Number of Inspections in the prescribed Groups Entrants 4,910 Second Age Group 3,371 Third Age Group 2,518 Total 10,799 Number of other Periodic Inspections (8-9 years). 2,456 Grand Total 13,255 B.—Other Inspections. Number of Special Inspections 3,716 Number of Re-Inspections 2,773 Total 6,489 C.—Pupils found to require Treatment. (Excluding Dental Disease and Infestation with Vermin). Group For defective vision (excluding squint) For any of the other conditions recorded in Table 11A. Total individual pupils. (1) (2) (3) (4) Entrants 20 432 451 Second Age Group 172 317 474 Third Age Group 181 214 390 Total (prescribed groups) 373 963 1315 Other Periodic Inspections including 8 to 9 years 117 259 369 Grand Total 490 1222 1684 139 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 30 15 3 1 5 Eyes— (a) Vision 490 35 55 11 (b) Squint 46 26 5 2 (c) Other 23 6 4 - 6 Ears— (a) Hearing 25 43 4 2 (b) Otitis Media 11 16 1 - (c) Other 9 9 3 4 7 Nose or Throat 464 378 24 11 8 Speech 33 17 5 7 9 Cervical Glands 2 19 - 1 10 Heart and Circulation 80 75 10 13 11 Lunos 67 143 6 9 12 Developmental— (a) Hernia 4 5 - - (b) Other 20 14 - 1 13 Orthopaedic— (a) Posture 276 91 9 3 (b) Flat foot 142 132 7 9 (c) Other 110 64 8 6 14 Nervous System— (a) Epilepsy 1 8 - 3 (b) Other 14 29 - 3 15 Psychological— (a) Development 11 5 1 1 (b) Stability 11 10 1 3 16 Other 85 60 11 2 * These figures refer to Special Inspection in school only. 140 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 0) (2) (3) (4) (5) (6) (7) (8) Entrants 4912 1643 33.5 2997 61.0 272 5.5 Second Age Oroup 3371 1290 38.3 1969 58.4 112 3.3 Third Age Group 2518 1244 49.4 1228 48.8 46 1.8 Other Periodic Inspections including 8 to 9 years 2456 1000 40.7 1391 56.7 65 2.6 Total 13257 5177 39.1 7585 57.2 495 3.7 Table III. INFESTATION WITH VERMIN. (i) Total number of examinations in the schools by the school nurses or other authorized persons 69508 (ii) Total number of individual pupils found to be infested 399 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 9 (iv) Number of Individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) 141 Table IV. OROUP 1.—DISEASES OF THE SKIN (excluding uncleanliness, for which see Table III) Number of cases treated or under treatment during the year. By the Authority. Otherwise. Ringworm—(i) Scalp 4 - (ii) Body 8 - Scabies 1 - Impetigo 26 - Other Skin Diseases 41 - Total 80 - OROUP 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 211 - Errors of Refraction (including squint) - 1559 Total 211 1559 Number of pupils for whom spectacles were (a) Prescribed - 1091 (b) Obtained - 1091 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 - - (ft) for adenoids and chronic tonsilitis - 344 (c) for other nose and throat conditions - - Received other forms of treatment Ear 'Minor Ailments Clinic) 116 - Total 116 344 142 GROUP 4.—ORTHOPAEDIC AND POSTURAL DEFECTS. (a) Number Treated as in-patients Not available By the Authority. Otherwise. (b) Number treated otherwise, e.g., in clinics or outpatients departments 482 Not available GROUP 5.—CHILD OUIDANCE TREATMENT. Number of cases treated In the Authority's Child Guidance Clinics. Elsewhere Number of pupils treated at Child Guidance Clinics - 84 GROUP 6.—SPEECH THERAPY. Number of cases treated. By the Authority. Otherwise. Number of pupils treated by Speech Therapists 132 - GROUP 7.—OTHER TREATMENT GIVEN. Number of cases treated. By the Authority. Otherwise. (a) Miscellaneous minor ailments 1389 - (b) Other (specify) 1. Orthoptic - 104 2. Sunlight - 20 3. Verruca 280 - Total 1669 124 143 Table V. DENTAL INSPECTION AND TREATMENT. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 30319 (b) Specials 3642 (c) Total (Periodic and Specials) Total 33961 (2) Number found to require treatment *19556 (3) Number referred for treatment 18640 (4) Number actually treated 11482 (5) Attendances made by pupils for treatment 26633 (6) Half-days devoted to : (a) Inspection 221 (b) Treatment 2487 Total 6 2708 (7) Fillings: Permanent Teeth 9829 Temporary Teeth 2498 Total 7 12327 (8) Number of Teeth filled: Permanent Teeth 9403 and Temporary Teeth 2429 Total 8 11832 (9) Extractions: Permanent Teeth 2230 Temporary Teeth 10640 Total 9 12870 (10) Administration of general anaesthetics for extraction 4998 (11) Other Operations: (a) Permanent Teeth 9021 (b) Temporary Teeth 2850 Total 11 11871 144 APPENDIX B. NON-MAINTAINED SCHOOLS. Year ended 31st December, 1953. Table I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Year 1963 Year 1952 Age 11 or under 35 — 12 47 26 13 27 10 14 27 30 15 38 5 16 58 40 17 30 5 18 or over 15 5 Total 277 121 B.—Other Inspections. Number of Special Inspections - - Number of Re-inspections 10 12 Total 10 12 Visits to Non-maintained Schools 11 6 The following defects were found by Medical Inspection Treatment Observation Malnutrition 1 - Defective Vision 17 - Other Eye Conditions 3 - Nose and Throat 4 - Speech 1 - Heart 1 1 Lungs non T.B. 1 1 Deformities:— Flat Feet 9 - Posture 8 1 Other 4 - Other Defects and Diseases 5 - Totals 54 3 145 CONTENTS. A.—PUBLIC HEALTH REPORT. PAGE Airpor 101 Ambulance Service 57 Amusement Houses 75, 81 Animals, Keeping of 75,80 Ante-Natal Clinics 35 Births 5, 48 Blindness 104 Byelaws and Regulations 74 Cancer 13 Census 5 Chemical Analyses 98 Chest Clinic 22,28 Child Minders 100 Contacts, Tuberculosis 28 Convalescence 66 Committee 1 Cremation 101 Dairies, Cowsheds and Milkshops 87 Day Nurseries 41 Deaths 5,12 Dental Treatment—M. & C.W. 43 Diphtheria 15, 55 Disinfection 81 Disinfestation 82 Domestic Helps 66 Drainage 80 Dysentery 20 Epileptics 102 Extra Nourishment 27 Factories and Workshops 78 Fertilisers & Feeding Stuffs Act 82 Foods 84, 91 Gastro-Enteritis 19 Health Propaganda 67 Health Visitors, Work of 52 Home Helps 66 PAGE Home Nursing 39 Homework 79 Hospital, Isolation 18 Housing 76 Housing Act 73 Ice Cream 90 Illegitimacy 5, 36 Immunisation 55 Infant Welfare Clinics 36 Infant Mortality 8 Infectious Diseases 15 Inquests 7 Local Acts 74 Marriages 6 Maternity Homes 100 Maternity Homes, Registration 100 Measles 19 Meat Inspection 86 Medical Help Records 51 Men's Hostel 77 Mental Health 68 Midwives 51 Midwives, Municipal 48 Midwives Acts 51 Milk, Provision of 27, 31 Milk, Examination of 87,94 Milk, Tuberculous 88 Milkshops 87 Mortality in Childbirth 8 National Assistance Act 101 Neo-Natal Deaths 9 Notification of Birth Acts 7 Nuisances 74 Nursing Equipment 66 Nursing Homes 100 Nurses' Agencies 100 Offensive Trades 80 Outworkers 79 146 PAGE Pests 84 Physiotherapy 42 Poisons and Pharmacy Act 82 Poliomyelitis 20 Population 5 Post-Natal Clinics 35 Post-Mortems 7 Premature Infants 35 Puerperal Sepsis and Pyrexia 15 Rats & Mice (Destruction) Act 84 Refuse Collection 99 Road Traffic Accidents 59 Sanatoria, Treatment in 27 Sanitary Administration 72 Sanitary Certificates 78 Sanitary Inspectors, Work of 78 Scarlet Fever 19 Sewage 98 Shop Hours Acts 79 Slaughterhouses 86 Smoke Observation 74, 80 Spastics 102 Staff Examinations 101 Staff 4 Still-Births 5,7 B.—.SCHOOL MEDICAL REPOF PAGE Accommodation 108 Blind Children 135 Child Guidance 136 Cleansing of Children 116 Clinics 107 Cod Liver Oil 136 Cost 115 Crippling Defects 131 Deaf Children 135 Deaths 117 Defective Children 114 Defective Hearing 135 Deformities 131 Dental Service 121 Ear Disease 135 Epileptic Children 134 Exclusions 120 Following-up 120 Health Visitors, Work of 120 Heights and Weights 113 Immunization, Diphtheria 130 Infectious Diseases 119 Inspection Clinic 118 Inspections Ill Juvenile Employment 136 PAGE Tuberculosis—After Care 31 „ Allowances 31 „ Contacts 28 „ Deaths 21,26 „ Notifications 23 „ Home Nursing 28 „ Home Visits 28 „ Institutional Treatment 27 „ Occupational Therapy 31 „ Vaccination 28 „ Mass Radiography 30 „ Re-Housing 29 Vaccination 101 Verminous Persons 82 Venereal Diseases 32 Vital Statistics 5 Ward Statistics 11 Watercourses 80 Water Supply 97 Whooping Cough 20, 56 X-Ray 30 Zymotic Diseases 15 PAGE Malt 136 Meals, Provision of 136 Mentally Defective Children 133 Milk, etc., Provision of... 115, 136 Minor Ailments 118 Non-maintained Schools 137 Orthodontic Service 126 Parents' Attendances 112 Physically Defective Children 134 Population 117 Remedial Exercises 131 Rheumatism Clinic 131 Schools, Special 115,132 Speech 137 Staff 107 Statistical Tables 138 Surveys, Uncleanliness 116 St. Christopher's 133 Treatment 118 Tuberculosis 117 Uncleanliness 116 Vision, Defective 115 X-Ray 126