cro 56 1 HEALTH COMMITTEE 1954 Councillor M. Davis (Chairman) Councillor A. Goodbun Alderman H. Regan, J.P. Councillor Mrs. E.M. Jenkins (Vice-Chairman) Councillor A.L. Marriott Alderman W. Berners Price, J.P. Councillor Mrs. E.M. Maycock Councillor P.T. Adams Councillor Miss L.N. Overton Councillor J.T. Bell Councillor T.C. Pawling Councillor Mrs. H.M. Bunning Councillor G.H. Ward, 0. B. E. Councillor Mrs. V.L. Child Miss Dorothy Day, M.R.C. S. ,L.R. C. P. Councillor J.J. Cooper H. H. A. Elder, Esq., M. D., D. C. H. Councillor R.H. Davies O.E. Finch, Esq., M.C., M.D. Councillor K. A. Edwards T.P. Rees, Esq., O.B.E. ,B. Sc. ,M.D. Councillor E.J. Fowler 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., J L. R. C.P. }Croydon Local D.F. Kanaar, Esq., M.D., M.R.C.P. }MedlcaL Committee 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. 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 Midlives Miss J.C. Dickinson Croydon District Nursing Association Mrs. H. Thatcher Croydon Family Planning Association 2 COUNTY BOROUGH OF CROYDON. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1954 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, 1954. As judged by vital statistics, it was a satisfactory year with an increased birthrate, low general and infant mortality rates, fewer deaths from tuberculosis than ever before and an absence of any outbreak of serious infectious disease. These conditions are the result of measures advocated and applied in the past and now sustained and amplified by a rising standard of living. Such efforts must not be relaxed, but the rate of improvement due to them grows steadily smaller. We must look to other developments in preventive medicine for renewed impetus. In this connection, the report of the Committee on Air Pollution issued in 1954 is of the first importance. To secure for urban residents atmospheric conditions equal to those enjoyed by country dwellers will, in my view, bring advantages equalling any so far achieved by a single public health measure. This is unquestionably a complex national problem of very great magnitude and it is essential for general legislation to set the pattern within which local authorities may deal with local conditions. I hope that next year it will be possible to report on the commencement of this campaign. For the first time since 1939, surveys for Slum Clearance schemes were made. Fortunately, the percentage of houses in Croydon likely to be unfit appears less than 2% of the total. Difficulties of replacement will be due to lack of building sites, as approximately two new houses take up the ground occupied by three slum properties. On the general question of housing, the census figures quoted in the statistical section show that separate dwellings have increased in Croydon since 1931 by 28% and 3 holds, that is separate families, by 27%. The census report also showed that over 5,000 Croydon households shared a cooking stove; over 6,000 a kitchen sink; over 12,000 a W.C.; over 11,000 a bath; and over 17,000 households were without a fixed bath. The waiting list for Council houses rests therefore on the higher standards now regarded as essential and which the present system of housing subsidies makes an economic possibility for the majority of the community. The importance of improving existing properties in addition to new buildings is clearly apparent. Food poisoning notifications were fewer than in the previous year, but this is not regarded as any reason for relaxing the campaign for higher standards in food preparation and handling. Services under the National Health Service Act were continued and extended within the existing pattern. In the field of Maternity and Child Welfare, the building of a new Dental Centre was commenced and the central distribution of Welfare Poods was taken over from the Ministry of Pood. Plans for a new administrative centre and nurses' hostel were drawn up for the Home Nursing Service. Endeavour was made to foster co-operation between family doctors and the Corporation's Health Visitors. The efficiency of the Ambulance Service was greatly increased by the installation of two-way radiotelephony between the headquarters station and the ambulance vehicles. A pilot scheme for B.C.G. vaccination of school leavers was commenced in the New Addington area. The Council approved a scheme to promote the establishment of a hostel for old people, unsuitable for admission to a Welfare Services Home, but not sufficiently ill to require treatment in a mental hospital. The section of the Report which deals with action taken to obtain Magistrates' Orders for the removal of old persons to a suitable institution is a reminder of the painful duty to enforce assistance against the wishes of the recipient. Much time and effort is expended by all members of the staff concerned to prevent the necessity for legal proceedings. The importance of preventive work in connection with so-called "Problem Families" was emphasised during the year by a Circular from the Ministry of Health and I comment on some of the work being done and plans for the future. The Health Services generally being a major charge on national fundsare subject to very close scrutiny and hard criticism to ensure that value is received for the expenditure involved. There is even argument, somewhat acrimonious at times, between the various branches of the service regarding the most advantageous allocation of the funds available. Such interest and controversy 4 are excellent in removing the likelihood of complacency. In considering questions of the moment, however, we should not forget what has been accomplished. The chief value of the annual reports of Medical Officers of Health is probably that they present an annual examination of the health of the community on a basis which allows reasonable comparison between one generation and another. If we select 1927 as being nine years after a world war, perusal of the Report tof the Medical Officer of Health for Croydon for that year shows beyond question how the health of the community has improved in a manner which my predecess or may have deemed it rash to prophesy. With a population of just over 200,000 the death rate was 11.6 per 1,000 as compared with 9.5 for 1954. There were 178 infant deaths in contrast with 69, so that the infant mortality rate was then 56 as against 19 for 1954. Ten children died from Diphtheria, a disease of which not a single case was notified during the last 12 months. 21 children died from Whooping Cough, 6 from Measles and 3 from Scarlet Fever, whereas these infections killed no child in Croydon last year. In 1927, nine mothers died in childbirth and 203 deaths were recorded from tuberculosis. The figures for 1954 were 3 maternal deaths and 32 from tuberculosis. It is not only the mortality rates which show such differences, but almost any section of the 1927 Report gives reason for sober satisfaction for progress made, whether it is the figures of new cases attending the Venereal Diseases Clinic or the percentage of verminous children or the number of those crippled with rickets - a diagnosis which has entirely disappeared. It would be foolish for the Health Service to claim all the credit for these changes, since they cannot be separated from the general advance in social standards. It can be asserted with confidence, however, that the services recommended and the advice given in preventive medicine have, in the main, produced the results which were anticipated. Members and officers now operating the National Health Service are but the sucessors of those whose achievements I have thus outlined. I think we shall succeed in maintaining the example set to us. In Croydon, co-operation between the branches of the Health Service has remained close and cordial and assistance, when requested, has always been readily forthcoming from the Executive Council and the Group Hospital Management Committee. General practitioners and hospital medical staff have been ready at all times to co-ordinate action for individual patients whether in connection with controlling infection, housing problems or the innumerable other ways in which preventive and curative medicine meet. In taking this opportunity to express the thanks of the department, I would reaffirm that any apparent discourtesy during 5 the pursuit of statutory duties was inadvertent and is regretted. To the members of my staff I record my appreciation of the manner in which they carry the burden of the work and demonstrate their understanding of the need for a sense of vocation in those providing medical or social services. Finally to the Chairman and Members of the Health Committee, I express the Department's and my own gratitude for sustained encouragement and support and the implied confidence which enables your policy to be implemented with a minimum of administrative difficulty. I am. Yours faithfully, S.L. WRIGHT, Medical Officer of Health. 6 STAFF OF THE DEPARTMENT Medical Officer of Health and Deputy Medical Officer of Health (also Principal School Medical Officer and Deputy Principal School Medical Officer). General Administration Chief Clerk, Deputy Chief Clerk, 19 clerks (including 1 part time), 4 typists, 1 messenger. Sanitary and Food Inspection Chief Sanitary Inspector, Deputy, 21 Inspectors, 6 assistants, 4 Di si nfectors, ? Rodent Operatives, 10 clerks, 1 typist 1 Superintendent and 4 Porters (Men's Hostel) 1 Labourer (abattoir) Maternity and Child Welfare 6 Clinic Medical Officers whole time (also School duties), 4 part time. Superintendent Health Visitor, Deputy and 28 Health Visitors (also School Nurses), Almoner (part time) Assistant Almoner, Superintendent Midwife, Deputy, 17 midwives, 2 Physiotherapists, 1 Ante-natal Clinic Nurse (part time), 5 clerks, (Dental Service as for School Health) District Nursina (agency arrangements) Superintendent, 3 assistants, 37 nurses and l clerk. Domestic Help Supervisor, 2 assistants, ? clerks, 14 full time and 124 part time Home Helps. Day Nurseries 2 nurseries each with Matron and Deputy, nurses, students and. domestic staff, 1 Warden. Vaccination and Immunisation 1 Clerical Officer Ambulance Service Ambulance Of f icer, Deputy, Second Officer, Maintenance Officer, 4 Leading Drivers, 61 Driver-attendants, 3 clerks, 1 Telephone Operator, 1 Civil Defence Training Officer, 1 cleaner (part time) Prevention, Care and After Care Chest Physician (part time), Assistant Chest Physician (part time), 4 Tuberculous Visitors, 2 Almoners, 1 clerk, l Occupational Therapist (part time). Mental Health 5 Duly Authorised Officers, 1 clerk, 1 Occupational Centre Supervisor, 4 assistants, 1 handyman, 2 guides, 3 cleaners (part time) Welfare Foods 1 Supervisor and 3 clerks. 7 STATISTICS SUMMARY OF VITAL STATISTICS FOR 1954 Area, 12,672 acres. Population (Census 1951), 249,870. Total Population (estimate of Registrar-General), 249,800 (Midsummer, 1954). Number of Inhabited Houses: 69,876. Rateable Value (1st April, 1954): £2,778,686. Product of a Penny Rate (1953-1954): £11,109. Rate in the £: 16s. 10d. (for year ending 31.3.54) Live Births: M F Total Legitimate 1,709 1,664 3,373 Illegitimate 103 92 195 3,568 Birth-rate per 1,000 of the estimated resident population, 14.3 (England and Wales 15.2) Birth-rate(as adjusted by comparibility factor, 0.99),14.2. Still Births, 81. Rate per 1,000 total (live and still) births, 22.5. Deaths, 2,638. Death-rate per 1,000 of the estimated population, 10.6. (England and Wales 11.3) Death-rate (as adjusted by comparibility factor, 0.90), 9.5 Infant mortality rate, 19 per 1,000 live births. (England and Wales 25) Legitimate Infants (61 deaths), 18 per 1,000 live births. Illegitimate Infants (8 deaths), 41 per 1,000 live births. CENSUS, 1951 The following are extracts from the report of the Registrar General on the 1951 Census:- POPULATION OF CROYDON 1921 1931 1951 Increase or Decrease 1921-1931 1931-/951 Persons persons Ma /es Fema /es persons Ma /es Fema/es Per cent. Amoun t Per cent. Total By Births and Deaths Balance 191,468 233.108 107,496 125,612 249,870 115,382 134,488 21.7 16,762 7.2 7.6 -0.4 ACREAGE, POPULATION, PRIVATE HOUSEHOLDS AND DWELLINGS Acreage Populat ion Persons per acre Private Households Population in private households. Structurally separate dwellings occupied Persons per room. 12,672 249,870 19.7 78,685 243,464 68, 835 0.69 8 9 Private households according to possession of certain arrangements- Total Households 78,685 Piped water supply shared No piped water supply - 14,193) 75) 18% All 5 arrangements exclusive use - 47,338 60% Cooking stove shared No cooki ng stove - 5,026) 814) ' 7% Stove and sink exclusive use - 70,754 90% Kitchen sink shared No kitchen sink - 6,105) - 1,577) ,10% Bath shared or not available Other service - 13.733 17% Water Closet shared No Water CIoset - 12,357) 60 ) 16% exclusive use Fixed bath shared No fixed bath - 11,313) - 17,543) ,37% Sink shared or not available w.c. - 7,205 9% AGES (Quinary) and Sex AlI Ages Persons Males Females 249,870 115,382 134,488 0-4 20,948 10,661 10.287 5-9 17,539 9,072 8,467 10-14 14,734 7,383 7.351 15-19 13,030 5,684 7.346 20-24 15,217 6,922 8,295 25-29 18,177 8,603 9,574 30-34 17,611 8,492 9,119 35-39 19,701 9.375 10,326 40-44 20,197 9,715 10,482 45-49 18,660 8,778 9,882 50-54 16,577 7,476 9,101 55-59 14,348 6,411 7,937 60-64 12,654 5,356 7,298 65-69 11,247 4,602 6,645 70-74 8,751 3,375 5,376 75-79 5,808 2, 136 3,672 80-84 3,082 943 2, 139 85-89 1,214 329 885 90-94 310 59 251 95 and over 65 10 55 10 Principal Causes or Death in order of irequency (RegistrarGeneral' s Return) Rate per 1,000 Population (l) All Ages Deaths from diseases of Cardiac and Circulatory System 4.00 " " Cancer 1.96 " " diseases of the Respiratory System (excluding Tuberculosis) 1.03 " Suicide and Violent Causes 0. 30 " " Tuberculosis (all forms) 0.13 " " diseases of Digestive System 0.15 * *ulcers of stomach, duodenum: gastritis and enteritis Rate per 1,000 of age group (2) Ages 15-45 years Deaths from Tuberculosis (all forms) 0.07 " " Cardiac and Circulatory System 0.16 " " Cancer 0.05 Marriages The number of marriages solemnised was 1,882, compared with 1,987 in 1953, 1,993 in 1952, 1,960 in 1951. 2,051 in 1950, 2,066 in 1949, 2,169 in 1948, 2,416 in 1947 and 2,105 in 1946. 912 were solemnised in Established Churches, 336 in other places of worship, and 632 in the Register Office. 2 were by Jewish Ritual. Births The live births registered were 3,373 legitimate and 195 illegitimate. The birth-rate consequently was 14.3. For England and Wales the rate was 15. 2. The illegitimate births in Croydon were 5.5 of the total as in 1953, 5.3 in 1952, 5.4 in 1951, 5.0 in 1950, 4.9 in 1949 and 6.0 in 1948. The live male births numbered 1,812, the female 1,756, being a proportion of 1,031 males to 1,000 females. Deaths The deaths numbered 2,638, compared with 2,905 in 1953. For 1954 the death-rate was 10.6 compared with 11.6 in 1953. The death-rate for England and Wales was 11.3. 11 There were 89 inquests held by Coroners in respect of Croydon residents during 1954, and 343 findings by Coroners after postmortem without inquest. Wards with the highest death-rate were South (11.8), Central (10.5) and Whitehorse Manor (10.2). Lowest: Addington (3.5), Shirley (7.5) and Bensham Manor (7.6). Still Births During 1954, 81 still births were registered in respect of Croydon. Of these, 42 were male babies and 39 females; 4 males and 4 females were illegitimate. The proportion of still births to living children was 1 in 44. The still birth rate was 2.2 per cent, of the total births. The still birth rate, on the same basis as for Infant Mortality, was 22.2 per 1,000 births. Notification of Births Notifications were received in respect of confinements conducted by: - Live Births Still Births Total Midwives 3,032 65 3,097 Doctors 716 15 731 3,748 80 3, 828 Accommodation for Confinement The following table gives information concerning the accommodation utilised for confinements: - Number Percentage In Private Houses 1,282 33.47 In Public Institutions 2, 145 56.01 In Registered Maternity Homes 403 10.52 3, 830 12 Maternal Mortality. There were 3 deaths, as in 1953. The maternal mortality rate was 0.82 per 1,000 births, compared with 0.85 in 1953. The rate for England and Wales was 0.69. MATERNAL AND INFANT MORTALITY FOR THE YEARS 193»-1954 Year Births (Live and Still) Ma tern al Deaths Maternal Mortal i ty Ra te Infant Mortal i ty Rate 193 4 3,304 13 3.93 46 19 3 5 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 19 41 2, 472 8 3. 23 37 1942 3,579 12 3.35 39 1943 3,785 2 0.53 37 194 4 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 4, 10 2 5 1. 22 29 1950 3, 787 2 0.53 26 1951 3,697 3 0.8 1 19 1952 3, 548 2 0.56 20 1953 3.526 3 0.85 21 1954 3,649 3 0.82 19 Infant Mortality. The Infantile Mortality Rate was 19 per 1,000 live births. 13 For the past 5 years the number of infant deaths has been 1950 - 96, 1951 - 68, 1952 - 69, 1953 - 72 and 1954 - 69. Among the 69 deaths, 35 occurred in boy babies and 34 in girls. Of the births, 1,812 were males and 1,756 females. The infantile mortality rate for the two sexes was, therefore, Boys19, Girls-19. 57 deaths of infants occurred in Institutions, including Registered Nursing Homes. The following table gives the cause of death during the first month of life (Neo-natal mortality) (l) Complications of Labour- Trauma at Birth 4 - 4 (2) Foetal States- Congenital Deformities 5 Atelectasis 13 Haemorrhagic Disease of Newborn 2 - 20 (3) Prematurity 21 - 21 (4) Post-Natal Causes 3 - 3 48 Percentage Deaths under 1 year per Total Infantile Deaths Deaths under / year per 1,OOO Bir ths 1954 1953 1954 1953 Premature Births 30.4 34.7 5.88 7.26 Respiratory Diseases 11.6 22.2 2.24 4.65 Infectious Diseases - 1.4 - 0.29 Atelectasis, Debility and Marasmus 18.8 8.3 3.64 1. 74 Diseases of Digestion 1.4 4.2 0.28 0.87 Injury at Birth and Congenital 21.7 19.4 4.20 4.07 *This death was due to Diarrhoea 14 The rate of infant mortality amongst legitimate children was 18 per 1,000 births. The rate in illegitimate children was 41 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-l4th day 15th-21st day 22nd-28th day Under lmnth. 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. j TOTAL All Causes 28 6 4 - - 2 3 1 - 4 48 3 2 6 5 2 1 - 1 1 - - 69 Polio-Encephalitis - - - - - - - - - - - - - - - - - - - - - - - Chicken Pox - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - Diphtheria and croup - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - - - - - - - - - 1 - - - 1 Convulsions - - - - - - - - - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - 1 - - - - - - - - - - 1 Pneumonia (all forms) - - - - - - - - - 1 1 - 1 2 3 - - - - - - - 7 Diarrhoea and Enteritis - - - - - - - - - - - - - - - 1 - - - - - - 1 Gastritis - - - - - - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - - Congenital Malformations 1 1 - - - - - - — 3 5 1 - - 2 1 - - - 1 - - 10 Premature Birth 1? 2 2 - — 1 3 1 - - 21 - - - - - - - - — - — 21 Atrophy, Atelectasis, Debility and Marasmus 10 2 1 _ _ _ _ _ _ 13 _ _ - _ _ _ _ _ _ _ _ 13 Injury at Birth 2 1 1 - - - - - - - 4 - - 1 - - - - - - - - 5 Haemorrhagic disease of newborn 2 _ - - - _ _ 2 - _ _ - _ 2 Other Causes 1 — - - - 1 - - — - 2 1 1 3 - — 1 - - - — - 8 TOTALS 28 6 4 - - 2 3 1 - 4 48 3 2 6 5 2 1 - 1 1 - - 69 15 WARD STATISTICS WARDS Estimated Population Births Deaths Birth Rate Death Rate Deaths under 1 year per 1,000 Births Death Rate from Si x Zymotic Diseases (excluding Di arrhoea) Death Rate from Diarrhoea (under two years) Death Rate from Bronchi ti s and Pneumonia Death Rate from Pulmonary Tuberculosi s Death Rate from Non-Pulmonary Tuberculosi s Death Rate from Heart and Ci rculation Diseases Death Rate from Cancer Natural Increase or Decrease of Population Upper Norwood 17739 194 190 10.9 10.1 36 - - 1.35 0.11 - 4. 34 2. 14 + 4 Norbury 16552 154 153 9.2 9.2 13 - - 1. 39 0.06 - 3. 99 1.57 + 1 West Thornton 16098 229 147 14. 2 9. 1 4 - - 1. 24 0.12 - 3.54 1.68 + 82 Bensham Manor 17517 193 134 11.0 7.6 21 - 0.06 0.86 0.17 - 2.74 1.37 + 59 Thornton Heath 16322 234 127 14.3 7.8 17 - - 1.16 0.06 - 3.31 1. 29 +107 South Norwood 16514 234 163 14. 2 9.9 17 - - 1. 51 0.06 - 3. 39 2. 24 + 71 Woodside 14946 229 139 15.3 9.3 17 - - 1.94 0.07 - 3. 21 1.74 + 90 East 16476 175 154 10.6 9.3 11 - - 1.09 0.06 - 4. 13 2.06 + 21 Shirley 12205 168 91 13.8 7. 5 6 - - 0. 49 0. 16 - 2.95 1.64 + 77 Addiscombe 16128 241 164 14. 9 10. 1 25 - - 1. 12 0.06 - 4. 22 2. 11 + 77 Whitehorse Manor 13775 256 141 18.6 10. 2 31 - - 1.81 0. 14 0.07 3.99 1.67 + 115 Broad Green 13899 207 138 14.9 9.9 15 - - 1.94 0.36 - 3.02 2. 23 + 69 Central 11806 161 124 13.6 10.5 25 - - 1.95 0. 17 0. 17 3.56 2.12 + 37 Waddon 157 28 20 2 126 12.8 8.0 15 - - 1.08 - - 3.50 1. 27 + 76 South 16995 212 201 12. 5 11.8 19 - - 1. 24 0.12 0.06 4.88 2. 12 + 11 Addington 17100 479 59 28.0 3.5 23 - - 0. 47 0.12 - 0.88 0.70 +420 The Borough 249800 3568 2638 14. 3 9.5 19 - - 1. 49 0.11 0.02 4.00 1.95 +930 Deaths occurring in Queen's Hospital are not included in the Ward figures as they are no longer allocated to the home address 16 REGISTRAR GENERAL'S TABLE OF DEATHS ACCORDING TO CAUSE. AGE AND SEX Sex 0- /- 5- 15- 25- 45- 65- 75- Total All Causes M 35 10 3 12 50 3 28 368 471 1271 F 34 4 6 4 38 230 316 729 1361 Tuberculosis (respiratory) M - _ — 1 3 13 5 — 22 F — _ _ — 3 — 1 2 6 Tuberculosis (other forms) M - 1 - — 1 _ — _ 2 F - — _ _ 1 1 — _ 2 Syphilitic Diseases M - - - _ - 3 3 3 9 F _ _ _ _ _ - _ 2 2 Diphtheria M — - — _ - - _ - - F - - — — _ _ — — - Whooping Cough M - - _ _ _ - — — - F _ _ _ - — - - _ _ Meningococcal Infections M 1 - _ - - _ — _ 1 F - - - - - 1 — - 1 Acute Poliomyelitis M — _ _ _ _ _ _ _ - F - 1 _ — _ - - _ 1 Measles M - - - - - - - - - F — _ — — — — — — - Other infective and M — _ - _ 1 1 - - 2 parasitic diseases F - — 2 — 3 — 1 — 6 Malignant neoplasm, stomach M - - - - 3 20 13 7 43 „ lung, bronchus F — — — - 1 5 12 10 28 M — — _ — 3 52 26 13 94 " breast F - - - - 1 6 4 5 16 M - - - - - 1 - - 1 „ uterus F »- - - - 4 24 12 12 52 F - - - — 1 11 4 2 18 Other malignant and M 1 - - - 1 24 36 47 109 lymphatic neoplasms F - - - 1 5 36 37 35 114 Leukaemia; aleukamia M — — 1 — — 3 - - 4 F 1 - — - - 4 3 3 11 Diabetes M - - - - - - 2 - 2 F - - - - - 2 2 5 9 Vascular lesions of nervous system M 1 — — - 3. 29 49 70 152 F - - - - 1 35 63 156 255 Coronary disease, angina M — — - - 3 73 76 75 227 F — - - - — 16 48 76 140 Hypertension with heart disease M - - - - - 4 6 17 27 F - - - - - 3 6 18 27 Other heart diseases M - - - 1 4 17 36 92 150 F - - 2 1 4 22 46 197 272 Other circulatory diseases M - - - - 2 18 20 28 68 Influenza F - - - - 1 13 14 61 89 M — _ _ _ _ _ 1 _ 1 Pneumonia F _ _ _ - _ _ 1 4 5 M 3 2 - - - 6 14 21 46 Bronchitis F 6 1 1 - 2 9 11 31 61 M - 1 - - 1 14 29 47 92 Other diseases of respiratory system F 1 - - 1 - 4 10 29 45 M - — 1 - 1 l 5 1 9 F - - - - - l 1 2 4 Ulcer of stomach and M — - - - 2 8 8 5 23 duodenum F - - - _ - - 2 6 8 Gastritis, enteritis and M 1 — - — - _ 1 _ 2 diarrhoea F - - - - 1 1 2 4 Nephritis and nephrosis M - - 1 - 5 5 7 3 21 F — - - — 1 1 4 2 8 Hyperpl asia of prostate M - - - - - 5 4 10 19 Pregnancy,childbirth and abortion F - - - - 3 - - - 3 Congenital malformations M 7 2 - - 2 - - - 11 F 5 _ 1 _ _ _ _ - 6 Other defined and illdefined diseases M 19 3 - — 6 16 21 23 88 F 20 1 - 1 5 25 29 62 143 Motor vehicle accidents M — — — 6 5 5 2 4 22 F - - - - - 1 1 2 11 All Other accidents M 1 1 - 1 1 2 4 3 13 F 1 — _ - — 1 4 5 11 Suicide M - - - 3 3 8 - 2 16 F — — - - 1 8 _ _ 9 Homicide and operations of war M 1 _ - _ 1 F - 1 - - - - - - 1 TOTALS 69 14 9 16 88 558 684 1200 2638 17 Comparisons with 1953 (Registrar-General's Table) There were no deaths from Whooping Cough as in 1953 and none from Measles (1953 - 2). There were again no deaths in the Typhoid group and none from Diphtheria. The deaths from Pulmonary Tuberculosis numbered 28 (1953 - 30); those from Cancer decreased by 50; those from Pneumonia decreased by 30; and a decrease of 83 was also recorded in those caused by Bronchitis. There were only 6 deaths from Influenza (1953 - 79). Deaths from suicide show a decrease of 3, and motor vehicle accidents an increase of 8. The total number of deaths was 2,638 as compared with 2,905 in 1953. The percentage of deaths under 1 year of age to the total deaths was 2.6 per cent.; deaths under 15 years, 3.5 per cent.; deaths under 65 years, 28.6 per cent.; and deaths over 65 years, 71.4 per cent. The corresponding figures for 1953 were 2.4 per cent., 3.4 per cent., 29.2 per cent., and 70. 8 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 486 as compared with 540 in 1953; 567 in 1952; 479 in 1951; 501 in 1950; 481 in 1949; 510 in 1948; 492 in 1947; 451 in 1946; 470 in 1945 and 420 in 1944. Death-rate per 1,000 of the population for the last 11 years are as follows:- 1944 - 2. 21 (420) 1948 - 2.03 (510) 1952 - 2.26 (567) 1945 - 2.34 (470) 1949 - 1.93 (481) 1953 - 2.16 (540) 1946 - 1.93 (451) 1950 - 1.99 (501) 1954 - 1.95 (486) 1947 - 2.03 (492) 1951 - 1.91 (479) 18 Deaths from Cancer occurred at the following Ages:- Age period Ma!e Female Total Under 25 years 1 2 3 25 and under 35 years 1 5 6 35 and under 45 years 7 7 14 45 and under 65 years 98 87 185 65 years and over 138 140 278 245 241 486 Sites of Fatal Cancer Si te Mate Female Total percentage of Total Endocrine Glands 1 — 1 0.206 Skin 1 — 1 0.206 Oesophagus 8 5 13 2.680 Stomach 40 29 69 14.021 Liver 2 — 2 0.412 Bowel 21 37 58 11.959 Rectum 11 16 27 5.567 Bladder 10 1 11 2.268 Prostate 15 - 15 6.148 Larynx and Pharynx 4 - 4 0.825 Uterus - 19 19 7.884 Breast - 50 50 20.747 Ovary - 13 13 5.394 Panereas 5 10 15 3.093 Gall Bladder and Duct 3 5 8 1.650 Tongue and Mouth 2 2 4 0.825 Bones 2 2 4 0.825 Lungs 91 16 107 22.062 Kidney 3 3 6 1.237 Brain and Nervous System 3 6 9 1.856 Thyroid Gland - 2 2 0.412 Lymphatic Glands and Connective Tissue 12 3 15 3.093 Trachea - 1 1 0.206 Pylorus 1 - 1 0.206 Tonsil 2 - 2 0.412 Eye 2 - 2 0.412 Parotid Gland — 1 1 0.206 Hodgkin's Disease 1 1 2 0.412 Leukaemia 3 11 14 2.887 Genital Organs 4 4 0.825 Undefined 2 4 6 1.237 245 241 486 Comments on Foregoing Table. The organs most often attacked in descending order of incidence are: In the males - the Lungs (37.3 per cent.), the Stomach (16.0 per cent.) and the Bowels and Rectum (13.1 per cent.); in females - the Bowels and Rectum (22.0 per cent.), the Breast (20.7 per cent.) and the Stomach (12.0 per cent.). 19 COMMUNICABLE DISEASES NOTIFIED DURING YEAR 1954 Notifiabl e Disease Cases notifi ed Total cases notified in wards 1954 Sex Di st ribut ion of Noti f i ed Cases 1954 At all ages At ages - years Upper Norwood Norbury West Thornton Bensham Manor Thornton Heath South Norwood woodside East Addi scornbe Whitehorse Manor Broad Green Central Waddon South Addi ngton Sh irley Under l 1-4 5-14 15 - 24 25 - 44 45 - 64 65 and over M F Respiratory Tuber- culosis 211 2 6 9 53 75 47 19 12 16 14 19 18 19 10 6 16 6 13 10 16 16 11 9 139 72 Non-Respiratory Tuberculosis 27 _ 3 4 3 5 9 3 1 1 4 2 2 1 1 1 1 2 2 1 1 4 3 - 11 16 Scarlet Fever 4 06 - 90 301 12 2 1 - 15 28 24 43 13 27 11 39 11 19 17 10 21 20 84 24 215 191 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - Erysipelas 28 - — - 4 4 14 6 - 5 2 5 1 2 _ 1 1 1 3 _ _ 4 - 3 10 18 Meningococcal Infection 6 2 1 2 - - 1 - - - 1 - - 3 1 - - - - - - - 1 - 3 3 Enteric and Paratyphoid 3 - - 3 - - - - - 2 - - 1 - - - - - - - - - - - - 3 Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 63 - — - 24 39 - - 1 - 32 _ 1 2 _ _ — — 21 2 3 _ 1 _ 63 Ophthalmi a Neonatorum 7 7 - - - - - - - - 1 - - - - - - 1 5 - - - - - 3 4 Acute Poliomyelitis 7 - 1 2 3 1 - - - - _ — — - _ 2 3 _ 1 _ — - 1 _ 4 3 Dysentery 199 3 33 83 8 45 15 12 6 1 10 45 15 76 20 11 2 2 2 - 1 4 3 1 97 10 2 Malaria 1 — — — — 1 — — — — — 1 _ — _ — _ _ _ _ _ _ _ _ 1 _ Acute Primary and Influenzal Pneumonia 33 _ 3 10 _ 8 8 4 _ 1 3 2 11 1 3 - - 2 3 1 4 - 2 16 17 Food Poisoning 61 2 7 14 3 22 6 7 3 - 4 3 8 1 — 4 8 6 2 5 4 7 3 1 30 31 Acute Encephalitis 1 - - - 1 - - - - - - - - - - - - _ - - 1 1 Measles 194 8 72 108 3 1 2 - 18 10 36 35 7 10 2 14 1 2 6 1 5 9 13 25 98 96 Whooping Cough 50 5 54 206 235 1 7 2 — 27 35 30 27 44 40 8 16 23 45 33 37 30 18 74 18 242 263 1752 78 122 771 114 211 105 51 83 99 161 18 2 121 18 2 53 97 66 84 107 67 81 89 193 97 869 883 20 MONTHLY INCIDENCE OF COMMUNICABLE DISEASES, 1954 JAN. FEB. MARCH APRIL MAY JUNE JULY AUGUST SEP. OCT. NOV. DEC. TOTAL Respiratory Tuberculosis 18 16 17 15 20 . 17 14 14 14 24 29 13 211 Non-Respi ratory Tuberculosis 1 _ 2 3 5 4 - 3 2 5 2 27 Scarlet Fever 32 46 75 30 31 31 25 14 17 39 33 33 406 Diphtheria - — - — - - - - _ - - - - Erysipelas 1 5 5 2 2 1 1 _ 3 3 3 2 28 Meningococcal Infection - 1 - 1 2 - - - - - 1 1 6 Enteric and Paratyphoid - _ - - - - - - - - - 3 3 Smallpox - — - — — - - _ _ _ _ - - Choi era - - - - _ _ _ - _ - - _ Typhus - - - - - _ _ _ _ - _ - _ Puerperal Pyrexia 6 4 2 5 8 9 1 1 4 7 5 11 63 Ophthalmi a Neonatorum _ - - - 1 1 - - - - - 5 7 Poliomyelitis and Polio-encephalitis _ - - - - 2 - 3 1 1 - - 7 Dysentery 2 — 17 33 39 70 15 4 9 2 4 4 199 Malaria — — — — — — _ _ - - _ 1 1 Ac. Pri.and Ac. Inf. Pneumonia 5 3 1 1 1 5 2 2 3 3 4 3 33 Food Poisoning 7 4 4 1 2 5 3 8 16 5 4 2 61 Acute Encephalitis - - - - - - - - - - - 1 1 Measles - - 4 - 4 12 25 40 16 4 4 85 194 Whooping Cough 53 36 116 81 70 36 30 8 33 11 10 21 505 TOTAL 1752 21 FOOD POISONING In all instances of notified Pood Poisoning, or suspected Food Poisoning, immediate and careful enquiry is made and full bacteriological examinations carried out. For many years, I have observed in Croydon outbreaks of nausea and vomiting, sometimes accompanied by diarrhoea, occurring mainly in connection with schools. These are always fully investigated and the results rule out any common article of food or drink as being the cause, while all the specimens submitted for bacteriological examination, show no organisms of food poisoning. The outbreaks are commonly of short duration and the illness is not severe, although the abrupt onset is embarrassing for the children and annoying for those required to cope with the consequences. A similar outbreak occurred in the Croydon branch of a multiple stores, whose medical staff co-operated in an immediate and most thorough examination, which included many specimens from patients in the actual course of the illness. All were completely negative for any type of pathogenic organism. Such outbreaks have been described in this country and abroad and whilst there are conflicting theories regarding the cause, the view most generally accepted is that they are due to a virus, which is spread by droplet infection in the same way as influenza or the common cold. It must be emphasised that the diagnosis may be made only when there is irrefutable evidence that no common foodstuff has been consumed. Similar negative bacteriological findings have been observed in mild outbreaks of food poisoning, where a common foodstuff has been consumed, which was of the type likely to become infected and which had been prepared or kept in conditions favouring such a mishap. The fact that all those consuming the suspected food are not affected does not rule out its possible culpability. While there is still much to be learned in regard to food poisoning, the soundness of the teaching given by the department for the prevention of this condition has been amply confirmed in all the enquiries which we have carried out. The basic requirement is a high standard of education and conduct for food handlers. 22 The following figures give the food poisoning notifications, as corrected, for 1954:- lst Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 15 8 27 11 61 Outbreaks due to identified agents:- Total Outbreaks 4 Total Cases 15 Outbreaks due to: - (a) Chemical Poisons Nil (d) CI. Botulinum Nil (b) Salmonella Organisms 15 (e) Other Bacteria Nil (c) Staphylococci cluding toxin) Nil Outbreaks of undiscovered cause:- Total Outbreaks 6 Total Cases 17 Single Cases:- Agent identified 16 Unknown Cause 13 Total 29 23 WADDON (ISOLATION) HOSPITAL I am indebted to Dr. J.J. Linehan for the following report on infectious etc., cases admitted to the Hospital during 1954:- There was a total of 774 admissions, comprised of 560 to the acute infectious wards, 201 cases to the pulmonary tuberculosis wards and 13 to the ward for 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 125. Admissions to the Tuberculosis Wards - 197 (181) tuberculous patients were admitted and there were 13 deaths. As compared with the previous year, the number of admissions remained approximately the same but there were fewer deaths and the tendency for these to occur at a later age was now more pronounced, 10 of the 13 being over 50, of whom 7 were over GO. In addition, 4 cases of carcinoma of the respiratory tract, 3 of whom died, were treated in these wards. The average bed occupancy was 70.1. Admissions to the Acute Infectious niseases Wards - The following are the final diagnoses 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 22 days and the average bed occupancy 32. 2. Scarlet Fever 209 (206) Pharyngitis 7 (6) Castro-enteritis 52 (42) Streptococcal Sore Throat 6 (4) Whooping Cough 36 Quinsy 2 Dysentery 27 ( 22) Bronchiectasis 1 Chicken-pox 24 (20) Tonsillectomy 1 Ery sipel as 13 (12) Otitis Media 1 Meningitis 10 (9) Impetigo 13 (11) Food Poisoning 9 Herpes Zoster 2 Mump s 9 Scabies 2 Influenza 5 Urticaria 4 Poliomyelitis and Encephalitis 5 Alopecia Areata 1 Rheumatic Fever 3 Measles 4 (3) Staphylococcal Septicaemia 1 Paratyphoid 3 (2) Infective Hepatitis 3 Phlebitis 4 Rubella 1 Cellulitis 2 Neonatal Staphylococcal Infection 20 ( 19) Perinephric Infection 1 Whitlow 1 Non-Patient Mothers 13 (12) Ulcerative Colitis 1 Puerperal Infection 7 Pyloric Stenosis 1 Non-Patient Babies 3 Teething 1 Pneumonia 19 (10) Disseminated Sclerosis 1 Bronchitis 8 Pyrexia of Unknown Origin 1 Tonsillitis 12 Nil Abnormal Detected 5 24 Scarlet Fever: - The decline in admissionsof scarlet fever cases, evidenced in the previous three years, continued. The routine use of penicillin did not appear to affect the range of complications occurring but did reduce the total incidence of complications. Thus, the incidence of otitis media was 2.4% - about half the expected rate. Secondary attacks of scarlet fever are the exception in that they appear to occur more frequently after penicillin. There was no definite case of nephritis though albuminuria did develop in 1 case. There were 2 cases of endocarditis both of whom clinically appeared to make a full recovery. Gastro-enteritis:- The age groups of the patients treated were as follows:- under 1 year - 28, 1-5 years 12, school age 4 and adults 8. Classified according to severity 27 were mild, 16 moderately severe and 9 very sever e. Though the proportion of very severe cases were similar to that obtaining in the previous year, there were no deaths. Whooping Cough:- Of the cases admitted, 12 were under 1 year (8 being under 6 months), 4 were aged 1-2, 11 aged 2-5 and 9 over 5 years. 13 patients admitted from various institutions were all in the older age groups. Complications encountered were pneumonia 7 cases, gastro-enteritis 4 cases, and bronchitis 1 case. Dysentery:- The 27 dysentery admissions were all of the Sonne' type. 22 of these cases occurred in 4 groups of associated cases, the remaining 5 being seemingly sporadic. 17 were children up to 14 years and, of the 10 adults, 8 were aged and infirm. Chicken-pox:- Admissions were mainly due to accommodation difficulties in respect of patients in residential schools, rest centres, lodgings and undergoing in-patient treatment in general hospitals. The youngest was 2 months whilst the oldest, 76 years, illustrated the association with herpes zoster. Meningitis: - Meningitis appeared to be more prevalent than usual. Of the 10 cases admitted, 5 were meningococcal, 2 pneumococcal, 1 haemophilus influenza infection, 1 streptococcal and 1 pyogenic meningitis in which the causative organism could not be isolated. All made uncomplicated recoveries. 25 Neonatal Staphylococcal Infection:- The cases shown were mainly from a maternity hospital outbreak in the summer months. The lesions consisted of varying combinations of pemphigus, omphalitis, conjunctivitis and paronychiae. Salmonella Infections:- There were 8 acute cases of food poisoning and 1 carrier. All acute cases were children and came from 8 separate homes. 7 of the 8 were infected with salmonella typhimurium and 1 with salmonella Newport. All occurred in the second half of the year. In December, 3 cases of paratyphoid B were admitted, also from separate homes and each due to a different strain of organism. Other Infections:- There were conspicuously few cases of measles and poliomyelitis. Only 1 poliomyelitis patient had any residual weakness at the end of the isolation period and even in that case complete recovery appeared most likely. Chronic Sick Ward:- The 13 admissions were classified as follows:Senility - 10, Heart Disease - 2, Cerebral Thrombosis - 1. Fatal Cases:- There were 21 deaths from the following causes: Pulmonary Tuberculosis - 11; Senility - 4; Carcinoma of the Lung - 2: Pneumonia - 2; Carcinoma of the Larynx - 1; Cerebral Thrombosis - 1. In one of the pneumonia deaths congenital heart disease and renal tumour were contributory causes. 26 THE PREVENTION AND CONTROL OF TUBERCULOSIS The following table shows the great improvement in mortality from tuberculosis over the last forty years. Tuberculosis (All Forms) Tuberculosis (All Forms) 0-15 years All ages 0-15 years All ages Year Number of Deaths Death Rate per thousand of population Number of Deaths Death Rate per thousand of population Year Number of Deaths Death Rate per thousand of population Number of Deaths Death Rate per thousand of population 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 1934 10 - 157 0.65 1954 1 0.02 32 0. 13 27 I am indebted to Dr. R.H.J. Fanthorpe, Chest Physician, for the following section of the Report. In November 1954, the Chest Clinic was moved from 20 Katharine Street to its new premises at 33 Mayday Road. The new clinic is more spacious, and the patients have appreciated the improved facilities which have been provided. Although social conditions were different in 1954, a comparison with 1927 shows that in 1927, 90 per 100,000 of the population in Croydon died from all forms of tuberculosis; in 1954 the corresponding figure was 13.2. The years selected were nine years after a major war. Measures for the prevention of the disease are being extended each year, and during 1954 the number of contacts examined and the number of contacts who have received protection by B. C. G. vaccination have both increased substantially. During 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. 141 children were tuberculin tested and in 69 a positive reaction occurred. 5 children, who were found to be suffering from primary tuberculosis, required treatment at home or in hospital. 17 children were kept under supervision as outpatients of the Clinic. No case of infectious pulmonary tuberculosis was found and there were no deaths. 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 211 cases of Respiratory Tuberculosis and 27 cases of NonRespiratory Tuberculosis were notified on Form A during 1954 (Table 1 - Formal Notifications). Of these 139 males and 72 females were Respiratory cases and 11 males and 16 females were Non-Respiratory. In addition 95 Respiratory cases and 3 Non-Respiratory cases came to our notice as new cases otherwise than by notification (Table II - Supplemental Return). 28 The total number of new cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the year 1954 by notification or otherwise was 336 as compared with 304 in 1953, 331 in 1952, 316 in 1951, and 369 in 1950. 306 of these were cases of Respiratory Tuberculosis; 185 in males and 121 in females. There were 33 more males and 3 fewer females than in 1953. There were 7 cases of Non-Respiratory Tuberculosis among children under 15 years as compared with 6 in 1953. The number of cases in adults was 23 compared with 22 in 1953. Of the cases notified in 1954, 4 males and 1 female died from the Respiratory form of the disease during the year, equal to 2.4 per cent. of those notified. The incidence rate of Tuberculosis of all forms was 1.34 per 1,000 of the population; for Respiratory Tuberculosis 1.22, and for Non-Respiratory 0.12 per 1,000 population. The notification rate was 0.95 per 1,000. In 1953 the corresponding figures were 1.21, 1.10, 0.11 and 0.84 per 1.000. Public Health (Tuberculosis) Regulations, 1952 Summary of notifications during the period from 1st January, 1954 to 31st December, 1954:- TABLE I. Formal Notifications Age Periods Number ofPrimary Not i fi cat ions of new cases of tubercuiosis 0- /- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total (all ages) Respiratory, Males 1 1 4 2 2 10 12 32 18 22 19 13 3 139 Respiratory, Females 1 - 1 3 2 9 22 13 12 2 4 3 - 72 Non-Respiratory, Maies - 2 - 2 2 - - - 2 - 2 - 1 11 16 Non-Respiratory, Females - - 1 - - 3 - 2 1 4 3 2 - 29 Source of Information Number of cases in age Groups TABLE II. Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the period from 1st January, 1954 to 31st December, 1954, otherwise than by formal notification:- 0- /- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- TOTAL Death Returns from Local Registrars Respiratory M - - - - - - - - - - - - - - (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (c) F - - - - - - - - - - - - - - (D) Death Returns from RegistrarGeneral (Transferable deaths) Respiratory M - - - - - - - - - - - - 1 1 (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (c) F - - - - - - - - - - - - - - (D) Posthumous Notifications Respiratory M - - - - - - - - - - - - - - (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (c) F - - - - - - - - - - - - (D) "Transfers" from Other Areas (excluding transferable deaths) Respiratory M - - - - - - 10 18 9 4 2 - - 43 (A) F - - 1 - 2 1 16 17 9 1 - - - 47 (B) Non-Respiratory M — _ _ _ _ 1 1 1 _ _ _ _ 3 (C) F - - - - - - - - - - - - - - (D) Other Sources Respiratory M - - - - - - - - - - 2 - - 2 (A) F - - - - - - - - 2 - - - - 2 (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) TOTALS (A) 46 (B) 49 (C) 3 (D) - 30 Notification Register Number of cases of Tuberculosis remaining on the Notification Register on 31st December, 1954:- RESPIRATORY NON-RESPIRATORY Total Cases Ma/es Fema/es Total Males Females Total 1107 823 1930 96 102 198 2128 CLASSIFICATION OF NEW PATIENTS Respiratory Tuberculosis During 1954, 204 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) 112 or 54.9% B, or T. B. plus, 1 (early cases, sputum 28 or 13.7% positive) B, or T.B. plus, 2 (intermediate cases, 60 or 29.4% sputum positive) B, or T. B. plus, 3 (advanced cases, 4 or 2.0% sputum positive) 204 100.0% Non-Respiratory Tuberculosis There were 20 cases examined at the Clinic and found to have Non-Respiratory Tuberculosis in the following forms:- Bones and Joints 6 Abdominal Other Organs 8 Peripheral Glands 6 20 31 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 19 48 - - 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 19 52 - - - 10 22 20 52 1953 1 - - 5 11 14 31 1954 - - 1 6 15 6 28 All cases were notified during life. 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 1954 the death-rate from all forms of Tuberculosis was 0.128 per 1,000 population. The rate from Respiratory Tuberculosis was 0.112 and the rate for Non-Respiratory Tuberculosis 0.016. Similar figures for 1953 were 0.12 and 0.02. In 1954 the total number of deaths showed a further decrease when compared with 1953. 75% of the deaths occurred in the age groups 45 years and over. There were no deaths amongst children of school age. New cases showed an increase in males of 31% and a decrease in females of 14%, compared with 1953. The total new cases for the year 1954 showed an increase of 11%, compared with 1953. The reduction in the death rate to the low figure of 12.8 Per 100,000 population reflects the progress which is being made in the control of pulmonary tuberculosis. Heaths from Non-Respiratory Tuberculosis During 1954 4 deaths were certified to be due to Non-Respiratory Tuberculosis, compared with 6 in 1953, 2 in 1952, 13 in 1951 and 7 in 1950. 32 3 of the patients died in general hospitals and 1 at home, All of them were notified during life. The deaths were due to:- Males Fema/es Total Tuberculous Meningitis 1 1 2 Tuberculosis of the Spine 1 - 1 Miliary Tuberculosis - 1 1 Total s 2 2 4 Co-ordination with the Health Department During the year 114 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 289 men, 203 women and 9 children were admitted to Residential Institutions in Croydon during 19 54. The Chest Clinic and Home Visiting 1,632 new cases were examined during the year. 202 were found to be definitely tuberculous. The total number of attendances for examination at the Chest Clinic was 15,052. There were also 6 , 74 2 attendances by patients for collapse therapy. The Clinic doctors paid 204 home visits and the Tuberculosis Visitors 3,804 visits for Clinic purposes. In addition the Tuberculosis Visitors made 418 primary visits for the purposes of the Notification Register. There were also 1,608 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. 33 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 1954, 820 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, 16 were found to be tuberculous. This is equal to a tuberculosis rate per 1,000 contacts of 19, compared with 1.34 per 1,000 of the general population. In addition, there were 6 found to be tuberculous who had been under observation from previous years. The number of new contacts examined, together with the numbers of new cases of Tuberculosis notified in previous years are as follows:- 1953 - New contacts examined 668. New cases of tuberculosis 211 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 1954 and regular sessions are held at the Clinic for this purpose. 281 contacts were successfully vaccinated during the year, compared with 167 in 1953. In addition, 32 nurses and domestics were successfully vaccinated, and 43 babies of tuberculous parents were vaccinated in hospital during the neonatal period. During 1954 the Ministry of Health approved a pilot trial for the B.C.G. vaccination of school leavers in one selected school in the Borough. As a result of this trial 68 children over the age of 13 years were successfully vaccinated. It is hoped to repeat this trial during 1955, and over the past year members of the medical staff of the Public Health Department have attended some of the B.C. G. sessions at the Chest Clinic to obtain experience of the procedure. The response of parents to the B. C.G. vaccination for their children has been good, and in a very few instances has permission been refused. 34 The Chest Clinic Register of Tuberculosis Cases. On Clinic Register at 1st January, 1954 1,817 Transfers in from Other areas during the year 79 "Lost sight of" cases returned 8 Written off the Clinic Register as Recovered 72 Died (from all causes) 41 Removed to Other areas 117 Remaining on the Clinic Register at 31st 1, 886 December The following particulars give a summary of the work done in connection with the Clinic: Number of patients examined for the first time, excluding inward transfers, i.e., patients who have removed from Other areas 2,452 Number of visits paid by Clinic doctors to homes of patients 204 Number of visits paid to homes of patients by Tuberculosis Health Visitors 4,222 Attendances of patients at the Clinic:- At ordinary sessions 15,052 At refill sessions 6,742 21,794 Number of X-ray films taken 14,072 Re-housing of Tuberculosis Patients 49 families were re-housed specifically on the grounds of the presence of infective tuberculosis, so that the patient could have a separate bedroom. Switzerland During 1954 one more patient from the Croydon area was sent to Switzerland under the scheme for the treatment of certain cases of respiratory tuberculosis in Swiss sanatoria. 35 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 201 examinations were carried out in 1954 of staff coming into contact with children, such as teachers, the staff of nursery schools, residential schools and homes. MASS RADIOGRAPHY I am also indebted to the Medical Director of the Surrey Area of the South-West Metropolitan Regional Hospital Board Mass Radiography Service for the following particulars of persons examined and of abnormalities found:- No. of Persons examined Active Pulmonary Tubercu/os is inactive Pulmonary Tuberculosis NonTuberculous Conditions Croydon C.B. area 15,395 21 653 440 TUBERCULOSIS AFTER-CARE I am indebted to Miss Bridger, Almoner of the Chest Clinic, for the following reports:- In 1954, the After Care Scheme continued in very much the same way as in previous years, voluntary sources being called upon to provide extra comforts to supplement the basic provisions available from statutory sources. The National Assistance Board is, of course, the principal agency for supplementing National Insurance benefits, and at 31.12.54 198 families were receiving the special tuberculosis treatment allowance. Of these, 41 of the patients were in hospital, and 157 athome. Of these 157 patients, the vast majority had been discharged after treatment and returned to work shortly afterwards. Voluntary sources contributed very greatly to the patients' welfare, and over £500 was raised to meet special needs. To quote 3 examples, one man had an interest free loan to enable him to buy a car, to reduce fatigue in travelling to and from work; another was enabled to buy a light tractor, to reduce the strain of cultivating his small holding, and a third was provided with a small greenhouse so that he could pursue his hobby while he was as yet unfit for work. The grant from the Sunday Cinemas Fund has again been invaluable in meeting small but urgent needs which cannot be covered from any other fund. I am particularly grateful to the Norwood Round Table for the interest they have taken in our patients and the projects they have in view for future help. Their most practical gift of groceries and toys at Christmas time brought pleasure to many families 36 who would otherwise have had very little extra at this time. Over 70 families received a parcel, and very many children received toys. In the field of employment, the recently opened Industrial Rehabilitation Unit at Waddon has been a great help. In selected cases, patients who had had a long spell of illness and who were unsure about their future plans, were able to undergo a course of rehabilitation to help determine the most suitable work for them to undertake. Liaison with departments of the Local Authority has been maintained. Free milk was supplied to the value of £100, and bedding loaned in certain cases, and much help was given with domestic problems and the care of children by the Home Help, and Children's Departments. Arising out of these activities 358 visits were paid to homes and hospitals. Home Industry Scheme Report for 2954 Mrs. Higinbotham resigned in September 1954, and her place was taken by Mrs. Simon. The Home Industry Scheme has developed steadily throughout the year. In February, extra sessions for home visiting were authorised owing to the popularity of the scheme, and since then there has been the class at the Clinic, and one home visiting session every week instead of alternate weeks. This has enabled more patients to receive more frequent visits, and such is the demand that it is hoped to have a second weekly home visiting session shortly. The number of patients able to attend the classes varies with the weather, but most weeks there are 6 or 7, which is as many as can be conveniently accommodated and instructed at once. Any who are temporarily unfit to attend, receive home visits, and those who have been visited at home are encouraged to join the class as soon as they are able to do so. At the end of the year, there were 35 patients on the Clinic Register, and 20 on the visiting list. During the year, £95.2s.2d. was paid in for materials by patients, which is a considerable increase on the previous year. 37 VENEREAL DISEASES Return relating to all persons attending at the Treatment Centre at Special Clinic, General Hospital, Croydon, during the year ended the 31st December, 1934. Syphi1is Gonorrhoea Other Conditions TOTALS H F M F M F M F Ttls. 1. Number of patients on 1st January under treatment or observation 46 40 31 2 47 24 124 66 190 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 - - - - - - - - - 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 - - - - - 4 - 4 (b) " secondary 1 1 - - - - 1 1 2 (c) " latent in 1st year of infection 1 - - - - - 1 - 1 (d) "cardio-vascular — — - - - - - - - (e) " of the nervous system - 1 - - - - - 1 1 (f) " al1 other late or 1atent stages 11 7 - - - - 11 7 18 (g) " congenital (under 1 year) - - - - - - - - - (h) " congenital (over l year) 2 6 - - - - 2 6 8 (i) Gonorrhoea - - 49 10 - — 49 10 59 Other conditions:- (j ) Chancroid - - - - - - - - - (k) Lymphogranuloma venereum (SynLymphogranulomainguinale) - - - - - - - - - (!) Granuloma inguinale (Syn. Granuloma venereum) - - - - - - - - - (m) Non-aonococcal urethritis (males only) - - - - 51 - 51 - 51 (n) Any other conditions requiring treatment - - - - 72 69 72 69 141 (o) Conditions not requiring treatment - - - - 188 94 188 94 282 (p) Conditions remaining undiagnosed at 31st December - - - - - - - - - 4. Number of patients dealt with for the first time who have been transferred from other Centres (civil or Service) or from practitioners affiliated to other Centres 1 - - 1 6 2 7 3 10 TOTALS OF ITEMS 1, 2, 3 AND 4 66 55 80 13 364 189 510 257 767 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" 19 12 65 10 318 167 40 2 189 591 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 defaul ted after 3 months - - 1 - - - 1 - 1 38  Syphili s Gonorrhoea Other Conditions TOTALS M F M F M F M F Ttls. 7. Number of patients who ceased to attend before completion of treatment and were suffering from:- (a) Acquired syphilis of less than 1 year's duration - - - - - - - - - (b) Acquired syphilis of more than l year's duration - - - - - - - - - (c) Congenital syphilis (under l year) - - - - - - - - - (d) Congenital syphilis (over 1 year) - - - - - - - - - (e) Gonorrhoea — — 1 — — — 1 — 1 8. Number of patients under treatment or observation known to have died:- (a) From Syphi1is - - - - - - - - - (b) From treatment — - - - - - — - - (c) From other causes - - - - - - - - - 9. Number of patients transferred to other Centres or Institutions or to private practitioners - - - - - - - - - 10. Number of patients remaining under treatment or observation on 3lst December 47 43 13 3 46 22 106 68 174 TOTALS OF ITEMS 5.6.7.8.9 AND 10 66 55 80 13 364 189 510 257 767 11. Number of patients included in Item 7 who failed to complete one course of treatment of either penicil 1 in or of arsenic and bis— muth and were suffering from:- (a) Acquired syphilis of less than 1 year's duration - - - - - - - - - (b) Acquired syphilis of more than l year's duration - - - - - - - - - (c) Congenital syphilis of less than 1 year's duration - - - - - - - - - (d) Congenital syphilis of more than l year's duration - - - - - - - - - 12. Number of attendances:- (a) for individual attention by the physician 431 185 373 16 1527 482 2331 683 3014 (b) for intermediate treatment, e.g. dressings, etc. 402 715 134 12 360 684 896 1411 2307 TOTAL ATTENDANCES 833 900 507 28 1887 1166 3227 2094 5321 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 - - - - - - 2 6 2 6 39 14. Pathological work:- Microscopical Cultural Serum Cerebro. Sp i nal Fl ui d Others for Syphilis for G'n' rh. for Syphi1is W.R. A Kahn for G * n * rh (a) Number of specimens examined at, and by the medi cal 0 f f i cer of, the Treatment Centre 7 663 445 693 370 14 10 (b) Number of specimens from patients at the Treatment Centre sent to a pathological laboratory ... 24 15. Contacts attending for examination through the agency of:- Syphi1i s (less than 1 year) Syph i1i s (more than 1 year) Gonorrhoea Other Condi tions M F M F M F M F (*) Patients - - - - - 4 - 16 (b) Health vi si tor or soci al Service worker - - - - - - - - TOTALS - - " " " 4 - 16 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 17 10 4 3 34 Gonorrhoea 31 14 4 10 59 Other Conditions 247 112 56 59 474 136 64 72 567 PUBLIC HEALTH LABORATORY SERVICE Very considerable use has been made of the facilities for bacteriological and other laboratory examinations of Public Health nature. I take this opportunity to thank the Director of the County Hall, London laboratory, Dr. A.J.H. Tomlinson, for his ready assistance and most helpful advice, which have been available at all times. The following figures show the work carried out during the year under review:- Samples submitted to the Pathological Laboratory for Bacteriological Examination - 2954 Faeces outfits 1,864 Water samples 359 Milk samples 345 Ice Cream Samples 231 Sundry Food Specimens 32 Total 2,831 40 PERSONAL HEALTH SERVICES UNDER THE NATIONAL HEALTH SERVICE ACT ANTE-NATAL AND POST-NATAL CLINICS During the year 3,909 cases were seen at the Ante-Natal Clinics, of which 2,744 were new cases. A total of 23,387 attendances was recorded, and 1,714 cases were seen at the Post-Natal Clinics (1,596 new cases) and 1,744 attendances recorded. Mothercraft instruction classes were firmly established, and at times more applications were outstanding than could be included in current lectures. At relaxation exercise sessions 341 patients recorded 1,781 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. (l) Number of live premature babies notified during 1954 who were born- (i) at home 40 (ii) in private nursing homes 7 (iii) in hospital 156 (2) The number of those born at home - who were nursed entirely at home 36 who died during the first 24 hours - who survived at the end of one month 36 (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 7 (4) Number of those born in hospital - who died during the first 24 hours 12 who survived at the end of one month 135 (5) Number of premature still births who were born - (i) at home 1 (ii) in private nursing homes 1 (iii) in hospital 46 41 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 - 188 cases were dealt with by the Social Worker; 25 cases were admitted to Hostels; 4 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 eight infant deaths of illegitimate babies in 1954, only one child was born under such arrangements, the cause of death being prematurity. INFANT WELFARE CENTRES Their work continued without any major changes. Welfare Clinics continued to offer facilities for immunisation against diphtheria and vaccination against smallpox at all sessions. Ministry of Food Welfare Foods were also available at all Clinics following this function being taken over from the Ministry of Food in June. As Welfare Foods have for many years been issued from all Infant Welfare Centres in Croydon, the new responsibility was for a central store and central distribution office for the borough. The accommodation already in use was in Corporation premises and the tenancy was therefore transferred temporarily to the Health Department. Four members of the Food Office staff were engaged to continue these duties, and the changeover effected without any difficulty. Foods issued during the period were:- National Dried Milk 67,391 Cod Liver Oil and Malt 18,173 Vitamins A and B (for Expectant Mothers) 6,248 Orange Juice 102,887 42 ATTENDANCES AT INFANT CENTRES - 1954 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, Friday, P.M. Monks Hill, Tuesday.P.M. Municipal, Monday, P.M. Municipa1, 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. ludes, 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. woods ide Friday, P.M. Total, 1954 Total, 1953 New cases under 1 year 60 90 87 102 85 174 87 52 129 146 104 155 71 94 100 67 107 53 109 66 84 70 87 88 95 126 80 188 69 34 66 94 3019 3247 No. of Re-attendances 1054 1480 1279 1785 1856 2231 1178 785 1848 2161 1867 1907 1299 1743 1362 583 1638 1079 1721 1172 1614 1074 1217 1273 1326 1625 1135 2121 1043 850 1066 1454 45826 47058 New cases over l year 19 21 17 19 7 22 10 11 17 31 17 28 12 12 10 6 6 3 19 9 24 10 16 20 16 12 10 22 8 1 13 15 463 582 No. of Re-attendances 811 1299 746 736 679 832 635 518 370 468 1035 901 896 984 743 659 499 822 1002 721 925 907 544 936 552 649 681 899 519 717 626 813 24124 26428 Attendances of Children 0-5 1944 2890 2129 2642 2627 3259 1910 1366 2364 2806 3023 2991 2278 2833 2215 1315 2250 1957 2851 1968 2647 2061 1864 2317 1989 2412 1906 3230 1639 1602 1771 2376 73432 77315 Consultations with Doctor 759 935 679 795 831 1051 461 261 820 842 874 882 720 787 631 425 727 545 750 764 796 642 376 625 551 651 431 830 586 379 551 674 21631 21799 No. of Sessions 48 48 49 49 49 49 49 49 48 49 48 49 49 49 49 49 48 49 49 49 49 49 49 49 49 48 48 49 49 48 49 48 1559 1534 EXPECTANT MOTHERS; No. of new cases 1 - - - - - - - - - - - - 1 - - - - 3 - 1 2 - - - - - - 9 1 2 - 21 21 No. of Re-attendances - 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 38 27 Total attendances of Expectant Mothers 1 3 - - - - - 1 - - - - - 1 - - - - 3 - 1 2 - - - - - - 44 1 2 _ 59 48 Total Attendances 1945 2893 2129 2642 2627 3259 1910 1367 2364 2806 3023 2991 2278 2834 2215 1315 2250 1957 2854 1968 2648 2063 1864 2317 1989 2412 1906 3230 1683 1603 1773 2376 73491 77363 Average per Session, 1954 40.5 60.3 43.4 53.9 53.6 66.5 39.0 27.9 49.3 57.3 63.0 61.0 46.5 57.8 45.2 26.8 46.9 39.9 58.2 40.2 54.0 42.1 38.0 47.3 40.6 50.3 39.7 65.9 34.3 33.4 36.2 49.5 47.1 - 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 43 HOME NURSING This service continued to be carried out by the Croydon District Nursing Association, acting as agents for the Corporation. When the voluntary association was first established, the work covered was but a fraction of the duties performed at present. Nevertheless, before 1948, the Association had an office in Katharine Street, in addition to the hostel and district room in Chepstow Road. This division of administration from the actual allocation of work to the nurses impeded efficiency, and was emphasised by the steady growth in the demands made upon the service. The urgent need to provide adequate premises led the Association to ask the Corporation to make available to them an appropriate building. Plans were drawn up during 1954 for a new administrative centre and to provide hostel accommodation for a small percentage of the permanent staff who wish to be resident and for the six student nurses who are normally being trained in District Nursing work at any one time. It is hoped that the accommodation will be provided in the near future. I am indebted to the Superintendent of the Croydon District Nursing Association, Miss J.C. Dickinson, for the following information regarding the work carried out during the year under review:- Staff at 31.12.54 Superintendent 3 Assistant Superintendents 29 whole time Nurses (including 3 males) 8 Queen's Students Summary of work carried out during the year under review:- Patients remaining on books from 1953 729 New patients 5,239 Total 5,968 New Patients Medical 2,390 Surgical 2,739 Gynaecological 68 Obstetric 21 Maternity 21 Total 5,239 44 Specially classified:- Cases Visits Tuberculosis 136 3,831 Pneumonia 201 2,018 Maternity Complications 58 528 Infectious Diseases (including influenza) 23 156 Children under five years 178 1,047 Visits:- Termmation of Cases:- Convalescent 3,350 Hospital 693 Died 442 Removed for other causes 609 Still on books 874 Total 5,968 January 12,578 February 11,208 March 12,360 April 11,689 May 11,539 June 10,325 July 9,850 August 9,915 September 10,361 October 11,489 November 12,051 December 11,683 Total 135,048 45 PAY NURSERIES Attendances at Day Nurseries, 1954 Whitehorse Road Morland Road Date opened 1/6/42 8/3/43 Capacity 50 56 Number on books at end of year 29 27 Attendances: under 2 23 39 1121 over 2 4299 3749 TOTAL 6638 4870 Number of days opened 256 256 Average daily attendance (excluding Saturdays) 26 19 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 6 4 10 Knock Knees and Flat Feet 40 38 78 Valgus Ankles 11 15 26 Chest Conditions: Post T. A. and Asthma 4 2 6 Kyphosis - 1 1 Torti-collis 4 3 7 Pigeon-toes 10 17 27 Inco-ordination - 11 1 75 81 156 Total attendances: 2122 46 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 PostNatal 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. During the year there has been a change in the method of dealing with mothers under supervision at Ante-Natal Clinics. Following the introduction of the National Health Service patients attending were automatically referred for a routine dental examination, unless a desire was expressed to visit their own dental practitioners. Though this meant a considerable decline in the numbers dealt with at the local Authority' s clinics, the practice of offering a freer choice of treatment was thought to be a good one and was therefore adhered to as far as was practical. Unfortunately, experience has shown that the above system was open to a good deal of abuse, which was reflected in a subsequent increase in the demand for emergency treatment at later stages of the pregnancy. More recently a tighter supervision has been introduced in the Ante-Natal Department, and all patients are now referred to the Dental Department at their initial medical examination, and whenever possible this inspection is performed at the same visit. In this way mothers can be acquainted with their immediate dental requirements and a stronger inducement is offered to treatment. More accurate information can be obtained as to those intending to visit outside practitioners and a follow-up on doubtful cases can be instituted if thought advisable. As reported previously closure of Day Nurseries has caused unfortunate reduction in the number of pre-school children previously referred from this source. Despite this fact there has been an appreciable build up of cases introduced by Dental Officers themselves, and final results have been considerably better than was expected. The problem of securing early supervision for the above patients is discussed later in this narrative. As in the case of the School Service shortage of staff has considerably hampered activities and visits to Welfare Centres have been less numerous than was hoped. Provision of treatment for those in the New Addington area has been greatly assisted by the opening of the Overbury Dental Clinic, and the response has been specially gratifying. Additional sessions have now been set 47 aside for the treatment of expectant mothers and young children in the above area. Progress with the new Dental Centre at Stroud Green has proceeded satisfactorily during the latter part of the year and completion should be possible during the coming months. The new building, which is of modern design, will include certain features which will add to the scope of treatment. In addition to housing two full-time Dental Units, ancillary accommodation will be provided to permit regular visits by a Dental Consultant in connection with the Orthodontic Scheme. Provision for the taking of X-Ray photographs on the premises will be an added aid to diagnosis. Besides the normal service for school children, extended facilities will be possible for treatment of expectant and nursing mothers and pre-school children with special emphasis on the preventative side of this work. Practical demonstrations to the younger children on the correct method of brushing the teeth will be given by an Oral Hygienist, who will also advise parents on minor dental matters. Activities of this kind should have the effect of stimulating the toddlers' interest in dental care and pave the way for more active treatment at a later date. Expectant and Nursing Mothers. The total number of expectant and nursing mothers referred from all sources was 593, compared with 329 in 1953. 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. Despite shortage of staff, all those applying for treatment received appointments to attend the Dental Clinic. Absenteeism has shown a welcome decline and now stands at some 16 per cent. of those referred for treatment. Expectant mothers examined for the first time numbered 322 against 268 last year. Of these, 74.5 per cent. were seen during the first six months of pregnancy, compared with 69.8 per cent. previously recorded. It is significant that certain of those attending at later stages of their confinements did so as the result of pain or discomfort, which might have been avoided had treatment been sought at an earlier date. There has been a slight decrease in the amount of work carried out for nursing mothers. In some cases this resulted from late reference from the Ante-Natal Department which did not 48 permit of treatment until after the confinement; in others, names were actually received during the post-natal period. 47 nursing mothers were referred during the current year, compared with 53 in 1953. Treatment. Including those continuing treatment from the previous year, 407 mothers were dealt with, compared with 371 in 1953. Whenever conditions are favourable full conservation of teeth is advised; however, in this respect much depends on the conditions 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. Whatever the extent of the measures decided upon, it will be obvious that early attention will secure the best results, and for this reason it is hoped that the revised method of referring patients will permit a more comprehensive treatment. The Pre-School Child. The number of children referred from all sources during the year was 605, compared with 557 in 1953. In the face of the reduction in the number of Day Nurseries this may be considered a minor achievement. As stated previously, the major difficulty 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 visual observations, with the inevitable result that many cavities are found to be beyond repair when eventually brought to notice. The condition of many mouths at the first school inspection is a constant reminder of the fact that until a far greater degree of supervision can be exercised during the pre-school period, there can be no satisfactory solution to the problem of safeguarding the foundation teeth. For those not visiting Welfare Centres the introduction of nursery classes at certain primary schools can make a useful contribution until the programme for Nursery Schools can be put into effect. In addition to the above, activities of the kind envisaged at the new Centre should greatly assist in encouraging parents to seek attention at an early date. 49 Treatment. The following summary shows particulars of the work accomplished:- Expectant Mothers Nursing Mothers Total Young Children New Cases Examined 322 47 369 452 Re-treated 19 19 38 153 Total 341 66 407 605  Expectant and Nursing Mothers Young Children Attendances 862 1,132 Fillings 234 389 Extractions 382 510 Gas Cases 103 225 Local Anaesthesia 94 11 Scaling and Gum Treatment 95 - Dressings 269 366 Denture Dressings 105 - Silver Nitrate - 359 Treatments Completed 156 332 Number of Sessions (treatment) 338 Dentures Fitted 32 Dentures Repaired 9 50 The Centres at which patients were examined, or from which they were referred, are given in the following list:- Mothers Young ChiIdren Mothers Young Children Ante Natal 49 2 - South Croydon - 3 Municipal Midwives 83 - St. Alban's _ 7 Woodside 1 Post Natal 10 — Norbury - 10 Welfare Centres etc.: Addington 6 25 Municipal 1 11 St. Andrew's - 1 East Croydon - 2 Waddon - 6 Upper Norwood - 1 Boston Road - 3 Holy Trinity _ 3 St. Jude's - 9 St. Oswald's - 8 St. John's (Shirley) - 6 Bensham Manor - 1 Monks Hill - 4 West Croydon - 11 Fa irchildes 1 4 South Norwood - 3 Hartland House - 1 Crossfield Nursery - 5 Referred by Dental Officers: 480 Mothers: 593 Young Children: 605 Total: 1,198 51 MIDWIFERY SERVICE The Corporation employ directly a Superintendent and 18 domiciliary midwives. 10 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 1954 1,265 2.-The number of spontaneous deliveries 1,251 3.-The number of forceps deliveries 14 4.-The number of live births 1,256 5.-The number of stillbirths 9 6.-The number of neo-natal deaths 4 7.-The number of premature infants treated in their own homes, and their weights and ultimate result 11 (1) 38 weeks - 5 lbs. Discharge weight 5 lbs.4 ozs. (2) 37 weeks - 5 lbs 5 lbs.4 ozs. (3) 36 weeks - 4 lbs. 12 ozs 5 lbs.3 ozs. (4) 35 weeks - 5 lbs 5 lbs. (5) 37 weeks - 5 lbs 5 lbs.4 ozs. (6) 34 weeks - 5 1 bs 5 lbs.4 ozs. (7) 36 weeks - 5 lbs 5 lbs.8 ozs. (8) 34 weeks - 3 lbs Still born (9) 36 weeks - 5 lbs 5 lbs. 8 ozs. (10) 36 weeks - 4 lbs. 12 ozs 4 lbs.4 ozs. (11). 36 weeks - 5 lbs 5 lbs. 8.-The number who received Gas and Air Analgesia 1,178 9.-The number of cases of P.P.H 31 (13 remained at home, 18 transferred Mayday) 10.-The number of cases of manual removal of the placenta None 11.-The number who received blood transfusion 6 12.-The number of cases to which the Emergency Obstetric Service was called 6 13.-The number of patients sent into Mayday Hospital: During the A.N. period 240 During and after delivery 28 14.-The number of cases of toxaemia of pregnancy treated at home 1 15.-The number of cases of prolonged labour (over 24 hours) 33 16.-The number of breech deliveries: In primipara 2 In multipara 3 17.-The number of twins delivered in their own homes and the weights of the babies 1 set 4 1 bs. 4 lbs.12 ozs. 18.-The number of triplets delivered in their own homes and the weights of the babies 1 set (all died) 14 ozs. 16 ozs. 16 ozs. 19.-The number of cases of Puerperal Pyrexia: Genital Extra-Genital 16 Total: 16 20.-The number of congenital malformations 9 52 Midwife Mileage Oeliveries Midwifery Maternity Gas and Air AnteNatal Visits PostNatal visits Bookings Office Bookings Home Visits Normal Abnormal Normal Abnormal Midwives Pupils Midwives Pupils 1 1695 - - - - - - 13 - 63 - - - - 2 Auto Cycl e 64 40 - 24 - 54 351 - 804 - 42 - 42 3 1937 53 45 1 5 2 46 180 16 799 94 79 - 52 4 Auto Cycl e 11 4 - 5 2 10 20 - 97 - - - 8 5 799 96 93 2 - 1 89 191 146 8 69 902 121 - - 6 3icycle 73 40 4 28 1 70 402 230 1186 162 64 - 73 7 587 89 70 5 11 3 82 562 275 1086 1046 125 - 57 8 Auto Cycle 102 81 2 17 2 89 299 171 826 896 100 - 73 9 3979 110 91 1 18 - 105 311 244 1305 1237 97 - 79 10 4312 88 87 - 1 - 85 451 - 1197 - 74 - 9 11 Auto Cycl e 65 39 3 20 3 62 4 27 - 778 - 60 - 36 12 355 25 9 - 16 - 21 120 - 470 - 40 - 4 13 17 79 102 100 2 - - 97 299 126 1276 1033 134 - 3 14 3649 99 74 - 23 2 95 4 33 170 957 876 109 - 53 15 5888 83 63 - 20 - 76 545 217 1264 1181 113 - 83 16 Bicycle 45 28 5 11 1 44 495 - 964 - 58 - 54 17 3957 83 55 - 27 1 79 462 262 956 126 2 114 - 32 18 3382 77 52 3 21 1 74 452 337 803 1155 128 - 81 Total 32319 1265 971 28 247 19 1178 6013 2197 15700 9844 1458 - 739 53 The following table gives the details of the reasons for Mid- wives summoning medical aid: - FOR COMPLICATIONS DURING PREGNANCY Abortion 8 Other Causes 17 25 FOR COMPLICATIONS DURING LABOUR Breech 3 Mal presentation — 4 Premature Labour 9 16 Delayed Labour 27 Haemorrhage Ante-partum 11 Post-partum 17 28 Other Causes Adherent and Retained Torn Perineum 117 Placenta 4 121 FOR COMPLICATIONS DURING PUERPERIUM Pyrexia 16 Pain in Breasts 6 Pain in Legs 6 Other Causes 19 47 FOR COMPLICATIONS IN REGARD TO THE BABY Inflammation of Eyes 29 Still Birth 4 Feebleness 3 Other Causes 37 73 337 In accordance with Rule 33 of The Central Midwives' Board the following reasons for the discontinuance of breast feeding were received:- Illness of Mother 50 Defects of lactation 247 Other causes 47 Total 344 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 71. 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. THE WORK OF THE HEALTH VISITORS Despite the fact that a Working Party, set up by the Minister of Health is at present considering the training and functions of Health Visitors, there have been notable developments in the scope of their work. The British Medical Association took the 54 initiative in suggesting the desirability of greater co-operation between general practitioners and the health visitors employed by local health authorities. This was cordially accepted by the Croydon division of the B.M.A. and the Local Medical Committee and a letter was therefore sent to all general practitioners in the borough drawing attention to these decisions and expressing the willingness of health visitors to assist individual practitioners in the care of their patients. The letter pointed out that all health visitors in Croydon were State Registered Nurses and also School Nurses and examples of their help might be supervising infant feeding, advising on nursing techniques or diets in cases where the attendance of the District Nurse was not required, giving information regarding a child's behaviour at school, advising the appropriate agency or voluntary organisation for solving a family's social difficulties, or reporting on patients after recovery from a serious illness when routine medical visits were no longer being paid. A booklet issued by the Women's Public Health Officers Association enlarging on the duties of health visitors was enclosed with the letter, together with a list of the health visitors' names and the areas of the borough which they serve. The letter concluded by inviting the doctors to contact the Superintendent Health Visitor, so that the district health visitor concerned could be asked to obtain his direct instructions, or to visit the family and report, as might be requested. This approach appears to have been helpful and there is a growing use of the health visitors by general practitioners. Co-operation which depends on personal contact and mutual confidence requires time for its proper development. We must show by action that our offers of assistance are not merely paper promises and on the whole, I think progress is reasonably satisfactory. A major difficulty is the relatively high frequency of change of staff as far as the health visitors are concerned, which does tend to impede the building-up of local co-operation in the areas of the borough affected. Now that physical diseases which kill or cripple children have been largely overcome, the importance of mental and emotional developments are becoming apparent. Health visitors have shown a keen realisation of their responsibilities in this field and a firm resolve to equip themselves with the necessary knowledge to develop such work. Considerable thought has been given to the best method of meeting this challenge and it was finally decided that "in service" training by group discussion methods was likely to be the most effective. In the connection, the advice of the Director of the Child Guidance Clinic was most helpful and it was possible to draw up a scheme in which members of his staff would assist, to commence operating in 1955. THE WORK OF THE HEALTH VISITORS - MATERNITY AND CHILD WELFARE VISITS ONLY, 1954 Visits Baker Left 31.5.54 Bird Black more Blest Chapman Left 12.9.54 E.M. Coll ins Com. 15.2.54 Devaney Early Eldridge Elliott Emms Com. 16.12.54 Gregg Com. 1.4.54 Griggs Hall Hawkins Com. 9.8.54 Hinton Left 17.10.54 Liang Com. 11.6.54 Left 30.7.54 | Llewellyn Lucey Mayo Com. 1.11.54 1 [ Morton 0 Brian Com.l.7.54 Left 30.11.54 Cartridge Pickering Railings Left 7.5.54 Poupard Com. 3.8.54 Thaisen Thompson Toneri Tripet Vince we 00 Left 31.1.54 waller Weston Left 31.3.54 Wilton Wybrew TOTAL, 19M TOTAL. 1953 Infants under l year - First Visits 33 101 55 98 142 87 169 72 171 168 6 116 151 60 69 35 22 114 119 14 100 70 99 133 59 59 116 128 97 189 117 - 74 50 139 179 3511 3699 Re-visits 88 549 544 531 416 182 525 846 614 508 8 411 611 301 203 615 75 657 599 180 386 354 245 826 120 370 481 571 78 1018 709 60 180 132 622 556 15,171 17,413 Children 1-2 years - First Visits 2 - 1 6 3 6 68 6 4 6 - 2 - - 2 - - - 4 5 11 10 3 - 8 2 - 5 1 4 - - - 1 - - 160 18* Re-visits 61 543 410 329 210 88 513 710 424 211 18 236 212 193 90 43 27 484 489 161 408 302 169 379 89 140 217 424 258 656 996 35 40 96 329 12 10.002 11.446 Children 2-5 years - First Visits 2 - 5 12 2 1 65 - 1 2 - 4 - - 7 - - 3 - 3 16 5 - - 13 4 - - - 5 - - 1 2 6 23 182 246 Re-visits 233 431 627 685 441 119 586 741 1029 273 27 419 655 381 228 361 72 612 658 178 502 328 330 686 158 310 323 640 349 1187 1312 60 203 195 587 949 17.075 20.506 Expectant Mothers - First Visits 12 1 47 17 10 - - 6 11 33 - 41 66 19 26 - - 31 45 3 27 39 19 15 16 34 9 21 6 129 24 3 9 - 44 54 817 869 Re-visits - - 17 3 1 - - 17 - 9 - 17 14 2 3 - - 30 - 7 3 - 3 31 1 22 6 19 1 93 1 1 - 1 1 5 308 245 Still Births - - 5 - - - - - - - - - - - - - - 1 - - - 1 - 1 - - - - - - 2 - - - - - 10 10 Deaths under l year - - 4 - - - - - - - - - - - - - - - - - - - 2 - - - 1 2 - 1 3 - 2 - - 15 22 Miscellaneous Visits 51 403 302 247 70 45 402 35 98 452 2 48 597 69 20 3 13 58 224 23 440 40 39 19 33 65 82 232 142 32 44 61 45 4 221 80 4,741 4,930 Ineffective Visits 66 435 441 302 363 275 387 419 111 236 18 369 336 222 244 86 116 291 266 85 578 329 177 543 111 237 239 287 282 136 258 29 107 154 231 411 9,177 10.832 TOTALS. 195*4 548 2463 24 58 2230 1658 803 2715 2852 2463 1898 79 1663 2842 1247 892 1143 325 2281 2404 659 2471 ,478 1086 2633 608 1243 1474 2329 1214 3450 3466 249 661 635 2180 2269 61.069 " 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 3995 1465 2925 2667 2749 - *70.402 'Including Health Visitors who left in 1953 Number of families or households visited during the year. 12.582 56 IMMUNISATION AGAINST DIPHTHERIA A total of 2,856 children came from the following sources:- Of these, 32 failed to return for completion of the course. School Children 302 Children under 5 2,554 Reinforcing injections are now being recommended, just before the child starts school, and again at 10 years of age, i.e. at about 5-yearly intervals. The number of such injections given during the year was 2,373. The ensuing comparative tables give some further details:- Year Chi ldren Compl eted Treatment Fai led to attend for complet i on of Course Reinforcing Inject ions 1939 1020 1201 - - 1940 428 419 - - 1941 6639 5833 - - 1942 6133 5511 - - 1943 5200 4854 - - 1944 2482 1851 - - 1 945 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 1954 2856 2824 32 2373 Origin and Source of Children attending School Pre-school Year Total Per cent Total Per cent 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 1954 302 10.6 2554 89.4 57 IMMUNISATION AGAINST WHOOPING COUGH A total of 2,545 children were immunised against whooping cough, comprising 2,474 under school age and 71 school children. 412 children were given reinforcing injections. VACCINATION AGAINST SMALL-POX A total of 2,003 persons were vaccinated against Small-pox. Under 1 year of age 1 2 - 4 5 - 14 15 or over Total Successful Vaccinations 1562 119 100 61 20 1862 " Re-vaccinations - 1 9 9 40 59 Insuscept ible to Vaccination 68 6 1 3 4 82 2003 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION Number of children at 31st December, 1954, who had completed a course of Immunisation at any time before that date (i.e. at any time since 1st January, 1940) Age at 31. 12.54 i.e. Born in Year Under 1 1954 1 - 4 1953 - 1950 5 - 9 1949 - 1945 10 - 14 1944 - 1940 Under 15 Total Last complete course of i nject ions (whether primary or booster A. 1950 — ' 1954 173 9,475 6,692 1, 856 18,196 B. 1949 or earl i er - - 8,260 13, 365 21,625 C. Estimated midyear child population 3,420 14, 080 36,700 54 , 200 Immunity Index 100 A/C 5. 06 67. 29 82. 21 73.47 58 AMBULANCE SERVICE To the Medical Officer of Health I submit the Thirteenth Annual Report of the Croydon Ambulance Service, for the year ended 31st December, 1954. During the year the Service was called upon to deal with 95,254 patients, which necessitated 43 , 358 journeys and a mileage of 421,684. This mileage shows an increase of 2.3% over that for 1953 (412, 178). The following vehicles were delivered during the year:- 1 Bedford Utilecon 1 Daimler Ambulance 1 Bedford 30 Seater coach for M.D. children and vehicles from this Service were disposed of as under:- 2 Albions (Ex R.A. P.) 1 Morris (Ex R.N.) 1 Armstrong Ambulance 2 Humber Hawk Sitting Case Cars Thus, with the exception of two Hillman Minx sitting-case cars and two Humber Pullman Ambulances which it is hoped will be replaced in 1955, the fleet of Ambulance Service Vehicles is relatively new, and in consequence the maintenance has not been quite the same problem as in previous years. Eighteen vehicles were fitted with radio-telephony in midyear, and after a period spent in familiarisation, has proved of inestimable value, with one incident clearly standing out as an illustration, i.e. the accident at Croydon Gas Works, Purley Way on 22nd November, 1954 when two men lost their lives due to fumes from the coke hoppers. On this occasion it was possible to direct 7 ambulances to the scene and for them to arrive in a matter of minutes, which could possibly have been of vital importance. But the various times in which radio-telephony has been useful in the re-direction of vehicles is too numerous to itemise, and it is sufficient to say that not only has it justified the expense of installation for the reasons quoted, but it is to be anticipated that a general overall saving in mileage, petrol, etc., will be the eventual outcome. Two members of this Service were presented with Royal Humane Society Certificates on the recommendation of the Police for their work of resuscitation on the case of coal-gas poisoning. 59 List of Serviceable Vehicles at 31st December, 1954 Six Humber Pullman Ambulances One Austin Ambulance Six Daimler Ambulances Two Bedford Sitting Case Vehicles Two Bedford Coaches (for Mental Defectives) Pour Bedford Utilecon Sitting Case Vehicles Two Hillman Minx Sitting Case Cars One Austin Breakdown Vehicle Classifications of Journeys, Patients and Mileage. Patients Journeys Mileage Health Service Removals 70, 822 36,551 357,999 Mental Defectives 20,046 819 24 , 204 Spastic Children (St.Margaret's) 921 396 3, 152 Accidents 3,465 3,312 16,560 Abortive - 267 1, 335 Occupational School Meals - 200 1, 800 Gas and Air Analgesia - 914 7, 649 Hospitals (Conveying Drs. etc.) - 306 3, 153 Parks (Conveying First Aid Equip - 28 261 Vehicles to Repair Depots, Testing etc. - 218 1,090 Service Requirements (Oxygen, visiting Sub-Stns, etc.) - 143 715 Pay Round - 52 624 95, 254 43, 206 418,542 Vehicles on Loan to Other Depts. Sanitary (PVB 793) 27 991 Civil Defence (DVB 344) 125 2, 151 TOTALS 95, 254 43,358 421,684 15,718 cases were conveyed to Hospitals, etc., outside the Borough boundary, and on these journeys 133,505 miles were travelled. It should be noted that on the Annual Report for 1953 the number of cases was appreciably less. This is due to classifying the round trip as one case and not two which has been done for 1954. 60 Classification of Accident Calls. Home Accidents (Children) 335 (Adults) 387 Miscellaneous Accidents (Children) 70 (Adults) 154 Recreational Accidents (Children) 53 (Adults) 71 School Accidents 177 Street Accidents (Children) 178 (Adults) 702 Work Accidents 320 Home Illness (Children) 32 (Adults) 168 Street Illness (Children) 12 (Adults) 508 Work Illness 66 Attempted Suicide 21 Suicide 15 Common Assault 43 3,312 CIVIL DEFENCE (Ambulance Section) The number of Volunteers available for training at 31st December was 291, composed of 198 females and 93 males. This figure shows an increase of 90 since my last Annual Report. An average of 130 Volunteers was maintained during each week of training. An intensive First Aid Course was given in January by the St. John Ambulance Association and in the following month an examination was held in which 53 Volunteers entered and I am pleased to say all passed. A new First Aid Course will shortly be starting in which 70 Volunteers will be taking part plus 16 who will be requalifying. The number of personnel under driving instruction is 12, and one of these will be taking the Driving Test on 3rd February. The number of qualified drivers is now 42. The number of Instructors is 12, an increase of 4, the number of Volunteers who have moved from the borough is 2, and the number of resignations is 4. A.L. HILL, Chief Officer 61 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, 50 cases were dealt with, 34 women, 12 men, 3 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 year the undermentioned loans were made:- Bed Pans 255 Bed Rests 177 Mackintosh Sheets 252 Feeding Cups 12 Wheel Chairs 24 Commodes 10 Crutches, pairs 2 Air Cushions 249 Bed Cradles 26 Urinals 93 Air Beds 11 Dunlopillo Mattresses 2 Bed Pulley 1 Bed Tables 2 Draw Sheets 79 DOMESTIC HELPS This service continued in great demand and an analysis of applications during the year shows the following percentages:- Maternity Cases 20.76 Sickness (including Tuberculosis 3. 89) 79 . 24 (l) Number of Home Helps - January 1st and December 3lst, 1954:- (a) Full-time 12 (b) Part-time 129 62 (2) Number of new applications:- (a) Maternity 4 33 (b) Sickness 969 (c) Sick Room Helpe 3 (y) Number of applications met:- (a) Maternity 267 (b) Tuberculosis 50 (c) Chronic Sick (including aged and infirm) 501 (d) Others (including sick room helpers) 468 (4) Number of cases attended during year 2135 (5) Average duration of services given:- (a) Maternity 12 days (b) Sickness (acute cases) 10-21 days (6) Amount recovered for services 4,972 (7) Rate of remuneration of "Helps" at 31.12.54 was 2s. 8¼d. per hour. HEALTH PROPAGANDA The general policy of concentrating on advice to mothers by doctors, health visitors and home nurses was continued. Copies of "Better Health" were distributed as in the past at Infant Welfare Clinics and elsewhere. Poster sites continued to show the Central Council for Health Education posters. The question of education to promote the early treatment of cancer was reconsidered, bearing in mind the decision of the Health Committee that only in regard to certain types of cancer was such propaganda likely to be effective. Accordingly, all the Women's organisations in the borough were again approached and asked if they would accept a lecture to their members on "What We can do about Cancer" . This would have been a repetition of the lecture given by Mr. Donaldson, to selected members of all the women's organisations in Croydon. A negative result was achieved, except three replies indicating that members might attend a lecture arranged centrally, or for some other society. An arrangement was made therefore, to repeat this lecture during 1955 at the Health Department and all women's organisations were so informed. As a matter of interest, when it was held in March 1955, eight ladies only attended. 63 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 Clerk. 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 0.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 13 mental defectives placed under guardianship in Brighton, by the Guardianship Society. Work carried out in the Community. On the recommendation of the Medical Staff of Warlingham Park Hospital, the Corporation accept financial responsibility for patients to stay at approved homes conducted by the Cental After Care Association and three 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 1954, are as follows:- (a) Certified and admitted to Warlingham Park Hospital 75 (b) Admitted to Warlingham Park Hospital as voluntary patients 46 (c) Removed to Mayday Hospital under Detention Order 423 (d) Admitted to Warlingham Park Hospital as temporary patients - (e) Investigated and no action taken 136 (f) Urgency Orders 680 64 Under the Mental Deficiency Act. Number of known Mentally Defective Patients in the Borough:- 2953 1954 Under 5 years 45 64 Aged 5-16 years 108 120 Over 16 years 567 550 Total 720 734 Compared with 1953 the cases show an increase of 14. 4 Institution patients have died in hospital. The cases are distributed as follows:- In Certified Institutions 305 In Approved Homes 4 On Licence from Institutions 35 Under Statutory supervision at home 291 Under Guardianship 58 In Mental Hospitals 11 Observation cases 30 In "Place of Safety" - 734 During the year the Certifying Medical Officers made examinations and paid visits to the number of 100 cases. The Mental Deficiency Visitors paid 3,911 visits. 24 new cases were examined during 1954 and certified as mentally defective. 10 of these cases were recommended for the Occupation Centre and 10 were placed under statutory supervision. 4 were recommended for institutional care. During 1954, 26 cases were dealt with as follows:- 1953 1954 Sent to Certified Institutions 18 15 Placed under Guardianship 1 - Sent to Warlingham Park Hospital 1 1 Varying Orders: (a) Change of Guardian 2 2 (b) From one Institution to another 4 - (c) Prom Guardianship to Institution 2 1 (d) Institution to Guardianship 1 - (e) Orders closed 4 7 65 36 Orders were renewed during the year, 18 of which were Guardianship. 28 children were admitted to the Occupation Centre during 1954. 13 left or were excluded. There were 17 cases awaiting vacancies in Institutions on the 31st December, 1954. There were 58 cases under Statutory Guardianship, 30 of these under the care of relatives, and 28 with Guardians who are not relatives. 4 males are at work. 533 visits have been paid to Guardianship cases during the year. There are 30 cases on licence from Institutions (10 males and 20 females). Report on the Occupation Centre, January-December, 1954. Number on Register, January 58 '' " " December 66 Number of Admissions 21 Number left or excluded 13 Average attendance per session 54 Times open, Morning-Afternoon 403 Total attendance for year 21,752 I am indebted to Miss Cooney, supervisor of the Occupation Centre, for the following report:- "The patients attending the Centre are divided into groups according to age and ability, i.e. Nursery - Intermediate Adult Male and Female. In January 1954 the Centre opened with 58 patients on roll. At the end of December the number was 66. In January the patients and staff attended a Party given by the N. A. P. B. C. Miss Gavin, Inspector - Board of Control, visited the Centre in April for routine inspection. The N.A. P.B.C. gave the patients an outing in June to Sunbury Court. The Annual Sale of Work was held at the beginning of December. Proceeds from the Sale amounted to £32.0.0. The sales for the year amounted to £51.4.1. The Christmas Party took place on December 21st with the usual Tree, Tea and Presents. 48 Students visited the Centre during the year" . 66 SANITARY CIRCUMSTANCES I beg to submit a report for the year ending 31st December, 1954, of the work of the Sanitary Inspectors and other officers under my control. On the 1st July the Ministry of Food ceased to control the slaughtering of animals and the distribution of butchers' meat, but no difficulty was experienced locally in maintaining a fresh meat supply as arrangements had already been made for slaughtering to continue at the Public Abattoir. The Council and the "trade" co-operated to such good effect that supplies of freshly killed meat were readily available and were in fact on sale from a newly established Market, within the Abattoir, immediately after the Ministry control ceased. One cannot leave this subject of meat supplies without complimenting the firms controlling the various wholesale meat markets in the Borough on the speed and efficiency of their re-establishment. These changes put much extra work on the Department but one felt the results were well worth the extra time and effort involved. On the 31st August the Housing Repairs and Rents Act came into operation and this necessitated a survey, by my staff, of some thousands of houses in the Borough with a view to determining the number to be included in a return, to be sent to the Minister of Housing and Local Government, of unfit properties suitable for clearance. Another part of this Act dealt with the granting of certificates of disrepair, the inspections for which had to be made by the Sanitary Inspectors. Up to the end of the year 210 had been applied for, of which 172 were issued. In spite of the above "extra" duties it will be seen from the body of the report that there has been little diminution in the amount and variety of work undertaken by the staff in matters of environmental health and I take this opportunity to thank them for the loyal and conscientious assistance they have given me during the year under review. GEO. GRIEVE, Chief Sanitary Inspector. 67 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 3,926 Houses inspected where zymotic diseases have occurred 259 " " following applications for certificates of disrepair 210 Inspections of underground rooms 17 Special inspections in connection with the Housing Survey 2,227 Houses inspected for overcrowding conditions 135 Reinspections of work outstanding on housing notices 10,236 Number of visits regarding infectious diseases 1,265 ,, ,,food poisoning 816 Inspections of drainage work during repair 3,400 House drains tested with smoke and colour - routine and complaint 1.934 House drains tested with smoke (on written application) 15 House drains tested with smoke during repair 160 " " "" " " water during repair 120 Inspections of cesspools and earth closets 45 " " " schools and school sanitary conveniences 59 " " " 11 public conveniences 172 " " " verminous premises 112 " " " ponds and ditches 95 " " " yards, stables and passages 310 " " " theatres, cinemas, halls etc. 142 " " " pig styes 104 " " " tents, vans and similar structures 77 " " " knackers yards 25 Visits regarding smoke abatement 1,481 Inspections of swimming baths 17 " " " wells 1 " " " gathering grounds of water supply 11 " " gipsy encampments, camps, fairs etc 93 " " " offices 16 " » " rivers and streams for pollutions 351 Food and Drugs Acts: food and drugs samples taken 333 " " " milk samples taken 297 Milk (Special Designations) Orders: samples taken 349 Ice cream samples takerr 231 Samples taken of fertilisers and feeding stuffs 9 " " " swimming baths water 42 " " " " drinking water 287 " " " subsoil water 26 " " " from rivers, streams etc 35 " " " of rag flock and other filling materials 17 " " " sundry specimens (food poisoning etc.) 29 Inspections of butchers premises 769 " " " meat premises (wholesale) 1,023 " " " horseflesh premises 16 poultry and game dealers premises 330 " " " fishmongers premises 185 " " " fried fish premises 71 " " " grocers premises 1,287 " " " fruiterers and greengrocers premises " " " bakers premises - including bakehouses 322 " " " dairies 54 " " " milk shops 40 " " " general shops and their premises 25 " " " premises where cooked meats etc. are prepared 61 or sold " " " confectioners premises 264 " " " confectionery manufacturers premises 31 68 Inspections of cafes, snack bars, canteens, hotels and their kitchens 629 " " " school kitchens and serveries 139 " " " hospital kitchens21 " " " ice cream manufacturers premises 49 " " " vendors premises " " " " " barrows and carts 13 " " " markets (day inspections) 84 " " " " (weekend inspections) 50 " " " barrows, other than in markets 160 " " " imported foods at Aerodromes 10 " " " other food premises not enumerated above 109 " " " premises where offensive trades are conducted 20 " " " factories with mechanical power 600 " " " " " without mechanical power " " " works of building and engineering " " outworkers premises 179 Visits to employers of outworkers Inspections of shops (under Shops Acts) 1,361 Special early closing, evening and Sunday trading patrols of shops 889 Appointments kept with owners, builders etc 3,052 Investigation of complaints other than housing matters 1,671 Re inspect ions of works outstanding (other than houses) 6,499 Inspections under Fertilisers and Feeding Stuffs Act 12 " " " " Merchandise Marks Act 327 " " "Pets Act 49 " " " " Rag Flock and Other Filling Materials Act 46 " " " " Pharmacy and Poisons Act 124 Sundry inspections and visits 3.549 Visits regarding rats and mice infestations 9.169 Informal Notices outstanding 31.12.53 1,355 " " " served 3,179 " " " " complied 2,999 Number of Informal Notices referred for Statutory Orders 352 Informal Notices outstanding 31.12.54 1,183 Statutory Notices outstanding 31.12.53 " " " " served 756 " " " " complied 787 " " " " outstanding 31.12.54 299 Total number of callers and complaints received at the office 6,817 Total number of letters received at the office 6,510 Nuisances, Infringements of Acts, Byelaws, Regulations or Orders, ascertained by the Sanitary Inspectors during the year 1954 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 386 Conditions causing dampness: Defective roofs 578 Defective window frames 380 Defective walls, etc 539 Want of efficient damp-proof course Defective gutters and downspouts 437 Other structural defects: Defective plaster 490 Cleansing and re-decoration required 138 Defective floors and stairs 298 Insufficient ventilation under floor 93 Defective brickwork, sills, lintels, chimneys 252 Defective stoves and fireplaces and flues 116 69 Defective drains, sanitary fittings, etc.: Defective sinks and waste pipes 145 Defective w.c.s 330 Defective drainage 309 Stoppages in drains 240 Defective water services and tanks 48 Domestic nuisances: Want of cleanliness Verminous conditions 27 Other nuisances and infringements: Offensive accumulations 60 Overcrowding 48 Sundry nuisances or defects 264 Particulars not inserted in Rent Book (Housing Act) 38 (2) INFRINGEMENTS OF CROYDON CORPORATION ACT, 1924 Food cupboards defective or required 24 (3) INFRINGEMENTS OF FOOD AND DRUGS ACT, 1938, AND FOOD BYELAWS Structural defects in shops and stores 85 Cleansing or repair of walls and ceilings 195 Cleansing or repair of floors, utensils, fixtures, etc. 115 Insufficient or defective sink accommodation and water supply 19 Insufficient lighting or ventilation 7 Defective drainage 38 W.C. accom. - Insufficient 17 " " Repair or cleansing required 42 " " " Artificial light required 8 " " Want of intervening ventilated space 7 Cloakroom accommodation required or defective 7 Overalls required or dirty 10 Ablutions - Wash basins required 28 " " Hot water supplies required 52 " " Soap and towels required 14 Food improperly stored 68 Food store - Required or defective 25 " " Animals kept in 5 Accumulation in yards or stores 17 Offal and refuse bins uncovered or defective 31 Yard paving defective 18 Vehicles - dirty or defective 8 (4) INFRINGEMENTS OF PUBLIC HEALTH ACT, PAVING. Etc. Defective Yard Paving 95 Want of a sanitary dustbin 95 Public Urinal s - defective or dirty 11 (5) INSPECTION OF AMUSEMENT HOUSES Defective sanitary fittings 6 W.C. defective and dirty 10 (6) KEEPING OF ANIMALS Nuisances arising from the keeping of animals 5 (7) SMOKE ABATEMENT Nuisances observed 12 70 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) 3,926 (b) Number of inspections and re-inspections made for the purposem, 162 (2) (a) Number of dwelling houses included under the sub-head (1) above, which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 (b) Number of inspections made for the purpose (3) Number of houses found to be in a state so dangerous and injurious to health as to be unfit for human habitation (u) 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 2,171 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 2,094 III.- Action under Statutory Powers during the year:- A.-Proceedi ngs under Sections 9,10 arid 16 of the Housing Act, 1936:- (1) Number of dwelling houses in respect of which notices were served during the year requiring repai rs 3 18 (2) Number of dwelling houses which were rendered fit after service of formal notices- (a) By owners 316 (b) By local authority in default of owners 56 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 373 (2) Number of dwelling houses in which defects were remedied after service of formal notices- (a) By owners 182 (b) By local authority in default of owners 169 71 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 3 (2) Number of dwelling houses demolished in suance of Demolition Orders D.-Proceedings under Section 12 of the Housing Act,1936:- (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 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 E.-Proceedings under Section 10 of the Local Government (Miscellaneous Provisions) Act 1953:- (l) Number of dwelling houses in respect of which Closing orders were made 1 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 11s.6d. per week, and 1s.9d. per night or 8s. per week for Old Age Pensioners. Cooking facilities are provided. Hot baths may be taken any time after 9 a.m. Clothes may be washed and dried in the wash-house provided. The average number of nightly lettings during the year was 98, and the number accommodated during the year 35.780. year 35,780. The receipts and expenditure for the past 5 years have been as follows: - Receipts Expenditure £ s. d. £ s. d. 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 1954 2,584 0 0 4, 142 0 0 Houses - Sanitary Certificates House drains and sanitary fittings are tested and examined on request, at a fee. During the year 15 such requests were made. 72 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 Not ices Prosecutions Factories:- With Mechanical Power 600 89 _ Without Mechanical Power 78 15 - Other Premises 78 4 - Outworkers and Employers of outworkers 207 1 - Total 963 109 _ Defects Found Particulars Number of Defects Referred to H.M. Inspector Prosecutions Found Remed ied Want of Cleanliness 24 21 - - Overcrowding - - - - Unreasonable Temperature - - - - Inadequate Ventilation 3 3 - - Ineffective Drainage of Floors - - - - Sanitary Conveniences (a) Insufficient 15 14 - - (b) unsuitable or Defective 40 35 - - (c) Not Separate for Sexes - - - - Other offences against the Act (not including offences relating to Outworkers) 50 45 1 - Total 132 118 1 - 73 Home Work Lists of home workers, or outworkers as they are termed, are sent in twice yearly, and this year contained the names of 126 workers resident in the Borough. 179 visits were paid to outworkers. Nature of Fmployment of Outworkers on the Register, 31st December, 1954 Nature of Work Number Employed Outwork in Infected Premises Outwork in unsatis factory Premises Remarks Making, Cleaning, Altering and Repairing Wearing Apparel 87 - - - Upholstery Work - - - - Other Classes of Work 39 - - - Total 126 - - - Inspection of Schools These are inspected with particular reference to sanitary accommodation including washing facilities. During the year 59 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. 1,361 inspections were made under the Shops Acts, and the infringements found were as follows:- Hours of Closing 25 Hours of employment of staff 1 Provision of means of heating 12 Insufficient W.C. accommodation 6 Want of washing facilities 3 74 Defective W.C. accommodation 12 Defective walls, floors, ceiling, etc. 10 Defective and insufficient lighting 7 Want of seating accommodation 6 Notices to be exhibited or amended 286 DRAINAGE During the year there was no lessening of work in this branch of the department's duties. Some 3,400 visits of inspection were made to underground drains in course of repair. Of 373 Statutory Orders served, 169 had to be done in default of the owners. 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 446 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 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. 73 such observations were carried out and in 12 instances black smoke was emitted for more than the statutory limit. The Managements were immediately interviewed and informed of the offence and advised. In two cases it became necessary to serve Statutory notices to abate smoke nuisances. 75 AMUSEMENT HOUSES 142 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 9,372 articles " Formalin Gas 6,796 " " " Spray 1,034 Total 17,202 In addition, 777 articles were destroyed on request. During the year the disinfection of bedding following cases of scarlet fever was discontinued. Disinfection of bedding and upholstered articles is carried out for traders, who deliver them to, and collect them from, the Station. For this service a charge is made. During 1954, 676 articles were disinfected, the receipts amounting to 02. 11. 9d. Disinfection was carried out after infectious or contagious disease at the following premises:- 1,462 rooms at 764 houses, hospital wards, clinics and creches. 1,261 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 2 adults and 45 children were cleansed of verminous conditions and 4 adults and 4 children were treated for scabies. 76 DISINFESTATION OF PREMISES The new insecticides have provided a ready and easily appplied remedy for vermin and pest infestation of premises,and occupiers are advised and instructed in their use by the Inspectors. The department assists in the more difficult cases either by spraying or fumigation. PHARMACY AND POISONS ACT, 1933 The object is to regulate the sale of certain poisonous substances and the Act contains important provisions. During the year the number of applications granted for entry of names on the list of persons entitled to sell poisons under Part 2 of the Act was 17. In addition, 292 applications were made for the retention of names on the list for a further period of 12 months. 8 infringements of the Act were found. FERTILISERS AND FEEDING STUFFS ACT, 1926 12 inspections of premises where fertilisers and feeding stuffs were sold, were carried out during 1954. During the year the undermentioned samples were taken: - Fertilisers 6 Feeding Stuffs 3 These were all reported on as complying 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 1954, 17 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 Black Flock 2 Washed Flock 8 Cotton Felt 2 Woollen Mixture Felt ... 2 Cotton Millpuff ] Kapok 1 Coir Fibre 1 77 PET ANIMALS ACT, 1951 16 premises were licensed for the purpose of keeping Pet Shops. During the year 49 inspections were made and there were no infringements of the conditions, specified in the licences. DISEASES OF ANIMALS ACTS Suspected swine fever was notified from 3 premises during the year. These and 1 notified from the slaughterhouses were confirmed and appropriate action was taken in conjunction with the Officers of the Ministry of Agriculture and Fisheries to provide against the spread of the disease. 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. 2 ratcatchers, officially designated rodent operatives, are employed to deal with such complaints. During the year, 1,537 private dwellings were inspected following complaints and in 982 instances infestation was confirmed and dealt with by the rodent operatives. In 47 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. 123 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. 33 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. 78 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 3,350 premises in the Borough at which food is known to be sold, manufactured or stored:- Bakehouses 66 Bakers Shops 115 Sugar Confectioners 539 Cafes, Restaurants, Snack Bars and Eating Houses and Kitchens 476 Works and Club Canteens 256 Public Houses 152 Off Licences 65 Grocers 626 Butchers 204 Chemists 86 Greengrocers 361 Fishmongers 88 Fried Fish Shops 49 Milk Distributors and Dairies 70 Premises from which Roundsmen and Mobile Shops operate 32 Stalls in Markets 92 Food Manufactories 22 Other food premises not enumerated above 51 3, 350 Of the abow premises 813 are registered under Section 14 of the Food and Drugs Act, as follows:- Retail sale of ice-cream 614 Manufacturers of ice-cream 5 Preparation or manufacture for sale of sausages, or potted, pressed, pickled or preserved food 191 The following table gives a summary of the inspections made during the year, not including visits made to slaughterhouses or dairies: - Butchers 1 , 808 Ice-Cream Vendors Bakers and Bakehouses 322 and Manufacturers ... 335 Confectioners 295 Greengrocers 238 Fishmongers 185 Grocers 1,287 Pried Fish Shops 71 Stalls and Rounds other Poultry and Game than in Markets 160 Dealers 330 Catering Establishments 1,311 Cooked Meat General Shops 25 tion Premises 61 Miscellaneous 109 6,537 79 In addition to the above, Croydon Airport was visited on 10 occasions to inspect foodstuffs arriving by air from the Continent. Such foodstuffs included Kosher Sausage, GoudaCheese, Butter and Delicacies. It was not found necessary to condemn any article. General Summary of meat and other articles of food found to be unfit and condemned by the Inspectors during 1954:- Art icles Weight in lbs. Diseased Unsound Total Beef 25826 3696 29 5 2 2 Veal 3 11 - 311 Mutton 200 5 161 2169 Pork 9983 288 10271 Offal 46275 203 16178 Sundry Foodstuffs – 11105 11105 Canned, bottled anc packeted goods – 11109 11109 81103 56565 110968 Disposal of Condemned Foodstuffs The Meat was condemned at either the Public Abattoir, Wholesale Meat Depots or at shops supplied therefrom and was disposed of by the Corporation. Some of the condemned foods are processed for industrial use and the remainder are destroyed. 80 MEAT INSPECTION During the year the Ministry of Pood ceased to control the slaughter of livestock for human consumption. Parliament decreed that Local Authorities should satisfy themselves that sufficient slaughtering facilities were made available for the use of traders to maintain a supply of fresh meat. The Corporation after consultation with the trade leased the Public Abattoirs to Contractors whom they, and the trade, considered were best able to supply the needs of the Borough in the way of freshly killed meat. During the year there has been an increase in the number of animals slaughtered of 40% over the 1953 figure. A 100% inspection has been maintained by the Corporation Meat Inspectors of the following: - Cattle excluding Cows 5, 774 Cows 831 Calves 1,646 Sheep and Lambs 16,491 Goats 106 Pigs 13, 810 Total 38,658 The result of these inspections was as follows:CARCASES INSPECTED AND CONDEMNED Cattle exclud ing Cows Cows Calves Sheep and Lambs Pigs Goats Number killed 5,774 831 1,646 16,491 13,810 106 Number inspected 5,774 831 1,646 16, 491 13,810 106 A11 Di seases except Tuberculosi s Whole carcases condemned NIL 5 2 7 57 NIL Carcases of which some part or organ was condemned 2,061 267 4 1.322 784 NIL Percentage of the number inspected affected with d i seases other than Tuberculosi s 35.7 32.73 .36 8.06 6.1 NIL Tuberculosi s only Whole carcases condemned 13 8 NIL NIL 1 NIL Carcases of which some part or organ was condemned 331 163 NIL NIL 235 NIL Percentage inspected affected with Tuberculosi s 5.9 20.57 NIL NIL 1.7 NIL 81 The District Sanitary Inspectors, all qualified Meat Inspectors, inspect meat at the 7 wholesale Meat Depots in the Borough, as well as that exposed for sale in the butcher's shops. MILK SUPPLY During the year 94 inspections were made of dairies and milkshops. Milk and Dairies Regulations, 1940 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 Licences to use the designation "Sterilised "- Dealers' Licences 97 Dealers' Supplementary Licences to use the designation - (a) Tuberculin Tested 8 (b) Sterilised 8 (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. Oactcriological Examinations of Milk During the year the following samples of milk were examined:- Tuberculin-Tested Milk 12 Tuberculin-Tested Pasteurised Milk 26 Pasteurised Milk 307 Sterilised Milk 4 The following table summarises the results of the bacteriological examinations of Tuberculin Tested, Pasteurised and Sterilised milk samples during the year:- Tubercu/in- Tested Mi Ik Methylene Blue Test No. Samples Taken NOt Sat i sf i ed 3atisfied 12 1 11 82 Tubercu / in -Tes ted Pasteurised Milk Methylene Blue Test Phosphatase Test No. Samples Taken Not Satisfied Satisfied Not Satisfiec Satisfied 26 – 26 – 26 Pasteurised Milk No. Samples Taken Methylene Blue Test Phosphatase Test Not Satisfied Satisfied Not Satisfied Satisfied 307 1 306 4 303 Steril ised Milk No. Samples Taken Turbidity Test Not Satisfied fied 4 NIL 4 BACTERIOLOGICAL EXAMINATIONS OF ICE CREAM 231 samples were taken, the results being as under:- Grade No. of Samples 1 181 2 34 3 8 4 8 Out of a total of 231 samples taken, 16 (6.9 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 9 samples were taken from local manufacturers and were found to comply with the standard. • 83 FOOD AND DRUGS ACT, 1938 During the year 297 samples of milk and 333 other samples were taken. Summary of Samples During 1954 samples were obtained and submitted to the Public Analyst as follows:- Samples of Total Samples Genuine Not Senuint Prosecutions Convictions Ammoniated Tine, of Quinine 1 _ 1 — - Apricots, tinned Arti ficial Colour 5 5 - - - 1 1 - - - Aspro 1 1 - - - Beans, baked i n Tom. Sauce 5 5 — - - Beer Q 9 — - — Bicarbonate of Soda 1 1 - - - Biscuits 3 3 — — - Blackcurrants, tinned 1 1 - - - Black Pudding 1 1 - - - Blancmange Powder 1 1 - - - Bread 8 7 1 - — Bread Crumbs 2 2 - - - Bread rolls 1 i - - - Brawn 1 1 - — - Butter 5 u 1 - - Cakes 6 6 - — - Cake and Pudding Mixture 3 3 - - - Calamine Lotion B.P. 1 — 1 - - Camphorated Oil 1 l - - - Castor Oil 1 l - — — Cheese tt u - - - Cheese Straws 1 1 - — - Chemical Food B.P. 1 - 1 - - Cherries, tinned 2 2 - - - Chicken Rissoles 1 1 — - - Chocolate drink 2 2 - - - Cinnamon Tablets 1 1 - - - Cocoa 2 2 - — — Coconut - desiccated 2 2 - - - Cod Liver Oil Capsules 1 - 1 - - Cod 1 iver Oil Emulsion 1 1 — - - Coffee-ground 3 3 - - - Coffee and Chicory essence 2 2 — — - Cooking fat 3 3 - - - Cooking fat - Vegetarian 2 2 - - — Cordial 5 5 — — — Cornflakes 1 1 - - - Cream 4 4 — — — Cream - tinned 1 1 - - - Crab - dressed 1 1 - - - Currants 2 2 - — — Custard Powder 3 3 - - - Dessert Powder 1 1 - — — Dessert Caramel 1 1 - - - Dripping 2 2 - — — Essences - Flavouring 3 3 — — — (cont i nued on next page) 84 Samples of Total Samples Genuine Not Genuine Prosecut ions Convic t ions Farinoca 1 1 _ _ _ Fat-compound 1 1 - - - Fish cakes 2 2 — — - Flour, self-raising 3 3 - - - Gees Linctus 2 2 — — - Gin 7 7 - — - G1 auber Sal ts 1 1 - - - Grapefruit, tinned 1 1 - - - Gravy Powder 1 1 — — - Ground Nut Oil 1 1 — — - Hal i but Oi 1 Capsul es 1 1 - - - Hog Fat 1 1 - - - Honey 1 1 - — - Ice Cream 10 10 — — — Ice Lolly 9 9 - - - Ice Lolly, milk and cream Iodine, resubl imed 3 3 - - - 1 1 - - - Iodine, Tincture of 1 1 — — - Ketchup, tomato 1 1 - - - Lard 1 1 — - - Lemonade Powder 1 1 — — - Liquid paraffin 1 1 - - - Loganberries, tinned 1 1 - - - Luncheon meat 6 6 — - - Macaroni 1 1 - - - Margarine 4 4 - - - Margarine with butter 2 2 — - - Marmal ade 5 4 1 - - Marzipan 2 2 - - - Meat, raw 1 1 - — - Milk 294 272 22 - - Milk, Channel Island 3 3 — — - Milk, evaporated 1 1 - - - Mustard, French 1 1 - - - Mustard, mixture 1 1 - - - Olives 1 1 — - — 01ive Oi1 1 1 - - - Oranges 4 4 - - - Orange Drink 2 2 — — - Paste, fish 2 2 — — — Paste, meat 4 4 — - - Peaches, sliced, tinned 1 1 - - - Peanuts 4 4 - - - Peas, tinned Peel 2 2 — - - 1 1 - - - Pepper 2 2 - - - Pickles 3 3 - — - Pilchards, tinned 2 2 - - - Pineapple, tinned 3 2 1 - - Pineapple, Preserve 1 1 — — - Port 1 — 1 1 1 Rennet, essence 1 1 - - . - Rice 2 2 - - - Rhubarb, tinned 1 1 - - - Rum 6 6 - - - Sago 1 1 - - - Sauce 2 2 — — - Saveloys 1 1 - - - Sausage, beef 6 6 - - - Sausage, pork 15 12 3 1 1 Sausage Meat, beef 1 1 - – — (continued on next page) 85 Samples of Total Samples Genuine Not Genuine Prosecutions Convic t ions Sausage Meat, pork 1 1 — — _ Semol i na 1 1 — — — Soup, cream 2 2 - - — Soya Flour 1 — 1 1 1 Spice, pickling 1 1 - — — Sponge mixture 4 4 - - - Steak and gravy, tinned 1 - 1 — - Steak pudding 1 - 1 — - Stomach Powder 1 1 - - - Strawberries in Syrup 1 — 1 — — Suet, beef, shredded 3 2 1 — — Sugar 2 2 - - - Sugar, demerara 3 3 — — — SuTphur oi ntment 1 1 - - - Sultanas 1 1 - - - Sweets 20 20 - - — Tea 5 5 - - — Tomatoes, tinned 1 1 - - - Tomato Juice, tinned 3 1 2 - - Tongue 1 1 - - - Tuna, tinned 1 1 — — — Veal and egg loaf 1 1 - - - Vinegar 1 1 - — - Vitamin A Capsules 1 1 — — — Walnuts, pickled 1 1 — — — Whisky 9 9 - - - Wine 5 5 — — — Witch Hazel 1 1 - - - Yeast Extract 1 1 - — - Yoghourt 1 1 - - - Zinc Ointment 1 1 - — — 630 589 41 3 3_ 86 Result of Analysis of Milk Samples Solids not Fat (Legal standard is S.rfhl 8.11 1 8. 12 1 8. 18 1 8.21 1 8. 29 I 8. 32 1 8.33 1 8.34 1 8.37 1 8. 38 1 8.41 1 8.45 1 8.47 1 8.5 32 8.6 46 8.7 66 8. 8 78 8.9 44 9.0 12 9.1 3 Milk Fat (Legal standard is -f-l 2.53 1 2. 60 1 3.1 6 3. 2 20 3.3 41 3.4 59 3. 5 38 3.6 50 3. 7 35 3.8 27 3. 9 12 4.0 3 4.1 1 (Excluding South Devon and Channel Islands milks) South Devon and Channel Islands Milks Solids not Fat (Legal standard is S.ffi) 8. 8 2 9. 1 1 Milk Fat (Legal standard is /fh) 4. 7 2 5.0 1 Average composition of Milk Samples Milk (excluding South Devon and Channel Island Milks) Solids not Fat 8.72 Milk Pat 3.58 South Devon and Channel Island Milk Solids not Pat 8.9 MilkFat 4.8 Total number Milk Samples 297 87 The samples of milk for analysis were obtained as follows: Taken on Milk Rounds 210 " at Dairies 63 " at Institutions 18 '' at Local Farms 4 " at Schools 2 297 DETAILS OF NON-GENUINE SAMPLES TAKEN Article Nature of Adulteration or Deficiency Remarks Ammoniated Tine, of Quinine Contained only 0.65? W/V of ammonia whereas the B.P. Codex for the ammonia content in ammoniated tine, of quinine is 0.90 to 1.05? W/V. The sample was deficient in ammonia to the extent of 28*. Remainder of stock withdrawn from sale. Bread Consisted of bread contaminated with carbonaceous matter. Producer advised regarding improvement of baking methods. Butter Contained 16.5$ of water whereas the maximum proportion permitted is 16.0$. Packers requested to take necessary measures to prevent recurrence. Calamine Lotion B.P. The composition of calamine lotion has been altered in the current B.P. so as to include proportions of Bentomite and Liquified Phenol. This article was not of the substance or quality prescribed by the B.P. The composi tion of th i s art i cle indicated that it had been prepared to the formula for calamine lotion gi\en in the B. P. 1948. The article being from old stock the Retailer's attention was drawn to the circumstance and the stock was withdrawn from sale. Chemical Food B.P. The current B.P. (1953) does not include Chemical Food and this article was not correctly described as B.P. It was found that the article was from old stock and the retailer's attention was drawn to thi s ci rcumstance. Cod Liver Oil Capsul es 33$ deficient in Vit. A of the amount claimed on the label. Manufacturers i nformed. Exhaustive enqui ries failed to account for deficiency. No further stock avai 1 abl e. 88 Art ic/e Nature of Adutteration or Remarks Deficiency Marmal ade frui t) (Grape- Contents had a distinct metallic Consignment was taste particularly where the surrendered and marmalade was close to the metal destroyed of the can. Can considerably blown. Milk Sample No 527 1% deficient in milk solids other than milk fat. Hortvet tests showed these " " 528 " " " " " were apparently natural deficiencies:- " " 534 " " " " " subsequent samples " " 536 UJ deficient in milk solids 1 other than mi 1k fat. proved satisfactory. " " 485 Contained 5% of added water. Full investigations have been made. Samples taken in course of del ivery to the vendor, and subsequent samples have been found genu i ne. " " 592 Contained 4% of added water. The freezing point conf i rmed the presence of added water. Further samples were taken and found to be sat i sfactory. " " 324 1% deficient in milk solids other than milk fat. The freezing point was consi stent with but did not necessarily indicate the presence of a small proportion of added water. " " 5/2 2% deficient in milk solids other than milk fat. II N II " " 5/4 Slightly deficient in milk solids other than milk fat. The freezing point did not indicate the presence of added water. " " 5/7 1? deficient in milk solids other than milk fat. The freezing point was consistent with but did not necessari ly indicate the presence of a smal 1 proportion of added water. " " 336 31 deficient in milk solids other than milk fat. The freezing point did not necessarily indicate the presence of added water In all the above instances the distributors were informed and requested to check their supplies. Further samples taken were found to be satisfactory. 89 Article Nature of Adu/teration or Defic iency ks Milk (cont. ) Sample No. 9 13$ deficient in milk fat and ?$ deficient in milk solids other than fat. Freezi ng po i nt did no t indicate the These samples were part of a consignment. The average mil k fats and sol ids of the consignment was wi thi n the legal standards. " " 10 Slightly deficient in milk solids other than milk fat. " "12 15? deficient in milk fat and 2$ deficient in mi 1k solids other than fat. presence of added water " " 160 Contained in an unclean bottle The vendor was given an official warni ng. " " 161 it it n it tt it n " " 162 it ti it it n tt ii " " 164 ii n ii ii ii ii n " " 166 ii ii ii ii ii ii ii " " 168 Contained in an unclean bottle and the milk was contaminated with dried up milk residue mould growth and green al qal growth. " " 169 Contained in an unclean bottle " " 170 and the milk was contaminated with dried up milk residue and mould growth. Pi neapple, si i ces Not of ordinary commercial quality both slices and syrup being abnormally dark in colour. The stock from which this sampl e was taken was examined, the contents of al 1 other tins examined were found to be of a normal composition. The Importer's attehtion was drawn to the circumstance. Port Consisted of water coloured with caramel. Vendor prosecuted Conviction recorded but Court of the opinion "that it is inexpedient to i nfl i ct puni shment". Sausage, Pork Contained only 30? of meat instead of a minimum of 65$. Manufacturers prosecuted - convicted and fined £2. Sausage, Pork (Preserved) Contained only 55$ of meat instead of a minimum of 65$, and contained 560 ppm of sulphur dioxide instead of a maximum of 450 ppm. Vendor warned Sausage, Pork (Preserved) Contained only 60$ of meat instead of a maximum of 65$. Vendor warned Soya Flour The sample was rancid and quite unfit for human consumption. Vendor prosecuted convicted and fined £5 wi th £3.3s. Od. costs. 90 Art ic le Nature of Adulterat ion or Defic iency Remarks Steak and Gravy (Ti nned) The ingredients were specified on the label as beef, flour, edible fat, meat extract, onions, salt, spices, herbs and caramel. The flour and beef were not specified in the correct order of the proportion in which they were used as is required by the Labelling of Food Order. The Manufacturer was commun icated wi th. He has submi tted records f rom h i s own Analyst showing sat i sfactory samples taken from stock. Strawberries in Syrup Labelling not satisfactory in that the ingredients were not specified altogether in the order of the proportion in which they were used as is required by the Labelling of Food Order. The statement "Sucre" at the bottom of the label was not explicit and not readily understandable by the purchaser. Importer undertook to have article rel abel 1 ed. Suet, beef. Shredded Contained 80.2% of beef fat instead of not less than 83%. Vendor warned. Tomato Juice (? Samples) The tin had been dissolved from the inside surface of the unlacquered cans and its presence had imparted an objectionable metallic taste The articles were so unpalatable as to render them unfit for human consumption. The whole stock from which these sampl es were taken was surrendered and dest royed. 91 WATER I am indebted to the Water Engineer, W.C. Knill, Esq., B.Sc., M. I.C. E., M. I. Mech. E., M. I.VV. 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 - Gal Ions Corporation Wells 2,359,457,000 M.W.B. Bulk Supplies 781,193,000 Total: 3,140,650,000 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. 346 raw water samples and 1060 treated water samples were thus examined bacteriologically during the year by the Chemist and Bacteriologist on the staff of the Water Undertaking. In addition 13 samples of raw water and 49 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 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. 92 (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 67 of raw waters and 157 of treated waters going into supply. The results of the chemical analyses were uniformly satisfactory. The waters are not liable to have pi umbo-sol vent 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. Weekly samples have been 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 to 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 255 Chemical 8 93 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 1954 the following tonnages were dealt with:- House Refuse 59, 145 tons Street Sweepings 3,722 " Street Markets refuse 1,326 " 64,193 " This was disposed of by Controlled Tipping and two sites were in use during the year, viz. Ballards School and Mitcham Common. The former, 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 28 vehicles, including part of the fleet of Refuse Collecting Vehicles, have been running on this gas during 1954, and by this means about 35,000 gallons of petrol were saved. 94 MISCELLANEOUS Nursing Homes - Public Health Act, 1936. Number of Homes Number of Beds provided for:- Matern i ty Others Total Homes registered during the year 1 3 20 23 Homes on the Register at the end of the year 28 39 560 599 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-HINDERS 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 3 Nurseries which take 2^ to 5-yearolds daily excepting Saturdays, 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. Premises Daily Minders Number registered at 31.12.54 5 21 Number of children provided for 107 157 All child-minders are required before registration to show by a satisfactory X-ray of the chest that they are free from pulmonary tuberculosis. Annual re X-rays are also.required. 95 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 " 1,314 5,385 Europe outside Excepted Area 234 3, 835 Africa, Middle East 8 113 Asia 5 31 1,561 9,364 Included in the above figures were 1,537 Aliens carried in 411 Aircraft. CREMATIONS ACT, 1902 During the year 2,166 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 901 certificates were dealt with at the office (799 Smallpox, 59 Cholera, 36 T.A.B., 1 Typhus and 6 in respect of general condition of health). STAFF MEDICAL EXAMINATIONS 1,018 examinations were made during the year by the Medical Staff of the Department. NATIONAL ASSISTANCE ACT, 1948 (Section 47) NATIONAL ASSISTANCE(AMENDMENT) ACT, 1951 3 cases were dealt with by use of Section 47 of the National Assistance (Amendment) Act, 1951. All were aged, infirm ladies. 2 of them aged 78 and 82 were removed to Queen' s Hospital, where the one aged 82 died within three weeks and the other stayed in voluntarily and still remained at the end of the year. The third was a blind lady, who was removed to a Corporation Old People's Hostel and later transferred to hospital. 16 other old people, borderline Section 47 cases were also visited during the year and dealt with as follows:- Admitted to Queen's Hospital 6 Home Help, Meals on wheels, District Nurse, or other assistance given 5 Home Care by relatives 1 Kept under observation 4 2 Cases pending action involved in a fire overnight 1 died, l admitted to hospital and subsequently sent home 2 96 BLINDNESS I am indebted to the Chief Welfare Officer for access to his records regarding newly registered Blind Persons during the twelve months ending December 31st, 1954. These show that 88 new cases were certified on Forms B. D. 8, including 7 cases of Glaucoma and 39 of Cataract. Surgical treatment was advised in 10 cases and subsequent enquiries showed operation refused, 5 - operation performed, 2 - admission to hospital being awaited, 2 - patient deceased, 1 In 5 cases where operation was considered of doubtful value, no action had been taken. PROBLEM FAMILIES Prom a strictly practical viewpoint, we may regard them as families making excessive demands on the services of public authorities and voluntary organisations. There is no reason to believe that they are now more numerous than in the past, but with a rising standard of general education and improvement in material well-being, they stand out in greater contrast. The chief interest of the Health Department is, of course, the children of these families and the effect upon their health, physical and mental, of ignorance, cruelty or neglect. A Joint Circular of the Ministry of Health, the Ministry of Education and the Home Office recommended the setting up of co-ordinating machinery in each county and county borough area, as the first step in dealing with children neglected or ill-treated in their own homes. Such a co-ordinating committee convened by the Medical Officer of Health has been meeting in Croydon each month since 1951. During 1954, 61 families were discussed, 32 on one occasion only and 15 at two meetings. The approximate total of "problem" families is indicated by the numbers discussed more frequently, viz: 6 families on 3 occasions, 3 on 4 occasions, Ion 5 occasions, 3 on 6 occasions and ] on 9 occasions. These are case conferences of officers only and the Croydon organisations and statutory departments represented include the Marriage Guidance Council, the Association for Moral Welfare, the National Society for the Prevention of Cruelty to Children, the Guild of Social Service, the Women's Voluntary Services, the Child Guidance Clinic, the Hospital Almoners, the Probation Officers, the National Assistance Board, the Police Force (Women Police) and the Corporation's Housing, Welfare Services, Education, Children's and Health Departments. There seems to be general agreement amongst those attending that these conferences are of great assistance and as 97 convener, I have been requested to ensure at least a monthly meeting whatever the number of current cases for discussion. As a generalisation, the problem families do not produce many instances of active ill treatment of their children. Indeed, against the gloom of squalor, dirt and apparent neglect, maternal affection is often a shining virtue. It would be unreasonable to expect a mother of very mediocre intelligence and exhausted by a succession of pregnancies, to cope successfully with the care of a large family of which probably four members are under the age of 5 years. Male partners, are frequently unable or unwilling to work, and in some cases, there may be a succession of men involved, who depart leaving the children to the care of the mother or to local or voluntary authorities. There is nothing new in these observations and in former times, they would have been concluded with the reflection "that the poor are always with us " . Today, National Assistance benefit and family allowances ensure for any family a regular weekly income, so that the poor are those destitute for want of accommodation. The basic requirements to give some form of stable family life can now be assured if there is a mother with safe tenure of reasonable accommodation. It does seem therefore, that the essential dutiesof those concerned to prevent family break-up are to safeguard against eviction, to promote the health of the mother and to preserve her presence as the pivot of the family. While this may need the co-operation of many organisations, as far as preventive work is concerned, the main responsibility should rest upon the department providing most domiciliary services. Admission of children to a "home" is required when no practicable alternative exists. It is, however, an indication of failure of the preventive services and it is only right that Welfare and Children's Committees should stress the need to obviate this course whenever possible, but questionable that either should set up a separate organisation for domiciliary preventive work. The members of the Croydon conference on "Neglected Children" have frequently expressed the view that with the effective system of co-ordination operating in the borough, the need is for helpers rather than advisers. It was first thought this could be supplied by a Family Service Unit, but as single cases tend to occur in widely dispersed areas of the borough, this did not seem the answer to the problem. We were also warned that it was extremely difficult to find suitable personnel for this work. On many occasions, the Home Help Service has had to contend with the short-term care of families living 98 in very poor conditions and their success suggested the obvious use of selected members for this purpose. Co-operation between the Health Visiting and Home Help Service and other sections of the department and other Corporation staff engaged on domiciliary duties was already well developed and this extension of their work was generally welcomed. It was decided, other things being equal, to concentrate on families where arrears of rent threatened eviction and whilst the results must be a matter for future report, it does seem likely to be a successful method of approach. 99 COUNTY BOROUGH OF CROYDON ANNUAL REPORT OF THE PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1954 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, 1954. The School Health Service and Handicapped Pupils Regulations, 1953, while prescribing a minimum of three medical inspections, during the period of school life, leave to the authority's discretion, the timing of such general examinations and permit additional general inspections, if these are deemed necessary. For some years now, four general medical inspections during school life have been carried out in Croydon and I remain convinced of their value. When performed properly with skill and care by experienced Medical Officers, they reinforce the efforts of the conscientious and remedy some of the deficiencies of the neglectful parents. The former group, comprising the much greater majority, usually find these medical inspections helpful and reassuring, it is unusual now for gross physical defects to be detected for the first time at school and the main advantage of these examinations is the general survey and the opportunity for the parents to discuss relatively minor matters of general 100 hygiene or child-parent relationship. Now that physical disorders have diminished so greatly in frequency, the mental and emotional development of the children become all the more important. In this connection, much thought has been given to the alteration of the existing Croydon system of examining children as "Entrants", "8-year olds", "Primary leavers", and "Final Leavers". To have three examinations of the Primary and one only of the Secondary School group appears out of balance and there are strong reasons for recommending the third examination to be of "Secondary Entrants". Attention has been drawn, however, to particular problems which arise in the 'Primary Leavers" .apparently in relation to the common entrance examination. Parental anxiety is communicated to the children and words of guidance at this stage may be of immediate help and prevent future difficulties. However, parental reaction to the failure of a child to obtain a Grammar School place appears to be an attitude with which Head Teachers of Secondary Modern Schools are required to contend. On balance, it would seem in the best interests of the child that the third medical examination should take place on entry to the Secondary School, so that parents, teachers and doctors may combine to ensure that the child obtains the maximum possible benefit from the vital years of Secondary School education. Recorded defects ascertained at routine medical inspections follow the pattern of previous years. Respiratory infections such as the common cold or a specific communicable disease, such as measles, or as an indeterminate illness, to which no other name than "upper respiratory tract infection" can be affixed, remain an unsolved problem of our present day society. The Primary School Entrants soon show evidence of their repeated encounters with new infections by enlargement of lymph tissues in the nose and throat, which are recorded under defects of these regions. Like the immature mind, the body also has its lessons to learn for which time and patience are essential. It is often necessary to advise against surgical intervention during the early years of school life in opposition to parental pressure for some drastic action to end their child's continuous series of minor respiratory infections. Unfortunately, no practicable system of air sterilisation of classrooms has been produced to lessen these risks. Good nutrition, and general fitness are not certain safeguards, but aid resistance and speed recovery. While we must consider special action for the dangerous illnesses, for example, diphtheria or poliomyelitis, for the troublesome but relatively 101 minor infections, we can only continue to advise general measures of the avoidance of overcrowding of classrooms, a high standard of domestic cleanliness in school buildings, and heating and ventilation which permit adequate air changes even in the winter months. With regard to particular infectious diseases, scarlet fever reappeared in the school which gave difficulties in 1953, but to a much lesser degree. A teacher in a private school was found suffering from infectious pulmonary tuberculosis and the usual steps were taken to examine all other members of staff and child contacts. In contrast with previous investigations, in Corporation maintained schools, secondary cases were found. When the Corporation adopted the recommendations of the Joint Tuberculosis Council, I wrote to all private schools in the Borough, suggesting that they might wish to adopt these recommendations for their own staff. Obviously, however, there are difficulties in their arranging for X-ray examinations of impending applicants, if a Mass X-ray Unit does not happen to be operating at the time in some part of the Borough. The Corporation have therefore, resolved that the Health Department shall affordto private schools facilities for X-raying the chests of new entrants before they actually take up their duties. As regards handicapped children, endeavour was made to diagnose deafness or partial deafness as early as possible in infant life. The School Nurses, who are also Health Visitors, were informed of the possibility and need to identify children with hearing defects before the age of one year, as it is believed that treatment at this stage may enable the child to learn to speak in the normal manner. An additional whole-time Speech Therapist was appointed during the year under review, but unfortunately,resigned owing to ill health within three months. Her appointment demonstrated the inadequacy of the premises at present available for this service and plans for a proper treatment centre were approved to be provided early in 1955. Arrangements were made for an Orthopaedic Surgeon and a Specialist in Physical Medicine, who advise the Special School for Spastics, to attend once a term at the Corporation's Day School for Handicapped Children. At this School, a new physiotherapy room and rearranged medical treatment rooms were provided during the year under review. Provision for the education of all types of handicapped children was adequate, with the exception of places in residential schools for educationally subnormal children. Steps were 102 taken to arrange for places in new schools being built for this purpose by adjoining education authorities. The Principal School Dental Officer deals with the continuing difficulties of this service and our conviction that the provision of new premises will assist greatly despite the persisting lack of dental surgeons. Finally, my thanks are due to the Members of the Education Committee, who are always anxious to provide the best practicable facilities for the children and to the Members of the Department for their advice and application to routine duties. 103 STAFF OF THE SCHOOL HEALTH SERVICE *Medical Officers 9 (including 1 part-time) *Dental Officers 8 (including 3 part-time) *Physiotherapists 2 Speech Therapists 3 (including 2 part-time) *School Nurses 30 (including S.H.V. and Deputy) *Dental Attendants 6 •Performing also duties in other sections of Public Health Depar tmen t. 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. James' Road, Broad Green, Croydon and at Salcot Crescent, New Addington. 104 RETURN OF ATTENDANCE IN MAINTAINED PRIMARY, MODERN, CENTRAL, TECHNICAL AND GRAMMAR SCHOOLS 1954 School Average No. on Register Average Attendance Average Attendance per cent. Average 1953 Attendance per cent. COUNCIL PRIMARY SCHOOLS Ashburton Junior Mixed 585 552 94.3 94.0 Ashburton Infants 278 259 93.1 90.3 Benson Junior Mixed and Infants 580 544 93.8 92.6 Beulah Junior Boys 446 420 94.2 93.1 Beulah Junior Girls 368 348 94.6 9?.0 Beulah Infants 210 183 87.1 89.9 Cypress Junior Mixed 236 220 92.8 90.2 Cypress Infants 160 142 88.8 Davidson Infants 260 239 91.9 90.8 Duppas Junior Mixed and Infants 454 410 90.3 87.3 Ecclesbourne Junior Boys 297 273 91.9 91.7 Ecclesbourne Infants 192 178 92.8 90.4 Elmwood Junior Boys 310 286 92.3 92.7 Elmwood Junior Girls 329 301 91.5 90.6 Elmwood Infants 284 252 88.7 86.8 Fairchildes Junior Mixed 306 279 91.1 84.5 Fairchildes Infants 430 378 87.9 Gilbert Scott Junior Mixed 493 462 93.2 93.1 Gilbert Scott Infants 256 235 91.8 91.7 Gonville Junior Mixed and Infants 480 450 93.7 89.4 Howard Junior Mixed and Infants 521 484 92.9 92.3 Ingram Infants 198 178 89.9 86.4 Kensington Avenue Junior Mixed and Infants 613 571 93.1 91.3 Kingsley Junior Mixed 504 457 90.7 90.9 Kingsley Infants 347 290 83.5(G. 1.) 85.9 Monks Orchard Junior Mixed and Infants 415 389 93.7 91.5 Overbury Infants and Junior Mixed 481 431 89.6 85.4 Norbury Manor Junior Mixed 478 450 94.1 92.8 Norbury Manor Infants 265 239 90.1 89.7 Oval Junior Mixed 456 426 93.4 93.0 Oval Infants 192 172 89.6 87.8 Portland Infants 258 240 93.0 89.1 Purley Oaks Senior and Junior Mixed 588 542 91.3 Purley Oaks Infants 199 182 91.5 87.1 Rockmount Junior Mixed 374 352 94.1 94.0 Rockmount Infants 192 174 90.6 84.6 Rowdown Junior Mixed 310 285 91.9 Rowdown Infants 316 278 87.9 South Norwood Junior Boys 342 319 93.3 91.9 South Norwood Junior Girls 333 308 92.5 92.5 South Norwood Infants 301 265 88.0 85.1 St. Peter's Junior Mixed and Infants 375 346 92.2 89.2 Spring Park Junior Mixed 447 422 94.4 92.1 Spring Park Infants 217 198 91.2 Sydenham Junior Boys 331 309 93.9 91.5 Sydenham Junior Girls and Infants 380 340 89.4 90.6 Waddon Infants 214 173 80.8(C. P.) 92.4 West Thornton Junior Boys 214 202 93.9 92.7 West Thornton Junior Girls 198 186 93.9 93.2 West Thornton Infants 242 223 92.1 89.1 Whitehorse Manor Junior Girls 292 272 93.1 90.3 Whitehorse Infants 269 237 88.1 86.6 (table continued on next page) 105 School Average No. on Regis ter Average Attendance Average Attendance per cent. Average 1953 Attendance per cent. Winterbourne Junior Boys 417 394 94.9 92.9 Winterbourne Junior Girls 453 428 94.5 94.0 Winterbourne Infants 355 302 85.1 82.9 Wolsey Junior Mixed 625 575 92.0 91.4 Wolsey Infants 329 294 89.3 88.5 Woodside Junior Boys 449 423 94. 2 94.1 Woodside Junior Girls 400 376 94.0 92.7 Woodside Infants 316 285 90.1 84.9 TOTALS 21,160 19,428 91.7 90.2 G.I. - General Illness C.P. - Chicken Pox COUNCIL SECONDARY MODERN SCHOOLS Ashburton Senior Boys 522 490 93.9 94.0 Ashburton Senior Girls 497 458 92.2 92.1 Davidson Senior Boys 297 277 93.2 92.5 Davidson Senior Girls 163 149 91.4 89.5 Ecclesbourne Senior Girls 269 241 89.6 87.0 Fairchildes Senior Mixed 606 537 88.6 88.6 Ingram Senior Boys 416 383 92.1 91.9 Ingram Senior Gi rls 278 254 91.4 89.1 John Newnham Senior Mixed 405 378 93.3 92.1 Lanfranc Senior Boys 450 405 90.0 90.2 Lanfranc Senior Girls 614 551 91.3 90.4 Norbury Manor Senior Boys 293 277 94.5 92.2 Norbury Manor Senior Girls 288 270 93.8 92.4 Portland Senior Boys 184 174 94.6 93.4 Portland Senior Girls 221 200 90.5 90.7 Shirley Secondary Modern Mixed 87 83 95.4 South Croydon Senior Mixed 320 261 81. 5 (C. P.) Tavistock Senior Boys 431 386 89.5 90.3 Tavistock Senior Girls 408 368 90.2 88.9 Whitehorse Manor Senior Boys 198 178 90.0 91.4 TOTALS 6,947 6,320 90.9 90.6 St. Andrew's Vol. Sec. Mod. Mixed 215 191 88.8 Our Lady's Vol. Sec. Girls 177 158 89.3 TOTALS 392 349 89.0 SPECIAL SCHOOLS St. Christopher's (E.S.N.) 204 178 87.2 87.2 St. Giles Delicate and Physically Handicapped 199 169 84.4 83.9 St. Luke's Partially Sighted 28 23 82.2 87.8 TOTALS 431 370 85.8 85.8 106 School Average No. on Register Average Attendance Average Attendance per cent. Average 1953 Attendance per cent. VOLUNTARY PRIMARY SCHOOLS All Saints' Mixed and Infants 286 263 91.9 88.7 Christ Church Junior Mixed and Infants 238 214 89.9 90.3 Parish Church Junior Mixed and Infants 463 426 92.0 89.3 St. Joseph's Mixed and Infants 477 425 89. 1 90.4 St. Mark's Junior Mixed and Infants 195 179 91.8 85.3 St. Mary's R.C. (Senior and Junior Mixed) 426 382 89. 2 91.0 St. Michael's Infants 166 141 84.9 85.8 Shirley Junior Mixed and Infants (St. John's) 245 230 93.9 88.3 TOTALS 2,496 2,260 90.5 89.1 SELECTIVE CENTRAL SCHOOLS Archbishop Tenison's Senior Mixed 297 282 94.9 94.4 Heath Clark Mixed 393 367 92.4 94.8 TOTAL 690 649 94. 1 94.6 GRAMMAR SCHOOLS Selhurst Boys 580 552 95.1 94.0 Selhurst Girls 536 508 94.7 93.6 John Ruskin Boys 387 369 95.3 95.4 Coloma Girls 535 500 93.4 90.7 Lady Ed ridge Girls 396 378 95.5 95.9 TOTALS 2,434 2,307 94.7 93.8 TECHNICAL SCHOOLS Stanley Technical Boys 281 269 95.7 98.9 Croydon Secondary Technical 252 235 93.2 94.6 TOTALS 533 504 94.5 96.9 SUMMARY OF SCHOOLS Council Primary 21,160 19,428 91.7 90.2 Voluntary Primary 2,496 2,260 90.5 89. 1 Council Secondary Modern 6,947 6,320 90.9 90.6 Voluntary Secondary Modern 392 349 89.0 89.0 Grammar 2,434 2,307 94.7 93.8 Central 690 649 94.0 Technical 533 504 94. 5 96.9 Specials 431 370 85.8 85.8 TOTALS 35,083 32,187 91.7 90.5 Crosfield Nursery 42 37 88.0 88.3 107 MEDICAL INSPECTION IN SCHOOLS The system of routine medical inspection is now as follows:A. Primary and Modern Secondary Schools. (1) Entrants i.e., Children admitted for the first time to a Maintained School. (2) 8-year-old. Group i.e., Children who had attained their 8th birthday at the opening date of the Term but have not yet reached their 9th birthday and who have not been medically examined at the age of 8 years. (3) Primary Leavers i.e., Children in their last year of attendance in a Maintained Primary School and who have not been medically examined in that year. (4) Leavers (Final) i.e., Children in their last year of attendance in a Maintained Secondary School who have not been medically examined in that year. (5) Special Cases (if any) i.e., Children of other ages who are apparently defective and whom the Head Teacher and parents wish the Medical Officer to see at his next visit. A total of 13,796 children were examined as compared with 13,257 in 1953, and 9,495 parents attended the examinations. The percentage attendance of parents in the Entrants' group was for boys 89.3 per cent, and girls 91.2 per cent.; in the Intermediate group, boys 64.7 per cent., girls 73.2 per cent.; in the Leavers' group, boys 13.5 per cent., girls 34.6 per cent.; and in the Other Ages group, boys 71.3 per cent., girls 81.2 per cent The total percentage of parents attending was 68.8 as against 69.0 last year. 708 specials and 766 re-inspections of children were carried out. 108 PARENTS PRESENT 195* ENTRANTS INTERMEDIATE LEAVERS 8 TO 9 YEARS TOTAL Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined Parents Present Number Examined M F M F M F M F M F M F M F M F M F All Saints 17 19 13 15 28 16 17 5 - - - - 23 19 13 13 66 54 Arch. Teni son's - - - - - - - - - 23 - 4 - - - - - 23 Ashburton 43 84 39 77 135 110 96 79 99 171 6 50 49 44 30 40 326 409 Benson 28 23 24 22 71 35 60 22 - - - - 95 43 66 40 194 101 Beulah 50 66 48 61 227 162 145 125 - - - - 175 64 147 59 452 292 Christ Church 18 10 13 7 4 23 3 19 - - - - 5 7 2 7 27 40 Coloma - - - - - - - - - - - - - - - - - 67 Croydon Tech. - - - - - - - - 81 - 2 - - - - - 81 - Cypress 47 65 45 61 48 20 41 15 - - - - 33 27 27 23 128 112 Davidson 66 48 55 48 - - - - 95 41 9 12 16 8 14 6 177 107 Duppas - - - - - 58 - 40 - - - - 60 45 37 33 60 103 Ecclesbourne 48 34 44 32 125 - 72 - 13 82 2 24 68 - 52 - 254 116 Elmwood 61 44 56 43 76 66 59 48 - - - - 110 83 87 73 247 193 FairchiIdes 66 70 64 68 50 46 28 37 50 69 5 13 44 34 28 15 210 219 Gilbert Scott 60 42 50 37 63 66 38 39 25 - 15 - 51 82 38 65 199 190 Gonville 41 23 38 23 32 39 26 22 - - - - 35 33 31 28 108 95 Heath Clark - - - - - - - - 45 20 - 3 - - - - 45 20 Howard 25 20 24 20 25 1 17 1 - - - 59 42 49 38 159 63 Ingram 45 35 45 32 - - - - 54 72 8 17 - - - - 99 107 John Newnham - - - - - - - - 21 17 3 4 - - - - 21 17 John Rusk in - - - - - - - - - - - - - - - - - - Kensington 49 50 46 44 74 80 52 57 1 - 1 - 8 64 8 58 132 194 Kingsley 68 84 61 69 25 47 13 42 - - - - 62 71 47 48 155 202 Lady Ed ridge - - - - - - - - - - - - - - - - - - Lanfranc - - - - - 6 - 2 107 138 12 57 - - - - 107 144 Monks Orchard 29 28 27 27 33 39 19 31 - - - - 42 29 37 25 104 96 Norbury Manor 89 82 76 77 72 52 47 39 75 65 8 38 58 66 51 68 294 265 Our Lady - - - - - - - - - 27 - 1 - - - - - 27 Oval 59 68 52 63 1 48 1 42 3 - 1 - 25 26 19 20 88 142 Overbury - - - - 20 31 13 22 - - - 19 19 7 17 39 50 Parish Church 26 32 23 32 41 33 20 20 - - - - 30 32 21 23 97 97 Portland 46 39 40 37 - - - - 33 68 9 21 54 57 24 51 133 164 Purley Oaks 34 41 29 38 46 32 17 23 23 29 6 11 51 49 41 44 154 151 Rockmount 51 57 49 50 57 37 33 33 - - - - 41 62 37 53 149 156 Rowdown 83 89 77 79 25 - 20 - - - - - - - - - 108 89 St. Andrew's - - - - - - - - 35 32 9 16 - - - - 35 32 St. Joseph's 36 42 30 32 36 40 12 14 - - - - 74 61 45 24 146 143 St. Mark's 16 22 12 18 - 15 - 10 - - - - 9 24 6 20 25 61 St. Mary's R.C. 16 12 9 11 34 19 15 6 14 6 3 1 49 36 25 24 113 73 St. Michael's 48 30 34 27 - - - - - - - - - - - - 48 30 St. Peter's 34 24 18 22 15 30 5 15 - - - - 58 42 31 30 107 96 Selhurst Grammar - - - - - 29 - 21 86 59 14 45 - - - - 86 88 Sh i rl ey 12 11 7 9 30 23 18 16 - - - - 13 12 7 10 55 46 South Norwood 96 62 86 52 105 137 81 112 - - - - 90 73 48 55 291 272 Spring Park 15 25 15 24 40 49 29 37 2 - - - 79 46 65 42 136 120 Stanley Tech. - - - - - - - 83 - 1 - - - - 83 - Sydenham 43 33 41 32 90 24 55 18 - - - 85 88 49 69 218 145 Tavistock - - - - 3 - - 120 99 19 46 - - - - 120 102 waddon 19 16 18 13 - - - - 17 - - - - - - - 36 16 West Thornton 34 27 32 23 86 48 56 35 - - - - 30 36 22 30 150 111 Whitehorse 63 63 59 55 - 50 - 38 73 - 15 - - 111 - 96 136 224 Winterbourne 93 109 90 101 87 181 58 125 - - - - 97 140 58 100 277 430 Wol sey 23 14 22 14 124 156 89 131 - - - - 85 108 74 88 232 278 Woodside 72 69 69 66 152 178 88 144 24 25 11 21 138 117 98 107 386 389 1769 1712 1580 1561 ?077 2029 1343 1485 11 79 1110 159 384 2020 1900 1441 1542 7045 6751 3481 3141 4106 28 28 2289 543 3920 2983 13796 PERCENTAGE OF PARENTS PRESENT AT MEDICAL INSPECTIONS Entrants Boys 89.3 90.2 68.8 „ Gi rl s 91.2 Intermediate Boys 64.7 68.9 „ Gi rl s 73.2 Leavers Boys 13.5 23.7 „ Gi rl s 34.6 Other Ages Boys 71.3 76.1 8 to 9 years Gi rl s 81.2 109 HEIGHTS AND WEIGHTS. 1954 Age Number ined 1954 Average Height in inches Average weight in lbs. 1954 19 53 1952 1951 1939 1954 1953 1952 1951 1939 BOYS 5 years 1109 42.7 42.9 43.0 43.0 41.8 42.9 42.5 43.0 42.8 41.5 6 „ 494 44. 2 44.3 43.8 44.3 43.8 45.2 44.8 44.4 45.4 43.4 7 „ 222 47.8 47.4 48. 1 47.4 45.3 53.3 52.0 54.4 51.7 47.9 8 „ 1018 50. 2 49.9 50.0 50.3 49.5 58.6 58.1 58.3 59.4 55.5 9 „ 838 51.6 50.9 51.2 51.3 51.2 61.7 61.6 61.8 61.7 58.8 10 „ 1016 54.7 55. 1 54.9 54.7 52.7 72.2 73.0 72.9 72.6 62.9 11 „ 853 55.8 55.5 55.3 55.5 53.7 76.4 75.6 75.3 74.7 68.7 12 „ 253 56.5 56.3 56.8 56.6 55.7 79.7 77. 1 78.7 78.6 79.9 13 „ 15 60.5 60.0 56.7 - 58.4 97.1 90.0 91.0 - 81.6 14 „ 409 62.4 63.1 61.8 62.7 59.0 105.6 105.6 104.7 106.2 90.8 15 „ 534 63.8 64. 1 64.4 64.4 - 112.8 115.6 114.6 115.5 - 16 „ 134 66.9 67.7 67.0 67.6 - 129.4 129. a 128.2 134.9 - 17 „ 17 66.7 67.2 67.8 69.8 - 126.5 127.2 137.4 146. 1 - GIRLS 5 years 1067 42.6 42.6 42.6 42.6 41.2 41.9 41.4 41.5 41.5 39.7 6 „ 473 43.8 43.8 43.2 44.1 42.7 45.3 43.4 42.8 43.8 41.4 7 „ 241 47.5 46.8 47.6 47.5 44.1 52.4 50.0 52.0 52.7 43.6 8 „ 936 49.6 49.7 49.7 49.9 49.9 56.6 56.5 56.9 56.8 54.7 9 „ 736 51.0 50.5 51.0 50.8 50. 9 60.5 60.4 59.6 59.5 57.6 10 „ 1029 54.6 54.6 55.4 54.5 52.1 73.1 73.8 72.5 72.7 62.9 11 „ 809 55.9 55.8 55.9 55.8 53.6 77.9 76.5 77.6 76.2 68.3 12 „ 298 57.1 57.1 58.0 56.9 56.6 81.9 82.6 86.0 31.5 77.2 13 „ 56 61.4 59.8 59.3 60. 6 58.8 100.6 96.0 91.8 96.6 85.3 14 „ 587 62.2 61.8 62.0 62.1 60.3 109. 2 109.0 107.7 110.0 97.9 15 „ 368 62.7 62.9 63.0 62.7 62.0 114.0 116.0 112.2 111.3 105. 5 16 „ 39 63.3 64.7 64. 2 64.1 L 21.8 121.9 123.2 125.0 - 17 „ 6 63.5 64.9 64. 2 64.5 116.3 127.4 121.4 125.5 " 110 RETURN OF DEFECTS FOUND IN THE COURSE OF ROUTINE MEDICAL INSPECTION, 1954 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 3 2 0.07 4 3 0.10 Uncieanliness Head - - - - - - Body Skin Disease 18 4 0.31 28 12 0.59 Eye Disease Defective Vision 305 15 4.54 304 44 5.15 Squint 38 13 0.72 34 9 0.64 External Eye Trouble 10 - 0.14 12 2 0.21 Ear Disease Deafness 17 23 0.57 16 15 0.46 Ot it is Media 10 4 0.20 6 1 0.10 Other Disease 7 5 0.17 5 9 0.21 Nose and Throat Enlarged Tonsils only 40 45 1.21 42 63 1.56 Adenoids only 31 2 0.47 27 5 0.47 Enlarged Tonsils and Adenoids 74 61 1.92 73 44 1.73 Other Conditions 47 15 0.88 27 12 0.59 Enlarged Cervical Glands (not T.B.) 1 4 0.07 1 9 0.15 Dental Defects 71 1 1.02 44 1 0.67 Speech Defects 24 21 0.64 9 11 0.29 Heart and Circulation Organic 10 27 0.53 13 10 0.34 Functional 8 27 0.50 5 22 0.40 Anaemia 1 1 0.03 5 4 0.13 Bronchitis 27 50 1.09 16 27 0.64 Other Non-T.B. 23 36 0.84 9 40 0.72 Pulmonary Tuberculosis 4 8 0.17 3 1 0.06 Other Tuberculosis 1 1 0.03 2 2 0.06 Nervous System Disorders (including Epilepsy, Chorea, etc.) 10 18 0.40 10 13 0.34 Developmental (a) Hernia 2 1 0.04 3 1 0.06 (b) Other 23 70 1.32 3 3 0.09 Psychological (a) Development - 3 0.04 3 7 0.15 (b) Stabi1ity 3 12 0.21 5 2 0.10 Deformities Flat Feet 115 41 2.21 69 38 1.58 Posture 120 33 2.17 134 34 2.49 Others 63 43 1.50 70 44 1.69 Other Defects and Diseases 62 36 1.39 47 36 1.23 TOTALS 1,168 622 1,029 524 Total Children Examined 7,054 6,751 Ill VISION Extent of Defect Intermediate Leavers 8 to 9 years and Other Ages Total Boys Girls Boys Girls Boys Girls Boys Girls No. x No. X No. X No. I No. X No. X No. X No. X Normal: 6/6ths or 6/9ths R 1976 95.2 19U6 95.9 1132 96.0 1066 96.0 1950 96.5 1809 95.2 5058 95.9 4821 95.7 L 1986 95.6 1941 95.7 1119 94.9 1069 96.3 1954 96.7 1815 95.5 5059 95.9 4825 95.8 6/12ths or 6/24ths R 88 4.2 73 3.6 35 3.0 30 2.7 64 3.2 79 4.2 187 3.5 182 3.6 L 73 3.5 75 3.7 53 4.5 30 2.7 58 2.9 77 4.1 184 3.5 182 3.6 6/36ths or worse R 13 0.6 10 0.5 12 1.0 14 1.3 6 0.3 12 0.6 31 0.6 36 0.7 L 18 0.9 13 0.6 7 0.6 11 1.0 8 0.4 8 0.4 33 0.6 32 0.6 Cost of the School Health Service The gross cost of the medical, dental and nursing services was £33,668. The expenditure is subject to Education grant. Cost of Special Schools £ Schools maintained by the Council 27,699 Other Schools (not maintained by local Education Authorities) 5,752 Adjustments with other authorities in respect of Special Schools, at rate cost 2,128 £35,579 With the exception of the £2,128 calculated at Rate Cost, the above expenditure is subject to Education grant. Cost of Milk and Meals Meals and Milk cost £209,140. Income from payment for meals was £102,741, making a net cost of £106,399, on which grant is paid of 100 per cent, on approved expenditure. 112 SUMMARY OF FINDINGS AT ROUTINE MEDICAL INSPECTIONS. 1954 (Percentages of Children examined) Condition Entrants In termediates Leavers Other Ages and 8 to 9 yrs. All Groups Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Circulatory System 1.1 0.9 1.3 1.4 0.8 1.3 1.6 1.2 1.3 1.2 Pulmonary System Skin Disease 4.3 0.6 2.8 0.8 1.8 0.6 0.8 1.3 1.0 0.9 0.9 1.4 2.6 0.5 1.9 0.7 2.5 0.7 1.6 1.0 Defects of Nose and Throat 15.1 14.2 5.3 5.0 0.7 2.2 7.2 9.6 7.5 8.1 Enlarged Cervical Glands 3.8 2.3 2.3 0.2 0.8 - 3.4 3.2 2.7 2.1 Squint 2.2 1.9 0.8 0.6 0.2 0.4 2.5 0.6 1.0 0.9 External Eye Disease 0.3 0.3 0.4 0.3 0.2 0.1 0.2 0.4 0.3 0.3 Defective V i si on 0.5 0.3 6.7 5.5 5.0 6.8 5.6 8.2 4.5 5.2 Defective Hearing and other Ear Defects 1.8 1.3 0.7 0.7 0.8 0.5 1.1 1.2 1.1 0.9 Speech Defects 1.7 0.7 0.4 0.2 0.1 0.2 0.4 0.2 0.7 0.3 Dental Disease (more than four decayed) 1.1 0.9 0.8 0.5 0.3 0.1 0.9 0.2 0.8 0.5 Dull and Backward 0.1 0.1 - 0.1 0.1 - 0.2 0.1 0.1 0.1 Malnutrition 4.5 3.9 7.7 3.8 1.3 2.4 3.1 3.7 3.4 3.6 Nervous System 0.4 0.2 0.4 0.7 0.3 0.3 0.9 0.3 0.5 0.4 Deformities 9.2 7.2 9.1 7.3 2.8 8.4 7.9 7.6 7.7 7.5 Developmental Hernia 0.1 0.2 0.1 - - - - 0.1 0.1 0.1 Other 1.6 - 1.7 0.1 0.2 0.2 1.7 0.1 1.4 0.1 Psychological Developmental 0.2 0.2 0.1 0.2 - 0.2 0.1 0.2 0.1 0.2 Stabi1ity 0.6 0.2 0.2 - - 0.1 0.2 0.2 0.3 0.1 Other Defects 2.6 2.3 1.7 1.5 1.3 1.1 1.6 1.4 1.8 1.6 UNCLEANLINESS Cleanliness inspections are carried out by the School Nurses each term in every school, so that all pupils are brought under review. The finding of slight infestation in unexpected offenders leads to the issue of an informal letter to the parents, setting out a method of treatment and offering a supply of suitable emulsion. The appropriate formal notices are sent to the parents of children previously found verminous. Steel combs are sold or loaned where necessary. Endeavour is made to serve notices on the parents by the School Nurse personally, so that she has opportunity to emphasise that infestation may be a family complaint and not limited to the school child, and the need for constant cleanliness to prevent relapses. A cleansing station is provided for the treatment of scabies and very occasionally deals with other verminous conditions. Number of children inspected for Cleanliness (first inspection) 67,628 113 Number of children inspected (subsequent inspections) 1,974 Number of children found unclean (first inspection) (526 occasions of infestation) 303 Number of occasions in which children found unclean (subsequent inspections) 144 At the primary inspections vermin were found in 25 and nits alone in 501 children. On these inspections 0.9 per cent, of the children showed evidence of infestation as against 1.8 in 1953. 57 children attended the Cleansing Station for treatment. TUBERCULOSIS IN CHILDREN OF SCHOOL AGE Contacts among school children kept under supervision during 1954:- Number of cases under observation at beginning of 1954 152 Number of cases added during year none Number of cases discharged from observation during the year 24 Number of cases under observation at the end of 1954 128 Number of cases of Notified Tuberculosis - Pulmonary 9 Non-Pulmonary 4 Taking the total child population at 39,083, the pulmonary tuberculosis incidence rate per 100,000 was 23.3, and the nonpulmonary incidence rate 10.2. There were no deaths from tuberculosis. • CAUSES OF DEATH IN SCHOOL CHILDREN Child population, 39,083. Number of deaths 11, which is equal to a death-rate of 0.28 per 1,000. The deaths were due to: Acute Encephalitis 1 Cardiac Conditions 4 Chronic Nephritis 2 Schilder's Disease 1 Leukaemia 1 Tonsil and Adenoidectomy (Misadventure) 1 Road Accident 1 114 TREATMENT The Work of the School Clinics SUMMARY OF ATTENDANCES 1954 1953 Increase or Decrease Minor Ailments and Verruca Clinics 10581 11151 - 570 Inspection Clinic 2040 2391 - 351 Dental Clinics 24833 26633 -1800 Remedial Exercises Clinic 6515 7388 - 873 43969 47563 -3594 The Minor Ailments Clinics At the Lodge Road Clinic 1,059 defects involved 4,222 attendances, while at the subsidiary Clinics held at Ashburton School 252 defects, 1,768 attendances; at Duppas School 391 defects, 2,735 attendances; at Rockmount School 131 defects, 1,143 attendances; and at Wolsey School 164 defects, 713 attendances. Complaint 1954 1953 Cases Attendances Average No. of Attendances per case Cases Attendances Average No. of Attendances per case Ringworm 2 7 3.5 12 24 2.0 Scabies - - - - - - Impetigo 35 229 6.5 26 148 5.7 Other Skin Diseases 20 53 2.7 40 131 3.3 Otorrhoea and other Ear defects 108 549 5.1 116 428 3.7 External Eye Disease 187 556 3.0 211 653 3.1 Miscellaneous 1645 10087 6. 1 1669 9767 5.9 1997 11481 5.8 2074 11151 5.4 115 CONDITIONS NOTIFIED BY TEACHERS AND SCHOOL ENQUIRY OFFICERS AND CONFIRMED BY HEALTH VISITORS NAME OF SCHOOL School Population Measles German Measles Whooping Cough Chicken Pox Mumps Scabies Impetigo Ringworm Diphtheria Scarlet Fever Dysentery Poliomyelitis Jaundice Conjunctivitis Sore Throat Indefinite Sickness) Enteric Group Erysipel as Vermin Meningococcal Infaction TOTALS Body Scalp All Saints 286 2 - - 3 - - 4 - - - 11 - - - - - - - - - - 20 Archbp. Tenison 297 - - - - - - 1 - - - 3 - - - - - - - - - - 4 Ashburton 1882 - - - 4 2 - - - - - 11 1 - - - - - - - - 1 19 Benson 580 2 - - 11 - - - - - - 9 - - - - - - - - - - 24 Beulah 1024 1 - 6 30 6 - 2 - - - 4 1 - - - - - - - 4 - 54 Christchurch 238 - - 1 2 - - - - - - 7 - - - - - - - - 6 - 16 Coloma 535 - - - 5 - - - - - - 7 - - - - - - - - - - 12 Crossfield Nursery 42 - - - - - - - - - - 1 - - - - - - - - - - 1 Croydon Art 265 - - - - - - - - - - - 1 - - - - - - - - - 1 Croydon High 879 - - - - - - - - - - - - - - - - - - - - - - Croydon Technical 252 - - - - - - - - - - 2 - - - - - - - - - - 2 Cypress 396 1 1 2 - - 1 - - - 4 1 - - - - - - - - - 10 Davidson 720 - - 5 16 6 - - - - - 3 - - - - - - - - 7 - 37 Duppas 451 - - 3 - 1 - 1 - - - 1 - - - - - - - - - - 6 Ecclesbourne 768 - 1 6 18 - - - - - - 9 16 - - - - - - - 1 - 51 El mwood 923 - 1 14 1 - - 2 - - - 12 2 - - - - - - - 5 - 37 Fairchildes 1342 - 1 9 1 33 - 2 - - - 23 1 - - - - - - - 3 - 75 Gilbert Scott 749 - - 17 8 - - 5 - - - 4 1 - - - - - - - - - 35 Gonville 480 - 1 1 22 13 - - - - - 8 - - - - - - - - - - 45 Heath Clark 393 - - - - - - - - - - 1 - - - - - - - - - - 1 Howard 521 - 11 52 2 - - - - - 5 - - - - - 1 - - 2 - 73 Ingram 892 - - 11 32 3 - 2 - - - 6 - - - - 1 - - - 4 - 61 John Newnham 405 - - - - - - - - - - 1 - - - - - - - - - - 1 John Rusk in 387 - - - - - - - - - - - - - - - - - - - - - - Kensington Avenue 613 - - 6 1 4 - - - - - 6 - - - - - - - - - - 19 Kingsley 851 - 1 12 61 8 - 5 - - - 6 - 1 - - 1 1 - - 2 - 98 Lady Edridge 396 - - - - - - - - - - 1 - - - - - - - - - - 1 Lanfranc 1064 - - - 12 1 - 1 - - - 1 2 - - - - - - - 3 - 20 Monks Orchard 415 - - - - - - - - - - 9 - - - - - - - - - - 9 Norbury Manor 1324 - - 10 1 7 - - - - - 13 - - - - - - - - - - 31 Old Palace 403 - - - - - - - - - - 1 - 1 - - - - - - - - 2 Our Lady's Convent 477 - - - - - - - - - - - - - - - - - - - - - - Qval 648 - - 2 8 31 - 1 - - - 10 - - - - - - - - - - 52 Overbury 481 - - 1 - i - - 1 - - 3 - - - - - - - - - 2 8 Parish Church 463 - - 7 - - - - - - - 1 - - - - - - - - - - 8 Portland 663 . - - - - - - 1 - 1 - 4 1 - - - - - - - - - 7 Purley Oaks 787 - - 2 32 1 - - - - - 9 - - - - - - - - - - 44 Rockmount 566 1 - 10 5 12 - 3 - - - 3 - - - - - - - - 1 - 35 Rowdown 626 - - 1 - - - - - - - 10 1 - - - - - - - - - 12 St. Andrew's 215 - - - - - - - - - - - - - - - - - - - - - 1 St. Christopher's 204 - 1 - 2 - - - - - - - - - - - - - - - - - 3 St. Giles' 199 - - 8 2 2 - - - - - - - - - - - - - - - - 12 St. Joseph's 477 - - - 1 - - - - - - 1 - - - - - - - - - - 2 St. Luke's 28 - - - - - - - - - - - - - - - - - - - - - - St. Mark's 195 - - - - 1 - - - 1 - 2 - - - - - - - - 1 - 5 St. Mary's R.C. - - 2 - - - - - 1 - - 1 - - - - - - - 2 - 6 St. Michael's 166 1 - 7 5 - - - - - - 7 - - - - - - - - - 1 21 St. Peter's 375 - 1 2 8 - - - - - - 7 - - - - - - - - - - 18 Selhurst Grammar 1116 - - - - - - 1 - - - 2 - - - - - - 1 - - - 4 Shirley (St. John's) 332 - - - 1 - - - - - - 1 - - - - - - - - - - 2 South Croydon 320 - - - - - - 1 - - - - - - - - - - - - - - 1 South Norwood 976 - 1 4 48 52 - - 1 - - 8 41 - - - - - - - 1 - 156 Spring park 664 - - 1 4 - - 4 - - - 8 - - - - - - - - - - 17 Stanley Technical 281 - - - - - - - - - - 1 - - - - - - - - - - l Sydenham 711 - - 1 18 - - 1 - - - 2 1 - - - - - - - 7 - 30 Tavistock 839 - - - - - - - - - - - 2 - - - - - - - 17 - 20 Waddon 214 - 1 3 52 5 - 1 - - - 5 - - - - - 1 - - - - 68 West Thornton 654 1 - - 5 1 - - - - - 6 - - - - - 1 - - 2 - 16 Whitehorse Manor 759 - - 7 - - - - - - - 8 1 - - - - - - - 3 2 21 Whitgift Grantnar 800 - - - - - - - - - - - - - - - - - - - - - - Whitgift Middle 556 - - - - - - - - - - - - - - - - - - - - - - Winterbourne 1225 - - - 1 1 - - - - - 35 3 - - - - - - - - - 40 Molsey 954 - - - - 1 - - - - - 7 - - - - - - - - 2 - 10 Woodslde 1265 - - 2 3 1 - 3 - - - 4 - - - - - - - - - - 13 TOTALS 9 9 175 481 196 - 42 2 3 - 313 77 2 - 1 2 5 1 - 74 6 1398 116 CHIEF CAUSES OF EXCLUSIONS FROM SCHOOL Condition Exclusions during 1954 Percentage of total exc1usions Exclusions during 1953 Percentage of total exclusions Ringworm 5 0.36 6 0.24 Verminous Conditions 74 5.30 95 3.81 Impetigo 42 3.00 21 0.84 Scabies - — 1 0.04 Scarlet Fever 313 22.39 295 11.86 Measles (inc. German) 18 1.29 969 38.95 Diphtheria — - — - Whooping Cough 175 12.52 191 7.68 Chicken Pox 481 34.41 588 23.63 Mumps 196 14.02 238 9.57 External Eye Disease 1 0.07 15 0.60 Poliomyelitis 2 0. 14 9 0.38 Dysentery 77 5.51 46 1.85 Sore Throat 2 0.14 - - Other Cause 12 0.86 14 0.56 1398 - 2488 - The figures for exclusions are not related in any way to the figures obtained in routine medical inspections. These figures show an increase in Impetigo. Scarlet Fever and Dysentery, whilst the remainder all show a decrease. School Visits Visits to School Departments re Cleanliness 459 Visits re Scabies - Visits re Infectious Disease 48 Visits re Medical Inspections 646 Visits re Medical Preparations 652 All other reasons 585 Home Visits Concerning defects found at routine medical inspections 1,273 Subsequent visits re defects found at routine medical inspections 282 Visits re special cases 274 Visits re dental cases 14 Visits other than infectious cases 1,037 Visits in connection with infectious cases (including 276 visits concerning uncleanliness) 2,014 117 SCHOOL DENTAL SERVICE Report of the Principal School Dental Officer, Mr.P.G.Oliver. The 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 this 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. Except for the fact that rather fewer schools could be visited, the above Service has functioned reasonably satisfactorily and treatment has been maintained at approximately the same level as in 1953. Because of fluctuations in Staff no major expansion has been possible and available resources had largely to be concentrated in improving the position in undermanned areas where fresh arrears of work had become apparent. Time spent in dealing with "casuals" continues to be substantial, but the position is far less acute than previously and numbers requiring attention have been reduced to reasonable proportions. Staffing. Attempts to obtain candidates for full-time posts have been disappointing and though numerous enquiries have been received regarding part-time employment, the nature and scope of these offers has been so limited as to render them of little practical application. In view of the apparent reawakening of interest shown in the previous year, the position at the moment must be regarded as rather less satisfactory. During the year one fulltime and one part-time Officer resigned. To offset this loss one Part-timer has been appointed to the permanent staff and a further Dentist has been re-engaged on part-time work. Including the above, total staff now represents the equivalent of five and a half Full-time Officers. 118 Building and Maintenance. As part of a campaign to encourage new comers into the Service a scheme for re-organising and bringing up to date existing Clinics is being systematically carried out. New and up to date lighting has been installed at certain Branch Clinics which will improve working conditions generally. Other items, such as chair upholstery and anaesthetic equipment have received special attention. Substantial progress has been made in redecoration and improving the lay-out at other Surgeries to render them more attractive to patients and staff. Unfortunately, some buildings of the older type are still lacking by modern standards, and recent adaptations must be regarded as a short term measure until newer premises can be obtained. Construction of the new Dental Centre at Stroud Green has proceeded satisfactorily during recent months and building should be completed in the reasonably near future. Provided the fitting out and equipping can be carried through to schedule, it is hoped that occupation should be possible in the late Spring or early Summer of 1955. The new Centre will be of up-to-date design and include certain new features which will allow a broadening of the scope of treatment. A twin surgery unit has been included for the treatment of school children, expectant and nursing mothers and pre-school children. When in full operation ancillary accommodation included will permit regular visits by a Dental Consultant in connection with the Orthodontic Scheme, and a part-time Oral Hygienist. The duties of the latter will be largely of a preventative nature, including advice to mothers and instructions to younger children on care of the teeth and gums. Fuller details regarding the function and aims of the new Centre will be found in the Maternity and Welfare Report. The new premises will serve maintained schools in the Woodside, Shirley and Monks Hill Districts and certain projected schools in adjacent areas. During the year a Survey of the mouths of children at certain schools in the Borough was carried out by Staff from the Ministry of Health. Details of findings are not at present available as this work forms part of a comprehensive study on the incidence of dental decay in British children, to be the subject of a report to the World Health Organisation. 119 Inspections. The number of children on the register at maintained schools within the Borough at the close of 1954 was 35,083. Including an additional 60 free-place scholars at grant assisted schools, this represents a sum total of 35,143. During the year 75.7 per cent, of the school population were examined compared with 88.4 per cent, in 1953, indicating a reduction of 12.7 per cent. This decline was brought about by loss of staff during the early part of the year and the necessity of concentrating on areas where treatment was outstanding. According to recent returns some 6,570 children received no examination during 1954, Because of inequalities in staffing certain schools were revisited at approximately 13 months interval, whilst in less fortunate areas this still extends to 18 months. At those schools visited 26,613 were inspected and 12,961 (48.7 per cent.) referred for treatment, compared with 30,319 inspected and 14,998 (49.4 per cent.) referred in 1953. 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 53. 6% Refused Treatment 35. 5% Forms Not Returned 10. 9% Compared with last year this represents a further fall of 5. per cent, in the acceptance rate, and a total decrease of some 20 per cent, since the peak of 1949. The corresponding figure for 1937 was in the region of 57 per cent. Acceptance Rate. The introduction of free treatment for children under the National Health Service has as anticipated had its repercussions on the acceptance rate at School Clinics. The fact that the above decline coincides with areas where private treatment is readily available may therefore be regarded as a natural corollary, and not to any increased neglect on the part of the parents. Provided treatment obtained is of a regular and systematic kind 120 the new balance between the two services may to this extent turn to the advantage of Local Authority staffs, by allowing them to concentrate more effectively on those for whom the system was primarily designed. The following Table demonstrates the variations in the acceptance rate during recent years:- RESULTS OF SCHOOL INSPECTIONS 1954 1953 1952 1949 1937 No. referred for- Treatment 12961 14998 10723 9 40 4 13498 Consents 6946: 53.6? 8854: 59% 6867:64% 6996:74. i°/ 7762: 57. 5% (Total Consents including Specials)* ( 10197: (12496: ( 9727: ( 10098: (10146: 62.8%) 66.1%) 7 1.6%) 80.7%) 6 3%) Refusals 4 592: 4496: 2639: 1213: 3242: 3 5.5% 30% 24.6% 12.9% 24% Forms not 1423: 1648: 1217: 1195: 2494: returned 10.9% 11% 11.4% 12.7% 18.5% *SPECIALS - Those referred by Head Teachers with Emergency Forms. Arrangements for Treatment. Of 16.212 Children referred for treatment (including specials) 11.194 (69 per cent.) were treated and 7, 824 (42 per cent.) cured completely, compared with 18,640 referred, 11,482 (61.6 per cent.) treated and 8, 794 (47. 1 per cent. ) cured in 1953. As a result of retirements and fluctuations in staff the total of treatment sessions declined from 2,487 to 2,349. Time devoted to this work by part-time Dentists was also appreciably reduced, and sessions fell from 705 to 404. The fact that fewer sessions were available has led to some reduction of output; otherwise a reasonable range of treatment was maintained. With minor exceptions delay in carrying out required treatment has not been excessive and call-up has been possible within a couple of months of schools being visited. From the clinical aspect the standard to be adopted in deciding a line of treatment still appears to present problems for those new to the Service. The simple axiom of attempting the greatest good for the greatest number is in reality difficult to apply without achieving an end result resembling a "lowest common denominator". As a practical compromise existing policy is to provide the highest possible level of attention for those who attend regularly and are likely to benefit from the work. 121 Where there is evidence of lack of oral hygiene and a relatively poor appreciation of treatment a more "utility" approach is indicated and likely to produce a better dividend. With patients of this latter type attempts at extensive conservation are obviously misplaced, and removal of sepsis and restoration should be the principal aim. In the field of more specialised work limited progress has been possible in improving technique for dealing with the "fractured incisor" tooth, which presents itself with unfailing regularity. Partial amputations of the pulp have been carried out on several occasions with encouraging results, a periodic check-up on these patients has been instituted to ascertain the permanance of the cure. In suitable cases where pulp vitality seems reasonably assured, restorations of the coronal portion of the tooth by means of acrylic "cap" splints have been employed to improve the aesthetic effect and maintain normal spacing in the arch. Items of Treatment. The ensuing Table gives particulars of the principal items of treatment compared with those obtained last year:- 1954 1953 Attendances 24, 833 26,633 Treated 11, 194 11,482 Re-treated 5,312 5,534 Fillings - Permanent 8,667 9,829 Temporary 1, 740 2,498 No. of Teeth Filled: Permanent 8,346 9, 403 Temporary 1, 702 2,429 Extractions - Permanent 2, 153 2, 230 Temporary 10,713 10, 640 Gas Administration 5,040 4,998 Local Anaesthetics 787 1, 184 Other Operations - Permanent 9, 196 9,021 Temporary 2,498 2,850 Cases Completed 7, 824 8,794 122 Miscellaneous Operations. These include:- 1954 1953 Root treatment in anterior teeth 2 13 Removal of nerves under local anaesthetic 2 8 Gingivectomy 1 8 Removal of bone sequestra 5 1 Splints for fractured incisors 2 2 Partial pulpotomy 2 3 Number of M.D.s treated 23 24 Dentures inserted 41 47 Denture repairs 15 18 After treatment of sockets, etc. 25 19 Removal of impacted and difficult teeth 18 38 Ulcerated Stomatitis (Vincent's infection) 9 10 Cleft Palate 8 1 Application of Penicillin "Cones" 26 13 Acrylic caps for Incisor Teeth 8 18 Forms from Head Teachers. The number of forms issued by Head Teachers for emergency treatment was 3,251 compared with 3,642 in 1953. X-ray Examinations. The number of cases referred to Mayday Hospital for the above purpose was 210, compared with 240 in 1953. Orthodontic Service. Much excellent work continues to be carried out by members of the staff in correcting less complicated irregularities of the teeth and dental arches. Various forms of both "fixed" and "removable" apparatus as well as functional appliances are in use, choice of the above being left as far as possible to the operator. "Serial" extractions are undertaken when deemed advisable to relieve overcrowding and assist a more normal alignment of the teeth. A reasonable liason exists between Speech and Remedial Exercise Clinics enabling cases to be referred between both departments. Little attention has unfortunately been possible for those with major deformities mentioned in the last Report; when accommodation permits the introduction of a Special Unit under the supervision of a Specialist would materially assist in bringing treatment within easier reach of this class of patient. 123 The number of sessions devoted to this work was 233 compared with 231 last year. The following is a summary of treated performed:- 1954 1953 Cases under Treatment 354 333 New Cases 137 171 Cases Treated by Extraction 38 - Cases Completed 132 131 Attendances 2,747 2, 925 Appliances - Fixed 42 38 Removable 181 225 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:- 1954 1953 Attendances 123 312 New Cases Treated 14 27 Re-treated 46 56 Fillings - Permanent 144 209 Extractions - Permanent 24 43 Temporary 16 6 Other Operations 40 45 "Gas" Cases 13 25 Local Anaesthesia 6 9 Cases Completed 39 51 Dentures Fitted 2 2 Referred X-Ray 2 5 124 DENTAL DEFECTS (1) Number of children who were:- (a) Inspected by Dental Officers: Year 1954 Year 1953 Aged 5-6 1,694 1,894 " 6-7 2,891 3,879 " 7-8 3,826 3, 742 " 8-9 3,413 2,866 " 9 -10 2,683 3,060 " 10 -11 2,867 2, 838 " 11 -12 2,146 Total: 2, 645 "12-13 1, 903 26,613 2,221 " 13-14 1,618 2,284 " 14-15 1,624 2,393 " 15 -16 1, 381 1, 767 " 16 up 567 730 Specials 3,210 3,642 29, 823 33,961 Year Year 1954 1953 (2) Number found to require treatment 17,594 19,556 (3) Number referred for treatment 16, 212 18, 640 (4) Number actually treated 11, 194 11,482 (5) Attendances made by children for treatment 24,833 26,633 (6) Half days devoted to: Inspection 189 221 Treatment 2, 349 2,487 2, 538 2,708 Number of Gas Sessions 329 317 Administrative Sessions 98 86 Orthodontic Sessions 233 231 (7) Fillings - Permanent Teeth 8,667 9, 829 Temporary Teeth 1,740 2,498 10,407 12,327 125  Year 1954 Year 1953 (8) Teeth Filled - Permanent Teeth 8,346 9,403 Temporary Teeth 1,702 2,429 10,048 11, 832 (9) Extractions - Permanent Teeth 2,153 2, 230 Temporary Teeth . 10,713 10,640 12,866 12,870 (10)Administrations of general anaesthetics for extractions 5,040 4,998 Administrations of local anaesthetics for extractions 787 1,184 (ll)Other Operations - Permanent Teeth 9,196 9,021 Temporary Teeth 2,498 11,694 2,850 11,871 Attendances per session 10.6 10.6 126 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 302 together with 2,554 who were given re-inforcing injections. SPINAL AND OTHER REMEDIAL CLINICS 1954 1953 Attendances Av. att. Attendances Av. att. Spinal 2, 922 487 6.0 2, 187 354 6.2 Flat Feet 2, 162 364 5.9 3,427 556 6.2 Breathing 1,431 254 5.6 1, 592 313 5.1 6, 515 1, 105 7, 206 1,223 365 individual cases were treated and 792 examinations were made by doctor. 127 ST. GILES' SCHOOL FOR PHYSICALLY HANDICAPPED AND DELICATE CHILDREN I am indebted to the Head Teacher, Miss Lambert, for the following report:- This year has seen the fulfilment of long-cheri shed hopes; in the addition of a fine, well equipped Physiotherapy Room; in the conversion of the former Physiotherapy Room into a useful and pleasant Medical Room; and in the provision of specially good wheeled chairs and other aids for the disabled. Further, there took place the first of conferences to be held each term, in which Spastic children were examined, and their parents advised, by a specialist in the treatment of Cerebral Palsy and by an Orthopaedic Specialist. Our attached School Medical Officer co-operated, and also present were the Physiotherapist, the Speech Therapist, the School Nursing Sister and the Head Teacher. It is felt that these conferences are a decided step forward in the co-operation of many services in securing prompt and comprehensive treatment for the children concerned. Another hope that has been realised this year has been the granting to the school of a second swimming period each week. An average of 32 children and 5 teachers have attended the baths after school on Tuesdays and Wednesdays, and the additional training and practice have resulted in the securing of 37 swimming certificates; 14 for 20 yds., 9 for 50 yds., 6 for ]00 yds. 6 for 220 yds. and 2 for ¼ mile. It is notable that several of the certificate winners are quite seriously disabled. Throughout the year work has progressed steadily in all classes;- and boys and girls have again taken part in combined school activities such as the Festival and Carol choir and the Junior Sports Finals. There have been several very successful Parent-Teacher meetings and 235 parents and friends attended the July Sports Meeting when Alderman and Mrs. Cole, Councillor and Mrs. Cooper, Councillor Edwards and Mrs. Marriott honoured us by their presence; and Mrs. Cole presented her Coronation Cup to the winner of the highest number of individual points, and the John C. Lyell House Cup to Nelson House. Again at our Christmas Prize Giving and Party we were very happy to welcome Alderman and Mrs. Cole, Councillor Cooper and Councillor Edwards, and honoured by Mrs. Cole's presentation of the prizes, particularly of the two special prizes she has given us each year. We were given great pleasure during the year by the visits of Her Majesty's In spec to r o f Special Schools, Mr. Parnham, Mr. Moody, H.M.I. and two parties of teachers from the Ministry of Education Course for teachers in Special Schools. The visits of the Youth Employment Officer and his Staff to meet present scholars. Old Scholars and their parents, have been most helpful; and we are a 11 truly grateful for the unremitting efforts made to place the boys and girls in suitable employment. In the Summer Vacation the holiday at Heme Bay was repeated, when 22 children in the charge of 3 members of the Staff spent a very happy fortnight there, swimming, boating, playing games and making excursions to Canterbury, Dover and many other places. 128 Old Scholars' Meetings have been joyful occasions, when it was rewarding to see how well they are playing their part in the world. Old Scholars now in distant parts, and many in the Services, keep well in touch by letter. DISABILITIES AND TREATMENT. There were, in the school 69 children disabled by cerebral palsy, poliomyelitis, tubercular bone disease, spina bifida, skeletal deformity and other causes. 19 children suffered from cardiac disability, and 7 2 from respiratory diseases. The remainder, 39, are delicate from various causes. Physiotherapy has been given on 4 days each week; and a Speech Therapist recently appointed, gave treatment on one day per week to certain children. The Nursing Sister has given other prescribed treatment, dealt with minor ailments, supervised physical welfare, and kept all records of individual progress. The work of the Male Attendant, particularly in the case of the more disabled boys, has helped us to enlarge the scope, and considerably to improve the routine of medical work. There have been 20 medical inspections at which a total of 369 children were examined, an average of 18 on each occasion and of 9 parents present. Parents, Staff and children wish again to express their continued gratitude for the devoted servicesof Dr. Hegarty. The Head Teacher desires to record again her thanks to the Medical Officer of Health and his Staff, the Chief Education Officer and his Staff, and to the Staff of St. Giles' School, for guidance, help and co-operation during the year. Average number on roll 199 Left for:- Employment 10 Grammar School 3 Technical School 1 Other vocational training 3 Ordinary Schools 28 Hospital Schools 2 Families emigrated 2 Home Teaching 1 129 ST. CHRISTOPHER'S SPECIAL EDUCATIONALLY SUB-NORMAL SCHOOL I am indebted to Mr. Ramsden, the Head Master, for the following observations:- During the past year of 1954 steady progress has once again been made in all subjects in spite of staffing trouble throughout the year. As a result of many years of excellent work and the high standard achieved we have been informed by Mr. Goddard, Her Majesty's Inspector of Schools, that St. Christopher's School has been placed on the Ministry's selected List of Schools for visitors desirous of making a study of this type of child. We are now happy to report that we now have a full staff of permanent teachers. We welcome to our ranks Messrs. J. M. Thomas and G. F. Doe, and Miss B. F. Wilds. We are very pleased that Mrs. M.B. Gilligan, who came to the school as a Supply Teacher in September, 1953, has now been appointed to the permanent staff. We would like to place on record our great appreciation of the work that Mr. William P. West has given to this school for the past eighteen years. He was appointed from the Kingsley Senior School on the 31st August, 19 36 and re ti red, with our best wishes, tinged with regret at losing him, on the 21st December, 1954. Mr. J.H. Powell was appointed Senior Assistant Master on the 31st August, 1954. Our third Annual Sports Day was carried through with great enthusiasm in the p resence o f many parents. There was keen competition for the Sports Shield, the Fisher and the Thome Cups; Andrew House winning the Shield and Fisher Cup, and Patrick House winning the Thorne Cup. A re-union of old scholars was held in July, and it was very pleasing to see the Hall crowded with such a fine set of young men and women who have made good as a result of the training given them at this school. Our Eighth Annual Carol Service and Tableaux was once again held in a crowded School Hall. Our Christmas Party was attended by the Deputy Mayor and Deputy Mayoress, Alderman and Mrs. Cole. Number attending January 1st, 1954 210 " " December 3lst, 1954 209 " referred to Public Elementary Schools 2 Number discharged: (i) Ineducable and referred to Mental Health Committee 4 (ii) Unfit to work " " '' 2 (iii) Pit to work " " " 11 130 CLINIC FOR EDUCATIONALLY SUB-NORMAL CHILDREN 300 children were examined during 1954. The classifications arrived at, together with recommendations made, are as follows:- (1) Pound to be mentally defective: (a) Pound to be mentally defective and referred to Local Authority and Occupation Centre 4 (b) Pound to be mentally defective and referred to Local Authority for Statutory Supervision 14 (c) Recommended Institutional Care and referred to Local Authority 6 (2) Pound to be educationally sub-normal: (a) Recommended to St, Christopher's Special School 42 (b) Recommended to Residental School 2 (c) Referred to Slow Stream in Ordinary Elementary Schoo1 30 (d) Recommended for re-test 30 (e) Deferred for Medical Treatment 28 (f) Recommended for St. Giles' 2 (g) Recommended Epileptic Colony - (h) Referred back to Ordinary Elementary School 60 (3) Referred to Child Guidance Clinic 18 (4) Examined for other Authorities 1 237 Mental Tests at St. Christopher 'S 63 300 10 home visits have been paid to Education cases. 131 ST. LUKE'S PARTIALLY SIGHTED SCHOOL I am indebted to Mrs. C. E. Davies, the Head Mistress, for the following observations:- The School is now back in its old building at Winterbourne Road after being at New Addington for nearly three years. The school syllabus is based on the ophthalmic surgeon's recommendations and no physical exercises are done without his advice. The children are allowed to go swimming and every week a party of children go for instruction to Croydon Public Baths. Because of the children's enthusiasm this has been continued all through the winter. The sight of several children has improved sufficiently for them to return to ordinary schools. One child went straight from St. Luke's to Wallington Grammar School, one was transferred to Gilbert Scott School and one has returned to a Secondary Modern School • On Open Day last year, although the school was then at New Addington, nearly all the parents made the long journey to see the school and the work, and al1 applauded the play given by the Senior Class. It will be appreciated that all the teaching in a school of this nature is individual, and because of this many of the children are able to obtain employment of a high standard. One boy has been given a five year apprenticeship with an engineering firm, who, because of his educational standard, are paying for him to continue his education at the Polytechnid. Another is employed by an electrical firm who are also paying for his further education at the Polytechnic. One girl is employed at a large departmental store in Croydon. Another girl who started work as a general clerk with a local firm, is now being trained by them for secretarial work. On the 31st December last the number on roll at this school was 29, of which number more than half were of senior school age. 132 HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS OR BOARDING IN BOARDING SCHOOLS. 1954 Blind Partially Sighted Deaf Partially Deaf Delicate Physically Handicapped Educationally Sub-normal Maladjusted Epileptic TOTAL In the Calendar year:- (1) (2) (3) w (5) (6) (7) (8) (9) (10) A. Handicapped Pupils newly placed in Special Schools or Homes 1 3 5 4 29 22 48 1 1 114 B. Handicapped Pupils newly ascerta ined as requiring education at Special Schools or boarding in Homes 1 3 5 5 36 25 44 3 1 123 On or about December lst:- C. Number of Handicapped Pupils from the area: (i) attending Special Schools as Day Pupils — 26 17 4 86 108 204 — — 445 Boarding Pupils 2 — 7 2 — 6 13 1 2 36 (ii) attending independent schools (under approved arrangements) — — — — — — — — — — (iii) Boarded in Homes — — 2 2 — 1 — 2 — 7 TOTAL (C) 2 26 26 8 89 115 217 3 2 488 D. Number of Handicapped pupils being educated under arrangements made under Section 56 of the Education Act, 1944- (a) in hospitals — — — — 5 5 — — — 10 (b) elsewhere — — — — — 4 — — — 4 E. Number of Handicapped pupils from the area requiring places in special schools-(inc1uding any such unplaced children who are temporarily receiving home tuition and whose parents have not yet consented to their attending a special school) (i) Day — — — 1 5 5 9 — — 20 (ii) Boarding — — 1 — 1 2 3 2 — 9 Number of children reported during the Calendar Year: Under Section 57(3) of Education Act, 1944 19 '' '' 57(4) '' '' '' l '' '' 57(5) " " 16 133 JUVENILE EMPLOYMENT RETURN The following numbers of children were examined by the medical officers during 1954 as to their fitness to following the parttime employment indicated: - 1954 19 53 1952 1951 1950 Delivery of Goods for Shopkeepers 122 53 74 72 71 Delivery of Newspapers 501 328 338 225 323 Delivery of Milk 33 15 32 30 29 Shop Assistants 48 77 118 133 104 704 473 562 460 527 THE PROVISION OF MEALS AND MILK AND COD LIVER OIL AND MALT During 1954 all milk was supplied free of charge, and approximately 28,800 children per day received l/3rd pint each. This was equal to 88 per cent, of the children attending schools. All the milk supplied is pasteurised milk, and the sources of supply are subject to the approval and constant supervision of the Medical Officer of Health. The number of meals supplied daily during 1954 was approximately 15,400. CHILD GUIDANCE CLINIC Return of Cases referred by the School Medical Officer and the Education Department, from 1st January to 31st December, 1954 Boys Girls Total number referred 37 26 Analysis of the above Cases:- Diagnostic only 6 4 Current Cases under treatment 22 13 Cases Closed - improved 4 4 Cases Closed - not improved 5 5 37 26 134 Speech Defects Clinic. Total no. of cases treated 159 Cases discharged 60 Cases still attending 99 Cases referred for physical treatment 15 Cases referred for residental treatment 1 Cases referred to Child Guidance 1 Stammerers 28 Cleft Palate 11 Sigmatism 20 Dyslalia 72 Undeveloped Speech 20 Dysarthria 6 Developmental Aphasia 2 Stammering. The number of stammerers has increased again during 1953-54. The success of treatment is difficult to evaluate, but it would not be presumptuous to claim that at least 50% have been very greatly helped, others have gained in a rather lesser degree, while there remains a small proportion who do not appear to benefit at all. Cleft Palate. With the high standard of operational interference Cleft Palate speech does not present the same problem as formerly. The cases under our care have all received benefit from treatment and in most instances speech has become intelligible or near normal. Sigmatism. Provided the patient and parents co-operate normal speech may be effected quite rapidly. A fair estimate would be that 75% acquire normal speech. Dyslalia. These cases are not discharged until normal speech is acquired. Failure to reach 100% success only occur when cases are discharged for non attendance. Undeveloped Speech. The degree of normalcy attained depends on the intelligence and co-operation of the patient. All cases show some improvement and about 60% attain normal speech development, although treatment is always of long duration. Developmental Aphasia. Two cases are under treatment. One shows some improvement, the other one has only just started attendance. In September Miss Smart took up an appointment as full time Assistant Speech Therapist. This brought our Staffing nearer to the complement required for the numbers in the borough, though accommodation was still inadequate for the increased number of 135 sessions. However by holding some Clinics at New Addington, a session at St. Giles and one at St. Christophers the problem was solved to some degree and we welcome the opportunity of co-operating with these schools. During the latter part of the year an evening meeting for parents was held. A short talk was given on the problem of handling the speech defective child in the home and this was followed by questions and discussion. It was held in the evening to enable more fathers to attend as it is not always easy to get the co-operation of the male parent in these cases. The mothers still outnumbered them greatly but those who attended evidently found it of value. It is hoped to repeat these meetings as a regular feature. NON-MAINTAINED SCHOOLS The usual arrangements for the medical inspection of nonmaintained school children were continued in 1954, 106 children were examined at routine examination and also 5 re-examinations. Appendix B gives the detailed findings. Yours faithfully, S.L. WRIGHT, School Medical Officer 136 APPENDIX A MEDICAL INSPECTION RETURNS Year ended 31st December, 1954. Table I MEDICAL INSPECTION OP PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS A.- Periodic Medical Inspections Number of Inspections in the prescribed Groups: Entrants 3,481 Second Age Group 4,106 Third Age Group 2,289 Total 9,876 Number of other Periodic Inspections 3,920 (8-9 years) Grand Total 13,796 B.- Other Inspections Number of Special Inspections 2,551 Number of Re-Inspections 3,407 Total 5,958 C.- Pupils found to require Treatment (Excluding Dental Disease and Infestation with Vermin). Group For defect ive vis ion (excluding squin t) For any of the other cond i t i ons recorded in Table Total Individua/ Pupi Is (I) (2) (3) (4) Entrants 12 475 484 Second Age Group 224 409 591 Third Age Group 132 163 274 Total (prescribed groups) 368 1047 1349 Other Periodic Inspections including 8 to 9 years 241 405 625 Grand Total 609 1452 1974 137 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 46 16 4 — 5 EYES- (a) Vision 609 59 34 5 (b) Squint 72 22 4 2 (c) Other 22 2 2 2 6 EARS- (a) Hearing 33 38 4 3 (b) otitis Media 16 5 2 3 (c) other 12 14 — 3 7 NOSE OR THROAT 361 247 21 14 8 SPEECH 33 32 5 5 9 CERVICAL GLANDS 2 13 1 1 10 HEART AND LATION 42 91 2 7 11 LUNGS 82 16 6 5 12 DEVELOPMENTAL- (a) Hernia 5 2 2 — (b) Other 26 73 1 1 13 ORTHOPAED1C- (a) Posture 254 67 11 5 (b) Flat foot 184 79 4 6 (c) Other 133 87 6 13 14 NERVOUS SYSTEM- (a) Epilepsy 5 8 1 2 (b) Other 15 23 2 1 15 PSYCHOLOG1CAL- (a) Development 3 10 8 6 (b) stabi1ity 8 14 2 1 16 OTHER . 109 72 12 5 *These figures refer to Special Inspection in school only. 138 B. CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS INSPECTED DURING THE YEAR IN THE AGE GROUPS Age Groups Number of Pupi1s Inspected A (Good) B (Fair) C (Poor) NO. % of col 2 NO. % of col. 2 No. % of col. 2 (1) (2) (3) (4) (5) (6) (7) (8) Entrants 3481 1410 40.5 1924 55.3 147 4. 2 Second Age Group 4106 1827 44. 5 2121 51.7 158 3.8 Third Age Group 2289 1204 52.6 1043 45.5 42 1.9 Other Periodic Inspections including 8 to 9 years 3920 1827 46.6 1960 50.0 133 3.4 TOTAL 13796 6259 45. 4 7057 51.1 480 3.5 Table III INFESTATION WITH VERMIN (i) Total number of examinations in the schools by the school nurses or other authorized persons 69602 (ii) Total number of individual pupils found to be infested 315 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 3 (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) 139 Table IV GROUP 1.- DISEASES OF THE SKIN (excluding uncieanl iness, for which see Table III) Number of cases treated or under treatment during the year By the Authority Otherwise Ringworm- (i) Scalp 2 — (ii) Body — — Scabies. — — Impetigo 35 — Other Skin Diseases 20 — Total 57 — GROUP 2.- EYE DISEASES. DEFECTIVE VISION AND SQUINT Number of cases dealt with By the Authority Otherwise External and other, excluding errors of refraction and squint Errors of Refraction (including squint) 187 1350 Total 187 1350 Number of pupils for whom spectacles were (a) Prescribed — 1061 (b) Obtained — 1061 GROUP 3.- DISEASES AND DEFECTS OF EAR, NOSE AND THROAT Number of cases treated By the Authority Otherwise Received operative treatment (a) for diseases of the ear — — (b) for adenoids and chronic tonsillitis — 700 (c)for other nose and throat conditions — — Received other forms of treatment Ear (Minor Ailments Clinic) 108 — Total 108 700 140 GROUP 4.- ORTHOPAEDIC AND POSTURAL DEFECTS (a) Number Treated as in-patients Hot available By the Authority Otherwise (b) Number treated otherwise, e.g. in clinics or out-patients departments 315 Not Available GROUP 5.-CHILD GUIDANCE TREATMENT Number of cases treated In the Authority's Child Guidance Clinics Elsewhere Number of pupils treated at Child Guidance Clinics — 63 GROUP 6.- SPEECH THERAPY Number of cases treated By the Authority Otherwise Number of pupils treated by Speech Therapists 159 — GROUP 7.- OTHER TREATMENT GIVEN Number of cases treated By the Authority Otherwise (a) Miscellaneous minor ailments 1442 — (b) other (specify) /. Orthoptic — 87 2. Sunlight — 8 3. Verruca 203 Total 1645 95 141 Table V DENTAL INSPECTION AND TREATMENT (l) Number of pupils inspected by the Authority's Dental Officers(a) Periodic age groups 26613 (b) Specials 3 251 (c) TOTAL (Periodic and Specials) TOTAL 29864 (2) Number found to require treatment 17594 (3) Number referred for treatment 16212 (4) Number actually treated 11194 (5) Attendances made by pupils for treatment 2 4 833 (6) Half-days devoted to: (a) Inspection 189 (b) Treatment 2349 TOTAL 6 2538 (7) Fillings: Permanent Teeth 8667 Temporary Teeth TOTAL 7 1740 10407 (8) Number of Teeth filled: Permanent Teeth 8346 and Temporary Teeth 1702 TOTAL 8 10048 (9) Extractions: Permanent Teeth 2153 Temporary Teeth 10 713 TOTAL 9 12 866 (10) Admi ni st rat ion of general anaesthetics for extraction 5040 (ll)Other Operations: (a) Permanent Teeth 9196 (b) Temporary Teeth TOTAL 11 2498 11694 142 APPENDIX B NON-MAINTAINED SCHOOLS Year ended 31st December, 1954 Table I RETURN OF MEDICAL INSPECTIONS A.-Routine Medical Inspections. Year 1954 Year 1953 Age 11 or under — 35 12 1 47 13 18 27 14 34 27 15 33 38 16 18 58 17 2 30 18 or over ... 15 Total 106 277 B. -Other Inspections Number of Special Inspections — — Number of Re-inspections 5 10 Total 5 10 Visits to Non-maintained Schools 5 11 The following defects were found by Medical Inspection:- Treatment Observation Defective Vision 7 1 Other Eye Conditions 2 — Skin: Other Conditions 1 — Lungs non T. B. — 1 Deformities:- Posture 2 — Other Defects and Diseases 1 — Total 13 2 143 CONTENTS A - PUBLIC HEALTH REPORT Page Airport 95 Ambulance Service 58 Amusement Houses 69,75 Animals, Diseases of 77 Animals, Keeping of 69 Ante-Natal Clinics 40 Births 7,10 Blindness 96 Byelaws 68 Cancer 17 Census 8 Chemical Analyses 92 Chest Clinic 27 Child Minders 94 Civil Defence 60 Contacts, Tuberculosis 33 Convalescence 61 Committee 1 Communicable Diseases 19 Cremation 95 Dairies, Cowsheds and Milkshops 45 Day Nurseries 100 Deaths 7,10,16,26,31 Dental Treatment - M. A C.W. 46 Diphtheria 56 Disinfection 75 Disinfestation 76 Domestic Helps 61 Drainage 74 Dysentery 23 Extra Nourishment 32 Factories and workshops 72 Fertilisers and Feeding Stuffs Act 76 Food Poisoning 21,23 Foods 69, 78,83,87 Gastro - Enteritis 23 Health Propaganda 62 Health Visitors, Work of 53 Home Helps 61 Home Nursing 43 Homework 73 Hospital, Isolation 23 Housing 70 Housing Act 70 Ice Cream 78,82 Illegitimacy 7,41 Immunisation 56 Infant welfare Clinics 41,50 Page Infant Mortality 7,12 Infectious Diseases 19 Inquests 11 Laboratory Examinations 39,91 Local Acts 68 Marriages 10 Maternity Homes 94 Maternity Homes, Registration 94 Measles 23 Meat Inspection 79 Meat, Tuberculous 80 Medical Help Records 53 Men's Hostel 71 Mental Health 63 Midwives 53 Midwives, Municipal 51 Midwives Acts 53 Milk, Provision of 81 Milk, Examination of 81,86 Milk, Tuberculous 81 Milkshops 81 Mortality in Childbirth 12 National Assistance Act 95 Neglected Children 96 Neo-Natal Deaths 13 Notification of Birth Acts 11 Nuisances 68 Nursing Equipment 61 Nursing Homes 94 Nurses' Agencies 94 Occupation Centre 65 Offensive Trades 74 Outworkers 73 Pests 77 Physiotherapy 45 Poisons and Pharmacy Act 23,76 Poliomyelitis 19, 23 Population 7 Post - Natal Clinics 40 Post - Mortems 11 Premature Infants 40 Problem Families 96 Puerperal Sepsis and Pyrexia 23 Rag Flock Act 76 Rats and Mice (Destruction)Act 77 Refuse Collection 93 Rivers and Streams 14 Sanatoria, Treatment in 32 Sanitary Administration 66 Sanitary Certificates 71 Sanitary Inspectors, Work of 67 144 Page Scarlet Fever 23 Sewage 93 Shops Acts 73 Slaughterhouses 80 Small-Pox 57 Smoke Observation 69,74 Staff Examinations 95 Staff 6,95 Still-Births 7,11 Street Accidents 17,60 Tuberculosis, After Care 35 " Allowances 35 " Contacts 33 " Home Nursing 32 '' Home Visits 32 " Institutional Treatment 32 " Mass Radiography 27,35 Page Tuberculosis, Mortality 26,31 " Notifications 28 " Occupational Therapy 36 " Re-Housing 3^ " Vaccination 33 Vaccination 57,95 Verminous Persons 75 Venereal Diseases 37 Vital Statistics 7 Ward Statistics 15 Watercourses 74 Water Supply 91 Wei fare Foods 41 Whooping Cough 23 X-Ray 35 Zymotic Diseases 19 B - SCHOOL MEDICAL REPORT Page Accommodation 104 Attendances 114 B1ind Children 132 Child Guidance 133 Cleansing of Children 112 Clinics 103 Cod Liver Oil 133 Cost 1ll Crippling Defects 127,140 Deaf Children 132 Deaths 113 Defective Children 110 Defective Hearing 110 Deformities 127,140 Dental Service 117 Ear Disease 110,132 Epileptic Children 132 Exclusions 116 Following-up 116 Health Visitors, Work of 116 Heights and weights 109 Immunization, Diphtheria 126 Infectious Diseases 115 Inspection Clinic 103 Inspections 107 Juvenile Employment 133 Page Malt 133 Meals, Provision of 133 Mentally Defective Children 130 Milk, etc., Provision of 133 Mi nor A i lments 114 Non-maintained Schools 135 Orthodontic Service 122 Parents' Attendances 108 Physically Defective Children 127,132 Population 113 Remedial Exercises 126 Schools, Special 105 Speech 134 Staff 103 Statistical Tables 136 Surveys, Unclean liness 112 St. Christopher's 129 St. Giles' 127 St. Luke's 131 Treatment 114 Tuberculosis 113 Uncleanliness 112 Vision, Defective 111,131 X-Ray 122 l"' »', ' T I ..>.'f^ .HBtrra* ■ri.~..*V.;i ■it r 1 11- ■■ ;i 11,' i- ■ ■■ s:i. ■■ : 1 1 '■■"'■y "^iggs aa>-'- II 1-T-TT .